灵枢云。夫中热消瘅则便寒。寒中之属则便热。胃中热则消谷。令人悬心善饥。脐以上皮热。
肠中热则出黄如糜。脐以下皮寒。胃中热则腹胀。肠中寒则肠鸣飧泄。胃中寒肠中热。则胀而且
泄。胃中热肠中寒。则疾饥。小腹痛胀。
世医治病。但知热以寒治。寒以热治。外此总不讲也。设病中热消瘅而见悬心善饥。洵为热
证无疑。然必审其脐以上皮热。方是胃中热气蕴隆。若出黄如糜。不但胃中有热。而肠中亦为热
邪奔迫可知。倘脐以下皮寒而见腹胀。有似乎实热固结。实为胃中虚寒之候。或见肠鸣飧泄。非
特胃中有寒。且移寒于二肠矣。盖热泄则肠垢黄赤。寒泄则 溏清冷。此病机之最显著者。可以
明辨。况有胀而泄利黄赤。此胀为胃寒阳气不布之胀。泄为肠热便垢之泄。复有消谷易饥小腹胀
痛之病。岂非胃中有热肠中有寒之一验乎。若此种种。苟未明仲景三泻心汤、黄连汤、干姜黄芩
黄连人参汤、浓朴生姜半夏甘草人参汤、干姜人参半夏丸等法。必不可以语至治也。
经云。春伤于风。夏生飧泄。（风木之邪内乘湿土也。）邪气留连。乃为洞泄。（邪气留连
既久。则中气失职而为洞泄无度矣。）清气在下。则生飧泄。（下焦虚寒。火不生土。则中气不
治而为飧泄食不化也。）大肠小肠。皆属于胃。胃脉虚则泄。（脉者气血之先。脉虚则胃虚。二
肠失其上源而为泄泻矣。）湿胜则濡泄。（脾恶湿。湿胜则绵绵而泻无止期矣。）诸厥固泄。皆
属于下。（脾肾俱虚则阳气不能运于四末。故厥冷沉固而泄泻清冷也。）暴注下迫。皆属于热。
（暴泄而肛门迸迫。此属火化。若暴泄而肛门不禁。即属阴寒。久泄而肛门不禁。又属阳虚。所
谓暴泄非阳。久泄非阴是也。诸病水液。澄澈清冷。皆属于寒。（火气炎上。寒性润下。加以澄
澈清冷。安得不为寒乎。）
原病式曰。泻白为寒。青为风。黄赤黑皆为热也。大抵泻利。小便清白不涩。谷不化而色不
变者。寒也。谷虽不化而色变黄赤。烦渴小便赤涩者。热证也。寒泄而消化者。未之有也。或火
性急速。传化失常。谷虽不化。而暴泄臭秽色黄者有之。仲景云。邪热不杀谷。以热得湿。则飧泄也。
东垣云。夏间淫雨阴晦。时行泻利。予一日体重肢痛。泄利而小便闭涩。思其治法。必用淡
渗以利之。今受寒湿之邪。若从淡渗。非暮年所宜。行年五十以上。降气多而升气少。得淡渗之
剂。是降之又降。阳气愈弱。精神愈短矣。合用风药。以羌、独、升、柴、甘、防同煎。所谓湿
寒之胜。以风平之。又曰。下者举之。是因曲而为之直也。若不达升降之理而一概施治。安得愈
乎。李士材云。内经之论泄泻。或言风。或言湿。或言热。或言寒。此明四气皆能为泄也。又言
清气在下。则生飧泄。此名脾虚下陷之泄也。统而论之。脾土强者。自能胜湿。无湿则不泄。故
曰湿多成五泄。若土虚不能制湿。则风寒与热。皆得干之而为病。治法有九。一曰淡渗。使湿从
小便而去。如农夫治涝。导其下流。虽处卑监。不忧巨浸。经云。治湿不利小便。非其治也。又
云。在下者引而竭之是也。一曰升提。气属于阳。性本上升。胃气注迫。辄尔下陷。升、柴、羌、
葛之类。鼓舞胃气上胜。则注下自止。又如地土淖泽。风之即干。故风药多燥。且湿为土病。风
能胜湿。所谓下者举之是也。一曰清凉。热淫所至。暴注下迫。苦寒诸剂。用涤燔蒸。犹当溽暑
郁蒸之时。而商 飒然倏动。则炎 如失矣。所谓热者清之是也。一曰疏利。痰凝气滞。食积水
停。皆令人泻。随证祛逐。勿使稽留。经云。实者泻之。又云。通因通用
是也。一曰甘缓。泻利不已。急而下趋。愈趋愈下。泄何由止。甘能缓中。善禁急速。且稼穑作
甘。甘为土味。所谓急者缓之是也。一曰酸收。泻下有日。则气散而不收。无能统摄。注泄何时
而已。酸之一味。能助收摄之权。经云。散者收之是也。一曰燥脾。土德无惭。水邪不滥。故泻
皆成于土湿。湿皆本于脾虚。仓廪得职。水谷善分。虚而不培。湿淫转甚。经云。虚者补之是也。
一曰温肾。肾主二便。封藏之本。虽属水。而真阳寓焉。少火生气。火为土母。此火一衰。何以
营运三焦。熟腐水谷乎。故肾虚者必挟寒。脾虚者必补母。经云。寒者温之是也。一曰固涩。注
泄日久。幽门道滑。虽投温补。未克奏功。须行涩剂。则变化不愆。揆度合节。所谓滑者涩之是
也。以上九治。治泻之大法。至于先后缓急之权。岂能豫设。须临证之顷。圆机灵变耳。
戴复庵云。泻水而腹不痛者。湿也。升阳除湿汤或胃苓汤。饮食入胃。辄后便完谷者。气虚
也。香砂六君子。或枳实理中汤。腹痛泻水肠鸣。痛一阵。泻一阵者。火也。黄芩芍药汤。痰留
于肺。大肠不固。或时泻。或时不泻。或多或少者。痰也。脉必弦滑。其人神色不瘁。二陈加苍
术、木香。或探吐之更佳。腹痛甚而不泄。泄后痛减者。食积也。保和丸消导之。餐泄者。史记
名迥风。水谷不化。湿兼风也。风邪干胃。木来贼土。清气在下。升阳除湿汤。若饮食下嗌而辄
出不留者死。溏泄者。污积粘垢。湿兼热也。黄芩芍药汤加香、连。 溏者。中寒糟粕不化。色
如鸭粪。所以澄澈清冷。小便清白。湿兼寒也。附子理中汤。洞泄者。即名濡泄。体重软弱。泻
下多水。湿自盛也。胃苓汤。水液去多。甚而转经血枯。故筋急也。升阳除湿汤。滑泄者。久下
不能禁。湿胜气脱也。四柱饮。不应。用六柱饮。热泻。粪色赤黄。弹响作疼。粪门焦痛。粪出
谷道。犹如汤热。烦渴小便不利。五苓散。泻水多者亦必用之。若去桂。即不效。寒泻。腹胀泄
注。食即呕吐。理中汤加肉桂、诃子、升麻。食久窘迫。大便色白。肠鸣切痛。脉沉迟。身冷不
渴。溲清。或绵绵腹痛。附子理中汤加肉果。夏暑暴泻如水。周身疼痛汗出。脉弱少气。甚者加
吐。此名紧病。浆水散。盛暑逼于外。阴冷伏于其中。非连理汤不可。气虚而泻。四君子加升、
柴、肉果、诃子。伤食泄泻。必嗳气如败卵臭。保和丸。虚者。治中汤加减。积滞泄泻。腹必绞
痛方泄者是也。平胃散加磨积药。伤酒泻。葛花解酲汤。痰泻。则头晕恶心。胸腹迷闷。或时泻
甚。或时不泻。二陈汤加海石、香附、星、香、芩、连。姜汁调。神曲糊丸服。有人患早起泄泻。
或时有血。午后仍便结粪。能食善饮。此是酒积作泻。二陈加炮姜、酒炒川连、红曲。陈酒曲糊
丸。乌梅汤下。有血。去半夏加麝少许。晨夕各一服。日间无事。将晡腹膨。一夜肠鸣不得宽泰。
次早洞泄。此名顿泻。是脾虚湿盛也。胃苓汤加木香、砂仁。虚者。理苓汤加木香。气泄。肠鸣
