脉 右关脉弦大。或弦濡而滑。为泄泻。脉数疾为热。沉细为寒。弦而迟者气泄。心脉止者
惊泄。诀云。下利微小即为生。脉大浮洪无瘥日。
症 经曰∶春伤于风。夏生飧泄。又曰∶湿多成五泄。戴氏云∶有飧泄者。谓水谷
不化而完出。湿兼风也。溏泄者。渐下污积粘垢。湿兼热也。 泄者。利下澄澈清冷。小
便清白。湿兼寒也。濡泄者。体重软弱。泄下多水。湿自甚也。滑泄者。久下不能禁。因湿
胜气脱也。若此有寒热虚实之不同。其可执一而治之乎。
治 按戴氏云∶泻水腹不痛者。湿也。宜四苓散。加二术。饮食入胃不住。完谷不化者。
气虚也。四君子汤。加白芍药、升麻、腹痛。泻水。肠鸣。痛一阵泻一阵者。火也。四苓散
。加芩、连、木通、或泻或不泻。或多或少者。痰也。二陈加苍白术、海石、青黛、黄芩、
神曲、或用吐法。腹痛甚而泻。泻后痛减者。食积也。轻者。保和丸。重者白术、枳实、山
楂、神曲大黄、消而下之。后用参苓平胃散调之。大抵治泻通用胃苓汤。随症加减。
方 胃苓汤治泻通用。
浓朴 苍术（各一钱） 白术（一钱五分） 陈皮（八分） 甘草（炙三分） 茯苓（八分） 猪苓 泽泻
车前子（各七分） 桂（三分）
上作一服。姜一片。红枣一枚。水一钟半。煎八分。食远服。
夏秋之间。温热大行。暴注水泄。加黄连、扁豆（各八分）、升麻、山栀、木通（各五分）、白
芍药（一钱）。
发热燥渴。加葛根、石膏、滑石（各一钱）。
黄胆。小便赤涩，加茵陈、石膏（各一钱）、山栀、木通、白芍药（各八分）。
饮酒便泄。此酒积也。加白芍药、黄连、扁豆、干葛（各一钱），去桂。
寒月溏泄清冷。腹痛。或伤生冷冻饮料食者。加神曲、麦芽、砂仁、益智、木香（各七分）、干姜
（五分）。
久泻胃气下陷者。去猪苓、泽泻、车前子，加人参、黄 、白芍药（各一钱）、升麻、柴胡、羌
活、防风（各四分）。
久泻。脾胃虚滑不禁。加肉豆蔻（一钱）、诃子（八分）、木香、干姜（各五分）。
久泻。胃虚膨闷。干呕者。加藿香、砂仁、半夏、干姜（各七分），去猪苓泽泻、车前子。
热甚下泄如热汤者。加芩连、木通、滑石（各八分），去桂、腹中 痛。下泄清冷。喜热不渴
。此寒泻也。倍桂，加干姜、肉果（各八分）、木香（五分）、寒甚者。附子理中汤。（方见寒
门）。
久泻谷道不合。或脱肛。此元气下陷。及大肠不行收令而然也。本方去浓朴、苍术、猪苓泽
泻、车前子，加人参、芍药、神曲、诃子、肉果、乌梅、五倍子（各等分）为丸。防风升麻
汤下。完谷不化。属热。加芩连、滑石（各一钱）、属气虚者。加人参、芍药、升麻（各等
分），去猪苓泽泻、桂。食积泻。加山楂、神曲、麦芽、白豆蔻仁（各一钱）、甚者。枳壳大黄
汤。
凡诸泻。本方。春加防风、白芍药（各八分）夏加黄连、香薷、扁豆（各一钱）。秋加
藿香、槟榔、枳壳（各七分）、乌梅（二个）。冬加干姜、砂仁（各七分）。
又方 助胃丸治大人小儿诸般泄泻。
浓朴 苍术 陈皮（各一两五钱） 甘草（炙四钱） 猪苓 泽泻 茯苓（各一两） 白术（一两
五钱） 桂（三钱） 肉果（鸡蛋清炒一两） 山楂（二两）
上为末。神曲二两。打糊为丸。如龙眼大。每服一丸。清米汤化下。
【脉象】右关脉呈现弦大之象，或者弦而濡滑，这是泄泻的脉象。脉数且急促属于热证；脉沉细属于寒证；脉弦而迟缓是气虚下陷；心脉微弱或停止跳动，是惊恐导致的泄泻。医诀说：下利（腹泻）时脉象微小者尚有生机，若脉象大、浮、洪大，则无痊愈之日。
【症状】《内经》说：春季感受风邪，到了夏季就会发生完谷不化的飧泄。又说：湿气重会导致五种泄泻。戴氏说：飧泄，是指水谷不能消化，原样排出，这是湿邪兼夹风邪所致。溏泄，是指逐渐排出污浊粘稠的粪便，这是湿邪兼夹热邪所致。泄，是指排泄物清澈寒冷，小便清白，这是湿邪兼夹寒邪所致。濡泄，是指身体沉重软弱，排泄物多为水液，这是湿气过盛所致。滑泄，是指长期腹泻无法控制，这是因为湿气胜而正气脱失所致。像这样，有寒、热、虚、实的不同，怎么能拘泥于一种方法治疗呢？
