大便燥结，须分气血。阳数而实，阴迟而涩。
燥结一证，稍有分别。大抵血液少者多燥涩，气火盛者多结滞。然而燥则必结，
结则必燥，又似难为分别。但以脉合证，而属气属血，自井然矣。气火盛者为阳，
脉必有余，故数实也。（宜局方麻仁丸之类。）血液少者为阴，脉必不足，故迟涩也。（宜四物汤、
东垣导滞通幽汤之类。）气血一判，而再审其因、有风燥、（宜五仁丸、得效皂荚丸、搜风顺气丸之类。）火
燥、（宜大小承气汤、麻仁丸之类。）亡血燥、（宜四物汤之类。）产后脱血燥、（宜四物汤加人参、
黄之类。）呕吐伤液燥、（宜四君子加麦冬、五味之类。）汗后亡液燥、（宜八珍汤、十全大补汤之类。）
肾虚液少燥、（宜六味丸、八味丸之类。）老年血衰燥、（宜四物汤，麻仁丸、济生苁蓉润肠丸之类。）
气实壅盛结、（宜六磨汤、得效橘杏丸、苏麻粥之类。）气虚不能传送亦结、（宜黄 汤之类。）气热
干涸结、（宜大承气汤、麻仁丸、六一散之类。）气寒凝滞不行亦结。（宜局方半硫丸、枳实理
中汤之类。）但宜以脉辨证，以证求因。而用药拟方，无余蕴矣。
和剂麻仁丸 治肠胃热燥，大便秘结。
浓朴（去皮、姜制炒） 白芍药 枳实（麸炒，各半斤） 大黄（蒸焙，一斤） 麻仁（别研，
五两） 杏仁（去皮尖、炒，五两半）
上为末，炼蜜丸如桐子大。每服二十丸，临卧温水下。大便通利则止。
四物汤（见第二十一）
东垣导滞通幽汤 治幽门不通，上冲吸门不开，噎塞气不得上下，大便难。脾胃初
受热中，多有此证。治在幽门，以辛润之。
当归身 升麻梢 桃仁泥 甘草（各一钱） 红花（少许） 熟地黄 生地黄（各五分）
水二盏，煎一盏，调槟榔末五分，稍热服。
得效五仁丸 治津液枯竭，大肠秘涩，传道艰难。
桃仁 杏仁（炒、去皮尖，各一两） 柏子仁（半两） 松子仁（一钱二分半） 郁李
仁（炒，一钱） 陈皮（四
两，另为末）
上将五仁另研如膏，入陈皮末，研匀，炼蜜丸如桐子大。每服五十丸，空心米饮下。
得效皂角丸 专治有风人脏腑秘塞。大效。
猪牙皂角 枳壳（去瓤） 羌活 桑白皮 槟榔 杏仁（去皮尖、另研） 麻仁（另研） 防风 川
白芷 陈皮（去白，各等分）
上为末，蜜丸如桐子大。每服三五十丸，白汤下。蜜汤亦可。
圣惠搜风顺气丸 治三十六种风，七十二种气。去上热下冷，腰脚疼痛，四肢无力，
多睡少食，羸瘦，颜色不完黄赤，恶疮下疰，口苦无味，憎寒毛耸，积年 瘕气
块，丈夫阳事断绝，女子久无子嗣，久患寒疟，吐逆泻痢，变成劳疾，百节 疼。
小儿、老人皆可服。补精驻颜，疏风顺气。
车前子（二两半） 白槟榔 火麻子（微炒、去壳另研） 郁李仁（汤泡、去皮、研） 菟丝子（酒浸，焙、
炮、晒干） 牛膝（酒浸一宿） 干山药（各三两） 枳壳（去瓤，麸炒） 防风（去叉） 独活（各一两） 锦纹大
黄（五钱，半生半熟）
上为末，炼蜜丸如桐子大。每服二十丸，酒茶米饮任下，百无所忌。早晨、临
卧各一服。服一月消食，二月去肠内宿滞，三月无倦少睡，四月精神强胜，五月
耳目聪明，六月腰脚轻健，一年百病皆除，老者返少。如服药觉脏腑微动，以羊
肚肺羹补之。久患肠风便血，服之除根。如颤语蹇涩及瘫痪，服之随即平复。酒
后一服，宿酲消尽，百病不生。孕妇勿服。
济生苁蓉润肠丸 治发汗利小便，亡津液，大肠秘。老人、虚人皆可服。
肉苁蓉（酒浸、焙，二两） 沉香（另研，一两）
上为末，麻子仁汁打糊，丸如桐子大。每服七十丸，空心米饮下。
大承气汤（见第十七）
小承气汤（见第十七）
四君子汤（见第十六）
八珍汤（见第十六）
十全大补汤（见第十六）
六味丸（见第十六）
八味丸（见第十六）
