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(Quoting a physician's statement. Recorded in *Yidu*. Refer to the section on "Accumulation and Mass" for details.)

Formulas for Clearing and Purging Heat

**Sanhuang Tang (Three-Yellow Decoction)**: Treats constipation due to heat accumulation in the lower jiao.
* Radix Rhhei Palmatae (Dahuang, 3 liang)
* Radix Scutellariae (Huangqin, 2 liang)
* Radix Glycyrrhizae (Gancao, 1 liang)
* Fructus Gardeniae (Zhizi, 14 fruits)

Chop the four ingredients. Boil in 5 sheng of water until reduced to 1.8 sheng. Divide into three doses. If constipation is severe, add Natrii Sulfas (Mangxiao, 2 liang). (From *Qianjin Fang*)

**Xionghuang Wan**: Treats dizziness, red eyes, and difficult defecation caused by abundant wind-heat obstruction.
* Rhizoma Chuanxiong (Chuanxiong)
* Radix Rhhei Palmatae (Dahuang): Select those with "brocade patterns". Simmer in one bowl of pure wine over slow fire until the wine is evaporated, then dry. Use 2 liang each.

Grind into fine powder. Mix with refined honey to make pills the size of paulownia seeds. Take 20 pills per dose with warm water after meals. (From *Yangshi Jiacang Fang*) (*Benshi Fang*'s Xiongxiong Wan contains Gleditsiae Sinensis Spina (Zaojiao), see the section on Phlegm-Saliva.)

**Jingyan Houfang Formula**: Resolves wind-heat, disperses accumulated wind-heat obstruction, promotes digestion, moves qi and blood, and relieves severe constipation.
* Radix Rhhei Palmatae (Dahuang, 4 liang)
* Semen Kochiae (Qianniuzi, 4.5 liang, half raw, half processed)

Grind into powder. Mix with refined honey to make pills the size of paulownia seeds. Take 10 pills with tea water per dose. To induce mild purgation, take 15 pills. Most suitable for winter use; it does not disturb the body's righteous qi. (Cited from *Bencao Gangmu*) **Niuhuang Tongge Wan** in *Shixing Sanliao* adds Caulis Akebiae (Mutong) to this formula. **Quanzhen Wan** (also known as Bao'an Wan, named by Emperor Xuanzong of Jin) in *Baojian* treats heat accumulation in the five zang organs and cleans intestinal filth. This formula uses Gleditsiae Sinensis Spina (Zaojiao) soaked in water, boiled with sliced radish, mixed with herb powder to make pills. (*Defang* version omits radish, named Zaojiao Gao, treats heat in the Kidney meridian causing red, swollen, and painful scrotum with constipation.) **Dahuang Qianni San** in *Baoming Ji* treats wandering pathogenic fire qi causing constipation; this formula is prepared as a powder. (Note: Named Niuhuang San in *Bacui Fang*, treats upper jiao heat and organ constipation.) *Gangmu* records: When using 0.5 to 1 liang of Dahuang without relief, add a small amount of Moschus (Shexiang) to the medicine, which will ensure bowel movement. (Under Dahuang Qianni San)

For heat accumulation from rich foods, use **Jiawei Qingwei San**. (From *Liuyao*) (Note: Qingwei San is found under bleeding gums. The "modified" version adds Dahuang and Gypsum Fibrosum (Shigao), verified from the Toothache section.)

**Treatment for Constipation** (Repeatedly effective by Zhang Xuanqing).
* Cinnabar (Zhusha, ground like flour, 5 qian)
* Aloe Vera (Luhui, finely ground, 7 qian)

Add a little good wine to form pills. Take 1.2 qian per dose swallowed with good wine. Morning dose leads to evening evacuation; evening dose leads to morning evacuation. Best compounded on sunny days. (From *Guang Biji*) Named **Gengyi Wan** in *Shifang Gekuo*.

