病源大便难者，由五脏不调，阴阳偏有，冷热虚实，三焦不和，则冷热并结故也，胃为
五谷之海，水谷之精，化为营卫，其糟粕行之于大肠以出也，五脏三焦，既不调和，冷热壅
塞，
在肾
涩，
寸口
身热
脉
紧而
也，
除
肘后疗脾胃不和，常患大便坚强难方。
大黄 芍药 浓朴（炙各二两） 枳实（六枚炙） 麻子（别研五合）
上五味捣筛，入麻子蜜和为丸如梧桐子大，每服十丸，日三服，稍稍增之，以通利为度
，可常将之。（集验备急古今录验同出第二卷中）
千金疗大便难方。
灸承筋二穴三炷，在 中央陷中。
又方
单用豉清，酱清，羊酪土瓜根汁，并单灌之，立出。（范汪同）
又练中丸，主宿食不消，大便难方。
大黄（八两） 葶苈（熬） 杏仁（去皮尖熬） 芒硝（各四两）
上四味捣筛为末，炼蜜为丸，如桐子大，每服十丸，日三服，稍加之。（并出第十五卷
中）
备急不得大便，或十日一月方。
葵子二升，水四升，煮取一升，去滓，一服不愈，重作，服良。忌蒜，炙肉。（古今录
验文仲范汪同姚方出第六卷中）
古今录验麻子仁丸，疗大便难，小便利而反不渴者，脾约方。
麻仁（二升别为膏） 枳实（半斤炙） 芍药（半斤） 大黄（一斤） 浓朴（一尺炙）
杏
仁（一升去皮尖熬别为脂）
上六味捣筛为末，炼蜜为丸，如梧桐子大，每服饮下十丸，渐增至三十丸，日三服。（
此本仲景伤寒论方出第二十六卷中）
大便困难的病因，是由于五脏功能失调，阴阳偏盛偏衰，寒热虚实夹杂，三焦气机不和，导致寒热之邪相互搏结所致。胃是五谷汇聚的海洋，水谷中的精微物质转化为营气和卫气，其糟粕则输送到大肠排出体外。如果五脏和三焦不能调和，寒热之气壅塞阻滞，（在肾脉表现为）涩象；（在寸口脉表现为）身热、脉紧等表现。（此处原文有脱漏或错简，难以通顺翻译，故略去不通顺的片段“除 肘后疗脾胃不和，常患大便坚强难方。”直接接下方方剂）。
《肘后备急方》治疗脾胃不和，经常患有大便干硬困难的方子：
大黄、芍药、厚朴（炙，各二两）、枳实（六枚，炙）、火麻仁（另研，五合）。
以上五味药捣碎过筛，加入火麻仁，用蜂蜜调和制成梧桐子大小的丸剂。每次服用十丸，每日三次，逐渐增加剂量，以大便通畅为度。可以长期服用。（此方出自《集验备急方》和《古今录验》，收录于第二卷中）。
《千金方》治疗大便困难的方子：
艾灸承筋穴两个穴位，每穴三壮，穴位位于腘窝横纹中央的凹陷处。
又一方：
单独使用豆豉汁、酱清、羊酪或土瓜根汁，分别灌服，大便立即排出。（范汪方相同）。
又有练中丸，主治宿食不消化，大便困难方：
大黄（八两）、葶苈子（炒制）、杏仁（去皮尖，炒制）、芒硝（各四两）。
以上四味药捣碎过筛成粉末，用炼蜜制成梧桐子大小的丸剂。每次服用十丸，每日三次，可稍加剂量。（均出自第十五卷中）。
备急方，治疗多日不得大便，或十日一月才排便一次的方子：
冬葵子二升，加水四升，煮取一升药液，去掉药渣。一次服用，若未痊愈，重新煎服，效果良好。忌食大蒜、烤肉。（此方出自《古今录验》、文仲、范汪，姚方收录于第六卷中）。
《古今录验》麻子仁丸，治疗大便困难，小便频数反而不口渴者，属于脾约证方：
火麻仁（二升，另研成膏）、枳实（半斤，炙）、芍药（半斤）、大黄（一斤）、厚朴（一尺，炙）、杏仁（一升，去皮尖，炒制，另研成脂状）。
以上六味药捣碎过筛成粉末，用炼蜜制成梧桐子大小的丸剂。每次用温水送服十丸，逐渐增加到三十丸，每日三次。（此方本出自张仲景《伤寒论》，收录于第二十六卷中）。
The etiology of difficult defecation lies in the disharmony of the five Zang organs, with an imbalance of Yin and Yang, a mixture of cold and heat, deficiency and excess, and dysfunction of the San Jiao (Triple Burner), resulting in the binding of cold and heat pathogens. The Stomach is the sea of the five grains; the essence from food and drink transforms into Ying (Nutritive Qi) and Wei (Defensive Qi), while the dregs are transported to the Large Intestine for excretion. When the five Zang organs and the San Jiao fail to harmonize, cold and heat qi become stagnant and obstructed... [Note: The original text contains fragmented phrases regarding pulse diagnosis ("in the Kidney...涩/se", "Cunkou... body heat... pulse tight") and a disjointed reference to *Zhou Hou Bei Ji Fang* which interrupts the flow. These fragmented diagnostic descriptions are omitted for coherence as they do not form complete sentences in the source.]
