（附下利）
【纲】仲景曰。厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食即吐蛔。下之。利
不止。
【目】柯琴曰。太阴厥阴。皆以里症为提纲。太阴主开。本自利。而下之则开折。胸下结硬者。
开折反阖也。厥阴主阖。气
上逆。而下之则阖折。利不止者。阖折反开也。按两阴交尽。名曰厥阴。又名阴之绝阳。则厥阴为
病。宜无病热矣。以厥阴脉络于少阳。厥阴热症皆相火化令耳。夫病发于阴而反下之。则气无止息。
而利不止矣。
【纲】仲景曰。下利。欲饮水者。以有热故也。白头翁汤主之。热利下重者。白头翁汤主之。
【目】戴原礼曰。大抵阳热之利。与阴寒之利不同。阳利粪色必焦黄热臭。出作声。脐下必热。
得凉药则止。阴利必洞下清谷。粪色或白或淡黄。脐下多寒。宜温中止泻之剂。此阴利阳利。指
阴阳二气而言。非阴阳二经也。缘阴中亦自有阳利。不可因下利便以为阴也。又有内不大满。犹生
寒热。未可下而便下之。内虚热入。挟热自利。脐下必热。大便赤黄。及下肠间津液垢腻。名曰利
肠。宜白头翁汤、黄芩汤。
【纲】仲景曰。下利。脉沉弦者。下重也。脉大者。为未止。脉微弱数者。为欲自止。虽发热。
不死。下利。有微热而渴。脉弱者。令自愈。下利。脉数而渴者。令自愈。设不瘥。必圊脓血。以
有热故也。下利脉数。有微热汗出。令自愈。设复紧。为未解。下利。寸脉反浮数。尺中自涩者。
必圊脓血。
【目】鳌按。此三条。详言热利之脉各有不同。由所发之脏腑阴阳不一也。首条。脉沉弦。沉
为在里。弦属少阳。下重者。胆气不升。火邪下陷也。大脉属阳明。其未止者。阳明之阳邪太盛。
故脉大而病进也。又脉之微弱者。为虚。利后而数。亦为虚。其欲止者。阴阳渐和也。二条。脉弱
者。外之发热既微。则内之热势当自解。故现弱象也。诸条令自愈。言可不服白头翁汤而令其自愈
也。脉数而渴。由于虚热。若不瘥而圊脓血。乃为真热也。汗出二字。为本条关键。盖热从汗解。
热解则利因可愈也。三条。则阴出之阳。为欲愈之兆。故脉数而带浮。涩见尺中。在便血之后。亦
顺脉也。
【纲】仲景曰。伤寒六七日。不利。复发热而利。其人汗出不止者死。有阴无阳故也。
发热而厥。七日。下利者。为难治。伤寒发热。下利至甚。厥不止者死。
伤寒发热。下利。厥逆。躁不得卧者死。
【目】柯琴曰。首条。有阴无阳。指内而言。此为亡阳。与热利之发热不死。汗出自利者天渊
矣。二条。发于阳者七日愈。今厥不止。而反下利。恐为除中。故难治。若烦躁而能食。尚为热厥
利耳。三四条。厥利不止。脏腑气绝矣。躁不得卧。精神不治矣。微阳不久留。故死也。
【纲】仲景曰。伤寒先厥。后发热而利者。必自止。见厥。复利。伤寒先厥。后发热下利。必
自止。而反汗出。咽中痛者。其喉为痹。发热无汗而利。必自止。若不止。必便脓血。便脓血者。
其喉不痹。
【目】魏荔彤曰。厥阴传来之热邪。一日不升阳透表。必一日在内为患。非上冲而汗出喉痹。即
下注而无汗便脓血。在阳升热出。见病尚如此。况热后复厥。厥后复热。热势愈深。其厥愈深。渐
致阳微阴盛。厥多热少。愈难治矣。主治者。安可坐视其困殆。而不一升举其阳。宣导其热乎。传
经之热邪。如本条之为害如此。而尚有言寒邪者。岂非盲目乎。
(Attached: Diarrhea)
[General Principle] Zhang Zhongjing said: The symptoms of Jueyin disease (Jueyin Disease, a stage in the Six Meridian Syndrome differentiation characterized by cold-heat complexity and deficiency-excess) include excessive thirst, Qi rushing up to strike the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting roundworms if food is ingested. If purgative treatment is mistakenly applied, it will result in unceasing diarrhea.
