诃黎勒（煨）十枚
右一味，为散，粥饮和顿服。
【集解】
李□曰：气利者，下利气虚，下陷而滑脱也。诃黎勒性敛涩，能温胃固肠。粥饮和者
，假谷气以助胃。顿服者，药味并下，更有力也。
尤怡曰：气利，气与屎俱失也。诃黎勒涩肠而利气，粥饮安中益肠胃。顿服者，补下
治下制以急也。
@@@
若下利脉数，有微热汗出，令自愈；设脉紧，为未解。
【注】
下利脉数，内热利也，微热汗出，其邪衰矣，故令自愈。设脉紧者，是表未衰，故为
未解也。
【集注】
程林曰：寒则下利，脉数有微热，则里寒去，汗出则表气和，表里俱和，故令自愈；
设复紧者，知寒邪尚在，是为未解也。
@@@
下利，有微热而渴，脉弱者，令自愈。
【注】
下利大热而渴，则为邪盛，脉弱则为正虚，不能愈也。今微热而渴，脉弱者，邪正俱
衰，故知自愈也。
【集注】
程林曰：下利大热而渴，则偏于阳，无热不渴，则偏于阴，皆不能愈；以微热而渴，
知阴阳和，脉弱，知邪气去，故即自愈。
@@@
下利，脉数而渴者，令自愈；设不差，必清脓血，以有热故也。
【注】
此承上条邪正俱衰，病当自愈而不愈之义也。设不差者，则必表和，热退而数渴，仍
然是里热未除也，故圊脓血。
【集注】
魏荔彤：下利，固以阳气有余为吉，又不可太盛，成热邪伤阴，致阳复有偏胜之患。
@@@
下利，寸脉反浮数，尺中自涩者，必圊脓血。
【注】
此承上表里已和，病当自愈而不愈之义也。下利里病，而得浮数表脉，故曰：脉反浮
数也。但尺中自涩，则知热陷血分，必圊脓血也。
【集注】
徐彬曰：下利属寒，脉应沉迟，反浮数，其阳胜可知。而尺中自涩，涩为阳邪入阴，
此亦热多，故曰：必圊脓血。
程林曰：寸脉浮数，为热有余，尺脉自涩，为血不足，以热有余，则挟热而便脓血。
@@@
下利，三部脉皆平，按之心下坚者，急下之，宜大承气汤。
【注】
下利之人，心下□者，诸泻心汤证也。若寸、关、尺三部脉皆平实有力，虽下利，宜
攻坚也。
【集注】
李□曰：下利，按之心下坚者，实也。设或脉见微弱，犹未可下，今三部脉皆平，则
里气不虚可知，自宜急下之，此凭脉又证书之法也。
诃黎勒（煨）十枚
以上一味药，研成散剂，用米粥汤送服，一次性服完。
【集解】
李□说：气利，是指下利时伴有肛门排气，因气虚下陷导致滑脱不禁。诃黎勒性质收敛涩滞，能温胃固肠。用米粥汤调和，是借助谷物的气机来辅助胃气。一次性服完，是因为药物集中进入体内，效力更强。
尤怡说：气利，是指气和粪便同时失禁。诃黎勒能涩肠止泻并调理气机，米粥汤能安中益肠胃。一次性服完，体现了“补下治下”采用急迫制法的原理。
@@@
如果下利患者脉象数，伴有轻微发热和出汗，病情会自行痊愈；如果脉象紧，说明病邪未解。
【注】
下利且脉数，属于内热引起的下利；出现轻微发热和出汗，说明邪气已衰退，所以病情会自行痊愈。如果脉象紧，说明表邪未衰，因此病邪仍未解除。
【集注】
程林说：寒邪会导致下利，若脉数且有轻微发热，说明里寒已去，出汗则表气调和，表里俱和，所以病情会自行痊愈；如果脉再次变紧，可知寒邪仍在，这是病邪未解的表现。
【注】
下利伴有大热和口渴，说明邪气盛；脉弱说明正气虚，无法自愈。现在是轻微发热和口渴，脉弱，说明邪气和正气都衰退了，所以知道病情会自行痊愈。
【集注】
程林说：下利伴有大热和口渴，说明偏于阳证；无热不渴，说明偏于阴证，这两种情况都不能自愈；现在轻微发热而口渴，说明阴阳调和，脉弱说明邪气已去，所以会立即自愈。
@@@
下利，脉数且口渴的，病情会自行痊愈；如果不好转，必然会出现便脓血，这是因为有热邪的缘故。
【注】
这是承接上一条邪正俱衰、病当自愈但不愈的情况。如果病情不好转，则说明表证已和，热退但依然脉数口渴，仍然是里热未除，所以会出现便脓血。
【集注】
魏荔彤说：下利，固然以阳气有余为吉兆，但又不可太盛，以免形成热邪伤阴，导致阳气复归后出现偏胜的祸患。
@@@
下利，寸脉反而浮数，尺脉自涩的，必然会出现便脓血。
【注】
这是承接上一条表里已和、病当自愈但不愈的情况。下利是里病，却出现浮数的表脉，所以说“脉反浮数”。但尺脉自涩，可知热邪陷入血分，必然会出现便脓血。
【集注】
徐彬说：下利属寒证，脉象应沉迟，反而浮数，可知阳气胜。而尺脉自涩，涩表示阳邪入阴，这也是热多所致，所以说“必然便脓血”。
程林说：寸脉浮数，说明热有余；尺脉自涩，说明血不足。因为热有余，所以夹杂热邪而便脓血。
@@@
下利，三部脉象都平和，按压心下部坚硬的，应当紧急攻下，适宜用大承气汤。
【注】
下利的病人，如果心下部痞塞，属于诸泻心汤证的范畴。如果寸、关、尺三部脉象都平实有力，虽然下利，也应当攻坚破积。
【集注】
李□说：下利，按压心下部坚硬，属实证。如果脉象微弱，尚不可攻下，现在三部脉皆平，可知里气不虚，自然应当紧急攻下，这是凭脉诊又结合症状诊断的方法。
Heqile (Roasted) 10 pieces.
