食泻者，腹中绞痛，痛一阵下一阵，下即稍宽，少顷又痛又下者是也，宜以通利为先。气食兼并而泻者，两
胁中脘皆痛，腹中尝闷，泻亦不甚通利者是也，宜以行气消食为先。宿食不消作泻者，饱闷作痛，或时嗳酸臭之
气，大便溏滑不甚通快者是也，专以消宿食为主，不必治其泻，审其所伤之物，而以所治之药消之。（《医镜》）
积证，香苏散，治食伤脾胃，噫生熟气，及所泄秽气殊甚，或腹紧块痛，水煎，吞卢氏感应丸，每服三七粒，
立效。久患食积，泄泻不止，经验。（《得效》）
若食积凝结成块，留滞肠胃者，虽泄泻而不能出，譬如菜篮漏物，不过微细之物耳，而凝结成块者尚在，故用
大承气以下之。（《医圣阶梯》）
泻而腹热、脉滑坚者，属实，当与消导。不应，是食积发热也，加香连。更不应，大黄微下之。（《医通》）
酒泻 酒泄证，饮酒之人多有之，但酒有阴阳二性，人有阴阳二脏，而人多不能辨也。夫酒性本热，酒
质则寒。人但知酒有湿热，而不知酒有寒湿也。故凡因酒而生湿热者，因其性也，以 汁不滋阴而悍气生热也。
因酒而生寒湿者，因其质也，以性去质不去而水留为寒也。何以辨之？常见人有阳强气充而善饮者，亦每多泄泻。
若一日不泻，反云热闷。盖其随饮随泻，则虽泻不致伤气，而得泻反以去湿，此其先天禀浓胃气过人者也，最不
易得，亦不多见，此而病者，是为
阳证，不过宜清宜利，如四苓散、大厘清饮或酒蒸黄连丸之类，去其湿热而病可愈也。若阳虚之人，则与此大
异。盖脾虚不能胜湿，而湿胜即能生寒，阳气因寒所以日散，胃气因湿所以日虚。其证则形容渐羸，饮食渐减，
或脉息见弦细，或口体常怯寒，或脐腹常有隐疼，或眩运常多困倦，或不安于五鼓，或加甚于秋冬，但无热证
可据而常多飧泄者，则总属虚寒也。凡若此者，若不速培阳气，必致渐衰而日以危矣。（《景岳》）（按∶原于
酒泄虚寒证，拟以胃关煎，其说甚长，不录。）
因伤于酒，每晨起必泻者，宜理中汤加干葛，吞酒煮黄连丸。或重而泻泄频数者，宜冲和汤。（《要诀》）
有人患早起泄泻，或时有血，午后仍便结粪，能食善饮，此是酒积作泻，二陈加炮姜、酒炒川连、红曲，陈
酒曲糊丸，乌梅汤下。有血去半夏，加麝少许，晨夕各一服。（《医通》）
气泄 气泄证，凡遇怒气便作泄泻者，必先以怒时挟食，致伤脾胃，故但有所犯，即随触而发，此肝脾
二脏之病也。盖以肝木克土，脾气受伤而然。使脾气本强，即见肝邪，未必能入。今既易伤，则脾气非强可知矣。
故治此者，当补脾之虚而顺肝之气，此固大法也。但虚实有微甚，则治疗宜分轻重耳。若既畏此证为患，则必须
切戒气怒。（《景岳》）
积泻 有人因忧愁中伤食，结积在肠胃，故发吐利。自后至暑月，稍伤则发，暴下数日不已。《玉函》
云∶下利至隔年月日不期而发者，此为有积，宜下之，止。用温脾汤尤佳，若难取效，可佐以干姜丸，后服白术
散。（《本事》）（白术散，出温中方四柱散下。）
泻已愈，隔年及后期复泻。古论云∶病有期年而发者，有积故也。宜感应丸。（《要诀》）
久泄不止，百药不效，或暂止而复来，此必有陈积在肠胃之间。积一日不去，则泻一日不愈，必先逐去陈积
而复补之，庶几获益。（《金匮翼》）
溢饮滑泄、水恣 诸泻痢入胃，名曰溢饮滑泄，渴能饮水，水下复泻而又渴，此无药证，当灸大椎。
（《保命集》）（按∶《医通》入胃上，补水渍二字，盖此证即《厥阴篇》所谓水渍入胃必下利之类。）假令渴
引饮者，是热在膈上，水多入则下膈入胃中，胃经本无热，不胜其本（按∶疑其水讹），名曰水恣，故使米谷一
时下。此证当灸大椎三、五壮立已，乃泻督也。如用药乃用车前子擂丸，白术、茯苓之类可选用之，五苓散亦可。
（同上）（按∶《医通》溢饮滑泄主五苓散，曰∶乃督脉之病也。盖系凑合此段。）
饭后随泻证 脾肾交济，所以有水谷之分。脾气虽强，而肾气不足，故饮食下咽，而大腑为之飧泄也。
治法二神丸，用故纸、肉豆蔻修合，或不换金正气散吞安肾丸主之。盖脾肾之气交通，则水谷自然克化，此所谓
妙合而凝者也。（《直指》）
有脾气久虚，不受饮食者，食毕即肠鸣腹急，尽下所食物，才觉宽快，不食则无事，俗名录食泻（按∶《医学原
理》作漏食泄），经年累月，宜快脾丸下二五粒。（《要诀》）
脾胃虚弱，内挟风冷，泄泻注下，水谷不化，脐下 痛，腹中雷鸣，乃积寒久利，肠滑不禁，木香散（按∶即
四逆汤加丁香、肉豆蔻、木香、藿香、诃子、赤石脂）。若药与食入口即泻下者，名直肠泻，难治（按∶此本于
《要诀》。
先教谕曰∶《活幼口议》痢门云∶日夜频并，饭食直过者，名曰刮肠。又《灵枢》所谓洞泄，《仓公传》洞风，
皆此证也），本方加人参、白术，用伏龙肝汤煎服。（《医通》）
脾泄、肾泄 有脾泄，有肾泄。脾泄者，肢体重着，中脘有妨，面色虚黄，腹肚微满。肾泄者，肤腠怯
冷，腰膂酸疼，上咳面黧，脐腹乍痛。治脾泄，用苍术、白术、浓朴、干姜、木香、生肉豆蔻辈。治肾泄，用补
骨脂及安肾丸、震灵丹辈。（《直指》）
诸泄泻，有用不换金正气散、除湿汤之类，以去风湿，以安肠胃，此上品药也。次则温脾养胃之剂投之，是为
正法。然用之而不作效，抑且腹痛走上走下，或脐间隐痛，腰膂疼酸，骨节软弱，面色黧悴，尺脉虚弱，病安在
哉？曰∶此肾泄也，当以炒故纸、生干姜、官桂、木香、当归辈主之，仍用安肾丸为佐。其或肾水下涸，心火上
炎，燥渴溺多，引饮无度，此阴阳离绝也，识者忧焉。（同上）
有每日五更初洞泻，服止泻药并无效，米饮下五味丸（按∶此本《本事方》文，见于后），或专以北五味煎
饮。亦治脾肾泄，虽省节饮食，大段忌口，但得日间上半夜无事，近五更其泻复作，此病在肾，俗呼脾肾泄，分水
饮下二神丸及椒朴丸，或平胃散下小茴香丸。病久而重，其人虚甚，椒附汤。（《要诀》）
