甲、概况
大便不实，利下无度谓之泻。泻有溏、泄、利、滑、洞五种，因虚实寒热之别而证状遂有不同也。溏者，
下稠粘垢秽，溏薄之物，多属于湿，多属于热，间亦有属于寒者；泄者，腹泻注下，多属于寒，然暴注下迫
有声，有属于热者；利者，泻而利也，不利者则属于痢之一类；滑者，泄下不禁也，多属于寒；洞
者，泄泻过甚，空洞无物也，多属于虚。而泻之寒热之大别，大概其色黄赤而其味臭者为热，其色灰白嫩黄
臭不甚者为寒，其间夹痰者为痰湿，渣滓不化者为食积也。惟小儿之泻，食积为多，故恒见气味酸臭，渣滓不
化之状，泻出色黄者病浅，以胃气盛也，泻出色青者病深，以胃气衰也。更有小儿多病脾弱，泄泻为
半化之状，时止时泻，则宜健脾为主，因循必伤脾，转成慢惊之证，则难治矣。又小儿腹泻，恒多大腹膨胀，
初起膨胀，按之坚结者，积滞不行而胀也，宜攻下之，积去宜急和其脾；继则虽胀而不坚，能食而不化者，虚
胀也，宜扶脾健胃。然腹胀多兼有虫积，故须参看疳证治法以为之变通。总之，泄泻者，肠之病也。
其源因脾受水湿，不能转运，致使小肠无由分别水谷，遂并入大肠而成泻。《经》称小肠为受盛之官，化
物出焉。今肠病泄泻，无由出其化物之用，则饮食之精微，尽为糟粕而下注，势必脾伤
水溃，津液枯竭，终至陷成不治之证。故泄泻一证，决不可以等闲视之也。
乙、治法
泻证之于小儿，非因食积，即为脾弱，故主治宜以消积扶脾为大法。但消积之中，食积宜消，寒积宜温，
热积宜泻，痰积宜化，消积同而用药各别也。扶脾之中，湿盛宜渗，土衰宜培，扶
脾同而用药各别也。大凡初起之泻，先宜祛湿消积，用二陈汤去甘草加猪苓、泽泻、神曲、浓朴主之。泻之
多稀水者，宜多加祛湿之剂；泻之多滓渣者，宜多加消积之剂；再如溏薄之泻谓之溏，不似水之稀，不似
食之积，所下稠粘垢秽者，如属酸臭，多由湿热，宜胃苓汤加黄连，暑月用六一散加陈皮、泽泻、佩兰、
神曲；如属清冷，多由于寒，宜用陈皮、煨姜、苍术、白术、白豆蔻、吴萸、紫苏，甚者用附子理中汤；再
如注下之泻谓之泄，若完谷不化，困倦少力者，多虚而夹湿，宜四君子汤合升阳除湿汤；若暴注下迫，稀而
热臭者，多热而夹暑，宜白虎汤或桂苓甘露饮；再如泻下不禁谓之滑，大肠寒冷，收缩无权，宜固肠丸；
再如泄泻过甚，空洞无物谓之洞，虚而兼寒，宜万全丸加人参、白术、陈皮、黄 、禹余粮。此外有夹火而
泻者，腹痛一阵泻一阵，虽泻而仍觉后重，小便赤涩，宜黄芩芍药汤；有盛暑伤于外，阴冷伤其中，内外受迫
而泻者，多腹痛足冷自利，但小便赤而口气浊，宜连理丸；有由寒湿化热而泻者，里急后重，数至圊
而不能便，茎中作痛，宜八正散加木香、槟榔通之；有肾虚无火而泻者，天明则泄，一注而空，宜四神丸；有
暴注而泻，大便如水，中有小结屎，欲起又泻，欲止不止者，小便多清，身冷自
汗，此属于寒，宜浆水散温之；有夹痰而泻者，宜二陈汤加神曲、姜竹沥荡涤之。此诸泻之治法也。总之，
治泻纲领，初宜淡渗理湿，久则升举之，必滑脱不禁，乃可止涩，虚寒悉现，始进
温补，在小儿尤不宜过事消导，伤其脾阳，庶无贻误之虑也。
附方
（一）二陈汤 见第一章第四节。
（二）胃苓汤 和血，补血。治脾胃受湿，饮食停积，霍乱呕吐，浮肿泄泻，四肢酸痛，小便短
少，及湿疟水蛊。
苍术 浓朴 陈皮 白术 茯苓（各一钱五分） 泽泻 猪苓（各一钱） 甘草（六分） 肉桂（五分）
加生姜三片，大枣三枚，清水煎服。
（三）六一散 治诸热证，及热泄烦躁，小便不通，石淋，麻疹色紫黑者。
滑石（水飞净，六两） 甘草（一两）
共为细末，每服一钱。
此方为暑令常饮妙品，加辰砂名益元散，热病加豆豉、葱白，热吐用姜汁调灯芯汤下，白痢加吴萸，血
痢加红曲，止泄加炮姜，消斑加青黛，肺热咳嗽加薄荷，胃热口渴加石膏。
（四）附子理中汤 见第五章第四节。
（五）四君子汤 见第三章第五节。
（六）升阳除湿汤 治脾胃虚弱，不思饮食，腹鸣泄泻，四肢困弱，溺黄脱肛。
苍术（一钱） 升麻 柴胡 羌活 防风 神曲 泽泻 猪苓（各五分） 陈皮 麦芽 甘草（炙。各三分）
清水煎服。
（七）白虎汤 见第五章第二节。
