泄泻之症有五，而总不离于湿。初起只以平胃散加猪苓、泽泻治之，他方皆不逮也。又
有五更天将明时，必洞泻一二次，名曰脾肾泄，难治。盖以肾旺于亥子，今肾大虚，闭藏失
职，故五更之时而特甚也。亦谓之脾者，以泄泻之时，一定不移，五行之土，犹五常之信也
，四神丸加味主之。大抵初泻与泻之未甚，宜利水，次补脾；久泻大泻，宜补肾，以胃关煎
、八味丸之类为主，兼服补中益气汤，以升其下陷之气。盖以肾为胃关，二便开合，皆肾所
主也。
宜沉细，忌浮大。
加味平胃散
苍术（二钱，炒） 炙草 陈皮（各一钱） 猪苓 浓朴（姜汁炒） 泽泻（各一钱五分） 生姜（三片）
水煎服。
如头痛发热恶寒者，外感风寒也，加紫苏二钱，川芎、防风各一钱。
如伤食饱闷胀痛等症，加山楂、麦芽之类；大醉之后，更加干葛二钱。
如腹痛不休，脉细手足冷，中寒也，加干姜二钱，肉桂、吴萸各一钱。
如脉洪数有力，口中热，舌红，腹痛时作时止，小便短涩，火泻痛也，加木通一钱、干
葛一钱五分；若兼肠垢里急后重，再加黄连一钱、白芍三钱。
如暑月水泻口渴，小便不利，加滑石三钱研末。
如泻而腹痛不止，为土伤木贼，加酒白芍三钱、防风一钱。
如服前药不能效者，是脾肾虚寒，宜加补骨脂、炒扁豆、白术各二钱、吴萸八分、干姜
一钱以温之；如滑脱不止，再加诃子、肉豆蔻一钱五分，罂粟壳一钱以涩之。
四神丸（方见《时方》）
乡前辈林公讳祖成，加白术八两、罂粟壳二两、肉桂一两，醋调炒米粉为丸，名六神丸
，治同。再加杜仲四两、茯苓四两，名固肾启脾丸。自注云∶久服此丸，俾脾元足而营卫运
，斯分消之力旺，肾元足而开合神，斯固摄之权行。
温补脾肾元气主方（《林公传》）
杜仲（二钱） 人参 白术（各五分） 茯苓 肉豆蔻（去油，各一钱） 补骨脂 砂仁（各五分） 五味（二分）
水煎，空心午前服。小腹隐痛，加肉桂五分；小便不利，加泽泻一钱。
胃关煎
治大泻将脱，久泻不止。
熟地（三四五七钱） 白术（二三钱） 干姜（一二钱，炒） 吴萸（五七分） 炙草（一钱） 扁豆（炒，研） 山
药（炒，各二钱）
水煎服。
按∶以上为治泻之恒法。又有变通活法，不可不知。
如久泻服温补及固涩之药不止，或愈而复作，或既愈，次年又应期而作，俱是痼积未除
，宜通因通用之法，《本事》温脾汤主之。
又有感秋金燥气，始则咳嗽，久则往来寒热，泄泻无度，服温补药更甚，或完谷不化，
有似虚寒，而不知肺中之热，无处可宣，急奔大肠，食入则不待传化而直出，食不入则肠中
之垢，亦随气奔而出，是以泻利无休也。宜以黄芩、地骨皮、甘草、杏仁、阿胶润肺之药，兼
润其肠，则源流俱清。寒热咳嗽泄泻，一齐俱止矣。
又有泻久亡阴，过服香燥之品，发热口渴，微喘汗出，烦躁，阴气虚尽，阳气不能久留
，宜急养其阴，以阿胶、地黄、门冬等类，熬膏三四斤，日服十余次。半月药尽遂效，另制
补脾药末善后，痊愈。此喻嘉言之验案也。
温脾汤（《本事方》见《时方》）
主治痼冷在肠胃间，泄泻腹痛。宜先取去，然后调治，不可畏虚以养病也。
《千金》温脾汤（方见《实在易》）
治积久热痢赤白。
生姜泻心汤 治心下痞硬，干噎食臭，胁下有水气，腹中雷鸣下利者。
甘草泻心汤
下后痞益甚，日利数十行，谷不化，此非热结，但以胃中虚，客气上逆，
故便硬也。
半夏泻心汤
呕而发热，心下满而不痛。
黄芩汤
太阳少阳合病自利者。
若呕者，加生姜一钱五分、半夏一钱，名黄芩加半夏生姜汤。
黄连汤
胸中热，胃中有邪气，腹中痛欲呕者。
即半夏泻心汤，去黄芩，加桂枝，以和表里。
干姜黄连黄芩人参汤 下利，医复吐下之，食入口即吐。
此方治呕家夹热，不利于香、砂、橘、半者，服此如神。昔张石顽先生借治脾胃虚寒、
肠有积热之泄，甚效。
浓朴生姜甘草半夏人参汤
此仲景治汗后腹胀满之方也。张石顽借治泻后腹胀满，甚效。
石顽治总戎陈孟庸，泻利腹胀作痛，服黄芩、白芍之类，胀急愈甚。其脉洪盛而数，按
之则濡，此湿热伤脾胃之气也。与浓朴生姜甘草半夏人参汤，二剂痛止，胀减而泄利未已。
与干姜黄芩黄连人参汤，二剂泻止，而饮食不思，与半夏泻心汤二剂而安。
葛根黄芩黄连汤（各见《伤寒》）
此汤仲景治桂枝症，医反下之，利遂不止，脉促，喘而汗出之症。今借治表邪未解，肠
胃俱热之泻，甚效。
按∶君气质轻清之葛根，以解肌而止利；佐苦寒清肃之芩连，以止汗而除喘；又加甘草
以和中，先煮葛根，后纳诸药。解肌之力缓，清中之气锐，又与补中逐邪者殊法矣。
锅粑莲肉散
治老幼脾泻久不愈神方。
饭锅粑（四两，净末） 莲肉（四两，去心，净末） 白糖（四两）
