【歌】濡泻如倾湿所浸，分消利水便安宁。完谷不化名飧泄，内挟风邪发散平。肠垢稠粘为协热，寒如鸭
粪水澄清。热当伐火黄芩治，寒用温中香桂行。不禁直须诃子散，脾虚久泻术参苓。
【论】夫人之泄泻，乃水湿所为也。由脾土受湿则不能渗泄，致伤阑门，元气不能分别水谷，并入大肠而
成泻。故小便涩而大便反快，肠鸣腹痛之候。王叔和所谓∶湿多成五泄，肠走若雷奔是也。古云∶治湿不利小
便，非其治也。故世俗治泄泻多用淡渗之剂利其小便，利而不已，则以燥剂兜涩之，此一偏之治也。殊不知泻
虽生于湿，亦有协风、寒、热、虚、实之不同。如∶飧泄者，湿兼于风也，故完谷不化，肠鸣脉弦之候。肠垢
者，湿兼于火，所下稠粘垢秽，小水赤涩，脉数之候。鸭溏者，湿兼于寒，故所下澄澈清冷，如鸭 粪，小便
清白，脉迟之候。濡泻者，湿自甚也，故所下多水，小便不利，肠鸣漉漉有声，脉沉缓之候。脾肾泻，虚也，
故朝泻暮已，久而神瘁肉削。滑泄者，湿胜气脱，所下不禁，大孔如竹筒之候。又有积湿成痰而泻者，东垣云∶
一人久病，泄而神瘁，小便少而赤，脉滑而类弦，肺闷食减。因悟此久积成痰，流于肺中，宜大肠之不固也，
以茱萸等汤温服一碗
许，探喉中痰出，吐半升而利减半，次朝复饮一碗，又吐半升而泄止。病有若此之不同，岂可执一而治乎？
谨按∶“泄”者，大便溏清，“泻”者，大便直下，略有轻重，总是脾虚。若小便短少，当利小便以分
其水。若小便自利，不必再利，惟实脾而已。若口渴求饮，须滋津液，不可纯用燥脾之药，亦不可纯用利小便
之剂也。若粪中有积如稠脓，须消化为上。粪深黄秽臭者，以热治；青白者，以寒治；完谷不化者，以火治。
夫火能消谷，今反以不化为火者，何也？盖脾火和缓，自能化谷，今脾已虚，真火不炽，而邪火得以客之，火
性急速，不及传化而自出矣。然亦有寒而不化者，何以别之？视小便之赤与不赤耳。才进饮食，少倾即泻出者，
为气虚不能收摄，名曰直肠，患者多死。痛一阵，泄一阵，泄复涩滞者，火也。痛一阵，泄一阵，泄后觉通快
者，食也。腹中绞痛，下无时者，气、食交并也。腹中觉冷，隐隐微痛，下如稠饮者，痰也。
【脉】泻脉自沉，沉迟寒侵，沉数火热，沉虚滑脱。暑湿缓弱，多在夏月。
濡泻
濡泻者，肠鸣多水，胃苓汤主之，腹痛加芍药、缩砂。水泄，渴而小便赤涩，热也，益元散水调服。
胃苓汤
治脾胃不和，腹痛泄泻，水谷不化，阴阳不分者主之。
即五苓合平胃也。
小水赤涩加滑石。腹痛后重去桂，加木香、黄连、槟榔。久泄加升麻。湿胜加防风。食积加曲 、山楂。
气虚加参、术。
益元散
滑石（六两，水飞） 甘草（一两）
末之，每服二钱，水调服。
飧泄
飧泄者，所下完谷不化，湿兼风也，升阳除湿汤，外伤于风，有表证者，加发表药。元气不足，风入肠胃，
泄利清血，加减胃风汤。
升阳除湿汤
升麻 柴胡 防风 神曲（炒） 泽泻 猪苓（各半两） 苍术（一两） 陈皮 甘草（炙） 麦芽
（炒，三钱）
每服一两，饭后热服。
加减胃风汤
治风冷乘虚客于肠胃，水谷不化，泄泻注下，腹胁虚满，肠鸣疼痛，及肠胃湿毒，下如豆汁或下瘀血并效。
人参 白术 茯苓 当归 川芎 白芍（等分）
去肉桂，加升麻、秦艽。
上锉，入粟米一撮同煎，温服。
肠垢泄
肠垢，热泄也。所下粘垢，小便赤涩，脉数烦渴，黄芩芍药汤。痛一阵，泻一阵，下迫窘痛，口渴，火也，
宜伐火，四苓散加黄芩、木通。协热自利，身热脉数，白头翁汤。
四苓散
即五苓散去桂。
白头翁汤
治协热自利，小便赤涩。
