机要云有太阴经受湿而为水泄虚滑身重微满不知谷味久则防变而为脓血脾经传肾谓之贼
邪故难愈若先利而后滑谓之微邪故易痊此皆脾土受湿之所为也
有厥阴经下痢不止其脉沉而迟手足厥逆涕唾脓血此难治宜麻黄汤小续命汗之此有表邪缩
于内当泻表邪而愈
有暴下无声身冷自汗小便自利大便不禁气难布息脉微呕吐急以重药温之浆水散是也
子和云夫暴注泻水不已内经曰注下也注下水利也暴速甚者属火宜用水调桂苓甘露饮五苓
益元
散或以长流水煎放冷服凉膈通圣亦能治之慎不可骤用罂粟壳干姜豆蔻之类纵泻止亦转生他疾
止可分阴阳利水道而已
按以上所论辨寒热风湿火等证所以明六淫之邪皆能为泻为注者亦当各随所淫之邪分而治
之可也
机要云夫脾胃同湿土之化主腐熟水谷胃气和平饮食入胃精气则输于脾土归于肺行于百脉
而成
荣卫若饮食一伤起居不时损其胃气则上升精华之气反下降是为飧泄久则太阴转少阴而为肠
机要云春宜缓形形缓动则肝木乃荣反静密则是行秋令金能制木风五内夏至则火盛而金去
独火
木旺而脾土损矣轻则飧泄脉泄谷不化重则下痢脓血稠粘良方云经云春伤于风夏必飧泄盖风喜
伤肝春时木旺不受邪反移气克于脾土脾既受克不能运化因成积滞夏秋之间再感暑湿风冷之气
发动而成痢也
《玉机微义》中引用的《机要》指出：太阴经受湿邪侵袭会导致水样泄泻，表现为大便虚滑、身体沉重、轻微胀满、不知食物滋味，日久则可能转变为脓血便。脾经之邪传于肾经，称为“贼邪”，因此难以治愈；若先出现小便通利而后转为滑泄，则称为“微邪”，容易痊愈。这些都是脾土受湿邪影响所致。
厥阴经下痢不止，脉象沉而迟，手足逆冷，鼻涕和唾液中带有脓血，这种情况难治，适宜使用麻黄汤或小续命汤发汗解表。这是因为有表邪内缩，应当通过发散表邪来使病情痊愈。
突然发生的大泻无声响，身体寒冷，自汗出，小便清长，大便失禁，气息微弱且呕吐，此时应立即用重剂温补药物进行治疗，如浆水散。
张子和说：急性暴注下泻如水般不停止，《内经》解释为“注下”即水样腹泻。暴速严重的属于火邪，宜用水调桂苓甘露饮、五苓散或益元散治疗，或者用长流水煎煮后放冷服用。凉膈散、通圣散也能治疗此症。切忌骤然使用罂粟壳、干姜、豆蔻等收敛温热之品，即使腹泻停止，也会转而引发其他疾病。只能分辨阴阳，通利水道罢了。
按语：以上论述辨别寒、热、风、湿、火等证候，旨在说明六淫之邪都能导致泄泻和水样腹泻，应当根据所感受的邪气不同分别治疗即可。
《机要》指出：脾胃同属湿土之气，主要功能是腐熟水谷。胃气平和，饮食入胃后，精气输送到脾土，归于肺，运行于全身血脉，从而形成营卫之气。如果饮食不节或起居无常损伤了胃气，那么上升的精华之气反而下降，这就形成了飧泄（完谷不化的泄泻）。日久则太阴病转归为少阴病，进而发展为肠澼（痢疾）。
《机要》指出：春季宜舒缓形体，形体舒缓则肝木之气得以荣盛；反之如果过于静密，则是行秋季金令，金能克木。五脏之中，夏至时火气旺盛而金气退去，唯独木气旺盛而脾土受损。轻者表现为飧泄、脉泄、完谷不化；重者表现为下痢脓血、黏稠不爽。《良方》引用经文说：“春伤于风，夏必飧泄。”因为风邪易伤肝，春季木气旺盛，风邪不能直接侵犯肝脏，反而移气克制脾土。脾土既受克制，不能运化，因而形成积滞。到了夏秋之间，再感受暑湿、风冷之气，发动而成痢疾。
The *Jiyao* (Essential Principles) states: When the Taiyin meridian is invaded by dampness, it leads to watery diarrhea characterized by loose and slippery stools, heaviness of the body, slight fullness, loss of taste for food, and if prolonged, may transform into dysentery with pus and blood. Transmission of pathogenic factors from the Spleen meridian to the Kidney meridian is called "Zei Xie" (Robber Evil), making it difficult to cure. If urination becomes frequent first followed by slippery diarrhea, it is called "Wei Xie" (Minor Evil), which is easy to recover from. These are all caused by the Spleen Earth being affected by dampness.