五更泻，是肾虚失其闭藏之职也。惟八味丸以补其阴，则肾中之水火既济，而开阖之权得宜。况命门之火旺，
则能生土，而脾亦强矣。有用六味丸加沉香、砂仁，以山药末打糊，代蜜为丸，以摄火归源而愈者。有用六味丸加
远志、益智，兼调脾肾而愈者。有用六味丸七分，杂二神丸三分，服之而愈者。有用五味子煎汤，送四神丸者。
有用二神丸加五
味子、山茱萸、肉桂、茴香，陈米饮糊为丸服者。亦有属酒积、食积者，盖一日进取之物，至此时皆下大府而急
奔也。但食积之泻，其腹必胀满，泻后则顿减，泻下皆是稀粪。酒积泻下都是稀沫，或有兼血积者，与肾泻之纯
清水液，迥乎不同也。审系何积，即以何积治之。（《医通》）
凡兼真阴不足而为泄泻者，则或多脐下之痛，或于寅卯时为甚，或食入已久，反多不化而为呕恶溏泻，或泻
不甚臭而多见完谷等证。盖因丹田不暖，所以尾闾不固，阴中少火，所以中焦易寒，此其咎在下焦，故曰真阴不
足也。本与中焦无涉，故非分利所及也，惟胃关煎一剂，乃为最上之乘。且人之患此者最多，勿谓其为新病而不
可用也，勿谓其为年少而未宜用也。觉有是证，即宜是药，剂少功多，攸利非小。但知者见其先，昧者见其后，
见其后恐见之迟矣，所以贵先见也。（《景岳》）
虚损泄泻（互见骨蒸门） 泄泻诸治法颇详，何独不及虚损之泄泻也。盖肾藏真阴虚则火邪胜，火邪上升，
必伤肺而为咳逆。真阳虚则水邪胜，水气内溢，必渍脾而为泄泻。既嗽且泄，上下俱病，先后天之气并伤，故虚损
关捩，全系乎此。余尝用理中丸加五味子以治下泄，异功散加细辛以治上咳，每每获效。若服之作胀发热者，终
难挽回，不可以其咳泻俱缓，轻许其治也。（《医通》）
口疮糜烂泄泻 口疮糜烂泄泻一证，古经未载，以理推之、虽云属热，然其上发口糜，下泻即止，泄泻
方止，口糜即生，观其上下相移之情状，亦必纯实热之所为也。心之窍开于舌，脾之窍开于口，心脾之热，故上发
口舌疮赤糜烂。胃主消化水谷，小肠主盛受消化，心脾之热下移小肠胃府，则运化之职失矣，故下注泄泻也，口糜
发时，晚用泻心导赤
散，滚汤淬服之，即生地、木通、黄连、甘草梢也。下泄泻时，早晚用参苓白术散，糯米汤服之。若小便甚少，
下利不止，则为水走大肠，宜用茯苓、车前子二味各等分，煎汤时时代饮，利水导热。若服寒凉药口疮不效，则
为虚火上泛，宜用理中汤加肉桂，大倍茯苓，降阳利水，降阳而口糜自消，水利而泄泻自止，可并愈也。（《金
鉴》）
渴 凡泻，津液既去，口必渴，小便多是赤涩（《医通》曰∶钱氏白术散），未可便作热论。的知热泻，
方用冷剂。不然，勿妄投以致增剧。泻止渴自止，小便亦能如常。（《要诀》）
肾水不足之人，患泄或过服分利之剂而渴者，加减八味丸。失治必致小便不利，水肿胀满等证成矣。（《医
通》）
小便不利 泄泻之病，多见小水不利，水谷分则泻自止，故曰治泻不利小水，非其治也。然小水不利，
其因非一，而有可利者，有不可利者，宜详辨之。如湿胜作泻而小水不利者，以一时水土相乱，并归大肠而然也。
有热胜作泻而小水不利者，以火乘阴分，水道闭涩而然也。有寒泻而小水不利者，以小肠之火受伤，气化无权而
然也。有脾虚作泻而小水不利者，以土不制水，清浊不分而然也。有命门火衰作泻而小水不利者，以真阴亏损，
元精枯涸而然也。凡此皆小水不利之候，然惟暴注新病者可利，形气强壮者可利，酒湿过度、口腹不慎者可利，实
热闭涩者可利，小腹胀满、水道痛急者可利。又若病久者不可利，阴不足者不可利，脉证多寒者不可利，形虚气弱
者不可利，口干非渴而不喜冷者不可利。盖虚寒之泻，本非水有余，实因火不足；本非水不利，实因气不行。夫病
不因水，而利则亡阴；泻以火虚，而利复伤气。倘不察其所病之本，则未有不愈利愈虚而速其危
者矣。（《景岳》）
肠鸣 湿多成五泻，肠走如雷奔，此寒湿之患。然亦有火势攻冲，搏击水气而鸣者，必兼腹痛，暴注下
迫，肛门涩滞，小水色黄，非若湿症之腹不痛也。（《证治汇补》）
生死诀 大抵滑泄最忌五虚。五虚者，脉细、皮寒、少气、前后泄利、饮食不入，得此必死。其有生者，
浆粥入胃，泄注止，则虚者活，诚哉斯言也。（《济生》）（按∶《要诀》有说，见前冷泻条。）
若泻不止，手足寒，脉虚脱，烦躁发呃气短，目直视，昏冒不识人者，皆死症也。（《回春》）
下则泄泻，上则吐痰，皆不已，为上下俱脱，死。（《必读》）（宜参回阳方法）
治例诸说 医疗之法，寒则温之，风则散之，热则清之，湿则分利之，此不易之法。其如饮食不节，过
食生冷而成泄泻者，乃由中州不运，脾胃有伤也。但停滞泄泻一证，直须积滞已消，然后用以断下药（按∶《集成》
曰∶凡治泻之法，先理其中焦，分利水谷，然后断下）。今人往往便固止之，蕴积于中而成痢疾者多有之。其如
七情伤感所致，兼以调气药，随证主治，则不失其机要矣。（《济生》）
古云∶治湿不利小便，非其治也。故世俗治泄泻，多用淡渗之剂，利其小便；利而不已，即以燥剂兜涩之，此
一偏之冶也。殊不知泄虽主于湿，亦所协风寒热虚实之不同，岂可执一而治乎。学人当验脉症用药，无不瘳矣。（《明
医指掌》）
治须分利小便，健脾燥湿为主。若泻久多而不止者，当用补住为要。若泄泻初起，不可就用补塞，恐积气未
尽，而成腹疼饱闷，恶心烦躁，发呃而死。直待泻去四五次，方可
补住，此大法也。（《回春》）
泄泻久不止，不可离甘草、芍药，为脾病也。不可离白术，为湿也。忌枳壳，为能宽肠也。忌当归，为能滑
肠也（用补中益气者，白芍代之）。（《医碥》）
治当用治伤寒法 凡湿勿针，《内经》虽云缪刺其处，莫若以张长沙治伤寒法治之。盖泄者，亦四时伤
寒之一也。仲景曰∶上涌而下泄，表汗而里攻。半在表，半在里，则宜和解之。表里俱见，随证渗泄。此虽以治
伤寒，其于治湿乃同也。察脉以视深浅，问年壮以视虚实，所投必如其意矣。顷商水县白堤酒监单昭信，病飧泄逾
