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。
夫阴阳二气。贵乎不偏。然后津液流通。肠胃润溢。则传送如经矣。摄养乖理。三焦气滞
运掉不行。遂成闭结之患有五。曰风闭、气闭、热闭、寒闭、湿闭是也。更有发汗利小便。
及妇人产后亡
血。走耗精液。往往皆能令人闭结。燥则润之。涩则活之。闭则通之。寒则温。热则清。此
一定之法也。
一论大肠实热。大便闭结不通。用大黄、皮硝、牙皂三味各等分。水煎。一服立效。
又方。用大黄末三钱。皮硝五钱。用好烧酒一碗泡化。服之立效。
又方。用皮硝五钱。热酒化开。澄去渣。加香油三四茶匙。温服立通。
一论凡大便难。幽门不通上冲。吸门不开噎闭。大便燥结。气不得下。治在幽门。以辛
润之。专治大肠血少。结燥不通。
润肠汤 通幽汤去大黄、火麻仁。
当归（一钱五分） 生地黄（二钱） 熟地黄（二钱） 桃仁（一钱五分） 红花（五分） 升麻
（一钱） 大黄（煨一钱） 火麻仁（一钱） 甘草（五分）
上锉。水煎。去渣。调槟榔末二钱。稍温服。
一论大便闭结至极。昏不知人事。用大田螺二三枚。以盐一小撮。和壳捣碎。置病患脐
下一寸三分。以宽帛紧系之即通。
一论大便闭结。
导气丸
木香 槟榔 火麻仁 枳壳
上将枳壳。每个切作四片。用不蛀皂角三寸。生姜五片。巴豆三枚。略捶碎。不去壳油
用水
一盏。将枳壳同煎熟。滤去三味不用。只将枳壳锉细焙干为末。入前三味末。炼蜜为丸。蜜
汤下。不拘时服。
一治大便不通。乌 木方停一寸劈破。以水煎取半盏。服之立通。不用多吃。极其神效
一人大小便闭。数日不通。用商陆捣烂敷脐上。立通。
一论自汗大便闭结不通。且便于老人。并日久不能服药者。
蜜导法
蜜炼如饴。乘热作如指长二寸。两头如锐。纳谷道中。良久。下燥粪。加皂角捻末少许
更效。
香油导法
用竹管蘸葱汁。深入大便内。以香油一半。温水一半。同入猪尿胞内。捻入竹管。将病
人倒放。脚向上。立时即通。一论自汗小便利。而大便燥硬。不可攻。以此方导之。
猪胆导法
猪胆一枚。倾去一小半。仍入好醋在内。用竹管相接。套入谷道中。以手指捻之。令胆
汁直射入内。少许即通。盖酸苦益阴以润燥也。
一论大便不通。并伤寒杂症。用药不行者。粟米水煮至熟。入火麻仁微炒。不拘多少。
入粥内再煮二三沸。饮汤下。即通。一论虚弱老人。大便闭涩不通。
润肠丸
杏仁（炒去皮尖） 枳壳（炒去穣） 火麻仁（炒） 陈皮（炒各五钱） 阿胶（炒） 防风（各
二钱五分）
上为细末。炼蜜为丸。如梧桐子大。每服五十丸。白汤送下。
一老儒素有风湿。饮食如常。大便十七日不通。肚腹不胀。两尺脉洪大而虚。此阴火内
燥津液。用六味丸。二十余剂。至三十二日。始欲去。用猪胆润。而通利如常。
一妇人年七十有三。痰喘内热。大便不通。两月不寐。脉洪大。重按散乱。此属肝肺肾
亏损
朝用六味丸。夕用逍遥散。各三十余剂。计所进诸药百余碗。腹始痞闷。乃以猪胆汁导而
通之。用十全大补调理而安。若服前药。饮食不进。诸症复作。
一治老人大便闭涩。连日不通。火麻仁一盏半。研。水浸取汁。芝麻半盏。炒研。水浸
取汁。荆芥穗一两。桃仁去皮尖。炒研一两。入盐少许。同煎服之。立效。
一治大便常闭结。宜久服
活血润燥丸
当归（酒洗二两） 怀生地黄（一两） 怀熟地黄（一两） 火麻仁（一两五钱） 枳壳（麸炒
七钱） 杏仁（去皮五钱）
上为细末。炼蜜为丸。如梧桐子大。每服七十丸。空心。温水送下。
一治大便不通。
大黄 皮硝 牙皂 上三味各等分。水煎一服立通。
脉象多表现为沉伏且结滞。阳结的脉象沉实而数急。阴结的脉象伏匿而迟缓或结滞。老年人及体虚之人出现大便干结，若脉象如雀啄般急促无序，则属不治之症。
阴阳二气，贵在平衡不偏，如此津液才能流通，肠胃得以滋润充盈，传导功能才能正常进行。如果摄生调养违背常理，导致三焦气机阻滞，运化转输不行，就会形成闭结之病。其病因主要有五种：风闭、气闭、热闭、寒闭、湿闭。此外，还有因发汗过度、利小便太过，以及妇女产后失血，耗伤精液，往往也能导致大便闭结。燥者宜润，涩者宜活（活血润燥），闭者宜通，寒者宜温，热者宜清，这是一定的法则。
