经曰。北方黑色。入通于肾。开窍于二阴。（可知大便闭结专责之少阴。证状虽殊。总由津
液枯竭也。）肾苦燥。急食辛以润之。（当归肉苁蓉之类。）
肾主五液。津液盛则大便如常。房欲过度。精血耗竭。多致秘结。或饥饱劳役。损伤胃气。
或辛热浓味。渐渍助火。伏于血中。耗散真阴。津液亏少。致令大便结燥。高年血不充。每患是
疾。故古人有胃实脾虚。风秘气秘痰秘。冷秘热秘。虚秘实秘之分。临证所当细察详问也。胃实
而秘。善饮食。小便赤涩。麻仁丸。脾虚不能运化。倦怠懒于言动。补中益气倍升、柴、当归。
煎成调生蜜、麻油。清气一升。浊气自降。有脾虚下秘者。以此汤下麻仁丸。风秘者。风入大肠。
传化失职。羌、防、苏子、枳壳、麻仁、杏仁、皂角灰。煎服润肠丸。气秘者。气不升降。谷气
不升。其人多噫。枳壳、沉香、苏子、槟榔、乌药、陈皮。煎服降气散。或四磨、六磨选用。痰
秘者。痰饮湿热阻碍。气不升降。头汗喘满。胸胁痞闷。眩晕腹鸣。半夏、茯苓、木香、槟榔、
枳实、橘红、香附、白芥子、姜汁、竹沥。不应。加大黄、黄连。甚则控涎丹下之。冷秘者。六
脉沉迟。面白或黑。凝阴固结。胃气闭塞。肠内气攻。腹中喜热恶冷。藿香、浓朴、姜、桂、枳
壳、陈皮、生姜。煎服半硫丸。热药多秘。惟硫黄性缓而通。冷药多泄。惟黄连浓肠止泄。如阴
寒秘结。当与阳药冰冷服之。然数服中。间与清润药一服。不令结秘。若病本虚寒。标显躁热。
亦宜助阳药中少加苦寒以去热躁。躁止勿加。热秘者。六脉数实。面赤口干。身热肠胃胀闷。时
欲得冷。或口舌生疮。二肠热结。苏子、黄芩、生地、芍药、杏仁、枳壳。煎服润肠丸。或四顺
清凉饮。虚秘者。不能饮食。小便清白。或年高。或病久。或脾虚津枯血少。归身、熟地、苁蓉、
参、 、沉香、松子仁、桃仁、麻仁、蜂蜜。或麻仁、枳壳、当归、人参。蜜丸服之。瘦人血枯
火秘。通幽汤煎成。入蜜服之。老人津枯。妇人产后去血过多。及发汗利小便。病后血气未复。
虚劳骨蒸。皆能作秘。惟当益气补水养血。不可用硝、黄利药。巴豆、牵牛。尤在所禁。有一种
大便不通。腹中胀闷。求通不得。频频登厕。努力太过。虚气被挣下注。肛门里急后重。时不可
忍。气逆呕恶。渴而索水。饮食不能。呻吟不绝。欲与
通利。则气以下脱。欲与升提。则气以上逆。呕恶难堪。人参、枳壳、当归煎服。加陈香橼皮尤
效。肾脏血虚。大肠风秘。生何首乌捣自然汁一盏。和白蜜。炖热服之。六味丸加蜜调服亦通。
固本丸作膏常服亦妙。古方治老人燥结。多用苁蓉。不知胃气虚者。下口即作呕吐。肥人胃中多
有痰湿。尤非所宜。惟命门火衰。开阖失职者。方为合剂。然须丸服。若作汤。亦必作吐。以其
味咸气浊也。丹方。治肾肝风秘。至夜微发寒热者。用生何首乌两许顿煎。服之神应。若暴病热
邪固结。及中有留滞者禁用。以其纯阴味涩。无养正祛邪之力也。失血后烦渴。大便不通。一味
生地黄捣汁服之。大病后不得寐。大便不通。一味熟枣仁。擂水去滓。煮粥频食。血枯燥结。恒
用熟地黄蜜煎常服。或熬膏亦佳。又老人血枯便闭。用生地黄、当归身、鲜首乌各四两。广皮一
两。熬膏炖热服半小杯。不通。三五次效。实秘者。能饮食。小便赤涩。枳实、槟榔、木香、砂
仁、蓬术、大黄、皂肉灰之属。气滞腹急。大便秘涩。六磨汤加大黄。诸秘服药不通。或虚人畏
服利药者。宜蜜煎导、削酱姜导。分寒热选用。其猪胆导。非伤寒邪热。不可轻试。病患胃气虚
者。用之往往有呃逆之虞。不可不慎。
或问干结之甚。硝、黄亦可暂用否。曰。承气汤用硝、黄。乃伤寒邪热入里。胃液干枯。肾
水涸竭。故宜急下以救阴津为务。若老人虚人。及病后肾水本亏。以致燥结。再用硝、黄下之。
是虚其虚。目下取快一时。来日复秘愈甚。欲再下之。虽铁石不能通矣。倘遇此证。当劝慰之。
缓图奏效。切勿性急。自贻其咎也。
〔诊〕阳结脉沉数。或促。阴结脉迟伏。或结。老人虚人便秘。脉多沉伏而结促不匀。若见雀啄者不治。
《黄帝内经》说：北方对应黑色，肾气通过经络与肾脏相通，其窍穴开于前后二阴。（由此可知，大便闭结主要责之于少阴肾经。虽然症状表现各异，但根本原因总归是津液枯竭。）肾脏厌恶干燥，应当紧急食用辛味药物来滋润它（如当归、肉苁蓉之类）。
