虞恒德治一妇。年五十余。身材瘦小。得大便燥结不通。饮食少进。小腹作痛。虞诊之
六脉皆沉伏而结涩。作血虚治。用四物汤加桃仁、麻仁煨大黄等药。数服不通。反加满闷
与东垣枳实导滞丸及备急丸等药。下咽片时即吐出。盖胃气虚而不能久留性速之药耳。遂
以备急丸。外用黄蜡包之。又以细针穿一窍。令服三丸。盖以腊匮者制其不犯胃气。故得出
幽门。达大小肠也。明日下燥屎一升许。继以四物汤加减。煎吞润肠丸。如此调理月余。得
大便如常。饮食进而安。
一男子因出痘。大便秘结不通。儿医云。便实为佳兆。自病至痘疮愈后。不如厕者凡二
十五日。肛门连大肠痛甚。叫号声彻四邻。用皂角末及蜜煎导法。内服大小承气汤。及枳实
导滞丸、备急丸。皆不效。计无所出。虞曰。此痘疮余毒郁热。结滞于大小肠之间而然。以
香油一大盏令饮。自朝至暮亦不效。乃令婢者口含香油。以小竹筒一个套入肛门。以油吹入
过半时许。病者自云。其油入肠内。如蚯蚓渐渐上行。再过片时许。下黑粪一二升。困睡
而安。
薛立斋治一妇。年七十三。痰喘内热。大便不通。两月不寐。脉洪大。重按微细。此属
肝肺肾亏损。朝用六味丸。夕用逍遥散。各三十余剂。计所进饮食百余碗。腹始痞闷。乃以
猪胆汁导而通之。用十全大补调理而安。若间前药。饮食不进。诸证复作。
汪石山治一妇。因改醮。乘轿劳倦。加以忧惧。成婚之际。遂病小腹胀痛。大小便秘结
不通。医以硝、黄三下之。随通随闭。病增胸膈胃腕胀痛。自汗食少。汪诊之。脉皆濡细近
快。心脉颇大。右脉觉弱。汪曰。此劳倦忧惧伤脾也。盖脾失健运之职。故气滞不行。以致
秘结。今用硝、黄。但利血而不能利气。遂用人参二钱。归身一钱五分。陈皮、枳壳、黄芩
各七分。煎服而愈。
李时珍曰。一宗室夫人。年几六十。平生苦肠结病。旬日一行。甚于生产。服养血润燥
药。则腻膈不快。服硝黄通利药。则若罔知。如此三十余年矣。予诊其人。体肥膏粱而多忧
郁。日吐酸涎碗许乃宽。又多火病。此三焦之气壅滞。有升无降。津液皆化为痰饮。不能下
滋肠腑。非血燥比也。润剂留滞。硝黄徒入血分。不能通气。俱为痰阻。故无效也。乃用牵
牛末。以皂荚膏丸与服。即便通利。自是但觉肠结。一服即瘥。亦不妨食。且复精爽。盖牵
牛走气分。通三焦。气顺则痰逐饮消。上下通快矣。
高果哉治温相国体仁。初谢政归乌程。患大便燥结不通。胸膈塞闷而不食。肾脉沉小而
无神。以枳壳五钱。苁蓉二两。洗净。水煎服即效。后又秘结。以当归、生首乌。大剂煎服
遂全愈。
李士材治少宰蒋恬庵。服五加皮酒。遂患大便秘结。腹中胀闷。服大黄一钱。通后复结
李曰。肾气衰少。津液不充。误行疏利。是助其燥矣。以六味汤加人乳一钟。白蜜五钱。
三剂后即通。十日而康复矣。
文学顾以贞素有风疾。大便秘结。经年不愈。士材曰。此名风秘。治风先治血。乃大法
也。用十全大补汤。加秦艽、麻仁、杏仁、防风、煨皂角仁。半月而效。三月以后。永不患
矣。
张景岳治朱翰林太夫人。年近七旬。于五月时。偶因一跌。即致寒热。医为之滋阴清火
用生地、芍药、丹皮、黄芩、知母之属。其势日甚。张诊之。见其六脉无力。虽头面上身
有热。而口则不渴。且足冷至股。乃曰。此阴虚受邪。非跌之为病。实阴证也。遂以理阴煎
加人参、柴胡。二剂而热退。日进粥食二三碗。而大便以半月不通。腹且渐胀。群议燥结为
火。复欲用清凉等剂。张谓如此之脉。如此之年。如此之足冷。若再一清火。其原必败。不
可为矣。经曰。肾恶燥。急食辛以润之。正此谓也。仍以前药。更加姜、附。倍用人参、当
归。数剂而便即通。胀即退。日渐撤消矣。
震按花溪峻药急攻。妙在腊包穿窍。而香油解毒。妙在上饮下吹。薛案汪案之用补。轻
重不同。高公李公之用润。淡浓微别。李时珍之牵牛、皂荚。疏通迥异硝、黄。张景岳之姜
附、参、归。辛热远殊寒滑。精华既录。浅陋可删。
