脏腑泻利。其证多端。大抵皆因脾胃而作。东垣先生制脾胃论一篇。专以补中益气汤。升提清气为主其间
治脾泄之证。庶无余蕴矣。特未及乎肾泄也。是故以其湿也。利水以分之。以其风也。助风以平之。以其实
也。下之。以其虚也。补之。寒则温之。热则清之。有食者化之。有积者祛之。凡五行之相胜。与六
气之加临。莫不以生克制化之法治之。然而经年经月。不得一效者何耶。仲景云。下利不止。医以理中汤与
之。利益甚。理中者理中焦也。此利在下焦。当以理下焦法则愈矣。昔赵以德有云。予闻先师言泄泻之病。其
类多端。得于六淫五邪饮食所伤之外。复有杂合之邪。似难执法而治。乃见先师治气暴脱而虚。
顿泻不知人事。口眼俱闭。呼吸甚微几欲绝者。急灸气海。饮人参膏十余斤而愈。治积痰在肺。致其所合大肠
之气不固者。涌出上焦之痰。则肺气下降。而大肠之虚自复矣。治忧思太过。脾气结而不能升举。陷入下焦而
成泄泻者。开其郁结。补其脾胃。使谷气升发也。治阴虚而肾不能司禁固之权者。峻补其肾而愈也。凡此之类
甚多。因问先生治病何神也。先生曰无他。圆机活法。内经熟自得之矣。
经曰。肾主大小便。又曰。肾司开阖。又曰。肾开窍于二阴。可见肾不但主小便。而大便之能开而复能闭
者。肾操权也。今肾既虚衰。则命门之火熄矣。火熄则水独治。故令人多水泻不止。其泻每在五更天将明时。
必洞泄二三次。此其故何也。盖肾属水。其位在北。于时为亥子。五更之时。正亥子水旺之秋。故特甚也。
惟八味丸以补真阴。则肾中之水火既济。而开阖之权得宜。况命门之火旺。火能生土。而脾亦强矣。故古方有
椒附丸五味子散。皆治肾泄之神方。不可不考也。考之薛案云。脾胃虚寒下陷者。用补中益气汤。加木香肉果
补骨脂。若脾气虚寒不禁者。用六君子汤。加炮姜肉桂。若命门火衰。脾土虚寒者。用八味丸。若脾胃气血俱
虚者。用十全大补汤。送四神丸。若大便滑利。小便闭涩。或肢体渐肿。喘嗽唾痰。为脾肾亏损。宜
金匮加减肾气丸。
秦越人难经。有五泄之分。曰胃泄。曰脾泄。曰大肠泄。曰小肠泄。曰大瘕泄。夫所谓大瘕泄者。即肾泄
也。注云。里急后重。数至圊而不能便。茎中痛。世人不知此证。误为滞下治之。祸不旋踵。（滞下即今所谓
痢疾也。）此是肾虚之证。欲去不去。似痢非痢。似虚努而非虚努。盖痢疾后重。为因邪压大肠坠下。故大肠
不能升举而重。治以大黄槟榔辈。泻其所压之邪而愈。又有久
泻大肠虚滑。元气下陷。不能自收而重。乃用粟壳等涩剂。以固
其脱升其坠而愈。其虚坐努责。此痢后积已去尽。无便而但虚坐耳。此为亡血过多。倍用归芎以和之而愈。
惟肾虚后重者。亦数至圊而不能便。必茎中痛。或大便不能得。而小便先行而涩。或欲小便。而大便反欲去而
痛。独褚氏精血论中云。精已耗而复竭之。则大小便道牵痛。愈痛则愈便。愈便则愈痛。须以补中
益气汤。倍升麻送四神丸。又以八味地黄丸料。加五味吴茱萸补骨脂肉豆蔻。多服乃效。此等证候。以痢药致
损元气。肢体肿胀而毙者。不可枚举。肾既主大小便而司开阖。故大小便不禁者责之肾。即此推之。然则大便
不通者。独非肾乎。金匮真言论云。北方黑色。入通于肾。开窍于二阴。故肾气虚。则大小便难。宜以地黄苁
蓉车前子茯苓之属。补其阴利水道。少佐辛药。开腠理致津液。而润其燥。洁古云。脏腑之秘。不可一概治疗。
有热秘。有冷秘。有实秘。有虚秘。有风秘。有气秘。老人与产后。及发汗利小便过多。病后气血未复者。皆能
成秘。禁用硝黄巴豆牵牛等药。世人但知热秘。不知冷秘。冷秘者冷气横于肠胃。凝阴固结。津液不通。胃气
闭塞。其人肠内气攻。喜热恶冷。宜以八味地黄丸料。大剂煎之。冷冻饮料即愈。或局方半硫丸。碾生姜。调乳香
下之。或海藏己寒丸俱效。海藏云。己寒丸虽热。得芍药茴香润剂。引而下之。阴得阳而化。故大小便自通。
如遇春和之阳。水自消矣。然不若八味丸更妙也。
东垣云。肾主五液。津液盛则大便如常。若饥饱劳役。损伤胃气。及食辛热浓味而助火邪。伏于血中。耗
散真阴。津液亏少。故大肠结燥。又有老年气虚。津液衰少而结者。肾恶燥。急食辛以润之是也。予尝体法
东垣之论。不用东垣之方。如润肠丸润燥汤通幽散之类俱不用。惟用六味地黄丸料。煎服自愈。如热
秘而又兼气虚者。以前汤内加参 各五钱立愈。此因气虚不能推送。阴虚不能濡润故耳。以上治法。予尝
亲试而必验。且又不
犯大黄桃仁枳壳等破气破血之禁。可以久服。永无秘结。故表而出之。
或问曰。何为不用四物汤。曰四物汤特能补血耳。此是先天津液不足。故便难。经曰。大肠主津。小肠主
液。又曰。肾主五液。津液皆肾水所化。与血何干。故不用四物汤。或又问曰。如干结之甚。硝黄亦可暂用
否。曰承气汤用硝黄。乃为伤寒从表入里。寒变为热。热入三阴。恐肾干枯。故用硝黄以逐去外邪。
急救肾水。余独禁用者。乃是论老人虚人及病后人。肾水原不足。以致干枯。若再用硝黄等药以下之。是虚其
虚。今日虽取一时之快。来日必愈结。再下之。后日虽铁石亦不能通矣。倘有患此者。当劝慰之。勿令性急。