肾主管五液，津液充足则大便正常。如果房事过度，导致精血耗竭，多会引起便秘；或者因饥饱不均、劳役过度，损伤了胃气；又或者长期食用辛辣热性、浓烈厚味的食物，逐渐助长火热之邪，潜伏在血中，耗散真阴，导致津液亏少，致使大便干结燥硬。老年人血液不充盈，常患此病。所以古人将便秘分为胃实脾虚、风秘、气秘、痰秘、冷秘、热秘、虚秘、实秘等不同类型，临证时必须仔细审查询问。
如果是胃实导致的便秘，患者食欲好，小便赤涩，可用麻仁丸。如果是脾虚不能运化，表现为倦怠、懒言懒动，可用补中益气汤，重用升麻、柴胡、当归，煎好后调入生蜜、麻油。清气上升，浊气自然下降。有脾虚导致下部便秘的，可用此汤送服麻仁丸。
风秘者，是风邪侵入大肠，导致传化功能失职，可用羌活、防风、苏子、枳壳、火麻仁、杏仁、皂角灰，煎服润肠丸。
气秘者，是气机升降失常，谷气不能上升，这类人容易打嗝，可用枳壳、沉香、苏子、槟榔、乌药、陈皮，煎服降气散，或者选用四磨汤、六磨汤。
痰秘者，是痰饮湿热阻碍气机，导致气不升降，表现为头部出汗、气喘胸闷、胸胁痞闷、眩晕、腹中鸣响，可用半夏、茯苓、木香、槟榔、枳实、橘红、香附、白芥子、姜汁、竹沥。如果无效，加大黄、黄连。严重时可用控涎丹攻下。
冷秘者，六脉沉迟，面色白或黑，阴寒凝固定结，胃气闭塞，肠内气攻，腹部喜欢温热而厌恶寒冷，可用藿香、厚朴、干姜、肉桂、枳壳、陈皮、生姜，煎服半硫丸。热药多导致便秘，只有硫黄药性缓和且能通便；冷药多导致腹泻，只有黄连能厚肠止泻。如果是阴寒秘结，应当将阳药放凉后服用。但是在连续服药过程中，偶尔夹杂一服清润药，以防止再次结秘。如果病本是虚寒，标象显现躁热，也应当在助阳药中少量加入苦寒药以去除热躁，躁热停止后就不要再加。
热秘者，六脉数实，面赤口干，身体发热，肠胃胀闷，时常想要冷饮，或者口舌生疮，这是大小肠热结，可用苏子、黄芩、生地、芍药、杏仁、枳壳，煎服润肠丸，或者四顺清凉饮。
虚秘者，不能饮食，小便清白，或者是老年人，或者久病，或者脾虚津枯血少，可用当归身、熟地、肉苁蓉、人参、[缺字]、沉香、松子仁、桃仁、火麻仁、蜂蜜。或者用火麻仁、枳壳、当归、人参，炼蜜为丸服用。瘦人血枯火秘，用通幽汤煎成，加入蜂蜜服用。老人津液枯竭，妇人产后失血过多，以及发汗利小便后，病后气血未恢复，虚劳骨蒸，都能导致便秘。这些都应当益气、补水、养血，不可使用芒硝、大黄等泻下药。巴豆、牵牛更是禁忌。
有一种大便不通，腹中胀闷，想通却通不了，频繁上厕所，用力过猛，导致虚气被挣得下注肛门，出现里急后重，时刻难以忍受，气逆呕恶，口渴索水，无法进食，呻吟不止。此时如果想用通利药，气就会随之下脱；如果想用升提药，气就会向上逆乱，导致呕恶难忍。可用人参、枳壳、当归煎服，加入陈香橼皮效果更佳。
肾脏血虚，大肠风秘，可用生何首乌捣取自然汁一盏，和入白蜜，炖热服用。六味丸加蜜调服也能通便。固本丸做成膏方常服也很妙。古方治疗老人燥结，多用肉苁蓉，却不知道如果胃气虚的人服用，一下口就会呕吐。肥胖的人胃中多有痰湿，更不适合使用。只有命门火衰，开阖功能失职的，才适合使用。而且必须做成丸剂服用，如果做成汤剂，也会引起呕吐，因为它的味道咸、气味浊。
丹方治疗肾肝风秘，到夜晚轻微发作寒热的，用生何首乌一两许顿服煎剂，服用后神效。如果是暴病热邪固结，以及体内有留滞的，禁用此法，因为它纯阴味涩，没有扶正祛邪的力量。
失血后烦渴，大便不通，单用一味生地黄捣汁服用。大病后失眠，大便不通，单用一味熟枣仁，研磨取水去渣，煮粥频频食用。血枯燥结，常用熟地黄蜜煎常服，或者熬膏也很好。另外，老人血枯便闭，用生地黄、当归身、鲜首乌各四两，广皮一两，熬膏炖热服用半小杯，如果不通，三五次见效。
实秘者，能饮食，小便赤涩，可用枳实、槟榔、木香、砂仁、蓬术、大黄、皂角肉灰之类。气滞腹急，大便秘涩，用六磨汤加大黄。各种秘症服药不通，或者虚人害怕服用泻药的，宜用蜜煎导法、削酱姜导法，根据寒热选用。猪胆导法，如果不是伤寒邪热，不可轻易尝试。病患胃气虚的人，使用往往会有呃逆的危险，不可不慎。
