东垣曰。予病脾胃久衰。视听半失。此阴盛乘阳。加之气短。精神不足。此由弦脉令虚
多言之故。阳气衰弱。不能舒伸。伏匿于阴中耳。癸卯六七月间。霖雨阴寒。逾月不止。时
人多病泄利。乃湿多成五泄故也。一日体重肢痛。大便泄泻。小便秘涩。默思内经云。在下
者。引而竭之。是利小便也。故经又云。治湿不利小便。非其治也。当用淡渗之剂以利之为
正法。但圣人之法。虽布在方策。其不尽者。可以意求。今客邪寒湿之淫。自外入里而甚暴
若以淡渗之剂利之。病虽即已。是降之又降。复益其阴而重竭其阳。则阳气愈削而精神愈
短矣。唯以升阳之药为宜。用羌、独、升麻各一钱。防风、炙甘草各五分。水煎热服。大法
云。寒湿之胜。助风以平之。又云。下者举之。此得阳气升腾故愈。是因曲而为之直也。
震按升阳以助春生之令。东垣开创此法。故群推为内伤圣手。向来医学十三科。有脾胃
一科。谓调其脾胃而诸病自愈。今已失传。虽读脾胃论。不能用也。
张子和治赵明之。米谷不消。腹作雷鸣。自五月至六月不愈。诸医以为脾受大寒。屡用
圣散子、豆蔻丸等。俱不效。戴人曰。春伤于风。夏必飧泄。飧泄者。米谷不化而直出
又曰。久风入中。则为肠风飧泄。中者脾胃也。风属甲乙。脾胃属戊己。甲乙能克戊己。肠
中有风故鸣。经又曰。岁木太过。风气流行。脾土受邪。民病飧泄。诊其两手脉皆浮数。
在表也。可汗之。风随汗出泄当愈。以火二盆。暗置床下。给之入室。使服涌剂。以麻黄投
之。乃闭其户。待一时许。汗出如洗。开户。减火一半。须臾。汗止泄亦止。
〔附〕神秘名医录载庞从善治著作王公 泄利。诊之。曰。两手三部中得脾脉浮而弦。
浮主风。弦主湿。又弦为肝脉。病因风湿外伤。致肝木刑于脾土而为洞泄。又名飧泄也。内
经云。春伤于风。邪气留连。乃为洞泄。又云。春伤于风。夏生飧泄。其利下物。主浑白而
完出是也。遂以五泄丸煎服之。数服而瘥。王公曰。从善年未四十。亦医之妙进。曾撰脉法
源论一部。共二十篇。示愚观之。诚得叔和未尽之趣者也。
震按庞公此条。已为张戴人导其先路矣。又郝允治夏英公病泄。太医皆为中虚。郝曰。
风客于胃则泄。殆 本汤证也。夏骇曰。吾服金石等药无数。泄不止。其敢饮 本乎。郝强
进之。泄止。此皆以风药治泄之模范也。然考仓公诊阳虚侯相赵章病。曰。其脉滑。是内风
气也。饮食下咽。而辄出不留者。名曰 风。法五日死。犹能嗜粥。后十日乃死。所谓安谷
者。过期也。即予所阅历。凡直肠泻者多死。不可概许以风药能治也。
子和又治讲僧德明。初闻家遭兵革。继又为寇贼所惊。得脏腑不调证。后入京。不伏水
土。又兼心气。以致危笃。前后三年。八仙丸、鹿茸丸、烧肝散皆服之不效。乃求药于戴人
戴人曰。此洞泄也。以谋虑久不决而成。肝主谋虑。甚则乘脾。久思则脾湿下流。乃上涌
痰半盆。末后有血数点。肝藏血故也。又以舟车丸、浚川散下数行。仍使澡浴出汗。自尔病
乃日轻。后以胃风汤、白术散调养之。一月而强实复故矣。
又治一人泻利不止。腹鸣如雷。不敢冷坐。坐则下注如倾。诸医例断为寒证。姜、桂、
丁香、豆蔻。及枯矾、龙骨之类。靡不遍服。兼以燔针灼艾。迁延将二十载。戴人诊之。曰
两寸脉皆滑。余不以为寒。然其所以寒者水也。以茶调散涌寒水五七升。无忧散泄积水数
十行。乃通因通用之法也。次以五苓散淡剂渗利之。又以甘露散止渴。不数日而全愈。
震按久泻治以吐法尚可学。吐后复用大下。不敢学。及观项彦章治南台治书郭公。久患
泄泻。恶寒。日卧密室。以毡蒙首。炽炭助之。皆作沉寒痼冷治。不效。项曰。公之六脉。
浮濡且微数。濡者湿也。数者脾有伏火也。病由湿热。而且加之以热剂。非苦寒逐之不可。
乃先用羌活、升、柴、泽泻以升阳散火。继以神芎丸下之。即去毡及炭而愈。此正善学子和
罗谦甫随征南副元帅大忒木儿。驻扬州。时年六十八。仲冬病自利。完谷不化。脐腹冷
疼。足 寒。以手搔之。不知痛痒。烧石以温之。亦不得暖。罗诊之。脉沉细而微。乃曰。
年高气弱。深入敌境。军事烦冗。朝暮形寒。饮食失节。多饮乳酪。履于卑湿。阳不能外
由是清湿袭虚。病起于下。故 寒而逆。内经云。感于寒而受病。微则为咳。盛则为泻为
痛。此寒湿相合而为病也。法当急退寒湿之邪。峻补其阳。非灸不能已其病。先以大艾炷于
气海。灸百壮。补下焦阳虚。次灸三里二穴。各三七壮。治形寒而逆。且接引阳气下行。又
灸三阴交二穴。以散足受寒湿之邪。遂处方云。寒淫所胜。治以辛热。湿淫于外。治以苦热
以苦发之。以附子大辛热。助阳退阴。温经散寒。故以为君。干姜、官桂。大热辛甘。亦
除寒湿。白术、半夏。苦辛温而燥脾湿。故以为臣。人参、草豆蔻、炙甘草。甘辛大温。温
中益气。生姜大辛温。能散清湿之邪。葱白辛温。以通上焦阳气。故以为佐。又云。补下治
下制以急。急则气味浓。故作大剂服之。不数服。泻止痛减。足 渐温。调其饮食。逾十日
平复。明年秋过襄阳。值霖雨旬余。前证复作。根据前灸。添阳辅各灸三七壮。再以前药投之
数服良愈。方名加减白通汤。
震按用苦甘辛温热燥药。乃治泻正法。而辅以灸法尤妙。
白云集曰。黄子浓者。江西人也。精医术。邻郡一富翁。病泄泻弥年。礼致子浓诊疗。
旬莫效。子浓曰。予未得其说。求归。一日读易。至乾卦天行健。朱子有曰。天之气运转不
息。故阁得地在中间。如人弄碗珠。只运动不住。故在空中不坠。少有息则坠矣。因悟向者
富翁之病。乃气不能举。为下脱也。又作字持水滴吸水。初以大指按滴上窍。则水满筒。放
其按则水下溜无余。乃豁悟曰。吾可治翁证矣。即治装往。以艾灸百会穴三四十壮。泄泻止
矣。医说会编注曰。百会属督脉。居顶巅。为天之中。是主一身之气者。元气下脱。脾胃无
凭。所以泄泻。是谓阁不得地。经云。下者上之。所以灸百会愈者。使天之气复健行。而脾
土得以凭之耳。铜人经谓百会灸脱肛。其义一也。
震按仲景伤寒论曰。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。上字即指百会穴也。何待黄子浓始悟耶。及读资生经曰。旧传有人年老而颜如童子
者。盖每岁以鼠粪灸脐中神阙穴一壮故也。予尝久患溏利。一夕灸三七壮。则次日不如厕。
连数夕灸。则数日不如厕。足见经言主泄利不止之验。是又与灸百会穴同一捷法。又张子和
云。山东杨先生者。治府主洞泄不已。杨虽对病患。却与众人谈日月星辰缠度。及风云雷雨
之变。自辰至未。病者听之而忘其圊。杨尝曰。治洞泄不已之人。先问其所慧之事。好棋者
与之棋。好乐者与之笙笛。勿辍。是又于服药灸火之外。添一巧法。盖脾主信。泻久则以泻
为信。使忘其圊。则失其泻之信而泻可止矣。
丹溪云。叔祖年七十。禀甚壮。形甚瘦。夏末患泻利。至秋深。百方不效。病虽久而神
不悴。小便涩少而不赤。两手脉俱涩而颇弦。自言膈微闷。食亦减。此必多年沉积。僻在肠
胃。询其平生喜食何物。曰。我喜食鲤鱼。三年无一日缺。予曰。积痰在肺。肺为大肠之藏
宜大肠之不固也。当与澄其源则流自清。以茱萸、青葱、陈皮、苜蓿根、生姜煎浓汤。和
以沙糖。饮一碗许。自以指探喉中。至半时。吐痰半升许如胶。是夜减半。次早又饮。又吐
痰半升而利止。又与平胃散加白术、黄连。旬日十余帖而安。
又治一老人。右手风挛多年。九月内泄泻。百药不效。右手脉浮大洪数。此太阴经有积
痰。肺气壅遏。不能下降。则大肠虚而作泻。当治上焦。用萝卜子擂和为浆水探之。吐大块
胶痰碗许。随安。
一富儿面黄。善啖易饥。非肉不食。泄泻一月。脉大。以为湿热。当困而食少。今反形
健而食多。不渴。此必疳虫也。验其大便果有蛔。治虫而愈。次年夏初。复泻。不痛而口干
朱曰。昔治虫而不治甜故也。以去疳热之药。白术汤下。三日而愈。后用白术为君。芍药
