Library

The *Classic of Difficult Issues* (Nanjing) states: "Injury by wind in spring leads to undigested stool diarrhea (Sun Xie, diarrhea with undigested food) in summer; if the pathogenic factor lingers, it becomes hole diarrhea (Dong Xie, severe watery diarrhea)." This is because the wind-wood pathogen lingers for a long time, causing wood qi to overact on earth qi (spleen/stomach), resulting in the failure of the granary (stomach and spleen) to store, thus leading to Dong Xie. It can be seen that this disease is also caused by latent pathogenic factors (Fu Qi). Li Shicai stated: "Dong Xie is also known as Ru Xie (damp diarrhea); Ru Xie is caused by excessive dampness." This disease is not only due to internal retention of latent pathogens and dysfunction of middle qi, but also involves concurrent pathogenic dampness. Examining its pulse presentation, it is soft, slow, and weak, or the guan position shows a wiry quality; symptoms include heavy body, mental fatigue, limb laxity, passage of clear undigested stool, and short, dark urine. The appropriate treatment is Pei Zhong Xie Mu Fa (Nourish Middle and Drain Wood method) added with Cang Zhu (Atractylodis Rhizoma) and Ze Xie (Alismatis Rhizoma). The *Classic* states: "If the kidney pulse is very small, it indicates Dong Xie." This is because the kidney serves as the gate of the stomach; due to kidney deficiency failing in its function of closure and storage, latent pathogens sink deeply into the deficiency. The appropriate treatment is Bu Huo Sheng Tu Fa (Tonify Fire to Generate Earth method) added with Wei Ge Gen (Prepared Puerariae Radix) and He Ye (Nelumbinis Folium). In summary, for spleen deficiency, tonifying the middle is paramount; for kidney deficiency, securing the lower is urgent. If wind is excessive, assist with dispersing and penetrating methods; if dampness is excessive, assist with leaching and draining methods. During clinical practice, if one can apply these principles with spiritual clarity and adaptability, the disaster that could occur at any moment may hopefully be avoided.

Cheng Xi stated: "Observing the discussions on Sun Xie and Dong Xie, they all revolve around wood qi overacting on earth. Therefore, treating Dong Xie generally follows the methods for Sun Xie; however, the excess and deficiency within must be carefully distinguished." Generally, Sun Xie is mostly due to spleen deficiency, hence the presence of undigested food; Dong Xie is mostly due to excessive dampness, hence the heavy body and red urine. For cases belonging to spleen deficiency, one should not rely excessively on draining; for cases belonging to excessive dampness, one should not rely excessively on tonifying. Both conditions require assessing excess and deficiency to treat them separately.

Han Xie (Cold Diarrhea) is diarrhea caused by cold, which differs from Sun Xie and Dong Xie, as those belong to latent pathogens from spring wind injury. Diarrhea caused by latent pathogens has been detailed in the previous two chapters. Although diarrhea caused by cold, fire, summerheat, dampness, phlegm, and food stagnation does not necessarily stem from latent pathogens, it cannot fail to be discussed in detail. The root cause of Han Xie is indeed contracting cold; cold qi invades internally affecting the spleen. When the spleen and stomach are affected by cold, yang qi becomes deficient. Due to deficiency, it fails to govern transformation and transportation. Clear yang qi fails to ascend properly and instead sinks downward, causing loose stools. Therefore, the excrement is clear, cold, and resembles duck feces; there is continuous abdominal pain; urination is clear and white; and the pulse is slow, lethargic, and approaching a delayed rate. The appropriate treatment is Nuan Pei Bei Jian Fa (Warm and Nourish the Inferior Monitor method), removing Xi Lu Dang Shen (Codonopsis Pilosula) and Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), and adding Mu Xiang (Aucklandiae Radix) and Zha Tan (Charred Crataegi Fructus). Medical texts also state: "Han Xie is equivalent to Tang Xie (pasty diarrhea), because the discharge resembles duck feces." It is also said: "Ya Tang (duck paste diarrhea) refers to dampness combined with cold." If signs of dampness are present, it is appropriate to add herbs that transform dampness, adjusting according to the specific syndrome.