上共和匀。每服三五匙，一日三次，食远服。
丹矾蜡榴丸
治一切久泻，诸药不效，宜服止丸。
黄丹 枯矾 黄蜡（各一两） 石榴皮（八钱，炒研）
将蜡溶化小铜勺内，再以丹、矾、榴皮三味细末，乘热为丸，如豆大，空心服五丸。兼
治红痢，用清茶下，白痢用姜汤下。
锅粑松花散
治白泻不止神效方。
饭锅粑（二两） 松花（二两，炒） 蜡肉骨头（五钱，烘脆）
共为末，砂糖调，不拘时服。
火腿红曲散（各见《种福堂》）
治脾泄。
陈火腿骨（ 存性研末） 红曲
上二味各等分，为细末，砂糖调陈酒送下。
The syndrome of diarrhea (Xie Xie) has five types, but all are inseparable from dampness (Shi). At the onset, it should only be treated with Pingwei San (Calm the Stomach Powder) added with Zhu Ling (Polyporus) and Ze Xie (Alisma), as other prescriptions cannot compare. Additionally, there is a condition where severe watery diarrhea occurs one or two times just before dawn at the fifth watch (Wu Geng), named Pi Shen Xie (Spleen-Kidney Diarrhea), which is difficult to treat. This is because the Kidney (Shen) is prosperous during Hai and Zi hours (9 PM - 3 AM); now, with severe Kidney deficiency, its function of closure and storage fails, so symptoms are particularly severe at the fifth watch. It is also called Spleen (Pi) diarrhea because, during the occurrence of diarrhea, the condition remains fixed and unchanging; in the Five Elements (Wu Xing), Earth corresponds to the virtue of Trustworthiness (Xin), implying stability. The main treatment is Si Shen Wan (Four Spirits Pill) with modifications. Generally, for initial diarrhea or when diarrhea is not severe, promoting water metabolism is suitable, followed by tonifying the Spleen; for chronic or severe diarrhea, tonifying the Kidney is suitable, mainly using Wei Guan Jian (Stomach Gate Decoction) or Ba Wei Wan (Eight-Ingredient Pill), combined with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the sinking Qi. This is because the Kidney serves as the gate of the Stomach, controlling the opening and closing of urination and defecation.
The pulse should be deep and fine; floating and large pulses are contraindicated.
