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Symptoms of diarrhea include stool containing water and undigested food, abdominal pain or no pain, without tenesmus (the feeling of incomplete defecation), pus, blood, or the sensation of urgency with little output. The patient only feels fatigue and lethargy; thus, it differs from dysentery. When food and drink enter the stomach and move down to the small intestine, the movement of Qi separates the clear from the turbid. Water seeps into the bladder, while grain residues tend toward the large intestine, resulting in normal urination and defecation. How does diarrhea occur? If Qi fails to transform and transport, causing water and grain to mix indistinguishably and all flow into the large intestine, diarrhea ensues. The reason for Qi's failure to move is that various pathogens from the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions can stagnate Qi. The details are as follows.

Sometimes it is due to Wind. The classics state: "Injury by Wind in Spring leads to unformed stools (Sun-xie) in Summer." This means that in Spring, Wind-Cold invades from the skin and meridians, transmitting to the intestines and stomach, causing abdominal distension and borborygmus (sound caused by wind moving between the intestines), leading to Sun-xie (stool containing undigested original food). This type of Wind pathogen must be expelled through sweating. Initially, it is Cold, but over time, it stagnates and transforms into Heat. Additionally, the Qi of the Liver Wood is also called Wind. In Spring, Liver Qi should ascend; if injured by pathogens, it stagnates and sinks. Prolonged stagnation generates Heat, which steams and transforms into Dampness, eventually causing Sun-xie. This condition requires ascending Yang and resolving Dampness. Both syndromes present with borborygmus (also caused by internal stirring of Liver Wind), a wiry pulse, and during defecation, there may be obstruction with no output, or copious white foam with popping sounds. The odor is not particularly foul because the food is undigested. The phrase "Summer implies duration" should not be taken literally. (Some argue that when Wood Qi is dominant in Spring, although it cannot ascend, it refuses to descend, merely stagnating into Heat. By Summer, intense Heat steams Dampness like clouds producing rain, hence diarrhea occurs in Summer. This explanation is also valid.)

Sometimes it is due to Cold. Cold causes Qi to congeal, unable to transport water and grain, resulting in diarrhea. Cold pathogen attacks, causing continuous abdominal pain, borborygmus, sudden silent diarrhea, undigested food, cold watery stool resembling duck feces (stool like water with little solid matter), clear urine, a deep and slow pulse, and cold body. If the pulse is fine (Heart deficiency), skin is cold (Lung deficiency), breath is short (Liver deficiency), both bowels and urethra discharge profusely (Kidney deficiency), and food intake is absent (Spleen deficiency), this is called the Five Deficiencies. It is difficult to treat and requires early rescue with tonifying decoctions containing Ginseng and Atractylodes Macrocephala; delay makes recovery impossible.

Sometimes it is due to Heat. Fire has an urgent nature, forcing water and grain downward before they can be transformed. Do not mistake undigested food for deficiency-cold. The pulse is surging and rapid, urine is red and scanty, abdominal stabbing pain occurs with each episode of diarrhea, dry mouth and thirst are present, stool makes popping sounds upon exit, and the anus feels hot and painful. Diarrhea due to heat is indeed caused by the urgency of fire, but it can also result from stagnation of Heat Qi, not just the inability of Cold to transport. Stool is often dirty, sticky, yellow-red in color, with stifling abdominal pain.

Sometimes it is due to Summerheat. The principle is the same as heat diarrhea. Symptoms include a greasy complexion, profuse sweating, irritability, and thirst.

Sometimes it is due to Dampness. Excessive Dampness leads to difficult urination; water flows into the intestines making gurgling sounds, without abdominal pain. The pulse is deep and moderate, and the body feels heavy and weak. Treatment for Dampness should promote urination. If diarrhea is caused by Qi deficiency and sinking, using diuretics is lowering again after lowering; one should instead raise the Yang, as stated: "For sinking conditions, lift them." To raise Yang, use Wind herbs, which also overcome Dampness.

