夫大便难者。由五脏不调。阴阳偏有虚实。谓三焦不和。则冷热并结故也。胃为水谷之
海。
肠胃
治身有大热。热毒流于四肢。骨节急痛不可忍。腹中烦满。大便涩难。大黄饮子
方。
川大黄（一两锉碎微炒） 杏仁（一两汤浸去皮尖双仁麸炒微黄） 栀子仁（一两） 川
升麻
（一两） 枳实（一两麸炒微黄） 黄芩（一两） 生地黄（二两） 人参（半两去芦头） 甘
草（半
两炙
上件药。细锉和匀。每服半两。以水一大盏。入生姜半分。豉半合。煎至五分。去滓。
空腹温服。
治五实病。大便难。宜服此方。
川大黄（二两锉碎微炒） 郁李仁（一两汤浸去皮微炒） 川朴硝〔一（二）两半〕 吴
茱萸
（半两汤浸七遍焙干微炒）
上件药。捣细罗为散。每于食前。以蜜水调下三钱。以利为度。
治大便难。五脏气壅。三焦不和。热结秘涩。麻仁丸方。
大麻仁（二两） 川大黄（一两锉碎微炒） 枳壳（一两麸炒微黄去瓤） 赤芍药（一
两） 郁
李仁（一两汤浸去皮微炒） 川芒硝（一两） 槟榔（一两）
上件药。捣罗为末。炼蜜和捣三二百杵。丸如梧桐子大。每服空心。以生姜汤下三十丸。
晚再服之。
治宿食不消。大便难。宜服此方。
川大黄（二两锉碎微炒） 甜葶苈（一两隔纸炒令紫色） 川芒硝（一两） 杏仁〔二
（一）
两汤浸去皮尖双仁麸炒微黄〕 青橘皮〔一两汤浸去白瓤焙（微炒）〕
上件药。捣罗为末。炼蜜和丸。如梧桐子大。每服空心。以生姜汤下三十丸。晚再服之
治肠胃冷热不和。大便难秘。食饮不消。心腹妨闷。槟榔丸方。
槟榔（一两） 诃黎勒皮（一两） 柴胡（三分去苗） 桂心（一两） 草豆蔻（半两
去皮） 木
香
七遍微
炒）
治脾胃不和。常患大便坚难。宜服此方。
川大黄（二两锉碎微炒） 枳实（一两麸炒微黄） 大麻仁（二两别捣如膏） 赤芍药
（二两）
浓朴（二两去粗皮涂生姜汁炙令香熟）
上件药。捣罗为末。研入麻仁令匀。炼蜜和捣三二百杵。丸如梧桐子大。每服空心。以
生姜汤下三十丸。晚食前再服。以利为度
Difficulty in defecation arises from the disharmony of the Five Zang Organs (Five Viscera), with an imbalance of Yin and Yang manifesting as excess or deficiency. Specifically, it is due to the dysfunction of the Sanjiao (Triple Burner), causing cold and heat pathogens to bind together. The Stomach is the sea of water and grain.
For treating severe body heat, where heat-toxins flow into the four limbs, causing unbearable stiffness and pain in the bone joints, abdominal vexation and fullness, and difficult, astringent defecation: Da Huang Yin Zi Decoction (Rhubarb Drink Formula).
Chuan Dahuang (Cortex et Radix Rhei, 1 liang, crushed and slightly stir-fried) Xingren (Semen Armeniacae Amarum, 1 liang, soaked in hot water, skin and pointed end removed, double-kernel wheat bran-stir-fried until slightly yellow) Zhizi Ren (Fructus Gardeniae, 1 liang) Chuan Shengma (Rhizoma Cimicifugae, 1 liang) Zhishi (Fructus Aurantii Immaturus, 1 liang, wheat bran-stir-fried until slightly yellow) Huangqin (Radix Scutellariae, 1 liang) Sheng Dihuang (Radix Rehmanniae Praeparata, 2 liang) Renshen (Radix Ginseng, 0.5 liang, rhizome removed) Gancao (Radix Glycyrrhizae, 0.5 liang, honey-fried).
