【因】 火邪伏于血中，耗散真阴，津液亏少，夫肾主大便。肾主津液，液润则
大便如常
【证】 小肠移热于大肠，为 瘕，为沉。 瘕，是便涩闭也。
【脉治】 燥热 有云∶脾脉沉数，下连于尺，脏中有热。亦有吐泻后肠胃虚，
服燥热药多者，宜承气汤下之。
风燥 有云，右尺浮也，内肺受风，传入肠中，宜麻仁丸。
阳结 脉数大而实，宜苦寒类治。
阴结 阴燥欲坐井中，二肾脉搐之必虚，或沉细而迟者是也。
如有阴证烦躁，脉坚实，阳药中少加苦寒，以去热燥。
有年老气弱津液不足而结；有产妇内亡津液而结。二证并宜地黄丸。
大便闭，小便涩数，谓之脾约。约者，脾血耗燥，肺金受火无所摄，脾津液故竭。理宜
养血润燥。
有产妇便秘，脉沉细，服柏、知母、附子而愈。
外有香港脚、虚寒、气实，皆相似，亦大便不通。
肾恶燥，急食辛以调之，结者散之。如少阴不得大便，以辛润之；太阴不得大便，以苦
泻之。如食伤腹满，腹响是也。阳结者散之，阴结者热之。
润肠丸 麻仁 桃仁（去皮、尖，各一两） 羌活 归尾 大黄（煨，各半两）
除二仁别研，余味共捣，火枯，蜜丸，梧子大，汤下。如不大便，邪气盛急，加大黄酒
制；
如血燥而大便干燥，加桃仁、大黄酒制；如风结燥，大便不行，加麻仁、大黄；如风涩，加
皂角仁、秦艽、大黄；如脉涩，身觉有短气，加郁李仁、大黄；如阴结寒证，加干姜、附子
。
有云，大便不通有五证，热、冷、气、风、湿，尺脉伏也，宜温补之。
风，老人、产妇，秘有虚实。能饮食，小便赤为实。实者，秘物也。麻仁、七宣等主之
。（见前。）不能饮食，小便清为虚。虚者，秘气也。浓朴汤主之。
浓朴 半夏 神曲 甘草（三两） 白术（五两） 枳实 陈皮（一两）
[Pathogenesis] Fire pathogen lurks within the blood level, consuming the True Yin (Zhen Yin), leading to a deficiency of body fluids. The Kidney governs defecation. The Kidney controls body fluids; when fluids are moistening, bowel movements are normal.
[Syndrome] Heat from the Small Intestine transfers to the Large Intestine, forming masses (Jia), presenting with a Deep pulse (Chen). "Jia" refers to obstructed and closed bowel movements.
[Pulse and Treatment] Regarding Dryness-Heat syndrome: It is stated that if the Spleen pulse is Deep and Rapid (Shen Shu) extending down to the Chi position, it indicates heat within the zang organs. In cases where gastrointestinal weakness follows vomiting or diarrhea, or due to excessive intake of dryness-heat promoting drugs, Chengqi Tang (Cassia Twig Decoction) is suitable for purgation.
Regarding Wind-Dryness syndrome: It is stated that a Floating pulse at the Right Chi position indicates wind affecting the Lung, transmitting to the intestines; Maren Wan (Hemp Seed Pill) is suitable.
Yang Jie (Yang Constipation): The pulse is Rapid, Large, and Excess; treatment with Bitter-Cold category herbs is suitable.
Yin Jie (Yin Constipation): Patients feel an intense internal dryness, desiring to sit in a well (seeking coolness); the pulses at both Kidney positions are Deficient upon palpation, or present as Deep, Fine, and Slow. If there is irritability characteristic of Yin syndromes with a Firm pulse, add a small amount of Bitter-Cold herbs to warm-tonifying medicines to clear heat and dryness.
Constipation due to advanced age, Qi weakness, and insufficient body fluids; constipation in postpartum women due to loss of internal body fluids. Both conditions are suitable for Dihuang Wan (Rehmannia Pill).
Obstructed defecation with scanty, frequent, and difficult urination is called Pi Yue (Spleen Restriction). "Yue" implies that Spleen blood is consumed and dried, Metal of the Lung is affected by fire and loses its controlling function, causing the exhaustion of Spleen fluids. The appropriate method is to nourish blood and moisten dryness.
A case of postpartum constipation with a Deep and Fine pulse was cured by applying Baizi Ren (Biota Seed), Zhimu (Anemarrhena Rhizome), and Fuzi (Prepared Aconite Root).
Additionally, Jiaoxie (Gout/Leg Swelling), Deficiency-Cold, and Qi Excess present similar symptoms, also manifesting as inability to pass stool.
The Kidney detests dryness; urgently consume Pungent substances to regulate it. For obstruction, disperse it. For Shaoyin channel constipation, use Pungent-Moistening methods; for Taiyin channel constipation, use Bitter-Purging methods. For example, dietary injury causing abdominal fullness and borborygmus falls into this category. Yang Jie should be dispersed; Yin Jie should be treated with Heat.
Runchang Wan (Intestine-Moistening Pill): Mahuang (Hemp Seed), Taoren (Peach Kernel - peeled and removed of tips, 1 liang each), Qianghuo (Notopterygium Rhizome), Guiwei (Angelica Sinensis Tail), Dahuang (Rhubarb Rhizome - roasted, half liang each).
Except for the two kernels which are ground separately, the remaining ingredients are pounded together, roasted until dry, and formed into honey pills the size of wutong seeds, taken with decoction. If there is no bowel movement and pathogenic qi is vigorous and urgent, increase Dahuang prepared with wine.
If blood dryness causes dry stool, add Taoren and Dahuang prepared with wine. If wind-dryness causes failure of stool passage, add Mahuang and Dahuang. If wind-obstruction occurs, add Zaojiaoren (Gleditsia Sinensis Fruit Kernel), Qinjiao (Gentiana Macrophylla Root), and Dahuang. If the pulse is Choppy and the body feels short of breath, add Yuliren (Prunus Armeniaca Seed) and Dahuang. If it is Yin-Jie Cold syndrome, add Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root).
It is stated that there are five syndromes of inability to pass stool: Heat, Cold, Qi, Wind, and Dampness, with a Hidden Chi pulse; warm-tonification is suitable.
Wind Constipation: Constipation in the elderly and postpartum women has Excess and Deficiency types. Ability to eat and red urine indicate Excess. Excess type involves solid accumulation. Treat primarily with Maren Wan or Qixuan Wan (see previous text). Inability to eat and clear urine indicate Deficiency. Deficiency type involves qi stagnation. Treat primarily with Nongpo Tang (Magnolia Bark Decoction).
Nongpo Tang: Houpo (Magnolia Bark), Banxia (Pinellia Tuber), Shenqu (Mass Medicamentum Fermentatum), Gancao (Licorice Root - 3 liang each), Baizhu (Atractylodes Macrocephala Rhizome - 5 liang), Zhishi (Immature Bitter Orange), Chenpi (Citrus Reticulata Pericarp - 1 liang each).