下利

xià lì

Diarrhoea · xia li

Also rendered: Diarrhoea (This site) · Downward free passage (Literal) · Loose stools (Clinical, loses the pattern)

Pathology

Reviewed · 2026-10-31

At a glance

Pinyin: xià lì
Simplified: 下利
Literal: 下 xià is downward; 利 lì is to pass freely, to let go without restraint. The pair describes stool moving downward too easily — not a single loose motion but a pattern of passing, which may be watery, may contain undigested grain, may carry pus and blood. The chapter counts it among the signs that decide whether lesser yin is turning toward cold or toward heat.
Shuowen: **《說文》：「下，底也。」「利，銛也。」** 利本訓銛，引申為通利、滑利；下利者，水穀下趨而不禁。**凡四十二見**：第二篇五、第四篇一、第六篇六、第七篇十、第八篇三、第十篇一、第十一篇十六。**用字**：本篇「利」「痢」雜出（下痢三見：行60、63、90前），各存底本，詞目取「下利」。**與「吐利」之别**：吐利並作者，中焦升降俱亂；但下利者，病偏於下。

In brief

The passing of stool too freely, taken in this chapter as the sign that sorts lesser yin into its cold and hot branches. Cold diarrhoea with a faint pulse calls for white penetrating decoction to warm the yang and stop the downward flow. Diarrhoea of pus and blood, slippery and uncontrolled, is cold dampness injuring the intestinal network and asks for mume flower decoction to warm and bind. Watery diarrhoea with abdominal pain and heavy limbs is water qi that the kidney cannot transform, and true martial decoction moves it. Diarrhoea with cough, vomiting, thirst and restless sleeplessness is hot water bound with spent yin, and polyporus decoction separates the clear from the turbid. The same word, four mechanisms, four formulas.

Senses in the classical corpus

少陰寒化下利少陰病，下利，白通湯主之

陰寒內盛，下焦不固，下利而脉微，白通湯溫陽通脉以止利

Yin cold prevails within and the lower burner no longer holds: diarrhoea with a faint pulse. White penetrating decoction warms the yang, opens the vessels and stops the downward flow.

少陰病，下利，白通湯主之。 — 辨少陰病脉證并治第十一

少陰滑脫便膿血少陰病，下利便膿血者

寒濕傷於腸絡，滑脫不禁而便膿血，桃花湯溫澀固脫

Cold dampness has injured the intestinal network; the bowel slips and will not hold, and pus and blood appear in the stool. Mume flower decoction warms, astringes and secures what is leaking.

少陰病，下利便膿血者，桃花湯主之。 — 辨少陰病脉證并治第十一

少陰水氣下利自下利者，此爲有水氣

腎陽不化，水寒浸漬，腹痛、四肢沉重而自下利，真武湯溫腎利水

The kidney yang does not transform, water and cold soak the interior, and there is abdominal pain, heavy aching limbs and spontaneous diarrhoea. True martial decoction warms the kidney and moves the water.

少陰病，二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此爲有水氣。 — 辨少陰病脉證并治第十一

少陰熱化下利下利六七日，欬而嘔渴

陰虚而水熱互結，下利兼欬嘔渴煩、不得眠，猪苓湯育陰利水

After six or seven days of diarrhoea, yin is spent and water is bound with heat: cough, vomiting, thirst, vexation and sleeplessness. Polyporus decoction nourishes the yin and drains the water.

少陰病，下利六七日，欬而嘔渴，心煩不得眠者，猪苓湯主之。 — 辨少陰病脉證并治第十一

Occurrences in the classics

Passages where the term does real work, with the original, pinyin and English on the same line.

Display

4 passages

辨太陽病脉證并治中第六·辨太陽病脉證并治中第六 Read in context →

傷寒醫下之，續得下利，清榖不止，身疼痛者，急當救裏。後身疼痛，清便自調者，急當救表。救裏宜四逆湯，救表宜桂枝湯。伤寒医下之，续得下利，清谷不止，身疼痛者，急当救里。后身疼痛，清便自调者，急当救表。救里宜四逆汤，救表宜桂枝汤。

shāng hán yī xià zhī xù dé xià lì qīng gǔ bù zhǐ shēn téng tòng zhě jí dāng jiù lǐ hòu shēn téng tòng qīng biàn zì tiáo zhě jí dāng jiù biǎo jiù lǐ yí sì nì tāng jiù biǎo yí guì zhī tāng

In cold damage, when a physician purges and diarrhoea follows with undigested food and does not stop, while the body aches, the interior must be rescued first. If afterwards the body still aches but the stool has become regular of itself, the exterior must be rescued urgently. Four-Reversal Decoction is right for the interior, Cinnamon Twig Decoction for the exterior.

下利清榖不止而身疼痛，先救裏後救表；四逆湯溫裏，桂枝湯解表，次序即治法。

辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →

少陰病，下利，白通湯主之。少阴病，下利，白通汤主之。

shào yīn bìng xià lì bái tōng tāng zhǔ zhī

In shaoyin disease with diarrhoea, White Penetrating Decoction governs.

下利而脉微，寒從中生，非實熱之下利，故白通湯溫通而非清利。

辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →

少陰病，下利便膿血者，桃花湯主之。少阴病，下利便脓血者，桃花汤主之。

shào yīn bìng xià lì biàn nóng xuè zhě táo huā tāng zhǔ zhī

In shaoyin disease with diarrhoea and pus and blood in the stool, Peach Blossom Decoction governs.

便膿血而用溫澀，是寒濕滑脫，與白頭翁湯之熱利後重者正相反。

辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →

少陰病，下利六七日，欬而嘔渴，心煩不得眠者，猪苓湯主之。少阴病，下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。

shào yīn bìng xià lì liù qī rì kài ér ǒu kě xīn fán bù dé mián zhě zhū líng tāng zhǔ zhī

In shaoyin disease with diarrhoea for six or seven days, cough with vomiting and thirst, and restlessness at heart with inability to sleep, Polyporus Decoction governs.

下利而見欬嘔渴煩不得眠，知非純寒，水熱互結，故猪苓湯。

Compounds built on this term

下利清榖

xià lì qīng gǔ

diarrhoea with undigested grain

辨少陰病脉證并治第十一

自下利

zì xià lì

spontaneous diarrhoea

辨少陰病脉證并治第十一

下利不止

xià lì bù zhǐ

diarrhoea that will not stop

辨少陰病脉證并治第十一

便膿血

biàn nóng xuè

pus and blood in the stool

辨少陰病脉證并治第十一

How it has been translated

Every rendering below is a decision about which reader is being addressed. There is no neutral option.

This site	diarrhoea	familiar, keeps the downward sense
Literal	downward free passage	exact, reads oddly
Clinical	loose stools of lesser yin	names the chapter and the pattern

Entry status

Review pending — who reviews this?

2026-10-31

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