论曰伤寒大便不通者，胃腑实也，盖因太阳病，若发汗若下若利小便，亡其津液，胃中
干燥，因转属阳明，不更衣，内实，大便难。此阳明证也，当下之，然有阳明证，不可下者，
当问其小便日几行，若本小便日三四行，今日再行，故知大便不久出，为小便数少，津液当
还胃中，故知不久必大便也，如此则伤寒呕多，虽有阳明证，其不可下明矣，大凡胃中有燥
粪。法当以汤水和之，汤入腹中，转失气者，此所谓有结燥，下之无害，若不转失气者，此
但初硬后必溏，不可下，下之则胀满不能食也。
治阳明病潮热，若不大便六七日，恐有燥屎，欲知之法，少与小承气汤，汤入腹中转失
气者，此有燥屎也，乃可攻之，若不转失气者，此但初头硬，后必溏，不可攻，攻之必腹胀
不能食也，欲饮水者，与水则哕。其后发热者，必大便硬而少也。以小承气汤和之方。
大黄（酒洗四两） 浓朴（去粗皮二两） 枳实（三枚麸炒）
上三味，细锉，如麻豆大，每服五钱匕，水一盏半，煎至七分，去滓温服，当更衣，不
尔者再服，更衣者勿服，服后若不转失气者，慎不可攻也。
治伤寒不大便五六日，绕脐痛烦躁，发作有时，此有燥屎。宜大承气汤方
大黄（酒洗四两） 浓朴（去粗皮炙半斤） 枳实（五枚麸炒）
上三味，细锉，如麻豆大，每服五钱匕，水一盏半，煎至八分，去滓入芒硝末一钱匕，
再煎一两沸温服，仲景又云，少阴病六七日不大便者，宜大承气汤。
治伤寒五六日大便不通，壮热头疼谵语，肠中有结燥。浓朴汤方
浓朴（去粗皮姜汁炙一两） 柴胡（去苗） 大黄（锉炒各一两半） 朴硝（二两） 枳
实（去瓤麸炒三分）
上五味，粗捣筛，每服五钱匕，水一盏，入生姜一枣大拍碎，煎至七分，去滓空心温服，
良久再服，以通为度，未通再服。
治伤寒大便不通，呕吐。浓朴半夏汤方
浓朴（去粗皮生姜汁炙锉） 半夏（汤洗七遍焙各一两） 枳壳（去瓤麸炒半两） 大
黄（锉二两）
上四味，粗捣筛，每服五钱匕，水一盏半，生姜一枣大拍碎，煎至八分，去滓空心温服，
如人行五里再服。
治伤寒五六日大便不通，气喘。桑白皮汤方
桑根白皮（锉一两） 大腹皮（锉半两） 枳实去（瓤麸炒） 大黄（锉炒各二两）
上四味，粗捣筛，每服三钱匕，水一盏，入生姜一枣大拍碎，煎至六分，去滓下朴硝末
半钱匕，空心温服，未通再服，以通为度。
治伤寒热气未解，恶寒头痛壮热，四五日大便不通。柴胡黄芩汤方
柴胡（去苗） 黄芩（去黑心） 土瓜根 白藓皮（各一两） 木香 茵陈蒿（各一两
一分） 山栀子仁（三分） 大黄（细锉醋炒一两半）
上八味，粗捣筛，每服三钱匕，水一盏，煎至六分，去滓下朴硝末半钱匕，空心温服，
如人行五里再服，未通以葱豉粥投之。
治伤寒伏热在肠胃，大便不通。槟榔散方
槟榔（锉二两） 木香 枳壳（去瓤麸炒） 陈橘皮（汤浸去白炒各一两） 白术 大
戟（锉炒各半两） 杏仁（汤浸去皮尖炒） 干姜（炮各三分）
上八味，捣罗为细散，每服一钱匕，煎生姜汤调下，不拘时。
治伤寒趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，则人便硬，其脾为约。麻
仁丸方
麻子仁（半升） 芍药（二两） 浓朴（二寸半去粗皮姜汁炙透） 枳实（麸炒一两三
分） 杏仁（去皮尖双仁炒二合半） 大黄（四两）
上六味，为细末，炼蜜丸如梧桐子大，每服十丸，以饮下，未知渐加，以知为度日三。
治伤寒大便不通。郁李仁散方
郁李仁（去皮尖炒研） 桃仁（去皮尖双仁炒研） 大黄（锉炒） 槟榔锉（各二两） 芎
（一两半） 木香（半两）
上六味，捣罗四味为细散，入二味研者和匀，每服三钱匕，食前温汤调下，以通为度。
治伤寒后风气壅滞，胸膈聚痰，大便不通。牵牛丸方
牵牛子（一半生一半炒二两） 半夏（汤洗七遍炒干） 木通（锉各一两） 桑根白皮
（锉三分） 青橘皮（去白锉炒半两）
上五味，捣罗为末，炼蜜和捣三五百杵。丸如梧桐子大，每服二十丸，空心生姜汤下，
临卧再服。
治伤寒大便五六日不通。麻仁汤方
麻子仁 黄芩（去黑心） 甘草（炙锉） 栀子仁（各半两） 大黄（锉炒一两）
上五味，粗捣筛，每服五钱匕，水一盏半，煎至八分，去滓下朴硝末半钱匕温服。如人
行五里再服。
治伤寒阳明证自汗若发汗，小便自利者，此为津液内竭，虽硬不可攻之，当须自欲大便。
宜蜜煎导方
蜜（四两）
上一味，纳铜器中，微火煎，搅勿令焦，稍凝如饴状，可丸即捻如指许长二寸，乘热纳
下部中，若土瓜根及大猪胆汁，皆可为导。
治伤寒后，大便秘涩，服药不便，蜜胆导方
白蜜（三合） 猪胆（一枚） 腻粉（半分）
上三味，先炼蜜一二十沸，次下猪胆汁，慢火煎成膏，入腻粉相和为丸，如枣核大，以
薄绵裹，纳下部中，未通再用。
治伤寒后，大便不通，并吃转泻药后。腹胁转胀不通利方
盐（半斤）
上一味，熬令色变，用醋浆水二斗，煎五七沸，下盐搅匀，泻入盆中，看冷暖得所，令
病患盆中坐，淋浴少腹，须臾便通。
Commentary states: In typhoid fever (Shanghan), constipation is caused by excess syndrome in the stomach fu. This usually occurs because, during the Taiyang disease stage, whether through sweating, purging, or promoting urination, body fluids are depleted, leading to dryness in the stomach. Consequently, the condition transforms into Yangming disease, manifesting as infrequent bowel movements, internal excess accumulation, and difficulty defecating. This is a Yangming syndrome, which should be treated with purgation. However, even if Yangming symptoms are present, purgation should not be used lightly; one must inquire about the frequency of urination per day. If the patient originally urinated three or four times a day but only