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Yu Hengde treated a woman in her fifties. She was of small stature and suffered from dry, obstructed stool with reduced food intake and lower abdominal pain. Yu palpated her six pulses, finding them all deep, hidden, knotted, and choppy, diagnosing it as Blood Deficiency (Xue Xu). He prescribed Siwu Tang (Four Substances Decoction) added with Tao Ren (Peach Seed), Ma Ren (Hemp Seed), and Da Huang (Rhubarb Root) calcined. After several doses, the obstruction persisted, and distension worsened. He then administered Zhishi Daozhi Wan (Immature Bitter Orange to Guide Out Stagnation Pill) from Li Dongyuan and Beiji Wan (Emergency Rescue Pill), but the medicine was vomited shortly after swallowing. This was because the Stomach Qi (Wei Qi) was deficient and could not retain potent, fast-acting drugs. Consequently, he wrapped Beiji Wan in beeswax, pierced a hole with a fine needle, and instructed the patient to take three pills. The wax coating prevented the drug from directly irritating the Stomach Qi, allowing it to pass through the pylorus into the large and small intestines. The next day, she passed approximately one jin (approx. 500g) of dry feces. Subsequently, he continued with modified Siwu Tang, taken with Run Chang Wan (Intestine Moistening Pill). After over a month of such regulation, her bowel movements normalized, food intake increased, and she recovered.

A man suffered from severe constipation due to smallpox. Pediatricians considered retained stool a good omen. From onset until the resolution of the rash, he had not defecated for twenty-five days. His anus and large intestine were in severe pain, with cries heard by neighbors. Enema with Gao Jiao Fen (Gleditsia Sinensis Powder) and honey suppositories, along with internal administration of Dachengqi Tang (Major Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), Zhishi Daozhi Wan, and Beiji Wan, were all ineffective. Yu stated: "This is residual toxin and stagnant heat from the smallpox lodged between the large and small intestines." He ordered the patient to drink a large cup of sesame oil, but this failed from morning till night. Then, he had a maid hold sesame oil in her mouth and blow it into the patient's anus using a small bamboo tube for over half an hour. The patient reported feeling the oil moving upward like an earthworm. After another short while, he passed one or two jin of black stool and fell into a restful sleep, recovering.

Xue Lizhai treated a seventy-three-year-old woman suffering from phlegm-wheezing, internal heat, constipation, and insomnia for two months. Her pulse was surging and large, but faint and thin upon heavy pressure. This indicated deficiency of the Liver, Lung, and Kidney. He prescribed Liuwei Wan (Six-Ingredient Pill with Rehmannia) in the morning and Xiaoyao San (Free and Easy Wanderer Powder) in the evening, each for over thirty doses. After consuming over a hundred bowls of medicinal diet, abdominal fullness began. He then used pig bile enema to unblock the bowels, followed by Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) for regulation, leading to recovery. If the previous medicines were interrupted, food intake would decrease and symptoms would recur.

Wang Shishan treated a woman who became ill at her wedding due to fatigue from riding in a sedan chair and emotional distress. She suffered from lower abdominal distension and pain, with both large and small bowel obstructions. Physicians had purged her three times with Mang Xiao (Mirabilite) and Da Huang, but obstruction returned immediately after relief. Symptoms worsened to include chest/diaphragm and epigastric distension/pain, spontaneous sweating, and poor appetite. Wang palpated her pulses as soft, thin, and rapid; the Heart pulse was prominent, and the Right pulse felt weak. Wang said: "This is Spleen injury due to fatigue and emotional distress. The Spleen has lost its function of transformation and transportation, causing Qi stagnation and resulting in constipation. Using Mang Xiao and Da Huang only benefits Blood but does not move Qi." He prescribed Ren Shen (Ginseng Root) 2 qian, Dang Gui Shen (Angelica Sinensis Root Body) 1.5 qian, Chen Pi (Tangerine Peel), Zhi Ke (Bitter Orange Fruit), and Huang Qin (Scutellaria Root) each 0.7 qian. The patient recovered after decocting and taking this formula.

