此提出脏腑以阳绝阴绝。为危笃证指出两大生路。总结上文呕吐哕等证。并起下文
利证。此于上下交界处着神。
沈自南云、六腑为阳。气行于外。盖胃为众腑之原。而原气衰。阳不充于四肢。则
众腑之阳亦弱。故手足寒。上气脚缩。即阳虚而现诸寒收引之象也。诸脏属阴。藏而不
泻。然五脏之中。肾为众阴之主。真阳所寄之地。但真阳衰微。则五脏气皆不足。胃关
不阖。泻而不藏。则利不禁。而下甚。甚者。阳气脱。而阴血痹着不行。故手足不仁。
此仲景本意。欲人治病以胃肾为要也。
（下利证有重轻。当以脉别之。假如）下利脉沉（者主里。）弦者。（主急。见是
脉者。则知其里急）下重。脉大者。（为邪盛。又为病进。见是脉者。）为未止。（微
弱者。正衰而邪亦衰也。数者。阳之象也。）脉微弱（中而见）数者。（则）为（阳气
将复。故知其利）欲自止。虽（下利以发热为逆证。而既得微弱中见数之脉。邪去正复。
）发热（必自已而）不死。
此以脉而别下利之轻重也。内经以肠 身热则死。寒则生。此言虽发热不死者。以
微弱数之脉。知其邪去而正将自复。热必不久而自退。正与内经之说相表里也。
下利手足厥冷（阳陷下。不能行于手足也。）无脉者。（阳陷下。不能充于经脉也。
）灸之。（起陷下之阳。手足应温。而竟）不温。（然手足虽不温。而犹望其脉还为
吉兆。）若脉（亦）不还。反（加）微喘者。（是下焦之生气。不能归元。而反上脱也。
必）死。（所以然者。脉之元始于少阴。生于趺阳。少阴趺阳。为脉生始之根。少阴脉
不至。则趺阳脉不出。故少阴在下。趺阳在上。故必）少阴（上合而）负（于）趺
阳者。（戊癸相合。脉气有根。其证）为顺也。（其名负。奈何。如负戴之负也。）
此言下利阳陷之死证。而并及于脉之本原也。
下利（大热而渴。则偏于阳。无热不渴。则偏于阴。皆未能即愈。若）有微热而渴。
（则知其阴阳和也。）脉弱者。（则知其邪气去也。见此脉证。）今自愈。
下利脉数。（为热利也。若身无大热。止）有微热汗出。（其热亦随汗而衰矣。）
今自愈。设脉紧（者。为表邪未衰。故）为未解。
下利（以见阳为吉。若）脉数而渴者。（是阳能胜阴。）今自愈。（表和热退。
而脉数与渴。）设不瘥。必圊脓血。以（里）有热（反动其血）故也。（下利。脾病也。
弦。肝脉。脾病忌见肝脉。若）下利脉反弦。（似非美证。但弦中浮而不沉。兼见外证
）发热身汗者（其弦不作阴脉看。与脉数有微热汗出一例。当自）愈。
下利（而失）气（不已）者。（是气滞而乱。又在寒热之外。但）当利其小便。（
小便利。则气化而不乱矣。）
下利（属寒者。脉应沉迟。今）寸脉反浮数。（其阳强可知）尺中自涩者。（其阴弱
可知。以强阳而加弱阴。）必圊脓血。
前章既言下利脉微弱数。为欲自止。虽发热不死。此六节即承前意而言脉证或有参
差。其内邪喜于外出。则一理也。但变热者。必见血耳。
下利清谷。（为里虚气寒也。宜温其中。）不可攻其表。（若服表药。令其）汗出
（则阳虚者气不化。）必胀满。
此言里气虚寒。不可误汗以变胀也。
下利脉沉而迟。（其为阴盛阳虚无疑矣。阳虚则气浮于上。故）其人面少赤。（虽
）身有微热。（尚见阳气有根。其奈阳不敌阴。为）下利清谷（而不能遽止。）者。（
是阳热在上。阴寒在下。两不相接。惟以大药救之。令阴阳和。上下通。）必郁冒汗出
而解。（然虽解而）病患必微厥。所以然者。其面戴阳。（阳在上而不行于下。）下（
焦阳）虚故也。
此言三阳之阳热在上。而在下阴寒之利。可以冀其得解。师于最危急之证。审其一
线可回者。亦不以不治而弃之。其济人无已之心。可谓至矣。
下利后。（中土虚也。中土虚。则不能从中焦而注于手太阴。故）脉绝。（土贯四
旁。而主四肢。土虚则）手足厥冷。（脉以平旦为纪。一日一夜。终而复始。共五十度
而大周于身。） 时（为循环一周。而）脉（得）还手足温者。（中土之气将复。复能从中焦
而注于太阴。故）生。脉不还者。（中土已败。生气已绝。故）死。
此言生死之机。全凭于脉。而脉之根。又藉于中土也。其脉生于中焦。从中焦而注
于手太阴。终于足厥阴。行阳二十五度。行阴二十五度。水下百刻一周。循环至五十度。
而复会于手太阴。故还与不还。必视乎 时也。
通脉四逆汤。白通汤。或加胆尿。皆神剂也。
前皆言下利。此复言利后。须当分别。
下利后。腹胀满。（里有寒也。）身体疼痛者。（表有寒也。一时并发。当以里为