twice today, it can be deduced that stool will pass soon. This is because reduced urination allows body fluids to return to the stomach, indicating that bowel movement will likely resume shortly. Similarly, if a typhoid patient has frequent vomiting, even if Yangming symptoms are present, purgation is clearly contraindicated. Generally, when there is dry fecal impaction in the stomach, according to principles, decoctions should be administered to harmonize. If, after the decoction enters the abdomen, the patient passes gas, this indicates dry impaction, and purgation is harmless. If the patient does not pass gas, it suggests that only the initial stool is hard while the rest is loose; purgation is contraindicated here, as it would cause abdominal distension and an inability to eat.
For treating Yangming disease with tidal fever, if there has been no bowel movement for six or seven days and dry impaction is suspected, the method to confirm this is to administer a small dose of Xiaochengqi Tang (Minor Order the Yellow Decoction). If the patient passes gas after taking the decoction, it confirms dry impaction, and aggressive purgation may proceed. If no gas is passed, it indicates only the initial stool is hard and the rest is loose; aggressive purgation is contraindicated, as it will inevitably lead to abdominal distension, anorexia, and hiccups if water is given. Subsequent fever indicates the stool will be hard and scanty. The formula for harmonizing with Xiaochengqi Tang is as follows:
Da Huang (Rhubarb Root and Rhizome, washed in wine, 4 liang) Hou Po (Magnolia Bark, coarse skin removed, 2 liang) Zhi Shi (Immature Bitter Orange, stir-fried with bran, 3 pieces)
The above three herbs are finely chopped to the size of hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.7 sheng. Strain and take warm. Bowel movement should occur; if not, administer again. Stop if bowel movement occurs. If no gas is passed after administration, strictly avoid aggressive purgation.
For treating typhoid fever with five to six days of constipation, periumbilical pain, irritability, and intermittent onset, indicating dry impaction, use Dachengqi Tang (Major Order the Yellow Decoction):
Da Huang (Rhubarb Root and Rhizome, washed in wine, 4 liang) Hou Po (Magnolia Bark, coarse skin removed, roasted, half jin) Zhi Shi (Immature Bitter Orange, stir-fried with bran, 5 pieces)
The above three herbs are finely chopped to the size of hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.8 sheng. Strain and add 1 qianbi of Mang Xiao (Mirabilite powder). Boil for one or two more boils and take warm. Zhang Zhongjing also stated that for Shaoyin disease with five to six days of constipation, Dachengqi Tang is appropriate.
