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Digestive-promoting and phlegm-resolving herbs, such as *Fructus Aurantii Immaturus* (Zhishi, 枳实), *Pericarpium Aurantii* (Zhike, 枳壳), *Pericarpium Citri Reticulatae* (Chenpi, 陈皮), *Rhizoma Pinelliae* (Banxia, 半夏), *Semen Cardamomi* (Caodoukou, 草豆蔻), *Radish Seed* (Laifuzi, 莱菔子), *Fructus Crataegi* (Shanzha, 山楂), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), *Rhizoma Cyperi Rotundi* (Xiangfu, 香附), *Semen Hordei Germinatum* (Maiya, 麦芽), *Massa Medicata Fermentata* (Shenqu, 神曲) etc., are selected according to the specific syndrome.

Heat-clearing and stomach-calming (harmonizing spleen and stomach qi mechanism) herbs, such as *Herba Elsholtziae* (Xiangru, 香薷), *Rhizoma Coptidis* (Huanglian, 黄连), *Sarcandra Glabra* (Mu Gua, 木瓜 - note: usually refers to Chaenomelis Fructus in TCM context for dampness, here likely Pseudocydonia or Chaenomeles), *Herba Agastaches* (Huoxiang, 藿香), *Herba Akebiae Trifoliate* (Mutong, 木通), *Dendrobii Caulis* (Shihu, 石斛), *Pericarpium Citri Reticulatae* (Chenpi, 陈皮), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), *Radix Glycyrrhizae Preparata* (Gancao, 甘草), *Rhizoma Alismatis* (Zexie, 泽泻), *Polyporus* (Zhuling, 猪苓), *Rhizoma Atractylodis Macrocephalae* (Cangzhu, 苍术), *Talcum* (Huashi, 滑石) etc., are selected according to the specific syndrome.

Warming-tonifying and diarrhea-stopping herbs, such as *Semen Myristicae* (Rouguo/Roudoukou, 肉果/肉豆蔻), *Fructus Evodiae* (Wuzhuyu, 吴茱萸), *Cortex Cinnamomi* (Rougui, 肉桂), *Flos Caryophylli* (Dingxiang, 丁香), *Lignum Aucklandiae* (Muxiang, 木香), *Fructus Chebulae* (Hezi, 诃子), *Halloysit Rubra* (Chishizhi, 赤石脂), *Os Draconis* (Longgu, 龙骨), *Radix Ginseng* (Renshen, 人参), *Poria* (Fuling, 茯苓), *Rhizoma Dioscoreae* (Shanyao, 山药), *Fructus Amomi* (Sharen, 砂仁), *Semen Alpiniae Oxyphyllae* (Yizhi, 益智仁), *Semen Coicis* (Yiren, 薏苡仁), *Rhizoma Atractylodis Macrocephalae* (Baizhu, 白术), *Radix Glycyrrhizae Preparata* (Zhi Gancao, 炙甘草), *Semen Cardamomi Album* (Baidoukou, 白豆蔻), *Oryza Sativa Vetusta* (Chenmi, 陈米), *Semen Nelumbinis* (Lianrou, 莲肉), *Semini Dolichoris Lablab* (Baibian Dou, 白扁豆), *Zingiberis Rhizoma Preparatum* (Weijiang, 煨姜), *Fructus Mume* (Wumei, 乌梅) etc., are selected according to the specific syndrome.

Constipation due to dryness (Zaojie) is divided into deficiency (Xu) and excess (Shi) syndromes. Some cases arise from wind-cold pathogens entering from outside, while others stem from internal fire generated by the seven emotions. This represents dryness caused by stagnation of damp-heat, which is sometimes an excess syndrome. For excess syndromes, it is appropriate to purge the intestines and stomach, open blockages, and soften hardness, using herbs like *Radix et Rhizoma Rhei* (Dahuang, 大黄), *Natrii Sulfas* (Xiaoshi/Niaoshui, 硝石), *Fructus Aurantii Immaturus* (Zhishi, 枳实), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), and formulas like Chengqi Tang (Chengqi Decoction). Alternatively, constipation may result from prolonged illness with reduced food intake, sudden loss of body fluids after vomiting, diarrhea, or sweating, exhaustion of essence and blood in old age, or blood loss after childbirth. These lead to dryness because dried-up blood fails to moisten, constituting a deficiency syndrome. For deficiency syndromes, it is appropriate to nourish yin and blood, moisten dryness, and clear heat, preventing fire from imposing its drying nature. The large intestine (Metal organ) will naturally transform pure qi, fluids enter the stomach, the spleen earth functions vigorously, and constipation resolves spontaneously. Formulas like Guide Tao Ren Run Zao Tang (Angelica and Peach Kernel Moistening Dryness Decoction) can be used. One may also consume pig blood and offal soup cooked as usual, adding butter; this moistens both blood and organs. For those with strong stomachs capable of eating, Run Chang Wan (Intestine-Moistening Pill) can be taken intermittently for mild purgation. If one fails to distinguish between deficiency and excess and rashly uses harsh purgatives like Natrii Sulfas, *Radix et Rhizoma Rhei*, or *Radix Crotonis Tiglii* (Badou, 巴豆), death can occur as easily as flipping a hand. Therefore, Li Dongyuan stated: "When the stomach is strong but the spleen weak, fluids are constrained and cannot circulate widely, only flowing to the bladder, causing frequent urination and difficult defecation. In such cases, use Pi Yue Wan (Spleen-Restriction Pill)." If constipation stems from withered yin-blood, one should nourish Metal (Lung) and Water (Kidney) so that yin channels grow, generating internal fluids, thus eliminating dryness.

