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Use acrid (pungent) substances to moisten; the acridity of Danggui Tang (Angelica Decoction), Guizhi (Cinnamon Twig), and Ganjiang (Dried Ginger) disperses cold. For heat in the upper jiao, use bitter substances to drain it; the bitterness of Zhimu (Anemarrhena Rhizome) and Huangqin (Scutellaria Root) cools the heart and removes heat. For deficiency of body fluids, use sweet substances to moisten; the sweetness of Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) moderates the spleen and generates fluids. For dryness and heat in the lungs, use sour substances to astringe and sweet substances to relax; the sourness of Shaoyao (Peony Root) astringes rebellious qi, while the sweetness of Weirui (Polygonatum Rhizome), Mendong (Ophiopogon Tuber), Shigao (Gypsum Fibrosum), and Gancao (Licorice Root) moistens the lungs and removes heat.

The above fourteen ingredients are boiled in one dou of water. First, boil Mahuang (Ephedra Herba) for two or three boils, remove the foam on the surface, then add the remaining herbs. Boil until three sheng of liquid remain, strain, and divide into three warm doses. Administer the doses at intervals equivalent to the time required to cook three dou of rice, ensuring the full amount is consumed. Recovery occurs with sweating.

In shaoyang disease after four or five days, abdominal pain accompanied by a sensation of gas moving downward toward the lower abdomen indicates impending spontaneous diarrhea.

Four or five days into shaoyang disease is the time when pathogenic factors transmit inward. Abdominal pain and gas moving downward toward the lower abdomen occur due to interior deficiency encountering cold, causing cold qi to descend, leading to spontaneous diarrhea.

If the patient originally had cold-type diarrhea, and the physician incorrectly employs vomiting or purgation methods, cold obstruction occurs, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.

Shaoyang pathogens typically transmit from the exterior, but if the patient originally suffered from cold-type diarrhea, and the physician incorrectly uses vomiting and purgation, righteous qi is damaged, and cold qi creates internal obstruction. The Classics state: "Obstruction leads to vomiting and reversal." Vomiting food immediately upon ingestion is termed "cold obstruction." Further use of vomiting or purgation would doubly weaken the righteous qi, leading to death. Therefore, Ganjiang Huanglian Huangqin Renshen Tang is administered to resolve the cold obstruction.

Formula of Ganjiang Huanglian Huangqin Renshen Tang:
Ganjiang (Acrid-Hot), Huanglian (Bitter-Cold), Huangqin (Bitter-Cold), Renshen (Each 3 liang, Sweet-Warm).
Acrid substances disperse, sweet substances moderate. The acrid-sweet nature of Ganjiang and Renshen tonifies righteous qi; the bitter nature of Huanglian and Huangqin drains and resolves cold obstruction.

The above four ingredients are boiled in six sheng of water until two sheng remain. Strain and divide into two warm doses.

In diarrhea, slight fever and thirst with a weak pulse indicate spontaneous recovery.

Diarrhea is a yin-cold disease; sudden high fever is an adverse sign. Slight fever and thirst indicate that interior warmth is returning. The Classics state: "Weak pulse with fever." A weak pulse indicates the restoration of yang qi, so spontaneous recovery is expected.

In diarrhea, if the pulse is rapid, accompanied by slight fever and sweating, spontaneous recovery is expected. If the pulse becomes tight again, the disease is not resolved. (Zhao edition note: "Alternatively: if the pulse is floating and tight.")

Diarrhea is a yin disease. A rapid pulse is a yang pulse. In yin diseases, the appearance of a yang pulse indicates life. Slight fever and sweating indicate the unblocking of yang qi, so diarrhea will spontaneously cease. Tight pulses generally indicate cold; if the pulse becomes tight again, yin qi still prevails, hence the disease is not resolved.

In diarrhea, if the hands and feet are cold and the pulse is absent, moxibustion fails to warm them, and if the pulse does not return, accompanied by slight panting, it is a fatal condition.

In diarrhea, cold hands and feet with an absent pulse indicate excessive yin qi and severe deficiency of yang qi. After moxibustion, if yang qi restores, hands and feet become warm, and the pulse returns, recovery is imminent. If hands and feet remain cold and the pulse does not return, yang qi is exhausted. Slight panting indicates the collapse of yang qi.

