初宜通解或分消，
通因通用，下也。然汗、吐亦谓之通，初病元气实者可行。若五七日，脾胃虚者
，只宜和解及分利小便，消导食积，无积不成痢也。
久乃升涩补脾胃；
稍久，以气血药中加升麻、柴胡、防风、苍术以提之；久甚，及用粟壳、肉豆蔻
、龙骨、牡蛎、诃子以涩之敛之。食少者，专调脾胃，饮食进而气血自和，盖痢以胃气为本
也。其间有里急甚而无表者，即宜通利；有虚而不敢痛者，或和解，或即升举；有气陷下痢
如注者，即暂止涩；有滑脱痛甚者，痰火盛也，宜吐宜升，痰消火降，而大肠自敛，须凭脉
证断之。
愈后余瘀却当防，
三白汤、六神丸、枳术丸、太和羹选用。
恐成肿痛鹤膝类。
有手足肿者，有遍身历节痛者，俱余瘀留滞经络，不可纯用风药。鹤膝风，大防
风汤、五积交加散；脚细者，苍龟丸（详外科）。
痞满
痞满先分便易难，
痞与否卦义同。精神气血，出入流行之纹理闭密，而为心下痞塞，按之不痛，非
若胀满外有胀急之形。大要∶大便易而利者，为虚；大便难而闭者，为实。
外感半表同伤寒；
外感邪气，自肌表传至胸膈，为半表里证，宜和解。或已经下，胸满而痛者，为
结胸；不痛者，为痞满，同伤寒治法。
杂病食壅兼养血，
杂病食积，下之太过，或误下，则脾胃之阴顿亡，以致胸中至高
之气，乘虚下陷
心肺分野，其所蓄之邪，又且不散，宜理脾胃，兼以血药调之。若用气药导利，则气愈降而
痞愈甚，久则变为中满鼓胀。盖痞皆自血中来，但伤寒从外之内，宜以苦泄；杂病从内之外
，宜以辛散。人徒知气之不运，而概用枳梗、槟榔，而不知养阴调血，惜哉！古方，食壅胸
中窒塞者，二陈汤探吐；伤饮食胸痞者，枳术丸；食后感寒，以致饮食不化者，二陈汤加山
楂、麦芽、神曲；虚寒不散，或宽或急，常喜热物者，理中汤加枳实；稍久，郁成湿热者，
平补枳术丸。
痰火气郁利膈间；
痰火因浓味郁成。痰滞者，小陷胸汤，或枳梗二陈汤，导痰汤；火盛者，二陈汤
，
加芩、连、栝蒌，或黄芩利膈丸，用白术、陈皮煎汤下，或古萸连丸，以泻肝补脾，清湿热
开痞结；久病者，黄连消痞丸；如痰火湿热太甚者，方敢用三黄泻心汤，加减量下之。虚者
，只宜分消上下，与湿同治。七情气郁成痞，不思饮食，食之不散者，木香化滞汤，或顺气
导痰汤。
中虚如刺瘀碍阻，
有禀受中虚，痞滞不运，如饥如微刺者，六君子汤加香附、砂仁；有内伤劳役，
浊气犯上，清气下陷，虚痞者，补中益气汤加黄连、枳实、芍药。便闭，加大黄；呕，加黄
连、
生姜、陈皮；冬月，加黄连、丁香。食已心下痞者，平补枳术丸。停饮中寒者，枳实理中丸
。
瘀血结成窠囊下，而心下痞者，用桃仁、红花、香附、大黄等分为末，酒调服利之，或犀角地
黄汤。血虚挟火，遇劳则发，心下不快者，四物二陈汤加桔梗、栝蒌降之。气血俱虚者，枳
实消痞丸。
王道消补总可安。
王道消补，不轻吐下，故古方以芩、连、枳实苦泄，浓朴、生姜、半夏辛散，参
、术甘苦温补，茯苓、泽泻淡渗，随病所在调之。通用二陈汤为主，肥人多湿痰，加苍术
、砂仁、滑石，倍茯苓、半夏；瘦人多郁热中焦，加枳实、黄连、干葛、升麻；禀受素实，
面苍骨露者，加枳壳、黄连、青皮、浓朴；素虚者，加白术、山楂、麦芽、陈皮；误下阴
虚者，去茯苓、半夏，加参、术、升麻、柴胡、枳实以升胃气，更合四物汤以济阴血；饮食
积
痞，加枳壳、砂仁、姜汁炒黄连；食后感寒，加藿香、草豆蔻、吴萸、砂仁；气痞、痰痞，
加木香、枳壳、南星；中虚，加参、术、香附、砂仁；瘀血，合四物汤，加桃仁、红花。
泄泻
五泻须知溺赤清，
五泻∶濡泻即湿泻，肠垢即热泻，鸭溏即寒泻，虚泻，滑泻。大要，热者小便赤
涩，烦渴腹中热，谷或不化，而色变青黄，或红赤黑，身能动作，声响亮，手足温；寒者小
便清白，不渴腹中冷，完谷色亦不色，变亦白色，身懒动作，目睛不了了，饮食不下。《
机要》云∶暴泻非阳，久泻非阴。正如伤寒始寒而终热也。
湿泻身重注如倾；
湿泻，如水倾下，肠鸣身重，腹不疼。外湿者，胃苓汤、除湿汤，或术附汤加茯
