石顽曰。交肠证虽见于方书。而世罕见。绿石山詹石匠之妇。产后五六日。恶露不行。
腹胀喘满。大便从前阴而出。省其故。缘平昔酷嗜烟酒。所产之儿。身软无骨。因而惊骇。
遂患此证。余以芎归汤加莪术、肉桂、炒黑山楂。一服恶露通。而二便如常。又陆圣祥之女
方四岁。新秋患血痢。而稀粪出于前阴。作冷热不调食积治。与五苓散。服香连丸。二剂
而愈。又钱吉甫女。年十三。体肥痰盛。因邻居被盗。发热头痛。呕逆面青。六脉弦促。而
便溺易位。此因惊气乱。痰袭窍端所致也。与四七汤下礞石滚痰丸。开通痰气而安。
喻嘉言曰。姜宜人得奇证。二便俱从前阴而出。拟之交肠。有似是实非者。交肠乃暴病
骤然而气乱于中。此证乃久病。以渐而血枯于内。迥然不同也。原夫疾之所始。以忧思伤
脾。脾不统血。下行如崩漏。在癸汛久绝之年。实名脱营。脱营宜大补急固。乃以崩漏法凉
血清火为治。则脱出转多。胞门子户之血。日渐消亡。转将大肠之血运转而渗入胞囊。久之
大肠之血亦尽。而大肠之气附血而行者。孤而无主。涣散错乱。幽门不能泌别。迸入渗血之
径。酿为谷道。岂可用交肠所列之方。以五苓再辟其水道乎。是必大肠之旧路复通。乃可拨
乱返正。今病中多哭泣。所谓脏燥者多泣。大肠已废而不用也。来春枣叶生时。大肠绝而死
矣。果验。
震初习医时。里有金姓裁缝。年二十余岁。雨途道滑。臀仆坐地。亦无痛苦。次日腹中
欲去大便而转失气。从阳具出。自觉大便不往后去。转向前走。阳具中痛苦不堪。其粪逼
细如稻柴心而出。震师金上陶先生。用补中益气汤。一服即愈。四五日。病复再发。用此汤
不效矣。小便行时。并不带粪。粪来亦不夹杂小便。尿孔渐为干粪撑大。痛苦莫可名言。大
肠竟废而不用。是时吴郡名医王叶薛诸公皆在。遍求之。皆不能疗。吾师断其次年三月死。
当届期。人已羸瘠不堪。然犹能饮食。二便之迭从阳具出者。反习以为常。痛苦亦减。似可
未死。忽一日。小便顿闭。大便仍来。闭三日。而小便从鼻孔涌出。其色黑。立死。似与喻
案病机仿佛。予近日治一舟人蛔虫从阳具出。蛔活。有一折叠而出者。痛不可言。三日出蛔
五条。从此阴吹甚喧。投以补中益气汤。得愈。
石顽说：交肠证虽然在医书中有所记载，但在世间极为罕见。绿石山有一位姓詹的石匠的妻子，产后五六天，恶露不下，腹部胀满且气喘胸闷。询问其病因，原来是因为她平时酷爱吸烟饮酒，所生的孩子身体柔软、没有骨头，因此受到惊吓，于是患上了这个病。我用芎归汤加入莪术、肉桂、炒黑山楂，服用一剂后恶露通畅，大小便也恢复正常。
又有一位陆圣祥的女儿，才四岁，初秋时节患上血痢，稀粪从前阴排出。我将其辨为冷热不调兼有食积进行治疗，给予五苓散，并服用香连丸，两剂药后痊愈。
还有钱吉甫的女儿，十三岁，体型肥胖且痰湿盛重。因为邻居被盗受到惊吓，出现发热头痛、呕吐逆气、面色发青的症状，六脉弦而急促，大小便排泄位置颠倒。这是因为惊恐之气扰乱体内，痰邪侵袭窍道末端所致。给予四七汤送服礞石滚痰丸，开通痰气后病情安定。
喻嘉言说：姜宜人得了奇异的病症，大小便都从前阴排出，拟名为交肠证。但有一种情况看似相似实则不同。交肠证是突发急病，骤然导致中焦气机紊乱；而此证是久病，逐渐导致内部血液枯竭，两者截然不同。追溯疾病的起始，是由于忧思损伤脾脏，脾不能统摄血液，血液下行如同崩漏。在月经早已停止的年纪，这实际上是“脱营”之证。脱营应当大补元气、紧急固摄，却误用治疗崩漏的方法，以凉血清火来处置，导致脱出的血液更多，胞宫和子宫的血液日渐消亡。久而久之，大肠的血液运转并渗入胞囊，最终大肠的血液也耗尽，依附于血液运行的大肠之气孤立无主，涣散错乱，幽门不能分别清浊，迸入渗血的径路，酿成类似谷道的病变。哪里还能使用交肠证所列的方剂，再用五苓散来通利水道呢？必须是大肠的旧路重新通畅，才能拨乱反正。如今病人多哭泣，这就是所谓的“脏燥”，表现为多泪。大肠已经废弃不用了。到了明年枣叶生长的时候，大肠气绝就会死亡。果然应验。
我刚开始学医时，同乡有一位姓金的裁缝，二十多岁。雨天道路滑，臀部摔坐在地，当时也没有感到痛苦。第二天腹中想排大便却转放屁，气体从阴茎排出，自觉大便不向后走，反而向前走，阴茎中痛苦不堪。粪便逼窄细如稻草芯一样排出。我的老师金上陶先生，用补中益气汤，服用一剂即愈。四五天后，病情复发，再用此汤就不见效了。小便排出时并不夹杂粪便，粪便来时也不夹杂小便，尿孔逐渐被干硬的粪便撑大，痛苦无法形容。大肠竟然废弃不用。当时吴郡的名医王叶薛诸位先生都在，遍请他们诊治，都不能治愈。我的老师判断他次年三月会死。到期时，人已瘦弱不堪，但还能饮食，大小便交替从阴茎排出，反而习以为常，痛苦也减轻了，似乎可以不死。忽然有一天，小便突然闭塞，大便仍然排出，闭尿三天后，小便从鼻孔涌出，颜色黑，立刻死亡。这似乎与喻嘉言案例的病机相似。我最近治疗一位船夫，蛔虫从阴茎排出，蛔虫是活的，有一条折叠着出来，疼痛不可言状。三天排出五条蛔虫，从此阴吹声很响，投用补中益气汤，得以痊愈。
Shi Wan stated: Although the syndrome of Jiaochang (Intestinal Cross-Connection) is recorded in medical texts, it is rarely seen in the world. The wife of a stone mason surnamed Zhan from Lushi Mountain, five or six days postpartum, had retained lochia. Her abdomen was distended and full, accompanied by wheezing and chest oppression. Upon inquiry into the cause, it was found that she had a strong preference for smoking and drinking alcohol in her daily life. The child she delivered was soft-bodied and lacked bones, which caused her great shock, leading to this syndrome. I prescribed Xiong Gui Tang (Cnidium and Angelica Decoction) added with Ezhu (Curcuma Zedoaria Rhizome), Rougui (Cinnamon Bark), and charred Shan Zha (Crataegus Fruit). After one dose, the lochia flowed freely, and urination and defecation returned to normal.
