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Xu Lingtai stated: The syndrome of fecal impaction is mostly caused by dryness of blood in the intestines with latent fire. Methods such as opening the lungs and regulating qi are occasionally effective, but not universally applicable.

The Prefect of Ankang suffered from wind-constipation (constipation caused by wind pathogen). Chen prescribed Er Ren Wan (Two Kernels Pill): Apricot kernels peeled and de-husked, stir-fried with flour; Hemp seeds separately ground; Aurantii Fructus removed of pith, stir-fried with flour and powdered; Chebulae Fructus stir-fried and de-seeded, powdered. These were made into pills the size of a Chinese quince seed using refined honey. Each dose was 20-30 pills, taken with warm water. If bowel movement did not occur, the dose was increased until cured.

Xue Lizhai treated an elderly woman who had difficulty defecating, though the stool was not hard. Her abdomen was sometimes normal, sometimes distended. Her Guan and Chi pulses on both hands were floating and large. Xue diagnosed it as deficiency of Qi and blood in the stomach and intestines. He prescribed Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) added with Cistanches Herba. She felt relieved after defecation. If she did not take medicine for two or three days, her abdomen would become distended again, and defecation difficult.

A woman suffered from severe constipation unresponsive to various medicines, causing unbearable suffering. She was instructed to drink human milk, which brought relief.

Zhang Zihe said: Previously, there was an eighty-year-old man whose organ functions were sluggish, with no bowel movement for several days. Whenever he attempted to defecate, he experienced dizziness, nasal congestion, and lower back pain. His appetite gradually decreased. Even when eating, his stool became hard like a pellet. One day, a friend suggested he eat mallow soup with animal blood and spinach blanched in oil. He ate this daily without fail, resulting in smooth bowel movements, improved appetite, and clear spirit. He lived to ninety years old and died peacefully. The "Tu Jing" records that spinach is cold in nature and promotes intestinal function; sesame oil-fried spinach promotes bowel movement. Mallow widens the intestines and promotes urination. For the elderly, difficulty in urination and defecation is most urgent. This was also an accidental use of purgative methods.

Zhang Zihe's cousin suffered from dry and stagnant bowels without other symptoms. He dared not eat too much; if he did, defecation became extremely difficult, with stool hard as iron. Every three to five days, he would have one bowel movement, accompanied by visual disturbances (stars flying before eyes), epistaxis, pain in the anus extending to the rectum, leading to fainting upon pain. Medications worsened the condition. He had used Crotonis Semen (Badou), Genkwa Flos (Yuanhua), and Kansui Radix (Gansui). Overuse led to exhaustion, and cessation led to recurrence of dryness. After years of this, he feared medication, became irritable, refused treatment, and lay ill waiting for death. Both radial pulses were slippery, solid, and forceful. Zhang administered Dachengqi Tang (Major Order the Qi Decoction) to purge, followed by Shengong Wan and Mahuang Wan. He advised eating spinach and animal blood soup. Within a hundred days, the patient regained robust health, astonishing his relatives. Crude physicians do not know that dryness syndromes are divided into four types: dryness on the exterior causes skin wrinkling; dryness in the interior causes depletion of essence and blood; dryness above causes dryness of throat and nose; dryness below causes constipation and urinary retention. Dryness is a transformation of the Yangming channel. Due to scarcity of body fluids, this occurs. However, purgatives can be used, but selection is crucial. Badou purges cold accumulation; Gansui and Yuanhua purge damp accumulation; Dahuang and Xiaoshi purge food accumulation. The "Neijing" states: Pungent flavors moisten; salty flavors soften. The "Zhou Li" states: Use slippery substances to nourish orifices.

Gong Zicai treated a sixty-seven-year-old man who, due to anger, developed three movable, painful masses on the left side. Rubbing dispersed them. He experienced epigastric fullness and burning sensation, feeling blocked after eating, restless sleep, scanty urine, and no bowel movement for eight days. One physician used Dachengqi Tang, another Huazhi Wan, another pig bile suppository, and another honey suppository, all ineffective. Pulse diagnosis revealed wiry, rapid, and forceful pulses on all six positions. This indicated insufficient blood, excess Qi, and stagnation. Gong prescribed 3 qian of Dahuang powder and 5 qian of Xiaoshi, mixed with hot rice wine. The patient passed dozens of black, stone-like stools. Upon re-administration, he passed a basin-full of pellets, and symptoms resolved. Subsequently, he was treated with Sini Tang modified with Taoren, Honghua, wine-steamed Dahuang, Huanglian, Zhizi, Sanleng, Ezhu, Zhike, Qingpi, Mutong, and Gancao for over ten doses, resulting in recovery.

