〔垣〕津液耗而燥者，以辛润之。肾主五液，津液盛则大便如常。若饥饱劳役，损伤胃气，及食辛热浓味
之物而助火，邪伏于血中，耗散真阴，津液亏少，故大便结燥。又有年老气虚，津液不足而结者，肾恶燥急，
食卒以润之是也。
润肠丸（并加减法） 治胃中伏火，大便闭涩，或干燥不通，全不思食，乃风结血秘，皆令闭塞，须润
燥和血疏风，则自然通矣。
羌活 归梢 大黄（煨。各半两） 麻仁 桃仁（泡，去皮尖。各一两）
上为末，除麻仁、桃仁另研如泥外，为细末，炼蜜为丸，如桐子大。每服三五十丸。空心白汤下。如病患
不小便，因大便不通而涩，其邪盛者，急加酒洗大黄以利之。如血燥者，加桃仁、酒洗大黄。如风结燥者，
加麻仁、大黄。如风涩者，加煨皂角仁、大黄、秦艽以利之。如脉涩觉身痒气涩者，加郁李仁、大黄以除
气躁。如寒阴之病，为寒结闭者，以《局方》中半硫丸，或加煎附子生姜汤，冰冷与之。其病虽阴寒之症，
当服阳药补之，若大便恒不甚通者，亦当十服中与一服利药，微通其大便，不令闭结，乃治之大法也。若病患
虽是阴症，或者阴寒之症，其病显躁，脉坚实，亦宜阳药中少加苦寒之剂以去热躁，躁止勿加。如阴躁欲坐
井中者，其二肾脉按之必虚，或沉细而迟，此为易辨。如有客邪之病，亦从权加药以去之。
上一方加减法，随寒热、虚实，及血秘、气秘、风秘，用药至为详尽，余方皆不出此也。
〔垣〕活血润肠丸 治大便风秘、血秘，时常结燥。
当归梢（一钱） 防风梢（二钱） 羌活（一两） 大黄（煨，一两） 麻子仁（二两半） 桃仁（二两，研如泥）
皂角仁（炮，存性，去皮、秤二两，其性得湿则滑，滑则燥结自除。）
上除麻仁、桃仁另研如泥外，为极细末，炼蜜为丸，桐子大。每服五十丸，白汤下。三二服后，须以苏子、
麻子粥每日早晚食之，大便日久再不结燥。以瓷器盛之，纸封勿令见风。
当归润肠汤
升麻（二钱） 当归梢（一钱） 熟地（一钱） 生地（二钱） 红花（五分） 大黄（煨） 甘草梢（生）
桃仁 麻仁（各一钱。研如泥）
上锉如麻豆大，作一服，水三盏，入桃、麻仁煎一盏，空心稍热服。
导滞通幽汤 治大便难，幽门不通，上冲吸门不开，噎塞，不便，燥闭，气不得下，治在幽门，以辛润之。
当归身 升麻梢 桃仁泥 甘草（炙。各一钱） 红花（少许） 熟地 生地（各五分）
上 咀，作一服，水二大盏，煎至一盏，调槟榔细末五分，稍热服之。
〔海〕许学士治年老虚秘，麻仁、苏子各半合，研取汁，分二服，煮粥服之，不药而愈。
〔罗〕润肠橘杏丸 降气润肠。服之，大肠自无涩滞。
橘皮 杏仁（去皮尖并双仁者，面炒黄。各等分。本草云∶杏仁能润气燥。）
上等分为末，炼蜜丸，如桐子大。每服五十丸，空心温水下。亦不损胃气。
上乃润燥法。盖桃仁、麻仁治血燥；杏仁、郁李仁治气燥；皂角仁治风燥也。
〔丹〕杨淳三哥，大便秘涩，小便如常，咽塞不通，食下便有痰出，脉涩左右手同，此血虚肠燥为脾约。
病甚者，人参散主之。
人参 黄 （各一钱） 浓朴（八分，炒） 地黄（七分） 桃仁 枳壳（炒。各一钱） 甘草（少许，炙）
煎入竹沥、姜汁饮之，又与锁阳、苁蓉二钱，桃仁一钱，煮粥入竹沥，名润肠散。
妇人肠秘，补血和气以通之。
肉苁蓉（一两半） 麻仁 白芍药 陈皮 当归身（各一两）
上为末，晒干，炒神曲糊为丸，如桐子大。食前白汤下五十丸，二次服。
〔世〕苁蓉润肠丸 治发汗过多，耗散津液，大腑秘结。
苁蓉（酒浸，焙二两） 沉香（另研，一两）
上为末，用麻仁汁打糊丸，如桐子大。每服七十丸，米饮下。
〔海〕益血丹 治大便燥，久虚亡血。
当归（酒浸，焙） 熟地（各等分）
上为末，炼蜜丸，如弹子大，细嚼，酒下。
〔丹〕大肠虚秘而热者。
白芍药（一两半） 陈皮 生地 当归身（各一两） 条芩 甘草
上粥为丸，白汤下。
上苁蓉、当归、地黄润燥法，盖积血枯竭而虚甚者宜之
〔垣〕有物有积而结者，当下之。食伤太阴，肠满食不化，腹响响然不能大便者，以苦泄之。（仲景麻仁、《局方》
七宣丸，皆以大黄为君之类是也。）
〔垣〕治注夏，大便涩滞者血少，血中伏火也。黄 人参汤加生地黄、当归身、桃仁泥、麻仁泥润之。
（黄 人参汤方见注夏。）如润之大便久不快利者，少加煨大黄微利之。如加大黄久不快利者，非血结血秘，是热则生
风，病必湿风症，止当服黄 人参汤，只用羌活半两、防风半两，水四盏，煎至一盏，去渣，空心服之，其大便必
大走也。
〔丹〕脾约丸论 成无己曰∶约者，结约之约，又束约之约。胃强脾弱，约束津液不得四布，但输膀胱，故
小便数而大便硬，故曰脾约。与此丸以下脾之结燥，润肠结，化津液入胃，则大便利，小便少而愈矣。愚窃有
疑者，既曰脾约，脾弱不能运也，脾弱则土亏矣，必脾气之散，脾血之耗。原其所由，久病大下大汗之后，阴
血枯槁，内火燔灼，热伤元气，又伤于脾而成此症。伤元气者，肺金受火克，气无所摄；伤脾者，肺为脾之子，
肺耗则津竭，必窃母气以自救，金耗则木寡于畏，土欲不伤不可得也。脾失转输之令，肺失传送之官，宜大便
秘而难下，小便数而无藏蓄也。理宜滋养阴血，使孤阳之火不炽而金行清化，木邪有制，脾土清健而营运津液，
津液入胃，则肠润而通矣。今以大黄为君，枳实、浓朴为臣，虽有芍药之养血，麻仁、杏仁之温润为之佐使，
用之热甚而气实者，无有不安。愚恐西北二方，地气高浓，人禀壮实者可用。若用之东南之人，内热自甚，而
血气不实者，虽得暂通，将见脾愈弱而燥矣。后之用此方者，须知在西北以开结为主，在东南以润燥为主，慎
勿胶柱而鼓瑟可也。
〔洁〕脏腑之秘，不可一概治疗，有虚秘，有实秘。胃实而秘者能饮食，小便赤，当以麻仁丸、七宣丸之
类主之。（仲景麻仁丸方见伤寒阳明病，每服二十丸，未知加至五十丸，日三服，以利为度。）
〔《局》〕七宣丸
柴胡（五两） 桃仁（去皮尖，炒，六两） 枳实（麸炒，五两） 甘草（炙，四两） 诃子皮 木香（各五两）
大黄（面裹煨，十五两）
上为细末，炼蜜丸，如桐子大。每服二十丸，米饮送下，渐加四五十丸，以利为度。
〔《斗》〕治大便不通。用乌 木皮方一寸，劈破，以水煎取小半盏，服之立通，不用多服，其功神圣。兼能
取水，或以此汤调下五苓散二钱，空心更妙。
〔洁〕胃虚而秘者，不能饮食，小便清利，浓朴汤主之。
陈皮（一两） 甘草（炙，二两） 浓朴（制，二两） 白术（三两） 半夏曲（一两） 枳实（炒，一两）
上粗末。每用三五钱，水盏半，姜三片，枣一枚，煎至一盏，去渣，空心温服。实秘者物也，虚秘者气也。
〔世〕槟榔散 治肠胃受湿，大便秘涩。用槟榔（不拘多少）为末。每服二钱，蜜汤点服，不拘时。
〔海〕桃、杏仁俱治大便秘，当以血、气分之。年老虚人，大便燥秘者，脉浮在气，杏仁、陈皮主之。脉
