大意
肾主五液。故肾实则津液足而大便润。肾虚则津液竭而大便秘。（正传）虽有热燥、风燥、火燥、气血虚燥、阴
结阳结之不同。要皆血虚所致。大约燥属肾。结属脾。须当分辨。（汇补）
内因
或房劳过度。饮食失节。或恣饮酒浆。多食辛辣。饮食之火。起于脾胃。淫欲之火。起于命门。以致火盛水亏。
传送失常。渐成燥结之症。（正传）
外候
胃实而秘者。善饮食。小便赤。胃虚而秘者。不能食。小便清。热秘者。面赤身热。六脉数实。或口疮喜冷。冷秘
者。面白或黑。六脉沉迟。或溺清喜热。气秘者。气不升降。谷气不行。则多噫。风秘者。风抟肺脏。传于大肠。则
筋枯。（汇补）
病久变膈
有津液干枯。三脘俱燥。初则幽门不通。渐至上冲吸门。拒格饮食。变为噎膈。此即三阳结。谓之膈也。（汇补）
脉法
脉多沉伏。阳结沉数。阴结沉迟。风燥脉浮。血燥脉洪。老人虚人。脉雀啄者不治。（脉诀）
治法
如少阴不得大便。以辛润之。太阴不得大便。以苦泄之。阳结者清之。阴结者温之。气滞者疏导之。津少者
滋润之。大抵以养血清热为先。急攻通下为次。（汇补）
峻剂宜戒
如老人津液干枯。妇人产后亡血。反发汗利便。病后气血未复。皆令秘结。治宜滋养气血。不可概用牵牛、
巴豆之类。损其津液。燥结愈甚。复下复结。遂成不救。（秘藏）或变肺痿。咳唾脓血。或饮食不进而死。（汇补）
发汗宜戒
血虚脉大。发热便燥者。慎不可发汗。汗之则重亡津液。（正传）所谓燥者濡之。养血之义也。（汇补）
用药
主以四物汤。加杏仁、枳壳。热加条芩、黄连。风加防风、麻仁。寒加木香、肉蔻。血少加桃仁、红花。气滞加槟
榔、浓朴。老人虚人。病后汗多。不可用通法者。皆宜胆导蜜导法。壮实人可下者。承气汤。冷闭。用酱生姜导之。
久虚者。煮猪血脏汤加酥食之。血仍润血。脏仍润脏。此良法也。（汇补）
【附脾约】
有平素津液燥结之人。因患伤寒热病。邪热未至于胃。津液先已消烁。故胃强脾弱。水饮不能四布。但输
膀胱。致小便数而大便难者。用脾约丸以开结。若邪传至阳明腑症而秘结。自有承气汤法。不在此例。（汇补）
【附阴结】
阴结者。阴寒固结。肠胃血气凝滞而秘结也。外症不渴不食。肢冷身凉。大便硬闭。脉沉而迟。宜四物合附
子汤。如久不大便而脉反微涩者。黄 建中汤。
秘结选方
导滞通幽汤 统治便燥之病属少阴者。
当归 生地 熟地 桃仁 升麻 大黄 红花
大承气汤 统治便结之病属太阴者。
大黄 芒硝 枳实 浓朴
脾约丸（和剂） 治气滞血热便结。
浓朴 芍药 枳实（各二两） 大黄（四两） 麻仁（二两另研） 杏仁（一两半）
炼蜜丸。温水下。通利即止。
润肠丸（东垣） 治风秘症。
羌活 归梢 大黄（各五钱） 麻仁 桃仁（各一两）
仁另研。蜜丸。白汤下。
麻仁丸 治气滞血凝之症。
麻仁 桃仁 杏仁 郁李仁 大黄 枳实 浓朴 当归 芍药
去枳朴。加生熟地、升麻。名润燥汤。
五仁丸（得效）
桃仁 杏仁（各一两） 柏子仁（五钱） 松子仁（一钱半） 郁李仁（五钱） 陈皮（四两）
蜜丸。米饮下。
苁蓉丸（济生） 治津少血虚之症。
肉苁蓉（二两） 沉香（一两另研）
为末。麻仁汁打糊丸。米饮下。
益血丹（海藏） 治亡血便燥。
当归 熟地（等分）
蜜丸。弹子大。细嚼。酒下。
黄 汤 治老人便涩。
黄 陈皮（各五钱）
为末。每三钱。用麻仁一合。研烂。投水一杯。取浆去渣。煎候乳起。入白蜜一大匙。再煎令沸。调药。空心服。
秘甚者两服愈。
通导法
用猪胆去汁少许。入醋在内。将芦管相接缚定。纳谷道中。以手捻之。胆汁入内即通。
或用白蜜炼成。入盐、皂荚、麝香少许。捻如指大。入谷道。待欲便时乃去。
火熨法
用大黄一两、巴豆五钱为末。葱白十枚。酒曲和成饼。加麝香三分。贴脐上。布护火熨。觉腹中响甚。去之。
快捷方式方
用白蜜化汤。入玄明粉三钱。空心服。如血热便燥者。加当归五钱煎服。
又法。取麻仁、苏子合研细。入水再研。取汁煮粥。啜之。一法。用菠菜取自然汁饮之。
[General Principle]
The Kidney governs the five fluids. Therefore, when Kidney Qi is substantial, body fluids are sufficient and stool is moist; when Kidney Qi is deficient, body fluids are exhausted, leading to constipation (Zheng Chuan). Although there are differences in etiology such as heat dryness, wind dryness, fire dryness, Qi and blood deficiency dryness, as well as Yin binding and Yang binding, they all essentially result from blood deficiency. Generally speaking, dryness belongs to the Kidney, while binding/stagnation belongs to the Spleen; these must be distinguished (Hui Bu).
[Internal Causes]