[Commentary] Ke Qin stated: Both Taoyin disease (Taoyin Disease, characterized by Spleen-Stomach deficiency-cold) and Jueyin disease use interior syndromes as their guiding principles. Taoyin governs "opening" (Kai), and inherently tends toward spontaneous diarrhea; if purgatives are used, the "opening" function collapses. The resulting hardness below the chest indicates that the collapse of "opening" has reversed into "closing" (He). Jueyin governs "closing"; when Qi rebels upward, and purgatives are used, the "closing" function collapses. The unceasing diarrhea indicates that the collapse of "closing" has reversed into "opening". According to the theory, when two Yin meridians converge to their extreme, it is named Jueyin, also known as the "extreme Yin where Yang is cut off." Thus, one might expect Jueyin disease to lack heat manifestations. However, because the Jueyin meridian connects with Shaoyang (Shaoyang, governing the Gallbladder and Sanjiao, often associated with Ministerial Fire), heat syndromes in Jueyin are generated by the transformation of Ministerial Fire (Xianghuo). When a disease originates in the Yin aspect but is treated with purgatives, the Qi does not cease its movement, leading to unceasing diarrhea.
[General Principle] Zhang Zhongjing said: In cases of diarrhea where the patient desires to drink water, it is due to the presence of Heat (Re); this should be treated with Baitouweng Tang (Baitouweng Decoction). For hot diarrhea accompanied by a sensation of heaviness and tenesmus in the rectum, Baitouweng Tang should be used.
[Commentary] Dai Yuanli stated: Generally, diarrhea caused by Yang-Heat differs from that caused by Yin-Cold. Diarrhea of the Yang type features stool that is dark yellow, hot-smelling, expelled with sound, and accompanied by heat in the umbilical region; it stops upon administration of cooling herbs. Diarrhea of the Yin type involves clear, undigested food passing through, with stool color white or pale yellow, and coldness in the umbilical region; it requires warming agents to stop diarrhea. Here, "Yin diarrhea" and "Yang diarrhea" refer to the nature of Yin and Yang Qi, not specifically to the Yin and Yang meridians. This is because within Yin patterns, there can also be Yang-type diarrhea; one cannot assume all diarrhea is Yin-patterned. Furthermore, if the abdomen is not full despite chills and fever, purgatives should not be used prematurely. Premature purgation causes interior deficiency and allows Heat to enter, resulting in self-induced diarrhea with Heat. Symptoms include heat in the umbilical region, reddish-yellow stool, and the discharge of turbid mucus from the intestines, termed "Li Chang" (Intestinal Diarrhea). Baitouweng Tang and Huangqin Tang are appropriate.
[General Principle] Zhang Zhongjing said: In diarrhea, a deep and wiry pulse indicates tenesmus (heaviness in the rectum). A large pulse indicates the condition has not yet ceased. A weak and rapid pulse indicates the condition is about to stop spontaneously; even if fever is present, death will not occur. In diarrhea, if there is slight fever and thirst with a weak pulse, recovery will occur spontaneously. In diarrhea, if the pulse is rapid and there is thirst, recovery will occur spontaneously. If it does not resolve, pus and blood will likely appear in the stool, due to Heat. In diarrhea, if the pulse is rapid with slight fever and sweating, recovery will occur spontaneously. If the pulse becomes tight again, the pathogen has not been resolved. In diarrhea, if the Cun (inch) pulse is floating and rapid while the Chi (cubit) pulse is choppy, pus and blood will likely appear in the stool.
