痿者。两足痿弱不能行也。（痿而不痛。）治宜独取阳明。阳明为五脏六腑之海。主润宗
筋
而痿 作矣。若用辛热风药。及蒸灸等法。立危。
脉浮数可治。虚弱难医。
一痿症皆属于热。宜
虎潜丸。（二八三）
阳明为诸筋总会。故取虎潜丸为主。而足所以能健步者。则在于骨。三因方又取加减四
筋丸为主。以肾为筋骨之总司也。方用肉苁蓉牛膝木瓜鹿茸熟地五味子菟丝子各等分为末。
炼蜜丸桐子大。每服十丸。温酒米饮下。
一痿症服前丸。若气虚多痰者。间服
六君子汤。加黄柏苍术紫菀。神农本经云。紫菀主痿 。今人不读圣经。只知为
治咳也。（
一瘦黑人血虚多火。宜间服
六味丸。加黄柏苍术。（十四）
肥白人痰多气虚。宜间服
当归补血汤。加竹沥姜汁。（六）
难经有五泄之分。曰胃泄脾泄大肠泄小肠泄大瘕泄。（即痢疾。）其实不必泥也。总以虚
实久暂为辨。
脉小手足寒。难已。 脉小手足温。易已。泄而脱血。难治。 泄而脉大。难治。
一内经云。湿胜则濡泄。此为泻病之总论。宜平胃散。加茯苓猪苓泽泻白术桂枝。名胃
苓汤。统治诸泻如神。（八十）
口中热。溺赤下泻肠垢。为湿热。去桂枝。加防风黄连一钱。○溺清。口中和。下利清
谷。为湿寒。加干姜二钱。○胸满痞闷。嗳腐吞酸。泻下臭秽。为食积。加山楂麦芽。○食
少便频。面色 白。为脾虚。去浓朴。加人参干姜。○五更天明。根据时作泻。或脐下痛。为
肾
一忽然大泻不止。大汗大喘。手足厥冷兼吐者。须防脾肾之气暴脱。夏月伏阴在内。最
多此症。若服藿香香薷必死。急用附子理中汤大剂。
一内经云。诸病暴注。皆属于热。然必有热症热脉可凭。不可以凉药姑试。宜香连丸。
（八十九）六一散。（五十一）
一内经云。清气在下。则生飧泄。须用升清法。宜
补中益气汤。去当归。加木香干葛。（五分）
一内经云。春伤于风。夏生飧泄。又云。久风生飧泄。宜
神术汤。（七十八）圣济附子丸（七十一）
久泻愈而又作泻。时腹痛。诸药不效。此痼冷在肠间。必先取去。然后调治。宜
平胃散。去苍术。加干姜肉桂附子各一钱半。大黄八分。水煎服。法本千金。（八
十）或用温
久泻诸药不效。有脏热肠寒。脏寒肠热之辨。微乎微乎。余详于从众录等书。兹用仲景
乌梅丸。每服二钱。米饮下。日三服。半月愈。又冬泻。有用肉苁蓉鹿角霜当归须等法。有
用芩连甘草葛根等法。有用阿胶羊脂乳酥黄连末蜂蜜熬膏等法。此理更微。可以心会。不可
以言传。喻嘉言颇得其秘。
一五更泄。名脾肾泻。及虚人时常作泻。必以温补肾元为主。宜
回神丸。加白术人参干姜附子茯苓罂粟壳。炼蜜丸。朝服三钱。临睡服五钱。米
饮送下。（七十二）
痿症，是指双足痿软无力，无法行走。（痿症的特点是软弱无力而不疼痛。）治疗应当专门选取阳明经。因为阳明经是五脏六腑气血汇聚的大海，主要滋养宗筋（全身大筋），若阳明经气不足，宗筋失养，就会发生痿症。如果误用辛温发散的风药，以及艾灸等温热疗法，病人会立刻陷入危险境地。
脉象浮数者可以治疗，脉象虚弱者难以医治。
《内经》说：“所有痿症都归属于热证。”适宜服用虎潜丸。（见第283条）
阳明经是诸筋的总汇，所以以虎潜丸为主方。而脚之所以能健步如飞，关键在于骨骼。《三因方》又取加减四斤丸为主方，这是因为肾主管筋骨。该方使用肉苁蓉、牛膝、木瓜、鹿茸、熟地黄、五味子、菟丝子，各等分研为细末，炼蜜制成梧桐子大小的丸药。每次服用十丸，用温酒或米汤送服。
对于痿症，如果服用前面的丸药后，发现患者气虚且多痰，可间歇性服用六君子汤，加入黄柏、苍术、紫菀。《神农本草经》记载：紫菀主治痿症。如今的人不研读经典，只知道紫菀是用来治疗咳嗽的。（此处原文似有缺漏，结合上下文推测可能指另一种情况或省略了主语，按字面翻译为：一痿症……今人不读圣经……）
形体消瘦、肤色黑的人，多为血虚火旺，适宜间歇性服用六味地黄丸，加入黄柏、苍术。（见第14条）
形体肥胖、肤色白的人，多为痰多气虚，适宜间歇性服用当归补血汤，加入竹沥、姜汁。（见第6条）
《难经》将泄泻分为五种：胃泄、脾泄、大肠泄、小肠泄、大瘕泄（即痢疾）。其实不必拘泥于这五种分类，总的原则是以辨别虚实和病程久暂为准。
