有风秘、气秘、热秘、寒秘、湿秘。风秘者，风痰燥结不通也。气秘者，气滞烦闷不
通也。热秘者，内府积热，消耗津液，大便结燥不通也。寒秘者，年高脏冷，及 癖冷气
结滞，大便不利也。湿秘者、湿热郁结，津液不行而秘涩也。所以病证不同，难以一例而
施治也。
秘结脉，多沉伏而结。阳结脉沉实而数。阴结脉伏而迟或结。老人虚人便结，脉雀啄
者不治。
在西北，多为风燥所成，以疏风润燥为主。（搜风顺气丸是也；）在东南，多为湿热所
致，以开结清热为要。（木香槟榔丸是也。）大抵审其人之虚实，察其脉之强弱，参而治
之，罔有不当。
凡病实热初然秘结者，脉实大而有力，宜以塞因通用之法，承气等汤通之可也。其病
之久者，老人、虚人、及亡津之后，悉皆以润燥通幽之剂缓而图之，庶不有误，如润肠丸、
通幽汤之属是也。
血虚之人，大便结燥，脉大如葱管，而身发热，切不可发汗，汗之则重亡津液，结燥
愈甚，而致死者有之。
卒以巴豆、牵牛峻剂攻下，暂得通快，必然再结愈甚，卒不能调，则亦重竭津液之过
也。丹溪所谓古方通大便，皆用降气品剂，盖肺气不降，则大肠难传送，用杏仁、枳壳、沉
香、诃子是也。又老人、虚人、风人津液少而秘者，宜药以滑之，用麻仁、胡麻、阿胶
之属是也。如投以快药利之，津液走，气血耗，虽暂通，而即秘矣，更生他病，何可胜言？
存在风秘、气秘、热秘、寒秘、湿秘这几种类型。所谓风秘，是指风邪与痰浊导致肠道燥结、排便不通。所谓气秘，是指气机阻滞，伴有烦闷不适且排便不通。所谓热秘，是指脏腑内积聚热邪，消耗津液，导致大便干结干燥、排便不通。所谓寒秘，多见于年老体衰、内脏寒冷，或因癖积冷气凝结阻滞，导致大便排泄不畅。所谓湿秘，是指湿热之邪郁结，津液运行受阻而导致的便秘涩滞。因此，病证表现各不相同，难以用一种方法统一治疗。
秘结病的脉象，多表现为沉伏且结代。阳结的脉象沉实而数急。阴结的脉象伏匿而迟缓或出现结代。老年人及体质虚弱者若出现大便干结，脉象如雀啄般急促无序者，属于难治之症（预后不良）。
在西北地区，便秘多由风燥引起，治疗以疏风润燥为主。（例如搜风顺气丸）。在东南地区，便秘多由湿热所致，治疗以开结清热为关键。（例如木香槟榔丸）。大抵需要审察患者的虚实状况，观察脉象的强弱，综合参详后进行治疗，就不会有不恰当的情况。
凡是实证热邪初期导致的便秘，脉象实大而有力，适宜采用“塞因通用”（即针对闭塞症状使用通利药物）的方法，使用承气汤等方剂进行通下即可。如果是病程较长的情况，或者是老年人、体质虚弱者、以及津液耗伤之后出现的便秘，都应当使用润燥通幽的药剂，缓慢调理以求治愈，这样才不会出错，例如润肠丸、通幽汤这类方剂就是如此。
血虚的人，大便干结，脉象大如葱管，且身体发热，千万不可发汗，如果发汗则会再次严重耗伤津液，使干结更加严重，甚至导致死亡。
如果突然使用巴豆、牵牛子等峻猛的药物攻下，虽然暂时得到通畅爽快，但必然会导致再次便秘且程度更重，最终无法调理，这也是因为过度耗竭津液的过错。朱丹溪曾说，古代方剂中通便大便，都使用降气类的药物，这是因为肺气不下降，大肠就难以传导传送，使用的药物如杏仁、枳壳、沉香、诃子等就是这样。另外，对于老年人、虚弱者、以及风病患者津液少而便秘的情况，适宜用药物的滑利作用来缓解，使用麻仁、胡麻、阿胶这类药物。如果投用快速泻下的药物来利导，会导致津液流失，气血耗损，虽然暂时通畅，但随即又会便秘，甚至引发其他疾病，其后果不胜枚举？
There are five types of constipation: Wind Constipation (Feng Mi), Qi Stagnation Constipation (Qi Mi), Heat Constipation (Re Mi), Cold Constipation (Han Mi), and Dampness Constipation (Shi Mi). Wind Constipation refers to blockage caused by wind-phlegm and dryness accumulation. Qi Stagnation Constipation refers to blockage accompanied by irritability and fullness due to Qi stagnation. Heat Constipation refers to the accumulation of internal heat in the fu organs, consuming body fluids, resulting in dry, hard stools that are difficult to pass. Cold Constipation often occurs in the elderly with cold internal organs, or due to the stagnation of cold qi from abdominal masses, leading to difficulty in defecation. Dampness Constipation refers to constipation and涩滞 (astringency/stagnation) caused by the郁结 (stagnation/accumulation) of damp-heat, which impedes the flow of body fluids. Therefore, since the syndromes differ, they cannot be treated with a single uniform method.
The pulse in constipation is mostly deep (Chen), hidden (Fu), or knotted (Jie). In Yang Knotting (Yang Jie), the pulse is deep, solid, and rapid (Shu). In Yin Knotting (Yin Jie), the pulse is hidden and slow (Chi) or knotted. For the elderly or debilitated individuals with dry stool, if the pulse resembles the pecking of a sparrow (Que Zhuo Mai), it indicates a difficult-to-treat condition with poor prognosis.