六磨汤 治气滞腹急，大便秘涩。
沉香 木香 槟榔 乌药 枳壳 大黄（各等分）
上各件热汤磨服。
得效橘杏丸 气秘老人、虚弱人皆可服。
橘红（取末） 杏仁（去皮尖另研，各等分）
上和匀，炼蜜丸如桐子大。每服七十丸。空心米饮下。
苏麻粥 顺气，滑大便。
紫苏子 麻子仁（不拘多少）
二味研烂，水滤取汁，煮粥食之。
黄 汤 年高便秘宜服。
绵黄 陈皮（去白，各半两）
为末。每服三钱。用大麻仁一合烂研，以水投取浆水一盏，滤去滓，于银、石
器内煎。候有乳起，即入白蜜一大匙，再煎令沸，调药末空心服。此药不冷不燥，其效如神。
六一散（见第四十四）
局方半硫丸 年高泠秘、虚秘，及 癖冷气。
半夏（汤洗七次，焙干为细末） 硫黄（明净者、研极细、用柳木槌杀过）
上以生姜自然汁同熬，入干蒸饼末搅和匀，入臼内杵数百下。丸如桐子大。每
服十五丸至二十丸。无灰温酒或生姜汤任下。妇人醋汤下。俱空心服。
枳实理中汤（见第十七）
大便燥结，必须区分是气病还是血病。阳气偏盛则脉数而实，阴血不足则脉迟而涩。
燥结这一证候，虽有细微差别。大抵血液亏少的人多表现为燥涩，气火亢盛的人多表现为结滞。然而燥必然导致结，结必然源于燥，这似乎难以区分。但只要将脉象与症状结合，判断属于气分还是血分，自然条理清晰。气火亢盛属于阳证，脉象必然有余，所以表现为数而实。（适宜使用局方麻仁丸之类的方剂。）血液亏少属于阴证，脉象必然不足，所以表现为迟而涩。（适宜使用四物汤、东垣导滞通幽汤之类的方剂。）一旦气血辨别清楚，再进一步审查病因：有风燥引起的（适宜五仁丸、得效皂荚丸、搜风顺气丸之类的方剂），火燥引起的（适宜大小承气汤、麻仁丸之类的方剂），亡血导致的燥（适宜四物汤之类的方剂），产后失血导致的燥（适宜四物汤加人参、黄芪之类的方剂），呕吐损伤津液导致的燥（适宜四君子汤加麦冬、五味子之类的方剂），发汗后津液耗损导致的燥（适宜八珍汤、十全大补汤之类的方剂），肾虚津液少导致的燥（适宜六味丸、八味丸之类的方剂），老年血衰导致的燥（适宜四物汤、麻仁丸、济生苁蓉润肠丸之类的方剂），气实壅盛导致的结（适宜六磨汤、得效橘杏丸、苏麻粥之类的方剂），气虚不能传送糟粕也导致结（适宜黄芪汤之类的方剂），气热干涸导致的结（适宜大承气汤、麻仁丸、六一散之类的方剂），气寒凝滞不行也导致结（适宜局方半硫丸、枳实理中汤之类的方剂）。只要依据脉象辨证，通过症状求索病因，那么用药拟方就没有什么遗漏了。
和剂局方麻仁丸：治疗肠胃热燥，大便秘结。
浓朴（去皮，姜制炒） 白芍药 枳实（麸炒，各半斤） 大黄（蒸焙，一斤） 麻仁（另研，五两） 杏仁（去皮尖，炒，五两半）
以上药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用二十丸，临睡前用温开水送服。大便通畅即停止服药。
四物汤（参见第二十一节）
东垣导滞通幽汤：治疗幽门不通，上冲吸门不开，噎塞气机不能上下通行，大便困难。脾胃初受热邪困扰时，多有此证。治疗重点在幽门，用辛润之法。
当归身 升麻梢 桃仁泥 甘草（各一钱） 红花（少许） 熟地黄 生地黄（各五分）
加水二盏，煎至一盏，调入槟榔末五分，稍热时服用。
得效五仁丸：治疗津液枯竭，大肠秘涩，传导艰难。
桃仁 杏仁（炒，去皮尖，各一两） 柏子仁（半两） 松子仁（一钱二分半） 郁李仁（炒，一钱） 陈皮（四两，另研为末）
先将五种仁类分别研如膏状，加入陈皮末，研匀，用炼蜜制成梧桐子大小的丸剂。每次服用五十丸，空腹时用米饮送服。
得效皂角丸：专治有风之人脏腑秘塞。效果显著。
