泄泻本非大病，而前人所叙，颇属烦细。今采其要，以着于篇。治之之方，往往与滞下相出入，学人宜与波
门参看焉。
名义 泄泻，人为一证耳。岂知泄者，泄漏之义，时时溏泄，或作或愈。泻者，一时水去如注泄。（《奇
效》）
粪出少而势缓者为泄，若漏泄之谓也。粪大出而势直不阻者为泻，倾泻之谓也。（《赤水》）
泄者，如水之泄也，势犹舒缓。泻者，势似直下。微有不同，而其为病则一，故总名之曰泄泻。（《玉案》）
源由 《素问》曰∶春伤于风，夏必飧泄，邪气留连，
乃为洞泄。此由荣卫不足，腠理空疏，春伤于风，邪气留连于肌肉之内，后因肠胃虚怯乘袭之，遂成泄泻。又云
湿胜则濡泻，寒甚为泄，暑热乘之亦为泄。至于七情伤感，藏气不平，亦致溏泄。邪气久客肠胃，则为不禁之患
矣。（《济生》）
泻利证候者，暴泻、水泻，此二证秋夏间多有之。皆因饮食所伤，及食生冷之物，暴泻不止。须用子细询问，
若噫气吞酸，干呕气臭者，此是伤食也。（《和剂指南》）
《内经》之论泄泻，或言风，或言湿，或言热，或言寒，此明四气皆能为泄也。又言清气在下，则生飧泄，
此明脾虚下陷之泄也。统而论之，脾土强者，自能胜湿，无湿则不泄，故曰湿多成五泄。若土虚不能制湿，则风寒
与热皆得干之而为病。（《必读》）
泄泻之本，无不由于脾胃。盖胃为水谷之海而脾主运化，使脾健胃和，则水谷腐熟而化气化血，以行营卫。
若饮食失节，起居不时，以致脾胃受伤，则水反为湿，谷反为滞，精萃之气不能输化，乃致合污下降而泻痢作矣。
脾强者，滞去即愈，此强者之宜清宜利，可逐可攻也。脾弱者，因虚所以易泻，因泻所以愈虚。盖关门不固则气
随泻去，气去则阳衰，阳衰则寒从中生，固不必外受风寒而始谓之寒也。且阴寒性降，下必及肾，故泻多必亡阴，
谓亡其阴中之阳耳。（《景岳》）
脉候 脉滑按之虚绝者，其人必下利。（《脉经》）
洞泄，食不化，不得留，下脓血，脉微小迟者生，紧急者死。泄注，脉缓时小结者生，浮大数者死。（同上）
泻痢异同（互见《滞下》辨证要领中）凡《内经》有言飧泄者，有言濡泄者，皆泄泻也。有言肠 者，
即下痢也。
然痢之初作，必由于泻，此泻之与痢本为同类，但泻浅而痢深，泻轻而痢重。泻由水谷不分，出于中焦，痢以
脂血伤败，病在下焦。然病实相关，不可不兼察以为治也。（《景岳》）
盖宿食停于中，得湿热而始变，则有赤白诸般之色而为下痢，此受病已久，故有积而无粪也。饮食过饱，挟
湿而不尽化，则大便通利，无里急后重之苦而为泄泻，此受病未久，故有粪而无积也。此泄痢之别，用药者其
可一概施乎。诸痢多热而寒者少，诸泻多寒而热者间或有之。（《玉案》）
冷热虚实 大法泻痢小便清白不涩为寒，赤色者为热。又完谷不化而色不变，吐利腥秽（按∶四字《正
传》作利不腥秽）澄彻清冷，小便清白不涩，身凉不渴，脉迟细而微者，寒证也。谷虽不化而色变非白，烦渴，
小便赤黄而或涩者，热证也。凡谷消化者，无问色及他证，便为热也。寒泄而谷消化者，未之有也，由寒则不能
消化谷也。或火主疾速，而热甚则传化失常，谷不能化而飧泄者，亦有之矣。仲景曰邪热不杀谷，然热得于湿则飧
泄也。（《原病式》）
暴泄非阳，久泄非阴。大便完谷下有寒有热者，脉疾身多动，音声响亮，暴注下迫，此阳也。寒者，脉沉而
细疾，身不动作，目睛不了。饮食不下，鼻准气息者，姜附汤主之。若身重四肢不举，术附汤主之。（《保命集》）
法曰泄有虚实寒热。虚则无力更衣，不便已泄出，谓不能禁固也。实则数至圊而不能便，俗云虚坐努责故也。
（同上）
冷泻不言而喻，热亦能泻者，盖冷泻譬之盐，见火热则凝，冷则复消；热泻譬之水，寒则结冰，热则复化为
水。（《要诀》）
大都热者多实，虚者多寒。凡实热之证，必其脉盛形
强，声音壮亮，食饮裕如，举动轻健者，此多阳也。虚寒之证，必其脉息无力，形气少神，言语轻微，举动疲倦
者，此多阴也。故必察其因，而于初泻之时，即当辨其有余不足，则治无不愈而亦不致有误矣。（《景岳》）
暴久之别 泄泻亦是急症，但暴泻为轻，久泻为重。暴泻元气未衰，湿者散之，羌活胜湿汤、五苓散。
火者清之，香连丸、清六丸（按∶即益元散加红曲）。寒者温之，理中丸或加附子。虚者实之，钱氏白术散、参
苓白术散。痰者化之，清气化痰丸。食者消之，保和丸、枳实导滞丸。辨之精，治之当，其效易见，故暴泻为轻
也，若夫久泻，上亡津液，下损脾胃，补之则热增，涩之则胀剧，分利之则虚甚，甚则成脾泄，五更定泻数次，
衰老虚弱之人，多致不救，故久泻为重也。遇斯病者，须急治之。（《苍生司命》）
泄泻之暴病者，或为饮食所伤，或为时气所犯，无不由于口腹，必各有所因，宜察其因而治之。凡初感者，
病气未深，脏气未败，但略去其所病之滞，则胃气自安，不难愈也。凡脾气稍弱，阳气素不强者，一有所伤，未
免即有泄泻，此虽为初病，盒饭调理元气，自非强盛偶伤者之比。（《景岳》）
暴泄者，皆由生冷油腻，恣食无节，或饮酒无忌，适触寒邪，故成暴泄。其泻出者皆是水，乃阴阳不分，偏
渗大肠，而小便必短涩。治者以利小便为先，小便利则大便止矣。（《医镜》）（按∶《金匮翼》有说，见暑泻
中。）
久泻诸药不效，有脏热肠寒、脏寒肠热之辨，微乎微乎，余详于《从众录》等书。兹用仲景乌梅丸，每服二
钱，米饮下，日三服，半月愈。（《时方妙用》）
诸证概略 戴云。凡泻水腹不痛者。是湿也。饮食入胃
不住。或完谷不化者。是气虚也。腹痛泻水腹鸣。痛一阵泻一阵。是火也。或时泻或不泻。或多或少。是痰也。
腹痛甚而泻。泻后痛减者。是食积也。（《金匮钩玄》）
冷泻 病水泄青白或黄白，或米谷不化，肠鸣腹鸣者，此伤冷也，为洞泄寒中，又为霍乱吐泻，其脉细
弱而紧，宜理中丸、平胃散、调中汤以温补之，盛则金液丹、朝真丹主之。或药入则吐出者，内阴盛也，用汤者
当以冷服，用丸者以地浆服，热因寒用之法也。（《医说》引《集验方》）
寒泄脉沉细，腹肚切痛，下必青黑，泄后腹胀身痛，先温其里。（《永类》）
寒泻，寒气在腹，攻刺作痛，洞下清水，腹内雷鸣，米饮不化者，理中汤或附子补中汤（按∶即附子理中
汤）吞大己寒丸。五虚者死∶脉细，皮寒，少气，前后泄利，饮食不入。元是冷泻，因泻而烦躁引饮，转饮转
泻者，参附汤。（《要诀》）
寒泻腹中大疼，服前药外，间进乳豆丸。服诸热药以温中，并不见效，登圊不迭，秽物随出，此属下焦，宜
桃花丸二五粒、诃黎勒丸以涩之。（同上）
冷证，去麻黄五积散炒过，名和气散，治脾胃宿冷，腹内切痛，或外感风寒，内伤生冷，泄泻黄白色不止，
或肝经受寒，面色青惨，厥而泄利，生姜三片，盐梅一个，红枣二枚同煎，大效。（《得效》）
寒泻者，腹中微微作痛，痛久而后下者是也，宜以温脾为先。（《医镜》）
寒泻一名 溏， 溏者，水粪并趋大肠也。夫脾，主为胃行其津液者也。脾气衰弱，不能分布，则津液糟粕
并趋一窍而下，《金匮》所谓脾气衰则 溏也。又寒气在下焦，令人水粪杂
下，而色多青黑，所谓大肠有寒则 溏也。（《金匮翼》）
热泻（冷热不调泻）病水泄，下深黄及有完谷，小便赤，腹胁但胀满而不痛，烦躁闷乱，渴而喜饮者，
此伤热也，为挟热下利，其脉洪大而数，宜驻车丸、参连散、柏皮汤以和之，甚则三黄丸、调胃承气汤。挟热下血者，