虞恒德治疗一位妇女，五十多岁。身材瘦小，出现大便干燥结滞不通，饮食摄入减少，小腹疼痛。虞诊察其六脉皆沉伏且结涩，判断为血虚证进行治疗。使用四物汤加入桃仁、麻仁、煨大黄等药物。服用数剂后大便仍不通，反而加重了胀闷感。又给予东垣的枳实导滞丸及备急丸等药物。药液咽下片刻即吐出，这是因为胃气虚弱，无法久留性质峻猛的速效药物所致。于是将备急丸用黄蜡包裹，又以细针穿一个小孔，令患者服用三丸。因为蜡封可以制约药物不直接损伤胃气，所以能顺利通过幽门，到达大小肠。第二天排出燥屎约一升。随后继续以四物汤加减，煎煮后吞服润肠丸。如此调理月余，大便恢复正常，饮食增加而身体安宁。
一名男子因出痘疮，大便秘结不通。儿科医生认为便实是佳兆。从患病到痘疮痊愈后，共有二十五天未排便。肛门连大肠剧烈疼痛，呼叫声传遍四邻。使用皂角末及蜜煎导法，内服大小承气汤，以及枳实导滞丸、备急丸，均无效。计无可施时，虞医生说：“这是痘疮余毒郁热，结滞于大小肠之间所致。”让患者饮一大盏香油，从早到晚也不见效。于是让婢女口含香油，用小竹筒套入肛门，将油吹入过半时许。病人自述油进入肠道后，像蚯蚓慢慢上行。再过片刻，排出黑粪一二升，困倦睡去而病情安定。
薛立斋治疗一位妇女，七十三岁。痰喘伴内热，大便不通，两个月未入睡。脉象洪大，重按微细。此属肝、肺、肾亏损。早晨服用六味丸，晚上服用逍遥散，各三十余剂。累计进食百余碗药膳，腹部才开始痞闷。于是用猪胆汁导法通便。再用十全大补汤调理而安。如果间断前药，饮食不进，诸证复发。
汪石山治疗一位妇女，因改嫁，乘轿劳累，加上忧惧，成婚之际，遂患小腹胀痛，大小便秘结不通。医生用芒硝、大黄三次攻下，随即通后又闭，病势加重，出现胸膈胃脘胀痛，自汗食少。汪诊察其脉皆濡细近快，心脉颇大，右脉觉弱。汪说：“这是劳倦忧惧伤脾。脾失健运之职，故气滞不行，以致秘结。现在用硝、黄，只能利血而不能利气。”于是用人参二钱，当归身一钱五分，陈皮、枳壳、黄芩各七分，煎服而愈。
李时珍说：有一位宗室夫人，年近六十，平生苦于肠结病，十天一行，痛苦甚于生产。服用养血润燥药，则腻膈不快；服用硝黄通利药，则若无其事（无效）。如此三十余年。我诊察其人，体肥膏粱而多忧郁，每日吐酸涎碗许才宽舒，又多火病。这是三焦之气壅滞，有升无降，津液皆化为痰饮，不能下滋肠腑，并非血燥可比。润剂留滞，硝黄徒入血分，不能通气，俱为痰阻，故无效也。于是用牵牛子末，以皂荚膏制丸与服，即便通利。从此只要觉得肠结，一服即愈，也不妨碍饮食，且精神复爽。盖牵牛走气分，通三焦，气顺则痰逐饮消，上下通快矣。
高果哉治疗温相国体仁。初谢政归乌程，患大便燥结不通，胸膈塞闷而不食。肾脉沉小而无神。以枳壳五钱，肉苁蓉二两，洗净，水煎服即效。后又秘结，以当归、生首乌，大剂煎服遂全愈。
李士材治疗少宰蒋恬庵。服五加皮酒，遂患大便秘结，腹中胀闷。服大黄一钱，通后复结。李说：“肾气衰少，津液不充。误行疏利，是助其燥矣。”以六味汤加人乳一钟，白蜜五钱，三剂后即通，十日而康复矣。
文学顾以贞素有风疾，大便秘结，经年不愈。士材说：“此名风秘。治风先治血，乃大法也。”用十全大补汤，加秦艽、麻仁、杏仁、防风、煨皂角仁。半月而效，三月以后，永不患矣。
张景岳治疗朱翰林太夫人。年近七旬，于五月时，偶因一跌，即致寒热。医为之滋阴清火，用生地、芍药、丹皮、黄芩、知母之属。其势日甚。张诊之，见其六脉无力，虽头面上身有热，而口则不渴，且足冷至股。乃曰：“此阴虚受邪，非跌之为病，实阴证也。”遂以理阴煎加人参、柴胡，二剂而热退，日进粥食二三碗，而大便以半月不通，腹且渐胀。群议燥结为火，复欲用清凉等剂。张谓如此之脉，如此之年，如此之足冷，若再一清火，其原必败，不可为矣。经曰：“肾恶燥，急食辛以润之。”正此谓也。仍以前药，更加姜、附，倍用人参、当归，数剂而便即通，胀即退，日渐撤消矣。