猪牙皂角 枳壳（去瓤） 羌活 桑白皮 槟榔 杏仁（去皮尖，另研） 麻仁（另研） 防风 川白芷 陈皮（去白，各等分）
以上药物研为细末，用蜜制成梧桐子大小的丸剂。每次服用三五十丸，用白开水送服。也可用蜜汤送服。
圣惠搜风顺气丸：治疗三十六种风邪，七十二种气疾。去除上热下冷，腰脚疼痛，四肢无力，嗜睡少食，消瘦，面色萎黄或赤红，恶疮下疰，口苦无味，怕冷毫毛竖起，多年积聚瘕块气块，男子阳痿，女子久不孕育，久患寒疟，呕吐逆气腹泻痢疾，演变成劳损疾病，全身关节疼痛。小儿、老人都可服用。具有补精驻颜、疏风顺气的作用。
车前子（二两半） 白槟榔 火麻子（微炒，去壳另研） 郁李仁（汤泡，去皮，研） 菟丝子（酒浸，焙，炮，晒干） 牛膝（酒浸一夜） 干山药（各三两） 枳壳（去瓤，麸炒） 防风（去叉） 独活（各一两） 锦纹大黄（五钱，半生半熟）
以上药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用二十丸，用酒、茶或米饮任一种送服，百无禁忌。早晨、临睡前各服一次。服药一个月消化食物，两个月清除肠道宿便，三个月不再疲倦嗜睡，四个月精神强盛，五个月耳目聪明，六个月腰脚轻健，一年百病皆除，老人返老还童。如果服药感觉脏腑轻微蠕动，可用羊肚肺羹进补。久患肠风便血者，服用可除根。如果出现颤动言语蹇涩及瘫痪，服用后可随即平复。酒后服用一次，宿醉尽消，百病不生。孕妇勿服。
济生苁蓉润肠丸：治疗发汗利小便后，津液亡失，大肠秘结。老人、体虚者皆可服用。
肉苁蓉（酒浸，焙，二两） 沉香（另研，一两）
以上药物研为细末，用麻子仁汁打糊，制成梧桐子大小的丸剂。每次服用七十丸，空腹时用米饮送服。
大承气汤（参见第十七节）
小承气汤（参见第十七节）
四君子汤（参见第十六节）
八珍汤（参见第十六节）
十全大补汤（参见第十六节）
六味丸（参见第十六节）
八味丸（参见第十六节）
六磨汤：治疗气滞腹急，大便秘涩。
沉香 木香 槟榔 乌药 枳壳 大黄（各等分）
以上各药放入热汤中磨碎服用。
得效橘杏丸：气秘老人、虚弱者皆可服用。
橘红（取末） 杏仁（去皮尖另研，各等分）
以上调和均匀，用炼蜜制成梧桐子大小的丸剂。每次服用七十丸。空腹时用米饮送服。
苏麻粥：顺气，滑利大便。
紫苏子 麻子仁（不拘多少）
将两味药研烂，用水过滤取汁，煮粥食用。
黄芪汤：年高便秘宜服。
绵黄芪 陈皮（去白，各半两）
研为细末。每次服用三钱。用大麻仁一合烂研，加水取浆水一盏，滤去渣滓，在银器或石器内煎煮。待表面泛起泡沫，即加入白蜜一大匙，再煎至沸腾，调药末空腹服用。此药不冷不燥，效果神奇。
六一散（参见第四十四节）
局方半硫丸：年高冷秘、虚秘，以及癖冷气。
半夏（汤洗七次，焙干为细末） 硫黄（明净者，研极细，用柳木槌捣杀过）
以上用生姜自然汁同熬，加入干蒸饼末搅和均匀，放入臼内杵数百下。制成梧桐子大小的丸剂。每次服用十五丸至二十丸。用无灰温酒或生姜汤任一种送服。妇人用醋汤送服。均空腹服用。
枳实理中汤（参见第十七节）
Dryness and constipation of the stool must be differentiated into Qi disorders and Blood disorders. Yang excess presents with a rapid and solid pulse, while Yin deficiency presents with a slow and choppy pulse.
