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Fire diarrhea, also known as heat diarrhea. The Classics state: "Sudden and violent diarrhea with tenesmus all belong to heat." "Sudden and violent" refers to abrupt and severe watery diarrhea; "tenesmus" refers to the sensation of rectal heaviness and urgency. The symptoms include stool being expelled like a jet, the anus feeling scalded by hot water, burning pain in the anus that is difficult to endure, borborygmus and pain in the abdomen, where pain occurs in waves followed by diarrhea, and a lingering sense of incomplete evacuation after defecation. This cannot be compared to food stagnation diarrhea, where relief is felt after defecation. The pulse must be rapid, the tongue coating yellow, urination red and scanty or painful, and thirst present. These are all signs of fire diarrhea. Zhang Jiebin stated: "Heat excess causes diarrhea; if urination is obstructed, it is because fire invades the Yin aspect, causing blockage of the water passages. It is appropriate to use the method of promoting diuresis via the Zhou Du (bladder), removing Cang Zhu (Atractylodis Rhizoma), and adding Huang Qin (Scutellariae Radix) and Lian Zi (Coptidis Rhizoma) for treatment." Generally speaking, acute onset new diseases can be treated with purgation/diuresis, excess-heat with obstruction can be treated with purgation/diuresis, those with strong constitution can be treated with purgation/diuresis, and those with lower abdominal distension can be treated with purgation/diuresis. Current diarrhea belonging to fire rather than cold, and excess rather than deficiency, can thus use methods of promoting diuresis. However, for those with chronic illness leading to Yin deficiency, or Qi deficiency with cold nature, diuretic methods must not be used; physicians must be aware of this.

During the late summer season when dampness and heat prevail, many cases of diarrhea are due to summerheat diarrhea. Summerheat qi is inseparable from dampness, as heavenly summerheat presses downward and earthly damp-heat rises upward. Humans exist within the intersection of these two qi, so the pathogen enters through the mouth and nose, directly disturbing the Middle Jiao (spleen and stomach). The spleen and stomach lose their functions of digestion and transportation, failing to separate the clear from the turbid. Instead of ascending, the essence qi descends and becomes diarrheal stool. Examining the signs of summerheat diarrhea: stool is thick and sticky, urine is hot and red, the pulse is soggy and rapid or deep and slippery, the face appears greasy with sweating, there is thirst with a preference for cool drinks, and the whole body feels hot, resembling blazing fire. It is appropriate to use Qing Liang Di Shu Fang (Cooling and Clearing Summerheat Decoction) to eliminate the scorching heat, just as a gentle breeze blows suddenly, causing the intense heat to dissipate completely. If accompanied by dampness, with little thirst, Mu Tong (Akebiae Caulis) and Ze Xie (Alismatis Rhizoma) should be added. If dampness exceeds summerheat, one may follow the treatment principles for damp diarrhea.

The Neijing states: "Excess dampness leads to Ru Xie (damp diarrhea)." The Nanjing states: "Dampness often results in five types of diarrhea." This shows that diarrhea is mostly caused by dampness. Dampness invades the Spleen, causing the Spleen to lose its robust transportation function and fail to transform and transport fluids. Consequently, the Large Intestine fails to separate the clear from the turbid, allowing water and grain to mix and enter the Large Intestine, resulting in diarrhea. The signs of damp diarrhea include a slow and choppy pulse, watery stool without abdominal pain, chest oppression, no thirst, yellow-red urine, or possibly slight abdominal pain and loose stools. Regarding the treatment of damp diarrhea, only the views of Mr. Nian E are worthy of following. He said: "Promote diuresis to allow dampness to exit via the urine, similar to how farmers manage floodwaters by guiding them downstream; even in low-lying areas, one need not fear inundation." The Classics state: "Treating diarrhea without promoting diuresis is not the correct method." Based on this theory, one must promote diuresis in the Bladder. Using the method of promoting diuresis via the Zhou Du (bladder) will naturally stop the diarrhea.
A question was asked: "Observing your discussion, you cite Ru Xie from the Neijing and the Five Diarrheas from the Nanjing. Why does the book not list a separate category for Ru Xie, nor elaborate on the Five Diarrheas? Is such brevity an omission?" The answer is: "Ru Xie is synonymous with Dong Xie (cavity diarrhea), which has already been discussed previously. The Five Diarrheas refer to Wei Xie (Stomach diarrhea), Pi Xie (Spleen diarrhea), Da Chang Xie (Large Intestine diarrhea), Xiao Chang Xie (Small Intestine diarrhea), and Da Jia Xie (large mass diarrhea). Examining the Fifty-Seventh Difficulty, Wei Xie and Pi Xie correspond to current Shi Xie (food stagnation diarrhea); Da Chang Xie, Xiao Chang Xie, and Da Jia Xie correspond to current Li Ji (dysentery). Since Shi Xie and Li Ji are detailed later in the text, there is no need to discuss them here."