上二味。以水七升。煮取三升。温服一升。下咽即愈。
哕逆者。橘皮竹茹汤主之。
橘皮竹茹汤方
橘皮（二升） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
上六味。以水一斗。煮取三升。温服一升。日三服。
〔衍义〕中焦者。脾胃也。土虚则在下之木得以乘之。而谷气因之不宣。变为哕逆。
用橘皮理中气而升降之。人参、甘草。补土之不足。生姜、大枣。宣发谷气。更散其
逆。竹茹性凉。得金之正。用之以降胆木之风热耳。
夫六腑气绝于外者。手足寒。上气脚缩。五脏气绝于内者。利不禁。下甚者。手足不仁。
〔衍义〕六腑主表为阳。五脏主里为阴。阳为卫。阴为荣。六腑绝。卫先不行于外。故
手足寒。阳主升、在息为呼。外绝则气上出。出而不返。则下绝。下绝则筋急。故脚
蜷缩也。五脏绝。荣先不行于内。则阴气去。大便属阴。故下利不禁。甚则血离于外。故手足不仁。
下利脉沉弦者下重。脉大者为未止。脉微弱数者。为欲自止。虽发热不死。
〔衍义〕仲景伤寒论厥阴证中注云。沉为在里。弦为拘急。里气不足主下重。脉大
则病进。为利未止。脉弱数者。邪气微而阳气复。为欲自止。虽发热。正由阳胜。非
邪逆也。成注如此。然弱阴不敌所回之阳。发热甚者。亦必治之。但不死而已。恐
亦不宜大热。内经曰。下利发热者死。虽然。不惟厥阴。少阴下利亦然。伤寒论谓
脉紧下利。脉暴微。手足温。利自愈。又谓下利手足不逆冷。反发热者不死。是皆
少阴下利者说也。非滞下之利。滞下则多热。若更发热。必难治。
下利手足厥冷。无脉者。灸之不温。若脉不还。反微喘者死。少阴负趺阳者为顺也。
〔衍义〕手足诸阳之本。十二经脉之所由起也。论曰。脉者血之府。气主煦之。血主
濡之。是气司脉之动息。血充脉之形体也。血不自至。必气以运之。气即阳也。火
也。若阴寒之气盛。则阳火之气衰。不能布散通于经脉。津液亦不行。聚而下利。
所以脉无而手足冷矣。若残阳尚根于中。未竭于脏者。则以艾灸接引孤宿之
火。布散经脉。手足温则生。其阳已绝于脏。止息呼吸之息。用艾灸之。无根之阳。
反从艾火上炎。奔迫为喘而脱矣。故死。夫趺阳胃脉。土也。少阴肾脉。水也。负者。
克也。若少阴受负于趺阳。是后天之阳尚存。阴寒犹可回也。仲景谓下利脉不
出者属少阴。灸少阴穴。此虽不言所灸之处。系厥阴证中。则必当灸厥阴之穴也。
下利有微热而渴。脉弱者令自愈。
〔衍义〕此条亦在厥阴证中。以上条发热下利观之。若同而异。以脉弱数为阳复
而阳胜。惟言不死耳。此脉独弱。乃阴退阳复。在表作微热。在里作渴。终不与热
甚更胜者同。故曰自愈。虽然。病在乎审察毫厘。不惟热有微甚。渴亦不可一途
论也。如少阴伤寒五六日。自利而渴。小便白者。则为肾虚。引水自救。病之变端。岂一言可尽乎。
下利脉数。有微热汗出。令自愈。设脉紧。为未解。
〔衍义〕厥阴证中。注谓下利阴证也。脉数阳病也。阴病见阳脉者生。微热汗出。阴气得通也。
虽然。本经亦自有阴阳退复之义。何也。内经曰。厥阴之下。中见少阴厥阴者。两阴交尽而阳乃复。
阴是其本。阳是其标。从本则寒。从标则热。所以厥阴不治标本。从乎中治。此下利者。是其本之
阴寒过也。微热是其标之阳火复也。复则内之阴邪。从而之表。发热汗出而散。散则标本和。
不治自愈。设脉紧。为
寒胜。故未解。
下利脉数而渴者。令自愈。设不瘥。必圊脓血。以有热故也。
〔衍义〕仲景少阴证中下利便脓血者。悉属虚寒。以桃花汤主治。留聚者刺之。此
厥阴圊脓血者何。盖为脉数而有热也。少阴桃花主者。脉必不数也。此数非先
有热。初因阴盛而后阳复胜之。故数。脉数而渴。令自愈。以阳复而可退其阴寒
也。更不瘥。则是复之过。更胜其阴。逐阳热而圊脓血也。非若上条微热而渴。脉
弱者。脉弱则热不甚。不甚则不能更胜。惟与阴和而已。脉数下利又不止。故成协热也。
下利脉反弦。发热身汗者自愈。
〔衍义〕此脉初不弦。后乃弦。故曰脉反弦。弦者。必轻虚。春脉也。见少阳之气升发
矣。阳气久为阴寒所覆。下陷聚液成利。一旦得升发之。攻其阴邪。从而之表。发
汗而散。故利自愈。与上条脉数微热汗出不同。其自表而解之义则同也。
下利气者。当利其小便。
〔衍义〕下利气者。气与邪俱下也。由气不化。以致水谷不分。并于下焦而成利。然
阴前通则阳气行。气行则水谷分而利止矣。
下利寸脉反浮数。尺中自涩者。必圊脓血。
〔衍义〕此证伤寒厥阴篇中云。寸以候阳。尺以候阴。阳为气。阴为血。下利本属阴寒之病。当脉沉。今反寸脉浮
数。
则是阳盛于上。而下不与阴和。阴血也。血不得与气和。则不荣经。不藏于肝。则散入肠胃。故尺脉涩。血积为脓也。