失气。胸膈痞闷。腹急而痛。泻则腹下稍安。须臾又急。亦有腹急气塞而不通者。此由中脘停滞。
气不流转。水谷不分所致。木香调气散。水渍入胃。名为溢饮滑泄。渴能饮水。水下复泄。泄而
大渴。茯苓甘草汤。五苓散。并灸大椎三五壮立已。乃督脉之病也。泄而口渴引饮。小便短涩。
此为津液内亡。钱氏白术散。肾水不足之人患泄。或过服分利之剂而渴者。加减八味丸。失治。
必致小便不利。水肿胀满等证成矣。凡大便泄。服理中汤。小便不利。大便反泄。不知气化之故。
本肺不传化。以纯热之药治之。是以转泄。少服则不止。多服则愈。热所以不分。五苓散加人参、
炙甘草。名春泽汤。经云。膀胱者。州都之官。津液藏焉。气化则能出矣。泻而腹热。脉滑坚者。
属实。当与消导。不应。是食积发热也。加香连。更不应。加大黄微下之。泻而经年不止者。属
寒积。备急丸神效。泄泻恶心欲吐。或水土不伏。或感山岚瘴气而泻。藿香正气散。脾胃虚弱。
内挟风冷。泄泻注下。水谷不化。脐下 痛。腹中雷
鸣。乃积寒久利。肠滑不禁。木香散。若药与食入口即泻下者。名直肠泻。难治。本方加人参、
白术。用伏龙肝汤煎服。忧思太过。脾气结而不能升举。陷入下焦而成泄泻者。逍遥散去归加升
麻、木香。或越鞠、枳术相和服。不应。用补中益气加木香。久泻谷道不合。或脱肛。乃元气下
陷。大肠不行收令而然。补中益气加诃子、肉果、五味。乌梅肉为丸。或四君子加防风、升麻。
老人消运不及。而膨胀作泻。九味资生丸加木香。善饮者。加泽泻、肉桂。凡泻多因于湿。分利
小水为上。若老人气虚下陷。又宜风药以胜之。如补中益气加羌、防之类。或升阳除湿汤升举脾
胃。所谓下者举之。湿寒之胜。以风平之是也。大泻气脱而不知人。口眼俱闭。呼吸欲绝。急灸
气海穴。大进参、附辈温补之。稍迟即不可救。
五更泻。是肾虚失其闭藏之职也。经曰。肾司开阖。肾开窍于二阴。可见肾不但治小便。而
大便之开阖。皆肾操权也。今肾既衰。则命门之火熄而水独治。故令人水泻不止。其泻每在五更。
天将明时。必洞泄二三次。以肾旺于亥子五更之时。故特甚也。惟八味丸以补其阴。则肾中之水
火既济。而开阖之权得宜。况命门之火旺。则能生土。而脾亦强矣。有用六味丸加沉香、砂仁。
以山药末打糊。代蜜为丸。以摄火归源而愈者。有用六味丸加远志、益智。兼调脾肾而愈者。有
用六味丸七分。杂二神丸三分。服之而愈者。有用五味子煎汤送四神丸者。有用二神丸加五味子、
山茱萸、肉桂、茴香。陈米饮糊为丸服者。亦有属酒积食积者。盖一日进取之物。至此时皆下大
府而急奔也。但食积之泻。其腹必胀满。泻后则顿减。泻下皆是稀粪。酒积泻下。都是稀沫。或
有兼血积者。与肾泻之纯清水液。迥乎不同也。审系何积。即以何积治之。
石顽曰。泄泻诸治法颇详。何独不及虚损之泄泻也。盖肾脏真阴虚。则火邪胜。火邪上升。必伤
肺而为咳逆。真阳虚则水邪胜。水气内溢。必渍脾而为泄泻。既嗽且泄。上下俱病先后天之气并
伤。故虚损关捩。全系乎此。余尝用理中丸加五味子以治下泄。异功散加细辛以治上咳。每每获
效。若服之作胀发热者。终难挽回。不可以其咳泻俱缓。轻许其治也。
〔诊〕内经云。脉细。皮寒气少。泄利前后。饮食不入。是谓五虚。死。其浆粥入胃。泄注止。
则虚者活。泄而脉大者难治。大便赤瓣。飧泄脉小者。手足寒难已。飧泄脉小。手足温者易已。
脉经云。泄注脉缓。时小结者生。浮大数者死。又洞泄食不化。脉微小留连者生。紧急者死。脉
滑按之虚者。必下利。肾脉小甚为洞泄。脾脉小为泄泻。仲景云。下利日十余行。脉反实者死。
腹鸣而满。四肢清。诊其脉。洪大者死。腹大胀。四肢清。脱形。泄甚。不及一时而死。下则泄
泻。上则吐痰。皆不已。为上下俱脱。死。
滑伯仁治一人年老色苍。夏月与人争辨。冒雨劳役受饥。且犯房事。夜半忽病发热恶寒。上
吐下泻。昏闷烦躁。头身俱痛。因自发汗。汗遂不止。脉皆洪数。盖吐泻内虚。汗多表虚。兼之
脉不为汗衰泻减。法在不治。姑以大剂参、 。兼白术、干姜、甘草、茯苓、陈皮。水煎不时服。
至七剂见面赤。四肢发出红斑。凡斑证自吐泻者吉。谓邪从上下出也。但伤寒发斑。胃热所致。
今之发斑。由胃虚而无根之火游行于外。可补不可泄。可温不可凉。若用化斑、升麻、黑参之类。
则死生反掌矣。仍服前方十余剂而愈。
又治一人。每日早起大泻。或时腹痛。或不痛。空心服热药不效。令至晚食前服即效。以暖
药一夜在腹。可胜阴气
也。与酒客湿泄。服汤药不效。服丸散即效同意。
石顽治总戎陈孟庸。泻利腹胀作病。服黄芩、白芍之类。胀急愈甚。其脉洪盛而数。按之则
濡。气口大三倍于人迎。此湿热伤脾胃之气也。与浓朴生姜甘草半夏人参汤二剂。痛止胀减。而
泻利未已。与干姜黄芩黄连人参汤二剂。泻利止而饮食不思。与半夏泻心汤二剂而安。
《灵枢》说：体内有热邪导致消渴病证的，适宜用寒凉法治疗；属于中焦寒邪的，适宜用温热法治疗。胃中有热，则消化食物过快，使人心中悬空、容易饥饿，肚脐以上的皮肤发热。肠中有热，则排出黄色如粥状的粪便，肚脐以下的皮肤发冷。胃中有热会导致腹胀；肠中有寒会导致肠鸣和完谷不化的泄泻。如果胃中有热而肠中有寒，就会出现腹胀且泄泻的症状；如果胃中有寒而肠中有热，就会感到急切地饥饿，并伴有小腹部疼痛和胀满。
世俗医生治病，只知道热证用寒药治，寒证用热药治，除此之外就不加讨论了。假设病人患有热邪导致的消渴病，出现心中悬空、容易饥饿的症状，这确实是热证无疑。但是必须诊察到肚脐以上皮肤发热，这才是胃中热气蕴积隆盛的表现。如果排出黄色如粥状的粪便，不仅说明胃中有热，而且可知肠中也受到热邪的逼迫。倘若肚脐以下皮肤发冷且出现腹胀，看起来像是实热固结，实际上是胃中虚寒的征候。或者见到肠鸣和完谷不化的泄泻，这不仅说明胃中有寒，而且寒气已经转移到了大肠和小肠。大概热性泄泻排出的肠垢是黄红色的，寒性泄泻排出的粪便是稀薄清冷的。这是病机中最显著的特征，可以明确辨别。况且有的病人既腹胀又排泄黄赤色的粪便，这种腹胀是因为胃寒导致阳气不能布散引起的，这种泄泻是因为肠热导致便垢排出的。又有吃得多容易饥饿且小腹胀痛的情况，这难道不是胃中有热、肠中有寒的一个验证吗？像这样的种种情况，如果不明白张仲景的三泻心汤、黄连汤、干姜黄芩黄连人参汤、厚朴生姜半夏甘草人参汤、干姜人参半夏丸等治疗方法，就一定无法谈论最高明的治疗了。
