脉盛，皮热，腹胀，前后不通，瞀闷，此谓五实。脾胃气滞，不能转输，加以痰饮食积阻碍清道，
大小便秘涩不快，升柴二术二陈汤数服，能令大便润而小便长。湿热痰火结滞，脉洪盛，大小便秘赤，
肢节烦疼，凉膈散、通圣散、《金匮》浓朴大黄汤选用。丹溪治一妇人，脾疼后患大小便不通，此是
痰隔中焦，气聚上焦。二陈加木通，初服后吐，渣再服。烧皂角灰为末，粥清调下。推车客七个，土
狗七个，二物新瓦上焙干为末。以虎目树皮（即虎杖）。向东南者，煎浓汤服之。连根葱一二茎带
土，生姜一块，淡豆豉二十一粒，盐二匙、同研烂作饼，烘热掩脐中，以帛扎定，良久气透自通，不
通再换一饼。阴证大小便不通，及诸杂病阴候，大小便不通危急者，用牡蛎、陈粉、干姜炮各一两，
上为细末。男病用女人唾调，手内擦热，紧掩二卵上，得汗出愈。女病用男子唾调，手内擦热，紧掩
二乳上，得汗出愈。盖卵与乳乃男女之根蒂，坎离之分属也。非急不用。
洁古云∶脏腑之秘，不可一概治疗。有虚秘，有实秘。胃实而秘者，能饮食，小便赤，当以麻仁
丸、七宣丸之类主之。胃虚而秘者，不能饮食，小便清利，浓朴汤主之。胃气实者，秘物也。胃气虚
者，秘气也。有风秘、有冷秘、有气秘、有热秘，有老人津液干燥，及妇人分产亡血，及发汗利小便，
病后血气未复，皆能作秘。不可一例用硝黄利药。巴豆、牵牛，尤在所禁。风秘者，由风搏肺脏，传
于大肠，故传化难。或其人素有风病者，亦多有秘。宜小续命汤，去附子，倍芍药，入竹沥一杯，吞
润肠丸，或活血润肠丸。冷秘，由冷气横于肠胃，凝阴固结，津液不通，
胃气闭塞，其人肠内气攻，喜热恶冷，宜藿香正气散加官桂、枳壳各半钱，吞半硫丸。热药多秘，惟
硫黄暖而通。冷药多泄，惟黄连肥肠而止泄。气秘，由气不升降，谷气不行，其人多噫。宜苏子降气
汤加枳壳，吞养正丹，或半硫丸、来复丹。未效佐以木香槟榔丸。有气作痛，大便秘塞，用通剂而便
愈不通，又有气秘，强通之虽通复秘，或迫之使通因而下血者。此当顺气，气顺则便自通，又当求温
暖之剂。热秘，面赤身热，肠胃胀闷，时欲得冷，或口舌生疮，此由大肠热结。宜四顺清凉饮，吞润
肠丸，或木香槟榔丸。实者承气汤。仲景云∶脉有阳结阴结者，何以别之？曰∶其脉浮而数，能食不
大便者，此为实，名曰阳结也，期十七日当剧。其脉沉而迟，不能食，身体重，大便反硬，名曰阴结
也，期十四日当剧。东垣云∶阳结者散之，阴结者热之。前所云实秘、热秘，即阳结也。前所云 秘、
冷秘，即阴结也。老人虚秘，及出汗、利小便过多，一切病后血气未复而秘者，宜苏子降气汤，倍加
当归，吞威灵仙丸。或肉黄饮，苁蓉润肠丸尤宜。东垣云∶津液耗而燥者，以辛润之。肾主五液，津
液盛则大便如常，若饥饱劳役损伤胃气，及食辛热浓味之物而助火邪，伏于血中，耗散真阴，津液
亏少，故大便结燥。又有年老气虚，津液不足而结者。
肾恶燥，急食辛以润之是也。血虚津液枯竭而秘结者，脉必小涩，面无精光，大便虽软，努责不出。
大剂四物汤，加陈皮、甘草、酒红花，导滞通幽汤，益血丹。血少兼有热者，脉洪数，口干，小便赤
少，大便秘硬。润燥汤、活血润燥丸、四物汤加酒芩、栀子、桃仁、红花。大法云∶大便秘，服神芎
丸。大便不通，小便反利，不知燥湿之过，本大肠少津液，以寒燥之药治之，是以转燥，少服则不济，
多服则亡血，所以不通。若用四物、麻子、杏仁之类则可。经云∶燥则为枯，湿剂所以润之。金匮真
言论云∶北方黑色，入通于肾，开窍于二阴，故肾阴虚则小大便难，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，欲利之则气以下脱，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，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。《元戎》五燥大便秘∶
东方其脉弦，风燥也。宜泻风之药治之，独活、羌活、防风、茱萸、地黄、柴胡、川芎。南方其脉洪，
热燥也。宜咸苦之药治之，黄芩、黄连、大黄、黄柏、芒硝。西南方其脉缓，土燥也。宜润湿之药治
