〔大〕经云∶春伤于风，夏必飧泄。盖木气刑土也。土不能渗泄则木气胜，故泄。风
气行精液燥，故秘。即不可转以秘燥为风也。余家中宗亲张公度母氏年七十，日下利数十
行，百方治之不愈，又苦腰脚拘挛，公度以蒺藜、酸枣仁治拘挛而利愈。黄鲁直母安康
郡太夫人苦秘结，以公度药投之而大便利。故知秘与利皆出于风。公度，潞人，名 ，世
有令德，承父医学而克其家，清修不妄取，真有德君子，今见于此。
〔薛〕按前证若因足三阴亏损，发热作渴，胸膈不利，饮食善消，面带阳色，脉洪
而虚，肢体倦怠者，用补中益气汤、六味地黄丸。脾肺气虚，补中益气汤。脾经郁结，用
加味归脾汤。气血俱虚者，八珍加肉苁蓉。肾经津液不足者，六味地黄丸。胃火销铄津液，
竹叶黄 汤。肝木侮脾土，小柴胡加山栀、郁李仁、枳壳。膏粱积热，清胃散加山栀、郁
李仁、枳壳。若燥在直肠，用猪胆导之。
治风人、香港脚人大便或秘或利。虚人尤宜。
皂角子（三百粒，破作两片，慢火炒燥甚，入酥一枣大，又炒至燥，又入酥炒至焦黑为度）
上细末，炼蜜丸如梧桐子大。每服三十丸，煎蒺藜、酸枣仁汤下，空腹服。两时久
未利，再进一服，渐加至百丸不妨，以通为度。
蒺藜汤方 用蒺藜不以多少，炒至赤黑色，臼内以木杵舂去刺，拣簸净，每蒺藜三
两，以酸枣仁一两炒令香，同杵为粗末，马尾罗筛。每三钱，水一盏，煎至七分，去滓
温服，下前丸子。
大五柔丸 主脏气不调，大便难。通荣卫，利九窍，进饮食。
大黄（斗米上蒸，切焙） 枳壳（去瓤，麸炒） 白芍药 葶苈（炒香，别研）
肉苁蓉（酒浸软，温水洗切焙，各一两） 桃仁（一百枚） 杏仁（四十枚，并去皮尖，麸炒
令黄，别杵） 牛脂（去筋膜熬成油，与葶苈、杏仁等杵）
上除有油药并为末，入牛脂、桃杏仁、葶苈，杵数千下，丸如梧桐子大。米饮下三丸，
日三服，腹稍空时服，未知稍增，以知为度。
安康郡太苦风秘，予为处枳诃二仁丸。
杏仁（去皮尖，麸炒黄） 麻仁（别研各二两） 枳壳（去幅，麸炒研） 诃子（慢火炒，
捶去核）
上二物各一两为细末，同二仁杵，炼蜜和杵丸如梧桐子大，温水下二三十丸。未知
稍增。
潞公在北门日，盛夏间苦大便不调，公随行医官李琬，本衢州市户，公不独终始涵
容之，又教以医事。公病泄利，琬以言动摇之，又求速效，即以赤石脂、龙骨、干姜等
药馈公，公服之不大便者累日，其势甚苦，予方自共城来见公，未坐定，语及此事，公又
不喜服大黄药。予告曰∶此燥粪在直肠，药所不及，请以蜜兑导之，公为然。时七月中
苦热，予挥汗为公作蜜兑。是夕三用药，下结粪四五十枚，黑如橡栗，公二三日间饮食
已如故。世有一种虚人不可服利药，今载其法。
蜜兑法 好蜜四五两，银石器中微火熬，不住手以匙搅，候可丸，见风硬，即以蛤粉
涂手，捏作人指状，长三寸许，坐厕上纳之，以手掩定，候大便通即放手，未快再作。（以上
四方出初虞世。）
补遗通气散 治妇人忧怒伤肺，肺与大肠为传送，致令秘涩不通。或服燥药过多，大
便秘，亦可用。
陈皮 苏叶 枳壳 木通（去皮节）
上等分锉，每服四钱，水煎温服。
皂角丸、苏麻粥亦佳。（见前。）
〔大〕《黄帝内经》中说：春季感受风邪，到了夏季必然发生完谷不化的泄泻。这是因为肝木之气克制脾土所致。如果脾气虚弱不能正常运化水湿，则肝木之气偏胜，从而导致泄泻；若风气导致体内津液干燥，则会导致便秘。因此，不能反过来将便秘和燥结归咎于风邪。我家族中的宗亲张公度的母亲七十岁了，每天腹泻数十次，用各种方法治疗都不见效，又苦于腰脚拘挛抽搐。张公度用蒺藜、酸枣仁治疗其拘挛，结果腹泻也随之痊愈。黄庭坚的母亲安康郡太夫人苦于便秘，用张公度的药方治疗后大便通畅。由此可知，便秘与泄泻都可能是由风邪引起的。张公度是潞州人，名字未载，世代拥有美好的德行，继承父亲的医学并光耀门楣，清心修身，不随意索取财物，真是有德行的君子，如今在此可见一斑。
〔薛〕按：上述病症如果是由于足三阴经（肝、脾、肾）亏损，伴有发热口渴、胸膈不畅、饮食易消化、面色红润、脉象洪大而虚、肢体倦怠等症状的，使用补中益气汤、六味地黄丸。若是脾肺气虚，用补中益气汤。若是脾经郁结，用加味归脾汤。若是气血俱虚，用八珍汤加肉苁蓉。若是肾经津液不足，用六味地黄丸。若是胃火灼烧津液，用竹叶石膏汤。若是肝木侮乘脾土，用小柴胡汤加山栀、郁李仁、枳壳。若是膏粱厚味积热，用清胃散加山栀、郁李仁、枳壳。若燥屎在直肠，可用猪胆导法通便。
治疗中风患者、香港脚（脚气病）患者大便或秘或利。体虚者尤其适宜。
皂角子方：皂角子三百粒，破成两片，用慢火炒至极干，加入如枣核大小的酥油，再炒至干燥，再加入酥油炒至焦黑为止。以上药物研成细末，用炼蜜制成梧桐子大小的丸剂。每次服用三十丸，用煎好的蒺藜、酸枣仁汤送服，空腹服用。若两个时辰后仍未排便，可再服一次，逐渐增加至一百丸也无妨，以大便通畅为度。
蒺藜汤方：取适量蒺藜，炒至赤黑色，在臼中用木杵捣去刺，拣选簸净。每用蒺藜三两，配酸枣仁一两，炒出香味，一同捣成粗末，用马尾罗筛过。每次取三钱，加水一盏，煎至七分，去渣温服，用以送服前面的丸子。
大五柔丸：主治脏气不调，大便困难。能通调荣卫，利九窍，增进饮食。
大黄（在斗米上蒸熟，切片焙干） 枳壳（去瓤，麸皮炒） 白芍药 葶苈子（炒香，另研）
肉苁蓉（酒浸软，温水洗净切块焙干，各一两） 桃仁（一百枚） 杏仁（四十枚，去皮尖，麸皮炒至黄色，另捣） 牛脂（去除筋膜熬成油，与葶苈、杏仁等同捣）
除含油的药物外，其余研成粉末，加入牛脂、桃仁、杏仁、葶苈子，捣数千下，制成梧桐子大小的丸剂。用米饮送服三丸，每日三次，腹部稍空时服用，若无效可稍增量，以见效为度。
