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
,必先逐陈积而后补之,庶几获益。如果系脏虚滑泄,审无腹痛,脉微虚不沉滞者,可以温
涩之药固之。
《本事》温脾汤 治痼冷在肠胃间,连年腹痛泄泻,休作无时,服诸热药不效,
宜先取去,然后调治易瘥。不可畏虚以养病也。
浓朴 干姜 甘草 桂心 附子(生,各二两) 大黄(生,四钱,碎切,汤一盏浸半日
滤去渣,煎汤时和渣下)
上细锉,水二升半,煎八合,后下大黄汁,再煎六合,去滓澄去脚,分三服,自夜至晓
,令尽,不受,食前更以干姜丸佐之。
干姜丸
干姜 巴豆(去心,炒黄) 人参 大黄(各一两)
上除巴豆,余为末同研,炼蜜丸如桐子大,服前汤时,用汤下一丸。
震灵丹(一名紫金丹) 治一切沉寒痼冷,久泻久痢,脐腹冷痛,呕吐不食,及妇
人血气虚损,崩漏带下。
禹余粮(火 醋淬不计遍数,手捻得碎为度) 紫石英 赤石脂 丁头代赭石(如禹余粮
制法,各四两)
以上四味,并作小块,入瓦锅内盐泥固济,候干,用炭十斤 通红,火尽为度,入地埋
出火毒二宿。
滴乳香(另研) 五灵脂(去沙石,筛) 没药(去砂石,各二两) 朱砂(水飞,一两)
上八味并为细末,以糯米粉煮糊为丸,如芡实大,晒干出光,每一丸,空心温酒下或冷
水下。忌猪羊血,恐减药力。妇人醋汤下。
乳豆丸 治滑泄不止,诸药无效。
肉豆蔻(生为末)
上用通明乳香,以酒浸过,研成膏,丸如桐子大,每五十丸,空心米饮送下。
《和剂》桃花丸 寒泻腹中痛,服诸热药以温中,并不见效,登圊不迭,秽物随
出。此属下焦,宜桃花丸以温涩之。
赤石脂 干姜(炮,等分)
上为末,面和丸如梧子大,每服三十丸,空心食前米饮下。日三。
河间诃子散 治泄久腹痛渐已,泻下渐少,宜此药止之。
诃子(一两,半生半熟) 黄连(三钱) 木香(半两) 甘草(二钱)
上为细末,每服二钱,以白术芍药汤调下。如止之未已,宜因其归而送之。于诃子散内
加浓
朴一两,竭其邪气也。按∶收涩之剂,固肠丸、诃子散皆治热滑,扶脾丸、桃花丸皆治寒滑
,盖滑泄虽同,而有阴阳之分也。(以下食泄。)
加味平胃散 治食积泻,噫气作酸,泄而腹痛甚,泻后痛减,臭如抱坏鸡子。《
得效》云∶伤食积而泻者,粪白可验,且腹必耕痛方泄是也。
苍术 浓朴 陈皮 甘草 缩砂 草果 山楂子 麦芽
水煎服。有停饮食数日乃泻,后屡作屡止,饮食稍多即发,名曰 泻,宜枳术曲 丸。
治饮酒过多,遂成酒泄,骨立不能食,但饮一二杯即发,经年不愈方。
苍术 浓朴 陈皮 甘草 丁香 缩砂 干葛 麦芽 神曲
上为末,空心米饮调下二钱。
治伤酒晨起必泻方
人参 白术 干姜 炙甘草 茯苓 干葛 陈皮 川黄连(酒浸,炒)
上锉,姜水煎服。
久泻不止,服用各种药物均无效,或者暂时停止后又复发,这必定是因为肠胃之间有陈旧的积滞。积滞一天不除去,腹泻就一天不能痊愈,必须先祛除陈旧积滞然后再进行补益,这样才可能获得疗效。如果确实是脏腑虚弱导致的滑泄,仔细诊察确认没有腹痛,脉象微细虚弱且不沉滞的,可以使用温涩的药物来固摄止泻。
《本事方》中的温脾汤,治疗顽固性寒邪停留在肠胃之间,连年腹痛腹泻,发作和休止没有固定时间,服用各种热性药物都无效的情况,应当先攻逐去除病邪,然后调理治疗就容易痊愈了。不要因为担心身体虚弱而养着病邪不去除。
药材:浓朴、干姜、甘草、桂心、附子(生用,各二两)、大黄(生用,四钱,切碎,用一盏水浸泡半天,滤去药渣,煎煮汤剂时将药渣一同放入)。
将上述药材(除大黄外)细细切碎,加入二升半水,煎煮至八合,随后加入大黄的汁液,再煎煮至六合,去掉药渣并澄清,分三次服用,从夜间到清晨服完。如果患者无法耐受,可在饭前再用干姜丸辅助服用。
干姜丸配方:
干姜、巴豆(去心,炒至黄色)、人参、大黄(各一两)。
将除巴豆外的药材研成细末混合研磨,用炼蜜制成梧桐子大小的药丸。在服用前述温脾汤时,用汤药送服一丸。
震灵丹(又名紫金丹),治疗一切沉寒痼冷、久泻久痢、脐腹冷痛、呕吐不能进食,以及妇女气血虚损、崩漏带下等症。
