一 一人患遗精，闻妇人声即泄，瘠甚欲死。医告术窍。仲淳之门人，以远志为君，莲须、石莲子为
臣，龙齿，茯神、沙苑蒺藜、牡蛎为佐使，丸服稍止，然终不断。仲淳于前方加鱼鳔一味，不终剂而愈矣。
二 一人因肆业劳心太过，患梦遗症，已三、四、年矣。不数日一发，发过则虚火上炎，头面烘
热，手足逆冷，终夜不寐。补心肾及涩精药投之罔效。仲淳疏一丸方，以黄柏清相火为君，佐以地黄、
枸杞、萸肉、天冬补肾，麦冬清心，莲须、五味涩精，鱼鳔胶填精，车前利湿热之水，使相火安宁，不
终剂而愈，病者初时，恐黄柏大寒，不欲用之。仲淳谓∶尊病之所以久而不愈者，正未用此药耳。经
曰∶肾欲坚，急食苦以坚之，黄柏是也。肾得坚则心经虽有火，而精自固，何梦遗之有哉。向徒用收涩
补益，而未及此，故难收效。
大便秘结，因热者多，宜分虚实。然有因气滞，因风燥，致秘之不同。治亦有异。又间有冷秘一症，
亦当审察。至若老人津液干枯，产后亡血，及发汗，利小便过多，病后气血木复，皆能使大便秘结。当
滋阴养血，生津润
澡，则便自通。误用硝、黄利药，多遗后患。按东垣云∶肾主二便，主五液，津液盛则大便如常，若
饥饱劳役，损伤胃气。及过食辛热浓味，则火邪伏于血中，耗散真阴，津液不足，故大便燥结，赵氏
云∶余尝法东垣之论，而不用其通幽、润肠等，惟用大剂六味，加生津二冬润燥〔人乳、白蜜。〕之
品，煎服自效。如热秘而又兼气虚者于前方再加参、 三、五钱立应。此因气虚不能推送，阴虚不能
濡润故也，亲试甚验，故表出之。
六一散顺气汤〔见伤寒。〕
此方治一切实热秘结。随症采用。
麻仁丸 治脾约〔脾土燥热，将胃中三、五日之谷省约为一、二弹丸而出。〕大便艰难。〔肠中
津液干燥之故、必胃强者，方可暂用。〕
麻仁〔三两。〕杏仁〔润燥。〕白芍〔养阴。〕大黄〔泄热。制，各二两五
钱。〕枳实 浓朴〔散结，各一两。〕〔炼蜜丸服。〕
此泻热散结，润下之剂。
象胆丸〔以味苦象胆也。〕
真芦荟〔苦寒清热，湿润滋燥。同以朱砂清镇下坠之剂，自然热结开通。研细，一两四
钱。〕朱砂〔研细。一两。滴好酒少许，和丸小豆大，天晴时修合。每服一钱二分或三钱。白汤
送下。朝服暮通，暮服朝通。〕
此清热下通之缓剂。此方亦实热秘结者宜之。只行一、二次，甚为稳当。但味极苦，最难
服，胃弱者恐不能胜。
养阴清热润燥汤〔见燥。〕治一切虚热秘结，随症加减。
如内热甚，可加蔗浆或梨汁。
生地蜜油饮 治老人津液干枯，及产后大便秘结。
生地〔四两作小块。〕芝麻油〔四两，入生地同煎，以浮起油面为度，去地，将油倾
入大碗。〕加生白蜜〔两许。〕调滚汤〔一碗。〕同油顿饮。或独用生地〔三、四两。〕煎
汤顿饮亦效，再加松子仁〔一两。〕更佳。
此二方一切虚，热秘结可采用。
橘杏汤 治气滞不通，大便秘结〔三焦相通，不过一气。气闭则大便亦闭。〕
橘红〔利气。二、三钱。〕杏仁〔利气而兼润燥。五钱至一两。〕宜加枳壳〔一、三
钱。〕苏子〔炒研三、五钱。〕磨真沉香汁数匙冲服。麦冬、蔗浆、梨汁皆可用。
此利气而兼润燥之剂也。
养血祛风润燥汤〔自制。〕治风燥秘结。
秦艽〔二、三钱。〕胡麻〔炒研。三、五钱。〕鲜首乌〔养血祛风，五钱至一
两。〕生地〔凉血润燥，三、五钱。〕松子仁〔五钱至二两。研烂调服。〕牛乳〔补血润
燥。一杯或牛酥一、二两。〕梨汁〔治风热，利大肠。一杯。〕
此方素患风热，大便秘者甚宜，不用风药者，治风先治血，血行风自灭。若用风药，则燥复伤
血，而大便愈秘矣。
