泄泻之证，水谷或化或不化，并无努责，惟觉困倦。若滞下则不然，或脓或血，或脓血相杂，或
肠垢或无糟粕，或糟粕相杂。虽有痛不痛之异，然皆里急后重，逼迫恼人。
洁古论曰∶脏腑泻利，其证多种，大抵从风湿热论之，是知寒少热多，寒则不能久也。故曰暴泄
非阴，久泄非阳。论云∶春宜缓形，形缓动则肝木乃荣，反静密则是行秋令，金能制木，风气五内，
夏至则火盛而金去，独火木旺而脾土损矣。轻
则餐泄，身热脉洪，谷不能化。重则下利，脓血稠粘，里急后重。故曰诸泄稠粘，皆属于火。经曰∶
溲而便脓血，知气行而血止也。宜大黄汤下之，是为重剂。黄芩芍药汤，是为轻剂。是实则泄其子，
木能自虚而脾土实矣。故经曰∶春伤于风，夏为餐泄。此逆四时之气，人所自为也。（此一节热泄，
所谓滞下也）。有自太阴脾经受湿，而为水泄虚滑，身重微满，不知谷味。假令春宜益黄散补之，夏
宜泄之。法云宜补、宜泄、宜和、宜止。和则芍药汤，止则诃子汤。久则防变而为脓血，是脾经传受
于肾，谓之贼邪，故难愈也。若先利而后滑，谓之微邪，故易安也。此皆脾土受湿，天之所为也。虽
圣智不能逃，口食味，鼻食气，从鼻而入，留积于脾，而为水泄也。（此一节湿泄，所谓泄泻也）。
有厥阴经动下利不止，其脉沉而迟，手足厥逆，脓血稠粘，此为难治，宜麻黄汤、小续命汤汗之。法
云谓有表邪缩于内，当散表邪而自愈。（此一节风泄，所谓久泄也）。有暴下无声，身冷自汗，小便
清利，大便不禁，气难布息，脉微呕吐，急以重药温之，浆水散是也。（此一节寒泄，所谓暴泄也）。
故法曰后重者宜下，腹痛者宜和，身重者宜除湿，脉弦者去风。脓血稠粘者，以重药竭之。身冷自汗
者，以毒药温之。风邪内缩者，宜汗之则愈。 溏为利，宜温之而已。又曰在表者发之，在里者下之，
在上者涌之，在下者竭之。身表热者内疏之，小便涩者分利之。又曰盛者和之，去者送之，过者止之。
兵法曰∶避其来锐，击其惰归，此之谓也。凡病泄而恶寒，太阴传少阴，为土来克水也。用除湿白术、
茯苓，安脾芍药，桂枝、黄连破血。火邪不能胜水，太阴经不能传少阴，而反助火邪上乘肺经，而痢
必白脓也，加当归、芍药之类是已。又里急后重，脉大而洪实，为里实证，而痛甚是有物结坠也，宜
下之。若脉浮大，慎不可下。虽里急后重，脉沉细而弱者，谓寒邪在内而气散也，可温养而自安。里
急后重闭者，大肠气不宣通也。宜加槟榔、木香，宣通其气。若四肢慵倦，小便少或不利，大便走沉
困，饮食减少，宜调胃去湿，白术、芍药、茯苓三味水煎服。白术除脾胃之湿，芍药除胃之湿热，四
肢困倦，茯苓能通水道走湿。如发热恶寒腹不痛，加黄芩为主。如未见脓而恶寒，乃太阴欲传少阴也，
加黄连为主，桂枝佐之。如腹痛甚，加当归、倍芍药。如见血加黄连为主，桂枝、当归佐之。如烦躁
或先便白脓后血，或发热，或恶寒，非黄连不能止上部血也。如恶寒脉
沉，先血后便，非地榆不能除下部血也。如恶寒脉沉，或腰痛，或脐下痛，非黄芩不能除中部血也。
如便脓血相杂而脉浮大，慎勿以大黄下之，下之必死，谓气下竭也，而阳无所收。凡阴阳不和，惟以
分阴阳之法治之。又曰∶暴泄非阴，久泄非阳。有热者脉疾，身动声亮，暴注下迫，此阳也。寒者脉
沉而细，身困，鼻息微者，姜附汤主之。身重不举，术附汤主之。渴引饮者，是热在膈上，水多入则
自胸膈入胃中，胃本无热，因不胜其水，胃受水攻，故水谷一时下。此证当灸大椎三五壮立已，乃督
脉泻也。如用药使，车前子、雷丸、白术、茯苓之类，五苓散亦可。又有寒泄者，大腹满而泄。又有
溏者，是寒泄也。 者、鸭也，大便如水，其中有少结粪者是也。如此者，当用天麻、附子、干姜
之类。又法曰泄有虚实寒热，虚则无力，不及拈衣，未便已泄出，谓不能禁固也。实则数至圊而不便，
俗云虚坐努责是也。里急后重，皆根据前法，进退大承气汤主之。太阳病为挟热痢，凉膈散主之。（表
证误下，因而下利不止，为挟热利）。阳明为痼瘕，进退大承气汤主之。太阴湿胜濡泻，不可下，而
可温，四逆汤主之。少阴蛰风不动，禁固可涩，赤石脂丸、干姜汤主之。厥阴风泄以风治，宜小续命
汤、消风汤主之。少阳风气自动，大柴胡汤主之。胃泄，饮食不化，色黄。
（承气汤。）脾泄，腹胀满泄注，食即呕吐逆。（建中、理中汤。）大肠泄，食已窘迫，大便色白，
肠鸣切痛。（干姜附子汤。）小肠泄，溲而便脓血，少腹痛。（承气汤。）大瘕泄，里急后重，数至
圊而不能便，茎中痛。五泄之病，胃、小肠、大瘕三证，皆以清凉饮子主之，其泄自止。厥阴证，加
