Library

Incontinence of feces is caused by deficiency-cold and slipping of the large intestine and anus. The anus is the external manifestation of the large intestine; both are responsible for waste excretion. Since they are deficient, cold, and slippery, Qi fails to warm and secure them, leading to incontinence. (*Zhubing Yuanhou Lun*) Treatment should employ astringent methods to consolidate fluids, as stated in medical texts: "Astringency can treat prolapse." (*Shengji Zonglu*)

Fecal incontinence presents with two patterns: one is due to Spleen-Stomach deficiency, where the granary is insecure and the intestines are slippery causing leakage; the other is due to rapid Fire nature forcing leakage. They should be treated separately: for Spleen deficiency, *Lizhong Tang* (Cinnamon Twig and Atractylodes Macrocephala Decoction); for excess Fire, *Shaoyao Gancao Tang* (Peony and Licorice Decoction) added with Coptis Rhizome. (*Yimen Bangmo*)

The cases recorded in this section refer to ordinary constipation. Conditions like Guan-Ge (Obstruction and Rejection) represent extremely critical illness, hence listed separately, but should be read in conjunction.

General Discussion Difficulty in urination and defecation results from imbalance of cold and heat, with wandering Qi in the small and large intestines. This wandering Qi stays between the intestinal walls, clashing with chaff and residue, blocking the flow of urine and stool, thus causing difficulty. Palpating the Chi pulse reveals it slippery and floating-large; this indicates Yang invading Yin. The patient suffers from lower abdominal fullness and inability to urinate, with pain in the genitalia upon urination, and similar symptoms in defecation. (*Zhubing Yuanhou Lun*) [Note: This diagnostic method originates from *Mai Jing*; "Yang invading Yin" is written as "Named Yin-Zhong-Yang" in *Mai Jing*.]

For constipation with涩 (astringency/stagnation), if there is temporary retention with only drops of urine passing, it is easy to cure. If retention lasts long, distension rises to the chest and heart, cutting pain occurs with shortness of breath, body becomes cold and face black, and both bowels and bladder are blocked, it is named Qi Excess syndrome; if it transforms severely, death ensues. (*Shiyi Dexiao Fang*)

When both urine and stool are blocked, one must first unblock the stool, then urine will naturally flow. *Bazheng San* (Eight-Herb Corrective Powder) or similar formulas are suitable. (*Jingyue Quanshu*)

Case of Excess Pattern: The son of Mr. Zhang in Qucun, aged fourteen, had been ill for about a year and a half, contracting it during wheat harvest. Attacks involved severe pain in urination; holding his penis made him jump, spin, and cry incessantly. Urine was retained for days, passing only as sand-stones. Stool was dry and difficult, with the anus prolapsing one or two inches. Physicians could not treat it. Dairen (Zhang Congzheng) was staying at Zhuge Temple for summer retreat. The father carried his son and begged Dairen for help. Dairen said, "Treat today, effect today." It was already Chen-Si hours. He prescribed *Tiaowei Chengqi Tang* (Regulate the Stomach and Order the Qi Decoction) only one tael, plus three qian of the head powder of *Qian Niu Zi* (Morning Glory Seed), decocted in river water, to be swallowed in three to five doses. Also administered sixty pills of *Kumo Wan* (Bitter End Pill - details unknown per *Bencao Gangmu*), size of mustard seeds. By dusk, vomiting and purging occurred simultaneously, expelling pus and blood. After settling, he drank a large cup of fresh well-water. Urination became smooth after one or two times. That night, drinking fresh water twenty to thirty times, the disease receded by nine-tenths, crying stopped once. The next day, he slept drowsily like being drunk. From morning to evening, he suddenly rose, asked his mother for food, sang and laughed happily, instantly relieved of suffering. Subsequently, *Taibai San* (White Tiger Powder - to be verified) and *Bazheng San* were used for one day of regulation, resulting in great recovery. Fearing improper nourishment in summer, he stayed five days before returning. Dairen said, "This is Lower Jiao constraint. Without vomiting and purging, how can the Lower Jiao open? Without drinking water, how can urine benefit? Generally, if the source is clear, the stream is clear." (*Rumen Shiqin*)

