槟榔、木香，一剂而滞见。病患虑药克伐，意欲用补。曰∶有是病，服是药，邪气方张，非亟攻不退，邪退则
正复，攻即是补也。前方再服三剂愈矣。设不早攻，必致病痰，非一月不痊。
谢武功素患大便溏泄，兼病咳嗽。用凉药则咳减而泻增，用热药则泻减而咳剧，用补脾则咳泻俱盛。诊之，
右尺软如烂绵，两寸实数抟指。酌用附子、肉果以温下焦之寒，麦冬、川连以清心肺之火，茯苓、甘草一以降
气，一以和中，（上实下虚，上热下寒，最为棘手之症。其用药规矩森然，足为后学程序。）甫四剂而证顿
减。不加人参者，缘肺有郁热耳。
喻嘉言治胡太夫人病，偶然肚腹不宁，泻下数行。医以痢疾药治之，其利转多。更引通因通用之法，用九
蒸大黄丸三钱下之，遂扰动胃气，胀痛，全不思食，状如噤口。诊之，六脉皆沉而伏，应指模糊，曰∶此非痢
病，乃误治之证也。今但安其胃，不必治利而利自止，不必治胀痛而胀痛自除。遂以四君子汤为主，少加姜、
蔻暖胃之药，二剂利果不作。但苦胃中胀痛不安，必欲加入行气之药，以冀胀痛止而速得进食。固争曰∶宁可
缓于食，不可急于药。盖前因药误，引动胃气作楚，若再加行气，则胀痛必无纪极。即用橘皮和中，亦须炒而
又炒，绝不惹动其气。凡五日，未得大便，亦听之，痛止胀消食进便利，共七日全安。浑不见药之功，其实
为无功之功也。
陆养愚治许默庵，素有肠风证，常服寒凉之药，中年后，肠风幸愈，致伤脾胃，因成泄泻之证。初时，服
胃苓汤，一帖便愈，久之不效。近来四肢浮肿而厥，肚腹膨胀而鸣，面色萎黄而带青，身体苦冷而带热。诊之，
左脉沉缓而迟，右脉沉弱而弦，曰∶诸缓为湿，应泻而浮肿；诸迟为寒，应厥而苦冷；右弦为木乘土位，应腹
胀而面青。沉者，阳气不升也；弱者，阴精不实也。脉色与证患相应，用人参、白术、黄 、炙甘草为君，以
补其虚；炮姜、附子为臣，以温其寒；升麻、防风为佐，以升其阳；茯苓、泽泻为使，以胜其湿。十剂而诸证
减，又合八味丸间服而愈。（疑从薛案化出。）
沈少西女年二十，自小脾胃受伤，不时作泄作呕，近则寒热不时，手足厥冷，胸膈不舒，胁胀嗳气。左眠
则气不通畅，左胁胃脘时疼时止，渴而不欲饮，小便短，大便日二三行，腹中雷鸣，弹之如鼓，揉之如水。大
约气上塞则胀而痛，气下坠则泄而痛。幸饮食不甚减。常服胃苓、白术、黄连及消导之药，或调气补血之品，
不应。谓此证非参、术不能取效，但今微有表邪，先与小柴胡加桔梗二三帖。寒热稍和，（近时庸师专得此诀。）
易以调中益气汤去黄柏，加青皮以伐肝，神曲以助脾，炮姜以温中。四帖，胀痛俱减，大便稍实，但微有寒热，
中宫不实不坚，且聚且散，无积可攻，法当补益脏气。用人参、黄 、白术、茯苓、枣仁、柴胡、远志、炙
草、炮姜、龙眼肉，大益元气以退虚热。数剂后，夜来略胀，更以六君子料加枳实、黄连、神曲、木香、
砂仁为丸，与煎剂间服，月余而安。
陆祖愚治潘古臣母，患脾泄久，多啖水果，泻更甚。尝因经行腹痛，服攻瘀去血之剂，致淋沥不止，肌肉
枯槁，身体发热，不能转侧，不思饮食，气短口渴，夜卧不安。服养血健脾药，内有麦冬、生地、枣仁等物，
而泻不止，渴益甚。脉之，两寸关虚数，两尺隐隐若无，此下元不足，中气虚寒，虚火上炎之证。乃用人参、
炮姜、白术、陈皮、山楂、木香、薏仁、木通、山药、甘草、蔻仁服之，颇觉相宜。又用肉果、人参、白术、
炮姜、枣肉为丸，日服两次，一月泻止，两月肌肉渐长，月事亦调。
黄履素曰∶乙巳之夏，余患中脘痛，既而泄泻。偶遇姑苏一名医，令诊之。惊曰∶脾胃久伤，不治将滞下。
予体素弱，惮服攻克之药，因此医有盛名，一时惑之，遂服枳、术、黄连、浓朴、山楂、木通等药数剂，又服
枳术丸一月，以致脾胃大伤。是秋，遂溏泄不止，渐觉饮食难化，痞闷胀饱，深自悔恨。乃服参、 等药，及八
味丸十余年，始得愈。然中气不能如故，苦不耐饥，稍饥则中气大虚，惫不可状。凡山楂消导之物，入口即虚，
脾胃之不可妄攻如此。方书极言枳术丸之妙，孰知白术虽多，不能胜枳实之迅利。予友胡孝辕刺史，亦误服枳
术丸而大病，可见此丸断非健脾之药。或饮食停滞，偶一二服则可耳。
又曰∶脾胃喜暖而恶寒，脾虚必宜温暖之药。或饮食停滞，偶一二服。患呕吐不止，服聂逆源五气。丹数丸，
遂不复发。予近患脾不和，不时溏泄，服参、术三日不效，服胡与辰金铅一丸，脾气顿佳，得两三月安妥。家
庵中一比邱尼，患脾疾甚殆，肛门不收，秽水任出，服金铅一丸，肛门顿敛，渐调而愈。其神效有如此者，故知
