自利不渴者，属太阴，以其脏有寒故也，当温之，宜四逆汤。
甘草（一两） 干姜（三钱） 附子（半个）
上 咀，水煎温服，强人加附子半个，干姜一两半。
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也，虚故引水自救。若小便色白者，少阴
病形悉具。小便白，以下焦虚有寒，不能制水，故令色白也。（《活人》云∶四逆主之。）少阴病，下利
六七日，咳而呕渴，心烦不能眠者，猪苓汤主之。少阴病，自利清水色纯青者，心下必痛，口干燥者，急下
之，宜大承气汤。
〔孙〕窦大郎患伤寒，经十余日，口燥舌干而渴，心中疼，自利清水。众医皆相守，但调理耳，汗下
皆所不敢，窦氏亲故相谓曰∶伤寒邪气害人性命甚速，安可以不决之疾，投不明之医乎？召孙至，曰∶即日不
可下，明日正当下。投小承气汤，遂大便通，得睡，明日平复。众皆曰∶此症缘何下之而愈？孙曰∶不深
于书，徒知有书耳，不知书之奥也。口燥舌干而渴，岂非少阴症乎？少阴症固不可下，岂不知少阴一症，
自利清水，心下痛者，下之而愈，仲景之书，明有是说也。众皆钦服。下利欲饮水者，以有热故也，宜白头翁汤。
白头翁 黄柏 秦皮 黄连（各三钱）
上 咀，水煎，去渣温服。不瘥，再服。
少阴病下利，白通汤主之。
少阴病，二三日不已，至四五日腹满痛，小便利，或下利，或呕者，宜真武汤。
茯苓 芍药（各三钱） 附子（一个） 白术（半两。加减法从本方）
上 咀，每服五钱，生姜五片，煎至八分，温服，日三。咳者，加五味子、细辛、干姜各一分。小
便利者，去茯苓。下利者去芍药，加干姜。呕者去附子，加生姜七片。少阴下利，咽痛，胸满心烦者，
猪肤汤主之。
用猪肤四两，以水一盏半，煎取一盏，去渣，加白蜜二合半，白粉一合二勺半，熬煮和相得，温服。
（海藏云∶猪肤即猪皮。）
大汗利而厥冷者，宜四逆汤。少阴病，但欲寐，下利，若兼手足厥逆者，白通加猪胆汁汤、通脉四逆汤。
（方论见后厥利。）兼便脓血者，宜桃花汤。（方论见后便脓血条。）少阴病，咳而下利，谵语者，被火
气劫故也，小便必难。以强责少阴汗故也。少阴病，下利，脉微涩，呕而汗出，必数更衣，反少者，当
温其上，灸之。温其上，（义见前条。）少阴病，下利，若利自止，恶寒而蜷，手足温者可治。大汗出，
热不去，内拘急，四肢疼，必下利厥逆而恶寒者，四逆汤主之。伤寒六七日，大下后，寸脉沉而迟，手足
厥逆，下部脉不至，咽喉不利，吐脓血，泄下不止者，为难治，宜麻黄升麻汤。
麻黄（去节，二两半） 升麻（二两） 当归 知母 黄芩 葳蕤（各十八铢） 石膏（碎） 白术 干姜
芍药 天门冬 桂枝 茯苓 甘草（各六铢）
上 咀，每服五钱，水煎温服，相次一炊时，又进一服，汗出愈。
下利脉沉而迟，其人面少赤，身有微汗，下利清谷者，必郁冒汗出而解，病患必微厥。所以然者，其
面戴阳，下虚故也。凡厥利当不能食，今反能食者，恐为除中。试食以索饼，不发热者，知胃气尚在，必愈也。（论
见厥。）伤寒先厥后发热下利者，必自止，而反汗出，咽中痛者，其喉为痹，发热无汗，而利必自止；必便脓血，
便脓血者，其喉不痹。下利后脉绝，手足厥冷， 时脉还，手足温者生，脉不还者死。下利，手足厥
冷，无脉者，灸之不温，若脉不还，反微喘者死。伤寒发热下利，厥逆，躁不得卧者死。伤寒发热下利，
至甚，厥不止者死。
少阴病下利脉微，与白通汤，利不止，厥逆无脉，干呕烦者，白通加猪胆汁汤主之。服汤后，脉暴
出者死，微续者生。
白通汤
干姜（一两） 附子（一枚，生用）
上 咀，每服五钱，入葱白二寸，同煎温服。
白通加猪胆汁汤
干姜（一分） 葱白（一茎） 附子（一枚） 童便（一合二勺半） 猪胆（一个）
上水一盏，煎至五分，去渣，入童便、胆汁相和得所，温服。少阴病，下利清谷，里寒外热，手足厥逆，
脉微欲绝，身反不恶寒，其病面赤色，或腹痛，或干呕，或咽痛，或利止脉不出者，通脉四逆汤主之。
甘草（炙） 干姜（各二两） 附子（一个，生用） 面赤色者，加葱九茎。腹中痛者，去葱加芍药二两。
呕者，加生姜二两。咽痛者，去芍药加桔梗一两。利止脉不出者，去桔梗加人参一两。
上 咀，每服五钱，水煎温服。未瘥，急更作一剂，其脉续续出者愈。
少阴病，但欲寐，四肢逆而利，若下重者，四逆散加薤白也。（论见厥。方见但欲寐。）若恶寒身
蜷者不治。（论见欲寐。）
下利腹胀满，身体疼痛，先温其里，乃攻其表。温里四逆汤，攻表桂枝汤。伤寒表不解，干呕发热，咳而
下利者，此为水气，宜小青龙去麻黄加芫花汤。（方论见效。）太阳与阳明合病者，必自下利，葛根汤
主之。（方见太阳病。）《活人》云∶下利而头痛腰疼，肌热目疼鼻干，其脉浮大而长者，是其症也。）太阳
与少阳合病，自下利者，与黄芩汤；若呕者，黄芩加
半夏生姜汤主之。（下利而头疼胸满，或口苦咽干，或往来寒热，其脉浮大而弦是也。）
黄芩汤
黄芩（三分） 甘草（炙） 芍药（各二分） 大枣（二枚）
上 咀，水煎温服。若呕加半夏六钱，生姜五片。
太阳病，桂枝症，医反下之，利遂不止，脉促者，表未解也，喘而汗出者，宜葛根芩连汤。
葛根（三两） 黄连 黄芩（各二两） 甘草（炙，半两）
上 咀，每服五钱，水煎温服，日进二三服。
下利清谷，脉沉微，手足厥逆者为阴，宜通脉四逆汤。（论见前条。）脉浮而迟，表热里寒，下
利清谷者，四逆汤主之。伤寒医下之，续得下利清谷不止，身疼痛者，急当救里，下后身疼痛，清便
自调者，急当救表。救里宜四逆汤，救表宜桂枝汤。少阴病下利，便脓血者，桃花汤主之。少阴病，二三
日至四五日，腹满，小便不利，下利不止，便脓血者，宜桃花汤。
赤石脂（四两，一半全，一半取末） 大米（二合半） 干姜（二钱半）
上水二大盏，煮三味，米熟去渣，纳赤石脂细末一方寸匕，温服，日三。愈，勿服。
少阴病，下利脓血者，可刺。下利便脓血，若厥而发热，厥少热多者，病当愈也。（论见厥。）先厥
后发热无汗者，利不止也。（论见前条。）下利脉数而渴者，令自愈。设不瘥者，必清脓血，以有热