须用利而出之。
下利清谷。不可攻其表。汗出必胀满。
〔衍义〕成注下利者。属胃虚也。胃为津液之府。发汗亡液。故胃愈虚。必胀满。固也。
何仲景不叙阳明太阳病中。而叙于厥阴证。盖有说焉。清谷非飧泄欤。内经曰。
清气在下。则生飧泄。清阳之气。即苍天之气。自肝木而生。少阳主生气者也。其
气当升发于上。若反入于下。则谷气升转不得举矣。故食入则完出。清阳下陷。即少阳伏于厥阴之
中。今不从厥阴起其少阳。乃反攻无辜之表。强发胃中谷气之津液。故虚其胃而作胀满也。
〔补辩〕厥阴下利。与竟下利有别。何以名厥阴。以邪传是经耳。经何以下利。以厥
阴经虽非藏。由里行。故厥阴必下利也。厥阴下利。有本经现证。何谓不叙于太
阳阳明病中。如二阳经亦有下利。此为协热。乃先救里之说在。何先生亦昧此。
下利脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患必微
厥。所以然者。其面戴阳。下虚故也。
〔衍义〕成注。下利清谷。脉沉而迟。里有寒也。面少赤。身有微热。表未解也。病患以
下虚渐厥。表邪欲解。临汗之时。以里气先虚。必郁冒然后汗出而解。以余观之。
仲景叙六经形证。未尝不由表而入里。岂可便以身微热为表邪未解乎。宁知
不因邪入厥阴也。厥阴气化为里寒。格阳于外而然也。里寒则下利清谷。必微
厥。阳格于外。则身微热。格于上则面赤。故曰面戴阳而下虚。下虚者。为下无阳
也。然阳欲复。必深入与阴争。阴虽不得拒格。然犹散走发其阳。而阳不得宣通。
怫热神昏。故为郁冒。郁冒然后阳胜。而阴出为汗矣。
下利后脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。
〔衍义〕亦在厥阴证中。脉者气血之候。下利脉绝。不惟无阳。亦且无阴。气血养神
者也。气血亡。其脉亦绝。 时复还。手足温。此可见气血暂息耳。故生。脉不还。则
亡矣。故死。所谓生者非不治自生。救其气血。止其利也。如前条无脉而厥。灸之
者。亦是治之而生。又少阴下利清谷。手足厥逆。脉微欲绝者。以通脉四逆治。利止脉不出。
加人参补正。以救其亡血。病有二经之异。然厥而无脉则一。此证利止。手足温。脉还。始可治。
下利腹胀满。身体疼痛者。先温其里。乃攻其表。温里宜四逆汤。攻表宜桂枝汤。
〔衍义〕出厥阴证中。盖内有虚寒。故下利腹胀满。表邪未解。故身体疼痛。以下利
为重。先治其里。后治其表者。若伤寒论。太阳证。以医下之。续得下利清谷身疼
痛者。当先以四逆治其里。清便自调。然后以桂枝救其表。即此意。
下利三部脉皆平。按之心下坚者。急下之。宜大承气汤。
〔衍义〕伤寒论。坚作硬。注曰。下利脉当微。今反和者。此为内实也。下利三部脉平。
此非和平之平。气下泄矣。或有宿食寒热结于中焦。故硬则邪甚也。宜大承气下之。
下利脉迟而滑者。实也。利未欲止。急下之。宜大承气汤。
〔行义〕成注。脉迟者。食干物得之。滑者谷气实。脾胃不消水谷。以致下利者。与大
承气去宿食。利自止矣。
下利脉反滑者。当有所去。下乃愈。宜大承气汤。
〔衍义〕下利、虚证也。脉滑、实证也。以下利而反见滑脉者。当有所去也。上章以内
实而阻经气。故兼迟。此乃滑动而欲去。故惟见滑。然皆有形之实证。故并用大承气。
下利已瘥。至其年月日时复发者。以病不尽故也。当下之。宜大承气汤。
〔衍义〕因四时之气所感而为积者。必有所合之脏蓄之。病下利已。去不尽。非其时。则所
感之脏气不旺。故积伏而不动。再遇其时。则乘旺而动。动则下利自作。肠胃病积聚不尽。故当下之。
下利谵语者。有燥屎也。小承气汤主之。
〔衍义〕伤寒论。凡谵语燥屎。悉在阳明。此独出厥阴病。成注谵语燥屎为胃实。下
利为肠虚。不言厥阴之由何也。尝考阳明证无下利论。惟与少阳合病者有之。
少阳木克土而下利也。若自利。则为阳陷下。必死。然则伤寒以阳明无下利者。
阳明乃两阳合明属热。其手经更属之燥金。经主合。于是燥热易于闭结。津液
易于耗竭。更遇邪热入腑。热甚为谵语。燥甚为屎结。故阳明无下利病也。今下
利多出厥阴者。乃两阴交尽之极而复升。如邪热传入于阴。屈而未得伸者。遂
从其阴降而为下利矣。故下利证多少阴厥阴也。盖阳明燥金屈其木。不得升。
遂为厥阴下利之证。厥阴尽而变升者。又是苍天之气清净。清气贵乎发越。内
经清气在下。则飧泄也。在伤寒邪热所传言之。阳明无下利证。若经气可属者
言之。则阳明病下利亦多矣。阳明与太阴为表里。尽属于湿。经曰。湿胜则濡泄。
阳明又属燥金。一脏一腑。亦常更胜。太阴胜则内外俱湿。故身重而泻。阳明胜
