大便失禁者，由大肠与肛门虚冷滑故也。肛门，大肠之候也，俱主糟粕，既虚弱冷滑，气不能温制，故使失
禁。（《病源论》）治之宜涩固津液，方论所谓涩可去脱是也。（《圣济》）
遗屎有二证∶一因脾胃虚弱，仓廪不固，肠滑而遗者；一因火性急速，逼迫而遗者。宜分别治之，脾虚，理
中汤；火
盛，芍药甘草汤加黄连。（《心悟》）
此门所载为寻常秘闭证，如关格则为病之殆极者，故自立类，然宜相参看。
总说 大小便难者，由冷热不调，大小肠有游气，游气在于肠间，搏于槽粕，溲便不通流，故大小便难
也。诊其尺脉滑而浮大，此为阳干于阴，其人苦小腹痛满不能尿，尿即阴中痛，大便亦然。（《病源论》）
（按∶此诊法本出《脉经》，“此为阳干于阴”作“名曰阴中之阳”。）
二便秘涩之证，暂秘小漩，还有点滴利者，易愈。若秘日久，膨上心胸，切痛气促，身冷面色黑，前后俱
无，名曰气实，转 而殂。（《得效》）
大小便俱不通者，必先通其大便，则小便自通矣，宜八正散之类主之。（《景岳》）
实证治验 屈村张氏小儿，年十四岁，病约一年半矣，得之麦秋，发则小便大痛，至握其 ，跳跃旋
转，号呼不已，小便数日不得下，下则成砂石，大便秘涩，肛门脱出一二寸，诸医莫能治。戴人在朱葛寺避暑，
乃负其子而哀请戴人。戴人曰∶今日治，今日效，时日在辰已间矣。以调胃承气仅一两，加牵牛头末三钱，汲
河水煎之，令作三五度咽之，又服苦末丸（按∶《纲目》曰∶苦末丸未详考）如芥子许六十丸。日加晡，上涌下
泄，一时齐出，有脓有血。涌泻既觉定，令饮新汲水一大盏，小溲已利，一二次矣。是夜凡饮新水二三十遍，
病去九分，止哭一次。明日困卧如醉，自晨至暮，猛然起来，索食于母，歌笑自得，顿释所苦。继与太白散（当
考）、八正散等，调一日大瘥。恐暑天失所养，
留五日而归。戴人曰∶此下焦约也。不吐不下，则下焦何以开，不令饮水，则小便何以利，大抵源清则流清也。
（《十形三疗》）
虚证治验 石顽治杨松龄，夏月感冒，曾服发散药十余剂，大小便俱闭涩不通。更一医用硝黄下之，少
腹左畔遂胀起如墩，不赤不热，有时哗哗作声。复延疡医，以敷药治其外，以解毒利水药治其内，药未进而躁扰
不宁。因延石顽诊之，六脉紧细而 ，此过汗津液大伤，又与苦寒攻里，致阴邪内结，膀胱不化，溺积不通，
法在不救。幸胃气有权，形神未槁，尚能稍进糜饮，姑许以治。因与济生肾气大剂，煎成入有嘴壶，托起其项，
徐徐仰灌升许，顷令转侧，以鹅翎探吐，实时溲便如注，少腹顿平，更与十全大补调理而安。此证前后患者四五
人，或小便淋沥，或遗溺不止，或形羸气脱，皆立辞不治。（《医通》）
老人证治《金匮真言论》云∶北方黑色，入通于肾，开窍于二阴。故肾阴虚则大小便难，宜以地黄、
苁蓉、车前、茯苓之属，补真阴，利水道，少佐辛药，开腠理，致津液，而润其燥，施之于老人尤宜。若大小
便燥结之甚，求通不得，登厕用力太过，便仍不通，而气被挣脱，下注肛门，有时泄出清水，而里急后重，不可
忍者，胸膈间梗梗作恶，干呕有声，渴而索水，饮食不进，呻吟不绝。欲利之，则气已下脱，命在须臾，再下即
绝；欲固之，则溺与燥矢膨满腹肠间，恐反增剧；欲升之使气自举，而秽物不为气所结，自然通利，则呕恶不堪
（按∶《医通》举此证曰∶人参、枳壳、当归煎服，加陈香 皮尤效），宜如何处？家姑年八十余，尝得此患，予
惟用调气利小便之药，虽小获效，不收全功，尝慰之令勿急性。后因不能食，遽索末药，利下数行，不以
