人有大便闭结者，其症口干舌燥，咽喉肿痛，头目昏晕，面红烦躁，人以为火盛闭结
也，谁知是肾水之涸乎。夫肾水为肺金之子，大肠与肺为表里，肺能生子，岂大肠独不能
生水乎？不知金各不同，金得清气则能生水，金得浊气不特不能生水，反欲得水以相养，故
大肠得气之浊，无水则不能润也。虽然大肠之开阖，虽肾水润之，亦肾火主之也。而肾火必
得肾水以相济，无肾火，而大肠洞开矣。无肾水以济肾火，则大肠又固结而不得出，故肾
虚而大肠不通，不可徒泻大肠也，泻大肠愈损其真阴矣。此等之症，老人最多，正以老人阴
衰干燥，火有余而水不足耳。治法但补其肾中之水，则水足以济火，大肠自润矣。方用濡肠饮∶
熟地（二两） 当归（一两） 肉苁蓉（一两，水洗淡水浸，一日换水五次） 水煎，
空腹服。一连数剂，无不通者。
此方用熟地补肾，用当归生血润肠，用苁蓉性动以通便，补阴而非亡阴，于老人尤宜，
而少年肾虚之辈，亦何独不利哉。
此症用濡肠汤亦效。
熟地 当归（各一两） 升麻（五分） 牛膝（三钱）水煎服。
人有大便闭结，小腹作痛，胸中嗳气，畏寒畏冷，喜饮热汤，人以为火衰闭结也，谁
知是肾火之微乎。夫大肠属金，金宜畏火之刑，何无火而金反闭耶？不知顽金非火不 ，所
以大肠必得火始能开阖。大肠者，传导之官也，有火则转输无碍，无火则幽阴之气闭塞，其
输挽之途，如大溪巨壑，霜雪堆，结成冰冻，坚浓而不可开，倘得太阳照临，则立时
消化，非大肠有火则通，无火则闭之明验乎。然而大肠本经，不可有火也。火在大肠，则
大肠有太热之虞；火在肾中，则大肠无大寒之 。倘肾中无火，则大肠何以传化水谷哉。治法
必须补肾中之火，不必通大肠之结也。方用温肠开闭汤∶
巴戟天（一两） 白术（一两） 熟地（一两） 山茱萸（五钱） 附子（二钱）水煎服。
此方用巴戟、熟地、山茱萸以补肾，至阴之中，仍有至阳之气，又用白术以利
腰脐。因附子直通其肾，迅达于膀胱，则火气熏蒸，阳回黍谷，雪消冰泮，何至固结闭塞哉。
此症用暖阳汤亦效。
白术 肉苁蓉（各一两） 附子（一钱）水煎服。
人有大便闭结，烦躁不宁，口渴舌裂，两目赤突，汗出不止，人以为火盛闭结也，谁知
是胃火之沸腾乎。夫阳明胃火一发，必有烁干肾水之祸。大便不通，正胃火烁干肾水也。似宜
急救息其火，但火性炎上，若以细微之水泼之，则火势愈烈而不可止，必得滂沱大雨，倾盆
倒瓮，淋漓浇濯，则燎原之火庶几尽息。方用竹叶石膏汤∶
石膏（一两） 知母（三钱） 麦冬（一两） 甘草（一钱） 茯苓（二钱） 人参（五
钱） 竹叶（一百片） 粘米（一撮）
水煎服。一剂火泻，二济便通，改用清肃汤∶
玄参（一两） 麦冬（五钱） 白芥子（三钱） 竹叶（三十片） 甘菊花（二钱） 生
地（三钱） 陈皮（五分） 丹皮（二钱）水煎服。十剂大便永无闭结之苦。
前用白虎汤，以火势太盛，不得已暂救肾中之水也。但石膏辛散，而性又猛烈，
频用多用，反致损耗真阴，真阴一耗，则前火虽消，后火又将复起，况火之有余，
水之不足也。与其泻火以损阴，何若补水以制阳之为得，所以改用清肃汤，补水以息阳火之
余焰耳。
此症用润胃丹亦效。
石膏（五钱） 知母（一钱） 玄参（一两） 生地（五钱） 牛膝（三钱） 甘草（五
分）水煎服。
人有大便闭结，胸中饱闷，两胁疼痛，呕酸作吐，不思饮食，人以为火之作祟也，亦
知为肝火之故乎。夫肝属木，木易生火，火旺似宜生脾胃之土，土又生金，何至大肠无津，成
闭结之症？不知肝中之火，乃木中之火，半是雷火也。雷火最能烁水，试看连阴久雨，必得雷
电交作，始散阴霾，正烁水之明征也。故肝火不动则已，动则引心包之火而沸腾，引阳明之火
而震动，火多而水有不涸者乎，水涸而大肠安得不闭结哉。故欲开大肠之闭，必先泻肝木之
火，则肝气自平，不来克土，胃脾之津液，自能转输于大肠，而无阻滞之苦矣。方用散火汤∶
白芍（一两） 当归（一两） 炒栀子（三钱） 柴胡（三分） 大黄（一钱） 地
榆（二钱）水煎服。一剂大便通，二剂肝火尽散，不再闭结也。
此方专入肝以泻火，又能舒肝之郁，盖肝不郁则肝火必不旺。肝火一散，各经之火无不
尽散，岂独留大肠一经之火哉。况方中原有地榆，又专解大肠之火者也。
此症用丹黄汤亦神。
炒栀子 丹皮（各三钱） 白芍（五钱） 甘草 黄芩（各一钱）水煎服。
人有大便闭结，口干唇裂，食不能消，腹痛难忍，按之益痛，小便短涩，人以为大便之
火闭也，谁知是脾火之作祟哉。夫脾乃湿土，得火则燥，宜为脾之所喜，何反成闭结之症？不
知土太柔则崩，土太刚则燥；土崩则成废土，土燥则成焦土也。然而土焦，非阳明之焰下逼，
必命门之火上炎，二火合攻，脾之津液涸矣。水谷之入，仅足供脾之用，何能分润于大肠
乎，大肠无津液之润，则肠必缩小，不能容物，安得不闭结哉。治法须急救脾土之焦，又必
先泻阳明、命门之火，始脾土得养，自易生阴，阴生而津液自润，何必通大肠之多事哉。方
用救土通肠汤∶
玄参（二两） 当归（一两） 生地（一两） 知母（一钱） 浓朴（三钱） 升麻（五
分） 大麻子（三十粒）水煎服。二剂大便必通，减去大麻子与知母，再用四剂，脾火尽散，
大便不再结矣。
此方玄参、生地补脾土之阴，又是泻命门、脾胃之火，当归取以润肠，知母、
浓朴取其下行以解热，升麻提脾土之气，则阳升而阴自降，大麻子最润大肠而引火
下行，不使阴气上升，正助升麻以提阳气。阳既升而阴又降，则津液无干涩之虞，
何患大肠之不通哉。
