Bigu fasting

1. Introduction

Version followed: the classical Daoist grain-avoidance tradition as historians report it (Robert Ford Campany's study of early medieval transcendents, Making Transcendents, 2009, as summarised in Kieschnick's 2010 review; the Mawangdui manuscript Quegu shiqi and Ge Hong's Baopuzi as secondary sources describe them), plus one present-day temple presentation (Wudang Five Immortals Temple). Clinical material follows NHS, APA (psychiatry) and published contemplative-safety sources. Nothing here is a fasting plan: this guide gives no lengths, schedules or food rules.

What it is. Bigu 辟穀 ("avoiding grains") is a family of Daoist practices in which the practitioner gives up cereal grains, and in some versions most or all ordinary food. In the texts, this is part of cultivating longevity and transcendence (xian 仙). Related terms include duangu 斷穀 and quegu 卻穀. Dictionaries disagree on whether the word means giving up cereals only or all food. [source: Wikipedia, Bigu; uncertain: secondary, unverified]

Core idea of change, as the tradition holds it. In the textual tradition, the practitioner replaces grain with nourishment held to be finer. This includes qi 氣 taken in through breath-centred practice (fuqi 服氣 / shiqi 食氣), herbs, fungi, resins, minerals, dew and one's own saliva. The aim is a lighter, purified body on the path to transcendence. [source: Kieschnick 2010 review of Campany; Chen Feng 2019 review of Campany (Chinese edition)]

Some texts say grain feeds the "Three Corpses" (sanshi 三尸), body-dwelling spirits that report a person's misdeeds to heaven. Campany, as his reviewer summarises him, argues that this link to grain is rare and appears only in texts after the fourth century. Campany also argues that grain mattered as a symbol: it was the staple of settled farming life and of ancestral offerings, so giving it up meant stepping outside ordinary society. [source: Kieschnick 2010]

Some Daoists treated bigu as a basic route to transcendence, and Ge Hong's Baopuzi records many methods. [source: Chen Feng 2019]

A present-day Wudang temple frames bigu as cultivation for longevity and clarity. It is practised with qi-gathering and meditation, and the temple distinguishes it from fasting for healing. [source: Wudang Five Immortals Temple, Fasting page]

These are the tradition's own concepts. This guide neither asserts nor dismisses them.

Health claims. Commercial "bigu" courses in China have claimed to cure illness, including cancer. Medical experts quoted by People's Daily said such claims lack scientific support, and that the benefits of proposed mechanisms such as autophagy are unclear and not ready for clinical use. [source: China News Service / People's Daily, 2022] No health benefit is claimed here.

What this guide covers. The psychotherapist does not teach, supervise or plan bigu. The therapist's work is to understand the practice's meaning for the client, to screen for eating-disorder risk, and to route every health question to the client's doctor (and medicine questions to the prescriber). The therapist also supports client-led spiritual integration, works with the client's teacher when the client wishes, and watches for adverse effects of the qi and meditation practice that usually accompanies bigu. [synthesis]

2. Framework

No source gives session counts or a phased psychotherapy protocol for bigu. The phases below are an organising scheme. [synthesis]

How the tradition describes the course of a practice (qualitative only).

• Classical sources describe weakness and dizziness in the early phase and advise taking the practice up gradually. [source: Wikipedia, citing Maspero and Ge Hong; uncertain: secondary, unverified]
• Ge Hong is reported as warning that the practice is hard and that a critical period can be dangerous. He is also reported as suggesting that most people would do better simply to regulate their diet. [source: Wikipedia; uncertain: secondary, unverified]
• The Wudang Five Immortals Temple describes adapting gradually ("from easy to hard"), within the temple's guided cultivation and evening meditation. It describes a gradual return to ordinary food followed by a recovery period. [source: Wudang Five Immortals Temple]
• Who authorises it: in temple settings, the master or teacher guides the practice. [source: Wudang Five Immortals Temple] Modern qigong movements have also promoted bigu (for example, Yan Xin qigong). [source: Wikipedia; uncertain: secondary, unverified] So have unlicensed commercial courses. [source: China News Service 2022]

