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The *Yellow Emperor's Inner Canon* states: The North corresponds to the color black; Kidney Qi communicates through the meridians with the Kidneys, and its orifices open at the two yin (anterior and posterior). (From this, it can be known that constipation is primarily attributed to the Shaoyin Kidney channel. Although symptoms vary, the root cause is always the depletion of body fluids.) The Kidneys dislike dryness; one should urgently consume pungent substances to moisten them (such as *Danggui* [Angelicae Sinensis Radix] and *Rongrong* [Cistanches Herba]).

The Kidneys govern the five fluids. When body fluids are abundant, bowel movements are normal. Excessive sexual activity depletes essence and blood, often leading to constipation. Alternatively, irregular eating or overexertion damages Stomach Qi. Or, long-term consumption of spicy, hot, rich, and strong flavors gradually aids fire, which lurks in the blood, dissipating true Yin and causing a deficiency of body fluids, resulting in dry and hard stools. Elderly people, whose blood is not abundant, often suffer from this disease. Therefore, ancient physicians classified constipation into types such as Stomach excess with Spleen deficiency, Wind Constipation, Qi Constipation, Phlegm Constipation, Cold Constipation, Heat Constipation, Deficiency Constipation, and Excess Constipation. In clinical practice, careful inquiry and examination are essential.

In cases of Stomach Excess Constipation, the patient has a good appetite and dark, scanty urine; *Maren Wan* (Hemp Seed Pill) is indicated. In cases of Spleen Deficiency failing to transport and transform, manifesting as fatigue and reluctance to speak or move, *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) is used, with increased doses of *Shengma* (Cimicifugae Rhizoma), *Chaihu* (Bupleuri Radix), and *Danggui*. After decocting, raw honey and sesame oil are added. As clear Qi ascends, turbid Qi naturally descends. For Spleen deficiency leading to lower constipation, this decoction can be used to administer *Maren Wan*.

Wind Constipation occurs when wind pathogens invade the Large Intestine, impairing transmission functions. It is treated with *Qufang*, *Suzi*, *Zhike*, *Maren*, *Xingren*, and *Zaojiao Hui* (Ash of Gleditsia Sinensis Fruit Pod), decocted and administered as *Runchang Wan* (Moisten the Intestines Pill).

Qi Constipation arises from dysfunction in the ascending and descending of Qi, where Grain Qi fails to ascend. Patients often belch. It is treated with *Zhike*, *Chenxiang*, *Suzi*, *Binglang*, *Wuyao*, and *Chenpi*, decocted and administered as *Jiangqi San* (Descend Qi Powder), or alternatively *Simoge Tang* (Four Mo Decoction) or *Liuge Tang* (Six Mo Decoction).

Phlegm Constipation is caused by phlegm-fluids and damp-heat obstructing Qi dynamics, leading to impaired ascent and descent. Symptoms include sweating on the head, asthma, chest fullness, hypochondriac stuffiness, dizziness, and borborygmus. It is treated with *Banxia*, *Fuling*, *Muxiang*, *Binglang*, *Zhishi*, *Juhong*, *Xiangfu*, *Baijiezi*, ginger juice, and *Zhuli* (Bamboo Sap). If ineffective, *Dahuang* and *Huanglian* are added. In severe cases, *Kongxian Dan* (Control Fluids Pill) is used for purgation.

Cold Constipation presents with deep and slow pulses, white or dark complexion, congealed cold binding, blocked Stomach Qi, abdominal pain aggravated by movement, and a preference for warmth while disliking cold. It is treated with *Huoxiang*, *Houpo*, *Ganjiang*, *Rougui*, *Zhike*, *Chenpi*, and *Shengjiang*, decocted and administered as *Banshou Wan* (Half-Sulfur Pill). Hot medicines often cause constipation, but *Sulfur* is mild and promotes bowel movement. Cold medicines often cause diarrhea, but *Huanglian* thickens the intestines and stops diarrhea. In cases of Yin-cold constipation, Yang-promoting medicines should be taken cool. However, among several doses, occasionally insert one dose of clearing and moistening medicine to prevent re-accumulation of constipation. If the root pathology is deficiency-cold but the branch manifests as restlessness and heat, a small amount of bitter-cold medicine should be added to the Yang-warming formula to remove heat and restlessness; stop adding once restlessness ceases.

Heat Constipation presents with rapid and solid pulses, red face, dry mouth, body heat, intestinal bloating, desire for cold drinks, or mouth and tongue sores, indicating heat binding in the Small and Large Intestines. It is treated with *Suzi*, *Huangqin*, *Shengdi*, *Shaoyao*, *Xingren*, and *Zhike*, decocted and administered as *Runchang Wan* or *Sishun Qingliang Yin* (Four-Obedience Cooling Clearing Drink).