告予，自谓稍快矣，而脉忽数动一止，气息奄奄，颓然床褥。予知真气已泄，若不收摄，恐遂无救，急以生脉药
投之，数剂后结脉始退，因合益血润肠丸（用熟地、杏仁、麻仁、枳壳、橘红、阿胶、苁蓉、苏子、荆芥、当归）
与服，劝以勿求速效，勿服他药，久之自有奇功，如言调理两月余，而二便通调，四肢康胜矣。便秘自是老人
常事，俗以为后门固寿考之征，而一时难堪，辄躁扰而致疾，予所处方，不犯大黄，可以久服，故表而出之。
（《准绳》）
内服诸方 郁李仁丸，治大小便秘涩不通。
郁李仁（二两汤浸去皮） 大黄（一两） 槟榔（三两） 青皮（去穣半两）
上为细末，炼蜜和丸，绿豆大，每服十丸至十五丸，姜汤下无时。（《小儿总征论》）
颠倒散，治脏腑实热，或小便不通，或大便不通，或大小便俱不通。
大黄（八钱） 滑石（三钱） 皂角（三钱）
上为末，黄酒送下。如大便不通，根据前方两服。如小便不通，大黄三钱，滑石六钱，皂角如前。如大小便
俱不通，黄、石均分，皂角如前。（《回春》）
治大小便不通，百方不效，肚腹胀痛，咽喉饱塞，或痰壅盛气喘，伤寒结胸，卧不倒床，水米不下，死在
须臾，此幽门气闭不通。用甘遂五分，面裹火煨熟，取出为末，入麝香三厘，用饭捣为丸，淡姜汤下，立通。或小
便不通，或大便不通，或大小便俱不通者，皆效。（《寿世》）
有下焦阳虚不化者，夫肾开窍于二阴，肾中阳虚则二阴之窍闭，闭则大小便俱不得出，如重阴冱寒，地道闭
塞，惟与白通汤多加葱白，阳气一至，二便立通矣。（《金匮翼》）（按∶此本于《辨证录》，宜参《关格》）
外治诸方 治大小便不通，腹股坚胀，蒸下部方。
莲叶（三两） 葱（三七茎并须用去叶切） 皂荚（一挺炙锉） 生姜（一两切）
上四味，以浆水一斗二升，煮十余沸，并滓分两度用，旋旋盛入小口瓷缸中，坐缸口上熏蒸，冷则易之。未
通，即倾药于桶斛中，添热水坐，蘸下部即通。（《圣济》）
经验方，治大小便不通。用白矾细研末，令患人仰卧，置矾末于脐中满，以新汲水滴之，候患人觉冷透腹
内，即自然通。如是曾灸无脐孔，即于元灸盘上，用纸作 子，笼灸盘，高一指半已来，着矾末在内，仍根据前法
用水滴之。（《本草》）
治闭结并香港脚方。大螺，以盐匕和壳生捣碎，置病者脐下一寸三分，用宽帛系之，即通，（《朱氏》）（按∶
原更载饶医熊彦诚，年五十五岁，病前后溲便不通，五日腹胀如鼓，试之暴下。此本出《夷坚志·辛集》。）便
溺不通者，热秘之也。大螺性寒而善厘清，故浊水之中，一着大螺，便能澄澈。剂之以盐，取其善润而已。
（《方考》）（按∶螺即田螺。）
贴脐膏，治大小便不通。
上用甘遂为细末，以生白面调为糊，摊纸花上，掺末在上，涂脐中，并涂脐下硬处。另煎甘草水，温凉随意
服之，以通为度。（《端效》）
膀胱蓄血，膏血砂垢，每溺则甚痛不可言，便溲俱不通，秘闷将死。余即令用细灰，于患人连脐带丹田作一
泥塘，径如碗大，下令用一指浓灰，四围高起，以新汲水调朴硝一两余令化，渐渐倾入灰塘中，勿令漫溢横流，
须臾大小便迸然而出。（《养生主论》）（按∶此出治验中，本为淋
病，今节而录之，取其溲便俱闭之治以拈于兹。）
大小便不通秘方。用火烧盐放脐内，切蒜一片盖盐上，艾灸二三通止，无时用。（《袖珍》）
蜗牛膏，大小便不通，此方治之殊效。用蜗牛三枚，去壳捣如泥，加麝香少许，纳脐中，以手掇按之，立
通。或用田螺亦可。（《寿世》）
