The patient has not had a bowel movement for five or six days, experiences pain around the navel, dysphoria, and these symptoms occur intermittently. This indicates the presence of dry stool, which is causing the lack of bowel movement.

bubble_chart Note

• If a patient has not had a bowel movement for five or six days and experiences pain around the navel, it is due to dry stool in the intestines and stomach with no way out, hence the pain around the navel.
• The intermittent occurrence of dysphoria is due to the foul heat from the dry stool attacking upwards, causing dysphoria; when it does not attack, there is no dysphoria, hence the symptoms occur intermittently.
• There is no need to test with Minor Purgative Decoction, but directly use Major Purgative Decoction to expel the dry stool, and the bowel movement will naturally improve.

bubble_chart Collected Annotations

• Fang You-zhi said: "The term 'patient' refers to anyone who is ill and exhibits these symptoms, and should be treated accordingly. This demonstrates the main principle of identifying any stomach excess."
• Cheng Yingmao said: "The method of purging must wait until there is dry stool to avoid mistaken purging. Therefore, the method to verify the presence of dry stool must be comprehensive and not rely solely on the passing of gas. Even if a patient has not had a bowel movement for five or six days, it is uncertain whether the stool is dry or not. However, if there is pain around the navel, it indicates dryness in the intestines and stomach, with stool having no way out, stagnating and causing pain in one place; the intermittent occurrence of dysphoria is due to the stool's qi attacking and moving, causing dysphoria; sometimes it lies dormant and does not move, and there is no dysphoria, but there is pain around the navel, then it can be concluded that the lack of bowel movement is accurate, so why not use Major Purgative Decoction to purge?"