张 食进脘中难下。大便气塞不爽。肠中收痛。此为肠痹。（肺气不开降）
大杏仁 枇杷叶 川郁金 土栝蒌皮 山栀 香豉
夏（二十） 食下 胀。旬日得一更衣。肠胃皆腑。以通为用。丹溪每治肠痹。必开肺气。
谓表里相应治法。
杏仁 紫菀 冬葵子 桑叶 土栝蒌皮
又 肠痹开肺不效。用更衣丸三钱。
吴 身重不能转移。尻髀板着。必得抚摩少安。大便不通。小溲短少。不饥少饮。此时序湿邪。蒸
郁化热。阻于气分。经腑气隧皆阻。病名湿痹。
木防己（一钱） 杏仁（二钱） 川桂枝（一钱） 石膏（三钱研） 桑叶（一钱） 丹皮（一钱）
又 舌白。不渴不饥。大便经旬不解。皮肤麻痒。腹中鸣动。皆风湿化热。阻遏气分。诸经脉络皆
闭。昔丹溪谓肠痹。宜开肺气以宣通。以气通则湿热自走。仿此论治。
杏仁 栝蒌皮 郁金 枳壳汁 山栀 香豉 紫菀
沈（二五） 湿结在气。二阳之痹。丹溪每治在肺。肺气化。则便自通。
紫菀 杏仁 枇杷叶 土栝蒌皮 郁金 山栀皮 枳壳汁 桔梗汁
蒋（三一） 肺痹。鼻渊。胸满。目痛。便阻。用辛润自上宣下法。
紫菀 杏仁 栝蒌皮 山栀 香豉 白蔻仁
董 高年疟后。内伤食物。腑气阻痹。浊攻腹痛。二便至今不通。诊脉右部弦搏。渴思冷冻饮料。昔丹
溪大小肠气闭于下。每每开提肺窍。内经谓肺主一身气化。天气降。斯云雾清。而诸窍皆
为通利。若必以消食辛温。恐胃口再伤。滋扰忧症。圣人以真气不可破泄。老年当遵守。
紫菀 杏仁 栝蒌皮 郁金 山栀 香豉
又 舌赤咽干。阳明津衰。但痰多不饥不食。小溲不爽。大便尚秘。仿古人以九窍不利。咸推胃
中不和论治。
炒半夏 竹茹 枳实 花粉 橘红 姜汁
叶（女） 二便不通。此阳痹。当治在肺。
紫菀 杏仁 蒌皮 郁金 黑山栀 桔梗
又 威喜丸。
某 瘅疟肺病。未经清理。致热邪透入营中。遂有瘀血暴下。今诊舌白不渴。不能纳食。大便九
日不通。乃气痹为结。宗丹溪上窍闭。则下窍不出矣。
杏仁 枇杷叶 栝蒌皮 川郁金 香豉 苡仁
又 用手太阴药。即思纳谷。阳明气痹无疑。
紫菀 杏仁 枇杷叶 栝蒌皮 郁金 黑山栀
肠痹本与便闭同类。今另分一门者。欲人知腑病治脏。下病治上之法也。盖肠痹之便闭。
较之燥屎坚结欲便不通者稍缓。故先生但开降上焦肺气。上窍开泄。下窍自通矣。若燥
屎坚闭。则有三承气。润肠丸。通幽汤。及温脾汤之类主之。然余谓便闭之症。伤寒门中。当
急下之条无几。余皆感六淫之邪。病后而成者为多。斯时胃气未复。元气已虚。若遽用下
药。于理难进。莫若外治之法为稳。用蜜煎导法。设不通爽。虚者间二三日再导。余见
有渐导渐去燥粪五六枚。或七八枚。直至二旬以外第七次。导去六十余枚而愈者。
此所谓下不嫌迟也。学人不可忽诸。（华玉堂）
张姓患者：进食后食物在胃脘中难以下行。大便时感觉气机堵塞，排便不畅。肠道中有收缩性疼痛。这是肠痹证。（因肺气不能宣发肃降所致）
处方：大杏仁、枇杷叶、川郁金、土栝蒌皮、山栀、香豉。
夏姓患者（二十岁）：进食后感到腹胀。十天才能解一次大便。肠胃都属于六腑，以通畅为用。丹溪先生每次治疗肠痹，必定要开通肺气。
认为这是表里相应的治疗方法。
处方：杏仁、紫菀、冬葵子、桑叶、土栝蒌皮。
吴姓患者：身体沉重，无法移动。臀部和大腿僵硬板着，必须经过抚摸按摩才稍微舒适。大便不通。小便短少。没有饥饿感，饮水很少。此时正值时令湿邪，蒸腾郁结化为热邪，阻滞于气分。经络和腑的气机通道都受阻。病名湿痹。
处方：木防己（一钱）、杏仁（二钱）、川桂枝（一钱）、石膏（三钱，研细）、桑叶（一钱）、丹皮（一钱）。