脾病之宜于温暖也。
张路玉治陈总戎泄泻，腹胀作痛，服黄芩、白芍之类，胀急愈更甚。其脉洪盛而数，按之则濡，气口大三
倍于人迎，此湿热伤脾胃之气也。与浓朴生姜半夏人参汤二剂，泻痢止而饮食不思。与半夏泻心汤，二剂而安。
柴屿青治学士于鹤泉，痢后久泻。医以人参、川连为末日服，遂至饮食不思，每欲小便，大便先出。求治，
其两尺微细欲绝。经曰∶肾主二便。又曰∶肾司启闭。今肾气不固，是以大便不能自主。况年逾六旬，不
必诊脉，已知其概，而脉又如此，更无疑义。遂用补中益气汤，更加熟附子二钱，煨肉果二钱，送八味，
二剂。彼颇思饮食，大便止泻，勃有生机。乃慕时医某，以为一剂立效，二剂而殁。惜哉。
马次周令嗣，于甲子场前，身热脾泄。医以外感治之，屡药不效。诊其人迎左尺平弱，气口微缓，此属肝
肾脾胃不足。用六君子汤加柴胡，数剂身凉。去柴胡再加归、芍，调理而安。是科获隽。
张三锡治一人，泄泻，口干舌燥，脉洪数。与六一散，一服知，二服已。又一人，服不应，用芩连四物
散效。
一老妪久泻，服补剂不应。以参苓白术散加黄连、肉豆蔻少许作丸，服未半斤，永不发。
立斋治横金陈子复，面带赤色，吐痰口干，或时作泻。或用二陈、黄连、枳实之类，不应。脉之，左关弦
急，右关弦大，此乃肾水挟肝木之势而胜脾土也。不信。后交夏，果患痢而亡。
娄全善治翁仲政久泄，每早必泻一二行，泄后便轻快，脉濡而少弱。先与浓朴和中丸五十丸，大下之。后
以白术为君，枳壳、茯苓、半夏为臣，浓朴、炙甘草、芩、连、川芎、滑石为佐，吴茱萸十余粒为使，生姜煎
服，十余帖而愈。（作食积伤脾治。）
罗谦甫曰∶丁巳，予从军至开州，夏月，有千户高国用谓予曰∶父亲七十有三，于去岁七月间，因内伤饮
食，又值霖雨，泻利暴下数行。医以药止之，不数日，又伤又泻，止而复伤，伤而复泻。至十月间，肢体瘦弱，
四肢倦怠，饮食减少，腹痛肠鸣。又易李医，治以养脏汤，数日泄止，复添呕吐。又易王医，用丁香、人参、
藿香、橘红、甘草，同为细末，生姜煎，数服而呕吐止。延至今正月间，饮食不进，扶而后起。又数日，不见
大便，问何以治之。医曰∶老人年过七旬，血气俱衰弱，又况泻利半载，脾胃久虚，津液耗少，以麻仁丸润之
可也。或谓冯村牛山人，见证不疑，有果决，遂请治之。诊其脉，问其病，曰∶此是风结也。以搜风丸百余
丸服之，利数行而死。悔恨不已，敢以为问。予曰∶人以水谷为本，今高年老人久泻，胃中精液耗少，又重泻
之，神将何根据？《灵枢经》曰∶形气不足，病气不足，则阴阳俱竭，血气皆尽，五脏空虚，筋骨髓枯，老者绝
减，少者不复矣。又曰∶上工平气，中工乱脉，下工绝气危生。绝气危生，牛山人之谓欤。
按∶是证牛山人固无足论，前李、王二君，惟知治呕治泻，不知下多亡阴，力进香燥，至脏腑枯竭，
而上不纳，下不出，其视牛亦鲁卫之政也。盖当时此等证候，即罗公生平，亦未解用峻剂养荣，矧其他哉。
予有治宋复华兄母夫人一案，可参阅。
缪仲淳治梁溪一女人，茹素患内热，每食肠鸣，清晨水泄，教服脾肾双补丸，立愈。人参一斤，莲肉一斤，
菟丝一斤半，五味六两半，萸肉一斤，山药一斤，车前十二两，橘红六两，砂仁六两，巴戟天十二两，补骨脂
一斤，白芍十两，扁豆十二两，蜜丸绿豆大。每五钱，空心食时各一服。如虚有火，火盛肺热者，去人参、巴
戟，添补骨脂。一方有肉豆蔻，无白芍、扁豆。（《广笔记》。）
开庆己未年七月间，裕斋马观文夫人费氏，病气弱怠，四肢厥冷，恶寒自汗，不进饮食。一医作伏暑治之，
投暑药，一医作虚寒治之，投热药，无效。召仆诊之，六脉虽弱，而关独甚，此中焦寒也。中焦者，脾也。脾
胃既寒，非特但有是证，必有腹痛吐泻之证。今四肢厥冷属脾，是脾胃虚冷，无可疑者。答云∶未见有腹痛吐
泻之证。今用何药治之？仆答云∶宜用附子理中汤。未服药，间旋即腹痛而泻。莫不神之，即治此药，一投而
瘥。（《良方》。）
陈良甫治赵府博与 宜人，病泄泻不止。如附子、木香、诃子、肉豆蔻、龙骨等药及诸丹，服之皆无效。
诊之云∶是肝肾脉虚弱，此肝肾虚也。府博云∶其说见在何经？曰∶诸方论泄泻，止是言脾胃病，不过谓风冷
湿毒之所侵入，及饮食伤滞。遇肠风则泄利，而不知肝肾气虚，亦能为泄利。古书所载甚明，不可不辨。经云∶
泄泻前后不止，肾虚也。又，诸厥固泄，皆属于下。下，谓下焦肝肾之气分也。门户束要，肝之气也。守司于
下，肾之气也。肝气厥而上行，不能禁固而泄利。肾为胃关，门户不要，仓库不藏也。若病泄利，其源或出于
