Part 3 of 7 in the "digestive discomfort" series. Part 1 is what the TCM "spleen-stomach" is; part 2 is the five-situation table; part 4 is how the theory explains constipation; part 5 is reflux and heartburn; part 6 is when to see a doctor first; part 7 is what an online consultation does.

"Does this count as constipation?" This part answers that, using the Western yardstick — the NHS's public pages give a definition to hold it against.

The short version

• The NHS's words: it is likely to be constipation if you have not had a poo at least 3 times during the last week, or you're pooing less often than usual.
• It is not only a count of days: how dry, how much straining, whether you feel fully emptied, and whether it has changed from your usual all count.
• NHS England's Bristol Stool Chart divides stools into 7 types and states that a poo that does not look like type 3 or type 4 could be constipation. "About a type 2" is much clearer than "very hard".
• The NHS lists six common causes of constipation in adults, and the measures it gives answer that list. The theory's account is part 4.
• This yardstick is for describing, not for self-diagnosis.

First, the things that cannot wait

⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. For heavy bleeding, severe abdominal pain, if you cannot poo or fart, or vomiting blood, call 999 now, or go to the nearest hospital emergency department. All four sit on the "call 999" lists of the NHS's rectal-bleeding and stomach-ache pages.

The full list, the reason for each, and which situations mean a same-day visit are in part 6.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. What counts as constipation

① The number first. It is likely to be constipation if "you have not had a poo at least 3 times during the last week or you're pooing less often than usual" — that is the NHS constipation page.

The same page lists three more: "the poo is unusually large or small and is dry, hard or lumpy", "you are straining or in pain when you have a poo", or "you feel like you haven't fully emptied your bowels". So it is not only a count of days: how dry, how much straining, and whether it has changed from your usual all count.

The NHS also states that constipation "is also more common if you are over 65 years old" and "is common during pregnancy and after giving birth".

② Stool shape has a chart. NHS England's Bristol Stool Chart divides stools into 7 types.

Type 1 is "Separate hard lumps, like nuts (hard to pass)", Type 4 "Like a sausage or snake, smooth and soft", Type 7 "Watery, no solid pieces. Entirely liquid". Saying "about a type 2" at a consultation is much clearer than "very hard".

The chart's note on constipation is a single sentence: "If a poo does not look like type 3 or type 4 it could be constipation." So types 3 and 4 are the chart's reference point.

A practitioner asks about shape because shape carries a direction: towards types 1 and 2, and towards types 6 and 7, are two different questions in the theory (rows 1 and 5 of part 2's table).

II. The NHS's common causes, and the measures that answer them

③ The cause list. The NHS's common causes of constipation in adults include "not eating enough fibre, which is found in fruits, vegetables and cereals", "not drinking enough fluids", "not moving enough and spending long periods sitting or lying down", "often ignoring the urge to go to the toilet", "changing your diet or daily routine" and "a side effect of medicine". The same page also states that "Sometimes there's no obvious reason".

④ The measures answer that list. Drinking plenty of water and gradually increasing fibre are, in the NHS's words, "To make your poo softer and easier to pass".

Toilet routine: "Keep to a regular time and place and give yourself plenty of time to use the toilet", and "Do not delay if you feel the urge to poo". Activity: "A daily walk or run can help you poo more regularly".

⑤ The medicine item. The NHS's own words are: "Speak to the GP before you stop taking any prescribed medicine." Never stop your medication on your own. For Chinese herbs alongside Western medication, see Can Chinese herbs be taken with Western medicine.

How the theory accounts for the same thing — fluids, propulsion, "movement" — is part 4.

Three things about life in Malaysia

• All day in an air-conditioned office: the NHS lists "not moving enough and spending long periods sitting or lying down" among common causes of constipation and suggests considering more activity, such as a daily walk.
• Holding it in: meetings, deadlines, classes. The NHS's own words are "Do not delay if you feel the urge to poo", and it advises keeping to a regular time and place and giving yourself plenty of time.
• Confinement (坐月子): the NHS states that constipation is common after giving birth. Confinement diets have their own arrangements, so whether something suits yours is a question for the practitioner in charge, not an online recipe.

The words in this part

All three come from the NHS constipation page and the Bristol Stool Chart quoted above, and all three are things you will actually use at a clinic.

• Constipation (便秘) — the NHS's definition: fewer than 3 poos in the last week or pooing less often than usual, or poo that is dry, hard or lumpy, or straining or pain, or not feeling fully emptied. It is a set of descriptions, not one number.
• Bristol Stool Chart (布里斯托大便分类表) — an NHS England chart dividing stools into types 1 to 7; it states that a poo not looking like type 3 or type 4 could be constipation. Reporting a type number is more use at a consultation than an adjective.
• Fibre (纤维) — the NHS's note: fibre "is found in fruits, vegetables and cereals". It lists "not eating enough fibre" among the common causes of constipation in adults.

