泄泻者，水泻所为也。由湿本土，土乃脾胃之气也。得此证者，或因于内伤，或感于外邪，皆能动乎脾湿。
脾病则升举之气下陷，湿变注并出大肠之道，以胃与大肠同乎阳明一经也。云湿可成泄，垂教治湿大意而言。
后世方论泥云∶治湿不利小便，非其治也。故凡泄泻之药，多用淡渗之剂利之。下久不止，不分所得之因，遽
以为寒，而用紧涩热药兜之。夫泄有五飧。泄者，水谷不化而完出，湿兼风也；溏泄者，所下汁积粘垢，湿兼
热也； 泄者，所下澄澈清冷，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
下不能禁固，湿胜气脱也。若此有寒热虚实之不同，举治不可执一而言。谨书数法于后∶夫泄有宜汗解者。经
言春伤于风，夏必飧泄。又云∶久风为飧泄，若保命集云，用苍术、麻黄、防风之属是也。有宜下而保安者。
若长沙言，下痢脉滑而数者，有宿食也，当下之。下利已瘥至其时复发者，此为下未尽更下之安，悉用大承气
汤加减之剂。有宜化而得安者。格致余论，夏月患泄，百方不效，视之，久病而神亦瘁，小便少而赤，脉滑而
颇弦，格闷食减。因悟此久积所为，积湿成痰留于肺中，宜大肠之不固也。清其源则流自清。以茱萸等作汤，
温服一碗许，探喉中，一吐痰半升，
如利减半，次早晨饮，吐半升而利止。有以补养而愈者，若脾胃论，言脉弦、气弱、自汗，四肢发热，大便泄
泻，从黄 建中汤。有宜调和脾湿而得止者，若洁古言曰∶四肢懒倦，小便不利，大便走泄，沉困，饮食减少，
以白术、芍药、茯苓，加减治之。有宜升举而安者，若试效方言∶胃中湿脾弱，不能营运，食下则为泄，助甲
胆风胜以克之。以升阳之药羌活、独活、升麻、防风、炙甘草之属。有宜燥湿而后除者，若脾胃论言∶上湿有
余，脉缓，怠惰嗜卧，四肢不收，大便泄泻，从平胃散。有宜寒凉而愈者，若长沙言∶协热自利者，黄芩汤主
之。举其湿热之相宜者，若长沙言，下利脉迟紧痛未欲止当温之；下利心痛急当救里；下利清白水液澄澈，可
与理中四逆汤辈。究其利小便之相宜者，河间言湿胜则濡泄。小便不利者，可与五苓散、益元散分导之。以其
收敛之相宜者，东垣言∶寒滑气泄不固，制诃子散涩之。以上诸法，各有所主，宜独利小便而湿动也。岂独病
因寒，必待龙骨、石脂紧重燥毒之属涩之。治者又当审择其说，一途取利，约而不博可乎。
泄泻，是指水样便的腹泻。其病机源于湿邪，湿属土，而土对应脾胃之气。出现此证候，或因内伤饮食，或感外邪侵袭，皆能扰动脾脏之湿气。
脾脏患病，则升清举陷之气下陷，湿气转化并注于大肠通道，因为胃与大肠同属阳明一经。文中说“湿可致泄”，是从治疗湿邪的大意而言。
后世医家拘泥于说法：“治湿若不通利小便，就不是正确的治疗方法。”因此，凡是治疗泄泻的药物，多使用淡味渗湿之剂来利尿。若腹泻日久不止，不分导致的原因，就匆忙认为是寒证，而使用收敛固涩且性热的药物来兜住止泻。
其实泄泻有五种：飧泄（sūn xiè），指水谷不化而完谷排出，是湿兼风邪；溏泄（táng xiè），指所下之物如汁液积聚粘垢，是湿兼热邪；澄澈清冷之泄，指所下之物清澈寒冷，小便清白，是湿兼寒邪；濡泄（rú xiè），指身体沉重软弱，泄下多水，是湿气自盛；滑泄（huá xiè），指久泻不能固摄，是湿胜气脱。像这样，其中有寒热虚实的不同，治疗不可固执一端而论。谨记录几种方法如下：
有的泄泻适宜用发汗法解除。经文说：春季伤于风邪，夏季必定发生飧泄。又说：久风可致飧泄。如《保命集》所言，使用苍术、麻黄、防风等药物即是此理。
有的泄泻适宜用攻下法而获安。如张仲景（长沙）所言，痢疾脉象滑而数者，是有宿食，应当攻下。若下利已愈到此时复发者，这是因为下未尽，再次攻下即可安宁，全部使用大承气汤加减之剂。
有的泄泻适宜用化痰消积法而得安。《格致余论》记载，夏季患泄泻，百方无效，诊视发现，久病且精神憔悴，小便少而赤，脉滑而颇弦，胸膈痞闷食欲减退。于是悟出这是久积所致，积湿成痰留于肺中，影响了大肠的固摄功能。清除源头则水流自然清澈。用吴茱萸等煎汤，温服一碗左右，探喉催吐，吐出痰半升，腹泻减半；次日早晨再饮，又吐半升，腹泻即止。
有的泄泻通过补养而痊愈。如李东垣《脾胃论》所言，脉弦、气弱、自汗，四肢发热，大便泄泻，适用黄芪建中汤。
有的泄泻适宜调和脾湿而得以停止。如张洁古所言：四肢懒倦，小便不利，大便泄泻，沉困乏力，饮食减少，以白术、芍药、茯苓加减治疗。
有的泄泻适宜用升举阳气法而安宁。如罗天益《试效方》所言：胃中湿盛脾弱，不能运化，进食后则为泄泻，助甲胆风胜以克之。使用升阳药物如羌活、独活、升麻、防风、炙甘草等。
有的泄泻适宜用燥湿法而后除。如《脾胃论》所言：上焦湿气有余，脉缓，怠惰嗜卧，四肢不收，大便泄泻，适用平胃散。
有的泄泻适宜用寒凉法而痊愈。如张仲景所言：协热自利者，主用黄芩汤。
列举湿热相宜的情况，如张仲景所言：下利脉迟紧痛未欲止当温之；下利心痛急当救里；下利清白水液澄澈，可与理中汤、四逆汤之类。
究其利小便相宜的情况，如刘河间所言：湿胜则濡泄。小便不利者，可与五苓散、益元散分导之。
以其收敛相宜的情况，如李东垣所言：寒滑气泄不固，制诃子散涩之。
以上诸法，各有所主，不宜单独只知利小便而忽视湿邪动因。岂止病因是寒，必待龙骨、赤石脂等重镇燥毒之属来涩止。医者又应当审慎选择其说，仅取一途求利，简约而不广博，可以吗？
