冯楚瞻治崔姓人，六脉沉微，身热，四肢厥冷，发狂谵语，连夜不寐，口渴浩饮，二便俱秘。（绝似阳明热症，
而断为阴伏逼阳，乃舍症从脉之治。）此阴伏于内，逼阳于外，因津液不行，故小便秘而口干渴，非实热也。
因谷食久虚，故大便虚秘不通，非燥结也。若不急为敛纳，则真阴真阳并竭矣。乃用熟地、麦冬以壮金水，炒
白术以托住中气，牛膝、五味以下趋藏敛，制附子以引火归原，另重煎人参冲服，不三剂狂定神清，思食而愈。
按∶此亦阴虚阳越之病，甚则为类中，其治法亦大醇而小疵耳。至云阴伏于内，逼阳于外，亦与景岳
案中谓为阴症同一模糊也。此二案不入类中门者，以世俗惟以二便为急，且风秘一条，人不讲也。
胡念庵治陈盐商，年七十六矣，春时患中风脱症，重剂参、附，二百余帖获痊。至十月，大便秘结不行，日
登厕数十次，冷汗大出，面青肢厥，医用滋补剂入生大黄三钱。胡深以为不可，戒之曰∶老年脱后，幸参、附
救全，不能安养，过于思虑，以致津液枯竭，传送失宜，何事性急，以速其变。若一投大黄，往而不返，恐难
收功矣。姑忍二三日，势当自解。病者怪其迟缓，口出怨咨之辞。次日不得已用人参二两，苁蓉一两，当归五
钱，松、柏仁各五钱，附子三钱，升麻四钱，煎服，外用绿矾一斤，入圊桶，以滚水冲入，扶坐其上，一刻利
下而通。（《医林纲目》。）
按∶伤寒疟利之后，患秘结者，皆由攻下散表失宜所致。究其由，则皆血燥为病。至若风秘一条，其
病本由燥火生风，医者昧于风字，动用风药，死者已矣。其存者亦必贻后患，然此尚其轻者也。
张路玉治杨松龄，夏月感冒，服发散十余剂，二便俱闭。一医用硝、黄下之，少腹左畔遂胀起如墩，不赤
不热，有时哔哔作声。疡医以敷药治其外，以解毒利水药治其内，药未进而躁扰不宁。诊之，六脉紧细而驶，
此过汗津液大伤，又与苦寒攻里，致阴邪内结膀胱不化，溺积不通。法在不救，幸胃气有权，形神未槁，尚能
少进粥糜，姑许以治。因与《济生》肾气大剂，煎成入有嘴壶，托起其项，徐徐仰灌升许。顷令转侧，以鹅翎
探吐，实时溲便如注，少腹顿平。更与十全大补，调理而安。此症前后患者四五人，或小便淋沥，或遗溺不止，
或形羸气脱，皆力辞不治。
按∶此由感症混表混攻而成秘结，收入此门，以备参酌。
孙文垣治温南溪内人，居常大便秘结，面赤不思饮食，头时眩晕。诊之，右关尺滑大有力，此痰火症也。
用栝蒌四钱为君，滑石三钱，枳实二钱，半夏一钱半为臣，萝卜子、姜黄各一钱为佐，两帖愈矣。又教以或遇
大便秘结，每服当归龙荟丸加牛胆南星一钱立应。
一人大小便秘，数日不通，用商陆捣烂，敷脐上立通。（《本草纲目》。）
一人大便秘久，用乌 木方停一寸，劈破，以水煎取半盏，服之立愈。
陆养愚治沈望亭，年近古稀，常患胁痛，用行气药及当归龙荟丸即愈。后患便秘，服润肠丸，便虽通而饮
食减，胸膈不舒，有时温温作痛，若数日不服，又秘结矣。或以高年血不足所致，投以四物汤数剂，并小便亦
不通，三日胀急殊甚，蜜导熨脐，百计不解。脉之，沉迟而弱。询其平日，大便有欲解之状，及解又润而不燥。
曰∶此非血秘，乃气虚不能传送所致也。用补中益气汤，少以木香、白豆蔻佐之，二剂两便俱通。此后常服一
剂，不惟无秘结之患，且饮食倍增，胁痛亦不作矣。
陆祖愚治邱彦昭，禀赋薄弱，常有梦遗症，爱食燥炒饭，大便二三日一度。忽受风寒，仍吃燥饭，且日进
四餐，旬日间饮食如旧，而大便竟不行。后复寒热头痛，身热不止，间日一作，延及二十余日。左手浮弦，气
口沉实而滑，知其风邪饮食俱未消散。遂用葛根、柴胡、山楂、浓朴、栝蒌仁、黄芩、陈皮、半夏之类，头疼
止，寒热轻。忽发黄，前方去半夏、陈皮、浓朴，加茵陈、花粉、木香、枳实、黄连，二帖黄退。转而为斑色
纯红，前方去茵陈、木通，加犀角、升麻，煎送润字丸二钱五分，良久去燥矢七八块，斑消身微凉。然胸口尚
不可按，前方去犀角、升麻，倍黄连、枳实，六剂便不行而小腹微满。或谓病已月余，可以议下，弗之听，仍用
润字丸二钱五分，姜汤服。少顷去大便七八块，而胸中如故，令以前方日服一剂，间二日投润字丸二钱。病至
七十余日，服润字丸计五两，胸膈犹未清。然病久肌肉削尽，况常有遗症，不宜再行消导矣。枳实二钱，山楂
二钱，人参六分，附子四分，连进三剂，遂大便日行一次。人参渐加，枳实渐减，数剂后食进病起。服参至半
斤，始得复元。
丹溪治一妇人脾疼，后患二便不通。此是痰隔中焦，气聚上焦。二陈加木通，先服后吐，渣再煎，烧皂角
灰为末，粥清下。一尼体浓，病吐逆，忽小便不利，头汗出，立毙。
薛立斋治儒者王录之，素痰甚，导吐之后，大便燥结，头晕眼花等症，尺脉浮大，按之则涩。此肾气虚而
兼血虚也。四物送六味，四剂诸症悉退，仍用前丸月余而康。
佥宪高如斋，素唾痰，服下痰药，痰去甚多，大便秘结，小便频数，头晕眼花，尺脉浮大，按之如无。谓
肾家不能纳气归源，前药复耗金水，用加减八味料，煎服而愈。
陈三农治中州王太学，素多酒食，病下极胀痛，二便不通，坐卧不能，沉吟七日矣，百般通利不应。此湿
热之邪遏塞二阴，壅胀隧路，故前后不通，病不在大肠膀胱也。乃用韭菜子，以山甲、茴香、楝实各一钱五分，
入牵牛头末三钱水煎，一服即减，三服即愈。乃知牵牛能达右肾命门，走精隧。故东垣天真丹，以牵牛盐水炒
黑，入佐沉香、官桂、杜仲、破故纸，治下焦阳虚也。
陈良甫曰∶一男子病风淫末疾，或用快药利之，患肺痿咯脓血，至大便不通而死。惜哉。
