《金匮》下利病脉证并治∶夫六腑气绝于外者，手足寒，上气脚缩。五脏气绝于内者，利不禁，
甚者手足不仁。下利，脉沉弦者下重，脉大者为未止，脉微弱数为欲自止，虽发热不死。下利，手足
厥冷无脉者，灸之不温，若脉不还，反微喘者死。少阴负趺阳者，为顺也。下利，有微热而渴，脉弱
者，当自愈。下利，脉数有微热，汗出，今当自愈。设脉紧，为未解。下利，脉数而渴者，当自愈，
设不瘥，必清脓血，以有热也。（清，古圊字）。下利，脉反弦，发热身汗者，自愈。下利气者，当
利小便。下利，寸脉反浮数，尺中自涩者，必清脓血。下利清谷，不可攻其表，汗出必胀满。下利脉
沉而迟，其人面少赤，身微热，下利清谷者，必郁冒，汗出而解，病患必微厥，所以然者，其面戴阳，
下虚故也。下利后脉绝，手足厥冷， 时脉还，手足温者生，脉不还者死。下利腹胀满，身体疼痛者，
先温其里，后攻其表，
温里宜四逆汤，攻表宜桂枝汤。下利，三部脉皆平，按之心下坚者，急下之，宜大承气汤。下利脉迟
而滑者，实也。利未欲止，急下之，宜大承气汤。下利脉反滑者，当有所去，下乃愈，宜大承气汤。
下利已瘥，至年月日时复发者，以病不尽故也。当下之，大承气汤。（以上数承气汤，本虚者当别议。）
下利谵语者，有燥矢故也。小承气汤主之。下利便脓血者，桃花汤主之。热利下重者，白头翁汤主之。
下利后更烦，按之心下濡者，为虚烦也，栀子豉汤主之。下利清谷，里寒外热，汗出而厥者，通脉四
逆汤主之。下利腹痛，紫参汤主之。干呕下利，黄芩汤主之。上此下利一章，后世名医诸书，皆以为
法。古之所谓下利，即今之所谓泄泻也。内有治伤寒数方，仲景用治杂病，今全录之，使后人知云治
伤寒有法，治杂病有方者非也。伤寒杂病同一法矣。
丹溪云∶有湿、有气虚、火、痰、食积。戴复庵云∶泻水腹不痛者，湿也。饮食入胃，辄后之，
完谷不化者，气虚也。腹痛泻水，肠鸣，痛一阵泻一阵者，火也。
或泻或不泻，或多或少者，痰也。腹痛甚而泻，泻后痛减者，食积也。湿多成五泄。戴云∶餐泄者，
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，所下澄彻清冷，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，久下不能禁固，湿胜气脱也。湿泻脉
濡细，乃太阴经脾土受湿，泄水虚滑，身重微满，不知谷味，口不渴，久雨泉溢河溢，或运气湿土司
令之时，多有此疾。宜除湿汤吞戊己丸，佐以胃苓汤，重者术附汤。东垣云∶予病脾胃久衰，视听半
失，此阴盛乘阳，加之气短，精神不足，此由弦脉令虚，多言之过也。皆阳气衰弱不得舒伸，伏匿于
阴中耳。癸卯岁六七月间，淫雨阴寒，逾月不止，时人多病泄利。一日予体重肢节疼痛，大便泄并下
者三，而小便闭塞。思其治法，按《内经》标本论，大小不利，无问标本，先利小便。又云∶在下者引
而竭之，亦是先利小便也。又云∶诸泄利，小便不利，先分利之。又云∶治湿不利小便，非其治也。
皆言当利小便，必用淡味渗泄之剂以利之，是其法也。噫，圣人之法，虽布在方策，其不尽者，可以意
求耳。今客邪寒湿之淫，从外而入里，以暴加之，若从已
上法度，用淡渗之剂以除之，病虽即已，是降之又降，是复益其阴，而重竭其阳，则阳气愈削而精神
愈短矣。是阴重强、阳重衰，反助其邪之谓也。故必用升阳风药即瘥，以羌活、独活、柴胡、升麻各
一钱，防风根半钱，炙甘草半钱，同 咀，水二钟煎至一盏，去渣稍热服。大法云∶湿寒之胜，助风
以平之。又曰∶下者举之，得阳气升腾而去矣。又法云∶客者除之，是因曲而为之直也。夫圣人之法，
可以类推，举一而知百者也。若不达升降浮沉之理，而一概施治，其愈者幸也。湿兼寒泻，《内经》
曰∶湿胜则濡泄。《甲乙经》云∶寒气客于下焦，传为濡泄。夫脾者，五脏之至阴，其性恶寒湿。今
寒湿之气内客于脾，故不能裨助胃气腐熟水谷，致清浊不分，水入肠间，虚莫能制，故洞泄如水，随
气而下，谓之濡泄。法当除湿利小便也，治之以对金饮子。湿兼热泻，益元散、参萸丸。湿兼风，见
餐泄条。寒泻，脉沉细或弦迟，身冷口不渴，小便清白，或腹中绵绵作疼，宜理中汤、附子温中汤、
浆水散。暴泄如水，周身汗出，一身尽冷，脉沉而弱，气少而不能语，甚者加吐，此谓紧病，宜以浆
水散治之。若太阳经伤动，传太阴下利，为 溏，大肠不能禁固，卒然而下，中有硬物，欲起而又下，
欲了而又不了，小便多清，此寒也，宜温之。
春夏桂枝汤，秋冬白术汤。理中汤治泄泻，加橘红、茯苓各一两，名补中汤。若溏泄不已者，于补中
汤内加附子一两，不喜饮食，水谷不化者，再加砂仁一两，共成八味。仲景云∶下利不止，医以理中
与之，利益甚。理中者，理中焦。此利在下焦，赤石脂禹余粮汤主之。用此加法则能理下焦矣。戴云∶
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，或附子桂香丸。畏食者，八味丸。元是冷泻，因泻而烦躁引饮，转饮转泻者，参附汤、连理汤。
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，宜十补饮。寒泻腹中大疼，服
前药外，兼进乳豆丸。服诸热药以温中，并不见效，登圊不迭，秽物随出，此属下焦。宜桃花丸二五
粒，诃梨勒丸以涩之。按戴方多过于亢热，用者审之。热泻，脉数疾或洪大，口干燥，身多动，音声
响亮，暴注下迫，益元散加芩、连、灯心、淡竹叶之属。泄而身热，小便不利，口渴者，益元、五苓。
若火多，四苓加木通、黄芩。泄而困倦不便者，及脉数虚热者，宜参、术、滑石、苓、通。泄而脉滑
坚者，实热。宜大承气汤。戴云∶热泻，粪色赤黄，
弹响作疼，粪门焦痛，粪出谷道，犹如汤热，烦渴，小便不利，宜五苓散吞香连丸。凡泻津液既去，
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。玉龙丸，治
一切伏暑泄泻神效。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，自合用热药，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，复用暑药，则决不能取效，便用姜附辈，又似难施，疑似之间，
尤宜用此。气泻，肠鸣气走，胸膈痞闷，腹急而痛，泻则腹下稍可，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。戴法用大七香丸，入米煎服。久而不愈者，五膈宽中
散吞震灵丹，仍佐以米饮调香附末。调气散。《金匮》诃梨勒散，治气利。气虚泻，用四君子汤加曲、
柏、升、柴，吞二神加木香丸。积滞泄泻，腹必耕痛方泄者是也。或肚腹满，按之坚者亦是也。受病
浅者，宜神曲之类消导之。病深而顽者，必用进退承气之类，下之方安。伤食泻，因饮食过多，脾胃
之气不足以运化而泻。其人必噫气如败卵臭，
宜治中汤加砂仁半钱，曲 枳术丸。或七香丸、红丸子杂服。食积腹疼而泻，不可遽用治中 住，宜
先用消导推荡之药。或因食一物过伤而泻，后复食之即泻者，以脾为所伤未复而然，宜大建脾汤，（寒
者可用。）仍烧所伤之物，存性为末，三五钱重，调服。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。有脾气久虚，不受饮食者，食毕即肠鸣
