Constipated, Bloated, Days Without a Bowel Movement? What the Purging Method (Xia Fa) Really Is — How to Unblock Constipation, and Who Must Never Be Purged

Patient search terms: constipation remedies / can’t have a bowel movement / days without pooping / can’t poop / elderly constipation / what to eat for constipation

Corresponding medical names: the purging method · laxation · interior excess-heat pattern · cold purging · warm purging · moistening purging · qi-deficiency constipation · blood-deficiency constipation

A word first: if you are eating right now, pause the episode

Doctor Luo Dalun begins with a friendly heads-up: if you are in the middle of a meal, hold off on listening to this one, all right? The topic is a little special — come back to it after you finish eating.

💬 Note from Doctor Luo: What are we talking about today? The purging method. Among the ways Chinese medicine treats disease, we have already covered the sweating method; today we talk about purging — and this is an extremely important method too. A word of caution in advance: this topic is a bit special, so listen after your meal.

Why should everyone understand the purging method? Doctor Luo puts it plainly —

💬 Note from Doctor Luo: Tell me, who has never been constipated? A blocked bowel movement — everyone has experienced that. We humans eat the five grains and all kinds of food; how could we never get sick? The digestive system especially — how could it never have problems? Sometimes its function goes off, you get constipated, the bowel movement doesn’t flow well — all of this is possible.

In ordinary cases, a mild blockage can be corrected by self-adjustment — adjusting your diet, resting a couple of days, or eating something therapeutic.

💬 Note from Doctor Luo: For example, what I often say — sip some apricot-kernel drink, eat more high-fiber vegetables, keep the diet light, and so on. This, too, counts as a kind of purging — but it is a very narrow, very restricted form of purging. The purging method of Chinese medicine is not like that.

The purging method of TCM is not simply taking a couple of laxatives

So what is the real purging method? Doctor Luo starts from “how constipation comes about”.

💬 Note from Doctor Luo: The purging method in Chinese medicine works like this — when some aspect of your body goes abnormal and that leads to a blocked bowel movement. Say an exterior pathogen arrives and the whole body is fighting it; in the course of resisting, high fever develops, which consumes the fluids, the body’s moisture is insufficient, and the stool turns dry; the dry stool then further disturbs the metabolism and circulation of qi and blood inside us, and the fever climbs even higher. You see, what caused the bowel blockage in this case? It was caused by the whole body fighting the exterior pathogen.

And this kind of blockage can even cause further damage to the body, making the circulation of qi and blood even more abnormal. What do we do then?

💬 Note from Doctor Luo: The ancients were exceptionally clever. The Chinese pondered the workings of the human body with tremendous wisdom, and they saw this very early — in the Huang Di Nei Jing (Yellow Emperor’s Inner Classic), at the very founding of Chinese medicine, the purging method already existed; by the time of the Shang Han Lun (Treatise on Cold Damage) it had matured. What happens is this: through purging, you expel the retained accumulation in the intestines, change the state of the body, and let the body recover.

Is the purging method used much today? Doctor Luo answers honestly —

💬 Note from Doctor Luo: To be fair, purging is not used as much nowadays. Why? Because modern people are rather delicate. You give a patient a good purge and the next day they may jump up and find you — why did the medicine make me diarrhea this badly? But in ancient times, working people labored all day and their bodies were sturdy, so purging was extremely, extremely common — I would even say that at times it was used more often than the sweating method. Why? The sweating method is mostly for exterior-contraction illnesses; the purging method — all sorts of internal injuries, many diseases can use purging. So in the past it was used a great deal.

Cold purging: when even the tongue coating is scorched yellow, the disease is truly severe

How many kinds of purging are there? Doctor Luo starts with the most typical one — cold purging (han xia fa).

💬 Note from Doctor Luo: Cold purging means using cold-natured herbs to purge, treating an interior excess-heat pattern — the disease is located in the interior, its nature is excess, and it is a heat pattern. You see, this is not a deficiency pattern — for deficiency, don’t use it recklessly. The formula Da Cheng Qi Tang (Major Order the Qi Decoction) that we have discussed is a typical example.

