泄者如水之泄也。势犹HT 缓。泻者势似直下微有不同。而其为病则一。故总名之曰泄泻。
要
病斯作矣。然亦有先感怒气。而后伤饮食者。有先伤饮食。而后感怒气者。有适值饮食之间
。而忽发暴怒者。有忧郁内结。而含悲以食者。有饮食后。即入水洗浴者。有饮食未久。复
饮食者。凡此皆足以成其病。善调摄者。不饥不食。不渴不饮。喜怒有节。不使太过。何至
有泄泻之患哉。大抵泄泻与下痢。皆脾家之疾。而受病之新久不同。故势有轻重。而治之有
难易也。然果何以知之。盖宿食停于中得湿热而始变。则有赤白诸般之色。而为下痢。此受
病已久。故有积而无粪也。饮食过饱。挟湿而不尽化。则大便通痢。无里急后重之苦。而为
泄泻。此受病未久。故有粪而无积也。此泄痢之别。用药者其可以概施乎。诸痢多热。而寒
者少。诸泻多寒。而热者间或有之。惟完谷不化。属于客热在脾。火性急速。不及传化而自
出也。然亦有脾寒。不能运而完谷不化者。此其常也。治此病者。当视其小便之赤白。察其
脉之洪数沉迟而已。小便赤。脉洪数则为热。小便清。脉沉迟则为寒。不可不辨也。
沉迟寒侵沉数火热微小者生浮弦者死。
调脾除湿汤 治湿气伤脾。久泻不止。中气下陷小便黄赤腹微作胀。
升麻 柴胡 防风 麦芽（各一钱） 苍术 陈皮 猪苓 泽泻 半夏（各一钱二分） 木
通羌活（各八分） 水煎温服。
十珍散 治一切脾泻。久久不愈。元气亏伤。脾胃虚弱。面黄肌瘦。饮食减少。
薏苡仁（炒） 宿砂 山药（炒） 莲子（去心各一钱） 白术（土炒） 白茯苓 人参 黄
（蜜炒） 白扁豆（各一钱二分） 北五味（二十粒） 水煎温服。
五苓散 治泄泻小便赤涩。并霍乱吐泻。
白茯苓 泽泻 猪苓（各二钱） 白术（八分） 肉桂（五分） 灯心三十茎。食前服。
肉豆蔻散 治脾胃虚弱。腹胁胀满。水谷不消。脏腑冷滑。
川乌 诃子 肉豆蔻 小茴香 干姜 肉桂（各八分） 甘草 浓朴 陈皮 苍术（各一
钱） 枣二枚。姜三片。食前服。
立效饮 治脾经湿热作泻。
白茯苓 车前子 木通（各二钱） 黄连（一钱八分） 泽泻 苍术（各一钱） 灯心三十
茎。煎服。
立愈饮 治过伤生冷。以致脾胃不和。呕吐泄泻。
草果仁 肉豆蔻（面包煨各一钱） 红曲（炒） 山楂（各一钱五分） 苍术（米泔浸炒） 白
茯苓
扶元汤 治脾胃久虚。泄泻不止。神思倦怠。饮食少进。四肢酸软。
人参 白术（各二钱） 石斛 白茯苓（各一钱五分） 肉桂（一钱） 升麻（一钱） 山茱萸
黄连（各一钱二分） 加枣二枚。食前服。
诸般所伤作泻。暨各经泄泻。引经录后。 如伤肉食泻。以山楂为君。佐以蓬术。三棱
。枳
如伤生冷泻。以肉桂为君。佐以干姜。槟榔。莱菔子。陈皮。枳壳。如伤油腻泻。以苍术为
君。佐以滑石。茯苓。陈皮。浓朴炙甘草。白术。神曲。 如伤米食泻。以麦芽为君。佐以
神曲。陈皮。苍蓬术。三棱。枳实。黄连。 如伤于酒泻。以消食药中。加消酒之药。如葛粉
。绿豆粉。天花粉。黄连。山楂。 如伤于暑泻。以香薷。黄连。为君。佐以车前子。滑石
。茯苓。木通。浓朴。扁豆。直肠自下者。名曰洞泄。以白术为君。佐以五味子。诃子。肉
果。牡蛎。粟壳。每朝登厕溏滑者。名曰脾泄以白术为君。佐以煨姜。大枣。茯苓。炙甘草
。久泄腰痛者。名曰肾泄。以白术杜仲为君佐以茯苓。人参。肉果。诃子。五味子。
泄泻两胁痛。名曰肝泄。以芍药为君。佐以白术茯苓苍术浓朴。青皮。甘草。当泄时又
闭而不下。及所下者多白沫而有声。乃风泄以防风为君。佐以苍术。浓朴。陈皮。甘草。白术。
灸法 治吐泻日久。服药不效。垂危之极。
天枢二穴（在脐傍各周二寸灸五十壮） 气海一穴（在脐下一寸五分灸五壮）
泄，指水液般的排泄，势态较为和缓；泻，指势态直下，二者虽略有不同，但致病机理一致，因此统称为“泄泻”。
疾病的发生往往与此有关。然而也有先感受怒气，而后损伤饮食的；有先损伤饮食，而后感受怒气的；有正值进食之间，忽然爆发暴怒的；有内心忧郁结滞，含着悲伤进食的；有进食后，立即入水沐浴的；有进食不久，又再次进食的。凡此种种，都足以导致这种疾病。善于调养的人，不饿就不吃，不渴就不喝，喜怒有节制，不让情绪过度，怎么会患上泄泻之患呢？
大抵泄泻与痢疾，都是脾脏的疾病，只是患病的新久不同，所以病情有轻重之分，治疗也有难易之别。那么究竟如何区分呢？大概是因为宿食停滞在中焦，遇到湿热才开始变化，出现赤白等各种颜色，从而成为痢疾。这是患病已久，所以有积滞而无正常粪便。如果饮食过饱，挟带湿气而不能完全消化，则大便通畅地排出，没有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）的痛苦，而成为泄泻。这是患病未久，所以有粪便而无积滞。这就是泄泻与痢疾的区别，用药者怎么能一概施用呢？各种痢疾多属热证，寒证较少；各种泄泻多属寒证，热证间或有之。只有完谷不化（食物未经消化即排出），属于客热在脾，火性急速，来不及传化就自行排出了。但也有因为脾寒，不能运化而导致完谷不化的，这是一般情况。治疗这种病，应当观察小便的颜色是红还是白，诊察脉象是洪数还是沉迟即可。小便红，脉象洪数则为热证；小便清，脉象沉迟则为寒证，不可不辨别清楚。
脉象沉迟为寒邪侵袭，沉数为火热，微小者预后良好，浮弦者预后不良（主死）。
调脾除湿汤：治疗湿气伤脾，久泻不止，中气下陷，小便黄赤，腹部微胀。
处方：升麻、柴胡、防风、麦芽（各一钱），苍术、陈皮、猪苓、泽泻、半夏（各一钱二分），木通、羌活（各八分）。水煎，温服。
