木防己 生白术 苡仁 木瓜 桂枝木 泽泻
马（四一） 饮酒少谷。中气久虚。晨泄。下部冷。肾阳脾阳两惫。知饥少纳。法当理阳。酒客性不喜甘腻
滋柔之药。（脾肾阳虚）
茯苓 覆盆子 生益智 炒菟丝饼 补骨脂 芡实
朱（四十） 酒湿内困。脾肾阳虚。用黑地黄丸蒸饼水煮和丸。
徐（五九） 晨泄病在肾。少腹有瘕。亦是阴邪。若食荤腥浓味。病即顿发。乃阳气积衰。议用四神丸。
席（五四） 阴疟初愈。不慎食物。清阳既微。健运失司。肠胃气滞。遂为洞泄。且足跗微肿。虑其腹笥欲
满。夏季脾胃主令。尤宜淡薄。药以通阳为先。平时脾肾两治。胃苓汤去白术甘草 接服黑地黄丸去五味。
朱（四一） 久泻无有不伤肾者。食减不化。阳不用事。八味肾气。乃从阴引阳。宜乎少效。议与升阳。
鹿茸 人参 阳起石 茯苓 炮附子 淡干姜
又 久泻必从脾肾主治。但痛利必有粘积。小溲短缩不爽。温补不应。议通腑气。
浓朴 广皮 茯苓 猪苓 泽泻 川连 煨木香 炒山楂 炒神曲
僧（五五） 瘕泄一年。食减腹鸣属脾肾阳衰。近腹中微痛。兼理气滞。用陈无择三神丸。
某 背部牵掣入胁。晨泻。 苓桂术甘去甘加鹿角姜枣。
龚（五二） 诊脉两关缓弱。尺动下垂。早晨未食。心下懊 。纳谷仍不易化。盖脾阳微。中焦聚湿则少
运。肾阴衰。固摄失司为瘕泄。是中宜旋则运。下宜封乃藏。是医药至理。议早进治中法。夕用
四神丸。
高（氏） 经来腹膨。脐脊酸垂。自秋季泄泻不已。脘痞妨食。用济生丸不应。
鹿角霜 炒菟丝饼 生杜仲 淡苁蓉 茯苓 沙苑 焦归身 炒黑小茴
陈（氏） 产育十五胎。下元气少固摄。晨泄。自古治肾阳自下涵蒸。脾阳始得运变。王氏以食下不
化为无阳。凡腥腻沉着之物当忌。早用四神丸晚服理中去术草加益智木瓜砂仁。
张（妪） 泄泻。脾肾虚。得食胀。
人参 炒菟丝子 炒黄干姜 茯苓 煨益智 木瓜
某 泻五十日。腹鸣渴饮。溲溺不利。畏寒形倦。寐醒汗出。用温中平木法。
人参 胡芦巴 炮姜 茯苓 诃子皮 附子 粟壳
某 脾肾不摄。五更泻。
巴戟 菟丝子 五味 补骨脂 芡实 建莲 山药 炙草
某 久泻。脉虚。
人参 五味 禹余粮石
张（氏） 产后不复。腹疼瘕泻。
炒菟丝饼 鹿角霜 生杜仲 淡补骨脂 炒黑小茴 炒杞子 茯苓
顾（氏） 阅病原。是劳损。自三阴及于奇经。第腹中气升胃痛。暨有形动触。冲任脉乏。守补则滞。凉
润则滑。漏疡久泻寒热。最为吃紧。先固摄下焦为治。
人参 炒菟丝饼 芡实 湖莲 茯神 赤石脂
某 肾虚瘕泄。
炒香菟丝子 生杜仲 炒焦补骨脂 茴香 云茯苓
又 阳微。子后腹鸣。前方瘕泄已止。
人参 炒菟丝子 炒补骨脂 湖莲肉 芡实 茯苓
顾 脾肾瘕泄。腹膨肢肿。久病大虚。议通补中下之阳。
人参 川熟附 茯苓 泽泻 炒黄干姜
某 肾虚瘕泄。乃下焦不摄。纯刚恐伤阴液。以肾恶燥也。早服震灵丹二十丸。晚间米饮
汤调服参苓白术散二钱。二药服十二日。
高 脉细下垂。高年久咳。腹痛泄泻。形神憔悴。乃病伤难复。非攻病药石可愈。拟进甘缓法。
（中虚腹痛）
炙甘草 炒白芍 炒饴糖 茯神 南枣
