〔丹〕治产后泄泻,恶露不行。此余血渗入大肠为泻,洞泄不禁,下青白黑色。用荆芥大者四五穗,于盏内烧
灰,不得犯油火,入麝香研,汤三呷调下。此药虽微,能治大病。(方名的奇散。)
产后泄方
茯苓 川芎 黄芩 白术 干姜 滑石 陈皮 芍药(炒)
上,水煎服之。
飧泄,米谷不化而完出是也。
〔《素》〕清气在下,则生飧泄。(阴阳应象论 王注云∶热气在下则谷不化,故飧泄。东垣云∶清气在下者,
乃人之脾胃气衰不能升发阳气,故用升麻、柴胡助甘辛之味,以引元气之升,不令下陷为飧泄也。)
〔罗〕《内经》曰∶清气在下,则生飧泄。又曰∶久风入胃中,则为肠风飧泄。夫脾胃,土也,气冲和以化为事。
今清气下降而不升,则风邪久而干胃,是木贼土也。故冲和之气不能化而令物完出,所以谓之飧泄。或饮食
太过,肠胃所伤,亦致米谷不化,此俗呼水谷利也。法当下者举之而消克之也。以加减木香散主之。
木香 良姜 升麻 槟榔 人参(各二钱半) 肉豆蔻(煨) 吴茱萸(泡) 干姜(炮。各五分) 神曲(炒,
二钱) 陈皮(五分) 砂仁(五分)
上十一味,为细末。每服四钱,水盏半,煎至一盏,去渣,食前温服,宜加白术。
〔河〕白术汤 治飧泄,风冷入中,泄利不止,脉虚而细,日夜数行,口干,腹痛不已。
浓朴(姜制) 当归(去苗) 龙骨(各五钱) 白术(一两) 艾叶(半钱,炒熟)
上为末。每服三钱,水一盏,生姜三片,同煎至八分,去渣,空心温服。
〔垣〕凡泄则米谷不化,谓之飧泄。是清气在下,乃胃气不升。上古圣人皆以升浮药扶持胃气,一服而愈,
知病在中焦脾胃也。《脉诀》曰∶湿多成五泄。湿者,胃之别名也。病本在胃,真气弱,真气者,谷气也,不能
克化饮食,乃湿盛故也,以此论之,正以脾胃之弱故也。初病夺食,或绝不食,一二日使胃气日胜,泄不作也。
今已成大泄矣。经云∶治湿不利小便,非其治也。又云∶下焦如渎。又云∶在下者,引而竭之。唯虚症不宜,
此论其病得之于胃气下流,清气不升,阳道不行,宜升宜举,不宜利小便。《灵枢》云∶头有疾,取之足,谓阳
病在阴也;足有疾,取之上,谓阴病在阳也。经曰∶阳病在阴,阴病在阳,此之谓也。中有疾,傍取之。傍者,
少阳甲胆是也。中者,脾胃也。脾胃有疾,取之足少阳。甲胆者,甲风是也,东方春也,胃中谷气者,便是风
化也。作一体而认,故曰胃中湿胜而成泄泻,宜助甲胆风胜以克之,又是升阳助清气上行之法也。又一说中焦
元气不足,溲便为之变,肠为之苦鸣,亦缘胃气不升,故令甲气上行。又云∶风胜湿也。大抵此症本胃气弱不
能化食,夺食则一日而可止。夫夺食之理,为胃弱不能克化,食则为泄。如食不下,何以作泄?更当以药滋养
元气,令和候泄止,渐与食,胃胜则安矣。若食不化者,于升阳风药内,加炒曲同煎。兼食入顿至心头者,胃
之上口也,必口沃沫,或食入反出,皆胃土停寒。其右手关脉中弦,按之洪缓,是风热湿相合,谷气不行,清
气不升,为弦脉之寒所隔,故不下也。曲之热亦能去之。若翻胃者,更加半夏、生姜入于风药内同煎。夺食少
食,欲使胃气强盛也。若药剂大则胃不胜药,泄亦不止,当渐渐与之。今病既久,已至衰弱,当以常法治之,
不可多服饵也。人之肉如地之土,岂可人而无肉,故肉消尽则死矣。消瘦人有必死者八∶《内经》有七,《外
经》有一。又病肌肉去尽勿治之,天命也。如肌肉不至瘦尽,当急疗之。宜先夺食而益胃气,便与升阳先助真
气,次用风药胜湿,以助升腾之气,病可已矣。余皆勿论,此治之上法也。(治用升阳除湿汤之类是也。)
〔罗〕加减木香散。(方见正条。)
〔仲〕下利清谷,里寒外热,汗出而厥者,通脉四逆汤主之。(方见伤寒。)
〔河〕白术散 治飧泄脉细。(方见上条。)
〔垣〕治泄痢飧泄,身热脉弦,腹痛而渴,及头痛微汗,宜防风芍药汤。
防风 芍药 黄芩(各等分)
上粗末。每服半两或一两,水二盏,煎至一半,温服。
〔梅〕治水谷痢久不瘥。浓朴三两,黄连三两,锉细,水三升,煎取一升,空心服。
〔《素》〕春伤于风,夏生飧泄。(生气通天论)久风为飧泄。(全文见诊法。)久风入中,为肠风飧泄。
(风论)
上久风入中为飧泄。经云∶虚邪之中人也,始于皮肤,留而不去,传舍于络脉,留而不去,传舍于经,
留而不去,传舍于输,留而不去,传舍于伏冲之脉,留而不去,传舍于肠胃。在肠胃之时,贲响腹胀,多
寒则肠鸣飧泄,食不化,此久风入中为飧泄之义同也。
洁古云∶大渴饮水,多因致水谷一时下者,宜灸大椎三五壮;或用车前子、雷丸、白术、茯苓及五苓散等
药渗之,详见大法条。又如久风为飧泄者,则不饮水而谷完出,治法当以宣风散导之。后服苍术防风汤。
宣风散(方见小儿痘发热条 服之大便利,服后药。)
苍术防风汤
苍术(去皮,四两) 麻黄(一两) 防风(五钱)
