之时而言。面戴阳。系下虚。此申言面少赤之故。下虚。即下焦元气虚。按仲景虽云汗出
而解。然于未解之时。当用何药。郭白云云。不解。宜通脉四逆汤。
下利后。脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。
〔尤〕下利后。脉绝手足厥冷者。阴先竭而阳后脱也。是必俟其 时经气一周。其脉当还。其手足当
温。设脉不还。其手足亦必不温。则死之事也。
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。
〔尤〕下利腹胀满。里有寒也。身体疼痛。表有邪也。然必先温其里。而后攻其表。所以然者。里气
不充。则外攻无力。阳气外泄。则里寒转增。自然之势也。而四逆用生附。则寓发散于温补之中。桂枝有
甘芍。则兼固里于散邪之内。仲景用法之精如此。
四逆汤方（方见上。）
桂枝汤方
桂枝（三两去皮） 芍药（三两） 甘草（三两炙○赵本作二两案据太阳篇当作二两）
生姜（三两○案据太阳篇脱切字） 大枣（十二枚○案据太阳篇脱擘字）
上五味 咀。以水七升。微火煮。取三升。去滓。适寒温。服一升。服已须臾。啜稀粥一升。以助药力。
温覆令一时许。遍身 。微似有汗者益佳。不可令如水淋漓。若一
服汗出病瘥。停后服。（淋漓。太阳篇。作流离。）
下利三部脉皆平。按之心下坚者。急下之。宜大承气汤。利下。脉经有后字。似是。
〔沈〕三部脉皆平。下利而按之心下坚者。脉证不符。是非风寒所属。当责食填胃中。未伤血气。而不
形于脉也。故用大承气汤。峻攻有形之滞。则下利自止。经谓土郁夺之。通因通用之法也。
下利脉迟而滑者。实也。利未欲止。急下之。宜大承气汤。
〔沈〕此亦食滞之利也。食壅于胃。气道不利。故脉来迟。然脉虽迟。而非虚寒之比。但迟为气壅。滑为血
实。血实气壅。水谷为病。故为实也。内滞中气不和。利未欲止。但恐成停搁之患。故宜大承气汤。急夺其邪也。
下利。脉反滑者。当有所去。下乃愈。宜大承气汤。
〔程〕经曰。滑为有宿食。故当下去之。而利自愈。
〔鉴〕赵良曰。下利。虚证也。脉滑。实脉也。以下
利之虚证。而反见滑实之脉。故当有所去也。
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。
〔沉〕此旧积之邪复病也。下利瘥后。至期年月日时复发者。是前次下利之邪。隐僻肠间。今值脏腑司令
之期。触动旧邪而复发。然隐僻之根未除。终不能愈。故当大承气迅除
之耳。
案程尤并云。脾主信。故按期复发。凿甚。许氏本事方云。有人因忧愁中伤食。结积在肠胃。故发
吐利。自冬后至暑月。稍伤则发暴下。数日不已。玉函云。下利至隔年月日。不期而发者。此为有积。宜下
之。止用温脾汤。（浓朴。干姜。甘草。桂心。附子。大黄。）尤佳。如难取。可佐以干姜丸。（即备急丸。
加人参。）后服白术散。（即附子理中汤。去甘草干姜。加木香生姜大枣。）戴氏证治要
诀云。泻已愈。隔年及后期复泻。古论云。病有期年而发者。有积故也。宜感应丸。并本条之义也。
大承气汤（见 病中。）
下利谵语者。有燥屎也。小承气汤主之。
〔鉴〕下利。里虚证也。谵语。里实证也。何以决其有燥屎也。若脉滑数。知有宿食也。其利秽粘。
知有积热也。然必脉证如此。始可知其有燥屎也。宜下之以小承气汤。于此推之。而燥屎又不在大便硬不硬
也。
〔尤〕谵语者。胃实之征。为有燥屎也。与心下坚。脉滑者大同。然前用大承气者。以
因实而致利去之。惟恐不速也。此用小承气者。以病成而适实攻之。恐伤及其正也。（见厥阴篇。当参考。）
小承气汤方
大黄（四两） 浓朴（三两炙○赵本作二两） 枳实（大者三枚炙）
上三味。以水四升。煮取一升二合。去滓分温二服。得利则止。
下利便脓血者。桃花汤主之。
〔尤〕此治湿寒内淫。脏气不固。脓血不止者之法。赤石脂理血固脱。干姜温胃驱寒。粳米安中益气。
崔氏去粳米。加黄连当归。用治热利。乃桃花汤之变法也。（案崔氏方。名黄连丸。
出外台伤寒门。）
〔鉴〕初病下利。便脓血者。大承气汤。或芍药
汤下之。热盛者。白头翁汤清之。若日久滑脱。则当以桃花汤。养肠固脱可也。
