【歌】肺经蕴热肛门闭，肺气虚时脱出肛。更主血虚与血热，须知治疗不相同。（肛音工。）
【论】夫肺与大肠相为表里，故肺脏蕴热，则肛门闭结，热极反挺出其肛也。肺气不足，不能收敛，则肛
门脱出，故妇人生产用力过者，及小儿痢久不已者，多致脱肛，即可见也。亦有血热、血虚，亦令脱肛也，审
而疗之。
气虚
气虚不能收敛，脉虚，或久病后脱肛，补中益气汤。（方见内伤。）丹溪云∶气虚者，宜大补元气兼升提，
人参、黄 、川芎、当归、芍药、升麻、柴胡，外肥皂水洗之。
气热
气热及内有热，脉数者，三补丸加柴胡、升麻。又有气热盛而脱肛者，条芩六两、升麻一两，神曲糊丸，
空心白汤下五钱。
三补丸
治热盛脱肛。
黄芩（炒，一两半） 黄柏（炒，一两半） 黄连（炒，二两半）
末之，炼蜜丸如桐子大，每七十丸，空心白汤送下。
血虚
血虚者，或因失血后，脉芤涩，四物汤加黄 、升麻、
柴胡。（方见血证。）外用五倍子为细末涂之，以手托而上之，至五、六次，待收乃止。
血热
内原有热证，血虚，脉数而虚者，四物汤加炒黄柏、柴胡、防风、秦艽、升麻，或凉血地黄汤加升麻、柴
胡、防风、秦艽。（方见血证。）
【歌】牛马猪羊鸡五痫，治须寻火与寻痰。更将痰火分多少，识得枢机总不难。
【论】夫痫有五∶马痫则张口摇头马鸣；牛痫则目正直视腹胀；猪痫则喜吐沫；羊痫则扬目吐舌；鸡痫
则摇头反折善惊。盖以其形之类而名之也。古者既有五痫之名，治无分别，概用香窜镇坠之药，殊为未当。丹
溪云∶痫病盖因痰涎壅盛，迷瞒孔窍，发则头旋颠倒，手足搐搦，口眼相引，胸背强直，叫吼吐沫，食倾乃苏，
大率属痰与火。法当寻火寻痰，分多分少治之。亦有因惊而得者，惊则神不守舍，舍空而痰聚也，宜以行痰为
主，佐以定悸宁心安神可也。彼香窜燥剂，宁不助火耗气乎？！
痰
痰者，动则有声，脉滑，涎沫出，必得吐，后用安神丸。大率以行痰为主，二陈汤加南星、栝蒌、黄连。
（方见痰证。）
安神丸
治痰痫。
黄连（一两五钱，酒制） 朱砂（水飞，一两） 生地黄（一两） 当归（一两，酒洗） 甘草（炙，五钱）
蜜丸，每五十丸。
火
火者，有热面赤，脉散。大抵肥人痰多，瘦人火多，宜
吐后用平肝，青黛、黄连、川芎、柴胡，或宁神丹。
宁神丹
治火盛痫证。
天麻（五钱） 人参（五钱，去芦） 陈皮（五钱） 白术（五钱，炒） 当归身（五钱） 白茯苓（五
钱） 荆芥（五钱） 僵蚕（五钱） 独活（五钱） 远志（五钱，去心） 犀角（五钱） 麦门冬 枣仁（炒，
五钱） 辰砂（五钱，另研） 半夏（一两） 南星（一两） 石膏（一两） 甘草（炙，三钱） 白附子（三
钱） 川芎（三钱） 牛黄（三钱） 珍珠（三钱） 生地黄（五钱） 黄连（五钱） 金箔（三十片）
酒丸，空心白汤下，五十丸。
惊
因惊而得者，则神不守舍，舍空痰聚，必先行痰，亦用吐痰。吐后安神丸，（方见前痰痫下。）或三痫丸。
三痫丸
治一切惊痫。
荆芥穗（二两） 白矾（一两，半生半枯）
朱砂为衣。
[Verse]
Heat accumulating in the Lung Meridian causes anal closure; when Lung Qi is deficient, the anus prolapses. This also involves Blood Deficiency and Blood Heat; one must know that the treatments differ. ("Gang" sounds like "Gong".)