脉象细小、手足寒冷者，难以治愈。脉象细小、手足温暖者，容易治愈。泄泻并伴有失血者，难以治疗。泄泻而脉象洪大者，难以治疗。
《内经》说：“湿气过重则导致濡泄”，这是关于泄泻病症的总体论述。适宜服用平胃散，加入茯苓、猪苓、泽泻、白术、桂枝，命名为胃苓汤。统治各种泄泻效果神奇。（见第80条）
口中感觉发热，小便赤涩，下泻肠垢，属于湿热证。去掉桂枝，加入防风、黄连一钱。○小便清长，口中和缓，下利完谷不化，属于湿寒证。加入干姜二钱。○胸脘满闷痞塞，嗳气腐臭，吞酸，泻下物气味臭秽，属于食积证。加入山楂、麦芽。○进食少，大便次数频繁，面色㿠白，属于脾虚证。去掉厚朴，加入人参、干姜。○五更天明时分，按时发作泄泻，或者脐下疼痛，属于肾虚证。（此处原文“为肾”后似有缺字，通常指肾泄/五更泻）
忽然出现剧烈泄泻不止，伴随大汗、严重气喘、手足厥冷兼有呕吐的情况，必须防止脾肾之气突然脱绝。夏季体内潜伏阴寒，最容易发生这种病症。如果服用藿香正气散或香薷饮等药，必死无疑。急需使用大剂量的附子理中汤。
《内经》说：“所有暴注下迫的病证，都归属于热证。”但是必须有热症和热脉作为依据，不可以随意试用凉药。适宜服用香连丸。（见第89条）六一散。（见第51条）
《内经》说：“清气在下，则产生飧泄（完谷不化的泄泻）。”必须使用升提清阳的方法。适宜服用补中益气汤，去掉当归，加入木香、干葛。（见第5分条）
《内经》说：“春季感受风邪，夏季产生飧泄。”又说：“久风内侵产生飧泄。”适宜服用神术汤。（见第78条）圣济附子丸。（见第71条）
久泻痊愈后又复发泄泻，时常腹痛，各种药物无效，这是顽固的冷邪停留在肠间。必须先祛除冷邪，然后进行调理。适宜服用平胃散，去掉苍术，加入干姜、肉桂、附子各一钱半，大黄八分，水煎服。此法源自《千金方》。（见第80条）或者使用温……（此处原文截断，推测为温里之法）
久泻各种药物无效，存在脏热肠寒、脏寒肠热的区别，非常微妙。我详细记载在《从众录》等书中。这里使用张仲景的乌梅丸，每次服用二钱，米汤送服，每日三次，半个月痊愈。另外，冬季泄泻，有用肉苁蓉、鹿角霜、当归须等方法的；有用黄芩、黄连、甘草、葛根等方法的；有用阿胶、羊脂、乳酥、黄连末、蜂蜜熬膏等方法的。这些道理更加精微，可以用心领会，无法完全用言语传达。喻嘉言颇得其奥秘。
五更泄，称为脾肾泄，以及体虚之人经常发作泄泻，必须以温补肾元为主。适宜服用回神丸，加入白术、人参、干姜、附子、茯苓、罂粟壳，炼蜜制丸。早晨服用三钱，临睡前服用五钱，米汤送服。（见第72条）
Wei Syndrome (Atrophy Syndrome) refers to the weakness and inability to walk in both lower limbs. (The characteristic of Wei Syndrome is weakness without pain.) The treatment should focus exclusively on the Yangming Meridian. The Yangming Meridian is the sea of Qi and Blood for the five Zang and six Fu organs, primarily nourishing the Zong Jin (Major Tendons). If the Yangming Meridian lacks Qi and Blood, the Zong Jin lose their nourishment, leading to Wei Syndrome. If one mistakenly uses acrid-wind-dispersing herbs or moxibustion and other warming methods, the patient will immediately face danger.
