泄泻有三。寒热积也。
寒泻者不渴。宜理中丸主之。
热泻者有渴。宜五苓散合六一散主之。
积泻者面黄。所下酸臭食也。宜丁香脾积丸下之。积不去。泻不止也。
三棱（煨） 莪术（煨） 良姜（醋煮） 青皮（去白醋煮各五分） 丁香（去蒂三钱五分） 木
香
胡三溪子病泻不止。三溪自与甘大用同医。皆吾所传也。不效。其兄元溪云。今有璞玉
于此
结拜我。吾闻之即归。问其所用之方。皆不对证。观其外候。面色黄。所下酸臭。此积泻。
宜下之。积去泻斯止矣。乃取丁香脾积丸。一服而安。其父问云。吾闻湿多成五泻。未闻所
谓积泻也。予曰。难经有所谓大瘕泻者是也。湿成五泻者。有内因者。有外因者。有不内外
因者。如因于风者。水谷不分。谓之飧泄。因于热者。水谷暴泄。谓之洞泄。因于寒者。水
谷不化。谓之溏泻。因于湿者。水谷稠粘。谓之濡泻。此四泻者。外因之病。湿自外生者也
。因于积者。脓血交杂。肠鸣腹痛。所下腥臭。谓之瘕泻。瘕者。宿食积滞之名。乃食症也
。此内因之病。湿自内生者也。有不内外因者。乃误下之病。有挟热挟寒之分。所谓肠垢
溏者是也。又问。脾积丸乃取下之剂。何以能止泻也。曰。胃者。水谷之海。肠者。水谷流
行之道路也。泄泻者。肠胃之病也。肠胃无邪。则水谷变化。便溺流行。是为无病儿矣。今
有宿食不化。陈腐之物。菀积于肠胃之中。变为泄痢。如源泉之水。停积于中。流出于外。
苟不溯其源而出之。则泄痢终不止也。故以脾积丸去其陈腐。此拔本塞源之法。按本草云。
巴豆未泄能令人泄。已泄能令人止。脾积丸之治积泄。祖训当遵守也。余教诸子治泄泻。始
终三法。
初用理中丸一服。不止。次用五苓散。一二服分利。不止。三用白术散服之良。又不止
。用参苓白术散调理。未有不效。再不止。用参苓白术散二分。豆蔻一分。
发挥云。难经五泻之论甚详。予论大肠泻。小肠泻。大瘕泻。则易明。予论脾泻肾泻。
则难
藏之舍。无有所受。岂有所出哉。其脾泻者。即胃泻也。谓脾不能约束其胃。胃不能藏而泻
也。故泻有属脾者。有属肾者。但自胃来者。水谷注下而多。自脾来者。则成黄糜。泻无度
而少也。观仲景伤寒论中。大便不通者。用脾约丸。其意明矣。肾亦脏也。谓之肾泻者。肾
开窍于二阴。为闭藏之主。肾虚则不能主闭藏。而水谷自下。且下焦如渎。有所受则有所出
也。但泻不同。难经云。其泻下重者。即肾泻也。观东垣先生脾胃论。补中益气汤方。凡大
便弩责者。加当归身红花。弩责者即下重。当归红花以润血。盖肾恶燥。故用二物以润之。
肾泻亦与大瘕泻同。泻者痢也。乃积滞之物。故痢曰滞下。况痢则腹痛。有肠鸣。有里急。
有赤白。若肾泻。则便时略难。却无里急后重之证。故云。痢则下重也。古人立方治肾泻。
有用破故纸者。补其肾也。有用吴茱萸者。补其肝也。皆苦以坚之辛以润之之法。今吾立方
治脾泻者。只用参苓白术丸。治肾泻者。只用六味地黄丸加破故纸。甚效。
胃泻。大肠泄。小肠泄。三者不同。盖自胃来者。水谷注下而不分。所下者皆完谷也。
此寒。治宜理中丸主之。自小肠来者。亦水谷注下而不分。则成糟粕而非完谷。且小肠为受气之
府。水谷到此。已变化而未尽变化也。治宜分别水谷。以五苓散主之。使水谷分利。则泻止
矣。自大肠来者。则变化尽而成屎。但不结聚。而所下皆酸臭也。宜用伤寒论中禹余粮汤。
陈文中痘疹方中肉豆蔻丸主之。此涩可以去滑之法也。
叔和云。湿多五泻。此本内经湿胜则濡泻之论。所谓五泻。则与难经之论不同。素问以
脏腑分五泻。叔和以风寒湿热食分五泻。
如泄时有发热恶寒。水谷不分者。此风湿证也。谓飧泄。经云。春伤于风。夏生飧泄者
是也。宜小建中汤加防风主之。若兼脓血者。胃风汤主之。
如泻时有腹痛。或吐或不吐。所泻者多完谷未化。此寒湿证也。宜理中汤主之。
如泻时有腹痛。或痛或不痛。所下亦有完谷而未尽化者。此邪热不杀谷也。有成糟粕者
。皆属热湿。以伤寒论中猪苓汤主之。寒湿热湿宜详辨之。属寒者不渴。属热者渴也。
如泻时水谷混下。小便少而大便多者。此湿泻也。有溏泻无度者。此久湿也。并宜五苓
散主之。
如泻时有腹痛腹鸣之证。恶食。所下酸臭之物。此因宿食停滞于中而成湿。此食化为湿
也。宜下之。积去泄自止也。丁香脾积丸主之。
泄泻二字。亦当辨之。泄者。谓水谷之物泄出也。泻者。谓肠胃之气下陷也。
猪苓汤
猪苓 泽泻 阿胶 滑石 茯苓（各一钱） 水煎。
春月得之名伤风。其证发热而渴。小便短少。宜先清热后补脾。清热薷苓汤。补脾白术
夏至后得之泻者。有寒有热。渴欲饮水者。热泻也。先服玉露散以清暑止渴。后服白术
散以补脾。
如不渴者。寒泻也。先服理中丸以温中补脾。后服五苓散。以清暑。此祖传之妙也。
夏月水泻。其详在因五邪之气所生病条内有案。
秋月得之。伤湿泻也。其证体重。所下溏粪。谓之濡泻。宜渗湿补脾利小便。胃苓汤主
之。或升麻除湿汤。
冬月得之。伤寒泻也。其证腹痛。所下清水。宜温。理中丸或理中汤加熟附子少许主之
。不止宜豆蔻丸。
四时之中。有积泻者。面黄善肿。腹中时痛。所下酸臭者是也。宜先去积。后调脾胃。
去积丁香脾积丸。调理脾胃胃苓丸。
治泻大法。不问寒热。先服理中丸。理中者。理中气也。治泄不利小便。非其治也。五
主之。更不止。胃气下陷也。补中益气汤。清气上升则不泻矣。又不止者。此滑泻也。宜涩
之。豆蔻丸主之。此祖傅之秘法也。
小儿泄泻。根据法治之不效者。脾胃已衰。不能转运药性以施变化。只以补脾为主。脾胃
既健。药自效也。白术散主之。常与无间。此予先父之秘授也。
久泻不止。津液消耗。脾胃倒败。下之谷亡。必成慢惊。所谓脾虚则吐泻生风者是也。
补脾胃于将衰之先。宜用白术散补之。补之不效。宜用调元汤加建中汤急救。否则慢风已成