沉在血，桃仁、陈皮主之。所以俱用陈皮者，以其于阳明病，与手太阴为表里也。又云∶盛则难便，行阳气也；
败则便难，行阴血也。
〔仲〕问曰∶脉有阳结、阴结者，何以别之？曰∶其脉浮而数，能食，不大便者，此为实，名曰阳结也，
期十七日当剧。其脉沉而迟，不能食，身体重，大便反硬，名曰阴结也，期十四日当剧。
〔垣〕有阳结，有阴结。阳结者散之，阴结者热之。
热气留于小肠，肠中痛，脐热焦渴，则坚干不得出，故痛而闭不通矣。（全文见诸痛。）
膀胱移热于小肠，膈肠不便。（全文见诊病传变。）
〔《保》〕大黄牵牛散 治相火之气，游走脏腑，大便秘结。
大黄（一两） 牵牛（头末，半两）
上为细末，每服三钱。有厥冷，合用酒调；无厥冷而手足烦热者，蜜汤调下，食后以微利为度。此谓不时
而热者，湿热也。（凡用大黄半两至一两而大便不通利者，加麝少许，调于药中，则大便必大走也。）
上热秘皆阳结之属，仲景大、小承气及麻仁丸之类是也。（方见伤寒阳明病。）
〔世〕治后分闭塞。用萱草根一捻，同生姜捣碎，取自然汁服之，立愈。
〔《局》〕半硫丸 治年高冷秘虚秘。
硫黄（研细，生用） 半夏（为末）
上等分和匀，生姜自然汁打面糊为丸，桐子大。每服五十丸，空心温酒、姜汤任下。
〔垣〕麻黄白术汤 治大便不通，五日一遍，小便黄赤，浑身肿，面上及腹尤甚，色黄麻木，身重如山，沉困
无力，四肢痿软，不能举动，喘促唾清水，吐秽痰白沫如胶，时躁热发欲去衣，须臾而过，振寒，顶额有时如
冰，额寒尤甚，头旋眼黑，目中溜火，冷泪，鼻不闻香臭，小腹急痛，当脐有动气，按之坚硬而痛。
麻黄（不去根节，五分） 桂枝（三分） 杏仁（四个） 吴茱萸（四分） 白豆蔻（五分） 浓朴（三分）
炒曲（五分） 升麻（二分） 柴胡 白术 苍术（各三分） 甘草（生，一分） 泽泻 白茯苓（各四分）
橘红（二分） 青皮（去穣） 黄连（酒浸） 黄柏（酒浸） 黄 人参 猪苓（各三分） 熟甘草（一分）
上 咀，分作二服。每服水二大盏半，先煎麻黄沸去沫，再入诸药同煎至一盏，去渣，稍热食远服。此症
宿有风湿，热伏于荣血之中，其水火乘于阳道而上盛，元气短少，上喘，为阴火伤其气，四肢痿，在肾水之
间，乃所胜之病。今正遇冬寒，得时乘其肝木，又实其母，肺金克木凌火，是大胜必有大复，其症善怒欠多
嚏，鼻中如有物，不闻香臭，目视KT KT ，多悲健忘，少腹急痛，遍身黄，腹大胀，面目肿尤甚，食不下，痰
唾涕有血，目 疡，大便不通，只二服皆愈。
运气 大便闭有三∶
一曰热。经云∶热至则淋闭。又云∶少阴之复，膈肠不便是也。
二曰寒。经云∶太阳所至，为禁止是也。
三曰湿。经云∶太阴司天，湿淫所胜，病大便难是也。
〔仲〕蜜煎导法。（方见伤寒胃实。丹溪云∶潞公夏中病泄，有人与石脂、龙骨、干姜等药，痢虽止而势甚
苦，公又不乐大黄药，遂一夕用蜜煎三下结粪五十枚，遂安。若虚人秘者，难下药，宜用此法。）
〔海〕霹雳煎用盐与蜜乘热捻如蜜煎法，上头锐，用十许纳谷道中，少许化开即通。（一法，用蜜煎不通者，
纯用盐吹入谷道中，亦妙。）
〔海〕蜜煎与盐相合，如用草乌头末相合亦可。盖盐能软坚润燥，草乌能化寒消结，可随症阴阳所宜用之。
急提盆散 治杂病非阴候者。
用草乌头不拘多少，为极细末，每用葱一枝，肥者削去须，圆头上有汁，湿蘸之纳谷道中。
〔仲〕猪胆汁方（方见伤寒胃实。）
〔孟〕大便不通，气奔欲死者。以乌梅十个置汤中，须臾挪去核，杵为丸，如枣大，纳下部，少时即通。
又方，治大小便不通。
江子肉 杏仁 皂角
上为末，作饼置脐上，艾灸自通。
〔世〕通关散 治卒闭不通。用盐入脐中灸即通，去之。
〔《本》〕宣积丸 手心握药便通。
巴豆 干姜 韭子 良姜 硫黄 甘遂 白槟榔（各等分）
上为细末，研饭为丸，如龙眼大。早朝先用椒汤洗手，麻油涂手掌口，握药一粒，移时便泻。欲止，以冷
水洗手。
针灸 大便闭有二法∶
其一取胃。经云∶肠中不便，取三里。盛泻之，虚补之是也。
其二取肾。经云∶邪在肾，病大便难，取之涌泉、昆仑，视有血者尽之。
〔《玉》〕大便秘塞∶照海（五分。补，二呼；泻，六吸，立通） 支沟（半寸，泻三吸）
〔《撮》〕又法∶照海（泻之立通） 太白（泻之，灸亦可）
〔《集》〕又法∶照海（半寸，灸二十壮，泻之） 章门（灸，二七壮） 太白（半寸，灸五壮。
以上诸穴看虚实补泻之，虚结补则通，热结泻则通。寒结先泻后补，热结先补后泻之）
〔《摘》〕又法∶气海（八分，令病患觉便三五次为度。出针时记令人挟脐揉之，却刺三里） 三里（五分，
觉腹中鸣三五次即透）
〔世〕又法∶合谷
〔东〕大便闭。背七椎两傍相去各一寸（灸三壮） 承筋（灸三壮） 阳绕（挟玉泉相去二寸，随年壮针灸。
书无此穴，或云非正穴也）
又法∶石门（寸半） 大都（五分）
〔《摘》〕治大便不通，并伤寒水结∶三间（沿皮下向至合谷穴，三补三泻，候腹中通出针）承山（七分，
泻之）
〔《甲》〕大便难。中渚及太白主之。又大钟主之。
〔丹〕予观古方通大便，皆用降气品剂。盖肺气不降，则大便难传送，用杏仁、枳壳、沉香、诃子等是也。
【李东垣】津液耗损导致干燥的，用辛味药来润燥。肾主管五液，津液充足则大便正常。如果因饥饿、饱食或劳累过度，损伤了胃气，以及食用辛辣、热性、浓烈滋味的食物而助长火邪，邪气潜伏在血中，耗散真阴，导致津液亏少，所以大便干结燥硬。又有年老体弱气虚，津液不足而导致便秘的，肾厌恶燥急，突然进食以润燥之法治疗即可。
润肠丸（包括加减法） 治疗胃中潜伏的火邪，大便闭塞涩滞，或者干燥不通，完全不想吃东西，这是风结和血秘，都导致闭塞，必须润燥、和血、疏风，大便自然通畅。
羌活 当归梢 大黄（煨制，各半两） 麻子仁 桃仁（去皮尖，泡制，各一两）
以上药物研成末，除了麻仁、桃仁另外研磨如泥状外，其余研为细末，用炼蜜制成丸药，大小如梧桐子。每次服用三五十丸。空腹时用白开水送服。如果患者小便不利，是因为大便不通导致的涩滞，邪气盛者，紧急加入酒洗的大黄以利下。如果是血燥，加入桃仁、酒洗大黄。如果是风结燥，加入麻仁、大黄。如果是风涩，加入煨皂角仁、大黄、秦艽以利下。如果脉涩且感觉身体瘙痒、气机涩滞，加入郁李仁、大黄以消除气躁。如果是寒阴之病，属于寒结闭阻，使用《局方》中的半硫丸，或者加煎附子生姜汤，冷后服用。虽然病症是阴寒之症，应当服用阳药补益，如果大便长期不太通畅，也应当在十服药中给一服泻下药，轻微通导大便，不让其闭结，这是治疗的大法。如果患者虽然是阴症，或者是阴寒之症，但症状表现明显烦躁，脉象坚实，也应当在阳药中少量加入苦寒的药物以去除热躁，烦躁停止后不再添加。如果是阴躁想坐在井中的人，触摸其双侧肾脉必然虚弱，或者沉细而迟，这容易辨别。如果有外感客邪的病，也权宜加入药物以去除它。