甘草以缓之。少阴证，里急后重加大黄。又有太阴、阳明二证，当进退大承气汤主之。太阴证，不能
食是也，当先补而后泄之，乃进药法也。先煎浓朴半两，制，水煎，二三服后，未已，谓有宿食未消，
又加枳实二钱，同煎，二三服泄又未已，如稍进食，尚有热毒，又加大黄三钱推过，泄止住药。如泄
未已，为肠胃有久尘垢滑粘，加芒硝半合，宿垢去尽则愈也。阳明证，能食是也，当先泄而后补，谓
退药法也。先用大承气汤五钱，水煎服，如利过泄未止，去芒硝；后稍热退，减大黄一半，再煎两服，
如热气虽已，其人必腹满，又减去大黄，与枳实浓朴汤，又煎三两服；如腹满退，泄亦自愈，后服浓
朴汤数服则已。按进退承气法，须审之脉证的，知有积热，及形病俱实，而后可下。此以上虽出《洁
古家珍》、东垣《活法机要》而多出于刘河间《保命集》之文，故其用药于疏荡为多，观者会其意，
毋泥其辞可矣。东垣云∶胃气和平，饮食入胃，精气则输于脾，上归于肺，行于百
脉，而养荣卫也。若饮食一伤，起居不时，损其胃气，则上升精华之气反下降，是为餐泄，久则太阴
传少阴而为肠 。假令伤寒冷冻饮料食， 满而胀，传为餐泄者，宜温热之剂以消导之。伤湿热之物而成
脓血者，宜苦寒之剂以内疏之。风邪下陷者升举之。湿气内盛者分利之。里急者下之。后重者调之。
腹痛者和之。洞泄肠鸣无力，不及拈衣，其脉细微而弱者，温之收之。脓血稠粘，数至圊而不能便，
其脉洪大而有力者，下之寒之。大抵治病，当求其所因，察何气之胜，取相克之药平之，随其所利而
利之，以平为期。此治之大法也。泻利久不止，或暴下者，皆太阴受病，不可离甘草、芍药。若不受
湿则不利，故须用白术。是以圣人立法，若四时下利，于芍药、白术内，春加防风，夏加黄芩，秋加
浓朴，冬加桂、附。然更详外证寒热处之，如里急后重，须加大黄。如身困倦，须用白术。若自汗逆
冷气息微，加桂、附以温之。如或后重，脓血稠粘，虽在盛冬，于温药内亦加大黄。
【诊】胃脉虚则泄。脉滑按之虚绝者，其人必下利。肺脉小甚为泄。（小者，气血皆虚。）肾脉小
甚为洞泄。（小者，气血皆少，肾主闭脏，今气血俱少，无以闭脏，故泄）。尺寒脉细，谓之后泄。
尺肤寒，其脉小者，泄，少气。下利脉沉弦者，下重。下利寸口反浮数，尺中
自涩者，必清脓血。病若腹大而泄者，脉当细微而涩，反紧大而滑者死。泄而脉大者，难治。病泄脉
洪大，是逆也。泄注脉缓，时小结者生，浮大数者死。下利脉大为不止。下利日十余行，脉反实者死。
大便赤瓣，餐泄脉小者，手足寒难已。餐泄脉小，手足温易已。腹鸣而满，四肢清泄，其脉大，是逆
也。如是者，不过十五日死矣。腹大胀，四末清，脱形泄甚，是逆也。如是者，不及一时死矣。下利，
手足厥冷无脉者，灸之不温，若脉不还，反微喘者死。下利后脉绝，手足厥冷， 时脉还，手足温者
生，脉不还者死。病者痿黄，燥而不渴，胸中寒而利不止者死。假令下利，寸口关上尺中悉不见脉，
然尺中时一小见，脉再举头者，肾气也。若见损脉来，为难治。下利如鱼脑者，半死半生。下利如尘
腐色者死。纯血者死。如屋漏汁者死。下利如竹筒注者，不可治。脉细，皮寒，气少，泄利前后，饮
食不入，此谓五虚，不治。若用参术膏早救之，亦有生者。下则泄泻，上则吐痰，皆不已，为上下俱
脱，死。
泄泻这一病证，食物和水谷有的能消化，有的不能消化，但没有排便时用力努责的感觉，只感到身体困倦乏力。如果是滞下（痢疾），就不是这样了，大便中或有脓，或有血，或脓血混杂，或有肠垢，或没有糟粕，或糟粕与脓血混杂。虽然有腹痛或不痛的区别，但都有里急后重（腹内急迫疼痛，肛门重坠，便意频繁）的症状，令人感到紧迫烦恼。
张洁古论述说：脏腑的泻利，症状多种多样，大抵从风、湿、热来论述，这说明寒证少而热证多，寒邪致病通常不会持久。所以说暴发的泄泻不属于阴证，久延不愈的泄泻不属于阳证。医论说：春季应当使形体舒缓，形体舒缓则肝木之气得以荣盛；如果反而保持静止严密的状态，就像是施行秋季的政令，金气能够克制木气，风气侵入五脏内部，到了夏至时节火气旺盛而金气退去，只有火和木气旺盛而脾土受损了。轻症表现为餐泄（进食即泻），身体发热，脉象洪大，食物不能消化。重症表现为下利（痢疾），脓血稠厚粘腻，里急后重。所以说各种排泄物稠厚粘腻的泄泻，都属于火邪。经书说：小便混浊且大便脓血，说明气机运行而血止（此处指通过通下法使气血调和）。适宜用大黄汤攻下，这是重剂。黄芩芍药汤，是轻剂。这是“实则泻其子”的原则，肝木虚弱则脾土自然充实。所以经书说：春季伤于风邪，夏季就会发生餐泄。这是违背四时气候变化的结果，是人自己造成的。（这一段讲的是热泄，也就是所谓的滞下）。
