脾气久虚，不受饮食者，食毕即肠鸣腹急，尽下所食之物方快，不食则无事，经年累
月，此录食泻之症。宜快脾丸主之，五味丸亦主之。此症汤药下咽，实时下泄，与直肠之症相
似，但直肠之症，急症暴症，录食之泻，久病缓病。故直肠条内，则曰难治，录食泻，仍立
方治，然皆是改常之症也。
按∶食入即泻，有寒热虚实之别。脾胃积热，火性急速，则食入即泻。河间云∶食入即
泻，肠胃填满，无容物之地故也，栀连平胃散。酒入即泻，肠胃热甚，复得酒性之热，则寻
窍下泻也，川连枳壳汤，加木通、干葛，此湿热之泻也。
快脾丸、五味丸主之。夫脾胃虚寒而泄泻，人
人知之；脾胃实热而泻，有不知者，大凡着书立说，不能尽举，有虚寒一条，即有实热一条
，故着积热食积之脾实热泻，随着脾虚脾寒之不足泻，则虚实并着，学人可以类推矣。
《准绳》云∶用收涩以治滑，须分热滑寒滑。寒滑可以收敛，热滑未宜收也。如泻已愈
，至明年此月日复发者，有积根于中。如痢症休息痢相等看，然亦分热积寒积治之。热积寒
下，寒积温下。真元不足，佐以补元之药。脾虚不运，大安丸以助脾。赵以德云∶泄泻寒脱
而虚，殆似绝者，急灸气海，饮人参膏而愈。治肾虚不能司禁闭者，肾气丸峻补其肾。痰积
在肺，肺气下降，大肠不禁者，清上焦之痰，则肺气清而大肠之泻自愈。治思虑伤脾，脾气
郁结，不能升举，陷入下焦而泄泻者，开其郁结，升举清阳之气。东垣云∶凡泻而水谷不化
，谓之飧泄，乃清气不升，古人皆以升浮之味，升举胃气，脾胃清和，则水谷消而湿自化。
不比治湿，利小便，在下者引而竭之之例。故曰胃中湿胜而成泄泻，宜助甲胆，以风胜之，
人但知脾病恶湿，利湿则泻自止，不知久泻传虚，脾胃之清气下陷者，反用升举清阳之气，
鼓舞脾胃之妙也。《内经》云∶小便不利，无问标本，先利小便。又云∶诸泄利，小便不利
，先分利之。又云∶治湿不利小便，非其治也。此正在下者引而竭之之法。但可治湿气侵入
，初病暴病者，若漫用之，则降而又降，脾胃失阳和之令，而阴阳愈不能分泄矣。戴氏曰∶
泻水腹不痛者，湿也，若泻势缓慢，泻次匀下，完谷不化，脾虚也。泻水腹痛，泻次不均，
痛一阵，泻一阵，火也。或多或少，肠鸣漉漉者，痰也。腹皮成条扛起，痛而欲利，利后
稍减者，食积也。又按之张三锡曰∶泄泻之症，湿火痰虚暑积风冷，八者之
殊，必以渗湿燥脾为主，而随症加减。湿则利之，火则清之，寒则温之，虚则补之，痰则豁
之，暑则祛之，泻则消之，风则散之。此其大法也。八症既明，三虚宜讲。三虚者，脾虚、
肾虚、肝虚也。脾主制水，饮食伤脾，则不能运化水谷而成泄泻。肾主闭藏，色欲伤肾，则
失封闭之权而成泻。肝主施泄，恼怒伤肝，则木能克土，而彰施泄之令。三者皆令泄泻，
然肝肾二经不恒见，惟脾家泄泻者为多。夫人饮食偶伤，便令泄泻，又尝论泄泻疟痢，同乎
一源，皆由暑月伤脾，初伤便作泄泻为轻，停滞既久，而作疟作痢者重。而疟与痢，又有
分别。饮食伤脾成痰，充塞胸膈则为疟；饮食成积，胶乎肠胃则为痢。故曰无痰不成疟，无
积不成痢。夫泄泻疟痢之由，不一而足，此只论饮食伤脾而成泄泻疟痢耳。节斋曰∶泻本属
湿，多因饮食不节，损伤脾胃而作，须看时令寒热燥湿，患病新久虚实而治。大法渗湿、补
脾、消导、分利。若久病脾虚下陷，宜以风药升提，肠胃虚滑，又当补涩。
脾气长期虚弱，无法承受饮食负担的，进食后立刻出现肠鸣和腹部急迫感，只有将吃下的食物全部排泄出去才会感到舒适，如果不吃东西则没有不适。长年累月如此，这是积食泻的症状。应当使用快脾丸为主进行治疗，五味丸也可以用于治疗。这种病症汤药喝下去后，随即就会腹泻排出，与直肠病症状相似，但直肠病是急性、暴发的病症，而积食泻是慢性、缓和的病症。所以在直肠病的条目下，说它难治；对于积食泻，仍然设立方剂治疗，然而这些都是改变常态的病症。
按语：食物吃下后立即腹泻，有寒、热、虚、实的区别。脾胃积聚热邪，火性急速，所以食物吃下后立即腹泻。刘河间说：食物吃下后立即腹泻，是因为肠胃被填满，没有容纳食物的空间所致，可用栀连平胃散治疗。饮酒后立即腹泻，是因为肠胃热盛，再加上酒性的热，所以迅速通过窍道向下排泄，可用川连枳壳汤，加木通、干葛，这是湿热导致的腹泻。
用快脾丸、五味丸来治疗。脾胃虚寒导致的泄泻，人人都知道；脾胃实热导致的泄泻，有人不知道。大凡著书立说，不能穷尽列举，有虚寒这一条，就有实热这一条，所以记载积热、食积导致的脾实热泄泻，随着脾虚、脾寒导致的不足泄泻一起列出，那么虚实就能并列呈现，学习的人可以由此类推了。
