下利当分阴阳、表里。在表有寒湿、风湿、湿热；在里有积热、伤食、脏寒、冷冻饮料、外感、
寒湿、下利、恶寒身痛、无汗、脉浮、泻下清水、色如屋漏、口不作渴，此寒湿伤于太阳
也，北方麻黄桂枝汤，江南用羌胡败毒散，先散毒邪。利未止，五苓散分利小便，若头额眼
眶痛，六脉长大，此寒湿伤于阳明也，苍防干葛汤解表，后用猪苓汤利小便。若时寒时热，
六脉弦大，此寒湿伤于少阳也，以柴苓汤主之。外感风湿下利，则骨节烦疼，恶风身痛，自
汗脉浮，此风湿伤于太阳也，北方用桂枝防风汤，江南羌活防风汤。小便不利，苍防四苓
散。若额痛目痛，手足拘痛，身热多汗，六脉长大，此风湿伤阳明也，苍防干葛汤。利未
止，合猪苓汤。若寒热往来，呕而口苦，此风湿伤于少阳也，苍防柴胡汤主之。外感湿热，下
利，发热恶寒，六脉浮大，此湿热伤于太阳也，先用羌独败毒散发表，后用清湿热。若发热
自汗，六脉长数，此湿热伤于阳明也，先用干葛石膏汤，后用川连枳壳汤。若寒热口苦，此
湿热伤于少阳也，先用柴胡汤，后用黄芩芍药汤，河间芍药黄连汤。脐腹作痛，里急后重，
大柴胡汤、香连丸。又有发热汗出，烦躁口干，头痛身痛，时寒时热下利，脉大，三阳挟热
下利，俗名漏底伤寒，此湿热先伤肠胃。又因早晚风露外束，湿热不得外泄，下流大肠而下
利，宜以羌防柴苓汤，先散表邪，后以猪苓汤，分利湿热。若寒热往来，口苦而呕，症兼少
阳，宜柴胡汤。此症若不先散表邪，即用清里，则表邪内缩，不死不休。又有表邪已解，里
热不散而下利，当用清里治法，如黄芩黄连汤、香连丸等。若痛而即利，利后稍减，少顷复
痛复利，宜川连枳壳汤。欲便不得便，腹痛有下症，承气汤下之。又有饮食不节，损伤肠
胃，腹中常痛常利者，此伤食成利症也，宜保和平胃散。家秘消积散。又有本是积热，日发
热口干，过食生冷，以致肠鸣下利，此因热伤冷症，宜大顺饮等。另有初起不发热，口不
渴，小便清白，大便滑泄下利，六脉沉迟，此三阴脏寒下利也，轻者理中汤；重者四逆汤。
夫三阴寒利，脉宜沉小；三阳外感下利，脉忌沉小。内伤下利，左关弦大者，主死。外感下
利，左关弦大，反不作死论，以人迎脉大，正合外感身热症耳。
太阳病，外证未除，而数下之，遂协热而利，利下不止，心下痞硬，表里不利者，桂枝人参汤主之。
表症误下，若不见表邪，变下利，痞满结胸者，用泻心汤、陷胸汤。今下后表里不解，故
仍用桂枝解表，加人参和中气。
伤寒服汤药，下利不止，心下痞硬，服泻心汤已。复以他药下之，利不止，医以理中与之，
利益甚。理中者，理中焦，此利在下焦，赤石脂禹余粮汤主之。复利不止者，当利其小便。
此因误下多下，以致下焦不固，又以理中误治中焦，故用固下焦药。设利不止，又当分利
小便，以此条是水谷利耳。
二伤寒发热，汗出不解，心下痞硬，呕吐而下利者，大柴胡汤主之。
发热，阳邪也。汗出不解，心下痞硬而下利，里症也。故以此方双解表里。
太阳与少阳合病，自下利者，与黄芩汤。若呕者，黄芩加半夏生姜汤。
太阳与少阳合病，自下利，宜治少阳，故用黄芩汤。若见呕，加半夏、生姜。
阳明少阳合病，必下利。其脉不负者，顺也。负者，失也，互相克贼者，为负也。脉滑而数
者，有宿食也，当下之，宜承气汤。
木邪乘克，肠胃下利，若少阳脉大，则阳明受病重。设阳明脉滑数，方可下之。此关防下
利，忌阳明脉弱，更不可误下。
太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。若下之，必胸下结硬。
太阴腹满，吐，食不下，自利而腹自痛，非阳明下症腹痛，若误下之，则胸下结硬。
自利不渴者，属太阴，以其脏有寒故也，当温之，宜服四逆辈。
上章以腹满吐食自利定真太阴，此章以自利不渴承明太阴寒症，《尚论书》皆注热邪，误也。
伤寒脉浮而缓，手足自温者，系在太阴，太阴当发身黄。若小便自利，不能发黄。至七八
日，虽暴烦下利日十余行，必自止，以脾家实，秽腐当去故也。
脉浮，阳脉也；脉缓，太阴也。上章以自利不渴，定其太阴寒症下利；此章以脉浮，手足
自温，定其太阴湿热下利。太阴湿热，当发身黄。若小便自利，不发黄。至七八日，大便
结硬，此外传阳明，湿热变燥而为脾约等症。若不外传而发暴烦下利，虽每日十余行，湿
热去尽，必自止而愈，以脾热秽腐当去者也。同一太阴热邪，以湿热系住太阴下利，则入
太阴篇。以外传阳明湿热变燥，大便干结，则入阳明篇。此千古未白。
少阴病，二三日至四五日，腹痛，小便不利，下利不止，便脓血者，桃花汤主之。
此言少阴火虚滑脱便脓血，宜用桃花汤。旧注阳邪传入，误也。
少阴病便脓血者，可刺。
此言少阴热病便脓血，不可用桃花汤，但可刺，泄血中之热。
少阴病，下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。
少阴病，自利清水，色纯清，心下必痛，口干燥者，急下之，宜大承气汤。
上二条，皆少阴热症。详注渴门。
伤寒先厥后发热，下利必自止，而反汗出，咽中痛者，其喉为痹。
先厥后发热，则真阳回而利止。若反汗出，咽中痛，则回阳太过，上冲其喉必痹。
发热无汗，而利必自止。若不止，必便脓血，便脓血者，其喉不痹。
阳经发热无汗，利必不止；阴经发热无汗，利必自止。若不止而无汗，则回阳太过，下移
大肠，而必便脓血，热邪下泄，故喉不痹。
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。
此言里寒之人，外冒表邪之症。下利腹胀满，是里寒；身体疼痛者，是表邪。下利腹胀之
身痛，必以四逆汤先救里，后以桂枝汤再发表。
下利清谷，不可攻表，汗出必胀满。
此重申下利清谷，必先救里。若先发其汗出，必胀满不治。
下利，有微热而渴，脉弱者，令自愈。下利脉数而渴者，令自愈。设不瘥，必清脓血，以有
热故也。下利脉数，有微热，汗出令自愈。设复紧，为未解。
前条言下利清谷，外冒表寒之利。此条言微热而渴，又见脉弱，则邪衰正复，故令自愈。
第二段言脉数而渴，较之上段则里有热，故设不瘥，必下脓血。第三段言脉数微热，是表
热内陷，故自汗出令自愈。设复紧，则表邪伏而未散。
下利，寸脉反浮数，尺中自涩者，必圊脓血。
寸脉主气，尺脉主血。今寸脉浮数，气中有热。尺中自涩，血分受伤。热胜于血，故必圊脓血。
下利，脉沉弦者，下重也。脉大者，为未止。脉微弱数者，为欲自止，虽发热，不死。