Modified Pingwei San
Cang Zhu (Atractodis Rhizoma, 2 qian, stir-fried) Zhi Cao (Prepared Licorice Root) Chen Pi (Citri Reticulatae Pericarpium, each 1 qian) Zhu Ling (Polyporus, 1 qian 5 fen) Hou Po (Magnolia Bark, stir-fried with ginger juice) Ze Xie (Alisma, each 1 qian 5 fen) Sheng Jiang (Fresh Ginger, 3 slices)
Decoct in water and take orally.
If accompanied by headache, fever, and aversion to cold, this is due to external contraction of wind-cold; add Zi Su (Perilla Leaf) 2 qian, Chuan Xiong (Ligusticum Rhizome) and Fang Feng (Saposhnikovia Root) each 1 qian.
If symptoms include fullness, stuffiness, distension, and pain due to food stagnation, add Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus); after heavy drinking, add Ge Gen (Puerariae Radix) 2 qian.
If abdominal pain persists, the pulse is fine, and hands and feet are cold, this is due to cold invading the middle; add Gan Jiang (Zingiberis Rhizoma) 2 qian, Rou Gui (Cinnamon Bark) and Wu Zhu Yu (Evodiae Fructus) each 1 qian.
If the pulse is surging, rapid, and forceful, the mouth feels hot, the tongue is red, abdominal pain comes and goes, and urine is scanty and dysuric, this is fire-diarrhea with pain; add Mu Tong (Akebiae Caulis) 1 qian, Ge Gen (Puerariae Radix) 1 qian 5 fen; if accompanied by intestinal mucus, tenesmus, and a feeling of incomplete evacuation, add Huang Lian (Coptidis Rhizoma) 1 qian, Bai Shao (Paeoniae Radix Alba) 3 qian.
If watery diarrhea and thirst occur in summer heat with impaired urination, add Hua Shi (Talcum) 3 qian, ground into powder.
If diarrhea persists with continuous abdominal pain, this indicates Earth injury by Wood invasion (Spleen deficiency with Liver overacting); add Jiu Bai Shao (Wine-processed Paeoniae Radix Alba) 3 qian, Fang Feng (Saposhnikovia Root) 1 qian.
If previous medications are ineffective, this indicates Spleen-Kidney deficiency-cold; it is suitable to add Gu Pu Zhi (Psoraleae Fructus), Chao Bian Dou (Fried Vigna Seed), Bai Zhu (Atractodis Rhizoma) each 2 qian, Wu Zhu Yu (Evodiae Fructus) 8 fen, Gan Jiang (Zingiberis Rhizoma) 1 qian to warm; if there is sliding and uncontrollable discharge, add He Zi (Chebulae Fructus) and Rou Dou Kou (Myristicae Semen) 1 qian 5 fen, Ying Su Qiao (Papaveris Pericarpium) 1 qian to astringe.
Si Shen Wan (Formula see "Shi Fang")
Senior Lin Zu Cheng, a predecessor from our township, added Bai Zhu (Atractodis Rhizoma) 8 liang, Ying Su Qiao (Papaveris Pericarpium) 2 liang, Rou Gui (Cinnamon Bark) 1 liang to the formula, mixed with vinegar and stir-fried rice flour to make pills, named Liu Shen Wan (Six Spirits Pill), with the same therapeutic effect. Adding Du Zhong (Eucommiae Cortex) 4 liang and Fu Ling (Poria) 4 liang creates Gu Shen Qi Pi Wan (Kidney-Securing and Spleen-Initiating Pill). His self-note states: Long-term use of this pill ensures sufficient Spleen Yuan, allowing Ying and Wei to circulate, thus strengthening the power of dispersing and eliminating; sufficient Kidney Yuan makes opening and closing functions divine, thus exercising the authority of retention.
Main Formula for Warming and Tonifying Spleen-Kidney Original Qi (From "Lin Gong Zhuan")
Du Zhong (Eucommiae Cortex, 2 qian) Ren Shen (Ginseng Radix) Bai Zhu (Atractodis Rhizoma, each 5 fen) Fu Ling (Poria) Rou Dou Kou (Myristicae Semen, de-oiled, each 1 qian) Gu Pu Zhi (Psoraleae Fructus) Sha Ren (Amomi Fructus, each 5 fen) Wu Wei Zi (Schisandrae Fructus, 2 fen)
Decoct in water and take on an empty stomach before noon. For dull lower abdominal pain, add Rou Gui (Cinnamon Bark) 5 fen; for impaired urination, add Ze Xie (Alisma) 1 qian.
