经曰∶春伤于风,夏必飧泄。又曰∶湿胜则濡泄。又曰∶暴注下迫,皆属于热。又曰∶诸病水
液,澄澈清冷,皆属于寒。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,归于肺经,行于百脉,而成荣卫。若饮食过多,起居不时,伤其脾胃,则不输化上升精华之气
,反至下降,是为飧泄。经谓清气在下,则生飧泄是也。久则太阴传于少阴而为痢疾矣。治泻大纲
,必分寒热为要。但以脉沉迟,口不渴,身倦少食,腹温温常痛,直出清水,小便清白者属寒;脉
沉数,口渴,声响亮,暴注下迫,肛门热痛,腹忽大痛,小便短赤者属热。(无药,可包暖脐腹,
一日不食,安。)
主方 白术 茯苓 车前子 泽泻 芍药(煨) 陈皮 炙甘草(等分) 加生姜、枣,
(热加灯心,)水煎服。
伤食加山楂、神曲、麦芽;热泻加滑石、黄连、栀子;寒加木香、砂仁、干姜、肉桂。冬月再
加益智、香附、丁香,去车、芍、泽泻、灯心。夏月,香薷、扁豆、木通、浓朴;口渴,葛根、石
膏;小便短赤或不通,猪苓、木通、滑石、石莲子;湿加苍术、半夏;痰乍泻乍止,加半夏、南星
;胸胀,浓朴、枳实、香砂;口渴引饮,人参、五味、麦冬、葛根、升麻(少许)、乌梅(一个);胃气
下陷,人参、黄 、升
麻、柴胡;久泻滑脱不禁,肉果(面煨、) 诃子肉、粟壳、木香、干姜(各五分;) 五更泻,加
肉果、茴香、破故纸(炒);脾虚加人参、山药、苡仁、扁豆、莲肉;暑泻,六一散;夏秋湿热大行,
暴注水泻,加炒黄连、苍术、升麻、木通。
胃苓汤 治男、妇暑湿停饮,泄泻,不伏水土等证。
苍术(制) 浓朴(制) 陈皮 甘草(减半) 白术 茯苓 猪苓 泽泻(各等分)
上咀。加姜、枣,水煎服。本方加黄连、扁豆、香薷,去苍术、陈皮、甘草,名薷苓汤(治
夏月欲成痢者。)
青六丸 治三焦湿热泄泻,兼治产后腹痛自利,亦治血痢。
六一散(六两) 红曲(炒,一两)
上为末,饭丸桐子大。每七十丸白汤下。
温六散 治泄泻、呕吐,神效。
六一散(六两) 干姜(一两)
上研匀,每服三钱,姜汤下。
温脾散 治大人、小儿外受风寒,内伤饮食,腹痛泄泻,一服安。
香附(四两) 山楂 三棱 甘草(各二两) 甘松 益智(各一两) 丁香 三奈(各五钱)
上为末,每服二钱,空心姜汤下。小儿量服。
固肠丸 治日久泄泻,痢后滑脱不禁。
白术(二两) 人参 诃子肉 木香 肉果(面包煨) 龙骨(研) 山药 白茯苓 赤石脂
(研,各一两) 肉桂 炙草 升麻(各五钱)
上为末,研入龙骨、赤脂,水法丸或神曲糊丸,桐子大。每百丸,空心姜、枣汤下。
脾虚加黄 、莲肉、芡实;虚寒加附子、干姜、丁香、荜茇;腹胀加陈皮、浓朴、茴香,去炙
草;不食加藿香、白豆蔻;食不消加砂仁、山楂、麦芽;五更泻加破故纸;甚不止加粟壳、没石子
、臭椿(根皮)。
参苓白术散 治泄泻。因脾虚者及泻后调补。
白术(二两) 人参 山药 茯苓 薏苡仁 扁豆 砂仁 桔梗 莲肉 甘草(炙。各一两)
上末,每二钱白汤下。老幼虚弱久泻,去桔梗加芡实,配米粉、白糖为末,蒸糕大效。
桂苓甘露饮(方见卷末) 治夏月水泻口渴,小便短赤。加香薷。
简便方 (止水泻)车前子(炒,研末,一钱,)米汤下。
又 生姜、半夏、枣子煎服。
又方 生姜一块打细,同艾煎服。
又 干姜末(一钱),米汤调下。
又方 黄连 浓朴(各二钱,姜汁炒,)加生姜三片,煎服。
又方 吐泻,神昏,手足冷。
南星末(五钱),姜、枣煎服。
水泻及男遗精,女白带: 风化锻石(五钱) 茯苓(一两五钱)
上为末,糊丸白汤下。
又方 百年锻石一味,丸服亦效。
又 蜡矾丸(方见外科)止泻,效。
灸法 百会(顶心、) 关元(脐下三寸、) 气海(脐下一寸。)
《内经》说:春季感受风邪,到了夏季必定发生完谷不化的泄泻。又说:湿气偏盛则导致大便稀溏的泄泻。还说:突然剧烈腹泻且伴有肛门急迫感,都归属于热证。又说:各种病理性水液分泌物,如果清澈寒冷,都归属于寒证。脾胃同属湿土之化,主要负责腐熟消化水谷。胃气平和时,饮食进入胃中,其中的精微物质输送到脾土,再归于肺经,运行于全身血脉,从而形成营气和卫气。如果饮食过量,起居没有规律,损伤了脾胃,那么精华之气就不能向上输布转化,反而向下流失,这就形成了完谷不化的泄泻。经文所说的“清气在下,则生飧泄”正是这个意思。时间久了,太阴脾经的病邪会传变至少阴肾经,进而发展为痢疾。治疗泄泻的大纲,必须区分寒热作为关键。如果脉象沉迟,口不渴,身体疲倦、食欲减退,腹部温暖且经常疼痛,排出的是清水,小便颜色清白,这属于寒证;如果脉象沉数,口渴,声音洪亮,突然剧烈腹泻且伴有肛门急迫感,肛门发热疼痛,腹部突然剧烈疼痛,小便短少且颜色深红,这属于热证。(如果没有药物,可以用包裹物暖敷脐腹,一天不进食,即可安宁。)