桃花汤方
赤石脂（一斤一半锉一半筛末） 干姜（一两） 粳米（一升）
上三味以水七升。煮米令熟。去滓温七合。内赤石脂末方寸匕。日三服。若一服愈。余勿服。
张氏伤寒宗印云。石脂色如桃花。故名桃花汤。或曰。即桃花石。徐氏伤寒类方云。兼末服。取其留滞收涩。
外台。崔氏疗伤寒后。赤白滞下无数。阮氏桃华汤方。
赤石脂（八两冷多白滞者加四两） 粳米（一升） 干姜（四两冷多白滞加四两切）
上三味。以水一斗。煮米熟汤成。去滓。服一升。不瘥
复作。热多则带赤。冷多则带白。（伤寒论。千金。范汪同。张仲景伤寒论煮汤和赤石脂末一方寸匕服。）
千金桃花丸 治下冷脐下搅痛。
干姜 赤石脂（各十两）
上二味。蜜丸如豌豆。服十丸。日三服。加至二十丸。
和剂局方。桃花丸。治肠胃虚弱。冷气乘之。脐腹搅痛。
下痢纯白。或冷热相搏。赤白相杂。肠滑不禁。日夜无度。（方同上。只面和为丸为异。）
肘后方。赤石脂汤。疗伤寒若下脓血者。
于本方中。去粳米。加附子。
外台。文仲久下痢脓血方。
于本方中。加乌梅。
千金。大桃花汤。治冷白滞痢腹痛。
于本方。去粳米。加当归。龙骨。牡蛎。附子。白术。人参。甘草。芍药。
热利下重者。白头翁汤主之。（赵本。作重下。）
〔程〕热利下重。则热客于肠胃。非寒不足以除热。非苦不足以坚下焦。故加一热字。别以上之寒利。
〔魏〕滞下之病多热。不同于泻泄下利之证多寒也。故名之曰热利。而以下重别之。
白头翁汤方（外台。引千金翼云。此张仲景伤寒论方。）
白头翁（三两○赵本及伤寒论作二两） 黄连 黄柏 秦皮（各三两）
上四味。以水七升。煮取二升。去滓。温服一升。不愈更服。
钱氏溯源集云。白头翁。神农本经。言其能逐血止腹痛。陶弘景谓其能止毒痢。故以治厥阴热痢。黄连苦
寒。能清湿热浓肠胃。黄柏泻下焦之火。秦皮亦属苦寒。治下痢崩带。取其收涩也。
外台。古今录验。白头翁汤。疗寒急下。及滞下方。
本方。去黄柏。加干姜。甘草。当归。石榴皮。
证类本草。阿胶条。引续传信方。张仲景调气方。治赤白痢。无问远近。小腹 痛不可忍。出入无常。下
重疼闷。每发面青。手足俱变者。黄连。一两。去毛。好胶。手许大碎。蜡。如弹子大。三味以水一大升。
先煎胶令散。次下蜡。又煎令散。即下黄连末。搅相和分为三服。惟须热吃。冷即难吃。神效。案此方。亦见
玉函经附遗。名调气饮。用三味。各三钱。知却是系于后人改定。并附备考。
下利后。更烦。按之心下濡者。为虚烦也。栀子豉汤主之。
〔程〕更烦。言本有烦。不为利除而转甚也。
〔尤〕热邪不从下减。而复上动也。按之心下濡。则中无
阻滞可知。故曰虚烦。
〔鉴〕此利后。热遗于胸中也。按之心下濡。虽热而非实热。故用此以清其虚烦。
栀子豉汤方
栀子（十四枚） 香豉（四合绵裹○赵本绵作绢非）
上二味。以水四升。先煮栀子。得二升半。内豉。煮取
一升半。去滓。分二服。温进一服。得吐则止。（详伤寒论辑义。厥阴篇。下同。）
下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。
〔尤〕挟热下利者。久则必伤脾阴。中寒清谷者。甚则并伤肾阳。里寒外热。汗出而厥。有阴内盛而
阳外亡之象。通脉四逆汤。即四逆加干姜一倍。所谓进而求阳。以收散亡之气也。（详伤寒论辑义厥阴篇。）
通脉四逆汤方
附子（大者一枚生用） 干姜（三两强人可四两） 甘草（二两炙）
上三味。以水三升。煮取一升二合。去滓。分温再服。
〔程〕厥甚者。脉必绝。附子辛热。用以复脉回阳。下清
谷者。胃必寒。干姜辛温。用以温胃止利。甘草甘平。用以佐姜附之热。而回厥逆。
下利肺痛。紫参汤主之。（本草图经肺痛二字。作者一字。）
〔程〕肺痛未详。或云肺痛。当是腹痛。本草云。紫参。治心腹积聚。寒热邪气。
〔鉴〕按此文脱简。不释。
紫参汤方
紫参（半斤） 甘草（三两）
上二味。以水五升。先煮紫参。取二升。内甘草。煮取一升半。分温三服。（〔原注〕疑非仲景方。）
气利。诃黎勒散主之。
〔尤〕气利。气与屎俱失也。诃黎勒。涩肠而利气。粥饮。安中益肠胃。顿服者。补下治下制以急也。