白头翁 秦皮 黄连
泄
泄，即鸭溏。所下澄澈清冷，小便清白，寒也，胃苓
汤加木香、砂仁。泻利腹痛，不渴，厥逆，脉沉迟，理中汤。（方见中寒。）肢节寒甚，泄不止，脉沉迟者，
术附汤。
术附汤
白术 甘草（炙） 熟附子（等分）
姜、枣煎服。
虚泄
脾虚气弱，阑门元气不足，不能分别水谷，卫生汤。自汗沉困，脉迟久泻，黄 建中汤。（方见恶寒。）
脾肾不足，久泻不止，形瘦，肾气丸、四神丸兼服之。
卫生汤（方见痢疾。）
肾气丸（方见虚损。一名八味地黄丸。）
四神丸
治脾胃虚弱，大便不实，饮食不思，或泄利腹痛等证。兼治肾泄，清晨溏泄一、二次，经年不止。
破故纸（四两，酒浸一宿，炒） 肉豆蔻（二两，面裹，煨） 五味子（二两，去梗） 吴茱萸（一两，
泡过，炒）
上为末，用生姜八两切片，同大枣百枚，煮烂去姜，取枣肉丸如梧子大，每服一钱半，淡姜汤送下。
滑泄
泻久不止，大孔如竹筒，直出无禁者，气将脱也，诃子散。（方见痢疾。）老人元气衰，滑泄无禁，四君
子汤加肉蔻、诃子，若元气下陷，加升麻。
四君子汤（方见脾胃。）
钱氏白术散
治气血俱虚，或泻或痢，或吐或渴。
人参 白术 白茯 甘草 木香 藿香 干葛
上，水煎服。
王节斋治泄主方
白术 茯苓 陈皮 甘草 泽泻 砂仁 神曲 麦芽
寒泻加木香、煨姜。热泻加芩、连、白芍。夏月暑泻加香薷、扁豆。湿泻加苍术、半夏、猪苓、滑石。食
泻加山楂、枳实。久泻不愈加人参、黄 、升麻。滑泻不禁加肉蔻、诃子。
[Song] Ru diarrhea (diarrhea caused by dampness infiltration) flows like pouring water; dispersing and draining dampness through diuresis brings peace. Uncooked stool in feces is called Sun diarrhea (diarrhea with undigested food); if internally complicated by wind pathogen, use dispersing methods to calm it. Intestinal mucus that is thick and sticky indicates Xie Re diarrhea (diarrhea with mixed damp-heat); cold presentation resembles duck feces with clear fluid. For heat patterns, purge fire using Huangqin (Scutellariae Radix); for cold patterns, warm the middle using Xiangfu (Cyperi Rhizoma) and Rougui (Cinnamomi Cortex). Incontinence requires Hezi San (Katsurii Fructus Powder); chronic spleen deficiency diarrhea uses Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), and Fuling (Poria).