A floating and rapid pulse indicates a treatable condition; a deficient and weak pulse indicates a difficult-to-treat condition.
The *Neijing* states: "All Wei Syndromes belong to Heat." It is appropriate to administer **Hujian Wan** (Tiger Secret Pill).
Yangming is the gathering point of all tendons, so **Hujian Wan** is used as the primary formula. However, the ability of the feet to walk firmly lies in the bones. The *San Yin Fang* (*Three Causes Formulary*) uses **Jiajian Sijin Wan** (Modified Four-Jin Pill) as the primary formula, because the Kidney governs the bones and tendons. This formula consists of equal parts of *Cistanche Herba* (Rou Cong Rong), *Achyranthis Bidentatae Radix* (Niu Xi), *Chaenomelis Fructus* (Mu Gua), *Cornu Cervi Pantotrichum* (Lu Rong), *Rehmanniae Radix Preparata* (Shu Di Huang), *Schisandrae Fructus* (Wu Wei Zi), and *Cuscutae Semen* (Tu Si Zi), ground into powder. Honey pills are made the size of tung tree seeds. Take ten pills per dose, washed down with warm wine or rice water.
For Wei Syndrome, if the patient has Qi deficiency and excessive phlegm after taking the previous pill, **Liujunzi Tang** (Six Gentlemen Decoction) can be taken intermittently, added with *Phellodendri Cortex* (Huang Bo), *Atractylodis Rhizoma* (Cang Zhu), and *Asterae Radix* (Zi Wan). The *Shennong Bencao Jing* records that *Asterae Radix* treats Wei Syndrome. Today's practitioners do not read the classics and only know it as a cough remedy.
Individuals who are thin and dark-complexioned often have Blood deficiency with abundant Fire; they may take **Liuwei Wan** (Six-Ingredient Pill with Rehmannia) intermittently, added with *Phellodendri Cortex* (Huang Bo) and *Atractylodis Rhizoma* (Cang Zhu).
Individuals who are fat and pale-complexioned often have excessive Phlegm and Qi deficiency; they may take **Danggui Buxue Tang** (Angelica Tonifying Qi Decoction) intermittently, added with *Zhuli* (Bamboo Juice) and *Jiangzhi* (Ginger Juice).
The *Nanjing* (*Classic of Difficult Issues*) divides Xie Xie (Diarrhea/Dysentery) into five types: Stomach Xie, Spleen Xie, Large Intestine Xie, Small Intestine Xie, and Da Jia Xie (which is Dysentery). In reality, one need not rigidly adhere to these five categories. The general principle is to differentiate based on Deficiency/Excess and duration.
A small pulse with cold hands and feet indicates a difficult cure. A small pulse with warm hands and feet indicates an easy cure. Diarrhea accompanied by blood loss is difficult to treat. Diarrhea with a large pulse is difficult to treat.
The *Neijing* states: "Excessive Dampness leads to Ru Xie (Loose Stool)." This is the general theory for diarrhea diseases. It is appropriate to use **Pingwei San** (Powder to Calm the Stomach), added with *Poria* (Fu Ling), *Polyporus* (Zhu Ling), *Alismatis Rhizoma* (Ze Xie), *Atractylodis Macrocephalae Rhizoma* (Bai Zhu), and *Cinnamomi Ramulus* (Gui Zhi), named **Weiling Tang** (Stomach-Calm Decoction). It effectively treats various diarrheas.
Heat in the mouth, red urine, and discharge of intestinal mucus indicate Damp-Heat. Remove *Cinnamomi Ramulus* (Gui Zhi), add *Saposhnikoviae Radix* (Fang Feng) and *Coptidis Rhizoma* (Huang Lian) 1 qian. ○ Clear urine and a neutral sensation in the mouth with undigested food in stool indicate Damp-Cold. Add *Zingiberis Rhizoma* (Gan Jiang) 2 qian. ○ Chest fullness and stuffiness, belching with sour regurgitation, and foul-smelling stool indicate Food Retention. Add *Crataegi Fructus* (Shan Zha) and *Malta* (Mai Ya). ○ Poor appetite, frequent bowel movements, and sallow complexion indicate Spleen Deficiency. Remove *Magnoliae Officinalis Cortex* (Hou Po), add *Ginseng Radix* (Ren Shen) and *Zingiberis Rhizoma* (Gan Jiang). ○ Diarrhea occurring at dawn (5-7 AM) or pain below the navel indicates Kidney Deficiency.