〔鉴〕气利。所下之气秽臭。所利之物稠粘。则为气滞不宣。或下之。或利之。
皆可也。若所利之气不臭。所下之物不粘。则谓气陷肠滑。故用诃黎勒散。以固肠。或用补中益气。以举陷亦可。
诃黎勒散方
诃黎勒（十枚煨）
上一味为散。粥饮和顿服。（〔原注〕疑非仲景方。）
〔程〕寇宗 曰。诃黎勒。能涩便而又宽肠。涩能治利。宽肠能治气。故气利宜之。调以粥饮者。藉谷
气以助肠胃也。论曰。仲景治气利。用诃黎勒散。详其主治。不知其义。及后读杜壬方。言气利。里急后重。
始知诃黎勒。用以调气。盖有形之伤。则便垢而后重。无形之伤。则气坠而后重。便肠垢者。得诸实。气下坠
者。得诸虚。故用词藜勒。温涩之剂也。唐贞观中。太宗苦气利。众医不效。金吾长张宝藏以牛乳。煎荜茇。
进服之立瘥。（案此见刘禹锡隋唐嘉话。）荜茇。温脾药也。刘禹锡传信方。治气利。用矾石。矾石亦涩气
药也。大都气利。得之虚寒。气下陷者。多其用温涩之药可见矣。
案杨氏直指方。牛乳汤。治气痢泄如蟹渤。荜茇末二钱。牛乳半升。同煎减半。空腹服。今验之。气坠
而后重。气与屎俱失者。其所泄多如蟹渤。程注得直指。而义尤明显。
外台广济。疗呕逆不能多食方。
诃黎勒（三两去核煨）
上一味。捣为散。蜜和丸。空腹服二十丸。日二服。以知为度。利多减服。无所忌。
附方
千金翼。小承气汤。治大便不通。哕数谵语。（方见上○案千金翼。用枳实五枚。）
案尤氏云。即前下利谵语有燥屎之法。虽不赘可也。误。本文主下利。而此条示哕用小承气之法。
即上文哕而腹满后
部不利者。丹溪医案。载超越陈氏二十余载。因饱后奔走数里。遂患哕病。但食物则连哕百余声。半日不止。
饮酒与汤。则不作。至晚发热。如此者二月。脉涩数。以血入气中治之。用桃仁承气汤。加红花煎服。下污
血数次。即减。再用木香和中丸。加丁香服之。十日而愈。此亦以攻下治哕之一格也。
外台。黄芩汤。治干呕下利。（外台。引仲景伤寒论。云出篇十六卷。）
黄芩 人参 干姜（各三两） 桂枝（二两） 大枣（十二枚） 半夏（半升）
上六味。以水七升。煮取三升。温分三服。
〔尤〕此与前黄芩加半夏生姜汤治同。而无芍药甘草生姜。有人参桂枝干姜。则温里益气之意居多。
凡中寒气少者。可于此取法焉。
Regarding the term "Dai Yang on the Face" (facial flushing due to deficiency). Dai Yang on the Face refers to a condition caused by deficiency in the lower jiao. This further elaborates on the cause of slight redness on the face. Lower deficiency refers to the deficiency of primal qi in the lower jiao. According to Zhang Zhongjing, although sweating can resolve the disease, what medicine should be used when the disease has not yet resolved? Guo Baiyun stated that if the disease does not resolve, Tongmai Sini Tang (Pulse-Reviving Decoction) is appropriate.
After diarrhea, if the pulse disappears and the hands and feet are cold: if the pulse returns and the hands and feet become warm after a period of time, the prognosis is good; if the pulse does not return, the prognosis is fatal.