[Discussion] Human diarrhea is caused by water-dampness. When Spleen Earth is affected by dampness, it cannot seep and drain properly, damaging the Lanmen (junction of small and large intestine). The Yuan Qi (Primary Qi) fails to separate clear turbid fluids and grain, causing them to mix and enter the Large Intestine, resulting in diarrhea. Thus, urine becomes scanty and difficult while stool becomes loose, accompanied by borborygmus and abdominal pain. Wang Shuhe stated: "Excess dampness leads to five types of diarrhea, with intestinal sounds rushing like thunder." This is correct. Ancient texts say: "Treating dampness without promoting urination is not the proper treatment." Therefore, common practitioners often use bland-draining agents to promote urination for diarrhea. If this fails, they use drying and astringent agents to stop diarrhea, which is a one-sided approach. One should not know that although diarrhea arises from dampness, it may also be complicated by wind, cold, heat, deficiency, or excess. For example: Sun diarrhea is dampness complicated by wind, hence uncooked stool, borborygmus, and wiry pulse. Changgou diarrhea is dampness complicated by fire, hence thick, sticky, foul discharge, red scanty urine, and rapid pulse. Yatang diarrhea is dampness complicated by cold, hence clear, cold discharge resembling duck feces, clear white urine, and slow pulse. Ru diarrhea is extreme dampness, hence watery stool, impaired urination, loud borborygmus, and deep-slow pulse. Spleen-Kidney diarrhea is deficiency, hence morning diarrhea ceasing by evening, leading to mental fatigue and emaciation over time. Huaxie (Slippery diarrhea) is dampness overwhelming Qi depletion, with uncontrollable discharge and an anus relaxed like a bamboo tube. There are also cases where accumulated dampness transforms into phlegm causing diarrhea. Li Dongyuan said: A patient with chronic illness had diarrhea, mental fatigue, scanty red urine, slippery-wiry pulse, chest fullness, and poor appetite. Realizing this was long-standing phlegm flowing into the Lungs, affecting Large Intestine consolidation, he prescribed Wuzhuyu Decoction etc., taken warm. After one bowl, inducing vomiting expelled half a sheng of phlegm, reducing diarrhea by half. The next day, another bowl expelled more phlegm, stopping diarrhea. Diseases vary so much; how can one stick to a single treatment?
Note: "Xie" refers to loose stool; "Xie" (flushing) refers to direct downward flow, differing slightly in severity, but both stem from Spleen deficiency. If urine is short, promote urination to separate water. If urine flows freely, do not promote urination further; only strengthen the Spleen. If thirsty and desiring drink, nourish fluids; do not use purely drying Spleen herbs or purely diuretic agents. If feces contain accumulation like thick pus, prioritize digestion/dispersion. Deep yellow foul feces indicate heat, treated with clearing heat; green-white feces indicate cold, treated with warming cold; uncooked stool indicates fire deficiency, treated with warming fire. Fire digests grain; why attribute non-digestion to "fire"? Because when Spleen fire is mild, it naturally digests grain. Now, with Spleen deficiency, true fire is weak, allowing evil fire to lodge. Fire's nature is rapid, so food exits before transformation. However, some cannot digest due to cold; how to distinguish? Check if urine is red. Immediate evacuation after eating indicates Qi deficiency failing to consolidate, called Zhichang (Straight Intestine) diarrhea; patients often die. Pain followed by diarrhea then stagnation indicates fire. Pain followed by diarrhea then relief indicates food retention. Colicky pain with constant diarrhea indicates Qi and food stagnation combined. Cold abdomen with dull pain and thick drink-like diarrhea indicates phlegm.
[Pulse] Diarrhea pulses are naturally deep. Deep-slow indicates cold invasion; deep-rapid indicates fire/heat; deep-deficient slippery indicates collapse. Summer-dampness presents with weak-slow pulses, mostly in summer.
Ru Diarrhea
Ru diarrhea features borborygmus and abundant watery stool; main formula is Weiling Tang (Gastrodia and Poria Decoction). Add Shaoyao (Paeoniae Radix Alba) and Suosha (Amomi Fructus Rotundus) for abdominal pain. Water diarrhea with thirst and red scanty urine indicates heat; treat with Yiyuan San (Yi Yi Yuan Formula) mixed with water.
Weiling Tang
Main formula for Spleen-Stomach disharmony, abdominal pain, diarrhea, indigestion, and failure to differentiate Yin-Yang.