年不愈，此邑刘继先命予药之，为桂枝麻黄汤数两，一剂而愈。（《撮要图》）
治法有九 治法有九∶一曰淡渗，使湿从小便而去，如众人治涝，导其下流，虽处卑监，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，胃气注迫，辄尔下
食泻，表现为腹部绞痛，疼痛一阵接着一阵，排便后疼痛稍缓解，但过一会儿又痛又泻，治疗应以通利为先。气滞与食积兼夹导致的泄泻，表现为两胁及中脘部均疼痛，腹部时常感到闷胀，大便排泄也不甚通畅，治疗应以行气消食为先。宿食不消化引起的泄泻，表现为饱胀闷痛，有时嗳出酸臭气味，大便溏滑且排泄不畅快，治疗应专门以消除宿食为主，不必直接止泻，需审察所伤之物，用相应的药物来消除它。（《医镜》）
积证，使用香苏散，治疗饮食损伤脾胃，打嗝带有生熟食物的气味，以及排泄物秽恶之气特别严重，或者腹部紧绷、有块状疼痛的情况，用水煎服，同时吞服卢氏感应丸，每次服用三七粒，立即见效。长期患有食积，泄泻不止的经验方。（《得效》）
如果食积凝结成块，留滞在肠胃中，虽然发生泄泻但无法排出，就像菜篮子漏东西一样，只能漏出微小的物品，而凝结成块的积滞仍在，因此需要使用大承气汤来攻下。（《医圣阶梯》）
泄泻伴有腹部发热、脉象滑而坚硬的，属于实证，应当给予消导法治疗。如果无效，说明是食积发热，加入香连丸。如果仍然无效，用大黄轻微攻下。（《医通》）
酒泻：酒泄证，饮酒的人多有此病，但酒具有阴阳两种性质，人也有阴阳两种脏腑，而人们大多不能辨别。酒的性质本热，但酒的质地则寒。人们只知道酒有湿热，却不知道酒也有寒湿。因此，凡是因酒产生湿热的，是因为酒的性质，因为酒汁不滋阴而悍气生热。因酒产生寒湿的，是因为酒的质地，因为酒的性质散去而质地留下，导致水液停留成为寒湿。如何辨别呢？常见有人阳气强盛、气血充沛且善于饮酒的，也常常多泄泻。如果一天不泻，反而说热闷。大概是因为随饮随泻，所以即使泻也不会伤气，而且通过泻反能去湿，这是先天禀赋浓厚、胃气超过常人的表现，最难得，也不多见，这类患者属于阳证，不过适宜清热利湿，如四苓散、大厘清饮或酒蒸黄连丸之类，去除湿热后病可痊愈。如果是阳虚之人，则与此大不相同。因为脾虚不能胜湿，而湿胜就能生寒，阳气因为寒所以日渐消散，胃气因为湿所以日渐虚弱。其症状则是形体逐渐消瘦，饮食逐渐减少，或者脉象见弦细，或者口体经常怕冷，或者脐腹常有隐痛，或者眩晕头晕经常困倦，或者在五更时分不安宁，或者在秋冬季节加重，只要没有热证依据而经常多完谷不化的泄泻，则总属虚寒。凡是这样的，如果不迅速培补阳气，必定会导致日渐衰弱而每天陷入危险。（《景岳》）（按：原书针对酒泄虚寒证，拟用胃关煎，其论述很长，此处不录。）
因为饮酒受伤，每天早晨起床必泻的，适宜用理中汤加干葛，吞服酒煮黄连丸。或者病情重而泄泻频数的，适宜用冲和汤。（《要诀》）
有人患早起泄泻，有时带血，午后仍大便干结，能吃能喝，这是酒积作泻，用二陈汤加炮姜、酒炒川连、红曲，用陈酒曲糊制为丸，乌梅汤送下。如果有血，去掉半夏，加少许麝香，早晚各服一次。（《医通》）
气泄：气泄证，凡是遇到生气就发作泄泻的，必定是先因生气时夹杂进食，导致损伤脾胃，所以只要有所触犯，就会随即发作，这是肝脾两脏的疾病。因为肝木克伐脾土，脾气受伤所致。假如脾气本来强盛，即使见到肝邪侵犯，未必能侵入。现在既然容易受伤，那么脾气不强就可以知道了。所以治疗此病，应当补脾之虚而顺肝之气，这固然是大法。但虚实有轻重之分，治疗宜分轻重。如果既畏惧此证为患，则必须切戒生气发怒。（《景岳》）
积泻：有人因忧愁中伤食，结积在肠胃，所以发生呕吐和下利。自从之后到暑月，稍微受点刺激就发作，暴下数日不停。《玉函》说：下利隔年月日不定期发作的，这是因为有积滞，应当攻下，停止。用温脾汤尤其好，如果难以取效，可佐以干姜丸，随后服用白术散。（《本事》）（白术散，出自温中方四柱散下。）
泄泻已经痊愈，隔年及后期再次复泻。古论说：病有一年才发作的，是有积滞的缘故。适宜用感应丸。（《要诀》）
久泄不止，百药无效，或者暂时停止后又复发，这必定有陈旧的积滞在肠胃之间。积滞一日不去，则泄泻一日不愈，必须先驱逐去陈旧积滞然后再补益，这样或许能获得益处。（《金匮翼》）
溢饮滑泄、水恣：各种泻痢入胃，名叫溢饮滑泄，口渴能饮水，水喝下去又泻而又渴，这种情况没有合适的药物证候，应当灸大椎穴。（《保命集》）（按：《医通》在“入胃”上补了“补水渍”二字，大概这个证就是《厥阴篇》所谓的水渍入胃必下利之类的情况。）假令口渴想喝水的，是热在膈上，水多进入则下膈入胃中，胃经本来无热，不胜其本（按：疑为“水”字讹误），名叫水恣，所以使米谷一时下行。这个证应当灸大椎三、五壮立即好转，这是泻督脉的方法。如果用药物，则用车前子擂丸，白术、茯苓之类可选用，五苓散也可以。（同上）（按：《医通》认为溢饮滑泄主用五苓散，说：这是督脉的病。大概是凑合这段文字。）
饭后随泻证：脾肾交济，所以有水谷之分。脾气虽然强盛，但肾气不足，所以饮食咽下，大肠为之飧泄。治法用二神丸，用破故纸、肉豆蔻修合，或者不换金正气散吞服安肾丸主治。因为脾肾之气交通，则水谷自然消化，这就是所谓的妙合而凝。（《直指》）
有脾气长久虚弱，不能接受饮食的，吃完饭后即肠鸣腹急，将所吃的食物全部排下，刚觉得宽快，不吃则没事，俗名录食泻（按：《医学原理》作漏食泄），经年累月，适宜用快脾丸下二五粒。（《要诀》）
