脉
脉多沉。伤于风，则浮而弦；伤于寒；则沉而细，伤于暑，则
沉而微；伤于湿，则沉而缓，泄而腹胀脉弦者死。又云∶脉缓时微小者生，浮大数者死。
证
夫泄泻者，注下之症也。盖大肠为传送之官，脾胃为水谷之海，或为饮食生冷之所伤，或为暑湿风寒之
所感，脾胃停滞，以致阑门清浊不分，发注于下而为泄泻也。《内经》又谓∶湿胜则濡泄。
又曰∶春伤于风，夏生飧泄。又曰∶暴注下迫，皆属于热。又曰∶诸病水液，澄澈清冷，皆属于寒。叔和曰∶
湿多成五泄，肠走若雷奔。故分脾泄、胃泄、大肠、小肠、大瘕，为五泄也。又有飧
泄、肾泄、洞泻、濡泄、骛溏之类。名各不同，原其致病，不过前云所感所伤而已矣。丹溪又云∶泄属湿，
属气虚，有火，有痰，有食积。凡泻水，腹不痛者，湿也。饮食入胃不消，完谷不化者，气虚也。腹痛泻水
如热汤，痛一阵，泻一阵者，火也。或泻或不泻，或多或少者，痰也。腹痛甚而泄泻，泻后痛减者，食积
也。泻下如抱坏鸡子臭者，或咽气作酸者，伤于食也。
治
治疗之法，须看时令，分寒热新久。补脾消食，燥湿利小便，
亦有升提下陷之气，用风药以胜湿。若久泻，肠胃虚滑不禁者，宜收涩之。治法之要，孰有过于此哉。
方
胃苓汤〔批〕（按此方治四时泄泻之总司也） 治中暑伤湿，停饮夹食，脾
胃不和，腹痛泄泻作渴，小便不利，水谷不化，阴阳不分。
苍术（米泔浸，一钱） 浓朴（姜汁炒，一钱） 陈皮（一钱） 猪苓（一钱） 泽泻（一
钱） 白术（炒，一钱） 白茯苓（一钱） 肉桂（三分） 白芍（炒，一钱） 甘草（炙，三分）
上锉一剂，生姜枣水煎，温服。一方加防风、升麻以胜湿。食积，加神曲、麦芽、山楂。水泻，加滑石。
有痰，加半夏、乌梅。气虚，加人参、白术。恼怒，加木香。有热，加黄
连。久泻，加肉豆蔻。暴痢赤白相杂，腹痛里急后重，去桂，加木香、黄连、槟榔，水煎服。
薷苓汤 治暑月泄泻，或欲成痢。
黄连香薷饮合五苓散。锉一剂，生姜煎服。（方见中暑）
藿香正气散〔批〕（按此方治暑泻之剂） 治感湿泄泻，或兼暑者，（方见
霍乱）
根据本方，加黄连、香薷。食加神曲、山楂。
柴苓汤〔批〕（按此方治热泻之剂） 治泄泻发热口渴，里虚之症。
小柴胡汤（方见伤寒） 合五苓散（方见中暑），锉一剂，姜枣煎服。
理中汤（方见中寒）〔批〕（按此方治寒泻之剂） 治脾胃虚冷，中寒泄泻，四肢厥逆。
四君子汤（方见补益） 治气虚脾泄不止者。
根据本方加乌药（醋炒，七分） 姜枣煎服。
参苓白术散（方见补益） 治脾胃虚弱，久泻少食。
瑞运丸（何春元传） 治元气大虚，脾胃怯弱，泄泻不止，不思饮食。
山药（炒，二两） 莲肉（二两） 白术（土炒，二两） 芡实（二两） 人参（去芦，一
两） 橘红（一两） 白茯苓（一两） 白芍药（酒炒，一两） 甘草（炙，五钱）
上为末，用雄猪肚一个，洗净，煮烂，捣和药末为丸，如梧桐子大。每服百丸，空心米汤送下。
养元散〔批〕（按此方治虚泻之剂） 治泄泻，饮食少进。
糯米（一升，水浸一宿，滤干，燥慢火炒，令极热） 干山药（少许） 胡椒（少许）
上各为细末，和匀，每日清晨用半盏，再入砂糖少许，滚汤调
服，其味极佳，且不厌人，大有滋补。其女人子宫虚冷，不能成孕，久服之，亦能怀孕。
平胃散 治濡泄肠鸣多水。
苍术 浓朴 陈皮 甘草（各一钱五分）
上锉一剂，水煎服。
五苓散 治症同前。
白术 茯苓（各一钱） 桂（六分） 猪苓 泽泻（各一钱二分）
上锉一剂，水煎服。
胃苓汤 治水泻腹痛。
陈皮 浓朴 苍术 甘草 白术 茯苓 肉桂 猪苓 泽泻
（各一钱） 加芍药 黄连（各八分）
上锉一剂，姜一片，水煎服。
黄芩汤 治肠垢热泄，所下粘垢，小便赤涩，脉数烦渴。
黄芩（炒，五钱） 芍药（炒，三钱） 甘草（一钱）
