1. Maziren Wan from "Shang Han Lun"

1. Maziren Wan from "Shang Han Lun"

[Composition] Mazhu ren 15 grams (two sheng), Xing ren 9 grams (one sheng), Citrus aurantium immaturus 9 grams (half jin), Rheum palmatum 9 grams (one jin, peeled), Magnolia officinalis 9 grams (one chi, roasted and peeled), Peony root 9 grams (half jin).

[Administration] Grind all ingredients into powder, mix with white honey to form pills the size of a wutong seed, take ten pills daily, three times a day. Modern usage: take 9 grams each time, once or twice a day, washed down with warm water.

[Indications] Pathogenic heat damages yin, leading to dry and hard stools.

[Symptoms] Abdominal distension, severe constipation, frequent urination, and a floating, rough pulse at the foot of the leg.

[Functions] Clear heat and nourish yin, lubricate the intestines and promote bowel movements.

[Explanation] According to "Shang Han Lun," "When the pulse at the foot of the leg is floating and rough, floating indicates strong stomach qi, while rough indicates frequent urination; the combination of floating and rough leads to hard stools, with the spleen acting as a constraint. Maziren Wan is the primary remedy." It is evident that the pathogenesis of this formula lies in the imbalance between strong stomach qi and weak spleen qi. The stomach belongs to the Yangming meridian; when it is strong, it damages yin fluids and leads to dry, hard stools. Weak spleen qi is relative to strong stomach qi, indicating an imbalance between yin and yang in the spleen and stomach—yang prevails over yin, meaning yin cannot control yang, and the spleen cannot restrain the stomach. Hence, this formula is also known as Spleen Constraint Pill. In this formula, Rheum palmatum clears fire and promotes bowel movements, addressing the root cause as the primary function; Mazhu ren, Xing ren, and white honey lubricate the intestines and promote bowel movements as supplementary actions; when the qi of the organs is blocked, it leads to abdominal distension, so Citrus aurantium and Magnolia officinalis help regulate qi and expand the middle burner as additional measures; dry heat easily damages yin and blood, so Peony root nourishes yin and replenishes blood as an additional measure.

[Clinical Modifications] ① Remove Citrus aurantium, Magnolia officinalis, and Peony root, add Dang Gui, Qiang Huo, and Tao Ren to form Run Chang Wan ("Spleen and Stomach Theory"). Treats constipation caused by dietary fatigue. ② Add Sophora japonica and Sanguisorba officinalis to treat hemorrhoids with bleeding.

[Reference Materials] Weak spleen qi must be strengthened! Why use Rheum palmatum, Magnolia officinalis, and Citrus aurantium? The spleen soil is too dry, causing the gastrointestinal tract to lack fluids, making it difficult to digest food. If the spleen is weak, it either produces loose stools or diarrhea—how can it possibly constrain the amount of food consumed in the stomach? (Yu Jia Yan)

[Commentary] This formula is often used for habitual constipation and constipation caused by hemorrhoids. However, since the formula contains many purgative ingredients, it is not suitable for those with weak constitutions, the elderly, or pregnant women.