大便秘结者，手足阳明之病也。但伤寒阳明之便结，固纯属肠胃之燥热。若寻常之便结，往往胃湿而
肠燥。盖阳主开，阴主阖，阳盛则窍隧开，阴盛则关门阖，凡粪若羊矢者，皆阴盛而肠结，非关火旺也。
且肾司二便之开阖。或寒，或热，或虚，或干燥，均能致秘结之证，又宜理肾为主。如阳盛土燥，大便
坚硬者，以阿胶麻仁汤主之。如阳衰土湿，粪若羊矢者，以肉苁蓉汤主之。如大便坚，其脾为约者，以麻仁
丸主之。
阿胶麻仁汤
生地（三钱） 当归（三钱） 阿胶（三钱） 麻仁（三钱研） 水煎一杯，去渣，入阿胶火化
，温服。结甚加白蜜半杯，胃热加芒硝、大黄，精液枯槁，加天冬、龟胶。
肉苁蓉汤
肉苁蓉（三钱） 麻仁（三钱） 茯苓（三钱） 半夏（三钱） 甘草（二钱） 桂枝（三钱）
水煎一杯，温服。
麻仁丸
浓朴（八两姜制） 枳实（八两面炒） 芍药（八两） 大黄（一斤蒸焙） 麻仁（八两别研）
杏仁（五两半去皮尖炒） 上为末，炼蜜和丸梧子大，每服二十丸，临卧温水下，大便通利则止。
淋病者，小便短数，淋漓不断，茎中痛是也。癃闭者，小便点滴不通，胀闭欲死是也。二证虽属热结
于膀胱，实由三焦之气化不行所致也。且肝主疏泄，如木不能泄，则生气幽郁而为
热，溲溺所以结涩。肾主闭藏，如水不能藏，则阳根泄露而生寒，精血所以流溢，此又二证所由来也。如五
淋初起，以五淋汤加减主之。如癃闭证，阴不化阳者，以滋肾丸主之。阳不化阴者，以白通汤主之。如阴阳
俱不化者，以济生肾气丸主之。如服利水药不效者，以补中益气汤，服后以手探吐之。此开上窍以通下窍之
法也。二证或统以桂枝苓泽汤主之。
五淋汤
赤茯苓（三钱） 白芍（二钱） 生山栀（二钱） 当归（一钱四分） 细甘草（一钱四分） 水煎
服
。如因动气而得，脐下胀痛为气淋，加荆芥、香附、生麦芽，如溺血茎中割痛，为血淋，加牛膝、
桃仁、红花、生地、入麝香少许。如溺如沙石，为石淋，送下六一散三钱。如尿出如膏，为膏淋，合萆 厘清
饮。如因劳而得。为劳淋，合补中益气汤。如过服金石药，与老人阳已萎，思色以降其精，致精内败而为
淋，加萆 、石菖蒲、菟丝子以导之。如因色欲过度，似淋非淋，溺短而数，茎中痛甚者，酌加肉苁蓉、淫羊
藿、生杜仲、白蜜、羊脂之类。
滋肾丸
黄柏（一两） 知母（一两） 肉桂（一钱）研末，蜜丸每服三钱，开水送下。
白通汤
葱白（二茎每茎寸半） 干姜（三钱） 附子（三钱） 水煎大半杯，温服。按葱白宜多加，再
加人尿一盏，尤效。
济生肾气丸
熟地 山萸肉 山药 丹皮 茯苓 泽泻 肉桂 附子 牛膝 车前子 炼蜜为丸，如
桐子大，作汤服亦可。
补中益气汤
黄 （二钱蜜炙） 人参 白术 当归 陈皮 甘草（各一钱） 升麻 柴胡（各三分）
水煎服，二时许，二煎再服，即以手探吐之。
桂枝苓泽汤
茯苓（三钱） 泽泻（三钱） 猪苓（三钱） 桂枝（三钱） 阿胶（三钱炒） 水煎大半杯
，热服。
大便秘结，是手足阳明经的病变。伤寒病中阳明经的大便干结，确实完全属于肠胃的燥热所致。但寻常的大便干结，往往是胃中有湿而肠道干燥。因为阳主开泄，阴主闭藏，阳气盛则孔窍隧道开通，阴气盛则关门关闭。凡是粪便像羊屎一样的，都是阴气盛导致肠道结滞，并非火旺所致。而且肾主管二便的开阖。无论是寒、热、虚、干燥，都能导致秘结的证候，治疗又应当以调理肾脏为主。如果是阳气盛、脾土燥热，大便坚硬的，用阿胶麻仁汤主治。如果是阳气衰、脾土湿困，粪便像羊屎一样的，用肉苁蓉汤主治。如果大便坚硬，脾气被约束不能散精的，用麻仁丸主治。
阿胶麻仁汤
生地（三钱） 当归（三钱） 阿胶（三钱） 麻仁（三钱研碎） 水煎取一杯，去药渣，加入阿胶用火溶化，温服。若便秘严重加白蜜半杯，胃热加芒硝、大黄，精液枯槁，加天冬、龟胶。
肉苁蓉汤
肉苁蓉（三钱） 麻仁（三钱） 茯苓（三钱） 半夏（三钱） 甘草（二钱） 桂枝（三钱）
水煎取一杯，温服。
麻仁丸
浓朴（八两姜制） 枳实（八两面炒） 芍药（八两） 大黄（一斤蒸焙） 麻仁（八两别研） 杏仁（五两半去皮尖炒） 以上药物研为细末，炼蜜和丸如梧桐子大，每次服用二十丸，临睡前温水送下，大便通畅即止。