主方:白术、茯苓、车前子、泽泻、芍药(煨制)、陈皮、炙甘草(各等分),加入生姜、大枣,水煎服。
因伤食引起的,加山楂、神曲、麦芽;热性泄泻加滑石、黄连、栀子;寒性泄泻加木香、砂仁、干姜、肉桂。冬季再加益智仁、香附、丁香,去掉车前子、芍药、泽泻、灯心草。夏季用香薷、扁豆、木通、厚朴;口渴加葛根、石膏;小便短赤或不通畅,加猪苓、木通、滑石、石莲子;湿气重加苍术、半夏;痰湿导致的泄泻时好时坏,加半夏、天南星;胸腹胀满加厚朴、枳实、香附、砂仁;口渴想喝水,加人参、五味子、麦冬、葛根、升麻(少量)、乌梅(一个);胃气下陷,用人参、黄芪、升麻、柴胡;久泻导致滑脱不禁,加肉豆蔻(面裹煨制)、诃子肉、罂粟壳、木香、干姜(各五分);五更泻,加肉豆蔻、小茴香、补骨脂(炒制);脾虚加人参、山药、薏苡仁、扁豆、莲子肉;暑湿泄泻用六一散;夏秋季节湿热盛行,突发水样腹泻,加炒黄连、苍术、升麻、木通。
胃苓汤:治疗男女暑湿停滞饮水,泄泻,不服水土等症状。
苍术(制)、厚朴(制)、陈皮、甘草(减半)、白术、茯苓、猪苓、泽泻(各等分)。
以上药材切碎。加入姜、枣,水煎服。本方加黄连、扁豆、香薷,去掉苍术、陈皮、甘草,名为薷苓汤(治疗夏季快要发展成痢疾的情况)。
青六丸:治疗三焦湿热引起的泄泻,兼治产后腹痛自利,也治疗血痢。
六一散(六两)、红曲(炒制,一两)。
以上研为细末,用米饭做丸,如梧桐子大小。每次七十丸,用白开水送服。
温六散:治疗泄泻、呕吐,效果神奇。
六一散(六两)、干姜(一两)。
以上研匀,每次服用三钱,用姜汤送服。
温脾散:治疗大人、小儿外受风寒,内伤饮食,腹痛泄泻,一服药即安。
香附(四两)、山楂、三棱、甘草(各二两)、甘松、益智仁(各一两)、丁香、三奈(各五钱)。
以上研为细末,每次服用二钱,空腹时用姜汤送服。小儿酌情减量服用。
固肠丸:治疗日久泄泻,痢疾后滑脱不禁。
白术(二两)、人参、诃子肉、木香、肉豆蔻(面包煨制)、龙骨(研碎)、山药、白茯苓、赤石脂(研碎,各一两)、肉桂、炙甘草、升麻(各五钱)。
以上研为细末,将龙骨、赤石脂研入其中,用水泛丸或用神曲糊做丸,如梧桐子大小。每次一百丸,空腹时用姜、枣汤送服。
脾虚加黄芪、莲子肉、芡实;虚寒加附子、干姜、丁香、荜茇;腹胀加陈皮、厚朴、小茴香,去掉炙甘草;不吃饭加藿香、白豆蔻;食物不消化加砂仁、山楂、麦芽;五更泻加补骨脂;严重不止加罂粟壳、没石子、臭椿(根皮)。
参苓白术散:治疗泄泻。适用于脾虚者及泄泻后的调理补益。
白术(二两)、人参、山药、茯苓、薏苡仁、扁豆、砂仁、桔梗、莲子肉、甘草(炙,各一两)。
以上研为细末,每次二钱,用白开水送服。老人、儿童虚弱久泻者,去掉桔梗加芡实,配合米粉、白糖做成细末,蒸成糕状,效果显著。
桂苓甘露饮(方剂见卷末):治疗夏季水泻口渴,小便短赤。加香薷。
简便方(止住水泻):车前子(炒制,研为细末,一钱),用米汤送服。
又方:生姜、半夏、大枣煎服。
又一方:生姜一块捣细,同艾叶煎服。
又方:干姜末(一钱),用米汤调服。
又方:黄连、厚朴(各二钱,用姜汁炒制),加生姜三片,煎服。
又方:用于吐泻,神志昏迷,手足冰冷。
天南星末(五钱),用姜、枣煎服。
水泻以及男子遗精,女子白带:风化煅石(五钱)、茯苓(一两五钱)。
以上研为细末,用糊做丸,白开水送服。
又方:单用百年煅石一味,做丸服用也有效。
又方:蜡矾丸(方剂见外科篇),止泻,有效。
