天之气一也。一之用为风、火、燥、湿、寒、暑。故湿之气，一之一也，相乘而
为五变，其化在天为雨，在地为泥，在人为脾，甚则为泄。故风而湿其泄也，胃暑而湿其泄也，脾燥而
湿其泄也，大肠热而湿其泄也，小肠寒而湿其泄也。
大瘕，若胃不已，变而为飧泄；飧泄不
已，变而为洞泄；洞泄不已，变而为脾泄寒中。此风乘湿之变也。若脾泄不已，变而为霍乱；霍乱
不已，变而为注下；注下不已，变而为肿蛊。此暑乘湿之变也。若大肠泄不已，变而为
胀； 胀不已，变而
为肠鸣；肠鸣不已，变而为支满 溏。此燥乘湿之变也。若小肠泄不已，变而为肠 ；肠
不已，变而为脏毒；脏毒不已，变而为前后便血。此热乘湿之变也。若大瘕泄不已，变而为
脱肛；脱肛不已，变而为广肠痛；广肠痛不已，变而为乳痔肠风。此寒乘湿之变也。凡此二
十五变，若无湿则终不成疾。况脾胃二土，共管中州，脾好饮，脾亦恶湿，此泄之所由生也。
凡下痢之脉，微且小者生，浮大者死。水肿则反是，浮大者生，沉细者死。夫病在里脉沉
，在表脉浮。里当下之，表当汗之。下痢而脉浮滑，水肿者脉沉细，表里俱受病，故不治也
。凡脏血便血，两手脉俱弦者死绝，俱滑大者生，血温身热者死。王太仆则曰∶若下血而身
热血温，是血去而外逸也，血属火故也。七日而死者，火之成数也。
夫飧泄得之于风，亦汗
可愈。或伏惊怖，则胆木受邪，暴下绿水。盖谓戊己见伐于甲木也。婴儿泄绿水，《素问》
有婴儿风，理亦如之。洞泄者，飧泄之甚，但飧泄近于洞泄，洞泄久则寒中，温之可也。治法曰∶
和之则可也，汗之则不可。盖在腑则易治，入脏则难攻。洞泄寒中，自腑而入脏，宜和解而勿争。
水肿之作者，未遽而然也。由湿遍于大肠，小溲自涩，水湿既潴，肿满日倍，面黄腹
大，肢体如泥，湿气周身，难专一法。越其高而夺其下，发其表而渗其中，酸收而辛散，淡
渗而苦坚，用攻剂以救其甚，缓剂以平其余。如是则孤精得气，独魄反阳，亦可保形，陈
去而净府洁矣。
彼豆蔻、乌梅、罂粟壳勿骤用也。设病形一变，必致大误。
或通而塞，或塞而通，塞塞通通，岂限一法？世俗止知塞剂之能塞，而不知通剂之能塞者，拘于方也！凡治
湿，皆以利小溲为主。诸泄不已，宜灸水分穴，谓水谷之所别也。脐之上一寸半，灸五、七
壮。腹鸣如雷，水道行之候也。凡湿勿针。《内经》虽云缪刺其处，莫若以张长沙治伤寒法
治之。盖泄者，亦四时伤寒之一也。仲景曰∶上涌而下泄，表汗而里攻，半在表，半在里，则宜和
解之，表里俱见，随证渗泄。此虽以治伤寒，其于治湿也同。仍察脉以视深浅，问年壮以视
虚实，所投必如其意矣。
顷商水县白堤酒监单昭信，病飧泄，逾年不愈。此邑刘继先命予药
之。为桂枝麻黄汤数两，一剂而愈。因作五泄图，摭《难》《素》本意。书录于上，刊而行
之，诚有望于后之君子，戴人张子和述以上之图，校改为篇法。
天的气是统一的。统一的气表现为风、火、燥、湿、寒、暑六种变化。所以湿之气，也是统一之气中的一种，相互乘袭而产生五种变化，其化生在天空为雨，在地面为泥，在人体对应脾脏，严重时就导致泄泻。因此，风邪兼夹湿邪导致的泄泻，暑邪兼夹湿邪导致的泄泻，燥邪兼夹湿邪导致的泄泻，大肠热邪兼夹湿邪导致的泄泻，小肠寒邪兼夹湿邪导致的泄泻。
大瘕（腹部结块），如果胃部的病变不止，会转变为飧泄（完谷不化的泄泻）；飧泄不止，会转变为洞泄（水样直下的泄泻）；洞泄不止，会转变为脾泄寒中（脾虚寒盛之泄泻）。这是风邪乘袭湿邪的变化。如果脾泄不止，会转变为霍乱（上吐下泻的急性病）；霍乱不止，会转变为注下（急迫下痢）；注下不止，会转变为肿蛊（水肿鼓胀）。这是暑邪乘袭湿邪的变化。如果大肠泄不止，会转变为胀满；胀满不止，会转变为肠鸣；肠鸣不止，会转变为支满溏（胸胁胀满伴大便稀溏）。这是燥邪乘袭湿邪的变化。如果小肠泄不止，会转变为肠痈（肠道脓肿）；肠痈不止，会转变为脏毒（肛门直肠部位的毒疮）；脏毒不止，会转变为前后二便出血。这是热邪乘袭湿邪的变化。如果大瘕泄不止，会转变为脱肛；脱肛不止，会转变为广肠痛（直肠疼痛）；广肠痛不止，会转变为乳痔肠风（痔疮伴肠风下血）。这是寒邪乘袭湿邪的变化。以上这二十五种变化，如果没有湿邪，最终都不会形成疾病。何况脾胃两脏同属土，共同管理中焦，脾喜欢湿润，但也厌恶湿气，这就是泄泻产生的原因。
凡是患痢疾的人，脉象微细且小的能生，脉象浮大的会死。水肿则相反，脉象浮大的能生，脉象沉细的会死。病在里脉象沉，病在表脉象浮。里证应当用攻下法，表证应当用发汗法。患痢疾而脉象浮滑，患水肿而脉象沉细，说明表里都受了病邪，所以难以治疗。凡是脏血便血，两手脉象都弦硬的属于死绝之脉，脉象都滑大的能生，如果血色温热且身体发热则会死。王太仆曾说：如果下血且身体发热、血液温热，这是因为血流失散到体外，因为血属于火的原因。七天后死亡的，是因为火的成数是七。
飧泄是由于风邪引起的，也可以用发汗法治愈。或者因潜伏的惊恐恐惧，导致胆木受邪，突然排出绿水。这说的是戊己（脾胃）受到甲木（肝胆）的克制。婴儿排泄绿水，《素问》中有婴儿风的记载，道理也是一样的。洞泄是严重的飧泄，只是飧泄接近于洞泄，洞泄久了会导致寒中，用温补法是可以的。治法说：调和即可，不可发汗。因为在腑容易治疗，入脏则难攻。洞泄寒中，是从腑传入脏，适宜和解而不宜强攻。
