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The etiology of difficult defecation lies in the disharmony of the five Zang organs, with an imbalance of Yin and Yang, a mixture of cold and heat, deficiency and excess, and dysfunction of the San Jiao (Triple Burner), resulting in the binding of cold and heat pathogens. The Stomach is the sea of the five grains; the essence from food and drink transforms into Ying (Nutritive Qi) and Wei (Defensive Qi), while the dregs are transported to the Large Intestine for excretion. When the five Zang organs and the San Jiao fail to harmonize, cold and heat qi become stagnant and obstructed... [Note: The original text contains fragmented phrases regarding pulse diagnosis ("in the Kidney...涩/se", "Cunkou... body heat... pulse tight") and a disjointed reference to *Zhou Hou Bei Ji Fang* which interrupts the flow. These fragmented diagnostic descriptions are omitted for coherence as they do not form complete sentences in the source.]

**Zhou Hou Bei Ji Fang** (Handbook of Prescriptions for Emergencies) treats disharmony of the Spleen and Stomach, specifically chronic hard and difficult defecation:
Da Huang (Rhei Radix et Rhizoma), Shao Yao (Paeoniae Radix Alba), Hou Po (Magnoliae Officinalis Cortex) [stir-fried, each 2 liang], Zhi Shi (Aurantii Fructus Immaturus) [6 pieces, stir-fried], Huo Ma Ren (Cannabis Semen) [separately ground, 5 he].
Grind the above five herbs into powder, mix with Huo Ma Ren, and use honey to form pills the size of paulownia seeds. Take 10 pills per dose, three times daily, gradually increasing the dosage until bowel movement becomes smooth. This can be taken regularly. (This formula also appears in *Ji Yan Bei Ji Fang* and *Gu Jin Lu Yan*, recorded in Volume 2).

**Qian Jin Fang** (Essential Prescriptions Worth a Thousand Gold) treats difficult defecation:
Moxibustion on two points of Chengjin (BL57), three moxa cones per point, located in the depression at the center of the popliteal crease.

Another prescription:
Use only Dou Chi (Sojae Semens Praeparatum) juice, Jiang Qing (fermented soybean liquid), Yang Lao (sheep cheese), or Tu Gua Gen (Trichosanthis Radix) juice, administered alone via enema or oral intake, resulting in immediate evacuation. (Fan Wang's formula is identical).

There is also Lian Zhong Wan, primarily treating retained food stagnation and difficult defecation:
Da Huang (Rhei Radix et Rhizoma) [8 liang], Ting Li Zi (Lepidii Semen) [roasted], Xing Ren (Armeniacae Semen Amarum) [skin and tip removed, roasted], Mang Xiao (Natrii Sulfas) [each 4 liang].
Grind the above four herbs into powder, use refined honey to form pills the size of paulownia seeds. Take 10 pills per dose, three times daily, with slight increases if necessary. (All from Volume 15).

**Bei Ji Fang** (Emergency Prescription) for constipation lasting ten days to a month:
Kui Zi (Malvae Semen) [2 sheng], water [4 sheng], boil to obtain 1 sheng of decoction, remove dregs. Take once; if not cured, prepare again and take, yielding good results. Avoid garlic and roasted meat. (From *Gu Jin Lu Yan*, Wen Zhong, Fan Wang; Yao Fang recorded in Volume 6).

**Gu Jin Lu Yan** Maziren Wan treats difficult defecation with frequent urination but no thirst, known as Pi Yue (Spleen Constraint):
Huo Ren (Cannabis Semen) [2 sheng, separately ground into paste], Zhi Shi (Aurantii Fructus Immaturus) [half jin, stir-fried], Shao Yao (Paeoniae Radix Alba) [half jin], Da Huang (Rhei Radix et Rhizoma) [1 jin], Hou Po (Magnoliae Officinalis Cortex) [1 chi, stir-fried], Xing Ren (Armeniacae Semen Amarum) [1 sheng, skin and tip removed, roasted, separately ground into fat/oil].
Grind the above six herbs into powder, use refined honey to form pills the size of paulownia seeds. Take 10 pills per dose with warm water, gradually increasing to 30 pills, three times daily. (This originates from Zhang Zhongjing's *Shanghan Lun*, recorded in Volume 26).