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1. Sudden onset of diarrhea may be caused by dietary injury or invasion by seasonal pathogens, all stemming from oral intake, each with specific causes that must be identified for treatment. If caused by consumption of cold and raw foods leading to cold stagnation, Yi Fu Decoction (Support and Suppress Decoction) or He Wei Yin (Stomach Harmonizing Drink) should be used to warm the middle. If caused by dampness stagnation, Ping Wei San (Calm the Stomach Powder), Wei Ling Tang (Stomach and Intestine Decoction), or Bai Zhu Shao Yao San (Atractylodes Macrocephala and Peony Powder) should be used to dry dampness and stop diarrhea. If caused by food stagnation with excess distension and pain, Da Zhong He Yin (Great Middle Harmonizing Drink) or Xiao Zhong He Yin (Small Middle Harmonizing Drink) should be used to resolve stagnation. If caused by qi stagnation with severe abdominal pain and diarrhea, Pai Qi Yin (Expel Qi Drink) or Ping Wei San should be used to regulate qi. If food stagnation is firmly bound and unresolved, or if stomach qi is strong and excessive, Shen You Wan (Divine Protection Pill), Chi Jin Dou (Red Gold Bean), or Bai Shun Wan (Hundred Smooth Pills) should be used to purge accumulation. In early stages, when pathogenic factors are not deep and organ qi is not depleted, merely removing the stagnation will restore stomach qi, making recovery easy.

2. Individuals with slightly weak spleen qi and inherently deficient yang, upon any injury, are prone to immediate diarrhea. Although this is an initial illness, it requires tonifying primordial qi, differing from those with strong constitutions who suffer occasional injuries. If diarrhea leads to mental fatigue and lethargy, Yang Zhong Jian (Nourish the Middle Decoction), Wen Wei Yin (Warm the Stomach Drink), Sheng Zhu Jian (Sage Atractylodes Decoction), Si Jun Zi Tang (Four Gentlemen Decoction), or Wu Jun Zi Jian (Five Gentlemen Decoction) are suitable. For mild cold combined with stagnation without deficiency, Zuo Guan Jian (Assist the Gate Decoction) is appropriate. For spleen deficiency with slight stagnation, Wu Wei Yi Gong San (Five Ingredients Extraordinary Efficacy Powder) is indicated. For spleen deficiency with slight cold and stagnation, Liu Wei Yi Gong Jian (Six Ingredients Extraordinary Efficacy Decoction) or Wen Wei Yin is suitable. If irregular diet causes sudden loose stools that gradually worsen, accompanied by mild pain, sour/foul odor, and pale yellow color, this indicates spleen deficiency and stomach cold failing to transform food; Wude Wan (Five Virtues Pill) should be used immediately. For more severe cases, Weiguan Jian (Stomach Gate Decoction) is required without hesitation.

3. Diarrhea associated with insufficiency of True Yin often presents with pain below the umbilicus, worsening during Yin and Mao hours (3:00–7:00 AM), delayed digestion after eating, vomiting, nausea, loose stools, or undigested food in stool despite lack of foul odor. This is due to a warming failure in the Dantian and insecurity of the Tailgate gate, with insufficient fire within yin leading to cold in the middle jiao. The root lies in the lower jiao, termed "insufficiency of True Yin," unrelated to the middle jiao, thus diuretic methods are ineffective. Weiguan Jian is the superior choice. Many suffer from this; do not dismiss it as a new disease unsuitable for treatment, nor assume young patients cannot use it. Recognize the syndrome and apply the formula; small doses yield great benefits. Wise practitioners anticipate symptoms early, while the ignorant react late, highlighting the value of foresight.

4. Kidney Diarrhea refers to the aforementioned insufficiency of True Yin. It typically occurs at dawn (Wu Geng time) or just before daybreak, causing profuse diarrhea several times daily, persisting for months or years, recurring after temporary remission, with or without pain. Why? The Kidneys act as the gate for the Stomach, opening into the two yin passages, governing bowel and bladder control. Insufficient kidney yang leads to decline of Mingmen Fire and dominance of yin-cold. After Zi and Chou hours (11 PM–3 AM) and during Wu Geng time, when yang qi has not recovered and yin-cold is at its peak, profuse diarrhea ensues. Ancient formulas like Jiao Fu Wan (Pepper and Aconite Pill) and Wu Wei Zi San (Schisandra Powder) are effective. To generate yang from yin and solidify kidney qi, Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) is suitable. However, I found it imperfect, so I formulated Weiguan Jian, Yi Qi Dan (One Qi Elixir), Jiu Qi Dan (Nine Qi Elixir), and Fu Yang Dan (Restore Yang Elixir), which have saved many lives. Wu Wei Zi Wan (Schisandra Pill) is also good; for milder cases, add Wude Wan or Si Shen Wan.