[You Zaijing] After diarrhea, if the pulse disappears and the hands and feet are cold, it indicates that yin qi has exhausted first and yang qi subsequently collapses. One must wait for one cycle of meridian qi circulation for the pulse to return and the hands and feet to warm up. If the pulse does not return, the hands and feet will certainly not warm up, which signifies death.
In cases of diarrhea accompanied by abdominal fullness and body pain, one should first warm the interior, then attack the exterior. To warm the interior, Sini Tang (Four Reversals Decoction) is appropriate; to attack the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[You Zaijing] Diarrhea with abdominal fullness indicates cold in the interior; body pain indicates pathogenic factors in the exterior. However, one must first warm the interior before attacking the exterior. The reason is that if the interior qi is not sufficient, there is no strength to attack externally; if yang qi leaks out, the interior cold will increase further. This is the natural trend. Sini Tang uses raw Fuzi (Aconiti Lateralis Radix Preparata) to contain dispersing properties within warming and tonifying; Guizhi Tang contains Gancao (Glycyrrhizae Radix et Rhizoma) and Shaoyao (Paeoniae Radix Alba) to protect the interior while dispersing pathogens. Such is the subtlety of Zhang Zhongjing's prescription methods.
Sini Tang Formula (See formula above.)
Guizhi Tang Formula
Guizhi (Cinnamomi Ramulus, 3 liang, bark removed) Shaoyao (Paeoniae Radix Alba, 3 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparata, 3 liang ○ Zhao edition says 2 liang; note: according to Taiyang Chapter, it should be 2 liang)
Shengjiang (Zingiberis Rhizoma Recens, 3 liang ○ Note: according to Taiyang Chapter, the character 'qie' [cut] is missing) Dazao (Jujubae Fructus, 12 pieces ○ Note: according to Taiyang Chapter, the character 'bai' [split open] is missing)
The above five herbs are crushed. Boil in 7 sheng of water, simmer to obtain 3 sheng, remove dregs. Take at a suitable warm temperature, 1 sheng per dose. Shortly after taking the medicine, drink 1 sheng of thin rice gruel to assist the medicinal power. Cover with blankets for about one shichen (two hours) until the whole body has a slight sweat. It is best not to have profuse sweating like dripping water. If the disease resolves after one dose, stop taking the remaining doses. ("Linli" [dripping], Taiyang Chapter writes "Liuli".)
If all three pulses (cun, guan, chi) are peaceful during diarrhea, but pressing the epigastrium reveals hardness, urgent purgation is required; Dachengqi Tang (Major Order the Qi Decoction) is appropriate. The word "hou" [after] appears in Mai Jing [Classic of Pulse Diagnosis], which seems correct.
[Shen Mingzong] All three pulses being peaceful, yet having diarrhea with hardness upon pressing the epigastrium, indicates a discrepancy between pulse and symptoms. This is not caused by wind-cold. One should attribute it to food stagnation in the stomach, which has not damaged blood and qi, hence not manifesting in the pulse. Therefore, use Dachengqi Tang to vigorously purge有形 (tangible) stagnation, and the diarrhea will stop naturally. As the classic states, "When earth is obstructed, seize it," this is the method of treating obstruction with purgatives (Tong Yin Tong Yong).
If the pulse is slow and slippery during diarrhea, it is an excess pattern. Since the diarrhea has not stopped, urgent purgation is required; Dachengqi Tang is appropriate.
[Shen Mingzong] This is also diarrhea caused by food stagnation. Food accumulates in the stomach, obstructing the qi mechanism, causing the pulse to be slow. However, a slow pulse here is different from deficiency-cold. Slow indicates qi stagnation, slippery indicates blood excess. Blood excess and qi stagnation, combined with pathological water and grain, constitute an excess pattern. Internal stagnation disrupts middle qi harmony, and since diarrhea persists, one fears stagnation complications. Thus, Dachengqi Tang is appropriate to urgently eliminate the pathogen.
If the pulse becomes slippery during diarrhea, there should be something to expel; once expelled, the disease will heal; Dachengqi Tang is appropriate.
[Cheng Zhi] The classic says: "Slippery pulse indicates retained food." Therefore, one should expel the retention, and the diarrhea will heal itself.
[Wu Qian] Zhao Liang said: Diarrhea is a deficiency pattern; a slippery pulse is an excess pulse. Seeing an excess-slippery pulse in a deficiency-diarrhea case means there is something to expel.