有因太阴脾经受湿邪侵袭，导致水泄虚滑，身体沉重微感胀满，不知食物滋味。假如春季适宜用益黄散补益，夏季适宜用清泄之法。治法说：适宜补益、适宜清泄、适宜调和、适宜固涩。调和可用芍药汤，固涩可用诃子汤。如果病程长久，防止病变转化为脓血，这是脾经的病传变到肾经，称为贼邪，所以难以治愈。如果先腹泻而后转为滑脱不禁，称为微邪，所以容易痊愈。这些都是脾土受湿邪困扰，是天时的影响。即使是圣智之人也不能逃避，口尝味道，鼻嗅气味，从鼻而入，留积在脾脏，从而形成水泄。（这一段讲的是湿泄，也就是所谓的泄泻）。
有厥阴经动乱导致下利不止，脉象沉而迟，手足冰冷逆冷，脓血稠厚粘腻，这属于难治之症，适宜用麻黄汤、小续命汤发汗解表。治法说：如果有表邪收缩入内，应当发散表邪而自愈。（这一段讲的是风泄，也就是所谓的久泄）。有突然腹泻声音微弱，身体寒冷自汗，小便清长通畅，大便失禁，气息短促难布，脉象微弱伴有呕吐，急需重用温性药物救治，浆水散就是此类方剂。（这一段讲的是寒泄，也就是所谓的暴泄）。
所以治法说：肛门重坠者适宜攻下，腹痛者适宜调和，身体沉重者适宜祛除湿邪，脉弦者适宜祛风。脓血稠厚粘腻者，用重剂攻逐。身体寒冷自汗者，用毒性较大的温热药温补。风邪内陷者，发汗即可痊愈。大便稀溏为利，适宜温补而已。又说：病邪在表的发汗解表，在里的攻下泄热，在上部的涌吐，在下部的竭除。体表发热者内疏清热，小便涩滞者分利水道。又说：邪气盛的调和它，正气去的护送它，过度的制止它。兵法说：避开敌人锐气，攻击敌人懈怠归来之时，说的就是这个道理。凡是患泄泻并恶寒的，是太阴传至少阴，为土来克水。使用除湿白术、茯苓，安脾芍药，桂枝、黄连破血。如果火邪不能胜过水邪，太阴经不能传至少阴，反而助长火邪上乘肺经，那么痢疾必定排出白色脓液，加入当归、芍药之类就是了。又有里急后重，脉象大而洪实，属于里实证，而且疼痛严重是有实物结聚下坠，适宜攻下。如果脉象浮大，千万不可攻下。虽然里急后重，但脉象沉细而弱，说明寒邪在内而气机涣散，可以温养而自愈。里急后重闭塞不通，是大肠气机不宣通。适宜加槟榔、木香，宣通气机。如果四肢慵懒疲倦，小便少或不利，大便走注困重，饮食减少，适宜调理胃气祛除湿邪，白术、芍药、茯苓三味药水煎服。白术祛除脾胃之湿，芍药祛除胃之湿热，四肢困倦，茯苓能通调水道走泄湿气。如果发热恶寒腹部不痛，加黄芩为主药。如果未见脓血而恶寒，是太阴欲传少阴，加黄连为主药，桂枝佐助。如果腹痛严重，加当归、加倍芍药。如果见血加黄连为主药，桂枝、当归佐助。如果烦躁或先排白色脓液后排血，或发热，或恶寒，非黄连不能止住上部的出血。如果恶寒脉沉，先血后便，非地榆不能清除下部的出血。如果恶寒脉沉，或腰痛，或脐下痛，非黄芩不能清除中部的出血。如果便脓血混杂而脉象浮大，千万不要用大黄攻下，攻下必死，这是因为气机下竭，阳气无所收敛。凡是阴阳不和，只用分理阴阳的方法治疗。又说：暴发性泄泻不属于阴证，久延泄泻不属于阳证。有热证的脉象急数，身体躁动声音响亮，暴注下迫，这是阳证。有寒证的脉象沉而细，身体困倦，呼吸微弱的，主用姜附汤。身体沉重不能抬举的，主用术附汤。口渴引饮的，是热在膈上，水多进入则从胸膈进入胃中，胃本无热，因为承受不了这么多水，胃受到水的冲击，所以水谷一时下行。这个病症应当灸大椎穴三五壮立刻痊愈，这是督脉泄热。如果用药物治疗，车前子、雷丸、白术、茯苓之类，五苓散也可以。又有寒泄者，大腹满闷而泄泻。又有溏泄者，也是寒泄。鹜溏（鸭粪样便），大便像水一样，其中夹杂少量成形粪便的是。这样的病症，应当用天麻、附子、干姜之类。又一种说法：泄泻有虚实寒热之分，虚证则无力，连衣服都拿不起来，还没排便就已经泄出，称为不能固摄。实证则是多次去厕所却排不出，俗称虚坐努责。里急后重，都依据前面的方法，进退使用大承气汤主治。太阳病为挟热痢，凉膈散主治。（表证误用下法，因而下利不止，称为挟热利）。阳明病为痼瘕，进退大承气汤主治。太阴病湿胜濡泻，不可攻下，而可温补，四逆汤主治。少阴病蛰风不动，固涩可止，赤石脂丸、干姜汤主治。厥阴病风泄以风邪论治，宜用小续命汤、消风汤主治。少阳病风气自动，大柴胡汤主治。胃泄，饮食不化，颜色发黄。（承气汤。）脾泄，腹胀满泄注，食后即呕吐逆。（建中汤、理中汤。）大肠泄，食后即窘迫，大便色白，肠鸣切痛。（干姜附子汤。）小肠泄，小便混浊且大便脓血，少腹痛。（承气汤。）