葱白（四两） 干姜（一两） 附子（一枚生用去皮破八片）上三味以水三升煮取一升去滓分温再服（内经曰肾苦
燥急食辛以润之葱白之辛以通阳气姜附之辛以散阴寒）
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片） 人尿（五合） 猪胆汁（一合）以上三味以水三升煮
取一升去滓纳胆汁人尿和令相得分温再服如无猪胆亦可用（内经曰若调寒热之逆冷热必行则热物冷服下嗌之后冷体既消
热性便发由是病气随愈呕哕皆除情且不违而致大益此和人尿猪胆汁咸苦寒物于白通汤热剂中要其气相从则可以去格拒
之寒也）
张 或谓白通汤及白通加猪胆汤真武汤与通脉四逆汤皆为少阴下利而设除用姜附相同其余之药俱各殊异何也盖
病
殊则药异夫少阴下利寒气已甚非姜附则不能治然下利之理无殊而兼有之证不一用药故不同耳亦各从其宜也如白通汤用
姜附以散寒止利加葱白以通调阳气若利而干呕烦者寒气太甚内为格拒姜附非烦者之所宜姜附必呕而不纳加人尿猪胆汁
于白通汤中候温冷而服之人尿猪胆汁皆咸苦性寒之物是以纳而不阻至其所则冷体既消热性便发真武汤治少阴病二三日
不已至四五日腹满小便不利四肢沉重疼痛自下利者为有水气故多或为之证夫水气者寒湿也肾主之肾病不能制水水饮停
蓄为水气腹痛寒湿内甚也四肢沉重疼痛寒湿外甚也小便不利自下利者湿甚而水谷不能别也经曰脾恶湿甘先入脾茯苓白
术之甘可以益脾逐水寒湿所胜平以辛热湿淫所胜佐以酸辛附子芍药生姜之酸辛以温经散湿太阳篇中小青龙汤证亦为有
水气故多或为之证如真武汤者不殊此理也通脉四逆治少阴下利清谷里寒外热手足厥逆脉微欲绝者为里寒身热恶寒而面
色赤为外热此阴甚于内格阳于外不相通与通脉四逆汤以散阴通阳其或为之证根据法加减而治之以上四证俱云下利而兼有
或为之证不一是以用药大同而小异也又曰或云白通汤用附子凡四证惟真武汤一证熟用余皆生用何也凡附子生用则温经
散寒非干姜佐之则不可炮熟则益阳除湿用生姜相辅以为宜矣干姜辛热故佐生附为用生姜辛温少资熟附之功原佐使之元
无出此理然白通等汤以下利为重其真武汤证以寒湿为先故用药有轻重之殊耳盖寒淫风湿大体颇同如太阳下编桂枝附子
汤治寒湿相搏附子亦用炮熟仍用生姜以佐之其生熟之用轻重之分无过此理也
少阴病咳而下利谵语者被火气劫故也小便必难以强责少阴汗也（成 咳而下利者里寒而亡津液也反以火劫强责少阴
汗者津液内竭加火气烦之故谵语小便难也）少阴病下利便脓血者可刺少阴病下利脉微涩呕而汗出必数更衣反少者当其上
灸之少阴病脉紧至七八日自下利脉暴微手足反温脉紧反去者为欲解也虽烦下利必自愈少阴病脉微沉细欲卧汗出而烦欲
吐自下利复烦躁不得寐者死少阴病下利止而头眩时时自冒者死（庞 此合是少阳冒昧汗 然出脉匀小浮者生少阴无眩冒
之证）少阴病恶寒身蜷而利手足逆冷者不治
厥阴 伤寒始发热六日厥反九日而利凡厥利者当不能食今反能食者恐为除中食以索饼不发热者知胃气尚在必愈恐
暴热来出而复去也后三日脉之其热续在者期之旦日夜半愈所以然者本发热六日厥反九日复发热三日并前六日亦为九日
与厥相应故期之旦日夜半愈后三日脉之而脉数其热不罢者此为热气有余必发痈脓也（详厥）伤寒先厥后发热下利必自止
而反汗出咽中痛者其喉为痹发热无汗而利必自止若不止必便脓血便脓血者其喉不痹 下利寸脉反浮数尺中自涩者必清
脓血（黄连阿胶汤黄芩汤成 下利者脉当沉而迟反浮数者里有热也涩为无血尺中涩者肠胃血散也热随利下必便浓血清与
圊通脉经曰清者厕也）热利下重者白头翁汤主之（利则津液少热则伤气气虚下利致后重也与白头翁汤散气浓肠）下利欲
饮水者以有热故也白头翁汤主之（渴自利不为脏寒与四逆以温脏下利饮水为有热与白头翁汤以凉中按少阴自利而渴乃下
焦虚寒而用四逆者恐不可以渴不渴分热寒也正当以小便黄白别之耳）
白头翁汤方
白头翁（二两） 黄柏 秦皮 黄连（各三两）上四味以水七升煮取二升去滓温服一升不愈更服一升（内经曰肾欲
坚急食苦以坚之利则下焦虚是以纯苦之剂坚之）
下利脉数有微热汗出今自愈设复紧为未解（干姜黄连人参汤）下利脉数而渴者今自愈设不瘥必清脓血以有热故也（黄
连汤）下利脉沉弦者下重也脉大者为未止脉微弱数者为欲自止虽发热不死（成 沉为在里弦为拘急里气不足是主下重大
则病进为利未止脉微数弱者邪气微而阳气复为欲自止虽发热止由阳胜非大逆也脉沉弦四逆之类脉大葛根黄芩黄连汤）伤
寒六七日大下后寸脉沉而迟手足厥逆下部脉不至咽喉不利唾脓血泄利不止者为难治麻黄升麻汤主之（成 伤寒六七日邪
传厥阴之时大下之后下焦气虚阳气内陷寸脉迟而手足厥逆下部脉不至厥阴之脉贯膈上注肺循喉咙在厥阴随经射肺因亡
津液遂成肺痿咽喉不利而唾脓血也金匮要略曰肺痿之病从何得之被快药下利重亡津液故得之若泄利不止者为里气大虚
故云难治与麻黄升麻汤以调肝肺之气）
麻黄升麻汤方
麻黄（去节二两半） 升麻 当归（各一两二钱半） 知母 黄芩 葳蕤（各十八铢） 石膏（碎绵裹） 白术 干
姜芍药 天门冬（去心） 桂枝 茯苓 甘草（炙各六铢）
上十四味以水一斗先煮麻黄一两沸去上沫纳诸药煮取三升去滓分温三服相去如炊三斗米顷令尽汗出愈（成 玉函曰
大热之气寒以取之甚热之气以汗发之麻黄升麻之甘以发浮热正气虚者以辛润之当归桂姜之辛以散寒上热者以苦泄之知
母黄芩之苦凉心去热津液少者以甘润之茯苓白术之甘缓脾生津肺燥气热以酸收之以甘缓之芍药之酸以敛逆气葳蕤门冬
石膏甘草之甘润肺除热）
厥阴病消渴气上撞心心中疼热饥而不欲食食则吐蛔下之利不止（详厥阴病）伤寒四五日腹中痛若转气下趣少腹者此