以上方的加减法，根据寒热、虚实，以及血秘、气秘、风秘，用药非常详尽，其他方剂都不出这个范围。
【李东垣】活血润肠丸 治疗大便风秘、血秘，时常干结燥硬。
当归梢（一钱） 防风梢（二钱） 羌活（一两） 大黄（煨制，一两） 麻子仁（二两半） 桃仁（二两，研磨如泥）
皂角仁（炮制，存性，去皮，称二两，其性质遇湿则滑，滑则燥结自然消除。）
以上除麻仁、桃仁另外研磨如泥外，其余研为极细末，用炼蜜制成丸药，大小如梧桐子。每次服用五十丸，白开水送服。服用二三服后，必须每天早晚吃苏子、麻子粥，大便长久不再干结燥硬。用瓷器盛装，用纸密封，不要让风吹到。
当归润肠汤
升麻（二钱） 当归梢（一钱） 熟地黄（一钱） 生地黄（二钱） 红花（五分） 大黄（煨制） 甘草梢（生用）
桃仁 麻仁（各一钱，研磨如泥）
以上切碎如麻豆大小，作为一服，用水三盏，放入桃仁、麻仁煎至一盏，空腹时稍热服用。
导滞通幽汤 治疗大便困难，幽门不通，向上冲击吸门不开，噎塞，不便，燥闭，气不能下行，治疗重点在幽门，用辛味药润燥。
当归身 升麻梢 桃仁泥 甘草（炙制，各一钱） 红花（少许） 熟地黄 生地黄（各五分）
以上切碎，作为一服，用水两大盏，煎至一盏，调入槟榔细末五分，稍热服用。
【朱丹溪引用许叔微案例】许学士治疗年老体虚便秘，用麻仁、苏子各半合，研磨取汁，分两次服用，煮粥吃，不用吃药就好了。
【罗天益】润肠橘杏丸 降气润肠。服用后，大肠自然没有涩滞感。
橘皮 杏仁（去皮尖及双仁者，面粉炒黄。各等分。本草说：杏仁能润气燥。）
以上研为细末，炼蜜制成丸药，大小如梧桐子。每次服用五十丸，空腹用温水送服。也不损伤胃气。
以上是润燥的方法。大概桃仁、麻仁治疗血燥；杏仁、郁李仁治疗气燥；皂角仁治疗风燥。
【朱丹溪】杨淳的三哥，大便秘涩，小便正常，咽喉堵塞不通，吃东西下去就有痰出来，左右手脉象都涩，这是血虚肠燥导致的脾约证。
病情严重的，用人参散主治。
人参 黄芪（各一钱） 厚朴（八分，炒制） 地黄（七分） 桃仁 枳壳（炒制，各一钱） 甘草（少许，炙制）
煎药时加入竹沥、姜汁饮用，又给予锁阳、肉苁蓉二钱，桃仁一钱，煮粥加入竹沥，名叫润肠散。
妇人肠道便秘，补血和气以通导大便。
肉苁蓉（一两半） 麻仁 白芍药 陈皮 当归身（各一两）
以上研为末，晒干，用炒神曲糊制成丸药，大小如梧桐子。饭前白开水送服五十丸，分两次服用。
【世传方】苁蓉润肠丸 治疗发汗过多，耗散津液，大肠秘结。
肉苁蓉（酒浸，焙干二两） 沉香（另研，一两）
以上研为末，用麻仁汁打糊制成丸药，大小如梧桐子。每次服用七十丸，米饮送服。
【朱震亨】益血丹 治疗大便干燥，久病体虚亡血。
当归（酒浸，焙干） 熟地黄（各等分）
以上研为末，炼蜜制成丸药，大小如弹丸，细细咀嚼，酒送服。
【朱丹溪】大肠虚秘而有热的情况。
白芍药（一两半） 陈皮 生地黄 当归身（各一两） 黄芩 甘草
以上用粥糊制成丸药，白开水送服。
以上是肉苁蓉、当归、地黄润燥的方法，大概适用于积血枯竭且虚损严重的人。
【李东垣】有实物积聚而结滞的，应当用攻下法。饮食损伤太阴脾经，肠满食物不消化，腹部响响作响不能大便的，用苦味药泄下。（张仲景的麻仁丸、《局方》七宣丸，都是以大黄为君药的这类方子。）
【李东垣】治疗注夏（夏季倦怠嗜卧），大便涩滞的是血少，血中有伏火。用黄芪人参汤加生地黄、当归身、桃仁泥、麻仁泥来润燥。（黄芪人参汤方见注夏篇。）如果润燥后大便长久不快利，少量加入煨大黄轻微通利。如果加入大黄后长久不快利，就不是血结血秘，而是热则生风，病症一定是湿风症，只应当服用黄芪人参汤，只用羌活半两、防风半两，水四盏，煎至一盏，去渣，空腹服用，大便必定会大量排出。
【朱丹溪】脾约丸论 成无己说：约，是结约的意思，又是束约的意思。胃强脾弱，约束津液不得四处布散，只输送到膀胱，所以小便频数而大便硬，所以叫脾约。给此丸药以下除脾的结燥，润肠结，化津液入胃，则大便通利，小便减少而痊愈了。我私下有疑问，既然叫脾约，说明脾弱不能运化，脾弱则土气亏损，必然是脾气散失，脾血耗伤。推究其由来，是在久病大汗大下之后，阴血枯槁，内火燃烧灼热，热伤元气，又伤于脾而成为此症。伤元气，是肺金受火克制，气无所摄纳；伤脾，肺为脾之子，肺耗则津液枯竭，必然窃取母气以自救，金耗则木缺乏制约，土想要不受伤也不可能。脾失去转输的命令，肺失去传送的功能，应该大便秘结难下，小便频数而无藏蓄。理应滋养阴血，使孤阳之火不炽盛而金行清化，木邪有制约，脾土清健而营运津液，津液入胃，则肠润而通了。现在用大黄为君药，枳实、厚朴为臣药，虽然有芍药养血，麻仁、杏仁温润作为佐使，用于热甚而气实的人，没有不安宁的。我担心西北两地，地势高燥，人体禀赋壮实的人可以用。如果用东南地区的人，内热自甚，而血气不实的人，虽然得到暂时通畅，将会看到脾更弱而更燥。后来使用此方的人，要知道在西北以开结为主，在东南以润燥为主，千万不要拘泥固执。
【张洁古】脏腑的秘结，不可一概治疗，有虚秘，有实秘。胃实而秘的人能饮食，小便赤，应当用麻仁丸、七宣丸之类主治。（张仲景麻仁丸方见伤寒阳明病篇，每次服用二十丸，不知道是否加至五十丸，每日三次服用，以通利为度。）
【《太平惠民和剂局方》】七宣丸
柴胡（五两） 桃仁（去皮尖，炒，六两） 枳实（麸炒，五两） 甘草（炙制，四两） 诃子皮 木香（各五两）
大黄（面裹煨制，十五两）
以上研为细末，炼蜜制成丸药，大小如梧桐子。每次服用二十丸，米饮送下，逐渐加至四五十丸，以通利为度。
【《斗门方》】治疗大便不通。用乌桕树皮一方寸，劈破，用水煎取小半盏，服用后立即通畅，不要多服，功效神圣。兼能取水，或者用此汤调下五苓散二钱，空腹服用更好。
【张洁古】胃虚而秘的人，不能饮食，小便清利，用厚朴汤主治。
陈皮（一两） 甘草（炙制，二两） 厚朴（制，二两） 白术（三两） 半夏曲（一两） 枳实（炒制，一两）
以上粗末。每次用三五钱，水一盏半，姜三片，枣一枚，煎至一盏，去渣，空腹温服。实秘是有形之物，虚秘是无形之气。
【世传方】槟榔散 治疗肠胃受湿，大便秘涩。用槟榔（不拘多少）研为末。每次服用二钱，蜜汤点服，不拘时间。
【朱震亨】桃仁、杏仁都治疗大便秘结，应当以血、气区分。年老体虚之人，大便燥秘，脉浮在气分，用杏仁、陈皮主治。脉沉在血分，用桃仁、陈皮主治。所以都用陈皮，是因为陈皮对于阳明病，与手太阴肺经互为表里。又说：盛则难便，是行阳气；败则便难，是行阴血。