腹急，尽下所食之物方快，不食则无事，俗名录食泻，经年累月，宜快脾丸。因伤于酒，每晨起必泻
者，宜理中汤加干葛，吞酒煮黄连丸。或葛花解酲汤吞之。因伤面而泻者，养胃汤加莱菔子炒研一钱，
痛者更加木香五分，泻甚者去藿香，加炮姜如其数。痰泻，二陈汤、海石、青黛、黄芩、神曲、姜汁、
竹沥为丸。每服三五十丸。少者必用吐法，吐之方愈。一男子夜数如厕，或教以生姜一两，碎之，半
夏汤洗，与大枣各三十枚，水一升，瓷瓶中慢火烧为熟水，时时呷之，数日便已。每日五更即泄泻，
有酒积、有寒积、有食积、有肾虚，俗呼脾肾泄。有人每早须大泻一行，或腹痛，或不腹痛，空心服
热药亦无效。有人教以夜食前，又进热药一服遂安，后如此
常服愈。盖暖药虽平旦服之，至夜力已尽，无以敌一夜阴气之故也。有人每五更将天明时必溏利一次，
有人云此名肾泄，服五味子散顿愈。有人久泄，早必泄一二行，泄后便轻快，脉滑而少弱，先与浓朴
和中丸五十丸，大下之后，以白术为君，枳壳、半夏、茯苓为臣，浓朴、炙甘草、芩、连、川芎、滑
石为佐，吴茱萸十余粒为使，生姜煎服，十余帖而愈。戴云∶有每日五更初洞泻，服止泻药并无效，
米饮下五味丸，或专以北五味煎饮。虽节省饮食，大段忌口，但得日间上半夜无事，近五更其泻复作。
此病在肾分。水饮下二神丸及椒朴丸，或平胃散下小茴香丸。二神丸合五味子散，名为四神丸，治泻
尤妙。小便不利而泄，若津液偏渗于大肠，大便泻而小便少者，用胃苓散分利之。若阴阳已分而小便
短少，此脾肺气虚不能生水也，宜补中益气汤加麦门、五味。阴火上炎而小便赤少，此肺气受伤不能
生水也，用六味地黄丸加麦门、五味。肾经阴虚，阳无所生，而小便短少者，用滋肾丸、肾气丸。肾
经阳虚，阴无所化，而小便短少者，用益气汤、六味丸。若误用渗泄分利，复伤阳气，阴无所生，而
小便益不利，则肿胀之证作而疾危矣。凡大便泄，服理中汤，小便不利，大便反泄，不知气化之过。
本肺不传化，以纯热之药治之，是以转泄，少
服则不止，多服则愈热，所以不分。若以青皮、陈皮之类治之则可。经云∶膀胱者，州都之官，津液
脏焉，气化则能出矣。泄而口渴引饮，此为津液内亡，用钱氏白术散，或补中益气汤。肾水不足之人
患泄，或过服分利之剂而渴者，加减八味丸。失治，必变小便不利，水肿胀满等危证矣。水渍入胃，
名为溢饮滑泄，渴能饮水，水下复泄，泄而大渴，此无药证，当灸大 。（在第一椎下陷中。）滑泻，
东垣云∶中焦气弱，脾胃受寒冷，大便滑泄，腹中雷鸣，或因误下，末传寒中，复遇时寒，四肢厥逆，
心胃绞痛，冷汗不止，此肾之脾胃虚也。沉香温胃丸治之。薛氏曰∶前证若脾胃虚寒下陷者，用补中
益气汤，加木香、肉豆蔻、补骨脂。若脾气虚寒不禁者，用六君子汤，加炮姜、肉桂。若命门火衰，
脾土虚寒者，用八味丸。若脾肾气血俱虚者，用十全大补汤送四神丸。若大便滑利，小便闭涩，或肢
体渐肿，喘嗽唾痰，为脾肾气血俱虚。宜用十全大补汤送四神丸。若大便滑利，小便闭涩，或肢体渐
肿，喘嗽唾痰，为脾胃亏损，宜《金匮》加减肾气丸。《保命集》云∶虚滑久而不止
者，多传变为利，太阴传少阴是为鬼邪，先以浓朴枳实汤，防其传变。按此法实者用之，虚者不若四
神丸实肾之为得也。收涩之剂，固肠丸、诃子散，皆治热滑。扶脾丸、桃花丸、诃子丸、赤石脂禹余
粮汤，皆治寒滑。泻已愈，至明年此月日时复发者，有积故也。脾主信，故至期复发。热积，大承气
汤。寒积、感应丸。虚者，以保和丸加三棱、蓬术之属投之。赵以德云∶昔闻先生言泄泻之病，其类
多端，得于六淫五邪、饮食所伤之外，复有杂合之邪，似难执法而治，乃见先生治气暴脱而虚，顿泻，
不知人，口眼俱闭，呼吸微甚，殆欲绝者，急灸气海，饮人参膏十余斤而愈。治阴虚而肾不能司禁固
之权者，峻补其肾。治积痰在肺，致其所合大肠之气不固者，涌出上焦之痰，则肺气下降，而大肠之
虚自复矣。治忧思太过，脾气结而不能升举，陷入下焦而成泄泻者，开其郁结，补其脾胃，使谷气升
发也。凡此之类，不可枚举。因问先生治病何其神也，先生曰无他，圆机活法，具在《内经》，熟之自
得矣。
【飧泄】水谷不化而完出是也，《史记·仓公传》 风即此。经云∶清气在下，则生餐泄。又曰∶
久风入中，则为肠风餐泄。夫脾胃土也，气冲和以化为事，今清
气下降而不升，则风邪久而干胃，是木贼土也，故冲和之气不能化而令物完出，谓之餐泄。或饮食太
过，肠胃所伤，亦致米谷不化，此俗呼水谷利也。法当下者举之而消克之也，以加减木香散主之。东
垣云∶清气在下者，乃人之脾胃气衰，不能升发阳气，故用升麻、柴胡，助甘辛之味，以引元气之升，
《金匮要略》中关于下利（腹泻）的病脉证治篇：如果六腑的阳气在体表衰竭，会出现手脚冰凉、气逆上冲、双脚收缩的症状。如果五脏的阴气在体内衰竭，会出现大便失禁，严重的甚至手脚麻木不仁。
下利患者，如果脉象沉弦，会有肛门坠胀感；脉象大，说明病势未止；脉象微弱而数，说明病情即将自愈，即使伴有发热也不会死亡。下利患者，如果手脚厥冷且摸不到脉搏，经过艾灸后手脚仍不温暖，如果脉搏仍未恢复，反而出现轻微喘息，这是死证。少阴脉弱于趺阳脉，属于顺证。下利患者，如果有轻微发热和口渴，脉象虚弱，应当会自愈。下利患者，脉象数且有轻微发热、出汗，现在应当会自愈。如果脉象紧，说明病邪未解。下利患者，脉象数且口渴，应当会自愈；如果不痊愈，必然会出现脓血便，这是因为体内有热。（“清”字，通古“圊”字，指排泄）。下利患者，脉象反见弦象，伴有发热和身体出汗的，会自愈。下利伴有排气（气利），应当通过利小便来治疗。下利患者，寸脉反见浮数，尺脉自涩，必然会出现脓血便。下利排出未消化的食物（完谷不化），不可攻伐其表证，发汗会导致腹部胀满。下利脉象沉而迟，病人面部微红，身体微热，下利排出未消化食物的，必然会出现头目昏眩（郁冒），出汗后病愈，病人必定手脚微凉，之所以这样，是因为面部戴阳（虚阳上浮），下部虚寒的缘故。下利停止后脉搏消失，手脚厥冷，如果脉搏逐渐恢复，手脚转温的则生，脉搏不恢复的则死。下利伴有腹胀满，身体疼痛的，先温补里证，后解除表证，温里适宜用四逆汤，解表适宜用桂枝汤。下利患者，三部脉象都平和，但按压心下部位感觉坚硬的，应当急下之，适宜用大承气汤。下利脉象迟而滑的，是实证。痢疾未止，应当急下之，适宜用大承气汤。下利脉象反滑的，说明体内有积滞需要排出，泻下后病愈，适宜用大承气汤。下利已经痊愈，到了年、月、日、时又复发的，是因为病邪未尽的缘故。应当用下法，适宜用大承气汤。（以上多次提到承气汤，对于本虚的病人应当另行讨论）。下利伴有谵语的，是有燥屎的缘故。用小承气汤主治。下利伴有便脓血的，用桃花汤主治。热利伴有肛门重坠感的，用白头翁汤主治。下利之后更加烦躁，按压心下部位柔软的，是虚烦，用栀子豉汤主治。下利排出未消化食物，里寒外热，出汗且手脚厥冷的，用通脉四逆汤主治。下利伴有腹痛的，用紫参汤主治。干呕伴下利的，用黄芩汤主治。以上下利一章，后世名医的各种书籍，都以此为准则。古代所说的下利，就是现在所说的泄泻。其中包含治疗伤寒的数个方剂，张仲景用来治疗杂病，现在全部收录，使后人知道，认为治疗伤寒有固定法则、治疗杂病有固定方剂的观点是错误的。伤寒和杂病的治疗法是统一的。
