按∶五更泄泻，多属肾虚，然亦有酒积、寒积、食积、肝火之不同。病机既多，变化用
药，尤贵圆通，兹复明列五条，以备临症之用云。
【肾虚泻之症】每至五更，即连次而泻，或当脐作痛，痛连腰背，腹冷膝冷，此肾虚泄
【肾虚泻之因】真阳不足，肾经虚寒，火不能生土，肾主闭藏，肾虚则封闭之令不行，
肾主五更，至此时则发泻也。
【肾虚泻之脉】或两尺浮大，虚阳外浮。按之细小，肾气不足。右关弦大，脾气不足。
【肾虚泻之治】尺脉细小，火不生土者，肾气丸。尺中皆软，脾肾俱虚者，五味子丸。
八味肾气丸
生地 丹皮 泽泻 山药 萸肉 白茯苓 肉桂 附子
五味子丸
人参 白术 山药 五味子 补骨脂 肉果 益智仁
【酒积泻之症】每至五更，腹中作痛，痛而后利，利下黄沫，小便赤色，或如米泔，此
【酒积泻之因】其人浩饮失度，或饮冷酒，伤其肠胃，湿热之气，蒸酿于中，积温成热
【酒积泻之脉】多见洪数。或见弦数。酒积若甚，脉见促结。右脉洪数，酒热伤胃，左
【酒积泻之治】平胃四苓散，加干葛、黄柏。腹痛，家秘川连枳壳汤。
平胃四苓散
苍术 浓朴 陈皮 甘草 白术 白茯苓 泽泻 猪苓 干葛 黄柏
胸次不宽，加砂仁、白豆蔻。
家秘川连枳壳汤 治湿热泻利。
黄连 枳壳 木通 浓朴 甘草
口干加干葛。腹痛应下者，加大黄、玄明粉。
Note: Wugeng diarrhea (diarrhea occurring at the fifth watch, approx. 1-3 AM) mostly belongs to Kidney deficiency; however, there are also differences caused by alcohol accumulation, cold accumulation, food stagnation, and Liver fire. Since the pathogenesis is diverse, the variation in medication requires particular flexibility and adaptability. Here, five categories are explicitly listed for reference in clinical practice.
[Symptoms of Kidney Deficiency Diarrhea] Every time it reaches the fifth watch, one experiences multiple episodes of diarrhea consecutively. There may be pain around the umbilicus, radiating to the lower back, accompanied by a cold sensation in the abdomen and knees. This constitutes diarrhea due to Kidney deficiency.
[Etiology of Kidney Deficiency Diarrhea] Insufficiency of True Yang and deficiency-cold of the Kidney meridian result in "Fire failing to generate Earth" (Kidney Fire failing to warm Spleen Earth). The Kidney governs closure and storage; when deficient, its closing function fails. The Kidney corresponds to the fifth watch; thus, diarrhea occurs at this time.
[Pulse of Kidney Deficiency Diarrhea] The two Chi pulses may appear floating and large, indicating floating of deficient Yang. Upon deep pressure, they feel fine and small, indicating insufficiency of Kidney Qi. The Right Guan pulse may appear wiry and large, indicating insufficiency of Spleen Qi.
[Treatment of Kidney Deficiency Diarrhea] If the Chi pulse is fine and small, indicating "Fire failing to generate Earth," use Shenqi Wan (Kidney Qi Pill). If both sides of the Chi pulse are soft, indicating simultaneous deficiency of Spleen and Kidney, use Wuweizi Wan (Schisandra Pill).
Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill)
Shu Di Huang (Prepared Rehmannia Root), Mu Dan Pi (Moutan Cortex), Ze Xie (Alisma Rhizome), Shan Yao (Dioscorea Rhizome), Yu Rou (Cornus Fruit), Bai Fu Ling (Poria with Hostwood), Rou Gui (Cinnamon Bark), Fu Zi (Aconite Lateral Root).
Wuweizi Wan (Schisandra Pill)
Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Shan Yao (Dioscorea Rhizome), Wu Wei Zi (Schisandra Fruit), Bu Gu Zhi (Psoralea Fruit), Rou Dou Kou (Nutmeg), Yi Zhi Ren (Alpinia Oxyphylla Fruit).
[Symptoms of Alcohol Accumulation Diarrhea] Every time it reaches the fifth watch, abdominal pain occurs, followed by loose stools. The discharge consists of yellow froth. Urine is red or turbid like rice wash water. This [constitutes diarrhea due to alcohol accumulation].
[Etiology of Alcohol Accumulation Diarrhea] The individual drinks excessively without restraint, or consumes cold wine, damaging the intestines and stomach. Damp-heat steeps and brews within, accumulating warmth to become heat... [text truncated].
[Pulse of Alcohol Accumulation Diarrhea] Typically presents as a Hong-Shu pulse (Surging-Rapid). Alternatively, a Xuan-Shu pulse (Wiry-Rapid) may be seen. If alcohol accumulation is severe, the pulse may show Cu-Jie characteristics (Hasty-Irregular). A Right pulse that is Hong-Shu indicates alcohol-heat damaging the Stomach; the Left... [text truncated].
[Treatment of Alcohol Accumulation Diarrhea] Use Pingwei Siling San (Pingwei Four-Substance Powder) added with Ge Gen (Kudzu Root) and Huang Bo (Phellodendron Bark). For abdominal pain, use Jiami Chuanlian Zhike Tang (Secret Formula Coptis and Aurantium Decoction).
Pingwei Siling San
Cang Zhu (Atractylodes Lancea Rhizome), Hou Po (Magnolia Bark), Chen Pi (Citrus Reticulata Peel), Gan Cao (Licorice Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Fu Ling (Poria with Hostwood), Ze Xie (Alisma Rhizome), Zhu Ling (Polyporus), Ge Gen (Kudzu Root), Huang Bo (Phellodendron Bark).
If the chest feels constrained, add Sha Ren (Amomum Fruit) and Bai Dou Kou (Cardamom Seed).
Jiami Chuanlian Zhike Tang (Secret Formula Coptis and Aurantium Decoction) treats damp-heat diarrhea and dysentery.
Huang Lian (Coptis Rhizome), Zhi Ke (Aurantium Fructus Immaturus), Mu Tong (Akebia Caulis), Hou Po (Magnolia Bark), Gan Cao (Licorice Root).
For dry mouth, add Ge Gen (Kudzu Root). For abdominal pain requiring purgation, add Da Huang (Rhubarb Root) and Xuan Ming Fen (Mirabilite).