冷泄不言而喻。热亦能泻者。盖冷泻譬之盐见火热则凝。冷则复消。热泻譬之水寒则结
凝
热则复化为水。此外证状不一。疑似之间。并用先见分水丸一二服。惟伤食泻不可用。
寒泻。寒气在腹。攻刺作痛。洞下清水。腹内雷鸣。米饮不化者。理中汤或附子补中汤
吞大已寒丸。宜附子桂香丸。畏食者。八味汤。
五虚者。死。脉细脾寒。少气。前后泄痢。饮食不入。元是冷泻。因泻而烦躁。饮水转
饮转
泻者。参附汤。理中汤。加茯苓黄连。名连理汤。用之多有奇功。且如今当暑月。若的知暑
泻。自合用暑药。的知冷泻。自合热药。中间有一等盛暑。又复内伤生冷。非连理汤不可。
下泄无度。泄后却弹过响。肛门热。小便赤涩。心下烦渴。且又喜冷。此药为宜。若元是暑
泻。经久下元虚甚。日夜频并。暑毒之势已然。而泻不已。后用暑药。则决不能取效。便用
姜附辈。又以难施。疑似之间。尤宜用此。余生治伤寒协然自利。有用白姜黄连对半。名金
银汤。即此意也。然不若连理汤为稳。如寒泻服上药未效。宜木香汤。或姜附汤。六柱汤。
吞震灵丹养气丹。手足厥逆者。兼进朱砂丹。药食方入口而即下者名曰直肠。难治。如泻已
愈
而精神未复旧者。宜十补汤。寒泻腹中大疼。于服前药外。间进乳豆丸。服诸热药以温中。
并不见效。登圊不迭。秽物而出。此属下焦。宜桃花丸二五粒诃梨勒丸以涩之。
热泻。粪色赤黄。弹响作痛。粪门焦痛。粪出谷道。犹如汤热。烦渴小便不利。宜五苓
饮。吞香连丸。
暑泻。由胃感暑气。或饮啖日中之所晒物。坐日中热处。证状与热泻略同。宜胃苓饮。
或五
苓散。加车前子少许。兼进来复丹。丹泻。津液既去。口必渴。小便多是赤涩。未可便作热
论。的知热泻。方用冷剂。不然。勿妄投以致增剧。泻止渴自止。小便赤能如常
气泻。肠鸣。气走胸膈。痞闷腹急而痛。泻则腹下须臾又急。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。宜大七香丸。入米煎服。久而不愈者。宽中散。吞震
灵丹。仍佐以米饮调香附末。
湿泻。由坐卧湿处。以致湿气伤脾。土不克水。梅雨阴久。多有此病。宜除湿汤。吞戊
己丸
佐以胃苓汤。重者宜术附汤。如其人本不甚泻。每日两三次鸭溏。此脾家不燥。常服平胃
散自愈。缘内有苍术。可以燥脾。
伤食泻。因饮食过多。有伤脾气。遂成泻泄。俗呼为伤败腹。其人必噫气如败卵臭。宜
治中
汤加砂仁半钱。或七香丸红丸子杂服。
食积腹痛而泻。不可遽用治中兜住。先用调脾饮。吞
感应丸。或因食一物过伤而泻。后复食之即泻者。以脾为其所伤未复而然。宜健脾汤。因食
冷物停滞伤脾。脾气不暖。所食之物。不能消化。泻出而食物如故。宜治中汤加干葛。吞酒
煮黄连丸。于泻中求之。
有脾气久虚不受饮食者。食毕即肠鸣腹急。尽下所食物。才方宽快。不食则无事。俗名
录食
泻。经年累月。宜快脾丸下二五粒。因伤于酒。每晨起必泻。宜理中汤加干葛。吞酒煮黄连丸
或重而泻泄频数者。宜冲和汤。
因伤面而泻者。养胃汤加萝卜子。炒研破一钱。痛者。更加木香半钱。泻甚者。去藿香
加炮
姜如其数。泻已愈隔年。及后期复泻。古论云。病有期年而发者。有积故也。宜感应丸。
有每日五更初洞泻。服止泻药并无效。米饮下五味丸。或专以杜五味煎饮。宜治脾肾泄
虽
省节饮食。大段忌口。但得日间上半夜无事。近五更其泻复作。此病在肾。俗呼脾肾泄。分
水饮下二神丸。及椒朴丸。或平胃散。下小茴香丸。病久而重。其人虚甚。椒附汤。
冷泻不必多言。热邪也能导致腹泻，这是因为冷泻好比盐遇到火热就会凝固，遇冷则重新溶解；热泻好比水遇寒则凝结成冰，遇热则重新化为水。此外症状表现不一，在疑似难辨之间，可先用分水丸一二服。只有伤食泻不可使用。
寒泻：寒气在腹部，攻冲刺痛，泻下清水，腹内雷鸣，米饮不能消化者，用理中汤或附子补中汤，吞服大已寒丸，宜用附子桂香丸。畏食者，用八味汤。
五虚证：属死证。脉象细弱，脾脏寒冷，气短少气，前后二阴泄痢，饮食无法入口。原本是冷泻，因腹泻而出现烦躁，饮水后反而加重腹泻者，用参附汤、理中汤，加茯苓、黄连，名为连理汤。使用此方多有奇效。况且如今正值暑月，若确知是暑泻，自然应当用治暑的药；确知是冷泻，自然应当用温热的药。中间有一类情况，是在盛暑时节，又内伤生冷食物，非连理汤不可用。