What does such a disease look like? Doctor Luo describes it very concretely —

💬 Note from Doctor Luo: The stool is tightly bound, unpassed for many days, the belly is distended and full, and pressing on it hurts. The body’s hands and feet sweat — sweating in waves, especially in the afternoon, worse around five or six o’clock. The person may even talk nonsense — this is not what ordinary constipation looks like; this person is already seriously ill, the brain nerves are stimulated and malfunctioning. At this point the tongue coating is scorched yellow — how scorched? Patches in the middle have turned black, like a burnt tongue coating, dry and cracked. If you have never seen it you cannot imagine it, but such tongue coatings really exist.

In the old days you could still meet such patients in the countryside.

💬 Note from Doctor Luo: Go down to a village clinic and you can still see patients like this — an elderly person comes in with a stroke; you look at the tongue and the coating is yellow-black, yellow-black, and they haven’t had a bowel movement for many days. This calls for the purging method: Da Cheng Qi Tang, Xiao Cheng Qi Tang (Minor Order the Qi Decoction), Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) — formulas using cold-natured herbs like rhubarb to purge it down. Once purged, the harmful bacteria in the gut decrease, the passage opens, the congestion in the intestinal wall improves, the exudation improves, and the intestinal toxins no longer enter the blood — in fact, if you measured the toxin level in such a patient’s blood, it would be clearly elevated; the whole composition of the blood has changed. After purging, the pressure on the other organs is relieved, and the condition eases dramatically. This is cold purging.

How to take rhubarb: the method Doctor Zhao Shaoqin taught, which ordinary people can also learn

Do ordinary people ever need cold purging? Yes.

💬 Note from Doctor Luo: Some people eat too much rich, fatty, sweet food, the food packs densely inside, and because of other reasons — a flare of heat, say — the constitution is heat-typed: the tongue body is red, the coating is yellow, and constipation blocks everything inside, days without a stool. At this point the face is red, the whole body is bloated and uncomfortable, and they feel qi rushing upward. These people can use a little rhubarb to purge — it works very well.

But rhubarb is not to be taken casually. Doctor Luo explains it clearly —

💬 Note from Doctor Luo: Rhubarb comes in several forms: raw rhubarb, cooked rhubarb, wine-processed rhubarb. Cooked rhubarb is gentler; raw rhubarb is stronger. Raw rhubarb loses effect if decocted too long, so it can’t be boiled with everything else — you add it in the last ten to twenty minutes before the pot comes off, and only then does it work well. Ordinary people can just steep it in hot water; steeping works too. Many years ago there was an expert in Shanghai who advocated rhubarb for weight loss, and the method became popular — but I find it highly questionable: taking rhubarb purges, yet bodies differ between cold and heat — does everyone really need rhubarb purging? If you really purge like that, the gut can undergo changes over time; it’s not right.

What is the core principle for using rhubarb? Doctor Luo stresses it repeatedly —

💬 Note from Doctor Luo: First, it must be a heat pattern — truly hot: qi rushing upward, red face and ears, eyes bloodshot, mouth sores, constipation that won’t move, feeling hot all over — then rhubarb purging is appropriate. Second, start with a small amount: begin with a small dose like three to six grams steeped in water and see whether it moves; if it doesn’t, increase the amount, and increase until it moves — once it moves, stop increasing, then gradually taper down, and after it moves you basically don’t need to keep drinking. You don’t start with twenty grams gulped down at once — what if it purges too violently? This is the principle of rhubarb use.

The late great physician Doctor Zhao Shaoqin used this approach especially well.

