经曰∶太阴司天，阴痹，大便难，阴气不用，病在于肾。
又曰∶太阳之胜，隐曲不利，互引阴股。陈飞霞曰∶夫饮食之物，有入必有出也。苟大便不通，出入之机，几乎
息矣。急宜通之，使旧谷去，而新谷得入。然有实闭，有虚闭，最宜详审。如形实、气实、脉实，又能食者，的有
可下之证，则下之。如八正散、承气汤、木香槟榔丸之类，择而用之。中病即止，不可过也。如形虚、气虚、脉虚，
而兼食少者，虽有可下之证，宜缓不宜急，但用保和丸，加枳实微利之。如平素便难者，血不足也，宜润肠丸，
蜜导煎法。
八正散 （见二便方内）
大承气汤 （见前痉病方内）
枳壳（一钱） 浓朴（一钱） 大黄（一钱） 芒硝（一钱）
《集成》木香槟榔丸
黑牵牛（炒取头末，五个） 尖槟榔 锦纹黄 木香 神曲
上共为细末，姜汁打米糊为丸，量儿大小加减用之。
《集成》保和丸
神曲（一钱） 陈皮（一钱） 法半夏（一钱） 茯苓（一钱） 山楂肉（一钱） 连翘（一钱）
《集成》润肠丸
火麻仁（去壳） 光杏仁（去皮） 桃仁（去皮） 陈枳壳 当归尾（以上各七钱半） 阿胶珠 萝卜子
苏叶（各二钱）
上为细末，炼蜜为丸，每服一二钱，量人加减，白汤调下。
涂蔚生曰∶润肠丸即仲景脾约丸之意。脾约丸为治脾火太旺，将肠胃津液煎枯，而大便干结者。润肠丸
虽本此意以为加减，而苏叶之杂于其间，则不如脾约丸之纯。推此意以求，则阴虚至急，肾火至盛，将肠胃煎熬
极枯，燥结极甚者，则生地萸肉知柏芩连俱可加入。予在正阳，曾治一素患阴虚之人。忽患大便
燥结，他医尽为推荡，愈治而愈甚。予为之用脾约丸原方，重用生地、龟胶、芩连等味而愈者。足见大便之结，
不仅实热然也。而陈飞霞以虚者用保和丸，加枳实微利之，是其既未免患虚之嫌。又未知虚者，又有何种类，如
何治法也。若夫脾湿阴滞，津液不降，须得苓术而大便通者，则犹非飞霞所能知者也。但此中最少，不过百分之
一二耳，不可不知。
仲景脾约丸（一名麻仁丸）
麻仁（二钱） 白芍（一钱） 大黄（一钱） 枳壳（七分） 浓朴（五分） 杏仁（一钱）
《黄帝内经》说：当太阴湿土主司天时，会出现阴痹（寒湿阻滞经络引起的疼痛），大便困难，这是阴气运行失常，病位在于肾脏。
又说：当太阳寒水之气偏胜时，会出现前阴或后阴排泄不畅，牵引大腿内侧疼痛。陈飞霞说：饮食进入体内，必然有排出体外的时候。如果大便不通，人体出入代谢的机能，几乎就要停止了。应当紧急疏通，使宿食排去，新食才能摄入。然而便秘有实秘和虚秘之分，最需要详细审察。如果形体壮实、气息充实、脉象有力，且能进食的，确实具备可攻下的指征，就使用攻下法。如八正散、承气汤、木香槟榔丸之类的方剂，选择其中一种使用。中病即止，不可过度。如果形体虚弱、气息不足、脉象无力，且兼有食欲减退的，即使有可攻下的指征，也宜缓不宜急，只需用保和丸，加入枳实轻微通利即可。如果平时排便困难，是血虚所致，适宜用润肠丸，配合蜜导煎法（蜂蜜栓剂）治疗。
八正散（见二便方内）
大承气汤（见前痉病方内）
《集成》木香槟榔丸
以上共研为细末，用姜汁调和米糊制成丸药，根据患儿年龄大小加减用量。
《集成》保和丸
神曲（一钱） 陈皮（一钱） 法半夏（一钱） 茯苓（一钱） 山楂肉（一钱） 连翘（一钱）
《集成》润肠丸
火麻仁（去壳） 光杏仁（去皮） 桃仁（去皮） 陈枳壳 当归尾（以上各七钱半） 阿胶珠 萝卜子 苏叶（各二钱）
以上研为细末，用炼蜜制成丸药，每次服用一二钱，根据患者情况加减，用白开水调服。
涂蔚生说：润肠丸即是张仲景脾约丸（Spleen-Restriction Pill）的本意。脾约丸用于治疗脾火过旺，将肠胃津液煎熬枯竭，导致大便干结的情况。润肠丸虽然基于此意进行加减，但其中夹杂了苏叶，则不如脾约丸纯粹。推究此意来寻求治疗方法，如果是阴虚至极紧急，肾火极盛，将肠胃煎熬得极度干枯，燥结极其严重的，那么生地、山茱萸、知母、黄柏、黄芩、黄连都可以加入。我在正阳时，曾治疗一个素来患有阴虚的人。突然患上大便燥结，其他医生都用攻逐泻下的方法治疗，结果越治越严重。我为他使用脾约丸原方，重用生地、龟胶、黄芩、黄连等药物而治愈。足见大便干结，不仅仅是实热所致。而陈飞霞认为虚证用保和丸加枳实轻微通利，这未免有顾护虚证的嫌疑。他又不知道虚证还有何种分类，以及相应的治疗方法。至于脾湿阴滞，津液不降，必须依靠茯苓、白术才能使大便通畅的情况，那就不是陈飞霞所能知晓的了。但这类情况最少，不过百分之一二罢了，不可不知。
The *Huangdi Neijing* states: When Taiyin (Taiyin Wet Earth) governs the year, Yin Bi (pain caused by cold-dampness obstructing the meridians) occurs, accompanied by difficult defecation. This is due to the dysfunction of Yin Qi, with the pathology located in the Kidney.
