叶（二十） 阳气郁勃。腑失传导。纳食中痞。大便结燥。调理少进酒肉坚凝。以宣通肠胃中郁热可效。
（大便闭郁热燥结）
川连 芦荟 莱菔子 炒山楂 广皮 川楝子 山栀 浓朴（姜汁炒） 青皮
又 热郁气阻。三焦通法。
杏仁 郁金 浓朴 广皮白 芦荟 川楝子
李（四九） 诊脉如前。服咸苦入阴。大便仍秘涩。针刺一次。病无增减。可谓沉锢之疾。夫病
着深远。平
素饮酒浓味。酿湿聚热。渍筋烁骨。既已经年不拔。区区汤液。焉能通逐。议以大苦寒坚阴燥
湿方法。参入酒醴引导。亦同气相求之至理。（湿火）
黄柏 茅术 生大黄 干地龙 金毛狗脊 川连 萆 晚蚕砂 穿山甲 汉防己
仙灵脾 海金沙 川独活 北细辛 油松节 白茄根 黄酒烧酒各半。浸七日。
吴（妪） 脉右如昨。左略小动。肝风震动。里气大燥。更议镇重苦滑。以通火腑。逾六时
便通浊行。亦肝喜疏泄之一助。（火腑不通） 更衣丸一钱五分。
江 脾宜升则健。胃宜降则和。盖太阴之土。得阳始运。阳明阳土。得阴自安。以脾喜刚燥。胃喜
柔润。仲景急下存津。治在胃也。东垣大升阳气。治在脾也。今能食不运。医家悉指脾弱是病。
但诊脉较诸冬春。盛大兼弦。据经论病。独大独小。斯为病脉。脾脏属阴。胃腑属阳。脉见弦大。
非脏阴见病之象。久病少餐。犹勉强支撑。兼以大便窒塞。泄气不爽。坐谈片刻。嗳气频频。平
素痔疮肠红。未向安适。此脉症。全是胃气不降。肠中不通。腑失传导变化之司。古人云。九窍
不和。都属胃病。六腑为病。以通为补。经年调摄。不越参术桂附。而毫乏应效。不必再进
汤药。议仿丹溪小温中丸。服至七日。俾三阴三阳一周。再议治之义。（湿热小肠痹）小温中丸二两
（一钱）
朱 足麻偻废。大热阴伤。内郁。大便不通。由怀抱不舒病加。先用滋肾丸四钱。盐汤下四服。（肾燥热）
某 术守中。渐生满胀。小便少。大便窒。肠气亦滞。病久延虚。补汤难进。议以每日开水送半
硫丸一钱五分。以通经腑之阳。（虚风便闭）
吴 有年。二气自虚。长夏大气发泄。肝风鸱张。见症类中。投剂以来。诸恙皆减。所嫌旬日犹未
更衣。仍是老人风秘。阅古人书。以半硫丸为首方。今当采取用之。半硫丸一钱开水送三服。
陈（三八） 用苦药。反十四日不大便。肠中阳气窒闭。气结聚成形。非硝黄攻坚。半硫丸一钱二分。
又 阳气窒闭。浊阴凝痞。成氏称为阴结。口甜夜胀。清浊未分。每日用来复丹一钱五分。
甘（五三） 脉左微弱右弦前议入夜反胃脘痛是浊阴上攻据说食粥不化早食至晚吐出仍是不
变之形。火土不生。不司腐熟。温药一定至理。第气攻膈中。究泻不得爽。必肠间屈曲隐处。无
以旋转机关。风动则鸣。议用半硫丸。
周（三一） 减食过半。粪坚若弹丸。脾胃病。从劳伤治。（血液枯燥）
当归 麻仁 柏子仁 肉苁蓉 松子肉
某 液耗胃弱。火升便难。三才加麦冬茯神川斛。
天冬 地黄 人参 麦冬 茯神 川斛
潘 肝血肾液久伤。阳不潜伏。频年不愈。伤延胃腑。由阴干及乎阳。越人且畏。凡肝体刚。肾恶
燥。问大便五六日更衣。小溲时间淋浊。尤非呆滞补涩所宜。
炒杞子 沙苑 天冬 桂酒拌白芍 茯苓 猪脊筋
又 精血损伤。五液必燥。问六七日更衣。以润剂涵下。用后有遗精。而阳乘巅顶。法当潜阳固阴。
龟甲心 生地 阿胶 锁阳 川石斛
顾（妪） 阳明脉大。环跳尻骨筋掣而痛。痛甚足筋皆缩。大便燥艰常秘。此老年血枯。内燥风生。由
春升上僭。下失滋养。昔喻氏上燥治肺。下燥治肝。盖肝风木横。胃土必衰。阳明诸脉。不主束
筋骨。流利机关也。用微咸微苦以入阴方法。
鲜生地（八钱） 阿胶（三钱） 天冬（一钱半） 人中白（一钱） 川斛（二钱） 寒水石（一钱）
又 咸苦治下入阴。病样已减。当暮春万花开放。阳气全升于上。内风亦属阳化。其下焦脂液。
悉受阳风引吸。燥病之来。实基乎此。高年生生既少。和阳必用阴药。与直攻其病者有间矣。
（丸方）生地（三钱） 阿胶（二钱） 天冬（一钱） 麦冬（一钱） 柏子霜（二钱） 松子仁（二钱）
虎潜丸去琐阳加咸苁蓉猪脊筋丸。
包 阳升风秘。
柏子仁 当归 红花 桃仁 郁李仁 牛膝
吴 液耗便艰。进辛甘法。
杞子 柏子仁 归身 茯神 沙苑 炒山楂
某 饥饱劳碌。中州受伤。中脘痛两胁胀。嗳泄气宽。静则安。大便艰。
柏子仁 归须 菠菜 韭菜 五灵脂 桃仁 丹皮
某 高年下焦阴弱。六腑之气不利。多痛。不得大便。乃幽门之病。面白脉小。不可峻攻。拟五仁
润燥。以代通幽。是王道之治。
火麻仁 郁李仁 柏子仁 松子仁 桃仁 当归 白芍 牛膝
李（三六） 脉小弱。形瘦。肠风已久。年来食少便难。得嗳噫泄气。自觉爽释。夫六腑通即为补。仿东垣
通幽意。
当归 桃仁 红花 郁李仁 冬葵子 柏子霜 芦荟 松子肉 水熬膏。服五钱。
金（二十） 汤饮下咽。嗳噫不已。不饥不食。大便干坚若弹丸。大凡受纳饮食。全在胃口。已经胃逆为
病。加以嗔怒。其肝木之气。贯膈犯胃。斯病加剧。况平昔常似有形骨梗。脉得左部弦实。血郁
血结甚肖。进商辛润方法。（血结）
桃仁 冬葵子 皂荚核 郁李仁 大黄 降香 郁金
李 据云。两次服辛温药。瘀浊随溢退场门。此必热瘀在肝胃络间。故脘胁痞胀。大便阻塞不通。
芦荟苦寒通其阴。仅仅更衣。究竟未能却瘀攻病。有年久恙。自当缓攻。汤药荡涤。理难于用。
议以桃仁承气汤为丸。
某（三十） 左脉弦数。溺短而痛。（小便闭）导赤散加丹皮赤苓。
某 舌白身热。溺不利。（湿壅三焦）
杏仁（一钱半） 桔梗（一钱） 滑石（三钱） 通草（一钱半） 连翘（一钱半） 芦根（一两）
汪 秋暑秽浊。由吸而入。寒热如疟。上咳痰。下洞泄。三焦皆热。气不化则小便不通。拟芳香辟
秽。分利渗热。必要小溲通为主。
藿香梗 浓朴 檀香汁 广皮 木瓜 猪苓 茯苓 泽泻 六一散
又 昨进分消方。热势略减。小便略通。所有湿热秽浊。混处三焦。非臆说矣。其阴茎囊肿。是湿
热甚而下坠入腑。与方书茎肿款症有间。议河间法。
飞滑石 石膏 寒水石 大杏仁 浓朴 猪苓 泽泻 丝瓜叶
又 川连 淡黄芩 生白芍 枳实 六一散 广皮白 生谷芽
陈 暑热不得解散。壅肿癃闭。宜通六腑。已现痉厥。非轻小症。
防己 茯苓皮 猪苓 通草 海金沙 苡仁
又 经腑窒热不通。治在气分。三焦之病何疑。
滑石 石膏 寒水石 猪苓 泽泻 蚕砂汤煎药。
又 定三焦分消。