之，芍药、半夏、生姜、乌梅、木瓜。西方其脉涩，血燥也。宜滋血之药治之，杏仁、麻仁、桃仁、
当归。气结用木香、槟榔、枳实、陈皮、地黄、郁李仁。北方其脉迟，寒燥也。宜温热之药治之，当
归、肉桂、附子、乌头、硫黄、良姜、巴豆。润肠丸加减法∶如病患不小便，因大便不通而涩其邪，
盛者急加酒洗大黄以利之。如血燥者，加桃仁、酒洗大黄。如风结燥者，加麻仁、大黄。如风涩者，
加煨皂角仁、大黄、秦艽以利之。如脉涩，觉身痒气涩者，加郁李仁、大黄以除气燥。如寒阴之病，
为寒结闭者，以《局方》中半硫丸，或加煎附子生姜
汤，冰冷与之。其病虽阴寒之证，当服阳药补之，若大便恒不甚通者，亦当十服中与一服利药，微通
其大便，不令秘结，乃治之大法也。若病患虽是阴证，或者阴寒之证，其病显躁，脉坚实，亦宜阳药
中少加苦寒之剂，以去热躁，躁止勿加。如阴躁欲坐井中者，其二肾脉按之必虚，或沉细而迟，此为
易辨。如有客邪之病，亦从权加之。有物有积而结者，当下之。食伤太阴，肠满食不化，腹响响然，
不能大便者，以苦泄之，七宣丸、木香槟榔丸。桃杏仁俱治大便秘，当以血气分之。年老虚人大便燥
秘者，脉浮在气，杏仁、陈皮主之。脉沉在血，桃仁、陈皮主之。所以俱用陈皮者，以手阳明病与手
太阴为表里也。又云∶盛则难便，行阳气也。败则便难，行阴血也。注夏大便涩滞者，血少、血中伏
火也。黄 人参汤，加生地黄、当归身、桃仁泥、麻仁泥润之。如润之大便久不快利者，少加煨大黄
微利之。如加大黄久不快利者，非血结、血秘，是热则生风，病必湿风证，止当服黄 人参汤，只用
羌活、防风各半两，水四盏，煎至一盏，去渣空心服之，其大便必大走也。大便不通，五日一遍，小
便黄赤，浑身肿，面上及腹尤甚，色黄，麻木，身重如山，
沉困无力，四肢痿软，不能举动，喘促，唾清水，吐秽痰白沫如胶，时躁热，发欲去衣，须臾而过，
振寒顶额有时如冰，额寒尤甚，头旋眼黑，目中溜火，冷泪，鼻不闻香臭，小腹急痛，当脐有动气，
按之坚硬而痛，宜麻黄白术汤。此病宿有风湿热伏于荣血之中，其水火乘于阳道而上盛，元气短少上
喘，为阴火伤其气，四肢痿，在肾水之间，乃所胜之病，今正遇冬寒得时，乘其肝木，又实其母，肺
金克木凌火，是大胜必有大复。其证善怒，欠，多嚏，鼻中如有物，不闻香臭，目视KT KT ，多悲
健忘，少腹急痛，遍身黄，腹大胀，面目肿尤甚，食不下，痰唾涕有血，目 疡，大便不通，只二服
皆愈。凡诸秘服药不通，或虚人畏服利药者，用蜜煎导。或用盐及皂角末，和入蜜煎中尤捷，盖盐能
软坚润燥，皂角能通气疏风故也。冷秘，用酱生姜导。或于蜜煎中，加草乌头末，以化寒消结。热者，
猪胆汁导。乌梅汤浸去核，为丸如枣子大，亦可导。酱瓜削如枣，亦可导。丹溪云∶予观古方通大便，
皆用降气品剂，盖肺气不降，则大便难传送，用枳壳、沉香、诃子、杏仁等是也。又老人、虚人、风
人、津液少而秘者，宜以药而滑之，用胡麻、麻仁、阿胶等是也。如妄以峻利药逐之，则津液走，气
血耗，虽暂通而即秘矣，必更生他病。昔王少腑
患此疾，有人以驶药利之者屡矣，后为肺痿咯脓血，卒至不通而死。
脉象盛大，皮肤发热，腹部胀满，大小便不通畅，头昏目眩且心中烦闷，这称为“五实”。若因脾胃气机阻滞，无法正常运化转输，加之痰湿、饮食积滞阻碍了清阳之道，导致大小便秘涩不畅，可服用升柴二术二陈汤，连续服用数次，能使大便滋润、小便通利。若是湿热、痰火结滞所致，脉象洪大盛实，大小便颜色红赤，肢体关节烦躁疼痛，可选用凉膈散、防风通圣散或《金匮要略》中的厚朴大黄汤。
朱丹溪曾治疗一位妇人，脾脏疼痛后出现大小便不通，这是痰浊阻隔中焦，气机聚于上焦所致。使用二陈汤加木通，初次服用后发生呕吐，将药渣再次煎服。另法：将皂角烧成灰研末，用米汤调服；或用推车客（一种植物）七个、土狗（蝼蛄）七个，在新瓦上焙干研末；再用虎杖皮（选取向东南生长的），煎煮浓汤服用。此外，取带土的葱一二根、生姜一块、淡豆豉二十一粒、盐两匙，一同捣烂做成饼状，加热后敷在脐中，用布扎紧，过一段时间后气机通畅自然排便，若不通则更换一张饼。
