Constipated But Peeing Too Much? What to Do When the Fluids Are All Going Out in the Urine — Song Dynasty Master Xu Shuwei Cures Spleen-Binding Constipation With the Hemp Seed Pill
Patient search words: can’t pass stool / constipation / dry hard stool / peeing too much / always needing to go / bloated belly / constipation after a cold
Corresponding medical terms: spleen-binding syndrome (pi yue) · constipation · strong stomach with a weak spleen (wei qiang pi ruo, the Maziren Wan / Hemp Seed Pill pattern, belonging to tai yang-yang ming)
The opening: a wealthy patient who called in every doctor in town
Today we continue the stories of Doctor Xu Shuwei, the great formula master of the Song dynasty. Doctor Xu Shuwei lived through the transition between the Northern and Southern Song. Also known by his courtesy name Zhike and honored as “Scholar Xu,” he devoted himself to studying Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage), excelled at the classical formulas, and wrote Shang Han Jiu Shi Lun — Discussion of Ninety Cases of Cold Damage, the earliest surviving case-record monograph in Chinese medical history. One case, one discussion: he faithfully recorded the illnesses he had personally treated, one by one.
Today’s case is the eighty-fourth syndrome in that book, and the patient has an impressive pedigree — a hao zi Guo shi, a very wealthy member of the Guo family.
💬 Note from Doctor Luo: What does “hao zi Guo shi” mean? It means a really, really rich person — the master of the Guo family. Notice that Doctor Xu deliberately flagged the word “rich.” When rich people seek treatment, the scale is grand and the complications are many — you’ll understand in a moment that this “hao” (wealthy) carries a whole story of its own.
Who was the patient? Mr. Guo the tycoon: a few days of cold damage, and a belly swollen tight
What was Mr. Guo’s illness? Shang han shu ri — cold damage for several days. A few days into it, he developed external-attack body heat: he was running a fever; headache with aversion to wind: his head ached and he dreaded the draft; and worst of all — constipation, no bowel movement at all, and then qi fu peng zhang, his belly distended around the navel until he could hardly bear it.
💬 Note from Doctor Luo: Remember this combination: fever, chills and wind-aversion from a cold, plus constipation and a bloated belly. This is an externally contracted illness, yet it is dragging a bowel problem along with it. How do you treat that? That is exactly the difficulty of this case.
The Guo family had money, so they invited several doctors to see him. But with more doctors came more trouble — everyone had a different opinion, and the family was completely lost.
The doctors argued first: one wanted Da Cheng Qi Tang, another wanted the honey suppository
The earlier physicians split into two camps.
One camp argued for Da Cheng Qi Tang (Major Order the Qi Decoction). Their reasoning was blunt: a swollen belly with dry, hard stool means real heat blocked up in the intestines, so you must use the purging method — Da Cheng Qi Tang is Zhang Zhongjing’s most ferocious laxative formula, rhubarb (da huang), mirabilite (mang xiao), magnolia bark (hou po), and immature bitter orange (zhi shi) charging downward all the way.
The other camp argued for the honey suppository (mi jian dao). This is also Zhang Zhongjing’s method: slowly roast honey dry, shape it into a long spindle-like stick, insert it into the anus, and let the honey dissolve in the gut — moistening dryness and freeing the bowels with gentle power.
💬 Note from Doctor Luo: “They called in several more doctors, three or five of them, each championing his own theory” — three or five physicians, three or five different stories, no agreement in sight, and the family was in total chaos: oh heavens, whom on earth do I listen to? The same thing happens today: rich patients invite a panel of experts for a conference, they debate for hours without a verdict, and in the end the patient’s family still has to decide for themselves.
Just as the Guo household was boiling over, Doctor Xu Shuwei arrived.
Doctor Xu Shuwei asked one question: how is your urine? — and the case flipped
On arrival, Doctor Xu asked a single question: “Your stool is blocked — so how is your urine?”
The family answered: frequent — he is always running to urinate, far more often than normal.
💬 Note from Doctor Luo: That one question uncovered the key to the whole case! With constipation, the difference between passing lots of urine and passing little changes the treatment completely. Remember this detail — it will all make sense shortly.
Then Doctor Xu Shuwei felt all six pulses — and he did not stop at the wrist positions (cun, guan, chi). He went on to “xia ji fu yang mai,” to the Fuyang pulse as well: he felt the pulse on top of the patient’s foot.