Wei Guan Jian (Stomach Gate Decoction)
Treats severe diarrhea nearing collapse and chronic persistent diarrhea.
Shu Di Huang (Rehmanniae Radix Preparata, 3-7 qian) Bai Zhu (Atractodis Rhizoma, 2-3 qian) Gan Jiang (Zingiberis Rhizoma, 1-2 qian, stir-fried) Wu Zhu Yu (Evodiae Fructus, 5-7 fen) Zhi Cao (Prepared Licorice Root, 1 qian) Bian Dou (Vigna Seed, stir-fried and ground) Shan Yao (Dioscoreae Rhizoma, stir-fried, each 2 qian)
Decoct in water and take orally.
Note: The above are constant methods for treating diarrhea. There are also flexible variations that must be known.
If chronic diarrhea does not stop despite warming and tonifying or astringent medicines, or recurs after cure, or recurs annually at the same time, this is due to entrenched accumulation not being removed. The method of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) is suitable, primarily using Wen Pi Tang (Warm the Spleen Decoction) from "Ben Shi".
Another case involves contracting autumn dry-metal qi, initially causing cough, later leading to alternating chills and fever, and unlimited diarrhea. Taking warming and tonifying medicines worsens the condition, or results in undigested food in stool. Although it resembles deficiency-cold, the heat in the Lung (Fei) has no outlet to vent, rushing urgently to the Large Intestine (Chang). Food enters and exits directly without digestion/transportation; even without food intake, intestinal waste rushes out with the Qi, causing ceaseless diarrhea. It is suitable to use Huang Qin (Scutellariae Radix), Di Gu Pi (Lycii Cortex), Gan Cao (Licorice Root), Xing Ren (Armeniacae Semen), E Jiao (Asini Corii Colla) to moisten the Lung and intestines, clearing both source and branch. Chills, fever, cough, and diarrhea will all stop simultaneously.
Another case involves Yin exhaustion from long-term diarrhea, exacerbated by overuse of aromatic-dry substances, resulting in fever, thirst, slight panting, sweating, and irritability. With Yin exhausted and Yang unable to remain long, it is urgent to nourish Yin. Use E Jiao (Asini Corii Colla), Di Huang (Rehmanniae Radix), Dong Gua (Ophiopogonis Tuber) etc., decocted into paste (3-4 jin), taken more than ten times daily. After half a month, when the medicine is consumed, efficacy appears; then prepare Spleen-tonifying powder for follow-up care until recovery. This is a verified case by Yu Jiayan.
Wen Pi Tang (Warm the Spleen Decoction) ("Ben Shi Fang" see "Shi Fang")
Mainly treats entrenched cold in the stomach and intestines, causing diarrhea and abdominal pain. One should first purge/remove the pathogen, then regulate; do not fear deficiency and thereby nurture the disease.
Qian Jin Wen Pi Tang (Warm the Spleen Decoction from Thousand Golden Prescriptions) (See "Shi Zai Yi")
Treats chronic heat-dysentery with red and white stools.
Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction)
Treats epigastric hardness and fullness, belching with food odor, fluid retention under the hypochondrium, borborygmus, and diarrhea.
Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction)
After purgative treatment, epigastric fullness worsens, with dozens of bowel movements daily and undigested food. This is not heat binding, but due to Stomach deficiency and rebellious guest Qi ascending, causing hard stools.
Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction)
Vomiting with fever, epigastric fullness without pain.
Huang Qin Tang (Scutellaria Decoction)
Taiyang-Shaoyang combined disease with spontaneous diarrhea.
If vomiting occurs, add Sheng Jiang (Fresh Ginger) 1 qian 5 fen, Ban Xia (Pinelliae Tuber) 1 qian, named Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction).
Huang Lian Tang (Coptis Decoction)
Heat in the chest, pathogenic Qi in the Stomach, abdominal pain with urge to vomit.
