失血虚痨。最忌泄泻。以脾胃败坏。不能任药。且少纳谷。胃气将绝故也。杂病泄泻。用参术姜苓。应手取效。
此则姜术补胃。转伤其阴。下咽之后。立见喘热。竟成枯骨矣。然使用滋阴之药。则脾已泻泄。益阴则愈动
其泻。势必土崩不救矣。病至此者。吾莫如之何也已。拟用黄土汤。作调停之计。效否不敢必也。
以上所论。乃虚极胃将绝之泻也。如非胃气将绝之泻。盒饭按证治之。毋得语断其死。以恐骇病患。
湿泻者。如水倾下。肠鸣身重。其腹不痛。胃苓汤主之。
风泄者。大便不聚。或带清血。八珍汤。加粉葛根丹皮防风白芷。
寒泄者。腹中切痛。雷鸣鸭溏。下利清白色。附子理中汤主之。六君子汤加姜附亦治之。
暑泄者。烦渴尿赤。暴泻如水。越鞠丸。加竹茹粉葛根连翘车前子牛蒡子白芍黄连扁豆枳壳浓朴生姜藿香。
飧泄者。米谷不化。香砂六君子治之。此与暴注完谷。为肺气迫下者不同。暴注则水与谷。食入即下为热
迫。三一承气汤。
食积泄者。泻后痛减。臭如抱坏鸡子。噫气作酸。失血虚人。停食作泻者尤多。宜逍遥散。或小柴胡汤。加山
楂神曲麦芽莱菔子治之。越鞠丸。平胃散皆治之。
又有泄血泄痢者。另详便血门。
又有肾泄。五更作泄。一名晨泄。乃色欲过度。足冷气虚所致。宜四君子汤。加熟地黄枸杞子菟丝子巴戟
天杜仲破故纸肉豆蔻五味子山茱萸治之。猪肾一枚。加故纸小茴香青盐烧服亦可。
In cases of consumptive disease (Xulao) resulting from blood loss, diarrhea is most contraindicated. This is because the Spleen and Stomach functions are deteriorating, rendering them unable to tolerate medication; furthermore, food intake is minimal, indicating that the Stomach Qi is on the verge of exhaustion. For general miscellaneous diseases involving diarrhea, prescriptions containing Ginseng Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Zingiberis Rhizoma (Ganjiang), and Poria (Fuling) often yield immediate results.
However, in such consumptive conditions, using Zingiberis Rhizoma (Ganjiang) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify the Stomach will inadvertently damage Yin. Immediately after swallowing the medicine, panting and fever may appear, ultimately leading to a withered, emaciated state resembling dry bones. Conversely, if yin-nourishing herbs are used, since the Spleen is already suffering from diarrhea, nourishing Yin will further aggravate the diarrhea, inevitably leading to a total collapse of the Earth element (Spleen/Stomach) that cannot be saved. When the disease reaches this stage, I have no other recourse. I propose using Huangtu Tang (Yellow Earth Decoction) as a mediating strategy, though efficacy is not guaranteed.
The above discussion pertains specifically to diarrhea occurring when deficiency is extreme and Stomach Qi is nearly exhausted. If it is not diarrhea due to impending exhaustion of Stomach Qi, treatment should be based on the specific syndrome differentiation. One must not arbitrarily pronounce death sentences, so as not to frighten the patient.
Diarrhea caused by Dampness is characterized by watery stool pouring down, heavy bowel sounds, heaviness of the body, and absence of abdominal pain. It is primarily treated with Weiling Tang (Stomach-Purging Decoction).
Diarrhea caused by Wind presents with unconsolidated stools, sometimes mixed with clear blood. It is treated with Bazhen Tang (Eight-Treasure Decoction) added with Kudzu Root (Ge Gen), Moutan Cortex (Dan Pi), Saposhnikovia Root (Fang Feng), and Angelica Dahurica Root (Bai Zhi).
Diarrhea caused by Cold involves severe cutting pain in the abdomen, rumbling bowel sounds like thunder, duck-like loose stools, and the passage of clear, white watery feces. It is primarily treated with Fuzi Lizhong Tang (Aconite Regulate-the-Middle Decoction). Liujunzi Tang (Six-Gentlemen Decoction) added with Zingiberis Rhizoma (Ganjiang) and Prepared Aconite Root (Fuzi) can also treat it.
Diarrhea caused by Summerheat manifests as irritability, thirst, dark urine, and sudden profuse watery diarrhea. It is treated with Yueju Wan (Yueju Pill) added with Bamboo Shavings (Zhu Ru), Kudzu Root (Ge Gen), Forsythia Fruit (Lian Qiao), Plantago Seed (Che Qian Zi), Burdock Fruit (Niu Bang Zi), White Peony Root (Bai Shao), Coptis Rhizome (Huang Lian), Coix Seed (Yi Yi Ren), Aurantium Fructus (Zhi Ke), Magnolia Bark (Hou Po), Fresh Ginger (Sheng Jiang), and Pogostemon Herb (Huo Xiang).
Sunxiexie (Incomplete Digestion Diarrhea) is characterized by undigested rice and grain in the stool. It is treated with Xiangsha Liujunzi Tang (Aromatic-Amomum Six-Gentlemen Decoction). This differs from sudden violent diarrhea with undigested food caused by Lung Qi forcing downward. In sudden violent diarrhea, water and food pass through immediately upon ingestion due to Heat forcing downward; this is treated with Sanyi Chengqi Tang (Three-One Purging-Decoction).
Diarrhea caused by Food Stagnation is characterized by pain relief after defecation, foul odor resembling rotten eggs, and sour belching. In patients with blood loss and deficiency, diarrhea due to retained food is particularly common. Xiaoyao San (Free and Easy Wanderer Powder) or Xiaochaihu Tang (Minor Bupleurum Decoction) added with Hawthorn Fruit (Shan Zha), Medicated Leaven (Shen Qu), Barley Sprout (Mai Ya), and Radish Seed (Lai Fu Zi) are suitable. Yueju Wan (Yueju Pill) and Pingwei San (Calm-the-Stomach Powder) are also effective.
Hemorrhagic diarrhea or dysentery are discussed separately in the section on Hematochezia.
Kidney diarrhea occurs at the fifth watch (around 3-5 AM) and is also known as morning diarrhea. It is caused by excessive sexual activity leading to coldness in the lower limbs and deficiency of Kidney Qi. It is treated with Sijunzi Tang (Four-Gentlemen Decoction) added with Prepared Rehmannia Root (Shu Di Huang), Goji Berry (Gou Qi Zi), Dodder Seed (Tu Si Zi), Morinda Root (Ba Ji Tian), Eucommia Bark (Du Zhong), Psoralea Fruit (Gu Zhi), Myristica Seed (Rou Dou Kou), Schisandra Fruit (Wu Wei Zi), and Cornus Fruit (Shan Zhu Yu). Alternatively, one pig kidney can be roasted with Psoralea Fruit (Gu Zhi), Fennel Seed (Xiao Hui Xiang), and Green Salt for consumption.