（交肠症男子亦有。）
张路玉治詹石匠妻，产后五六日，恶露不行，腹胀喘满，大便从前阴而出。省其故，平日酷嗜烟酒。所产
之儿，身软无骨，因而惊骇，遂患此症。以芎归汤加莪术、肉桂、炒黑山楂，一服恶露通，而二便如常。
陆圣祥之女，方四岁，新秋患血痢，而稀粪出于前阴。作冷热不调食积治，与五苓散，服香连丸，二剂而愈。
钱吉甫女，年十三，体肥痰盛。因邻家被盗，发热头痛，呕逆面青，六脉弦促，而便溺易位，此因惊而气
乱，痰袭窍端所致也。与四七汤，下礞石滚痰丸，开通痰气而安。
喻嘉言治姜宜人得奇症。简《本草经疏》治交肠用五苓散之说，以为神秘，喻曰∶交肠一症，大小二便易
位而出，若交肠然。古用五苓治之，专为通前阴而设也。若此症闭在后阴，二便俱从前阴而出，拟之交肠，诚
有似是而非者。况交肠乃暴病，骤然而气乱于中。此症乃久病，以渐而血枯于内，有毫厘千里之别。原夫疾之
所始，始于忧思伤脾，脾伤则不能统血，而错出下行，有若崩漏，实名脱营，宜大补急固。乃误以凉血清火为
治，脱出转多，于是手阳明之血，亦渐消亡。故血尽然后气乱，气乱然后水谷舍故趋新，并归一路，大肠枯槁，
幽门骤闭，饮食至此无庸泌别，遂清浊并走前阴。势必大肠复通，令渣滓率由故道，斯为得耳。与五苓一方，
有何干涉？况五苓之劫阴，又为亡血家所深戒乎。向诊时尝问病中多哭泣否？答曰∶时时泣下。乃知脏燥者多
泣，大肠方废而不用也，交肠云乎哉！今大肠之脉累累而现于指，可虞之时，其来春枣叶生乎，枣叶生而言果
验。（按∶此仍是交肠症，惟与骤然气乱者不同耳。）
愚拟治之之法，宜集灵膏，重用人参以补肺而润之。盖肺与大肠相表里而主气。又肺者，相传之官，治
节出焉。肺得养，斯大肠之燥可清。又得枸杞、二冬以滋其失血之槁，然后故道可复，而清浊自分矣。
薛立斋治一产妇，小便出粪，名大小肠交，乃气血俱虚，失行故道。先用六君子汤二剂，又用五苓散二剂
而痊。（《妇人良方》作先用五苓散二剂而愈，又用补中益气汤而安。）
沈明生治叶惟和室，月夜探亲，其母留之食，时春寒犹峭，归途即觉肌寒懔懔。次早复当窗梳栉，重感于
邪，无热恶寒，胸膈 闷。一医见其肌表无热，竟作食伤太阴主治，遽用大黄下之，不特不更衣，反致水道闭
涩。尤可异者，白物腥秽如膏淋之状，从大肠来，绵锦不绝，渐至肌体萎弱，骨立难支。诊之，脉沉而涩，虚
寒可知，计惟有温中益元之法。然虑大便尚结，小水未行，或有增满之患。遂先用五苓散倍加肉桂，一服而水
道果通，再服而宿垢并下。嗣用附子理中汤三四剂，后白物渐止。更以十全大补，调理一月而安。夫白淫白沃，
载在灵兰之典，皆指前窍中来，今乃转移于后，何也？盖此病始终是一寒症，初因食在胃脘之上，火衰不能熟
腐，而反下之太早，则有形之物不能即降，而无形之寒抑遏于阑门之际，遂致清浊混淆，涓涓不息，似乎淋带，
而实非淋带也。今先以五苓分利阴阳，而倍肉桂，使寒随溺泄，上下宣通。继以理中之剂，撤其余邪，鼓其阳
气，令脾土湿燥，而浊流有制，宜其效如桴鼓也。夫始用行大便之药，大便不行，并致小便赤涩。今用利小便
之药，小便即利，并致大便亦通，其得失为何如哉。
董魏如曰∶膀胱有下口而无上口，下口则通乎宗筋，宗筋本为精道，而溺亦同出乎此，则宗筋虽一口，其
内实精道溺道之两口也。故膀胱虽系于肠旁，而与肠不相通。乃论交肠症者，俱谓阑门不清，以致清浊混乱，
故大小便易位而出。夫阑门为大小肠交接之门户，虽曰不清，而二便各有所出之道路，又焉能遽易其位而出？