此。而专以脾胃药治之，则谬固千里矣。遂服木香散，数服而愈。
旧传有人年老，而颜如童子者，盖每岁以鼠粪灸脐中神阙穴一壮故也。予尝患久溏利，一夕，灸三七壮，
则次日不如厕，连数夕灸，则数日不如厕，足见经言主泄利不止之验也。又予年逾壮，觉左手足无力，偶灸此而愈。
薛立斋治佥宪高如斋，饮食难化，腹痛泄泻，用六君子加砂仁、木香治之而痊。后复作，完谷不化，腹痛
头疼，体重困倦，以为脾虚受湿，用芍药防风汤而愈。
太仆杨举元，先为饮食停滞，小腹重坠，用六君子加升麻、柴胡渐愈。后饮食难化，大便患泄泻，心腹作
痛，饮食不甘，用和中丸倍加益智仁而寻愈。
光禄杨立之，元气素弱，饮食难化，泄泻不已，小便短少，洒淅恶寒，体重节痛，以为脾肺虚，用升阳益
胃汤而痊。大凡泄泻，服分利调补等剂不应者，此肝木郁于脾土，必用升阳益胃之剂。
一儒者季夏患泄泻，腹中作痛，饮食无味，肢体倦怠，用补中益气汤、八味地黄丸，月余而痊。后彼云∶
每秋间必患痢，今则无恙，何也？曰∶此闭藏之月，不远帏 ，妄泄真阳而然。前药善能补真火，火能生土，
脾气生旺而免患也。
宪副屠九峰，先泻而口渴，尺脉数而无力。恪用解酒毒利小便之剂，不应。曰∶此肾阴亏损，虚火炽甚。
宜急壮水之主，不然必发疽，而不能收敛也。不信，别服降火化痰之剂，果发疽而殁。
缪仲淳治无锡秦公安，患中气虚，不能食，食亦难化，时作泄，胸膈不宽。一医误投枳壳、青皮等破气药，
下利完谷不化，面色黯白。乃用人参四钱，白术二钱，橘红一钱，干姜七分，甘草炙一钱，大枣、肉豆蔻四五
剂，渐加参至一两而愈。三年后，病寒热不思食，一医欲用参。仲淳至曰∶此阴虚证也，不宜参。乃用麦冬、
五味、牛膝、枸杞、白芍、茯苓、石斛、枣仁、鳖甲，十余剂愈。（《广笔记》。）
从妹患泄后虚弱，腹胀不食，季父延诸医疗之。予偶问疾，见其用二陈汤及枳壳、山楂等味，予曰∶请一
看病者。见其向内眠卧，两手置一处，不复动，曰∶元气虚甚矣，法宜理中汤。恐食积未尽，进以人参三钱，
橘红二钱，加姜汁、竹沥数匙，夜半食粥，神思顿活。季父大喜，尽谢三医。再以六君子汤加山楂、砂仁、麦
冬调理之，数剂立起。（同上。）
朱丹溪治一老人，奉养太过，饮食伤脾，常常泄泻，亦是脾泄。白术二两，白芍、神曲、山楂、半夏各一
两，黄芩五钱。上为末，荷叶包饭，烧为丸。（《平治会萃》。）
聂久吾治卢陵尹之岳，素以善医名，患伤感泄利，自治不效。脉之，知其原感风寒，未经发汗，久则入里，
郁为温热。又内伤饮食，脾胃不和，是以下泄。乃先与清解，涤其入里之邪。前胡、甘草、麦冬、连翘、赤芍、
赤茯苓、花粉、广皮、山楂、浓朴、黄芩、干葛、黄连、枳壳、生姜。次日再诊，知其热郁已去，脾胃虚滑，
用补脾药，一剂而安。
魏玉横曰∶宋复华兄尊堂，年七十，体素肥，长夏病泄泻。诊之曰∶此肝木乘脾也。（雄按∶所云肝木乘脾，
实皆乘胃之症也，故润药相宜。如果乘脾，则参、术又为主药矣。）宜养肝肾则愈，勿治脾。与数剂，病已略减。
Binglang (Areca Seed) and Muxiang (Aucklandia Root), after one dose, revealed the presence of stagnation. The patient feared the drugs were too draining and intended to use tonics. The physician said: "When there is disease, take the corresponding medicine. When pathogenic factors are rampant, urgent attack is required for resolution. Once pathogens recede, healthy qi recovers; attacking is also tonifying." Take the previous prescription for three more doses to be cured. If not attacked early, phlegm disorders will surely result, taking a month to recover.
