左 大便闭阻，时辄少寐。脏阴亏损，则腑阳转燥矣。
鲜苁蓉（七钱洗） 栝蒌仁（二钱） 火麻仁（二钱） 杏仁泥（三钱） 白芍（一钱五分） 茯
神（三钱） 风化硝（一钱五分） 炒枣仁（二钱） 油当归（三钱） 白蜜（二钱冲）
左 大便闭结，身热痰多。脉象弦大，舌干无津。此由痉搐之后，痰热内滞，清津不升，浊
液不降。衰羸情形也。
淡豆豉（三钱） 制半夏（一钱五分） 白桔梗（一钱） 杏仁泥（四钱） 黑山栀（三钱） 广郁
金（一钱五分） 炙紫菀（一钱） 栝蒌仁（七钱） 风化硝（七分） 枇杷叶（去毛四片）
左 偏右腹板不舒，大便闭阻不行。湿滞而脾土不能鼓舞运旋也。
光杏仁 紫菀肉 广郁金 制香附 南楂炭 焦麦芽
炒枳壳 皂荚子 枇杷叶
某 久痢脏阴损伤，腑阳转燥。便艰不爽。
火麻仁 光杏仁 生山药 白芍 黑芝麻 栝蒌仁 油当归 鲜苁蓉 生甘草
某 年近古稀，腿股软弱，兹则大便不解。六脉细涩。血液枯燥。宜养血润肠。
鲜苁蓉（一两洗） 火麻仁（三钱） 甜杏仁（三钱） 松子仁（三钱） 当归（二钱） 柏子仁（去油三
钱） 炒牛膝（三钱） 鲜首乌（六钱） 生山药（二钱）
二诊 便虽畅行，而肠液枯燥，但食而不便者，又三日矣。再滋润咸降。
火麻仁（三钱） 杭白芍（一钱五分） 生熟草（各一分五厘） 当归（二钱） 生山药（三钱） 炒麦冬
（一钱五分） 鲜苁蓉（六钱洗） 炒杞子（三钱） 黑元参（二钱） 炒牛膝（三钱） 枇杷叶（去毛四片）
三诊 大便渐调。再润肠养血，参以补气。
西党参 当归 生山药 火麻仁 生熟谷芽 野于术 白芍 柏子仁 炒杞子 炒牛膝
邱（右） 形寒里热，腹膨不舒，腰酸气坠，大便坚硬，欲解不解。木旺肠枯。拟养营润肠。
鲜苁蓉（七钱） 栝蒌仁（四钱） 甘杞子（三钱） 怀牛膝（三钱） 白蜜（二钱冲） 大麻仁（三钱）
光杏仁（三钱） 金铃子（一钱五分） 杭白芍（一钱五分）
二诊 大便渐通，腹膨较舒，而少腹偏左仍觉板滞。的是木旺气化为火，脏阴日亏，则腑阳日燥。再养
血润肠，以清气火。
细生地（四钱） 大麦冬（三钱） 生白芍（二钱） 郁李仁（三钱） 白蜜（二钱冲） 大元参（四钱）
火麻仁（三钱） 柏子仁（三钱） 甘杞子（三钱） 更衣丸（先服二钱）
三诊 大便通行，腹胀板滞已化。肝木纵横之气，化而为火，暗铄阴津，频带口渴。宜甘凉清养。
杭白芍（一钱五分） 川石斛（四钱） 生甘草（三分） 白茯苓（三钱） 青果（二枚） 川楝子（一钱五分）
大天冬（二钱） 干橘叶（二钱） 白蒺藜（二钱） 左金丸（五分）
四诊 口渴稍定，大便仍然艰燥。还是气火有余。
川石斛（四钱） 甜杏仁（三钱） 川楝子（一钱五分） 茯苓（三钱） 南花粉（二钱） 大天冬（三钱）
干橘叶（一钱五分） 白芍（酒炒一钱五分） 更衣丸（三钱先服）
五诊 大便已经畅行，胀满已退，口渴大减。然舌苔仍然花糙。气化为火，劫烁阴津，不能遽复。再降气
火而育阴津。
阿胶珠（二钱） 细生地（四钱） 生甘草（三分） 大天冬（三钱） 橘叶（一钱五分） 川雅连（三分）
天花粉（二钱） 川楝子（一钱五分） 杭白芍（一钱五分）
翁 便不畅行，虽解溏薄，依然胀满不舒。此府浊不泄，与燥结者有间。
砂仁 郁金 磨沉香 广皮 藿梗 紫菀 枳壳 桔梗 光杏仁 小温中丸
此方不用栝蒌，因湿结也。不用白蜜麻油，非热结风结也。（清儒附志）
贾（左） 便不畅行，胸次不舒，每至便阻，头面辄发 瘰。脉濡不爽。此湿热有余，脾土不能鼓舞运旋。拟
和中泄浊，参以分利。
制半夏 广皮 泽泻 赤猪苓 小温中丸（三钱） 广郁金 蔻仁 沉香 大腹皮
右 营血素亏，肝火湿热蕴于大肠。大便坚燥。暂用子和玉烛意。
大生地 当归炭 炒丹皮 火麻仁 生山药 炒白芍 缩砂仁 左金丸 润肠丸
奚 用介宾先生化肝煎法，原欲其化气化火，化有为无也。乃下坠之气，依然不松。脉关弦，右部微滑。
良以浊在府中，浊不得泄，致肝木之气不能和协。暂为破泄府浊，以觇动静如何。
冬瓜子 光杏仁 生薏仁 青芦管 小温中丸（三钱药汤送下）
二诊 胀气稍舒，大便未解。
冬瓜子 云茯苓 光杏仁 盐竹茹 青芦管 枇杷叶 小温中丸