则燥热郁甚。亦宜有燥屎焉。不必外之传热而后有也。故宜下。岂独伤寒已哉。
下利便脓血者。桃花汤主之。
桃花汤方
赤石脂（一斤半筛半锉） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米熟去渣。内方寸匕。日三服。一服愈。止后服。
〔衍义〕此少阴证。少阴肾水也。肾寒则水盛。与血相搏。渗入肠间。积久化腐。遂成
便脓。成注。下焦不约而里寒。用赤石脂寸匕。日三服。一服愈。即止。涩以固肠胃
虚脱。干姜散寒。粳米补胃。然赤石脂在血理血。在水理水。在脱则固。在涩则行。
所以知其行泣也。本草用治难产。胎衣不下。干姜非惟散寒。且能益寒止血。欲
诸药入肠胃。必粳米引之也。虽然。有不可固者。如云便脓血者可利。利非行气
血乎。然气血欲行者不可温。温者不可行。二者实相反。仲景两出之。后人不可
不审也。若成注阳明下利便脓血者。协热也。岂阴经病尽属脏寒。而不有其邪
热蓄之者乎。病邪相乘。不可一言穷矣。仲景不过互相举例。以俟后人之消息处治耳。
热利下重者。白头翁汤主之。
白头翁汤方
白头翁（二两） 黄连 黄柏 秦皮（各三两）
上四味。以水七升。煮取三升。去滓。温服一升。不愈再服。
〔衍义〕此亦厥阴证中。成注。热伤气。气虚不利。则后重。下焦虚。以绝苦之味坚之。
虽然。后重不可概论。前条有下利沉弦者。下重。为气虚寒不能升举也。然亦有
热伤为气滞闭塞者。有血虚者。有血泣者。大孔痛亦然。不独气虚不能升也。大
率皆固燥气外郁束敛所致。刘河间谓下利。由燥郁肠胃之外。湿聚肠胃之内。
又谓血行则粪自止。气行则后重除。解燥郁必分寒热之微甚。热微用辛温以
行气。热甚用苦寒以治热。张子和歌曰。休治风。休治燥。治得火时风燥了。血虚
补之。泣者行之。血调则气和。气和则郁解。用苦寒以治燥。宁独坚其下焦之虚
乎。要略。于下利一证。独引伤寒少阴厥阴二论为多。然其论中又先指何经。今
则去其经与各部所病之原。将谓伤寒有传变之故。杂病则不问其传否。随所
病处而云故耳。产后下利虚极。亦用白头翁汤者。可概见矣。
下利后更烦。按之心下濡者。为虚烦也。栀子豉汤主之。
栀子豉汤方
栀子（十四枚炒） 香豉（四合绵裹）
上二味。以水四升。先煮栀子汤二升半。内豉。煮取一升半。去滓。分二服。进一服。得吐则止。
〔衍义〕伤寒论。太阳病。用药下后而虚烦者。仍叙太阳证中。此必自下利虚烦。不
由他故。注故叙厥阴证中。虽有二经之异。然热乘虚入客。病烦则一。皆用栀豉
汤之苦。吐其客热也。
下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。
通脉四逆汤方
甘草（二两） 干姜（三两） 附子（一枚生用） 葱白（四茎）
上四味。以水三升。煮取一升二合。去滓。分温再服。
〔衍义〕里寒外热。格阳于外也。阳不得内和。故下利清谷。阴不得外和。故发身热。
The above two ingredients are boiled in seven sheng of water until three sheng remain. Take one sheng warm; the illness will be cured immediately upon swallowing.
For hiccups (Yue Ni), Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary treatment.
Ju Pi Zhu Ru Tang Formula:
Ju Pi (Tangerine Peel, 2 sheng), Zhu Ru (Bamboo Shavings, 2 sheng), Da Zao (Jujube, 30 pieces), Sheng Jiang (Fresh Ginger, half jin), Gan Cao (Licorice Root, 5 liang), Ren Shen (Ginseng Root, 1 liang).
The above six ingredients are boiled in ten dou of water until three sheng remain. Take one sheng warm, three times a day.