安康郡太夫人苦于风邪导致的便秘，我为她处方枳诃二仁丸。
杏仁（去皮尖，麸皮炒黄） 麻仁（另研，各二两） 枳壳（去瓤，麸皮炒研） 诃子（慢火炒，捶去核）
以上两味药各一两研成细末，同两种仁类一起捣匀，用炼蜜调和制成梧桐子大小的丸剂，温水送服二三十丸。若无效可稍增量。
潞国公在北门任职期间，盛夏时节苦于大便不调，他的随行医官李琬，本是衢州市民，潞公不仅始终包容他，还教他医术。潞公患泄泻，李琬言语动摇其信心，又求速效，便给潞公进献赤石脂、龙骨、干姜等药，潞公服用后数日不大便，形势非常痛苦。我当时从共城来见潞公，还没坐定，谈及此事，潞公又不喜欢服用大黄类药物。我告诉他说：“这是燥屎在直肠，药物难以到达，请用蜜兑导法通便。”潞公认为对。当时七月酷暑，我挥汗为潞公制作蜜兑。当晚用药三次，排出结粪四五十枚，黑得像橡栗一样，潞公在两三天内饮食已恢复正常。世间有一种体虚之人不可服用泻药，现记载此法。
蜜兑法：好蜂蜜四五两，在银器或石器中用微火熬煮，不停地用勺子搅拌，等到可以捏成团，遇风变硬时，就用蛤粉涂手，捏成人手指状，长约三寸，坐在厕所上纳入肛门，用手按住，待大便通畅即放手，若不痛快再做。（以上四个方子出自初虞世。）
补遗通气散：治疗妇人因忧怒伤肺，肺与大肠相表里，导致传导失常，致使大便秘涩不通。或因服用过多燥药，导致大便秘结，也可使用。
陈皮 苏叶 枳壳 木通（去皮节）
以上药物等分锉碎，每次服用四钱，水煎温服。
[Da] The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "If wind is injured in spring, diarrhea with undigested food will occur in summer." This is because the Wood Qi (Liver) overacts on Earth Qi (Spleen). If the Spleen cannot transform and transport fluids properly, the Wood Qi becomes excessive, leading to diarrhea. Conversely, if Wind pathogen causes dryness of body fluids, constipation results. Therefore, one should not reverse this logic and attribute constipation and dryness solely to Wind. My relative, Lord Zhang Gongdu's mother, was seventy years old. She suffered from diarrhea dozens of times a day, which resisted all treatments. She also suffered from stiffness and spasms in her waist and legs. Lord Zhang Gongdu treated her spasms with Tribulus seeds (*Jili*) and Sour Jujube seeds (*Suanzaoren*), resulting in the cessation of her diarrhea. Huang Tingjian's mother, the Lady of An'kang Commandery, suffered from severe constipation. After administering Lord Zhang Gongdu's prescription, her bowels moved freely. Thus, it can be known that both constipation and diarrhea can stem from Wind pathogen. Lord Zhang Gongdu was from Luzhou. His name is not recorded here, but his family possessed virtue for generations. He inherited his father's medical skills and brought honor to his family. He cultivated himself purely and did not take wealth improperly; he is truly a virtuous gentleman, as seen here.