。虽使仲阳复生。不可为也。（详见慢惊内。）小儿泄泻。大渴不止者。勿与汤水饮之。水入
则愈加渴而病益甚。宜生脾胃之津液。白术散主之。
久泻不止。发热者。此津液不足。乃虚热也。勿投以凉药。反耗津液。宜白术散主之。
如热更甚。黄连丸主之。
白术散 治小儿泄泻烦渴者。
四君子加木香 藿香（各等分） 葛根（加一倍） 上作大剂。水煎常服。以代汤水。
黄连丸 治久泻发热。此虚热也。
黄连 干蟾（炙各二钱） 木香（一钱） 使君子（一钱） 芦荟 夜明砂（各七分） 上为末
。山药研粉。水糊丸。麻子大。米水下。
升麻除湿汤 治风湿作泻。自下而上者。引而竭之。如脾胃甚弱。不思饮食。肠鸣腹痛
。泄泻无度。小便赤涩。四肢困倦。
升麻 柴胡 防风 神曲 泽泻 猪苓（各五分） 苍术（一钱） 陈皮 甘草（炙） 麦
（各三分） 为末。水煎热服。
玉露散 治伤热泻黄。（方见前） 与五苓散合匀。名桂苓甘露饮。治热泻。此予心得之
一儿有病。一日夜三五行。或泻或止。连年不愈。此脾泻也。胃苓丸加人参主之。
一儿无病。时值盛夏。医以天水散与之。谓其能解暑毒也。服后暴泻。医悔。用作理中
连进三剂。泻变痢疾。日夜无度。脓血相杂。儿益困顿。皮燥无汗。发聚成穗。请予治之。
予曰。挟热而痢者。其肠必垢。泻久不止。则成疳泻。此儿初泻。本时行之病。非干天水散
也。医当用天水散调五苓散服之可也。反以理中汤热剂投之。遂成挟热肠垢之病。皮燥发穗
者。表有热甚也。下痢窘迫者。里有热甚也。表里俱热。津液亦衰。事急矣。因制一方。用
黄连 干蟾（炙各一钱） 木香 青皮 白茯苓 当归身 诃子肉（各一钱五分）
共为末。粟米粉作糊为丸。每服三十丸。炒陈米汤下。十日后满头出小疖。身上发痱如
粟。热平痢止而愈。噫。此子非吾无生矣。
一儿病泻。大渴不止。医以五苓散玉露散皆不效。病益困。腮妍唇红。予见之曰。不可
泄泻大渴者。水去谷少。津液不足故也。法当用白术散。补其津液可也。乃服五苓散玉露散
渗利之剂。重亡津液。脾胃转虚。诀云。大渴不止。止而又渴者死。泄泻不止。精神好者死
。父母不信。三日后。发搐而死。
壬子经魁万宾兰。石泉翁之伯子也。翁得子晚。始生宾兰。爱如珠玉。周岁得水泻。一
十余行。翁善医。自作理中汤加诃子肉豆蔻与之。不效。乃急请予至。叙其用药不效。予曰。
正理论云。理中者。理中气也。治泄不利小便。非其治也。遂用五苓散去桂加甘草。一服泻
止。三日后遍身发出赤斑。石泉惧。予曰。无妨。活人书云。伤寒病下之太早。热气乘虚入
胃发斑。今夏月热盛之时。泻久里虚。热气乘虚而入。且多服理中辛甘之剂。热留胃中。今
发赤斑。热自里而出于表也。宜作化斑汤必易愈。翁曰。石膏性寒。非泻所宜。曰。有是病
则投是药。在夏月白虎犹宜用也。一服而斑没热退。
本县大尹朱云阁。公子病泄。十日不止。众医或用理中五苓益元白术散等。皆不效。泻
甚。公亟召余至。视其外侯。启曰。渴太甚当先止渴。公曰当先止泻。余曰。病本湿热。水
谷不分。更饮水多。则湿伤脾胃。水积肠胃。所泻之水。乃所饮之水也。故当先止其渴。渴
止泻亦止矣。公曰。当用何方。曰。白术散。尹曰。已服过多。余曰。用之不同也。尹曰。
用之更有别法乎。余曰。本方在常与服之。此常字便是法也。盖白术散。乃治泻作渴之神方
。此方有二法。人参白术茯苓甘草藿香木香六味各一钱。葛根倍二钱者。泄泻久不止。胃中
津液下陷也。故葛根倍用之。以升胃中之津液。此一法也。今人不知倍用之法。与六味等分
同。故效少也。儿病渴者。汤水不离。今人不知常服之法。以药常代汤饮之也。故所用之方
虽是。所用之法不同。药剂少而汤水犹多。药少汤多。犹以一杯之水。救一车薪之火。水不
胜火。如何有效。当作大剂煎汤以代汤水饮之。渴只饮本方。一切汤水禁之勿与。则胃气上
升。津液自生。渴泻止矣。尹闻而是之。果一剂治矣。不问泄泻痢疾。并宜服此。多多益善
。不唯泄泻可止。亦不至脾虚生风也。真神妙方也。谨详述之。公子脾胃素弱。常伤食。一
医枳术丸。保和丸。其意常用枳术丸补脾。至伤食则服保和丸。不效。公以问予。予曰。此
法固好。但专用枳术丸。则无消导之药。初不能制其饮食之伤。专服保和丸。则脾胃之虚。
不能胜其消导。而反损中和之气。当立一方。七分补养。三分消导。则脾胃自强。不能再伤
矣。公曰。甚善。汝作一方来看。余乃制用人参白术青皮陈皮甘草木香缩砂仁山药莲肉使君
子神曲麦芽为末。荷叶煨饭捣烂为丸。米饮送下。名之曰养脾消食肥儿丸。服后精采顿异。
饮食无伤。公益喜。录其方常久用之。亲书儒医二字。作匾赐之。
庠生胡逸泉。东郊翁之伯子也。周岁时得水泄。先请医甘大用。治之不效。复请予至。
则肌肉消削。面色 白。时盛夏。凝汗不润。皮肤干燥。发竖。所下频并。略带后重。此气
血俱虚也。按治法之。补中气。利小便。升举其阳。固涩其滑。次第调之。略无寸效。或曰
。何如。予曰。术将穷矣。唯有一法未用耳。乃作疳泻治之。用人参白术白茯苓甘草陈皮山
药当归莲肉砂仁诃子肉豆蔻黄连木香干蟾为末。神曲糊丸。煎四君子汤下。服未二日。肤
润有微汗。再一日头上见出红疮。小便渐多。五日而泻止。后更以参苓白术散作丸服之。调
理而安。
汪望峰长子城南。生一子。寄姊夫南河胡家养。南河尝语人曰。万老先生好小儿科。今
作聪明。儿有病。可请张祖兄医之。乃先生亲传。予亦与人会药。不执方合宜而用。吾之活
人多矣。试举其一二验者实之。城南一子病泻。十余日不止。一向是张用药。以胃苓丸一粒
丹服之。皆无效。请予治之。望峰知其故。恐予不肯用心。取白金二两作利市。予叹曰。不
在利市。只在信我也。我之治病。敢作聪明。皆先人之旧方。顾用之不同耳。盖治大病以重
