奇恒痢疾最堪惊，阳并于阴势莫京，喉塞咽干君切记（嘉庆戊午夏，泉郡王孝？患痢七日
。忽于寅午之交，声微哑，谵语半刻即止，酉则死。七月，榕城叶广文观凤之弟，患同前证
，来延，自言伊芳弟痢亦不重，饮食如常，惟早晨咽干微痛，如见鬼状，半刻即止，时届酉刻
，余告以不必往诊，令其速回看看，果于酉戌之交死，）大承急下可回生。
泄泻之证，《内经》所谓∶“湿胜则濡泄，”是也。宜以胃苓汤为主。如寒胜则下利清
谷，加干姜、附子、吴茱萸。如热甚则下利肠垢，去桂枝，加黄连、黄芩、干葛。如食积加
麦芽、山楂炒黑。如虚甚加人参。若五更后根据时作泻，名脾肾泻，宜四神丸去肉豆蔻，加人
参、白术、罂粟壳、干姜、茯苓，以枣汤叠丸，临卧以姜汤送下四、五钱。久泻宜圣济附子
丸。又《金匮翼》乳豆丸，治滑泄不止，诸药罔效。方用肉豆蔻(生为末)、通明乳香(以酒
浸过)研成膏，丸如梧桐子大，每服五十丸，空心米饮送下。
（经义）《金匮真言》曰∶“长夏善病，洞泄寒中。”《阴阳应象大论》曰∶“清气在下，
则生飧泄。”又曰∶“湿胜则濡泄。”又曰∶“春伤于风，夏生飧泄。”又曰∶“水谷之寒
湿，感则害人六腑。”《脏气发时论》曰∶“脾病者，虚则腹满，肠鸣，飧泄，食不化。”
《经脉篇》曰∶“脾所生病，心下急痛，溏瘕泄。肝所生病，胸满呕逆，飧泄狐疝。”《厥
论》曰∶“少阴厥逆，虚满呕，变下泄清。”《阴阳别论》曰∶“一阳发病，少气善咳，善
泄邪气。”《脏腑病形篇》曰∶“肺脉小甚为泄，肾脉小甚为洞泄。”《脉要精微论》曰∶
“胃脉实则胀，虚则泄。”又曰∶“脉动一代者，病在阳之脉也，泄及便脓血。”《玉机真
脏论》曰∶“泄以脉大，脱血而脉实，皆难治。”《师传篇》曰∶“脐以上皮热，肠中热，
则出黄如糜。脐以下皮寒，胃中寒，则腹胀肠中寒，则肠鸣飧泄。胃中寒，肠中热，则胀而
且泄。”
奇恒痢疾最为惊人，阳气并聚于阴分，病势极其猛烈，咽喉堵塞、口干舌燥，请务必牢记。（嘉庆戊午年夏季，泉州郡的王孝？患痢疾七日。忽然在寅时与午时交替之际，声音轻微嘶哑，胡言乱语片刻即止，到了酉时便死亡。七月，福州城的叶广文观凤之弟，患了与前例相同的证候，前来邀请诊治，他自称其弟的痢疾并不严重，饮食如常，只是早晨咽喉干燥微痛，出现如见鬼魅般的幻觉，片刻即止，当时正值酉时，我告知不必前往诊视，让他速回查看，果然在酉时与戌时交替之际死亡。）此时急用大承气汤攻下可挽回生命。
泄泻这一证候，正如《内经》所说：“湿气偏胜则导致濡泄（大便稀溏）。”治疗应以胃苓汤为主方。如果寒邪偏胜，则出现下利清谷（排出未消化的食物），需加干姜、附子、吴茱萸。如果热邪极盛，则出现下利肠垢（排泄黏液脓血或污浊之物），去掉桂枝，加黄连、黄芩、干葛。如果有食积，加麦芽、山楂炒黑。如果正气虚弱严重，加人参。如果在五更之后按时发作腹泻，称为脾肾泻，适宜使用四神丸去掉肉豆蔻，加入人参、白术、罂粟壳、干姜、茯苓，用枣汤泛丸，临睡前用姜汤送服四、五钱。久泻适宜使用圣济附子丸。另外，《金匮翼》中的乳豆丸，治疗滑泄不止，其他药物无效的情况。方剂组成：肉豆蔻（生研为末）、通明乳香（用酒浸泡过）研成膏状，制成梧桐子大小的药丸，每次服用五十丸，空腹时用米饮送下。
（经文义理）《金匮真言论》说：“长夏季节容易患病，表现为洞泄（剧烈腹泻）和寒中（中焦虚寒）。”《阴阳应象大论》说：“清气在下，则产生飧泄（完谷不化的腹泻）。”又说：“湿气偏胜则导致濡泄。”又说：“春季受风邪侵袭，夏季发生飧泄。”又说：“水谷产生的寒湿，感受后伤害六腑。”《脏气法时论》说：“脾脏发病，虚证则腹部胀满，肠鸣，飧泄，食物不消化。”《经脉篇》说：“脾所生的疾病，有心下急痛，溏瘕泄（大便稀薄夹杂未消化物）。肝所生的疾病，有胸满呕逆，飧泄，狐疝。”《厥论》说：“少阴经气厥逆，虚满呕逆，变为下泄清稀。”《阴阳别论》说：“一阳发病，少气善咳，易泄邪气。”《脏腑病形篇》说：“肺脉小甚为泄，肾脉小甚为洞泄。”《脉要精微论》说：“胃脉实则腹胀，虚则泄泻。”又说：“脉动一代者，是阳分之脉的病，伴有泄泻及便脓血。”《玉机真脏论》说：“泄泻而脉大，脱血而脉实，都难治。”《师传篇》说：“脐以上皮肤发热，说明肠中有热，则排出黄色如糜粥样的粪便。脐以下皮肤寒冷，说明胃中寒冷，则腹胀；肠中寒冷，则肠鸣飧泄。胃中寒冷，肠中有热，则既腹胀又泄泻。”
Qi Heng Li Ji (Atypical Dysentery) is most alarming; when Yang Qi merges with Yin, the condition becomes extremely severe. Remember well: throat obstruction and dryness of the pharynx. (In the summer of Wuwu year of the Jiaqing reign, Wang Xiaofu in Quanzhou suffered from dysentery for seven days. Suddenly, at the transition between Yin and Wu hours, his voice became slightly hoarse, he spoke deliriously for a moment before stopping, and died at You hour. In July, the younger brother of Ye Guangwen Guan Feng in Rongcheng suffered from the same syndrome and invited me to treat him. He stated that his brother's dysentery was not severe, his diet was normal, but his throat was dry and slightly painful in the morning, accompanied by hallucinations of seeing ghosts for a moment before stopping. It was then You hour. I told him there was no need to visit for diagnosis and instructed him to return quickly to check. Indeed, he died at the transition between You and Xu hours.) At this point, urgently administering Da Cheng Qi Tang (Major Order the Qi Decoction) can save life.