💬 Note from Doctor Luo: Back when we were studying the formulas for kidney disease, Doctor Zhao Shaoqin treated kidney disorders — some uremia patients need their gut cleared, and he would generally put rhubarb in the formula. How is the rhubarb used? Wrapped separately, and you adjust the amount yourself: if the stool is normal, reduce it a little; if the stool is still dry, increase it a little, increasing until it’s unblocked. Remember, this is the method of using rhubarb — plain raw rhubarb is usually fine; long-processed rhubarb is too weak. Stop once it purges — that is the principle: no one should drink rhubarb casually for a long time.

And what about after the purge? Doctor Luo tells a case of Doctor Xu Shuwei —

💬 Note from Doctor Luo: In yesterday’s case, Doctor Xu Shuwei’s patient was over seventy; after the purge the disease was cured, and he asked: could you prescribe some tonics? Doctor Xu Shuwei said no tonics needed. After Da Cheng Qi Tang, you don’t supplement — supplementing would only throw the body into confusion. What should you do? Drink congee, keep the diet light, nurse the spleen and stomach, drink congee for ten days. So purging agents are not for long-term use.

Two more groups of people must be especially careful with purging —

💬 Note from Doctor Luo: Pregnant women must be cautious — some pregnant women are weak, and a strong purge can be more than they can bear. Also, people who are extremely weak cannot use it — we’ll discuss what to do for weak people when we cover the other methods.

Cold hands and feet, cold belly: the “warm purging method” is for you

Not all constipation is treated with cold rhubarb purging. The second type is warm purging (wen xia fa) — some people’s gut blockage comes from insufficient yang qi with cold pathogen condensed inside.

💬 Note from Doctor Luo: Insufficient yang qi is one side; the other side is cold pathogen, cold lodging in the middle burner — for instance, eating too much cold food, catching a chill, staying in a cold place. These two often cause each other and easily produce problems together. After the illness, the belly is also full and distended, but the main feature is: the whole body is cold, especially the hands and feet — once the qi mechanism of the intestines and abdomen is obstructed, qi and blood can’t reach the whole body, and the four limbs show it especially clearly. Touch the belly and it’s icy too. The tongue? The tongue body is white, the coating is white and greasy, possibly with a lot of moisture — pale, pale white. The pulse is deep and wiry, deep and slow, very weak.

This kind of yang-deficient, cold-caused constipation is actually quite common. And like heat lodging inside, it can trigger serious chain problems.

💬 Note from Doctor Luo: When cold pathogen condenses, the body’s qi mechanism is further obstructed — cold lodges in the middle burner and inside the intestines, the body’s qi mechanism becomes chaotic, stagnant, and runs poorly, further causing other problems elsewhere in the body; this is also quite nasty. In the past, Chinese medicine used the warm purging approach: rhubarb is cold-natured, but ba dou shuang (croton seed frost) is warm — it is a purging medicine, yet its nature is warm, so the ancients made all sorts of preparations with croton seed and croton frost to purge downward. They also paired warming herbs with rhubarb — warm-yang herbs like fu zi (aconite) combined with rhubarb. After the purge, the qi mechanism in the gut opens up, the abdominal qi mechanism opens up, blood and qi circulate normally again, and the body recovers. Warm purging was used a great deal in ancient times.

As for croton seed, Doctor Luo has a special warning — it is highly toxic, never try it yourself.

💬 Note from Doctor Luo: Croton frost is rarely used today, but in ancient times it was common, and its direction is exactly opposite to rhubarb: rhubarb purges but is cold; croton is warm. The old practice was very elaborate — wrapping croton in longan flesh and then purging with it. Because croton is so toxic, it’s no joke — in the past, pranksters fed people croton and nearly killed them from diarrhea; it’s a serious business, the intestines can’t take it. So the ancients would make a little frost from croton and match it with a tiny bit of purging. Don’t try any of this yourself — ask a qualified Chinese medicine practitioner to write a prescription: some warming herbs like fu zi and gan jiang (dried ginger), paired with a little rhubarb to purge — that is warm purging.

Frail elderly people and constipation: the oil in fruit kernels is the gentlest “moistening purging method”

The third type is moistening purging (run xia fa), prepared especially for weak people.