故也。下利寸脉反浮数，尺中自涩者，必清脓血。下利脉数不解，而下利不止者，必挟热而便脓血
也。（论见蓄血。）
下利谵语，若脉微，手足厥，但欲寐，小便难者，为阴，宜补剂和之。
若脉和，手足温，及不欲寐，小便利者，为阳，宜调胃承气汤。（论见谵语及前少阴下利欲寐条。）
阳明少阳合病，必下利，其脉不负者顺也，负者失也，互相克贼，名为负也。脉滑而数者，有宿食也，当
下之，宜大承气汤。下利脉迟而滑者，内实也，利未欲止，当下之，宜大承气汤。下利脉反滑，当有所去，下
之乃愈，宜大承气汤。
下利脉微者，白通汤也。若微涩，呕而汗出，数更衣者，当温而灸之。（方论见少阴不利条。）
下利脉大者，虚也，以其强下之故也。设脉浮革，故尔肠鸣者，属当归四逆汤主之。
热利下重者，白头翁汤主之。四肢逆而泄利下重，四逆散加薤白主之。（论见前厥利条。）
下利身体疼痛，若但四肢沉重疼痛，小便不利者，前条真武汤症也；若四肢疼，厥逆恶寒者，四逆
汤；若通身疼痛者，先以四逆汤温里，后用桂枝攻表也。（方论见前。）
下利，三部脉皆平，按之心下硬者，急下之，宜大承气汤。下利后，心下痞硬者，此非结热，但胃
虚，客气上逆，故使硬，甘草泻心汤主之。（论见痞。）
下利咽喉痛，若兼胸满者，猪肤汤；兼厥逆者，通脉四逆汤。
若下利不止，厥逆，下部无力，咳唾脓血者，麻黄升麻汤。（方论并见前条。）
下利十余行，胸中痛，寸口脉滑者，宜吐之，则利止。（论见胸满）伤寒服汤药，下利不止，心下痞
硬。服泻心汤后，以他药下之，利不止，医以理中与之，利益甚。理中者，理中焦，此利在下焦，赤石脂禹
余粮汤主之。复利不止者，宜利其小便。
赤石脂禹余粮汤
赤石脂 禹余粮（各四两）
上锉碎，每服五钱，水煎温服。不瘥，再服。
下后心下痞硬，腹中雷鸣，干呕而利者，甘草泻心汤。（方论见痞。）下后心下痞硬，表里不解而利
者，桂枝人参汤。（方论见痞。）下利脉促，表不解，喘汗而利者，葛根黄芩黄连汤。（论见前下利有表条。）
凡药下后，潮热胁满，呕而利者，先用小柴胡汤解外，后以柴胡加芒硝汤。（论见潮热。）凡药下后，谵
语，脉调和，小便利，而下利不厥者，调胃承气
汤。（论见谵语。）下后脉大浮革，肠鸣而利者，当归四逆汤。（论见前下利脉治条。）下后脉数不解者，
必便脓血。（论见前便血条。）下后成阴症，厥逆，咽不利，唾脓而利者，麻黄升麻汤。（论见厥利条。）
少阴病，脉紧，至七八日自下利，脉暴微，手足反温，脉紧反去者，为欲解也。虽烦，下利必自愈。伤寒
脉浮缓，手足温，至七八日忽暴烦，下利日十余行者，必自止。（论见黄门。）发热而厥，七日下利者，
为难治。伤寒六七日不利，便发热而利，其人汗出不止者死，有阴无阳故也。少阴病但欲卧，不烦，至五
六日，忽自利，烦躁不得寐者死。（论见但欲寐。）下利，脉沉弦者，下重也；脉大者，为未止；脉微数者，
为欲自止，虽发热不死。下利有微热而渴，脉弱，今自愈。下利脉数而渴者，自愈。设不瘥者，必清脓血。
（论见前。）下利脉数，有微热，汗出，今自愈。设复紧，为末解。伤寒下利日十余行，脉反沉者死。假
令下利，寸口关上尺中悉不见脉，然尺中时一小见，脉再举头者，肾气也，若损脉来至，为难治。下利清
谷，不可攻表，汗出必胀满。
自发性腹泻且不口渴的，属于太阴病，这是因为内脏有寒邪所致，应当采用温法治疗，适宜使用四逆汤。
甘草（一两） 干姜（三钱） 附子（半个）
将药材切碎，加水煎煮，温服。体质强壮者，附子加半个，干姜加至一两半。
少阴病，想呕吐却吐不出来，心烦意乱，只想睡觉，过了五六天出现自发性腹泻且口渴的，属于少阴病，这是由于正气虚弱，机体引水来自救。如果小便颜色发白的，说明少阴病的症状全部具备。小便色白，是因为下焦虚寒，不能制约水液，所以导致小便颜色发白。（《活人书》说：适宜用四逆汤主治。）少阴病，腹泻持续六七天，伴有咳嗽、呕吐、口渴、心烦且无法入睡的，由猪苓汤主治。少阴病，排出清水样粪便且颜色纯青的，心下部必定疼痛，口干燥的，应当紧急攻下，适宜使用大承气汤。
〔孙〕窦大郎患伤寒，经过十多天，口燥舌干而渴，心中疼痛，排出清水样粪便。众医生都保守治疗，只是调理而已，不敢使用发汗或攻下的方法。窦氏的亲友互相议论说：“伤寒邪气危害人命非常迅速，怎么能让不明确的疾病，交给不明了医理的医生呢？”于是召请孙思邈前来，孙思邈说：“今天不可以攻下，明天正当攻下。”投用小承气汤，随后大便通畅，得以安睡，第二天便康复了。众人都说：“这个病症为什么通过攻下而痊愈？”孙思邈说：“如果不深入研读医书，只是徒然知道有书罢了，并不知道书中的奥妙。口燥舌干而渴，难道不是少阴症吗？少阴症固然不可攻下，但岂不知少阴症中，自利清水、心下痛的，通过攻下可以痊愈，张仲景的书上明确有这样的说法。众人都钦佩信服。腹泻想要喝水的，是因为体内有热，适宜使用白头翁汤。
白头翁 黄柏 秦皮 黄连（各三钱）
将药材切碎，加水煎煮，去渣温服。若未痊愈，再服用。
少阴病腹泻，由白通汤主治。
少阴病，两三天未愈，到了四五天出现腹部胀满疼痛，小便通畅，或者腹泻，或者呕吐的，适宜使用真武汤。
茯苓 芍药（各三钱） 附子（一个） 白术（半两。加减法遵循本方）
将药材切碎，每次服用五钱，生姜五片，煎至八分，温服，每日三次。若有咳嗽，加五味子、细辛、干姜各一分。小便通畅的，去掉茯苓。腹泻的，去掉芍药，加干姜。呕吐的，去掉附子，加生姜七片。少阴病腹泻，伴有咽喉痛、胸满、心烦的，由猪肤汤主治。
取猪肤四两，用水一盏半，煎取一盏，去渣，加入白蜜二合半，米粉一合二勺半，熬煮调和均匀，温服。（海藏说：猪肤即猪皮。）