Formulas for Moistening and Purging Dryness

**Formula for Dispersing Exterior and Relieving Constipation**.
* Juice of Radix Rehmanniae Preparata (Shengdihuang Zhi, 5 he)
* Radix Rhhei Palmatae (Dahuang)
* Radix Glycyrrhizae Preparata (Zhigancao, 0.5 liang each)

Chop the three ingredients. Boil in 3 sheng of water until reduced to 1 sheng. Add Rehmannia juice, boil three more times. Divide into two doses. (From *Qianjin Yifang*) (Note: Originally for treating side effects of mineral drugs, but also suitable for dry-heat constipation, hence listed in *Guanju Fang*.)

**Sishun Yinzi**: Treats constipation, fever of face/eyes/body, mouth/tongue sores, upper jiao oppression, desire for cold drinks. This is yang qi obstruction with heat merging into the Large Intestine, pulse is flooding and large.
* Radix Rhhei Palmatae (Dahuang)
* Radix Paeoniae Rubra (Chishaoyao)
* Radix Glycyrrhizae (Gancao)
* Radix Angelicae Sinensis (Danggui) (Equal parts)

Make coarse powder. Take 5 qian per dose with 1.5 cups of water, decoct to 1 cup. Take warm. Stop when bowels move. (From *Jifeng Puji Fang*) (Note: Originally from *Zhouhou Beiji Fang · Pediatrics*, applicable for various diseases with excess heat.)

**Yuzhu San**: Equal parts of Siwu Tang, Chengqi Tang, and Mirabilite (Puxiao). Decoct in water, remove dregs, take before meals. (From *Sanfa Liumen*)

**Shengong Wan**: Treats triple-jiao qi obstruction, epigastric fullness, six fu organs' wind-heat, constipation, internal fluid depletion, dry Large Intestine, tenesmus, or fresh blood in stool.
* Radix Rhhei Palmatae (Dahuang, 3 liang)
* Radix Ginseng (Renshen, 0.5 liang)
* Semen Cannabis (Maren, 5 liang, crushed)
* Pericarpium Terminaliae Chebulae (Hezipi, roasted, 2 liang)

Grind to fine powder. Mix with refined honey to make paulownia seed-sized pills. Take 20 pills with warm water, three times daily. Stop when bowels move. (From *Huo Ren Shu*) (Note: Based on modified Maren Wan from *Waitai Mi Yao*, treating chronic qi disease, anorexia, indigestion, and rising wind/cold/heat qi.) **Jiawei Shengong Wan** in *Xuanqi Houji* adds Costus Root (Muxiang), Immature Bitter Orange (Zhishi), and Peach Kernel (Taoren).

**Runchang Tang**: Treats severe constipation lasting several days.
* Semen Platycladi (Baiziren, 1.5 cups, finely ground, soaked in water, skin removed, thick juice extracted)
* Sesame (Zhima, 0.5 cup, lightly stir-fried, ground, soaked in water, thick juice extracted)
* Peach Kernel (Taoren, soaked in hot water, skin and tip removed, stir-fried with bran until yellow, 1 liang, ground to paste)
* Schizonepeta Spike (Jingjisui, pounded to powder, 1 liang)

Boil these ingredients briefly. Add a little salt. Prepare like tea. Do not over-boil. Drink freely until bowels move. Take before meals. (From *Yangshi Jiacang Fang*)

**Tongyou Tang**: Treats difficult defecation, pyloric obstruction, failure of Huxmen opening, dysphagia, dry constipation, qi failing to descend. Treatment focuses on the pylorus using acrid-moistening methods.
* Prepared Licorice Root (Zhigancao, 1 fen)
* Safflower (Honghua, 1 fen)
* Raw Rehmannia Root (Shengdihuang, 5 fen)
* Cooked Rehmannia Root (Shudihuang, 5 fen)
* Cimicifuga Rhizome (Shengma, 1 qian)
* Peach Kernel Paste (Taoren ni, 1 qian)
* Angelica Sinensis Body (Danggui shen, 1 qian)

One dose. Boil in 2 large cups of water until reduced to 1 cup. Strain. Mix with 0.5 fen of Areca Seed (Binglang) powder. Take slightly warm before meals. (From *Lanshi Micang*) **Runzao Tang** adds baked Dahuang and Maren, uses raw Gancao, removes Binglang. (Also named Runchang Tang.)