为臣。川芎、陈皮、黄连、胡黄连。佐芦荟为丸。白术汤下。禁肉与甜。防其再举。
一人性狡躁。素患下疳疮。或作或止。夏初患自利。膈微闷。医与理中汤。闷厥而苏。
脉涩。重取略弦数。朱曰。此下疳之深重者。与当归龙荟丸去麝。四帖而利减。又与小柴胡
去半夏。加黄连、白芍、川芎、生姜。数帖而愈。
震按丹溪四案。其吐法犹为子和所常用。而一究其嗜食之何物。一凭其右脉之洪数。灼
见为积痰在肺。然后用吐。吐药亦复不同。较之子和不辨寒热虚实。总与吐下者。谁圣谁狂
至于治虫疳治下疳。其巧更难及。
吕沧洲治帅府从事帖木失尔。病下利完谷。众医咸谓洞泄寒中。日服四逆理中辈。弥剧。吕
诊其脉。两尺寸俱弦大。右关浮于左关一倍。其目外 如草滋。盖知肝风传脾。因成飧泄。
非藏寒所致。饮以小续命汤。损麻黄加术三五升。利止。续命非止利药。饮不终剂而利止者
以从本治故也。
震按此条与张子和治赵明之条似同而不同。彼为外风所伤。此则内风相传。治虽仿佛。
义有分别也。又沧洲治御史王彦芳内飧泄弥年。当秋半。脉双弦而浮。乃曰。夫人之病。盖
由惊风。非饮食劳倦所致也。以肝主惊。故虚风自甚。因乘脾而成泻。当金气正隆尚尔。至
明春则病将益加。夫人自述因失铜符而惊惧。由是疾作。乃用黄 牛肝。和以攻风健脾之剂
逾月泻止。是又内风一种也。
滑伯仁治一人。暑月泄泻。小便赤。四肢疲困不欲举。自汗。微热口渴。且素羸瘠。医
以虚劳。将峻补之。伯仁诊视六脉虚微。曰。此东垣所谓夏月中暑。饮食劳倦。法宜服清暑
益气汤。投二剂而病如失。
震按自汗微热口渴溺赤。在暑月自属中暑形象。四肢困倦不欲举。固虚也。亦即暑伤气
也。法本宜补而峻补。则暑不能清。仍未入彀。故清暑益气汤效最速。
汪石山治一人。于幼时误服毒药。泄痢。复伤食。大泻不止。后虽能食。不作肌肤。每
至六七月。遇服毒之时。痛泻复作。善饥多食。胸膈似冷。夜间发热。嗜卧懒语。闻淫欲言
阳举心动。惊悸盗汗。喉中有痰。小便不利。大便或结或溏。过食则呕吐泄泻。脉皆濡弱
而缓。右脉略大。犹觉弱也。次日左脉三五不调。或二三至缓。三五至快。右脉如旧缓弱。
其左脉不调者。必动欲以摇其精也。其右脉缓弱者。由于毒药损其脾也。理宜固肾养脾。遂
以参、术、茯苓、芍药、黄 、麦冬各一钱。归身、泽泻各七分。知、柏、山楂各六分。煎
震按此条脉甚奇。论脉亦奇。可以广学人之见。
程明佑治一人。下泄。勺水粒米不纳。服汤药即呕。程诊之曰。病得之饮酒。脾恶湿。
汤药滋湿矣。以参、苓、白术和粳米为糕食之。病旋已。所以知其病得之饮酒过多者。切其
脉濡缓而弱。脾伤于湿也。
震按濡缓而弱是虚脉。亦是湿脉。参、苓、术作糕代汤。补虚不助湿。与后之晚食前进
热药。同一巧思。
薛立斋治钱可久。善饮。面赤痰盛。大便不实。此肠胃湿痰壅滞。用二陈、芩、连、山
栀、枳实、干葛、泽泻、升麻一剂。吐痰甚多。大便始实。此后。日以黄连三钱。泡汤饮之
而安。但如此禀浓不多耳。
震按此条重在如此禀浓不多句。而日以黄连三钱泡汤饮。又当知如此治法亦殊少。
又一人年六十。面带赤色。吐痰口干。或时作泻。春谓立斋曰。仆之证或以为脾经湿热
痰火作泻。率用二陈、黄连、枳实、神曲、麦芽、白术、柴胡之类不应。何也。薛诊之。左
关弦紧。肾水不能生肝木也。右关弦大。肝木乘脾土也。此乃脾肾亏损。不能生克制化。当
滋化源。不信。薛谓人曰。此翁不久。当损于痢矣。次年果患痢殁。
震按左关弦紧。右关弦大。浅见者不过平肝清湿热而已。服之不应。不能解其何以不
应也。院使此案。可作暗室一灯。
江应宿治黄水部新阳公。患脾肾泄十余年。五鼓初。必腹痛。数如厕。至辰刻。共四度
巳午腹微痛而泄。凡七八度。日以为常。食少倦怠嗜卧。诊得右关滑数。左尺微弦无力。
此肾虚而脾中有积热也。投黄连枳实丸。腹痛渐除。渐至天明而起。更与四神丸、八味丸。
滋其化源。半年饮食倍进而泄愈。
震按此条本虚标实。又是一格局。先清后温。却是正法。
〔附〕有人每日早起。必大泻一行。或时腹痛。或不痛。空心服热药。亦无效。后一医
令于晚食前。更进热药。遂安。盖热药服于清晨。至晚药力已过。一夜阴气。何以敌之。晚
间再进热药。则一夜热药在腹。足以胜阴气矣。此可为用热药者又辟一法。
一人久患泄泻。以暖药补脾。及分利小水诸法。不应。一医诊之。心脉独弱。乃以益心
李东垣说：我患脾胃久衰之症，视听功能半失。这是阴气盛而乘袭阳气，加之气短、精神不足。这是由于脉象弦细导致正气虚弱，多言耗气的缘故。阳气衰弱，不能舒展伸张，潜伏隐匿于阴分之中。癸卯年六七月间，连绵阴雨，阴寒之气超过一个月不停止。当时许多人患病泄泻，这是因为湿气重而形成五种泄泻的缘故。有一天，我感到身体沉重、四肢疼痛，大便泄泻，小便涩滞不通。我默想《内经》所说：“病位在下者，用通利的方法使邪气排尽。”这就是利小便的意思。所以经书又说：“治疗湿证如果不通利小便，就不是正确的治法。”应当使用淡味渗湿的药物来利水，这才是正法。但是圣人的法则，虽然记载在医书中，其中未尽之意，可以通过心意去推求。如今外来的客邪寒湿之邪，从外部侵入内部而且发病急暴，如果只用淡渗利水的药物来治疗，病虽然立即痊愈，但这属于降之又降，反而助长阴气而再次竭损阳气，那么阳气会更加削弱，精神更加短少。只有使用升阳的药物才适宜。我用羌活、独活、升麻各一钱，防风、炙甘草各五分，水煎热服。大法说：“寒湿偏胜，用风药来平抑它。”又说：“下陷的病证，用升提的方法。”这是因为得到阳气升腾所以痊愈。这是顺应弯曲之势而使其正直的方法。
俞震按语：升阳以辅助春生之气，是李东垣开创的这种方法，所以众人推崇他为内伤病的圣手。向来医学分为十三科，其中有脾胃一科，认为调理好脾胃而各种疾病自然痊愈。现在已经失传了，虽然读了《脾胃论》，也不能应用。
张子和治疗赵明之，米谷不消化，腹部发出雷鸣般的声音，从五月到六月没有痊愈。各位医生认为是脾受大寒，多次使用圣散子、豆蔻丸等药，都不见效。戴人（张子和号）说：“春天伤于风邪，夏天必定发生飧泄（完谷不化的泄泻）。飧泄的症状是米谷不化而直接排出。”又说：“久风入中，就会成为肠风飧泄。中指的是脾胃。风属甲乙木，脾胃属戊己土。甲乙木能克制戊己土。肠中有风所以鸣响。经书又说：‘岁木太过，风气流行，脾土受邪，百姓得飧泄病。’”诊察他两手脉象都浮数，说明病在表。可以用发汗法。风随汗出，泄泻应当痊愈。于是放置两盆火，暗中放在床下，让他进入室内，给他服用涌吐剂，并用麻黄投药。然后关闭门窗，等待大约一个时辰，出汗如洗。打开窗户，减少一半的火势。不久，汗止住，泄泻也停止。
〔附〕《神秘名医录》记载庞从善治疗著作王公的泄利。诊察后说：“两手三部脉中，脾脉浮而弦。浮主风，弦主湿。又弦为肝脉。病因风湿外伤，导致肝木克伐脾土而发生洞泄（严重的泄泻），又名飧泄。《内经》说：‘春天伤于风，邪气留连，就成为洞泄。’又说：‘春天伤于风，夏天产生飧泄。’其排泄物，主要是浑浊白色且完谷而出。”于是用五泄丸煎服，服用几次后病愈。王公说：“从善年龄不到四十，也是医术精妙进步很快。曾撰写《脉法源论》一部，共二十篇，给我观看。确实得到了王叔和未尽的意趣。”
俞震按语：庞公这一条，已经为张戴人开辟了先路。另外郝允治疗夏英公的泄泻，太医们都认为是中气虚寒。郝允说：“风邪客于胃则发生泄泻，这大概是桂枝汤证吧。”夏英公害怕地说：“我服用了无数金石等药，泄泻不止，怎么敢喝桂枝汤呢？”郝允强行进药，泄泻停止。这都是用风药治疗泄泻的模范案例。然而考察仓公诊断阳虚侯相赵章的病，说：“他的脉滑，这是内风气。饮食咽下，随即吐出不能停留，名叫贲风，法当五日死。”赵章还能喜欢吃粥，十天后才死。所谓“安谷者过期”，就是即使能吃也能延长寿命。即我所阅历的，凡是直肠泻的多死，不可一概许诺风药能治。
