（一名伤寒夹泄泻）
【因】素有脾虚泄泻。或肝邪侮脾作泻。或寒邪先中太阴。而为泄泻。或先伤食物。欲泻不畅。再感风寒。
而犯太阳证者。
【证】头痛身热。胸闷或不闷。溲短大便泄泻。舌苔白为中寒泄泻。舌黄而浓。胸满腹 痛。头痛身热。口粘
而秽。为宿食化泻。若舌淡红。苔青白色。脘闷腹满。鸣响作痛而泄泻。得泻则腹满痛鸣响皆瘥。为肝
邪侮脾化泻。再新受外感。亦头痛发热。
【脉】左脉濡数。右脉沉弱。为寒泻。若左弦坚或弦劲。右软弱或沉缓。肝强脾弱。为肝邪侮脾。
【治】中寒感邪。用葱豉胃苓汤。（即胃苓汤去甘草加葱豉。）夹食化泻身热。用楂曲平胃散。加豆豉、藿
香、薄荷、猪苓、茯苓、泽泻。之类。肝邪侮脾。腹鸣痛泻。用扶土抑木煎。（炒白芍六钱、炒白术
三钱、煨防风钱半、新会皮一钱、炒黄芩二钱、煨葛根一钱。）加豆豉、焦栀之类。
【秀按】俞氏所分泄泻为三种。乃因先泄泻。后受风寒感邪。而病头痛身热。与伤寒自病之下利不同。
所谓伤寒下利者。不因攻下。自然溏泻也。要在辨寒热而治之。庶几无差。大抵阳热之利。渴欲饮水。溺色赤。
发热后重。粪色必焦黄。或为肠垢。所下皆热臭。脐下必热。得凉药则止。得热药愈增。阴寒之利。口不渴。
小便色白。肢或厥冷。脉沉迟无力。必洞下清谷。或为 溏。粪色或白或淡黄。脐下多寒。三阳证下利身热。
太阴下利。手足温。少阴厥阴下利。身凉无热。此其大概耳。太阳阳明合病下利。葛根汤。太阳少阳合病下利。
黄芩汤。阳明少阳合病下利。小柴胡汤加葛根、芍药。合病发热自利。则为表邪。不可例以为里证也。温热病
发热而渴。小便赤色。大便自利。五苓散去桂加黄芩。热内盛而利不止。黄连解毒汤。躁闷狂乱者。三黄石膏
汤。或大柴胡汤。自利不渴属太阴。以其藏有寒故也。当温之。宜服四逆辈。以太阴藏寒。或用理中汤。若寒
甚逆冷。脉沉细者。理中汤加附子。若腹满小便不利者。五苓散合理中汤主之。若呕者。加半夏。生姜。自利而
渴属少阴虚。故引水自救。白通汤主之。以通其阳而消其阴。与白通汤利不止。厥逆无脉。干呕烦者。白通加
猪胆汁汤主之。借猪胆汁向导之力。以引阳药深入。服汤后。脉暴出者死。正气因发泄而脱也。脉微续者生。
阳气渐复也。少阴病。腹痛小便不利。四肢沉重疼痛。自下利者。此为有水气。其人或咳。或小便利。或下
利。或呕者。真武汤主之。以运脾渗水为务。少阴病。下利清谷。里寒外热。手足厥冷。脉微欲绝。身反不恶
寒。其人面色赤。通脉四逆汤主之。少阴病。吐利手足厥冷。烦躁欲死者。吴茱萸汤主之。自汗不止。里寒下
脱。此利在下焦。赤石脂禹余粮汤主之。少阴病四逆。其人或咳或悸。或小便不利。或腹中痛。或泄利下重
者。四逆散主之。此阳邪传至少阴。陷入于里。而不能交通阳分。故不宜苦寒攻之。而但以此利解之。少阴病。
自利清水。心下必痛。口干燥者。急下之。热邪传入少阴。逼迫津水。注为自利。质清而无滓秽相杂。色青而
无赤黄相间。此正阳邪暴横。反类阴邪。但阳邪传自上焦。其人心下必痛。口必干燥。设系阴邪。则心下满而
不痛。口中和而不渴。必无此枯槁之象。故宜急下以救其阴也。厥阴下利清谷。里寒外热。汗出而厥者。通
脉四逆汤主之。下利腹胀满。身体疼痛者。先温其里。乃攻其表。温里四逆汤。攻表桂枝汤。此总以温里为急
也。大汗出。热不止。内拘急。四肢痛。又下利厥逆而恶寒者。四逆汤主之。恶寒脉微而复利。利止亡血也。
四逆加人参汤主之。亡血本不宜用姜附以损阴。阳虚又不当用归芍以敛阳气。以利后恶寒。阳虚下脱已甚。故
用四逆以复阳。为阳脱加人参。则阳药愈加得力。阳生则阴长。设误用阴药。必致腹满不食。或重加泄利呕
逆。转成下脱矣。下利手足厥冷无脉者。灸之。下利谵语者有燥屎也。宜小承气汤下之。盖下利则热不结。胃
不实。何缘得有谵语。此必邪返于胃。内有燥粪。故虽下利而结者自若也。爰用小承气以微攻其胃。大抵下利
脱气至急。五夺之中。惟此为甚。故不厌详审。下利日十余行。脉反实者死。伤寒发热下利至甚。厥不止者
死。厥证但发热则不死。以发热则邪出于表。而里证自除。下利自止也。若反下利厥逆。烦躁有加。则其发热
又为真阳外散之候。阴阳两绝。故主死也。伤寒发热下利。厥逆。躁不得卧者死。躁不得卧。肾中阳气越绝
之象也。下利而手足厥冷。皆为危候。加以发热躁不得卧。不但虚阳发露。而真阴亦以烁尽无余矣。安得不死
乎。《金匮要略》云。六府气绝于外者手足寒。五藏气绝于内者利下不禁。气已脱矣。此参合陈素中辨证之
大略也。
【廉勘】伤寒协热下利。十有七八。俗人不识。呼为漏底伤寒。往往妄用温燥止涩之剂。以助热邪。转变危
症。可悲也夫。然据前辨。皆以伤寒之下利以立法。其他泄泻类证甚多。原因尤别。今举其重要者。再辨于
下。景岳云。泄泻之本。无不由于饮食不节。起居不时。脾胃受伤。则水反为湿。谷反为滞。水谷精华之气不
能输化。而泄泻作矣。泄者、大便溏薄。或作或止。泻者、大便直下。水去如注。虽分轻重。总属脾伤。脾受
湿而不能渗泄。伤阑门之元气。而分利无权。并入大肠。遂致成泄。故肠鸣溺少。大便反快。是泄固由于湿
矣。难经云。湿多成五泄。曰飧、曰溏、曰 、曰濡、曰滑。飧泄者、完谷不化。湿兼风也。兼恶风自汗。肠
鸣。脉弦者。宜胃苓汤加升麻、煨防风。又有久风入中。令清气下降而不升。则风邪入胃。是木贼土也。故冲
