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Rhubarb (Radix et Rhizoma Rhei) four liang, Cinnamon Twig (Cortex Cinnamomi) [processed by stir-frying] three liang, Immature Bitter Orange (Fructus Aurantii Immaturus) [processed by stir-frying], three large fruits.
The above three ingredients are decocted with four sheng of water until one sheng and two he remain. The dregs are removed, and the liquid is divided into three warm doses. Discontinue use once bowel movement is achieved.
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In cases of diarrhea where the pulse is unexpectedly wiry (Xian), accompanied by fever and sweating, the disease will resolve spontaneously.
[Annotation]
Diarrhea is a disorder of the Spleen. A wiry pulse corresponds to the Liver. Since a Spleen disorder should not present with a wiry pulse, it is termed "unexpectedly wiry pulse." Diarrhea is an interior syndrome, while fever is an exterior syndrome. If there is both fever and sweating, it indicates that the exterior and interior are harmonized; even if the pulse is wiry, spontaneous recovery is expected.
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In cases of diarrhea, if the pulse is deep and wiry, there is a sensation of heaviness in the rectum (tenesmus). If the pulse is large, the disease has not yet ceased. If the pulse is faint and rapid, the pathogenic factor is declining, and the disease is about to stop spontaneously; even with fever, death will not occur.
[Annotation]
A deep pulse indicates an interior condition, and a wiry pulse indicates tension or urgency. Tenesmus refers to the feeling of incomplete evacuation. In diarrhea with a deep and wiry pulse, this results in abdominal urgency and tenesmus. In dysentery-like conditions, if there is fever and a large pulse, it signifies excess pathogenic factors, indicating the disease is ongoing. If the pulse is faint and rapid, it signifies the decline of pathogenic factors, and the disease should cease spontaneously; even with fever, death is not imminent. From this, we can deduce that a large pulse combined with high body heat indicates a fatal prognosis.
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For hot diarrhea accompanied by tenesmus, Betel Nut Decoction (Baitouweng Tang) is the primary treatment.
[Annotation]
This follows the previous clause to explain the treatment method. When diarrhea involves pus and blood, with tenesmus and deep accumulation of heat, Betel Nut Decoction (Baitouweng Tang) is used due to its bitter and cold nature. Coldness overcomes heat, and bitterness dries dampness; once damp-heat is eliminated, tenesmus naturally resolves.
[Collected Annotations]
Cheng Lin stated: Hot diarrhea with tenesmus occurs because heat forces its way into the intestines and stomach. Only bitter flavors can firm the lower jiao, and only cold properties can eliminate heat. Thus, the character "hot" is added to distinguish it from the preceding cold diarrhea.
You Yi stated: This condition involves damp-heat pouring downward, so Betel Nut Root (Radix Pulsatillae) is used; its bitterness drains dampness, and its coldness overcomes heat.

Betel Nut Root (Radix Pulsatillae) three liang, Coptis Rhizome (Rhizoma Coptidis) three liang, Phellodendron Bark (Cortex Phellodendri) three liang, Privet Tree Bark (Cortex Fraxini) three liang.
The above four ingredients are decocted with seven sheng of water until two sheng remain. The dregs are removed, and one sheng is taken warm. If not cured, administer another dose.
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For diarrhea involving the passage of pus and blood, Peach Blossom Decoction (Taohua Tang) is the primary treatment.
[Annotation]
In early-stage diarrhea with pus and blood, Da Chengqi Tang or Shaoyao Tang may be used for purgation. If heat is excessive, Baitouweng Tang is used to clear heat. If the condition persists for a long time leading to incontinence (slippage), Taohua Tang should be used to nourish the intestines and secure against slippage.