Psychotherapist's phases [synthesis]

If an active eating disorder, a medical red flag or a psychotic or manic presentation appears at any point, go back to Phase B and prioritise medical and psychiatric care. [synthesis]

3. Guiding principles

• Attribute, don't adjudicate. Describe the Three Corpses, qi and transcendence as the tradition holds them. In practice, use the client's terms and avoid both endorsing and debunking. [source: CFI Module 5 guidance on using the person's own terms; synthesis]
• No prescriptions from the therapist. Never suggest fasting lengths, foods to avoid or schedules. In practice, if asked "how long should I go?", route the question to the doctor and the teacher. [synthesis]
• Health questions belong to the doctor; medicines to the prescriber. In practice, get consent early to contact the GP, and never advise on medicines, including whether to take them during a practice. [synthesis]
• Intention does not neutralise restriction. Restricting food can be a risk factor whatever the intention behind it. In practice, screen everyone, including clients whose motive is plainly spiritual. [source: Renfrew Center 2025]
• Symptoms are not "detox" by default. Commercial courses have attributed weakness, dizziness and rashes to detoxification, and one temple page frames fatigue, dizziness, blurred vision and abnormal liver tests as natural. In practice, any such symptom prompts medical review. [source: China News Service 2022; Wudang Five Immortals Temple]
• The tradition has its own voices of caution. Classical sources record warnings about danger and impostors. In practice, the client can be invited to draw on these from within the tradition. [source: Kieschnick 2010; Wikipedia, uncertain: secondary, unverified]
• Client-led integration. The client sets the spiritual aims. In practice, explore and do not steer. Spiritual content enters therapy only with consent. [synthesis]
• Know your role. The therapist is not a Daoist teacher or qigong master. In practice, refer practice questions to a qualified teacher or temple, and avoid dual roles. [synthesis; see section 4]
• Watch the accompanying practice too. Qi-ingestion and meditation can bring adverse experiences of their own. In practice, ask about them at every check-in. [source: Cheetah House VCE; Shan 2000]
• Watch the context as well as the practice. Unlicensed courses with cure claims and high fees are a separate risk. In practice, ask who runs the course, what it claims and what it costs. [source: China News Service 2022]

4. Intervention inventory

The tradition's practice is described in sections 1 and 2 at the level of public outline. The entries below are the psychotherapist's own work alongside it.

4.1 Understanding bigu in the client's own tradition and life

• Purpose / when: When a client mentions bigu, grain avoidance, a qigong "bigu" course or Daoist fasting. The aim is to learn which version the client follows and what it means to them before assessing risk. [synthesis]
• Steps:
  1. Ask the client to describe the practice in their own words: its name, who teaches it (temple, lineage master, qigong group, online course) and how they came to it.
  2. Ask about purpose as the client holds it: transcendence and longevity, purification (for example the Three Corpses), clarity in meditation, discipline, health, or belonging to a group.
  3. Ask whether the practice comes with qi-ingestion, meditation or other cultivation, and who supervises it.
  4. Record the client's terms (bigu, fuqi, sanshi) with a short gloss in the notes. Do not translate them into pathology.
  5. Note any health claims the client has been given, and their source.
• Example language (illustrative): "Can you tell me how bigu is understood where you practise, and what it means for you personally?" "Who guides you in it, and what have they told you to expect?"
• Watch for: Health or cure claims presented as certain. A source the client cannot name. Secrecy about the practice from family or doctor. Bigu framed mainly around weight or body shape, which is a cue for 4.3. It is working when the client feels understood and describes the practice openly. [synthesis; China News Service 2022 for cure claims]