Case of Deficiency Pattern: Shiwan (Luo Mei) treated Yang Songling. In summer, he caught a cold and took more than ten doses of diaphoretic medicines, resulting in complete blockage of urine and stool. Another physician used *Xiao Huang* (Mirabilite and Rhubarb) to purge, causing the left lower abdomen to swell like a mound, without redness or heat, making gurgling sounds occasionally. An external surgeon was consulted; external applications and internal detoxifying/diuretic drugs were given, but before the medicine entered, the patient became restless. Shiwan was invited. The six pulses were tight, fine, and slow. This was excessive sweating damaging fluids, followed by bitter-cold interior-purging, causing Yin pathogen to knot internally, Bladder failing to transform, urine accumulating and blocking. Medically, this is incurable. Fortunately, Stomach Qi remained strong, form and spirit not emaciated, able to take some rice gruel. Agreed to treat. Prescribed a large dose of *Jisheng Shenqi Wan* (Kidney Qi Pill for Salvation). Decocted, poured into a spouted pot, lifted the neck, slowly instilled upward. Then turned the patient, used goose feather to induce vomiting. Immediately, urine flowed like a spring, lower abdomen flattened. Followed by *Shiquan Dabu Tang* (Ten-Agent Great Tonifying Decoction) for regulation and peace. Four or five patients had this condition previously: some with dribbling urine, some with continuous enuresis, some with emaciation and Qi collapse, all refused treatment. (*Yitong*)

Elderly Patient Treatment: *Jingui Zhenyan Lun* states: "North corresponds to Black, enters through Kidney, opens to the Two Yins." Thus, Kidney Yin deficiency causes difficulty in urination and defecation. Use Rehmannia Root, Cistanche Stem, Plantago Seed, Poria, etc., to tonify True Yin, promote water passages, add slight acrid herbs to open pores, generate fluids, and moisten dryness. Especially suitable for the elderly. If constipation is severe, straining on the toilet fails, Qi breaks downward to the anus, leaking clear water, with tenesmus unbearable, epigastric fullness, dry retching, thirst for water, anorexia, continuous groaning. To purge would cause Qi collapse and imminent death; to astringe would worsen distension of urine and dry stool in intestines; to lift Qi might relieve obstruction but cause severe nausea (Note: *Yitong* suggests Ginseng, Bitter Orange, Angelica Decoction with Tangerine Peel is effective). How to handle? My aunt, over eighty, suffered this. I used Qi-regulating and diuretic herbs, slight effect but not curative. Comforted her not to rush. Later, unable to eat, she secretly took powdered laxatives, purged several times, felt relief, but pulse became intermittent with pauses, breathing faint, collapsing on bed. I knew True Qi leaked;若不收敛摄纳 (if not consolidated), no rescue possible. Urgently gave *Shengmai San* (Generate Pulse Powder). After several doses, intermittent pulse receded. Combined with *Yixue Runchang Wan* (Nourish Blood Moisten Intestine Pill: Prepared Rehmannia, Apricot Kernel, Sesame Seed, Bitter Orange, Tangerine Peel, Donkey-hide Gelatin, Cistanche, Perilla Seed, Schizonepeta, Angelica), advised against seeking quick effects or other meds. Long-term regulation for over two months resulted in smooth bowel/bladder movement and healthy limbs. Constipation is common in elderly; folk believe firm buttocks indicate longevity, but sudden distress causes illness. My prescriptions avoid Rhubarb, safe for long use, so recorded. (*Yixue Zhunsheng*)

Internal Formulas:
*Yuliren Wan* (Prunus Humilis Seed Pill): Treats constipation of both urine and stool. Prunus Humilis Seed (2 liang, soaked in hot water, skin removed), Rhubarb (1 liang), Areca Nut (3 liang), Green Citrus Peel (0.5 liang, pith removed). Powder finely, mix with refined honey, make pills size of mung beans. Take 10-15 pills with ginger soup, any time. (*Xiao'er Zongzheng Lun*)