Diarrhea (xiè xiè) refers to watery stool. Its pathogenesis originates from dampness (shī), which belongs to Earth, and Earth corresponds to the Qi of the Spleen and Stomach. Manifestation of this syndrome may result from internal injury or external pathogenic invasion, both of which can disturb Spleen dampness.
When the Spleen is diseased, the ascending and uplifting Qi sinks downward. Dampness transforms and pours into the pathway of the Large Intestine, because the Stomach and Large Intestine belong to the same Yangming channel. The statement "dampness can cause diarrhea" speaks generally to the treatment principle of addressing dampness.
Later generations adhered rigidly to the saying: "To treat dampness without promoting urination is not correct treatment." Therefore, drugs for diarrhea often use bland and leaching agents to promote urination. If diarrhea persists for a long time without distinguishing the cause, it is hastily considered a Cold pattern, and tight, astringent, and hot drugs are used to stop it.
In fact, there are five types of diarrhea: Sun diarrhea (Sūn xiè), where undigested food and water are excreted whole, caused by dampness combined with Wind; Tang diarrhea (Táng xiè), where the excrement is sticky and turbid like juice, caused by dampness combined with Heat; Clear and cold diarrhea, where the excrement is clear and cold with clear urine, caused by dampness combined with Cold; Ru diarrhea (Rú xiè), characterized by heavy body and weakness with excessive watery stool, caused by self-abundance of dampness; Hua diarrhea (Huá xiè), where prolonged diarrhea cannot be controlled, caused by dampness excess leading to Qi collapse. As such, there are differences in Cold, Heat, Deficiency, and Excess; treatment cannot be rigidly fixed to one approach. I record several methods below:
Some diarrhea is suitable for resolution via sweating. The Classic states: "Wind injury in Spring leads to Sun diarrhea in Summer." It also says: "Prolonged Wind causes Sun diarrhea." As stated in *Bao Ming Ji*, using herbs such as Cang Zhu (Atractylodis Rhizoma), Ma Huang (Ephedrae Herba), and Fang Feng (Saposhnikoviae Radix) follows this logic.
