（仲景）
治伤寒服汤药下利不止，心中痞硬；服泻心汤已，复以他药下之，利不止，医以理中与
之，
止者
赤石脂禹余粮，等分。杵碎，煎。
此手阳明药也。涩可去脱，重可达下，石脂、余粮之涩以止脱，重以固下，甘以益气（李
先知
（仲景）
治少阴病二三日至四五日，腹痛，小便不利，下利不止，便脓血者（成氏曰∶阳明下利
便脓血者，协热也；少阴下利腹痛便脓血者，下焦不约而里寒也。凡下利便脓血，身凉脉小
者易治
赤石脂（一斤） 干姜（一两） 粳米（一升。）
此足少阴药也。李时珍曰∶赤石脂之重涩，入下焦血分而固脱；干姜之辛温，暖下焦气
分而补虚；粳米之甘温，佐石脂、干姜而润肠胃也（朱丹溪曰∶桃花汤主下焦血虚且寒，非
干姜之温、石脂之重涩不能止血，用粳米之甘以引入肠胃。《准绳》曰∶便脓血，热势下流
也；成氏释为里寒，非也。桃花汤虽用干姜，然分两最微，石脂、粳米居多，以调正气、涩
滑脱，佐以干姜，用辛以散之之义。诸便脓血，皆传经之热邪也。吴鹤皋曰∶少阴肾水主
固二便，为火所灼，克伐大肠庚金，故下利脓血。石脂寒能胜热，涩可收脱；用干姜者，假
其辛热以从治；用粳米者，恐石脂性寒损胃也。聊摄之明，而犹昧此，况其下乎。程郊倩曰∶
此证终是火衰不能生土，未可指为传经之热邪也，不知此而漫云渗泄，肾防一彻，前后泄利，
而阳神陷矣。昂按∶成氏生于千载之后，而能昌明仲景之书，使后学有所循入，其功非小，
奈何后起之士，动辄非之，成氏之死已久，安能起而辨其是非乎。如此证成氏以为寒，而王
肯堂、吴鹤皋皆以为热，窃谓便脓血者，固多属热，热岂无下焦虚寒，肠胃不固，而亦便脓
血者乎；若以此为传经热邪，仲景当用寒剂以散其热，而反用石脂固涩之药，使热闭于内而
不得泄，岂非关门养盗，自贻伊芳戚也耶。观仲景之治协热利，如甘草泻心、生姜泻心、白头
翁等汤，皆用芩连黄柏；而治下焦虚寒下利者，用赤石脂禹余粮汤，此类以观，斯可见矣。
此证乃因虚以见寒，非大寒者，故不必用热药，惟用甘辛温之剂以镇固之耳。《本草》言石
脂性温，能益气、调中、固下，未闻寒能损胃也。若《准绳》则执凡传经者皆属热邪一语，
遂以为热耳。程郊倩每以直中为寒邪，传经为热邪，古今相传二语觉未尽然，不为无见，若
学未深造，而轻议古人，多见其不知量也矣）。
（张仲景）
治疗伤寒服用汤药后，腹泻不止，心下痞塞坚硬；服用泻心汤后，又用其他药物攻下，导致腹泻仍不止。医生若用理中汤治疗，腹泻停止的，可用赤石脂禹余粮汤。
赤石脂、禹余粮，各等分。捣碎，煎煮服用。
这是手阳明经的药物。涩味可以去除滑脱不禁，重坠之性可达下部。赤石脂和禹余粮的涩性能止住滑脱，重性能固摄下部，甘味能补益元气。（李知先注）
（张仲景）
治疗少阴病，从二三天到四五天，出现腹痛，小便不利，腹泻不止，大便带有脓血者。（成无己说：阳明经下利伴大便脓血，是协热利；少阴病下利伴腹痛和大便脓血，是下焦约束无力且体内有寒。凡是下利伴大便脓血，身体凉爽、脉象细小的，容易治疗。）
赤石脂（一斤） 干姜（一两） 粳米（一升）
这是足少阴经的药物。李时珍说：赤石脂的重涩之性，进入下焦血分而固摄滑脱；干姜的辛温之性，温暖下焦气分而补虚；粳米的甘温之性，辅助石脂和干姜来滋润肠胃。（朱丹溪说：桃花汤主治下焦血虚兼寒，若非干姜的温性和石脂的重涩性，不能止血，使用粳米的甘味以引入肠胃。《医学六要》说：大便脓血，是热势下流；成无己解释为里寒，是不对的。桃花汤虽然用了干姜，但分量最轻，石脂和粳米居多，用以调护正气、涩住滑脱，佐以干姜，是用辛味以散之的意思。各种大便脓血，都是传经的热邪所致。吴鹤皋说：少阴肾水主管固摄大小便，被火邪灼伤，克制大肠庚金，所以下利脓血。石脂性寒能胜热，涩味可收摄滑脱；使用干姜，是假借其辛热以顺从其病情（从治法）；使用粳米，是担心石脂性寒损伤胃气。聊摄派的明眼人尚且不明白这一点，何况其他人呢？程郊倩说：这个病症终究是火衰不能生土，不能指认为传经的热邪。不了解这一点而随意谈论渗泄之法，肾气一旦彻底崩溃，前后二便都会泄利，阳气神机就会陷落。汪昂按语：成无己生于千载之后，却能阐发张仲景的著作，使后学者有所遵循，他的功劳不小。为何后来的士人动辄非议他？成氏已死很久，怎能起来辩驳是非呢？