《难经》训泄有五∶胃泄，饮食不化；脾泄，腹胀呕吐，所谓大肠泄者，食已窘迫，可该脾泄论；所谓小
肠泄者，便血腹痛；大瘕泄者，数至圊而不便，宜以痢门论。则泄止可言脾胃二经。诊其脉数，而邪之自外来
者，属胃，其气化而为热，轻则黄连浓肠，佐以利水和胃之品（经验方∶焦术、云苓、桂枝、黄连、泽泄、猪
苓、车前、苡米）。至于完谷不化，则泄之甚者也，须芒硝、大黄（经验方∶芒硝、大黄、银花、炙草、姜枣
引），涤其邪而泄自止；诊其脉迟，而虚之由内生者，属脾，其气积而为寒，轻则焦术和中，佐以燥湿补脾之
味（经验方∶黄 、白术、云苓、莲肉、法夏、诃子、陈皮、苡米、姜枣引）。至于胀满呕逆，则泄之剧者也，
必附片、干姜（经验方∶黄 、附片、干姜、焦术、肉桂、莲肉、炙甘草、生姜大枣引，尝与道人分别是症，
知其随手辄验者，有由来矣），温其寒而泄乃
除。夫泄，显而小者也，以其泄天妙趣而言，则为水先（混沌之初，冲漠无朕，先天一团氤氲之气，降而为水，
犹未见其昭着，渐至昭着而生火；犹未有其形质，渐有形质而生木；犹未至于坚实，渐至坚实而生金，土则随
行而生。郭璞《葬经》∶泄天妙趣水居先。”《河图》之数，天一生水）；以其承天时行而言，则土为重（坤
承天之施，奉以行之，时未至。不敢先时以立始∶时既至，不敢后时以堕功。坤道之所以顺也，然载万物者坤，
含万物者坤，非有坤以承天，则天亦将虚于所施。故曰浓德至静，无成有终，可知配天之功用者惟坤土独也。
正许氏《说文》，重字从土，是以土为重之义）。脾为己土，胃为戊土，一动一静，一阴一阳，互相为用，所
以十二官中，各司一职，独脾胃统司仓廪之官。以其物之资始而论，惟恃动气（战乎干，战即鼓荡之意，谓资始
也。杨子云∶“太初者，气之始；太素者，质之始。禀干之始，出而为动。”）；以其物之资生而论，全仗谷
气（致役于坤，役即孳字之意，谓资生也。《淮南子》云∶“毛虫则横生， 虫则纵生。”萃坤之生养而归谷）。
脾主消谷，胃主纳谷，一表一里，一刚一柔，还相为质。所以五行宝内，但养一脏，惟脾胃实养性命之宝。
至哉坤元，厥惟脾胃。拟七斗以摩霄（上顶心，心有七
窍）高悬西北；断六鳌以立极（下临六腑），美尽东南。富媪（《汉书》后上富媪）敷文，宅中叶裳元之吉；
媒婆（方书脾为媒婆）践约，婚媾迨冰至之辰。卜操柄之有归（《说卦传》∶“坤为柄”），应差竖亥（《史
记·天宫书》∶“竖亥步经大章行纬”）；占括囊之无咎，稳塞夷庚（《左传》∶“以塞夷庚。”谓要道也）。
象推吝啬，义取含章，后得无患乎。先迷方外必根据直内。
以故胃与脾合，马之所以称牝也；脾与胃分，龙之所以战野也。调理得宜，百体从兹而安；调理失宜，百病
从兹而起。夫泄，显而小者也。
《难经》将泄症分为五种：胃泄，表现为饮食不消化；脾泄，表现为腹胀、呕吐；所谓大肠泄，是指进食后感到窘迫急迫，这可以归入脾泄的论述范畴；所谓小肠泄，表现为便血和腹痛；大瘕泄（类似痢疾），表现为频繁去厕所却排不出大便，这部分适宜在痢疾门类中讨论。因此，泄症主要可以归结为脾胃两经的病证。
如果诊得脉象数（快），且病邪是从外感而来的，属于胃经病变，其气化功能转化为热邪。病情较轻时，使用黄连来厚肠止泻，并配合利水、和胃的药物（经验方：炒白术、茯苓、桂枝、黄连、泽泻、猪苓、车前子、薏苡仁）。如果是完谷不化（粪便中含有未消化的食物），这是泄症中较严重的情况，需要使用芒硝、大黄（经验方：芒硝、大黄、金银花、炙甘草，以生姜、大枣为引），通过涤荡邪气从而使泄症自止。
如果诊得脉象迟（慢），且虚弱是由内生虚寒导致的，属于脾经病变，其气积聚而化为寒邪。病情较轻时，使用炒白术调和脾胃，并配合燥湿、补脾的药物（经验方：黄芪、白术、茯苓、莲子肉、法半夏、诃子、陈皮、薏苡仁，以生姜、大枣为引）。如果出现腹胀满、呕吐逆气，这是泄症中剧烈的情况，必须使用附片、干姜（经验方：黄芪、附片、干姜、炒白术、肉桂、莲子肉、炙甘草，以生姜、大枣为引，我曾与道人共同辨析此症，发现此方随手即验，是有其渊源道理的），通过温散寒邪从而使泄症消除。
泄症虽然表现明显但相对轻微，若从探讨天地生成之妙趣的角度来说，则以“水”为先（混沌初开之时，寂静无形，先天一团氤氲之气，下降化为水，此时尚不明显，逐渐显现而生火；尚无具体形质，逐渐有形质而生木；尚未达到坚实，逐渐坚实而生金，土则随五行运行而生。郭璞《葬经》说：“探寻天地妙趣，水居首位。”《河图》数理中，“天一生水”）；若从顺应天时运行的角度来看，则以“土”为重（坤土承受天的施予，奉行执行，时辰未到，不敢抢先确立开始；时辰已到，不敢落后而荒废功效。这就是坤道顺承的特性。然而，承载万物的是坤，包含万物的是坤，如果没有坤土来承接天，天也将无处施予。所以说厚德至静，虽有终而无成，可知配天之功用唯有坤土独当。正如许慎《说文解字》中，“重”字从土，体现了以土为重的含义）。
