4 Excessive pattern: Table 2: Dominant symptoms and signs of the ﬁve syndromes. Excess heat: 13 patients (5.8%) Dry mouth 12/13 (92.3%), fatigue 10/13 (76.9%), phlegm production 7/13 (53.8%), slimy fur 8/13 (61.5%), white fur 8/13 (61.5%), ﬁne pulse 7/13 (53.8%), and string-like pulse 9/13 (69.2%) Qi Stagnation: 90 patients (40.0%) Dry mouth 69/90 (76.7%), fatigue 81/90 (90.0%), mind disquieted/susceptible to fright 49/90 (54.4%), belching/nausea/vomiting 61/90 (67.8%), abdominal distension/pain 58/90 (64.4%), anorexia 46/90 (51.1%), inadequate pushing force 56/90 (62.2%), pale red tongue 51/90 (56.7%), white fur 60/90 (66.7%), ﬁne pulse 64/90 (71.1%), and string-like pulse 47/90 (52.2%) Deﬁcient patterns: Qi deﬁciency: 210 patients (93.3%) Dry mouth 148/210 (70.5%), fatigue 200/210 (95.2%), mind disquieted/susceptible to fright 114/210 (54.3%), inadequate pushing force 110/210 (52.4%), pale red tongue 116/210 (55.2%), white fur 139/210 (66.2%), and ﬁne pulse 147/210 (70.0%) Blood (Yin) deﬁciency: 65 patients (28.9%) Dry mouth 57/65 (87.7%), fatigue 62/65 (95.4%), mind disquieted/susceptible to fright 45/65 (69.2%), anorexia 43/65 (66.2%), inadequate pushing force 38/65 (58.5%), red tongue 51/65 (78.5%), scanty fur/peeling fur/peeled fur 48/65(73.8%), and ﬁne pulse 45/65 (69.2%) Yang deﬁciency: 50 patients (22.2%) Dry mouth 39/50 (78.0%), fatigue 48/50 (96%), mind disquieted/susceptible to fright 32/50 (64.0%), cold intolerance 41/50 (82.0%), pale red tongue 25/50 (50%), white fur 29/50 (58.0%), and ﬁne pulse 33/50 (66.0%) Dominant symptoms and signs were deﬁned as prevalent for more than or equal to 50% of each syndrome. Evidence-Based Complementary and Alternative Medicine cancer patients with constipation, with prevalence of 93.3%. For further analyzing its combination with other syndromes, one-third were in pure Qi deﬁciency, another one-third were coexistence with Qi stagnation or blood (Yin) deﬁciency, and the rest were in diﬀerent combinations between the ﬁve syndromes (Table 3). 3.3. Manifestations for Patients in the Three Patterns. The prevalence of symptoms and signs for patients in deﬁcient pattern, excessive pattern, and deﬁciency-excess complex was determined. The manifestations of pale/sallow complexion, fatigue, mind disquieted/susceptible to fright and anorexia among patients were signiﬁcantly higher in deﬁcient pattern than that in excess, with P value < 0.05. On the contrary, bitter taste, belching/nausea/vomiting, stuﬃness and fullness of chest, abdominal distension/pain, water intention, insom- nia, and vacuous pulse were more common in excessive pattern than that in deﬁciency, with P value < 0.05. For the description of constipation symptoms, patients in deﬁcient pattern reported signiﬁcantly higher prevalence of inade- quate pushing force (42.5%), sense of incomplete defecation (15.7%), and diﬃculty in defecation (24.4%) when compar- ing with the group in excess (Table 4). 3.4. Patients’ Severity of Constipation and Prescription of Opi- oid. The severity of constipation was signiﬁcantly diﬀerent among the three groups of patients with the most severe in the group of deﬁciency-excess complex (3.91±1.57 points) and least in the deﬁcient pattern (3.19 ± 1.85 points) (P = 0.012). About 50% patients in deﬁcient pattern and deﬁciency-excess complex were in constipation, while patients in excessive pattern showed a discrete distribution of severity of constipation, for which 42.9% were in non- constipation and severe constipation, respectively. For the prescription of opioids, there were no signiﬁcant diﬀerence on Syndrome distribution for whether patients were pre- scribed morphine, methadone, fentanyl, tramadol, dihy- drocodeine, dextropropoxyphene or codeine, with P value > 0.05 (Table 5). 4. Discussion From the results of this study, more than 90% of patients presented in deﬁcient pattern, while 40% were in deﬁciency- excess complex. It illustrated that the healthy Qi (a collective designation for all normal functions of the human body and the abilities to maintain health [3]) of advanced cancer patients was greatly damaged, and many of them were complicated by excessive pattern. The excess condition could be caused by the accumulation of pathological factors, such as Qi, blood, phlegm, food, and dampness. Only a small number of patients were in pure excessive pattern. Therefore, the treatment principle of advanced cancer patients with constipation should reinforce the deﬁciency and eliminate the excess condition simultaneously. For the distribution of ﬁve common syndromes, two-thirds of patients present in Qi deﬁciency, or its combination with Qi stagnation and blood (Yin) deﬁciency, respectively. A designated TCM formula targeting on replenishing the deﬁciency of Qi, redirecting the ﬂow of Qi stagnation and moistening the dryness caused by the blood (Yin) deﬁciency should be eﬀective for the management of constipation in palliative care. For analyzing the prevalence of symptoms and signs, there are many coincidences between diﬀerent syndrome patterns. For example, dry mouth, fatigue, and ﬁne pulse were the common manifestations of the ﬁve syndromes (Table 2). Even there were signiﬁcant diﬀerences between deﬁcient and excessive patterns, a large proportion of cases