葶苈 杏仁 浓朴 大腹皮 猪苓 泽泻 海金沙煎汤。
陈（六七） 昨用五苓通膀胱见效。治从气分。继而乱治。溲溺不通。粪溏。急当通阳。（肾阳不通）
生干姜 爆黑川附子 调入猪胆汁
孔（六二） 膏粱形体充盛。壮年不觉。酿积既久。湿热壅痹。致小肠火腑。失其变化传导之司。二便闭
阻日盛。右胁壅阻作疼。当以苦药通调。必臻小效。（二便俱闭小肠火结）
芦荟 川楝子 郁李仁 炒桃仁 当归须 红花
夜服小温中丸二钱。
高 多郁多怒。诸气皆痹。肠胃不司流通。攻触有形。乃肝胆厥逆之气。木必犯土。呕咳恶心。致
纳食日减。勉进水谷。小肠屈曲不司变化。为二便不爽。所谓不足之中而兼有余。医勿夯视。
（湿热小肠痹） 丹溪小温中丸每服二钱五分。
邵（二三） 气攻腹胁咽脘。得溲溺泄气乃安。此病由饥饱失和。小肠屈曲之处。不为转旋营运。二便
皆致不爽。当用丹溪小温中丸。
金 湿热在经。医不对症。遂令一身气阻。邪势散漫。壅肿赤块。初因湿热为泄泻。今则窍闭。致
二便不通。但理肺气。邪可宣通。（湿热肺气不降） 苇茎汤去瓜瓣加滑石通草西瓜翠衣。
许 暑湿热。皆气分先病。肺先受伤。气少司降。致二便癃闭。此滋血之燥无效。今虽小安。宜生
津清养胃阴。
麦冬 知母 甜杏仁 白沙参 三角胡麻
顾（四二） 腹满坚实。足跗胫痛肿。二便皆不通利。因湿热壅其腑气也。此非中虚。当以宣通为法。
（湿热壅腑）
黄芩 黄连 浓朴 枳实 青皮 卜子 丹皮 山栀皮
某 少腹胀痛。二便皆秘。（腑阳不行） 玉壶丹。
李（三四） 能食知味。食已超时乃胀。小便不利。气坠愈不肯出。大便四日一通。治在小肠火腑。
（火腑不通）
先用滋肾丸。每早服三钱。淡盐汤送。
某 腹中胀满。当通火腑。更衣丸一钱六分。
某 脉动数。舌干白。不欲饮水。交夏脐下左右攻痛。服米饮痛缓。超时复痛。六七日大便不通。
小溲甚少。部位在小肠。屈曲有阻乃痛。未便骤认虫病。凡六腑宜通。通则不痛。以更衣丸二
钱。专通火腑之壅结。一服。
王 日来便难溺涩。是下焦幽门气钝血燥。议东垣通幽意。（血液枯燥）
咸苁蓉（一两） 细生地（二钱） 当归（一钱半） 郁李仁（二钱研） 柏子霜（一钱半） 牛膝（二钱）
张（四九） 少腹微胀。小便通利方安。大便三四日一通。而燥坚殊甚。下焦诸病。须推肝肾。腑络必究
幽门二肠。阅所服药。是香砂六君以治脾。不思肾恶燥耶。
当归 苁蓉 郁李仁 冬葵子 牛膝 小茴 茯苓 车前 蜜丸。
张（六六） 脉左弦如刃。六旬又六。真阴衰。五液涸。小溲血水。点滴不爽。少腹右胁聚瘕。此属癃闭。非
若少壮泻火通利可效。
柏子霜 小茴 鹿角霜 茯苓 当归 苁蓉
马（三六） 脉实。病久瘀热在血。胸不爽。小腹坠。能食不渴。二便涩少。两进苦辛宣腑。病未能却。此属
血病。用通幽法。（气血结痹）
桃仁 红花 郁李仁 制大黄 归须 小茴 桂枝木 川楝子
薛（妪） 大小便不爽。古人每以通络。兼入奇经。六旬有年。又属久病。进疏气开腑无效。议两通
下焦气血方。
川芎（一两醋炒） 当归（一两醋炒） 生大黄（一两） 肉桂（三钱） 川楝子（一两） 青皮（一两）
蓬术（煨五钱） 三棱（煨五钱） 五灵脂（醋炒五钱） 炒黑楂肉（一两） 小香附（醋炒一两）
上为末。用青葱白去根捣烂。略加清水淋滤清汁泛为丸。每日进食时服三钱。用红枣五
枚。生艾叶三分。煎汤一杯服药。
王 远行劳动。肝肾气乏。不司约束。肛门痛坠。若是疡症。初起必然寒热。排毒药味。苦辛寒
燥。下焦阴阳再伤。二便皆涩。此为癃闭。背寒烦渴。少腹满胀。议通厥阴。（厥阴热闭）
老韭根 穿山甲 两头尖 川楝子 归须 小茴 橘红 乳香
又 驱浊泄肝。仅仅泄气。二便仍不得通。仿东垣治王善夫癃闭意。滋肾丸三钱三服。
又 气郁肠中。二便交阻。清理肠胃壅热。
川连 黄柏 川楝子 吴萸 黑山栀 青皮
通草五钱。海金沙五钱。煎汤代水。
又 苦辛已效。当约其制。
川连 黑山栀 丹皮 川楝子 吴萸 海金沙 飞滑石
按便闭症。当与肠痹淋浊门兼参。其大便不通。有血液枯燥者。则用养血润燥。若血燥风
生。则用辛甘熄风。或咸苦入阴。故三才五仁通幽虎潜等法。所必用者也。若血液燥则气
亦滞。致气血结痹。又当于养阴润燥中。加行气活血之品。若火腑秘结。宜苦滑重镇者。用
更衣丸以通之。若老人阳衰风闭。用半硫丸温润以通之。腑阳不行。则用玉壶丹。阳窒阴
凝。清浊混淆痞胀。用来复丹。若郁热阻气。则用苦寒泄热。辛以开郁。或用三焦通法。若湿
热伤气。阻遏经腑。则理肺气以开降之。此治大便之闭也。小便闭者。若小肠火结。则用导
赤。湿壅三焦。则用河间分消。膀胱气化失司。则用五苓。若湿郁热伏。致小肠痹郁。用小温
中丸清热燥湿。若肾与膀胱阴分蓄热致燥。无阴则阳无以化。故用滋肾丸。通下焦至阴
之热闭。以上诸法。前人虽皆论及。然经案中逐一分晰发明。不啻如耳提面命。使人得有
所遵循矣。至若膏粱曲 。酿成湿火。渍筋烁骨。用大苦寒坚阴燥湿。仍用酒醴引导。又厥
阴热闭为癃。少腹胀满。用秽浊气味之品。直泄厥阴之闭。此皆发前人未发之秘。学人尤
当究心焉。大凡小便闭而大便通调者。或系膀胱热结。或水源不清。湿症居多。若大便闭
而小便通调者。或二肠气滞。或津液不流。燥症居多。若二便俱闭。当先通大便。小溲自利。
此其大略也。至若胃腑邪热化燥便坚。太阳热邪传入膀胱之腑癃秘。又当于仲景伤寒
门下法中。承气五苓等方酌而用之。斯无遗义矣。（华岫云）
大便燥结。本有承气汤。更衣等丸下之。外用猪胆蜜煎润之。可谓无遗蕴矣。然竟有效有
叶（二十岁）阳气郁结亢盛。六腑失去传导功能。进食后胸脘痞闷。大便干结燥硬。调理期间应减少饮酒吃肉及坚硬难消化食物。用宣通肠胃中郁热的方法可以见效。
（大便闭阻，郁热燥结）
黄连 芦荟 莱菔子 炒山楂 广陈皮 川楝子 山栀 厚朴（姜汁炒） 青皮
又诊：热邪郁结，气机阻滞。采用通调三焦的方法。
杏仁 郁金 厚朴 广陈皮白 芦荟 川楝子
李（四十九岁）脉象如前所述。服用咸苦入阴的药物后，大便仍然秘涩。针刺一次后，病情没有增减。这可以说是沉疴痼疾。病邪深入日久，平时嗜酒且饮食浓腻，酿生湿浊聚积化热，浸渍筋脉，灼伤骨骼。既然已经患病多年难以拔除，区区汤药，怎能通达驱逐？建议采用大苦寒坚阴燥湿的方法，参入酒醴作为引导，这也符合“同气相求”的道理。（湿火证）