[Commentary]: The Middle Jiao refers to the Spleen and Stomach. When Earth Qi (Spleen/Stomach) is deficient, Wood Qi (Liver/Gallbladder) from below can overact upon it, causing Grain Qi to fail to circulate freely, transforming into hiccups.
Ju Pi regulates the Qi of the Middle Jiao, promoting its ascending and descending movements. Ren Shen and Gan Cao tonify the deficiency of Earth. Sheng Jiang and Da Zao promote the circulation of Grain Qi and disperse rebellious Qi. Zhu Ru is cool in nature and possesses the correct Qi of Metal; it is used to descend the Wind-Heat of Gallbladder Wood.
When the Qi of the Six Fu Organs fails at the exterior, symptoms include cold hands and feet, upward rushing of Qi, and curling up of the legs. When the Qi of the Five Zang Organs fails within, symptoms include uncontrollable diarrhea. In severe cases, there is numbness of the hands and feet.
[Commentary]: The Six Fu Organs govern the exterior and belong to Yang; the Five Zang Organs govern the interior and belong to Yin. Yang corresponds to Wei Qi (Defensive Qi), and Yin corresponds to Ying Qi (Nutritive Qi). When the Qi of the Six Fu Organs fails, Wei Qi fails first to circulate at the exterior, hence cold hands and feet. Yang governs ascending; in respiration, it manifests as exhalation. If external Qi is severed, Qi rushes out and does not return, leading to the severance of lower Qi. Lower Qi failure causes tendon tension, hence curled legs. When the Qi of the Five Zang Organs fails, Ying Qi fails first to circulate within, leading to the departure of Yin Qi. Since stool belongs to Yin, uncontrollable diarrhea occurs. In severe cases, blood leaves its vessels, causing numbness of the hands and feet.
In diarrhea with a deep and wiry pulse, there is a sensation of heaviness in the rectum. A large pulse indicates the condition has not ceased. A weak and rapid pulse indicates it is about to stop spontaneously; even if fever is present, death will not occur.
