论曰。脏腑泄痢。其证多种。大抵从风湿热论之。是知寒少热多。寒则不能久也。故曰暴泄非
阴。久泄非阳。论云。春宜缓形。形缓动则肝木乃荣。反静密则是行秋令。金能制木。风气内藏。
夏至则火盛而金去。独火木旺而脾土损矣。轻则飧泄。身热脉洪。谷不能化。重则下痢。脓血稠粘
。里急后重。故曰诸泄稠粘。皆属于火。经曰。溲而便脓血。知气行而血止。也宜大黄汤下之。是
为重剂。黄芩芍药汤。是为轻剂。是实则泄其子。木能自虚而脾土实矣。故经曰。春伤于风。夏为
飧泄。此逆四时之气。人所自为也。有自太阴脾经受湿。而为水泄虚滑。身重微满。不知谷味。假
令春宜益黄散补之。夏宜泄之。法云。宜补、宜泄、宜和、宜止。和则芍药汤。止则诃子汤。久则
防变而为脓血。是脾经传受于肾。谓之贼邪。故难愈也。若先利而后滑。谓之微邪。故易痊也。此
皆脾土受湿。天之所为也。虽圣智不能逃。口食味。鼻食气。从鼻而入。留积于脾而为水泄也。有
厥阴经动。下痢不止。其脉沉而迟。手足厥逆。脓血稠粘。此为难治。宜麻黄汤、小续命汤汗之。
法云。谓有表邪缩于内。当散表邪而自愈。有暴下无声。身冷自汗。小便清利。大便不禁。气难布
息。脉微。呕吐。急以重药温之。浆水散是也。故法云。后重者宜下。腹痛者当和。身重者除湿。
脉弦者去风。脓血稠粘者。以重药竭之。
身冷自汗者。以毒药温之。风邪内缩者。宜汗之则愈。 溏为痢。当温之而已。又云。在外者发之
。在内者下之。在上者涌之。在下者竭之。身表热者内疏之。小便涩者分利之。又曰。盛者和之。
去者送之。过者止之。兵法有云。避其来锐。击其惰归。泄之谓也。（上出活法机要）
【芍药黄芩汤】治泄痢腹痛。后重身热。久不愈。脉洪疾者。及下痢、脓血稠粘。
黄芩 芍药（各一两） 甘草（半两）
上 咀。每服半两。水一盏半。煎至一盏。去渣。温服。不拘时。
【大黄汤】治泻痢久不愈。脓血稠粘。里急后重。日夜无度。
大黄（一两）
上一味锉碎。好酒二大盏。浸半日许。再同煎至一半。去渣。将酒分作二服。顿服之。痢止勿
服。如未止再服。取利为度。后服芍药汤和之。痢止。再服白术黄芩汤。盖彻其毒也。
【芍药汤】行血调气。经曰。溲而便脓血。知气行而血止。行血则便自愈。调气则后重除
。
芍药（一两） 当归 黄连 黄芩（各半两）
大黄（三钱） 桂（二钱半） 甘草（炒） 槟榔（各二钱）
木香（一钱）
上九味 咀。每服五钱。水二盏。煎至一盏。去渣。温服。如痢不减。渐加大黄。食后。○如
便后脏毒。加黄柏
半两。
【白术黄芩汤】服前药痢疾虽除。更宜调和。
白术（一两） 黄芩（七钱） 甘草（三钱）
上三味 咀。作三服。水一盏半。煎至一盏。温服。
【浆水散】治暴泄如水。周身汗自出。一身尽冷。脉微而弱。气少不能语。甚者加吐。此
为急病。
半夏（二两。又泡） 附子（炮） 桂 干姜（炮）
甘草（炙。各五钱） 良姜（二钱半）
上六味为末。每服三五钱。浆水二盏。煎至一盏。和渣热服。甚者三四服。微者一二服。太阳
经伤动。传太阴下痢为 溏。大肠不能禁固。卒然而下。下成小油光色。其中或有硬物。欲起而又
下。欲了而不了小便多清。此寒也。宜温之。春夏宜桂枝汤。秋冬宜白术汤。
【桂枝汤】
桂枝 白术 芍药（各五钱） 甘草（炙。二钱）
上四味 咀。每服五钱。水一盏。煎七分。去渣。温服。
【白术汤】
白术 芍药（各三钱） 干姜（五钱。炮） 甘草（炙。二钱）
上四味为粗散。如前煎。甚者去干姜。加附子三钱。谓辛能发散也。
论述说：脏腑泄痢，其症状表现多种多样。大抵从风、湿、热三个方面来论述，可知寒证少而热证多。寒证不能持久，所以说暴发性泄泻不属于阴证，久泄不属于阳证。医论云：春季适宜舒缓形体，形体舒缓则肝木之气得以荣养；如果反而保持静止密闭的状态，则是行秋季的令，金能克制木，风气内藏。到了夏至，火气旺盛而金气退去，唯独火、木之气旺盛而脾土受损。轻症表现为飧泄（完谷不化的泄泻），身体发热，脉象洪大，食物不能消化；重症表现为下痢，脓血稠厚粘腻，里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）。所以说各种泄泻伴有稠粘物的，都属于火邪。经书说：小便涩痛且大便脓血，说明气机运行而血自止。应当用大黄汤攻下，这是重剂；黄芩芍药汤是轻剂。这是通过“实则泄其子”的方法，使肝木自虚而脾土充实。所以经书说：春季伤于风邪，夏季发生飧泄，这是违背四时气候变化的结果，是人自身造成的。有因太阴脾经受湿邪侵袭，导致水泄虚滑，身体沉重，轻微胀满，不知谷物滋味。假如春季适宜用益黄散补益，夏季适宜疏泄。医法云：适宜补益、适宜疏泄、适宜调和、适宜收敛。调和可用芍药汤，收敛可用诃子汤。久病则防止变为脓血之痢，这是脾经病邪传受于肾，称为贼邪，所以难以痊愈。如果先腹泻而后转为滑脱不禁，称为微邪，所以容易痊愈。这些都是脾土受湿邪影响，是天时的作用，即使是圣智之人也不能逃避。口食味道，鼻吸气息，气味从鼻而入，留积于脾而导致水泄。有厥阴经动乱，下痢不止，脉象沉迟，手足厥冷，脓血稠粘，这属于难治之症。适宜用麻黄汤、小续命汤发汗解表。医法云：谓有表邪收缩于体内，应当发散表邪而自愈。有暴发性腹泻无声响，身体寒冷，自汗，小便清利，大便失禁，气息微弱，呕吐，急需以重药温补，浆水散就是此类方剂。所以医法云：里急后重者适宜攻下，腹痛者应当调和，身体沉重者应当除湿，脉弦者应当祛风，脓血稠粘者应当用重药竭尽邪气，身体寒冷自汗者应当用毒药温补，风邪内缩者应当发汗则愈，溏泄为痢疾，应当温补而已。又说：病在表者发散之，病在里者攻下之，病在上者涌吐之，病在下者竭除之。身体表面发热者内部疏泄之，小便涩滞者分利之。又说：邪盛者调和之，正气亏去者送补之，过甚者止之。兵法有云：避开敌人锐气，攻击敌人惰归之时，泄泻治疗也遵循此理。（以上出自《活法机要》）
【芍药黄芩汤】治疗泄痢腹痛，后重身热，久不愈，脉象洪数疾速者，以及下痢、脓血稠粘。
黄芩、芍药（各一两），甘草（半两）。
将药材切碎，每次服用半两，加水一盏半，煎至一盏，去渣滓，温服，不拘时间。
【大黄汤】治疗泻痢久不愈，脓血稠粘，里急后重，日夜无度。
大黄（一两）。