If diarrhea has healed but recurs at the same month, day, or hour as before, it is because the root of the disease was not fully eliminated. Purgation is required; Dachengqi Tang is appropriate.
[Shen Mingzong] This is the recurrence of old accumulated pathogens. After diarrhea heals, recurrence at specific times indicates that pathogens from the previous episode hid in the intestines and were triggered by the timing of zang-fu command periods. Since the hidden root remains, it cannot heal completely. Therefore, Dachengqi Tang should be used to rapidly clear it.
Note: Cheng Zhi and You Zaijing argue that the spleen governs trustworthiness/cycles, hence the periodic recurrence, which is overly forced. Xu Shumi's *Ben Shi Fang* records: A person suffered from food stagnation due to worry, forming accumulation in the intestines and stomach, causing vomiting and diarrhea. From winter to summer, slight dietary indiscretion triggered violent diarrhea lasting days. *Yu Han Jing* states: Diarrhea recurring at intervals of months or years without expectation indicates accumulation, requiring purgation. Using Wenyi Tang (Houpo, Ganjiang, Gancao, Guixin, Fuzi, Dahuang) is excellent. If unavailable, supplement with Ganjiang Wan (Beiji Wan plus Renshen). Later take Baizhu San (Fuzi Lizhong Tang minus Gancao and Ganjiang, plus Muxiang, Shengjiang, Dazao). Dai Yuanli's *Zheng Zhi Yao Jue* states: Diarrhea recurring after a year or later aligns with ancient theories attributing annual recurrence to accumulation, recommending Yinggan Wan. This aligns with the meaning of this clause.
Dachengqi Tang (See Miscellaneous Diseases Chapter.)
Diarrhea accompanied by delirium indicates dry fecal matter; Xiao Chengqi Tang (Minor Order the Qi Decoction) is the primary treatment.
[Wu Qian] Diarrhea is a deficiency pattern of the interior; delirium is an excess pattern of the interior. How do we determine the presence of dry feces? If the pulse is slippery and rapid, it indicates retained food; if the excrement is foul and sticky, it indicates accumulated heat. Only when pulse and symptoms match can we confirm dry feces. Purgation with Xiao Chengqi Tang is appropriate. From this, we infer that dry feces are not determined solely by hard stool.
[You Zaijing] Delirium is a sign of stomach excess due to dry feces. It is similar to epigastric hardness and slippery pulse. Previously, Dachengqi Tang was used because diarrhea was caused by excess, requiring rapid removal. Here, Xiao Chengqi Tang is used because the disease has formed excess, and gentle attack is needed to avoid damaging healthy qi. (See Jueyin Chapter for reference.)
Xiao Chengqi Tang Formula
Dahuang (Rhei Radix et Rhizoma, 4 liang) Houpo (Magnoliae Officinalis Cortex, 3 liang, prepared ○ Zhao edition says 2 liang) Zhishi (Immature Bitter Orange Fruit, 3 large pieces, prepared)
The above three herbs are boiled in 4 sheng of water to obtain 1 sheng 2 he, remove dregs, divide into two warm doses. Stop when bowel movement occurs.
Diarrhea with pus and blood is treated with Taohua Tang (Peach Blossom Decoction).
[You Zaijing] This treats damp-cold invading internally, failing organ qi, resulting in continuous pus and blood. Chishizhi (Halloysitum Rubrum) regulates blood and secures collapse; Ganjiang (Zingiberis Rhizoma) warms the stomach and dispels cold; Jingmi (Oryza Sativa) stabilizes the middle and benefits qi. Cui Shi removed Jingmi, added Huanglian (Coptidis Rhizoma) and Danggui (Angelicae Sinensis Radix) to treat heat-type diarrhea, a modification of Taohua Tang. (Note: Cui Shi's formula is named Huanglian Wan, found in *Wai Tai Mi Yao·Shanghan Men*.)
[Wu Qian] For initial diarrhea with pus and blood, use Dachengqi Tang or Shaoyao Tang to purge; if heat is severe, use Baitouweng Tang to clear. If prolonged with sliding/leakage, use Taohua Tang to nourish the intestines and secure collapse.
Taohua Tang Formula
Chishizhi (Halloysitum Rubrum, 1 jin, half crushed, half sifted into powder) Ganjiang (Zingiberis Rhizoma, 1 liang) Jingmi (Oryza Sativa, 1 sheng)
The above three herbs are boiled in 7 sheng of water until the rice is cooked. Remove dregs, take 7 he warm. Add 1 fangcun bi of Chishizhi powder. Take three times daily. If cured after one dose, do not take the rest.