The *Classic of Internal Medicine* states: If one is injured by wind in spring, one will inevitably suffer from undigested stool diarrhea (sun-xie) in summer. It also states: When dampness prevails, it leads to loose stool diarrhea (ru-xie). Furthermore, sudden violent diarrhea with tenesmus all belong to heat syndromes. Additionally, all pathological fluid discharges that are clear and cold belong to cold syndromes. The Spleen and Stomach share the transformation of damp-earth, primarily responsible for rotting and ripening food and drink. When Stomach Qi is harmonious, after food enters the Stomach, its essence is transported to the Spleen earth, returns to the Lung meridian, circulates through the hundred vessels, and thereby forms Ying (Nutritive Qi) and Wei (Defensive Qi). If there is excessive eating or irregular daily routine, damaging the Spleen and Stomach, the essence Qi fails to ascend and transform, instead descending downwards, resulting in undigested stool diarrhea (sun-xie). This corresponds to the classic statement: "Clear Qi remaining below generates sun-xie." Over time, Taiyin disease may transmit to Shaoyin, developing into dysentery (li-ji). The general principle for treating diarrhea must prioritize distinguishing between cold and heat. If the pulse is deep and slow, there is no thirst, the body feels fatigued with poor appetite, the abdomen is warm and frequently painful, watery stools are passed directly, and urine is clear and white, this belongs to cold; if the pulse is deep and rapid, there is thirst, the voice is loud, there is sudden violent diarrhea with tenesmus, the anus feels hot and painful, the abdomen suffers sudden severe pain, and urine is scanty and dark red, this belongs to heat. (If no medicine is available, one can wrap and warm the navel and abdomen, and abstain from food for one day to find relief.)