朱丹溪说：泄泻的原因有湿、气虚、火、痰、食积。戴复庵说：泻水且腹部不痛的，是湿邪。饮食入胃后随即排出，完谷不化的，是气虚。腹痛泻水，肠鸣，痛一阵泻一阵的，是火邪。或者泻或者不泻，或多或少的是痰邪。腹痛剧烈且泻，泻后疼痛减轻的是食积。湿气多会形成五种泄泻。戴氏说：餐泄（飧泄），水谷不化而完整排出，是湿兼风邪。溏泄，逐渐排出污秽粘垢，是湿兼热邪。㵼泄（注：原文为“泄”，结合上下文及五泄分类，此处指澄彻清冷之泄），所下之物清澈寒冷，小便清白，是湿兼寒邪。濡泄，身体沉重软弱，泄下多水，是湿气极盛。滑泄，长期腹泻不能固摄，是湿胜气脱。湿泻脉象濡细，这是太阴经脾土受湿，导致泄水虚滑，身体沉重微满，不知谷味，口不渴，多在久雨泉水溢出河流泛滥，或运气中湿土当令之时发生，多有此病。适宜用除湿汤送服戊己丸，佐以胃苓汤，重症用术附汤。李东垣说：我患病脾胃长期衰弱，视听功能减半丧失，这是阴盛乘阳，加之气短，精神不足，这是由于弦脉令正气虚弱，多说话造成的。都是阳气衰弱不得舒展，伏匿在阴中罢了。癸卯年六七月份之间，淫雨连绵阴寒，超过一个月不停，当时很多人患病泄利。有一天我身体沉重关节疼痛，大便泄泻并排尿三次，而小便闭塞。思考治疗方法，按照《内经》标本论，大小便不利，无论标本，先利小便。又说：“在下者引而竭之”，也是先利小便。又说：“各种泄利，小便不利，先分利之”。又说：“治疗湿邪不利小便，不是正确的治法”。都说应当利小便，必须用淡味渗泄的药物来利它，这是它的法则。唉，圣人的法则，虽然记载在书籍中，但不完全的部分，可以通过意会来寻求。如今客邪寒湿之邪，从外侵入里，突然加身，如果按照上述法度，用淡渗药物来清除它，病虽然立即好了，这是降之又降，这会再次增益阴气，而严重耗竭阳气，那么阳气更加削弱而精神更加短少。这是阴气再次强盛、阳气再次衰弱，反而帮助了邪气。所以必须用升阳风药才能痊愈，用羌活、独活、柴胡、升麻各一钱，防风根半钱，炙甘草半钱，同捣碎，用水二钟煎至一盏，去渣稍热服用。大法说：“湿寒之胜，助风以平之”。又说：“下陷者举之，得阳气升腾而去”。又法说：“客邪者除之”，这是因曲而为之直。圣人的法则，可以类推，举一反三。如果不通达升降浮沉的道理，而一概施治，能痊愈的只是侥幸。湿兼寒泻，《内经》说：“湿胜则濡泄”。《甲乙经》说：“寒气客于下焦，传为濡泄”。脾脏，是五脏中的至阴，其性质厌恶寒湿。如今寒湿之气内侵于脾，所以不能辅助胃气腐熟水谷，导致清浊不分，水进入肠间，虚弱不能制约，所以洞泄如水，随气而下，称为濡泄。治法应当除湿利小便，用对金饮子治疗。湿兼热泻，用益元散、参萸丸。湿兼风，见餐泄条。寒泻，脉象沉细或弦迟，身体冷口不渴，小便清白，或腹中绵绵作痛，适宜用理中汤、附子温中汤、浆水散。暴泄如水，周身出汗，全身尽冷，脉沉而弱，气少不能说话，严重的加上呕吐，这称为紧病，适宜用浆水散治疗。如果太阳经伤动，传入太阴下利，成为溏泄，大肠不能固摄，突然而下，中有硬物，想起却又下，想结束却未结束，小便多清，这是寒邪，适宜温之。春夏用桂枝汤，秋冬用白术汤。理中汤治疗泄泻，加橘红、茯苓各一两，名为补中汤。如果溏泄不止，在补中汤内加附子一两，不喜欢饮食，水谷不化的，再加砂仁一两，共成八味。张仲景说：下利不止，医生用理中汤给予治疗，利下更甚。理中汤，是调理中焦的。此利在下焦，用赤石脂禹余粮汤主治。使用这个加法则能调理下焦了。戴氏说：寒泻，寒气在腹，攻刺作痛，洞下清水，腹内雷鸣，米饮不化的，用理中汤，或附子补中汤，吞服大已寒丸，或附子桂香丸。畏食的，用八味丸。原本是冷泻，因泻而烦躁引饮，越喝越泻的，用参附汤、连理汤。如果寒泻服用上述药物无效，适宜用木香汤，或姜附汤、六柱汤，吞服震灵丹、养气丹。手足厥逆的，兼进朱砂丹。药食刚入口就排出的，名叫直肠（注：此处指滑脱不禁，非现代解剖直肠），难治。如果泻已愈，而精神未恢复旧的，适宜用十补饮。寒泻腹中大疼，服用前药外，兼进乳豆丸。服用各种热药以温中，并不见效，登厕频繁，秽物随出，这属于下焦。适宜用桃花丸二十五粒，诃梨勒丸以涩之。按戴氏的方法多过于亢热，使用者请审慎。热泻，脉象数疾或洪大，口干燥，身体多动，声音响亮，暴注下迫，用益元散加黄芩、黄连、灯心草、淡竹叶之类。泄而身热，小便不利，口渴的，用益元散、五苓散。如果火多，用四苓散加木通、黄芩。泄而困倦不便的，以及脉数虚热的，适宜用人参、白术、滑石、茯苓、木通。泄而脉滑坚的，是实热。适宜用大承气汤。戴氏说：热泻，粪便色赤黄，弹响作痛，粪门焦痛，粪出谷道，犹如汤热，烦渴，小便不利，适宜用五苓散吞服香连丸。凡是泻津液既去，口必渴，小便多是赤涩，不可便当作热证论断，确知是热泻，才用冷剂。不然，不要妄投以免加重病情。玉龙丸，治疗一切伏暑泄泻神效。理中汤加茯苓、黄连，名为连理汤，使用之多有奇功。况且如今正当暑月，如果确知是暑泻，自然合用暑药，确知是冷泻，自然合用热药，中间有一类人在盛暑时节，又内伤生冷，非连理汤不可。下泄无度，泄后却弹响过猛，肛门热，小便赤涩，心下烦渴，且又喜冷，此药适宜。如果原本是暑泻，经久下元虚甚，日夜频并，暑毒之势已退，然而泻不已，再用暑药，则决不能取效，便用姜附辈，又似乎难以施用，疑似之间，尤其适宜用此药。气泻，肠鸣气走，胸膈痞闷，腹急而痛，泻则腹下稍可，须臾又急，也有腹急气塞而不通的，这是由于中脘停滞，气不流转，水谷不分所致。戴氏法用大七香丸，入米煎服。久而不愈的，用五膈宽中散吞服震灵丹，仍佐以米饮调香附末。调气散。《金匮要略》诃梨勒散，治疗气利。气虚泻，用四君子汤加神曲、黄柏、升麻、柴胡，吞服二神丸加木香丸。积滞泄泻，腹部耕痛（形容腹痛如耕地般不适）才泻的是。或者肚腹满，按之坚硬的是。受病浅的，适宜用神曲之类消导。病深而顽固的，必须用进退承气之类，下之才安。伤食泻，因为饮食过多，脾胃之气不足以运化而泻。其人必定打嗝有败卵臭味，适宜用治中汤加砂仁半钱，曲枳术丸。或七香丸、红丸子杂服。食积腹疼而泻，不可立即用治中汤止泻，适宜先用消导推荡的药物。或者因为吃一种食物过伤而泻，后来再吃这种食物即泻的，是因为脾被损伤尚未恢复所致，适宜用大建脾汤（寒者可用）。仍将所伤之物烧存性为末，三五钱重，调服。因为吃冷物停滞伤脾，脾气不暖，所食之物，不能消化，泻出而食物如故，适宜用治中汤加干葛，吞服酒煮黄连丸。有脾气久虚，不受饮食的，食毕即肠鸣腹急，尽下所食之物才快，不食则无事，俗名录食泻，经年累月，适宜用快脾丸。因为饮酒受伤，每晨起必泻的，适宜用理中汤加干葛，吞服酒煮黄连丸。或葛花解酲汤吞服。因为吃面食受伤而泻的，用养胃汤加莱菔子炒研一钱，痛的再加木香五分，泻甚的去藿香，加炮姜如其数量。痰泻，用二陈汤、海浮石、青黛、黄芩、神曲、姜汁、竹沥为丸。每服三五十丸。少的必须用吐法，吐之才愈。一男子夜里多次如厕，有人教他用生姜一两，捣碎，半夏汤洗，与大枣各三十枚，水一升，瓷瓶中慢火烧为熟水，时时呷之，数日便好。每天五更即泄泻，有酒积、有寒积、有食积、有肾虚，俗呼脾肾泄。有人每早必须大泻一行，或腹痛，或不腹痛，空腹服热药也无效。有人教他在夜饭前，又进热药一服遂安，后来如此常服愈。大概暖药虽在平旦服用，到夜晚力量已尽，无法敌一夜阴气的缘故。有人每五更将天明时必溏利一次，有人说此名肾泄，服五味子散顿愈。有人久泄，早必泄一二行，泄后便轻快，脉滑而少弱，先与浓朴和中丸五十丸，大下之后，以白术为君，枳壳、半夏、茯苓为臣，浓朴、炙甘草、黄芩、黄连、川芎、滑石为佐，吴茱萸十余粒为使，生姜煎服，十余帖而愈。戴氏说：有每日五更初洞泻，服止泻药并无效，米饮下五味丸，或专以北五味煎饮。虽然节省饮食，大段忌口，但得日间上半夜无事，近五更其泻复作。