和之气不能化。能令腹鸣而痛。完谷出而为泻也。宜痛泻要方合四苓散。（焦白术三钱、炒白芍五钱、新会皮
钱半、煨防风钱半、茯苓四钱、猪苓三钱、泽泻三钱。）若飧泄脉弦。腹痛而渴。及头痛微汗。宜防风芍药
汤。（煨防风三钱、炒白芍五钱、炒黄芩三钱。）或饮食太过。肠胃受伤。亦致水谷不化。下者举之。宜加减
木香散。（木香一钱、干姜八分、党参二钱、六神曲二钱、肉豆蔻一钱、新会皮一钱、焦白术二钱、阳春砂五
分、升麻八分、槟榔一钱。）溏泄者、肠垢污积。湿兼热也。其证脉数。溲赤涩。所下稠粘垢秽。宜黄芩芍药
汤。合益元散。（黄芩三钱、白芍五钱、益元散八钱。） 溏者、澄清溺白。湿兼寒也。其证大便如水。其中
稍有结粪者是也。若清冷如鸭粪。脉见沉迟。小溲清白。理中汤加橘红、茯苓治之。若泄不已。更加附子。濡
泄者（一名洞泄。）身重脉软。湿自胜也。由脾虚不能制湿。湿反胜而成病。故腹不痛。而肠鸣溺少。利下多
水。宜五苓散主之。滑泄者、久下不禁。湿胜气脱也。其证大泻如竹筒直下不止。宜用扶脾丸。（炒白术二
钱、茯苓三钱、新会皮钱半、姜半夏钱半、诃子皮钱半、炙甘草八分、乌梅二枚、干姜钱半、藿香二钱、杜赤
豆三钱、肉桂一钱、炒麦芽三钱、六神曲二钱、荷叶包烧饭为丸。）或补中益气汤加诃子。肉蔻。或四柱饮。
（人参、附子、茯苓、木香、加生姜、盐、少许。）或六柱饮。（即四柱饮、加肉蔻、诃子。）其他尚有胃泄。
则面黄而饮食不化。宜理中汤。脾泄则呕吐而腹胀注下。如食后饱满。泻出即宽。宜香砂六君子汤。大肠泄则
食已窘迫。大便色白。而肠鸣切痛。宜五苓散加木香。小肠泄则溲涩而便脓血。小腹痛。先宜下之。继用清
利。肾泄则五更便泄。足冷腹痛。宜四神丸。（肉豆蔻、破故纸、五味子、吴茱萸、姜枣为丸。）肝泄则木来
侮土。腹痛兼胀。脾虚故泻。宜泄肝培土。刘草窗痛泻方。（炒白术、炒白芍、新会皮、煨防风。）有因痰而
泄者。胸满泻沫。右脉弦滑。甚则呕吐。腹中觉冷。隐隐作痛。宜浓朴二陈汤。（川朴、半夏、茯苓、陈皮、
甘草。）肥人滑泻。多属于痰。不食不饥。亦责之痰。宜青州白丸子。（半夏、南星、白附子、川乌。）有因食
而泻者。泻下臭腐。噫气作酸。腹痛、泻后痛减。宜香砂胃苓汤。（即胃苓汤、加木香、砂仁。）或保和丸。
加砂仁、豆蔻。有大瘕泄者。里急后重。每至圊而不能便。似痢非痢。所下皆是粪水。茎中痛。乃寒湿化为湿热
也。宜八珍散。（木通、车前子、焦栀子、扁蓄、瞿麦、滑石、甘草梢、大黄、灯草。）加木香、槟榔。有伤酒
而泻。晨起必泄。素嗜饮。经年不愈者。宜葛花解酲汤。（葛花、豆蔻、木香、陈皮、青皮、神曲、茯苓、干
姜、人参、白术、泽泻、猪苓、砂仁。）或理中汤加葛根。吞酒煮川连丸。（酒煮黄连一味为丸。）夏月暴注水
泻。脉虚细。口干烦闷。肠胃之暑湿也。宜五苓散加煨葛根。兼胀者、加浓朴、茅术。小便赤涩。加木通。兼
烦、加山栀、淡竹叶。暑火泻者。去官桂。加川连、黄芩炭。暑食泻者。加神曲、木香。暑湿泻者。加茅术、滑
石。兼呕。加半夏、浓朴、竹茹、藿香。若伤暑又伤生冷而化泻者。宜连理汤。（川连、人参、白术、甘草、
炮姜。）泄泻虽有多端。大要不离乎脾伤积湿。治法则初用调中分利。继用风药燥湿。久则升提。滑须固涩。
风兼解表。寒佐温中。食者消之。痰者化之。虚者补之。热者清之。随证施治。自无不愈。此条乃参合吴云峰
治泄泻之心法也。
【荣斋按】本节（夹泻伤寒）俞氏所说太简略，秀山先生补出六经下利症，廉臣先生参合吴云峰学说阐明了
《难经》的五泄，及肝、肾、胃、肠等泄泻，并总结出泻症的原因和治法，可以说大致具备。吴坤安《伤寒指掌》
所集的周禹载、叶天士二家学说，更觉明白晓畅，切于实用。《指掌》说∶
“如伤寒热症，下利纯水，或黄沫，潮热腹硬，脉沉滑有力者，此名傍流。因肠有燥矢，阻塞水浆，从旁渗
出。病在阳明，非关脾也，导燥矢其痢自止。
有阳明火症邪火不杀谷，吃汤下汤，吃水下水，此有阳明实证可据，非若脾肾俱败者；此亦只清其火邪，其利
自止。有一种外感风寒，内伤饮食，其症头痛，恶寒发热恶心饱闷，肠胃窘迫而泄泻者；此表里俱病，法当外
散表邪，内消积滞，不在伤寒变病之例。
有一种表热里寒之症，初起头痛恶寒发热，继即下利清谷，脉浮而迟，口不渴，俗名漏底伤寒是也。因其
人脾胃本虚，一感外邪，即得直入肠胃，不在太少留连。当温中散寒；如紫苏、桂枝、羌活、浓朴、广皮，木香、
茯苓、甘草之类。甚者加冬术、干姜。
若阳邪传里，热邪攻于肠胃，而下利脓血者，重症也。然亦有寒热之分∶
邪至三阴，为日已久，实者则从阳化热，虚者则从阴化寒矣。如少阴下利用猪苓汤者，从阳化热也；用桃花汤者，
从阴化寒也。辨症之法∶以脉数有力为热，脉缓无力为寒。舌燥口渴属热，舌润不渴属寒。小便赤涩属热，清
白属寒。下利肠垢属热。鸭溏属寒。热利脐下必热，寒利脐下必寒。热利当清其肠，寒利当温其下。凡伤寒疫
疠热邪传里，下利肠垢或下鲜血，小溺赤涩，舌苔黄燥如刺，或红刺如杨梅状，身热口渴，六脉洪数，脐腹大
痛者，此热毒内攻肠胃也；不治则烂矣！急用大黄、芩、连、银花、丹皮、芍药、甘草之类，下之清之。继用
鲜生地数两，代大黄与之，以养阴解毒。若下利肠垢其势稍缓者，宜黄芩汤加川连、银花、丹皮之属清之。
血利加丹参、槐米、川断。
