张 食进脘中难下。大便气塞不爽。肠中收痛。此为肠痹。（肺气不开降）
大杏仁 枇杷叶 川郁金 土栝蒌皮 山栀 香豉
夏（二十） 食下 胀。旬日得一更衣。肠胃皆腑。以通为用。丹溪每治肠痹。必开肺气。
谓表里相应治法。
杏仁 紫菀 冬葵子 桑叶 土栝蒌皮
又 肠痹开肺不效。用更衣丸三钱。
吴 身重不能转移。尻髀板着。必得抚摩少安。大便不通。小溲短少。不饥少饮。此时序湿邪。蒸
郁化热。阻于气分。经腑气隧皆阻。病名湿痹。
木防己（一钱） 杏仁（二钱） 川桂枝（一钱） 石膏（三钱研） 桑叶（一钱） 丹皮（一钱）
又 舌白。不渴不饥。大便经旬不解。皮肤麻痒。腹中鸣动。皆风湿化热。阻遏气分。诸经脉络皆
闭。昔丹溪谓肠痹。宜开肺气以宣通。以气通则湿热自走。仿此论治。
杏仁 栝蒌皮 郁金 枳壳汁 山栀 香豉 紫菀
沈（二五） 湿结在气。二阳之痹。丹溪每治在肺。肺气化。则便自通。
紫菀 杏仁 枇杷叶 土栝蒌皮 郁金 山栀皮 枳壳汁 桔梗汁
蒋（三一） 肺痹。鼻渊。胸满。目痛。便阻。用辛润自上宣下法。
紫菀 杏仁 栝蒌皮 山栀 香豉 白蔻仁
董 高年疟后。内伤食物。腑气阻痹。浊攻腹痛。二便至今不通。诊脉右部弦搏。渴思冷冻饮料。昔丹
溪大小肠气闭于下。每每开提肺窍。内经谓肺主一身气化。天气降。斯云雾清。而诸窍皆
为通利。若必以消食辛温。恐胃口再伤。滋扰忧症。圣人以真气不可破泄。老年当遵守。
紫菀 杏仁 栝蒌皮 郁金 山栀 香豉
又 舌赤咽干。阳明津衰。但痰多不饥不食。小溲不爽。大便尚秘。仿古人以九窍不利。咸推胃
中不和论治。
炒半夏 竹茹 枳实 花粉 橘红 姜汁
叶（女） 二便不通。此阳痹。当治在肺。
紫菀 杏仁 蒌皮 郁金 黑山栀 桔梗
又 威喜丸。
某 瘅疟肺病。未经清理。致热邪透入营中。遂有瘀血暴下。今诊舌白不渴。不能纳食。大便九
日不通。乃气痹为结。宗丹溪上窍闭。则下窍不出矣。
杏仁 枇杷叶 栝蒌皮 川郁金 香豉 苡仁
又 用手太阴药。即思纳谷。阳明气痹无疑。
紫菀 杏仁 枇杷叶 栝蒌皮 郁金 黑山栀
肠痹本与便闭同类。今另分一门者。欲人知腑病治脏。下病治上之法也。盖肠痹之便闭。
较之燥屎坚结欲便不通者稍缓。故先生但开降上焦肺气。上窍开泄。下窍自通矣。若燥
屎坚闭。则有三承气。润肠丸。通幽汤。及温脾汤之类主之。然余谓便闭之症。伤寒门中。当
急下之条无几。余皆感六淫之邪。病后而成者为多。斯时胃气未复。元气已虚。若遽用下
药。于理难进。莫若外治之法为稳。用蜜煎导法。设不通爽。虚者间二三日再导。余见
有渐导渐去燥粪五六枚。或七八枚。直至二旬以外第七次。导去六十余枚而愈者。
此所谓下不嫌迟也。学人不可忽诸。（华玉堂）
Patient Zhang: Food feels difficult to descend after entering the stomach. Bowel movements feel obstructed by Qi, with unsmooth defecation. There is contracting pain in the intestines. This is Intestinal Bi (Intestinal Obstruction due to Qi stagnation) [caused by Lung Qi failing to diffuse and descend].
Prescription: Da Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Chuan Yu Jin (Curcuma Aromatica Rhizome), Tu Gua Lou Pi (Trichosanthes Peel), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean).
Patient Xia (20 years old): Abdominal distension occurs after eating. Defecation happens only once every ten days. The Large Intestine and Small Intestine are both Fu organs (Hollow Organs), whose function relies on patency. Mr. Danxi always treated Intestinal Bi by opening Lung Qi first.
This is considered a treatment method based on the correspondence between interior and exterior.
Prescription: Xing Ren (Apricot Seed), Zi Wan (Aster Root), Dong Kui Zi (Malva Seeds), Sang Ye (Mulberry Leaf), Tu Gua Lou Pi (Trichosanthes Peel).
Re-consultation: Treatment of Intestinal Bi using the method of opening Lung Qi was ineffective. Changed to Geng Yi Wan (Change Stool Pill), 3 qian.
Patient Wu: Heavy body, unable to move. The buttocks and thighs feel stiff and rigid, requiring massage for slight relief. No bowel movement. Urine is scanty. No hunger, drinking little. At this time, seasonal Dampness pathogen steams and stagnates, transforming into Heat, blocking the Qi level. The Qi pathways of meridians and Fu organs are all obstructed. The disease name is Damp Bi (Dampness Obstruction).
Prescription: Mu Fang Ji (Stephania Tetrandra, 1 qian), Xing Ren (Apricot Seed, 2 qian), Chuan Gui Zhi (Cinnamon Twig, 1 qian), Shi Gao (Gypsum Fibrosum, 3 qian, crushed), Sang Ye (Mulberry Leaf, 1 qian), Dan Pi (Moutan Cortex, 1 qian).