4.2 Cultural Formulation Interview, Module 5 (Spirituality, Religion, and Moral Traditions)

• Purpose / when: During assessment, to clarify how the client's tradition shapes the presenting problem, coping and stresses. The module can be used alongside the core CFI or on its own. [source: APA, CFI Supplementary Modules]
• Steps: Cover the module's four areas in your own words. Do not read out item text.
  1. Identity and community: the client's spiritual, religious or moral identity, their temple or community ties, and family background.
  2. Role in daily and family life, and in private and communal practice.
  3. Links to the presenting problem: help from leaders, texts and personal practices.
  4. Stresses and conflicts: the tradition's contribution to the problem, personal distress, discrimination, interpersonal conflict.
  Use the client's own name for the tradition. Ask about the level of involvement in any specific practice, such as bigu. Rephrase questions to keep the conversation natural. [source: APA, CFI Supplementary Modules] You can add the Explanatory Model and Coping and Help-Seeking modules where relevant. [source: same; synthesis]
• Example language (illustrative): "How does your Daoist practice fit into your everyday life and your family's?" "Has your practice, or anyone in your community, been a help or a strain with what brought you here?"
• Watch for: Family conflict over the practice. Isolation from the community. A practice that has become the client's main coping route. It is working when the formulation includes the tradition as a resource as well as a possible stressor. [synthesis]

4.3 Eating-disorder screening and history

• Purpose / when: For every client considering or practising bigu, and urgently where there is any past or current eating disorder. Food restriction can be a risk factor whatever its intention. [source: Renfrew Center 2025]
• Steps:
  1. Ask about past diagnoses or treatment for an eating disorder, and about current recovery status.
  2. Ask about weight, shape and control concerns, and whether these feed into the wish to practise. Explore gently and do not assume.
  3. Ask about the warning signs Renfrew lists [source: Renfrew Center 2025]:
     • the shift from hunger cues to external rules about eating;
     • preoccupation with food;
     • eating alone outside "approved" times;
     • binge urges after deprivation;
     • being driven on by others' feedback;
     • food dreams or waking with urges to eat;
     • poor concentration and low mood;
     • social withdrawal;
     • fasting interfering with work or study.
  4. Use your service's validated brief eating-disorder screen where one is in use. Some services use the SCOFF. [uncertain: not verified] Follow local pathways for a positive screen.
  5. If the client is in eating-disorder treatment, involve their eating-disorder team (with consent) before anything else. [synthesis]
• Example language (illustrative): "Some people find that any period of restricting food stirs up old patterns, even when the reason is spiritual. Has eating ever been a struggle for you?" "Have you noticed thinking about food more, or feeling a pull to keep going longer than you meant to?"
• Watch for:
  • Spiritual language masking restriction, for example pride in endurance, or secrecy.
  • Weight loss welcomed as a sign of progress.
  • Rigidity and distress when routines are disrupted.
  • Binge-restrict cycles after the practice ends.
  It is working when risk is documented, the client engages honestly, and an eating-disorder pathway is used if needed. [Renfrew Center 2025; synthesis]

