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Zhang Zihe stated: The combination of wind, dampness, and cold pathogens results in cholera-like vomiting, diarrhea, and muscle cramps. Wind corresponds to the Jueyin Liver Wood, and dampness corresponds to the Taiyin Spleen Earth. He further stated: When Jueyin Qi arrives, it manifests as hypochondriac pain, vomiting, and diarrhea; when Shaoyang Qi arrives, it manifests as vomiting and regurgitation; when Taiyang Qi arrives, it manifests as epigastric fullness, cholera-like vomiting and diarrhea; when Taiyin Qi arrives, it manifests with impaired water metabolism. Muscle cramps occur because wind governs the Liver, and the Liver governs the sinews; when wind is severe and urgent, it causes cramping. Vomiting occurs because fire governs the Heart, and the Heart's nature is to flare upward, leading to vomiting. Diarrhea and dysentery occur because Earth governs dampness, and spleen dampness flows downward, causing diarrhea. Spleen dampness arises because the Earth Qi is constrained by Wind-Wood, preventing the transformation and transportation of Earth. In drought without rain, fire becomes excessively strong and flares upward; severely, this resembles thunderstorms, flooding, landslides, and bank collapses—is this not a manifestation of Taiyin (dampness) flaring up? Therefore, when people suffer from abdominal distension, borborygmus, and frequent stools, or severely heart pain, hypochondriac distension, vomiting, cholera, cold limbs with profuse diarrhea, dorsal edema, and heavy body, Qiyuanzi correctly stated that these symptoms are all generated by spleen dampness.

Wang Haizang stated: Vomiting accompanied by diarrhea is cholera. The Sanjiao (Triple Burner) is the pathway for food and fluids. If pathogenic factors are in the Upper Jiao, there is vomiting without diarrhea; if in the Lower Jiao, there is diarrhea without vomiting; if in the Middle Jiao, both vomiting and diarrhea occur. This is caused by irregular diet, imbalance of cold and heat, interference between clear and turbid Qi, and separation of Yin and Yang, resulting in cholera. "Huohuo" describes the rapid and severe onset; "liaoluan" describes the chaotic symptoms. If only vomiting or diarrhea occurs, the condition is mild. External invasion of wind-dampness combined with internal generation of cold-raw-hard foods creates disease internally and externally. The six excess pathogens injure the body in various sequences; dietary stagnation varies in degree; internal and external transmission varies in severity. Treatment should follow the corresponding meridians and zang-fu organs. After vomiting and diarrhea cease, if exterior symptoms remain, treat them as exterior injuries.

Xue Lizhai stated: For diarrhea caused by rice injury, use Liujunzi Tang (Six Gentlemen Decoction) with Guya (Valley Sprout); for flour injury, add Maiya (Barley Sprout); for meat injury, add Shanzha (Hawthorn). If accompanied by alternating cold and heat with vomiting, indicating Liver Wood insulting Spleen Earth, use Liujunzi Tang with Chaihu (Bupleurum) and Shengjiang (Fresh Ginger). If accompanied by vomiting, abdominal pain, and cold extremities, indicating Cold Water insulting Earth, use Liujunzi Tang with Ganjiang (Dried Ginger) and Rongui (Cinnamon Bark); if ineffective, use Qian Shi Yihuang San (Child Master's Yellow-Regulating Powder). If Yuan Qi sinks, with fever, thirst, and limb fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If diarrhea stool is yellow, revealing the true color of Spleen Earth, use Liujunzi Tang with Muxiang (Aucklandia), Ganjiang, and Rongui. If diarrhea occurs at dawn (fifth watch) with poor appetite in the morning, indicating Spleen-Kidney deficiency, administer Sishen Wan (Four Spirits Pill) at dawn and Baizhu San (Atractylodes Macrocephala Powder) during the day; if ineffective, or if relapse occurs with poor appetite, urgently use Bawei Wan (Eight-Ingredient Pill) to tonify Mingmen Fire to generate Spleen Earth.

Zhu Danxi stated: Diarrhea can be caused by dampness, fire, Qi deficiency, phlegm accumulation, or food stagnation. For dampness, use Siling San (Four-Ingredient Powder) with Cangzhu (Atractylodes Lancea); for severe cases, add Baizhu (Atractylodes Macrocephala) to dry dampness and promote diuresis. For fire, use Siling San with Muxiang and Huangqin (Scutellaria) to subdue fire. For phlegm accumulation, resolve it using Haifen (Sea Powder), Qingdai (Indigo Naturalis), Huangqin, and Shenqu (Medicated Leaven), formed into pills with paste. For upper-level pathology, induce vomiting. For sinking pathology, raise Qi using Shengma (Cimicifuga) and Fangfeng (Saposhnikovia). For Qi deficiency, use Renshen (Ginseng), Baizhu, Chao Shaoyao (Fried White Peony Root), and Shengma. For food stagnation, use Erchen Tang (Two-Aged Decoction) with Zexie (Alisma), Cangzhu, Baizhu, Shanzha, Shenqu, and Xiong (Ligusticum Chuanxiong), or swallow Baohe Wan (Harmonize the Stomach Pill). For watery diarrhea, continue using Wuling San (Five-Ingredient Powder). For chronic large intestine Qi leakage, use Shudi (Rehmannia) 1.5 liang, Chao Shaoyao and Zhimu (Anemarrhena) 3 qian each, Shengma and Ganjiang 2 qian each, and Zhi Gancao (Honey-fried Licorice) 1 qian, powdered and made into pills with congee. Also, moxa cones should be applied to Baihui (GV20) acupoint for three burns. For Spleen diarrhea, tonify Spleen Qi; after strengthening transport, commonly use Chao Baizhu 4 liang, Chao Shenqu 3 liang, and Chao Shaoyao 3.5 liang; in winter and early spring, substitute with Rou Doukou (Nutmeg). These can be used as powder or decoction, but forming them into cakes is best. For long-standing Spleen diarrhea with uncontrolled large intestine, indicating Spleen collapse, urgently astringe using Chishizhi (Red Halloysite), Rou Doukou, and Ganjiang.