[Commentary]: Zhang Zhongjing notes in the Jueyin syndrome section of *Shanghan Lun*: Deep pulse indicates disease in the interior; wiry pulse indicates tension. Interior Qi deficiency leads to rectal heaviness. A large pulse indicates disease progression, meaning diarrhea has not stopped. A weak and rapid pulse indicates pathogenic factors are fading and Yang Qi is recovering, signaling that diarrhea is about to stop. Although fever is present, it is due to Yang overcoming Yin, not pathogenic rebellion. Cheng Wuji's commentary states this. However, if weak Yin cannot overcome returning Yang, severe fever requires treatment, though death is unlikely. Great heat herbs should probably be avoided. *Neijing* states: "Diarrhea with fever indicates death." Nevertheless, this applies not only to Jueyin but also Shaoyin diarrhea. *Shanghan Lun* states: "With tight pulse and diarrhea, if the pulse suddenly becomes slight and hands/feet warm, diarrhea heals itself." It also states: "If hands/feet are not cold during diarrhea but instead feverish, death will not occur." These refer to Shaoyin diarrhea, not dysentery (Li Xia). Dysentery is mostly heat-related; if accompanied by fever, it is difficult to treat.
In diarrhea with cold hands and feet and absent pulse, if moxibustion does not warm the limbs and the pulse does not return, but mild wheezing appears, death ensues. If the Shaoyin pulse is weaker than the Fuyang pulse, it is a favorable sign.
[Commentary]: Hands and feet are the root of all Yang meridians, from which the twelve meridians originate. Theory states: Pulse is the house of Blood; Qi warms, and Blood nourishes. Qi controls pulse movement; Blood fills the pulse vessel. Blood cannot reach on its own but relies on Qi for transport. Qi is Yang/Fire. If Yin-Cold is excessive, Yang Fire declines, failing to distribute through meridians, causing fluid stagnation and diarrhea, resulting in absent pulse and cold limbs. If residual Yang remains rooted internally, moxibustion can guide this solitary fire to distribute through meridians; warmth of limbs indicates survival. If Yang is already extinct in the organs, breathing ceases; applying moxibustion may cause rootless Yang to flare up with the moxa fire, leading to wheezing and collapse, hence death. Fuyang pulse belongs to Stomach (Earth); Shaoyin pulse belongs to Kidney (Water). "Fu" means being overcome. If Shaoyin is overcome by Fuyang, post-heaven Yang still exists, and Yin-Cold can be reversed. Zhang Zhongjing says absent pulse in diarrhea belongs to Shaoyin; moxa Shaoyin points. Though unspecified here, since listed under Jueyin, Jueyin points should likely be moxaed.
In diarrhea with slight fever and thirst, and a weak pulse, spontaneous recovery is expected.
[Commentary]: This clause is also in the Jueyin section. Comparing with the previous clause on fever and diarrhea, they appear similar but differ. Weak and rapid pulse indicates Yang recovery and dominance, merely stating non-fatal. Here, solely weak pulse indicates Yin retreat and Yang recovery, manifesting as slight fever externally and thirst internally. It differs from severe heat overcoming Yin, hence spontaneous recovery. However, diagnosis requires precision; fever and thirst vary. For example, in Shaoyin Cold Damage after five-six days, self-diarrhea with thirst and white urine indicates Kidney deficiency seeking water; this is a variation, not easily summarized.
In diarrhea with a rapid pulse, slight fever, and sweating, spontaneous recovery is expected. If the pulse is tight, the disease is unresolved.
[Commentary]: In Jueyin syndrome, diarrhea is a Yin syndrome; rapid pulse is a Yang sign. Yin syndrome showing Yang pulse indicates life. Slight fever and sweating indicate Yin Qi is unblocked.
Furthermore, the text implies the principle of Yin-Yang retreat and return. *Neijing* states: Below Jueyin lies Shaoyin. Jueyin represents the end of two Yins where Yang returns. Yin is root, Yang is branch. Following root brings cold; following branch brings heat. Thus, Jueyin treats via the middle Qi (Shaoyin). This diarrhea stems from excessive root Yin-Cold. Slight fever reflects returning branch Yang-Fire. Return drives internal Yin pathogens to the exterior, dispersing via fever and sweat. Harmony restores health without treatment. Tight pulse indicates Cold dominance, hence unresolved.
In diarrhea with rapid pulse and thirst, spontaneous recovery is expected. If it does not improve, pus and blood will appear in stool due to Heat.
[Commentary]: In *Shanghan Lun* Shaoyin section, diarrhea with pus/blood is treated as deficiency-cold using Taohua Tang. Stagnation is treated with acupuncture. Why does Jueyin diarrhea involve pus/blood? Because of rapid pulse and heat. Shaoyin Taohua Tang cases have non-rapid pulses. Here, rapidity arises not from initial heat but from Yin excess followed by Yang recovery overcoming Yin. Rapid pulse and thirst indicate Yang recovery can dispel Yin-Cold, leading to recovery. If it persists, Yang recovery was excessive, overpowering Yin and forcing Yang-Heat to expel pus/blood. This differs from the previous clause (slight fever/thirst/weak pulse) where weak pulse means mild heat insufficient to overcome Yin, merely harmonizing. Now, rapid pulse with persistent diarrhea forms "Xie Re" (Collateral Heat) diarrhea.