张子和又治疗讲僧德明，起初听说家中遭遇战乱，接着又被寇贼惊吓，得了脏腑不调证。后来进京，不服水土，又兼有心气不足，以致病情危重。前后三年，八仙丸、鹿茸丸、烧肝散都服用过，都不见效。于是向戴人求药。戴人说：“这是洞泄，因为谋虑长久不决而成。肝主谋虑，甚则乘袭脾土。久思则脾湿下流。”于是先用涌吐法吐出痰液半盆，最后有几滴血，因为肝藏血。又用舟车丸、浚川散攻下数次，仍然让他洗澡出汗。从此病一天天减轻。后来用胃风汤、白术散调养，一个月后身体强壮恢复原状。
又治疗一人泄泻不止，腹鸣如雷，不敢冷坐，一坐则下身注泄如倾盆。各位医生都断定为寒证，姜、桂、丁香、豆蔻，以及枯矾、龙骨之类，无不遍服。兼用燔针灼艾，拖延将近二十年。戴人诊察后说：“两寸脉都滑，我不认为他是寒证。然而他之所以感觉寒，是因为有水饮。”用茶调散涌吐寒水五七升，用无忧散泄积水数十行，这是通因通用的方法。随后用五苓散淡剂渗利，又用甘露散止渴，不几天就全愈。
俞震按语：久泻用吐法还可以学习，吐后再用大下法，不敢学习。及至看到项彦章治疗南台治书郭公，长期患泄泻，恶寒，每天躺在密室里，用毡子蒙头，烧炭取暖，都当作沉寒痼冷治疗，无效。项彦章说：“您的六脉，浮濡且微数。濡代表湿，数代表脾有伏火。病由湿热引起，而且加上热剂，非苦寒药驱逐不可。”于是先用羌活、升麻、柴胡、泽泻来升阳散火，继用神芎丸攻下，就去掉毡子和炭火而痊愈。这正是善于学习张子和的案例。
罗谦甫跟随征南副元帅大忒木儿，驻扎扬州。当时他六十八岁，仲冬季节患自利（自发性腹泻），完谷不化，脐腹冷痛，足部寒冷，用手搔抓，不知痛痒。烧石头来温暖，也不能暖。罗谦甫诊察，脉沉细而微，就说：“年老气弱，深入敌境，军事烦冗，早晚受寒，饮食失节，多喝乳酪，处于卑湿之地，阳气不能外达。由此清湿侵袭虚处，病起于下，所以足寒而逆。《内经》说：‘感于寒而受病，轻微则为咳，严重则为泻为痛。’这是寒湿相合而为病。法当急退寒湿之邪，峻补其阳，非艾灸不能治愈此病。”先用大艾炷在气海穴灸百壮，补下焦阳虚；其次灸三里二穴，各三七壮，治疗形寒而逆，并且接引阳气下行；又灸三阴交二穴，以散发足部受寒湿之邪。于是处方说：“寒淫所胜，治以辛热；湿淫于外，治以苦热；以苦发之。”用附子大辛热，助阳退阴，温经散寒，所以作为君药。干姜、官桂，大热辛甘，也除寒湿；白术、半夏，苦辛温而燥脾湿，所以作为臣药。人参、草豆蔻、炙甘草，甘辛大温，温中益气；生姜大辛温，能散清湿之邪；葱白辛温，以通上焦阳气，所以作为佐药。又说：“补下治下，制以急，急则气味浓。”所以做大剂服用。不几天，泻止痛减，足渐温。调理饮食，过了十天就平复。第二年秋天经过襄阳，正值霖雨十多天，前证复发。根据前面的灸法，添加阳辅穴各灸三七壮，再用前面的药投服，几次就良愈。方名加减白通汤。
俞震按语：用苦甘辛温热燥药，乃是治疗泄泻的正法，辅以灸法尤其巧妙。
《白云集》说：黄子浓，江西人，精通医术。邻郡一位富翁，患泄泻一年，礼聘子浓诊疗，十天没有效果。子浓说：“我没有找到原因，请求回家。”一天读《易经》，读到乾卦“天行健”，朱熹曾说：“天的之气运转不息，所以支撑着地处在中间。就像人玩弄碗珠，只运动不停，所以在空中不坠落。稍有停息就会坠落。”于是领悟到先前富翁的病，是气不能举托，为下脱之证。又写字时滴水吸水，初以大指按住滴水上窍，则水满筒；放开按住的手指，则水下溜无余。于是豁然领悟说：“我可以治疗翁的疾病了。”于是整理行装前往，用艾灸百会穴三四十壮，泄泻停止了。《医说会编注》说：百会属督脉，居头顶，为天之中，是主宰一身之气的。元气下脱，脾胃无凭依，所以泄泻，这叫作“阁不得地”。经书说：“下者上之”，所以灸百会痊愈，是使天之之气恢复健行，而脾土得以凭依。《铜人腧穴针灸图经》说百会灸脱肛，道理是一样的。
俞震按语：张仲景《伤寒论》说：“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。”上字即指百会穴。何待黄子浓才领悟呢？及至读《资生经》说：“旧传有人年老而颜如童子，大概每年用鼠粪灸脐中神阙穴一壮。”我曾长期患溏利，一晚灸三七壮，则次日不用上厕所。连续几晚灸，则数日不用上厕所。足见经书所言主治泄利不止的验证。这又是与灸百会穴同样的捷法。另外张子和说：山东杨先生，治疗府主洞泄不已。杨先生虽然面对病患，却与众人谈论日月星辰缠度，以及风云雷雨的变化，从辰时到未时，病人听之而忘记去厕所。杨先生曾说：“治疗洞泄不已的人，先问他所喜欢的事。喜欢棋的与他下棋，喜欢音乐的给他笙笛，不要停止。”这又在服药灸火之外，增添了一种巧法。因为脾主信，泻久了则以泻为常信，使他忘记去厕所，则失去泻之信而泻可止了。
朱丹溪说：叔父七十岁，禀赋很壮实，形体很瘦。夏末患泄利，到秋深，百方无效。病虽久但精神不憔悴，小便涩少而不赤，两手脉都涩而颇弦。自己说膈部微闷，食欲也减少。这一定是多年沉积，僻滞在肠胃。询问他平生喜欢吃什么，说：“我喜欢吃鲤鱼，三年没有一天缺。”我说：“积痰在肺，肺为大肠之脏，宜大肠之不固。应当澄其源则流自清。”用吴茱萸、青葱、陈皮、苜蓿根、生姜煎浓汤，调和沙糖，饮一碗左右。自己用手指探喉中，半小时，吐出痰半升许如胶。当晚减半，次早又饮，又吐痰半升而利止。又给平胃散加白术、黄连，旬日十余帖而安。
又治疗一老人，右手风挛多年，九月内泄泻，百药无效。右手脉浮大洪数，这是太阴经有积痰，肺气壅遏，不能下降，则大肠虚而作泻。应当治上焦，用萝卜子擂和为浆水探之，吐出大块胶痰碗许，随即安宁。
一富家儿面色黄，善食易饥，非肉不食，泄泻一月，脉大，以为是湿热，应当困倦而食少，现在反而形体健壮而食多，不渴，这一定是疳虫。验其大便果然有蛔，治虫而愈。次年夏初，又泻，不痛而口干。朱丹溪说：“昔日治虫而不治甜的原因。”用去疳热的药，白术汤送下，三日而愈。后用白术为君，芍药为臣，川芎、陈皮、黄连、胡黄连，佐芦荟为丸，白术汤送下。禁肉与甜，防其再发。
一人性情狡诈急躁，素患下疳疮，或作或止。夏初患自利，膈微闷。医生给理中汤，闷厥而苏。脉涩，重取略弦数。朱丹溪说：“这是下疳之深重者。”给当归龙荟丸去麝香，四帖而利减。又与小柴胡汤去半夏，加黄连、白芍、川芎、生姜，数帖而愈。
俞震按语：丹溪四案，其吐法还是张子和常用的。而一究其嗜食之何物，一凭其右脉之洪数，灼见为积痰在肺，然后用吐。吐药亦复不同。较之张子和不辨寒热虚实，总与吐下者，谁圣谁狂？至于治虫疳治下疳，其巧更难及。
吕沧洲治疗帅府从事帖木失尔，病下利完谷。众医都说是洞泄寒中，日服四逆理中辈，更剧。吕诊其脉，两尺寸俱弦大，右关浮于左关一倍。其目外眦如草滋。盖知肝风传脾，因成飧泄。非藏寒所致。饮以小续命汤，减去麻黄加术三五升，利止。续命非止利药，饮不终剂而利止者，以从本治故也。
俞震按语：此条与张子和治赵明之条似同而不同。彼为外风所伤，此则内风相传。治虽仿佛，义有分别也。另外沧洲治疗御史王彦芳内飧泄弥年，当秋半，脉双弦而浮，乃曰：“夫人之病，盖由惊风，非饮食劳倦所致也。以肝主惊，故虚风自甚，因乘脾而成泻。当金气正隆尚尔，至明春则病将益加。”夫人自述因失铜符而惊惧，由是疾作。乃用黄牛肝，和以攻风健脾之剂，逾月泻止。是又内风一种也。
滑伯仁治疗一人，暑月泄泻，小便赤，四肢疲困不欲举，自汗，微热口渴，且素羸瘠。医生以为虚劳，将峻补之。伯仁诊视六脉虚微，曰：“此东垣所谓夏月中暑，饮食劳倦，法宜服清暑益气汤。”投二剂而病如失。