如遇伤寒疫症，下利如豆汁鱼脑之色。脉象沉濡，舌白如粉，小便不利，而口不
渴者，温毒聚于肠胃也；宜茅
术、浓朴，广皮，二苓，滑石，泽泻，晚蚕砂， 本之类，渗之和之。
如下利杂色，六脉沉迟，舌润无苔，或紫色而光，口不渴饮，肠胃并连，直出无关闭者，此脾肾虚寒，关
闸不阖，元气下泄之也；急投胃关煎合桃花汤，兼从手阳明以堵截之，或桃花汤重加人参以截之。
如见外热内烦，舌燥口渴，脘中痞闷，或痛或呕，而利不止者；中焦湿热也。当用泻心法──芩、连、
半夏、干姜、枳实、木香、赤苓、泽泻之类。
凡下痢舌苔遍处白浓如雪花者，藏结也。不治。
凡三阴下利小便不利者。津液竭也。不可利小便。”
【病因】患者平素脾虚导致泄泻。或因肝气过旺克制脾土而引发泄泻。或因寒邪先侵袭太阴经，从而引起泄泻。或先因饮食积滞，想要排便却排不畅快，再次感受风寒之邪，进而出现太阳病证候的。
【症状】头痛、身体发热，胸闷或不闷，小便短少，大便泄泻。舌苔白，属于中寒泄泻；舌苔黄且厚腻，胸满腹痛，头痛身热，口中有粘腻秽浊感，属于宿食化生之泄泻。若舌质淡红，苔呈青白色，胃脘部闷胀，腹部胀满，肠鸣作痛并伴有泄泻，排便后腹胀、腹痛及肠鸣均缓解，属于肝气乘脾化生之泄泻。此时若新近感受外感邪气，也会出现头痛发热的症状。
【脉象】左脉濡数，右脉沉弱，属于寒性泄泻。若左脉弦硬或弦劲有力，右脉软弱或沉缓，属于肝强脾弱，即肝气乘脾。
【治法】对于中寒感邪者，使用葱豉胃苓汤。（即胃苓汤去掉甘草，加入葱白和豆豉。）对于夹带食积化热的身热泄泻，使用楂曲平胃散，加豆豉、藿香、薄荷、猪苓、茯苓、泽泻等药。对于肝气乘脾引起的腹鸣、腹痛、泄泻，使用扶土抑木煎。（炒白芍六钱、炒白术三钱、煨防风半钱、新会皮一钱、炒黄芩二钱、煨葛根一钱。）加豆豉、焦栀子等药。
【秀按】俞氏将泄泻分为三种情况，是因为先有泄泻，后受风寒邪气侵袭，从而出现头痛身热，这与伤寒病本身出现的下利不同。所谓伤寒下利，是指没有经过攻下治疗，自然出现的溏泻。关键在于辨别寒热进行治疗，这样才能不出差错。大致而言，阳热性质的下利，口渴想喝水，尿色赤红，发热且有肛门重坠感，粪便颜色必定焦黄，或者是肠道粘液垢腻，所下的东西都有热臭气味，脐下部位必然发热，服用凉药则停止，服用热药则加重。阴寒性质的下利，口不渴，小便颜色清白，四肢有时厥冷，脉象沉迟无力，必定是完谷不化的洞泄，或者是稀溏便，粪便颜色或者白或者淡黄，脐下多寒冷，三阳证的下利伴有身热，太阴病的下利手足温暖，少阴、厥阴病的下利身凉无热，这是大概的情况。太阳阳明合病下利，用葛根汤。太阳少阳合病下利，用黄芩汤。阳明少阳合病下利，用小柴胡汤加葛根、芍药。合病发热且自利，说明是表邪，不可一概当作里证处理。温热病发热且口渴，小便赤色，大便自利，用五苓散去桂枝加黄芩。热邪内盛而泄泻不止，用黄连解毒汤。烦躁闷乱甚至狂乱者，用三黄石膏汤，或者大柴胡汤。自利且不渴属于太阴病，因为脏腑内有寒邪，应当温补，适宜服用四逆汤类方剂。由于太阴脏寒，也可以使用理中汤。如果寒邪严重导致四肢逆冷，脉象沉细，理中汤加附子。如果腹部胀满、小便不利，用五苓散配合理中汤主治。如果有呕吐症状，加半夏、生姜。自利且口渴属于少阴阴虚，所以引水自救，用白通汤主治，以通达阳气而消除阴寒。如果服用白通汤后泄泻不止，四肢厥冷，无脉，干呕心烦，用白通加猪胆汁汤主治，借助猪胆汁的向导之力，引导阳药深入体内。服药后，脉搏突然暴出的是死证，这是因为正气因发泄而脱失。脉搏微弱逐渐恢复的是生证，这是因为阳气逐渐恢复。少阴病，腹痛，小便不利，四肢沉重疼痛，自下利，这是有水气。其人或者咳嗽，或者小便利，或者下利，或者呕吐的，用真武汤主治，以运脾渗湿利水为要务。少阴病，下利完谷不化，里有寒邪外有假热，手足厥冷，脉微欲绝，身体反而不恶寒，其人面色发红，用通脉四逆汤主治。少阴病，吐利，手足厥冷，烦躁欲死，用吴茱萸汤主治。自汗不止，里有寒邪下脱，这种下利在下焦，用赤石脂禹余粮汤主治。少阴病四肢厥逆，其人或者咳嗽或者心悸，或者小便不利，或者腹中痛，或者泄利下重感的，用四逆散主治。这是阳邪传入少阴，陷入于里，而不能交通阳分，所以不宜用苦寒攻下，而只以此方疏解。少阴病，自利清水，心下必然疼痛，口干燥的，急当攻下。热邪传入少阴，逼迫津液，注为自利，质地清澈而无渣滓混杂，颜色青而无赤黄相间，这正是阳邪暴横，反像阴邪，但阳邪传自上焦，其人心中必然疼痛，口中必然干燥，如果是阴邪，则心下满而不痛，口中平和而不渴，必定没有这种枯槁的现象，所以宜急下以救其阴液。厥阴病下利完谷不化，里有寒邪外有假热，出汗且四肢厥冷的，用通脉四逆汤主治。下利伴腹胀满，身体疼痛的，先温其里，再攻其表。温里用四逆汤，攻表用桂枝汤，这总以温里为急务。大汗出，热不止，内部拘急，四肢疼痛，又下利厥逆且恶寒的，用四逆汤主治。恶寒脉微而又下利，利止是因为亡血，用四逆加人参汤主治。亡血本来不宜用姜、附以损伤阴液，阳虚又不当用当归、白芍以收敛阳气，因为利后恶寒，阳虚下脱已经很严重，所以用四逆汤以回复阳气，为阳脱加人参，则阳药更加得力，阳生则阴长，如果误用阴药，必定导致腹部胀满不能进食，或者加重泄利呕吐，转而变成下脱证。下利手足厥冷无脉的，艾灸治疗。下利说胡话的，是有燥屎，宜用小承气汤攻下。