王 过食泄泻。胃伤气陷。津不上涵。卧则舌干微渴。且宜薄味调摄。和中之剂。量进二三可安。（食伤）
人参 葛根 生谷芽 炙甘草 广皮 荷叶蒂
泄泻。注下症也。经云。湿多成五泄。曰飧。曰溏。曰 。曰濡。曰滑。飧泄之完谷不化。湿兼风也。
溏泄之肠垢污积。湿兼热也。惊溏之澄清溺白。湿兼寒也。濡泄之身重软弱。湿自胜也。滑
泄之久下不能禁固。湿胜气脱也。是以胃风汤治有血之飧泄。清六丸疗肠垢之热溏。
溏便清溺白。中有硬物。选用理中治中。滑泄脉微气脱。洞下不禁。急投四柱六柱饮。惟濡
泄有虚有实。或以胃苓。或以术附。至于脾泄胃泄肾泄大肠泄小肠泄大瘕泄。痰泄郁泄。
伤酒伤食泄。古方古法。条载甚详。其急则治标。必使因时随症理固然也。及其缓则治本。
惟知燥脾渗湿。义有未尽者乎。盖脾同坤土。本至静之体。而有干健之用。生万物而役于
万物。从水从火。为寒为热。历观协热下利者。十不得一二。从水之寒泄者。十常八九焉。言
当然者。主治在脾。推所以然者。必求之水火。因思人身水火。犹权衡也。一胜则一负。火胜
则水负。水胜则火负。五泄多湿。湿水同气。水之盛。则火之衰也。于是推少阳为三阳之枢。
相火寄焉。风火扇胃。而熟腐五谷。少阴为三阴之枢。龙火寓焉。熏蒸脏腑。而转输糟粕。胃
之纳。脾之输。皆火之运也。然非雷藏龙 。何能无燥无湿。势有冒明燎上之HT 。如果土奠
水安。从此不泛不滥。定无清气在下之患矣。吾故曰。五泄之治。平水火者清其源。崇堤土
者塞其流耳。令观叶氏诊记。配合气味。妙在清新。纵横治术。不离规矩。依然下者升。滑者
固。寒者温。热者清。脉弦治风。脉濡渗湿。总之长于辨症立方。因而投剂自能辄效。所谓读
古而不泥于古。采方而不执于方。化裁之妙。人所难能者。余友吴子翼文。昔在叶氏门墙。
曾言先生洞达人情。谙练时务。使之应世。一人杰也。以故小道居此盛名。又闻其应酬之
暇。好读两汉。出辞自必高古。惜乎著作长案。不能一见。令人叹息不忘耳。（蒋式玉）
徐评 治泻之法。不过厘清降浊利水通气。案中方亦平妥。重复者七八。编书之人。意欲何为。
凡泄泻无不有痰有湿有寒有风。故肠内不和而生此病。案中一味蛮补蛮涩。人参五味方
居其半。无邪而纯虚者。或能有效。如正虽虚而尚有留邪者。则此症永无愈期矣。当时误人亦
不少也。当时此老名重。凡延诊者。想必病重而久。故案中补涩之味甚多。而厘清降浊者少也。
马某（四十一岁）：饮酒多而谷物摄入少。中气长期虚弱，导致晨起泄泻，下部寒冷。这是肾阳和脾阳都衰竭的表现。虽然知道饥饿但进食量少。治疗法则应当温理阳气。因为酒客体质通常不喜欢甘腻滋柔的药物。（辨证为脾肾阳虚）
朱某（四十岁）：酒湿内困，导致脾肾阳虚。使用黑地黄丸，用蒸饼水煮后制成丸剂服用。
徐某（五十九岁）：晨起泄泻的病位在肾，少腹部有瘕积（腹内结块），这也属于阴邪。如果食用荤腥浓味食物，病情就会立即发作。这是阳气积累性衰败。建议采用四神丸治疗。
席某（五十四岁）：阴疟疾初愈，不慎饮食，导致清阳之气微弱，脾胃健运功能失调，肠胃气机阻滞，于是发生洞泄（严重的水样腹泻）。并且足背轻微肿胀，担心腹部胀满如鼓。夏季是脾胃主令的季节，尤其适宜清淡饮食。用药以通阳为先。平时应脾肾同治。胃苓汤去掉白术和甘草，接续服用黑地黄丸去掉五味子。