【张仲景】问：脉有阳结、阴结，怎么区别？答：脉浮而数，能食，不大便的，这是实，名叫阳结，预期十七日当加重。脉沉而迟，不能食，身体重，大便反硬，名叫阴结，预期十四日当加重。
【李东垣】有阳结，有阴结。阳结用散法，阴结用热法。
热气留在小肠，肠中痛，脐热焦渴，则坚干不得出，所以痛而闭不通。（全文见诸痛篇。）
膀胱移热于小肠，膈肠不便。（全文见诊病传变篇。）
【《保命集》】大黄牵牛散 治疗相火之气，游走脏腑，大便秘结。
大黄（一两） 牵牛（头末，半两）
以上研为细末，每次服用三钱。有四肢厥冷的，配合酒调服；无四肢厥冷而手足烦热的，蜜汤调下，饭后服用以轻微通利为度。这叫不时而热，是湿热。（凡是用大黄半两至一两而大便不通利的，加少许麝香，调在药中，则大便必定大量排出。）
以上是热秘，都属于阳结一类，张仲景的大承气汤、小承气汤及麻仁丸之类是。（方见伤寒阳明病篇。）
【世传方】治疗后阴闭塞。用萱草根一捻，同生姜捣碎，取自然汁服用，立即痊愈。
【《太平惠民和剂局方》】半硫丸 治疗年高冷秘虚秘。
硫黄（研细，生用） 半夏（研为末）
以上等分和匀，生姜自然汁打面糊制成丸药，大小如梧桐子。每次服用五十丸，空腹温酒、姜汤任下。
【李东垣】麻黄白术汤 治疗大便不通，五日一次大便，小便黄赤，浑身肿，面部及腹部尤其严重，色黄麻木，身重如山，沉困无力，四肢痿软，不能举动，喘促唾清水，吐秽痰白沫如胶，时而躁热发作想脱衣，片刻而过，振寒，头顶额头有时像冰一样，额寒尤其严重，头晕眼黑，眼中冒火，冷泪，鼻子闻不到香臭，小腹急痛，肚脐处有动气，按压坚硬而痛。
麻黄（不去根节，五分） 桂枝（三分） 杏仁（四个） 吴茱萸（四分） 白豆蔻（五分） 厚朴（三分）
炒神曲（五分） 升麻（二分） 柴胡 白术 苍术（各三分） 甘草（生用，一分） 泽泻 白茯苓（各四分）
橘红（二分） 青皮（去瓤） 黄连（酒浸） 黄柏（酒浸） 黄芪 人参 猪苓（各三分） 熟甘草（一分）
以上切碎，分作两服。每服用两大盏半水，先煎麻黄沸去沫，再入其他药物同煎至一盏，去渣，稍热饭后服用。此症素有风湿，热伏在荣血之中，水火乘于阳道而上盛，元气短少，上喘，为阴火伤了气，四肢痿，在肾水之间，是所胜之病。现在正遇冬寒，得时令乘其肝木，又实其母，肺金克木凌火，是大胜必有大复，症状易怒呵欠多喷嚏，鼻中如有物，闻不到香臭，视物模糊，多悲健忘，少腹急痛，遍身黄，腹大胀，面目肿尤其严重，吃不进东西，痰唾涕带血，目生疮疡，大便不通，只服两剂都好了。
运气学说 大便闭有三种：
一是热。经文说：热至则淋闭。又说：少阴之复，膈肠不便是。
二是寒。经文说：太阳所至，为禁止。
三是湿。经文说：太阴司天，湿淫所胜，病大便难。
【张仲景】蜜煎导法。（方见伤寒胃实证。丹溪说：潞公夏天患泄泻，有人给石脂、龙骨、干姜等药，痢虽止但势头很苦，潞公又不喜欢大黄药，于是晚上一夜用蜜煎排出结粪五十枚，于是安宁。如果是虚人便秘，难以下药，适宜用此法。）
【朱震亨】霹雳煎用盐与蜜趁热捏如蜜煎法，上头尖，用十个左右纳入肛门中，少许化开即通。（一种方法，用蜜煎不通的，纯用盐吹入肛门中，也很好。）
【朱震亨】蜜煎与盐相合，如果用草乌头末相合也可以。大概盐能软坚润燥，草乌能化寒消结，可根据病症阴阳适宜选用。
急提盆散 治疗杂病非阴证者。
用草乌头不拘多少，研为极细末，每次用葱一枝，肥大的削去须，圆头上有汁，湿润蘸之纳入肛门中。
【孟诜】大便不通，气奔欲死。用乌梅十个放在汤中，一会儿去掉核，杵为丸，如枣大，纳入下部，不久即通。
又一方，治大小便不通。
江子肉 杏仁 皂角
以上研为末，做成饼放在脐上，艾灸自然通畅。
【世传方】通关散 治疗卒然闭不通。用盐放入脐中灸即通，去掉。
【《本草》】宣积丸 手心握药便通。
巴豆 干姜 韭子 良姜 硫黄 甘遂 白槟榔（各等分）
以上研为细末，研饭为丸，如龙眼大。早晨先用椒汤洗手，麻油涂手掌口，握药一粒，过一时辰便泻。想停止，用冷水洗手。
针灸 大便闭有两种方法：
其一取胃经。经文说：肠中不便，取三里。盛则泻之，虚则补之。
其二取肾经。经文说：邪在肾，病大便难，取之涌泉、昆仑，看有血的放尽血。
【《玉机微义》】大便秘塞：照海（五分。补，二呼；泻，六吸，立通） 支沟（半寸，泻三吸）
【《针灸集成》】又法：照海（半寸，灸二十壮，泻之） 章门（灸，二七壮） 太白（半寸，灸五壮。以上诸穴看虚实补泻，虚结补则通，热结泻则通。寒结先泻后补，热结先补后泻）
【《针灸摘英》】又法：气海（八分，令病患感觉排便三五次为度。出针时让人挟脐揉之，再刺三里） 三里（五分，感觉腹中鸣响三五次即透）
【东垣】大便闭。背第七椎两旁相距各一寸（灸三壮） 承筋（灸三壮） 阳绕（挟玉泉相距二寸，随年龄壮数针灸。书中无此穴，有人说不是正穴）
又法：石门（寸半） 大都（五分）
[Li Dongyuan] When dryness is caused by the consumption of body fluids, use acrid (pungent) herbs to moisten. The Kidney governs the five fluids; when body fluids are abundant, bowel movements are normal. If stomach Qi is damaged by hunger, overeating, or laborious work, and if one consumes spicy, hot, and rich flavors that aid fire, pathogenic factors lie hidden in the blood, consuming true Yin. This leads to a deficiency of body fluids, resulting in dry and hard stools. Additionally, elderly people with Qi deficiency and insufficient body fluids may experience constipation. The Kidney dislikes dryness and urgency; sudden administration of moistening methods is appropriate.