有人问：干结非常严重，芒硝、大黄也可以暂时使用吗？回答说：承气汤使用芒硝、大黄，是因为伤寒邪热入里，胃液干枯，肾水涸竭，所以应当急下以救阴津为首要任务。如果是老人、虚人，以及病后肾水本来亏损，导致燥结，再用芒硝、大黄攻下，这是使虚者更虚，眼下虽然取快一时，日后便秘会更加严重。想要再次攻下，即使是铁石也不能通了。如果遇到这种情况，应当劝慰病人，慢慢图谋见效，切勿性急，自己招致灾祸。
The *Yellow Emperor's Inner Canon* states: The North corresponds to the color black; Kidney Qi communicates through the meridians with the Kidneys, and its orifices open at the two yin (anterior and posterior). (From this, it can be known that constipation is primarily attributed to the Shaoyin Kidney channel. Although symptoms vary, the root cause is always the depletion of body fluids.) The Kidneys dislike dryness; one should urgently consume pungent substances to moisten them (such as *Danggui* [Angelicae Sinensis Radix] and *Rongrong* [Cistanches Herba]).
The Kidneys govern the five fluids. When body fluids are abundant, bowel movements are normal. Excessive sexual activity depletes essence and blood, often leading to constipation. Alternatively, irregular eating or overexertion damages Stomach Qi. Or, long-term consumption of spicy, hot, rich, and strong flavors gradually aids fire, which lurks in the blood, dissipating true Yin and causing a deficiency of body fluids, resulting in dry and hard stools. Elderly people, whose blood is not abundant, often suffer from this disease. Therefore, ancient physicians classified constipation into types such as Stomach excess with Spleen deficiency, Wind Constipation, Qi Constipation, Phlegm Constipation, Cold Constipation, Heat Constipation, Deficiency Constipation, and Excess Constipation. In clinical practice, careful inquiry and examination are essential.
