经义
春伤于风，夏生飧泄。○久风为飧泄。○清气在下，则生飧泄。○脾病者，虚则腹满，肠鸣飧泄，食不化。
○长夏善病洞泄寒中。○湿胜则濡泻。○暴注下迫，皆属于热。○诸病水液，澄澈清冷，皆属于寒。○大肠小肠
为泄。○仓廪不藏者，是门户不要也。（《素问》）
胃泄，饮食不化，色黄；脾泄，腹胀满泄注，食即呕吐；大肠泄，食已窘迫，大便色白，肠鸣切痛；小
肠泄，溲而便脓血，少腹痛；大瘕泄，里急后重，数至圊而不能便，茎中痛。（《难经》）
哲言
泄证，有湿泄、濡泄、风泄、寒泄、暑泄、火泄、热泄、虚泄、滑泄、飧泄、酒泄、痰泄、食泄、积泄、
脾泄、肾泄、晨泄、暴泄、久泄、洞泄。（《医学入门》）
按∶泄泻二字，取义有轻重，非一证而无分别也。据书有云泄者，有云泻者，有云泄泻者。愚谓∶粪出
少而势缓者为泄，漏泄之谓也；粪大出而势直下不阻者为泻，倾泻之谓也。（《医旨绪余》）
泄者，大便溏薄；泻者，大便直下，略分轻重，总属脾虚。（《证治汇补》）
暴注下迫，食不及化，是无水也；溏泄日久，止发无恒，是无火也。（王太仆）
泻黄腹痛者，湿也；泻白腹痛者，寒也；痛一阵泻一阵，泻后涩滞者，火也；痛一阵泻一阵，泻后痛减
者，食也；腹中胀痛，泻不减者，肝气也；腹中绞痛，暴泻烦渴者，霍乱也；腹中绞痛，下无休时，去如蟹渤
者，气食交并也；腹中隐痛，下如稠饮者，痰也。○冷泻，譬之盐，见火则凝，冷则复消；热泻，譬之水，
寒则凝结成冰，热则复化为水。（戴复庵）
暴泄，肛门迸迫，属火化；暴泄，肛门不禁，属阴寒；久泄，肛门不禁，属阳虚。（张路玉）
湿胜则濡泻。湿从何得？缘脾虚不能布液，水谷留于胃中而化湿也。若注水者，邪气暴乘肠胃，土制不及，
则为注水。（程郊倩）
脾土强者，自能胜湿，无湿则不泄。若土虚不能制湿，则风寒与热皆得干之而为病。故曰∶湿多成五泄。
（李士材）
脾胃者土也，其气冲和，以化为事。今清浊相干，风邪久干于胃，中气不能运化，而食物完出。夕食谓之
飧，食之难化在于夕，故谓之飧泄。（《圣济总录》）
完谷不化，其因有四∶曰气虚，曰胃寒，曰胃火，曰胃风。夫气虚胃寒，固不能传化矣。火者，火性急速，
传运失常，即邪热不杀谷也。至于胃风者，肝风传脾，脾受其克，不能变化，名为飧泄，乃五泄之一也。（《医统》）
泻属脾胃，人固知之，然门户束要者，肝之气也；守司于下者，肾之气也。若肝肾气实，则能约束而不泻；
虚则失职，而无禁固之权矣。（《冯氏锦囊》）
泄泻之本，无不由于脾胃。盖胃为水谷之海，而脾主运化，使脾健胃和，则水谷腐熟而化气化血以行营卫。
若饮食失节，起
居不时，脾胃受伤，则水反为湿，谷反为滞，精华之气不能输化，乃致合污下降，而泻痢作矣。脾强者，滞去
即愈；脾弱者，因虚易泻，因泻愈虚。盖关门不固，则气随泻去，气去则阳衰，阳衰则寒从中生，固不必外受
风寒而始谓之寒也。且阴寒性降，下必及肾，故泻多必亡阴，谓亡其阴中之阳耳。所以久泻不愈，必自太阴传
于少阴而为肠 ，岂非降泄之甚，而阳气不升，脏气不固之病乎？○肾泄，每于五更或天明时即洞泄数次，有
经月连年弗止者，或暂愈而复作者，或痛或不痛者。盖肾为胃关，开窍于二阴，二便开闭，皆肾所主。肾阳不
足，则命门火衰，而阴寒独盛，故于子丑之后，阳气未复阴气盛极之时，即令人洞泄不止也。（张景岳）
补编
凡泻皆兼湿，初宜分理中焦，次则分利下焦，继以风药燥湿，久则升举元气；滑脱不禁，然后涩之。其间
风胜兼以解表，寒胜兼以温中，虚弱补益，食积消导，湿则淡渗，火则清凉，痰则涌吐，陷则升提，随证而用，
不拘次序。（《证治汇朴》）
治泻，补虚不可纯用甘温，太甘则生湿；清热，不可纯用苦寒，太苦则伤脾；兜涩，不可太早，恐留滞余
邪；淡渗，不可太多，恐津枯阳陷。（《见闻录》）
泄泻治法有九∶一曰淡渗。使湿从小便而去，如农夫治涝，导其下流，虽处卑监，不忧巨浸。《经》云∶
治湿不利小便，非其治也；又云∶在下者，引而竭之是也。一曰升提。气属于阳，性本上升，胃气注迫，辄尔
下陷。升、柴、羌、葛，鼓舞胃气上腾，如地土淖泽，风之即干。风药多燥，湿为土病，风能胜湿，所谓下者
举之是也。一曰清凉。热淫所至，暴注下迫。苦寒诸剂，用涤燎蒸，犹当溽暑之时，而商飙倏动则炎 如失矣。
所谓热者清之是也。一曰疏利。痰凝气滞，食积水停，皆令人泻。随证祛逐，勿使稽留。《经》曰∶实者泻之；
又云∶通因通用，是也。
一曰甘缓。泻利不已，急而下趋，愈趋愈下，泄何由止？甘能缓中，善禁急速，且稼穑作甘，甘为土味，所谓急
者缓之，是也。一曰酸收。泻下多日，则气散不收，无能统摄。酸之一味，能助收摄之权，《经》云∶散者收
之，是也。一曰燥脾。土德无惭，水邪不滥，故泻皆成于土湿，湿皆本于脾虚。仓廪得职，水谷善分，《经》
云∶虚者补之，是也。一曰温肾。肾主二便，封藏之本，虽属水脏，而真阳寓焉；少火生气，火为土母，此火
一衰，何以营运三焦、熟腐水谷乎？故肾虚者必挟寒，脾虚者必补母。《经》云∶寒者温之，是也。一曰固涩。
注泄日久，幽门道滑，虽投温补，未克奏功，须行涩剂，则变化不愆，揆度合节，所谓滑者涩之，是也。（李士材）
泄泻，注下证也。《经》曰∶湿多成五泄。飧泄之完谷不化，湿兼风也；溏泄之肠垢污积，湿兼热也；骛
溏之澄清溺白，湿兼寒也；濡泄之身重软弱，湿自胜也；滑泄之不能禁固，湿胜气脱也。是以胃风汤治有血之
飧泄，清六丸疗肠垢之热溏；骛溏便清溺白，选用理中治中；滑泄脉微气脱，急投四柱、六柱；惟濡泄有虚有
实，或以胃苓，或以术附。至于脾泄、胃泄、肾泄、大肠泄、小肠泄、大瘕泄、痰泄、郁泄、伤酒伤食泄，古
法条载甚详。其急则治标，必使因时随证，理固然也。其缓则治本，惟知燥脾渗湿，义有未尽。盖脾司坤土，
本至静之体，而有干健之用，生万物而役于万物，从水从火，为寒为热。历观协热下利者，十不得一、二；从
水之寒泄者，十常八、九。言所当然者，主治在脾；推所以然者，必求之水火。因思人身水火，犹权衡也，一