大便失禁，是由于大肠和肛门虚寒滑脱所致。肛门是大肠的外候，二者共同主管糟粕的排泄；既然虚弱且寒冷滑脱，气机不能温煦固摄，所以导致失禁。（《诸病源候论》）治疗应当采用涩法以固护津液，方书所说的“涩可去脱”就是这个道理。（《圣济总录》）
遗屎有两种证型：一是因脾胃虚弱，仓廪不固，肠道滑利而遗泄的；二是因火性急速，逼迫肠道而遗泄的。应当分别治疗，脾虚者用理中汤；火盛者用芍药甘草汤加黄连。（《医门棒喝·心悟》）
本节所载为寻常的便秘闭结证，如关格证则是病情极其危重的，所以单独列为一类，但阅读时宜相互参照。
总说 大小便困难，是由于冷热不调，大小肠中有游动之气，游气停留在肠间，搏结于糟粕，导致小便和大便不通流，所以大小便困难。诊察其尺脉滑而浮大，这是阳邪干犯阴分，患者苦于小腹胀满不能排尿，排尿时尿道疼痛，大便也类似如此。（《诸病源候论》）（按语：此诊法原本出自《脉经》，“此为阳干于阴”在《脉经》中作“名曰阴中之阳”。）
二便秘涩的证候，如果暂时便秘只有少量尿液排出，还有点滴通利的，容易治愈。如果便秘日久，胀气上冲心胸，剧烈疼痛且气短，身体发冷面色发黑，前后二便都闭塞不通，名为气实证，若转变严重则会死亡。（《世医得效方》）
大小便都不通的，必须先通大便，那么小便自然就会通畅，适宜用八正散之类的方剂主治。（《景岳全书》）
实证治验 屈村张家的儿子，十四岁，患病约一年半了，得病于麦收季节，发作时小便剧痛，让人握住他的阴茎，他跳跃旋转，大声呼号不停，小便数日排不出，排出时呈砂石状，大便秘涩，肛门脱出一二寸，众医生都不能治。戴人（张从正）在朱葛寺避暑，那人背着孩子哀求戴人救治。戴人说：“今天治，今天见效。”当时时间已在辰巳之间。用调胃承气汤仅一两，加牵牛头末三钱，汲取河水煎煮，让他分三五次咽下，又服用苦末丸（按语：《本草纲目》说：苦末丸未详考）如芥子大小的六十丸。到了傍晚，上涌下泄，一时齐出，有脓有血。涌泻之后感觉安定，让他喝一大盏新汲水，小便已通利，一两次后。当晚共喝新水二三十遍，病去十分之九，只哭了一次。第二天困倦卧睡如醉酒一般，从早晨到傍晚，猛然起来，向母亲索要食物，唱歌欢笑自得，顿时解脱了痛苦。继而又用太白散（当考证）、八正散等，调理一天后大病痊愈。担心暑天调养不当，留住了五天才回去。戴人说：“这是下焦约束。不吐不下，则下焦何以开通？不让饮水，则小便何以通利？大体上游源清则水流清。”（《儒门事亲·十形三疗》）
虚证治验 石顽（罗美）治疗杨松龄，夏季感冒，曾服用发散药十余剂，大小便都闭涩不通。换了一个医生用硝黄攻下，左下腹遂胀起如土墩，不红不热，有时哗哗作响。又延请外科医生，用敷药治其外，用解毒利水药治其内，药还没进去就躁扰不宁。于是延请石顽诊治，六脉紧细而迟，这是过汗导致津液大伤，又用苦寒攻里药，致使阴邪内结，膀胱不化，溺积不通，法度上属于不治之症。幸好胃气尚存，形体神气未枯槁，还能稍进米饮，姑且答应治疗。于是给予济生肾气汤大剂，煎成后装入有嘴的壶中，托起患者的颈部，慢慢仰灌入少许，随即令其转动身体，用鹅毛管探喉催吐，实时小便如注，小腹顿时平复，再给予十全大补汤调理而安。这个证候前后有四五个患者，有的小便淋沥，有的遗尿不止，有的形体消瘦气息将脱，都立即推辞不治。（《古今医统大全》）