易思兰治一儒官，仲秋末患便秘症。初因小便时秘，服五苓散、八正散、益元散俱不效。一医诊得二尺俱
无脉，作下元阴虚水涸，用八味丸治之，日一服，三日大便亦秘，口渴咽干，烦满不睡。用脾约丸、润肠丸，
小便日数十次，惟点滴而已，大便连闭十日，腹满难禁。众议急用三一承气汤下之，服后微利随闭，又加小腹
绕脐满痛。复用舟车丸、遇仙丹，每空心一服，日利三五次，里急后重，粪皆赤白。如此半月，日夜呻吟，惟
饮清米饮及茶盂许。九月终，易诊之，两寸沉伏有力，两关洪缓无力，两尺不见。易曰∶关尺无恙，病在膈
上，此思虑劳神气秘病也。以越鞠汤投之，香附醋炒一钱，苏梗、连翘、山栀、川芎各六分，苍术、黄芩各八
分，神曲一钱，桔梗四分，枳壳五分，甘草三分，服一盂嗳气连出，再一盂大小便若倾，所下皆沉积之物，浑
身稠汗。因进姜汤一盂，就榻熟睡，睡觉觅粥。次早复诊，六脉无恙，调理气血数日全愈。易自注曰∶人身之
病，上下表里，虽有不同，不过一气为之流通耳。气之通塞，均于脉息辨之。今两尺皆无，众以为如树之无根，
不知今年己卯燥金司天，君火在泉，己土运于中，正是南面以象君位。君火不行，两尺不相应，今两尺隐然不
见，正为得卯年之令。若尺脉盛于寸，则为尺寸反矣。经曰∶尺寸反者死。岂八味丸所能治乎？然而里急后重，
赤白相杂，痛则欲解，有似乎滞下，但滞下之脉，见于两关，今关脉不浮不紧不数，其非滞下明矣。既非滞下，
而用承气、舟车、遇仙等药，则元气大伤，而病愈增矣。其病源在上焦气秘，而下焦不通也。心脉居上，两寸
之脉当浮，今不浮而沉，下手脉沉，便知是气。气郁不行，则升降失职，是以下窍秘结，二便不顺，吸门不开，
幽门不通，正此谓也。譬如注水之器，闭其上窍，则下窍不通，水安从出？用香附之辛，以快滞气；苏梗通表
里之窍；连翘辛香升上，以散六经之郁火；苍术、神曲，健脾导气，散中结于四肢；炙甘草以和中；少加桔梗，
引黄芩、枳壳荡涤大肠之积；山栀去三焦屈曲之火，而利小肠；川芎畅达肝木，使上窍一通，则下窍随开。表
气一顺，则里气自畅，是以周身汗出，二便俱利，正所谓一通百通也。气秘者，病之本；便闭者，病之标。专
治其本，故见效速也。
吴孚先治曹庶常，小便不通，多服分利之药，遗尿一夜不止，既而仍复秘塞，点滴不行。此利药太过，肾
气亏极，急用补中益气汤，送肾气丸遂痊。
孙文垣治袁洪溪，以冲暑往来，经略政事，致发热燥渴，因过食冰浸瓜果，遂成泄泻，小水短少。医与胃
苓汤加利药，泻止，而小水失其常度，脐下胀急，立溺则点滴不出，卧则流溢不竭，以频取夜壶，致通宵不寐。
治半月，精神削，寝食废。诊之，两寸短弱，关缓大，两尺洪大。此余暑未清，素善饮，湿热流于下部也。以
益元散三钱，煎香薷汤服之，略无进退，脉亦如昨。再思之，此盖尿窍不对也。膀胱者，脬之室也，脬中湿热
下坠，立便则窍不对，小水因不得出，卧则脬下坠而渗出膀胱，犹以窍不对，涓涓流溢，不能畅达，故了而不
了也，治惟提补上中二焦元气，急用三一承气汤下之。服后微利随秘，又加小腹绕脐满痛，复用舟车丸、遇仙丹，
每空心一服，日利三五次，里急后重，下皆赤白。如此半月，日夜呻吟，惟进米饮及茶盂许。诊得两寸沉伏有
力，两关洪缓无力，两尺不见。曰∶关尺无恙，病在膈上，此思虑劳神，气秘病也。以越鞠汤投之，服一盂嗳
气连出，再一盂大小便若倾，所下皆沉积之物，浑身稠汗。因进姜汤一盂，熟睡。睡觉，粥进二盏。复诊脉平，
调理气血而愈。
立斋诊职方陈莪斋，年逾六旬，先因大便不通，服内疏等剂后，饮食少思，胸腹作胀，两胁作痛，形体倦
怠，两尺浮大，左关短涩，右关弦涩。时五月，此乃命门火衰，不能生脾土，而肺金又克肝木。决其金旺之际
不起，后果然。
万密斋治汪玉虹，大便不通，服通幽汤、润肠丸俱不效。诊其脉微气弱，乃内伤症也；气口脉浮大而软，
此气不运而血不润，气血两虚故也。宜亟补之。曰∶其如腹胀何？曰∶无虑，但服补中益气汤，倍加当归，五
日而愈。
许学士治一人母，年八十四，忽尔腹痛头疼，恶心不食。召医数十，议皆用补脾进食、治风清利头目等药，
数日难愈，全不入食。其家忧惶，许辨说前药皆误矣。此症正是老人风秘，脏腑壅滞，聚于胸中，则腹胀恶心，
不思饮食。又上至于巅，则头痛，神不清也。若脏腑流畅，诸疾悉去矣。乃用紫苏子、大麻子各半合，洗净研
细，取汁一盏，分二次煮粥，两啜而气滞通，先下结粪如胡椒者十余枚，后渐得通利，不用药而愈矣。
文潞公在北门曰∶盛夏间苦大腑不调。公随行医官李琬，本衢州市户，公不独终始涵容之，又教以医事。
公病泄利，琬以言动摇之，又求速效，以赤石脂、龙骨、干姜等药馈公。公服之屡日不大便，其势甚苦。初虞
世共城来见，公未坐定，语及此事，公又不喜服大黄药。虞世告曰∶比燥粪在直肠，药所不及，请以蜜兑导之。
公以为然，时七月中苦热，虞世冒汗为公作蜜兑，是夕三用，下结粪四五十枚，大如胡桃，色黑如橡栗。公二
三日间，饮食已如故。（《良方》。）
攒宫有一老人患风秘，八九日不通，有木匠授以此方，只一服见效。用不蛀皂角，当中取一寸许，去黑皮，
以沸汤半盏泡，上用盏盖定，候温服之。先备少粥，通后即食。（《是斋方》。）
缪仲淳治唐震山，年七十余，便燥结，胸中作闷。曰∶此血液枯槁之候。用大肉苁蓉三两，白酒浸洗，去
鳞甲，切片，白汤三碗，煎一碗，顿时饮尽，大便通，胸中快然。偶一医问疾曰∶此劫药也，当调补脾胃为主。
易以白术、浓朴、茯苓、陈皮，病如故。唐翁曰∶误矣。仍饮前药立解。高存之闻而叩其故。缪曰∶肉苁蓉峻