（八）桂苓甘露饮 治霍乱，温热病，烦渴引饮，小便不通，大便泄泻者。
滑石 赤苓 泽泻 石膏 寒水石 甘草（炙） 白术 猪苓 肉桂
（九）固肠丸 治滑泄。
龙骨 附子 诃子 枯矾 丁香 石脂 高良姜 豆蔻仁 缩砂仁 木香
（十）万全丸 治滑泄。
赤石脂 炮姜（各一两） 胡椒（五钱）
共研末，醋糊丸如梧子大，每服五七丸。
（十一）连理丸 治胃虚挟食，痞满发热及暑泻。
人参 白术 甘草 干姜 黄连 茯苓
（十二）黄芩芍药汤 治太阳少阳合病，自利。
黄芩 甘草（炙） 白芍
（十三）八正散 治膀胱结热，热淋血淋，甚至大便闭塞，及大小便不利作痛者。
瞿麦 蓄草 木通 山栀 车前子 大黄 滑石 甘草
加灯芯，清水煎服。
（十四）四神丸 治脾肾虚寒，五更泄泻，不思饮食，或久痢虚痛，腰酸肢冷。
肉豆蔻（曲裹煨） 五味子（炒。各二两） 补骨脂（酒浸炒，四两） 吴茱萸（盐汤泡淡再炒，一两）
研为末，用生姜八两，红枣百枚，清水煮烂去皮核，与药末捣和丸，如梧子大。
（十五）浆水散 治太阴少阴中暑，泄泻身冷，多汗脉弱。
半夏 干姜 肉桂 附子 炙甘草 高良姜
A. General Overview
Loose stools with uncontrolled frequency are termed "Xie" (Diarrhea). "Xie" is categorized into five types: Tang (Semi-solid stool), Xie (Watery diarrhea), Li (Smooth discharge), Hua (Involuntary discharge), and Dong (Empty evacuation). The symptoms vary according to the differentiation of deficiency/excess and cold/heat.
"Tang" refers to the discharge of thick, sticky, foul-smelling, thin substances; it mostly belongs to dampness and heat, though occasionally it may belong to cold.
"Xie" refers to diarrhea with watery rush; it mostly belongs to cold, but if accompanied by sudden violent rushing and audible sounds, it belongs to heat.
"Li" refers to smooth discharge; if not smooth, it falls under the category of "Li Ji" (Dysentery).
"Hua" refers to involuntary discharge, mostly belonging to cold.
"Dong" refers to severe diarrhea where the bowels feel empty after evacuation, mostly belonging to deficiency.
Regarding the general distinction between cold and heat in diarrhea: yellow-red color with foul odor indicates heat; gray-white or pale yellow color with mild odor indicates cold. Stools containing phlegm indicate Phlegm-Dampness; stools containing undigested food residue indicate Food Stagnation.