苓；内湿者，白术芍药汤、白术茯苓汤、二白丸；风湿相搏者，曲芎丸；痛甚者，治痛泻方
。
协风完谷寒急痛，
风泻，恶风自汗，或带清血，即太阴飧泻，反其所食原物。由春伤风寒，夏感冷
湿发动，故其泻暴，一方长幼相似，不可温涩，以致变为痢胀。要知四季脾受风湿，亦名飧
泻。春，古苍防汤、苍芍汤；夏，二香散；秋，神术散；冬，不换正金气散，微汗之。稍久
者，三白汤、曲芎丸；带血虚者，胃风汤。寒泻，恶寒身痛，腹胀切痛雷鸣，鸭溏清冷，完
谷不化，甚则脾败肢冷，理中汤倍加茯苓、浓朴，治中汤加砂仁，或大已寒丸。又有一种脏冷
泻，以热手按之则缓者，四柱散、古姜附汤。
身热烦渴暑分明。
暑泻，如水，烦渴尿赤，暴泻，实者，薷苓汤加黄连、车前子，或桂苓甘露饮；
虚者，六和汤、清暑益气汤；有潮热者，柴苓汤、升麻葛根汤；日久，香连丸、黄连阿胶丸
、来复丹。
内伤饮食痛且臭，
食积痛甚，泻后痛减，臭如抱坏鸡子，噎气作酸，须先消克所伤之物。伤冷食者
，感应丸、平胃散加香附、砂仁、草果、山楂、麦芽；伤热食及酒者，二黄丸加神曲；伤
酒晨泻者，理中加生姜、干葛，或香茸丸；热者，酒蒸黄连丸；伤面者，人参养胃汤加萝卜
子；伤水饮者，五苓散、温六丸。
痞胀不顺属七情；
七情泻，腹常虚痞，欲去不去，去不通泰，藿香正气散加丁香、砂仁、良姜，或
木香匀气散、七气汤、古萸连丸，调其气而泻自止矣。
痰泻多少火暴速，
痰泻，或泻不泻，或多或少，此因痰流肺中，以致大肠不固，二陈汤加白术、神
曲。实者，海青丸；虚者，六君子汤。火泻，实火口渴喜冷，痛一陈，泻一陈，肛门焦痛，
其来暴速，稠粘，五苓散去桂，加黄连、芍药，或黄芩汤加木通、六一散，兼呕者加姜汁
。又火性急，或米谷不化者，姜汁炒黄连为丸服。虚火，气虚不能泌别水谷者，卫生汤。
阴虚火动，不能凝聚者，三白汤敛之，久者，升阴丸。
虚泻厥汗面多青。
虚泻，困倦无力，脾虚饮食所伤。有遇饮食即泻者，四君子汤加木香、砂仁、莲
肉、陈糯米为末，砂糖汤调服。久者，只加升麻、白芍，或平胃蒜肚丸。有停蓄饮食，数日
乃泻腹胀者，名 泻，枳术丸，没石子丸。
烦渴或兼
呕者，钱氏白术散、参苓白术散。食少肠鸣，四肢困倦者，升阳除湿汤。日止夜泻者，
启脾丸。又脾泻久传肾，为肠癖，经年不愈者，调中健脾丸。又老人脾肾虚泻者，用吴茱萸
盐水浸透，以 猪脏头一截，洗去脂膜，将
茱萸入
内
扎两头，蒸烂捣丸绿豆大，每五十丸，米饮下，暖膀胱，清水道，固大肠，进饮食。肾虚色
欲所伤，泻多足冷，久则肉削，五鼓脐下绞痛，或只微响，溏泻一次者，古味萸散、二神丸
、四神丸。阳虚者，三味安肾丸、金锁正元丹、养气丹；阴虚者，肾气丸。肝虚忿怒所伤
，木克脾土，门户不束，厥而面青，当归浓朴汤，或熟料五积散去麻黄。汗多者，黄 建中
汤。凡泻，脉细皮寒，前后泻利，饮食不入，是谓五虚，不治。
滑泻不禁气陷脱，
泻久不止，大孔如竹筒直出无禁，气陷者，升阳补胃汤、补中益气汤加白芍；有
风者，小白术汤；挟热者，诃子散、没石子丸，或古萸连丸，罂粟壳煎汤下；气欲脱者，真
人养脏汤加附子，或四柱散、大断下丸、古蔻附丸、香茸丸、妇人四制香附丸。又有大肠滑
泻，小便精出者，万全丸。
交肠似痢何由名；
交肠泻者，大、小便易位而出，此因气不循故道，清浊混淆所致，当分利阴阳，
使气顺各安其位，胃苓汤、木香匀气散、肾气丸。似痢非痢，寒热不调之证，或热积于中
，而以冷物冷药冰之；或冷积于中，而以热物热药压之，故热与冷搏而成泻，或涩或溏，里
急后重者，戊己丸、香连丸，或理中汤加黄连、木香。
风宜微发寒温涩，虚补积消湿渗升。
凡泻皆兼湿，初直分理中焦，渗利下焦，又则升提，必滑脱不禁，然后用药涩之
。其间有风胜兼以解表，寒胜兼以温中，滑脱涩住，虚弱补益，食积消导，湿则淡渗，陷则
升举，随证变用，又不拘于次序，与痢大同。且补虚不可纯用甘温，太甘则生湿；清热亦不
太苦，苦则伤脾，每兼淡剂利窍为妙。抑考《难经》云∶胃泄，饮食不化，色黄；脾泄；腹