胜则一负。五泄多湿，湿水同气，水之盛，则火之衰也。于是推少阳为阳枢，相火寄焉，风火扇胃而熟腐五谷；
少阴为阴枢，龙火寓焉，熏蒸脏腑而转输糟粕。胃之纳，脾之输，皆火之运也。然
非雷藏龙驯，何能无燥无湿？势有冒明燎上之眚如果土奠水安，从此不泛不滥，定无清气在下之患矣。五泄之
治，平水火者清其源，崇堤土者塞其流耳。（《临证指南》）
凡泄，水谷不化，谓之飧泄，是清气在下，胃气不升，古人皆以升浮药治之。《经》曰∶湿多成五泄。治
湿不利小便，非其治也。惟此证不宜此论，盖其病得之于胃气下流，清气不升，阳道不行，故宜升宜举，不宜利
小便。（李东垣）
风邪伤人，必入空窍，而空窍惟肠胃为最。风既居于肠胃，其导引之机，如顺风扬帆，不俟脾之运化，食
入即出，故飧已即泄。不知者，以为脾虚，完谷不化，如长夏洞泄寒中；及冬月飧泄之泄，反以补脾刚燥之药，
助风性之劲，有泄无已，每至束手无策。倘知从春令治之，用桂枝领风邪从肌表而出，一、二剂可愈。至若秋
月伤肺者，伤肺之燥也，与秋伤于燥，冬生咳嗽，同是一病。但在肺则咳嗽，在大肠则飧泄，所谓肺移热于大
肠，久为肠 者也。但使肺热不传于大肠，则飧泄自止，惟务止泄，以燥益燥者多矣。（喻嘉言）
脏腑泻利，其证多端。东垣专以补中益气汤升提清气，但未及乎肾泄也。仲景云∶下利不止，医以理中汤
与之，利益甚，此利在下焦，当理下焦则愈。赵以德云∶泻类多端，似难执一而治。先师治暴脱顿泻几欲绝者，
急灸气海，饮人参膏而愈。治积痰在肺，致其所合大肠之气不固者，涌出上焦之痰，则肺气下降，而大肠之虚
自复。治忧思太过，脾气郁结而不能升举，陷入下焦而成泄泻者，开其郁结，补其脾胃，使谷气升发。治阴虚
而肾不能司禁固之权者，峻补其肾而愈。因问∶先生治病何神？曰∶无他，圆机活法，具在《内经》，熟之自
得矣。（赵养葵）
命门无火，不能为中宫蒸腐水谷，而湿停在脾，先有其泻料，
而藏寒在肾，谁复司其闭藏？故经木气才萌，不待疏泄，遂成其泻令。虽是木邪干土，实肾之脾胃虚也。此际
补脾不如补肾，四神丸温能暖肾而使气蒸，辛能破滞而使气壮，则补肾仍是补脾也。（程郊倩）
元阴不足而泄泻者，名曰肾泻。其状则水谷不分，至圊即去，足胫冷，少腹下重。但去有常度，昼夜或一、
二次，与他证之泻不同。盖元阴之气衰弱，不能健运其水谷故也。世不知此，但见泄泻，概用参、术补之，殊
不知参、术乃补脾胃中阳气之药，况脾属土而肾属水，肾泻补脾，则土愈胜而水愈亏，故肾泻不可用参、术，宜
以补阴之药兼山药、芡实、茯苓、莲肉，其泻自止。如挟阳气不足而泻者，则不拘于此。（罗赤诚）
泻多由于湿，惟分利小水最为上策。此惟酒湿肥甘之辈，为暴泄之病，小腹胀满，水道痛急者为宜。若病
久阴虚，脉虚气弱，口干，渴而不喜冷者，不可利也。盖本非水有余，实因火不足；本非水不利，实因气不行。
故病不因水而利则亡阴；泻因火虚而利复伤气。倘不察其本，则未有不速其危矣。（张景岳）
晨泻，空心服药不效，令至晚服即效。以暖药一夜在腹，可胜阴气也。与酒客湿泄，服汤药不效，改服丸
散即效同意。（滑伯仁）
治泻诸药，多作丸子服，效速。（朱丹溪）
脉候
肾脉小甚为洞泻，脾脉小甚为泄泻。（《脉经》）
选案
一妇得暴注证，食粥粥下，饮汤汤下，服药药下，物色不变。众医议用姜、附、参、 。予诘之。答曰∶
完谷不化，胃虚明矣。予曰∶非也。《经》言∶暴注下迫，皆属于热。河间谓∶火性急速，不容停留。仲景谓∶
邪热不杀谷。公言完谷不化，属之虚寒，此则属之实火，用药一瘥，死生反掌。先令以香连丸，服之安然，
饮汤水半钟亦不下，众始信为其火。疏方用平胃散，加黄连一钱、大黄三钱。其家人曰∶病下而复下之可乎？
予曰∶通因通用，塞
因塞用，变通之妙，存乎一心，试服此药，得效必矣。服后微下二、三行，食粥一碗，继以白芍汤调理而安。（余午亭）
一妇患泄泻，医以脾虚治，不效；又云是虚且寒，用参、术、姜、桂温之，更甚。两关脉浮而有力。予曰∶
此风干肠胃也。风性最速，故食入即完谷而出。温补则风性益烈，传递更速耳。遂用升麻、柴胡、桂枝、防风、
苍术、白芍、薏仁、泽泻、陈皮，服之而愈。（吴天士）
一人痢后久泻，屡进温中、益火、健脾、固肾之剂不愈。余曰∶下多亡阴。加白芍、阿胶于理脾药中，一
服而瘥。（余子敬）
一妇泻下如油，以纸捻蘸燃，与油无异，医不能疗。孙滋九先生令买补中益气汤十剂，天王补心丹四两，
以煎剂下丸，服讫而愈。众诘所由，曰∶惊则气下，大肠伤损所致。此妇必因惊后得此疾也，问之果然。此方
书所未载。（《同寿录》）
附方
虚损泄泻方 治虚损泄泻，诸药不愈，胃虚难受药者。用陈腊肉、骨灰、陈米锅焦，共三分，炒松花一分，
米饮糊丸，人参汤送下六、七十丸。此法活人多矣。
附∶肠鸣
《内经》肠鸣有五∶一曰脾虚则腹满，肠鸣飧泄，食不化，宜枳实理中汤加木香；二曰中气不足，肠为之
苦鸣，宜六君子汤加木香；三曰邪在大肠，肠中雷鸣，气上冲胸，宜半夏泻心汤；四曰土郁之发，肠鸣而为数
后，宜平胃散加半夏、木香、茯苓；五曰少阴在泉，热淫所胜，民病腹中肠鸣，气上冲胸，宜葶苈木香散。○
《金匮》云∶腹中寒气，雷鸣切痛，胸腹逆满呕吐者，宜附子粳米汤。○东垣云∶如胃寒泄泻肠鸣，于升阳除湿
汤中加智、半夏、生姜、大枣。○丹溪云∶腹中鸣者，病本于胃，乃火激动益其水也。二陈汤加芩、连、山栀；
不应，用胃苓汤加减。（《赵氏医贯》）
[Classical Discourse]
