消食化痰，如枳实、枳壳、陈皮、半夏、草豆蔻、莱菔子、山楂、浓朴、香附、
麦芽、神曲之类，随候采用。
清热平胃，如香薷、黄连、木瓜、藿香、木通、石斛、陈皮、浓朴、甘草、泽
泻、猪苓、苍术、滑石之类，随候采用。
温补止泻，如肉果、吴茱萸、肉桂、丁香、木香、诃子、赤石脂、龙骨、人参、茯
苓、山药、砂仁、益智、米仁、白术、炙甘草、白豆蔻、陈米、莲肉、白扁豆、煨姜、
乌梅之类，随候采用。
燥结之症，有虚实二者之分。或因风寒邪从外入，或因七气火自内起，此是湿热怫
郁燥结，有时乃为实也。实则宜荡涤肠胃，开结软坚，如大黄、硝石、枳实、浓朴、承
气汤之类是也。或因病久，饮食少进，或因吐泻汗后，津液暴亡，或因年高精血干枯，
妇人产后亡血，皆能秘结，此是血液枯涸，不能润泽而燥结，乃为虚也。虚则宜滋养阴
血，润燥散热，使火不行燥热之令，肠金自化清纯之气，精液入胃，脾土健行，自不秘
结矣，如归地桃仁润燥汤之类。如常饮食煮猪血脏汤，加酥食之，血仍润血，脏仍润
脏，胃强能食者，间服润肠丸微利之，苟不审虚实而轻用硝黄巴豆，杀人如反掌也。故
东垣曰∶凡人胃强脾弱，约束津液，不得四布，但输膀胱，故小便数而大便难者，用脾
约丸。若由阴血枯槁，宜滋金水，使阴道一长，津液内生，何燥结之有哉。
《经》曰∶北方黑色，入通于肾，开窍于二阴。肾虚则津液竭而大便燥，然肾恶
燥，急食辛以润之，以苦泄之，或六味料加苁蓉、人乳、白蜜，服之最宜。故大便秘
结，专责之少阴一经，证状虽殊，总之津液枯干，盖肾主五液，津液足则大便如常。若
饥饱劳役，损伤胃气，矢于输化，及过食辛热浓味，则火邪于血中，耗散真阴，血液少
而燥结矣。分而言之，更有胃实、胃虚、热秘、冷秘、风秘、气秘、血秘之分。胃实而
秘者，脉浮而数，善饮食，小便赤。胃虚而秘者，脉沉而迟，不能饮食，小便清利，体
重便鞭。若面赤身热，六脉数实，时欲得冷，或口舌生疮，大肠热结，此热秘也。若
面目或黑，六脉沉迟，小便清白，喜热恶冷，此由冷气横于肠胃，凝阴固结，津液不
通，实非燥粪，此冷秘也。若由亡血血虚，津液不足，此血秘也。若气不升降，谷气不
行，其人多噫，此气秘也。风搏肺脏，传于大肠，或素有风病者，此风秘也。东垣曰∶
实秘、热秘即阳结也，宜散之。虚秘、冷秘即阴结也，宜温之。《准绳》曰∶胃实而秘
者，能饮食，小便赤，秘物也。胃虚而秘者，不能食，小便清利，秘气也。然脏得血
而能液，若肾阴既虚，不以津液骤生，欲求速效，未有不致危困，然登厕用力劳苦，势
亦难堪，只有大滋津液，以为不治之治也。下脘即幽门，胃之下口也。人身上下有七
门，皆下冲上也。幽门上冲吸门，吸门即会厌气喉，上掩饮食者也。冲其吸人之气，不
得下归肝肾，为阴火相拒，故隔噎不通，浊阴不得，降而大便干燥不行，胃之湿与阴火
俱在其中，则腹胀作矣。治在幽门，使幽门通利，泄其阴火，润其燥血，生其新血，则
幽门通，吸门亦不受邪，膈噎得开，胀满俱去，浊阴得归下地道也。脉浮在气，杏仁、
陈皮主之，脉沉在血，桃仁、陈皮主之，俱用陈皮者，以手太阴与手阳明为表里，肺气
不降，大肠难传送也。然须兼用滑润，如生
首乌、麻仁、归梢、苁蓉之类。如欲坐井中者，两尺脉按之必虚，或沉细而迟，旦煎理
中汤极冷而服，不应不可用猛剂，宜蜜煎导之。冷秘，蜜煎中加草乌头末；热者，猪胆
汁导之亦可。如因久病。虽多日不便，然因饮食久少，糟粕何从而得，日数虽多不甚后
急，只须补理气血，中气一旺，自能健运，调摄饮食，新谷既充，自能推送旧谷，切不
可通利，以致变生虚脱危症。阳结脉沉而数或促，阴结脉伏而迟或结。老人虚人脉雀啄
者，不治。
消除食积、化解痰湿的药物，如枳实、枳壳、陈皮、半夏、草豆蔻、莱菔子、山楂、厚朴、香附、麦芽、神曲等，根据具体证候选用。