对于阴证引起的大小便不通，以及各类杂病中表现为阴证的危急情况，可用牡蛎、陈年米粉、炮干姜各一两，研为细末。男性患者用女性唾液调和，在手心搓热后，紧紧敷贴于两个睾丸上，待出汗即愈；女性患者用男性唾液调和，在手心搓热后，紧紧敷贴于两侧乳房上，待出汗即愈。这是因为睾丸和乳房分别是男女的根本所在，属于坎离阴阳之分野。此法仅在紧急情况下使用。
李东垣（洁古）说：脏腑的秘结，不能一概而论地治疗。有虚秘，也有实秘。胃气实而秘结的，能进食，小便色赤，应当以麻仁丸、七宣丸等为主治疗。胃气虚而秘结的，不能进食，小便清长，以厚朴汤为主治疗。胃气实的，是实物（宿食等）停滞导致的秘结；胃气虚的，是气机运行无力导致的秘结。还有风秘、冷秘、气秘、热秘，以及老年人津液干燥，妇女分娩失血，发汗过多或利小便过度，病后气血尚未恢复，都能导致秘结。不可一律使用芒硝、大黄等泻下药物。巴豆、牵牛子更是禁忌。
风秘，是由于风邪搏结肺脏，传至大肠，导致传导功能困难。或者素来有风病的人，也多有秘结。宜用小续命汤，去掉附子，加倍芍药，加入一杯竹沥，吞服润肠丸，或活血润肠丸。
冷秘，是由于冷气横亘于肠胃，阴寒凝结，津液不通，胃气闭塞，病人感觉肠内气攻冲，喜热恶冷，宜用藿香正气散加官桂、枳壳各半钱，吞服半硫丸。热性药多导致便秘，只有硫黄既能暖身又能通便；寒性药多导致泄泻，只有黄连能肥肠止泻。
气秘，是由于气机升降失常，谷气不行，病人多打嗝。宜用苏子降气汤加枳壳，吞服养正丹，或半硫丸、来复丹。若无效，辅以木香槟榔丸。若有气滞作痛，大便秘塞，使用通下剂反而使大便更加不通，这又是一种气秘，强行通下虽然暂时通畅但很快又秘结，或者逼迫通下导致便血的，此时应当顺气，气顺则大便自通，还应当寻求温通的药剂。
热秘，表现为面赤身热，肠胃胀闷，时常想喝冷饮，或口舌生疮，这是由于大肠热结所致。宜用四顺清凉饮，吞服润肠丸，或木香槟榔丸。实证用承气汤。
张仲景说：脉象有阳结和阴结，如何区别？回答说：脉象浮而数，能进食但不大便的，这是实证，名叫阳结，预计十七天病情会加重。脉象沉而迟，不能进食，身体沉重，大便反而硬结的，名叫阴结，预计十四天病情会加重。李东垣说：阳结者用发散法，阴结者用温热法。前面所说的实秘、热秘，就是阳结；前面所说的虚秘、冷秘，就是阴结。
老年人虚秘，以及出汗、利小便过多，一切病后气血未恢复而秘结的，宜用苏子降气汤，加倍当归，吞服威灵仙丸。或者肉苁蓉饮、肉苁蓉润肠丸尤其适宜。李东垣说：津液耗损而干燥的，用辛味药来润燥。肾主五液，津液充足则大便正常，如果饥饱劳役损伤胃气，以及食用辛辣浓厚之物助长火邪，伏于血中，耗散真阴，津液亏少，所以大便结燥。又有年老气虚，津液不足而结燥的。“肾恶燥，急食辛以润之”说的就是这个道理。
血虚津液枯竭而秘结的，脉象必然细小涩滞，面色无光泽，大便虽然软，但用力努责却排不出。宜用大剂量四物汤，加陈皮、甘草、酒炒红花，或导滞通幽汤，益血丹。血少兼有热的，脉象洪数，口干，小便赤少，大便秘硬。宜用润燥汤、活血润燥丸、四物汤加酒芩、栀子、桃仁、红花。
医书大法说：大便秘结，服用神芎丸。大便不通，小便反而通利，是不明白燥湿的过错，本是大肠缺少津液，却用寒燥的药治疗，所以变得更加干燥，少服则无效，多服则耗伤血液，因此不通。如果用四物汤、麻子、杏仁之类就可以。经书说：燥则干枯，用湿剂来润燥。《金匮真言论》说：北方黑色，入通于肾，开窍于前后二阴，所以肾阴虚则大小便困难，宜用地黄、肉苁蓉、车前子、茯苓等药，补真阴利水道，稍佐辛药开腠理以生津液滋润其燥，施用于老人尤其适宜。
如果大小便燥结非常严重，求通不得，登厕用力太过，大便仍不通，而气被挣脱，下注肛门，有时泄出清水，里急后重不可忍受，胸膈间梗塞恶心，干呕有声，口渴索水，饮食不进，呻吟不绝，想要利下则气以下脱，性命在顷刻之间，再下则绝气；想要固摄则溺与燥屎膨满腹肠间，恐怕反而加重；想要升提使气自举，而秽物不为气所结，自然通利，则呕恶不堪，该如何处置？家姑八十多岁，曾患此病，我只用调气利小便的药，虽然小获效，但未收全功，曾安慰她不要急躁，后来因不能进食，突然索要末药，利下数次，不告诉我，自以为稍微舒服了。但脉忽见数动一止，气息奄奄，颓然卧床。我知道真气已泄，若不收敛摄纳，恐怕无法挽救，急忙投以生脉散，几剂后结代脉才退。于是合制益血润肠丸与她服用，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，二便通调，四肢康健。
