胃苓汤 治诸泻及腹痛肿胀等证。
茯苓 猪苓 泽泻 白术 桂枝 苍术 浓朴 陈皮（各一钱五分） 炙草（八分
加生姜三片，水煎服。
四神丸 治五更至天明腹痛而泻，有定候，名脾肾泻。又通治久泻。
补骨脂（四两，酒炒） 肉豆蔻（面煨，去油） 五味子（各二两） 吴茱萸（汤泡，一两
以大枣八十一粒，生姜四两，同煮烂，去皮核，和为丸，如梧子大，临睡以米汤送下四
钱。去肉豆蔻加人参、茯苓、干姜、附子、罂粟壳，以米汤泛丸更效。
圣济附子丸 治洞泄寒中，注下水谷，或痢赤白，食已即出，食物不消。
黄连 乌梅肉（各三两） 干姜 附子（炮，各一两五钱
炼蜜丸，每服三钱，米汤下，日二服。
按∶原注云∶“春伤于风，邪气流连，至夏发为飧泄，至长夏发为洞泄，阴生于午，至
未为甚，长夏之时，脾土当旺，脾为阴中之至阴，故阴气盛，阴气既盛，则生内寒而洞泄矣
。”
千金温脾汤 治积久热痢赤白。
大黄（四钱） 人参 甘草（各二钱） 熟附子（一钱） 炮干姜（二钱
水煎温服。
冷痢去甘草，加桂心三钱，倍人参、姜、附，减大黄一钱。
《灵枢》云∶“中热消脾，则便寒，寒中之属，则便热，胃中热则消谷，令人悬心善饥
。脐以上皮热，肠中热，则出黄如糜，脐以下皮寒，胃中热，则腹胀。肠中寒，则肠鸣飧泄
，胃中寒、肠中热，则胀而且泄，胃中热胀，肠中寒，则疾饥，小腹痛胀。”
张石顽注云∶世医治病，但知热以寒治，寒以热治，外此总不讲也。设病中热消脾，而
见悬心善饥，洵为热症无疑，然必审其脐以上皮热，方是胃中热气蕴隆。若出黄如糜，不但
胃中有热，而肠中亦为热邪奔迫可知。倘脐以下皮寒，而见腹胀，有似乎实热固结，实为胃
中虚寒之候，或见肠鸣飧泄，非特胃有寒，且移寒于二肠矣。盖热泄则肠垢黄赤，寒泄则
溏清冷，此病机之最显著者，可以明辨。况有胀而泄利，此胀为胃寒阳气不布之胀，泄为肠
热便垢之泄，复有消谷易饥，小腹胀痛之病，岂非胃中有热，肠中有寒之一验乎。若此种种
，苟未明仲景三泻心汤，黄连汤，干姜黄芩黄连人参汤，浓朴生姜半夏甘草人参汤，干姜人
参半夏丸等法，必不可以语至治也。
乳豆丸（方详本论
胃苓汤：治疗各种泄泻以及腹痛、肿胀等证候。
茯苓、猪苓、泽泻、白术、桂枝（Cinnamon Twig）、苍术、厚朴、陈皮（各一钱五分），炙甘草（八分）。
加生姜三片，用水煎煮后服用。
四神丸：治疗从五更天到黎明时分出现腹痛并腹泻，发作时间固定，称为脾肾泻。又通用治疗久泻。
补骨脂（四两，用酒炒制），肉豆蔻（用面粉煨制，去油），五味子（各二两），吴茱萸（用汤浸泡，一两）。
用大枣八十一粒，生姜四两，一同煮烂，去掉皮和核，混合制成丸药，大小如梧桐子大，临睡前用米汤送服四钱。去掉肉豆蔻，加入人参、茯苓、干姜、附子、罂粟壳，用米汤泛丸效果更好。
圣济附子丸：治疗洞泄寒中（严重的寒性泄泻），水谷直下，或者痢疾排出赤白脓血，吃完食物立刻吐出或排出，食物不消化。
黄连、乌梅肉（各三两），干姜、附子（炮制，各一两五钱）。
炼蜜为丸，每次服用三钱，用米汤送服，每日两次。
按语：原注说：“春季感受风邪，邪气滞留体内，到了夏季发为飧泄（完谷不化的泄泻），到了长夏发为洞泄。阴气生于午时，到未时达到极盛。长夏之时，脾土当令旺盛，脾是阴中之至阴，所以阴气盛，阴气既盛，则产生内寒而导致洞泄。”
千金温脾汤：治疗积久形成的热痢，排出赤白脓血。
大黄（四钱），人参、甘草（各二钱），熟附子（一钱），炮干姜（二钱）。
用水煎煮，温服。
如果是冷痢，去掉甘草，加入桂心三钱，加倍使用人参、干姜、附子，减少大黄一钱。
《灵枢》说：“中焦有热导致脾功能受损，则大便偏寒；属于寒中的病证，则大便偏热。胃中有热则消谷善饥，使人心中悬空感且容易饥饿。肚脐以上的皮肤发热，说明肠中有热，则大便排出黄色如糜粥状的物质；肚脐以下的皮肤发凉，若胃中有热，则腹部胀满。肠中有寒，则肠鸣且发生飧泄；胃中有寒而肠中有热，则既腹胀又腹泻；胃中有热导致腹胀，肠中有寒，则急于进食但小腹疼痛胀满。”