《准绳》说：使用收涩法治疗滑脱不禁，必须区分热滑和寒滑。寒滑可以用收敛法，热滑暂时不宜收敛。如果腹泻已经痊愈，到了明年同样的月份日期又复发，说明体内有积滞的病根。这种情况要像休息痢一样看待，但也需要区分热积和寒积来治疗。热积用寒下药，寒积用温下药。真元不足，辅助使用补益真元的药物。脾虚运化无力，用大安丸来助脾。赵以德说：泄泻导致寒气脱失而虚衰，几乎像断气一样，紧急艾灸气海穴，饮用人参膏即可痊愈。治疗肾虚不能固摄闭藏的，用肾气丸峻补肾脏。痰积在肺，肺气下降，大肠失去约束的，清除上焦的痰，肺气清肃则大肠的腹泻自然痊愈。治疗思虑伤脾，脾气郁结，不能升举，陷入下焦而导致泄泻的，疏通其郁结，升举清阳之气。李东垣说：凡是腹泻且水谷不消化的，称为飧泄，这是因为清气不升，古人都用升浮性质的药物来升举胃气，脾胃清和，则水谷消化而湿气自化。这与治疗湿邪，利小便，对在下位的病邪引导其排出的原则不同。所以说胃中湿胜而成泄泻，应当辅助甲胆（少阳胆经），以风胜湿。人们只知道脾病厌恶湿气，利湿则腹泻自然停止，却不知道久泻传变导致虚证，脾胃的清气下陷时，反而应该用升举清阳之气的方法，这是鼓舞脾胃的妙法。《内经》说：小便不利，无论标本，先利小便。又说：各种泄利，如果小便不利，先分利小便。又说：治疗湿邪不利小便，不是正确的治疗方法。这正是“在下者引而竭之”的方法。但这只适用于湿气侵入，初病、暴病的情况，如果滥用这种方法，则会降之又降，使脾胃失去阳和之气，阴阳更加不能分清泄浊。戴氏说：腹泻清水、腹部不痛的，是湿邪；如果腹泻势头缓慢，排便次数均匀，完谷不化，是脾虚。腹泻清水、腹痛，排便次数不均，痛一阵泻一阵，是火邪。或多或少，肠鸣漉漉有声的，是痰饮。腹皮成条状隆起，疼痛想排便，排便后稍减轻的，是食积。又按张三锡的说法：泄泻的症状，湿、火、痰、虚、暑、积、风、冷，这八者的区别，必须以渗湿燥脾为主，并根据症状加减。湿则利之，火则清之，寒则温之，虚则补之，痰则豁之，暑则祛之，积则消之，风则散之。这是基本大法。八种症状既然明确，三种虚证宜加讲解。三种虚证，指脾虚、肾虚、肝虚。脾主制约水液，饮食损伤脾，则不能运化水谷而成泄泻。肾主闭藏，色欲损伤肾，则失去封闭的权力而成泄泻。肝主施泄，恼怒损伤肝，则木能克土，彰显施泄的命令。这三种情况都会导致泄泻，然而肝肾二经不常常见到，只有脾家泄泻的情况最多。人饮食偶尔受伤，便导致泄泻，又曾论述泄泻、疟疾、痢疾，同出一源，都是由暑月伤脾引起，初伤便作泄泻为轻症，停滞既久，而发为疟疾或痢疾者为重症。而疟疾与痢疾，又有分别。饮食伤脾成痰，充塞胸膈则为疟疾；饮食成积，胶着于肠胃则为痢疾。所以说无痰不成疟，无积不成痢。夫泄泻、疟疾、痢疾的原因，不一而足，这里只讨论饮食伤脾而成泄泻、疟疾、痢疾的情况。节斋说：泻本属于湿，多因饮食不节，损伤脾胃而引起，须看时令的寒热燥湿，患病的新久虚实来治疗。基本大法是渗湿、补脾、消导、分利。如果久病脾虚下陷，宜用风药升提，肠胃虚滑，又当补涩。
When the Spleen Qi is deficient for a long time and cannot tolerate food intake, one experiences borborygmus (intestinal rumbling) and abdominal urgency immediately after eating. Only after evacuating all ingested food does one feel relief; without eating, there are no issues. Persisting year after year, this is the syndrome of Food Stagnation Diarrhea (Ji Shi Xie). It should be primarily treated with Kuai Pi Wan (Spleen-Quickening Pill), and Wu Wei Wan (Five-Flavor Pill) can also be used. In this syndrome, herbal decoctions are expelled via diarrhea immediately upon