经曰∶太阴司天，阴痹，大便难，阴气不用，病在于肾。
又曰∶太阳之胜，隐曲不利，互引阴股。陈飞霞曰∶夫饮食之物，有入必有出也。苟大便不通，出入之机，几乎
息矣。急宜通之，使旧谷去，而新谷得入。然有实闭，有虚闭，最宜详审。如形实、气实、脉实，又能食者，的有
可下之证，则下之。如八正散、承气汤、木香槟榔丸之类，择而用之。中病即止，不可过也。如形虚、气虚、脉虚，
而兼食少者，虽有可下之证，宜缓不宜急，但用保和丸，加枳实微利之。如平素便难者，血不足也，宜润肠丸，
蜜导煎法。
八正散 （见二便方内）
大承气汤 （见前痉病方内）
枳壳（一钱） 浓朴（一钱） 大黄（一钱） 芒硝（一钱）
《集成》木香槟榔丸
黑牵牛（炒取头末，五个） 尖槟榔 锦纹黄 木香 神曲
上共为细末，姜汁打米糊为丸，量儿大小加减用之。
《集成》保和丸
神曲（一钱） 陈皮（一钱） 法半夏（一钱） 茯苓（一钱） 山楂肉（一钱） 连翘（一钱）
《集成》润肠丸
火麻仁（去壳） 光杏仁（去皮） 桃仁（去皮） 陈枳壳 当归尾（以上各七钱半） 阿胶珠 萝卜子
苏叶（各二钱）
上为细末，炼蜜为丸，每服一二钱，量人加减，白汤调下。
涂蔚生曰∶润肠丸即仲景脾约丸之意。脾约丸为治脾火太旺，将肠胃津液煎枯，而大便干结者。润肠丸
虽本此意以为加减，而苏叶之杂于其间，则不如脾约丸之纯。推此意以求，则阴虚至急，肾火至盛，将肠胃煎熬
极枯，燥结极甚者，则生地萸肉知柏芩连俱可加入。予在正阳，曾治一素患阴虚之人。忽患大便
燥结，他医尽为推荡，愈治而愈甚。予为之用脾约丸原方，重用生地、龟胶、芩连等味而愈者。足见大便之结，
不仅实热然也。而陈飞霞以虚者用保和丸，加枳实微利之，是其既未免患虚之嫌。又未知虚者，又有何种类，如
何治法也。若夫脾湿阴滞，津液不降，须得苓术而大便通者，则犹非飞霞所能知者也。但此中最少，不过百分之
一二耳，不可不知。
仲景脾约丸（一名麻仁丸）
麻仁（二钱） 白芍（一钱） 大黄（一钱） 枳壳（七分） 浓朴（五分） 杏仁（一钱）
The *Huangdi Neijing* states: When Taiyin (Taiyin Wet Earth) governs the year, Yin Bi (pain caused by cold-dampness obstructing the meridians) occurs, accompanied by difficult defecation. This is due to the dysfunction of Yin Qi, with the pathology located in the Kidney.
It also states: When Taiyang (Taiyang Cold Water) qi prevails, there will be obstruction in urination or defecation, and pain radiating to the inner thighs. Chen Feixia said: Food and drink enter the body and must eventually exit. If defecation is blocked, the mechanism of intake and output is nearly ceased. It is urgent to unblock it so that old food residue can leave and new food can enter. However, constipation is divided into Excess Constipation (Shi Bi) and Deficiency Constipation (Xu Bi), which requires careful differentiation. If the patient's constitution is robust, Qi is sufficient, the pulse is forceful, and appetite is good, there are indeed indications for purgation; thus, purgative methods should be employed. Formulas such as Bazen San (Eight-Right Powder), Chengqi Tang (Chengqi Decoction), and Muxiang Binglang Wan (Areca Seed and Costus Root Pill) may be selected for use. Stop taking the medicine once the disease is addressed; do not overdo it. If the patient's constitution is weak, Qi is deficient, the pulse is thready/weak, and appetite is poor, even if there are indications for purgation, a gentle approach is preferred over an aggressive one. One should only use Baohe Wan (Harmonize the Stomach Pill) with added Zhishi (Immature Bitter Orange) to gently promote bowel movement. If one usually suffers from difficult defecation, it is due to Blood deficiency; Runchang Wan (Moisten the Intestines Pill) combined with Midao Jianfa (Honey Suppository Method) is appropriate.
