《内经》之言泄泻，或言风，或言湿，或言热，或言寒，此明四气皆能泄也。又云清气
在下
，则生飧泄，此明脾虚下陷之泄也。统而论之，脾土强者，自能胜湿，无湿则不泻，故曰湿
多成五泄。若土虚不能胜湿，则风寒与热皆得干之而为病。其治法有九，一曰淡渗，使湿从
小
便而出。如农人治潦，导其下流，虽处卑湿，不忧巨浸。经云∶治湿不利小便，非其治也。
又云∶在下者，引而竭之是也。一曰升提，气属于阳，性本上升。胃气迫注，辄尔下陷，升
柴羌葛之类，鼓舞胃气上腾，则注下自止。又如地下淖泽，风之即干，故风药多燥，且湿为
土病，风为木药，木可胜土，风亦胜湿。所谓下者举之是也。一曰清凉，热淫所致，暴注下
迫，苦寒之剂，用涤烦蒸，犹溽暑伊芳郁之时，而商 飒然倏动，则炎 如失矣。所谓热者清
之是也。一曰疏利，痰凝气滞，食积所停，皆令人泄。随证祛逐，勿使逗留。经云∶热者泄
之。又云∶通因通用也。一曰甘温、泄利不已，急而下趋，愈趋愈下，泄何由止？夫甘能缓
急，善禁急速，且稼穑作甘，甘为土味，所谓甘以缓之是也。一曰酸收，泻下有日，则气散
不收，无能统摄，则注下何时而已。酸之一味，能助收摄之权，经云∶散者收之是也。一曰
燥脾，土德无 ，水邪不溢，故泻者，皆成于土湿，湿皆本于脾虚。仓廪得职，水谷善分，
虚而不培，湿淫转甚。经云∶虚者补之是也。一曰温肾，肾主二便，封藏之本，位虽属水，
真阳之火寓焉。少火生气，火为土母，此火一衰，何以营运三焦，熟腐水谷乎？故积虚者必
挟寒，脾虚者必补母。经云∶寒者温之是也。一曰固涩，注泻日久，幽门道滑，虽投温补，
未克奏功，须以涩剂，久则变化不愆，揆度合节，所谓滑者涩之是也。夫是九者，治泄之大
法。业无遗蕴，至于先后缓急之权，岂能预拟，临证之顷，圆机灵变，可以胥天下并登于寿
域矣。
《黄帝内经》中关于泄泻的论述，有的提到风邪，有的提到湿邪，有的提到热邪，有的提到寒邪，这明确说明了四气（风、寒、暑、湿、燥、火中的四种）都能导致泄泻。又说“清气在下，则生飧泄”，这明确说明了脾虚下陷所致的泄泻。统而言之，脾土强健，自然能胜湿，没有湿邪就不会发生泄泻，所以说“湿多成五泄”。如果脾土虚弱不能胜湿，那么风寒与热邪都能侵犯人体而致病。其治疗方法有九种：第一种是淡渗利湿，使湿邪从小便排出。就像农民治理积水，疏导下游水流，即使身处低洼潮湿之地，也不必担忧大水漫溢。医经说：“治湿不利小便，非其治也。”又说：“病位在下者，用引而竭之的方法治疗。”第二种是升提阳气，气属于阳，本性上升。胃气被迫下注，就会发生下陷，使用柴胡、升麻、羌活、葛根等药物，可以鼓舞胃气向上腾升，则腹泻自止。又比如地下沼泽，风吹即干，所以风药大多干燥，且湿是脾土之病，风是肝木之药，木能克土，风也能胜湿。这就是所谓“下者举之”的方法。第三种是清凉清热，由热邪淫盛所致，表现为急迫暴注、肛门灼热下迫，使用苦寒药物，用以涤除烦热蒸腾，就像闷热潮湿的盛夏时节，忽然一阵凉爽的西风刮起，那么酷热之感就消失了。这就是所谓“热者清之”的方法。第四种是疏利通导，痰凝气滞、食积停滞，都会导致泄泻。根据证候祛除病邪，不要让病邪逗留体内。医经说：“热者泄之。”又说：“通因通用。”第五种是甘温补中，泄利不止，病情急迫向下趋下，越趋向下面越严重，泄泻如何能止？甘味能缓解急迫，善于禁止急速的症状，且稼穑产生甘味，甘为脾土之味，这就是所谓“甘以缓之”的方法。第六种是酸收敛涩，泄泻日久，则气散不收，失去统摄能力，那么注下泄泻何时才能停止？酸味这一类药物，能辅助收摄的功能，医经说：“散者收之。”第七种是燥湿健脾，脾土德行充实，水邪就不会泛滥，所以泄泻，都是由于脾土湿盛而成，湿邪都源于脾虚。仓廪（脾胃）职能正常，水谷就能很好地分清别浊，脾虚而不培补，湿邪淫盛反而加重。医经说：“虚者补之。”第八种是温补肾阳，肾主管二便，是封藏的根本，位置虽属水，但真阳之火寓于其中。少火（生理之火）生气，火为土之母，此火一旦衰弱，凭什么营运三焦，熟腐水谷呢？所以积虚的人必然夹杂寒邪，脾虚的人必须补母（肾）。医经说：“寒者温之。”第九种是固涩止泻，注泻日久，幽门滑脱，虽然投用温补药物，未能奏效，必须使用涩剂，只要久用不致偏差，权衡度量合乎节度，这就是所谓“滑者涩之”的方法。以上这九种，是治疗泄泻的大法。医术没有遗漏蕴藏的道理，至于先后缓急的权变，岂能预先拟定，在临证之际，圆机灵变，就可以让天下人都登上长寿的境界了。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) discusses diarrhea in terms of wind, dampness, heat, and cold, clearly indicating that the four pathogenic factors can all cause diarrhea. It also states, "When clear yang fails to ascend and remains below, it leads to undigested stool diarrhea (Sunxie)," which clarifies diarrhea caused by Spleen deficiency with sinking of clear yang. Generally speaking, when Spleen Earth is strong, it naturally overcomes dampness; without dampness, there is no diarrhea, hence it is said that "excess dampness leads to the five types of diarrhea." If Spleen Earth is weak and cannot overcome dampness, then wind-cold and heat pathogens can invade the body and cause disease. There are nine treatment methods:
1. **Diuresis (Dan Shen)**: Promotes the excretion of dampness via urination. This is like a farmer managing floodwaters by guiding them downstream; even in low-lying wet areas, one need not fear overwhelming inundation. The classics state: "To treat dampness without promoting urination is not the correct method." It also says: "For conditions located below, use the method of draining from below."