老人证治 《金匮真言论》说：“北方黑色，入通于肾，开窍于二阴。”所以肾阴虚则大小便困难，适宜用地黄、肉苁蓉、车前子、茯苓之类，补益真阴，利水道，少佐辛味药，开腠理，致津液，以润其燥，施用于老人尤其适宜。如果大小便燥结得很厉害，求通不得，登厕用力太过，便仍不通，而气被挣脱，下注肛门，有时泄出清水，而里急后重，不可忍受，胸膈间梗梗作恶，干呕有声，渴而索水，饮食不进，呻吟不绝。想利它，则气已下脱，命在须臾，再攻下即绝；想固它，则溺与燥屎胀满腹肠间，恐怕反而加重；想升提使气自举，而秽物不为气所结，自然通利，则呕吐恶心不堪（按语：《古今医统大全》列举此证说：人参、枳壳、当归煎服，加陈皮尤效），该如何处置？家姑年八十多岁，曾经患此病，我只用调气利小便的药，虽然小有效果，但未获全功，常安慰她不要急躁。后来因为不能进食，突然索要粉末药，利下数次，没有告诉我，自以为稍微痛快了，而脉忽数动一止，气息奄奄，颓然倒在床褥上。我知道真气已泄，若不收敛摄纳，恐怕最终无救，急忙用生脉散投之，数剂后结脉才退，于是合用益血润肠丸（用熟地黄、杏仁、麻仁、枳壳、橘红、阿胶、肉苁蓉、苏子、荆芥、当归）与服，劝她不要追求速效，不要服其他药，久而久之自有奇功，照此调理两月余，而二便通调，四肢康健了。便秘本是老人的常事，世俗认为后门固守是长寿的征兆，而一时难以忍受，往往躁扰而致病，我所开的处方，不犯大黄，可以久服，所以表而出之。（《医学准绳六要》）
内服诸方 郁李仁丸，治大小便秘涩不通。
郁李仁（二两，汤浸去皮） 大黄（一两） 槟榔（三两） 青皮（去瓤半两）
以上为细末，炼蜜和丸，绿豆大，每服十丸至十五丸，姜汤送下，不拘时候。（《小儿卫生总微论方》）
颠倒散，治脏腑实热，或小便不通，或大便不通，或大小便俱不通。
大黄（八钱） 滑石（三钱） 皂角（三钱）
以上为末，黄酒送下。如大便不通，依前方服两剂。如小便不通，大黄三钱，滑石六钱，皂角如前。如大小便俱不通，大黄、滑石均分，皂角如前。（《内科摘要·回春》）
治大小便不通，百方不效，肚腹胀痛，咽喉饱塞，或痰壅盛气喘，伤寒结胸，卧不倒床，水米不下，死在须臾，此幽门气闭不通。用甘遂五分，面裹火煨熟，取出为末，入麝香三厘，用饭捣为丸，淡姜汤送下，立通。或小便不通，或大便不通，或大小便俱不通者，皆效。（《寿世保元》）
有下焦阳虚不化的，肾开窍于二阴，肾中阳虚则二阴之窍闭，闭则大小便俱不得出，如重阴冱寒，地道闭塞，惟与白通汤多加葱白，阳气一至，二便立通矣。（《金匮翼》）（按语：此本于《辨证录》，宜参看《关格》篇）
外治诸方 治大小便不通，腹股坚胀，蒸下部方。
莲叶（三两） 葱（三七茎并须用，去叶切） 皂荚（一挺炙锉） 生姜（一两切）
以上四味，以浆水一斗二升，煮十余沸，连同药渣分两度用，旋旋盛入小口瓷缸中，坐缸口上熏蒸，冷则换之。未通，即倾药于桶斛中，添热水坐，蘸下部即通。（《圣济总录》）
经验方，治大小便不通。用白矾细研末，令患者仰卧，置矾末于脐中满，以新汲水滴之，候患者觉冷透腹内，即自然通。如是曾灸无脐孔，即于元灸盘上，用纸作筒子，笼灸盘，高一指半以来，着矾末在内，仍根据前法用水滴之。（《本草纲目》）
治闭结并香港脚方。大螺，以盐匕和壳生捣碎，置病者脐下一寸三分，用宽帛系之，即通，（《朱氏集验方》）（按语：原书更载饶医熊彦诚，年五十五岁，病前后溲便不通，五日腹胀如鼓，试之暴下。此本出《夷坚志·辛集》。）便溺不通者，热秘之也。大螺性寒而善厘清，故浊水之中，一着大螺，便能澄澈。剂之以盐，取其善润而已。（《医方考》）（按语：螺即田螺。）
贴脐膏，治大小便不通。
上用甘遂为细末，以生白面调为糊，摊纸花上，掺末在上，涂脐中，并涂脐下硬处。另煎甘草水，温凉随意服之，以通为度。（《端效方》）