4.4 Medical routing and coordination with the client's doctor

• Purpose / when: Before any practice that involves eating little or no food, and at any new symptom. The therapist raises health issues as clinical sources state them, and decisions rest with the doctor. [synthesis]
• What clinical sources state (for the conversation, not as advice):
  • Medical experts quoted in a People's Daily investigation said fasting therapy should only be used under professional medical supervision. They said people with malnutrition, severe hypertension, diabetes, heart disease, mental illness, or severe liver or kidney impairment should not fast this way. [source: China News Service 2022]
  • Course participants reported weakness, dizziness and rashes. [source: same]
  • An NHS trust explains refeeding syndrome. After a prolonged period of very little food, starting to eat more can make potassium, phosphate and magnesium fall quickly, with serious complications affecting the heart and breathing. People at high risk are managed in hospital, and any refeeding is supervised by a dietitian with blood tests. [source: Lancashire and South Cumbria NHS FT]
• Steps:
  1. Ask about medical conditions, pregnancy, and any medicines. Do not advise on medicines. Questions about taking or stopping them go to the prescriber.
  2. With consent, ask the client to see their GP or doctor before starting, or write to the doctor yourself. Name the practice neutrally, for example "a period of religious food restriction within Daoist practice".
  3. Agree with the client which symptoms mean stopping and seeking medical help the same day. Take these from the doctor's advice. In their absence, cover dizziness, fainting, palpitations, blurred vision, confusion and marked weakness. [synthesis]
  4. For a return to eating after a long restriction, the client follows the doctor's or dietitian's plan, not the therapist's. [source: Lancashire and South Cumbria NHS FT]
  5. Document what was discussed and the client's decision.
• Example language (illustrative): "I'm not the right person to say what's safe for your body. That's a question for your doctor, and I'd encourage you to see them before you begin." "If you notice dizziness or your heart racing, please treat that as a reason to stop and get checked, not as part of the process."
• Watch for:
  • Symptoms reframed as "detox" or as a battle between upright and evil qi.
  • Reluctance to tell the doctor.
  • Plans to stop medicines on the course's advice.
  • Diabetes, pregnancy, older age, or low weight.
  It is working when a medical opinion is in place and the client knows the stop signs. [China News Service 2022; Wudang Five Immortals Temple; synthesis]

4.5 Assessing the context: temple, teacher, group or commercial course

• Purpose / when: When the practice is run by a group, course or online seller, or the client describes pressure to continue. [synthesis]
• Steps:
  1. Ask who runs it, what qualifications they claim, what it costs, and what it promises.
  2. Note claims to cure disease (the 2022 investigation found claims including cancer), unlicensed medical procedures, logos or certificates of doubtful origin, and escalating fees. [source: China News Service 2022]
  3. Ask whether the client can stop, ask questions or see a doctor without disapproval.
  4. Ask about isolation from family, demands for secrecy, and how doubts are handled.
  5. If the client is concerned, they can check whether the course is subject to consumer-protection or health regulators where they live. In China, market and health authorities closed a similar course in 2017. [source: China News Service 2022] Avoid labelling the group.
• Example language (illustrative): "What happens in the group if someone feels unwell, or decides to stop?" "What have they said this will do for your health?"
• Watch for:
  • Discouraging medical care.
  • Attributing every symptom to cleansing.
  • Financial pressure.
  • Punishing doubt.
  It is working when the client can weigh the context freely. [synthesis]

4.6 Client-led integration within spiritually integrated psychotherapy

• Purpose / when: When the client wants their Daoist practice included in therapy. Spirituality enters therapy by consent and in the client's own tradition and language. Cross-refer Domain VII (spiritually integrated psychotherapy). [synthesis]
• Steps:
  1. Ask explicitly whether and how the client wants their practice discussed.
  2. Explore what the practice is reaching for: lightness, purity, freedom from ordinary entanglements, transcendence. Campany reads grain avoidance as stepping outside settled social life. [source: Kieschnick 2010] Explore what that means for this client now.
  3. Help the client find, within their own tradition, the full range of ways to pursue those aims. Where fasting is medically ruled out, this includes the tradition's own reported counsel of moderation. [source: Wikipedia on Ge Hong; uncertain: secondary, unverified] The client and teacher decide, not the therapist.
  4. Link the practice's values to therapy goals only as the client chooses.
• Example language (illustrative): "What are you hoping this practice will open up for you?" "If your doctor says fasting isn't right for you at the moment, what else in your tradition speaks to that same hope? Is that something to ask your teacher about?"
• Watch for: The therapist steering towards or away from the practice. Spiritual bypassing of distress. It is working when the client's meaning is honoured and safety holds. [synthesis]