胀呕逆，言泻也；大肠泄，食已窘迫，色白，肠鸣切痛；小肠泄，溲而便脓血，小腹痛；大
瘕泄，里急后重，数至圊而不能便，茎中痛而溺涩，言痢也。观此泻与痢，亦惟脓血与粪之
异，除伤寒三阳、三阴传变自利，杂病湿热，食积之根，皆责肠胃。盖泄泻、疟、痢，同
由暑月饮食所致，轻者便作泄泻，重者停为疟痢，痰冲胸胁则为疟，积滞肠胃则为痢。《局
方》有分《难经》五泻者，不免失之牵强。
吞酸
吞酸吐酸皆湿热，
经云∶诸呕吐酸，皆属于热。又云∶少阳之胜呕酸。盖酸者，肝味，火盛制金不能
平木，则肝木自甚为酸，譬之饮食热则酸。但吐酸，乃平时津液上升之气，郁为痰火，留饮
不化，酿为酸水吐出；吞酸，乃湿热伏于肺胃，咯不得上，咽不得下，宿食郁遏而作，其因
、治一也。惟湿多则吞而便利，热多则吐而便闭。东垣言寒者，论其标耳。
大要初起宜反折；
素有湿热，因内感风寒，则内热愈郁，酸味刺心，或即吐出，或欲吐不吐，胸中
无奈，或得热汤暂解，盖风寒郁在肌表，得暖则腠理开泄，譬之伤寒表热，以麻黄热药发表
而愈。不问外感风寒，内伤生冷，初起俱宜生姜汁半夏汤，或二陈汤加丁香、木香、肉桂、
干姜、砂仁，姜、枣煎服，暂与开豁，此反佐之药，非正治也，中病即止。如中寒停水者，
神曲丸；上膈寒者，三味参萸汤；上热下寒者，黄连一两，附子七钱，神曲糊丸，淡姜汤下
。
久消食积降火痰，
久则郁热，宜以寒药调之下之，结散热去，则气自通和，所以中酸宜素食者，
恐滞气也。宿食，通用二陈汤，或生料平胃散加香附、砂仁、神曲、山楂、麦芽、山栀仁、
黄连，或枳术丸。宿食留饮，酸蜇心痛，牙齿亦酸者，曲术丸。专吐清水者，用苍术、茯苓
、滑石、白术、陈皮，水煎服。兼嘈杂者，保和丸。痰火停食，一日半日，腐化酸水，吐
出黄臭，或酸心不安，通用二陈汤加山楂、神曲、桔梗、南星、枇杷叶、黄连、竹茹，姜煎
临熟入姜汁一匙调服，或九味萸连丸。挟瘀血者，四味萸连丸。兼嘈杂者，清痰丸。通用，
大便闭者，透膈汤；大便自利者，用六一散七两，加吴萸一两，饭丸服。
阴虚暮剧须养血。
朝食甘养，至晡心腹刺酸吐出，此血虚火盛，宜四物汤加陈皮、黄连、黄芩、桃
仁、红花、麻仁、甘草。便闭结者，更加大黄；气虚者，更合四君子汤。
黄胆
黄胆须知有湿干，
发黄，譬如 曲，五疸，同归湿热。盖湿热熏蒸血热，土色上行面目，延及爪甲
身体俱黄，黄即疸也。干黄热胜，色黄而明，大便燥结；湿黄湿胜，色黄而晦，大便润利。
又湿病与黄病相似，但湿病在表，一身尽痛，黄病在里，一身不痛。
渴多喘满治之难。
凡疸，以十八日为期，十日以外，入腹喘满渴多，面黑者死，要知疸兼杂证最多
，脾胃稍实，更断浓味可治。酒色伤，恣口腹者难。
汗溺俱黄身体肿，
汗出染衣亦黄，身肿者，曰黄汗。因阳明表热多汗，带汗入水，宜桂枝苦酒汤、
陈汤。小溺、面目、牙齿、肢体如金，曰黄胆。因暴热用冷水洗浴，热留胃中，故食已善
饥，安卧懒动，宜茵陈三物汤加木通、栝蒌仁、石膏，或单桃根煎汤服之。
头眩懊 发赤斑。
食已头眩腹胀，曰谷疸。因胃热大饥过食，停滞胸膈，宜小柴胡汤加谷芽、枳实
、山栀，或谷疸丸、红丸子。伤冷食，肢厥者，四逆汤加茵陈。心胸懊 ，欲吐不食，腹如
水状，足心热，胫满面发赤斑，眼黄鼻痈，曰酒疸。因大醉当风入水，酒毒留于清道，初起
令病患先含水，后以瓜蒂末一字搐鼻，吐出黄水，次服葛术汤，探吐亦可。热者，小柴胡汤
加茵陈、白术、豆豉、干葛、黄连、泽泻。便闭者，栀豉枳实汤加大黄，或酒蒸黄连丸。如
酒后犯房，瘀热入心成疸者，妙香散；痰火入肺成疸，咳嗽见血，喉腥，及妇人血崩，龙脑
鸡苏丸。
甚则额黑小腹满，
额上黑，微汗，手足心热，薄暮即发，膀胱小便不利，曰女劳疸。因大热犯房入
Initially, it is appropriate to use unblocking resolution or simultaneous elimination.