💬 Note from Doctor Luo: Moistening purging generally refers to when the body is quite weak — fluids inside are insufficient, the stool is dry, especially in elderly people with long-standing dryness. Then we use herbs containing oily substances: huo ma ren (hemp seed) — the common laxative, it contains oil called hemp oil; also xing ren (apricot kernel), tao ren (peach kernel), yu li ren (borage seed) — all kinds of kernels contain oils. These herbs have their own medicinal actions — they can move qi and descend lung qi — the apricot kernel itself can descend and open lung qi, and since the lung and the large intestine are interior-exterior paired, it benefits the large intestine. That’s why I often say: if you’re constipated, drink some apricot-kernel drink. The oily substances from these kernels enter the intestines, soften the stool, and moisten it. This is the moistening purging method.

Which elderly people does this especially suit?

💬 Note from Doctor Luo: It suits elderly people whose bodies are extremely weak, with fluids exhausted and dried up — the sort who look withered and parched, who go days without a stool, or chronically can’t move their bowels. Regularly eating these kernel-type foods is extremely, extremely helpful for bowel movement. That is one form of moistening purging.

Yin-deficient people and constipation: adding water to the river — replenishing the waterway

There is a second form of moistening purging: nourishing yin to moisten the bowel. Yin-deficient people get dry stool.

💬 Note from Doctor Luo: What does yin deficiency look like? Five-center heat — heat in the palms, soles and chest; vexation, easy irritability and anger; dry mouth and tongue, wanting cold drinks; bone-steaming tidal fever — in the afternoon heat rises like a tide; night sweats; urine easily yellow, stool easily dry. In many yin-deficient people, because yin deficiency generates internal heat, the internal heat consumes the fluids, and once the fluids are damaged, there isn’t much moisture in the gut either.

Doctor Luo offers a wonderfully vivid analogy —

💬 Note from Doctor Luo: This is like a river channel carrying grain boats: when the river has no water, the grain boats can’t move either. What do we do? We call it zeng ye xing zhou — adding fluid to move the boat: replenish your fluids fully. With what? Sheng di (raw rehmannia), sha shen (glehnia), mai dong (ophiopogon), xuan shen (scrophularia) — these yin-nourishing, fluid-generating herbs, matched with some blood-nourishing ones. Once used, the yin-deficient state corrects itself and the fluids start to be sufficient — the false fire comes down, it stops consuming fluids, and fluids generate on their own. Then the gut is no longer parched, the river has water, the boat can sail, and the stool moves. This, too, is called the moistening purging method.

The hidden cause of long-term constipation in women: blood deficiency

The third form of moistening purging is nourishing blood to moisten the bowel — blood-deficient people get constipated. Here Doctor Luo explains an especially important TCM concept: blood, fluids and essence share the same origin.

💬 Note from Doctor Luo: You must understand this: these yin-type substances all have the same foundation. Blood is yin-blood; fluids are jin and ye (thin and thick fluids); and there is essence (jing). In reality they are all liquid-type substances, sharing one origin — they draw on the same fluids, only with different assigned uses; if you’re short in one, you redistribute a little from another. If one is depleted, the others are depleted too. If you sweat heavily, purge heavily, or lose essence, you are injuring all of these — they are damaged together. So blood-deficient people also become dry — when blood is deficient, the body naturally mobilizes fluids over, and once the fluids come over, the fluids become deficient, so dryness results.

And blood deficiency plus constipation form a terrible vicious circle —

💬 Note from Doctor Luo: Constipation produces heat patterns, and heat further consumes yin-blood — that is a vicious circle. Many women are known to be blood-deficient and constipated, chronically constipated: the stool can’t pass, the more it won’t pass the more irritable they get, the more irritable the worse they sleep, the worse they sleep the more blood-deficient they get, the more blood-deficient the drier they get, the drier the more heat inside, the more heat the less they can eat, the less they eat the less source the blood has, and the more blood-deficient they become. Once one link of the circle breaks, the whole vicious circle emerges. Many women suffer from this torment and don’t know how to solve it. Taking laxatives? Laxatives don’t nourish blood — stop them and the dryness returns.