Main Formula: Baizhu (Atractylodis Rhizoma), Fuling (Poria), Cheqianzi (Plantaginis Semen), Zexie (Alismatis Rhizoma), Shaoyao (Paeoniae Radix Alba, baked), Chenpi (Citri Reticulatae Pericarpium), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) in equal parts. Add Shengjiang (Zingiberis Rhizoma Recens) and Zao (Jujubae Fructus), decoct in water and take orally.
For injury by food stagnation, add Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), and Maiya (Hordei Fructus Germinatus); for heat diarrhea, add Huashi (Talcum), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus); for cold, add Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Ganjiang (Zingiberis Rhizoma), and Rougui (Cinnamomi Cortex). In winter, add Yizhi (Alpiniae Oxymatophyllae Fructus), Xiangfu (Cyperi Rhizoma), and Dingxiang (Caryophylli Flos); remove Cheqianzi, Shaoyao, Zexie, and Dengxincao (Junci Medulla). In summer, use Xiangru (Moslae Herba), Bian Dou (Dolichoris Semen), Mutong (Akebiae Caulis), and Houpo (Magnoliae Officinalis Cortex); for thirst, add Gegen (Puerariae Lobatae Radix) and Shigao (Gypsum Fibrosum); for scanty/dark or obstructed urination, add Zhuling (Polyporus), Mutong, Huashi, and Shilianzi (Nelumbinis Semen); for dampness, add Cangzhu (Atractylodis Rhizoma) and Banxia (Pinelliae Rhizoma); for intermittent diarrhea due to phlegm-damp, add Banxia and Nanting (Arisaematis Rhizoma Preparatum); for chest distension, add Houpo, Zhishi (Aurantii Fructus Immaturus), Xiangsha (Amomi Fructus); for intense thirst with desire to drink, add Renshen (Ginseng Radix et Rhizoma), Wuweizi (Schisandrae Fructus), Maidong (Ophiopogonis Radix), Gegen, Shengma (Bupleuri Radix, small amount), and Wumei (Mume Fructus, one piece); for sinking of Stomach Qi, add Renshen, Huangqi (Astragali Radix), Shengma, and Chaihu (Bupleuri Radix); for chronic diarrhea with slipping and incontinence, add Roudoukou (Myristicae Semen, baked in flour), Hezi Rou (Terminaliae Chebulae Fructus Carnosus), Susu Ke (Papaveris Pericarpium), Muxiang, and Ganjiang (each 0.5 fen); for wukeng diarrhea (dawn diarrhea), add Roudoukou, Huixiang (Foeniculi Fructus), and Poguzhi (Psoraleae Fructus, stir-fried); for Spleen deficiency, add Renshen, Shanyao (Dioscoreae Rhizoma), Yiren (Coicis Semen), Bian Dou, and Lianrou (Nelumbinis Plumula); for summerheat diarrhea, use Liuyi San (Six-to-one Powder); when summer-autumn damp-heat prevails with sudden watery diarrhea, add stir-fried Huanglian, Cangzhu, Shengma, and Mutong.
Weiling Tang (Stomach-Cinnamon Decoction): Treats summer-dampness and retained fluids in men and women, causing diarrhea and intolerance to local climate/water-soil.
Cangzhu (Prepared), Houpo (Prepared), Chenpi, Gancao (halved dosage), Baizhu, Fuling, Zhuling, Zexie (all equal parts).
Cut the herbs. Add Jiang and Zao, decoct in water and take orally. Adding Huanglian, Bian Dou, and Xiangru to this formula, while removing Cangzhu, Chenpi, and Gancao, creates the name Ru Ling Tang (Herb-Cinnamon Decoction), which treats cases in summer approaching dysentery.
Qing Liu Wan (Blue Six Pill): Treats damp-heat diarrhea involving the Triple Burner; also treats postpartum abdominal pain with spontaneous diarrhea, and bloody dysentery.
Liuyi San (6 liang), Hong Qu (Red Yeast Rice, stir-fried, 1 liang).
Grind into powder, make pills the size of tung tree seeds with rice paste. Take 70 pills each time with plain boiled water.
Wen Liu San (Warm Six Powder): Treats diarrhea and vomiting with miraculous effect.