《内经》说：春季感受风邪，夏季会发生完谷不化的泄泻。（这是因为风木之邪内侵湿土。）邪气留连不去，就会变成洞泄（邪气留连日久，导致中气失职，从而发生无度量的洞泄）。清气在下，就会发生完谷不化的泄泻。（下焦虚寒，命门之火不生脾土，导致中气不治而发生完谷不化、食物不消化的飧泄。）大肠和小肠都隶属于胃，胃脉虚弱就会导致泄泻。（脉是气血的先导，脉虚则胃虚，大小肠失去其源头供应而发生泄泻。）湿气胜则发生濡泄。（脾恶湿，湿气胜则绵绵不断地腹泻，没有止期。）各种厥逆、闭塞和泄泻，都属于下焦。（脾肾都虚，则阳气不能运达四肢末端，所以出现厥冷、沉固和泄泻清冷的症状。）突然剧烈腹泻且肛门急迫窘迫，都属于热证。（突然腹泻且肛门迸迫，这属于火化；如果是突然腹泻且肛门失禁，就属于阴寒；久泻且肛门失禁，又属于阳虚。这就是所谓的“暴泄非阳，久泄非阴”。）各种水液病症，清澈透明且寒冷，都属于寒证。（火气炎上，寒性润下，再加上清澈透明且寒冷，怎么能不是寒证呢？）
《原病式》说：大便白色为寒，青色为风，黄色、黑色、红色都为热。大抵来说，泄利时小便清白且不涩滞，食物不消化且颜色不变的，是寒证。食物虽然不消化但颜色变为黄赤，伴有烦躁口渴、小便赤涩的，是热证。寒性泄泻却能消化食物的，是没有过的。或者是火性急速，传化失常，食物虽然不消化，但突然腹泻且气味臭秽、颜色黄的，这种情况是有的。张仲景说：邪热不能腐熟谷物，因为热得湿，就会发生飧泄。李东垣说：夏天连绵阴雨阴暗晦涩，时行泄利，我有一天身体沉重、肢体疼痛，泄利且小便闭涩。思考其治法，必定要用淡味渗湿的药来利尿。现在遭受寒湿之邪，如果用淡渗之法，不适合五十岁以上的人。年过五十，降气多而升气少，得到淡渗的药物，是降之又降，阳气更加虚弱，精神更加短少。应当使用风药，用羌活、独活、升麻、柴胡、甘草、防风同煎。这就是所说的“湿寒之胜，以风平之”，又说“下者举之”，这是因势利导使其恢复正直的道理。如果不通达升降的原理而一概施治，怎么能痊愈呢？李士材说：《内经》论述泄泻，有的说风，有的说湿，有的说热，有的说寒，这说明四气都能导致泄泻。又说“清气在下，则生飧泄”，这叫脾虚下陷的泄泻。统而言之，脾土强盛，自然能胜湿，无湿则不泄，所以说“湿多成五泄”。如果土虚不能制湿，那么风寒与热，都能干扰它而致病。治疗方法有九种：一是淡渗，使湿气从小便排出，就像农夫治理涝灾，引导水流向下，即使处于低洼之地，也不担心大水淹没。《内经》说：“治湿不利小便，非其治也。”又说：“在下者引而竭之”，就是这个意思。二是升提，气属于阳，本性上升，胃气下注紧迫，就会下陷。升麻、柴胡、羌活、葛根之类的药物，能鼓舞胃气向上胜过下陷，那么注下的泄泻自然停止。又像地土泥泞沼泽，风吹即干，所以风药大多燥烈，且湿是脾土的病，风能胜湿。所谓“下者举之”就是这个道理。三是清凉，热邪淫溢所致，突然剧烈腹泻且肛门急迫，用苦寒的各种药剂，用来清除炽热的蒸腾，就像在闷热潮湿的时候，忽然吹来凉爽的风，那么炎热就像消失了一样。所谓“热者清之”就是这个道理。四是疏利，痰凝气滞，食积水停，都会让人腹泻。根据证候祛除驱逐，不要让它们稽留。《内经》说：“实者泻之”，又说“通因通用”，就是这个道理。五是甘缓，泄泻不止，急迫地下趋，越趋越下，泄泻怎么停止？甘味能缓和其中焦，善于禁止急迫。且稼穑作甘，甘是土的味道。所谓“急者缓之”就是这个道理。六是酸收，泄下有日子久了，气就会散漫而不收敛，无能统摄，注泄什么时候才能停止？酸这一味药，能帮助收摄的权力。《内经》说：“散者收之”，就是这个道理。七是燥脾，土的德行无愧，水邪就不会泛滥。所以泄泻都形成于土湿，湿都本源于脾虚。仓库廪禄得到尽职，水谷就能很好地分辨。虚而不培补，湿邪淫溢反而更甚。《内经》说：“虚者补之”，就是这个道理。八是温肾，肾主管二便，是封藏的根本，虽然属水，但真阳寓在其中。少火生气，火是土的母源。这个火一旦衰弱，凭什么营运三焦、熟腐水谷呢？所以肾虚的人一定夹杂寒邪，脾虚的人一定要补母（肾）。《内经》说：“寒者温之”，就是这个道理。九是固涩，注泄日子久了，幽门道滑，虽然投用温补，未能奏效。必须使用涩剂，那么变化就不会出错，揣度符合节律。所谓“滑者涩之”就是这个道理。以上九种治法，是治疗泄泻的大法。至于先后缓急的权衡，怎么能预先设定？必须在临证之时，圆机灵变才行。
戴复庵说：泻水且腹部不痛的，是湿证。用升阳除湿汤或胃苓汤。饮食进入胃后，随即排出完谷不化的粪便，是气虚证。用香砂六君子汤，或枳实理中汤。腹痛、泻水、肠鸣，痛一阵、泻一阵的，是火证。用黄芩芍药汤。痰留在肺，大肠不固，有时泻，有时不泻，或多或少，是痰证。脉象一定弦滑，人的神色不憔悴，用二陈汤加苍术、木香，或者探吐效果更好。腹痛严重但不泻，泻后疼痛减轻的，是食积证。用保和丸消导。飧泄，史记名为迥风，水谷不化，是湿兼风。风邪干扰胃，木来克土，清气在下，用升阳除湿汤。如果饮食咽下就立即吐出且不留存的，预后不良。溏泄，污浊积聚粘垢，是湿兼热。用黄芩芍药汤加香附、黄连。鸭溏，是中寒糟粕不化，颜色像鸭粪，所以清澈透明且寒冷，小便清白，是湿兼寒。用附子理中汤。洞泄，就是名濡泄，身体沉重软弱，泻下多水，是湿自盛。用胃苓汤。水液去多，甚至导致经血枯竭，所以筋脉拘急。用升阳除湿汤。滑泄，久泻不能控制，是湿胜气脱。用四柱饮，无效，用六柱饮。热泻，粪便颜色赤黄，弹响作痛，肛门焦痛，粪便排出肛门，犹如汤热，烦躁口渴，小便不利。用五苓散，泻水多的也必须用。如果去掉桂枝，就没有效果。寒泻，腹胀泄注，进食即呕吐。用理中汤加肉桂、诃子、升麻。进食很久后窘迫，大便颜色白，肠鸣切痛，脉沉迟，身冷不渴，小便清，或绵绵腹痛。用附子理中汤加肉豆蔻。夏暑暴泻如水，周身疼痛汗出，脉弱少气，严重的加上呕吐。这叫紧病。用浆水散。盛暑逼迫于外，阴冷潜伏于其中，不用连理汤不可。气虚而泻，用四君子汤加升麻、柴胡、肉豆蔻、诃子。伤食泄泻，一定嗳气像败卵臭味。用保和丸。虚证，用治中汤加减。积滞泄泻，腹部一定绞痛才泻的是。用平胃散加磨积药。伤酒泻，用葛花解酲汤。痰泻，则头晕恶心，胸腹迷闷，有时泻得厉害，有时不泻。用二陈汤加海浮石、香附、天南星、木香、黄芩、黄连。姜汁调服，神曲糊丸服用。