上粗末。每一两,生姜七片,水一盏,煎至一半,去渣温服。如止后,服后药。
补本丸
苍术 小椒(去目,炒。各一两)
上为细末,醋糊丸,如桐子大。每服五十丸,食前温水下。治寒泄痢久不效者,弥佳。小儿丸如米大。
〔子和〕赵明之,米谷不消,腹作雷鸣,自五月六月不愈。诸医以为胃受大寒,故并与圣散子、豆蔻丸,
虽止一二日,药力尽而复作。诸医不知药之非,反责明之不忌口。戴人至而笑曰∶春伤于风,夏必飧泄。飧泄
者,水谷不化而直过下出。又曰∶米谷不化,热气在下,久风入中。中者,脾胃也。风属甲乙,脾胃属戊己,
甲乙能克戊己,肠中有风故鸣。《经》曰∶岁木太过,风气流行,脾土受邪,民病飧泄。诊其两手,脉皆浮数,
为病在表也,可汗之。直断曰∶风随汗出。以火二盆,暗置床下,不令病患见火,恐憎其热。诒之入室,更服
涌剂,以麻黄投之。乃闭其户,从外锁之。汗出如洗,待一时许,开户减火一半,须臾汗止,泄亦止。《内经》
曰∶春伤于风,夏生飧泻。此以风为根,风非汗不出者。有病此者,腹中雷鸣,泄注米谷,不分小便涩滞,皆
以脾胃虚寒故耳,服豆蔻、乌梅、粟壳、干姜、附子,曾无一效。中脘脐下灸已数千,燥热转甚,津液涸竭,
瘦削无力,饮食减少。命予视之,余以《应象论》曰∶热气在下,水谷不分,化生飧泄,寒气在上,则生 胀,
而气不散,何也?阴静而阳动故也。诊其脉两手皆浮大而长,身表微热。用桂枝麻黄汤,以姜、枣煎,大剂连
进三服,汗出终日,至旦而愈。次以胃风汤和其脏腑,调养阴阳,食进而愈。
〔河〕木香丸 治肠痹,多饮,不泄,上气喘争,时发飧泄腹痛。
木香 白术 官桂 芜荑 诃子皮 良姜 附子(炮,去皮) 浓朴(姜制) 肉豆蔻(各一两) 干姜
(六钱半) 甘草(五钱)
上为末,面糊丸,如桐子大。每服二十丸,姜汤空心下。
运气 飧泄,皆属风木攻脾。经云∶岁木太过,风气流行,脾土受邪,民病飧泄食减。又云∶岁土不及,
风乃大行,民病飧泄,体重腹痛。又云∶土不及曰卑监。卑监之纪,上角与正角同,其病飧泄,治以凉剂是也。
刺灸 飧泄有三法∶
其一取脾。经云∶脾虚则腹满肠鸣,泄食不化,取其经足太阴、阳明。又云∶飧泄,取三阴之上,补阴陵
泉,皆久留之,热行乃止。又云∶飧泄,取三阴者是也。三阴者,太阴也。
其二取肾。经云∶肾藏志,志有余,腹胀,飧泄泻,然筋血者是也。然筋,谓然骨,视血络盛则泄之。
其三取肝。经云∶肝足厥阴之脉,所生病者,胸满、呕逆、飧泄是也,视盛虚寒热陷下施法也。
渴饮水多,水谷一时下者,灸大椎三五壮,立已。(详见大法条。)
〔《甲》〕飧泄大肠痛,巨虚、上廉主之。又,太冲主之。
[Danxi] Treatment for postpartum diarrhea with lochia stasis. This is caused by residual blood seeping into the large intestine, leading to diarrhea characterized by incontinence of watery stools and the passage of green, white, or black feces. Use four to five large spikes of Schizonepetae Spica (Jingjie), burn them to ash in a cup, ensuring no oil or fire contaminates them, add Moschus (Shexiang), grind into powder, and take with three mouthfuls of decoction. Although this medicine is mild, it can treat serious diseases. (Formula name: Qisan.)
Postpartum Diarrhea Formula
Poria Cocos (Fuling)
Angelicae Sinensis Radix (Chuanxiong)
Scutellariae Radix (Huangqin)
Atractylodis Macrocephalae Rhizoma (Baizhu)
Zingiberis Rhizoma (Ganjiang)
Talcum (Huashi)
Citri Reticulatae Pericarpium (Chenpi)
Paeoniae Radix Alba (Shaoyao) (Stir-fried)
Decoct the above herbs in water and take.
