徐灵胎曰∶便闭之症，总以肠中血枯而有伏火者为多，开肺顺气等法，偶或有之，非尽然也。
安康郡太守苦风秘，陈为处二仁丸∶杏仁去皮尖，面炒；黄麻仁，另研；枳壳去穣，面炒为末；诃子炒去
核，为末。上用炼蜜为丸梧子大，每服二三十丸，温水下。未利，增之乃愈。
薛立斋治一老妇，大便欲去而难去，又不坚实，腹内或如故，或作胀，两关尺脉浮大。薛以为肠胃气虚血
弱，每服十全大补汤加肉苁蓉，去后始快。若间二三日不服，腹内仍胀，大便仍难。
一妇人大便秘涩，诸药不应，苦不可言，令饮人乳而安。
张子和曰∶顷有老人，年八十岁，脏腑涩滞，数日不便，每临后时，头目昏眩，鼻塞腰痛，积渐食减，纵
得食，便结燥如弹。一日，友人命食血脏葵羹、油渫菠 菜，遂顿食之，日日不乏，前后皆利，食进神清。年
九十岁，无疾而终。《图经》云∶菠 寒，利肠胃，芝麻油炒而食之，利大便。葵宽肠，利小便。年老之人，大
小便不利最为急切。此亦偶得泻法耳。
子和表兄病大便燥滞，无他症，常不敢饱食，饱则大便极难，结实如铁石。或三五日一如圊，目前星飞，
鼻中血出，肛门连广肠痛，痛则发昏，服药则病转剧。巴豆、芫花、甘遂之类皆用之，过多则困，泻止则复燥。
如此数年，遂畏药，性暴急不服，但卧病待尽。两手脉息俱滑实有力，以大承气汤下之，继服神功丸、麻仁丸
等药，使食菠 菜及猪羊血作羹，百余日充肥，亲知骇之。粗工不知燥分四种∶燥于外则皮肤皱揭，燥于中则
精血枯涸，燥于上则咽鼻焦干，燥于下则便溺结秘。夫燥之为病，是阳明之化也，水液衰少，故如此。然可下
之，当择之。巴豆可以下寒，甘遂、芫花可以下湿，大黄、朴硝可以下食。《内经》曰∶辛以润之，咸以软之。
《周礼》曰∶以滑养窍。
龚子才治一男子，年六十七，因怒，左边上中下三块，时动而胀痛，揉之则散去，心痞作嘈，食则胃口觉
滞，夜卧不宁，小便涩，大便八日不通。一医以大承气汤，一医以化滞丸，一用猪胆导法，一用蜜导，俱不效。
诊之，六脉弦数有力，此血不足，气有余，积滞壅实。大黄末三钱，皮硝五钱，热烧酒调服，下黑粪如石数十
枚。如前再进，下粪弹盆许遂安。后以四物汤加桃仁、红花、酒蒸大黄、黄连、栀子、三棱、莪术、枳壳、青
皮、木通、甘草，十数剂而愈。
李时珍治一宗室，年几六十，平生苦肠结病，旬日一行，甚于生产，服养血润燥药，则泥膈不快，服硝、
黄通利药，则若罔知，如此三十余年矣。诊其人体肥，膏粱而多忧郁，日吐酸痰碗余乃宽，又多火病。此乃三
焦之气壅滞，有升无降，津液皆化为痰饮，不能下滋肠腑，非血燥比也。润剂留滞，硝、黄徒入血分，不能通
气，俱为痰阻，故无效也。乃用牵牛末、皂角膏丸与服，即便通利。自是但觉肠结，一服就顺，亦不妨食，且
复精爽。盖牵牛能走气分，通三焦，气顺则痰逐饮消，上下通快矣。（《本草纲目》。）
外甥柳乔，素多酒色，病下极胀痛，二便不通，不能坐卧，立哭呻吟者昼夜。医用通利药不效，遣人叩李。
李思此乃湿热之邪在精道，壅胀隧路，病在二阴之间，故前阻小便，后阻大便，病不在大肠膀胱也。乃用楝实、
茴香、穿山甲诸药，入牵牛加倍，水煎服，一服而减，三服而平。（同上。）
张景岳治一壮年，素好火酒，适夏月醉则露卧，不畏风寒，此其食性脏气，皆有大过人者，因致热结三焦，
二便俱闭。先以大承气汤，用大黄五七钱如石投水。又用神佑丸及导法，俱不能通，且前后俱闭，危益甚。遂
仍以大承气汤加生黄二两，芒硝三钱，又加牙皂二钱煎服，黄昏进药，四鼓始通，大便通而后小便渐利。此
所谓盘根错节，有非斧斤不可者。若优柔不断，鲜不害矣。