药材:禹余粮(用火醋淬炼不限次数,直到用手能捻碎为止)、紫石英、赤石脂、丁头代赭石(制作方法同禹余粮,各四两)。
以上四味药,都切成小块,放入瓦锅内,用盐泥密封加固,待干后,用十斤炭烧得通红,直到火熄灭为止,取出埋入地下两天以去除火毒。
药材:滴乳香(另研)、五灵脂(去沙石,筛净)、没药(去砂石,各二两)、朱砂(水飞法处理,一两)。
将以上八味药一起研成细末,用糯米粉煮糊作为粘合剂制成芡实大小的药丸,晒干去光气。每次服用一丸,空腹时用温酒或冷水送服。忌食猪羊血,恐怕会减弱药效。妇女可用醋汤送服。
药材:肉豆蔻(生用研成末)。
取透明的乳香,用酒浸泡后,研磨成膏状,与肉豆蔻末混合,制成梧桐子大小的药丸。每次五十丸,空腹时用米饮送下。
《和剂局方》桃花丸,治疗寒性腹泻伴有腹痛,服用各种热性药物以温中,但都不见效,频繁上厕所,秽物随即排出。此证属于下焦,适宜用桃花丸来温中固涩。
将上述药材研成细末,用面糊制成梧桐子大小的药丸。每次服用三十丸,空腹饭前用米饮送下。每日三次。
河间诃子散,治疗久泻导致腹痛逐渐减轻,腹泻次数逐渐减少,适宜用此药止泻。
药材:诃子(一两,一半生用一半熟用)、黄连(三钱)、木香(半两)、甘草(二钱)。
将上述药材研成细末,每次服用二钱,用白术芍药汤调服。如果止泻效果未完全达到,宜顺势而为,在诃子散中加入浓朴一两,以彻底驱除邪气。按语:收涩类药物中,固肠丸、诃子散皆治疗热性滑泄;扶脾丸、桃花丸皆治疗寒性滑泄。虽然都是滑泄,但有阴阳之分。(以下为食积泄泻。)
加味平胃散,治疗食积引起的腹泻,嗳气泛酸,腹泻且腹痛剧烈,泻后疼痛减轻,粪便气味臭如腐烂的鸡蛋。《得效方》说:因伤食积滞而腹泻的,粪便发白可以验证,而且腹部一定像耕田一样绞痛才会腹泻,说的就是这个道理。
用水煎服。如果有停食数日后才腹泻,之后反复发作,饮食稍多即发病,这种称为“噤口泻”(注:原文此处可能有缺字或通假,通常指此类症状),适宜用枳术曲丸治疗。
治疗饮酒过多,遂成酒泄,身体消瘦不能进食,只喝一二杯酒即发病,经年不愈的方子。
药材:苍术、浓朴、陈皮、甘草、丁香、缩砂仁、干葛根、麦芽、神曲。
将上述药材研成细末,空腹时用米饮调服二钱。
治疗因饮酒损伤,晨起必腹泻的方子。
药材:人参、白术、干姜、炙甘草、茯苓、干葛根、陈皮、川黄连(酒浸,炒制)。
将上述药材切碎,用姜水煎服。
Prolonged diarrhea that does not cease, unresponsive to various medications, or temporarily stopping only to recur, necessarily indicates the presence of old accumulation (Chen Ji) in the intestines and stomach. As long as the accumulation remains for one day, the diarrhea will not heal for one day; it is essential to first expel the old accumulation before tonifying, so that beneficial effects may be achieved. If it is indeed a sliding diarrhea caused by visceral deficiency, provided there is no abdominal pain and the pulse is faint and deficient without being deep and stagnant, warming and astringent medicines can be used to consolidate and stop the diarrhea.