剂。治小病以轻剂。彼胃苓丸一粒丹。岂治此重病哉。乃取豆蔻丸五十。胃苓丸五十。陈仓
米煎汤下。语南河云。只此一剂而止。不再下也。南河初不听。泄止大悟曰。良工不示人以
朴信乎。
湖广右布政孙小姐。五月病泻。至七月犹未止。诸医治之皆不效。差人召余。余至见其
。乃知津液不足也。不止其渴。泻亦不止。热亦不除也。公问余曰。数日可安。曰。三日止
渴。五日止泻。十日热退。计十八日可安。公曰。病久矣。一月而安幸也。乃进白术散作大
泄泻有三种类型：寒泻、热泻和积泻。
寒泻的特点是口不渴，适宜用理中丸（温中散寒方剂）主治。
热泻的特点是口渴，适宜用五苓散（利水渗湿方剂）合六一散（清暑利湿方剂）主治。
积泻的特点是面色发黄，排泄物为酸臭的未消化食物，适宜用丁香脾积丸（消积导滞方剂）攻下治疗。积滞不去，腹泻就不会停止。
[丁香脾积丸组成] 三棱（煨制）、莪术（煨制）、良姜（醋煮）、青皮（去白瓤，醋煮，各五分）、丁香（去蒂，三钱五分）、木香。
胡三溪之子患腹泻不止。胡三溪自己与甘大用共同诊治，他们的方法都是我传授的，但无效。其兄元溪说：“现在有位叫璞玉的人在此。”我听说后便回去询问。问及所用的方药，发现都不对症。观察患者的外部征象，面色黄，排泄物酸臭，这是积泻，应当采用攻下法。积滞去除，腹泻自然停止。于是取来丁香脾积丸，服用一次后病情安定。患儿父亲问道：“我听说湿气多导致五种泻证，没听说过所谓的积泻。”我说：“《难经》中有‘大瘕泻’的说法，指的就是这种病。因湿致五泻的情况，有内因、外因和不内外因之分。如因风邪所致，水谷不分，称为飧泄；因热邪所致，水谷暴注下迫，称为洞泄；因寒邪所致，水谷不化，称为溏泻；因湿邪所致，水谷稠粘，称为濡泻。这四种泻证属于外因致病，湿气从外而生。因积滞所致者，脓血混杂，肠鸣腹痛，排泄物腥臭，称为瘕泻。‘瘕’是宿食积滞的名称，也就是食积症。这属于内因致病，湿气从内生发。有不内外因的，是由于误用攻下法导致的疾病，有挟热和挟寒的区别，所谓‘肠垢溏’就是这种情况。”又问：“脾积丸是攻下的方剂，为什么能止泻呢？”我说：“胃是水谷汇聚的海洋，肠是水谷运行的道路。泄泻是肠胃的疾病。如果肠胃没有邪气，那么水谷就能正常变化，大小便通畅流行，这就是健康的儿童。现在有宿食不化，陈腐之物郁积在肠胃之中，变成泄痢，就像源头的水，停滞在中焦，流出体外。如果不追溯源头将其排出，那么泄痢终究不会停止。所以用脾积丸去除陈腐之物，这是拔除病根、堵塞源头的治法。据《本草》记载：巴豆在未发生腹泻时能让人腹泻，在已经腹泻时能让人止泻。脾积丸治疗积滞性腹泻，应当遵循这一古训。”
我教导儿子们治疗泄泻，始终遵循三种方法：
起初用理中丸，服一剂后若不止泻，接着用五苓散，一二剂分利小便后若仍不止，第三用白术散服用效果良好；如果还不停止，就用参苓白术散进行调理，没有无效的。如果再不停止，用参苓白术散二分，豆蔻一分。
【发挥】《难经》关于五泻的论述非常详细，我论述大肠泻、小肠泻、大瘕泻，就容易明白了。我论述脾泻、肾泻，则比较难懂。脏腑的舍宅，如果没有受纳的东西，怎么会有排出的东西呢？所谓的脾泻，其实就是胃泻。意思是脾不能约束胃，胃不能藏纳而致泻。所以有的泻证属脾，有的属肾。但从胃来的，水谷直注而下且量多；从脾来的，则形成黄色的糜烂状粪便，泻下无度但量少。看张仲景《伤寒论》中，大便不通的用脾约丸，其中的意思就很明显了。肾也是脏，称为肾泻的，是因为肾开窍于二阴，是闭藏的主宰。肾虚则不能主司闭藏，水谷就会自行下泄。而且下焦像沟渠一样，有所受纳就有所排出。但泻证有所不同，《难经》说：“泻下伴有重坠感的，就是肾泻。”看李东垣先生的《脾胃论》，补中益气汤方中，凡是大便努责（用力排便困难）的，加当归身、红花。努责就是下重感，用当归、红花来润血。因为肾恶燥，所以用这两味药来滋润它。肾泻也和大瘕泻相似。泻和痢是一样的，都是积滞之物，所以痢疾称为“滞下”。况且痢疾会有腹痛、肠鸣、里急后重、赤白脓血等症状。如果是肾泻，只是排便时略微困难，却没有里急后重的症状。所以说痢疾才有下重感。古人立方治疗肾泻，有用破故纸（补骨脂）的，是为了补肾；有用吴茱萸的，是为了补肝。这都是“苦以坚之，辛以润之”的方法。现在我立方治疗脾泻，只用参苓白术丸；治疗肾泻，只用六味地黄丸加破故纸，效果很好。
胃泻、大肠泄、小肠泄，三者不同。大概从胃来的，水谷直注而下而不分，排泄的都是完谷（未消化的食物），这属于寒证，治疗适宜用理中丸主治。从小肠来的，也是水谷直注而下而不分，但形成的是糟粕而非完谷。而且小肠是受气的府库，水谷到这里，已经变化但未完全变化，治疗宜分别水谷，以五苓散主治，使水谷分利，那么腹泻就会停止。从大肠来的，则变化尽而成屎，只是不结聚，排泄物都酸臭，适宜用《伤寒论》中的禹余粮汤，或陈文中《痘疹方》中的肉豆蔻丸主治。这是“涩可以治滑”的方法。
王叔和说：“湿多成五泻”，这原本出自《内经》“湿胜则濡泻”的理论。所谓的五泻，则与《难经》的论述不同。《素问》以脏腑分五泻，王叔和以风寒湿热食分五泻。
如泄泻时有发热恶寒，水谷不分的，这是风湿证，称为飧泄。经文说：“春伤于风，夏生飧泄”就是这个意思。适宜用小建中汤加防风主治。如果兼有脓血的，用胃风汤主治。
如泄泻时有腹痛，或吐或不吐，所泻的多为完谷未化的，这是寒湿证，适宜用理中汤主治。
如泄泻时有腹痛，或痛或不痛，所下的也有完谷而未完全消化的，这是邪热不能腐熟水谷，有成糟粕的，都属于热湿，以《伤寒论》中的猪苓汤主治。寒湿和热湿应当仔细辨别。属寒的不渴，属热的口渴。