三诊 气之攻筑，虽退十三，而胀坠不舒，仍所不免，大便艰涩。浊得渐泄，而肾虚木旺。再进金匮润补法。
炒全当归（三钱） 生姜（三片） 精羊肉（一两五钱煎汤去油沫代水煎药）
四诊 泄浊之后，坠气较松。然肛门微觉不能收摄，气冲作呛。脉细带涩。府浊虽得稍泄，而病久肾虚，
阴不固摄，以此而呛咳不退。再摄其阴。
炒熟地 五味子 光杏仁 当归 砂仁 盐水炒菟丝子 青蛤散 制半夏 广皮
Left pulse presentation: Stool is obstructed and difficult to pass, accompanied by frequent insomnia. This is due to the deficiency of Zang Yin (Yin substances of the Zang organs), leading to the transformation of Fu Yang (Yang heat of the Fu organs) into dryness.
Prescription: Cistanche Herba (Rongrong), fresh, 7 qian, washed; Trichosanthis Semen (Gualou Ren), 2 qian; Cannabis Seed (Huomaren), 2 qian; Almond Paste (Xingren Ni), 3 qian; Paeoniae Radix Alba (Baishao), 1.5 qian; Poria (Fushen), 3 qian; Natrii Sulfas Exsiccatus (Fenghuaxiao), 1.5 qian; Ziziphi Spinosae Semen Torrefactum (Chao Zaoren), 2 qian; Angelicae Sinensis Radix (You Danggui), 3 qian; Honey (Baimi), 2 qian, dissolved in decoction.
Left pulse presentation: Stool is bound, body fever, and profuse phlegm. The pulse is wiry and large; the tongue is dry without fluids. This results from internal stagnation of Phlegm-Heat following convulsions/spasms, where clear fluids fail to ascend and turbid fluids fail to descend. It indicates a state of emaciation and debility.
Prescription: Soja Preparata (Dandouchi), 3 qian; Pinelliae Rhizoma Preparatum (Zhi Banxia), 1.5 qian; Platycodonis Radix (Bai Jiegeng), 1 qian; Almond Paste (Xingren Ni), 4 qian; Gardeniae Fructus (Hei Shanzhi), 3 qian; Curcumae Longae Rhizoma (Guang Yujin), 1.5 qian; Asteris Radix et Rhizoma Zhi (Zhi Ziwan), 1 qian; Trichosanthis Semen (Gualou Ren), 7 qian; Natrii Sulfas Exsiccatus (Fenghuaxiao), 0.7 qian; Eriobotryae Folium (Pipaye), 4 leaves, hairs removed.