论述大肠实热所致的大便闭结不通。用大黄、皮硝、牙皂三味药，各等分，水煎服，一剂即可见效。
又一方。用大黄末三钱，皮硝五钱，用好烧酒一碗浸泡至溶解，服用后立效。
又一方。用皮硝五钱，用热酒化开，澄清去渣，加入香油三四茶匙，温服后立即通畅。
论述凡是大便困难，幽门不通向上冲逆，吸门不开导致噎闭，大便燥结，气不得下行。治疗关键在于幽门，以辛润之法治疗。专治大肠血少，结燥不通。
润肠汤 即通幽汤去掉大黄、火麻仁。
当归（一钱五分） 生地黄（二钱） 熟地黄（二钱） 桃仁（一钱五分） 红花（五分） 升麻（一钱） 大黄（煨制一钱） 火麻仁（一钱） 甘草（五分）
以上药物切碎，水煎，去渣，调入槟榔末二钱，稍温时服用。
论述大便闭结至极，昏迷不知人事。用大田螺二三枚，加一小撮盐，连壳捣碎，敷在病患脐下一寸三分处，用宽布条紧紧系住，即可通便。
论述大便闭结。
导气丸
木香 槟榔 火麻仁 枳壳
先将枳壳每个切作四片，用无蛀虫的皂角三寸，生姜五片，巴豆三枚，略加捶碎，不去壳油，用水一盏，将枳壳同煎至熟。滤去前三味药不用，只将枳壳切碎焙干为末，加入前三味药的粉末，炼蜜为丸，蜜汤送下，不拘时候服用。
一方治疗大便不通。乌梅一枚，停在一寸长劈破，用水煎取半盏，服用后立即通畅。不要多吃，极其神效。
一人大小便闭结，数日不通。用商陆捣烂敷于脐上，立即通畅。
论述自汗且大便闭结不通，这种情况多见于老人，以及日久不能服药者。
蜜导法
蜂蜜炼得像饴糖一样，趁热做成像手指长两寸，两头尖锐的形状，纳入肛门中。过一会儿，排出燥粪。加入少许皂角捻成的粉末，效果更佳。
香油导法
用竹管蘸葱汁，深入大便内，将一半香油和一半温水混合，装入猪尿胞内，捻入竹管中。让病人倒放，脚向上，立即通畅。
论述自汗小便利，而大便燥硬，不可攻下，以此方导之。
猪胆导法
取猪胆一枚，倒去一小半胆汁，仍放入好醋在内，用竹管相接，套入肛门中，用手指捻动竹管，令胆汁直射入内，少许时间即可通畅。这是因为酸苦能益阴以润燥。
论述大便不通，以及伤寒杂症，用药无效者。粟米水煮至熟，加入微炒的火麻仁，不拘多少，放入粥内再煮二三沸，饮汤下，即可通畅。
论述虚弱老人，大便闭涩不通。
润肠丸
杏仁（炒去皮尖） 枳壳（炒去瓤） 火麻仁（炒） 陈皮（炒各五钱） 阿胶（炒） 防风（各二钱五分）
以上研为细末，炼蜜为丸，如梧桐子大。每服五十丸，白开水送下。
一位老儒素有风湿，饮食如常，大便十七日不通，肚腹不胀，两尺脉洪大而虚。这是阴火内燥津液。用六味丸，二十余剂，到第三十二天，才想排便。用猪胆润导，而通利如常。
一位七十三岁的妇人，痰喘内热，大便不通，两个月不睡觉，脉洪大，重按散乱。这属于肝肺肾亏损。早晨服用六味丸，晚上服用逍遥散，各三十余剂，共计进药百余碗，腹部才开始痞闷，于是用猪胆汁导引而通畅。再用十全大补汤调理而安。如果服用前面的药，饮食不进，诸症复发。
一方治疗老人大便闭涩，连日不通。火麻仁一盏半，研磨，水浸取汁；芝麻半盏，炒后研磨，水浸取汁；荆芥穗一两，桃仁去皮尖，炒后研磨一两。加入少许盐，同煎服之，立效。
一方治疗大便常闭结，宜久服。
活血润燥丸
当归（酒洗二两） 怀生地黄（一两） 怀熟地黄（一两） 火麻仁（一两五钱） 枳壳（麸炒七钱） 杏仁（去皮五钱）
以上研为细末，炼蜜为丸，如梧桐子大。每服七十丸，空腹，温水送下。
The pulse is often deep, hidden, and knotted. Yang knot presents with a deep, solid, and rapid pulse. Yin knot presents with a hidden, slow, or knotted pulse. In the elderly and the debilitated, if constipation is accompanied by a "sparrow pecking" pulse (a sign of erratic, intermittent rhythm indicating severe depletion), it is considered intractable.
