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[DA Yuanli] When women suffer from constipation (constipation), it is due to the dysfunction of the five zang organs, where cold and heat pathogens knot in the intestines and stomach, causing dryness and exhaustion of body fluids (Jin-Ye), leading to obstruction of the large intestine. Thus, stool cannot be passed. Zhang Zhongjing stated: "When women have excessive menstrual flow, they lose body fluids, which also leads to difficult defecation." One may use Da Sanwan Powder, or Siwu Decoction with Qingpi, or select Qixuan Pill or Mahuang Wan for treatment.

[XUE Ji] Regarding the aforementioned conditions, either the fluids of the large intestine are dried up, or deficiency fire scorches the blood. One should not judge solely by the duration of the illness. If food intake is high, one must wait until abdominal fullness and distension occur, accompanied by the urge to defecate but inability to do so, before using pig bile to moisten the intestines. If bitter-cold or acrid-dispersing agents are taken recklessly, the primordial qi (Yuan-Qi) will be further damaged, potentially leading to unceasing diarrhea or the formation of epigastric fullness (Zhong Pi). Generally, for blood deficiency with fire dryness, use Jiawei Xiaoyao San. For combined qi and blood deficiency, use Bazhen Tang. For blood injury caused by drying herbs, use Siwu Tang, Lianqiao, and Gancao. For qi injury caused by purgative attacks, use Sijunzi Tang, Chuanxiong, and Danggui. For internal heat causing thirst with a desire for warm drinks and a surging pulse, use Zhuye Shigao Tang (refer to Miscellaneous Diseases: Xiao Dan). For internal heat causing thirst with a desire for cold drinks and a choppy pulse, use Siwu Tang to deliver Run Chang Wan. When liver and gallbladder overact on spleen earth, preventing transportation and transformation, use Xiaochaihu Tang (refer to Shaoyang Disease in Cold Damage) with Zhizi and Yuliren. When intestinal and stomach qi deficiency prevents propulsion, use Buzhong Yiqi Tang with Shaoyao. For constipation caused by accumulation of heat from rich flavors, use Qingwei San with Shaoyao (refer to Miscellaneous Diseases: Toothache). In cases of heat dryness, wind dryness, yang binding, or yin binding, damaging the middle jiao qi should be avoided; practitioners must examine carefully. A woman suffered from phlegm-wheezing and internal heat, with constipation and insomnia for two months. Her pulse was surging and large, but faint and fine upon heavy pressure. This belonged to deficiency of liver, lung, and kidney. She took Liuwei Wan in the morning and Xiaoyao San in the evening, each for over thirty doses. After consuming over a hundred bowls of food, her abdomen became distended. This corresponds to the previously mentioned blood deficiency and fire scorching. Pig bile was used to guide the passage of stool, and Shiquan Dabu Tang was used for regulation, resulting in recovery.

Tongshen San treats severe heat constipation, characterized by abdominal pain and distension intolerable to touch, mental restlessness, and appetite.
Da Huang (stir-fried), Mangxiao, Binglang, Yuliren (soaked in water, peeled, lightly stir-fried), Taoren (pounded, each 1 liang; another version includes Muxiang 0.5 liang).
Grind into powder. Take 2 qian per dose, mixed with congee water on an empty stomach.

Dama Ren Wan treats wind-binding in the intestines and stomach, characterized by chronic constipation despite having an appetite.
Dama Ren (separately ground into paste), Da Huang (stir-fried, each 2 liang), Binglang, Muxiang, Zhike (bran-fried, each 1 liang).
Grind into powder, mix evenly with the sesame paste, and make pills with refined honey the size of paulownia seeds. Take 20 pills per dose with warm water.

Zaojiao Wan treats wind in the large intestine meridian, characterized by constipation that is not hard.
Zaojiao (roasted, seeds removed), Zhike (bran-fried, equal parts).
Grind into powder, make pills with refined honey the size of paulownia seeds. Take 70 pills per dose with rice drink on an empty stomach.

Suma Porridge promotes qi movement and lubricates the intestines. Use Zisuzi and Maziren, grind with water to extract juice, and cook as porridge.