下利脉沉弦，则邪满于里，故下重。若脉太过而大，为未愈。必得微弱而数，乃为自止。
即或脉数发热，乃沉弦转阳，亦不主死。
热利下重者，白头翁汤主之。
此言热利，以明上条皆寒利，下条皆热利也。热利下重，火热下迫，故用清火。
下利欲饮水者，以有热故也。白头翁汤主之。
此申明宜用白头翁汤方法。言阴症下利，口不渴，今欲饮水者，以上焦有热故也，亦以前方清热。
下利谵语，以有燥屎也，宜小承气汤。
上条以渴欲饮，水定热在上焦；此以下利谵语，定肠胃有燥屎。
下利后更烦，按之心下濡者，为虚烦也，宜栀子豉汤。
上条以谵语，故定肠胃实热；此条以利后，心下濡而不坚，故定虚烦也。
羌活败毒散 见发热。
五苓散 见小便不利。
干葛汤 见似疟。
猪苓木通汤
猪苓 白茯苓 泽泻 木通
太阳热结下焦，用五苓散。若阳明热结，家秘用此方。
柴苓汤
柴胡 黄芩 广皮 半夏 甘草 茯苓 猪苓
少阳湿热，每多协热下利，故用此方。家秘加干葛，兼治阳明大肠；加木通佐其分利。
桂枝防风汤
桂枝 防风 桔梗 浓朴 苍术 甘草
此治风寒湿热三气下利，故用桂枝、防风去太阳风寒，用苍术去阳明风湿。若风热、湿
热，当以羌活易桂枝。
苍术四苓散 即四苓散加苍术防风。
此方表有风湿，里有湿热，故以苍防散在表之风湿，以四苓利在里之湿热。家秘加木通汤
调服，功力更大。
苍防干葛汤
苍术 防风 干葛 白芷 浓朴 甘草
风湿内传，每多下利。河间云风邪内缩，以此方治之。
猪苓汤
猪苓 泽泻 茯苓 滑石 阿胶
湿热下利，先散表邪，随利小便。热结太阳，用五苓散；热结阳明，用此方。
苍防柴胡汤
苍术 柴胡 黄芩 半夏 广皮 甘草 防风
此方治风湿伤于少阳下利者。若见太阳表症，加羌活；见阳明表症，加干葛。
羌防柴苓汤
羌活 防风 柴胡 茯苓 黄芩 半夏 广皮 甘草
外感下利，皆从毛窍而入，必当仍从毛窍而出，故用此方。
黄芩芍药汤
黄芩 白芍药 川黄连 甘草
燥火利，以大黄、归、芍同用，则清血分之火；与枳壳同用，则清气分之火。今湿火伤
血，故以黄连、芍药同用，加枣肉，又名芍药黄连汤，兼治内伤血利。
香连丸
木香 川连 等分枣肉为丸
湿火伤血，用当归黄连清血中之火。今湿火伤气，故以木香、黄连同用。家秘加枣肉为
丸，则不损中州。
三乙承气汤 见大便秘。
保和丸 见发狂。
平胃散 见谵语。
理中汤 见呕吐。
四逆汤 见身痛。
大顺饮 见腹痛。
温中汤
草豆蔻 干姜 浓朴 甘草
此方与大顺饮，同治伤冷冻饮料者。若液干有热，反为害。
大柴胡汤 见潮热。
白通汤
葱白头 干姜 熟附子
此即四逆汤，去甘草加葱白，以通阳气，少阴下利，脉微厥冷，方可用。
白通加猪胆汁汤 即白通汤加人中黄、猪胆汁温服。
真武汤
白茯苓 生姜 熟附子 白术 白芍药
土虚不能制水，以此方补土中之火。
四逆散 见厥冷。
白头翁汤
白头翁 黄柏 秦皮 黄连
热利下重，乃是火势下迫，故以此方主治。
栀子豉汤
山栀 淡豆豉 加薤白 葱头
下利心烦，故以此方先治上焦。
下利应当区分阴证和阳证、表证和里证。在表证的有寒湿、风湿、湿热；在里证的有积热、伤食、脏寒、冷冻饮料损伤、外感、寒湿等。出现下利、恶寒身痛、无汗、脉浮、泻下清水、颜色像屋漏陈水、口不渴，这是寒湿伤了太阳经，北方地区用麻黄桂枝汤，江南地区用羌胡败毒散，先发散毒邪。如果下利未止，用五苓散分利小便。如果头额眼眶痛，六脉长大，这是寒湿伤了阳明经，用苍防干葛汤解表，后用猪苓汤利小便。如果时冷时热，六脉弦大，这是寒湿伤了少阳经，用柴苓汤主治。外感风湿导致下利，则骨节烦疼，恶风身痛，自汗脉浮，这是风湿伤了太阳经，北方用桂枝防风汤，江南用羌活防风汤。如果小便不利，用苍防四苓散。如果额头痛、眼睛痛，手足拘挛疼痛，身热多汗，六脉长大，这是风湿伤了阳明经，用苍防干葛汤。下利未止，合用猪苓汤。如果寒热往来，呕吐且口苦，这是风湿伤了少阳经，用苍防柴胡汤主治。外感湿热导致下利，发热恶寒，六脉浮大，这是湿热伤了太阳经，先用羌独败毒散发表，后用清湿热的方法。如果发热自汗，六脉长数，这是湿热伤了阳明经，先用干葛石膏汤，后用川连枳壳汤。如果寒热口苦，这是湿热伤了少阳经，先用柴胡汤，后用黄芩芍药汤（河间芍药黄连汤）。脐腹作痛，里急后重，用大柴胡汤、香连丸。又有发热汗出，烦躁口干，头痛身痛，时寒时热下利，脉大，这是三阳挟热下利，俗名漏底伤寒，这是湿热先伤了肠胃。又因早晚风露外束，湿热不得外泄，下流大肠而致下利，宜用羌防柴苓汤，先散表邪，后用猪苓汤，分利湿热。如果寒热往来，口苦而呕，症兼少阳，宜用柴胡汤。此症如果不先散表邪，就用清里的方法，则表邪内缩，不死不休。又有表邪已解，里热不散而下利，当用清里的治法，如黄芩黄连汤、香连丸等。如果痛后即利，利后稍减，片刻后又痛又利，宜用川连枳壳汤。想大便却排不出，腹痛有可下之症，用承气汤攻下。又有饮食不节，损伤肠胃，腹中常痛常利的，这是伤食成利症，宜用保和平胃散（家秘消积散）。又有本是积热，每日发热口干，过食生冷，以致肠鸣下利，这是因热伤冷症，宜用大顺饮等。另有初起不发热，口不渴，小便清白，大便滑泄下利，六脉沉迟，这是三阴脏寒下利，轻者用理中汤；重者用四逆汤。三阴寒利，脉象宜沉小；三阳外感下利，脉象忌沉小。内伤下利，左关脉弦大的，主死。外感下利，左关脉弦大，反而不作死论，因为人迎脉大，正符合外感身热的症状。
太阳病，外证未除，却多次攻下，于是协热而利，下利不止，心下痞硬，表里不和的，用桂枝人参汤主治。
表证误用攻下，如果没有见到表邪，变为下利、痞满结胸的，用泻心汤、陷胸汤。如今下之后表里不解，所以仍用桂枝解表，加人参和中气。
伤寒服用汤药，下利不止，心下痞硬，服泻心汤后。又用其他药攻下，下利不止，医生用理中汤给他，下利更严重。理中汤是调理中焦的，此下利在下焦，用赤石脂禹余粮汤主治。如果复利不止，应当利其小便。这是因为误下多下，以致下焦不固，又以理中汤误治中焦，所以用固下焦的药。假设下利不止，又当分利小便，因为这一条是水谷利。
二伤寒发热，汗出不解，心下痞硬，呕吐而下利的，用大柴胡汤主治。
发热，是阳邪。汗出不解，心下痞硬而下利，是里症。所以用此方双解表里。
太阳与少阳合病，自下利的，给黄芩汤。如果呕吐的，用黄芩加半夏生姜汤。