清热、平抑胃火（调和脾胃气机）的药物，如香薷、黄连、木瓜、藿香、木通、石斛、陈皮、厚朴、甘草、泽泻、猪苓、苍术、滑石等，根据具体证候选用。
温补、止泻的药物，如肉果（肉豆蔻）、吴茱萸、肉桂、丁香、木香、诃子、赤石脂、龙骨、人参、茯苓、山药、砂仁、益智仁、薏苡仁、白术、炙甘草、白豆蔻、陈米、莲肉、白扁豆、煨姜、乌梅等，根据具体证候选用。
燥结（大便干结难解）的病症，有虚证和实证两种区分。有的因为风寒邪气从外部侵入，有的因为七情之气化火从内部兴起，这是湿热郁遏导致的燥结，有时属于实证。实证应当荡涤肠胃，开通结滞、软化坚硬，如大黄、硝石、枳实、厚朴、承气汤等方药。或者因为患病日久，饮食摄入减少，或者因为吐泻、发汗之后，津液突然亡失，或者因为年老精血干枯，妇女产后失血，都能导致便秘，这是血液枯涸，不能滋润而导致的燥结，属于虚证。虚证应当滋养阴血，润燥散热，使火热不施行燥热的命令，大肠（肺金之腑）自然化生清纯之气，精液进入胃中，脾土健运，自然就不会便秘了，如归地桃仁润燥汤等方药。如果像平常饮食那样煮猪血脏汤，加入酥油食用，血液仍能滋润血液，脏腑仍能滋润脏腑，胃气强健能进食的人，间歇服用润肠丸轻微通便；如果不审察虚实而轻率使用硝石、大黄、巴豆等峻下之药，杀人就像翻手掌一样容易。所以李东垣说：凡是人胃强脾弱，约束津液，不能四布全身，只输送到膀胱，所以小便频数而大便困难的，用脾约丸。如果是由于阴血枯槁，应当滋补肾水与肺金，使阴道（阴液通道）生长，津液内生，哪里还会有燥结呢？
《黄帝内经》说：北方对应黑色，内通于肾，开窍于前后二阴。肾虚则津液枯竭而大便干燥，然而肾厌恶燥邪，应当急食辛味以润之，苦味以泄之，或者在六味地黄丸料中加入肉苁蓉、人乳、白蜜，服用最为适宜。所以大便秘结，专门责之于少阴肾经，症状虽然不同，总之都是津液干枯，大概因为肾主五液，津液充足则大便如常。如果因为饥饱失调、劳役过度，损伤胃气，影响输布转化，以及过食辛辣热性浓味食物，则火邪潜伏于血中，耗散真阴，血液减少而导致燥结。分别来说，更有胃实秘、胃虚秘、热秘、冷秘、风秘、气秘、血秘之分。胃实而秘者，脉象浮而数，食欲好，小便赤黄。胃虚而秘者，脉象沉而迟，不能进食，小便清利，身体沉重，大便硬结。如果面红身热，六脉数而有力，时常想要冷饮，或者口舌生疮，这是大肠热结，属于热秘。如果面目发黑，六脉沉迟，小便清白，喜热恶冷，这是由于冷气横亘于肠胃，凝阴固结，津液不通，其实并非燥粪，属于冷秘。如果是由于失血、血虚，津液不足，属于血秘。如果气机不升降，谷气不行，其人经常嗳气，属于气秘。风邪搏结肺脏，传于大肠，或者素来有风病的人，属于风秘。李东垣说：实秘、热秘就是阳结，应当发散；虚秘、冷秘就是阴结，应当温补。《准绳》说：胃实而秘者，能进食，小便赤，是秘物（有形之邪阻滞）；胃虚而秘者，不能进食，小便清利，是秘气（无形之气滞）。然而脏腑得到血液才能产生津液，如果肾阴既已虚弱，不迅速滋生津液，想要追求速效，没有不导致危困的，然而登厕用力辛苦，形势也难以忍受，只有大滋津液，作为不治之治的方法。下脘即幽门，是胃的下口。人身上下有七个门户，都是向下冲向上方的。幽门上冲吸门，吸门即会厌气喉，向上掩蔽饮食之处。冲击吸入的空气，不能向下归藏肝肾，被阴火抗拒，所以噎膈不通，浊阴不得下降，导致大便干燥不行，胃中的湿气与阴火都在其中，就会腹胀发作。治疗在于幽门，使幽门通利，泄去阴火，滋润燥血，生成新血，那么幽门通，吸门也不受邪气，噎膈得以开通，胀满全部去除，浊阴得以回归下地道。脉浮在气分，用杏仁、陈皮主治；脉沉在血分，用桃仁、陈皮主治，都用陈皮的原因，是因为手太阴肺经与手阳明大肠经互为表里，肺气不降，大肠难以传送。