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Pulse is full and forceful, skin is hot, abdomen is distended, urination and defecation are obstructed, dizziness and mental oppression occur; this is called "Five Excesses" (Wu Shi). If spleen and stomach qi stagnation prevents normal transportation and transformation, compounded by phlegm-dampness and food retention obstructing the clear pathways, causing constipation and difficult urination, Shengchai Eryue Erchen Tang (Shengma, Chaihu, Atractodopsis Rhizoma Decoction with Erchen Tang) can be taken several times to moisten the stool and promote urination. If caused by damp-heat, phlegm-fire stagnation, with a surging pulse, red urine and stool, and painful joints, Liangge San (Cool the Diaphragm Powder), Fengmi Tongsheng San (Wind-Resisting Universal Benefit Powder), or Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction from *Jin Gui Yao Lue*) may be selected.

Zhu Danxi treated a woman who developed urinary and fecal retention after spleen pain. This was due to phlegm blocking the middle jiao and qi gathering in the upper jiao. Erchen Tang (Two-Cured Decoction) with Mutong (Akebia Caulis) was used; after the first dose, vomiting occurred, so the dregs were decocted again. Alternatively, burn soap pod (Gleditsiae Fructus Spina) to ash, powder it, and take with rice water. Take seven fresh Carthamus fructus (Cheqiu Ke) and seven earth dogs (Mole Cricket), dry them on a new tile, powder them. Decoct bark of Hu Zhang (Polygonum Cuspidatum) facing southeast into a thick decoction to drink. Also, grind one or two green onions with roots and soil, one piece of ginger, twenty-one fermented soybeans (Dan Dou Chi), and two spoons of salt into a paste, make into cakes, heat them, and apply to the umbilicus, binding tightly. After some time, qi will penetrate and passage will open naturally; if not, replace with another cake.

For urinary and fecal retention due to Yin syndromes, or critical cases of miscellaneous diseases presenting as Yin patterns, use Oyster Shell (Muli), aged rice flour, and roasted dried ginger (one tael each), powdered finely. For male patients, mix with female saliva, warm in hand, and press firmly over both testes until sweating occurs for cure. For female patients, mix with male saliva, warm in hand, and press firmly over both breasts until sweating occurs for cure. This is because testes and breasts are the root foundations of men and women, corresponding to Kan and Li (Water and Fire). Do not use except in emergencies.

Jiegu (Li Dongyuan) said: Constipation of the zang-fu organs cannot be treated uniformly. There are deficiency constipation and excess constipation. In excess constipation due to stomach excess, the patient can eat and has red urine; treat primarily with Mahuang Wan (Hemp Seed Pill) or Qixuan Wan (Seven-Promoting Pill). In deficiency constipation due to stomach deficiency, the patient cannot eat and has clear urine; treat primarily with Houpo Tang (Magnolia Bark Decoction). Stomach qi excess leads to retention of solid matter; stomach qi deficiency leads to retention of qi. There is also wind constipation, cold constipation, qi constipation, and heat constipation. Additionally, dryness of fluids in the elderly, blood loss after childbirth, excessive sweating or diuresis, and incomplete recovery of qi and blood after illness can all cause constipation. Do not uniformly use laxatives like Mangxiao (Mirabilite) and Dahuang (Rhubarb Root and Rhizome). Badou (Croton Seed) and Qianniu (Pharbitis Seed) are especially contraindicated.

Wind constipation arises when wind combats the lung organ and transmits to the large intestine, making transportation difficult. Those with a history of wind diseases often have constipation. Use Xiao Xuming Tang (Minor Continue Life Decoction), remove Fuzi (Aconite Lateral Root), double Shaoyao (Peony Root), add one cup of Zhuli (Bamboo Sap), and swallow Run Chang Wan (Moisten Intestines Pill) or Huoxue Run Chang Wan (Invigorate Blood Moisten Intestines Pill).

