五十七难曰∶泄凡有几，皆有名不？
然∶泄凡有五，其名不同。有胃泄，有脾泄，有大肠泄，
有小肠泄。有大瘕泄，名曰后重。
泄，利也。其证有五，故有五泄之名。后重者，专指大瘕泄而言。盖肾邪下结，气坠不升故
也。此五泄之目，下文详之。
胃泄者，饮食不化，色黄。
胃泄者，甲木之克戊土也。胃主纳谷，风木之邪乘之，胃腑郁迫，水谷不化，必脉弦肠鸣。
黄者，胃土之色。经曰∶春伤于风，夏生飧泄者是也。
脾泄者，腹胀满泄注，食即呕吐逆。
脾泄者，脾土湿寒，不能蒸水化气，故水谷并下，胀满泄注也。食即呕吐者，脾弱下陷，则
胃逆也，必所下多水，脉缓，腹不痛。经曰∶湿甚则濡泄者是也。
大肠泄者，食已窘迫，大便色白，肠鸣切痛。
大肠泄者，肠虚气不能摄，故胃方实，即迫注于下，窘迫不及少待也。色白者，大肠属庚金，
白，金之色也。肠鸣切痛者，气不和则攻冲，故鸣而痛也。经曰∶清气在下，则生飧泄者是也。
小肠泄者，溲而便脓血，少腹痛。
小肠泄者，小肠属丙火，不化寒水。郁于湿土之中，内热淫蒸，脓血腐化。又小肠与心为表
里，心主血，盖气不相摄，而便脓血，小便亦不禁也。小肠之气郁冲，下达膀胱，膀胱近少腹，
故少腹痛也。此即血痢之类耳。
大瘕泄者，里急后重，数至圊而不能便，茎中痛，此五泄之要法也。
大瘕泄者，邪气结于下，成 瘕而不散也。里急后重者，肠气急迫；肛门重坠也。数至圊而
不能便者，皆 结不散，故欲便而不爽也。茎中痛者，乃湿郁为热，大便气不能达，则移于小
便也。此即古之滞下，今名痢疾者是也。
第五十七难问道：泄泻总共有几种，都有名称吗？
回答说：泄泻总共有五种，它们的名称各不相同。有胃泄，有脾泄，有大肠泄，有小肠泄，有大瘕泄（一种以里急后重为特征的泄泻），大瘕泄的名称叫做“后重”。
泄，就是利的意思。它的证候有五种，所以有五种泄的名称。“后重”这一症状，专门指大瘕泄而言。这是因为肾邪下结，气机下坠而不能上升的缘故。这五种泄的条目，下文将详细论述。
所谓胃泄，表现为饮食不消化，大便颜色发黄。
胃泄，是甲木（风/肝）克制戊土（胃）的表现。胃主受纳谷物，风木之邪侵犯它，导致胃腑郁滞紧迫，水谷不能消化，必然出现脉弦、肠鸣的症状。黄色，是胃土的本色。《内经》说：“春伤于风，夏生飧泄”，说的就是这种情况。
所谓脾泄，表现为腹部胀满，泄泻如水注，进食后立即呕吐逆乱。
脾泄，是因为脾土湿寒，不能蒸腾水汽化为气化功能，所以水谷一同下行，导致胀满和泄泻如水注。进食后立即呕吐，是因为脾虚下陷，导致胃气上逆，必然排泄物中水分多，脉象缓弱，腹部不痛。《内经》说：“湿气过重则发生濡泄”，说的就是这种情况。
所谓大肠泄，表现为刚吃完食物就感到窘迫急迫，大便颜色发白，肠鸣且剧烈疼痛。
大肠泄，是因为肠道虚弱，气机不能固摄，所以胃中食物尚实，就逼迫下行，窘迫得来不及稍作等待。大便颜色发白，是因为大肠属庚金，白色是金的本色。肠鸣且剧烈疼痛，是因为气机不和而攻冲，所以既鸣叫又疼痛。《内经》说：“清气在下，则产生飧泄”，说的就是这种情况。
所谓小肠泄，表现为小便与大便同时排出脓血，少腹疼痛。
小肠泄，是因为小肠属丙火，不能化除寒水。寒水郁积在湿土之中，内部热邪淫溢蒸灼，导致脓血腐化形成。另外，小肠与心互为表里，心主血脉，因为气机不能相互统摄，所以大小便排出脓血，小便也不能控制。小肠的气机郁结冲逆，下达至膀胱，膀胱靠近少腹，所以少腹疼痛。这属于血痢之类。
所谓大瘕泄，表现为腹内急迫、肛门重坠，频繁去厕所却不能顺利排便，尿道疼痛，这是五种泄的关键法则。
大瘕泄，是因为邪气结聚在下部，形成瘕块而不消散。里急后重，是指肠气急迫、肛门重坠。频繁去厕所却不能顺利排便，都是因为邪气结聚不散，所以想排便却排不顺畅。尿道疼痛，是因为湿气郁结化为热邪，大便的气机不能通达，就转移到了小便方面。这就是古代的“滞下”，现在的名称叫“痢疾”。
The Fifty-Seventh Difficulty states: How many types of diarrhea (Xie) are there, and do they all have names?