太阳与少阳合病，自下利，宜治少阳，所以用黄芩汤。如果见呕吐，加半夏、生姜。
阳明少阳合病，必下利。其脉不负的，是顺证。负的，是失证，互相克贼的，称为负。脉滑而数的，有宿食，当下之，宜用承气汤。
木邪乘克，肠胃下利，如果少阳脉大，则阳明受病重。假设阳明脉滑数，方可下之。这是关于防下利，忌阳明脉弱，更不可误下。
太阴病，腹满而吐，食不下，自利益甚，时腹自痛。如果攻下，必胸下结硬。
太阴腹满，吐，食不下，自利而腹自痛，不是阳明下症腹痛，如果误下，则胸下结硬。
自利不渴的，属太阴，因为内脏有寒，应当温之，宜服四逆辈。
上一章以腹满吐食自利确定真太阴，这一章以自利不渴承明太阴寒症，《尚论书》都注为热邪，是错误的。
伤寒脉浮而缓，手足自温的，系在太阴，太阴应当发身黄。如果小便自利，不能发黄。到了七八天，虽然暴烦下利日十余行，必定自止，因为脾家实，秽腐当去故也。
脉浮，是阳脉；脉缓，是太阴脉。上一章以自利不渴，定其太阴寒症下利；这一章以脉浮，手足自温，定其太阴湿热下利。太阴湿热，应当发身黄。如果小便自利，不发黄。到了七八天，大便结硬，这是外传阳明，湿热变燥而为脾约等症。如果不外传而发暴烦下利，虽每日十余行，湿热去尽，必定自止而愈，因为脾热秽腐当去。同一太阴热邪，以湿热系住太阴下利，则入太阴篇。以外传阳明湿热变燥，大便干结，则入阳明篇。这是千古未白之事。
少阴病，二三日至四五日，腹痛，小便不利，下利不止，便脓血的，用桃花汤主治。
这是说少阴火虚滑脱便脓血，宜用桃花汤。旧注认为是阳邪传入，是错误的。
少阴病便脓血的，可以针刺。
这是说少阴热病便脓血，不可用桃花汤，只可针刺，泄血中之热。
少阴病，下利六七日，咳而呕渴，心烦不得眠的，用猪苓汤主治。
少阴病，自利清水，色纯清，心下必痛，口干燥的，急下之，宜用大承气汤。
上两条，都是少阴热症。详细注解见渴门。
伤寒先厥后发热，下利必自止，而反汗出，咽中痛的，其喉为痹。
先厥后发热，则真阳回而利止。如果反汗出，咽中痛，则回阳太过，上冲其喉必痹。
发热无汗，而利必自止。如果不止，必便脓血，便脓血的，其喉不痹。
阳经发热无汗，利必不止；阴经发热无汗，利必自止。如果不止而无汗，则回阳太过，下移大肠，而必便脓血，热邪下泄，故喉不痹。
下利腹胀满，身体疼痛的，先温其里，乃攻其表，温里宜四逆汤，攻表宜桂枝汤。
这是说里寒之人，外冒表邪的症状。下利腹胀满是里寒；身体疼痛的是表邪。下利腹胀的身痛，必以四逆汤先救里，后以桂枝汤再发表。
下利清谷，不可攻表，汗出必胀满。
这是重申下利清谷，必先救里。如果先发其汗出，必胀满不治。
下利，有微热而渴，脉弱的，令自愈。下利脉数而渴的，令自愈。假设不瘥，必清脓血，因为有热故也。下利脉数，有微热，汗出令自愈。假设复紧，为未解。
前条言下利清谷，外冒表寒之利。此条言微热而渴，又见脉弱，则邪衰正复，故令自愈。第二段言脉数而渴，较之上段则里有热，故设不瘥，必下脓血。第三段言脉数微热，是表热内陷，故自汗出令自愈。假设复紧，则表邪伏而未散。
下利，寸脉反浮数，尺中自涩的，必圊脓血。
寸脉主气，尺脉主血。今寸脉浮数，气中有热。尺中自涩，血分受伤。热胜于血，故必圊脓血。
下利，脉沉弦的，下重也。脉大的，为未止。脉微弱数的，为欲自止，虽发热，不死。
下利脉沉弦，则邪满于里，故下重。若脉太过而大，为未愈。必得微弱而数，乃为自止。即或脉数发热，乃沉弦转阳，亦不主死。
热利下重的，白头翁汤主治。
这是说热利，以明上条皆寒利，下条皆热利也。热利下重，火热下迫，故用清火。
下利欲饮水的，因为有热故也。白头翁汤主治。
这是申明宜用白头翁汤方法。言阴症下利，口不渴，今欲饮水者，以上焦有热故也，亦以前方清热。
下利谵语的，因为有燥屎也，宜小承气汤。
上条以渴欲饮水，定热在上焦；此以下利谵语，定肠胃有燥屎。
下利后更烦，按之心下濡的，为虚烦也，宜栀子豉汤。
上条以谵语，故定肠胃实热；此条以利后，心下濡而不坚，故定虚烦也。
羌活败毒散 见发热。
五苓散 见小便不利。
干葛汤 见似疟。
猪苓木通汤
猪苓 白茯苓 泽泻 木通
太阳热结下焦，用五苓散。如果阳明热结，家秘用此方。
柴苓汤
柴胡 黄芩 广皮 半夏 甘草 茯苓 猪苓
少阳湿热，每多协热下利，故用此方。家秘加干葛，兼治阳明大肠；加木通佐其分利。
桂枝防风汤
桂枝 防风 桔梗 浓朴 苍术 甘草
此治风寒湿热三气下利，故用桂枝、防风去太阳风寒，用苍术去阳明风湿。如果风热、湿热，当以羌活易桂枝。
苍术四苓散 即四苓散加苍术防风。
此方表有风湿，里有湿热，故以苍防散在表之风湿，以四苓利在里之湿热。家秘加木通汤调服，功力更大。
苍防干葛汤
苍术 防风 干葛 白芷 浓朴 甘草
风湿内传，每多下利。河间云风邪内缩，以此方治之。
猪苓汤
猪苓 泽泻 茯苓 滑石 阿胶
湿热下利，先散表邪，随利小便。热结太阳，用五苓散；热结阳明，用此方。
苍防柴胡汤
苍术 柴胡 黄芩 半夏 广皮 甘草 防风
此方治风湿伤于少阳下利者。如果见太阳表症，加羌活；见阳明表症，加干葛。
羌防柴苓汤
羌活 防风 柴胡 茯苓 黄芩 半夏 广皮 甘草
外感下利，皆从毛窍而入，必当仍从毛窍而出，故用此方。
黄芩芍药汤
黄芩 白芍药 川黄连 甘草
燥火利，以大黄、归、芍同用，则清血分之火；与枳壳同用，则清气分之火。今湿火伤血，故以黄连、芍药同用，加枣肉，又名芍药黄连汤，兼治内伤血利。
香连丸
木香 川连 等分枣肉为丸
湿火伤血，用当归黄连清血中之火。今湿火伤气，故以木香、黄连同用。家秘加枣肉为丸，则不损中州。
三乙承气汤 见大便秘。
保和丸 见发狂。
平胃散 见谵语。
理中汤 见呕吐。
四逆汤 见身痛。
大顺饮 见腹痛。
温中汤
草豆蔻 干姜 浓朴 甘草
此方与大顺饮，同治伤冷冻饮料者。如果液干有热，反为害。
大柴胡汤 见潮热。
白通汤
葱白头 干姜 熟附子
此即四逆汤，去甘草加葱白，以通阳气，少阴下利，脉微厥冷，方可用。
白通加猪胆汁汤 即白通汤加人中黄、猪胆汁温服。
真武汤
白茯苓 生姜 熟附子 白术 白芍药
土虚不能制水，以此方补土中之火。
四逆散 见厥冷。
白头翁汤
白头翁 黄柏 秦皮 黄连
热利下重，乃是火势下迫，故以此方主治。
栀子豉汤
山栀 淡豆豉 加薤白 葱头
下利心烦，故以此方先治上焦。