大汗出后腹泻且四肢厥冷的，适宜使用四逆汤。少阴病，只想睡觉，腹泻，如果兼有手足厥逆的，用白通加猪胆汁汤、通脉四逆汤。（方论见后文“厥利”条。）兼有大便带脓血的，适宜使用桃花汤。（方论见后文“便脓血”条。）少阴病，咳嗽且腹泻，出现谵语的，是被火气劫夺津液所致，小便必定困难。这是因为强行要求少阴病发汗的缘故。少阴病，腹泻，脉象微涩，呕吐且出汗，必然频繁更衣排便，但量反而很少的，应当温补上部，并施以艾灸。温补上部，（义理见前条。）少阴病，腹泻，如果腹泻自行停止，恶寒且身体蜷缩，但手足温暖的，可以治愈。大汗出，发热不退，内部拘急，四肢疼痛，必然出现腹泻、四肢厥冷且恶寒的，由四逆汤主治。伤寒六七天，经过猛烈攻下后，寸脉沉而迟，手足厥逆，下部脉搏摸不到，咽喉不利，吐脓血，泄泻不止的，属于难治之症，适宜使用麻黄升麻汤。
麻黄（去节，二两半） 升麻（二两） 当归 知母 黄芩 葳蕤（各十八铢） 石膏（捣碎） 白术 干姜
芍药 天门冬 桂枝 茯苓 甘草（各六铢）
将药材切碎，每次服用五钱，加水煎煮温服，间隔一顿饭的时间，再进服一次，出汗则痊愈。
腹泻脉象沉而迟，病人面部微微发红，身上有微汗，排出未消化食物的，必然会出现郁冒出汗而病解，病人必定会有轻微的四肢厥冷。之所以这样，是因为病人面部戴阳，下焦虚寒的缘故。凡是厥逆腹泻应当不能进食，现在反而能进食的，恐怕是“除中”证。试着给病人吃索饼（面条），如果不发热，就知道胃气尚在，必定会痊愈。（论述见“厥”条。）伤寒先出现四肢厥冷，后来发热且腹泻的，腹泻必定自行停止；如果反而出汗，咽喉疼痛的，喉部会发生痹阻；如果发热无汗，腹泻必定自行停止；如果出现大便带脓血，大便带脓血的，喉部不会发生痹阻。腹泻后脉搏消失，手足厥冷，片刻后脉搏恢复，手足转温的，预后良好；脉搏不恢复的，预后不良。腹泻，手足厥冷，无脉搏的，施灸后若不回暖，如果脉搏不恢复，反而出现轻微喘息的，预后不良。伤寒发热腹泻，四肢厥冷，躁动不安无法躺卧的，预后不良。伤寒发热腹泻，程度严重，四肢厥冷不止的，预后不良。
少阴病腹泻，脉象微弱，给予白通汤，腹泻不止，四肢厥冷无脉，干呕心烦的，由白通加猪胆汁汤主治。服药后，脉搏突然暴出的，预后不良；脉搏逐渐微弱续接的，预后良好。
白通汤
干姜（一两） 附子（一枚，生用）
将药材切碎，每次服用五钱，加入葱白二寸，同煎温服。
白通加猪胆汁汤
干姜（一分） 葱白（一茎） 附子（一枚） 童便（一合二勺半） 猪胆（一个）
用水一盏，煎至五分，去渣，加入童便、胆汁调和均匀，温服。少阴病，腹泻排出未消化食物，里寒外热，手足厥冷，脉象微弱几乎摸不到，身体反而不恶寒，面色赤红，或者腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏不出现的，由通脉四逆汤主治。
甘草（炙） 干姜（各二两） 附子（一个，生用） 面色赤红的，加葱九茎。腹中痛的，去掉葱，加芍药二两。呕吐的，加生姜二两。咽痛的，去掉芍药，加桔梗一两。腹泻停止脉搏不出现的，去掉桔梗，加人参一两。
将药材切碎，每次服用五钱，加水煎煮温服。若未痊愈，急忙再制作一剂，其脉搏连续出现的，即可痊愈。
少阴病，只想睡觉，四肢逆冷且腹泻，如果有下重感（肛门坠胀）的，用四逆散加薤白。（论述见“厥”。方剂见“但欲寐”条。）如果恶寒身体蜷缩的，属于不治之症。（论述见“欲寐”条。）
腹泻伴有腹胀满，身体疼痛的，先温补其里，然后攻伐其表。温里用四逆汤，攻表用桂枝汤。伤寒表证未解，干呕发热，咳嗽且腹泻的，这是水气为患，适宜用小青龙汤去掉麻黄加上芫花汤。（方论见“效”条。）太阳与阳明合病，必然自发性腹泻，由葛根汤主治。（方剂见“太阳病”条。）《活人书》说：“腹泻且头痛腰痛，肌肉发热，眼睛疼痛，鼻子干燥，脉象浮大而长的，就是这种病症。”太阳与少阳合病，自发性腹泻的，给予黄芩汤；如果呕吐的，由黄芩加半夏生姜汤主治。（腹泻且头疼胸满，或者口苦咽干，或者往来寒热，脉象浮大而弦的，就是这种病症。）
黄芩汤
黄芩（三分） 甘草（炙） 芍药（各二分） 大枣（二枚）
将药材切碎，加水煎煮温服。如果呕吐，加半夏六钱，生姜五片。
太阳病，桂枝证，医生反而使用攻下法，腹泻随即不止，脉象急促的，说明表证未解，气喘且出汗的，适宜使用葛根芩连汤。
葛根（三两） 黄连 黄芩（各二两） 甘草（炙，半两）
将药材切碎，每次服用五钱，加水煎煮温服，每日进二三服。
腹泻排出未消化食物，脉象沉微，手足厥冷的，属于阴证，适宜使用通脉四逆汤。（论述见前条。）脉象浮而迟，表热里寒，腹泻排出未消化食物的，由四逆汤主治。伤寒医生使用攻下法，随后出现腹泻排出未消化食物不止，身体疼痛的，应当紧急救治里证；攻下后身体疼痛，大小便正常的，应当紧急救治表证。救治里证适宜用四逆汤，救治表证适宜用桂枝汤。少阴病腹泻，大便带脓血的，由桃花汤主治。少阴病，从二三天到四五天，腹部胀满，小便不利，腹泻不止，大便带脓血的，适宜使用桃花汤。
赤石脂（四两，一半整块，一半研成粉末） 大米（二合半） 干姜（二钱半）
用水两大盏，煮这三味药，米熟后去渣，纳入赤石脂细末一方寸匕，温服，每日三次。痊愈后，不要继续服用。
少阴病，腹泻带脓血的，可以针刺。腹泻大便带脓血，如果四肢厥冷且发热，厥冷时间短而发热时间长的，病应当痊愈。（论述见“厥”条。）先厥冷后来发热无汗的，腹泻不会停止。（论述见前条。）腹泻脉象数且口渴的，将会自愈。如果未痊愈的，必然排泄脓血，因为体内有热的缘故。腹泻寸脉反而浮数，尺中脉自涩的，必然排泄脓血。腹泻脉象数而不缓解，且腹泻不止的，必然挟热而大便带脓血。（论述见“蓄血”条。）
腹泻出现谵语，如果脉象微弱，手足厥冷，只想睡觉，小便困难的，属于阴证，适宜用补剂和调之法。
如果脉象平和，手足温暖，以及不想睡觉，小便通畅的，属于阳证，适宜使用调胃承气汤。（论述见“谵语”及前文“少阴下利欲寐”条。）
阳明与少阳合病，必然腹泻，脉象不负（即脉象与病情相符，如少阳病见弦脉）的为顺证，负（即脉象与病情相悖，如少阳病见肺金之脉）的为逆证，互相克贼，称为负。脉象滑而数的，是有宿食，应当攻下，适宜使用大承气汤。腹泻脉象迟而滑的，是内实，腹泻尚未停止，应当攻下，适宜使用大承气汤。腹泻脉象反而滑的，应当有所去除，攻下后才会痊愈，适宜使用大承气汤。