Some cases arise from excessive sexual activity, irregular diet, indulgence in alcohol, or excessive consumption of spicy foods. The fire generated by diet originates in the Spleen and Stomach, while the fire generated by lust originates in the Mingmen (Gate of Life). This leads to excess fire and deficient water, causing abnormal transportation and transformation, gradually forming a syndrome of dryness and binding (Zheng Chuan).
[External Manifestations]
Constipation due to Stomach excess is characterized by good appetite and dark urine; constipation due to Stomach deficiency is characterized by inability to eat and clear urine. In Heat Constipation, the patient has a red face, fever, rapid and forceful pulses in all six positions, or mouth ulcers with a preference for cold drinks. In Cold Constipation, the patient has a white or black complexion, deep and slow pulses, or clear urine with a preference for hot drinks. In Qi Constipation, the ascending and descending of Qi is impaired, and grain Qi does not move, resulting in frequent belching. In Wind Constipation, wind pathogens congregate in the Lung organ and transmit to the Large Intestine, causing withering of the sinews (Hui Bu).
[Long-term Disease Transforming into Ge Syndrome]
If the disease persists for a long time, body fluids become dry and withered, and the upper, middle, and lower Jiao (Three Burners) are all dry. Initially, the pylorus becomes obstructed; gradually, it reverses upward to the glottis (Xi Men), rejecting food and drink, transforming into Yige (dysphagia/ge syndrome). This is referred to as "binding of the Three Yang," known as Ge syndrome (Hui Bu).
[Pulse Diagnosis]
Pulses are mostly deep and hidden. Yang binding presents with deep and rapid pulses; Yin binding presents with deep and slow pulses. Wind dryness presents with floating pulses; blood dryness presents with surging pulses. For the elderly and debilitated individuals, if Que Zhuo pulse (a sparrow-pecking pulse indicating severe depletion) appears, it is incurable (Mai Jue).
[Therapeutic Methods]
For constipation involving the Shaoyin channel, use acrid-moistening methods; for constipation involving the Taiyin channel, use bitter-draining methods. Treat Yang binding with clearing heat; treat Yin binding with warming. Treat Qi stagnation with guiding and unblocking; treat fluid deficiency with moistening. Generally, nourishing blood and clearing heat should be prioritized, while urgent purgation is secondary (Hui Bu).