八味地黄丸〔见不能食。〕治冷秘。〔必畏寒厥冷，喜饮大热，小便清白，脉沉小迟者，方
作寒医。〕
宜加肉苁蓉。〔一、二两。〕
此方果属冷，气横于大肠，凝阴固结不通者，可用之。然此症甚少，勿概混投。愚谓当先用肉苁
蓉三两，性温人肾为君，酒煎，润燥，调服沉香末三钱，益命门真火为臣，亦可散其凝阴之气。如不
应，然后投以八味。所谓病宜用热，必当先以温药探之也。
一、有一人患遗精病，听到妇女的声音就会射精，身体极度消瘦，有生命危险。医生告知没有有效的治疗方法。缪仲淳（名希雍）的门人，以远志为君药，莲须、石莲子为臣药，龙齿、茯神、沙苑蒺藜、牡蛎为佐使药，制成丸药服用后症状稍有好转，但终究无法断根。缪仲淳在前方中加入鱼鳔一味药，未服完一剂便痊愈了。
二、有一人因读书用脑过度，患梦遗和滑精症，已经三四年了。每隔几天发作一次，发作过后虚火上炎，头面部烘热，手脚逆冷，整夜失眠。投用补益心肾及固涩精液的药物均无效。缪仲淳开具一个丸方，以黄柏清泻相火为君药，佐以地黄、枸杞、山茱萸、天冬补肾，麦冬清心，莲须、五味子固涩精气，鱼鳔胶填补精髓，车前子利湿热之水，使相火安宁，未服完一剂便痊愈。病人起初担心黄柏大寒，不想使用。缪仲淳说：“您的病之所以久治不愈，正是因为没用这味药罢了。”《内经》说：“肾欲坚，急食苦以坚之”，黄柏就是这样的药。肾气坚固，则心经虽有火，精气自然固摄，哪里还会有梦遗呢？先前只是徒然使用收涩补益的药物，而没有触及根本，所以难以见效。
大便秘结，多由热邪引起，应当分辨虚实。但也有因气机阻滞、因风燥所致，导致便秘的原因各不相同，治疗方法也有差异。间或有冷秘这一病症，也应当仔细审察。至于老人津液干枯，产后失血，以及发汗过多、利小便过多，病后气血未复等情况，都能导致大便秘结。应当滋阴养血，生津润燥，大便自然通畅。误用芒硝、大黄等泻下药物，大多会留下后患。按李东垣所说：肾主管二便，主管五液，津液充足则大便正常，如果饥饱失常、劳役过度，损伤胃气；以及过食辛辣温热厚味，则火邪潜伏于血中，耗散真阴，津液不足，所以大便燥结。赵献可先生说：我曾效法李东垣的论述，但不使用他的通幽汤、润肠丸等方，只使用大剂量的六味地黄丸，加入生津润燥的人乳、白蜜等品，煎服自有效验。如果是热秘又兼有气虚者，在前方中再加人参、党参三至五钱，立见成效。这是因为气虚不能推送，阴虚不能濡润的缘故，亲自试验非常灵验，所以记录下来公布出来。
六一顺气汤（见于伤寒章节）。此方治疗一切实热秘结。随症状采用。
麻仁丸 治疗脾约证（脾土燥热，将胃中三到五日的食物约束成一两个弹丸大小的形状排出）。大便艰难。（这是肠中津液干燥的缘故，必须是胃气强盛的人，才可以暂时使用。）
麻仁（三两）、杏仁（润燥）、白芍（养阴）、大黄（泄热，制过的，各二两五钱）、枳实、浓朴（散结，各一两）。（炼蜜为丸服用。）
这是泻热散结、润下的方剂。
象胆丸（因为味道像苦象胆而得名）。
真芦荟（苦寒清热，湿润滋燥，配合朱砂作为清镇下坠的药物，自然能使热结开通，研细，一两四钱）、朱砂（研细，一两，滴好酒少许，和丸如小豆大小，晴天时制作。每次服用一钱二分或三钱，白开水送下。早晨服药晚上通便，晚上服药早晨通便。）
这是清热下通的缓剂。此方也适合实热秘结者。只服用一两次，非常稳妥。但味道极苦，最难服用，胃弱的人恐怕不能承受。
养阴清热润燥汤（见于燥证章节）。治疗一切虚热秘结，随症状加减。
如果内热严重，可以加甘蔗浆或梨汁。
生地蜜油饮 治疗老人津液干枯，以及产后大便秘结。