便秘本是老人的常事，世俗认为后门固守是长寿的征兆，但一时难以忍受，往往躁扰致病。我所开的处方，不犯大黄，可以久服，故列出以供参考。《元戎》论五燥大便秘：东方脉弦，属风燥，宜用泻风药治之，如独活、羌活、防风、吴茱萸、地黄、柴胡、川芎。南方脉洪，属热燥，宜用咸苦药治之，如黄芩、黄连、大黄、黄柏、芒硝。西南方脉缓，属土燥，宜用润湿药治之，如芍药、半夏、生姜、乌梅、木瓜。西方脉涩，属血燥，宜用滋血药治之，如杏仁、麻仁、桃仁、当归。气结用木香、槟榔、枳实、陈皮、地黄、郁李仁。北方脉迟，属寒燥，宜用温热药治之，如当归、肉桂、附子、乌头、硫黄、良姜、巴豆。
润肠丸加减法：如果病患不小便，因大便不通而涩滞其邪，实证急加酒洗大黄以利之。如果是血燥，加桃仁、酒洗大黄。如果是风结燥，加麻仁、大黄。如果是风涩，加煨皂角仁、大黄、秦艽以利之。如果脉涩，觉身痒气涩，加郁李仁、大黄以除气燥。如果是寒阴之病，为寒结闭者，用《局方》中的半硫丸，或加煎附子生姜汤，冰冷与之。其病虽是阴寒之证，当服阳药补之，若大便恒不甚通者，也应当在十服药中给一服利药，微通其大便，不令秘结，这是治病的大法。如果病患虽是阴证，或者是阴寒之证，其病显躁，脉坚实，也宜在阳药中少加苦寒之剂，以去热躁，躁止勿加。如果是阴躁欲坐井中者，其二肾脉按之必虚，或沉细而迟，此为容易辨别。如果有客邪之病，亦从权加之。有物有积而结者，当下之。食伤太阴，肠满食不化，腹响响然，不能大便者，以苦泄之，用七宣丸、木香槟榔丸。
桃仁和杏仁都治大便秘，应当以血气分之。年老虚人大便燥秘者，脉浮在气分，用杏仁、陈皮主治；脉沉在血分，用桃仁、陈皮主治。所以都用陈皮，是因为手阳明大肠经与手太阴肺经互为表里。又说：盛则难便，行阳气也；败则便难，行阴血也。
注夏（夏季不适）大便涩滞者，是血少、血中伏火。用人参汤，加生地黄、当归身、桃仁泥、麻仁泥润之。如果润之大便久不快利者，少加煨大黄微利之。如果加大黄久不快利者，非血结、血秘，是热则生风，病必为湿风证，只当服人参汤，只用羌活、防风各半两，水四盏，煎至一盏，去渣空心服之，其大便必大走也。
大便不通，五日一遍，小便黄赤，浑身肿，面上及腹尤甚，色黄，麻木，身重如山，沉困无力，四肢痿软，不能举动，喘促，唾清水，吐秽痰白沫如胶，时躁热，发欲去衣，须臾而过，振寒顶额有时如冰，额寒尤甚，头旋眼黑，目中溜火，冷泪，鼻不闻香臭，小腹急痛，当脐有动气，按之坚硬而痛，宜用麻黄白术汤。此病宿有风湿热伏于营血之中，其水火乘于阳道而上盛，元气短少上喘，为阴火伤其气，四肢痿，在肾水之间，乃所胜之病，今正遇冬寒得时，乘其肝木，又实其母，肺金克木凌火，是大胜必有大复。其证善怒，欠伸，多嚏，鼻中如有物，不闻香臭，目视模糊，多悲健忘，少腹急痛，遍身黄，腹大胀，面目肿尤甚，食不下，痰唾涕有血，目疡，大便不通，只二服皆愈。
凡诸秘服药不通，或虚人畏服利药者，用蜜煎导法。或用盐及皂角末，和入蜜煎中尤捷，盖盐能软坚润燥，皂角能通气疏风故也。冷秘，用酱生姜导。或于蜜煎中，加草乌头末，以化寒消结。热者，猪胆汁导。乌梅汤浸去核，为丸如枣子大，亦可导。酱瓜削如枣，亦可导。
朱丹溪说：我观察古方通大便，皆用降气品剂，盖肺气不降，则大便难传送，用枳壳、沉香、诃子、杏仁等是也。又老人、虚人、风人、津液少而秘者，宜以药而滑之，用胡麻、麻仁、阿胶等是也。如妄以峻利药逐之，则津液走，气血耗，虽暂通而即秘矣，必更生他病。昔王少府患此疾，有人以驶药利之者屡矣，后为肺痿咯脓血，卒至不通而死。