💬 Note from Doctor Luo: This is where Doctor Xu’s meticulousness shows. The Fuyang pulse, on the instep, belongs to the stomach channel; feeling it tells you directly how strong or weak the stomach qi is. Other physicians only felt the wrist; he examined even the pulse on the foot — with that one gesture, the whole weight of this case comes through.
One touch of the pulse, and Doctor Xu knew what he was dealing with. He said: this too is a named illness — it is called pi yue, “spleen-binding” syndrome, and it belongs to the tai yang-yang ming pattern. Doctor Xu quoted Zhang Zhongjing — “Zhongjing says: In tai yang-yang ming there is spleen-binding.”
The spleen is “bound”: a strong stomach, a weak spleen, and all the fluids running out in the urine
What is pi yue (spleen-binding)? It is a special concept, and Doctor Luo explains it thoroughly:
💬 Note from Doctor Luo: A strong stomach with a weak spleen — why is the stomach strong? Because there is dry heat in the stomach. Why is the spleen weak? Because the spleen is short of fluids (jin ye). The spleen is constrained by the dry heat of the stomach and can no longer distribute fluids throughout the body. The result: whatever little fluid remains cannot moisten the upper body, and all of it drains into the bladder below — hence frequent urination. Once the fluids have all run out through the urine, the intestines have nothing left to moisten with, so of course the stool turns dry. That is “the spleen being bound” — pi yue.
So at its root, this illness is one of insufficient fluids, of inadequate moisture.
💬 Note from Doctor Luo: In this situation, you must not recklessly attack with purging — you can’t just say “hit it hard and purge it out”; that won’t do. Why moisturize? Moistening is the main task — moisten dryness and free the bowels — combined with a little gentle downward movement, and only then can the spleen-binding pattern be corrected.
Doctor Xu then quoted Zhang Zhongjing again to lay out the complete mechanism: “The Fuyang pulse is floating and rough. Floating means the stomach qi is strong; rough means the urine is copious; floating and rough working together make the stool hard. When the spleen is bound by this, Maziren Wan (Hemp Seed Pill) governs.” And he added: in a case like this, “Da Cheng Qi Tang and Da Chai Hu Tang (Major Bupleurum Decoction) are probably not appropriate” — neither of the big purging formulas would fit.
Zhang Zhongjing had already set the formula: Maziren Wan — not one herb to be changed
So which formula? Zhang Zhongjing had settled it long ago — Ma Ren Wan, that is, Maziren Wan (Hemp Seed Pill).
💬 Note from Doctor Luo: Doctor Xu put it bluntly: whenever it is spleen-binding, use this Hemp Seed Pill — this formula cannot be swapped for anything else. And we actually use this pill all the time today — the Ma Ren Run Chang Wan (Hemp Seed Intestine-Moistening Pill) sold in pharmacies now all descends from this very formula.
What does the formula contain? Doctor Xu (via Doctor Luo’s commentary) takes it apart herb by herb:
The first herb: ma ren (hemp seed, huo ma ren). The main ingredient, extremely rich in oils — it moistens the intestines and frees the bowels. The same hemp seed appears in Zhi Gan Cao Tang (Honey-Fried Licorice Decoction). Because this herb leads the formula, it is called “Maziren Wan” (Hemp Seed Pill).
The second herb: shao yao (white peony root, bai shao). Why add white peony? To gather and nourish yin (lian yin). This illness carries heat and has damaged yin, so the yin must be held and restored. Doctor Luo stresses that from a modern perspective, including white peony is highly significant — this kind of constipation is often tied to liver qi stagnation (gan qi yu jie), and stagnant liver qi readily causes the intestines to bind up. So for the constipation of modern people, the white peony is an exceptionally apt choice.
The third herb: xing ren (apricot kernel). Apricot kernel itself is oily and moistens the intestines; but even better, it sends the lung qi downward — and since the lung and the large intestine are interior-exterior paired (fei yu da chang xiang biao li), once the lung qi opens, the large intestine can pass.
💬 Note from Doctor Luo: Apricot kernel moistens the bowels extremely well. I have mentioned before that when children are constipated, giving them a little apricot-kernel drink — the packaged sweet kind — often works: one sip and some kids head straight for the toilet. Why? Apricot kernel opens the lung qi, and that frees the bowels.
The fourth herb: white honey. After the herbs are ground to powder, honey is used to form the pill — and honey itself is also a moisturizer.
The fifth group: da huang (rhubarb), hou po (magnolia bark), zhi shi (immature bitter orange). These move qi and free the bowels — xing qi tong bian — and at the same time drain the heat.
