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The etiology of diarrhea includes cold diarrhea and heat diarrhea. There are also food-stagnation diarrhea, watery diarrhea, accumulation diarrhea, fright-induced diarrhea, wind-induced diarrhea, visceral-cold diarrhea, and malnutrition-accumulation brewing diarrhea. These conditions vary greatly and are described separately below.

Cold diarrhea typically presents with white watery stools, frequent but scanty bowel movements, abdominal pain accompanied by borborygmus, furrowed eyebrows, sluggish gaze, a pale complexion, and excessive sweating on the forehead. This is termed cold diarrhea. It can be treated with Chonghe Yin (Harmonizing Decoction). Danggui San (Angelica Powder) should be taken combined with He Shui (Harmonizing Water) and roasted ginger decocted together; alternatively, it can be treated with Shouzhong Tang (Decoction to Guard the Center), Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Yizhong Gao (Paste to Benefit the Center), or Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill).

Heat diarrhea presents with dark yellow stools flowing straight down like water from a tube, stopping immediately after defecation, only to recur half a day later. It is accompanied by mental restlessness, thirst, and scanty yellow urine. The infant feeds eagerly and roughly. This is termed heat diarrhea. Initially, Wuling San (Five-Ingredient Poria Powder) or Dashun Yin (Great Smoothness Decoction) should be used, followed primarily by Qian Shi Baizhu San (Dr. Qian’s Atractylodes Powder); Xiangru San (Elsholtzia Powder) is also excellent.

Food-stagnation diarrhea occurs due to pre-existing weakness of the spleen and stomach, compounded by injury from raw, cold fruits and foods, resulting in unformed stools and diarrhea. Alternatively, if the nursing mother consumes raw, cold, fatty, or greasy foods, these qualities may transmit through breast milk, causing diarrhea in the infant. The child exhibits a pale face and lips, thin and scanty stools, sometimes resembling spoiled eggs with an exceptionally fishy and foul odor, along with a sallow, emaciated body. This is named food-stagnation diarrhea. Treatment should first warm and regulate stomach qi, then resolve stagnation, and finally secure the spleen. Chonghe Yin and Danggui San, decocted with He Shui, roasted ginger, and dates, are indicated. To resolve stagnation, older children may use Wuxi Wan (Rhino Horn Pill), while younger children may use Huapi Wan (Stasis-Resolving Pill), Sanleng San (Curcuma Powder), Gu Pi He Zhong San (Spleen-Securing and Middle-Harmonizing Powder), or Xing Pi San (Spleen-Awakening Powder).

Watery diarrhea is called Dongxie (Cavity Leakage Diarrhea). It results from disharmony of yin and yang and the failure to differentiate water and grain, presenting with yellow watery stools and scanty urination. Bowel movements are frequent and uncontrolled. This often occurs in summer and autumn when one exposes the body to cool air during the day and loses cover at night, allowing cold to invade. The clash of cold and heat confuses the clear and turbid qi. Alternatively, if the mother comes from a hot environment and breastfeeds immediately while her milk carries excess heat, it disrupts the infant’s spleen and stomach harmony, causing water and grain to mix and descend. Crushed Wuling San (Five-Ingredient Poria Powder) added with Yiyiren (Coix Seed), Cheqianzi (Plantago Seed), and Banxia (Pinellia Tuber), decocted with water and ginger, is prescribed to balance yin and yang. Alternatively, Dashun Yin (Great Smoothness Decoction) may be taken first with warm water. Xiangru San (Elsholtzia Powder) regulates the middle jiao and tonifies; Qian Shi Baizhu San (Dr. Qian’s Atractylodes Powder) and Liuhe Tang (Six-Harmonies Decoction) are also suitable.

Accumulation diarrhea arises from spleen qi deficiency, where ingested milk and food fail to transform and transport. Stagnation persists for a long time, and subsequent injury from cold foods transmits to the large intestine, resulting in persistent diarrhea that resists various treatments. Since the accumulation resides in the spleen and stomach, how can recovery occur without removing it? One must first eliminate the accumulation, then stop the diarrhea, and finally strengthen the spleen once the diarrhea ceases, leading to cure. Sanleng San (Curcuma Powder) and Wuxi Wan (Rhino Horn Pill) are used initially, followed by Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill), Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Hezhong San (Middle-Harmonizing Powder), and Xiangju Bing (Fragrant Tangerine Peel Cake) for regulation.