朱某（四十一岁）：久泻没有不损伤肾脏的。食欲减退且食物不消化，阳气不能发挥作用。八味肾气丸是从阴引阳的方法，应该只有少量疗效。建议采用升阳法。
鹿茸、人参、阳起石、茯苓、炮附子、淡干姜。
又诊：久泻必然从脾肾主治。但如果疼痛且排便急迫必有粘滞积滞，小便短少不畅，温补无效。建议疏通腑气。
厚朴、广陈皮、茯苓、猪苓、泽泻、黄连、煨木香、炒山楂、炒神曲。
僧人（五十五岁）：瘕泄一年，食欲减退、腹中鸣响属于脾肾阳衰。近期腹部微痛，兼有理气滞的需求。使用陈无择的三神丸。
某人：背部牵掣感放射至胁部，晨起泄泻。使用苓桂术甘汤去掉甘草，加入鹿角、生姜、大枣。
龚某（五十二岁）：诊脉两手关脉缓弱，尺脉动而下垂。早晨未进食时，心中烦闷懊恼，进食仍不易消化。这是因为脾阳微弱，中焦聚湿则运化无力；肾阴衰败，固摄功能失调导致瘕泄。所以中焦宜旋转运化，下焦宜封藏。这是医药的至理名言。建议早上进服治中汤法，晚上使用四神丸。
高氏：月经来潮时腹部膨隆，脐部和脊柱酸软下垂。自秋季以来泄泻不止，脘痞碍食。使用济生丸无效。
鹿角霜、炒菟丝饼、生杜仲、淡肉苁蓉、茯苓、沙苑蒺藜、焦当归身、炒黑小茴香。
陈氏：生育十五胎，下元气少固摄，导致晨起泄泻。自古以来治疗肾阳需自下而上涵蒸，脾阳才能开始运化变化。王氏认为食后不化为无阳。凡是腥腻沉着之物应当禁忌。早上服用四神丸，晚上服用理中汤去掉白术、甘草，加入益智仁、木瓜、砂仁。
张老太：泄泻。脾肾虚，得食后腹胀。
人参、炒菟丝子、炒黄干姜、茯苓、煨益智仁、木瓜。
某人：腹泻五十天，腹中鸣响口渴饮水，小便不利，畏寒身体疲倦，睡眠醒来出汗。使用温中平肝法。
人参、胡芦巴、炮姜、茯苓、诃子皮、附子、粟壳。
某人：脾肾不摄，五更泄泻。
巴戟天、菟丝子、五味子、补骨脂、芡实、建莲、山药、炙甘草。
张氏：产后不复元，腹痛瘕泄。
炒菟丝饼、鹿角霜、生杜仲、淡补骨脂、炒黑小茴香、炒枸杞子、茯苓。
顾氏：阅读病源，这是劳损所致。病邪自三阴经波及奇经。只是腹中气机上逆胃痛，以及有形之邪触动，冲任脉匮乏。守补则气滞，凉润则滑泄。漏疡、久泻、寒热交错，最为关键。先以下焦固摄为治法。
人参、炒菟丝饼、芡实、湖莲子、茯神、赤石脂。
某人：肾虚瘕泄。
炒香菟丝子、生杜仲、炒焦补骨脂、茴香、云茯苓。
又诊：阳气微弱，子时后腹中鸣响。前方治疗后瘕泄已止。
人参、炒菟丝子、炒补骨脂、湖莲肉、芡实、茯苓。
顾某：脾肾瘕泄，腹部膨隆肢体肿胀。久病大虚。建议通补中下二焦之阳。
人参、川熟附子、茯苓、泽泻、炒黄干姜。
某人：肾虚瘕泄，乃下焦不摄。纯刚燥之药恐怕伤阴液，因为肾恶燥。早上服用震灵丹二十丸，晚间用米饮汤调服参苓白术散二钱。两药服用十二日。
高某：脉细下垂，高龄久咳，腹痛泄泻，形神憔悴。这是病伤难复，不是攻病药物可以治愈的。拟进甘缓法。
（中虚腹痛）
炙甘草、炒白芍、炒饴糖、茯神、南枣。
王某：过食导致泄泻，胃受伤气机下陷，津液不能上承滋润，卧位时舌干微渴。且宜薄味调摄，和中剂。适量进服二三剂可安。
