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Scallion White (Cibuli Bulbus, 4 liang), Dried Ginger (Ganjiang, 1 liang), Aconite Root (Fuzi, 1 raw piece, peeled and broken into eight slices). The above three ingredients are boiled in three sheng of water to obtain one sheng of decoction. Strain the dregs and divide into two warm doses. (*Neijing* states: The Kidney dislikes dryness and urgency; eat pungent foods to moisten it. The pungency of Scallion White unblocks Yang Qi, while the pungency of Ginger and Aconite disperses Yin Cold.)

Baotong Decoction plus Pig Bile Formula
Scallion White (four stems), Dried Ginger (Ganjiang, 1 liang), Aconite Root (Fuzi, 1 raw piece, peeled and broken into eight slices), Human Urine (Ren Niao, 5 he), Pig Bile (Zhu Danzhi, 1 he). The above five ingredients: boil the first three in three sheng of water to obtain one sheng of decoction. Strain the dregs, add the bile and human urine, mix well, and divide into two warm doses. If pig bile is unavailable, alternatives may be used. (*Neijing* states: When regulating reversed cold-heat, if cold and heat alternate, the condition will worsen. In such cases, hot medicines should be taken cold. After swallowing, the cold nature dissipates first, then the hot nature activates, causing the pathogenic qi to resolve, vomiting and hiccups to cease, and emotions to remain harmonious, bringing great benefit. This involves adding salty-bitter-cold substances like human urine and pig bile to the hot Baotong Decoction, aiming for their qi to follow each other, thereby eliminating the cold that causes rejection.)

Zhang Jingyue said: Some ask why Baotong Decoction, Baotong Decoction plus Pig Bile, Zhenwu Decoction, and Tongmai Sini Decoction are all prescribed for Shaoyin disease with diarrhea, yet besides using Ginger and Aconite, the remaining herbs differ significantly. The answer lies in the principle that different diseases require different medications. In Shaoyin diarrhea, the cold pathogen is severe, requiring Ginger and Aconite for treatment. Although the mechanism of diarrhea is similar, accompanying symptoms vary, necessitating different prescriptions suited to specific conditions. For instance, Baotong Decoction uses Ginger and Aconite to disperse cold and stop diarrhea, adding Scallion White to regulate Yang Qi. If diarrhea is accompanied by dry retching and irritability, the cold is too severe, causing internal rejection; Ginger and Aconite are unsuitable here as they may induce vomiting and prevent absorption. Therefore, human urine and pig bile are added to Baotong Decoction and taken when cool. These are salty-bitter-cold substances that facilitate acceptance without obstruction. Once reaching the site, the cold nature dissipates, and the hot nature activates. Zhenwu Decoction treats Shaoyin disease persisting for two to three days, progressing to four or five days with abdominal fullness, difficult urination, heavy/painful limbs, and spontaneous diarrhea, indicating water retention. Water retention refers to cold-dampness governed by the Kidney. Kidney dysfunction fails to control water, leading to fluid accumulation. Abdominal pain indicates severe internal cold-dampness; heavy/painful limbs indicate severe external cold-dampness; difficult urination and diarrhea indicate dampness preventing the separation of water and grain. The Classics state: The Spleen dislikes dampness; sweet flavors enter the Splein first. Poria (Fuling) and Atractylodes Macrocephala (Baizhu) have sweet flavors to tonify the Spleen and drain water. For cold-damp dominance, use neutral-pungent-hot herbs; for damp excess, assist with sour-pungent herbs. The sour-pungent nature of Aconite, Peony, and Fresh Ginger warms meridians and dispels dampness. In the Taiyang chapter, Xiao Qinglong Tang syndrome also involves water retention and multiple variable symptoms, sharing the same logic as Zhenwu Decoction. Tongmai Sini Decoction treats Shaoyin diarrhea with undigested food, interior cold with exterior heat, cold extremities, and faint pulse. Interior cold manifests as fever, aversion to cold, and red facial color due to exterior heat. This represents Yin cold prevailing internally, repelling Yang externally, disrupting communication. Tongmai Sini Decoction is used to disperse Yin and unblock Yang. Variable symptoms are treated with modifications based on principles. All four syndromes involve diarrhea with various accompanying symptoms, resulting in major similarities but minor differences in prescription. Another query: Why is processed Aconite used only in Zhenwu Decoction among these four, while raw Aconite is used in others? Raw Aconite warms meridians and dispels cold, requiring Ginger's assistance; processed Aconite tonifies Yang and removes dampness, suitably assisted by Fresh Ginger. Dried Ginger is pungent-hot, assisting raw Aconite; Fresh Ginger is pungent-warm, slightly supporting processed Aconite. This reflects the original rationale for auxiliary herbs. However, Baotong-type formulas prioritize stopping diarrhea, whereas Zhenwu Decoction prioritizes cold-dampness, explaining dosage variations. Generally, cold-dampness shares similarities; e.g., Guizhi Fuzi Tang in the Taiyang section uses processed Aconite with Fresh Ginger for cold-damp binding, illustrating this principle of raw vs. processed usage and dosage differentiation.