十珍散：治疗一切脾泻，久久不愈，元气亏伤，脾胃虚弱，面色萎黄，肌肉消瘦，饮食减少。
处方：薏苡仁（炒）、砂仁、山药（炒）、莲子（去心，各一钱），白术（土炒）、白茯苓、人参、黄芪（蜜炒）、白扁豆（各一钱二分），北五味子（二十粒）。水煎，温服。
五苓散：治疗泄泻小便赤涩，以及霍乱吐泻。
处方：白茯苓、泽泻、猪苓（各二钱），白术（八分），肉桂（五分），灯心草三十茎。饭前服用。
肉豆蔻散：治疗脾胃虚弱，腹胁胀满，水谷不消，脏腑冷滑。
处方：川乌、诃子、肉豆蔻、小茴香、干姜、肉桂（各八分），甘草、厚朴、陈皮、苍术（各一钱），大枣二枚，生姜三片。饭前服用。
立效饮：治疗脾经湿热作泻。
处方：白茯苓、车前子、木通（各二钱），黄连（一钱八分），泽泻、苍术（各一钱），灯心草三十茎。煎服。
立愈饮：治疗过食生冷，以致脾胃不和，呕吐泄泻。
处方：草果仁、肉豆蔻（面包煨，各一钱），红曲（炒）、山楂（各一钱五分），苍术（米泔水浸炒），白茯苓。
扶元汤：治疗脾胃久虚，泄泻不止，神思倦怠，饮食少进，四肢酸软。
处方：人参、白术（各二钱），石斛、白茯苓（各一钱五分），肉桂（一钱），升麻（一钱），山茱萸、黄连（各一钱二分）。加大枣二枚，饭前服用。
各种所伤导致的泄泻，以及各经泄泻，引经药录于后：
如伤肉食致泻，以山楂为君药，佐以蓬术、三棱、枳实。
如伤生冷致泻，以肉桂为君药，佐以干姜、槟榔、莱菔子、陈皮、枳壳。
如伤油腻致泻，以苍术为君药，佐以滑石、茯苓、陈皮、厚朴、炙甘草、白术、神曲。
如伤米食致泻，以麦芽为君药，佐以神曲、陈皮、苍术、蓬术、三棱、枳实、黄连。
如伤酒致泻，在消食药中加入消酒之药，如葛粉、绿豆粉、天花粉、黄连、山楂。
如伤暑致泻，以香薷、黄连为君药，佐以车前子、滑石、茯苓、木通、厚朴、扁豆。
直肠自下者，名为洞泄，以白术为君药，佐以五味子、诃子、肉豆蔻、牡蛎、罂粟壳。
每朝登厕溏滑者，名为脾泄，以白术为君药，佐以煨姜、大枣、茯苓、炙甘草。
久泄腰痛者，名为肾泄，以白术、杜仲为君药，佐以茯苓、人参、肉豆蔻、诃子、五味子。
泄泻伴两胁痛者，名为肝泄，以芍药为君药，佐以白术、茯苓、苍术、厚朴、青皮、甘草。
当泄时又闭而不下，及所下者多白沫而有声者，乃风泄，以防风为君药，佐以苍术、厚朴、陈皮、甘草、白术。
灸法：治疗吐泻日久，服药无效，垂危至极。
穴位：天枢二穴（在脐旁各开二寸，灸五十壮），气海一穴（在脐下一寸五分，灸五壮）。
Xie (diarrhea with watery stool) refers to the discharge resembling water, with a relatively gentle momentum; Xie (profuse diarrhea) refers to a direct and forceful downward flow. Although there are slight differences in their presentation, their pathogenic mechanisms are identical, hence they are collectively termed "Xie Xie" (diarrhea).
The onset of this disease is often related to these factors. However, there are cases where one first suffers from anger, followed by dietary injury; or first suffers from dietary injury, followed by anger; or experiences sudden violent rage during meals; or eats while harboring inner depression and sorrow; or takes a bath in water immediately after eating; or eats again shortly after a meal. All such circumstances are sufficient to cause this disease. Those who are skilled in self-care do not eat when not hungry, do not drink when not thirsty, keep their emotions in check, and avoid excess. How could they suffer from diarrhea?