腹泻脉象微弱的，用白通汤。如果脉象微涩，呕吐且出汗，频繁更衣的，应当温补并施以艾灸。（方论见“少阴不利”条。）
腹泻脉象大的，属于虚证，这是因为强行攻下的缘故。如果脉象浮革，因此肠鸣的，属于当归四逆汤主治。
热性腹泻伴有肛门坠重感的，由白头翁汤主治。四肢逆冷且泄利伴有肛门坠重感的，由四逆散加薤白主治。（论述见前文“厥利”条。）
腹泻身体疼痛，如果只是四肢沉重疼痛，小便不利的，是前条的真武汤证；如果四肢疼痛，四肢厥冷恶寒的，用四逆汤；如果全身疼痛的，先用四逆汤温里，后用桂枝汤攻表。（方论见前文。）
腹泻，三部脉皆平和，按压心下部硬实的，紧急攻下，适宜使用大承气汤。腹泻后，心下部痞塞硬满的，这不是结热，只是胃气虚弱，客气上逆，所以导致硬满，由甘草泻心汤主治。（论述见“痞”条。）
腹泻咽喉痛，如果兼有胸满的，用猪肤汤；兼有四肢厥冷的，用通脉四逆汤。
如果腹泻不止，四肢厥冷，下部无力，咳嗽吐脓血的，用麻黄升麻汤。（方论并见前条。）
腹泻十多次，胸中痛，寸口脉滑的，适宜用吐法，则腹泻停止。（论述见“胸满”条。）伤寒服用汤药后，腹泻不止，心下部痞塞硬满。服用泻心汤后，又用其他药物攻下，腹泻不止，医生用理中汤与之，腹泻更加严重。理中汤是调理中焦的，此腹泻在下焦，由赤石脂禹余粮汤主治。再次腹泻不止的，适宜利小便。
赤石脂禹余粮汤
赤石脂 禹余粮（各四两）
将药材锉碎，每次服用五钱，加水煎煮温服。若未痊愈，再服用。
攻下后心下部痞塞硬满，腹中雷鸣，干呕且腹泻的，用甘草泻心汤。（方论见“痞”条。）攻下后心下部痞塞硬满，表里不解且腹泻的，用桂枝人参汤。（方论见“痞”条。）腹泻脉象急促，表证未解，气喘出汗且腹泻的，用葛根黄芩黄连汤。（论述见前文“下利有表”条。）
凡是服药攻下后，潮热胁满，呕吐且腹泻的，先用小柴胡汤解外，后用柴胡加芒硝汤。（论述见“潮热”条。）凡是服药攻下后，谵语，脉象调和，小便通畅，且腹泻不厥冷的，用调胃承气汤。（论述见“谵语”条。）攻下后脉象大浮革，肠鸣而腹泻的，用当归四逆汤。（论述见前文“下利脉治”条。）攻下后脉象数而不缓解的，必然大便带脓血。（论述见前文“便血”条。）攻下后形成阴症，四肢厥冷，咽喉不利，吐脓且腹泻的，用麻黄升麻汤。（论述见“厥利”条。）
少阴病，脉紧，到了七八天自发性腹泻，脉象突然变微弱，手足反而温暖，脉紧反而消失的，是即将痊愈的迹象。虽然心烦，腹泻必定自愈。伤寒脉象浮缓，手足温暖，到了七八天忽然暴烦，腹泻一天十多次的，必定会自行停止。（论述见“黄门”条。）发热且四肢厥冷，七天腹泻的，属于难治。伤寒六七天没有腹泻，突然出现发热且腹泻，其人汗出不止的，预后不良，因为有阴无阳的缘故。少阴病只想睡觉，不心烦，到了五六年，忽然自发性腹泻，烦躁无法入睡的，预后不良。（论述见“但欲寐”条。）腹泻，脉象沉弦的，是肛门坠重；脉象大的，是病未停止；脉象微数的，是病将要自行停止，虽然有发热也不会死。腹泻有轻微发热且口渴，脉象弱，将会自愈。腹泻脉象数且口渴的，将会自愈。如果未痊愈的，必然排泄脓血。（论述见前文。）腹泻脉象数，有轻微发热，出汗，将会自愈。如果脉象再次变紧，是病未解除。伤寒腹泻一天十多次，脉象反而沉的，预后不良。假如腹泻，寸口、关上、尺中完全摸不到脉搏，然而尺中偶尔出现一小次脉搏，脉象再举头（指脉来有力）的，是肾气尚存，如果脉象受损来至无力，属于难治。腹泻排出未消化食物，不可攻表，发汗必然导致腹胀满。
Spontaneous diarrhea without thirst belongs to Taiyin disease, caused by cold in the zang organs; it should be treated with warming methods, and Sini Tang (Four Reversal Decoction) is appropriate.
Gancao (Licorice Root, 1 liang), Ganjiang (Dried Ginger, 3 qian), Fuzi (Prepared Aconite Root, half a piece).
Crush the herbs, decoct in water, and take warm. For robust individuals, add half a piece of Fuzi and increase Ganjiang to 1.5 liang.
Shaoyin disease characterized by the desire to vomit but inability to do so, irritability, and a strong desire to sleep, followed by spontaneous diarrhea and thirst after five or six days, belongs to Shaoyin disease. This is due to deficiency, leading the body to draw water for self-rescue. If the urine is white, the signs of Shaoyin disease are fully present. White urine results from deficiency-cold in the lower jiao, which fails to control water metabolism, thus causing the urine to appear white. (The *Ren Shu* states: Sini Tang is indicated.) In Shaoyin disease, if diarrhea persists for six or seven days accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhu Ling Tang (Polyporus Decoction) is indicated. In Shaoyin disease, if clear watery stool is passed that is purely green, there must be pain in the epigastrium and dryness of the mouth; urgent purgation is required, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate.
