〔大〕妇人大便不通者，由五脏不调，冷热之气结于肠胃，则津液燥竭，大肠壅塞，
故大便不通也。仲景云∶妇人经水过多，则亡津液，亦大便难也。大三脘散，或四物加
青皮，或七宣丸、麻仁丸选而用之。
〔薛〕前证或大肠津液干涸，或血虚火烁，不可计其日期，饮食数多，必待腹满胀，
自欲去而不能者，乃用猪胆汁润之。若妄服苦寒辛散之剂，元气愈伤，或通而不止，或
成中痞之证。大抵血虚火燥，用加味逍遥散。气血俱虚，用八珍汤。燥药伤血，用四物、连
翘、甘草。克伐伤气，用四君、川芎、当归。内热作渴，饮汤，脉实，用竹叶黄 汤。（杂病
消瘅。）内热作渴饮冷脉涩，用四物送润肠丸。肝胆克脾土而不能输送，用小柴胡汤（伤寒少
阳。）加山栀、郁李仁。肠胃气虚而不能传送，用补中益气加芍药。浓味积热而秘结，用清
胃散加芍药。（杂病齿。）其有热燥、风燥、阳结、阴结，皆不宜损中气，治者审之。一妇人
痰喘内热，大便不通，两月不寐，脉洪大，重按微细，此属肝肺肾亏损，朝用六味丸，夕
用逍遥散各三十余剂，计所进饮食百余碗，腹始痞闷，正前所谓血虚火烁也。以猪胆汁导
而通之，用十全大补汤调理而安。
通神散 治大便实热不通，其证心腹胀痛，手不得近，心胸烦闷而欲饮食者。
大黄（炒） 芒硝 槟榔 郁李仁（汤浸去皮，微炒） 桃仁（杵，各一两， 一方有木香半两。）
上为末，每服二钱，空心粥饮调下。
大麻仁丸 治肠胃风结，大便常秘而欲饮食者。
大麻仁（别研如膏） 大黄（炒，各二两） 槟榔 木香 枳壳（麸炒，各一两）
上为末，入麻仁研匀，炼蜜丸桐子大。每服二十丸，温水下。
皂角丸 治大肠经有风，大便秘结而不坚实者。
皂角（炙，去子） 枳壳（麸炒，各等分）
上为末，炼蜜丸桐子大。每服七十丸，空心米饮下。
苏麻粥 顺气滑肠。用紫苏子、麻子仁，水研取汁，煮粥食之。
润肠丸 治伏火风热，大肠干燥。若因失血或因肾虚，当滋肾水，最忌此丸。
麻子仁 桃仁（去皮尖，别研，各一两） 羌活 当归尾 大黄（煨） 皂角仁 秦艽（各五钱）
上另研为末，炼蜜丸。每服五十丸，空心白汤送下。如直肠干涩，用猪胆汁导之，亦
忌前药。
搜风顺气丸 治痔漏肠风，风热秘结，元气充实者。
车前子（一两五钱） 大麻子（微炒） 大黄（五钱，半生半熟） 牛膝（酒浸） 郁李仁（汤泡）
菟丝子（酒浸蒸，杵晒为末） 枳壳（麸炒） 山药（各二钱）
上为末，炼蜜丸桐子大。每服三十丸，空心白汤下。
子和脾约丸
麻仁（一两二钱半） 枳壳（麸炒） 浓朴（姜制） 芍药（各一两） 大黄（蒸，四两）
杏仁（去皮尖炒，研烂如膏，一两二钱）
上为末，入杏仁膏炼蜜丸梧子大。每服三二十丸，空心用滚汤送下。
初虞世云∶余历观古人用通药，率用降气等药。盖肺气不下降，则大肠不能传送，以
杏仁、枳壳、诃子等味是也。又老人、虚人、风人，津液少，大便秘。经云∶涩者滑之。故
用胡麻、杏仁、麻子仁、阿胶之类是也。今人学不师古，妄意斟酌，每至大便秘燥，即
以驶药荡涤之，既走津液气血，大便随手愈更秘涩，兼生他病。予昔在鲁山日，有一
少自称太医，曹镇有寄居王世安少府，本京师人，始病风淫末疾，为此生以驶药累累利
之，后为肺痿咯脓血，卒至大便不通而死。古人服药尤所谨重，不若今人之轻生，故举此
以戒后人尔。
〔薛〕前证若胃强脾弱，津液不得四布，但输膀胱，小便数而大便难者，用脾约丸。若
阴血枯槁，内火燔灼，脾肺失传，大便秘而小便数者，用润肠丸。此丸若用之于热甚气
实，与西北之禀浓者，无有不效。若用于东南及虚热而气血不足者，则脾愈弱而肠愈燥，
反致虚痞矣。此东垣先生之治法也。其搜风顺气丸，中贵及西北人用之多效，东南人用
之无不致害。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。余以为肠胃气血虚弱，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。一老妇大便月余不通，痰喘内热，不得就枕，脉洪大，重按微细，朝
用六味丸，夕用逍遥散各五十余剂，计进饮食百余碗，小腹始闷，此火燥而消铄也，以
猪胆汁润之，用十全大补而安。后仍不通，用八珍倍加苁蓉常服而通。
【王肯堂】妇女大便不通，是由于五脏功能失调，冷气和热气结聚在肠胃，导致津液干枯枯竭，大肠壅塞阻滞，所以出现大便不通。张仲景说：妇女月经量过多，就会耗伤津液，也会导致大便困难。可选用大三脘散，或在四物汤中加入青皮，或者选用七宣丸、麻仁丸，根据情况选择使用。