Wen Pi Tang (Warm the Spleen Decoction) from *Ben Shi Fang* treats stubborn cold lodged in the intestines and stomach, causing continuous years of abdominal pain and diarrhea with irregular onset and remission. When various hot-natured medicines have proven ineffective, the pathogenic factor should first be purged away, after which regulation and treatment will easily lead to recovery. One must not fear deficiency and thereby nurture the disease.
Ingredients: Houpo (Magnoliae Officinalis Cortex), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata - raw, 2 liang each); Dahuang (Rhei Radix et Rhizoma - raw, 4 qian, crushed, soaked in one cup of water for half a day, filtered to remove dregs; during decoction, add the dregs back).
Finely chop the ingredients (except Dahuang), add two and a half sheng of water, and decoct until eight he remain. Then add the Dahuang juice, decoct again until six he remain, filter out the dregs, clarify, and divide into three doses. Take from night until dawn, finishing all contents. If the patient cannot tolerate this, administer Ganjiang Wan (Dry Ginger Pill) before meals as an adjunct.
Ganjiang Wan Formula:
Ganjiang (Zingiberis Rhizoma), Badou (Crotonis Fructus - heart removed, stir-fried until yellow), Renshen (Ginseng Radix), Dahuang (Rhei Radix et Rhizoma) (1 liang each).
Remove the Badou, grind the remaining ingredients into powder and mix thoroughly. Use refined honey to form pills the size of paulownia seeds. Take one pill with the Wen Pi Tang when administering it.
Zhen Ling Dan (also known as Zi Jin Dan) treats all types of deep-seated cold and stubborn chill, prolonged diarrhea and dysentery, cold pain in the umbilical and abdominal regions, vomiting with inability to eat, as well as qi and blood deficiency in women, metrorrhagia, and leukorrhea.
Ingredients: Yuyuliang (Halloysitum Rubrum - quenched in vinegar over fire repeatedly until it can be crushed by hand), Zhi Shiyin (Quartzum Roseum), Chishizhi (Kaolinitum Rubrum), Ding Tou Daizheshi (Haematitum) (processed same as Yuyuliang, 4 liang each).
Cut the above four ingredients into small pieces, place them in a clay pot, seal tightly with salt mud, let dry, then roast with ten jin of charcoal until red-hot. Allow the fire to extinguish naturally. Bury the pot in the ground for two nights to eliminate fire toxicity.
Ingredients: Diluxiang (Boswelliae Resina - separately ground), Wulingzhi (Trogopterori Faeces - free of sand and stones, sifted), Moyao (Myrrhae Resina - free of sand and stones, 2 liang each), Zhusha (Cinnabaris - water-triturated, 1 liang).
Grind all eight ingredients into fine powder. Use glutinous rice flour paste as a binder to form pills the size of Euryale Seed (Qianshi). Dry in the sun to remove moisture. Take one pill on an empty stomach with warm wine or cold water. Avoid pork and mutton blood, as they may reduce the efficacy of the medicine. For women, take with vinegar water.