Run Chang Wan (Moistening Intestine Pill) [including modifications]: Treats latent fire in the Stomach, obstinate constipation, or dryness and obstruction, complete loss of appetite. These are Wind-Obstruction and Blood-Concealment, all causing blockage. One must moisten dryness, harmonize blood, and disperse wind for natural unblocking.
Qiang Huo (Notopterygii Rhizoma et Radix), Dang Gui Shao (Angelicae Sinensis Radix tip), Da Huang (Rhubarb Root and Rhizome, baked, each 0.5 liang), Ma Ren (Cannabis Seed), Tao Ren (Peach Kernel, soaked, skin and tips removed, each 1 liang).
Grind the above into powder. Except for Ma Ren and Tao Ren which are separately ground into a paste, grind the rest into fine powder. Mix with refined honey to form pills the size of tung seeds. Take 30–50 pills per dose. Swallow with plain warm water on an empty stomach. If the patient has difficulty urinating due to constipation and stagnation, and pathogenic factors are strong, urgently add wine-washed Da Huang to promote purgation. If it is blood dryness, add Tao Ren and wine-washed Da Huang. If it is wind-dryness, add Ma Ren and Da Huang. If it is wind-stagnation, add baked Zao Jiao Ren (Gleditsia Sinensis Fruit Kernel), Da Huang, and Qin Jiao (Gentianae Macrophyllae Radix) to promote purgation. If the pulse is choppy and the body feels itchy with stagnant Qi, add Yu Li Ren (Prunus japonica Seed) and Da Huang to eliminate Qi irritability. If it is a Cold-Yin disease characterized by cold obstruction, use Ban Shou Wan from *Ju Fang* (Formulas of the Bureau), or decoct Fu Zi (Aconiti Lateralis Radix Preparata) and Sheng Jiang (Zingiberis Rhizoma) and administer cold. Although the syndrome is Cold-Yin, Yang-tonifying medicines should be taken. If bowel movements are chronically not very smooth, among ten doses, give one dose of a purgative to slightly unblock the bowels and prevent closure; this is the general principle of treatment. If the patient has a Yin syndrome or Cold-Yin syndrome but manifests obvious irritability and a firm pulse, add a small amount of bitter-cold medicine to the Yang medicine to remove heat and irritability; stop adding once irritability ceases. For those with Yin-irritability wanting to sit in a well, palpating both Kidney pulses will reveal them to be weak, or deep, thin, and slow; this is easy to distinguish. For diseases with exogenous pathogens, add medicines opportunistically to dispel them.
The modification methods for the above formula are extremely detailed regarding cold/heat, deficiency/excess, and blood/Qi/Wind constipation; other formulas do not exceed this scope.
[Li Dongyuan] Huo Xue Run Chang Wan (Invigorate Blood and Moisten Intestine Pill): Treats Wind-Constipation and Blood-Constipation of the bowels, frequently dry and hard.
Dang Gui Shao (Angelicae Sinensis Radix tip, 1 qian), Fang Feng Shao (Saposhnikoviae Radix tip, 2 qian), Qiang Huo (Notopterygii Rhizoma et Radix, 1 liang), Da Huang (Rhubarb Root and Rhizome, baked, 1 liang), Ma Zi Ren (Cannabis Seed, 2.5 liang), Tao Ren (Peach Kernel, 2 liang, ground into paste).
Zao Jiao Ren (Gleditsia Sinensis Fruit Kernel, processed to retain nature, skin removed, weighed 2 liang; its nature becomes slippery when wet, and slipperiness eliminates dryness and obstruction naturally).
Except for Ma Zi Ren and Tao Ren which are separately ground into paste, grind the rest into extremely fine powder. Mix with refined honey to form pills the size of tung seeds. Take 50 pills per dose, swallow with plain warm water. After two or three doses, eat Su Zi (Perillae Fructus) and Ma Zi (Cannabis Seed) porridge morning and evening daily so that bowel movements remain dry-free for a long time. Store in porcelain vessels, seal with paper to avoid exposure to wind.
Dang Gui Run Chang Tang (Angelica Decoction to Moisten the Intestines)
Sheng Ma (Cimicifugae Rhizoma, 2 qian), Dang Gui Shao (Angelicae Sinensis Radix tip, 1 qian), Shu Di Huang (Prepared Rehmanniae Radix, 1 qian), Sheng Di Huang (Rehmanniae Radix, 2 qian), Hong Hua (Carthami Flos, 5 fen), Da Huang (Rhubarb Root and Rhizome, baked), Gan Cao Shao (Licorice Root tip, raw).
Tao Ren (Peach Kernel), Ma Ren (Cannabis Seed, each 1 qian, ground into paste).
Cut into sizes like hemp beans. As one dose, use three cups of water, add Tao Ren and Ma Ren, decoct until one cup remains. Take slightly warm on an empty stomach.
Dao Zhi Tong You Tang (Guide Stasis and Unblock the幽 Orifice Decoction): Treats difficult defecation, obstruction of the幽门 (Pylorus/Anus region), upward impact blocking the吸门 (Glottis/Throat), dysphagia, inconvenience, dry obstruction, Qi unable to descend. Treatment focuses on the幽门, using acrid herbs to moisten.
Dang Gui Shen (Angelicae Sinensis Radix body), Sheng Ma Shao (Cimicifugae Rhizoma tip), Tao Ren Ni (Peach Kernel Paste), Gan Cao (Licorice Root, roasted, each 1 qian), Hong Hua (Carthami Flos, a little), Shu Di Huang (Prepared Rehmanniae Radix), Sheng Di Huang (Rehmanniae Radix, each 5 fen).
Cut roughly. As one dose, use two large cups of water, decoct until one cup remains. Mix with 5 fen of fine Bing Lang (Arecae Semen) powder. Take slightly warm.
