脉
两寸俱盛，四倍以上。经曰∶人迎大四倍于气口，大四倍于人
迎，名曰关。此谓俱盛四倍，盖以其病甚，而至于上则遏绝，下则闭塞，关格俱病者言之。
病
夫关格者，谓膈中觉有所碍，欲升不升，欲降不降，欲食不
食，此为气之横格也。必用吐以提其气之横格，不必在出痰也。有痰以二陈汤探吐之，吐
中便有降。有气虚不运者，补气药中升降。
丹溪曰∶此证多死，寒在上，热在下也。寒在胸中，遏绝不入，无入之理，故曰格；热在下焦，填
塞不通，无出入之由，故曰关。格则吐逆，关则不得小便。
《内经》曰∶人迎与气口俱盛，四倍以上为关格。关格之脉，羸不能极于天地之精气，则死矣。
方
两枳三陈汤 治关格，上焦痰壅，两手脉盛是也。
陈皮 半夏（各二钱） 白茯苓（一钱半） 南星 枳壳 枳实 甘草（各一钱）
上锉一剂，水煎服。用鹅毛于病患咽喉探吐之，如病虚弱，不可用也。
一方 治关格吐逆，小便不通，藿香平胃散合五苓散，加姜、枣煎服。
脉
多伏沉而结。脾脉沉数，下连于尺，为阳结；二尺脉虚，或沉
细而迟，为阴结；右尺脉浮，为风结。老人虚人脉结。脉雀啄者不治。多面黄可候。
病
夫闭结者，大便不通。《内经》云∶北方黑色，入通于肾，开窍于二阴，藏精于肾。又云∶肾主大便，
大便难者，取足少阴，夫肾主五液，津液润，则大便如常。若饥饱失节，劳役过度，损伤胃
气，反食辛热浓味之物，而助火邪，伏于血中，耗散真阴，津液
亏少，故大便结燥。然结燥之病不一，有热燥，有风燥，有阳结，有阴结，又有年老气虚，津液不足而结
燥者。法云肾恶燥，急食辛以润之，结者散之。如少阴不得大便，以辛润之；太阴不得大便，以苦泻之。阳
结者散之，阴结者温之。仲景云∶小便利而大便硬，不可攻下，以脾约丸润之。食伤太阴，腹满而食不化，
腹响而不能大便者，以苦泄之；如血燥而不能大便者，以桃仁、酒制大黄通之；风结燥者，以麻仁、大黄
利之；如风滞而不通者，以郁李仁、枳实、皂角仁润之。大抵治病必究其原，不可一概、用巴豆、牵牛
之类下之，损其津液，结燥愈甚，复下复结，极则以至导引于下而不通，遂成不救噫，可不慎哉？
治
凡脏腑之闭，不可一例治疗，有虚实之分。胃实而闭者，能饮食，小便赤，当以利气丸、三黄丸、脾药
丸之类下之；胃虚而闭者，不能饮食，小便清利，浓朴汤主之。盖实，闭物也；虚，闭气也。
若胃中停滞寒冷之物，大便不通，心腹作痛者，备急丹主之；若食伤太阴，气滞不通者，利气丸主之。
大便闭，服承气汤之类不通者，以四物汤加槟榔、枳壳、桃仁、红花。
方
润肠汤（秘方） 治虚老人大便闭结。
蜂蜜（一两） 香油（五钱） 朴硝（一撮）
上合一处，水一钟，煎数服，温服。
东流饮（谷同知传）〔批〕（按此方治实热闭结之剂） 治大便热结闭塞良方。
细茶（一撮） 生芝麻（一撮） 生桃仁（七枚） 大黄（一钱，或二、三钱） 甘草（五分）
上用长流水，生擂碎服，立效。
浓朴汤〔批〕（按此方治胃虚闭结之剂） 治胃虚而闭，不能饮食，小
便清利。
浓朴（姜汁炒，二钱六分） 白术（四钱） 枳实（面炒，一钱半） 陈皮（二钱） 半
夏（一钱八分） 甘草（炙，二钱）
上锉作二剂，每生姜三片，煎，食远温服
三和汤 治七情之气结于五脏，不能流通，以致脾胃不和，心腹痞闷，大便闭结。
羌活 紫苏（去梗） 木瓜 沉香（各一钱） 木香 白术 槟榔（各七分半）
川芎 甘草（炙） 陈皮（各七分半） 大腹皮（一钱）
上锉一剂，水煎，不拘时服。
六磨汤〔批〕（按此方治气滞闭结之剂） 治气滞腹急，大便闭结。
沉香 木香 槟榔 乌药 枳壳 大黄
上各磨浓汁，合一处，重汤煮，温服之，即通。
通幽汤 治大便难，幽门不通，上冲吸门不开，噎塞不便燥闭，气不得下，治在幽门，以辛润之。
当归（一钱） 生地黄 熟地黄 甘草（炙，各五分） 升麻 桃仁（各一钱）
红花（三分） 大黄（煨） 火麻仁（各三钱）
上作一剂，水煎去渣，调槟榔末五分，食前稍热服。
润肠丸 治老人血少，肠胃干燥，大便闭结，几日不行，甚至七八日难下，色如猪粪，小如羊粪者。
当归 生地黄 枳壳 桃仁 火麻仁（各等分）
上为末，炼蜜为丸，如梧子大。每四五十丸，清米饮下。
活血润燥丸〔批〕（按此方治血虚闭结之剂） 治久病，腹中有实热者，
脾胃中伏火，大便闭涩，不思饮食，及风门血闭，时常结燥。
当归梢（一钱） 防风（三钱） 羌活（一两） 大黄（一两，湿纸裹煨） 皂角仁（烧存
性，一两半） 桃仁（一两） 仁火麻（二两半，研）
上为末，炼蜜为丸，如梧子大。每五十丸，白汤下，二三服
后，须以苏子麻仁粥每日早晚服之，二味不拘多少，研烂，水滤取汁，煮粥食之，能顺气滑大便。
治大便不通神方（方外异人传）〔批〕（按此方治闭结下取之剂）
