张子和曰∶风、湿、 三气，合而成霍乱吐泻转筋，风应厥阴肝木，湿应太阴脾土也。又曰∶厥阴所
至，为胁痛呕泄；少阳所至，为呕涌；太阳所至，为中满霍乱吐下；太阴所至，为濡化也。转筋者，风
主肝，肝主筋，风急甚，故转筋也。吐者 也，火主心，心主炎上；故呕吐也。泄注者，土主湿，脾湿下注
，故泄注也。脾湿，土气为风木所克，土化不行矣。亢无雨，火盛过极，上怒发焉，
甚则雷霆骤雨，大水横流，山崩岸落，讵非太阴怒发之象耶？故人病心腹满胀、肠鸣，而为数便，甚则心痛
胁胀，呕吐霍乱，厥发则注下，跗肿身重。启元子谓以上病症，皆脾湿所生，是矣。
王海藏曰∶夫呕吐而利者，霍乱也。三焦者，水谷之道路。邪在上焦者，则吐而不利；邪在下焦者，
则利而不吐；邪在中焦，既吐且利。以饮食不节，冷热不调，清浊相干，阴阳乖隔，遂成霍乱。挥霍撩乱，
重也；吐利而已，轻也。风湿 外至，生冷硬内生，内外合而为病。六淫所伤，各有先后；饮食所滞，各有
多少；内外传变，各有轻重。以经脉脏腑，随所应见治之。吐利止后，见外症者，只作外伤治之。
薛立斋曰∶泄泻，米食所伤，用六君子加谷芽；面食所伤，加麦芽；肉食所伤，加山楂。若兼寒热作
呕，乃肝木侮脾土，用六君子加柴胡、生姜。兼呕吐腹痛，手足厥冷，乃寒水侮土，六君加姜、桂；不应，
用钱氏益黄散。若元气下陷，发热作渴，肢体倦怠，用补中益气汤。若泄泻色黄，乃脾土之真色，用六君加木
香、姜、桂。若泻在五更，清晨饮
食少思，乃脾肾虚弱，五更服四神丸，日间用白术散；如不应，或愈而复作，或饮食少思，急用八味丸
补命门火，以生脾土为善。
朱丹溪曰∶泄泻有湿、火、气虚、痰积，食积。湿用四苓散加苍术，甚者苍白二术同加，燥湿并渗泄。
火用四苓散加木香、黄芩，伐火邪。痰积宜豁之，用海粉、青黛、黄芩、神曲，糊丸服之。在上者用吐提。
在下陷者宜升提之，用升麻、防风。气虚用人参、白术、炒芍药、升麻。食积二陈汤加泽泻、苍术、白术、
山楂、神曲、芎 ，或吞保和丸。泻水者仍用五苓散。久病大肠气泄，用熟地半两，炒白芍、知母各三钱，
升麻、干姜各二钱，炙甘草一钱，为末，粥丸服之。仍用艾炷于百会穴灸三壮。脾泻当补脾气，健运后常用
炒白术四两，炒神曲三两，炒芍药三两半，冬月及春初用肉豆蔻代之，或散或汤，作饼子尤佳。脾泄已久，
大肠不禁，此脾已脱，宜急涩之，以赤石脂、肉豆蔻、干姜。
戴元礼曰∶凡泻水腹不痛者，是湿。饮食入胃不住，或完谷不化，是气虚。腹痛泄水，肠鸣，痛一阵
泻一阵，是火。或时泻，或时不泻，或多或少，是痰积。腹痛，甚而泻，泻后痛减者，是食积。
王节斋曰∶凡泄泻病，误用参、 等甘温之药，则病不能愈，而成变为黄瘅，盖泻属湿，甘温之药能生
湿热，故反助病邪，久则湿热甚，而为瘅矣。惟用苦温、苦寒之药以治之则愈，若寒泻湿热，苦温除湿寒也。
泄止后脾胃虚弱，方可参、 之药以补之。
赵养葵曰∶泻痢，东垣着脾胃之论，其间治脾泄之症，庶无余蕴矣，特未及乎肾泄也。仲景云∶下
利不止，医以理中与之，利益甚，理中者，理中焦也。此利在下焦，当以理下
焦法，则愈矣。昔赵以德云∶闻先师言泄泻之症，其类多端，得于六淫、五邪、饮食所伤之外，复有杂合之
邪，似难执法而治。乃见先师治气暴脱而虚，顿泻不知人，口眼俱闭，呼吸甚微，凡欲绝者，灸气海，
饮人参膏十余斤而愈。治积痰在肺，致其所合大肠之气不固者，涌出上焦之痰，则肺气不降，而大肠之虚自
复矣。治忧思太过，脾气结而不能升举，陷入下焦而成泄泻者，开其郁结，补其脾胃，使谷气升发也。治
阴虚而不能司禁固之权者，峻补其肾而愈也。凡此之类甚多，先生治之，圆机活法，无他，熟在《内经》耳。
经曰∶肾主大小便。又曰∶肾司开阖。又曰∶肾开窍于二阴。肾既虚衰，则命门之火熄而水独治，故每天五更
天明时，正亥子水旺之刻，故特甚也。惟八味丸以补其阳，则肾中之水火既济，而开阖之权得宜。况命门之火
旺，火能生土，而脾亦强矣。古方有椒附丸、五味子散，皆治肾泄之神方，不可不考也。
秦越人《难经》有大瘕泄者，即肾泄也。注云∶里急后重，数至圊而不能便，茎中痛。世人不知，误为