In children, diarrhea is mostly due to Food Stagnation, thus often presenting with sour-foul odor and undigested residues. Diarrhea with yellow color indicates a superficial disease because Stomach Qi is robust; diarrhea with green color indicates deep disease because Stomach Qi is declining.
Furthermore, many children suffer from Spleen Deficiency, presenting as semi-digested diarrhea that comes and goes. Treatment should primarily focus on invigorating the Spleen. If treated incorrectly (lingering with inappropriate methods), it will damage the Spleen further, potentially transforming into "Man Jing Feng" (Slow Convulsion Syndrome), which is difficult to treat.
Additionally, children with diarrhea often have abdominal distension. In the early stage, if the abdomen is distended and hard upon palpation, it is distension caused by stagnation of accumulation; purgative treatment is appropriate, followed by harmonizing the Spleen once the accumulation is removed. Later, if there is distension but no hardness, and the child can eat but cannot digest, it is "Xu Zhang" (Deficiency Distension); supporting Spleen Qi and strengthening Stomach function is appropriate. However, abdominal distension often involves Parasite Accumulation, so treatment must be adjusted by referring to the methods for "Gan Zheng" (Malnutrition Syndrome).
In summary, diarrhea is a disease of the intestines. Its origin lies in the Spleen being constrained by Water-Dampness, failing to transport normally, causing the Small Intestine to fail in separating clear from turbid (water and grain), leading to their mixture into the Large Intestine and resulting in diarrhea. The *Classic* states that the Small Intestine is the "Official of Reception and Transformation," responsible for processing substances. Now, due to intestinal disease causing diarrhea, this function is lost; thus, the essence of food and drink becomes waste and flows downward. This inevitably leads to Spleen injury, flooding of water, and depletion of body fluids, eventually becoming an incurable condition. Therefore, the syndrome of diarrhea must never be taken lightly.
B. Treatment Methods
For children, diarrhea is either due to Food Stagnation or Spleen Weakness; thus, the main treatment principle is to eliminate stagnation and support the Spleen. Within the method of eliminating stagnation: Food Stagnation requires digestion-promoting herbs, Cold Stagnation requires warming herbs, Heat Stagnation requires purgative herbs, and Phlegm Stagnation requires phlegm-resolving herbs. Although the goal is the same, the medications differ. Within the method of supporting the Spleen: Dampness Excess requires diaphoretic/damp-draining herbs, Earth Deficiency (Spleen Deficiency) requires tonifying herbs. Although the goal is the same, the medications differ.
Generally, for initial diarrhea, first dispel dampness and eliminate stagnation using Er Chen Tang (Two-Aged Decoction) minus Gan Cao (Licorice Root), plus Zhu Ling (Polyporus), Ze Xie (Alisma), Shen Qu (Medicated Leaven), and Hou Po (Magnolia Bark).
If diarrhea consists mostly of watery fluid, add more damp-dispelling agents.
If diarrhea consists mostly of residue, add more stagnation-eliminating agents.
For "Tang" type diarrhea (thin/mushy, neither purely watery nor purely solid), if the smell is sour-foul, it is mostly due to Damp-Heat; use Wei Ling Tang (Stomach-Cinnamon Decoction) plus Huang Lian (Coptis Rhizome). In summer months, use Liu Yi San (Six-to-One Powder) plus Chen Pi (Tangerine Peel), Ze Xie (Alisma), Pei Lan (Eupatorium), and Shen Qu (Medicated Leaven).
If the smell is clear/cold, it is mostly due to Cold; use Chen Pi (Tangerine Peel), Wei Jiang (Baked Ginger), Cang Zhu (Atractylodes Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Dou Kou (Cardamom Seed), Wu Zhu Yu (Evodia Fruit), and Zi Su (Perilla Leaf). For severe cases, use Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction).