引起水肿的，不是突然形成的。是由湿气遍布大肠，小便自然涩滞，水湿既已积聚，肿胀日益加倍，面色黄、腹部大，肢体像泥一样，湿气遍布周身，不能只用一种方法。要越过高处而夺取下方，发散表邪而渗利其中，酸味收敛而辛味发散，淡味渗利而苦味坚阴，用攻伐剂来救治严重的症状，用缓和剂来平复剩余的症状。这样就能使孤精得到气，独魄恢复阳气，也可以保全形体，陈腐去除而净府洁净了。
那些豆蔻、乌梅、罂粟壳不要急于使用。假设病情形态发生变化，必然导致大的错误。
或者通而塞，或者塞而通，塞塞通通，难道只局限于一种方法吗？世俗之人只知道固涩剂的能止泻，却不知道通利剂的也能致塞，这是拘泥于固定方剂造成的！凡是治疗湿邪，都以利小便为主。各种泄泻不止，适宜灸水分穴，说是水谷分别的地方。脐上一寸半，灸五到七壮。腹鸣如雷，是水道运行的征候。凡是湿邪不要用针刺。《内经》虽然说要缪刺患处，不如用张仲景治疗伤寒的方法来处理。因为泄泻，也是四时伤寒的一种。张仲景说：上涌而下泄，表汗而里攻，半在表，半在里，则适宜和解，表里症状俱见，随证渗泄。这虽然是用来治疗伤寒，但治疗湿邪也是同样的道理。仍然要观察脉象以视深浅，询问年龄体质以视虚实，所投用的药物一定能符合心意。
近来商水县白堤酒监单昭信，患飧泄，一年多不好。这个县的刘继先让我给他开药。我开了几两桂枝麻黄汤，一剂就痊愈了。因此绘制了五泄图，摘取《难经》《素问》的本意。书写记录在上面，刊印发行，确实希望后世君子参考，戴人张子和叙述以上内容，校改为篇章格式。
The Qi of Heaven is unified. The application of this unity manifests as Wind, Fire, Dryness, Dampness, Cold, and Summerheat. Thus, Dampness (Shi) is one aspect of this unified Qi. Through mutual overacting, it produces five transformations: its manifestation in the sky is Rain, on the ground is Mud, in the human body corresponds to the Spleen, and when severe, it leads to Diarrhea (Xie). Therefore, diarrhea caused by Wind combining with Dampness, Summerheat combining with Dampness, Dryness combining with Dampness, Large Intestine Heat combining with Dampness, and Small Intestine Cold combining with Dampness.
Da Jia (Large Mass), if the Stomach pathology persists, transforms into Sun Xie (Diarrhea with undigested food); if Sun Xie persists, it transforms into Dong Xie (Watery diarrhea flowing directly down); if Dong Xie persists, it transforms into Pi Xie Han Zhong (Spleen deficiency with Cold accumulation). This is the transformation of Wind overacting on Dampness. If Pi Xie persists, it transforms into Huo Luan (Acute vomiting and diarrhea); if Huo Luan persists, it transforms into Zhu Xia (Urgent dysentery); if Zhu Xia persists, it transforms into Zhong Gu (Edema and abdominal distension). This is the transformation of Summerheat overacting on Dampness. If Large Intestine diarrhea persists, it transforms into Zhang Man (Abdominal fullness); if Zhang Man persists, it transforms into Chang Ming (Borborygmus); if Chang Ming persists, it transforms into Zhi Man Tang (Hypochondriac