Part 4 of 7 in the "digestive discomfort" series. Part 1 is what the TCM "spleen-stomach" is; part 2 is the five-situation table; part 3 is what counts as constipation and what the NHS gives as its causes; part 5 is reflux and heartburn; part 6 is when to see a doctor first; part 7 is what an online consultation does.
Part 3 gave the Western yardstick and its cause list — that list is on the NHS constipation page, and it comes down to fibre, fluids, toilet routine and activity. This part is how the theory accounts for the same thing.
Where the World Health Organization's 2022 TCM terminology standard is quoted below it is called "the standard"; only definition sentences are quoted, never a symptom list.
The short version
- The standard has a separate definition for each segment of the route from intake to exit: the spleen governs transportation and transformation; the small intestine separates the clear from the turbid; the large intestine governs conveyance, and the thin body fluids.
- Within the theory, how dry the stool is has to do with how fluids are handled, and whether it moves has to do with whether qi is stagnant — those two sentences are the theory's common teaching, which the standard does not join up that way.
- The standard's "physical inactivity" entry states that it "leads to imbalances in the flow of qi and blood, weak tendons and bones, stagnant qi of the spleen and stomach". So "a daily walk" has a reason on each side.
- The last section lays an ordinary week under both models. It describes how each model reads these habits, not any particular reader, and it is not a 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. The route from intake to exit
Along the route from intake to exit, the standard has a separate definition for each of these segments:
- The spleen governs transportation and transformation (脾主运化): the spleen "digests water and food, absorbs and distributes nutrients and regulates water metabolism".
- The small intestine separates the clear from the turbid (小肠泌别清浊): it "absorbs nutrients and body fluids and passes the food residue and water down to the large intestine".
- The large intestine governs conveyance (大肠主传导): it "conducts wastes and discharges faeces".
- The large intestine governs the thin body fluids (大肠主津): it "absorbs the thin, clear fluids while eliminating waste".
So within the theory, how dry the stool is has to do with how fluids are handled along that route, and whether it moves has to do with whether qi is stagnant. Those two sentences are the theory's common teaching; the standard does not join them up that way.
The standard has a further entry, "physical inactivity" (过逸): it "leads to imbalances in the flow of qi and blood, weak tendons and bones, stagnant qi of the spleen and stomach". So the NHS's "a daily walk" in part 3 and the theory's "movement" are two different reasons pointing at one habit.
💡 Remember: the theory looks at water and propulsion; the NHS looks at fibre, fluids, toilet routine and activity. They overlap on habits and differ in their sources.
II. One week, two readings
Below, an ordinary week is laid under both models. It describes how each model reads these habits, not any particular reader, and it is not a diagnosis.
- Monday to Friday: breakfast in the car, nasi campur with little veg at lunch, overtime dinner from a delivery app. On the NHS's cause list this is "not eating enough fibre". The theory sees "dietary irregularities" (饮食不节), which the standard defines as "Improper diet, including excessive hunger and binge eating".
- All day in an air-conditioned room, the water bottle barely touched. On the NHS's cause list, "not drinking enough fluids". The theory's common teaching: when fluids are short the large intestine loses its moistening and the stool turns dry; "the large intestine governs the thin body fluids" is about the water in exactly that segment.
- The urge arrives in a meeting and is held until it ends. The NHS's own words are "Do not delay if you feel the urge to poo". The theory reads this as "conveyance" interrupted: what should move down stays where it is; that too is common teaching.
- Over the week, far more time sitting than walking. On the NHS's cause list, "not moving enough and spending long periods sitting or lying down". The standard's "physical inactivity": "stagnant qi of the spleen and stomach".
- Sunday, looking back: two stools that week, and towards types 1 and 2. By the NHS yardstick, fewer than 3 times during the last week is likely to be constipation. By NHS England's Bristol Stool Chart, "If a poo does not look like type 3 or type 4 it could be constipation".
- Where the two readings land. The NHS lands on fibre, fluids, toilet routine and activity; the theory lands on transformation, conveyance and "movement". They overlap on habits; their sources differ.
This passage describes the models, not a diagnosis. The same week landing on different people can turn out differently; the NHS itself states that "Sometimes there's no obvious reason".
If the definition of constipation fits, the next step is the one in part 3: a pharmacist or a doctor; with any item from part 6, a doctor first.
The words in this part
All three come from the World Health Organization's TCM terminology standard, and all three are used above.
- The small intestine separates the clear from the turbid (小肠泌别清浊) — the standard's definition: it "absorbs nutrients and body fluids and passes the food residue and water down to the large intestine". It is the middle of that route.
- The large intestine governs the thin body fluids (大肠主津) — the standard's definition: it "absorbs the thin, clear fluids while eliminating waste". When the theory talks about dryness, this is the segment it means.
- Physical inactivity (过逸) — the first sentence of the standard's definition: it "leads to imbalances in the flow of qi and blood, weak tendons and bones, stagnant qi of the spleen and stomach". It is the theory's word for sitting still.
Frequently asked
That week above — is it describing me? No. That section describes how the models read these habits, not any particular reader, and it is not a diagnosis. The same week landing on different people can turn out differently, and the NHS itself states that sometimes there is no obvious reason. To find out where you stand, the first step is part 3's yardstick; with any item from part 6, see a doctor first.
Why do three days of food and stool notes help? Because what both accounts need to ask about is inside those three days: what you ate, how much you drank, how much you moved, how many times you went, and what shape it was. The NHS's cause list is organised around exactly those items; and the "water" and "propulsion" the theory looks at can only be read from the same everyday detail. For shape, report the Bristol type number — part 3 covers how.
Whose advice is "a daily walk", exactly? Both sides have it, for different reasons. The NHS lists "not moving enough and spending long periods sitting or lying down" among the common causes of constipation in adults and suggests considering more activity, such as a daily walk. The standard's "physical inactivity" entry states that it "leads to imbalances in the flow of qi and blood, weak tendons and bones, stagnant qi of the spleen and stomach". So the "a daily walk" cell in part 2's table holds two independent reasons pointing at one habit — which is why this series marks its sources item by item: the same advice does not mean the same account.
Do not: take the route above and use it to label yourself. The theory's function names are there to explain, not to diagnose.
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 3: How long before it counts as constipation? What stool shape says, and the NHS's causes
- 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
For general wellness education only — not medical advice. Consult a registered TCM practitioner for personal guidance.
Sources
- World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322
- 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/