In diarrhea with a reverse wiry pulse, fever, and sweating, spontaneous recovery is expected.
[Commentary]: The pulse was initially not wiry but became so, hence "reverse wiry." Wiry pulse is light and empty, characteristic of Spring, indicating Shaoyang Qi rising. Yang Qi, long suppressed by Yin-Cold and sinking to form diarrhea, now rises to attack Yin pathogens, driving them to the exterior via sweating, curing diarrhea. This differs from the previous clause (rapid pulse/slight fever/sweat) but shares the mechanism of resolution via the exterior.
In diarrhea with flatus, benefit from promoting urination.
[Commentary]: Diarrhea with flatus involves Qi and pathogens moving downward together. Due to failed Qi transformation, Water and Grain are not separated, merging in the Lower Jiao to cause diarrhea. Once the anterior Yin (urinary tract) opens, Yang Qi moves; Qi movement separates Water and Grain, stopping diarrhea.
In diarrhea, if the Cun pulse is reverse floating and rapid, while Chi pulse is naturally choppy, pus and blood will inevitably appear in stool.
[Commentary]: In *Shanghan Lun* Jueyin chapter: Cun probes Yang, Chi probes Yin. Yang is Qi, Yin is Blood. Diarrhea is Yin-Cold, so pulse should be deep. Reverse floating/rapid Cun indicates Yang excess above, failing to harmonize with Yin below. Blood fails to harmonize with Qi, failing to nourish meridians or store in Liver, scattering into intestines, causing choppy Chi pulse. Blood stagnates into pus. It must be drained.
In diarrhea with undigested food, do not attack the exterior. Sweating will cause abdominal fullness.
[Commentary]: Cheng Wuji notes: Diarrhea belongs to Stomach deficiency. Stomach is the mansion of fluids; sweating depletes fluids, worsening Stomach deficiency and causing fullness. Why is this in Jueyin rather than Yangming/Taiyang? Undigested food resembles Sun Xie (grain diarrhea). *Neijing* states: "Clear Qi sinking below generates Sun Xie." Clear Yang Qi arises from Liver Wood, governed by Shaoyang as the source of life. It should ascend. If it sinks, Grain Qi cannot lift, causing undigested food exit. Clear Yang sinking means Shaoyang hides within Jueyin. Instead of stimulating Shaoyang from Jueyin, attacking the innocent exterior forcibly dissipates Stomach Grain fluids, causing deficiency and fullness.
[Supplemental Debate]: Jueyin diarrhea differs from ordinary diarrhea. Named Jueyin because pathogen transmitted to this meridian. Why diarrhea? Jueyin travels from interior, thus prone to diarrhea. It has specific manifestations. Why not in Taiyang/Yangming? Those involve collateral heat, prioritizing interior rescue. Mr. He missed this point.
In diarrhea with deep and slow pulse, slight facial redness, slight body fever, and undigested food,郁冒 (vertigo/fainting) and sweating will occur before resolution. Patient likely has slight cold limbs. Reason: Facial redness ("Dai Yang") indicates lower deficiency.
[Commentary]: Cheng Wuji notes: Undigested food/deep-slow pulse indicates interior cold. Facial redness/slight fever indicates exterior unresolved. Patient becomes cold due to lower deficiency; exterior pathogen resolves. At sweating time, interior deficiency causes vertigo before sweating resolves. I argue Zhang Zhongjing describes Six Meridians progressing from exterior to interior. Can slight fever simply mean exterior unresolved? Perhaps pathogen entered Jueyin. Jueyin transforms into interior cold, repelling Yang outward. Interior cold causes undigested food/diarrhea and slight cold limbs. Yang repelled outward causes slight fever; repelled upward causes facial redness. "Lower deficiency" means lack of Yang below. Yang seeks recovery, entering deeply to struggle with Yin. Yin cannot reject but scatters Yang, preventing smooth flow, causing stifled heat and confusion (vertigo). After vertigo, Yang wins, Yin exits as sweat.
After diarrhea, if pulse vanishes and limbs are cold, but pulse returns and limbs warm later, life is preserved; if pulse does not return, death ensues.
