实闭者，胃实而闭。东垣所谓胃气实者闭物，胃气虚者闭气是也。其人能食，小便赤，
其脉沉实。
麻仁丸
浓朴（姜制） 枳实（麸炒） 芍药（各八两） 大黄（蒸焙，一斤） 麻仁（别研，五两） 杏
仁（去皮尖，炒，五两半）
上为末，炼蜜和丸梧子大，每服二十丸，临卧温水下，大便通利则止。
木香逐气丸
槟榔（鸡心者） 青皮（去白） 陈皮（去白，各半两） 南木香（二钱半） 川巴豆肉（一钱
半，研如泥，渐入药同研）
上件并末，生姜自然汁，调神曲末为糊丸，麻子大，每服十丸，姜汤下，如气攻腹痛，
枳壳、木瓜煎汤下。
按∶实闭有寒有热，热实者，宜寒下。寒实者，宜温下。麻仁丸、浓朴三物汤治实而热
者。逐气丸、温脾汤治实而寒者也。
风闭者，风胜则干也。由风搏肺脏，传于大肠，津液燥涩，传化则难。或其人素有风病
者，亦多有闭，或肠胃积热，久而风从内生，亦能成闭也。
皂角丸 治大肠有风，大便闭结。
皂角（炙，去子） 枳壳（去瓤，麸炒，各等分）
上为末，炼蜜丸梧子大，每服七十丸，空心米饮下，或加麻仁、杏仁、防风、陈皮亦得
。
东垣润肠丸
当归梢 羌活 大黄（煨，各半两） 麻仁 桃仁（去皮尖，各一两）
蜜丸桐子大，每服三五十丸，白汤下。
实闭，是指胃气充实而导致的便秘。正如李东垣所说：“胃气实的，是食物停滞不通；胃气虚的，是气机阻滞不通。”这类患者能够进食，小便颜色深红，脉象沉而有力。
麻仁丸
方药组成：厚朴（姜汁制）八两、枳实（麸皮炒）八两、芍药八两、大黄（蒸后焙干）一斤、火麻仁（单独研碎）五两、杏仁（去皮尖，炒）五两半。
制法与用法：将上述药物研为细末，用炼蜜调和制成梧桐子大小的丸剂。每次服用二十丸，临睡前用温开水送服，待大便通畅后即停止服药。
木香逐气丸
方药组成：槟榔（选用鸡心形的）、青皮（去白瓤）、陈皮（去白瓤，各半两）、南木香二钱半、川巴豆肉一钱半（研成泥状，逐渐加入药粉中共同研磨）。
制法与用法：将上述药物研为细末，用生姜自然汁调和神曲末作为粘合剂，制成麻子大小的丸剂。每次服用十丸，用姜汤送服。如果出现气攻冲导致腹痛的情况，可用枳壳和木瓜煎汤送服。
按语：实闭有寒证和热证之分。热实证，适宜用寒性泻下法；寒实证，适宜用温性泻下法。麻仁丸、厚朴三物汤用于治疗实而热的病证；逐气丸、温脾汤用于治疗实而寒的病证。
风闭，是因为风邪偏胜导致肠道干燥。这是由于风邪搏结于肺脏，传变至大肠，致使津液干枯涩滞，传导功能困难。或者患者平素就有风病，也多有便秘发生；或者是肠胃积热日久，内生风邪，也能形成便秘。
皂角丸 治疗大肠有风邪，大便闭结不通。
方药组成：皂角（炙烤，去种子）、枳壳（去瓤，麸皮炒，各等分）。
制法与用法：将上述药物研为细末，用炼蜜调和制成梧桐子大小的丸剂。每次服用七十丸，空腹时用米汤送服。也可以加入火麻仁、杏仁、防风、陈皮，同样有效。
东垣润肠丸
方药组成：当归梢、羌活、大黄（煨制，各半两）、火麻仁、桃仁（去皮尖，各一两）。
制法与用法：用蜂蜜调和制成梧桐子大小的丸剂。每次服用三五十丸，用白开水送服。
Shi Bi (Excess Constipation) refers to constipation caused by excess in the Stomach. As Li Dongyuan stated: "When Stomach Qi is excess, it is the obstruction of food; when Stomach Qi is deficient, it is the obstruction of Qi." Patients with this condition can eat, have dark red urine, and present a deep and forceful pulse.
