Written By Jun Heo (許浚, 1539~1615), translated by Namil Kim, Wung Seok Cha et al. Published by Ministry of Health & Welfare (Korea).
21 Constipation 大便秘結 변비
① The kidney is in charge of the five humor. Feces is normal when it gets wet by fluid and humor. Starving, overeating, overworking, or eating spicy and hot food hide the Fire pathogen in blood, which consumes true yin and results in dried and constipated stools. In the Classic (經), it is said, “Because the kidneys dislike dry things, the patient has to eat a pungent taste urgently so it can get wet.”
② As there is a yang bound pulse and yin bound pulse, how can they be distinguished? Yang bound accompanies the floating and rapid pulse, good intake of food, and difficulties in defacation that becomes even more severe after seventeen days. Yin bound is where the pulse is sunken and slow and the patient cannot eat well with heaviness of body and hardened feces, which worsens after fourteen days.
③ There are heat-dryness, wind-dryness, yang bound, and yin bound types in constipation. In the Classic (經), it is said, “What is bound should be dispersed.” It means that bound yang should be dispersed and bound yin should be warmed. Rhubarb Morning Glory Powder (大黃牽牛散) is prescribed for bound yang and a Pinellia and Sulphur Pill (半硫丸) for bound yin.
④ Jo Gyul (燥 結:Dry stagnation in the stomach and intestines.) Is blocked feces. As dryness pertains to lesser yin with little fluid and humor, it should be moistened by a spicy taste. Also, stagnation belonging to greater yin should be induced for diarrhea with a bitter taste.
⑤ Treatment of constipation cannot be described in a word since there are excess and deficient types. Excess constipation comes from food and deficient constipation comes from qi. The patient with an excess stomach and constipation will be able to take in food well and the urine will be red. A Spleen Restraint Pill and Seven Substances Draining Pill (七宣丸) are commonly used. However, the patient with a deficient stomach will not be able to take food well and clear urine will come without difficulty. A Magnolia Bark Decoction (厚朴湯) is commonly prescribed.
⑥ There are excess and deficient constipation. The excess type should be softened of the hardness and release the accumulation by cleaning the intestine-stomach. Herbs like Rhei Radix et Rhizoma (大黃), Natrii Sulfas (芒硝), Ponciri Fructus Immaturus (枳實), and Magnoliae Cortex (厚朴) similar to an Order the qi Decoction should be used. Angelica Gigantis Radix (當歸), Rehmanniae Radix Crudus (地黃), Persicae Semen (桃 仁), Cannabis Semen (麻仁), and Scutellariae Radix (黃芩) (thin one with a full interior) similar to Moisten Dryness Decoction (潤燥湯) are prescribed for deficient cases.
⑦ Although Persicae Semen (桃仁) and Armeniacae Semen (杏 仁) treat constipation, they have to be used after qi and blood are well identified. Difficulties of defacation during the day result from problems in yang qi and Armeniacae Semen (杏仁) should be used, and difficulties of defacation in night are from problems in yin-blood and Persicae Semen (桃仁) should be chosen. Constipation in the aged or deficient person with a floating pulse results from qi so Armeniacae Semen (杏仁) and Citrus Unshius Pericarpium (陳皮) should be used. Persicae Semen (桃仁) and Citrus Unshius Pericarpium (陳皮) should be used in persons with a sunken pulse, which means problems in blood. The reason Citrus Unshius Pericarpium (陳皮) is used in both types is that the large intestine meridian and lung meridian are in the exterior-interior relationship.
⑧ Blood dryness should be treated with Persicae Semen (桃仁) and Rhei Radix et Rhizoma (大黃) (processed with alcohol) and qi dryness should be treated with Armeniacae Semen (杏仁) and Ponciri Fructus Immaturus (枳實). Add Cannabis Semen (麻仁) and Rhei Radix et Rhizoma (大黃) for wind dryness and moisten with Pruni Nakaii Semen (郁李仁) and Gleditsiae Semen (皂子) when qi does not flow smoothly.
