论
《内经》曰∶湿胜则濡泄。又曰∶春伤于风，夏必飧泄。又曰∶暴注下迫，皆属于热。又曰∶诸病水液，澄澈清冷，
皆属于寒。叔和云∶湿多成五泄。是故知风寒湿热皆能令人泄泻，但湿热良多而风寒差少耳。《原病式》曰∶泻白为寒，
青黄赤黑为热也。大抵泻利，小便清白不涩为寒，赤涩为热。又大便完谷不化而色不变，吐利不腥秽，水液澄澈清冷，
小便清白不涩，身冷不渴，脉迟细而微者，皆寒证也。凡谷肉消化者，无问色及他证，便断为热。夫寒泄而谷消化者，
未之有也。或火性急速，转化失常，完谷不化而为飧泄者，亦有之矣。仲景曰∶邪热不杀谷。然热得湿，则为飧泄也。
噫！寒热二证，冰炭相反，治之者差之毫厘，谬以千里者也，医者可不谨乎。
脉法
《内经》曰∶脉细，皮寒，少气，泄利前后，饮食不入，是为五虚，死。其浆粥入胃，泄注止，则虚者活。脉经曰∶
泄注，脉缓时小结者生，浮大数者死。
又洞泄，食不化，不得留，下脓血，脉微小流连者生，劲急者死。
《脉诀》云∶下利微小则为生，脉大浮洪无瘥日。
方法
丹溪曰∶泄属湿，属气虚，有火，有痰，有食积者。
戴氏曰∶凡泻水，腹不痛者，湿也。饮食入胃不住，完谷不化者，气虚也。腹痛泻水肠鸣，痛一阵泻一阵者，火也。
或泻或不泻，或多或少者，痰也。腹痛甚而泻，泻后痛减者，食积也。
燥湿，四苓散加苍术，倍白术。甚者，二术炒为末，米饮调服。
气虚，用人参、白术、芍药。
火宜伐火利小水，四苓散加滑石、黄芩、栀子、木通。
痰宜伐痰，海石、青黛、黄芩、神曲为丸服，或用吐以提其清气。
食积，宜消导疏涤之，神曲、大黄、枳实之类。
水泻，用苍术、浓朴、陈皮、炒曲、茯苓、猪苓、泽泻、地榆、甘草，冬加干姜，等分煎服。
泄泻水多者，必用五苓散。
夏月水泻，桂苓甘露饮。（二方并见暑门。）
治泄泻诸药，多作丸子效。
脾胃不和泄泻者，胃苓汤。（五苓合平胃散是也。）
世俗例用涩药治泻，若病久而虚者或可。若初得者，必变他证，为祸不小。殊不知泻多因于湿，分利小水，为上策
也。
（以上丹溪方法凡十二条）
清六丸 治泄泻。
六一散（一料） 加红曲五钱。
上为细末，汤浸蒸饼为丸服。
温六丸 治泄泻，或兼呕吐者。
六一散加干姜，或生姜汁亦可，蒸饼丸服。
姜曲丸 治食积泻。
陈曲 茴香（各五钱） 生姜（一两）
上为细末，蒸饼丸服。
止泻方
肉豆蔻（五钱） 白滑石（春冬一两二钱五分，夏二两五钱，秋二两）
上为细末，姜汁调神曲作糊，为丸服。
脾泄丸
白术 神曲 芍药（并炒，各等分）
冬加肉豆蔻，去芍药，为细末，神曲糊为丸服。
（以上皆丹溪方）
茯苓汤（东垣） 治因伤冷冻饮料水，泄泻注下，一夜十余次，变作白痢，或变赤白相杂，腹中 痛，食减热燥，
四肢沉因无力。
生黄芩（一钱五分） 当归（二钱） 肉桂 炙甘草（各二分半） 猪苓 茯苓（各三分） 泽泻（五分） 芍药
（七分半） 苍术 生甘草 升麻 柴胡（各一钱）
上细切，作一服，水二盏，煎至一盏，稍热服。
黄 补胃汤（东垣） 治一日大便三、四次，溏而不多，有时作泄，肠中鸣，小便黄。
黄 柴胡 当归身 益智 橘红（各一钱五分） 升麻（二钱） 炙甘草（五分） 红花（少许）
上细切，作一服，水二盏，煎至一盏，稍热，食前服。
升阳除湿汤（东垣） 自下而上者，引而去之。
苍术（一钱） 柴胡 羌活 防风 升麻 神曲 泽泻 猪苓（各五分） 炙甘草 陈皮 麦 面（各三分）
上细切，作一服，水二盏，煎至一盏，去渣空心服。如胃寒肠鸣，加益智仁、半夏各五分，生姜三片，大枣一枚同
煎。非肠鸣勿用。
治痛泄要方（刘草窗）
白术（二两，炒） 白芍药（二两，炒） 陈皮（一两五钱，炒） 防风（一两）
上细切，分作八服，水煎或丸服。久泻，加升麻六钱。
白术芍药汤（机要） 治太阴脾经受湿，水泄注下，体重微满，困弱无力，不欲饮食，水谷不化，宜此和之。
身
重暴下，是大势来，亦宜和也。
白术 白芍药（各四钱） 甘草（二钱）
上细切，作一服，水二盏，煎至一盏，温服。
茯苓汤（机要） 治湿泻，又治食积、湿热作泻。
白术 茯苓（各五钱）
上细切，作一服，水煎，食前服。一方有芍药，三味各等分，名白术散，为末，米饮调下。
苍术芍药汤 治证如前。
苍术（五钱） 芍药（二钱五分） 黄芩（一钱五分） 淡桂（五分）
上细切，作一服，水二盏，煎至一盏，温服。
防风芍药汤（机要） 治飧泄身热，脉弦，腰痛微汗。
防风 芍药 黄芩（各二钱）
上细切，作一服，水煎，空心服。
苍术防风汤（机要） 治泄泻，脉弦头痛。
苍术（二钱） 防风（一钱） 白术（四钱） 麻黄（一钱）
上细切，作一服，加生姜五片，水二盏，煎至一盏，食前服。
神术散（良方） 治春伤于风，夏必飧泄之证。
苍术（一钱五分） 本 川芎（各六分） 羌活（四分） 甘草（炙，三分） 细辛（二分）
上细切，作一服，加生姜三片，水二盏，煎至一盏，去渣温服。如欲汗，加葱白三茎。
胃风汤（局方） 治证如前，及治风冷乘虚，入客肠胃，米谷不化，泄泻注下，及肠胃湿毒，下如豆汁，或下
瘀
血，或如鱼脑，日夜无度，久不得愈者。（方见中风门。）
（丹溪活套）云∶泄泻注下如水，用生料五苓散，加苍术、车前子，倍白术，为末，米汤调服。湿热甚、下泄如热
汤者，本方去桂，加滑石、黄芩、栀子、木通之类。如腹中 痛，下泄清冷，喜热手荡熨，口不燥渴，乃寒泄也。本方
