〔大〕妇人大便不通者，由五脏不调，冷热之气结于肠胃，则津液燥竭，大肠壅塞，
故大便不通也。仲景云∶妇人经水过多，则亡津液，亦大便难也。大三脘散，或四物加
青皮，或七宣丸、麻仁丸选而用之。
〔薛〕前证或大肠津液干涸，或血虚火烁，不可计其日期，饮食数多，必待腹满胀，
自欲去而不能者，乃用猪胆汁润之。若妄服苦寒辛散之剂，元气愈伤，或通而不止，或
成中痞之证。大抵血虚火燥，用加味逍遥散。气血俱虚，用八珍汤。燥药伤血，用四物、连
翘、甘草。克伐伤气，用四君、川芎、当归。内热作渴，饮汤，脉实，用竹叶黄 汤。（杂病
消瘅。）内热作渴饮冷脉涩，用四物送润肠丸。肝胆克脾土而不能输送，用小柴胡汤（伤寒少
阳。）加山栀、郁李仁。肠胃气虚而不能传送，用补中益气加芍药。浓味积热而秘结，用清
胃散加芍药。（杂病齿。）其有热燥、风燥、阳结、阴结，皆不宜损中气，治者审之。一妇人
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，正前所谓血虚火烁也。以猪胆汁导
而通之，用十全大补汤调理而安。
通神散 治大便实热不通，其证心腹胀痛，手不得近，心胸烦闷而欲饮食者。
大黄（炒） 芒硝 槟榔 郁李仁（汤浸去皮，微炒） 桃仁（杵，各一两， 一方有木香半两。）
上为末，每服二钱，空心粥饮调下。
大麻仁丸 治肠胃风结，大便常秘而欲饮食者。
大麻仁（别研如膏） 大黄（炒，各二两） 槟榔 木香 枳壳（麸炒，各一两）
上为末，入麻仁研匀，炼蜜丸桐子大。每服二十丸，温水下。
皂角丸 治大肠经有风，大便秘结而不坚实者。
皂角（炙，去子） 枳壳（麸炒，各等分）
上为末，炼蜜丸桐子大。每服七十丸，空心米饮下。
苏麻粥 顺气滑肠。用紫苏子、麻子仁，水研取汁，煮粥食之。
润肠丸 治伏火风热，大肠干燥。若因失血或因肾虚，当滋肾水，最忌此丸。
麻子仁 桃仁（去皮尖，别研，各一两） 羌活 当归尾 大黄（煨） 皂角仁 秦艽（各五钱）
上另研为末，炼蜜丸。每服五十丸，空心白汤送下。如直肠干涩，用猪胆汁导之，亦
忌前药。
搜风顺气丸 治痔漏肠风，风热秘结，元气充实者。
车前子（一两五钱） 大麻子（微炒） 大黄（五钱，半生半熟） 牛膝（酒浸） 郁李仁（汤泡）
菟丝子（酒浸蒸，杵晒为末） 枳壳（麸炒） 山药（各二钱）
上为末，炼蜜丸桐子大。每服三十丸，空心白汤下。
子和脾约丸
麻仁（一两二钱半） 枳壳（麸炒） 浓朴（姜制） 芍药（各一两） 大黄（蒸，四两）
杏仁（去皮尖炒，研烂如膏，一两二钱）
上为末，入杏仁膏炼蜜丸梧子大。每服三二十丸，空心用滚汤送下。
初虞世云∶余历观古人用通药，率用降气等药。盖肺气不下降，则大肠不能传送，以
杏仁、枳壳、诃子等味是也。又老人、虚人、风人，津液少，大便秘。经云∶涩者滑之。故
用胡麻、杏仁、麻子仁、阿胶之类是也。今人学不师古，妄意斟酌，每至大便秘燥，即
以驶药荡涤之，既走津液气血，大便随手愈更秘涩，兼生他病。予昔在鲁山日，有一
少自称太医，曹镇有寄居王世安少府，本京师人，始病风淫末疾，为此生以驶药累累利
之，后为肺痿咯脓血，卒至大便不通而死。古人服药尤所谨重，不若今人之轻生，故举此
以戒后人尔。
〔薛〕前证若胃强脾弱，津液不得四布，但输膀胱，小便数而大便难者，用脾约丸。若
阴血枯槁，内火燔灼，脾肺失传，大便秘而小便数者，用润肠丸。此丸若用之于热甚气
实，与西北之禀浓者，无有不效。若用于东南及虚热而气血不足者，则脾愈弱而肠愈燥，
反致虚痞矣。此东垣先生之治法也。其搜风顺气丸，中贵及西北人用之多效，东南人用
之无不致害。一老妇大便欲去而难去，又不坚实，腹内或如故，或作胀，两关尺脉浮