For treating typhoid fever with five to six days of constipation, high fever, headache, delirium, and intestinal dry impaction, use Houpo Tang (Magnolia Bark Decoction):
Hou Po (Magnolia Bark, coarse skin removed, roasted with ginger juice, 1 liang) Chai Hu (Bupleurum Root, shoots removed) Da Huang (Rhubarb Root and Rhizome, crushed and stir-fried, each 1.5 liang) Piao Xiao (Mirabilite, 2 liang) Zhi Shi (Immature Bitter Orange, pulp removed, stir-fried with bran, 3 fen)
The above five herbs are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1 sheng of water with a piece of fresh ginger (size of a jujube, crushed) until reduced to 0.7 sheng. Strain and take warm on an empty stomach. Take again after some time. Continue until unobstructed; if not unobstructed, administer again.
For treating typhoid fever with constipation and vomiting, use Houpo Banxia Tang (Magnolia Bark and Pinellia Decoction):
Hou Po (Magnolia Bark, coarse skin removed, roasted with ginger juice, crushed) Banxia (Pinellia Tuber, washed in hot water seven times, dried, each 1 liang) Zhi Ke (Aurantii Fructus, pulp removed, stir-fried with bran, 0.5 liang) Da Huang (Rhubarb Root and Rhizome, crushed, 2 liang)
The above four herbs are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with a piece of fresh ginger (size of a jujube, crushed) until reduced to 0.8 sheng. Strain and take warm on an empty stomach. Administer again after the time it takes to walk five li.
For treating typhoid fever with five to six days of constipation and panting, use Sangbaipi Tang (Mulberry Root Bark Decoction):
Sang Gen Bai Pi (Mulberry Root Bark, crushed, 1 liang) Da Fu Pi (Areca Peel, crushed, 0.5 liang) Zhi Shi (Immature Bitter Orange, pulp removed, stir-fried with bran) Da Huang (Rhubarb Root and Rhizome, crushed and stir-fried, each 2 liang)
The above four herbs are coarsely crushed and sifted. Each dose consists of 3 qianbi, boiled in 1 sheng of water with a piece of fresh ginger (size of a jujube, crushed) until reduced to 0.6 sheng. Strain and add 0.5 qianbi of Piao Xiao (Mirabilite powder). Take warm on an empty stomach. If not unobstructed, administer again. Continue until unobstructed.
For treating typhoid fever where heat pathogen has not resolved, with aversion to cold, headache, high fever, and constipation for four to five days, use Chaihu Huangqin Tang (Bupleurum and Scutellaria Decoction):
Chai Hu (Bupleurum Root, shoots removed) Huang Qin (Scutellaria Root, black heart removed) Tu Gua Gen (Trichosanthes Root) Bai Xian Pi (Dictamni Cortex, each 1 liang) Mu Xiang (Costus Root) Yin Chen Hao (Artemisiae Scopariae Herba, each 1 liang 1 fen) Shan Zhi Zi Ren (Gardeniae Semen, 3 fen) Da Huang (Rhubarb Root and Rhizome, finely crushed, stir-fried with vinegar, 1.5 liang)
The above eight herbs are coarsely crushed and sifted. Each dose consists of 3 qianbi, boiled in 1 sheng of water until reduced to 0.6 sheng. Strain and add 0.5 qianbi of Piao Xiao (Mirabilite powder). Take warm on an empty stomach. Administer again after the time it takes to walk five li. If not unobstructed, administer Cong Chi Zhou (Green Onion and Fermented Soybean Porridge).
For treating typhoid fever with latent heat in the stomach and intestines causing constipation, use Binglang San (Areca Seed Powder):
Bing Lang (Areca Seed, crushed, 2 liang) Mu Xiang (Costus Root) Zhi Ke (Aurantii Fructus, pulp removed, stir-fried with bran) Chen Pi (Aged Tangerine Peel, soaked in hot water, white pith removed, stir-fried, each 1 liang) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Da Ji (Euphorbiae Pekinensis Radix, crushed and stir-fried, each 0.5 liang) Xing Ren (Prunus Armeniaca Seed, soaked in hot water, skin and tip removed, stir-fried) Gan Jiang (Dried Ginger, roasted, each 3 fen)
The above eight herbs are pounded and sieved into a fine powder. Each dose consists of 1 qianbi, taken with ginger decoction. Time of administration is unrestricted.