Pulse is full and forceful, skin is hot, abdomen is distended, urination and defecation are obstructed, dizziness and mental oppression occur; this is called "Five Excesses" (Wu Shi). If spleen and stomach qi stagnation prevents normal transportation and transformation, compounded by phlegm-dampness and food retention obstructing the clear pathways, causing constipation and difficult urination, Shengchai Eryue Erchen Tang (Shengma, Chaihu, Atractodopsis Rhizoma Decoction with Erchen Tang) can be taken several times to moisten the stool and promote urination. If caused by damp-heat, phlegm-fire stagnation, with a surging pulse, red urine and stool, and painful joints, Liangge San (Cool the Diaphragm Powder), Fengmi Tongsheng San (Wind-Resisting Universal Benefit Powder), or Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction from *Jin Gui Yao Lue*) may be selected.
Zhu Danxi treated a woman who developed urinary and fecal retention after spleen pain. This was due to phlegm blocking the middle jiao and qi gathering in the upper jiao. Erchen Tang (Two-Cured Decoction) with Mutong (Akebia Caulis) was used; after the first dose, vomiting occurred, so the dregs were decocted again. Alternatively, burn soap pod (Gleditsiae Fructus Spina) to ash, powder it, and take with rice water. Take seven fresh Carthamus fructus (Cheqiu Ke) and seven earth dogs (Mole Cricket), dry them on a new tile, powder them. Decoct bark of Hu Zhang (Polygonum Cuspidatum) facing southeast into a thick decoction to drink. Also, grind one or two green onions with roots and soil, one piece of ginger, twenty-one fermented soybeans (Dan Dou Chi), and two spoons of salt into a paste, make into cakes, heat them, and apply to the umbilicus, binding tightly. After some time, qi will penetrate and passage will open naturally; if not, replace with another cake.