Xie Wugong suffered from loose stools and cough. Cooling herbs reduced the cough but increased diarrhea; warming herbs reduced diarrhea but worsened the cough; spleen-tonifying herbs exacerbated both. Pulse diagnosis showed the right Chixi (Cunian) pulse soft as rotten cotton, and both Cun (Inch) pulses solid, rapid, and pounding against the finger. He prescribed Fuzi (Prepared Aconite Root) and Rouguo (Nutmeg) to warm the lower jiao cold, Maidong (Ophiopogon Tuber) and Chuanlian (Coptis Rhizome) to clear heart and lung fire, Fuling (Poria) and Gancao (Licorice Root), one to descend qi and one to harmonize the middle (Upper excess and lower deficiency, upper heat and lower cold, is a most thorny condition. Its medication rules are strict, serving as a model for students). After four doses, symptoms decreased significantly. Ginseng was omitted because of stagnant heat in the lungs.
Yu Jiayan treated Lady Hu who had occasional abdominal discomfort and several episodes of diarrhea. Physicians treated it with dysentery medicines, causing more discharge. Applying the method of "treating obstruction with unblocking agents," nine-steamed Dahuang (Rhubarb Root and Rhizome) pills were administered, which disturbed stomach qi, causing distension and pain, loss of appetite, resembling Jin Kou Li (Dysentery with inability to eat). Pulse diagnosis showed all six pulses deep and hidden, vague upon pressure. The physician said: "This is not dysentery, but a condition caused by mis-treatment. Now, only stabilize the stomach; do not treat the diarrhea directly, and it will stop spontaneously; do not treat the distension and pain directly, and they will resolve spontaneously." Si Jun Zi Tang (Four Gentlemen Decoction) was used as the main formula, with small amounts of Shengjiang (Fresh Ginger) and Doukou (Black Cardamom) to warm the stomach. After two doses, diarrhea ceased. However, due to persistent gastric distension and pain, the addition of qi-moving herbs was desired to facilitate eating. The physician firmly argued: "Better to delay eating than to rush with medication." Since previous medication errors had agitated stomach qi, adding more qi-movers would cause endless pain. Even Chenpi (Tangerine Peel) must be stir-fried repeatedly to avoid agitating qi. For five days, no bowel movement occurred, which was allowed. Pain stopped, distension subsided, appetite returned, and bowels moved freely. Fully recovered in seven days. This appeared to have no medicinal effect, yet it was the merit of non-action.
Lu Yangyu treated Xu Mo'an who had chronic Chang Feng (Intestinal Wind/Bleeding) and often took cooling herbs. In middle age, Chang Feng fortunately healed, but spleen and stomach were injured, leading to Xie Xie (Diarrhea). Initially, Wei Ling Tang (Stomach-Ling Decoction) worked in one dose, but later became ineffective. Recently, limbs became edematous and cold, abdomen distended and noisy, complexion sallow with bluish tinge, body felt cold yet hot. Pulse diagnosis: left pulse deep, slow, and delayed; right pulse deep, weak, and wiry. The physician said: "All slow pulses indicate dampness, corresponding to diarrhea and edema; all delayed pulses indicate cold, corresponding to cold limbs and aversion to cold; right wiry pulse indicates Liver Wood overacting on Spleen Earth, corresponding to abdominal distension and bluish face. Deep pulses indicate yang qi failing to ascend; weak pulses indicate yin essence failing to fill. Pulse and color correspond to symptoms. Ren Shen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Huangqi (Astragalus Root), and Zhi Gancao (Honey-fried Licorice Root) are used as sovereigns to tonify deficiency; Pao Jiang (Fried Ginger) and Fuzi (Prepared Aconite Root) as ministers to warm cold; Shengma (Cimicifuga Rhizome) and Fangfeng (Saposhnikovia Root) as assistants to raise yang; Fuling (Poria) and Zexie (Alisma Rhizome) as guides to overcome dampness. After ten doses, symptoms decreased. Ba Wei Wan (Eight-Ingredient Pill) was taken intermittently until recovery."
Shen Shaoxi's daughter, aged twenty, had damaged spleen and stomach since childhood, suffering from intermittent diarrhea and vomiting. Recently, she experienced irregular chills and fever, cold extremities, chest oppression, hypochondriac distension, and belching. Lying on the left side obstructed qi flow, causing intermittent pain in the left hypochondrium and epigastrium. She was thirsty but did not desire to drink, had scanty urine, and passed stool two to three times daily. Abdomen sounded like a drum when tapped and gurgled like water when rubbed. Generally, qi blocking upwards causes distension and pain; qi sinking downwards causes diarrhea and pain. Fortunately, food intake was not significantly reduced. She had frequently taken Wei Ling Tang, Baizhu, Huanglian (Coptis Rhizome), and digestive aids, or qi-regulating and blood-nourishing preparations, without effect. It was stated that this condition requires Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) to be effective, but since there is slight exterior pathogen, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Jiegeng (Platycodon Root) was given for two to three doses. As chills and fever缓和 (harmonized), the formula was changed to Tiao Zhong Yi Qi Tang (Regulate the Middle and Boost Qi Decoction) removing Huangbai (Phellodendron Bark), adding Qingpi (Green Tangerine Peel) to subdue liver, Shenqu (Medicated Leaven) to assist spleen, and Pao Jiang (Fried Ginger) to warm the middle. After four doses, distension and pain decreased, stool became firmer, though slight chills and fever remained. The middle jiao was unstable and fluctuating, with no accumulation to purge; the method should be to tonify zang qi. Renshen (Ginseng Root), Huangqi (Astragalus Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Suanzaoren (Ziziphus Seed), Chaihu (Bupleurum Root), Yuanzhi (Polygala Root), Zhi Gancao (Honey-fried Licorice Root), Pao Jiang (Fried Ginger), and Longyanrou (Longan Aril) were used to greatly boost yuan qi and retreat deficient heat. After several doses, slight nighttime bloating occurred. Liu Jun Zi Tang (Six Gentlemen Decoction) material plus Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome), Shenqu (Medicated Leaven), Muxiang (Aucklandia Root), and Sharen (Amomum Fruit) were made into pills and taken alternately with decoctions. Within a month, she recovered.