此症用助阴汤亦效。
玄参 当归 生地（各五钱） 知母（一钱） 牛膝（二钱）水煎服。
人有大便闭结，舌下无津，胸前出汗，手足冰冷，烦闷发躁，大 红赤，人以为大便之
火闭也，然亦知是心火之焚烧乎。夫心与小肠为表里，未闻心与大肠有妨碍也。然大肠虽不
与心为表里，实与肺为表里，心火之盛刑肺，即刑大肠矣。盖大肠属金，心火太盛，则心不
能受，自分其火与大肠。而大肠又最畏心火，火盛烁金，可立而待也。虽肺能生水，肺与大
肠有表里之关切，岂无津液之降，以救大肠之枯渴。无如肺先受心火之刑，自救不遑，亲子
如肾，尚不能分润，安有余波以及兄弟，来救援大肠乎？此大肠之所以不通也。治法宜急泻
火，但徒泻其火，无汪洋甘泽之降，恐不足以济大旱之渴也。必须以大雨淋之，则旱魃之气
顿除，而河渠尽通矣。方用扫氛汤∶
黄连（三钱） 玄参（三两） 沙参（一两） 当归（一两） 麦冬（一两） 丹皮（
一两） 栝蒌（二钱）水煎服。一剂心火降，大便即通，不必二剂。
此方用黄连以直解其心中之热。然徒用黄连，不益之玄参，则黄连虽寒而性燥，火虽解
而大肠之燥如故也。得玄参之润，以匡赞黄连，则浮游之火，不特尽除，且润以去燥，不啻如
夏热之时，忽得大雨，既去火炎，又 渥也。至于沙参生阴，当归生血，麦冬凉肺，丹皮
凉肾，无非断四路之氛，使其不来助心中之焰。加入栝蒌，使火存于心中者，尽随濡润之药下
降而消灭之也。火灭水生，则大肠之炎氛顿扫，欲不通得乎，所以一剂而奏功也。
此症用散襟汤亦效。
黄连 丹皮（各三钱） 当归 麦冬（各一两） 天花粉（二钱）水煎服。
人有大便闭塞不通，咳嗽不宁，口吐白沫，咽喉干燥，两脚冰冷，人以为三焦之火
旺也，谁知是肺经之火旺乎。夫肺属金，大肠相表里最为关切者也。肺火之旺，何竟傅入于大肠？不知肺乃娇脏，仅可
微火熏蒸，不可猛火 炼，故一遇火生，即
移其热于大肠也。且肺主皮毛，肺气少虚，风寒袭之，因肺中正气与邪气相战，寒变热而风
变邪，肺因生火，自烁其津，肺与大肠既相唇齿，肺之津涸，大肠之液亦竭矣。治法但宜轻治
肺火，而不可重施。以轻清下降之味，少抑其火，庶胃中之火，不来助炎，心中之火，不来
添旺，则肺火自散，阴液自生，大肠不必通而自通也。方用抑火汤∶
山豆根（二钱） 黄芩（三钱） 麦冬（一两） 天门冬（五钱） 当归（一两） 升
麻（五分）水煎服。
二剂肺火清，又服二剂，大肠之闭开，冉服二剂全愈。
此方抑肺金之火，又不伤肺金之气，肺金得养，津液通而大肠润矣。
此症用芩麻地冬汤亦效。
麦冬（二两） 黄芩 天门冬（各三钱） 升麻 甘草（各一钱） 生地（五钱）水煎服。
人有大肠闭结不通，饮食无碍，并无火症之见，亦无后重之机，有至一月不便者，人
以为肾中之无津也，谁知是气虚而不能推送乎。夫大肠无津，固不能润，而气弱亦不能行。
阳气一衰，则阳不能通阴，而阴与阳相隔，水谷入于肠，各消各化，
不相统会，故留中而不下也。治法不可滋阴以降之，亟当助阳以升之也。方用升阳降浊汤∶
人参（五钱） 黄 （五钱） 白术（五钱） 当归（五钱） 柴胡（三分） 荆芥（
五分） 麦冬（五钱） 肉桂（一钱） 附子（一分）水煎服。一剂大通。
此方纯是补阳分之药，止麦冬、当归少益其阴，则阳气胜阴，始有偏旺之势，又得附
子、肉桂直入于至阴之中，引柴胡、荆芥升提其阳气也。阳气一升，阴气立降，安能阻塞之哉。
此症用润输汤亦效。
黄 （五钱） 当归（一两） 川芎（五钱） 升麻（五分） 红花（五分） 麦冬 肉
苁蓉（各五钱）水煎服。
人有大便闭结不通，手按之痛甚欲死，心中烦躁，坐卧不宁，似乎有火，然小便又复
清长，人以为有硬屎留于肠中也，谁知有蓄血不散乎。夫蓄血之症，伤寒多有之，今其人并
不感风寒之邪，何亦有蓄血之病？不知人之气血，无刻不流通于经络之中，一有拂抑，则气即
郁塞不通，血即停住不散，于是遂遏于皮肤而为痈，留
于肠胃而成痛，搏结成块，阻住传化之机，隔断糟粕之路，大肠因而不通矣。治法宜通大肠，
佐之逐秽之味，然而草木之药，可通无形之结，不能通有形之结也。血乃有形之物，必得有形
相制之物，始能入其中而散其结。方用抵当汤治之。
水蛭（三钱，剪碎如米粒大，炒黑） 虻虫（二钱，各为末） 桃仁（十四粒，研碎）
大黄（五钱）水煎调服。
一剂而大便通，顿失痛楚矣。
盖大黄泄下，其势最猛，得水蛭、虻虫、桃仁破血之味相佐，其破坚逐秽之效更神。此
等闭结，不速通利，必有发狂之变。但何以辨其为蓄血之病乎？全在看其小便之利与不利耳。
盖蓄血之病，小便必利，以血不能入于膀胱之中，故膀胱之气能行能化，无害其下出之水
道耳。故见小便利而大便结者，用抵当汤万无差谬耳。
此症用大黄散瘀汤亦神。
水蛭（炒黑，三钱） 大黄 丹皮（各三钱） 当归（一两） 红花（三钱） 桃仁（十
四个） 生地（五钱）水煎服。
有一位大便闭结不通的患者，症状表现为口干舌燥、咽喉肿痛、头目昏晕、面色发红且烦躁不安。人们认为这是火邪过盛导致的闭结，却不知这其实是肾水枯竭所致。肾水是肺金的子脏（五行相生关系），大肠与肺互为表里。肺能滋生肾水，难道大肠就不能生水吗？这是因为金气有清浊之分：金若得清气则能生水，若得浊气则不仅不能生水，反而需要水来滋养。因此，大肠若受浊气影响，没有津液滋润就会干涩。虽然大肠的开阖功能由肾水滋润，但也由肾火主导。而肾火必须得到肾水的济助才能平衡；如果没有肾火，大肠就会洞开失禁；如果没有肾水来济助肾火，大肠又会固结闭塞无法排便。所以肾虚导致的大肠不通，不能单纯泻下大肠，因为泻大肠会进一步损伤真阴。这类病症在老年人中最为常见，正是因为老年人阴气衰退、身体干燥，火有余而水不足。治疗方法只需补益肾中的水，使水足以济助火，大肠自然润泽。方用濡肠饮：熟地黄（二两）、当归（一两）、肉苁蓉（一两，用水洗净后用淡盐水浸泡，一天换水五次）。水煎，空腹服用。连续服用数剂，没有不通的。