皮硝（一撮，水化） 香油（一盏） 皂角末（少许）
用竹管，一头套入谷道中，一头以猪尿胞，将三味入内，放竹管里，用手着力一捻，药入即通。
颠倒散（周芑崖方） 治脏腑实热，或小便不通，或大便不通，或大小便俱不通。
大黄（三钱） 滑石（三钱） 皂角（三钱）
如大便不通，加大黄三钱。如小便不通，加滑石三钱。如
大小便俱不通，大黄、滑石各加三钱，为末，空心温酒调下。
倒换散 治大小便不通。
大便不通，大黄一两，杏仁三钱。小便不通，大黄三钱，杏仁一两，水煎服。
治大小便不通（按此方治大小便不通之剂）
六七月间，寻牛粪中有大蜣螂，不拘多少，用线串起，阴干收贮，用时取一个要全者，放净砖上，
四面以灰火烘干，以刀从腰切断。如大便闭，用上半截；小便闭，用下半截，各为末，新汲水调
服。二便俱闭，则全用之。
Pulse
Both cun positions of the pulse are excessively vigorous, exceeding four times the normal rate. The Classics state: "When the Renying (carotid) pulse is four times larger than the Qikou (radial) pulse, and the Qikou pulse is four times larger than the Renying pulse, it is called Guan-Ge." This refers to both being excessively vigorous by four times, indicating that the disease is severe, causing obstruction at the upper part and blockage at the lower part, with both Guan and Ge pathologies present simultaneously.
Disease
Guan-Ge refers to a sensation of obstruction in the chest and diaphragm, where Qi desires to ascend but cannot, desires to descend but cannot, and food is desired but cannot be eaten. This is due to the horizontal obstruction of Qi. It is necessary to use emesis to lift the horizontally obstructed Qi; it is not strictly required to expectorate phlegm. If there is phlegm, Er Chen Tang (Two-Aged Powder) can be used to induce vomiting, which naturally facilitates the descent of Qi. If Qi deficiency leads to failure of transportation, ascending and descending agents should be added to Qi-tonifying herbs.
Zhu Danxi said: "This condition often results in death, characterized by cold in the upper Jiao and heat in the lower Jiao." Cold in the chest obstructs entry, leaving no way for intake, hence called "Ge" (regurgitation/obstruction); heat in the lower Jiao fills and blocks passage, leaving no way for exit or entry, hence called "Guan" (closure). Ge manifests as vomiting and reflux, while Guan manifests as inability to urinate.