急。）先温其里。乃攻其表。（所以然者。恐里气不充。则外攻无力。阳气外泄。则里
寒转增也。）温里宜四逆汤。攻表宜桂枝汤。
此为寒而下利。表里兼病之治法也。
四逆汤方 （见上）
桂枝汤方
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚）
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。啜热
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。
病必不除。若一服汗出。病瘥。停后服。
（然亦有实邪之利。所谓承气证者。何以别之。）下利三部脉皆平。（不应胸中有
病。然）按之心下坚者。（此有形之实证也。其初未动气血。不形于脉。而杜渐即在
此时。法当）急下之。宜大承气汤。
下利脉迟（者。寒也。）而（迟与）滑（俱见）者。（不为寒。而为）实也。（中
实有物。能阻其脉行之期也。实不去。则）利未欲止。急下之。宜大承气汤。
下利脉（本不滑。而）反滑者。（为有宿食。）当有所去。下乃愈。宜大承气汤。
下利已瘥。至其年月日时复发者。（陈积在脾。脾主信而不愆期。）以（前此之积
）病（去而）不尽故也。当下之。宜大承气汤。
此言下利有实邪者。不问虚实久暂。皆当去之。不得迁延养患也。
大承气汤（见痉病）
（然大承气外。又有小承气之证。不可不知。）下利谵语者。（火与阳明之燥气相
合。中）有燥屎也。（燥屎坚结如羊屎。若得水气之浸灌不骤者。可以入其中。而润之
使下。若荡涤过急。如以水投石。水去而石自若也。故不用大承气。而以）小承气汤主
之。
此言为下利谵语。下不宜急者。出其方治也。
小承气汤方
大黄（四两） 枳实（三枚） 浓朴（二两炙）
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。（由寒郁转为湿热。因而动血也。以）桃花汤主之。
此为利伤中气。及于血分。即内经阴络伤则便血之旨也。桃花汤姜米以安中益气。
赤石脂入血分而利湿热。后人以过涩疑之。是未读本草经之过也。
桃花汤方
赤石脂（一斤一半全用一半研末） 干姜（二两） 粳米（一升）
上三味。以水七升。煮米热。去滓。温七合。纳赤石脂末方寸匕。日三服。若一服
愈。余勿服。
热利下重者。（热邪下入于大肠。火性急速。邪热甚。则气滞壅闭。其恶浊之物。急
欲出而未得遽出故也。以）白头翁汤主之。
此为热利之后重。出其方治也。辨证全在后重。而里急亦在其中。
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。不愈更服。
（前既言下利后之厥冷矣。今更请言下利后之烦乎。）下利后（水液下竭。必热上
盛。不得相济。乃）更（端复起而作）烦。（然）按之心下濡者。（非上焦君火亢盛之
烦。乃下焦水阴不得上济之烦。此）为虚烦也。（以）栀子豉汤主之。
此为利后更烦者。出其方治也。下利后二条。一以厥冷。一以虚烦。遥遥作对子。
汉文之奥妙处。不可不细绎之。
栀子豉汤方
栀子（十四枚擘） 香豉（四合绵裹）
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。得吐则愈。（末八字。宜从张氏删之。）
（屎水杂出。而色不大黄。名为）下利清谷。里寒（而格其）外热。（阳气外散而
）汗出（阳气虚微）而厥。（以）通脉四逆汤主之。
此为下利阴内盛而阳外亡者。出其方治也。里不通于外。而阴寒内拒。外不通于里。
而孤阳外越。非急用大温之剂。必不能通阴阳之气于顷刻。 上言里热下利而为下重。
此言里寒下利而为清谷。隔一节。以寒热作对子。
通脉四逆汤方
附子（一枚生用） 干姜（二两强人可四两） 甘草（二两炙）
上三味。以水三升。煮取一升二合。去滓。分温再服。
下利肺痛。紫参汤主之。
赵氏曰、大肠与肺合。大抵肠中积聚。则肺气不行。肺有所积。大肠亦不固。二害
互为病。大肠病而气塞于肺者痛。肺有积者亦痛。痛必通用。紫参通九窍。利大小肠。
气通则痛愈。积去则利自止。喻氏曰、后人有疑此非仲景之方者。夫讵知肠胃有病。其所
关全在肺气耶。程氏疑是腹痛。本草云、紫参治心腹积聚。寒热邪气。