如泄泻时水谷混下，小便少而大便多的，这是湿泻。有溏泻无度的，这是久湿，都适宜用五苓散主治。
如泄泻时有腹痛腹鸣的症状，厌恶饮食，排泄酸臭之物，这是因为宿食停滞在中焦而成湿，这是食化为湿，适宜攻下。积滞去除，泄泻自然停止。用丁香脾积丸主治。
“泄”和“泻”两个字，也应当辨别。“泄”，是指水谷之物泄出；“泻”，是指肠胃之气下陷。
猪苓汤
猪苓、泽泻、阿胶、滑石、茯苓（各一钱），水煎。
春季得此病名为伤风。症状是发热而渴，小便短少。适宜先清热后补脾。清热用薷苓汤，补脾用白术散。
夏至后得的泻证，有寒有热。口渴想喝水的，是热泻。先服玉露散以清暑止渴，后服白术散以补脾。
如果不渴的，是寒泻。先服理中丸以温中补脾，后服五苓散以清暑。这是祖传的妙法。
夏季的水泻，详情在“因五邪之气所生病”条内有医案记录。
秋季得此病，是伤湿泻。症状是身体沉重，排泄稀粪，称为濡泻。适宜渗湿补脾利小便，用胃苓汤主治。或用升麻除湿汤。
冬季得此病，是伤寒泻。症状是腹痛，排泄清水，适宜温补，用理中丸或理中汤加少许熟附子主治。若不止，宜用豆蔻丸。
四季之中，有积泻的，特征是面色黄、容易浮肿、腹部时常疼痛、排泄酸臭之物。适宜先去积滞，后调理脾胃。去积用丁香脾积丸，调理脾胃用胃苓丸。
治疗泄泻的大法，不问寒热，先服理中丸。理中，就是调理中气。治疗泄泻如果不通利小便，不是正确的治法。再用五苓散。如果还不停止，是胃气下陷，用补中益气汤。清气上升则不泻了。如果仍不停止，这是滑泻，适宜固涩，用豆蔻丸主治。这是祖传的秘法。
小儿泄泻，根据上述法治疗无效的，说明脾胃已经衰弱，不能转运药性以施变化，只以补脾为主。脾胃既健运，药物自然见效。用白术散主治。经常服用不间断。这是我先父的秘授。
久泻不止，津液消耗，脾胃败坏，后天之本亡失，必成慢惊风。所谓“脾虚则吐泻生风”就是这样。在脾胃将衰之前补益脾胃，适宜用白术散补之。补之无效，适宜用调元汤加建中汤急救。否则慢风已成，即使张仲景复生，也无法救治。（详见慢惊风章节。）小儿泄泻，大渴不止的，不要给汤水饮用。水入则更加口渴而病情加重。适宜生脾胃之津液，用白术散主治。
久泻不止，发热的，这是津液不足，乃虚热。不要投用凉药，反而耗伤津液，适宜用白术散主治。如果热更甚，用黄连丸主治。
白术散：治疗小儿泄泻烦渴者。
四君子汤加木香、藿香（各等分），葛根（加一倍）。上药作大剂量，水煎常服，以代汤水。
黄连丸：治疗久泻发热，此为虚热。
黄连、干蟾（炙，各二钱）、木香（一钱）、使君子（一钱）、芦荟、夜明砂（各七分）。上药为末，山药研粉，水糊丸，如麻子大。米汤送下。
升麻除湿汤：治疗风湿作泻，自下而上者，引而竭之。如脾胃甚弱，不思饮食，肠鸣腹痛，泄泻无度，小便赤涩，四肢困倦。
升麻、柴胡、防风、神曲、泽泻、猪苓（各五分）、苍术（一钱）、陈皮、甘草（炙）、麦冬（各三分）。为末，水煎热服。
玉露散：治疗伤热泻黄。（方见前文）与五苓散合匀，名桂苓甘露饮，治疗热泻。这是我心得的一个方子。
有一个孩子生病，一天一夜泻三四次，有时泻有时止，连年不愈，这是脾泻。用胃苓丸加人参主治。
有一个孩子原本无病，正值盛夏，医生给他天水散，说能解暑毒。服用后突然暴泻，医生后悔，改用理中汤。连进三剂，泻变成了痢疾，日夜无度，脓血相杂，孩子更加困顿，皮肤干燥无汗，头发聚结成穗状。请我诊治。我说：“挟热而痢的，肠道必有垢腻。泻久不止，则成疳泻。这个孩子初起腹泻，本是时行病，与天水散无关。医生应当用天水散调五苓散服用即可。反而用理中汤这种热剂投之，遂成了挟热肠垢的病。皮肤干燥、头发聚穗，是表热甚；下痢窘迫，是里热甚。表里俱热，津液亦衰，情况危急。于是制定一方，用黄连、干蟾（炙，各一钱）、木香、青皮、白茯苓、当归身、诃子肉（各一钱五分），共为末，粟米粉作糊为丸。每服三十丸，炒陈米汤送下。十日后满头出小疖，身上发痱如粟，热平痢止而痊愈。唉，这孩子如果不是我，就没命了。”
有一个孩子患泻，大渴不止。医生用五苓散、玉露散都无效，病情更加困重，腮红唇红。我见到后说：“不可再泄泻了。泄泻大渴，是因为水去谷少，津液不足。法当用白术散，补其津液即可。但他服用了五苓散、玉露散这些渗利之剂，重伤津液，脾胃转虚。诀云：‘大渴不止，止而又渴者死；泄泻不止，精神好者死。’父母不信，三天后，孩子发搐而死。”
壬子科经魁万宾兰，是石泉翁的伯父之子。石泉翁得子晚，刚生下宾兰，爱如珠玉。周岁时得水泻，一天十余次。石泉翁擅长医术，自作理中汤加诃子肉、豆蔻给他服用，无效，于是急忙请我到。叙述用药无效的情况。我说：“《正理论》说：理中，就是调理中气。治疗泄泻如果不通利小便，不是正确的治法。”于是用五苓散去桂枝加甘草，一服泻止。三天后遍身发出赤斑。石泉翁害怕。我说：“无妨。《活人书》说：伤寒病下之太早，热气乘虚入胃发斑。现在是夏季热盛之时，泻久里虚，热气乘虚而入，且多服理中辛甘之剂，热留胃中，现在发赤斑，是热自里而出于表。适宜作化斑汤，必定容易痊愈。”石泉翁说：“石膏性寒，不适合泻证使用。”我说：“有是病则投是药，在夏季白虎汤犹宜用也。”一服而斑没热退。