下泄无度，泻后肛门弹响，肛门发热，小便赤涩，心下烦渴，且喜冷饮，此药为宜。若原本是暑泻，经久不愈导致下元虚损严重，日夜频繁发作，暑毒之势已成，而腹泻不止，后续再用治暑药，则决不能取效，便改用姜附类药物，又难以施治。在疑似难辨之间，尤其适宜用连理汤。我余生治疗伤寒协热自利（表里俱热之下利），有用白姜、黄连各半，名为金银汤，即此意也。然而不如连理汤稳妥。如寒泻服用上述药物无效，宜用木香汤，或姜附汤、六柱汤，吞服震灵丹、养气丹。手足厥逆者，兼进朱砂丹。药食刚入口就立即排出者，名为直肠（直泻），难治。如腹泻已愈但精神未恢复旧观者，宜用十补汤。寒泻腹部剧烈疼痛，在服用前药之外，间或进服乳豆丸。服用各种热药以温中，并不见效，登厕频繁，秽物而出，这属于下焦病变，宜用桃花丸二三十粒或诃梨勒丸以收敛固涩。
热泻：粪便颜色赤黄，排便时弹响作痛，肛门焦痛，粪便排出时犹如热水烫人，烦渴，小便不利，宜用五苓饮，吞服香连丸。
暑泻：由胃感受暑气，或饮用、食用被烈日暴晒过的物品，坐在日中炎热处所致，症状与热泻大致相同，宜用胃苓饮或五苓散，加少许车前子，兼服来复丹。
丹泻（服丹药导致的腹泻）：津液既已耗去，口必渴，小便多是赤涩，不可立刻当作热证论治。确知是热泻，方才用冷剂。不然，不要妄投药物以致病情加重。腹泻止住，口渴自然停止，小便赤涩也能恢复正常。
气泻：肠鸣，气走窜胸膈，痞闷腹胀急而痛，泻后腹部须臾又感急迫。也有腹胀急气塞不通的。这是由于中脘停滞，气机不流转，水谷不分所致。宜用大七香丸，入米煎服。久治不愈者，用宽中散，吞服震灵丹，仍佐以米饮调服香附末。
湿泻：由坐卧湿地，致使湿气损伤脾土，土不能克水，梅雨季节阴雨连绵，多有此病。宜用除湿汤，吞服戊己丸，佐以胃苓汤。重者宜用术附汤。如果其人原本腹泻不甚，每日两三次鸭溏（稀薄不成形），这是脾家不燥，常服平胃散自愈，因为方内有苍术，可以燥脾。
伤食泻：因饮食过多，损伤脾气，遂成泻泄，俗呼为伤败腹。其人必打嗝有败卵臭味，宜用治中汤加砂仁半钱，或七香丸、红丸子杂服。
食积腹痛而泻，不可遽用治中汤兜住（强行止泻）。先用调脾饮，吞服感应丸。或因吃某种食物过伤而腹泻，后来再吃这种食物即腹泻者，是因为脾脏被该食物所伤尚未恢复所致，宜用健脾汤。因吃冷物停滞伤脾，脾气不暖，所食之物不能消化，泻出而食物原样排出，宜用治中汤加干葛，吞服酒煮黄连丸，于泻中求之（通过止泻来调理脾胃）。
有脾气久虚不受饮食者，食毕即肠鸣腹急，将所食之物尽数排出，才感到宽快，不食则无事，俗名录食泻（完谷不化之泻）。经年累月，宜用快脾丸下二三十粒。因饮酒受伤，每晨起必泻，宜用理中汤加干葛，吞服酒煮黄连丸。或重而泻泄频数者，宜用冲和汤。
因面食而泻者，用养胃汤加萝卜子，炒研破一钱。痛者，更加木香半钱。泻甚者，去藿香，加炮姜如其数。泻已愈隔年，及后期复发腹泻，古论云：病有期年而发者，有积故也。宜用感应丸。
有每日五更初洞泻，服止泻药并无效，米饮送下五味丸，或专以杜仲、五味子煎饮，宜治脾肾泄。虽省节饮食，大段忌口，但得日间上半夜无事，近五更其泻复作，此病在肾，俗呼脾肾泄。分水分饮下二神丸，及椒朴丸，或平胃散，下小茴香丸。病久而重，其人虚甚，用椒附汤。
Cold diarrhea needs no further explanation. Heat can also cause diarrhea; this is because cold diarrhea is like salt that coagulates when exposed to fire and heat, but dissolves again when cold. Heat diarrhea is like water that freezes into ice when cold, but turns back into liquid when heated. The external symptoms vary, and in cases of doubt or similarity, one may first administer one or two doses of Fen Shui Wan (Water Separation Pill). However, it must not be used for diarrhea caused by food stagnation.