余忆二十岁时。村中桥亭。新到一方士。蓬头跣足。腊月冷食露卧。自言悬壶遍天
下。每诊一人。只取铜钱八文。到十人外。一文不取。人疑不敢服其药。间有服之者。
奇效。掀髯谈今古事。声出金石。观者绕于亭畔。时余在众人中。渠与余拱而立曰。我
别老友二十年矣。我乐而汝苦奈何。随口赠韵语百余言。皆不可解。良久又曰。士有书。
农医无书。重在口传。汉人去古未远。得所传而笔之。归其名于古。即于本经中指出
笔误十条。紫参其一也。南山有桔梗根。似人参而松。花开白而带紫。又名紫参等语。
余归而考之。与书不合。次早往问之。而其人去无踪迹矣。始知走江湖人。好作不可解
语以欺人。大概如此。渠妄言之。而予不能妄听之也。今因注是方。而忆及紫参即桔梗
之说。颇亦近似。姑附之以广闻见。
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。
气利。诃黎勒散主之。
沈自南云、此下利气之方也。前云当利小便。此以诃黎勒味涩性温。反固肺与大肠
之气。何也。盖欲大肠之气。不从后泄。则肺旺木平。气走膀胱。使小便自利。正为此
通则彼塞。不用淡渗药。而小便自利之妙法也。
诃黎勒散方
诃黎勒（十枚煨）
上一味。为散。粥饮和。顿服。
附方
千金翼小承气汤 治大便不通。哕数谵语。（方见上）
外台黄芩汤 治干呕下利。
尤在泾云、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。其小承气汤。即前下利谵语有燥
屎之法。虽不赘可也。
黄芩 人参 干姜（各三两） 桂枝（一两） 大枣（十二枚） 半夏（半斤）
上六味。以水七升。煮取三升。温分三服。
次男（元犀）按、金匮此篇。论证透发无遗。惟方书所谓隔食证。指胃脘干枯。汤
水可下。谷气不入者。金匮呕吐哕证中。尚未论及。虽伤寒论厥阴篇有干姜黄芩黄连人
参汤方。治食入即吐。本论有大黄甘草汤方。治食已即吐。略陈其概。而其详则不得而
闻也。先君宗其大旨。于时方妙用医学实在易二书中。引各家之说而发明之。学人当参
考。而知其一本万殊。万殊一本之妙。其下利一证。本论已详。参之伤寒论厥阴篇。则
更备矣。惟方书有里急后重脓血赤白痢证。专指湿热而言。时医用芍药汤。调气则便
脓自愈。行血则后重自除等句。颇有取义。即内经肠 之证也。但下利证以厥少热多为
顺。肠 证以身热则死寒则生立训。冰炭相反。先君于时方妙用而续论之。更于实在易
书中。参以时贤伏邪之说。张隐 奇恒之论以补之。且于发热危证云非肌表有邪。即经
络不和。取用活人人参败毒散。加食米煎服。得汗则痢自松。又口授众门人云。痢证初
起发热。宜按六经而治之。如头痛项强。恶寒恶风。为太阳证。自汗宜桂枝汤。无汗宜
麻黄汤。如身热鼻干不眠。为阳明证。宜葛根汤。如目眩口苦咽干。喜呕胁痛。寒热往
来。为少阳证。宜小柴胡汤。如见三阴之症。亦按三阴之法而治之。此发前人所未发也。
其余详于本论。一字一珠。学人潜心而体认之。则头头是道矣。
又按、隔食证。后人以为火阻于上。其说本于论中黄芩加半夏生姜一汤。及伤寒干
姜黄连黄芩人参汤。其甘蔗汁芦根汁。及左归饮去茯苓加当归人参地黄之类。变苦为甘。
变燥为润。取其滋养胃阴。俾胃阴上济。则贲门宽展而饮食纳。胃阴下济。则幽门
阑门滋润而二便通。此从本论大半夏汤中之人参白蜜二味得出也。其借用伤寒论代赭石
This passage highlights the organs and viscera to explain Yang exhaustion and Yin exhaustion as critical conditions, pointing out two major paths for survival. It summarizes the preceding discussion on vomiting, belching, and other syndromes, and introduces the following section on diarrhea (Li syndrome). The author demonstrates skillful transitions at the junction of these sections.