此方用熟地黄补肾，用当归生血润肠，用肉苁蓉性动以通便，属于补阴而非耗伤阴液，对老年人尤为适宜，少年肾虚的人使用又有什么不利呢？
这种病症用濡肠汤也有效。
熟地黄、当归（各一两）、升麻（五分）、牛膝（三钱）。水煎服。
有人大便闭结，小腹疼痛，胸中嗳气，畏寒怕冷，喜欢喝热汤。人们以为这是火衰导致的闭结，却不知这是肾火微弱所致。大肠属金，金本应畏惧火的克制，为何没有火反而金气闭结呢？这是因为顽钝之金非火不熔，所以大肠必须得到火气的温煦才能开阖。大肠是传导之官，有火则转输通畅无阻，无火则幽阴之气闭塞，其输送的道路就像深溪巨壑，霜雪堆积结成冰冻，坚硬浓稠而无法打开。倘若得到太阳照耀，则立即融化消散，这不是大肠有火则通、无火则闭的明证吗？然而大肠本经不可有过多的火，火在大肠则大肠会有太热的忧虑；火在肾中，则大肠不会有太寒的问题。如果肾中没有火，大肠如何传化水谷呢？治疗方法必须补益肾中的火，不必强行通导大肠的结滞。方用温肠开闭汤：巴戟天（一两）、白术（一两）、熟地黄（一两）、山茱萸（五钱）、附子（二钱）。水煎服。
此方用巴戟天、熟地黄、山茱萸补肾，在至阴之中蕴含至阳之气，又用白术利腰脐。因附子直通肾脏，迅达膀胱，则火气熏蒸，阳气回复，如雪消冰解，怎么会固结闭塞呢？
这种病症用暖阳汤也有效。
白术、肉苁蓉（各一两）、附子（一钱）。水煎服。
有人大便闭结，烦躁不宁，口渴舌裂，两眼赤红突出，汗出不止。人们以为这是火盛导致的闭结，却不知这是胃火沸腾所致。阳明胃火一发，必然有灼干肾水的祸患。大便不通，正是胃火灼干肾水的结果。似乎应该急救以平息火势，但火性炎上，如果用少量的水泼它，火势会更猛烈而不可遏制，必须像滂沱大雨一样倾盆倒瓮淋漓浇濯，燎原之火才能熄灭。方用竹叶石膏汤：石膏（一两）、知母（三钱）、麦冬（一两）、甘草（一钱）、茯苓（二钱）、人参（五钱）、竹叶（一百片）、粘米（一撮）。水煎服。一剂后火泻，二剂后大便通，改用清肃汤：玄参（一两）、麦冬（五钱）、白芥子（三钱）、竹叶（三十片）、甘菊花（二钱）、生地黄（三钱）、陈皮（五分）、牡丹皮（二钱）。水煎服。十剂后大便永远不再有闭结之苦。
前面用白虎汤，是因为火势太盛，不得已暂时急救肾中之水。但石膏辛散且性猛烈，频繁多用反而损耗真阴。真阴一旦耗损，前火虽消，后火又将复起，何况是火有余而水不足的情况。与其泻火以损阴，不如补水以制阳更为得当，所以改用清肃汤，通过补水来平息阳火的余焰。
这种病症用润胃丹也有效。
石膏（五钱）、知母（一钱）、玄参（一两）、生地黄（五钱）、牛膝（三钱）、甘草（五分）。水煎服。
有人大便闭结，胸中饱闷，两胁疼痛，呕酸作吐，不思饮食。人们以为是火邪作祟，可知道这是肝火的原因吗？肝属木，木易生火，火旺似乎应该生脾胃之土，土又生金，为何会导致大肠无津液而成闭结症？不知道肝中之火乃是木中之火，其中一半是雷火。雷火最能灼烧水气，试看连阴久雨后，必得雷电交作，才能散去阴霾，这正是灼烧水气的明证。所以肝火不动则已，一动则引动心包之火沸腾，引动阳明之火震动，火多而水有不干涸的吗？水干涸了，大肠怎么能不闭结呢？所以想要开通大肠的闭结，必须先泻肝木之火，则肝气自然平和，不再克制脾土，胃脾的津液自然能转输于大肠，而没有阻滞的痛苦了。方用散火汤：白芍（一两）、当归（一两）、炒栀子（三钱）、柴胡（三分）、大黄（一钱）、地榆（二钱）。水煎服。一剂大便通，二剂肝火尽散，不再闭结。
此方专入肝经以泻火，又能疏解肝郁，盖因肝不郁则肝火必不旺。肝火一散，各经之火无不尽散，岂独留大肠一经之火呢？况且方中原有地榆，又是专门解除大肠之火的药物。
这种病症用丹黄汤也很神奇。
炒栀子、牡丹皮（各三钱）、白芍（五钱）、甘草、黄芩（各一钱）。水煎服。
有人大便闭结，口干唇裂，食物不能消化，腹痛难忍，按压时疼痛加剧，小便短少涩滞。人们以为是大便的火邪闭结，却不知这是脾火作祟。脾乃湿土，得火则燥，这本是脾所喜欢的，为何反而成闭结症？不知道土太柔则会崩塌，土太刚则会干燥；土崩则成废土，土燥则成焦土。然而土焦，若非阳明之火下逼，必是命门之火上炎，二火合攻，脾的津液就枯竭了。进入的水谷仅够供给脾之用，哪能分润给大肠呢？大肠没有津液滋润，肠道就会缩小，不能容纳食物，怎么能不闭结呢？治疗方法须急救脾土的焦枯，又必须先泻阳明、命门之火，始能让脾土得到滋养，自然容易生阴，阴生而津液自然润泽，何必多事去通大肠呢？方用救土通肠汤：玄参（二两）、当归（一两）、生地黄（一两）、知母（一钱）、厚朴（三钱）、升麻（五分）、大麻子（三十粒）。水煎服。二剂后大便必通，减去大麻子和知母，再用四剂，脾火尽散，大便不再结滞。
此方中玄参、生地黄补脾土之阴，又是泻命门、脾胃之火；当归取以润肠；知母、厚朴取其下行以解热；升麻提脾土之气，则阳升而阴自降；大麻子最润大肠而引火下行，不使阴气上升，正助升麻以提阳气。阳既升而阴又降，则津液无干涩之虞，何患大肠之不通呢？