[Sun] Si Dalang suffered from Shanghan (Cold Damage) for over ten days, presenting with dry mouth and tongue with thirst, heart pain, and passage of clear watery stool. The attending physicians adopted a conservative approach, merely providing supportive care, fearing to use sweating or purging methods. Si's relatives discussed among themselves, saying, "Shanghan pathogenic qi harms life very rapidly; how can we entrust an uncertain illness to a physician lacking clarity?" They summoned Sun Simiao. Sun said, "Purgation is not suitable today; it is appropriate tomorrow." He administered Xiao Chengqi Tang (Minor Order the Qi Decoction). Subsequently, the bowels moved freely, he slept soundly, and recovered the next day. Everyone asked, "Why did this condition heal through purgation?" Sun replied, "If one does not study deeply, one merely knows of the books but does not understand their profundity. Dry mouth, tongue, and thirst—are these not Shaoyin symptoms? Although Shaoyin disease generally contraindicates purgation, does one not know that in Shaoyin disease, spontaneous diarrhea with clear water and epigastric pain can be cured by purgation? Zhang Zhongjing's writings explicitly state this." All were convinced. Diarrhea accompanied by a desire to drink indicates heat within; Baitouweng Tang (Pulsatilla Decoction) is appropriate.
Baitouweng (Pulsatilla Root), Huangbai (Phellodendron Bark), Qinpi (Ash Bark), Huanglian (Coptis Rhizome) (each 3 qian).
Crush the herbs, decoct in water, remove the dregs, and take warm. If not healed, administer again.
Shaoyin disease with diarrhea is treated by Baitong Tang (White Connective Decoction).
In Shaoyin disease, if the condition persists for two or three days and progresses to four or five days with abdominal fullness and pain, free urination, or alternatively diarrhea or vomiting, Zhenwu Tang (True Warrior Decoction) is appropriate.
Fuling (Poria, 3 qian), Shaoyao (Peony Root, 3 qian), Fuzi (Prepared Aconite Root, one piece), Baizhu (Atractylodes Macrocephala Rhizome, 0.5 liang. Modifications follow the main formula).