朱翰林太夫人，年近七旬，偶因一跌，即致寒热。医与滋阴清火，势转甚。诊之，六脉无力，虽头面上身
有热而口不渴，且足冷过股，曰∶此阴虚受邪，非跌之为，实阴症也。遂以理阴煎加人参、柴胡，二剂而热退，
日进粥二三碗。已而大便半月不通，腹且渐胀，咸以燥结为火，欲复用凉剂，张不可，谓若再用清火，其原必
败，不可为矣。经曰肾恶燥，急食辛以润之，正此谓也。乃以前药更加姜、附，倍用人参、当归，数剂而便通，
腹胀退，日就瘥。（此实风秘之类，未可归功姜、附。）
按∶此症乃阴虚阳越，亦类中之轻者。一跌而病，良有以也。不知阴症二字，何以插入。其生平见解，
大可知矣。
李士材治蒋少宰，服五加皮酒，遂患大便秘结。四日以来，腹中胀闷，服大黄一钱，通后复结。李曰∶肾
气衰少，津液不充，误行疏利，（疏字不妥。）是助其火矣。以八味丸料，煎成加人乳一钟，白蜜五钱，二剂后
即通，十日而愈。
顾文学素有风痰，大便秘。治风须治血，乃大法也。用十全大补汤加秦艽、麻仁、杏仁、防风、煨皂角仁，
半月而效，三月以后永不再发。（此亦风秘之候。）
徐灵胎说：大便闭塞的病症，大多是因为肠道中血液枯竭且有潜伏的火邪所致。采用开宣肺气、顺气等方法，偶尔有效，但并非普遍适用的法则。
安康郡太守患有风秘（因风邪引起的便秘），陈氏为他处方二仁丸：杏仁去皮和尖，用面粉炒制；火麻仁单独研磨；枳壳去掉瓤，用面粉炒后研成粉末；诃子炒去核，研成粉末。以上药物用炼蜜制成梧桐子大小的药丸，每次服用二三十丸，温水送服。如果未通便，增加剂量直到痊愈。
薛立斋治疗一位老妇人，她大便想排却难以排出，粪便并不干硬，腹部有时正常，有时感到胀满，两手关脉和尺脉浮大。薛立斋认为是肠胃气虚血弱，每服用十全大补汤加肉苁蓉，排便后才感觉舒畅。如果间隔两三天不服药，腹部仍然胀满，大便依然困难。
另一位妇女大便秘结涩滞，各种药物无效，痛苦不堪，让她饮用牛奶后症状缓解。
张子和说：以前有一位老人，八十岁，脏腑功能涩滞，几天不大便，每次临厕时，头目昏眩，鼻塞腰痛，逐渐食欲减退，即使进食，大便也干结如弹丸。一天，朋友让他吃猪羊血葵菜羹、油拌菠菜，于是顿顿食用，前后大便都通畅，食欲增进，精神清爽。九十多岁时，无病而终。《图经》记载：菠菜性寒，通利肠胃，芝麻油炒食可通大便。葵菜宽肠，通利小便。老年人大小便不通最为急切。这也是偶然使用泻法的效果罢了。
张子和表兄患大便燥滞，没有其他症状，常不敢吃饱，饱食则大便极难排出，坚硬如铁石。或三五天一次排便，眼前金星飞舞，鼻出血，肛门连及直肠疼痛，痛则昏厥，服药则病情加重。巴豆、芫花、甘遂等药都用过，过量则身体困倦，泻止后大便又干燥。如此数年，于是畏惧药物，性情暴躁不服药，只是卧病等待死亡。两手脉搏滑实有力，用大承气汤攻下，继服神功丸、麻仁丸等药，并让食用菠菜及猪羊血作羹，百余日后身体丰满健壮，亲友震惊。粗劣的医生不知道燥证分为四种：燥在外部则皮肤皱裂，燥在内部则精血枯竭，燥在上部则咽喉鼻腔焦干，燥在下部则二便闭结。燥这种病，是阳明经的化生，水液衰少，所以如此。然而可以攻下，应当选择适宜的药物。巴豆可以攻下寒积，甘遂、芫花可以攻下湿积，大黄、朴硝可以攻下食积。《内经》说：辛味能润燥，咸味能软坚。《周礼》说：用滑利之物滋养孔窍。
龚子才治疗一名男子，六十七岁，因愤怒，左侧上下三处肿块，时而移动且胀痛，揉搓则散去，心窝痞闷嘈杂，进食时胃口觉得阻滞，夜间睡眠不安，小便涩滞，大便八日不通。一位医生用大承气汤，一位医生用化滞丸，一位用猪胆导法，一位用蜜导法，均无效。诊察发现，六脉弦数有力，这是血不足，气有余，积滞壅实。用大黄末三钱，皮硝五钱，热烧酒调服，排出黑粪如石头数十枚。再次服用，排出粪便约一盆许，于是安定。后来用四物汤加桃仁、红花、酒蒸大黄、黄连、栀子、三棱、莪术、枳壳、青皮、木通、甘草，十余剂后痊愈。