脾胃虚弱，内挟风冷，泄泻注下，水谷不化，脐下疼痛，腹中雷鸣，这是积寒久利，肠滑不禁，用木香散（按：即四逆汤加丁香、肉豆蔻、木香、藿香、诃子、赤石脂）。如果药与食入口即泻下的，名叫直肠泻，难治（按：这原本出于《要诀》。先教谕说：《活幼口议》痢门说：日夜频繁并见，饭食直过者，名叫刮肠。又《灵枢》所谓洞泄，《仓公传》洞风，都是这个证），本方加人参、白术，用伏龙肝汤煎服。（《医通》）
脾泄、肾泄：有脾泄，有肾泄。脾泄的症状，肢体沉重，中脘有妨碍感，面色虚黄，腹部微满。肾泄的症状，肌肤腠理怯冷，腰脊酸痛，向上咳嗽面色黧黑，脐腹时而疼痛。治疗脾泄，用苍术、白术、浓朴、干姜、木香、生肉豆蔻等。治疗肾泄，用补骨脂及安肾丸、震灵丹等。（《直指》）
各种泄泻，有用不换金正气散、除湿汤之类，以去除风湿，安定肠胃，这是上品药。其次则投用温脾养胃的药剂，这是正法。然而用了却不生效，并且腹痛走上走下，或者脐间隐痛，腰脊疼酸，骨节软弱，面色黧悴，尺脉虚弱，病在哪里呢？说：这是肾泄，应当用炒破故纸、生干姜、官桂、木香、当归等为主，仍用安肾丸为佐。或者肾水下涸，心火上炎，燥渴溺多，引饮无度，这是阴阳离绝，识者担忧。（同上）
有每天五更初洞泻，服用止泻药并无效，用米饮送下五味丸（按：这原本出自《本事方》文，见于后），或者专以北五味煎饮。也治疗脾肾泄，虽然节省节制饮食，大段忌口，但只要得到白天上半夜无事，接近五更时其泻又发作，这个病在肾，俗呼脾肾泄，分水饮送下二神丸及椒朴丸，或者平胃散送下小茴香丸。病久而重，其人虚甚，用椒附汤。（《要诀》）
五更泻，是肾虚失其闭藏的职责。只有八味丸以补其阴，则肾中的水火既济，而开阖的权柄得宜。况且命门之火旺，则能生土，而脾也强了。有用六味丸加沉香、砂仁，用山药末打糊，代替蜜为丸，以摄火归源而痊愈的。有用六味丸加远志、益智，兼调脾肾而痊愈的。有用六味丸七分，杂二神丸三分，服用而痊愈的。有用五味子煎汤，送服四神丸的。有用二神丸加五味子、山茱萸、肉桂、茴香，陈米饮糊为丸服用的。也有属于酒积、食积的，大概是一天进取的食物，到了这个时候都下到大肠而急奔而出。但食积的泄泻，其腹部必定胀满，泻后则顿减，泻下皆是稀粪。酒积泻下都是稀沫，或者有兼血积的，与肾泻的纯清水液，截然不同。审察是何种积滞，就以何种积滞治疗。（《医通》）
凡是兼真阴不足而为泄泻的，则或多脐下之痛，或在寅卯时为甚，或者食入已久，反而多不化而为呕恶溏泻，或者泻不甚臭而多见完谷等证。因为丹田不暖，所以尾闾不固，阴中少火，所以中焦易寒，这个过错在下焦，所以说真阴不足。本来与中焦无关，所以不是分利法所能达到的，只有胃关煎一剂，才是最好的选择。而且患此病的人最多，不要说是新病而不可用，也不要说是年少而不宜用。觉得有这个证，就用这个药，剂量少功效多，利益不小。但知情者见其先，无知者见其后，见其后恐怕见得太迟了，所以贵在先见。（《景岳》）
虚损泄泻（互见骨蒸门）：泄泻的各种治法很详细，为什么唯独不及虚损的泄泻呢？因为肾藏真阴虚则火邪胜，火邪上升，必伤肺而为咳逆。真阳虚则水邪胜，水气内溢，必渍脾而为泄泻。既咳嗽又泄泻，上下俱病，先后天之气并伤，所以虚损的关键，全系于此。我曾经用理中丸加五味子以下泄，异功散加细辛以上咳，每每获效。如果服用后出现腹胀发热，终究难挽回，不可以因为其咳泻都缓和，就轻易许诺能治愈。（《医通》）
口疮糜烂泄泻：口疮糜烂泄泻一证，古经未记载，以理推之，虽然属热，然而其上发口糜，下泻即止，泄泻方止，口糜即生，观其上下相移的情状，也必然是纯实热所为。心的窍开于舌，脾的窍开于口，心脾之热，所以上发口舌疮赤糜烂。胃主消化水谷，小肠主盛受消化，心脾之热下移小肠胃府，则运化之职失矣，所以下注泄泻。口糜发时，晚上用泻心导赤散，滚汤淬服之，即生地、木通、黄连、甘草梢。下泄泻时，早晚用参苓白术散，糯米汤服之。如果小便甚少，下利不止，则为水走大肠，宜用茯苓、车前子二味各等分，煎汤时时饮用，利水导热。如果服寒凉药口疮不效，则为虚火上泛，宜用理中汤加肉桂，大倍茯苓，降阳利水，降阳而口糜自消，水利而泄泻自止，可以并愈。（《金鉴》）
渴：凡泄泻，津液既去，口必渴，小便多是赤涩（《医通》说：钱氏白术散），不可便作热论。确知是热泻，才用冷剂。否则，不要妄投以致加重。泻止渴自止，小便也能如常。（《要诀》）
肾水不足之人，患泄或过服分利之剂而渴的，用加减八味丸。失治必致小便不利，水肿胀满等证形成。（《医通》）
小便不利：泄泻的病，多见小水不利，水谷分则泻自止，所以说治泻不利小水，不是正确的治法。然而小水不利，其原因非一，而有可利的，有不可利的，宜详辨之。如湿胜作泻而小水不利的，是因为一时水土相乱，并归大肠所致。有热胜作泻而小水不利的，是因为火乘阴分，水道闭涩所致。有寒泻而小水不利的，是因为小肠之火受伤，气化无权所致。有脾虚作泻而小水不利的，是因为土不制水，清浊不分所致。有命门火衰作泻而小水不利的，是因为真阴亏损，元精枯涸所致。凡此皆小水不利之候，然而只有暴注新病者可利，形气强壮者可利，酒湿过度、口腹不慎者可利，实热闭涩者可利，小腹胀满、水道痛急者可利。又若病久者不可利，阴不足者不可利，脉证多寒者不可利，形虚气弱者不可利，口干非渴而不喜冷者不可利。因为虚寒之泻，本来不是水有余，实因火不足；本来不是水不利，实因气不行。病不因水，而利则亡阴；泻以火虚，而利复伤气。倘若不察其所病之本，则没有不愈利愈虚而加速其危重的了。（《景岳》）
肠鸣：湿多成五泻，肠走如雷奔，这是寒湿之患。然而也有火势攻冲，搏击水气而鸣的，必兼腹痛，暴注下迫，肛门涩滞，小水色黄，不像湿症那样腹不痛。（《证治汇补》）
生死诀：大致滑泄最忌五虚。五虚者，脉细、皮寒、少气、前后泄利、饮食不入，得此必死。其有生者，浆粥入胃，泄注止，则虚者活，诚哉斯言也。（《济生》）（按：《要诀》有说法，见前冷泻条。）