俞震按语：自汗微热口渴溺赤，在暑月自属中暑形象。四肢困倦不欲举，固虚也，亦即暑伤气也。法本宜补而峻补，则暑不能清，仍未入彀。故清暑益气汤效最速。
汪石山治疗一人，于幼时误服毒药，泄痢，复伤食，大泻不止。后虽能食，不作肌肤。每至六七月，遇服毒之时，痛泻复作。善饥多食，胸膈似冷，夜间发热，嗜卧懒语，闻淫欲言阳举心动，惊悸盗汗，喉中有痰，小便不利，大便或结或溏，过食则呕吐泄泻。脉皆濡弱而缓，右脉略大，犹觉弱也。次日左脉三五不调，或二三至缓，三五至快，右脉如旧缓弱。其左脉不调者，必动欲以摇其精也。其右脉缓弱者，由于毒药损其脾也。理宜固肾养脾，遂以参、术、茯苓、芍药、黄芪、麦冬各一钱，归身、泽泻各七分，知母、黄柏、山楂各六分，煎服。
俞震按语：此条脉甚奇，论脉亦奇，可以广学人之见。
程明佑治疗一人，下泄，勺水粒米不纳，服汤药即呕。程诊之曰：“病得之饮酒。脾恶湿，汤药滋湿矣。”以参、苓、白术和粳米为糕食之，病旋已。所以知其病得之饮酒过多者，切其脉濡缓而弱，脾伤于湿也。
俞震按语：濡缓而弱是虚脉，亦是湿脉。参、苓、术作糕代汤，补虚不助湿，与后之晚食前进热药，同一巧思。
薛立斋治疗钱可久，善饮，面赤痰盛，大便不实。此肠胃湿痰壅滞，用二陈汤、黄芩、黄连、山栀、枳实、干葛、泽泻、升麻一剂，吐痰甚多，大便始实。此后，日以黄连三钱，泡汤饮之而安。但如此禀赋浓厚者不多耳。
俞震按语：此条重在“如此禀浓不多”句，而日以黄连三钱泡汤饮，又当知如此治法亦殊少。
又一人年六十，面带赤色，吐痰口干，或时作泻。春季对薛立斋说：“我的证或以为脾经湿热痰火作泻，率用二陈、黄连、枳实、神曲、麦芽、白术、柴胡之类不应，何也？”薛诊之，左关弦紧，肾水不能生肝木也。右关弦大，肝木乘脾土也。此乃脾肾亏损，不能生克制化，当滋化源。不信。薛谓人曰：“此翁不久，当损于痢矣。”次年果患痢殁。
俞震按语：左关弦紧，右关弦大，浅见者不过平肝清湿热而已。服之不应，不能解其何以不应也。院使此案，可作暗室一灯。
江应宿治疗黄水部新阳公，患脾肾泄十余年，五鼓初，必腹痛，数如厕，至辰刻，共四度。巳午腹微痛而泄，凡七八度，日以为常。食少倦怠嗜卧。诊得右关滑数，左尺微弦无力。此肾虚而脾中有积热也。投黄连枳实丸，腹痛渐除，渐至天明而起。更与四神丸、八味丸，滋其化源。半年饮食倍进而泄愈。
俞震按语：此条本虚标实，又是一格局。先清后温，却是正法。
〔附〕有人每日早起，必大泻一行，或时腹痛，或不痛。空心服热药，亦无效。后一医令于晚食前，更进热药，遂安。盖热药服于清晨，至晚药力已过，一夜阴气，何以敌之。晚间再进热药，则一夜热药在腹，足以胜阴气矣。此可为用热药者又辟一法。
一人久患泄泻，以暖药补脾，及分利小水诸法，不应。一医诊之，心脉独弱，乃以益心
Li Dongyuan said: I suffered from long-term decline of the Spleen and Stomach, resulting in partial loss of hearing and vision. This is due to Yin pathogen overwhelming Yang Qi, accompanied by shortness of breath and insufficient spirit. This condition arises because the wiry pulse indicates deficiency, exacerbated by excessive talking which depletes Qi. The Yang Qi is weak and cannot extend freely, hiding within the Yin aspect. During the sixth and seventh months of the Gui-Mao year, continuous rain and cold persisted for over a month. Many people at that time suffered from diarrhea, as excessive dampness leads to the five types of diarrhea (Wu Xie). One day, I felt heavy body and painful limbs, with loose stools and difficult, scanty urination. I recalled the statement in the *Nei Jing*: "For diseases located below, use draining methods to exhaust them." This refers to promoting urination. Thus, the classics also state: "To treat dampness without promoting urination is not the correct method." One should use bland and leaching agents to promote urination, which is the standard treatment. However, although the methods of the sages are recorded in medical texts, their unspoken implications can be deduced through insight. Currently, external pathogenic cold-dampness invades from outside to inside and acts violently. If treated solely with bland leaching agents, although the disease may resolve immediately, this represents a further downward draining, which increases Yin and further depletes Yang. Consequently, Yang Qi becomes more weakened, and spirit becomes more deficient. It is only appropriate to use herbs that raise Yang. I used Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), and Sheng Ma (Cimicifugae Rhizoma) each at 1 qian, Fang Feng (Saposhnikoviae Radix) and Zhi Gan Cao (Prepared Licorice Root) each at 5 fen, decocted in water and taken hot. The general principle states: "When cold-dampness prevails, use wind-dispelling herbs to pacify it." It also states: "For sinking conditions, use lifting methods." Recovery occurred because Yang Qi was raised. This is making straight what was bent by following its nature.
