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Zhengsheng (repetitive, low-pitched speech due to mental confusion) in Shanghan disease refers to disordered speech caused by pathogenic factors. Confucius said, "I detest Zhengsheng for disrupting Ya Yue (elegant music)." He also said, "Discard Zhengsheng, stay away from flattering people. For Zhengsheng is licentious."

If the urine flows freely (normal or frequent urination), it is not a blood syndrome but rather Kidney deficiency. Only in a blood syndrome will there be hardness and fullness in the lower abdomen accompanied by a manic-like state. Only when both the Kidney and Bladder are deficient can water metabolism be impaired, leading to frequent urination and abdominal fullness. If there is Zhanyu (delirious speech), administer a small amount of Tiaowei Chengqi Tang to harmonize the Stomach. In Taiyang disease with spontaneous sweating, stiffness and spasms of the four limbs, vexation, slight aversion to cold, and calf cramps with frequent urination, this is a complication resulting from the mistaken use of Guizhi Tang.

The verse states: Frequent urination often involves disturbance in the Blood level. Honey suppositories are indicated for Yangming excess or Kidney Yang deficiency cold. Splei-yue syndrome presenting with delirium and leg cramps results from difficulty in defecation after erroneous sweating and purging in Taiyang disease.

It is also stated: In Taiyang disease with heat in the Lower Jiao, if the urine flows freely, there must be lower abdominal fullness; normally, urination should be difficult. If it is instead free, it indicates a blood syndrome, treated with Didang Tang.

There are many types of Li (diarrhea/dysentery) in Shanghan disease; one must distinguish between Yin and Yang to avoid diagnostic errors. In San Yang (Taiyang, Yangming, Shaoyang) diarrhea, the body is hot. In Taiyin diarrhea, the hands and feet are warm. In Shaoyin and Jueyin diarrhea, the body is not hot; this distinguishes them. Generally, if diarrhea accompanies Taiyang pulse and symptoms, warming herbs should not be used immediately. Common physicians, seeing only diarrhea, label it as a Yin syndrome and indiscriminately use warming tonics.

In combined Taiyang and Yangming disease, diarrhea inevitably occurs, primarily treated with Gegen Tang. Diarrhea accompanied by headache, back pain, muscle fever, eye pain, dry nose, and a floating, large, and long pulse belongs to this category.

In combined Taiyang and Shaoyang disease, spontaneous diarrhea occurs, primarily treated with Huangqin Tang. If vomiting is present, add Banxia and Shengjiang to Huangqin Tang. Diarrhea accompanied by headache and chest fullness belongs to this category.

In combined Yangming and Shaoyang disease, diarrhea inevitably occurs. A pulse that does not show deficiency is a favorable sign (Shun); a deficient pulse is an unfavorable sign (Ni). This is due to mutual overcoming (Ke Ze), termed "Fu" (Defeat/Negative). Diarrhea accompanied by fever belongs to this category.

Spontaneous diarrhea without thirst belongs to Taiyin disease, primarily treated with Sini Tang or Lizhong Tang.
Spontaneous diarrhea with thirst belongs to Shaoyin disease, primarily treated with Baitong Tang, Baitong Zhu Dan Tang, Tongmai Sini Tang, Zhuling Tang, Zhenwu Tang, or Sini Jia Renshen Tang.

The remaining cases of diarrhea are mostly complications after sweating or purging. Generally, in Shanghan diarrhea, one must observe the pulse and external symptoms. Diarrhea with a large pulse indicates deficiency; a faint and weak pulse also indicates deficiency; a slippery pulse suggests retained food. Or, diarrhea with undigested food (Qinggu); if damp-toxic qi is abundant, there is painful diarrhea with stool resembling pus and blood, or like rotten meat juice. Desire to drink water during diarrhea indicates internal heat. Delirium during diarrhea indicates dry feces (Zaoshi) accumulation. Cold toxin entering the Stomach is treated with Sini Tang, Lizhong Tang, Baitong Tang plus Fuzi, or Sini San plus Xiebai. Heat-collateral diarrhea is treated with Huangqin Tang, Baitouweng Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, or Chishizhi Wan. Damp-toxic diarrhea with pus and blood is treated with Taohua Tang.

Zhang Zhongjing said: If the Yuyang pulse is floating and choppy, and the Shaoyin pulse is normal, the disease lies in the Spleen, and diarrhea is expected. The annotation states: Spleen deficiency fails to control water; Kidney Qi is balanced, so the disease is in the Spleen.

The verse states: There are many types of Shanghan diarrhea; one must distinguish Yin and Yang to avoid error. Only in Yangming-Shaoyang combination, if mutual overcoming occurs, it is named "Fu".

It is also said: Kidney deficiency causing diarrhea brings bitter dryness in the throat; failing to recognize this, one only knows of organ cold. Heat-collateral, Stomach cold, and damp-toxic diarrhea, if accompanied by delirium, are settled by purging.

Delirium with diarrhea indicates dry feces, treated with Tiaowei Chengqi Tang. Combined Taiyang-Yangming disease with floating, large, long pulse and diarrhea is treated with Gegen Tang. A slow and slippery pulse indicates retained food, suitable for purging with Xiao Chengqi Tang. Spontaneous diarrhea without thirst belongs to Taiyin, treated with Sini Tang and Lizhong Tang. Spontaneous diarrhea with thirst belongs to Shaoyin; a faint pulse uses Baitong Tang; cold extremities with absent pulse use Baitong Zhu Dan Tang and Tongmai Sini Tang. Cough, vomiting, thirst, vexation, and insomnia are treated with Zhuling Tang. San Yin diarrhea should generally be treated with warming methods. Clear water diarrhea with epigastric pain and dry mouth requires purging; this must not be ignored. Warming methods include Sini and Lizhong categories; purging methods include Dachaihu and Chengqi categories. San Yang diarrhea may also involve drinking water due to heat, treated according to the Changgou method. Diarrhea with epigastric stagnation has its own sections on stagnation and diarrhea.

Although hard stool usually requires purging, there are various conditions where attack is contraindicated. Changgou (intestinal mucus) is divided into cold and heat types; one need not fear following the footsteps of the ancients. Hua Tuo said: Cold causes loose stools... One must select pills or Ya Jiao Tang based on differentiation.