柏皮汤主之。（《医说》引《集验方》）
热泻，粪色赤黄，弹响作疼，粪门焦痛，粪出谷道，犹如汤热，烦渴小便不利，宜五苓散吞香连丸。（《要诀》）
（按∶《金匮翼》有说，见暑泻。）
热泻者，肚腹尝热而痛，口干舌燥，小便赤涩，所下之粪皆深黄色，臭秽不可近者是也，宜以清热为先。
（《医镜》）
一人患泄泻，凡食一切药粥菜蔬，入喉觉如针刺，下咽即辣，因而满腹绞痛，随觉腹中有气，先从左升，次
从右升，氤氲遍腹，即欲登厕，弹响大泄，粪门恍如火灼，一阵方毕，一阵继之，更番转厕，超时方得离厕。谛
视所泄，俱清水盈器，白脂上浮，菜粥及菜蔬俱不化而出，甚至梦中大泄，了不收摄。诸医或云停滞，或云受
暑，或云中寒，百药虽投，竟如沃石，月余大肉尽脱，束手待毙。诊其脉洪大而数，知其为火热所生，川黄连三钱，
白芍药二钱，甘草八分，水煎，一服即止。（《本草汇言》）
病泄泻，色黄而有沫，肠鸣，腹胁胀满，时微作痛者，为冷热不调，其脉沉紧而小数也，服热药则转甚，戊
己丸、香连丸主之。下部滞闷，里急后重者，必欲变脓血，利之则愈。（《医说》引《集验方》）
似痢非痢，寒热不调之症，或热积于中，而以冷物冷药冰之，或冷积于中，而以热物热药压之，故热与冷搏
而成泻，
或涩或溏，里急后重者，戊己丸、香连丸或理中汤加黄连、木香。（《入门》）
飧泄（治法互见散邪、利水、温中诸方中。） 病暴泄注下，或青白或黄白，米谷或化或不化，腹胁
或胀或不胀，或痛或不痛，但噫生熟气，全不思食，因与温补诸药而后转有异证者，有所伤也，此为飧泄，其脉
外虚而内实，关脉沉且紧也，宜消积丸、不二丸以化之，甚则用备急丸主之（上不二丸用砒，不可多服，曾见医
用有害）。又春伤于风，夏必飧泄，又风气行于肠胃，则暴泄下利，其脉浮缓而虚也，并宜服羌活安中汤、胃风
汤、荆黄汤、诃黎勒散主之。（《医说》引《集验方》）（按∶此诸方多不可考，姑存其说。）
暑泻 暑月破腹∶一曰伤暑，二曰伤冷物、食瓜果、饮水之类，三曰夏季心火旺，心经热则小水不利，
行大肠，谓之水谷不分。伤暑而泻者，心躁头痛作渴，宜服香薷饮、乌金散。伤冷物而泻者，腹痛水泻，谷食不
化，宜服暖药，如附子及理中丸、二气丹、正元丹、紫苏丸之类。水谷不分者，宜服大顺散、五苓散。二药专分
清浊，暑月多此疾，故人多用之。凡泻不可急以热药止之，恐成痢。（《医说》引《医余》）
暑泻，因冒感暑气，或饮啖日中之所晒物，坐日中热处，证状与热泻略同，宜胃苓饮或五苓散加车前子少许，
兼进来复丹。理中汤加茯苓、黄连，名连理汤，用之多有奇功。且如今当暑月，若的知暑泻，自合用暑药；的
知冷泻，自合用热药。中间有一等盛暑，又复内伤生冷，非连理汤不可。下泄无度，泄后却弹过响，肛门热，小
便赤涩，心下烦渴（按∶文似有讹脱），且又喜冷，此药为宜。若元是暑泻，经久下元虚甚，日夜频并，暑毒
之势已然，而泻不已，
复用暑药，则决不能取效，便用姜附辈，又似难施，疑似之间，尤宜用此（按∶《医通》曰∶盛暑逼于外，阴
冷伏其内，非连理汤不可）。余曾治伤寒协热自利，有用白姜、黄连对半，名金银汤，即此意也，然不若连理汤
为稳。（《要诀》）
热泻者，夏月热气乍乘太阴，与湿相合，一时倾泻如水之注，亦名暴泄，《内经》所谓暴注下迫，皆属于
热是也。其症腹痛自汗，烦渴面垢，脉洪数或虚，肛门热痛，粪出如汤，或兼呕吐，心腹绞痛者，即藿乱之候
也。（《金匮翼》）
湿泻（水土不伏、顿泻）湿泻由坐卧湿处，以致湿气伤脾，土不克水，梅雨久阴，多有此病，宜除湿汤
吞戊己丸，佐以胃苓汤，重者术附汤。（《要诀》）
湿泻一名濡泄，其脉濡细，其症泄水，虚滑肠鸣，身重腹不痛。由脾胃有湿，则水谷不化，清浊不分，久
雨潮湿，或运气湿土司令之时，多有此疾，《内经》所谓湿胜则濡泄，《左传》所谓雨淫腹疾者是也。又水寒
之气，入客肠间，亦令人濡泻，经云太阳之胜，寒客下焦，传为濡泄是也。（《金匮翼》）
泄泻，恶心欲吐，或水土不伏，或感山岚瘴气而泻，藿香正气散。（《医通》）
日间无事，将脯腹膨，一夜肠鸣，不得宽泰，次早洞泄，此名顿泻，是脾虚湿盛也，以胃苓汤加缩砂仁主之。
（《原病集》）（《医通》曰∶虚者，理中汤加木香。）
食泻（宜参源由录）伤食泻，因饮食过多，有伤脾气，遂成泄泻，俗呼为伤食败腹，其人必噫气如败卵
臭，宜治中汤加砂仁半钱，或七香丸、红丸子杂服。食积腹疼而泻，不可遽用治中兜住，先用调脾饮吞感应丸。
或因食一物过
伤而泻，后复食之即泻者，以脾为其所伤，未复而然，宜建脾汤。因食冷物停滞伤脾，脾气不暖，所食之物不能
消化，泻出而食物如故，宜治中汤。因伤面而泻者，宜养胃汤，加萝卜子炒研破一钱，痛者更加木香半钱。泻甚
者去藿香加炮姜如其数。（《要诀》）
Diarrhea is essentially not a severe disease, yet the descriptions by predecessors are quite detailed and complex. Now, I have extracted the key points to present in this chapter. The treatment methods often overlap with those for dysentery (Li Xia), so students should refer to them together.
[Naming]
People generally regard diarrhea as a single syndrome. However, "Xie" (leakage) implies leakage, characterized by frequent loose stools that come and go. "Xia" (pouring) refers to water-like discharge rushing out at once. (*Qi Xiao Liang Fang*)
When stool is discharged in small amounts with a slow momentum, it is called Xie, akin to leaking. When stool is discharged in large quantities with a direct and unobstructed momentum, it is called Xia, akin to pouring. (*Chi Shui Xuan Zhu*)
Xie resembles water leaking, with a gentle momentum. Xia has a momentum like falling straight down. Although slightly different, their pathological mechanisms are the same, hence collectively named Diarrhea. (*Yu An*)