Dysentery involving the Jueyin meridian that does not stop, with a deep and slow pulse, cold extremities, and pus and blood in nasal discharge and saliva, is difficult to treat. It is suitable to use Mahuang Tang (Ephedra Decoction) or Xiao Xuming Tang (Minor Continue Life Decoction) to induce sweating and resolve the exterior. This is because there is an exterior pathogen contracting inward; one should dissipate the exterior pathogen to achieve recovery.
Sudden profuse diarrhea without sound, cold body, spontaneous sweating, clear and abundant urination, involuntary defecation, weak breathing, and vomiting require immediate treatment with heavy warming medicines, such as Jiangshui San (Fermented Grain Water Powder).
Zihe said: Acute violent diarrhea with continuous watery stool is described in the *Neijing* (Inner Canon) as "Zhuxia" (Pouring Down), meaning watery diarrhea. Severe and rapid cases belong to Fire pathogen. One should use Shuitiao Guiling Ganlu Yin (Water-Adjusted Cinnamon Twig, Poria, and Sweet Dew Drink), Wuling San (Five-Ingredient Powder with Poria), or Yiyuan San (Benefit Origin Powder). Alternatively, decoct with long-flowing water and take after cooling. Liangge San (Cooling Chest Powder) and Tongsheng San (Unimpeded Generation Powder) can also treat this condition. One must strictly avoid suddenly using astringent and warm substances like Ying Susu Ke (Poppy Shell), Ganjiang (Dried Ginger), and Doukou (Cardamom). Even if diarrhea stops, other diseases will arise. One should only differentiate Yin and Yang and promote water pathways.
Commentary: The above discussions differentiate syndromes of Cold, Heat, Wind, Dampness, and Fire to clarify that the Six Excesses (Liu Yin) can all cause diarrhea and pouring down. Treatment should be differentiated according to the specific pathogenic factor involved.
The *Jiyao* states: The Spleen and Stomach share the transformation of Damp-Earth, primarily responsible for rotting and ripening food and drink. When Stomach Qi is harmonious, nutrients from ingested food are transported to the Spleen Earth, return to the Lung, circulate through the hundred vessels, and thereby form Ying (Nutrient) and Wei (Defensive) Qi. If diet is irregular or daily routine is untimely, damaging Stomach Qi, the ascending essence instead descends, resulting in Sunxie (diarrhea with undigested food). Over time, Taiyin disease transforms into Shaoyin disease, leading to Changpi (intestinal dysentery).
The *Jiyao* states: In Spring, one should keep the body relaxed; relaxation allows Liver Wood Qi to flourish. Conversely, excessive stillness follows the Metal command of Autumn, where Metal controls Wood. Among the Five Viscera, at Summer Solstice, Fire Qi is prosperous while Metal recedes, leaving Wood Qi dominant and damaging Spleen Earth. Mild cases present as Sunxie, Mai Xie (pulse-related diarrhea), and undigested food in stool; severe cases present with dysentery containing pus and blood, thick and sticky. The *Liangfang* cites the classic saying: "Injured by Wind in Spring, Sunxie occurs in Summer." This is because Wind pathogen easily injures the Liver. In Spring, when Wood Qi is vigorous, Wind cannot directly invade the Liver but instead transfers its qi to attack Spleen Earth. Since Spleen Earth is controlled, it fails to transport and transform, leading to accumulation. Between Summer and Autumn, upon re-exposure to Summer Heat, Dampness, Wind, and Cold, these factors activate to form dysentery.