Generally speaking, both diarrhea and dysentery are diseases of the Spleen. The difference lies in the duration of the illness: thus, the severity varies, and treatment ranges from easy to difficult. How can one distinguish them? Roughly speaking, if retained food stagnates in the middle jiao and transforms due to damp-heat, it presents with various colors such as red and white, becoming dysentery. This indicates a long-standing condition, characterized by accumulation without normal feces. If one overeats, carrying dampness that is not fully digested, the stool passes freely without the discomfort of tenesmus (urgent need to defecate with heavy sensation in the anus), becoming diarrhea. This indicates a recent onset, characterized by feces without accumulation. This is the distinction between diarrhea and dysentery; practitioners cannot apply treatments indiscriminately. Most dysenteries are heat patterns, with few cold patterns; most diarrheas are cold patterns, with occasional heat patterns. Only when undigested food is excreted intact does it belong to external heat in the Spleen, where the rapid nature of fire prevents proper transformation and digestion, leading to immediate expulsion. However, there are also cases of undigested food due to Spleen cold failing to transport and transform, which is the common scenario. To treat this disease, one should observe whether the urine is red or clear, and palpate whether the pulse is flooding and rapid or deep and slow. Red urine and a flooding, rapid pulse indicate heat; clear urine and a deep, slow pulse indicate cold. This must be distinguished carefully.
A deep and slow pulse indicates cold invasion; a deep and rapid pulse indicates fire/heat; a minute pulse suggests a favorable prognosis; a floating and wiry pulse suggests a poor prognosis (death).
Tiaopi Chushi Tang (Spleen-Regulating Damp-Removing Decoction): Treats dampness injuring the Spleen, chronic persistent diarrhea, sinking of Middle Qi, yellow-red urine, and mild abdominal distension.
Ingredients: Shengma (Rhizoma Cimicifugae), Chaihu (Radix Bupleuri), Fangfeng (Radix Saposhnikoviae), Maiya (Fructus Hordei Germinatus) (each 1 qian); Cangzhu (Rhizoma Atractylodis Lanceae), Chenpi (Pericarpium Citri Reticulatae), Zhuling (Polyporus), Zexie (Rhizoma Alismatis), Banxia (Rhizoma Pinelliae Preparatum) (each 1.2 qian); Mutong (Caulis Akebiae), Qianghuo (Rhizoma et Radix Notopterygii) (each 0.8 qian). Decoct in water and take warm.