Shaoyin disease with cough and diarrhea, accompanied by delirium, results from fire therapy劫夺 (seizing/robbery) of fluids. Urination will certainly be difficult due to forcibly inducing sweat from the Shaoyin. (Cheng Wuji notes: Cough and diarrhea indicate interior cold and fluid depletion. Using fire therapy to forcibly induce Shaoyin sweat depletes internal fluids further. Combined with fire heat irritation, delirium and difficult urination occur.)

Shaoyin disease with diarrhea and pus/blood in stool can be treated with acupuncture. Shaoyin disease with diarrhea, faint and choppy pulse, vomiting, sweating, frequent defecation attempts with little output, should be treated with moxibustion on upper acupoints. Shaoyin disease with tight pulse, progressing to day seven with spontaneous diarrhea, sudden mild pulse, warm hands/feet, and disappearance of tight pulse indicates recovery. Despite irritability and diarrhea, self-healing is expected. Shaoyin disease with faint, deep, fine pulse, desire to sleep, sweating, irritability, nausea, spontaneous diarrhea, restlessness, and insomnia indicates death. Shaoyin disease where diarrhea stops but dizziness occurs with occasional vertigo indicates death. (Pang Anshi notes: This resembles Shaoyang vertigo and sweating. If the pulse is uniform, small, and floating, survival is possible. Shaoyin disease typically lacks vertigo.) Shaoyin disease with aversion to cold, curled body posture, diarrhea, and cold extremities is untreatable.

Jueyin disease: Shanyin initially febrile for six days, followed by nine days of cold extremities and diarrhea. Typically, cold/diarrhea patients cannot eat. Current ability to eat suggests "Chu Zhong" (stomach qi exhaustion). Testing with noodles: if no fever follows, stomach qi remains, and recovery is expected. Fear of sudden heat returning and disappearing. Three days later, if pulse shows sustained heat, recovery is expected at midnight the next day. Reason: Initial six days fever + nine days cold + subsequent three days fever = nine days total, matching the cold period, predicting recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. (See Jueyin Disease section.) Shanyin starting with cold extremities then fever usually stops diarrhea spontaneously. If sweating and sore throat occur, throat bi (obstruction) develops. Fever without sweat and diarrhea usually stops spontaneously; if not, pus/blood in stool appears. Pus/blood in stool prevents throat bi. Diarrhea with floating-rapid cun pulse and choppy chi pulse indicates pus/blood in stool. (Huanglian Ejiao Tang, Huangqin Tang. Cheng Wuji notes: Diarrhea pulse should be deep-slow; floating-rapid indicates interior heat. Choppy indicates blood deficiency; choppy chi pulse indicates intestinal blood scattering. Heat follows diarrhea, causing pus/blood stool. "Qing" connects to toilet.)

Heat diarrhea with tenesmus is primarily treated with Baitouweng Tang. (Diarrhea reduces fluids; heat damages qi. Qi deficiency leads to tenesmus. Baitouweng Tang disperses qi and thickens intestines.)

Diarrhea with thirst indicates heat, primarily treated with Baitouweng Tang. (Thirst with diarrhea is not organ cold; does not match Sini Tang warming organs. Thirst with diarrhea indicates heat, matched with Baitouweng Tang cooling middle. Regarding Shaoyin spontaneous diarrhea with thirst being lower jiao deficiency-cold treated with Sini Tang, relying solely on thirst/non-thirst to distinguish heat/cold is insufficient; yellow/white urine should differentiate.)

Baitouweng Tang Formula
Baitouweng Root (Polygala Tenuifolia Radix, 2 liang), Phellodendron Bark (Huangbai, 3 liang), Ash Bark (Qinpi, 3 liang), Coptis Rhizome (Huanglian, 3 liang). Boil four ingredients in seven sheng of water to obtain two sheng. Strain, take one sheng warm. If ineffective, take another sheng. (*Neijing*: Kidney desires firmness; urgent situations require bitter taste to firm it. Diarrhea causes lower jiao deficiency, so pure bitter agents are used to firm it.)

