Constipated and Can’t Poop? Doctor Xue Lizhai Cured Deficient Constipation by Rebuilding Qi and Blood

Patient search terms: constipation / dry stool / hard stool / can’t poop / bowel obstruction / no appetite / no energy at all / high pressure / thinking too much

Medical terms for this condition: deficient constipation · stagnation damaging the spleen · dual deficiency of heart and spleen · qi and blood deficiency · liver-kidney yin deficiency

Opening: seven characters that say everything about a man’s illness

Doctor Luo Dalun continues his stories of how Doctor Xue Lizhai treated his patients. Today’s subject opens with just seven characters in the case record — “yi ru zhe, huai bao yu jie” — a Confucian scholar, with pent-up aspirations.

A “ru zhe” is a scholar, a student who sat the imperial examinations. “Huai bao yu jie” means his ambitions could not stretch out — year after year he nursed a low, unfulfilled gloom. Seven characters, and both his profession and his state of mind are told.

💬 Note from Doctor Luo: Don’t underestimate those seven characters. When an old Chinese medicine doctor sees you, the first thing he asks after taking your pulse is: “What do you do for a living?” — that isn’t idle small talk. Occupation and body are intimately connected. Chinese medicine diagnosis is very much like detective work: complexion, clothing, profession, habits — all of it is evidence, and the more evidence you gather, the more accurate the conclusion. A good practitioner is basically a Sherlock Holmes.

Who was the patient: a scholar who burned the midnight oil

What kind of man was this scholar? Every day he lit his lamp and burned the midnight oil — reading, memorizing, studying deep into the night, draining his heart blood (xin xue). And his luck was bad: he failed the imperial examinations — he sat them again and again, and never passed. People around him didn’t think much of him either; they wrote him off as a bookworm who couldn’t make anything of his learning. His ambition could not rise, his knowledge had no outlet, and the frustration in his chest just kept tightening.

Burning heart blood every day, on top of the liver qi stagnation (gan qi yu jie) of a man whose talents went unrecognized — and illness arrived: fa re zuo ke — his body flushed with heat in waves and he was thirsty; xiong ge bu li — his chest was oppressed and his breathing not free; yin shi shao si — his appetite fell, he looked at food and didn’t want it.

Round one: clearing heat and phlegm — the more they treated, the worse he got

Look at those symptoms — fever, thirst, chest oppression. Doesn’t it look like heat and phlegm? So the doctors prescribed heat-clearing, phlegm-resolving, qi-moving herbs to attack the “fire” and the “phlegm.”

The result? The previous symptoms got worse — not better — and a new one appeared: zhi ti dai duo — his limbs became heavy and limp, no strength in his body at all.

💬 Note from Doctor Luo: This is mistreatment. Seeing fever and reaching for heat-clearing herbs, seeing chest oppression and reaching for phlegm-resolving, qi-moving herbs — that’s guessing from the symptoms, not digging to the root. Doctor Xue Lizhai’s brilliance is that he asked one layer deeper: Where does this heat come from? Where does this oppression come from?

The diagnostic highlight: one touch of the pulse — heart and spleen positions choppy

Doctor Xue Lizhai felt his pulse. On the left wrist sit the heart, liver and kidney positions — the heart at the top; on the right, lung, spleen and mingmen. What he found: the heart pulse and the spleen pulse were both choppy (se) — sluggish, stuck, not flowing freely. He pronounced at once:

“Ci yu jie shang pi zhi zheng ye” — “This is a pattern of stagnation damaging the spleen.”

What does that mean? Liver qi stagnation plus excessive brooding had injured the spleen — the spleen’s qi was tied in a knot. Then Doctor Xue laid out the whole chain of reasoning, layer by layer:

• Constant brooding injures the spleen; constant burning of heart blood leaves the heart blood insufficient — a dual deficiency of heart and spleen (xin pi liang xu), and the upright qi (zheng qi) drains away day by day;
• With heart blood insufficient, there is deficient fire (xu huo); add the frustration of unrecognized talent and liver fire flares on top. Deficient fire plus liver fire — that’s why his body flushed hot and he was thirsty;
• The spleen earth (pi tu) is already weak and the liver qi is not flowing — the liver wood runs sideways and attacks the spleen earth (gan mu heng ni ke pi tu) — the qi mechanism knots up, so the chest feels oppressed;
• The spleen, weak, can’t transport and transform, and on top of that his mood is bad — so his appetite falls and he doesn’t want to eat.

In one sentence: this is not excess fire and excess phlegm. It is deficiency layered with stagnation.

The first prescription: Modified Gui Pi Tang — tonify and disperse at the same time

How to treat it? Doctor Xue Lizhai prescribed Modified Gui Pi Tang (Jia Wei Gui Pi Tang) — that is, the classic Gui Pi Tang (Spleen-Restoring Decoction) plus chai hu (bupleurum) and zhi zi (gardenia).

First, Gui Pi Tang itself. It is the classic formula for the symptoms that come from overthinking injuring the spleen and dual damage to heart and spleen — insomnia, palpitations and a racing heart, sallow complexion, fatigue, and even the uterine bleeding and excessive bleeding that come from the spleen failing to govern the blood:

• Si Jun Zi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), gan cao (licorice) — tonifies the spleen qi; this is the foundation of the formula;
• Dang gui (angelica) and long yan rou (longan fruit) — nourish the heart blood and settle the spirit;
• Yuan zhi (polygala root) — eases the emotions and nourishes the spirit;
• Mu xiang (costus root) — keeps the qi mechanism moving.