大。余以为肠胃气血虚弱，每服十全大补汤加肉苁蓉，去后始快，若间二三日不服，腹
内仍胀，大便仍难。一老妇大便月余不通，痰喘内热，不得就枕，脉洪大，重按微细，朝
用六味丸，夕用逍遥散各五十余剂，计进饮食百余碗，小腹始闷，此火燥而消铄也，以
猪胆汁润之，用十全大补而安。后仍不通，用八珍倍加苁蓉常服而通。
【戴元礼】妇女出现大便不通的症状，是由于五脏功能失调，冷气和热气在肠胃中郁结，导致津液枯竭，大肠壅塞，因此大便无法排出。张仲景说：妇女月经量过多，会耗伤津液，也会导致大便困难。可以使用大三脘散，或者在四物汤中加入青皮，或者选用七宣丸、麻仁丸进行治疗。
【薛己】上述病症，或者是由于大肠津液干涸，或者是由于血虚导致虚火灼烧，不能单纯根据患病天数来判断。如果饮食较多，必须等到腹部胀满，有便意却无法排出的时候，才使用猪胆汁来润肠通便。如果胡乱服用苦寒或辛散的药物，元气会更加受损，可能出现腹泻不止，或者形成中焦痞塞的病症。大抵血虚火燥的情况，使用加味逍遥散。气血俱虚的情况，使用八珍汤。因燥药损伤血液的情况，使用四物汤、连翘、甘草。因攻伐药物损伤元气的情况，使用四君子汤、川芎、当归。内热引起口渴且想喝热水、脉象实有力的，使用竹叶石膏汤（参考杂病消瘅篇）。内热引起口渴且想喝冷水、脉象涩滞的，使用四物汤送服润肠丸。肝胆克制脾土，导致脾胃不能正常运化输送的，使用小柴胡汤（参考伤寒少阳病篇）加入山栀、郁李仁。肠胃气虚，不能推动传导的，使用补中益气汤加入芍药。食用肥甘厚味积滞内热导致便秘的，使用清胃散加入芍药（参考杂病齿痛篇）。如果有热燥、风燥、阳结、阴结等情况，都不宜损伤中焦正气，治疗者应当仔细审察。有一位妇人患有痰喘和内热，大便不通，两个月无法入睡，脉象洪大，重按则微细，这属于肝、肺、肾亏损。早晨服用六味地黄丸，晚上服用逍遥散，各服用三十多剂，累计进食一百多碗饭，腹部才开始感到痞闷，这正是前面所说的血虚火烁的情况。用猪胆汁导引通便，再用十全大补汤调理而痊愈。
通神散 治疗大便实热不通，症状为心腹胀痛，手不可触碰，心胸烦闷且想吃东西。
大黄（炒制） 芒硝 槟榔 郁李仁（开水浸泡去皮，微炒） 桃仁（捣碎，以上各一两，另一版本有木香半两。）
以上药物研为细末，每次服用二钱，空腹时用米粥汁调服。
大麻仁丸 治疗肠胃风邪郁结，大便经常秘结但仍有食欲的情况。
大麻仁（单独研磨如膏状） 大黄（炒制，以上各二两） 槟榔 木香 枳壳（麸皮炒制，以上各一两）
以上药物研为细末，加入麻仁粉混合均匀，用炼蜜制成梧桐子大小的丸剂。每次服用二十丸，温水送下。
皂角丸 治疗大肠经有风邪，大便秘结但不坚硬的情况。
皂角（炙烤，去籽） 枳壳（麸皮炒制，以上等分）
以上药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用七十丸，空腹时用米饮送下。
苏麻粥 具有顺气滑肠的功效。使用紫苏子、麻子仁，加水研磨取汁，煮粥食用。
润肠丸 治疗伏火风热导致的大肠干燥。如果是因失血或因肾虚引起的，应当滋补肾水，最忌用此丸。
麻子仁 桃仁（去皮尖，单独研磨，以上各一两） 羌活 当归尾 大黄（煨制） 皂角仁 秦艽（以上各五钱）
以上药物分别研磨为细末，用炼蜜制成丸剂。每次服用五十丸，空腹时用白开水送下。如果直肠干涩，可用猪胆汁导引通便，同时也忌讳使用前面的药物。
搜风顺气丸 治疗痔漏、肠风、风热秘结，且元气充实的患者。
车前子（一两五钱） 大麻子（微炒） 大黄（五钱，半生半熟） 牛膝（酒浸） 郁李仁（开水泡） 菟丝子（酒浸蒸后，捣碎晒干研末） 枳壳（麸皮炒） 山药（以上各二钱）