人参、葛根、生谷芽、炙甘草、广陈皮、荷叶蒂。
泄泻，属于注下症。经文说：湿气多形成五种泄泻。曰飧泄，曰溏泄，曰濡泄，曰滑泄，曰垢泄（原文缺字，据上下文推测为垢或类似描述，此处依原文留白或意译，原文为“曰 ”，结合下文解释应为垢泄或类似，但严格按原文翻译则保留空缺或根据下文“肠垢污积”推断为垢泄，此处暂译为垢泄以对应下文，或仅列名称）。飧泄完谷不化，是湿兼风。溏泄肠垢污积，是湿兼热。惊溏（原文作惊溏，通常指寒湿或惊恐致泻，下文解释为澄清溺白，属寒）澄清尿白，是湿兼寒。濡泄身体沉重软弱，是湿自胜。滑泄久下不能禁固，是湿胜气脱。因此，胃风汤治疗伴有血的飧泄，清六丸治疗肠垢的热溏。便清尿白，中有硬物，选用理中汤或治中汤。滑泄脉微气脱，洞泄不禁，急投四柱饮或六柱饮。只有濡泄有虚有实，或者用胃苓汤，或者用术附汤。至于脾泄、胃泄、肾泄、大肠泄、小肠泄、大瘕泄、痰泄、郁泄、伤酒泄、伤食泄，古方古法，记载非常详细。其急则治标，必须使因时随症处理是理所当然的。及其缓则治本，只知道燥脾渗湿，义理还有未尽之处吗？盖脾同坤土，本是至静之体，而有乾健之用，生万物而役于万物。从水从火，为寒为热。纵观协热下利者，十不得一二。从水之寒泄者，十常八九焉。言当然者，主治在脾。推所以然者，必求之水火。因思人身水火，犹权衡也。一胜则一负。火胜则水负，水胜则火负。五泄多湿，湿水同气，水之盛，则火之衰也。于是推少阳为三阳之枢，相火寄焉，风火扇胃，而熟腐五谷。少阴为三阴之枢，龙火寓焉，熏蒸脏腑，而转输糟粕。胃之纳，脾之输，皆火之运也。然非雷藏龙潜，何能无燥无湿。势有冒明燎上之势。如果土奠水安，从此不泛不滥，定无清气在下之患矣。吾故曰：五泄之治，平水火者清其源，崇堤土者塞其流耳。令观叶氏诊记，配合气味，妙在清新。纵横治术，不离规矩。依然下者升，滑者固，寒者温，热者清。脉弦治风，脉濡渗湿。总之长于辨症立方，因而投剂自能辄效。所谓读古而不泥于古，采方而不执于方，化裁之妙，人所难能者。余友吴子翼文，昔在叶氏门墙，曾言先生洞达人情，谙练时务，使之应世，一人杰也。以故小道居此盛名。又闻其应酬之暇，好读两汉，出辞自必高古。惜乎著作长案，不能一见，令人叹息不忘耳。（蒋式玉评）
徐评：治泻之法，不过厘清降浊利水通气。案中方亦平妥。重复者七八。编书之人，意欲何为。凡泄泻无不有痰有湿有寒有风，故肠内不和而生此病。案中一味蛮补蛮涩，人参五味方居其半。无邪而纯虚者，或能有效。如正虽虚而尚有留邪者，则此症永无愈期矣。当时误人亦不少也。当时此老名重，凡延诊者，想必病重而久，故案中补涩之味甚多，而厘清降浊者少也。
Euodiae Fructus (Mufangji), Raw Atractylodis Rhizoma (Sheng Baizhu), Coix Seed (Yiren), Papaveris Fructus (Mugua), Cinnamomi Ramulus (Guizhi Mu), Alismatis Rhizoma (Zexie).
