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Diarrhea with pain in the anal canal should be treated by applying hot salt powder externally, or by warm application of fried Zhi Shi (Fructus Aurantii) powder; using both together is more effective. If there is cold accumulation below the umbilicus, external heat application must not be performed immediately, as cold qi attacking the heart and abdomen will lead to death. One must first use medication to warm the area, and only after a period of time can heat application be used. In cases where cold accumulation below the umbilicus forms Guan Yin syndrome (a critical condition characterized by obstruction of urination and defecation), with no passage of urine or stool, and despite extensive medication showing no effect, applying hot salt to the lower abdomen can result in immediate bowel movement. However, once Guan Yin syndrome is resolved, excessive use of purgatives such as Ba Dou (Seminar Crotonis), Gan Sui (Radix Euphorbiae Kansui), Da Huang (Radix et Rhizoma Rhei), and Qing Fen (Calomel) will cause sudden severe diarrhea and damage the body; this requires careful consideration.

The general principle: In winter, it is appropriate to use warming and heating medications.

Shaoyin disease (disease of the Shaoyin channel), where the patient vomits immediately after eating, feels nauseous and wants to vomit but cannot, and initially presents with cold hands and feet and a wiry, slow pulse. If there is dry retching due to cold-fluid retention above the diaphragm, vomiting should not be induced; instead, Si Ni Tang (Counterflow Decoction) should be used to warm yang. (Formula see "Si Ni Syndrome" section.)

In diarrhea, if the pulse is floating and large, this indicates deficiency caused by forced purgation. If the pulse is floating and large accompanied by abdominal borborygmus, Dang Gui Si Ni Tang (Angelica Sinensis Counterflow Decoction) should be used to warm the channels. (Formula see "Si Ni Syndrome" section.)

(When physicians use fire under the bed, apply fire pressure to force sweating over the whole body, use hot compresses, or mistakenly use moxibustion, these all constitute Fire Evil pathogenic factors.)

In Shang Han (Cold Damage) disease, if the pulse is floating, and the physician uses fire pressure to force sweating, leading to Yang collapse (loss of yang qi), resulting in palpitations, mania, restlessness, and inability to lie still or sit comfortably, Gui Zhi Qu Shao Yao Jia Shu Kuai Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction without Paeonia, plus Farfara Flower, Oyster Shell, and Dragon Bone to Rescue from Peril) is indicated.

Gui Zhi (Cinnamon Twig, 1.5 liang) Shu Kuai (Farfara Flower, 1.5 liang) Gan Cao (Licorice Root, 1 liang) Long Gu (Dragon Bone, 2 liang) Mu Li (Oyster Shell, 2.5 liang) Sheng Jiang (Fresh Ginger, 1.5 liang) Da Zao (Jujube, 6 pieces)

Boil in six sheng of water, first boil Shu Kuai until one sheng is reduced, then add other herbs, boil to obtain two sheng, remove dregs, and take one zhan cup warm. If Shu Kuai is unavailable, Heng Shan (Polygala Tenuifolia Root) may substitute. After fire coercion, if the pulse remains floating, recovery comes through sweating.

If Fire Evil pathology is further mistreated with purgation, and burning needles cause irritability, Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment.

Gui Zhi (Cinnamon Twig, 0.5 liang) Gan Cao (Licorice Root) Mu Li (Oyster Shell) Long Gu (Dragon Bone) (each 1 liang)

Boil in two sheng of water to obtain one sheng, remove dregs, and take one zhan cup warm; this can substitute for Jiu Ni Tang.

Pang Anshi stated: After moxibustion and burning needles, if symptoms resemble those of fire coercion, they should be treated according to the principles of fire coercion therapy. For irritability, palpitations, and mania, Liu Shi Feng Yin Tang (Six-Metal Wind-Driving Decoction) is particularly effective; Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) is also generally applicable.

A patient treated with fire coercion, on the fifteenth or sixteenth day, developed yellowing of the skin, diarrhea, and mania with a desire to run. The physician palpated the pulse and predicted that passing blood resembling pig liver would lead to recovery, which subsequently occurred.

How was this known? The physician said: The Cun Kou (inch position) pulse showed floating at the yang level and weak/soft at the yin level. Floating indicates wind; weak/soft indicates deficiency. A floating and deficient constitution susceptible to wind, with insufficient blood, presents with fever, aversion to cold, chills, neck stiffness, and dizziness. The physician used fire fumigation to force sweat, exacerbating the aversion to cold. External heat, triggered by fire, stagnated and steamed the skin, causing yellowing. There was slight difficulty in urination, shortness of breath, and epistaxis. Subsequently, the physician mistakenly used purgation, depleting stomach fluids and causing persistent diarrhea. Heat stagnated in the Bladder, accumulating into masses resembling pig liver. Failure to purge the stasis led to mental confusion, coma, mania, running, and attempts to jump into water, indicating loss of self-control. If the blood stasis is removed, vision clears and the mind settles. These outcomes are results of medical error; mild cases recover, while extreme cases are incurable.