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The *Jingui Zhenyan Lun* (Treatise on True Discussions of the Golden Cabinet) states: The North corresponds to the color black, internally connects with the Kidney (Shen, 肾), and externally opens into the two orifices (the urethra and anus). Therefore, when Kidney Yin is deficient, difficulty in urination and defecation occurs. It is appropriate to use herbs such as Shudi Huang (Rehmanniae Radix Praeparata, 熟地黄), Rongrong (Cistanches Herba, 肉苁蓉), Cheqianzi (Plantaginis Semen, 车前子), and Fuling (Poria, 茯苓) to tonify True Yin and promote water passages. A small amount of acrid-warm herbs should be added to open the cou li (interstitial spaces/skin pores), facilitate the generation of body fluids, and moisten dryness; this method is particularly suitable for the elderly. If dryness and constipation are severe, and one cannot defecate despite straining excessively in the toilet, causing Qi to be forcibly disrupted and sinking into the anus, sometimes clear fluid leaks out, accompanied by tenesmus (a feeling of incomplete defecation with urgency and heaviness in the rectum) that is unbearable, a sensation of obstruction in the chest and diaphragm with nausea, dry heaving with sound, thirst with desire for water, inability to eat, and continuous groaning. If one attempts to promote bowel movement, Qi may collapse downward. In such cases, Tingli (Descurainiae Semen seu Lepidii Semen, 葶苈子) and Sangbaipi (Mori Cortex, 桑白皮) should be used together; their combined action will surely hit the target. Mutong (Akebiae Caulis, 木通) and Huashi (Talcum, 滑石) can be added as assistants to enhance penetration. Although the meridians of the large and small intestines are interconnected, some people suffer from urinary retention for many days and can be treated simply with Shenbao Wan (Divine Preservation Pill). (Blood dryness and depletion of body fluids both lead to difficult defecation. Shenbao Wan and similar formulas are excellent for excess patterns, but for the elderly with depleted fluids, careful examination is essential.) Prepared as Tingli Wan, causing several large bowel movements, urination will naturally resume. Note: This method is applicable only to excess patterns and requires careful assessment. If both urine and stool are blocked, promoting only the stool will cause urine to flow spontaneously shortly after. If Qi has already collapsed, using purgatives will lead to death; if astringents are used, urine and dry feces will distend the abdomen and intestines, likely worsening the condition. Using lifting methods to raise Qi, while allowing waste to pass without being bound by Qi, will naturally result in unblocking. However, if vomiting and nausea are unbearable, how should this be managed? My paternal aunt, over eighty years old, once suffered from this illness. I initially intended to use herbs that regulate Qi and promote urination. Although she gained partial relief, full recovery was not achieved. I comforted her, advising patience. Later, unable to endure further, she secretly took powdered laxatives multiple times without informing me. She felt slightly relieved, but her pulse suddenly became rapid with intermittent stops (Cu or Jie Dai pulse), her breath grew faint, and she collapsed onto the bed. I realized that True Qi had leaked out. Without immediate consolidation, she might not survive. I urgently administered Shengmai San (Generate the Pulse Powder), and after several doses, the irregular pulse subsided. Then, Yixue Runchang Wan (Nourish Blood and Moisten Intestine Pill) was combined and taken. I advised against taking other medicines. Over time, miraculous effects appeared. Following this regimen for over two months, her urination and defecation normalized, and her limbs recovered better than usual. Had she sought immediate relief and disregarded the wisdom of addressing the root cause, could she have avoided regret? Constipation is common among the elderly, largely because their essence is conserved rather than wasted, which contributes to longevity. When discomfort arises, impatience leads to agitation and disease. To seek remedies for unblocking and moistening, one must nourish blood and tonify kidney yin; otherwise, it is impossible. Although this pill formula was originally designed for my aunt, it can be applied universally. Thus, I present it as an aid for filial sons caring for parents and benevolent persons supporting the elderly.

Yixue Runchang Wan Formula: Shudi Huang (Prepared Rehmannia Root) 6 liang; Xingren (Apricot Seed), stir-fried and peeled; Zhike (Bitter Orange Peel), stir-fried with bran until yellow; Haren (Hemp Seed), shells removed to ensure purity (as shells can cause intestinal astringency), prepared quantity 3 liang. The above three herbs are each pounded into paste. Juhong (Exocarpium Citri Reticulatae Rubrum) 3.5 liang; Ejiao (Donkey-hide Gelatin), stir-fried; Rongrong (Cistanche Stem), cooked with su (animal fat/butter) until thorough, then dried, each 1.5 liang; Suzi (Perilla Fruit), stir-fried and ground; Suoyang (Cynomorium Herb), cooked with su; Jingjie (Schizonepeta Herb), each 1 qian.
Grind all ingredients into fine powder. Mix with the pastes of the first three herbs, pounding more than a thousand times. Add refined honey to form pills, sized like tung tree seeds. Take 50-60 pills per dose, on an empty stomach, washed down with plain warm water.

The Great Method states: For severe constipation, take Shenxiong Wan (Divine Xionghuang Pill). If stool is blocked but urine flows freely, it indicates a misunderstanding of dryness and dampness. The root cause is insufficient body fluids in the Large Intestine, yet cold-drying herbs are used for treatment. This exacerbates dryness; a small dose is ineffective, while a large dose depletes blood. Hence, blockage persists. Using Siwu Tang (Four Substances Decoction), Hemp Seed, or Apricot Seed would be appropriate. The Classics state: "Excessive dryness leads to withering." Wet agents are used to moisten it. Kidney dryness causes difficult defecation.
Yixue Runchang Wan is a "King's Way" army (gentle and effective remedy), unlike Shenxiong Wan which causes mingxuan reactions (severe initial reaction to expel pathogens). If body fluids are depleted, use Siwu Tang to moisten dryness, and intermittently take Yixue Runchang Wan.