Elderly Parent Always Constipated, Stools Dry and Hard to Pass? Doctor Zhu Danxi’s Yang Lao Lun (Essay on Caring for the Elderly): Nourish the Blood and Strengthen the Spleen-Stomach — His Mother Lived to 87 and Passed Away Without Illness

Opening: a great doctor’s journey began with his mother’s illness

Doctor Zhu Danxi (Zhu Zhenheng) — one of the Four Great Masters of the Jin-Yuan era and the founder of the yin-nourishing school (zi yin pai) — took up medicine for a very simple, very personal reason: to save his own mother.

💬 Note from Doctor Luo: Doctor Zhu’s mother once suffered from a condition the old texts describe as “body pain” (ti teng) — most likely a problem with the spleen and stomach that tormented her for a long time. At that point Doctor Zhu had not yet studied medicine. Watching his mother suffer, he began teaching himself the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) and studying medical knowledge on his own — and as he learned, he actually succeeded in writing a prescription that cured her. Exactly how he treated her is not recorded in any case file. But the fact remains: because of his mother’s illness, a great master of Chinese medicine was born. In misfortune, there was a piece of good luck.

Later, when his mother was old, Doctor Zhu treated her once more — and this time there is a clear record. It was this second round of treatment that moved him to write a famous essay called Yang Lao Lun (Essay on Caring for the Elderly), devoted entirely to how to care for the aged.

At seventy-something, his mother’s stools became dry and bound

Doctor Zhu himself said that when it came to caring for his old mother, he could not match the ancients — he was ashamed before the sages of old (you kui yu gu zhe). Still, his mother was past seventy, her health was holding up, the phlegm-rheum of earlier years had gradually disappeared, and he had kept her nourished with restraint and discipline (jie yang you dao) — about this he felt he had some genuine insight, and he shared it with the world.

💬 Note from Doctor Luo: The core of Doctor Zhu’s entire theoretical system, as I’ve repeated many times in this series, is this: control your desires as much as possible — especially sexual desire. Today we’re talking about a different pillar of caring for the elderly — keeping the diet light and plain. Here’s the story he tells: when his mother was around seventy, she developed “dry and bound stools” (da bian zao jie) — in plain words, constipation.

What do you do about constipation? Doctor Zhu reasoned: moisten the dryness. So he had his mother eat fresh milk and lard stirred into her rice porridge. The method did loosen her bowels — but milk and lard are, after all, slippery, rich, cloying things, heavy with oil. The following summer, his mother’s phlegm increased, and later a sore broke out beside her ribs — on one side of her flank, a painful boil. A bitter lesson.

💬 Note from Doctor Luo: Doctor Zhu understood at once: the rich, cloying things he had added to her food had gone too far. As a son, he blamed himself without reserve (zi jiu wu di) — he was deeply ashamed. So he began to think carefully: how should he adjust the treatment?

The approach: ren shen and bai zhu — tonify the stomach and nourish the blood

What Doctor Zhu came up with was to use ren shen (ginseng) and bai zhu (atractylodes) — herbs that tonify the stomach and nourish the blood. This is actually a hallmark of Doctor Zhu’s practice: he always spoke of ren shen and bai zhu as blood-nourishing herbs, especially when combined with Si Wu Tang (Four Substances Decoction) to build the blood.

💬 Note from Doctor Luo: Why did he use them this way? Two theories stand behind it. First, yin and yang give birth to each other (yin yang hu sheng) — to make the blood sufficient, you must first tonify the qi; only when the qi is sufficient can it generate blood. Conversely, once the blood is well nourished, tonifying the qi becomes easier too. This is the mutual generation of qi, blood, yin and yang. Second, both ren shen and bai zhu tonify the spleen — and where does blood come from? The blood is produced when the spleen and stomach absorb nutrients from food and transform them. So tonifying the qi and the spleen-stomach is, in effect, nourishing the blood. This is Doctor Zhu Danxi’s signature line of reasoning.

The formula was adjusted with the changing seasons:

Ren shen and bai zhu were the sovereign herbs (jun yao), with niu xi (achyranthes) and shao yao (peony) as the minister herbs (chen yao) — niu xi strengthens the sinews and bones and tonifies the liver and kidneys, a tonic in its own right; shao yao astringes the liver, softens it, and nourishes the yin. To these were added chen pi (aged tangerine peel) and fu ling (poria) — because tonics can clog, chen pi moves the qi and fu ling drains dampness.