Patient Ma (41 years old): Consumed much alcohol and little grain. The Middle Qi has been deficient for a long time, leading to morning diarrhea and coldness in the lower body. This indicates the exhaustion of both Kidney Yang and Spleen Yang. Although feeling hungry, the appetite is low. The treatment principle should be to regulate and warm Yang. Patients accustomed to drinking alcohol generally do not tolerate sweet, greasy, or nourishing-yin herbs. (Syndrome differentiation: Spleen-Kidney Yang Deficiency)
Poria (Fuling), Rubi Fructus (Fupenzi), Alpiniae Oxyphyllae Fructus (Sheng Yizhi), Fried Cuscutae Semen (Chao Tusibing), Psoraleae Fructus (Buguzhi), Euryales Semen (Qianshi).
Patient Zhu (40 years old): Internal obstruction by dampness from alcohol, leading to Spleen-Kidney Yang Deficiency. Use Hei Di Huang Wan (Black Earth Pill), prepared by boiling steamed buns in water and mixing with the powder to form pills.
Patient Xu (59 years old): Morning diarrhea originates in the Kidney; there is a mass in the lower abdomen, which also belongs to Yin pathogenic factors. If rich meat or strong-flavored foods are consumed, the disease will flare up immediately due to accumulated depletion of Yang Qi. It is proposed to use Si Shen Wan (Four Spirits Pill).
Patient Xi (54 years old): After recovering from Yin Malaria, dietary indiscretion led to weakened Clear Yang and loss of Spleen-Stomach transportation function, causing Qi stagnation in the intestines and stomach, resulting in profuse watery diarrhea. There is slight swelling on the dorsum of the foot, raising concern about abdominal distension resembling a drum. In summer, when the Spleen and Stomach govern, a bland diet is especially suitable. Medication should prioritize unblocking Yang. For daily maintenance, treat both Spleen and Kidney. Use Wei Ling Tang (Stomach-Ling Decoction) removing Baizhu and Gancao, followed by Hei Di Huang Wan removing Wuweizi.
Patient Zhu (41 years old): Chronic diarrhea inevitably damages the Kidneys. Reduced appetite and indigestion indicate that Yang Qi is not functioning. Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill) draws Yang from Yin and yields only slight effect. It is proposed to use a method to raise Yang.
Deer Antler (Lurong), Ginseng Radix et Rhizoma (Renshen), Actinidiae Radix (Yangqishi), Poria (Fuling), Prepared Aconiti Lateralis Radix (Pao Fuzi), Dried Ginger (Dan Jiang).
Re-examination: Chronic diarrhea must be treated primarily from the Spleen and Kidney. However, if there is pain with sticky stools and short, difficult urination, warming and tonifying are ineffective. It is proposed to unblock the Fu organs' Qi.
Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Guangpi), Poria (Fuling), Polyporus (Zhuling), Alismatis Rhizoma (Zexie), Coptidis Rhizoma (Chuanlian), Prepared Aucklandiae Radix (Wei Muxiang), Fried Crataegi Fructus (Chao Shanzha), Fried Massae Fermentatae Medicinalis (Chao Shenqu).
Monk (55 years old): Five-year history of Jia diarrhea (diarrhea associated with masses), reduced appetite, and borborygmus belong to Spleen-Kidney Yang Decline. Recent mild abdominal pain combined with Qi stagnation requires regulating Qi. Use Chen Wuzhe's San Shen Wan (Three Divine Pills).