Yin and Yang qi must be balanced and not biased, so that body fluids can circulate freely, and the intestines and stomach remain moist and full, allowing for normal transmission and transformation. If health preservation violates proper principles, causing Qi stagnation in the San Jiao (Triple Burner) and failure of transportation and transformation, constipation results. There are five types of causes: Wind Constipation, Qi Constipation, Heat Constipation, Cold Constipation, and Dampness Constipation. Additionally, excessive sweating, excessive diuresis, and blood loss after childbirth, which deplete essence and fluids, often lead to constipation. Dryness requires moistening;涩 (astringency/stagnation) requires promoting circulation; obstruction requires unblocking; cold requires warming; heat requires clearing. This is a fixed principle.
Regarding excess-heat in the Large Intestine causing constipation: Use Rhizoma Rhei Preparata (Dahuang), Natrii Sulfas (Pixiao), and Fructus Gleditsiae Sinensis (Yazao) in equal parts. Decoct in water. One dose yields immediate effect.
Another prescription: Use three qian of Rhizoma Rhei Preparata (Dahuang) powder and five qian of Natrii Sulfas (Pixiao). Soak in one bowl of good distilled liquor until dissolved. Take orally for immediate effect.
Another prescription: Use five qian of Natrii Sulfas (Pixiao). Dissolve in hot wine, clarify and remove dregs. Add three to four tea spoons of Sesame Oil (Xiangyou). Take warm for immediate passage.
Regarding difficulty in defecation where the pylorus is obstructed causing upward reflux, and the glottis fails to open causing dysphagia, with dry stool and Qi unable to descend. Treatment focuses on the pylorus using acrid-moistening methods. Specifically treats Large Intestine blood deficiency leading to dryness and obstruction.
Run Chang Tang (Moisten the Intestines Decoction) is Tong You Tang (Open the Dark Decoction) without Rhizoma Rhei Preparata (Dahuang) and Semen Cannabis (Huomaren).
Radix Angelicae Sinensis (Danggui, 1.5 qian), Radix Rehmanniae Preparata (Shengdihuang, 2 qian), Radix Rehmanniae Preparata (Shudihuang, 2 qian), Semen Persicae (Taoren, 1.5 qian), Flos Carthami Tinctorii (Honghua, 0.5 qian), Radix Cimicifugae (Shengma, 1 qian), Rhizoma Rhei Preparata (Dahuang, stir-baked, 1 qian), Semen Cannabis (Huomaren, 1 qian), Radix Glycyrrhizae Preparata (Gancao, 0.5 qian).
Cut into pieces, decoct in water, remove dregs, mix with two qian of Areca Seed (Binglang) powder. Take when slightly warm.
Regarding extreme constipation leading to coma and unconsciousness: Use two or three large pond snails (Tianluo) mixed with a small pinch of salt, crush them including the shell, apply to the abdomen one cun three fen below the umbilicus, and bind tightly with a wide cloth strip. Passage will occur immediately.
Regarding constipation.
Dao Qi Wan (Guide Qi Pill)
Radix Aucklandiae (Muxiang), Areca Seed (Binglang), Semen Cannabis (Huomaren), Pericarpium Citri Reticulatae (Zhike).
First, cut each Zhike into four slices. Use three cun of non-worm-eaten Fructus Gleditsiae Sinensis (Zaojiao), five slices of Rhizoma Zingiberis Recens (Shengjiang), and three seeds of Croton Tiglium (Badou), slightly crush them (keeping the oil in the shell). Add one cup of water, decoct the Zhike together until cooked. Filter out the first three ingredients, keeping only the Zhike. Cut the Zhike finely, bake dry, and grind into powder. Mix with the powders of the other three ingredients. Form pills with refined honey. Take with honey water at any time.
One prescription for constipation: Take one Wumei (Fructus Mume), split it lengthwise (approx. one cun long). Decoct in water to obtain half a cup. Take orally for immediate passage. Do not consume too much; it is extremely effective.
For a person with both urinary and fecal retention for several days: Crush Phytolacca Acinosa (Shanglu) and apply to the umbilicus. Passage occurs immediately.