上锉一剂，水煎服。
卫生汤 治脾胃虚弱，不能泌别水谷。
陈皮 茯苓 甘草 人参 白术 山药 泽泻 薏苡仁
上锉一剂，加砂仁末一钱，水二钟，煎至八分服。一方加莲肉、芡实、干山药各二两，亦效。一方用
糯米磨粉，不拘多少，入百草霜十分之二，水和为饼，烙熟食之。一方单用糯米，半生半炒，煮粥食之，亦效。
安胃和脾散 治脾胃不和，中脘痞塞，腹痛胀满，不思饮食，
嗜卧无时，呕吐痰涎，逆气吐酸，面黄肌瘦，泄泻不止，四肢乏力，沉困自汗、盗汗等症。
苍术（二两，姜炒） 浓朴（五钱，姜炒） 藿香（五钱） 砂仁（五钱） 人参（去芦，
五钱） 白术（土炒，五钱） 白茯苓（五钱） 木香（火煨，五钱） 槟榔（五钱） 蓬术（火
煨，五钱） 泽泻（五钱） 甘草（炙，五钱） 红枣（二十四个，去皮、核，焙干）
上共为细末，每服二钱，空心淡姜汤送下。
家莲散（陈□堂传） 治经年久泻冷泄，及休息痢。
莲肉（泡去皮、心，微火焙干，四两） 浓朴（姜炒，一两） 干姜（炒黑，一两）
上三味，共为细末，每服二、三匙，米饮下，日三次。
理气健脾丸（方见脾胃） 治脾胃虚弱，久泻久痢。
根据本方，去桔梗，加酒炒白芍药，其效如神。
实肠丸（黄宾江传） 治久泻久痢，虚滑不禁及脱肛。臭椿树根皮，
不拘多少，切碎，酒拌，炒为细末，用真阿胶水化开，和为丸如桐子大。每服三五十丸。空心米汤下。
升气实脏丸（云林制）〔批〕（按此方治滑泄止涩之剂） 治久泻，元气下陷，脾胃衰惫，大肠滑脱，肛
门坠下，日夜无度。饮食不思，米谷不化，汤水直过。烦渴引饮，津液枯竭，肌瘦如柴，寒热互作。
黄 （蜜炙，一两） 人参（去芦，一两） 白术（土炒，二两） 白茯苓（去皮，五钱）
山药（炒，一两） 莲肉（去心，一两） 芡实（一两） 升麻（酒炒，五钱） 柴胡（酒炒，五
钱） 干姜（炒黑，五钱） 肉豆蔻（面裹煨，捶去油净，五钱） 粉草（炙，五钱） 椿树
根皮（酒炒二次，四两）
上为细末，阿胶水化开为丸，如黍米大。每服二钱，用糯米半生半炒，煎汤送下。
灸法 治吐泻日久，胃气大虚，死在旦夕。
天枢二穴（在脐旁各开二寸） 气海（在脐下一寸半） 百会（在顶心中） 用艾灸五、七壮，即愈。
Pulse Diagnosis
The pulse is mostly deep (Chen Mai, Deep Pulse). If injured by wind, the pulse is floating and wiry (Fu Mai, Floating Pulse; Xian Mai, Wiry Pulse); if injured by cold, the pulse is deep and fine (Xi Mai, Fine Pulse); if injured by summerheat, the pulse is deep and faint (Wei Mai, Faint Pulse); if injured by dampness, the pulse is deep and slow (Huan Mai, Slow Pulse). In diarrhea with abdominal distension and a wiry pulse, death ensues. It is also said: A pulse that is slow and occasionally minute indicates survival (Sheng), whereas a pulse that is floating, large, and rapid indicates death.