滞下，治之祸不旋踵，此是肾虚之症。
褚氏精血论中云∶精已耗而复竭之，则大小便牵痛，愈痛则愈便，愈便则愈痛，须以补中益气汤倍升
麻送四神丸，又以八味丸料加五味子、茱萸、补骨脂、肉豆蔻，多服乃愈。此等症候，以利药致损元气，
肢体肿胀而毙者，不可枚举。
方约之曰∶久泄肠胃虚脱，止涩之剂不得已而用之，又用药不可太苦太甘，太苦则伤脾，太甘则生湿。
惟当以淡剂利窍为最，以渗湿燥脾为主。症虽分湿、火、虚、寒、痰、食六者之殊，而三虚不可不察。三虚
者，脾虚、肾虚、肝虚也。脾虚饮食所伤也，肾虚色欲所伤也，肝虚忿怒所伤也。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。
又尝论之∶泻泄、痢、疟，同乎一治，多由暑月脾胃气虚，饮食伤损所致。才伤便作，则为泄泻；
停积既久，则为疟痢。而疟与痢又有分别∶饮食为痰，充乎胸胁，则为疟疾；饮食为积，胶乎肠胃，则
为痢症。古人谓无痰不成疟，无积不成痢，有以哉。
工海藏曰∶吐泻转筋，身热脉长，阳明本病也，宜和中，四君、平胃、建中选用。自汗脉浮者，四
君加桂。胁下痛，脉弦者，建中加木瓜柴胡汤，平胃加木瓜亦可。如吐泻后大便不通，胃中实痛，四君加
大黄主之。如腹中痛，体重，脉沉细，四君加芍药、高良姜。四肢拘急，脉沉迟，属少阴，四君加姜、附、
浓朴。四肢厥冷，微缓，属厥阴，建中加附子、当归。
张景岳曰∶泄泻之本，由于脾胃受伤，则水反为湿，谷反为滞，精华之气不能输化。惟脾强者滞去则
愈，此可以清利攻逐也。脾弱者因虚，所以易泄，因泄所以愈虚。盖关门不固，则气随泄去，气去则阳衰，
而寒从中生。且阴寒之性降下，必及肾，故泄多亡阴，谓亡其阴中之阳耳。所以泄泻不愈，必自太阴传于少
阴，而为肠 ，讵非降泄之甚，而阳气不升，脏气不固之病乎？若复以寒凉攻逐，无不致败。
先哲曰∶治泄不利小便，非其治也。然小便不利，其因非一，宜详辨之。如湿胜而不利，以水土相乱，
并归大肠而然也。热胜而不利，以火乘阴分，水道闭涩而然也。有寒泻而不利，以小肠之火受伤，气化无
权也。有脾虚而不利，以土不制水，清浊不分也，有命门火衰而不利，以真阴亏损，元精枯涸也。凡此小水
不利之候，惟暴注新病，形气强壮者可利。若病久形不足，脉症多寒，形气虚弱者不可利。盖虚寒
之泄，本非水有余，实因火不足；本非水不利，实因气不行。倘不察其所病之根，未有不愈利愈虚，
而速其危者矣。
又气泄症，必先怒时挟食，随触而发。此肝、脾二脏受病，法当补脾之虚，顺肝之气。但虚实有微甚，
宜分轻重治之。
程郊倩曰∶凡病至而能奠安治定者，全赖脾胃之气为之主。今则邪犯中焦，卒然而起，致令脾胃失其主
持，一任邪之挥霍，呕吐下利，从其治处而扰乱之。毋论受寒中暑及挟饮食之邪，皆属中气乖张，阴邪来侮。
以其病阴而症则阳，变治为乱，是名霍乱。故中虚受扰，外气辄亦失治，病发热、头痛、身疼、恶寒，夹此吐
利而来，其脉则微涩。此属正虚邪胜，阳微阴扰。舍温经散寒、扶阳抑阴外，均非其治。自其初证言之，其有
头疼、发热、身疼痛之表症，要以分寒热而治。热多饮水者，五苓散主之，于温经植土中，彻其寒水；寒多恶
饮水者，理中丸主之，一意温中补土。若恶寒脉微复利，利止为亡血，所以更复发热，四逆加人参汤主之，
助阳生阴，务复尽真阳为主。若吐利止而身痛不休，当消息和解其外，宜桂枝汤小和之。若吐利汗出，发热恶
寒，四肢拘急，手足厥冷者，与既吐且利，小便复利，而大汗出，下利清谷，内寒外热，脉微欲绝者，四逆
汤主之，回阳救急，交通其气，用仲景之法可耳。
张子和说：风、湿、寒三气，结合而成霍乱吐泻转筋。风对应厥阴肝木，湿对应太阴脾土。又说：厥阴之气到来，表现为胁痛呕吐泄泻；少阳之气到来，表现为呕吐涌逆；太阳之气到来，表现为中焦胀满、霍乱吐下；太阴之气到来，表现为水湿运化失常。转筋的症状，是因为风主肝，肝主筋，风气急盛，所以导致转筋。呕吐的症状，是因为火主心，心主炎上，所以发生呕吐。泄泻注下的症状，是因为土主湿，脾湿下注，所以发生泄泻注下。脾湿，是土气被风木所克制，土的气化功能不能运行了。干旱无雨，火势过盛至极，向上怒发，严重时像雷霆骤雨、大水横流、山崩岸落，这难道不是太阴（湿气）怒发的景象吗？所以人患有心腹满胀、肠鸣，并且频繁大便，严重时心痛胁胀，呕吐霍乱，四肢厥冷则泄泻注下，足背浮肿身体沉重。启元子说以上病症，都是脾湿所生，这是正确的。