盖因下利则热不结，胃不实，怎么会得说胡话的症状？这一定是邪气返回于胃，内有燥粪，所以虽然下利但结滞依然如故，于是用小承气汤轻微攻伐胃腑。大致而言，下利脱气非常紧急，在五夺之中，只有这个最严重，所以不厌其烦地详细审辨。下利一天十多次，脉象反而实大的，是死证。伤寒发热下利非常严重，厥逆不止的，是死证。厥证只要发热就不死，因为发热则邪气出于体表，而里证自然解除，下利也会停止。如果反而下利厥逆，烦躁加重，那么这种发热又是真阳外散的征兆，阴阳两绝，所以主死。伤寒发热下利，厥逆，躁动不得卧的，是死证。躁动不得卧，是肾中阳气越绝的现象。下利且手足厥冷，都是危重征象，加上发热躁动不得卧，不但虚阳外露，而且真阴也被烧尽无余了，怎么能不死呢？《金匮要略》说：六腑之气绝于外，则手足寒冷；五脏之气绝于内，则下利不禁。气已经脱失了，这是参合陈素中辨证的大概情况。
【廉勘】伤寒协热下利，十有七八，世俗之人不认识，称之为漏底伤寒，往往妄用温燥止涩的药物，来助长热邪，转变为危重病症，真是可悲啊。然而根据前面的辨证，都是以伤寒之下利来确立治法，其他泄泻类证非常多，原因尤其不同。现在列举其中重要的，再辨析如下。景岳说：泄泻的根本，无不由于饮食不节，起居不时，脾胃受伤，则水反为湿，谷反为滞，水谷精华之气不能输化，而泄泻就产生了。泄，是大便溏薄，时好时坏；泻，是大便直下，如水倾注。虽然分轻重，总属脾伤。脾受湿邪而不能渗泄，损伤阑门的元气，而分利无权，并入大肠，遂致成泄。所以肠鸣尿少，大便反而畅快，泄固然是由于湿邪所致。《难经》说：湿多成五泄，曰飧泄、曰溏泄、曰濡泄、曰滑泄、曰鹜泄（注：原文此处可能有缺字或异体，通常指飧、溏、濡、滑、鹜）。飧泄，是完谷不化，湿兼风邪。兼有恶风自汗，肠鸣，脉弦的，宜用胃苓汤加升麻、煨防风。又有久风入中，令清气下降而不升，则风邪入胃，这是木贼土也。所以冲和之气不能化，能令腹鸣而痛，完谷出而为泻。宜用痛泻要方合四苓散。（焦白术三钱、炒白芍五钱、新会皮半钱、煨防风半钱、茯苓四钱、猪苓三钱、泽泻三钱。）如果飧泄脉弦，腹痛而渴，以及头痛微汗，宜用防风芍药汤。（煨防风三钱、炒白芍五钱、炒黄芩三钱。）或者饮食太过，肠胃受伤，也导致水谷不化。下者举之，宜用加减木香散。（木香一钱、干姜八分、党参二钱、六神曲二钱、肉豆蔻一钱、新会皮一钱、焦白术二钱、阳春砂五分、升麻八分、槟榔一钱。）溏泄，是肠垢污积，湿兼热邪。其证脉数，尿赤涩，所下稠粘垢秽，宜用黄芩芍药汤，合益元散。（黄芩三钱、白芍五钱、益元散八钱。）鹜泄（注：原文此处似缺字，结合上下文应为“鹜”或类似描述澄清溺白），是澄清溺白，湿兼寒邪。其证大便如水，其中稍有结粪的是。如果清冷如鸭粪，脉见沉迟，小溲清白，用理中汤加橘红、茯苓治疗。如果泄泻不已，再加附子。濡泄（一名洞泄），身重脉软，湿自胜也。由脾虚不能制湿，湿反胜而成病，所以腹不痛，而肠鸣尿少，利下多水，宜用五苓散主治。滑泄，是久下不禁，湿胜气脱。其证大泻如竹筒直下不止，宜用扶脾丸。（炒白术二钱、茯苓三钱、新会皮半钱、姜半夏半钱、诃子皮半钱、炙甘草八分、乌梅二枚、干姜半钱、藿香二钱、杜赤豆三钱、肉桂一钱、炒麦芽三钱、六神曲二钱、荷叶包烧饭为丸。）或者补中益气汤加诃子、肉蔻。或者四柱饮。（人参、附子、茯苓、木香、加生姜、盐少许。）或者六柱饮。（即四柱饮，加肉蔻、诃子。）其他尚有胃泄，则面黄而饮食不化，宜用理中汤。脾泄则呕吐而腹胀注下，如食后饱满，泻出即宽，宜用香砂六君子汤。大肠泄则食已窘迫，大便色白，而肠鸣切痛，宜用五苓散加木香。小肠泄则尿涩而便脓血，小腹痛，先宜攻下，继用清利。肾泄则五更便泄，足冷腹痛，宜用四神丸。（肉豆蔻、破故纸、五味子、吴茱萸、姜枣为丸。）肝泄则木来侮土，腹痛兼胀，脾虚故泻，宜泄肝培土，刘草窗痛泻方。（炒白术、炒白芍、新会皮、煨防风。）有因痰而泄者，胸满泻沫，右脉弦滑，甚则呕吐，腹中觉冷，隐隐作痛，宜用浓朴二陈汤。（川朴、半夏、茯苓、陈皮、甘草。）肥人滑泻，多属于痰，不食不饥，也责之于痰，宜用青州白丸子。（半夏、南星、白附子、川乌。）有因食而泻者，泻下臭腐，噫气作酸，腹痛、泻后痛减，宜用香砂胃苓汤。（即胃苓汤，加木香、砂仁。）或者保和丸，加砂仁、豆蔻。有大瘕泄者，里急后重，每至厕所却不能排便，似痢非痢，所下皆是粪水，茎中痛，乃寒湿化为湿热也，宜用八珍散。（木通、车前子、焦栀子、扁蓄、瞿麦、滑石、甘草梢、大黄、灯草。）加木香、槟榔。有伤酒而泻，晨起必泄，素嗜饮酒，经年不愈者，宜用葛花解酲汤。（葛花、豆蔻、木香、陈皮、青皮、神曲、茯苓、干姜、人参、白术、泽泻、猪苓、砂仁。）或者理中汤加葛根，吞服酒煮川连丸。（酒煮黄连一味为丸。）夏月暴注水泻，脉虚细，口干烦闷，肠胃之暑湿也，宜用五苓散加煨葛根。兼胀者，加浓朴、茅术。小便赤涩，加木通。兼烦，加山栀、淡竹叶。暑火泻者，去官桂，加川连、黄芩炭。暑食泻者，加神曲、木香。暑湿泻者，加茅术、滑石。兼呕，加半夏、浓朴、竹茹、藿香。若伤暑又伤生冷而化泻者，宜用连理汤。（川连、人参、白术、甘草、炮姜。）泄泻虽有多端，大要不离乎脾伤积湿，治法则初用调中分利，继用风药燥湿，久则升提，滑须固涩，风兼解表，寒佐温中，食者消之，痰者化之，虚者补之，热者清之，随证施治，自无不愈。此条乃参合吴云峰治泄泻之心法。
