脉∶燥结之脉，沉伏勿疑；热结沉数；虚结沉迟；若是风燥，右尺浮肥。
身热烦渴，大便不通者，是热闭也；久病患虚，大便不通者，是虚闭也；因汗出多，大
便不通者，精液枯竭而闭也；风证大便不通者，是风闭也；老人大便不通者，是血气枯燥而
闭也；虚弱并产妇及失血，大便不通者，血虚而闭也；多食辛热之物，大便不通者，实热也
（并宜后方）。
润肠汤 治大便闭结不通。
当归 熟地 生地 麻仁（去壳） 桃仁（去皮） 杏仁（去皮） 枳壳 浓朴（去粗皮） 黄
芩大黄（各等分） 甘草（减半）
上锉一剂。水煎，空心热服。大便通即止药，不能多服。如修合润肠丸，将药加减各为
末，炼蜜为丸，如梧桐子大。每服五十丸，空心白汤吞下。切忌辛热之物。实热燥闭，根据本
方；发热，加柴胡；腹痛，加木香；血虚枯燥，加当归、熟地、桃仁、红花；风燥闭，郁李
仁、皂角、羌活；气虚而闭，加人参、郁李仁；气实而闭，加槟榔、木香；痰火而闭，加瓜
萎、竹沥；因汗多或小便去多，津液枯竭而闭，加人参、麦门冬；老人气血枯燥而闭，加人
参、锁阳、麦门冬、郁李仁，倍加当归、熟地、生地，少用桃仁；产妇去血多，枯燥而闭，
加人参、红花，倍加当归、熟地，去黄芩、桃仁。此方加槟榔，即通幽汤。
蜜导法 用火炼蜜，稠浓黄色倾入水中，急捻如指大，随用皂角末、麝香共为衣。将油
涂抹大便润湿，放入谷道，大便即通。
猪胆汁导法 治自汗，小便利而大便燥硬，不可攻，以此法导之。猪胆一枚，倾去一小
半，仍入醋在内，用竹管相接，套入谷道中，以手指捻之，令胆汁直射入内，少时即通。盖
酸苦益阴以润燥也。
香油导法 治大便不通，腹胀，死在须臾。用竹管蘸葱汁深入大便内，以香油一半、温
水一半同入猪尿胞内，捻入竹管。将病患倒放，脚向上，半时即顺，立通。
一大便闭结，若大肠血虚火炽者，用四物汤送下润肠丸，或以猪胆汁导之；若肾虚火燥
者，用六味丸；若肠胃气虚，用补中益气汤（二方俱见补益）。
一男子年六十七岁，因气恼，左边上中下有三块，时动而胀痛，喜揉，揉即散去。心痞
作嘈，食下胃口觉涩，夜卧不宁，小便涩，大便八日不通。一医以大承气汤，一医以化滞丸
，一用猪胆导法，一用蜜导法，俱不效。余诊六脉弦数有力，此血不足气有余，积热壅实。
以大黄末三钱、皮硝五钱，热烧酒调服。打下黑粪，其硬如石，数十条。如前又一服，又打
下粪弹盆许，遂安。后以四物汤加桃仁、红花、酒蒸大黄、黄连、栀子、三棱、莪术、枳壳
、青皮、木通、甘草，十数剂而愈。
脉象：燥结的脉象，沉伏而不可怀疑；热结的脉象沉数；虚结的脉象沉迟；若是风燥，右尺脉浮肥。
身体发热、烦躁口渴，大便不通的，是热闭证；久病体虚，大便不通的，是虚闭证；因出汗过多，大便不通的，是精液枯竭导致的闭塞；风证导致大便不通的，是风闭证；老年人大便不通的，是血气干枯导致的闭塞；虚弱兼产妇及失血者，大便不通的，是血虚导致的闭塞；多食辛辣温热之物，大便不通的，是实热证（均适宜使用后方）。
润肠汤 治疗大便闭结不通。
当归、熟地黄、生地黄、火麻仁（去壳）、桃仁（去皮）、杏仁（去皮）、枳壳、厚朴（去粗皮）、黄芩、大黄（各等分）、甘草（减半）
以上药材锉碎为一剂。加水煎煮，空腹时热服。大便通畅后即停药，不可多服。如果制作润肠丸，将药物加减后分别研为细末，用炼蜜制成丸药，大小如梧桐子。每次服用五十丸，空腹时用白开水送下。切忌食用辛辣温热之物。实热燥闭，依据本方；若发热，加柴胡；若腹痛，加木香；若血虚干枯，加当归、熟地黄、桃仁、红花；若风燥闭结，加郁李仁、皂角、羌活；若气虚而闭结，加人参、郁李仁；若气实而闭结，加槟榔、木香；若痰火而闭结，加瓜蒌、竹沥；因出汗多或小便排出多，津液枯竭而闭结，加人参、麦门冬；老人气血干枯而闭结，加人参、锁阳、麦门冬、郁李仁，加倍使用当归、熟地黄、生地黄，少量使用桃仁；产妇失血多，干枯而闭结，加人参、红花，加倍使用当归、熟地黄，去掉黄芩、桃仁。此方加入槟榔，即为通幽汤。
蜜导法 用火炼制蜂蜜，至稠浓黄色时倾入水中，迅速捏成如手指粗细的形状，使用时配合皂角末、麝香共同作为外衣。将油涂抹肛门使其湿润，放入谷道（肛门），大便即可通畅。
猪胆汁导法 治疗自汗，小便通利而大便燥硬，不可攻下，用此法导引。取一个猪胆，倒去一小半胆汁，仍留醋在内，用竹管连接，套入谷道中，用手指捻动，使胆汁直接射入内部，片刻后即可通畅。这是因为酸苦之味能益阴以润燥。
香油导法 治疗大便不通，腹胀，情况危急，随时可能死亡。用竹管蘸取葱汁深入大便内，将一半香油、一半温水同装入猪尿胞内，捻入竹管。让患者倒置放置，脚向上，半小时后即可顺畅，立即通畅。
一大便闭结，若大肠血虚火旺者，用四物汤送服润肠丸，或用猪胆汁导引；若肾虚火燥者，用六味地黄丸；若肠胃气虚，用补中益气汤（这两方均见补益篇）。
