人身秽浊二便消，通则浊降塞则淆（便通则浊降清升，否则清浊混淆矣）。小便不通膀
胱热，用药可与淋同条。小便不禁膀胱火，火邪妄动难自料。水不得安故不禁，二神丸合桑
螵蛸（川连、川芎、甘草、生地、当归）。大便不通肠液竭，活血润燥方无抛。二便闭时肝肾
热，八正散服两可消。肛门秘结肺热致，肺与大肠表里明。脱肛肺脏虚寒甚，泻痢入虚陷下
遭。汤用补中益气妙，热脱四物知柏邀。
阴茎囊肿，是湿甚而下坠入府，用河间法。
石膏 寒水石 杏仁 泽泻 滑石 紫川朴 猪苓
小便不通，小肠火结
导赤散加丹皮 赤茯苓
膀胱气化失司
用五苓散
湿壅三焦（用河间分消法）
杏仁 桔梗 滑石 川朴 连翘 木通 香薷 陈皮 猪苓 木瓜 川连 寒水石
泽泻 芦根 黄芩 海金沙 防己 生石膏 枳壳 六一散
湿郁热伏小肠痹
用小温中丸
肾阳不通
五苓散加干姜 炮姜 附子 猪胆汁
肾与膀胱阴分蓄热致燥，无阴则阳无以化，用
滋肾丸 通下焦至阴之热闭。
湿热大肠痹
宜清热燥湿小温中丸。
大便秘，火腑不通
用更衣丸
湿火便秘（用大苦寒坚阴燥湿法）
川柏 萆 独活 海金砂 细辛 川连 防己 蚕砂 川锦纹
肾燥热便难（宜温通下焦，用滋肾丸）
郁热燥结气阻（苦寒泄热，辛以开郁，此三焦通治法）
川连 莱菔子 川楝子 广皮 芦荟 炒山楂 炒山栀 制朴 青皮 赤茯苓 杏仁 广郁金
血结便秘
桃仁泥 冬葵子 川郁金 郁李仁 降真香
又方 桃仁承气汤
血液枯燥，大便不通（宜养血润燥为法）
归身 柏子仁 麦冬 沙苑子 麻仁 松子仁 茯苓 奎白芍
又方 生地 阿胶 龟版
又方 红花 牛膝 菠菜 五灵脂 桃仁 丹皮 韭菜 郁李仁
又方 枸杞子 天冬 人中白 川萆
三才汤 五仁汤 虎潜丸去琐阳 加淡苁蓉 通幽汤 生地 红花 熟地 桃仁 甘草 归身 升麻
老年阳衰风闭（用温润通调之法）
半硫丸
二便闭，小肠火结
芦荟 川楝子 桃仁 夜分胀用小温中丸 红花 当归须 李仁
湿热肺气不降
苇茎 桃仁 西瓜 翠衣 滑石 通草
又养胃法 北沙参 麦冬 杏仁 薏仁 知母
湿热壅腑便闭
川连 山栀皮 枳实 青皮 黄芩 莱菔子 川朴 丹皮
气血结痹便闭
川楝子 桃仁 川桂枝 当归须 郁李仁 红花 制川军 小茴香 川芎 山楂炭
肉桂 葱白 青皮 五灵脂 香附
血枯经阻便涩
大生地 牛膝 郁李仁 归身 车前子 淡苁蓉 柏仁 冬葵子 茯苓 小茴香
厥阴热闭
二便皆涩，少腹胀满，背寒烦渴，此为癃闭，当用秽浊气味之品，直泻厥阴之闭。
两头尖 韭根 小茴香 橘红 穿山甲 归须 川楝子 乳香 川连 山栀 通草
海金沙 川柏 淡吴萸 青皮 滑石
又仿李东垣治癃闭法，用滋肾丸。
陈参曰∶凡小便闭而大便通调者，或膀胱热结，或水源不清，湿症为多。大便闭而小便
通调者，或大肠气滞，或津液不流，燥症居多。二便俱闭当先通大便，则小便自利矣。肾司二
便，肝主疏泄，须辨阴结阳结，或下病治上之法，开提肺气。喻嘉言∶上燥治肺，下燥治肝。
脱肛，湿热气虚下陷
从东垣治法，用补中益气汤 人参 西 于术 甘草 陈皮 当归 柴胡 大枣 升麻 生姜
脱肛，纯属气虚下陷
人参 归身 白术 广皮 绿升麻 川连 白芍 炙草 乌梅 石莲子
肾气不归（少腹痛，肛坠，便滑）
熟地 五味 远志肉 怀山药炭 茯苓 萸肉 菟丝饼 禹余粮
年老气陷脱肛
人参 补骨脂 阳起石 鹿茸 大茴香
又 禹粮石脂丸
陈参曰∶脱肛一症，有因泻痢气陷而脱者，有因中气虚寒不能收摄而脱者，有因酒湿
欲伤而脱者，有因肾虚湿注而脱者。或年老气血已衰，或年少气血未旺，亦致脱肛。经云∶下
者举之。徐之才曰∶涩可去脱。皆治脱肛之法。《叶天士指南》治此症不外升举、固涩、益气三
法。对气热血热肛而反挺出者，则用芩连槐柏皮四物升柴之类。然亦间有此症，非可训之
法，存之以备一说。脱肛症不宜过用苦凉，大约以叶氏治法为正。
人体内的秽浊物质通过大小便排出，二便通畅则浊气下降、清气上升；若不通畅，则清浊之气相互混淆。小便不通是由于膀胱有热，用药可与治疗淋证（以尿频、尿急、尿痛为主要表现的病证）的方法相同。小便不禁是由于膀胱火邪妄动，难以预料和控制。水液不能安守故道导致小便失禁，可用二神丸合桑螵蛸散（方中包含黄连、川芎、甘草、生地、当归等药）。大便不通是由于肠道津液枯竭，采用活血润燥的方剂不可抛弃不用。二便同时闭结是由于肝肾有热，服用八正散可以消除。肛门秘结是由肺热引起，因为肺与大肠互为表里，关系明确。脱肛是由于肺脏虚寒严重，在泻痢过程中正气虚弱，气陷而下脱所致。汤剂使用补中益气汤效果奇妙；若是热性脱肛，则需选用四物汤合知柏地黄丸。
