脉∶燥结之脉，沉伏勿疑；热结沉数；虚结沉迟；若是风燥，右尺浮肥。
身热烦渴，大便不通者，是热闭也；久病患虚，大便不通者，是虚闭也；因汗出多，大
便不通者，精液枯竭而闭也；风证大便不通者，是风闭也；老人大便不通者，是血气枯燥而
闭也；虚弱并产妇及失血，大便不通者，血虚而闭也；多食辛热之物，大便不通者，实热也
（并宜后方）。
润肠汤 治大便闭结不通。
当归 熟地 生地 麻仁（去壳） 桃仁（去皮） 杏仁（去皮） 枳壳 浓朴（去粗皮） 黄
芩大黄（各等分） 甘草（减半）
上锉一剂。水煎，空心热服。大便通即止药，不能多服。如修合润肠丸，将药加减各为
末，炼蜜为丸，如梧桐子大。每服五十丸，空心白汤吞下。切忌辛热之物。实热燥闭，根据本
方；发热，加柴胡；腹痛，加木香；血虚枯燥，加当归、熟地、桃仁、红花；风燥闭，郁李
仁、皂角、羌活；气虚而闭，加人参、郁李仁；气实而闭，加槟榔、木香；痰火而闭，加瓜
萎、竹沥；因汗多或小便去多，津液枯竭而闭，加人参、麦门冬；老人气血枯燥而闭，加人
参、锁阳、麦门冬、郁李仁，倍加当归、熟地、生地，少用桃仁；产妇去血多，枯燥而闭，
加人参、红花，倍加当归、熟地，去黄芩、桃仁。此方加槟榔，即通幽汤。
蜜导法 用火炼蜜，稠浓黄色倾入水中，急捻如指大，随用皂角末、麝香共为衣。将油
涂抹大便润湿，放入谷道，大便即通。
猪胆汁导法 治自汗，小便利而大便燥硬，不可攻，以此法导之。猪胆一枚，倾去一小
半，仍入醋在内，用竹管相接，套入谷道中，以手指捻之，令胆汁直射入内，少时即通。盖
酸苦益阴以润燥也。
香油导法 治大便不通，腹胀，死在须臾。用竹管蘸葱汁深入大便内，以香油一半、温
水一半同入猪尿胞内，捻入竹管。将病患倒放，脚向上，半时即顺，立通。
一大便闭结，若大肠血虚火炽者，用四物汤送下润肠丸，或以猪胆汁导之；若肾虚火燥
者，用六味丸；若肠胃气虚，用补中益气汤（二方俱见补益）。
一男子年六十七岁，因气恼，左边上中下有三块，时动而胀痛，喜揉，揉即散去。心痞
作嘈，食下胃口觉涩，夜卧不宁，小便涩，大便八日不通。一医以大承气汤，一医以化滞丸
，一用猪胆导法，一用蜜导法，俱不效。余诊六脉弦数有力，此血不足气有余，积热壅实。
以大黄末三钱、皮硝五钱，热烧酒调服。打下黑粪，其硬如石，数十条。如前又一服，又打
下粪弹盆许，遂安。后以四物汤加桃仁、红花、酒蒸大黄、黄连、栀子、三棱、莪术、枳壳
、青皮、木通、甘草，十数剂而愈。
Pulse: For dryness accumulation (dryness accumulation), the pulse is deep and hidden, leaving no doubt; for heat accumulation (heat accumulation), the pulse is deep and rapid; for deficiency accumulation (deficiency accumulation), the pulse is deep and slow; if it is wind-dryness (wind-dryness), the right chi (chi position on the radial artery) pulse is floating and plump.
Body fever, irritability, thirst, and constipation indicate Heat Obstruction (Heat Obstruction); chronic illness with deficiency, constipation indicates Deficiency Obstruction (Deficiency Obstruction); excessive sweating leading to constipation indicates closure due to exhaustion of essence and fluids (exhaustion of essence and fluids); constipation caused by wind syndromes indicates Wind Obstruction (Wind Obstruction); constipation in the elderly indicates closure due to dryness of blood and qi (dryness of blood and qi); constipation in those who are weak, postpartum women, or those who have lost blood indicates closure due to blood deficiency (blood deficiency); constipation after consuming much spicy and hot food indicates Excess Heat (Excess Heat) (all suitable for the following formula).
Run Chang Tang (Moistening Intestine Decoction) treats constipation and blockage.
Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Rehmanniae Radix Recens (Shengdi), Cannabis Fructus (Maren, processed to remove shells), Persicam Semen (Taoren, peeled), Armeniacae Semen Amarum (Xingren, peeled), Aurantii Fructus (Zhiqiao), Magnoliae Officinalis Cortex (Houpo, rough bark removed), Scutellariae Radix (Huangqin), Rhei Radix et Rhizoma (Dahuang) (all equal parts), Glycyrrhizae Radix et Rhizoma (Gancao, half dose).