It is Wuling San (Five-Ingredient Powder with Poria) combined with Pingwei San (Peaceful Stomach Powder).
Add Shihui (Talcum) for red scanty urine. Remove Guizhi (Cinnamon Twig) for abdominal pain with tenesmus; add Muxiang (Aucklandiae Radix), Huanglian (Coptidis Rhizoma), Binglang (Arecae Semen). Add Shengma (Cimicifugae Rhizoma) for chronic diarrhea. Add Fangfeng (Saposhnikoviae Radix) for excessive dampness. Add Shenqu (Massae Fermentatae Medicinatae) and Shanzha (Crataegi Fructus) for food retention. Add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) for Qi deficiency.
Yiyuan San
Shihui (Talcum, six liang, water-ground) Gancao (Licorice Root, one liang)
Grind into powder. Take two qian per dose, mixed with water.
Sun Diarrhea
Sun diarrhea features uncooked stool in feces, indicating dampness complicated by wind. Main formula is Shengyang Chushi Tang (Raising Yang and Dispersing Dampness Decoction). If external wind pathogen causes exterior syndrome, add exterior-releasing herbs. If Yuan Qi is insufficient and wind enters intestines/stomach causing bloody diarrhea, use Jiawei Weifeng Tang (Modified Wind-Protecting Decoction).
Shengyang Chushi Tang
Shengma (Cimicifugae Rhizoma) Chaihu (Bupleuri Radix) Fangfeng (Saposhnikoviae Radix) Shenqu (Massae Fermentatae Medicinatae, stir-fried) Zexie (Alismatis Rhizoma) Zhuling (Poria, each half liang) Cangzhu (Atractylodis Rhizoma, one liang) Chenpi (Citri Reticulatae Pericarpium) Gancao (Licorice Root, honey-fried) Maiya (Hordei Fructus Germinatus, stir-fried, three qian)
Take one liang per dose, hot after meals.
Jiawei Weifeng Tang
Treats wind-cold invading intestines/stomach due to deficiency, causing indigestion, profuse diarrhea, abdominal/flank fullness, borborygmus, pain, as well as intestinal damp-toxins, dysentery like bean curd dregs, or bloody stools.
Renshen (Ginseng Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) Fuling (Poria) Danggui (Angelicae Sinensis Radix) Chuanxiong (Ligustici Chuanxiong Rhizoma) Baishao (Paeoniae Radix Alba, equal parts)
Remove Rougui (Cinnamomi Cortex), add Shengma (Cimicifugae Rhizoma) and Qinjiao (Gentianae Macrophyllae Radix).
Cut into pieces, decoct with a pinch of millet. Take warm.
Changgou Diarrhea
Changgou is heat diarrhea. Discharge is sticky/foul, urine red/scanty, pulse rapid with thirst. Use Huangqin Shaoyao Tang (Scutellaria and Peony Decoction). Pain followed by diarrhea, tenesmus, thirst indicates fire; purge fire using Siling San (Four-Ingredient Powder) plus Huangqin (Scutellariae Radix) and Mutong (Akebiae Caulis). Xie Re spontaneous diarrhea with fever and rapid pulse uses Baitouweng Tang (Pulsatillae Decoction).
Siling San
Wuling San minus Guizhi (Cinnamon Twig).
Baitouweng Tang
Treats Xie Re spontaneous diarrhea, red scanty urine.
Baitouweng (Pulsatillae Radix) Qinpi (Fraxini Cortex) Huanglian (Coptidis Rhizoma)
Han Diarrhea
Han diarrhea, i.e., Yatang. Discharge is clear/cold, urine clear/white, indicating cold. Use Weiling Tang plus Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus). Diarrhea with abdominal pain, no thirst, cold limbs, deep-slow pulse uses Lizhong Tang (Regulate the Middle Decoction). (Formula see Cold Damage - Interior Cold). Severe limb/joint cold with persistent diarrhea and deep-slow pulse uses Shufu Tang (Atractylodes and Prepared Aconite Decoction).