然而必须兼用滑润药物，如生首乌、麻仁、当归梢、肉苁蓉等。如果想要坐井中（形容极度寒冷或需极寒药），两尺脉按之必然虚弱，或者沉细而迟，早晨煎煮理中汤极冷后服用，无效不可用猛剂，宜用蜜煎导法。冷秘，在蜜煎中加入草乌头末；热秘，用猪胆汁导法也可以。如果因为久病，虽然多日不便，但因为饮食长久很少，糟粕从哪里得来，日子虽多但不甚紧急，只需要补益调理气血，中气一旺，自然能健运，调摄饮食，新谷既充，自然能推送旧谷，切不可通利，以致变生虚脱危症。阳结脉沉而数或促，阴结脉伏而迟或结。老人虚人脉象如雀啄者，不治。
Digestive-promoting and phlegm-resolving herbs, such as *Fructus Aurantii Immaturus* (Zhishi, 枳实), *Pericarpium Aurantii* (Zhike, 枳壳), *Pericarpium Citri Reticulatae* (Chenpi, 陈皮), *Rhizoma Pinelliae* (Banxia, 半夏), *Semen Cardamomi* (Caodoukou, 草豆蔻), *Radish Seed* (Laifuzi, 莱菔子), *Fructus Crataegi* (Shanzha, 山楂), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), *Rhizoma Cyperi Rotundi* (Xiangfu, 香附), *Semen Hordei Germinatum* (Maiya, 麦芽), *Massa Medicata Fermentata* (Shenqu, 神曲) etc., are selected according to the specific syndrome.
Heat-clearing and stomach-calming (harmonizing spleen and stomach qi mechanism) herbs, such as *Herba Elsholtziae* (Xiangru, 香薷), *Rhizoma Coptidis* (Huanglian, 黄连), *Sarcandra Glabra* (Mu Gua, 木瓜 - note: usually refers to Chaenomelis Fructus in TCM context for dampness, here likely Pseudocydonia or Chaenomeles), *Herba Agastaches* (Huoxiang, 藿香), *Herba Akebiae Trifoliate* (Mutong, 木通), *Dendrobii Caulis* (Shihu, 石斛), *Pericarpium Citri Reticulatae* (Chenpi, 陈皮), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), *Radix Glycyrrhizae Preparata* (Gancao, 甘草), *Rhizoma Alismatis* (Zexie, 泽泻), *Polyporus* (Zhuling, 猪苓), *Rhizoma Atractylodis Macrocephalae* (Cangzhu, 苍术), *Talcum* (Huashi, 滑石) etc., are selected according to the specific syndrome.