swallowing, resembling the symptoms of Rectal Disease (Zhi Chang Zheng). However, Rectal Disease is an acute and sudden condition, whereas Food Stagnation Diarrhea is a chronic and gradual condition. Therefore, in the section on Rectal Disease, it is stated as difficult to treat; for Food Stagnation Diarrhea, prescriptions are still established for treatment, yet these are all conditions that deviate from normal physiology.
Commentary: Immediate diarrhea after food ingestion varies by Cold, Heat, Deficiency, and Excess. If Spleen and Stomach accumulate Heat, the fiery nature is rapid, causing immediate diarrhea after eating. He Jian (Liu Wansu) stated: "Immediate diarrhea after eating occurs because the intestines and stomach are filled, leaving no room for food." This can be treated with Zhi Lian Ping Wei San (Gardenia and Coptis Powder to Regulate the Stomach). Immediate diarrhea after alcohol consumption occurs because the intestines and stomach are already hot, compounded by the heat of alcohol, leading to rapid downward discharge through orifices. This can be treated with Chuan Lian Zhi Ke Tang (Coptis and Aurantium Decoction), adding Tong Cao (Akebia Caulis) and Ge Gen (Puerariae Radix); this is Diarrhea due to Damp-Heat.
Kuai Pi Wan and Wu Wei Wan are used to treat this. While everyone knows that Spleen-Stomach Deficiency-Cold causes diarrhea, few know that Spleen-Stomach Excess-Heat also causes diarrhea. Generally, when writing medical texts, not everything can be exhaustively listed. Since there is a section on Deficiency-Cold, there must be one on Excess-Heat. By recording Excess-Heat Diarrhea due to Accumulated Heat and Food Stagnation alongside Deficiency Diarrhea due to Spleen Deficiency and Cold, both Excess and Deficiency are presented together, allowing students to infer other cases by analogy.