Crush the herbs. Take 5 qian per dose with five slices of Shengjiang (Fresh Ginger), decoct until reduced to 80%, and take warm, three times daily. If coughing occurs, add Wuweizi (Schisandra Berry), Xixin (Asarum Root), and Ganjiang (Dried Ginger) each 1 fen. If urination is free, remove Fuling. If diarrhea occurs, remove Shaoyao and add Ganjiang. If vomiting occurs, remove Fuzi and add seven slices of Shengjiang. Shaoyin disease with diarrhea, sore throat, chest fullness, and irritability is treated by Zhufu Tang (Pig Skin Decoction).
Take 4 liang of Zhufu (Pig Skin), decoct in 1.5 sheng of water until 1 sheng remains, remove dregs, add 2.5 he of Baimi (White Honey) and 1.25 shao of Baifen (Rice Flour), cook until well mixed, and take warm. (Haizang states: Zhufu is pig skin.)
Profuse sweating followed by diarrhea and cold extremities requires Sini Tang. In Shaoyin disease, if there is a desire to sleep and diarrhea, accompanied by cold extremities, Baitong Jia Zhuyedan Tang (White Connective Decoction plus Porcine Bile) or Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) are indicated. (Formula commentary see section on Jue-Li.) If accompanied by pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) is appropriate. (Formula commentary see section on Bian Nongxue.) In Shaoyin disease, if cough and diarrhea are accompanied by delirium, it is due to the robbery of fluids by fire therapy, and urination will certainly be difficult. This results from forcing sweat in Shaoyin disease. In Shaoyin disease with diarrhea, if the pulse is faint and choppy, vomiting and sweating occur, and there is frequent defecation with little output, one should warm the upper part and apply moxibustion. Warming the upper part (meaning see previous section). In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, there is aversion to cold and curling up, but the hands and feet are warm; this is treatable. Profuse sweating, persistent fever, internal tension, limb pain, inevitably leading to diarrhea, cold extremities, and aversion to cold, is treated by Sini Tang. In Shanghan, after six or seven days, following severe purgation, if the cun pulse is deep and slow, extremities are cold, the radial pulse at the lower position is imperceptible, the throat is obstructed, pus and blood are expectorated, and diarrhea is unceasing, it is difficult to treat; Mahuang Shengma Tang (Ephedra and Cyathula Decoction) is appropriate.
Mahuang (Ephedra Stem, 2.5 liang, tips removed), Shengma (Cyathula Root, 2 liang), Danggui (Angelica Sinensis Root), Zhimu (Anemarrhena Rhizome), Huangqin (Scutellaria Root), Weirui (Polygonatum Rhizome) (each 18 zhu), Shigao (Gypsum, crushed), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), Shaoyao (Peony Root), Tianmendong (Asparagus Tuber), Guizhi (Cinnamon Twig), Fuling (Poria), Gancao (Licorice Root) (each 6 zhu).
Crush the herbs. Take 5 qian per dose, decoct in water, and take warm. After the time it takes to cook a meal, administer another dose. Recovery follows sweating.
Diarrhea with a deep and slow pulse, slight redness on the face, slight sweating on the body, and passage of undigested food indicates that depression and dizziness with subsequent sweating will lead to resolution. The patient will likely have mild cold extremities. This is because the face shows floating yang due to lower jiao deficiency. Generally, patients with Jue (cold extremities) and Li (diarrhea) cannot eat; if they suddenly can eat, it may be Chu Zhong (Stomach Qi Exhaustion). Test by feeding Suobing (noodles); if no fever ensues, stomach qi remains, and recovery is certain. (Discussion see Jue section.) In Shanghan, if initial cold extremities are followed by fever and diarrhea, the diarrhea will stop spontaneously. If instead sweating occurs and throat pain develops, the throat becomes Bi (obstructed). If fever occurs without sweating, the diarrhea will stop spontaneously; however, if pus and blood appear in the stool, the throat will not become Bi. After diarrhea, if the pulse vanishes and extremities are cold, but the pulse returns and extremities warm, survival is expected; if the pulse does not return, death ensues. In diarrhea with cold extremities and absent pulse, if moxibustion fails to warm the limbs and the pulse does not return, accompanied by slight panting, death ensues. In Shanghan with fever, diarrhea, cold extremities, restlessness, and inability to lie down, death ensues. In Shanghan with severe fever and diarrhea, if cold extremities persist, death ensues.
In Shaoyin disease with diarrhea and faint pulse, if Baitong Tang is given but diarrhea continues, with cold extremities, absent pulse, dry heaving, and irritability, Baitong Jia Zhuyedan Tang (White Connective Decoction plus Porcine Bile) is indicated. If after taking the decoction the pulse suddenly appears, death ensues; if the pulse gradually returns, survival is expected.
Baitong Tang
Ganjiang (Dried Ginger, 1 liang), Fuzi (Prepared Aconite Root, one piece, raw).
Crush the herbs. Take 5 qian per dose with 2 cun of Congbai (Green Onion White), decoct together, and take warm.
Baitong Jia Zhuyedan Tang
Ganjiang (Dried Ginger, 1 fen), Congbai (Green Onion White, one stalk), Fuzi (Prepared Aconite Root, one piece), Tongbian (Child Urine, 1.5 he), Zhudan (Porcine Gallbladder, one).
Decoct in 1 sheng of water until 0.5 sheng remains, remove dregs, mix with Tongbian and bile, and take warm. In Shaoyin disease, if diarrhea passes undigested food, with interior cold and exterior heat, cold extremities, faint pulse nearly imperceptible, yet the body feels no aversion to cold, and the face is red, or there is abdominal pain, dry heaving, sore throat, or diarrhea stopping with absent pulse, Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is indicated.
Gancao (Honey-fried Licorice Root), Ganjiang (Dried Ginger) (each 2 liang), Fuzi (Prepared Aconite Root, one piece, raw). If the face is red, add nine stalks of Congbai. If abdominal pain, remove Congbai and add 2 liang of Shaoyao. If vomiting, add 2 liang of Shengjiang. If sore throat, remove Shaoyao and add 1 liang of Jiegeng. If diarrhea stops and pulse is absent, remove Jiegeng and add 1 liang of Renshen.
