仲淳云∶交肠之病，大小便易位而出，或大怒，或因使醉饱，遂致脏气乖乱，不循常道，法宜宣
吐，以开提其气，阑门清利，得司泌别之职则愈矣。
治交肠应用诸药，大法宜升清降浊，兼补气淡渗，忌破气燥热。
治交肠方
升麻 柴胡〔升清。〕橘红 降香〔降浊。〕苏子 人
参白芍〔补气。〕茯苓 猪苓 泽泻 木通 车前 滑石〔淡渗。〕
仲淳曰∶不得大小便为关，是热在丹田也；吐逆水浆不得下为格，是寒反在胸中也。阴阳易位，故
上下俱病。宜先投辛香通窍、〔丁香、白蔻、龙脑香、苏合香。〕下降〔苏子、橘红、沉香。〕之
药，以治其上，次用苦寒〔知母、黄柏。〕下泄之药〔车前、木通、滑石、大黄。〕以通二便。此系急
症，不宜缓治，纵有里虚，后当议补。愚按∶论关格之脉，盛于平人四倍以上，为真阴败竭，必死之
症。仲淳宗丹溪立言，而景岳甚辟其非，谓岂有脉盛四倍以上而属寒之理。又按仲景曰∶关则不得小便，
格则吐逆。沈氏注言∶溺闭因丹田有热，吐逆因火炎上升。愚甚韪之。亦拟数品处治，大意以甘寒清热
下降为主，临症合宜则用治。关洛方。
治关格方
竹茹〔二、三钱。〕枇杷叶〔下气，止呕、数大片。〕麦冬〔五钱至二两。〕梨汁〔清
胃止呕。〕芦根汁、甘蔗浆。
〔各一杯，〕茅根〔三、四两捣。〕绿豆〔一合。〕茯苓〔皆止呕逆，又利小便。二、
三钱。〕煎浓汤，同诸汁和匀，频频饮之，外用大田螺〔二、三枚捣烂，入盐少许，敷脐下，取汁
数匙入药中，尤效。〕
Gu Zhongchun stated: The disease of Jiaochang (Intercrossed Bowels), characterized by the exchange of positions for urination and defecation, may be caused by severe anger or overindulgence in alcohol and food. This leads to the disorder of Zang-Fu Qi (Vital Energy of the Organs), causing them to deviate from their normal pathways. The treatment principle should involve inducing vomiting to lift and open the Qi mechanism. Once the Lanmen (the junction between the small and large intestines) is cleared and promoted, allowing it to resume its function of separating the clear from the turbid, the disease will heal.
The general principle for treating Jiaochang with various herbs is to raise the Clear and descend the Turbid, while simultaneously tonifying Qi and using bland-draining diuretics. Herbs that break Qi or are drying and hot should be avoided.
Formula for Treating Jiaochang:
Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix) [Function: Raise the Clear]. Juhong (Citri Reticulatae Pericarpium Rubrum), Jiangxiang (Dalbergiae Odoriferae Lignum). Suzi (Perillae Fructus), Renshen (Ginseng Radix et Rhizoma), Baishao (Paeoniae Radix Alba) [Function: Tonify Qi]. Fuling (Poria), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), Cheqian (Plantaginis Semen), Huashi (Talcum) [Function: Bland-draining diuresis].
Gu Zhongchun also said: Inability to pass urine or stool is called "Guan" (Obstruction), indicating Heat in the Dantian (Lower Jiao); vomiting and inability to swallow water or food is called "Ge" (Rebellion), indicating Cold counterflow in the Chest (Upper Jiao). When Yin and Yang exchange positions, both the upper and lower parts become diseased. It is appropriate to first administer acrid-aromatic orifices-opening herbs (Dingxiang, Baikou, Longnaoxiang, Suhexiang) and Qi-descending herbs (Suzi, Juhong, Chenxiang) to treat the upper part, followed by bitter-cold downward-draining herbs (Zhimu, Huangbai) and herbs to unblock the bowels and bladder (Cheqian, Mutong, Huashi, Dahuang) to facilitate the passage of urine and stool. This is an acute condition and should not be treated slowly. Even if there is interior deficiency, tonification should be considered later.
My commentary: Regarding the pulse of Guan-Ge, if it is more than four times stronger than a normal person's pulse, it indicates the exhaustion of True Yin and is a fatal sign. Gu Zhongchun’s views were based on Zhu Danxi, but Zhang Jingyue strongly refuted them, arguing that it makes no sense for a pulse to be four times stronger yet belong to a Cold pattern. Furthermore, Zhang Zhongjing stated: "Guan results in the inability to urinate; Ge results in vomiting." Shen’s annotation explains: "Urinary retention is due to Heat in the Dantian; vomiting is due to Fire flaming upward." I highly approve of this view. I have also devised several herbs for treatment, primarily focusing on Sweet-Cold herbs to clear Heat and descend Qi, applied according to clinical appropriateness. This is the Guanluo Formula.
Formula for Treating Guan-Ge:
Zhuru (Bambusae Caulis in Taeniam), Pipaye (Eriobotryae Folium) [Descends Qi, stops vomiting, several large slices]. Maidong (Ophiopogonis Radix) [5 qian to 2 liang]. Lizhi (Pyrus Sinkiangensis Juice) [Clears Stomach, stops vomiting]. Lugenzhi (Phragmitis Rhizoma Juice), Ganzheshuang (Sacchari Tabulae Formosae Decoctum) [One cup each]. Maogen (Imperatae Rhizoma Juice) [3-4 liang, crushed]. Ludou (Phaseoli Radiatus Semen) [1 he]. Fuling (Poria) [All stop vomiting and promote urination, 2-3 qian]. Decoct into a thick liquid, mix evenly with all the juices, and drink frequently. Externally: Use large river snails (2-3 pieces, crushed, mixed with a little salt, applied below the umbilicus). Take a few spoons of the juice and add it to the medicine for enhanced efficacy.