本县大尹朱云阁，他的公子患泄泻，十日不止。众医生或用理中丸、五苓散、益元散、白术散等，都无效。泻势严重，公紧急召我至。观察其外部征象，启奏道：“渴太甚应当先止渴。”公说：“应当先止泻。”我说：“病本是湿热，水谷不分，更饮水多，则湿伤脾胃，水积肠胃。所泻之水，乃是所饮之水。所以应当先止其渴，渴止泻亦止矣。”公说：“当用何方？”我说：“白术散。”尹说：“已服过多。”我说：“用法不同。”尹说：“用之更有别法吗？”我说：“本方在于常与服之，这个‘常’字便是法。盖白术散，是治疗泄泻作渴的神方。此方有二法：人参、白术、茯苓、甘草、藿香、木香六味各一钱，葛根倍用至二钱的，是泄泻久不止，胃中津液下陷。所以葛根倍用之，以升胃中之津液，这是一法。今人不知倍用之法，与六味等分同用，所以效少。儿病渴者，汤水不离，今人不知常服之法，以药常代汤饮之。所以所用之方虽是，所用之法不同。药剂少而汤水犹多，药少汤多，犹如以一杯之水，救一车薪之火，水不胜火，如何有效？当作大剂煎汤以代汤水饮之。渴只饮本方，一切汤水禁之勿与，则胃气上升，津液自生，渴泻止矣。”尹闻而认为是这样，果然一剂治愈。不问泄泻痢疾，并宜服此，多多益善。不唯泄泻可止，亦不至脾虚生风也。真是神妙方啊。谨详述之。公子脾胃素弱，常伤食。一位医生用枳术丸、保和丸，其意常用枳术丸补脾，至伤食则服保和丸，不效。公以此问我。我说：“此法固然好，但专用枳术丸，则无消导之药，初不能制其饮食之伤。专服保和丸，则脾胃之虚，不能胜其消导，而反损中和之气。当立一方，七分补养，三分消导，则脾胃自强，不能再伤了。”公说：“甚善。你作一方来看。”于是我制用人参、白术、青皮、陈皮、甘草、木香、缩砂仁、山药、莲肉、使君子、神曲、麦芽为末，荷叶煨饭捣烂为丸，米饮送下，名之曰“养脾消食肥儿丸”。服后精采顿异，饮食无伤。公非常高兴，录其方常久用之，亲书“儒医”二字，作匾赐之。
庠生胡逸泉，是东郊翁的伯父之子。周岁时得水泄，先请医生甘大用，治之不效，又请我至。此时肌肉消削，面色㿠白，时值盛夏，凝汗不润，皮肤干燥，发竖，所下频并，略带后重。这是气血俱虚。按治法调理，补中气，利小便，升举其阳，固涩其滑，次第调之，略无寸效。有人说：“怎么样？”我说：“术将穷矣，唯有一法未用耳。”于是作疳泻治之，用人参、白术、白茯苓、甘草、陈皮、山药、当归、莲肉、砂仁、诃子肉、豆蔻、黄连、木香、干蟾为末，神曲糊丸，煎四君子汤送下。服不到两天，肤润有微汗，再一日头上见出红疮，小便渐多，五日而泻止。后更以参苓白术散作丸服之，调理而安。
汪望峰长子城南，生一子，寄放在姊夫南河胡家抚养。南河曾对人讲：“万老先生好小儿科。如今自作聪明，儿有病，可请张祖兄医之。乃先生亲传，予亦与人会药，不执方合宜而用，吾之活人多矣。试举其一二验者实之。”城南一子病泻，十余日不止。一向是张用药，以胃苓丸一粒丹服之，皆无效。请我诊治。望峰知其故，恐我不肯用心，取白金二两作为利市（酬金）。我叹曰：“不在利市，只在信我也。我之治病，敢作聪明，皆先人之旧方，顾用之不同耳。盖治大病以重剂，治小病以轻剂。彼胃苓丸一粒丹，岂治此重病哉？”于是取豆蔻丸五十，胃苓丸五十，陈仓米煎汤送下。语南河云：“只此一剂而止，不再下也。”南河初不听。泄止大悟曰：“良工不示人以朴，信乎？”
湖广右布政孙小姐，五月病泻，至七月犹未止。诸医治之皆无效，差人召我。我至见其……（原文此处似有缺漏，推测为见其形瘦或脉细等），乃知津液不足也。不止其渴，泻亦不止，热亦不除也。公问我：“数日可安？”我说：“三日止渴，五日止泻，十日热退。计十八日可安。”公说：“病久矣，一月而安幸也。”乃进白术散作大……（原文未完）
Diarrhea has three types: cold diarrhea, heat diarrhea, and accumulation diarrhea.
Cold diarrhea is characterized by no thirst; it should be treated primarily with Lizhong Wan (Warming the Middle Decoction).
Heat diarrhea is characterized by thirst; it should be treated primarily with Wuling San (Five-Ingredient Powder with Poria) combined with Liuyi San (Six-to-One Powder).
Accumulation diarrhea is characterized by a sallow complexion and the passage of sour, foul-smelling undigested food; it should be treated with Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill) to purge. If the accumulation is not removed, the diarrhea will not stop.
[Composition of Dingxiang Pi Ji Wan] Sanleng (Broomrape Rhizome, roasted), Ezhu (Curcuma Zedoaria Rhizome, roasted), Liangjiang (Galangal Rhizome, boiled in vinegar), Qingpi (Citrus Reticulata Pericarpium, pith removed, boiled in vinegar, each 0.5 fen), Dingxiang (Caryophylli Flos, calyx removed, 3.5 qian), Muxiang (Aucklandiae Radix).