李时珍治疗一位宗室成员，年近六十，平生苦于肠结病，十天排便一次，比生产还痛苦，服用养血润燥药，则阻碍膈部不适，服用硝黄通利药，则毫无反应，如此三十多年了。诊察其人体形肥胖，饮食肥甘厚味且多忧郁，每天呕吐酸痰一碗多才舒服，又多火病。这是三焦之气壅滞，有升无降，津液都化为痰饮，不能向下滋润肠腑，不是血燥可比。润剂留滞，硝黄徒然进入血分，不能通气，都被痰阻，所以无效。于是用牵牛子末、皂角膏丸服用，大便立即通畅。从此只要觉得肠结，一服药就顺畅，也不妨碍饮食，而且恢复精神清爽。因为牵牛子能走气分，通三焦，气顺则痰饮消除，上下通畅。（《本草纲目》。）
外甥柳乔，素来多酒色，病在下极胀痛，二便不通，不能坐卧，站立哭泣呻吟昼夜不停。医生用通利药无效，派人请教李士材。李士材思考这乃是湿热之邪在精道，壅胀隧道，病在二阴之间，所以前阻小便，后阻大便，病不在大肠膀胱。于是用楝实、茴香、穿山甲等药，加入加倍的牵牛子，水煎服，一服减轻，三服平复。（同上。）
张景岳治疗一名壮年人，素好喝烈性酒，适逢夏季醉酒露宿，不畏风寒，这是他的食性和脏气都有过人之处，因此导致热结三焦，二便俱闭。先用大承气汤，用大黄五七钱，如石投水般猛烈。又用神佑丸及导法，都不能通，且前后俱闭，危重更甚。于是仍用大承气汤加生黄芪二两，芒硝三钱，又加牙皂二钱煎服，黄昏进药，四鼓始通，大便通而后小便渐利。这就是所谓的盘根错节，非斧斤不可解决。如果优柔寡断，很少有不受害的。
朱翰林太夫人，年近七十，偶然因跌倒，即致寒热。医生给予滋阴清火，病情转重。诊察发现，六脉无力，虽然头面身上有热但口不渴，且脚冷过股，说：这是阴虚受邪，不是跌倒所致，实际上是阴症。于是用理阴煎加人参、柴胡，两剂后热退，每天进粥二三碗。不久大便半月不通，腹部逐渐胀满，大家都认为是燥结为火，想再用凉剂，张景岳不同意，说如果再清火，元气必败，不可救治了。经书说肾恶燥，急食辛以润之，正是此意。于是用前方再加姜、附，倍用人参、当归，数剂后便通，腹胀退，日渐康复。（这实际上是风秘之类，不能归功于姜、附。）
按语：此症乃阴虚阳越，也是类中风中的轻者。因跌倒而发病，确实有其道理。不知“阴症”二字为何插入。其生平见解，大致可知矣。
李士材治疗蒋少宰，服用五加皮酒后，患大便秘结。四天以来，腹中胀闷，服用大黄一钱，通后复结。李士材说：肾气衰少，津液不充，误行疏利，（“疏”字不妥），这是助其火。用八味丸料，煎成后人乳一杯，白蜜五钱，两剂后即通，十日痊愈。
顾文学素有风痰，大便秘。治风须治血，是大法。用十全大补汤加秦艽、麻仁、杏仁、防风、煨皂角仁，半月见效，三月以后永不再发。（这也是风秘之候。）
Xu Lingtai stated: The syndrome of fecal impaction is mostly caused by dryness of blood in the intestines with latent fire. Methods such as opening the lungs and regulating qi are occasionally effective, but not universally applicable.