倍桂，加肉豆蔻。有气，加木香。病甚者，更加丁香、附子。作丸服。如久泄，谷道不合，或脱肛，此元气下陷、及大
肠不行收令而然。用白术、芍药、神曲、陈皮、肉豆蔻、诃子肉、五倍子、乌梅为丸，以四君子汤加防风、升麻，煎汤
送下。如食积，时常腹痛，泻积先以木香槟榔丸或东垣枳实导滞丸推遂之，而后以四苓加浓扑、苍术、神曲、麦芽之类，
作丸服之，以安胃气。如泻水腹不痛者，属气虚，宜四君子汤倍白术，加黄 、升麻、柴胡、防风之类，补以提之而愈。
（祖传方）
治暴泄注下用。
车前子（一两，微炒）
上一味，研为细末，清米饮调服。
又方 治腹痛泄泻用。
艾叶（一握） 车前子叶（一握，阴干）
上先将二叶细切，用水二盏，煎至一盏，去渣入姜汁，再煎一沸，稍热服，立愈。
（医案）
一人泄泻，日夜无度，诸药不效。偶得一方，用针沙、地龙、猪
苓三味，共为细末，生葱捣汁，调方寸匕，贴脐上，小便长而泻止。
一人吐泻三日，垂死嘱付后事。予为灸天枢、气海三穴，立止。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When dampness prevails, loose stools occur." It also says: "If wind is injured in spring, sunken diarrhea (canxue, diarrhea with undigested food) will definitely occur in summer." Furthermore: "Sudden violent diarrhea with tenesmus all belong to heat." And: "All pathological fluid discharges that are clear, cold, and thin all belong to cold." Wang Shuhe said: "Excessive dampness leads to five types of diarrhea." Thus, it is known that wind, cold, dampness, and heat can all cause diarrhea, but those caused by damp-heat are more common, while those caused by wind-cold are fewer. Liu Wansu in the *Yuanbing Shi* (Book on the Origin of Diseases) stated: "White stool indicates cold; green, yellow, red, and black indicate heat." Generally, if during diarrhea the urine is clear and white without dysuria, it is cold; if red and painful, it is heat. Additionally, if the stool contains undigested food without color change, vomiting and diarrhea lack a foul odor, fluids are clear and cold, urine is clear and white without dysuria, the body is cold without thirst, and the pulse is slow, fine, and weak, these are all cold syndromes. Whenever grains and meats are digested, regardless of color or other symptoms, it is judged as heat. There is no case where cold diarrhea presents with digested food. However, due to the rapid nature of fire, if transformation functions fail, leading to undigested food and sunken diarrhea (sunken diarrhea), this does exist. Zhang Zhongjing said: "Pathogenic heat fails to cook grain." Yet when heat meets dampness, it forms sunken diarrhea. Alas! Cold and heat syndromes are opposite like ice and charcoal; a slight error in treatment leads to a thousand-mile deviation. Can physicians not be cautious?