Wind pathogen injuring in spring leads to undigested stool diarrhea (sun-xie) in summer. ○ Long-term wind pathogen invasion causes undigested stool diarrhea. ○ When clear yang qi fails to ascend and sinks below, it produces undigested stool diarrhea. ○ In spleen disease, deficiency manifests as abdominal fullness, borborygmus, undigested stool diarrhea, and food indigestion.
○ During the late summer season, one is prone to torrential diarrhea (dong-xie) and cold in the middle jiao. ○ Excess dampness leads to loose stool diarrhea (ru-xie). ○ Sudden violent diarrhea with tenesmus belongs to heat. ○ All pathological fluids that are clear and cold belong to cold. ○ Dysfunction of the large intestine and small intestine leads to diarrhea. ○ The inability of the granary official (Spleen/Stomach) to store indicates failure of the gate (anus/sphincter) to constrain. (From *Su Wen*)
Stomach diarrhea presents with undigested food and yellowish stool; Spleen diarrhea presents with abdominal fullness, watery diarrhea, and vomiting immediately after eating; Large intestine diarrhea presents with urgency after eating, white stool, severe borborygmus, and pain; Small intestine diarrhea presents with turbid urine containing pus and blood, and lower abdominal pain; Da Jia diarrhea presents with tenesmus, frequent trips to the toilet with little output, and penile pain. (From *Nan Jing*)
[Masters' Discourse]
Diarrhea syndromes include: Damp Diarrhea, Loose Stool Diarrhea, Wind Diarrhea, Cold Diarrhea, Summerheat Diarrhea, Fire Diarrhea, Heat Diarrhea, Deficiency Diarrhea, Slippery Diarrhea, Undigested Stool Diarrhea, Alcohol Diarrhea, Phlegm Diarrhea, Food Retention Diarrhea, Accumulation Diarrhea, Spleen Diarrhea, Kidney Diarrhea, Morning Diarrhea, Acute Diarrhea, Chronic Diarrhea, and Torrential Diarrhea. (From *Yi Xue Ru Men*)
Note: The terms "Xie" (leakage) and "Xie" (pouring) have different degrees of severity and do not refer to a single syndrome without distinction. Some texts use "Xie," some "Xie," and some "Xie-Xie." I believe: When feces are discharged in small amounts with a slow force, it is called "Xie" (leakage); when feces are discharged in large amounts with a direct, unobstructed force, it is called "Xie" (pouring). (From *Yi Zhi Xu Yu*)
"Xie" refers to loose, unformed stools; "Xie" refers to stools flowing directly out. This merely distinguishes light from heavy, but both generally belong to Spleen deficiency. (From *Zheng Zhi Hui Bu*)
Sudden violent diarrhea with tenesmus and undigested food indicates a lack of fluids (water); chronic loose stools with irregular onset indicate a lack of fire (yang qi). (Wang Bing)