Yu Zhen commented: Raising Yang to assist the spring-generating function was pioneered by Li Dongyuan, who is thus revered as a master of treating internal injuries. Traditionally, medicine was divided into thirteen departments, including one for the Spleen and Stomach, based on the idea that regulating the Spleen and Stomach cures all diseases. This has now been lost; although one reads the *Pi Wei Lun* (Treatise on the Spleen and Stomach), one cannot apply it.
Zi He (He Zi) treated Zhao Mingzhi, who could not digest rice and grain, with borborygmus in the abdomen, persisting from May to June. Various physicians attributed it to severe cold affecting the Spleen, repeatedly using Sheng San Zi (Holy Dispersion Powder) and Dou Kou Wan (Cardamom Pill) without effect. Dai Ren (Zi He's courtesy name) said: "Injury by wind in spring leads to Sun Xie (diarrhea with undigested food) in summer. Sun Xie involves undigested food passing directly out. Also, 'long-standing wind entering the interior becomes Chang Feng Sun Xie.' The 'interior' refers to the Spleen and Stomach. Wind belongs to Jia-Yi (Wood), while Spleen and Stomach belong to Wu-Ji (Earth). Wood conquers Earth. Wind in the intestines causes rumbling. The classics also say: 'Excess Wood qi leads to prevalent wind, damaging Spleen Earth, causing people to suffer from Sun Xie.'" Examination showed both radial pulses were floating and rapid, indicating the pathogen is in the exterior. Sweating should be induced. As wind exits with sweat, diarrhea should cease. Two basins of fire were placed secretly under the bed, and he was asked to enter the room. An emetic agent was administered along with Ma Huang (Ephedrae Herba). The doors were closed, and after about one hour, profuse sweating occurred like washing. The windows were opened, and half the fire was removed. Soon, sweating stopped, and so did the diarrhea.
[Appendix] Shen Mi Ming Yi Lu records Pang Congshan treating Wang Gong's diarrhea. Upon examination, he said: "The Spleen pulse in all three positions of both hands is floating and wiry. Floating indicates wind, wiry indicates dampness. Wiry is also the Liver pulse. The cause is external wind-dampness invading, causing Liver Wood to attack Spleen Earth, resulting in Dong Xie (severe diarrhea), also known as Sun Xie. The *Nei Jing* says: 'Wind injury in spring, if pathogens linger, becomes Dong Xie.' It also says: 'Spring wind injury leads to Summer Sun Xie.' The excretions are turbid white and undigested." He then prescribed Wu Xie Wan (Five Diarrheas Pill) decocted and taken orally. After several doses, the patient recovered. Wang Gong said: "Congshan is under forty, yet his medical skill is remarkably advanced. He wrote *Mai Fa Yuan Lun* (Source Theory of Pulse Methods), twenty chapters in total, shown to me. It truly captures insights not fully expressed by Wang Shuhe."