王海藏说：呕吐而腹泻的，就是霍乱。三焦，是水谷运行的道路。邪气在上焦的，就只吐不泻；邪气在下焦的，就只泻不吐；邪气在中焦的，既吐又泻。因为饮食不节制，冷热不调和，清浊之气相互干扰，阴阳之气乖违阻隔，于是形成霍乱。“挥霍”形容病情变化迅速且严重，“撩乱”形容症状杂乱；如果只有呕吐或腹泻，病情较轻。风湿等外邪侵袭，生冷坚硬食物内生，内外合而为病。六淫邪气伤人，各有先后顺序；饮食停滞，各有轻重多少；内外传变，各有轻重程度。根据经脉脏腑，随其相应的表现进行治疗。吐泻停止后，如果还有外感症状，只按外伤治疗。
薛立斋说：泄泻，如果是米食所伤，用六君子汤加谷芽；面食所伤，加麦芽；肉食所伤，加山楂。如果兼有寒热作呕，这是肝木侮犯脾土，用六君子汤加柴胡、生姜。如果兼有呕吐腹痛，手足厥冷，这是寒水侮犯脾土，六君子汤加干姜、肉桂；如果无效，用钱氏益黄散。如果元气下陷，发热口渴，肢体倦怠，用补中益气汤。如果泄泻颜色发黄，这是脾土的本色外露，用六君子汤加木香、干姜、肉桂。如果在五更时分泄泻，清晨饮食减少思虑减退，这是脾肾虚弱，五更时服四神丸，白天用白术散；如果无效，或者痊愈后又复发，或者饮食减少思虑减退，急忙用八味丸补命门之火，以生脾土为好。
朱丹溪说：泄泻有湿、火、气虚、痰积、食积几种类型。湿证用四苓散加苍术，严重的苍白二术同加，燥湿并渗泄。火证用四苓散加木香、黄芩，伐除火邪。痰积应当豁除，用海粉、青黛、黄芩、神曲，糊丸服用。病位在上者用吐法提之。病位在下陷者宜升提，用升麻、防风。气虚用人参、白术、炒芍药、升麻。食积用二陈汤加泽泻、苍术、白术、山楂、神曲、川芎，或者吞服保和丸。泻水者仍用五苓散。久病大肠气泄，用熟地黄半两，炒白芍、知母各三钱，升麻、干姜各二钱，炙甘草一钱，研为末，粥丸服用。仍然用艾炷在百会穴灸三壮。脾泻应当补脾气，健运之后常用炒白术四两，炒神曲三两，炒芍药三两半，冬季及初春用肉豆蔻替代，或者散剂或者汤剂，做成饼子尤其好。脾泄已久，大肠不禁固，这是脾已脱失，应当紧急涩止，用赤石脂、肉豆蔻、干姜。
戴元礼说：凡是泻水而腹部不痛的，是湿证。饮食入胃留不住，或者完谷不化，是气虚证。腹痛泄水，肠鸣，痛一阵泻一阵，是火证。或者时而泻，时而又不泻，或多或少，是痰积证。腹痛，甚至腹泻，泻后疼痛减轻的，是食积证。
王节斋说：凡是泄泻病，误用人参、黄芪等甘温的药物，则病不能愈，反而变成黄瘅，因为泻属湿，甘温的药物能生湿热，所以反而助长病邪，久了湿热甚，就变成瘅病了。只有用苦温、苦寒的药物来治疗才能痊愈，如果是寒泻湿热，苦温药可以除湿寒。泄泻停止后脾胃虚弱，才可以用人参、黄芪等药物来补益。
赵养葵说：泻痢，李东垣著述了脾胃的论述，其中治疗脾泄的病症，几乎没有遗漏了，只是没有涉及到肾泄。张仲景说：下利不止，医生用理中丸给他，利更加严重，理中丸是调理中焦的。这个利在下焦，应当用调理下焦的方法，才能痊愈。以前赵以德说：听先师说泄泻的病症，其种类很多端绪，除了得于六淫、五邪、饮食所伤之外，还有杂合的邪气，似乎难以拘执一种方法治疗。曾见先师治疗气暴脱而虚，突然腹泻不知人事，口眼都闭着，呼吸很微弱，凡是要断气的，灸气海穴，饮人参膏十余斤而痊愈。治疗积痰在肺，导致其所合的大肠之气不固的，涌出上焦的痰，那么肺气不降，而大肠的虚损自然恢复。治疗忧思太过，脾气结滞而不能升举，陷入下焦而成泄泻的，开其郁结，补其脾胃，使谷气升发。治疗阴虚而不能司掌禁固权力的，峻补其肾而痊愈。凡此之类很多，先生治疗它们，圆机活法，没有其他原因，只是熟悉《内经》罢了。经典说：肾主管大小便。又说：肾主管开阖。又说：肾开窍于二阴。肾既然虚衰，那么命门之火熄灭而水独治，所以每天五更天明时，正是亥子水旺的时刻，所以特别严重。只有八味丸来补其阳，那么肾中的水火既济，而开阖的权力得当。况且命门之火旺，火能生土，而脾也强了。古方有椒附丸、五味子散，都是治疗肾泄的神方，不可不考察。