Now the two additions: chai hu (bupleurum) soothes the liver and unties the knotted liver qi; zhi zi (gardenia) drains heart fire and puts out the fire flaring upward.

💬 Note from Doctor Luo: This strategy is worth memorizing: nourish the heart blood, settle the spirit and rebuild the spleen qi on one side; soothe the liver and drain heart fire on the other. Tonifying and dispersing at the same time — that’s the secret of Modified Gui Pi Tang. If you want to try it at home, take Gui Pi Wan (the pill form) and swallow it with a little tea brewed from chai hu and zhi zi — the direction is the same. Even better, of course, is to have a doctor write you a proper decoction of Gui Pi Tang with chai hu and zhi zi added.

A twist in the treatment: most of the illness healed, but two tails were left

After taking Modified Gui Pi Tang, the scholar regained his appetite and the symptoms gradually receded — the fever, the chest oppression, they slowly eased.

But two things would not leave: dry stool — constipation, he couldn’t push it out — and liang quan chi se — a faint red flush over both cheekbones.

Doctor Xue Lizhai took one look and read it as liver-kidney deficient fire and internal injury with yin deficiency. How so? The man had carried liver fire for years; fire that smolders long will inevitably injure yin and injure the blood. Blood depleted and yin deficient — and the stool dries up.

The second prescription: Ba Zhen Tang plus cistanche — adding fluid to move the boat

This time Doctor Xue Lizhai did not reach for da huang (rhubarb) or fan xie ye (senna). He prescribed Ba Zhen Tang (Eight Treasures Decoction) plus rou cong rong (cistanche), mai dong (ophiopogon) and wu wei zi (schisandra):

• Ba Zhen Tang = Si Jun Zi Tang (the chief qi-tonifying formula) + Si Wu Tang (shu di huang/prepared rehmannia, dang gui/angelica, chuan xiong/ligusticum, shao yao/peony — the chief blood-nourishing formula). It tonifies qi and blood together;
• Rou cong rong (cistanche) — tonifies kidney qi and is excellent at moistening the intestines and moving the stool. Experienced doctors use it all the time for elderly constipation; even 30 grams is fine;
• Mai dong (ophiopogon) — nourishes yin and builds the fluids;
• Wu wei zi (schisandra) — tonifies the five viscera.

Doctor Xue Lizhai put it as a picture: the river channel has run dry, so the boat can’t move; and the sails have no wind, so the boat can’t move either. Depleted yin blood — that’s the river with no water. Deficient qi — that’s the sails with no wind. Ba Zhen Tang fills the water by nourishing the blood and blows the wind by tonifying the qi, while rou cong rong adds the moisture. This is what Chinese medicine calls zeng ye xing zhou — adding fluid to move the boat.

The result: thirty-plus doses — about a month of medicine — and his bowel movements returned to normal, moist and smooth.

💬 Note from Doctor Luo: Why not rhubarb or senna? Because Doctor Xue saw clearly that this constipation came from insufficient upright qi (zheng qi) — it was not an excess pathogen. Fill the water, blow the wind, and the boat moves by itself; the bowel movement is only the result. Qi and blood sufficient — that is the root. Every ailment caused by qi-blood deficiency — the lack of energy, the lethargy, the constipation — gets better together.

Doctor Xue Lizhai’s medical philosophy: treat the person, not the disease

This case shows Doctor Xue Lizhai’s academic thinking better than almost any other — supporting the upright (fu zheng). He did not treat a single symptom; he adjusted the whole person, and let the body clear its own illness.

💬 Note from Doctor Luo: What’s the good of studying case records? It’s like copying prescriptions with Doctor Xue Lizhai himself. Read enough cases and your clinical thinking becomes very clear: you meet a patient, and suddenly it clicks — an ancient doctor once met almost exactly this situation, and this is how he thought. So I urge everyone to read more case records. It’s the rain that soaks in silently — you absorb Chinese medicine gradually through the stories, and one day one of these cases will match your own body, and it will do you good.

Going further: Gui Pi Tang is a modern person’s “old friend”

Doctor Luo stresses that this case is not dated in the least — the rate at which modern people deplete their heart and spleen is extremely high: racking your brains over work, chasing performance targets, burning heart blood every day; and when it’s all spent, the results still don’t come, and you’re not even happy — liver qi stagnates. It is exactly the same picture as this frustrated scholar.

💬 Note from Doctor Luo: I often tell friends: of every ten people who come to ask me for advice, nine should be taking Gui Pi Wan. Gui Pi Tang is a formula extraordinarily well suited to modern people — master a few classic formulas and a great many people will benefit. But there is one point to watch: Gui Pi Tang is a tonifying formula. If you carry some liver fire, tonifying alone can brew more fire. Then you must learn from Doctor Xue Lizhai — Modified Gui Pi Tang: tonify while soothing the liver and draining fire. Drain the fire, then tonify slowly — and the whole pattern begins to change.

Strong-willed people, people under heavy pressure — their liver fire gradually wounds their own yin and blood, and that needs regulating. For this scholar, the stool moving was only the first step. Qi and blood sufficient — that is the true foundation of the body.

Based on Doctor Luo Dalun’s lecture on Doctor Xue Lizhai’s case records; the case is from The Medical Case Records of Xue Lizhai (《薛氏医案》).