Crush the herbs. Take 5 qian per dose, decoct in water, and take warm. If not healed, urgently prepare another dose. If the pulse continuously emerges, healing occurs.
In Shaoyin disease, if there is a desire to sleep, cold extremities, and diarrhea, with a sensation of heaviness in the rectum (Zhongzhong), Sini San (Four Reversal Powder) plus Xiebai (Allium Macrostemon Bulb) is used. (Discussion see Jue. Formula see Dan Yu Mei section.) If there is aversion to cold and curling up, it is incurable. (Discussion see Yu Mei section.)
Diarrhea with abdominal fullness and body pain requires first warming the interior, then attacking the exterior. Warm the interior with Sini Tang; attack the exterior with Guizhi Tang. In Shanghan, if the exterior syndrome is unresolved, accompanied by dry heaving, fever, cough, and diarrhea, this is Water Qi (Fluid Retention); Xia Qinglong Tang (Minor Green Dragon Decoction) with Mahuang removed and Yuanhua added is appropriate. (Formula commentary see Xiao section.) When Taiyang and Yangming combine, spontaneous diarrhea occurs; Gegen Tang (Kudzu Decoction) is indicated. (Formula see Taiyang Disease section.) The *Ren Shu* states: "Diarrhea with headache and lumbar pain, muscle heat, eye pain, nasal dryness, and a large, long, floating pulse characterizes this syndrome." When Taiyang and Shaoyang combine, spontaneous diarrhea occurs; Huangqin Tang (Scutellaria Decoction) is given. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) is indicated. (Diarrhea with headache, chest fullness, bitter taste, dry throat, alternating chills and fever, and a large, string-taut floating pulse characterizes this syndrome.)
Huangqin Tang
Huangqin (Scutellaria Root, 3 fen), Gancao (Honey-fried Licorice Root), Shaoyao (Peony Root) (each 2 fen), Dazao (Jujube, 2 pieces).
Crush the herbs, decoct in water, and take warm. If vomiting, add 6 qian of Banxia and 5 slices of Shengjiang.
In Taiyang disease, if the Guizhi pattern is present but the physician incorrectly uses purgation, resulting in unceasing diarrhea, a rapid pulse indicates the exterior is unresolved. If accompanied by wheezing and sweating, Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction) is appropriate.
Gegen (Kudzu Root, 3 liang), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root) (each 2 liang), Gancao (Honey-fried Licorice Root, 0.5 liang).
Crush the herbs. Take 5 qian per dose, decoct in water, and take warm, two to three times daily.
Diarrhea passing undigested food, with deep and faint pulse and cold extremities, indicates Yin syndrome; Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is appropriate. (Discussion see previous section.) If the pulse is floating and slow, with exterior heat and interior cold, and diarrhea passing undigested food, Sini Tang (Four Reversal Decoction) is indicated. In Shanghan, if a physician uses purgation and subsequently unceasing diarrhea with undigested food occurs, accompanied by body pain, urgent treatment of the interior is required. If after purgation body pain persists but bowel movements are normal, urgent treatment of the exterior is required. Treat the interior with Sini Tang; treat the exterior with Guizhi Tang. In Shaoyin disease with diarrhea and pus/blood in the stool, Taohua Tang (Peach Blossom Decoction) is indicated. In Shaoyin disease, progressing from two to three days to four to five days, with abdominal fullness, difficulty urinating, unceasing diarrhea, and pus/blood in the stool, Taohua Tang (Peach Blossom Decoction) is appropriate.
Chishizhi (Halloysitum Rubrum, 4 liang, half whole, half powdered), Damii (Rice, 2.5 he), Ganjiang (Dried Ginger, 2.5 qian).
Decoct the three ingredients in two large shengs of water until the rice is cooked, remove dregs, add one Fang Cun Bi of fine Chishizhi powder, and take warm, three times daily. Stop when healed.
In Shaoyin disease with diarrhea and pus/blood in the stool, acupuncture may be used. In diarrhea with pus/blood, if there are cold extremities and fever, if cold predominates less than heat, the disease will heal. (Discussion see Jue section.) If initial cold extremities are followed by fever without sweating, diarrhea will not stop. (Discussion see previous section.) In diarrhea with a rapid pulse and thirst, spontaneous healing is expected. If not healed, pus/blood in the stool will definitely occur due to heat. If the cun pulse in diarrhea is unexpectedly floating and rapid, while the chi pulse is choppy, pus/blood in the stool will definitely occur. If the rapid pulse in diarrhea does not resolve and diarrhea continues, heat-clasped pus/blood in the stool will occur. (Discussion see Xu Xue section.)
Delirium with diarrhea, if accompanied by faint pulse, cold extremities, desire to sleep, and difficult urination, indicates Yin syndrome; harmonize with tonifying methods.
If the pulse is harmonious, extremities are warm, there is no desire to sleep, and urination is free, it indicates Yang syndrome; Tiaowei Chengqi Tang (Harmonizing Stomach Major Order the Qi Decoction) is appropriate. (Discussion see Zanyu and previous Shaoyin diarrhea/desire to sleep sections.)
When Yangming and Shaoyang combine, diarrhea inevitably occurs. If the pulse is "not negative" (harmonious with the syndrome), it is favorable; if "negative" (clashing with the syndrome), it is unfavorable. Mutual overcoming is called "negative." A slippery and rapid pulse indicates retained food; purgation is required, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate. A slow and slippery pulse in diarrhea indicates interior excess; as diarrhea has not stopped, purgation is required, and Dachengqi Tang is appropriate. An unexpectedly slippery pulse in diarrhea indicates something needs removal; purgation leads to healing, and Dachengqi Tang is appropriate.
A faint pulse in diarrhea indicates Baitong Tang. If the pulse is faint and choppy, with vomiting, sweating, and frequent defecation, warming and moxibustion are required. (Formula commentary see Shaoyin Li section.)