For urinary and fecal retention due to Yin syndromes, or critical cases of miscellaneous diseases presenting as Yin patterns, use Oyster Shell (Muli), aged rice flour, and roasted dried ginger (one tael each), powdered finely. For male patients, mix with female saliva, warm in hand, and press firmly over both testes until sweating occurs for cure. For female patients, mix with male saliva, warm in hand, and press firmly over both breasts until sweating occurs for cure. This is because testes and breasts are the root foundations of men and women, corresponding to Kan and Li (Water and Fire). Do not use except in emergencies.
Jiegu (Li Dongyuan) said: Constipation of the zang-fu organs cannot be treated uniformly. There are deficiency constipation and excess constipation. In excess constipation due to stomach excess, the patient can eat and has red urine; treat primarily with Mahuang Wan (Hemp Seed Pill) or Qixuan Wan (Seven-Promoting Pill). In deficiency constipation due to stomach deficiency, the patient cannot eat and has clear urine; treat primarily with Houpo Tang (Magnolia Bark Decoction). Stomach qi excess leads to retention of solid matter; stomach qi deficiency leads to retention of qi. There is also wind constipation, cold constipation, qi constipation, and heat constipation. Additionally, dryness of fluids in the elderly, blood loss after childbirth, excessive sweating or diuresis, and incomplete recovery of qi and blood after illness can all cause constipation. Do not uniformly use laxatives like Mangxiao (Mirabilite) and Dahuang (Rhubarb Root and Rhizome). Badou (Croton Seed) and Qianniu (Pharbitis Seed) are especially contraindicated.
Wind constipation arises when wind combats the lung organ and transmits to the large intestine, making transportation difficult. Those with a history of wind diseases often have constipation. Use Xiao Xuming Tang (Minor Continue Life Decoction), remove Fuzi (Aconite Lateral Root), double Shaoyao (Peony Root), add one cup of Zhuli (Bamboo Sap), and swallow Run Chang Wan (Moisten Intestines Pill) or Huoxue Run Chang Wan (Invigorate Blood Moisten Intestines Pill).
Cold constipation arises when cold qi dominates the stomach and intestines, condensing yin and binding, blocking fluids and closing stomach qi. The patient feels qi attacking inside the intestines, prefers heat and dislikes cold. Use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with Guigui (Cinnamon Twig) and Zhike (Bitter Orange Fruit), half qian each, swallowing Banshu Wan (Half-Sulfur Pill). Hot medicines often cause constipation, only Sulfur warms and unblocks. Cold medicines often cause diarrhea, only Huanglian (Coptis Rhizome) fattens the intestines and stops diarrhea.
Qi constipation arises from failure of qi ascending and descending, and grain qi not moving; the patient often belches. Use Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) with Zhike, swallowing Yangzheng Dan (Nourish Righteousness Pellet), or Banshu Wan, Laifu Dan. If ineffective, assist with Muxiang Binglang Wan (Aquilaria and Areca Nut Pill). If qi stagnation causes pain and severe constipation, using purgatives makes it worse; this is another type of qi constipation. Forced purgation may temporarily relieve but quickly recurs, or forcing it causes bleeding. Here, one must soothe the qi; when qi flows smoothly, stool passes naturally. Seek warm and unblocking agents.
Heat constipation presents with red face, body heat, abdominal distension and stuffiness, desire for cold drinks, or mouth/tongue ulcers, due to heat knotting in the large intestine. Use Sishun Qingliang Yin (Four-Obedience Cooling Drink), swallowing Run Chang Wan or Muxiang Binglang Wan. Excess patterns use Chengqi Tang (Order the Qi Decoction).
Zhongjing said: How to distinguish Yang Jie (Yang Knot) and Yin Jie (Yin Knot) by pulse? If the pulse is floating and rapid, the patient can eat but does not defecate, this is excess, named Yang Jie, expected to worsen on the 17th day. If the pulse is deep and slow, the patient cannot eat, body is heavy, stool is hard, this is Yin Jie, expected to worsen on the 14th day. Dongyuan said: Yang Jie is dispersed, Yin Jie is warmed. The previously mentioned excess and heat constipation are Yang Jie; deficiency and cold constipation are Yin Jie.
For elderly deficiency constipation, or constipation after excessive sweating/diuresis or post-illness qi-blood deficiency, use Suzi Jiangqi Tang with doubled Danggui (Angelica Sinensis), swallowing Weilingxian Wan (Symplocos Berry Pill). Roucong Rong Yin (Cistanche Drink) or Roucong Run Chang Wan (Cistanche Moisten Intestines Pill) are especially suitable. Dongyuan said: For dryness due to fluid consumption, use acrid substances to moisten. Kidney governs five fluids; sufficient fluids mean normal stool. Injury to stomach qi from hunger/fullness or labor, or consuming spicy/heavy foods aiding fire evil hidden in blood, consumes true yin and reduces fluids, causing dry stool. Elderly qi deficiency and insufficient fluids also cause knotting. "Kidney dislikes dryness, urgently eat acrid to moisten" refers to this.
