郑媪年逾古稀，证患便闭，腹痛肛胀，寝食俱废，已经两旬，诸治不应。延诊以下为嘱
，切
脉虚细而涩，谓曰∶此虚闭也，一补中益气汤足矣。何下为。服药两日，便仍不通，自言胀
痛欲死，刻不可耐，必欲下之。予曰∶下法吾非不知，但年高病久，正气亏虚，下后恐其脱
耳。媪曰∶与其胀闭而死，莫若脱之为快。因忆心悟篇云∶病有不可下，而又不可以不下，
下之不得其法，多致误人。沉思良久，于前汤内加入制大黄三钱，仿古人寓攻于补之意。饮
后肠鸣矢气，当晚便解，结粪数枚，略能安卧。次日少腹尚痛，知其燥矢未净，仍用前方大
黄分两减半，再剂便行两次，先硬后溏，痛止食进而愈。夫补中益气汤，原无加大黄之法，
此虽予之创见，然医贵变通，固不容胶柱鼓瑟也。
光翁年逾七旬，偏中卧床不起，治用地黄饮子，参左右二归饮。服药半月，证已守住，
惟大
便两旬未圊，腹痛肛胀，盖由气血俱亏，不能传送。方如通幽汤、补中益气汤、五仁汤、济
川煎，屡投不验。思用猪胆汁蜜煎导法，无如燥粪已抵肛门，阻不能入，每一努挣，魄汗淋
漓，头晕欲脱，无可如何。偶记叶氏案中载治便闭，有用挖法，令病患自用中指染油探入
肛内，将燥粪挖碎而出。奈病者肢废自难掉动，嘱其孙根据法行之，当即挖出燥粪数块，随后
自解，秽腐甚多。不劳余力，病者称快，洵治便闭捷法也。
郑家老妇人年过七十，患病大便闭塞，腹部疼痛、肛门胀满，睡觉和吃饭都废弛，已经二十天，各种治疗方法都没有效果。请我诊治时嘱咐我用攻下法治疗。切脉发现脉象虚细而涩，我对她说：这是虚性便秘，用补中益气汤就足够了。为什么要用攻下法呢？服药两天后，大便仍然不通，她自述胀痛欲死，片刻都不能忍受，一定要用攻下法。我说：攻下法我不是不知道，但患者年事已高、病程长久，正气亏虚，攻下后恐怕会导致气脱。老妇人说：与其因胀闭而死，不如气脱痛快些。于是想起《心悟篇》中说：有病不可以攻下，但又不能不用攻下法，如果攻下不得其法，多会误人。沉思良久，在前方的基础上加入制大黄三钱，仿效古人寓攻于补的意思。服用后肠鸣矢气，当晚大便通畅，排出结硬的粪便几枚，稍微能安睡。第二天小腹部还痛，知道燥屎未净，仍用前方，将大黄的剂量减半，再服两剂，大便排了两次，先硬后稀，疼痛停止，食欲恢复而痊愈。补中益气汤原本没有加大黄的方法，这虽然是我的创见，但医学贵在变通，确实不容固执拘泥。
吴光先老先生年过七旬，半身不遂卧床不起，治疗用地黄饮子、参左右二归饮。服药半个月，病情已经稳住，只是大便二十天未解，腹部疼痛、肛门胀满，大概是由于气血俱亏，不能传送。方剂如通幽汤、补中益气汤、五仁汤、济川煎，屡次投药无效。考虑使用猪胆汁蜜煎导法，无奈燥粪已经抵住肛门，阻碍无法进入，每次用力努挣，冷汗淋漓，头晕欲脱，无可奈何。偶然记得叶氏医案中记载治疗便秘，有用挖法，让病人自己用中指蘸油探入肛内，将燥粪挖碎而出。无奈病人肢体废用难以自行活动，嘱咐他的孙子按照这个方法施行，当即挖出燥粪数块，随后自然排出，秽腐很多。不费余力，病人感到畅快，确实是治疗便秘的快捷方法。
Mrs. Zheng, over seventy years old, suffered from constipation (Bian Bi), abdominal pain, and anal distension, unable to sleep or eat for twenty days; various treatments had failed. Upon consultation, she requested purgative therapy. Her pulse was deficient, fine, and choppy. I stated: This is deficiency-type constipation; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) suffices. Why use purgatives? After two days of medication, bowel movement remained unobstructed. She reported excruciating distending pain, intolerable even for a moment, insisting on purgation. I replied: I am not unaware of purgative methods, but given her advanced age and prolonged illness with deficient healthy qi (Zheng Qi), purgation may risk collapse (Tuo). She said: Better to die from collapse than from distending obstruction. Recalling the *Xin Wu Pian* stating that some cases require purgation despite contraindications, and improper use often harms patients, I pondered deeply. I added three qian of processed Da Huang (Rhei Radix et Rhizoma Preparata) to the previous formula, imitating the ancient principle of embedding attack within tonification. After ingestion, borborygmus and flatus occurred, and stool passed that night, consisting of several hard pellets, allowing slight rest. The next day, lower abdominal pain persisted, indicating residual dry feces. I retained the previous formula but halved the dosage of Da Huang. After two more doses, two bowel movements occurred, initially hard then loose, pain ceased, appetite returned, and she recovered. Although adding Da Huang to Bu Zhong Yi Qi Tang is unconventional, medical practice values flexibility rather than rigid adherence to dogma.
Mr. Wu Guangxian, over seventy, was bedridden due to hemiplegia (Pian Zhong). He was treated with Di Huang Yin Zi (Rehmannia Decoction) and Shen Zuo You Er Gui Yin (Ginseng Left and Right Two Cinnamon Decoctions). After half a month of medication, his condition stabilized, but he had not defecated for twenty days, suffering from abdominal pain and anal distension, likely due to dual deficiency of qi and blood failing to transport waste. Formulas such as Tong You Tang (Open the Obstruction Decoction), Bu Zhong Yi Qi Tang, Wu Ren Tang (Five Seeds Decoction), and Ji Chuan Jian (Ji Chuan Infusion) were repeatedly administered without effect. I considered using the pig bile and honey suppository method, but the dry feces had already reached the anus, blocking entry. Each effort caused profuse cold sweat and dizziness threatening collapse, leaving me helpless. Recalling Ye Tianshi’s case records describing an excavation method for constipation—where the patient inserts an oiled middle finger into the anus to break up and remove dry feces—I instructed his grandson to perform this technique since the patient could not move himself. Several pieces of dry feces were immediately excavated, followed by spontaneous passage of much foul matter. With minimal effort, the patient felt relief, proving it to be an expedient method for treating constipation.