震按：花溪（虞恒德）峻药急攻，妙在腊包穿窍，而香油解毒，妙在上饮下吹。薛案、汪案之用补，轻重不同。高公、李公之用润，淡浓微别。李时珍之牵牛、皂荚，疏通迥异硝、黄。张景岳之姜附、参、归，辛热远殊寒滑。精华既录，浅陋可删。
Yu Hengde treated a woman in her fifties. She was of small stature and suffered from dry, obstructed stool with reduced food intake and lower abdominal pain. Yu palpated her six pulses, finding them all deep, hidden, knotted, and choppy, diagnosing it as Blood Deficiency (Xue Xu). He prescribed Siwu Tang (Four Substances Decoction) added with Tao Ren (Peach Seed), Ma Ren (Hemp Seed), and Da Huang (Rhubarb Root) calcined. After several doses, the obstruction persisted, and distension worsened. He then administered Zhishi Daozhi Wan (Immature Bitter Orange to Guide Out Stagnation Pill) from Li Dongyuan and Beiji Wan (Emergency Rescue Pill), but the medicine was vomited shortly after swallowing. This was because the Stomach Qi (Wei Qi) was deficient and could not retain potent, fast-acting drugs. Consequently, he wrapped Beiji Wan in beeswax, pierced a hole with a fine needle, and instructed the patient to take three pills. The wax coating prevented the drug from directly irritating the Stomach Qi, allowing it to pass through the pylorus into the large and small intestines. The next day, she passed approximately one jin (approx. 500g) of dry feces. Subsequently, he continued with modified Siwu Tang, taken with Run Chang Wan (Intestine Moistening Pill). After over a month of such regulation, her bowel movements normalized, food intake increased, and she recovered.