将一味药锉碎，用好酒两大盏，浸泡半天左右，再同煎至一半，去渣滓，将酒分为两次服用，顿服。痢止勿服，如未止再服，以通利为度。之后服用芍药汤调和。痢止后，再服用白术黄芩汤，以彻底清除毒邪。
【芍药汤】行血调气。经书说：小便涩痛且大便脓血，说明气机运行而血自止。行血则便自愈，调气则后重除。
芍药（一两），当归、黄连、黄芩（各半两），大黄（三钱），桂枝（二钱半），甘草（炒）、槟榔（各二钱），木香（一钱）。
以上九味药切碎，每次服用五钱，加水二盏，煎至一盏，去渣滓，温服。如果痢疾不减，逐渐增加大黄用量，饭后服用。○如果便后脏毒，加黄柏半两。
【白术黄芩汤】服用前药痢疾虽除，更宜调和脾胃。
白术（一两），黄芩（七钱），甘草（三钱）。
以上三味药切碎，作三次服用，加水一盏半，煎至一盏，温服。
【浆水散】治疗暴泄如水，周身汗自出，一身尽冷，脉微而弱，气少不能语，严重者加呕吐。此为急病。
半夏（二两，另泡制），附子（炮制），桂枝，干姜（炮制），甘草（炙，各五钱），良姜（二钱半）。
以上六味药研为末，每次服用三五钱，用浆水二盏，煎至一盏，连渣热服。严重者三四服，轻者一二服。太阳经伤动，传变至太阴导致下痢为溏，大肠不能固摄，突然而下，排出物呈小油光色，其中或有硬物，想起身却又腹泻，想结束却未结束，小便多清亮，这是寒证，适宜温补。春夏适宜桂枝汤，秋冬适宜白术汤。
【桂枝汤】
桂枝、白术、芍药（各五钱），甘草（炙，二钱）。
以上四味药切碎，每次服用五钱，加水一盏，煎至七分，去渣滓，温服。
【白术汤】
白术、芍药（各三钱），干姜（五钱，炮制），甘草（炙，二钱）。
以上四味药为粗散，按前述方法煎煮。严重者去掉干姜，加附子三钱，因为辛味能发散。
It is stated that diarrhea and dysentery originating from the zang-fu organs present various symptoms. Generally, they are analyzed in terms of wind, dampness, and heat, indicating that cold patterns are rare while heat patterns are common. Cold patterns do not persist; thus, it is said that acute diarrhea does not belong to Yin, and chronic diarrhea does not belong to Yang. Medical theories state: In spring, one should keep the body relaxed; relaxation allows the Liver Wood Qi to flourish. Conversely, remaining still and closed mimics the autumnal phase, where Metal controls Wood, causing Wind Qi to be stored internally. By the Summer Solstice, Fire Qi is abundant and Metal Qi recedes, leaving only excessive Fire and Wood Qi, which damages Spleen Earth. Mild cases manifest as *sun-xie* (diarrhea with undigested food), fever, a洪 (surging) pulse, and inability to digest food; severe cases manifest as dysentery with thick, sticky pus and blood, tenesmus (urgent need to defecate with heavy sensation in the rectum). Therefore, all diarrheal discharges containing thick, sticky substances are attributed to Fire. The Classics state: When urination is painful accompanied by pus and blood in stool, it indicates that Qi movement stops bleeding. One should use Dahuang Tang (Rhubarb Decoction) for purgation, which is a heavy formula; Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) is a light formula. This follows the principle of "draining the son when excess," allowing Liver Wood to become deficient thereby strengthening Spleen Earth. Thus, the Classics say: Injury by Wind in Spring leads to *sun-xie* in Summer; this violates the Qi of the four seasons and is self-inflicted. Some suffer from dampness invading the Taiyin Spleen Meridian, resulting in watery, loose stools, heaviness of the body, slight fullness, and loss of taste for grains. If