Run Chang Wan treats hidden fire and wind-heat causing dryness of the large intestine. If caused by blood loss or kidney deficiency, one should nourish kidney water; this pill is strictly contraindicated.
Maziren, Taoren (peeled, cored, separately ground, each 1 liang), Qianghuo, Dangguiwei, Da Huang (simmered), Zaojiaoren, Qinjiao (each 5 qian).
Separately grind into powder, make pills with refined honey. Take 50 pills per dose with plain boiled water on an empty stomach. If the rectum is dry and rough, use pig bile to guide the passage; the aforementioned drugs are also contraindicated.

Soushun Fengqi Wan treats hemorrhoids, fistulas, intestinal wind, wind-heat constipation, in patients with sufficient primordial qi.
Cheqianzi (1.5 liang), Damazi (lightly stir-fried), Da Huang (5 qian, half raw half cooked), Niuxi (wine-soaked), Yuliren (water-soaked), Tusizi (wine-soaked, steamed, pounded, dried, ground), Zhike (bran-fried), Shanyao (each 2 qian).
Grind into powder, make pills with refined honey the size of paulownia seeds. Take 30 pills per dose with plain boiled water on an empty stomach.

Hezi Pi Yue Wan
Maren (1.25 liang), Zhike (bran-fried), Houpo (ginger-processed), Shaoyao (each 1 liang), Da Huang (steamed, 4 liang), Xingren (peeled, cored, stir-fried, ground into paste, 1.2 liang).
Grind into powder, add almond paste and refined honey to make pills the size of paulownia seeds. Take 30-20 pills per dose with boiling water on an empty stomach.

ZHU Danxi said: I have observed that ancients generally used qi-descending herbs for purgatives. Since lung qi does not descend, the large intestine cannot transport; hence herbs like Xingren, Zhike, and Hezi are used. Furthermore, the elderly, the deficient, and those with wind disorders have less body fluids, leading to constipation. The classics state: "For stagnation, use lubrication." Hence, Huma, Xingren, Maziren, and Ejiao are used. Modern practitioners do not follow ancient methods, making arbitrary adjustments. Whenever constipation occurs, they use harsh purgatives to scour the bowels, depleting fluids and qi/blood, causing even greater constipation and other diseases. Once in Lushan, a self-proclaimed imperial physician treated Wang Shi'an, a resident from the capital suffering from wind-induced limb ailments. The physician repeatedly used harsh purgatives, leading to lung atrophy (Fei Wei) with hemoptysis of pus and blood, and finally death due to constipation. Ancients were cautious with medication, unlike moderns who disregard life. I cite this to warn future generations.

[XUE Ji] Regarding the aforementioned conditions, if stomach strength is strong but spleen weakness prevails, preventing fluids from distributing everywhere, causing them to only flow to the bladder, resulting in frequent urination and difficult defecation, use Pi Yue Wan. If yin blood is exhausted and internal fire blazes, causing spleen and lung transmission failure, resulting in constipation and frequent urination, use Run Chang Wan. This pill is effective for severe heat and excess qi, and for people in the northwest with robust constitutions. However, for people in the southeast or those with deficiency-heat and insufficient qi/blood, it will weaken the spleen further and dry the intestines, causing false fullness. This is Mr. Dongyuan's treatment method. As for Soushun Fengqi Wan, it is effective for nobles and northwesterners, but harmful to southeasterners. An elderly woman had difficulty passing stool, which was not hard, with occasional abdominal normalcy or distension. Her guan and chi pulses on both sides were floating and large. I diagnosed it as deficiency of qi and blood in the intestines and stomach. Each time she took Shiquan Dabu Tang with Rongzong, she felt relief after defecation. If she skipped doses for two or three days, abdominal distension and difficulty persisted. Another elderly woman had been constipated for over a month, with phlegm-wheezing, internal heat, and inability to lie down. Her pulse was surging and large, faint and fine upon heavy pressure. She took Liuwei Wan in the morning and Xiaoyao San in the evening, each for over fifty doses, consuming over a hundred bowls of food. Her lower abdomen became distended, indicating fire dryness consuming fluids. Pig bile was used to moisten, and Shiquan Dabu Tang was used for stabilization. Later, when constipation recurred, Bazhen Tang with increased Rongzong was taken regularly to restore regularity.