Sunxie (Diarrhea with undigested food) refers to the complete expulsion of rice and grain without digestion.
[Suwen] When clear qi descends below, Sunxie occurs. (Wang Bing's commentary on Yin-Yang Ying Xiang Lun states: Heat in the lower part causes undigested food, hence Sunxie. Li Dongyuan states: "Clear qi descending below" refers to the decline of Spleen-Stomach Qi, which fails to ascend Yang Qi. Therefore, use Shengma and Chaihu to assist sweet and acrid flavors to guide Yuan Qi upward, preventing it from sinking and causing Sunxie.)
[Luo Tianyi] The Neijing states: When clear qi descends below, Sunxie occurs. It also states: Long-standing Wind entering the Stomach becomes Changfeng Sunxie. The Spleen and Stomach belong to Earth, functioning through harmonious Qi transformation. Now that clear Qi descends instead of ascending, Wind pathogen interferes with the Stomach for a long time; this is Wood overacting on Earth. Thus, the harmonious Qi cannot transform, causing food to pass through unchanged, hence called Sunxie. Alternatively, excessive diet damages the intestines and stomach, also leading to undigested food, commonly known as Shuigu Li. The treatment method should involve lifting the sunken Qi and promoting digestion. Use Jiajian Muxiang San as the main formula.
Muxiang
Alpiniae Katsumadai Rhizoma (Liangjiang)
Bupleuri Radix (Shengma)
Arecae Semen (Binglang)
Ginseng Radix et Rhizoma (Renshen) (2.5 qian each)
Myristicae Semen (Roudoukou) (Roasted)
Evodiae Fructus (Wuzhuyu) (Soaked)
Zingiberis Rhizoma (Ganjiang) (Processed, 0.5 fen each)
Schisandrae Fructus? No, Shenqu (Fermented Wheat Mass) (Stir-fried, 2 qian)
Citri Reticulatae Pericarpium (Chenpi) (0.5 fen)
Amomi Fructus Rotundus (Sharen) (0.5 fen)
Grind the above eleven ingredients into fine powder. Take 4 qian per dose, decoct with 1.5 cups of water until reduced to 1 cup, remove dregs, and take warm before meals. Baizhu is suitable to add.