Lu Zuyu treated the mother of Pan Guchen who suffered from long-term Pi Xie (Spleen Diarrhea). Eating more fruits worsened the diarrhea. Previously, due to abdominal pain during menstruation, she took blood-invigorating and blood-dispelling agents, resulting in continuous dripping, emaciation, fever, immobility, anorexia, shortness of breath, thirst, and insomnia. Taking blood-nourishing and spleen-tonifying herbs containing Maidong (Ophiopogon Tuber), Shengdi (Rehmannia Root), and Suanzaoren (Ziziphus Seed) failed to stop diarrhea and worsened thirst. Pulse diagnosis: Cun and Guan pulses on both sides were deficient and rapid; Chi pulses on both sides were faint and almost absent. This indicated deficiency of the lower origin, deficiency-cold of the middle qi, and flaming up of deficient fire. Renshen (Ginseng Root), Pao Jiang (Fried Ginger), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), Shanzha (Hawthorn Fruit), Muxiang (Aucklandia Root), Yiren (Coix Seed), Mutong (Akebia Stem), Shanyao (Dioscorea Rhizome), Gancao (Licorice Root), and Kouren (Cardamom Seed) were taken with good effect. Rouguo (Nutmeg), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Pao Jiang (Fried Ginger), and Zaorou (Jujube Flesh) were made into pills, taken twice daily. Diarrhea stopped in one month, muscles grew back in two months, and menstruation regulated.
Huang Lvusu said: In the summer of Yisi year, I suffered from Zhongwan (Middle Epigastrium) pain followed by diarrhea. I met a famous physician in Suzhou who diagnosed me. Startlingly, he said: "Spleen and stomach have been injured for a long time; if untreated, it will become Zhixia (Dysentery)." My constitution was weak, and I feared attacking drugs. Due to his fame, I was confused and took Zhishi (Immature Bitter Orange), Baizhu (Atractylodes Macrocephala Rhizome), Huanglian (Coptis Rhizome), Houpo (Magnolia Bark), Shanzha (Hawthorn Fruit), Mutong (Akebia Stem) for several doses, and Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) for a month, severely damaging spleen and stomach. That autumn, I suffered from continuous loose stools, difficulty digesting food, fullness and bloating, and deep regret. I then took Renshen (Ginseng Root) and Huangqi (Astragalus Root) and Ba Wei Wan (Eight-Ingredient Pill) for over ten years before recovering. However, middle qi never fully recovered; I suffered from intolerance to hunger. Any slight hunger caused severe middle qi deficiency and exhaustion. Any Hawthorn or digestive items caused immediate deficiency upon ingestion. Thus, spleen and stomach cannot be recklessly attacked. Formulas praise Zhizhu Wan highly, but who knows that even with much Baizhu (Atractylodes Macrocephala Rhizome), it cannot overcome the swift action of Zhishi (Immature Bitter Orange). My friend Hu Xiaoyuan also fell seriously ill from mistakenly taking Zhizhu Wan, proving this pill is definitely not a spleen-tonifying drug. It may be taken occasionally once or twice for food stagnation.
He also said: Spleen and stomach prefer warmth and dislike cold; spleen deficiency requires warming herbs. Or for food stagnation, take occasionally. I suffered from persistent vomiting, took Nie Jiyuan Wuqi Dan (Five Qi Pills) a few times, and it did not recur. Recently, I suffered from spleen disharmony and intermittent loose stools. Taking Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) for three days was ineffective. Taking Hu Yuichen Jin Qian Wan (Golden Lead Pill) one pill improved spleen qi immediately, granting peace for two to three months. A nun in my family suffered from severe spleen disease, with anus prolapse and leakage of foul fluid. One Jin Qian Wan (Golden Lead Pill) caused the anus to retract, and she gradually recovered. Such miraculous efficacy proves that spleen diseases suit warming treatments.
Zhang Luyu treated General Chen with diarrhea, abdominal distension, and pain. After taking Huangqin (Scutellaria Root) and Baishao (White Peony Root), distension and urgency worsened. Pulse was surging, full, and rapid, but soft upon pressure. Qi Kou (Radial artery at the wrist) was three times larger than Ying Kou (Carotid artery). This indicated damp-heat injuring spleen and stomach qi. Houpo (Magnolia Bark), Shengjiang (Fresh Ginger), Banxia (Pinellia Tuber), and Renshen (Ginseng Root) Tang was given for two doses; diarrhea and dysentery stopped, but appetite remained poor. Banxia Xi Xin Tang (Pinellia, Cinnamon Twig, and Ginger Decoction) was given for two doses, bringing relief.
