汤氏 初秋寒热吐泻，或以为感暑，用香薷饮；或以为霍乱，用藿香正气散；其家两置之。诊其脉濡而
弱，烦热无汗，自利呕渴。予谓湿甚则濡泻，今湿郁生热，热蒸更为湿，故烦而呕渴也，宜猪苓汤去阿胶主之。
猪苓（二钱）、茯苓（三钱）、泽泻（八分）、滑石（六分），加半夏（钱半）、薄荷梗（八分）、薏苡、
煨姜（各三钱）、灯心（六分）。一服呕止泄稀，去滑石、煨姜、半夏，再加麦冬、山栀、车前。二剂而安。
汤氏 冒暑重感新凉，寒热头晕，口干舌燥，呕泻不已，头汗剂颈而还。医用消导，转益烦渴，脉不数
而滑大，此邪郁蒸痰。先挑姜汁止呕，用正气散加减。藿香、薄荷以辟恶，丹皮、栀、芩以解热，夏、曲、
煨姜以除痰，赤茯、猪苓、薏仁以利湿，花粉、麦冬以生津，一服汗凉脉和舌润矣。因有年体弱，明晨怯寒，
手足微凉，此脾阳虚也。用理中汤，炮姜改煨姜，加砂仁。苓、薏、炙草，一剂呕泻止，手足和。但气微坠，
宵分少寐，原方去煨姜，加茯神、炙 、枣仁、白芍、升麻，一服而安。
予馆新洲，（江水泛潮，地最卑湿。）长夏晨泄，每阴雨前尤验。痰多不渴，或吐白沫，清晨左胁气
响，必阵泻稀水，此湿多成五泄也。胃苓汤加神曲（炒）、半夏（制）、干姜（少许）。一则劫阳明之停饮以
燥湿，一则开太阳之里气以导湿，故一啜辄止。良由长夏湿淫，水谷停湿，脾阳少运故也。嗣后去桂，加砂仁、
小茴、二术生用，或苍术、姜、曲煎服，亦止。
潘 色苍嗜饮，助湿酿热，濡泻经年，脉寸关实大，岂温补升提所得效。细询平昔吞酸，去秋连发腿疡，
明系湿邪蕴热，流注经络所致。治者不察，当夏令主火，仍以四神丸加炮姜、乌梅，补中汤加吴萸、肉果，
愈服愈剧，致头晕口燥，气坠里迫，溺涩肛痛，皆火性急速征据，必清理湿热之邪，乃为按脉切理，仍当
戒饮，毋谓六旬外久泻延虚也。四苓散加薏仁、车前子、麦冬、山栀、灯心，二服已效。加神曲、砂仁壳、
枳子以理酒伤而泻稀，加黄芩、白芍而脉敛，后用参苓白术散加减而痊。
曹 脉左濡，右关尺弦大，腹鸣则痛坠泄泻。前因怫悒，木制脾土，为中焦痞痛。服破气燥剂，再伤中气，
每日晡少腹痛泄，下焦阴气又伤，急须甘缓和中，佐以温摄。潞参、炙草、白芍、茯苓、小茴、橘核（俱酒焙）、
益智、木香（俱煨）、饴糖、红枣，十数剂，痛泻止。
于 五泄无不由湿，寓居斥卤，水味咸浊，便泻三年不止。凡运脾利湿，温肾补土，及升提疏利固涩诸法，
毫不一效。今夏诊右脉寸微关滑，乃湿中伏热，大小腑清浊不分，火性急速，水谷倾注无余，脾失输精，肺
苦燥渴，气不化液，肾不司关，所下污液，自觉热甚，或痛泄，或不痛亦泄，日夕数行，口干溺少，时想凉润。
略用守补，即嫌胀满，可知气坠全是腑症。若清浊分，则泄泻渐已。（煎方∶）茯苓、猪苓、车前、山栀、神
曲、薏苡、大腹皮、乌梅、黄连，午前服。（丸方∶）益智仁（煨）、补骨脂、南烛子、诃子、茴香、茯苓、山
药、广皮、砂仁、半夏曲、杜仲、首乌、莲子，蒸饼为丸，晚服，至秋渐愈。
汤氏，初秋时节出现寒热交替、呕吐和腹泻的症状。有人认为是中暑，使用了香薷饮；有人认为是霍乱，使用了藿香正气散；但其家属将这两种方案都搁置了。诊察其脉象濡弱，伴有烦热无汗、自发性腹泻、呕吐和口渴。我认为湿邪严重会导致濡泻，如今湿邪郁结而生热，热气蒸腾又加重湿气，所以出现烦躁、呕吐和口渴的症状，适宜使用猪苓汤去掉阿胶来主治。
处方：猪苓（二钱）、茯苓（三钱）、泽泻（八分）、滑石（六分），加入半夏（一钱半）、薄荷梗（八分）、薏苡仁、煨姜（各三钱）、灯心草（六分）。服用一次后呕吐停止，腹泻变稀，于是去掉滑石、煨姜、半夏，再加入麦冬、山栀、车前子。服用两剂后病情安定。
汤氏，因感受暑气后又受新凉侵袭，出现寒热、头晕、口干舌燥、呕吐腹泻不止，头部出汗至颈部即止。医生使用消导类药物，反而加重了烦躁和口渴，脉象不数但滑大，这是邪气郁结蒸腾生痰所致。先用姜汁挑治以止呕，再用正气散加减治疗。用藿香、薄荷来辟除秽恶之气，丹皮、山栀、黄芩来解热，半夏、神曲、煨姜来除痰，赤茯苓、猪苓、薏苡仁来利湿，花粉、麦冬来生津，服用一次后汗出清凉，脉象平和，舌面滋润。因为患者年事已高且体质虚弱，次日清晨感到怯寒，手足微凉，这是脾阳虚的表现。使用理中汤，将炮姜改为煨姜，加入砂仁。茯苓、薏苡仁、炙甘草，服用一剂后呕吐腹泻停止，手足温暖。但仍有气微下坠感，深夜睡眠少，在原方中去掉煨姜，加入茯神、炙远志、酸枣仁、白芍、升麻，服用一剂后病情安定。