[Zhang Yuansu] Baizhu Tang treats Sunxie caused by Wind-Cold invading the interior, continuous diarrhea, pulse deficient and thin, frequent bowel movements day and night, dry mouth, and unceasing abdominal pain.
Magnoliae Officinalis Cortex (N Houpo) (Ginger-processed)
Angelicae Sinensis Radix (Danggui) (Remove radicle)
Os Draconis (Longgu) (5 qian each)
Atractylodis Macrocephalae Rhizoma (Baizhu) (1 liang)
Artemisiae Argyi Folium (Aiye) (0.5 qian, stir-fried until cooked)
Grind into powder. Take 3 qian per dose, decoct with 1 cup of water and 3 slices of Zingiberis Rhizoma Freshum (Shengjiang) until reduced to 0.8 cup, remove dregs, and take warm on an empty stomach.
[Li Gao] Any diarrhea where rice and grain are not digested is called Sunxie. This is due to clear Qi being below, meaning Stomach Qi does not ascend. Ancient sages all used ascending and floating herbs to support Stomach Qi, resulting in cure after one dose, indicating the disease is in the Middle Jiao Spleen and Stomach. Maijue states: Dampness often leads to five types of diarrhea. Dampness is another name for the Stomach. The root of the disease is in the Stomach; Zhen Qi is weak. Zhen Qi is Gu Qi (Grain Qi), which fails to digest food due to excess Dampness. Thus, it is precisely due to Spleen-Stomach weakness. In early stages, withholding food or eating nothing allows Stomach Qi to strengthen over one or two days, stopping diarrhea. Now that severe diarrhea has developed. The Classics state: Treating Dampness without promoting urination is incorrect. Also: The Lower Jiao is like a ditch. And: For diseases below, drain them. However, this is not suitable for deficiency patterns. This discussion addresses diseases caused by Stomach Qi flowing downward, clear Qi failing to ascend, and Yang pathways blocked; thus, lifting and raising is indicated, not promoting urination. Ling Shu states: Diseases of the head are treated by foot points, meaning Yang disease is in Yin; diseases of the feet are treated by upper points, meaning Yin disease is in Yang. The Classics say: Yang disease in Yin, Yin disease in Yang, this is what is meant. Diseases in the center are treated by lateral points. Lateral refers to Shaoyang Gallbladder Meridian. Center refers to Spleen and Stomach. Spleen-Stomach diseases are treated by Foot Shaoyang. Jia Dan (Wood Gallbladder) represents Jia Wind, corresponding to East Spring. Grain Qi in the Stomach is Wind transformation. Recognizing them as one entity, we say Stomach Dampness excess causes diarrhea; assisting Jia Dan Wind excess to overcome it is also a method of raising Yang and assisting clear Qi ascent. Another view is that Middle Jiao Yuan Qi is insufficient, causing urinary/fecal abnormalities and intestinal borborygmus, also due to Stomach Qi not ascending, causing Jia Qi to ascend. Also: Wind overcomes Dampness. Generally, this condition stems from weak Stomach Qi unable to digest food; withholding food for one day can stop it. The rationale for withholding food is that weak Stomach Qi cannot digest, so eating causes diarrhea. If one cannot eat, how can it cause diarrhea? One must nourish Yuan Qi with medicine. Wait for the body to harmonize and diarrhea to stop, then gradually introduce food. When Stomach Qi strengthens, peace is restored. If food is not digested, add stir-fried Shenqu to Yang-raising Wind herbs. If food feels immediately at the heart upon entry, this is the upper opening of the Stomach, likely accompanied by salivation or regurgitation, indicating Cold stagnation in Stomach Earth. The Guan position of the Right Hand pulse is Wiry, pressing reveals Surging and Slow qualities, indicating Wind-Heat-Dampness combination, stagnant Gu Qi, non-ascending clear Qi, blocked by Wiry Cold pulse, hence no descent. The heat of Shenqu can also resolve this. For Fanwei (Reflux Vomiting), add Banxia and Shengjiang to Wind herbs. Withhold or reduce food intake to strengthen Stomach Qi. If the medicinal dose is too large, the Stomach cannot tolerate it, and diarrhea persists; administer gradually. Since the disease has been prolonged and the patient is weak, treat with standard methods; do not overdose. Human flesh is like earth soil; how can a person exist without flesh? Thus, when flesh is exhausted, death ensues. There are eight signs of inevitable death in emaciated patients: Seven in Neijing, one in Waijing. Do not treat if muscles are completely gone; this is fate. If muscles are not yet exhausted, treat urgently. First withhold food to benefit Stomach Qi, then use Yang-raising drugs to boost Zhen Qi, followed by Wind drugs to overcome Dampness and assist ascending Qi; the disease can be cured. Other matters are not discussed; this is the supreme treatment method. (Use formulas like Shengyang Chu Shi Tang.)