如果泻不止，手足寒，脉虚脱，烦躁发呃气短，目直视，昏冒不识人者，都是死症。（《回春》）
下则泄泻，上则吐痰，都不已，为上下俱脱，死。（《必读》）（宜参考回阳方法）
治例诸说：医疗之法，寒则温之，风则散之，热则清之，湿则分利之，这是不易之法。至于饮食不节，过食生冷而成泄泻的，乃由中州不运，脾胃有伤。但停滞泄泻一证，直须积滞已消，然后用断下药（按：《集成》说：凡治泻之法，先理其中焦，分利水谷，然后断下）。今人往往便固止之，蕴积于中而成痢疾者多有之。至于七情伤感所致，兼以调气药，随证主治，则不失其机要了。（《济生》）
古云：治湿不利小便，非其治也。所以世俗治泄泻，多用淡渗之剂，利其小便；利而不已，即以燥剂兜涩之，这是一偏之冶。殊不知泄虽主于湿，亦所协风寒热虚实之不同，岂可执一而治乎。学人当验脉症用药，无不瘳矣。（《明医指掌》）
治须分利小便，健脾燥湿为主。若泻久多而不止者，当用补住为要。若泄泻初起，不可就用补塞，恐积气未尽，而成腹疼饱闷，恶心烦躁，发呃而死。直待泻去四五次，方可补住，这是大法。（《回春》）
泄泻久不止，不可离甘草、芍药，因为脾病。不可离白术，因为湿。忌枳壳，因为能宽肠。忌当归，因为能滑肠（用补中益气者，白芍代之）。（《医碥》）
治当用治伤寒法：凡湿勿针，《内经》虽云缪刺其处，莫若以张长沙治伤寒法治之。盖泄者，亦四时伤寒之一也。仲景说：上涌而下泄，表汗而里攻。半在表，半在里，则宜和解之。表里俱见，随证渗泄。这虽然是以治伤寒，其于治湿乃同也。察脉以视深浅，问年壮以视虚实，所投必如其意矣。顷商水县白堤酒监单昭信，病飧泄逾年不愈，此邑刘继先命予药之，为桂枝麻黄汤数两，一剂而愈。（《撮要图》）
治法有九：治法有九：一是淡渗，使湿从小便而去，如众人治涝，导其下流，虽处卑监，不忧巨浸。经云：治湿不利小便，非其治也。又说在下者引而竭之是也。一是升提，气属于阳，性本上升，胃气注迫，辄尔下
Food diarrhea manifests as colicky abdominal pain, occurring in waves; pain is slightly relieved after defecation, but recurs shortly thereafter. Treatment should prioritize promoting drainage and unblocking. When Qi stagnation and food retention combine to cause diarrhea, there is pain in both hypochondriac regions and the epigastrium, frequent abdominal fullness and oppression, and incomplete or difficult defecation. Treatment should prioritize moving Qi and resolving food retention. Diarrhea caused by undigested retained food presents with postprandial fullness, distension, and pain, sometimes accompanied by belching of sour, foul-smelling gas, and loose, slippery stools that are not discharged smoothly. Treatment should focus exclusively on eliminating retained food rather than directly stopping diarrhea; one must identify the offending food and use appropriate herbs to resolve it. (Yi Jing)
For accumulation syndromes, Xiang Su San (Perilla and Bupleurum Powder) treats food injury to the Spleen and Stomach, belching of raw or cooked food odors, extremely foul-smelling excreta, or abdominal tightness with mass-like pain. Decoct in water and swallow with Lushi Yinggan Wan (Lu’s Responsive Pill), 3–7 pills per dose, for immediate effect. An empirical formula for chronic food retention with persistent diarrhea. (De Xiao)
