泄泻病因湿胜来，胃苓（汤）旧法出新裁，四神（丸）固肾时传外，苦领酸甘效首推（此一句，非
读十年书，治千百症者，不解其妙。
秘结证。《金匮真言》曰∶“北方黑色，入通于肾，开窍于二阴。”《气厥论》曰∶“膀
胱移热于小肠，隔肠不便。”《脏气法时论》曰∶“肾苦燥，急食辛以润之，开腠理，致津
液，通气也。”《杂病篇》曰∶“厥气走喉而不能言，手足清，大便不利，取足少阴。”读
此则知秘结之证，除阳明结热，轻者用脾约丸，重者择用三承气汤外，无不由之于肾。盖肾主
二阴，而司开阖，彼大小便不禁者，责其开而不阖，而大小便不通者，又当责其阖而不开。
故肾热者，凉而滋之，肾寒者，温而滋之，肾虚者，补而滋之，肾干燥者，润而滋之。且滋
肾而膀胱亦治，移热隔肠之病自已矣。秘结多由于肾，故列于里证。
秘结三承（气汤）慎用之，麻仁（丸，又名脾约丸）泽润不支离，须知肾脏为阴主，补泻寒温总
是滋。
隔食证。水饮可下，食物难入。高鼓峰专主阳明，用左归饮去茯苓，加生地、当归以养胃
阴。此法从薛氏医按胸满不食以六味汤加此二味得来也。去茯苓者，恐其旁流入坎，不如专
顾阳明之速效也。用此方俾胃阴上济，则贲门宽展而饮食进，胃阴下达，则幽门阑门滋润而
二便通，十余剂可效。如若不愈，《人镜经》专主《内经》“三阳结谓之隔”一语，以三一
承气汤节次下之，令陈卒去，则新物纳，此峻剂也。然此证多死，即勉治之，亦不过尽人
事
而已。又有朝食暮吐，名反胃，为中焦虚寒，下焦无火，宜吴茱萸汤，附子理中汤，加茯苓
、半夏、川椒之类，或以真武汤、八味丸间服，然《金匮》有大半夏汤，主降冲脉之逆，为
隔证反胃初起之神方。
（经义）《阴阳别论》曰∶“一阳发病，其传为隔。”按∶一阳，少阳也。手少阳三焦，足
少阳胆，为初气从中见之相火治之，大小柴胡汤，诸泻心汤，按证用之如神。又曰∶“三阳
结，谓之隔。”按∶三阳，太阳也，手太阳小肠，足太阳膀胱，从本为寒，从标为热。结者
，寒热之气，皆能为结，此深一层论也。张景岳谓∶“小肠属火，膀胱属水，火不化则阳气
不行而传导失职，水不化则阴气不行而清浊不分，皆致结之由。”此浅一层论也。《伤寒论
》中尽有神妙之方。《邪气脏腑病形篇》曰∶“脾脉微急为膈中，食饮入而还出，后沃沫。
”按∶脉微为脾虚而中气欲馁，沃沫为脾虚而津液不摄，理中丸为上策，如若未效，宜于脉
之急处，寻出所以急之源头而治之。《大奇论》曰∶“胃脉沉鼓涩胃外鼓大，心脉小坚急，
皆隔偏枯。”按∶此即前论高鼓峰之意也。《通评虚实论》曰∶“隔则闭绝，上下不通，则
暴忧之病也。”《本神篇》曰∶“忧愁者，气闭塞而不行。”按∶此二节，即张鸡峰所谓∶
“噎膈是神思间病”之意。《金匮》茯苓浓朴汤，丹溪越鞠丸可治，但当更求其本则得矣。
《血气形志篇》曰∶“形苦志苦，病生于咽噎，治以苦药。”愚谓亦不外泻心汤之类。反胃
证《内经》无专论，当以《金匮》为主。
泄泻的病因是湿邪偏胜，治疗应基于胃苓汤（由平胃散和五苓散组成）的旧法进行灵活变通。四神丸（温肾暖脾、固肠止泻之剂）用于固护肾脏，若兼有外感则需配合使用；对于苦味与酸甘配伍的治法，其疗效首屈一指（这一句，不是读书十年、诊治千百种病症的人，无法理解其中的奥妙）。
秘结证，《金匮真言论》说：“北方对应黑色，内通于肾，开窍于前后二阴。”《气厥论》说：“膀胱的热邪移注于小肠，导致肠道阻隔而大便不通。”《脏气法时论》说：“肾恶燥，应当急食辛味药物以润之，开发腠理，促使津液生成，以通气机。”《杂病篇》说：“厥逆之气上冲咽喉而不能言语，手足寒冷，大便不利，应取足少阴肾经穴位。”读到这里就知道，秘结证除了阳明腑实结热者，轻症用脾约丸，重症选用三承气汤之外，没有不源于肾脏的。因为肾主管前后二阴，并司职开阖功能。那些大小便失禁的人，责任在于只开不阖；而大小便不通的人，责任在于只阖不开。所以肾热者，用清凉滋润之法；肾寒者，用温补滋润之法；肾虚者，用补益滋润之法；肾干燥者，用润泽滋润之法。而且滋补肾阴也能治愈膀胱疾病，移热隔肠的病症自然痊愈。秘结多由于肾引起，所以将其列在里证之中。
秘结证慎用三承气汤，麻仁丸（又名脾约丸）性质泽润而不致耗伤正气。须知肾脏为阴脏之主，无论是补法、泻法、寒法还是温法，总以滋润为原则。
噎膈证表现为水饮可下，但食物难入。高鼓峰专门主张从阳明胃论治，使用左归饮去掉茯苓，加入生地、当归以滋养胃阴。这种方法是从薛己《医案》中关于胸满不食，用六味地黄丸加这两味药演变而来的。去掉茯苓，是担心其旁流入肾（坎），不如专顾阳明以求速效。使用此方使胃阴上济，则贲门宽展而能进食；胃阴下达，则幽门、阑门得到滋润而二便通畅，服用十余剂可见效。如果无效，《人镜经》专门依据《内经》“三阳结谓之隔”的说法，用三一承气汤分次攻下，令陈积去尽，则新物可纳，这是峻猛之剂。然而此证大多死亡，即使勉强治疗，也不过是尽人事罢了。又有朝食暮吐的情况，名为反胃，属于中焦虚寒，下焦无火，宜用吴茱萸汤、附子理中汤，加茯苓、半夏、川椒等药，或者交替服用真武汤、八味丸。然而《金匮要略》中有大半夏汤，主治降冲脉之逆气，是治疗噎膈证和反胃初起的神方。
（经文义理）《阴阳别论》说：“一阳发病，其传变为噎膈。”按：一阳指少阳。手少阳三焦经和足少阳胆经，由初气从中见之相火所治理，大小柴胡汤及诸泻心汤，根据证候使用如神。又说：“三阳结，谓之噎膈。”按：三阳指太阳。手太阳小肠经和足太阳膀胱经，从本为寒，从标为热。所谓结，寒热之气都能导致结滞，这是更深一层的论述。张景岳说：“小肠属火，膀胱属水，火不化则阳气不行而传导失职，水不化则阴气不行而清浊不分，这都是导致结滞的原因。”这是较浅一层的论述。《伤寒论》中尽有神妙的方剂。《邪气脏腑病形篇》说：“脾脉微急为膈中，饮食入胃后吐出，且排泄物中有大量涎沫。”按：脉微表示脾虚而中气欲衰，沃沫表示脾虚而津液不能摄持，理中丸为上策，如果无效，应当在脉象急迫之处，找出导致急迫的根源进行治疗。《大奇论》说：“胃脉沉而鼓动涩滞，或胃脉浮取鼓动大而心脉小坚急，都是噎膈偏枯之证。”按：这即是前面论述的高鼓峰之意。《通评虚实论》说：“噎膈则闭塞隔绝，上下不通，这是暴怒忧愁所致之病。”《本神篇》说：“忧愁的人，气机闭塞而不行。”按：这两节内容，即张鸡峰所谓“噎膈是神思间病”的意思。《金匮要略》中的茯苓浓朴汤，丹溪的越鞠丸可以治疗，但应当进一步探求其根本原因即可治愈。《血气形志篇》说：“形体劳苦且精神忧苦，病生于咽喉噎塞，治疗用苦味药物。”我认为也不外乎泻心汤之类的方剂。反胃证《内经》没有专门论述，应当以《金匮要略》为主。
