泄泻有湿 有火 气虚 痰积 食积
经曰湿胜则濡泄太阴者脾也脾恶湿因寒湿之气客于脾土不能与胃腐热水谷致使清浊不分
水入肠间则洞泄如水随气而下故小便不利为濡泄也又曰清气在下则生飧泄夫脾胃土也其气冲
和传化水谷令清气下降而不升因春伤风邪久而干胃是木贼土也使冲和之气不能运化致令完谷
而出所谓春伤于风夏必飧泄者是也至如飧泄洞泄肾泄濡泄 溏之类名虽不同未有不因脾胃虚
弱饮食不节及外来四气所伤而致也治当分其所受因脾湿自胜则燥湿利水因风下陷则升提其气
因食伤脾胃则消导理脾不可使用参术之药以补之切恐邪气得补愈增其势而欲取效者戛戛乎其
难矣
戴云凡水泻腹不痛者是湿食入于胃即泻完谷不化者是气虚泻水腹痛鸣痛一阵者泻一阵者
是大或泻或不泻或多或少者是痰积腹痛甚而泻泻后痛减者是食积
经曰泄凡有五有胃泄有脾泄有大肠泄有小肠泄有大瘕泄 胃泄者饮食不化色黄 脾泄者
腹胀肿满泄注食即呕逆 大肠泄者食已窘迫大便色白肠鸣切痛 小肠泄者溲而便脓血小腹痛
大瘕泄者里急后重数至圊而不能便茎中痛 此五泄也
一濡泄者是湿身重泄下如水宜用 五苓散 加苍术
一飧泄者水谷不化湿兼风也宜用 防风苍术汤
一大泄者肠鸣切痛阵痛阵泻急迫者宜用 四苓散 加黄芩 黄连
一食积泄者腹痛甚则泄泄后则痛减宜利利后用胃苓汤 加神曲 麦芽 青皮 或调中散
一虚寒泄者久下不止气虚脉沉宜用 四柱散 理中汤
一痰积泄者宜用 二陈汤 加海粉 神曲 苍术 白术之类
一酒积泄者晨起即泄色黄腹痛宜用 黄连丸 姜黄散
一脾虚久泄者宜用 参术养脾汤 启脾丸 参苓白术散
一脾肾泄者每至五更便泄宜用 五味子散 或四苓散 二神丸
一久泄肠滑不固者宜用 固肠丸 豆蔻散
一泄泻之症虽分湿火寒虚痰食六者之殊必以渗湿燥脾为主而随症以治之湿则燥之火则清
之寒则温之虚则补之痰则豁之食则消之是其治也六症既明三虚不可不察有脾虚有肾虚有肝虚
脾虚者饮食之所伤也肾虚者色欲之所伤也肝虚者忿怒之所伤也饮食伤脾不能运化色欲伤肾不
能闭藏忿怒伤肝木邪克土皆令泄泻然肾泄肝泄间或有之而脾泄恒多盖人终日饮食一或有伤泄
泻必矣
泄泻的病因包括湿邪、火邪、气虚、痰积和食积。
《内经》说：湿气过盛就会导致濡泄（大便稀溏如水）。太阴经对应脾脏，脾脏厌恶湿气。如果寒湿之气侵袭脾土，导致脾不能与胃共同腐熟水谷，致使清浊不分，水液进入肠间，就会发生洞泄（腹泻如注），水液随气下行，所以小便不利，这就是濡泄。又说：清气在下不升，就会产生飧泄（完谷不化）。脾胃属土，其气冲和，负责传化水谷，使清气下降而不升。如果春季受伤于风邪，日久侵犯胃气，这是木气克制土气，使得冲和之气不能运化，导致食物原样排出，所谓“春伤于风，夏必飧泄”就是这个道理。至于飧泄、洞泄、肾泄、濡泄、溏泄等，名称虽然不同，但无不因为脾胃虚弱、饮食不节以及外感四时邪气所致。治疗应当区分病因：如果是脾湿自胜，则用燥湿利水法；如果是风邪下陷，则用升提气机法；如果是饮食损伤脾胃，则用消导理脾法。不可使用人参、白术等补益药物，切恐邪气得到补益后更加猖獗，想要取得疗效是非常困难的。
戴元礼说：凡是水泻而腹部不痛的，是湿邪所致；进食后即泻且完谷不化的，是气虚所致；腹泻时腹痛鸣响，痛一阵泻一阵的，是大实之证；有时泻有时不泻，或多或少的是痰积所致；腹痛剧烈，泻后疼痛减轻的，是食积所致。
《内经》说：泄泻共有五种，即胃泄、脾泄、大肠泄、小肠泄和大瘕泄。
胃泄的症状是饮食不消化，粪便色黄；
脾泄的症状是腹胀肿满，泄泻伴有呕吐逆气；
大肠泄的症状是进食后立即感到窘迫，大便色白，肠鸣切痛；
小肠泄的症状是小便涩痛并伴有便脓血，小腹痛；
大瘕泄的症状是里急后重，频繁去厕所却排不出大便，尿道疼痛。
这称为五泄。
第一种是濡泄，症状为身体沉重，泄下如水，宜用五苓散加苍术。
第二种是飧泄，症状为水谷不化，兼有湿和风，宜用防风苍术汤。
第三种是大泄，症状为肠鸣切痛，阵发性疼痛和腹泻，病情急迫，宜用四苓散加黄芩、黄连。
第四种是食积泄，症状为腹痛剧烈才泻，泻后疼痛减轻，宜先通利，后用胃苓汤加神曲、麦芽、青皮，或服用调中散。
第五种是虚寒泄，症状为久泻不止，气虚脉沉，宜用四柱散或理中汤。
第六种是痰积泄，宜用二陈汤加海粉、神曲、苍术、白术等。
第七种是酒积泄，症状为早晨起床即泻，粪便色黄，腹痛，宜用黄连丸或姜黄散。
第八种是脾虚久泄，宜用参术养脾汤、启脾丸或参苓白术散。
第九种是脾肾泄，症状为每至五更时分即泄泻，宜用五味子散或四苓散、二神丸。
第十种是久泄导致肠滑不固，宜用固肠丸或豆蔻散。
泄泻这一病症，虽然分为湿、火、寒、虚、痰、食六种不同情况，但必须以渗湿燥脾为主，并根据症状进行治疗：湿邪则燥湿，火邪则清热，寒邪则温中，虚证则补益，痰积则豁痰，食积则消导，这就是治疗方法。明确了这六种症状后，还必须仔细辨别三种虚损：有脾虚、肾虚、肝虚。脾虚是由饮食所伤，肾虚是由房劳色欲所伤，肝虚是由忿怒所伤。饮食伤脾导致不能运化，色欲伤肾导致不能闭藏，忿怒伤肝导致木邪克土，都会引起泄泻。然而，肾泄和肝泄间或有之，而脾泄最为常见。因为人整天都在饮食，一旦有伤，必然导致泄泻。