秦越人《难经》中有大瘕泄的说法，就是肾泄。注释说：里急后重，多次去厕所却不能排便，茎中痛。世人不知道，误认为是滞下（痢疾），治疗祸患立刻降临，这是肾虚的病症。
褚氏精血论中说：精已经耗损而又竭尽它，那么大小便牵拉疼痛，越痛就越想大便，越大便就越痛，必须用补中益气汤倍加升麻送服四神丸，又用八味丸料加五味子、茱萸、补骨脂、肉豆蔻，多服用才能痊愈。这类症候，因为用利药导致损伤元气，肢体肿胀而死亡的，不可枚举。
方约之说：久泄肠胃虚脱，止涩的药剂不得已才使用，又用药不可太苦太甘，太苦则伤脾，太甘则生湿。只应当以淡剂利窍为最好，以渗湿燥脾为主。症状虽然分为湿、火、虚、寒、痰、食六者的不同，但三虚不可不察。三虚，是脾虚、肾虚、肝虚。脾虚是饮食所伤，肾虚是色欲所伤，肝虚是忿怒所伤。饮食伤脾，不能运化；色欲伤肾，不能闭藏；忿怒伤肝，木邪克土，都令泄泻。
又曾经论述：泄泻、痢、疟，同一治疗方法，多由暑月脾胃气虚，饮食伤损所致。刚受伤就发作，就成为泄泻；停积既久，就成为疟痢。而疟与痢又有分别：饮食化为痰，充满胸胁，就成为疟疾；饮食化为积，胶着肠胃，就成为痢症。古人说无痰不成疟，无积不成痢，是有道理的。
王海藏说：吐泻转筋，身热脉长，是阳明本病，应当和中，四君子汤、平胃散、建中汤选用。自汗脉浮的，四君子汤加桂枝。胁下痛，脉弦的，建中汤加木瓜柴胡汤，平胃散加木瓜也可以。如吐泻后大便不通，胃中实痛，四君子汤加大黄主治。如腹中痛，体重，脉沉细，四君子汤加芍药、高良姜。四肢拘急，脉沉迟，属于少阴，四君子汤加干姜、附子、厚朴。四肢厥冷，微缓，属于厥阴，建中汤加附子、当归。
张景岳说：泄泻的根本，由于脾胃受伤，则水反为湿，谷反为滞，精华之气不能输化。只有脾强者滞去则愈，这可以用清利攻逐的方法。脾弱者因虚，所以易泄，因泄所以愈虚。盖关门不固，则气随泄去，气去则阳衰，而寒从中生。而且阴寒的性质降下，必及于肾，所以泄多亡阴，说是亡其阴中之阳罢了。所以泄泻不愈，必然从太阴传于少阴，而为肠澼，难道不是降泄之甚，而阳气不升，脏气不固的病吗？如果再以寒凉攻逐，无不导致败坏。
先哲说：治泄不利小便，不是正确的治法。然而小便不利，其原因不只一个，应当详细辨别。如湿胜而不利，是因为水土相乱，并归大肠而然。热胜而不利，是因为火乘阴分，水道闭涩而然。有寒泻而不利，是因为小肠之火受伤，气化无权。有脾虚而不利，是因为土不制水，清浊不分。有命门火衰而不利，是因为真阴亏损，元精枯涸。凡此小便不利的症候，只有暴注新病，形气强壮的可以利。如果病久形不足，脉症多寒，形气虚弱者不可利。因为虚寒之泄，本来不是水有余，实在是因火不足；本来不是水不利，实在是因气不行。如果不察其所病的根，没有不愈利愈虚，而加速其危殆的了。
又气泄症，必定先是在愤怒时挟带饮食，随即触发而发。这是肝、脾二脏受病，法当补脾之虚，顺肝之气。但虚实有微甚，应当分轻重治疗。
程郊倩说：凡是病至而能奠安治定的，全赖脾胃之气为之主宰。现在邪犯中焦，卒然而起，致使脾胃失去其主持，一任邪气的挥霍，呕吐下利，从其治处而扰乱之。不论受寒中暑及挟饮食之邪，皆属中气乖张，阴邪来侮。因为病在阴而症状表现为阳，变治为乱，名叫霍乱。所以中虚受扰，外气也就失治，病发热、头痛、身疼、恶寒，夹此吐利而来，其脉则微涩。这属于正虚邪胜，阳微阴扰。除了温经散寒、扶阳抑阴之外，都不是正确的治法。从其初证来说，如果有头疼、发热、身疼痛的表症，要分辨寒热而治。热多饮水的，五苓散主治，在温经植土中，彻其寒水；寒多恶饮水的，理中丸主治，一意温中补土。如果恶寒脉微复利，利止为亡血，所以更复发热，四逆加人参汤主治，助阳生阴，务必恢复尽真阳为主。如果吐利止而身痛不休，应当斟酌和解其外，宜桂枝汤小和之。如果吐利汗出，发热恶寒，四肢拘急，手足厥冷的，与既吐且利，小便复利，而大汗出，下利清谷，内寒外热，脉微欲绝的，四逆汤主治，回阳救急，交通其气，用张仲景的方法就可以了。