Unknown Patient: Pulling sensation from the back radiating to the hypochondrium, morning diarrhea. Use Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) removing Gancao, adding Deer Horn (Lujiao), Fresh Ginger (Shengjiang), and Jujube (Dazao).
Patient Gong (52 years old): Pulse at both Guan positions is slow and weak; Chi pulse moves downward. Before eating in the morning, there is mental restlessness and difficulty digesting food. This is because Spleen Yang is weak, causing dampness accumulation in the Middle Jiao and impaired transportation; Kidney Yin is depleted, leading to loss of consolidation and Jia diarrhea. Therefore, the Middle Jiao needs rotation and transportation, while the Lower Jiao needs sealing and storing. This is the fundamental principle of medicine. It is proposed to take Zhi Zhong Tang (Regulate Middle Decoction) in the morning and Si Shen Wan in the evening.
Gao Shi: Abdominal distension during menstruation, soreness and heaviness in the umbilicus and spine. Diarrhea has persisted since autumn, with epigastric fullness interfering with eating. Ji Sheng Wan was ineffective.
Deer Horn Glue (Lujiao Shuang), Fried Cuscutae Semen (Chao Tusibing), Raw Eucommiae Cortex (Sheng Duzhong), Dried Cynomorii Herba (Dan Congrong), Poria (Fuling), Astragali Complanati Semen (Shayuan), Scorched Angelicae Sinensis Radix (Jiao Guishen), Charred Foeniculum Vulgare Fructus (Chaohei Xiaohui).
Chen Shi: Having given birth fifteen times, the Yuan Qi in the lower body lacks consolidation, leading to morning diarrhea. Since ancient times, treating Kidney Yang requires nourishment from below so that Spleen Yang can transform and transport. Wang Shi considers postprandial indigestion as a lack of Yang. All greasy and heavy foods should be avoided. Take Si Shen Wan in the morning and Lizhong Tang removing Baizhu and Gancao, adding Yizhi, Mugua, and Sharen in the evening.
Zhang Shi (Elderly Woman): Diarrhea, Spleen-Kidney Deficiency, abdominal distension after eating.
Ginseng Radix et Rhizoma (Renshen), Fried Cuscutae Semen (Chao Tusizi), Fried Dry Ginger (Chao Huang Ganjiang), Poria (Fuling), Prepared Alpiniae Oxyphyllae Fructus (Wei Yizhi), Papaveris Fructus (Mugua).
Unknown Patient: Diarrhea for fifty days, borborygmus, thirst with desire to drink, difficult urination, aversion to cold, physical fatigue, sweating upon waking from sleep. Use the method of warming the Middle and calming Liver Wind.
Ginseng Radix et Rhizoma (Renshen), Pedalium Fruit (Huluba), Prepared Ginger (Pao Jiang), Poria (Fuling), Terminalia Chebula Retzii Pericarpium (Hezi Pi), Aconiti Lateralis Radix Preparata (Fuzi), Poppy Shell (Suke).
Unknown Patient: Spleen-Kidney failing to consolidate, Dawn Diarrhea (Wu Geng Xie).
Morinda Officinalis Root (Baji), Cuscutae Semen (Tusizi), Schisandrae Chinensis Fructus (Wuweizi), Psoraleae Fructus (Buguzhi), Euryales Semen (Qianshi), Nelumbinis Plumula (Jianlian), Dioscoreae Rhizoma (Shanyao), Honey-fried Glycyrrhizae Radix et Rhizoma (Zhicao).
Unknown Patient: Chronic diarrhea, deficiency pulse.
Ginseng Radix et Rhizoma (Renshen), Schisandrae Chinensis Fructus (Wuweizi), Halloysitum Rubrum (Yuyuliangshi).
Zhang Shi: Poor recovery postpartum, abdominal pain with Jia diarrhea.