Diarrhea (Xie Xie) arises from dampness, fire, qi deficiency, phlegm accumulation, and food stagnation.
The *Classic of Internal Medicine* states: "Excess dampness leads to Ru Xie" (damp diarrhea characterized by loose, watery stools). The Taiyin channel corresponds to the Spleen, which dislikes dampness. If cold-damp pathogenic factors invade the Spleen Earth, impairing its ability to collaborate with the Stomach in rotting and ripening water and grain, clear and turbid elements fail to separate. Water enters the intestines, causing Dong Xie (profuse, gushing diarrhea), where water flows downward with Qi; thus, urination is difficult, constituting Ru Xie. It is also stated: "When clear Qi fails to ascend and remains below, Sun Xie" (diarrhea with undigested food) occurs. The Spleen and Stomach belong to Earth; their Qi is harmonious and responsible for transforming and transporting water and grain, allowing clear Qi to descend without ascending. If Wind pathogenic factors are injured in Spring and linger to affect the Stomach over time, this represents Wood overacting on Earth. This prevents the harmonious Qi from functioning properly, leading to the expulsion of undigested food—hence the saying, "Injury by Wind in Spring leads to Sun Xie in Summer." Regarding Sun Xie, Dong Xie, Kidney Xie, Ru Xie, and Tang Xie (loose stools), although named differently, all stem from Spleen-Stomach weakness, irregular diet, and external injury by the four seasonal pathogens. Treatment must distinguish the cause: if caused by Spleen dampness overcoming itself, employ drying dampness and promoting diuresis; if caused by Wind sinking downward, employ lifting and raising Qi; if caused by dietary injury to the Spleen and Stomach, employ resolving stagnation and regulating the Spleen. Do not use tonifying herbs like Ginseng Radix (Renshen) or Atractylodis Rhizoma (Baizhu), lest the pathogen be strengthened by tonification, making efficacy extremely difficult to achieve.