This is Ban Xia Xie Xin Tang minus Huang Qin, plus Gui Zhi (Cinnamomi Ramulus) to harmonize exterior and interior.
Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Dried Ginger, Coptis, Scutellaria, Ginseng Decoction)
Diarrhea; after physician incorrectly used emesis and purgation, food is vomited immediately upon entry.
This formula treats vomiting patients with internal heat, unsuitable for aromatic, amomum, citrus, or pinellia herbs; effective like magic. Mr. Zhang Shiwen previously borrowed this formula to treat diarrhea due to Spleen-Stomach deficiency-cold with intestinal accumulated heat, with great efficacy.
Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, Ginseng Decoction)
This is Zhang Zhongjing's formula for abdominal distension after sweating. Zhang Shiwen borrowed it to treat post-diarrhea abdominal distension, with great efficacy.
Shiwen treated Commander-in-Chief Chen Mengyong, who had diarrhea, dysentery, abdominal distension, and pain. After taking Huang Qin and Bai Shao, distension became worse. His pulse was surging, full, and rapid, but soft upon pressure, indicating damp-heat damaging Spleen-Stomach Qi. Given Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang, pain stopped and distension decreased after two doses, but diarrhea persisted. Then given Gan Jiang Huang Lian Huang Qin Ren Shen Tang, diarrhea stopped after two doses, but appetite remained poor; given Ban Xia Xie Xin Tang for two doses, he recovered.
Ge Gen Huang Qin Huang Lian Tang (Pueraria, Scutellaria, Coptis Decoction) (See "Shang Han Lun")
This decoction was used by Zhang Zhongjing to treat cases where Guizhi pattern was present, but the physician incorrectly used purgatives, leading to persistent diarrhea, surging pulse, panting, and sweating. Now borrowed to treat diarrhea due to unresolved exterior pathogen and heat in stomach/intestines, with great efficacy.
Note: The monarch herb Ge Gen (Puerariae Radix) has light and clear properties to release the muscle layer and stop diarrhea; the assistant herbs Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) are bitter and cold to clear turbidity, stop sweating, and relieve panting; Gan Cao (Licorice Root) harmonizes the middle. Ge Gen is boiled first, then other herbs added. The muscle-releasing action is gentle, while the clearing action is sharp, differing from methods that tonify the middle and expel pathogens.
Guo Ba Lian Rou San (Rice Crust and Lotus Seed Powder)
A miraculous formula for chronic Spleen-deficiency diarrhea in elderly and children.
Guo Ba (Rice Crust, 4 liang, clean powder) Lian Rou (Lotus Seed, 4 liang, heart removed, clean powder) Bai Tang (White Sugar, 4 liang)
Mix evenly. Take 3-5 spoons per dose, three times daily, well after meals.
Dan Fan La Liu Wan (Red Lead, Alum, Beeswax, Pomegranate Peel Pill)
Treats all chronic diarrhea cases unresponsive to other drugs.
Huang Dan (Red Lead) Ku Fan (Alumen) Huang La (Beeswax) each 1 liang; Shi Liu Pi (Pomegranate Peel, 8 qian, stir-fried and ground)
Melt beeswax in a small copper spoon, mix with the fine powders of lead, alum, and pomegranate peel while hot, form pills the size of beans. Take 5 pills on an empty stomach. Also treats red dysentery; take with clear tea for red dysentery, ginger soup for white dysentery.
Guo Ba Song Hua San (Rice Crust and Pine Flower Powder)
A highly effective formula for persistent white diarrhea.
Guo Ba (Rice Crust, 2 liang) Song Hua (Pollen Pinus, 2 liang, stir-fried) La Rou Gu Tou (Bone from cured meat, 5 qian, baked crisp)
Grind into powder, mix with sugar, take anytime.
Huo La Hong Qu San (Ham and Red Yeast Rice Powder) (See "Zhong Fu Tang")
Treats Spleen diarrhea.
Chen Huo La Gu (Old Ham Bone, preserved nature, ground) Hong Qu (Red Yeast Rice)
Equal parts of the two ingredients, ground into fine powder, mixed with sugar and taken with aged wine.