For "Xie" type diarrhea (violent rushing), if there is undigested food, fatigue, and weakness, it is mostly Deficiency with Dampness; use Si Jun Zi Tang (Four Gentlemen Decoction) combined with Sheng Yang Chu Shi Tang (Raise Yang and Drain Dampness Decoction). If there is violent rushing, watery consistency, and hot-foul odor, it is mostly Heat with Summerheat; use Bai Hu Tang (White Tiger Decoction) or Gui Ling Gan Lu Yin (Cinnamon-Poria Sweet Dew Drink).
For "Hua" type diarrhea (involuntary discharge), due to Cold in the Large Intestine and lack of contraction power, use Gu Chang Wan (Intestine-Solidifying Pill).
For "Dong" type diarrhea (severe empty evacuation), due to Deficiency with Cold, use Wan Quan Wan (Complete Perfection Pill) plus Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Chen Pi (Tangerine Peel), Huang Qi (Astragalus Root), and Yu Yu Liang (Yucca Lithium).
Additionally:
- Diarrhea with Fire: Abdominal pain followed by diarrhea, tenesmus despite evacuation, red scanty urine. Use Huang Qin Shao Yao Tang (Scutellaria and White Peony Decoction).
- Summerheat external invasion and Cold internal injury: Abdominal pain, cold feet, spontaneous diarrhea, red urine, turbid breath. Use Lian Li Wan (Connective Regulation Pill).
- Cold-Damp transforming into Heat: Tenesmus, frequent trips to toilet without passage, urethral pain. Use Ba Zheng San (Eight Righteousness Powder) plus Mu Xiang (Aucklandia Root) and Bing Lang (Areca Seed) to promote flow.
- Kidney Deficiency without Fire: Morning diarrhea, complete emptying, use Si Shen Wan (Four Spirits Pill).
- Violent watery diarrhea with small hard stools, inability to stop/start, clear urine, cold body, spontaneous sweating: Belongs to Cold, use Jiang Shui San (Fermented Grain Water Powder) to warm.
- Diarrhea with Phlegm: Use Er Chen Tang (Two-Aged Decoction) plus Shen Qu (Medicated Leaven) and Jiang Zhu Li (Bamboo Juice) to cleanse.
In summary, the guideline for treating diarrhea is: initially use bland leaching to manage dampness; for chronic cases, raise and lift Qi; only use astringents when incontinence occurs; only use warming tonics when Deficiency-Cold signs are fully present. For children, one must avoid excessive use of digestive/purgative herbs to prevent damaging Spleen Yang, thereby avoiding the risk of worsening the condition.
Attached Formulas
(1) Er Chen Tang (Two-Aged Decoction): See Chapter 1, Section 4.
(2) Wei Ling Tang (Stomach-Cinnamon Decoction): Harmonizes blood, nourishes blood. Treats Spleen-Stomach dampness, food stagnation, cholera vomiting, edema, diarrhea, limb soreness, scanty urine, wet malaria, and ascites.
Ingredients: Cang Zhu (Atractylodis Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Chen Pi (Citri Reticulatae Pericarpium), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), Zhu Ling (Polypori Parietes), Gan Cao (Glycyrrhizae Radix et Rhizoma), Rou Gui (Cinnamomi Cortex). Add fresh ginger and jujube. Decoct in water.
(3) Liu Yi San (Six-to-One Powder): Treats various heat syndromes, heat-diarrhea with irritability, dysuria, lithiasis, and purple-black measles.
Ingredients: Hua Shi (Talcum), Gan Cao (Glycyrrhizae Radix et Rhizoma). Grind into fine powder. Take 1 qian per dose.
This formula is excellent for summer consumption. Added with Chen Sha (Cinnabar), it is named Yi Yuan San. Modifications exist for various conditions (e.g., adding Dou Chi for heat diseases, Jiang Zhi for heat vomiting, etc.).
(4) Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction): See Chapter 5, Section 4.
(5) Si Jun Zi Tang (Four Gentlemen Decoction): See Chapter 3, Section 5.
(6) Sheng Yang Chu Shi Tang (Raise Yang and Drain Dampness Decoction): Treats Spleen-Stomach weakness, poor appetite, borborygmus, diarrhea, weak limbs, dark urine, and rectal prolapse.
