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The *Classic* (Huangdi Neijing) states: "When Yang Qi is located below, it generates sun-xie (diarrhea with undigested food)." This is because accumulated heat Qi cannot ascend and instead sinks downward to cause diarrhea. Therefore, in formulas for treating diarrhea, ascending herbs are often added to prevent the sinking of Qi. It also states: "Excess dampness leads to diarrhea." Generally, diarrhea occurring at the onset of a disease belongs to Heat, while diarrhea recurring after a long duration belongs to Cold. If the fluid is clear, cold, and white in color, it belongs to Cold; if it is green, yellow, red, or black and dry/astringent, it belongs to Heat. Diarrhea with undigested food, a cool body without thirst, a slow and faint pulse, and clear, non-astringent urine indicate Deficient-Cold; treatment should involve herbs such as Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Paoyangjiang (Prepared Ginger), and Zhigancao (Honey-fried Licorice). Reddish, astringent urine, undigested food in stool accompanied by internal heat signs, a hot body with thirst, and a surging and rapid pulse indicate Excess-Heat; treatment should involve herbs such as Mutong (Akebia Stem), Zhuling (Polyporus), and Chifuling (Red Poria). During the initial eruption and the scabbing stage of smallpox/variolae, temporary diarrhea is not harmful. However, diarrhea accompanying the rupture and suppuration of pustules requires urgent treatment. One should treat the cause of the diarrhea rather than the diarrhea itself as a disease. If defecation occurs only once or twice daily, one should not lightly use astringents, lest the toxic factors fail to vent outward, retaining residual toxins and generating other complications. Instead, one should regulate and consolidate Middle Qi and allow nature to take its course. Forcibly suppressing any of the hundred diseases is not a good method; just as subduing people by force is inferior to winning them over by virtue, so too is forcibly stopping diarrhea inferior to resolving the underlying imbalance.

Diarrhea occurring before the eruption of sores indicates that pathogenic factors have merged into the interior, causing excessive heat in the intestines and stomach and disrupting transmission and transformation; treatment should address Heat-Toxin. Diarrhea occurring after the eruption of sores indicates that pathogenic factors have merged into the exterior, where Zheng Qi (Upright Qi) is expelling pathogens; thus, the pathology is primarily on the exterior rather than the interior. At this time, Interior Qi is slightly deficient and unable to transport and receive water and grain, leading to spontaneous diarrhea; treatment should address Qi Deficiency. Diarrhea without thirst indicates Cold in the Zang organs leading to lower purging; treatment should employ Warmtonic methods. Furthermore, in cases of smallpox/variolae where the patient has high fever but develops diarrhea and abdominal distension due to consuming cold foods or overdosing on cold medicines, and the erupted sores appear as pale, bloodless scars, this results from Interior Cold and latent cold in the Spleen and Stomach, which impedes the circulation of Ying and Wei Qi, causing toxic factors to remain internalized and unvented. Urgent warming of the Spleen and tonification to vent the toxin is required; this will harmonize Blood and Qi, turn the pale scars red, and cure the diarrhea. Finally, the passage of scabs, pus, and blood in the stool during the late stage of smallpox/variolae indicates residual toxins; astringents should not be used. Instead, detoxification and regulation of the Middle Jiao should be employed to assist Ying and Wei circulation; once the toxins are exhausted, the diarrhea will cease naturally.