Chai Yuqing treated Scholar Yu Hequan with prolonged diarrhea after dysentery. Physicians gave Renshen (Ginseng Root) and Chuanlian (Coptis Rhizome) daily until death. Appetite was lost; urination urge preceded defecation. Upon consultation, Chi (Cheel) pulses on both sides were minute and nearly absent. Classics state: Kidney governs two passages. Also: Kidney controls opening and closing. Now kidney qi is insecure, hence bowel control is lost. Moreover, being over sixty, the general picture is known without pulse, confirmed by such pulse findings. Bu Zhong Yi Qi Tang (Supplement the Middle and Boost Qi Decoction) was used, plus Shu Fuzi (Prepared Aconite Root) 2 qian and Wei Rouguo (Nutmeg) 2 qian, delivered with Ba Wei Wan (Eight-Ingredient Pill). After two doses, he desired food, diarrhea stopped, and vitality returned. He admired a contemporary doctor who claimed one dose cures instantly; instead, he died after two doses. Regrettable.
Ma Cizhou's son suffered from fever and spleen diarrhea before the Jiazi examination. Doctors treated it as external contraction; multiple prescriptions failed. Renying (Carotid pulse) and Zuochi (Left Chi pulse) were flat and weak; Qikou (Radial pulse) was slightly slow. This belonged to deficiency of liver, kidney, spleen, and stomach. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) cooled the body in several doses. Removing Chaihu (Bupleurum Root) and adding Danggui (Angelica Sinensis Root) and Baishao (White Peony Root) regulated him to health. He passed the exam.
Zhang Sanxi treated a person with diarrhea, dry mouth, dry tongue, and surging-rapid pulse. Liu Yi San (Six-to-One Powder) was given; effective after one dose, cured after two. Another person did not respond; Qin Lian Si Wu San (Scutellaria, Coptis, and Four Substances Powder) was effective.
An old woman with chronic diarrhea did not respond to tonics. Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) plus Huanglian (Coptis Rhizome) and Rou Doukou (Nutmeg) in small amounts was made into pills. Taking less than half a jin cured her permanently.
Xue Lizhai treated Chen Zifu from Hengjin, with red face, phlegm spitting, dry mouth, and intermittent diarrhea. Er Chen Tang (Two-Aged Decoction), Huanglian (Coptis Rhizome), Zhishi (Immature Bitter Orange) were ineffective. Pulse: Left Guan was wiry and urgent; Right Guan was wiry and large. This was Kidney Water carrying Liver Wood to overwhelm Spleen Earth. He did not believe it. Entering summer, he indeed developed dysentery and died.
Lou Quanshan treated Weng Zhongzheng with chronic diarrhea, passing one or two stools every morning, feeling lighter after defecation, pulse soft and slightly weak. First, Houpo He Zhong Wan (Magnolia Bark and Harmonizing Middle Pill) fifty pills were given to purge heavily. Then, Baizhu (Atractylodes Macrocephala Rhizome) as sovereign, Zhike (Bitter Orange Peel), Fuling (Poria), Banxia (Pinellia Tuber) as ministers, Houpo (Magnolia Bark), Zhi Gancao (Honey-fried Licorice Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Chuanxiong (Ligusticum Rhizome), Huashi (Talcum) as assistants, Wuzhuyu (Evodia Fruit) over ten grains as guides, decocted with Shengjiang (Fresh Ginger). Over ten doses cured it. (Treated as food stagnation injuring spleen.)
Luo Qianfu said: In Ding Si year, I traveled to Kaizhou. In summer, Qianhu Gao Guoyong told me: "My father is seventy-three. Last July, due to internal injury from diet and continuous rain, he suffered sudden violent diarrhea. Doctors stopped it with medicine. Not long after, injury and diarrhea recurred, stopping then injuring again. By October, limbs were emaciated, fatigue in four limbs, reduced appetite, abdominal pain, and borborygmus. Doctor Li treated with Yang Zang Tang (Nourish Viscera Decoction); diarrhea stopped in days, but vomiting ensued. Doctor Wang used Dingxiang (Clove), Renshen (Ginseng Root), Huoxiang (Patchouli), Juhong (Pomelo Peel), Gancao (Licorice Root), powdered and decocted with ginger; vomiting stopped after several doses. By January this year, no food intake, needing support to rise. Days later, no bowel movement. Doctor said: 'Elderly over seventy, blood and qi both weak, diarrhea for half a year, spleen and stomach long deficient, fluids consumed. Hemp seed pill can moisten.' Someone recommended Niu Shanshan from Fengcun, decisive and accurate. Pulse and history taken, he said: 'This is wind constipation.' Over a hundred Sou Feng Wan (Wind-Expelling Pills) were given; several diarrheal movements followed, then death. Great regret, dare to ask." I said: "Humans rely on water and grain as root. Now, an elderly person with long diarrhea has depleted stomach fluids; heavy purging leaves spirit without foundation. Ling Shu Jing says: 'If form and qi are insufficient, and disease qi is insufficient, yin and yang both exhaust, blood and qi both finish, five viscera empty, sinews, marrow, and bone wither. Elderly perish, young do not recover.' Also: 'Superior physicians regulate qi, medium physicians disorder pulse, inferior physicians cut off qi and endanger life.' Cutting off qi and endangering life refers to Niu Shanshan."
