大意
湿胜则濡泻。（内经）脾土受湿。不能渗化。致伤阑门元气。不能分别水谷。并入大肠而泄泻。（指掌）泄者。大便
溏薄。泻者。大便直下。略分轻重。总属脾虚。（汇补）
内因
胃气和平。饮食入胃。精气则输于脾。归于肺。行于百脉而成营卫。若饮食起居内外之邪。伤于脾胃。传化
失节。清浊不分。上升精华之气。反下降而为泄泻矣。（机要）
外候
泄分五种。如脾泄。饮食不和。色黄。胃泄。腹胀注下。食则呕吐。大肠泄。食已窘迫。色白。肠鸣切痛。小肠泄。
溲涩。便脓血。小腹痛。大瘕泄。里急后重。数至圊而不能便。茎中痛。（难经）又有飧泄、肠垢、鸭溏、濡泄、滑泄之
名。
飧泄者。湿兼风也。故恶风自汗。完谷不化。肠鸣脉弦。肠垢者。湿兼暑也，故稠粘垢秽。小水赤涩。烦渴脉数。
鸭溏者。湿兼寒也。故澄彻清冷。俨如鸭粪。溺白脉迟。濡泄者。湿邪自甚也。故泻多清水。肠鸣身重。溺短脉
沉。滑泄者。湿胜气虚也。故所下不禁。大孔如竹筒。直出不止。又食积泄者。泻下腐臭。噫气作酸也。痰泄者。
或多或少。胸闷泻沫。火泄者。暴注下迫。焦黄秽臭。气泄者。腹常痞满。去不通泰。虚泻者。困倦无力。食减微
溏。必兼体瘦。 泻者。停蓄饮食。数日一泻。必兼腹胀。肾泄者。五更腹痛。微响乃泄。必兼足冷。肝泄者。忿怒
所伤。厥而面青。必兼胁满。交肠泻者。大小便易位而出。直肠泻者。饮食入口。少顷即泻。（汇补）
泻分久暴
暴注下迫。食不及化。是无水也。溏泄日久。止发无恒。是无火也。（太仆）
腹痛分辨
泻不腹痛者。湿也。泻白腹痛者。寒也。痛一阵。泻一阵。泄复涩滞者。火也。痛一阵。泻一阵。泻后痛减者。食
也。腹中胀痛。泻不减者。肝气也。腹中绞痛。暴泻烦渴者。霍乱也。腹中绞痛。下无休时。去如蟹渤者。气食交并
也。腹中觉冷。隐隐微痛。下如稠饮者。痰也。（戴氏）
寒热分辨
热者。小便赤涩。烦渴。肛门热。谷食腐化。或虽不化。而色变焦黄。身能动作。手足温暧。寒者。小便清白。不
渴。腹中冷。完谷不化。色亦不变。变亦白色。身懒动作。饮食不下。手足清冷。（河间）
肠鸣分辨
湿多成五泻。肠走若雷奔。此寒湿之患。然亦有火势攻冲。抟击水气而鸣者。必兼腹痛。暴注下迫。肛门涩
滞。小水色黄。非若湿症之腹不痛也。（汇补）
完谷分辨
完谷不化。其因有四。曰气虚。曰胃寒。曰胃火。曰胃风。夫气虚胃寒。固不能传化矣。火者。火性急速。传运失
常。即邪热不杀谷也。至于胃风者。肝风传脾。脾受其克。不能变化。名为飧泄。乃五泄之一也。（医统）
泄泻死症
脉细。皮寒。少气。泄利前后。饮食不入。是谓五虚者死。其浆粥入胃。泄注止。则虚者活。（素问）
脉法
泻脉自沉。沉迟寒侵。沉数火热。沉缓湿邪。沉虚滑脱。凡泄注沉缓弱小者生。浮大弦数者死。（汇补）
治法
凡泻皆兼湿。初宜分理中焦。次则分利下焦。继以风药燥湿。久则升举元气。滑脱不禁。然后涩之。其间风
胜。兼以解表。寒胜。兼以温中。虚弱补益。食积消导。湿则淡渗。火则清凉。痰则涌吐。陷则升提。随症而用。不
拘次序。（汇补）
治审虚实
下积如稠脓者。消化为上。去薄而小便短少者。利水为捷。若小便如常。不必再利。惟燥脾而已。如兼口渴。
则利水与燥脾。皆不可用。但审溺赤为有热。如溺短而色不变。则补益无疑也。（汇补）
郁结当开
忧思太过。脾气结而不能升举。陷入下焦而泄泻者。宜开郁结。使气升而谷自化。（汇补）
郁热当清
有肺热闭锢。咳嗽胸满。误服参、术。使肺中之热。回奔大肠而泻者。当先清肺金。然后和脾。（汇补）
泄泻忌用
补虚不可纯用甘温。太甘则生湿。清热不可纯用苦寒。太苦则伤脾。兜涩不可太早。恐留滞余邪。淡渗不
可太多。恐津枯阳陷。（必读）
用药
主以茯苓、白术。加陈皮、半夏。湿加猪苓、泽泻。火加黄连、白芍。寒加炮姜、益智。风加防风、苍术。食加枳
实、浓朴。食积加楂肉、麦芽。气虚加人参、黄 。气陷加升麻、柴胡。泄久脾虚。饮食难化。加参、 、神曲、麦芽、
干姜。泄久肠滑。加肉果、诃子、木香。有夏月暴注水泄。用香薷散、益元散。有肾脾两虚。每朝五更洞泻。用四神丸、
浆水散。有经年脾泻。用桂香丸、椒附丸。有痰积肺中。魄门不禁。用二陈加防风、桔梗探吐。有肺热移肠。下为
肠癖。用黄芩、地骨皮、阿胶、百合、兜铃、甘草。有酒积作泻者。五更腹鸣作痛。泻下黄赤。此酒湿入脏所致。非
肾虚者比也。宜四苓、葛花。或金匮泽泻汤加萆 之类。凡煎泻药。用甘澜水者。取其不助湿而益脾胃也。
（汇补）
泄泻选方
白术茯苓汤 统治泄泻。
白术 茯苓 甘草
胃苓汤
即五苓合平胃散
益元散（方见暑症） 理中汤（方见中寒）
香薷饮 治夏月暑泻（方见暑症）
