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On the L, the guan is the first you meet and then cun and chi are deeper? With the cun also slippery (yang rushing out) and chi tight (no yang in lower), then this sounds like a Ht/Kid. Think tingling of hands and feet as yang leaving the extremities, and dizziness as rushing up. With a bigger R guan, this sounds like a GZJNT, or as a back up if this isn’t strong enough to treat the tingling, a WTGZT+LG&ML–a Wu Tou Jiu Ni Tang. But first there is other business that must be taken care of with that wiry L guan. He needs to be harmonised. I suspect this is where the tendency to constipation is coming from, and with the bigger slippery R guan and thirst CHGZGJT+LG would fit the bill. Now in terms of the bowels, it really depends what you mean by constipation. If it’s just mild, then a CHT alone should take care of this. If more severe then maybe +GL, or even consider adding a ZSSYS, especially if there is more lower abdominal bloating, skipping a day, and/or incomplete or dropping-like stools. Though with the Ht/Kid, I tend to stay away from BS and use CS, but I don’t find this as effective for moving the bowels in a ZS/SY combo. If it is more severe with dry stool, skipping more days and/or pronounced abdominal fullness, you could start with a DCHT and with the thirst â€“BX +THF. Furthermore, if you suspect you may be on this for a while, even add GZGCLGMLT, or if the stools start moving pretty soon, then you may not need to add this. In summary: harmonize with CHT, with THF, and LG/ML, or whatever assistance is needed for the bowels. Then move onto a GZ/FZ/mineral combo. If that doesn’t work, try GZ/WT/minerals (or even a WT&FZ combo if you really need the rooting of FZ in addition to the WT).