[Zhu Danxi citing Xu Shimwei's case]: Xu Xueshi treated constipation in the elderly due to deficiency using Ma Ren (Cannabis Seed) and Su Zi (Perillae Fructus), half he each, ground to extract juice, divided into two doses, eaten as porridge; cured without medication.
[Luo Tianyi] Run Chang Ju Xing Wan (Moisten Intestine Tangerine Peel and Apricot Kernel Pill): Descends Qi and moistens the intestines. After taking it, the Large Intestine naturally has no stagnation.
Ju Pi (Tangerine Peel), Xing Ren (Apricot Kernel, skin and tips removed, double kernels removed, stir-fried with flour until yellow. Equal parts. Materia Medica states: Apricot Kernel can moisten Qi dryness).
Grind the above into powder, mix with refined honey to form pills the size of tung seeds. Take 50 pills per dose, swallow with warm water on an empty stomach. It does not damage Stomach Qi.
These are moistening methods. Generally, Tao Ren (Peach Kernel) and Ma Ren (Cannabis Seed) treat Blood Dryness; Xing Ren (Apricot Kernel) and Yu Li Ren (Prunus japonica Seed) treat Qi Dryness; Zao Jiao Ren (Gleditsia Sinensis Fruit Kernel) treats Wind Dryness.
[Zhu Danxi]: Yang Chun's third brother had dry and obstinate stool, normal urination, throat blockage preventing passage, phlegm produced immediately after eating, choppy pulse in both left and right hands. This is Blood Deficiency and Intestinal Dryness leading to Pi Yue (Spleen Constraint).
For severe cases, Ren Shen San (Ginseng Powder) is the main treatment.
Ren Shen (Panax Ginseng Root), Huang Qi (Astragali Radix, each 1 qian), Hou Po (Magnoliae Officinalis Cortex, 8 fen, stir-fried), Di Huang (Rehmanniae Radix, 7 fen), Tao Ren (Peach Kernel), Zhi Ke (Aurantii Fructus, stir-fried, each 1 qian), Gan Cao (Licorice Root, a little, roasted).
Decoct and drink with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice). Also give Suo Yang (Cynomorii Herba) and Cong Rong (Cistanche Stem) 2 qian, Tao Ren 1 qian, cooked into porridge with Zhu Li, named Run Chang San (Moisten Intestine Powder).
For women with intestinal constipation, tonify Blood and harmonize Qi to unblock.
Cong Rong (Cistanche Stem, 1.5 liang), Ma Ren (Cannabis Seed), Bai Shao Yao (Paeoniae Radix Alba), Chen Pi (Tangerine Peel), Dang Gui Shen (Angelicae Sinensis Radix body, each 1 liang).
Grind into powder, sun-dry, make pills with Chao Shen Qu (Stir-fried Medicinal Leaven Paste) the size of tung seeds. Take 50 pills before meals with plain warm water, divided into two doses.
[Worldly Formula] Cong Rong Run Chang Wan (Cistanche Moistening Intestine Pill): Treats excessive sweating consuming body fluids, leading to Large Intestine constipation.
Cong Rong (Cistanche Stem, wine-soaked, dried 2 liang), Chen Xiang (Aquilaria Wood, separately ground 1 liang).
Grind into powder, use Ma Ren juice to make paste for pills the size of tung seeds. Take 70 pills per dose, swallow with rice drink.
[Zhu Zhenheng] Yi Xue Dan (Benefit Blood Pill): Treats dry stool, chronic deficiency and blood loss.
Dang Gui (Angelicae Sinensis Radix, wine-soaked, dried), Shu Di Huang (Prepared Rehmanniae Radix, equal parts).
Grind into powder, mix with refined honey to form pills the size of a bullet. Chew thoroughly, swallow with wine.
[Zhu Danxi]: Large Intestine deficiency constipation with heat.
Bai Shao Yao (Paeoniae Radix Alba, 1.5 liang), Chen Pi (Tangerine Peel), Sheng Di Huang (Rehmanniae Radix), Dang Gui Shen (Angelicae Sinensis Radix body, each 1 liang), Tiao Qin (Scutellariae Radix), Gan Cao (Licorice Root).
Make pills with congee paste, swallow with plain warm water.
The above methods using Cong Rong, Dang Gui, and Di Huang for moistening dryness are suitable for cases of exhausted accumulated blood and severe deficiency.
[Li Dongyuan]: When there is tangible accumulation causing obstruction, use purgation. Food injury to the Taiyin Spleen channel causes fullness in the intestines, undigested food, rumbling abdomen, and inability to defecate; use bitter-draining methods. (Zhang Zhongjing's Ma Ren Wan and *Ju Fang*'s Qi Xuan Wan are examples where Da Huang is the sovereign herb.)
[Li Dongyuan]: Treating "Zhu Xia" (Summer lethargy), constipation with sluggishness is due to Blood deficiency and latent fire in the Blood. Use Huang Qi Ren Shen Tang (Astragalus and Ginseng Decoction) plus Sheng Di Huang (Rehmanniae Radix), Dang Gui Shen (Angelicae Sinensis Radix body), Tao Ren Ni (Peach Kernel Paste), and Ma Ren Ni (Cannabis Seed Paste) to moisten. (Huang Qi Ren Shen Tang formula see Zhu Xia section.) If moistening does not result in smooth bowel movement for a long time, add a small amount of baked Da Huang for mild purgation. If adding Da Huang still results in no smooth movement, it is not Blood Obstruction or Blood Concealment, but Heat generating Wind; the disease must be Damp-Wind Syndrome. Only take Huang Qi Ren Shen Tang, using only Qiang Huo (Notopterygii Rhizoma et Radix) 0.5 liang and Fang Feng (Saposhnikoviae Radix) 0.5 liang, four cups of water, decoct to one cup, strain, and take on an empty stomach; the stool will likely pass in large quantities.
[Zhu Danxi] On Pi Yue Wan (Spleen Constraint Pill): Cheng Wuji said: "Yue" means constrained and bound. Stomach Strong and Spleen Weak constrain body fluids so they cannot distribute everywhere, only transferring to the Bladder, hence frequent urination and hard stool, thus called Spleen Constraint. Give this pill to purge the Spleen's dryness, moisten the intestines, transform fluids into the Stomach, then bowel movements become smooth, urine decreases, and health returns. I have private doubts: since it is called Spleen Constraint, the Spleen is weak and cannot transport; Spleen weakness implies Earth deficiency, meaning Spleen Qi scatters and Spleen Blood depletes. Tracing the origin, it occurs after prolonged illness with massive sweating and purging, where Yin Blood is withered, internal fire burns fiercely, heat damages Yuan Qi, and injures the Spleen to form this syndrome. Damaging Yuan Qi means Lung Metal is controlled by Fire, and Qi has no control; injuring the Spleen, since Lung is the child of Spleen, Lung depletion leads to fluid exhaustion, inevitably stealing Mother Qi to save itself. Metal depletion means Wood lacks restraint, and Earth cannot help but be injured. The Spleen loses its transport command, the Lung loses its transmission function; thus stool is constipated and hard to pass, urine is frequent and lacks storage. Reasonably, one should nourish Yin Blood so that lone Yang fire does not blaze, Metal performs clear transformation, Wood evil is restrained, Spleen Earth becomes clear and healthy, transporting fluids; fluids enter the Stomach, intestines become moist and unblocked. Now, using Da Huang as sovereign, Zhi Shi (Immature Bitter Orange) and Hou Po (Magnoliae Officinalis Cortex) as ministers, although having Shao Yao (Paeoniae Radix) to nourish blood, and Ma Ren (Cannabis Seed) and Xing Ren (Apricot Kernel) as auxiliaries, this is safe for those with intense heat and excess Qi. I fear that in the Northwest, where terrain is high and air dense, and people are robust, it can be used. But for people in the Southeast, who have intense internal heat and deficient Qi and Blood, although temporary relief is achieved, the Spleen will become weaker and drier. Those using this formula later must know: in the Northwest, focus on opening obstruction; in the Southeast, focus on moistening dryness. Do not play the zither while stuck to the tuning pegs (be rigid).