有人患早起泄泻，有时带血，午后仍然大便干结，能吃能喝，这是酒积作泻。用二陈汤加炮姜、酒炒黄连、红曲，陈酒曲糊丸，乌梅汤送下。有血，去掉半夏加少许麝香。早晚各一服，日间无事，傍晚腹部膨隆，一夜肠鸣不得宽泰，次日早晨洞泄。这叫顿泻，是脾虚湿盛。用胃苓汤加木香、砂仁。虚证，用理苓汤加木香。气泄，肠鸣失气，胸膈痞闷，腹急而痛，泻后腹部稍安，一会儿又急。也有腹急气塞不通的。这是由于中脘停滞，气不流转，水谷不分所致。用木香调气散。水渍入胃，名为溢饮滑泄，渴能饮水，水下复泻，泻而大渴。用茯苓甘草汤，五苓散，并灸大椎穴三五壮立刻痊愈，这是督脉的病。泄而口渴引饮，小便短涩，这是津液内亡。用钱氏白术散。肾水不足的人患泄，或过服分利之剂而渴的，用加减八味丸。失治，必然导致小便不利，水肿胀满等证形成。凡大便泄，服理中汤，小便不利，大便反泄，不知道气化缘故的，本是肺不传化，用纯热之药治之，所以转泄。少服则不止，多服则愈。热所以不分，用五苓散加人参、炙甘草，名叫春泽汤。《内经》说：膀胱者，州都之官，津液藏焉，气化则能出矣。泻而腹热，脉滑坚的，属实，应当给予消导。无效，是食积发热。加香附、黄连。更无效，加大黄轻微攻下。泄泻经年不止的，属寒积。备急丸神效。泄泻恶心欲吐，或水土不服，或感山岚瘴气而泻。用藿香正气散。脾胃虚弱，内挟风冷，泄泻注下，水谷不化，脐下痛，腹中雷鸣，乃积寒久利，肠滑不禁。用木香散。如果药与食入口即泻下的，名叫直肠泻，难治。本方加人参、白术，用伏龙肝汤煎服。忧思太过，脾气结而不能升举，陷入下焦而成泄泻的，用逍遥散去当归加升麻、木香，或越鞠丸、枳术丸相和服。无效，用补中益气汤加木香。久泻谷道不合，或脱肛，乃元气下陷，大肠不行收令而然。用补中益气汤加诃子、肉豆蔻、五味子，乌梅肉为丸。或用四君子汤加防风、升麻。老人消运不及，而膨胀作泻，用九味资生丸加木香。善饮者，加泽泻、肉桂。凡泻多因于湿，分利小水是上策。如果老人气虚下陷，又宜用风药以胜之，如补中益气汤加羌活、防风之类，或升阳除湿汤升举脾胃。所谓“下者举之”，“湿寒之胜，以风平之”就是这个道理。大泻气脱而不知人，口眼俱闭，呼吸欲绝，急灸气海穴，大进人参、附子辈温补之。稍迟即不可救。
五更泻，是肾虚失其闭藏的职能。《内经》说：肾司开阖，肾开窍于二阴，可见肾不但治小便，而大便的开阖，都由肾掌握权力。现在肾既衰，则命门之火熄灭而水独治，所以让人水泻不止。其泻每每在五更，天将明时，必洞泄二三次，因为肾旺于亥子五更之时，所以特别严重。只有八味丸来补其阴，则肾中之水火既济，而开阖的权力得宜。况且命门之火旺，则能生土，而脾也强了。有用六味丸加沉香、砂仁，以山药末打糊，代蜜为丸，以摄火归源而痊愈的。有用六味丸加远志、益智仁，兼调脾肾而痊愈的。有用六味丸七分，杂二神丸三分，服之而痊愈的。有用五味子煎汤送四神丸的。有用二神丸加五味子、山茱萸、肉桂、茴香，陈米饮糊为丸服的。也有属于酒积食积的。大概一天进取之物，到此时都下到大肠而急奔。但食积之泻，其腹部一定胀满，泻后则顿时减轻。泻下都是稀粪。酒积泻下，都是稀沫。或者有兼血积的，与肾泻的纯清水液，截然不同。审察是何种积，就以何种积治疗。
石顽说：泄泻的各种治法很详细，为什么唯独不及虚损的泄泻呢？大概肾脏真阴虚，则火邪胜，火邪上升，必伤肺而为咳逆。真阳虚则水邪胜，水气内溢，必渍脾而为泄泻。既咳嗽又泄泻，上下俱病，先后天之气并伤，所以虚损的关键，全系于此。我曾经用理中丸加五味子来治下泄，异功散加细辛来治上咳，每每获得疗效。如果服药后出现腹胀发热的，终究难以挽回，不可以因为其咳泻都缓慢，就轻易许诺能治愈。
〔诊〕《内经》说：脉细，皮寒，气少，泄利前后，饮食不入，这叫五虚，死。如果浆粥入胃，泄注止，则虚者活。泄而脉大的难治。大便赤瓣，飧泄脉小的，手足寒难已。飧泄脉小，手足温的易已。《脉经》说：泄注脉缓，时小结者生。浮大数者死。又洞泄食不化，脉微小留连者生，紧急者死。脉滑按之虚的，必下利。肾脉小甚为洞泄，脾脉小为泄泻。张仲景说：下利日十余行，脉反实的死。腹鸣而满，四肢清冷，诊其脉，洪大的死。腹大胀，四肢清冷，脱形，泄甚，不及一时而死。下则泄泻，上则吐痰，都不愈，为上下俱脱，死。
滑伯仁治疗一个人，年老面色青苍，夏天与人争辩，冒雨劳役受饥，且犯房事，半夜忽然病发热恶寒，上吐下泻，昏闷烦躁，头身俱痛，因为自己发汗，汗遂不止，脉皆洪数。大概吐泻内虚，汗多表虚，兼之脉不为汗衰泻减，法在不治。姑且用大剂量人参、黄芪，兼白术、干姜、甘草、茯苓、陈皮，水煎不时服。到七剂见面赤，四肢发出红斑。凡是斑证自吐泻的是吉兆，说是邪从上下出。但伤寒发斑，是胃热所致。现在的发斑，由胃虚而无根之火游行于外，可补不可泄，可温不可凉。如果用化斑、升麻、黑参之类，则死生反掌。仍服前方十余剂而愈。
又治疗一个人，每天早起大泻，有时腹痛，有时不痛，空腹服热药无效，让他至晚食前服即有效，因为暖药一夜在腹，可胜阴气。这与酒客湿泄，服汤药无效，服丸散即效同意。
石顽治疗总戎陈孟庸，泻利腹胀作病，服黄芩、白芍之类，胀急愈甚，其脉洪盛而数，按之则濡，气口大三倍于人迎，这是湿热伤脾胃之气。用厚朴生姜甘草半夏人参汤二剂，痛止胀减，而泻利未已。用干姜黄芩黄连人参汤二剂，泻利止而饮食不思。用半夏泻心汤二剂而安。