Left pulse presentation: Right abdominal area feels hard and uncomfortable; stool is obstructed and does not pass. This is caused by Dampness stagnation, preventing the Spleen Earth from inspiring and rotating transportation.
Prescription: Almond (Guang Xingren); Aster Root (Ziwan Rou); Curcuma Longa (Guang Yujin); Cyperi Rhizoma (Zhi Xiangfu); Crataegi Fructus Carbonized (Nanzha Tan); Malto Fermentatus Carbonized (Jiao Maiya); Aurantii Fructus Immaturus Torrefactus (Chao Zhiqiao); Gleditsiae Spina (Zaojiazi); Eriobotryae Folium (Pipaye).
Certain patient: Chronic dysentery has damaged Zang Yin, causing Fu Yang to turn dry. Defecation is difficult and unsatisfactory.
Prescription: Cannabis Seed (Huomaren); Almond (Guang Xingren); Dioscoreae Rhizoma (Sheng Shanyao); Paeoniae Radix Alba (Baishao); Sesame Seed Niger (Heimazhi); Trichosanthis Semen (Gualou Ren); Angelicae Sinensis Radix (You Danggui); Cistanche Herba (Xian Rongrong); Glycyrrhizae Radix et Rhizoma (Sheng Gancao).
Certain patient: Approaching seventy years of age, legs and thighs are weak; currently unable to pass stool. All six pulses are fine and choppy. Blood is dry and deficient. Treatment should nourish blood and moisten the intestines.
Prescription: Cistanche Herba (Rongrong), fresh, 1 liang, washed; Cannabis Seed (Huomaren), 3 qian; Sweet Almond (Tian Xingren), 3 qian; Pine Nut (Songziren), 3 qian; Angelicae Sinensis Radix (Danggui), 2 qian; Platycladi Semen (Baiziren), oil removed, 3 qian; Achyranthis Bidentatae Radix Torrefacta (Chao Niuxi), 3 qian; Polygoni Multiflori Caulis (Xian Shouwu), 6 qian; Dioscoreae Rhizoma (Sheng Shanyao), 2 qian.
Second visit: Although stool passes freely, intestinal fluids are dry; food was consumed three days ago but no bowel movement occurred. Continue with moistening and salty-descending methods.
Prescription: Cannabis Seed (Huomaren), 3 qian; Hangzhou Paeoniae Radix Alba (Hang Baishao), 1.5 qian; Raw and Prepared Licorice Roots (Sheng Shu Cao), each 0.15 qian; Angelicae Sinensis Radix (Danggui), 2 qian; Dioscoreae Rhizoma (Sheng Shanyao), 3 qian; Ophiopogonis Tuber Torrefacta (Chao Maidong), 1.5 qian; Cistanche Herba (Rongrong), fresh, 6 qian, washed; Lycii Fructus Torrefacta (Chao Qizi), 3 qian; Scrophulariae Radix (Hei Yuanshen), 2 qian; Achyranthis Bidentatae Radix Torrefacta (Chao Niuxi), 3 qian; Eriobotryae Folium (Pipaye), 4 leaves, hairs removed.
Third visit: Bowel movements are gradually regulated. Continue to moisten intestines and nourish blood, supplemented by Qi-tonifying methods.
Prescription: Codonopsis Radix (Xi Dangshen); Angelicae Sinensis Radix (Danggui); Dioscoreae Rhizoma (Sheng Shanyao); Cannabis Seed (Huomaren); Raw and Prepared Hordei Fructus Germinatus (Sheng Shu Guya); Wild Atractylodis Macrocephalae Rhizoma (Ye Yuzhu); Paeoniae Radix Alba (Baishao); Platycladi Semen (Baiziren); Lycii Fructus Torrefacta (Chao Qizi); Achyranthis Bidentatae Radix Torrefacta (Chao Niuxi).
Qiu (Right pulse): Chills externally and heat internally, abdominal distension and discomfort, sore lower back, sensation of Qi sinking, hard stool, desire to defecate but inability to do so. Liver Wood is hyperactive, intestines are withered. Propose nourishing Ying and moistening intestines.