Pulse Diagnosis
The *Huangdi Neijing* states: "A fine pulse, cold skin, shortness of breath, continuous diarrhea of both bowels and bladder, and inability to eat or drink constitute the 'Five Deficiencies,' which is a death sign. If gruel enters the stomach and diarrhea stops, the deficient patient will survive." The *Mai Jing* (Classic of Pulse Diagnosis) states: "In diarrhea, a slow pulse with occasional small knotty beats indicates survival; a floating, large, and rapid pulse indicates death."
Furthermore, in severe watery diarrhea (dongxie) where food is not digested, cannot stay inside, and pus and blood are discharged, a minute and lingering pulse indicates survival, while a strong and urgent pulse indicates death.
The *Mai Jue* (Pulse Mantra) says: "Diarrhea with a minute pulse indicates life; a large, floating, and洪 (full) pulse indicates no day of recovery."
Methods
Zhu Danxi said: "Diarrhea belongs to dampness, qi deficiency, fire, phlegm, and food stagnation."
Dai Shi said: "For diarrhea of water without abdominal pain, it is dampness. For food entering the stomach but not staying, resulting in undigested food, it is qi deficiency. For abdominal pain with watery diarrhea and borborygmus, where pain comes in waves followed by diarrhea, it is fire. For irregular diarrhea varying in amount, it is phlegm. For severe abdominal pain with diarrhea that relieves after defecation, it is food stagnation."
For dampness: Dry dampness using Siling San (Four-Powder Decoction) added with Cangzhu (Atractylodis Rhizoma), doubling Baizhu (Atractylodis Macrocephalae Rhizoma). For severe cases, stir-fry Cangzhu and Baizhu into powder, mix with rice water, and take.
For qi deficiency: Use Renshen (Ginseng Radix et Rhizoma), Baizhu, and Shaoyao (Paeoniae Radix).
For fire: Clear fire and promote urination using Siling San added with Huashi (Talcum), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Mutong (Akebiae Caulis).
For phlegm: Eliminate phlegm using Haishi (Pumice), Qingdai (Indigo Naturalis), Huangqin, and Shenqu (Medicated Leaven) made into pills, or induce vomiting to raise clear qi.
For food stagnation: Promote digestion and purging using Shenqu, Dahuang (Rhei Radix et Rhizoma), and Zhishi (Aurantii Fructus).
For watery diarrhea: Use Cangzhu, Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), stir-fried Shenqu, Fuling (Poria), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Diyu (Sanguisorbae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma). In winter, add Ganjiang (Zingiberis Rhizoma). Decoct equal parts.
For profuse watery diarrhea, Wuling San (Five-Ling Powder) must be used.
For summer watery diarrhea, use Guiling Ganlu Yin (Cinnamon Twig, Polyporus, and Dew-Drop Decoction). (Both formulas are seen in the Summerheat section.)
Most medicines for treating diarrhea are effective when made into pills.
For diarrhea due to spleen-stomach disharmony, use Weiling Tang (Stomach-Ling Decoction). (This is the combination of Wuling San and Pingwei San.)
Secular custom often uses astringent drugs to treat diarrhea; this may be suitable for chronic and deficient cases. However, for initial onset, it will surely transform into other syndromes, causing significant harm. One should not know that diarrhea is mostly due to dampness; promoting diuresis is the best strategy.