以上药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用三十丸，空腹时用白开水送下。
子和脾约丸
麻仁（一两二钱半） 枳壳（麸皮炒） 浓朴（姜汁制） 芍药（以上各一两） 大黄（蒸制，四两） 杏仁（去皮尖炒制，研烂如膏，一两二钱）
以上药物研为细末，加入杏仁膏和炼蜜制成梧桐子大小的丸剂。每次服用三二十丸，空腹用滚开水送下。
朱丹溪说：我观察古人使用通便药物，大多使用降气类药物。因为肺气不下降，大肠就不能正常传导，比如使用杏仁、枳壳、诃子等药物。另外，老人、体虚之人、中风患者，津液较少，容易大便秘结。医经说：涩滞的要用滑利的方法治疗。所以使用胡麻、杏仁、麻子仁、阿胶之类的药物。现在的人学习不效法古人，随意斟酌用药，每当遇到大便秘燥，就用峻烈的药物荡涤，结果导致津液气血流失，大便随即更加秘涩，并产生其他疾病。我以前在鲁山时，有一个自称太医的人，曹镇有个寄居的王世安少府，本是京城人，起初患风邪引发的四肢疾病，这个医生用峻烈药物多次让他泻下，后来发展成肺痿，咳出脓血，最终因大便不通而死。古人服药尤其谨慎，不像今人轻视生命，所以举这个例子来告诫后人。
【薛己】上述病症，如果是胃强脾弱，津液不能四处布散，只输送到膀胱，导致小便频数而大便困难的，使用脾约丸。如果是阴血枯槁，内火炽盛，脾肺失去传化功能，大便秘结而小便频数的，使用润肠丸。这个丸剂如果用于热势很盛、气机实证，以及西北方体质厚重的人，没有不有效的。但如果用于东南方人或虚热且气血不足的人，就会使脾气更弱、肠道更燥，反而导致虚性痞塞。这是东垣先生的治疗方法。至于搜风顺气丸，权贵及西北人使用大多有效，东南人使用无不致害。一位老年妇女大便想排却难排，且不坚硬，腹部有时正常，有时发胀，左右关尺脉浮大。我认为这是肠胃气血虚弱，每次服用十全大补汤加肉苁蓉，排便后才感觉畅快，如果间隔两三天不服药，腹部仍然发胀，大便仍然困难。另一位老年妇女大便一个多月不通，伴有痰喘内热，无法躺卧入睡，脉象洪大，重按微细，早晨服用六味地黄丸，晚上服用逍遥散，各五十多剂，累计进食一百多碗饭，小腹才开始感到闷堵，这是火燥消耗津液所致，用猪胆汁润肠通便，再用十全大补汤调理而安定。后来仍然不通，使用八珍汤加倍肉苁蓉常服而通畅。
[DA Yuanli] When women suffer from constipation (constipation), it is due to the dysfunction of the five zang organs, where cold and heat pathogens knot in the intestines and stomach, causing dryness and exhaustion of body fluids (Jin-Ye), leading to obstruction of the large intestine. Thus, stool cannot be passed. Zhang Zhongjing stated: "When women have excessive menstrual flow, they lose body fluids, which also leads to difficult defecation." One may use Da Sanwan Powder, or Siwu Decoction with Qingpi, or select Qixuan Pill or Mahuang Wan for treatment.