Blood deficiency and fluid exhaustion causing constipation present with small, choppy pulse, dull complexion, soft stool but inability to expel despite straining. Use large doses of Siwu Tang (Four Substances Decoction) with Chenpi (Tangerine Peel), Gancao (Licorice Root), Jiuhonghua (Safflower processed with wine), Daozhi Tongyou Tang (Guide Stasis Unblock Nethermost Decoction), or Yixue Dan (Benefit Blood Pellet). Blood deficiency with heat presents with surging-rapid pulse, dry mouth, scanty red urine, hard dry stool. Use Rundao Tang (Moisten Dryness Decoction), Huoxue Runzao Wan (Invigorate Blood Moisten Dryness Pill), or Siwu Tang with Jiuqin (Scutellaria processed with wine), Zhizi (Gardenia Fruit), Taoren (Peach Kernel), Honghua (Safflower).
General principles state: For large bowel constipation, use Shenxiong Wan. If stool is blocked but urine is free, it is an error of not understanding dryness/wetness. The large intestine lacks fluids, yet cold-drying drugs are used, increasing dryness. Small doses are ineffective, large doses deplete blood, causing blockage. Using Siwu Tang, Hemp Seed, Apricot Kernel is correct. Classics say: Dryness leads to withering, wet agents moisten it. *Jin Gui Zhen Yan Lun* says: North corresponds to black, enters kidney, opens at the two yin orifices. Kidney yin deficiency causes difficulty in urination/defecation. Use Dihuang (Rehmannia Root), Roucongcong (Cistanche Stem), Cheqianzi (Plantago Seed), Fuling (Poria) to tonify true yin and promote water passages, slightly adding acrid drugs to open pores and generate fluids to moisten dryness, especially suitable for the elderly.
If severe dryness/knotting of stool and urine persists despite efforts, straining too hard fails to pass stool, qi escapes downward to the anus, leaking clear water, with tenesmus unbearable, chest/stomach obstruction, nausea, dry heaving, thirst, refusal to eat, groaning, danger of qi collapse if purged, or worsening if bound, how to treat? My aunt, over eighty, suffered this. I used qi-regulating and diuretic herbs, achieving partial success but not full cure. I advised patience. Later, unable to eat, she secretly took powder herbs, purging several times, feeling relieved. But her pulse became rapid with intermittent pauses, breath faint, collapsed in bed. I knew true qi had leaked; without consolidation, rescue was impossible. Urgently administered Shengmai San (Generate Pulse Powder). After several doses, the knotted pulse receded. Then combined Yixue Runchang Wan, advising against seeking quick results or other drugs. Long-term regulation led to normal bowel/bladder function and strong limbs within two months. Constipation is common in the elderly;俗 believe firm closure indicates longevity, but sudden distress causes disease. My prescriptions avoid Dahuang, safe for long-term use, hence recorded.
*Yuan Rong* discusses Five Drynesses causing constipation: East, string-like pulse, wind dryness, treat with wind-dispersing drugs: Duduo (Angelica Dahurica), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Zhuyu (Cornus Fruit), Dihuang, Chaihu (Bupleurum Root), Chuanxiong (Ligusticum Rhizome). South, surging pulse, heat dryness, treat with salty-bitter drugs: Huangqin (Scutellaria Root), Huanglian, Dahuang, Huangbai (Phellodendron Bark), Mangxiao. Southwest, slow pulse, earth dryness, treat with moistening-damp drugs: Shaoyao, Banxia (Pinellia Tuber), Shengjiang (Fresh Ginger), Wumei (Mume Fruit), Mugua (Chaenomelis Fructus). West, choppy pulse, blood dryness, treat with blood-nourishing drugs: Xingren (Apricot Kernel), Maziren (Hemp Seed), Taoren, Danggui. Qi knot uses Muxiang (Aucklandia Root), Binglang (Areca Nut), Zhishi (Bitter Orange Fruit), Chenpi, Dihuang, Yuliren (Coix Seed). North, slow pulse, cold dryness, treat with warm-hot drugs: Danggui, Rougui (Cinnamon Bark), Fuzi, Wutou (Aconite Root), Sulfur, Liangjiang (Galangal Root), Badou.