Yellow stool with abdominal pain in diarrhea indicates dampness; white stool with abdominal pain indicates cold; pain followed by diarrhea with a sensation of obstruction afterward indicates fire; pain followed by diarrhea with pain relief afterward indicates food retention; abdominal distending pain unrelieved by diarrhea indicates Liver qi stagnation; abdominal cramping pain with sudden diarrhea, irritability, and thirst indicates Cholera; continuous abdominal cramping pain with crab-like stool indicates mixed Qi stagnation and food retention; dull abdominal pain with thick, drink-like stool indicates Phlegm fluid. ○ Cold diarrhea is like salt: it coagulates with fire and dissolves with cold; Heat diarrhea is like water: it freezes with cold and melts with heat. (Dai Yuanli)
Acute diarrhea with anal bursting and urgency belongs to Fire transformation; acute diarrhea with anal incontinence belongs to Yin-Cold; chronic diarrhea with anal incontinence belongs to Yang deficiency. (Zhang Luyu)
Excess dampness leads to loose stool diarrhea. Where does dampness come from? It arises because Spleen deficiency fails to distribute fluids, causing water and grain to remain in the stomach and transform into dampness. If the diarrhea flows like water, it is due to pathogenic factors violently attacking the intestines and stomach, exceeding the restraining capacity of Earth (Spleen), resulting in pouring diarrhea. (Cheng Guopeng)
When Spleen Earth is strong, it naturally overcomes dampness; without dampness, there is no diarrhea. If Spleen Earth is weak and cannot control dampness, then Wind-Cold and Heat can interfere and cause disease. Thus it is said: Dampness often forms the five types of diarrhea. (Li Zhongzi)
The Spleen and Stomach belong to Earth; their qi is harmonious, and their function is digestion/transformation. Now, if clear and turbid qi interfere with each other, and Wind pathogen invades the Stomach for a long time, the Middle Qi cannot transport and transform, leading to the complete expulsion of food. Evening meal is called "Sun"; food is difficult to digest in the evening, hence "Sun Diarrhea." (From *Sheng Ji Zong Lu*)