[Origins]
The *Su Wen* states: If wind pathogen invades in spring, Suncie (undigested food diarrhea) will inevitably occur in summer. If the pathogen lingers, it becomes Dongxie (profuse diarrhea). This occurs due to deficiency of Ying and Wei Qi, laxity of Couli (pores/skin texture), where wind pathogen from spring lingers within muscles. Later, due to weakness of the stomach and intestines, the pathogen attacks, resulting in diarrhea. It also states: Excess dampness leads to Ru Xie (damp diarrhea); severe cold leads to diarrhea; summer-heat invading also causes diarrhea. Furthermore, emotional injuries causing imbalance of Zang organs can lead to loose stools. If pathogens stay in the stomach and intestines for a long time, it leads to incontinence. (*Ji Sheng Fang*)
Regarding symptoms of diarrhea and dysentery, sudden diarrhea and watery diarrhea are common in summer and autumn. Both are caused by dietary injury or consumption of raw/cold foods, leading to incessant sudden diarrhea. One must inquire carefully: if there is belching, acid regurgitation, dry heaving with foul odor, this indicates food injury. (*He Ji Ju Fang Zhi Nan*)
The *Nei Jing* discusses diarrhea mentioning wind, dampness, heat, and cold, indicating that all four climatic factors can cause diarrhea. It also states: "Clear Qi sinking below generates Suncie," indicating diarrhea due to Spleen Qi deficiency and sinking. Generally, strong Spleen Earth can overcome dampness; without dampness, there is no diarrhea, hence "excess dampness causes five types of diarrhea." If Spleen Earth is weak and cannot control dampness, wind-cold and heat can interfere and cause disease. (*Yi Zong Bi Du*)
The root of diarrhea lies invariably in the Stomach and Spleen. The Stomach is the sea of water and grain, and the Spleen governs transportation and transformation. If the Spleen is healthy and the Stomach harmonious, water and grain are digested, transforming into Qi and Blood to circulate Ying and Wei. If diet is irregular or daily routine is disordered, damaging the Spleen and Stomach, water turns to dampness, and grain turns to stagnation. Essence Qi cannot be distributed, leading to turbid descent and the onset of diarrhea/dysentery. In cases of strong Spleen, removing stagnation leads to recovery; such cases may benefit from clearing heat and promoting urination, or purging. In cases of weak Spleen, deficiency leads to easy diarrhea, and diarrhea worsens deficiency. Since the anal gate is not secure, Qi escapes with the stool; loss of Qi leads to Yang decline, and Yang decline generates internal cold. Thus, cold does not necessarily require external wind-cold invasion. Yin-cold descends and affects the Kidney; thus, diarrhea often depletes Yin-Yang (specifically the Yang within Yin). (*Jing Yue Quan Shu*)
[Pulse Diagnosis]
A slippery pulse that feels empty upon deep pressure indicates the person will suffer from diarrhea. (*Mai Jing*)