"Treating obstruction with unblocking methods" belongs to purgation. However, sweating and emesis are also referred to as "unblocking," which can be used in the early stage when the primordial qi is substantial. If the disease has progressed to five or seven days, for those with weak spleen and stomach, only harmonizing and promoting diuresis, along with resolving food stagnation, are suitable, because dysentery does not form without accumulation.
As the duration increases, lifting, astringing, and tonifying the spleen and stomach should be employed;
For a slightly longer duration, add Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), and Cangzhu (Atractylodis Rhizoma) to blood-qi tonifying formulas to lift the qi; for a very long duration, use Yingsuke (Papaveris Pericarpium), Roudoukou (Myristicae Semen), Longgu (Fossilia Ossis Mastodi), Muli (Concha Ostreae), and Hezi (Terminalia Chebulae Fructus) to astringe and consolidate. For those with reduced appetite, focus on regulating the spleen and stomach; once diet improves, blood and qi will naturally harmonize, as dysentery relies on stomach qi as its root. Among these cases, those with severe tenesmus but no exterior syndrome should be treated with unblocking and draining methods; those who are deficient and dare not feel pain may be treated by harmonizing or immediately lifting; those with qi sinking and profuse diarrhea should be temporarily astringed; those with incontinence and severe pain indicate excessive phlegm-fire, requiring emesis and lifting methods; once phlegm dissipates and fire descends, the large intestine will naturally contract, but this must be judged based on pulse and symptoms.
After recovery, residual blood stasis should be prevented;
Select from Sanbai Tang (Three Whites Decoction), Liushen Wan (Six Spirits Pill), Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill), or Taihe Geng (Taihe Broth).
One must fear the formation of swelling and pain resembling Crane's Knee Wind (Xike Feng).
Cases with swollen hands and feet, or pain throughout all joints, are due to residual stasis lingering in the meridians; wind-dispelling drugs should not be used exclusively. For Crane's Knee Wind, use Dafangfeng Tang (Great Saposhnikovia Decoction) or Wuji Jiaosan San (Five Accumulations Mixed Powder); for thin legs, use Canggui Wan (Green Turtle Pill) (see Surgery).
Pi Man (Fullness and Obstruction)
Pi Man must first be differentiated by the ease or difficulty of defecation.
The term "Pi" shares the same meaning as the hexagram Pi (Obstruction) in the I Ching. It refers to the closure of the textures through which spirit, qi, and blood circulate, resulting in subcardiac fullness that is non-tender upon pressure, unlike distension which presents with external tension. The general principle: easy and smooth defecation indicates deficiency; difficult and obstructed defecation indicates excess.
Exterior-half interior half resembles Shaoyang syndrome in Cold Damage;
When exogenous pathogens transmit from the muscle surface to the chest and diaphragm, it becomes an exterior-half interior-half syndrome, suitable for harmonizing. If purgation has already been used and there is chest fullness and pain, it is Jie Xiong (Chest Binding); if there is no pain, it is Pi Man, treated similarly to Cold Damage.
Miscellaneous diseases involving food stagnation require nourishing blood;
In miscellaneous diseases, excessive or mistaken purgation causes sudden loss of spleen and stomach yin, leading to the high qi of the chest sinking into the lung-heart regions due to deficiency. The accumulated pathogen does not disperse, so regulating the spleen and stomach while using blood-invigorating herbs is appropriate. Using qi-moving drugs for drainage will cause qi to sink further and worsen the fullness, eventually transforming into abdominal distension. Generally, Pi originates from blood issues; however, Cold Damage moves from outside to inside, requiring bitter-draining methods, whereas miscellaneous diseases move from inside to outside, requiring acrid-dispersing methods. People only know that qi fails to circulate and indiscriminately use Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix), and Binglang (Arecae Semen), ignoring the need to nourish yin and regulate blood—what a pity! Ancient formulas: for food stagnation causing chest obstruction, use Erchen Tang (Two-Aged Decoction) to induce vomiting; for chest fullness due to dietary injury, use Zhizhu Wan; for cold acquired after eating causing indigestion, use Erchen Tang plus ShanZha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), and Shenqu (Massa Medicata Fermentata); for persistent deficiency-cold, whether loose or urgent, preferring hot substances, use Lizhong Tang (Regulate the Middle Decoction) plus Zhishi (Aurantii Fructus Immaturus); for slightly longer duration turning into damp-heat, use Pingbu Zhizhu Wan (Balanced Tonifying Zhizhu Pill).
Phlegm-fire and qi stagnation benefit from clearing the diaphragm;
Phlegm-fire forms from rich flavors causing stagnation. For phlegm obstruction, use Xiaoxianxiong Tang (Small Cave Chest Decoction), or Zhigeng Erchen Tang (Scutellaria and Platycodon Two-Aged Decoction), or Daotan Tang (Abundant Phlegm Decoction); for excessive fire, use Erchen Tang plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Gualou (Trichosanthis Fructus), or Huangqin Lige Wan (Scutellaria Diaphragm-Clearing Pill) taken with decoction of Baizhu (Atractodis Macrocephalae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium), or Guyu Lian Wan (Ancient Cornus and Coptis Pill) to drain liver and tonify spleen, clearing damp-heat and opening Pi knots; for chronic illness, use Huanglian Xiaopi Wan (Coptis Eliminating Pi Pill); only if phlegm-fire and damp-heat are extremely severe should Sanhuang Xiexin Tang (Three Yellows Draining Heart Decoction) be used with modifications. For deficiency, only simultaneous elimination of upper and lower jiao and treating dampness together is suitable. For Pi caused by emotional qi stagnation, with loss of appetite and undigested food, use Muxiang Huazhi Tang (Costus Regulating Stagnation Decoction) or Shunqi Daotan Tang (Smooth Qi Abundant Phlegm Decoction).