四苓散 治清浊不分。因作泄泻。
茯苓 猪苓 白术 泽泻
加桂。名五苓散。
白术散
白术 芍药（各三钱） 炮姜（五钱） 甘草（二两）
每服二钱。水煎。
桂枝汤
桂枝 白芍 白术（各五钱） 炙草（二钱）
每服五钱。水煎。
术附汤
白术 附子 甘草
连理汤
即理中加茯苓、黄连。
五味子散 治肾虚人感阴气。而每泄于五更者。
五味（二两） 吴萸（五钱）
炒研末。每服二钱。陈米饮下。加补骨、肉果。名四神丸。
参附汤
人参（一两） 附子（五钱）
每服五钱。加姜十片煎。
二神丸 治脾肾虚泄。五更肠鸣。
补骨脂（四两） 肉豆蔻（二两）
加五味子二两。吴茱萸五钱。名四神丸。
四柱散 济生治脏腑虚冷。真阳耗散。脐腹冷痛泄泻。
茯苓 附子 人参 木香（各一两）
每服三钱。姜五片。加肉果、诃子。名六柱散。活人方有白术。无诃子。
浆水散（洁古） 治脾土阴寒。水泻清冷。
半夏（二两） 良姜（二钱半） 干姜 肉桂 甘草 附子（各五钱）
为末。每服三钱。
椒朴丸（魏氏）
益智 川椒（炒） 浓朴 陈皮 白姜 茴香（炒各等分）
上用青盐。于银石器内。以水浸干药。用火煮干。焙燥为末。酒糊丸。盐汤下。
椒附丸 治肾脏虚寒。大便久泻。
椒红（炒） 熟附 鹿茸（焙） 桑螵蛸（炙） 山药 山萸 龙骨（ ）
桂香丸（三因） 治脏腑虚寒。为风寒所迫。冷滑注下。老人虚人。危笃。累效。
附子 肉豆蔻 茯苓（各一两） 桂心 干姜 木香（各半两） 丁香（二钱半）
为末。面糊丸。米饮下五十丸。
戊己丸（和剂） 治脾胃不足。湿热下乘而泄。
黄连 吴萸 白芍（各等分）
为末。面糊丸。如梧子大。米饮下。
温六丸（丹溪） 治湿热气滞。用为向导。上可治吞酸。下可治自利。
六一散（七两） 干姜（一两）
末之。粥丸。一方。去干姜。加吴萸二两。名参萸丸。
节斋泄利方
白术 茯苓 半夏 陈皮 甘草 砂仁 神曲 麦芽
[General Principle]
Excess dampness leads to loose stools and diarrhea (Xie Xie). When the Spleen Earth is affected by dampness, it fails to transform and transport fluids properly. This damages the Yuan Qi at the Lanmen (the junction between the small intestine and large intestine), preventing the separation of clear and turbid food and fluids. Consequently, these mixtures enter the large intestine, causing diarrhea. "Xie" refers to loose, unformed stools, while "Xie" (in the context of heavy diarrhea) refers to watery stool flowing down directly. Although there are slight differences in severity, they all fundamentally belong to Spleen deficiency.
[Internal Causes]
If Stomach Qi is harmonious, food entering the Stomach allows its essence to be transported to the Spleen, returned to the Lung, and circulated through the vessels to form Ying (Nutritive Qi) and Wei (Defensive Qi). However, if improper diet or lifestyle, along with internal or external pathogenic factors, injure the Spleen and Stomach, leading to disordered transformation and transportation, the clear and turbid will not separate. The essence that should ascend instead descends, resulting in diarrhea.
