薛立斋曰∶泄泻，若米食所伤，六君子加谷芽；面食所伤，六君子加麦芽；肉食所伤，六君子加山楂。若
兼寒热作呕，乃肝木侮脾土，六君子加柴胡、生姜。兼呕吐腹痛，手足逆冷，乃寒水侮土，六君子加姜、桂。
不应，钱氏益黄散。若元气下陷，发热作渴，肢体倦怠，补中汤。若泄泻色黄，乃脾土真色，六君子加木香、肉
果。若作呕不食，腹痛恶寒，乃脾土虚寒，六君子加木香、姜、桂。若泻在五更侵晨，饮食少思，乃脾肾虚弱，
五更服四神丸，日间服白术散。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。
慎斋按∶以上二条，序胎前有泄泻证也。妊娠泄泻，必原其由。大抵不外脾肾二脏虚者居多。夫血统于脾，
血壅胎元，则脾阴虚而食不运化，水谷难消而作泻。胎系于肾，肾气弱，命门火衰，胎窃其气以拥护，而肾间
之阳不能上蒸脾土，则为泻。此妊娠泄泻之由也。虽其间不无风寒暑湿之外感，饮食生冷之内伤，而属于脾肾
有亏者，其本也。《大全》漫序四证，为妊娠泄泻大略，已属草率无理。立斋又以大概泄泻证候，分发某证用
某药为治，此胶柱鼓瑟，印定后人眼目，予
不能无议者也。
《大全》曰∶经云∶饮食自倍，肠胃乃伤。又云∶阴之所生，本在五味，阴之五宫，伤在五味。若妊娠饮食
不节，生冷毒物，恣性食啖，致伤脾胃。故妊娠伤食，最难用药，唯木香丸、白术散二方最稳。
薛立斋说：对于泄泻，如果是米食损伤所致，在六君子汤中加入谷芽；如果是面食损伤所致，在六君子汤中加入麦芽；如果是肉食损伤所致，在六君子汤中加入山楂。如果兼有寒热往来且呕吐，这是肝木（肝脏功能亢进）克制脾土（脾胃功能虚弱），在六君子汤中加入柴胡、生姜。如果兼有呕吐、腹痛、手足逆冷，这是寒水（肾寒）克制脾土，在六君子汤中加入干姜、肉桂。如果服药后无效，使用钱乙的益黄散。如果是元气下陷，伴有发热、口渴、肢体倦怠，使用补中益气汤。如果泄泻颜色发黄，这是脾土的本色外露，在六君子汤中加入木香、肉豆蔻。如果出现呕吐、不能进食、腹痛、恶寒，这是脾土虚寒，在六君子汤中加入木香、干姜、肉桂。如果在五更天（凌晨3-5点）或清晨腹泻，饮食减少，这是脾肾虚弱，五更时服用四神丸，白天服用白术散。如果无效，或者病愈后又复发，或者饮食减少，急需使用八味丸，补益命门之火，以温煦脾土为妙。
慎斋按语：以上两条，叙述的是怀孕前出现泄泻证候的情况。妊娠期间的泄泻，必须探究其病因。大抵不外乎是脾、肾两脏虚弱居多。血液由脾统摄，血气壅滞于胎元，导致脾阴虚而食物无法运化，水谷难以消化从而发生泄泻。胎儿系于肾，肾气虚弱，命门火衰，胎儿窃取肾气来拥护自身，导致肾间的阳气不能上蒸温煦脾土，从而发生泄泻。这就是妊娠泄泻的原因。虽然其中不无风寒暑湿等外感邪气，以及饮食生冷等内伤因素，但属于脾肾亏损的才是根本。《妇人大全良方》随意列举四种证候，作为妊娠泄泻的大略情况，已经显得草率无理。薛立斋又以一般的泄泻证候，分发某种证候用某种药物治疗，这种拘泥成法、束缚后人思路的做法，我不能没有异议。
《妇人大全良方》说：医经云：“饮食加倍，肠胃就会受伤。”又说：“阴精的产生，本源于五味，但主管阴精的五脏，也会因五味不当而受伤。”如果妊娠期间饮食不节制，食用生冷毒物，放纵食欲，导致脾胃受损。因此，妊娠期间伤食，用药最为困难，只有木香丸、白术散这两个方剂最为稳妥。
Xue Lizhai stated: For diarrhea, if caused by excessive consumption of rice, add Guoya (Sprouted Rice) to Liujunzi Tang (Six Gentlemen Decoction); if caused by excessive consumption of wheat products, add Maiya (Sprouted Barley) to Liujunzi Tang; if caused by excessive consumption of meat, add Shanzha (Hawthorn Fruit) to Liujunzi Tang. If accompanied by alternating chills and fever with vomiting, this indicates Liver Wood overacting on Spleen Earth, so add Chaihu (Bupleurum Root) and Shengjiang (Fresh Ginger) to Liujunzi Tang. If accompanied by vomiting, abdominal pain, and cold extremities, this indicates Cold Water overacting on Spleen Earth, so add Jiang (Dried Ginger) and Rongui (Cinnamon Bark) to Liujunzi Tang. If there is no response, use Yihuang San (Yellow Protecting Powder) from Qian Yi. If due to sinking of Yuan Qi (Primal Qi), accompanied by fever, thirst, and limb fatigue, use Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting the Qi). If the stool is yellow in color, representing the true color of Spleen Earth, add Muxiang (Aucklandia Root) and Rouguo (Nutmeg) to Liujunzi