补精血，骤用反动大便，药性载甚明也。（《广笔记》。）
张选卿治大便不通屡验方∶朱砂研如飞面五钱，真芦荟研细七钱，滴好酒少许，和丸。每服一钱二分，好
酒吞下。朝服暮通，暮服朝通，须天晴时修合为妙。（同上。）
刘云密治一老人，因冒雨感寒，未经发汗，至春初内热烦躁，胸膈紧满，十日不大便，用清解二剂，入口
即吐其半。加熟大黄利之，下咽即吐去殆尽。盖因痰热凝结胸膈，是以治血分者，反拒而不受也。因用牵牛大
黄丸，缓缓服之，而大便通后，乃服清热化痰药，十余剂而渐安。则较濒湖所说老妇肠结症，又进一解矣。
吴桥治张邦达，谢邑归，年逾艾矣，其貌壮硕如昔，偶以信宿梦遗，早呼旨酒，进人参膏二匕，既而大便
稍实，无他恙也。张所善者巴深，以为误饮而酿内热，不急下，且虞有他。既饮大黄汤，不为动，犹以为热甚，
至于再三，腹胀膨 ， 石矣，旬日尸寝，不食不言。桥诊之，脉隐隐将绝。桥曰∶肾司启闭，主二溲，脾
Feng Chuzhan treated a patient surnamed Cui. The six pulses were deep and faint (shen wei), the body was hot, the four limbs were cold (jue leng), there was madness and delirious speech (kuang wang chan yu), sleeplessness throughout the night, thirst with a desire for copious drinking, and both urine and stool were obstructed. (The symptoms closely resembled Yangming heat syndrome, but it was diagnosed as Yin latent within forcing Yang outward; this is a treatment strategy of abandoning symptoms in favor of pulse diagnosis.) This condition arises from Yin pathogenic factors latent inside, forcing Yang Qi to float outward, causing the failure of Jin Ye (body fluids) to circulate, thus resulting in scanty urination and dry mouth/thirst; it is not excess heat. Due to long-term deficiency from food intake, the stool is obstructed due to deficiency rather than dryness accumulation. If immediate astringency and consolidation are not performed, both True Yin and True Yang will be exhausted. Therefore, Shu Di Huang (Prepared Rehmannia Root), Mai Dong (Ophiopogon Tuber) were used to strengthen Metal and Water (Lung and Kidney); Chao Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) was used to support Middle Jiao Qi; Niu Xi (Achyranthes Root) and Wu Wei Zi (Schisandra Fruit) were used to guide Qi downward and store/consolidate; Zhi Fu Zi (Processed Aconite Lateral Root) was used to guide Fire back to its source; and Ren Shen (Ginseng Root) was decocted heavily separately and taken with the main prescription. Within three doses, the madness subsided, clarity returned, appetite increased, and recovery occurred.