此病在肾分。水饮下二神丸及椒朴丸，或平胃散下小茴香丸。二神丸合五味子散，名为四神丸，治泻尤妙。小便不利而泄，若津液偏渗于大肠，大便泻而小便少的，用胃苓散分利之。如果阴阳已分而小便短少，这是脾肺气虚不能生水，适宜用补中益气汤加麦门冬、五味子。阴火上炎而小便赤少，这是肺气受伤不能生水，用六味地黄丸加麦门冬、五味子。肾经阴虚，阳无所生，而小便短少的，用滋肾丸、肾气丸。肾经阳虚，阴无所化，而小便短少的，用益气汤、六味丸。如果误用渗泄分利，再次损伤阳气，阴无所生，而小便更加不利，则肿胀之证发作而疾病危急了。凡大便泄，服理中汤，小便不利，大便反泄，不知气化之过。本是肺不传化，以纯热之药治之，所以转泄，少服则不止，多服则愈热，所以不分。如果用青皮、陈皮之类治之则可以。经云：膀胱者，州都之官，津液藏焉，气化则能出矣。泄而口渴引饮，此为津液内亡，用钱氏白术散，或补中益气汤。肾水不足之人患泄，或过服分利之剂而渴的，用加减八味丸。失治，必变小便不利，水肿胀满等危证。水渍入胃，名为溢饮滑泄，渴能饮水，水下复泄，泄而大渴，此无药证，应当灸大椎穴（在第一椎下陷中）。滑泻，李东垣说：中焦气弱，脾胃受寒冷，大便滑泄，腹中雷鸣，或因误下，末传寒中，复遇时寒，四肢厥逆，心胃绞痛，冷汗不止，这是肾之脾胃虚。用沉香温胃丸治疗。薛氏说：前证如果脾胃虚寒下陷的，用补中益气汤，加木香、肉豆蔻、补骨脂。如果脾气虚寒不禁的，用六君子汤，加炮姜、肉桂。如果命门火衰，脾土虚寒的，用八味丸。如果脾肾气血俱虚的，用十全大补汤送四神丸。如果大便滑利，小便闭涩，或肢体渐肿，喘嗽唾痰，为脾肾气血俱虚。宜用十全大补汤送四神丸。如果大便滑利，小便闭涩，或肢体渐肿，喘嗽唾痰，为脾胃亏损，宜《金匮要略》加减肾气丸。《保命集》说：虚滑久而不止的，多传变为利，太阴传少阴是为鬼邪，先以浓朴枳实汤，防其传变。按此法实者用之，虚者不如四神丸实肾之为得也。收涩之剂，固肠丸、诃子散，皆治热滑。扶脾丸、桃花丸、诃子丸、赤石脂禹余粮汤，皆治寒滑。泻已愈，至明年此月日时复发者，有积故也。脾主信，故至期复发。热积，大承气汤。寒积、感应丸。虚者，以保和丸加三棱、蓬术之类投之。赵以德说：过去听先生说过泄泻的病，其种类多端，得于六淫五邪、饮食所伤之外，复有杂合之邪，似难执法而治，乃见先生治疗气暴脱而虚，顿泻，不知人，口眼俱闭，呼吸微甚，殆欲绝的，急灸气海，饮人参膏十余斤而愈。治疗阴虚而肾不能司禁固之权的，峻补其肾。治疗积痰在肺，致其所合大肠之气不固的，涌出上焦之痰，则肺气下降，而大肠之虚自复了。治疗忧思太过，脾气结而不能升举，陷入下焦而成泄泻的，开其郁结，补其脾胃，使谷气升发也。凡此之类，不可枚举。因为问先生治病何其神也，先生说没有别的，圆机活法，具在《内经》，熟之自得矣。
【飧泄】水谷不化而完整排出就是，《史记·仓公传》中的风即此。经云：清气在下，则生餐泄（飧泄）。又说：久风入中，则为肠风餐泄。脾胃属土，气冲和以化为事，如今清气下降而不升，则风邪久而干犯胃，是木贼土也，所以冲和之气不能化而令物完出，称为餐泄。或者饮食太过，肠胃所伤，亦致米谷不化，此俗呼水谷利也。治法应当下者举之而消克之，以加减木香散主治。李东垣说：清气在下，乃是人的脾胃气衰，不能升发阳气，所以用升麻、柴胡，助甘辛之味，以引元气之升，
The chapter on Pulse, Pathogenesis, and Symptoms of Diarrhea in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet): If the Yang Qi of the Six Fu Organs fails at the exterior, there will be cold hands and feet, rebellious Qi ascending, and contraction of the legs. If the Yin Qi of the Five Zang Organs fails at the interior, there will be incontinence of stool; in severe cases, the hands and feet will be insensible. In diarrhea, if the pulse is deep and wiry, there is a sensation of heaviness in the anus; if the pulse is large, the disease has not yet ceased; if the pulse is weak and rapid, it indicates that the condition is about to stop spontaneously, and death will not occur even if fever is present. In diarrhea, if the hands and feet are cold and the pulse is absent, and after moxibustion the extremities remain cold and the pulse does not return, accompanied by slight panting, this is a fatal sign. If the Shaoyin pulse is weaker than the Fuyang pulse, it is a favorable sign. In diarrhea, if there is slight fever and thirst, and the pulse is weak, recovery is expected. In diarrhea, if the pulse is rapid with slight fever and sweating, recovery is expected. If the pulse is tight, the pathogen has not been resolved. In diarrhea, if the pulse is rapid and there is thirst, recovery is expected; if it does not heal, pus and blood will appear in the stool due to heat. ("Qing" 清 is an ancient character for "Qing" 圊, meaning toilet/excretion). In diarrhea, if the pulse is unexpectedly wiry, accompanied by fever and sweating, recovery is expected. In diarrhea with excessive flatus (Qi Li), treatment should focus on promoting urination. In diarrhea, if the Cun