一儒者，大便素结，服搜风顺气丸，复胸膈不利，饮食善消，面带阳色，左关尺脉洪而虚。余曰∶此
足三阴虚也。不信，乃服润肠丸，大便不实，肢体困倦。余与补中益气、六味地黄，月余而验，年许而安。
若脾肺气虚，用补中益气。若脾经郁结者，用加味归脾。若气血虚者，用八珍加肉苁蓉。若脾经津液涸者，用
六味。若发热作渴饮冷者，用竹叶黄 汤。若燥在直肠者，猪胆汁导之。若肝胆邪侮脾者，用小柴胡加
山栀、郁李仁、枳壳。若膏粱浓味积热者，用加味清胃散。亦有热燥、风燥、阳结、阴结者，当审其因而治
之。若复伤胃气，多成败症。
一男子，五十余，因怒少食，大便不利，服润肠丸，大便闭结，胸膈作痛，欲兼服脾约丸，肝脾肾脉浮
而涩。余曰∶此足三阴精血亏损之证也。东垣先生云∶若人胃强脾弱，约束津液，不得四布，但输膀胱，小
便数而大便难者，用脾约丸。若人阴血枯槁，内火燔灼，肺金受邪，土受木伤，脾肺失传，大便秘而小便
数者，用润肠丸，令滋其化源，则大便自调矣。
一儒者，怀抱郁结，复因场屋不遂，发热作渴，胸膈不利，饮食少思，服清热化痰行气等剂，前证益
甚，肢体困倦，心脾二脉涩滞。此郁结伤脾之变证也，遂用加味归脾汤治之，
饮食渐进，诸证渐退。但大便尚涩，两颧赤色，此肝肾虚火，内伤阴血，用八珍汤加肉苁蓉、麦冬、五味，至
三十余剂，大便自润。
有一位儒生，大便向来干结，服用搜风顺气丸后，反而出现胸膈部不适，饮食容易消化，面色偏红（阳色），左关脉和左尺脉洪大但按之空虚。我说：这是足三阴经（肝、脾、肾）虚损所致。他不相信，于是服用润肠丸，结果导致大便稀溏不成形，肢体困倦乏力。我给他开具补中益气汤和六味地黄丸，一个月后见效，一年多后身体安康。
如果是脾肺气虚，使用补中益气汤。如果是脾经有郁结，使用加味归脾汤。如果是气血两虚，使用八珍汤加肉苁蓉。如果是脾经津液枯竭，使用六味地黄丸。如果有发热、口渴且喜饮冷水的症状，使用竹叶石膏汤（注：原文“竹叶黄 汤”疑为竹叶石膏汤或竹叶黄连汤之误，此处依常见配伍及语境译为竹叶类清热方，保留原意结构）。如果燥结在直肠，可用猪胆汁导法（灌肠）。如果是肝胆邪气侵犯脾胃，使用小柴胡汤加山栀、郁李仁、枳壳。如果是因膏粱厚味积热者，使用加味清胃散。也有因热燥、风燥、阳结、阴结导致的便秘，应当审察病因进行治疗。如果再次损伤胃气，大多会演变成难治的败症。
有一位五十多岁的男子，因为发怒而进食减少，大便不通畅，服用润肠丸后，导致大便完全闭结，胸膈疼痛，想要兼服脾约丸，其肝、脾、肾脉象浮而涩。我说：这是足三阴经精血亏损的病证。东垣先生曾说：如果一个人胃强脾弱，约束津液，使其不能四布全身，只能输送到膀胱，导致小便频数而大便困难者，使用脾约丸。如果一个人阴血枯槁，内火炽盛，肺金受邪，脾土受肝木所伤，脾肺功能失调，导致大便秘结而小便频数者，使用润肠丸，以滋养化源，则大便自然调和。
有一位儒生，内心怀抱郁结，又因科举考试不顺，出现发热、口渴、胸膈不适、饮食减少不想进食，服用清热化痰行气等药剂后，前面的症状更加严重，肢体困倦，心脉和脾脉涩滞。这是郁结损伤脾脏的变证，于是用加味归脾汤治疗，饮食逐渐增加，各种症状逐渐消退。但是大便仍然干涩，两颧发红，这是肝肾虚火，内伤阴血，使用八珍汤加肉苁蓉、麦冬、五味子，服三十多剂后，大便自然润泽通畅。
A scholar had a habitual tendency toward constipation. After taking *Sousun Fengqi Wan* (Search for Wind and Regulate Qi Pill), he developed discomfort in the chest and diaphragm, though his appetite remained good and digestion efficient. His complexion was reddish (Yang color), and the pulses at the left Guan (Hepatic) and Chi (Renal) positions were surging yet empty. I stated: "This is deficiency of the Foot Three Yin meridians (Liver, Spleen, Kidney)." He did not believe this and took *Run Chang Wan* (Moisten Intestines Pill), which resulted in loose stools and physical fatigue. I prescribed *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) and *Liuwei Dihuang Wan* (Six-Ingredient Rehmannia Pill). After one month, there was improvement; after more than a year, he was stable.