⑨ Prescribe a Dredge Wind and Moisten Intestines Pill, Honeylocust Fruit Formula, and Invigorate Blood and Moisten Dryness Pill for wind dryness.
⑩ Prescribe a Moisten Intestines Pill, Moistening Cannabis Seeds Pill, Cistanche and Aquilaria Pill, Five Seeds Enable Pregnancy Pill, Minor Cannabis Seed Pill, Unblock Hidden Decoction, Harmonise Blood and Moisten Intestines Decoction, and Angelica Moisten Dryness Decoction for blood dryness.
⑪ Prescribe a Ginseng and Cannabis Pill, Track Down Wind and Moisten Intestines Pill, Triple Harmonies Decoction, Four Milled Herbs Decoction, and Six Milled Ingredients Decoction for qi stagnation.
⑫ Prescribe Unblock Spirit Powder and Great Cannabis Seed Pill for women’s constipation.
- Rhubarb Morning Glory Powder 大黃牽牛散 대황견우산: It treats constipation by moving ministerial Fire to the viscera and bowels. Rhei Radix et Rhizoma (大黃) 1 nyang, and Pharbitidis Semen (黑丑) (first powder after grinding and sieving) 5 don. Powder these medicines and take 3 don at a time. It should be taken with alcohol if the patient’s hands and feet are cold, and with honey water if the hands and feet are hot.
- Pinellia and Sulphur Pill 半硫丸 반류환: It treats constipation in the aged from bound phlegm. Pinelliae Tuber (半夏) (dried after soaked in Zingiberis Rhizoma (乾薑) juice, and then powdered), Sulfur (硫黃) (ground very finely and then pounded with a hammer made of a willow tree). Prepare the same quantities of each herb and make into dough with slices soaked in Zingiberis Rhizoma (乾薑) juice and make into pills the size of a seed of a foxglove tree. Take 50~70 pills with warm alcohol or water decocted with Zingiberis Rhizoma (乾薑).
- Seven Substances Draining Pill 七宣丸 칠선환: It treats constipation from heat maintained in the intestines. Rhei Radix et Rhizoma (大黃) 1 nyang, Aucklandiae Radix (木香), Arecae Semen (檳榔), Terminaliae Fructus (訶子皮) 5 don each, and 12 Persicae Semen (桃仁). Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50 pills with warm water.
- Magnolia Bark Decoction 厚朴湯 후박탕: It treats deficient-type constipation. Atractylodis Rhizoma (蒼朮) 2 don, Magnoliae Cortex (厚朴) 1.3 don, Citrus Unshius Pericarpium (陳皮), Glycyrrhizae Radix (甘草) 1 don each, Pinelliae Tube Fermentata (半夏麴) 9 pun, and Ponciri Fructus Immaturus (枳實) 8 pun. Slice these medicines as 1 pack, put 3 pieces of Zingiberis Rhizoma (乾薑), 2 Zizyphi Fructus (大棗), decoct in water, and take.
- Angelica Moisten Dryness Decoction 當歸潤燥湯 당귀윤조탕: This is also known as a “Moisten Dryness Decoction”. It treats constipation from blood dryness. Angelica Gigantis Radix (當歸), Rhei Radix et Rhizoma (大黃), Rehmanniae Radix Preparata (熟地黃), Persicae Semen (桃仁), Cannabis Semen (麻仁), Glycyrrhizae Radix (甘草) (raw one) 1 don each, Rehmanniae Radix Crudus (生地黃), Cimicifugae Rhizoma (升麻) 7 pun each, and Carthami Flos (紅 花) 2 pun. Slice these medicines and decoct the seven medicinals as 1 pack until half remains. Then add Persicae Semen (桃仁) and Cannabis Semen (麻仁) and decoct again until half remains. Take on an empty stomach.