欲自利也（详腹痛）脉浮而迟表热里热下利清谷四逆汤大汗出热不去内拘急四肢疼又下利厥逆而恶寒者四逆汤下利清谷
里寒外热汗出而厥者通脉四逆汤大汗若大下利而厥冷者四逆汤下利清谷不可攻表汗出必胀满四逆汤伤寒先厥后发热而
利者必自止见厥复利四逆汤下利脉沉而迟其人面少赤身有微热下利清谷者必郁冒汗出而解病患必微厥下虚故也四逆汤
下利后脉绝手足厥冷 时（周时也）脉还手足温者生脉不还者死（或用白通汤通脉四逆汤）下利后更烦按之心下濡者虚
烦也栀子豉汤下利谵语有燥屎也宜小承气汤下利手足厥冷无脉者灸之不温若脉不还反微喘者死少阴负趺阳者为顺也（少
阴肾水趺阳脾土下利为肾邪干脾水不胜土则为微邪故为顺也）下利有微热而渴脉弱者今自愈伤寒发热下利厥逆躁不得卧
者死伤寒发热下利至甚厥不止者死（金匮要略曰六腑气绝于外者手足寒五脏气绝于内者利下不禁）伤寒六七日不利便发
热而利其人汗出不止者死有阴无阳故也（伤寒至七日为邪正相争之时正胜则生邪胜则死始不下利而暴忽发热下利汗出不
止者邪气胜正阳气脱也故死）伤寒下利日十余行脉反实者死（下利者里虚也脉当微弱反实者邪气胜也故死难经曰脉不应
病病不应脉是为死病）发热而厥七日下（利者）为难治（发热而厥邪传里也至七日传经尽则正气胜邪当汗出而解反下利
则邪气胜里气虚为难治）
戴 自利须辨阴阳三阳自利各于本经见之太阳与阳明合病下利头痛腰疼肌热目疼鼻干宜葛根汤太阳与少阳合病
下
利身热胸胁痞满而呕或往来寒热目疼鼻干宜大柴胡汤大抵阳热之利与阴寒之利自不同阳利粪色必焦黄热臭出作声脐下
必热得凉药则止得热药愈增阴利必洞下清谷粪色或白或淡黄脐下多寒宜温中止泻之剂此阴利阳利指阴阳二气而言非曰
阴阳二经也缘阴中亦自有阳利不可因下利便以为阴也又有内不大满犹生寒热未可下而便下之内虚热入挟热自利脐下必
热大便赤黄色及下肠间津汁垢腻名曰利肠宜白头翁汤黄芩汤要知均为自利身不热手足自温者太阴身体四逆者少阴厥阴
其余身热下利皆属阳经然阴利有反发热或初病无热利后却热或初得病即身热继而自利此阴利非阳传阴经之利详见前条
发热证又有大便五六日以药利之利遂不止用极热剂方瘥阳有利阳有秘当更以他证别之外热内烦下利上渴或痞或痛或呕
常法多用黄芩汤半夏泻心汤亦可不若生姜泻心汤之当用温胆汤加入黄连其中枳壳去取在人
吴 凡自利者不因攻下而自泻利俗言漏底伤寒是也有协热有协寒俱宜详辨原病式曰泻白为寒青黄红黑皆为热也
太
抵泻利完谷不化色不变有如惊溏或吐利腥臭小便澄澈清冷口无燥渴其脉或沉细或迟微无力或身虽热手足逆冷恶寒蜷卧
此皆为寒也凡热证则口中燥渴小便或黄赤或涩而不利或所下如垢腻之状其脉多数或浮或滑或弦或大或洪或有邪热不杀
谷其物不消化者当以脉证别之凡胃虚内热烦渴泻利脉弱者七味人参白术散若发热者参胡三白汤去黄芩加炒黄连若腹满
小便不利者五苓散合理中汤若呕者加藿香半夏生姜陈皮如湿多而泻不止者加苍术白术如腹胀者加浓朴腹疼不止加炒白
芍肉桂木香温之凡伤寒作利脉浮表未解者仲景以小青龙汤去麻黄加荛花二钱炒令赤色盖散表邪兼治水也若小便不利大
便水泻不止者宜五苓散水甚不解亦加荛花一钱以行水水行利自止也凡下利不可发汗当先治利止内实正气得复邪气得解
则汗出而愈也盖利下由内虚若加发汗则内外皆虚变证为难治也
附
活 寒毒入胃者脐下必寒腹胀满大便黄白或青黑或下利清谷宜四逆汤理中汤白通加附子汤四逆加薤白散挟热利
者
脐下必热大便赤黄色及肠间津液垢腻宜黄芩汤白头翁汤三黄熟艾汤薤白汤赤石脂丸
三黄熟艾汤 治伤寒四日而大下热利时作白通汤诸药多不得止宜服此汤除热止利
黄芩 黄连 黄柏 熟艾（半鸡子大） 上 咀水煎温服
薤白汤 治伤寒下利如烂肉汁赤带下伏气腹痛诸热悉皆主之
豆豉（半合绵裹） 薤白（一握） 山栀（七枚）上 咀用水二升半先煮栀子十沸下薤白煎至二升下豉煎取一升二
合温服
赤石脂丸 治伤寒热利
赤石脂 干姜（炮各一两） 黄连 当归（各二两）为末炼蜜丸如桐子大每服三十丸米（饮下）日三服湿毒瓦斯盛者
利下腹痛大便如脓血或如烂肉汁宜桃花汤地榆散黄连阿胶汤
地榆散 治伤寒热毒不解日晚即壮热腹痛便利脓血
地榆 犀角屑 黄连（炒） 葛根（各一两） 栀子（半两） 黄芩（一两）上 咀每服五钱水一盏入薤白五寸同
煎温服
海 黄连阿胶汤 治伤寒热毒入胃下利脓血
黄芩（炒二两） 山栀（半两） 阿胶（炒） 黄柏（各一两）上 咀每服四钱水煎服
云 伤寒汗下后大小便利而腹中痛者宜燥肠丸
附子（炮一枚） 龙骨（半两） 干姜（一两） 吴茱萸 粟壳 诃黎皮（各半两）为细末酒糊丸桐子大每服三十
丸温水下利止勿服
伤寒汗下后里急后重下利者宜七宣丸
大黄（一两） 木香 槟榔 柴胡 诃子皮 甘草（各半两） 桃仁（三十枚去皮尖）上为细末炼蜜丸如桐子大每
服五十丸温水下
伤寒汗下后气逆利不止者寒也宜枳实芍药甘草汤
芍药 甘草 枳实（炒） 干姜（炮各半两）上 咀每服三钱水煎服
【葱白汤】
葱白（四两） 干姜（一两） 附子（一枚，生用，去皮，破成八片）以上三味药，用水三升，煎煮取汁一升，去渣，分两次温服。（《内经》说：肾恶燥，急食辛以润之。葱白的辛味能通调阳气，姜、附的辛味能驱散阴寒。）
【白通加猪胆汁汤方】
葱白（四茎） 干姜（一两） 附子（一枚，生用，去皮，破成八片） 人尿（五合） 猪胆汁（一合）以上五味药，用水三升，煎煮前三种药取汁一升，去渣，纳入胆汁和人尿，调和均匀，分两次温服。如果没有猪胆，也可以用其他替代品。（《内经》说：如果调理寒热逆乱，冷热相争，那么热药冷服，咽下之后，冷性消散，热性便发作，因此病气随之痊愈，呕吐哕逆皆除，情志不违而获得大益。这是将人尿、猪胆汁等咸苦寒之物加入白通汤的热剂中，取其气味相从，从而消除格拒之寒邪。）
张景岳曰：有人问白通汤及白通加猪胆汁汤、真武汤与通脉四逆汤，都是为少阴病下利而设，除了都用姜、附相同外，其余药物各不相同，为什么呢？这是因为病情不同所以用药不同。少阴病下利，寒气已经非常严重，不用姜、附则不能治疗。然而下利的机理没有区别，但兼夹的症状不一，所以用药也不同，各取适宜罢了。比如白通汤用姜、附来散寒止利，加葱白来通调阳气。如果下利且伴有干呕、心烦，说明寒气太甚，在体内形成格拒，姜、附对于心烦者不宜，因为姜、附会导致呕吐且不纳受。所以在白通汤中加入人尿、猪胆汁，待其变冷后服用。人尿、猪胆汁都是咸苦性寒之物，所以进入体内不会受阻，等到冷性消散，热性便发作。真武汤治疗少阴病二三日未愈，至四五日出现腹胀满、小便不利、四肢沉重疼痛、自下利，这是有水气所致，所以多有或然证。所谓水气，就是寒湿，由肾所主。肾病不能制约水液，水饮停蓄成为水气。腹痛是因为寒湿内盛；四肢沉重疼痛是因为寒湿外盛；小便不利、自下利是因为湿盛而水谷不能分别。《经》说：脾恶湿，甘先入脾。茯苓、白术的甘味可以健脾逐水。寒湿所胜，用平性的辛热药；湿淫所胜，佐以酸辛。附子、芍药、生姜的酸辛可以温经散湿。太阳篇中的小青龙汤证也是因为有水气，所以多有或然证，如真武汤的道理是一样的。通脉四逆汤治疗少阴病下利清谷、里寒外热、手足厥逆、脉微欲绝，这是里寒身热、恶寒而面色赤为外热。这是阴寒盛于内，格阳于外，不相交通，用通脉四逆汤来散阴通阳。其或然证根据法则加减治疗。以上四个证候都说是下利，但兼夹的或然证不一，所以用药大同小异。又有人说：白通汤用附子，凡四个证候中只有真武汤一证用熟附子，其余都用生附子，为什么？凡是附子生用则温经散寒，非干姜辅助不可；炮熟则益阳除湿，用生姜相辅为宜。干姜辛热，所以辅助生附子发挥作用；生姜辛温，稍微资助熟附子的功效。原本辅佐的原理没有超出这个道理。然而白通等汤以下利为重症，真武汤证以寒湿为先，所以用药有轻重之分。大概寒淫风湿大体相似，如太阳编下的桂枝附子汤治疗寒湿相搏，附子也用炮熟的，仍用生姜来辅助。这生熟之用、轻重的区分，没有超过这个道理的。
少阴病咳嗽而下利，说胡话的，是被火气劫夺津液所致。小便必定困难，因为强行索取少阴汗液。（成无己注：咳嗽而下利，是里寒而亡失津液。反而用火劫法强行索取少阴汗液，导致津液内竭，加上火气烦扰，所以说胡话，小便难。）少阴病下利，大便带脓血的，可以针刺少阴经穴位。少阴病下利，脉象微涩，呕吐而汗出，必须频繁更衣却排便量少，应当在上部施灸。少阴病脉紧，到了七八天，自下利，脉突然变微弱，手足反而温暖，脉紧反而消失，这是将要痊愈的表现。虽然心烦下利，也一定会自愈。少阴病脉微沉细，想睡觉，汗出而心烦，想吐，自下利，又烦躁不得入睡的，死证。少阴病下利停止，但头晕目眩，时常自觉头昏蒙的，死证。（庞安时注：这应该是少阳病的头昏蒙汗出，但如果脉象匀小浮的还有一线生机。少阴病本无眩冒之证。）少阴病恶寒，身体蜷缩而下利，手足逆冷的，不治。
厥阴病：伤寒开始发热六天，厥冷反而九天而下利。凡是厥冷下利的，应当不能进食，现在反而能进食，恐怕是“除中”证。给吃索饼（面条），如果不发热，就知道胃气尚在，会痊愈；恐怕是暴热来去匆匆。三天后诊脉，如果热度持续存在，预期在第二天半夜痊愈。之所以这样，是因为本来发热六天，厥冷反九天，后来又发热三天，加上之前的六天，一共九天，与厥冷天数相应，所以预期在第二天半夜痊愈。三天后诊脉，如果脉数，热度不退，这是热气有余，一定会发痈脓。（详见厥阴病篇）伤寒先厥冷后发热，下利一定会自行停止，反而汗出、咽喉痛的，喉部会变成痹证。发热无汗而下利一定会自行停止，如果不停止，一定会便脓血。便脓血的，喉部不会痹。下利，寸脉反而浮数，尺中自涩的，一定会便脓血。（黄连阿胶汤、黄芩汤。成无己注：下利脉应当沉迟，反而浮数，说明里有热。涩为无血，尺中涩说明肠胃血散。热随利下，必便脓血。“清”与“圊”通，指厕所。）热利，肛门重坠的，白头翁汤主治。（下利则津液少，热则伤气，气虚下利导致后重，与白头翁汤散气浓肠。）下利想喝水的，因为有热，白头翁汤主治。（渴自利，不是脏寒，不与四逆汤温脏。下利饮水为有热，与白头翁汤凉中。按少阴自利而渴，乃是下焦虚寒，应用四逆汤，恐怕不可以仅凭渴不渴来分寒热，正当以小便黄白来辨别。）
【白头翁汤方】
白头翁（二两） 黄柏 秦皮 黄连（各三两）以上四味药，用水七升，煎煮取汁二升，去渣，温服一升，不愈再服一升。（《内经》说：肾欲坚，急食苦以坚之。下利则下焦虚，所以用纯苦之剂来坚固它。）
下利，脉数，有微热汗出，现在将要自愈。如果脉再次变紧，为未解。（干姜黄连人参汤）下利，脉数而口渴的，现在将要自愈。如果不愈，一定会便脓血，因为有热。（黄连汤）下利，脉沉弦的，是肛门重坠。脉大的，病未止。脉微弱数的，想要自行停止。虽然有发热也不死。（成无己注：沉为在里，弦为拘急，里气不足，主下重大。大则病进，为下利未止。脉微数弱者，邪气微而阳气复，为欲自止。虽有发热，只是由阳胜，并非大逆。脉沉弦属四逆之类，脉大属葛根黄芩黄连汤。）伤寒六七天，大下之后，寸脉沉而迟，手足厥逆，下部脉摸不到，咽喉不利，唾脓血，泄利不止的，为难治，麻黄升麻汤主治。（成无己注：伤寒六七天，邪传厥阴之时，大下之后，下焦气虚，阳气内陷。寸脉迟而手足厥逆，下部脉不至。厥阴之脉贯膈上注肺，循喉咙。因亡津液，遂成肺痿，咽喉不利而唾脓血。《金匮要略》说：肺痿之病从何得之？被快药下利，重亡津液，故得之。若泄利不止，为里气大虚，所以说难治。与麻黄升麻汤以调肝肺之气。）
【麻黄升麻汤方】
麻黄（去节二两半） 升麻 当归（各一两二钱半） 知母 黄芩 葳蕤（各十八铢） 石膏（碎，绵裹） 白术 干姜 芍药 天门冬（去心） 桂枝 茯苓 甘草（炙，各六铢）
以上十四味药，用水一斗，先煮麻黄一两沸，去掉上面的沫，纳入诸药，煮取三升，去渣，分三次温服。间隔时间如同做三斗饭的时间，让药尽，出汗即愈。（成无己注：《玉函经》说：大热之气，寒以取之；甚热之气，以汗发之。麻黄、升麻的甘味以发散浮热；正气虚者，以辛润之，当归、桂枝、干姜的辛味以散寒；上热者，以苦泄之，知母、黄芩的苦凉以清心去热；津液少者，以甘润之，茯苓、白术的甘味缓脾生津；肺燥气热，以酸收之，以甘缓之，芍药的酸味以敛逆气；葳蕤、门冬、石膏、甘草的甘味润肺除热。）
厥阴病：消渴，气上撞心，心中疼热，饥而不欲食，食则吐蛔，下之利不止。（详见厥阴病篇）伤寒四五天，腹中痛，如果有转气下趋少腹的，这是想要自下利。（详见腹痛篇）脉浮而迟，表热里热，下利清谷，四逆汤。大汗出，热不去，内拘急，四肢疼，又下利厥逆而恶寒的，四逆汤。下利清谷，里寒外热，汗出而厥的，通脉四逆汤。大汗或者大下利而厥冷的，四逆汤。下利清谷，不可攻表，汗出必胀满，四逆汤。伤寒先厥后发热而利的，必自止，见厥复利，四逆汤。下利脉沉而迟，其人面少赤，身有微热，下利清谷的，必郁冒汗出而解。病患必微厥，下虚的缘故，四逆汤。下利后脉绝，手足厥冷，过一个时辰脉搏恢复，手足温暖的，生；脉搏不恢复的，死。（或用白通汤、通脉四逆汤）下利后更烦，按之心下软的，是虚烦，栀子豉汤。下利谵语，有燥屎的，宜小承气汤。下利手足厥冷无脉的，灸之不温，如果脉搏不恢复，反而微喘的，死。少阴脉弱于趺阳脉的为顺。（少阴属肾水，趺阳属脾土。下利为肾邪干脾，水不胜土，则为微邪，故为顺。）下利有微热而渴，脉弱的，现在将要自愈。伤寒发热，下利厥逆，躁不得卧的，死。伤寒发热，下利至极，厥不止的，死。（《金匮要略》说：六腑气绝于外者，手足寒；五脏气绝于内者，利下不禁。）伤寒六七天，本不该下利却突发发热而下利，其人汗出不止的，死，有阴无阳的缘故。（伤寒至七天为邪正相争之时，正胜则生，邪胜则死。始不下利而暴忽发热下利汗出不止，是邪气胜正，阳气脱也，故死。）伤寒下利，一天十多次，脉反而实的，死。（下利者里虚，脉当微弱，反实者是邪气胜，故死。《难经》说：脉不应病，病不应脉，是为死病。）发热而厥，七天，下利的，为难治。（发热而厥，邪传里。至七天传经尽，则正气胜邪，当汗出而解，反下利，则邪气胜，里气虚，为难治。）
戴元礼曰：自利须辨别阴阳。三阳自利，各在本经显现。太阳与阳明合病下利，头痛腰疼，肌热目疼鼻干，宜葛根汤。太阳与少阳合病下利，身热胸胁痞满而呕，或往来寒热，目疼鼻干，宜大柴胡汤。大抵阳热之利与阴寒之利自然不同。阳利粪便颜色必焦黄，气味热臭，排出有声，脐下必热，得凉药则止，得热药愈增。阴利必洞泄清谷，粪便颜色或白或淡黄，脐下多寒，宜温中止泻之剂。此阴利阳利是指阴阳二气而言，不是说阴阳二经。因为阴中亦自有阳利，不可因下利就认为是阴证。又有内不大满，犹生寒热，未可下而便下之，内虚热入，挟热自利，脐下必热，大便赤黄色，及下肠间津汁垢腻，名叫“利肠”，宜白头翁汤、黄芩汤。要知道均为自利，身不热、手足自温的是太阴病，身体四逆的是少阴、厥阴病，其余身热下利皆属阳经。然而阴利有反发热，或初病无热，利后却热，或初得病即身热，继而自利，此阴利非阳传阴经之利，详见前条发热证。又有大便五六日用药利之，利遂不止，用极热剂才好转。阳有利，阳有秘，应当以他证别之。外热内烦下利，上渴或痞或痛或呕，常法多用黄芩汤、半夏泻心汤，也不如生姜泻心汤恰当。温胆汤加入黄连其中，枳壳去取，在于人的灵活运用。
吴球曰：凡是自利，不因攻下而自泻利，俗言漏底伤寒。有的是协热，有的是协寒，俱宜详辨。《原病式》说：泻白为寒，青黄红黑皆为热。大抵泻利完谷不化，颜色不变，有如惊溏，或吐利腥臭，小便澄澈清冷，口无燥渴，其脉或沉细或迟微无力，或身虽热手足逆冷，恶寒蜷卧，此皆为寒证。凡热证则口中燥渴，小便或黄赤或涩而不利，或所下如垢腻之状，其脉多数或浮或滑或弦或大或洪，或有邪热不杀谷，其物不消化者，当以脉证别之。凡胃虚内热烦渴泻利脉弱的，用七味人参白术散。若发热者，用参胡三白汤去黄芩加炒黄连。若腹满小便不利的，用五苓散合理中汤。若呕的，加藿香、半夏、生姜、陈皮。如湿多而泻不止的，加苍术、白术。如腹胀的，加厚朴。腹疼不止的，加炒白芍、肉桂、木香温之。凡伤寒作利，脉浮表未解的，仲景用小青龙汤去麻黄加荛花二钱，炒令赤色，盖散表邪兼治水也。若小便不利，大便水泻不止的，宜五苓散。水甚不解，亦加荛花一钱以行水，水行利自止也。凡下利不可发汗，当先治利，止内实正气得复，邪气得解，则汗出而愈也。盖利下由内虚，若加发汗，则内外皆虚，变证为难治也。
附录
活人书曰：寒毒入胃者，脐下必寒，腹胀满，大便黄白或青黑或下利清谷，宜四逆汤、理中汤、白通加附子汤、四逆加薤白散。挟热利者，脐下必热，大便赤黄色及肠间津液垢腻，宜黄芩汤、白头翁汤、三黄熟艾汤、薤白汤、赤石脂丸。
【三黄熟艾汤】 治伤寒四日而大下，热利时作，白通汤诸药多不得止，宜服此汤除热止利。
黄芩 黄连 黄柏 熟艾（半鸡子大） 上药切碎，水煎，温服。
【薤白汤】 治伤寒下利如烂肉汁，赤带下，伏气腹痛，诸热悉皆主之。
豆豉（半合，绵裹） 薤白（一握） 山栀（七枚） 上药切碎，用水二升半，先煮栀子十沸，下薤白煎至二升，下豉煎取一升二合，温服。
【赤石脂丸】 治伤寒热利。
赤石脂 干姜（炮，各一两） 黄连 当归（各二两） 为末，炼蜜丸如桐子大。每服三十丸，米饮送下，日三服。湿毒瓦斯盛者，利下腹痛，大便如脓血或如烂肉汁，宜桃花汤、地榆散、黄连阿胶汤。
【地榆散】 治伤寒热毒不解，日晚即壮热，腹痛便利脓血。
地榆 犀角屑 黄连（炒） 葛根（各一两） 栀子（半两） 黄芩（一两） 上药切碎。每服五钱，水一盏，入薤白五寸同煎，温服。
海藏曰：【黄连阿胶汤】 治伤寒热毒入胃，下利脓血。
黄芩（炒二两） 山栀（半两） 阿胶（炒） 黄柏（各一两） 上药切碎。每服四钱，水煎服。
云岐子曰：伤寒汗下后，大小便利而腹中痛者，宜燥肠丸。
附子（炮一枚） 龙骨（半两） 干姜（一两） 吴茱萸 粟壳 诃黎皮（各半两） 为细末，酒糊丸桐子大。每服三十丸，温水下。利止勿服。
伤寒汗下后，里急后重下利者，宜七宣丸。
大黄（一两） 木香 槟榔 柴胡 诃子皮 甘草（各半两） 桃仁（三十枚，去皮尖） 上为细末，炼蜜丸如桐子大。每服五十丸，温水下。
伤寒汗下后，气逆利不止者，寒也，宜枳实芍药甘草汤。
芍药 甘草 枳实（炒） 干姜（炮，各半两） 上药切碎。每服三钱，水煎服。
[Scallion White Decoction]
Scallion White (Radix Allii Fistulosi, Congbai) (4 liang), Dried Ginger (Rhizoma Zingiberis Officinalis, Ganjiang) (1 liang), Prepared Aconite Root (Radix Aconiti Lateralis Preparata, Fuzi) (1 piece, used raw, skin removed, broken into eight pieces). The above three herbs are boiled in 3 sheng of water to obtain 1 sheng of decoction. Strain and divide into two warm doses. (*Neijing* states: The Kidney dislikes dryness; urgently eat pungent substances to moisten it. The pungency of Scallion White unblocks Yang Qi, while the pungency of Ginger and Aconite disperses Yin Cold.)
[Baitong Jia Zhuyedan Tang Formula]
Scallion White (Radix Allii Fistulosi, Congbai) (4 stems), Dried Ginger (Rhizoma Zingiberis Officinalis, Ganjiang) (1 liang), Prepared Aconite Root (Radix Aconiti Lateralis Preparata, Fuzi) (1 piece, used raw, skin removed, broken into eight pieces), Human Urine (Ren Niao) (5 he), Pig Bile (Zhu Danzhi) (1 he). Boil the first three herbs in 3 sheng of water to obtain 1 sheng of decoction. Strain, then add Pig Bile and Human Urine, mix well, and divide into two warm doses. If Pig Bile is unavailable, alternatives may be used. (*Neijing* states: When regulating reversed cold-heat, if cold and heat contend, taking hot medicine cold allows the cold nature to dissipate after swallowing, so the hot nature takes effect, curing the disease, stopping vomiting and hiccups, and bringing great benefit. This involves adding salty-bitter-cold substances like Human Urine and Pig Bile to the hot agent of Baitong Tang, relying on their qi to follow each other to eliminate the cold that causes rejection.)
Zhang Jingyue stated: Some ask why Baitong Tang, Baitong Jia Zhuyedan Tang, Zhenwu Tang, and Tongmai Sini Tang are all set for Shaoyin syndrome with diarrhea, yet besides using Ginger and Aconite, the remaining herbs differ greatly. This is because different diseases require different medicines. In Shaoyin diarrhea, the cold pathogen is severe; without Ginger and Aconite, it cannot be treated. However, although the mechanism of diarrhea is similar, accompanying symptoms vary, hence the different prescriptions, each chosen for appropriateness. For instance, Baitong Tang uses Ginger and Aconite to disperse cold and stop diarrhea, adding Scallion White to regulate Yang Qi. If diarrhea is accompanied by dry retching and irritability, the cold is too severe and causes internal rejection; Ginger and Aconite are unsuitable for irritability as they may induce vomiting and non-reception. Therefore, Human Urine and Pig Bile are added to Baitong Tang and taken when cool. These are salty-bitter-cold substances, so they enter without obstruction; once the cold nature dissipates, the hot nature takes effect. Zhenwu Tang treats Shaoyin syndrome where, after two or three days not resolving, by day four or five, abdominal fullness, difficult urination, heavy/painful limbs, and spontaneous diarrhea occur due to Water-Qi. Water-Qi refers to Cold-Dampness, governed by the Kidney. Kidney disease fails to control water, leading to fluid retention. Abdominal pain indicates severe internal Cold-Dampness; heavy/painful limbs indicate severe external Cold-Dampness; difficult urination and diarrhea indicate dampness overwhelming the separation of water and grain. The Classic says: The Spleen dislikes dampness; sweet flavors enter the Splein first. The sweetness of Poria (Fuling) and Atractylodes Macrocephala (Baizhu) tonifies the Spleen and expels water. For Cold-Dampness dominance, use neutral-pungent-hot drugs; for Dampness dominance, assist with sour-pungent drugs. The sour-pungency of Aconite, Peony, and Fresh Ginger warms meridians and disperses dampness. In the Taiyang chapter, Xiao Qinglong Tang syndrome also involves Water-Qi and has various variations, similar to the logic of Zhenwu Tang. Tongmai Sini Tang treats Shaoyin diarrhea with undigested food, interior cold with exterior heat, cold extremities, and faint pulse nearly imperceptible. Interior cold causes body heat, aversion to cold, and red facial color (exterior heat). This is Yin excess internally rejecting Yang externally, preventing communication. Tongmai Sini Tang disperses Yin and unblocks Yang. Its variable symptoms are treated according to modifications. These four syndromes all mention diarrhea with various accompanying symptoms, hence the major similarities but minor differences in medication. Another question: Why does Baitong Tang use Aconite, and among four syndromes, only Zhenwu Tang uses prepared Aconite while others use raw? Raw Aconite warms meridians and dispels cold, requiring Ginger's assistance; prepared Aconite tonifies Yang and removes dampness, suitably assisted by Fresh Ginger. Dried Ginger is pungent-hot, assisting raw Aconite; Fresh Ginger is pungent-warm, slightly aiding prepared Aconite. This principle applies generally. However, Baitong Tang prioritizes diarrhea, while Zhenwu Tang prioritizes Cold-Dampness, hence differences in dosage and preparation. Generally, Cold-Dampness is similar; e.g., Guizhi Fuzi Tang in Taiyang treats Cold-Damp binding, using prepared Aconite assisted by Fresh Ginger. This illustrates the principles of raw/prepared use and weight differentiation.
Shaoyin syndrome with cough and diarrhea, accompanied by delirium, results from Fire Qi robbing fluids. Urination will certainly be difficult due to forcing sweat from Shaoyin. (Cheng Wuji notes: Cough and diarrhea indicate interior cold and loss of body fluids. Using fire therapy to force Shaoyin sweat exhausts internal fluids; combined with Fire Qi irritation, delirium occurs, and urination becomes difficult.) Shaoyin syndrome with diarrhea and pus/blood in stool can be treated with acupuncture at Shaoyin points. Shaoyin syndrome with diarrhea, faint and choppy pulse, vomiting, sweating, frequent defecation attempts but small volume, should be treated with moxibustion on the upper body. Shaoyin syndrome with tight pulse, progressing to day seven or eight with spontaneous diarrhea, sudden weak pulse, warm extremities, and disappearance of tight pulse indicates impending resolution. Despite irritability and diarrhea, self-healing is expected. Shaoyin syndrome with faint, deep, fine pulse, desire to sleep, sweating, irritability, desire to vomit, spontaneous diarrhea, restlessness, and insomnia is a death syndrome. Shaoyin syndrome where diarrhea stops but dizziness and occasional vertigo occur is a death syndrome. (Pang Anshi notes: This resembles Shaoyang vertigo with sweating; if the pulse is uniform, small, and floating, there is hope. Shaoyin syndrome typically lacks vertigo.) Shaoyin syndrome with aversion to cold, curled body posture, diarrhea, and cold extremities is untreatable.
Jueyin syndrome: Cold damage begins with fever for six days, followed by nine days of coldness and diarrhea. Usually, coldness and diarrhea imply inability to eat; the ability to eat now suggests "Chu Zhong" (stomach energy exhaustion). Feeding wheat cakes: if no fever follows, stomach energy remains, and recovery is expected; otherwise, it may be a fleeting heat returning and leaving. Three days later, if pulse shows sustained heat, recovery is expected at midnight of the next day. This is because initial fever (6 days) + coldness (9 days) + subsequent fever (3 days) equals 9 days, matching the coldness duration, predicting recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. (See Jueyin chapter.) Cold damage starting with coldness then fever: diarrhea will stop spontaneously. If sweating and sore throat follow, throat bi occurs. If fever, no sweat, and diarrhea stop spontaneously, but continue, pus/blood in stool will occur. Pus/blood in stool precludes throat bi. Diarrhea with floating-rapid cun pulse and choppy chi pulse indicates pus/blood in stool. (Huanglian Ejiao Tang, Huangqin Tang. Cheng Wuji notes: Diarrhea pulse should be deep-slow; floating-rapid indicates interior heat. Choppy indicates blood deficiency; choppy chi pulse indicates intestinal blood dispersion. Heat follows diarrhea, causing pus/blood stool. "Qing" means toilet.) Hot diarrhea with tenesmus is treated with Baiteng Wang Tang. (Diarrhea depletes fluids; heat damages Qi. Qi deficiency causes tenesmus. Baiteng Wang Tang disperses Qi and thickens intestines.) Diarrhea with thirst indicates heat; treat with Baiteng Wang Tang. (Thirst with diarrhea is not organ cold, unlike Sini Tang warming organs. Thirst with diarrhea indicates heat, cooled by Baiteng Wang Tang. Note: Shaoyin spontaneous diarrhea with thirst is lower jiao deficiency-cold, treated with Sini Tang. Do not distinguish heat/cold solely by thirst; use urine color.)
[Baiteng Wang Tang Formula]
Baiteng Wang (Radix Pulsatillae, Baitengwang) (2 liang), Huangbai (Cortex Phellodendri, Huangbai), Qinpi (Cortex Fraxini, Qinpi), Huanglian (Rhizoma Coptidis, Huanglian) (each 3 liang). Boil these four herbs in 7 sheng of water to obtain 2 sheng. Strain, take 1 sheng warm. If ineffective, take another 1 sheng. (*Neijing* states: The Kidney desires firmness; urgently eat bitter substances to firm it. Diarrhea causes lower jiao deficiency, so pure bitter agents are used to firm it.)
Diarrhea with rapid pulse, slight fever, and sweating indicates self-resolution. If pulse becomes tight again, unresolved. (Ganjiang Huanglian Renshen Tang) Diarrhea with rapid pulse and thirst indicates self-resolution. If not resolved, pus/blood in stool will occur due to heat. (Huanglian Tang) Diarrhea with deep-choppy pulse indicates tenesmus. Large pulse indicates progression/unresolved. Weak-rapid pulse indicates impending resolution. Fever alone is not fatal. (Cheng Wuji notes: Deep indicates interior; choppy indicates tension/deficiency, causing tenesmus. Large pulse indicates disease progression. Weak-rapid indicates declining pathogen and recovering Yang. Fever here is due to Yang victory, not adverse. Deep-choppy pulse relates to Sini Tang types; large pulse relates to Gegen Huangqin Huanglian Tang.) Cold damage after six-seven days and drastic purgation: deep-slow cun pulse, cold extremities, absent lower pulses, blocked throat, spitting pus/blood, uncontrollable diarrhea is difficult to treat. Treat with Mahuang Shengma Tang. (Cheng Wuji notes: At day six-seven, pathogen enters Jueyin. Drastic purgation empties lower jiao Qi, sinking Yang. Deep-slow cun pulse and cold extremities reflect this. Jueyin meridian passes through diaphragm to lung and throat. Fluid loss causes Lung萎 (flaccidity), throat blockage, and pus/blood sputum. *Jingui Yaolue* states: Lung flaccidity comes from harsh purgatives causing severe fluid loss. Uncontrollable diarrhea means severe interior deficiency, hence difficult. Mahuang Shengma Tang regulates Liver-Lung Qi.)
[Mahuang Shengma Tang Formula]
Mahuang (Ephedrae Herba, Mahuang, removed nodes, 2.5 liang), Shengma (Cimicifugae Rhizoma, Shengma), Danggui (Angelicae Sinensis Radix, Danggui) (each 1.25 liang), Zhimu (Anemarrhenae Rhizoma, Zhimu), Huangqin (Scutellariae Radix, Huangqin), Weirui (Polygonati Odorati Rhizoma, Weirui) (each 18 zhu), Shigao (Gypsum Fibrosum, Shigao, crushed, wrapped in silk), Baizhu (Atractylodis Macrocephalae Rhizoma, Baizhu), Ganjiang (Zingiberis Rhizoma, Ganjiang), Shaoyao (Paeoniae Radix Alba, Shaoyao), Tianmendong (Asparagi Radix, Tianmendong, removed heart), Guizhi (Cinnamomi Ramulus, Guizhi), Fuling (Poria, Fuling), Gancao (Glycyrrhizae Radix et Rhizoma, Gancao, honey-fried) (each 6 zhu).
Boil these fourteen herbs in 1 dou of water. First boil Mahuang until boiling, remove foam. Add other herbs, boil to obtain 3 sheng. Strain, divide into three warm doses. Take doses spaced by the time it takes to cook three dou of rice. Sweating indicates cure. (Cheng Wuji notes: *Yuhan Jing* states: Great heat is taken by cold; extreme heat is released by sweat. Mahuang and Shengma's sweetness disperses floating heat. For deficient Zheng Qi, use pungent-moistening herbs: Danggui, Guizhi, Jiang's pungency disperses cold. For upper heat, use bitter-draining herbs: Zhimu, Huangqin's bitterness-coolness clears Heart heat. For low fluids, use sweet-moistening herbs: Fuling, Baizhu's sweetness soothes Spleen and generates fluids. For Lung dryness/heat, use sour-astringent and sweet-soothing herbs: Shaoyao's sourness restrains rebellious Qi. Weirui, Tianmendong, Shigao, Gancao's sweetness moistens Lung and clears heat.)
Jueyin syndrome: Excessive thirst, Qi rushing up to the heart, painful heat in the chest, hunger without desire to eat, vomiting roundworms upon eating, and worsening diarrhea after purgation. (See Jueyin chapter.) Cold damage on day four-five with abdominal pain and gas moving toward the lower abdomen indicates impending diarrhea. (See Abdominal Pain chapter.) Floating-slow pulse with exterior heat, interior heat, and diarrhea with undigested food requires Sini Tang. Profuse sweating with persistent heat, internal cramping, limb pain, plus diarrhea, cold extremities, and aversion to cold requires Sini Tang. Diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities requires Tongmai Sini Tang. Profuse sweating or drastic diarrhea with cold extremities requires Sini Tang. Diarrhea with undigested food: do not attack the exterior; sweating will cause abdominal fullness. Use Sini Tang. Cold damage starting with coldness then fever: diarrhea stops spontaneously; return of coldness brings back diarrhea. Use Sini Tang. Diarrhea with deep-slow pulse, slightly red face, slight body heat, and diarrhea with undigested food leads to depression/dizziness and sweating for resolution due to lower deficiency. Use Sini Tang. After diarrhea, if pulse vanishes and extremities are cold, pulse returning within one shichen (2 hours) with warm extremities indicates life; no return indicates death. (Use Baitong Tang or Tongmai Sini Tang.) After diarrhea, increased irritability with soft epigastrium indicates empty irritability; treat with Zhizi Chi Tang. Diarrhea with delirium indicates dry feces; use Xiaochengqi Tang. Diarrhea with cold extremities and no pulse: moxibustion if not warming. If pulse doesn't return and shallow panting occurs, death. If Shaoyin pulse is weaker than Fuyang pulse, it is favorable. (Shaoyin is Kidney Water; Fuyang is Spleen Earth. Diarrhea implies Kidney evil attacking Spleen; Water failing to overcome Earth is mild evil, hence favorable.) Diarrhea with slight fever, thirst, and weak pulse indicates self-resolution. Cold damage with fever, severe diarrhea, cold extremities, restlessness, and inability to lie down is death. Cold damage with fever, severe diarrhea, and persistent cold extremities is death. (*Jingui Yaolue* states: Six Fu organs failing externally cause cold hands/feet; Five Zang organs failing internally cause uncontrollable diarrhea.) Cold damage on day six-seven without prior diarrhea suddenly developing fever, diarrhea, and unstoppable sweating is death due to Yin excess and Yang absence. (Day seven is struggle between pathogen and healthy Qi. Victory of healthy Qi brings life; pathogen victory brings death. Sudden fever, diarrhea, and sweating indicate pathogen victory and Yang collapse.) Diarrhea occurring ten-plus times daily with strong pulse is death. (Diarrhea indicates interior deficiency; pulse should be weak/faint. Strong pulse indicates pathogen victory, hence death. *Nanjing* states: Pulse not matching disease, disease not matching pulse, is death.) Fever with coldness for seven days, followed by diarrhea, is difficult to treat. (Fever with coldness indicates pathogen entering interior. By day seven, transmission completes; healthy Qi should defeat pathogen via sweating. Diarrhea indicates pathogen victory and interior deficiency, hence difficult.)
Dai Yuanli stated: Spontaneous diarrhea must distinguish Yin and Yang. Three Yang spontaneous diarrhea manifests in their respective meridians. Taiyang-Yangming combined syndrome with diarrhea, headache, backache, muscle heat, eye pain, nasal dryness: Gegen Tang. Taiyang-Shaoyang combined syndrome with diarrhea, body heat, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, nasal dryness: Da Chaihu Tang. Generally, Yang-heat diarrhea differs from Yin-cold diarrhea. Yang diarrhea stools are dark yellow, hot-smelling, noisy, with warm umbilicus; relieved by cool meds, worsened by hot meds. Yin diarrhea presents as clear undigested food, white/pale yellow stools, cold umbilicus; treated with warming/astringent agents. "Yin/Yang diarrhea" refers to Qi natures, not meridians. Yin can have Yang diarrhea; do not assume all diarrhea is Yin. Internal deficiency with heat invasion causing hot diarrhea, warm umbilicus, dark yellow stools, or greasy intestinal fluids is called "Li Chang"; treat with Baiteng Wang Tang or Huangqin Tang. Note: Spontaneous diarrhea with normal body temperature and warm extremities is Taiyin; cold extremities are Shaoyin/Jueyin. Other heat-diarrhea cases belong to Yang meridians. However, Yin diarrhea may have rebound fever, post-diarrhea fever, or initial fever followed by diarrhea; this is not Yang transmitting to Yin. See previous Fever chapter. Also, prolonged laxative use causing unremitting diarrhea requires extreme hot meds to resolve. Yang has both diarrhea and constipation; differentiate by other signs. Exterior heat with interior irritability, diarrhea, thirst, oppression, pain, or vomiting often uses Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang is more appropriate. Wendan Tang with Huanglian, adjusting Zhike based on judgment.
Wu Qiu stated: Spontaneous diarrhea not caused by purgation is俗称 "Lou Di Shang Han". Differentiate heat-assisted vs. cold-assisted. *Yuan Bing Shi* states: White discharge is cold; green/yellow/red/black is heat. Generally, undigested food, unchanged color, loose stools, or foul vomiting/diarrhea, clear cold urine, no oral thirst, deep/faint/slow/weak pulse, or body heat with cold extremities/aversion to cold/curled posture indicates Cold syndrome. Heat syndrome features oral thirst, yellow/scanty/difficult urine, greasy discharge, rapid/floating/sliding/tight/large/hyperactive pulse, or undigested food due to heat. Differentiate by pulse/symptoms. Stomach deficiency with interior heat/thirst/diarrhea/weak pulse: Qiwei Renshen Baizhu San. With fever: Shenhu Sanbai Tang minus Huangqin, add fried Huanglian. With abdominal fullness/difficult urination: Wuling San combined with Lizhong Tang. With vomiting: add Huoxiang, Banxia, Shengjiang, Chenpi. With excessive dampness/unremitting diarrhea: add Cangzhu, Baizhu. With abdominal distension: Houpo. With persistent abdominal pain: fried Shaoyao, Rougui, Muxiang to warm. For cold damage with diarrhea, floating pulse, unresolved exterior: Zhang Zhongjing uses Xiao Qinglong Tang minus Mahuang, add 2 qian roasted Ruahua to scatter exterior pathogen and manage water. If difficult urination and watery diarrhea: Wuling San. If severe, add 1 qian Ruahua to move water; water movement stops diarrhea. Diarrhea should not be treated with sweating; treat diarrhea first. Once interior is solid, Qi recovers, pathogen resolves, and sweating occurs naturally. Diarrhea stems from interior deficiency; sweating causes dual deficiency, making complications difficult.
Appendix
Huoren Shu stated: Cold toxin entering stomach causes cold umbilicus, abdominal fullness, yellow/white/green/black stools or clear undigested food diarrhea: Sini Tang, Lizhong Tang, Baitong Jia Fuzi Tang, Sini Jia Xiebai San. Heat-associated diarrhea causes warm umbilicus, dark yellow stools, greasy intestinal fluids: Huangqin Tang, Baiteng Wang Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, Chishizhi Wan.
[Sanhuang Shuai Ai Tang] Treats cold damage after drastic purgation on day four, intermittent hot diarrhea unresponsive to Baitong Tang. Clears heat, stops diarrhea.
Huangqin, Huanglian, Huangbai, Shuai Ai (half egg size). Chop, decoct in water, take warm.
[Xiebai Tang] Treats cold damage diarrhea resembling rotten meat juice, bloody discharge, latent Qi abdominal pain, and various heats.
Douchi (half he, wrapped in silk), Xiebai (one handful), Shanzhi (seven fruits). Chop, boil in 2.5 sheng water. First boil Shanzhi for ten boils, add Xiebai, boil to 2 sheng, add Douchi, boil to 1.2 sheng. Take warm.
[Chishizhi Wan] Treats cold damage hot diarrhea.
Chishizhi, Pao Ganjiang (each 1 liang), Huanglian, Danggui (each 2 liang). Powder, honey pills like wattle seeds. 30 pills per dose, rice water, three times daily. For severe damp-toxin with abdominal pain and pus/blood-like stools: Taohua Tang, Diyü San, Huanglian Ejiao Tang.
[Diyü San] Treats unresolved cold damage heat-toxin, evening high fever, abdominal pain, pus/blood diarrhea.
Diyü, Xijiao Xie, Fried Huanglian, Gegen (each 1 liang), Shanzhi (0.5 liang), Huangqin (1 liang). Chop. 5 qian per dose, 1 cup water, add 5 cun Xiebai, decoct, take warm.
Haizang stated: [Huanglian Ejiao Tang] Treats cold damage heat-toxin entering stomach, pus/blood diarrhea.
Fried Huangqin (2 liang), Shanzhi (0.5 liang), Fried Ejiao, Huangbai (each 1 liang). Chop. 4 qian per dose, decoct in water.
Yunqi Zi stated: After cold damage sweating/purgation, free urination/defecation with abdominal pain: Zaochang Wan.
Pao Fuzi (1 piece), Longgu (0.5 liang), Ganjiang (1 liang), Wuzhuyu, Susuke, Helipi (each 0.5 liang). Fine powder, wine paste pills, wattle seed size. 30 pills per dose, warm water. Stop when diarrhea ceases.
After cold damage sweating/purgation, tenesmus and diarrhea: Qixuan Wan.
Dahuang (1 liang), Muxiang, Binglang, Chaihu, Hezipi, Gancao (each 0.5 liang), Taoren (30 kernels, peeled/cored). Fine powder, honey pills, wattle seed size. 50 pills per dose, warm water.
After cold damage sweating/purgation, rebellious Qi and unremitting diarrhea due to cold: Zhishi Shaoyao Gancao Tang.
Shaoyao, Gancao, Fried Zhishi, Pao Ganjiang (each 0.5 liang). Chop. 3 qian per dose, decoct in water.