Diarrhea (Xia Li) should be differentiated into Yin and Yang, Exterior and Interior syndromes. In the Exterior, there are Cold-Dampness (Han Shi), Wind-Dampness (Feng Shi), and Damp-Heat (Shi Re); in the Interior, there are Accumulated Heat (Ji Re), Food Injury (Shang Shi), Visceral Cold (Zang Han), injury from frozen drinks, External Contraction (Wai Gan), and Cold-Dampness. Manifestations include diarrhea, aversion to cold with body pain, absence of sweating, floating pulse (Mai Fu), purging of clear water, color resembling stagnant roof-leak water, and no thirst in the mouth. This indicates Cold-Dampness injuring the Taiyang (Taiyang Jing) channel. In Northern regions, Mahuang Guizhi Tang is used; in Jiangnan regions, Qianghuo Baidu San is used to first disperse toxic pathogens. If diarrhea does not stop, Wuling San is used to separate and promote urination. If there is pain in the forehead and eye sockets, and all six pulses are large and long, this indicates Cold-Dampness injuring the Yangming (Yangming Jing) channel; Cangfang Gange Tang is used to release the exterior, followed by Zhuling Tang to promote urination. If there is alternating chills and fever, and the six pulses are wiry and large, this indicates Cold-Dampness injuring the Shaoyang (Shaoyang Jing) channel; Chailing Tang is the primary formula. For external contraction of Wind-Dampness causing diarrhea, there is vexing pain in the bone joints, aversion to wind with body pain, spontaneous sweating, and a floating pulse. This indicates Wind-Dampness injuring the Taiyang channel. In the North, Guizhi Fangfeng Tang is used; in Jiangnan, Qianghuo Fangfeng Tang. If urination is difficult, Cangfang Siling San is used. If there is forehead pain, eye pain, stiffness and pain in the hands and feet, fever with profuse sweating, and large, long pulses, this indicates Wind-Dampness injuring the Yangming channel; Cangfang Gange Tang is used. If diarrhea persists, combine with Zhuling Tang. If there is alternating chills and fever, vomiting, and bitter taste in the mouth, this indicates Wind-Dampness injuring the Shaoyang channel; Cangfang Chaihu Tang is the primary formula. For external contraction of Damp-Heat causing diarrhea, with fever, aversion to cold, and floating, large pulses, this indicates Damp-Heat injuring the Taiyang channel; first use Qiangduo Baidu San to release the exterior, then use methods to clear Damp-Heat. If there is fever with spontaneous sweating, and long, rapid pulses, this indicates Damp-Heat injuring the Yangming channel; first use Gange Shigao Tang, then Chuanlian Zhike Tang. If there is