Zhang Shi's *Shanghan Zong Yin* states: Stone lipid resembles peach blossoms, hence the name Taohua Tang. Some say it is Peach Blossom Stone. Xu Shi's *Shanghan Lei Fang* notes taking the powder together for its astringent property. *Wai Tai Mi Yao* records Cui Shi's treatment for post-febrile dysentery. Ruan Shi's Taohua Tang Formula:
Chishizhi (8 liang, add 4 liang if cold predominates with white discharge) Jingmi (1 sheng) Ganjiang (4 liang, cut; add 4 liang if cold predominates with white discharge)
Boil in 10 sheng of water until rice is cooked and soup is ready. Remove dregs, take 1 sheng. If not cured, repeat. Heat predominant causes redness; cold predominant causes whiteness. (*Shanghan Lun*, *Qian Jin*, Fan Wang agree. Zhang Zhongjing's *Shanghan Lun* mixes decoction with 1 fangcun bi of Chishizhi powder.)
Qian Jin Taohua Wan: Treats cold diarrhea with umbilical pain.
Ganjiang (Zingiberis Rhizoma), Chishizhi (Halloysitum Rubrum) (each 10 liang)
Grind into pills the size of pea seeds with honey. Take 10 pills, three times daily, increasing to 20.
Heji Jufang Taohua Wan: Treats weak intestines/stomach invaded by cold qi, causing umbilical/abdominal twisting pain.
Pure white dysentery, or mixed hot/cold, red and white, intestinal sliding uncontrollable, day and night without limit. (Formula same as above, only pill preparation differs.)
Zhou Hou Fang Chishizhi Tang: Treats febrile disease with pus and blood.
Remove Jingmi from the base formula, add Fuzi (Aconiti Lateralis Radix Preparata).
Wai Tai Wen Zhong Chronic Dysentery with Pus and Blood Formula:
Add Wumei (Mume Fructus) to the base formula.
Qian Jin Da Taohua Tang: Treats cold white dysentery with abdominal pain.
Remove Jingmi from the base formula, add Danggui, Longgu, Muli, Fuzi, Baizhu, Renshen, Gancao, Shaoyao.
Heat-type diarrhea with tenesmus (heavy sensation in rectum) is treated with Baitouweng Tang (Pulsatilla Decoction). (Zhao edition writes "Zhong Xia".)
[Cheng Zhi] Heat-type diarrhea with tenesmus indicates heat pathogens in the intestines/stomach. Only cold can dispel heat; only bitter can strengthen the lower jiao. Hence the addition of "heat" to distinguish from previous cold diarrhea.
[Wei Litong] Dysentery is mostly heat-pattern, unlike diarrhea which is mostly cold. Hence named Heat-Type Diarrhea, distinguished by tenesmus.
Baitouweng Tang Formula (*Wai Tai Mi Yao* cites *Qian Jin Yi* saying this is from Zhang Zhongjing's *Shanghan Lun*.)
Baitouweng (Pulsatillae Radix, 3 liang ○ Zhao edition and *Shanghan Lun* say 2 liang) Huanglian (Coptidis Rhizoma) Huangbo (Phellodendri Cortex) Qinpi (Fraxini Cortex) (each 3 liang)
The above four herbs are boiled in 7 sheng of water to obtain 2 sheng. Remove dregs, take 1 sheng warm. If not cured, take again.
Qian Shi's *Su Yuan Ji* states: Baitouweng, according to *Shennong Ben Cao Jing*, expels blood and stops abdominal pain. Tao Hongjing said it stops toxic dysentery. Thus it treats Jueyin heat-dysentery. Huanglian is bitter and cold, clearing damp-heat in intestines/stomach; Huangbo drains fire from lower jiao; Qinpi is also bitter and cold, treating dysentery and leukorrhea, utilizing its astringent property.
*Wai Tai Mi Yao* Ancient Records Verification Baitouweng Tang: Treats cold urgency/purgation and dysentery.
Base formula removes Huangbo, adds Ganjiang, Gancao, Danggui, Shiliupi (Pomegranate Peel).