Cold constipation arises when cold qi dominates the stomach and intestines, condensing yin and binding, blocking fluids and closing stomach qi. The patient feels qi attacking inside the intestines, prefers heat and dislikes cold. Use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with Guigui (Cinnamon Twig) and Zhike (Bitter Orange Fruit), half qian each, swallowing Banshu Wan (Half-Sulfur Pill). Hot medicines often cause constipation, only Sulfur warms and unblocks. Cold medicines often cause diarrhea, only Huanglian (Coptis Rhizome) fattens the intestines and stops diarrhea.

Qi constipation arises from failure of qi ascending and descending, and grain qi not moving; the patient often belches. Use Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) with Zhike, swallowing Yangzheng Dan (Nourish Righteousness Pellet), or Banshu Wan, Laifu Dan. If ineffective, assist with Muxiang Binglang Wan (Aquilaria and Areca Nut Pill). If qi stagnation causes pain and severe constipation, using purgatives makes it worse; this is another type of qi constipation. Forced purgation may temporarily relieve but quickly recurs, or forcing it causes bleeding. Here, one must soothe the qi; when qi flows smoothly, stool passes naturally. Seek warm and unblocking agents.

Heat constipation presents with red face, body heat, abdominal distension and stuffiness, desire for cold drinks, or mouth/tongue ulcers, due to heat knotting in the large intestine. Use Sishun Qingliang Yin (Four-Obedience Cooling Drink), swallowing Run Chang Wan or Muxiang Binglang Wan. Excess patterns use Chengqi Tang (Order the Qi Decoction).

Zhongjing said: How to distinguish Yang Jie (Yang Knot) and Yin Jie (Yin Knot) by pulse? If the pulse is floating and rapid, the patient can eat but does not defecate, this is excess, named Yang Jie, expected to worsen on the 17th day. If the pulse is deep and slow, the patient cannot eat, body is heavy, stool is hard, this is Yin Jie, expected to worsen on the 14th day. Dongyuan said: Yang Jie is dispersed, Yin Jie is warmed. The previously mentioned excess and heat constipation are Yang Jie; deficiency and cold constipation are Yin Jie.

For elderly deficiency constipation, or constipation after excessive sweating/diuresis or post-illness qi-blood deficiency, use Suzi Jiangqi Tang with doubled Danggui (Angelica Sinensis), swallowing Weilingxian Wan (Symplocos Berry Pill). Roucong Rong Yin (Cistanche Drink) or Roucong Run Chang Wan (Cistanche Moisten Intestines Pill) are especially suitable. Dongyuan said: For dryness due to fluid consumption, use acrid substances to moisten. Kidney governs five fluids; sufficient fluids mean normal stool. Injury to stomach qi from hunger/fullness or labor, or consuming spicy/heavy foods aiding fire evil hidden in blood, consumes true yin and reduces fluids, causing dry stool. Elderly qi deficiency and insufficient fluids also cause knotting. "Kidney dislikes dryness, urgently eat acrid to moisten" refers to this.

Blood deficiency and fluid exhaustion causing constipation present with small, choppy pulse, dull complexion, soft stool but inability to expel despite straining. Use large doses of Siwu Tang (Four Substances Decoction) with Chenpi (Tangerine Peel), Gancao (Licorice Root), Jiuhonghua (Safflower processed with wine), Daozhi Tongyou Tang (Guide Stasis Unblock Nethermost Decoction), or Yixue Dan (Benefit Blood Pellet). Blood deficiency with heat presents with surging-rapid pulse, dry mouth, scanty red urine, hard dry stool. Use Rundao Tang (Moisten Dryness Decoction), Huoxue Runzao Wan (Invigorate Blood Moisten Dryness Pill), or Siwu Tang with Jiuqin (Scutellaria processed with wine), Zhizi (Gardenia Fruit), Taoren (Peach Kernel), Honghua (Safflower).

