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1. A patient suffered from spermatorrhea, ejaculating upon hearing a woman's voice. His body was extremely emaciated, and he was on the verge of death. The physician admitted having no effective treatment. A disciple of Miao Zhongchun (Miao Xiyong) prescribed Wan Zhi (Polygalae Radix) as the sovereign drug, Lian Xu (Nelumbinis Stamen) and Shi Lian Zi (Nelumbinis Semen) as the minister drugs, Long Chi (Draconis Os), Fu Shen (Poria Cum Pinus), Sha Yuan Ji Li (Astragali Complanati Semen), and Mu Li (Ostreae Concha) as the assistant and envoy drugs. The pills were taken orally, and symptoms subsided slightly, but the condition could not be cured completely. Miao Zhongchun added Yi Biao (Bovis Bladder) to the previous prescription. The patient recovered before finishing one dose.

2. Another patient suffered from nocturnal emission and involuntary seminal discharge due to excessive mental labor from studying for three or four years. The episodes occurred every few days. After each episode, deficiency fire flared upward, causing heat in the head and face, cold extremities, and insomnia throughout the night. Treatments tonifying the Heart and Kidney and astringing essence were ineffective. Miao Zhongchun prescribed a pill formula with Huang Bo (Phellodendri Cortex) as the sovereign drug to clear Minister Fire, assisted by Di Huang (Rehmanniae Radix), Gou Qi Zi (Lycii Fructus), Yu Rou (Corni Fructus), and Tian Dong (Asparagi Radix) to tonify the Kidney; Mai Dong (Ophiopogonis Radix) to clear the Heart; Lian Xu (Nelumbinis Stamen) and Wu Wei Zi (Schisandrae Fructus) to astringe essence; Yi Biao Jiao (Colla Bladdicae Bovis) to fill essence; and Che Qian Zi (Plantaginis Semen) to promote urination and drain damp-heat, thereby calming the Minister Fire. The patient recovered before finishing one dose. Initially, the patient feared that Huang Bo was too cold and refused to use it. Miao Zhongchun said: "The reason your illness has persisted is precisely because this herb was not used." The *Classic* states: "The Kidney desires firmness; hasten to eat bitter substances to firm it," and Huang Bo is such a substance. When the Kidney is firm, even if there is fire in the Heart meridian, essence will naturally remain secure, preventing nocturnal emission. Previously, only astringent and tonifying herbs were used without addressing the root cause, hence the lack of efficacy.

Constipation is mostly caused by heat and should be differentiated into excess and deficiency patterns. However, constipation can also result from qi stagnation or wind-dryness, requiring different treatments. Occasionally, there is a pattern of cold constipation, which must also be carefully examined. In the case of elderly people with dry fluids, postpartum blood loss, excessive sweating, excessive diuresis, or recovery from illness where qi and blood have not yet restored, all these conditions can lead to constipation. One should nourish yin and tonify blood, generate fluids and moisten dryness, so that bowel movements will naturally become unobstructed. Misusing Xi Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) purgatives often leads to subsequent complications. According to Li Dongyuan: "The Kidneys govern the two lower orifices and the five fluids. When fluids are abundant, stool is normal. If diet is irregular or physical labor is excessive, damaging Stomach qi, or if spicy, hot, and rich foods are overconsumed, fire pathogens lurk in the blood, consuming true yin and depleting fluids, resulting in dry and hard stool." Zhao Xianke stated: "I have followed Li Dongyuan's theory but do not use his Tong You Tang or Run Chang Wan. Instead, I use large doses of Liu Wei Di Huang Wan, adding fluid-generating and moistening agents like Ren Ru (Human Milk) and Bai Mi (Honey). Decoction and administration yield good results." For heat constipation accompanied by qi deficiency, adding Ren Shen (Ginseng Radix) and Dang Shen (Codonopsis Radix) at 3-5 qian in the above formula yields immediate results. This is because qi deficiency fails to push stool forward, and yin deficiency fails to moisten. I have personally tested this with great efficacy, so I record it here.

Liu Yi Shun Qi Tang (see Shang Han section): This formula treats all types of excess-heat constipation. Use according to symptoms.

Ma Ren Wan: Treats Pi Yue syndrome (Spleen earth dryness-heat constrains the food in the Stomach from three to five days into one or two pellet-like shapes for excretion). It addresses difficult defecation (due to dryness of intestinal fluids; it may only be temporarily used if Stomach qi is strong). Ingredients: Ma Ren (Cannabis Seed, 3 liang), Xing Ren (Armeniacae Semen Amarum, for moistening dryness), Bai Shao (Paeoniae Radix Alba, for nourishing yin), Da Huang (Rhei Radix et Rhizoma, for draining heat, processed, 2.5 liang each), Zhi Shi (Aurantii Fructus Immaturus), and Hou Po (Magnoliae Officinalis Cortex, for dispersing nodulation, 1 liang each). Prepare as honey pills. This is a formula for draining heat, dispersing nodulation, and moistening the bowels.