alternating chills, fever, and bitter taste, this indicates Damp-Heat injuring the Shaoyang channel; first use Chaihu Tang, then Huangqin Shaoyao Tang (Hejian Shaoyao Huanglian Tang). With umbilical and abdominal pain, tenesmus (Li Ji Hou Zhong), use Dachaihu Tang or Xianglian Wan. There is also fever with sweating, irritability, dry mouth, headache, body pain, alternating chills and fever with diarrhea, and a large pulse. This is "Three Yangs carrying heat causing diarrhea," commonly known as "Lou Di Shanghan" (Leaky Bottom Cold Damage), where Damp-Heat first injures the intestines and stomach. Due to wind and dew binding externally in the morning and evening, Damp-Heat cannot vent outward, flows down into the Large Intestine causing diarrhea. Use Qiangfang Chailing Tang to first disperse exterior pathogens, then Zhuling Tang to separate and drain Damp-Heat. If there is alternating chills and fever, bitter taste, and vomiting, involving the Shaoyang syndrome, use Chaihu Tang. If this condition does not first disperse exterior pathogens but uses interior-clearing methods, the exterior pathogens will retreat inward, leading to death if not resolved. If exterior pathogens have been resolved but interior heat remains un-dispersed causing diarrhea, interior-clearing methods should be used, such as Huangqin Huanglian Tang or Xianglian Wan. If pain occurs immediately before defecation, relief follows defecation, but pain and diarrhea recur shortly after, use Chuanlian Zhike Tang. If one desires to defecate but cannot, with abdominal pain indicating a downward-indication, use Chengqi Tang to purge. If irregular diet injures the intestines and stomach, causing frequent abdominal pain and diarrhea, this is diarrhea due to food injury; use Baohe Pingwei San (Jiami Xiaoji San). If there was originally accumulated heat with daily fever and dry mouth, but excessive consumption of cold/raw foods causes borborygmus and diarrhea, this is "heat injured by cold"; use Dashun Yin etc. If initially there is no fever, no thirst, clear urine, slippery diarrhea, and deep, slow pulses, this is Three Yin visceral cold diarrhea; for mild cases, Lizhong Tang; for severe cases, Sini Tang. For Three Yin cold diarrhea, the pulse should be deep and small; for Three Yang external contraction diarrhea, a deep and small pulse is contraindicated. For internal injury diarrhea, a wiry and large left Guan pulse indicates death. For external contraction diarrhea, a wiry and large left Guan pulse is not considered fatal, as a large Renying pulse corresponds to the external contraction fever symptom.