If the Shaoyin pulse is weaker than the Zuyang pulse, it is a favorable sign.

Shaoyin corresponds to Kidney Water; Zuyang corresponds to Spleen Earth. Diarrhea involves kidney pathogenic factors affecting the spleen. If water cannot overcome earth, it is considered a minor pathogen, thus a favorable sign.

In diarrhea, if the cun pulse is unexpectedly floating and rapid, while the chi pulse is choppy, pus and blood will inevitably appear in the stool.

In diarrhea, the pulse should be deep and slow. An unexpected floating and rapid pulse indicates interior heat. A choppy pulse indicates blood deficiency. A choppy chi pulse indicates scattered blood in the intestines and stomach, which will pass with the diarrhea as pus and blood.

"Qing" (clear) is interchangeable with "Qing" (to defecate). The Mai Jing states: "Qing refers to the toilet."

In diarrhea with undigested food, exterior-attacking methods (sweating) are contraindicated. Sweating will inevitably lead to abdominal distension.

Diarrhea indicates spleen-stomach deficiency. The Stomach is the master of body fluids. Sweating depletes fluids, further weakening stomach qi, inevitably causing abdominal distension.

In diarrhea, a deep-chord pulse indicates tenesmus (heavy sensation in the rectum); a large pulse indicates the disease has not ceased; a weak-rapid pulse indicates the disease is about to stop spontaneously. Even with fever, death will not occur.

Deep pulse indicates interior location; chord pulse indicates tension. Interior qi deficiency causes tenesmus. A large pulse indicates disease progression, meaning diarrhea has not stopped. A weak-rapid pulse indicates minimal pathogenic qi and restored yang qi, suggesting spontaneous cessation. Fever here results from yang excess, not a major adverse condition.

In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, there is slight body heat, and undigested food passes in stool, the patient will likely experience vertigo and dizziness (Yu Mao). Recovery occurs with sweating. The patient will likely have mild cold extremities. This occurs because the face shows "floating yang" due to lower deficiency.

Undigested food in diarrhea with a deep-slow pulse indicates interior cold. Slight facial redness and body heat indicate unresolved exterior pathogens. Mild cold extremities, as stated in the Zhen Jing: "Lower deficiency leads to cold limbs." As exterior pathogens resolve, just before sweating, the pre-existing interior deficiency causes vertigo, followed by sweating and resolution.

In diarrhea, if the pulse is rapid and there is thirst, spontaneous recovery is expected. If it does not improve, pus and blood will appear due to heat.

The Classics state: "If rapid pulse persists and diarrhea continues, heat-collateral diarrhea with pus and blood will occur."

After diarrhea, if the pulse is absent and hands/feet are cold, but the pulse returns and hands/feet become warm after a cycle (12 hours), life is preserved. If the pulse does not return, death ensues.

After diarrhea, absent pulse and cold extremities indicate lack of yang. "Cycle" refers to twelve hours. If extremities warm and pulse appears after a cycle, yang qi has restored, indicating survival. If extremities remain cold and pulse does not return, yang qi is exhausted, indicating death.

In shaoyang diarrhea occurring more than ten times a day, if the pulse is unexpectedly strong/excess, it is a fatal condition.

Diarrhea indicates interior deficiency. The pulse should be weak; an unexpectedly strong pulse indicates the disease overcomes the viscera, hence death. The Nan Jing states: "When the pulse does not match the disease, and the disease does not match the pulse, it is a fatal illness."

In diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) is indicated. (Zhao edition contains the formula details in Volume 6).

Undigested food in diarrhea indicates interior cold; persistent body heat indicates exterior heat. Sweating usually indicates yang qi circulating outward, preventing cold limbs. However, sweating with cold limbs indicates severe yang deficiency. Tongmai Sini Tang is given to secure yang qi.

In hot diarrhea with tenesmus, Baitouweng Tang (Pulsatilla Decoction) is indicated.

Diarrhea depletes fluids; heat damages qi. Qi deficiency sinking downward causes tenesmus. Baitouweng Tang clears heat and firms the intestines.