黄柏 茅术 生大黄 干地龙 金毛狗脊 黄连 萆薢 晚蚕砂 穿山甲 汉防己 仙灵脾 海金沙 川独活 北细辛 油松节 白茄根 黄酒、烧酒各半，浸泡七日。
吴（老妇人）右脉与昨日相同，左脉略小且有动象。肝风震动，体内津液大燥。再议用镇重苦滑的药物，以通利火腑。过了六个时辰，大便通畅，浊物下行，这也是帮助肝喜疏泄的一个方面。（火腑不通）
更衣丸一钱五分。
江某 脾脏宜升发则健运，胃腑宜降和则调和。太阴脾土，得阳气始能运化；阳明胃土，得阴气自然安宁。因为脾喜刚燥，胃喜柔润。张仲景急下存津，治疗重点在胃；李东垣大升阳气，治疗重点在脾。如今患者能食但不能运化，医生都指出是脾弱致病。但诊脉较之冬春季节，盛大兼弦。依据经典论述疾病，脉独大或独小，这是病脉。脾脏属阴，胃腑属阳。脉见弦大，不是脏阴发病的征象。久病少餐，尚勉强支撑，兼有大便窒塞，排气不畅，坐谈片刻，频频嗳气。平素有痔疮肠红，未曾安适。此脉症，全是胃气不降，肠中不通，六腑失去传导变化的职能。古人说，九窍不和，都归属于胃病。六腑为病，以通为补。经年调理，不离人参、白术、桂枝、附子，却毫无疗效。不必再进汤药。建议仿照丹溪的小温中丸，服用至七日，使三阴三阳循环一周，再议治疗原则。（湿热小肠痹证）小温中丸二两（每次一钱）
朱某 足部麻木痿废，大热伤阴，内热郁结，大便不通。因情怀不舒导致病情加重。先用滋肾丸四钱，盐汤送服四次。（肾燥热证）
某人 用药守中焦之法，逐渐产生满胀。小便少，大便窒塞，肠气也滞涩。病久延转为虚证，补益汤药难进。建议每日用开水送服半硫丸一钱五分，以通经腑之阳。（虚风便闭证）
吴某 年事已高，阴阳二气自虚。长夏时节大气发泄，肝风鸱张。症状类似中风。投药以来，诸症皆减。所嫌恶的是十几天仍未排便。仍是老人的风秘。阅读古人书籍，以半硫丸为首选方剂。现在应当采取使用它。半硫丸一钱，开水送服三次。
陈某（三十八岁）服用苦寒药物后，反而十四日不大便。肠中阳气窒闭，气结聚成形。非硝石、大黄攻坚不能解决。半硫丸一钱二分。
又诊：阳气窒闭，浊阴凝滞痞块。成无己称为阴结。口甜夜间腹胀，清浊未分。每日用来复丹一钱五分。
甘（五十三岁）脉左微弱右弦。前议认为入夜反胃脘痛是浊阴上攻。据说喝粥不化，早食至晚吐出，仍是不变之形。火不生土，不能腐熟水谷。温药一定是正确的道理。但气攻膈中，终究泻下不爽。必定是肠间屈曲隐处，无以旋转机关。风动则鸣。建议用半硫丸。
周某（三十一岁）饮食减半，粪便坚硬如弹丸。脾胃病，从劳伤治疗。（血液枯燥证）
当归 麻仁 柏子仁 肉苁蓉 松子肉
某人 津液耗损，胃弱，火升便难。用三才汤加麦冬、茯神、川石斛。
天冬 地黄 人参 麦冬 茯神 川石斛
潘某 肝血肾液久伤，阳不潜伏，频年不愈。损伤延及胃腑，由阴干及乎阳。越人（扁鹊）对此也畏惧。凡肝体刚，肾恶燥。问大便五六日更衣一次，小便时常淋浊。尤其不适合呆滞的补涩法。
炒杞子 沙苑 天冬 桂酒拌白芍 茯苓 猪脊筋
又诊：精血损伤，五液必燥。问六七日更衣一次。用润剂涵下，用后有遗精，而阳乘巅顶。法当潜阳固阴。
龟甲心 生地 阿胶 锁阳 川石斛
顾（老妇人）阳明脉大，环跳穴及尻骨筋掣痛而痛甚，足筋皆缩。大便燥艰常秘。这是老年血枯，内燥风生。由春升之气上僭，下失滋养。昔喻嘉言上燥治肺，下燥治肝。盖肝风木横，胃土必衰。阳明诸脉，不主束筋骨、流利机关。用微咸微苦以入阴的方法。
鲜生地（八钱） 阿胶（三钱） 天冬（一钱半） 人中白（一钱） 川斛（二钱） 寒水石（一钱）
又诊：咸苦治下入阴，病样已减。当暮春万花开放，阳气全升于上。内风亦属阳化。其下焦脂液，悉受阳风引吸。燥病之来，实基乎此。高年生生既少，和阳必用阴药。这与直攻其病者有区别了。
（丸方）生地（三钱） 阿胶（二钱） 天冬（一钱） 麦冬（一钱） 柏子霜（二钱） 松子仁（二钱）
虎潜丸去琐阳加咸苁蓉猪脊筋丸。
吴某 液耗便艰。进辛甘法。
杞子 柏子仁 归身 茯神 沙苑 炒山楂
某人 饥饱劳碌，中州受伤。中脘痛两胁胀，嗳气泄气后宽舒，静则安。大便艰。
柏子仁 归须 菠菜 韭菜 五灵脂 桃仁 丹皮
某人 高年下焦阴弱，六腑之气不利。多痛，不得大便。乃幽门之病。面白脉小，不可峻攻。拟五仁润燥，以代通幽。是王道之治。
火麻仁 郁李仁 柏子仁 松子仁 桃仁 当归 白芍 牛膝
李某（三十六岁）脉小弱，形体瘦。肠风已久，年来食少便难，得嗳噫泄气，自觉爽释。夫六腑通即为补。仿东垣通幽意。
当归 桃仁 红花 郁李仁 冬葵子 柏子霜 芦荟 松子肉 水熬膏，服五钱。
金某（二十岁）汤饮下咽，嗳噫不已，不饥不食，大便干坚若弹丸。大凡受纳饮食，全在胃口。已经胃逆为病，加以嗔怒，其肝木之气，贯膈犯胃，斯病加剧。况平昔常似有形骨梗，脉得左部弦实，血郁血结甚肖。进商辛润方法。（血结证）
桃仁 冬葵子 皂荚核 郁李仁 大黄 降香 郁金
李某 据云，两次服辛温药，瘀浊随溢退场门。此必热瘀在肝胃络间，故脘胁痞胀，大便阻塞不通。芦荟苦寒通其阴，仅仅更衣，究竟未能却瘀攻病。有年久恙，自当缓攻。汤药荡涤，理难于用。
议以桃仁承气汤为丸。
某人（三十岁）左脉弦数，溺短而痛。（小便闭证）导赤散加丹皮赤苓。
某人 舌白身热，溺不利。（湿壅三焦证）
杏仁（一钱半） 桔梗（一钱） 滑石（三钱） 通草（一钱半） 连翘（一钱半） 芦根（一两）
汪某 秋暑秽浊，由吸而入。寒热如疟，上咳痰，下洞泄，三焦皆热。气不化则小便不通。拟芳香辟秽，分利渗热。必要小溲通为主。
藿香梗 厚朴 檀香汁 广陈皮 木瓜 猪苓 茯苓 泽泻 六一散
又诊：昨进分消方，热势略减，小便略通。所有湿热秽浊，混处三焦，非臆说矣。其阴茎囊肿，是湿热甚而下坠入腑，与方书茎肿款症有间。议河间法。
飞滑石 石膏 寒水石 大杏仁 厚朴 猪苓 泽泻 丝瓜叶
陈某 暑热不得解散，壅肿癃闭，宜通六腑。已现痉厥，非轻小症。
防己 茯苓皮 猪苓 通草 海金沙 苡仁
又诊：经腑窒热不通，治在气分。三焦之病何疑。
滑石 石膏 寒水石 猪苓 泽泻 蚕砂汤煎药。
又诊：定三焦分消。
葶苈 杏仁 厚朴 大腹皮 猪苓 泽泻 海金沙煎汤。
陈某（六十七岁）昨用五苓通膀胱见效，治从气分。继而乱治，溲溺不通，粪溏。急当通阳。（肾阳不通证）