The etiology of diarrhea (Xie Xie) is excessive dampness. Treatment should be based on the traditional method of Weiling Tang (Stomach-Calm Decoction, composed of Pingwei San and Wuling San) with flexible adaptation. Sishen Wan (Four Spirits Pill, a formula for warming the kidney and spleen to secure the intestines and stop diarrhea) is used to consolidate the Kidney; if accompanied by external pathogens, it must be combined with other treatments. The combination of bitter and sour-sweet flavors is highly recommended for its efficacy (This statement cannot be understood by anyone who has not studied for ten years and treated thousands of cases).
Regarding constipation (Mi Jie), *Jingui Zhenyan Lun* states: "The North corresponds to black, connects internally to the Kidney, and opens through the two yin orifices." *Qi Jue Lun* states: "Heat from the Bladder transfers to the Small Intestine, causing obstruction in the intestines and difficulty in defecation." *Zangqi Fashi Lun* states: "The Kidney dislikes dryness; urgently consume pungent foods to moisten it, open the interstices, generate fluids, and promote Qi circulation." *Zabing Pian* states: "When rebellious Qi rushes to the throat causing inability to speak, cold hands and feet, and difficulty in defecation, treat the Foot Shaoyin channel." From this, we know that except for cases of Yangming internal heat accumulation, where mild cases use Piyue Wan and severe cases use one of the Three Chengqi Decoctions, all constipation originates from the Kidney. The Kidney governs the two yin orifices and controls opening and closing. Those with incontinence are blamed for opening without closing; those with obstruction are blamed for closing without opening. Therefore, for Kidney heat, cool and moisten; for Kidney cold, warm and moisten; for Kidney deficiency, tonify and moisten; for Kidney dryness, lubricate and moisten. Furthermore, nourishing the Kidney also treats the Bladder, and the disease of transferred heat obstructing the intestines will resolve itself. Since constipation mostly stems from the Kidney, it is classified under interior syndromes.