fullness with loose stools). This is the transformation of Dryness overacting on Dampness. If Small Intestine diarrhea persists, it transforms into Chang Yong (Intestinal abscess); if Chang Yong persists, it transforms into Zang Du (Toxic sores of the anus/rectum); if Zang Du persists, it transforms into Bleeding from both anterior and posterior orifices. This is the transformation of Heat overacting on Dampness. If Da Jia diarrhea persists, it transforms into Tuo Gang (Rectal prolapse); if Tuo Gang persists, it transforms into Guang Chang Tong (Pain of the rectum); if Guang Chang Tong persists, it transforms into Ru Zhi Chang Feng (Hemorrhoids accompanied by intestinal wind bleeding). This is the transformation of Cold overacting on Dampness. All these twenty-five transformations will not ultimately form disease without Dampness. Moreover, the Spleen and Stomach, both belonging to Earth, jointly govern the Middle Jiao. The Spleen likes moisture but also detests Dampness; this is the origin of Diarrhea.
Regarding pulse diagnosis for Dysentery (Li Ji): a pulse that is fine and small indicates survival, while a floating and large pulse indicates death. For Edema (Shui Zhong), it is the opposite: a floating and large pulse indicates survival, while a deep and fine pulse indicates death. Disease in the Interior presents with a Deep pulse, disease in the Exterior presents with a Floating pulse. Interior syndromes should be treated with Purging methods, Exterior syndromes with Sweating methods. If Dysentery presents with a floating and slippery pulse, and Edema presents with a deep and fine pulse, it means both Exterior and Interior are affected by pathogens, making it untreatable. Regarding Blood in the stool from Zang organs: if both hands' pulses are wiry, it indicates death; if both are slippery and large, it indicates survival; if the blood is warm and the body is hot, it indicates death. Wang Tai Pu stated: "If there is bloody stool accompanied by body heat and warm blood, it is because the blood has escaped outward, as Blood belongs to Fire." Death after seven days occurs because seven is the completed number of Fire.