膀胱蓄血，膏血砂垢，每溺则甚痛不可言，便溲俱不通，秘闷将死。余即令用细灰，于患者连脐带丹田作一泥塘，径如碗大，下令用一指浓灰，四围高起，以新汲水调朴硝一两余令化，渐渐倾入灰塘中，勿令漫溢横流，须臾大小便迸然而出。（《养生主论》）（按语：此出治验中，本为淋病，今节而录之，取其溲便俱闭之治以拈于兹。）
大小便不通秘方。用火烧盐放脐内，切蒜一片盖盐上，艾灸二三壮止，无时用。（《袖珍方》）
蜗牛膏，大小便不通，此方治之殊效。用蜗牛三枚，去壳捣如泥，加麝香少许，纳脐中，以手掇按之，立通。或用田螺亦可。（《寿世保元》）
Incontinence of feces is caused by deficiency-cold and slipping of the large intestine and anus. The anus is the external manifestation of the large intestine; both are responsible for waste excretion. Since they are deficient, cold, and slippery, Qi fails to warm and secure them, leading to incontinence. (*Zhubing Yuanhou Lun*) Treatment should employ astringent methods to consolidate fluids, as stated in medical texts: "Astringency can treat prolapse." (*Shengji Zonglu*)
Fecal incontinence presents with two patterns: one is due to Spleen-Stomach deficiency, where the granary is insecure and the intestines are slippery causing leakage; the other is due to rapid Fire nature forcing leakage. They should be treated separately: for Spleen deficiency, *Lizhong Tang* (Cinnamon Twig and Atractylodes Macrocephala Decoction); for excess Fire, *Shaoyao Gancao Tang* (Peony and Licorice Decoction) added with Coptis Rhizome. (*Yimen Bangmo*)
The cases recorded in this section refer to ordinary constipation. Conditions like Guan-Ge (Obstruction and Rejection) represent extremely critical illness, hence listed separately, but should be read in conjunction.