[External Manifestations]
Diarrhea is classified into five types:
1. Spleen Diarrhea: Indigestion, yellow complexion.
2. Stomach Diarrhea: Abdominal distension, urgent diarrhea, vomiting after eating.
3. Large Intestine Diarrhea: Urgency and pain after eating, white stool, borborygmus with severe pain.
4. Small Intestine Diarrhea: Dysuria, pus and blood in stool, lower abdominal pain.
5. Da Jia Diarrhea (Severe Tenesmus): Tenesmus, frequent trips to the toilet with little output, pain in the urethra.
Other names include Sun Xie (Sporadic Diarrhea), Chang Gou (Intestinal Mucus), Ya Tang (Duck-like Loose Stool), Ru Xie (Soft Diarrhea), and Hua Xie (Slippery Diarrhea).
- Sun Xie: Dampness combined with Wind; symptoms include aversion to wind, spontaneous sweating, undigested food in stool, borborygmus, and a wiry pulse.
- Chang Gou: Dampness combined with Summerheat; symptoms include thick, sticky, foul stool, dark and scanty urine, irritability, thirst, and a rapid pulse.
- Ya Tang: Dampness combined with Cold; symptoms include clear, cold, duck-like stool, white urine, and a slow pulse.
- Ru Xie: Severe Dampness; symptoms include profuse watery diarrhea, borborygmus, heaviness of the body, short urine, and a deep pulse.
- Hua Xie: Excess Dampness with Qi Deficiency; symptoms include involuntary defecation, anus like a bamboo tube, continuous flow without stop.
Additionally:
- Food Retention Diarrhea: Foul-smelling stool, sour belching.
- Phlegm Diarrhea: Variable volume, chest tightness, frothy stool.
- Fire Diarrhea: Sudden violent diarrhea with urgency, dark yellow foul stool.
- Qi Diarrhea: Frequent abdominal fullness and obstruction, difficult passage.
- Deficiency Diarrhea: Fatigue, weakness, poor appetite, slightly loose stool, always accompanied by emaciation.
