《金匮真言论》云∶北方黑色，入通于肾，开窍于二阴，故肾阴虚则大小便难，宜以地黄、
苁蓉、车前子、茯苓之属，补真阴，利水道，少佐辛药开腠理，致津液而润其燥，施之于老
人尤宜。若大小便燥
结之甚，求通不得，登厕用力太过，便仍不通，而气被挣脱，下注肛门，有时泄清水，而里
急后
重，不可忍者，胸膈间梗梗作恶，干呕有声，渴而索水，饮食不进，呻吟不绝，欲利之则气
以下脱，合用葶苈、桑白皮，二者得兼，必然中病，其间更以木通、滑石佐之，尤能透达，
虽然，大便
小便脉络相贯也，人有多日小便不通，但用神保丸。(血燥津液涸，皆致便难。神保丸等治
实症
固妙，而年老液涸者，不可不审。)作葶苈丸，大泻数行，小便自利。按∶此法实者可用，
不可不审。二
便俱闭，只利大便，小便须臾自下。若气已脱，下之即绝，固之则溺与燥矢膨满腹肠间，恐
反增
剧，升之使气自举，而秽独不为气所结，自然通利，则呕恶不堪，宜何处之。家姑八十余，
尝得
此患，余惟欲调气利小便之药，虽仅获效，而不收全功。尝慰之，令勿性急，后因不能忍，
遽索
末药利下数行，不以告余。自谓稍快矣，而脉忽数动一止，气息奄奄，颓然床褥，余知真气
已
泄，若不收摄，恐遂不救。急以生脉药投之，数剂后，结脉始退，因合益血润肠丸与服，劝
以勿服
他药，久之自有奇效。如言调理两月余，而二便通调，四肢康胜如平时矣。向使图目前之快
，蔑
探本之明，宁免于悔哉。便秘是老人常事，盖所固而不泄，故能寿考。而一时难堪，辄躁扰
而
致疾，若求通润之方，非益血而滋肾，乌乎可也。丸方虽为家姑设，而可以通行天下，故表
而出之，以为孝子养亲，仁人安老之一助云。
益血润肠丸，熟地黄六两，杏仁炒去皮尖，枳壳麸皮炒黄，麻仁拣去壳令
净，
壳反涩大肠也，备三两，以上三味各杵膏，橘红三两五钱，阿胶炒，肉苁蓉酥煮透
烘干各一两五钱，苏子炒研，琐阳酥煮，荆芥各一钱。
上末之，以前三味膏，同杵千余下，仍加炼蜜丸，桐子大，每服五六十丸，空心白汤下
。
大法云∶
大便秘，服神芎丸。大便不通，小便反利，不知燥湿之过，本大肠少津液，以寒燥之药治之
。是
以转燥，少服则不济，多服则亡血。所以不通，若用四物、麻子、杏仁之类则可。经云∶燥
则为枯。湿剂所以润之。肾燥便难也。
益血润肠丸，乃王道之师，非神芎丸之瞑眩。若津涸液少，当用四物润燥，间服益血润
肠丸。
《金匮真言论》中说：北方对应黑色，内通于肾，外开窍于前后二阴。因此，肾阴亏虚会导致大小便困难，适宜使用地黄、肉苁蓉、车前子、茯苓这类药物，以补益真阴，通利水道，并少量佐用辛味药物以开发腠理，促使津液生成从而滋润燥结，这种方法施用于老年人尤为适宜。如果大小便燥结非常严重，想通便却通不下来，上厕所时用力过猛，大便仍然不通，导致气机被强行挣脱，下注于肛门，有时排出清水，伴有里急后重（腹痛窘迫，时时欲泻，肛门重坠，便出不爽），痛苦难忍，胸膈间感觉梗塞不适而恶心，干呕有声，口渴想喝水，饮食不进，呻吟不止。想要通利大便则气机会随之脱陷，此时应当合用葶苈子和桑白皮，这两味药兼具泻肺行水之功，必然能击中病处，其间再辅以木通、滑石来辅助，更能透达病所。虽然如此，大便和小便的脉络是相互贯通的，有的人多天小便不通，只需使用神保丸。（血燥津液枯竭，都会导致排便困难。神保丸等方剂治疗实证固然巧妙，但对于年老津液枯竭者，不可不仔细审察。）制成葶苈丸，使其大泻数次，小便自然通利。按语：这种方法适用于实证患者，不可不仔细审察。如果二便都闭塞，只通利大便，小便片刻之后自然会下来。如果气机已经脱陷，再用攻下法就会导致绝症；如果用固涩法，则尿液和燥屎会在腹肠间胀满，恐怕反而加重病情。采用升提之法使气机自举，而秽浊之物独不被气机所结聚，自然就会通利，但如果呕吐恶心不堪忍受，又该如何处置呢？我的姑母八十多岁时，曾患此病，我只想用调气利小便的药物，虽然仅获得部分疗效，但未获全功。我曾安慰她，让她不要性急，后来她因不能忍耐，突然索取末药（散剂）通利下行数次，没有告诉我。自以为稍微舒服了，但脉搏忽然出现数动一止（促脉或结代脉），气息微弱，颓然倒在床褥上。我知道真气已经泄出，如果不加以收摄，恐怕就无法挽救。急忙投用生脉散类药物，服用几剂后，结脉才消退，于是配合益血润肠丸一起服用，劝她不要服用其他药物，久而久之自有奇效。按照这个方法调理了两个多月，二便通调，四肢康健胜过平时。假使贪图眼前的痛快，蔑视探求根本的明智，难道能免于后悔吗？便秘是老年人的常事，大概是因为精气固守而不妄泄，所以能长寿。而一时难以忍受，就躁动扰乱而导致疾病，如果寻求通润的方剂，不是补益血液而滋补肾阴，怎么行得通呢？这个丸方虽然是为我的姑母设立的，但可以通行天下，所以把它列出来，作为孝子赡养父母、仁人安顿老人的帮助。
益血润肠丸方：熟地黄六两，杏仁炒后去皮尖，枳壳用麸皮炒至黄色，麻仁拣去壳令其干净（因为壳反而会使大肠涩滞），备三两，以上三味药各捣成膏状；橘红三两五钱，阿胶炒制，肉苁蓉用酥油煮透后烘干，各一两五钱，苏子炒研，琐阳用酥油煮，荆芥各一钱。
将上述药材研为细末，以前三味药膏同杵千余下，再加入炼蜜制成丸药，如梧桐子大，每次服用五六十丸，空腹时用白开水送服。
大法说：大便秘结，服用神芎丸。大便不通，小便反而通利，这是不知道燥湿的过错，本是大肠缺少津液，却用寒燥的药物来治疗。因此变得更加干燥，少服则无效，多服则耗伤血液。所以导致不通，如果使用四物汤、麻子、杏仁之类就可以。经书说：燥盛则为枯槁。用湿剂来滋润它。肾燥导致排便困难。
益血润肠丸，是王道之师（温和有效的方剂），不是神芎丸那种引起瞑眩反应（服药后出现剧烈反应以祛邪）的方剂。如果津液枯竭，应当使用四物汤润燥，间服益血润肠丸。
The *Jingui Zhenyan Lun* (Treatise on True Discussions of the Golden Cabinet) states: The North corresponds to the color black, internally connects with the Kidney (Shen, 肾), and externally opens into the two orifices (the urethra and anus). Therefore, when Kidney Yin is deficient, difficulty in urination and defecation occurs. It is appropriate to use herbs such as Shudi Huang (Rehmanniae Radix Praeparata, 熟地黄), Rongrong (Cistanches Herba, 肉苁蓉), Cheqianzi (Plantaginis Semen, 车前子), and Fuling (Poria, 茯苓) to tonify True Yin and promote