大瘕泄，里急后重，多次去厕所却不能排便，尿道疼痛。五泄之病，胃、小肠、大瘕三个证候，都以清凉饮子主治，泄泻自然停止。厥阴证，加甘草以缓和病情。少阴证，里急后重加大黄。又有太阴、阳明两个证候，当进退使用大承气汤主治。太阴证，是不能进食，应当先补益而后攻泄，这是进药的方法。先煎浓朴半两，制过，水煎，二三服后，如果未愈，说明有宿食未消，再加枳实二钱，同煎，二三服后泄泻仍未止，如果稍进食，还有热毒，再加大黄三钱推荡排出，泄止停药。如果泄泻未止，是因为肠胃有久积的尘垢滑粘，加芒硝半合，宿垢去尽则痊愈。阳明证，是能进食，应当先攻泄而后补益，这是退药的方法。先用大承气汤五钱，水煎服，如果利下过多泄泻未止，去掉芒硝；后来热势稍退，减去一半大黄，再煎两服，如果热气虽已消除，其人必然腹满，又减去大黄，配合枳实浓朴汤，再煎三两服；如果腹满消退，泄泻也自愈，后来服用浓朴汤几服就好了。按进退承气法，必须审察脉证，知道有积热，以及形体和病邪都属实证，然后才可以攻下。这部分内容虽然出自《洁古家珍》、东垣《活法机要》，但大多出于刘河间《保命集》的文字，所以其用药疏荡居多，读者领会其意旨，不要拘泥于辞句就可以了。李东垣说：胃气和平，饮食入胃，精气则输送给脾，向上归于肺，行于百脉，而滋养营卫。如果饮食一伤，起居不时，损伤胃气，则上升的精华之气反而下降，这就是餐泄，久了则太阴传至少阴而为肠澼。假如伤于寒冷冻饮料食，脘腹胀满而胀，传为餐泄的，适宜用温热药剂以消导它。伤于湿热之物而成脓血的，适宜用苦寒药剂以内疏它。风邪下陷的升举它。湿气内盛的分别利导它。里急的攻下它。后重的调畅它。腹痛的调和它。洞泄肠鸣无力，连衣服都拿不起来，脉象细微而弱的，温补收涩它。脓血稠厚粘腻，多次去厕所却不能排便，脉象洪大而有力的，攻下寒凉它。大抵治病，应当探求病因，观察哪种气偏胜，选取相克的药物来平抑它，随着其所利的方面而利导它，以平衡为准则。这是治疗的根本大法。泻利久不止，或暴下的，都是太阴受病，不可离开甘草、芍药。如果不祛湿则不利，所以必须用白术。因此圣人立法，如果在四季出现下利，在芍药、白术之内，春季加防风，夏季加黄芩，秋季加浓朴，冬季加桂枝、附子。然而更要详细辨别外证的寒热来处理，如里急后重，须加大黄。如身体困倦，须用白术。如果自汗逆冷气息微弱，加桂枝、附子以温补。如果或后重，脓血稠厚粘腻，即使在严冬，在温药内也加大黄。
【诊法】胃脉虚弱则泄泻。脉滑按之空虚绝断的，其人必定下利。肺脉小甚为泄泻。（小脉，表示气血皆虚。）肾脉小甚为洞泄。（小脉，表示气血俱少，肾主闭藏，现在气血俱少，无法闭藏，所以泄泻。）尺部寒冷脉细，称为后泄。尺肤寒冷，脉小的，泄泻，少气。下利脉沉弦的，肛门重坠。下利寸口脉反浮数，尺中自涩的，必定便脓血。病若腹部膨大而泄泻，脉应当细微而涩，反见紧大而滑的预后不良。泄泻而脉大的，难治。病泄脉洪大，是逆证。泄注脉缓，偶尔小结的预后良好，浮大数的预后不良。下利脉大为不止。下利日十余行，脉反实的预后不良。大便赤瓣，餐泄脉小的，手足寒冷难愈。餐泄脉小的，手足温暖的易愈。腹鸣而满，四肢清冷泄泻，脉大的，是逆证。像这样的，不超过十五日死亡。腹部大胀，四肢清冷，形体脱失泄泻严重，是逆证。像这样的，不到一个时辰死亡。下利，手足厥冷无脉的，艾灸后不温暖，如果脉不还复，反而微喘的预后不良。下利后脉绝，手足厥冷，偶尔脉还复，手足温暖的预后良好，脉不还复的预后不良。病者面色痿黄，干燥但不口渴，胸中寒而利不止的预后不良。假如下利，寸口、关上、尺中都不见脉，然而尺中偶尔一小见，脉再举头的，是肾气尚存。如果见到损脉来，为难治。下利如鱼脑样的，半死半生。下利如尘土腐败色的预后不良。纯血的预后不良。如屋漏汁样的预后不良。下利如竹筒注样的，不可治。脉细，皮肤寒冷，气少，泄利前后，饮食不入，这叫五虚，不治。如果用参术膏早救，也有生还的可能。下则泄泻，上则吐痰，都不停止，为上下俱脱，预后不良。