Sometimes it is due to Food Stagnation. Injury to food causes Spleen stagnation, preventing the transport of water and grain, leading to diarrhea. Belching smells like rotten eggs, there is colicky abdominal pain, pain followed by diarrhea, relief after passing stool, then pain returns shortly. Stool is foul, sticky, and yellow (previous food stagnates, subsequent food stops, accumulating over time before being expelled, hence the foul smell).

Sometimes it is due to Alcohol. Diarrhea occurs once or twice every dawn. (Alcohol is damp in nature; night Qi is Yin and cold, unable to retain it long, so diarrhea inevitably occurs at dawn.)

Sometimes it is due to Drinking Water. Thirst leads to drinking, drinking leads to diarrhea, diarrhea leads back to thirst, repeating the cycle.

Sometimes it is due to Phlegm. Phlegm stagnation blocks Qi movement, causing water and grain to mix indistinguishably. There is dull, slight abdominal pain or a feeling of cold. Stool resembles thick fluid, intermittent diarrhea varying in amount, loss of appetite without hunger, emaciation despite previous obesity, and a slippery pulse.

If the Spleen is deficient and cannot accept food, borborygmus and abdominal fullness occur immediately after eating, relieved only by vomiting up the food. Without eating, there is no issue; this is called Spleen Diarrhea.

Diarrhea occurring once or twice at dawn is called Kidney Diarrhea (due to Kidney Fire deficiency and cold).

If Liver Qi is stagnant, accompanied by hypochondriac pain and diarrhea, it is called Liver Diarrhea.

If oral and tongue ulceration accompanies diarrhea, it is Heat in the Heart and Spleen meridians. The Heart opens into the tongue, and the Spleen opens into the mouth; Heat attacking upward causes ulceration. If Heat transfers to the Stomach and Small Intestine, transport and transformation fail, causing diarrhea, called Mouth Ulcer Diarrhea.

Chronic diarrhea that does not stop is called Slippery Diarrhea or Hole Diarrhea. The anus is like a bamboo tube; food enters and exits directly without control, indicating impending Qi collapse. If food intake ceases, there is no cure.