窃谓交肠一症，乃屎出前阴，溺出后孔之候。溺出后孔者，水气并入大肠，自阑门不能泌别清浊，可以阑门不
清为论。若屎出前阴者，乃肠膀并破之候，非肠穿则屎从何窦而出？膀胱不破，则屎从何窦而入？要必肠穿膀
破，而后屎溺得以易位而出。又必破损之处，其窦贴连，而后得出入不爽也。尝验诸兽之膀胱，皆附于大肠之
募，与广肠下连。故肠膀一通，而便可易位，否则难乎其为交矣。余治交肠症四五人，皆得于险产之后，其为
肠膀破损，不言可喻。余舆人朱姓者，年三十余，素患血疝，年发二三次，遇寒则发，服温降药随已。其发必
攻痛腹肋，甚则攻胸，乃呕血三两口，此手足厥阴之候，习以为常。忽冬月遇寒陡发，囊肿如石，时届岁终，
服药一二剂，归家度岁。正月初疝症愈，而囊痈竟成，不数日大溃，囊中流粪，大便不行，肚腹两角连串肿赤，
复成肚角痈，三五日而溃，亦屎脓并出。一囊一腹连串洞穿者六，人虽羸瘦，而语言自若，饮食如常。夫睾囊
之系，上连广肠，系损而及肠，膜破而屎出，此方书所已载也。若腹痈溃而屎出，是必大小二肠，先结痈而内
溃，故复由外痈而出。否则腹痈虽穿，而肠不破，屎亦何从而出乎？此症之溃，在正月七日，至三月十七日始
不食，十八日屎从口出，三日乃死。始知肠断即死，肠破未即死也。故交肠囊痈二证，多有愈者。
（交肠症男子也有。）
张路玉治疗詹石匠的妻子，产后五六天，恶露不通，腹部胀满气喘，大便从前阴排出。询问病因，得知她平时酷爱吸烟喝酒。所生的孩子，身体柔软无骨，因此受到惊吓，于是患上了这个病。用芎归汤加莪术、肉桂、炒黑山楂，一服药后恶露通畅，大小便恢复正常。
陆圣祥的女儿，才四岁，初秋患血痢，稀粪从前阴排出。按冷热不调兼食积治疗，给予五苓散，服用香连丸，两剂后痊愈。
钱吉甫的女儿，十三岁，体型肥胖痰多。因为邻居家被盗，发热头痛，呕吐逆气面色发青，六脉弦而急促，大小便位置互换，这是因惊吓导致气机紊乱，痰邪侵袭窍道末端所致。给予四七汤，送服礞石滚痰丸，开通痰气而安定病情。
喻嘉言治疗姜宜人得了奇症。查阅《本草经疏》中关于治疗交肠症使用五苓散的说法，认为很神秘。喻嘉言说：交肠这一病症，大小二便位置互换而出，像交叉一样。古人用五苓散治疗，专门是为了通利前阴而设的。如果这个病症是后阴闭塞，大小便都从前阴排出，拟名为交肠症，确实有似是而非的地方。况且交肠症是暴病，突然之间气机在中焦紊乱。此症却是久病，逐渐地阴血在内枯竭，有着毫厘千里般的区别。推究疾病的起始，始于忧思损伤脾脏，脾伤则不能统摄血液，血液错乱下行，如同崩漏，实际上名为脱营，应当大补急固。却误用凉血清火的方法治疗，出血更多，于是手阳明大肠经的血，也逐渐消亡。所以血尽然后气乱，气乱然后水谷舍弃旧道趋向新道，并归入一路，大肠干枯萎缩，幽门骤然闭塞，饮食到了这里无需再泌别清浊，于是清浊一起走前阴。必须使大肠重新通畅，让渣滓率由故道而行，这才是正确的。与五苓散一方，有什么关联呢？况且五苓散劫夺阴液，又是失血之人所深深忌讳的。当初诊治时曾问病人是否经常哭泣？回答说：时时流泪。才知道脏燥的病人多哭泣，大肠功能废弛而不用的时候，这哪里是交肠症呢！如今大肠的脉象累累显现于指下，这是令人担忧的时候，大概要到明年春天枣叶长出来的时候吧，枣叶长出时预言果然应验。（按：这仍然是交肠症，只是与突然气乱的情况不同罢了。）
我拟定治疗方法，宜用集灵膏，重用人参以补肺并滋润它。因为肺与大肠相表里且主气。又肺是相传之官，治节由此产生。肺得到滋养，那么大肠的燥热可以清除。再加上枸杞、天冬、麦冬来滋补充血后的枯槁，然后故道可恢复，清浊自然分开。
