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The verse:

“趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则硬，其脾为约，麻子仁丸主之。” (line 247)

Here we get a glimpse of the unfettered logic of Zhang Ji and perhaps all his predecessors and post-decessors. He says that the fuyang pulse is floating and rough (literally: astringent). And then he explains why: floating means that the stomach qi is strong (from this we know that during exterior illnesses, your stomach qi is always strong enough for you to garner up some immune reaction), and rough means your pee comes out fast.

And he continues: Now, when floating and rough interact, your shit will be hard. The logic of this two-pronged:

1. when your stomach qi is strong, you won’t produce sloppy shit (便溏).
2. when your pee is coming out alot, the level of fluids in the shit is also compromised.

The concept of 脾约：

“When the shit is hard, your spleen must be hindered.” This is the what the last part of the line is trying to say. And we can then link the idea of strong stomach qi to weak spleen qi. A relative idea albeit, but it then gave birth to the idea of 胃强脾弱.

The next verse:

“脉阳微而汗出少者，为自和也，

汗出多者，为太过。” (line 245a)

“阳脉实，因发其汗，出多者，亦为太过。” (line 245b)

“太过者，为阳绝于里，亡津液，大便因硬也。” (line 245c)

The above three sections of line 245 are summarized as below:

1. When the surface pulse is weak and
   1. sweating is mild, the situation will resolve (harmonize) on its own.
   2. sweating is alot, it is considered in excess.
2. When the surface pulse is replete, if due to perspiration the sweat is alot, it is also considered in excess.
3. That which is in excess, is where yang is trapped inside, drying up all the fluids, thence will the shit be hard.

Okay, he explains that sweating in excess will cause yang to build up but be trapped inside. His rationale is not that fluids are lost via sweating - rather fluids are dried up inside, causing the interior to be lacking in fluids, hence the hard stool.

From here, we can recap that there are two ways to cause hard shit:

1. One is by having strong agni (stomach fire) while having your urine drain very quickly
2. The other is by sweating alot.

The next and last verse supports first patho-mechanism:

“脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气生热，其阳则绝。” (line 246)

Again, our dear Zhang Ji uses the pulse as a starting point to explain what happens in the organs. Two pulses interacts and cause the stomach qi to create fire. This fire then is trapped [inside].

Back to 麻子仁丸 - Something on how to prepare it:

“上六味，蜜和丸如梧桐子大，饮服十丸 ，日三服，渐加，以知为度。

The important point is to take the six herbs and roll it into huge balls (size of a 梧桐子) with honey. Then swallow down ten balls each time, three times daily, until not necessary.