生干姜 爆黑川附子 调入猪胆汁
孔（六十二岁）膏粱形体充盛，壮年不觉，酿积既久，湿热壅痹，致小肠火腑，失其变化传导之司。二便闭阻日盛，右胁壅阻作疼。当以苦药通调，必臻小效。（二便俱闭小肠火结证）
芦荟 川楝子 郁李仁 炒桃仁 当归须 红花
夜服小温中丸二钱。
高某 多郁多怒，诸气皆痹，肠胃不司流通。攻触有形，乃肝胆厥逆之气。木必犯土，呕咳恶心，致纳食日减。勉进水谷，小肠屈曲不司变化，为二便不爽。所谓不足之中而兼有余。医勿夯视。
（湿热小肠痹证） 丹溪小温中丸每服二钱五分。
邵某（二十三岁）气攻腹胁咽脘，得溲溺泄气乃安。此病由饥饱失和，小肠屈曲之处，不为转旋营运，二便皆致不爽。当用丹溪小温中丸。
金某 湿热在经，医不对症，遂令一身气阻，邪势散漫，壅肿赤块。初因湿热为泄泻，今则窍闭，致二便不通。但理肺气，邪可宣通。（湿热肺气不降证） 苇茎汤去瓜瓣加滑石通草西瓜翠衣。
许某 暑湿热，皆气分先病，肺先受伤，气少司降，致二便癃闭。此滋血之燥无效。今虽小安，宜生津清养胃阴。
麦冬 知母 甜杏仁 白沙参 三角胡麻
顾某（四十二岁）腹满坚实，足跗胫痛肿，二便皆不通利。因湿热壅其腑气也。此非中虚，当以宣通为法。
（湿热壅腑证）
黄芩 黄连 厚朴 枳实 青皮 卜子 丹皮 山栀皮
李某（三十四岁）能食知味，食已超时乃胀，小便不利，气坠愈不肯出，大便四日一通。治在小肠火腑。
（火腑不通证）
先用滋肾丸。每早服三钱，淡盐汤送。
某人 脉动数，舌干白，不欲饮水。交夏脐下左右攻痛，服米饮痛缓，超时复痛。六七日大便不通，小溲甚少。部位在小肠，屈曲有阻乃痛，未便骤认虫病。凡六腑宜通，通则不痛。以更衣丸二钱，专通火腑之壅结。一服。
王某 日来便难溺涩，是下焦幽门气钝血燥。议东垣通幽意。（血液枯燥证）
咸苁蓉（一两） 细生地（二钱） 当归（一钱半） 郁李仁（二钱研） 柏子霜（一钱半） 牛膝（二钱）
张某（四十九岁）少腹微胀，小便通利方安，大便三四日一通，而燥坚殊甚。下焦诸病，须推肝肾，腑络必究幽门二肠。阅所服药，是香砂六君以治脾，不思肾恶燥耶。
当归 苁蓉 郁李仁 冬葵子 牛膝 小茴 茯苓 车前 蜜丸。
张某（六十六岁）脉左弦如刃，六旬又六，真阴衰，五液涸，小溲血水，点滴不爽，少腹右胁聚瘕。此属癃闭，非若少壮泻火通利可效。
柏子霜 小茴 鹿角霜 茯苓 当归 苁蓉
马某（三十六岁）脉实，病久瘀热在血，胸不爽，小腹坠，能食不渴，二便涩少。两进苦辛宣腑，病未能却。此属血病，用通幽法。（气血结痹证）
桃仁 红花 郁李仁 制大黄 归须 小茴 桂枝木 川楝子
薛某（老妇人）大小便不爽，古人每以通络，兼入奇经。六旬有年，又属久病，进疏气开腑无效。议两通下焦气血方。
川芎（一两醋炒） 当归（一两醋炒） 生大黄（一两） 肉桂（三钱） 川楝子（一两） 青皮（一两）
蓬术（煨五钱） 三棱（煨五钱） 五灵脂（醋炒五钱） 炒黑楂肉（一两） 小香附（醋炒一两）
上为末，用青葱白去根捣烂，略加清水淋滤清汁泛为丸。每日进食时服三钱，用红枣五枚，生艾叶三分，煎汤一杯服药。
王某 远行劳动，肝肾气乏，不司约束，肛门痛坠。若是疡症，初起必然寒热。排毒药味，苦辛寒燥，下焦阴阳再伤，二便皆涩。此为癃闭，背寒烦渴，少腹满胀。议通厥阴。（厥阴热闭证）
老韭根 穿山甲 两头尖 川楝子 归须 小茴 橘红 乳香
又诊：驱浊泄肝，仅仅泄气，二便仍不得通。仿东垣治王善夫癃闭意，滋肾丸三钱三服。
又诊：气郁肠中，二便交阻，清理肠胃壅热。
川连 黄柏 川楝子 吴萸 黑山栀 青皮
通草五钱，海金沙五钱，煎汤代水。
又诊：苦辛已效，当约其制。
川连 黑山栀 丹皮 川楝子 吴萸 海金沙 飞滑石
按便闭症，当与肠痹淋浊门兼参。其大便不通，有血液枯燥者，则用养血润燥。若血燥风生，则用辛甘熄风，或咸苦入阴，故三才五仁通幽虎潜等法，所必用者也。若血液燥则气亦滞，致气血结痹，又当于养阴润燥中，加行气活血之品。若火腑秘结，宜苦滑重镇者，用更衣丸以通之。若老人阳衰风闭，用半硫丸温润以通之。腑阳不行，则用玉壶丹。阳窒阴凝，清浊混淆痞胀，用来复丹。若郁热阻气，则用苦寒泄热，辛以开郁，或用三焦通法。若湿热伤气，阻遏经腑，则理肺气以开降之。此治大便之闭也。小便闭者，若小肠火结，则用导赤。湿壅三焦，则用河间分消。膀胱气化失司，则用五苓。若湿郁热伏，致小肠痹郁，用小温中丸清热燥湿。若肾与膀胱阴分蓄热致燥，无阴则阳无以化，故用滋肾丸，通下焦至阴之热闭。以上诸法，前人虽皆论及，然经案中逐一分晰发明，不啻如耳提面命，使人得有所遵循矣。至若膏粱曲 ，酿成湿火，渍筋烁骨，用大苦寒坚阴燥湿，仍用酒醴引导，又厥阴热闭为癃，少腹胀满，用秽浊气味之品，直泄厥阴之闭，此皆发前人未发之秘，学人尤当究心焉。大凡小便闭而大便通调者，或系膀胱热结，或水源不清，湿症居多。若大便闭而小便通调者，或二肠气滞，或津液不流，燥症居多。若二便俱闭，当先通大便，小溲自利。此其大略也。至若胃腑邪热化燥便坚，太阳热邪传入膀胱之腑癃秘，又当于仲景伤寒门下法中，承气五苓等方酌而用之。斯无遗义矣。（华岫云）
大便燥结，本有承气汤、更衣等丸下之，外用猪胆蜜煎润之，可谓无遗蕴矣。然竟有效有
Ye (20 years old) Yang qi is stagnant and hyperactive. The fu organs have lost their function of conduction and transformation. After eating, there is fullness and stuffiness in the chest and epigastrium. Stool is dry and hard. During regulation, intake of alcohol, meat, and solid/congealed foods should be reduced. Using methods to diffuse and unblock the stagnant heat in the stomach and intestines can be effective.
