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Diarrhea (Xie Xie) originally belongs to dampness pathogen, but it is mostly caused by irregular diet, which damages the Spleen and Stomach. Treatment must consider the seasonal climate, distinguishing between cold and heat patterns, as well as acute and chronic conditions. Therapeutic methods include: tonifying the Spleen, resolving food stagnation, and promoting urination. There are also cases where Qi sinking requires lifting using wind-dispelling herbs to overcome dampness; for chronic diarrhea with weak intestines and stomach leading to incontinence, astringent methods are appropriate.

Main Formula: Baizhu (Atractylodis Macrocephalae Rhizoma, 2 qian), Bai Fuling (Poria, 1.5 qian), Baishao Yao (Paeoniae Radix Alba, stir-fried, 1.5 qian) (These three are essential for treating diarrhea). Chenpi (Citri Reticulatae Pericarpium, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 qian).

If diarrhea is yellow due to food injury or food stagnation, add Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), and Shanzha (Crataegi Fructus) each 1 qian, and Huanglian (Coptidis Rhizoma, stir-fried) 0.7 fen. If there is a sensation of tightness in the abdomen, add Houpo (Magnoliae Officinalis Cortex) and Zhishi (Aurantii Fructus Immaturus) to resolve stagnation.

My Commentary: In the aforementioned symptoms, if digestion has occurred but diarrhea persists, this indicates injury to Spleen and Stomach Qi; Wuyi Yigong San (Five-Ingredient Powder for Extraordinary Efficacy) should be used. If diarrhea is accompanied by a heavy bearing sensation in the abdomen, this indicates Sinking of Spleen and Stomach Qi; Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) should be used. If abdominal fullness and tightness persist after taking qi-breaking and stagnation-resolving agents, this indicates Pi Man (Spleen Deficiency Fullness); Liu Junzi Tang (Six-Gentlemen Decoction) should be used. If there is hypochondriac distension, poor appetite, irritability, and green stools, this indicates Spleen Deficiency with Liver Overacting; Liu Junzi Tang plus Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), and Muxiang (Aucklandiae Radix) should be used. If there is poor appetite, fatigue, frequent belching, and yellow stools, this indicates Sinking of Clear Yang due to Spleen Deficiency; Liu Junzi Tang plus Shengma and Chaihu should be used. Generally, if the Spleen pulse is wiry and long, it indicates Liver Wood overacting on Spleen Earth; tonify the Spleen and pacify the Liver. If the Spleen pulse is deep and wiry, it indicates Cold Water insulting Spleen Earth; warm the Middle and tonify the Kidney. Although Huanglian and Zhishi can resolve stagnation and open fullness, they should only be used temporarily for acute excess fullness in individuals with robust Spleen and Stomach. For recurrent use or in cases of deficiency-type fullness, they will damage the Spleen and Stomach further, causing various symptoms to arise. As Mr. Dongyuan stated: For Spleen/Stomach Excess, use Huanglian and Zhishi to purge; for Deficiency, use Baizhu and Chenpi to tonify. Treatment must distinguish between disease excess/deficiency and regional constitutions. Subsequent cases follow this principle.

If urine is red, scanty, and difficult to pass, add Zhuling (Polyporus, 1 qian) and Zexie (Alismatis Rhizoma, 1 qian) to separate and drain dampness. In summer, add Yinchen (Artemisiae Scopariae Herba, 0.7 fen) and Shanzhiren (Gardeniae Semen, stir-fried, 0.4 fen).

My Commentary: In the aforementioned symptoms, if fluids leak into the Large Intestine causing diarrhea and scanty urine, separation and drainage are appropriate. If Yin and Yang are distinct but urine is scanty, this is Spleen/Lung Qi Deficiency failing to generate fluids; Buzhong Yiqi Tang plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) should be used. If Yin Fire flares up causing red, scanty urine, this is Lung Injury failing to generate fluids; Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Maidong and Wuweizi should be used. If Kidney Yin Deficiency leads to lack of Yang generation and scanty urine, Zishen Wan (Kidney-Nourishing Pill) or Shenqi Wan (Kidney-Qi Pill) should be used. If Kidney Yang Deficiency leads to failure to transform Yin and scanty urine, Yiqi Tang (Qi-Supplementing Decoction) or Liuwei Wan should be used. Misuse of draining agents damages Yang, preventing Yin generation, leading to urinary difficulty, proptosis, drum-like abdominal distension, hard swollen legs/knees, or skin fissures. Use Zishen Wan and Yiqi Tang first. I often see patients with deficient Yuan Qi who take Zexie and Zhuling, damaging True Yin and worsening symptoms; urgently administer Jinkui Jiajian Shenqi Wan (Modified Kidney-Qi Pill from the Golden Cabinet), which often results in recovery. Conversely, using harsh purgatives like Qiuniu (Kochiae Semen) or Dahuang (Rhei Radix et Rhizoma) accelerates death.