The Prefect of Ankang suffered from wind-constipation (constipation caused by wind pathogen). Chen prescribed Er Ren Wan (Two Kernels Pill): Apricot kernels peeled and de-husked, stir-fried with flour; Hemp seeds separately ground; Aurantii Fructus removed of pith, stir-fried with flour and powdered; Chebulae Fructus stir-fried and de-seeded, powdered. These were made into pills the size of a Chinese quince seed using refined honey. Each dose was 20-30 pills, taken with warm water. If bowel movement did not occur, the dose was increased until cured.
Xue Lizhai treated an elderly woman who had difficulty defecating, though the stool was not hard. Her abdomen was sometimes normal, sometimes distended. Her Guan and Chi pulses on both hands were floating and large. Xue diagnosed it as deficiency of Qi and blood in the stomach and intestines. He prescribed Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) added with Cistanches Herba. She felt relieved after defecation. If she did not take medicine for two or three days, her abdomen would become distended again, and defecation difficult.
A woman suffered from severe constipation unresponsive to various medicines, causing unbearable suffering. She was instructed to drink human milk, which brought relief.
Zhang Zihe said: Previously, there was an eighty-year-old man whose organ functions were sluggish, with no bowel movement for several days. Whenever he attempted to defecate, he experienced dizziness, nasal congestion, and lower back pain. His appetite gradually decreased. Even when eating, his stool became hard like a pellet. One day, a friend suggested he eat mallow soup with animal blood and spinach blanched in oil. He ate this daily without fail, resulting in smooth bowel movements, improved appetite, and clear spirit. He lived to ninety years old and died peacefully. The "Tu Jing" records that spinach is cold in nature and promotes intestinal function; sesame oil-fried spinach promotes bowel movement. Mallow widens the intestines and promotes urination. For the elderly, difficulty in urination and defecation is most urgent. This was also an accidental use of purgative methods.
Zhang Zihe's cousin suffered from dry and stagnant bowels without other symptoms. He dared not eat too much; if he did, defecation became extremely difficult, with stool hard as iron. Every three to five days, he would have one bowel movement, accompanied by visual disturbances (stars flying before eyes), epistaxis, pain in the anus extending to the rectum, leading to fainting upon pain. Medications worsened the condition. He had used Crotonis Semen (Badou), Genkwa Flos (Yuanhua), and Kansui Radix (Gansui). Overuse led to exhaustion, and cessation led to recurrence of dryness. After years of this, he feared medication, became irritable, refused treatment, and lay ill waiting for death. Both radial pulses were slippery, solid, and forceful. Zhang administered Dachengqi Tang (Major Order the Qi Decoction) to purge, followed by Shengong Wan and Mahuang Wan. He advised eating spinach and animal blood soup. Within a hundred days, the patient regained robust health, astonishing his relatives. Crude physicians do not know that dryness syndromes are divided into four types: dryness on the exterior causes skin wrinkling; dryness in the interior causes depletion of essence and blood; dryness above causes dryness of throat and nose; dryness below causes constipation and urinary retention. Dryness is a transformation of the Yangming channel. Due to scarcity of body fluids, this occurs. However, purgatives can be used, but selection is crucial. Badou purges cold accumulation; Gansui and Yuanhua purge damp accumulation; Dahuang and Xiaoshi purge food accumulation. The "Neijing" states: Pungent flavors moisten; salty flavors soften. The "Zhou Li" states: Use slippery substances to nourish orifices.
Gong Zicai treated a sixty-seven-year-old man who, due to anger, developed three movable, painful masses on the left side. Rubbing dispersed them. He experienced epigastric fullness and burning sensation, feeling blocked after eating, restless sleep, scanty urine, and no bowel movement for eight days. One physician used Dachengqi Tang, another Huazhi Wan, another pig bile suppository, and another honey suppository, all ineffective. Pulse diagnosis revealed wiry, rapid, and forceful pulses on all six positions. This indicated insufficient blood, excess Qi, and stagnation. Gong prescribed 3 qian of Dahuang powder and 5 qian of Xiaoshi, mixed with hot rice wine. The patient passed dozens of black, stone-like stools. Upon re-administration, he passed a basin-full of pellets, and symptoms resolved. Subsequently, he was treated with Sini Tang modified with Taoren, Honghua, wine-steamed Dahuang, Huanglian, Zhizi, Sanleng, Ezhu, Zhike, Qingpi, Mutong, and Gancao for over ten doses, resulting in recovery.