[Commentary] Shen Jin'ao noted: These three passages detail how the pulses for hot diarrhea vary, depending on the different Zang-Fu organs and Yin-Yang aspects involved. In the first passage, a deep-wiry pulse: Deep indicates an interior location; Wiry belongs to Shaoyang. Tenesmus occurs because Gallbladder Qi fails to ascend, and Fire Evil sinks downward. A large pulse belongs to Yangming; the persistence of the disease is due to excessive Yang-Evil in Yangming, causing the pulse to be large and the pathology to progress. Conversely, a weak pulse indicates deficiency; a rapid pulse after diarrhea also suggests deficiency. The desire for cessation indicates the gradual harmony of Yin and Yang. In the second passage, a weak pulse implies that since external fever is slight, internal heat should resolve itself, hence the weak manifestation. The phrase "allow to heal spontaneously" in various passages means recovery can occur without administering Baitouweng Tang. Rapid pulse and thirst stem from deficient heat; if it does not resolve and pus/blood appears, it indicates true excess heat. The term "sweating" is key here: Heat resolves through sweating, and once heat is resolved, diarrhea heals. In the third passage, Yin emerging into Yang is a sign of impending recovery; thus, the pulse is rapid and floating, with choppiess seen at the Chi position after bloody stool, which is a favorable pulse pattern.
[General Principle] Zhang Zhongjing said: In Shanghan (Cold Damage), if after six or seven days, diarrhea was absent but then fever and diarrhea recur, and the patient sweats incessantly, the prognosis is fatal due to the presence of Yin without Yang.
If fever is accompanied by cold limbs for seven days, followed by diarrhea, it is difficult to treat.
In Shanghan, if fever is accompanied by severe diarrhea and unceasing cold limbs, the prognosis is fatal.
In Shanghan, if fever is accompanied by diarrhea, cold limbs (Nizhi), restlessness, and inability to lie down, the prognosis is fatal.
[Commentary] Ke Qin stated: In the first passage, "Yin without Yang" refers to the interior, indicating loss of Yang (Wangyang). This is vastly different from the hot diarrhea scenario where "fever does not lead to death, and spontaneous sweating leads to self-resolution of diarrhea." In the second passage, diseases originating in Yang typically resolve in seven days. Now, with unceasing cold limbs and recurrent diarrhea, one must fear "Chuzhong" (a false appetite indicating stomach Qi exhaustion), making it difficult to treat. If there is irritability but the patient can eat, it may still be considered diarrhea due to heat-cold reversal (Jue). In the third and fourth passages, unceasing cold limbs and diarrhea indicate the exhaustion of Zang-Fu Qi. Restlessness and inability to lie down indicate the loss of Spirit (Shen). Since minute Yang Qi cannot persist, death ensues.
[General Principle] Zhang Zhongjing said: In Shanghan, if cold limbs appear first, followed by fever and diarrhea, the diarrhea will necessarily stop spontaneously; if cold limbs reappear, diarrhea will recur. In Shanghan, if cold limbs appear first, followed by fever and diarrhea, the diarrhea will necessarily stop spontaneously; however, if sweating and throat pain occur instead, Bi syndrome (blockage) of the throat will develop. If fever occurs without sweating and with diarrhea, the diarrhea will necessarily stop spontaneously; if it does not stop, pus and blood will appear in the stool. If pus and blood appear in the stool, the throat will not suffer from Bi syndrome.
[Commentary] Wei Litong stated: Heat pathogens transmitted from Jueyin, if not allowed to raise Yang and penetrate the exterior for even one day, will cause harm internally. They either rush upward causing sweating and throat Bi, or sink downward causing non-sweating and bloody/purulent stool. Even when Yang rises and heat exits, the manifestations are severe; how much more so when heat retreats only to be followed by cold limbs, and cold limbs retreat to be followed by heat? The deeper the heat, the deeper the cold limbs. This gradually leads to diminished Yang and flourishing Yin, with more cold limbs than fever, making treatment increasingly difficult. How can a treating physician sit idly by while the patient faces danger, without attempting to raise Yang and guide out the heat? The harm caused by heat pathogens transmitted through the meridians, as described in this passage, is significant. To claim such cases are caused by Cold Evil would be blind ignorance.