脾为己土，胃为戊土，一动一静，一阴一阳，互相为用。所以在十二脏腑官职中，各司其职，唯独脾胃统管仓廪之官的职责。从万物资始的角度来看，只依赖动气（乾卦象征战栗/鼓荡，意为发动，指资始。扬子云说：“太初是气的开始，太素是质的开始。禀受乾的开始，表现出来就是动。”）；从万物资生的角度来看，全仗谷气（服务于坤，役即滋生之意，指资生。《淮南子》说：“毛虫横生，卵虫纵生。”汇聚坤的生养之功而归结于谷物）。脾主消化谷物，胃主接纳谷物，一表一里，一刚一柔，互为根本。所以在五行之中，保养一脏，只有脾胃真正养育了性命之宝。
坤元之美德至极，关键在于脾胃。拟喻北斗七星以摩挲云霄（上对顶心，心有七窍）高悬西北；断绝六鳌以建立极点（下临六腑），美景尽在于东南。富媪（大地母亲，《汉书》称后土为富媪）铺展文采，居于中央协和裳元之吉；媒婆（医书中称脾为媒婆）践行约定，婚嫁等到冰融之时。卜问操柄有所归属（《说卦传》：“坤为柄”），应验差竖亥（《史记·天宫书》：“竖亥步量经度大章行纬”）；占卜括囊无咎，稳固塞夷庚（《左传》：“以塞夷庚”，谓要道也）。象辞推演吝啬，义理取含章，后来者无患乎？先迷失方向在外，必定要根据直内。
因此，胃与脾相合，就像马之所以被称为牝（雌性）一样和谐；脾与胃分离，就像龙之所以在原野争斗一样失和。调理得当，百体从此安宁；调理失宜，百病从此而起。泄症，虽然表现明显但相对轻微。
The *Nan Jing* (Classic of Difficult Issues) instructs that there are five types of diarrhea: Wei (Stomach) diarrhea, characterized by undigested food; Pi (Spleen) diarrhea, characterized by abdominal distension and vomiting; what is called Da Chang (Large Intestine) diarrhea refers to urgency after eating, which can be included in the discussion of Spleen diarrhea; what is called Xiao Chang (Small Intestine) diarrhea involves blood in the stool and abdominal pain; Da Jia Xie (Great Mass Diarrhea, similar to dysentery) involves frequent trips to the toilet without ability to defecate, which should be discussed under the category of Dysentery. Thus, diarrhea can mainly be attributed to the Stomach and Spleen meridians.
If the pulse is Shu (rapid), and the pathogen comes from external invasion, it belongs to the Stomach channel, where Qi transformation turns into Heat. For mild cases, Huang Lian (Coptidis Rhizoma) is used to thicken the intestines and stop diarrhea, assisted by herbs that promote urination and harmonize the Stomach (Empirical Formula: Chao Bai Zhu, Fu Ling, Gui Zhi, Huang Lian, Ze Xie, Zhu Ling, Che Qian Zi, Yi Yi Ren). If there is complete undigested food in the stool (Wan Gu Bu Hua), this is a severe form of diarrhea, requiring Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) (Empirical Formula: Mang Xiao, Da Huang, Yin Hua, Zhi Gan Cao, with Sheng Jiang and Da Zao as guides) to purge the pathogen so that diarrhea stops spontaneously.