Commentary: This is also a disease of Yin deficiency with Yang floating outward; if severe, it develops into Lei Zhong Feng (Stroke-like syndrome). Its treatment method is largely sound but has minor flaws. The statement that "Yin is latent inside, forcing Yang outward" is as ambiguous as Zhang Jingyue's classification of Yin syndromes in his case records. These two cases are not included in the Stroke category because the public only considers obstruction of urine and stool as urgent, and few study the category of Wind Constipation.
Hu Nian'an treated a salt merchant surnamed Chen, aged seventy-six. In spring, he suffered from Zhong Feng Tuo Zheng (Stroke Collapse Syndrome) and recovered after more than two hundred doses of heavy Ren Shen (Ginseng Root) and Fu Zi (Aconite Root). By October, he suffered from severe constipation, visiting the toilet dozens of times daily, profuse cold sweat, cyanotic face, and cold limbs. A physician added San Da Huang (Raw Rhubarb Rhizome, 3 qian) to tonifying formulas. Hu deeply considered this inadvisable and warned: "After collapse in an elderly person, saved by Ren Shen and Fu Zi, one should rest and nourish. Overthinking leads to exhaustion of Jin Ye (body fluids) and dysfunction of transmission. Why be impatient and hasten change? If Da Huang is administered, the purgative effect may be irreversible, making recovery difficult. Endure for two or three days; the situation should resolve itself." The patient complained of the delay. The next day, reluctantly, Ren Shen (2 liang), Rong Rong (Cistanche Stem, 1 liang), Dang Gui (Angelica Sinensis Root, 5 qian), Song Ren (Pine Kernel, 5 qian), Bai Zi Ren (Biota Seed, 5 qian), Fu Zi (Aconite Root, 3 qian), and Sheng Ma (Cimicifuga Rhizome, 4 qian) were decocted and taken. Externally, Lv Fan (Green Vitriol, 1 jin) was placed in the toilet bowl, poured with boiling water, and the patient sat on it. After a quarter of an hour, stool passed freely. (From *Yi Lin Gang Mu*.)
Commentary: Constipation following Tai Yang Shang Han (Cold Damage), Malaria, or Dysentery is caused by improper use of purgatives or diaphoretics. The root cause is Blood Dryness. Regarding Wind Constipation, the pathology originates from Dryness-Fire generating Wind. Physicians who misunderstand the term "Wind" and use Wind-dispelling herbs cause death or lasting sequelae, though these are relatively mild outcomes.