Zhang Zihe stated: The combination of wind, dampness, and cold pathogens results in cholera-like vomiting, diarrhea, and muscle cramps. Wind corresponds to the Jueyin Liver Wood, and dampness corresponds to the Taiyin Spleen Earth. He further stated: When Jueyin Qi arrives, it manifests as hypochondriac pain, vomiting, and diarrhea; when Shaoyang Qi arrives, it manifests as vomiting and regurgitation; when Taiyang Qi arrives, it manifests as epigastric fullness, cholera-like vomiting and diarrhea; when Taiyin Qi arrives, it manifests with impaired water metabolism. Muscle cramps occur because wind governs the Liver, and the Liver governs the sinews; when wind is severe and urgent, it causes cramping. Vomiting occurs because fire governs the Heart, and the Heart's nature is to flare upward, leading to vomiting. Diarrhea and dysentery occur because Earth governs dampness, and spleen dampness flows downward, causing diarrhea. Spleen dampness arises because the Earth Qi is constrained by Wind-Wood, preventing the transformation and transportation of Earth. In drought without rain, fire becomes excessively strong and flares upward; severely, this resembles thunderstorms, flooding, landslides, and bank collapses—is this not a manifestation of Taiyin (dampness) flaring up? Therefore, when people suffer from abdominal distension, borborygmus, and frequent stools, or severely heart pain, hypochondriac distension, vomiting, cholera, cold limbs with profuse diarrhea, dorsal edema, and heavy body, Qiyuanzi correctly stated that these symptoms are all generated by spleen dampness.