A large pulse in diarrhea indicates deficiency, caused by forced purgation. If the pulse is floating and革 (leather-like), with borborygmus, Danggui Sini Tang (Angelica Sinensis Four Reversal Decoction) is indicated.
Heat-diarrhea with rectal heaviness is treated by Baitouweng Tang (Pulsatilla Decoction). Cold extremities with diarrhea and rectal heaviness are treated by Sini San (Four Reversal Powder) plus Xiebai. (Discussion see previous Jue-Li section.)
Diarrhea with body pain: if only limbs are heavy and painful with difficult urination, it is the Zhenwu Tang pattern mentioned earlier; if limbs are painful with cold extremities and aversion to cold, use Sini Tang; if the whole body is painful, first warm the interior with Sini Tang, then attack the exterior with Guizhi Tang. (Formula commentary see previous section.)
Diarrhea with all three pulses (cun, guan, chi) being level, but hardness upon pressing the epigastrium, requires urgent purgation; Dachengqi Tang (Major Order the Qi Decoction) is appropriate. After diarrhea, if the epigastrium is痞 (full/hard), this is not constrained heat, but rather stomach deficiency with rebellious pathogenic qi; Ganxiao Xiexin Tang (Licorice, Ginger, and Scutellaria Decoction) is indicated. (Discussion see Pi section.)
Diarrhea with sore throat, if accompanied by chest fullness, use Zhufu Tang (Pig Skin Decoction); if accompanied by cold extremities, use Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction).
If diarrhea is unceasing, with cold extremities, weakness in the lower body, and coughing up pus/blood, use Mahuang Shengma Tang (Ephedra and Cyathula Decoction). (Formula commentary see previous section.)
Diarrhea occurring more than ten times daily, with chest pain and a slippery cun pulse, indicates the use of emesis to stop the diarrhea. (Discussion see Xiong Man section.) In Shanghan, after taking herbal medicine, if diarrhea is unceasing with epigastric fullness/hardness, and after taking Xiexin Tang, further purgation causes unceasing diarrhea, and the physician administers Lizhong Tang (Middle-Regulating Decoction) making the diarrhea worse: Lizhong Tang regulates the middle jiao, but this diarrhea is in the lower jiao; Chishizhi Yuyuliang Tang (Halloysite and Illite Decoction) is indicated. If diarrhea remains unceasing, promoting urination is appropriate.
Chishizhi Yuyuliang Tang
Chishizhi (Halloysitum Rubrum), Yuyuliang (Illite) (each 4 liang).
Crush the herbs. Take 5 qian per dose, decoct in water, and take warm. If not healed, administer again.
After purgation, if the epigastrium is full/hard, borborygmus is audible, with dry heaving and diarrhea, Ganxiao Xiexin Tang (Licorice, Ginger, and Scutellaria Decoction) is used. (Formula commentary see Pi section.) After purgation, if the epigastrium is full/hard, exterior and interior are unresolved with diarrhea, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is used. (Formula commentary see Pi section.) Diarrhea with a rapid pulse, unresolved exterior, wheezing, sweating, and diarrhea, Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction) is used. (Discussion see previous Diarrhea with Exterior section.)
Generally, after purgation, if tidal fever, hypochondriac fullness, vomiting, and diarrhea occur, first use Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve the exterior, then use Chaihu Jia Mangxiao Tang (Bupleurum Plus Gypsum Decoction). (Discussion see Chao Re section.) Generally, after purgation, if delirium occurs, the pulse is harmonious, urination is free, and there is diarrhea without cold extremities, Tiaowei Chengqi Tang (Harmonizing Stomach Major Order the Qi Decoction) is used. (Discussion see Zanyu section.) After purgation, if the pulse is large, floating, and leather-like, with borborygmus and diarrhea, Danggui Sini Tang (Angelica Sinensis Four Reversal Decoction) is used. (Discussion see previous Pulse Treatment section.) After purgation, if the rapid pulse does not resolve, pus/blood in the stool will definitely occur. (Discussion see previous Blood Stool section.) After purgation, if Yin syndrome forms with cold extremities, obstructed throat, expectoration of pus, and diarrhea, Mahuang Shengma Tang (Ephedra and Cyathula Decoction) is used. (Discussion see Jue-Li section.)
In Shaoyin disease, if the pulse is tight, and after seven or eight days spontaneous diarrhea occurs with a suddenly faint pulse, warm extremities, and disappearance of the tight pulse, resolution is imminent. Although there is irritability, diarrhea will heal spontaneously. In Shanghan, if the pulse is floating and slow, extremities are warm, and after seven or eight days sudden irritability and diarrhea more than ten times daily occur, it will stop spontaneously. (Discussion see Huang Men section.) Fever with cold extremities and diarrhea for seven days is difficult to treat. In Shanghan, if there was no diarrhea for six or seven days, but suddenly fever and diarrhea occur with unceasing sweating, death ensues due to Yin without Yang. In Shaoyin disease, if the patient desires to sleep without irritability, but after five or six days spontaneous diarrhea, irritability, and insomnia occur, death ensues. (Discussion see Dan Yu Mei section.) In diarrhea, a deep and string-taut pulse indicates rectal heaviness; a large pulse indicates the disease has not stopped; a faint and rapid pulse indicates impending cessation of diarrhea, and even with fever, death will not occur. Diarrhea with slight fever and thirst, and a weak pulse, indicates spontaneous healing. Diarrhea with a rapid pulse and thirst indicates spontaneous healing. If not healed, pus/blood in the stool will occur. (Discussion see previous section.) Diarrhea with a rapid pulse, slight fever, and sweating indicates spontaneous healing. If the pulse becomes tight again, the disease is unresolved. In Shanghan, diarrhea more than ten times daily with an unexpectedly deep pulse indicates death. If in diarrhea, the cun, guan, and chi positions all lack a pulse, but occasionally a small pulse appears at the chi position, and the pulse rises strongly, this indicates Kidney Qi remains; if the pulse is damaged and weak, it is difficult to treat. In diarrhea passing undigested food, attacking the exterior is contraindicated; sweating will inevitably cause abdominal fullness.