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Mrs. Zheng, over seventy years old, suffered from constipation (Bian Bi), abdominal pain, and anal distension, unable to sleep or eat for twenty days; various treatments had failed. Upon consultation, she requested purgative therapy. Her pulse was deficient, fine, and choppy. I stated: This is deficiency-type constipation; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) suffices. Why use purgatives? After two days of medication, bowel movement remained unobstructed. She reported excruciating distending pain, intolerable even for a moment, insisting on purgation. I replied: I am not unaware of purgative methods, but given her advanced age and prolonged illness with deficient healthy qi (Zheng Qi), purgation may risk collapse (Tuo). She said: Better to die from collapse than from distending obstruction. Recalling the *Xin Wu Pian* stating that some cases require purgation despite contraindications, and improper use often harms patients, I pondered deeply. I added three qian of processed Da Huang (Rhei Radix et Rhizoma Preparata) to the previous formula, imitating the ancient principle of embedding attack within tonification. After ingestion, borborygmus and flatus occurred, and stool passed that night, consisting of several hard pellets, allowing slight rest. The next day, lower abdominal pain persisted, indicating residual dry feces. I retained the previous formula but halved the dosage of Da Huang. After two more doses, two bowel movements occurred, initially hard then loose, pain ceased, appetite returned, and she recovered. Although adding Da Huang to Bu Zhong Yi Qi Tang is unconventional, medical practice values flexibility rather than rigid adherence to dogma.

Mr. Wu Guangxian, over seventy, was bedridden due to hemiplegia (Pian Zhong). He was treated with Di Huang Yin Zi (Rehmannia Decoction) and Shen Zuo You Er Gui Yin (Ginseng Left and Right Two Cinnamon Decoctions). After half a month of medication, his condition stabilized, but he had not defecated for twenty days, suffering from abdominal pain and anal distension, likely due to dual deficiency of qi and blood failing to transport waste. Formulas such as Tong You Tang (Open the Obstruction Decoction), Bu Zhong Yi Qi Tang, Wu Ren Tang (Five Seeds Decoction), and Ji Chuan Jian (Ji Chuan Infusion) were repeatedly administered without effect. I considered using the pig bile and honey suppository method, but the dry feces had already reached the anus, blocking entry. Each effort caused profuse cold sweat and dizziness threatening collapse, leaving me helpless. Recalling Ye Tianshi’s case records describing an excavation method for constipation—where the patient inserts an oiled middle finger into the anus to break up and remove dry feces—I instructed his grandson to perform this technique since the patient could not move himself. Several pieces of dry feces were immediately excavated, followed by spontaneous passage of much foul matter. With minimal effort, the patient felt relief, proving it to be an expedient method for treating constipation.