pulse is unexpectedly floating and rapid, while the Chi pulse is choppy, pus and blood will appear in the stool. In diarrhea with undigested food (Wan Gu Hua), one must not attack the exterior; sweating will lead to abdominal fullness. In diarrhea with a deep and slow pulse, where the patient's face is slightly red, body slightly warm, and stool contains undigested food, there will likely be dizziness and confusion (Yu Mao), followed by sweating and resolution; the patient will have slightly cold extremities because the face shows "Dai Yang" (floating Yang) due to deficiency at the lower Jiao. After diarrhea stops, if the pulse disappears and hands/feet are cold, but the pulse returns and extremities become warm, life is saved; if the pulse does not return, death occurs. In diarrhea with abdominal fullness and body pain, first warm the interior, then release the exterior. For warming the interior, Si Ni Tang (Four Reversal Decoction) is indicated; for releasing the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. In diarrhea, if the pulses in all three positions are level, but palpation of the epigastrium reveals hardness, urgent purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction). In diarrhea with a slow and slippery pulse, it is an excess pattern. Since the diarrhea has not ceased, urgent purgation is required using Da Cheng Qi Tang. In diarrhea with an unexpectedly slippery pulse, there is something to be expelled; purgation leads to recovery using Da Cheng Qi Tang. If diarrhea resolves but recurs at specific years, months, days, or hours, it is because the pathogen was not fully eliminated. Purgation is required using Da Cheng Qi Tang. (Note: Regarding the repeated use of Cheng Qi Tang formulas, patients with root deficiency should be discussed separately.) In diarrhea with delirium, it is due to dry fecal masses. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is indicated. In diarrhea with pus and blood in the stool, Tao Hua Tang (Peach Blossom Decoction) is indicated. In hot diarrhea with rectal tenesmus, Bai Tou Weng Tang (Pulsatilla Decoction) is indicated. After diarrhea, if irritability increases and the epigastrium is soft upon pressure, it is empty irritability; Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. In diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tong Mai Si Ni Tang (Pulse-Restoring Four Reversal Decoction) is indicated. In diarrhea with abdominal pain, Zi Shen Tang is indicated. In dry vomiting with diarrhea, Huang Qin Tang (Scutellaria Decoction) is indicated. The above chapter on diarrhea has been adopted as a standard by later famous physicians. What was formerly called "Xia Li" (Lower Flow/Diarrhea) is now called "Xie Xie" (Leaking Diarrhea). It includes several formulas originally used for Shang Han (Cold Damage), which Zhang Zhongjing applied to miscellaneous diseases. They are recorded here in full to show that the view that Shang Han and miscellaneous diseases have separate methods is incorrect; their therapeutic principles are unified.