(Stool retention with stagnant heat and dryness)
Coptidis Rhizoma (Huanglian), Aloe (Luhui), Radish Seed (Laifuzi), Fried Hawthorn Fruit (Chao Shanzha), Tangerine Peel (Guangpi), Toosendan Fruit (Chuanlianzi), Gardenia Fruit (Shanzhi), Magnolia Bark (Noupu) stir-fried with ginger juice, Green Tangerine Peel (Qingpi).
Second visit: Heat is stagnant and qi mechanism is obstructed. Adopt the method of unblocking the San Jiao (Triple Burner).
Apricot Seed (Xingren), Curcuma Aromatica Rhizome (Yujin), Magnolia Bark (Noupu), White part of Tangerine Peel (Guangpi Bai), Aloe (Luhui), Toosendan Fruit (Chuanlianzi).
Li (49 years old) Pulse remains as previously described. After taking salty and bitter herbs entering the Yin, stool remains constipated. After one acupuncture session, the condition has neither improved nor worsened. This can be considered a deep-seated and entrenched disease. The pathogen has penetrated deeply over time. Due to habitual consumption of alcohol and rich/flavorful foods, dampness is brewed and accumulates into heat, soaking the sinews and scorching the bones. Since it has been ill for many years without being cured, how can simple decoctions achieve clearance and expulsion? It is proposed to use great bitter-cold methods to consolidate Yin and dry dampness, incorporating wine as a guide. This also conforms to the profound principle of "seeking resonance with similar qi" (Damp-Fire pattern).
Phellodendron Bark (Huangbai), Atractylodes Rhizome (Maozhu), Raw Rhubarb Root (Sheng Dahuang), Earthworm (Gan Dilong), Golden-haired Dog Fern Rhizome (Jinmao Gouji), Coptis Rhizome (Chuanlian), Dioscorea Hypoglauca Rhizome (Bixie), Silkworm Frass (Wancansha), Pangolin Scales (Chuanshanjia), Podophyllum Emodi Root (Hanfangji), Epimedium Herb (Xianlingpi), Goldcoin Grass Herb (Haijinsha), Notopterygium Rhizome (Chuan Duohuo), Asarum Root (Bei Xixin), Pine Joint Oil (Yousongjie), White Eggplant Root (Baiqiegen). Half yellow wine, half sorghum liquor, soak for seven days.
Wu (Elderly woman) Right pulse is like yesterday's; left pulse is slightly small and moving. Liver wind is stirring, internal fluids are greatly dried. Further discuss using heavy, bitter, and slippery agents to unblock the Fire Fu organ. After six hours, stool passes smoothly and turbid matter descends. This also assists the Liver's preference for free flow and discharge (Fire Fu obstruction).
Gengyi Pill (Bianyi Wan), 1 qian 5 fen.
Jiang Spleen prefers ascending to be healthy; Stomach prefers descending to harmonize. Taiyin Spleen Earth requires Yang Qi to begin transportation; Yangming Stomach Earth finds peace through Yin. Because Spleen likes dryness and warmth, while Stomach likes softness and moisture. Zhang Zhongjing's urgent purgation to preserve fluids treats the Stomach. Li Dongyuan's great lifting of Yang Qi treats the Spleen. Now, the patient can eat but cannot transport. Physicians all point to Spleen weakness as the disease. However, compared to winter and spring, the pulse is vigorous and large, accompanied by wiriness. According to classics, a pulse that is exclusively large or exclusively small is a pathological pulse. Spleen belongs to Yin, Stomach belongs to Yang. A wiry and large pulse is not an image of Zang-Yin pathology. Having been ill for a long time with little food intake, yet barely sustaining oneself, combined with stool blockage and poor gas passage, sitting and talking for a moment leads to frequent belching. Usually suffering from hemorrhoids and intestinal bleeding, never comfortable. These pulse and symptoms indicate entirely that Stomach Qi does not descend, intestines are blocked, and the Fu organs have lost their control over conduction and transformation. Ancients said: Disharmony of the nine orifices all belong to Stomach disease. Diseases of the Six Fu organs are treated by promoting free flow as tonification. Years of regulation involved only Ginseng, Atractylodes, Cinnamon Twig, and Aconite Root, yet with no effect. There is no need to continue decoctions. It is proposed to imitate Danxi's Xiaowenzhong Wan. Take until seven days pass, allowing a cycle of the Three Yin and Three Yang, then re-discuss treatment principles (Damp-Heat Small Intestine Bi syndrome). Xiaowenzhong Wan, 2 liang (1 qian per dose).
Zhu Foot numbness and flaccidity/atrophy. Great heat damages Yin, internal stagnation. Stool does not pass. Condition worsened by emotional discomfort. First use Zishen Wan, 4 qian, taken with salt water, four doses (Kidney Dryness-Heat pattern).
Certain person Medicines guarding the Middle Jiao gradually cause fullness and distension. Urine is scant, stool is blocked, intestinal Qi is also stagnant. Disease prolonged becomes deficiency, difficult to take tonic decoctions. Propose taking Banliu Wan, 1 qian 5 fen daily with boiled water, to unblock the Yang of the meridians and Fu organs (Deficiency Wind Constipation).
Wu Advanced age. Both Qi and Yin are naturally deficient. In midsummer, atmospheric Qi dissipates, Liver wind rises violently. Symptoms resemble stroke. Since medication, all ailments have decreased. The complaint is still no bowel movement after ten days. Still elderly wind constipation. Reading ancient books, Banliu Wan is the first prescription. Now adopt its use. Banliu Wan, 1 qian, taken with boiled water, three doses.
Chen (38 years old) Used bitter medicines, instead had no bowel movement for fourteen days. Intestinal Yang Qi is blocked, Qi knots and forms masses. Not solved by Saltpeter and Rhubarb attacking hardness. Banliu Wan, 1 qian 2 fen.
Second visit: Yang Qi blocked, Turbid Yin coagulates causing fullness. Cheng Wuji calls this Yin Knot. Sweet taste in mouth, bloating at night, Clear and Turbid not separated. Take Laifu Dan, 1 qian 5 fen daily.