The *Classic* states: "North corresponds to black, connecting internally to the Kidney, opening at the two lower orifices." Kidney deficiency leads to fluid exhaustion and dry stool. Since the Kidney dislikes dryness, one should urgently consume pungent substances to moisten and bitter substances to drain. Adding *Caulis Cibotii Barometz* (Congrong, 肉苁蓉), human milk, and white honey to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is most suitable. Thus, severe constipation is specifically attributed to the Shaoyin (Kidney) meridian. Although symptoms vary, the root cause is always fluid exhaustion, as the Kidney governs the five fluids; sufficient fluids ensure normal bowel movements. However, irregular diet, overwork, or damage to Stomach qi affecting transformation and transportation, along with excessive consumption of spicy, hot, and rich foods, allow fire pathogens to linger in the blood, consuming true yin. Reduced blood volume leads to dryness. Specifically, there are distinctions among Stomach-excess constipation, Stomach-deficiency constipation, Heat constipation, Cold constipation, Wind constipation, Qi constipation, and Blood constipation.
Stomach-excess constipation presents with floating and rapid pulse, good appetite, and dark urine.
Stomach-deficiency constipation presents with deep and slow pulse, inability to eat, clear urine, heavy body, and hard stool.
If there is red face, body heat, surging and solid pulses, desire for cold drinks, or mouth/tongue ulcers, this is Large Intestine heat accumulation, known as Heat Constipation.
If the face or eyes appear dark, pulses are deep and slow, urine is clear, and there is preference for warmth and aversion to cold, this is due to cold qi obstructing the intestines and stomach, congealing yin and binding, blocking fluids. It is not truly dry feces but Cold Constipation.
If caused by blood loss or blood deficiency leading to insufficient fluids, it is Blood Constipation.
If qi does not ascend and descend, and grain qi does not move, accompanied by belching, it is Qi Constipation.
If wind attacks the Lung, transmitting to the Large Intestine, or in patients with chronic wind diseases, it is Wind Constipation.
Li Dongyuan said: Excess and Heat constipation are Yang Binding, requiring dispersal. Deficiency and Cold constipation are Yin Binding, requiring warming.
The *Zhunsheng* states: Stomach-excess constipation involves eating well and dark urine, indicating physical obstruction. Stomach-deficiency constipation involves inability to eat and clear urine, indicating qi stagnation.
However, organs require blood to generate fluids. If Kidney yin is deficient and fluids do not regenerate quickly, seeking rapid results without addressing this will lead to danger. Straining on the toilet is unbearable; the only cure is to heavily nourish fluids, treating the disease by not directly attacking it.
Xiawan (Lower Confluence) is the幽门 (Pylorus/Houmen), the lower exit of the Stomach. There are seven gates in the body, all directing downward but pushing upward. Houmen pushes up to Ximen (Inhalation Gate), which is the epiglottis/larynx, covering food entry. If inhaled air cannot descend to Liver and Kidney, being resisted by yin-fire, dysphagia occurs. Turbid yin cannot descend, causing dry stool. Dampness in the Stomach combined with yin-fire causes abdominal distension. Treatment focuses on Houmen: unblock it, drain yin-fire, moisten dry blood, generate new blood. Once Houmen is open, Ximen is protected, dysphagia opens, distension resolves, and turbid yin returns to the lower pathways.
For pulses floating in the qi level, use *Semen Armeniacae Amarum* (Xingren, 杏仁) and *Pericarpium Citri Reticulatae* (Chenpi, 陈皮). For pulses sinking in the blood level, use *Semen Persicae* (Taoren, 桃仁) and *Pericarpium Citri Reticulatae* (Chenpi, 陈皮). Chenpi is used in both because Hand-Taiyin Lung and Hand-Yangming Large Intestine are exterior-interior pairs; if Lung qi does not descend, Large Intestine transport is difficult. However, slippery and moistening herbs like *Polygoni Multiflori Preparati* (Shouwu, 生首乌), *Semen Cannabis* (Maren, 麻仁), *Radix Angelicae Sinensis Cauda* (Guishao, 归梢), and *Caulis Cibotii Barometz* (Congrong, 肉苁蓉) must be added.
If the patient desires sitting in a well (indicating extreme cold need), the radial pulses at both chi positions will be empty upon pressure, or deep, thin, and slow. Boiling Lizhong Tang (Regulate the Middle Decoction) until very cold and administering it is appropriate. If ineffective, harsh agents should not be used; instead, honey suppositories (Mi Jian Dao) are suitable. For Cold Constipation, add *Radix Aconiti Lateralis Preparata* (Caowutou, 草乌头) powder to the honey suppository. For Heat Constipation, pig bile suppositories are also effective.
If constipation persists for many days due to long-term illness, but food intake has been low for a long time, where would waste come from? Even if days pass, it is not urgent. One should only tonify and regulate qi and blood. Once middle qi strengthens, natural transport resumes. Adjusting diet ensures new grain fills the system, pushing out old grain. Do not use purgatives, lest they induce collapse and critical conditions.
Yang Binding pulses are deep, rapid, or hurried. Yin Binding pulses are hidden, slow, or knotted. In elderly or deficient patients, a sparrow-pecking pulse indicates incurability.