[Discussion]
The Lung and Large Intestine are exteriorly-interiorly related. Therefore, heat accumulating in the Lung causes anal constipation/closure; extreme heat may cause the anus to protrude. When Lung Qi is insufficient and cannot consolidate, the anus prolapses. Thus, women who exert too much force during childbirth, and children with chronic dysentery, often suffer from rectal prolapse, which can be understood. There are also cases where Blood Heat or Blood Deficiency leads to rectal prolapse; these must be carefully differentiated and treated.
Qi Deficiency Type
When Qi is deficient and cannot consolidate, presenting with a weak pulse, or rectal prolapse after a long illness, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). (Formula see Internal Injury section.) Danxi stated: For Qi deficiency, one should greatly tonify Yuan Qi and simultaneously lift it, using Renshen (Ginseng Radix), Huangqi (Astragali Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), and wash the area externally with soap water.
Qi Heat Type
For Qi Heat and internal heat, presenting with a rapid pulse, use Sanbu Wan (Three Purges Pill) added with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma). In cases of severe Qi Heat leading to rectal prolapse, use Liuhuang Qin (Scutellariae Baicalensis Radix) six liang and Shengma (Cimicifugae Rhizoma) one liang, made into pills with Shenqu (Massa Medicata Fermentata), taken orally on an empty stomach with plain water, five qian per dose.
Sanbu Wan (Three Purges Pill)
Treats rectal prolapse due to excessive heat.
Huangqin (Scutellariae Baicalensis Radix, stir-fried, 1.5 liang) Huangbai (Phellodendri Cortex, stir-fried, 1.5 liang) Huanglian (Coptidis Rhizoma, stir-fried, 2.5 liang)
Grind into powder, make pills with refined honey the size of paulownia seeds. Take seventy pills orally on an empty stomach with plain water.
Blood Deficiency Type
In Blood Deficiency, possibly after blood loss, presenting with a knotted and choppy pulse, use Siwu Tang (Four Substances Decoction) added with Huangqi (Astragali Radix), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix). (Formula see Blood Syndrome section.) Externally, apply Wubeizi (Galae Chinensis) finely ground powder, manually reduce the prolapse, repeating five to six times until retracted.
Blood Heat Type
For internal heat syndrome combined with Blood Deficiency, presenting with a rapid but weak pulse, use Siwu Tang (Four Substances Decoction) added with stir-fried Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Qinjiao (Gentianae Macrophyllae Radix), and Shengma (Cimicifugae Rhizoma); or Liangxue Dihuang Tang (Cool Blood and Rehmannia Decoction) added with Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), and Qinjiao (Gentianae Macrophyllae Radix). (Formula see Blood Syndrome section.)
[Verse]
The five epilepsies of Cow, Horse, Pig, Sheep, and Chicken require treatment by seeking Fire and Phlegm. By distinguishing the degree of Phlegm and Fire, grasping the key mechanism is not difficult.
[Discussion]
Epilepsy is divided into five types: Ma Xian (Horse Epilepsy) manifests as opening the mouth, shaking the head, and making horse-like sounds; Niu Xian (Cow Epilepsy) manifests as staring straight ahead and abdominal distension; Zhu Xian (Pig Epilepsy) manifests as frequent spitting of saliva; Yang Xian (Sheep Epilepsy) manifests as wide eyes and sticking out the tongue; Ji Xian (Chicken Epilepsy) manifests as shaking the head, opisthotonos, and susceptibility to fright. These names are derived from their animal-like forms. Although ancient texts named the five epilepsies, treatments were undifferentiated, generally using aromatic, penetrating, and sedative/heavy drugs, which is inappropriate. Danxi stated: Epilepsy is generally caused by abundant phlegm-fluid obstructing and clouding the orifices. During attacks, there is dizziness and falling, convulsions of hands and feet, deviation of mouth and eyes, rigidity of chest and back, roaring and spitting foam, with recovery after about the time it takes to eat a meal. It largely belongs to Phlegm and Fire. The method should be to seek Fire and Phlegm and treat according to their predominance. Some cases arise from Fright; Fright causes the Spirit to lose its residence, leaving the residence empty so Phlegm gathers. Treatment should primarily move Phlegm, assisted by herbs to calm palpitations, soothe the Mind, and calm the Spirit. Do not aromatic, drying, and penetrating agents merely assist Fire and consume Qi?!