Warming-tonifying and diarrhea-stopping herbs, such as *Semen Myristicae* (Rouguo/Roudoukou, 肉果/肉豆蔻), *Fructus Evodiae* (Wuzhuyu, 吴茱萸), *Cortex Cinnamomi* (Rougui, 肉桂), *Flos Caryophylli* (Dingxiang, 丁香), *Lignum Aucklandiae* (Muxiang, 木香), *Fructus Chebulae* (Hezi, 诃子), *Halloysit Rubra* (Chishizhi, 赤石脂), *Os Draconis* (Longgu, 龙骨), *Radix Ginseng* (Renshen, 人参), *Poria* (Fuling, 茯苓), *Rhizoma Dioscoreae* (Shanyao, 山药), *Fructus Amomi* (Sharen, 砂仁), *Semen Alpiniae Oxyphyllae* (Yizhi, 益智仁), *Semen Coicis* (Yiren, 薏苡仁), *Rhizoma Atractylodis Macrocephalae* (Baizhu, 白术), *Radix Glycyrrhizae Preparata* (Zhi Gancao, 炙甘草), *Semen Cardamomi Album* (Baidoukou, 白豆蔻), *Oryza Sativa Vetusta* (Chenmi, 陈米), *Semen Nelumbinis* (Lianrou, 莲肉), *Semini Dolichoris Lablab* (Baibian Dou, 白扁豆), *Zingiberis Rhizoma Preparatum* (Weijiang, 煨姜), *Fructus Mume* (Wumei, 乌梅) etc., are selected according to the specific syndrome.
Constipation due to dryness (Zaojie) is divided into deficiency (Xu) and excess (Shi) syndromes. Some cases arise from wind-cold pathogens entering from outside, while others stem from internal fire generated by the seven emotions. This represents dryness caused by stagnation of damp-heat, which is sometimes an excess syndrome. For excess syndromes, it is appropriate to purge the intestines and stomach, open blockages, and soften hardness, using herbs like *Radix et Rhizoma Rhei* (Dahuang, 大黄), *Natrii Sulfas* (Xiaoshi/Niaoshui, 硝石), *Fructus Aurantii Immaturus* (Zhishi, 枳实), *Cortex Magnoliae Officinalis* (Houpo, 厚朴), and formulas like Chengqi Tang (Chengqi Decoction). Alternatively, constipation may result from prolonged illness with reduced food intake, sudden loss of body fluids after vomiting, diarrhea, or sweating, exhaustion of essence and blood in old age, or blood loss after childbirth. These lead to dryness because dried-up blood fails to moisten, constituting a deficiency syndrome. For deficiency syndromes, it is appropriate to nourish yin and blood, moisten dryness, and clear heat, preventing fire from imposing its drying nature. The large intestine (Metal organ) will naturally transform pure qi, fluids enter the stomach, the spleen earth functions vigorously, and constipation resolves spontaneously. Formulas like Guide Tao Ren Run Zao Tang (Angelica and Peach Kernel Moistening Dryness Decoction) can be used. One may also consume pig blood and offal soup cooked as usual, adding butter; this moistens both blood and organs. For those with strong stomachs capable of eating, Run Chang Wan (Intestine-Moistening Pill) can be taken intermittently for mild purgation. If one fails to distinguish between deficiency and excess and rashly uses harsh purgatives like Natrii Sulfas, *Radix et Rhizoma Rhei*, or *Radix Crotonis Tiglii* (Badou, 巴豆), death can occur as easily as flipping a hand. Therefore, Li Dongyuan stated: "When the stomach is strong but the spleen weak, fluids are constrained and cannot circulate widely, only flowing to the bladder, causing frequent urination and difficult defecation. In such cases, use Pi Yue Wan (Spleen-Restriction Pill)." If constipation stems from withered yin-blood, one should nourish Metal (Lung) and Water (Kidney) so that yin channels grow, generating internal fluids, thus eliminating dryness.
The *Classic* states: "North corresponds to black, connecting internally to the Kidney, opening at the two lower orifices." Kidney deficiency leads to fluid exhaustion and dry stool. Since the Kidney dislikes dryness, one should urgently consume pungent substances to moisten and bitter substances to drain. Adding *Caulis Cibotii Barometz* (Congrong, 肉苁蓉), human milk, and white honey to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is most suitable. Thus, severe constipation is specifically attributed to the Shaoyin (Kidney) meridian. Although symptoms vary, the root cause is always fluid exhaustion, as the Kidney governs the five fluids; sufficient fluids ensure normal bowel movements. However, irregular diet, overwork, or damage to Stomach qi affecting transformation and transportation, along with excessive consumption of spicy, hot, and rich foods, allow fire pathogens to linger in the blood, consuming true yin. Reduced blood volume leads to dryness. Specifically, there are distinctions among Stomach-excess constipation, Stomach-deficiency constipation, Heat constipation, Cold constipation, Wind constipation, Qi constipation, and Blood constipation.