Shen Zinan stated: The six Fu organs belong to Yang, and their Qi circulates externally. The Stomach is the source of all Fu organs. If the primal Qi declines, Yang cannot fill the four limbs, causing the Yang of all Fu organs to weaken. Thus, there is coldness in the hands and feet, upward rushing of Qi, and retraction of the legs. This represents various signs of contraction and coldness manifesting due to Yang deficiency. The five Zang organs belong to Yin; they store essence without draining. Among the five Zang, the Kidney is the master of all Yin and the residence of True Yang. If True Yang declines significantly, the Qi of all five Zang becomes insufficient. The gate of the Stomach fails to close, leading to uncontrolled discharge and inability to store, resulting in unceasing diarrhea that worsens downwards. In severe cases, Yang collapses, and Yin blood becomes obstructed and stagnant, causing numbness in the hands and feet. This is Zhang Zhongjing’s original intent: he wished for people to treat diseases by focusing on the Stomach and Kidneys.
(Diarrhea syndromes vary in severity and should be distinguished by pulse diagnosis. For example:) Diarrhea with a deep pulse (indicates an interior condition). A wiry pulse (indicates urgency; seeing this pulse implies tenesmus [Li Ji]). A large pulse (indicates excess pathogenic factors and disease progression; seeing this pulse means the condition has not yet ceased). A weak and thin pulse indicates both righteous Qi decline and pathogenic decline; a rapid pulse is a sign of Yang. If a rapid pulse appears within a weak and thin pulse context, it indicates that Yang Qi is about to recover, so the diarrhea will likely stop spontaneously. Although fever accompanying diarrhea is generally considered an adverse sign, if the pulse is weak and thin with a rapid quality, indicating pathogen departure and righteous Qi recovery, the fever will subside spontaneously, and death will not occur.
This distinguishes the severity of diarrhea based on the pulse. The *Neijing* states that in Chang Pi (dysentery), body heat leads to death, while cold leads to survival. Here, saying that fever does not lead to death is because the weak, thin, and rapid pulse indicates pathogen departure and impending righteous Qi recovery; the heat will subside soon. This aligns with the *Neijing*.
Diarrhea accompanied by cold extremities (due to Yang sinking and failing to reach the limbs) and absence of pulse (due to Yang sinking and failing to fill the meridians) should be treated with moxibustion (to raise the sunk Yang; the limbs should warm up, but if they do not...). Even if the limbs do not warm up, one still hopes for the return of the pulse as a good omen. If the pulse also does not return, and instead slight panting occurs (indicating the vital Qi of the Lower Jiao fails to return to its root and instead floats upward), death is certain. This is because the root of the pulse begins in the Shaoyin meridian and arises from the Duzuyang pulse. If the Shaoyin pulse is absent, the Duzuyang pulse will not emerge. Therefore, the Shaoyin (lower) must harmonize with and support the Duzuyang (upper). When Wu and Gui combine, the pulse Qi has a root, and the syndrome is favorable. This relationship is called "Fu" (support/bearing burden).
This discusses the fatal syndrome of Yang sinking in diarrhea and touches upon the origin of the pulse.
In diarrhea, if there is high fever and thirst, it leans towards Yang; if there is no fever and no thirst, it leans towards Yin; neither can heal immediately. However, if there is slight fever and thirst, it indicates harmony between Yin and Yang. A weak pulse indicates the pathogen has departed. Seeing these pulse and symptom patterns suggests spontaneous recovery.
If the pulse is rapid in diarrhea, it indicates a heat-type diarrhea. If there is no high fever, only slight fever and sweating, the heat will dissipate with the sweat, leading to spontaneous recovery. If the pulse is tight, it indicates the exterior pathogen has not resolved, so the condition remains unresolved.