[Commentary]: Also in Jueyin section. Pulse reflects Qi/Blood. Diarrhea with vanished pulse indicates loss of both Yin and Yang. Qi/Blood nourish Spirit. Loss of Qi/Blood leads to vanished pulse. Temporary return with warm limbs shows Qi/Blood merely paused, hence survival. No return means loss, hence death. Survival implies treating Qi/Blood and stopping diarrhea, not spontaneous cure. As in previous clause, moxa helped. Shaoyin undigested food/cold limbs/micro-pulse uses Tongmai Sini Tang. If pulse doesn't return after diarrhea stops, add Ren Shen to save lost blood. Two meridians differ, but cold/pulseless state is same. Here, diarrhea stops, limbs warm, pulse returns, allowing treatment.
In diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior. Warm interior with Sini Tang; attack exterior with Guizhi Tang.
[Commentary]: From Jueyin section. Interior deficiency-cold causes diarrhea/fullness; exterior pathogen causes body pain. Diarrhea is severe, so treat interior first. Similar to *Shanghan Lun* Taiyang case where mistaken purgation caused undigested food/body pain; treat interior with Sini Tang first, then exterior with Guizhi Tang once bowels normalize.
In diarrhea with normal pulses in all three positions, but hardness upon pressing the epigastrium, urgent purgation is needed using Dachengqi Tang.
[Commentary]: *Shanghan Lun* reads "hard." Note: Diarrhea pulse should be micro; normal pulse indicates interior excess. Normal pulses here mean Qi leakage, not harmony. Food retention or cold-heat knotting in Middle Jiao causes hardness/excess. Use Dachengqi Tang to purge.
In diarrhea with slow and slippery pulse, it is excess. Diarrhea will not stop; urgent purgation with Dachengqi Tang.
[Commentary]: Cheng Wuji notes: Slow pulse from dry food; slippery pulse indicates substantial Grain Qi. Spleen/Stomach fail to digest Water/Grain, causing diarrhea. Dachengqi Tang removes retention, stopping diarrhea.
In diarrhea with reverse slippery pulse, something must be expelled; diarrhea stops upon purging, using Dachengqi Tang.
[Commentary]: Diarrhea is deficiency; slippery pulse is excess. Reverse slippery pulse in diarrhea indicates need to expel. Previous clause had slow pulse due to interior excess blocking Qi; this has slippery pulse indicating desire to expel. Both are tangible excesses, hence both use Dachengqi Tang.
If diarrhea recurs at the same year/month/day/hour after recovery, it is because the pathogen was not fully eliminated. Purge it using Dachengqi Tang.
[Commentary]: Accumulations caused by seasonal Qi reside in corresponding Zang organs. After diarrhea stops, if residue remains, and season changes, organ Qi wanes, hiding accumulation. When the season returns, Qi peaks, activating accumulation, causing recurrence. Gastrointestinal accumulation requires purgation.
In diarrhea with delirium, there is dry fecal mass; Xiao Chengqi Tang is indicated.
[Commentary]: *Shanghan Lun* places delirium/dry feces in Yangming. Here in Jueyin. Cheng Wuji notes delirium/dry feces is Stomach excess, diarrhea is Intestine deficiency, omitting Jueyin reason. Yangming usually lacks diarrhea unless combined with Shaoyang (Wood overacting on Earth). Self-diarrhea in Yangming implies Yang sinking, fatal. Yangming is double-Yang heat, associated with Dry Metal, prone to closure and fluid depletion. Heat causes delirium; dryness causes fecal mass, hence no diarrhea. Jueyin diarrhea arises from extreme Yin turning to Yang rise. Pathogenic heat enters Yin, unable to extend, descends as diarrhea. Hence many Shaoyin/Jueyin diarrheas. Yangming Dry Metal suppresses Wood, causing Jueyin diarrhea. Jueyin end transforms to rising clear Qi. *Neijing*: Clear Qi below causes grain diarrhea. From transmission view, Yangming lacks diarrhea. From meridian view, Yangming diarrhea is common. Yangming/Taiyin are exterior-interior, both related to Dampness (*Neijing*: Damp excess causes loose stool). Yangming is Dry Metal; Zang/Fu alternate dominance. Taiyin excess causes heavy body/diarrhea (Damp). Yangming excess causes stifled dry-heat and dry feces, requiring purgation, not just from external heat.
For diarrhea with pus and blood, Taohua Tang is indicated.