Prescription: Cistanche Herba (Rongrong), fresh, 7 qian; Trichosanthis Semen (Gualou Ren), 4 qian; Lycii Fructus (Gan Qizi), 3 qian; Huai Achyranthis Bidentatae Radix (Huai Niuxi), 3 qian; Honey (Baimi), 2 qian, dissolved in decoction; Hemp Seed (Dama Ren), 3 qian; Almond (Guang Xingren), 3 qian; Meliae Semen (Jinlingzi), 1.5 qian; Hangzhou Paeoniae Radix Alba (Hang Baishao), 1.5 qian.
Second visit: Bowel movements gradually unblock, abdominal distension is more comfortable, but the left side of the hypogastrium still feels hard. Indeed, Liver Wood hyperactivity transforms Qi into Fire; as Zang Yin declines daily, Fu Yang becomes dry daily. Continue nourishing blood and moistening intestines to clear Qi-level Fire.
Prescription: Rehmanniae Radix Recens (Xi Shengdi), 4 qian; Liriope Tuber (Da Maidong), 3 qian; Raw Paeoniae Radix Alba (Sheng Baishao), 2 qian; Prunus Armeniaca Kernel (Yuliren), 3 qian; Honey (Baimi), 2 qian, dissolved in decoction; Scrophulariae Radix (Da Yuanshen), 4 qian; Cannabis Seed (Huomaren), 3 qian; Platycladi Semen (Baiziren), 3 qian; Lycii Fructus (Gan Qizi), 3 qian; Gengyi Pill (Gengyi Wan), take 2 qian first.
Third visit: Bowel movements flow, abdominal distension and hardness have resolved. The rampant Qi of Liver Wood has transformed into Fire, secretly burning Yin fluids, causing frequent thirst. Use sweet-cool clearing and nourishing methods.
Prescription: Hangzhou Paeoniae Radix Alba (Hang Baishao), 1.5 qian; Dendrobii Caulis (Chuan Shihu), 4 qian; Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao), 0.3 qian; Poria (Bai Fuling), 3 qian; Canarium Fruit (Qingguo), 2 pieces; Meliae Semen (Chuan Lianzi), 1.5 qian; Asparagi Tuber (Da Tiandong), 2 qian; Dried Tangerine Peel (Gan Jiuye), 2 qian; Tribuli Fructus (Bai Jili), 2 qian; Zuojin Pill (Zuojin Wan), 0.5 qian.
Fourth visit: Thirst slightly subsided, but stool remains hard and dry. Still excess Qi-Fire.
Prescription: Dendrobii Caulis (Chuan Shihu), 4 qian; Sweet Almond (Tian Xingren), 3 qian; Meliae Semen (Chuan Lianzi), 1.5 qian; Poria (Fuling), 3 qian; Nardostachys Radix et Rhizoma (Nanhua Fen), 2 qian; Asparagi Tuber (Da Tiandong), 3 qian; Dried Tangerine Peel (Gan Jiuye), 1.5 qian; Paeoniae Radix Alba (Baishao), wine-fried, 1.5 qian; Gengyi Pill (Gengyi Wan), 3 qian, take first.
Fifth visit: Bowel movements have flowed freely, distension has receded, thirst greatly reduced. However, tongue coating is still mottled and rough. Qi transforming into Fire has depleted Yin fluids, which cannot recover immediately. Continue descending Qi-Fire and nurturing Yin fluids.
Prescription: Gelatinae Corii Asini Pulvis (Ejiao Zhu), 2 qian; Rehmanniae Radix Recens (Xi Shengdi), 4 qian; Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao), 0.3 qian; Asparagi Tuber (Da Tiandong), 3 qian; Tangerine Peel (Jiuye), 1.5 qian; Coptidis Rhizoma (Chuan Yalian), 0.3 qian; Trichosanthis Radix (Tianhuafen), 2 qian; Meliae Semen (Chuan Lianzi), 1.5 qian; Hangzhou Paeoniae Radix Alba (Hang Baishao), 1.5 qian.
Weng: Bowel movements are not smooth; although loose stools are passed, abdominal distension and discomfort persist. This is failure of Fu turbidity to evacuate, distinct from dry obstruction.