淋病，是指小便短少频数，淋漓不断，尿道疼痛的症状。癃闭，是指小便点滴不通，胀满闭塞痛苦欲死的症状。这两种证候虽然属于热结于膀胱，实际上是由三焦的气化功能不行所致。而且肝主疏泄，如果木气不能疏泄，则生发之气幽郁而产生热，所以小便结涩。肾主闭藏，如果水液不能闭藏，则阳根泄露而产生寒，所以精血流溢，这又是这两种证候产生的由来。如果是五淋初起，用五淋汤加减主治。如果是癃闭证，阴不化阳的，用滋肾丸主治。阳不化阴的，用白通汤主治。如果阴阳都不化的，用济生肾气丸主治。如果服用利水药无效的，用补中益气汤，服药后用手探吐。这是开启上窍以通下窍的方法。这两种证候有时统一用桂枝苓泽汤主治。
五淋汤
赤茯苓（三钱） 白芍（二钱） 生山栀（二钱） 当归（一钱四分） 细甘草（一钱四分） 水煎服。
如果是因动气而得的，脐下胀痛为气淋，加荆芥、香附、生麦芽；如果尿血且尿道割痛，为血淋，加牛膝、桃仁、红花、生地、入少许麝香；如果尿出如沙石，为石淋，送服六一散三钱；如果尿出如膏，为膏淋，合用萆薢分清饮；如果是因劳累而得的，为劳淋，合用补中益气汤；如果过服金石类药物，以及老人阳气已萎，思色欲以泄精，导致精败而为淋，加萆薢、石菖蒲、菟丝子以疏导之；如果是因色欲过度，似淋非淋，尿短而频数，尿道疼痛严重的，酌情加肉苁蓉、淫羊藿、生杜仲、白蜜、羊脂之类。
滋肾丸
黄柏（一两） 知母（一两） 肉桂（一钱） 研为细末，蜜丸，每次服用三钱，开水送下。
白通汤
葱白（二茎，每茎寸半） 干姜（三钱） 附子（三钱） 水煎取大半杯，温服。按：葱白宜多加，再加人尿一盏，尤其有效。
济生肾气丸
熟地 山萸肉 山药 丹皮 茯苓 泽泻 肉桂 附子 牛膝 车前子 炼蜜为丸，如梧桐子大，作汤剂服用也可以。
补中益气汤
黄芪（二钱蜜炙） 人参 白术 当归 陈皮 甘草（各一钱） 升麻 柴胡（各三分）
水煎服，约两个时辰后，再煎第二次服用，随即用手探吐。
Constipation is a disease of the Hand-Yangming and Foot-Yangming meridians. In Shanghan (Cold Damage) diseases, constipation in the Yangming stage indeed belongs purely to dryness-heat in the stomach and intestines. However, ordinary constipation often involves dampness in the stomach and dryness in the intestines. Yang governs opening, and Yin governs closing; when Yang is excessive, orifices and tunnels open, and when Yin is excessive, the gates close. Stools resembling sheep droppings are all due to Yin excess causing intestinal binding, not related to fire hyperactivity. Moreover, the Kidney governs the opening and closing of the two lower orifices. Cold, heat, deficiency, or dryness can all lead to constipation, so treatment should primarily focus on regulating the Kidney. If Yang is excessive and Spleen-earth is dry with hard stools, Aojiao Mahuang Decoction is used as the principal formula. If Yang is deficient and Spleen-earth is damp with stools resembling sheep droppings, Rongcongrou Tang is used as the principal formula. If stools are hard and the Spleen's function of distributing essence is constrained, Maren Wan is used as the principal formula.