If food retention condenses into a mass and lingers in the intestines and stomach, although diarrhea occurs, the mass cannot be expelled. This is like a vegetable basket leaking only fine particles while the clumped contents remain. Therefore, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge downward. (Yi Sheng Jie Ti)
Diarrhea accompanied by abdominal heat and a slippery, firm pulse indicates excess syndrome; treatment should employ digestion-promoting methods. If ineffective, it indicates fever due to food retention; add Xiang Lian Wan (Coptis and Aucklandia Pill). If still ineffective, mildly purge with Rhubarb. (Yi Tong)
Alcohol Diarrhea: Alcohol-induced diarrhea is common among drinkers, yet wine possesses both Yin and Yang natures, and humans possess Yin and Yang organs, which people often fail to distinguish. Wine’s nature is hot, but its substance is cold. People know wine causes damp-heat but ignore damp-cold. Damp-heat from wine arises from its nature, as wine juice does not nourish Yin but generates heat through its vigorous Qi. Damp-cold from wine arises from its substance, as the nature dissipates while the substance remains, causing water retention leading to cold. How to differentiate? Often, individuals with strong Yang and abundant Qi who drink heavily suffer frequent diarrhea. If they do not defecate for a day, they feel hot and stifled. Since drinking and defecating occur simultaneously, defecation does not damage Qi but removes dampness. This indicates strong congenital constitution and robust Stomach Qi, which is rare. Such cases are Yang syndromes, treated with clearing and draining methods, such as Si Ling San (Four Poria Powder), Da Li Qing Yin (Great Clearing Decoction), or Jiu Zheng Huang Lian Wan (Wine-Processed Coptis Pill), to remove damp-heat and cure the disease. In contrast, Yang-deficient patients differ significantly. Spleen deficiency fails to overcome dampness, allowing dampness to generate cold; Yang Qi scatters due to cold, and Stomach Qi weakens due to dampness. Symptoms include gradual emaciation, reduced appetite, wiry-thin pulses, aversion to cold, dull umbical/abdominal pain, dizziness, fatigue, discomfort at dawn (5–7 AM), or worsening in autumn/winter. Without heat signs but with frequent undigested stool, it belongs to deficiency-cold. If Yang Qi is not rapidly tonified, decline and danger will ensue. (Jing Yue) [Note: Original text proposes Wei Guan Jian for deficiency-cold alcohol diarrhea; omitted here.]