Diarrhea with rapid pulse, slight fever, and sweating indicates impending recovery. If pulse becomes tight again, unresolved. (Use Ganjiang Huanglian Renshen Tang.)

Diarrhea with rapid pulse and thirst indicates impending recovery. If not resolved, pus/blood in stool will occur due to heat. (Use Huanglian Tang.)

Diarrhea with deep-chordic pulse indicates tenesmus. Large pulse means progression/unresolved. Weak-rapid pulse means approaching resolution; even with fever, death is unlikely. (Cheng Wuji notes: Deep indicates interior; chordic indicates tension/lack of interior qi causing heaviness. Large pulse indicates disease progression. Weak-rapid pulse indicates declining pathogen and recovering yang. Fever due to yang victory is not adverse. Deep-chordic pulse suits Sini Tang category; large pulse suits Gegen Huangqin Huanglian Tang.)

Shanyin after six-seven days, following drastic purgation, presents with deep-slow cun pulse, cold extremities, absent lower pulses, blocked throat, spitting pus/blood, and uncontrollable diarrhea. This is difficult to treat; use Mahuang Shengma Tang. (Cheng Wuji notes: At six-seven days, pathogen enters Jueyin. Drastic purgation weakens lower jiao qi, sinking yang. Deep-slow cun pulse and cold extremities/absent lower pulses reflect Jueyin meridian passing through diaphragm to lung/throat. Fluid loss causes Lung萎 (withering), throat blockage, and pus/blood sputum. *Jingui Yaolue*: Lung withering arises from harsh purgatives causing severe fluid loss. Uncontrollable diarrhea indicates severe interior deficiency, hence difficult. Mahuang Shengma Tang regulates Liver-Lung qi.)

Mahuang Shengma Tang Formula
Ephedra Stem (Mahuang, removed nodes, 2.5 liang), Cimicifuga Rhizome (Shengma, 1.25 liang), Angelica Sinensis Root (Danggui, 1.25 liang), Anemarrhena Rhizome (Zhimu, 18 zhu), Scutellaria Root (Huangqin, 18 zhu), Polygonatum Rhizome (Weirui, 18 zhu), Gypsum Fibrosum (Shigao, crushed, wrapped in silk), Atractylodes Macrocephala Rhizome (Baizhu, 6 zhu), Dried Ginger (Ganjiang, 6 zhu), White Peony Root (Shaoyao, 6 zhu), Asparagus Tuber (Tianmendong, removed heart, 6 zhu), Cinnamon Twig (Guizhi, 6 zhu), Poria (Fuling, 6 zhu), Licorice Root (Gancao, roasted, 6 zhu).
Boil fourteen ingredients in one dou of water. First boil Mahuang until boiling, remove foam. Add remaining herbs, boil to obtain three sheng. Strain, divide into three warm doses. Take within the time it takes to cook three dou of rice. Sweating indicates cure. (Cheng Wuji notes: *Yuhan Jing*: Great heat requires cold to subdue; intense heat requires sweating to release. Mahuang/Shengma sweetness releases floating heat. Deficient righteous qi requires pungent-moistening agents; Danggui/Guizhi/Ganjiang pungency disperses cold. Upper heat requires bitter-draining; Zhimu/Huangqin bitterness-coolness clears heart heat. Fluid deficiency requires sweet-moistening; Fuling/Baizhu sweetness soothes Spleen and generates fluids. Lung dryness-heat requires astringent-sweet method; Shaoyao sourness restrains rebellious qi. Weirui/Tianmendong/Shigao/Gancao sweetness moistens Lung and clears heat.)

Jueyin disease: Excessive thirst, qi rushing up to the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms upon eating, and worsening diarrhea if purged. (See Jueyin Disease section.)

Shanyin on day four-five, abdominal pain with gas moving toward the lower abdomen indicates impending diarrhea. (See Abdominal Pain section.)

