推飧泄致病之因，乃风邪也，木胜也，寒气也，脾虚也，伏
气也。《内经》云∶春伤于风，夏生飧泄。又云∶久风为飧泄。据此而论，因风邪致病，又云∶厥阴之胜，肠
鸣飧泄。又云∶岁木太过，民病飧泄。据此而论，因木胜致病。又云∶胃中寒则腹胀，肠中寒则飧泄。据此
而论，因寒气致病。又云∶脾病者，虚则腹满，肠鸣飧泄食不化。据此而论，因脾虚致病。又
云∶虚邪之中人也，留而不去，传舍于肠胃，多寒则肠鸣飧泄食不化，多热则溏出糜。据此而论，因伏气致
病。总而言之，良由春伤于风，风气通于肝，肝木之邪，不能条达，郁伏于脾土之中，中土虚寒，则风
木更胜，而脾土更不主升，反下陷而为泄也，故经又谓∶清气在下，则生飧泄。所以当春升发之令而不
得发，交夏而成斯证矣。其脉两关不调，或弦而缓，肠鸣腹痛，完谷不消，宜以培中泻木法治之；如尺脉沉
迟，按之无力，乃属下焦虚寒，寒则不能消谷而成是病，宜以补火生土法治之；倘脉细小而迟，手足寒者，不
易治也，勉以暖培卑监法治之；倘日久谷道不合，或肛门下脱，乃元气下陷也，急以补中收脱法治
之；飧泄之病，属虚者多，属实者少，如执治泻不利小便之偏，必致不起，悲夫！
或问曰∶诸贤论飧泄，皆谓湿兼风也，又谓湿多成五泻，又谓治湿不利小便，非其治也。今先生论中
一无湿字，反谓偏利小便，必致不起，能不违悖古人乎？答曰∶是病专论春伤于风之伏气，所以论风而未及
湿，如有湿邪相混，即有湿之见证，辨之明确，始可佐之通利。盖飧泄下利清谷，乃属脾土虚寒，不能运化而
下陷，倘执通利趋下之方，岂非落井而又下石哉！通篇皆本《内经》，何违悖之有？又问曰∶先生谓飧泄乃属
脾土虚寒，所以下利清谷，殊未见《医统》又云∶胃火，由火性急速，传化失常，为邪热不杀谷也。《指掌》
亦谓，完谷不化，以火治之。由是观之，又与先生之论，不相符节，究竟以前人为
火乎？抑亦以先生为寒乎？答曰∶丰按《内经》而推，飧泄属虚者固矣；《医统》《指掌》皆谓为火者，其
实即诸泻中之火泻也。须知寒与火，极易明辨，如脉数苔黄，小溲热赤，即是属火
之泻，否则便是虚寒。问者首肯而退。
分析飧泄（完谷不化的腹泻）致病的原因，主要是风邪、肝木过胜、寒气、脾虚以及伏气。《黄帝内经》说：春季感受风邪，到了夏季就会发生飧泄。又说：久留的风邪会导致飧泄。根据这些论述，可知是因风邪致病。又说：厥阴风木之气偏胜，会出现肠鸣和飧泄。又说：岁运木气太过，百姓容易患飧泄。根据这些论述，可知是因肝木过胜致病。又说：胃中有寒则腹部胀满，肠中有寒则发生飧泄。根据这些论述，可知是因寒气致病。又说：脾脏患病时，正气虚弱就会出现腹部胀满、肠鸣、飧泄且食物不消化。根据这些论述，可知是因脾虚致病。又说：虚邪侵入人体，停留不去，传变停留在肠胃之间，寒气多则肠鸣、飧泄、食物不消化；热气多则排出稀烂如糜的粪便。根据这些论述，可知是因伏气致病。总而言之，这主要是由于春季受伤于风邪，风气与肝脏相通，肝木之邪不能条达舒畅，郁结潜伏在脾土之中，中焦脾胃虚寒，导致风木之气更加亢盛，而脾土更无法正常升清，反而下陷形成泄泻，所以经文又说：清阳之气在下部，就会发生飧泄。因此，当春季生发之气应当升发而不能升发时，进入夏季就形成了这种病证。其脉象表现为左右关脉不调，或弦而缓，伴有肠鸣腹痛，大便中含有未消化的食物，适宜用培补中焦、泻除肝木的方法来治疗；如果尺脉沉迟，按之无力，这属于下焦虚寒，寒气不能腐熟水谷而形成此病，适宜用补益命门之火以温煦脾土的方法来治疗；倘若脉象细小而迟，手足寒冷，这就难以治疗了，勉强使用暖脾培土的方法治疗；倘若病程日久，肛门闭合不严，或者肛门脱出，这是元气下陷的表现，急需使用补中益气、收敛固脱的方法来治疗；飧泄这一疾病，属虚的多，属实的少，如果固执于“治泻必须利小便”的片面观点，必然导致病情恶化甚至死亡，可悲啊！
有人问道：各位贤者论述飧泄，都认为兼夹湿邪，又说湿气重会形成五种泄泻，还说治疗湿邪如果不通利小便，就不是正确的治法。现在先生的论述中完全没有提到“湿”字，反而认为片面利小便会导致死亡，这难道不违背古人的观点吗？回答说：本文专门论述因春季伤于风邪所致的伏气病，所以只论风邪而未涉及湿邪。如果有湿邪混杂其中，就会有湿邪的见证，辨证明确后，才可以辅助使用通利小便的方法。因为飧泄下利清谷，属于脾土虚寒，不能运化而下陷，如果固执于通利趋下的方药，岂不是落井下石吗！整篇论述都依据《黄帝内经》，有什么违背之处呢？又问道：先生认为飧泄属于脾土虚寒，所以下利清谷，但《医统》又说：胃火炽盛，由于火性急速，传导消化失常，邪热不能腐熟水谷。《指掌》也说，完谷不化，应用火（热）来治疗。由此看来，这与先生的论述不相符合，究竟应该以前人说的“火”为准，还是以先生说的“寒”为准？回答说：我依据《黄帝内经》推演，飧泄属虚是确定的；《医统》和《指掌》所说的“火”，实际上是指各种泄泻中的火泻。须知寒证与火证极易辨别，如果脉数、舌苔黄、小便短赤灼热，就是属火的泄泻，否则就是虚寒。提问者点头称是后离去。
Analyzing the causes of Sun Xie (diarrhea with undigested food), they are primarily Wind Evil, excessive Wood energy, Cold Qi, Spleen Deficiency, and latent pathogenic factors. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "If injured by Wind in Spring, Sun Xie will arise in Summer." It also states: "Long-standing Wind leads to Sun Xie." Based on these statements, it is evident that the disease is caused by Wind Evil. It further states: "When Jueyin [Liver/Gallbladder] excess occurs, there is borborygmus and Sun Xie." And: "When the annual Wood qi is excessive, the people suffer from Sun Xie." Based on these, it is clear that the disease is caused by excessive Wood energy. It also states: "Cold in the Stomach causes abdominal distension; Cold in the Intestines causes Sun Xie." Based on this, it is clear that the disease is caused by Cold Qi. It also states: "In diseases of the Spleen, deficiency manifests as abdominal fullness, borborygmus, Sun Xie, and indigestion." Based on this, it is clear that the disease is caused by Spleen Deficiency. It also states: "When deficient pathogens enter the human body and remain without departing, transmitting and lodging in the intestines and stomach, an excess of Cold causes borborygmus, Sun Xie, and indigestion; an excess of Heat causes the discharge of loose, mushy stools." Based on this, it is clear that the disease is caused by latent pathogenic factors. In summary, this is fundamentally due to injury by Wind in Spring. Wind Qi connects with the Liver; the evil of Liver Wood cannot