干姜（辛热去皮三两） 黄连（三两去须苦寒） 黄芩（三两苦寒） 人参（三两
甘温）
上四味。以水六升。煮取二升。去滓。分温。再服。
辛以散之。甘以缓之。干姜人参之甘辛。以补正气。苦以泄之。黄连黄芩之苦。以
通寒格。
下利有微热而渴。脉弱者。令自愈。
下利阴寒之疾。反大热者逆。有微热而渴。里气方温也。经曰。诸弱发热。脉弱者。
阳气得复也。令必自愈。
下利。脉数。有微热。汗出。令自愈。设复紧。为未解。
下利阴病也。脉数。阳脉也。阴病见阳脉者生。微热汗出。阳气得通也。利必自愈。
诸紧为寒。设复脉紧。阴气犹胜。故云未解。
下利。手足厥冷。无脉者。灸之不温。若脉不还。反微喘者死。
下利。手足厥逆无脉者。阴气独胜。阳气大虚也。灸之阳气复。手足温而脉还。为
欲愈。若手足不温。脉不还者。阳已绝也。反微喘者。阳气脱也。
少阴负趺阳者。为顺也。
少阴肾水。趺阳脾土。下利为肾邪干脾。水不胜土。则为微邪。故为顺也。
下利。寸脉反浮数。尺中自涩者。必清脓血。
下利者。脉当沉而迟。反浮数者。里有热也。涩为无血。尺中自涩者。肠胃血散也。
随利下。必便脓血。清与圊通。脉经曰。清者厕也。
下利清谷。不可攻表。汗出必胀满。
下利者。脾胃虚也。胃为津液之主。发汗亡津液。则胃气愈虚。必胀满。
下利。脉沉弦者。下重也。脉大者为未止。脉微弱数者。为欲自止。虽发热不死。
沉为在里。弦为拘急。里气不足。是主下重。大则病进。此利未止。脉微弱数者。邪气
微而阳气复。为欲自止。虽发热。止由阳胜。非大逆也。
下利脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患必微
厥。所以然者。其面戴阳。下虚故也。
下利清谷。脉沉而迟。里有寒也。面少赤。身有微热。表未解也。病患微厥。针经
曰。下虚则厥。表邪欲解。临汗之时。以里先虚。必郁冒。然后汗出而解也。
下利。脉数而渴者。令自愈。设不瘥。必清脓血。以有热故也。
经曰。脉数不解。而下不止。必胁热便脓血也。
下利后。脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。
下利后。脉绝。手足厥冷者。无阳也。 时。周时也。周时厥愈脉出。为阳气复。则生。
若手足不温。脉不还者。为阳气绝则死。
伤寒下利。日十余行。脉反实者死。
下利者。里虚也。脉当微弱。反实者。病胜脏也。故死。难经曰。脉不应病。病不
应脉。是为死病。
下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。
下利清谷。为里寒。身热不解。为外热。汗出。阳气通行于外。则未当厥。其汗出
而厥者。阳气太虚也。与通脉四逆汤。以固阳气。
热利下重者。白头翁汤主之。
利则津液少。热则伤气。气虚下利。致后重也。与白头翁汤。散热浓肠。
Ganjiang (Rhizoma Zingiberis Preparatum, pungent and hot, peeled, 3 liang) Huanglian (Rhizoma Coptidis, 3 liang, remove the rootlets, bitter and cold) Huangqin (Radix Scutellariae, 3 liang, bitter and cold) Renshen (Radix Ginseng, 3 liang, sweet and warm).
The above four herbs. Boil with six sheng of water. Reduce to two sheng of decoction. Remove the dregs. Divide into two doses and take warm.
Pungent substances disperse [pathogens]. Sweet substances moderate [tension]. The pungent and sweet properties of Ganjiang and Renshen tonify the righteous qi. Bitter substances drain [excess]. The bitter properties of Huanglian and Huangqin unblock cold-ge [a condition of upper heat and lower cold causing rejection].
In diarrhea accompanied by slight fever and thirst, if the pulse is weak, it will resolve spontaneously.
Diarrhea is a yin-cold disease. If there is sudden intense heat, it is an adverse sign. With slight fever and thirst, it indicates that the interior qi is warming up. The Classics state: "Weak pulses with fever." A weak pulse indicates the restoration of yang qi. It will certainly resolve spontaneously.
In diarrhea, if the pulse is rapid, with slight fever and sweating, it will resolve spontaneously. If the pulse becomes tight again, the pathogen has not been resolved.
Diarrhea is a yin disease. A rapid pulse is a yang pulse. When a yin disease presents with a yang pulse, life is preserved. Slight fever and sweating indicate that yang qi is circulating. The diarrhea will certainly resolve spontaneously.