Deficiency Constipation is characterized by inability to eat, clear and copious urine, or occurs in the elderly, after prolonged illness, or due to Spleen deficiency with fluid exhaustion and blood shortage. Ingredients include *Guishen* (Angelicae Sinensis Radix), *Shudi* (Rehmanniae Radix Preparata), *Rongrong*, *Renshen*, [missing character], *Chenxiang*, *Songziren*, *Taoren*, *Maren*, and honey. Alternatively, *Maren*, *Zhike*, *Danggui*, and *Renshen* are made into honey pills. For thin individuals with blood deficiency and fire-induced constipation, *Tongyou Tang* (Open the Hidden Passage Decoction) is decocted with honey. For the elderly with fluid exhaustion, postpartum women with excessive blood loss, patients after diaphoresis or diuresis, those with unresolved Qi and Blood deficiency after illness, or those with deficiency fever and bone-steaming, all can develop constipation. These conditions require tonifying Qi, replenishing water, and nourishing blood. Purgatives like *Xiaoshi* (Natrii Sulfas) and *Dahuang* (Rhei Radix et Rhizoma) must be avoided. *Badou* (Crotonis Fructus) and *Qianniu* (Pharbitidis Semen) are strictly prohibited.

There is a type of constipation where the abdomen is bloated and distended, the urge to defecate is present but unsuccessful, frequent attempts to use the toilet lead to excessive straining, causing deficient Qi to sink into the anus, resulting in tenesmus and unbearable urgency, accompanied by rebellious Qi, nausea, thirst, inability to eat, and continuous groaning. Using purgatives causes Qi to collapse downward; using lifting agents causes Qi to rebel upward, worsening nausea. This is treated with *Renshen*, *Zhike*, and *Danggui* decocted together; adding *Chen Xiangyuan Pi* (Exocarpium Citri Grandis) is particularly effective.

For Kidney Blood deficiency with Large Intestine Wind Constipation, fresh *Heshouwu* (Polygoni Multiflori Radix) is crushed to extract one cup of natural juice, mixed with white honey, warmed, and taken. *Liuwei Wan* (Six-Ingredient Pill with Rehmannia) mixed with honey also promotes bowel movement. *Guben Wan* (Solidify the Root Pill) taken regularly as an electuary is also excellent. Ancient formulas for elderly dry constipation often use *Rongrong*. However, if the Stomach Qi is deficient, taking it orally may induce vomiting. Obese individuals often have phlegm-dampness in the Stomach, making it unsuitable. Only in cases of Mingmen Fire decline with failure of opening and closing functions is it appropriate. It must be taken as pills; if decocted, it will likely cause vomiting due to its salty taste and turbid aroma.

A Daoist prescription for Kidney-Liver Wind Constipation with slight chills and fever at night uses a large dose of fresh *Heshouwu* decocted and taken at once, showing miraculous effects. However, it is contraindicated in acute diseases with heat pathogen binding or internal stagnation, as it is purely Yin, astringent, and lacks the power to support healthy Qi and expel pathogens.

After blood loss, with irritability, thirst, and constipation, take fresh *Shengdi* (Rehmanniae Radix) juice alone. After severe illness, with insomnia and constipation, take roasted *Zaoren* (Ziziphi Spinosae Semen), ground and mixed with water, strained, and cooked into porridge to be eaten frequently. For blood dryness and constipation, *Shudi* fried with honey is commonly taken regularly, or prepared as an electuary. For elderly blood-deficiency constipation, use 4 liang each of *Shengdi*, *Guishen*, and fresh *Heshouwu*, plus 1 liang of *Guangpi* (Citri Reticulatae Pericarpium), decocted into an electuary; take half a small cup warm. If ineffective, repeat three to five times for effect.

Excess Constipation is characterized by good appetite, dark and scanty urine. Ingredients include *Zhishi*, *Binglang*, *Muxiang*, *Sharen*, *Pzhu* (Curcumae Aromatica Rhizoma), *Dahuang*, and ash of soap pod flesh. For Qi stagnation with abdominal urgency and hard stool, *Liuge Tang* with added *Dahuang* is used. For various constipations unresponsive to medication, or for deficient patients fearing purgatives, use *Mi Jian Dao* (Honey Suppository) or *Jiang Dao* (Ginger Suppository), selected based on cold or heat patterns. *Zhu Dan Dao* (Pig Bile Suppository) should not be lightly tried unless there is Shaoyang heat pathogen binding. In patients with deficient Stomach Qi, its use often risks hiccups; caution is required.

Someone asked: "If dryness is extreme, can *Xiaoshi* and *Dahuang* be used temporarily?" The answer was: "*Chengqi Tang*" uses *Xiaoshi* and *Dahuang* because Shaoyang heat pathogens have entered the interior, drying up Stomach fluids and exhausting Kidney water. Thus, urgent purgation to save Yin fluids is necessary. However, for the elderly, deficient persons, or those post-illness with pre-existing Kidney water deficiency causing dryness, using *Xiaoshi* and *Dahuang* again makes deficiency more deficient. Although immediate relief is gained, constipation will worsen later. Further purgation would fail even on iron or stone. In such cases, advise the patient to remain calm and seek gradual recovery. Do not act rashly and bring harm upon yourself.

[Diagnosis] Yang-Jie (Yang Binding) pulse is deep and rapid, or hurried. Yin-Jie (Yin Binding) pulse is slow and hidden, or knotted. In the elderly and deficient persons with constipation, the pulse is often deep, hidden, knotted, and irregular. If a "Sparrow Pecking" pulse appears, the condition is untreatable.