Liuyi San (6 liang), Ganjiang (1 liang).
Grind evenly, take 3 qian per dose, administered with ginger soup.
Wen Pi San (Warm Spleen Powder): Treats adults and children suffering from external wind-cold and internal dietary injury, causing abdominal pain and diarrhea; provides relief with one dose.
Xiangfu (4 liang), Shanzha, Sanleng (Sparganii Rhizoma), Gancao (2 liang each), Gansong (Nardostachyos Radix et Rhizoma), Yizhi (1 liang each), Dingxiang, Sansai (Kaempferiae Galangal Rhizoma) (0.5 liang each).
Grind into powder, take 2 qian per dose on an empty stomach with ginger soup. Children should take adjusted doses.
Gu Chang Wan (Intestine-Securing Pill): Treats long-term diarrhea and slipping/incontinence following dysentery.
Baizhu (2 liang), Renshen, Hezi Rou, Muxiang, Roudoukou (baked in bread), Longgu (Os Draconis, ground), Shanyao, Bai Fuling, Chishizhi (Red Halloysite, ground, 1 liang each), Rougui, Zhigancao, Shengma (0.5 liang each).
Grind into powder, mix in the ground Longgu and Chishizhi. Make pills using water method or Massa Medicata Fermentata paste, size of tung tree seeds. Take 100 pills on an empty stomach with ginger and jujube soup.
For Spleen deficiency, add Huangqi, Lianrou, Qianshi (Euryales Semen); for deficiency-cold, add Fuzi (Aconiti Lateralis Radix Preparata), Ganjiang, Dingxiang, Bibo (Piperis Kadsurae Fructus); for abdominal distension, add Chenpi, Houpo, Huixiang, remove Zhigancao; for loss of appetite, add Huoxiang (Agastaches Herba), Ba Doukou (Amomi Fructus Rotundus); for indigestion, add Sharen, Shanzha, Maiya; for dawn diarrhea, add Poguzhi; if severe and unceasing, add Susu Ke, Meishi Zi (Arecae Semen Preparatum), and Chouchun (Toosendan Cortex).
Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder): Treats diarrhea. Suitable for those with Spleen deficiency and for conditioning/replenishing after diarrhea.
Baizhu (2 liang), Renshen, Shanyao, Fuling, Yiyiren (Coicis Semen), Bian Dou, Sharen, Jiegeng (Platycodonis Radix), Lianrou, Zhigancao (prepared, 1 liang each).
Grind into powder, take 2 qian each time with plain boiled water. For elderly and young weak persons with chronic diarrhea, remove Jiegeng and add Qianshi; mix with rice flour and white sugar to make powder, steam into cakes for great efficacy.
Guiling Ganlu Yin (Cassia Twig, Poria, and Sweet Dew Drink) (Formula seen at end of volume): Treats summer watery diarrhea with thirst and scanty dark urine. Add Xiangru.
Simple Prescription (Stop Watery Diarrhea): Cheqianzi (stir-fried, ground to powder, 1 qian), taken with rice soup.
Another prescription: Shengjiang, Banxia, and Zao decocted and taken.
Another prescription: One piece of Shengjiang beaten fine, decocted with Aiye (Artemisiae Argyi Folium) and taken.
Another prescription: Ganjiang powder (1 qian), mixed with rice soup and taken.
Another prescription: Huanglian, Houpo (2 qian each, stir-fried with ginger juice), add three slices of Shengjiang, decoct and take.
Another prescription: For vomiting and diarrhea, coma, and cold hands and feet.
Nanting powder (5 qian), decocted with Jiang and Zao and taken.
Watery diarrhea, along with nocturnal emission in men and leukorrhea in women: Fenghua Duanshi (Calcined Alum weathered), Fuling (1.5 liang).
Grind into powder, make pills with paste, taken with plain boiled water.
Another prescription: Using only century-old Duanshi as a single herb, made into pills, is also effective.
Another prescription: Lafan Wan (Wax and Aluminum Pill) (See Surgery section), stops diarrhea, effective.
Moxibustion Points: Baihui (GV20, center of vertex), Guanyuan (CV4, 3 cun below umbilicus), Qihai (CV6, 1 cun below umbilicus).