Regarding spontaneous sweating and constipation, common in the elderly or those who cannot take oral medication for long periods.
Mi Dao Fa (Honey Suppository Method): Refine honey until it resembles maltose syrup. While hot, shape it into a cylinder two cun long, resembling a finger, with pointed ends. Insert into the anus. After some time, dry stool will pass. Adding a small amount of powdered Fructus Gleditsiae Sinensis (Zaojiao) enhances efficacy.
Xiang You Dao Fa (Sesame Oil Suppository Method): Dip a bamboo tube in Allium Fistulosum Juice (Congzhi). Insert deeply into the rectum. Mix half sesame oil and half warm water inside a pig bladder. Insert the bladder into the bamboo tube. Place the patient upside down with feet elevated. Passage occurs immediately.
Regarding spontaneous sweating, frequent urination, but hard and dry stool. Purging is contraindicated; use this method for guidance.
Zhu Dan Dao Fa (Pig Gallbladder Suppository Method): Take one pig gallbladder, pour out slightly less than half of the bile. Pour good vinegar into it. Connect with a bamboo tube and insert into the anus. Manipulate the tube with fingers to direct the bile straight inside. Passage occurs shortly. Sour and bitter flavors nourish Yin and moisten dryness.
Regarding constipation and complications from Cold Damage or miscellaneous diseases where medications fail: Boil millet rice until cooked. Add lightly stir-fried Semen Cannabis (Huomaren) in any amount. Simmer in the porridge for two or three boils. Drink the soup for immediate passage.
Regarding constipation in weak elderly persons.
Run Chang Wan (Moisten the Intestines Pill)
Semen Armeniacae Amarum (Xingren, stir-fried, peeled, and core removed), Pericarpium Citri Reticulatae (Zhike, stir-fried, pith removed), Semen Cannabis (Huomaren, stir-fried), Pericarpium Citri Reticulatae (Chenpi, stir-fried, 5 qian each), Colla Corii Asini (Ejiao, stir-fried), Radix Saposhnikoviae (Fangfeng, 2.5 qian each).
Grind into fine powder. Form pills with refined honey, size of Sophora japonica seeds. Take fifty pills per dose with plain boiled water.
An old scholar with chronic wind-dampness had normal appetite but no bowel movement for seventeen days. Abdomen was not distended. The radial pulses at both chi positions were surging yet empty. This indicated internal dryness of fluids due to deficient fire. Prescribed Liu Wei Wan (Six-Ingredient Pill with Rehmannia) for over twenty doses. On the thirty-second day, he felt the urge to defecate. Used pig gallbladder suppository, and bowel movements returned to normal.
A seventy-three-year-old woman with phlegm-panting, internal heat, and constipation suffered from insomnia for two months. Her pulse was surging and disordered upon heavy pressure, indicating deficiency of Liver, Lung, and Kidney. She took Liu Wei Wan (Six-Ingredient Pill with Rehmannia) in the morning and Xiao Yao San (Free and Easy Wanderer Powder) in the evening, over thirty doses each, totaling over a hundred bowls of medicine. Only then did abdominal bloating subside. A pig gallbladder suppository was used to induce passage. She was then regulated with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) and recovered. Had she taken previous purgatives, she would have lost appetite and symptoms would have recurred.
One prescription for elderly constipation lasting several days: Semen Cannabis (Huomaren) one and a half zhan, ground and soaked in water to extract juice. Sesame seeds half a zhan, stir-fried, ground, and soaked in water to extract juice. Schizonepeta Spike (Jingjie Sui) one liang, Peach Kernel (Taoren) peeled and stir-fried, ground, one liang. Add a little salt. Decoct together and take orally for immediate effect.
One prescription for chronic constipation, suitable for long-term use.
Huo Xue Run Zao Wan (Invigorate Blood and Moisten Dryness Pill)
Radix Angelicae Sinensis (Danggui, washed in wine, 2 liang), Radix Rehmanniae Preparata (Shengdihuang, 1 liang), Radix Rehmanniae Preparata (Shudihuang, 1 liang), Semen Cannabis (Huomaren, 1.5 liang), Pericarpium Citri Reticulatae (Zhike, bran-stir-fried, 7 qian), Semen Armeniacae Amarum (Xingren, peeled, 5 qian).
Grind into fine powder. Form pills with refined honey, size of Sophora japonica seeds. Take seventy pills per dose on an empty stomach with warm water.
One prescription for constipation: Rhizoma Rhei Preparata (Dahuang), Natrii Sulfas (Pixiao), Fructus Gleditsiae Sinensis (Yazao). Equal parts of these three. Decoct in water. One dose yields immediate passage.