【气秘便结之症】心腹胀满，胁肋刺痛，欲便而不得便，此气实壅滞之症也。若质弱形
弱，言语力怯，神思倦怠，大便不出，此气虚不振之症也。
【气秘便结之因】怒则气上，思则气结，
忧愁思虑，诸气怫郁，则气壅大肠，而大便乃结。若元气不足，肺气不能下达，则大肠
不得传道之令，而大便亦结矣。
【气秘便结之脉】盛则沉实，虚则细微。右寸沉实，肺气郁结。右关沉实，脾气郁结。
左关沉实，肝胆气结。右寸细微，肺气不足。右关微细，脾气不足。
【气秘便结之治】肝气壅盛者，枳桔泻白散。脾胃郁结者，平胃二陈汤。肝胆气结者，
清肝饮。大肠气结者，枳桔汤。元气不足者，四君子汤。肺虚不能下达，生脉散合参橘煎。
枳桔泻白散
枳壳 桔梗 桑白皮 地骨皮 甘草
平胃二陈汤 平胃散加茯苓、半夏。
清肝饮 见腹痛。
枳桔汤 即枳壳、桔梗二味同煎。
四君子汤 见痢疾门。
生脉散 见前。
参橘煎 即人参、橘皮二味。
【血枯便结之症】形弱神衰，肌肉消瘦，内无实热，大便秘结，此阴血不足，精竭血燥
之虚症也。若内热烦热，或夜间发热，睡中盗汗，此阴中伏火，煎熬血干之火症也。
【血枯便结之因】或久病伤阴，阴血亏损，高年阴耗，血燥津竭，则大便干而秘结。若
血中伏火，煎熬真阴，阴血燥热，则大便亦为之闭结。
【血枯便结之脉】六脉沉数，血液干枯，细小而数，阴血不足。滑大而数，血中伏火。
津竭者，生脉散、天地煎。血中伏火，滋血润肠汤、脾约丸。
四物麻仁丸
当归 白芍药 生地黄 川芎 麻仁 生何首乌
生脉散 见前小便不利。
天地煎
天门冬 生地黄
等分同煎。
滋血润肠汤
当归 白芍药 生地 大黄 红花 麻仁
脾约丸 见前。
大凡去病真诀，止有毛窍二便，三条去路。故伤寒身热不减，首重发汗解肌；里热不解
，又重于清利二便。《内经》治肿胀，惟立开鬼门，洁净府，内外分消。开鬼门者，发汗解
肌也，洁净府者，清利二便也。按此三条，初学无有不知，究其下手真诀，则白首皆不知矣
。故余着《伤寒大白》，外感症，苦心于发汗、解肌、清利二便三法。着《症因脉治》，首
卷之伤寒，独开发汗散邪之法门。末卷反复详论大小二便不利也。
[Symptoms of Constipation due to Qi Stagnation] Fullness and distension in the heart and abdomen, stabbing pain in the hypochondrium, a desire to defecate but inability to do so; this is a syndrome of excess Qi stagnation. If the constitution is weak, the physique is frail, speech is faint and lacking in strength, and there is mental fatigue with constipation, this is a syndrome of deficient Qi failing to rise and move.
[Causes of Constipation due to Qi Stagnation] Anger causes Qi to ascend; excessive thinking causes Qi to knot. Worry and anxiety lead to the depression of various Qi mechanisms (stagnation of Qi flow), causing Qi to congest in the Large Intestine, resulting in constipation. If Yuan Qi (Original Qi) is insufficient, Lung Qi cannot descend, and the Large Intestine fails to execute its function of transmission, also leading to constipation.
[Pulse Signs of Constipation due to Qi Stagnation] In excess conditions, the pulse is deep and forceful; in deficiency conditions, it is fine and minute. A deep and forceful pulse at the Right Cun position indicates Depression of Lung Qi. A deep and forceful pulse at the Right Guan position indicates Depression of Spleen Qi. A deep and forceful pulse at the Left Guan position indicates Knotting of Liver and Gallbladder Qi. A fine and minute pulse at the Right Cun position indicates Deficiency of Lung Qi. A minute and fine pulse at the Right Guan position indicates Deficiency of Spleen Qi.
[Treatment of Constipation due to Qi Stagnation] For Liver Qi congestion and excess: Zhi Jie Xie Bai San (Bitter Orange and Platycodon Decoction to Drain White). For Spleen and Stomach depression and knotting: Ping Wei Er Chen Tang (Calm the Stomach and Two-Chen Decoction). For Liver and Gallbladder Qi knotting: Qing Gan Yin (Liver-Clearing Drink). For Large Intestine Qi knotting: Zhi Jie Tang (Bitter Orange and Platycodon Decoction). For insufficiency of Yuan Qi (Original Qi): Si Jun Zi Tang (Four Gentlemen Decoction). For Lung deficiency failing to descend: Sheng Mai San (Generate the Pulse Powder) combined with Shen Ju Jian (Ginseng and Tangerina Peel Decoction).