💬 Note from Doctor Luo: With this one formula, Doctor Xu opened up an entire approach to treating constipation in Chinese medicine: use oily seeds and kernels as medicine — moisten the intestines and the stool passes naturally, moisturizing and draining heat at the same time. That is far better than attacking with plain rhubarb! This is Zhang Zhongjing’s genius: one formula, a crystal-clear direction. Later generations could add similar herbs to it, but the direction he set long ago never changes.
The relatives all had opinions, and Doctor Xu lost patience: if you don’t trust me, I’m leaving
The formula was settled — but now the trouble began. The Guo household was rich, and a whole crowd of relatives took charge of the case: aunts, uncles, cousins — everyone crowded in.
💬 Note from Doctor Luo: Doctor Xu’s description of the scene is wonderful: the eldest aunt said “I don’t think this is right,” the second aunt said “I think that other doctor is the one,” the second uncle said “I was so worried about you last night I couldn’t sleep” … every relative showed off how close they were to Mr. Guo, each insisting on a different opinion, until the whole room was shouting.
Doctor Xu had had enough. He said: “If you do not believe me, I fear other illnesses will arise” — if you won’t trust me, complications are likely. “Qing ci! — I take my leave.” Don’t look for me again; if anything goes wrong, I am not responsible.
At that, everyone froze. Then a man stepped out of the crowd — Mr. Guo’s younger brother.
Mr. Guo’s brother silenced the room: Zhongjing’s method is right here — who objects?
The younger brother had come to mediate. He said: “Everyone, stop arguing!” And why? He said:
“Since there is a method of Zhongjing that corresponds exactly — since Zhang Zhongjing’s own method matches this illness — then anyone who disagrees, what grounds do you have?”
💬 Note from Doctor Luo: What a line! What does it show? It shows that in those days Zhang Zhongjing carried enormous authority in the public mind — the medical sage, his methods universally respected. In fact the earlier physicians had also used Zhang Zhongjing’s formulas — the question was only whether they fit the pattern. And this brother was modest: “I am ignorant, but I am willing to follow the Zhongjing doctrine that Doctor Xu has cited. If any of you have something to say, speak up!”
And the result? Zhong ren mo mo, fen zheng sui ding — the crowd fell silent, and the dispute was settled. Why did nobody speak?
💬 Note from Doctor Luo: Because nobody could recite the Shang Han Lun as well as Doctor Xu Shuwei! Once he quoted the text, no one else could match him — they hadn’t studied it as deeply, so what was left to argue about? That settled it: they went with Doctor Xu’s method.
The result: three doses, and that night the stool passed, the sweat broke, and the pathogen left
Doctor Xu used Maziren Wan (Hemp Seed Pill), divided into three doses — and within the span of one meal, all three doses were taken.
That very night, the stool passed. And the moment the bowels moved, he started sweating — and once the sweat came out, the external pathogen was released.
💬 Note from Doctor Luo: This is the beauty of the case: Doctor Xu was treating an externally contracted illness, yet because fluids were insufficient and the bowels were bound, the qi mechanism could not run freely and the external evil could not be expelled. So the moment the stool passed, the qi mechanism opened, sweat poured over the whole body, and the evil left with it — pulling the fuel out from under the cauldron; one stone, two birds.
After finishing the case, Doctor Xu discussed it again: the Fuyang pulse is floating — floating indicates wind; rough indicates scant fluids. Wind evil has entered, the fluids are few, the urine is copious — the fluids are dried up, so the stool is hard. At this point the priority should be supplementing fluids, and Maziren Wan does exactly that. If instead you threw Da Cheng Qi Tang — rhubarb and mirabilite — at it in a savage purge, you would injure the upright qi and truly “sheng ta zheng” — give birth to other illnesses.
Doctor Xu’s reflection: the Qian Jin Fang said it long ago — relatives cause trouble, physicians need conviction
The most distinctive part of this case is Doctor Xu’s “aside.” He reflected: reading the section on jiao qi (beriberi) in the Qian Jin Fang (Thousand Golden Formulas), Master Sun — Sun Simiao — put it perfectly: “When someone in the world falls ill, relatives and old friends, near and far, all come to ask after him.” When rich people fall ill, it is so; when officials fall ill, it is so; but an ordinary commoner may fall ill and no one comes to visit at all.
And the visitors? “Bu jing yi shi” — they may never have been through such an illness, never seen such a patient, and know nothing of medicine. Yet they feel compelled to show concern and display their cleverness, so they start talking nonsense: one moment it is wind, the next it is worms, the next it is water — all sorts of wild theories that churn up the patient’s mind until mo zhong yi shi, no one can say what is right. And so the time slips away.