Li Shizhen stated: A noble lady nearly sixty years old suffered from intestinal obstruction for decades, having a bowel movement only once every ten days, with pain worse than childbirth. Nourishing Blood and moistening dryness herbs caused chest discomfort; purgatives like Mang Xiao and Da Huang were ineffective. For over thirty years, she experienced this. I examined her: she was obese, consumed rich foods, and was prone to melancholy, often vomiting about a bowl of sour saliva before feeling relief. She also had frequent fire-related illnesses. This was due to Qi congestion in the Triple Burner (San Jiao), rising without descending, where body fluids transformed into phlegm-fluids that could not nourish the intestines downward. It was not comparable to Blood dryness. Moistening agents stayed stagnant; Mang Xiao and Da Huang entered only the Blood level and could not move Qi, all blocked by phlegm, hence ineffective. He used Qian Niu Zi (Morning Glory Seed) powder made into pills with Gao Jiao Gao (Gleditsia Extract). Bowel movements became smooth immediately. Thereafter, one dose relieved any sensation of obstruction, allowed normal eating, and restored vitality. Qian Niu moves the Qi level and unblocks the Triple Burner; when Qi flows smoothly, phlegm and fluids dissipate, and the upper and lower passages become clear.

Gao Guozai treated Prime Minister Wen Tiren. Upon retiring to Wucheng, he suffered from dry, obstructed stool, chest/diaphragm fullness, and anorexia. His Kidney pulse was deep, small, and spiritless. He prescribed Zhi Ke (Bitter Orange Fruit) 5 qian and Rong Cao (Cistanche Stem) 2 liang, washed and decocted in water, which was effective. When constipation recurred, he prescribed Dang Gui (Angelica Sinensis Root) and Shou Wu (Polygonum Multiflorum Root) in large doses, leading to complete recovery.

Li Shicai treated Vice Minister Jiang Tian'an. After drinking Wu Jia Pi Wine (Acanthopanax Bark Wine), he developed severe constipation and abdominal distension. Taking 1 qian of Da Huang provided temporary relief followed by recurrence. Li said: "Kidney Qi is declining, and body fluids are insufficient. Mistaken use of draining purgatives exacerbates dryness." He prescribed Liuwei Tang (Six-Ingredient Decoction) added with 1 zhong of human milk and 5 qian of white honey. Bowel movements resumed after three doses, and he recovered fully in ten days.

Literati Gu Yizhen suffered from wind-disease and chronic constipation for years. Shicai said: "This is called Wind Constipation (Feng Mi). The general principle is to treat Blood first when treating wind." He used Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) added with Qin Jiao (Gentiana Macrophylla Root), Ma Ren (Hemp Seed), Xing Ren (Apricot Seed), Fang Feng (Saposhnikovia Root), and roasted Gao Jiao Ren (Gleditsia Seed). Effect was seen in half a month, and no recurrence occurred after three months.

Zhang Jingyue treated the mother of Academician Zhu. Nearly seventy years old, she developed chills and fever after a fall in May. Physicians treated her with Yin-nourishing and fire-clearing herbs such as Sheng Di Huang (Rehmannia Root), Bai Shao (White Peony Root), Mu Dan Pi (Moutan Cortex), Huang Qin (Scutellaria Root), and Zhi Mu (Anemarrhena Rhizome). Her condition worsened daily. Zhang palpated her pulses as powerless. Although she had heat on her head and upper body, her mouth was not thirsty, and her feet were cold up to the thighs. He said: "This is Yin deficiency with pathogenic invasion, not caused by the fall itself, but truly a Yin syndrome." He prescribed Liyin Jian (Decoction to Benefit Yin) added with Ren Shen (Ginseng Root) and Chai Hu (Bupleurum Root). After two doses, fever subsided, and she ate two to three bowls of porridge daily. However, she had not had a bowel movement for half a month, and her abdomen gradually distended. Others argued the dryness was due to fire and wanted to use cooling agents. Zhang said: "With such pulses, at such an age, and with such cold feet, if we clear fire again, the root will collapse, and it cannot be done." The Classic states: "The Kidney dislikes dryness; hasten to eat pungent substances to moisten it." This applies here. He continued with the previous prescription, adding Jiang (Ginger) and Fu Zi (Aconite Root), doubling Ren Shen and Dang Gui. After several doses, bowel movements resumed, distension receded, and symptoms gradually resolved.

Zhen notes: Yu's aggressive attack with harsh drugs was ingenious in wrapping pills in wax and piercing holes, and the sesame oil's detoxification was ingenious in drinking above and blowing below. Xue's and Wang's use of tonification differed in weight. Gao's and Li's use of moistening agents differed slightly in strength. Li Shizhen's use of Qian Niu and Gao Jiao for unblocking was vastly different from Mang Xiao and Da Huang. Zhang Jingyue's use of Ginger, Aconite, Ginseng, and Angelica was sharply distinct from cold-slippery agents. Having recorded the essence, the superficial may be deleted.