【治法】根据戴氏的说法：泻下水液而腹部不痛的，是湿邪，适宜用四苓散，加苍术、白术。饮食进入胃中停留不住，完谷不化的，是气虚，用四君子汤，加白芍药、升麻。腹痛，泻下水液，肠鸣，痛一阵泻一阵的，是火邪，用四苓散，加黄芩、黄连、木通。有时泻有时不泻，或多或少的是痰饮，用二陈汤加苍术、白术、海浮石、青黛、黄芩、神曲，或者使用吐法。腹痛剧烈而后腹泻，泻后疼痛减轻的，是食积，轻症用保和丸，重症用白术、枳实、山楂、神曲、大黄，消食导滞并攻下，之后用参苓平胃散调理。大抵治疗泄泻通用方为胃苓汤，随症状加减。
【方剂】胃苓汤是治疗泄泻的通用方。
厚朴、苍术（各一钱）、白术（一钱五分）、陈皮（八分）、甘草（炙三分）、茯苓（八分）、猪苓、泽泻、车前子（各七分）、桂枝（三分）。
以上为一服量，加生姜一片、红枣一枚，水一碗半，煎至八分，饭后服用。
夏秋之间，温热之气盛行，突发急性水样腹泻，加黄连、扁豆（各八分）、升麻、山栀、木通（各五分）、白芍药（一钱）。
发热、烦躁口渴，加葛根、石膏、滑石（各一钱）。
黄疸，小便赤涩，加茵陈、石膏（各一钱）、山栀、木通、白芍药（各八分）。
饮酒后即腹泻，这是酒积，加白芍药、黄连、扁豆、干葛（各一钱），去掉桂枝。
寒冷季节出现溏泄清冷，腹痛，或者是吃了生冷冷冻食物损伤脾胃，加神曲、麦芽、砂仁、益智仁、木香（各七分）、干姜（五分）。
久泻导致胃气下陷，去掉猪苓、泽泻、车前子，加人参、黄芪、白芍药（各一钱）、升麻、柴胡、羌活、防风（各四分）。
久泻，脾胃虚弱滑脱不禁，加肉豆蔻（一钱）、诃子（八分）、木香、干姜（各五分）。
久泻，胃虚胀闷，干呕，加藿香、砂仁、半夏、干姜（各七分），去掉猪苓、泽泻、车前子。
热势严重，下泄如热汤般灼热，加黄芩、黄连、木通、滑石（各八分），去掉桂枝。腹中疼痛，下泄清冷，喜欢热饮且不口渴，这是寒泻，加倍桂枝，加干姜、肉豆蔻（各八分）、木香（五分），寒邪严重者，用附子理中汤。（方剂见寒门章节）。
久泻导致肛门松弛不合，或者脱肛，这是元气下陷，以及大肠失去收敛功能所致。本方去掉厚朴、苍术、猪苓、泽泻、车前子，加人参、芍药、神曲、诃子、肉豆蔻、乌梅、五倍子（各等分）制成丸药，用防风升麻汤送服。完谷不化，属热证，加黄芩、黄连、滑石（各一钱）；属气虚者，加人参、芍药、升麻（各等分），去掉猪苓、泽泻、桂枝。食积泻，加山楂、神曲、麦芽、白豆蔻仁（各一钱），严重者，用枳壳大黄汤。
凡是各种泄泻，用本方为基础：春季加防风、白芍药（各八分）；夏季加黄连、香薷、扁豆（各一钱）；秋季加藿香、槟榔、枳壳（各七分）、乌梅（二个）；冬季加干姜、砂仁（各七分）。
又一方：助胃丸治疗大人小儿各种泄泻。
厚朴、苍术、陈皮（各一两五钱）、甘草（炙四钱）、猪苓、泽泻、茯苓（各一两）、白术（一两五钱）、桂枝（三钱）、肉豆蔻（鸡蛋清炒一两）、山楂（二两）。
以上研为末，用神曲二两打糊为丸，如龙眼大小。每服一丸，用清米汤化开送服。
[Pulse] The pulse at the right Guan position (middle cun) is wiry and large, or wiry, soggy, and slippery, indicating diarrhea. A rapid and hurried pulse indicates heat; a deep and fine pulse indicates cold; a wiry and slow pulse indicates Qi deficiency with sinking. If the Heart pulse is weak or absent, it indicates panic-induced diarrhea. Medical aphorisms state: In cases of dysentery/diarrhea, a small pulse suggests survival potential, whereas a large, floating, or surging pulse indicates no hope of recovery.