以自取危殆。况老人后门固者。寿考之征。自是常事。若以六味八味常服。永保无虞。
脏腑引起的泄泻痢疾，其症状表现多种多样。大体上都是由于脾胃功能失调而引发的。李东垣先生撰写了《脾胃论》一篇，专门以补中益气汤为主方，通过升提清气来治疗，其中对于脾虚泄泻的证治，可以说已经详尽无遗了。只是没有涉及到肾泄（因肾虚导致的泄泻）的治疗。因此，针对湿邪引起的，采用利水的方法以分消湿邪；针对风邪引起的，采用祛风的方法以平息风邪；针对实证，采用攻下的方法；针对虚证，采用补益的方法；寒证则用温法，热证则用清法；有食积的予以消导化积，有积滞的予以祛除。凡是五行相克的关系，以及六气加临的变化，无不运用生克制化的法则进行治疗。然而，为什么有些患者经年累月治疗却不见疗效呢？张仲景曾说：“下利不止，医生给予理中汤治疗，结果腹泻更加严重。”理中汤是调理中焦脾胃的，而这种腹泻病位在下焦，应当采用调理下焦的方法才能痊愈。
过去赵以德曾引用他老师的话说：“我听说先师讲过，泄泻这类疾病，种类繁多，除了感受六淫、五邪以及饮食损伤之外，还有多种邪气杂合致病，似乎难以拘泥于固定法则来治疗。”但他见到先师治疗因气机暴脱导致的虚证，突然发生剧烈腹泻甚至昏迷不醒，口眼紧闭，呼吸微弱几乎断绝的情况，立即急灸气海穴，并让人服用十余斤人参膏，最终治愈。又治疗因肺中有积痰，导致与其相表里的大肠之气固摄无力者，通过涌吐上焦之痰，使肺气得以肃降，大肠的虚弱自然恢复。又治疗因忧思过度，导致脾气郁结不能升举，陷入下焦而形成泄泻者，通过开解郁结，补益脾胃，使谷气得以升发。又治疗因阴虚导致肾气不能行使固摄权限者，峻补其肾而痊愈。像这样的情形非常多。有人问先生治病为何如此神奇？先生回答说：“没有别的奥秘，只是圆机活法罢了，只要熟读《内经》，自然就能领悟。”
《内经》说：“肾主管大小便。”又说：“肾司管开阖功能。”还说：“肾开窍于前后二阴。”由此可见，肾不仅主管小便，大便能够开启和闭合，也是由肾掌握权力的。如今肾气既已虚衰，那么命门之火也就熄灭了。火熄灭则水气独盛，所以使人出现多发性水泻不止。这种腹泻往往在五更天将亮时发生，必定会洞泄两三次。这是什么原因呢？因为肾属水，方位在北，对应的时间是亥时和子时。五更时分，正是亥子水气旺盛的时候，所以病情特别严重。只有使用八味丸（金匮肾气丸）来补益真阴，才能使肾中的水火既济，从而让开阖的功能恢复正常。况且命门之火旺盛，火能生土，脾脏也会变得强健。所以古方中有椒附丸、五味子散，都是治疗肾泄的神效方剂，不可不加以考究。
查阅薛己的医案记载：如果是脾胃虚寒且气陷的，使用补中益气汤，加入木香、肉豆蔻、补骨脂。如果是脾气虚寒且固摄无权者，使用六君子汤，加入炮姜、肉桂。如果是命门火衰、脾土虚寒者，使用八味丸。如果是脾胃气血俱虚者，使用十全大补汤，送服四神丸。如果大便滑利不禁，小便闭塞涩痛，或者肢体逐渐浮肿，气喘咳嗽咳痰，这是脾肾亏损的表现，适宜使用金匮加减肾气丸。
秦越人在《难经》中将泄泻分为五种：胃泄、脾泄、大肠泄、小肠泄、大瘕泄。所谓大瘕泄，就是肾泄。注释中说：“伴有里急后重，频繁去厕所却无法排便，尿道疼痛。”世人不知道这个证候，误当作痢疾（滞下）来治疗，灾祸立刻就会降临。（滞下即现在所说的痢疾。）这是肾虚的证候，想排排不出，似痢非痢，似虚努责而非真正的虚努责。痢疾的后重感，是因为邪气压迫大肠使其下坠，所以大肠不能升举而感到沉重，治疗应用大黄、槟榔之类药物，泻除被压迫的邪气即可痊愈。又有长期腹泻导致大肠虚滑，元气下陷，不能自行收摄而感到沉重，这时应用罂粟壳等收敛固涩的药物，以固脱升坠即可痊愈。至于“虚坐努责”，是指痢疾后积滞已去尽，没有粪便排出但强行用力排便，这是因为失血过多，应加倍使用当归、川芎来调和气血即可痊愈。
唯独肾虚导致的后重感，也是频繁去厕所却无法排便，必然伴有尿道疼痛，或者大便排不出，反而小便先出来且涩痛，或者想要小便，大便反而想排且疼痛。只有褚澄在《精血论》中提到：“精气已经耗损如果再进一步竭尽，那么大小便通道都会牵拉疼痛，越痛越想排便，越排便越痛。”这种情况必须使用补中益气汤，加倍升麻用量，送服四神丸；或者使用八味地黄丸的药料，加入五味子、吴茱萸、补骨脂、肉豆蔻，多服用才能见效。这类证候，因为误用治痢药损伤元气，导致肢体肿胀而死的人，数不胜数。肾既然主管大小便并司管开阖，所以大小便失禁的责任在于肾。由此推论，大便不通，难道不是也关乎肾吗？《金匮真言论》说：“北方色黑，内通于肾，开窍于前后二阴。”所以肾气虚，就会导致大小便困难，适宜用地黄、肉苁蓉、车前子、茯苓这类药物，补益阴液并通利水道，稍加辛温药物，开发腠理以布散津液，从而滋润燥结。