The syndrome of Xie Xie (Diarrhea/Loose Stools) is what the *Nei Jing* (Inner Canon) refers to as: "When Dampness prevails, it leads to Ru Xie (Moist Diarrhea)." The primary treatment should be Wei Ling Tang (Stomach and Five-Ingredient Decoction). If Cold prevails, leading to Xia Li Qing Gu (Passage of undigested food), add Gan Jiang (Dried Ginger), Fu Zi (Prepared Aconite Root), and Wu Zhu Yu (Evodia Fruit). If Heat is excessive, leading to Xia Li Chang Gou (Passage of intestinal mucus/pus), remove Gui Zhi (Cinnamon Twig), and add Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), and Gan Ge (Pueraria Root). If there is Food Stagnation, add Mai Ya (Barley Sprout) and Shan Zha (Hawthorn Fruit) stir-fried until black. If Deficiency is severe, add Ren Shen (Ginseng Root). If diarrhea occurs on schedule after the fifth watch (5-7 AM), it is named Pi Shen Xie (Spleen-Kidney Diarrhea). Si Shen Wan (Four Spirits Pill) is suitable, removing Dou Kou (Nutmeg), and adding Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Ying Su Qiao (Poppy Shell), Gan Jiang (Dried Ginger), and Fu Ling (Poria). Form pills using Jujube decoction, and take 4-5 qian with Ginger decoction before sleep. For chronic diarrhea, Sheng Ji Fu Zi Wan (Sheng Ji Aconite Pill) is suitable. Additionally, Ru Dou Wan (Milk Bean Pill) from *Jin Kui Yi* treats Hu Xie Bu Zhi (Slippery Diarrhea unceasing) where other medicines are ineffective. The formula uses Rou Dou Kou (Nutmeg, raw and powdered) and Tong Ming Ru Xiang (Transparent Frankincense, soaked in wine), ground into a paste, formed into pills the size of Sophora seeds. Take 50 pills each time, with Rice Drink on an empty stomach.
(Interpretation of Canonical Texts) *Jin Kui Zhen Yan Lun* states: "In late summer, diseases such as Dong Xie (Profuse Diarrhea) and Han Zhong (Cold in the Middle Jiao) are common." *Yin Yang Ying Xiang Da Lun* states: "If Clear Qi sinks below, it generates Sun Xie (Undigested Diarrhea)." It also states: "When Dampness prevails, it leads to Ru Xie." It also states: "If Wind is injured in Spring, Sun Xie arises in Summer." It also states: "Cold-Dampness from water and grain, when contracted, harms the Six Fu Organs." *Zang Qi Fa Shi Lun* states: "In Spleen disease, deficiency manifests as abdominal fullness, borborygmus, Sun Xie, and indigestion." *Jing Mai Pian* states: "Diseases generated by the Spleen include urgent pain under the heart, Tang Jia Xie (Loose stools with undigested food). Diseases generated by the Liver include chest fullness, vomiting and reflux, Sun Xie, and Hu Shan (Fox Hernia)." *Jue Lun* states: "Shaoyin Jue Ni (Shaoyin Reversal Cold) presents with deficiency-fullness, vomiting, and changes into clear lower discharge." *Yin Yang Bie Lun* states: "When One Yang is diseased, there is shortness of breath, frequent coughing, and susceptibility to Xie Qi (Pathogenic Factors) causing diarrhea." *Zang Fu Bing Xing Pian* states: "If the Lung pulse is very small, it indicates diarrhea; if the Kidney pulse is very small, it indicates Dong Xie." *Mai Yao Jing Wei Lun* states: "If the Stomach pulse is excess, there is distension; if deficient, there is diarrhea." It also states: "If the pulse beats intermittently (Dai Mai), the disease is in the Yang pulses, accompanied by diarrhea and pus/blood in stool." *Yu Ji Zhen Zang Lun* states: "Diarrhea with a large pulse, or blood loss with an excess pulse, are both difficult to treat." *Shi Chuan Pian* states: "If the skin above the umbilicus is hot, there is heat in the intestines, resulting in yellow excrement like porridge. If the skin below the umbilicus is cold, there is cold in the Stomach, leading to abdominal distension; if there is cold in the intestines, there is borborygmus and Sun Xie. If there is cold in the Stomach and heat in the intestines, there is both distension and diarrhea."