- Food Stagnation Diarrhea: Infrequent bowel movements (once every few days), accompanied by abdominal distension.
- Kidney Diarrhea: Abdominal pain in the early morning (Wu Geng), mild rumbling before diarrhea, accompanied by cold feet.
- Liver Diarrhea: Caused by anger, characterized by cold limbs, blue-green complexion, and hypochondriac fullness.
- Jiao Chang Diarrhea (Crossed Intestines): Urine and feces exit from wrong orifices.
- Rectal Diarrhea: Immediate evacuation shortly after eating.
[Acute vs. Chronic Diarrhea]
Sudden violent diarrhea with urgency and undigested food indicates a lack of Yin/Fluids (Water). Chronic loose diarrhea with irregular onset and remission indicates a lack of Yang/Fire (Fire).
[Differentiation of Abdominal Pain]
- Diarrhea without pain: Dampness.
- White stool with pain: Cold.
- Pain followed by diarrhea, then stagnation: Fire.
- Pain followed by diarrhea, relief after defecation: Food retention.
- Distending pain, no relief after diarrhea: Liver Qi stagnation.
- Cramping pain, sudden diarrhea with irritability and thirst: Huo Luan (Cholera-like syndrome).
- Cramping pain, continuous diarrhea, stool like crab foam: Combination of Qi stagnation and Food retention.
- Cold sensation in abdomen, dull mild pain, thick drink-like stool: Phlegm.
[Differentiation of Cold vs. Heat]
- Heat Syndrome: Dark/scanty urine, irritability/thirst, hot anus, food putrefies or turns dark yellow even if undigested, ability to move, warm hands/feet.
- Cold Syndrome: Clear/white urine, no thirst, cold abdomen, undigested food, white stool color, lethargy, inability to eat, cold hands/feet.
[Differentiation of Borborygmus]
Most diarrhea involves dampness, with borborygmus sounding like thunder, indicating Cold-Damp. However, borborygmus can also result from Fire attacking and agitating Water Qi, accompanied by abdominal pain, sudden violent diarrhea, anal tenesmus, and yellow urine. This differs from Dampness patterns where abdominal pain is absent.
[Differentiation of Undigested Food]
Undigested food in stool has four causes: Qi Deficiency, Stomach Cold, Stomach Fire, and Stomach Wind.
- Qi Deficiency and Stomach Cold: Fail to transform and transport.
- Fire: Rapid nature disrupts transport, known as "Pathogenic Heat failing to digest food."
- Stomach Wind: Liver Wind transmits to Spleen; Spleen is controlled by Liver Wood and fails to transform. This is called Sun Xie, one of the Five Diarrheas.
[Prognosis of Fatal Diarrhea]
Fine pulse, cold skin, shortness of breath, incontinence of both bowels and bladder, and inability to eat constitute the "Five Deficiencies," which indicate death. If gruel enters the stomach and diarrhea stops, the patient survives.
[Pulse Diagnosis]
Diarrhea pulses are naturally Deep.
- Deep and Slow: Cold invasion.
- Deep and Rapid: Fire/Heat.
- Deep and Moderate: Dampness.
- Deep, Empty, and Slippery: Collapse of Qi.
- Prognosis: Deep, moderate, weak, small pulses indicate survival; Floating, Large, Wiry, Rapid pulses indicate death.
[Therapeutic Principles]
All diarrhea involves Dampness. Initially, regulate the Middle Jiao. Then, drain the Lower Jiao. Next, use Wind herbs to dry Dampness. For chronic cases, raise Yuan Qi. If there is incontinence, use astringents.
- Wind excess: Resolve the exterior.
- Cold excess: Warm the Middle.
- Deficiency: Tonify.
- Food retention: Digest and guide out.
- Dampness: Leach out with bland herbs.
- Fire: Cool and clear.
- Phlegm: Induce vomiting.
- Sinking Qi: Lift and raise.
Apply according to symptoms, without rigid sequence.