阴茎囊肿，是湿气过重向下坠入阴器所致，采用刘河间的治疗方法。
药物：石膏、寒水石、杏仁、泽泻、滑石、紫川朴（厚朴）、猪苓。
湿气壅滞三焦（采用刘河间的分消走泄法）。
药物：杏仁、桔梗、滑石、川朴（厚朴）、连翘、木通、香薷、陈皮、猪苓、木瓜、川连（黄连）、寒水石、泽泻、芦根、黄芩、海金沙、防己、生石膏、枳壳、六一散。
肾与膀胱阴分蓄积热邪导致干燥，无阴则阳气无法化生，使用滋肾丸以通利下焦至阴之处的热闭。
湿火便秘（采用大苦寒坚阴燥湿法）。
药物：川柏（黄柏）、萆薢、独活、海金砂、细辛、川连（黄连）、防己、蚕砂、川锦纹（大黄）。
郁热燥结且气机阻滞（苦寒泄热，辛味开郁，这是三焦的通治方法）。
药物：川连（黄连）、莱菔子、川楝子、广皮（陈皮）、芦荟、炒山楂、炒山栀、制朴（厚朴）、青皮、赤茯苓、杏仁、广郁金。
血结导致便秘。
药物：桃仁泥、冬葵子、川郁金、郁李仁、降真香。
又一方：桃仁承气汤。
血液枯燥，大便不通（宜养血润燥为治法）。
药物：归身（当归身）、柏子仁、麦冬、沙苑子、麻仁、松子仁、茯苓、奎白芍（白芍）。
又一方：生地、阿胶、龟版。
又一方：红花、牛膝、菠菜、五灵脂、桃仁、丹皮、韭菜、郁李仁。
又一方：枸杞子、天冬、人中白、川萆薢。
方剂：三才汤、五仁汤、虎潜丸去锁阳加淡苁蓉、通幽汤、生地、红花、熟地、桃仁、甘草、归身、升麻。
二便闭结，小肠火结。
药物：芦荟、川楝子、桃仁、夜间胀满用小温中丸、红花、当归须、李仁。
湿热导致肺气不降。
药物：苇茎、桃仁、西瓜、翠衣（西瓜翠衣）、滑石、通草。
又养胃法：北沙参、麦冬、杏仁、薏仁、知母。
湿热壅滞腑气导致便闭。
药物：川连（黄连）、山栀皮、枳实、青皮、黄芩、莱菔子、川朴（厚朴）、丹皮。
气血结痹导致便闭。
药物：川楝子、桃仁、川桂枝、当归须、郁李仁、红花、制川军（大黄）、小茴香、川芎、山楂炭、肉桂、葱白、青皮、五灵脂、香附。
血枯经血阻滞导致便涩。
药物：大生地、牛膝、郁李仁、归身（当归身）、车前子、淡苁蓉（肉苁蓉）、柏仁（柏子仁）、冬葵子、茯苓、小茴香。
厥阴热闭。
症状：二便皆涩，少腹胀满，背部发冷，烦躁口渴，此为癃闭（小便点滴而出或闭塞不通），应当使用气味秽浊的药物，直接泻除厥阴经的热闭。
药物：两头尖、韭根、小茴香、橘红、穿山甲、归须（当归须）、川楝子、乳香、川连（黄连）、山栀、通草、海金沙、川柏（黄柏）、淡吴茱萸、青皮、滑石。
又仿照李东垣治疗癃闭的方法，使用滋肾丸。
陈参说：凡是小便闭而大便通调的，或者是膀胱热结，或者是水源不清，多为湿症。大便闭而小便通调的，或者是大肠气滞，或者是津液不流，多为燥症。二便都闭结时，应当先通大便，那么小便自然通利了。肾主管大小便，肝主疏泄，必须辨别阴结和阳结，或者采用下病治上的方法，开提肺气。喻嘉言说：上部的燥症治肺，下部的燥症治肝。
脱肛，由湿热气虚下陷引起。
遵循李东垣的治疗法则，使用补中益气汤。
药物：人参、西于术（白术）、甘草、陈皮、当归、柴胡、大枣、升麻、生姜。
脱肛，纯属气虚下陷。
药物：人参、归身（当归身）、白术、广皮（陈皮）、绿升麻、川连（黄连）、白芍、炙草（炙甘草）、乌梅、石莲子。
肾气不归（症状：少腹痛，肛门下坠，大便滑泄）。
药物：熟地、五味子、远志肉、怀山药炭、茯苓、萸肉（山茱萸）、菟丝饼（菟丝子）、禹余粮。
年老气陷导致脱肛。
药物：人参、补骨脂、阳起石、鹿茸、大茴香。
又方：禹粮石脂丸。
陈参说：脱肛这一病症，有因泻痢气陷而脱出的，有因中气虚寒不能收摄而脱出的，有因酒湿欲伤而脱出的，有因肾虚湿注而脱出的。或者年老气血已衰，或者年少气血未旺，也会导致脱肛。《内经》说：下陷者举之。徐之才说：涩可去脱。这些都是治疗脱肛的方法。《叶天士指南》治疗此症不外乎升举、固涩、益气三种方法。对于气热血热导致肛门反而挺出的情况，则使用黄芩、黄连、槐花、黄柏、四物汤加升麻、柴胡之类的药物。然而这种情况也是偶尔出现，不是常规可效法的方法，记录下来以备一说。脱肛症不宜过度使用苦寒凉药，大体上以叶天士的治疗法则为正统。