Although the syndrome of dryness and constipation has slight variations, generally speaking, those with deficient Blood tend to experience dryness and roughness, while those with hyperactive Qi and Fire tend to experience stagnation and obstruction. However, dryness inevitably leads to obstruction, and obstruction inevitably stems from dryness, making them seemingly difficult to distinguish. Yet, by correlating the pulse with symptoms to determine whether the pathology belongs to Qi or Blood, the distinction becomes clear. Hyperactive Qi and Fire belong to Yang; the pulse is invariably excessive, thus appearing rapid and solid. (Suitable formulas include Mahuan Wan from the Bureau of Taiping Huimin Heji Ju.) Deficient Blood belongs to Yin; the pulse is invariably insufficient, thus appearing slow and choppy. (Suitable formulas include Siwu Tang and Daoyi Tongyou Tang from Dongyuan.) Once Qi and Blood are distinguished, further investigation into the etiology reveals: Wind-dryness (suitable for Wuren Wan, De Xiao Zaojiao Wan, Soushun Fengqi Wan), Fire-dryness (suitable for Da Chengqi Tang, Xiao Chengqi Tang, Mahuan Wan), dryness due to blood loss (suitable for Siwu Tang), dryness due to postpartum hemorrhage (suitable for Siwu Tang plus Renshen and Huangqi), dryness due to fluid injury from vomiting (suitable for Sijunzi Tang plus Maidong and Wuweizi), dryness due to fluid loss after sweating (suitable for Bazhen Tang and Shiquan Dabu Tang), dryness due to Kidney deficiency and scant fluids (suitable for Liuwei Wan and Bawei Wan), dryness due to age-related decline in Blood (suitable for Siwu Tang, Mahuan Wan, Jisheng Congrong Runchang Wan), obstruction due to Qi excess and stagnation (suitable for Limo Tang, De Xiao Ju Xing Wan, Suma Zhou), obstruction due to Qi deficiency failing to transport (suitable for Huangqi Tang), obstruction due to Qi heat causing dryness (suitable for Da Chengqi Tang, Mahuan Wan, Liuyi San), and obstruction due to Cold Qi causing stagnation and immobility (suitable for Banliu Wan from the Bureau and Zhishi Lizhong Tang). By differentiating syndromes based on pulses and seeking causes through symptoms, there will be no omission in prescribing medications and formulating recipes.
Heji Mahuan Wan: Treats intestinal and stomach heat-dryness and severe constipation.
Moxiang (Cortex Magnoliae Officinalis, peeled and stir-fried with ginger juice) Baishao Yao (Radix Paeoniae Rubra) Zhishi (Fructus Aurantii Immaturus, bran-stir-fried, each half jin) Dahuang (Rhizoma et Radix Rhei, steamed and baked, one jin) Mahuang Ren (Semen Cannabis, separately ground, five liang) Xingren (Semen Armeniacae Amarum, peeled, de-veined, stir-fried, five and a half liang)
Grind all ingredients into fine powder, mix with refined honey, and make pills the size of paulownia seeds. Take twenty pills each time, swallowed with warm water before bedtime. Discontinue when bowel movements become free.