In diarrhea, seeing Yang pulses is auspicious. If the pulse is rapid and there is thirst, Yang overcomes Yin, suggesting spontaneous recovery. If the exterior harmony is achieved and heat recedes, but the rapid pulse and thirst persist without improvement, pus and blood will likely appear in the stool due to internal heat disturbing the blood. Diarrhea is a Spleen disorder; a wiry pulse belongs to the Liver. Spleen disorders忌讳 (taboo/avoid) seeing Liver pulses. If the pulse is unexpectedly wiry, it seems unfavorable. However, if the wiry pulse is floating rather than sunken, accompanied by external symptoms like fever and sweating, it should not be viewed as a Yin pulse. Similar to the case of rapid pulse with slight fever and sweating, it should resolve spontaneously.
For diarrhea with continuous flatus (Qi leakage), this indicates Qi stagnation and chaos, distinct from typical cold or heat patterns. One should promote urination. When urination is clear and abundant, Qi transformation normalizes, and the chaos resolves.
If diarrhea belongs to Cold, the pulse should be deep and slow. If the Cun pulse is unexpectedly floating and rapid (indicating strong Yang), while the Chi pulse is naturally choppy (indicating weak Yin), the strong Yang attacking the weak Yin will likely result in pus and blood in the stool.
The previous chapter stated that a weak, thin, and rapid pulse in diarrhea indicates impending spontaneous cessation, and even with fever, death is unlikely. These six sections continue this theme, explaining that although pulse and symptoms may vary, the internal pathogen preferring to exit outward follows the same principle. However, if it transforms into heat, bleeding will inevitably occur.
Diarrhea with undigested food (Qing Gu) indicates interior deficiency and cold Qi; warming the middle is appropriate. One must not attack the exterior. If exterior-releasing herbs are taken, inducing sweating, the Qi of the Yang-deficient patient cannot transform, leading to abdominal distension.
This explains that interior Qi deficiency and cold should not be mistaken for a reason to induce sweating, which would cause distension.
Diarrhea with a deep and slow pulse undoubtedly indicates Yin excess and Yang deficiency. Yang deficiency causes Qi to float upwards, so the person’s face may appear slightly red. Although there is slight body heat (showing Yang still has a root), Yang cannot overcome Yin, so the diarrhea with undigested food cannot stop immediately. This represents Yang heat above and Yin cold below, failing to connect. Only with potent medicine can Yin and Yang harmonize and upper/lower channels connect. There will likely be Yu Mao (dizziness/heaviness like being covered), sweating, and resolution. However, after resolution, the patient will likely have slight cold extremities because the face shows Dai Yang (Yang floating above and not descending), due to Lower Jiao Yang deficiency.
This discusses how Yang heat of the Three Yang channels is above, while Yin cold causes diarrhea below, offering hope for resolution. The Master examines even the slightest chance of recovery in critical conditions, never abandoning treatment. His heart for saving people is truly supreme.
After diarrhea, if the Middle Earth (Spleen/Stomach) is deficient, it cannot transmit Qi from the Middle Jiao to the Hand Taiyin Lung Meridian, leading to an absent pulse. Earth connects to the four extremities; deficiency leads to cold extremities. Pulse cycles through the body fifty times in a day and night. If the pulse returns and extremities warm, the Middle Earth Qi is recovering, and life is possible. If the pulse does not return, the Middle Earth has failed, vital Qi is extinct, and death ensues.
This explains that the mechanism of life and death depends entirely on the pulse, whose root relies on the Middle Earth. The pulse originates in the Middle Jiao, transmits to the Hand Taiyin, ends at the Foot Jueyin, circulating Yang twenty-five times and Yin twenty-five times. Whether the pulse returns depends on timing.
Tongmai Sini Decoction, Baitong Decoction, or those added with bile/urine, are divine formulas.
Previous sections discussed diarrhea; this section discusses post-diarrhea conditions, requiring distinction.
After diarrhea, if there is abdominal fullness (interior cold) and body pain (exterior cold), occurring simultaneously, the interior condition is urgent. First, warm the interior, then attack the exterior. This is because if interior Qi is not sufficient, external attack will be ineffective; if Yang leaks outward, interior cold increases. Warming the interior suits Sini Decoction; attacking the exterior suits Guizhi Decoction.
This is the treatment method for cold-induced diarrhea with simultaneous exterior and interior involvement.
**Sini Decoction Formula** (See above)
**Guizhi Decoction Formula**
Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Shengjiang (Fresh Ginger) (each 3 liang); Gancao (Licorice Root) (2 liang); Dazao (Jujube) (12 pieces).