In cases of Stomach Excess Constipation, the patient has a good appetite and dark, scanty urine; *Maren Wan* (Hemp Seed Pill) is indicated. In cases of Spleen Deficiency failing to transport and transform, manifesting as fatigue and reluctance to speak or move, *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) is used, with increased doses of *Shengma* (Cimicifugae Rhizoma), *Chaihu* (Bupleuri Radix), and *Danggui*. After decocting, raw honey and sesame oil are added. As clear Qi ascends, turbid Qi naturally descends. For Spleen deficiency leading to lower constipation, this decoction can be used to administer *Maren Wan*.
Wind Constipation occurs when wind pathogens invade the Large Intestine, impairing transmission functions. It is treated with *Qufang*, *Suzi*, *Zhike*, *Maren*, *Xingren*, and *Zaojiao Hui* (Ash of Gleditsia Sinensis Fruit Pod), decocted and administered as *Runchang Wan* (Moisten the Intestines Pill).
Qi Constipation arises from dysfunction in the ascending and descending of Qi, where Grain Qi fails to ascend. Patients often belch. It is treated with *Zhike*, *Chenxiang*, *Suzi*, *Binglang*, *Wuyao*, and *Chenpi*, decocted and administered as *Jiangqi San* (Descend Qi Powder), or alternatively *Simoge Tang* (Four Mo Decoction) or *Liuge Tang* (Six Mo Decoction).
Phlegm Constipation is caused by phlegm-fluids and damp-heat obstructing Qi dynamics, leading to impaired ascent and descent. Symptoms include sweating on the head, asthma, chest fullness, hypochondriac stuffiness, dizziness, and borborygmus. It is treated with *Banxia*, *Fuling*, *Muxiang*, *Binglang*, *Zhishi*, *Juhong*, *Xiangfu*, *Baijiezi*, ginger juice, and *Zhuli* (Bamboo Sap). If ineffective, *Dahuang* and *Huanglian* are added. In severe cases, *Kongxian Dan* (Control Fluids Pill) is used for purgation.
Cold Constipation presents with deep and slow pulses, white or dark complexion, congealed cold binding, blocked Stomach Qi, abdominal pain aggravated by movement, and a preference for warmth while disliking cold. It is treated with *Huoxiang*, *Houpo*, *Ganjiang*, *Rougui*, *Zhike*, *Chenpi*, and *Shengjiang*, decocted and administered as *Banshou Wan* (Half-Sulfur Pill). Hot medicines often cause constipation, but *Sulfur* is mild and promotes bowel movement. Cold medicines often cause diarrhea, but *Huanglian* thickens the intestines and stops diarrhea. In cases of Yin-cold constipation, Yang-promoting medicines should be taken cool. However, among several doses, occasionally insert one dose of clearing and moistening medicine to prevent re-accumulation of constipation. If the root pathology is deficiency-cold but the branch manifests as restlessness and heat, a small amount of bitter-cold medicine should be added to the Yang-warming formula to remove heat and restlessness; stop adding once restlessness ceases.
Heat Constipation presents with rapid and solid pulses, red face, dry mouth, body heat, intestinal bloating, desire for cold drinks, or mouth and tongue sores, indicating heat binding in the Small and Large Intestines. It is treated with *Suzi*, *Huangqin*, *Shengdi*, *Shaoyao*, *Xingren*, and *Zhike*, decocted and administered as *Runchang Wan* or *Sishun Qingliang Yin* (Four-Obedience Cooling Clearing Drink).
Deficiency Constipation is characterized by inability to eat, clear and copious urine, or occurs in the elderly, after prolonged illness, or due to Spleen deficiency with fluid exhaustion and blood shortage. Ingredients include *Guishen* (Angelicae Sinensis Radix), *Shudi* (Rehmanniae Radix Preparata), *Rongrong*, *Renshen*, [missing character], *Chenxiang*, *Songziren*, *Taoren*, *Maren*, and honey. Alternatively, *Maren*, *Zhike*, *Danggui*, and *Renshen* are made into honey pills. For thin individuals with blood deficiency and fire-induced constipation, *Tongyou Tang* (Open the Hidden Passage Decoction) is decocted with honey. For the elderly with fluid exhaustion, postpartum women with excessive blood loss, patients after diaphoresis or diuresis, those with unresolved Qi and Blood deficiency after illness, or those with deficiency fever and bone-steaming, all can develop constipation. These conditions require tonifying Qi, replenishing water, and nourishing blood. Purgatives like *Xiaoshi* (Natrii Sulfas) and *Dahuang* (Rhei Radix et Rhizoma) must be avoided. *Badou* (Crotonis Fructus) and *Qianniu* (Pharbitidis Semen) are strictly prohibited.