*Zhun Sheng* states: When using astringents to treat sliding/loose evacuation, one must distinguish between Heat Sliding and Cold Sliding. Cold Sliding can be treated with astringency, but Heat Sliding is not suitable for astringency at this stage. If diarrhea has healed but recurs in the same month and day of the following year, it indicates a root of accumulation within. This should be viewed similarly to Resting Dysentery (Xiu Xi Li), but treated according to whether it is Heat Accumulation or Cold Accumulation. Heat Accumulation is purged with cold agents; Cold Accumulation is purged with warm agents. If True Yuan (True Qi/Essence) is insufficient, assist with herbs that tonify Yuan. If Spleen Deficiency fails to transport, use Da An Wan (Great Peace Pill) to assist the Spleen. Zhao Yi De stated: For diarrhea leading to Cold collapse and extreme deficiency, appearing nearly fatal, urgently moxa Qihai (CV6), and drink Ren Shen Gao (Ginseng Paste) to achieve recovery. For Kidney Deficiency failing to control closure, use Shen Qi Wan (Kidney Qi Pill) to strongly tonify the Kidney. If Phlegm Accumulation is in the Lung, causing Lung Qi to descend and the Large Intestine to lose restraint, clear Phlegm from the Upper Jiao; once Lung Qi is clear, Large Intestine diarrhea will heal spontaneously. For diarrhea caused by overthinking injuring the Spleen, where Spleen Qi is stagnant, fails to ascend, and sinks into the Lower Jiao, resolve the stagnation and ascend Clear Yang Qi. Dong Yuan (Li Dongyuan) stated: Any diarrhea where water and grain are undigested is called Sun Xie (Morning Twilight Diarrhea/Diarrhea with Undigested Food). This is due to the failure of Clear Qi to ascend. Ancients used ascending and floating herbs to raise Stomach Qi. When Spleen and Stomach are clear and harmonious, food and fluid digest, and Dampness transforms naturally. This differs from treating Dampness by promoting urination, i.e., draining downward pathogens. Thus, it is said that when Stomach Dampness prevails causing diarrhea, one should assist the Gallbladder (Shaoyang) and use Wind to overcome Dampness. People only know that Spleen disease dislikes Dampness and that promoting urination stops diarrhea; they do not know that for chronic diarrhea transmitting to deficiency, where Spleen-Stomach Clear Qi has sunk, the method of ascending Clear Yang Qi is the subtle art of encouraging Spleen and Stomach function. *Nei Jing* states: Regarding difficulty in urination, regardless of root or branch, first promote urination. It also states: For various dysenteric/diarrheal conditions, if urination is difficult, first separate and drain fluids. And again: Treating Dampness without promoting urination is not the correct treatment. This is the method of "draining downward pathogens." However, this applies only to initial, acute Dampness invasion. Misuse leads to excessive descending, causing Spleen and Stomach to lose Yang harmony, making Yin-Yang separation even more difficult. Dai Shi stated: Diarrhea of watery stool without abdominal pain indicates Dampness. If the diarrhea is slow, regular in frequency, and contains undigested food, it indicates Spleen Deficiency. Watery diarrhea with abdominal pain, irregular frequency, alternating pain and diarrhea, indicates Fire. Variable amounts with loud borborygmus indicate Phlegm. Abdominal wall showing strip-like protrusions, pain with urge to defecate, relieved slightly after defecation, indicates Food Stagnation. Furthermore, Zhang Sanxi stated: The syndromes of diarrhea—Damp, Fire, Phlegm, Deficiency, Summerheat, Accumulation, Wind, Cold—are distinct. The main principle must be to leach out Dampness and dry the Spleen, modifying based on symptoms. Damp: drain it. Fire: clear it. Cold: warm it. Deficiency: tonify it. Phlegm: resolve it. Summerheat: dispel it. Accumulation: reduce it. Wind: scatter it. This is the general principle. Having clarified the eight syndromes, the three deficiencies should be discussed. The three deficiencies are Spleen Deficiency, Kidney Deficiency, and Liver Deficiency. The Spleen controls water; injury to the Spleen by diet impairs transformation of food/fluid, causing diarrhea. The Kidney governs closure; sexual excess injures the Kidney, losing its sealing power, causing diarrhea. The Liver governs discharge; anger injures the Liver, allowing Wood to overact on Earth, manifesting discharge commands. All three cause diarrhea, but Liver/Kidney syndromes are less common; Spleen-origin diarrhea is most frequent. Occasional dietary injury causes diarrhea. Regarding diarrhea, malaria, and dysentery, they share a source: summer heat injuring the Spleen. Initial injury causing diarrhea is mild; prolonged stagnation causing malaria or dysentery is severe. Malaria and dysentery differ: Dietary injury creating Phlegm filling the chest/diaphragm causes malaria; dietary accumulation sticking to intestines/stomach causes dysentery. Hence, "No Phlegm, No Malaria; No Accumulation, No Dysentery." The causes of diarrhea, malaria, and dysentery are manifold; here we only discuss those arising from dietary injury to the Spleen. Jie Zhai stated: Diarrhea belongs to Dampness, often caused by irregular diet injuring Spleen/Stomach. Treatment must consider seasonal Cold/Heat/Dryness/Dampness and the newness/chronicity and Deficiency/Excess of the disease. General principles: Leach Dampness, Tonify Spleen, Reduce Accumulation, Separate Fluids. For chronic Spleen Deficiency with sinking Qi, use Wind herbs to lift; for Spleen/Stomach deficiency with loose sliding, use tonification and astringency.