Re-consultation: White tongue coating. No thirst, no hunger. Bowel movement has not occurred for over ten days. Skin feels numb and itchy. Borborygmus in the abdomen. All these are due to Wind-Damp transforming into Heat, obstructing the Qi level, causing closure of various meridian collaterals. In the past, Mr. Danxi stated that for Intestinal Bi, it is suitable to open Lung Qi to promote circulation; because when Qi flows smoothly, Damp-Heat naturally exits. Following this theory for treatment.
Prescription: Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Zhi Ke Zhi (Bitter Orange Juice), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean), Zi Wan (Aster Root).
Patient Shen (25 years old): Dampness knots in the Qi level, constituting Bi syndrome of the Yangming channels. Mr. Danxi always treated such cases focusing on the Lung; when Lung Qi transforms and moves, stool passes naturally.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Tu Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Shan Zhi Pi (Gardenia Bark), Zhi Ke Zhi (Bitter Orange Juice), Jie Geng Zhi (Platycodon Juice).
Patient Jiang (31 years old): Lung Bi. Bi Yuan (Nasal Sinusitis with turbid discharge). Chest fullness. Eye pain. Blocked stool. Using Acrid-Moistening method to disperse from above and guide down.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean), Bai Kou Ren (White Cardamom Seed).
Patient Dong: Elderly patient, post-malaria, internal injury from food. Fu Qi obstruction and bi-stagnation. Turbid Qi attacking causes abdominal pain. Both urine and stool have been blocked until now. Pulse diagnosis shows the right position is wiry and forceful. Thirsty, desiring cold drinks. In the past, Mr. Danxi said that when Qi of the Large and Small Intestines is closed below, one often opens the Lung orifices to treat it. The *Neijing* states that the Lung governs the Qi transformation of the whole body. When Heavenly Qi descends, clouds and mist clear, and all orifices become patent. If one insists on using digestive, acrid-warm medicines, it may further damage the stomach appetite and disturb the mind. The Sages teach that True Qi must not be broken or drained; the elderly should abide by this.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Shan Zhi (Gardenia Fruit), Xiang Chi (Fermented Soybean).
Re-consultation: Red tongue, dry throat. Yangming fluids are deficient. Only much phlegm, no hunger, anorexia. Urination is unsatisfactory. Stool remains constipated. Following the ancients' theory that dysfunction of the nine orifices is attributed to disharmony in the Stomach.
Prescription: Chao Ban Xia (Processed Pinellia Tuber), Zhu Ru (Bamboo Shavings), Zhi Shi (Immature Bitter Orange), Hua Fen (Trichosanthes Root), Ju Hong (Tangerine Peel), Jiang Zhi (Ginger Juice).
Patient Ye (Female): Blockage of both urine and stool. This is Yang Bi. Treatment should focus on the Lung.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Hei Shan Zhi (Blackened Gardenia Fruit), Jie Geng (Platycodon Root).
Re-consultation: Wei Xi Wan (Wei Xi Pill).
Certain Patient: Dan Nue (Feverish Malaria) caused Lung disease, which was not cleared properly, leading Heat pathogens to penetrate into the Ying (Nutrient) level. Consequently, sudden massive bleeding of Blood stasis occurred. Current pulse/tongue shows white coating, no thirst, inability to eat. No bowel movement for nine days. This is Qi Bi (Qi Obstruction) forming a knot. Following Mr. Danxi's principle: "If the upper orifices are closed, the lower orifices cannot exit."
Prescription: Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Gua Lou Pi (Trichosanthes Peel), Chuan Yu Jin (Curcuma Aromatica Rhizome), Xiang Chi (Fermented Soybean), Yi Yi Ren (Coix Seed).
Re-consultation: After using herbs of the Hand-Taiyin Lung Meridian, the patient began to desire food. Yangming Qi Bi is undoubtedly confirmed.
Prescription: Zi Wan (Aster Root), Xing Ren (Apricot Seed), Pi Ye (Loquat Leaf), Gua Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Aromatica Rhizome), Hei Shan Zhi (Blackened Gardenia Fruit).
Intestinal Bi is essentially similar to Constipation. It is separated into another category here to make learners aware of the methods of treating Zang organs for Fu diseases, and treating upper areas for lower diseases. Generally, constipation caused by Intestinal Bi is slightly slower/milder than that caused by hard, dry fecal impaction where defecation is impossible. Therefore, the Master only opens and descends the Lung Qi of the Upper Jiao. Once the upper orifices are opened and released, the lower orifices naturally become patent. If it is hard, dry fecal impaction, then San Cheng Qi Tang (Three Decoctions for Purging), Run Chang Wan (Moisten Intestines Pill), Tong You Tang (Unblock the Abyss Decoction), and Wen Pi Tang (Warm the Spleen Decoction) are indicated. However, I believe that among symptoms of Constipation, there are very few instances in the Shang Han (Cold Damage) chapters requiring urgent purgation. Most others arise after illness due to contraction of the Six Exogenous Pathogens. At this time, Stomach Qi has not recovered, and Yuan Qi (Original Qi) is already deficient. If purgative drugs are used abruptly, it is theoretically inappropriate. It is better to use external treatment methods for stability. Use Mi Jian Dao (Honey Suppository) method. If still not smooth, for deficiency patterns, wait two or three days before supposing again. I have seen cases where gradually expelled five or six, or seven or eight pieces of dry feces, until the seventh time after twenty days, expelling more than sixty pieces in total, resulting in cure.
This is what is meant by "purging need not be rushed." Students must not ignore this. (Recorded by Hua Yutang)