[XUE Ji] Regarding the aforementioned conditions, either the fluids of the large intestine are dried up, or deficiency fire scorches the blood. One should not judge solely by the duration of the illness. If food intake is high, one must wait until abdominal fullness and distension occur, accompanied by the urge to defecate but inability to do so, before using pig bile to moisten the intestines. If bitter-cold or acrid-dispersing agents are taken recklessly, the primordial qi (Yuan-Qi) will be further damaged, potentially leading to unceasing diarrhea or the formation of epigastric fullness (Zhong Pi). Generally, for blood deficiency with fire dryness, use Jiawei Xiaoyao San. For combined qi and blood deficiency, use Bazhen Tang. For blood injury caused by drying herbs, use Siwu Tang, Lianqiao, and Gancao. For qi injury caused by purgative attacks, use Sijunzi Tang, Chuanxiong, and Danggui. For internal heat causing thirst with a desire for warm drinks and a surging pulse, use Zhuye Shigao Tang (refer to Miscellaneous Diseases: Xiao Dan). For internal heat causing thirst with a desire for cold drinks and a choppy pulse, use Siwu Tang to deliver Run Chang Wan. When liver and gallbladder overact on spleen earth, preventing transportation and transformation, use Xiaochaihu Tang (refer to Shaoyang Disease in Cold Damage) with Zhizi and Yuliren. When intestinal and stomach qi deficiency prevents propulsion, use Buzhong Yiqi Tang with Shaoyao. For constipation caused by accumulation of heat from rich flavors, use Qingwei San with Shaoyao (refer to Miscellaneous Diseases: Toothache). In cases of heat dryness, wind dryness, yang binding, or yin binding, damaging the middle jiao qi should be avoided; practitioners must examine carefully. A woman suffered from phlegm-wheezing and internal heat, with constipation and insomnia for two months. Her pulse was surging and large, but faint and fine upon heavy pressure. This belonged to deficiency of liver, lung, and kidney. She took Liuwei Wan in the morning and Xiaoyao San in the evening, each for over thirty doses. After consuming over a hundred bowls of food, her abdomen became distended. This corresponds to the previously mentioned blood deficiency and fire scorching. Pig bile was used to guide the passage of stool, and Shiquan Dabu Tang was used for regulation, resulting in recovery.
Tongshen San treats severe heat constipation, characterized by abdominal pain and distension intolerable to touch, mental restlessness, and appetite.
Da Huang (stir-fried), Mangxiao, Binglang, Yuliren (soaked in water, peeled, lightly stir-fried), Taoren (pounded, each 1 liang; another version includes Muxiang 0.5 liang).
Grind into powder. Take 2 qian per dose, mixed with congee water on an empty stomach.
Dama Ren Wan treats wind-binding in the intestines and stomach, characterized by chronic constipation despite having an appetite.
Dama Ren (separately ground into paste), Da Huang (stir-fried, each 2 liang), Binglang, Muxiang, Zhike (bran-fried, each 1 liang).
Grind into powder, mix evenly with the sesame paste, and make pills with refined honey the size of paulownia seeds. Take 20 pills per dose with warm water.
Zaojiao Wan treats wind in the large intestine meridian, characterized by constipation that is not hard.
Zaojiao (roasted, seeds removed), Zhike (bran-fried, equal parts).
Grind into powder, make pills with refined honey the size of paulownia seeds. Take 70 pills per dose with rice drink on an empty stomach.
Suma Porridge promotes qi movement and lubricates the intestines. Use Zisuzi and Maziren, grind with water to extract juice, and cook as porridge.
Run Chang Wan treats hidden fire and wind-heat causing dryness of the large intestine. If caused by blood loss or kidney deficiency, one should nourish kidney water; this pill is strictly contraindicated.