这种病症用助阴汤也有效。
玄参、当归、生地黄（各五钱）、知母（一钱）、牛膝（二钱）。水煎服。
有人大便闭结，舌下无津，胸前出汗，手足冰冷，烦闷发躁，大便色红赤。人们以为是大便的火邪闭结，然而可知道这是心火焚烧所致吗？心与小肠互为表里，没听说过心与大肠有妨碍。但大肠虽不与心为表里，实与肺为表里。心火过盛会刑克肺金，即刑克大肠。盖因大肠属金，心火太盛，则心不能承受，自然将火气转移给大肠。而大肠最畏惧心火，火盛烁金，后果立等可见。虽然肺能生水，肺与大肠有表里关切，岂无津液下降以救大肠之枯渴？无奈肺先受心火刑克，自救尚且不暇，连亲子如肾都尚不能分润津液，哪里还有余力波及兄弟（大肠）来救援呢？这就是大肠不通的原因。治疗方法宜急泻火，但单纯泻火，若无汪洋甘泽般的滋润，恐怕不足以济大旱之渴。必须以大雨淋之，则旱魃之气顿除，河渠尽通。方用扫氛汤：黄连（三钱）、玄参（三两）、沙参（一两）、当归（一两）、麦冬（一两）、牡丹皮（一两）、栝蒌（二钱）。水煎服。一剂后心火降，大便即通，不必服第二剂。
此方用黄连直解心中之热。然而只用黄连，不加玄参，则黄连虽寒但性燥，火虽解而大肠之燥如故。得玄参之润，以匡助黄连，则浮游之火，不仅尽除，且润以去燥，不啻如夏热之时忽得大雨，既去火炎，又湿润也。至于沙参生阴，当归生血，麦冬凉肺，牡丹皮凉肾，无非切断四条路径的氛热，使其不来助心中之焰。加入栝蒌，使存于心中的火，尽随濡润之药下降而消灭。火灭水生，则大肠之炎氛顿扫，想不通都不可能，所以一剂而奏效。
这种病症用散襟汤也有效。
黄连、牡丹皮（各三钱）、当归、麦冬（各一两）、天花粉（二钱）。水煎服。
有人大便闭塞不通，咳嗽不宁，口吐白沫，咽喉干燥，两脚冰冷。人们以为三焦之火旺，却不知是肺经之火旺。肺属金，大肠相表里最为关切。肺火旺盛，为何竟传入大肠？不知道肺乃娇脏，仅可微火熏蒸，不可猛火锻炼，故一遇火生，即移其热于大肠。且肺主皮毛，肺气稍虚，风寒袭之，因肺中正气与邪气相战，寒变热而风变邪，肺因生火，自烁其津。肺与大肠既相唇齿相依，肺之津液枯竭，大肠之液亦竭尽了。治疗方法只宜轻治肺火，不可重施。以轻清下降的药物，稍抑其火，庶几胃中之火不来助炎，心中之火不来添旺，则肺火自散，阴液自生，大肠不必通而自通。方用抑火汤：山豆根（二钱）、黄芩（三钱）、麦冬（一两）、天门冬（五钱）、当归（一两）、升麻（五分）。水煎服。
此方抑制肺金之火，又不伤肺金之气，肺金得养，津液通而大肠润矣。
这种病症用芩麻地冬汤也有效。
麦冬（二两）、黄芩、天门冬（各三钱）、升麻、甘草（各一钱）、生地黄（五钱）。水煎服。
有人大肠闭结不通，饮食无碍，并无火症表现，也无后重之感，甚至有长达一月不便者。人们以为是肾中无津，却不知是气虚而不能推送。大肠无津固然不能润，气弱也不能行。阳气一衰，则阳不能通阴，而阴与阳相隔，水谷入于肠，各消各化，不相统会，故留滞中焦而不向下排泄。治疗方法不可滋阴以降之，亟当助阳以升之。方用升阳降浊汤：人参（五钱）、黄芪（五钱）、白术（五钱）、当归（五钱）、柴胡（三分）、荆芥（五分）、麦冬（五钱）、肉桂（一钱）、附子（一分）。水煎服。一剂后大通。
此方纯是补阳分之药，仅麦冬、当归少许益其阴，则阳气胜阴，始有偏旺之势，又得附子、肉桂直入至阴之中，引柴胡、荆芥升提其阳气。阳气一升，阴气立降，怎能阻塞呢？
这种病症用润输汤也有效。
黄芪（五钱）、当归（一两）、川芎（五钱）、升麻（五分）、红花（五分）、麦冬、肉苁蓉（各五钱）。水煎服。
有人大便闭结不通，手按之痛甚欲死，心中烦躁，坐卧不宁，似乎有火，然而小便又复清长。人们以为是有硬屎留在肠中，却不知是有蓄血不散。蓄血的病症，伤寒病中多有发生，如今此人并不感风寒之邪，为何也有蓄血之病？不知道人的气血，无刻不在经络中流通，一有拂抑，则气即郁塞不通，血即停住不散，于是遂遏于皮肤而为痈，留于肠胃而成痛，搏结成块，阻住传化之机，隔断糟粕之路，大肠因而不通。治疗方法宜通大肠，佐之逐秽之味，然而草木之药，可通无形之结，不能通有形之结。血乃有形之物，必得有形相制之物，始能入其中而散其结。方用抵当汤治之。
水蛭（三钱，剪碎如米粒大，炒黑）、虻虫（二钱，各为末）、桃仁（十四粒，研碎）、大黄（五钱）。水煎调服。
一剂后大便通，顿失痛楚。
盖大黄泄下，其势最猛，得水蛭、虻虫、桃仁破血之味相佐，其破坚逐秽之效更神。此类闭结，若不速通利，必有发狂之变。但何以辨其为蓄血之病呢？全在看其小便之利与不利。盖蓄血之病，小便必利，以血不能入于膀胱之中，故膀胱之气能行能化，无害其下出之水道耳。故见小便利而大便结者，用抵当汤万无差谬。
这种病症用大黄散瘀汤也很神奇。
水蛭（炒黑，三钱）、大黄、牡丹皮（各三钱）、当归（一两）、红花（三钱）、桃仁（十四个）、生地黄（五钱）。水煎服。