[Luo Tianyi] Jiajian Muxiang San. (See main section.)
[Zhang Zhongjing] For diarrhea with undigested food, interior cold with exterior heat, sweating, and cold limbs, Tongmai Sini Tang governs. (See Shanghan section.)
[Zhang Yuansu] Baizhu San treats Sunxie with thin pulse. (See previous section.)
[Li Gao] For diarrhea/dysentery Sunxie with fever, wiry pulse, abdominal pain with thirst, headache with slight sweating, use Fangfeng Shaoyao Tang.
Saposhnikoviae Radix (Fangfeng)
Paeoniae Radix Alba (Shaoyao)
Scutellariae Radix (Huangqin) (Equal parts)
Coarse powder. Take 0.5 liang or 1 liang per dose, decoct with 2 cups of water until half remains, take warm.
[Mei] Treat chronic Shuigu Li not healing. Houpo 3 liang, Huanglian 3 liang, cut finely, decoct with 3 sheng of water until 1 sheng remains, take on empty stomach.
[Suwen] Injury by Wind in Spring leads to Sunxie in Summer. (Shengqi Tongtian Lun) Long Wind causes Sunxie. (Full text in Diagnosis section) Long Wind entering the interior causes Changfeng Sunxie. (Feng Lun)
Regarding Long Wind entering the interior causing Sunxie: The Classics state: Deficient pathogens enter humans starting from skin, lingering without departing, passing to collateral vessels, then meridians, then transport points, then Fu Chong vessels, finally to intestines and stomach. During the stage in intestines/stomach, there is rushing sounds and abdominal distension. Excess Cold causes borborygmus, Sunxie, and undigested food, consistent with the meaning of Long Wind entering interior causing Sunxie.
Jiegu says: Great thirst and drinking water, leading to simultaneous passage of water and food, should be treated by moxa on Dazhui 3-5 moxa cones; or use Cheqianzi, Leiwan, Baizhu, Fuling, and Wuling San to leach dampness. See Da Fa section. For Sunxie caused by Long Wind, where water is not drunk but food passes whole, treat with Xuanfeng San to guide it out. Follow with Cangzhu Fangfeng Tang.
Xuanfeng San (See Pediatric Fever section. Causes free stool, take subsequent medicine.)
Cangzhu Fangfeng Tang
Atractylodis Rhizoma (Cangzhu) (Peeled, 4 liang)
Ephedrae Herba (Mahuang) (1 liang)
Saposhnikoviae Radix (Fangfeng) (5 qian)
Coarse powder. Take 1 liang, 7 slices of Shengjiang, 1 cup of water, decoct until half remains, remove dregs, take warm. After stopping, take subsequent medicine.
Huben Wan
Atractylodis Rhizoma (Cangzhu)
Zanthoxyli Fructus (Xiao Jiao) (Remove eyes, stir-fry. 1 liang each)
Grind to fine powder, make pills with vinegar paste, size of Sophora japonica seeds. Take 50 pills per dose, warm water before meals. Excellent for chronic Cold diarrhea/dysentery unresponsive to other treatments. For children, make pill size of rice grains.
