秦子曰∶大便秘结之症，外感门有表未解，太阳阳明之脾约，有半表半里，少阳阳明
之大便难，又有正阳阳明之胃实，大便硬，又有表邪传里，系在太阴，七八日不大便，又有
少阴病，六七日不大便，厥阴下利谵语有燥屎者，以分应下、急下、大下、可下。又互发未
可下、不可下。俟之，蜜导、胆汁导等法。内伤门则有积热、气秘、血枯各条之不同，今但
立外感两条，内伤三条，亦去繁求约之意也。
【伤寒便结之症】恶寒身热，大便闭结，此表邪未解，里症又急，即太阳阳明脾约症也
。时寒时热，口苦耳聋，大便闭结，此半表半里，即少阳阳明症也。口燥舌黄，恶热多汗，大便闭结，
此正阳阳明症也。若表症全除，口燥咽干，大便不通，此
少阴里热症也。若手足自温，七八日不大便，脐腹胀满，此太阴里热症也。若烦满囊缩，下
利谵语，有燥屎者，此厥阴里热症也。
【伤寒便结之因】肠胃素热，偶因外感风寒，郁而发热，表里互相蒸酿，是以三阳表邪
未解，而大便先已秘结矣。若表邪已散，阳明里热不解，亦令大便秘结。若三阳表热，传入三
阴，亦令大便秘结。若三阴里热不结，后来返还阳明，亦令大便秘结。
【伤寒便结之脉】左脉浮数，右脉沉数，太阳阳明。左脉弦数，右脉沉数，少阳阳明。
六脉沉数，正阳阳明。沉细而数，三阴里热。
【伤寒便结之治】太阳阳明，仲景脾约丸，今推展羌活汤加大黄，以遵双解表里之法。
正阳阳明者，大承气汤。少阳阳明者，大柴胡汤。言阳明者，即言不大便也；言太阳者，即言
有表邪也。若热邪传三阴，大便秘结，三承气汤，随症加减用之。若三阴外传阳明，胃实
脾约丸
麻仁 杏仁 大黄 枳实 浓朴 白芍药
羌活汤
羌活 防风 黄芩 柴胡 大黄
大承气汤
大黄 芒硝 浓朴 枳实
大柴胡汤
柴胡 黄芩 陈皮 甘草 大黄
秦子说：大便秘结的病症，在外感病门类中，有表证未解、属于太阳阳明经的脾约证；有在半表半里、属于少阳阳明经的大便难证；又有正阳阳明经的胃实热证，表现为大便硬；还有表邪传入体内，关联太阴经，经过七八天不大便的情况；又有少阴病，六七天不大便；以及厥阴病出现下利且伴有谵语、体内有燥屎的情况。针对这些情况，分别对应使用缓下、急下、峻下或可下的治疗方法。此外，还有互相交错发作、不可使用泻下法或暂时不宜使用泻下法的情况，需等待时机，或使用蜜导、胆汁导等外用导便方法。在内伤病门类中，则有积热、气秘、血枯等不同条目的区别。现在仅设立外感两条、内伤三条，这也是去除繁杂、寻求简约的意思。
【伤寒导致便秘的病症】恶寒且身体发热，大便闭结不通，这是表邪未解，里证又急迫，即属于太阳阳明脾约证。时而发冷时而发热，口苦耳聋，大便闭结不通，这是处于半表半里之间，即属于少阳阳明证。口干舌燥、舌苔黄，怕热且多汗，大便闭结不通，这是正阳阳明证。如果表证完全消除，出现口干咽干，大便不通，这是少阴经里热证。如果手足自然温暖，经过七八天不大便，脐部及腹部胀满，这是太阴经里热证。如果出现烦闷、阴囊收缩，下利且伴有谵语，体内有燥屎，这是厥阴经里热证。
【伤寒导致便秘的原因】肠胃原本就有热，偶然因感受风寒之邪，郁结而发热，表里相互蒸腾酝酿，因此三阳经的表邪尚未解除，但大便已经先秘结了。如果表邪已经消散，但阳明经的里热仍未解除，也会导致大便秘结。如果三阳经的表热传入三阴经，也会导致大便秘结。如果三阴经的里热没有形成结滞，后来返还到阳明经，也会导致大便秘结。
【伤寒导致便秘的脉象】左手脉浮数，右手脉沉数，属于太阳阳明证。左手脉弦数，右手脉沉数，属于少阳阳明证。六部脉均沉数，属于正阳阳明证。脉象沉细而数，属于三阴经里热证。
【伤寒导致便秘的治疗】对于太阳阳明证，张仲景使用脾约丸（Piyue Wan），如今推广使用羌活汤（Qianghuo Tang）加大黄，以遵循表里双解的治疗方法。正阳阳明证，使用大承气汤（Da Chengqi Decoction）。少阳阳明证，使用大柴胡汤（Da Chaihu Decoction）。提到阳明证，即指有大便不通的症状；提到太阳证，即指有表邪存在。如果热邪传入三阴经，导致大便秘结，可根据症状加减使用三承气汤（San Chengqi Decoctions）。如果三阴经的病邪外传至阳明经，出现胃实或脾约的情况，使用脾约丸。
麻仁（Renshen, 火麻仁）
杏仁（Xingren, 苦杏仁）
大黄（Dahuang, 大黄）