Frequently asked

How long before it counts as constipation? The NHS says it is likely to be constipation if you "have not had a poo at least 3 times during the last week" or are "pooing less often than usual"; poo that is "dry, hard or lumpy", "straining or in pain", or feeling you "haven't fully emptied your bowels" count too. See a doctor if you are regularly constipated, it is not getting better with treatment, there is blood in your poo, or you have lost weight without trying; blood in your poo for 3 weeks also means see a doctor, on the NHS's rectal-bleeding page. Bleeding non-stop or a lot of blood means call 999 now, or go to the nearest hospital emergency department.

How do I describe stool shape to a practitioner? Use the Bristol type number. On NHS England's chart, type 1 is separate hard lumps like nuts, hard to pass; type 4 is like a sausage or snake, smooth and soft; type 7 is watery, no solid pieces. "About a type 2 these three days, more like a 6 last week" is clearer than "sometimes hard, sometimes soft". The chart says nothing about what types 6 and 7 indicate, and neither does this article.

Can these measures be used in pregnancy and after giving birth? The NHS states that constipation is common during pregnancy and after giving birth, and that "It's safe to try these simple measures when you're pregnant" — meaning the ones in section II above: drink plenty of water, increase fibre gradually, keep a regular toilet routine, walk daily. Whether herbs or acupuncture suit you is a question for the practitioner first; for medicines in pregnancy, ask a pharmacist or a doctor.

Do not: stop medication your doctor prescribed because you have started TCM care — never stop your medication on your own.

The other six parts

• Part 1: Digestive discomfort, how TCM sees it: first, which part of "stomach trouble" you mean
• Part 2: Five situations in one table: what the theory says, the usual practice, when to see a doctor first
• Part 4: How TCM theory explains constipation: the route from intake to exit, and an ordinary week
• Part 5: Reflux and heartburn, especially at night: what to do, and how it happens
• Part 6: When to see a doctor first — each sign, and what it can indicate
• Part 7: What an online consultation does, and what needs an in-person visit or a doctor

👉 If you are unsure where to even start describing your digestive situation, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in part 6 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• NHS, Constipation, page last reviewed 26 October 2023 — https://www.nhs.uk/conditions/constipation/
• NHS England, Bristol Stool Chart (carer web version, PDF created 15 August 2023) — https://www.england.nhs.uk/wp-content/uploads/2023/07/Bristol-stool-chart-for-carer-web-version.pdf
• NHS, Bleeding from the bottom (rectal bleeding), page last reviewed 12 April 2023 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
• NHS, Stomach ache, page last reviewed 26 May 2023 — https://www.nhs.uk/conditions/stomach-ache/

本文是「肠胃不舒服」系列的第 3 篇，共 7 篇。第 1 篇讲理论里的「脾胃」是什么，第 2 篇是五种情况的对照表，第 4 篇讲理论怎么解释便秘，第 5 篇讲反酸烧心，第 6 篇讲什么时候要先看医生，第 7 篇讲线上问诊会做什么。

「我这样算不算便秘？」这一篇回答这句话，用的是西医的尺——NHS 的公开页面给了可以对照的定义。

一分钟看完

• NHS 的说法：过去一周排便不足 3 次，或比平常少，很可能就是便秘。
• 不只数天数：干不干、要不要用力、有没有排干净、和平常比有没有变，一样重要。
• NHS 英格兰的布里斯托大便分类表把大便分成 7 型，并写明不像 3 型或 4 型可能是便秘。说「大概是 2 型」比说「很硬」清楚得多。
• NHS 列的成人便秘常见原因有六项，它给的做法就对着这张原因表来。理论的那一套解释在第 4 篇。
• 这把尺是用来描述的，不是用来自我诊断的。

先说不能等的几件事

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。若出现大量出血、严重腹痛、无法排便也无法排气，或呕血，请立刻拨打 999，或前往最近的医院急诊部。这四项都列在 NHS 便血页与腹痛页的「立刻拨打 999」清单上。

完整的清单、每一项的理由，以及哪些情况要当天看医生，见第 6 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、便秘怎么算

① 先说数字。 过去一周排便不足 3 次，或比平常少，很可能就是便秘——这是 NHS 便秘页的说法。

同一页还列了三种情况：大便异常地大或小，而且干、硬或成块；排便时用力或疼痛；感觉没有排干净。所以不能只数天数——干不干、要不要用力、和平常比有没有变，一样重要。

NHS 也写明，65 岁以上更常见，孕期与产后也常见。

② 大便的形状有一张图。 NHS 英格兰的布里斯托大便分类表把大便分成 7 型。

其中 1 型是「分开的硬块，像坚果（难以排出）」，4 型「像香肠或蛇，光滑柔软」，7 型「水状，没有固体」。看诊时说「大概是 2 型」，比说「很硬」清楚得多。

图上关于便秘的说明只有一句：如果大便看起来不像 3 型或 4 型，可能是便秘。所以 3 型和 4 型是这张图的参照点。

医师问形状，是因为形状带着方向：偏 1、2 型和偏 6、7 型，在理论里是两个不同的问题（第 2 篇表的第 1 行和第 5 行）。

二、NHS 说的常见原因，和对着它来的做法

③ 原因表。 NHS 列出的成人便秘常见原因包括：纤维不够（纤维在水果、蔬菜和谷物里）、水分不够、久坐少动、常忍住便意、饮食或作息改变、药物的副作用。同一页也写明：有时候没有明显的原因。