生地（四两切成小块）、芝麻油（四两，与生地同煎，以油浮起为度，去掉渣滓，将油倒入大碗中），加生白蜜（一两左右），调匀滚开的汤（一碗），连同油一起顿服。或者单独用地地（三、四两）煎汤顿服也有效，再加松子仁（一两）更好。
这两个方子一切虚热秘结都可以采用。
橘杏汤 治疗气滞不通，大便秘结（三焦相通，不过是一股气。气闭则大便也闭）。
橘红（利气，二、三钱）、杏仁（利气而兼润燥，五钱至一两），宜加枳壳（一、三钱）、苏子（炒研三、五钱），磨真沉香汁数匙冲服。麦冬、蔗浆、梨汁都可以用。
这是利气而兼润燥的方剂。
养血祛风润燥汤（自制）。治疗风燥秘结。
秦艽（二、三钱）、胡麻（炒研，三、五钱）、鲜首乌（养血祛风，五钱至一两）、生地（凉血润燥，三、五钱）、松子仁（五钱至二两，研烂调服）、牛乳（补血润燥，一杯或牛酥一两至二两）、梨汁（治风热，利大肠，一杯）。
此方对于素来患有风热、大便秘结的人非常适宜。不用风药的原因在于，治风先治血，血行风自灭。如果使用风药，则会再次伤血，导致大便更加秘结。
八味地黄丸（见于不能食章节）。治疗冷秘。（必须伴有畏寒肢冷，喜欢喝大热的东西，小便清白，脉象沉小迟，才能诊断为寒证。）
宜加肉苁蓉（一两至二两）。
此方如果确实属于冷气横亘于大肠，凝阴固结不通的情况，可以使用它。然而这种病症很少见，不要一概混用。我认为应当先用肉苁蓉三两，性温入肾为君药，酒煎，润燥，调服沉香末三钱，以益命门真火为臣药，也可以消散其凝阴之气。如果无效，然后再投予八味地黄丸。这就是所谓病宜用热，必须先以温药试探的道理。
1. A patient suffered from spermatorrhea, ejaculating upon hearing a woman's voice. His body was extremely emaciated, and he was on the verge of death. The physician admitted having no effective treatment. A disciple of Miao Zhongchun (Miao Xiyong) prescribed Wan Zhi (Polygalae Radix) as the sovereign drug, Lian Xu (Nelumbinis Stamen) and Shi Lian Zi (Nelumbinis Semen) as the minister drugs, Long Chi (Draconis Os), Fu Shen (Poria Cum Pinus), Sha Yuan Ji Li (Astragali Complanati Semen), and Mu Li (Ostreae Concha) as the assistant and envoy drugs. The pills were taken orally, and symptoms subsided slightly, but the condition could not be cured completely. Miao Zhongchun added Yi Biao (Bovis Bladder) to the previous prescription. The patient recovered before finishing one dose.