The *Ling Shu* (Spiritual Pivot) states: When internal heat leads to Xiao Dao (wasting and thirsting syndrome), cold methods are appropriate; when it belongs to middle-jiao cold, hot methods are appropriate. Heat in the Stomach causes rapid digestion of food, making one feel a hanging sensation in the heart and prone to hunger, with heat in the skin above the navel. Heat in the Intestines causes the discharge of yellow stool like porridge, with cold in the skin below the navel. Heat in the Stomach leads to abdominal distension; cold in the Intestines leads to borborygmus and Sun Xie (diarrhea with undigested food). If there is heat in the Stomach and cold in the Intestines, there will be distension accompanied by diarrhea; if there is cold in the Stomach and heat in the Intestines, there will be urgent hunger accompanied by pain and distension in the lower abdomen.
Worldly physicians, when treating diseases, only know that heat is treated with cold and cold is treated with heat, and do not discuss anything beyond this. Suppose a patient suffers from heat-induced Xiao Dao, presenting with a hanging sensation in the heart and easy hunger; this is undoubtedly a heat syndrome. However, one must examine whether the skin above the navel is hot to confirm that heat qi is accumulating and flourishing in the Stomach. If yellow porridge-like stool is discharged, it indicates not only heat in the Stomach but also that the Intestines are being driven by pathogenic heat. If the skin below the navel is cold and abdominal distension occurs, it may appear as solid accumulation of excess heat, but it is actually a sign of deficiency-cold in the Stomach. Or if borborygmus and Sun Xie are seen, it indicates not only cold in the Stomach but also that the cold has transferred to the Large and Small Intestines. Generally, heat-induced diarrhea discharges yellow-red intestinal mucus, while cold-induced diarrhea discharges thin, clear, and cold stool. These are the most prominent features of disease mechanisms and can be clearly distinguished. Moreover, some patients have both distension and discharge of yellow-red stool; this distension is caused by Stomach cold preventing the distribution of Yang Qi, and this diarrhea is caused by Intestinal heat leading to the discharge of mucus. There are also cases of increased appetite, easy hunger, and lower abdominal pain/distension; is this not a verification of heat in the Stomach and cold in the Intestines? In such various situations, without understanding Zhang Zhongjing's methods such as the Three Xi Xin Decoctions, Huang Lian Tang (Coptis Decoction), Gan Jiang Huang Qin Huang Lian Ren Shen Tang (Pinellia, Coptis, and Ginseng Decoction), Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Magnolia Bark, Ginger, Pinellia, Licorice, and Ginseng Decoction), and Gan Jiang Ren Shen Ban Xia Wan (Ginger, Ginseng, and Pinellia Pill), one cannot speak of supreme treatment.