General Discussion Difficulty in urination and defecation results from imbalance of cold and heat, with wandering Qi in the small and large intestines. This wandering Qi stays between the intestinal walls, clashing with chaff and residue, blocking the flow of urine and stool, thus causing difficulty. Palpating the Chi pulse reveals it slippery and floating-large; this indicates Yang invading Yin. The patient suffers from lower abdominal fullness and inability to urinate, with pain in the genitalia upon urination, and similar symptoms in defecation. (*Zhubing Yuanhou Lun*) [Note: This diagnostic method originates from *Mai Jing*; "Yang invading Yin" is written as "Named Yin-Zhong-Yang" in *Mai Jing*.]
For constipation with涩 (astringency/stagnation), if there is temporary retention with only drops of urine passing, it is easy to cure. If retention lasts long, distension rises to the chest and heart, cutting pain occurs with shortness of breath, body becomes cold and face black, and both bowels and bladder are blocked, it is named Qi Excess syndrome; if it transforms severely, death ensues. (*Shiyi Dexiao Fang*)
When both urine and stool are blocked, one must first unblock the stool, then urine will naturally flow. *Bazheng San* (Eight-Herb Corrective Powder) or similar formulas are suitable. (*Jingyue Quanshu*)
Case of Excess Pattern: The son of Mr. Zhang in Qucun, aged fourteen, had been ill for about a year and a half, contracting it during wheat harvest. Attacks involved severe pain in urination; holding his penis made him jump, spin, and cry incessantly. Urine was retained for days, passing only as sand-stones. Stool was dry and difficult, with the anus prolapsing one or two inches. Physicians could not treat it. Dairen (Zhang Congzheng) was staying at Zhuge Temple for summer retreat. The father carried his son and begged Dairen for help. Dairen said, "Treat today, effect today." It was already Chen-Si hours. He prescribed *Tiaowei Chengqi Tang* (Regulate the Stomach and Order the Qi Decoction) only one tael, plus three qian of the head powder of *Qian Niu Zi* (Morning Glory Seed), decocted in river water, to be swallowed in three to five doses. Also administered sixty pills of *Kumo Wan* (Bitter End Pill - details unknown per *Bencao Gangmu*), size of mustard seeds. By dusk, vomiting and purging occurred simultaneously, expelling pus and blood. After settling, he drank a large cup of fresh well-water. Urination became smooth after one or two times. That night, drinking fresh water twenty to thirty times, the disease receded by nine-tenths, crying stopped once. The next day, he slept drowsily like being drunk. From morning to evening, he suddenly rose, asked his mother for food, sang and laughed happily, instantly relieved of suffering. Subsequently, *Taibai San* (White Tiger Powder - to be verified) and *Bazheng San* were used for one day of regulation, resulting in great recovery. Fearing improper nourishment in summer, he stayed five days before returning. Dairen said, "This is Lower Jiao constraint. Without vomiting and purging, how can the Lower Jiao open? Without drinking water, how can urine benefit? Generally, if the source is clear, the stream is clear." (*Rumen Shiqin*)
Case of Deficiency Pattern: Shiwan (Luo Mei) treated Yang Songling. In summer, he caught a cold and took more than ten doses of diaphoretic medicines, resulting in complete blockage of urine and stool. Another physician used *Xiao Huang* (Mirabilite and Rhubarb) to purge, causing the left lower abdomen to swell like a mound, without redness or heat, making gurgling sounds occasionally. An external surgeon was consulted; external applications and internal detoxifying/diuretic drugs were given, but before the medicine entered, the patient became restless. Shiwan was invited. The six pulses were tight, fine, and slow. This was excessive sweating damaging fluids, followed by bitter-cold interior-purging, causing Yin pathogen to knot internally, Bladder failing to transform, urine accumulating and blocking. Medically, this is incurable. Fortunately, Stomach Qi remained strong, form and spirit not emaciated, able to take some rice gruel. Agreed to treat. Prescribed a large dose of *Jisheng Shenqi Wan* (Kidney Qi Pill for Salvation). Decocted, poured into a spouted pot, lifted the neck, slowly instilled upward. Then turned the patient, used goose feather to induce vomiting. Immediately, urine flowed like a spring, lower abdomen flattened. Followed by *Shiquan Dabu Tang* (Ten-Agent Great Tonifying Decoction) for regulation and peace. Four or five patients had this condition previously: some with dribbling urine, some with continuous enuresis, some with emaciation and Qi collapse, all refused treatment. (*Yitong*)