枳实（Zhishi, 枳实）
浓朴（Houpo, 厚朴）
白芍药（Baishao, 白芍）
羌活汤（Qianghuo Tang）
羌活（Qianghuo, 羌活）
防风（Fangfeng, 防风）
黄芩（Huangqin, 黄芩）
柴胡（Chaihu, 柴胡）
大黄（Dahuang, 大黄）
大承气汤（Da Chengqi Decoction）
大黄（Dahuang, 大黄）
芒硝（Mangxiao, 芒硝）
浓朴（Houpo, 厚朴）
枳实（Zhishi, 枳实）
大柴胡汤（Da Chaihu Decoction）
柴胡（Chaihu, 柴胡）
黄芩（Huangqin, 黄芩）
陈皮（Chenpi, 陈皮）
甘草（Gancao, 甘草）
大黄（Dahuang, 大黄）
Mr. Qin said: Regarding the syndrome of fecal impaction (constipation), in the category of external contraction diseases, there is the Pi Yue syndrome (Spleen Restriction) of Taiyang and Yangming channels where the exterior syndrome has not yet resolved; there is the difficulty in defecation of Shaoyang and Yangming channels located at half-exterior and half-interior; there is also the stomach excess heat syndrome of Zhengyang Yangming, characterized by hard stool; there are cases where exterior pathogens transmit to the interior, involving the Taiyin channel, with no bowel movement for seven or eight days; there are cases of Shaoyin disease with no bowel movement for six or seven days; and there are Jueyin cases presenting with diarrhea, delirium, and dry feces. These conditions correspond respectively to mild purgation, urgent purgation, severe purgation, or permissible purgation methods. Additionally, there are alternating patterns where purgation is either contraindicated or temporarily inappropriate, requiring waiting for the right timing, or using external suppository methods such as honey suppositories or bile suppositories. In the category of internal injury diseases, there are differences among entries such as accumulated heat, qi stagnation constipation, and blood deficiency. Currently, only two entries for external contraction and three for internal injury are established, reflecting the intention to simplify complexity.
