Ji Chuan Jian (济川煎), known in English as Benefit the River Decoction, is a classical TCM formula by Zhang Jing-yue for treating constipation due to Kidney deficiency. It is particularly indicated for dry stools, difficult defecation, and constipation in elderly patients, postpartum women, or those with Kidney Yin or Yang deficiency, often accompanied by lower back weakness and fatigue. In modern clinical practice, Ji Chuan Jian is used for chronic constipation caused by Kidney deficiency failing to moisten the intestines. By nourishing the Kidney while moistening the intestines and promoting bowel movement, it effectively relieves constipation caused by deficiency at the root.

I. Origins and History

1. Classical Records

Ji Chuan Jian originates from the Jingyue Quanshu (Complete Works of Jingyue), authored by Zhang Jingyue of the Ming dynasty. Zhang Jingyue was a celebrated physician of the Ming dynasty, whose academic thought exerted a far-reaching influence on later generations. In the Jingyue Quanshu, Ji Chuan Jian was listed as one of the representative formulas of the "Harmonising Array" within the "Eight Arrays of New Formulas." This work encompasses Zhang Jingyue's rich clinical experience and academic insights, and Ji Chuan Jian, as one of its important formulas, holds distinctive theoretical value and clinical significance.

2. Historical Evolution

Since its emergence in the Ming dynasty, Ji Chuan Jian has been widely applied in Chinese medicine clinical practice. Over time, later physicians, in the course of inheriting and applying Ji Chuan Jian, continued to research and develop the formula. Some physicians, drawing on clinical experience, made fine adjustments to its herb composition to suit different patients' conditions; others explored aspects such as the formula's processing methods and administered dosage, striving to make Ji Chuan Jian's therapeutic effect more stable and pronounced. Throughout the long history of Chinese medicine formula studies, it has consistently held an important place, relieving the suffering of countless patients.

II. Herb Composition (Sovereign, Minister, Assistant, Envoy)

1. Chief Herb — Roucongrong (Cistanche)

Roucongrong is sweet and salty in flavour and warm in nature, entering the Kidney and Large Intestine channels. It has a soft, moist texture and the actions of tonifying kidney yang and boosting essence and blood. In Ji Chuan Jian, Roucongrong serves as the chief herb, capable of warming and nourishing kidney yang, ensuring sufficient yang qi within the kidneys, thereby driving the intestines' function of conducting and expelling waste matter. With kidney yang supplemented, this is akin to providing powerful motive force for intestinal peristalsis, allowing the intestines to operate normally and the waste matter to be smoothly expelled from the body. It tonifies kidney yang without dryness, and boosts essence and blood without greasiness, making it the key herb within the formula.

2. Deputy Herbs — Danggui (Angelica Root) and Niuxi (Achyranthes Root)

Danggui is sweet and acrid in flavour and warm in nature, entering the Liver, Heart, and Spleen channels. It has the actions of tonifying blood and activating blood, and regulating menstruation to relieve pain. In Ji Chuan Jian, Danggui on one hand tonifies blood to moisten the intestines, providing nourishment to the intestines and ensuring sufficient fluids, which benefits the downward movement of waste matter; on the other hand, its blood-activating action helps promote the circulation of qi and blood, acting synergistically with Roucongrong to reinforce the force driving intestinal conduction. Niuxi is bitter, sweet, and sour in flavour and neutral in nature, entering the Liver and Kidney channels. It can tonify the liver and kidneys, strengthen the sinews and bones, and guide blood downward. Here, Niuxi assists Roucongrong in warming and tonifying kidney yang, while simultaneously guiding the medicinal force downward, ensuring that tonification does not cause stagnation, better allowing the formula to exert its effect and promoting the expulsion of intestinal waste matter.

3. Assistant Herbs — Zexie (Alisma Rhizome) and Shengma (Cimicifuga Rhizome)

Zexie is sweet and bland in flavour and cold in nature, entering the Kidney and Bladder channels. It has the action of disinhibiting water and percolating dampness. In Ji Chuan Jian, Zexie, by percolating and disinhibiting urination, allows the fluids within the intestines to be appropriately drained, thereby preventing excessive accumulation of fluids from causing stools to become sticky and difficult to pass — performing the role of unblocking both bowel and bladder functions and assisting defecation. Shengma is acrid and sweet in flavour and slightly cold in nature, entering the Lung, Spleen, Stomach, and Large Intestine channels. It can raise yang and lift what has prolapsed, and clear heat and resolve toxicity. A small amount of Shengma in the formula performs the role of raising clear yang, using the ascent of clear yang to promote the descent of turbid yin, helping to ensure free flow of intestinal qi movement and allowing waste matter to be smoothly expelled.