我在新洲馆舍居住时，（江水泛潮，地势最为卑湿。）长夏季节早晨腹泻，每逢阴雨天前尤为明显。痰多但不渴，有时吐出白色泡沫，清晨左侧胁部有气响，必然伴随阵发性稀水样腹泻，这是湿邪过多导致五泄之一。使用胃苓汤加入炒神曲、制半夏、少许干姜。一则劫取阳明经的停饮以燥湿，二则开通太阳经的里气以导湿，所以喝一次就停止了。这主要是因为长夏季节湿邪盛行，水谷停滞于湿，脾阳运化无力所致。此后去掉桂枝，加入砂仁、小茴香、生用的苍术和白术，或者用苍术、生姜、神曲煎服，也能止住。
潘某，面色黧黑且嗜好饮酒，助湿酿热，导致濡泻持续多年，脉象寸关部实大，岂是温补升提所能见效的。仔细询问平素吞酸，去年秋季连续发作腿部溃疡，明确是湿邪蕴结化热，流注经络所致。治疗者没有察觉，正值夏令主火，仍然使用四神丸加炮姜、乌梅，补中益气汤加吴茱萸、肉豆蔻，越服用病情越重，导致头晕口燥，气坠肛门紧迫，小便涩滞肛门疼痛，这些都是火性急速的特征依据，必须清理湿热之邪，这才是符合脉理的治疗方法，仍应当戒酒，不要认为六十岁以外久泻导致虚损就可以随意进补。使用四苓散加薏苡仁、车前子、麦冬、山栀、灯心草，服用两剂已见效。加入神曲、砂仁壳、枳壳来调理酒伤而腹泻变稀，加入黄芩、白芍使脉象收敛，后来用参苓白术散加减治疗而痊愈。
曹某，脉象左部濡，右关尺部弦大，腹部鸣响则疼痛并伴有下坠感腹泻。之前因为情绪抑郁，肝木克制脾土，导致中焦痞塞疼痛。服用破气燥烈药物，再次损伤中气，每天傍晚少腹痛泻，下焦阴气又受损伤，急需甘缓和中，佐以温摄。使用潞党参、炙甘草、白芍、茯苓、小茴香、橘核（均用酒焙）、益智仁、木香（均煨制）、饴糖、红枣，服用十数剂后，痛泻停止。
于某，五泄无不与湿有关，寓居在盐碱地，水质咸浊，腹泻三年不止。凡是运脾利湿、温肾补土，以及升提疏利固涩等各种方法，都没有丝毫效果。今年夏天诊察右脉寸部微弱关部滑，这是湿中伏藏热邪，大小肠清浊不分，火性急速，水谷倾注无余，脾失输精功能，肺苦于燥渴，气不能化液，肾不能司管关门，所下的污秽液体，自觉非常热，有时痛泻，有时不痛也泻，早晚数次，口干尿少，时常想要凉润之物。稍微使用守补之法，就嫌胀满，可知气坠完全是腑症。如果清浊分开，则腹泻逐渐停止。（煎剂方：）茯苓、猪苓、车前子、山栀、神曲、薏苡仁、大腹皮、乌梅、黄连，午前服用。（丸剂方：）益智仁（煨制）、补骨脂、南烛子、诃子、茴香、茯苓、山药、广陈皮、砂仁、半夏曲、杜仲、首乌、莲子，蒸饼为丸，晚间服用，到秋天逐渐痊愈。
Mr. Tang, in early autumn, presented with alternating chills and fever, vomiting, and diarrhea. Some attributed it to summerheat (Shu) and prescribed Xiangru Yin (Elsholtzia Decoction); others diagnosed it as cholera (Huoluan) and prescribed Huoxiang Zhengqi San (Patchouli Powder for Regulating the Qi). However, his family set both treatments aside. Upon examination, his pulse was soggy (Ru) and weak, accompanied by vexatious heat without sweating, spontaneous diarrhea, vomiting, and thirst. I reasoned that severe dampness leads to soggy diarrhea (Ruxie). Now, dampness is stagnant generating heat, and heat steaming exacerbates dampness, hence the vexation, vomiting, and thirst. It is appropriate to treat with Zhuling Tang (Polyporus Decoction) minus Ejiao (Donkey-hide Gelatin).