- Dredge Wind and Moisten Intestines Pill 疏風潤腸丸 소풍윤장환: It treats blocked and dried feces from accumulated wind-heat. When dryness is moistened and blood is harmonized, wind will be removed and constipation will be treated naturally. Cannabis Semen (麻仁) 2.5 nyang, Persicae Semen (桃仁) 2 nyang, Gleditsiae Spina (皂角) (burned while maintaining the property) 1.3 nyang, Rhei Radix et Rhizoma (大黃), Osterici Radix (羌活) 1 nyang each, Saposhnikoviae Radix (防風), and Angelica Gigantis Radix (當歸) 3 don each. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50~70 pills with boiled water.
- Honey Locust Fruit Formula 皂角元 조각원: It is only for constipation in patients with wind stroke. Osterici Radix (羌活), Saposhnikoviae Radix (防風), Gleditsiae Spina (猪牙皂角), Aruantii Fructus Immaturus (枳殼), Mori Cortex (桑白皮), Arecae Semen (檳榔), Armeniacae Semen (杏仁), Cannabis Semen (麻仁), Angelicae Dahuricae Radix (白芷), and Citrus Unshius Pericarpium (陳皮) all the same quantities. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 30~50 pills with warm water. Add Rhei Radix et Rhizoma (大黃) when heat exists.
- Invigorate Blood and Moisten Dryness Pill 活血潤燥丸 활혈윤조환: It treats dried and bound feces from wind or blood. This is same as the Dredge Wind and Moisten Intestines Pill which was introduced previously. The only difference lies in the use of the seeds of Gleditsiae Spina (皂角).
- Moisten Intestines Pill 潤腸丸 윤장환: It treats constipation. Armeniacae Semen (杏仁), Aruantii Fructus Immaturus (枳殼), Cannabis Semen (麻仁), Citrus Unshius Pericarpium (陳皮) 5 don each, Asini CoriiColla (阿膠珠), and Saposhnikoviae Radix (防風) 2.5 don each. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50 pills at a time. The aged should take with water decocted with Perillae Semen (蘇子) and others should take with water decocted with Schizonepetae Spica (荊芥).
- Moistening Cannabis Seeds Pill 潤麻丸 윤마환: ① It treats constipation from blood dryness by moistening. Cannabis Semen (麻仁), Persicae Semen (桃仁), Rehmanniae Radix Crudus (生地黃), Angelica Gigantis Radix (當歸), and Aruantii Fructus Immaturus (枳殼) 1 nyang each. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50 pills each time with boiled water. ② In the Orthodox Transmission of Medicine (正傳) it is called a Moisten the Private Parts Pill.
- Cistanche and Aquilaria Pill 蓯沈丸 종침환: This is also known as a Cistanche Pill to Moisten the Intestines. It treats constant constipation from the loss of fluid and humor. Cistanchis Herba (肉 蓗蓉) 2 nyang, Aquillariae Lignum (沈香) 1 nyang. Powder these medicines, make into paste by adding Cannabis Semen (麻仁) juice, and make into pills the size of a seed of a foxglove tree. Take 70 pills each with porridge on an empty stomach.
- Five Seeds Enable Pregnancy Pill 五仁丸 오인환: This is also known as a Five Seeds Enable Pregnancy Pill to Moisten the Intestines. It treats constipation from the exhaustion of fluid and humor. This is all the effective for postnatal constipation. Citrus Unshius Pericarpium (橘紅) 4 nyang (powdered separately), Persicae Semen (桃仁), Armeniacae Semen (杏仁) 1 nyang each, Thujae Orientalis Semen (柏子仁) 5 don, Pruni Nakaii Semen (郁李仁) (fried) 2 don, and pinenuts 1.25 don. Powder these medicines each, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50~70 pills each time with porridge on an empty stomach.
- Minor Cannabis Seed Pill 小麻仁丸 소마인환: It treats constipation from blood dryness. This prescription is the same as the Moistening Cannabis Seeds Pill mentioned previously.