**Zhou Hou Bei Ji Fang** (Handbook of Prescriptions for Emergencies) treats disharmony of the Spleen and Stomach, specifically chronic hard and difficult defecation:
Da Huang (Rhei Radix et Rhizoma), Shao Yao (Paeoniae Radix Alba), Hou Po (Magnoliae Officinalis Cortex) [stir-fried, each 2 liang], Zhi Shi (Aurantii Fructus Immaturus) [6 pieces, stir-fried], Huo Ma Ren (Cannabis Semen) [separately ground, 5 he].
Grind the above five herbs into powder, mix with Huo Ma Ren, and use honey to form pills the size of paulownia seeds. Take 10 pills per dose, three times daily, gradually increasing the dosage until bowel movement becomes smooth. This can be taken regularly. (This formula also appears in *Ji Yan Bei Ji Fang* and *Gu Jin Lu Yan*, recorded in Volume 2).
**Qian Jin Fang** (Essential Prescriptions Worth a Thousand Gold) treats difficult defecation:
Moxibustion on two points of Chengjin (BL57), three moxa cones per point, located in the depression at the center of the popliteal crease.
Another prescription:
Use only Dou Chi (Sojae Semens Praeparatum) juice, Jiang Qing (fermented soybean liquid), Yang Lao (sheep cheese), or Tu Gua Gen (Trichosanthis Radix) juice, administered alone via enema or oral intake, resulting in immediate evacuation. (Fan Wang's formula is identical).
There is also Lian Zhong Wan, primarily treating retained food stagnation and difficult defecation:
Da Huang (Rhei Radix et Rhizoma) [8 liang], Ting Li Zi (Lepidii Semen) [roasted], Xing Ren (Armeniacae Semen Amarum) [skin and tip removed, roasted], Mang Xiao (Natrii Sulfas) [each 4 liang].
Grind the above four herbs into powder, use refined honey to form pills the size of paulownia seeds. Take 10 pills per dose, three times daily, with slight increases if necessary. (All from Volume 15).
**Bei Ji Fang** (Emergency Prescription) for constipation lasting ten days to a month:
Kui Zi (Malvae Semen) [2 sheng], water [4 sheng], boil to obtain 1 sheng of decoction, remove dregs. Take once; if not cured, prepare again and take, yielding good results. Avoid garlic and roasted meat. (From *Gu Jin Lu Yan*, Wen Zhong, Fan Wang; Yao Fang recorded in Volume 6).
**Gu Jin Lu Yan** Maziren Wan treats difficult defecation with frequent urination but no thirst, known as Pi Yue (Spleen Constraint):
Huo Ren (Cannabis Semen) [2 sheng, separately ground into paste], Zhi Shi (Aurantii Fructus Immaturus) [half jin, stir-fried], Shao Yao (Paeoniae Radix Alba) [half jin], Da Huang (Rhei Radix et Rhizoma) [1 jin], Hou Po (Magnoliae Officinalis Cortex) [1 chi, stir-fried], Xing Ren (Armeniacae Semen Amarum) [1 sheng, skin and tip removed, roasted, separately ground into fat/oil].
Grind the above six herbs into powder, use refined honey to form pills the size of paulownia seeds. Take 10 pills per dose with warm water, gradually increasing to 30 pills, three times daily. (This originates from Zhang Zhongjing's *Shanghan Lun*, recorded in Volume 26).