Fried Cuscutae Semen (Chao Tusibing), Deer Horn Glue (Lujiao Shuang), Raw Eucommiae Cortex (Sheng Duzhong), Mild Psoraleae Fructus (Dan Buguzhi), Charred Foeniculum Vulgare Fructus (Chaohei Xiaohui), Fried Lycii Fructus (Chao Qizi), Poria (Fuling).
Gu Shi: Reviewing the pathology, this is damage from overwork, affecting the Three Yin meridians and the extraordinary vessels. However, Qi rises in the abdomen causing stomach pain, and tangible pathogens cause movement, indicating deficiency in Chong and Ren meridians. Tonifying statically causes stagnation; cooling and moistening causes slipping. Fistulas, chronic diarrhea, and alternating chills and fever are most critical. First, consolidate and secure the Lower Jiao.
Ginseng Radix et Rhizoma (Renshen), Fried Cuscutae Semen (Chao Tusibing), Euryales Semen (Qianshi), Lotus Seed (Hulian), Poria Cum Radix Pini (Fushen), Halloysitum Rubrum (Chishizhi).
Unknown Patient: Kidney Deficiency with Jia diarrhea.
Fragrant Fried Cuscutae Semen (Chaoxiang Tusizi), Raw Eucommiae Cortex (Sheng Duzhong), Charred Fried Psoraleae Fructus (Chaojiao Buguzhi), Fennel (Huixiang), Cloud Poria (Yun Fuling).
Re-examination: Yang is weak, borborygmus occurs after midnight. The previous formula stopped the Jia diarrhea.
Ginseng Radix et Rhizoma (Renshen), Fried Cuscutae Semen (Chao Tusizi), Fried Psoraleae Fructus (Chao Buguzhi), Lotus Seed Meat (Hulianrou), Euryales Semen (Qianshi), Poria (Fuling).
Gu Shi: Spleen-Kidney Jia diarrhea, abdominal distension, limb edema. Long-term illness leads to severe deficiency. It is proposed to unblock and tonify the Yang of the Middle and Lower Jiao.
Ginseng Radix et Rhizoma (Renshen), Prepared Aconiti Radix (Chuan Shu Fu), Poria (Fuling), Alismatis Rhizoma (Zexie), Fried Dry Ginger (Chao Huang Ganjiang).
Unknown Patient: Kidney Deficiency with Jia diarrhea, due to Lower Jiao failure to consolidate. Purely acrid-hot herbs may damage Yin fluids, as the Kidney dislikes dryness. Take Zhen Ling Dan (Shaking Spirit Pill) twenty pills in the morning. In the evening, take Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) two qian mixed with rice water. Take both medicines for twelve days.
Gao Shi: Fine and sinking pulse, elderly with chronic cough, abdominal pain and diarrhea, emaciated spirit and physique. This injury is difficult to recover from and cannot be cured by attacking drugs. Propose the Sweet-Slow method.
(Hollow Middle Abdominal Pain)
Honey-fried Glycyrrhizae Radix et Rhizoma (Zhigancao), Fried Paeoniae Radix Alba (Chaobaishao), Fried Maltose (Chao Yitang), Poria Cum Radix Pini (Fushen), Southern Jujube (Nanzao).
Wang Shi: Diarrhea from overeating, Stomach injury with Qi sinking, fluids unable to ascend and moisten. Tongue is dry and slightly thirsty when lying down. Diet should be bland for regulation. Use Harmonizing Middle agents; taking two or three doses can bring relief. (Food Injury)
Ginseng Radix et Rhizoma (Renshen), Kudzu Root (Gegen), Raw Hordei Fructus Germinatus (Sheng Guya), Honey-fried Glycyrrhizae Radix et Rhizoma (Zhigancao), Citri Reticulatae Pericarpium (Guangpi), Lotus Leaf Stem (Heyetidi).
Diarrhea is a type of pouring-down syndrome. The Classics state: "Excess dampness forms five types of diarrhea." These are Sun diarrhea, Tang diarrhea, Wu diarrhea, Ru diarrhea, and Hua diarrhea. Sun diarrhea with undigested food is dampness combined with Wind. Tang diarrhea with foul intestinal mucus is dampness combined with Heat. Wu diarrhea (clear watery stool) is dampness combined with Cold. Ru diarrhea with heavy and weak body is dampness prevailing. Hua diarrhea with inability to control prolonged discharge is dampness excess leading to Qi collapse. Therefore, Wei Feng Tang treats Sun diarrhea with blood; Qing Liu Wan treats hot Tang diarrhea with intestinal mucus.