The syndrome of Xie Xie (diarrhea), food and grain may or may not be digested, without tenesmus (straining during defecation), only feeling fatigue. If it is Zhi Xia (dysentery), however, it is different; there may be pus or blood, or a mixture of pus and blood, or intestinal mucus, or no undigested food residue, or a mixture of residue. Although there are differences in pain or no pain, all involve tenesmus and a sense of urgency and heaviness in the anus, causing distress.
Jie Gu discussed: The syndromes of diarrhea and dysentery from the zang-fu organs are varied, generally discussed in terms of wind, dampness, and heat, indicating that cold syndromes are few and heat syndromes are many, and cold pathogens do not persist long. Thus it is said: Acute diarrhea is not Yin, chronic diarrhea is not Yang. The treatise states: In spring, one should keep the body relaxed; relaxation allows the Liver Wood to flourish. Conversely, remaining still and rigid resembles the action of Autumn Metal, which controls Wood. Wind Qi invades the internal organs. By Summer Solstice, Fire is prosperous and Metal recedes, leaving only Fire and Wood flourishing while Spleen Earth is damaged. Mild cases present as Can Xie (immediate postprandial diarrhea) with fever and a洪 (surging) pulse, where food cannot be digested. Severe cases present as Xia Li (dysentery) with thick, sticky pus and blood, and tenesmus. Thus it is said: All diarrhea with thick, sticky discharge belongs to Fire. The Classic says: Urine mixed with pus and blood indicates that Qi moves and Blood stops. It is appropriate to use Da Huang Tang (Rhubarb Decoction) to purge, which is a heavy formula. Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is a light formula. This follows the principle of "purging the son when excess," so if Liver Wood is weakened, Spleen Earth becomes solid. Thus the Classic says: Injury by Wind in Spring leads to Can Xie in Summer. This goes against the Qi of the four seasons and is self-inflicted. (This section discusses Heat Diarrhea, also known as Zhi Xia).