一男子六十七岁，因生气恼怒，左边上中下部位有三块肿块，时而移动且胀痛，喜欢揉按，揉按即消散。心中痞塞嘈杂，进食后胃口感觉涩滞，夜间睡眠不宁，小便涩痛，大便八日不通。一位医生用大承气汤，一位医生用化滞丸，一位用猪胆导法，一位用蜜导法，均无效。我诊察六脉弦数有力，这是血不足气有余，积热壅实。用大黄末三钱、芒硝五钱，用热烧酒调服。排出黑色粪便，坚硬如石，有数十条。像前面那样再服一次，又排出粪弹约一盆许，于是安定。后来用四物汤加桃仁、红花、酒蒸大黄、黄连、栀子、三棱、莪术、枳壳、青皮、木通、甘草，十余剂后痊愈。
Pulse: For dryness accumulation (dryness accumulation), the pulse is deep and hidden, leaving no doubt; for heat accumulation (heat accumulation), the pulse is deep and rapid; for deficiency accumulation (deficiency accumulation), the pulse is deep and slow; if it is wind-dryness (wind-dryness), the right chi (chi position on the radial artery) pulse is floating and plump.
Body fever, irritability, thirst, and constipation indicate Heat Obstruction (Heat Obstruction); chronic illness with deficiency, constipation indicates Deficiency Obstruction (Deficiency Obstruction); excessive sweating leading to constipation indicates closure due to exhaustion of essence and fluids (exhaustion of essence and fluids); constipation caused by wind syndromes indicates Wind Obstruction (Wind Obstruction); constipation in the elderly indicates closure due to dryness of blood and qi (dryness of blood and qi); constipation in those who are weak, postpartum women, or those who have lost blood indicates closure due to blood deficiency (blood deficiency); constipation after consuming much spicy and hot food indicates Excess Heat (Excess Heat) (all suitable for the following formula).
Run Chang Tang (Moistening Intestine Decoction) treats constipation and blockage.
Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Rehmanniae Radix Recens (Shengdi), Cannabis Fructus (Maren, processed to remove shells), Persicam Semen (Taoren, peeled), Armeniacae Semen Amarum (Xingren, peeled), Aurantii Fructus (Zhiqiao), Magnoliae Officinalis Cortex (Houpo, rough bark removed), Scutellariae Radix (Huangqin), Rhei Radix et Rhizoma (Dahuang) (all equal parts), Glycyrrhizae Radix et Rhizoma (Gancao, half dose).