In Dongxie (profuse diarrhea), with undigested food, inability to retain contents, and passage of pus and blood: a minute, faint, or slow pulse indicates survival; an urgent pulse indicates death. In Xiezhu (diarrheal rush): a slow pulse with occasional small knots indicates survival; a floating, large, and rapid pulse indicates death. (Same source)
[Differences and Similarities between Diarrhea and Dysentery]
(See differentiation essentials in "Li Xia/Dysentery")
Whenever *Nei Jing* mentions Suncie or Ru Xie, it refers to diarrhea. When it mentions Chang Pi, it refers to dysentery.
However, dysentery initially arises from diarrhea; they are of the same category but differ in depth and severity. Diarrhea is superficial and mild, originating from failure to distinguish water and grain in the Middle Jiao. Dysentery is deep and severe, resulting from damage to mucous membranes and blood in the Lower Jiao. Since the conditions are related, they must be observed jointly for treatment. (*Jing Yue Quan Shu*)
Retained food in the middle jiao transforms under damp-heat, producing various colors (red/white) in dysentery. This indicates long-standing disease with accumulation but no normal stool. Overeating with dampness hindering digestion leads to free bowel movements without tenesmus, constituting diarrhea. This indicates recent disease with stool but no accumulation. These distinctions mean medications cannot be applied uniformly. Most dysenteries are hot with few cold cases; most diarrheas are cold with occasional hot cases. (*Yu An*)
[Cold, Heat, Deficiency, and Excess]
General rule: Clear, non-acrid urine in diarrhea/dysentery indicates cold; red color indicates heat. Complete undigested food with unchanged color, clear/cold vomiting/diarrhea, clear/non-acrid urine, cool body without thirst, and slow/fine/micro pulse indicate Cold Syndrome. Undigested food with color change (not white), irritability/thirst, red/yellow/acrid urine indicate Heat Syndrome. Any digestible food indicates Heat, regardless of other signs. There is no case of cold diarrhea with digestible food, as cold prevents digestion. However, extreme heat can disrupt transmission, causing undigested food in Suncie. Zhang Zhongjing said "pathogenic heat fails to digest grain," but heat combined with dampness causes Suncie. (*Yuan Bing Shi*)
Sudden diarrhea is not necessarily Yang syndrome; chronic diarrhea is not necessarily Yin syndrome. Undigested food in stool with cold/heat signs: rapid pulse, hyperactivity, loud voice, sudden violent diarrhea with urgency indicates Yang. Cold type: deep/fine/rapid pulse, immobility, dull eyes. Inability to eat, weak breath from nose: treat with Jiang Fu Tang. Heavy body/unmovable limbs: treat with Zhu Fu Tang. (*Bao Ming Ji*)
Rule: Diarrhea involves deficiency/excess and cold/heat. Deficiency manifests as lack of strength to defecate or inability to retain stool after evacuation. Excess manifests as frequent trips to toilet with inability to pass stool, commonly known as "false straining." (Same source)