Zhang Luyu treated Yang Songling. In summer, he caught a cold and took ten-plus doses of diaphoretic herbs, leading to obstruction of both urine and stool. A physician used Xiao Shi (Mirabilite) and Da Huang (Rhubarb Rhizome) to purge. The left lower abdomen swelled like a mound, without redness or heat, sometimes making buzzing sounds. A surgeon applied external plasters and internal detoxifying/diuretic herbs, but before ingestion, the patient became restless. Pulse diagnosis revealed tight, thin, and rapid pulses in all six positions. This resulted from excessive sweating damaging Jin Ye (body fluids), followed by bitter-cold interior-purging herbs causing Yin pathogenic factors to knot internally, failing to transform in the Bladder, leading to urine accumulation and obstruction. The prognosis was poor, but fortunately, Stomach Qi remained strong, and the form/spirit were not emaciated; he could still eat small amounts of porridge. Treatment was attempted. A large dose of *Ji Sheng Fang* Shen Qi Wan (Kidney Qi Pill) was decocted, poured into a spouted pot, the patient's neck supported, and slowly instilled orally (approx. 1 sheng). Shortly after, the patient was turned over, and goose feather induced vomiting. Immediately, urine and stool flowed profusely, and the abdomen flattened. Then, Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) was given for regulation and peace. Four or five patients had similar conditions: some with dribbling urine, some with incontinence, some with emaciation and Qi depletion; all refused treatment.
Commentary: This constipation resulted from confusing exterior-releasing and interior-purging treatments during exogenous diseases. It is recorded here for reference.
Sun Wen Yuan treated the wife of Wen Nanxi. She usually suffered from constipation, red face, loss of appetite, and occasional dizziness. Pulse diagnosis showed slippery, large, and forceful pulses at the right Guan and Chi positions. This was Tan Huo (Phlegm-Fire) syndrome. Gua Lou (Trichosanthes Fruit, 4 qian) was used as the sovereign herb; Hua Shi (Talcum, 3 qian), Zhi Shi (Immature Bitter Orange, 2 qian), Ban Xia (Pinellia Tuber, 1.5 qian) as ministers; Luo Bo Zi (Radish Seed, 1 qian) and Jiang Huang (Turmeric Rhizome, 1 qian) as assistants. Two doses cured her. He advised that for future constipation, Dang Gui Long Hui Wan (Angelica and Gelsemium Pill) plus Niu Dan Nan Xing (Ox Gall Phlegm, 1 qian) would work immediately.
One person had obstruction of both urine and stool for several days. Shang Lu (Monsa Root) was mashed and applied to the umbilicus, resulting in immediate passage. (From *Ben Cao Gang Mu*.)
One person had long-term constipation. Wu Mu (Ebony Wood, 1 cun segment) was split and decocted in water to yield half a cup. Ingestion led to immediate cure.
Lu Yang Yu treated Shen Wang Ting, nearly seventy years old. He often suffered from hypochondriac pain, cured by Qi-moving herbs and Dang Gui Long Hui Wan. Later, he developed constipation. Run Chang Wan (Intestine-Moistening Pill) allowed passage but reduced appetite, caused chest/diaphragm discomfort, and dull pain. If not taken for a few days, constipation recurred. Some attributed this to blood deficiency in old age and prescribed Si Wu Tang (Four Substances Decoction) for several doses, which stopped urination and caused severe abdominal distension after three days. Mi Dao (Honey Suppository) and umbilical warming failed. Pulse was deep, slow, and weak. Inquiry revealed a sensation of wanting to defecate, but stools were moist, not dry. Diagnosis: Not Blood Constipation, but Qi deficiency failing to transport. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Mu Xiang (Aucklandia Root) and Bai Dou Kou (Black Cardamom Seed) was used. Two doses restored bowel and bladder function. Continued monthly use prevented constipation, doubled appetite, and eliminated hypochondriac pain.