4. Envoy Herb — Zhike (Bitter Orange Fruit)

Zhike is bitter, acrid, and sour in flavour and slightly cold in nature, entering the Spleen and Stomach channels. It has the actions of regulating qi and widening the middle, and moving stagnation to reduce distension. It can regulate gastrointestinal qi movement, ensuring free flow of intestinal qi movement and reinforcing intestinal peristaltic function. In Ji Chuan Jian, Zhike, as the envoy herb, guides all the herbs to act synergistically upon the intestines, promoting the expulsion of waste matter, and performs the role of harmonising all the herbs and reinforcing the therapeutic effect.

III. Pathomechanism, Actions, and Indications

1. Pathomechanism Analysis

The pathomechanism targeted by Ji Chuan Jian is primarily kidney yang weakness, with the intestines losing moistness and lacking the force to conduct. The kidneys govern the two lower orifices; when kidney yang is insufficient, the kidneys' qi-transforming function weakens, and the intestines' function of conducting waste matter is correspondingly affected. Kidney yang depletion fails to warm and nourish the intestines, leading to insufficient intestinal fluids and dry, hard-to-pass stools; at the same time, intestinal peristalsis becomes sluggish, and waste matter remains within the intestines for too long, further aggravating the symptoms of constipation.

2. Actions

Ji Chuan Jian has the actions of warming the kidneys and boosting essence, and moistening the intestines to unblock the bowels. Through warming and tonifying kidney yang, the yang qi within the kidneys becomes sufficient, driving the intestines' conducting function; boosting essence supplements the yin essence within the kidneys, allowing yin and yang to be mutually rooted and mutually supportive; moistening the intestines and unblocking the bowels directly targets the symptoms of intestinal dryness and hard, dry stools, ensuring the intestines remain unobstructed and allowing waste matter to descend.

3. Indications

Ji Chuan Jian is indicated for the pattern of kidney yang weakness with insufficient essence and fluids. Symptoms include constipation, clear and copious urination, soreness and weakness of the lumbar region and knees, dizziness and vertigo, a pale tongue with white coating, and a sunken and slow pulse. This pattern type is commonly seen in the elderly, those weakened by prolonged illness, or those with a constitutionally yang-deficient body; due to insufficient kidney yang and declining intestinal function, symptoms such as constipation arise. Ji Chuan Jian, through its distinctive herb combination, can effectively improve these symptoms and restore normal intestinal function.

IV. Formula Analysis

1. Combining Warming the Kidneys with Moistening the Intestines

Within the formula, Roucongrong warms and tonifies kidney yang, serving as the primary herb for warming the kidneys; Danggui tonifies blood and moistens the intestines. The two combined warm the kidneys without damaging yin, and tonify blood and moisten the intestines to assist defecation — embodying the characteristic of combining kidney-warming with intestine-moistening. With kidney yang warmed and the intestines moistened, intestinal conducting function is restored to normal, and the stools naturally become unobstructed.

2. Combining Tonification with Purgation

Zexie disinhibits water and percolates dampness; Zhike regulates qi and moves stagnation. The two — one draining, one descending — are combined with tonifying herbs such as Roucongrong and Danggui, achieving tonification with purgation within it, so that tonification does not cause stagnation. The tonifying herbs supplement the body's righteous qi and reinforce its function; the purgative herbs clear waste matter from within the intestines, keeping the intestines unobstructed. This combination method of tonification together with purgation can both correct the body's state of depletion and resolve the problem of disordered intestinal conduction, achieving the goal of treating both root and manifestation.

3. Combining Raising the Clear with Descending the Turbid

Shengma raises clear yang; Zhike descends turbid yin — one ascending, one descending, regulating intestinal qi movement. The ascent of clear yang assists the dispersal and driving action of yang qi; the descent of turbid yin allows intestinal waste matter to be smoothly expelled. The two act synergistically, ensuring orderly ascent and descent of intestinal qi movement, promoting the restoration of normal intestinal function, thereby achieving the therapeutic effect for constipation.