The *Jing* (Classic) says: Wind injury in Spring leads to Sun Xie in Summer. (This is because Wind-Wood pathogen invades Damp-Earth internally.) If pathogenic qi lingers, it becomes Dong Xie (profuse diarrhea). (Prolonged lingering of pathogenic qi causes the Middle Qi to lose its function, resulting in uncontrolled Dong Xie.) Clear Qi sinking below leads to Sun Xie. (Deficiency-cold in the Lower Jiao, where Fire fails to generate Earth, causes Middle Qi dysfunction, leading to Sun Xie with undigested food.) The Large and Small Intestines belong to the Stomach; deficiency of the Stomach pulse leads to diarrhea. (The pulse is the precursor of Qi and Blood; pulse deficiency implies Stomach deficiency, causing the two Intestines to lose their source and result in diarrhea.) Excess Dampness leads to Ru Xie (damp diarrhea). (The Spleen dislikes Dampness; excess Dampness causes continuous, endless diarrhea.) Various Jue (cold extremities), Gu (constipation/obstruction), and Xie (diarrhea) all belong to the Lower Jiao. (Spleen and Kidney deficiency means Yang Qi cannot reach the four extremities, resulting in cold extremities, deep/firm pulse, and cold diarrhea.) Sudden violent diarrhea with tenesmus all belong to Heat. (Sudden diarrhea with anal protrusion/pain belongs to Fire transformation; if sudden diarrhea with anal incontinence, it belongs to Yin-Cold; chronic diarrhea with anal incontinence belongs to Yang deficiency. This is what is meant by "sudden diarrhea is not purely Yang, chronic diarrhea is not purely Yin".) All fluid conditions that are clear, transparent, and cold belong to Cold. (Fire flares upward, Cold moistens downward; combined with clarity and cold, how can it not be Cold?)
The *Yuan Bing Shi* (Treatise on Original Disease Patterns) states: White stool indicates Cold, green indicates Wind, and yellow, red, or black indicate Heat. Generally, if diarrhea presents with clear, white, non-astringent urine, undigested food, and unchanged color, it is Cold. If undigested food changes to yellow-red color, accompanied by irritability, thirst, and red/astringent urine, it is a Heat syndrome. It is unheard of for Cold diarrhea to digest food properly. However, due to the rapid nature of Fire, if transmission and transformation are abnormal, although food is undigested, sudden foul-smelling yellow diarrhea may occur. Zhang Zhongjing said: Pathogenic heat fails to cook grain; when heat combines with dampness, Sun Xie occurs. Li Dongyuan said: During summer rains and gloomy weather, during epidemic diarrhea, I once had heavy body and limb pain, diarrhea, and closed/astringent urination. Considering the treatment method, I must use light/disperse drugs to promote urination. Now suffering from Cold-Damp pathogen, using light/disperse methods is not suitable for someone in their twilight years. Over fifty, descending Qi is abundant while ascending Qi is scarce; receiving light/disperse agents further descends, weakening Yang Qi and shortening spirit. One should use Wind drugs, decocting Qiang Huo (Notopterygium Root), Du Huo (Angelica Pubescens Root), Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Gan Cao (Licorice Root), and Fang Feng (Saposhnikovia Root). This is what is meant by "using Wind to calm excessive Cold-Damp," and also "lifting what sinks," which is straightening the bent through appropriate guidance. Without understanding the principles of ascending and descending, how can uniform treatment succeed? Li Shicai said: The *Nei Jing* discusses diarrhea mentioning Wind, Dampness, Heat, and Cold, indicating that all four climates can cause diarrhea. It also says "Clear Qi sinking below leads to Sun Xie," which is called Spleen deficiency with sinking. Generally, strong Spleen Earth overcomes Dampness; without Dampness, there is no diarrhea, hence "Dampness often forms five types of diarrhea." If Earth is deficient and cannot control Dampness, then Wind, Cold, and Heat can interfere and cause disease. There are nine treatment methods: 1. Light/Disperse: To let Dampness exit via urine, like a farmer draining floodwater; even in lowlands, great floods are not feared. The *Jing* says: "Treating Dampness without promoting urination is not its proper treatment," and "What is below, drain it completely." 2. Ascending/Lifting: Qi belongs to Yang and naturally ascends; if Stomach Qi sinks, it causes downward flow. Drugs like Sheng Ma, Chai Hu, Qiang Huo, and Ge Gen (Kudzu Root) inspire Stomach Qi to overcome sinking, stopping downward flow. Like wind drying muddy land, Wind drugs are drying; since Dampness is a Spleen Earth disease, Wind overcomes Dampness. This is "lifting what sinks." 3. Cooling/Clearing: When Heat dominates, causing sudden violent diarrhea with tenesmus, bitter-cold agents cleanse the blazing heat, like a cool breeze dispelling summer heat. This is "clearing Heat." 4. Draining/Promoting Movement: Phlegm stagnation, Qi obstruction, food retention, and water accumulation all cause diarrhea. Remove them according to the syndrome, do not let them linger. The *Jing* says: "Excess is purged," and "Use unblocking to treat unblocking." 5. Sweet/Moderating: Unstopping diarrhea accelerates downward flow. Sweet flavors moderate the Middle and stop urgency. Since grains produce sweetness, and sweetness is the flavor of Earth, this is "moderating urgency." 6. Sour/Astringing: Prolonged diarrhea scatters Qi, losing control. Sour flavors aid astringency. The *Jing* says: "Scattered things are gathered." 7. Drying Spleen: If Earth virtue is intact, Water evil does not overflow. Diarrhea arises from Earth Dampness, rooted in Spleen deficiency. If the granary functions well, water and grain separate. Deficiency without tonification worsens Dampness. The *Jing* says: "Deficiency is supplemented." 8. Warming Kidney: The Kidney governs the two orifices and is the root of storage. Though Water, it contains True Yang. Mild Fire generates Qi; Fire is the mother of Earth. If this Fire declines, how can it circulate the Triple Burner and cook food/water? Kidney deficiency always involves Cold; Spleen deficiency requires tonifying the Mother (Kidney). The *Jing* says: "Cold is warmed." 9. Astringing/Fixing: Chronic profuse diarrhea slides the pylorus/intestines; warm/tonic drugs may fail. Astringent agents are needed to prevent errors. This is "astringing sliding." These nine methods are the general principles for treating diarrhea. The timing and urgency must be flexible during clinical practice.