Cold Diarrhea: Cold pathogenic qi resides in the abdomen, causing stabbing pain, with watery stools, borborygmus (rumbling in the intestines), and inability to digest rice or drinks. In such cases, use Lizhong Tang (Regulate the Middle Decoction) or Fuzi Buzhong Tang (Aconite Tonify the Middle Decoction), swallowed with Da Yi Han Wan (Greatly Resolve Cold Pill); Fuzi Guixiang Wan (Cinnamon Twig and Aquilaria Pill) is suitable. For those with aversion to eating, use Bawei Tang (Eight-Ingredient Decoction).
Wu Xu (Five Deficiencies): This is a fatal condition. The pulse is thin, the spleen is cold, there is shortness of breath, dysentery or diarrhea from both bowels, and an inability to take in food or drink. If it was originally cold diarrhea, but irritability arises due to the diarrhea, and drinking water exacerbates the diarrhea, use Shenfu Tang (Ginseng and Aconite Decoction) or Lizhong Tang (Regulate the Middle Decoction) added with Fuling (Poria) and Huanglian (Coptis Rhizome), named Lianli Tang (Coptis and Ginseng Regulating Decoction). Using this formula often yields miraculous results. Moreover, if it is currently midsummer, if it is confirmed as summerheat diarrhea, summerheat-resolving medicines should naturally be used; if it is confirmed as cold diarrhea, warming medicines should naturally be used. There is a category of cases occurring during intense summerheat where internal injury from raw and cold foods occurs; for these, Lianli Tang is indispensable.