张石顽注释说：世间的医生治病，只知道热证用寒药治，寒证用热药治，除此之外一概不讲。假设病人中焦有热损伤脾脏，出现心中悬空感且容易饥饿，这确实是热证无疑，然而必须审察其肚脐以上皮肤发热，这才是胃中热气蕴结隆盛的表现。如果大便排出黄色如糜粥状，不仅胃中有热，而且肠中也受到热邪的逼迫。倘若肚脐以下皮肤发凉，却出现腹胀，看似实热固结，实际上是胃中虚寒的征候；或者出现肠鸣飧泄，不仅仅是胃有寒，而且寒气已经转移到大肠和小肠了。大概热性泄泻的大便垢秽呈黄红色，寒性泄泻的大便溏薄清冷，这是病机最显著的区别，可以明确辨别。况且有腹胀且泄利的情况，这种胀是由于胃寒阳气不能布散导致的胀，这种泄是由于肠热便垢导致的泄；又有消谷易饥、小腹胀痛的症状，这难道不是胃中有热、肠中有寒的一个验证吗？像这样的种种情况，如果不明白张仲景的三泻心汤、黄连汤、干姜黄芩黄连人参汤、厚朴生姜半夏甘草人参汤、干姜人参半夏丸等治法，就一定无法谈论最高明的治疗了。
乳豆丸（方剂详情见本论）
Guizhi Tang (Cinnamon Twig Decoction): Treats various types of diarrhea as well as syndromes such as abdominal pain and swelling.
Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma), Baizhu (Atractylodes Macrocephala Rhizome), Guizhi (Cinnamon Twig), Cangzhu (Atractylodes Lancea Rhizome), Houpo (Magnolia Bark), Chenpi (Citrus Reticulata Pericarp) (each 1.5 qian), Zhi Cao (Prepared Licorice Root) (0.8 qian).
Add three slices of Shengjiang (Fresh Ginger), decoct with water, and take orally.
Sishen Wan (Four Spirits Pill): Treats abdominal pain followed by diarrhea occurring from the fifth watch (11 PM - 1 AM) until dawn, with a fixed timing, known as Pi Shen Xie (Spleen-Kidney Diarrhea). It is also generally used for chronic diarrhea.
Buguzhi (Psoraleae Fructus) (4 liang, stir-fried with wine), Roudoukou (Myristicae Semen) (baked in flour, remove oil), Wuweizi (Schisandrae Fructus) (each 2 liang), Wuzhuyu (Evodiae Fructus) (soaked in hot water, 1 liang).
Use 81 Dazao (Jujubae Fructus) and 4 liang of Shengjiang (Fresh Ginger), boil together until soft, remove skin and seeds, mix and form pills the size of Sophora seeds. Take 4 qian with Rice Decoction before going to sleep. Removing Roudoukou (Myristicae Semen) and adding Ren Shen (Ginseng Radix et Rhizoma), Fuling (Poria), Gan Jiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Ying Su Qiao (Papaveris Capsicum) makes the pill more effective when formed with Rice Decoction.