张洁古说：“脏腑的便秘，不可以一概而论地治疗。有热秘，有冷秘，有实秘，有虚秘，有风秘，有气秘。老年人、产后妇女，以及发汗或利小便过多，病后气血尚未恢复的人，都能形成便秘。严禁使用芒硝、大黄、巴豆、牵牛子等药物。”世人只知道热秘，不知道冷秘。冷秘是由于冷气横亘于肠胃之间，阴寒凝结，津液不通，胃气闭塞。病人感觉肠内有气攻冲，喜欢热恶寒冷，适宜使用八味地黄丸的药料，大量煎煮，冷冻后饮用即可痊愈。或者使用局方半硫丸，碾碎生姜，调乳香送服。或者海藏己寒丸也都有效。海藏说：“己寒丸虽然性热，但配合芍药、茴香等润剂，引导药力下行。阴寒得到阳气则化解，所以大小便自然通畅。就像遇到春天温和的阳气，冰雪自然消融一样。但这都不如八味丸更妙。”
李东垣说：“肾主管五液，津液充足则大便正常。如果饥饱失常、劳役过度，损伤了胃气，以及食用辛辣浓味食物助长火邪，火邪潜伏在血中，耗散真阴，导致津液亏少，所以大肠干燥结滞。”又有老年人气虚，津液衰少而结滞的情况，这就是“肾恶燥，急食辛以润之”的道理。我曾体悟并效法李东垣的理论，但不使用他的方剂，如润肠丸、润燥汤、通幽散等都不用。只使用六味地黄丸的药料煎服，自愈。如果是热秘兼有气虚的，在上述汤剂中加入人参、黄芪各五钱，立竿见影。这是因为气虚不能推送，阴虚不能濡润的缘故。以上治疗方法，我曾亲自尝试且必定有效，而且不触犯大黄、桃仁、枳壳等破气破血的禁忌，可以长期服用，永远不会有便秘之苦。所以我将其列出展示。
有人问：“为什么不用四物汤？”回答说：“四物汤只能补血而已。这是由于津液不足导致大便困难。《内经》说：‘大肠主津，小肠主液。’又说：‘肾主五液。’津液都是由肾水化生的，与血液有什么关系呢？所以不用四物汤。”又有人问：“如果干结非常严重，芒硝和大黄也可以暂时使用吗？”回答说：“承气汤中使用芒硝和大黄，是为了治疗伤寒从体表传入体内，寒邪变为热邪，热邪侵入三阴，担心肾水干枯，所以用芒硝、大黄来驱逐外邪，急救肾水。我唯独禁止使用的情况，是针对老人、虚人及病后之人，他们肾水原本就不足，导致干枯。如果再用芒硝、大黄等药攻下，这是使虚者更虚。今天虽然取得一时的痛快，明天一定会更加结滞。再攻下，后天即使像铁石一样坚硬也不能通了。如果有患此病的人，应当劝慰他，不要让他性子急躁，以免自取危殆。况且老年人肛门固摄有力，是长寿的象征，本是常事。如果常服六味丸、八味丸，永远保持健康无忧。”
Diarrhea and dysentery originating from the Zang-Fu organs present with diverse symptoms. Generally, they arise due to dysfunction of the Spleen and Stomach. Mr. Li Dongyuan wrote a treatise titled *Pi Wei Lun* (Treatise on the Spleen and Stomach), which focuses primarily on using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise and lift clear Yang Qi. Regarding the treatment of Pi Xie (Spleen Deficiency Diarrhea), his methods were comprehensive. However, he did not address Shen Xie (Kidney Deficiency Diarrhea). Therefore, for cases caused by Dampness, water-draining methods are used to separate and eliminate it; for those caused by Wind, wind-dispelling methods are used to calm it; for Excess patterns, purgative methods are applied; for Deficiency patterns, tonifying methods are employed; Cold patterns are treated with warming methods, and Heat patterns with clearing methods. Food stagnation is resolved by digestion-promoting agents, and accumulations are removed. Whether dealing with the mutual overcoming of the Five Elements or the superimposition of the Six