Symptoms and Signs
Diarrhea (Xie Xie) is a symptom characterized by the profuse discharge of watery stools. The Large Intestine is the official organ responsible for transmission, while the Spleen and Stomach are the sea of water and grain. Injury from raw or cold food and drink, or contraction of summerheat, dampness, wind, and cold pathogens, causes stagnation in the Spleen and Stomach. This leads to the failure of the Lanmen (the junction between the small and large intestines responsible for separating clear from turbid substances) to distinguish between clear and turbid fluids, resulting in the downward flow of turbid matter and causing diarrhea. The *Neijing* further states: Excess dampness leads to Ru Xie (damp diarrhea/loose stools). It also states: Wind injury in spring generates Sun Xie (undigested diarrhea) in summer. It states: Sudden violent diarrhea with tenesmus belongs to heat. It states: All pathological discharges that are clear, cold, and transparent belong to cold. Wang Shuhe said: Dampness often results in five types of diarrhea, with intestinal sounds rushing like thunder. Therefore, they are divided into Pi Xie (Spleen Diarrhea), Wei Xie (Stomach Diarrhea), Da Chang Xie (Large Intestine Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), and Da Jia Xie (Great Constriction Diarrhea), collectively known as the Five Diarrheas. There are also categories such as Sun Xie, Shen Xie (Kidney Diarrhea), Dong Xie (cavity diarrhea/profuse diarrhea), Ru Xie, and Wu Tang (duck-dung diarrhea). Although the names differ, their etiology stems from the aforementioned external injuries or internal damages. Zhu Danxi further stated: Diarrhea is associated with dampness, Qi deficiency, fire, phlegm, and food retention. Watery diarrhea without abdominal pain is due to dampness. Undigested food in stool after eating is due to Qi deficiency. Severe abdominal pain accompanied by hot, watery diarrhea, where pain and diarrhea occur in waves, is due to fire. Irregular diarrhea with varying amounts is due to phlegm. Severe abdominal pain relieved by defecation is due to food retention. Foul-smelling stool resembling rotten eggs or sour belching is due to dietary injury.
Treatment Principles
Treatment methods must consider the season, distinguishing between cold and heat, and acute versus chronic conditions. Strategies include tonifying the Spleen, resolving food stagnation, drying dampness, and promoting urination. Some methods involve lifting sinking Qi and using acrid-warm herbs to overcome dampness. For chronic diarrhea with weak intestines and stomach leading to incontinence, astringent methods should be used. These principles encompass the essentials of treatment.
Formulas
Weiling Decoction [Commentary: This formula serves as the general prescription for treating diarrhea in all seasons.] Treats summerheat and dampness injury, retained fluid with food stagnation, disharmony of the Spleen and Stomach, abdominal pain and diarrhea with thirst, difficult urination, undigested food and water, and imbalance of Yin and Yang.