The turbid waste products of the human body are eliminated through urination and defecation. When these two excretions are unobstructed, turbidity descends and clarity ascends; otherwise, clear and turbid energies become confused. Obstruction of urination is caused by heat in the Bladder (Bladder organ); the medication can follow the same principles as treating Lin syndrome (a pattern characterized by frequent, urgent, and painful urination). Incontinence of urine is caused by reckless movement of fire-evil in the Bladder, which is difficult to predict or control. Because water fails to remain in its proper place, incontinence occurs; Er Shen Wan (Two Spirit Pill) combined with Sang Piao Xiao San (Mantis Egg-case Powder), containing Chuan Lian (Sichuan Sichuan Peppercorn - *Note: Text says Chuan Lian but context implies herbs like Huanglian etc., sticking to text entities*), Chuan Xiong, Gan Cao, Sheng Di, Dang Gui. Obstruction of defecation is due to exhaustion of intestinal fluids; blood-invigorating and dryness-moistening prescriptions should not be discarded. When both urination and defecation are obstructed, it is due to heat in the Liver and Kidney; Ba Zheng San (Eight-Herb Corrective Powder) can resolve both. Constipation of the anus is caused by Lung heat, as the Lung and Large Intestine have a interior-exterior relationship that is clear. Rectal prolapse is caused by severe deficiency-cold of the Lung, occurring when deficiency sinks during dysentery or diarrhea. Decoctions using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) are excellent; for heat-type prolapse, Si Wu Tang (Four Substance Decoction) combined with Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rehmannia Pill) is invited.
Penile cysts are caused by excessive dampness sinking into the lower jiao; use Liu Hejian's method.
Herbs: Shi Gao (Gypsum Fibrosum), Han Shui Shi (Halloysitum Rubrum), Xing Ren (Armeniacae Semen Amarum), Ze Xie (Alismatis Rhizoma), Hua Shi (Talcum), Zi Chuan Pu (Magnoliae Officinalis Cortex), Zhu Ling (Polypori Sclerotium).
Obstruction of urination, caused by fire obstruction in the Small Intestine.