【荣斋按】本节（夹泻伤寒）俞氏所说太简略，秀山先生补出了六经下利症，廉臣先生参合吴云峰学说阐明了《难经》的五泄，及肝、肾、胃、肠等泄泻，并总结出泻症的原因和治法，可以说大致具备。吴坤安《伤寒指掌》所集的周禹载、叶天士二家学说，更觉明白晓畅，切于实用。《指掌》说：“如伤寒热症，下利纯水，或黄沫，潮热腹硬，脉沉滑有力者，此名旁流。因肠有燥矢，阻塞水浆，从旁渗出。病在阳明，非关脾也，导燥矢其痢自止。有阳明火症邪火不杀谷，吃汤下汤，吃水下水，此有阳明实证可据，非若脾肾俱败者；此亦只清其火邪，其利自止。有一种外感风寒，内伤饮食，其症头痛，恶寒发热恶心饱闷，肠胃窘迫而泄泻者；此表里俱病，法当外散表邪，内消积滞，不在伤寒变病之例。有一种表热里寒之症，初起头痛恶寒发热，继即下利清谷，脉浮而迟，口不渴，俗名漏底伤寒是也。因其人脾胃本虚，一感外邪，即得直入肠胃，不在太少留连。当温中散寒；如紫苏、桂枝、羌活、浓朴、广皮，木香、茯苓、甘草之类。甚者加冬术、干姜。若阳邪传里，热邪攻于肠胃，而下利脓血者，重症也。然亦有寒热之分：邪至三阴，为日已久，实者则从阳化热，虚者则从阴化寒矣。如少阴下利用猪苓汤者，从阳化热也；用桃花汤者，从阴化寒也。辨症之法：以脉数有力为热，脉缓无力为寒。舌燥口渴属热，舌润不渴属寒。小便赤涩属热，清白属寒。下利肠垢属热。鸭溏属寒。热利脐下必热，寒利脐下必寒。热利当清其肠，寒利当温其下。凡伤寒疫疠热邪传里，下利肠垢或下鲜血，小溺赤涩，舌苔黄燥如刺，或红刺如杨梅状，身热口渴，六脉洪数，脐腹大痛者，此热毒内攻肠胃也；不治则烂矣！急用大黄、芩、连、银花、丹皮、芍药、甘草之类，下之清之。继用鲜生地数两，代大黄与之，以养阴解毒。若下利肠垢其势稍缓者，宜黄芩汤加川连、银花、丹皮之属清之。血利加丹参、槐米、川断。如遇伤寒疫症，下利如豆汁鱼脑之色。脉象沉濡，舌白如粉，小便不利，而口不渴者，温毒聚于肠胃也；宜茅术、浓朴，广皮，二苓，滑石，泽泻，晚蚕砂， 本之类，渗之和之。如下利杂色，六脉沉迟，舌润无苔，或紫色而光，口不渴饮，肠胃并连，直出无关闭者，此脾肾虚寒，关闸不阖，元气下泄之也；急投胃关煎合桃花汤，兼从手阳明以堵截之，或桃花汤重加人参以截之。如见外热内烦，舌燥口渴，脘中痞闷，或痛或呕，而利不止者；中焦湿热也。当用泻心法──芩、连、半夏、干姜、枳实、木香、赤苓、泽泻之类。凡下痢舌苔遍处白浓如雪花者，藏结也。不治。凡三阴下利小便不利者。津液竭也。不可利小便。”
(Also known as Cold Damage complicated with Diarrhea)
[Etiology] The patient has a history of diarrhea due to Spleen deficiency. Or the diarrhea is caused by Liver pathogen invading the Spleen. Or the Cold pathogen first attacks the Taiyin meridian, resulting in diarrhea. Or there was initially food stagnation, with incomplete desire to defecate, followed by a secondary contraction of Wind-Cold pathogen, leading to symptoms of the Taiyang syndrome.
[Symptoms] Headache and fever, chest fullness or no fullness, short urination, and loose stools. A white tongue coating indicates Cold-diarrhea; a yellow and thick tongue coating, chest and abdominal fullness/pain, headache, fever, and a sticky/foul taste in the mouth indicate diarrhea from transformed food stagnation. If the tongue body is pale red with a cyan-white coating, epigastric stuffiness, abdominal distension, borborygmus with pain and diarrhea, which relieve after defecation, it indicates diarrhea from Liver pathogen invading the Spleen. If newly contracted external pathogens are present, headache and fever will also occur.