Gan (53 years old) Left pulse weak, right pulse wiry. Previous discussion suggested nighttime regurgitation and epigastric pain due to Turbid Yin attacking upwards. Said to digest porridge poorly, morning meal vomited out by evening, unchanged form. Fire and Earth do not generate, failing to rot and cook. Warming medicines are definitely correct principle. But Qi attacks the diaphragm, ultimately defecation is not smooth. Must be in the curved hidden places of the intestines, unable to rotate the mechanism. Wind movement causes rumbling. Propose using Banliu Wan.
Zhou (31 years old) Food intake reduced by more than half. Feces hard like pellets. Spleen and Stomach disease, treat from labor injury perspective (Blood and Fluid Dryness).
Angelica Sinensis Root (Danggui), Hemp Seed (Maren), Biota Seed (Baizi Ren), Cistanche Stem (Roucongrou), Pine Kernel (Songzi Rou).
Certain person Fluids consumed, Stomach weak, Fire rises, difficulty passing stool. Use Santian Tang plus Ophiopogon Tuber (Maidong), Poria (Fushen), Dendrobium Stem (Chuan Hu).
Asparagus Tuber (Tiantong), Rehmannia Root (Dihuang), Ginseng Root (Renshen), Ophiopogon Tuber (Maidong), Poria (Fushen), Dendrobium Stem (Chuan Hu).
Pan Spleen Blood and Kidney Essence long damaged. Yang fails to submerge. Unhealed for years. Damage extends to Stomach Fu, from Yin affecting Yang. Yue Ren (Bian Que) would fear this. Generally, Liver body is rigid, Kidney dislikes dryness. Bowel movement every five to six days. Urination occasionally turbid. Especially unsuitable for static astringent tonics.
Fried Goji Berry (Chao Qizi), Astragalus Complanatus Seed (Shayuan), Asparagus Tuber (Tiantong), White Peony Root (Baishao) mixed with wine, Poria (Fuling), Pig Spinal Cord (Zhujijin).
Second visit: Essence and Blood damaged, Five Fluids must be dry. Bowel movement every six to seven days. Use moistening agents to nourish below. After use, nocturnal emission occurs, and Yang climbs to the vertex. Method should be to subdue Yang and secure Yin.
Tortoise Shell and Plastron (Guijia), Heart of Tortoise (Xin), Rehmannia Root (Shengdi), Donkey-hide Gelatin (Ejiao), Cynomorium Stem (Suoyang), Dendrobium Stem (Chuan Shihu).
Gu (Elderly woman) Yangming pulse is large. Cramping pain in Ring Jump (Huantiao) and sacral bone sinews. Pain severe, foot sinews contract. Stool dry and difficult, often constipated. This is elderly blood depletion, internal dryness generating wind. From Spring rising Qi encroaching upwards, lower part lacks nourishment. Formerly Yu Ji said: Upper dryness treats Lung, Lower dryness treats Liver. Because Liver Wind Wood transverse, Stomach Earth must decline. Yangming meridians fail to bind sinews and bones and lubricate joints. Use slightly salty and slightly bitter methods entering Yin.
Fresh Rehmannia Root (Xian Shengdi, 8 qian), Donkey-hide Gelatin (Ejiao, 3 qian), Asparagus Tuber (Tiantong, 1.5 qian), Human Waste Ash (Renzhongbai, 1 qian), Dendrobium Stem (Chuan Hu, 2 qian), Halloysitum Rubrum (Hanshuishi, 1 qian).
Second visit: Salty and bitter treating lower entering Yin, condition already reduced. When late spring flowers bloom, Yang Qi fully rises upwards. Internal wind also transforms via Yang. Its lower Jiao lipid fluids are all drawn by Yang wind. The coming of dryness disease is based on this. High age, generation is scarce. Harmonizing Yang must use Yin medicines. This differs from directly attacking the disease.
(Pill Formula) Rehmannia Root (Shengdi, 3 qian), Donkey-hide Gelatin (Ejiao, 2 qian), Asparagus Tuber (Tiantong, 1 qian), Ophiopogon Tuber (Maidong, 1 qian), Biota Seed Powder (Baizi Shuang, 2 qian), Pine Kernel (Songzi Ren, 2 qian).
Huqian Wan remove Suoyang, add salty Cistanche and Pig Spinal Cord, make into pills.
Bao Yang rises, Wind Constipation.
Biota Seed (Baizi Ren), Angelica Sinensis Root (Danggui), Safflower (Honghua), Peach Kernel (Taoren), Apricot Seed (Yuliren), Achyranthes Root (Niuxi).
Wu Fluids consumed, difficulty passing stool. Advance pungent-sweet method.
Goji Berry (Qizi), Biota Seed (Baizi Ren), Angelica Root Body (Guishen), Poria (Fushen), Astragalus Complanatus Seed (Shayuan), Fried Hawthorn (Chao Shanzha).
Certain person Hunger, fullness, labor fatigue, Middle Jiao injured. Zhongwan pain, hypochondriac distension. Belching and gas passage bring relief, quiet brings peace. Stool difficult.
Biota Seed (Baizi Ren), Angelica Root Tip (Guixu), Spinach (Bocai), Chinese Chive (Jiucai), Trogopterus Dung (Wulingzhi), Peach Kernel (Taoren), Moutan Cortex (Danpi).
Certain person Advanced age, lower Jiao Yin weak, Qi of Six Fu organs not smooth. Much pain, cannot pass stool. This is pylorus disease. Pale face, small pulse, cannot use drastic purgation. Propose Five Seeds to moisten dryness, replacing Tongyou. This is the kingly way of treatment.
Hemp Seed (Huomaren), Apricot Seed (Yuliren), Biota Seed (Baizi Ren), Pine Kernel (Songzi Ren), Peach Kernel (Taoren), Angelica Sinensis Root (Danggui), White Peony Root (Baishao), Achyranthes Root (Niuxi).
Li (36 years old) Pulse small and weak, emaciated. Intestinal wind for a long time. In recent years, little food, difficulty passing stool. Getting belching and gas passage feels relieved. The Six Fu organs being unblocked is equivalent to tonification. Imitate Dongyuan's Tongyou intent.
Angelica Sinensis Root (Danggui), Peach Kernel (Taoren), Safflower (Honghua), Apricot Seed (Yuliren), Malva Seed (Dongkui Zi), Biota Seed Powder (Baizi Shuang), Aloe (Luhui), Pine Kernel (Songzi Rou). Decoct with water to paste, take 5 qian.
Jin (20 years old) After swallowing soup/drink, belching continues endlessly. No hunger, no appetite. Stool dry and hard like pellets. Generally, receiving and accepting food depends entirely on the stomach gate. Already suffering from rebellious Stomach Qi. Added to anger, Liver Wood Qi pierces diaphragm and invades Stomach, worsening the disease. Moreover, usually feels like a solid object stuck in throat. Pulse left section wiry and solid, resembling Blood Stagnation and Blood Knot. Advance pungent-warm-moistening method (Blood Knot pattern).
Peach Kernel (Taoren), Malva Seed (Dongkui Zi), Gleditsia Sinensis Fruit (Zaojia He), Apricot Seed (Yuliren), Rhubarb Root (Dahuang), Dalbergia Odorifera Tree (Xiangjiang), Curcuma Aromatica Rhizome (Yujin).
Li Claimed twice taking pungent-warm medicines, turbid stasis flowed out through the anus. This must be Heat-Stasis between Liver and Stomach collaterals, hence epigastric/hypochondriac fullness, stool blocked and unpassable. Aloe bitter-cold unblocks Yin, merely passed stool, ultimately failed to eliminate stasis and attack disease. Long-standing illness, should naturally attack slowly. Decoction cleansing is theoretically difficult to use.
Propose making Taoren Chengqi Wan (Peach Kernel and Da Huang Decoction Pills).
Certain person (30 years old) Left pulse wiry and rapid, urine short and painful (Urinary Retention). Daochi San add Moutan Cortex and Red Poria (Danpi Chiling).
