Constipation

Most people know the feeling without needing a definition: fewer trips to the toilet than usual, stools that are hard, dry or lumpy, a lot of straining, and a nagging sense that the job is not quite finished. Some feel bloated or heavy in the lower belly; others notice little except that a regular rhythm has gone missing. It is one of the most common complaints in any family doctor's surgery, and in most cases it has no serious cause behind it.

The everyday triggers repeat themselves: travel and changed routines, too little water, meals light on vegetables, fruit and whole grains, long days sitting still, ignoring the urge because the moment is inconvenient, and rushing the toilet when you do go. Later life, pregnancy, a period in hospital or recovery from illness all make it more likely, and so do a number of medicines, including some painkillers, iron tablets and certain antidepressants. Listing these is not a diagnosis; it simply explains why the same advice comes up again and again.

One framing note before anything else. The descriptions here speak of patterns, not of people, and nothing on this page tells you why your own bowels have slowed. A lasting change deserves a proper conversation with a clinician, and the red flags further down list the signs that should not wait for self-care.

Classical Chinese medicine pictures the large intestine as the organ that conveys and passes on what is left after digestion. When that movement stalls, the stool sits too long and dries. Teaching then divides constipation into two broad kinds. Excess patterns describe heat binding the bowel, with dryness, thirst and a hot, uncomfortable belly, or stuck qi, with bloating, sighing and belching that ease when the bowels move. Deficiency patterns describe a system too tired or too cold to push, seen in people worn down by age, illness or blood loss, who strain without much result and feel drained afterwards.

The 2026 nursing protocols of the China Association of Chinese Medicine follow the same split. In their care of constipation for heart-disease patients they suggest point pressing at tianshu (ST25) and shangjuxu (ST37) when the constipation is of the cold, deficient kind, and at zusanli (ST36) and zhigou (TH6) when it runs hot. Across their stroke, heart and lung-cancer sections they also teach clockwise kneading of the belly around the navel. The national acupuncture textbook names tianshu, shangjuxu and zhigou among its main points for constipation, alongside a point on the lower back.

Each point carries a classical role. Tianshu is the gathering point of the large intestine on the front of the body, recorded for abdominal pain, distension and constipation. Shangjuxu is the large intestine's lower sea point on the shin, reflecting the old rule that such points serve the inner organs. Zhigou, on the forearm, has long been a favoured point for constipation. Zusanli is the great strengthening point of the stomach channel, recorded for distension, constipation and fatigue. In the vocabulary this site prefers, all four were traditionally used for constipation — a report of practice, not a promise of results.

Tianshu (ST25) — “heavenly pivot” — sits on the belly at the level of the navel, two body-inches out from its centre on each side. A quick measure is three finger-widths: lay your index, middle and ring fingers side by side, start at the edge of the navel, and the point lies just beyond the outer finger. Expect a soft, slightly yielding spot; you are pressing through the belly wall, not into anything hard.

Zhigou (TH6) — “branching ditch” — is on the back of the forearm. Turn your hand palm down and place four fingers across the back of the wrist, starting at the wrist crease; the point lies just above the top finger, in the groove between the two forearm bones. Press gently and you will feel the slight channel the name describes.

Zusanli (ST36) — “leg three miles” — lies on the front of the lower leg. Sit with the knee bent and find the hollow just below the kneecap on its outer side. Measure four finger-widths straight down from there, then move about one finger-width out from the sharp front edge of the shin bone. The point often feels a little tender.

Shangjuxu (ST37) — “upper great hollow” — sits on the same line, another four finger-widths below zusanli, still about one finger-width out from the shin's front edge. Walk your thumb down from zusanli and you will usually find a soft give in the muscle there.

Treat this routine as something that sits on top of good habits, not in place of them. Choose a quiet time, perhaps in the morning before your usual toilet time, and not straight after a big meal. Lie on your back with the knees bent and a pillow under the head, so that the belly can soften. Warm your hands first.

Begin with the belly massage. Rest a warm palm flat on the belly around the navel and make slow, broad circles in a clockwise direction as you look down: up the right side, across under the ribs, down the left side, and back across low down. Keep the pressure gentle and even, a light sinking rather than a push, and breathe out slowly as the hand travels. Continue for a few minutes, or until the belly feels warm and loose. Then settle two or three finger pads on tianshu (ST25) on both sides at once, press in only as far as feels comfortable while breathing out, make a few small circles, and release gradually; about a minute is plenty.

Then sit up for the distant points. Press zhigou (TH6) with the thumb of the other hand, firm but comfortable, for about a minute on each arm. Move to the legs: press zusanli (ST36) with a thumb for about a minute on each leg, then slide four finger-widths down to shangjuxu (ST37) and do the same. Once or twice a day is enough.

The stop rules matter more than the order. Stop at once on sharp, electric or radiating sensation, and skip broken, bruised or inflamed skin. Never press hard into a belly that is already painful, swollen or tender to touch. During pregnancy avoid deep pressure on the belly altogether; keep any belly massage feather-light, or leave it out and press only the arm and leg points.

The Chinese source for this routine is the China Association of Chinese Medicine's 2026 nursing protocols, which build point pressing, clockwise belly massage and ear-seed pressing into constipation care for stroke, heart-disease and lung-cancer patients. The national acupuncture textbook names the same family of points. These are expert guidance, not trial results.

Two small trials pressed points by hand against a sham. One, in people in hospital after a stroke, pressed tianshu with two other belly points, zhongwan and qihai, and found less constipation and less need for laxatives. The other taught psychiatric inpatients to press tianshu, zhongwan and quchi themselves, and found symptoms and quality of life improved more than with light sham touching. A review of belly massage across many trials found more frequent bowel movements and fewer symptoms. A review of ear-seed pressing found benefits.

