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Diarrheal syndromes vary. "Tang" (loose stool) and slippery flow refer to "Dong" diarrhea (sudden, profuse diarrhea). "Tang" implies a state resembling diarrhea but not fully so, where essence and dregs fail to consolidate, with a color resembling pus; "Xie" (leakage) occurs without specific timing, with uncontrolled discharge; "Li" (profuse flow) involves direct splashing streams, where Qi slides through the Zhongwan area, allowing food and water to pass directly through the intestines and stomach without digestion; "Dong" refers to sudden downward expulsion, like a bucket bursting and scattering without retention. One must carefully examine the pulse to distinguish clearly between deficiency and excess patterns. Cold diarrhea presents with white-colored stools; heat diarrhea presents with yellow or reddish stools, or fecal foam ejected forcefully at a distance, as fire nature is rapid and primal Yang rushes forth, which should not be taken lightly. However, there are cases of fire generated from deficiency after prolonged cold, cases of cold contracted due to extreme heat, cases of deficiency resulting from excess, cases of apparent excess due to failure of transformation in deficiency, cases of white color resembling cold after repeated injuries, cases of yellow color resembling heat due to prolonged injury causing dryness, fluid depletion, and thirst, and cases of green color resembling fright due to Liver Wood overacting on Spleen Earth.

Furthermore, diarrhea syndromes are categorized into five types: Stomach Xie, Spleen Xie, Large Intestine Xie, Small Intestine Xie, and Da Jia Xie. Stomach Xie features undigested food and yellow stools; Spleen Xie features abdominal distension and fullness with pouring diarrhea, vomiting and regurgitation immediately after eating; Large Intestine Xie features urgency and distress, white stools, intestinal borborygmi, and cutting pain; Small Intestine Xie features short, frequent passages with pus and blood, and lower abdominal pain; Da Jia Xie features frequent trips to the toilet with inability to defecate, and pain in the urethra. There is also Food Stagnation Diarrhea, characterized by accumulation of retained fluids, chest and diaphragm stuffiness and fullness, hypochondriac pain, coolness by day and fever by night, and acid regurgitation. If the pulse is Excess, tonify after purging; if Deficient, purge after tonifying. For example, spring wind-cold cough accompanied by diarrhea indicates both exterior and interior deficiency, with hyperactive Liver Wood and deficient Spleen Earth. Winter cold-induced diarrhea is difficult to treat and may develop into Slow Spleen Wind. Dampness-induced diarrhea features borborygmi, abdominal pain, and cold hands and feet, suitable for promoting urination to drain dampness.

However, diarrhea, malaria, and dysentery share the same origin, caused by Spleen injury during the hot summer months. When food transforms into Phlegm and fills the chest and diaphragm, it becomes Malaria; when food forms stagnation and adheres to the intestines and stomach, it becomes Dysentery. Initial injury leading to diarrhea is mild; prolonged stagnation leading to malaria or dysentery is severe. Water diarrhea without abdominal pain, flaccid muscles, and heavy body indicates Dampness; undigested food indicates Qi Deficiency. Abdominal pain with borborygmi, sudden pain followed by watery diarrhea, indicates Fire; mental cloudiness with frequent symptoms, intermittent diarrhea varying in amount, indicates Phlegm. Severe pain with diarrhea that relieves pain afterward indicates Food Stagnation. Greasy complexion, irritability, thirst for drinks, cold back with spontaneous sweating, hot head, and vomiting indicate Summerheat Injury.

Generally, diarrhea belongs to Dampness, often caused by dietary injury to the Spleen. Treatment methods do not exceed draining dampness, resolving stagnation, separating clear from turbid, and tonifying the Spleen. It is crucial to differentiate cold/heat and new/chronic. For chronic diarrhea with sinking Yuan Qi, lifting methods are appropriate; for loose intestines and uncontrollable leakage, astringent methods are appropriate. Diuretics should not be used after long-term illness; astringents should not be used at the onset. Reddish-brown facial complexion with diarrhea contraindicates warm agents; chronic diarrhea with thirst contraindicates cooling agents. Acute diarrhea is typically not Yin-pattern; chronic diarrhea is typically not Yang-pattern. Thirst should resolve for cure, indicating elimination of pathogenic heat, restoration of Spleen Qi, and generation of fluids. Absence of thirst should lead to slight thirst for recovery, indicating elimination of stagnation and harmony of Yin and Yang. Intermittent diarrhea can be treated by dispersing Spleen dampness, followed by supporting the Spleen. Diarrhea occurring at Yin hour (3-5 AM) is called Morning Diarrhea, suitable for warming and tonifying Kidney Yang, as the Kidney opens into the two yin orifices and fails in its storing function. Thus, there are three deficiencies: Spleen, Liver, and Kidney. There are eight syndromes: caused by Dampness, Fire, Phlegm, Deficiency, Summerheat, Stagnation, Wind, and Cold. Vomiting milk with yellow diarrhea indicates Heat Milk Injury; vomiting milk with green diarrhea indicates Cold Milk Injury. Feces smelling like rotten eggs with abdominal distension, purple finger veins, and fever indicate Gan Diarrhea (malnutrition diarrhea). Green feces with night crying or occasional palpitations indicate Fright Diarrhea. Initially yellow stool turning green after a while indicates Cold Viscera. Green stool mixed with white pus, thick and sticky like saliva, indicates Cold Large Intestine. Prolonged cases may lead to abdominal pain, crying, pale face, bluish complexion, gradually forming Yin Epilepsy. The Spleen and Stomach are the ancestors of the whole body and the source of all meridians; disease here affects all twelve meridians.