Stomach-excess constipation presents with floating and rapid pulse, good appetite, and dark urine.
Stomach-deficiency constipation presents with deep and slow pulse, inability to eat, clear urine, heavy body, and hard stool.
If there is red face, body heat, surging and solid pulses, desire for cold drinks, or mouth/tongue ulcers, this is Large Intestine heat accumulation, known as Heat Constipation.
If the face or eyes appear dark, pulses are deep and slow, urine is clear, and there is preference for warmth and aversion to cold, this is due to cold qi obstructing the intestines and stomach, congealing yin and binding, blocking fluids. It is not truly dry feces but Cold Constipation.
If caused by blood loss or blood deficiency leading to insufficient fluids, it is Blood Constipation.
If qi does not ascend and descend, and grain qi does not move, accompanied by belching, it is Qi Constipation.
If wind attacks the Lung, transmitting to the Large Intestine, or in patients with chronic wind diseases, it is Wind Constipation.
Li Dongyuan said: Excess and Heat constipation are Yang Binding, requiring dispersal. Deficiency and Cold constipation are Yin Binding, requiring warming.
The *Zhunsheng* states: Stomach-excess constipation involves eating well and dark urine, indicating physical obstruction. Stomach-deficiency constipation involves inability to eat and clear urine, indicating qi stagnation.
However, organs require blood to generate fluids. If Kidney yin is deficient and fluids do not regenerate quickly, seeking rapid results without addressing this will lead to danger. Straining on the toilet is unbearable; the only cure is to heavily nourish fluids, treating the disease by not directly attacking it.
Xiawan (Lower Confluence) is the幽门 (Pylorus/Houmen), the lower exit of the Stomach. There are seven gates in the body, all directing downward but pushing upward. Houmen pushes up to Ximen (Inhalation Gate), which is the epiglottis/larynx, covering food entry. If inhaled air cannot descend to Liver and Kidney, being resisted by yin-fire, dysphagia occurs. Turbid yin cannot descend, causing dry stool. Dampness in the Stomach combined with yin-fire causes abdominal distension. Treatment focuses on Houmen: unblock it, drain yin-fire, moisten dry blood, generate new blood. Once Houmen is open, Ximen is protected, dysphagia opens, distension resolves, and turbid yin returns to the lower pathways.
For pulses floating in the qi level, use *Semen Armeniacae Amarum* (Xingren, 杏仁) and *Pericarpium Citri Reticulatae* (Chenpi, 陈皮). For pulses sinking in the blood level, use *Semen Persicae* (Taoren, 桃仁) and *Pericarpium Citri Reticulatae* (Chenpi, 陈皮). Chenpi is used in both because Hand-Taiyin Lung and Hand-Yangming Large Intestine are exterior-interior pairs; if Lung qi does not descend, Large Intestine transport is difficult. However, slippery and moistening herbs like *Polygoni Multiflori Preparati* (Shouwu, 生首乌), *Semen Cannabis* (Maren, 麻仁), *Radix Angelicae Sinensis Cauda* (Guishao, 归梢), and *Caulis Cibotii Barometz* (Congrong, 肉苁蓉) must be added.
If the patient desires sitting in a well (indicating extreme cold need), the radial pulses at both chi positions will be empty upon pressure, or deep, thin, and slow. Boiling Lizhong Tang (Regulate the Middle Decoction) until very cold and administering it is appropriate. If ineffective, harsh agents should not be used; instead, honey suppositories (Mi Jian Dao) are suitable. For Cold Constipation, add *Radix Aconiti Lateralis Preparata* (Caowutou, 草乌头) powder to the honey suppository. For Heat Constipation, pig bile suppositories are also effective.
If constipation persists for many days due to long-term illness, but food intake has been low for a long time, where would waste come from? Even if days pass, it is not urgent. One should only tonify and regulate qi and blood. Once middle qi strengthens, natural transport resumes. Adjusting diet ensures new grain fills the system, pushing out old grain. Do not use purgatives, lest they induce collapse and critical conditions.
Yang Binding pulses are deep, rapid, or hurried. Yin Binding pulses are hidden, slow, or knotted. In elderly or deficient patients, a sparrow-pecking pulse indicates incurability.