【脉】 脉疾身多动，音声响亮，暴注下迫，此阳也、热也。脉沉细疾，目睛不
了了，饮食不下，鼻准气息，此阴也、寒也。
【因】 湿多成五泄者，胃泄、脾泄、大肠泄、小肠泄、大瘕泄。
【证治】 胃泄，饮食不化、色黄，宜承气汤。
脾泄，腹胀满，泄注食呕吐逆，宜理中汤。一云，肠鸣食不化者，经云脾虚。
大肠泄；食已窘迫，大便色白，肠鸣切痛，宜干姜附子汤。
小肠泄，溲便脓血，小腹痛，宜承气汤。
大瘕泄，里急后重，数圊不得，茎中痛，宜五苓散。
五病治虽不同，其湿一也。有化寒、化热之异故也。虚则无力，不及拈衣而已出，故谓
之不禁故也。温之、热之；实则圊不便，虚坐努责，宜下之。
痰积下流，因太阴分有积痰，肺气不得下流降而瘀，大肠虚而作泄，当治上焦，以萝卜
子等吐之。
水恣泄，乃大引饮，是热在膈上，水多入下，胃经无热不胜。寒泄，大肠满而泄 溏。
风泄，久风为飧泄，乃水谷不化而出也，防风为君。
平胃五苓散 治湿泄、水恣泄、热泄。此方治一切阳证。
平胃散、五苓散、白术。热，加黄连、木通。
补胃丸 治气虚下溜。
四君子、白芍（炒）、升麻。
流积丸 治痰积下流。甚则吐之。
青黛 黄芩 海石 神曲 砂仁
止泻丸 肉豆蔻（五两） 滑石（春一两，夏二两，秋一两半）
寒，加神曲、砂仁、吴茱萸；热，加黄连、茯苓；滑，加诃子（煨）。
温六丸 清六丸
脾泄丸 白术（二两，炒） 白芍（一两，酒炒） 神曲（一两半，炒） 查子 半夏
（一两半） 黄芩（半两，炒） 苍术
虚，加参、术、甘草；里急后重，加槟榔、木香、荷叶煨饭丸。
姜附汤 治寒泄。
椒术丸 治湿泻。
川椒 苍术 肉果。
胃风汤 治风泄。
太平丸 治泄。
黄连
一方与干姜炮各一两，或加诃、归，名驻车丸；一方与茱萸各一两，或加芍药，又名苦
散。
肠鸣，乃湿与热相搏也；或大热亦然；或饮水亦鸣。
许论 泄泻有八。冷泻，脉微，宜暖药。热泻，胃中有热，伤寒多有脉数，宜凉
解之。积泻
，脾脉沉弦，宜逐积。脾泻，同上条。气泄者，躁怒不常，伤动其气，肝气乘脾而泄，脉弦
而逆，宜调气。飧泄者，春伤于风，肝旺受病而传于脾，至季夏土而泄，宜泻肝补土。惊泻
者，因心受惊，惊则气乱，心气不通，水入谷道而泄，心脉散大者，是宜调心利水。病亟气
败而泻者，《素问》云∶门户不要也。
厥逆幽闷，困泻不止，四肢冷，困软不能转侧，下泄不知，脉亡阳，喘者死。
[Pulse] A rapid pulse accompanied by frequent body movements and a loud voice, along with sudden severe diarrhea and tenesmus (urgent feeling to defecate), indicates Yang syndrome and Heat syndrome. A deep, fine, and rapid pulse, blurred vision, inability to eat or drink, and weak breath at the nose tip indicate Yin syndrome and Cold syndrome.
[Etiology] Excessive dampness easily leads to five types of diarrhea: Wei (Stomach) diarrhea, Pi (Spleen) diarrhea, Dachang (Large Intestine) diarrhea, Xiaochang (Small Intestine) diarrhea, and Dajia diarrhea (a type characterized by tenesmus).
[Syndrome Differentiation and Treatment]
Wei (Stomach) diarrhea is characterized by undigested food in stool and yellowish color; it is suitable for treatment with Chengqi Tang (Purging Decoction).
Pi (Spleen) diarrhea presents with abdominal distension and fullness, watery diarrhea with vomiting and regurgitation; it is suitable for treatment with Lizhong Tang (Regulate the Middle Decoction). Another view states that borborygmus (intestinal rumbling) and undigested food indicate Spleen deficiency according to the classics.
Dachang (Large Intestine) diarrhea involves urgency after eating, white-colored stool, intense borborygmus, and cutting pain; it is suitable for treatment with Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction).
Xiaochang (Small Intestine) diarrhea presents with pus and blood in urine and stool, and lower abdominal pain; it is suitable for treatment with Chengqi Tang.
Dajia diarrhea is characterized by tenesmus (feeling of incomplete evacuation), frequent attempts to defecate with little output, and pain in the urethra; it is suitable for treatment with Wuling San (Five-Ingredient Powder with Poria).