Xiang Dan Wan (named for its bitter taste resembling elephant bile): Ingredients: Zhen Lu Hui (Aloe, bitter-cold to clear heat, moisten dryness; combined with Zhu Sha as a clearing and settling downward agent to naturally open heat accumulation, finely powdered, 1.4 liang); Zhu Sha (Cinnabar, finely powdered, 1 liang, mixed with a little good wine into pills the size of small beans, prepared on sunny days. Take 1.2 qian or 3 qian per dose, washed down with plain water. Morning dosing leads to evening evacuation; evening dosing leads to morning evacuation.) This is a mild formula for clearing heat and promoting bowel movement. It is suitable for excess-heat constipation. Taking it once or twice is very safe. However, it tastes extremely bitter and is difficult to take; those with weak Stomachs may not tolerate it.

Yang Yin Qing Re Run Zao Tang (see Zao section): Treats all types of deficiency-heat constipation; modify according to symptoms. If internal heat is severe, add Zhe Jiang (Saccharum Japonicum Juice) or Li Zhi (Pyrus Sinkiangensis Juice).

Sheng Di Mi You Yin: Treats dry fluids in the elderly and postpartum constipation. Ingredients: Sheng Di Huang (Rehmanniae Radix Recens, 4 liang cut into small pieces); Zhi Ma You (Sesamum Oil, 4 liang, decocted with Sheng Di Huang until the oil floats to the surface, remove dregs, pour oil into a large bowl); add Sheng Bai Mi (Raw White Honey, approx. 1 liang); mix with boiling water (1 bowl) and drink together with the oil. Alternatively, using only Sheng Di Huang (3-4 liang) decocted in water and drunk at once is also effective; adding Song Zi Ren (Pinus Kernel, 1 liang) is even better. These two formulas can be adopted for all deficiency-heat constipation cases.

Ju Xing Tang: Treats qi stagnation leading to obstruction and constipation (The San Jiao are connected through a single qi. When qi is closed, stool is also closed). Ingredients: Ju Hong (Citri Reticulatae Pericarpium Rubrum, promotes qi movement, 2-3 qian); Xing Ren (Armeniacae Semen Amarum, promotes qi movement and moistens dryness, 5 qian to 1 liang); it is advisable to add Zhi Ke (Aurantii Fructus, 1-3 qian), Su Zi (Perillae Fructus, stir-fried and ground, 3-5 qian), and flush with several spoons of Chen Xiang juice (Aquilariae Wood). Mai Dong (Ophiopogonis Radix), Zhe Jiang (Saccharum Japonicum Juice), and Li Zhi (Pyrus Sinkiangensis Juice) can also be used. This is a formula that promotes qi movement and moistens dryness.

Yang Xue Qu Feng Run Zao Tang (Self-made): Treats wind-dryness constipation. Ingredients: Qin Jiao (Gentianae Macrophyllae Radix, 2-3 qian); Hu Ma (Sesamum Indicum Seed, stir-fried and ground, 3-5 qian); Xian Shou Wu (Polygoni Multiflori Caulis Recens, nourishes blood and dispels wind, 5 qian to 1 liang); Sheng Di Huang (Rehmanniae Radix Recens, cools blood and moistens dryness, 3-5 qian); Song Zi Ren (Pinus Kernel, 5 qian to 2 liang, ground and mixed for administration); Niu Nai (Bovis Lac, nourishes blood and moistens dryness, one cup or Niu Su 1-2 liang); Li Zhi (Pyrus Sinkiangensis Juice, treats wind-heat and benefits the Large Intestine, one cup). This formula is highly suitable for those prone to wind-heat and constipation. Wind-dispelling herbs are not used because treating wind requires first treating the blood; when blood moves, wind extinguishes itself. Using wind-dispelling herbs would further damage blood and worsen constipation.

Ba Wei Di Huang Wan (see Bu Neng Shi section): Treats cold constipation. (It must be accompanied by aversion to cold and cold limbs, desire for hot drinks, clear and copious urine, and a deep, small, and slow pulse to diagnose as a cold pattern.) It is advisable to add Rou Cong Rong (Cistanches Herba, 1-2 liang). If the pattern is indeed cold qi obstructing the Large Intestine with congealed yin causing blockage, this formula can be used. However, such cases are rare; do not administer indiscriminately. I believe one should first use Rou Cong Rong (3 liang), which is warm and enters the Kidney as the sovereign drug, decocted in wine to moisten dryness, mixed with Chen Xiang powder (3 qian) to benefit Ming Men True Fire as the minister drug, which can also dissipate congealed yin qi. If there is no response, then administer Ba Wei Di Huang Wan. This illustrates the principle that when a disease requires heat therapy, one should first probe with warm herbs.