If stool is clear and urine white with hard objects inside, select Lizhong Tang or Zhi Zhong Tang. For Hua diarrhea with faint pulse and Qi collapse, or uncontrollable pouring diarrhea, urgently administer Si Zhu Yin or Liu Zhu Yin. Only Ru diarrhea has deficiency and excess patterns, treated with either Wei Ling Tang or Shu Fu Tang. As for Spleen diarrhea, Stomach diarrhea, Kidney diarrhea, Large Intestine diarrhea, Small Intestine diarrhea, Da Jia diarrhea, Phlegm diarrhea, Depression diarrhea, Alcohol-injury diarrhea, and Food-injury diarrhea, ancient formulas and methods are detailed. Acute cases treat the branch, adapting to time and symptoms, which is natural. Chronic cases treat the root. Is it sufficient to only know how to dry Spleen and leach out dampness?
The Spleen is like Kun Earth, fundamentally still yet possessing Qian's strength, generating all things and serving them. It follows Water and Fire, manifesting as Cold and Heat. Observing diarrhea with coordinated heat, less than one or two in ten cases are from Water-Cold diarrhea, eight or nine in ten. Speaking of the obvious, treatment focuses on the Spleen; deducing the reason, one must seek it in Water and Fire. Human Water and Fire are like a balance; if one wins, the other loses. Fire winning means Water losing; Water winning means Fire losing. The five diarrheas involve much dampness; dampness and water share the same qi. When Water is abundant, Fire is deficient. Thus, Shaoyang is the pivot of the Three Yang, housing Ministerial Fire, fanning the Stomach with wind-fire to cook grains; Shaoyin is the pivot of the Three Yin, housing Dragon Fire, steaming the zang-fu to transport waste. Stomach reception and Spleen transport rely on Fire's operation. However, without Thunder hiding and Dragon submerging, how can there be no dryness or dampness? If the trend is like fire blazing upwards, but Earth is stable and Water is safe, preventing overflow, there will be no worry of Clear Qi sinking below. Thus I say: Treating the five diarrheas involves clearing the source by balancing Water and Fire, and blocking the flow by reinforcing Earth.
Observing Ye Tianshi's case records, the combination of flavors is fresh and elegant. His therapeutic techniques follow rules. He raises what sinks, consolidates what slips, warms what is cold, clears what is hot. Stringent pulse treats Wind; soggy pulse leaches Dampness. In short, he excels at differentiating syndromes and prescribing formulas, ensuring efficacy. This is reading the ancients without being bound by them, selecting formulas without being attached to them. The subtlety of modification is rare. My friend Wu Zi Yiwen, formerly a student of Ye Tianshi, said that the Master understood human nature and current affairs well, making him a hero of his time. Hence, through this minor art, he gained great fame. It is also heard that in his spare time, he liked reading the Han Dynasties histories, so his words were always high and ancient. It is a pity that we cannot see his complete case records, causing sighs and unforgettable regret. (Commentary by Jiang Shiyu)
Xu's Commentary: The method of treating diarrhea is merely clarifying, descending turbidity, promoting urination, and unblocking Qi. The formulas in the cases are balanced and appropriate, with seven or eight repetitions. What is the compiler's intention? All diarrheas involve phlegm, dampness, cold, and wind, causing disharmony in the intestines. The cases blindly use tonifying and astringent herbs; formulas with Renshen and Wuweizi account for half. For pure deficiency without pathogenic factors, they may be effective. But if the righteous Qi is deficient yet pathogenic factors remain, this condition will never heal. Many were misled at that time. This elder was famous then; those seeking his diagnosis likely had severe and chronic illnesses, hence many tonifying and astringent herbs in the cases, and few herbs for clarifying and descending turbidity.