Wang Haizang stated: Vomiting accompanied by diarrhea is cholera. The Sanjiao (Triple Burner) is the pathway for food and fluids. If pathogenic factors are in the Upper Jiao, there is vomiting without diarrhea; if in the Lower Jiao, there is diarrhea without vomiting; if in the Middle Jiao, both vomiting and diarrhea occur. This is caused by irregular diet, imbalance of cold and heat, interference between clear and turbid Qi, and separation of Yin and Yang, resulting in cholera. "Huohuo" describes the rapid and severe onset; "liaoluan" describes the chaotic symptoms. If only vomiting or diarrhea occurs, the condition is mild. External invasion of wind-dampness combined with internal generation of cold-raw-hard foods creates disease internally and externally. The six excess pathogens injure the body in various sequences; dietary stagnation varies in degree; internal and external transmission varies in severity. Treatment should follow the corresponding meridians and zang-fu organs. After vomiting and diarrhea cease, if exterior symptoms remain, treat them as exterior injuries.
Xue Lizhai stated: For diarrhea caused by rice injury, use Liujunzi Tang (Six Gentlemen Decoction) with Guya (Valley Sprout); for flour injury, add Maiya (Barley Sprout); for meat injury, add Shanzha (Hawthorn). If accompanied by alternating cold and heat with vomiting, indicating Liver Wood insulting Spleen Earth, use Liujunzi Tang with Chaihu (Bupleurum) and Shengjiang (Fresh Ginger). If accompanied by vomiting, abdominal pain, and cold extremities, indicating Cold Water insulting Earth, use Liujunzi Tang with Ganjiang (Dried Ginger) and Rongui (Cinnamon Bark); if ineffective, use Qian Shi Yihuang San (Child Master's Yellow-Regulating Powder). If Yuan Qi sinks, with fever, thirst, and limb fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If diarrhea stool is yellow, revealing the true color of Spleen Earth, use Liujunzi Tang with Muxiang (Aucklandia), Ganjiang, and Rongui. If diarrhea occurs at dawn (fifth watch) with poor appetite in the morning, indicating Spleen-Kidney deficiency, administer Sishen Wan (Four Spirits Pill) at dawn and Baizhu San (Atractylodes Macrocephala Powder) during the day; if ineffective, or if relapse occurs with poor appetite, urgently use Bawei Wan (Eight-Ingredient Pill) to tonify Mingmen Fire to generate Spleen Earth.
Zhu Danxi stated: Diarrhea can be caused by dampness, fire, Qi deficiency, phlegm accumulation, or food stagnation. For dampness, use Siling San (Four-Ingredient Powder) with Cangzhu (Atractylodes Lancea); for severe cases, add Baizhu (Atractylodes Macrocephala) to dry dampness and promote diuresis. For fire, use Siling San with Muxiang and Huangqin (Scutellaria) to subdue fire. For phlegm accumulation, resolve it using Haifen (Sea Powder), Qingdai (Indigo Naturalis), Huangqin, and Shenqu (Medicated Leaven), formed into pills with paste. For upper-level pathology, induce vomiting. For sinking pathology, raise Qi using Shengma (Cimicifuga) and Fangfeng (Saposhnikovia). For Qi deficiency, use Renshen (Ginseng), Baizhu, Chao Shaoyao (Fried White Peony Root), and Shengma. For food stagnation, use Erchen Tang (Two-Aged Decoction) with Zexie (Alisma), Cangzhu, Baizhu, Shanzha, Shenqu, and Xiong (Ligusticum Chuanxiong), or swallow Baohe Wan (Harmonize the Stomach Pill). For watery diarrhea, continue using Wuling San (Five-Ingredient Powder). For chronic large intestine Qi leakage, use Shudi (Rehmannia) 1.5 liang, Chao Shaoyao and Zhimu (Anemarrhena) 3 qian each, Shengma and Ganjiang 2 qian each, and Zhi Gancao (Honey-fried Licorice) 1 qian, powdered and made into pills with congee. Also, moxa cones should be applied to Baihui (GV20) acupoint for three burns. For Spleen diarrhea, tonify Spleen Qi; after strengthening transport, commonly use Chao Baizhu 4 liang, Chao Shenqu 3 liang, and Chao Shaoyao 3.5 liang; in winter and early spring, substitute with Rou Doukou (Nutmeg). These can be used as powder or decoction, but forming them into cakes is best. For long-standing Spleen diarrhea with uncontrolled large intestine, indicating Spleen collapse, urgently astringe using Chishizhi (Red Halloysite), Rou Doukou, and Ganjiang.