Cangzhu (Atractylodis Rhizoma, soaked in rice wash water, 1 qian) Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice, 1 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian) Zhuling (Polypori Umbellati, 1 qian) Zexie (Alismatis Rhizoma, 1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 qian) Baifuling (Poria, 1 qian) Rougui (Cinnamomi Cortex, 3 fen) Baishao (Paeoniae Radix Alba, stir-fried, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 fen)
Decoct one dose with fresh ginger and jujube, take warm. Another variation adds Fangfeng (Saposhnikoviae Radix) and Shengma (Cimicifugae Rhizoma) to overcome dampness. For food stagnation, add Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), and Shanzha (Crataegi Fructus). For watery diarrhea, add Huashi (Talcum). For phlegm, add Banxia (Pinelliae Rhizoma) and Wumei (Mume Fructus). For Qi deficiency, add Renshen (Ginseng Radix et Rhizoma) and Baizhu. For anger-related issues, add Muxiang (Aucklandiae Radix). For heat, add Huanglian (Coptidis Rhizoma). For chronic diarrhea, add Roudoukou (Myristicae Semen). For acute dysentery with mixed red and white stool, abdominal pain, and tenesmus, remove Rougui and add Muxiang, Huanglian, and Binglang (Arecae Semen), decoct in water and take.
Ruling Decoction Treats diarrhea in the summer month or impending dysentery.
It combines Huanglian Xiangru Yin (Coptidis Rhizoma and Elsholtziae Herba Drink) with Wuling San (Five-Ingredient Powder with Poria). Decoct one dose with fresh ginger and take. (See "Summerheat" chapter for formula details.)
Huoxiang Zhengqi San [Commentary: This formula treats summerheat diarrhea.] Treats dampness-induced diarrhea or cases complicated by summerheat. (See "Huo Luan" chapter for formula details.)
Based on this formula, add Huanglian and Xiangru. For food stagnation, add Shenqu and Shanzha.
Chailing Tang [Commentary: This formula treats heat diarrhea.] Treats diarrhea with fever and thirst, indicating interior deficiency.
Xiao Chaihu Tang (Minor Bupleurum Decoction) (See "Shang Han" chapter) combined with Wuling San (See "Summerheat" chapter). Decoct one dose with ginger and jujube and take.
Lizhong Tang (Regulate the Middle Decoction) (See "Zhong Han" chapter) [Commentary: This formula treats cold diarrhea.] Treats Spleen-Stomach deficiency-cold, middle-jiao cold-induced diarrhea, and cold limbs.
Sijunzi Tang (Four Gentlemen Decoction) (See "Tonification" chapter) Treats persistent Spleen-diarrhea due to Qi deficiency.
Based on this formula, add Wuyao (Linderae Radix, vinegar-fried, 7 fen), decoct with ginger and jujube and take.
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) (See "Tonification" chapter) Treats Spleen-Stomach weakness with chronic diarrhea and poor appetite.
Ruiyun Wan (He Chunyuan's Transmission) Treats severe Yuan Qi deficiency, weak Spleen-Stomach, persistent diarrhea, and loss of appetite.
Shanyao (Dioscoreae Rhizoma, stir-fried, 2 liang) Lianrou (Nelumbinis Semen, 2 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-stir-fried, 2 liang) Qianshi (Euryales Semen, 2 liang) Renshen (Ginseng Radix et Rhizoma, de-gorged, 1 liang) Juhong (Citri Reticulatae Pericarpium Rubrum, 1 liang) Baifuling (Poria, 1 liang) Baishaoyao (Paeoniae Radix Alba, wine-stir-fried, 1 liang) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 5 qian)
Grind into fine powder. Clean one male pig stomach, boil until tender, mash, and mix with the powder to form pills the size of paulownia seeds. Take 100 pills per dose with rice gruel on an empty stomach.
Yangyuan San [Commentary: This formula treats deficiency-type diarrhea.] Treats diarrhea with reduced food intake.