[Warning Against Harsh Medicinals]
For example, in the elderly with dry body fluids, postpartum women who have lost blood, or patients whose Qi and blood have not yet recovered after illness, using diaphoresis or laxatives will exacerbate constipation. Treatment should focus on nourishing Qi and blood. One should not indiscriminately use harsh drugs like Qian Niu (Pharbitis Seed) or Ba Dou (Croton Seed), which damage body fluids and worsen dryness and binding. Repeated purgation followed by re-binding may lead to untreatable conditions (Mi Cang). It may also transform into Fei Wei (Lung萎/atrophy), presenting with coughing up pus and blood, or death due to inability to eat (Hui Bu).
[Warning Against Diaphoresis]
For those with blood deficiency, large pulses, fever, and dry stools, diaphoresis must be strictly avoided. Sweating will cause further loss of body fluids (Zheng Chuan). The principle "dryness should be moistened" refers to the meaning of nourishing blood (Hui Bu).
[Medication]
The main formula is Si Wu Tang (Four Substances Decoction), added with Xing Ren (Apricot Seed) and Zhi Ke (Bitter Orange). Add Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) for heat; add Fang Feng (Saposhnikovia Root) and Ma Ren (Hemp Seed) for wind; add Mu Xiang (Aucklandia Root) and Rou Dou Kou (Nutmeg) for cold; add Tao Ren (Peach Kernel) and Hong Hua (Carthamus Flower) for blood deficiency; add Bing Lang (Areca Seed) and Hou Po (Magnolia Bark) for Qi stagnation. For the elderly, debilitated individuals, or those with excessive sweating after illness who cannot tolerate purgation, Dan Dao (Gallbladder Suppository) or Mi Dao (Honey Suppository) methods are suitable. For robust individuals who can undergo purgation, Cheng Qi Tang (Order the Qi Decoction) is used. For cold closure, Jiang Sheng Jiang Dao (Pickled Ginger Suppository) is used. For chronic deficiency, boiling pig blood viscera soup with butter is recommended. This method moistens the blood and the organs, and is an excellent remedy (Hui Bu).
[Appendix: Pi Yue (Splee Constriction)]
In individuals who normally have dry and bound body fluids, contracting a Shang Han (Cold Damage) febrile disease may result in pathogenic heat reaching the stomach only after the body fluids have already been consumed. Thus, Stomach strength is high but Spleen weakness prevails; fluids cannot distribute to the four directions but instead flow to the Bladder, causing frequent urination and difficulty in defecation. Use Pi Yue Wan (Splee Constriction Pill) to resolve the binding. If the pathogen transmits to the Yangming Fu-organ syndrome causing constipation, the Cheng Qi Tang method applies naturally and is not discussed here (Hui Bu).
[Appendix: Yin Jie (Yin Binding)]
Yin Jie refers to constipation caused by Yin-cold binding and stagnation of Qi and blood in the intestines and stomach. External symptoms include no thirst, anorexia, cold limbs, cool body, hard and closed stool, and deep, slow pulses. Si Wu Tang combined with Fu Zi Tang (Aconite Decoction) is appropriate. If there is prolonged constipation with a faint and choppy pulse, Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle) is used.
Selected Formulas for Constipation
Dao Zhi Tong You Tang (Guide Stasis and Unblock the Hidden Decoction)
Indicated for constipation belonging to Shaoyin.
Dang Gui (Angelica Sinensis), Sheng Di Huang (Rehmannia Root), Shu Di Huang (Prepared Rehmannia Root), Tao Ren (Peach Kernel), Sheng Ma (Cimicifuga Rhizome), Da Huang (Rhubarb Root), Hong Hua (Carthamus Flower).
Da Cheng Qi Tang (Major Order the Qi Decoction)
Indicated for constipation belonging to Taiyin.
Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark).
Pi Yue Wan (Splee Constriction Pill) [From He Ji Ju Fang]
Indicated for constipation due to Qi stagnation and blood heat.
Hou Po (Magnolia Bark), Shao Yao (Peony Root), Zhi Shi (Immature Bitter Orange) (2 liang each), Da Huang (Rhubarb Root) (4 liang), Ma Ren (Hemp Seed) (2 liang, ground separately), Xing Ren (Apricot Seed) (1.5 liang).