2. Another patient suffered from nocturnal emission and involuntary seminal discharge due to excessive mental labor from studying for three or four years. The episodes occurred every few days. After each episode, deficiency fire flared upward, causing heat in the head and face, cold extremities, and insomnia throughout the night. Treatments tonifying the Heart and Kidney and astringing essence were ineffective. Miao Zhongchun prescribed a pill formula with Huang Bo (Phellodendri Cortex) as the sovereign drug to clear Minister Fire, assisted by Di Huang (Rehmanniae Radix), Gou Qi Zi (Lycii Fructus), Yu Rou (Corni Fructus), and Tian Dong (Asparagi Radix) to tonify the Kidney; Mai Dong (Ophiopogonis Radix) to clear the Heart; Lian Xu (Nelumbinis Stamen) and Wu Wei Zi (Schisandrae Fructus) to astringe essence; Yi Biao Jiao (Colla Bladdicae Bovis) to fill essence; and Che Qian Zi (Plantaginis Semen) to promote urination and drain damp-heat, thereby calming the Minister Fire. The patient recovered before finishing one dose. Initially, the patient feared that Huang Bo was too cold and refused to use it. Miao Zhongchun said: "The reason your illness has persisted is precisely because this herb was not used." The *Classic* states: "The Kidney desires firmness; hasten to eat bitter substances to firm it," and Huang Bo is such a substance. When the Kidney is firm, even if there is fire in the Heart meridian, essence will naturally remain secure, preventing nocturnal emission. Previously, only astringent and tonifying herbs were used without addressing the root cause, hence the lack of efficacy.
Constipation is mostly caused by heat and should be differentiated into excess and deficiency patterns. However, constipation can also result from qi stagnation or wind-dryness, requiring different treatments. Occasionally, there is a pattern of cold constipation, which must also be carefully examined. In the case of elderly people with dry fluids, postpartum blood loss, excessive sweating, excessive diuresis, or recovery from illness where qi and blood have not yet restored, all these conditions can lead to constipation. One should nourish yin and tonify blood, generate fluids and moisten dryness, so that bowel movements will naturally become unobstructed. Misusing Xi Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) purgatives often leads to subsequent complications. According to Li Dongyuan: "The Kidneys govern the two lower orifices and the five fluids. When fluids are abundant, stool is normal. If diet is irregular or physical labor is excessive, damaging Stomach qi, or if spicy, hot, and rich foods are overconsumed, fire pathogens lurk in the blood, consuming true yin and depleting fluids, resulting in dry and hard stool." Zhao Xianke stated: "I have followed Li Dongyuan's theory but do not use his Tong You Tang or Run Chang Wan. Instead, I use large doses of Liu Wei Di Huang Wan, adding fluid-generating and moistening agents like Ren Ru (Human Milk) and Bai Mi (Honey). Decoction and administration yield good results." For heat constipation accompanied by qi deficiency, adding Ren Shen (Ginseng Radix) and Dang Shen (Codonopsis Radix) at 3-5 qian in the above formula yields immediate results. This is because qi deficiency fails to push stool forward, and yin deficiency fails to moisten. I have personally tested this with great efficacy, so I record it here.
Liu Yi Shun Qi Tang (see Shang Han section): This formula treats all types of excess-heat constipation. Use according to symptoms.
Ma Ren Wan: Treats Pi Yue syndrome (Spleen earth dryness-heat constrains the food in the Stomach from three to five days into one or two pellet-like shapes for excretion). It addresses difficult defecation (due to dryness of intestinal fluids; it may only be temporarily used if Stomach qi is strong). Ingredients: Ma Ren (Cannabis Seed, 3 liang), Xing Ren (Armeniacae Semen Amarum, for moistening dryness), Bai Shao (Paeoniae Radix Alba, for nourishing yin), Da Huang (Rhei Radix et Rhizoma, for draining heat, processed, 2.5 liang each), Zhi Shi (Aurantii Fructus Immaturus), and Hou Po (Magnoliae Officinalis Cortex, for dispersing nodulation, 1 liang each). Prepare as honey pills. This is a formula for draining heat, dispersing nodulation, and moistening the bowels.
Xiang Dan Wan (named for its bitter taste resembling elephant bile): Ingredients: Zhen Lu Hui (Aloe, bitter-cold to clear heat, moisten dryness; combined with Zhu Sha as a clearing and settling downward agent to naturally open heat accumulation, finely powdered, 1.4 liang); Zhu Sha (Cinnabar, finely powdered, 1 liang, mixed with a little good wine into pills the size of small beans, prepared on sunny days. Take 1.2 qian or 3 qian per dose, washed down with plain water. Morning dosing leads to evening evacuation; evening dosing leads to morning evacuation.) This is a mild formula for clearing heat and promoting bowel movement. It is suitable for excess-heat constipation. Taking it once or twice is very safe. However, it tastes extremely bitter and is difficult to take; those with weak Stomachs may not tolerate it.