【薛己】上述病症，有的是因为大肠津液干涸，有的是因为血虚导致火热内灼，不能单纯计算发病天数。如果饮食较多，必须等到腹部胀满，有便意却排不出来的时候，才使用猪胆汁来润肠通便。如果胡乱服用苦寒或辛散的药物，元气会更加受损，可能出现腹泻不止，或者形成中痞（胸腹痞塞）的病症。大抵血虚火燥者，使用加味逍遥散。气血俱虚者，使用八珍汤。因燥药损伤血液者，使用四物汤、连翘、甘草。因攻伐药物损伤气机者，使用四君子汤、川芎、当归。内有热邪导致口渴且想喝热水、脉象实者，使用竹叶石膏汤。（出自杂病消瘅篇。）内有热邪导致口渴且想喝冷水、脉象涩者，使用四物汤送服润肠丸。肝胆克制脾土，导致脾失运化输送功能者，使用小柴胡汤（出自伤寒少阳篇），加入山栀、郁李仁。肠胃气虚，不能推动传导者，使用补中益气汤加入芍药。食用肥甘厚味积滞生热而导致便秘者，使用清胃散加入芍药。（出自杂病齿痛篇。）那些属于热燥、风燥、阳结、阴结的证候，都不宜损伤中气，治疗者应当仔细审察。有一位妇人痰喘伴有内热，大便不通，两个月无法入睡，脉象洪大，重按则微细，这属于肝、肺、肾亏损。早晨服用六味地黄丸，晚上服用逍遥散，各三十多剂，累计进食百余碗饭，腹部才开始感到痞闷，这正是前面所说的血虚火烁。用猪胆汁导引通便，再用十全大补汤调理而痊愈。
通神散 治疗大便实热不通，症状为心腹胀痛，手不可触碰，心胸烦闷且想吃东西。
大黄（炒） 芒硝 槟榔 郁李仁（开水浸泡去皮，微炒） 桃仁（捣碎，以上各一两，另一版本加木香半两。）
以上研为末，每次服用二钱，空腹时用米粥汁调服。
大麻仁丸 治疗肠胃风结，大便经常秘结但仍有食欲者。
大麻仁（单独研成膏状） 大黄（炒，以上各二两） 槟榔 木香 枳壳（麸炒，以上各一两）
以上研为末，加入麻仁研匀，用炼蜜制成梧桐子大小的丸剂。每次服用二十丸，温水送下。
皂角丸 治疗大肠经有风，大便秘结但不坚硬者。
皂角（炙烤，去籽） 枳壳（麸炒，以上等分）
以上研为末，用炼蜜制成梧桐子大小的丸剂。每次服用七十丸，空腹时用米饮送下。
苏麻粥 顺气滑肠。用紫苏子、麻子仁，用水研磨取汁，煮粥食用。
润肠丸 治疗伏火风热，大肠干燥。如果是因失血或因肾虚引起，应当滋补肾水，最忌用此丸。
麻子仁 桃仁（去皮尖，单独研碎，以上各一两） 羌活 当归尾 大黄（煨制） 皂角仁 秦艽（以上各五钱）
以上分别研为末，用炼蜜制成丸剂。每次服用五十丸，空腹时用白开水送下。如果直肠干涩，可用猪胆汁导引通便，同时也忌用前面的药物。
搜风顺气丸 治疗痔漏肠风，风热秘结，元气充实者。
车前子（一两五钱） 大麻子（微炒） 大黄（五钱，半生半熟） 牛膝（酒浸） 郁李仁（开水泡） 菟丝子（酒浸蒸后，捣碎晒干为末） 枳壳（麸炒） 山药（以上各二钱）
以上研为末，用炼蜜制成梧桐子大小的丸剂。每次服用三十丸，空腹时用白开水送下。
子和脾约丸
麻仁（一两二钱半） 枳壳（麸炒） 浓朴（姜制） 芍药（以上各一两） 大黄（蒸，四两） 杏仁（去皮尖炒，研烂如膏，一两二钱）
以上研为末，加入杏仁膏，用炼蜜制成梧桐子大小的丸剂。每次服用三二十丸，空腹用滚开水送下。
初虞世说：我观察古人使用通便药物，大都使用降气等药物。因为肺气不下降，大肠就不能传送糟粕，像杏仁、枳壳、诃子等就是这类药。另外老人、虚人、中风患者，津液少，容易大便秘结。医经说：涩者滑之。所以使用胡麻、杏仁、麻子仁、阿胶之类的药物。现在的人学习不效法古人，随意斟酌用药，每当遇到大便秘燥，就用猛烈的药物荡涤，结果既耗走了津液气血，大便虽然暂时通畅，随后却更加秘涩，并且产生其他疾病。我以前在鲁山时，有一个自称太医的人，曹镇有个寄居的王世安少府，本是京师人，起初患风淫末疾（四肢病变），这个医生用猛烈药物多次让他泻下，后来导致肺痿咯脓血，最终因大便不通而死。古人服药尤其谨慎，不像今人轻率对待生命，所以举这个例子来告诫后人。
【薛己】上述病症，如果是胃强脾弱，津液不能四处布散，只输注到膀胱，导致小便频数而大便困难者，使用脾约丸。如果是阴血枯槁，内火炽盛，脾肺失去传化功能，大便秘结而小便频数者，使用润肠丸。这个丸剂如果用于热甚气实的患者，以及禀赋厚实的西北人，没有不有效的。如果用于东南地区及虚热而气血不足的人，则会使得脾气更弱、肠道更燥，反而导致虚痞。这是东垣先生的治法。至于搜风顺气丸，权贵及西北人使用大多有效，东南人使用无不致害。一位老妇人大便有便意却难排出，且不坚硬，腹部有时正常，有时发胀，左右关尺脉浮大。我认为这是肠胃气血虚弱，每次服用十全大补汤加肉苁蓉，排便后才感觉爽快，如果间隔两三天不服药，腹部仍然发胀，大便仍然困难。另一位老妇人大便一个多月不通，痰喘伴有内热，无法躺卧入睡，脉象洪大，重按微细，早晨服用六味地黄丸，晚上服用逍遥散，各五十多剂，累计进食百余碗饭，小腹才开始感到闷堵，这是火燥消耗津液所致，用猪胆汁润肠通便，再用十全大补汤调理而安定。后来仍然不通，使用八珍汤加倍加入肉苁蓉常服而通便。