A man suffered from severe constipation due to smallpox. Pediatricians considered retained stool a good omen. From onset until the resolution of the rash, he had not defecated for twenty-five days. His anus and large intestine were in severe pain, with cries heard by neighbors. Enema with Gao Jiao Fen (Gleditsia Sinensis Powder) and honey suppositories, along with internal administration of Dachengqi Tang (Major Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), Zhishi Daozhi Wan, and Beiji Wan, were all ineffective. Yu stated: "This is residual toxin and stagnant heat from the smallpox lodged between the large and small intestines." He ordered the patient to drink a large cup of sesame oil, but this failed from morning till night. Then, he had a maid hold sesame oil in her mouth and blow it into the patient's anus using a small bamboo tube for over half an hour. The patient reported feeling the oil moving upward like an earthworm. After another short while, he passed one or two jin of black stool and fell into a restful sleep, recovering.
Xue Lizhai treated a seventy-three-year-old woman suffering from phlegm-wheezing, internal heat, constipation, and insomnia for two months. Her pulse was surging and large, but faint and thin upon heavy pressure. This indicated deficiency of the Liver, Lung, and Kidney. He prescribed Liuwei Wan (Six-Ingredient Pill with Rehmannia) in the morning and Xiaoyao San (Free and Easy Wanderer Powder) in the evening, each for over thirty doses. After consuming over a hundred bowls of medicinal diet, abdominal fullness began. He then used pig bile enema to unblock the bowels, followed by Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) for regulation, leading to recovery. If the previous medicines were interrupted, food intake would decrease and symptoms would recur.
Wang Shishan treated a woman who became ill at her wedding due to fatigue from riding in a sedan chair and emotional distress. She suffered from lower abdominal distension and pain, with both large and small bowel obstructions. Physicians had purged her three times with Mang Xiao (Mirabilite) and Da Huang, but obstruction returned immediately after relief. Symptoms worsened to include chest/diaphragm and epigastric distension/pain, spontaneous sweating, and poor appetite. Wang palpated her pulses as soft, thin, and rapid; the Heart pulse was prominent, and the Right pulse felt weak. Wang said: "This is Spleen injury due to fatigue and emotional distress. The Spleen has lost its function of transformation and transportation, causing Qi stagnation and resulting in constipation. Using Mang Xiao and Da Huang only benefits Blood but does not move Qi." He prescribed Ren Shen (Ginseng Root) 2 qian, Dang Gui Shen (Angelica Sinensis Root Body) 1.5 qian, Chen Pi (Tangerine Peel), Zhi Ke (Bitter Orange Fruit), and Huang Qin (Scutellaria Root) each 0.7 qian. The patient recovered after decocting and taking this formula.
Li Shizhen stated: A noble lady nearly sixty years old suffered from intestinal obstruction for decades, having a bowel movement only once every ten days, with pain worse than childbirth. Nourishing Blood and moistening dryness herbs caused chest discomfort; purgatives like Mang Xiao and Da Huang were ineffective. For over thirty years, she experienced this. I examined her: she was obese, consumed rich foods, and was prone to melancholy, often vomiting about a bowl of sour saliva before feeling relief. She also had frequent fire-related illnesses. This was due to Qi congestion in the Triple Burner (San Jiao), rising without descending, where body fluids transformed into phlegm-fluids that could not nourish the intestines downward. It was not comparable to Blood dryness. Moistening agents stayed stagnant; Mang Xiao and Da Huang entered only the Blood level and could not move Qi, all blocked by phlegm, hence ineffective. He used Qian Niu Zi (Morning Glory Seed) powder made into pills with Gao Jiao Gao (Gleditsia Extract). Bowel movements became smooth immediately. Thereafter, one dose relieved any sensation of obstruction, allowed normal eating, and restored vitality. Qian Niu moves the Qi level and unblocks the Triple Burner; when Qi flows smoothly, phlegm and fluids dissipate, and the upper and lower passages become clear.