The son of Hu Sanxi suffered from incessant diarrhea. Hu Sanxi himself, along with Gan Dayong, treated him using methods I had transmitted, but without effect. His elder brother Yuanxi said, "There is a person named Puyu here." Upon hearing this, I returned to inquire. When asked about the prescriptions used, I found they were not indicated for the condition. Observing the external signs, the patient had a sallow complexion and passed sour, foul-smelling stools; this was accumulation diarrhea, and purgation was required. Once the accumulation was removed, the diarrhea would cease. Thus, I administered Dingxiang Pi Ji Wan, and after one dose, the condition stabilized. The father asked, "I have heard that dampness often causes five types of diarrhea, but I have never heard of so-called accumulation diarrhea." I replied, "The *Nan Jing* mentions 'Da Jia Xie' (Great Mass Diarrhea), which refers to this condition. Regarding the five diarrheas caused by dampness, there are internal causes, external causes, and neither-internal-nor-external causes. For example, if caused by wind, where water and grain are not separated, it is called *Sun Xie* (Sporadic Diarrhea); if caused by heat, where water and grain rush down violently, it is called *Dong Xie* (Cavernous Diarrhea); if caused by cold, where water and grain are not digested, it is called *Tang Xie* (Pasty Diarrhea); if caused by dampness, where water and grain are thick and sticky, it is called *Ru Xie* (Moist Diarrhea). These four types belong to diseases caused by external factors, where dampness arises from outside. If caused by accumulation, with pus and blood mixed, borborygmus, abdominal pain, and foul-smelling excrement, it is called *Jia Xie* (Mass Diarrhea). 'Jia' refers to the name for retained food and stagnation, i.e., food retention syndrome. This belongs to diseases caused by internal factors, where dampness arises from within. There are also neither-internal-nor-external causes, resulting from improper use of purgatives, divided into cases with accompanying heat or cold, such as 'intestinal mucus pasty stool'." He asked again, "Pi Ji Wan is a purgative formula; how can it stop diarrhea?" I said, "The stomach is the sea of water and grain, and the intestines are the pathways through which water and grain flow. Diarrhea is a disease of the stomach and intestines. If there is no pathogen in the stomach and intestines, water and grain transform properly, and urination and defecation flow smoothly, indicating a healthy child. Now, if there is retained food that fails to digest, and stale matter accumulates in the stomach and intestines, transforming into diarrhea and dysentery, it is like spring water stagnant in the middle and flowing out externally. If one does not trace the source and expel it, the diarrhea and dysentery will never cease. Therefore, Pi Ji Wan removes the stale matter; this is the method of pulling up the root and blocking the source. According to the *Ben Cao*, Ban Dou (Croton Seed) can induce diarrhea in those who are not yet having diarrhea, and can stop diarrhea in those who already have it. In treating accumulation diarrhea with Pi Ji Wan, one must follow this ancient principle."
I teach my sons to treat diarrhea using three consistent methods:
Initially, administer Lizhong Wan. If it does not stop after one dose, next use Wuling San. If it does not stop after one or two doses of promoting diuresis, thirdly use Baizhu San, which is effective. If it still does not stop, regulate with Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), which is invariably effective. If it still does not stop, use Baizhu San in a ratio of two parts to Doukou (Cardamom) in one part.
[Commentary] The discussion on the five diarrheas in the *Nan Jing* is very detailed. My discussion on Large Intestine Diarrhea, Small Intestine Diarrhea, and Da Jia Diarrhea is easy to understand. My discussion on Spleen Diarrhea and Kidney Diarrhea is difficult. The dwelling of the zang-fu organs, if there is nothing received, how can there be anything discharged? The so-called Spleen Diarrhea is actually Stomach Diarrhea. It means the spleen cannot constrain the stomach, and the stomach cannot store, leading to diarrhea. Thus, some diarrheas belong to the spleen, and some to the kidney. Those coming from the stomach involve water and grain pouring down directly and in large quantities; those coming from the spleen form yellow, mushy stools, with profuse but small-volume diarrhea. Looking at Zhang Zhongjing's *Shanghan Lun*, the use of Miyue Wan (Spleen-Restraining Pill) for constipation makes the intent clear. The kidney is also a zang organ. It is called Kidney Diarrhea because the kidney opens into the two yin orifices and is the master of closure. When the kidney is deficient, it cannot govern closure, and water and grain descend spontaneously. Moreover, the lower jiao is like a ditch; what is received is discharged. However, the diarrhea differs. The *Nan Jing* states: "Diarrhea accompanied by a feeling of heaviness/tenesmus is Kidney Diarrhea." Looking at Li Dongyuan's *Pi Wei Lun*, in the Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), when there is straining during defecation, Danggui Shenhong (Angelica Sinensis Root and Carthamus Flower) are added. Straining refers to tenesmus; Danggui and Honghua are used to moisten the blood. Since the kidney dislikes dryness, these two herbs are used to moisten it. Kidney diarrhea is similar to Da Jia diarrhea. Diarrhea and dysentery are essentially the same, being stagnant materials; thus, dysentery is called "Zhi Xia" (Stagnant Downward Flow). Furthermore, dysentery involves abdominal pain, borborygmus, tenesmus, and red-and-white discharge. In contrast, Kidney Diarrhea involves only slight difficulty during defecation, without tenesmus. Hence, it is said that dysentery involves tenesmus. Ancients formulated prescriptions for Kidney Diarrhea using Pogostemon Cablin (Gu Zhi/Bu Gu Zhi) to tonify the kidney, or Evodia Fruit (Wu Zhu Yu) to tonify the liver. These employ the method of "bitterness to firm and pungency to moisten." Now, for Spleen Diarrhea, I use only Shenling Baizhu Wan; for Kidney Diarrhea, I use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Bu Gu Zhi, which is very effective.
Stomach Diarrhea, Large Intestine Leakage, and Small Intestine Leakage are different. Generally, those originating from the stomach involve water and grain pouring down without separation, passing as complete undigested grains; this is a cold pattern, treated primarily with Lizhong Wan. Those originating from the small intestine also involve water and grain pouring down without separation, forming dregs rather than complete grains. Since the small intestine is the palace receiving qi, water and grain reaching here have transformed but not completely. Treatment should separate water and grain, primarily using Wuling San to promote diuresis, so that diarrhea stops. Those originating from the large intestine undergo complete transformation into feces, but do not coagulate, and the excrement is sour and foul; treat with Yuyuliang Tang (Hematitum Decoction) from the *Shanghan Lun*, or Roudoukou Wan (Myristica Pill) from Chen Zhongwen's *Douzhen Fang*. This is the method of "astringency to treat slipperiness."
He Suhe stated, "Dampness abounds to cause five diarrheas," which originates from the *Neijing* theory "Excess dampness leads to moist diarrhea." The so-called five diarrheas differ from the *Nan Jing*. The *Suwen* divides five diarrheas by zang-fu, while He Suhe divides them by wind, cold, heat, dampness, and food.
If diarrhea occurs with fever and aversion to cold, and water/grain are not separated, this is a wind-damp pattern, called *Sun Xie*. The classics state: "Wind injury in spring leads to *Sun Xie* in summer." Treat primarily with Xiao Jianzhong Tang (Minor Construct the Middle Decoction) plus Fangfeng. If accompanied by pus and blood, use Weifeng Tang.
If diarrhea occurs with abdominal pain, with or without vomiting, and the excrement consists mostly of undigested grains, this is a cold-damp pattern, treated primarily with Lizhong Tang.
If diarrhea occurs with abdominal pain, sometimes painful, sometimes not, and the excrement contains undigested grains, this is due to pathogenic heat failing to cook the grain, forming dregs; all belong to heat-damp. Treat primarily with Zhuling Tang (Polyporus Decoction) from the *Shanghan Lun*. Cold-damp and heat-damp must be carefully distinguished. Cold patterns present without thirst; heat patterns present with thirst.
If diarrhea involves mixed water and grain, with scanty urine and abundant stool, this is damp diarrhea. Profuse pasty diarrhea indicates chronic dampness; both are treated primarily with Wuling San.