4.7 Referral to and collaboration with a qualified teacher or Daoist clergy

• Purpose / when: For questions about how to practise, its meaning or its exemptions, and when the client wants their teacher involved. [synthesis]
• Steps:
  1. Ask who the client's teacher is and whether they want contact. Get written consent and agree what will be shared.
  2. Questions about practice go to the teacher, temple or Daoist priest (daoshi). Health questions go to the doctor.
  3. With consent, share the doctor's view and ask how the tradition makes room for people who cannot safely fast.
  4. Keep roles distinct and do not take on the teacher's role. In the temple setting described, practice runs under guided cultivation. [source: Wudang Five Immortals Temple]
• Example language (illustrative): "Would it help if I spoke with your teacher, with your permission, so we're all aware of what your doctor has said?"
• Watch for: A teacher who discourages medical care. A client who uses the therapist to bypass the teacher, or the reverse. It is working when the client feels their teacher and clinicians are not at odds. [synthesis]

4.8 Monitoring adverse experiences from the accompanying qi and meditation practice

• Purpose / when: At every check-in where bigu is practised with qi-ingestion or meditation, and especially in intensive or self-taught practice. Cross-refer the qigong guide (X 123) and Domain II. [synthesis]
• What sources describe:
  • The Varieties of Contemplative Experience study (Lindahl et al. 2017, PLOS ONE) mapped meditation-related challenges across perceptual, affective, conative, cognitive, sense-of-self, social and somatic domains. [source: Cheetah House VCE page]
  • A Hong Kong psychiatric paper describes "Qigong deviation": acute, usually brief episodes after practice. They can be psychotic (delusions, hallucinations, elated mood), affective, dissociative or neurotic, and include sensations of qi rushing into the head, headache and dizziness. In the author's series, most patients had practised alone. Risk factors named were over-practice, vulnerable individuals and self-teaching. The author recommends education before and after starting. [source: Shan 2000]
  • Food restriction itself can lower mood and concentration and disturb sleep, which can blur the picture. [source: Renfrew Center 2025]
  • The Farias et al. 2020 systematic review of meditation adverse effects is also relevant. [uncertain: not verified]
• Steps:
  1. Ask about sleep, mood, concentration, unusual perceptions, energy sensations, sense of self and functioning.
  2. If difficulties appear, grounding and reducing the amount of practice are the usual first steps, agreed with the client and the teacher. [synthesis] Cheetah House offers consultations for meditators and clinicians. [source: Cheetah House]
  3. Tell a spiritual crisis apart from psychosis, mania, depression or dissociation, without pathologising the experience and without missing illness:
     • look at insight, functioning, safety, sleep loss, and persistence after the practice stops (a criterion in the Chinese diagnostic description) [source: Shan 2000];
     • DSM-5-TR includes a code for a religious or spiritual problem, Z65.8 [source: ICD-10-CM Z65.8].
  4. If symptoms are psychotic or manic, or safety is at risk, refer for urgent psychiatric and medical assessment. Check physical causes too, since restriction may contribute. [synthesis]
• Example language (illustrative): "Alongside the fasting, how has your qi practice been: any sensations or experiences that felt too strong or hard to settle?" "Would you be willing to ease off the practice for now while we check what's going on?"
• Watch for:
  • Sleep loss.
  • Pressured speech.
  • Fixed beliefs.
  • Uncontrollable movements.
  • Inability to stop practising.
  It is working when the experiences settle and functioning returns. [Shan 2000; synthesis]

4.9 Trauma-sensitive adaptation of accompanying practice

• Purpose / when: For clients with trauma histories who practise bigu with meditation or qi work. Food deprivation and inward attention can both raise arousal or bring up memories. Cross-refer Domain IV (trauma-sensitive yoga) and Treleaven's 2018 trauma-sensitive mindfulness. [uncertain: not verified; synthesis]
• Steps:
  1. Map the client's arousal signs and grounding resources: open eyes, external focus, movement, contact with the floor.
  2. Emphasise choice. The client can pause, shorten or stop any practice without failing spiritually, in terms the client and teacher accept.
  3. Watch for links between deprivation and past experiences of hunger, neglect or control.
  4. Agree a plan for overwhelm that includes eating as the doctor has advised.
• Example language (illustrative): "You're always free to pause or open your eyes. Noticing your limits is part of practising wisely."
• Watch for:
  • Dissociation.
  • Flashbacks.
  • Hunger triggering memories of past deprivation.
  • Pushing through distress as a test of discipline.
  It is working when the client can stay within tolerable arousal. [synthesis]