Dai Fu'an said: Diarrhea with water but no abdominal pain is Dampness. Use Sheng Yang Chu Shi Tang (Ascending Yang and Dispersing Dampness Decoction) or Wei Ling Tang (Stomach and Spleen Regulating Decoction). Food entering the stomach and immediately passing as undigested stool indicates Qi deficiency. Use Xiang Sha Liu Jun Zi Tang (Aucklandia, Amomum, and Six Gentlemen Decoction) or Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle Warming Decoction). Abdominal pain, watery diarrhea, borborygmus, pain followed by diarrhea, indicates Fire. Use Huang Qin Shao Yao Tang (Coptis and Peony Decoction). Phlegm retained in the Lung, Large Intestine insecurity, intermittent diarrhea of varying amounts, indicates Phlegm. Pulse is wiry-slippery, complexion is not haggard. Use Er Chen Tang (Two Aged Substances Decoction) plus Cang Zhu (Atractylodes Lancea Rhizome) and Mu Xiang (Vladimiria Root), or induce vomiting. Severe abdominal pain without diarrhea, pain relieved after diarrhea, indicates Food Stagnation. Use Bao He Wan (Preserve Harmony Pill). Sun Xie, named Hui Feng in historical records, undigested food, Dampness combined with Wind. Wind pathogen interferes with Stomach, Wood attacks Earth, Clear Qi sinks. Use Sheng Yang Chu Shi Tang. If food enters and immediately vomits out without staying, prognosis is poor. Tang Xie (pasty diarrhea), sticky residue, Dampness combined with Heat. Use Huang Qin Shao Yao Tang plus Xiang Lian (Aucklandia and Coptis). Ya Tang (duck-pasty stool), Middle Cold, undigested residue, duck-feces color, clear/cold, clear urine, Dampness combined with Cold. Use Fu Zi Li Zhong Tang (Aconite and Middle Warming Decoction). Dong Xie (cavity diarrhea), also called Ru Xie, heavy body, weakness, watery diarrhea, Dampness self-abundant. Use Wei Ling Tang. Excessive fluid loss leading to menstrual blood depletion and tendon stiffness. Use Sheng Yang Chu Shi Tang. Hua Xie (slippery diarrhea), long-term uncontrollable diarrhea, Dampness excess with Qi collapse. Use Si Zhu Yin (Four Pillows Drink); if ineffective, Liu Zhu Yin (Six Pillows Drink). Re Xie (Heat diarrhea), red-yellow stool, snapping sound, pain, burning anus, hot sensation upon expulsion, irritability/thirst, difficult urination. Use Wu Ling San (Five-Ling Powder); essential for watery diarrhea. Removing Gui Zhi (Cinnamon Twig) renders it ineffective. Han Xie (Cold diarrhea), abdominal distension, projectile diarrhea, vomiting after eating. Use Li Zhong Tang plus Rou Gui (Cinnamon Bark), He Zi (Chebula Fruit), Sheng Ma. Late discomfort, white stool, severe borborygmus, deep-slow pulse, cold body, no thirst, clear urine, or lingering abdominal pain. Use Fu Zi Li Zhong Tang plus Rou Dou Kou (Myristica Seed). Summer heat sudden diarrhea like water, body pain/sweat, weak pulse/shortness of breath, severe vomiting. Called Jin Bing (Tight Disease). Use Jiang Shui San (Fermented Grain Water Powder). Intense summer heat outside, latent cold inside; Lian Li Tang (Continuous Warming Decoction) is indispensable. Qi deficiency diarrhea: Si Jun Zi Tang plus Sheng/Dai, Rou Dou Kou, He Zi. Food injury diarrhea: belching like rotten eggs. Use Bao He Wan. Deficiency: Zhi Zhong Tang modifications. Stagnation diarrhea: twisting abdominal pain before diarrhea. Use Ping Wei San plus food-stagnation resolving drugs. Alcohol injury diarrhea: Ge Hua Jie Cheng Tang (Kudua Flower Relieving Intoxication Decoction). Phlegm diarrhea: dizziness, nausea, chest/abdominal stuffiness, variable severity. Use Er Chen Tang plus Hai Shi (Halloysitum), Xiang Fu (Cyperus Rhizome), Xing (Apricot Seed/Nan Xing), Mu Xiang, Qin, Lian. Mix with Ginger Juice, form pills with Shen Qu paste. Someone with morning diarrhea, occasional blood, afternoon constipation, good appetite/drinking, is Alcohol Stagnation diarrhea. Use Er Chen Tang plus Pao Jiang (Fried Ginger), Jiu Chuan Lian (Wine-fried Coptis), Hong Qu (Red Yeast Rice), Chen Qu paste, swallow with Wu Mei Tang (Mume Decoction). With blood, remove Ban Xia, add She Xiang (Musk). Morning/evening dose. Evening bloating, night borborygmus, next morning Dong Xie. Called Dun Xie (Instant Diarrhea), Spleen deficiency with Dampness abundance. Use Wei Ling Tang plus Mu Xiang, Sha Ren. Deficiency: Li Ling Tang plus Mu Xiang. Qi diarrhea: borborygmus, flatulence, chest oppression, abdominal urgency/pain, relief after diarrhea, then recurrence. Also abdominal tightness/blockage. Due to Middle Jiao stagnation, Qi not circulating, water/grain not separating. Use Mu Xiang Tiao Qi San. Water soaking into Stomach, called Yi Yin slippery diarrhea, thirst drinking, water exits as diarrhea, extreme thirst. Use Fu Ling Gan Cao Tang, Wu Ling San, moxa Da Zhui 3-5 cones immediately; this is a Du Mai (Governing Vessel) disease. Diarrhea with thirst drinking, short/astringent urine, indicates internal loss of Body Fluids. Use Qian Shi Bai Zhu San (Child Master's Atractylodes Powder). Kidney Water deficiency diarrhea, or thirst from overusing diuretics: Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill). Untreated, leads to difficult urination, edema, distension. For diarrhea taking Li Zhong Tang, if urination is difficult and diarrhea persists, ignoring Qi transformation, originally Lung fails to transmit, treating with pure heat drugs causes more diarrhea. Small dose ineffective, large dose curative. Heat not separating: Wu Ling San plus Ren Shen, Zhi Gan Cao, named Chun Ze Tang. The *Jing* says: Bladder is the official of the capital, stores fluids, Qi transformation allows exit. Diarrhea with abdominal heat, slippery/firm pulse, indicates Excess. Use digestion-promoting methods. If ineffective, Food Stagnation Heat. Add Xiang Lian. Still ineffective, add Da Huang (Rhubarb) for mild purgation. Chronic diarrhea indicates Cold Stagnation. Bei Ji Wan (Emergency Pill) is miraculous. Diarrhea with nausea/vomiting,水土不服 (acclimatization issues), or mountain miasma: Huo Xiang Zheng Qi San (Patchouli Regulating Qi Decoction). Spleen/Stomach deficiency with internal Wind-Cold, projectile diarrhea, undigested food, umbilical pain, borborygmus, chronic cold diarrhea, slippery intestines: Mu Xiang San. Medicine/food immediately expelled upon entry: Zhi Chang Xie (Straight Intestine Diarrhea), difficult to treat. Ben Fang plus Ren Shen, Bai Zhu, decoct with Fu Long Gan Tang (Dragon's House Earth Decoction). Excessive worry, Spleen Qi knotted unable to ascend, sinking to Lower Jiao causing diarrhea: Xiao Yao San remove Dang Gui, add Sheng Ma, Mu Xiang; or Yue Ju Wan mixed with Zhi Zhu Wan. Ineffective: Bu Zhong Yi Qi Tang plus Mu Xiang. Long-term diarrhea with prolapsed anus, Yuan Qi sinking, Large Intestine failing to contract: Bu Zhong Yi Qi Tang plus He Zi, Rou Dou Kou, Wu Mei, form pills with Wu Mei flesh. Or Si Jun Zi Tang plus Fang Feng, Sheng Ma. Elderly poor digestion with distension/diarrhea: Jiu Wei Zi Sheng Wan plus Mu Xiang. Heavy drinkers: add Ze Xie, Rou Gui. Diarrhea mostly due to Dampness; promoting urination is superior. For elderly Qi deficiency sinking, use Wind drugs to overcome, e.g., Bu Zhong Yi Qi Tang plus Qiang/Huang, or Sheng Yang Chu Shi Tang to lift Spleen/Stomach. "Lift what sinks," "Wind calms Cold-Damp." Profuse diarrhea with Qi collapse, unconsciousness, closed eyes/mouth, near-apnea: Moxa Qi Hai acutely, administer large doses of Ren Shen, Fu Zi for warming/tonifying. Delay is fatal.