Dai Yanli stated: Diarrhea with water but no abdominal pain indicates dampness. Food remaining undigested in the stomach or passing through undigested indicates Qi deficiency. Abdominal pain with watery diarrhea, borborygmus, and pain preceding each bowel movement indicates fire. Intermittent diarrhea varying in amount indicates phlegm accumulation. Abdominal pain worsening with diarrhea but relieving after defecation indicates food stagnation.
Wang Jiezhai stated: In diarrhea, mistakenly using sweet-warm herbs like Renshen (Ginseng) and Huangqi (Astragalus) will prevent cure and may transform the condition into jaundice (Huangdan), as diarrhea involves dampness, and sweet-warm herbs generate damp-heat, thereby aiding the pathogen. Long-term damp-heat leads to jaundice. Only bitter-warm and bitter-cold herbs can cure it; bitter-warm herbs remove cold-damp. After diarrhea ceases and Spleen-Stomach weakness remains, Renshen and Huangqi can be used to tonify.
Zhao Yangkui stated: Regarding dysentery and diarrhea, Li Dongyuan's theories on Spleen-Stomach are comprehensive regarding Spleen diarrhea, but omit Kidney diarrhea. Zhang Zhongjing said: Persistent diarrhea treated with Lizhong Tang (Regulate the Middle Decoction) worsens because Lizhong regulates the Middle Jiao. This diarrhea is in the Lower Jiao and requires treatment targeting the Lower Jiao. Zhao Yi-de recalled his master treating sudden Qi collapse with acute diarrhea, unconsciousness, closed eyes/mouth, and faint respiration by moxing Qihai (CV6) and administering over ten jin of Renshen Gao (Ginseng Paste). For phlegm accumulation in the Lungs causing insecure Large Intestine Qi, inducing vomiting to clear Upper Jiao phlegm restores Lung descent and Large Intestine security. For excessive worry knotting Spleen Qi preventing ascent and sinking into Lower Jiao causing diarrhea, resolve depression and tonify Spleen-Stomach to raise Grain Qi. For Yin deficiency failing to control closure, vigorously tonify the Kidneys. These varied treatments rely on familiarity with the Neijing. The Classic states: The Kidney governs urination and defecation; it controls opening and closing; it opens into the two yin orifices. When Kidney is deficient, Mingmen Fire extinguishes, leaving Water dominant. Thus, symptoms peak at dawn (Hai-Zi hours) when Water is prosperous. Bawei Wan (Eight-Ingredient Pill) tonifies Yang, achieving water-fire balance and proper opening/closing. Strong Mingmen Fire generates Earth, strengthening the Spleen. Ancient formulas like Jiaofu Wan and Wuweizi San are divine prescriptions for Kidney diarrhea and must be studied.
Qibo's Nanjing mentions Dajia Xie (Great Mass Diarrhea), which is Kidney diarrhea. Annotations describe tenesmus, frequent unsuccessful attempts to defecate, and penile pain. Laypeople mistake this for dysentery (Zhixia); misdiagnosis leads to immediate disaster, as this is a Kidney deficiency syndrome.
Chu Shi's Jingxuelun states: Exhausting essence repeatedly causes painful urination and defecation; pain increases desire to defecate, and defecation increases pain. Treat with Buzhong Yiqi Tang doubled with Shengma to deliver Sishen Wan, followed by Bawei Wan formula plus Wuweizi (Schisandra), Zhuyu (Cornus), Buguzhi (Psoralea), and Rou Doukou, taken in large quantities. Many die from limb swelling due to Qi damage from improper purgatives.
Fang Yuezhi stated: For chronic diarrhea with intestinal collapse, astringents are used only as a last resort. Medicines should not be too bitter (injures Spleen) or too sweet (generates dampness). Light-diuretic agents to open orifices are best, focusing on leaching dampness and drying Spleen. Although symptoms divide into damp, fire, deficiency, cold, phlegm, and food, the Three Deficiencies (Spleen, Kidney, Liver) must be examined. Spleen deficiency stems from diet; Kidney deficiency from sexual excess; Liver deficiency from anger. Dietary injury impairs transport; sexual injury impairs storage; anger allows Wood to overcome Earth, all causing diarrhea.
He also discussed that diarrhea, dysentery, and malaria share treatments, often caused by Summerheat damaging Spleen-Stomach Qi and diet injuring the system. Immediate onset causes diarrhea; prolonged stagnation causes malaria or dysentery. Malaria differs from dysentery: Phlegm filling chest/hypochondrium causes malaria; accumulation sticking to intestines/stomach causes dysentery. Hence, "No phlegm, no malaria; no accumulation, no dysentery."