It is answered: There are five types of diarrhea, and their names differ. There is Stomach Diarrhea (Wei Xie), Spleen Diarrhea (Pi Xie), Large Intestine Diarrhea (Da Chang Xie), Small Intestine Diarrhea (Xiao Chang Xie), and Da Jia Diarrhea (Da Xia Xie). Da Jia Diarrhea is named "Hou Zhong" (Tenesmus/Heaviness in the rectum).
"Xie" refers to purging or loose stools. Since there are five types of syndromes, there are five names for diarrhea. The term "Hou Zhong" specifically refers to Da Jia Diarrhea. This is because pathogenic factors from the Kidney accumulate downward, causing Qi to sink and fail to ascend. The categories of these five diarrheas will be detailed in the following text.
Stomach Diarrhea is characterized by undigested food in the stool and yellowish color.
Stomach Diarrhea results from Wood (Jia Wood, representing Wind/Liver) overcoming Earth (Wu Earth, representing the Stomach). The Stomach governs the reception of grains; when Wind-Pathogen invades it, the Stomach Fu organ becomes stagnant and pressured, leading to the failure to digest water and grain. This inevitably presents with a wiry pulse and borborygmus. Yellow is the color of Stomach Earth. As stated in the Classics: "If injured by Wind in Spring, Sunxi diarrhea (diarrhea with undigested food) arises in Summer."
Spleen Diarrhea is characterized by abdominal distension and fullness, watery diarrhea, and vomiting/regurgitation immediately after eating.
Spleen Diarrhea occurs because Spleen Earth is damp and cold, failing to vaporize water to transform Qi. Consequently, water and grain descend together, causing distension, fullness, and watery diarrhea. Vomiting immediately after eating occurs because Spleen deficiency leads to sinking, causing Stomach Qi to rebel upward. The excrement will likely contain much water, the pulse will be moderate/slow, and the abdomen will not hurt. As stated in the Classics: "When Dampness is excessive, Ru diarrhea (damp diarrhea) occurs."
Large Intestine Diarrhea is characterized by urgency and distress immediately after eating, white-colored stool, borborygmus, and severe pain.
Large Intestine Diarrhea happens because the intestines are deficient, and Qi fails to secure and retain. Thus, when the Stomach is full, contents are forced downward urgently, leaving no time to wait. The stool is white because the Large Intestine belongs to Geng Metal, and white is the color of Metal. Borborygmus and severe pain occur because disharmony of Qi leads to attacking and rushing, causing both noise and pain. As stated in the Classics: "When Clear Qi remains below, Sunxi diarrhea arises."
Small Intestine Diarrhea is characterized by passing pus and blood in both urine and stool, and lower abdominal pain.
Small Intestine Diarrhea occurs because the Small Intestine belongs to Bing Fire and fails to transform Cold Water. Cold water stagnates within Damp Earth, internal Heat overflows and steams, causing pus and blood to rot and form. Furthermore, the Small Intestine and Heart are exterior-interior partners; the Heart governs Blood. Because Qi fails to control each other, pus and blood are passed in the stool and urine, and urination is also incontinent. The Qi of the Small Intestine stagnates and rushes downward to the Bladder. Since the Bladder is near the lower abdomen, lower abdominal pain occurs. This belongs to the category of bloody dysentery.
Da Jia Diarrhea is characterized by internal urgency, tenesmus (heaviness in the rectum), frequent trips to the toilet without successful defecation, and pain in the urethra. This is the essential principle among the five diarrheas.
Da Jia Diarrhea occurs because pathogenic factors knot at the lower part, forming a mass (Jia) that does not dissipate. "Internal urgency and tenesmus" refers to urgent intestinal Qi and heaviness/dragging sensation in the anus. Frequent trips to the toilet without successful defecation occur because the knotting does not dissipate, so one desires to defecate but cannot feel relieved. Pain in the urethra occurs because Dampness stagnates and transforms into Heat; when the Qi of the stool cannot reach, it shifts to the urine. This is what was anciently called "Zhi Xia" (stagnant downflow) and is now named Dysentery (Li Ji).