Tang. If accompanied by vomiting, anorexia, abdominal pain, and aversion to cold, this indicates deficiency-cold of Spleen Earth, so add Muxiang, Jiang, and Rongui to Liujunzi Tang. If diarrhea occurs during the fifth watch (between 3 a.m. and 5 a.m.) or early morning, with reduced appetite, this indicates deficiency of both Spleen and Kidney; take Sishen Wan (Four Spirits Pill) at the fifth watch and Baizhu San (Atractylodes Powder) during the day. If there is no response, or if the condition recurs after remission, or if appetite remains poor, urgently use Bawei Wan (Eight-Ingredient Pill) to tonify the Fire of the Gate of Vitality (Mingmen), thereby generating Spleen Earth, which is advisable.
Shenzhen commented: The above two paragraphs describe diarrhea occurring before pregnancy. Diarrhea during pregnancy must be traced to its cause. Generally, it is mostly due to deficiency of the Spleen and Kidney organs. Blood is governed by the Spleen; when blood becomes stagnant affecting the fetal origin, Spleen Yin becomes deficient, leading to failure of food transformation and digestion, resulting in diarrhea. The fetus is rooted in the Kidney; when Kidney Qi is weak and the Fire of the Gate of Vitality declines, the fetus steals Qi for support, causing the Yang Qi within the Kidneys to fail to steam upwards to warm Spleen Earth, resulting in diarrhea. This is the etiology of diarrhea during pregnancy. Although external pathogens such as Wind, Cold, Summer-heat, and Dampness, or internal injuries from raw and cold foods may exist, the root lies in the deficiency of the Spleen and Kidney. *Daquan* arbitrarily lists four syndromes as a general overview of pregnancy diarrhea, which is hasty and unreasonable. Xue Lizhai further categorized general diarrhea syndromes with specific prescriptions for each, a rigid approach that restricts future practitioners' perspectives, which I cannot but criticize.
*Daquan* states: The classics say: "If food intake doubles, the intestines and stomach will be injured." It also says: "The generation of Yin originates from the five flavors, but the five viscera governing Yin can be injured by improper use of the five flavors." If dietary habits are irregular during pregnancy, consuming raw, cold, or toxic substances without restraint, damaging the Spleen and Stomach, then treating food stagnation during pregnancy is difficult. Only Muxiang Wan (Aucklandia Pill) and Baizhu San (Atractylodes Powder) are considered the safest formulas.