Yu Zhen commented: This case by Mr. Pang paved the way for Zhang Dai Ren. Additionally, Hao Yun treated Xia Ying Gong's diarrhea. Imperial physicians diagnosed it as deficiency-cold of the middle jiao. Hao Yun said: "Wind lodging in the Stomach causes diarrhea; this is likely a Gui Zhi Tang (Cinnamon Twig Decoction) pattern." Xia was alarmed, saying: "I have taken countless mineral drugs, yet diarrhea persists; how dare I drink Gui Zhi Tang?" Hao Yun forced the administration, and the diarrhea stopped. These are model cases of treating diarrhea with wind-dispelling herbs. However, examining Cang Gong's diagnosis of Zhao Zhang, Marquis of Yang Xu: "His pulse is slippery, indicating internal wind. Food swallowed is immediately vomited up without staying; this is called Ben Feng. According to the method, death occurs in five days." Zhao Zhang could still eat porridge and died ten days later. This illustrates that those who can eat survive longer. In my experience, patients with rectal diarrhea often die; one cannot universally claim wind herbs cure all cases.
Zi He also treated Monk Deming, a lecturer. Initially, he learned of war disrupting his family, followed by terror from bandits, leading to disharmony of the Zang-Fu organs. Later, upon arriving in the capital, he failed to adapt to the local environment and suffered from Heart Qi deficiency, becoming critically ill. Over three years, Ba Xian Wan (Eight Immortals Pill), Lu Rong Wan (Deer Antler Pill), and Shao Gan San (Burnt Liver Powder) were ineffective. He sought treatment from Dai Ren. Dai Ren said: "This is Dong Xie, caused by prolonged indecision in planning. The Liver governs planning; when extreme, it attacks the Spleen. Long-term thinking causes Spleen dampness to flow downward." He first induced vomiting, expelling half a basin of phlegm, ending with a few drops of blood, as the Liver stores blood. Then he used Zhou Che Wan (Boat Cart Pill) and Jun Chuan San (River Clearing Powder) to purge several times, followed by bathing to induce sweating. The illness improved daily. Later, Wei Feng Tang (Stomach Wind Decoction) and Bai Zhu San (Atractylodes Macrocephala Powder) were used for recovery, restoring strength within a month.
He also treated another person with persistent diarrhea, abdominal borborygmus like thunder, unable to sit on cold surfaces; sitting caused profuse watery discharge. Physicians uniformly diagnosed cold syndrome, administering Ginger, Cinnamon, Ding Xiang (Caryophylli Flos), Dou Kou (Cardamomi Fructus), Ku Fan (Alumen), Long Gu (Fossilia Ossis Mastodi), and other herbs, plus moxibustion and burning needles, for nearly twenty years. Dai Ren examined him and said: "Both Cun positions are slippery. I do not consider this cold. The reason he feels cold is due to water retention." He used Cha Tiao San (Tea Regulation Powder) to vomit five to seven sheng of cold water, and Wu You San (Worry-Free Powder) to drain dozens of movements of accumulated water. This is the method of "treating obstruction with unblocking" (Tong Yin Tong Yong). Subsequently, Wu Ling San (Five-Ingredient Powder with Poria) was used as a bland leaching agent, and Gan Lu San (Sweet Dew Powder) to stop thirst. Full recovery occurred within a few days.
Yu Zhen commented: Using emesis for chronic diarrhea is learnable, but using strong purgatives afterward is not. Regarding Xiang Yanzhang treating Guo Gong, Secretary of the Nan Tai Court: suffering chronic diarrhea, aversion to cold, lying in a dark room covered with felt, heating charcoal—treated as deep-seated cold and stubborn chill without success. Xiang said: "Your six pulses are floating, soft, and slightly rapid. Soft indicates dampness; rapid indicates latent fire in the Spleen. The disease stems from damp-heat, aggravated by heat-inducing agents. Bitter-cold herbs are necessary to drive it out." He first used Qiang Huo, Sheng Ma, Chai Hu (Bupleuri Radix), and Ze Xie (Alismatis Rhizoma) to raise Yang and scatter fire, then used Shen Xiong Wan (Divine Costus Pill) to purge. Removing the felt and charcoal led to recovery. This is indeed learning well from Zi He.
Luo Qianfu accompanied Marshal Tai Mu'er on campaign in Yangzhou. At sixty-eight years old, in mid-winter, he suffered spontaneous diarrhea with undigested food, cold pain in the umbilical and abdominal region, cold feet where scratching produced no sensation of pain or itch. Heating stones provided no warmth. Luo diagnosed a deep, fine, and faint pulse, stating: "Advanced age and weak Qi, deep in enemy territory, busy military affairs, morning and evening exposure to cold, irregular diet, excessive consumption of milk and cheese, dwelling in low, damp places. Yang cannot reach the exterior. Thus, clear dampness attacks the deficiency, disease arising from below, causing cold feet and reversal. The *Nei Jing* says: 'Cold invasion causes disease; mild cases result in cough, severe cases in diarrhea and pain.' This is combined cold-dampness. The method requires urgently dispelling cold-dampness and strongly tonifying Yang. Only moxibustion can cure this." First, large moxa cones were applied to Qi Hai (CV6) for one hundred burns to tonify lower Jiao Yang deficiency. Next, Zu San Li (ST36) bilaterally were moxibusted for thirty-seven burns each to treat cold extremities and guide Yang Qi downward. San Yin Jiao (SP6) bilaterally were moxibusted to disperse cold-dampness in the feet. The prescription stated: "When cold prevails, treat with acrid-hot; when dampness prevails externally, treat with bitter-hot; use bitter to vent." Fu Zi (Aconiti Lateralis Radix Praeparata), greatly acrid and hot, assists Yang, retreats Yin, warms meridians, and disperses cold, serving as the Sovereign herb. Gan Jiang (Zingiberis Rhizoma) and Guan Gui (Cinnamomi Cortex), greatly hot and acrid-sweet, also dispel cold-dampness. Bai Zhu (Atractodis Macrocephalae Rhizoma) and Ban Xia (Pinelliae Rhizoma), bitter-acrid-warm and drying Spleen dampness, serve as Ministers. Ren Shen (Ginseng Radix), Cao Dou Kou (Cardamomi Fructus Rotundus), and Zhi Gan Cao (Prepared Licorice Root), sweet-acrid-greatly warm, warm the middle and benefit Qi. Sheng Jiang (Zingiberis Rhizoma Recens), greatly acrid-warm, disperses clear-dampness. Cong Bai (Allii Fistulosi Bulbus), acrid-warm, unblocks Upper Jiao Yang Qi, serving as Assistants. It is also stated: "Tonifying below and treating below requires urgent preparation; urgency implies strong flavor and potency." Thus, a large dose was prepared. Within a few doses, diarrhea ceased, pain decreased, and feet warmed. Dietary regulation led to full recovery after ten days. The following autumn, passing through Xiangyang during prolonged rain, symptoms recurred. Following previous moxibustion, adding Yang Fu (GB38) with thirty-seven burns each, and re-administering the previous prescription resulted in good recovery. The formula is named Jia Jian Bai Tong Tang (Modified Bai Tong Decoction).