Aojiao Mahuang Decoction
Shengdi (3 qian), Danggui (3 qian), Ejiao (3 qian), Mahuang (3 qian, ground). Decoct in water to obtain one cup, remove dregs, add Ejiao and melt over fire, take warm. For severe binding, add half a cup of white honey; for Stomach heat, add Mangxiao and Dahuang; for exhaustion of essence and fluids, add Tiandong and Guijiao.
Rongcongrou Tang
Rongcongrou (3 qian), Mahuang (3 qian), Fuling (3 qian), Banxia (3 qian), Gancao (2 qian), Guizhi (3 qian). Decoct in water to obtain one cup, take warm.
Maren Wan
Houpo (8 liang, processed with ginger), Zhishi (8 liang, stir-fried with flour), Shaoyao (8 liang), Dahuang (1 jin, steamed and baked), Mahuang (8 liang, separately ground), Xingren (5.5 liang, skin and tips removed, stir-fried). Grind the above into powder, mix with refined honey to form pills the size of wutong seeds. Take 20 pills each time, with warm water before bed. Stop when bowel movement becomes smooth.
Lingbing (Strangury) refers to short, frequent urination, dripping continuously, and pain in the urethra. Longbi (Retention of Urine) refers to inability to pass even drops of urine, with distension and closure causing extreme suffering. Although these two conditions belong to heat binding in the Bladder, they are actually caused by the failure of Qi transformation in the Sanjiao. The Liver governs free flow; if Wood fails to vent, the Shengqi (generating energy) becomes depressed and generates heat, leading to difficult and obstructed urination. The Kidney governs storage; if Water fails to store, the root of Yang leaks and generates cold, leading to the overflow of essence and blood. This is the origin of these two conditions. For the initial stage of Wulin (Five Stranguries), Wulin Tang with modifications is used as the principal formula. For Longbi where Yin fails to transform Yang, Zishen Wan is used as the principal formula. Where Yang fails to transform Yin, Baitong Tang is used as the principal formula. Where both Yin and Yang fail to transform, Jisheng Shenqi Wan is used as the principal formula. If diuretic herbs are ineffective, Buzhong Yiqi Tang is administered, followed by inducing vomiting by probing the throat with fingers. This is the method of opening the upper orifice to unblock the lower orifice. These two conditions may sometimes be treated uniformly with Guizhi Lingze Tang.
Wulin Tang
Chifuling (3 qian), Baishao (2 qian), Sheng Shanzhi (2 qian), Danggui (1.4 qian), Xi Gancao (1.4 qian). Decoct in water and take.
If caused by moving Qi, with distension and pain below the umbilicus, it is Qiling (Qi Strangury); add Jingjie, Xiangfu, and Sheng Maiya. If hematuria with cutting pain in the urethra, it is Xueling (Blood Strangury); add Niuxi, Taoren, Honghua, Shengdi, and a small amount of Shexiang. If urine passes like sand and stones, it is Shiling (Stone Strangury); administer Liuyisan (3 qian) with water. If urine passes like paste, it is Gaoling (Paste Strangury); combine with Bixie Fenqing Yin. If caused by labor, it is Laoling (Labor Strangury); combine with Buzhong Yiqi Tang. If excessive use of mineral drugs, or in elderly men with depleted Yang who indulge in sexual desire to release essence, causing internal corruption of essence leading to strangury, add Bixie, Shichangpu, and Tusizi to guide it out. If due to excessive sexual desire, resembling strangury but not quite, with short, frequent urination and severe urethral pain,酌情 (discretionarily) add Rongcongrou, Yinyanghuo, Sheng Duzhong, white honey, and Yangzhi.
Zishen Wan
Huangbai (1 liang), Zhimu (1 liang), Rougui (1 qian). Grind into powder, mix with honey to form pills. Take 3 qian each time, with boiled water.
Baitong Tang
Congbai (2 stalks, each 1.5 cun), Ganjiang (3 qian), Fuzi (3 qian). Decoct in water to obtain more than half a cup, take warm. Note: Congbai should be increased in quantity; adding one cup of human urine is especially effective.
Jisheng Shenqi Wan
Shudi, Shanyurou, Shanyao, Danpi, Fuling, Zexie, Rougui, Fuzi, Niuxi, Cheqianzi. Mix with refined honey to form pills the size of wutong seeds. Can also be taken as a decoction.
Buzhong Yiqi Tang
Huangqi (2 qian, honey-fried), Renshen, Baizhu, Danggui, Chenpi, Gancao (each 1 qian), Shengma, Chaihu (each 0.3 qian). Decoct in water and take. After about two shichen (4 hours), take the second decoction, then induce vomiting by probing the throat with fingers.
Guizhi Lingze Tang
Fuling (3 qian), Zexie (3 qian), Zhuling (3 qian), Guizhi (3 qian), Ejiao (3 qian, stir-fried). Decoct in water to obtain more than half a cup, take hot.