Zhu Danxi stated: Causes include dampness, Qi deficiency, fire, phlegm, and food stagnation. Dai Fu'an stated: Diarrhea with water discharge and no abdominal pain is due to dampness. Food entering the stomach and immediately passing through, with undigested grains, is due to Qi deficiency. Abdominal pain with watery diarrhea, borborygmus, where pain comes in waves followed by diarrhea, is due to fire. Irregular frequency and volume of diarrhea is due to phlegm. Severe abdominal pain relieved by diarrhea is due to food stagnation. Excess dampness can lead to five types of diarrhea. Dai stated: Sun Xie (Spoon Diarrhea/Incomplete Digestion), where water and grain pass out undigested, is dampness combined with wind. Tang Xie (Loose Stool), gradually discharging dirty, sticky residue, is dampness combined with heat. Xie Xie (Clear Cold Diarrhea), discharging clear and cold fluid with clear urine, is dampness combined with cold. Ru Xie (Soft Diarrhea), with heavy body and weakness, discharging much water, is extreme dampness. Hua Xie (Slippery Diarrhea), long-term incontinence, is dampness overwhelming and Qi escaping. Damp diarrhea presents with a soft and fine pulse, indicating Taiyin Spleen Earth affected by dampness, leading to watery loose stools, heavy body, slight fullness, loss of taste, and no thirst. This often occurs during prolonged rain or when damp-earth climate factors dominate. Treatment involves Chu Shi Tang (Dampness-Removing Decoction) taken with Wu Ji Wan (Five-Abdomen Pill), assisted by Wei Ling Tang (Stomach-Cinnamon Decoction); severe cases use Shu Fu Tang (Atractylodes and Aconite Decoction).
Li Dongyuan stated: I suffered from long-term Spleen-Stomach decline, resulting in half-loss of hearing and vision. This is Yin flourishing attacking Yang, compounded by shortness of breath and insufficient spirit, caused by a wiry pulse indicating deficiency and excessive talking. All these indicate declining Yang Qi unable to extend, hiding within Yin. In the sixth and seventh months of the Gui-Mao year, continuous rainy and cold weather lasted over a month, and many people suffered from diarrhea. One day, my body felt heavy and joints painful, with frequent bowel movements and urinary retention. Recalling the *Neijing* theory of root and branch, for difficulty in both urination and defecation, regardless of root or branch, one should first promote urination. It also says: "For conditions below, draw them out and exhaust them," which also implies promoting urination first. It further states: "For various diarrheas with urinary difficulty, first separate and promote urination." And: "To treat dampness without promoting urination is not the correct method." All suggest promoting urination using bland, permeating agents. Alas, although the Sage's methods are written in books, the unwritten parts can be understood through intuition. Now, if external cold-damp pathogens invade deeply and suddenly, treating them solely with bland permeating agents might cure the disease quickly, but this is lowering again and lowering, re-enriching Yin and severely depleting Yang, causing Yang to weaken further and spirit to diminish. This strengthens Yin and weakens Yang, inadvertently assisting the pathogen. Therefore, one must use acrid-warm herbs to raise Yang to recover. Use Qiang Huo, Du Huo, Chai Hu, Sheng Ma each 1 qian, Fang Feng Gen 0.5 qian, Zhi Gan Cao 0.5 qian. Crush, decoct in two zhong of water to one zhong, strain, and drink warm. The general principle states: "When damp-cold prevails, assist with wind to pacify it." Also: "For sinking conditions, lift them; obtain Yang Qi rising to dispel [the pathogen]." Another method: "Expel the intruder"; this is straightening what is crooked. The Sage's methods can be inferred; knowing one allows knowing hundreds. Without understanding the principles of ascending/descending and floating/sinking, applying uniform treatment yields success only by luck.