④ 做法对着原因表来。 多喝水、逐步加纤维，NHS 说目的是让大便变软、容易排出。

如厕习惯：固定时间和地点、给自己足够时间，有便意不要拖延。活动：每天走动。

⑤ 药物那一项。 NHS 的原话是：停用任何处方药之前，先和医生谈。切勿自行停药。 中药与西药同用的问题，另见：中药和西药可以一起吃吗。

理论那一边怎么解释同一件事——水液、推动、「动」——在第 4 篇。

大马生活里的三件事

• 冷气房坐一整天：NHS 把久坐、少动列为便秘常见的原因之一，建议考虑增加活动，例如每天散步。
• 有便意却忍着：开会、赶工、上课，常见。NHS 的原话是「有便意时不要拖延」，并建议固定时间和地点、给自己足够的时间。
• 坐月子：NHS 写明产后便秘常见。月子里的饮食有自己的安排，是否适合，请问负责的医师，不要照网上的方子。

这篇出现的几个词

三个词都来自上面引用的 NHS 便秘页与布里斯托大便分类表，而且都是您在诊所里真的会用到的说法。

• 便秘（constipation）——NHS 的定义：过去一周排便不足 3 次或比平常少，或大便干、硬、成块，或排便时用力、疼痛，或感觉没排干净。它是一组描述，不是一个数字。
• 布里斯托大便分类表（Bristol Stool Chart）——NHS 英格兰的一张图，把大便分成 1 至 7 型；该图写明不像 3 型或 4 型可能是便秘。看诊时报型号比形容词有用。
• 纤维（fibre）——NHS 的说明：纤维在水果、蔬菜和谷物里。它把「纤维不够」列为成人便秘的常见原因之一。

常见问题

便秘多久算便秘？ NHS 的说法是，过去一周排便不足 3 次，或比平常少，很可能就是便秘；干、硬、要用力或没排干净，也算。经常便秘、治疗后不见好、便血或体重无故下降，请看医生；便血持续 3 周，按 NHS 便血页也要看医生。出血不止或大量出血，请立刻拨打 999，或前往最近的医院急诊部。

大便形状要怎么跟医师说？ 用布里斯托的型号。NHS 英格兰那张图的 1 型是分开的硬块像坚果、难以排出；4 型像香肠或蛇、光滑柔软；7 型水状、没有固体。报「这三天大概 2 型，上周偏 6 型」，比「有时硬有时软」清楚。该图没有写 6、7 型代表什么，本文也不写。

孕期和产后便秘，可以照这些做法吗？ NHS 写明，便秘在孕期和产后常见，而这些简单的做法在孕期可以安全地试——指的就是上面第二节那几项：多喝水、逐步加纤维、固定如厕时间、每天走动。中药与针灸是否适合，先问医师；孕期的用药，请问药剂师或医生。

不要这样做： 不要因为开始中医调理就自行停掉医生开的药——切勿自行停药。

这个系列的另外六篇

• 第 1 篇：肠胃不舒服，中医怎么看？先分清「肠胃不好」指的是哪一件事
• 第 2 篇：五种情况一张表：理论怎么说、一般怎么做、什么时候先看医生
• 第 4 篇：中医理论怎么解释便秘：从进到出的那条路，和一个普通的星期
• 第 5 篇：反酸、烧心，尤其在夜里：怎么做，以及它是怎么发生的
• 第 6 篇：什么时候要先看医生——每一项信号，以及它可能意味着什么
• 第 7 篇：线上问诊会做什么，什么需要亲诊或看医生

👉 如果您不确定「我这种肠胃情况，该从哪里说起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有第 6 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• NHS，Constipation，页面最后审阅 2023 年 10 月 26 日 — https://www.nhs.uk/conditions/constipation/
• NHS England，Bristol Stool Chart（carer web version，PDF 建立于 2023 年 8 月 15 日）— https://www.england.nhs.uk/wp-content/uploads/2023/07/Bristol-stool-chart-for-carer-web-version.pdf
• NHS，Bleeding from the bottom (rectal bleeding)，页面最后审阅 2023 年 4 月 12 日 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/
• NHS，Stomach ache，页面最后审阅 2023 年 5 月 26 日 — https://www.nhs.uk/conditions/stomach-ache/