[Syndromes of Constipation due to Cold Damage] Aversion to cold with fever and closed bowels indicates that the exterior pathogen has not resolved while the interior syndrome is urgent, which is the Taiyang-Yangming Pi Yue syndrome. Alternating chills and fever, bitter taste in the mouth, deafness, and closed bowels indicate a position between half-exterior and half-interior, which is the Shaoyang-Yangming syndrome. Dry mouth, yellow tongue coating, aversion to heat, excessive sweating, and closed bowels indicate the Zhengyang Yangming syndrome. If the exterior syndrome is completely eliminated, accompanied by dry mouth and throat and inability to pass stool, this is the Shaoyin interior heat syndrome. If the hands and feet are naturally warm, with no bowel movement for seven or eight days and abdominal distension around the umbilicus, this is the Taiyin interior heat syndrome. If there is irritability and fullness, retraction of the scrotum, diarrhea with delirium, and the presence of dry feces, this is the Jueyin interior heat syndrome.
[Etiology of Constipation due to Cold Damage] The intestines and stomach originally possess heat. Accidental exposure to wind-cold causes stagnation and fever. The exterior and interior steam each other, so even though the exterior pathogens of the Three Yang channels have not resolved, the stool becomes constipated first. If the exterior pathogen dissipates but the Yangming interior heat remains unresolved, it also leads to constipation. If the heat of the Three Yang exterior transmits to the Three Yin channels, it also leads to constipation. If the interior heat of the Three Yin does not form a knot but later returns to the Yangming channel, it also leads to constipation.
[Pulse Patterns of Constipation due to Cold Damage] Floating and rapid pulse on the left, deep and rapid pulse on the right indicates Taiyang-Yangming syndrome. Wiry and rapid pulse on the left, deep and rapid pulse on the right indicates Shaoyang-Yangming syndrome. Deep and rapid pulses in all six positions indicate Zhengyang Yangming syndrome. Deep, fine, and rapid pulse indicates Three Yin interior heat syndrome.
[Treatment of Constipation due to Cold Damage] For Taiyang-Yangming syndrome, Zhang Zhongjing used Piyue Wan (Spleen Restriction Pill). Nowadays, Qianghuo Tang (Notopterygium Decoction) augmented with Dahuang (Rhubarb) is promoted to follow the method of simultaneously resolving the exterior and interior. For Zhengyang Yangming syndrome, Da Chengqi Decoction (Major Order the Qi Decoction) is used. For Shaoyang-Yangming syndrome, Da Chaihu Decoction (Major Bupleurum Decoction) is used. Mentioning Yangming implies bowel obstruction; mentioning Taiyang implies the presence of exterior pathogens. If heat pathogens transmit to the Three Yin channels causing constipation, the San Chengqi Decoctions (Three Major Order the Qi Decoctions) should be used with modifications according to symptoms. If pathogens from the Three Yin channels transmit outward to Yangming, resulting in stomach excess or spleen restriction, Piyue Wan is used.
Renshen (Cannabis Seed, Huomaren)
Xingren (Apricot Seed, Ku Xingren)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)
Zhishi (Immature Bitter Orange Fructus Aurantii Immaturus)
Houpo (Magnolia Bark, Cortex Magnoliae Officinalis)
Baishao (White Peony Root, Radix Paeoniae Alba)
Qianghuo Tang (Notopterygium Decoction)
Qianghuo (Notopterygium Rhizome and Root, Rhizoma Notopterygii)
Fangfeng (Saposhnikovia Root, Radix Saposhnikoviae)
Huangqin (Scutellaria Root, Radix Scutellariae)
Chaihu (Bupleurum Root, Radix Bupleuri)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)
Da Chengqi Decoction (Major Order the Qi Decoction)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)
Mangxiao (Mirabilite, Natrii Sulfas)
Houpo (Magnolia Bark, Cortex Magnoliae Officinalis)
Zhishi (Immature Bitter Orange Fructus Aurantii Immaturus)
Da Chaihu Decoction (Major Bupleurum Decoction)
Chaihu (Bupleurum Root, Radix Bupleuri)
Huangqin (Scutellaria Root, Radix Scutellariae)
Chenpi (Aged Tangerine Peel, Pericarpium Citri Reticulatae)
Gancao (Licorice Root, Radix Glycyrrhizae)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)