In Taiyang disease, if exterior signs persist and multiple purgatives are applied, it leads to diarrhea accompanied by heat, continuous diarrhea, epigastric fullness and hardness, and disharmony of both interior and exterior; Guizhi Renshen Tang is the primary formula.
If exterior syndrome is mistakenly purged, and instead of resolving exterior pathogens, it transforms into diarrhea, epigastric fullness, or chest binding, use Xiexin Tang or Xiantong Tang. Now, after purging, both interior and exterior remain unresolved, so Guizhi is still used to release the exterior, adding Renshen to harmonize the Middle Jiao Qi.
In Cold Damage, after taking herbal decoctions, if diarrhea continues incessantly with epigastric fullness and hardness, and after taking Xiexin Tang, another drug is used to purge, resulting in continued diarrhea. The physician gives Lizhong Tang, but the diarrhea worsens. Lizhong Tang regulates the Middle Jiao, but this diarrhea is in the Lower Jiao; Shizhi Yiyuli Tang is the primary formula. If diarrhea continues despite this, promoting urination is indicated. This is due to excessive mistaken purging causing instability of the Lower Jiao, and the mistaken treatment of the Middle Jiao with Lizhong Tang; thus, herbs that secure the Lower Jiao are used. If diarrhea persists, one must again separate and promote urination, as this case involves watery stool and grain.
In "Er Shanghan" (Double Cold Damage) with fever, sweating without resolution, epigastric fullness and hardness, vomiting, and diarrhea, Dachaihu Tang is the primary formula.
Fever is a Yang pathogen. Sweating without resolution, epigastric fullness/hardness, and diarrhea are Interior symptoms. Thus, this formula resolves both Exterior and Interior.
When Taiyang and Shaoyang combined diseases present with spontaneous diarrhea, give Huangqin Tang. If there is vomiting, use Huangqin Jia Banxia Shengjiang Tang.
For Taiyang and Shaoyang combined disease with spontaneous diarrhea, treat the Shaoyang; hence, Huangqin Tang is used. If vomiting is seen, add Banxia and Shengjiang.
When Yangming and Shaoyang combined diseases occur, diarrhea is inevitable. If the pulse is "not negative" (Fu), it is a favorable progression. "Negative" implies loss; mutual overacting constitutes "negative." A slippery and rapid pulse indicates retained food; purging is indicated, using Chengqi Tang.
When Wood pathogen overacts, causing intestinal/colonic diarrhea, if the Shaoyang pulse is large, Yangming is severely affected. Only if the Yangming pulse is slippery and rapid can purging be performed. Regarding preventing diarrhea, a weak Yangming pulse is contraindicated, and mistaken purging must be avoided.
The Taiyin disease presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, there will be knotting and hardness below the chest.
Taiyin abdominal fullness, vomiting, inability to eat, spontaneous diarrhea with spontaneous abdominal pain, is not the abdominal pain of Yangming downward-indication. Mistaken purging will cause knotting and hardness below the chest.
Spontaneous diarrhea without thirst belongs to Taiyin, because the viscera have Cold; it should be warmed, suitable for Si Ni Lei (Si Ni class formulas).
The previous chapter defined true Taiyin by abdominal fullness, vomiting, food refusal, and spontaneous diarrhea. This chapter clarifies Taiyin Cold syndrome by spontaneous diarrhea without thirst. *Shanglun Shu* annotates these as Heat pathogens, which is incorrect.
In Cold Damage, if the pulse is floating and slow, and hands/feet are spontaneously warm, it relates to Taiyin. Taiyin should manifest as yellowing of the body. If urination is spontaneous and free, yellowing cannot occur. By the 7th or 8th day, although sudden vexation and diarrhea occurring more than ten times a day happen, it will surely stop spontaneously, because the Spleen Qi becomes substantial, and turbid filth must be expelled.