There are cases where the Taiyin Spleen Meridian is affected by Dampness, leading to watery, loose stools, heaviness of the body, slight fullness, and loss of taste for food. For example, in Spring, Yi Huang San (Benefit Yellow Powder) is suitable for tonification; in Summer, purgation is suitable. The method states: Suitable for tonification, purgation, harmonization, or astringency. Harmonization uses Shao Yao Tang (Peony Decoction); astringency uses He Zi Tang (Chebula Decoction). If prolonged, prevention of transformation into pus and blood is necessary; this is the transmission of the Spleen Meridian to the Kidney, called Zei Xie (Robber Pathogen), making it difficult to cure. If diarrhea precedes sliding incontinence, it is called Wei Xie (Minor Pathogen), making it easy to recover. These are all due to Spleen Earth being affected by Dampness, an act of Heaven. Even sages and wise men cannot escape it. Taste enters through the mouth, Qi through the nose; entering via the nose, it accumulates in the Spleen, forming watery diarrhea. (This section discusses Damp Diarrhea, also known as Xie Xie).
There are cases where the Jueyin Meridian is disturbed, causing continuous diarrhea, with a deep and slow pulse, cold limbs, and thick, sticky pus and blood; this is difficult to treat. It is appropriate to use Ma Huang Tang (Ephedra Decoction) or Xiao Xu Ming Tang (Small Continuation of Life Decoction) to induce sweating. The method states: If exterior pathogen has contracted inward, dispersing the exterior pathogen leads to self-healing. (This section discusses Wind Diarrhea, also known as Chronic Diarrhea). There are cases of sudden, silent diarrhea, cold body with spontaneous sweating, clear and profuse urination, involuntary defecation, shortness of breath, weak pulse, and vomiting; urgent treatment with heavy warming medicines is required, such as Jiang Shui San (Fermented Grain Water Powder). (This section discusses Cold Diarrhea, also known as Acute Diarrhea).
Thus the method states: For tenesmus, use purgation; for abdominal pain, use harmonization; for heaviness, use dampness removal; for wiry pulse, use wind expulsion. For thick, sticky pus and blood, use heavy purgatives. For cold body and spontaneous sweating, use toxic warming agents. For contracted wind pathogen, sweating leads to recovery. Loose stools indicate Li (diarrhea), suitable for warming only. It is also said: Exterior pathogens are released via sweating; interior pathogens are purged; upper pathogens are vomited; lower pathogens are exhausted. For exterior heat, clear internally; for astringent urination, separate and promote diuresis. It is also said: For excess, harmonize; for deficiency, support; for excess, stop. As military strategy says: Avoid their sharp onset, strike when they are tired and returning. This is what is meant. Whenever disease involves diarrhea and aversion to cold, it is Taiyin transmitting to Shaoyin, where Earth overcomes Water. Use Chu Shi Bai Zhu (Damp-Removing Atractylodes), Fu Ling (Poria), An Pi Shao Yao (Spleen-Calming Peony), Gui Zhi (Cinnamon Twig), and Huang Lian (Coptis) to break blood stasis. If Fire pathogen cannot overcome Water, Taiyin cannot transmit to Shaoyin, but instead aids Fire pathogen to ascend to the Lung Meridian, resulting in white pus in dysentery; adding Dang Gui (Angelica Sinensis) and Shao Yao (Peony) addresses this. Also, tenesmus with a large, surging, and solid pulse indicates interior excess syndrome, and severe pain indicates physical obstruction; purgation is suitable. If the pulse is floating and large, purgation must be avoided. Although there is tenesmus, if the pulse is deep, fine, and weak, it indicates interior cold pathogen and scattered Qi; warming and nourishing will lead to recovery. Tenesmus with blockage indicates lack of circulation in Large Intestine Qi. Adding Bing Lang (Areca Seed) and Mu Xiang (Aucklandia Root) promotes Qi circulation. If limbs are lethargic, urine is scanty or obstructed, stool is frequent and heavy, and appetite is reduced, regulate Stomach Qi and remove dampness using Bai Zhu (Atractylodes Macrocephala), Shao Yao (Peony), and Fu Ling (Poria) decocted in water. Bai Zhu removes Spleen-Stomach dampness; Shao Yao removes Stomach damp-heat; Fu Ling unblocks water passages to drain dampness. If fever and aversion to cold occur without abdominal pain, add Huang Qin (Scutellaria) as the chief herb. If no pus is seen but aversion to cold exists, Taiyin is about to transmit to Shaoyin; add Huang Lian as chief, Gui Zhi as assistant. If abdominal pain is severe, add Dang Gui and double Shao Yao. If blood appears, add Huang Lian as chief, Gui Zhi and Dang Gui as assistants. If irritability occurs, or white pus precedes