有虚、有风、有湿、有火、有津液不足、有寒、有气结。有此者,多面黄可候,切不可一例用硝黄等药;巴
豆、牵牛亦不宜例用,当审大法,阳方主润燥,阴方主开结。用郁李仁、桃仁、羌活、大黄、当归、麻子仁,上为
末,或少加木香、槟榔亦可。大肠燥结不通,润肠汤,一名当归润肠汤。幽门不通,上冲吸门噎塞,大便燥秘,通
幽汤。又有脾胃中伏火,便秘干燥,不思饮食,及风结、血结,皆令闭塞也,以润燥、和血、疏风自通,治以润肠
丸。湿热为病,大便燥结,神芎丸。大便秘,不通燥结,活血润燥主之。有热者,大承气汤。胃中停滞寒冷
之物,大便不通,心腹作痛者,备急丸;食伤太阴,气滞不运为病者,木香槟榔丸。大肠虚秘而热,白芍药(一两半)
陈皮 生地 当归身(以上各一两) 甘草(五钱) 上末之,粥丸,白汤下。论中有治腹胀而不通者,用杏仁、葱
白、盐,于脐上摩之;又有皂荚、白梅肉蜜丸纳之,或用其汁入蜜熬为丸,或用汁和糯米炒,燥存性,以糖为丸,或止
用蜜乌梅肉,皆可纳肛门中,皆开风热结燥之药故也。
关则不得小便,格则吐逆。此证多死,寒在上,热在下。必用吐,提其气之横格,不必出痰亦可,盖用二陈汤
吐之,吐中有降之义。有中气虚不运者,补气药中升降,脉两寸俱盛四倍以上。戴云∶关格者,调膈中觉有所碍,
欲升不升,欲降不降,饮食不下,此为气之横格。
大便秘结的原因,有因虚、因风、因湿、因火、因津液不足、因寒、因气机郁结。出现这些情况时,患者多见面色萎黄可供诊察,切不可一概使用芒硝、大黄等泻下药;巴豆、牵牛子也不宜常规使用,应当审察治疗大法:阳证方剂主要作用是润燥,阴证方剂主要作用是开结。可用郁李仁、桃仁、羌活、大黄、当归、麻子仁,研为细末,或少量加入木香、槟榔也可以。大肠燥热结实导致大便不通,用润肠汤,又名当归润肠汤。幽门不通,浊气上冲至吸门导致噎塞,大便干燥秘结,用通幽汤。又有脾胃中有潜伏之火,导致便秘干燥,不想饮食,以及风邪结滞、血瘀结滞,都会导致闭塞,通过润燥、和血、疏风的方法自然通畅,治疗用润肠丸。湿热致病,大便干燥结滞,用神芎丸。大便秘结不通且干燥结滞,以活血润燥为主治法。有热证的,用大承气汤。胃中停滞寒冷之物,导致大便不通,心腹部疼痛的,用备急丸;饮食损伤太阴脾经,气机阻滞不能运化导致的病证,用木香槟榔丸。大肠虚秘兼有热象,用白芍药(一两半)、陈皮、生地、当归身(以上各一两)、甘草(五钱),研为细末,用米粥泛丸,温开水送服。医论中有治疗腹胀而大便不通的,用杏仁、葱白、盐,在肚脐上按摩;又有用皂荚、白梅肉加蜜制成丸剂纳入肛门中,或者用其汁液加蜜熬制成丸,或者用汁液调和糯米炒至存性,用糖制成丸,或者仅用蜜渍乌梅肉,都可以纳入肛门中,这些都是开通风热结燥的药物。
关格病,关则小便不通,格则呕吐逆乱。这种病症大多预后不良,表现为寒邪在上焦,热邪在下焦。必须使用催吐法,提起横格之气,不一定需要吐出痰涎也可以,大概是用二陈汤催吐,吐法中包含降逆的意义。有中气虚弱不能运化的,在补气药中加入升降气机的药物,脉象两寸都盛大超过正常四倍以上。戴元礼说:关格病,感觉膈中有所阻碍,想升不能升,想降不能降,饮食无法下咽,这是气机横格所致。
The causes of constipation include deficiency, wind, dampness, fire, insufficient body fluids, cold, and qi stagnation. In cases presenting these patterns, the patient's complexion is often sallow, which serves as a diagnostic indicator. One must absolutely avoid using laxatives such as Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) indiscriminately; Badou (Crotonis Fructus) and Qianniu (Pharbitidis Semen) should also not be used routinely. The general principles of treatment must be assessed: yang-pattern formulas primarily moisten dryness, while yin-pattern formulas primarily resolve stagnation. One may use Yuliren (Pruni Semen), Taoren (Persicae Semen), Qianghuo (Notopterygii Rhizoma et Radix), Dahuang (Rhei Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), and Maziren (Cannabis Fructus), pulverized into fine powder, with a small amount of Muxiang (Aucklandiae Radix) or Binglang (Arecae Semen) added if necessary. For dry-heat accumulation in the Large Intestine leading to bowel obstruction, Run Chang Tang (Moistening the Intestines Decoction), also known as Danggui Run Chang Tang (Danggui Moistening the Intestines Decoction), is indicated. For blockage at the pylorus, with turbid qi rushing upward to the shimen causing dysphagia and dry, obstinate stool, Tong You Tang (Unblocking the Lower Orifice Decoction) is used. Additionally, latent fire in the Spleen and Stomach causing constipation, dryness, and anorexia, as well as blockage due to wind-stagnation or blood-stasis, all lead to