Yang Yin Qing Re Run Zao Tang (see Zao section): Treats all types of deficiency-heat constipation; modify according to symptoms. If internal heat is severe, add Zhe Jiang (Saccharum Japonicum Juice) or Li Zhi (Pyrus Sinkiangensis Juice).
Sheng Di Mi You Yin: Treats dry fluids in the elderly and postpartum constipation. Ingredients: Sheng Di Huang (Rehmanniae Radix Recens, 4 liang cut into small pieces); Zhi Ma You (Sesamum Oil, 4 liang, decocted with Sheng Di Huang until the oil floats to the surface, remove dregs, pour oil into a large bowl); add Sheng Bai Mi (Raw White Honey, approx. 1 liang); mix with boiling water (1 bowl) and drink together with the oil. Alternatively, using only Sheng Di Huang (3-4 liang) decocted in water and drunk at once is also effective; adding Song Zi Ren (Pinus Kernel, 1 liang) is even better. These two formulas can be adopted for all deficiency-heat constipation cases.
Ju Xing Tang: Treats qi stagnation leading to obstruction and constipation (The San Jiao are connected through a single qi. When qi is closed, stool is also closed). Ingredients: Ju Hong (Citri Reticulatae Pericarpium Rubrum, promotes qi movement, 2-3 qian); Xing Ren (Armeniacae Semen Amarum, promotes qi movement and moistens dryness, 5 qian to 1 liang); it is advisable to add Zhi Ke (Aurantii Fructus, 1-3 qian), Su Zi (Perillae Fructus, stir-fried and ground, 3-5 qian), and flush with several spoons of Chen Xiang juice (Aquilariae Wood). Mai Dong (Ophiopogonis Radix), Zhe Jiang (Saccharum Japonicum Juice), and Li Zhi (Pyrus Sinkiangensis Juice) can also be used. This is a formula that promotes qi movement and moistens dryness.
Yang Xue Qu Feng Run Zao Tang (Self-made): Treats wind-dryness constipation. Ingredients: Qin Jiao (Gentianae Macrophyllae Radix, 2-3 qian); Hu Ma (Sesamum Indicum Seed, stir-fried and ground, 3-5 qian); Xian Shou Wu (Polygoni Multiflori Caulis Recens, nourishes blood and dispels wind, 5 qian to 1 liang); Sheng Di Huang (Rehmanniae Radix Recens, cools blood and moistens dryness, 3-5 qian); Song Zi Ren (Pinus Kernel, 5 qian to 2 liang, ground and mixed for administration); Niu Nai (Bovis Lac, nourishes blood and moistens dryness, one cup or Niu Su 1-2 liang); Li Zhi (Pyrus Sinkiangensis Juice, treats wind-heat and benefits the Large Intestine, one cup). This formula is highly suitable for those prone to wind-heat and constipation. Wind-dispelling herbs are not used because treating wind requires first treating the blood; when blood moves, wind extinguishes itself. Using wind-dispelling herbs would further damage blood and worsen constipation.
Ba Wei Di Huang Wan (see Bu Neng Shi section): Treats cold constipation. (It must be accompanied by aversion to cold and cold limbs, desire for hot drinks, clear and copious urine, and a deep, small, and slow pulse to diagnose as a cold pattern.) It is advisable to add Rou Cong Rong (Cistanches Herba, 1-2 liang). If the pattern is indeed cold qi obstructing the Large Intestine with congealed yin causing blockage, this formula can be used. However, such cases are rare; do not administer indiscriminately. I believe one should first use Rou Cong Rong (3 liang), which is warm and enters the Kidney as the sovereign drug, decocted in wine to moisten dryness, mixed with Chen Xiang powder (3 qian) to benefit Ming Men True Fire as the minister drug, which can also dissipate congealed yin qi. If there is no response, then administer Ba Wei Di Huang Wan. This illustrates the principle that when a disease requires heat therapy, one should first probe with warm herbs.