4.10 After the practice: return to eating and integration

• Purpose / when: When a period of restriction ends. The tradition describes a gradual return to food and a recovery period. [source: Wudang Five Immortals Temple] Clinically, the risk of refeeding syndrome after prolonged low intake means the return should be medically guided. [source: Lancashire and South Cumbria NHS FT]
• Steps:
  1. Check the client is following the doctor's or dietitian's plan for the return to eating. Do not give food advice yourself.
  2. Screen again for binge urges, food preoccupation and low mood after deprivation. [source: Renfrew Center 2025]
  3. Invite the client to reflect on the spiritual meaning of the experience, including disappointment if expectations were not met.
  4. Review whether, and on what terms, the client wants to practise again, with the doctor and teacher involved.
• Example language (illustrative): "How has it been coming back to ordinary meals, physically and emotionally?" "What did the practice give you, and what did it cost?"
• Watch for:
  • Rapid repeat cycles.
  • Bingeing followed by renewed restriction.
  • Shame at "failing".
  • Physical symptoms during refeeding, which mean the client should contact the doctor the same day.
  [synthesis; NHS source for refeeding]

4.11 Scrupulosity and moral self-accounting

• Purpose / when: When purity themes dominate. In the textual tradition, the Three Corpses report misdeeds to heaven. A client with obsessive-compulsive features may experience intrusive fear of impurity or of being reported, and use restriction or rituals as compulsions. [source for the concept: Kieschnick 2010; clinical application: synthesis]
• Steps:
  1. Separate devotion from compulsion. Ask whether the practice brings peace or relief from anxiety, whether rules multiply, and whether there is constant reassurance-seeking.
  2. If OCD is likely, assess it formally and offer exposure and response prevention (ERP). Plan exposures with the client's consent and, where the client wishes, in consultation with their teacher or Daoist clergy. The aim is to keep exposures within what the tradition actually asks. [synthesis; IOCDF guidance not verified]
  3. Do not set exposures that involve fasting or food restriction. Any food-related work goes through the eating-disorder pathway and the doctor. [synthesis]
• Example language (illustrative): "It sounds as if the fear of being impure is driving this more than your faith is. Would it help to ask your teacher what the tradition actually requires?"
• Watch for: Escalating restriction to neutralise fear. Reassurance loops with the therapist. It is working when the client can practise from choice, not dread. [synthesis]

4.12 Safeguarding children and young people

• Purpose / when: If a minor is involved in bigu or a course offering it. [synthesis]
• Steps: Assess the young person's understanding, their assent and the parents' consent. Involve the paediatrician or GP. Follow local safeguarding procedures where food restriction is imposed, harms health, or is linked to unlicensed treatment claims. Safeguarding-body guidance specific to bigu is not cited here. [uncertain: not verified]
• Example language (illustrative): "Before anything like this, a doctor needs to check it's safe for someone still growing."
• Watch for: Weight loss, growth concerns, missed school, coercion. [synthesis]

4.13 The therapist's role, boundaries and ethics

• Purpose / when: Throughout. [synthesis]
• Steps:
  1. Do not teach, endorse or design fasting practice, and do not act as a spiritual director. Avoid dual relationships, for example practising in the client's group.
  2. Reflect on your own views about religious fasting, Daoism or qigong. Use self-disclosure sparingly and only for the client's benefit.
  3. Build spiritual and religious competence through training and consultation. Vieten et al. 2013 set out spiritual and religious competencies for psychologists. [uncertain: not verified]
  4. Follow your professional ethics code on competence, informed consent, boundaries and respect for religious difference. [synthesis]
• Example language (illustrative): "My part is to support you and keep an eye on your wellbeing. Your teacher guides the practice, and your doctor guides the health side."
• Watch for: The therapist sliding into adviser or opponent. Countertransference around food or religion. [synthesis]

5. Handling problems

Unless tagged otherwise, the guidance in this section is synthesis.