Prescription: Amomi Fructus (Sharen); Curcumae Longae Rhizoma (Yujin); Agarwood (Moxiang); Citri Reticulatae Pericarpium (Guangpi); Agastaches Herba (Huogeng); Asteris Radix et Rhizoma (Ziwan); Aurantii Fructus Immaturus (Zhiqiao); Platycodonis Radix (Jiegeng); Almond (Guang Xingren); Xiaowenzhong Pill.
Note: This prescription excludes Trichosanthis Semen because it is Dampness obstruction, not Heat or Wind obstruction. It excludes honey and sesame oil for similar reasons. (Recorded by Qing scholar)
Jia (Left pulse): Bowel movements are not smooth, chest feels uncomfortable; whenever stool is blocked, scrofula appears on head and face. Pulse is soggy and unsmooth. This is excess Damp-Heat, with Spleen Earth failing to inspire and rotate transportation. Propose harmonizing middle and draining turbidity, supplemented by separating clear from turbid.
Prescription: Pinelliae Rhizoma Preparatum (Zhi Banxia); Citri Reticulatae Pericarpium (Guangpi); Alismatis Rhizoma (Zexie); Polyporus (Chi Zhuling); Xiaowenzhong Pill (3 qian); Curcumae Longae Rhizoma (Guang Yujin); Cardamomi Fructus (Kouren); Agarwood (Chenxiang); Arecae Pericarpium (Dafupi).
Right pulse presentation: Ying-Blood has been deficient since youth; Liver Fire and Damp-Heat accumulate in the Large Intestine. Stool is hard and dry. Temporarily use the intent of Hezi's Yuzhu Decoction.
Prescription: Rehmanniae Radix Recens (Da Shengdi); Angelicae Sinensis Radix Carbonized (Danggui Tan); Paeoniae Radix Rubra Torrefacta (Chao Danpi); Cannabis Seed (Huomaren); Dioscoreae Rhizoma (Sheng Shanyao); Paeoniae Radix Alba Torrefacta (Chao Baishao); Amomi Fructus (Suosha Ren); Zuojin Pill; Runchang Pill.
Xi: Used Mr. Meibin's Huagan Jian method, originally intending to transform Qi and Fire into nothingness. However, the sinking Qi remains unresolved. The Guan pulse position is wiry, right side slightly slippery. This is because turbidity is in the Fu organs and fails to evacuate, preventing Liver Wood Qi from harmonizing. Temporarily break down and drain Fu turbidity to observe dynamics.
Prescription: Benincasae Semen (Dongguazi); Almond (Guang Xingren); Coicis Semen (Sheng Yiren); Reed Rhizome (Qing Luguan); Xiaowenzhong Pill (3 qian, taken with decoction).
Second visit: Distension and Qi slightly relieved, but stool not yet passed.
Prescription: Benincasae Semen (Dongguazi); Cloud Poria (Yun Fuling); Almond (Guang Xingren); Bamboo Shavings Salt-Fried (Yan Zhuru); Reed Rhizome (Qing Luguan); Eriobotryae Folium (Pipaye); Xiaowenzongi Pill.
Third visit: Qi attacking and pressing has receded by about one-third, but distension and heaviness remain unavoidable; stool is difficult and slippery. Turbidity is gradually draining, but Kidney deficiency and Liver Wood hyperactivity exist. Advance to Jin Gui moistening and tonifying method.
Prescription: Angelicae Sinensis Radix Torrefacta (Chao Quandanggui), 3 qian; Fresh Ginger (Shengjiang), 3 slices; Lean Mutton (Jing Yangrou), 1.5 liang, decocted to remove fat foam, used as water to decoct herbs.
Fourth visit: After draining turbidity, sinking Qi is looser. However, anus feels slightly unable to retain, Qi rushing causes coughing. Pulse is fine and slightly choppy. Although Fu turbidity has slightly drained, long-standing illness has caused Kidney deficiency; Yin fails to secure and retain, hence cough persists. Continue to secure Yin.
Prescription: Rehmanniae Radix Preparata (Chao Shudi); Schisandrae Fructus (Wuweizi); Almond (Guang Xingren); Angelicae Sinensis Radix (Danggui); Amomi Fructus (Sharen); Cuscutae Semen Salt-Fried (Yanshui Chao Tusizi); Qingge San; Pinelliae Rhizoma Preparatum (Zhi Banxia); Citri Reticulatae Pericarpium (Guangpi).