If thirst with desire to drink occurs, add Ganjiang (Zingiberis Rhizoma, 1.5 qian), Renshen (Ginseng Radix, 1 qian), Maidong (1 qian), Shengma (0.4 fen), and Wumei Rou (Mume Fructus Flesh, 5 pieces).

My Commentary: In the aforementioned symptoms, if Stomach Qi is injured and internal fluids are lost, Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder) should be used. If Stomach Qi is weak with little fluid, Buzhong Yiqi Tang should be used. If both Qi and Blood are deficient with little fluid, Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) should be used. If Kidney Deficiency causes short fluids, Liuwei Dihuang Wan should be used. If insufficient Kidney Water leads to defying Fire, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) should be used. If a person with insufficient Kidney Water suffers diarrhea or excessive diuretic use leading to thirst, failing to use these drugs to secure the root will injure Lung and Kidney, potentially causing critical conditions like urinary retention and abdominal edema.

Tu Jiufeng, Vice Commissioner, suffered diarrhea followed by thirst, with a rapid and forceless Chi pulse. He strictly used alcohol-detoxifying and diuretic agents without effect. I said: This is Kidney Yin Deficiency with blazing Deficient Fire; urgently nourish Water. Otherwise, carbuncles will develop and fail to heal. He did not believe, took fire-descending and phlegm-resolving agents, and indeed died from carbuncles.

During summer and autumn when damp-heat prevails, sudden violent watery diarrhea warrants adding Huanglian, Cangzhu (Atractylodis Rhizoma), and Zexiei each 1 qian, and Shengma and Mutong (Akebiae Caulis) each 0.5 fen. For fever with thirst, add Ganjiang and Shigao (Gypsum Fibrosum) each 1 qian. For jaundice with red urine, add Yinchen 1 qian, Shanzhi (Gardeniae Fructus) and Mutong each 0.5 fen.

My Commentary: Mr. Dongyuan stated: When autumn dryness rules and damp-heat recedes, with heavy body, joint pain, dry mouth/tongue, loss of taste, bowel/bladder dysfunction, anorexia, indigestion, chills, and aversion to cold, this is Lung/Spleen-Stomach Deficiency with unextended Yang; Shengyang Yizhe Tang (Yang-Raising Stomach-Supplementing Decoction) treats it. For damp-heat internal production causing Spleen/Stomach dysfunction, use separation/drainage. For post-damp-heat Spleen/Stomach weakness, use Liu Junzi Tang and Danggui (Angelicae Sinensis Radix) to tonify. For post-damp-heat Spleen Qi sinking, use Buzhong Yiqi Tang to lift. For jaundice with urinary difficulty, heavy limbs, thirst without desire to drink (Damp > Heat), use Da Yinchen Tang (Great Coix Seed Decoction). For spontaneous loose stools, use Yinchen Zhizi Huanglian Tang. For alternating chills/fever with jaundice, use Xiao Chaihu Tang plus Zhizi. For jaundice due to labor injury and dietary irregularity, use Xiao Banxia Tang (Minor Pinellia Decoction). Jaundice is an insufficiency syndrome; tonify Spleen/Stomach Yuan Qi primarily. Reckless purging damages Qi and often proves fatal.

For chronic diarrhea with Spleen/Stomach weakness and indigestion, add Huangqi (Astragali Radix, honey-fried) and Renshen each 1 qian, Shenqu and Maiya each 1.2 qian, Muxiang (stir-baked) and Ganjiang (honey-fried) each 0.5 fen.

My Commentary: Symptoms of vomiting or poor appetite indicate Spleen/Stomach weakness; Si Junzi Tang plus Banxia (Pinelliae Rhizoma) and Muxiang. Vomiting with abdominal pain indicates Spleen/Stomach Deficiency-Cold; Liu Junzi Tang plus Paojiang (Prepared Ginger) and Muxiang. Maiya damages Kidney; Shenqu transforms fetal essence and consumes Kidney Qi; avoid light use. Chronic diarrhea often results from indiscriminate use of digestive/diuretic agents damaging True Yin, leaving Yuan Qi unable to control, leading to chronic diarrhea. Without Buzhong Yiqi Tang or Sishen Wan to nourish the root, chest fullness, abdominal distension, and dribbling urine may ensue, often proving fatal.

For chronic diarrhea with weak intestines/stomach and incontinence, add Roudoukou (Myristicae Semen), Hezi Pi (Terminaliae Chebulae Pericarpium), and Chishizhi (Halloysit Rubrum) each 1 qian, Muxiang (stir-baked) and Ganjiang (honey-fried) each 0.5 fen.