The Inner Canon states: "When both Renying and Qikou pulses are excessively vigorous by four times, it is Guan-Ge. In Guan-Ge, if the body is emaciated and unable to sustain the essence and Qi of Heaven and Earth, death ensues."
Formula
Liang Zhi San Chen Tang (Two-Zhi Three-Chen Decoction): Treats Guan-Ge with turbid phlegm stagnation in the Upper Jiao and excessive pulse in both hands.
Chen Pi (Aged Tangerine Peel), Ban Xia (Pinellia Tuber) (each 2 qian), Bai Fu Ling (Poria) (1.5 qian), Nan Xing (Arisaema Rhizome), Zhi Ke (Bitter Orange Fruit), Zhi Shi (Immature Bitter Orange Fruit), Gan Cao (Licorice Root) (each 1 qian).
Crush these ingredients into one dose, decoct with water, and take orally. Use a goose feather to stimulate the patient's throat to induce vomiting. Do not use this method if the patient is weak.
Another Formula: Treats Guan-Ge with vomiting/reflux and inability to urinate. Combine Huo Xiang Ping Wei San (Agastache Powder to Stabilize the Middle) and Wu Ling San (Five-Ingredient Powder with Poria), add Sheng Jiang (Fresh Ginger) and Da Zao (Jujube), decoct, and take orally.
Pulse
The pulse is often hidden, deep, and knotted. If the Spleen pulse is deep and rapid, extending downward to the Chi position, it is Yang Jie (Yang Knot); if both Chi positions are deficient, or deep, fine, and slow, it is Yin Jie (Yin Knot); if the Right Chi pulse is floating, it is Feng Jie (Wind Knot). Elderly people and those with deficiency may present with a knotted pulse. A pulse resembling the pecking of a sparrow indicates an untreatable condition. A yellow complexion suggests a favorable prognosis.
Disease
Bi-Jie refers to constipation (inability to pass stool). The Inner Canon states: "North corresponds to black, connects internally to the Kidney, opens through the two yin passages (anus and urethra), and stores Essence in the Kidney." It also states: "The Kidney governs defecation; when defecation is difficult, select points from the Foot-Shaoyin Kidney Meridian." The Kidney governs the five fluids; when fluids are moistening, defecation is normal. If diet is irregular, labor is excessive, damaging Stomach Qi, and spicy, rich foods are consumed, aiding Fire pathogens that hide in the blood and consume True Yin, leading to fluid deficiency, stool becomes dry and hard. However, dryness/hardness varies: there is Heat Dryness, Wind Dryness, Yang Jie, Yin Jie, and dryness due to elderly Qi deficiency and insufficient fluids. The method states: "The Kidney dislikes dryness; urgently eat pungent substances to moisten it; scattered obstructions should be dispersed." For Shaoyin constipation, use pungent moistening methods; for Taiyin constipation, use bitter purgative methods. Disperse Yang Jie; warm Yin Jie. Zhang Zhongjing said: "If urination is free but stool is hard, do not purge aggressively; use Pi Yue Wan (Splee-Restriction Pill) to moisten." If dietary injury affects Taiyin, causing abdominal fullness, indigestion, borborygmus, and constipation, use bitter draining methods. If blood dryness causes constipation, use Tao Ren (Peach Kernel) and wine-processed Da Huang (Rhubarb) to unblock. For wind-dryness, use Ma Ren (Hemp Seed) and Da Huang to lubricate and promote movement. For wind-stagnation causing blockage, use Yu Li Ren (Bush Cherry Kernel), Zhi Shi, and Zao Jiao Ren (Soapberry Kernel) to moisten. Generally, treating disease requires investigating the root cause; one must not indiscriminately use harsh purgatives like Ba Dou (Croton Seed) or Qian Niu (Morning Glory Seed), as this damages fluids and worsens dryness. Repeated purging and re-blocking can lead to extreme cases where even enemas fail, resulting in incurable conditions. Is this not something to be cautious about?