There is a patient with constipation (Bianbi, 便秘), presenting with dry mouth and tongue, swollen and painful throat, dizziness of the head and eyes, red face, and irritability. People assume this is constipation caused by excessive Fire (Huo, 火), but little do they know it is actually due to the exhaustion of Kidney Water (Shenshui, 肾水). The Kidney Water is the "child" of Lung Metal (Feijin, 肺金) in the Five Elements generation cycle; the Large Intestine (Dachang, 大肠) and Lung are exterior-interior paired organs. If the Lung can generate water for the Kidney, why cannot the Large Intestine generate fluids? This is because Metal Qi varies: when Metal receives clear Qi, it can generate water; when it receives turbid Qi, not only can it not generate water, but it also desires water to nourish itself. Therefore, if the Large Intestine is affected by turbid Qi and lacks fluids, it becomes dry. Although the opening and closing of the Large Intestine is moistened by Kidney Water, it is also governed by Kidney Fire (Shenhuo, 肾火). Kidney Fire must be balanced by Kidney Water; without Kidney Fire, the Large Intestine would open uncontrollably; without Kidney Water to balance Kidney Fire, the Large Intestine would become fixed and closed, unable to expel stool. Thus, constipation due to Kidney deficiency should not be treated merely by purging the Large Intestine, as purging would further damage True Yin (Zhenyin, 真阴). Such cases are most common in the elderly, precisely because the elderly suffer from declining Yin, dryness, excess Fire, and insufficient Water. The treatment method is simply to tonify the Water in the Kidney, so that Water is sufficient to balance Fire, and the Large Intestine will naturally become moist. Use Run Chang Yin (Nourishing Intestine Decoction): Shu Di Huang (Prepared Rehmannia Root, 2 liang), Dang Gui (Angelica Sinensis, 1 liang), Rou Cong Rong (Cistanche Stem, 1 liang, washed and soaked in light salt water, changing water five times a day). Decoct in water, take on an empty stomach. After several doses, there will be no case of non-passage.
This formula uses Shu Di Huang to tonify the Kidney, Dang Gui to generate blood and moisten the intestines, and Rou Cong Rong whose moving nature helps relieve constipation. It tonifies Yin without exhausting it, making it particularly suitable for the elderly, and what harm could it do to young people with Kidney deficiency?