Phlegm Type
Phlegm epilepsy presents with sound upon movement, slippery pulse, and discharge of saliva/phlegm, requiring expectoration, followed by Anshen Wan (Calming the Spirit Pill). Generally, the focus is on moving Phlegm, using Erchen Tang (Two Aged Decoction) added with Nanxing (Arisaematis Cum Bile), Gualou (Trichosanthis Fructus), and Huanglian (Coptidis Rhizoma). (Formula see Phlegm Syndrome section.)
Anshen Wan (Calming the Spirit Pill)
Treats Phlegm Epilepsy.
Huanglian (Coptidis Rhizoma, 1.5 qian, processed with wine) Zhusha (Cinnabar, water-triturated, 1 liang) Shengdihuang (Rehmanniae Radix Recens, 1 liang) Danggui (Angelicae Sinensis Radix, 1 liang, washed with wine) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 5 qian)
Make pills with honey, fifty pills per dose.
Fire Type
Fire epilepsy presents with red face and heat, and a scattered pulse. Generally, obese people have more Phlegm, while thin people have more Fire. After inducing vomiting, use Liver-calming formulas such as Qingdai (Indigo Naturalis), Huanglian (Coptidis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Chaihu (Bupleuri Radix), or Ningshen Dan (Spirit-Calming Pellet).
Ningshen Dan (Spirit-Calming Pellet)
Treats Epilepsy due to Excessive Fire.
Tianma (Gastrodiae Rhizoma, 5 qian) Renshen (Ginseng Radix, 5 qian, remove rhizome) Chenpi (Citri Reticulatae Pericarpium, 5 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, 5 qian, stir-fried) Dangguishen (Angelicae Sinensis Radix, body part, 5 qian) BaiFuling (Poria, 5 qian) Jingjie (Schizonepetae Spica, 5 qian) Jiangcan (Bombyx Batryticatus, 5 qian) Duohuo (Angelicae Pubescentis Radix, 5 qian) Yuanzhi (Polygalae Radix, 5 qian, remove heart) Xijiao (Rhinocerotis Cornu, 5 qian) Maimendong (Ophiopogonis Radix) Zaoren (Ziziphi Spinosae Semen, 5 qian, stir-fried) Chensha (Cinnabar, 5 qian, separately ground) Banxia (Pinelliae Rhizoma, 1 liang) Nanxing (Arisaematis Cum Bile, 1 liang) Shigao (Gypsum Fibrosum, 1 liang) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 3 qian) Baifuzi (Typhonii Rhizoma, 3 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma, 3 qian) Niuhuang (Bovis Calculus, 3 qian) Zhenzhu (Margarita, 3 qian) Shengdihuang (Rehmanniae Radix Recens, 5 qian) Huanglian (Coptidis Rhizoma, 5 qian) Jinbo (Folium Aureum, 30 leaves)
Make pills with wine, take fifty pills orally on an empty stomach with plain water.
Fright Type
Cases arising from Fright cause the Spirit to lose its residence, leaving the residence empty for Phlegm to gather. One must first move Phlegm, also using emetics to expel Phlegm. After vomiting, use Anshen Wan (Calming the Spirit Pill), (Formula see Phlegm Epilepsy above,) or Sanxian Wan (Three Epilepsies Pill).
Sanxian Wan (Three Epilepsies Pill)
Treats all types of Fright Epilepsy.
Jingjisui (Schizonepetae Spica, 2 liang) Baifan (Alumen, 1 liang, half raw half calcined)
Coat with Zhusha (Cinnabar).