And the most maddening part? Once something truly goes wrong, this crowd of relatives scatters in an instant — when it was time to give advice, every one of them was louder than the last; when it is time to take responsibility, nobody does; in the end, the one who bears the responsibility is the patient himself.
💬 Note from Doctor Luo: That is why Master Sun said: “Whoever practices medicine must know the depth and shallowness of illness” — a doctor must have real insight; and must also read widely in the medical books — “read broadly ancient and modern, and distinguish right from wrong” — you must know not only medicine but also the ways of the world, and know how to help the patient make up his mind, so that he truly listens to the doctor instead of to the relatives’ wild talk. Doctor Xu concluded: “Take this one affair as a warning to physicians.”
Doctor Luo adds a note: Yu Jiayan (the famous late-Ming/early-Qing physician) ran into this kind of situation constantly — he would be infuriated by patients, who then ignored his advice, and the patient died; all Yu Jiayan could do was rage and sigh, helpless. So in the end a physician must develop this kind of experience — knowing how to deal with people is itself part of the physician’s craft.
💬 Note from Doctor Luo: You see, in this case Doctor Xu had a temper — facing all those doctors and all those relatives, he had to hold his ground, so his personality came out. That is fairly rare in Doctor Xu’s case records — a very interesting man.
Bonus: how modern people can use this — “add fluid to move the boat,” and don’t dump laxatives on elderly constipation
Building on this case, Doctor Luo explains modern constipation thoroughly:
First, genuine Da Cheng Qi Tang patterns are actually rare today. Unless there is a true emergency, the savage purge is seldom used. What modern people have far more often is precisely the spleen-binding pattern — tied to emotions, tied to years of damaging the upright qi, leaving the body short of fluids with the bowels bound up.
Second, elderly constipation is mostly fluid deficiency. As people age, fluids gradually run low; and there are those who stay up late every night, who are perpetually “on fire,” whose liver fire burns strong — slowly exhausting the fluids, leaving the intestines undermoistened and the stool dry.
💬 Note from Doctor Luo: Chinese medicine later coined the phrase “zeng ye xing zhou — add fluid to move the boat”: the intestine is like a river channel; when the water is gone and the bed is dry, the stool — like a little boat — cannot move. What to do? Zeng ye! Add water, and push the boat along. This is the method Zhang Zhongjing opened up with the Hemp Seed Pill: moistening first, gentle and harmless to the upright qi, and usually hitting the very core of the pathology.
Third, constipation in women is often tied to emotions. Liver qi stagnation, liver fire burning inside — this too depletes fluids and disrupts the intestine’s transporting function. In that case, nourish the blood, nourish the fluids, supplement yin, and add a little bowel-freeing, liver-soothing, qi-moving medicine — the results are good. The basic framework is still the Hemp Seed Pill.
Fourth, how should you use the pharmacy’s Ma Ren Run Chang Wan (Hemp Seed Intestine-Moistening Pill)? Its composition is essentially the same as the Hemp Seed Pill — hemp seed, apricot kernel, white peony, rhubarb — with mu xiang (costus root) and chen pi (tangerine peel) added (to move the qi), and the zhi shi and hou po removed. It suits constipation with heat — remember, whenever rhubarb is in the formula, there is heat: dry, bound stool with abdominal distension from accumulated heat in the stomach and intestines will pass smoothly with this pill.
💬 Note from Doctor Luo: But Ma Ren Run Chang Wan is actually fairly strong — once taken, it usually does produce a bowel movement. So use it flexibly: if the person’s upright qi is insufficient, or the blockage is not that severe, you may not need that much — you can combine hemp seed, apricot kernel, and pine nuts on your own to moisten the intestines, with just a touch of bowel-freeing medicine. In my experience, elderly people almost always get moving with it; but don’t overuse it — once the bowels have moved, switch to plain nut-and-seed moisturizing.
And Doctor Luo leaves one final reminder: an enormous number of people today have the spleen-binding pattern, so everyone should understand this line of thinking — when you are constipated, don’t rush out to buy rhubarb and purge yourself. First ask: is this fluid deficiency that needs moistening, or genuine heat stuck in the gut? Get the direction right, and half the illness is already cured.
Compiled from Doctor Luo Dalun’s commentary on Doctor Xu Shuwei’s case records; the case is from Discussion of Ninety Cases of Cold Damage (《伤寒九十论》, Southern Song dynasty, by Doctor Xu Shuwei).