abstracted & translated by
Robert Helmer, D.TCM (Canada)
Keywords: Chinese medicine, Chinese herbal medicine, pediatrics, constipation
On page 31 of issue #8, 2003 of Bei Jing Zhong Yi (Beijing Chinese Medicine), Suan Yan-ping et al. published an article titled, “The Treatment of 80 Cases of Functional Immaturity Constipation with San Zi San Ren Tang (Three Seeds & Three Kernels Decoction).” A summary of this article is presented below.
Among the 80 patients enrolled in this study, 33 were female and 47 were male. The youngest child was 10 months old and the oldest was 14 years old. Five cases were less than one year old, 23 cases were 1-3 years old, 43 cases were 4-7 years old, and nine cases were more than eight years old. The course of the disease was as short as three months and as long as nine years. The course of disease was less than one year in 13 cases, 1-2 years in 16 cases, 3-4 years in 22 cases, 5-7 years in 21 cases, and more than eight years in eight cases. Half of these patients presented with recurrent cough due to common cold, restless sleep, profuse sweat on the head, aversion to food, abdominal pain or distention, vomiting, heat in the palms and soles, and/or nosebleeds. The other half had no obvious clinical symptoms.
The following standardized criteria (1994) was used to diagnose each case:
1. More than three days between bowel movements and, when occurring, are hard and bound
2. If severe, the stool was difficult to evacuate and was dry and shaped like chestnuts. This type of stool may have been accompanied by acute distention in the lesser abdomen, lassitude of the spirit, lack of strength, decreased appetite, and sometimes bleeding with the stool. If chronic, the child relied on suppositories to have a bowel movement.
3. The course of the disease was more than three months.
4. Examinations had eliminated any organic problems with the intestinal tract.
San Zi San Ren Tang (Three Seeds & Three Kernels Decoction) was composed of:
Zi Su Zi (Fructus Perillae), 9g
Lai Fu Zi (Semen Raphani), 9g
Niu Bang Zi (Fructus Arctii), 9g
Sang Pi (Cortex Mori), 9g
Xing Ren (Semen Armeniacae), 9g
Gua Lou Ren (Semen Trichosanthis), 12g
Yu Li Ren (Semen Pruni), 3g
Huang Qin (Radix Scutellariae), 9g
Hua Fen (Radix Trichosanthis), 9g
Fu Ling (Poria), 12g
The above medicinals were decocted in water two times, resulting 150-200 milliliters of strained fluid which was divided into three doses and taken. Thirty days equaled one course of treatment.
If there was marked spleen-lung qi vacuity, Huang Qi (Radix Astragali) and Tai Zi Shen (Radix Pseudostellariae) were added.
For heart blood vacuity, Dang Gui (Radix Angelicae Sinensis) and Shou Wu (Radix Polygoni Multiflori) were added.
For kidney yin vacuity, Sheng Di (uncooked Radix Rehmanniae) was added.
For kidney yang vacuity, Rou Cong Rong (Herba Cistanchis) was added.
Cured: 64 cases (one bowel movement at least every two days, the stool was not dry or inhibited, and there was no reoccurrence in more than three months)
Improved: 9 cases (one bowel movement at least every three days, the stool was not dry but at times was inhibited, and there was no reoccurrence in more than three months)
No improvement: 7 cases (no change in the patients symptoms)
The total effectiveness rate was 91.2%.
Most cases of pediatric constipation are due to functional immaturity which is mostly caused by improper diet. Being a “picky” eater or irregular meals over a long period of time will cause damage to the spleen and stomach. The lungs and large intestine share an exterior-interior relationship in Chinese medicine. If the lung qi does not descend, the large intestine’s function will be affected, and this may lead to constipation. The authors, therefore, say that the treatment of constipation must begin with the regulation of the spleen and lungs, and San Zi San Ren Tang accomplishes this main objective of treatment. According to the authors, Hua Fen and Fu Ling fortify the spleen and boost the qi, nourish the stomach and engender fluids. Zi Su Zi, Lai Fu Zi, Niu Bang Zi, Sang Pi, Xing Ren, Gua Lou Ren, Yu Li Ren, and Huang Qin clear and downbear the lung qi, moisten the intestines and free the flow of the stool. In general, the patients took 7-14 packets of the above medicinals to return their frequency of bowel movements to normal.
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