In spring, add chuan xiong (ligusticum) to raise and move the qi and blood; in summer, add wu wei zi (schisandra) on top of that — schisandra tonifies all five organs, the “summer schisandra” that Doctor Sun Simiao praised and Doctor Li Dongyuan often used to replenish the yuan qi of the five organs — and then, according to the situation, add huang qin (scutellaria) and mai men dong (ophiopogon), cooling, yin-nourishing, heat-clearing herbs for the hottest weather; in winter, add dang gui (angelica) to nourish the blood — in winter the blood runs thin, and the limbs easily stiffen with cold, so you build the blood up fully and add a little sheng jiang (fresh ginger) to counter the outer cold and keep the body warm.

One dose or two a day — but when exactly should it be taken?

💬 Note from Doctor Luo: Doctor Zhu had a signal — whenever he heard that his mother’s urine had decreased, that her waterworks had suddenly dwindled over the past two days, it meant the body’s fluids were running low. When yin is deficient, the urine immediately shrinks. This is exactly the logic of the Wu Mei Bai Tang Tang (Black Plum and White Sugar Decoction) that I often discuss: when the urine becomes scanty and dark, it tells you the body’s fluids are insufficient, and you drink a few doses — the black plum and white sugar decoction works by “sour-sweet transforming into yin” (suan gan hua yin), nourishing the yin. Doctor Zhu’s formula worked the same way: the moment he saw her urine decrease, he gave her a few doses; once her urine was back to normal volume, he stopped.

Why is constipation in the elderly so often a matter of blood deficiency?

After using this formula, his mother’s stools were no longer dry. So why is constipation in the elderly so frequently a matter of blood deficiency?

💬 Note from Doctor Luo: Constipation has many causes: some are qi deficiency, some yang deficiency, some insufficiency of the blood — and of all these, blood deficiency is the most common. Then there are people whose liver fire is blazing and has scorched away their fluids. Why is blood deficiency such a large share? Think of it this way: the intestines are like a river channel. When there is water in it — when the body’s fluids are plentiful — the little boat, meaning the stool, can sail out. If the body’s fluids are insufficient, if yin is inadequate, the channel runs dry and the boat cannot move. So the treatment is called “adding fluid to float the boat” (zeng ye xing zhou): give the elderly herbs that nourish yin and blood. This is an enormously important idea for treating constipation — and the elderly are especially often blood deficient. If you see an old person whose tongue is very pale — a sign of insufficient qi and blood — with signs of blood deficiency and dry, bound stools, you should consider nourishing the blood. Do that, and you will find the constipation resolves by itself.

After Doctor Zhu treated his mother with herbs that tonified the spleen-stomach and nourished the blood, her stools became regular, her complexion was clean and clear; though she looked thin, she was free of illness, and her later years were peaceful (lao jing de an).

How old did his mother live to be? 87 — a great age, passing away without illness. Many literati of the time wrote memorial essays for her.

💬 Note from Doctor Luo: In the Yuan dynasty, for an old person to live into their eighties — to die at 87 without illness — was an extraordinary achievement. It shows how well Doctor Zhu cared for his mother. And it was for this that he wrote Yang Lao Lun, in which he made two central points. First: the elderly should not casually use warming, drying herbs (wen zao zhi yao) — yang-warming medicines must be used with great caution. Second: the elderly should eat light and plain — not rich, fatty, sweet foods.

Can warming, drying herbs be used at all? — It depends on the constitution, but aim for stability

Point one of Yang Lao Lun: the elderly should be cautious with warming, drying herbs. Is that right? Doctor Luo says: it depends on the situation.

💬 Note from Doctor Luo: The constitutions of elderly people are not all the same. If you are a healthy, balanced person (ping ren), no problem — just live according to your natural state. But if an elderly person is weak and struggling with illness, I would still recommend pattern differentiation and treatment (bian zheng lun zhi). It is not true that warming, drying herbs must never be used; fu zi (aconite) and other yang-warming herbs are not absolute taboos either. There really are many elderly people with yang deficiency: in the northeast of China, for example, people who have been struck by wind-cold get joint pain every winter, and unless you use some warming herbs, the wind-cold cannot get out, the cold-damp cannot be driven off, and the illness will not heal. Doctor Zhu lived in the Jiangnan region, south of the Yangtze, where the climate is mostly warm, and he had a particular horror of the damage done by the Song dynasty’s fashionable warming, drying herbs — so he opposed them fiercely. But his starting point was right: an old body is extremely fragile. Sometimes a single wrong move — made in the pursuit of quick results — leaves no room to turn back. Rather than violent methods, it is better to use steady methods and let the upright qi (zheng qi) gradually fill up. It may be slower, but for the elderly it is safe.

