大黄四两 厚朴(炙)三两 枳实(炙)大者三枚
右三味,以水四升,煮取一升二合,去滓,分温三服,得利则止。
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下利,脉反弦,发热身汗者,自愈。
【注】
下利,脾病也。弦,肝脉也。脾病不当见弦脉,故曰脉反弦也。下利里病也,发热表
证也,若发热身汗,则为表与里和,虽脉弦亦可自愈也。
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下利,脉沉弦者下重,脉大者为未止,脉微弱数者为欲自止,虽发热不死。
【注】
沉主里,弦主急,下重后重也。下利脉沉弦者,故里急后重也。滞下之证,发热脉大
则邪盛为未已也,脉微弱数者则邪衰,病当自止,虽发热不死也。由此可知脉大身热
者死也。
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热利下重者,白头翁汤主之。
【注】
此承上条以明治其也。下利脓血,里急后重,积热已深,故以白头翁汤大苦大寒;寒
能胜热,苦能燥湿,湿热去,下重自除矣。
【集注】
程林曰:热利下重,则热迫于肠胃,非苦不足以坚下焦,非寒不足以除热,故加一「
热」字,别以上之寒利。
尤怡曰:此证湿热下注,故用白头翁,苦以除湿,寒以胜热也。
白头翁 黄连 黄蘖 秦皮各三两
右四味,以水七升,煮取二升,去滓,温服一升,不愈更服。
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下利,便脓血者,桃花汤主之。
【注】
初病下利便脓血者,大承气汤或芍药汤下之。热盛者,白头翁汤清之。若日久滑脱,
则当以桃花汤养肠固脱可也。
大黄四两,厚朴(经炙烤处理)三两,枳实(经炙烤处理,选用较大的果实)三枚。
以上三味药,用水四升,煎煮至剩余一升二合,滤去药渣,分三次温服,若大便通畅则停止服用。
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腹泻,脉象反而呈现弦象,伴有发热且身体出汗的,疾病将自行痊愈。
【注释】
腹泻,属于脾脏病变。弦脉,是肝脏的脉象。脾病不应当出现弦脉,所以称为“脉反弦”。腹泻是里证,发热是表证,如果既发热又出汗,说明表证与里证调和,即使脉象弦,也可以自行痊愈。
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腹泻,脉象沉而弦的,伴有肛门重坠感;脉象大的,表示病邪未止;脉象微弱而数的,表示病邪衰退,病情将要自行停止,即使发热也不会死亡。
【注释】
沉脉主里证,弦脉主急迫,肛门重坠即后重感。腹泻脉象沉弦的,因此出现腹部急迫和后重感。痢疾类病症,如果发热且脉大,说明邪气盛实,病势未已;脉象微弱而数,说明邪气衰退,疾病应当自行停止,即使发热也不会死亡。由此可知,如果是脉大且身热的,则是死证。
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热性腹泻伴有肛门重坠感的,以白头翁汤为主治方剂。
【注释】
这是承接上一条来阐述治疗方法。腹泻伴有脓血,里急后重,积热已经深入,所以用白头翁汤,其性大苦大寒;寒性能胜热,苦性能燥湿,湿热去除,肛门重坠自然消除。
【集注】
程林说:热性腹泻伴有肛门重坠,是因为热邪逼迫肠胃,非苦味不足以坚固下焦,非寒性不足以清除热邪,所以加一个“热”字,以区别于之前的寒性腹泻。
尤怡说:此证是湿热下注,所以使用白头翁,苦味以除湿,寒性以胜热。
白头翁三两,黄连三两,黄柏三两,秦皮各三两。
以上四味药,用水七升,煎煮至剩余二升,滤去药渣,温服一升,若未愈再服。
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腹泻,排出脓血的,以桃花汤为主治方剂。
【注释】
初起腹泻并排出脓血的,可用大承气汤或芍药汤攻下。热势盛的,用白头翁汤清热。如果病程日久导致滑脱不禁,则应当用桃花汤滋养肠道、固涩止脱。
Rhubarb (Radix et Rhizoma Rhei) four liang, Cinnamon Twig (Cortex Cinnamomi) [processed by stir-frying] three liang, Immature Bitter Orange (Fructus Aurantii Immaturus) [processed by stir-frying], three large fruits.
The above three ingredients are decocted with four sheng of water until one sheng and two he remain. The dregs are removed, and the liquid is divided into three warm doses. Discontinue use once bowel movement is achieved.
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In cases of diarrhea where the pulse is unexpectedly wiry (Xian), accompanied by fever and sweating, the disease will resolve spontaneously.
[Annotation]
Diarrhea is a disorder of the Spleen. A wiry pulse corresponds to the Liver. Since a Spleen disorder should not present with a wiry pulse, it is termed "unexpectedly wiry pulse." Diarrhea is an interior syndrome, while fever is an exterior syndrome. If there is both fever and sweating, it indicates that the exterior and interior are harmonized; even if the pulse is wiry, spontaneous recovery is expected.
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In cases of diarrhea, if the pulse is deep and wiry, there is a sensation of heaviness in the rectum (tenesmus). If the pulse is large, the disease has not yet ceased. If the pulse is faint and rapid, the pathogenic factor is declining, and the disease is about to stop spontaneously; even with fever, death will not occur.
[Annotation]
A deep pulse indicates an interior condition, and a wiry pulse indicates tension or urgency. Tenesmus refers to the feeling of incomplete evacuation. In diarrhea with a deep and wiry pulse, this results in abdominal urgency and tenesmus. In dysentery-like conditions, if there is fever and a large pulse, it signifies excess pathogenic factors, indicating the disease is ongoing. If the pulse is faint and rapid, it signifies the decline of pathogenic factors, and the disease should cease spontaneously; even with fever, death is not imminent. From this, we can deduce that a large pulse combined with high body heat indicates a fatal prognosis.
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For hot diarrhea accompanied by tenesmus, Betel Nut Decoction (Baitouweng Tang) is the primary treatment.
[Annotation]
This follows the previous clause to explain the treatment method. When diarrhea involves pus and blood, with tenesmus and deep accumulation of heat, Betel Nut Decoction (Baitouweng Tang) is used due to its bitter and cold nature. Coldness overcomes heat, and bitterness dries dampness; once damp-heat is eliminated, tenesmus naturally resolves.
[Collected Annotations]
Cheng Lin stated: Hot diarrhea with tenesmus occurs because heat forces its way into the intestines and stomach. Only bitter flavors can firm the lower jiao, and only cold properties can eliminate heat. Thus, the character "hot" is added to distinguish it from the preceding cold diarrhea.
You Yi stated: This condition involves damp-heat pouring downward, so Betel Nut Root (Radix Pulsatillae) is used; its bitterness drains dampness, and its coldness overcomes heat.
Betel Nut Root (Radix Pulsatillae) three liang, Coptis Rhizome (Rhizoma Coptidis) three liang, Phellodendron Bark (Cortex Phellodendri) three liang, Privet Tree Bark (Cortex Fraxini) three liang.
The above four ingredients are decocted with seven sheng of water until two sheng remain. The dregs are removed, and one sheng is taken warm. If not cured, administer another dose.
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For diarrhea involving the passage of pus and blood, Peach Blossom Decoction (Taohua Tang) is the primary treatment.
[Annotation]
In early-stage diarrhea with pus and blood, Da Chengqi Tang or Shaoyao Tang may be used for purgation. If heat is excessive, Baitouweng Tang is used to clear heat. If the condition persists for a long time leading to incontinence (slippage), Taohua Tang should be used to nourish the intestines and secure against slippage.