[Wang Kentang] In women, constipation (Dabian Butong) arises from the dysfunction of the five Zang organs, where cold and heat pathogens knot in the intestines and stomach. This leads to the exhaustion of body fluids (Jinye), causing obstruction and stagnation in the large intestine, resulting in constipation. Zhang Zhongjing stated: "If a woman suffers from excessive menstrual bleeding, she loses body fluids, which also leads to difficult defecation." One may select and use San Da Wan San (Three Large Abdomen Powder), Si Wu Tang (Four Substances Decoction) added with Qing Pi (Green Tangerine Peel), or Qi Xuan Wan (Seven Ventilation Pills), Ma Ren Wan (Hemp Seed Pills), according to the specific condition.
[Xue Ji] For the aforementioned conditions, whether due to dryness of the large intestine's body fluids or blood deficiency with fire scorching, one should not rely solely on the duration of the illness. If dietary intake is high, one must wait until abdominal fullness occurs, accompanied by the urge to defecate but inability to do so, before using pig bile (Zhu Dan Zhi) to moisten the intestines. Blindly administering bitter-cold or acrid-dispersing agents will further damage Yuan Qi (Primal Qi), potentially leading to unceasing diarrhea or the formation of Zhong Pi (Middle Jiao Stagnation). Generally, for blood deficiency with fire dryness, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). For combined Qi and Blood deficiency, use Ba Zhen Tang (Eight Treasures Decoction). For blood injury caused by drying agents, use Si Wu Tang (Four Substances Decoction) with Lian Qiao (Forsythia Fruit) and Gan Cao (Licorice Root). For Qi injury caused by purgative attacks, use Si Jun Zi Tang (Four Gentlemen Decoction) with Chuan Xiong (Szechwan Lovage Rhizome) and Dang Gui (Angelica Sinensis). For internal heat causing thirst with a desire for warm drinks and a excess pulse, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) [from Miscellaneous Diseases: Xiao Dan]. For internal heat causing thirst with a desire for cold drinks and a choppy pulse, use Si Wu Tang (Four Substances Decoction) to deliver Run Chang Wan (Moisten Intestines Pills). When Liver and Gallbladder overact on Spleen Earth, impairing transport and transformation, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) [from Shaoyang Syndrome of Cold Damage] added with Shan Zhi (Gardenia Fruit) and Yu Li Ren (Bush Cherry Seed). For Qi deficiency of the intestines and stomach failing to transmit, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shao Yao (Peony Root). For constipation due to accumulation of heat from rich flavors, use Qing Wei San (Clear the Stomach Powder) added with Shao Yao (Peony Root) [from Miscellaneous Diseases: Toothache]. For patterns of Heat Dryness, Wind Dryness, Yang Knotting, and Yin Knotting, one must avoid damaging the Middle Qi; practitioners should examine carefully. A certain woman suffered from phlegm-wheezing with internal heat, constipation, and insomnia for two months. Her pulse was洪大 (Surging and Large), but fine upon heavy pressure. This belonged to deficiency of Liver, Lung, and Kidney. She took Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in the morning and Xiao Yao San (Free and Easy Wanderer Powder) in the evening, each for over thirty doses. After consuming over a hundred bowls of food, her abdomen began to feel distended and blocked, which corresponds to the previously mentioned "blood deficiency with fire scorching." Pig bile was used to guide the bowels open, and she recovered after regulation with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction).