There are four causes for undigested stool: Qi deficiency, Stomach cold, Stomach fire, and Stomach Wind. Qi deficiency and Stomach cold certainly fail to transmit and transform. Fire is rapid; abnormal transmission means evil heat fails to cook the grain. As for Stomach Wind, Liver Wind transmits to the Spleen, which is controlled and fails to change food, named Undigested Stool Diarrhea, which is one of the five diarrheas. (From *Yi Tong*)
Diarrhea belongs to the Spleen and Stomach, which people know well. However, the constraint of the gate is governed by Liver Qi; the guarding at the lower jiao is governed by Kidney Qi. If Liver and Kidney Qi are substantial, they can constrain and prevent diarrhea; if deficient, they lose their function and power of retention. (From *Feng Shi Jin Nang Mi Lu*)
The root of diarrhea lies invariably in the Spleen and Stomach. The Stomach is the sea of water and grain, and the Spleen governs transformation. If the Spleen is healthy and the Stomach harmonious, water and grain are cooked and transformed into Qi and Blood to circulate Ying and Wei. If diet is irregular or daily routine disrupted, damaging the Spleen and Stomach, water becomes dampness and grain becomes stagnation. Essence cannot be transported, leading to the descent of filth and the onset of diarrhea/dysentery. A strong Spleen heals once stagnation leaves; a weak Spleen easily suffers diarrhea due to deficiency, and diarrhea worsens deficiency. Because the gate is not firm, Qi escapes with diarrhea; loss of Qi leads to Yang decline; Yang decline generates internal cold. This does not require external Wind-Cold to be called cold. Moreover, Yin-Cold descends and reaches the Kidneys; thus, diarrhea often consumes Yin-Yang. Therefore, chronic diarrhea not healing must transmit from Taiyin (Spleen) to Shaoyin (Kidney) becoming Chang Pi (dysentery/severe diarrhea). Is this not excessive descending, failure of Yang to ascend, and failure of Zang Qi to consolidate? ○ Kidney Diarrhea typically occurs several times in torrential form during the fifth watch or at dawn. Some last months or years continuously, some remit and recur, some hurt, some do not. The Kidney is the gate of the Stomach, opening to the two yin passages; the opening and closing of urination and defecation are all governed by the Kidney. Insufficient Kidney Yang leads to衰竭 of Mingmen Fire and dominance of Yin-Cold. Thus, after Zi and Chou hours, when Yang has not recovered and Yin-Cold is at its peak, it causes endless torrential diarrhea. (Zhang Jingyue)
[Supplement]