[Symptoms] The *Neijing* states: Wind injury in spring leads to undigested stool diarrhea (Sun Xie) in summer. It also states: Excessive dampness causes five types of diarrhea. Dai Shi stated: "Sun Xie" refers to water and grain passing through undigested, caused by dampness combined with wind. "Tang Xie" refers to gradual discharge of foul, sticky residue, caused by dampness combined with heat. "Xie" refers to clear, cold discharge with clear urine, caused by dampness combined with cold. "Ru Xie" refers to heavy body and weakness with watery discharge, caused by excessive dampness. "Hua Xie" refers to chronic, uncontrollable diarrhea due to dampness overwhelming and causing Qi collapse. Thus, there are differences in cold, heat, deficiency, and excess; how can one adhere to a single treatment method?
[Treatment] According to Dai Shi: Diarrhea with water discharge but no abdominal pain is due to dampness; Si Ling San (Four-Ingredient Poria Decoction) with added Cang Zhu (Atractylodis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) is suitable. Food remaining in the stomach undigested indicates Qi deficiency; Si Jun Zi Tang (Four-Gentlemen Decoction) with added Bai Shao Yao (Paeoniae Radix Alba) and Sheng Ma (Cimicifugae Rhizoma) is used. Abdominal pain, watery diarrhea, borborygmus, and pain preceding each bowel movement indicate fire; Si Ling San with added Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Mu Tong (Akebiae Caulis) is used. Intermittent diarrhea with varying amounts indicates phlegm; Er Chen Tang (Two-Aged Decoction) with added Cang Zhu, Bai Zhu, Hai Shi (Calcium Carbonatum), Qing Dai (Indigo Naturalis), Huang Qin, and Shen Qu (Massa Medicata Fermentata) is used, or emesis may be induced. Severe abdominal pain relieved after diarrhea indicates food stagnation; mild cases use Bao He Wan (Preserve Harmony Pill), severe cases use Bai Zhu, Zhi Shi (Aurantii Fructus Immaturus), Shan Zha (Crataegi Fructus), Shen Qu, and Da Huang (Rhei Radix et Rhizoma) to digest and purge, followed by adjustment with Shen Ling Ping Wei San (Ginseng, Poria, and Magnolia Bark Powder). Generally, Wei Ling Tang (Stomach and Poria Decoction) is the universal formula for treating diarrhea, modified according to symptoms.
[Formula] Wei Ling Tang is the universal formula for treating diarrhea.
Hou Po (Magnoliae Officinalis Cortex), Cang Zhu (Atractylodis Rhizoma) (each 1 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian), Chen Pi (Citri Reticulatae Pericarpium) (0.8 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, prepared) (0.3 qian), Fu Ling (Poria) (0.8 qian), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Che Qian Zi (Plantaginis Semen) (each 0.7 qian), Gui Zhi (Cinnamomi Ramulus) (0.3 qian).
Take as one dose. Add one slice of fresh ginger and one red date. Boil in 1.5 zhong of water until reduced to 0.8 zhong. Take after meals.
Between summer and autumn, when warm-heat prevails, acute watery diarrhea occurs: add Huang Lian (Coptidis Rhizoma), Dou Bian Dou (Dolichoris Semen), Sheng Ma (Cimicifugae Rhizoma), Shan Zhi (Gardeniae Fructus), Mu Tong (Akebiae Caulis) (each 0.5 qian), and Bai Shao Yao (Paeoniae Radix Alba) (1 qian).
For fever, dryness, and thirst: add Ge Gen (Puerariae Lobatae Radix), Shi Gao (Gypsum Fibrosum), Hua Shi (Talcum) (each 1 qian).
For jaundice with red, scanty urination: add Yin Chen (Artemisiae Scopariae Herba), Shi Gao (Gypsum Fibrosum) (each 1 qian), Shan Zhi (Gardeniae Fructus), Mu Tong (Akebiae Caulis), Bai Shao Yao (Paeoniae Radix Alba) (each 0.8 qian).
Diarrhea immediately after drinking alcohol indicates wine accumulation: add Bai Shao Yao (Paeoniae Radix Alba), Huang Lian (Coptidis Rhizoma), Dou Bian Dou (Dolichoris Semen), Ge Gen (Puerariae Lobatae Radix) (each 1 qian); remove Gui Zhi (Cinnamomi Ramulus).