V. Comparison with Related Formulas

1. Comparison with Maziren Wan

Maziren Wan originates from the Shanghan Lun (Treatise on Cold Damage), with its primary actions being moistening the intestines to drain heat, and moving qi to unblock the bowels. Its herb composition centres primarily on Mazirenn (Hemp Seed), Shaoyao (Peony Root), Zhishi (Unripe Bitter Orange), Dahuang (Rhubarb Root), Houpo (Magnolia Bark), and Xingren (Apricot Kernel), emphasising heat-clearing and intestine-moistening. Ji Chuan Jian, by contrast, focuses primarily on warming the kidneys and boosting essence, with moistening the intestines and unblocking the bowels as a secondary action, indicated for constipation due to kidney yang weakness with insufficient essence and fluids. The two formulas differ markedly in pathomechanism, actions, and herb composition. Maziren Wan is suited to constipation from intestinal and stomach dryness-heat with insufficient fluids, manifesting as dry, hard stools and frequent urination; Ji Chuan Jian, by contrast, is suited to constipation caused by kidney yang insufficiency, accompanied by manifestations of kidney yang deficiency such as clear, copious urination and soreness and weakness of the lumbar region and knees.

2. Comparison with Wuren Wan

Wuren Wan has the action of moistening the intestines and unblocking the bowels, composed primarily of Taoren (Peach Kernel), Xingren (Apricot Kernel), Baiziren (Arborvitae Seed), Songziren (Pine Nut), and Yuliren (Bush Cherry Seed). Its medicinal potency is relatively mild, focusing on moistening the intestines. Ji Chuan Jian, by contrast, moistens the intestines and unblocks the bowels on the foundation of warming and tonifying kidney yang, with a relatively stronger medicinal potency. Wuren Wan is suited to constipation from intestinal dryness with fluid depletion, where the degree of dry, hard stools is relatively mild; Ji Chuan Jian is more suited to constipation patients with kidney yang weakness and more pronounced loss of intestinal moisture, where the dry, hard stools are often more severe and accompanied by marked kidney yang deficiency symptoms.

VI. Clinical Functions and Indications

1. Constipation in the Elderly

As the function of the zang-fu organs gradually declines in the elderly, kidney yang insufficiency is relatively common. The actions of Ji Chuan Jian in warming the kidneys, boosting essence, moistening the intestines, and unblocking the bowels make it well suited to constipation caused by kidney yang weakness in elderly patients. Beyond constipation, these patients often have accompanying symptoms such as soreness and weakness of the lumbar region and knees, aversion to cold with cold limbs, and clear, copious urination. After using Ji Chuan Jian, intestinal function can be effectively improved and constipation symptoms relieved, while simultaneously reinforcing the body's yang qi and improving quality of life.

2. Postpartum Constipation

Postpartum women have a weakened constitution with insufficient qi and blood, and kidney yang is also frequently injured. Ji Chuan Jian can both warm and tonify kidney yang and nourish blood to moisten the intestines, producing good therapeutic results for postpartum constipation caused by kidney yang weakness with the intestines losing moistness. When postpartum women use Ji Chuan Jian, it not only resolves the problem of constipation but also promotes bodily recovery and strengthens the constitution.

3. Constipation with Bodily Weakness After Illness

Some patients, after a major illness, have a weakened constitution with the righteous qi not yet recovered and kidney yang not vigorous, making them prone to constipation symptoms. Ji Chuan Jian, through warming the kidneys and boosting essence, regulates the body's yin-yang balance and restores intestinal function, producing good therapeutic results for constipation with bodily weakness following illness. It can help patients pass stools smoothly despite a weakened bodily state, promoting bodily recovery.

VII. Clinical Modifications

1. When Accompanied by Qi Deficiency

Qi-tonifying herbs such as Huangqi (Astragalus Root) and Dangshen (Codonopsis Root) may be added. Huangqi is sweet in flavour and slightly warm in nature, entering the Spleen and Lung channels, capable of tonifying qi, raising yang, consolidating the exterior, and stopping perspiration; Dangshen is sweet in flavour and neutral in nature, entering the Spleen and Lung channels, capable of strengthening the spleen, benefiting the lungs, nourishing blood, and generating fluids. After adding Huangqi and Dangshen, the qi-tonifying potency is reinforced, allowing abundant qi to assist in driving intestinal conduction, producing better therapeutic results for constipation caused by qi deficiency.

2. When Accompanied by Blood Deficiency

Blood-tonifying herbs such as Shudi (Prepared Rehmannia Root) and Baishao (White Peony Root) may be added. Shudi is sweet in flavour and slightly warm in nature, entering the Liver and Kidney channels, capable of tonifying blood, nourishing yin, boosting essence, and filling the marrow; Baishao is bitter and sour in flavour and slightly cold in nature, entering the Liver and Spleen channels, capable of nourishing blood, regulating menstruation, astringing yin, and stopping perspiration. With the addition of Shudi and Baishao, the blood-tonifying action is further reinforced, providing the intestines with more sufficient nourishment and relieving constipation symptoms caused by blood deficiency.

