有热结者，热耗血液干燥，故结也。脉洪数，能食，（即仲景所谓阳结。）麻仁丸，四
顺饮子吞润肠丸。若燥实坚，腹满痛，承气汤（见中气）治之。
有寒结，冷气横于肠胃，阴凝不运，津液不通，故结也。脉沉迟，不能食
腹痛。（即仲景所谓阴结也。）寒而实者，备急丸、（见伤饮食。）温脾汤。寒而虚者，半硫丸，
姜汁调乳香吞之，或八味丸。（见虚损。）外用握药。
有气秘，气壅滞不通，不升不降，其人多噫。实者破结导滞，木香、槟榔、
枳壳、陈皮、杏仁等类。虚者（气虚不运故壅滞）补而行之，不宜破散，人参多用。若气
阻隔不通，而见噎膈反胃等证者，人参利膈丸、四磨汤（见气）选用。仍分虚实治之，若
气少气弱，无力推送，则惟有助气而已。（肺主气，肺与大肠为表里，气秘治在肺。）
丹溪云∶肺
气不降，则难传送，用枳壳、沉香、诃子、杏仁等。老人、虚人津液少，宜滑之，
用胡麻、麻仁、阿胶等。
有血秘，老人、（老人后门固，寿之征。）产妇（产后有秘至数十日者，勿亟通之）。
血液干枯，或病
后血虚，或发汗利小便以致津涸，（津亦属血。）均宜润剂，苁蓉润肠丸、更衣丸、四物
汤（见血）、麻仁、杏仁辛润之品。又肾司二便，肾水虚燥，宜以六味（见虚损）滋水，少佐辛
味以润之。若跌打损伤，瘀血凝滞，致气不行，而大小便不通者，破瘀导滞为主。
有风秘，其人肠胃素有风，风能燥湿燥血，故大肠不润而结，搜风顺气丸（见中风）、
滋燥养荣汤。
老人气血多虚，察其脉浮虚者，气虚也；沉虚者，血虚也。凡结实难下之证，
可用穿结药及妙香丸。（见烦躁。）
燥屎巨硬，结在肛门难出，名直肠结，从导法治之。
导法∶以蜂蜜炼成条，大如指，粘皂角末，油抹，入便门。寒结者加草乌头末，
以化寒消结。热结者以猪胆汁导。
有热结的情况，是热邪耗伤血液导致干燥，从而形成便秘。脉象洪大且数，食欲正常（这就是张仲景所说的阳结）。可用麻仁丸，配合四顺饮子吞服润肠丸。如果大便燥实坚硬，腹部胀满疼痛，用承气汤（见中气篇）治疗。
有寒结的情况，是冷气横亘于肠胃之间，阴寒凝滞导致运化失常，津液不通畅，从而形成便秘。脉象沉迟，不能进食，腹痛（这就是张仲景所说的阴结）。属于寒而实证者，用备急丸（见伤饮食篇）、温脾汤。属于寒而虚证者，用半硫丸，用姜汁调匀乳香后吞服，或者服用八味丸（见虚损篇）。也可外用握药疗法。
有气秘的情况，是气机壅滞不通，升降失调，这类人经常打嗝。属实证者，宜破结导滞，选用木香、槟榔、枳壳、陈皮、杏仁等药物。属虚证者（因气虚无法推动而导致壅滞），宜补益并促进运行，不宜使用破气消散的药物，人参应多用。如果是气机阻隔不通，并出现噎膈、反胃等症状的，可选用人参利膈丸、四磨汤（见气篇）。仍需分辨虚实进行治疗。如果是气少气弱，无力推送粪便，则只需补气即可。（肺主一身之气，肺与大肠相表里，气秘的治疗重点在肺。）丹溪说：肺气不降，则难以传导，可用枳壳、沉香、诃子、杏仁等药。老人、体虚之人津液不足，宜用滑利之法，选用胡麻、麻仁、阿胶等药。
有血秘的情况，多见于老人（老人肛门紧缩，是长寿的象征）、产妇（产后便秘长达数十日的，不要急于通便）。由于血液干枯，或病后血虚，或因发汗、利小便导致津液枯竭（津液也属于血的范畴），均适宜使用润剂，如苁蓉润肠丸、更衣丸、四物汤（见血篇）、麻仁、杏仁等辛润之品。另外，肾主管二便，若肾水亏虚干燥，宜用六味地黄丸（见虚损篇）滋补肾水，稍加辛味药物以润燥。如果是跌打损伤，瘀血凝滞，导致气机不行，从而大小便不通的，以破瘀导滞为主。
有风秘的情况，是患者肠胃素有风邪，风能燥湿、燥血，导致大肠失润而便秘，可用搜风顺气丸（见中风篇）、滋燥养荣汤。
老人的气血多虚弱，诊察脉象浮而虚的，是气虚；脉象沉而虚的，是血虚。凡是结实难下的证候，可使用穿结药及妙香丸（见烦躁篇）。
燥屎巨大坚硬，结在肛门处难以排出，称为直肠结，采用导法治疗。
导法：将蜂蜜炼制成条状，粗细如手指，粘附皂角末，涂抹油脂，插入肛门。寒结者加入草乌头末，以化解寒邪、消除结滞。热结者用猪胆汁进行导引。
There is the condition of Heat Constipation, where heat consumes blood fluids causing dryness, leading to accumulation. The pulse is surging and rapid, appetite is normal (this is what Zhang Zhongjing referred to as Yang Constipation). Use Hemp Seed Pill (Maren Wan), taken with Four-Compliance Decoction (Sishun Yinzi) swallowing Intestine-Moistening Pill (Runchang Wan). If the stool is dry, solid, and hard, accompanied by abdominal fullness and pain, treat with Chengqi Decoction (Jian Zhongqi Pian).