It also states: When Taiyang (Taiyang Cold Water) qi prevails, there will be obstruction in urination or defecation, and pain radiating to the inner thighs. Chen Feixia said: Food and drink enter the body and must eventually exit. If defecation is blocked, the mechanism of intake and output is nearly ceased. It is urgent to unblock it so that old food residue can leave and new food can enter. However, constipation is divided into Excess Constipation (Shi Bi) and Deficiency Constipation (Xu Bi), which requires careful differentiation. If the patient's constitution is robust, Qi is sufficient, the pulse is forceful, and appetite is good, there are indeed indications for purgation; thus, purgative methods should be employed. Formulas such as Bazen San (Eight-Right Powder), Chengqi Tang (Chengqi Decoction), and Muxiang Binglang Wan (Areca Seed and Costus Root Pill) may be selected for use. Stop taking the medicine once the disease is addressed; do not overdo it. If the patient's constitution is weak, Qi is deficient, the pulse is thready/weak, and appetite is poor, even if there are indications for purgation, a gentle approach is preferred over an aggressive one. One should only use Baohe Wan (Harmonize the Stomach Pill) with added Zhishi (Immature Bitter Orange) to gently promote bowel movement. If one usually suffers from difficult defecation, it is due to Blood deficiency; Runchang Wan (Moisten the Intestines Pill) combined with Midao Jianfa (Honey Suppository Method) is appropriate.
Bazen San (See formulas for urinary and fecal disorders)
Dachengqi Tang (See formulas for Spasm disease previously mentioned)
Zhiqiao (1 qian) Nongpo (1 qian) Dahuang (1 qian) Mangxiao (1 qian)
Jicheng Muxiang Binglang Wan (Integrated Collection Muxiang Binglang Pill)
Heiqianniu (Stir-fried, take the finest powder, 5 units) Jianbinglang (Acuminated Areca Nut) Jinwenhuang (Brocade-patterned Rhubarb) Muxiang (Costus Root) Shenqu (Medicated Leaven)
Grind all above into fine powder. Use Ginger Juice to mix with Rice Paste to form pills. Adjust dosage according to the child's age and size.
Jicheng Baohe Wan (Integrated Collection Harmonize the Stomach Pill)
Shenqu (1 qian) Chenpi (1 qian) Fa Banxia (1 qian) Fuling (1 qian) Shanzha Rou (1 qian) Lianqiao (1 qian)
Jicheng Runchang Wan (Integrated Collection Moisten the Intestines Pill)
Huomaren (Shelled) Guang Xingren (Peeled) Taoren (Peeled) Chen Zhiqiao (Aged Zhiqiao) Danggui Wei (1 qian half each of the above five ingredients) Ejiao Zhu (Glue-ball made from Donkey-hide Gelatin) Luobozi (Radish Seed) Suye (Perilla Leaf) (2 qian each of the last three)
Grind all above into fine powder. Use refined Honey to form pills. Take 1-2 qian per dose, adjust according to the patient's condition, and swallow with warm water.
Tu Weisheng said: Runchang Wan embodies the principle of Zhang Zhongjing's Pi Yue Wan (Spleen-Restriction Pill). Pi Yue Wan treats cases where excessive Spleen Fire scorching and drying up the fluids of the stomach and intestines leads to dry, hard stools. Although Runchang Wan is based on this principle with modifications, the inclusion of Suye (Perilla Leaf) makes it less pure than Pi Yue Wan. Deducting from this logic, if Yin deficiency is extremely urgent and Kidney Fire is excessively strong, scorching the stomach and intestines to extreme dryness and severe constipation, then Shengdi (Rehmannia Root), Yurou (Cornus Fruit), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huangqin (Scutellaria Root), and Lianqiao (Forsythia Fruit) can all be added. While in Zhengyang, I treated a patient who had always suffered from Yin deficiency. Suddenly, they developed severe dry constipation. Other physicians used harsh purgatives, but the condition worsened with treatment. I treated them with the original formula of Pi Yue Wan, heavily using Shengdi, Guijiao (Tortoise Shell Glue), Huangqin, and Huanglian, resulting in a cure. This proves that constipation is not solely caused by Excess Heat. Furthermore, Chen Feixia's suggestion to use Baohe Wan with Zhishi for deficiency cases carries the risk of neglecting the deficiency aspect. He also fails to recognize the various subtypes of deficiency and their respective treatments. As for cases of Spleen Dampness and Yin stagnation, where fluids fail to descend and require Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) to restore bowel movement, these are beyond Chen Feixia's knowledge. Such cases are rare, accounting for only 1-2 percent, but this must be known.
Zhongjing Pi Yue Wan (Also known as Mahuan Wan)
Maren (2 qian) Baishao (1 qian) Dahuang (1 qian) Zhiqiao (0.7 qian) Nongpo (0.5 qian) Xingren (1 qian)