Li Shizhen treated a royal clan member nearing sixty, who suffered from intestinal obstruction for decades, having a bowel movement only once every ten days, more painful than childbirth. Blood-nourishing and moistening agents caused chest discomfort, while purgatives like Xiaoshi and Dahuang had no effect. The patient was obese, consumed rich foods, and was prone to melancholy, vomiting over a bowl of sour phlegm daily for relief. He also had frequent heat syndromes. Li diagnosed this as stagnation of Qi in the Triple Burner, with ascending but no descending, causing body fluids to transform into phlegm-fluids that could not nourish the intestines downwards. It was not merely blood dryness. Moistening agents were retained, and purgatives entered the blood level but could not move Qi, being blocked by phlegm. Li prescribed Qian Niu Zi powder and Zao Jiao paste pills, which immediately promoted bowel movement. From then on, one dose ensured smooth passage, allowed normal diet, and restored mental clarity. Qian Niu Zi moves Qi, opens the Triple Burner, and resolves phlegm and fluids when Qi flows smoothly. (From "Bencao Gangmu".)

Li Shi Cai's nephew, Liu Qiao, indulged in alcohol and sex, suffering from severe lower abdominal distension and pain, with inability to urinate or defecate. He cried and groaned day and night, unable to sit or lie down. Purging medicines failed. Li Shi Cai reasoned that damp-heat pathogen was obstructing the spermatic duct, blocking the pathways between the two yin openings, thus obstructing urine anteriorly and stool posteriorly. The disease was not in the Large Intestine or Bladder. He used Litseae Fructus, Foeniculi Fructus, and Manis Squama, with doubled Qian Niu Zi, decocted in water. One dose reduced symptoms, three doses resolved them. (Same source.)

Zhang Jingyue treated a vigorous young man who loved strong liquor. In summer, he slept exposed after drunkenness, fearing neither wind nor cold. His dietary habits and organ constitution were exceptional, leading to heat binding in the Triple Burner and closure of both urine and stool. Initially, Dachengqi Tang was used with 5-7 qian of Dahuang, acting forcefully like a stone thrown in water. Shenyou Wan and enemas failed. The condition worsened with complete closure. Zhang then used Dachengqi Tang with 2 liang of raw Huangqi, 3 qian of Mangxiao, and 2 qian of Yazao, decocted together. Medicine was taken at dusk, and bowel movement occurred at midnight. Urination followed. This illustrates that complex, entrenched problems require decisive action ("axe and hatchet"). Indecision leads to disaster.

Madam Zhu, mother of Hanlin Academician Zhu, nearly seventy, developed fever and chills after a fall. Physicians prescribed Yin-nourishing and heat-clearing herbs, worsening the condition. Pulses were weak. Although she had heat in the head and upper body, she had no thirst, and her legs were cold above the thighs. Zhang diagnosed this as Yin deficiency with pathogen invasion, not caused by the fall, but actually a Yin syndrome. He prescribed Liyin Jian (Replenish Yin Decoction) with Renshen and Chaihu. Fever subsided after two doses, and she resumed eating porridge. Later, she had no bowel movement for half a month, with increasing abdominal distension. Others attributed this to dryness-fire and wanted to use cooling herbs. Zhang disagreed, stating that further clearing of heat would damage the root cause beyond repair. The Classics state: The Kidney dislikes dryness; urgently use pungent flavors to moisten. Zhang added Jiang (Ginger) and Fu (Aconite) to the previous formula, doubling Renshen and Danggui. After several doses, bowel movement resumed, distension subsided, and she recovered. (This is actually a type of wind-constipation; attributing success solely to Ginger and Aconite is incomplete.)

Commentary: This syndrome is Yin deficiency with Yang floating, a mild form of stroke-like illness. The fall triggered it. The insertion of "Yin syndrome" is questionable, revealing Zhang's theoretical biases.

Li Shicai treated Jiang Shouzai, who developed severe constipation after drinking Wujiapi Wine. For four days, he suffered abdominal distension. One qian of Dahuang provided temporary relief, but constipation recurred. Li stated that declining Kidney Qi and insufficient body fluids were the root. Mistaken use of draining methods exacerbated the fire. He prescribed Bawei Wan (Eight-Ingredient Pill) decocted with one cup of human milk and 5 qian of white honey. Bowel movement occurred after two doses, and he recovered in ten days.

Gu Wenxue had chronic wind-phlegm and constipation. Treating wind requires treating blood, a fundamental principle. He was treated with Shiquan Dabu Tang added with Qinjiao, Hemaoren, Xingren, Fangfeng, and roasted Zao Jiao Ren. Symptoms improved in half a month and did not recur after three months. (This is also a manifestation of wind-constipation.)