姜宜人得奇证。简本草经疏治交肠用五苓散之说。以为神秘。余见之。辨曰。交肠一证。大小二便。易
位而出。若交易然。古用五苓治之。专为通前阴而设也。若此证闭在后阴。二便俱从前阴而出。
拟之交肠。诚有似是实非者。况交肠乃暴病。骤然而气乱于中。此证乃久病。以渐而血枯于内。有毫厘千里
之不同。安得拟之。原夫疾之所始。始于忧思。结而伤脾。脾统血者也。脾伤则不能统摄。
而错出下行。有若崩漏。实名脱营。脱营
病宜大补急固。乃误认为崩漏。以凉血清火为治。则脱出转多。不思天癸已尽。潮汛已绝。万无是病。其年
高气弱。无血以实漏卮者。毫不念也。于是胞门子户之血。日渐消亡。势不得不借资。不仰给矣。借资于大肠。
转将大肠之血。运输而渗入胞囊。久之大肠之血亦尽。而大肠之气。附血而行者。孤而无主。为拳
为块。奔疼涣散。与林木池鱼之殃祸同矣。又如救荒者。剥邻国为立尽之墟所罔顾矣。犹未也。仰给于胃脘。
转将胃脘之血。吸引而渗入胞囊。久之胃脘之血亦尽。下脱之血。始无源自止。夫胃脘之血。所以荣周身而
灌百脉者。今乃暗归乌有。则苞稂失润。而黍离足忧。血尽而止。较之血存而脱。又倍远矣。故血尽
然后气乱。气乱然后水谷舍故趋新。舍宽趋隘。江汉两渠。并归一路。身中为之大乱。势必大肠之故道复通。
乃可拨乱返治。与五苓一方。全无干涉。又况水谷由胃入肠。另有幽门泌别清浊。今以渗血之故。酿为谷道。
是幽门辟为坦径矣。尚可用五苓再辟之乎。又况五苓之劫阴。为亡血家所深戒乎。今之见一病辄
有一药横于胸中。与夫执成方奉为灵秘者。大率皆误人者也。若宜人之病。余三指才下。便问曰。病中多哭泣
否。婢媪曰。时时泣下。乃知脏燥者多泣。大肠方废而不用也。交肠云乎哉。今
大肠之脉。累累而现于指。可虞之时。其来春枣叶生乎。枣叶生而言果验。
胡卣臣先生曰。此等证他人不能道只字。似此河汉无极。而更精切不可移易。为难能矣。
Jiang Yi Ren (a title for a woman of rank) suffered from a peculiar syndrome. Someone consulted the *Bencao Jing Shu* (Comprehensive Analysis of Materia Medica), saw the statement that Wu Ling San (Five-Ingredient Powder with Poria) was used to treat "Jiao Chang" (Intestinal Exchange Syndrome), and considered it a mysterious prescription. Upon seeing this, I analyzed and stated: "Jiao Chang" is a syndrome where feces and urine exit through swapped orifices, as if their positions were exchanged. The ancients used Wu Ling San (Five-Ingredient Powder with Poria) to treat it, specifically designed to promote urination via the anterior yin (urethra). If this case involves obstruction at the posterior yin (anus), with both feces and urine exiting from the anterior yin, classifying it as 'Jiao Chang' is indeed superficially similar but fundamentally incorrect. Moreover, 'Jiao Chang' is an acute disease characterized by sudden qi chaos in the middle jiao; whereas this case is a chronic disease characterized by gradual blood depletion internally. There is a difference of miles between a millimeter's deviation here and there. How can they be equated?
Tracing the origin of the disease, it began with sorrow and overthinking, leading to constriction and spleen injury. The Spleen governs the containment of blood. When the Spleen is injured, it fails to contain blood, causing it to flow erratically downward, resembling uterine bleeding (Beng Lou). This is actually named "Tuo Ying" (Depleted Camp/Syndrome of Blood Depletion). Tuo Ying should be treated with major tonification and urgent consolidation. However, it was mistakenly identified as Beng Lou and treated with cooling blood and clearing fire methods, resulting in increased hemorrhage. They failed to consider that Tian Gui (menstrual essence) had already ceased and menstrual cycles had long stopped; such a disease was impossible. For this patient, who was elderly, qi-deficient, and lacking blood to fill the 'leaking urn', no consideration was given. Consequently, the blood of the Bao Men Zi Hu (uterus) gradually diminished. Driven by circumstances, she had to borrow resources from the Large Intestine, no longer relying on internal supply. Thus, borrowing from the Large Intestine, its blood was transported and seeped into the uterine sac. Over time, the blood in the Large Intestine was exhausted. The qi of the Large Intestine, which usually travels with blood, became isolated and masterless, forming clumps like fists or masses, running with pain and scattering. This is akin to the disaster befalling forests and fish ponds.
It is like a person saving themselves from famine, stripping neighboring countries until they become ruins, disregarding everything else. This was not enough; she then relied on the Stomach, drawing its blood and seeping it into the uterine sac. Eventually, the blood in the Stomach was also exhausted, and the downward hemorrhage stopped only because it ran out of source. The blood of the Stomach is what nourishes the whole body and irrigates the hundred vessels. Now it has secretly vanished. Just as weeds lose moisture and the sorrow of Shu Li (decline of state/nature) becomes a cause for worry, stopping after blood exhaustion is far more severe than hemorrhaging while blood remains—by double. Therefore, only after blood exhaustion does qi become chaotic. Once qi is chaotic, grain and water abandon old paths for new ones, abandoning wide channels for narrow ones, like the Yangtze and Han rivers merging into one channel. The body undergoes great disorder. It is inevitable that the old path of the Large Intestine must reopen before order can be restored. This has nothing to do with Wu Ling San (Five-Ingredient Powder with Poria).
Furthermore, grain and water enter the intestines from the stomach, where the You Men (Pylorus) separates clear from turbid. Now, due to blood seepage, a false passage has formed, effectively turning the You Men into a thoroughfare. Can Wu Ling San still be used to open another way? Moreover, the Yin-capturing nature of Wu Ling San is strictly contraindicated for those who have lost blood. People today who see a disease and immediately think of a specific drug, or who cling to established prescriptions as miraculous secrets, are mostly those who harm others.
Regarding Jiang Yi Ren's illness, as soon as my three fingers touched her pulse, I asked: "Do you cry often during the illness?" The maids replied: "She cries frequently." I then realized this was Zang Zao (Organ Dryness Syndrome), which often presents with weeping. This indicated the dysfunction of the Large Intestine, not Jiao Chang. Currently, the pulse of the Large Intestine appears bead-like and prominent under the fingers. The time to worry would be when jujube leaves sprout next spring. Indeed, when jujube leaves sprouted, the prognosis proved accurate.
Mr. Hu You Chen said: "Others cannot utter a single word about such cases. Such analysis is as boundless as the Milky Way, yet precise and unchangeable. It is truly rare and commendable."