appropriate in Spring to tonify with Yihuang San (Benefit Yellow Powder), in Summer one should drain. Medical methods state: Tonification, draining, harmonization, and astringency are indicated. Harmonization uses Shaoyao Tang (Peony Decoction); astringency uses Hezi Tang (Persimmon Seed Decoction). Chronic cases risk progressing to pus and blood dysentery; this is transmission from Spleen Meridian to Kidney, termed "Thief Evil" (Zei Xie), making it difficult to cure. If diarrhea precedes slippage/incontinence, it is termed "Minor Evil" and is easy to recover from. These are all due to Spleen Earth being affected by dampness, an action of Heaven, which even sages cannot escape. Mouth tastes flavors, nose inhales Qi; these enter via the nose, accumulate in the Spleen, and cause watery diarrhea. Disorder of the Jueyin Meridian causes persistent dysentery with a deep, slow pulse, cold extremities, and thick, sticky pus and blood; this is difficult to treat. Ma Huang Tang (Ephedra Decoction) and Xiao Xuming Tang (Minor Continuation of Life Decoction) should be used to induce sweating. Medical methods state: When exterior pathogens retreat inward, dispersing the exterior pathogens leads to self-healing. Sudden silent diarrhea, cold body, spontaneous sweating, clear urine, fecal incontinence, weak breathing, micro-pulse, and vomiting require urgent warming with heavy medicines; Jiangshui San (Fermented Grain Water Powder) is such a formula. Thus, medical methods state: Tenesmus requires purgation; abdominal pain requires harmonization; body heaviness requires removal of dampness; wiry pulse requires dispelling wind; thick, sticky pus and blood require exhausting pathogens with heavy medicines; cold body with spontaneous sweating requires warming with toxic medicines; internal contraction of Wind pathogens requires sweating for recovery; loose stools constituting dysentery require warming. Furthermore: Exterior conditions are dispersed; interior conditions are purged; upper conditions are vomited; lower conditions are exhausted. Surface heat is internally drained; urinary obstruction is separated and promoted. Also: Excess is harmonized; deficiency is supported; excessiveness is stopped. Military strategy states: Avoid the enemy's sharp onset, strike their fatigue and return; this applies to treating diarrhea. (Above excerpted from *Huofa Jiyao*)
[Shaoyao Huangqin Tang] Treats diarrhea/dysentery with abdominal pain, tenesmus, fever, chronic non-resolution, surging/rapid pulse, and dysentery with thick, sticky pus and blood.
Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix Alba) (each 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 liang).
Crush the herbs. Take 0.5 liang per dose, add 1.5 cups of water, decoct to 1 cup, remove dregs, and take warm. No fixed time.
[Dahuang Tang] Treats chronic diarrhea/dysentery with thick, sticky pus and blood, tenesmus, and uncontrolled frequency day and night.
Dahuang (Rhei Radix et Rhizoma) (1 liang).
Crush the single herb, soak in 2 large cups of good wine for half a day, then decoct together until half remains. Remove dregs, divide the liquid into two doses, and take at once. Stop if dysentery ceases; if not, repeat. Take until purgation occurs. Afterwards, administer Shaoyao Tang to harmonize. Once dysentery stops, administer Baizhu Huangqin Tang to thoroughly eliminate toxicity.
[Shaoyao Tang] Moves Blood and regulates Qi. The Classics state: Painful urination with pus/blood in stool indicates Qi movement stops bleeding. Moving Blood heals the bowel; regulating Qi eliminates tenesmus.
Shaoyao (Paeoniae Radix Alba) (1 liang), Danggui (Angelicae Sinensis Radix), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix) (each 0.5 liang), Dahuang (Rhei Radix et Rhizoma) (3 qian), Guizhi (Cinnamomi Ramulus) (2.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (stir-baked), Binglang (Arecae Semen) (each 2 qian), Muxiang (Aucklandiae Radix) (1 qian).
Crush the nine herbs. Take 5 qian per dose, add 2 cups of water, decoct to 1 cup, remove dregs, and take warm. If dysentery persists, gradually increase Dahuang. Take after meals. ○ For post-defecation intestinal toxin, add Huangbai (Phellodendri Cortex) 0.5 liang.
[Baizhu Huangqin Tang] After previous medicines clear dysentery, further harmonization is needed.
Baizhu (Atractylodis Macrocephalae Rhizoma) (1 liang), Huangqin (Scutellariae Radix) (7 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian).
Crush the three herbs, divide into three doses. Add 1.5 cups of water, decoct to 1 cup, and take warm.
[Jiangshui San] Treats sudden watery diarrhea, generalized spontaneous sweating, whole-body coldness, micro/weak pulse, scarcity of Qi unable to speak, and severe vomiting. This is an acute condition.
Banxia (Pinelliae Rhizoma) (2 liang, prepared separately), Fuzi (Aconiti Lateralis Radix Praeparata), Guizhi (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma) (prepared), Gancao (Glycyrrhizae Radix et Rhizoma) (honey-roasted, each 5 qian), Liangjiang (Alpiniae Officinarum Rhizoma) (2.5 qian).
Grind the six herbs into powder. Take 3-5 qian per dose, add 2 cups of fermented grain water (Jiangshui), decoct to 1 cup, and take hot with dregs. Severe cases: 3-4 doses; mild cases: 1-2 doses. Taiyang Meridian injury transmitting to Taiyin causes dysentery with loose stools; Da Chang (Large Intestine) fails to consolidate, leading to sudden defecation of oily, shiny stool, possibly with hard particles. Urging without completion, copious clear urine indicates Cold; warming is indicated. Spring/Summer: Guizhi Tang (Cinnamon Twig Decoction); Autumn/Winter: Baizhu Tang (Atractylodes Decoction).
[Guizhi Tang]
Guizhi (Cinnamomi Ramulus), Baizhu (Atractylodis Macrocephalae Rhizoma), Shaoyao (Paeoniae Radix Alba) (each 5 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (honey-roasted, 2 qian).
Crush the four herbs. Take 5 qian per dose, add 1 cup of water, decoct to 0.7 cup, remove dregs, and take warm.
[Baizhu Tang]
Baizhu (Atractylodis Macrocephalae Rhizoma), Shaoyao (Paeoniae Radix Alba) (each 3 qian), Ganjiang (Zingiberis Rhizoma) (5 qian, prepared), Gancao (Glycyrrhizae Radix et Rhizoma) (honey-roasted, 2 qian).
Make into coarse powder. Decoct as above. For severe cases, remove Ganjiang and add Fuzi (Aconiti Lateralis Radix Praeparata) 3 qian, because pungent flavors can disperse.