Floating-slow pulse, exterior heat, interior heat, diarrhea with undigested food: Use Sini Tang. Profuse sweating, persistent heat, internal cramping, limb pain, plus diarrhea, cold extremities, aversion to cold: Use Sini Tang. Diarrhea with undigested food, interior cold with exterior heat, sweating with cold extremities: Use Tongmai Sini Tang. Profuse sweating or massive diarrhea with cold extremities: Use Sini Tang. Diarrhea with undigested food, do not attack exterior; sweating causes abdominal fullness: Use Sini Tang. Shanyin starting with cold then fever stops diarrhea; return of cold brings back diarrhea: Use Sini Tang. Diarrhea with deep-slow pulse, slightly red face, slight body heat, diarrhea with undigested food: Expect depression/sweating resolution. Patient likely has mild cold extremities due to lower deficiency: Use Sini Tang. Post-diarrhea pulseless, cold extremities: If pulse returns and extremities warm within a week, survival; if not, death. (Use Baotong Tang or Tongmai Sini Tang.) Post-diarrhea increased irritability, soft epigastrium on palpation indicates empty irritability: Use Zhizi Chihui Tang. Diarrhea with delirium and dry feces: Use Xiaochengqi Tang. Diarrhea with cold extremities and no pulse: Moxibustion if not warming. If pulse doesn't return and slight panting occurs, death. Shaoyin weaker than Dubo pulse is favorable. (Shaoyin Kidney Water vs. Dubo Spleen Earth. Diarrhea implies Kidney evil attacking Spleen; Water failing to overcome Earth is mild evil, thus favorable.)

Diarrhea with slight fever, thirst, and weak pulse indicates recovery. Shanyin fever, severe diarrhea, cold extremities, restlessness, inability to lie down: Death. Shanyin fever, extreme diarrhea, unrelenting cold extremities: Death. (*Jingui Yaolue*: Six Fu organs failing externally cause cold hands/feet; Five Zang organs failing internally cause uncontrollable diarrhea.)

Shanyin day six-seven, sudden fever with diarrhea and unstoppable sweating: Death, presence of Yin without Yang. (Day seven marks struggle between pathogen and righteous qi. Victory of righteous qi brings life; pathogen victory brings death. Sudden fever/diarrhea/sweating indicates pathogen victory and Yang collapse.)

Shanyin diarrhea occurring ten-plus times daily with strong pulse: Death. (Diarrhea indicates interior deficiency; pulse should be weak/faint. Strong pulse indicates pathogen victory. *Nanjing*: Pulse mismatching disease indicates death.)

Fever with cold extremities for seven days, followed by diarrhea: Difficult to treat. (Fever/cold indicates pathogen entering interior. By day seven, transmission completes; righteous qi should win, causing sweating/resolution. Diarrhea indicates pathogen victory and interior weakness.)

Dai Yuanli said: Spontaneous diarrhea must distinguish Yin/Yang. Three Yang spontaneous diarrhea presents in respective meridians. Taiyang-Yangming combined disease with diarrhea, headache, waist pain, muscle heat, eye pain, nasal dryness: Ge Gen Tang. Taiyang-Shaoyang combined disease with diarrhea, body heat, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, nasal dryness: Da Chai Hu Tang. Generally, Yang heat diarrhea differs from Yin cold diarrhea. Yang diarrhea features dark yellow foul-smelling stool, audible expulsion, warm umbilicus, relief with cool meds, worsening with hot meds. Yin diarrhea features clear undigested food, white/pale yellow stool, cold umbilicus, treated with warming/astringent agents. Here, Yin/Yang refers to Qi, not meridians. Yin conditions can have Yang diarrhea; don't assume all diarrhea is Yin. Internal fullness with chills/fever shouldn't be purged; improper purging causes interior deficiency, heat entry, and heat-carrying diarrhea with warm umbilicus, dark yellow stool, and greasy intestinal fluid ("Li Chang"), treated with Baitouweng Tang or Huangqin Tang. Note: Non-febrile, warm extremity diarrhea is Taiyin; cold extremity diarrhea is Shaoyin/Jueyin. Other febrile diarrhea belongs to Yang meridians. Yin diarrhea may feature rebound fever, post-diarrhea fever, or initial fever followed by diarrhea, distinct from Yang transmitting to Yin. See Febrile Disease section. Also, prolonged laxative use causing unremitting diarrhea requires extreme hot agents. Yang has diarrhea/constipation; differentiate via other signs. Exterior heat/internal irritability/diarrhea, thirst, distension/pain/vomiting: Often use Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang is often better. Wendan Tang plus Huanglian, removing Zhi Shi, choice depends on practitioner.