Prescription: Zhu Ling (Polypori, 2 qian), Fu Ling (Poria, 3 qian), Ze Xie (Alismatis Rhizoma, 8 fen), Hua Shi (Talcum, 6 fen), added Ban Xia (Pinelliae Rhizoma, 1.5 qian), Bo He Geng (Menthae Haplocalycis Caulis, 8 fen), Yi Yi Ren (Coicis Semen), Wei Jiang (Prepared Ginger, each 3 qian), Deng Xin Cao (Junci Medullia, 6 fen). After one dose, vomiting ceased and diarrhea became thin. Then, Hua Shi, Wei Jiang, and Ban Xia were removed, and Mai Dong (Ophiopogonis Radix), Shan Zhi (Gardeniae Fructus), and Che Qian Zi (Plantaginis Semen) were added. After two doses, the condition stabilized.
Mr. Tang, having contracted summerheat and subsequently exposed to new cold, presented with chills and fever, dizziness, dry mouth and tongue, incessant vomiting and diarrhea, and sweating on the head stopping at the neck. The physician used digestive-promoting methods, which exacerbated vexation and thirst. The pulse was not rapid but slippery and large, indicating pathogenic factors stagnating and steaming to generate phlegm. First, ginger juice was applied via pricking to stop vomiting, followed by a modified Zhengqi San (Regulate Qi Powder). Huo Xiang (Agastaches Herba) and Bo He (Menthae Haplocalycis Herba) were used to dispel evil turbidity; Dan Pi (Moutan Cortex), Shan Zhi, and Huang Qin (Scutellariae Radix) to clear heat; Ban Xia, Shen Qu (Massae Fermentatae Medicinalis), and Wei Jiang to resolve phlegm; Chi Fu Ling (Red Poria), Zhu Ling, and Yi Ren to promote urination and drain dampness; Hua Fen (Trichosanthis Radix) and Mai Dong to generate fluids. After one dose, sweat became cool, the pulse harmonized, and the tongue moistened. As the patient was elderly and weak, he felt aversion to cold the next morning with slightly cold hands and feet, indicating Spleen Yang deficiency. Lizhong Tang (Regulate the Middle Decoction) was used, substituting Pao Jiang (Prepared Ginger) with Wei Jiang, and adding Sha Ren (Amomi Fructus). Fu Ling, Yi Ren, and Zhi Gan Cao (Honey-fried Licorice Root) were included. After one dose, vomiting and diarrhea stopped, and hands and feet warmed. However, there was slight sensation of qi sinking and poor sleep late at night. Wei Jiang was removed from the original formula, and Fu Shen (Poria with Hostwood), Zhi Yuan Zhi (Polygalae Radix processed with honey), Suan Zao Ren (Ziziphi Spinosae Semen), Bai Shao (Paeoniae Radix Alba), and Sheng Ma (Cimicifugae Rhizoma) were added. After one dose, stability was achieved.
While residing in Xinzhou (where river water floods and the terrain is low and damp), during midsummer, I experienced morning diarrhea, which was particularly evident before rainy days. There was much phlegm but no thirst, sometimes spitting white foam. In the early morning, qi resonated in the left hypochondrium, inevitably followed by paroxysmal watery diarrhea. This is one of the Five Diarrheas caused by excessive dampness. Weiling Tang (Atractylodes and Poria Decoction) was added with Chao Shen Qu (Fried Massae Fermentatae Medicinalis), Zhi Ban Xia (Processed Pinelliae Rhizoma), and a small amount of Gan Jiang (Dried Ginger). One aspect captures the retained fluid in the Yangming channel to dry dampness; the other opens the interior qi of the Taiyang channel to guide out dampness. Thus, it stopped after one sip. This was primarily due to the prevalence of dampness in midsummer, where food and water stagnate in dampness, and Spleen Yang transport is insufficient. Later, Gui Zhi (Cinnamomi Ramulus) was removed, and Sha Ren, Xiao Hui Xiang (Foeniculi Fructus), and raw Cang Zhu (Atractylodis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) were added. Alternatively, Cang Zhu, Sheng Jiang (Fresh Ginger), and Shen Qu decocted also stopped the diarrhea.