Floating pulse is a Yang pulse; slow pulse relates to Taiyin. The previous chapter defined Taiyin Cold diarrhea by spontaneous diarrhea without thirst; this chapter defines Taiyin Damp-Heat diarrhea by floating pulse and spontaneously warm hands/feet. Taiyin Damp-Heat should cause yellowing. If urination is free, no yellowing occurs. By the 7th or 8th day, if stool becomes hard, this is transmission to Yangming, where Damp-Heat transforms into Dryness, causing Spleen Restriction (Pi Yue) etc. If it does not transmit outward but causes sudden vexation and diarrhea (even >10 times/day), once Damp-Heat is exhausted, it will stop and heal spontaneously, because Spleen Heat expels turbid filth. The same Taiyin Heat pathogen: if Damp-Heat stays in Taiyin causing diarrhea, it enters the Taiyin chapter. If it transmits to Yangming, transforming Damp-Heat into Dryness with hard stool, it enters the Yangming chapter. This has been unclear for millennia.
In Shaoyin disease, from the 2nd-3rd day to the 4th-5th day, if there is abdominal pain, difficulty urinating, continuous diarrhea, and pus/blood in stool, Taohua Tang is the primary formula.
This describes Shaoyin Fire deficiency causing slipping and leakage of pus/blood in stool, suitable for Taohua Tang. Old annotations claiming transmission of Yang pathogens are incorrect.
For Shaoyin disease with pus/blood in stool, acupuncture may be used.
This states that for Shaoyin Heat disease with pus/blood in stool, Taohua Tang is not suitable; only acupuncture is appropriate to drain Heat from the Blood level.
In Shaoyin disease, if diarrhea lasts 6-7 days, accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhuling Tang is the primary formula.
In Shaoyin disease, if there is spontaneous purging of clear water, purely clear color,必 pain in the epigastrium, and dry mouth/thirst, urgent purging is required, using Da Chengqi Tang.
The above two clauses both describe Shaoyin Heat syndromes. See detailed notes in the Thirst section.
In Cold Damage, if there is initial cold extremities (Jue) followed by fever, diarrhea will stop spontaneously. However, if sweating occurs instead, and throat pain appears, the throat becomes Bi (obstructed).
Initial Jue followed by fever means True Yang returns and diarrhea stops. If sweating occurs instead, and throat pain appears, the return of Yang is excessive, rushing upward to obstruct the throat.
With fever and no sweating, diarrhea will stop spontaneously. If it does not stop, pus/blood in stool will occur; if pus/blood occurs, the throat will not become Bi.
Yang meridian fever with no sweating leads to persistent diarrhea; Yin meridian fever with no sweating leads to stopping of diarrhea. If diarrhea persists without sweating, the return of Yang is excessive, shifting downward to the Large Intestine, causing pus/blood in stool. As Heat pathogens drain downward, the throat does not become Bi.
For diarrhea with abdominal distension/fullness and body pain, first warm the Interior, then attack the Exterior. Warming the Interior suits Sini Tang; attacking the Exterior suits Guizhi Tang.
This describes a person with Interior Cold contracting an Exterior pathogen. Diarrhea with abdominal distension/fullness is Interior Cold; body pain is Exterior pathogen. For diarrhea, abdominal distension, and body pain, Sini Tang must first save the Interior, followed by Guizhi Tang to release the Exterior.
For diarrhea with undigested food (Qing Gu), do not attack the Exterior; sweating will cause distension/fullness.
This reiterates that for diarrhea with undigested food, saving the Interior is priority. If sweating is induced first, untreatable distension/fullness will result.
For diarrhea, if there is slight fever and thirst, and the pulse is weak, self-healing is expected. For diarrhea with a rapid pulse and thirst, self-healing is expected. If it does not improve, pus/blood in stool will certainly occur, due to Heat. For diarrhea with a rapid pulse, slight fever, and sweating, self-healing is expected. If the pulse becomes tight again, the condition is unresolved.
The previous clause discussed diarrhea with undigested food and external cold contraction. This clause discusses slight fever, thirst, and weak pulse, indicating pathogen decline and Zheng recovery, hence self-healing. The second segment discusses rapid pulse and thirst, indicating Interior Heat compared to the previous segment; if it does not improve, pus/blood in stool will occur. The third segment discusses rapid pulse and slight fever, indicating Exterior Heat sinking inward; spontaneous sweating leads to self-healing. If the pulse becomes tight again, the Exterior pathogen is latent and undispersed.
For diarrhea, if the Cun pulse is unexpectedly floating and rapid, and Chi pulse is naturally choppy, pus/blood in stool will certainly occur.
Cun pulse governs Qi; Chi pulse governs Blood. Floating and rapid Cun pulse indicates Heat in Qi. Choppy Chi pulse indicates injury to the Blood level. Heat surpasses Blood, hence pus/blood in stool.
For diarrhea, a deep and wiry pulse indicates heaviness in defecation (Xia Zhong). A large pulse indicates it has not stopped. A weak, fine, and rapid pulse indicates it is about to stop; even with fever, death is not imminent.
Deep and wiry diarrhea pulse means pathogens fill the Interior, causing heaviness. If the pulse is excessively large, it is not cured. It must become weak, fine, and rapid to indicate cessation. Even if the pulse is rapid with fever, if it shifts from deep/wiry to Yang, death is not indicated.
For Hot Diarrhea with heaviness in defecation, Baitouweng Tang is the primary formula.
This describes Hot Diarrhea, clarifying that the previous clause was Cold Diarrhea and this one is Hot Diarrhea. Hot Diarrhea with heaviness is caused by Fire-Heat pressing downward, hence clearing Fire is used.
