Library

Spontaneous diarrhea caused by plague-qi (epidemic pathogenic factors) all belongs to heat syndromes; the nature of the excrement differs significantly from that of internal deficiency and cold. The color of cold-type diarrhea is pale white, whereas the color of heat-type diarrhea is bright yellow, and in severe cases, deep yellow or sauce-colored. Cold-type diarrhea is thin and watery, while heat-type diarrhea is thick and sticky. Deficiency-cold type excrement is loose and odorless, whereas heat-type excrement has a foul odor and contains much foam. Deficiency-cold type is easy to pass, while heat syndromes manifest as straining during defecation (Li Ji Hou Zhong). Cold-type diarrhea is slow in onset, whereas heat-type diarrhea presents as sudden violent purging with urgency, burning sensation at the anus, and abdominal cramping. These are the general principles for distinguishing heat-type diarrhea of plague-qi from various cold-type diarrheas.

At the initial stage of plague-qi, if there are symptoms such as cold extremities, aversion to cold, vomiting, abdominal pain, and spontaneous diarrhea, it completely resembles a Taiyin cold syndrome. To distinguish it as an epidemic disease, one only needs to observe a foul smell in the mouth accompanied by a sticky sensation, a thick and coarse white coating on the tongue, yellow urine, and mental restlessness. Based on these signs, it can be known that this is not cold invading the Taiyin channel directly, but rather plague-qi manifesting in the Taiyin organ. If the restlessness is mild, Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) is used; if the restlessness is severe, Dayuan Yin (Origin-Reaching Decoction) is used. After one or two doses, heat syndromes of the Three Yang channels will appear. At this time, if warm-natured Chinese medicines are mistakenly used, it will lead to worsening cold limbs, cyanosis of the hands and feet, and death; therefore, careful examination is essential.

At the initial stage of plague-qi, if headache, fever, and spontaneous diarrhea occur, Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) is indicated. If the pathogen transmits to a combined syndrome of Taiyang and Shaoyang, presenting with body heat, bitter taste in the mouth, dry throat, dizziness, and spontaneous diarrhea, Huangqin Tang (Scutellaria Decoction) is indicated; add Banxia (Pinellia Rhizome) if vomiting is present. If the pathogen enters the interior, presenting with a yellow tongue coating, delirium, and spontaneous diarrhea, and pressing from the epigastrium down to the lower abdomen reveals hardness and pain, Dachengqi Tang (Major Order the Qi Decoction) is indicated; if there is no hardness or pain, Xiao Chengqi Tang (Minor Order the Qi Decoction), Xiaoxianxiong Tang (Minor Chest-Harvesting Decoction), or Da Chaihu Tang (Major Bupleurum Decoction) may be selected. Here, the aim is to clear heat from the lower part; it does not primarily focus on fecal impaction. Therefore, even without hardness or pain, Dahuang (Rhubarb Root and Rhizome) is the primary herb. In cases of plague-qi spontaneous diarrhea accompanied by difficult urination, abdominal fullness without hard masses, and occasional borborygmus, this indicates water retention due to heat in the Small Intestine and Bladder. Siling San (Four-Powder Decoction), Zhuling Tang (Polyporus Decoction), or Yiyuan San (Benefit-Origin Powder) may be selected.

Patients with plague-qi spontaneous diarrhea rarely tolerate tonifying therapies. However, after repeated clearing and purging treatments, when neither exterior nor interior excess syndromes remain, and the spontaneous diarrhea gradually progresses to uncooked stool (Wan Gu Bu Hua - undigested food in feces) with a faint and fine pulse, then Liu Junzi Tang (Six-Gentlemen Decoction), Buzhong Yiqi Tang (Middle-Warming and Qi-Supplementing Decoction), or Lizhong Tang (Regulate the Middle Decoction) should be considered for use.