Wu Qian said: Spontaneous diarrhea not caused by purgatives is colloquially "Lou Di Shang Han." Differentiate heat-carrying vs. cold-carrying. *Yuan Bing Shi* states: White stool indicates cold; green/yellow/red/black indicates heat. Complete undigested food, unchanged color, akin to fright loose stools, or foul vomiting/diarrhea, clear cold urine, no oral dryness, deep/faint/weak pulse, or fever with cold extremities/aversion to cold/curled posture: Cold syndrome. Heat syndrome features oral dryness/thirst, yellow/scanty urine, greasy stool, rapid/floating/sliding/chordic/large/hyperactive pulse, or heat failing to digest food. Differentiate by pulse/symptoms. Stomach deficiency with internal heat/irritability/thirst/diarrhea/weak pulse: Qiwei Renshen Baizhu San. With fever: Shenhu Sanbai Tang minus Huangqin plus fried Huanglian. Abdominal fullness/difficult urination: Wuling San combined with Lizhong Tang. Vomiting: Add Huoxiang, Banxia, Shengjiang, Chenpi. Heavy dampness/unremitting diarrhea: Add Cangzhu, Baizhu. Abdominal distension: Add Houpo. Abdominal pain: Add fried Shaoyao, Rougui, Muxiang to warm. Shanyin diarrhea with floating pulse (exterior unresolved): Zhang Zhongjing uses Xiao Qinglong Tang minus Mahuang plus Ruanghua (fried red) to scatter exterior and manage water. Difficult urination/watery diarrhea: Wuling San. Severe water retention adds Ruanghua to move water, stopping diarrhea. Diarrhea contraindicates sweating; treat diarrhea first. Once interior solidifies, righteous qi recovers, pathogen resolves, and sweating occurs naturally. Diarrhea stems from interior deficiency; sweating causes dual deficiency, making complications difficult.

Appendix

Huoren Shu says: Cold toxin entering stomach causes cold umbilicus, abdominal fullness, yellow/white/green/black stool, or clear undigested food diarrhea: Sini Tang, Lizhong Tang, Baotong plus Fuzi Tang, Sini plus Xiebai San. Heat-carrying diarrhea causes warm umbilicus, dark yellow stool, greasy intestinal fluid: Huangqin Tang, Baitouweng Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, Chishizhi Wan.

Sanhuang Shuai Ai Tang: Treats Shanyin day four post-drastic purgation, intermittent heat diarrhea unresponsive to Baotong Tang. Clears heat, stops diarrhea.
Huangqin, Huanglian, Huangbai, Shuai Ai (half egg size). Chop, decoct in water, take warm.

Xiebai Tang: Treats Shanyin diarrhea like rotten meat juice, bloody discharge, latent qi abdominal pain, all heat types.
Dou Chi (half he, wrapped), Xiebai (one handful), Zhizi (seven pieces). Chop, boil in 2.5 sheng water. Boil Zhizi ten times, add Xiebai, boil to 2 sheng, add Dou Chi, boil to 1.2 sheng. Take warm.

Chishizhi Wan: Treats Shanyin heat diarrhea.
Chishizhi, Fried Ganjiang (1 liang each), Huanglian, Danggui (2 liang each). Powder, honey pills like wattle seeds. 30 pills per dose, rice water, three times daily. For severe damp-toxin, abdominal pain, pus/blood or rotten meat-like stool: Taohua Tang, Diyü San, Huanglian Ejiao Tang.

Diyü San: Treats Shanyin unresolved heat toxin, evening high fever, abdominal pain, pus/blood stool.
Diyü, Xijiao Xie, Fried Huanglian, Gegen (1 liang each), Zhizi (0.5 liang), Huangqin (1 liang). Chop. 5 qian per dose, one cup water, add 5 cun Xiebai, decoct, take warm.

Haizang says: Huanglian Ejiao Tang: Treats Shanyin heat toxin entering stomach, pus/blood diarrhea.
Fried Huangqin (2 liang), Zhizi (0.5 liang), Fried Ejiao, Huangbai (1 liang each). Chop. 4 qian per dose, decoct in water.

Yun Qizi says: Post-shanyin sweating/purgation, free urination/defecation with abdominal pain: Zaochang Wan.
Fried Fuzi (1 piece), Longgu (0.5 liang), Ganjiang (1 liang), Wuzhuyu, Susuke, Helipi (0.5 liang each). Fine powder, wine paste pills like wattle seeds. 30 pills per dose, warm water. Stop when diarrhea ceases.

Post-shanyin sweating/purgation, tenesmus/diarrhea: Qixuan Wan.
Dahuang (1 liang), Muxiang, Binglang, Chaihu, Hezipi, Gancao (0.5 liang each), Tao Ren (30 pieces, peeled/cored). Fine powder, honey pills like wattle seeds. 50 pills per dose, warm water.

Post-shanyin sweating/purgation, rebellious qi/unremitting diarrhea (cold): Zhishi Shaoyao Gancao Tang.
Shaoyao, Gancao, Fried Zhishi, Fried Ganjiang (0.5 liang each). Chop. 3 qian per dose, decoct in water.