[Pulse] A soggy and rapid pulse on the left and a deep and weak pulse on the right indicate Cold diarrhea. If the left pulse is wiry and firm/tense, and the right pulse is soft/weak or deep/slow, it indicates strong Liver and weak Spleen, i.e., Liver pathogen invading the Spleen.
[Treatment] For Cold invasion with pathogenic factors, use Congchi Weiling Tang (Scallion and Fermented Soybean Decoction combined with Guizhi Tang and Pingwei San, specifically Weiling Tang minus Licorice plus Scallion and Fermented Soybean). For diarrhea with food stagnation and transformation into heat accompanied by fever, use Zhaqu Pingwei San (Hawthorn and Malt Decoction combined with Pingwei San), adding Dou Chi (Fermented Soybean), Huoxiang (Patchouli), Bohe (Mint), Zhuling (Polyporus), Fuling (Poria), and Zexie (Alisma). For diarrhea with borborygmus and abdominal pain due to Liver pathogen invading the Spleen, use Futu Yimu Jian (Decoction to Support Earth and Suppress Wood), consisting of Chao Baishao (Stir-fried White Peony Root) 6 qian, Chao Baizhu (Stir-fried Atractylodes Macrocephala Rhizome) 3 qian, Wei Fangfeng (Baked Saposhnikovia Root) 0.5 qian, Xinhui Pi (Tangerine Peel) 1 qian, Chao Huangqin (Stir-fried Scutellaria Root) 2 qian, and Wei Gegen (Baked Kudzu Root) 1 qian. Add Dou Chi (Fermented Soybean) and Jiao Zhizi (Charred Gardenia Fruit).
[Xiu's Commentary] Yu divides diarrhea into three types based on the sequence: pre-existing diarrhea followed by contraction of Wind-Cold, leading to headache and fever. This differs from the spontaneous diarrhea seen in Cold Damage disease itself. The so-called "Cold Damage diarrhea" refers to loose stools occurring naturally without prior purgative treatment. The key is to differentiate between Cold and Heat for treatment to avoid errors. Generally, Yang-Heat type diarrhea presents with thirst, desire to drink, dark urine, fever with tenesmus,焦黄 (scorched yellow) stool color, or intestinal mucus, with hot foul odor, and heat below the umbilicus; it stops with cold herbs and worsens with warm herbs. Yin-Cold type diarrhea presents with no thirst, clear urine, occasional cold limbs, deep/slow/weak pulse, complete undigested food in stool (Dongxia), or loose stools, white or pale yellow stool color, coldness below the umbilicus. Taiyang-Yangming combined disease with diarrhea uses Gegen Tang (Kudzu Decoction). Taiyang-Shaoyang combined disease with diarrhea uses Huangqin Tang (Scutellaria Decoction). Yangming-Shaoyang combined disease with diarrhea uses Xiaochaihu Tang (Minor Bupleurum Decoction) added with Gegen (Kudzu Root) and Shaoyao (Peony Root). Combined disease with fever and spontaneous diarrhea indicates exterior pathogen, not to be treated merely as interior syndrome. Warm-heat disease with fever, thirst, dark urine, and spontaneous diarrhea uses Wuling San (Five-Ingredient Powder with Poria) minus Guizhi (Cinnamon Twig) plus Huangqin (Scutellaria Root). If internal heat is excessive with unceasing diarrhea, use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity). For restlessness, oppression, mania, or confusion, use Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction) or Daxiehu Tang (Major Bupleurum Decoction). Spontaneous diarrhea without thirst belongs to Taiyin due to interior cold; it should be warmed, suitable for Sini Tang (Frigid Extremities Decoction) category. Due to Taiyin organ cold, Lizhong Tang (Regulate the Middle Decoction) may be used. If cold is severe with cold limbs and deep/thready pulse, add Fuzi (Aconite Root) to Lizhong Tang. If abdominal fullness and difficult urination occur, combine Wuling San (Five-Ingredient Powder with Poria) with Lizhong Tang. If vomiting occurs, add Banxia (Pinellia Tuber) and Shengjiang (Fresh Ginger). Spontaneous diarrhea with thirst belongs to Shaoyin Yin deficiency, seeking water to save itself; treat with Bitong Tang (Unblock Yang Decoction) to unblock Yang and dissipate Yin. If diarrhea persists despite Bitong Tang, with cold limbs, absent pulse, dry retching, and irritability, use Bitong Jia Zhuyedan Tang (Bitong Decoction plus Porcine Bile) to guide Yang medicine deeply using porcine bile as a guide. If the pulse suddenly emerges after taking the decoction, death ensues due to Qi collapse from leakage. If the pulse slowly returns, survival is indicated by gradual Yang recovery. Shaoyin disease with abdominal pain, difficult urination, heavy/painful limbs, and spontaneous diarrhea indicates Water-Qi; if coughing, frequent urination, diarrhea, or vomiting occur, treat with Zhenwu Tang (True Warrior Decoction) to transport Spleen and leach out water. Shaoyin disease with diarrhea of undigested food, interior cold with exterior false heat, cold limbs, thready/almost imperceptible pulse, absence of aversion to cold, and flushed face is treated with Tongmai Sini Tang (Pulse-Unblocking Frigid Extremities Decoction). Shaoyin disease with vomiting, diarrhea, cold limbs, and severe irritability is treated with Wuzhuyu Tang (Evodia Decoction). Spontaneous sweating unceasing, interior cold with lower jiao collapse, treated with Chishizhi Yuyuliang Tang (Red Stone Liparid and Hematite Decoction). Shaoyin disease with cold limbs, optionally coughing, palpitations, difficult urination, abdominal pain, or heaviness in defecation is treated with Sini San (Frigid Extremities Powder) because Yang pathogen has entered Shaoyin and sunk inward, failing to communicate with Yang; bitter-cold purgatives are unsuitable, so this formula resolves it. Shaoyin disease with spontaneous watery diarrhea,必 painful epigastrium, and dry mouth requires urgent purging. Heat pathogen entering Shaoyin forces fluids, causing spontaneous diarrhea that is clear without dregs, blue-green without red/yellow mix. This resembles Yin pathogen but originates from upper Jiao Yang pathogen, causing epigastric pain and dry mouth; Yin pathogen would cause fullness without pain and a neutral mouth without thirst. Thus, urgent