Middle deficiency like stabbing pain obstructed by stasis;
For congenital middle deficiency causing Pi stagnation and immobility, feeling like hunger or slight stabbing pain, use Liujunzi Tang (Six Gentlemen Decoction) plus Xiangfu (Cyperi Rhizoma) and Sharen (Amomi Fructus); for internal injury from overwork, turbid qi attacking upward, clear qi sinking, and deficiency-Pi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huanglian, Zhishi, and Shaoyao (Paeoniae Radix Alba). For constipation, add Dahuang (Rhei Radix et Rhizoma); for vomiting, add Huanglian, Shengjiang (Zingiberis Rhizoma Recens), and Chenpi; in winter, add Huanglian and Dingxiang (Eugeniae Flos). For subcardiac fullness after eating, use Pingbu Zhizhu Wan. For retained fluid and middle cold, use Zhishi Lizhong Wan (Zhishi Regulate Middle Pill).
If blood stasis forms nests below causing subcardiac Pi, use Tao Ren (Persicae Semen), Honghua (Carthami Flos), Xiangfu, and Dahuang in equal parts, powdered and taken with wine to promote drainage, or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). For blood deficiency with fire, recurring with fatigue and subcardiac discomfort, use Siwu Erchen Tang (Four Substances Two-Aged Decoction) plus Jiegeng and Gualou to descend. For combined qi and blood deficiency, use Zhishi Xiaopi Wan.
Kingly methods of eliminating and tonifying ensure peace.
Kingly methods of eliminating and tonifying do not lightly use emesis or purgation. Thus, ancient formulas use Huangqin, Huanglian, and Zhishi for bitter-draining, Houpo (Magnoliae Officinalis Cortex), Shengjiang, and Banxia (Pinelliae Rhizoma) for acrid-dispersing, Renshen (Ginseng Radix), and Baizhu for sweet-bitter-warm tonifying, and Fuling (Poria) and Zexie (Alismatis Rhizoma) for bland-leaching, adjusting according to the disease location. Erchen Tang is generally used as the base: for fat people with much damp-phlegm, add Cangzhu, Sharen, Huashi (Talcum), and double Fuling and Banxia; for thin people with depression-heat in the middle jiao, add Zhishi, Huanglian, Gegen (Puerariae Radix), and Shengma; for those with strong constitution, dark complexion, and prominent bones, add Zhike (Aurantii Fructus), Huanglian, Qingpi (Citri Reticulatae Pericarpium Viride), and Houpo; for those with inherent deficiency, add Baizhu, ShanZha, Maiya, and Chenpi; for yin deficiency due to mistaken purgation, remove Fuling and Banxia, add Renshen, Baizhu, Shengma, Chaihu, and Zhishi to lift stomach qi, combined with Siwu Tang (Four Substances Decoction) to nourish yin blood; for food stagnation Pi, add Zhike, Sharen, and Huanglian stir-fried with ginger juice; for cold after eating, add Huoxiang (Agastaches Herba), Caodoukou (Amomi Fructus), Wuzhuyu (Evodiae Fructus), and Sharen; for qi-Pi and phlegm-Pi, add Muxiang (Aucklandiae Radix), Zhike, and Nansxing (Arisaematis Rhizoma Preparatum); for middle deficiency, add Renshen, Baizhu, Xiangfu, and Sharen; for blood stasis, combine with Siwu Tang and add Tao Ren and Honghua.
Xie Xie (Diarrhea)
For five types of diarrhea, know if urine is red or clear.
Five types of diarrhea: Ru Xie (Moist Diarrhea) is damp diarrhea; Chang Gou (Intestinal Mucus) is heat diarrhea; Ya Tang (Duck Droppings) is cold diarrhea; Xu Xie (Deficiency Diarrhea); Hua Xie (Slippery Diarrhea). General principles: Heat type presents with red and astringent urine, irritability, thirst, abdominal heat, undigested food, stool color changing to green-yellow, red-black, body movement possible, voice loud, warm hands and feet; Cold type presents with clear white urine, no thirst, cold abdomen, undigested food, white stool color, lazy body movement, unclear vision, inability to eat. *Jiyao* states: Sudden diarrhea is not purely yang, chronic diarrhea is not purely yin. Just as Cold Damage starts with cold and ends with heat.
Damp diarrhea features heavy body like pouring water;
Damp diarrhea flows like pouring water, with borborygmus and heaviness, no abdominal pain. For external dampness, use Weiling Tang (Stomach and Poria Decoction), Chushi Tang (Eliminate Dampness Decoction), or Zhufu Tang (Aconite and Atractylodes Decoction) plus Fuling; for internal dampness, use Baizhu Shaoyao Tang (Atractylodes and Peony Decoction), Baizhu Fuling Tang, or Erbai Wan (Two Whites Pill); for wind-damp interaction, use Quxiong Wan; for severe pain, use Zhitong Xie Fang (Stop Pain Diarrhea Formula).