(Above are twelve methods from Danxi.)
Qingliu Wan (Clear Six Pill) Treats diarrhea.
Liuyi San (Six-to-One Powder) (one dose) plus Hongqu (Red Yeast Rice) 5 qian.
Grind into fine powder, soak steamed bread dough in decoction, make into pills, and take.
Wenliu Wan (Warm Six Pills) Treats diarrhea, or with vomiting.
Liuyi San plus Ganjiang, or fresh ginger juice, made into pills with steamed bread dough.
Jiangqu Wan (Ginger-Leaven Pill) Treats food stagnation diarrhea.
Chenqu (Old Medicated Leaven) Huixiang (Foeniculi Fructus) (each 5 qian) Shengjiang (Fresh Ginger) (1 liang)
Grind into fine powder, make into pills with steamed bread dough.
Zhixie Fang (Stop Diarrhea Formula)
Roudoukou (Myristicae Semen) (5 qian) Bai Huashi (White Talcum) (Spring/Winter 1 liang 2 qian 5 fen, Summer 2 liang 5 qian, Autumn 2 liang)
Grind into fine powder, mix Shenqu with ginger juice to make paste, form pills, and take.
Pixie Wan (Spleen Diarrhea Pill)
Baizhu Shenqu Shaoyao (all stir-fried, equal parts)
In winter, add Roudoukou, remove Shaoyao, grind into fine powder, make pills with Shenqu paste.
(Above are all Danxi's formulas.)
Fuling Tang (Dongyuan) Treats diarrhea caused by consuming frozen drinks/water, with frequent watery stools (>10 times/night), transforming into white dysentery or mixed red-white dysentery, abdominal colic, reduced appetite, dryness/heat, and heavy/weak limbs.
Sheng Huangqin (1.5 qian) Danggui (2 qian) Rougui Cinnamon Twig/Glazed Gancao (each 0.25 qian) Zhuling Fuling (each 0.3 qian) Zexie (0.5 qian) Shaoyao (0.75 qian) Cangzhu Sheng Gancao Shengma Chaihu (each 1 qian)
Cut finely, one dose, decoct 2 cups of water to 1 cup, take slightly warm.
Huangqi Bawei Tang (Dongyuan) Treats bowel movements 3-4 times/day, loose but not voluminous, occasional diarrhea, borborygmus, yellow urine.
Huangqi (Astragali Radix) Chaihu Danggui Shen Yizhi Ju Hong (each 1.5 qian) Shengma (2 qian) Glazed Gancao (0.5 qian) Honghua (Safflower) (a little)
Cut finely, one dose, decoct 2 cups of water to 1 cup, take slightly warm before meals.
Shengyang Chushi Tang (Dongyuan) For conditions rising from below, guide them out.
Cangzhu (1 qian) Chaihu Qianghuo Fangfeng Shengma Shenqu Zexie Zhuling (each 0.5 qian) Glazed Gancao Chenpi Mai Mian (Bran) (each 0.3 qian)
Cut finely, one dose, decoct 2 cups of water to 1 cup, strain, take on an empty stomach. If stomach cold with borborygmus, add Yizhiren, Banxia (each 0.5 qian), Shengjiang (3 slices), Dazao (1 piece). Do not use if no borborygmus.
Zhi Tongxie Yaofang (Liu Caochuang)
Baizhu (2 liang, stir-fried) Baishaoyao (2 liang, stir-fried) Chenpi (1.5 liang, stir-fried) Fangfeng (1 liang)
Cut finely, divide into 8 doses, decoct or make pills. For chronic diarrhea, add Shengma (6 qian).
Baizhu Shaoyao Tang (Jiyao) Treats Taiyin Spleen channel dampness, watery diarrhea, heavy body with slight fullness, weakness, anorexia, undigested food. Harmonize with this.
Severe sudden diarrhea indicates a strong pathogen, also harmonize.
Baizhu Baishaoyao (each 4 qian) Gancao (2 qian)
Cut finely, one dose, decoct 2 cups of water to 1 cup, take warm.
Fuling Tang (Jiyao) Treats damp diarrhea, also food stagnation and damp-heat diarrhea.
Baizhu Fuling (each 5 qian)
Cut finely, one dose, decoct, take before meals. Another formula has Shaoyao, three ingredients equal parts, named Baizhu San, powder, take with rice water.
Cangzhu Shaoyao Tang Treats symptoms as above.