All diarrhea involves dampness. Initially, regulate the Middle Jiao; next, drain the Lower Jiao; subsequently, use Wind herbs to dry dampness; in chronic cases, raise Yuan Qi. For slippery incontinence, then use astringents. If Wind is dominant, add exterior-releasing methods; if Cold is dominant, add warming the Middle; for deficiency, tonify; for food accumulation, guide out; for dampness, use bland leaching; for Fire, use cooling; for Phlegm, induce vomiting; for sinking, raise. Apply according to the syndrome, without fixed order. (From *Zheng Zhi Hui Bu*)
In treating diarrhea, tonifying deficiency should not rely solely on sweet-warm herbs, as excessive sweetness generates dampness; clearing heat should not rely solely on bitter-cold herbs, as excessive bitterness damages the Spleen; astringing should not be too early, lest residual pathogens be retained; bland leaching should not be excessive, lest fluids dry up and Yang sink. (From *Jian Wen Lu*)
There are nine treatment methods for diarrhea:
1. Bland Leaching: Drains dampness via urination, like guiding floodwaters downstream. *Classic*: "Treating dampness without promoting urination is incorrect."
2. Raising/Lifting: Qi belongs to Yang and tends upward. Shengma, Chaihu, Qianghuo, Gegen boost Stomach Qi upward. Wind herbs are drying; Wind overcomes Dampness. "Those below, lift them up."
3. Cooling/Clearing: For excess heat causing sudden violent diarrhea. Bitter-cold formulas clear blazing heat, like cool winds dispelling summer heat. "Heat is cleared by cooling."
4. Unblocking/Purging: For phlegm stagnation, Qi blockage, food/water retention causing diarrhea. Remove pathogens. *Classic*: "Excess is purged"; "Treat obstruction with unblocking methods."
5. Sweet/Soothing: For urgent, downward-flowing diarrhea. Sweet flavors soothe the center and stop urgency. "Urgency is soothed by sweetness."
6. Sour/Astringing: For prolonged diarrhea causing Qi dispersion. Sour flavors aid retention. *Classic*: "Scattered things are gathered/astringed."
7. Drying the Spleen: Earth virtue prevents water overflow. Diarrhea stems from Spleen deficiency and dampness. Tonify the deficient. *Classic*: "Deficiency is tonified."
8. Warming the Kidney: The Kidney governs two passages and is the root of storage. True Yang resides within. If this Fire declines, Sanjiao operation and food cooking fail. Kidney deficiency implies Cold; Spleen deficiency requires tonifying the Mother (Kidney). *Classic*: "Cold is warmed."
