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According to the *Nan Jing* (Classic of Difficult Issues), there are five types of diarrhea: Stomach Diarrhea, Spleen Diarrhea, Large Intestine Diarrhea, Small Intestine Diarrhea, and Da Jia Diarrhea. The stomach corresponds to the color yellow and is the ocean of water and grain; therefore... [text missing in original]. Weakness and aversion to cold indicate injury by summerheat; turbid complexion, dry skin, thirst, and desire for fluids also indicate injury by summerheat; flaccid edema of muscles and heaviness of the limbs indicate injury by dampness. Cold causes borborygmus and cold abdomen with cold extremities; heat causes dry intestines, hot abdomen, and warm extremities; imbalance of cold and heat results in alternating constipation and loose stools. This occurs because heat accumulates internally but cannot be resolved; using only cold water or drinks suppresses it without allowing the heat to dissipate, causing cold and heat to mix and descend. Alternatively, cold accumulates in the middle jiao but cannot be cleared; using only hot medicines suppresses it without dispersing the cold accumulation, causing heat and cold to combine, resulting in diarrhea that is either constipated or loose, accompanied by tenesmus. These are its manifestations. Additionally, there is food stagnation syndrome caused by irregular eating habits, where the stomach fails to digest food, leading to epigastric and abdominal distension and sour-smelling feces. Treatment should investigate the source of the pathogenic factor before applying therapy; otherwise, the condition may worsen uncontrollably. Although people generally attribute diarrhea to spleen disorders, kidney disease can also cause diarrhea. Kidney diarrhea presents as unpredictable abdominal pain, resembling dysentery but not being dysentery, with weak bones, dark complexion, and cold soles of the feet.

For various diarrheas, use Bu Huan Jin San (Golden Change Powder) or Fu Chu Shi Tang (Dampness-Removing Decoction) to dispel wind-dampness and stabilize the intestines and stomach; these are superior remedies. Next are formulas that warm the spleen and nourish the stomach... [text missing]. Regarding post-dysenteric abdominal fullness and body pain, this indicates simultaneous exterior and interior involvement. First, warm the interior urgently with Si Ni Tang (Frigid Extremities Decoction). Then resolve the exterior urgently with Gui Zhi Tang (Cinnamon Twig Decoction)... [text missing].

The *Tai Su* states that the five diarrheas include Tang Xie (Loose Stool Diarrhea), Sun Xie (Undigested Food Diarrhea), Ru Xie (Soft Stool Diarrhea), and Hua Xie (Slippery Stool Diarrhea). Green stool corresponds to the liver wood phase... [text missing]. The large intestine is the official responsible for transporting grains. If the spleen and stomach are weak, overeating, or invaded by wind, cold, summerheat, or dampness, diarrhea can occur. Wind injury presents with a floating pulse and bloody stool; treat with Wei Feng Tang (Stomach Wind Decoction). Cold injury presents with a deep, fine pulse and severe abdominal pain with black-green stool; treat with Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) or Zhi Zhong Tang (Regulate the Middle Decoction). Summerheat injury presents with a deep, faint pulse, irritability, thirst, and watery stool; treat with Wu Ling San (Five-Ingredient Poria Pill) and Lai Fu Dan (Reviving Pill) to separate and drain dampness. If complicated by food stagnation, use Wei Ling Tang (Stomach Cinnamon Decoction) or Xia Su Gan Wan. Dampness invasion presents with a deep, slow pulse, cold bi-sensation in waist and legs, difficult urination, and yellow-black stool; treat with Shen Shi Tang (Dampness-Seeping Decoction) or Huo Xiang Zheng Qi Tang (Agarwood Rectify Qi Decoction). Food stagnation diarrhea features foul-smelling stool resembling spoiled eggs or acid belching; first use Gan Ying Wan to push out the stagnation, then regulate the spleen. For frail or elderly patients with spontaneous dysentery due to spleen qi deficiency, use Si Zhu San or Kou Fu Wan. Morning diarrhea due to spleen-kidney qi deficiency is treated with Er Shen Wan or Si Shen Wan. Kidney qi deficiency diarrhea requires Jin Suo Zheng Yuan Dan to secure. Generally, treat diarrhea by regulating the middle jiao, separating water and grain, then stopping diarrhea. Hong Kong foot-related diarrhea should be treated according to category. Slippery diarrhea contraindicates the "Five Deficiencies" syndrome: fine pulse, cold skin, shortness of breath, anterior/posterior discharge, and inability to eat. If millet gruel enters the stomach and diarrhea stops, it is treatable.