General principles state: For large bowel constipation, use Shenxiong Wan. If stool is blocked but urine is free, it is an error of not understanding dryness/wetness. The large intestine lacks fluids, yet cold-drying drugs are used, increasing dryness. Small doses are ineffective, large doses deplete blood, causing blockage. Using Siwu Tang, Hemp Seed, Apricot Kernel is correct. Classics say: Dryness leads to withering, wet agents moisten it. *Jin Gui Zhen Yan Lun* says: North corresponds to black, enters kidney, opens at the two yin orifices. Kidney yin deficiency causes difficulty in urination/defecation. Use Dihuang (Rehmannia Root), Roucongcong (Cistanche Stem), Cheqianzi (Plantago Seed), Fuling (Poria) to tonify true yin and promote water passages, slightly adding acrid drugs to open pores and generate fluids to moisten dryness, especially suitable for the elderly.

If severe dryness/knotting of stool and urine persists despite efforts, straining too hard fails to pass stool, qi escapes downward to the anus, leaking clear water, with tenesmus unbearable, chest/stomach obstruction, nausea, dry heaving, thirst, refusal to eat, groaning, danger of qi collapse if purged, or worsening if bound, how to treat? My aunt, over eighty, suffered this. I used qi-regulating and diuretic herbs, achieving partial success but not full cure. I advised patience. Later, unable to eat, she secretly took powder herbs, purging several times, feeling relieved. But her pulse became rapid with intermittent pauses, breath faint, collapsed in bed. I knew true qi had leaked; without consolidation, rescue was impossible. Urgently administered Shengmai San (Generate Pulse Powder). After several doses, the knotted pulse receded. Then combined Yixue Runchang Wan, advising against seeking quick results or other drugs. Long-term regulation led to normal bowel/bladder function and strong limbs within two months. Constipation is common in the elderly;俗 believe firm closure indicates longevity, but sudden distress causes disease. My prescriptions avoid Dahuang, safe for long-term use, hence recorded.

*Yuan Rong* discusses Five Drynesses causing constipation: East, string-like pulse, wind dryness, treat with wind-dispersing drugs: Duduo (Angelica Dahurica), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Zhuyu (Cornus Fruit), Dihuang, Chaihu (Bupleurum Root), Chuanxiong (Ligusticum Rhizome). South, surging pulse, heat dryness, treat with salty-bitter drugs: Huangqin (Scutellaria Root), Huanglian, Dahuang, Huangbai (Phellodendron Bark), Mangxiao. Southwest, slow pulse, earth dryness, treat with moistening-damp drugs: Shaoyao, Banxia (Pinellia Tuber), Shengjiang (Fresh Ginger), Wumei (Mume Fruit), Mugua (Chaenomelis Fructus). West, choppy pulse, blood dryness, treat with blood-nourishing drugs: Xingren (Apricot Kernel), Maziren (Hemp Seed), Taoren, Danggui. Qi knot uses Muxiang (Aucklandia Root), Binglang (Areca Nut), Zhishi (Bitter Orange Fruit), Chenpi, Dihuang, Yuliren (Coix Seed). North, slow pulse, cold dryness, treat with warm-hot drugs: Danggui, Rougui (Cinnamon Bark), Fuzi, Wutou (Aconite Root), Sulfur, Liangjiang (Galangal Root), Badou.

Run Chang Wan modifications: If no urination due to stool blockage, add Jiuhuang (Rhubarb processed with wine) urgently for excess. For blood dryness, add Taoren, Jiuhuang. For wind-knot dryness, add Maziren, Dahuang. For wind-choppy, add Wei Zaorou (Roasted Soap Pod Kernel), Dahuang, Qinjiao (Gentiana Macrophylla Root). For choppy pulse with itching/choppy qi, add Yuliren, Dahuang. For cold-yin disease with cold-knot closure, use Banshu Wan from *Ju Fang*, or add Fuzi Shengjiang Tang (Aconite and Ginger Decoction), served cold. Although cold-yin syndrome requires yang-tonifying drugs, if stool rarely passes, include one purgative dose in ten to mildly unblock, preventing constipation, which is the general method. If yin-syndrome shows restlessness with firm pulse, add slight bitter-cold drugs to yang formulas to remove heat-restlessness; stop when calm. If yin-restlessness desires sitting in wells, kidney pulses are empty/deep-slow; easy to distinguish. For external pathogens, adapt accordingly. Accumulations require purging. Food injury to Taiyin, intestinal fullness, undigested food, rumbling, inability to defecate, treat with bitter-draining: Qixuan Wan, Muxiang Binglang Wan.