像这种证候，成无己认为是寒，而王肯堂、吴鹤皋都认为是热。我私下认为，大便脓血固然多属热证，但难道没有下焦虚寒、肠胃不固而导致大便脓血的情况吗？如果将其视为传经热邪，张仲景应当用寒凉药剂来散其热，反而使用石脂固涩的药物，使热邪闭郁在内而不能排泄，这岂不是关门养盗，自找麻烦吗？看张仲景治疗协热利，如甘草泻心汤、生姜泻心汤、白头翁汤等，都用黄芩、黄连、黄柏；而治疗下焦虚寒下利的，用赤石脂禹余粮汤。由此类对比观察，就可以明白了。此证是因虚而见寒象，并非大寒证，所以不必用大热药，只用甘辛温的药剂来镇固即可。《本草》说石脂性温，能益气、调中、固下，没听说它能因性寒而损胃。至于《医学六要》则是执着于“凡传经者皆属热邪”这一句话，于是认为是热证。程郊倩常把直中当作寒邪，传经当作热邪，古今相传这两句话我觉得并不完全正确，但他并非毫无见解。只是如果学问未深造，就轻易议论古人，只会显得自己不知量力罢了）。
(Zhang Zhongjing)
Treats cases where, after taking decoctions for Shanghan (Cold Damage), diarrhea persists with a sensation of fullness and hardness in the epigastrium; after taking Xiexin Tang (Drain the Epigastrium Decoction), further purgatives are administered, yet diarrhea continues. If the physician treats it with Lizhong Tang (Regulate the Middle Decoction) and the diarrhea stops, [for persistent cases], use Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction).
Chishizhi (Red Halloysite), Yuyuliang (Hematite), equal parts. Pound into fragments, decoct, and take.
This acts on the Hand-Yangming channel. Astringents can resolve slippage; heavy substances can reach the lower part. The astringency of Shizhi and Yuliang stops slippage; their heaviness secures the lower jiao; their sweetness tonifies Qi (Li Zhixian's note).
(Zhang Zhongjing)
Treats Shaoyin disease progressing from two to three days to four or five days, presenting with abdominal pain, dysuria, persistent diarrhea, and passage of pus and blood in the stool. (Cheng Wuji states: Yangming diarrhea with pus and blood is Xiere (coordinated heat); Shaoyin diarrhea with abdominal pain and pus/blood indicates failure of the lower jiao to constrain and interior cold. Generally, diarrhea with pus/blood accompanied by a cool body and small pulse is easy to treat.)