**Mazi Suzi Zhou (Hemp and Perilla Porridge)**: Half a he each of Perilla Seed (Zisuzi) and Hemp Seed (Damaizi). Wash clean, grind extremely fine. Grind again with water to extract 1 cup of juice. Cook into porridge and eat in two portions. Suitable for postpartum women, elderly with deficiency, and wind-induced constipation. Case: An 84-year-old noblewoman suffered abdominal distension, headache, nausea, and anorexia. Physicians prescribed spleen-tonifying and wind-clearing herbs, worsening her condition. I diagnosed wind constipation with organ obstruction. Prescribed this porridge. After two bowls, gas passed, hard feces resembling peppercorns were expelled, followed by gradual relief without further medication. (From *Benshi Fang*) (Note: According to *Zisheng Jing*, originally from *Bi Yong Fang*.)

**Chixiaodou San**: Treats severe constipation. (From *Jifeng Puji Fang*) (Note: Same as Chixiaodou Danggui San.)

**Hua Tuo's Formula**: Describes a condition where one eats two dou of rice daily but has no bowel movement for 200 days without other discomfort. This is called "Grain Emaciation." Grain qi fluids fail to descend. Although seemingly healthy, the lower gate is blocked. Treatment:
* Kudzu Root (Gegen, 5 jin)
* Pig Fat (Zhufang, 3 jin)

Finely chop Gegen, wash, and decoct in 3 dou of water until reduced to 1.5 dou. Strain. Re-decoct the liquid to 7 sheng. Fry pig fat until it becomes ointment. Mix into Gegen liquid, decoct until mixture reaches about 4 sheng. Take 2 sheng per dose, finish within two days. This opens the lower gate, nourishes Ying and Wei, and induces defecation. No dietary restrictions during treatment. (From *Ishinpo*) (Note: Similar intent to *Qianjin Fang*'s Ruzang Tang using Gegen, pig grease, and Dahuang.)

Formulas for Regulating Qi and Promoting Movement (Including Stomach-Harmonizing Formulas)

**Dama Ren Wan**: For women with wind-binding in intestines/stomach and chronic constipation.
* Hemp Seed (Dama ren, 2 liang, pounded to paste separately)
* Rhubarb (Chuan Dahuang, 2 liang, chopped and lightly stir-fried)
* Areca Seed (Binglang, 1 liang)
* Costus Root (Muxiang, 1 liang)
* Immature Bitter Orange (Zhiqiao, 1 liang, stir-fried with flour until light yellow, pith removed)

Grind to powder, mix with hemp paste. Honey-pill paulownia seed-sized. Take 20 pills with warm water on empty stomach daily. (From *Taiping Shenghui Fang*)

**Binglang San**: For excess heat in Large Intestine, excessive qi rising, abdominal distension and oppression.
* Areca Seed (Binglang, 1 liang)
* Rhubarb (Dahuang, 3 fen, chopped and fried)
* Licorice (Gancao, 0.5 liang, roasted)
* Mirabilite (Puxiao, 0.5 liang)

Grind to powder. Take 2 qian per dose with 1 cup of water, add little ginger and a spoonful of honey. Decoct to 0.6 cup. Strain and take hot after meals. (From *Jizhong Fang*)

**Baishun Wan**: Treats all yang pathogen accumulations (qi, blood, parasite, food, cold damage, excess heat, constipation). Take with appropriate decoctions based on the syndrome.
* Rhubarb (Chuan Dahuang, brocade pattern piece)
* Gleditsia Spine (Ya Zaojiao, stir-fried light yellow, 1.6 liang)