water passages. A small amount of acrid-warm herbs should be added to open the cou li (interstitial spaces/skin pores), facilitate the generation of body fluids, and moisten dryness; this method is particularly suitable for the elderly. If dryness and constipation are severe, and one cannot defecate despite straining excessively in the toilet, causing Qi to be forcibly disrupted and sinking into the anus, sometimes clear fluid leaks out, accompanied by tenesmus (a feeling of incomplete defecation with urgency and heaviness in the rectum) that is unbearable, a sensation of obstruction in the chest and diaphragm with nausea, dry heaving with sound, thirst with desire for water, inability to eat, and continuous groaning. If one attempts to promote bowel movement, Qi may collapse downward. In such cases, Tingli (Descurainiae Semen seu Lepidii Semen, 葶苈子) and Sangbaipi (Mori Cortex, 桑白皮) should be used together; their combined action will surely hit the target. Mutong (Akebiae Caulis, 木通) and Huashi (Talcum, 滑石) can be added as assistants to enhance penetration. Although the meridians of the large and small intestines are interconnected, some people suffer from urinary retention for many days and can be treated simply with Shenbao Wan (Divine Preservation Pill). (Blood dryness and depletion of body fluids both lead to difficult defecation. Shenbao Wan and similar formulas are excellent for excess patterns, but for the elderly with depleted fluids, careful examination is essential.) Prepared as Tingli Wan, causing several large bowel movements, urination will naturally resume. Note: This method is applicable only to excess patterns and requires careful assessment. If both urine and stool are blocked, promoting only the stool will cause urine to flow spontaneously shortly after. If Qi has already collapsed, using purgatives will lead to death; if astringents are used, urine and dry feces will distend the abdomen and intestines, likely worsening the condition. Using lifting methods to raise Qi, while allowing waste to pass without being bound by Qi, will naturally result in unblocking. However, if vomiting and nausea are unbearable, how should this be managed? My paternal aunt, over eighty years old, once suffered from this illness. I initially intended to use herbs that regulate Qi and promote urination. Although she gained partial relief, full recovery was not achieved. I comforted her, advising patience. Later, unable to endure further, she secretly took powdered laxatives multiple times without informing me. She felt slightly relieved, but her pulse suddenly became rapid with intermittent stops (Cu or Jie Dai pulse), her breath grew faint, and she collapsed onto the bed. I realized that True Qi had leaked out. Without immediate consolidation, she might not survive. I urgently administered Shengmai San (Generate the Pulse Powder), and after several