Shizhen San (Ten-Treasure Powder): Treats all types of Spleen diarrhea, chronic non-healing cases, depletion of Yuan Qi, weakness of Spleen and Stomach, sallow complexion, emaciation, and reduced appetite.
Ingredients: Yiyiren (Semen Coicis, stir-fried), Sharen (Fructus Amomi Rotundus), Shanyao (Rhizoma Dioscoreae, stir-fried), Lianzi (Semen Nelumbinis, heart removed, each 1 qian); Baizhu (Rhizoma Atractylodis Macrocephalae, soil-stir-fried), Baifuling (Poria), Renshen (Radix Ginseng), Huangqi (Radix Astragali, honey-stir-fried), Baibiandou (Semen Phaseoli Multiflori) (each 1.2 qian); Bei Wuwei (Fructus Schisandrae Chinensis) (20 berries). Decoct in water and take warm.
Wuling San (Five-Ingredient Powder with Poria): Treats diarrhea with red and scanty urination, as well as Huoluan (cholera-like syndrome) with vomiting and diarrhea.
Ingredients: Baifuling (Poria), Zexie (Rhizoma Alismatis), Zhuling (Polyporus) (each 2 qian); Baizhu (Rhizoma Atractylodis Macrocephalae) (0.8 qian); Rougui (Cortex Cinnamomi) (0.5 qian); Dengxincao (Papyrus Medulla) (30 stems). Take before meals.
Roudoukou San (Myristica Powder): Treats Spleen and Stomach weakness, abdominal and hypochondriac fullness, inability to digest water and grain, and cold slipperiness of the Zang-Fu organs.
Ingredients: Chuanwu (Radix Aconiti Carmichaelii Preparatora), Hezi (Fructus Terminaliae Chebulae), Roudoukou (Semen Myristicae), Xiaohuixiang (Fructus Foeniculi), Ganjiang (Rhizoma Zingiberis Officinalis Preparatum), Rougui (Cortex Cinnamomi) (each 0.8 qian); Gancao (Radix Glycyrrhizae), Houpo (Cortex Magnoliae Officinalis), Chenpi (Pericarpium Citri Reticulatae), Cangzhu (Rhizoma Atractylodis Lanceae) (each 1 qian); Jujube (Fructus Jujubae) (2 pieces), Shengjiang (Rhizoma Zingiberis Officinalis) (3 slices). Take before meals.
Lixiao Yin (Instant-Efficacy Drink): Treats diarrhea caused by damp-heat in the Spleen meridian.
Ingredients: Baifuling (Poria), Cheqianzi (Semen Plantaginis), Mutong (Caulis Akebiae) (each 2 qian); Huanglian (Rhizoma Coptidis) (1.8 qian); Zexie (Rhizoma Alismatis), Cangzhu (Rhizoma Atractylodis Lanceae) (each 1 qian); Dengxincao (Papyrus Medulla) (30 stems). Decoct and take.
Liuyu Yin (Instant-Recovery Drink): Treats vomiting and diarrhea caused by excessive consumption of raw and cold foods, leading to disharmony between Spleen and Stomach.
Ingredients: Caoguoren (Fructus Tsaoko), Roudoukou (Semen Myristicae, baked in dough) (each 1 qian); Hongqu (Massa Medicata Fermentata Rubra, stir-fried), Shanzha (Fructus Crataegi) (each 1.5 qian); Cangzhu (Rhizoma Atractylodis Lanceae, stir-fried after soaking in rice wash water), Baifuling (Poria).
Fuyuan Tang (Yuan-Qi-Nourishing Decoction): Treats chronic Spleen and Stomach deficiency, persistent diarrhea, mental fatigue, reduced intake, and soreness/weakness of the four limbs.
Ingredients: Renshen (Radix Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae) (each 2 qian); Shihu (Herba Dendrobii), Baifuling (Poria) (each 1.5 qian); Rougui (Cortex Cinnamomi) (1 qian); Shengma (Rhizoma Cimicifugae) (1 qian); Shanzhuyu (Fructus Corni), Huanglian (Rhizoma Coptidis) (each 1.2 qian). Add Jujube (Fructus Jujubae) (2 pieces). Take before meals.
For diarrhea caused by various injuries and diarrhea of different meridians, the guiding herbs are listed below:
If diarrhea is caused by meat injury, use Shanzha (Fructus Crataegi) as the sovereign herb, assisted by Pengzhu (Rhizoma Curcumae), Sanleng (Rhizoma Sparganii), and Zhishi (Fructus Aurantii Immaturus).