Regarding dampness combined with cold diarrhea: *Neijing* says, "Excess dampness causes soft diarrhea." *Jiayi Jing* says, "Cold qi lodging in the Lower Jiao transmits as soft diarrhea." The Spleen is the ultimate Yin of the Zang organs, loathing cold-damp. When cold-damp invades the Spleen internally, it cannot assist the Stomach in rotting and ripening food, leading to confusion of clear and turbid, water entering the intestines, inability to control, resulting in profuse watery diarrhea following Qi, called Soft Diarrhea. The method is to remove dampness and promote urination, treating with Dui Jin Yin Zi. For dampness combined with heat diarrhea, use Yi Yuan San and Can Yu Wan. For dampness combined with wind, see Sun Xie section. For cold diarrhea, with deep/fine or wiry-slow pulse, cold body, no thirst, clear urine, or dull abdominal pain, use Li Zhong Tang, Fu Zi Wen Zhong Tang, or Jiang Shui San. For sudden watery diarrhea with whole-body sweating, total coldness, deep/weak pulse, scant Qi unable to speak, or vomiting, this is a critical condition; use Jiang Shui San. If Taiyang channel injury transmits to Taiyin causing diarrhea becoming loose stool, with Large Intestine inability to hold, sudden onset, hard objects in stool, urgency with incomplete evacuation, and clear urine, this is cold; warm it. Use Gui Zhi Tang in Spring/Summer, Bai Zhu Tang in Autumn/Winter. Li Zhong Tang for diarrhea, add Ju Hong and Fu Ling each 1 liang, named Bu Zhong Tang. If loose stool persists, add Fu Zi 1 liang to Bu Zhong Tang; for poor appetite and undigested food, add Sha Ren 1 liang, totaling eight ingredients. Zhang Zhongjing said: "Diarrhea unceasing, doctor gave Li Zhong Tang, diarrhea worsened." Li Zhong Tang regulates the Middle Jiao. This diarrhea is in the Lower Jiao; Chi Shi Zhi Yu Liang Tang is indicated. Using this addition regulates the Lower Jiao. Dai stated: For cold diarrhea with stabbing abdominal pain, profuse watery stool, borborygmus, undigested food, use Li Zhong Tang or Fu Zi Bu Zhong Tang, swallow Da Yi Han Wan or Fu Zi Gui Xiang Wan. For fear of eating, use Ba Wei Wan. For original cold diarrhea turning into irritability and thirst, drinking more leads to more diarrhea, use Shen Fu Tang or Lian Li Tang. If cold diarrhea drugs fail, use Mu Xiang Tang, Jiang Fu Tang, or Liu Zhu Tang, swallowing Zhen Ling Dan or Yang Qi Dan. For cold extremities, combine with Zhu Sha Dan. If medicine/food enters mouth and immediately passes, it is called "Zheng Chang" (Rectal Slippage), difficult to treat. If diarrhea stops but spirit hasn't recovered, use Shi Bu Yin. For severe cold diarrhea abdominal pain, combine with Ru Dou Wan after previous meds. If hot medicines for warming middle fail, frequent defecation of foul matter, this belongs to Lower Jiao. Use Tao Hua Wan (25 pills) or He Le Le Wan to astringe. Note: Dai's methods are often too hot; users should be cautious.
For heat diarrhea, with rapid/hurried or surging-large pulse, dry mouth, restlessness, loud voice, sudden violent diarrhea with urgency, use Yi Yuan San plus Huang Qin, Huang Lian, Deng Xin Cao, Dan Zhu Ye. For diarrhea with fever, urinary difficulty, thirst, use Yi Yuan San and Wu Ling San. If fire is excessive, use Si Ling San plus Mu Tong, Huang Qin. For diarrhea with fatigue and difficulty, and rapid/deficient-heat pulse, use Ren Shen, Bai Zhu, Hua Shi, Fu Ling, Mu Tong. For diarrhea with slippery/firm pulse, it is excess heat; use Da Cheng Qi Tang. Dai stated: Heat diarrhea with red-yellow stool, popping sounds/pain, burning anus, hot expulsion, irritability/thirst, urinary difficulty, use Wu Ling San swallowing Xiang Lian Wan. Whenever diarrhea loses fluids, thirst occurs, and urine becomes red/astringent; do not immediately diagnose as heat. Only confirm heat diarrhea before using cold agents. Otherwise, reckless use worsens the condition. Yu Long Wan is miraculous for all latent summer-heat diarrhea. Li Zhong Tang plus Fu Ling, Huang Lian is named Lian Li Tang, often effective. In summer, if confirmed summer-heat diarrhea, use summer-heat drugs; if confirmed cold diarrhea, use hot drugs. However, in intense summer heat with internal injury from cold/raw food, Lian Li Tang is indispensable. For uncontrolled lower diarrhea, loud post-defecation sounds, hot anus, red/astringent urine, epigastric irritability/thirst, preference for cold, this drug is suitable. If originally summer-heat diarrhea, long-term deficiency of lower yuan, frequent day/night diarrhea, summer-toxin power faded but diarrhea continues, using summer-heat drugs won't work; using Ginger/Aconite seems difficult; in such doubt, this drug is best.
For Qi diarrhea, with borborygmus, Qi movement, chest/diaphragm oppression, abdominal urgency/pain, relief after defecation but returning soon, or abdominal Qi blockage without passage, this is due to Middle Jiao stagnation, Qi non-flow, and unclear separation of water/grain. Dai's method uses Da Qi Xiang Wan decocted with rice. For chronic cases, use Wu Ge Kuan Zhong San swallowing Zhen Ling Dan, assisted by rice water mixed with Xiang Fu powder. Tiao Qi San. *Jingui* He Le Le San treats Qi Li. For Qi deficiency diarrhea, use Si Jun Zi Tang plus Shen Qu, Huang Bo, Sheng Ma, Chai Hu, swallowing Er Shen Wan plus Mu Xiang. For stagnation diarrhea, abdominal discomfort before diarrhea, or abdominal fullness with hardness on pressure: shallow disease uses Shen Qu for digestion; deep/stubborn disease requires Tui Jin Cheng Qi type purgatives. For food-injury diarrhea, due to excessive food overwhelming Spleen/Stomach transport: belching smells like rotten eggs; use Zhi Zhong Tang plus Sha Ren 0.5 qian, Qu Zhi Zhu Wan. Or Qi Xiang Wan, Hong Wan Zi mixed. For food-stagnation abdominal pain and diarrhea, do not immediately use Zhi Zhong Tang to stop; first use digestive/pushing drugs. If diarrhea recurs upon re-eating the offending food due to unrecovered Spleen, use Da Jian Pi Tang (for cold patterns). Burn the offending food to ash, take 3-5 qian with water. For cold-food stagnation injuring Spleen, cold Spleen Qi failing to digest: diarrhea with undigested food appearance; use Zhi Zhong Tang plus Gan Ge, swallowing Jiu Zhu Huang Lian Wan. For long-term Spleen Qi deficiency unable to accept food: borborygmus/urgency after eating, relief only after expelling food; known as "Lu Shi Xie" (Recorded Food Diarrhea), chronic; use Kuai Pi Wan. For alcohol-injury morning diarrhea, use Li Zhong Tang plus Gan Ge, swallowing Jiu Zhu Huang Lian Wan. Or Ge Hua Jie Ying Tang. For noodle/wheat-injury diarrhea, use Yang Wei Tang plus Chao Yan Lu Zi 1 qian; if painful, add Mu Xiang 0.5 fen; if severe diarrhea, remove Huo Xiang, add Pao Jiang equally. For phlegm diarrhea, use Er Chen Tang, Hai Shi, Qing Dai, Huang Qin, Shen Qu, Jiang Zhi, Zhu Li made into pills. Take 30-50 pills. Mild cases require emesis. A man with nocturnal frequent urination was taught to use 1 liang ginger, washed Ban Xia, 30 dates, decocted in 1 sheng water in a porcelain bottle; sip slowly, cured in days. Daily predawn diarrhea may be due to wine accumulation, cold accumulation, food accumulation, or Kidney deficiency,俗称 Pi Shen Xie. Some must have a large bowel movement every morning, with or without pain, ineffective hot meds on empty stomach. Someone advised taking hot meds before night meal, then continuing daily, curing it. Warm meds taken at dawn lose potency by night, unable to counteract night Yin. Some have loose stool at predawn; some call this Kidney Xie, cured by Wu Wei Zi San. Chronic diarrhea, morning 1-2 movements, relief after, slippery/weak pulse: first Nong Hou He Zhong Wan 50 pills, after purgation, use Bai Zhu as sovereign, Zhi Ke, Ban Xia, Fu Ling as ministers, Nong Hou, Zhi Gan Cao, Qin, Lian, Chuan Xiong, Hua Shi as assistants, Wu Zhu Yu ~10 grains as envoy, decocted with ginger, cured in >10 doses. Dai stated: Predawn profuse diarrhea unresponsive to anti-diarrheals, Wu Wei Wan with rice water, or pure Bei Wu Wei decoction. Despite diet control, symptoms cease until near predawn recurrence. Disease is in Kidney division. Er Shen Wan, Jiao Po Wan, or Ping Wei San with Xiao Hui Xiang Wan. Er Shen Wan + Wu Wei Zi San = Si Shen Wan, excellent for diarrhea.