Elderly Patient Treatment: *Jingui Zhenyan Lun* states: "North corresponds to Black, enters through Kidney, opens to the Two Yins." Thus, Kidney Yin deficiency causes difficulty in urination and defecation. Use Rehmannia Root, Cistanche Stem, Plantago Seed, Poria, etc., to tonify True Yin, promote water passages, add slight acrid herbs to open pores, generate fluids, and moisten dryness. Especially suitable for the elderly. If constipation is severe, straining on the toilet fails, Qi breaks downward to the anus, leaking clear water, with tenesmus unbearable, epigastric fullness, dry retching, thirst for water, anorexia, continuous groaning. To purge would cause Qi collapse and imminent death; to astringe would worsen distension of urine and dry stool in intestines; to lift Qi might relieve obstruction but cause severe nausea (Note: *Yitong* suggests Ginseng, Bitter Orange, Angelica Decoction with Tangerine Peel is effective). How to handle? My aunt, over eighty, suffered this. I used Qi-regulating and diuretic herbs, slight effect but not curative. Comforted her not to rush. Later, unable to eat, she secretly took powdered laxatives, purged several times, felt relief, but pulse became intermittent with pauses, breathing faint, collapsing on bed. I knew True Qi leaked;若不收敛摄纳 (if not consolidated), no rescue possible. Urgently gave *Shengmai San* (Generate Pulse Powder). After several doses, intermittent pulse receded. Combined with *Yixue Runchang Wan* (Nourish Blood Moisten Intestine Pill: Prepared Rehmannia, Apricot Kernel, Sesame Seed, Bitter Orange, Tangerine Peel, Donkey-hide Gelatin, Cistanche, Perilla Seed, Schizonepeta, Angelica), advised against seeking quick effects or other meds. Long-term regulation for over two months resulted in smooth bowel/bladder movement and healthy limbs. Constipation is common in elderly; folk believe firm buttocks indicate longevity, but sudden distress causes illness. My prescriptions avoid Rhubarb, safe for long use, so recorded. (*Yixue Zhunsheng*)
Internal Formulas:
*Yuliren Wan* (Prunus Humilis Seed Pill): Treats constipation of both urine and stool. Prunus Humilis Seed (2 liang, soaked in hot water, skin removed), Rhubarb (1 liang), Areca Nut (3 liang), Green Citrus Peel (0.5 liang, pith removed). Powder finely, mix with refined honey, make pills size of mung beans. Take 10-15 pills with ginger soup, any time. (*Xiao'er Zongzheng Lun*)
*Dian Dao San* (Inverted Powder): Treats organ-heat excess, or urinary retention, or fecal retention, or both. Rhubarb (8 qian), Talcum (3 qian), Gleditsia Sinensis Fruit (3 qian). Powder, take with yellow wine. For fecal retention, take two doses as above. For urinary retention, Rhubarb 3 qian, Talcum 6 qian, Gleditsia as above. For both, equal parts Rhubarb and Talcum, Gleditsia as above. (*Huichun*)
For stubborn constipation/urinary retention, abdominal distension/pain, throat fullness, phlegm-choking asthma, Taiyang Jie-Xiong (Cold Damage Chest Knotting), unable to lie flat, no food/water, dying soon: This is幽门 (Pylorus) Qi closure. Use Kansui Root (0.5 fen), wrapped in flour, fire-roasted until cooked, taken out, powdered. Add Musk (0.03 liang). Mix with rice paste to make pills. Take with light ginger soup. Immediate passage. Effective for urinary, fecal, or both blockages. (*Shoushi Baoyuan*)
Lower Jiao Yang deficiency failing to transform: Kidney opens to Two Yins. Kidney Yang deficiency closes these orifices, blocking both urine and stool, like heavy Yin freezing earth. Use *Baitong Tang* (White Connective Decoction) with extra Scallion White. Once Yang Qi arrives, bowels/bladder open immediately. (*Jingui Yi*) [Note: Based on *Bianzheng Lu*, see Guan-Ge.]