9. Astringing: For chronic pouring diarrhea with slippery幽门 (pylorus/anus). If warm-tonics fail, use astringents. "Slippery things are astringed." (Li Zhongzi)
Diarrhea is a pouring syndrome. *Classic*: "Dampness forms five diarrheas." Undigested Sun Diarrhea is Damp-Wind; Turbid Tang Diarrhea is Damp-Heat; Duck-stool Qing Bai Diarrhea is Damp-Cold; Soft Ru Diarrhea with heaviness is Damp dominance; Slippery Diarrhea with incontinence is Damp excess with Qi collapse. Thus, Weifeng Tang treats bloody Sun Diarrhea; Qing Liu Wan treats turbid Heat Tang; Lizhong/Zhizhong treat Qing Bai Duck-stool; Sizhu/Liu Zhu treat Slippery Diarrhea with pulse collapse; Weiling or Zhufu treat Ru Diarrhea based on deficiency/excess. Ancient texts detail Spleen, Stomach, Kidney, Large/Small Intestine, Da Jia, Phlegm, Depression, Alcohol/Food Diarrheas. Acute stage treats symptoms; chronic stage treats roots. Merely drying Spleen and leaching dampness is insufficient. Spleen is Kun Earth, still yet active, interacting with Water/Fire. Most cold diarrheas stem from Water excess/Fire deficiency. Shao Yang is the Yang pivot (Minister Fire); Shaoyin is the Yin pivot (Dragon Fire). Stomach intake and Spleen transport depend on Fire. Without hidden Thunder (Kidney Yang) and tamed Dragon (Heart Fire), dryness/dampness imbalance persists. Treating the five diarrheas involves balancing Water/Fire (clearing source) and reinforcing Earth (blocking flow). (From *Lin Zheng Zhi Nan Yi An*)
For undigested Sun Diarrhea due to sinking clear Qi and failing Stomach Qi, ancients used ascending/floating herbs. *Classic* says promote urination for dampness, but this case involves sinking Stomach Qi and blocked Yang pathways, requiring lifting/rising, not urination promotion. (Li Dongyuan)
Wind pathogen enters empty orifices, primarily the intestines/stomach. Once in the intestines, peristalsis accelerates like sailing with the wind, bypassing Spleen transformation, causing immediate excretion. Misdiagnosing this as Spleen deficiency and using drying/warming tonics exacerbates the Wind, causing endless diarrhea. Treating according to Spring (Wood/Wind) rules, using Guizhi Tang to release Wind from the surface, cures it in 1-2 doses. Autumn Lung injury (Dryness) mirrors Winter cough. Lung heat transferring to Large Intestine causes Chang Pi. Stopping Lung heat stops Sun Diarrhea; merely stopping diarrhea with drying herbs increases dryness. (Yu Jiayan)
Visceral dysentery/diarrhea has many presentations. Li Dongyuan uses Buzhong Yiqi Tang to lift clear Qi, ignoring Kidney Diarrhea. Zhang Zhongjing notes: Persistent diarrhea treated with Lizhong Tang worsening indicates pathology in the Lower Jiao; treat the Lower Jiao. Zhao Yi-de states: Diarrhea is diverse; do not stick to one method. My master treated near-fatal acute diarrhea with Moxibustion on Qihai and Ginseng paste. For phlegm in Lung causing Large Intestine insecurity, vomit upper phlegm to descend Lung Qi and restore Large Intestine. For worry-induced Spleen depression sinking to Lower Jiao, resolve depression and tonify Spleen. For Yin deficiency causing Kidney failure to constrain, strongly tonify Kidney. Asked why successful, he replied: Flexibility lies in *Nei Jing*; familiarity brings mastery. (Zhao Yangkui)
Mingmen Fire absence fails to steam/cook Middle Jiao grains, leaving dampness in Spleen. Kidney cold lacks closure. When Wood Qi sprouts, diarrhea ensues without needing venting. Though Wood attacks Earth, the root is Kidney/Spleen deficiency. Here, tonifying Kidney is better than tonifying Spleen. Sishen Wan warms Kidney (steam) and breaks stagnation (strengthen Qi); thus, tonifying Kidney is tonifying Spleen. (Cheng Guopeng)
Deficiency of Primordial Yin causing diarrhea is called Kidney Diarrhea. Symptoms: indistinguishable water/grain, immediate evacuation upon reaching toilet, cold calves, heavy lower abdomen. Regular frequency (1-2 times day/night) differs from other diarrheas. Weak Primordial Yin fails to transport grains. People mistakenly use Renshen/Atractylodes (tonifying Spleen Yang/Earth), worsening Water/Kidney deficiency. Use Yin-tonics with Yam, Euryale, Poria, Lotus Seed. If accompanied by Yang deficiency, adjust accordingly. (Luo Chicheng)