Formula: Dao Chi San (Guide Out the Red Powder) plus Dan Pi (Moutan Cortex) and Chi Fu Ling (Poria with Red Core).
Failure of Qi transformation in the Bladder.
Formula: Wu Ling San (Five-Ingredient Powder with Poria).
Dampness stagnating in the Three Jiao (use Liu Hejian's method of separating and eliminating).
Herbs: Xing Ren, Jie Geng, Hua Shi, Chuan Pu (Magnoliae Officinalis Cortex), Lian Qiao, Mu Tong, Xiang Ru, Chen Pi, Zhu Ling, Mu Gua, Chuan Lian (Coptidis Rhizoma - *Text says Chuan Lian, likely Huanglian*), Han Shui Shi, Ze Xie, Lu Gen, Huang Qin, Hai Jin Sha, Fang Ji, Sheng Shi Gao, Zhi Ke, Liu Yi San.
Dampness depression and latent heat causing Bi obstruction in the Small Intestine.
Formula: Xiao Wen Zhong Wan (Minor Warming the Middle Pill).
Kidney Yang obstruction.
Formula: Wu Ling San plus Gan Jiang (Zingiberis Rhizoma), Pao Jiang (Zingiberis Rhizoma Preparatum), Fu Zi (Aconiti Lateralis Radix Preparata), Pig Gallbladder Juice.
Heat accumulation in the Yin aspect of the Kidney and Bladder causes dryness; without Yin, Yang cannot transform. Use Zi Shen Wan (Nourish the Kidney Pill) to unblock heat closure in the extreme Yin of the Lower Jiao.
Damp-heat Bi obstruction in the Large Intestine.
Suitable for clearing heat and drying dampness with Xiao Wen Zhong Wan.
Severe constipation, fire fu obstruction.
Formula: Geng Yi Wan (Changing Clothes Pill).
Damp-fire constipation (use great bitter-cold methods to consolidate Yin and dry dampness).
Herbs: Chuan Bai (Phellodendri Chinensis Cortex), Bi Xie, Du Huo, Hai Jin Sha, Xi Xin, Chuan Lian, Fang Ji, Can Sha, Chuan Jin Wen (Rhei Radix et Rhizoma).
Kidney dryness and heat causing difficulty in defecation (suitable for warming and unblocking the Lower Jiao, use Zi Shen Wan).
Depressed heat and dryness obstruction with Qi blockage (bitter-cold to drain heat, acrid to open depression; this is a general treatment method for the Three Jiao).
Herbs: Chuan Lian, Lai Fu Zi, Chuan Lián Zǐ, Guang Pi, Lu Hui, Chao Shan Zha, Chao Shan Zhi, Zhi Pu, Qing Pi, Chi Fu Ling, Xing Ren, Guang Yu Jin.
Blood stasis causing constipation.
Herbs: Tao Ren Ni (Persicae Semen Paste), Dong Kui Zi, Chuan Yu Jin, Yu Li Ren, Jiang Zhen Xiang.
Another formula: Tao Ren Cheng Qi Tang.
Blood dryness and lack of moisture, causing constipation (suitable for nourishing blood and moistening dryness).
Herbs: Gui Shen (Angelicae Sinensis Radix), Bai Zi Ren, Mai Dong, Sha Yuan Zi, Ma Ren, Song Zi Ren, Fu Ling, Kui Bai Shao (Paeoniae Radix Alba).
Another formula: Sheng Di, E Jiao, Gui Ban.
Another formula: Hong Hua, Niu Xi, Bo Cai, Wu Ling Zhi, Tao Ren, Dan Pi, Jiu Cai, Yu Li Ren.
Another formula: Gou Qi Zi, Tian Dong, Ren Zhong Bai, Chuan Bi Xie.
Formulas: San Cai Tang, Wu Ren Tang, Hu Qian Wan removing Suo Yang and adding Dan Cong Rong, Tong You Tang, Sheng Di, Hong Hua, Shu Di, Tao Ren, Gan Cao, Gui Shen, Sheng Ma.
Elderly Yang deficiency causing wind closure (use warm and moistening methods to regulate flow).
Formula: Ban Shou Wan.
Obstruction of both urination and defecation, fire obstruction in the Small Intestine.
Herbs: Lu Hui, Chuan Lián Zǐ, Tao Ren, bloating at night use Xiao Wen Zhong Wan, Hong Hua, Dang Gui Xu, Li Ren.
Damp-heat causing failure of Lung Qi to descend.
Herbs: Wei Jing, Tao Ren, Xi Gua, Cui Yi, Hua Shi, Tong Cao.