Some diarrhea is suitable for purgation to achieve safety. As Zhang Zhongjing (of Changsha) stated, if dysentery presents with slippery and rapid pulse, there is retained food, and purgation is indicated. If diarrhea relapses at the proper time after initial relief, it is because the pathogen was not fully expelled; purging again will bring peace, using modified Da Cheng Qi Tang (Major Order the Qi Decoction).
Some diarrhea is suitable for resolution via resolving phlegm and accumulation. *Ge Zhi Yu Lun* records: In summer, a patient suffered diarrhea unresponsive to hundreds of prescriptions. Examination revealed chronic illness with depleted spirit, scanty red urine, slippery and slightly wiry pulse, chest oppression, and reduced appetite. It was realized that this was due to long-standing accumulation; accumulated dampness transformed into phlegm retained in the Lungs, affecting the stability of the Large Intestine. Clearing the source clears the flow. A decoction of Zhu Yu (Evodiae Fructus) etc. was taken warm, about one bowl, inducing vomiting by stimulating the throat. Half a sheng of phlegm was vomited, and diarrhea halved. The next morning, another dose induced half a sheng of vomiting, and diarrhea stopped.
Some diarrhea is cured by tonification. As stated in Li Dongyuan's *Pi Wei Lun*: With wiry pulse, weak Qi, spontaneous sweating, heat in the four limbs, and loose stools, Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle) is applicable.
Some diarrhea stops when Spleen dampness is harmonized. As Zhang Jiegu stated: For lazy limbs, difficult urination, loose stools, heaviness, and reduced diet, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Shao Yao (Paeoniae Radix Alba), and Fu Ling (Poria) are used in modified formulas.
Some diarrhea is stabilized by lifting and raising Qi. As Luo Tianyi's *Shi Xiao Fang* states: When dampness in the Stomach and weak Spleen fail to transport, eating leads to diarrhea, aided by Gallbladder Wind overcoming it. Yang-raising herbs such as Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Sheng Ma (Cimicifugae Rhizoma), Fang Feng (Saposhnikoviae Radix), and Zhi Gan Cao (Prepared Licorice Root) are used.
Some diarrhea is eliminated after drying dampness. As *Pi Wei Lun* states: When upper Jiao dampness is excessive, with slow pulse, lethargy, desire to lie down, inability to move limbs, and loose stools, Ping Wei San (Peace the Stomach Powder) is applicable.
Some diarrhea heals with cold-cooling methods. As Zhang Zhongjing stated: For diarrhea accompanied by heat, Huang Qin Tang (Scutellaria Decoction) is the primary treatment.
Regarding suitability for damp-heat: Zhang Zhongjing stated: If diarrhea has slow/tight pulse and pain not yet stopping, warm it; if diarrhea involves urgent heart pain, rescue the Interior; if diarrhea is clear water with clear fluid, Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang (Frigid Extremities Decoction) may be given.
Regarding suitability for promoting urination: Liu Wansu stated: Excess dampness causes Ru diarrhea. If urination is difficult, Wu Ling San (Five-Ling Powder) or Yi Yuan San (Benefit Origin Powder) can be used to guide and separate.
Regarding suitability for astringency: Li Dongyuan stated: For cold-slippery Qi leakage that is not secure, He Zi San (Kadaka Powder) is prepared to astringe.
The above methods each have their specific indications; one should not solely rely on promoting urination while ignoring the movement of dampness. Is it not true that only because the cause is Cold must one wait for heavy, toxic, drying astringents like Long Gu (Fossilia Ossis Mastodi) or Shi Zhi (Halloysitum Rubrum)? Physicians must carefully select these approaches. Relying on a single path for benefit, being concise but not comprehensive, is this acceptable?