Zhi Jie Xie Bai San (Bitter Orange and Platycodon Decoction to Drain White): Zhi Qiao (Aurantii Fructus), Jie Geng (Platycodonis Radix), Sang Bai Pi (Mori Cortex), Di Gu Pi (Lycii Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Ping Wei Er Chen Tang (Calm the Stomach and Two-Chen Decoction): Ping Wei San (Calm the Stomach Powder) added with Fu Ling (Poria) and Ban Xia (Pinelliae Rhizoma).
Qing Gan Yin (Liver-Clearing Drink): See section on Abdominal Pain.
Zhi Jie Tang (Bitter Orange and Platycodon Decoction): Decoction of Zhi Qiao (Aurantii Fructus) and Jie Geng (Platycodonis Radix) together.
Si Jun Zi Tang (Four Gentlemen Decoction): See section on Dysentery.
Sheng Mai San (Generate the Pulse Powder): See above.
Shen Ju Jian (Ginseng and Tangerina Peel Decoction): Consists of Ren Shen (Ginseng Radix) and Ju Pi (Citri Reticulatae Pericarpium).
[Symptoms of Constipation due to Blood Dryness] Weak physique, depleted spirit, emaciated muscles, no excess heat internally, but dry and constipated stool; this is a deficiency syndrome of insufficient Yin-Blood, exhaustion of Essence, and dryness of Blood. If accompanied by internal heat and vexation, or night fever, and night sweats during sleep, this is a fire syndrome where latent Fire within the Yin scorches the blood to dryness.
[Causes of Constipation due to Blood Dryness] Prolonged illness damages Yin, leading to loss of Yin-Blood; advanced age consumes Yin, causing blood dryness and depletion of fluids, resulting in dry and constipated stool. If latent Fire exists in the blood, scorching True Yin and causing Yin-Blood to become dry and hot, constipation will also occur.
[Pulse Signs of Constipation due to Blood Dryness] Six pulses are deep and rapid, indicating dried-up blood; fine and rapid pulses indicate insufficient Yin-Blood; slippery, large, and rapid pulses indicate latent Fire in the blood. For depletion of fluids: Sheng Mai San (Generate the Pulse Powder) and Tian Di Jian (Heaven and Earth Decoction). For latent Fire in the blood: Zi Xue Run Chang Tang (Nourish Blood and Moisten Intestines Decoction) and Pi Yue Wan (Spley-Restriction Pill).
Si Wu Ma Ren Wan (Four-Substance Hemp Seed Pill): Dang Gui (Angelicae Sinensis Radix), Bai Shao Yao (Paeoniae Radix Alba), Sheng Di Huang (Rehmanniae Radix), Chuan Xiong (Chuanxiong Rhizoma), Ma Ren (Cannabis Fructus), Sheng He Shou Wu (Polygoni Multiflori Preparated Radix).
Sheng Mai San (Generate the Pulse Powder): See section on Difficult Urination above.
Tian Di Jian (Heaven and Earth Decoction): Tian Men Dong (Asparagi Radix) and Sheng Di Huang (Rehmanniae Radix), decocted together in equal parts.
Zi Xue Run Chang Tang (Nourish Blood and Moisten Intestines Decoction): Dang Gui (Angelicae Sinensis Radix), Bai Shao Yao (Paeoniae Radix Alba), Sheng Di (Rehmanniae Radix), Da Huang (Rhei Radix et Rhizoma), Hong Hua (Carthami Flos), Ma Ren (Cannabis Fructus).
Pi Yue Wan (Spley-Restriction Pill): See above.
Generally, the true secret to eliminating disease lies only in three exit pathways: hair pores (sweat) and the two bowels (urine and feces). Therefore, when exterior Heat from Shang Han (Cold Damage) does not subside, primary emphasis is placed on inducing sweating and releasing the muscle layer; when interior Heat does not resolve, emphasis is again placed on clearing and draining the two bowels. The *Nei Jing* (Classic of Internal Medicine) for treating swelling establishes only "opening the ghost gate" (inducing sweat) and "purifying the residence" (promoting urination) methods to dissipate pathogens internally and externally. "Opening the ghost gate" refers to inducing sweat and releasing the muscle layer; "purifying the residence" refers to clearing and draining urine and feces. Regarding these three principles, beginners know them all, yet upon investigating the true key to application, many remain ignorant until old age. Thus, I wrote *Shang Han Da Bai* (Great Clarity on Cold Damage), focusing painstakingly on the three methods of inducing sweat, releasing the muscle layer, and clearing/drainng the two bowels for external contraction syndromes. In *Zheng Yin Mai Zhi* (Syndrome, Cause, and Pulse Treatment), the first volume on Shang Han specifically opens the door to methods of inducing sweat to scatter pathogens. The final volume repeatedly discusses in detail the obstruction of the two bowels.