Cold diarrhea is self-explanatory. Heat can also cause diarrhea: Cold diarrhea is like salt (solidifies in heat, dissolves in cold); Heat diarrhea is like water (freezes in cold, melts in heat). (*Yao Jue*)
Generally, heat syndromes are mostly excess, while deficiency syndromes are mostly cold. Excess-heat signs include full pulse, strong physique, loud voice, good appetite, and agile movement (Yang). Deficiency-cold signs include weak pulse, poor spirit, soft speech, and fatigue (Yin). Therefore, one must investigate the cause and differentiate excess/deficiency at the onset of diarrhea to ensure successful treatment. (*Jing Yue Quan Shu*)
[Sudden vs. Chronic]
Diarrhea is an acute condition, but sudden diarrhea is mild, while chronic diarrhea is severe. In sudden diarrhea, Yuan Qi is not yet depleted. For dampness, scatter it using Qiang Huo Sheng Shi Tang or Wu Ling San. For fire, clear it using Xiang Lian Wan or Qing Liu Wan (Yi Yuan San plus Hong Qu). For cold, warm it using Li Zhong Wan or add Fu Zi. For deficiency, tonify using Qian Shi Bai Zhu San or Shen Ling Bai Zhu San. For phlegm, resolve it using Qing Qi Hua Tan Wan. For food stagnation, eliminate it using Bao He Wan or Zhi Shi Dao Zhi Wan. Precise differentiation and appropriate treatment yield quick results, making sudden diarrhea mild. In chronic diarrhea, fluids are lost above, and Spleen/Stomach damaged below. Tonifying increases heat; astringing worsens bloating; promoting urination exacerbates deficiency. It may become Pi Xie (Spleen diarrhea) with multiple episodes at dawn. In elderly/weak patients, this is often fatal, making chronic diarrhea severe. Urgent treatment is required. (*Cang Sheng Si Ming*)
Acute diarrhea is caused by dietary injury or seasonal pathogens, always involving the mouth/stomach. Identify the cause and treat accordingly. In early stages, pathogenic qi is shallow and organ qi intact; removing stagnation restores Stomach Qi, ensuring easy recovery. In patients with weak Spleen Qi or inherent Yang deficiency, even minor injury causes diarrhea. Though early stage, Yuan Qi must be regulated, unlike sudden injury in robust individuals. (*Jing Yue Quan Shu*)
Sudden diarrhea results from excessive raw/cold/greasy food, unregulated drinking, or exposure to cold. The discharge is watery due to failure of Yin/Yang distinction and leakage into Large Intestine, accompanied by scanty/acrid urine. Treatment prioritizes promoting urination; once urine flows freely, diarrhea stops. (*Yi Jing*)
For chronic diarrhea unresponsive to drugs, distinguish between Hot Zang/Cold Chang and Cold Zang/Hot Chang. Use Zhang Zhongjing's Wu Mei Wan, 2 qian per dose with rice water, three times daily, curing in half a month. (*Shi Fang Miao Yong*)
[Overview of Syndromes]