doses, the irregular pulse subsided. Then, Yixue Runchang Wan (Nourish Blood and Moisten Intestine Pill) was combined and taken. I advised against taking other medicines. Over time, miraculous effects appeared. Following this regimen for over two months, her urination and defecation normalized, and her limbs recovered better than usual. Had she sought immediate relief and disregarded the wisdom of addressing the root cause, could she have avoided regret? Constipation is common among the elderly, largely because their essence is conserved rather than wasted, which contributes to longevity. When discomfort arises, impatience leads to agitation and disease. To seek remedies for unblocking and moistening, one must nourish blood and tonify kidney yin; otherwise, it is impossible. Although this pill formula was originally designed for my aunt, it can be applied universally. Thus, I present it as an aid for filial sons caring for parents and benevolent persons supporting the elderly.
Yixue Runchang Wan Formula: Shudi Huang (Prepared Rehmannia Root) 6 liang; Xingren (Apricot Seed), stir-fried and peeled; Zhike (Bitter Orange Peel), stir-fried with bran until yellow; Haren (Hemp Seed), shells removed to ensure purity (as shells can cause intestinal astringency), prepared quantity 3 liang. The above three herbs are each pounded into paste. Juhong (Exocarpium Citri Reticulatae Rubrum) 3.5 liang; Ejiao (Donkey-hide Gelatin), stir-fried; Rongrong (Cistanche Stem), cooked with su (animal fat/butter) until thorough, then dried, each 1.5 liang; Suzi (Perilla Fruit), stir-fried and ground; Suoyang (Cynomorium Herb), cooked with su; Jingjie (Schizonepeta Herb), each 1 qian.
Grind all ingredients into fine powder. Mix with the pastes of the first three herbs, pounding more than a thousand times. Add refined honey to form pills, sized like tung tree seeds. Take 50-60 pills per dose, on an empty stomach, washed down with plain warm water.
The Great Method states: For severe constipation, take Shenxiong Wan (Divine Xionghuang Pill). If stool is blocked but urine flows freely, it indicates a misunderstanding of dryness and dampness. The root cause is insufficient body fluids in the Large Intestine, yet cold-drying herbs are used for treatment. This exacerbates dryness; a small dose is ineffective, while a large dose depletes blood. Hence, blockage persists. Using Siwu Tang (Four Substances Decoction), Hemp Seed, or Apricot Seed would be appropriate. The Classics state: "Excessive dryness leads to withering." Wet agents are used to moisten it. Kidney dryness causes difficult defecation.
Yixue Runchang Wan is a "King's Way" army (gentle and effective remedy), unlike Shenxiong Wan which causes mingxuan reactions (severe initial reaction to expel pathogens). If body fluids are depleted, use Siwu Tang to moisten dryness, and intermittently take Yixue Runchang Wan.