凡治泻须理中焦，如理中汤丸等是也；次即分利水谷，如五苓散等是也。治中不效，然
后断下，即用禹余粮赤石脂等是也。玉机真脏论云∶五虚死。谓脉细，皮寒，少气，前后泄
利，饮食不入，得此必死。其有生者，浆粥入胃泄注止，则活也。又《金匮》云∶六腑气绝
于外者，手足寒，上气脚缩；五脏气绝于内者，下利不禁，甚者手足不仁。脉沉弦者为下重
，脉大者为未止。泄利手足厥冷，无脉，灸之不温，脉不还，微喘者死。有微热而渴，自汗
，脉或微弦数弱，法并当自愈。或脉沉迟而面少赤，身微热，郁冒汗出而解，必微厥，所以
然者，以其面戴阳，下虚故也。泄利后，腹胀满，身体疼痛者，先温其里，宜四逆汤；后攻
其表，宜桂枝汤。上件《金匮》节文，虽于三因不甚分明，其脉不可不究。即用四逆治伤寒
，不妨用桂枝加附子治伤风，术附加桂治伤湿，五苓散治伤暑，皆可类推。又古方泄利与滞
下，共为一门，《千金》又以宿食不消，在热利类，门类混滥，后学难明，不可甄别也。
《经》中所载，有血溢、血泄、血便、注下，古方则有清浓血及泄下，近世并为痢疾，
其实一也。但以寒、热、疳、蛊，分为四门，未为至当。且疳蚀疮脓，中蛊下血，与利脓
血，证状大别。疳蚀虽下赤白，当在疳湿疮门；蛊利清血，当在中毒蛊门。今之滞下赤白者
至多，皆是冷热相搏，非干疳湿蚀疮类；下利清血亦多，与中蛊毒者大异。临视须详，不可
道听，治法差互，立见夭伤，勉之勉之。
凡是治疗泄泻，必须调理中焦脾胃，比如理中汤、理中丸等方剂就是用来做这个的；其次就要分利水湿与谷食，比如五苓散等方剂就是用来做这个的。如果调理中焦的方法无效，然后再使用涩肠止泻的方法，比如禹余粮、赤石脂等药物就是用来做这个的。《素问·玉机真脏论》说：出现五种虚损脉象就会死亡。指的是脉象细弱，皮肤寒冷，气短少气，前后二阴泄利不止，饮食无法入口，出现这些症状必定死亡。那些能存活的，是因为浆粥能够进入胃中，泄泻注下停止，这样就能存活。另外《金匮要略》说：六腑之气在外衰竭的，表现为手足寒冷，气逆上冲，脚部收缩；五脏之气在内衰竭的，表现为大便失禁不能控制，严重的甚至手足麻木不仁。脉象沉弦的是里急后重，脉象大的是病邪尚未停止。泄利导致手足厥冷，摸不到脉搏，艾灸后手脚不回暖，脉搏不恢复，伴有轻微喘息的，属于死证。如果有轻微发热且口渴，自然出汗，脉象或微弦、数、弱，按照法度应当自愈。或者脉象沉迟而面部少许发红，身体微热，郁结闷乱并出汗而病解，必定会有轻微的四肢厥冷，之所以这样，是因为其面部戴阳（虚阳上浮于面），下部虚寒的缘故。泄利之后，出现腹部胀满，身体疼痛的，先温补其里虚，适宜用四逆汤；然后攻解其表邪，适宜用桂枝汤。上述《金匮要略》的节选文字，虽然对于三因（内因、外因、不内外因）分辨得不是很分明，但脉象是不可不研究的。如果用四逆汤治疗伤寒，不妨用桂枝加附子汤治疗伤风，用术附加桂（白术、附子、桂枝等）治疗伤湿，用五苓散治疗伤暑，都可以类推。另外古方中将泄利与滞下（痢疾）归为一门，《千金方》又将宿食不消化归入热利类，门类混乱滥杂，后学者难以明白，无法甄别。
《内经》中所记载的，有血溢、血泄、血便、注下，古方中有清脓血及泄下，近世都统称为痢疾，其实本质是一样的。但是仅仅以寒、热、疳、蛊分为四门，并不十分恰当。况且疳蚀疮脓、中蛊下血，与利出脓血，症状表现截然不同。疳蚀虽然排出赤白之物，应当归在疳湿疮门；蛊毒导致排出清血，应当归在中毒蛊门。现在的滞下（痢疾）排出赤白的非常多，都是冷热邪气相互搏结，与疳湿蚀疮一类无关；下利排出清血的也很多，与中蛊毒者大不相同。临症诊治必须详细审察，不可道听途说，治疗方法一旦差错混淆，立刻会导致夭折伤害，务必谨慎，务必谨慎。
In the treatment of diarrhea (Xie), it is necessary to regulate the Middle Jiao (Middle Burner), such as using Lizhong Tang (Regulate the Middle Decoction) or Lizhong Wan (Regulate the Middle Pill); subsequently, one must separate fluids from grain, such as using Wuling San (Five-Ingredient Poria Powder). If regulating the middle proves ineffective, then employ methods to stop dysentery/diarrhea, such as using Yuyuliang (Hematitum) and Chishizhi (Halloysitum Rubrum). The *Yu Ji Zhen Zang Lun* chapter of the *Su Wen* states: "Five deficiencies indicate death." This refers to a fine pulse, cold skin, shortness of breath, incontinence of both bowels and bladder, and inability to ingest food; these signs inevitably lead to death. Those who survive are those whose broth and congee can enter the Stomach and whose profuse diarrhea stops, indicating recovery. Furthermore, the *Jin Gui Yao Lue* states: "When the Qi of the Six Fu organs fails externally, there is coldness in the hands and feet, upward rushing of Qi, and retraction of the legs; when the Qi of the Five Zang organs fails internally, there is uncontrollable diarrhea, and in severe cases, insensibility of the hands and feet." A deep and wiry pulse indicates tenesmus (feeling of incomplete defecation); a large pulse