[He Hanzhong/Zihezheng] Zhao Mingzhi had undigested food, abdominal borborygmus, lasting from May to June without relief. Physicians attributed it to severe Cold in Stomach, prescribing Shengsan Zi and Doukou Wan. Symptoms stopped for 1-2 days but recurred when drug effect wore off. Physicians blamed Zhao for not observing dietary restrictions, unaware the medicine was inappropriate. Dai Ren (Zihezheng) laughed and said: Spring Wind injury leads to Summer Sunxie. Sunxie is undigested food passing directly down. Also: Undigested food indicates Heat in lower part, Long Wind entering interior. Interior refers to Spleen-Stomach. Wind belongs to Jia-Yi (Wood), Spleen-Stomach to Wu-Ji (Earth). Wood overacts on Earth; Wind in intestines causes rumbling. Classics: Excess Wood year, Wind prevalence, Spleen Earth pathogen, people suffer Sunxie. Pulse both hands floating and rapid, disease is in Exterior, can induce sweat. Directly stated: Wind exits with sweat. Placed two basins of fire under bed secretly, not letting patient see fire to avoid aversion to heat. Sent him into room, administered Yongji (Emetic/Purgative agent?), using Mahuang. Closed doors, locked from outside. Sweated profusely, waited about one hour, opened door, reduced fire by half, soon sweat stopped, diarrhea stopped. Neijing: Spring Wind injury, Summer Sunxie. Root is Wind; Wind does not exit without sweat. Patient had abdominal borborygmus, pouring diarrhea of rice/grain, no mention of urinary retention, all due to Spleen-Stomach Deficiency Cold. Used Doukou, Wumei, Susuke, Ganjiang, Fuzi with no effect. Moxa on Zhongwan and below navel thousands of times, Dry-Heat intensified, fluids exhausted, emaciated, weak, reduced appetite. Asked me to examine. I cited Yingxiang Lun: Heat below, water/food separation, generates Sunxie; Cold above, generates distension, Qi does not scatter. Why? Yin is still, Yang moves. Pulse both hands floating, large, long, slight exterior fever. Used Guizhi Mahuang Tang, decocted with Jiang and Zao, large dose taken three times continuously. Sweated all day, recovered by dawn. Then used Weifeng Tang to harmonize Zang-Fu, regulate Yin-Yang, resumed eating and recovered.
[Zhang Yuansu] Muxiang Wan treats Changbi (Intestinal Bi), polydipsia, no diarrhea, upper body panting/conflict, occasional Sunxie abdominal pain.
Muxiang
Atractylodis Macrocephalae Rhizoma (Baizhu)
Cinnamomi Cortex (Guigui)
Pyrethri Flors (Wuyi)
Terminalia Chebula Retusa (Hezipi)
Alpiniae Katsumadai Rhizoma (Liangjiang)
Aconiti Lateralis Radix Praeparata (Fuzi) (Processed, peeled)
Magnoliae Officinalis Cortex (Houpo) (Ginger-processed)
Myristicae Semen (Roudoukou) (1 liang each)
Zingiberis Rhizoma (Ganjiang) (6.5 qian)
Glycyrrhizae Radix et Rhizoma (Gancao) (5 qian)
Grind to powder, make pills with wheat paste, size of Sophora japonica seeds. Take 20 pills per dose, Ginger decoction on empty stomach.
Yunqi (Five Movements and Six Qi): Sunxie all belongs to Wind-Wood attacking Spleen. Classics: Excess Wood year, Wind prevalence, Spleen Earth pathogen, people suffer Sunxie and reduced appetite. Also: Insufficient Earth year, Wind prevails, people suffer Sunxie, heavy body, abdominal pain. Also: Insufficient Earth is called Beijian. Bei Jian era, Upper Jue matches Zheng Jue, disease is Sunxie, treat with Cool agents.
Acupuncture and Moxibustion: Three methods for Sunxie:
First, select Spleen. Classics: Spleen deficiency causes abdominal fullness, borborygmus, diarrhea with undigested food, select Foot Taiyin and Yangming meridians. Also: Sunxie, select above the Three Yin, tonify Yinlingquan, retain needle long until heat spreads. Also: Sunxie, select Three Yin. Three Yin refers to Taiyin.
Second, select Kidney. Classics: Kidney stores Zhi (Will). Excess Zhi causes abdominal distension, Sunxie diarrhea, Ranjin blood vessels. Ranjin refers to Ran Gu (calcaneus); observe if blood collaterals are full, then bleed.
Third, select Liver. Classics: Liver Foot Jueyin meridian diseases include chest fullness, vomiting/reversal, Sunxie. Apply methods based on excess/deficiency, Cold/Heat, sinking/prolapse.
Thirst with excessive drinking, simultaneous passage of water and food: Moxa Dazhui 3-5 cones, immediate relief. (See Da Fa section.)
[Jiayi Jing]: Sunxie with Large Intestine pain, Ju Xu and Shang Lian govern. Also, Taichong governs.