*Zheng Lei Ben Cao* under Ejiao entry cites *Xu Chuan Xin Fang*: Zhang Zhongjing Tiaoqi Formula treats red-white dysentery regardless of duration, unbearable lower abdominal cramping, irregular passage, tenesmus and pain, turning blue-faced with cold limbs upon onset. Huanglian 1 liang (remove hairs); Hao Ejiao (good gelatin), hand-sized, broken; La (beeswax), egg-sized. Three herbs in 1 da sheng of water. First boil gelatin until dissolved, then beeswax until dissolved, then add Huanglian powder. Mix well, divide into three doses. Must be taken hot; cold is difficult to swallow. Miraculous effect. Note: This formula also appears in *Yu Han Jing Fu Yi*, named Tiaoqi Yin, using three herbs, each 3 qian. Likely modified by later generations, attached for reference.
After diarrhea, if irritability worsens and pressing the epigastrium feels soft, it is empty irritability; Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
[Cheng Zhi] "More irritable" means pre-existing irritability worsened despite diarrhea.
[You Zaijing] Heat pathogen did not decrease via downward flow but moved upward. Pressing the epigastrium yields softness, indicating no obstruction in the middle. Hence called empty irritability.
[Wu Qian] This is heat lingering in the chest after diarrhea. Pressing the epigastrium is soft; though there is heat, it is not excess-heat. Thus use this formula to clear empty irritability.
Zhizi Chi Tang Formula
Zhizi (Genkwa Flos, 14 pieces) Xiangchi (Sojae Seminis Praeparatum, 4 he, wrapped in silk ○ Zhao edition writes 'juan' [silk gauze] instead of 'mian' [cotton/silk], which is incorrect)
The above two herbs are boiled in 4 sheng of water. First boil Zhizi to obtain 2.5 sheng, then add Xiangchi. Boil to obtain 1.5 sheng. Remove dregs, divide into two doses. Take 1 dose warm. Stop if vomiting occurs. (Detailed in *Shanghan Lun Ji Yi·Jueyin Chapter*, same below.)
Diarrhea with undigested food, interior cold with exterior heat, sweating and cold limbs is treated with Tongmai Sini Tang (Pulse-Reviving Decoction).
[You Zaijing] Heat-type diarrhea long-term damages spleen yin; cold-type diarrhea with undigested food severely damages kidney yang. Interior cold with exterior heat, sweating and cold limbs, indicates excessive yin internally and escaping yang externally. Tongmai Sini Tang is Sini Tang plus double the amount of Ganjiang, advancing to seek yang to gather scattered and escaping qi. (Detailed in *Shanghan Lun Ji Yi·Jueyin Chapter*.)
Tongmai Sini Tang Formula
Fuzi (Aconiti Lateralis Radix Preparata, 1 large piece, raw) Ganjiang (Zingiberis Rhizoma, 3 liang, strong persons may use 4 liang) Gancao (Glycyrrhizae Radix et Rhizoma Preparata, 2 liang)
The above three herbs are boiled in 3 sheng of water to obtain 1.2 sheng. Remove dregs, divide into two warm doses.
[Cheng Zhi] Severe cold reversal leads to absent pulse. Fuzi is acrid and hot, used to restore pulse and revive yang. Undigested food diarrhea indicates stomach cold. Ganjiang is acrid and warm, used to warm stomach and stop diarrhea. Gancao is sweet and neutral, assisting Ganjiang and Fuzi's heat to reverse cold.
Diarrhea with lung pain is treated with Zishen Tang (Purple Ginseng Decoction). (*Ben Cao Tu Jing* note: "Lung pain" characters might be a typo for one character.)
[Cheng Zhi] Lung pain is unclear. Some say it should be abdominal pain. *Ben Cao* states: Zishen treats heart/abdominal accumulation and cold-heat pathogens.
[Wu Qian] Note: This text has missing slips; no explanation provided.
Zishen Tang Formula
Zishen (Stemonae Radix, 0.5 jin) Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang)
The above two herbs are boiled in 5 sheng of water. First boil Zishen to obtain 2 sheng, then add Gancao. Boil to obtain 1.5 sheng. Divide into three warm doses. ([Original Note] Suspected not to be Zhang Zhongjing's formula.)
Qi-type diarrhea is treated as follows: Helile San (Chebula Powder) is the primary treatment.
[You Zaijing] Qi-type diarrhea involves simultaneous loss of gas and stool. Helile (Terminaliae Chebula Fructus) astringes intestines and regulates qi. Rice gruel stabilizes the middle and benefits intestines/stomach. Taking in one dose reflects the principle of urgent treatment for lower conditions.
[Wu Qian] Qi-type diarrhea: If expelled gas is foul and stool is sticky, it is qi stagnation not unblocking; purging or promoting flow is acceptable. If expelled gas is odorless and stool is non-sticky, it is qi sinking and intestinal sliding. Thus use Helile San to secure intestines, or Buyang Huanwu Tang/Buzhong Yiqi Tang to raise sinking qi.