Qi, all are treated according to the laws of generation and restriction. So why do some patients fail to see results after months or years of treatment? Zhang Zhongjing stated: "For persistent diarrhea, if the physician administers Li Zhong Tang (Regulate the Middle Decoction) and the diarrhea worsens, it is because Li Zhong Tang regulates the Middle Jiao, whereas this diarrhea originates in the Lower Jiao. It should be cured by applying rules for regulating the Lower Jiao."
Previously, Zhao Yi-de quoted his master saying: "I have heard my master say that diarrhea and loose stools come in many varieties. Besides injuries from the Six Exuberances, Five Evils, and diet, there are often mixed pathogens, making it difficult to adhere to fixed treatment principles." Yet, he observed his master treating a case of sudden Qi collapse leading to severe deficiency, where the patient suffered acute profuse diarrhea, lost consciousness, had closed eyes and mouth, and breathing was extremely faint, nearly ceasing. The master urgently moxaed Qihai (CV6) and administered over ten jin of Ren Shen Gao (Ginseng Paste), resulting in a cure. He also treated a case where phlegm accumulation in the Lungs caused the associated Large Intestine Qi to lose its securing power. By inducing vomiting to expel upper Jiao phlegm, Lung Qi descended, and the deficiency of the Large Intestine naturally recovered. In another case of excessive worry causing Spleen Qi to knot and fail to ascend, sinking into the Lower Jiao to cause diarrhea, he resolved the depression and tonified the Spleen and Stomach to allow Grain Qi to rise. For cases of Yin deficiency where the Kidney could not exercise its controlling authority, he vigorously tonified the Kidney to achieve a cure. There are many such examples. When asked why his treatments were so miraculous, he replied: "There is no secret. It is merely flexible application of principles. Once one has thoroughly mastered the *Nei Jing* (Inner Canon), understanding comes naturally."