Yu Zhen commented: Using bitter, sweet, acrid, hot, and drying herbs is the correct method for treating diarrhea, supplemented by moxibustion, which is particularly ingenious.
*Bai Yun Ji* states: Huang Zinong, from Jiangxi, was skilled in medicine. A wealthy man in a neighboring prefecture suffered from chronic diarrhea for a year. Huang was invited to treat him, but after ten days, there was no effect. Huang said: "I have not found the cause; I request to return." One day, reading the *I Ching*, he reached the Qian Hexagram "Heaven moves vigorously." Zhu Xi had said: "The Qi of Heaven rotates incessantly, supporting the Earth in the center. Like playing with a bowl and beads, constant motion keeps them aloft; slight cessation causes falling." He realized the wealthy man's illness was due to Qi failing to lift, resulting in sinking/collapse. He observed writing characters dripping water: pressing the upper aperture with the thumb filled the tube; releasing it caused empty drainage. He suddenly understood: "I can treat this patient." He traveled there and applied moxibustion to Bai Hui (GV20) for thirty to forty burns, stopping the diarrhea. *Yi Shui Hui Bian Zhu* notes: Bai Hui belongs to the Du Mai (Governing Vessel), located at the vertex, the center of Heaven, governing the Qi of the whole body. When Yuan Qi sinks, the Spleen and Stomach lack support, causing diarrhea, termed "unable to support the Earth." The classics say: "What is below, lift from above." Moxibustion on Bai Hui works by restoring the vigorous movement of Heavenly Qi, allowing Spleen Earth to find support. *Tong Ren Jing* states Bai Hui treats prolapse of the rectum by moxibustion; the principle is the same.
Yu Zhen commented: Zhang Zhongjing's *Shang Han Lun* states: "Shaoin disease, diarrhea, faint and choppy pulse, vomiting and sweating, frequent defecation but small volume, should be treated by warming the upper part with moxibustion." "Upper" refers to Bai Hui. Why wait for Huang Zinong to realize this? Reading *Zi Sheng Jing*, it is said: "It is traditionally believed that some elderly people retain youthful complexions because they moxa the Shen Que (CV8) point with mouse dung once a year." I once suffered from loose stools for a long time; one night of thirty-seven burns prevented the need to defecate the next day. Several nights of moxibustion prevented defecation for days. This verifies the classic statement regarding persistent diarrhea. This is another expedient method similar to moxibustion on Bai Hui. Furthermore, Zi He said: Mr. Yang from Shandong treated the Prefect's persistent Dong Xie. While facing the patient, Mr. Yang discussed celestial movements and weather changes with others from Chen to Wei hours. The patient listened and forgot the urge to defecate. Mr. Yang said: "To treat persistent Dong Xie, first ask what the patient enjoys. If they like chess, play chess; if music, provide instruments. Do not stop." This adds a clever method beyond herbs and moxibustion. Since the Spleen governs trust/routine, chronic diarrhea becomes a habit. Forgetting the toilet breaks this habit, stopping the diarrhea.
Zhu Danxi said: My uncle, aged seventy, was robust in constitution but thin in body. Late summer, he developed diarrhea, persisting until late autumn despite numerous treatments. Though ill for a long time, his spirit was not exhausted. Urination was scanty and not red. Both pulses were choppy and slightly wiry. He reported slight chest stuffiness and reduced appetite. This must be long-standing accumulation lodged in the intestines and stomach. Asking about his dietary preferences, he said: "I love eating carp; I have eaten it every day for three years." I said: "Phlegm accumulation in the Lung. The Lung is the paired organ of the Large Intestine; its dysfunction leads to Large Intestine insecurity. We must clear the source so the stream clears naturally." Using Zhu Yu (Evodiae Fructus), Qing Cong (Scallion Stem), Chen Pi (Citri Reticulatae Pericarpium), Mu Xu Gen (Medicago Root), and Sheng Jiang (Fresh Ginger), decocted thick, mixed with rock sugar, and drunk in small amounts. Inducing vomiting by stimulating the throat yielded half a sheng of glue-like phlegm. Symptoms halved that night. Drinking again the next morning yielded another half sheng of phlegm, and diarrhea stopped. Then, Ping Wei San (Peaceful Stomach Powder) added with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Huang Lian (Coptidis Rhizoma) was given for ten days, leading to stability.
He also treated an elderly man with chronic right-hand flexion deformity. In September, he developed diarrhea resistant to all medicines. The right pulse was floating, large, surging, and rapid. This indicated phlegm accumulation in the Taiyin channel, obstructing Lung Qi, preventing descent, causing Large Intestine deficiency and diarrhea. Treatment should focus on the Upper Jiao. Using crushed radish seeds mixed with fermented rice water to induce vomiting expelled a bowl of thick phlegm, bringing immediate relief.
A wealthy boy had a yellow complexion, voracious appetite, craving meat, and diarrhea for a month. The pulse was large. Suspecting damp-heat, which usually causes fatigue and poor appetite, he was instead energetic and ate much, without thirst. This suggested intestinal parasites (Gan Chong). Examination confirmed roundworms in stool. Treating the parasites cured him. Early the following summer, diarrhea recurred without pain but with dry mouth. Zhu said: "Previously, worms were treated but sweetness was not avoided." Using anti-Gan-heat herbs administered with Bai Zhu Tang (Atractylodes Macrocephala Decoction) cured him in three days. Thereafter, Bai Zhu was used as Sovereign, Shao Yao (Paeoniae Radix Alba) as Minister, with Chuan Xiong (Ligustici Chuanxiong Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Huang Lian (Coptidis Rhizoma), and Hu Huang Lian (Coptidis Chinensis Rhizoma), assisted by Lu Hui (Aloe), formed into pills, taken with Bai Zhu Tang. Meat and sweets were forbidden to prevent recurrence.
A cunning and irritable man, suffering from recurrent genital ulcers, developed spontaneous diarrhea in early summer with slight chest stuffiness. Physicians gave Li Zhong Tang (Regulate the Middle Decoction), causing syncope upon waking. The pulse was choppy, slightly wiry and rapid on deep pressure. Zhu said: "This is a severe case of genital ulceration." He prescribed Dang Gui Long Hui Wan (Angelica Dragon Bile Pill) minus She Xiang (Musk), four doses reducing diarrhea. Then Xiao Chai Hu Tang (Minor Bupleurum Decoction) minus Ban Xia (Pinelliae Rhizoma), added with Huang Lian (Coptidis Rhizoma), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Sheng Jiang (Fresh Ginger), cured him after several doses.
Yu Zhen commented: In Danxi's four cases, the emetic method is commonly used by Zi He. However, investigating dietary habits and relying on the right pulse's surging-rapid quality reveals phlegm in the Lung before inducing vomiting. The emetic agents differ. Compared to Zi He indiscriminately using emesis and purgation regardless of cold-heat or deficiency-excess, who is sage and who is mad? Treating parasitic GAN and genital ulcers shows even greater ingenuity.
Lu Cangzhou treated Tie Mu Shi Er, Official of the Commander-in-Chief, with diarrhea of undigested food. All physicians diagnosed Dong Xie Cold Center, administering Si Ni Tang (Frigid Extremities Decoction) and Li Zhong Wan (Regulate the Middle Pill) daily, worsening the condition. Lu diagnosed the pulse: both Chi and Cun positions were wiry and large; the Right Guan position was floating twice as much as the Left Guan. The outer canthus resembled grass growth. He knew Liver Wind transmitting to the Spleen caused Sun Xie, not internal organ cold. He administered Xiao Xu Ming Tang (Minor Continuation of Life Decoction), reducing Ma Huang (Ephedrae Herba) and adding Bai Zhu (Atractylodis Macrocephalae Rhizoma) by three to five sheng. Diarrhea stopped. Xu Ming Tang is not a specific antidiarrheal; stopping diarrhea before finishing the dose occurred because treatment addressed the root cause.