- Unblock Hidden Decoction 通幽湯 통유탕: It treats difficulties in defaction from blocked pylorus. It should be moistened with a spicy taste. Cimicifugae Rhizoma (升麻), Persicae Semen (桃仁) (ground sticky), Angelica Gigantis Radix (當歸) (body part) 1.5 don each, Rehmanniae Radix Crudus (生地黃), Rehmanniae Radix Preparata (熟地黃) 7 pun each, Glycyrrhizae Radix (甘草) (baked), and Carthami Flos (紅花) 2 pun each. Slice these medicines, decoct it as 1 pack and remove the leftovers, add Arecae Semen (檳榔) (powdered finely) 0.5 don, and take.
- Harmonise Blood and Moisten Intestines Decoction 和血潤腸湯 화혈윤장탕: It treats dried and bound feces. Cimicifugae Rhizoma (升麻), Persicae Semen (桃 仁), Cannabis Semen (麻仁) 1.5 don each, Rhei Radix et Rhizoma (大黃), Rehmanniae Radix Preparata (熟地黃), Angelica Gigantis Radix (當歸) (rootlets) 7 pun each, Rehmanniae Radix Crudus (生地黃), Glycyrrhizae Radix (甘草) (raw one) 5 pun each, and Carthami Flos (紅花) 3 pun. Slice these medicines as 1 pack, decoct with water, and take.
- Ginseng and Cannabis Pill 參仁丸 삼인환: It treats constipation from blocked qi. Cannabis Semen (麻仁), Rhei Radix et Rhizoma (大黃) 3 nyang each, Angelica Gigantis Radix (當歸) (body part) 1 nyang, and Ginseng Radix (人參) 7. 5 don. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 30 pills each time with boiled water on an empty stomach.
- Track Down Wind and Moisten Intestines Pill 搜風潤腸丸 수풍윤 장환: It treats obstructions of the chest and abdomen and constipation from the blocked flow of qi resulting from disharmony of the triple energizers. Pruni Nakaii Semen (郁李仁) 1 nyang, Aucklandiae Radix (木香), Arecae Semen (檳榔), Citri Unshius Pericarpium Immaturus (靑皮), Citrus Unshius Pericarpium (陳皮), Aquillariae Lignum (沈香), Raphani Semen (蘿蔔子) (fried), Sophorae Fructus (槐角), Aruantii Fructus Immaturus (枳殼), Ponciri Fructus Immaturus (枳實), Sparganii Rhizoma (三稜) (baked while buried under an ash Fire), and Rhei Radix et Rhizoma (大黃) 5 don each. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50~70 pills each time with porridge on an empty stomach.
- Triple Harmonies Decoction 三和湯 삼화탕: It treats constipation from qi stagnation. This is the same as the Triple Harmony Powder mentioned in the chapter Qi.
- Four Milled Herbs Decoction 四磨湯 사마탕: It treats constipation from qi stagnation. Large Arecae Semen (檳榔), Aquillariae Lignum (沈香), Aucklandiae Radix (木香), and Linderae Radix (烏藥). Put the same quantities of the four medicines in water and grind thick, fill seven-tenth of a glass, and decoct until it boils three to five times. Then take it warm on an empty stomach.
- Six Milled Ingredients Decoction 六磨湯 육마탕: It treats constipation accompanied by heat. Add Rhei Radix et Rhizoma (大黃) and Aruantii Fructus Immaturus (枳殼) to a Four Milled Herbs Decoction. Take the thick ground juice as in a Four Milled Herbs Decoction.
- Divine Unblocking Powder 通神散 통신산: It treats blocked feces in women. Rhei Radix et Rhizoma (大黃), Natrii Sulfas (芒硝), Persicae Semen (桃仁), Pruni Nakaii Semen (郁李仁) 1 nyang each, and Aucklandiae Radix (木香) 5 don. Powder these medicines, take 2 don at a time in porridge.