Crush the five ingredients. Boil in 7 sheng of water with mild fire until 3 sheng remain. Strain. Take 1 sheng at a suitable temperature. Shortly after taking, drink 1 sheng of hot thin porridge to assist the medicinal power. Cover with blankets for about an hour until a slight sweat appears all over the body. Profuse sweating is undesirable as it will not cure the disease. If sweating occurs after the first dose and the disease resolves, stop taking the remaining doses.
(However, there are also diarrhea cases caused by excess pathogens, known as Chengqi syndromes. How to distinguish them?) If the three positions of the pulse are all level (suggesting no pathology in the chest), but pressing the epigastrium reveals hardness (this is a tangible excess syndrome). Initially, Qi and Blood were not disturbed, so it did not manifest in the pulse. Preventive treatment is needed now. Urgent purgation is indicated, suitable for Dachengqi Decoction.
If the pulse is slow in diarrhea (indicating cold), but slow and slippery pulses appear together (indicating excess rather than cold), it is an excess syndrome. Solid matter in the middle obstructs pulse flow. If the excess is not removed, diarrhea will not cease. Urgent purgation is indicated, suitable for Dachengqi Decoction.
If the pulse is unexpectedly slippery in diarrhea (indicating retained food), evacuation is necessary. Diarrhea will heal after purgation. Suitable for Dachengqi Decoction.
If diarrhea has healed but recurs at specific years, months, days, or hours (retained accumulation in the Spleen, which keeps time faithfully), it is because previous accumulations were not completely eliminated. Purgation is required. Suitable for Dachengqi Decoction.
This states that for diarrhea with excess pathogens, regardless of duration or nature, they must be removed to prevent lingering illness.
**Dachengqi Decoction** (See Jingbing Chapter)
(Besides Dachengqi, there are Xiaochengqi syndromes, which must be known.) If diarrhea is accompanied by delirium (Fire combines with Yangming dryness, indicating dry fecal mass in the middle). Dry feces are hard like sheep droppings. If water infusion is not rapid, it can enter and moisten them for downward movement. If purging is too aggressive, like throwing water on stone, the water leaves but the stone remains. Therefore, Dachengqi is not used; instead, **Xiaochengqi Decoction** is administered.
This provides the formula for diarrhea with delirium where purging should not be too urgent.
**Xiaochengqi Decoction Formula**
Dahuang (Rhubarb Root) (4 liang); Zhishi (Immature Bitter Orange) (3 pieces); Houpo (Magnolia Bark) (2 liang, roasted).
Boil the three ingredients in 4 sheng of water until 1.2 sheng remains. Strain. Divide into two warm doses. Stop when bowel movement occurs.
For diarrhea with pus and blood in the stool (caused by cold stagnation transforming into damp-heat, disturbing the blood), **Taohua Decoction** is used.
This addresses injury to Middle Qi and involvement of the Blood layer, consistent with the *Neijing* principle that injury to Yin collaterals causes rectal bleeding. Taohua Decoction uses Ginger and Rice to calm the Middle and boost Qi; Chishizhi enters the Blood layer to drain damp-heat. Later scholars doubted its astringency due to not reading the *Bencao Jing*.
**Taohua Decoction Formula**
Chishizhi (Red Halloysite) (1 jin, half whole, half powdered); Ganjiang (Dried Ginger) (2 liang); Jingmi (Rice Grain) (1 sheng).
Boil the three ingredients in 7 sheng of water until the rice is cooked. Strain. Warm 0.7 sheng, mix with 1 fangcunbi of Chishizhi powder. Take three times daily. If cured after one dose, do not take the rest.
For heat-type diarrhea with tenesmus (Heat pathogen enters the Large Intestine; Fire is rapid. Severe heat causes Qi stagnation and blockage, making foul matter want to exit but unable to do so quickly). **Baitouweng Decoction** is used.
This addresses heat-type diarrhea with tenesmus. Differentiation focuses on tenesmus, which includes Li Ji (urgency).
**Baitouweng Decoction Formula**
Baitouweng (Pulsatilla Root) (2 liang); Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Qinpi (Ash Bark) (each 3 liang).
Boil the four ingredients in 7 sheng of water until 3 sheng remain. Strain. Warm and take 1 sheng. Repeat if not cured.
