Library

Hezi stated: For persistent sun-xie (diarrhea with undigested food), where the stool contains uncooked grains, diaphoresis (sweating method) may be employed. The principal formulas are Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction). This syndrome is rooted in Wind pathogen, as Wind exits with sweat.

Commentary: *Zheng Ji Yao* (Essentials of Syndrome Differentiation) posits that the mechanism of sun-xie involves the downward flow of Stomach Qi and the manifestation of Autumn's restrictive energy during Spring. *Liang Fang* (Excellent Prescriptions) attributes it to the exuberance of Wood Qi in Spring, which transfers its influence to attack Spleen Earth. Although these two theories differ, they essentially both attribute the condition to the transmission of Wind-Wood transforming into a pathogen that injures Spleen Earth. Hezi’s view that Wind resolves through sweating is indeed correct; however, treatment must also follow the transmission of the pathogen, and one cannot rigidly adhere to this single method.

Yan Shi in *San Yin Ji Yi Bing Zheng Fang Lun* (Prescriptions for Diseases Caused by the Three Categories) stated: The syndrome of Xie-Xie (diarrhea/loose stools), referred to in the Classics as Dong-Xie (cavity diarrhea), Sun-Xie, Tang-Xie (pasty diarrhea), Yi-Xie, Ru-Xie (damp diarrhea), and Mi-Gu Zhu-Xia (grainy diarrhea), constitutes this category. The causes involve external, internal, and neither-internal-nor-external factors, with variations.

The Classics state: Injury by Wind in Spring leads to Sun-Xie in Summer. It also states: Excess Dampness leads to Ru-Xie; severe Cold leads to Xie; excessive Summer-Heat also leads to Xie. Furthermore, agitation of the Seven Emotions (Joy, Anger, Worry, Thought, Sadness, Fear, Fright) causing disharmony of Zang-Qi can also result in Tang-Xie. Regarding diarrhea caused by irregular diet and excessive consumption of raw/cold foods, this is an injury to the Spleen and Stomach. However, for stagnation-type diarrhea, one must wait until the stagnation is eliminated before using purgative methods. Nowadays, people often immediately use astringent antidiarrheals, frequently resulting in Li-Ji (dysentery). The treatment method should first regulate the Middle Jiao, then separate fluids and grains. If regulating the Middle Jiao is ineffective, then employ methods to stop diarrhea.

Commentary: The classification according to the Three Categories is very detailed here. However, among the six external pathogens, prescriptions are provided for only two. For internal injuries caused by the Seven Emotions, treatment methods are not detailed.

Hezi stated: A monk suffered from disharmony of the Zang-Fu organs for three years without effect; this was Dong-Xie. It arose because his inability to resolve matters injured the Liver (which governs planning and deliberation); severely, it involved the Spleen, causing Spleen-Dampness to stagnate. Consequently, phlegm surged upward, amounting to half a basin. He was then purged several times using Zhouche Wan (Boat Vehicle Pill) and Xunchuan San (River Channel Powder). He was still made to bathe and sweat. From then on, he improved daily, maintaining health with Weifeng Tang (Stomach Wind Decoction) and Baizhu San (Atractylodes Macrocephala Powder).

Commentary: Hezi generally employs these three methods (emesis, purgation, diaphoresis) extensively in treatment. For Dong-Xie, even if there is severe stagnation and accumulation with robust Yuan-Qi (Original Qi), these three methods should not be used abruptly, let alone in cases where Yuan-Qi is particularly deficient despite severe stagnation. If these three methods are indeed indicated, one must observe the syndrome to differentiate, just as Zhang Zhongjing did, distinguishing when emesis, diaphoresis, or purgation are applicable or contraindicated. Moreover, Zhang Zhongjing’s treatment of Li-Ji includes methods combining purgation and warming. Is this not rash?

Danxi discussed the errors of using hot and astringent medicines from *Ju Fang* (Formulas of the Bureau) to treat Li-Ji.

Commentary: See the section on "Zhi-Xia" (Dysentery).

Careful examination: Ancient formulas generally attributed Xie-Xie to deficiency-cold of the Intestines and Stomach, and invasion by Wind-Cold, thus mostly employing astringent and warming agents. But do those with Xie-Li (diarrhea and dysentery) lack stagnation? Do they lack Heat syndromes? Now, observing the discussions in *Bing Ji Yao Yao*, there are syndromes attributed to Cold, Wind-Damp, and Fire, which are injuries from external pathogens. It also states that movement of the Jueyin Meridian combined with downward descent of Stomach Qi causes Xie-Li. *San Yin Fang* mentions that agitation of the Seven Emotions causing disharmony of Zang-Qi also leads to Tang-Xie; these are injuries from internal causes. External injuries require harmonizing the Six Qi; internal injuries require balancing the Five Zang. Furthermore, there are cases caused by dietary injury and intestinal-stomach stagnation, each requiring different treatment methods. Additionally, for diarrhea caused by the downward flow of Stomach Qi, the method is to raise and lift [the Qi]; for Sun-Xie caused by Wind, the method is to disperse [the Wind]; for diarrhea due to Phlegm accumulation in the Upper Jiao causing insecurity of the Large Intestine, one should remove the Phlegm from the Upper Jiao rather than directly treating the diarrhea; for diarrhea due to Spleen-Stomach Qi deficiency, one should tonify the Middle and augment Qi, allowing Stomach Qi to ascend, so that diarrhea stops naturally. Essentially, treating by addressing the root cause is sufficient.