Morning diarrhea due to alcohol injury: Use Li Zhong Tang (Regulate the Middle Decoction) with Kudzu Root, swallowing Jiu Zhu Huang Lian Wan (Wine-Cooked Coptis Pill). For severe, frequent diarrhea, use Chong He Tang (Harmonizing Decoction). (Yao Jue)
Early morning diarrhea with occasional blood, followed by constipation in the afternoon, in a person with good appetite and drinking habit, indicates alcohol retention diarrhea. Use Er Chen Tang (Two-Cured Decoction) with Fried Ginger, Wine-Fried Coptis, and Red Yeast Rice, formed into pills with aged yeast paste, taken with Sour Plum Decoction. If blood is present, remove Pinellia and add a little Musk, taken morning and evening. (Yi Tong)
Qi Diarrhea: Diarrhea triggered by anger arises from food intake during emotional upset, injuring the Spleen and Stomach. Thus, any trigger causes immediate recurrence, indicating Liver-Spleen pathology. Wood overacting on Earth injures Spleen Qi. If Spleen Qi were strong, Liver pathogenic factors could not invade. Ease of injury indicates weak Spleen Qi. Treatment must tonify Spleen deficiency and soothe Liver Qi. Severity dictates dosage. Prevention requires avoiding anger. (Jing Yue)
Accumulation Diarrhea: Diarrhea and vomiting due to food accumulation from sorrowful eating, lingering in intestines/stomach, recurring in summer with slight triggers, causing sudden profuse diarrhea for days. Yu Han states: Intermittent diarrhea lasting months/years indicates accumulation; purge it. Wen Pi Tang (Warm the Spleen Decoction) is best; if ineffective, add Gan Jiang Wan (Ginger Pill), then Bai Zhu San (Atractylodes Macrocephala Powder). (Ben Shi) [Bai Zhu San referenced below.]
Recurrence of diarrhea after remission, even years later, is due to residual accumulation. Yinggan Wan (Responsive Pill) is indicated. (Yao Jue)
Chronic persistent diarrhea unresponsive to various medicines, or recurring after temporary relief, implies old accumulation in intestines/stomach. Accumulation must be purged before tonification can succeed. (Jin Kui Yi)
Overflowing Drink and Slippery Leakage (Shui Zi): Diarrhea/dysentery entering the Stomach causes thirst despite drinking, with repeated drinking-diarrhea cycles. No herbal formula fits; moxa the Dazhui (GV14) acupoint. (Bao Ming Ji) [Note: Yi Tong adds "water infiltration"; corresponds to Jueyin chapter water infiltration diarrhea. If thirst drives drinking, heat is above the diaphragm; water enters Stomach where there is no heat, causing "Water Indulgence," leading to rapid passage of food. Moxa Dazhui 3–5 cones to drain Du Mai. Herbal options: Che Qian Zi Lei Wan, Bai Zhu, Fu Ling, or Wu Ling San.] (Same source)
Postprandial Immediate Diarrhea: Spleen-Kidney interaction regulates water/grain separation. Strong Spleen Qi with weak Kidney Qi causes immediate diarrhea after swallowing. Treat with Er Shen Wan (Two Spirit Pill) using Psoralea and Nutmeg, or Huan Jin Zheng Qi San (Transform Metal Regulate Qi Powder) with An Shen Wan (Calming Kidney Pill). Harmonized Spleen-Kidney Qi ensures proper digestion. (Zhi Zhi)
Chronic Spleen Qi deficiency unable to process food causes borborygmus and abdominal urgency immediately after eating, expelling all food, with relief upon emptying. Known as "Leaking Food Diarrhea." For chronic cases, Kuai Pi Wan (Quick Spleen Pill), 2–5 pills. (Yao Jue)
Spleen-Stomach deficiency with wind-cold invasion causes watery diarrhea, undigested food, umbical pain, and borborygmus, indicating chronic cold accumulation and intestinal slipperiness. Use Mu Xiang San (Costus Powder) [equivalent to Si Ni Tang plus Clove, Nutmeg, Costus, Patchouli, Chebula, and Red Kaolin]. If medicine/food is vomited/excreted immediately ("Rectal Diarrhea"), it is difficult to treat. Add Ginseng and Atractylodes, decocted in Long Gu Tan Tang (Dragon Bone Ash Decoction). (Yi Tong)
Spleen vs. Kidney Diarrhea: Spleen diarrhea features heavy limbs, epigastric obstruction, sallow complexion, and mild abdominal fullness. Kidney diarrhea features cold skin/pores, sore lower back, cough, dark complexion, and intermittent umbical pain. Treat Spleen diarrhea with Atractylodes, Magnolia Bark, Ginger, Costus, and raw Nutmeg. Treat Kidney diarrhea with Psoralea, An Shen Wan, or Zhen Ling Dan. (Zhi Zhi)
General diarrhea may use Huan Jin Zheng Qi San or Chu Shi Tang to dispel wind-damp and calm intestines. Next, warm Spleen/Stomach formulas. If ineffective with abdominal pain radiating, lumbar soreness, weak joints, sallow complexion, and weak Chi pulse, it is Kidney diarrhea. Treat with fried Psoralea, dried Ginger, Cinnamon, Costus, and Angelica, assisted by An Shen Wan. If Kidney Water is depleted and Heart Fire flares (dry mouth, polyuria), it is Yin-Yang separation, a grave prognosis. (Same source)
Dawn diarrhea unresponsive to astringents suggests Kidney involvement. Use Wu Wei Zi Wan (Schisandra Pill) with rice gruel, or concentrated Schisandra tea. Also for Spleen-Kidney diarrhea: Er Shen Wan or Jiao Po Wan with Fen Shui Yin, or Xiao Hui Xiang Wan with Ping Wei San. For severe, chronic deficiency, use Jiao Fu Tang. (Yao Jue)