Tong Shen San (Divine Spirit Powder): Treats constipation due to excess heat. Symptoms include abdominal pain and distension intolerable to touch, mental restlessness, and appetite.
Da Huang (Rhubarb Root and Rhizome, stir-fried), Mang Xiao (Mirabilite), Bing Lang (Areca Seed), Yu Li Ren (Bush Cherry Seed, soaked in water, peeled, slightly stir-fried), Tao Ren (Peach Seed, pounded, each 1 liang; another version adds Mu Xiang (Aucklandia Root) 0.5 liang).
Grind into powder. Take 2 qian per dose, mixed with congee broth on an empty stomach.
Da Ma Ren Wan (Hemp Seed Pills): Treats wind-knotting in the intestines and stomach, characterized by frequent constipation but preserved appetite.
Da Ma Ren (Hemp Seed, ground separately into paste), Da Huang (Rhubarb Root and Rhizome, stir-fried, each 2 liang), Bing Lang (Areca Seed), Mu Xiang (Aucklandia Root), Zhi Ke (Bitter Orange Pericarp, bran-stir-fried, each 1 liang).
Grind into powder, mix evenly with hemp seed paste, and form pills with refined honey the size of paulownia seeds. Take 20 pills per dose with warm water.
Zao Jiao Wan (Soap Pod Pills): Treats wind in the Large Intestine Meridian, characterized by constipation that is not hard.
Zao Jiao (Soap Pod, roasted, seeds removed), Zhi Ke (Bitter Orange Pericarp, bran-stir-fried, equal parts).
Grind into powder, form pills with refined honey the size of paulownia seeds. Take 70 pills per dose with rice drink on an empty stomach.
Su Ma Zhou (Perilla and Hemp Porridge): Promotes Qi flow and lubricates the intestines. Use Zi Su Zi (Perilla Fruit) and Ma Zi Ren (Hemp Seed), grind with water to extract juice, and cook into porridge.
Run Chang Wan (Moisten Intestines Pills): Treats latent fire and wind-heat causing dryness of the large intestine. If caused by blood loss or Kidney deficiency, one should nourish Kidney Water; this pill is strictly contraindicated.
Ma Zi Ren (Hemp Seed), Tao Ren (Peach Seed, peeled and cored, ground separately, each 1 liang), Qiang Huo (Notopterygium Rhizome), Dang Gui Wei (Angelica Sinensis Tail), Da Huang (Rhubarb Root and Rhizome, baked), Zao Jiao Ren (Soap Pod Kernel), Qin Jiao (Gentiana Macrophylla Root, each 5 qian).
Grind separately into powder, form pills with refined honey. Take 50 pills per dose with plain boiled water on an empty stomach. If the rectum is dry and rough, use pig bile for enema; also avoid the aforementioned drugs.
Sou Feng Shun Qi Wan (Search Wind and Smooth Qi Pills): Treats hemorrhoids, fistulas, intestinal wind, wind-heat constipation, in patients with sufficient Yuan Qi (Primal Qi).
Che Qian Zi (Plantago Seed, 1.5 liang), Da Ma Zi (Hemp Seed, slightly stir-fried), Da Huang (Rhubarb Root and Rhizome, 5 qian, half raw half cooked), Niu Xi (Achyranthes Root, wine-soaked), Yu Li Ren (Bush Cherry Seed, soaked in hot water), Tu Si Zi (Cuscuta Seed, wine-soaked, steamed, pounded and dried into powder), Zhi Ke (Bitter Orange Pericarp, bran-stir-fried), Shan Yao (Chinese Yam, each 2 qian).
Grind into powder, form pills with refined honey the size of paulownia seeds. Take 30 pills per dose with plain boiled water on an empty stomach.