For the three types among the five diarrheas—Stomach, Small Intestine, and Da Jia—Qing Liang Yin Zi (Cooling Drink) is primary. For Jue Yin syndrome, add Gan Cao (Licorice Root) to moderate... [text missing]. If diarrhea persists due to old filth and sticky residue in the intestines, add Mang Xiao (Mirabilite) half he. For Yang Ming syndrome characterized by appetite, use a method of purging then tonifying: start with Da Cheng Qi Tang (Major Order the Qi Decoction); if heat subsides after Mang Xiao, reduce Da Huang (Rhubarb Root); if abdominal fullness remains, use Zhi Shi Nong Po Tang (Immature Bitter Orange and Magnolia Bark Decoction); if fullness resolves, continue with Nong Po Tang. If chronic slippery stool persists from Taiyin transmitting to Shaoyin (called "Thief Evil"), use Nong Po Zhi Shi Tang.

*Rumen Shinqin* records a case of a man with persistent dysentery, loud borborygmus, and profuse discharge upon sitting. It states that acute watery dysentery is called "Bao Zhu" (Violent Purging) due to excessive fire movement. Use Xin Ji Shui (Freshly Drawn Water) to administer Gan Lu Yin Zi, Wu Ling San, or Tian Shui San, taken cold. Do not use Yu Mi Ke (Poppy Shell), Gan Jiang (Dried Ginger), Dou Kou (Cardamom), or Sheng San Zi, as they may cause abdominal fullness due to qi stagnation. The essence of treatment is to differentiate yin/yang and promote water pathways.

For uncontrolled diarrhea with undigested food and borborygmus, use Dao Shui Wan or Yu Gong San to purge. For dysentery with pus and blood and abdominal pain, attributed to Heart Fire, use Tong Jie Wan... [text missing]. Both diarrhea and dysentery arise from initial deficiency of the intestines and stomach, allowing six excesses and seven emotions to invade, compounded by dietary irregularities... [text missing]. Visceral dysentery stems largely from wind, dampness, and heat. Acute diarrhea is not yin; chronic diarrhea is not yang... [text missing]. Treat thick pus/blood with heavy drugs; cold sweat with toxic-warming drugs; internalized wind with sweating; soft stool dysentery with internal regulation; exterior symptoms with release; interior symptoms with purging; upper symptoms with emesis; lower symptoms with draining; surface heat with internal clearing; difficult urination with separation/draining; excess with harmonizing; depletion with supporting; overflow with stopping. Use Bai Zhu (Atractylodes Rhizome) and Fu Ling (Poria) to remove dampness; Shao Yao (Peony Root), Gui Zhi (Cinnamon Twig), Huang Lian (Coptis Rhizome), Dang Gui (Angelica Sinensis) to calm the spleen; Bing Lang (Areca Seed) and Mu Xiang (Vladimiria Root) to move qi. For vomiting with dysentery: upper jiao uses Sheng Jiang (Fresh Ginger) and Ju Pi (Tangerine Peel); middle jiao uses Shao Yao, Dang Gui, Gui, Fu Ling; lower jiao uses light/warm or heavy/warm drugs. For lethargy, scant urine, and reduced diet, use Bai Zhu, Fu Ling, Shao Yao. For sweating/aversion to cold without abdominal pain, add Huang Qin (Scutellaria Root). For aversion to cold without pus (Taiyin transmitting to Shaoyin), add Huang Lian assisted by Gui Zhi. For severe pain, add Dang Gui and Shao Yao. For blood, add Huang Lian assisted by Gui and Dang Gui. For restlessness or upper bleeding, Huang Lian is essential. For middle bleeding (waist/navel pain), Huang Qin is essential. For lower bleeding (blood before stool), Di Yu (Sedge Rhizome) is essential. Floating-large pulses contraindicate purging. Winter red-white dysentery involves cold/heat affecting blood. Chronic dysentery weakens spleen/stomach, leading to vomiting/hiccups. Parasites (Three Corps, Nine Worms) reside in the gut; when the gut is weak, they ascend to damage organs (causing mouth ulcers) or descend (damaging anus). Intestinal worm dysentery presents as red then white stool over years. Resting dysentery involves retained fluid in the stomach triggered by cold/heat, causing intermittent symptoms.

Water and grain essence transform into blood/qi/fluids. Wind invading the gut causes dysentery, depleting fluids. Watery diarrhea stems from spleen heat; grain diarrhea from spleen cold; blood dysentery from toxic heat entering the gut; pus dysentery from accumulated cold; intestinal filth dysentery from cold and unstable filth. All stem from dietary irregularity. Filth is intestinal fluid trapped by heat.