Sun Xie originates from Wind and can also be cured by Sweating. Or, due to latent fright and terror, the Gallbladder Wood suffers evil, leading to sudden discharge of green water. This refers to Wu Ji (Spleen/Stomach) being attacked by Jia Wood (Liver/Gallbladder). Infants discharging green water, as mentioned in Su Wen under "Infant Wind," follows the same principle. Dong Xie is severe Sun Xie; merely close to Dong Xie, prolonged Dong Xie leads to Cold accumulation in the interior, which can be treated with Warming methods. The treatment principle states: Harmonization is acceptable, Sweating is not. Because pathogen in the Fu organs is easy to treat, but entering the Zang organs makes it hard to attack. Dong Xie with Cold accumulation enters from Fu to Zang, suitable for Harmonization rather than aggressive attack.
The onset of Edema is not sudden. It arises from Dampness pervading the Large Intestine, causing urine to become naturally obstructed. Once Water-Dampness accumulates, swelling doubles daily, presenting with yellow complexion, large abdomen, limbs like mud, and Dampness pervading the whole body. One cannot rely on a single method. One must vent from above and drain from below, release the Exterior and渗利 (leach/drain) the Interior, use Sour astringents and Pungent dispersants, Light leaching agents and Bitter firming agents. Use attacking formulas to rescue severe conditions, and mild formulas to calm residual symptoms. In this way, isolated Jing (Essence) receives Qi, solitary Po (Corporeal Soul) returns to Yang, the physical form can be preserved, stale matter is removed, and the Clean Fu organs are purified.
Do not hastily use Dou Kou (Nutmeg), Wu Mei (Mume Fruit), or Ying Su Ke (Poppy Shell). If the pathological presentation changes, it will surely lead to major errors.
Sometimes Tonification leads to Obstruction, sometimes Obstruction leads to Tonification. Does Obstruction and Tonification limit oneself to only one method? The世俗 (common people) only know that Astringent agents can stop diarrhea, but do not know that Unblocking agents can cause obstruction; this is adherence to fixed prescriptions! Generally, treating Dampness focuses primarily on promoting urination. For various persistent diarrheas, moxibustion at Shui Fen (Water Separation, CV9) is appropriate, as it is where water and grain separate. Moxa 5-7 cones at 1.5 cun above the umbilicus. Abdominal rumbling like thunder is a sign of the Water pathway functioning. Do not use acupuncture for Dampness. Although Nei Jing mentions Mi Ci (Needling the opposite side), it is better to treat it using Zhang Zhongjing's methods for Shang Han (Cold Damage). Diarrhea is also one of the four-season Shang Han diseases. Zhongjing said: "Upper purging and lower draining, exterior sweating and interior attacking, half in the Exterior, half in the Interior, then Harmonization is suitable; if Exterior and Interior signs are both present, follow the syndrome to leach and drain." Although this applies to Shang Han, it is the same for treating Dampness. Still, observe the pulse to see depth, ask age and constitution to see deficiency or excess, and the administered medicine will certainly meet expectations.
Recently, Shan Zhao Xin, Wine Supervisor of Baidi in Shangshui County, suffered from Sun Xie for over a year without cure. Liu Jixian of this county asked me to prescribe medicine for him. I prescribed several taels of Guizhi Mahuang Tang (Cinnamon Twig and Ephedra Decoction), and he was cured after one dose. Therefore, I drew the Diagram of Five Diarrheas, extracting the original intent of Nan Jing and Su Wen. I recorded this text above, had it printed and circulated, sincerely hoping future gentlemen would refer to it. Dai Ren Zhang Zihe narrates the above content, revised and formatted into chapters.