Hezi Pi Yue Wan (Hezi's Spleen-Restriction Pills)
Ma Ren (Hemp Seed, 1.25 liang), Zhi Ke (Bitter Orange Pericarp, bran-stir-fried), Hou Po (Magnolia Bark, ginger-processed), Shao Yao (Peony Root, each 1 liang), Da Huang (Rhubarb Root and Rhizome, steamed, 4 liang), Xing Ren (Apricot Seed, peeled, cored, stir-fried, pounded into paste, 1.2 liang).
Grind into powder, add apricot seed paste, form pills with refined honey the size of paulownia seeds. Take 20-30 pills per dose with boiling water on an empty stomach.
Chu Yushi said: "I have observed that ancients generally used Qi-descending agents for purgatives. Since Lung Qi does not descend, the Large Intestine cannot transmit waste; examples include Xing Ren (Apricot Seed), Zhi Ke (Bitter Orange Pericarp), and He Zi (Chebulic Myrobalan Fruit). Furthermore, the elderly, deficient individuals, and those with wind disorders lack body fluids, leading to constipation. The Classics state: 'For obstruction, use lubricating methods.' Thus, they used Hu Ma (Sesame), Xing Ren (Apricot Seed), Ma Zi Ren (Hemp Seed), and E Jiao (Donkey-Hide Gelatin). Modern practitioners fail to learn from antiquity, arbitrarily adjusting prescriptions. Whenever constipation occurs, they use harsh purgatives to scour the bowels. This depletes body fluids and Qi/Blood; although the bowels move temporarily, they become more obstructed subsequently, generating other diseases. Once in Lushan, I encountered a self-proclaimed Imperial Physician. A resident official, Wang Shi'an, originally from the capital, initially suffered from wind-induced limb disorders. This physician repeatedly purged him with harsh medicines, later causing Fei Wei (Lung Atrophy) with expectoration of pus and blood, ultimately dying from constipation. Ancients were extremely cautious with medication, unlike modern people who treat life lightly. I cite this to warn future generations."
[Xue Ji] For the aforementioned conditions, if Stomach strength is strong but Spleen weakness prevails, preventing body fluids from distributing everywhere, causing them to only transfer to the Bladder, resulting in frequent urination and difficult defecation, use Pi Yue Wan (Spleen-Restriction Pills). If Yin Blood is exhausted and internal fire blazes, causing Spleen and Lung to lose transmission functions, resulting in constipation and frequent urination, use Run Chang Wan (Moisten Intestines Pills). This pill is effective for patients with severe heat and excess Qi, and for those in the Northwest with robust constitutions. However, if used for people in the Southeast or those with deficiency-heat and insufficient Qi/Blood, it will weaken the Spleen further and dry the intestines, causing false stagnation. This is the treatment method of Mr. Dongyuan. Regarding Sou Feng Shun Qi Wan (Search Wind and Smooth Qi Pills), it is effective for nobles and people in the Northwest, but harmful to those in the Southeast. An elderly woman had the urge to defecate but difficulty passing stool, which was not hard. Her abdomen was sometimes normal, sometimes distended. Her pulses at both Guan and Chi positions were floating and large. I diagnosed this as Qi and Blood deficiency of the intestines and stomach. Each time she took Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Rou Cong Rong (Cistanche Stem), she felt relieved after defecation. If she skipped the medicine for two or three days, her abdomen remained distended and defecation difficult. Another elderly woman had not defecated for over a month, suffering from phlegm-wheezing, internal heat, and inability to lie down. Her pulse was surging and large, but fine upon heavy pressure. She took Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in the morning and Xiao Yao San (Free and Easy Wanderer Powder) in the evening, each for over fifty doses, consuming over a hundred bowls of food. Her lower abdomen then became stuffy, indicating fire-dryness consuming fluids. Pig bile was used to moisten the intestines, and she stabilized with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). Later, constipation recurred. She was prescribed Ba Zhen Tang (Eight Treasures Decoction) with doubled Rou Cong Rong (Cistanche Stem) for regular use, which resolved the constipation.