purging is needed to save Yin. Jueyin disease with diarrhea of undigested food, interior cold with exterior false heat, sweating, and cold limbs is treated with Tongmai Sini Tang. Diarrhea with abdominal fullness and body pain requires warming the interior first, then attacking the exterior: Sini Tang (Frigid Extremities Decoction) to warm interior, Guizhi Tang (Cinnamon Twig Decoction) to attack exterior; warming interior is urgent. Profuse sweating, unceasing heat, internal cramping, limb pain, plus diarrhea, cold limbs, and aversion to cold is treated with Sini Tang (Frigid Extremities Decoction). Aversion to cold, thready pulse, and subsequent cessation of diarrhea indicates Blood loss; treat with Sini Jia Renshen Tang (Frigid Extremities Decoction plus Ginseng). Blood loss usually contraindicates Ginger/Aconite to protect Yin, while Yang deficiency contraindicates Danggui/Shaoyao to conserve Yang; however, post-diarrhea aversion to cold indicates severe Yang collapse, so Sini Tang restores Yang, and Ginseng aids Yang medicine; Yang generation promotes Yin growth. Misusing Yin herbs causes abdominal fullness, anorexia, or worsened diarrhea/vomiting, leading to lower collapse. Diarrhea with cold limbs and absent pulse requires moxibustion. Diarrhea with delirium indicates Dry Stool; treat with Xiao Chengqi Tang (Minor Order the Qi Decoction). Although diarrhea suggests no heat knotting or stomach excess, delirium implies pathogen returning to Stomach with dry feces; thus, mild purgation with Xiao Chengqi Tang is used. Lower collapse Qi depletion is critical among the Five Depletions; hence detailed differentiation is necessary. Diarrhea more than ten times daily with a surprisingly solid pulse indicates death. Cold damage with fever, severe diarrhea, and unceasing cold limbs indicates death. In Jue syndrome, fever alone is not fatal as it indicates pathogen exiting the exterior and resolving interior symptoms/diarrhea. However, if accompanied by worsening diarrhea, cold limbs, and irritability, the fever signifies true Yang scattering externally, indicating Yin-Yang exhaustion and death. Cold damage with fever, diarrhea, cold limbs, and inability to lie still due to irritability indicates death; this represents kidney Yang escaping. Diarrhea with cold limbs is critical; adding fever and irritability/exhaustion means both deficient Yang is exposed and true Yin is consumed, leading to death. *Jinkui Yaolue* states: Six Fu organs Qi failure externally leads to cold hands/feet; Five Zang organs Qi failure internally leads to uncontrollable diarrhea, indicating Qi collapse. This aligns with Chen Suzhong's diagnostic overview.
[Lian's Examination] Cold Damage combined-heat diarrhea accounts for 70-80%. Laypeople mistake it for "Leaking Bottom Cold Damage" and wrongly use warm-drying astringents, aggravating heat and causing critical conditions, which is tragic. Based on previous differentiation, treatments are established for Cold Damage diarrhea. Other diarrhea types have different etiologies. Important ones are differentiated below. Jingyue stated: The root of diarrhea lies in irregular diet and lifestyle injuring Spleen/Stomach, turning water into dampness and grain into stagnation, preventing essence transformation. 'Xie' (leakage) is loose stool, intermittent; 'Xie' (purge) is direct flow like water. Both involve Spleen injury. Spleen affected by dampness fails to separate clear/turbid, damaging Lanmen Qi, leading to mixing in Large Intestine. Hence borborygmus, scant urine, and loose stools. *Nan Jing* states dampness causes five diarrheas: Sun (undigested), Tang (loose), Ru (soft/sluggish), Hua (slippery/incontinent), Wu (duck-like). Sun diarrhea (undigested, wind-damp, aversion to wind/sweat, borborygmus, wiry pulse) uses Weiling Tang plus Shengma (Cimicifuga) and Wei Fangfeng (Baked Saposhnikovia). Long-term wind entering middle causes clear Qi to sink, Wind invading Stomach (Wood insulting Earth), causing borborygmus/pain and undigested stool; use Tongxie Yaofang (Essential Formula for Painful Diarrhea) combined with Siling San (Four-Poria Powder). Sun diarrhea with wiry pulse, abdominal pain/thirst, headache/slight sweat uses Fangfeng Shaoyao Tang (Saposhnikovia and Peony Decoction). Overeating injuring intestines/stomach causing undigested food uses Jiajian Muxiang San (Modified Costus Powder). Tang diarrhea (intestinal mucus, damp-heat, rapid pulse, dark/scanty urine, sticky stool) uses Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) combined with Yiyuan San (Benefit Origin Powder). Wu diarrhea (clear urine, damp-cold, watery stool with small hard feces, cold duck-like stool, deep/slow pulse, clear urine) uses Lizhong Tang plus Juhong (Tangerine Pith) and Fuling (Poria); if persistent, add Fuzi (Aconite). Ru diarrhea (also called Dongxia, heavy body, soft pulse, damp overcoming due to Spleen deficiency, no pain, borborygmus, scant urine, watery stool) uses Wuling San (Five-Ingredient Powder with Poria). Hua diarrhea (chronic incontinence, damp overwhelming Qi collapse, straight flow like bamboo tube) uses Fupi Wan (Spleen-Supporting Pill) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Hezi (Chebula) and Roukou (Nutmeg), or Sizhu Yin (Four-Pillar Drink) or Liuzhu Yin (Six-Pillar Drink). Gastric diarrhea (yellow face, undigested food) uses Lizhong Tang. Spleen diarrhea (vomiting, abdominal fullness, relief after defecation) uses Xiangsha Liujunzi Tang (Costus and Aucklandia Six-Gentlemen Decoction). Large Intestine diarrhea (urgency after eating, white stool, sharp borborygmus/pain) uses Wuling San plus Muxiang (Costus). Small Intestine diarrhea (scanty urine, pus/blood in stool, lower abdominal pain) requires initial purgation followed by clearing/drainage. Kidney diarrhea (dawn diarrhea, cold feet/abdomen) uses Sishen Wan (Four Miracle Pill). Liver diarrhea (Wood insulting Earth, abdominal pain/fullness, Spleen deficiency) uses Liu Caocuang's Tongxie