Another case involved the daughter of Lu Shengxiang, who was only four years old. In early autumn, she suffered from bloody dysentery, with loose stool discharging from the anterior yin (vulva/urethra). This was treated as a disorder of cold and heat imbalance combined with food stagnation. Wuling San (Five-Ingredient Poria Pill) was administered, along with Xianglian Wan (Coptis and Aucklandia Pill). She recovered after two doses.
Furthermore, the daughter of Qian Jifu, aged thirteen, was obese with abundant phlegm-dampness. Due to the shock of a burglary at her neighbor's house, she developed fever, headache, vomiting, and a bluish complexion. Her six pulses were wiry and rapid, and her urination and defecation were displaced. This was caused by chaotic qi due to fright and phlegm invading the orifices. Sizi Tang (Four-Gentleman Decoction variant for Qi Stagnation) was given to administer Mengshi Guntan Wan (Fluorite Rolling Phlegm Pill). By opening up the phlegm and qi, the condition stabilized.
Yu Jiayan stated: Jiang Yiren presented with a bizarre syndrome where both urine and feces discharged from the anterior yin. It was tentatively diagnosed as Jiaochang (Intestinal Cross-Connection). However, there are cases that appear similar but are fundamentally different. Jiaochang is an acute disease where qi becomes chaotic in the middle jiao suddenly. This case, however, is a chronic disease where blood gradually withers internally; they are completely distinct. Tracing the origin of the illness, it began with worry and thought damaging the Spleen. The Spleen failed to control the blood, causing it to descend like metrorrhagia or metrostaxis. At an age when menstruation had long ceased, this was actually a syndrome of Tuo Ying (Depletion of Essence/Blood). Tuo Ying requires vigorous tonification and urgent consolidation. Instead, it was treated using methods for metrorrhagia/metrostaxis, employing cooling blood and clearing fire, which resulted in even more blood loss. The blood of the Bao Men (Uterine Gate) and Zi Hu (Child Chamber) gradually perished. Eventually, blood from the Large Intestine circulated and seeped into the uterine sac. Over time, the blood in the Large Intestine was exhausted, and the qi of the Large Intestine, which usually accompanies blood, became isolated and leaderless, scattering chaotically. The Youmen (Pylorus) failed to separate clear from turbid, forcing its way into the path of bleeding, creating a channel resembling the anal passage. How could one use the formulas listed for Jiaochang, such as reusing Wuling San (Five-Ingredient Poria Pill) to open the water passages? Only when the old pathway of the Large Intestine is restored can order be re-established from chaos. Currently, the patient cries frequently, which is known as Zang Zao (Visceral Agitation), characterized by excessive weeping. The Large Intestine has become useless. When the jujube leaves sprout next spring, the Large Intestine qi will perish, and death will occur. This prediction proved accurate.
When I first studied medicine, there was a tailor in my village surnamed Jin, over twenty years old. On a rainy day, the road was slippery, and he fell on his buttocks. Initially, he felt no pain. The next day, his abdomen felt the urge to defecate, but gas passed from the penis. He felt the stool moving forward rather than backward, and the penis suffered unbearable pain. The stool was forced out thin as rice straw cores. My teacher, Mr. Jin Shangtao, used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). One dose cured him. Four or five days later, the illness recurred, and this decoction was ineffective. Urination did not mix with stool, nor did stool mix with urine. The urethral meatus gradually expanded due to dry, hard stool, causing indescribable pain. The Large Intestine had essentially ceased to function. At that time, renowned physicians in Wu Prefecture, such as Wang, Ye, and Xue, were present. We sought their help everywhere, but none could cure him. My teacher predicted he would die in March of the following year. When the time came, the patient was emaciated beyond belief, yet still able to eat and drink. The alternating discharge of urine and stool from the penis had become customary, and the pain had decreased, suggesting he might survive. Suddenly, one day, urination stopped completely, while defecation continued. After three days of urinary retention, urine gushed from the nostrils, black in color, and he died immediately. This seemed similar to the pathogenesis described in Yu's case. Recently, I treated a boatman whose roundworms exited from the penis. The worms were alive, with one emerging folded. The pain was unbearable. Five worms were expelled over three days. Subsequently, vaginal flatulence (Yin Chui) became very loud. I administered Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and he recovered.