Grind to powder. Soak steamed bread dough in water, pound into pills the size of mung beans. Take 0.5 qian, 1 qian, or 2-3 qian depending on need, with appropriate guiding decoction. Can also be honey-pilled. (From *Jingyue Quanshu*)

**Jiangqi Tang** (Same as Suzi Jiangqi Tang): For constipation, combine with Heixi Dan or Yangzheng Dan. For young people with strong qi, constipation, and robust spleen/stomach, combine with Shengong Wan or Sanhuang Wan. (From *Yijian Fang*) **Suzi Jiangqi Tang** treats qi stagnation oppression, phlegm abundance, and constipation. (From *Yixue Rudu*) (Note: This is the base formula plus Agarwood Chenxiang.)

**Kuaikuai Tang**: Treats qi failing to ascend/descend and large intestine stagnation.
* Cyperus Rhizome (Xiangfu, pounded clean, 2 liang)
* Tiantai Litsea Fruit (Tiantai Weyu, heart removed)
* Immature Bitter Orange (Zhiqiao, processed, 1.5 liang each)
* Amomum Fruit (Suosha, 0.75 liang)
* Perilla Seed (Zisuzi, stir-fried, 0.5 liang)
* Aquilaria Wood (Qingmuxiang, 3 qian)
* Licorice (Zhigancao, roasted, 0.75 liang)

Powder. Take 2 qian per dose with Tangerine Peel (Chenpi) decoction. (From *Zhizhi Fang*) (Note: From *Xuanqi Houji* Kuanqi Tang, removed Apricot Kernel, added Zisuzi and Muxiang.)

**Simotu Tang**: Treats qi stagnation with abdominal urgency and constipation. (See Qi Diseases section.) For heat cases, add Dahuang and Zhiquiao, named **Liumo Tang**. (From *Defang Fang*)

**Zaojiao Wan**: For wind in Large Intestine and constipation, suitable for the elderly.
* Gleditsia Seed (Zaojiao zi, roasted, pod removed)
* Immature Bitter Orange (Zhiquiao, pith removed, stir-fried with flour)

Equal parts powder. Honey-pill paulownia seed-sized. Take 70 pills with rice water on empty stomach before meals. (Same source)

**Pingwei Wan**: For chronic illness weakness, poor appetite, alternating constipation/diarrhea due to weak stomach qi. Regular use harmonizes middle, resolves phlegm-dampness, thickens intestines/stomach, and improves appetite.
* Magnolia Bark (Nanpu, 1 liang)
* Atractylodes Macrocephala Rhizome (Baizhu, 1.2 liang)
* Tangerine Peel (Chenpi, 0.8 liang, white pith removed)
* Costus Root (Muxiang)
* Pinellia Tuber (Sheng Banxia, washed in water, 1 liang)
* Areca Seed (Binglang, 0.25 liang)
* Immature Bitter Orange (Zhishi, 0.05 liang)
* Licorice (Zhigancao, roasted, 0.3 liang)

Fine powder. Steamed bread dough soaked in Ginger Juice (Jiangzhi). Pill paulownia seed-sized. Take 30-50 pills with Ginger Soup or warm water. (From *Baoming Ji*)

Warming and Purging Formulas

**Sugan Wan**: For qi-type constipation. Take with Perilla/Tangerine Peel decoction or Zhiquiao decoction. Suhe Xiang (Styrax) 4 fen, Yinggan 6 fen, mix and pill separately. For abdominal pain with vomiting and desire to purge, if other herbs cause vomiting, Sugan Wan taken with Ginger Juice decoction is best. (From *Zhizhi Fang*)

**Badou Wan**: For constipation.
* Croton Seed (Badou, 10 seeds, peel and membrane removed)

Soak in 1 cup vinegar, boil until soft. Pound into paste. Mix with half a spoonful of rice to form 70 pills. Take 3 pills on empty stomach with Millet Decoction. Wait a while, drink hot tea. Bowels will open. (From *Shengji Zonglu*)