Use the Three Chengqi Decoctions cautiously for constipation. Maren Wan (Hemp Seed Pill, also known as Piyue Wan) provides moisture without causing fragmentation or depletion. One must understand that the Kidney is the master of Yin; whether using tonification, purgation, cold, or warmth methods, the principle is always moistening.
In dysphagia (Ge Shi), water drinks can go down, but food is difficult to ingest. Gao Gufeng specifically advocates treating via the Yangming Stomach, using Zuogui Yin removing Fu Ling, adding Shu Di Huang and Dang Gui to nourish Stomach Yin. This method derives from Xue's *Medical Cases*, which treated chest fullness and anorexia by adding these two herbs to Liuwei Dihuang Wan. Fu Ling is removed to prevent its action from drifting into the Kan (Kidney/Water) region; instead, focusing solely on Yangming yields faster results. Using this formula allows Stomach Yin to ascend, widening the贲门 (cardia) for food intake; descending Stomach Yin moistens the pylorus and lanmen, facilitating bowel movements and urination. Effect is seen after more than ten doses. If ineffective, *Renjing Jing* strictly follows the *Neijing* saying "Obstruction of the Three Yang constitutes Ge," using Sanyi Chengqi Decoction in stages to purge, clearing old accumulations so new matter can enter. This is a harsh remedy. However, this syndrome often leads to death; even if treated vigorously, it is merely doing one's utmost human duty. Another condition is vomiting what was eaten in the morning at night, called Fan Wei (Reverse Regurgitation), caused by middle-jiao deficiency-cold and lower-jiao lack of fire. Suitable formulas include Wuzhuyu Tang, Fuzi Lizhong Tang, added with Fu Ling, Ban Xia, Chuan Jiao, etc., or alternating Zhenwu Tang and Bawei Wan. However, *Jingui Yaolue* contains Dabanxia Tang, which directs rebellious Chong Mai Qi downward, serving as a divine prescription for early-stage Ge Shi and Fan Wei.
(Interpretation of Classics) *Yinyang Bie Lun* states: "Disease of One Yang transmits to Ge." Note: One Yang refers to Shaoyang. Hand Shaoyang Sanjiao and Foot Shaoyang Gallbladder are governed by the ministerial fire seen in the initial qi. Xiao Chaihu Tang and various Xiexin Decoctions are used according to symptoms with miraculous effect. It also states: "Obstruction of the Three Yang constitutes Ge." Note: Three Yang refers to Taiyang. Hand Taiyang Small Intestine and Foot Taiyang Bladder, fundamentally cold but superficially hot. Obstruction can result from both cold and hot Qi, representing a deeper level of discussion. Zhang Jingyue stated: "Small Intestine belongs to Fire, Bladder to Water. If Fire fails to transform, Yang Qi does not circulate and transportation fails; if Water fails to transform, Yin Qi does not circulate and clear/turbid separation fails, both leading to obstruction." This is a shallower level of discussion. *Shanghan Lun* contains many miraculous prescriptions. *Xieqi Zangfu Bingxing Pian* states: "Slight urgency in the Spleen pulse indicates Ge Zhong, where food and drink are vomited back up, and copious saliva is discharged." Note: A slight pulse indicates Spleen deficiency and failing Middle Qi; copious saliva indicates Spleen deficiency and failure to control fluids. Lizhong Wan is the best strategy. If ineffective, identify the root cause of the pulse urgency and treat it. *Daqi Lun* states: "If the Stomach pulse is deep and beats涩ly, or if the Stomach pulse beats large superficially and the Heart pulse is small, firm, and urgent, these indicate Ge and hemiplegia." Note: This aligns with Gao Gufeng's previous argument. *Tongping Xuushi Lun* states: "Ge implies closure and isolation, upper and lower blockage, caused by sudden worry and anger." *Benshen Pian* states: "Those who worry have blocked Qi that does not circulate." Note: These two sections reflect Zhang Jifeng's view that "Yegge is a disorder of the spirit/mind." *Jingui Yaolue*'s Fuling Nongpu Tang and Danxi's Yueju Wan can treat this, but one must seek the root cause to achieve cure. *Xueqi Xingzhi Pian* states: "Physical hardship and mental suffering cause diseases arising in the throat and esophagus; treat with bitter medicines." I believe this also falls within the category of Xiexin Decoctions. For Fan Wei, *Neijing* lacks specific discussions; one should primarily rely on *Jingui Yaolue*.