[Distinguishing Excess and Deficiency]
- Accumulation like thick pus: Use digestion/drainage.
- Thin stool with scanty urine: Use diuresis.
- Normal urine: Do not use diuresis; only dry the Spleen.
- With thirst: Avoid diuresis and drying Spleen; check if urine is red for Heat.
- Short urine but normal color: Tonification is indicated.
[Opening Stagnation]
Excessive worry/sorrow knots Spleen Qi, preventing ascent and causing sinking into the Lower Jiao, leading to diarrhea. Open the stagnation to allow Qi to rise and food to digest.
[Clearing Depressed Heat]
If Lung Heat is blocked with cough and chest fullness, and Ginseng/Atractylodes are mistakenly taken, causing Lung heat to rush to the Large Intestine, first clear Lung Metal, then harmonize the Spleen.
[Contraindications in Diarrhea Treatment]
- Tonifying deficiency: Do not use purely sweet/warm herbs; excessive sweetness generates Dampness.
- Clearing heat: Do not use purely bitter/cold herbs; excessive bitterness injures the Spleen.
- Astringents: Do not use too early; risk of retaining residual pathogens.
- Bland leaching herbs: Do not use excessively; risk of fluid depletion and Yang sinking.
[Herbal Formulations]
Main formula: Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala), Chen Pi (Tangerine Peel), Ban Xia (Pinellia).
- Add Zhu Ling (Polyporus), Ze Xie (Alisma) for Dampness.
- Add Huang Lian (Coptis), Bai Shao (White Peony) for Fire.
- Add Pao Jiang (Roasted Ginger), Yi Zhi Ren (Alpinia Oxyphylla) for Cold.
- Add Fang Feng (Saposhnikovia), Cang Zhu (Atractylodes Lancea) for Wind.
- Add Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark) for Food.
- Add Shan Zha (Hawthorn), Mai Ya (Barley Sprout) for Food Retention.
- Add Ren Shen (Ginseng), Huang Qi (Astragalus) for Qi Deficiency.
- Add Sheng Ma (Cimicifuga), Chai Hu (Bupleurum) for Qi Sinking.
- Chronic Spleen Deficiency: Add Ren Shen, Huang Qi, Shen Qu (Medicated Leaven), Mai Ya, Gan Jiang (Dried Ginger).
- Chronic Intestinal Slippage: Add Rou Dou Kou (Nutmeg), He Zi (Chebula), Mu Xiang (Aucklandia).
- Summer acute watery diarrhea: Xiang Ru San (Elsholtzia Powder), Yi Yuan San (Benefiting Primordial Powder).
- Kidney/Spleen Double Deficiency (Morning Diarrhea): Si Shen Wan (Four Spirits Pill), Jiang Shui San (Fermented Grain Water Powder).
- Chronic Spleen Diarrhea: Gui Xiang Wan (Cinnamon Fragrance Pill), Jiao Fu Wan (Pepper and Aconite Pill).
- Phlegm in Lung with Anal Incontinence: Er Chen Tang + Fang Feng, Jie Geng (Platycodon) to induce vomiting.
- Lung Heat transferring to Intestines (Dysentery): Huang Qin (Scutellaria), Di Gu Pi (Lycium Bark), E Jiao (Donkey-hide Gelatin), Bai He (Lily Bulb), Dou Ling (Loquat Leaf), Gan Cao (Licorice).
- Wine Retention Diarrhea: Morning borborygmus/pain, yellow/red stool. Not Kidney Deficiency. Use Si Ling San, Ge Hua (Kudzu Flower), or Jin Kui Ze Xie Tang + Bi Xie (Dioscorea Hypoglauca).
- Decoction water: Use Gan Lan Shui (Ganlan Water/Gale Water) to avoid aiding Dampness and benefit Spleen/Stomach.