Lu Zu Yu treated Qiu Yanzhao, who had weak constitution, frequent nocturnal emissions, loved dry fried rice, and had bowel movements every 2-3 days. Suddenly catching wind-cold while eating dry rice and dining four times daily, he maintained normal diet for ten days but stool ceased. Later, alternating chills/fever, headache, and persistent fever lasted over twenty days. Left hand pulse was floating and wiry; Qi Kou (Cun Kou) pulse was deep, solid, and slippery. Wind pathogen and food stagnation were unresolved. Ge Gen (Kudzu Root), Chai Hu (Bupleurum Root), Shan Zha (Hawthorn Fruit), Hou Po (Magnolia Bark), Gua Lou Ren (Trichosanthes Seed), Huang Qin (Scutellaria Root), Chen Pi (Citrus Peel), Ban Xia (Pinellia Tuber) were used. Headache stopped, fever/lightened. Jaundice appeared; Ban Xia, Chen Pi, Hou Po were removed; Yin Chen (Artemisia Capillaris), Hua Fen (Trichosanthes Root), Mu Xiang (Aucklandia Root), Zhi Shi (Immature Bitter Orange), Huang Lian (Coptis Rhizome) were added. Two doses cleared jaundice. Red macules appeared; Yin Chen, Mu Tong (Akebia Stem) were removed; Xi Jiao (Rhinoceros Horn - substitute: Water Buffalo Horn), Sheng Ma (Cimicifuga Rhizome) were added. Run Zi Wan (Moisten Intestines Pill, 2.5 qian) was taken with decoction. After a long time, 7-8 pieces of dry stool passed, macules faded, slight coolness ensued. Chest tenderness persisted; Xi Jiao, Sheng Ma were removed; Huang Lian, Zhi Shi were doubled. Six doses resulted in no stool and slight lower abdominal fullness. Some suggested purging due to duration (>1 month); Lu disagreed, continuing Run Zi Wan (2.5 qian) with Ginger Decoction. Soon, 7-8 pieces of stool passed, chest unchanged. Daily decoction + Run Zi Wan every other day. At 70+ days, total Run Zi Wan consumed was 5 liang, chest still unclear. Given muscle wasting and history of emissions, further draining was contraindicated. Zhi Shi (2 qian), Shan Zha (2 qian), Ren Shen (0.6 qian), Fu Zi (0.4 qian) were given for three doses, restoring daily bowel movement. Ren Shen gradually increased, Zhi Shi decreased. After several doses, appetite returned, illness receded. Half a jin of Ren Shen restored health.
Dan Xi treated a woman with Spleen pain, later developing obstruction of urine and stool. This was Phlegm blocking the Middle Jiao, Qi gathering in the Upper Jiao. Er Chen Tang (Two-Cured Decoction) plus Mu Tong (Akebia Stem) was given. First dose induced vomiting; residue decocted again. Shao Zao Jiao Hui (Burned Gleditsia Sinensis Fruit Ash) powder was taken with Rice Decoction. A nun, obese, suffering from vomiting/reversal, suddenly developed dysuria and head sweating, dying instantly.
Xue Li Zhai treated Scholar Wang Luzhi, who had abundant phlegm. After induced vomiting, he suffered dry constipation, dizziness, blurred vision. Chi pulse was floating and large, coarse upon pressure. Diagnosis: Kidney Qi deficiency combined with Blood deficiency. Si Wu Tang (Four Substances Decoction) delivered Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) for four doses; symptoms resolved. Continued pill therapy for a month led to recovery.
Counselor Gao Ru Zhai, prone to salivating phlegm, took phlegm-draining medicines, losing much phlegm but developing constipation, frequent urination, dizziness, blurred vision. Chi pulse floating/large, imperceptible on pressure. Diagnosis: Kidney failing to grasp Qi; previous drugs damaged Metal/Water. Jia Jian Ba Wei Pian (Modified Eight-Ingredient Pill) cured him.
Chen San Nong treated Wang Tai Xue from Central Plains, accustomed to alcohol/fatty foods. Suffered extreme lower abdominal pain/swelling, obstruction of urine/stool, unable to sit/lie down, groaning for seven days. Various unblocking methods failed. Diagnosis: Damp-Heat pathogens blocking the two Yin openings, obstructing channels. Pathology not in Large Intestine/Bladder. Jiu Cai Zi (Leek Seed), Shan Jia (Pangolin Scale), Hui Xiang (Fennel Fruit), Lian Shi (Melia Toosendan Fruit, 1.5 qian each), Qian Niu Tou Mo (Morning Glory Seed Powder, 3 qian) decocted in water. One dose reduced symptoms, three doses cured. Qian Niu reaches Right Kidney Ming Men (Gate of Life), traversing Essence tunnels. Hence, Dong Yuan Tian Zhen Dan uses Salt-fried Black Qian Niu with Chen Xiang (Agarwood), Guan Gui (Cinnamon Bark), Du Zhong (Eucommia Bark), Gu Zhi (Cibotium Rhizome) to treat Lower Jiao Yang deficiency.
Chen Liang Fu said: A man with Wind-induced extremity disease used harsh purgatives, developed Fei Wei (Flaccid Lung) with hemoptysis/pus, and died of constipation. Pity.