Treatment
Obstructions of the Zang-Fu organs must not be treated uniformly; they differ in excess and deficiency. For Stomach Excess obstruction, where the patient can eat and urine is red/scanty, use Li Qi Wan (Qi-Regulating Pill), San Huang Wan (Three-Yellow Pill), or Pi Yao Wan (Spleen Medicine Pill) to purge. For Stomach Deficiency obstruction, where the patient cannot eat and urine is clear/profuse, treat with Hou Po Tang (Magnolia Bark Decoction). Excess involves blocking tangible matter; deficiency involves blocking Qi.
If cold substances stagnate in the Stomach, causing constipation and heart/abdominal pain, treat with Bei Ji Dan (Emergency Rescue Pill). If dietary injury affects Taiyin with Qi stagnation and blockage, treat with Li Qi Wan.
For constipation unresponsive to Cheng Qi Tang (Descending Qi Decoction) type formulas, use Si Wu Tang (Four-Substance Decoction) plus Bing Lang (Areca Seed), Zhi Ke, Tao Ren, and Hong Hua (Safflower).
Formula
Run Chang Tang (Intestine-Moistening Decoction) [Secret Recipe]: Treats constipation in frail elderly patients.
Feng Mi (Honey) (1 liang), Xiang You (Sesame Oil) (5 qian), Xiao Ming Piao Xiao (Mirabilite) (a pinch).
Mix together, add one zhong of water, decoct, divide into several doses, and take warm.
Dong Liu Yin (Eastern Flow Drink) [Transmitted by Gu Tongzhi] [Commentary: A formula for treating excess-heat constipation]: An excellent prescription for heat-bound constipation.
Xi Cha (Fine Tea) (a pinch), Sheng Zhi Ma (Raw Sesame Seed) (a pinch), Sheng Tao Ren (Raw Peach Kernel) (7 pieces), Da Huang (Rhubarb) (1 qian, or 2-3 qian), Gan Cao (Licorice Root) (0.5 qian).
Grind fresh with long-flowing water and take orally; effect is immediate.
Hou Po Tang [Commentary: A formula for treating Stomach-deficiency constipation]: Treats Stomach deficiency with obstruction, inability to eat, and clear urine.
Hou Po (Magnolia Bark, stir-fried with ginger juice) (2.6 qian), Bai Zhu (Atractylodes Macrocephala Rhizome) (4 qian), Zhi Shi (Immature Bitter Orange Fruit, stir-fried with flour) (1.5 qian), Chen Pi (Aged Tangerine Peel) (2 qian), Ban Xia (Pinellia Tuber) (1.8 qian), Gan Cao (Licorice Root, honey-fried) (2 qian).
Crush into two doses. For each dose, add three slices of fresh Sheng Jiang (Fresh Ginger), decoct, and take warm well after meals.
San He Tang (Three-Harmony Decoction): Treats Qi knotting in the Five Zang organs due to seven emotions, preventing circulation, leading to Spleen-Stomach disharmony, epigastric/chest fullness, and constipation.
Qiang Huo (Notopterygium Rhizome), Zi Su (Perilla Leaf, stems removed), Mu Gua (Chaenomeles Fruit), Chen Xiang (Aquilaria Wood) (each 1 qian), Mu Xiang (Vladimiria Root), Bai Zhu, Bing Lang (Areca Seed) (each 0.75 qian), Chuan Xiong (Ligusticum Rhizome), Gan Cao (Licorice Root, honey-fried), Chen Pi (Aged Tangerine Peel) (each 0.75 qian), Da Fu Pi (Areca Peel) (1 qian).
Crush into one dose, decoct with water, take at any time.
Liu Mo Tang (Six-Grinding Decoction) [Commentary: A formula for treating Qi-stagnation constipation]: Treats Qi stagnation with abdominal urgency and constipation.
Chen Xiang, Mu Xiang, Bing Lang, Wu Yao (Lindera Root), Zhi Ke, Da Huang.
Grind each into thick juice, mix together, heat in a double boiler, and take warm; bowel movement will follow immediately.
Tong You Tang (Unblocking the Hidden Passages Decoction): Treats difficulty defecating, obstruction of the幽门 (Pylorus/Hui-Yang), upward rushing to the吸门 (Hiatus/Aperture), dysphagia, dry constipation, and Qi failing to descend. Treatment focuses on the Hui-Yang using pungent moistening methods.