So what to do? Nourish the blood —

💬 Note from Doctor Luo: At this point eat blood-nourishing things: some Yu Ling Gao (Crystal Nectar Paste), some e jiao (donkey-hide gelatin), some dang gui (Chinese angelica). Why can dang gui moisten the stool? Let me tell you — one of dang gui’s important functions is unblocking the bowels — really, use several dozen grams of dang gui and the stool moves immediately. Many people who eat Yu Ling Gao say: hey, why is my bowel movement smooth now? For years it was abnormal, and now it’s normal — because the blood has been nourished enough. Using blood nourishment to unblock the bowels is also a form of the moistening purging method, and it’s very important.

Bad moods can constipate you: the belly is the “second brain”

There is also the qi-moving method — people with constrained liver qi and bad moods develop qi stagnation, qi blocked up inside.

💬 Note from Doctor Luo: When qi stagnates, qi and blood don’t circulate normally, intestinal function is affected, and constipation results. You can basically say this: if your emotions are bad, your abdomen is certainly affected. Because the abdomen, as we now know, contains billions of neurons that sense your emotions — it’s called the second brain — it is extremely sensitive to mood. A young man gets his heart broken and immediately can’t drink tea or eat — why? The neurons in his digestive system feel that emotion. So many people’s constipation comes from constrained liver qi; constipation in turn aggravates qi stagnation, qi stagnation makes qi and blood less fluent, which makes the constrained liver qi even more obvious — this qi stagnation is a nasty business.

How to treat it? Soothe the liver and move qi —

💬 Note from Doctor Luo: Soothe the liver qi open. Take a bit of Xiao Yao Wan (Free and Easy Pill), take some liver-soothing qi-moving pills — there are many kinds. Tong Ren Tang pharmacy alone puts out so many liver-soothing qi-moving medicines under different names; look at the ingredients and they’re all soothing the liver, moving qi, and harmonizing the spleen and stomach. Once used, the qi mechanism flows smoothly, the qi stagnation in the gut resolves, and the constipation clears.

Doctor Luo also tells a true story from his own experience — qi stagnation, when severe, can really threaten life.

💬 Note from Doctor Luo: There was an elderly gentleman in my mother’s nursing home. One night he got up and ate some cold corn from the fridge — and that did it: his belly swelled up enormously, he couldn’t take in any food, he was at death’s door. They took him to the hospital, where the heads of several departments held a consultation and nobody knew what the problem was; no matter how they tested, they couldn’t find it — anyway, the man was done for, couldn’t eat. Then his wife said: if anything happens, let it happen back at the nursing home, we’re not staying in the hospital. Back they came, and she phoned my mother, asking me: son, give us an idea. Listening to his description, I said: try some Mu Xiang Bing Lang Wan (Aucklandia and Areca Pill). One dose and the qi broke through — he recovered; a second dose and he was fine. A couple of days later I went over and he was already strolling around inside, perfectly fine. This was cold-induced qi stagnation — it was truly critical at the time; the hospital considered it hopeless: an eighty-something man, not eating or drinking, icy cold all over, lying there. And then once the qi was released and the bowels moved, he was fine. This is a medicine specifically for freeing the qi of the bowels — a qi-regulating medicine.

The more you purge a qi-deficient person, the weaker they get: “tonifying qi to unblock the bowels” is the right road

There is also the qi-tonifying method — many people’s constipation comes from qi deficiency.