Dai Yanli stated: Diarrhea with water but no abdominal pain indicates dampness. Food remaining undigested in the stomach or passing through undigested indicates Qi deficiency. Abdominal pain with watery diarrhea, borborygmus, and pain preceding each bowel movement indicates fire. Intermittent diarrhea varying in amount indicates phlegm accumulation. Abdominal pain worsening with diarrhea but relieving after defecation indicates food stagnation.

Wang Jiezhai stated: In diarrhea, mistakenly using sweet-warm herbs like Renshen (Ginseng) and Huangqi (Astragalus) will prevent cure and may transform the condition into jaundice (Huangdan), as diarrhea involves dampness, and sweet-warm herbs generate damp-heat, thereby aiding the pathogen. Long-term damp-heat leads to jaundice. Only bitter-warm and bitter-cold herbs can cure it; bitter-warm herbs remove cold-damp. After diarrhea ceases and Spleen-Stomach weakness remains, Renshen and Huangqi can be used to tonify.

Zhao Yangkui stated: Regarding dysentery and diarrhea, Li Dongyuan's theories on Spleen-Stomach are comprehensive regarding Spleen diarrhea, but omit Kidney diarrhea. Zhang Zhongjing said: Persistent diarrhea treated with Lizhong Tang (Regulate the Middle Decoction) worsens because Lizhong regulates the Middle Jiao. This diarrhea is in the Lower Jiao and requires treatment targeting the Lower Jiao. Zhao Yi-de recalled his master treating sudden Qi collapse with acute diarrhea, unconsciousness, closed eyes/mouth, and faint respiration by moxing Qihai (CV6) and administering over ten jin of Renshen Gao (Ginseng Paste). For phlegm accumulation in the Lungs causing insecure Large Intestine Qi, inducing vomiting to clear Upper Jiao phlegm restores Lung descent and Large Intestine security. For excessive worry knotting Spleen Qi preventing ascent and sinking into Lower Jiao causing diarrhea, resolve depression and tonify Spleen-Stomach to raise Grain Qi. For Yin deficiency failing to control closure, vigorously tonify the Kidneys. These varied treatments rely on familiarity with the Neijing. The Classic states: The Kidney governs urination and defecation; it controls opening and closing; it opens into the two yin orifices. When Kidney is deficient, Mingmen Fire extinguishes, leaving Water dominant. Thus, symptoms peak at dawn (Hai-Zi hours) when Water is prosperous. Bawei Wan (Eight-Ingredient Pill) tonifies Yang, achieving water-fire balance and proper opening/closing. Strong Mingmen Fire generates Earth, strengthening the Spleen. Ancient formulas like Jiaofu Wan and Wuweizi San are divine prescriptions for Kidney diarrhea and must be studied.

Qibo's Nanjing mentions Dajia Xie (Great Mass Diarrhea), which is Kidney diarrhea. Annotations describe tenesmus, frequent unsuccessful attempts to defecate, and penile pain. Laypeople mistake this for dysentery (Zhixia); misdiagnosis leads to immediate disaster, as this is a Kidney deficiency syndrome.

Chu Shi's Jingxuelun states: Exhausting essence repeatedly causes painful urination and defecation; pain increases desire to defecate, and defecation increases pain. Treat with Buzhong Yiqi Tang doubled with Shengma to deliver Sishen Wan, followed by Bawei Wan formula plus Wuweizi (Schisandra), Zhuyu (Cornus), Buguzhi (Psoralea), and Rou Doukou, taken in large quantities. Many die from limb swelling due to Qi damage from improper purgatives.

Fang Yuezhi stated: For chronic diarrhea with intestinal collapse, astringents are used only as a last resort. Medicines should not be too bitter (injures Spleen) or too sweet (generates dampness). Light-diuretic agents to open orifices are best, focusing on leaching dampness and drying Spleen. Although symptoms divide into damp, fire, deficiency, cold, phlegm, and food, the Three Deficiencies (Spleen, Kidney, Liver) must be examined. Spleen deficiency stems from diet; Kidney deficiency from sexual excess; Liver deficiency from anger. Dietary injury impairs transport; sexual injury impairs storage; anger allows Wood to overcome Earth, all causing diarrhea.