- Great Cannabis Seed Pill 大麻仁丸 대마인환: It treats wind constipation in women. Aucklandiae Radix (木香), Arecae Semen (檳榔), Aruantii Fructus Immaturus (枳殼) 1 nyang each, Cannabis Semen (麻仁), and Rhei Radix et Rhizoma (大黃) (fried) 3 don each. Grind these and knead with honey and make into pills the size of a seed of a foxglove tree. Take 30~50 pills at a time with boiled water on an empty stomach.
22 Constipation in the Aged 老人秘結 노인의 변비
① Rhei Radix et Rhizoma (大黃) should not be used for constipation in the aged since the desease is from decreased fluid and humor. Intake of Rhei Radix et Rhizoma (大黃) may induce diarrhea and remove all fluid and humor, which in turn results in more severe constipation. Therefore, moistening medicine for the large intestine should be taken. It is also effective to wash the anus with water boiled with Sophorae Flos (槐花).
② A Dredge Wind and Smooth Qi Formula, Minor Honey Locust Fruit Formula, Two Seeds Formula, Aurantii and Apricot Pill, Astragalus Decoction, Honey Glue Decoction, Perilla and Ephedra Porridge (蘇麻粥), or Three Kernels Porridge (三仁粥) should be used for constipation in the aged.
③ It is good to drink milk, cattle milk, Seonji soup, and sesame oil all the time.
- Dredge Wind and Smooth Qi Formula 疏風順氣元 소풍순기원: ① It treats blocked stools and urine from accumulated heat in the intestines, wind constipation, and qi constipation. This is better for constipation in the aged. Rhei Radix et Rhizoma (大黃) (steamed 7 times in alcohol and dried under the sun) 5 nyang, Plantaginis Semen (車前子) (fried) 2.5 nyang, Pruni Nakaii Semen (郁李仁), Arecae Semen (檳榔), Cannabis Semen (麻仁) (fried slightly), Cuscutae Semen (兎絲子) (processed with alcohol), Achyranthis Radix (牛膝) (washed with alcohol), Dioscoreae Rhizoma (山藥), Corni Fructus (山茱萸) 2 nyang each, Aruantii Fructus Immaturus (枳殼), Saposhnikoviae Radix (防風), Araliae Continentalis Radix (獨活) 1 nyang each. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50~70 pills at a time with tea, alcohol, or porridge on an empty stomach. ② In treating constipation, this is a really good prescription. The mind becomes healthy and all diseases do not occur if this medicine is taken for a long period. This is better for the old person.
- Minor Honey Locust Fruit Formula 小皂角元 소조각원: It treats constipation due to wind. It is for the aged. Gleditsiae Spina (皂角) (baked), Aruantii Fructus Immaturus (枳殼) the same quantities. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 70 pills at a time with porridge.
- Two Seeds Formula 二仁元 이인원: It treats wind constipation in the aged and deficient persons. Armeniacae Semen (杏仁), Cannabis Semen (麻仁), Aruantii Fructus Immaturus (枳殼), Terminaliae Fructus (訶子肉) all the same quantities. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50 pills at a time with warm water.
- Aurantii and Apricot Pill 橘杏丸 귤행환: ① It treats qi constipation in the aged and deficient persons. Blocked feces will naturally be unblocked after taking this medicine. Citrus Unshius Pericarpium (橘皮) and Armeniacae Semen (杏仁) all same quantity. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 70 pills at time with porridge. ② This prescription treats constipation during daytime. Constipation at night time should be prescribed with the addition of Persicae Semen (桃仁) in place of Armeniacae Semen (杏仁).
- Astragalus Decoction 黃芪湯 황기탕: It treats constipation of the aged. Astragali Radix (黃芪) and Citrus Unshius Pericarpium (陳皮) 5 don each. Powder these medicines. Boil 1 glass of Cannabis Semen (麻仁) juice in a silver bowl or stone bowl. When milk-like liquid appears, put one big spoon of honey and boil again. Add 3 don of the powder and take on an empty stomach. It will show effect after taking the medicine twice and constipation will not reoccur when taken everyday.