Another stomach-nourishing method: Bei Sha Shen, Mai Dong, Xing Ren, Yi Ren, Zhi Mu.
Damp-heat stagnating in the Fu organs causing constipation.
Herbs: Chuan Lian, Shan Zhi Pi, Zhi Shi, Qing Pi, Huang Qin, Lai Fu Zi, Chuan Pu, Dan Pi.
Qi and Blood Bi obstruction causing constipation.
Herbs: Chuan Lián Zǐ, Tao Ren, Chuan Gui Zhi, Dang Gui Xu, Yu Li Ren, Hong Hua, Zhi Chuan Jun (Rhei Radix et Rhizoma), Xiao Hui Xiang, Chuan Xiong, Shan Zha Tan, Rou Gui, Cong Bai, Qing Pi, Wu Ling Zhi, Xiang Fu.
Blood depletion and menstrual obstruction causing difficult urination/defecation.
Herbs: Da Sheng Di, Niu Xi, Yu Li Ren, Gui Shen, Che Qian Zi, Dan Cong Rong, Bai Ren, Dong Kui Zi, Fu Ling, Xiao Hui Xiang.
Jueyin heat closure.
Symptoms: Both urination and defecation are obstructed, hypogastric distension and fullness, back cold, irritability, and thirst. This is Long Bi (difficulty in urination); one should use substances with turbid odors to directly drain the Jueyin closure.
Herbs: Liang Tou Jian, Jiu Gen, Xiao Hui Xiang, Ju Hong, Chuan Shan Jia, Gui Xu, Chuan Lián Zǐ, Ru Xiang, Chuan Lian, Shan Zhi, Tong Cao, Hai Jin Sha, Chuan Bai, Dan Wu Zhu Yu, Qing Pi, Hua Shi.
Also imitating Li Dongyuan's method for treating Long Bi, use Zi Shen Wan.
Chen Can said: Whenever urination is obstructed but defecation is smooth, it is either bladder heat obstruction or unclear water source, mostly dampness patterns. When defecation is obstructed but urination is smooth, it is either Large Intestine Qi stagnation or non-flowing body fluids, mostly dryness patterns. When both are obstructed, one should first unblock defecation, then urination will naturally flow. The Kidney governs both excretions; the Liver governs free flow and drainage. One must distinguish between Yin and Yang obstruction, or use the method of treating upper diseases from below, by lifting Lung Qi. Yu Jiayan said: Treat upper dryness with the Lung; treat lower dryness with the Liver.
Rectal prolapse, caused by damp-heat and Qi deficiency sinking.
Follow Dongyuan's treatment method, use Bu Zhong Yi Qi Tang.
Herbs: Ren Shen, Xi Yu Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao, Chen Pi, Dang Gui, Chai Hu, Da Zao, Sheng Ma, Sheng Jiang.
Rectal prolapse, purely due to Qi deficiency sinking.
Herbs: Ren Shen, Gui Shen, Bai Zhu, Guang Pi, Lv Sheng Ma, Chuan Lian, Bai Shao, Zhi Cao, Wu Mei, Shi Lian Zi.
Kidney Qi failing to return (symptoms: lower abdominal pain, anal heaviness/prolapse, loose stools).
Herbs: Shu Di, Wu Wei Zi, Yuan Zhi Rou, Huai Shan Yao Tan, Fu Ling, Yu Rou, Tu Si Bing, Yu Yu Liang.
Elderly Qi sinking causing rectal prolapse.
Herbs: Ren Shen, Bu Gu Zhi, Yang Qi Shi, Lu Rong, Da Hui Xiang.
Another: Yu Liang Shi Zhi Wan.
Chen Can said: Regarding rectal prolapse, some cases are due to Qi sinking from dysentery/diarrhea; some are due to middle Qi deficiency-cold failing to retain; some are due to alcohol-dampness injury; some are due to Kidney deficiency with dampness pouring down. Whether due to elderly decline of Qi and Blood, or young immaturity of Qi and Blood, rectal prolapse can occur. The Classics say: "What has sunk, lift it." Xu Zhicai said: "Astringents can remove prolapse." These are all methods for treating rectal prolapse. Ye Tianshi's Guide states that treatment involves three methods: lifting, astringing, and tonifying Qi. For cases where Qi and Blood heat cause the anus to protrude, use Huang Qin, Huang Lian, Huai Hua, Huang Bai, Si Wu Tang plus Sheng Ma and Chai Hu. However, such cases are rare and not standard practice; recorded here for reference. Rectal prolapse should not be over-treated with bitter-cold cooling agents; generally, Ye Tianshi's methods are considered orthodox.