[Zhang Jiegu]: Constipation of the Zang-Fu organs cannot be treated uniformly; there is Deficiency Constipation and Excess Constipation. Stomach Excess constipation involves ability to eat and red urine; treat mainly with Ma Ren Wan (Cannabis Seed Pill) or Qi Xuan Wan (Seven Purge Pills). (Zhang Zhongjing's Ma Ren Wan formula see Shaoyang Yangming Disease chapter, take 20 pills per dose, unknown if increased to 50, three times daily, stop when loose).
*[Tai Ping Hui Min He Ji Ju Fang]* Qi Xuan Wan (Seven Purge Pills)
Chai Hu (Bupleuri Radix, 5 liang), Tao Ren (Peach Kernel, skin and tips removed, fried, 6 liang), Zhi Shi (Immature Bitter Orange, bran-fried, 5 liang), Gan Cao (Licorice Root, roasted, 4 liang), He Zi Pi (Terminalia Chebula Pericarpium), Mu Xiang (Aucklandiae Radix, each 5 liang).
Da Huang (Rhubarb Root and Rhizome, wrapped in flour and baked, 15 liang).
Grind into fine powder, mix with refined honey to form pills the size of tung seeds. Take 20 pills per dose, swallow with rice drink, gradually increase to 40–50 pills, stop when loose.
*[Dou Men Fang]* Treats constipation. Use Wu Zhou Mu Pi (Ulmus macrocarpa Bark) one square inch, split, decoct in water to obtain half a small cup. Take it, and passage is immediate. Do not take too much; its efficacy is divine. It also helps collect water; or use this decoction to mix with Wu Ling San (Five-Ingredient Powder with Poria) 2 qian, better taken on an empty stomach.
[Zhang Jiegu]: Stomach Deficiency constipation involves inability to eat and clear, profuse urine; treat mainly with Hou Po Tang (Magnolia Decoction).
Chen Pi (Tangerine Peel, 1 liang), Gan Cao (Licorice Root, roasted, 2 liang), Hou Po (Magnoliae Officinalis Cortex, processed, 2 liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 liang), Ban Xia Qu (Pinelliae Fermented Paste, 1 liang), Zhi Shi (Immature Bitter Orange, fried, 1 liang).
Coarse powder. Use 3–5 qian per dose, one and a half cups of water, three slices of ginger, one jujube, decoct to one cup, strain, take warm on an empty stomach. Excess constipation is due to tangible matter; Deficiency constipation is due to Qi.
[Worldly Formula] Bing Lang San (Areca Powder): Treats Large Intestine and Stomach dampness causing dry constipation. Use Bing Lang (Areca Seed, any amount) ground into powder. Take 2 qian per dose, mix with honey water, anytime.
[Zhu Zhenheng]: Tao Ren (Peach Kernel) and Xing Ren (Apricot Kernel) both treat constipation; differentiate by Blood and Qi. In elderly and deficient persons with dry constipation, floating pulse indicates Qi level; use Xing Ren (Apricot Kernel) and Chen Pi (Tangerine Peel). Deep pulse indicates Blood level; use Tao Ren (Peach Kernel) and Chen Pi (Tangerine Peel). Both use Chen Pi because for Yangming disease, it is exterior-interior related to Hand-Taiyin Lung. Also said: Abundance makes passing difficult, moving Yang Qi; Decline makes passing difficult, moving Yin Blood.
[Zhang Zhongjing]: Asked: How to distinguish Pulse Yang Jie and Yin Jie? Answer: Floating and rapid pulse, able to eat, no stool, this is Excess, named Yang Jie (Yang Knot), expected to worsen on the 17th day. Deep and slow pulse, unable to eat, heavy body, stool contrary hard, named Yin Jie (Yin Knot), expected to worsen on the 14th day.
[Li Dongyuan]: There is Yang Jie and Yin Jie. Yang Jie is dispersed; Yin Jie is warmed.
Heat qi lingering in the Small Intestine causes pain in the intestines, heat and thirst at the umbilicus, making stool hard and dry unable to exit, thus painful and closed. (Full text see All Pain chapter.)
Bladder transferring heat to the Small Intestine causes diaphragmatic and intestinal obstruction. (Full text see Diagnosis of Disease Transmission chapter.)
*[Bao Ming Ji]* Da Huang Qian Niu San (Rhubarb and Morning Glory Powder): Treats Minister Fire qi wandering through Zang-Fu, causing large intestine constipation.
Da Huang (Rhubarb Root and Rhizome, 1 liang), Qian Niu (Pharbitidis Semen, head powder, 0.5 liang).
Grind into fine powder. Take 3 qian per dose. With cold limbs, mix with wine; without cold limbs but with hot palms/soles, mix with honey water. Take after meals, stop when mildly loose. This is called intermittent heat, which is Damp-Heat. (Whenever Da Huang 0.5–1 liang fails to loosen stool, add a little She Xiang (Musk) mixed in the medicine, and stool will surely pass in large quantities.)
Above are Heat Constipations, belonging to Yang Jie, such as Zhang Zhongjing's Da Cheng Qi Tang, Xiao Cheng Qi Tang, and Ma Ren Wan. (Formulas see Shaoyang Yangming Disease chapter.)
[Worldly Formula]: Treat posterior orifice obstruction. Use Xuan Cao Gen (Daylily Root) a pinch, crush with fresh ginger, take natural juice, cured immediately.
*[Tai Ping Hui Min He Ji Ju Fang]* Ban Shou Wan (Half-Sulfur Pill): Treats elderly cold constipation and deficiency constipation.
Liu Huang (Sulfur, finely ground, raw), Ban Xia (Pinelliae Rhizoma, powdered).
Mix equally, use fresh ginger juice to make wheat starch paste for pills the size of tung seeds. Take 50 pills per dose, swallow with warm wine or ginger tea on an empty stomach.
[Li Dongyuan] Ma Huang Bai Zhu Tang (Ephedra and Atractylodes Decoction): Treats constipation, bowel movement once every five days, yellow-red urine, whole-body edema, especially face and abdomen, yellow color and numbness, body heavy as mountain, sinking and weak, flaccid paralysis of limbs, unable to move, panting with clear saliva, vomiting turbid white foam like glue, occasional irritability and heat wanting to remove clothes, passing quickly, chills, top of head and forehead sometimes like ice, forehead cold especially severe, vertigo and black eyes, fire flashing in eyes, cold tears, nose unable to smell fragrances, lower abdominal urgent pain, moving Qi at umbilicus, hard and painful upon pressure.
Ma Huang (Ephedrae Herba, roots and nodes not removed, 5 fen), Gui Zhi (Cinnamomi Ramulus, 3 fen), Xing Ren (Armeniacae Semen Amarum, 4 pieces), Wu Zhu Yu (Evodiae Fructus, 4 fen), Bai Dou Kou (Amomi Fructus Rotundus, 5 fen), Hou Po (Magnoliae Officinalis Cortex, 3 fen).
Chao Qu (Stir-fried Medicinal Leaven, 5 fen), Sheng Ma (Cimicifugae Rhizoma, 2 fen), Chai Hu (Bupleuri Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma, each 3 fen), Gan Cao (Licorice Root, raw, 1 fen), Ze Xie (Alismatis Rhizoma), Bai Fu Ling (Poria, each 4 fen).