Chishizhi (Red Halloysite) (1 jin), Ganjiang (Dried Ginger) (1 liang), Jingmi (Oryza sativa var. japonica) (1 sheng).
This acts on the Foot-Shaoyin channel. Li Shizhen says: The heavy and astringent nature of Chishizhi enters the blood aspect of the lower jiao to secure slippage; the pungent and warm nature of Ganjiang warms the qi aspect of the lower jiao and tonifies deficiency; the sweet and warm nature of Jingmi assists Shizhi and Ganjiang to moisten the intestines and stomach. (Zhu Danxi says: Taohua Tang (Peach Blossom Decoction) governs lower jiao blood deficiency with cold; without the warmth of Ganjiang and the heavy astringency of Shizhi, bleeding cannot be stopped; the sweetness of Jingmi is used to guide the herbs into the intestines and stomach. *Qingsheng* (Medical Standard) states: Passage of pus and blood indicates downward flow of heat; Cheng Wuji’s interpretation as interior cold is incorrect. Although Taohua Tang uses Ganjiang, its dosage is minimal, while Shizhi and Jingmi predominate to regulate healthy Qi and astringe slippage, with Ganjiang assisting via the principle of using pungency to disperse. All cases of pus and blood in stool result from heat pathogens transmitted through channels. Wu Hegao says: Shaoyin Kidney Water governs the consolidation of excretion; when scorched by Fire, it overacts upon the Large Intestine Geng Metal, causing diarrhea with pus and blood. Shizhi is cold and can overcome heat, and its astringency can collect slippage; Ganjiang is used to borrow its pungent-heat for congruent treatment (congruent therapy); Jingmi is used fearing that Shizhi’s cold nature might damage the Stomach. Even the insightful scholars of Liaoshe fail to grasp this, let alone others. Cheng Jiaoqian says: This condition ultimately stems from Fire failing to generate Earth; it should not be identified as transmitted heat pathogen. Failing to understand this and casually discussing draining/diffusing methods risks total collapse of Kidney Qi, leading to uncontrolled anterior and posterior discharge and sinking of Yang Shen. Wang Ang’s commentary: Cheng Wuji, born a millennium later, was able to elucidate Zhang Zhongjing’s works, allowing later students to follow a clear path; his merit is significant. Why do later scholars constantly criticize him? Cheng has been dead for ages; how can he rise to defend himself? Regarding such cases, Cheng considered them Cold, while Wang Kentang and Wu Hegao considered them Heat. I privately believe that while pus and blood in stool often belong to Heat, can there not be cases of lower jiao deficiency-cold and insecure intestines/stomach resulting in pus and blood? If this were merely transmitted heat, Zhang Zhongjing would have used cold formulas to dissipate the heat. Instead, he used astringents like Shizhi to close the gate, trapping heat inside and preventing its exit. Would this not be akin to locking the door to feed thieves, bringing disaster upon oneself? Observing Zhang Zhongjing’s treatment of Xiere (coordinated heat) diarrhea, such as Gancao Xiexin Tang, Shengjiang Xiexin Tang, and Baitouweng Tang, all utilize Huangqin, Huanglian, and Huangbai; whereas for lower jiao deficiency-cold diarrhea, he uses Chishizhi Yuyuliang Tang. By comparing these categories, the truth becomes evident. This condition manifests cold due to deficiency, but is not severe cold; thus, strong hot medicines are unnecessary. Only sweet-pungent-warm agents are needed to stabilize and secure. *Bencao* states Shizhi is warm, capable of tonifying Qi, regulating the middle, and securing the lower; it is unheard of that it damages the Stomach due to cold nature. *Qingsheng*, however, clings to the maxim "all transmitted diseases belong to heat pathogens," and thus labels it Heat. Cheng Jiaoqian often distinguishes direct invasion as Cold and transmission as Heat. While the ancient saying has some merit, it is not entirely accurate. However, those whose learning is not profound who lightly critique ancients only reveal their lack of self-awareness).