Gao Guozai treated Prime Minister Wen Tiren. Upon retiring to Wucheng, he suffered from dry, obstructed stool, chest/diaphragm fullness, and anorexia. His Kidney pulse was deep, small, and spiritless. He prescribed Zhi Ke (Bitter Orange Fruit) 5 qian and Rong Cao (Cistanche Stem) 2 liang, washed and decocted in water, which was effective. When constipation recurred, he prescribed Dang Gui (Angelica Sinensis Root) and Shou Wu (Polygonum Multiflorum Root) in large doses, leading to complete recovery.
Li Shicai treated Vice Minister Jiang Tian'an. After drinking Wu Jia Pi Wine (Acanthopanax Bark Wine), he developed severe constipation and abdominal distension. Taking 1 qian of Da Huang provided temporary relief followed by recurrence. Li said: "Kidney Qi is declining, and body fluids are insufficient. Mistaken use of draining purgatives exacerbates dryness." He prescribed Liuwei Tang (Six-Ingredient Decoction) added with 1 zhong of human milk and 5 qian of white honey. Bowel movements resumed after three doses, and he recovered fully in ten days.
Literati Gu Yizhen suffered from wind-disease and chronic constipation for years. Shicai said: "This is called Wind Constipation (Feng Mi). The general principle is to treat Blood first when treating wind." He used Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) added with Qin Jiao (Gentiana Macrophylla Root), Ma Ren (Hemp Seed), Xing Ren (Apricot Seed), Fang Feng (Saposhnikovia Root), and roasted Gao Jiao Ren (Gleditsia Seed). Effect was seen in half a month, and no recurrence occurred after three months.
Zhang Jingyue treated the mother of Academician Zhu. Nearly seventy years old, she developed chills and fever after a fall in May. Physicians treated her with Yin-nourishing and fire-clearing herbs such as Sheng Di Huang (Rehmannia Root), Bai Shao (White Peony Root), Mu Dan Pi (Moutan Cortex), Huang Qin (Scutellaria Root), and Zhi Mu (Anemarrhena Rhizome). Her condition worsened daily. Zhang palpated her pulses as powerless. Although she had heat on her head and upper body, her mouth was not thirsty, and her feet were cold up to the thighs. He said: "This is Yin deficiency with pathogenic invasion, not caused by the fall itself, but truly a Yin syndrome." He prescribed Liyin Jian (Decoction to Benefit Yin) added with Ren Shen (Ginseng Root) and Chai Hu (Bupleurum Root). After two doses, fever subsided, and she ate two to three bowls of porridge daily. However, she had not had a bowel movement for half a month, and her abdomen gradually distended. Others argued the dryness was due to fire and wanted to use cooling agents. Zhang said: "With such pulses, at such an age, and with such cold feet, if we clear fire again, the root will collapse, and it cannot be done." The Classic states: "The Kidney dislikes dryness; hasten to eat pungent substances to moisten it." This applies here. He continued with the previous prescription, adding Jiang (Ginger) and Fu Zi (Aconite Root), doubling Ren Shen and Dang Gui. After several doses, bowel movements resumed, distension receded, and symptoms gradually resolved.
Zhen notes: Yu's aggressive attack with harsh drugs was ingenious in wrapping pills in wax and piercing holes, and the sesame oil's detoxification was ingenious in drinking above and blowing below. Xue's and Wang's use of tonification differed in weight. Gao's and Li's use of moistening agents differed slightly in strength. Li Shizhen's use of Qian Niu and Gao Jiao for unblocking was vastly different from Mang Xiao and Da Huang. Zhang Jingyue's use of Ginger, Aconite, Ginseng, and Angelica was sharply distinct from cold-slippery agents. Having recorded the essence, the superficial may be deleted.