Shengji Fuzi Wan (Shengji Aconite Pill): Treats Dong Xie Han Zhong (severe cold-type diarrhea with internal cold), where watery undigested food passes directly through, or dysentery with red and white pus and blood, where food is expelled immediately after eating without digestion.
Huanglian (Coptidis Rhizoma), Wumei Rou (Mume Semen Flesh) (each 3 liang), Gan Jiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata) (processed, each 1.5 liang).
Form pills with refined honey. Take 3 qian per dose, with Rice Decoction, twice daily.
Commentary: The original note states: "If wind pathogen injures the body in spring, the pathogenic factor lingers; by summer it manifests as Sun Xie (diarrhea with undigested food); by late summer it manifests as Dong Xie (profuse watery diarrhea). Yin qi arises at Wu hour (11 AM-1 PM) and peaks at Wei hour (1 PM-3 PM). During late summer, Spleen Earth is prosperous. The Spleen is the 'extreme yin within yin'. Therefore, yin qi becomes abundant. Once yin qi is abundant, internal cold is generated, leading to Dong Xie."
Qianjin Wen Pi Tang (Thousand Golden Warm the Spleen Decoction): Treats long-standing heat dysentery with red and white discharge.
Dahuang (Rhei Radix et Rhizoma) (4 qian), Ren Shen (Ginseng Radix et Rhizoma), Gancao (Licorice Radix et Rhizoma) (each 2 qian), Shu Fuzi (Prepared Aconiti Lateralis Radix) (1 qian), Pao Gan Jiang (Processed Zingiberis Rhizoma) (2 qian).
Decoct with water and take warm.
For cold dysentery, remove Gancao (Licorice Radix et Rhizoma), add Guixin (Cinnamomi Ramulus Cortex) 3 qian, double the dosage of Ren Shen (Ginseng Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata), and reduce Dahuang (Rhei Radix et Rhizoma) by 1 qian.
The *Ling Shu* (Spiritual Pivot) states: "Internal heat damaging the spleen leads to cold stools; conditions belonging to internal cold lead to hot stools. Heat in the stomach digests food quickly, causing a hanging sensation in the heart and frequent hunger. Heat in the skin above the umbilicus indicates heat in the intestines, resulting in yellow, mushy stools. Cold in the skin below the umbilicus, combined with heat in the stomach, causes abdominal distension. Cold in the intestines causes borborygmus and Sun Xie (diarrhea with undigested food). Cold in the stomach and heat in the intestines cause both distension and diarrhea. Heat in the stomach causing distension, and cold in the intestines, lead to urgent hunger but small abdominal pain and distension."
Zhang Shiwan commented: Physicians of the world only know to treat heat with cold and cold with heat, ignoring everything else. Suppose a patient has internal heat damaging the spleen, presenting with a hanging sensation in the heart and frequent hunger; this is undoubtedly a heat syndrome. However, one must examine if the skin above the umbilicus is hot to confirm that stomach heat is accumulating and flourishing. If yellow, mushy stools are passed, it indicates not only stomach heat but also intestinal heat forcing the passage. If the skin below the umbilicus is cold yet abdominal distension occurs, it may appear like solidified excess heat, but it is actually a sign of deficiency-cold in the stomach. Or if borborygmus and Sun Xie occur, it is not just stomach cold, but cold has transferred to the large and small intestines. Generally, heat diarrhea presents with yellow-red turbid stool, while cold diarrhea presents with loose, clear, and cold stool; this is the most significant distinction in pathology, allowing for clear differentiation. Furthermore, cases of distension with diarrhea involve distension due to stomach cold preventing the distribution of yang qi, and diarrhea due to intestinal heat causing turbid discharge. Cases of digesting food easily with hunger and small abdominal pain/distension are indeed evidence of stomach heat and intestinal cold. In such various situations, unless one understands the methods of Zhang Zhongjing's Three Xi Xin Tangs, Huanglian Tang, Ganjiang Huangqin Huanglian Renshen Tang, Houpo Shengjiang Banxia Gancao Renshen Tang, and Ganjiang Renshen Banxia Wan, one cannot discuss supreme treatment.
Rudou Wan (Milky Bean Pill) (Formula details see this chapter)