In the northwest regions, constipation is mostly caused by wind-dryness, so treatment focuses on dispersing wind and moistening dryness (e.g., Soufeng Shunqi Wan). In the southeast regions, constipation is mostly caused by damp-heat, so treatment emphasizes resolving stagnation and clearing heat (e.g., Muxiang Binglang Wan). Generally, one must assess the patient's deficiency or excess, observe the strength of the pulse, and integrate these factors for treatment, ensuring no inappropriate actions are taken.
For initial constipation caused by excess heat, where the pulse is large, solid, and forceful, the method of "treating obstruction with unblocking agents" (Sai Yin Tong Yong) should be used; decoctions such as Chengqi Tang can be employed to promote purgation. For chronic cases, or in the elderly, debilitated individuals, or those who have lost body fluids, remedies that moisten dryness and open the obscure pathways (Run Zao Tong You) should be used to treat slowly and cautiously, avoiding errors. Examples include Run Chang Wan and Tongyou Tang.
Individuals with Blood Deficiency (Xue Xu) presenting with dry stools, a pulse large like a scallion stalk, and fever, must absolutely not undergo sweating therapy. Sweating will cause further severe loss of body fluids, worsening the dryness and potentially leading to death.
Suddenly using harsh purgatives such as Croton Seed (Badou) and Morning Glory Seed (Qianniu) may provide temporary relief, but inevitably leads to more severe recurrence of constipation and inability to regulate the condition, primarily due to the excessive depletion of body fluids. Danxi stated that ancient formulas for promoting bowel movements all utilized Qi-descending agents. This is because if Lung Qi does not descend, the Large Intestine finds it difficult to transport and transmit. Herbs such as Apricot Kernel (Xingren), Bitter Orange (Zhike), Agarwood (Chenxiang), and Chebula Fruit (Heshi) are examples of this principle. Furthermore, for the elderly, debilitated individuals, and those with wind diseases suffering from constipation due to scanty body fluids, it is appropriate to use lubricating herbs such as Hemp Seed (Maren), Sesame Seed (Huma), and Donkey-hide Gelatin (Ejiao). If fast-acting purgative drugs are administered, body fluids will escape, and Qi and Blood will be depleted. Although there may be temporary passage, constipation will immediately return, and other diseases may arise, the consequences of which are too numerous to mention.