Defecation in our body is governed by a far more complex and delicate system than one might think. What Donguibogam describes as fluid deficiency, weakened spleen and stomach qi, and liver qi stagnation can be explained in modern medicine as neurological, endocrine, and microbiological imbalances closely linked to intestinal peristalsis.
First, fluid deficiency goes beyond a simple lack of water and is deeply connected to a reduced water-retention capacity of the intestinal mucosa. The intestinal mucosa secretes mucus called mucin to help stool pass smoothly. However, chronic dehydration, certain medications, or age-related mucosal hypofunction can reduce mucin secretion, causing stool to harden. In addition, an imbalance in the gut microbiome can weaken intestinal barrier function and accelerate the loss of body fluids. When beneficial bacteria decrease, the production of short-chain fatty acids drops, impairing the energy supply to intestinal cells and compromising intestinal barrier health.
Weakened spleen and stomach qi substantially aligns with modern medical concepts of intestinal inertia or chronic idiopathic constipation. This is closely tied to autonomic nervous system dysfunction, particularly hypofunction of the parasympathetic nerve. The parasympathetic nerve activates intestinal peristalsis and promotes digestive secretion. When parasympathetic activity is suppressed due to stress or irregular lifestyle habits, bowel movements slow down significantly. In addition, abnormalities in enteric ganglion cells or hypofunction of smooth muscle, known as colonic inertia, can weaken the propulsive force pushing stool forward. Neurotransmitters like serotonin play a critical role in intestinal peristalsis, so problems with its secretion or receptor function can also lead to intestinal inertia.
Moreover, liver qi stagnation can be explained by the gut-brain axis theory. The brain and the gut constantly interact via the vagus nerve, hormones, neurotransmitters, and the gut microbiota. Psychological factors such as stress, anxiety, and depression activate the hypothalamic-pituitary-adrenal axis, increasing the secretion of stress hormones like cortisol. These hormones alter intestinal motility, induce inflammatory responses, and adversely affect the gut microbial environment. Stress can inhibit intestinal peristalsis or, conversely, overstimulate it, triggering symptoms such as irritable bowel syndrome. In particular, chronic stress increases intestinal permeability, causing leaky gut syndrome, which affects systemic inflammation and immune responses, aggravating digestive symptoms.
In conclusion, intractable constipation is not merely a problem of evacuation, but a signal that the body's complex physiological systems are out of balance, making a holistic approach essential to resolving it.