Maziren, Taoren (peeled, cored, separately ground, each 1 liang), Qianghuo, Dangguiwei, Da Huang (simmered), Zaojiaoren, Qinjiao (each 5 qian).
Separately grind into powder, make pills with refined honey. Take 50 pills per dose with plain boiled water on an empty stomach. If the rectum is dry and rough, use pig bile to guide the passage; the aforementioned drugs are also contraindicated.
Soushun Fengqi Wan treats hemorrhoids, fistulas, intestinal wind, wind-heat constipation, in patients with sufficient primordial qi.
Cheqianzi (1.5 liang), Damazi (lightly stir-fried), Da Huang (5 qian, half raw half cooked), Niuxi (wine-soaked), Yuliren (water-soaked), Tusizi (wine-soaked, steamed, pounded, dried, ground), Zhike (bran-fried), Shanyao (each 2 qian).
Grind into powder, make pills with refined honey the size of paulownia seeds. Take 30 pills per dose with plain boiled water on an empty stomach.
Hezi Pi Yue Wan
Maren (1.25 liang), Zhike (bran-fried), Houpo (ginger-processed), Shaoyao (each 1 liang), Da Huang (steamed, 4 liang), Xingren (peeled, cored, stir-fried, ground into paste, 1.2 liang).
Grind into powder, add almond paste and refined honey to make pills the size of paulownia seeds. Take 30-20 pills per dose with boiling water on an empty stomach.
ZHU Danxi said: I have observed that ancients generally used qi-descending herbs for purgatives. Since lung qi does not descend, the large intestine cannot transport; hence herbs like Xingren, Zhike, and Hezi are used. Furthermore, the elderly, the deficient, and those with wind disorders have less body fluids, leading to constipation. The classics state: "For stagnation, use lubrication." Hence, Huma, Xingren, Maziren, and Ejiao are used. Modern practitioners do not follow ancient methods, making arbitrary adjustments. Whenever constipation occurs, they use harsh purgatives to scour the bowels, depleting fluids and qi/blood, causing even greater constipation and other diseases. Once in Lushan, a self-proclaimed imperial physician treated Wang Shi'an, a resident from the capital suffering from wind-induced limb ailments. The physician repeatedly used harsh purgatives, leading to lung atrophy (Fei Wei) with hemoptysis of pus and blood, and finally death due to constipation. Ancients were cautious with medication, unlike moderns who disregard life. I cite this to warn future generations.
[XUE Ji] Regarding the aforementioned conditions, if stomach strength is strong but spleen weakness prevails, preventing fluids from distributing everywhere, causing them to only flow to the bladder, resulting in frequent urination and difficult defecation, use Pi Yue Wan. If yin blood is exhausted and internal fire blazes, causing spleen and lung transmission failure, resulting in constipation and frequent urination, use Run Chang Wan. This pill is effective for severe heat and excess qi, and for people in the northwest with robust constitutions. However, for people in the southeast or those with deficiency-heat and insufficient qi/blood, it will weaken the spleen further and dry the intestines, causing false fullness. This is Mr. Dongyuan's treatment method. As for Soushun Fengqi Wan, it is effective for nobles and northwesterners, but harmful to southeasterners. An elderly woman had difficulty passing stool, which was not hard, with occasional abdominal normalcy or distension. Her guan and chi pulses on both sides were floating and large. I diagnosed it as deficiency of qi and blood in the intestines and stomach. Each time she took Shiquan Dabu Tang with Rongzong, she felt relief after defecation. If she skipped doses for two or three days, abdominal distension and difficulty persisted. Another elderly woman had been constipated for over a month, with phlegm-wheezing, internal heat, and inability to lie down. Her pulse was surging and large, faint and fine upon heavy pressure. She took Liuwei Wan in the morning and Xiaoyao San in the evening, each for over fifty doses, consuming over a hundred bowls of food. Her lower abdomen became distended, indicating fire dryness consuming fluids. Pig bile was used to moisten, and Shiquan Dabu Tang was used for stabilization. Later, when constipation recurred, Bazhen Tang with increased Rongzong was taken regularly to restore regularity.