[Xue] Commentary: Regarding the aforementioned conditions, if they are caused by deficiency of the Three Yin meridians of the foot (Liver, Spleen, Kidney), accompanied by fever, thirst, chest and diaphragm discomfort, easy digestion, a ruddy complexion, a surging yet empty pulse, and limb fatigue, use *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) and *Liuwei Dihuang Wan* (Six-Ingredient Pill with Rehmannia). For Spleen and Lung Qi deficiency, use *Buzhong Yiqi Tang*. For Spleen meridian depression and stagnation, use *Jiawei Guipi Tang* (Modified Restore the Spleen Decoction). For combined Qi and Blood deficiency, use *Bazhen Tang* (Eight-Treasure Decoction) plus *Roucongrong* (Cistanche). For insufficiency of Kidney meridian fluids, use *Liuwei Dihuang Wan*. For Stomach fire consuming fluids, use *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction). For Liver Wood insulting Spleen Earth, use *Xiao Chaihu Tang* (Minor Bupleurum Decoction) plus Gardenia (*Shanzhi*), Prunus seed (*Yuliren*), and Aurantium peel (*Zhiqiao*). For accumulation of heat from rich foods, use *Qingwei San* (Clear the Stomach Powder) plus Gardenia, Prunus seed, and Aurantium peel. If dry stool is in the rectum, use Pig Gallbladder enema (*Zhudan Dao*).
Treat constipation or diarrhea in patients with Wind stroke or Hongjiao (Foot Qi disease). This is especially suitable for deficient persons.
**Sapodilla Seed Pill (Zaojiao Zi Wan):** Take three hundred Sapodilla seeds (*Zaojiaozi*), break them into two pieces, stir-fry slowly until very dry. Add butter equivalent to the size of a jujube pit, stir-fry until dry again. Add more butter and stir-fry until charred black. Grind into fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take thirty pills each time, washed down with decoction of Tribulus seeds and Sour Jujube seeds. Take on an empty stomach. If no bowel movement after two shichen (four hours), take another dose. Gradually increase up to one hundred pills without harm. Stop when bowels move smoothly.
**Tribulus Soup (Jili Tang):** Use an appropriate amount of Tribulus seeds (*Jili*), stir-fry until red-black. Pound in a mortar with a wooden pestle to remove spines. Winnow and clean. Take three taels of Tribulus seeds and one tael of Sour Jujube seeds (*Suanzaoren*), stir-fry until fragrant. Pound together into coarse powder. Sieve through a horsehair sieve. Take three qian per dose. Add one cup of water, decoct until seven-tenths remain. Strain and take warm. Use to wash down the above pills.