He also discussed that diarrhea, dysentery, and malaria share treatments, often caused by Summerheat damaging Spleen-Stomach Qi and diet injuring the system. Immediate onset causes diarrhea; prolonged stagnation causes malaria or dysentery. Malaria differs from dysentery: Phlegm filling chest/hypochondrium causes malaria; accumulation sticking to intestines/stomach causes dysentery. Hence, "No phlegm, no malaria; no accumulation, no dysentery."

Wang Haizang stated: Vomiting, diarrhea, cramps, fever, and long pulse indicate Yangming root disease; harmonize the middle using Sizijunzi Tang, Pingwei San, or Jianzhong Tang. Spontaneous sweating with floating pulse: Sizijunzi Tang plus Guizhi (Cinnamon Twig). Hypochondriac pain with wiry pulse: Jianzhong Tang plus Mugua (Papaya) and Chaihu, or Pingwei San plus Mugua. Post-vomit/diarrhea constipation with epigastric solid pain: Sizijunzi Tang plus Dahuang (Rhubarb). Abdominal pain, heaviness, deep-thin pulse: Sizijunzi Tang plus Shaoyao (Peony) and Gaoliangjiang (Galangal). Limb stiffness, deep-slow pulse (Shaoyin): Sizijunzi Tang plus Ganjiang, Fuzi (Aconite), and Houpo (Magnolia Bark). Cold limbs, slow pulse (Jueyin): Jianzhong Tang plus Fuzi and Danggui (Angelica Sinensis).

Zhang Jingyue stated: The root of diarrhea is Spleen-Stomach injury, turning water into dampness and grain into stagnation, preventing essence distribution. Strong Spleen resolves stagnation and cures via clearing/draining. Weak Spleen causes easy diarrhea, which further weakens it. Unsecured gatelets lose Qi with diarrhea; loss of Qi leads to Yang decline and internal cold. Yin-cold descends to Kidneys; thus, diarrhea often depletes Yin (specifically Yang within Yin). Uncured diarrhea transmits from Taiyin to Shaoyin, causing intestinal issues, reflecting failed Yang ascent and organ insecurity. Further cold-draining treatments lead to failure.

Ancient sages stated: Treating diarrhea without promoting urination is incorrect. However, causes of scanty urine vary. Damp excess causes mixing of water/earth into large intestine. Heat excess causes fire invading Yin levels, blocking water passages. Cold diarrhea causes small intestine fire injury, impairing Qi transformation. Spleen deficiency causes Earth failing to control Water, mixing clear/turbid. Mingmen fire decline causes true Yin depletion and essence exhaustion. Only acute, strong patients with sudden violent diarrhea can benefit from diuretics. Chronic, weak, cold-pattern patients must not use diuretics. Cold-deficiency diarrhea is not water excess but fire insufficiency; not water blockage but Qi stagnation. Ignoring the root causes worsening deficiency and accelerating danger.

Qi-diarrhea arises from anger combined with food, triggering immediately. This affects Liver and Spleen; treat by tonifying Spleen deficiency and smoothing Liver Qi, distinguishing severity.

Cheng Jiaoqian stated: Stability in illness relies on Spleen-Stomach Qi. Now, pathogens invade the Middle Jiao abruptly, disrupting Spleen-Stomach control, allowing chaotic vomiting and diarrhea regardless of cold, summerheat, or food pathogens. This is Middle Qi disorder with Yin pathogens insulting. Though the disease is Yin, symptoms appear Yang, creating chaos—named Cholera. Middle deficiency allows external Qi disorder, causing fever, headache, body ache, aversion to cold, with thin-choppy pulse. This is righteous deficiency and pathogen excess, weak Yang and disturbed Yin. Besides warming meridians, dispersing cold, supporting Yang, and suppressing Yin, other treatments are invalid. For initial exterior symptoms (headache, fever, body ache), differentiate cold/heat. More heat/thirst: Wuling San (Five-Ingredient Powder) warms meridians, grounds Earth, and clears cold-water. More cold/aversion to drinking: Lizhong Wan (Regulate the Middle Pill) warms the middle and tonifies Earth. Aversion to cold, thin pulse, recurrent diarrhea stopping indicates blood loss; subsequent fever requires Sini Jia Renshen Tang (Cold Extremities Plus Ginseng Decoction) to assist Yang generating Yin, restoring True Yang. If vomiting/diarrhea stop but body pain persists, harmonize the exterior with Guizhi Tang (Cinnamon Twig Decoction). If vomiting/diarrhea with sweating, fever, aversion to cold, limb stiffness, cold extremities, or profuse sweating, clear grain diarrhea, interior cold/exterior heat, and nearly imperceptible pulse, use Sini Tang (Cold Extremities Decoction) to restore Yang, rescue emergency, and communicate Qi, following Zhang Zhongjing's methods.