Shufu Tang
Baizhu (Atractylodis Macrocephalae Rhizoma) Gancao (Licorice Root, honey-fried) Shufuzi (Prepared Aconiti Lateralis Radix, equal parts)
Decoct with Ginger and Jujube.
Xu Diarrhea
Spleen deficiency with weak Qi, Lanmen Yuan Qi insufficient to separate grain/water, use Weisheng Tang. Spontaneous sweating, heaviness, slow pulse, chronic diarrhea use Huangqi Jianzhong Tang (Astragalus Decoction to Regulate the Middle). (Formula see Aversion to Cold).
Spleen-Kidney insufficiency with chronic diarrhea and emaciation: take Shenqi Wan (Kidney Qi Pill) and Sishen Wan (Four Spirits Pill) together.
Weisheng Tang (Formula see Dysentery).
Shenqi Wan (Formula see Deficiency Damage. Also known as Bawei Dihuang Wan).
Sishen Wan
Treats Spleen-Stomach weakness, loose stools, poor appetite, or diarrhea with abdominal pain. Also treats Kidney diarrhea: morning loose stools 1-2 times daily persisting for years.
Poguzhi (Psoraleae Fructus, four liang, soaked in wine overnight, stir-fried) Roudoukou (Myristicae Semen, two liang, wrapped in flour, roasted) Wuweizi (Schisandrae Fructus, two liang, stems removed) Wuzhuyu (Evodiae Fructus, one liang, soaked, stir-fried)
Grind into powder. Slice eight liang of fresh ginger, boil with hundred jujubes until soft. Remove ginger, use jujube flesh to make pills size of wutong seeds. Take one and a half qian per dose, washed down with light ginger soup.
Huaxie (Slippery Diarrhea)
Chronic diarrhea, anus relaxed like a bamboo tube with uncontrollable discharge, indicates impending Qi collapse. Use Hezi San (Katsurii Fructus Powder). (Formula see Dysentery). Elderly with depleted Yuan Qi and slippery diarrhea: use Sijunzi Tang (Four Gentlemen Decoction) plus Roudoukou (Myristicae Semen) and Hezi (Katsurii Fructus). If Yuan Qi sinks, add Shengma (Cimicifugae Rhizoma).
Sijunzi Tang (Formula see Spleen-Stomach).
Qian Shi Baizhu San
Treats dual Qi-Blood deficiency, or diarrhea/dysentery, or vomiting/thirst.
Renshen (Ginseng Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) Bai Fu Ling (Poria) Gancao (Licorice Root) Muxiang (Aucklandiae Radix) Huoxiang (Agastaches Herba) Gange (Puerariae Radix)
Decoct in water and take.
Wang Jiezhai's Main Formula for Treating Diarrhea
Baizhu (Atractylodis Macrocephalae Rhizoma) Fuling (Poria) Chenpi (Citri Reticulatae Pericarpium) Gancao (Licorice Root) Zexie (Alismatis Rhizoma) Sharen (Amomi Fructus) Shenqu (Massae Fermentatae Medicinatae) Maiya (Hordei Fructus Germinatus)
Cold diarrhea adds Muxiang (Aucklandiae Radix) and Wei Jiang (Roasted Ginger). Heat diarrhea adds Huangqin (Scutellariae Radix), Lian (Coptidis Rhizoma), Baishao (Paeoniae Radix Alba). Summer heat diarrhea adds Xiangru (Elsholtziae Herba) and Biandou (Dolichoris Semen). Damp diarrhea adds Cangzhu (Atractylodis Rhizoma), Banxia (Pinelliae Rhizoma), Zhuling (Poria), Shihui (Talcum). Food diarrhea adds Shanzha (Crataegi Fructus) and Zhishi (Aurantii Fructus Immaturus). Chronic diarrhea unrelenting adds Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Shengma (Cimicifugae Rhizoma). Slippery uncontrollable diarrhea adds Roudoukou (Myristicae Semen) and Hezi (Katsurii Fructus).