脉 两关脉实数。右寸涩数。两尺弦涩。盖数者火盛也。涩者血枯也。由火盛而血衰。服药
而脉变缓滑者。易治。反结促者。难治。集成云∶脾脉沉数。下连于尺。为热结。两尺脉虚
。或沉细而迟者。为阴结。右尺浮。为风结也。
症 内经云∶肾主大便。大便难取足少阴。东垣曰∶肾主五液。津液润。则大便如常。若饥
饱劳逸。损伤胃气。及食辛热味浓之物。而助火邪伏于血中。耗散真阴。津液亏少。故大便
结燥。窃详燥之为病不一。有热燥有风燥。有阳结。有阴结。吐泻后。肠胃虚。服热药多
者。为热结。宜承气汤下之。肺受风邪入肠中。为风结。宜麻仁丸。年老气弱。津液不足。
或产后内亡津液。而结为气血虚也。六味地黄丸主之。大便闭。小便数则为脾约。脾约者。
脾血耗散。肺金受火。无所摄脾。津液故竭。宜养血润燥。若能食。小便赤。为实闭。麻仁
七宣等药主之。不能饮食。小便清。为虚闭。为气闭也。浓朴汤主之。小肠移热于大肠。为
宓瘕。是便涩闭也。医者不究其源。一概用巴豆牵牛等药下之。损其津液。燥结愈甚复下复
结。极则以致引导于下。而不能通者。遂成不救之症。可不谨哉。
治 内经云∶肾恶燥。急食辛以润之。结者散之。治法云∶如少阴不得大便。以辛润之。太
阴不得大便。以苦泻之。阳结者散之。阴结者温之。有物结者下之。久病腹中有实热。大肠
闭者。以润肠丸治之。慎勿峻利。脾约者。谓胃脾弱。约束津液。不得四布。但轮膀胱。故
小便数而大便难。名曰脾约。与脾约丸以下脾之结燥。使肠润结化。津液入胃而愈。然既曰
脾约。必阴枯槁。内火燔约。热伤元气。故肺金受火烁而津竭。必窃母气以自救。金耗则土
受木伤。脾失转输。肺失传送。宜大便难。小便数。而无藏蓄也。理宜滋养阴血。使阳火不
炽。肺金行清化。而脾土清健。津液入胃。肠润而通矣。今此丸用之于热甚而气实。与西北
人禀壮实者。服无不安。若用之于东南方人。与热虽盛而气血不实者。虽得暂安。将见脾愈
弱而肠愈燥矣。惟知西北以开结为主。东南以润燥为主。斯无误矣。
方 滋血润肠汤治大便秘结。或血虚秘。气滞秘。风秘。热秘。并治之。
当归（身尾一钱五分） 桃仁（一钱五分） 麻仁（去壳一钱五分） 大黄（一钱五分） 羌活 防
风（各一钱） 生地黄 枳壳 槟榔（各八分） 甘草（生五分） 皂仁（七分） 红花（二分） 木
香（一分）
上作一服。姜一片。枣一枚。煎。食前服。
又方 脾约丸治大便难。而小便数。名脾约。以此丸治之。
枳实（去穣麸炒） 浓朴（姜汁制） 芍药（各二两酒炒） 大黄（酒蒸四两） 麻仁（去壳净一两
三） 杏仁（去皮尖一两二钱）
上为末。炼蜜丸梧子大。每服三五十丸。白汤下。量虚实用之。
<Pulse>
The pulses at both Guan positions are full and rapid. The pulse at the right Cun position is choppy and rapid. The pulses at both Chi positions are wiry and choppy. Generally, a rapid pulse indicates an excess of Fire. A choppy pulse indicates blood depletion. This arises because excessive Fire leads to blood deficiency. If the pulse becomes slow and slippery after taking medicine, it is easy to treat. If it instead becomes knotted (intermittent) or hurried, it is difficult to treat. *Yi Zong Ji Cheng* states: If the Spleen pulse is deep and rapid, extending down to the Chi position, it indicates Heat binding. If both Chi pulses are deficient, or deep, fine, and slow, it indicates Yin binding. If the right Chi pulse is floating, it indicates Wind binding.