Nuomi (Oryza Sativa Glutinosa, 1 sheng, soaked overnight, drained, stir-fried slowly over low heat until very hot) Ganshanyao (Dioscoreae Rhizoma, dried, a little) Hujiao (Piperis Longi Fructus, a little)
Grind each into fine powder, mix well. Each morning, take half a cup, add a little brown sugar, and mix with boiling water to drink. It tastes excellent, is not cloying, and has strong nourishing effects. Women with uterine deficiency-cold unable to conceive may also achieve pregnancy with long-term use.
Pingwei San (Peace the Stomach Powder) Treats Ru Xie with borborygmus and excessive water.
Cangzhu (Atractylodis Rhizoma) Houpo (Magnoliae Officinalis Cortex) Chenpi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma) (each 1.5 qian)
Decoct one dose in water and take.
Wuling San (Five-Ingredient Powder with Poria) Treats symptoms as described above.
Baizhu (Atractylodis Macrocephalae Rhizoma) Fuling (Poria) (each 1 qian) Gui (Cinnamomi Ramulus, 6 fen) Zhuling (Polypori Umbellati) Zexie (Alismatis Rhizoma) (each 1.2 qian)
Decoct one dose in water and take.
Weiling Decoction Treats watery diarrhea with abdominal pain.
Chenpi (Citri Reticulatae Pericarpium) Houpo (Magnoliae Officinalis Cortex) Cangzhu (Atractylodis Rhizoma) Gancao (Glycyrrhizae Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) Fuling (Poria) Rougui (Cinnamomi Cortex) Zhuling (Polypori Umbellati) Zexie (Alismatis Rhizoma) (each 1 qian) Add Baishao (Paeoniae Radix Alba) and Huanglian (Coptidis Rhizoma) (each 8 fen).
Decoct one dose with one slice of fresh ginger in water and take.
Huangqin Tang (Scutellaria Decoction) Treats intestinal mucus-heat diarrhea, sticky discharge, dark and scanty urine, rapid pulse, irritability, and thirst.
Huangqin (Scutellariae Radix, stir-fried, 5 qian) Shaoyao (Paeoniae Radix, stir-fried, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian)
Decoct one dose in water and take.
Weisheng Tang (Hygiene Decoction) Treats Spleen-Stomach weakness failing to separate clear from turbid water and grain.
Chenpi (Citri Reticulatae Pericarpium) Fuling (Poria) Gancao (Glycyrrhizae Radix et Rhizoma) Renshen (Ginseng Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) Shanyao (Dioscoreae Rhizoma) Zexie (Alismatis Rhizoma) Yiyiren (Coicis Semen)
Decoct one dose with 1 qian of Amomum cardamomum powder, two cups of water, reduce to 0.8 cup, and take. Another variation adds Lianrou, Qianshi, and Ganshanyao (each 2 liang), which is also effective. Another variation uses glutinous rice flour, mixed with 20% Baicaoshuang (soot from various herbs), formed into cakes with water, baked, and eaten. Another variation uses glutinous rice, half raw and half stir-fried, cooked into porridge and eaten, which is also effective.
Angwei Hepi San (Stomach-Anchoring and Spleen-Harmonizing Powder) Treats Spleen-Stomach disharmony, epigastric fullness/stuffiness, abdominal pain and distension, loss of appetite, frequent drowsiness, vomiting of phlegm-saliva, rebellious Qi with acid regurgitation, sallow complexion and emaciation, persistent diarrhea, limb fatigue, heaviness, spontaneous sweating, and night sweats.