Taoren and Xingren treat constipation; differentiate by blood/qi. Elderly deficiency dryness: floating pulse (qi level) uses Xingren, Chenpi; deep pulse (blood level) uses Taoren, Chenpi. Chenpi is used because Hand-Yangming Large Intestine and Hand-Taiyin Lung are exterior-interior. "Excess makes passing difficult, moves yang qi"; "Deficiency makes passing difficult, moves yin blood." Summer fatigue with sticky stool is blood deficiency with latent fire in blood. Use Renshen Tang (Ginseng Decoction) with Shengdihuang (Fresh Rehmannia Root), Danggui Shen (Angelica Root Head), Taoren Paste, Maziren Paste to moisten. If still not loose, add slight Wei Dahuang (Roasted Rhubarb). If still not loose with Dahuang, it is not blood-knot/blood-constipation, but heat generating wind, likely damp-wind syndrome. Use Renshen Tang with Qianghuo, Fangfeng (half liang each), four cups water, boil to one cup, strain, take on empty stomach; stool will move significantly.

Constipation, once every five days, yellow-red urine, whole-body edema (face/abdomen worst), yellow color, numbness, heavy body, weakness, limb flaccidity, panting, spitting clear water, vomiting turbid white foam like glue, occasional heat/restlessness wanting to remove clothes, chills forehead like ice, dizziness, dark eyes, fire in eyes, cold tears, anosmia, lower abdominal urgency, pulsating Qi at navel, hard/painful on pressure. Use Mahuang Baizhu Tang (Ephedra and Atractylodes Macrocephala Decoction). This disease has latent wind-damp-heat in Ying-Blood. Water-fire attacks Yang path upwards, yuan qi short leading to panting, Yin fire damages qi, limb flaccidity relates to Kidney Water, a controlling-overacting pathology. Meeting winter cold, attacking Liver Wood, strengthening Mother (Metal generates Water?), Lung Metal controls Wood suppressing Fire, great victory brings great reaction. Symptoms: anger, yawning, sneezing, nasal obstruction, blurred vision, sadness, amnesia, lower abdominal pain, generalized jaundice, abdominal distension, facial edema, anorexia, bloody sputum/nasal discharge, eye sores, constipation. Two doses cure all.

For any constipation unresponsive to medicine, or frail patients fearing purgatives, use Honey Suppository (Mi Jian Dao). Or mix salt and soap powder into honey suppository for better effect, as salt softens hardness/moistens dryness, soap vents qi/disperses wind. Cold constipation: Soy sauce ginger suppository. Or add Caowutou (Wild Aconite) powder to honey suppository to melt cold/knot. Heat: Pig bile suppository. Soak Wumei (Mume Fruit), remove pits, make pills date-sized, also usable as suppository. Pickled cucumber cut date-shaped, also usable.

Danxi said: Ancient formulas for bowel movement use qi-descending agents because Lung Qi not descending makes stool transport difficult, using Zhike, Chenxiang (Agarwood), Hezi (Chebulic Myrobalan), Xingren. Elderly/frail/wind-patients/fluid-deficient constipation should be lubricated with Sesame, Hemp Seed, Ejiao (Donkey-hide Gel). Blindly using harsh purgatives drains fluids, depletes qi-blood; though temporarily open, quickly re-blocks, causing other diseases. Former Wang Shaofu suffered this, repeatedly purged with strong drugs, later developed Lung萎 (Atrophy Syndrome) with pus/blood cough, died of blockage.