shanghanlun line 159: 伤寒服泻下药-〉用甘草泻心汤无效 -〉反而再下之（方药无明确）-〉用理中汤补中焦之虚没用 -〉只能治标用赤石脂禹余粮涩肠止泻/利小便实大便（用五苓散）
By Karina • Jun 20th, 2008 • Category: Digestion & Elimination, shanghanlunThis line tells very clearly how diseases mutate from one form to the other when presented with medicines that don’t solve the problem.
In the end, we treat the symptoms by using 赤石脂 and 禹余粮:
- 赤石脂 is able to absorb all the bad stuff in the intestines, reducing the irritative effect of these things on the intestinal lining. it also protects the mucosa of the intestines.
- 禹余粮 can inhibit peristalsis, for better or worse. Worse is when you need to detox, but the medicine is not allowing that to happen. it’s like eating lomotil which while it slows down the gut and allows for more absoption of water and salts, it also allows the bad organisms to hang around even though your body wants to clear them out.
Interesting here is the statement “复不止者，当利其小便。” Recommended formula is 五苓散.
Karina is
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to say that 五苓散 is use to treat diarrhea is not the tightest link. it should be that 五苓散 is used to 利小便, and 利小便 can 实大便.
When exactly can 五苓散 be used to 利小便? most fitting is when there is dehydration, hence thirst. where dehydration somehow leads to 小便不利.
the idea of 利小便，实大便 appears in 湿病 in 《金匮要略》.
“湿痹之候，小便不利，大便反快，但当利其小便。”