3. When Constipation Is More Severe

Dahuang (Rhubarb Root) may be added to reinforce the purgative potency. Dahuang is bitter in flavour and cold in nature, entering the Spleen, Stomach, Large Intestine, Liver, and Pericardium channels, capable of draining downward to attack accumulation, clearing heat and draining fire, and cooling blood to resolve toxicity. However, the dosage of Dahuang should not be excessive, lest the righteous qi be damaged. Adding an appropriate amount of Dahuang to Ji Chuan Jian can effectively reinforce the formula's bowel-unblocking action, suitable for patients with more severe constipation symptoms.

VIII. Dosage and Preparation

1. Traditional Method

2. Modern Concentrated Granules

Modern concentrated granules are granule preparations produced from traditional Chinese herbs through extraction, concentration, and related processes, convenient to take. When using, simply dissolve in water according to the dosage indicated in the product instructions. Generally speaking, the dosage is equivalent to the traditional decoction, though the specific amount may vary slightly between products from different manufacturers. For example, the daily dosage of Roucongrong concentrated granules may be 6–9 g, Danggui concentrated granules 6–9 g, Niuxi concentrated granules 6 g, Zexie concentrated granules 4.5 g, Shengma concentrated granules 1.5–2.1 g, and Zhike concentrated granules 3 g. Dissolve in boiled water, one dose per day, taken in two administrations. Modern concentrated granules retain the therapeutic effect of the traditional herbs while being convenient to take, well suited to the fast-paced modern lifestyle.

IX. Precautions and Contraindications

1. Dietary Restrictions

During the course of taking Ji Chuan Jian, spicy, greasy, and raw, cold irritating foods should be avoided. These foods readily damage the spleen-stomach yang qi, affecting intestinal function and being unfavourable for the treatment of constipation. A light diet should be maintained, with increased consumption of foods rich in dietary fibre — such as vegetables and fruit — which helps promote intestinal peristalsis and reinforce the formula's therapeutic effect.

2. Constitutional Contraindications

Use with caution in those with yin deficiency and fire hyperactivity. Ji Chuan Jian is primarily suited to the pattern of kidney yang weakness; those with a yin deficiency and fire hyperactivity constitution already have insufficient yin fluids with relatively hyperactive yang, and using Ji Chuan Jian may aggravate symptoms of yin deficiency with fire hyperactivity, leading to adverse reactions such as dry mouth, dry throat, and worsening constipation. This population should instead select formulas that nourish yin, drain fire, moisten the intestines, and unblock the bowels for treatment.

3. Special Circumstances

Use with caution in pregnancy. Although Ji Chuan Jian contains no herbs with marked abortifacient properties, pregnant women must still exercise caution with medication. During pregnancy, a woman's body is in a unique physiological state, and improper medication may have adverse effects on the fetus. If a pregnant woman develops constipation symptoms, the appropriate treatment method should be selected according to the specific situation under medical guidance.

X. Modern Research

1. Pharmacological Research

As a formula for treating constipation due to kidney deficiency, qi deficiency constipation, and habitual constipation, Ji Chuan Jian's function lies in warming the kidneys, boosting essence, moistening the intestines, and unblocking the bowels, particularly suited to those with intestinal dryness; Huomaren (Hemp Seed) is commonly added clinically to reinforce the effect.

Modern pharmacological research has demonstrated that Roucongrong within Ji Chuan Jian has the actions of regulating the intestinal flora, promoting intestinal peristalsis, and improving intestinal function. The multiple active constituents it contains can reinforce the contractile force of intestinal smooth muscle, promoting the expulsion of stools. The active constituents within Danggui have the actions of tonifying blood and improving blood circulation, helping to provide sufficient nourishment and oxygen to the intestines and promoting intestinal metabolism. Zexie, Zhike, and the other herbs also exert a synergistic action by regulating intestinal physiological function, improving constipation symptoms.

2. Clinical Research

In recent years, numerous clinical studies have further verified the efficacy and safety of Ji Chuan Jian in treating constipation. Some research has demonstrated that Ji Chuan Jian produces good therapeutic results for multiple types of constipation, including elderly constipation and postpartum constipation, significantly improving indicators such as stool consistency and defecation frequency in patients. Compared with other medications for treating constipation, Ji Chuan Jian has the advantages of fewer side effects and a lower recurrence rate, providing an effective option for the clinical treatment of constipation. With the continuing deepening of modern research, the application prospects of Ji Chuan Jian in the field of constipation treatment will become broader still.