For diarrhea with urinary difficulty: if fluids leak to Large Intestine causing diarrhea and scant urine, use Wei Ling San to separate. If Yin/Yang separated but urine short, it is Spleen/Lung Qi deficiency failing to generate water; use Bu Zhong Yi Qi Tang plus Mai Men Dong, Wu Wei Zi. If Yin fire flares with red/scant urine, Lung Qi injured failing to generate water; use Liu Wei Di Huang Wan plus Mai Men Dong, Wu Wei Zi. If Kidney Yin deficiency, Yang has no source, short urine; use Zi Shen Wan, Shen Qi Wan. If Kidney Yang deficiency, Yin has no transformation, short urine; use Yi Qi Tang, Liu Wei Wan. Misusing permeating/separating drugs damages Yang, Yin has no source, urine becomes harder, leading to edema and critical illness. For diarrhea treated with Li Zhong Tang, urinary difficulty, worsening diarrhea, ignoring Qi transformation: originally Lung fails to transmit/transform, treating with pure hot drugs causes worsening diarrhea; small dose ineffective, large dose increases heat, so no separation. Using Qing Pi, Chen Pi works. Classic says: Bladder is the official of storage, stores fluids, transforms via Qi to excrete. Diarrhea with thirst/drinking indicates internal fluid loss; use Qian Shi Bai Zhu San or Bu Zhong Yi Qi Tang. For Kidney Water deficiency with diarrhea, or thirst from overusing separating drugs, use Jia Jian Ba Wei Wan. Untreated, it becomes urinary difficulty, edema, critical. Water soaking Stomach, named Yi Yin Slippery Diarrhea, thirsty for water, drinks then diarrhea, extreme thirst: no drug indication, moxa Da Zhui (depression below 1st thoracic vertebra). Slippery diarrhea: Li Dongyuan said: Middle Jiao Qi weak, Spleen/Stomach cold, slippery stool, borborygmus, or mis-purgation leading to cold center, plus seasonal cold, cold extremities, heart/stomach colic, cold sweat: Kidney-Spleen-Stomach deficiency. Treat with Chen Xiang Wen Wei Wan. Xue said: If Spleen/Stomach deficiency-cold sinking, use Bu Zhong Yi Qi Tang plus Mu Xiang, Rou Dou Kou, Gu Po Zi. If Spleen Qi deficiency-cold incontinence, use Liu Jun Zi Tang plus Pao Jiang, Rou Gui. If Ming Men fire decline, Spleen Earth cold, use Ba Wei Wan. If Spleen/Kidney Qi/Blood dual deficiency, use Shi Quan Da Bu Tang sending Si Shen Wan. If slippery stool, closed urine, limb swelling, cough/phlegm: Spleen/Kidney Qi/Blood dual deficiency; Shi Quan Da Bu Tang sending Si Shen Wan. If slippery stool, closed urine, swelling, cough/phlegm: Spleen/Stomach damage; *Jingui* Jia Jian Shen Qi Wan. *Bao Ming Ji* said: Chronic slippery diarrhea transforming into dysentery, Taiyin transmitting to Shaoyin is "Ghost Evil"; first use Nong Hou Zhi Shi Tang to prevent transmission. Note: This method suits excess; deficiency is better treated with Si Shen Wan solidifying Kidney. Astringents: Gu Chang Wan, He Zi San treat heat slip. Fu Pi Wan, Tao Hua Wan, He Zi Wan, Chi Shi Zhi Yu Liang Tang treat cold slip. Diarrhea cured but recurs next year same time: due to accumulation. Spleen governs trust/timing, hence recurrence. Heat accumulation: Da Cheng Qi Tang. Cold accumulation: Gan Ying Wan. Deficiency: Bao He Wan plus San Leng, Peng Ze.
Zhao Yi-de said: I heard masters say diarrhea has many types, beyond six evils, five pathogens, diet injury, including mixed pathogens, hard to treat uniformly. I saw a master treat sudden Qi collapse and deficiency, acute diarrhea, unconsciousness, closed eyes/mouth, faint breathing, near death: urgently moxa Qi Hai, drink Ren Shen Gao over 10 jin, cured. Treat Yin deficiency with Kidney failing to control: strongly tonify Kidney. Treat phlegm accumulation in Lung causing Large Intestine insecurity: induce vomit upper Jiao phlegm, Lung Qi descends, Large Intestine deficiency restores. Treat excessive worry/sorrow knotting Spleen Qi, sinking to Lower Jiao causing diarrhea: open depression, tonify Spleen/Stomach, raise Grain Qi. These cannot be enumerated. Asked why the master is so divine, he said: No secret, flexible methods are in *Neijing*; study it well and you will know.
[Sun Xie] Undigested water and grain passing out completely. *Shiji - Cang Gong Zhuan* Wind refers to this. Classic says: Clear Qi sinking generates Sun Xie. Also: Long-standing Wind entering middle becomes Chang Feng Sun Xie. Spleen/Stomach is Earth, harmonious Qi transforms food. Now Clear Qi sinks instead of rising, Wind pathogen harasses Stomach long-term, Wood attacks Earth, harmonious Qi fails to transform, food passes undigested, called Sun Xie. Or excessive diet injuring intestines/stomach, causing undigested grains, commonly called Water-Grain Li. Method: Lift the sinking and digest/remove, using Jia Jian Mu Xiang San. Li Dongyuan said: Clear Qi sinking is due to Spleen/Stomach Qi decline, unable to raise Yang Qi; thus use Sheng Ma, Chai Hu, aiding sweet-acrid flavors to guide Yuan Qi upward.