Dai Yun says: Watery diarrhea without abdominal pain indicates Dampness. Food staying in stomach or undigested food indicates Qi Deficiency. Abdominal pain with rumbling, pain preceding diarrhea, indicates Fire. Intermittent diarrhea varying in amount indicates Phlegm. Severe abdominal pain relieved by diarrhea indicates Food Stagnation. (*Jin Kui Gou Xuan*)
[Cold Diarrhea]
Watery stool green/white or yellow/white, undigested food, intestinal rumbling indicates Cold Injury, specifically Dongxie Han Zhong or Huoluan vomiting/diarrhea. Pulse fine/weak/tight: treat with Li Zhong Wan, Ping Wei San, or Tiao Zhong Tang to warm/tonify. Severe cases: Jin Ye Dan or Chao Zhen Dan. If vomited immediately, internal Yin is excessive; take decoctions cold or pills with earth slurry (Heat treated with Cold method). (*Yi Shuo* citing *Ji Yan Fang*)
Cold diarrhea: deep/fine pulse, cutting abdominal pain, black/dark stool, blooming/pain after diarrhea. Warm the interior first. (*Yong Lei*)
Cold diarrhea with cold in abdomen, stabbing pain, profuse clear water, rumbling, undigested food: Li Zhong Tang or Fu Zi Bu Zhong Tang (Fu Zi Li Zhong Tang) with Da Ji Han Wan. Five Deficiencies (death sign): fine pulse, cold skin, shortness of breath, incontinence, inability to eat. Original cold diarrhea turning irritable/thirsty with worsening diarrhea upon drinking: Shen Fu Tang. (*Yao Jue*)
Severe abdominal cold diarrhea unresponsive to warming herbs, frequent defecation of foul matter indicates Lower Jiao issue: use Tao Hua Wan or He Li Le Wan to astringe. (Same source)
Cold pattern: Remove Ma Huang from Wu Ji San, stir-fry to name He Qi San. Treats chronic Spleen/Stomach cold, cutting pain, or external wind-cold/internal raw food injury causing persistent yellow/white diarrhea or Liver channel cold (blue face, syncope/diarrhea). Decoct with ginger, salt plum, red dates. Highly effective. (*De Xiao Fang*)
Mild abdominal pain in cold diarrhea, pain preceding stool: prioritize warming Spleen. (*Yi Jing*)
Cold diarrhea is also called Tang (loose stool), where water and feces flow together to Large Intestine. Spleen transports fluids for Stomach. Weak Spleen fails to distribute, leading to fluid/waste descending together. As *Jin Gui* says, Spleen weakness causes Tang. Cold in Lower Jiao causes mixed water/feces, often dark/black, indicating Cold in Large Intestine. (*Jin Kui Yi*)
[Heat Diarrhea (Mixed Cold/Heat)]
Watery diarrhea, deep yellow stool with undigested food, red urine, abdominal/flank distension without pain, irritability, thirst preferring drinks indicates Heat Injury, specifically Heat-with-Dysentery. Pulse洪大 (surging/large) and rapid: treat with Zhu Che Wan, Can Lian San, or Bo Pi Tang to harmonize. Severe cases: San Huang Wan or Tiao Wei Cheng Qi Tang. Heat-with-blood: Bo Pi Tang. (*Yi Shuo* citing *Ji Yan Fang*)
Red/yellow stool, popping sound with pain, burning anus, hot sensation upon defecation, irritability/thirst, difficult urination: Wu Ling San with Xiang Lian Wan. (*Yao Jue*)