Treatment methods: For Wind Diarrhea, use Shengyang Yijie Decoction (see Chills). For Cold Diarrhea, use Lizhong Decoction (see Middle Cold) or Jiangshui San. For Heat Diarrhea, use Yiyuan San (see Summerheat Injury) added with Scutellaria Baicalensis Root, Coptis Chinensis Rhizome, Juncus Effusus Stem, and Bamboo Leaf. Remove Atractylodes Macrocephala Rhizome from Zhixie Tang, add Coptis Chinensis Rhizome, Talcum, and Dolichos Lablab Seed. If Heat stops in the upper chest, causing thirst and excessive drinking, but the Stomach lacks Heat to process water, leading to diarrhea, moxa the depression below the first thoracic vertebra; Wuling San (see Dampness Injury) is also suitable. For Summerheat Diarrhea, use Qingliu Wan (see Dysentery) or Yulong Wan. For Dampness Diarrhea, use Weiling Tang, Wuling San, or swallow Wuji Wan with Shengyang Chushi Tang or Zhixie Tang. Add Ginger and Cinnamon Twig for Cold-Damp; add Coptis Chinensis Rhizome and Pueraria Lobata Root for Heat-Damp. For Food Diarrhea, use Pingwei San (see Food Injury) added with Immature Bitter Orange. Identify the ingested substance, burn it to charcoal, and administer 3-5 qian. If constitution is strong, use purgatives. For Alcohol Diarrhea, use Lizhong Decoction (see Middle Cold) added with Kudzu Root, swallow Wine-processed Coptis Chinensis Rhizome Pills (see Summerheat Injury), or Gehua Jieying Tang (see Food Injury). For Water Drinking Diarrhea, use Shenyao Wan (see Swelling) for excess patterns, or Chunze Tang (see Dampness Injury) and Baizhu Tiaozhong Tang for deficiency patterns. For Phlegm Diarrhea, use Zhixie Tang added with Pinellia Ternata Tuber and Sea Powder. For excess, induce vomiting or purge; for deficiency, use Liujunzi Tang (see Qi). For Spleen Diarrhea, use Kuaipi Wan. For Kidney Diarrhea, use Sishen Wan, taken morning and evening. For Liver Diarrhea, use Zhixie Tang added with Bupleurum Root and Green Tangerina Peel. If Liver Qi fails to consolidate, causing Spleen Qi to scatter and fail to transport, add White Peony Root. For Mouth Ulcer Diarrhea, symptoms on top cease when diarrhea starts, and vice versa. During mouth ulcers, use Xiexin Daochi San brewed in boiling water. During diarrhea, use Shenling Baizhu San taken with rice gruel morning and evening. If urine is scanty and diuresis continues, water flows to the large intestine; use equal parts Poria and Plantago Seed boiled as tea. If cold-natured drugs fail to heal mouth ulcers, it indicates floating deficiency Fire; use Lizhong Decoction added with Cinnamon Bark and significantly increased Poria to descend Yang and promote urination. Descending Yang heals mouth ulcers; promoting urination stops diarrhea. For chronic diarrhea, use Bazhu San or Sijunzi Tang (see Qi) added with Myristica Seed and Cimicifuga Rhizome. Zhang Zhongjing said: "Unremitting diarrhea worsens with Lizhong Decoction because Lizhong regulates the Middle Jiao, whereas this diarrhea is in the Lower Jiao; treat with Red Stone Lapis and Hematite Decoction/Pill." Chronic unremitting diarrhea often transforms into dysentery (see Dysentery section). Use Magnolia Bark and Immature Bitter Orange Decoction to prevent in excess patterns; Sishen Wan for deficiency-cold. Astringents such as Guchang Wan and Chebulae Fructus Powder treat heat diarrhea; Fupi Wan, Taohua Wan, Chebulae Pill, and Red Stone Lapis and Hematite Decoction treat cold slipperiness. Chronic diarrhea离不开 Licorice Root and White Peony Root because it is a Spleen disease. It离不开 Atractylodes Macrocephala Rhizome because it is a Dampness disease. Avoid Aurantium Imperiale Fruit because it relaxes the intestines. Avoid Angelica Sinensis Root because it lubricates the intestines (use White Peony Root if using Buzhong Yiqi Tang). If diarrhea recurs next year in the same month, there is accumulation. For heat accumulation, use Dachengqi Tang (see Constipation); for deficiency, use Baohe Wan (see Food Injury) added with Curcuma Zedoaria Rhizome and Curcuma Phaeocaulis Rhizome. For cold accumulation, use Beiji Wan (see Food Injury).

Lizhong Decoction (see Middle Cold) added with Poria and Coptis Chinensis Rhizome is named Lianli Tang, most suitable for mixed cold-heat diarrhea (e.g., summerheat injury combined with internal damage from cold/raw food, or unresolved diarrhea after heat pathogen clears). In all diarrhea, after fluids are lost, thirst and red/scanty urine occur; do not immediately diagnose as heat. (It must be thirst and red/scanty urine from onset to be heat.) After Yin-Yang differentiation and cessation of diarrhea, if urine remains scanty, it is Lung Qi deficiency failing to generate water; use Buzhong Yiqi Tang (see Qi) added with Ophiopogon Japonicus Root and Schisandra Berry. Or Kidney Yin deficiency causing water depletion; use Liuwei Wan (see Deficiency Damage) added with Ophiopogon Japonicus Root and Schisandra Berry. Or Kidney Yang deficiency failing to transform Yin; use Bawei Wan (see Deficiency Damage). Further diuresis will worsen urine retention, cause water intoxication, and trigger swelling. Diarrhea pulse must be deep, preferably fine/small, not large/rapid/excess. Downward diarrhea with upward vomiting of phlegm, unceasing, indicates collapse of both upper and lower, a death sign. Abdominal distension, cold extremities, unremitting diarrhea, and physical emaciation indicate death.