For uncontrolled lower expulsion, loud snapping sounds after defecation, hot anus, red and scanty urine, vexation and thirst in the epigastrium, and a preference for cold drinks, this [Lianli Tang] is appropriate. If it was originally summerheat diarrhea, prolonged duration has severely depleted the lower yuan (kidney essence/energy), with frequent day and night episodes. The pathogenic force of summerheat toxin is already established, yet diarrhea persists. Subsequent use of summerheat-resolving medicines will certainly fail. Switching to ginger and aconite categories is also difficult to apply. In such ambiguous situations, Lianli Tang is especially suitable. In my practice treating exterior-interior heat diarrhea (Xie Re Zi Li) from Shanghan (Cold Damage), I have used equal parts of Bai Jiang (White Ginger) and Huanglian (Coptis Rhizome), named Jinyin Tang (Gold and Silver Decoction), which follows this principle. However, Lianli Tang is more stable. If cold diarrhea does not respond to the above medicines, use Muxiang Tang (Aucklandia Decoction), or Jiangfu Tang (Ginger and Aconite Decoction), Liuzhu Tang (Six Pillars Decoction), swallowed with Zhenling Dan (Vibrating Spirit Pill) or Yangqi Dan (Nourish Qi Pill). For cold extremities, concurrently administer Zhusha Dan (Cinnabar Pill). If medicine and food are immediately expelled upon entering the mouth, it is called "Zhichang" (Straight Intestine/Direct Purging), which is difficult to treat. If diarrhea has ceased but spirit and vitality have not recovered to their former state, use Shibu Tang (Ten Tonics Decoction). For severe abdominal pain in cold diarrhea, besides taking the previous medicines, occasionally administer Rudou Wan (Milky Bean Pill). If various warming medicines fail to work, and there is frequent defecation of foul matter, this belongs to disorders of the Lower Jiao (Lower Burner). Use Taohua Wan (Peach Blossom Pill) 20-30 pills or Helile Wan (Chebulic Myrobalan Pill) to astringe and stop diarrhea.
Heat Diarrhea: Stools are red-yellow, accompanied by snapping sounds and pain during defecation, burning pain at the anus, and stools feeling as hot as boiling water. With vexation, thirst, and difficult urination, use Wuling Yin (Five-Ingredient Decoction), swallowed with Xianglian Wan (Aquilaria and Coptis Pill).
Summerheat Diarrhea: Caused by the stomach contracting summerheat qi, or by consuming/drinking items exposed to the sun, or sitting in hot places under the sun. Symptoms are slightly similar to heat diarrhea. Use Weiling Yin (Stomach and Five-Ingredients Decoction) or Wuling San (Five-Ingredient Powder), adding a small amount of Cheqianzi (Plantago Seed), and concurrently服用 Laifu Dan (Restore Vitality Pill).
Dan Diarrhea (Diarrhea caused by mineral pills): Since body fluids are depleted, there is necessarily thirst, and urine is often red and scanty. Do not immediately classify this as a heat syndrome. Only use cooling agents if heat diarrhea is confirmed. Otherwise, do not recklessly prescribe medicines lest the condition worsen. When diarrhea stops, thirst will cease, and red urine will return to normal.
Qi Diarrhea: Borborygmus, qi moving through the chest and diaphragm, fullness, oppression, abdominal urgency, and pain. After defecation, abdominal urgency returns shortly. There are also cases of abdominal urgency with qi blockage and obstruction. This is caused by stagnation in the Zhongwan (CV12) area, failure of qi circulation, and failure to distinguish between water and grain. Use Daxiexiang Wan (Major Aucklandia Pill), decocted with rice. For chronic cases, use Kuanzhong San (Widen the Middle Powder), swallow Zhenling Dan (Vibrating Spirit Pill), and still assist with rice water mixed with Xiangfu powder (Cyperus Rotundus).
