Library

Diarrhea (Xiàlì) in the context of Cold Damage (Shānghán) is mostly attributable to Heat syndromes. When pathogenic heat transmits inward, causing deficiency in the interior accompanied by heat, diarrhea also occurs. In Yangming, Taiyang, and Shaoyang syndromes, diarrhea is accompanied by fever; in Taiyin syndrome, diarrhea presents with warm hands and feet; in Shaoyin and Jueyin syndromes, diarrhea presents with a cool body and absence of fever; this constitutes the general pattern. If there is spontaneous diarrhea with undigested food in the stool, no thirst, clear urine, slight aversion to cold, cold extremities, and aversion to cold with a deep, slow, and forceless pulse, these are all Cold syndromes. If there is thirst with desire to drink water, normal urine color, yellow-red excrement, fever, and tenesmus (Hòuzhòng), these are all Heat syndromes. For Cold syndromes, Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction) are used; for Heat syndromes, Xiaochaihu Tang (Minor Bupleurum Decoction) or Zhuling Tang (Polyporus Decoction) are used. Cold pathogens strike directly into the Yin meridians, while Heat pathogens enter the Stomach due to Wind pathogens; when Water Qi injures Earth (Spleen/Stomach), it causes sudden severe diarrhea. Treatments may involve warming, purging, securing the Lower Jiao, or promoting urination, applied according to the specific syndrome, but sweating methods should not be used. If sweating is induced erroneously, pathogenic factors will attack inward, further depleting Body Fluids, weakening Stomach Qi, and inevitably leading to abdominal distension. In combined Taiyang and Yangming syndromes presenting with diarrhea, Gegen Tang (Kudzu Decoction) is indicated. In combined Taiyang and Shaoyin syndromes presenting with diarrhea and dry heaving, with a full pulse, Chengqi Tang (Gastrointestinal Purge Decoction) is indicated. If the Taiyang exterior syndrome remains unresolved and repeated purgation leads to diarrhea accompanied by heat (Xié Rè Lì) and epigastric fullness/stuffiness (Xīn Xià Pǐ), Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is indicated. For spontaneous Taiyin diarrhea without thirst, or for cases with cold extremities, absent pulse, and diarrhea, Sini Tang (Frigid Extremities Decoction) is indicated. For Shaoyin sore throat with diarrhea, chest fullness, and irritability, Zhufu Ganjie Tang (Pig Skin and Licorice and Platycodon Decoction) is indicated. If there is thirst, spontaneous diarrhea passing only clear water, hardness and pain in the epigastrium, and dry mouth/throat, warming methods are contraindicated; one must urgently use Dachengqi Tang (Major Gastrointestinal Purge Decoction) to purge without doubt. In Cold Damage, if continuous diarrhea with undigested food occurs alongside body pain, the interior must be urgently rescued using Sini Tang (Frigid Extremities Decoction); if bowel and bladder functions are normal, the exterior must be urgently rescued using Guizhi Tang (Cinnamon Twig Decoction). Diarrhea accompanied by delirium and a deep, forceful pulse indicates dry feces (Zào Shǐ) and requires urgent purgation with Dachengqi Tang (Major Gastrointestinal Purge Decoction). Intestinal borborygmus, abdominal pain, diarrhea, and a deep, slow, forceless pulse require urgent warming with Xiaojianzhong Tang (Minor Construct the Middle Decoction). For diarrhea caused by Cold Toxins presenting with Daiyang syndrome (floating yang/false heat on the face), indicating lower jiao deficiency, Fuzi Lizhong Tang (Aconite and Regulate the Middle Decoction) is used. As for diarrhea with delirium, fixed gaze, diarrhea with cold extremities, restlessness and insomnia, diarrhea with fever and cold extremities accompanied by spontaneous sweating, diarrhea with cold extremities and absent pulse where moxibustion fails to restore warmth and pulse, or diarrhea occurring ten or more times a day with a paradoxically full pulse, these are all untreatable conditions.