blood, or fever/aversion to cold exist, only Huang Lian can stop upper bleeding. If aversion to cold with deep pulse, blood precedes stool, only Di Yu (Sanguisorba Root) can clear lower bleeding. If aversion to cold with deep pulse, or backache, or umbilical pain, only Huang Qin can clear middle bleeding. If pus and blood are mixed with a floating-large pulse, strictly avoid Da Huang (Rhubarb) purgation; purgation will cause death due to exhaustion of Qi and loss of Yang containment. For Yin-Yang disharmony, only methods separating Yin and Yang should be used. It is also said: Acute diarrhea is not Yin, chronic diarrhea is not Yang. Heat syndromes have rapid pulses, restless bodies, loud voices, acute pouring diarrhea; these are Yang. Cold syndromes have deep-fine pulses, heavy bodies, faint nasal breathing; treat with Jiang Fu Tang (Ginger and Aconite Decoction). Heavy body unable to move is treated with Shu Fu Tang (Atractylodes and Aconite Decoction). Thirst with drinking indicates heat above the diaphragm; excessive water enters from chest/diaphragm to Stomach; Stomach originally has no heat but cannot withstand the water, so water and grain descend rapidly. Moxibustion on Da Zhui (GV14) 3-5 moxa cones cures this immediately; this is Du Meridian heat clearance. If using herbs, Che Qian Zi (Plantago Seed), Lei Wan (Ascaris), Bai Zhu, Fu Ling, etc., or Wu Ling San (Five-Ingredient Powder with Poria) are suitable. There is also cold diarrhea with great abdominal fullness. There is also loose stool, which is cold diarrhea. Wu Tang (duck feces-like stool) is like water with small formed feces. Such cases require Tian Ma (Gastrodia Rhizome), Fu Zi (Aconite Lateralis Preparata), Gan Jiang (Zingiberis Rhizoma), etc. Another method states: Diarrhea has deficiency/excess and cold/heat. Deficiency presents with weakness, inability to lift clothes, leakage before defecation, indicating inability to secure. Excess presents with frequent trips to toilet without passage, commonly called false tenesmus. Tenesmus follows previous methods, using Da Cheng Qi Tang (Major Order the Qi Decoction) with modifications. Taiyang syndrome with heat-carrying dysentery is treated with Liang Ge San (Cooling Chest Powder). (Exterior syndrome mistakenly purged leads to continuous diarrhea, called heat-carrying diarrhea). Yangming syndrome with fixed masses is treated with Da Cheng Qi Tang with modifications. Taiyin syndrome with dampness-dominant soft diarrhea cannot be purged but warmed; Si Ni Tang (Frigid Extremities Decoction) is used. Shaoyin syndrome with dormant wind immobility requires astringency; Chi Shi Zhi Wan (Halloysitum Pill) and Gan Jiang Tang (Zingiber Decoction) are used. Jueyin wind diarrhea is treated for wind; Xiao Xu Ming Tang and Xiao Feng Tang (Wind-Expelling Decoction) are used. Shaoyang wind qi moving automatically is treated with Da Chai Hu Tang (Major Bupleurum Decoction). Wei Xie (Stomach Diarrhea): undigested food, yellow color. (Cheng Qi Tang.) Pi Xie (Spleen Diarrhea): abdominal fullness, pouring diarrhea, vomiting after eating. (Jian Zhong Tang, Li Zhong Tang.) Da Chang Xie (Large Intestine Diarrhea): urgency after eating, white stool, loud bowel sounds and cutting pain. (Gan Jiang Fu Zi Tang.) Xiao Chang Xie (Small Intestine Diarrhea): turbid urine with pus/blood stool, lower abdominal pain. (Cheng Qi Tang.) Da Jia Xie (Great Mass Diarrhea): tenesmus, frequent toilet visits without passage, penile pain. For the five diarrhea diseases, Stomach, Small Intestine, and Great Mass syndromes are all treated with Qing Liang Yin Zi (Cooling Drink), stopping the diarrhea. Jueyin syndrome adds Gan Cao (Licorice) to moderate. Shaoyin syndrome with tenesmus adds Da Huang. Taiyin and Yangming syndromes use Da Cheng Qi Tang with modifications. Taiyin syndrome is inability to eat; tonify first, then purge (advancing medicine). First decoct Hou Po (Magnolia Bark) 0.5 liang (processed) in water, take 2-3 doses. If unresolved, indicating undigested food, add Zhi Shi (Immature Bitter Orange) 2 qian, decoct together, take 2-3 doses. If diarrhea persists and slight intake reveals heat toxin, add Da Huang 3 qian to push out, stop medicine when diarrhea stops. If diarrhea persists due to old dirt/slime in intestines, add Mang Xiao (Mirabilite) 0.5 he; once old filth is gone, cure is achieved. Yangming syndrome is ability to eat; purge first, then tonify (retreating medicine). First use Da Cheng Qi Tang 5 qian decocted in water. If purgation is excessive and diarrhea continues, remove Mang Xiao. When heat slightly subsides, reduce Da Huang by half, decoct and take 2 doses. If heat clears but abdominal fullness remains, further reduce Da Huang, combine with Zhi Shi and Hou Po decoction, take 