再次就诊：舌苔白。不口渴，没有饥饿感。大便超过十天未解。皮肤麻木瘙痒。腹中鸣动。这都是风湿化热，阻遏气分，导致各经脉络都闭塞。过去丹溪先生说肠痹，适宜开通肺气以宣通，因为气机通畅则湿热自然排出。仿照此理论进行治疗。
处方：杏仁、栝蒌皮、郁金、枳壳汁、山栀、香豉、紫菀。
沈姓患者（二十五岁）：湿气结滞在气分，属于阳明经的痹证。丹溪先生每次治疗都在肺，肺气化行，则大便自然通畅。
处方：紫菀、杏仁、枇杷叶、土栝蒌皮、郁金、山栀皮、枳壳汁、桔梗汁。
蒋姓患者（三十一岁）：肺痹。鼻渊（鼻流浊涕）。胸满。眼睛疼痛。大便阻塞。使用辛润之法，从上焦宣散，向下疏导。
处方：紫菀、杏仁、栝蒌皮、山栀、香豉、白蔻仁。
董姓患者：年高之人患疟疾后，内伤饮食。腑气阻滞痹塞。浊气攻冲引起腹痛。大小便至今不通。诊脉右部弦而搏指。口渴想喝冷冻饮料。过去丹溪先生说大小肠气闭于下，每每通过开提肺窍来治疗。《内经》说肺主一身的气化，天气下降，云雾自清，那么各个孔窍都会通利。如果一定要用消食辛温的药物，恐怕会再次损伤胃口，滋扰忧症。圣人认为真气不可破泄，老年人应当遵守这一原则。
处方：紫菀、杏仁、栝蒌皮、郁金、山栀、香豉。
再次就诊：舌质红，咽干。阳明津液衰少。只是痰多，没有饥饿感，不想吃东西。小便不爽。大便仍然秘结。仿照古人关于九窍不利，都推究为胃中不和的理论进行治疗。
处方：炒半夏、竹茹、枳实、花粉、橘红、姜汁。
叶姓患者（女）：大小便不通。这是阳痹。应当治肺。
处方：紫菀、杏仁、蒌皮、郁金、黑山栀、桔梗。
再次就诊：威喜丸。
某患者：瘅疟导致肺病，未经过清理，致使热邪透入营分。于是有瘀血暴下。现在诊察舌苔白且不渴，不能进食。大便九天不通。这是气痹凝结。遵循丹溪先生“上窍闭，则下窍不出”的理论。
处方：杏仁、枇杷叶、栝蒌皮、川郁金、香豉、苡仁。
再次就诊：使用手太阴肺经的药物，就开始想吃东西了。阳明气痹无疑。
处方：紫菀、杏仁、枇杷叶、栝蒌皮、郁金、黑山栀。
肠痹本来与便秘同类，现在单独分出一门，是想让人知道腑病治脏、下病治上的方法。大概肠痹引起的便秘，比之燥屎坚结想要排便却不通的情况稍缓。所以先生只开通降上焦肺气，上窍开泄，下窍自然通畅。如果是燥屎坚闭，则有三承气汤、润肠丸、通幽汤以及温脾汤之类的主治。然而我认为便秘的症状，在伤寒门类中，需要急下的条文极少。其余大多是因为感受六淫之邪，病后形成的。此时胃气未恢复，元气已虚弱，如果立刻使用下药，从道理上讲难以进服。不如外治法稳妥。使用蜜煎导法。如果仍不通畅，虚证患者间隔两三天再导。我见过逐渐导去五六枚，或七八枚干燥粪便，直到二十天以外第七次，导去六十多枚而痊愈的。
这就是所谓的“下不嫌迟”。学习者不可忽视这一点。（华玉堂记录）
Patient Zhang: Food feels difficult to descend after entering the stomach. Bowel movements feel obstructed by Qi, with unsmooth defecation. There is contracting pain in the intestines. This is Intestinal Bi (Intestinal Obstruction due to Qi stagnation) [caused by Lung Qi failing to diffuse and descend].