If the pulse is Chi (slow), and the deficiency arises from internal cold, it belongs to the Spleen channel, where Qi accumulates and transforms into Cold. For mild cases, Chao Bai Zhu (Fried Atractylodis Macrocephalae Rhizoma) is used to harmonize the middle, assisted by herbs that dry dampness and tonify the Spleen (Empirical Formula: Huang Qi, Bai Zhu, Fu Ling, Lian Rou, Fa Xia, He Zi, Chen Pi, Yi Yi Ren, with Sheng Jiang and Da Zao as guides). If there is abdominal fullness and vomiting/reversal, this is a severe/critical form of diarrhea, requiring Fu Pian (Prepared Aconiti Lateralis Radix) and Gan Jiang (Zingiberis Rhizoma) (Empirical Formula: Huang Qi, Fu Pian, Gan Jiang, Chao Bai Zhu, Rou Gui, Lian Rou, Zhi Gan Cao, with Sheng Jiang and Da Zao as guides; I once analyzed this syndrome with a Daoist priest and found this formula effective immediately, having its origins). By warming the cold, the diarrhea is eliminated.
Diarrhea is manifest but minor. Speaking of the subtle interest of Heaven's generation, Water comes first (At the beginning of chaos, silent and formless, the primordial Yin-Yun Qi descends to become Water, not yet obvious, gradually becoming obvious generating Fire; having no form or substance, gradually gaining form/substance generating Wood; not yet solid, gradually becoming solid generating Metal, while Earth generates along with the movement of the Five Phases. Guo Pu's *Zang Jing* says: "Exploring the subtle interest of Heaven, Water takes precedence." In the numbers of *He Tu*, "Heaven generates One for Water"); speaking of following Heaven's timing, Earth is heavy (Kun Earth receives Heaven's bestowal and executes it; when the time has not arrived, one dares not take the lead to start; when the time has arrived, one dares not lag behind to fail in merit. This is the way Kun follows. However, carrying all things is Kun, containing all things is Kun. Without Kun to receive Heaven, Heaven would have nowhere to bestow. Thus it is said: Great Virtue is still and quiet, having no completion but having an end; it can be known that only Kun Earth matches Heaven's function. As Xu Shen's *Shuo Wen* states, the character "Zhong" (Heavy) contains "Tu" (Earth), thus meaning Earth is heavy).
Pi (Spleen) is Ji Earth, Wei (Stomach) is Wu Earth; one moves, one rests; one is Yin, one is Yang; they use each other mutually. Therefore, among the twelve officials (organs), each performs its duty, but only the Spleen and Stomach jointly manage the official of granaries. From the perspective of the origin of things, only Dynamic Qi is relied upon (Qian hexagram symbolizes trembling/agitation, meaning stirring, referring to origin. Yang Ziyun said: "Tai Chu is the beginning of Qi; Tai Su is the beginning of Substance. Receiving the beginning of Qian, emerging as Movement."); from the perspective of the nourishment of things, full reliance is placed on Grain Qi (Serving Kun, 'Yi' means proliferation, referring to nourishment. *Huainanzi* says: "Hair-covered creatures are born transversely, shell-covered creatures are born longitudinally." Gathering Kun's nurturing power returns to grain). The Spleen governs the digestion of grain, the Stomach governs the reception of grain; one is exterior, one is interior; one is firm, one is soft; they serve as quality for each other. Therefore, within the Five Phases, to nourish one organ, only the Spleen and Stomach truly nourish the treasure of life.
How great is the Yuan of Kun, it lies solely in the Spleen and Stomach. Comparing to the Big Dipper to touch the clouds (upper against the crown, the Heart has seven apertures) hanging high in the northwest; breaking six Ao turtles to establish the pole (lower facing the Six Fu organs), beauty is exhausted in the southeast. Fu Ao (Mother Earth, *Han Shu* calls Post Earth Fu Ao) spreads culture, dwelling in the center coordinating the auspiciousness of Shang Yuan; Mei Po (In medical books, the Spleen is called Mei Po/Matchmaker) fulfills the appointment, marriage arrives when ice melts. Divining that the handle has returned (*Shua Gua Zhuan*: "Kun is the handle"), responding to Cha Shuhai (*Shi Ji · Tian Gong Shu*: "Shu Huai measured the longitude Dazhang and latitude"); divinating that holding the bag brings no blame, steadily blocking the Yi Geng (*Zuo Zhuan*: "To block Yi Geng", meaning important roads). Imagery deduces stinginess, meaning takes containing brilliance, will the later one have no worry? First lost outside, must follow straight inside.
Therefore, the Stomach and Spleen combine, like why the horse is called female (Pin); the Spleen and Stomach separate, like why the dragon fights in the wild. If regulated properly, the hundred limbs become peaceful from here; if regulated improperly, the hundred diseases arise from here. Diarrhea, although manifest, is minor.