Commentary: Niu Shanshan is hardly worth discussing regarding this case. Doctors Li and Wang previously only knew to treat vomiting and diarrhea, unaware that excessive downward discharge injures yin. They aggressively used aromatic-dry herbs, leading to organ and腑 depletion, upper rejection of food, and lower blockage of excretion. Their approach was similar to Niu's. At that time, even Master Luo did not know how to use harsh herbs to nourish ying qi, let alone others. I have a case treating Sister Song Fuhua's mother for reference.
Miao Zhongchun treated a vegetarian woman from Liangxi with internal heat, borborygmus after eating, and morning watery diarrhea. Taught to take Pi Shen Shuang Bu Wan (Spleen-Kidney Dual Tonifying Pill), cured immediately. Renshen (Ginseng Root) 1 jin, Lianrou (Lotus Seed) 1 jin, Tusizi (Dodder Seed) 1.5 jin, Wuweizi (Schisandra Berry) 6.5 liang, Yurou (Cornus Fruit) 1 jin, Shanyao (Dioscorea Rhizome) 1 jin, Cheqian (Plantago Seed) 12 liang, Juhong (Pomelo Peel) 6 liang, Sharen (Amomum Fruit) 6 liang, Bajitian (Morinda Root) 12 liang, Buguzhi (Psoralea Fruit) 1 jin, Baishao (White Peony Root) 10 liang, Bidou (Lablab Bean) 12 liang. Honey pills, size of mung bean. 5 qian each, fasting and with meals. If deficiency with fire, or excessive fire-lung heat, remove Renshen (Ginseng Root) and Bajitian (Morinda Root), add Buguzhi (Psoralea Fruit). One formula has Rou Doukou (Nutmeg), no Baishao (White Peony Root) or Bidou (Lablab Bean). (Guang Biji.)
In July of Kaiqing Jiwei year, Madam Fei, wife of Ma Guanwen, suffered from weak qi, fatigue, cold extremities, aversion to cold, spontaneous sweating, and anorexia. One doctor treated as Fu Shu (Hidden Summerheat), giving summerheat drugs. Another treated as deficiency-cold, giving warming drugs; both ineffective. I was summoned. Six pulses were weak, but Guan (Carpel) pulse particularly strong, indicating middle jiao cold. Middle jiao is spleen. With spleen-stomach cold, besides these symptoms, abdominal pain, vomiting, and diarrhea must exist. Cold extremities belong to spleen; spleen-stomach deficiency-cold is undeniable. Answer: No abdominal pain, vomiting, or diarrhea seen. What medicine? Answer: Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle). Before taking medicine, abdominal pain and diarrhea suddenly occurred. Everyone marveled. The medicine was prepared; one dose cured. (Liang Fang.)
Chen Liangfu treated Prefect Zhao and his wife with incessant diarrhea. Fuzi (Prepared Aconite Root), Muxiang (Aucklandia Root), Hezi (Chebula Fruit), Rou Doukou (Nutmeg), Longgu (Fossil Bone), and various pills were ineffective. Diagnosis: Liver and kidney pulses were weak; this is liver-kidney deficiency. Prefect asked: Which meridian does this theory belong to? Answer: All formulas discuss diarrhea only mentioning spleen-stomach disease, attributing it to wind-cold-damp-toxin invasion or dietary injury. Intestinal wind causes diarrhea, but liver-kidney qi deficiency also causes diarrhea. Ancient texts are clear; this must be distinguished. Classics say: Diarrhea and dysentery continuing endlessly is kidney deficiency. Also: All厥 (cold extremities), retention, and diarrhea belong to the lower. Lower refers to lower jiao liver-kidney qi. The gate and key are liver qi. Guarding below is kidney qi. Liver qi rebels upward, unable to secure and stop diarrhea. Kidney is the stomach's gate; if the gate is loose, the warehouse is not stored. If suffering from diarrhea, the source may lie here. Treating solely with spleen-stomach herbs is a thousand-li error. Mu Xiang San (Aucklandia Powder) was taken; several doses cured.
It is traditionally said that some elderly people look like youths because they moxa Shenque (Navel) point with rat feces once yearly. I once suffered from chronic loose stools. Moxibustion for thirty-seven cones one night prevented the next day's toilet visit. Continuous nights' moxa prevented bowel movements for several days. This verifies classics stating Shenque treats incessant diarrhea. Also, past middle age, I felt weakness in left hand and foot; accidental moxa here cured it.
Xue Lizhai treated Vice Commissioner Gao Ruizhai with indigestion, abdominal pain, and diarrhea. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Sharen (Amomum Fruit) and Muxiang (Aucklandia Root) cured him. Relapse occurred with undigested food in stool, abdominal pain, headache, heaviness, and fatigue. Considered spleen deficiency with dampness; Shao Yao Fang Feng Tang (Peony and Saposhnikovia Decoction) cured him.
Taipu Yang Juyuan first had food stagnation with heavy sensation in lower abdomen. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root) gradually improved. Later, indigestion, diarrhea, heart-abdominal pain, and poor taste in food. He Zhong Wan (Harmonizing Middle Pill) with doubled Yizhiren (Bitter Apricot Seed) quickly cured him.