Prescription: Da Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Chuan Yu Jin (Curcuma Aromatica Rhizome), Tu Gua Lou Pi (Trichosanthes Peel), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean).
Patient Xia (20 years old): Abdominal distension occurs after eating. Defecation happens only once every ten days. The Large Intestine and Small Intestine are both Fu organs (Hollow Organs), whose function relies on patency. Mr. Danxi always treated Intestinal Bi by opening Lung Qi first.
This is considered a treatment method based on the correspondence between interior and exterior.
Prescription: Xing Ren (Apricot Seed), Zi Wan (Aster Root), Dong Kui Zi (Malva Seeds), Sang Ye (Mulberry Leaf), Tu Gua Lou Pi (Trichosanthes Peel).
Re-consultation: Treatment of Intestinal Bi using the method of opening Lung Qi was ineffective. Changed to Geng Yi Wan (Change Stool Pill), 3 qian.
Patient Wu: Heavy body, unable to move. The buttocks and thighs feel stiff and rigid, requiring massage for slight relief. No bowel movement. Urine is scanty. No hunger, drinking little. At this time, seasonal Dampness pathogen steams and stagnates, transforming into Heat, blocking the Qi level. The Qi pathways of meridians and Fu organs are all obstructed. The disease name is Damp Bi (Dampness Obstruction).
Prescription: Mu Fang Ji (Stephania Tetrandra, 1 qian), Xing Ren (Apricot Seed, 2 qian), Chuan Gui Zhi (Cinnamon Twig, 1 qian), Shi Gao (Gypsum Fibrosum, 3 qian, crushed), Sang Ye (Mulberry Leaf, 1 qian), Dan Pi (Moutan Cortex, 1 qian).
Re-consultation: White tongue coating. No thirst, no hunger. Bowel movement has not occurred for over ten days. Skin feels numb and itchy. Borborygmus in the abdomen. All these are due to Wind-Damp transforming into Heat, obstructing the Qi level, causing closure of various meridian collaterals. In the past, Mr. Danxi stated that for Intestinal Bi, it is suitable to open Lung Qi to promote circulation; because when Qi flows smoothly, Damp-Heat naturally exits. Following this theory for treatment.
Prescription: Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Zhi Ke Zhi (Bitter Orange Juice), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean), Zi Wan (Aster Root).
Patient Shen (25 years old): Dampness knots in the Qi level, constituting Bi syndrome of the Yangming channels. Mr. Danxi always treated such cases focusing on the Lung; when Lung Qi transforms and moves, stool passes naturally.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Tu Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Shan Zhi Pi (Gardenia Bark), Zhi Ke Zhi (Bitter Orange Juice), Jie Geng Zhi (Platycodon Juice).
Patient Jiang (31 years old): Lung Bi. Bi Yuan (Nasal Sinusitis with turbid discharge). Chest fullness. Eye pain. Blocked stool. Using Acrid-Moistening method to disperse from above and guide down.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean), Bai Kou Ren (White Cardamom Seed).