Rudou Wan treats persistent sliding diarrhea unresponsive to other medicines.
Ingredient: Roudoukou (Myristicae Semen - raw, ground into powder).
Take clear Xiangru (Frankincense), soak in wine, grind into a paste, and mix with the Roudoukou powder to form pills the size of paulownia seeds. Take fifty pills on an empty stomach with rice gruel.
Taohua Wan (Peach Blossom Pill) from *Heji Jufang* treats cold-type diarrhea with abdominal pain. When various hot medicines intended to warm the middle jiao fail to produce results, and the patient experiences urgent, frequent defecation with foul matter, this condition belongs to the lower jiao. Taohua Wan should be used to warm and astringe.
Ingredients: Chishizhi (Kaolinitum Rubrum), Ganjiang (Zingiberis Rhizoma - processed, equal parts).
Grind into powder, use dough paste to form pills the size of mulberry seeds. Take thirty pills per dose on an empty stomach before meals with rice gruel. Three times daily.
Hejian Hezi San (Persimmon Sepal Powder) treats prolonged diarrhea where abdominal pain gradually subsides and defecation frequency decreases. This medicine is suitable to stop the diarrhea.
Ingredients: Hezi (Terminaliae Chebulae Fructus - 1 liang, half raw, half processed), Huanglian (Coptidis Rhizoma - 3 qian), Muxiang (Vladimiriae Radix - 0.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma - 2 qian).
Grind into fine powder. Take 2 qian per dose, mixed with Baizhu Shaoyao Tang (Atractylodes Macrocephala and Paeonia Alba Decoction). If the effect is insufficient, follow the path of the pathogen to expel it. Add Houpo (Magnoliae Officinalis Cortex, 1 liang) to the Hezi San to exhaust the evil qi. Note: Astringent preparations such as Guchang Wan and Hezi San treat heat-type sliding diarrhea; Fupi Wan and Taohua Wan treat cold-type sliding diarrhea. Although both are sliding diarrhea, they differ in yin and yang nature. (The following section addresses food stagnation diarrhea.)
Jiawei Pingwei San (Modified Pingwei Powder) treats diarrhea due to food stagnation, accompanied by belching with sour taste, severe abdominal pain during diarrhea that alleviates after defecation, and feces smelling like rotten eggs. *De Xiao Fang* states: Diarrhea caused by food injury and stagnation can be verified by white feces, and the abdomen must feel like plowing soil (cramping pain) before defecation occurs.
Ingredients: Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Suosha (Amomi Fructus Rotundus), Caoguo (Tsao-ko Fructus), Shanzhazhi (Crataegi Fructus), Maiya (Hordei Fructus Germinatus).
Decoct in water and take orally. If food retention leads to diarrhea after several days, with recurrent episodes triggered by slight overeating, this is termed "Jinkou Xie" (Taboo Mouth Diarrhea). Zhizhu Qu Wan (Immature Bitter Orange and Atractylodes Fermented Pill) is appropriate.
Formula for treating alcohol-induced diarrhea resulting in emaciation and anorexia, where drinking one or two cups triggers immediate diarrhea, persisting for years:
Ingredients: Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Dingxiang (Eugeniae Flos), Suosha (Amomi Fructus Rotundus), Gange (Puerariae Radix), Maiya (Hordei Fructus Germinatus), Shenqu (Meditativus Mass).
Grind into powder. Take 2 qian on an empty stomach mixed with rice gruel.
Formula for morning diarrhea caused by alcohol injury:
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), Zhigancao (Glycyrrhizae Radix et Rhizoma - honey-fried), Fuling (Poria), Gange (Puerariae Radix), Chenpi (Citri Reticulatae Pericarpium), Chuan Huanglian (Coptidis Rhizoma - soaked in wine, stir-fried).
Chop the ingredients, decoct in ginger water, and take orally.