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Although the two bowels (urine and feces) are excreted by the large intestine and small intestine respectively, they are ultimately all orifices of the Kidney. In some cases, heat pathogen binds in the large and small intestines, causing fluids to fail to circulate and heat to have no outlet, thereby leading to symptoms such as delirium, madness, jaundice, and macules; bitter-cold purgatives should be used for downward drainage. In other cases, excessive sweating leads to loss of Yin fluids, and heat consumes body fluids, resulting in scanty, difficult urination and dry, constipated stool; moistening agents should be used to unblock. If only urinary retention occurs, unblocking the stool will naturally facilitate urination; diuresis alone is of no benefit. Furthermore, in plague diseases, promoting urination is intended to allow heat pathogen to be excreted through it, but excessive diuresis can lead to dry, constipated stool, a fact that must not be ignored.

Since ancient times, dysentery has been called "resting dysentery" (intermittent remission and recurrence), rarely has diarrhea been described as "resting." This condition was first encountered through my own experience; it is classified not as a Wang disease (pestilence with strong epidemic potential) but as a Yi disease (epidemic disease), likely because symptoms are identical regardless of age. The disease occurs from late summer to autumn, and may persist from summer into autumn without cure, lacking typical exterior and interior signs of plague. Some patients present with abdominal distension, others without; appetite remains unchanged after eating, yet there is a strong aversion to drinking water, suggesting dampness. However, during this time, the weather was extremely dry with no rain for a year, making the source of dampness unclear. Diarrhea occurred dozens of times daily and would not stop abruptly without treatment. During the intense heat of late summer, tonifying the Spleen and warming/tonifying herbs led to recovery. However, relapse occurred after a few days; even if cured temporarily, it recurred again after several days. The course was lingering, lasting months. Inquiry revealed that recurrence was partly due to consuming raw/cold foods and overeating. Patients were advised to eat only 70-80% full, and after taking medicine for over a month, relapses ceased. Mortality was rare, but patients became extremely debilitated.

(Referring to Diarrhea)
The appearance of diarrhea in plague indicates a serious condition. Generally, three parts are cold-type, seven parts are heat-type, and damp-type is merely occasional. Wu Keyou's *Treatise on Plague* discusses "collateral heat diarrhea," focusing solely on heat, which is biased. Cold-type diarrhea in plague is mild and cannot be compared to winter cold invasion or direct transmission to Yin meridians. There are three types of cold-type diarrhea: First, contracting a plague without significant heat but using too many cooling medicines causes the plague to persist while diarrhea starts. At this stage, treat the iatrogenic cause first by warming the interior; once the interior is warm, diarrhea stops, then resolve the exterior. Since plague does not typically use sweating methods, use harmonizing and draining methods at this time, treating based on the affected meridian. If pathogens remain unresolved, it is likely due to Qi damage and Yin/Blood depletion from prior diarrhea preventing sweating; thus, gentle tonification and Yin nourishment are needed. Use Shu Di Huang (Prepared Rehmannia Root), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Zhi Gan Cao (Honey-fried Licorice), supplemented by Bai Zhu (Atractylodes Macrocephala), Shan Yao (Chinese Yam), Lian Rou (Lotus Seed Flesh). Add Chen Pi (Tangerine Peel) for Qi stagnation, Wei Jiang (Baked Ginger) for cold, Zhi Ban Xia (Processed Pinellia) and Fu Shen (Poria with Hostwood) for insomnia, Huo Xiang (Patchouli) for vomiting. With proper regulation, sweating will occur naturally, leading to recovery. If loose stools suggest impending relapse, heavily use Fu Ling (Poria), Zhi He Shou Wu (Prepared Fleeceflower Root), and Bai Bian Dou (White Hyacinth Bean) in previous formulas, adjusting as needed for efficacy. Second, diarrhea following severe purging results from Qi deficiency and Blood/Qi damage; treatment may involve tonifying Spleen, tonifying Kidney, tonifying Qi/Blood, mild diuresis, or astringency, depending on severity and constitution. Third, spontaneous diarrhea without prior cooling/purgative use may result from climatic abnormalities, pestilential Qi, or environmental factors like drought/floods. Initial symptoms include headache, body pain, fever, spontaneous sweating, and slight aversion to cold, followed suddenly by diarrhea without delirium, coma, dry tongue coating, thirst, or jaundice. Pulse is neither surging-rapid nor fine-small. Using Da Yuan Yin (Reach the Origin Powder) worsens diarrhea; using Yuan Shuang or Su Xue pills fails to stop it. This case lacks significant heat, representing a variation in plague. Thirst is absent with aversion to drinking; tongue lacks yellow coating, confirming non-heat type. Main treatment focuses on tonifying Spleen and Kidney, assisted by diuresis. For Kidney tonification, avoid Shu Di Huang (slippery to intestines) and Dang Gui (strictly contraindicated); instead use Da He Shou Wu (Polygonum Multiflorum), Tu Si Zi (Cuscuta Seed), Shan Yao, Fu Ling, Bai Zhu, Cang Zhu (Atractylodes Lancea), Bai Bian Dou, Ren Shen (Ginseng), Chen Pi, Zhi Gan Cao. Here, diarrhea is the root, plague is the branch. Unstopping diarrhea depletes Qi daily, preventing exterior resolution. Once diarrhea stops, even if exterior pathogens remain, harmonize within tonics. After severe diarrhea, plague pathogens cannot linger. Although exterior signs exist with diarrhea, do not induce sweating to avoid fluid loss and gastric deficiency leading to distension. Treat diarrhea first; when stopped and interior solidified, Zheng Qi recovers, pathogens resolve via mild sweating. Diarrhea indicates internal deficiency; sweating causes both internal and external deficiency, leading to complications. Zhang Zhongjing's *Treatise on Cold Damage* states San Yang combined disease can cause self-diarrhea, distinguishable by exterior-releasing, harmonizing, or interior-purging methods. Plague theory rejects exterior-releasing; interior-purging uses cooling medicines to remove heat. Now discuss heat-type diarrhea. Heat diarrhea presents with accompanying symptoms: bitter taste, dry throat, cracked lips, dry tongue, delirium, irritability, thirst, red urine, red eyes, tidal fever. Treat with cold-cooling or purgative methods, applying "treat obstruction with unblocking" (Tong Yin Tong Yong). Ultimately, diarrhea falls into cold or heat categories, clearly distinguished by accompanying signs. Cold-type: no dry mouth/thirst, aversion to drinking/cold, clear urine, cold below umbilicus, hot body but cold extremities, white or pale yellow stool, undigested food, watery/clear/cold/fishy-smelling stool, pulse not surging-hard but weak. Symptoms like curling up, facing wall, covering with clothes, whispering, avoiding light, pale face belong to winter cold directly invading Yin meridians, absent in plague cold-diarrhea. Heat-type: fever, irritability, desire to drink, dry mouth/thirst, yellow-red urine (also seen in cold but accompanied by difficulty/dysuria, absent in cold), heat below umbilicus, noisy defecation, foul/greasy stool in colors green/yellow/red/brown/black, tenesmus, relief with cooling meds, worsening with heating meds. Pulse is surging-rapid-floating-slippery-string-tense-strong. Distinguishing cold/heat by these signs is infallible. Treatments differ; physicians must examine carefully.