External Treatments:
Steaming Lower Body Formula for urinary/fecal blockage, hard/swollen groin. Lotus Leaf (3 liang), Scallion (37 stems with roots, leaves removed, cut), Gleditsia Sinensis Fruit (1 stick, roasted/crushed), Ginger (1 liang, cut). Boil in grain vinegar water (12 dou) for ten boils. Strain dregs, divide into two portions. Pour into small-mouthed porcelain jar. Sit on jar mouth to steam. Change when cool. If not passed, pour medicine into bucket, add hot water, sit and soak lower body. Passage ensues. (*Shengji Zonglu*)
Empirical Formula: Fine powder of Alum. Patient lies supine. Fill umbilicus with alum powder. Drop fresh well-water onto it. When patient feels cold penetrating abdomen, natural passage occurs. If no umbilicus due to moxibustion, place paper tube on moxa plate, fill with alum, drop water as above. (*Bencao Gangmu*)
For constipation and Hongzhang (Gout/Leg Swelling): Large Snail. Mix with salt spoonful, crush raw with shell. Place 1.3 cun below umbilicus. Bind with wide cloth. Passage ensues. (*Zhu Shi Ji Yan Fang*) [Note: Original records Physician Xiong Yancheng, 55, 5-day abdominal distension like drum, failed attempts led to sudden purge. Source: *Yijian Zhi Xin Ji*.] Urinary blockage here is Heat Constipation. Snail is cold and clears turbidity; in muddy water, one snail clarifies it. Salt adds moisture. (*Yifang Kao*) [Note: Snail refers to Field Snail.]
Umbilical Paste for blockage: Kansui Root powder mixed with raw white flour paste. Spread on paper flower, sprinkle powder, apply to umbilicus and hard area below. Decoct Licorice Water, drink warm/cool as desired, stop when passage occurs. (*Duan Xiao Fang*)
Bladder Accumulated Blood:膏血砂垢 (fatty blood/sand debris) causes extreme pain on urination, total blockage, impending death. Use fine ash to make a mud pond around umbilicus/Dantian, bowl-sized diameter. Pile ash high around edges. Mix Mirabilite (over 1 liang) with fresh water, pour into ash pond gradually, do not spill. Soon, urine and stool burst forth. (*Yangsheng Zhu Lun*) [Note: Originally a strangury case, excerpted here for dual blockage treatment.]
Secret Formula for blockage: Burnt salt placed in umbilicus. Cover with garlic slice. Moxibustion 2-3 cones. Any time. (*Xiuzhen Fang*)
Snail Ointment: Highly effective for blockage. Three snails, remove shell, pound to paste. Add little Musk. Insert into umbilicus, press with hand. Immediate passage. Field snails also work. (*Shoushi Baoyuan*)