For this condition, Ru Chang Tang (Moistening Intestine Decoction) is also effective.
Shu Di Huang, Dang Gui (each 1 liang), Sheng Ma (Cimicifugae Rhizoma, 5 fen), Niu Xi (Achyranthis Bidentatae Radix, 3 qian). Decoct in water and take.
Some patients have constipation accompanied by lower abdominal pain, belching in the chest, aversion to cold, and a preference for hot drinks. People think this is constipation due to deficient Fire, but little do they know it is due to weak Kidney Fire. The Large Intestine belongs to Metal, which should fear the control of Fire; why does Metal close up without Fire? This is because stubborn Metal requires Fire to melt; thus, the Large Intestine needs Fire to open and close. The Large Intestine is the official of conduction; with Fire, transmission is unobstructed; without Fire, Yin-cold Qi blocks the passage, like deep ravines filled with frost and snow turning into ice, hard and impenetrable. If sunlight shines upon it, it melts instantly. Is this not clear proof that the Large Intestine opens with Fire and closes without it? However, the Large Intestine meridian itself should not have excessive Fire; Fire in the Large Intestine causes overheating; Fire in the Kidney prevents the Large Intestine from being too cold. If there is no Fire in the Kidney, how can the Large Intestine transform and transport food and fluids? The treatment must tonify the Fire in the Kidney, rather than forcibly unblocking the Large Intestine. Use Wen Chang Kai Bi Tang (Warming Intestine Opening Obstruction Decoction): Ba Ji Tian (Morinda Officinalis Root, 1 liang), Bai Zhu (Atractylodes Macrocephala Rhizome, 1 liang), Shu Di Huang (1 liang), Shan Zhu Yu (Cornus Officinalis Fruit, 5 qian), Fu Zi (Prepared Aconite Lateral Root, 2 qian). Decoct in water and take.
This formula uses Ba Ji Tian, Shu Di Huang, and Shan Zhu Yu to tonify the Kidney, containing Yang Qi within extreme Yin. Bai Zhu is used to benefit the waist and umbilicus. Since Fu Zi directly enters the Kidney and rapidly reaches the Bladder, the Fire Qi steams and Yang returns, melting ice and snow, preventing obstruction.
For this condition, Nuan Yang Tang (Warming Yang Decoction) is also effective.
Bai Zhu, Rou Cong Rong (each 1 liang), Fu Zi (1 qian). Decoct in water and take.
Some patients have constipation, irritability, thirst with cracked tongue, protruding red eyes, and continuous sweating. People assume this is constipation due to excessive Fire, but little do they know it is due to boiling Stomach Fire (Weihuo, 胃火). Once Yangming Stomach Fire erupts, it inevitably scorches Kidney Water. Constipation is exactly the result of Stomach Fire scorching Kidney Water. One might think to urgently extinguish the Fire, but since Fire flares upward, sprinkling a small amount of water will only make the fire more fierce and unstoppable. One needs a torrential rain to extinguish the prairie fire. Use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction): Shi Gao (Gypsum Fibrosum, 1 liang), Zhi Mu (Anemarrhenae Rhizoma, 3 qian), Mai Dong (Ophiopogonis Tuber, 1 liang), Gan Cao (Licorice Root, 1 qian), Fu Ling (Poria, 2 qian), Ren Shen (Ginseng Radix, 5 qian), Zhu Ye (Bamboo Leaf, 100 pieces), Zhan Mi (Sticky Rice, a pinch). Decoct in water and take. After one dose, the Fire drains; after two doses, stool passes. Then switch to Qing Su Tang (Clearing and Purifying Decoction): Xuan Shen (Scrophulariae Radix, 1 liang), Mai Dong (5 qian), Bai Jie Zi (White Mustard Seed, 3 qian), Zhu Ye (30 pieces), Gan Ju Hua (Chrysanthemi Flos, 2 qian), Sheng Di Huang (Rehmanniae Radix, 3 qian), Chen Pi (Citri Reticulatae Pericarpium, 5 fen), Dan Pi (Moutan Cortex, 2 qian). Decoct in water and take. After ten doses, the suffering of constipation ceases forever.
The previous use of Bai Hu Tang (White Tiger Decoction) was because the Fire was too strong, necessitating a temporary rescue of Kidney Water. However, Shi Gao is acrid and dispersing, and its nature is fierce; frequent or heavy use damages True Yin. Once True Yin is consumed, although the initial Fire subsides, subsequent Fire will rise again, especially given the condition of excess Fire and insufficient Water. Rather than purging Fire and damaging Yin, it is better to tonify Water to control Yang. Hence, Qing Su Tang is used to extinguish the remaining flames of Yang Fire by tonifying Water.
For this condition, Run Wei Dan (Nourishing Stomach Pill) is also effective.
Shi Gao (5 qian), Zhi Mu (1 qian), Xuan Shen (1 liang), Sheng Di Huang (5 qian), Niu Xi (3 qian), Gan Cao (5 fen). Decoct in water and take.
Some patients have constipation, chest fullness and oppression, hypochondriac pain, acid regurgitation, vomiting, and loss of appetite. People attribute this to Fire pathogenic factors, but do they know it is due to Liver Fire (Ganhuo, 肝火)? The Liver belongs to Wood, and Wood easily generates Fire. Strong Fire should generate Spleen/Earth, which in turn generates Metal; why does this lead to a lack of fluids in the Large Intestine and constipation? The Fire in the Liver is the Fire within Wood, half of which is Thunder Fire. Thunder Fire is best at scorching Water. Observe that after days of continuous rain, thunder and lightning are needed to disperse the gloom; this is clear evidence of scorching Water. When Liver Fire moves, it ignites Pericardium Fire and agitates Yangming Fire. With much Fire, how can Water not dry up? When Water dries, how can the Large Intestine not close? To open the Large Intestine, one must first purge Liver Wood Fire. Then Liver Qi will calm, stop attacking Spleen Earth, and the fluids of Stomach and Spleen will naturally transfer to the Large Intestine, relieving obstruction. Use San Huo Tang (Dispersing Fire Decoction): Bai Shao (White Peony Root, 1 liang), Dang Gui (1 liang), Chao Zhi Zi (Fried Gardenia Fruit, 3 qian), Chai Hu (Bupleuri Radix, 3 fen), Da Huang (Rhei Radix et Rhizoma, 1 qian), Di Yu (Sanguisorbae Radix, 2 qian). Decoct in water and take. After one dose, stool passes; after two doses, Liver Fire is dispersed, and constipation does not recur.