Patient Dong: Elderly patient, post-malaria, internal injury from food. Fu Qi obstruction and bi-stagnation. Turbid Qi attacking causes abdominal pain. Both urine and stool have been blocked until now. Pulse diagnosis shows the right position is wiry and forceful. Thirsty, desiring cold drinks. In the past, Mr. Danxi said that when Qi of the Large and Small Intestines is closed below, one often opens the Lung orifices to treat it. The *Neijing* states that the Lung governs the Qi transformation of the whole body. When Heavenly Qi descends, clouds and mist clear, and all orifices become patent. If one insists on using digestive, acrid-warm medicines, it may further damage the stomach appetite and disturb the mind. The Sages teach that True Qi must not be broken or drained; the elderly should abide by this.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean).
Re-consultation: Red tongue, dry throat. Yangming fluids are deficient. Only much phlegm, no hunger, anorexia. Urination is unsatisfactory. Stool remains constipated. Following the ancients' theory that dysfunction of the nine orifices is attributed to disharmony in the Stomach.
Prescription: Chao Ban Xia (Processed Pinellia Tuber), Zhu Ru (Bamboo Shavings), Zhi Shi (Immature Bitter Orange), Hua Fen (Trichosanthes Root), Ju Hong (Tangerine Peel), Jiang Zhi (Ginger Juice).
Patient Ye (Female): Blockage of both urine and stool. This is Yang Bi. Treatment should focus on the Lung.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Hei Shan Zhi (Blackened Gardenia Fruit), Jie Geng (Platycodon Root).
Re-consultation: Wei Xi Wan (Wei Xi Pill).
Certain Patient: Dan Nue (Feverish Malaria) caused Lung disease, which was not cleared properly, leading Heat pathogens to penetrate into the Ying (Nutrient) level. Consequently, sudden massive bleeding of Blood stasis occurred. Current pulse/tongue shows white coating, no thirst, inability to eat. No bowel movement for nine days. This is Qi Bi (Qi Obstruction) forming a knot. Following Mr. Danxi's principle: "If the upper orifices are closed, the lower orifices cannot exit."
Prescription: Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Gua Lou Pi (Trichosanthes Peel), Chuan Yu Jin (Curcuma Aromatica Rhizome), Xiang Chi (Fermented Soybean), Yi Yi Ren (Coix Seed).
Re-consultation: After using herbs of the Hand-Taiyin Lung Meridian, the patient began to desire food. Yangming Qi Bi is undoubtedly confirmed.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Hei Shan Zhi (Blackened Gardenia Fruit).
Intestinal Bi is essentially similar to Constipation. It is separated into another category here to make learners aware of the methods of treating Zang organs for Fu diseases, and treating upper areas for lower diseases. Generally, constipation caused by Intestinal Bi is slightly slower/milder than that caused by hard, dry fecal impaction where defecation is impossible. Therefore, the Master only opens and descends the Lung Qi of the Upper Jiao. Once the upper orifices are opened and released, the lower orifices naturally become patent. If it is hard, dry fecal impaction, then San Cheng Qi Tang (Three Decoctions for Purging), Run Chang Wan (Moisten Intestines Pill), Tong You Tang (Unblock the Abyss Decoction), and Wen Pi Tang (Warm the Spleen Decoction) are indicated. However, I believe that among symptoms of Constipation, there are very few instances in the Shang Han (Cold Damage) chapters requiring urgent purgation. Most others arise after illness due to contraction of the Six Exogenous Pathogens. At this time, Stomach Qi has not recovered, and Yuan Qi (Original Qi) is already deficient. If purgative drugs are used abruptly, it is theoretically inappropriate. It is better to use external treatment methods for stability. Use Mi Jian Dao (Honey Suppository) method. If still not smooth, for deficiency patterns, wait two or three days before supposing again. I have seen cases where gradually expelled five or six, or seven or eight pieces of dry feces, until the seventh time after twenty days, expelling more than sixty pieces in total, resulting in cure.
This is what is meant by "purging need not be rushed." Students must not ignore this. (Recorded by Hua Yutang)