Dawn diarrhea results from Kidney failure to store. Ba Wei Wan (Eight-Ingredient Pill) tonifies Yin, balancing Kidney Water/Fire and regulating opening/closing. Strong Mingmen Fire generates Earth, strengthening Spleen. Variations include Liu Wei Wan with Agarwood/Amomum, Polygala/Alpinia, or mixed with Er Shen Wan. Schisandra broth with Si Shen Wan also works. Differentiate from food/alcohol retention: food retention causes bloating relieved by defecation with loose stool; alcohol retention causes frothy stool; Kidney diarrhea causes clear watery stool. Treat according to the specific accumulation. (Yi Tong)
True Yin deficiency diarrhea features umbical pain, worsening at Yin/Mao hours (3–7 AM), undigested food/vomiting, odorless loose stool with undigested grains. Due to cold Dantian and insecure Weilu gate, with deficient Minfire causing middle Jiao cold. The root is Lower Jiao; fluid-draining methods fail. Wei Guan Jian (Stomach Gate Decoction) is superior. Early intervention is crucial regardless of age or duration. (Jing Yue)
Deficiency Consumption Diarrhea: Kidney True Yin deficiency leads to Fire attacking Lung (cough); True Yang deficiency leads to Water flooding Spleen (diarrhea). Both Upper/Lower Jiao and Pre/Post-Heaven Qi are damaged. Li Zhong Wan + Schisandra treats lower diarrhea; Yi Gong San + Asarum treats upper cough. Bloating/fever after medication indicates poor prognosis. (Yi Tong)
Mouth Ulcers with Diarrhea: Though seemingly heat-related, simultaneous upper ulcers and lower diarrhea suggest pure excess heat transferring from Heart/Spleen to Small Intestine/Stomach. At night, use Xie Xin Dao Chi San (Drain Heart Guide Out Redness Decoction: Rehmannia, Astilbe, Coptis, Licorice tip) with boiling water. During diarrhea, use Shen Ling Bai Zhu San with glutinous rice broth. If oliguria persists, use equal parts Poria and Plantago seed to drain water/heat. If cold herbs fail mouth ulcers, it is deficient fire floating up; use Li Zhong Tang + Cinnamon + large dose Poria to descend Yang and drain water. (Jin Jian)
Thirst: Post-diarrhea thirst with red/scanty urine is not necessarily heat. Confirm heat diarrhea before using cold formulas. Otherwise, avoid worsening the condition. Thirst resolves when diarrhea stops. (Yao Jue)
Kidney Water deficiency or overuse of diuretics causing thirst in diarrhea: Use Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill). Untreated, it leads to oliguria and edema. (Yi Tong)
Oliguria: Diarrhea often involves oliguria; separating water/grain stops diarrhea. Treating diarrhea without promoting urination is incorrect. However, causes vary. Dampness excess: water/damp merge in Large Intestine. Heat excess: Fire obstructs Yin channels. Cold diarrhea: Small Intestine Fire injured, Qi transformation fails. Spleen deficiency: Earth fails to control Water, turbidity/cloudiness mix. Mingmen Fire decline: True Yin/Essence depleted. Only acute, strong, damp-heat, or painful fullness cases benefit from diuretics. Chronic, Yin-deficient, cold-pulse, weak constitution, or dry-mouth-but-not-thirsty cases contraindicate diuretics. Deficiency-cold diarrhea stems from Fire insufficiency, not Water excess. Diuretics in these cases destroy Yin and Qi, accelerating crisis. (Jing Yue)
Borborygmus: Dampness causes five types of diarrhea; loud rumbling indicates cold-damp. Fire attacking water also causes rumbling with pain, tenesmus, and yellow urine, unlike painless dampness. (Zheng Zhi Hui Bu)
Life and Death Criteria: Slippery diarrhea is fatal with Five Deficiencies: thin pulse, cold skin, shortness of breath, anterior/posterior discharge, and inability to eat. Survival depends on grain entering Stomach and diarrhea stopping. Uncontrolled diarrhea with cold extremities, vacuous pulse, irritability, hiccups, shortness of breath, fixed gaze, and coma is fatal. Simultaneous upper vomiting/phlegm and lower diarrhea indicates total collapse, fatal. (Ji Sheng / Hui Chun / Bi Du)
Treatment Principles: Cold warms, Wind disperses, Heat clears, Damp drains. Food/cold injury damages Middle Jiao; purge only after stagnation resolves. Premature astringency causes dysentery. Emotional injuries require Qi-regulating herbs. (Ji Sheng)
Treating dampness requires promoting urination. Folk remedies use bland leeching agents, then astringents if ineffective, which is biased. Diarrhea involves Wind/Cold/Heat/Excess/Deficiency; treat based on pulse/symptoms. (Ming Yi Zhi Zhang)
Promote urination and strengthen Spleen/dry dampness initially. For chronic diarrhea, tonification is key. Do not tonify early in acute phases to avoid trapping Qi/pain. Wait for 4–5 episodes before tonifying. (Hui Chun)
Chronic diarrhea requires Licorice and Peony (for Spleen) and Atractylodes (for dampness). Avoid Zhi Ke (widens intestines) and Dang Gui (slippery intestines); use White Peony if using Bu Zhong Yi Qi Tang. (Yi Que)
Treat Dampness via Shanghan Methods: Needling is generally avoided for dampness; follow Zhang Zhongjing’s methods. Diarrhea is a form of seasonal cold. Half-exterior/half-interior requires harmonization. Pulse and age determine deficiency/excess. Case: Shan Zhaoxin cured of chronic diarrhea with Gui Zhi Ma Huang Tang (Cinnamon Twig and Ephedra Decoction). (Cuo Yao Tu)
Nine Treatment Methods: 1. Bland Leeching: Drain damp via urine. 2. Raising/Lifting: Qi rises naturally...