2. **Lifting Yang (Sheng Ti)**: Qi belongs to Yang and has a natural tendency to rise. When Stomach Qi sinks due to pathological pressure, lifting agents such as Chai Hu (Bupleuri Radix), Sheng Ma (Cimicifugae Rhizoma), Qiang Huo (Notopterygii Rhizoma et Radix), and Ge Gen (Puerariae Lobatae Radix) can stimulate the ascending movement of Stomach Qi, thereby stopping diarrhea. Just as wind dries up marshes, wind-dispelling herbs are often drying in nature. Since dampness is a disorder of Spleen Earth and wind corresponds to Liver Wood, Wood controls Earth, and thus wind can overcome dampness. This corresponds to the principle: "Lift what has sunk."
3. **Clearing Heat (Qing Liang)**: Caused by excessive heat, manifesting as sudden, violent diarrhea with burning urgency. Bitter-cold herbs are used to cleanse irritability and steaming heat, similar to how a cool breeze dispels the oppressive heat of a humid summer day. This corresponds to the principle: "Clear what is hot."
4. **Draining and Unblocking (Shu Li)**: Phlegm stagnation, Qi constraint, and food retention can all lead to diarrhea. Pathogens should be expelled according to the syndrome to prevent lingering. The classics state: "Treat heat by draining it" and "Use unblocking methods for unblocking symptoms (Tong Yin Tong Yong)."
5. **Sweet and Warm Tonification (Gan Wen)**: When diarrhea persists and progresses rapidly downward, it becomes increasingly severe. Sweet flavors can relieve urgency and restrain rapid progression. As sweet flavor is associated with Spleen Earth, this method follows the principle: "Soften and relax with sweetness (Gan Yi Huan Zhi)."
6. **Astringent Consolidation (Suan Shou)**: Prolonged diarrhea causes Qi to scatter and lose its holding power, leading to continuous discharge. Sour flavors assist in consolidation and retention. The classics state: "Astringe what is scattered."
7. **Drying Dampness and Strengthening Spleen (Zao Pi)**: When Spleen Earth functions properly, water dampness does not overflow. Diarrhea results from dampness in Spleen Earth, which originates from Spleen deficiency. If the Spleen is not fortified, dampness worsens. The classics state: "Tonify deficiency."
8. **Warming Kidney Yang (Wen Shen)**: The Kidneys govern urination and defecation and serve as the root of storage. Although associated with Water, they contain True Fire (Ming Men Fire). This mild fire generates Qi and serves as the mother of Earth. If this fire declines, it cannot facilitate the San Jiao (Triple Burner) or digest food. Thus, chronic deficiency often involves cold, and Spleen deficiency requires tonifying its mother (Kidney). The classics state: "Warm what is cold."
9. **Astringing and Securing (Gu Se)**: In cases of prolonged severe diarrhea with slipping of the anal sphincter, warm tonics alone may fail. Astringent agents must be used. Provided they are applied judiciously and consistently, this follows the principle: "Astringe what is slippery."
These nine methods constitute the general principles for treating diarrhea. While the fundamental theories are comprehensive, the timing and priority of treatments require clinical flexibility. Through agile and adaptive decision-making at the bedside, physicians can help patients achieve longevity.