Certain person White tongue, body heat, urination not smooth (Dampness Obstructing San Jiao).
Apricot Seed (Xingren, 1.5 qian), Platycodon Root (Jiegeng, 1 qian), Talcum (Huashi, 3 qian), Tetrapanax Pith (Tongcao, 1.5 qian), Forsythia Fruit (Lianqiao, 1.5 qian), Reed Rhizome (Lugen, 1 liang).
Wang Autumn summer miasma enters via inhalation. Chills and fever like malaria. Upper cough with phlegm, lower watery diarrhea. San Jiao all hot. Qi not transforming leads to urinary obstruction. Propose aromatic dispelling miasma, separating and draining heat. Essential that urine flows freely.
Agastache Rhizome (Huoxiang Geng), Magnolia Bark (Noupu), Sandalwood Juice (Tanxiang Zhi), Tangerine Peel (Guangpi), Quince (Muwa), Polyporus (Zhuling), Poria (Fuling), Alisma Rhizome (Zexie), Liu Yi San.
Second visit: Yesterday advanced dispersing formula, heat slightly reduced, urine slightly passed. All damp-heat miasma mixes in San Jiao, not mere speculation. Penile cyst is due to severe damp-heat sinking into Fu organs, differing from classic texts' penile swelling entries. Propose Hejian method.
Calcined Talcum (Fei Huashi), Gypsum Fibrosum (Shigao), Halloysitum Rubrum (Hanshuishi), Large Apricot Seed (Da Xingren), Magnolia Bark (Noupu), Polyporus (Zhuling), Alisma Rhizome (Zexie), Luffa Leaf (Siguye).
Third visit: Coptis Rhizome (Chuanlian), Light Scutellaria Root (Dan Huangqin), Raw White Peony Root (Sheng Baishao), Immature Bitter Orange (Zhishi), Liu Yi San, White Tangerine Peel (Guangpi Bai), Raw Barley Sprout (Sheng Guya).
Chen Summer heat cannot resolve, swelling and urinary retention. Should unblock Six Fu organs. Already presenting convulsions and coma, not a minor case.
Podophyllum Emodi Root (Fangji), Poria Skin (Fuling Pi), Polyporus (Zhuling), Tetrapanax Pith (Tongcao), Goldcoin Grass Herb (Haijinsha), Coix Seed (Yiyi Ren).
Second visit: Meridian and Fu organs blocked with heat and unsmooth, treatment focuses on Qi level. Doubtless San Jiao disease.
Talcum (Huashi), Gypsum Fibrosum (Shigao), Halloysitum Rubrum (Hanshuishi), Polyporus (Zhuling), Alisma Rhizome (Zexie), Decoct with Silkworm Frass (Cansha).
Third visit: Stabilize San Jiao dispersing.
Mustard Seed (Tingli), Apricot Seed (Xingren), Magnolia Bark (Noupu), Areca Seed (Dafupi), Polyporus (Zhuling), Alisma Rhizome (Zexie), Goldcoin Grass Herb (Haijinsha) decoct with water.
Chen (67 years old) Yesterday used Wuling to unblock Bladder, effective. Treatment from Qi level. Then chaotic treatment, urination stopped, loose stool. Urgently need to unblock Yang (Kidney Yang Obstruction).
Raw Dried Ginger (Sheng Ganjiang), Charred Black Aconite Root (Baohei Chuan Fuzi), mix in Pig Gallbladder Juice.
Kong (62 years old) Rich diet body full and robust. Young adult unaware. Accumulation brewing long time, damp-heat obstructs and blocks. Causes Small Intestine Fire Fu to lose transformation and conduction functions. Two excretions blocked increasingly day by day. Right hypochondriac obstruction pain. Should use bitter medicines to regulate, must achieve slight effect (Both Excretions Blocked, Small Intestine Fire Knot).
Aloe (Luhui), Toosendan Fruit (Chuanlianzi), Apricot Seed (Yuliren), Fried Peach Kernel (Chao Taoren), Angelica Root Tip (Guixu), Safflower (Honghua).
Night take Xiaowenzhong Wan, 2 qian.
Gao Much depression and anger, all Qi blocked, intestines and stomach fail circulation. Touching solid masses, it is Liver-Gallbladder rebellious Qi. Wood must invade Earth, vomiting/coughing nausea, causing daily decrease in food intake. Forced to take food/water, Small Intestine curves fail transformation, leading to unsatisfactory two excretions. So-called insufficiency combined with excess. Doctors must not ignore.
(Damp-Heat Small Intestine Bi Syndrome) Danxi Xiaowenzhong Wan, 2 qian 5 fen per dose.
Shao (23 years old) Qi attacks abdomen, hypochondrium, throat, epigastrium. Relief obtained after urination/gas passage. This disease caused by irregular eating, Small Intestine curved places fail rotation and operation, both excretions unsatisfactory. Should use Danxi Xiaowenzhong Wan.
Jin Damp-heat in meridians, doctors did not match symptoms, thus causing whole body Qi obstruction, pathogen spreading, swelling red lumps. Initially damp-heat caused diarrhea, now orifices closed, causing two excretions blocked. Only regulating Lung Qi, pathogen can be diffused (Damp-Heat Lung Qi Not Descending). Weijing Tang remove Melon Seed, add Talcum, Tetrapanax Pith, Watermelon Rind (Xigua Cuiyi).
Xu Summer heat-dampness, all affect Qi level first, Lung injured first, Qi fails to descend, causing two excretions retention. This nourishing blood dryness is ineffective. Now slightly safe, should generate fluids, clear and nourish Stomach Yin.
Ophiopogon Tuber (Maidong), Anemarrhena Rhizome (Zhimu), Sweet Apricot Seed (Tian Xingren), Ampelopsis Rhizome (Baisha Shen), Triangular Sesame (Sanjiao Huma).
Gu (42 years old) Abdominal fullness firm, foot/shin pain/swelling, both excretions not smooth. Due to damp-heat obstructing Fu Qi. This is not Middle Deficiency, should use dispersing/unblocking method (Damp-Heat Obstructing Fu Organs).
Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Magnolia Bark (Noupu), Immature Bitter Orange (Zhishi), Green Tangerine Peel (Qingpi), Radish Seed (Buzi), Moutan Cortex (Danpi), Gardenia Bark (Shanzhi Pi).
Certain person Lower abdominal distension/pain, both excretions blocked (Fu Yang Not Acting). Yuhu Dan.
Li (34 years old) Can eat knowing taste, bloating after eating past time. Urination not smooth, Qi sinking refuses to exit. Stool once every four days. Treat Small Intestine Fire Fu.
(Fire Fu Obstruction)
First use Zishen Wan. Take 3 qian every morning, sent down with light salt water.
Certain person Abdominal fullness, should unblock Fire Fu. Bianyi Wan, 1 qian 6 fen.
Certain person Pulse rapid/moving, tongue dry white, no desire to drink water. Entering summer, pain attacking around umbilicus left/right, rice drink relieves pain, returns after time. Six-seven days no stool, very little urine. Location in Small Intestine, curved obstruction causes pain, not rashly diagnosing parasite disease. Generally Six Fu organs should be unblocked, unblocked means no pain. Use Bianyi Wan, 2 qian, specifically unblocking Fire Fu congestion. One dose.
Wang Recent days difficulty passing stool, urine涩 (astringent/stagnant). Lower Jiao pylorus Qi dull, Blood dry. Discuss Dongyuan Tongyou intent (Blood Fluid Dryness).
Salty Cistanche (Xian Rongrou, 1 liang), Fine Rehmannia Root (Xi Shengdi, 2 qian), Angelica Sinensis Root (Danggui, 1.5 qian), Apricot Seed (Yuliren, 2 qian ground), Biota Seed Powder (Baizi Shuang, 1.5 qian), Achyranthes Root (Niuxi, 2 qian).