Dampness Diarrhea: Caused by sitting or lying in damp places, leading to dampness injuring the spleen. Earth fails to control Water. During plum rain seasons with long periods of overcast weather, this disease is common. Use Chushi Tang (Remove Dampness Decoction), swallow Wuji Wan (Earth-Wood-Harmony Pill), assisted by Weiling Tang (Stomach and Five-Ingredients Decoction). For severe cases, use Zhufu Tang (Atractylodes and Aconite Decoction). If the person does not have severe diarrhea but passes duck-like loose stools two or three times daily, this indicates the spleen lacks dryness. Regularly using Pingwei San (Peace the Stomach Powder) will lead to self-healing, as it contains Cangzhu (Atractylodes Rhizome), which can dry the spleen.
Food Stagnation Diarrhea: Caused by excessive food intake damaging spleen qi, resulting in diarrhea. Commonly called "Shangbai Fu" (Injured Rotten Belly). The patient likely belches with a smell of rotten eggs. Use Zhizhong Tang (Regulate the Middle Decoction) added with 0.5 qian of Sharen (Amomum Fruit), or mix with Qixiang Wan (Seven Fragrances Pill) and Hongwanzi (Red Pill).
Abdominal pain and diarrhea due to food accumulation: Do not abruptly use Zhizhong Tang to arrest diarrhea. First use Tiaopi Yin (Regulate Spleen Decoction), swallow Yinggan Wan (Miraculous Response Pill). Or, if diarrhea occurs after overeating a specific food, and recurs upon re-consumption because the spleen has not recovered from the injury, use Jianpi Tang (Strengthen Spleen Decoction). If cold food stagnates and injures the spleen, spleen qi becomes cold, and food cannot be digested, resulting in undigested food in stools, use Zhizhong Tang (Regulate the Middle Decoction) added with Gegen (Kudzu Root), swallow Jiuzhu Huanglian Wan (Wine-Boiled Coptis Pill), seeking resolution within the diarrhea itself.
For those with long-standing spleen qi deficiency unable to accept food/drink: Immediately after eating, there is borborygmus and abdominal urgency, expelling all ingested food, bringing relief only then; without eating, there are no issues. Commonly known as "Lu Shi Xie" (Recording Food Diarrhea/Undigested Food Diarrhea). Persisting for years, use Kuai Pi Wan (Quick Spleen Pill) 20-30 pills. For diarrhea every morning upon rising due to alcohol injury, use Lizhong Tang (Regulate the Middle Decoction) added with Gegen (Kudzu Root), swallow Jiuzhu Huanglian Wan (Wine-Boiled Coptis Pill). For heavy and frequent diarrhea, use Chonghe Tang (Harmonizing Decoction).
For diarrhea caused by wheat/gluten injury: Use Yangwei Tang (Nourish Stomach Decoction) added with fried and ground Luobozhi (Radish Seed) 1 qian. If painful, add 0.5 qian of Muxiang (Aucklandia Root). For severe diarrhea, remove Huoxiang (Patchouli) and add Paojiang (Prepared Ginger) in equal amounts. If diarrhea resolves for a year and then recurs later, ancient texts state: diseases recurring annually are due to accumulated pathogens. Use Yinggan Wan (Miraculous Response Pill).
For early morning (5 AM) explosive diarrhea unresponsive to anti-diarrheal medicines: Send down Wuwei Wan (Schisandra Pill) with rice water, or specifically decoct and drink Duzhong (Eucommia Bark) and Wuweizi (Schisandra Berry). This treats Pi Shen Xie (Spleen-Kidney Diarrhea). Although diet is restricted and taboos observed, the upper half of the day and night are fine, but diarrhea recurs near 5 AM. This disease lies in the Kidney, commonly called Pi Shen Xie (Spleen-Kidney Diarrhea). Takeershens Wan (Two Spirits Pill) and Jiaopu Wan (Zanthoxylum and Magnolia Pill) with Fen Shui Yin (Water-Separating Drink), or Pingwei San (Peace the Stomach Powder) with Xiaohuixiang Wan (Fennel Pill). For chronic, severe cases with extreme deficiency, use Jiaofu Tang (Zanthoxylum and Aconite Decoction).