（东垣） 治幽门不通，上冲吸门，噎塞不开，气不得下，大便艰难，名曰下脘不通，
治在幽门。（下脘即幽门，胃之下口也。人身上下有七门，皆下冲上也。幽门上冲吸门，吸
门即会厌，气喉上掩饮食者也。冲其吸入之气，不得下归肝肾，为阴火所拒，故膈噎不通。
浊阴不得下降，而大便干燥不行。胃之湿与阴火，俱在其中，则腹胀作矣。治在幽门，使
幽门通利，泄其阴火，润其燥血，生其新血，则幽门通，吸门亦不受邪，膈噎得开，胀满俱
去矣。是浊阴得下归地也。）
当归身 升麻 桃仁（研） 红花 甘草（炙） 原生地 原熟地 或加槟榔
当归二地，滋阴以养血，桃仁红花，润燥而行血，槟榔下坠而破气滞。加升麻者，天地
之道
垣曰
饱劳
便
以桃仁酒制大黄通之。风燥者，以麻仁加大黄利之。气塞者，郁李仁杏仁皂角仁润之。不可
概用牵牛巴豆之类下之，损其津液。暂得通快，燥结愈甚，遂成不救。）加大黄麻仁，名当
归润肠汤，治同。
凡病涉虚损，而大便闭结不通，则硝黄攻击等剂，必不可用。若势有不得不通者，
主之，此用通于补之剂也。
当归（三五钱） 牛膝（二钱） 肉苁蓉（酒洗去咸。二三钱。） 泽泻（一钱五分） 升
麻（五七
加黄芩，
（李东垣）治疗幽门不通，气机上冲至吸门，导致噎塞感无法缓解，气机不能下行，大便艰难，这种病症称为下脘不通，治疗重点在于疏通幽门。（注：下脘即幽门，是胃的下口。人体上下共有七道门户，气机皆由下向上冲逆。幽门上冲至吸门，吸门即会厌，是覆盖在气管和食道入口处的组织以保护气道。若冲逆之气吸入后不能下行归藏于肝肾，被阴火所抗拒，就会导致膈噎不通。浊阴之气不能下降，从而引起大便干燥秘结。胃中的湿邪与阴火交织其中，就会导致腹胀。治疗关键在于疏通幽门，使幽门通利，泄去阴火，滋润燥血，生发新血，这样幽门通畅，吸门也不受邪气侵扰，膈噎得以开通，胀满症状全部消除。这就是让浊阴之气重新下行归入地界。）
方药组成：当归身、升麻、桃仁（研碎）、红花、甘草（炙烤）、原生地黄、原生熟地黄，或者加入槟榔。
方解：当归和生地、熟地，滋阴以养血；桃仁和红花，润燥并活血行血；槟榔具有下坠之性，能破除气滞。加入升麻的原因，遵循天地之道……（原文此处有缺漏或错简，接下文“垣曰”）李东垣说：若是因饱食或劳累导致的便秘，用桃仁酒制大黄来通便。若是风燥引起的，用火麻仁加大黄来利便。若是气机闭塞引起的，用郁李仁、杏仁、皂角仁来润通。不可一概使用牵牛子、巴豆这类峻下药来攻下，否则会损伤津液。虽然暂时得到通畅爽快，但燥结会更加严重，最终导致无法救治。（若加入大黄、火麻仁，名为当归润肠汤，主治相同。）
凡是疾病涉及虚损，而大便闭结不通的，那么硝石、大黄等攻伐剂型的药物，绝对不可使用。如果形势紧迫，不得不通下的情况，（主用济川煎），这是属于在补益中求通利的方剂。
方药组成：当归（三五钱）、牛膝（二钱）、肉苁蓉（酒洗去咸味，二三钱）、泽泻（一钱五分）、升麻（五七分，原文似有缺字，通常为五七分或五分），加黄芩。
(Li Dongyuan) Treats the condition where the pylorus (lower opening of the stomach) is obstructed, causing qi to rush upward to the epiglottis (xi men), resulting in a sensation of choking and blockage that cannot be relieved. The qi fails to descend, and defecation is difficult. This condition is called "obstruction of the lower wan" (xia wan). The treatment focuses on unblocking the pylorus. (Note: The lower wan is synonymous with the pylorus, which is the lower outlet of the stomach. There are seven gates in the human body from top to bottom, through which qi tends to rush upward. When the pylorus rushes upward to the epiglottis—the epiglottis being the structure that covers the airway and esophagus during swallowing—if the inhaled qi cannot descend to return to the liver and kidneys due to rejection by yin-fire, it leads to obstruction in the chest and throat. Turbid yin fails to descend, resulting in dry and constipated stools. The dampness in the stomach combined with yin-fire causes abdominal distension. The treatment lies in unblocking the pylorus, making it patent, draining the yin-fire, moistening dry blood, and generating new blood. Once the pylorus is patent, the epiglottis is also protected from pathogenic factors, the chest and throat obstruction is resolved, and the distension disappears. This allows the turbid yin to descend back to the earth.)
Prescription: Danggui Shen (Radix Angelicae Sinensis Root End), Shengma (Rhizoma Cimicifugae), Taoren (Semen Persicae, pounded), Honghua (Flos Carthami), Gancao (Radix Glycyrrhizae Preparata), Yuanshengdi (Radix Rehmanniae Preparata), Yuanshudi (Radix Rehmanniae Preparata), or add Binglang (Areca Seed).
Analysis: Danggui, Shengdi, and Shudi nourish yin to generate blood; Taoren and Honghua moisten dryness and invigorate blood circulation; Binglang has a descending property and breaks qi stagnation. The reason for adding Shengma follows the way of heaven and earth... (Text gap/interpolation here, followed by "Yuan said") Li Dongyuan stated: For constipation caused by overeating or fatigue, use Taoren processed with wine and Dahuang (Radix et Rhizoma Rhei) to unblock bowels. For constipation due to wind-dryness, use Huomaren (Semen Cannabis) plus Dahuang to promote bowel movement. For constipation due to qi blockage, use Yuliren (Semen Pruni), Xingren (Semen Armeniacae Amarum), and Zaojiaoren (Fructus Gleditsiae Sinensis Seed) to moisten and unblock. One must not indiscriminately use harsh purgatives like Qianniuzi (Semel Phytolaccae Acinosae) or Badou (Semen Crotonis) to purge, as this damages body fluids. Although temporary relief may be achieved, the dryness and accumulation will worsen, eventually becoming incurable. (If Dahuang and Huomaren are added, it is named Danggui Runchang Tang [Danggui Intestine-Moistening Decoction], with the same indications.)
For any disease involving deficiency and damage, accompanied by closed and obstructed bowels, formulas containing Xiaoshi (Natrii Sulfas) and Dahuang (Radix et Rhizoma Rhei) that attack and purge must absolutely not be used. If the situation is urgent and evacuation is necessary, [Jichuan Jian] is the primary formula. This is a formula that achieves unblocking through tonification.
Prescription: Danggui (10-15 g), Niuxi (Radix Achyranthis Bidentatae) (6 g), Rongzhucong (Herba Cynomorii) (washed with wine to remove saltiness, 6-9 g), Zexie (Rhizoma Alismatis) (4.5 g), Shengma (Rhizoma Cimicifugae) (2-3.5 g), add Huangqin (Radix Scutellariae).