My Commentary: Mr. Dongyuan stated: Middle Jiao Qi weakness, Cold invading Spleen/Stomach, slippery diarrhea, borborygmus, or misdirected downward transmission leading to Cold, combined with seasonal cold, cold limbs, heart/stomach colic, and cold sweat, indicates Kidney/Spleen-Stomach Deficiency; Chenxiang Wenwei Wan (Agarwood Stomach-Warming Pill) treats it. I hold that for Spleen/Stomach Deficiency-Cold with sinking, use Buzhong Yiqi Tang plus Muxiang, Roudoukou, and Buguzhi (Psoraleae Fructus). For Spleen Qi Deficiency-Cold with incontinence, use Liu Junzi Tang plus Paojiang and Rougui (Cinnamomi Cortex). for Mingmen Fire Decline with Spleen Earth Deficiency-Cold, use Bawei Wan (Eight-Ingredient Pill). For Spleen/Kidney Qi/Blood Dual Deficiency, use Shiquan Dabu Tang delivered with Sishen Wan. For slippery stools, closed urine, gradual swelling, wheezing/cough with sputum indicating Spleen/Kidney Qi/Blood Deficiency, use Shiquan Dabu Tang with Sishen Wan. For slippery stools, closed urine, swelling, wheezing/cough/sputum indicating Spleen/Kidney Loss, use Jinkui Jiajian Shenqi Wan.

For immediate diarrhea after drinking alcohol, this is Alcohol Accumulation Heat Diarrhea; add Huanglian (stir-fried), Yinchen, and Ganjiang each 1 qian, Muxiang 0.5 fen.

My Commentary: If alcohol-damp remains and Spleen Qi is not yet deficient, use these to separate/drain damp-heat. If damp-heat is gone and Middle Qi is injured, use Liu Junzi Tang to tonify Middle Qi. If mistaken use of harsh/diuretic agents causes progressive chest fullness, scanty urine, or leg/abdominal swelling, urgently use Jiaban Jinkui Shenqi Wan to tonify Spleen/Stomach; survival is likely. Alcohol nature is hot and formless; injury to formless Yuan Qi requires Gegua Jiexing Tang (Honeysuckle Flower Awakening-Decoction) to dissipate damp. Often, people mistakenly take large-hot Jiuzheng Wan, purging formless Yin blood, causing Yang toxin to blaze and Yuan Qi to perish, shortening life. *Jinkui Yaolue* states: Purging Wine Jaundice leads to Black Jaundice over time. Many drinkers taking Jiuzheng Wan develop jaundice, misunderstanding the cause, taking diuretics/phlegm-resolvers, and dying from complications (see *Qixiao Fang*).

Bu Fengjun from Xiushui, a heavy drinker, had abdominal pain and diarrhea. Diuretic/phlegm-resolving agents failed. His pulse was slippery and rapid; skin was rough like fish scales. I said this was intestinal abscess ruptured due to alcohol toxicity; declined treatment. He refused, took previous formulas, and died passing pus.

Chai Fu'an, Guanglu, a heavy drinker, had diarrhea, abdominal distension, phlegm expectoration, vomiting, and dry mouth. I diagnosed Spleen/Stomach Qi Deficiency. Used Liu Junzi Tang plus Shenqu; phlegm/vomiting stopped. Then used Buzhong Yiqi Tang plus Fuling and Banxia; diarrhea/distension resolved.

Former colleague Qian Kejiu, a habitual drinker, had red face, profuse phlegm, and loose stools. I diagnosed Phlegm-Damp obstruction in intestines/stomach. Used Erchen Tang, Huangqin (Scutellariae Radix), Huanglian, Shanzhi, Zhishi, Gange (Puerariae Radix), Zexiei, and Shengma. One dose produced much phlegm; stool solidified. Thereafter, he drank water infused with 3 qian Huanglian daily and recovered.

For loose stools in cold months, clear cold abdominal pain, and ingestion of cold drinks/food, add Shenqu, Maiya (stir-fried), and Ganjiang (honey-fried) each 1 qian, Suosha (Amomi Fructus) and Yizhi (Alpiniae Oxyphyllae Fructus) and Muxiang each 0.7 fen.

My Commentary: For Spleen/Kidney Deficiency-Cold, use Sishen Wan. For Spleen/Kidney Collapse, use Liu Junzi Tang plus Jiang and Gui; if ineffective, urgently tonify Mingmen Fire to generate Spleen Earth. A scholar had urgent lower abdominal pain, cold loose stools, and tenesmus. I diagnosed Mingmen Fire Decline with Spleen Earth Deficiency-Cold. Treated with Bawei Wan for over a month; cured. Later, improper diet caused recurrence with heavy bearing in lower abdomen (Spleen Qi Sinking); treated with Buzhong Yiqi Tang; recovered.