Ju Hong (Tangerine Red Peel, 2 fen), Qing Pi (Citri Reticulatae Pericarpium Viride, pith removed), Huang Lian (Coptidis Rhizoma, wine-soaked), Huang Bo (Phellodendri Cortex, wine-soaked), Huang Qi (Astragali Radix), Ren Shen (Panax Ginseng Root), Zhu Ling (Polyporus, each 3 fen), Shu Gan Cao (Processed Licorice Root, 1 fen).
Cut roughly, divide into two doses. Each dose uses two and a half large cups of water. First boil Ma Huang until bubbling, remove foam, then add other herbs, decoct to one cup, strain, take slightly warm far from meals. This syndrome has chronic Wind-Damp, heat hidden in Ying-Blood, Water and Fire riding the Yang Dao and rising excessively, Yuan Qi is short, upper panting, Yin Fire damages Qi, limb flaccidity, located between Kidney Water, a disease of overcoming. Now encountering winter cold, seasonal factors attack Liver Wood, strengthening its mother, Lung Metal controls Wood and suppresses Fire, great victory leads to great recovery. Symptoms include anger, yawning, sneezing, sensation of object in nose, inability to smell, blurred vision, sadness, amnesia, lower abdominal urgent pain, generalized yellowing, abdominal distension, severe facial/eye edema, inability to eat, bloody sputum/nasal discharge, eye ulcers, constipation. Only two doses cure all.
Yun Qi (Luck and Qi) theory: Three types of constipation:
First is Heat. Classic says: Heat arrives then strangury and obstruction occur. Also: Shaoyin recurrence causes diaphragmatic and intestinal obstruction.
Second is Cold. Classic says: Taiyin arrival causes prohibition.
Third is Dampness. Classic says: Taiyin ruling Heaven, Dampness excess causes difficult defecation.
[Zhang Zhongjing] Mi Jian Dao Fa (Honey Suppository Method). (Formula see Shaoyang Yangming Excess Syndrome. Danxi said: Duke Lu Gong suffered diarrhea in summer. Someone gave Shi Zhi (Kaolin), Long Gu (Fossilized Bones), Gan Jiang (Dried Ginger), etc. Dysentery stopped but condition was bitter. Gong disliked Da Huang, so one night used honey suppositories to expel 50 pieces of hardened feces, then rested. For deficient persons with constipation, hard to medicate orally, this method is suitable.)
[Zhu Zhenheng] Pi Li Jian (Thunderbolt Decoction): Use salt and honey, knead while hot like honey suppository, sharpen the top, insert about ten into the anus. Melt slightly and passage occurs. (Another method: if honey suppository fails, blow pure salt into the anus, also excellent.)
[Zhu Zhenheng]: Honey suppository combined with salt; if combined with Cao Wu Tou (Aconiti Kusnezoffii Radix) powder, it also works. Salt softens hardness and moistens dryness; Cao Wu transforms cold and dissolves obstruction. Choose according to Yin/Yang suitability.
Ji Ti Pen San (Emergency Basin-Lifting Powder): Treats miscellaneous diseases not Yin syndromes.
Use Cao Wu Tou (Aconiti Kusnezoffii Radix) any amount, grind to extremely fine powder. Each time use one green onion, thick ones peel off roots, squeeze juice from round head, moisten with it and insert into anus.
[Zhang Zhongjing] Zhu Dan Huang Fang (Pig Gallbladder Formula). (Formula see Shaoyang Yangming Excess Syndrome.)
[Meng Shen]: Constipation, Qi rushing to death. Place ten W Mei (Chinese Plum) in soup, soon remove pits, pound into pills date-sized, insert into lower part, passes shortly.
Another formula, treats large and small bowel obstruction.
Jiang Zi Rou (Croton Seed Flesh), Xing Ren (Apricot Kernel), Zao Jiao (Gleditsia Sinensis Fruit).
Grind into powder, make cakes, place on umbilicus, moxa-bustion, naturally unblocks.
[Worldly Formula] Tong Guan San (Pass Through Obstruction Powder): Treats sudden total obstruction. Put salt in umbilicus and moxa-bustion, then remove.
*[Ben Cao]* Xuan Ji Wan (Disperse Accumulation Pill): Hold medicine in palm, then passage.
Ba Dou (Crotonis Fructus), Gan Jiang (Zingiberis Rhizoma), Jiu Zi (Allii Tuberosi Semen), Liang Jiang (Galangal Rhizome), Liu Huang (Sulfur), Gan Sui (Kansui Radix), Bai Bing Lang (Areca Seed, equal parts).
Grind to fine powder, mix with rice paste for pills dragon-eye sized. Early morning wash hands with pepper water first, coat palm mouth with sesame oil, hold one pill, after a period of time, diarrhea occurs. To stop, wash hands with cold water.
Acupuncture: Two methods for constipation:
First, take Stomach channel. Classic says: Intestinal obstruction, take Zusanli (ST36). Excess drain, Deficiency tonify.
Second, take Kidney channel. Classic says: Pathogen in Kidney, disease difficult defecation, take Yongquan (KI1) and Kunlun (BL60), drain all blood if visible.
*[Yu Ji Wei Yi]* Large Intestine Constipation: Zhao Hai (KI6) (5 fen. Tonify, 2 breaths; Drain, 6 inhalations, immediate passage). Zhi Gou (TE6) (0.5 cun, drain 3 inhalations).
*[Cuo Yao]* Another method: Zhao Hai (KI6) (Drain, immediate passage). Tai Bai (SP3) (Drain, moxa also okay).
*[Ji]* Another method: Zhao Hai (KI6) (0.5 cun, moxa 20 moxibullions, drain). Zhang Men (LR13) (Moxa, 14 moxibullions). Tai Bai (SP3) (0.5 cun, moxa 5 moxibullions. Above points look at deficiency/excess tonify/drain. Deficiency knot tonify to pass, Heat knot drain to pass. Cold knot drain then tonify, Heat knot tonify then drain).
*[Zhai]* Another method: Qi Hai (CV6) (0.8 cun, let patient feel bowel movement 3–5 times as limit. When withdrawing needle, ask someone to rub navel, then puncture Zusanli (ST36)). Zusanli (ST36) (0.5 cun, feel abdominal鸣鸣 3–5 times then penetrate).
[Worldly Formula] Another method: He Gu (LI4).
[Dongyuan]: Constipation. Back seventh vertebra, sides one cun apart (Moxa 3 moxibullions). Cheng Jin (BL57) (Moxa 3 moxibullions). Yang Rao (Beside Yu Quan, two cun apart, follow age moxa/acupuncture. Book has no this point, some say not orthodox point).
Another method: Shi Men (CV5) (1.5 cun). Da Du (SP2) (0.5 cun).
*[Zhai]* Treat constipation and Shaoyang Water Knot: San Jian (LI3) (Along subcutaneous towards He Gu (LI4), tonify 3, drain 3, wait for abdominal passage then withdraw needle). Cheng Shan (BL57) (0.7 cun, drain).
*[Jia Yi Jing]* Difficult defecation. Zhong Zhu (TE3) and Tai Bai (SP3) govern it. Also Da Zhong (KI4) governs it.
[Zhu Danxi]: I observe ancient formulas for通便 (passing stool) all use Qi-descending agents. Generally, if Lung Qi does not descend, stool transport is difficult; using Xing Ren (Apricot Kernel), Zhi Ke (Immature Bitter Orange), Chen Xiang (Aquilaria Wood), He Zi (Terminalia Chebula Fruit) etc. are examples.