The above herbs are finely chopped and mixed evenly. Take 0.5 liang per dose, add one large cup of water, half a portion of fresh ginger, and half a he of fermented soybeans. Decoct until five parts remain, filter out the dregs, and take warm on an empty stomach.
For treating Wu Shi Bing (Diseases of Five Excesses, referring to excessive pathogenic factors in the five Zang organs) with difficulty in defecation, this formula is suitable.
Chuan Dahuang (Cortex et Radix Rhei, 2 liang, crushed and slightly stir-fried) Yuliren (Semen Pruni, 1 liang, soaked in hot water, skin removed, slightly stir-fried) Chuan Puxiao (Natrii Sulfas, 1.5 liang) Wuzhuyu (Fructus Evodiae, 0.5 liang, soaked in hot water seven times, dried by baking, and slightly stir-fried).
The above herbs are pounded into a fine powder through a sieve. Before meals, take 3 qian per dose, mixed with honey-water. Stop when bowel movement becomes free.
For treating difficulty in defecation due to Qi stagnation in the Five Zang Organs, dysfunction of the Sanjiao (Triple Burner), and constipation caused by heat binding: Ma Ren Wan (Hemp Seed Pill).
Da Ma Ren (Semen Cannabis, 2 liang) Chuan Dahuang (Cortex et Radix Rhei, 1 liang, crushed and slightly stir-fried) Zhike (Fructus Aurantii, 1 liang, wheat bran-stir-fried until slightly yellow, pith removed) Chi Shaoyao (Radix Paeoniae Rubra, 1 liang) Yuliren (Semen Pruni, 1 liang, soaked in hot water, skin removed, slightly stir-fried) Chuan Mangxiao (Natrii Sulfas, 1 liang) Binglang (Semen Arecae, 1 liang).
The above herbs are pounded into powder, mixed with refined honey, and pounded for three to two hundred strokes. Form pills the size of paulownia seeds. Take 30 pills on an empty stomach with ginger decoction, and repeat at night.
For treating undigested food retention and difficulty in defecation, this formula is suitable.
Chuan Dahuang (Cortex et Radix Rhei, 2 liang, crushed and slightly stir-fried) Tingli (Semen Lepidii seu Descurainiae, 1 liang, stir-fried between papers until purple) Chuan Mangxiao (Natrii Sulfas, 1 liang) Xingren (Semen Armeniacae Amarum, 1 liang, soaked in hot water, skin and pointed end removed, double-kernel wheat bran-stir-fried until slightly yellow) Qing Ju Pi (Pericarpium Citri Reticulatae Viride, 1 liang, soaked in hot water, white pith removed, dried or slightly stir-fried).
The above herbs are pounded into powder, mixed with refined honey, and formed into pills the size of paulownia seeds. Take 30 pills on an empty stomach with ginger decoction, and repeat at night.
For treating disharmony of cold and heat in the intestines and stomach, difficult and bound defecation, indigestion, and chest/abdominal oppression: Binglang Wan (Areca Nut Pill).
Binglang (Semen Arecae, 1 liang) Helile Pi (Endocarpus Chebulae, 1 liang) Chaihu (Radix Bupleuri, 3 fen, radix removed) Guixin (Cortex Cinnamomi, 1 liang) Caodoukou (Semen Amomi Rotundum, 0.5 liang, skin removed) Muxiang (Radix Aucklandiae, stir-fried seven times).
For treating disharmony of the Spleen and Stomach, characterized by chronic hard and difficult defecation, this formula is suitable.
Chuan Dahuang (Cortex et Radix Rhei, 2 liang, crushed and slightly stir-fried) Zhishi (Fructus Aurantii Immaturus, 1 liang, wheat bran-stir-fried until slightly yellow) Da Ma Ren (Semen Cannabis, 2 liang, separately pounded into paste) Chi Shaoyao (Radix Paeoniae Rubra, 2 liang) Nongpo (Cortex Magnoliae Officinalis, 2 liang, coarse bark removed, coated with ginger juice, and roasted until fragrant).
The above herbs are pounded into powder, mixed with hemp seed paste, combined with refined honey, and pounded for three to two hundred strokes. Form pills the size of paulownia seeds. Take 30 pills on an empty stomach with ginger decoction, and repeat before dinner. Stop when bowel movement becomes free.