This formula specifically enters the Liver to purge Fire and soothe Liver stagnation, for if the Liver is not stagnant, its Fire will not be strong. Once Liver Fire disperses, Fire in all meridians disperses, leaving none in the Large Intestine. Moreover, the formula contains Di Yu, which specifically resolves Fire in the Large Intestine.
For this condition, Dan Huang Tang (Dan Pi and Da Huang Decoction) is also miraculous.
Chao Zhi Zi, Dan Pi (each 3 qian), Bai Shao (5 qian), Gan Cao, Huang Qin (Scutellariae Radix, each 1 qian). Decoct in water and take.
Some patients have constipation, dry mouth and cracked lips, inability to digest food, unbearable abdominal pain worsened by pressure, and scanty, difficult urination. People think this is Fire blocking the stool, but little do they know it is caused by Spleen Fire (Pi Huo, 脾火). The Spleen is damp Earth; getting Fire makes it dry, which seems favorable to the Spleen, yet it results in constipation. If Earth is too soft, it collapses; if too rigid, it dries. Collapsed Earth becomes waste soil; dried Earth becomes scorched soil. Scorched Earth is caused either by Yangming Fire pressing down or Mingmen Fire flaming up. These two Fires attack together, drying up Spleen fluids. Food and drink entering are only enough for the Spleen's use, leaving nothing to moisten the Large Intestine. Without fluid moisture, the intestine shrinks and cannot hold matter, leading to constipation. Treatment must urgently save the scorched Spleen Earth and first purge Yangming and Mingmen Fire, allowing Spleen Earth to be nourished and Yin to generate naturally. Once Yin generates, fluids moisten, making it unnecessary to forcibly unblock the Large Intestine. Use Jiu Tu Tong Chang Tang (Saving Earth Unblocking Intestine Decoction): Xuan Shen (2 liang), Dang Gui (1 liang), Sheng Di Huang (1 liang), Zhi Mu (1 qian), Hou Po (Magnolia Bark, 3 qian), Sheng Ma (5 fen), Da Ma Zi (Hemp Seed, 30 grains). Decoct in water and take. After two doses, stool passes. Remove Da Ma Zi and Zhi Mu, continue for four more doses, Spleen Fire disperses, and stool no longer binds.
In this formula, Xuan Shen and Sheng Di Huang tonify Spleen Yin and purge Mingmen/Stomach-Spleen Fire; Dang Gui moistens the intestines; Zhi Mu and Hou Po descend to clear heat; Sheng Ma raises Spleen Qi, causing Yang to rise and Yin to descend; Da Ma Zi moistens the Large Intestine and guides Fire downward, assisting Sheng Ma in raising Yang. With Yang rising and Yin descending, fluids are preserved, ensuring intestinal patency.
For this condition, Zhu Yin Tang (Assisting Yin Decoction) is also effective.
Xuan Shen, Dang Gui, Sheng Di Huang (each 5 qian), Zhi Mu (1 qian), Niu Xi (2 qian). Decoct in water and take.
Some patients have constipation, no saliva under the tongue, sweating on the chest, cold hands and feet, irritability, and dark red urine. People think this is Fire blocking the stool, but little do they know it is due to Heart Fire burning. The Heart and Small Intestine are exterior-interior paired; the Heart does not directly affect the Large Intestine. However, the Large Intestine is paired with the Lung. Excessive Heart Fire attacks Lung Metal, thereby attacking the Large Intestine. The Large Intestine belongs to Metal; if Heart Fire is too strong, it transfers to the Large Intestine. The Large Intestine fears Heart Fire; strong Fire scorches Metal quickly. Although the Lung generates Water and is paired with the Large Intestine, sending fluids to relieve dryness, the Lung is first attacked by Heart Fire and is too busy saving itself. Even its "child" the Kidney cannot spare fluids, let alone its "brother" the Large Intestine. This is why the Large Intestine is blocked. Treatment should urgently purge Fire, but mere purging without abundant moisture cannot relieve severe drought. One must pour rain to remove the drought demon and clear the channels. Use Sao Fen Tang (Sweeping Miasma Decoction): Huang Lian (Coptidis Rhizoma, 3 qian), Xuan Shen (3 liang), Sha Shen (Glehniae Radix, 1 liang), Dang Gui (1 liang), Mai Dong (1 liang), Dan Pi (1 liang), Gua Lou (Trichosanthis Fructus, 2 qian). Decoct in water and take. After one dose, Heart Fire descends, and stool passes immediately.
This formula uses Huang Lian to directly resolve Heat in the Heart. However, using Huang Lian alone, which is cold but drying, leaves the Large Intestine dry even if Fire is resolved. Adding Xuan Shen's moisture assists Huang Lian, removing floating Fire and moistening dryness, like sudden rain in summer. Sha Shen generates Yin, Dang Gui generates blood, Mai Dong cools the Lung, and Dan Pi cools the Kidney, cutting off four paths of heat aiding the Heart Fire. Gua Lou ensures Fire stored in the Heart descends with the moistening herbs. Fire extinguishes, Water generates, and intestinal inflammation is swept away, achieving effect in one dose.
For this condition, San Jin Tang (Dispersing Lapels Decoction) is also effective.