flow smoothly and freely, becoming depressed and latent within Spleen Earth. When the Middle Jiao [Spleen/Stomach] is deficient and cold, the Wind Wood becomes even more excessive, while the Spleen Earth fails to govern ascending [clear yang], instead sinking downward to form diarrhea. Thus, the classics also state: "When Clear Yang is located below, Sun Xie arises." Therefore, when the ascending and generating command of Spring fails to ascend, entering Summer results in this syndrome. The pulse presents as discordant between the left and right Guan positions, or wiry and moderate, accompanied by borborygmus and abdominal pain, with undigested food in the stool. This should be treated with methods to fortify the Middle and drain Wood; if the Chi position pulse is deep and slow, and powerless upon pressure, this belongs to Lower Jiao Deficiency-Cold. Cold fails to transform grain, causing this disease, which should be treated with methods to tonify Fire to generate Earth; if the pulse is fine, small, and slow, with cold hands and feet, it is difficult to treat, but one may tentatively use methods to warm and fortify the low-lying [deficient] Spleen; if the disease persists for a long time and the anal sphincter fails to close, or the anus prolapses, this is a sinking of Yuan Qi [Original Qi], requiring urgent treatment with methods to tonify the Middle and arrest prolapse. Diseases of Sun Xie are mostly deficiency and rarely excess. If one adheres strictly to the biased view that "treating diarrhea requires promoting urination," it will inevitably lead to death, how tragic!
Someone asked: "All sages discuss Sun Xie, stating it involves Dampness combined with Wind, that excessive Dampness forms five types of diarrhea, and that treating Dampness without promoting urination is incorrect. Now, your discussion contains not a single character for 'Dampness,' and conversely claims that blindly promoting urination will lead to death. Does this not contradict the ancients?" I replied: "This text specifically discusses the latent pathogenic factor of being injured by Wind in Spring; therefore, it discusses Wind without mentioning Dampness. If Dampness were mixed in, there would be manifestations of Dampness. Only after clear differentiation can one assist with methods to promote urination. Sun Xie with the passage of clear, undigested grain belongs to Spleen Earth Deficiency-Cold, failing to transport and transform, leading to sinking. If one adheres to formulas that promote urination and direct downward, is this not kicking someone when they are already down? The entire text is based on the *Huangdi Neijing*; where is the contradiction?" They asked again: "You state that Sun Xie belongs to Spleen Earth Deficiency-Cold, hence the passage of clear, undigested grain. However, *Yi Tong* states: 'Stomach Fire, due to the rapid nature of Fire, disrupts transmission and transformation, causing邪热 [pathogenic heat] to fail to cook grain.' *Zhi Zhang* also says that undigested food should be treated with Fire [Heat]. From this, it seems inconsistent with your theory. Whose view is correct, the ancients' 'Fire' or yours 'Cold'?" I replied: "Based on my analysis of the *Huangdi Neijing*, Sun Xie belonging to deficiency is certain. What *Yi Tong* and *Zhi Zhang* refer to as 'Fire' is actually Fire Diarrhea among various types of diarrhea. One must know that Cold and Fire are easy to distinguish. If the pulse is rapid, the coating is yellow, and urine is hot and red, it is a Fire-type diarrhea; otherwise, it is Deficiency-Cold." The questioner nodded in agreement and withdrew.