**Qufeng Wan**: For constipation or elderly wind-constipation.
* Gleditsia Spine (Zaojiao, 7 units, roasted, boiled in 2 bowls water)
* Croton Seed (Badou, 49 seeds, shell/membrane removed)
* Immature Bitter Orange (Zhiquiao, 1 liang)

Boil Zaojiao in water until dry. Remove Badou. Stir-fry Zhiquiao to powder. Add Muxiang (0.5 liang). Honey-pill paulownia seed-sized. Take 30 pills with plain water on empty stomach. (From *Zhushi Jiyian Fang*) **Nanmuxiang Wan** adds Binglang and Maren. (From *Xiuzhen Fang* citing *Shenghui Fang*, currently unverified.)

**Miaoying Wan**: For qi deficiency with cold causing constipation.
* Jinye Dan
* Banshu Wan (Equal parts)

Take 50-70 pills on empty stomach with rice water. (From *Jifeng Puji Fang*) (Note: *Xu Yijian Fang* states Jinye Dan is pure Sulfur, used for deficiency-cold diarrhea. It doesn't explicitly state it purges the Large Intestine. *Haiyao Ji* says Sulfur treats elderly wind-constipation. Elderly have deficient-cold organs and stagnant qi/blood, leading to constipation. Sulfur is hot; it warms organs, promotes qi/blood flow, allowing natural passage of waste, rather than having a direct laxative nature.)

**Banshu Wan**: For elderly wind/cold constipation, abdominal masses/cold qi, warming primal qi, stopping diarrhea, improving appetite.
* Sulfur (Huangshi, finely ground)
* Pinellia Tuber (Banxia, washed 7 times in water, dried, powdered)

Equal parts. Cook with Ginger Juice and steamed bread dough/powder. Pound hundreds of times. Pill paulownia seed-sized. Take 30 pills with warm wine or Ginger Soup on empty stomach. (From *Sanyuan Jiyi Bingzheng Fanlun*)

**Yangzheng Dan**: Especially suitable for elderly with cold-type constipation. Heixi Dan and Laifu Dan are similar and effective. (From *Yijian Fang*)

External Treatments

**Divine Formula for Severe Constipation**: Pig or Sheep Gallbladder. Insert a tube into the gallbladder, insert ~3 he into the anus, then remove. If not fully evacuated, repeat after a moment. Adding Winter Melon Seed (Dongkuizi) juice is also effective. (From *Qianjin Fang*) Chen Zangqi's *Bencao* states: For constipation, attach a reed tube to the gallbladder, insert 3 cun into the anus, and irrigate. Evacuation follows quickly. (Cited from *Kaibao Bencao*) (Note: *Zhouhou Beiji Fang* mentions using Trichosanthes root juice blown via tube, see Guan Ge section. Various enema methods exist; discussed in *Yaozhi Tongyi*, not repeated here.) For residual toxin heat from smallpox/chickenpox causing constipation, have patient hold sesame oil in mouth. Insert small bamboo tube into anus and blow oil in. After half an hour, patient feels oil moving up like an earthworm. After another short while, 1-2 sheng of black stool is passed, followed by restful sleep. (From *Zhengchuan*) (Note: Similar to above, very convenient, included here.)

**Formula for Post-Febrile Disease Constipation or Abdominal Distension after Purgatives**.
* Salt (Yan, 0.5 jin)

Heat salt until color changes. Decoct in 2 dou of Vinegar Water (Cujiangshui) for 5-7 boils. Pour salt solution into a basin. Adjust temperature comfortably. Patient sits in basin, bathing the lower abdomen. Bowels will open shortly. (From *Shengji Zonglu*)

Regulation Methods
Frequently consume Malva (Kuicai), Spinach (Bo cai), and Pig/Sheep Blood. Natural lubrication occurs. *Neijing* states: "Nourish orifices with slippery substances." (From *Zhibai Baifa*) (Note: "Nourish orifices with slippery substances" originates from *Zhouli · Yangyi*.)