(Previously discussed cold extremities after diarrhea; now let us discuss irritability after diarrhea.) After diarrhea, fluids deplete downwards, causing Heat to flourish upwards, preventing mutual nourishment, leading to restlessness (Fan). Pressing the epigastrium reveals softness (not due to Hyperactive Ministerial Fire in the Upper Jiao, but due to failure of Lower Jiao Yin Water to ascend). This is Empty Irritability (Xu Fan). **Zhizi Chi Tang** is used.
This addresses irritability after diarrhea. The two sections on post-diarrhea contrast cold extremities and empty irritability, showcasing the subtlety of Han literature.
**Zhizi Chi Tang Formula**
Zhizi (Gardenia Fruit) (14 pieces, broken); Xiangchi (Prepared Soybean) (4 he, wrapped in silk).
Boil Zhizi in 4 sheng of water until 2.5 sheng remains. Add Xiangchi and boil until 1.5 sheng remains. Strain. Divide into two doses. Take one warm dose. Vomiting indicates cure. (The last eight characters should be deleted according to Zhang Shi.)
For diarrhea with undigested food (Qing Gu), interior cold repelling exterior heat, sweating (Yang dispersion and weakness), and cold extremities, **Tongmai Sini Decoction** is used.
This addresses diarrhea with interior Yin excess and exterior Yang collapse. Interior does not communicate with exterior due to interior Yin cold rejection; exterior does not communicate with interior due to lone Yang escaping outward. Only urgent use of great warming agents can restore Yin-Yang communication instantly. The previous section discussed interior heat diarrhea with tenesmus; this section discusses interior cold diarrhea with undigested food, creating a contrast of cold and heat.
**Tongmai Sini Decoction Formula**
Fuzi (Aconite Root, raw) (1 piece); Ganjiang (Dried Ginger) (2 liang, 4 liang for robust individuals); Gancao (Licorice Root, roasted) (2 liang).
Boil the three ingredients in 3 sheng of water until 1.2 sheng remains. Strain. Divide into two warm doses.
For diarrhea with lung pain, **Zishen Tang** is used.
Mr. Zhao stated: The Large Intestine and Lung are paired. Accumulation in the intestines blocks Lung Qi; accumulation in the Lung affects Large Intestine stability. They harm each other. Qi blockage from intestinal disease causes Lung pain; Lung accumulation also causes pain. Zishen opens the nine orifices and benefits the Large and Small Intestines. Unblocking Qi cures pain; removing accumulation stops diarrhea. Mr. Yu stated: Later scholars doubted this was not Zhang Zhongjing’s formula. Do they not know that gastrointestinal diseases are fully connected to Lung Qi? Mr. Cheng suspected abdominal pain; *Bencao* states Zishen treats heart/abdominal accumulations and cold/heat pathogens.
I recall being twenty years old when a new itinerant practitioner arrived at a village bridge pavilion. He had unkempt hair, walked barefoot, ate cold food, and slept exposed in December, claiming to practice medicine everywhere. He charged only eight copper coins per patient; beyond ten patients, he took nothing. People were suspicious and hesitant to take his medicine, but those who did experienced miraculous effects. He talked animatedly about history, his voice resonant. Onlookers gathered around the pavilion. I was among them. He stood facing me and said, "I haven't seen my old friend for twenty years. Why am I happy while you suffer?" He randomly gifted over a hundred lines of verse, all incomprehensible. Later he said, "Scholars have books; farmers and doctors rely on oral transmission. Han people are close to antiquity; what was transmitted was written down and attributed to ancients." He pointed out ten errors in the *Bencao*, one being Zishen. He claimed there is a plant in Nanshan called Jiegeng Gen, resembling Ginseng but loose-textured, with white flowers tinged purple, also named Zishen. I verified this against books and found discrepancies. The next morning, I went to ask him, but he had vanished. I realized itinerant practitioners often use obscure language to deceive. Regarding this formula, recalling the claim that Zishen is Jiegeng seems plausible. I attach this note to broaden knowledge.
**Zishen Tang Formula**
Zishen (Half jin); Gancao (Licorice Root) (3 liang).
Boil Zishen in 5 sheng of water until 2 sheng remains. Add Gancao and boil until 1.5 sheng remains. Divide into three warm doses.
For Qi-type diarrhea (flatus with stool loss), **Helile San** is used.
Shen Zinan stated: This is a formula for diarrhea with Qi stagnation. Previously, promoting urination was advised. Here, Helile is astringent and warm, seemingly reinforcing Lung and Large Intestine Qi. Why? To prevent Large Intestine Qi from leaking posteriorly, allowing Lung Qi to flourish and Wood to balance, directing Qi to the Bladder to promote urination naturally. This is the subtle method of "unblocking one to block another," achieving diuresis without diuretic herbs.