💬 Note from Doctor Luo: Upright qi insufficient, no strength to drive the blood, no strength to drive qi and blood circulation; the gut’s power is affected too, and things stagnate inside and won’t come out. In such a person, ascending clarity and descending turbidity are certainly affected, the expulsion of food and waste is affected, the appetite deteriorates further, and the worse the appetite the more qi-deficient — folks, isn’t this a vicious circle? So many people’s constipation comes from qi deficiency, spleen deficiency. What to do then? Tonify qi to unblock the bowels. I have told you before: for some patients’ constipation, I simply use Bu Zhong Yi Qi Wan (Tonify the Middle and Augment Qi Pill) — tonify your middle qi fully, lift the clear qi upward, replenish the spleen-stomach qi; once your qi is sufficient, the descending function naturally arrives and can adjust itself. Modern people are enormously qi-deficient, and this condition is extremely common.

But qi-deficient people are exactly the ones who must never be purged recklessly —

💬 Note from Doctor Luo: For a weak person’s constipation, you cannot force it downward. The more you purge a qi-deficient person, the more the qi goes downward — after purging them a few times, the upright qi is gravely damaged. An ordinary person might be fine, but an elderly person — if you purge them, I tell you, something can go wrong; for some gravely ill patients, give them one purge and — whoa — something happens. So you must all have this awareness.

Purge even when the stool is normal? — attacking water accumulation, to save a life

There is one more form of purging, and it is not for treating constipation — the stool may be normal, but the body has other pathogens that need expulsion.

💬 Note from Doctor Luo: Some people have water pathogen inside the body, which is especially serious — for example ascites, accumulated fluid, pleural effusion. In these cases, some drastic herbs, water-expelling herbs are used, purging it out in gushes. Such formulas are all in Zhang Zhongjing’s book. Why do it? To save the life quickly — because ascites can turn severe fast; purge it down to save the life, and afterward slowly nurse the spleen and stomach and let the body recover gradually. This emergency method is also a form of purging, adopted reluctantly to rescue life. When it’s needed, we must purge.

Behind this lies the deepest wisdom of the purging method —

💬 Note from Doctor Luo: In Chinese medicine, purging is more often than not not aimed at constipation — we don’t treat you because you’re constipated; rather, you have discovered some other problem in the body, and solving that problem requires making the intestines unobstructed before the body can return to normal. So the focus is on the whole body, while the concrete measure is applied to the intestines — this is the wisdom of Chinese medicine, especially brilliant. It’s not that I see the gut blocked and treat it as merely blocked; I see that your blockage has a cause. Clear the blockage, make the gut unobstructed, and the original cause of your illness may disappear — and the harms that would have followed are eliminated too. This is the theoretical foundation of the purging method.

Closing: a smoothly moving bowel is a mark of health

At the end, Doctor Luo gathers the thread —

💬 Note from Doctor Luo: The smooth passage of a person’s bowels is extremely important. It is a fundamental basis for ascending clarity and descending turbidity, for healthy metabolism. When the bowels move smoothly and no other problems are triggered in the body, that is especially good, especially fortunate. Smooth bowel movement also means that other problems in the body are not interfering with the absorption of food and the absorption of nutrients and subtle essence — it is a marker. So a smoothly moving bowel is a marker of health.

Why not give more formulas today? Doctor Luo says: we’ll take our time in the future —

💬 Note from Doctor Luo: Today I haven’t talked much about the purging formulas themselves — Shi Zao Tang (Ten Jujubes Decoction), San Wu Bei Ji Wan (Three-Substance Emergency Pill) and so on were not expanded upon. Because when it comes to application, the ancients had too many methods, far too many formulas, and we’ll talk about them slowly when we have the chance. What I’ve said today sometimes sounds complicated, but the more you learn, the simpler it becomes — you see, this is just like the sweating method: it’s the same disorders of qi, blood, yin and yang, the same qi stagnation, phlegm-dampness and so on causing the problems, and we resolve them — through sweating, vomiting, purging, harmonizing, warming, clearing, reducing, and tonifying — remove the obstacles, replenish the upright qi, and the body recovers. That is how Chinese medicine works.

Tomorrow, we continue with Doctor Xu Shuwei’s healing stories.

Compiled from Doctor Luo Dalun’s commentary on the Doctor Xu Shuwei case series.