Bazen San (See formulas for urinary and fecal disorders)
Dachengqi Tang (See formulas for Spasm disease previously mentioned)
Zhiqiao (1 qian) Nongpo (1 qian) Dahuang (1 qian) Mangxiao (1 qian)
Jicheng Muxiang Binglang Wan (Integrated Collection Muxiang Binglang Pill)
Heiqianniu (Stir-fried, take the finest powder, 5 units) Jianbinglang (Acuminated Areca Nut) Jinwenhuang (Brocade-patterned Rhubarb) Muxiang (Costus Root) Shenqu (Medicated Leaven)
Grind all above into fine powder. Use Ginger Juice to mix with Rice Paste to form pills. Adjust dosage according to the child's age and size.
Jicheng Baohe Wan (Integrated Collection Harmonize the Stomach Pill)
Shenqu (1 qian) Chenpi (1 qian) Fa Banxia (1 qian) Fuling (1 qian) Shanzha Rou (1 qian) Lianqiao (1 qian)
Jicheng Runchang Wan (Integrated Collection Moisten the Intestines Pill)
Huomaren (Shelled) Guang Xingren (Peeled) Taoren (Peeled) Chen Zhiqiao (Aged Zhiqiao) Danggui Wei (1 qian half each of the above five ingredients) Ejiao Zhu (Glue-ball made from Donkey-hide Gelatin) Luobozi (Radish Seed) Suye (Perilla Leaf) (2 qian each of the last three)
Grind all above into fine powder. Use refined Honey to form pills. Take 1-2 qian per dose, adjust according to the patient's condition, and swallow with warm water.
Tu Weisheng said: Runchang Wan embodies the principle of Zhang Zhongjing's Pi Yue Wan (Spleen-Restriction Pill). Pi Yue Wan treats cases where excessive Spleen Fire scorching and drying up the fluids of the stomach and intestines leads to dry, hard stools. Although Runchang Wan is based on this principle with modifications, the inclusion of Suye (Perilla Leaf) makes it less pure than Pi Yue Wan. Deducting from this logic, if Yin deficiency is extremely urgent and Kidney Fire is excessively strong, scorching the stomach and intestines to extreme dryness and severe constipation, then Shengdi (Rehmannia Root), Yurou (Cornus Fruit), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huangqin (Scutellaria Root), and Lianqiao (Forsythia Fruit) can all be added. While in Zhengyang, I treated a patient who had always suffered from Yin deficiency. Suddenly, they developed severe dry constipation. Other physicians used harsh purgatives, but the condition worsened with treatment. I treated them with the original formula of Pi Yue Wan, heavily using Shengdi, Guijiao (Tortoise Shell Glue), Huangqin, and Huanglian, resulting in a cure. This proves that constipation is not solely caused by Excess Heat. Furthermore, Chen Feixia's suggestion to use Baohe Wan with Zhishi for deficiency cases carries the risk of neglecting the deficiency aspect. He also fails to recognize the various subtypes of deficiency and their respective treatments. As for cases of Spleen Dampness and Yin stagnation, where fluids fail to descend and require Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) to restore bowel movement, these are beyond Chen Feixia's knowledge. Such cases are rare, accounting for only 1-2 percent, but this must be known.
Zhongjing Pi Yue Wan (Also known as Mahuan Wan)
Maren (2 qian) Baishao (1 qian) Dahuang (1 qian) Zhiqiao (0.7 qian) Nongpo (0.5 qian) Xingren (1 qian)