If diarrhea presents with abdominal pain and borborygmus, anorexia, and passage of sour/foul matter, this is due to retained food stagnating in the middle, transforming into dampness (food converting to damp). Purge it. Once the accumulation is removed, the diarrhea stops. Use Dingxiang Pi Ji Wan.
The terms "Xie" (leakage) and "Xie" (pouring) should also be distinguished. "Xie" refers to the leakage of water and grain substances. "Xie" refers to the sinking of qi in the stomach and intestines.
Zhuling Tang
Zhuling, Zexie, Ejiao, Huashi, Fuling (each 1 qian). Decoct in water.
Acquired in spring, it is named Wind Injury. Symptoms include fever, thirst, and scanty urine. Clear heat first, then tonify the spleen. Use Ru Ling Tang to clear heat, and Baizhu San to tonify the spleen.
Acquired after the Summer Solstice, diarrhea may be cold or heat. Thirst with desire to drink water indicates heat diarrhea. First take Yulu San to clear summerheat and stop thirst, then take Baizhu San to tonify the spleen.
If there is no thirst, it is cold diarrhea. First take Lizhong Wan to warm the middle and tonify the spleen, then take Wuling San to clear summerheat. This is a secret method passed down from ancestors.
Summer water diarrhea details are recorded in the section on diseases caused by the five pathogens.
Acquired in autumn, it is Dampness Injury Diarrhea. Symptoms include heavy body and loose stools, called *Ru Xie*. Promote dampness resolution, tonify the spleen, and benefit urination. Use Weiling Tang. Or Shengma Chushi Tang.
Acquired in winter, it is Cold Damage Diarrhea. Symptoms include abdominal pain and watery stools. Warmth is indicated. Use Lizhong Wan or Lizhong Tang with a small amount of Shu Fuzi. If ineffective, use Doukou Wan.
In all four seasons, there is accumulation diarrhea, characterized by sallow complexion, propensity to swelling, intermittent abdominal pain, and sour/foul excrement. First remove the accumulation, then regulate the spleen and stomach. Remove accumulation with Dingxiang Pi Ji Wan; regulate spleen/stomach with Weiling Wan.
General principles for treating diarrhea: Regardless of cold or heat, first administer Lizhong Wan. "Lizhong" means regulating the middle qi. Treating diarrhea without benefiting urination is incorrect. Then use Wuling San. If still ineffective, it is sinking of stomach qi; use Buzhong Yiqi Tang. When clear qi ascends, diarrhea ceases. If still ineffective, it is slippery diarrhea; use astringents. Use Doukou Wan. This is an ancestral secret method.
For pediatric diarrhea, if treatment according to the above methods is ineffective, the spleen and stomach are already depleted and cannot transport medicinal properties to effect changes. Focus solely on tonifying the spleen. Once the spleen and stomach are robust, the medicine will naturally work. Use Baizhu San. Administer continuously without interruption. This was a secret transmission from my late father.
Chronic diarrhea that does not stop consumes fluids, leading to spleen/stomach collapse and loss of postnatal essence, inevitably resulting in slow convulsions. This is what is meant by "spleen deficiency leads to vomiting, diarrhea, and wind generation." Tonify the spleen and stomach before they decline significantly; use Baizhu San. If tonification is ineffective, use Tiaoyuan Tang combined with Jianzhong Tang for emergency rescue. Otherwise, once slow wind is established, even if Zhang Zhongjing were reborn, it could not be cured. (See Slow Convulsions chapter.) For pediatric diarrhea with extreme unquenchable thirst, do not give soup or water. Water intake increases thirst and worsens the disease. Generate spleen/stomach fluids; use Baizhu San.
Chronic diarrhea with fever indicates fluid deficiency and deficiency heat. Do not administer cooling medicines, as they consume fluids further. Use Baizhu San. If heat is more severe, use Huanglian Wan.
Baizhu San: Treats pediatric diarrhea with irritability and thirst.
Si Junzi Tang plus Muxiang, Huoxiang (equal parts), Gegen (doubled). Prepare a large dose, decoct in water, and take frequently as a substitute for water.
Huanglian Wan: Treats chronic diarrhea with fever (deficiency heat).
Huanglian, Ganchan (roasted, each 2 qian), Muxiang (1 qian), Shijunzi (1 qian), Lushui, Yeming Sha (each 0.7 fen). Grind into powder, mix with Shan Yao powder and water paste, make pills the size of hemp seeds. Take with rice water.
Shengma Chushi Tang: Treats wind-damp diarrhea ascending from below, drawing it out and exhausting it. For weak spleen/stomach, anorexia, borborygmus, abdominal pain, profuse diarrhea, dark/scanty urine, and limb fatigue.
Shengma, Chaihu, Fangfeng, Shenqu, Zexie, Zhuling (each 0.5 fen), Cangzhu (1 qian), Chenpi, Gancao (roasted), Maidong (each 0.3 fen). Grind into powder, decoct in water, and take hot.
Yulu San: Treats heat injury diarrhea with yellow stool. (Formula seen previously.) Mixed equally with Wuling San, named Guiling Ganlu Yin, treats heat diarrhea. This is a formula from my personal insights.
One child was ill, having diarrhea 3-4 times a day and night, alternating with cessation, lasting years without cure. This was spleen diarrhea. Treat with Weiling Wan plus Renshen.
One child was healthy during midsummer. A doctor gave him Tianshui San, claiming it could resolve summerheat toxicity. After ingestion, sudden violent diarrhea occurred. The doctor regretted it and switched to Lizhong Tang. After three doses, diarrhea turned into dysentery, day and night without limit, with pus and blood mixed. The child became increasingly exhausted, skin dry without sweat, hair clumping into tufts. I was invited to treat. I said, "Dysentery with accompanying heat implies intestinal filth. Chronic diarrhea leads to malnutrition diarrhea. This child's initial diarrhea was a seasonal epidemic disease, unrelated to Tianshui San. The doctor should have used Tianshui San adjusted with Wuling San. Instead, using the hot Lizhong Tang caused heat-accompanied intestinal filth. Dry skin and clumped hair indicate severe exterior heat; urgent dysentery indicates severe interior heat. Exterior and interior both hot, fluids depleted, critical situation." I formulated a prescription: Huanglian, Ganchan (roasted, each 1 qian), Muxiang, Qingpi, Baifuling, Danggui Shen, Hezirou (each 1.5 qian). Grind into powder, make pills with millet flour paste. Take 30 pills per dose with stir-fried old rice soup. Ten days later, small boils appeared on the head, and prickly heat like millet grains appeared on the body. Heat subsided, dysentery stopped, and the child recovered. Alas, without me, this child would not have survived.
One child had diarrhea with extreme unquenchable thirst. Doctors used Wuling San and Yulu San without effect; the condition worsened, with red cheeks and lips. I observed and said, "Do not drain further. Extreme thirst in diarrhea is due to fluid loss and insufficient grain/fluids. The method is to use Baizhu San to replenish fluids. But he took Wuling San and Yulu San, diuretic agents, severely depleting fluids and weakening the spleen/stomach. The aphorism says: 'Extreme thirst that returns after stopping is fatal; diarrhea that continues with good spirit is fatal.' Parents did not believe, and three days later, the child died from convulsions."