- Honey Glue Decoction 膠蜜湯 교밀탕: It treats constipation in the aged and deficient persons. Boil 3 stems of large Allii Fistulosi Bulbus (葱白) with its root in one glass of new water and pick out the stems. Then put 2 don of clear Asini Corii Colla (阿膠珠) and 2 spoons of honey. After mixing and melting them, take on an empty stomach.
- Perilla and Ephedra Porridge 蘇麻粥 소마죽: ① It unblocks the stools by smoothing the flow of qi. It treats wind constipation and blood constipation in the aged and deficient persons. Postpartum women with constipation should also take this. Pound the same quantities of Perillae Semen (蘇子), Cannabis Semen (麻子), and mix with water and filter the juice. Then make porridge with nonglutinous rice powder and take. It is better to take it for a long time. ② An aged women suddenly had abdominal pain, headaches, and nausea that she was unable to eat anything. This is wind constipation in the aged. Abdominal bloating and nausea result from blocked viscera and bowels which reach up to the top of head to cause headaches and unclear spirit. When this porridge is taken two times, qi will leak out, and about ten balls of bound feces will be discharged. Then the viscera and bowels will be moderated and the patient will be completely recovered.
- Three Seeds Porridge 三仁粥 삼인죽: It treats constipation. The aged and deficient persons can all take this. Persicae Semen (桃仁), Pine nut 1 hop each, and Pruni Nakaii Semen (郁李仁) 1 don. Pound these medicines, mix with water, and filter the juice. Put some nonglutinous rice and cook into porridge. Take it on an empty stomach.
23 Splenic Constipation 脾約證 비약증
① When the patient has spontaneous sweating and frequent urination in yang brightness disease of Cold Damage, humor and fluid are exhausted and constipation results. It is because the spleen is fastened, so a spleen Restraint Pill is prescribed commonly.
② Cheng Wuji (成無已) said, “As the stomach is strong and spleen is weak and fastened that fluid and humor is not spread and only sent to the bladder, there is always frequent urination and constipation.” A Spleen Restraint Pill should be used to discharge what is bound in the spleen and what is dried. Danxi (丹溪) said, “That the spleen is weak, the soil waned and lung-Metal is suppressed by Fire so that the lung is emaciated with exhausted fluid and humor. Since the spleen lost the delivering function and the lungs lost the delivering function, there results constipation and frequent urination. Therefore, yin-blood should be raised to control exuberant yang-Fire. Then lung-Metal will have the clearing function and spleen-soil will become clear and healthy which in turn moves fluid and humor, moistens the intestines, and unblocks constipation to normal stools. This pill medicine was always effective to persons with excess heat and excess qi and strong North-western people. In South-eastern people or persons with severe heat and weak qi and blood, it will function to weaken the spleen and intestines. Therefore, persons of the south-eastern region, or persons with much heat and weak qi and blood should experience weakening spleen and drying intestine when this medicine is used. Treatment should be focused on puncturing what is bound in the north-western region and moistening dryness in the south-eastern region.”
- Spleen Restraint Pill 脾約丸 비약환: Also known as a Cannabis Fruit Pill, it treats frequent urination and difficult stools. This symptom is called splenic constipation. Rhei Radix et Rhizoma (大 黃) (steamed) 4 nyang, Ponciri Fructus Immaturus (枳實), Magnoliae Cortex (厚朴), Paeoniae Radix (赤芍藥) 2 nyang each, Cannabis Semen (麻仁) 1.5 nyang, and Armeniacae Semen (杏仁) 1.25 nyang. Powder these medicines, make into dough with honey, and make into pills the size of a seed of a foxglove tree. Take 50 pills each time with warm water on an empty stomach.