Fright-induced diarrhea presents with green, moss-like, thick, and sticky stools. Forced cessation of diarrhea is contraindicated; instead, the treatment involves calming the heart and suppressing liver wind, harmonizing the spleen and stomach, and digesting milk and food. Initially, Wuling San (Five-Ingredient Poria Powder) is administered, followed by Sanleng San (Curcuma Powder) decocted with water, ginger, and Jingmi (Japonica Rice). Alternatively, Sanjie San (Three-Resolving Powder) mixed with roasted Shenqu (Medicated Leaven) and ginger decoction, or Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill) and Bu Jing Dan (Non-Frightening Elixir) may be used.

Wind-induced diarrhea often follows severe cases of slow convulsions. The stool is thin and yellow-brown, possibly containing undigested milk and food, caused by spleen deficiency. If brownish-black particles are present, it relates to the kidney, as spleen deficiency allows kidney water to overact. If the child refuses food for a long time and experiences convulsions again, one should drain kidney water, dispel spleen wind, and then tonify the spleen for natural recovery, preventing recurrence. To drain kidney water, crushed Wuling San (Five-Ingredient Poria Powder) added with Hei Qianniu (Black Morning Glory Seed, half raw and half stir-fried) and Yiyiren (Coix Seed), decocted with water and ginger, is used. To dispel spleen wind, Xiehuang San (Draining Yellow Powder) is prescribed. To regulate spleen qi, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is used.

Visceral-cold diarrhea presents with stools colored like green bamboo, thin and non-viscous, or discharging green water. Abdominal pain and borborygmus occur before defecation, followed by crying and then diarrhea. This condition typically appears within three to five months after birth and resolves by one year of age. It originates from a short umbilical cord stump, allowing wind and cold to invade from the exterior. Initially, Chonghe Yin (Harmonizing Decoction) is decocted with Shuicongbai (Water Scallion White) to warm the interior and release the exterior. Subsequently, Danggui San (Angelica Powder) decocted with water and roasted ginger, along with Yunqi San (Qi-Balancing Powder) and Lizhong Tang (Regulate the Middle Decoction), are administered.

Malnutrition-accumulation brewing diarrhea presents with a sallow complexion, distended abdomen, weak legs, a large head with a thin neck, sparse and erect hair, muscle emaciation, anorexia, daytime chilliness with nighttime fever, and possible abdominal masses. Stools vary in color and have an abnormal odor, occurring periodically (e.g., every ten days to a month), starting and stopping spontaneously. This is named malnutrition-accumulation brewing diarrhea. Initially, Danggui San (Angelica Powder) added with Sanleng (Curcuma) and Chenpi (Tangerine Peel), decocted with water and ginger, is given. Subsequently, Wuxi Wan (Rhino Horn Pill), Chenxiang Binglang Wan (Aquilaria and Areca Nut Pill), Huapi Wan (Stasis-Resolving Pill), Lushui Wan (Aloe Pill), and Moshizi Wan (Myrobalan Pill) are administered. For very young infants unable to swallow pills, only Sanleng San (Curcuma Powder) and Kuai Ge Tang (Rapid Epigastric Decoction) are used, leading to natural recovery.

If diarrhea or dysentery presents with colors ranging from deep green to pale yellow with white, indicating more cold than heat (yin pathogen overcoming yang), Shouzhong Tang (Decoction to Guard the Center) and Weiling Tang (Stomach and Poria Decoction) should be taken to support the exterior and rescue the interior. Then, Danggui San (Angelica Powder) added with Chenpi (Tangerine Peel) and Zisu (Perilla Leaf), decocted with water, ginger, and Nuomi (Glutinous Rice), is administered. Harmonization is also appropriate; Lizhong Tang (Regulate the Middle Decoction) and Qing Mi Yin (Clear Rice Drink) taken on an empty stomach warm the spleen, remove dampness, boost qi, and clarify the spirit. In cases of severe cold, Shu Fuzi (Prepared Aconite Root) is added to Lizhong Tang (Regulate the Middle Decoction), decocted with water, ginger, and dates. Subsequently, Nanxing Fupi Yin (Arisaema and Tangerine Peel Drink) decocted with water and ginger harmonizes the spleen and stomach and removes yin pathogens. If diarrhea is pale green with foam and thick consistency, indicating more heat than cold, leading to sallow complexion, emaciation, and irritability, crushed Wuling San (Five-Ingredient Poria Powder) added with Yiyiren (Coix Seed) and Cheqianzi (Plantago Seed), decocted with water and ginger, is used to dissipate residual pathogens. Still, Yinchenhao (Artemisia Capillaris Herb) and Zhiziren (Gardenia Seed) decoction is used to mix with fine powder of Wuling San (Five-Ingredient Poria Powder) for warm administration to reduce yellowness and clear yang toxicity. Additionally, Danggui San (Angelica Powder) decocted with water, ginger, and dates, or Wan’an Yin (Ten-Thousand Peace Drink) and Sishen San (Four-Essence Powder) may be taken.