Wind-collateralized complete grain diarrhea with cold and urgent pain;
Wind diarrhea features aversion to wind, spontaneous sweating, or clear blood, which is Taiyin Sun Xie (Sporadic Diarrhea), vomiting undigested original food. Caused by spring wind-cold injuring, summer cold-damp triggering, so the diarrhea is sudden, affecting families similarly. Do not use warming and astringing methods to avoid transforming into dysentery distension. Note that seasonal spleen wind-damp is also called Sun Xie. Spring: Gu Cangfang Tang, Cangshao Tang; Summer: Erxiang San; Autumn: Shenzhu San; Winter: Buhuan Zheng Jinqi San, induce slight sweating. Slightly longer duration: Sanbai Tang, Quxiong Wan; with blood deficiency: Weifeng Tang. Cold diarrhea features aversion to cold, body pain, abdominal distension with cutting pain and borborygmus, duck-like cold stool, undigested food, even spleen failure with cold limbs; use Lizhong Tang doubled with Fuling and Houpo, Zhizhong Tang plus Sharen, or Da Yihan Wan (Great Great Cold Pill). Another type is organ cold diarrhea, relieved by hot hand pressure; use Sizhu San, Gu Jiangfu Tang (Ancient Ginger and Aconite Decoction).
Body heat and irritability clearly indicate summerheat.
Summerheat diarrhea flows like water, with irritability, thirst, red urine, sudden diarrhea. Excess type: Ruling Tang plus Huanglian and Cheqianzi (Plantaginis Semen), or Guiling Ganlu Yin (Cassia Twig and Poria Sweet Dew Drink); Deficiency type: Liuhe Tang (Six Harmonies Decoction), Qingshu Yiqi Tang (Clear Summerheat Augment Qi Decoction); with tidal fever: Chailing Tang (Bupleurum and Poria Decoction), Shengma Gegen Tang; long duration: Xianglian Wan, Huanglian Ejiao Wan, Laifu Dan.
Internal injury from food causes pain and odor.
Food stagnation causes severe pain, relieved after diarrhea, smelling like rotten eggs, belching with sourness; must first eliminate the injured substance. For cold food injury: Yinggan Wan, Pingwei San plus Xiangfu, Sharen, Caoguo (Tsaoko Fructus), ShanZha, Maiya; for hot food and alcohol injury: Erhuang Wan plus Shenqu; for morning diarrhea from alcohol: Lizhong Tang plus Shengjiang and Gegen, or Xiangrong Wan; for heat: Jiuzheng Huanglian Wan (Wine-steamed Coptis Pill); for noodle injury: Renshen Yangwei Tang plus Luobozǐ (Raphani Semen); for water retention injury: Wuling San (Five Ling Powder), Wenliu Wan.
Fullness and obstruction due to seven emotions;
Seven-emotion diarrhea features constant abdominal false fullness, wanting to go but unable, or incomplete relief. Use Huoxiang Zhengqi San plus Dingxiang, Sharen, Liangjiang (Alpiniae Officinarum Rhizoma), or Muxiang Yunqi San, Qi Qi Tang, Guyu Lian Wan to regulate qi and stop diarrhea.
Phlegm diarrhea varies in amount, fire diarrhea is rapid;
Phlegm diarrhea varies in frequency and amount, caused by phlegm flowing into lungs making large intestine insecure. Use Erchen Tang plus Baizhu and Shenqu. Excess: Haiqing Wan; Deficiency: Liujunzi Tang. Fire diarrhea: Excess fire with thirst preferring cold, pain then diarrhea, burning anus, sudden onset, thick sticky stool. Use Wuling San minus Guizhi (Cinnamomi Ramulus), plus Huanglian and Shaoyao, or Huangqin Tang plus Mutong (Akebiae Caulis) and Liuyi San (Six-to-One Powder); with vomiting add ginger juice. Since fire is urgent, or undigested food, use Jiangzhi Huanglian Wan (Ginger Juice Coptis Pill). Deficiency fire with qi failing to separate fluids: Weisheng Tang. Yin deficiency with fire moving failing to condense: Sanbai Tang to astringe; chronic: Shengyin Wan.
Deficiency diarrhea with cold extremities, sweating, and blue face.
Deficiency diarrhea features fatigue and weakness, spleen deficiency from food injury. Those who diarrhea immediately after eating: Sijunzi Tang plus Muxiang, Sharen, Lianrou (Nelumbinis Semen), and aged glutinous rice powder, taken with brown sugar water. Chronic: add Shengma and Baishao, or Pingwei Suandu Wan. Those with retained food diarrhea after several days with abdominal distension: named [missing character] diarrhea, use Zhizhu Wan, Meishizi Wan (Myrobalan Pill).
