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Mr. Qin said: Regarding the syndrome of fecal impaction (constipation), in the category of external contraction diseases, there is the Pi Yue syndrome (Spleen Restriction) of Taiyang and Yangming channels where the exterior syndrome has not yet resolved; there is the difficulty in defecation of Shaoyang and Yangming channels located at half-exterior and half-interior; there is also the stomach excess heat syndrome of Zhengyang Yangming, characterized by hard stool; there are cases where exterior pathogens transmit to the interior, involving the Taiyin channel, with no bowel movement for seven or eight days; there are cases of Shaoyin disease with no bowel movement for six or seven days; and there are Jueyin cases presenting with diarrhea, delirium, and dry feces. These conditions correspond respectively to mild purgation, urgent purgation, severe purgation, or permissible purgation methods. Additionally, there are alternating patterns where purgation is either contraindicated or temporarily inappropriate, requiring waiting for the right timing, or using external suppository methods such as honey suppositories or bile suppositories. In the category of internal injury diseases, there are differences among entries such as accumulated heat, qi stagnation constipation, and blood deficiency. Currently, only two entries for external contraction and three for internal injury are established, reflecting the intention to simplify complexity.

[Syndromes of Constipation due to Cold Damage] Aversion to cold with fever and closed bowels indicates that the exterior pathogen has not resolved while the interior syndrome is urgent, which is the Taiyang-Yangming Pi Yue syndrome. Alternating chills and fever, bitter taste in the mouth, deafness, and closed bowels indicate a position between half-exterior and half-interior, which is the Shaoyang-Yangming syndrome. Dry mouth, yellow tongue coating, aversion to heat, excessive sweating, and closed bowels indicate the Zhengyang Yangming syndrome. If the exterior syndrome is completely eliminated, accompanied by dry mouth and throat and inability to pass stool, this is the Shaoyin interior heat syndrome. If the hands and feet are naturally warm, with no bowel movement for seven or eight days and abdominal distension around the umbilicus, this is the Taiyin interior heat syndrome. If there is irritability and fullness, retraction of the scrotum, diarrhea with delirium, and the presence of dry feces, this is the Jueyin interior heat syndrome.

[Etiology of Constipation due to Cold Damage] The intestines and stomach originally possess heat. Accidental exposure to wind-cold causes stagnation and fever. The exterior and interior steam each other, so even though the exterior pathogens of the Three Yang channels have not resolved, the stool becomes constipated first. If the exterior pathogen dissipates but the Yangming interior heat remains unresolved, it also leads to constipation. If the heat of the Three Yang exterior transmits to the Three Yin channels, it also leads to constipation. If the interior heat of the Three Yin does not form a knot but later returns to the Yangming channel, it also leads to constipation.

[Pulse Patterns of Constipation due to Cold Damage] Floating and rapid pulse on the left, deep and rapid pulse on the right indicates Taiyang-Yangming syndrome. Wiry and rapid pulse on the left, deep and rapid pulse on the right indicates Shaoyang-Yangming syndrome. Deep and rapid pulses in all six positions indicate Zhengyang Yangming syndrome. Deep, fine, and rapid pulse indicates Three Yin interior heat syndrome.

[Treatment of Constipation due to Cold Damage] For Taiyang-Yangming syndrome, Zhang Zhongjing used Piyue Wan (Spleen Restriction Pill). Nowadays, Qianghuo Tang (Notopterygium Decoction) augmented with Dahuang (Rhubarb) is promoted to follow the method of simultaneously resolving the exterior and interior. For Zhengyang Yangming syndrome, Da Chengqi Decoction (Major Order the Qi Decoction) is used. For Shaoyang-Yangming syndrome, Da Chaihu Decoction (Major Bupleurum Decoction) is used. Mentioning Yangming implies bowel obstruction; mentioning Taiyang implies the presence of exterior pathogens. If heat pathogens transmit to the Three Yin channels causing constipation, the San Chengqi Decoctions (Three Major Order the Qi Decoctions) should be used with modifications according to symptoms. If pathogens from the Three Yin channels transmit outward to Yangming, resulting in stomach excess or spleen restriction, Piyue Wan is used.

Renshen (Cannabis Seed, Huomaren)
Xingren (Apricot Seed, Ku Xingren)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)
Zhishi (Immature Bitter Orange Fructus Aurantii Immaturus)
Houpo (Magnolia Bark, Cortex Magnoliae Officinalis)
Baishao (White Peony Root, Radix Paeoniae Alba)

Qianghuo Tang (Notopterygium Decoction)
Qianghuo (Notopterygium Rhizome and Root, Rhizoma Notopterygii)
Fangfeng (Saposhnikovia Root, Radix Saposhnikoviae)
Huangqin (Scutellaria Root, Radix Scutellariae)
Chaihu (Bupleurum Root, Radix Bupleuri)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)

Da Chengqi Decoction (Major Order the Qi Decoction)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)
Mangxiao (Mirabilite, Natrii Sulfas)
Houpo (Magnolia Bark, Cortex Magnoliae Officinalis)
Zhishi (Immature Bitter Orange Fructus Aurantii Immaturus)

Da Chaihu Decoction (Major Bupleurum Decoction)
Chaihu (Bupleurum Root, Radix Bupleuri)
Huangqin (Scutellaria Root, Radix Scutellariae)
Chenpi (Aged Tangerine Peel, Pericarpium Citri Reticulatae)
Gancao (Licorice Root, Radix Glycyrrhizae)
Dahuang (Rhubarb Root and Rhizome, Radix et Rhizoma Rhei)