The above single herb is ground into powder, mixed with rice gruel, and taken in one dose.
[Collected Explanations]
Li □ stated: Qi li (flatus accompanied by diarrhea) refers to diarrhea with flatus due to qi deficiency sinking, leading to sliding and incontinence. Heqile has astringent properties and can warm the stomach and secure the intestines. Mixing with rice gruel utilizes the grain's qi to assist the stomach qi. Taking it in one dose ensures the medicinal flavor enters together, exerting greater force.
You Yi stated: Qi li refers to the simultaneous loss of qi and stool. Heqile secures the intestines and regulates qi; rice gruel stabilizes the middle and benefits the stomach and intestines. Taking it in one dose reflects the principle of "tonifying the lower and treating the lower" using an urgent method.
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If there is diarrhea with a rapid pulse, slight fever, and sweating, the condition will heal spontaneously; if the pulse is tight, the pathogen has not yet resolved.
[Annotation]
Diarrhea with a rapid pulse indicates internal heat diarrhea. Slight fever and sweating indicate that the pathogenic factor has declined, so the condition will heal spontaneously. If the pulse is tight, it indicates that the exterior pathogen has not declined, thus the disease remains unresolved.
[Collected Annotations]
Cheng Lin stated: Cold causes diarrhea. If the pulse is rapid with slight fever, the interior cold has departed; sweating harmonizes the exterior qi. With both interior and exterior harmonized, the condition heals spontaneously. If the pulse becomes tight again, it is known that the cold pathogen remains, indicating the disease is unresolved.
@@@
In cases of diarrhea with slight fever and thirst, and a weak pulse, the condition will heal spontaneously.
[Annotation]
Diarrhea with high fever and thirst indicates excess pathogen; a weak pulse indicates deficient healthy qi, which cannot recover on its own. Now, with slight fever and thirst and a weak pulse, both pathogen and healthy qi have declined, so it is known that the condition will heal spontaneously.
[Collected Annotations]
Cheng Lin stated: Diarrhea with high fever and thirst leans toward Yang syndrome; no fever and no thirst lean toward Yin syndrome; neither can heal spontaneously. Slight fever with thirst indicates harmony of Yin and Yang; a weak pulse indicates the departure of pathogenic qi, hence immediate spontaneous healing.
@@@
In cases of diarrhea with a rapid pulse and thirst, the condition will heal spontaneously; if it does not improve, pus and blood must appear in the stool, because of the presence of heat pathogen.
[Annotation]
This follows the meaning of the previous clause where both pathogen and healthy qi decline and the disease should heal spontaneously but does not. If it does not improve, the exterior harmonizes, heat recedes, but the pulse remains rapid with thirst, indicating interior heat remains unremoved, hence purging pus and blood.
[Collected Annotations]
Wei Litong stated: In diarrhea, although surplus Yang qi is auspicious, it must not be excessive, lest it form heat pathogen injuring Yin, causing the risk of Yang resurgence with bias.
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In cases of diarrhea, if the Cun pulse is unexpectedly floating and rapid, while the Chi pulse is naturally choppy, pus and blood must appear in the stool.
[Annotation]
This follows the meaning of the previous clause where interior and exterior are harmonized and the disease should heal spontaneously but does not. Diarrhea is an interior disease, yet a floating and rapid exterior pulse appears, hence it is said: "the pulse is unexpectedly floating and rapid." However, since the Chi pulse is naturally choppy, it is known that heat has sunk into the blood level, inevitably resulting in purging pus and blood.
[Collected Annotations]
Xu Bin stated: Diarrhea belongs to Cold; the pulse should be deep and slow. Unexpectedly floating and rapid indicates Yang superiority. The Chi pulse being naturally choppy indicates Yang pathogen entering Yin. This also results from excess heat, hence it is said: "must purge pus and blood."
Cheng Lin stated: Floating and rapid Cun pulse indicates excess heat; naturally choppy Chi pulse indicates blood deficiency. Due to excess heat, it accompanies heat to cause passage of pus and blood.
@@@
In cases of diarrhea, if the pulses at all three positions are equal, but pressing the epigastrium reveals hardness, urgent purgation is required, suitable for Dachengqi Tang (Major Order the Qi Decoction).
[Annotation]
For patients with diarrhea, if the epigastrium is obstructed, it belongs to the syndromes of various Xiexin Tangs (Drain the Epigastrium Decoctions). If the pulses at Cun, Guan, and Chi positions are all flat, solid, and forceful, despite diarrhea, one should attack the accumulation.
[Collected Annotations]
Li □ stated: In diarrhea, hardness upon pressing the epigastrium indicates excess. If the pulse were weak or faint, purgation would still be inadvisable. Now that the pulses at all three positions are flat, it is known that the interior qi is not deficient, and urgent purgation is naturally indicated. This is the method of diagnosing based on pulse and confirming with symptoms.