Run Chang Wan modifications: If no urination due to stool blockage, add Jiuhuang (Rhubarb processed with wine) urgently for excess. For blood dryness, add Taoren, Jiuhuang. For wind-knot dryness, add Maziren, Dahuang. For wind-choppy, add Wei Zaorou (Roasted Soap Pod Kernel), Dahuang, Qinjiao (Gentiana Macrophylla Root). For choppy pulse with itching/choppy qi, add Yuliren, Dahuang. For cold-yin disease with cold-knot closure, use Banshu Wan from *Ju Fang*, or add Fuzi Shengjiang Tang (Aconite and Ginger Decoction), served cold. Although cold-yin syndrome requires yang-tonifying drugs, if stool rarely passes, include one purgative dose in ten to mildly unblock, preventing constipation, which is the general method. If yin-syndrome shows restlessness with firm pulse, add slight bitter-cold drugs to yang formulas to remove heat-restlessness; stop when calm. If yin-restlessness desires sitting in wells, kidney pulses are empty/deep-slow; easy to distinguish. For external pathogens, adapt accordingly. Accumulations require purging. Food injury to Taiyin, intestinal fullness, undigested food, rumbling, inability to defecate, treat with bitter-draining: Qixuan Wan, Muxiang Binglang Wan.
Taoren and Xingren treat constipation; differentiate by blood/qi. Elderly deficiency dryness: floating pulse (qi level) uses Xingren, Chenpi; deep pulse (blood level) uses Taoren, Chenpi. Chenpi is used because Hand-Yangming Large Intestine and Hand-Taiyin Lung are exterior-interior. "Excess makes passing difficult, moves yang qi"; "Deficiency makes passing difficult, moves yin blood." Summer fatigue with sticky stool is blood deficiency with latent fire in blood. Use Renshen Tang (Ginseng Decoction) with Shengdihuang (Fresh Rehmannia Root), Danggui Shen (Angelica Root Head), Taoren Paste, Maziren Paste to moisten. If still not loose, add slight Wei Dahuang (Roasted Rhubarb). If still not loose with Dahuang, it is not blood-knot/blood-constipation, but heat generating wind, likely damp-wind syndrome. Use Renshen Tang with Qianghuo, Fangfeng (half liang each), four cups water, boil to one cup, strain, take on empty stomach; stool will move significantly.
Constipation, once every five days, yellow-red urine, whole-body edema (face/abdomen worst), yellow color, numbness, heavy body, weakness, limb flaccidity, panting, spitting clear water, vomiting turbid white foam like glue, occasional heat/restlessness wanting to remove clothes, chills forehead like ice, dizziness, dark eyes, fire in eyes, cold tears, anosmia, lower abdominal urgency, pulsating Qi at navel, hard/painful on pressure. Use Mahuang Baizhu Tang (Ephedra and Atractylodes Macrocephala Decoction). This disease has latent wind-damp-heat in Ying-Blood. Water-fire attacks Yang path upwards, yuan qi short leading to panting, Yin fire damages qi, limb flaccidity relates to Kidney Water, a controlling-overacting pathology. Meeting winter cold, attacking Liver Wood, strengthening Mother (Metal generates Water?), Lung Metal controls Wood suppressing Fire, great victory brings great reaction. Symptoms: anger, yawning, sneezing, nasal obstruction, blurred vision, sadness, amnesia, lower abdominal pain, generalized jaundice, abdominal distension, facial edema, anorexia, bloody sputum/nasal discharge, eye sores, constipation. Two doses cure all.
For any constipation unresponsive to medicine, or frail patients fearing purgatives, use Honey Suppository (Mi Jian Dao). Or mix salt and soap powder into honey suppository for better effect, as salt softens hardness/moistens dryness, soap vents qi/disperses wind. Cold constipation: Soy sauce ginger suppository. Or add Caowutou (Wild Aconite) powder to honey suppository to melt cold/knot. Heat: Pig bile suppository. Soak Wumei (Mume Fruit), remove pits, make pills date-sized, also usable as suppository. Pickled cucumber cut date-shaped, also usable.
Danxi said: Ancient formulas for bowel movement use qi-descending agents because Lung Qi not descending makes stool transport difficult, using Zhike, Chenxiang (Agarwood), Hezi (Chebulic Myrobalan), Xingren. Elderly/frail/wind-patients/fluid-deficient constipation should be lubricated with Sesame, Hemp Seed, Ejiao (Donkey-hide Gel). Blindly using harsh purgatives drains fluids, depletes qi-blood; though temporarily open, quickly re-blocks, causing other diseases. Former Wang Shaofu suffered this, repeatedly purged with strong drugs, later developed Lung萎 (Atrophy Syndrome) with pus/blood cough, died of blockage.