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General Overview: Spleen deficiency and stomach weakness constitute the root of disease; how can water and grain be properly transported and transformed? When clear and turbid qi interfere with each other, vomiting and diarrhea should occur; if prolonged transmission leads to deficiency-type diarrhea, internal wind may be generated.

Pulse Diagnosis: Diarrhea is primarily associated with a slow pulse (Huan Mai). A small and knotted pulse indicates a favorable prognosis (life), while a floating and large pulse indicates an unfavorable prognosis (death).

The *Neijing* states: "Wind injury in spring leads to undigested stool diarrhea (Sun Xie) in summer." It also says: "Excess dampness results in moist diarrhea (Ru Xie)." The spleen and stomach share the transformation of damp-earth, primarily responsible for rotting and ripening food and drink. When stomach qi is harmonious, after food enters the stomach, clear qi is transmitted to the spleen-earth, returns to lung-metal, circulates through the hundred vessels, and forms Ying and Wei qi. If diet causes injury or daily routine is irregular, damaging stomach qi, the essence qi that should ascend instead descends, resulting in Sun Xie! (Commentary: Generally, diarrhea belongs to qi deficiency, fire, phlegm, or food stagnation. Diarrhea with watery stool and no abdominal distension is dampness. Food entering the stomach without digestion, passing as undigested grains, is qi deficiency; borborygmus with watery diarrhea, pain followed by diarrhea, is fire; intermittent diarrhea with varying amounts is phlegm; severe abdominal pain relieved after defecation is food stagnation.)

Acute diarrhea is not a yin syndrome; chronic diarrhea is not a yang syndrome. All medical texts agree that treating diarrhea by promoting urination is an unchangeable principle for eternity. However, if chronic diarrhea causes spleen deficiency and weakening of yang qi, which lies latent within yin, using bland diuretic drugs would be lowering yet lowering, suppressing yin and further exhausting yang, causing yang to be further depleted and spirit to become increasingly short-lived. It is appropriate to use herbs that raise yang qi, treating with Qiang Huo, Du Huo, Chai Hu, Sheng Ma, Fang Feng, and Gan Cao.

The general principle is: when cold-dampness prevails, assist with wind herbs to pacify it. It also states: "For sinking conditions, lift them up"; obtaining the rising of yang qi leads to the departure of disease. This is Li Dongyuan's treatment method.

Cold diarrhea often presents with white watery stools, frequent but scant defecation, abdominal pain with borborygmus, furrowed brows, sluggish eyes, pale complexion, and excessive sweating on the forehead. This is called cold diarrhea, treated with Shou Zhong Tang and Yi Zhong Gao.

Hot diarrhea presents with yellow stools, like water dripping from a tube, stopping immediately after defecation but recurring half a day later, accompanied by vexation, thirst, scanty yellow urine, and a preference for coarse food/milk. This is called hot diarrhea, treated with Wu Ling San and Xiang Ru Yin.

Food-injury diarrhea occurs due to overeating, damaging spleen qi, leading to diarrhea. Thus, stools are unformed and smell foul like broken eggs; San Leng San is appropriate.

Watery diarrhea is called Dong Xie, characterized by disharmony of yin and yang, inability to distinguish between water and grain, yellow watery stools with scanty urination, frequent and unregulated episodes. This is caused by the clash of cold and heat, confusing clear and turbid qi. Or, if milk has hot qi and is fed immediately, it causes spleen-stomach disharmony, with water and grain mixing downward. Use crushed Wu Ling San added with Yi Yi Ren, Che Qian Zi, Ban Xia, and Sheng Jiang decocted in water, followed by Xiang Ru Yin. Excellent effect!

Accumulation diarrhea arises from spleen qi deficiency, where milk and food enter the stomach but cannot be transformed. Stagnation persists for a long time, further injured by cold food, transmitting to the large intestine to form diarrhea. It lingers incessantly, resisting all medicines, because the accumulation resides in the spleen and stomach. How can one recover while the accumulation remains? It is appropriate to first remove the accumulation then stop the diarrhea; once stopped, strengthening the spleen eliminates the disease. Use San Leng San, Xiang Ju Bing, or Shen Ling Bai Zhu San.

(Commentary: For drying dampness, use Si Ling San plus Cang Zhu, doubling Bai Zhu. For severe cases, stir-fry both Zhu herbs into powder, mix with water to take. For qi deficiency, use Ren Shen, Bai Zhu, Shao Yao. For fire, purge fire and promote urination: Si Ling San plus Hua Shi, Huang Qin, Zhi Zi, Mu Tong. For phlegm, use Hai Shi, Qing Dai, Huang Qin, Shen Qu made into pills. Alternatively, use emesis to lift clear qi. For food stagnation, use resolving and guiding methods: Shen Qu, Da Huang, Zhi Shi, etc. For watery diarrhea, use Cang Zhu, Hou Po, Chen Pi, Fu Ling, Zhu Ling, Ze Xie, Di Yu, Gan Cao, adding Gan Jiang in winter. For stomach disharmony, use Wei Ling Tang. People use astringent herbs to treat diarrhea; this is suitable only for chronic and deficient cases. If used initially, it will surely transform into other symptoms, causing significant harm. One must not know that diarrhea is mostly due to dampness; promoting urination is the superior approach.)

Fright-induced diarrhea presents with green feces like moss, thick and sticky like glue. Do not forcibly stop it; instead, calm the heart and benefit the liver, harmonize the spleen and stomach, and digest milk and food. This is the treatment. Administer San Jie San and Wu Ling San, decocted with Sheng Jiang and Cang Mi.

Gan Ji diarrhea presents with a red face, sallow complexion, abdominal distension, weak legs, large head with a thin neck, sparse and upright hair, emaciated muscles, loss of appetite, coolness by day and fever by night, or masses of Qi accumulation in the abdomen. The stool color varies during diarrhea, and the odor is abnormal. This diarrhea may occur once every month or half-month, starting and stopping spontaneously. First, use Dang Gui San plus San Leng and Chen Pi decocted; subsequently, administer San Leng San.

Commonly known as "Shou Du Xie," this condition arises when the abdomen is full of food, but the weak spleen cannot transport and transform it sufficiently, leading to accumulation and subsequent diarrhea until empty, then stopping, only to repeat. It is best to regulate the spleen and stomach and moderate the diet.

[Attached Formulas]
Shou Zhong Tang: Jie Geng, Cang Zhu, Gan Cao, Jiang Zhi
Yi Zhong Tang: Rou Guo, Ding Xiang, Sha Ren, He Zi, Chen Pi, Qing Pi, Ma Qin, Gan Cao
Wu Ling San: See under Fright Wind Syndrome.
Xiang Ru Yin: See under Various Vomiting Syndromes.
San Leng San: E Zhu, San Leng, Yi Zhi, Chen Pi, Shen Qu, Mai Ya, Gan Cao. Add Ban Xia if coughing.
Xiang Ju Bing: Mu Xiang, Chen Pi, Qing Pi, Hou Po, Sha Ren, Shen Qu, Mai Ya, San Leng
Shen Ling Bai Zhu San: Ren Shen, Fu Ling, Bai Zhu, Sha Ren, Yi Yi, Lian Rou, Bian Dou, Gan Cao, Jie Geng, Shan Yao
San Jie San: See under Fright Wind Syndrome.
Dang Gui San: Dang Gui, Chi Shao, Da Huang, Chuan Xiong, Ma Huang, Gan Cao
Si Ling San: Ze Xie, Zhu Ling (peeled), Bai Zhu, Fu Ling. Add Mu Tong, decoct in water. Or make into powder, take with warm water.