indicates the condition has not yet ceased. Diarrhea accompanied by cold extremities, absence of pulse, failure of warmth after moxibustion, non-return of the pulse, and slight panting constitute a fatal prognosis. However, if there is slight fever with thirst, spontaneous sweating, and a pulse that is slightly wiry, rapid, or weak, the condition should resolve spontaneously according to the principles. Alternatively, if the pulse is deep and slow, with slight redness on the face and slight body heat, resolution occurs through depression, dizziness, and sweating; this is necessarily accompanied by slight cold extremities. The reason for this is "Dai Yang" (floating Yang manifesting on the face) due to deficiency in the lower part. After diarrhea, if abdominal distension and fullness occur along with body pain, first warm the interior with Sini Tang (Frigid Extremities Decoction); subsequently, attack the exterior with Guizhi Tang (Cinnamon Twig Decoction). Although the excerpt from the *Jin Gui* does not clearly distinguish among the Three Causes (Internal, External, and Non-internal/External), the pulse diagnosis must be thoroughly investigated. Thus, using Sini Tang for Cold Damage (Shang Han) is appropriate; similarly, using Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) for Wind Strike (Shang Feng), adding Atractylodes and Aconite with Cinnamon for Dampness Injury (Shang Shi), and using Wuling San for Summerheat Injury (Shang Shu) can all be inferred by analogy. Furthermore, ancient formulas grouped diarrhea (Xie Li) and dysentery (Zhi Xia) into one category; the *Qian Jin Fang* further classified undigested food under hot diarrhea, causing confusion and making it difficult for later students to differentiate.
The *Nei Jing* records blood overflow, bloody discharge, bloody stool, and pouring down; ancient formulas mention clear pus-blood and discharge; modern times unify these as Dysentery (Li Ji), though their essence is similar. However, dividing them merely into Cold, Heat, Gan (parasitic/wasting), and Gu (poisonous) categories is not entirely appropriate. For instance, Gan erosion with pus, bleeding from Gu poisoning, and purging pus-blood present distinctly different symptoms. Although Gan erosion may discharge red and white matter, it belongs in the Gan-Dampness Ulcer category; Gu-induced clear blood discharge belongs in the Poisonous Gu category. Currently, most cases of Zhi Xia (dysentery) discharging red and white are caused by the struggle between Cold and Heat, unrelated to Gan-dampness ulcers; likewise, profuse clear blood discharge differs significantly from Gu poisoning. Clinical examination must be detailed; one must not rely on hearsay. Errors in treatment methods will immediately lead to premature death or injury. Exercise utmost caution.