Yi Si Lan treated a Confucian official in late mid-autumn with constipation. Initially intermittent urinary retention; Wu Ling San (Five-Ingredient Powder with Poria), Ba Zheng San (Eight-Substance Powder for Rectification), Yi Yuan San (Benefit Origin Powder) failed. A physician found absent Chi pulses, diagnosed Lower Yuan Yin deficiency/Dryness, prescribed Ba Wei Wan (Eight-Ingredient Pill) once daily. After three days, constipation worsened, thirst/dry throat, irritability/insomnia. Pi Yue Wan (Spleen-Restriction Pill), Run Chang Wan (Intestine-Moistening Pill) caused frequent scanty urination. Ten days of complete fecal obstruction, unbearable abdominal fullness. Consensus: Urgent San Yi Cheng Qi Tang (Three-One Bowel-Purging Decoction). Mild purging followed by re-obstruction, periumbilical pain. Zhou Che Wan (Boat Cart Pill), Yu Xian Dan (Immortal Meeting Pill) given fasting, 3-5 times daily purging, tenesmus, red/white stool. Half-month groaning, consuming only rice water/tea. End of September, Yi diagnosed: Cun pulses deep/hidden forceful; Guan pulses洪缓 (large/slow) weak; Chi pulses absent. Yi stated: Guan/Chi safe, pathology above diaphragm. This is Qi constipation from mental labor/worry. Yue Ju Tang (Resolve Frustration Decoction) given: Xiang Fu (Cyperus Rhizome, vinegar-fried, 1 qian), Su Geng (Perilla Stem), Lian Qiao (Forsythia Fruit), Shan Zhi (Gardenia Fruit), Chuan Xiong (Ligusticum Rhizome, 0.6 fen each), Cang Zhu (Atractylodes Lancea Rhizome), Huang Qin (Scutellaria Root, 0.8 fen each), Shen Qu (Medicated Leaven, 1 qian), Jie Geng (Platycodon Root, 0.4 fen), Zhi Ke (Bitter Orange, 0.5 fen), Gan Cao (Licorice Root, 0.3 fen). One bowl induced belching; second bowl caused profuse urine/stool discharge of accumulated matter, profuse sweat. Ginger tea helped sleep. Next morning, pulses normal; Qi/Blood regulation cured him. Yi noted: Disease location varies, but Qi circulation is key. Pulse differentiation determines obstruction. Absent Chi pulses mistaken for "rootless tree"; however, Ji Mao year (Dry Metal ruling Heaven, Ministerial Fire ruling Earth, Ji Earth operating middle) explains hidden Chi pulses. If Chi > Cun, it is "Size Reversal," fatal per Classic. Ba Wei Wan inappropriate. Tenesmus/red-white stool mimics Dysentery, but Guan pulse not floating/tight/rapid rules it out. Using Cheng Qi/Zhou Che/Yu Xian drugs injured Original Qi. Pathology: Upper Jiao Qi constipation causing Lower Jiao blockage. Heart pulse upper/Cun should float; sinking indicates Qi. Qi stagnation fails ascending/descending, closing lower orifices (Xi Men, You Men). Like a vessel: close top, bottom stops flowing. Xiang Fu moves stagnant Qi; Su Geng opens exterior/interior; Lian Qiao disperses Six Meridian郁Fire; Cang Zhu/Shen Qu strengthen Spleen/disperse knots; Zhi Gan Cao harmonizes; Jie Geng guides Huang Qin/Zhi Ke to cleanse Large Intestine; Shan Zhi clears San Jiao fire/dredges Small Intestine; Chuan Xiong soothes Liver Wood. Once upper orifice opens, lower follows. Exterior smoothness ensures Interior flow, sweating, and dual-orifice patency—"One open, all open." Qi constipation is root; stool blockage is branch. Treating root yields fast results.
Wu Fu Xian treated Cao Shu Chang with urinary retention. Overuse of diuretics caused nocturnal enuresis, then re-obstruction. Diagnosis: Diuretics excessive, Kidney Qi extremely deficient. Bu Zhong Yi Qi Tang delivered Shen Qi Wan cured him.
Sun Wen Yuan treated Yuan Hong Xi. Summer heat exposure, administrative stress caused fever/thirst. Overeating iced fruits caused diarrhea, scanty urine. Wei Ling Tang plus diuretics stopped diarrhea but disrupted urine rhythm. Umbilical swelling/urgency: standing yielded drops, lying caused continuous leakage. Frequent chamber emptying caused insomnia. Half-month treatment depleted spirit/appetite. Pulses: Cun short/weak; Guan slow/large; Chi洪大 (large/vigorous). Residual heat, alcohol habit, Damp-Heat sinking lower. Yi Yuan San (3 qian) with Xiang Ru (Mosla Herb) decoction ineffective. Recalled: Urinary orifice misalignment. Bladder is room of Pao (Urinary Bladder organ). Damp-Heat sinking in Pao causes orifice misalignment when standing. Lying allows leakage but not free flow. Treatment: Lift/tonify Upper/Middle Jiao Qi. Urgent San Yi Cheng Qi Tang. Mild purging/re-obstruction/pain. Zhou Che/Yu Xian pills caused tenesmus/red-white stool. Half-month groaning. Pulses: Cun deep/hidden forceful; Guan large/slow weak; Chi absent. Yi stated: Guan/Chi safe, pathology above diaphragm. Qi constipation from mental labor. Yue Ju Tang given. Belching, profuse discharge, sweat. Ginger tea, sleep, porridge. Pulse flat, regulation cured.