Li Shizhen treated a royal clan member nearing sixty, who suffered from intestinal obstruction for decades, having a bowel movement only once every ten days, more painful than childbirth. Blood-nourishing and moistening agents caused chest discomfort, while purgatives like Xiaoshi and Dahuang had no effect. The patient was obese, consumed rich foods, and was prone to melancholy, vomiting over a bowl of sour phlegm daily for relief. He also had frequent heat syndromes. Li diagnosed this as stagnation of Qi in the Triple Burner, with ascending but no descending, causing body fluids to transform into phlegm-fluids that could not nourish the intestines downwards. It was not merely blood dryness. Moistening agents were retained, and purgatives entered the blood level but could not move Qi, being blocked by phlegm. Li prescribed Qian Niu Zi powder and Zao Jiao paste pills, which immediately promoted bowel movement. From then on, one dose ensured smooth passage, allowed normal diet, and restored mental clarity. Qian Niu Zi moves Qi, opens the Triple Burner, and resolves phlegm and fluids when Qi flows smoothly. (From "Bencao Gangmu".)
Li Shi Cai's nephew, Liu Qiao, indulged in alcohol and sex, suffering from severe lower abdominal distension and pain, with inability to urinate or defecate. He cried and groaned day and night, unable to sit or lie down. Purging medicines failed. Li Shi Cai reasoned that damp-heat pathogen was obstructing the spermatic duct, blocking the pathways between the two yin openings, thus obstructing urine anteriorly and stool posteriorly. The disease was not in the Large Intestine or Bladder. He used Litseae Fructus, Foeniculi Fructus, and Manis Squama, with doubled Qian Niu Zi, decocted in water. One dose reduced symptoms, three doses resolved them. (Same source.)
Zhang Jingyue treated a vigorous young man who loved strong liquor. In summer, he slept exposed after drunkenness, fearing neither wind nor cold. His dietary habits and organ constitution were exceptional, leading to heat binding in the Triple Burner and closure of both urine and stool. Initially, Dachengqi Tang was used with 5-7 qian of Dahuang, acting forcefully like a stone thrown in water. Shenyou Wan and enemas failed. The condition worsened with complete closure. Zhang then used Dachengqi Tang with 2 liang of raw Huangqi, 3 qian of Mangxiao, and 2 qian of Yazao, decocted together. Medicine was taken at dusk, and bowel movement occurred at midnight. Urination followed. This illustrates that complex, entrenched problems require decisive action ("axe and hatchet"). Indecision leads to disaster.
Madam Zhu, mother of Hanlin Academician Zhu, nearly seventy, developed fever and chills after a fall. Physicians prescribed Yin-nourishing and heat-clearing herbs, worsening the condition. Pulses were weak. Although she had heat in the head and upper body, she had no thirst, and her legs were cold above the thighs. Zhang diagnosed this as Yin deficiency with pathogen invasion, not caused by the fall, but actually a Yin syndrome. He prescribed Liyin Jian (Replenish Yin Decoction) with Renshen and Chaihu. Fever subsided after two doses, and she resumed eating porridge. Later, she had no bowel movement for half a month, with increasing abdominal distension. Others attributed this to dryness-fire and wanted to use cooling herbs. Zhang disagreed, stating that further clearing of heat would damage the root cause beyond repair. The Classics state: The Kidney dislikes dryness; urgently use pungent flavors to moisten. Zhang added Jiang (Ginger) and Fu (Aconite) to the previous formula, doubling Renshen and Danggui. After several doses, bowel movement resumed, distension subsided, and she recovered. (This is actually a type of wind-constipation; attributing success solely to Ginger and Aconite is incomplete.)
Commentary: This syndrome is Yin deficiency with Yang floating, a mild form of stroke-like illness. The fall triggered it. The insertion of "Yin syndrome" is questionable, revealing Zhang's theoretical biases.
Li Shicai treated Jiang Shouzai, who developed severe constipation after drinking Wujiapi Wine. For four days, he suffered abdominal distension. One qian of Dahuang provided temporary relief, but constipation recurred. Li stated that declining Kidney Qi and insufficient body fluids were the root. Mistaken use of draining methods exacerbated the fire. He prescribed Bawei Wan (Eight-Ingredient Pill) decocted with one cup of human milk and 5 qian of white honey. Bowel movement occurred after two doses, and he recovered in ten days.
Gu Wenxue had chronic wind-phlegm and constipation. Treating wind requires treating blood, a fundamental principle. He was treated with Shiquan Dabu Tang added with Qinjiao, Hemaoren, Xingren, Fangfeng, and roasted Zao Jiao Ren. Symptoms improved in half a month and did not recur after three months. (This is also a manifestation of wind-constipation.)