薛立斋治疗一位产妇，小便排出粪便，名叫大小肠交，这是气血俱虚，失去正常通道所致。先用六君子汤两剂，又用五苓散两剂而痊愈。（《妇人良方》记载为先用五苓散两剂而愈，又用补中益气汤而安。）
沈明生治疗叶惟和的妻子，月夜探亲，她的母亲留她吃饭，当时春寒料峭，归途中即觉得肌肤寒冷战栗。第二天早上又对着窗户梳头，再次感受邪气，无发热但怕冷，胸膈闷塞。一位医生见她肌表没有发热，竟然当作食伤太阴主治，急忙用大黄泻下，不仅不排便，反而导致水道闭涩。更奇怪的是，白色腥秽之物如膏淋状，从大肠而来，连绵不绝，逐渐导致身体萎弱，骨瘦如柴难以支撑。诊察发现，脉沉而涩，可知是虚寒，计只有温中益元的方法。然而担心大便尚且结滞，小便未行，或许有胀满的祸患。于是先用五苓散倍加肉桂，一服药后水道果然通畅，再服药后宿垢一并排出。随后用附子理中汤三四剂，之后白色分泌物逐渐停止。再用十全大补汤，调理一个月而平安。白淫白沃，记载在灵兰之典中，都是指从前窍中来，现在却转移到后窍，为什么呢？大概这个病始终是一寒症，起初是因为食物在胃脘之上，火衰不能熟腐，而过早地泻下，则有形之物不能立即下降，而无形之寒邪抑遏在阑门之际，遂致清浊混淆，涓涓不息，看似淋带，实则不是淋带。如今先用五苓散分利阴阳，而倍加肉桂，使寒邪随尿液泄出，上下宣通。继以理中类的药剂，撤去其余邪，鼓动阳气，使脾土湿燥适宜，而浊流有节制，疗效应该像击鼓应声那样迅速。起初用通大便的药，大便不行，并导致小便赤涩。如今用利小便的药，小便即利，并导致大便也通，其中的得失如何呢？
董魏如说：膀胱有下口而无上口，下口则通乎宗筋，宗筋本为精道，而溺也同出于此，则宗筋虽然是一个口，其内实则是精道和溺道两个口。所以膀胱虽然系于肠旁，而与肠不相通。凡是论述交肠症的，都说阑门不清，以致清浊混乱，所以大小便位置互换而出。夫阑门是大肠小肠交接的门户，虽然说不清，但二便各有排出的道路，又怎么能突然互换位置而出呢？我私下认为交肠一症，是屎出前阴，尿出后孔的症状。尿出后孔者，是水气并入大肠，自阑门不能泌别清浊，可以用阑门不清来论述。若屎出前阴者，乃是肠膀并破的症状，如果不是肠穿破则屎从何窦而出？膀胱不破，则屎从何窦而入？一定要肠穿膀破，而后屎溺才得以互换位置而出。又必须破损之处，其窦贴连，而后才能出入无误。我曾验证动物的膀胱，都附于大肠的募穴，与广肠下连。所以肠膀一通，而便可易位，否则很难称之为交。我治疗交肠症四五人，都是在难产之后得的，其为肠膀破损，不言而喻。我的轿夫朱姓者，三十多岁，素患血疝，每年发作两三次，遇寒则发，服用温降药随即缓解。其发作必攻痛腹肋，甚则攻胸，于是呕血一两口，这是手足厥阴经的症状，习以为常。忽然冬天遇寒陡发，囊肿如石头，时值岁末，服药一二剂，回家过年。正月初疝症愈，而囊痈竟成，不数日大溃，囊中流粪，大便不行，肚腹两角连串肿赤，复成肚角痈，三五日而溃，也是屎脓并出。一囊一腹连串洞穿者六个，人虽羸瘦，而语言自如，饮食如常。睾丸囊的系带，上连广肠，系损而及肠，膜破而屎出，这是医书已有记载的。若腹痈溃而屎出，是必定大小二肠先结痈而内溃，所以再由外痈而出。否则腹痈虽穿，而肠不破，屎又从哪里出来呢？此症溃烂，在正月七日，到三月十七日才开始不食，十八日屎从口出，三天后死亡。才知道肠断即死，肠破未即死也。所以交肠和囊痈二证，多有治愈的。
(Interchanging Intestines syndrome also occurs in men.)
Zhang Luyu treated the wife of a stonemason named Zhan. Five or six days postpartum, lochia (postpartum vaginal discharge) failed to flow, accompanied by abdominal distension and fullness with panting. Stool was discharged from the anterior orifice (vagina). Upon inquiry into the cause, it was found that she had a strong habit of smoking and drinking alcohol. The newborn child was soft-bodied without bones, causing fright, which led to this condition. A decoction of Xiong Gui Tang (Safflower and Angelica Decoction) was prescribed with added Ezhu (Curcuma zedoaria Rhizome), Rougui (Cinnamon Twig Bark), and charred Shan Zha (Crataegus Fruit). After one dose, lochia flowed freely, and urination and defecation returned to normal.
Lu Shengxiang’s daughter, aged four, suffered from bloody dysentery in early autumn, with loose stool discharging from the anterior orifice. It was treated as disharmony of cold and heat combined with food stagnation. Wuling San (Five-Ingredient Poria Decoction) was administered, followed by Xianglian Wan (Coptis Pill), resulting in recovery after two doses.
Qian Jifu’s daughter, aged thirteen, was obese with abundant phlegm. Due to a burglary at her neighbor's house, she developed fever, headache, vomiting, and a greenish complexion. Her six pulses were wiry and rapid. Urination and defecation had swapped positions. This was attributed to qi chaos caused by fright, with phlegm invading the ends of the orifices. Siqi Tang (Four-Substance Decoction) was given, along with Mengshi Guntan Wan (Fluorite Rolling Phlegm Pill) to open the phlegm and regulate qi, thereby stabilizing the condition.
Yu Jiayan treated Jiang Yiren who presented with a bizarre symptom. Reviewing *Bencao Jing Shulou* (Elucidations on Materia Medica), which suggested using Wuling San for Interchanging Intestines, Yu considered it mysterious. Yu stated: "Interchanging Intestines" refers to the swapping of urinary and fecal outlets. Ancient use of Wuling San was specifically designed to promote urination. If the posterior orifice is blocked and both urine and stool exit via the anterior orifice, naming it 'Interchanging Intestines' is indeed somewhat misleading. Moreover, Interchanging Intestines is an acute disease characterized by sudden qi chaos in the middle jiao. This case, however, is a chronic illness involving gradual depletion of blood internally, differing by miles. The disease originated from worry and thought damaging the Spleen. Spleen damage impairs its ability to control blood, leading to erratic downward bleeding resembling metrorrhagia, actually termed 'Tuoying' (Depleted Camp). It requires vigorous tonification and consolidation. Instead, cooling blood and clearing fire treatments were mistakenly used, exacerbating the loss of blood until the blood of the Hand-Yangming Large Intestine channel gradually vanished. Thus, after blood exhaustion, qi became chaotic; due to qi chaos, food and water abandoned their old pathways and merged into one. The Large Intestine dried up, the pylorus suddenly closed, and food no longer underwent separation of clear and turbid substances, causing both to exit via the anterior orifice. Only by restoring patency to the Large Intestine, allowing waste to follow its original path, would treatment be correct. What relevance does Wuling San have? Furthermore, Wuling San’s potential to deplete yin is strictly contraindicated for those with blood loss. During initial diagnosis, I asked if the patient cried frequently. She replied, "Constantly." I realized that patients with Zang Zao (Organ Dryness) often cry. When the Large Intestine function fails, this is not Interchanging Intestines! The pulse of the Large Intestine appeared prominent and knotted under my fingers, indicating a critical time. Prediction: symptoms would resolve when jujube leaves sprout in spring. Indeed, they did. (Note: This remains Interchanging Intestines syndrome, but differs from cases of sudden qi chaos.)
I propose treating this with Jiling Gao (Jiling Paste), heavily dosed with Renshen (Ginseng Root) to tonify and moisten the Lung. The Lung and Large Intestine are exterior-interior pairs governing qi. The Lung is the official of transmission, where regulation arises. Nourishing the Lung clears Large Intestine dryness. Adding Gouqi (Lycium Fruit), Donghua (Winter Date Palm Flower/Leaves - likely referring to Tian Dong/Mai Dong contextually or specific herbs like Dong Gua Ren/Zi Xia, but here likely Tian Dong/Mai Dong for yin), and Mai Dong (Ophiopogon Tuber) nourishes the dryness from blood loss. Then the old paths restore, and clear/turbid separate naturally.
Xue Lizhai treated a puerperal woman whose urine contained feces, named Da Xiao Chang Jiao (Great and Small Intestine Interchange). This resulted from deficiency of both qi and blood, causing deviation from normal pathways. Six Junzi Tang (Six-Gentleman Decoction) was given for two doses, followed by Wuling San (Five-Ingredient Poria Decoction) for two doses, resulting in cure. (*Fu Ren Liang Fang* records: Wuling San for two doses first, then Buzhong Yiqi Tang for stabilization.)