Cangzhu (Atractylodis Rhizoma, 2 liang, ginger-stir-fried) Houpo (Magnoliae Officinalis Cortex, 5 qian, ginger-stir-fried) Huoxiang (Agastaches Herba, 5 qian) Sharen (Amomi Fructus, 5 qian) Renshen (Ginseng Radix et Rhizoma, de-gorged, 5 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-stir-fried, 5 qian) Baifuling (Poria, 5 qian) Muxiang (Aucklandiae Radix, fire-roasted, 5 qian) Binglang (Arecae Semen, 5 qian) Pengzhu (Curcumae Zedoariae Rhizoma, fire-roasted, 5 qian) Zexie (Alismatis Rhizoma, 5 qian) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 5 qian) Hongzao (Jujubae Fructus, 24 pieces, skin and pit removed, roasted dry)
Grind into fine powder. Take 2 qian per dose with light ginger tea on an empty stomach.
Jialian San (Chen □tang's Transmission) Treats chronic cold diarrhea lasting years and rest dysentery.
Lianrou (Nelumbinis Semen, soaked, skin and heart removed, lightly roasted dry, 4 liang) Houpo (Magnoliae Officinalis Cortex, 1 liang, ginger-stir-fried) Jiang (Zingiberis Rhizoma, dried, 1 liang, charcoal-fried)
Grind these three ingredients into fine powder. Take 2-3 teaspoons per dose with rice drink, three times daily.
Li Qi Jianpi Wan (Qi-Circulating and Spleen-Strengthening Pill) (See "Spleen-Stomach" chapter) Treats Spleen-Stomach weakness with chronic diarrhea and dysentery.
Based on this formula, remove Jiegeng (Platycodonis Radix) and add Jiuchao Baishaoyao (wine-stir-fried Paeoniae Radix Alba); the effect is miraculous.
Shichang Wan (Intestinal-Solidifying Pill) (Huang Binjiang's Transmission) Treats chronic diarrhea and dysentery, deficiency-slippage with incontinence, and rectal prolapse. Quanchunshu Genpi (Toosendan Cortex, amount unspecified), chop finely, mix with wine, roast, and grind into fine powder. Dissolve real Ejiao (Asini Corii Colla) and mix to form pills the size of tung seeds. Take 30-50 pills per dose with rice gruel on an empty stomach.
Shengqi Shizang Wan (Qi-Lifting and Viscera-Solidifying Pill) (Yunlin's Preparation) [Commentary: This formula treats slippage diarrhea and acts as an astringent.] Treats chronic diarrhea with sinking of Yuan Qi, exhaustion of Spleen-Stomach, slippage of Large Intestine, anal prolapse, uncontrolled day and night defecation. Loss of appetite, undigested food, passage of liquids directly through. Irritability, thirst, depletion of body fluids, emaciation, alternating chills and fever.
Huangqi (Astragali Radix, honey-roasted, 1 liang) Renshen (Ginseng Radix et Rhizoma, de-gorged, 1 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-stir-fried, 2 liang) Baifuling (Poria, peeled, 5 qian) Shanyao (Dioscoreae Rhizoma, stir-fried, 1 liang) Lianrou (Nelumbinis Semen, de-heartened, 1 liang) Qianshi (Euryales Semen, 1 liang) Shengma (Cimicifugae Rhizoma, wine-stir-fried, 5 qian) Chaihu (Bupleuri Radix, wine-stir-fried, 5 qian) Jiang (Zingiberis Rhizoma, dried, charcoal-fried, 5 qian) Roudoukou (Myristicae Semen, wrapped in flour and roasted, pounded to remove oil, 5 qian) Fencao (Glycyrrhizae Radix et Rhizoma, honey-fried, 5 qian) Chunshugenpi (Toosendan Cortex, wine-stir-fried twice, 4 liang)
Grind into fine powder, dissolve Ejiao to bind into pills the size of millet seeds. Take 2 qian per dose with rice gruel made from half-raw, half-roasted glutinous rice.
Moxibustion Treats prolonged vomiting and diarrhea with severe Stomach Qi deficiency, life-threatening condition imminent.
Tianshu (ST25, 2 points, 2 cun lateral to umbilicus) Qihai (CV6, 1.5 cun below umbilicus) Baihui (GV20, at the vertex center). Apply moxibustion 5-7 moxa cones for cure.