Wang Haizang stated: Vomiting, diarrhea, cramps, fever, and long pulse indicate Yangming root disease; harmonize the middle using Sizijunzi Tang, Pingwei San, or Jianzhong Tang. Spontaneous sweating with floating pulse: Sizijunzi Tang plus Guizhi (Cinnamon Twig). Hypochondriac pain with wiry pulse: Jianzhong Tang plus Mugua (Papaya) and Chaihu, or Pingwei San plus Mugua. Post-vomit/diarrhea constipation with epigastric solid pain: Sizijunzi Tang plus Dahuang (Rhubarb). Abdominal pain, heaviness, deep-thin pulse: Sizijunzi Tang plus Shaoyao (Peony) and Gaoliangjiang (Galangal). Limb stiffness, deep-slow pulse (Shaoyin): Sizijunzi Tang plus Ganjiang, Fuzi (Aconite), and Houpo (Magnolia Bark). Cold limbs, slow pulse (Jueyin): Jianzhong Tang plus Fuzi and Danggui (Angelica Sinensis).
Zhang Jingyue stated: The root of diarrhea is Spleen-Stomach injury, turning water into dampness and grain into stagnation, preventing essence distribution. Strong Spleen resolves stagnation and cures via clearing/draining. Weak Spleen causes easy diarrhea, which further weakens it. Unsecured gatelets lose Qi with diarrhea; loss of Qi leads to Yang decline and internal cold. Yin-cold descends to Kidneys; thus, diarrhea often depletes Yin (specifically Yang within Yin). Uncured diarrhea transmits from Taiyin to Shaoyin, causing intestinal issues, reflecting failed Yang ascent and organ insecurity. Further cold-draining treatments lead to failure.
Ancient sages stated: Treating diarrhea without promoting urination is incorrect. However, causes of scanty urine vary. Damp excess causes mixing of water/earth into large intestine. Heat excess causes fire invading Yin levels, blocking water passages. Cold diarrhea causes small intestine fire injury, impairing Qi transformation. Spleen deficiency causes Earth failing to control Water, mixing clear/turbid. Mingmen fire decline causes true Yin depletion and essence exhaustion. Only acute, strong patients with sudden violent diarrhea can benefit from diuretics. Chronic, weak, cold-pattern patients must not use diuretics. Cold-deficiency diarrhea is not water excess but fire insufficiency; not water blockage but Qi stagnation. Ignoring the root causes worsening deficiency and accelerating danger.
Qi-diarrhea arises from anger combined with food, triggering immediately. This affects Liver and Spleen; treat by tonifying Spleen deficiency and smoothing Liver Qi, distinguishing severity.
Cheng Jiaoqian stated: Stability in illness relies on Spleen-Stomach Qi. Now, pathogens invade the Middle Jiao abruptly, disrupting Spleen-Stomach control, allowing chaotic vomiting and diarrhea regardless of cold, summerheat, or food pathogens. This is Middle Qi disorder with Yin pathogens insulting. Though the disease is Yin, symptoms appear Yang, creating chaos—named Cholera. Middle deficiency allows external Qi disorder, causing fever, headache, body ache, aversion to cold, with thin-choppy pulse. This is righteous deficiency and pathogen excess, weak Yang and disturbed Yin. Besides warming meridians, dispersing cold, supporting Yang, and suppressing Yin, other treatments are invalid. For initial exterior symptoms (headache, fever, body ache), differentiate cold/heat. More heat/thirst: Wuling San (Five-Ingredient Powder) warms meridians, grounds Earth, and clears cold-water. More cold/aversion to drinking: Lizhong Wan (Regulate the Middle Pill) warms the middle and tonifies Earth. Aversion to cold, thin pulse, recurrent diarrhea stopping indicates blood loss; subsequent fever requires Sini Jia Renshen Tang (Cold Extremities Plus Ginseng Decoction) to assist Yang generating Yin, restoring True Yang. If vomiting/diarrhea stop but body pain persists, harmonize the exterior with Guizhi Tang (Cinnamon Twig Decoction). If vomiting/diarrhea with sweating, fever, aversion to cold, limb stiffness, cold extremities, or profuse sweating, clear grain diarrhea, interior cold/exterior heat, and nearly imperceptible pulse, use Sini Tang (Cold Extremities Decoction) to restore Yang, rescue emergency, and communicate Qi, following Zhang Zhongjing's methods.