Library

Spleen excess generates phlegm and causes slippery diarrhea; Kidney deficiency with weak Qi leads to frequent loose stools, spermatorrhea, and incontinence of urine or feces due to failure of consolidation. The combination of warming and astringent methods is most appropriate. The principle of treating "astringency" (conditions characterized by sliding and uncontrollable discharge) does not go beyond warming and tonifying the lower jiao. However, for conditions of lower yuan deficiency causing slippery diarrhea, it is not only necessary to strengthen the spleen (Jian Li Kun Wei), but also to consolidate the Kidney (Gu Shou Kan Gong). Since the Kidney serves as the gate of the Stomach, if the gate is tightly secured, urination and defecation will be regulated separately, naturally avoiding the hazard of inability to retain fluids and solids. (Wang Xushan said: Slippery stool can also be caused by Spleen dampness generating phlegm, which should be treated with Er Chen Tang. For those with deficiency of the lower origin, there is no method other than warming and tonifying, hence the distinction. Shen Zhai uses warming and tonifying as the footnote for the character "astringent," implying that when both Spleen and Kidney are solidified, urination and defecation are regulated, opening and closing are controlled, thus avoiding hazards such as loose stool, urgent diarrhea, and an unguarded gate. The key to treating "astringency" lies here, far removed from worldly physicians who specifically use herbs like Euryale Semen (Qianshi), Rosa Laevigata Fruit (Jinyingzi), and Poppy Capsule (Suhua) as astringents.)

For dysentery accompanied by abdominal pain, the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong) should be used. Clearly distinguish between recent and chronic cases by observing the color. If cold, apply warming methods; if excess, apply purgative methods. Applied skillfully, they work like magic. The principles of treating "unblocking" (methods involving purgation or drainage) do not exceed two aspects: purgation and drainage. If after diarrhea or dysentery there is still tenesmus and urgency, with severe pain, or if excretion is excessive without restraint, or if stagnation prevents passage, or if there is fever and redness of the body/face, these situations require immediate purgation. If there is no pain, this indicates accumulation; all substances that are blocked yet leaking out laterally should be purged. This is the so-called "treat obstruction with unblocking agents" method. If astringent medicines are used, diarrhea will worsen and the disease will increase! As for chronic dysentery where the stool is white, or mixed with red, with a fishy odor, cold body, weak pulse, uncontrolled downward discharge, and abdominal pain relieved by pressure, one must strictly avoid cold-cooling agents such as Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Gardenia Fruit (Zhizi), and Gentiana Macrophylla Root (Qinjiao). Urgently using Cinnamon Twig (Guizhi), Aconite Root (Fuzi), and Dried Ginger (Ganjiang) for warming and tonifying is essential. If diarrhea persists for a long time with loose stools, adding Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), and Chinese Yam Rhizome (Shanyao) for warming is also appropriate. The ancients said that various accumulations and pains prefer warmth and dislike cold; this statement is credible. People differ in status; the noble tend toward deficiency while the humble tend toward excess. This point deserves special recognition. (Wang Xushan said: Nobles are mostly deficient, while commoners are mostly excess. This applies to all diseases, not just diarrhea and dysentery. Shen Zhai specifically illustrates this example in this section. Rich people often strain their minds and indulge in desires, so when ill, their righteous Qi is mostly deficient. Poor people engage mainly in physical labor but cannot avoid exposure to wind, rain, cold, heat, dryness, and dampness, so their illnesses are mostly rooted in pathogenic excess. This is the natural course of human affairs. However, if nobles have strong congenital constitution or proper nurturing, and commoners, besides physical labor, also strain their minds or indulge in lust without limit, then the forms of deficiency and excess will necessarily reverse. One cannot argue rigidly based on a single standard.)