Maren Wan (Hemp Seed Pill)
Ingredients: Houpo (Cortex Magnoliae Officinalis, processed with ginger juice), Zhishi (Fructus Aurantii Immaturus, stir-fried with bran), Shaoyao (Radix Paeoniae Alba), each 8 liang; Dahuang (Radix et Rhizoma Rhei, steamed and dried), 1 jin; Huomaren (Semen Cannabis, separately ground), 5 liang; Xingren (Semen Armeniacae Amarum, peeled and de-veined, stir-fried), 5.5 liang.
Preparation and Administration: Grind the above ingredients into fine powder. Mix with refined honey to form pills the size of a wutong seed. Take 20 pills per dose, swallowed with warm water before bedtime. Discontinue use once bowel movement becomes smooth.
Muxiang Zhuqi Wan (Costus Qi-Expelling Pill)
Ingredients: Binglang (Arecae Semen, selecting those shaped like a chicken heart), Qingpi (Pericarpium Citri Reticulatae, white pith removed), Chenpi (Pericarpium Citri Reticulatae, white pith removed), each half liang; Nanmuxiang (Radix Aucklandiae), 2.5 qian; Chuan Badou Rou (Endocarpium Crotonis Tiglii, 1.5 qian, ground into paste, gradually mixed with other powders).
Preparation and Administration: Grind all ingredients into powder. Use fresh ginger juice to mix with Shenqu (Massa Medicata Fermentata) powder as a binder to form pills the size of hemp seeds. Take 10 pills per dose, swallowed with ginger decoction. If abdominal pain occurs due to Qi attacking, swallow with decoction of Zhike (Fructus Aurantii) and Mugua (Fructus Chaenomelis).
Commentary: Shi Bi (Excess Constipation) can be either cold or heat in nature. For heat-excess patterns, cold purgation is indicated; for cold-excess patterns, warm purgation is indicated. Maren Wan (Hemp Seed Pill) and Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction) treat excess-heat patterns. Zhuqi Wan (Qi-Expelling Pill) and Wenpi Tang (Warm the Spleen Decoction) treat excess-cold patterns.
Feng Bi (Wind Constipation) occurs when wind pathogen predominates, leading to dryness. This arises because wind combats the Lung Zang and transmits to the Large Intestine, causing dryness and astringency of body fluids, making transmission and transformation difficult. Alternatively, patients who historically suffer from wind diseases often experience constipation. Or, if intestinal and stomach heat accumulates over time, internal wind may generate, also resulting in constipation.
Zaojiao Wan (Gleditsia Sinensis Pill) Treats wind in the Large Intestine causing fecal impaction.
Ingredients: Zaojiao (Fructus Gleditsiae Sinensis, roasted, seeds removed), Zhike (Fructus Aurantii, pith removed, stir-fried with bran), equal parts.
Preparation and Administration: Grind into fine powder. Mix with refined honey to form pills the size of a wutong seed. Take 70 pills per dose, swallowed with rice water on an empty stomach. Adding Huomaren (Semen Cannabis), Xingren (Semen Armeniacae Amarum), Fangfeng (Radix Saposhnikoviae), and Chenpi (Pericarpium Citri Reticulatae) is also acceptable.
Dongyuan Runchang Wan (Li Dongyuan's Moistening Intestine Pill)
Ingredients: Danggui Shao (Radix Angelicae Sinensis, tip portion), Qianghuo (Rhizoma Notopterygii), Dahuang (Radix et Rhizoma Rhei, baked), each half liang; Huomaren (Semen Cannabis), Taoren (Semen Persicae, peeled and de-veined), each 1 liang.
Preparation and Administration: Mix with honey to form pills the size of a tung seed. Take 30–50 pills per dose, swallowed with plain boiled water.