With irritability/thirst or vomiting: Qianshi Baizhu San, Shenling Baizhu San. With poor appetite, borborygmus, limb fatigue: Shengyang Chushi Tang (Raise Yang Eliminate Dampness Decoction). Daytime/nighttime diarrhea: Qipi Wan. Spleen diarrhea transmitting to kidney over years becomes Chang Pi (Intestinal Dysentery): Tiaozhong Jianpi Wan. Elderly spleen-kidney deficiency diarrhea: Soak Wuzhuyu (Evodiae Fructus) in salt water, insert into pig stomach segment, steam until soft, make pills size of mung bean, 50 pills with rice drink, warms bladder, clears water passages, consolidates large intestine, promotes diet. Kidney deficiency from sexual excess, frequent diarrhea with cold feet, wasting, pre-dawn umbilical colic or mild sound, one loose stool: Gu Wei Yu San,ershén Wan, Sishen Wan. Yang deficiency: Sanwei Anshen Wan, Jin suo Zhengyuan Dan, Yangqi Dan; Yin deficiency: Shenqi Wan. Liver deficiency from anger, wood overcoming earth, loose sphincter, cold extremities blue face: Danggui Houpo Tang, or Shuliao Wuji San minus Mahuang (Ephedrae Herba). Profuse sweating: Huangqi Jianzhong Tang. Any diarrhea with fine pulse, cold skin, anterior/posterior discharge, inability to eat is called Five Deficiencies, untreatable.
Slippery uncontrollable diarrhea indicates qi sinking collapse;
Chronic uncontrolled diarrhea, anus like a bamboo tube, qi sinking: Shengyang Bugwei Tang, Buzhong Yiqi Tang plus Baishao; with wind: Xiaobaizhu Tang; with heat: Hezi San, Meishizi Wan, or Guyu Lian Wan taken with Yingsuqiao (Papaveris Pericarpium) decoction; qi about to collapse: Zhenren Yangzang Tang plus Fuzi (Aconiti Lateralis Radix Preparata), or Sizhu San, Daduanxia Wan, Gu Koufu Wan, Xiangrong Wan, Funren Sizhi Xiangfu Wan. Large intestine slippery diarrhea with seminal emission: Wanquan Wan.
Jiao Chang (Cross Intestines) resembles dysentery, what is its name?
Jiao Chang diarrhea involves exchange of urination and defecation positions, caused by qi not following normal paths, mixing clear and turbid. Must separate yin and yang, let qi settle in place. Use Weiling Tang, Muxiang Yunqi San, Shenqi Wan. Resembles dysentery but is not, cold-heat disharmony: heat accumulating in middle cooled by cold items/meds; or cold accumulating in middle suppressed by hot items/meds, causing heat-cold conflict diarrhea, either dry or loose, with tenesmus: Wuji Wan, Xianglian Wan, or Lizhong Tang plus Huanglian and Muxiang.
Wind requires mild release, cold requires warming/astringing, deficiency requires tonifying, accumulation requires eliminating, damp requires leaching/lifting.
All diarrhea involves dampness. Initially resolve middle jiao, leach lower jiao, then lift. Only use astringents for slippery uncontrollable cases. Wind excess adds exterior release; Cold excess adds middle warming; Slippery uses astringents; Weakness uses tonics; Food stagnation uses digestion promoters; Damp uses bland leaching; Sinking uses lifting. Vary according to syndrome, not fixed order, similar to dysentery. Tonifying deficiency should not be purely sweet-warm (too sweet generates damp); Clearing heat should not be too bitter (bitter damages spleen); combining bland diuretics is excellent. Examining *Nanjing*: Stomach diarrhea, undigested food, yellow color; Spleen diarrhea, abdominal distension, vomiting, refers to diarrhea; Large Intestine diarrhea, urgency after eating, white color, borborygmus cutting pain; Small Intestine diarrhea, urination with pus/blood, lower abdominal pain; Da Jia Xie (Great Mass Diarrhea/Dysentery), tenesmus, frequent visits unable to pass, penile pain and astringent urination, refers to dysentery. Diarrhea and dysentery differ only in pus/blood vs feces. Except Cold Damage transmission self-diarrhea, miscellaneous disease damp-heat and food stagnation roots are blamed on intestines/stomach. Diarrhea, malaria, dysentery all caused by summer diet. Mild becomes diarrhea; Severe stops as malaria/dysentery. Phlegm rushing chest/hypochondrium becomes malaria; Stagnation in intestines becomes dysentery. *Ju Fang* dividing *Nanjing* five diarrheas is somewhat forced.
Tun Suan (Acid Regurgitation)
Both swallowing and vomiting acid are damp-heat.
Classic says: All vomiting and acid regurgitation belong to heat. Also: Shaoyang victory causes vomiting acid. Sour taste is liver flavor. Fire excess controls Metal failing to balance Wood, so Liver Wood becomes excessive and sour, like food heating up becoming sour. Vomiting acid is daily rising fluid qi, stagnating into phlegm-fire, retained fluid not transforming, brewing into acid water vomited; Swallowing acid is damp-heat lurking in lung/stomach, cannot cough up or swallow down, old food stagnation causing it. Etiology and treatment are same. Wet dominant leads to swallowing and free passage; Heat dominant leads to vomiting and constipation. Dongyuan speaking of cold discusses the branch.