Helile San Formula
Helile (Terminaliae Chebula Fructus, 10 pieces, roasted)
One herb ground into powder. Mix with rice gruel and take in one dose. ([Original Note] Suspected not to be Zhang Zhongjing's formula.)
[Cheng Zhi] Kou Zongshi said: Helile can astringe bowels and broaden intestines. Astringency treats diarrhea; broadening treats qi issues. Hence suitable for Qi-type diarrhea. Mixing with rice gruel utilizes grain qi to assist intestines/stomach. Discussion: Zhang Zhongjing used Helile San for Qi-type diarrhea. Analyzing its main action, its meaning was unknown. Later reading Du Ren's formulas regarding Qi-type diarrhea with tenesmus revealed Helile is used to regulate qi. Tangentially, tangible injury causes mucus and tenesmus; intangible injury causes qi sinking and tenesmus. Mucus comes from excess; qi sinking comes from deficiency. Thus Helile, a warm-astringent agent, is used. During Zhenguan era, Emperor Taizong suffered Qi-type diarrhea; many doctors failed. General Zhang Baozang used cow milk boiled with Biba (Long Pepper Fruit), administered immediately curing him. (Note: See Liu Yuxi's *Sui Tang Jia Hua*.) Biba is a spleen-warming herb. Liu Yuxi's *Chuan Xin Fang* uses Fanshi (Alumen) for Qi-type diarrhea. Fanshi is also an astringent qi herb. Generally, Qi-type diarrhea stems from deficiency-cold and qi sinking, often treated with warm-astringent herbs.
Note: Yang Shi's *Zhi Zhi Fang* Niurou Tang treats Qi-dysentery with stool like crab foam. Biba powder 2 qian, cow milk 0.5 sheng, boil until reduced by half, take on empty stomach. Verification shows qi sinking with tenesmus and simultaneous loss of gas/stool results in stool like crab foam. Cheng's note citing *Zhi Zhi* clarifies the meaning further.
*Wai Tai Guang Ji* Treatment for Vomiting/Nausea preventing adequate food intake:
Helile (Terminaliae Chebula Fructus, 3 liang, pitted, roasted)
One herb ground into powder. Mix with honey into pills. Take 20 pills on empty stomach, twice daily. Adjust based on response. Reduce dose if diarrhea increases. No restrictions.
Attached Formulas
*Qian Jin Yi* Xiao Chengqi Tang: Treats constipation, frequent hiccups, and delirium. (Formula seen above ○ Note: *Qian Jin Yi* uses 5 Zhishi pieces.)
Note: You Zaijing claims this is the same method as previous diarrhea-delirium-with-dry-feces clause, so repetition is unnecessary. Error. This text focuses on diarrhea, while this clause demonstrates using Xiao Chengqi Tang for hiccups. i.e., "Hiccups with abdominal fullness and posterior obstruction." Danxi Medical Case: Chen exceeded 20 years old, ran several miles after a full meal, developed hiccups. Eating triggered over 100 hiccups continuously for half a day. Drinking wine or soup stopped them. Fever occurred at night. This lasted two months. Pulse was choppy and rapid. Treated as blood entering qi mechanism. Used TaoRen Chengqi Tang plus Honghua (Carthami Flos) decocted and taken. Passed dirty blood several times, symptoms reduced. Then used Muxiang Hezhong Wan plus Dingxiang (Caryophylli Flos). Cured in ten days. This is another method of treating hiccups with purgation.
*Wai Tai Mi Yao* Huangqin Tang: Treats dry vomiting and diarrhea. (*Wai Tai Mi Yao* cites Zhang Zhongjing's *Shanghan Lun*, stating it comes from Volume 16.)
Huangqin (Scutellariae Radix) Renshen (Ginseng Radix) Ganjiang (Zingiberis Rhizoma) (each 3 liang) Guizhi (Cinnamomi Ramulus, 2 liang) Dazao (Jujubae Fructus, 12 pieces) Banxia (Pinelliae Rhizoma, 0.5 sheng)
The above six herbs are boiled in 7 sheng of water to obtain 3 sheng. Take warm, divided into three doses.
[You Zaijing] This is similar to previous Huangqin Jia Banxia Shengjiang Tang treatment, but lacks Shaoyao, Gancao, and Shengjiang. Instead, it has Renshen, Guizhi, and Ganjiang, emphasizing warming the interior and benefiting qi. Those with internal cold and deficient qi can learn from this.