Li Zhai examined Zhi Fang Chen E Zhai, over sixty. Post-constipation, Ne Shu (Internal Purging) herbs caused poor appetite, abdominal/hypochondriac distension/pain, fatigue. Chi pulses floating/large; Left Guan short/coarse; Right Guan wiry/coarse. May. Diagnosis: Ming Men Fire decline failing to generate Spleen Earth; Lung Metal overcoming Liver Wood. Predicted death during Metal peak; confirmed.
Wan Mi Zhai treated Wang Yu Hong. Constipation unresponsive to Tong You Tang (Open Passage Decoction), Run Chang Wan. Pulses微弱 (faint/weak), internal injury. Qi Kou pulse large/soft: Qi not moving, Blood not moistening. Qi/Blood double deficiency. Urgent tonification needed. Objection: Abdominal distension? Response: Worry not. Bu Zhong Yi Qi Tang with doubled Dang Gui cured in five days.
Xu Xue Shi treated mother of a patient, eighty-four. Sudden abdominal/head pain, nausea/anorexia. Dozens of physicians prescribed Spleen-tonifying/Appetite-stimulating/Wind-clearing herbs; no improvement, no food intake. Family anxious. Xu argued previous meds wrong. Elderly Wind Constipation: Zang-Fu stagnation gathers in chest (distension/nausea/anorexia), ascends to vertex (headache/confusion). Smooth Zang-Fu resolves all. Zi Su Zi (Perilla Seed), Da Ma Zi (Hemp Seed, 0.5 he each) washed, ground, juice extracted (1 zhan), divided twice for porridge. Two servings moved Qi stagnation, passed pepper-like hard stools, then gradual relief. Cured without medicine.
Wen Lu Gong at North Gate: Midsummer suffered bowel irregularity. Attendant physician Li Wan (Quzhou native) encouraged him, taught medicine. Gong had diarrhea; Li Wan urged speed, gave Chi Shi Zhi (Halloysitum Rubrum), Long Gu (Fossilized Bone), Gan Jiang (Dried Ginger). Gong took them, severe constipation ensued. Chu Yu Shi visited. Gong disliked Da Huang. Yu Shi suggested Mi Dui (Honey Suppository) for rectal dry stool beyond drug reach. Gong agreed. July heat, Yu Shi sweated preparing suppository. Three applications that night passed 40-50 walnut-sized black stools. Diet restored in 2-3 days. (From *Liang Fang*.)
Zan Gong elderly man, Wind Constipation 8-9 days. Carpenter's formula: Non-moth-eaten Zao Jiao (Gleditsia Sinensis Fruit, 1 cun center), remove black skin, steep in half cup boiling water, cover, warm drink. Prepare porridge; eat after passage. (From *Shi Zhai Fang*.)
Miao Zhong Chun treated Tang Zhen Shan, over seventy, dry constipation, chest stuffiness. Diagnosis: Blood/Essence exhaustion. Rou Cong Rong (Cistanche Stem, 3 liang) soaked in white wine, sliced, decocted in 3 bowls white soup to 1 bowl, drunk instantly. Bowel opened, chest relieved. Another doctor called it "robbery drug," suggested Spleen/Stomach tonification with Bai Zhu, Hou Po, Fu Ling, Chen Pi. Condition unchanged. Tang said: Wrong. Previous drug worked instantly. Gao Cun Zhi asked why. Miao: Rou Cong Rong severely tonifies Essence/Blood; sudden use stimulates bowel. Drug nature clear. (From *Guang Bi Ji*.)
Zhang Xuan Qing effective formula for constipation: Zhu Sha (Cinnabar, 5 qian fine powder), Zhen Lu Hui (True Aloe, 7 qian fine powder), drop good wine, make pills. Take 1.2 qian with good wine. Morning dose passes evening; evening dose passes morning. Best prepared on sunny days. (Same source.)
Liu Yun Mi treated elderly man, rain/cold exposure, no sweating. Early spring internal heat/irritability, chest tightness, 10-day constipation. Qing Jie (Clear/Resolve) herbs vomited half. Added Shu Da Huang (Cooked Rhubarb), vomited almost all. Phlegm-Heat knotting chest/diaphragm rejected blood-treating herbs. Qian Niu Da Huang Wan (Morning Glory-Rhubarb Pill) slowly given. Bowel opened, then Heat-Clearing/Phlegm-Resolving herbs for 10+ doses, gradual peace. Advances upon Bin Hu's old woman case.
Wu Qiao treated Zhang Bang Da, returning from county, over fifty, robust appearance. Nocturnal emission after two nights, drank wine, took Ren Shen Gao (Ginseng Paste, 2 bi). Stool firmed, no other issues. Friend Ba Shen thought wine/Ginseng caused internal heat, urged purging. Da Huang Tang ineffective. Heat assumed severe, repeated dosing. Abdominal distension hard as stone, ten days bedridden, anorexic/aphasic. Qiao diagnosed: Pulses faint/almost gone. Qiao said: Kidney governs opening/closing, controls two outputs, Spleen...