**Da Wu Rou Wan (Great Five Softening Pills):** Mainly treats disordered Zang-Qi, causing difficult defecation. It unites Ying and Wei, benefits the nine orifices, and promotes appetite.
* Rhubarb (*Dahuang*): Steamed over rice in a bucket, sliced, and dried.
* Aurantium Peel (*Zhiqiao*): Pulp removed, stir-fried with bran.
* White Peony Root (*Baishaoyao*).
* Lepidium Seed (*Tingli*): Stir-fried until fragrant, separately ground.
* Cistanche (*Roucongrong*): Soaked in wine until soft, washed in warm water, sliced, and dried (one tael each).
* Peach Kernel (*Taoren*): One hundred kernels.
* Apricot Kernel (*Xingren*): Forty kernels, skin and tip removed, stir-fried with bran until yellow, separately pounded.
* Beef Fat (*Niuzhi*): Sinews and fascia removed, rendered into oil. Mixed with Lepidium and Apricot kernels.
Grind all non-oily ingredients into powder. Add beef fat, Peach kernels, Apricot kernels, and Lepidium. Pound thousands of times. Form pills the size of paulownia seeds. Take three pills with rice drink, three times daily. Take when the abdomen is slightly empty. If ineffective, slightly increase the dose until effective.
The Lady of An'kang Commandery suffered from Wind-induced constipation. I prescribed **Zhihe Erren Wan (Aurantium and Chebula Two-Kernel Pills)**.
* Apricot Kernel (*Xingren*): Skin and tip removed, stir-fried with bran until yellow.
* Hemp Seed (*Maren*): Separately ground (two taels each).
* Aurantium Peel (*Zhiqiao*): Pulp removed, stir-fried with bran and ground.
* Chebula Fruit (*Hezi*): Slowly stir-fried, crushed to remove pits.
Take one tael each of the above two powdered items. Mix with the two kernels. Combine with refined honey and pound to form pills the size of paulownia seeds. Take twenty to thirty pills with warm water. Increase slightly if ineffective.
When Duke Lu served at Beimen, during midsummer he suffered from irregular bowel movements. His attending physician, Li Wan, originally from Quzhou market town, was tolerated and taught medicine by the Duke. When the Duke suffered from diarrhea, Li Wan undermined his confidence and sought quick effects. He presented Red Halloysite (*Chishizhi*), Dragon Bone (*Longgu*), and Dried Ginger (*Ganjiang*). The Duke took these and suffered from constipation for several days, in great distress. I arrived from Gongcheng to see him. Before sitting down, we discussed this matter. The Duke disliked taking Rhubarb (*Dahuang*). I told him, "This is dry feces in the rectum, inaccessible to oral medication. Please use Honey Suppository (*Mi Dui*)." The Duke agreed. It was mid-July, extremely hot. I sweated profusely while making the honey suppository for him. That night, after three applications, he passed forty to fifty hard stools, black like acorns. Within two to three days, his diet returned to normal. There are some deficient persons who cannot tolerate purgatives. Here is the method.
**Honey Suppository Method (Mi Dui Fa):** Take four to five taels of good honey. Simmer gently in silver or earthenware vessels. Stir constantly with a spoon until it can be molded and hardens upon exposure to air. Dust hands with Clam Powder (*Ge Fen*). Mold into a finger shape, about three cun long. Sit on the toilet and insert it. Hold in place with hand. Release when bowel movement occurs. If not satisfied, make another. (The above four formulas are from Chu Yushi.)
**Supplementary Tongqi San (Ventilation Powder):** Treats women whose lungs are injured by worry and anger. Since the Lung and Large Intestine are exterior-interior related, this leads to transmission dysfunction, causing constipation and blockage. Also applicable if constipation results from excessive intake of drying medicines.
* Tangerine Peel (*Chenpi*).
* Perilla Leaf (*Suye*).
* Aurantium Peel (*Zhiqiao*).
* Akebia Stem (*Mutong*): Remove nodes and joints.
Equal parts, cut into pieces. Take four qian per dose. Decoct in water and take warm.
**Sapodilla Pill (Zaojiao Wan)** and **Perilla and Hemp Porridge (Suma Zhou)** are also excellent. (See previous text.)