Mr. Pan, with a dark complexion and a fondness for drinking, had dampness assisting heat generation, leading to chronic soggy diarrhea. His pulse was solid and large at the Cun and Guan positions. Could warming tonification and lifting methods be effective? Detailed inquiry revealed habitual acid regurgitation and continuous leg ulcers last autumn, clearly caused by damp-evil accumulating and transforming into heat, flowing into the collaterals. The treating physician failed to observe this. Since summer governs Fire, they still used Sishen Wan (Four Spirits Pill) with Pao Jiang and Wu Mei (Mume Fructus), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Wu Zhu Yu (Evodiae Fructus) and Rou Dou Kou (Myristicae Semen). The more they took it, the worse it became, resulting in dizziness, dry mouth, qi sinking with anal urgency, dysuria, and anal pain. These are all signs of the rapid nature of Fire. It is necessary to clear and regulate the damp-heat pathogen, which aligns with pulse diagnosis and pathology. Alcohol must be abstained from; do not assume that chronic diarrhea in those over sixty merely requires tonification for deficiency. Siling San (Four Polypori Powder) was added with Yi Ren, Che Qian Zi, Mai Dong, Shan Zhi, and Deng Xin Cao. After two doses, efficacy was seen. Shen Qu, Sha Ren Ke (Shell of Amomi Fructus), and Zhi Ke (Aurantii Fructus Immaturus) were added to manage alcohol injury while diarrhea thinned. Huang Qin and Bai Shao were added to constrain the pulse. Later, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) was modified to achieve recovery.
Mr. Cao, with a soggy pulse on the left and string-taut and large pulse at the right Guan and Chi positions, experienced abdominal borborygmus followed by pain and downward-pushing diarrhea. Previously, due to depression, Liver Wood overacting on Spleen Earth caused middle jiao obstruction and pain. Taking qi-breaking and drying agents further injured Middle Qi. Every afternoon, there was lower abdominal pain and diarrhea, injuring Lower Jiao Yin Qi again. Urgently, sweet and緩 (soothing) methods to harmonize the middle, assisted by warming and securing, were needed. Lu Shen (Codonopsis Radix), Zhi Gan Cao, Bai Shao, Fu Ling, Xiao Hui Xiang, Ju He (Citrini Reticulatae Pericarpium, wine-baked), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Mu Xiang (Aucklandiae Radix, both baked), Yi Tang (Maltose), and Hong Zao (Jujubae Fructus) were used. After more than ten doses, pain and diarrhea stopped.
Mr. Yu, suffering from any of the Five Diarrheas, all related to dampness, lived in a saline area with salty and turbid water, experiencing diarrhea for three years without cessation. Methods such as transporting Spleen and draining dampness, warming Kidney and tonifying Earth, as well as lifting, regulating, and astringing methods, yielded no effect. This summer, the right Cun pulse was faint and Guan was slippery, indicating latent heat within dampness. Clear and turbid substances in the Large and Small Intestines were not separated. Due to the rapid nature of Fire, food and water were poured out completely. Spleen lost its function of transporting essence; Lung suffered from dryness and thirst; Qi could not transform fluids; Kidney failed to control the gate. The discharged turbid fluid felt very hot internally. Sometimes painful diarrhea occurred, sometimes non-painful diarrhea, several times day and night. Dry mouth and scanty urine indicated a desire for cooling and moistening. Slightly using retaining tonification caused bloating, proving that qi sinking is entirely a Fu organ syndrome. If clear and turbid are separated, diarrhea will gradually cease. (Decoction: Fu Ling, Zhu Ling, Che Qian Zi, Shan Zhi, Shen Qu, Yi Yi Ren, Da Fu Pi (Arecae Pericarpium), Wu Mei, Huang Lian (Coptidis Rhizoma), taken before noon. Pill: Yi Zhi Ren (baked), Bu Gu Zhi (Psoraleae Fructus), Nan Zhu Zi (Myrtilli Fructus), He Zi (Terminalia Chebulae Fructus), Hui Xiang, Fu Ling, Shan Yao (Dioscoreae Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), Sha Ren, Ban Xia Qu, Du Zhong (Eucommiae Cortex), Shou Wu (Polygoni Multiflori Radix), Lian Zi (Nelumbinis Semen), made into pills with steamed cake dough, taken in the evening. Gradual improvement by autumn.)