5. Chronic Spleen Diarrhea largely follows methods for treating weak spleen, but acute diarrhea can address symptoms (biao), whereas chronic diarrhea requires addressing the root, as chronic diarrhea lacks heat and stems from spleen-kidney deficiency-cold. For pure spleen deficiency, Si Jun Zi Tang, Shen Zhu Tang (Ginseng and Atractylodes Decoction), or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder) are suitable. For spleen-stomach cold, Wu Jun Zi Jian, Huang Ya Wan (Yellow Sprout Pill), or Wude Wan are appropriate. For spleen qi deficiency-cold with stagnation and fullness, Liu Wei Yi Gong Jian, Wen Wei Yin, or Sheng Zhu Jian are indicated. For severe spleen qi deficiency-cold with reduced appetite, fatigue, and lethargy, Shen Fu Tang (Ginseng and Aconite Decoction), Shu Fu Tang (Atractylodes and Aconite Decoction), or Shi Quan Da Bu Tang (Ten Complete Tonifying Decoction) are needed. For lower jiao pathology with kidney qi deficiency and slight heat, Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) is used; for slight cold, Ba Wei Di Huang Tang or Weiguan Jian. For chronic spleen deficiency loose stools unresponsive to treatment, or persistent pediatric spleen diarrhea, Dun Fu Gao (Dun Fu Cake) or Nian Mi Gu Chang Gao (Glutinous Rice Intestinal-Solidifying Cake) show quick results. For spleen-stomach cold-dampness causing persistent loose stools, Cang Zhu Wan (Atractylodes Lancea Pill) is excellent. For chronic diarrhea with sinking yuan qi and lax large intestine, add Mei Zi (Mume Fruit), Wu Wei Zi (Schisandra Berry), or Yu Ke (Poppy Shell) to tonifying formulas to astringe.

6. Profuse diarrhea resembling a torrent with gradual loss of yuan qi requires immediate administration of Si Wei Hui Yang Yin (Four-Ingredient Return to Yang Drink) or Liu Wei Hui Yang Yin (Six-Ingredient Return to Yang Drink). Acute cases respond quickly; chronic cases reaching this stage are difficult to save, as diarrhea is the most urgent among the five types of depletion. Early detection is crucial. If medication fails, moxa Qihai (Sea of Qi, CV6) urgently to restore lower jiao yang qi, and administer Ren Shen Gao (Ginseng Paste) frequently.

7. Alcohol Diarrhea is common among drinkers, yet wine possesses both yin and yang natures, and humans have yin and yang organs, often unrecognized. Wine’s nature is hot, but its substance is cold. People know of wine’s damp-heat but ignore its cold-dampness. Damp-heat arises from wine’s nature (fierce qi generating heat); cold-dampness arises from its substance (water retention after the nature dissipates). Differentiation: Strong individuals with robust constitution who drink heavily may experience frequent diarrhea; if they don’t defecate, they feel hot and stifled. Frequent defecation removes dampness without damaging qi, indicating strong innate constitution and superior stomach qi—a rare type. This is a Yang syndrome, treated with clearing and draining methods like Si Ling San (Four Poria Powder), Da Li Qing Yin (Great Clarity Clearing Drink), or Jiu Zheng Huang Lian Wan (Wine-Steamed Coptis Pill) to remove damp-heat. Conversely, Yang-deficient individuals differ greatly. Spleen deficiency fails to overcome dampness, leading to cold generation, further damaging yang and stomach qi. Symptoms include emaciation, reduced appetite, wiry-thin pulse, aversion to cold, dull abdominal pain, dizziness, lethargy, restlessness at dawn, and worsening in autumn/winter. Without heat signs but with frequent undigested stool, it is total deficiency-cold. Failure to rapidly tonify yang leads to decline and danger. I suffered this for years past age forty. Seeking cures, I reviewed Zhu Danxi (Li Zhong Tang plus Ge Gen, or Jiu Zheng Huang Lian Wan), Wang Jiezhai (add Huang Lian, Yin Chen, Gan Jiang, Mu Xiang for alcohol-heat), and Xue Lizhai (Si Jun Zi Tang for damaged middle qi after damp-heat clears; Ge Hua Jie Cheng Tang for无形 yuan qi damage). While Zhu and Wang ignored cold, using Huang Lian indiscriminately, Xue focused on the spleen. I tried Ge Hua Jie Cheng Tang, Liu Jun Zi Tang, Bu Zhong Yi Qi Tang, Li Zhong Tang, and Ba Wei Di Huang Wan, all ineffective. Despairing, I realized only vigorous tonification of Mingmen would help. I created Weiguan Jian, You Gui Wan (Right Restoration Pill), and Yi Qi Dan, abstained from alcohol, and recovered after a year of regulation, gaining insight into wine’s nature. Had I stuck to damp-heat theories and used cooling/diuretic agents, recovery would be impossible. Now, distinguishing yin/yang is vital. Yang-excess individuals have strong spleen/stomach and resist qi loss; Yang-deficient individuals risk rapid qi collapse, requiring deep caution. Assuming wine is purely hot has misled many.

8. Qi Diarrhea occurs upon anger, usually triggered by eating while angry, injuring spleen and stomach. It recurs upon emotional trigger, involving Liver and Spleen, as Liver Wood overacts on Earth. If spleen qi were strong, Liver pathogen couldn’t invade; susceptibility proves spleen weakness. Treatment must tonify spleen deficiency and soothe Liver qi. Severity dictates approach. For robust youth with Qi Diarrhea, start with Ping Wei San or Wei Ling Tang. For uncalmed Liver qi with distension, Jie Gan Jian (Resolve Liver Decoction) to smooth qi first. For slightly weak spleen, Er Zhu Jian (Two Atractylodes Decoction), Nian Mi Gu Chang Gao, or Xiao Shi Dao Qi Yin (Digest Food and Guide Qi Drink). For slightly cold spleen, Yi Fu Jian, Wu Zhu Yu San (Evodia Powder), or Cang Zhu Wan. For predominant spleen weakness, Wen Wei Yin, Sheng Zhu Jian, or Liu Wei Yi Gong Jian. Prevention requires strict avoidance of anger.

9. Wind Diarrhea requires differentiation between Wind-Cold and Wind-Heat. Heat types, such as external contraction heat in Shang Han (Cold Damage), are treated per the Self-Diarrhea section in Shang Han chapters. Cold types, where wind-cold affects the stomach and injures Spleen Earth (as stated in Nei Jing: Spring wind injury leads to Summer undigested stool), are treated with warming the stomach and regulating the middle methods described previously.