Dai Yuanli stated: In cases of watery diarrhea without abdominal pain, it is due to dampness; immediate diarrhea after eating with undigested food indicates Qi deficiency; diarrhea accompanied by abdominal pain and borborygmus, where pain and diarrhea occur in waves, indicates excess syndrome; intermittent diarrhea with varying frequency and amount indicates Phlegm accumulation; severe abdominal pain that alleviates after defecation indicates Food stagnation.
The *Classic of Internal Medicine* states: There are five types of diarrhea: Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Dachang Xie (Large Intestine Diarrhea), Xiaochang Xie (Small Intestine Diarrhea), and Da Jia Xie (Major Mass Diarrhea).
Wei Xie symptoms include indigestion and yellow stool color.
Pi Xie symptoms include abdominal distension and fullness, profuse diarrhea, and vomiting/regurgitation upon eating.
Dachang Xie symptoms include urgency after eating, white stool color, intense borborygmus, and cutting pain.
Xiaochang Xie symptoms include painful urination with pus and blood in stool, and lower abdominal pain.
Da Jia Xie symptoms include tenesmus (feeling of incomplete evacuation), frequent trips to the toilet with inability to pass stool, and pain in the urethra.
These constitute the Five Diarrheas.
1. Ru Xie (Damp Diarrhea): Symptoms include heavy body and watery stools. Use Wu Ling San (Five-Ingredient Poria Powder) plus Cang Zhu (Atractylodis Rhizoma).
2. Sun Xie (Wind-Diarrhea with Undigested Food): Caused by dampness combined with wind. Use Fang Feng Cang Zhu Tang (Saposhnikovia and Atractylodes Decoction).
3. Da Xie (Severe Diarrhea): Symptoms include intense borborygmus, paroxysmal pain and diarrhea, and urgency. Use Si Ling San (Four-Poria Powder) plus Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma).
4. Shi Ji Xie (Food Stagnation Diarrhea): Symptoms include severe abdominal pain preceding diarrhea, with pain relief after defecation. First promote purgation/drainage, then use Wei Ling Tang (Stomach-Lining Decoction) plus Shen Qu (Massae Medicatae Fermentatae), Mai Ya (Hordei Fructus Germinatus), Qing Pi (Citri Reticulatae Pericarpium Viride), or Tiao Zhong San (Middle-Regulating Powder).
5. Xu Han Xie (Deficiency-Cold Diarrhea): Symptoms include chronic persistent diarrhea, Qi deficiency, and deep pulse. Use Si Zhu San (Four-Pillar Powder) or Li Zhong Tang (Regulate the Middle Decoction).
6. Tan Ji Xie (Phlegm Accumulation Diarrhea): Use Er Chen Tang (Two-Aged Decoction) plus Hai Fen (Sepiae Endoconcha), Shen Qu, Cang Zhu, and Bai Zhu (Atractylodis Macrocephalae Rhizoma).
7. Jiu Ji Xie (Alcohol Accumulation Diarrhea): Symptoms include morning diarrhea, yellow stool, and abdominal pain. Use Huang Lian Wan (Coptis Pill) or Jiang Huang San (Curcuma Powder).
8. Pi Xu Jiu Xie (Chronic Spleen Deficiency Diarrhea): Use Shen Zhu Yang Pi Tang (Ginseng and Atractylodes Spleen-Nourishing Decoction), Qi Pi Wan (Spleen-Initiating Pill), or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
9. Pi Shen Xie (Spleen-Kidney Diarrhea): Symptoms include diarrhea occurring every fifth watch (early morning). Use Wu Wei Zi San (Schisandra Powder) or Si Ling San combined with Er Shen Wan (Two-Gods Pill).
10. Jiu Xie Chang Hua Bu Gu (Chronic Diarrhea with Intestinal Slippage and Insecurity): Use Gu Chang Wan (Intestine-Securing Pill) or Dou Kou San (Cardamom Powder).
Although diarrhea is categorized into six distinct types—dampness, fire, cold, deficiency, phlegm, and food—the primary treatment principle is to promote fluid drainage and dry the Spleen, adjusting according to symptoms: dry dampness, clear fire, warm cold, tonify deficiency, resolve phlegm, and digest food. After clarifying these six syndromes, one must carefully examine three types of deficiency: Spleen, Kidney, and Liver. Spleen deficiency results from dietary injury; Kidney deficiency from sexual excess; Liver deficiency from anger. Dietary injury impairs Spleen transformation; sexual excess impairs Kidney storage; anger causes Liver Wood to overact on Earth, all leading to diarrhea. However, Kidney and Liver diarrhea are occasional, whereas Spleen diarrhea is most common, as humans eat daily, and any dietary injury inevitably leads to diarrhea.