Diagnosis of dysentery pulses: Micro/small indicates life; floating/huge indicates death; deep/tense indicates tenesmus; large indicates persistence; tight indicates unresolved evil; weak/faint... [text missing]. Floating/slippery pulse with borborygmus requires warming. Slow/urgent pulse with pain requires warming. Cold-induced fullness with filth requires warming. Body pain with dysentery requires urgent interior warming (Li Zhong, Si Ni, Fu Zi Tang). Anal pain requires warming. Abdominal fullness/body pain requires warming interior first, then attacking exterior. Clear undigested food contraindicates exterior attack. Qi dysentery requires promoting urination. Floating-numerous pulse with cleft涩 (rough) chi pulse indicates pus/blood. Numerous/thirsty pulse indicates self-healing or pus/blood if heat persists. Deep-tense indicates tenesmus; large indicates persistence; weak-numerous indicates impending stop even with fever. Deep-slow with slight facial redness and clear stool indicates dizziness/sweating resolution (face wearing yang, lower deficiency). Mild heat/thirst indicates healing. Strong pulse with sweating indicates healing. Yellow-dry tongue without thirst and chest fullness with unstoppable diarrhea indicates death. Pulseless/cold extremities: return of pulse/warmth indicates life; no warmth indicates death. Moxibustion failure with panting indicates death. Shaoyin negative/Diyang smooth is favorable. Six fu organ exterior collapse causes cold limbs/shrinking legs; five zang organ interior collapse causes incontinence/numbness.

Dysentery and diarrhea have different names but same sources. Treatment prioritizes dispelling wind, moving stagnation, opening the stomach. For high fever, use Bai Du San (Decoction to Overcome Toxins) with aged rice, alternating with Wu Ling San or Huang Lian E Jiao Wan. For heat/toxic red dysentery, use Bai Du San. For cold/white dysentery, use Bu Huan Jin Zheng Qi San with Mu Xiang. For extreme heat/pain, purge with drugs to clear damp-heat/stagnation. Do not strictly adhere to "no stagnation no dysentery." Adjust herbs based on heat/cold/parasites.

Prescriptions:
Zhi Gan San (Roasted Liver Powder): For spleen/stomach weakness, wasting, anorexia, chronic slippery diarrhea. Ingredients: Mu Xiang, Bai Zhu, Xi Jiao, Yin Chen, Dou Kou, Sha Ren, Rou Gui, Ren Shen, Fu Zi, Chen Pi, Bai Shao, Gan Jiang, Jie Geng, Fang Feng, Zi Wan, Wu Yi, Zhu Yu. Processed with sheep liver.

Mu Xiang Dou Kou Wan: For extreme cold, mouth ulcers, undigested food, postpartum cold diarrhea. Ingredients: Mu Xiang, Po Gu Zhi, Liang Jiang, Sha Ren, Hou Po, Chi Shao.

He Li Le Wan: For five diarrheas/dysentery. Ingredients: He Li Le, Rou Dou Kou, Mu Xiang, Gan Jiang, Gan Cao.

Zhong Ru Jian Pi Wan: For deficiency, heaviness, cold spleen/stomach, rumbling, clear stool, pure white discharge, chronic red/white dysentery. Ingredients: Rou Gui, Ren Shen, Huang Lian, Gan Jiang, Long Gu, Shu Jiao, Dang Gui, Shi Hu, Mai Mai, Fu Zi, Ru Fen.

Ding Xiang Dou Kou San: For cold accumulation, raw food injury, watery diarrhea, chest fullness, nausea. Ingredients: San Leng, Mu Xiang, Hou Po, Shao Yao, Rou Dou Kou, Ren Shen, Gan Jiang, Fu Ling, Gan Cao, Zhu Yu, Ding Xiang, Cang Zhu.

Bai Zhu Sheng Zi San: For chronic diarrhea/dysentery, postpartum dysentery. Ingredients: Yu Mi Ke, Dang Gui, Gan Jiang, Shi Liu Pi, Gan Cao, He Zi, Rou Dou Kou, Chen Pi, Bai Zhu, Sha Ren, Bai Shao.

Gu Chang Wan: For dysentery/diarrhea. Ingredients: Rou Dou Kou, Long Gu, E Jiao, Mu Xiang, Fu Zi, Gan Jiang, Bai Zhu.

Da Wen Pi Wan: For cold attacking spleen/stomach, undigested food, pain, vomiting, rumbling, clear stool, jaundice, lethargy. Ingredients: Zhu Yu, Mai Mai, Rou Gui, Gan Cao, Jie Geng, Ren Shen, Gan Jiang.

He Li Le San: For uncontrolled diarrhea. Ingredients: He Li Le, Mu Ding Xiang, Gan Cao, Rou Dou Kou.

Chan Jin Dan (He Ji Fang): For all diarrhea/dysentery, cold/heat/red/white, recurrent pain. Also known as Bu Er Wan. Ingredients: Sha, Ru Xiang, Xing Ren, Ba Dou, Huang La, Zhu Sha.

Rou Dou Kou Wan (Yu Yao Yuan Fang): For weak spleen/intestines, wind-cold stagnation, watery diarrhea, undigested food, pain, pus/blood dysentery, tenesmus, nausea, fatigue.