General principle: Initial stage requires counter-manipulation;
Those with chronic damp-heat, internally affected by wind-cold, internal heat becomes more stagnant, sour taste pierces heart, or vomits immediately, or wants to vomit but cannot, chest distress, or temporarily relieved by hot soup. Wind-cold stagnant in muscle surface, warmth opens pores, like Cold Damage exterior heat cured by Ma Huang (Ephedrae Herba) hot medicine releasing exterior. Regardless of external wind-cold or internal raw/cold injury, initial stage should use Shengjiang Zhi Banxia Tang (Ginger Juice Pinellia Decoction), or Erchen Tang plus Dingxiang, Muxiang, Rougui (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma), Sharen, decocted with ginger/jujube for temporary opening. This is counter-assisting medicine, not standard treatment, stop when effective. For middle cold with retained water: Shenqu Wan; Upper jiao cold: Sanwei Canyu Tang; Upper heat lower cold: Huanglian 1 liang, Fuzi 7 qian, Shenqu paste pill, taken with light ginger tea.
Long-term resolves food stagnation, descends fire/phlegm;
Long-term郁热 (stagnant heat) should be regulated and purged with cold medicines. Once knot dissipated and heat gone, qi naturally harmonizes. Hence acid sufferers should eat plain food to avoid qi stagnation. Old food: Generally Erchen Tang, or Shengliao Pingwei San plus Xiangfu, Sharen, Shenqu, ShanZha, Maiya, Shanzhiren (Gardeniae Semen), Huanglian, or Zhizhu Wan. Old food retained fluid, acid piercing heart pain, sour teeth: Quzhu Wan. Pure clear water vomiting: Cangzhu, Fuling, Huashi, Baizhu, Chenpi, water decoction. With rumbling: Baohe Wan. Phlegm-fire stopped food, 1-1.5 days rotting into acid water, vomiting yellow foul smell, or sour heart discomfort: Generally Erchen Tang plus ShanZha, Shenqu, Jiegeng, Nansxing, Pipaye (Loquat Leaf), Huanglian, Zhuru (Bambusa Caulis Intermedium), decocted with ginger, add ginger juice near end, or Jiawei Yulian Wan. With blood stasis: Siwei Yulian Wan. With rumbling: Qingtan Wan. Generally, constipation: Touge Tang; Free stool: Liuyi San 7 liang, Wuzhuyu 1 liang, rice pill.
Yin deficiency worse at dusk requires nourishing blood.
Morning eating sweet nourishment, until afternoon heart/abdomen stabbing sour vomited, this is blood deficiency fire excess. Use Siwu Tang plus Chenpi, Huanglian, Huangqin, Tao Ren, Honghua, Hema (Hemp Seed), Gancao (Licorice Root). Constipation: add Dahuang. Qi deficiency: combine with Sijunzi Tang.
Huang Dan (Jaundice)
Jaundice must know damp vs dry.
Yellowing, like fermentation, five jaundices all归于 (belong to) damp-heat. Damp-heat steaming blood heat, earth color rises to face/eyes, extending to nails/body all yellow, yellow is Dan. Dry Jaundice heat excess, yellow bright, dry stool; Damp Jaundice damp excess, yellow dull, moist stool. Damp disease resembles yellow disease, but damp is exterior, whole body pain; Yellow disease is interior, no whole body pain.
Thirst, panting, fullness makes treatment difficult.
All jaundice, deadline 18 days. After 10 days, entering abdomen with panting/fullness/thirst, black face means death. Know jaundice has most mixed syndromes. Spleen/stomach slightly solid, cut rich flavors, treatable. Alcohol/sex injury, indulging mouth/stomach, difficult.
Sweat and urine both yellow, body swollen.
Sweat staining clothes yellow, body swollen, called Huang Han (Yellow Sweat). Due to Yangming exterior heat sweating, entering water with sweat, use Guizhi Kujiu Tang (Cinnamon Twig Vinegar Decoction), Chen Tang. Urine, face, eyes, teeth, limbs like gold, called Huang Dan. Due to sudden heat bathing in cold water, heat staying in stomach, so hungry after eating, lying still lazy, use Yinchensanwu Tang plus Mutong, Gualouren (Trichosanthis Semen), Shigao (Gypsum Fibrosum), or single Taogen (Peach Root) decoction.
Vertigo, vexation, red spots.
After eating vertigo abdominal distension, called Gu Dan (Grain Jaundice). Due to stomach heat great hunger overeating, stagnating chest/diaphragm, use Xiao Chaihu Tang plus Guya (Sprouted Grain), Zhishi, Shanzhi, or Gudanyan Wan, Hongwanzi. Cold food injury, cold limbs: Sini Tang plus Yinchin. Chest vexation, want to vomit not eat, abdomen like water, sole heat, calf/face red spots, yellow eyes nasal abscess, called Jiu Dan (Wine Jaundice). Due to drunkenness facing wind entering water, wine toxin staying in clear pathways. Initial: patient holds water, then Gouti (Momordicae Fructus) powder insufflated into nose, vomit yellow water, then Ge Zhu Tang, inducing vomiting also ok. Heat: Xiao Chaihu Tang plus Yinchin, Baizhu, Douchi (Fermented Soybean), Gegen, Huanglian, Zexie. Constipation: Zhichi Zhishi Tang plus Dahuang, or Jiuzheng Huanglian Wan. Post-coital intercourse after drinking, blood-heat entering heart causing jaundice: Miaoxiang San; Phlegm-fire entering lung causing jaundice, coughing blood, throat fishy smell, women metrorrhagia: Longnao Jisu Wan.
Severe forehead black, lower abdomen full.
Forehead black, slight sweat, palm/sole heat, evening onset, bladder urination difficult, called Nu Lao Dan (Female Labor Jaundice). Due to great heat engaging in sex entering...