There is a type of constipation where the abdomen is bloated and distended, the urge to defecate is present but unsuccessful, frequent attempts to use the toilet lead to excessive straining, causing deficient Qi to sink into the anus, resulting in tenesmus and unbearable urgency, accompanied by rebellious Qi, nausea, thirst, inability to eat, and continuous groaning. Using purgatives causes Qi to collapse downward; using lifting agents causes Qi to rebel upward, worsening nausea. This is treated with *Renshen*, *Zhike*, and *Danggui* decocted together; adding *Chen Xiangyuan Pi* (Exocarpium Citri Grandis) is particularly effective.
For Kidney Blood deficiency with Large Intestine Wind Constipation, fresh *Heshouwu* (Polygoni Multiflori Radix) is crushed to extract one cup of natural juice, mixed with white honey, warmed, and taken. *Liuwei Wan* (Six-Ingredient Pill with Rehmannia) mixed with honey also promotes bowel movement. *Guben Wan* (Solidify the Root Pill) taken regularly as an electuary is also excellent. Ancient formulas for elderly dry constipation often use *Rongrong*. However, if the Stomach Qi is deficient, taking it orally may induce vomiting. Obese individuals often have phlegm-dampness in the Stomach, making it unsuitable. Only in cases of Mingmen Fire decline with failure of opening and closing functions is it appropriate. It must be taken as pills; if decocted, it will likely cause vomiting due to its salty taste and turbid aroma.
A Daoist prescription for Kidney-Liver Wind Constipation with slight chills and fever at night uses a large dose of fresh *Heshouwu* decocted and taken at once, showing miraculous effects. However, it is contraindicated in acute diseases with heat pathogen binding or internal stagnation, as it is purely Yin, astringent, and lacks the power to support healthy Qi and expel pathogens.
After blood loss, with irritability, thirst, and constipation, take fresh *Shengdi* (Rehmanniae Radix) juice alone. After severe illness, with insomnia and constipation, take roasted *Zaoren* (Ziziphi Spinosae Semen), ground and mixed with water, strained, and cooked into porridge to be eaten frequently. For blood dryness and constipation, *Shudi* fried with honey is commonly taken regularly, or prepared as an electuary. For elderly blood-deficiency constipation, use 4 liang each of *Shengdi*, *Guishen*, and fresh *Heshouwu*, plus 1 liang of *Guangpi* (Citri Reticulatae Pericarpium), decocted into an electuary; take half a small cup warm. If ineffective, repeat three to five times for effect.
Excess Constipation is characterized by good appetite, dark and scanty urine. Ingredients include *Zhishi*, *Binglang*, *Muxiang*, *Sharen*, *Pzhu* (Curcumae Aromatica Rhizoma), *Dahuang*, and ash of soap pod flesh. For Qi stagnation with abdominal urgency and hard stool, *Liuge Tang* with added *Dahuang* is used. For various constipations unresponsive to medication, or for deficient patients fearing purgatives, use *Mi Jian Dao* (Honey Suppository) or *Jiang Dao* (Ginger Suppository), selected based on cold or heat patterns. *Zhu Dan Dao* (Pig Bile Suppository) should not be lightly tried unless there is Shaoyang heat pathogen binding. In patients with deficient Stomach Qi, its use often risks hiccups; caution is required.
Someone asked: "If dryness is extreme, can *Xiaoshi* and *Dahuang* be used temporarily?" The answer was: "*Chengqi Tang*" uses *Xiaoshi* and *Dahuang* because Shaoyang heat pathogens have entered the interior, drying up Stomach fluids and exhausting Kidney water. Thus, urgent purgation to save Yin fluids is necessary. However, for the elderly, deficient persons, or those post-illness with pre-existing Kidney water deficiency causing dryness, using *Xiaoshi* and *Dahuang* again makes deficiency more deficient. Although immediate relief is gained, constipation will worsen later. Further purgation would fail even on iron or stone. In such cases, advise the patient to remain calm and seek gradual recovery. Do not act rashly and bring harm upon yourself.
[Diagnosis] Yang-Jie (Yang Binding) pulse is deep and rapid, or hurried. Yin-Jie (Yin Binding) pulse is slow and hidden, or knotted. In the elderly and deficient persons with constipation, the pulse is often deep, hidden, knotted, and irregular. If a "Sparrow Pecking" pulse appears, the condition is untreatable.