Cangzhu (5 qian) Shaoyao (2.5 qian) Huangqin (1.5 qian) Dan Gui (Light Cinnamon Twig) (0.5 qian)
Cut finely, one dose, decoct 2 cups of water to 1 cup, take warm.
Fangfeng Shaoyao Tang (Jiyao) Treats sunken diarrhea with fever, wiry pulse, lower back pain with slight sweating.
Fangfeng Shaoyao Huangqin (each 2 qian)
Cut finely, one dose, decoct, take on empty stomach.
Cangzhu Fangfeng Tang (Jiyao) Treats diarrhea, wiry pulse, headache.
Cangzhu (2 qian) Fangfeng (1 qian) Baizhu (4 qian) Mahuang (Ephedrae Herba) (1 qian)
Cut finely, one dose, add Shengjiang (5 slices), decoct 2 cups of water to 1 cup, take before meals.
Shenzhu San (Liangfang) Treats spring wind injury leading to summer sunken diarrhea.
Cangzhu (1.5 qian) Ben Cao (Ligustici Rhizoma et Radix) Chuanxiong Qianghuo (each 0.6 qian) Glazed Gancao (0.3 qian) Xixin (Asari Radix et Rhizoma) (0.2 qian)
Cut finely, one dose, add Shengjiang (3 slices), decoct 2 cups of water to 1 cup, strain, take warm. To induce sweat, add Congbai (Scallion White) (3 stems).
Weifeng Tang (Jufang) Treats symptoms as above, and wind-cold invading intestines/stomach due to deficiency, undigested food, watery diarrhea, intestinal damp-toxin, discharge like bean curd dregs, bruised blood, or fish brain, unceasing day and night, chronic non-healing. (Formula seen in Stroke section.)
(Danxi Huotao) says: For watery diarrhea, use raw material Wuling San, add Cangzhu, Cheqianzi (Plantaginis Semen), double Baizhu, powder, take with rice soup. For severe damp-heat, diarrhea like hot soup, remove Rougui from this formula, add Huashi, Huangqin, Zhizi, Mutong. If abdominal colic, cold clear diarrhea, preferring hot hand warming, no dry mouth/thirst, this is cold diarrhea. Double Rougui in this formula, add Roudoukou. For qi stagnation, add Muxiang (Aucklandiae Radix). For severe cases, add Dingxiang (Caryophylli Flos), Fuzi (Aconiti Lateralis Radix Praeparata). Make pills. For chronic diarrhea, anal laxity, or rectal prolapse, this is yuanqi sinking and large intestine failing to consolidate. Use Baizhu, Shaoyao, Shenqu, Chenpi, Roudoukou, Hezi Rou (Terminalia Chebula Retocarp), Wubeizi (Galla Chinensis), Wumei (Mume Fructus) to make pills. Send down with Si Junzi Tang (Four Gentlemen Decoction) plus Fangfeng, Shengma decoction. For food stagnation with frequent abdominal pain, first push out accumulation with Muxiang Binglang Wan or Dongyuan Zhishi Daozhi Wan, then use Siling San plus Houpo, Cangzhu, Shenqu, Maiya (Hordei Fructus Germinatus) to make pills, to soothe stomach qi. For watery diarrhea without abdominal pain, belonging to qi deficiency, use Si Junzi Tang doubled Baizhu, add Huangqi, Shengma, Chaihu, Fangfeng, tonify and lift to cure.
(Ancestral Formula)
For acute severe watery diarrhea.
Cheqianzi (1 liang, lightly stir-fried)
One ingredient, grind to fine powder, take with clear rice water.
Another Formula For abdominal pain diarrhea.
Aiye (Mugwort Leaf) (a handful) Cheqianzi Ye (Plantago Leaf) (a handful, dried in shade)
Finely chop leaves, decoct 2 cups of water to 1 cup, strain, add ginger juice, boil once more, take slightly warm, cures immediately.
Medical Case
One patient had diarrhea unceasing day and night, ineffective with various medicines. Accidentally obtained a formula: use Zhen Sha (Needle Sand), Dilong (Pheretima), Zhuling, grind to fine powder. Mix with raw scallion juice, apply one fangcun bi (measure) to the navel. Urine flow increased, diarrhea stopped.
One patient vomited and had diarrhea for three days, near death, arranging affairs. I moxa Tian Shu (ST25), Qi Hai (CV6) points. Stopped immediately.