For diarrhea with desire to drink water, it is due to Heat. Baitouweng Tang is the primary formula.
This clarifies the indication for Baitouweng Tang. Yin syndrome diarrhea involves no thirst; desire to drink indicates Heat in the Upper Jiao, cleared by the aforementioned formula.
For diarrhea with delirium, it is due to dry feces; Xiao Chengqi Tang is suitable.
The previous clause determined Heat in the Upper Jiao by thirst/desire to drink; this clause determines dry feces in the intestines/stomach by diarrhea with delirium.
After diarrhea, if vexation increases, and pressing on the epigastrium reveals softness, it is Empty Vexation (Xu Fan); Zhizi Chi Tang is suitable.
The previous clause determined Interior Excess Heat by delirium; this clause determines Empty Vexation by post-diarrhea softness in the epigastrium.
Qianghuo Baidu San - See Fever.
Wuling San - See Difficulty Urinating.
Gange Tang - See Similar to Malaria.
Zhuling Mutong Tang
Zhuling, Baifuling, Zexie, Mutong
For Taiyang Heat binding in the Lower Jiao, use Wuling San. For Yangming Heat binding, the author's secret method uses this formula.
Chailing Tang
Chaihu, Huangqin, Guangpi, Banxia, Gancao, Fuling, Zhuling
Shaoyang Damp-Heat often accompanies heat-induced diarrhea, hence this formula. The author adds Gange to treat Yangming Large Intestine; adds Mutong to assist separation/draining.
Guizhi Fangfeng Tang
Guizhi, Fangfeng, Jiegeng, Nongpo, Cangzhu, Gancao
This treats diarrhea from Wind-Cold-Damp-Heat three pathogens. Guizhi and Fangfeng remove Taiyang Wind-Cold; Cangzhu removes Yangming Wind-Damp. For Wind-Heat or Damp-Heat, replace Guizhi with Qianghuo.
Cangzhu Siling San is Siling San plus Cangzhu and Fangfeng.
This formula addresses Wind-Damp in the Exterior and Damp-Heat in the Interior. Cangfang disperses Exterior Wind-Damp; Siling drains Interior Damp-Heat. The author adds Mutong Tang for administration to enhance efficacy.
Cangfang Gange Tang
Cangzhu, Fangfeng, Gange, Baizhi, Nongpo, Gancao
Wind-Damp transmitting inward often causes diarrhea. Hejian stated Wind pathogen retreating inward is treated with this formula.
Zhuling Tang
Zhuling, Zexie, Fuling, Huashi, Ejiao
For Damp-Heat diarrhea, first disperse exterior pathogens, then promote urination. Heat binding in Taiyang uses Wuling San; Heat binding in Yangming uses this formula.
Cangfang Chaihu Tang
Cangzhu, Chaihu, Huangqin, Banxia, Guangpi, Gancao, Fangfeng
This formula treats diarrhea from Wind-Damp injuring Shaoyang. If Taiyang exterior signs appear, add Qianghuo; if Yangming exterior signs appear, add Gange.
Qiangfang Chailing Tang
Qianghuo, Fangfeng, Chaihu, Fuling, Huangqin, Banxia, Guangpi, Gancao
External contraction diarrhea enters via hair follicles/pores and must exit via them; hence this formula.
Huangqin Shaoyao Tang
Huangqin, Baishaoyao, Chuanhuanglian, Gancao
For Dry-Fire diarrhea, using Dahuang, Danggui, and Shaoyao clears Blood-level Fire; using Zhike clears Qi-level Fire. Currently, Damp-Fire injures Blood, so Huanglian and Shaoyao are used together, adding Jujube flesh, also named Shaoyao Huanglian Tang, treating internal injury blood diarrhea.
Xianglian Wan
Muxiang, Chuanhuanglian, equal parts made into pills with Jujube flesh
Damp-Fire injuring Blood uses Danggui and Huanglian to clear Blood Fire. Currently, Damp-Fire injures Qi, so Muxiang and Huanglian are used together. The author adds Jujube flesh to prevent damaging the Middle Jiao.
San Yi Chengqi Tang - See Constipation.
Baohe Wan - See Mania.
Pingwei San - See Delirium.
Lizhong Tang - See Vomiting.
Sini Tang - See Body Pain.
Dashun Yin - See Abdominal Pain.
Wenzhong Tang
Caodoukou, Ganjiang, Nongpo, Gancao
This formula and Dashun Yin both treat injury from frozen drinks. If fluids are dry and Heat exists, it is harmful.
Dachaihu Tang - See Tidal Fever.
Baitong Tang
Congbaitou, Ganjiang, Shufuzi
This is Sini Tang minus Gancao plus Congbai to unblock Yang Qi. Suitable for Shaoyin diarrhea with faint pulse and cold extremities.
Baitong Jia Zhu Danzhi Tang is Baitong Tang plus Renzhonghuang and Zhu Danzhi, taken warm.
Zhenwu Tang
Baifuling, Shengjiang, Shufuzi, Baizhu, Baishaoyao
Earth deficiency fails to control Water; this formula tonifies Fire within Earth.
Sini San - See Cold Extremities.
Baitouweng Tang
Baitouweng, Huangbo, Qinpi, Huanglian
Hot diarrhea with heaviness is caused by Fire pressure downward; hence this formula is primary.
Zhizi Chi Tang
Shanzhi, Danshichu, add Xiebai, Congtou
For diarrhea with heart vexation, this formula first treats the Upper Jiao.