The *Nei Jing* states: "The Kidney governs urination and defecation." It also says: "The Kidney controls opening and closing," and "The Kidney opens into the two yin orifices" (anus and urethra). Thus, the Kidney not only governs urination but also controls the opening and closing of defecation. If the Kidney is deficient and weak, the Fire of Ming Men (Gate of Life) extinguishes. With the fire extinguished, Water dominates alone, causing persistent watery diarrhea. This type of diarrhea typically occurs around dawn (Wu Geng time), involving several episodes of projectile stool. Why is this? The Kidney belongs to Water, its direction is North, and its corresponding earthly branches are Hai and Zi. Dawn corresponds to the peak of Hai-Zi Water energy, hence the exacerbation at this time. Only Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) can tonify True Yin, allowing Water and Fire to interact harmoniously within the Kidney, thereby restoring proper opening and closing functions. Moreover, when Ming Men Fire is robust, it generates Earth (Spleen), strengthening the Spleen. Thus, ancient formulas like Jiao Fu Wan (Pepper and Aconite Pill) and Wu Wei Zi San (Schisandra Powder) are divine prescriptions for treating Kidney Deficiency Diarrhea and must be studied.
Reviewing Xue Ji's medical records: For Spleen-Stomach deficiency-cold with sinking Qi, use Bu Zhong Yi Qi Tang added with Mu Xiang (Aucklandiae Radix), Rou Dou Kou (Arecae Semen), and Gu Po Zhi (Psoraleae Fructus). For Spleen Qi deficiency-cold with insecure retention, use Liu Jun Zi Tang (Six-Gentleman Decoction) added with Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark). For Ming Men Fire decline with Spleen-Earth deficiency-cold, use Ba Wei Wan. For combined Spleen-Stomach Qi and Blood deficiency, use Shi Quan Da Bu Tang (Ten Great Tonics Decoction) taken with Si Shen Wan (Four Spirits Pill). For slippery stools with obstructed urine, or gradual limb swelling, wheezing, coughing, and expectoration indicating Spleen-Kidney damage, use Jin Gui Jian Di Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet).
Qin Yue-ren (Bian Que) in *Nan Jing* (Classic of Difficult Issues) classifies diarrhea into five types: Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Da Chang Xie (Large Intestine Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), and Da Jia Xie (Great Mass Diarrhea). Da Jia Xie refers to Shen Xie (Kidney Diarrhea). Annotations state: "It involves tenesmus, frequent trips to the toilet without successful defecation, and pain in the penis." People unaware of this condition mistakenly treat it as Li Xia (Dysentery), bringing immediate disaster. (Li Xia is modern Dysentery.) This is a Kidney Deficiency pattern: the urge to defecate is present but nothing passes, resembling dysentery but not being dysentery, resembling empty straining but not being true empty straining. Tenesmus in dysentery is caused by pathogenic pressure pushing the Large Intestine downward, preventing its ascent and causing heaviness. Treatment uses Da Huang (Rhei Radix et Rhizoma) and Bing Lang (Arecae Semen) to purge the compressing pathogen. Conversely, chronic diarrhea causing Large Intestine laxity and Yuan Qi sinking leads to inability to retract, causing heaviness; here, Yu Ke (Papaveris Pericarpium) and other astringents are used to secure leakage and lift sinking Qi. "Empty straining" (Xu Zuo Nu Ze) occurs after dysentery residue is cleared; the patient strains without stool due to severe blood loss. Treatment doubles Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) to harmonize.