Siwu Tang (See Section 21)
Dongyuan Daoyi Tongyou Tang: Treats non-patency of the pylorus, upward reflux obstructing the glottis, dysphagia with qi unable to ascend or descend, and difficulty defecating. This syndrome often occurs when the Spleen and Stomach initially suffer from heat affecting the middle jiao. Treatment focuses on the pylorus using acrid-moistening methods.
Danggui Shen (Radix Angelicae Sinensis root body) Shengma Shao (Rhizoma Cimicifugae tip) Taoren Ni (Semen Persicae paste) Gancao (Radix Glycyrrhizae Uralensis, each one qian) Honghua (Flos Carthami Tinctorii, a small amount) Shudihuang (Radix Rehmanniae Preparata) Shengdihuang (Radix Rehmanniae Recens, each five fen)
Add two cups of water, decoct to one cup, add five fen of Binglang powder, and take slightly warm.
De Xiao Wuren Wan: Treats depletion of body fluids, constipation of the Large Intestine, and difficult transmission.
Taoren (Semen Persicae) Xingren (Semen Armeniacae Amarum, stir-fried, peeled, de-veined, each one liang) Baizi Ren (Semen Platycladi, half liang) Songzi Ren (Semen Massoniana Pine, one qian two fen half) Yuliren (Semen Pruni, stir-fried, one qian) Chenpi (Pericarpium Citri Reticulatae, four liang, separately ground into powder)
First, grind the five kernels separately into a paste, mix with Chenpi powder, blend evenly, and make pills with refined honey the size of paulownia seeds. Take fifty pills each time, swallowed with rice water on an empty stomach.
De Xiao Zaojiao Wan: Specifically treats internal organ blockage in individuals with wind pathogenic factors. Highly effective.
Zhuya Zaojiao (Fructus Gleditsiae Sinensis spine-like pods) Zhike (Fructus Aurantii, pulp removed) Qianghuo (Rhizoma et Radix Notopterygii) Sangbaipi (Cortex Mori Radicis) Binglang (Semen Arecae) Xingren (Semen Armeniacae Amarum, peeled, de-veined, separately ground) Mahuang Ren (Semen Cannabis, separately ground) Fangfeng (Radix Saposhnikoviae) Chuan Baizhi (Radix Angelicae Dahuricae) Chenpi (Pericarpium Citri Reticulatae, peeled white, equal parts)
Grind all ingredients into fine powder, mix with honey, and make pills the size of paulownia seeds. Take thirty to fifty pills each time, swallowed with plain boiled water. Honey water is also acceptable.
Shenghui Soushun Fengqi Wan: Treats thirty-six types of wind and seventy-two types of qi disorders. Eliminates upper heat and lower cold, waist and leg pain, limb weakness, excessive sleepiness with poor appetite, emaciation, sallow or ruddy complexion, malignant sores and infectious diseases, bitter taste and loss of flavor, aversion to cold with piloerection, chronic accumulations and masses, male impotence, female infertility, chronic cold malaria, vomiting, regurgitation, diarrhea, and dysentery evolving into consumptive disease, and joint pain. Suitable for children and the elderly. It tonifies essence, preserves youthfulness, disperses wind, and regulates qi.