Guanglu Yang Lizhi had weak yuan qi, indigestion, persistent diarrhea, scanty urine, aversion to cold, heaviness, and joint pain. Considered spleen-lung deficiency; Sheng Yang Yi Wei Tang (Raise Yang and Benefit Stomach Decoction) cured him. Generally, for diarrhea unresponsive to diuretic and regulating tonics, this is liver wood depression on spleen earth; Sheng Yang Yi Wei Tang (Raise Yang and Benefit Stomach Decoction) is necessary.
A scholar suffered from summer diarrhea, abdominal pain, tasteless food, and limb fatigue. Bu Zhong Yi Qi Tang (Supplement the Middle and Boost Qi Decoction) and Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) cured him in a month. Later he asked: Why no dysentery in autumn now? Answer: Autumn is the month of storage. Avoiding sexual indulgence preserved true yang. Previous medicines tonified true fire; fire generates earth, strengthening spleen qi and preventing disease.
Vice Commissioner Tu Jiufeng had diarrhea followed by thirst, Chi (Cheel) pulse rapid and weak. Strictly used alcohol-detoxifying and diuretic agents; ineffective. Said: This is kidney yin deficiency with fierce deficient fire. Urgently strengthen the master of water, otherwise abscess will develop and fail to heal. He did not believe, took fire-descending and phlegm-resolving agents, indeed developed abscess and died.
Miao Zhongchun treated Qin Anquan from Wuxi with middle qi deficiency, inability to eat, difficult digestion, intermittent diarrhea, and chest oppression. A doctor mistakenly gave Zhike (Bitter Orange Peel) and Qingpi (Green Tangerine Peel) breaking-qi drugs. Downward discharge of undigested food, dark white complexion. Renshen (Ginseng Root) 4 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian, Juhong (Pomelo Peel) 1 qian, Ganjiang (Dried Ginger) 7 fen, Zhi Gancao (Honey-fried Licorice Root) 1 qian, Dazao (Jujube) and Rou Doukou (Nutmeg) for four to five doses. Renshen (Ginseng Root) gradually increased to 1 liang until cured. Three years later, chills, fever, and anorexia. A doctor wanted to use Renshen (Ginseng Root). Zhongchun arrived and said: This is yin deficiency; Renshen (Ginseng Root) is unsuitable. Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Niuxi (Achyranthes Root), Gouqi (Goji Berry), Baishao (White Peony Root), Fuling (Poria), Shihu (Dendrobium Stem), Suanzaoren (Ziziphus Seed), Biejia (Turtle Shell) were used for over ten doses until cured. (Guang Biji.)
My cousin suffered from weakness, abdominal distension, and anorexia after diarrhea. My uncle invited many doctors. I happened to inquire, seeing them use Er Chen Tang (Two-Aged Decoction), Zhike (Bitter Orange Peel), Shanzha (Hawthorn Fruit). I said: Let me see the patient. She lay inward, hands together, motionless. I said: Yuan qi is extremely deficient; Li Zhong Tang (Center-Warming Decoction) is indicated. Fearing incomplete food stagnation, Renshen (Ginseng Root) 3 qian, Juhong (Pomelo Peel) 2 qian, plus ginger juice and bamboo sap were given. Midnight porridge restored mental clarity. Uncle was delighted, thanked three doctors. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shanzha (Hawthorn Fruit), Sharen (Amomum Fruit), Maidong (Ophiopogon Tuber) regulated her; several doses raised her. (Ibid.)
Zhu Danxi treated an elderly man whose excessive nourishment injured spleen with diet, causing frequent diarrhea, also Pi Xie (Spleen Diarrhea). Baizhu (Atractylodes Macrocephala Rhizome) 2 liang, Baishao (White Peony Root), Shenqu (Medicated Leaven), Shanzha (Hawthorn Fruit), Banxia (Pinellia Tuber) 1 liang each, Huangqin (Scutellaria Root) 5 qian. Powdered, wrapped in lotus leaf with rice, roasted into pills. (Pingzhi Huicui.)
Nie Jiuwu treated the father-in-law of Magistrate Lu Ling, famous for medical skill, who suffered from wind-cold-diarrhea. Self-treatment failed. Pulse diagnosis revealed original wind-cold invasion, un-sweated, entering interior, stagnating as warm-heat. Internal dietary injury caused spleen-stomach disharmony, leading to downward discharge. First, clearing and resolving herbs were given to wash out interior pathogens: Qianhu (Peucedanum Root), Gancao (Licorice Root), Maidong (Ophiopogon Tuber), Lianqiao (Forsythia Fruit), Chishao (Red Peony Root), Chifuling (Red Poria), Huafen (Trichosanthes Root), Guangpi (Tangerine Peel), Shanzha (Hawthorn Fruit), Houpo (Magnolia Bark), Huangqin (Scutellaria Root), Gegen (Kudzu Root), Huanglian (Coptis Rhizome), Zhike (Bitter Orange Peel), Shengjiang (Fresh Ginger). Next day, heat stagnation gone, spleen-stomach deficient and slippery. Spleen-tonifying herbs cured in one dose.
Wei Yuheng said: Brother Song Fuhua's mother, aged seventy, constitution fat, suffered diarrhea in midsummer. Diagnosis: Liver wood overacting on spleen. (Xiong Note: What is called liver wood overacting on spleen is actually overacting on stomach, so moistening herbs are suitable. If truly overacting on spleen, Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) would be main herbs.) Tonifying liver and kidney would cure; do not treat spleen. Several doses given, illness slightly decreased.