Fang (Painful Diarrhea Formula). Phlegm-induced diarrhea (chest fullness, frothy stool, wiry-slippery right pulse, vomiting, cold abdomen, dull pain) uses Nanhua Erchen Tang (Magnolia and Two-Aged Decoction). Obese people with slippery diarrhea often have phlegm; use Qingzhou Baiwanzi (Qingzhou White Pills). Food-induced diarrhea (foul stool, sour belching, abdominal pain relieved by defecation) uses Xiangsha Weiling Tang (Costus and Amomum combined with Weiling Tang) or Baohe Wan (Preserve Harmony Pill). Da Jia Xie (Great Mass Diarrhea, tenesmus, inability to defecate despite urgency, fecal water, penile pain, cold-damp transforming to damp-heat) uses Bazhen San (Eight-Treasure Powder) plus Muxiang and Binglang (Areca Seed). Alcohol-induced diarrhea (morning diarrhea, chronic drinkers) uses Gehua Jieying Tang (Kudzu Flower Relieving Intoxication Decoction) or Lizhong Tang plus Gegen (Kudzu Root) with Jiu Zhu Chuanlian Wan (Wine-Boiled Coptis Pills). Summer acute watery diarrhea (deficient/thready pulse, dry mouth/restlessness, summer-damp-heat in intestines) uses Wuling San plus Wei Gegen (Baked Kudzu Root); add Nanhua (Magnolia Bark) and Maoyu (Coix Seed) for fullness, Mutong (Akebia Stem) for dark/scanty urine, Shanzhi (Gardenia) and Danzhuye (Lophatherum Leaf) for irritability. Summer-Fire diarrhea removes Guigui (Cassia Bark) adds Chuanlian (Coptis) and Huangqin Tan (Charred Scutellaria). Summer-Food diarrhea adds Shenqu (Medicated Leaven) and Muxiang. Summer-Damp diarrhea adds Maoyu (Coix Seed) and Huashi (Talc). With vomiting, add Banxia, Nanhua, Zhuru (Bamboo Shavings), Huoxiang. Summer-Cold/Damp-Heat transformation uses Lianli Tang (Coptis and Lizhong Decoction). Diarrhea roots in Spleen injury and Damp accumulation. Treatment principles: Initially regulate middle and separate clear/turbid; subsequently use Wind herbs to dry damp; long-term lift Qi; slippery cases require astringents; Wind combines with exterior release; Cold assists with warming middle; Food is digested; Phlegm is resolved; Deficiency is tonified; Heat is cleared. Treat according to syndrome. This integrates Wu Yunfeng's methods.
[Rongzhai's Note] Yu's description of this section is too brief. Xiushan added Six Meridian diarrhea syndromes. Lianchen integrated Wu Yunfeng's theories to explain Nan Jing's Five Diarrheas and Liver/Kidney/Stomach/Intestine types, summarizing causes and treatments comprehensively. Wu Kun'an's *Shanghan Zhizhang* (Guiding Palms for Cold Damage), collecting Zhou Yuzai and Ye Tianshi's theories, is clearer and practical. It states: "Cold damage heat syndrome with pure water or yellow foam diarrhea, tidal fever, hard abdomen, deep/slippy/strong pulse is named Pangliu (Side Flow). Caused by dry feces blocking fluids, leaking from sides. Pathology is Yangming, not Spleen; guiding dry feces stops diarrhea. Yangming Fire syndrome where fire fails to digest food (drinking water results in immediate urination) has Yangming excess evidence; clearing fire stops diarrhea. Exterior Wind-Cold with interior food injury causing headache, aversion to cold/fever, nausea, fullness, and diarrhea involves both exterior and interior; treat by dispersing exterior and resolving stagnation, not a Cold Damage complication. Exterior heat with interior cold starts with headache/aversion to cold/fever, progressing to undigested food diarrhea, floating/slow pulse, no thirst ('Leaking Bottom Cold Damage'). Due to inherent Spleen/Stomach weakness, pathogen enters intestines directly, skipping Taiyang/Shaoyang. Warm middle and scatter cold with Zisu, Guizhi, Qianghuo, Nanhua, Guangpi, Muxiang, Fuling, Gancao; severe cases add Dongzhu (Winter Atractylodes) and Ganjiang (Dried Ginger). If Yang pathogen transmits interior, heat attacks intestines causing pus/blood diarrhea (severe case). Differentiate Cold/Heat: Pathogen in Three Yin for long time, Excess transforms to Heat from Yang, Deficiency transforms to Cold from Yin. Shaoyin diarrhea using Zhu Ling Tang indicates Heat transformation; Taohua Tang indicates Cold transformation. Differentiation: Rapid/strong pulse is Heat, slow/weak is Cold. Dry tongue/thirst is Heat, moist/no thirst is Cold. Dark/scanty urine is Heat, clear is Cold. Intestinal mucus is Heat, Duck-like stool is Cold. Heat diarrhea has heat below umbilicus; Cold has cold. Clear Heat intestine for Heat diarrhea; Warm lower for Cold diarrhea. Epidemic heat transmitting interior causing intestinal mucus/blood, dark urine, prickly yellow/red tongue, fever/thirst, surging/rapid pulse, severe abdominal pain indicates Heat-Toxin attacking intestines; untreated leads to rotting. Urgently purge/clear with Dahuang, Huangqin, Huanglian, Yinhua, Danpi, Shaoyao, Gancao. Follow with fresh Shengdi (Rehmannia) to nourish Yin and detoxify. Slower intestinal mucus diarrhea uses Huangqin Tang plus Chuanlian, Yinhua, Danpi. Blood diarrhea adds Danshen, Huaimi, Chuanduan. Epidemic diarrhea with bean-water/fish-brain color, deep/soggy pulse, powder-like white tongue, difficult urination, no thirst indicates Warm-Toxin gathering in intestines; use Maoyu, Nanhua, Guangpi, Erling (Zhu Ling/Fu Ling), Huashi, Zexie, Wancangsha (Silkworm Sand), Ben Cao to leach and harmonize. Mixed color diarrhea, deep/slow pulse, moist tongue without coating or purple/shiny, no thirst, continuous uncontrolled discharge indicates Spleen/Kidney deficiency-cold, failing closure, Qi collapsing downward. Urgently give Weiguan Jian combined with Taohua Tang, blocking via Hand-Yangming, or Taohua Tang with heavy Renshen. Exterior heat with interior irritability, dry tongue/thirst, epigastric oppression/pain/vomiting with unceasing diarrhea indicates Middle Jiao Damp-Heat. Use Xiexin Method: Huangqin, Huanglian, Banxia, Ganjiang, Zhishi, Muxiang, Chifuling, Zexie. Diffuse white snow-like tongue coating indicates Zang Knotting; untreatable. Three Yin diarrhea with difficult urination indicates fluid exhaustion; do not promote urination."