2-3 doses. If fullness resolves, diarrhea heals; follow with several doses of Hou Po decoction. According to the advancing/retreating Cheng Qi method, one must examine pulse and symptoms, know of accumulated heat, and confirm both form and pathogen are excess before purging. Although this comes from *Jie Gu Jia Zhen* and Dong Yuan's *Huo Fa Ji Yao*, much originates from Liu He Jian's *Bao Ming Ji*. Their medication is mostly purgative/draining; readers should grasp the intent, not stick to the words. Dong Yuan said: When Stomach Qi is peaceful, food enters Stomach, essence is transported to Spleen, returns to Lung, circulates in hundred vessels, nourishing Ying and Wei. If diet is injured, daily life irregular, damaging Stomach Qi, ascending clear Qi descends instead, becoming Can Xie; long-term Taiyin transmits to Shaoyin becoming Chang Pi. If injured by cold drinks/food, abdominal fullness transforms into Can Xie; treat with warm agents to digest. If injured by damp-heat foods forming pus/blood, treat with bitter-cold agents to clear internally. Sunken wind pathogen is lifted. Internal excess dampness is separated and drained. Tenesmus is purged. Heaviness is regulated. Abdominal pain is harmonized. Hole diarrhea with bowel sounds and weakness, unable to lift clothes, fine-weak pulse, is warmed and secured. Thick sticky pus/blood, frequent toilet without passage, surging-strong pulse, is purged and cooled. Generally, treating disease seeks the cause, observes which Qi is excessive, uses counteracting drugs to balance, facilitates according to benefit, aiming for balance. This is the general method. Long-standing or acute diarrhea involves Taiyin pathology; do not depart from Gan Cao and Shao Yao. Without removing dampness, there is no relief, so Bai Zhu is necessary. Thus sages established laws: For seasonal diarrhea within Shao Yao and Bai Zhu base, add Fang Feng (Saposhnikovia) in Spring, Huang Qin in Summer, Hou Po in Autumn, Gui Zhi and Fu Zi in Winter. However, detail external cold/heat signs: for tenesmus, add Da Huang; for body heaviness, use Bai Zhu; for spontaneous sweating, cold limbs, faint breath, add Gui Zhi and Fu Zi to warm. If tenesmus, thick pus/blood, even in deep winter, add Da Huang to warm medicines.
[Diagnosis] Weak Stomach pulse causes diarrhea. Slippery pulse that feels empty upon pressing indicates definite diarrhea. Very small Lung pulse indicates diarrhea (small means Qi and Blood are deficient). Very small Kidney pulse indicates hole diarrhea (small means Qi and Blood are scarce; Kidney governs closure; now Qi/Blood are scarce, unable to close, hence diarrhea). Cold chi pulse fine indicates posterior diarrhea. Cold chi skin with small pulse indicates diarrhea and shortness of breath. Diarrhea with deep-wiry pulse indicates heaviness in anus. Diarrhea with floating-rapid cunkou pulse and stagnant chi pulse indicates pus/blood stool. Disease with large abdomen and diarrhea should have fine-weak-choppy pulse; tight-large-sliding pulse indicates death. Diarrhea with large pulse is difficult to treat. Diarrhea with surging-large pulse is adverse. Pouring diarrhea with slow pulse, occasionally small knot, indicates survival; floating-large-rapid indicates death. Diarrhea with large pulse indicates non-stop. Diarrhea >10 times/day with real pulse indicates death. Red瓣 stool, Can Xie with small pulse, cold extremities, difficult to cure. Can Xie with small pulse, warm extremities, easy to cure. Bowel sounds with fullness, cold limbs with diarrhea, large pulse, is adverse; death within 15 days. Large abdominal distension, cold extremities, emaciation with severe diarrhea, is adverse; death within one shichen (2 hours). Diarrhea with cold limbs and no pulse, moxibustion does not warm, pulse does not return, slight panting indicates death. After diarrhea, pulse vanishes, cold limbs, pulse returns occasionally, warm limbs indicates survival; pulse does not return indicates death. Patient with sallow complexion, dry but not thirsty, cold chest with continuous diarrhea indicates death. If diarrhea, cunkou/guan/chizi pulses all absent, but chi pulse occasionally appears small, pulse rises twice, indicates Kidney Qi remains. If damaged pulse appears, difficult to treat. Diarrhea like fish brain: half dead, half alive. Diarrhea like dust/rotten color: death. Pure blood: death. Like roof leak juice: death. Diarrhea like bamboo tube pouring: incurable. Fine pulse, cold skin, shortness of breath, anterior/posterior diarrhea, no food/drink intake, called Five Deficiencies, incurable. Early rescue with Shen Zhu Gao (Ginseng and Atractylodes Paste) may yield survival. Downward diarrhea, upward phlegm vomiting, both unceasing, indicates upper/lower collapse, death.