Only Kidney Deficiency tenesmus presents with frequent toilet visits without stool, accompanied by penile pain, or inability to pass stool while urine comes first and is astringent, or the desire to urinate triggers painful defecation urges. Chu Cheng in *Jing Xie Lun* (Treatise on Essence and Blood) notes: "If essence is depleted and further exhausted, the pathways of urination and defecation will pull and hurt; the more it hurts, the more one wants to defecate; the more one defecates, the more it hurts." This requires Bu Zhong Yi Qi Tang with doubled Sheng Ma (Cimicifugae Rhizoma) sent down with Si Shen Wan, or Ba Wei Di Huang Wan ingredients added with Wu Wei Zi (Schisandrae Fructus), Wu Zhu Yu (Evodiae Fructus), Gu Po Zhi, and Rou Dou Kou. Long-term administration yields effects. Many die from limb swelling caused by damaging Yuan Qi with inappropriate dysentery medicines. Since the Kidney governs urination/defecation and opening/closing, incontinence is blamed on the Kidney. By analogy, constipation is also related to the Kidney. *Jin Gui Zhen Yan Lun* states: "North corresponds to Black, connects internally to the Kidney, and opens into the two yin orifices." Thus, Kidney Qi deficiency causes difficulty in both urination and defecation. Suitable herbs include Di Huang (Rehmanniae Radix), Rong Rong (Cistanches Herba), Che Qian Zi (Plantaginis Semen), and Fu Ling (Poria), to tonify Yin and promote water passages, with a little acrid medicine to open pores and distribute fluids to moisten dryness.
Zhang Jiegu said: "Constipation of Zang-Fu cannot be treated uniformly. There is Heat Constipation, Cold Constipation, Excess Constipation, Deficiency Constipation, Wind Constipation, and Qi Constipation. Elderly, postpartum women, those who sweated or diuresed excessively, and those recovering from illness with unrecovered Qi/Blood can all develop constipation. Drugs like Xiao Shi (Natrii Sulfas), Da Huang, Ba Dou, and Qiu Niu are strictly forbidden." People know Heat Constipation but ignore Cold Constipation. Cold Constipation arises from cold qi stagnating in the intestines/stomach, condensing Yin, blocking fluids, and closing Stomach Qi. Patients feel gas attacking inside the intestines, prefer heat, and dislike cold. Treatment uses Ba Wei Di Huang Wan decocted heavily, served cold. Or Ju Fang Ban Shou Wan (Half-Sulfur Pill), crushed fresh ginger, and Ru Xiang (Olibanum) taken together. Or Hai Zang Ji Han Wan are also effective. Hai Zang said: "Although Ji Han Wan is hot, paired with moisturizing agents like Shao Yao (Paeoniae Radix) and Hui Xiang (Foeniculi Fructus), it guides downward. Yin transforms upon receiving Yang, so urination/defecation flow freely. Like spring sun melting snow. Yet, Ba Wei Wan is superior."
Li Dongyuan said: "The Kidney governs the Five Fluids. Abundant fluids mean normal stool. Hunger/fullness irregularities, labor fatigue damaging Stomach Qi, or consuming spicy/hot rich foods aiding Fire evil, which hides in blood and consumes True Yin, leads to fluid scarcity and Large Intestine dryness/constipation. Also, elderly Qi deficiency and declining fluids cause constipation. 'The Kidney dislikes dryness; quickly eat acrid substances to moisten it.'" I adopted Dongyuan's theory but not his formulas, avoiding Run Chang Wan, Run Zao Tang, Tong You San. Instead, I use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) decocted and taken orally for self-healing. For Heat Constipation with Qi deficiency, adding Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) each 5 qian cures it immediately. This is because Qi deficiency fails to push, and Yin deficiency fails to moisten. I have personally tested these methods with certainty, avoiding prohibited Qi/Blood-breaking drugs like Da Huang, Tao Ren, and Zhi Ke. They can be taken long-term without constipation recurrence. Hence, I publish them.
Someone asked: "Why not use Si Wu Tang?" I replied: "Si Wu Tang only tonifies Blood. Here, the issue is insufficient Tian Jin Ye (Heavenly Fluids), causing hard stool. The *Nei Jing* says: 'Large Intestine governs Jin, Small Intestine governs Ye.' And 'Kidney governs Five Fluids.' All fluids derive from Kidney Water, having nothing to do with Blood. Hence, Si Wu Tang is not used." Another asked: "If dryness is extreme, can Xiao Shi and Da Huang be used temporarily?" I replied: "Cheng Qi Tang uses Xiao Shi and Da Huang to treat Tai Yang disease entering interior, transforming from Cold to Heat, invading Three Yin, fearing Kidney water exhaustion. Thus, they purge external pathogens to save Kidney Water. I forbid their use for elderly, deficient, or post-illness patients whose Kidney Water is originally insufficient, causing dryness. Using purgatives here makes deficiency worse. Today brings temporary relief, tomorrow brings worse blockage. Further purging makes even iron-stone impassable. Advise patients not to be impatient to avoid danger. Firm bowel control in elders indicates longevity. Regular use of Liu Wei Wan and Ba Wei Wan ensures health."