Abdominal heat/pain, dry mouth/tongue, red/acrid urine, deep yellow/foul stool: prioritize clearing heat. (*Yi Jing*)
Case: Patient with diarrhea felt needle-like刺痛 (stinging) in throat when eating any porridge/vegetables, spicy upon swallowing, followed by colic, rising gas from left then right filling abdomen, urgent defecation with popping sounds, burning anus, alternating episodes. Stool was clear water with white fat, undigested food. Even dream defecation occurred. Doctors diagnosed stagnation, summer-heat, or cold; hundred medicines failed. Flesh wasted away. Pulse surging/rapid indicated Fire-Heat. Prescription: Huang Lian 3 qian, Bai Shao 2 qian, Gan Cao 0.8 qian, decocted. One dose stopped it. (*Ben Cao Hui Yan*)
Yellow stool with foam, rumbling, flank distension, mild pain indicates Mixed Cold/Heat. Pulse deep/tight/slightly rapid. Heat meds worsen it: Wu Ji Wan or Xiang Lian Wan. Lower obstruction/tenesmus requiring pus/blood transformation: purgatives cure it. (*Yi Shuo* citing *Ji Yan Fang*)
Dysentery-like but not dysentery, mixed cold/heat: Heat accumulated and cooled by cold items/meds, or Cold accumulated and suppressed by heat items/meds, causing heat/cold conflict and diarrhea, either constipated or loose with tenesmus: Wu Ji Wan, Xiang Lian Wan, or Li Zhong Tang plus Huang Lian/Mu Xiang. (*Yi Men*)
[Suncie (Undigested Food Diarrhea)]
(See methods in Dispersing Pathogens, Promoting Urination, Warming Middle formulas)
Sudden profuse diarrhea, green/white or yellow/white, variable digestion, variable distension/pain, belching raw/cooked smells, loss of appetite, changing symptoms after warm/tonic meds indicates injury. This is Suncie. Pulse exteriorly deficient, interiorly excess, Guan pulse deep/tight: use Xiao Ji Wan or Bu Er Wan to resolve. Severe: Bei Ji Wan (Note: Bu Er Wan contains Arsenic, do not overuse). Spring wind injury leading to summer Suncie, or wind pathogen in intestines causing sudden diarrhea: pulse floating/soft/deficient. Use Qiang Huo An Zhong Tang, Wei Feng Tang, Jing Huang Tang, or He Li Le San. (*Yi Shuo* citing *Ji Yan Fang*)
[Summer-Heat Diarrhea]
Summer abdominal issues: 1. Summer-heat injury; 2. Cold food/watermelon/water injury; 3. Summer Heart Fire excess causing difficult urination, flowing to Large Intestine, causing water/grain confusion. Summer-heat diarrhea with irritability/headache/thirst: Xiang Ru Yin or Wu Jin San. Cold food diarrhea with abdominal pain/watery stool/undigested food: warm meds like Fu Zi, Li Zhong Wan, Er Qi Dan, Zheng Yuan Dan, Zi Su Wan. Water/grain confusion: Da Shun San or Wu Ling San. These two separate clear/turbid, commonly used in summer. Do not stop diarrhea quickly with hot meds, lest it become dysentery. (*Yi Shuo* citing *Yi Yu*)