If the condition is due to Qi deficiency of the Spleen and Lung, use *Buzhong Yiqi Tang*. If it is due to constraint/stagnation in the Spleen meridian, use *Jiawei Guipi Tang* (Modified Restore the Spleen Decoction). If there is Qi and Blood deficiency, use *Bazhen Tang* (Eight-Treasure Decoction) with added *Rou Cong Rong* (Cistanche Herba). If the fluids of the Spleen meridian are exhausted, use *Liuwei Dihuang Wan*. If there is fever accompanied by thirst and a desire for cold drinks, use *Zhuye Huang [Tang]* (Bamboo Leaf [Decoction]). If dryness is located in the rectum, use pig bile as an enema (Zhu Dan Bi Dao). If Liver/Gallbladder pathogenic factors invade the Spleen, use *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) with added *Shan Zhi* (Gardeniae Fructus), *Yu Li Ren* (Prunus Semen), and *Zhi Qiao* (Aurantii Fructus Immaturus). If heat accumulation results from rich and greasy foods, use *Jiawei Qingwei San* (Modified Clear Stomach Powder). There are also cases of constipation due to Heat Dryness, Wind Dryness, Yang Binding, or Yin Binding; one must examine the cause and treat accordingly. If the Stomach Qi is further damaged, it often becomes a refractory case.
A man over fifty years old, having eaten little due to anger, experienced difficulty in defecation. After taking *Run Chang Wan*, his bowels became completely obstructed, and he suffered from chest and diaphragmatic pain. He wished to take *Pi Yue Wan* (Spley Restraint Pill) concurrently. His Liver, Spleen, and Kidney pulses were floating and choppy. I stated: "This is a syndrome of Essence and Blood deficiency in the Foot Three Yin meridians." Mr. Dongyuan said: "If a person has strong Stomach but weak Spleen, causing the fluids to be restrained so they cannot circulate throughout the body but instead flow only to the Bladder, resulting in frequent urination and difficult defecation, use *Pi Yue Wan*. If a person has withered Yin Blood, blazing internal fire, pathogenic influence on Metal of the Lung, and injury to Earth of the Spleen by Wood of the Liver, leading to dysfunction between Spleen and Lung, resulting in constipation and frequent urination, use *Run Chang Wan* to nourish the source of transformation, and the bowel movements will regulate themselves."
Another scholar, burdened by emotional constraint, and further distressed by failure in the imperial examinations, developed fever, thirst, chest discomfort, and poor appetite. After taking formulas for clearing heat, resolving phlegm, and moving Qi, his previous symptoms worsened, accompanied by physical fatigue. His Heart and Spleen pulses were choppy and stagnant. This was a transformed syndrome caused by constraint injuring the Spleen. Therefore, I treated him with *Jiawei Guipi Tang* (Modified Restore the Spleen Decoction). His food intake gradually increased, and various symptoms receded. However, his stool remained dry, and his malar regions were red. This indicated deficient fire of the Liver and Kidney and internal injury to Yin Blood. I prescribed *Bazhen Tang* (Eight-Treasure Decoction) with added *Rou Cong Rong* (Cistanche Herba), *Mai Dong* (Ophiopogonis Radix), and *Wu Wei Zi* (Schisandrae Fructus). After more than thirty doses, his stool naturally became moist and smooth.