Make pills with refined honey. Take with warm water. Stop once bowel movement is facilitated.
Run Chang Wan (Moisten Intestines Pill) [From Li Dongyuan]
Indicated for Wind Constipation.
Qiang Huo (Notopterygium Rhizome), Gui Shao (Tip of Angelica Root), Da Huang (Rhubarb Root) (5 qian each), Ma Ren (Hemp Seed), Tao Ren (Peach Kernel) (1 liang each).
Grind the kernels separately. Make pills with honey. Take with plain boiled water.
Ma Ren Wan (Hemp Seed Pill)
Indicated for Qi stagnation and blood coagulation.
Ma Ren (Hemp Seed), Tao Ren (Peach Kernel), Xing Ren (Apricot Seed), Yu Li Ren (Bush Cherry Seed), Da Huang (Rhubarb Root), Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Dang Gui (Angelica Sinensis), Shao Yao (Peony Root).
Remove Zhi Shi and Hou Po. Add Sheng Di Huang (Rehmannia Root) and Shu Di Huang (Prepared Rehmannia Root), Sheng Ma (Cimicifuga Rhizome). Named Run Zao Tang (Moisten Dryness Decoction).
Wu Ren Wan (Five Kernels Pill) [From De Xiao Fang]
Tao Ren (Peach Kernel), Xing Ren (Apricot Seed) (1 liang each), Bai Zi Ren (Biota Seed) (5 qian), Song Zi Ren (Pine Nut) (1.5 qian), Yu Li Ren (Bush Cherry Seed) (5 qian), Chen Pi (Tangerine Peel) (4 liang).
Make pills with honey. Take with rice drink.
Cong Rong Wan (Cistanche Pill) [From Ji Sheng Fang]
Indicated for fluid deficiency and blood deficiency.
Rou Cong Rong (Cistanche Stem) (2 liang), Chen Xiang (Aquilaria Wood) (1 liang, ground separately).
Grind into powder. Make pills using Hemp Seed juice as a binder. Take with rice drink.
Yi Xue Dan (Blood-Nourishing Pellet) [From Zhang Yuansu/Hai Zang]
Indicated for constipation due to blood loss.
Dang Gui (Angelica Sinensis), Shu Di Huang (Prepared Rehmannia Root) (equal parts).
Make pills with honey, size of a bullet. Chew thoroughly and take with wine.
Huang Qi Tang (Astragalus Decoction)
Indicated for difficult defecation in the elderly.
Huang Qi (Astragalus Root), Chen Pi (Tangerine Peel) (5 qian each).
Grind into powder. Take 3 qian per dose. Grind 1 he of Hemp Seeds into a paste, mix with one cup of water, extract the juice, remove dregs, boil until milky foam appears. Add one large spoon of white honey, boil again. Mix with medicine and take on an empty stomach. Severe cases may be cured in two doses.
Conduction Method
Use a pig gallbladder, remove a small amount of bile, add vinegar inside. Connect a reed tube, secure it tightly, insert into the anus, and squeeze with hand. The bile entering will facilitate passage.
Alternatively, refine white honey, add salt, Gao Jia (Gleditsia Spine), and a little She Xiang (Musk). Shape into finger-sized suppositories. Insert into the anus. Remove when the urge to defecate arises.
Fire Moxibustion/Warming Method
Grind Da Huang (Rhubarb Root) (1 liang) and Ba Dou (Croton Seed) (5 qian) into powder. Mix with ten scallion whites and yeast to form cakes. Add 3 fen of She Xiang (Musk). Apply to the umbilicus. Cover with cloth and apply heat/fire. Remove when loud rumbling is felt in the abdomen.
Quick Remedy
Dissolve white honey in water, add 3 qian of Xuan Ming Fen (Thenardite/Natrii Sulfas). Take on an empty stomach. For blood heat and dry stools, add 5 qian of Dang Gui (Angelica Sinensis) and decoct.
Another method: Grind Ma Ren (Hemp Seed) and Su Zi (Perilla Fruit) finely together. Add water, grind again, extract juice, and cook porridge. Drink it. Another method: Drink fresh spinach juice.