Summer-heat diarrhea from exposure or eating sun-heated food/sitting in heat resembles heat diarrhea. Use Wei Ling Yin or Wu Ling San plus Che Qian Zi, combined with Lai Fu Dan. Li Zhong Tang plus Fu Ling/Huang Lian is Lian Li Tang, highly effective. In summer, confirm summer-heat for summer meds, cold for hot meds. In extreme heat with internal cold/raw food injury, only Lian Li Tang works. Profuse diarrhea, loud expulsion, hot anus, red/acrid urine, chest irritability/thirst preferring cold: this formula is suitable. If chronic summer-heat diarrhea with severe lower deficiency, continuing summer meds fails; hot meds like Jiang/Fu are hard to apply. In doubt, use this. (*Yi Tong*: External heat forces internal cold; only Lian Li Tang works). I treated Taiyang heat-collateral diarrhea with equal parts Bai Jiang and Huang Lian (Jin Yin Tang), similar intent, but Lian Li Tang is safer. (*Yao Jue*)
Heat diarrhea in summer: Heat attacks Taiyin, combines with dampness, causing sudden watery diarrhea (also called Sudden Diarrhea). *Nei Jing*: "Sudden violent diarrhea with urgency belongs to Heat." Symptoms: abdominal pain, sweating, irritability/thirst, dirty face, surging/rapid or deficient pulse, hot/painful anus, hot stool, possibly vomiting/cramps (Huoluan signs). (*Jin Kui Yi*)
[Damp Diarrhea (Water/Earth Mismatch, Sudden Diarrhea)]
Caused by sitting/lying in dampness, injuring Spleen, Earth failing to control Water. Common in plum rain season. Use Chu Shi Tang with Wu Ji Wan, assisted by Wei Ling Tang. Severe: Zhu Fu Tang. (*Yao Jue*)
Damp diarrhea is also Ru Xie. Pulse damp/fine. Symptoms: watery diarrhea, slippery rumbling, heavy body, no pain. Spleen/Stomach dampness prevents digestion, confusing clear/turbid. Common in rainy seasons or damp Earth years. *Nei Jing*: "Excess dampness causes Ru Xie." *Zuo Zhuan*: "Rain invades causing abdominal disease." Cold water/qi entering intestines also causes Ru Xie. *Jing*: "Taiyang victory, cold in Lower Jiao transmits to Ru Xie." (*Jin Kui Yi*)
Diarrhea with nausea/vomiting, water/earth mismatch, or mountain miasma: Huo Xiang Zheng Qi San. (*Yi Tong*)
Normal day, swollen belly, night rumbling, next morning profuse diarrhea is Dun Xie (Sudden Diarrhea), Spleen deficiency with damp excess. Use Wei Ling Tang plus Sha Ren. (*Yuan Bing Ji*) (*Yi Tong*: Deficiency type, Li Zhong Tang plus Mu Xiang).
[Food Diarrhea]
(See Origins)
Food injury diarrhea from overeating damages Spleen Qi. Commonly called "Food Injury Failure Belly." Belching smells like rotten eggs. Use Zhi Zhong Tang plus Sha Ren, or Qi Xiang Wan/Hong Wan. Food stagnation abdominal pain/diarrhea: do not immediately use Zhi Zhong to stop; first use Tiao Pi Yin with Ying Gan Wan. If diarrhea recurs after re-eating injured food, Spleen hasn't recovered: use Jian Pi Tang. Cold food stagnation injuring Spleen, undigested food in stool: Zhi Zhong Tang. Face-injury diarrhea: Yang Wei Tang plus fried Luobo Zi. Pain adds Mu Xiang. Severe diarrhea removes Huo Xiang, adds Pao Jiang. (*Yao Jue*)