Ingredients: Cang Zhu (Atractylodis Rhizoma), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Shen Qu (Meditated Leaven), Ze Xie (Alismatis Rhizoma), Zhu Ling (Polypori Parietes), Chen Pi (Citri Reticulatae Pericarpium), Mai Ya (Hordei Fructus Germinatus), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma). Decoct in water.
(7) Bai Hu Tang (White Tiger Decoction): See Chapter 5, Section 2.
(8) Gui Ling Gan Lu Yin (Cinnamon-Poria Sweet Dew Drink): Treats cholera, warm-heat diseases, thirst with desire to drink, dysuria, and diarrhea.
Ingredients: Hua Shi (Talcum), Chi Ling (Poria cum Rubro), Ze Xie (Alismatis Rhizoma), Shi Gao (Gypsum Fibrosum), Han Shui Shi (Halloysitum Rubrum), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Zhu Ling (Polypori Parietes), Rou Gui (Cinnamomi Cortex).
(9) Gu Chang Wan (Intestine-Solidifying Pill): Treats slippery diarrhea.
Ingredients: Long Gu (Fossilia Ossis Mastodi et Scapulae), Fu Zi (Aconiti Lateralis Radix Praeparata), He Zi (Terminaliae Chebulae Fructus), Ku Fan (Alumen), Ding Xiang (Caryophylli Flos), Shi Zhi (Lithocarpiti Glabri Resina), Gao Liang Jiang (Alpiniae Officinarum Rhizoma), Dou Kou Ren (Cardamomi Rotund Fructus), Suo Sha Ren (Amomi Fructus), Mu Xiang (Aucklandiae Radix).
(10) Wan Quan Wan (Complete Perfection Pill): Treats slippery diarrhea.
Ingredients: Chi Shi Zhi (Halloysitum Rubrum), Pao Jiang (Zingiberis Rhizoma Preparatum) (each 1 liang), Hu Jiao (Piperis Nigris Fructus) (5 qian). Grind into powder, make pills with vinegar paste, size of wu zi. Take 5-7 pills per dose.
(11) Lian Li Wan (Connective Regulation Pill): Treats Stomach deficiency with food retention, fullness, fever, and summerheat diarrhea.
Ingredients: Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), Huang Lian (Coptidis Rhizoma), Fu Ling (Poria).
(12) Huang Qin Shao Yao Tang (Scutellaria and White Peony Decoction): Treats Taiyang-Shaoyang combined disease with spontaneous diarrhea.
Ingredients: Huang Qin (Scutellariae Radix), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Bai Shao (Paeoniae Radix Alba).
(13) Ba Zheng San (Eight Righteousness Powder): Treats bladder heat, painful urinary dribbling, bloody urinary dribbling, fecal impaction, and painful difficulty in urination/defecation.
Ingredients: Qu Mai (Polygoni Avicularis Herba), Bian Xu (Polygoni Chinensis Herba), Mu Tong (Akebiae Caulis), Shan Zhi (Gardeniae Fructus), Che Qian Zi (Plantaginis Semen), Da Huang (Rhei Radix et Rhizoma), Hua Shi (Talcum), Gan Cao (Glycyrrhizae Radix et Rhizoma). Add Deng Xin Cao (Junci Medullae) and decoct in water.
(14) Si Shen Wan (Four Spirits Pill): Treats Spleen-Kidney Deficiency-Cold, morning diarrhea, poor appetite, chronic dysentery with deficiency pain, sore back, and cold limbs.
Ingredients: Rou Dou Kou (Myristicae Semen), Wu Wei Zi (Schisandrae Chinensis Fructus) (each 2 liang), Bu Gu Zhi (Psoraleae Fructus) (4 liang), Wu Zhu Yu (Evodiae Fructus) (1 liang). Grind into powder. Boil fresh ginger and jujubes in water until soft, remove skins/seeds, mix with powder to make pills, size of wu zi.
(15) Jiang Shui San (Fermented Grain Water Powder): Treats Taiyin-Shaoyin summerheat stroke, diarrhea with cold body, profuse sweating, and weak pulse.
Ingredients: Ban Xia (Pinelliae Rhizoma), Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Gao Liang Jiang (Alpiniae Officinarum Rhizoma).