[Selected Formulas for Diarrhea]
1. Bai Zhu Fu Ling Tang: General treatment for diarrhea. Ingredients: Bai Zhu, Fu Ling, Gan Cao.
2. Wei Ling Tang: Wu Ling San combined with Ping Wei San. Includes Yi Yuan San and Li Zhong Tang references.
3. Xiang Ru Yin: Treats summer heat diarrhea.
4. Si Ling San: Treats unclear/turbid separation causing diarrhea. Ingredients: Fu Ling, Zhu Ling, Bai Zhu, Ze Xie. Adding Gui Zhi makes Wu Ling San.
5. Bai Zhu San: Bai Zhu, Bai Shao (3 qian each), Pao Jiang (5 qian), Gan Cao (2 liang). Take 2 qian, decoct in water.
6. Gui Zhi Tang: Gui Zhi, Bai Shao, Bai Zhu (5 qian each), Zhi Gan Cao (2 qian). Take 5 qian, decoct in water.
7. Shu Fu Tang: Bai Zhu, Fu Zi, Gan Cao.
8. Lian Li Tang: Li Zhong Tang plus Fu Ling, Huang Lian.
9. Wu Wei Zi San: For Kidney Deficiency Yin Qi affecting Wu Geng diarrhea. Wu Wei Zi (2 liang), Wu Yu (5 qian). Grind, take 2 qian with aged rice water. Adding Bu Gu Zhi, Rou Dou Kou makes Si Shen Wan.
10. Shen Fu Tang: Ren Shen (1 liang), Fu Zi (5 qian). Take 5 qian with 10 slices of ginger.
11. Er Shen Wan: For Spleen/Kidney Deficiency, morning borborygmus. Bu Gu Zhi (4 liang), Rou Dou Kou (2 liang). Adding Wu Wei Zi, Wu Yu makes Si Shen Wan.
12. Si Zhu San: For organ cold, True Yang loss, umbilical/abdominal cold pain. Fu Ling, Fu Zi, Ren Shen, Mu Xiang (1 liang each). Take 3 qian with 5 ginger slices. Adding Rou Dou Kou, He Zi makes Liu Zhu San. Huo Ren Fang has Bai Zhu, no He Zi.
13. Jiang Shui San (Jie Gu): For Spleen Yin Cold, cold watery diarrhea. Ban Xia (2 liang), Liang Jiang (2.5 qian), Gan Jiang, Rou Gui, Gan Cao, Fu Zi (5 qian each). Grind, take 3 qian.
14. Jiao Po Wan (Wei Shi): Yi Zhi, Chuan Jiao (fried), Hou Po, Chen Pi, Bai Jiang, Hui Xiang (fried, equal parts). Soak in green salt water in silver/copper pot, boil dry, roast, grind, wine paste pills, take with salt water.
15. Jiao Fu Wan: For Kidney Cold, chronic diarrhea. Jiao Hong (fried), Shu Fu, Lu Rong (roasted), Sang Piao Xiao (roasted), Shan Yao, Shan Yu, Long Gu (calcined).
16. Gui Xiang Wan (San Yin): For organ cold, Wind-Cold forcing cold slippery diarrhea. Elderly/weak patients. Fu Zi, Rou Dou Kou, Fu Ling (1 liang each), Gui Xin, Gan Jiang, Mu Xiang (0.5 liang each), Ding Xiang (2.5 qian). Flour paste pills, 50 pills with rice water.
17. Wu Ji Wan (He Ji Ju Fang): For Spleen/Stomach insufficiency, Damp-Heat sinking. Huang Lian, Wu Yu, Bai Shao (equal parts). Pills with flour paste, size of wu zi, take with rice water.
18. Wen Liu Wan (Dan Xi): For Damp-Heat Qi Stagnation. Guides upward for acid regurgitation, downward for spontaneous diarrhea. Liu Yi San (7 liang), Gan Jiang (1 liang). Grind, congee pills. Alternative: Remove Gan Jiang, add Wu Yu (2 liang) -> Shen Yu Wan.
19. Jie Zhai Xie Li Fang: Bai Zhu, Fu Ling, Ban Xia, Chen Pi, Gan Cao, Sha Ren, Shen Qu, Mai Ya.