Chop the above into one dose. Decoct in water, take warm on an empty stomach. Stop medication once bowel movement is unblocked; do not take excessively. To prepare Run Chang Wan (Moistening Intestine Pill), modify the herbs according to needs, grind each into powder, and form pills with refined honey, sized like sophora seeds. Take fifty pills per dose, swallow with plain warm water on an empty stomach. Strictly avoid spicy and hot foods. For Excess Heat Dryness Obstruction, follow this base formula; for fever, add Bupleuri Radix (Chaihu); for abdominal pain, add Aucklandiae Radix (Muxiang); for blood deficiency dryness, add Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Persicam Semen (Taoren), Carthami Flos (Honghua); for Wind-Dryness Obstruction, add Prunellae Fructus (Yuziren), Gleditsiae Sinensis Spina (Zaojiao), Notopterygii Rhizoma et Radix (Qianghuo); for Qi deficiency obstruction, add Ginseng Radix (Renshen), Prunellae Fructus (Yuziren); for Qi excess obstruction, add Arecae Semen (Binglang), Aucklandiae Radix (Muxiang); for Phlegm-Fire obstruction, add Trichosanthis Fructus (Gualou), Bambusae Sap (Zhuli); for closure due to excessive sweating or urination leading to fluid exhaustion, add Ginseng Radix (Renshen), Ophiopogonis Radix (Maidong); for elderly closure due to blood and qi dryness, add Ginseng Radix (Renshen), Cynomorii Herba (Suoyang), Ophiopogonis Radix (Maidong), Prunellae Fructus (Yuziren), double the dose of Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), Rehmanniae Radix Recens (Shengdi), use less Persicam Semen (Taoren); for postpartum women with excessive blood loss and dryness obstruction, add Ginseng Radix (Renshen), Carthami Flos (Honghua), double the dose of Angelicae Sinensis Radix (Danggui), Rehmanniae Radix Praeparata (Shudi), remove Scutellariae Radix (Huangqin) and Persicam Semen (Taoren). Adding Arecae Semen (Binglang) to this formula creates Tong You Tang (Unblocking the Abyss Decoction).
Mi Dao Method (Honey Suppository Method): Refine honey over fire until thick and yellow, pour into water, quickly shape into finger-sized cylinders. Coat with powder of Gleditsiae Sinensis Spina (Zaojiao) and Moschus (Shexiang). Lubricate the anus with oil, insert into the rectum (valley gate), and bowel movement will be facilitated.
Zhu Dan Zhi Dao Method (Pig Gallbladder Juice Suppository Method): Treats spontaneous sweating, patent urination, but dry and hard stool that cannot be purged; use this method to guide. Take one pig gallbladder, discard a small portion of bile, keep vinegar inside, connect with a bamboo tube, insert into the rectum, manipulate with fingers to direct bile juice inward, passage occurs shortly. This is because sour and bitter flavors nourish Yin to moisten dryness.
Xiang You Dao Method (Sesame Oil Suppository Method): Treats constipation, abdominal distension, critical condition imminent. Dip a bamboo tube in scallion juice, insert deeply into the stool. Mix half sesame oil and half warm water in a pig bladder, insert the bamboo tube. Place the patient upside down, feet up; within half an hour, flow becomes smooth, and immediate passage occurs.
For constipation due to Large Intestine blood deficiency and blazing fire, use Si Wu Tang (Four Substances Decoction) to deliver Run Chang Wan, or use Pig Gallbladder Juice Suppository Method; for Kidney deficiency with dry fire, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia); for Spleen and Stomach Qi deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (both formulas see Tonification section).
A sixty-seven-year-old man, due to anger and resentment, had three lumps on the left side (upper, middle, lower), moving intermittently with distending pain, relieved by rubbing which dispersed them. He experienced epigastric fullness and hunger pangs, astringency in the throat after eating, restless sleep at night, astringent urination, and no bowel movement for eight days. One physician used Da Cheng Qi Tang (Major Order the Qi Decoction), another Hua Zhi Wan (Eliminate Stasis Pill), one used Pig Gallbladder Juice Suppository Method, another Honey Suppository Method, all ineffective. I palpated the six pulses as wiry, rapid, and forceful; this indicated insufficient blood and excess Qi, with accumulated heat and stagnation. Administered three qian of Rhei Radix et Rhizoma (Dahuang) powder and five qian of Natrii Sulfas (Pixiao), mixed with hot distilled liquor. Passed black feces, hard as stone, in dozens of strips. After another dose as before, passed feces resembling pellets filling a basin, then stabilized. Later, treated with Si Wu Tang (Four Substances Decoction) plus Persicam Semen (Taoren), Carthami Flos (Honghua), Rhei Radix et Rhizoma (Dahuang) steamed with wine, Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), Curcumae Radix (Sanleng), Curcumae Longae Rhizoma (Ezhu), Aurantii Fructus (Zhiqiao), Citri Reticulatae Pericarpium (Qingpi), Akebiae Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao). After more than ten doses, he recovered.