All tight pulses indicate cold. If the pulse remains tight, yin qi still prevails. Hence, it is said that the condition is not resolved.
In diarrhea, if the hands and feet are cold and there is no pulse, moxibustion applied fails to warm them. If the pulse does not return and there is instead slight panting, death ensues.
In diarrhea, with cold hands and feet and no pulse, yin qi alone prevails and yang qi is greatly deficient. After moxibustion, if yang qi restores, hands and feet become warm and the pulse returns, recovery is desired. If hands and feet remain cold and the pulse does not return, yang qi is exhausted. If there is slight panting, it indicates the collapse of yang qi.
If the Shaoyin pulse [radial artery at the wrist] is weaker than the Fuyang pulse [dorsalis pedis artery], it is a favorable sign.
Shaoyin corresponds to Kidney Water. Fuyang corresponds to Spleen Earth. Diarrhea occurs when Kidney evil interferes with Spleen. If Water cannot overcome Earth, it is merely a minor pathogen. Thus, it is favorable.
In diarrhea, if the Cun pulse [distal position on radial artery] is unexpectedly floating and rapid, while the Chi pulse [proximal position on radial artery] is naturally choppy, pus and blood must appear in the stool.
In diarrhea, the pulse should be deep and slow. If unexpectedly floating and rapid, it indicates heat in the interior. Choppy pulse signifies lack of blood. A naturally choppy Chi pulse indicates scattering of blood in the intestines and stomach. Accompanying the diarrhea, pus and blood will inevitably appear in the stool. "Qing" and "Qing" [to defecate] are interchangeable. The Maijing states: "Qing refers to the toilet."
In diarrhea with undigested food in the stool, exterior attack via sweating is contraindicated. Sweating will inevitably cause abdominal fullness.
Diarrhea indicates deficiency of the Spleen and Stomach. The Stomach is the master of fluid substances. Sweating depletes fluids, further weakening Stomach qi. Abdominal fullness will inevitably result.
In diarrhea, if the pulse is deep and wiry, there is a sensation of heaviness in the rectum [tenesmus]. If the pulse is large, the condition has not ceased. If the pulse is faint, weak, and rapid, the condition is about to cease. Even with fever, death will not occur.
Deep pulse indicates interior location. Wiry pulse indicates tension/constriction. Interior qi deficiency causes tenesmus. Large pulse indicates disease progression; this diarrhea has not ceased. A faint, weak, and rapid pulse indicates that the pathogen is mild and yang qi is restoring, suggesting the condition is about to cease. Although there is fever, it is due to yang predominance, not a major adverse reversal.
In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, the body has slight fever, and there is diarrhea with undigested food, there will inevitably be vertigo/dizziness [yumao] followed by sweating and resolution. The patient will have slight cold extremities. This is because the face exhibits "floating yang" [deficient yang floating upward] due to deficiency below.
Diarrhea with undigested food, deep and slow pulse, indicates cold in the interior. Slight facial redness and slight body fever indicate the exterior is not yet resolved. Slight cold extremities. The Zhijing states: "Deficiency below leads to cold extremities." As the exterior pathogen desires to resolve, at the time of impending sweating, due to prior interior deficiency, vertigo/dizziness will inevitably occur, followed by sweating and resolution.
In diarrhea, if the pulse is rapid and there is thirst, it will resolve spontaneously. If it does not improve, pus and blood will inevitably appear in the stool, due to the presence of heat.
The Classics state: "If rapid pulse persists and diarrhea does not cease, there will be heat in the hypochondrium and pus and blood in the stool."
After diarrhea, if the pulse vanishes and hands and feet are cold, but after a period (one zhou cycle) the pulse returns and hands and feet become warm, life is preserved. If the pulse does not return, death ensues.
In Taiyang disease with diarrhea, occurring more than ten times a day, if the pulse is unexpectedly excess/solid, death ensues.
Diarrhea indicates interior deficiency. The pulse should be faint and weak. An excess pulse indicates the pathogen overcomes the organ qi. Hence, death. The Nanjing states: "When the pulse does not correspond to the disease, and the disease does not correspond to the pulse, it is a fatal disease."
In diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tongmai Sini Tang (Decoction for Reviving the Pulse) is indicated.
Diarrhea with undigested food indicates interior cold. Unresolved body heat indicates exterior heat. Sweating allows yang qi to circulate outward; thus, cold extremities should not normally occur. Sweating with cold extremities indicates extreme deficiency of yang qi. Administer Tongmai Sini Tang to consolidate yang qi.
In heat-diarrhea with tenesmus, Baitouweng Tang (Decoction of Pulsatilla) is indicated.
Diarrhea reduces fluid substances. Heat injures qi. Qi deficiency leading to diarrhea causes tenesmus. Administer Baitouweng Tang to clear heat and strengthen the intestines.