Wu Geng Xie (Fifth Watch Diarrhea) is Kidney deficiency failing its closing/storage function. The *Jing* says: Kidney controls opening/closing, opens at the two yin orifices. Thus, Kidney governs not just urination but also defecation. With Kidney decline, Ming Men Fire extinguishes, Water dominates, causing continuous watery diarrhea. It occurs at the Fifth Watch (3-5 AM), dawn, profuse diarrhea 2-3 times, because Kidney prospers at Hai/Zi hours, so it is severe. Only Ba Wei Wan (Eight-Ingredient Pill) tonifies Yin, balancing Water/Fire in Kidney, restoring opening/closing balance. Moreover, strong Ming Men Fire generates Earth, strengthening Spleen. Some use Liu Wei Wan plus Chen Xiang, Sha Ren, pill with Shan Yao paste replacing honey, to guide fire back to source. Some use Liu Wei Wan plus Yuan Zhi, Yi Zhi Ren, regulating Spleen/Kidney. Some use 70% Liu Wei Wan + 30% Er Shen Wan. Some use Wu Wei Zi decoction to swallow Si Shen Wan. Some use Er Shen Wan plus Wu Wei Zi, Shan Zhu Yu, Rou Gui, Hui Xiang, Chen Mi drink paste. Some are Alcohol/Food Stagnation. Daily intake moves to Large Intestine urgently at this time. Food Stagnation diarrhea has abdominal fullness, relieved after diarrhea, loose stool. Alcohol Stagnation diarrhea has frothy loose stool. Sometimes mixed with Blood Stagnation, distinct from Kidney Diarrhea's pure clear water. Treat according to the specific stagnation.
Shi Wan said: Diarrhea treatments are detailed, why omit deficiency-related diarrhea? Kidney True Yin deficiency leads to Fire excess, rising to injure Lung causing cough. True Yang deficiency leads to Water excess, overflowing to soak Spleen causing diarrhea. Both cough and diarrhea mean Upper/Lower disease, Pre/Post Heaven Qi injured. The crux of deficiency lies here. I used Li Zhong Wan plus Wu Wei Zi for lower diarrhea, Yi Gong San plus Xi Xin for upper cough, often effective. If腹胀/fever occurs, recovery is hard; do not promise cure lightly despite slow symptoms.
[Diagnosis] The *Jing* says: Fine pulse, cold skin, shortness of breath, diarrhea both ways, no food intake, called Wu Xu (Five Deficiencies), death. If gruel enters stomach and diarrhea stops, deficiency lives. Diarrhea with large pulse is difficult to treat. Red fecal membranes, Sun Xie with small pulse, cold extremities, difficult to cure. Sun Xie with small pulse, warm extremities, easy to cure. *Mai Jing* says: Diarrhea with slow pulse, occasionally small knot, life. Floating/large/rapid pulse, death. Dong Xie undigested food, tiny/small lingering pulse, life; urgent/tight pulse, death. Slippery pulse, empty on pressure,必有下利 (must have diarrhea). Kidney pulse very small is Dong Xie; Spleen pulse small is diarrhea. Zhang Zhongjing said: Diarrhea >10 times/day, real/excess pulse, death. Borborygmus/fullness, cold extremities, large pulse, death. Abdominal distension, cold extremities, emaciation, severe diarrhea, death within an hour. Downward diarrhea, upward phlegm vomiting, unceasing, Upper/Lower collapse, death.
Hua Bo Ren treated an elderly man, sallow complexion, summer argument, rain exposure, labor/hunger, sexual activity. Midnight fever/chills, vomiting/diarrhea, confusion/irritability, head/body pain. Self-induced sweating, sweat continued, pulse large/rapid. Vomiting/diarrhea internal deficiency, sweating external deficiency, pulse not reduced by sweat/diarrhea, untreatable. Prescribed large dose Ren Shen, Huang Qi, plus Bai Zhu, Gan Jiang, Gan Cao, Fu Ling, Chen Pi, decocted frequently. After 7 doses, red face, red spots on limbs. Spots from vomiting/diarrhea are auspicious (pathogen exits up/down). Typhoid spots are Stomach Heat; these spots are Stomach deficiency with rootless Fire roaming outward. Tonify/Warm, do not purge/cool. Using Hua Ban, Sheng Ma, Hei Shen would cause death. Continued previous formula 10+ doses, cured.
Treated another: Morning profuse diarrhea, sometimes painful, sometimes not. Empty stomach hot meds ineffective; evening pre-meal effective, as warm meds stay overnight to overcome Yin. Similar to alcohol-damp diarrhea where pills work better than decoctions.
Shi Wan treated General Chen Mengyong: Diarrhea/abdominal distension. Took Huang Qin, Shao Yao, worsening distension. Pulse large/rapid, soft on pressure. Qi Kou 3x larger than Ying Kou. Damp-Heat injuring Spleen/Stomach Qi. Given Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang 2 doses: pain stopped, distension reduced, diarrhea continued. Given Gan Jiang Huang Qin Huang Lian Ren Shen Tang 2 doses: diarrhea stopped, no appetite. Given Ban Xia Xie Xin Tang 2 doses: recovered.