obstruction. Natural unblocking can be achieved by moistening dryness, harmonizing blood, and dispersing wind; this is treated with Run Chang Wan (Moistening the Intestines Pill). For diseases caused by damp-heat resulting in dry, hard stools, Shenxiong Wan (Shenxiong Pill) is prescribed. For severe constipation with dry, hard accumulation, the primary treatment is invigorating blood and moistening dryness. In cases with heat, Da Cheng Qi Tang (Major Order the Qi Decoction) is used. If cold substances stagnate in the Stomach, causing constipation and pain in the heart and abdomen, Bei Ji Wan (Emergency Aid Pill) is indicated. For illness caused by dietary injury to the Taiyin Spleen, where qi stagnation fails to transport, Muxiang Binglang Wan (Aucklandia and Areca Nut Pill) is used. For deficiency-type constipation in the Large Intestine accompanied by heat, use Baishao Yao (Paeoniae Radix Alba) (1.5 liang), Chenpi (Citri Reticulatae Pericarpium), Shengdi (Rehmanniae Radix), Danggui Shen (Radix Angelicae Sinensis, root portion) (each 1 liang), and Gancao (Glycyrrhizae Radix et Rhizoma) (5 qian). Pulverize these ingredients, form pills using rice porridge as a binder, and administer with warm water. Medical discussions mention treating abdominal distension with bowel obstruction by massaging Xingren (Armeniacae Semen Amarum), Congbai (Allii Fistulosi Bulbus), and Yan (Sal) above the umbilicus; alternatively, Zaojiao (Gleditsiae Sinensis Spina) and Bai Mei Rou (Mume Fructus Flesh) mixed with honey into pills can be inserted into the anus, or their juice boiled with honey into pills, or mixed with glutinous rice stir-fried until charred on the outside but raw inside, formed into pills with sugar, or simply using honey-preserved Wumei Rou (Mume Fructus Flesh) inserted into the anus. These are all herbs that open wind-heat and dryness accumulation.
Guan Ge syndrome involves Guan (closure), characterized by inability to urinate, and Ge (rejection), characterized by vomiting and regurgitation. This condition often has a poor prognosis, manifesting as cold in the upper jiao and heat in the lower jiao. Emetic therapy must be employed to lift the horizontally obstructed qi; it is not necessary to expectorate phlegm. Generally, Er Chen Tang (Two-Cured Decoction) is used for emesis, as the act of vomiting contains the principle of descending qi. In cases of Middle Qi deficiency failing to transport, ascending and descending agents are added to tonifying qi formulas; the pulse at both cun positions is excessively vigorous, more than four times normal. Dai Yun stated: In Guan Ge syndrome, there is a sensation of obstruction in the diaphragm, where qi desires to ascend but cannot, desires to descend but cannot, and food and drink cannot pass down. This is caused by horizontal obstruction of qi.