**Helile San Formula**
Helile (Persimmon Seed/Chebula Fruit) (10 pieces, roasted).
Grind into powder. Mix with rice broth and take in one dose.
**Attached Formulas**
**Qianjin Yi Xiaochengqi Decoction**: Treats constipation, frequent belching, and delirium. (Formula see above)
**Waitai Huangqin Decoction**: Treats dry vomiting and diarrhea.
Mr. You Zaijing stated: This is similar to the previous Huangqin plus Banxia and Shengjiang Decoction, but lacks Shaoyao, Gancao, and Shengjiang, adding Renshen, Guizhi, and Ganjiang. It emphasizes warming the interior and boosting Qi. Suitable for those with interior cold and deficient Qi. The Xiaochengqi Decoction mentioned refers to the previous method for diarrhea with delirium and dry feces; repetition is unnecessary.
Huangqin (Scutellaria Root), Renshen (Ginseng Root), Ganjiang (Dried Ginger) (each 3 liang); Guizhi (Cinnamon Twig) (1 liang); Dazao (Jujube) (12 pieces); Banxia (Pinellia Tuber) (0.5 jin).
Boil the six ingredients in 7 sheng of water until 3 sheng remain. Divide into three warm doses.
Second son (Yuanxi) notes: This chapter of *Jinkui Yaolue* thoroughly analyzes syndromes. However, the "Ge Shi" (food obstruction) syndrome described in later medical texts, characterized by dry gastric orifice where liquids pass but solids do not, is not discussed in the *Jinkui* vomiting/belching section. Although *Shanghan Lun* Jueyin chapter has Ganjiang Huangqin Huanglian Renshen Decoction for regurgitation immediately after eating, and this book has Dahuang Gancao Decoction for vomiting after eating, details are scarce. My father followed this main idea, elaborating in *Shifang Miaoyong* and *Yixue Shizaiyi*, citing various schools. Students should reference these to understand the unity of principles amidst diverse manifestations. The diarrhea section is detailed here; cross-referencing with *Shanghan Lun* Jueyin chapter makes it more complete. Medical texts describe dysentery with tenesmus and pus/blood, specifically referring to damp-heat. Contemporary physicians use Shaoyao Tang, believing regulating Qi heals pus/blood, and moving Blood removes tenesmus. This aligns with the *Neijing* Chang Pi syndrome. However, while diarrhea prognosis favors less cold/extremity cold and more heat, Chang Pi prognosis states body heat leads to death and cold leads to survival—contradictory principles. My father continued discussions in *Shifang Miaoyong* and supplemented *Shizaiyi* with contemporary theories on latent pathogens and Zhang Yinxan’s discussions on extraordinary constants. For critical fever cases, he stated it is either exterior pathogens or meridian disharmony, recommending Renshen Baidu San with rice grain to induce sweating, which loosens dysentery. He orally instructed students: Early-stage dysentery with fever should be treated according to Six Channels. Headache, stiff neck, aversion to cold/wind indicate Taiyang syndrome; spontaneous sweating suits Guizhi Decoction, no sweating suits Mahuang Decoction. Body heat, dry nose, insomnia indicate Yangming syndrome; Ge Gen Tang is suitable. Dizziness, bitter taste, dry throat, desire to vomit, hypochondriac pain, alternating chills/fever indicate Shaoyang syndrome; Xiao Chaihu Tang is suitable. Three Yin symptoms are treated according to Three Yin methods. This pioneers previously unstated ideas. Other details are in this text, word by pearl. Students should study deeply to grasp the logic.
Another note: Later scholars attribute "Ge Shi" to Fire blocking above, based on Huangqin plus Banxia/Shengjiang Decoction and Shanghan Ganjiang/Huanglian/Huangqin/Renshen Decoction. Sugarcane juice, reed rhizome juice, and modifications of Zuogui Yin (removing Fuling, adding Danggui, Renshen, Dihuang) change bitter to sweet and dry to moist, nourishing Stomach Yin. If Stomach Yin ascends, the贲门 (cardia) relaxes, allowing intake; if it descends, the pylorus and阑门 (valves) moisten, facilitating bowel/bladder function. This derives from Renshen and Honey in Banxia Decoction. Borrowing from Shanghan Lun...