Zhang (49 years old) Lower abdomen slightly distended, relief only when urination smooth. Stool once every three-four days, extremely dry/hard. Lower Jiao diseases must trace Liver-Kidney, Fu collaterals must investigate pylorus and two intestines. Reviewing taken medicines, it is Xiangsha Liujun treating Spleen, forgetting Kidney dislikes dryness?
Angelica Sinensis Root (Danggui), Cistanche (Rongrou), Apricot Seed (Yuliren), Malva Seed (Dongkui Zi), Achyranthes Root (Niuxi), Small Fennel (Xiaohui), Poria (Fuling), Plantago Seed (Cheqian). Honey pills.
Zhang (66 years old) Left pulse wiry like blade, sixty-six years old, True Yin declines, Five Fluids exhausted. Urine bloody water, drop by drop unsatisfactory. Lower abdomen/right hypochondrium mass accumulation. This belongs to urinary retention, not like young/adult clearing fire and unblocking effective.
Biota Seed Powder (Baizi Shuang), Small Fennel (Xiaohui), Deer Antler Glue (Lujiaoshuang), Poria (Fuling), Angelica Sinensis Root (Danggui), Cistanche (Rongrou).
Ma (36 years old) Pulse solid, disease long time stasis-heat in Blood, chest uncomfortable, lower abdomen sagging, can eat no thirst, two excretions scant/astringent. Twice advanced pungent-bitter unblocking Fu, disease not eliminated. This belongs to Blood disease, use Tongyou method (Qi-Blood Knot Bi).
Peach Kernel (Taoren), Safflower (Honghua), Apricot Seed (Yuliren), Processed Rhubarb (Zhi Dahuang), Angelica Root Tip (Guixu), Small Fennel (Xiaohui), Cinnamon Twig Wood (Guizhi Mu), Toosendan Fruit (Chuanlianzi).
Xue (Elderly woman) Unsatisfactory large/small bowel movements. Ancients often use unblocking collaterals, simultaneously entering extraordinary vessels. Sixty years old, also long disease. Advancing Qi-dispersing Fu-unblocking ineffective. Propose dual unblocking Lower Jiao Qi-Blood formula.
Ligusticum Rhizome (Chuanxiong, 1 liang vinegar fried), Angelica Sinensis Root (Danggui, 1 liang vinegar fried), Raw Rhubarb (Sheng Dahuang, 1 liang), Cinnamon Bark (Rougui, 3 qian), Toosendan Fruit (Chuanlianzi, 1 liang), Green Tangerine Peel (Qingpi, 1 liang).
Curcuma Zedoaria Rhizome (Pengzhu, roasted 5 qian), Burret Rhizome (Sanleng, roasted 5 qian), Trogopterus Dung (Wulingzhi, vinegar fried 5 qian), Fried Black Hawthorn Flesh (Chaohei Zharon, 1 liang), Small Cyperus Rhizome (Xiao Xiangfu, vinegar fried 1 liang).
Grind to powder. Use green onion white roots removed, pounded rotten, add little clear water filter clear juice, make pills. Take 3 qian during meals. Use five red dates, three fen raw mugwort leaf, decoct one cup tea to take medicine.
Wang Long travel labor, Liver-Kidney Qi lacking, failing constraint. Anal pain/sagging. If ulcer disease, initial stage must have chills/fever. Detoxifying medicines bitter-pungent-cold-dry, Lower Jiao Yin-Yang again injured, two excretions astringent. This is urinary retention, back cold vexation/thirst, lower abdomen full/distension. Propose unblocking Jueyin (Jueyin Heat Closure).
Old Leek Root (Laojiugen), Pangolin Scales (Chuanshanjia), Two-headed尖的 (Liangtoujian), Toosendan Fruit (Chuanlianzi), Angelica Root Tip (Guixu), Small Fennel (Xiaohui), Tangerine Peel (Juhong), Frankincense (Ruxiang).
Second visit: Discharge turbid drain Liver, merely gas passage, two excretions still cannot pass. Imitate Dongyuan treating Wang Shanfu urinary retention intent, Zishen Wan 3 qian, three doses.
Third visit: Qi stagnant in intestines, two excretions cross-blocked. Clearify Stomach-Intestine stagnant heat.
Coptis Rhizome (Chuanlian), Phellodendron Bark (Huangbai), Toosendan Fruit (Chuanlianzi), Evodia Fruit (Wuyu), Black Gardenia (Heishanzhi), Green Tangerine Peel (Qingpi).
Tetrapanax Pith (Tongcao, 5 qian), Goldcoin Grass Herb (Haijinsha, 5 qian), decoct water substitute water.
Fourth visit: Bitter-pungent already effective, should restrict dosage.
Coptis Rhizome (Chuanlian), Black Gardenia (Heishanzhi), Moutan Cortex (Danpi), Toosendan Fruit (Chuanlianzi), Evodia Fruit (Wuyu), Goldcoin Grass Herb (Haijinsha), Calcined Talcum (Fei Huashi).
Commentary on Constipation: Should refer to Intestinal Bi and Lin/Turbid sections. For stool not passing, if Blood-Fluid dry, use nourishing Blood moistening dryness. If Blood dry generating wind, use pungent-sweet extinguishing wind, or salty-bitter entering Yin. Thus Santian, Five Seeds, Tongyou, Huqian etc. methods are necessary. If Blood dry then Qi also stagnant, causing Qi-Blood knot bi, should add moving Qi activating Blood products among nourishing Yin moistening dryness. If Fire Fu secreted/knotted, suitable for bitter-slheavy sedatives, use Bianyi Wan to unblock. If elderly Yang decline wind closure, use Banliu Wan warm-moist to unblock. Fu Yang not acting, use Yuhu Dan. Yang blocked Yin coagulated, Clear-Turbid confused fullness, use Laifu Dan. If stagnant heat obstructs Qi, use bitter-cold clearing heat, pungent opening stagnation, or use San Jiao unblocking method. If damp-heat injures Qi, obstructing meridians/Fu, regulate Lung Qi to open/descend. This treats stool closure. For urine closure: if Small Intestine Fire knot, use Daochi. Dampness obstructing San Jiao, use Hejian dispersing. Bladder Qi transformation failure, use Wuling. If damp-stagnant heat lurking causing Small Intestine Bi stagnation, use Xiaowenzhong Wan clearing heat drying dampness. If Kidney/Bladder Yin portion accumulating heat causing dryness, without Yin Yang cannot transform, thus use Zishen Wan, unblocking Lower Jiao extreme Yin heat closure. Above methods, predecessors discussed, but in cases analyzed and explained one by one, like ear-tugging-face-commanding, making people have guidelines. Regarding rich food fermentation brewing damp-fire, soaking sinews/scorching bones, using great bitter-cold consolidating Yin drying dampness, still using wine guiding. Also Jueyin heat closure causing retention, lower abdomen full/distension, using foul-smelling substances directly draining Jueyin closure. These all reveal predecessors' undiscovered secrets, learners especially should study. Generally urine closed stool smooth: either Bladder heat knot, or unclear water source, mostly dampness. If stool closed urine smooth: either two intestines Qi stagnation, or fluids not flowing, mostly dryness. If both excretions closed, should first unblock stool, urine will naturally benefit. This is general outline. Regarding Stomach Fu pathogenic heat transforming dryness stool hard, Taiyang heat pathogen transmitting to Bladder Fu retention, should in Zhongjing Shanghan门下 methods, Chengqi, Wuling etc. formulas consider and use. Then no missing meaning. (Hua Xiuyun)
Stool dry knot, originally has Chengqi Tang, Bianyi etc. pills to purge externally, pig gall honey fry moisten externally. Can be said no missing essence. Yet actually effective and...