Taohua Tang Formula:
Chishi Zhi (Red Halloysite, 1.5 jin, sifted/crushed), Gan Jiang (Dried Ginger, 1 liang), Jing Mi (Rice, 1 sheng).
Boil three ingredients in seven sheng water until rice is cooked. Strain. Add one fangcunbi dose. Take three times daily. One dose cures; stop subsequent doses.
[Commentary]: This is Shaoyin syndrome. Kidney Water is cold, causing Water excess fighting Blood, seeping into intestines, rotting into pus. Cheng Wuji notes: Lower Jiao insecure, interior cold. Chishi Zhi astringes intestines; Gan Jiang disperses cold; Jing Mi tonifies Stomach. Chishi Zhi manages Blood/Water/leakage/astringency. Materia Medica uses it for difficult labor/placenta retention. Gan Jiang disperses cold/stops bleeding. Jing Mi guides drugs to intestines. However, some cases require draining, not astringing. Pus/blood can be drained (moving Qi/Blood). Moving Qi/Blood cannot be warmed; warming cannot move. They oppose. Zhang Zhongjing presents both; later scholars must discern. Cheng notes Yangming pus/blood is collateral heat. Do Yin meridian diseases always involve organ cold without pathogenic heat? Pathogens interact complexly. Zhang offers examples for future adaptation.
For hot diarrhea with rectal heaviness, Baitouweng Tang is indicated.
Baitouweng Tang Formula:
Baitouweng (Pulsatilla Root, 2 liang), Huang Lian (Coptis Rhizome), Huang Bai (Phellodendron Bark), Qin Pi (Ash Bark) (each 3 liang).
Boil four ingredients in seven sheng water until three sheng remain. Strain. Take one sheng warm. Repeat if ineffective.
[Commentary]: Also Jueyin syndrome. Cheng Wuji notes: Heat damages Qi; Qi deficiency causes heaviness. Lower Jiao deficiency requires bitter-cold to firm. However, heaviness varies. Previous clause (deep-wiry/heaviness) was Qi deficiency-cold failing to lift. Here, heat damages causing Qi stagnation, or Blood deficiency/stasis, or anal pain. Generally caused by dry-Qi exterior constraint. Liu Hejian states diarrhea results from dry-Qi郁 outside intestines and Dampness gathering inside. Blood movement stops stool; Qi movement relieves heaviness. Resolve dry-Qi郁 by distinguishing cold/heat. Mild heat uses acrid-warm to move Qi; severe heat uses bitter-cold to treat heat. Zhang Zihe song: Treat Fire, and Wind/Dryness resolve. Tonify Blood deficiency, move Blood stasis. Harmonized Blood/Qi resolves郁. Use bitter-cold to treat dryness, not just firm Lower Jiao deficiency. *Jingui Yaolue* cites Shaoyin/Jueyin diarrhea often. It questions why meridians are removed in miscellaneous diseases. Cold damage has transmission; miscellaneous diseases depend on location. Postpartum extreme deficiency diarrhea also uses Baitouweng Tang.
After diarrhea, if irritability worsens and epigastrium is soft upon pressure, it is deficiency irritability; Zhizi Chi Tang is indicated.
Zhizi Chi Tang Formula:
Zhi Zi (Gardenia Fruit, 14 seeds, fried), Xiang Chi (Fermented Soybean, 4 he, wrapped in silk).
Boil two ingredients in four sheng water. First boil Zhizi to 2.5 sheng, add Chi, boil to 1.5 sheng. Strain. Divide into two doses. Take one dose; stop if vomiting occurs.
[Commentary]: *Shanghan Lun* places post-treatment deficiency irritability in Taiyang. Here, it arises from diarrhea-induced deficiency irritability, noted in Jueyin. Though meridians differ, heat invading deficiency causes irritability similarly. Both use bitter Zhizi Chi Tang to vomit off pathogenic heat.
In diarrhea with undigested food, interior cold with exterior heat, sweating, and cold limbs, Tongmai Sini Tang is indicated.
Tongmai Sini Tang Formula:
Gan Cao (Licorice Root, 2 liang), Gan Jiang (Dried Ginger, 3 liang), Fu Zi (Aconite Root, raw, 1 piece), Cong Bai (Scallion White, 4 stalks).
Boil four ingredients in three sheng water until 1.2 sheng remain. Strain. Divide into two warm doses.
[Commentary]: Interior cold with exterior heat indicates Yang repelled outward. Yang cannot harmonize internally, causing undigested food diarrhea; Yin cannot harmonize externally, causing body heat.