Sudden severe diarrhea unceasing, accompanied by profuse sweating, severe panting, cold extremities, and vomiting, requires vigilance against sudden collapse of Spleen and Kidney Qi. In summer, Yin Cold lurks inside, making this syndrome common. If one takes **Huoxiang Zhengqi San** or **Xiangru Yin**, death is certain. Urgently use a large dose of **Fuzi Lizhong Tang** (Aconite Regulate the Middle Decoction).
The *Neijing* states: "All acute watery diarrhea belongs to Heat." However, there must be heat symptoms and heat pulses to rely upon; one cannot casually try cooling medicines. It is appropriate to use **Xianglian Wan** (Costus and Coptis Pill) and **Liuyi San** (Six-to-One Powder).
The *Neijing* states: "When Clear Qi sinks below, Sun Xie (diarrhea with undigested food) arises." One must use the method of ascending the Clear. It is appropriate to use **Buzhong Yiqi Tang** (Decoction to Supplement the Middle and Augment the Qi), remove *Angelicae Sinensis Radix* (Dang Gui), and add *Aucklandiae Radix* (Mu Xiang) and *Puerariae Lobatae Radix* (Ge Gen).
The *Neijing* states: "Wind contracted in spring generates Sun Xie in summer," and also says, "Chronic wind generates Sun Xie." It is appropriate to use **Shenzhu Tang** (Divine Efficacy Powder) and **Shengji Fuzi Wan** (Holy Relief Aconite Pill).
If chronic diarrhea recurs after healing, accompanied by abdominal pain and ineffectiveness of various drugs, this is stubborn Cold lodged in the intestines. The Cold must first be expelled before regulation. It is appropriate to use **Pingwei San**, remove *Atractylodis Rhizoma* (Cang Zhu), and add *Zingiberis Rhizoma* (Gan Jiang), *Cinnamomi Cortex* (Rou Gui), and *Aconiti Lateralis Radix Preparata* (Fu Zi) each 1.5 qian, and *Rhei Radix et Rhizoma* (Da Huang) 0.8 fen. Decoct in water and take. This method originates from the *Qianjin Fang*. Or use warming methods...
For chronic diarrhea where various drugs fail, there is a distinction between Heat in the Zang and Cold in the Chang (Intestines), or Cold in the Zang and Heat in the Chang. This is extremely subtle. I detail this in books like *Congzhong Lu*. Here, use Zhang Zhongjing's **Wumei Wan** (Mume Pill). Take 2 qian per dose, washed down with rice water, three times daily. Cure in half a month. Additionally, for winter diarrhea, methods using *Cistanche Herba*, *Cornu Cervi Pantotrichum* (Lu Jiao Shuang), and *Radix Angelicae Sinensis* (Dang Gui Xu) are used; methods using *Scutellariae Radix* (Huang Qin), *Coptidis Rhizoma* (Huang Lian), *Glycyrrhizae Radix* (Gan Cao), and *Puerariae Lobatae Radix* (Ge Gen) are used; methods using *Colla Corii Asini* (E Jiao), *Adipovis Ovis* (Yang Zhi), *Lactuca Sativa* (Ru Su - likely referring to dairy products/butter), *Coptidis Rhizoma* (Huang Lian), and honey paste are used. These principles are even more subtle; they can be understood by the mind but not fully conveyed by words. Yu Jiayan grasped their secrets well.
Wuxing Xie (Five-Watch Diarrhea) is called Spleen-Kidney Diarrhea. For deficient individuals who frequently suffer from diarrhea, the main treatment must be to warm and tonify the Kidney Yuan. It is appropriate to use **Huishen Wan** (Revive Spirit Pill), added with *Atractylodis Macrocephalae Rhizoma* (Bai Zhu), *Ginseng Radix* (Ren Shen), *Zingiberis Rhizoma* (Gan Jiang), *Aconiti Lateralis Radix Preparata* (Fu Zi), *Poria* (Fu Ling), and *Papaveris Pericarpium* (Yingsu Qiao). Honey pills. Take 3 qian in the morning, 5 qian before sleep, washed down with rice water.