• "Just tell me how long is safe." Decline warmly and explain why: safety depends on the client's body and is a medical judgment. Offer to write to the GP, and suggest the teacher for practice questions. [synthesis]
• The client calls dizziness, weakness or rashes "detox". Acknowledge the tradition's framing. Then name that the same symptoms can signal medical risk, and that a commercial course was reported to use the "detox" framing to explain away participants' symptoms. Ask for medical review that day if symptoms are marked. [source: China News Service 2022; synthesis]
• Eating-disorder history and a strong wish to practise. Do not argue theology. Involve the eating-disorder team. Explore the function the practice would serve. Ask the client whether their tradition or teacher allows non-fasting ways to take part (step 3 of 4.6). Restriction carries risk whatever the intention. [source: Renfrew Center 2025; synthesis]
• The client won't see a doctor. Explore the reasons: fear of being dismissed, or the teacher's view. Offer to help frame the conversation. Document your advice. If there are acute red flags, follow emergency procedures. [synthesis]
• The teacher or course discourages medical care or therapy. Avoid open conflict. Explore the client's own view, review the context (4.5) and keep the door open. If the client is in a commercial course making cure claims, give them the information on regulators. [source: China News Service 2022; synthesis]
• Rupture: the client feels judged or pathologised. Name the rupture and repair it. Affirm that you are not challenging their faith, and that your concern is for their body and wellbeing, as their doctor and teacher would also want. [synthesis]
• Stuck or ambivalent client. Use motivational interviewing-style exploration of the pull towards and away from the practice, without steering the outcome. [synthesis]
• Unusual experiences during or after practice. Follow 4.8:
  • ground the client and reduce or pause practice;
  • assess for psychosis or mania and refer urgently if present;
  • treat persistence after the practice stops as a key sign. [source: Shan 2000; Cheetah House]
• Covert continuation. If the client is restricting secretly, focus on safety and the relationship rather than rule-keeping. Reassess eating-disorder and medical risk. [synthesis]
• The therapist's own discomfort or scepticism. Take it to supervision. Cultural consultation on Daoist practice may help. [synthesis]
• Language and translation. Many bigu sources and courses are in Chinese. Use the client's terms. Use an interpreter for medical or eating-disorder assessment where needed, rather than relying on family. [synthesis]

Sources

• Kieschnick, J. (2010). Review of Making Transcendents by Robert Ford Campany. Journal of Chinese Studies (CUHK) 51
• Chen Feng (2019). “修仙”：中国古代的集体性社会精神追求, review of the Chinese edition of Campany, Jiemian / Economic Observer
• Wudang Five Immortals Temple: Fasting and Retreat
• Bigu (grain avoidance), Wikipedia [uncertain: secondary, unverified]
• China News Service / People's Daily (2 April 2022): 起底辟谷培训班
• Lancashire and South Cumbria NHS Foundation Trust: Refeeding syndrome and eating disorders
• Mehr, B. (2025). Can Fasting Lead to an Eating Disorder? The Renfrew Center
• American Psychiatric Association: Cultural Formulation Interview Supplementary Modules
• Cheetah House: The Varieties of Contemplative Experience (VCE) Study, citing Lindahl, J., et al. (2017). PLOS ONE 12(5): e0176239
• Shan, H. H. (2000). Culture-bound psychiatric disorders associated with Qigong practice in China. Hong Kong Journal of Psychiatry 10(4): 12–14
• Books referred to: Campany, R. F. (2009). Making Transcendents: Ascetics and Social Memory in Early Medieval China. University of Hawai'i Press (cited via the Kieschnick review).
• Also cited [uncertain: not checked against the original]: Farias et al. 2020, Acta Psychiatrica Scandinavica; Treleaven 2018 (Trauma-Sensitive Mindfulness); Vieten et al. 2013; IOCDF scrupulosity guidance; SCOFF screen; APA Ethical Principles of Psychologists and Code of Conduct.
• ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances