〔薛〕 疮疡大便泄泻，或因寒凉克伐，脾气亏损；或因脾气虚弱，食不克化；或因脾
虚下陷，不能升举；或因命门火衰，不能生土；或因肾经虚弱，不能禁止；或因脾肾虚
寒，不能司职。所主之法，若寒凉伤脾，用六君加木香、砂仁，送二神丸。脾虚下陷，用
补中益气，送二神丸。命门火衰，用八味丸料，送四神丸。肾虚不禁，用姜附汤加吴茱
萸、五味。脾肾虚寒，用参附汤送四神丸。《病机》云∶脉沉而细，身不动作，睛不了了，
饮食不下，鼻准气息者，姜附汤主之。身重四肢不举者，参附汤主之。仲景先生云∶下
痢肠鸣，当温之。脉迟紧，痛未止，当温之。大孔痛，当温之。心痛当救里，可与理中、附
子四逆辈。《精要》云∶痈疽呕泻，肾脉虚者不治。此发《内经》之微旨也，凡此实难治
之症，如按前法治之，多有可生者。一妇年逾四十，背疽不起发，泄泻作呕，食少厥逆，
脉息如无，属阳气虚寒。用大补剂加附子、姜桂。不应，再加附子二剂，泻愈甚，更以大
附子、姜桂，各三钱，参 、归术各五钱，作一剂，腹内始热，呕泻乃止，手足渐温，脉
息随后。更用大补而溃，再用托里而敛，十年后，仍患脾胃虚寒而殁。
加减托里消毒散 治饮食少思，肠鸣腹痛，腹冷泄泻，乃脾气虚寒也，去芷翘、银
花，加炮姜、木香。手足逆冷，脾血虚寒也，更加附子，煎送四神丸。
和气散 治痈疽溃后，气虚滑泄，四肢逆冷。
苍术（四两，米泔浸三日，洗净晒干，再以米醋炒，令香黄色） 甘草（炙） 青皮（去穣，各一两）
良姜（炒） 肉桂 干姜（炮，各半两） 陈粟（半升）
上七味为末。每服一钱，用炒茴香末半钱相和，温酒调下，不拘时。（按∶此但有燥温耳，
无补气药，非气虚者所宜。）
四神丸 治脾肾虚弱，大便不实，饮食少思，或小腹作痛。或产后泄泻，肚腹作痛，
不思饮食。
肉豆蔻 五味子（各二两） 补骨脂（四两） 吴茱萸（汤浸，炒，一两）
上为末。别以水二碗，生姜八两，煮红枣一百个，熟烂去皮核用，和末为丸，桐子
大。每服五七十丸，空心食前，白汤下。
二神丸 治脾肾虚寒，不思饮食，或侵晨五更泄泻，或饮食少思，大便不实，其功
甚效。如不应，乃命门火衰，急服八味丸，补火而生土。
破故纸（四两，炒） 肉豆蔻（二两，生用）
上为末。用大红枣四十枚，生姜四两，水煮熟。去姜，取枣肉和药丸，如桐子大。每
服五十丸，空心盐汤送下。
【薛己】疮疡患者出现大便泄泻，可能是因为寒凉药物攻伐过度，导致脾气亏损；也可能是因为脾气虚弱，食物无法消化；或者是脾虚气陷，不能升提举托；或者是命门火衰微，不能温煦脾土；或者是肾经虚弱，不能固摄禁闭；或者是脾肾两脏虚寒，不能履行其正常职能。针对这些情况的主要治法：如果是寒凉损伤了脾阳，使用六君子汤加木香、砂仁，配合送服二神丸。如果是脾虚气陷，使用补中益气汤，配合送服二神丸。如果是命门火衰，使用八味丸的药料，配合送服四神丸。如果是肾虚不固，使用姜附汤加吴茱萸、五味子。如果是脾肾两脏虚寒，使用参附汤配合送服四神丸。《病机》中说：脉象沉而细，身体僵硬不动，眼睛视物模糊不清，饮食难以下咽，鼻准部气息微弱者，用姜附汤主治。身体沉重、四肢不能抬举者，用参附汤主治。张仲景先生说：下痢且肠鸣，应当用温法治疗。脉象迟而紧，疼痛未停止，应当用温法治疗。肛门（大孔）疼痛，应当用温法治疗。心痛应当急救里虚，可以给予理中汤、附子四逆汤之类的方剂。《精要》中说：痈疽患者出现呕吐泄泻，如果肾脉虚弱，属于不治之症。这是阐发《内经》的深奥旨意，凡是这种实在难以治疗的病症，如果按照前面的方法治疗，大多有生存的希望。有一位四十多岁的女性，背部生疽疮不起发，伴有泄泻和呕吐，进食少且有四肢厥冷，脉搏微弱几乎摸不到，属于阳气虚寒证。使用大补剂加入附子、干姜、肉桂。服药后未见效果，再增加附子服用两剂，泄泻反而更严重，于是改用大附子、干姜、肉桂各三钱，人参、当归、白术各五钱，作为一剂药煎服，腹内才感到温热，呕吐泄泻才停止，手脚逐渐变暖，脉搏随后恢复。之后继续用大补之法使脓疮溃破，再用托里之法使疮口收敛，十年后，仍因脾胃虚寒去世。
加减托里消毒散：治疗饮食缺乏食欲，肠鸣腹痛，腹部寒冷泄泻，这是脾气虚寒所致，去掉白芷、连翘、金银花，加入炮姜、木香。如果手足逆冷，是脾血虚寒所致，再加附子，煎药送服四神丸。
和气散：治疗痈疽溃烂后，气虚导致的滑脱泄泻，四肢逆冷。
苍术（四两，用米泔水浸泡三天，洗净晒干，再用米醋炒至香气透出、呈黄色） 甘草（炙烤） 青皮（去瓤，各一两） 良姜（炒制） 肉桂 干姜（炮制，各半两） 陈粟米（半升）
以上七味药研为末。每次服用一钱，用炒茴香末半钱混合，温酒调服，不限时间。（按语：此方仅有燥湿温中之功，没有补气药物，不适合气虚患者。）
四神丸：治疗脾肾虚弱，大便不成形，饮食缺乏食欲，或者小腹作痛。或者是产后泄泻，肚腹作痛，不思饮食。
肉豆蔻 五味子（各二两） 补骨脂（四两） 吴茱萸（汤浸，炒制，一两）
以上研为末。另外取水二碗，生姜八两，煮红枣一百个，煮熟烂后去皮核，用枣肉拌药末制成丸药，如梧桐子大。每次服用五七十丸，空腹食前，用白开水送下。
二神丸：治疗脾肾两脏虚寒，不思饮食，或者清晨五更时分泄泻，或者饮食缺乏食欲，大便不成形，功效非常显著。如果无效，则是命门火衰，急服八味丸，补火以生土。
破故纸（即补骨脂，四两，炒制） 肉豆蔻（二两，生用）
以上研为末。用大红枣四十枚，生姜四两，水煮熟。去掉生姜，取枣肉拌药丸，如梧桐子大。每次服用五十丸，空腹时用盐汤送下。
[Xue Ji] For patients with sores and ulcers presenting with diarrhea, the cause may be excessive use of cold-natured drugs attacking the body, leading to Spleen Qi deficiency; or it may be due to weak Spleen Qi causing food stagnation and inability to digest; or Spleen deficiency with Qi sinking, failing to lift and support; or decline of Mingmen Fire (Gate of Life Fire), failing to warm the Earth (Spleen); or weakness of the Kidney Meridian, failing to secure and restrain; or cold-deficiency of both Spleen and Kidney, failing to perform their functions. The primary treatment methods are as follows: If cold-natured drugs have injured the Spleen Yang, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Mu Xiang (Aucklandiae Radix) and Sha Ren (Amomi Fructus Rotundus), taken together with Er Shen Wan (Two Spirits Pill). If there is Spleen deficiency with Qi sinking, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), taken together with Er Shen Wan. If there is decline of Mingmen Fire, use Ba Wei Wan (Eight-Ingredient Pill) formula, taken together with Si Shen Wan (Four Spirits Pill). If there is Kidney deficiency with incontinence, use Jiang Fu Tang (Ginger and Aconite Decoction) added with Wu Zhu Yu (Evodiae Fructus) and Wu Wei Zi (Schisandrae Fructus). If there is cold-deficiency of both Spleen and Kidney, use Shen Fu Tang (Ginseng and Aconite Decoction) taken together with Si Shen Wan. *Bing Ji* states: "If the pulse is deep and fine, the body is immobile, vision is blurred, food and drink cannot be swallowed, and breath at the tip of the nose is faint, treat with Jiang Fu Tang." "If the body is heavy and limbs cannot be lifted, treat with Shen Fu Tang." Mr. Zhang Zhongjing said: "For dysentery with borborygmus, apply warming method. If the pulse is slow and tight, and pain persists, apply warming method. If there is pain at the anus, apply warming method. For heart pain, rescue the interior deficiency immediately; Li Zhong Tang (Regulate the Middle Decoction) or Fu Zi Ni Xi Tang (Aconite Reversal Decoction) type formulas may be given." *Jing Yao* states: "For carbuncles and ulcers accompanied by vomiting and diarrhea, if the Kidney pulse is deficient, it is incurable." This elucidates the profound meaning of *Nei Jing*. For such difficult-to-treat conditions, applying the aforementioned methods often leads to survival. A woman over forty years old had a back carbuncle that failed to suppurate, accompanied by diarrhea, vomiting, poor appetite, and cold extremities. Her pulse was nearly imperceptible, indicating Yang deficiency and cold. She was treated with a major tonifying agent added with Fu Zi (Aconiti Lateralis Radix Praeparata), Gan Jiang (Zingiberis Rhizoma), and Rou Gui (Cinnamomi Cortex). There was no response. Two more doses of Fu Zi were added, but diarrhea worsened. Subsequently, Da Fu Zi (large prepared Aconite root), Gan Jiang, and Rou Gui (each 3 qian), along with Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) (each 5 qian) were combined into one dose. Only then did warmth arise in the abdomen, vomiting and diarrhea ceased, hands and feet gradually warmed, and the pulse returned. Later, major tonification promoted suppuration, and Tuo Li (supporting the interior) promoted healing. Ten years later, she died due to Spleen-Stomach cold-deficiency.
Jia Jian Tuo Li Xiao Du San (Modified Support-the-Interior and Detoxify Powder): Treats poor appetite, borborygmus, abdominal pain, and cold abdominal diarrhea, caused by Spleen Qi cold-deficiency. Remove Bai Zhi (Angelicae Dahuricae Radix), Qiao (Lian Qiao, Forsythiae Fructus), and Yin Hua (Jin Yin Hua, Lonicerae Japonicae Flos). Add Pao Jiang (Prepared Ginger) and Mu Xiang (Aucklandiae Radix). If there are cold extremities, it indicates Spleen Blood cold-deficiency; add Fu Zi (Aconiti Lateralis Radix Praeparata) and take with Si Shen Wan.
He Qi San (Harmonize Qi Powder): Treats slippery diarrhea and cold extremities after ulceration of carbuncles and ulcers, due to Qi deficiency.
Cang Zhu (4 liang, soaked in rice water for three days, washed, dried, then stir-fried with rice vinegar until fragrant and yellow) Gan Cao (Honey-fried) Qing Pi (Pummelo peel without albedo, each 1 liang) Liang Jiang (Stir-fried) Rou Gui Cui Gan Jiang (Prepared, each half liang) Chen Su Mi (Half sheng)
Grind the above seven ingredients into powder. Take 1 qian per dose, mix with half a qian of stir-fried Huixiang (Fennel Fructus) powder, and take with warm wine, at any time. (Note: This formula only has drying-dampness and warming properties, lacking Qi-tonifying herbs, and is not suitable for those with Qi deficiency.)
Si Shen Wan (Four Spirits Pill): Treats Spleen-Kidney weakness, loose stools, poor appetite, or lower abdominal pain. Also treats postpartum diarrhea with abdominal pain and loss of appetite.
Rou Dou Kou (Nutmeg) Wu Wei Zi (Schisandrae Fructus) (each 2 liang) Bu Gu Zhi (Psoraleae Fructus) (4 liang) Wu Zhu Yu (Evodiae Fructus) (Soaked in water, stir-fried, 1 liang)
Grind into powder. Separately, boil 100 Red Dates (Jujubae Fructus) in 2 bowls of water with 8 liang of Sheng Jiang (Fresh Ginger) until soft and rotten. Remove skin and pits. Mix the date pulp with the powder to make pills the size of wutong seeds. Take 50-70 pills on an empty stomach before meals, with plain boiled water.
Er Shen Wan (Two Spirits Pill): Treats Spleen-Kidney cold-deficiency, poor appetite, early morning (fifth watch) diarrhea, or loose stools with poor appetite. Its efficacy is very high. If ineffective, it indicates decline of Mingmen Fire; urgently take Ba Wei Wan (Eight-Ingredient Pill) to tonify fire and generate earth.
Po Gu Zhi (Bu Gu Zhi/Psoraleae Fructus) (4 liang, stir-fried) Rou Dou Kou (Nutmeg) (2 liang, raw)
Grind into powder. Boil 40 large red dates with 4 liang of fresh ginger in water until cooked. Remove ginger, take date pulp, and mix with medicine to form pills the size of wutong seeds. Take 50 pills on an empty stomach, sent down with salted water.