Formula of Baitouweng Tang:
Baitouweng (2 liang, Bitter-Cold), Huangbai (Bitter-Cold), Huanglian (Bitter-Cold), Qinpi (Each 3 liang, Bitter-Cold).

The Nei Jing states: "The Kidney desires firmness; urgently consume bitter substances to firm it." Diarrhea causes lower jiao deficiency, so purely bitter agents are used to firm it.

The above four ingredients are boiled in seven sheng of water until two sheng remain. Strain, take one sheng warm. If ineffective, take another sheng.

In diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior. Warm the interior with Sini Tang (Four Reversal Decoction); attack the exterior with Guizhi Tang (Cinnamon Twig Decoction). (Zhao edition notes Sini Tang uses the fifth formula from earlier, and Guizhi Tang details are in Volume 2).

Abdominal fullness in diarrhea indicates interior deficiency-cold; treat first with Sini Tang to warm the interior. Body pain indicates unresolved exterior pathogens. Once diarrhea stops and interior harmony is achieved, use Guizhi Tang to attack the exterior.

In diarrhea, if the patient desires to drink water, it is due to heat; Baitouweng Tang is indicated.

Spontaneous diarrhea without thirst indicates cold in the zang organs; treat with Sini Tang to warm the viscera. Diarrhea with desire to drink water indicates heat; treat with Baitouweng Tang to cool the middle.

In diarrhea, if delirium occurs, it indicates dry feces; Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate. (Zhao edition contains the formula details in Volume 5).

The Classics state: "Excess conditions cause delirium." Dry feces indicate stomach excess; diarrhea indicates intestinal deficiency. Xiao Chengqi Tang is given to purge the dry feces.

After diarrhea, if irritability increases and the epigastrium is soft upon palpation, it is empty irritability (Xu Fan); Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. (Zhao edition contains the formula details in Volume 3).

Absence of irritability after diarrhea suggests resolution. Increased irritability with a hard epigastrium suggests food stagnation. Here, irritability with a soft epigastrium indicates pathogenic heat invading the chest due to deficiency, constituting empty irritability. Zhizi Chi Tang is given; inducing vomiting leads to cure.

In patients with vomiting due to abscess pus, do not treat the vomiting directly. When the pus is exhausted, vomiting will cease spontaneously.

An abscess in the stomach region causes vomiting of pus. Do not treat the vomiting; once the pus is expelled, vomiting ceases.

In vomiting with a weak pulse, free urination, slight body heat, and cold extremities, the prognosis is difficult. Sini Tang is indicated.

Vomiting with a weak pulse indicates pathogenic transmission to the interior. Vomiting involves rebellious qi, so urination should be difficult. Free urination indicates interior deficiency. Slight heat with cold extremities indicates yin prevailing over yang, making it difficult to treat. Sini Tang warms the interior and assists yang.

In dry heaving, spitting saliva, and headache, Wuzhuyu Tang (Evodia Decoction) is indicated. (Zhao edition contains the formula details in Volume 5).

Dry heaving and spitting saliva indicate interior cold; headache indicates cold qi attacking upward. Wuzhuyu Tang warms the interior and disperses cold.

In vomiting with fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. (Zhao edition contains the formula details in Volume 3).

The Classics state: "Vomiting with fever indicates the Chai Hu syndrome is complete."

In shaoyang disease, after severe vomiting and purgation, the patient is extremely deficient. If extreme sweating occurs, and due to external qi stagnation (Fu Yu), the physician gives water to induce sweating, hiccups result. This occurs because of cold in the stomach.

Severe vomiting and purgation severely damage stomach qi. Extreme sweating further depletes yang qi. External pathogens stagnate at the exterior, causing fever. Giving water to induce sweating in a deficient stomach leads to a struggle between deficiency and cold, resulting in hiccups.

In shaoyang disease, if hiccups are accompanied by abdominal fullness, examine the anterior (urinary) and posterior (anal) orifices to determine which is obstructed. Relieving the obstruction cures the condition.

Hiccups with abdominal fullness indicate rebellious qi ascending without descending. Examine the anterior and posterior orifices; relieve any obstruction to descend the qi. The anterior orifice refers to urine; the posterior orifice refers to stool.