Huang Lian, Dan Pi (each 3 qian), Dang Gui, Mai Dong (each 1 liang), Tian Hua Fen (Trichosanthis Radix, 2 qian). Decoct in water and take.
Some patients have complete bowel obstruction, restless cough, foaming at the mouth, dry throat, and cold feet. People attribute this to excessive Three Burner Fire, but little do they know it is due to Lung Meridian Fire. The Lung belongs to Metal and is closely paired with the Large Intestine. Why does Lung Fire transmit to the Large Intestine? The Lung is a delicate organ, tolerating only slight warming, not fierce refining. When Fire arises, it transfers heat to the Large Intestine. The Lung governs skin and hair; if Lung Qi is slightly deficient, Wind-Cold attacks. The struggle between Righteous Qi and Pathogenic Qi transforms Cold to Heat and Wind to Evil, generating Lung Fire that scorches Lung fluids. Since Lung and Large Intestine are adjacent, when Lung fluids dry up, Large Intestine fluids are exhausted. Treatment should lightly address Lung Fire, not heavily. Using light, clear, descending herbs to slightly suppress Fire prevents Stomach and Heart Fire from adding fuel, allowing Lung Fire to dissipate and Yin fluids to generate, unblocking the Large Intestine naturally. Use Yi Huo Tang (Suppressing Fire Decoction): Shan Dou Gen (Sophorae Tonkinensis Radix, 2 qian), Huang Qin (3 qian), Mai Dong (1 liang), Tian Men Dong (Asparagi Tuber, 5 qian), Dang Gui (1 liang), Sheng Ma (5 fen). Decoct in water and take.
After two doses, Lung Fire clears; after another two, Large Intestine obstruction opens; after two more, full recovery.
This formula suppresses Lung Metal Fire without damaging Lung Qi. Nourished Lung Metal allows fluid flow and intestinal moistening.
For this condition, Qin Ma Di Dong Tang is also effective.
Mai Dong (2 liang), Huang Qin, Tian Men Dong (each 3 qian), Sheng Ma, Gan Cao (each 1 qian), Sheng Di Huang (5 qian). Decoct in water and take.
Some patients have Large Intestine obstruction, normal diet, no signs of Fire, and no tenesmus, yet may go a month without stool. People think this is lack of fluids in the Kidney, but little do they know it is Qi Deficiency failing to push. Lack of fluids prevents moistening, and weak Qi fails to move. When Yang Qi declines, Yang cannot connect with Yin, separating them. Food and drink enter the intestines, digest separately, and do not unite, staying in the middle and not descending. Treatment should not tonify Yin to descend, but urgently assist Yang to ascend. Use Sheng Yang Jiang Zhuo Tang (Raising Yang Descending Turbidity Decoction): Ren Shen (5 qian), Huang Qi (Astragali Radix, 5 qian), Bai Zhu (5 qian), Dang Gui (5 qian), Chai Hu (3 fen), Jing Jie (Schizonepetae Spica, 5 fen), Mai Dong (5 qian), Rou Gui (Cinnamomi Cortex, 1 qian), Fu Zi (1 fen). Decoct in water and take. After one dose, massive passage occurs.
This formula primarily tonifies Yang Qi, with only slight Yin tonification by Mai Dong and Dang Gui, creating a dominance of Yang over Yin. Fu Zi and Rou Gui enter extreme Yin to guide Chai Hu and Jing Jie in raising Yang Qi. Once Yang rises, Yin descends, preventing obstruction.
For this condition, Run Shu Tang (Moistening Transport Decoction) is also effective.
Huang Qi (5 qian), Dang Gui (1 liang), Chuan Xiong (Ligusticum Chuanxiong Rhizome, 5 qian), Sheng Ma (5 fen), Hong Hua (Carthami Flos, 5 fen), Mai Dong, Rou Cong Rong (each 5 qian). Decoct in water and take.
Some patients have constipation, severe pain upon palpation, irritability, restlessness, seeming Fire symptoms, yet clear and long urination. People think there is hard stool retained, but little do they know it is accumulated Blood (Xu Xue, 蓄血) not dispersing. Accumulated Blood is common in Shang Han (Cold Damage), but here there is no Wind-Cold invasion. Human Qi and Blood circulate constantly; any suppression causes Qi stagnation and Blood stasis. This stasis can form abscesses in skin or pain in intestines, forming clumps that block transformation and cut off fecal passage, causing constipation. Treatment should unblock the Large Intestine and aid in eliminating turbidity. Herbal medicines can unblock无形 (formless) obstructions but not 有形 (form) obstructions. Blood is a form substance requiring form-subduing agents to penetrate and disperse clots. Use Di Dang Tang (Break the Dam Decoction): Shui Zhi (Leech, 3 qian, chopped like rice grains, stir-fried black), Meng Chong (Dragonfly Larva, 2 qian, powdered), Tao Ren (Persicae Semen, 14 grains, crushed), Da Huang (5 qian). Decoct and mix with powder to take.
After one dose, stool passes, and pain vanishes instantly.
Da Huang purges vigorously; assisted by Shui Zhi, Meng Chong, and Tao Ren for breaking blood, its efficacy in breaking hardness and eliminating turbidity is miraculous. Such constipation, if not promptly unblocked, may lead to madness. How to distinguish accumulated Blood? Look at urination. In accumulated Blood, urination is usually free because blood cannot enter the Bladder, allowing Bladder Qi to function normally. Thus, seeing free urination with constipation indicates Di Dang Tang is infallible.
For this condition, Da Huang San Yu Tang (Da Huang Dispersing Stasis Decoction) is also miraculous.
Shui Zhi (stir-fried black, 3 qian), Da Huang, Dan Pi (each 3 qian), Dang Gui (1 liang), Hong Hua (3 qian), Tao Ren (14 grains), Sheng Di Huang (5 qian). Decoct in water and take.