*Dian Dao San* (Inverted Powder): Treats organ-heat excess, or urinary retention, or fecal retention, or both. Rhubarb (8 qian), Talcum (3 qian), Gleditsia Sinensis Fruit (3 qian). Powder, take with yellow wine. For fecal retention, take two doses as above. For urinary retention, Rhubarb 3 qian, Talcum 6 qian, Gleditsia as above. For both, equal parts Rhubarb and Talcum, Gleditsia as above. (*Huichun*)

For stubborn constipation/urinary retention, abdominal distension/pain, throat fullness, phlegm-choking asthma, Taiyang Jie-Xiong (Cold Damage Chest Knotting), unable to lie flat, no food/water, dying soon: This is幽门 (Pylorus) Qi closure. Use Kansui Root (0.5 fen), wrapped in flour, fire-roasted until cooked, taken out, powdered. Add Musk (0.03 liang). Mix with rice paste to make pills. Take with light ginger soup. Immediate passage. Effective for urinary, fecal, or both blockages. (*Shoushi Baoyuan*)

Lower Jiao Yang deficiency failing to transform: Kidney opens to Two Yins. Kidney Yang deficiency closes these orifices, blocking both urine and stool, like heavy Yin freezing earth. Use *Baitong Tang* (White Connective Decoction) with extra Scallion White. Once Yang Qi arrives, bowels/bladder open immediately. (*Jingui Yi*) [Note: Based on *Bianzheng Lu*, see Guan-Ge.]

External Treatments:
Steaming Lower Body Formula for urinary/fecal blockage, hard/swollen groin. Lotus Leaf (3 liang), Scallion (37 stems with roots, leaves removed, cut), Gleditsia Sinensis Fruit (1 stick, roasted/crushed), Ginger (1 liang, cut). Boil in grain vinegar water (12 dou) for ten boils. Strain dregs, divide into two portions. Pour into small-mouthed porcelain jar. Sit on jar mouth to steam. Change when cool. If not passed, pour medicine into bucket, add hot water, sit and soak lower body. Passage ensues. (*Shengji Zonglu*)

Empirical Formula: Fine powder of Alum. Patient lies supine. Fill umbilicus with alum powder. Drop fresh well-water onto it. When patient feels cold penetrating abdomen, natural passage occurs. If no umbilicus due to moxibustion, place paper tube on moxa plate, fill with alum, drop water as above. (*Bencao Gangmu*)

For constipation and Hongzhang (Gout/Leg Swelling): Large Snail. Mix with salt spoonful, crush raw with shell. Place 1.3 cun below umbilicus. Bind with wide cloth. Passage ensues. (*Zhu Shi Ji Yan Fang*) [Note: Original records Physician Xiong Yancheng, 55, 5-day abdominal distension like drum, failed attempts led to sudden purge. Source: *Yijian Zhi Xin Ji*.] Urinary blockage here is Heat Constipation. Snail is cold and clears turbidity; in muddy water, one snail clarifies it. Salt adds moisture. (*Yifang Kao*) [Note: Snail refers to Field Snail.]

Umbilical Paste for blockage: Kansui Root powder mixed with raw white flour paste. Spread on paper flower, sprinkle powder, apply to umbilicus and hard area below. Decoct Licorice Water, drink warm/cool as desired, stop when passage occurs. (*Duan Xiao Fang*)

Bladder Accumulated Blood:膏血砂垢 (fatty blood/sand debris) causes extreme pain on urination, total blockage, impending death. Use fine ash to make a mud pond around umbilicus/Dantian, bowl-sized diameter. Pile ash high around edges. Mix Mirabilite (over 1 liang) with fresh water, pour into ash pond gradually, do not spill. Soon, urine and stool burst forth. (*Yangsheng Zhu Lun*) [Note: Originally a strangury case, excerpted here for dual blockage treatment.]

Secret Formula for blockage: Burnt salt placed in umbilicus. Cover with garlic slice. Moxibustion 2-3 cones. Any time. (*Xiuzhen Fang*)

Snail Ointment: Highly effective for blockage. Three snails, remove shell, pound to paste. Add little Musk. Insert into umbilicus, press with hand. Immediate passage. Field snails also work. (*Shoushi Baoyuan*)