Much of the point-specific support comes from needling rather than pressing. A large trial in China gave electroacupuncture at tianshu (ST25), shangjuxu (ST37) and a nearby belly point, and found more complete bowel movements than with sham needling. Taken together, reviews suggest belly massage and acupoint pressing may help ordinary constipation.

Some signs mean leave the points for later and see a doctor promptly: blood in or on the stool, or black, tarry stool; weight loss you cannot explain; anaemia, often noticed as unusual tiredness, breathlessness or paleness; or a lasting change in your usual bowel habit, especially if you are over about 50 or have a family history of bowel cancer. Constipation that alternates with bouts of diarrhoea also needs checking rather than self-treatment.

Seek urgent care for severe belly pain, a swollen belly or vomiting, especially if you cannot pass wind, since that can mean the bowel is blocked. If constipation began soon after starting a new medicine, tell the prescriber rather than stopping the medicine yourself. In pregnancy, raise constipation with your midwife or doctor and avoid deep belly pressure. Persistent symptoms belong with a licensed practitioner — Western medicine or East Asian medicine, whichever suits the complaint.

Chinese nursing guidance and ordinary medical advice agree on the foundations, and they come before any point. Drink enough through the day; a glass of warm water on waking is a traditional start. Eat fibre at every meal, from vegetables, fruit, beans, oats and whole grains, and add it gradually so the belly can adjust. Move every day: a brisk walk does more for a sluggish bowel than most people expect.

Give the bowel a regular, unhurried slot, often after breakfast when it naturally stirs, and answer the urge when it comes rather than putting it off. On the toilet, rest your feet on a small footstool so the knees sit higher than the hips, lean forward with the elbows on the knees, and let the belly relax; this posture straightens the passage and means less straining. Avoid long sessions and forcing. A review of belly massage found more frequent bowel movements and fewer symptoms, and the points here are a calm, optional companion to these habits.

Which way should the belly massage go, and why clockwise?

Picture a clock printed on your own belly as you look down at it: the hand travels up the right side, across under the ribs, and down the left side towards the hip. That follows the route the large bowel takes through the abdomen, which is why Chinese nursing guidance and Western massage teaching both settle on the same direction.

How often can I do this routine?

Once or twice a day suits most healthy adults, kept gentle and unhurried. Many people like to do it in the morning before their usual toilet time, but not straight after a big meal. More pressure or more rounds is not better; if the belly feels sore afterwards, ease off.

Can I press these points while pregnant?

The four points here are not on the traditional list of points avoided in pregnancy, but deep pressure into the belly is not advisable while pregnant, so skip the deep work at tianshu (ST25) and keep any belly massage feather-light, or leave it out. The arm and leg points can be pressed gently. Constipation is common in pregnancy; talk to your midwife or doctor before relying on any self-care routine.

What about ear seeds? I have seen them recommended for constipation.

Ear-seed acupressure is the most researched form of pressing for constipation. A practitioner tapes small seeds to chosen spots on the outer ear, and you press them through the day. Because the spots must be chosen and placed by someone trained, and this site has no ear map, this page describes the method only and leaves the placing to a licensed practitioner.

Can acupressure replace laxatives my doctor prescribed?

No. Self-pressure is a comfort practice that sits beside habits and medical care, never in place of them. Do not stop or change a prescribed laxative on your own. If you would like to use less medicine, raise it with the clinician who prescribed it, and let them judge it alongside your other conditions and medicines.

What do the four names mean?

Tianshu reads as “heavenly pivot”, the hinge at navel level between the upper and lower body. Zhigou means “branching ditch”, a channel running between the two forearm bones. Zusanli is “leg three miles”, named after the stamina it was said to restore. Shangjuxu is “upper great hollow”, the upper of two hollows along the outer shin.

1. 01WHO Standard Acupuncture Point Locations in the Western Pacific Region (2008) — landmark descriptions followed for tianshu (ST25), zhigou (TH6), zusanli (ST36), and shangjuxu (ST37).
2. 02A Manual of Acupuncture (Deadman, Al-Khafaji & Baker) — point categories, name glosses, and general bowel-complaint framing consulted for context.
3. 03aijiu-mpvue (MIT License), licensed dataset — recorded indications and cautions underlying the four point identities.
4. 04China Association of Chinese Medicine, 中風等13個病種中醫護理方案（2026年版） — constipation care in the stroke, angina and lung-cancer sections (point pressing, clockwise abdominal massage, ear-seed pressing): https://www.cacm.org.cn/wp-content/uploads/2026/09/附件1.-中风等13个病种中医护理方案（2026年版）全文.pdf
5. 05《針灸學》 textbook, 便秘 chapter (online reproduction, A+醫學百科) — treatment principle and main points: https://www.a-hospital.com/w/针灸学/便秘
6. 06Nieh HC et al. (2023), acupressure for constipation in acute stroke inpatients, randomized sham-controlled trial: https://doi.org/10.1016/j.ctcp.2023.101801
7. 07Wong WK et al. (2015), self-administered acupressure for constipation in psychiatric inpatients, randomized sham-controlled trial: https://doi.org/10.1186/s13020-015-0064-7
8. 08Liu Z et al. (2016), electroacupuncture for chronic severe functional constipation, randomized sham-controlled trial: https://doi.org/10.7326/M15-3118
9. 09Jiang ZF et al. (2023), auricular acupressure for constipation in adults, systematic review and meta-analysis: https://doi.org/10.3389/fphys.2023.1257660
10. 10Huang SY et al. (2025), abdominal massage for chronic constipation in adults, systematic review and meta-analysis: https://doi.org/10.1016/j.ijnurstu.2024.104936