Shen Mingsheng treated the wife of Ye Weihe. On a moonlit night visiting relatives, her mother kept her for dinner. Spring chill was sharp; on the way back, she felt severe chills. The next morning, combing hair by the window, she contracted another pathogen. Symptoms included aversion to cold without fever and chest/diaphragmatic oppression. One physician, noting no surface heat, diagnosed Food Injury to the Taiyin and abruptly used Dahuang (Rhubarb Root) to purge. Not only did defecation fail, but urination also became obstructed. More strangely, white, foul-smelling matter resembling creamy gonorrhea discharge emerged continuously from the Large Intestine. The body grew emaciated and skeletal. Pulse was deep and choppy, indicating deficiency-cold. The method must be warming the middle and benefiting yuan qi. However, fearing constipation and urinary retention might cause distension, Shen first used Wuling San (Five-Ingredient Poria Decoction) with doubled Rougui (Cinnamon Twig Bark). After one dose, urination flowed; after two, retained feces passed. Subsequently, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) was given for three to four doses, stopping the white discharge. Finally, Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) was used for one month for recovery. Baiyin and Baiwo (White Leukorrhea/Gonorrhea) are recorded in *Linglan Zhidian*, originating from the anterior orifice. Why transfer to the posterior? This disease is fundamentally cold. Initially, food remained above the stomach due to deficient fire failing to cook it. Premature purging prevented有形 (solid) matter from descending, while无形 (intangible) cold oppressed the Lanmen (Gate of Separation between small and large intestines). Clear and turbid mixed, flowing incessantly, mimicking leukorrhea/gonorrhea but distinct. First, Wuling San separated yin and yang; doubled Rougui expelled cold via urine, unblocking upper and lower. Then Lizhong formulas removed residual pathogens and boosted yang, drying spleen dampness and controlling turbid flow. Efficacy was swift. Initially, purgatives failed to move bowels and worsened urinary burning. Now, diuretics promoted urination and simultaneously moved bowels. Compare the gain and loss.
Dong Weiru stated: The Bladder has a lower orifice but no upper orifice. The lower orifice connects to the Zongjin (Confluence Vessels). Zongjin serves as the spermatic channel, yet urine also exits here. Thus, although Zongjin is one opening, internally it comprises two channels: spermatic and urinary. Although the Bladder lies beside the intestines, it does not connect to them. Discussions on Interchanging Intestines attribute it to unclear Lanmen causing mixed clear/turbid and swapped outlets. But Lanmen is the junction of Small and Large Intestines. Even if unclear, each outlet has its own path; how can they swap? I believe Interchanging Intestines involves stool exiting the anterior orifice and urine the posterior. Urine from the posterior implies water qi merging into the Large Intestine, failing to separate clear/turbid at Lanmen—this fits 'unclear Lanmen'. However, stool from the anterior orifice indicates rupture of both intestine and bladder. Without intestinal perforation, where does stool come from? Without bladder rupture, where does stool enter? Both must rupture for swapping. The rupture sites must be adjacent for seamless exchange. Examining animal bladders, they attach near the Dachang (Large Intestine) Mu point and connect to the Guangchang (Rectum). Thus, intestinal-bladder connection allows swapping. I treated 4-5 cases post-difficult labor, implying intestinal-bladder rupture. My sedan-chair bearer, surnamed Zhu, aged 30+, suffered Blood Hernia twice yearly, triggered by cold, relieved by warming-descending herbs. Attacks caused abdominal/flank pain radiating to chest, sometimes hematemesis (Hand-Foot Jueyin signs). In winter, sudden attack caused stone-hard scrotal swelling. He took 1-2 doses before New Year. By Jan, hernia resolved, but Scrotal Carbuncle formed. Days later, it ulcerated, discharging feces from the scrotum. Bowel obstruction ensued. Abdominal angles swelled red, forming Du Jiao Yong (Abdominal Angle Carbuncle), ulcerating in 3-5 days with pus and feces. Six holes connected scrotum and abdomen. Though emaciated, speech and appetite remained normal. Testicular cords connect to Rectum; cord damage affects intestine; membrane rupture expels feces (recorded in texts). If abdominal carbuncle ulcerates with fecal discharge, Small/Large Intestines must have abscessed internally first, then ruptured externally. Otherwise, external rupture without internal intestinal break cannot expel feces. This case ulcerated Jan 7th. Anorexia started Mar 17th. Feces vomited Mar 18th. Death occurred 3 days later. Conclusion: Intestinal severance causes immediate death; intestinal rupture does not. Thus, Interchanging Intestines and Scrotal Carbuncle cases often recover.