Cheqianzi (Semen Plantaginis, two and a half liang) Bai Binglang (Semen Arecae, processed) Huomazi (Semen Cannabis, lightly stir-fried, shell removed, separately ground) Yuliren (Semen Pruni, soaked in water, peeled, ground) Tusizi (Semen Cuscutae, wine-soaked, baked, processed, sun-dried) Niuxi (Radix Achyranthis Bidentatae, wine-soaked overnight) Ganshan Yao (Rhizoma Dioscoreae Hypoglaucae, each three liang) Zhike (Fructus Aurantii, pulp removed, bran-stir-fried) Fangfeng (Radix Saposhnikoviae, de-bristled) Duhuo (Radix et Rhizoma Notopterygii, each one liang) Jinwen Dahuang (Rhizoma et Radix Rhei, five qian, half raw half processed)
Grind all ingredients into fine powder, mix with refined honey, and make pills the size of paulownia seeds. Take twenty pills each time, swallowed with wine, tea, or rice water as preferred, with no dietary restrictions. Take once in the morning and once before bed. After one month of use, digestion improves; after two months, old fecal matter in the intestines is cleared; after three months, fatigue and sleepiness decrease; after four months, spirit strengthens; after five months, hearing and vision improve; after six months, waist and legs become agile; after one year, hundred diseases are eliminated, and the elderly regain youthfulness. If mild abdominal movement is felt during medication, supplement with lamb lung soup. For chronic intestinal wind and hematochezia, it cures the root cause. For tremors, slurred speech, and paralysis, it restores normal function immediately. One dose after drinking eliminates hangover and prevents subsequent illnesses. Pregnant women should not take this medicine.
Jisheng Congrong Runchang Wan: Treats constipation of the Large Intestine due to fluid depletion following sweating and diuresis. Suitable for the elderly and debilitated individuals.
Roucongrou (Caulis Cistanche, wine-soaked, baked, two liang) Chenxiang (Lignum Aquilariae Resinatum, separately ground, one liang)
Grind all ingredients into fine powder, bind with Semen Cannabis juice paste, and make pills the size of paulownia seeds. Take seventy pills each time, swallowed with rice water on an empty stomach.
Da Chengqi Tang (See Section 17)
Xiao Chengqi Tang (See Section 17)
Sijunzi Tang (See Section 16)
Bazhen Tang (See Section 16)
Shiquan Dabu Tang (See Section 16)
Liuwei Wan (See Section 16)
Bawei Wan (See Section 16)
Limo Tang: Treats qi stagnation with abdominal urgency and dry constipation.
Chenxiang (Lignum Aquilariae Resinatum) Muxiang (Radix Aucklandiae) Binglang (Semen Arecae) Wuyao (Radix Linderae Aggregate) Zhike (Fructus Aurantii Immaturus) Dahuang (Rhizoma et Radix Rhei, equal parts)
Soak all ingredients in hot water and grind to consume.
De Xiao Ju Xing Wan: Suitable for the elderly and weak with qi-type constipation.
Juhong (Exocarpium Citri Grandis, powdered) Xingren (Semen Armeniacae Amarum, peeled, de-veined, separately ground, equal parts)
Mix evenly, bind with refined honey, and make pills the size of paulownia seeds. Take seventy pills each time. Swallow with rice water on an empty stomach.
Suma Zhou: Regulates qi and lubricates the bowels.
Zisu Zi (Fructus Perillae) Maziren (Semen Cannabis, any amount)
Grind both ingredients thoroughly, filter with water to extract juice, and cook into porridge to eat.
Huangqi Tang: Suitable for elderly constipation.
Mian Huangqi (Radix Astragali Membranaceus) Chenpi (Pericarpium Citri Reticulatae, peeled white, each half liang)
Grind into powder. Take three qian each time. Grind one he of large hemp seeds thoroughly, add water to extract one cup of liquid, filter out dregs, and decoct in silver or stone vessels. When foam rises, add one large spoonful of white honey, boil again, mix with the powder, and take on an empty stomach. This medicine is neither cold nor drying, with miraculous efficacy.
Liuyi San (See Section 44)
Banliu Wan from the Bureau: Suitable for elderly cold constipation, deficiency constipation, and pi-cold qi.
Banxia (Rhizoma Pinelliae Ternatae, washed seven times in boiling water, dried and ground to fine powder) Liuhuang (Sulfur, pure, ground extremely fine, killed with a willow mallet)
Simmer together with natural ginger juice, mix with dry steamed biscuit powder until uniform, pound in a mortar hundreds of times. Make pills the size of paulownia seeds. Take fifteen to twenty pills each time. Swallow with unadulterated warm wine or ginger water as preferred. Women swallow with vinegar water. Take on an empty stomach.
Zhishi Lizhong Tang (See Section 17)