💬 Note from Doctor Luo: Unless there is a real illness and a doctor is guiding you, never casually add warming, heating herbs to your daily health routine — for example, steeping lots of warming ingredients in wine and drinking it every day. That really can ruin an elderly person’s health: blood pressure shoots up, cerebrovascular problems are possible. So Doctor Zhu, out of a desire for steadiness, told people not to use harsh, drying herbs. That was his thinking.

Nourishing blood, nourishing yin, nourishing the spleen and stomach: Doctor Luo’s mother’s three serious illnesses

Point two of Yang Lao Lun: value nourishing the blood, nourishing the yin and nourishing the spleen and stomach. Doctor Luo says this is absolutely right — among the elderly, yin deficiency and blood deficiency are extremely common.

💬 Note from Doctor Luo: Especially what kind of person? The elderly who habitually have fire. I have met many old ladies like this: strong-willed all their lives, with liver fire smoldering up day after day — their liver yin is bound to be insufficient, and liver yin deficiency drains kidney yin in turn, until the yin of the whole body is insufficient; lung yin, heart yin, all of it goes wrong. Once the body enters a yin-deficient constitution, you must be very careful — if you don’t manage it, in the end serious problems appear. My own mother was exactly this type: strong-willed, with liver fire flaring up for no apparent reason, a lifetime of fire — a yin-deficient, fire-flourishing constitution. And she kept falling ill. She had chronic nephritis — I treated her with blood-cooling, blood-activating herbs for a year before the fire came down and the kidney disease healed. Later she developed rheumatoid arthritis — I cured that too. And after that she developed thrombocytopenic purpura: her platelets fell little by little, a very dangerous condition. I nourished her yin continuously — sheng di huang (raw rehmannia), shu di huang (prepared rehmannia), shan yu rou (cornus fruit) and other yin-nourishing herbs, plus water buffalo horn (shui niu jiao) to clear heat (the ancients used rhinoceros horn; we use water buffalo horn today). It took several months of that before her platelets returned to normal.

💬 Note from Doctor Luo: People with yin deficiency have a red tongue; people with blood deficiency have a pale, bloodless tongue. Such elderly people are extremely fragile — wind, cold and dampness easily invade their channels and collaterals, causing all kinds of joint pain. So you must tonify the qi and nourish the blood; only when the qi and blood are sufficient and the channels are unobstructed can the pathogens truly be driven out. Doctor Zhu’s thinking is especially important here: tonify the qi and nourish the blood — he laid particular weight on nourishing the blood — then resolve all the various stagnations — phlegm, stasis, blood stasis and the rest — keep the body unobstructed, and add emotional regulation on top of that. This was his whole medical system. The approach of nourishing the blood and strengthening the spleen and stomach is extremely useful for the elderly.

What should the elderly eat? — Light and plain, but don’t go to extremes

Doctor Zhu advocated that the elderly eat lightly and plainly. But some people object: “What about that hundred-year-old who eats braised pork every day and still lives past a hundred?”

💬 Note from Doctor Luo: Look at the majority (yao kan qi chang) — look at the pattern that holds for most people. The centenarian who eats braised pork is an exception. Why should most people eat lightly? Through the long ages of human evolution, we were basically never full. The body adapted to a state of slight hunger. The moment we do get full, the body rapidly stores everything away — to prepare for the next famine. Now that we eat well every day, the body accumulates a little at a time, the burden grows heavier and heavier, and eventually it cannot bear it. Doctor Zhu said: such people do not even reach fifty before “illnesses rise up like a swarm of bees” (ji yi feng qi) — diseases come buzzing in like a hive; the qi is exhausted, the blood is dried up; the sinews fail, the bones fail, all kinds of flaccidity set in; the spleen and stomach clog up, and phlegm-dampness fills the channels. All because they ate too much, too richly. Is that not exactly what we see today? The modern epidemic of disease is tied to eating too well: diabetes, metabolic disease, cardiovascular and cerebrovascular disease — so many illnesses surged right after people started eating richly.