Diarrhea mostly stems from dampness; draining urine is best. Suitable only for alcohol/greasy diet patients with acute diarrhea, lower abdominal fullness, and painful urination. For chronic Yin deficiency, weak pulse/qi, dry mouth, thirst preferring warm drinks, do NOT drain urine. It is not water excess but Fire insufficiency; not water blockage but Qi immobility. Draining urine harms Yin; draining due to Fire deficiency harms Qi. Ignoring the root accelerates danger. (Zhang Jingyue)
Morning diarrhea: Empty-stomach pills fail; evening dosing works because warm herbs stay overnight to overcome Yin. Similar to alcohol-dampness patients responding to pills instead of decoctions. (Hua Bo-ren)
Diarrhea herbs are often made into pills for faster effect. (Zhu Danxi)
[Pulse Diagnosis]
Extremely small Kidney pulse indicates Torrential Diarrhea; extremely small Spleen pulse indicates Diarrhea. (From *Mai Jing*)
[Selected Cases]
Case 1: A woman had sudden violent diarrhea; everything eaten/drank/pilled passed unchanged. Doctors suggested Ginger, Aconite, Ginseng, Astragalus. I questioned them. They said: Undigested stool proves Stomach deficiency. I said: Incorrect. *Classic*: "Violent diarrhea with tenesmus belongs to Heat." He Jian: "Fire nature is rapid." Zhongjing: "Evil heat fails to cook grain." You attribute undigested stool to deficiency/cold, but it is Excess Fire. One wrong prescription changes life/death. Prescribed Xianglian Wan; patient stabilized, even drinking water stopped diarrhea. Others believed it was Fire. Formula: Pingwei San + Coptis 1 qian, Rhubarb 3 qian. Family asked: Can we purge again after diarrhea? I said: Treat obstruction with unblocking; treat blockage with blocking. Try it. Result: Mild diarrhea 2-3 times, ate porridge, recovered with Baishao Tang. (Yu Wuting)
Case 2: Woman with diarrhea, treated for Spleen deficiency failed; treated for deficiency/cold with Ginseng, Atractylodes, Ginger, Cinnamon worsened it. Guan pulses floating and forceful. I said: Wind invading intestines/stomach. Wind is fast; food exits undigested. Warming tonics intensify Wind speed. Formula: Shengma, Chaihu, Guizhi, Fangfeng, Cangzhu, Baishao, Yiren, Zexie, Chenpi. Cured. (Wu Tianshi)
Case 3: Man with chronic diarrhea post-dysentery. Warm-middle, boost-fire, strengthen-Spleen, secure-Kidney herbs failed. I said: Profuse discharge consumes Yin. Added Baishao, Ejiao to Spleen-regulating herbs. Cured in one dose. (Yu Zijing)
Case 4: Woman with oily diarrhea (burns like oil). Doctor Sun Zijiu prescribed Buzhong Yiqi Tang (10 doses) and Tianwang Buxin Dan (4 liang), decoction with pills. Cured. Reason: Shock causes Qi to sink, damaging Large Intestine. Patient confirmed shock history. Formula not in books. (From *Tong Shou Lu*)
[Attached Formulas]
Deficiency Diarrhea Formula: For deficiency diarrhea unresponsive to other meds, intolerant to medicine. Old cured meat, bone ash, scorched rice crust (3 parts), fried pine pollen (1 part). Rice water pill paste. Take 60-70 pills with Ginseng soup. Saved many lives.
[Attached: Borborygmus]
*Nei Jing* lists five types of borborygmus:
1. Spleen deficiency: Abdominal fullness, borborygmus, sun-diarrhea, indigestion. Use Zhishi Lizhong Tang + Mugwort.
2. Middle Qi deficiency: Painful borborygmus. Use Liujunzi Tang + Mugwort.
3. Pathogen in Large Intestine: Thunderous borborygmus, Qi rushing to chest. Use Banxia Xiexin Tang.
4. Earth depression onset: Borborygmus with frequent diarrhea. Use Pingwei San + Banxia, Mugwort, Fuling.
5. Shaoyin ruling, Heat excess: Abdominal borborygmus, Qi rushing to chest. Use Tingli Mugwort Powder.
○ *Jin Gui*: Cold qi in abdomen, thunderous pain, chest/abdominal fullness/vomiting. Use Fuzi Jimi Tang.
○ Li Dongyuan: Stomach cold diarrhea with borborygmus. Add Yizhi, Banxia, Ginger, Jujube to Shengyang Chushi Tang.
○ Zhu Danxi: Abdominal rumbling originates in Stomach, Fire agitating Water. Erchen Tang + Huangqin, Huanglian, Zhizi; if ineffective, Weiling Tang modified. (From *Zhao Shi Yi Guan*)