Although the treatments for these five diseases differ, their pathogenic factor is dampness. The difference lies in whether it transforms into Cold or Heat. In deficiency cases, there is a lack of strength, and stool may leak out before one can lift their clothes, hence termed "incontinence." For deficiency-cold, warming and heating methods should be used. In excess cases, if defecation is difficult but there is straining without passage (false urge), purgative methods should be applied.
Phlegm accumulation flowing downward occurs when phlegm accumulates in the Taiyin channel, preventing Lung Qi from descending and causing stasis, while the Large Intestine becomes deficient leading to diarrhea. The upper Jiao should be treated first by inducing vomiting with seeds of Raphanus sativus (Radish seed) etc.
Water diarrhea results from excessive drinking; this indicates Heat above the diaphragm, where excessive water flows downward because the Stomach channel lacks Heat to counteract the Cold, leading to diarrhea. Cold diarrhea involves fullness in the Large Intestine and loose stools.
Wind diarrhea, caused by prolonged exposure to wind, results in undigested food in stool (canaval diarrhea); Fangfeng (Saposhnikovia Root) is used as the sovereign herb.
Formulas:
Pingwei Wuling San: Treats damp diarrhea, water diarrhea, and heat diarrhea. This formula treats all Yang syndromes.
Pingwei San (Calm the Stomach Powder), Wuling San, and Baizhu (Atractylodis Macrocephalae Rhizoma). If Heat is present, add Huanglian (Coptidis Rhizoma) and Mutong (Akebiae Caulis).
Bugwei Wan: Treats Qi deficiency with sinking.
Sijunzi Tang (Four Gentlemen Decoction), fried Baishao (Paeoniae Radix Alba), and Shengma (Cimicifugae Rhizoma).
Liujie Wan: Treats phlegm accumulation flowing downward. Severe cases require vomiting.
Qingdai (Indigo Naturalis), Huangqin (Scutellariae Radix), Haishi (Spongia), Shenqu (Massa Medicata Fermentata), and Sharen (Amomi Fructus).
Zhixie Wan: Roudoukou (Myristicae Semen, 5 liang), Huashi (Talcum, 1 liang in Spring, 2 liang in Summer, 1.5 liang in Autumn).
If Cold, add Shenqu, Sharen, and Wuzhuyu (Evodiae Fructus); if Heat, add Huanglian and Fuling (Poria); if slippery/incontinent, add roasted Hezi (Chebulae Fructus).
Wenliu Wan, Qingliu Wan.
Pixie Wan: Baizhu (2 liang, fried), Baishao (1 liang, wine-fried), Shenqu (1.5 liang, fried), Zhazhi (Crataegi Fructus), Banxia (Pinelliae Rhizoma, 1.5 liang), fried Huangqin (0.5 liang), Cangzhu (Atractylodis Rhizoma).
If deficiency, add Renshen (Ginseng Radix), Baizhu, and Gancao (Glycyrrhizae Radix et Rhizoma); if tenesmus is present, add Binglang (Arecae Semen) and Muxiang (Aucklandiae Radix), made into pills wrapped in lotus leaves with rice.
Jiangfu Tang: Treats cold diarrhea.
Jiaozhu Wan: Treats damp diarrhea.
Chuanjiao (Zanthoxyli Pericarpium), Cangzhu, and Roudoukou (Myristicae Semen).
Weifeng Tang: Treats wind diarrhea.
Taiping Wan: Treats diarrhea.
Huanglian.
One prescription combines fried Ganjiang (Dried Ginger) and Huanglian in equal amounts (1 liang each), or adds Hezi and Danggui (Angelicae Sinensis Radix), named Zhuche Wan (Stop Traveling Pill). Another prescription combines Huanglian and Wuzhuyu in equal amounts (1 liang each), or adds Shaoyao (Peony Root), also known as Kusan (Bitter Powder).
Borborygmus is caused by the struggle between Dampness and Heat; it can also occur with severe Heat or excessive water intake.
Xu Lun stated that there are eight types of diarrhea:
Cold diarrhea has a faint pulse and is suitable for warming herbs.
Heat diarrhea involves Heat in the Stomach; in Shanghan (Cold Damage) diseases, a rapid pulse is common, and cooling resolution is suitable.
Accumulation diarrhea has a deep and wiry Spleen pulse, and removing accumulation is suitable.
Spleen diarrhea follows the same principles as above.
Qi diarrhea is characterized by irritability and anger, damaging Qi; Liver Qi invades the Spleen causing diarrhea, with a wiry and rebellious pulse, so regulating Qi is suitable.
Canaval diarrhea results from Wind injury in Spring, where hyperactive Liver disease transmits to the Spleen, manifesting as diarrhea in late Summer when Earth is strong; draining the Liver and tonifying Earth is suitable.
Shock diarrhea results from Heart shock; shock causes Qi chaos, Heart Qi obstruction, and water entering the digestive tract causing diarrhea; if the Heart pulse is scattered and large, regulating the Heart and promoting urination is suitable.
Diarrhea due to critical illness and collapse of Qi is described in Suwen as "the gate cannot hold."
Cold limbs, darkness and oppression, continuous exhausting diarrhea, cold limbs, weakness unable to turn over, unconsciousness of defecation, pulse indicating Yang collapse, and panting indicate death.