💬 Note from Doctor Luo: I have been to the coast and watched the fishermen: in the morning they each have a bowl of rice noodles with a few little shrimp and tiny crabs in it — one bowl per person in the family — and they are strong as oxen, out fishing and working all day. The laborers on construction sites eat a big pot of cabbage soup at noon with a few steamed buns — no braised pork. Simple food, but their qi and blood are powerful. Now look at the big bosses, dining out every night until the grease shines on their lips — set them against the fishermen and the laborers, and they cannot compete on health. People who eat exceptionally well end up spending their old age shuttling between hospital departments, a string of diseases waiting for them — catch one and a dozen more come. This truth does not apply only to the elderly; it applies to the young and the middle-aged equally.

So why is it that some centenarians eat meat at every meal and stay healthy?

💬 Note from Doctor Luo: Such people were born with exceptionally strong yuan qi (primordial qi) and a very robust spleen and stomach. Their yuan qi can transform the meat — expelling what should be expelled, using what should be used. That is natural endowment; 99.999% of people are not built like them — so do not adopt their standards. Some old man drinks strong liquor every day, two bowls a day — will you copy that too? Copy it and your liver will be the casualty. Survey most centenarians and you will find they eat simply: in Bama, Guangxi — famous for its longevity — the genetics are good, the air is good, the water is good, and the diet is light: corn porridge, corn gruel, huo ma (hemp) greens, day after day. In those years it was a poor region; there was nothing good to eat. Once a rich tourist came to visit, and an old man joked: “We’re poor, we can’t get anything good to eat. How about we swap — you drink corn porridge and I’ll go eat lobster?” The rich man had nothing to say. The Bama fragrant pig is the same story: locally they only ate it once a year, at New Year. Now people think eating fragrant pig brings longevity, so they buy it and eat it every day — that is running in exactly the opposite direction.

💬 Note from Doctor Luo: But total vegetarianism — I don’t endorse that either. The elderly still need adequate nutrition. If you eat too plainly, you get malnutrition, osteoporosis and a host of other problems. When you are young, eating lightly — even vegetarian sometimes — has its benefits, because modern people are all over-consuming. As you get older, you can actually relax a little. Everything in moderation, no extremes — that is how you truly nourish yourself.

Ending: light prescriptions, clear thinking — 87 and gone without illness

Look back at the whole process by which Doctor Zhu regulated his mother’s health: nourishing the spleen and stomach and building the blood were the main directions — a little at a time, with light dosages, few herbs, and very clear reasoning. Tonify the spleen with ren shen and bai zhu; add a little niu xi and bai shao; adjust lightly; add chen pi and fu ling; vary the formula a little with the seasons. That was the entire strategy.

💬 Note from Doctor Luo: The result: his mother’s upright qi was relatively strong, her old age was very peaceful, and she died at 87 without illness — the success of Doctor Zhu’s way of caring. Every person’s body is different; adjusting your own diet and lifestyle will certainly benefit your health — especially if you are elderly. Give it some thought, and you can surely bring happiness to your parents’ later years.

What to take away

1. Blood deficiency is the most common cause of constipation in the elderly — think of the intestines as a river and the stool as a boat: no water, no movement. “Add fluid to float the boat” (zeng ye xing zhou) — nourish the yin and blood, and the bowels often open by themselves.
2. A pale tongue is the key sign. If an elderly person’s tongue is pale and bloodless with dry, bound stools, consider nourishing the blood rather than grabbing a laxative.
3. Tonifying the spleen-stomach is nourishing the blood. Since the blood is transformed from food by the spleen and stomach, ren shen and bai zhu — the qi- and spleen-tonifying pair Doctor Zhu used — are his way of building the blood; qi generates blood, and yin and yang generate each other.
4. Watch the urine as a fluid gauge. When an elderly person’s urine suddenly decreases, body fluids are running low — that is the moment to nourish the yin (the logic of Wu Mei Bai Tang Tang, sour-sweet transforming into yin).
5. Be cautious with warming, drying herbs in the old — but not dogmatically. There are truly yang-deficient elders who need warmth (e.g., winter joint pain from wind-cold in the northeast). The rule is: pattern differentiation first, and prefer steady methods over violent ones.
6. Elderly diet: light and plain, but not extreme. Eating too richly breeds illness like a swarm of bees — diabetes, metabolic and cardiovascular disease. Yet total vegetarianism brings malnutrition and osteoporosis. Moderation, not extremes — and don’t copy the exceptional centenarian who eats braised pork every day.

Compiled from Doctor Luo Dalun’s lecture series on Doctor Zhu Danxi.