Chop the above into one dose. Decoct in water, take warm on an empty stomach. Stop medication once bowel movement is unblocked; do not take excessively. To prepare Run Chang Wan (Moistening Intestine Pill), modify the herbs according to needs, grind each into powder, and form pills with refined honey, sized like sophora seeds. Take fifty pills per dose, swallow with plain warm water on an empty stomach. Strictly avoid spicy and hot foods. For Excess Heat Dryness Obstruction, follow this base formula; for fever, add Bupleuri Radix (Chaihu); for abdominal pain, add Aucklandiae Radix (Muxiang); for blood deficiency dryness, add Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Persicam Semen (Taoren), Carthami Flos (Honghua); for Wind-Dryness Obstruction, add Prunellae Fructus (Yuziren), Gleditsiae Sinensis Spina (Zaojiao), Notopterygii Rhizoma et Radix (Qianghuo); for Qi deficiency obstruction, add Ginseng Radix (Renshen), Prunellae Fructus (Yuziren); for Qi excess obstruction, add Arecae Semen (Binglang), Aucklandiae Radix (Muxiang); for Phlegm-Fire obstruction, add Trichosanthis Fructus (Gualou), Bambusae Sap (Zhuli); for closure due to excessive sweating or urination leading to fluid exhaustion, add Ginseng Radix (Renshen), Ophiopogonis Radix (Maidong); for elderly closure due to blood and qi dryness, add Ginseng Radix (Renshen), Cynomorii Herba (Suoyang), Ophiopogonis Radix (Maidong), Prunellae Fructus (Yuziren), double the dose of Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Rehmanniae Radix Recens (Shengdi), use less Persicam Semen (Taoren); for postpartum women with excessive blood loss and dryness obstruction, add Ginseng Radix (Renshen), Carthami Flos (Honghua), double the dose of Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), remove Scutellariae Radix (Huangqin) and Persicam Semen (Taoren). Adding Arecae Semen (Binglang) to this formula creates Tong You Tang (Unblocking the Abyss Decoction).
Mi Dao Method (Honey Suppository Method): Refine honey over fire until thick and yellow, pour into water, quickly shape into finger-sized cylinders. Coat with powder of Gleditsiae Sinensis Spina (Zaojiao) and Moschus (Shexiang). Lubricate the anus with oil, insert into the rectum (valley gate), and bowel movement will be facilitated.
Zhu Dan Zhi Dao Method (Pig Gallbladder Juice Suppository Method): Treats spontaneous sweating, patent urination, but dry and hard stool that cannot be purged; use this method to guide. Take one pig gallbladder, discard a small portion of bile, keep vinegar inside, connect with a bamboo tube, insert into the rectum, manipulate with fingers to direct bile juice inward, passage occurs shortly. This is because sour and bitter flavors nourish Yin to moisten dryness.
Xiang You Dao Method (Sesame Oil Suppository Method): Treats constipation, abdominal distension, critical condition imminent. Dip a bamboo tube in scallion juice, insert deeply into the stool. Mix half sesame oil and half warm water in a pig bladder, insert the bamboo tube. Place the patient upside down, feet up; within half an hour, flow becomes smooth, and immediate passage occurs.
For constipation due to Large Intestine blood deficiency and blazing fire, use Si Wu Tang (Four Substances Decoction) to deliver Run Chang Wan, or use Pig Gallbladder Juice Suppository Method; for Kidney deficiency with dry fire, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia); for Spleen and Stomach Qi deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (both formulas see Tonification section).
A sixty-seven-year-old man, due to anger and resentment, had three lumps on the left side (upper, middle, lower), moving intermittently with distending pain, relieved by rubbing which dispersed them. He experienced epigastric fullness and hunger pangs, astringency in the throat after eating, restless sleep at night, astringent urination, and no bowel movement for eight days. One physician used Da Cheng Qi Tang (Major Order the Qi Decoction), another Hua Zhi Wan (Eliminate Stasis Pill), one used Pig Gallbladder Juice Suppository Method, another Honey Suppository Method, all ineffective. I palpated the six pulses as wiry, rapid, and forceful; this indicated insufficient blood and excess Qi, with accumulated heat and stagnation. Administered three qian of Rhei Radix et Rhizoma (Dahuang) powder and five qian of Natrii Sulfas (Pixiao), mixed with hot distilled liquor. Passed black feces, hard as stone, in dozens of strips. After another dose as before, passed feces resembling pellets filling a basin, then stabilized. Later, treated with Si Wu Tang (Four Substances Decoction) plus Persicam Semen (Taoren), Carthami Flos (Honghua), Rhei Radix et Rhizoma (Dahuang) steamed with wine, Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), Curcumae Radix (Sanleng), Curcumae Longae Rhizoma (Ezhu), Aurantii Fructus (Zhiqiao), Citri Reticulatae Pericarpium (Qingpi), Akebiae Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao). After more than ten doses, he recovered.