<Symptoms>
*Huang Di Nei Jing* states: The Kidney governs defecation. For difficulty in defecation, points from the Foot-Shaoyin Kidney meridian should be selected. Li Dongyuan stated: The Kidney governs the five fluids. When body fluids are moistening, defecation is normal. If stomach Qi is damaged by irregular eating and drinking, overwork, or rest, and if one consumes pungent, hot, and rich-tasting foods, this aids Fire pathogenic factors to lurk within the blood, consuming True Yin. Consequently, body fluids become deficient, leading to dry and bound stools. Upon careful examination, diseases of dryness vary: there is Heat dryness, Wind dryness, Yang binding, and Yin binding. After vomiting and diarrhea, when the intestines and stomach are weak, and many hot medicines have been taken, it constitutes Heat binding, which should be purged with Chengqi Tang. When Lung Wind pathogens enter the intestines, it constitutes Wind binding, which should be treated with Maren Wan. In the elderly with weak Qi and insufficient body fluids, or postpartum patients who have lost body fluids internally, resulting in binding due to Qi and Blood deficiency, Liuwei Dihuang Wan is indicated. Constipation accompanied by frequent urination is called Pi Yue (Spleen Constraint). Pi Yue refers to the consumption of Spleen Blood, where Metal of the Lung is controlled by Fire and cannot regulate the Spleen, leading to the exhaustion of body fluids. Nourishing Blood and moistening dryness is appropriate. If the patient can eat and urine is red, it is Excess constipation, treated with drugs such as Maren Qixuan. If the patient cannot eat and urine is clear, it is Deficiency constipation, also known as Qi closure, treated with Houpo Tang. When Heat from the Small Intestine transfers to the Large Intestine, it forms masses (accumulations), causing涩 (astringent/stagnant) and bound stools. If physicians do not investigate the root cause and indiscriminately use drastic purgatives like Radix Crotonis (Badou) and Semen Persicae (Qianniu), they damage body fluids, making the dryness and binding worse. Repeated purging and binding eventually lead to sinking of Yuan Qi without unblocking, resulting in an incurable condition. How can one not be cautious?
<Treatment>
*Huang Di Nei Jing* states: The Kidney dislikes dryness; urgently consume Pungent substances to moisten it. Binding conditions should be dispersed. Treatment principles state: For Shaoyin cases with no stool, use Pungent substances to moisten. For Taiyin cases with no stool, use Bitter substances to purge. Yang binding should be dispersed; Yin binding should be warmed. Cases with tangible accumulations should be purged. For chronic illness with excess Heat in the abdomen and Large Intestine closure, Run Chang Wan is used. Do not use drastic purgatives. Pi Yue refers to weakness of the Stomach and Spleen, which constrain body fluids, preventing them from distributing throughout the body, causing them to flow only to the Bladder. Thus, there is frequent urination and difficult defecation, named Pi Yue. Administer Pi Yue Wan to resolve the Spleen's binding dryness, moisten the intestines, dissolve the binding, allow body fluids to enter the Stomach, and achieve recovery. However, since it is called Pi Yue, it implies Yin fluid is dry and withered, internal Fire is blazing and constraining, and Heat damages Yuan Qi. Therefore, Lung Metal is scorched by Fire, depleting fluids, and must steal Qi from its mother organ (Kidney) to save itself. When Metal is depleted, Earth suffers Wood injury; the Spleen loses its transport function, and the Lung loses its descending function. It is appropriate for symptoms of difficult defecation and frequent urination without internal accumulation. Ideally, nourish Yin and Blood to prevent Yang Fire from becoming excessive, allow Lung Metal to perform clearing and transforming functions, keep Spleen Earth pure and healthy, let body fluids enter the Stomach, and moisten the intestines for unblocking. Currently, this pill is suitable for those with severe Heat and solid Qi, and for people in the Northwest with robust constitutions, bringing safety. If used for people in the Southeast, or those with strong Heat but deficient Qi and Blood, although temporary relief may occur, the Spleen will become weaker and the intestines drier. One must know that the Northwest focuses on resolving binding, while the Southeast focuses on moistening dryness, to avoid errors.
<Formula>
Zixue Runchang Tang treats large bowel constipation. It treats all types including Blood deficiency constipation, Qi stagnation constipation, Wind constipation, and Heat constipation.
Dang Gui (Radix Angelicae Sinensis, body and tail 1 qian 5 fen)
Taoren (Semen Persicae 1 qian 5 fen)
Maren (Semen Cannabis, shelled 1 qian 5 fen)
Dahuang (Radix et Rhizoma Rhei 1 qian 5 fen)
Qianghuo (Rhizoma Notopterygii)
Fangfeng (Radix Saposhnikoviae, each 1 qian)
Sheng Dihuang (Radix Rehmanniae Preparata 8 fen)
Zhike (Fructus Aurantii 8 fen)
Binglang (Areca Seed 8 fen)
Gancao (Radix Glycyrrhizae, raw 5 fen)
Zaoren (Semen Gleditsiae Sinensis 7 fen)
Honghua (Flos Carthami 2 fen)
Muxiang (Radix Aucklandiae 1 fen)
Take as one dose. Add one slice of fresh ginger and one jujube. Decoct. Take before meals.
Another Formula: Pi Yue Wan treats difficult defecation with frequent urination, named Pi Yue. Treat with this pill.
Zhishi (Fructus Aurantii Immaturus, pith removed, bran-fried)
Houpo (Cortex Magnoliae Officinalis, processed with ginger juice)
Shaoyao (Radix Paeoniae Alba, each 2 liang, wine-fried)
Dahuang (Radix et Rhizoma Rhei, steamed with wine 4 liang)
Maren (Semen Cannabis, shelled and cleaned 1 liang 3 qian)
Xingren (Semen Pruni Armeniacae, skin and tip removed 1 liang 2 qian)
Grind into powder. Make pills using refined honey, size of wu zi (wukeng seeds). Take 30-50 pills per dose, washed down with warm water. Adjust dosage according to deficiency or excess.