Yu Zhen commented: This case resembles Zi He's treatment of Zhao Mingzhi but differs. That was external wind injury; this is internal wind transmission. Treatments seem similar, but principles differ. Cangzhou also treated Censor Wang Yanfang with chronic internal Sun Xie. Mid-autumn, pulses were double-wiry and floating. He said: "This disease stems from fright-wind, not diet or fatigue. The Liver governs fright; thus, deficient wind becomes severe, attacking the Spleen causing diarrhea. Metal Qi is strong now, yet the disease persists; by next spring, it will worsen." The patient admitted fright due to losing a copper tally triggered the illness. Ox liver was used, combined with wind-dispelling and Spleen-strengthening agents, stopping diarrhea after a month. This is another type of internal wind.
Hua Bo Ren treated a person with summer diarrhea, red urine, heavy and weak limbs unwilling to move, spontaneous sweating, slight fever, and thirst. Previously emaciated, physicians suspected deficiency-wasting and planned strong tonification. Hua examined six pulses as weak and minute, stating: "This is what Dongyuan calls Summer Heat stroke with diet and fatigue. The method suits Qing Shu Yi Qi Tang (Clear Summer Heat and Benefit Qi Decoction)." Two doses eliminated the illness.
Yu Zhen commented: Spontaneous sweating, slight fever, thirst, and red urine in summer clearly indicate Summer Heat. Heavy limbs indicate deficiency, specifically Qi damage by Summer Heat. Tonification is appropriate, but strong tonification fails to clear Summer Heat, missing the mark. Hence, Qing Shu Yi Qi Tang is most effective.
Wang Shishan treated a person who accidentally took poison in childhood, causing dysentery, then food stagnation, leading to persistent severe diarrhea. Although able to eat later, he remained emaciated. Every June and July, coinciding with the poisoning anniversary, painful diarrhea recurred. Voracious appetite, cold sensation in chest/diaphragm, night fevers, lethargy, reluctance to speak, sexual arousal upon hearing erotic words, palpitations, night sweats, phlegm in throat, difficult urination, alternating constipation and loose stools, vomiting/diarrhea after overeating. Pulses were all soft, weak, and slow; Right pulse slightly larger but still weak. Next day, Left pulse irregular: sometimes two or three beats slow, sometimes five fast; Right pulse remained slow and weak. Irregular Left pulse indicated sexual desire disturbing Essence. Weak Right pulse indicated Spleen damage from poison. Proper treatment should solidify Kidney and nourish Spleen. Prescription: Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Shao Yao (Paeoniae Radix), Huang Qi (Astragali Radix), Mai Dong (Ophiopogonis Radix) each 1 qian; Dang Gui (Angelicae Sinensis Radix), Ze Xie (Alismatis Rhizoma) each 7 fen; Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Shan Zha (Crataegi Fructus) each 6 fen, decocted and taken.
Yu Zhen commented: The pulse description here is unique, and the analysis is insightful, broadening learners' perspectives.
Cheng Mingyou treated a person with lower diarrhea, unable to tolerate even a spoonful of water or rice. Taking herbal decoctions caused vomiting. Cheng diagnosed: "Illness caused by drinking alcohol. Spleen dislikes dampness; decoctions add dampness." He used Ren Shen (Ginseng Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma) mixed with Jing Mi (Oryza Sativa Germ) made into cakes. The illness resolved quickly. Knowing the cause was excessive drinking, he felt the pulse was soft, slow, and weak, indicating Spleen damage by dampness.
Yu Zhen commented: Soft, slow, and weak pulses indicate both deficiency and dampness. Making Ren, Fu, and Zhu into cakes instead of decoctions tonifies deficiency without aiding dampness, showing the same ingenuity as taking heat-inducing herbs before evening meals later mentioned.
Xue Lizhai treated Qian Kejiu, who drank heavily, had a red face and abundant phlegm, and loose stools. This was damp-phlegm stagnation in intestines and stomach. He used Er Chen Tang (Two-Aged Decoction) plus Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Shan Zhi (Gardeniae Fructus), Zhi Shi (Aurantii Fructus), Gan Ge (Puerariae Radix), Ze Xie (Alismatis Rhizoma), Sheng Ma (Cimicifugae Rhizoma). One dose produced much phlegm vomiting, and stools became firm. Afterwards, he drank Huang Lian (Coptidis Rhizoma) tea daily at 3 qian to maintain health. Such robust constitutions are rare.
Yu Zhen commented: The emphasis is on "such robust constitutions are rare." Daily Huang Lian tea is also a rare method.
Another sixty-year-old man had a red face, phlegm expectoration, dry mouth, and occasional diarrhea. In spring, he told Xue Lizhai: "My condition is considered Spleen channel damp-heat/phlegm-fire causing diarrhea. I routinely use Er Chen, Huang Lian, Zhi Shi, Shen Qu (Massae Fermentatae Medicamentae), Mai Ya (Hordei Fructus Germinatus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chai Hu (Bupleuri Radix) without effect. Why?" Xue examined him: Left Guan position wiry-tight, Kidney Water failing to generate Liver Wood. Right Guan position wiry-large, Liver Wood attacking Spleen Earth. This is Spleen-Kidney deficiency failing to control generation and restriction. Tonifying the source of transformation is needed. The patient did not believe. Xue told others: "This elder will not live long; he will perish from dysentery." The following year, he indeed died of dysentery.
Yu Zhen commented: Left Guan wiry-tight, Right Guan wiry-large. Superficial observers would merely soothe Liver and clear damp-heat. Failure to respond leaves them puzzled. This case serves as a guiding light in darkness.
Jiang Yingsu treated Huang Shuibu Xin Yang Gong, suffering Spleen-Kidney diarrhea for over ten years. At dawn (Wu Gu), abdominal pain necessitated multiple toilet visits. By Chen hour, four episodes. Slight pain and diarrhea continued through Si and Wu hours, totaling seven or eight times daily as routine. Poor appetite, fatigue, lethargy. Right Guan pulse slippery-rapid; Left Chi pulse slightly wiry and powerless. This is Kidney deficiency with accumulated heat in Spleen. Huang Lian Zhi Shi Wan (Coptis and Immature Bitter Orange Pill) relieved abdominal pain gradually, allowing rising at dawn. Si Shen Wan (Four Spirits Pill) and Ba Wei Wan (Eight-Ingredient Pill) were given to tonify the source. Diet doubled in half a year, and diarrhea healed.
Yu Zhen commented: This case is root deficiency with branch excess, a different pattern. Clearing first, then warming, is the correct method.
[Appendix] Someone had daily morning diarrhea, sometimes with abdominal pain, sometimes without. Taking heat-inducing herbs on an empty stomach was ineffective. Later, a physician advised taking heat-inducing herbs before the evening meal, leading to peace. Heat herbs taken in the morning lose potency by evening; night Yin Qi cannot be opposed. Evening administration keeps heat in the abdomen all night to counter Yin Qi. This opens a new method for using heat herbs.
Another person suffered chronic diarrhea. Warm herbs tonifying Spleen and diuretics failed. A physician diagnosed isolated weakness of the Heart pulse, intending to tonify the Heart...