If diarrhea is caused by raw/cold injury, use Rougui (Cortex Cinnamomi) as the sovereign herb, assisted by Ganjiang (Rhizoma Zingiberis Officinalis Preparatum), Binglang (Semen Arecae), Laifuzi (Semen Raphani), Chenpi (Pericarpium Citri Reticulatae), and Zhike (Fructus Aurantii).
If diarrhea is caused by greasy food injury, use Cangzhu (Rhizoma Atractylodis Lanceae) as the sovereign herb, assisted by Huashi (Haloitum), Fuling (Poria), Chenpi (Pericarpium Citri Reticulatae), Houpo (Cortex Magnoliae Officinalis), Zhigancao (Radix Glycyrrhizae Preparata), Baizhu (Rhizoma Atractylodis Macrocephalae), and Shenqu (Massa Medicata Fermentata).
If diarrhea is caused by grain injury, use Maiya (Fructus Hordei Germinatus) as the sovereign herb, assisted by Shenqu (Massa Medicata Fermentata), Chenpi (Pericarpium Citri Reticulatae), Cangzhu (Rhizoma Atractylodis Lanceae), Pengzhu (Rhizoma Curcumae), Sanleng (Rhizoma Sparganii), Zhishi (Fructus Aurantii Immaturus), and Huanglian (Rhizoma Coptidis).
If diarrhea is caused by alcohol injury, add wine-resolving herbs to food-digesting herbs, such as Gefen (Amylum Tabernaemontanae), Lvdoufen (Amylum Phaseoli Radiati), Tianhuafen (Radix Trichosanthis), Huanglian (Rhizoma Coptidis), and Shanzha (Fructus Crataegi).
If diarrhea is caused by summerheat, use Xiangru (Herba Elsholtziae) and Huanglian (Rhizoma Coptidis) as sovereign herbs, assisted by Cheqianzi (Semen Plantaginis), Huashi (Haloitum), Fuling (Poria), Mutong (Caulis Akebiae), Houpo (Cortex Magnoliae Officinalis), and Bian Dou (Semen Phaseoli Angularis).
Direct expulsion from the rectum is called Dongxie (Cavernous Diarrhea). Use Baizhu (Rhizoma Atractylodis Macrocephalae) as the sovereign herb, assisted by Wuweizi (Fructus Schisandrae Chinensis), Hezi (Fructus Terminaliae Chebulae), Roudoukou (Semen Myristicae), Muli (Concha Ostreae), and Yuke (Cortex Papaveris).
Morning defecation with loose, slippery stools is called Pixie (Spleen Diarrhea). Use Baizhu (Rhizoma Atractylodis Macrocephalae) as the sovereign herb, assisted by Weijiang (Rhizoma Zingiberis Officinalis Preparatum), Dazao (Fructus Jujubae), Fuling (Poria), and Zhigancao (Radix Glycyrrhizae Preparata).
Chronic diarrhea with lower back pain is called Shenxie (Kidney Diarrhea). Use Baizhu (Rhizoma Atractylodis Macrocephalae) and Duzhong (Cortex Eucommiae) as sovereign herbs, assisted by Fuling (Poria), Renshen (Radix Ginseng), Roudoukou (Semen Myristicae), Hezi (Fructus Terminaliae Chebulae), and Wuweizi (Fructus Schisandrae Chinensis).
Diarrhea accompanied by bilateral hypochondriac pain is called Ganxie (Liver Diarrhea). Use Shaoyao (Radix Paeoniae Alba) as the sovereign herb, assisted by Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), Cangzhu (Rhizoma Atractylodis Lanceae), Houpo (Cortex Magnoliae Officinalis), Qingpi (Pericarpium Citri Reticulatae Viride), and Gancao (Radix Glycyrrhizae).
When diarrhea is blocked and cannot pass, and the discharged material consists mostly of white foam with sound, it is Fengxie (Wind Diarrhea). Use Fengfang (Radix Saposhnikoviae) as the sovereign herb, assisted by Cangzhu (Rhizoma Atractylodis Lanceae), Houpo (Cortex Magnoliae Officinalis), Chenpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae), and Baizhu (Rhizoma Atractylodis Macrocephalae).
Moxibustion: Treats prolonged vomiting and diarrhea unresponsive to medication, in critical condition.
Acupoints: Tianshu (ST25) x2 (located 2 cun lateral to the umbilicus, moxibustion 50 cones); Qihai (CV6) x1 (located 1.5 cun below the umbilicus, moxibustion 5 cones).