For treating typhoid fever with Fuyang pulse floating and choppy, where floating indicates strong stomach qi and choppy indicates frequent urination, the combination leads to hard stool and constrained spleen function, use Mahuang Wan (Hemp Seed Pill):
Ma Zi Ren (Cannabis Fruit, half sheng) Shao Yao (Peony Root, 2 liang) Hou Po (Magnolia Bark, 2.5 cun, coarse skin removed, roasted with ginger juice until permeated) Zhi Shi (Immature Bitter Orange, stir-fried with bran, 1 liang 3 fen) Xing Ren (Prunus Armeniaca Seed, skin and tip removed, double-kernel, stir-fried, 2.5 he) Da Huang (Rhubarb Root and Rhizome, 4 liang)
The above six herbs are ground into fine powder. Honey pills are made the size of paulownia seeds. Each dose consists of 10 pills, taken with drink. Increase gradually if effect is unknown, stopping when effective. Take three times daily.
For treating typhoid fever with constipation, use Yuliren San (Cherry Kernel Powder):
Yu Li Ren (Pruni Semen, skin and tip removed, stir-fried and ground) Tao Ren (Persicae Semen, skin and tip removed, double-kernel, stir-fried and ground) Da Huang (Rhubarb Root and Rhizome, crushed and stir-fried) Bing Lang (Areca Seed, crushed, each 2 liang) Xiong (Ligustici Chuanxiong Rhizoma, 1.5 liang) Mu Xiang (Costus Root, 0.5 liang)
The above six herbs: four are pounded and sieved into fine powder, mixed with the two ground ingredients. Each dose consists of 3 qianbi, taken with warm water before meals. Continue until unobstructed.
For treating post-typhoid wind-qiang stagnation, phlegm accumulation in chest and diaphragm, and constipation, use Qianni Wan (Morning Glory Seed Pill):
Qian Niu Zi (Pharbitidis Semen, half raw half stir-fried, 2 liang) Banxia (Pinellia Tuber, washed in hot water seven times, stir-fried dry) Mu Tong (Akebiae Caulis, crushed, each 1 liang) Sang Gen Bai Pi (Mulberry Root Bark, crushed, 3 fen) Qing Ju Pi (Green Tangerine Peel, white pith removed, crushed and stir-fried, 0.5 liang)
The above five herbs are pounded into powder. Mixed with honey and pounded 300-500 times. Pills are made the size of paulownia seeds. Each dose consists of 20 pills, taken with ginger decoction on an empty stomach. Take again before sleep.
For treating typhoid fever with five to six days of constipation, use Mahuang Tang (Hemp Seed Decoction):
Ma Zi Ren (Cannabis Fruit) Huang Qin (Scutellaria Root, black heart removed) Gan Cao (Licorice Root, roasted and crushed) Zhi Zi Ren (Gardeniae Semen, each 0.5 liang) Da Huang (Rhubarb Root and Rhizome, crushed and stir-fried, 1 liang)
The above five herbs are coarsely crushed and sifted. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water until reduced to 0.8 sheng. Strain and add 0.5 qianbi of Piao Xiao (Mirabilite powder). Take warm. Administer again after the time it takes to walk five li.
For treating Yangming syndrome in typhoid fever with spontaneous sweating, subsequent sweating, and free urination, indicating depletion of internal body fluids, even if stool is hard, aggressive purgation is contraindicated. One must wait for the natural urge to defecate. Use Mi Jian Dao (Honey Suppository):
Mi (Honey, 4 liang)
The above single ingredient is placed in a copper vessel and gently heated over low fire, stirring constantly to prevent burning. When slightly thickened like malt syrup, shape into a cylinder finger-thick and two cun long. Insert into the lower orifice (anus) while warm. Tu Gua Gen (Trichosanthes Root) or large pig bile can also be used as suppositories.
For treating post-typhoid severe constipation and difficulty taking oral medication, use Mi Dan Dao (Honey and Pig Gallbladder Suppository):
Bai Mi (White Honey, 3 he) Zhu Dan (Pig Gallbladder, one) Ni Fen (Calomelas, 0.5 fen)
The above three ingredients: first boil honey for ten to twenty boils, then add pig gallbladder juice. Simmer over low fire until paste-like. Mix in Ni Fen (Calomelas) and form pills the size of a jujube pit. Wrap in thin silk and insert into the lower orifice (anus). Repeat if unobstructed.
For treating post-typhoid constipation and abdominal/flank distension after using drastic purgatives, use Yan Fang (Salt Method):
Yan (Salt, half jin)
The above single ingredient is roasted until color changes. Add 2 dou of vinegar-brine water and boil for five to seven boils. Dissolve salt evenly, pour into a basin. Adjust temperature to suit. Have the patient sit in the basin and irrigate the lower abdomen. Stool will pass shortly.