There is the condition of Cold Constipation, where cold qi stagnates in the intestines and stomach, yin cold coagulates and fails to transport, and body fluids are blocked, leading to accumulation. The pulse is deep and slow, there is inability to eat, and abdominal pain (this is what Zhang Zhongjing referred to as Yin Constipation). For cold-excess patterns, use Emergency Rescue Pill (Beiji Wan) (Jian Shang Yinshi Pian) or Warm Spleen Decoction (Wenpi Tang). For cold-deficiency patterns, use Half-Sulfur Pill (Banshou Wan), taken with frankincense (Ruxiang) mixed in ginger juice, or Eight-Ingredient Pill (Bawei Wan) (Jian Xusun Pian). External grasping medicine therapy may also be applied.
There is the condition of Qi Constipation, characterized by qi stagnation and obstruction, failure of ascending and descending functions, and frequent belching in such individuals. For excess patterns, break stagnation and guide out retention using herbs such as Costus Root (Muxiang), Areca Nut (Binglang), Aurantium (Zhike), Tangerine Peel (Chenpi), and Apricot Kernel (Xingren). For deficiency patterns (stagnation due to qi deficiency failing to move), tonify and promote movement; avoid dispersing drugs, and use Ginseng (Renshen) in larger doses. If qi obstruction leads to symptoms like dysphagia (Yege) or regurgitation (Fanwei), select Ren Shen Li Ge Wan or Si Mo Tang (Jian Qi Pian). Treatment must still distinguish between excess and deficiency. If qi is insufficient and weak, lacking the strength to push, only qi supplementation is needed. (The Lung governs qi, and the Lung and Large Intestine are exterior-interior partners; thus, treating Qi Constipation focuses on the Lung.) Danxi stated: When Lung qi does not descend, transmission is difficult; use Aurantium (Zhike), Agarwood (Chenxiang), Chebula (Hezi), and Apricot Kernel (Xingren). For the elderly and deficient persons with scant body fluids, use lubricating methods with Sesame Seed (Huma), Hemp Seed (Maren), and Donkey-hide Gelatin (Ejiao).
There is the condition of Blood Constipation, common in the elderly (tight anal sphincter in the elderly is a sign of longevity) and postpartum women (do not rush to relieve constipation lasting dozens of days after childbirth). Due to dried-up blood, blood deficiency after illness, or depletion of fluids from sweating or diuresis (fluids belong to blood), lubricating agents are appropriate, such as Cistanche Intestine-Moistening Pill (Congrong Runchang Wan), Gengyi Pill, Four-Substance Decoction (Siwu Tang) (Jian Xue Pian), along with pungent-lubricating herbs like Hemp Seed (Maren) and Apricot Kernel (Xingren). Furthermore, the Kidney controls urination and defecation; if Kidney water is deficient and dry, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (Jian Xusun Pian) to nourish water, adding slightly pungent herbs to moisten. If trauma causes blood stasis and stagnation, blocking qi movement and resulting in both urinary and fecal retention, the primary treatment is breaking stasis and guiding out retention.
There is the condition of Wind Constipation, where wind pathogen exists in the intestines and stomach; wind dries dampness and blood, causing the Large Intestine to lose moisture and accumulate. Use Search Wind and Smooth Qi Pill (Soufeng Shunqi Wan) (Jian Zhongfeng Pian) or Zaozao Yangying Decoction.
The elderly often have deficiencies in qi and blood. If the pulse is floating and deficient, it indicates qi deficiency; if deep and deficient, it indicates blood deficiency. For conditions where stool is solid and difficult to pass, penetrating drugs and Miaoxiang Pill (Jian Fanzao) may be used.
When dry stool is huge and hard, stuck at the anus making expulsion difficult, it is called Rectal Accumulation (Zhichang Jie), treated with the Guiding Method (Dao Fa).
Guiding Method: Refine honey into a strip, thick as a finger, coat with Soap Fruit powder (Zaojiao), apply oil, and insert into the anus. For cold accumulation, add Aconite Root (Caowutou) powder to resolve cold and dissipate accumulation. For heat accumulation, use Pig Bile for guidance.