In cold months, loose, cold diarrhea with abdominal pain, or caused by consuming raw/cold foods: add Shen Qu (Massa Medicata Fermentata), Mai Ya (Hordei Fructus Germinatus), Sha Ren (Amomi Fructus), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Mu Xiang (Aucklandiae Radix) (each 0.7 qian), Gan Jiang (Zingiberis Rhizoma) (0.5 qian).
For chronic diarrhea with sinking of Stomach Qi: remove Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Che Qian Zi (Plantaginis Semen); add Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), Bai Shao Yao (Paeoniae Radix Alba) (each 1 qian), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix) (each 0.4 qian).
For chronic diarrhea with Spleen-Stomach deficiency and uncontrolled slipping: add Rou Dou Kou (Myristicae Semen), He Zi (Chebulae Fructus) (1 qian, 0.8 qian respectively), Mu Xiang (Aucklandiae Radix), Gan Jiang (Zingiberis Rhizoma) (each 0.5 qian).
For chronic diarrhea with Stomach deficiency, distension, and dry retching: add Huo Xiang (Agastaches Herba), Sha Ren (Amomi Fructus), Ban Xia (Pinelliae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (each 0.7 qian); remove Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Che Qian Zi (Plantaginis Semen).
For severe heat with scalding diarrhea: add Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Mu Tong (Akebiae Caulis), Hua Shi (Talcum) (each 0.8 qian); remove Gui Zhi (Cinnamomi Ramulus). For abdominal pain with cold, clear diarrhea, preference for warmth, and no thirst (Cold Diarrhea): double Gui Zhi (Cinnamomi Ramulus), add Gan Jiang (Zingiberis Rhizoma), Rou Dou Kou (Myristicae Semen) (each 0.8 qian), Mu Xiang (Aucklandiae Radix) (0.5 qian); for severe cold, use Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle). [See Cold Chapter].
For chronic diarrhea with anal laxity or prolapse, due to Yuan Qi sinking and Large Intestine failing to consolidate: remove Hou Po (Magnoliae Officinalis Cortex), Cang Zhu (Atractylodis Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Che Qian Zi (Plantaginis Semen); add Ren Shen (Ginseng Radix et Rhizoma), Shao Yao (Paeoniae Radix), Shen Qu (Massa Medicata Fermentata), He Zi (Chebulae Fructus), Rou Dou Kou (Myristicae Semen), Wu Mei (Mume Fructus), Wu Bei Zi (Galla Chinensis) (equal parts) to make pills. Take with Fang Feng Sheng Ma Tang (Saposhnikovia and Cimicifuga Decoction). For undigested stool due to heat: add Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Hua Shi (Talcum) (each 1 qian); due to Qi deficiency: add Ren Shen (Ginseng Radix et Rhizoma), Shao Yao (Paeoniae Radix), Sheng Ma (Cimicifugae Rhizoma) (equal parts); remove Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Gui Zhi (Cinnamomi Ramulus). For food stagnation diarrhea: add Shan Zha (Crataegi Fructus), Shen Qu (Massa Medicata Fermentata), Mai Ya (Hordei Fructus Germinatus), Bai Dou Kou (Amomi Fructus) (each 1 qian); for severe cases, use Zhi Ke Da Huang Tang (Immature Bitter Orange and Rhubarb Decoction).
For all types of diarrhea, using this base formula: Spring adds Fang Feng (Saposhnikoviae Radix), Bai Shao Yao (Paeoniae Radix Alba) (each 0.8 qian); Summer adds Huang Lian (Coptidis Rhizoma), Xiang Ru (Elsholtziae Herba), Dou Bian Dou (Dolichoris Semen) (each 1 qian); Autumn adds Huo Xiang (Agastaches Herba), Bing Lang (Arecae Semen), Zhi Ke (Aurantii Fructus) (each 0.7 qian), Wu Mei (Mume Fructus) (2 pieces); Winter adds Gan Jiang (Zingiberis Rhizoma), Sha Ren (Amomi Fructus) (each 0.7 qian).
Another Formula: Zhu Wei Wan (Stomach-Assisting Pill) treats various diarrheas in adults and children.
Hou Po (Magnoliae Officinalis Cortex), Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium) (each 1.5 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, prepared) (4 qian), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Fu Ling (Poria) (each 1 liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1.5 liang), Gui Zhi (Cinnamomi Ramulus) (3 qian), Rou Dou Kou (Myristicae Semen, stir-fried with egg white) (1 liang), Shan Zha (Crataegi Fructus) (2 liang).
Grind into powder. Use 2 liang of Shen Qu (Massa Medicata Fermentata) made into paste to form pills the size of longan seeds. Take one pill per dose, dissolved in clear rice soup.