【温热便结之症】发热自汗，汗出热仍不减，不恶寒而渴，或壮热唇焦，口渴引饮，谵
语神昏，大便不通，此温热便结之症也。
【温热便结之因】经云∶冬伤于寒，春必温病。伤寒论云∶若遇温气，则为温病。
更遇温热，则为温毒。温热内结，肠胃燥热，则大便闭结矣。
【温热便结之脉】云岐子云∶尺寸浮数，太阳阳明。尺寸洪数，正阳阳明。尺寸弦数，
少阳阳明。右关沉数，太阴温热。左寸洪数，少阴温热。左关沉数，厥阴温热。
【温热便结之治】太阳阳明，羌活汤，加大黄、枳壳。正阳阳明，干葛汤加大黄、枳
壳。少阳阳明，小柴胡汤加大黄、枳壳。言阳明者，即言不大便也。夫伤寒表解传里，则热邪敛
入肠胃，结实粪硬，可用承气下法。今温热病，则邪热散漫诸经，虽热之久者，亦不肯敛入
于里，即大便闭结，亦止宜以三阳表药中加通利之药，双解表里之邪，不比伤寒直下者也。
羌活 防风 柴胡 黄芩 大黄 枳壳
干葛汤
干葛 知母 石膏 大黄 枳壳
小柴胡汤
柴胡 黄芩 大黄 枳壳 陈皮 甘草
【积热便结之症】内热烦躁，口苦舌干，小便赤涩，夜卧不宁，腹中胀闷，胸前苦浊，
大便不行，此积热便结之症也。
【积热便结之因】或膏粱积热，热气聚于脾中而不散，或过服温热，热气伏于大肠而干
结，皆能令人大便闭结也。
【积热便结之脉】右寸细数，肺热下遗。右寸大数，大肠积热。右关细数，脾家之热。
【积热便结之治】肺热下遗大肠，清肺饮。大肠积热者，黄连枳壳汤。脾家积热者，黄
清脾饮 见前小便不利。
黄连枳壳汤
川黄连 枳壳
各半同煎。
黄连戊己汤 见前小便不利。
[Symptoms of Heat-Induced Constipation] Fever accompanied by spontaneous sweating, where the heat does not subside after sweating; aversion to cold is absent but thirst is present. Alternatively, there may be high fever with cracked lips, intense thirst prompting drinking, delirium, and coma, along with constipation. These constitute the symptoms of heat-induced constipation.
[Etiology of Heat-Induced Constipation] The *Neijing* states: "If one is injured by cold in winter, warm diseases will inevitably occur in spring." The *Shanghan Lun* states: "If one encounters warm qi, it is termed a warm disease." If further exposed to warm-heat pathogens, it becomes termed warm-toxin (Wendu). When warm-heat pathogens accumulate internally, causing dryness and heat in the intestines and stomach, constipation ensues.
[Pulse Patterns of Heat-Induced Constipation] Yun Qizi stated: Floating and rapid pulses at the Cun, Guan, and Chi positions indicate Taiyang-Yangming syndrome; Full and rapid pulses indicate Zhengyang-Yangming syndrome; Wiry and rapid pulses indicate Shaoyang-Yangming syndrome; Deep and rapid pulses at the Right Guan position indicate Taoyin warm-heat syndrome; Full and rapid pulses at the Left Cun position indicate Shaoyin warm-heat syndrome; Deep and rapid pulses at the Left Guan position indicate Jueyin warm-heat syndrome.
[Therapeutic Principles for Heat-Induced Constipation] For Taiyang-Yangming syndrome, use Qianghuo Tang (Notopterygium Decoction) augmented with Dahuang (Rhubarb Rhizome) and Zhike (Aurantium Fructus). For Zhengyang-Yangming syndrome, use Gange Tang (Puerariae Radix Decoction) augmented with Dahuang and Zhike. For Shaoyang-Yangming syndrome, use Xiaochaihu Tang (Minor Bupleurum Decoction) augmented with Dahuang and Zhike. Here, "Yangming" refers specifically to constipation. Generally, when the exterior syndrome of Cold Damage resolves and transmits inward, pathogenic heat converges into the intestines and stomach, resulting in hardened feces, which can be treated with purgative methods such as Chengqi Decoctions. However, in warm diseases, pathogenic heat diffuses through the meridians; even if the heat persists for a long time, it does not readily converge inward. Even with constipation, treatment should only involve adding laxatives to the exterior-resolving formulas of the Three Yang meridians to resolve both exterior and interior pathogens simultaneously, rather than using direct purgation as in Cold Damage.
Ingredients for Qianghuo Tang: Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma), Zhike (Aurantii Fructus).
Gange Tang: Gange (Puerariae Radix), Zhi mu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Dahuang, Zhike.
Xiaochaihu Tang: Chaihu, Huangqin, Dahuang, Zhike, Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
[Symptoms of Accumulated Heat-Induced Constipation] Internal heat with irritability, bitter taste in the mouth, dry tongue, dark and scanty urine, restlessness at night, abdominal distension and oppression, feeling of turbidity in the chest, and failure of bowel movements. These constitute the symptoms of accumulated heat-induced constipation.
[Etiology of Accumulated Heat-Induced Constipation] This may result from accumulated heat due to excessive consumption of rich and sweet foods, where heat qi gathers in the Spleen and fails to dissipate; or from overconsumption of warm-hot substances, where heat qi lies latent in the Large Intestine causing dryness and binding. Both conditions can lead to constipation.
[Pulse Patterns of Accumulated Heat-Induced Constipation] Fine and rapid pulses at the Right Cun position indicate Lung heat transmitting downward to the Large Intestine; Large and rapid pulses at the Right Cun position indicate accumulated heat in the Large Intestine; Fine and rapid pulses at the Right Guan position indicate heat in the Spleen.
[Therapeutic Principles for Accumulated Heat-Induced Constipation] For Lung heat transmitting downward to the Large Intestine, use Qingfei Yin (Lung-Clearing Beverage). For accumulated heat in the Large Intestine, use Huanglian Zhike Tang (Coptis and Aurantium Decoction). For accumulated heat in the Spleen, use Huang Qingpi Yin (Yellow Spleen-Clearing Beverage; see previous section on Dysuria).
Huanglian Zhike Tang: Chuan Huanglian (Coptidis Rhizoma), Zhike. Decoct half portions of each together.
Huanglian Wuji Tang (see previous section on Dysuria).