Wan Binlan, top scholar in the Renzi year, was the eldest son of Stone Spring's uncle. Stone Spring had a son late, loving Binlan like pearl and jade. At one year old, he got water diarrhea, over ten times daily. Stone Spring, skilled in medicine, made Lizhong Tang with Hezirou and Roudoukou for him, without effect. He urgently summoned me. I recounted the ineffectiveness of previous meds. I said, "The *Zhengli Lun* states: Lizhong regulates middle qi. Treating diarrhea without benefiting urination is incorrect." So I used Wuling San minus Guizhi plus Gancao. One dose stopped the diarrhea. Three days later, red spots appeared all over the body. Stone Spring feared. I said, "No harm. The *Huoren Shu* states: Early purgation in cold damage allows heat qi to enter the stomach causing spots. In summer heat, chronic diarrhea leaves the interior empty, allowing heat qi to enter. Plus, excessive use of Lizhong's pungent-sweet agents left heat in the stomach. Now red spots appear as heat exits the interior to the exterior. Use Huaban Tang, and recovery will be easy." Stone Spring said, "Shigao is cold, unsuitable for diarrhea." I said, "With the disease, administer the medicine. Even in summer, Baihu Tang is appropriate." One dose cleared the spots and reduced heat.
County Magistrate Zhu Yunge's son had diarrhea for ten days. Various doctors used Lizhong, Wuling, Yi Yuan, Baizhu San, etc., all ineffective. Diarrhea was severe. The magistrate urgently summoned me. Observing external signs, I advised, "Extreme thirst requires stopping thirst first." The magistrate said, "Stop diarrhea first." I said, "The root is damp-heat, water/grain not separated. Drinking more water damages spleen/stomach, accumulating water in intestines. The expelled water is the ingested water. Thus, stop thirst first; when thirst stops, diarrhea stops." Magistrate asked, "Which formula?" I said, "Baizhu San." Magistrate said, "Already taken too much." I said, "The usage differs." Magistrate asked, "Is there another method?" I said, "The method lies in frequent administration. 'Frequent' is the method. Baizhu San is the divine formula for diarrhea with thirst. There are two methods: Renshen, Baizhu, Fuling, Gancao, Huoxiang, Muxiang (each 1 qian), Gegen doubled (2 qian) is for chronic diarrhea where stomach fluids sink. Gegen is doubled to raise stomach fluids. This is one method. People today don't know to double Gegen, using equal parts, hence less efficacy. Children with thirst need constant water; people don't know to use medicine as water. Though the formula is correct, the method is wrong. Small medicine dose with large water volume is like saving a burning cart of firewood with a cup of water; water cannot overcome fire, so no effect. Make a large decoction to replace water. Drink only this formula for thirst, forbid all other water. Then stomach qi ascends, fluids generate, thirst and diarrhea stop." The magistrate agreed, and indeed one dose cured it. Regardless of diarrhea or dysentery, this is suitable, the more the better. Not only stops diarrhea, but prevents spleen deficiency wind. Truly a miraculous formula. I detail it herein. The young master had weak spleen/stomach since childhood, prone to food retention. A doctor used Zhizhu Wan and Baohe Wan, intending to use Zhizhu Wan to tonify spleen and Baohe Wan for food retention, but ineffective. The magistrate asked me. I said, "This method is good, but exclusive use of Zhizhu Wan lacks guiding/digesting herbs, unable to control food injury initially. Exclusive use of Baohe Wan, given spleen deficiency, cannot handle digestion, damaging neutral qi. Establish a formula: 70% tonification, 30% digestion, strengthening spleen/stomach so they cannot be injured again." Magistrate said, "Very good. Show me a formula." I formulated Renshen, Baizhu, Qingpi, Chenpi, Gancao, Muxiang, Suosharen, Shan Yao, Lianrou, Shijunzi, Shenqu, Maiya as powder, steamed lotus leaf with rice mashed into pills, taken with rice drink, named Yangpi Xiaoshi Fei'er Wan. After taking, vitality changed instantly, diet caused no injury. The magistrate was delighted, recorded the formula for long-term use, inscribed "Confucian Physician" on a plaque, and bestowed it upon me.
Xiangsheng Hu Yiquan, eldest son of East Suburb Old Man, had water diarrhea at one year old. First consulted doctor Gan Dayong, ineffective. Then consulted me. Muscles wasted, face pale, midsummer, sweat congealed not moistening, skin dry, hair erect, frequent stools with slight tenesmus. This was qi and blood deficiency. Regulated according to treatment: tonify middle qi, benefit urination, raise yang, astringe slipperiness, step-by-step regulation, with no effect. Someone asked, "What now?" I said, "Methods exhausted, only one method remains." Treated as malnutrition diarrhea, using Renshen, Baizhu, Baifuling, Gancao, Chenpi, Shan Yao, Danggui, Lianrou, Sharen, Hezirou, Roudoukou, Huanglian, Muxiang, Ganchan as powder, Shenqu paste pills, taken with Si Junzi Tang decoction. Within two days, skin moist with slight sweat; next day red sores appeared on head; urine gradually increased; diarrhea stopped in five days. Later, Shenling Baizhu Wan was taken for regulation and recovery.
Wang Wangfeng's eldest son, Chengnan, had a son raised by his sister's husband, Nanhe Hu. Nanhe told others, "Old Master Wan excels in pediatrics. Now acting clever, telling people to ask Brother Zhang for medical help. He was personally taught by the master. I also gather herbs with others, not sticking to fixed formulas, saving many lives. Let me cite a few verified cases." Chengnan's son had diarrhea for over ten days. Always treated by Zhang, using one pill of Weiling Wan, all ineffective. Summoned me. Wangfeng knew the reason, fearing I wouldn't try hard, offered two taels of silver as a gift. I sighed, "It's not about the gift, but trust. My treatments, though appearing clever, rely on ancestors' old formulas, just used differently. Treat major illnesses with heavy doses, minor with light ones. How can one pill of Weiling Wan treat this severe illness?" I took fifty Doukou Wan and fifty Weiling Wan, taken with Chen Cang Mi (aged rice) decoction. Told Nanhe, "One dose will stop it, no more needed." Nanhe initially didn't listen. Diarrhea stopped, he realized, "True masters do not show their simplicity, truly so?"
Miss Sun, Right Commissioner of Huguang, had diarrhea starting in May, continuing to July. All doctors failed. Sent for me. Upon arrival... [text missing], knowing fluid deficiency. Without stopping thirst, diarrhea won't stop, nor will heat. The lord asked, "How many days to recover?" I said, "Thirst stops in three days, diarrhea in five, heat gone in ten. Recover in eighteen days." Lord said, "Illness is long, recovering in a month is fortunate." Then administered Baizhu San in a large... [text ends]