有热结者，热耗血液干燥，故结也。脉洪数，能食，（即仲景所谓阳结。）麻仁丸，四
顺饮子吞润肠丸。若燥实坚，腹满痛，承气汤（见中气）治之。
有寒结，冷气横于肠胃，阴凝不运，津液不通，故结也。脉沉迟，不能食
腹痛。（即仲景所谓阴结也。）寒而实者，备急丸、（见伤饮食。）温脾汤。寒而虚者，半硫丸，
姜汁调乳香吞之，或八味丸。（见虚损。）外用握药。
有气秘，气壅滞不通，不升不降，其人多噫。实者破结导滞，木香、槟榔、
枳壳、陈皮、杏仁等类。虚者（气虚不运故壅滞）补而行之，不宜破散，人参多用。若气
阻隔不通，而见噎膈反胃等证者，人参利膈丸、四磨汤（见气）选用。仍分虚实治之，若
气少气弱，无力推送，则惟有助气而已。（肺主气，肺与大肠为表里，气秘治在肺。）
丹溪云∶肺
气不降，则难传送，用枳壳、沉香、诃子、杏仁等。老人、虚人津液少，宜滑之，
用胡麻、麻仁、阿胶等。
有血秘，老人、（老人后门固，寿之征。）产妇（产后有秘至数十日者，勿亟通之）。
血液干枯，或病
后血虚，或发汗利小便以致津涸，（津亦属血。）均宜润剂，苁蓉润肠丸、更衣丸、四物
汤（见血）、麻仁、杏仁辛润之品。又肾司二便，肾水虚燥，宜以六味（见虚损）滋水，少佐辛
味以润之。若跌打损伤，瘀血凝滞，致气不行，而大小便不通者，破瘀导滞为主。
有风秘，其人肠胃素有风，风能燥湿燥血，故大肠不润而结，搜风顺气丸（见中风）、
滋燥养荣汤。
老人气血多虚，察其脉浮虚者，气虚也；沉虚者，血虚也。凡结实难下之证，
可用穿结药及妙香丸。（见烦躁。）
燥屎巨硬，结在肛门难出，名直肠结，从导法治之。
导法∶以蜂蜜炼成条，大如指，粘皂角末，油抹，入便门。寒结者加草乌头末，
以化寒消结。热结者以猪胆汁导。
There is the condition of Heat Constipation, where heat consumes blood fluids causing dryness, leading to accumulation. The pulse is surging and rapid, appetite is normal (this is what Zhang Zhongjing referred to as Yang Constipation). Use Hemp Seed Pill (Maren Wan), taken with Four-Compliance Decoction (Sishun Yinzi) swallowing Intestine-Moistening Pill (Runchang Wan). If the stool is dry, solid, and hard, accompanied by abdominal fullness and pain, treat with Chengqi Decoction (Jian Zhongqi Pian).
There is the condition of Cold Constipation, where cold qi stagnates in the intestines and stomach, yin cold coagulates and fails to transport, and body fluids are blocked, leading to accumulation. The pulse is deep and slow, there is inability to eat, and abdominal pain (this is what Zhang Zhongjing referred to as Yin Constipation). For cold-excess patterns, use Emergency Rescue Pill (Beiji Wan) (Jian Shang Yinshi Pian) or Warm Spleen Decoction (Wenpi Tang). For cold-deficiency patterns, use Half-Sulfur Pill (Banshou Wan), taken with frankincense (Ruxiang) mixed in ginger juice, or Eight-Ingredient Pill (Bawei Wan) (Jian Xusun Pian). External grasping medicine therapy may also be applied.
There is the condition of Qi Constipation, characterized by qi stagnation and obstruction, failure of ascending and descending functions, and frequent belching in such individuals. For excess patterns, break stagnation and guide out retention using herbs such as Costus Root (Muxiang), Areca Nut (Binglang), Aurantium (Zhike), Tangerine Peel (Chenpi), and Apricot Kernel (Xingren). For deficiency patterns (stagnation due to qi deficiency failing to move), tonify and promote movement; avoid dispersing drugs, and use Ginseng (Renshen) in larger doses. If qi obstruction leads to symptoms like dysphagia (Yege) or regurgitation (Fanwei), select Ren Shen Li Ge Wan or Si Mo Tang (Jian Qi Pian). Treatment must still distinguish between excess and deficiency. If qi is insufficient and weak, lacking the strength to push, only qi supplementation is needed. (The Lung governs qi, and the Lung and Large Intestine are exterior-interior partners; thus, treating Qi Constipation focuses on the Lung.) Danxi stated: When Lung qi does not descend, transmission is difficult; use Aurantium (Zhike), Agarwood (Chenxiang), Chebula (Hezi), and Apricot Kernel (Xingren). For the elderly and deficient persons with scant body fluids, use lubricating methods with Sesame Seed (Huma), Hemp Seed (Maren), and Donkey-hide Gelatin (Ejiao).
There is the condition of Blood Constipation, common in the elderly (tight anal sphincter in the elderly is a sign of longevity) and postpartum women (do not rush to relieve constipation lasting dozens of days after childbirth). Due to dried-up blood, blood deficiency after illness, or depletion of fluids from sweating or diuresis (fluids belong to blood), lubricating agents are appropriate, such as Cistanche Intestine-Moistening Pill (Congrong Runchang Wan), Gengyi Pill, Four-Substance Decoction (Siwu Tang) (Jian Xue Pian), along with pungent-lubricating herbs like Hemp Seed (Maren) and Apricot Kernel (Xingren). Furthermore, the Kidney controls urination and defecation; if Kidney water is deficient and dry, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (Jian Xusun Pian) to nourish water, adding slightly pungent herbs to moisten. If trauma causes blood stasis and stagnation, blocking qi movement and resulting in both urinary and fecal retention, the primary treatment is breaking stasis and guiding out retention.
There is the condition of Wind Constipation, where wind pathogen exists in the intestines and stomach; wind dries dampness and blood, causing the Large Intestine to lose moisture and accumulate. Use Search Wind and Smooth Qi Pill (Soufeng Shunqi Wan) (Jian Zhongfeng Pian) or Zaozao Yangying Decoction.
The elderly often have deficiencies in qi and blood. If the pulse is floating and deficient, it indicates qi deficiency; if deep and deficient, it indicates blood deficiency. For conditions where stool is solid and difficult to pass, penetrating drugs and Miaoxiang Pill (Jian Fanzao) may be used.
When dry stool is huge and hard, stuck at the anus making expulsion difficult, it is called Rectal Accumulation (Zhichang Jie), treated with the Guiding Method (Dao Fa).
Guiding Method: Refine honey into a strip, thick as a finger, coat with Soap Fruit powder (Zaojiao), apply oil, and insert into the anus. For cold accumulation, add Aconite Root (Caowutou) powder to resolve cold and dissipate accumulation. For heat accumulation, use Pig Bile for guidance.