Dang Gui (Angelica Sinensis Root) (1 qian), Sheng Di Huang (Rehmannia Root, fresh), Shu Di Huang (Rehmannia Root, prepared), Gan Cao (Licorice Root, honey-fried) (each 0.5 qian), Sheng Ma (Cimicifuga Rhizome), Tao Ren (Peach Kernel) (each 1 qian), Hong Hua (Safflower) (0.3 qian), Da Huang (Rhubarb, baked), Huo Ma Ren (Hemp Seed) (each 3 qian).
Make one dose, decoct with water, strain, mix with 0.5 qian of Bing Lang (Areca Seed) powder, and take slightly warm before meals.
Run Chang Wan (Intestine-Moistening Pill): Treats elderly patients with blood deficiency, dry intestines/stomach, constipation lasting several days, or even 7-8 days with difficult passage, stool color like pig manure, small size like sheep dung.
Dang Gui, Sheng Di Huang, Zhi Ke, Tao Ren, Huo Ma Ren (equal parts).
Grind into powder, make pills with refined honey, size of wutong seeds. Take 40-50 pills per dose with clear rice water.
Huo Xue Run Zao Wan (Blood-Invigorating Dryness-Moistening Pill) [Commentary: A formula for treating blood-deficiency constipation]: Treats chronic illness with excess heat in the abdomen, latent fire in the Spleen/Stomach, constipation, loss of appetite, and blood closure at the Wind Gate causing frequent dryness.
Dang Gui Shao (Tip of Angelica Sinensis Root) (1 qian), Fang Feng (Saposhnikovia Root) (3 qian), Qiang Huo (Notopterygium Rhizome) (1 liang), Da Huang (Rhubarb) (1 liang, wrapped in wet paper and baked), Zao Jiao Ren (Soapberry Kernel, burned to retain character) (1.5 liang), Tao Ren (Peach Kernel) (1 liang), Huo Ma Ren (Hemp Seed) (2.5 liang, ground).
Grind into powder, make pills with refined honey, size of wutong seeds. Take 50 pills per dose with white boiled water. After 2-3 doses, must take Su Zi Ma Ren Zhou (Perilla Seed Hemp Seed Porridge) morning and evening daily. Use sufficient amounts of these two ingredients, grind thoroughly, filter juice with water, cook porridge, and eat. This promotes Qi flow and lubricates bowels.
Divine Prescription for Treating Constipation [Transmitted by an Outsider] [Commentary: A formula for treating constipation via lower extraction]:
Xiao Ming Piao Xiao (Mirabilite) (a pinch, dissolved in water), Xiang You (Sesame Oil) (1 zhan), Zao Jiao Mo (Soapberry Powder) (a little).
Insert one end of a bamboo tube into the anus. Attach a pig bladder to the other end. Place the three ingredients inside the bladder within the tube. Apply forceful pressure with hand to insert medicine; passage occurs immediately.
Dian Dao San (Inverted Powder) [Zhou Qiya's Formula]: Treats organ excess-heat, or inability to urinate, or inability to defecate, or both.
Da Huang (Rhubarb) (3 qian), Hua Shi (Talcum) (3 qian), Zao Jiao (Soapberry) (3 qian).
If unable to defecate, add 3 qian Da Huang. If unable to urinate, add 3 qian Hua Shi. If unable to do both, add 3 qian each of Da Huang and Hua Shi. Grind into powder, take with warm wine on an empty stomach.
Dao Huan San (Exchange Powder): Treats inability to pass both stool and urine.
For constipation: Da Huang (1 liang), Xing Ren (Apricot Seed) (3 qian). For urinary retention: Da Huang (3 qian), Xing Ren (1 liang). Decoct with water and take.
Treating Inability to Pass Both Stool and Urine [Commentary: A formula for treating both]
Between June and July, find large dung beetles in cow dung, string them with thread, dry in shade, and store. When needed, take one whole beetle, place on a clean brick, dry thoroughly with ash-fire around all sides, cut in half longitudinally with a knife. For constipation, use the upper half; for urinary retention, use the lower half. Grind into powder separately, mix with fresh drawn water, and take. If both are blocked, use the whole beetle.