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When the Spleen Qi is deficient for a long time and cannot tolerate food intake, one experiences borborygmus (intestinal rumbling) and abdominal urgency immediately after eating. Only after evacuating all ingested food does one feel relief; without eating, there are no issues. Persisting year after year, this is the syndrome of Food Stagnation Diarrhea (Ji Shi Xie). It should be primarily treated with Kuai Pi Wan (Spleen-Quickening Pill), and Wu Wei Wan (Five-Flavor Pill) can also be used. In this syndrome, herbal decoctions are expelled via diarrhea immediately upon swallowing, resembling the symptoms of Rectal Disease (Zhi Chang Zheng). However, Rectal Disease is an acute and sudden condition, whereas Food Stagnation Diarrhea is a chronic and gradual condition. Therefore, in the section on Rectal Disease, it is stated as difficult to treat; for Food Stagnation Diarrhea, prescriptions are still established for treatment, yet these are all conditions that deviate from normal physiology.

Commentary: Immediate diarrhea after food ingestion varies by Cold, Heat, Deficiency, and Excess. If Spleen and Stomach accumulate Heat, the fiery nature is rapid, causing immediate diarrhea after eating. He Jian (Liu Wansu) stated: "Immediate diarrhea after eating occurs because the intestines and stomach are filled, leaving no room for food." This can be treated with Zhi Lian Ping Wei San (Gardenia and Coptis Powder to Regulate the Stomach). Immediate diarrhea after alcohol consumption occurs because the intestines and stomach are already hot, compounded by the heat of alcohol, leading to rapid downward discharge through orifices. This can be treated with Chuan Lian Zhi Ke Tang (Coptis and Aurantium Decoction), adding Tong Cao (Akebia Caulis) and Ge Gen (Puerariae Radix); this is Diarrhea due to Damp-Heat.

Kuai Pi Wan and Wu Wei Wan are used to treat this. While everyone knows that Spleen-Stomach Deficiency-Cold causes diarrhea, few know that Spleen-Stomach Excess-Heat also causes diarrhea. Generally, when writing medical texts, not everything can be exhaustively listed. Since there is a section on Deficiency-Cold, there must be one on Excess-Heat. By recording Excess-Heat Diarrhea due to Accumulated Heat and Food Stagnation alongside Deficiency Diarrhea due to Spleen Deficiency and Cold, both Excess and Deficiency are presented together, allowing students to infer other cases by analogy.

*Zhun Sheng* states: When using astringents to treat sliding/loose evacuation, one must distinguish between Heat Sliding and Cold Sliding. Cold Sliding can be treated with astringency, but Heat Sliding is not suitable for astringency at this stage. If diarrhea has healed but recurs in the same month and day of the following year, it indicates a root of accumulation within. This should be viewed similarly to Resting Dysentery (Xiu Xi Li), but treated according to whether it is Heat Accumulation or Cold Accumulation. Heat Accumulation is purged with cold agents; Cold Accumulation is purged with warm agents. If True Yuan (True Qi/Essence) is insufficient, assist with herbs that tonify Yuan. If Spleen Deficiency fails to transport, use Da An Wan (Great Peace Pill) to assist the Spleen. Zhao Yi De stated: For diarrhea leading to Cold collapse and extreme deficiency, appearing nearly fatal, urgently moxa Qihai (CV6), and drink Ren Shen Gao (Ginseng Paste) to achieve recovery. For Kidney Deficiency failing to control closure, use Shen Qi Wan (Kidney Qi Pill) to strongly tonify the Kidney. If Phlegm Accumulation is in the Lung, causing Lung Qi to descend and the Large Intestine to lose restraint, clear Phlegm from the Upper Jiao; once Lung Qi is clear, Large Intestine diarrhea will heal spontaneously. For diarrhea caused by overthinking injuring the Spleen, where Spleen Qi is stagnant, fails to ascend, and sinks into the Lower Jiao, resolve the stagnation and ascend Clear Yang Qi. Dong Yuan (Li Dongyuan) stated: Any diarrhea where water and grain are undigested is called Sun Xie (Morning Twilight Diarrhea/Diarrhea with Undigested Food). This is due to the failure of Clear Qi to ascend. Ancients used ascending and floating herbs to raise Stomach Qi. When Spleen and Stomach are clear and harmonious, food and fluid digest, and Dampness transforms naturally. This differs from treating Dampness by promoting urination, i.e., draining downward pathogens. Thus, it is said that when Stomach Dampness prevails causing diarrhea, one should assist the Gallbladder (Shaoyang) and use Wind to overcome Dampness. People only know that Spleen disease dislikes Dampness and that promoting urination stops diarrhea; they do not know that for chronic diarrhea transmitting to deficiency, where Spleen-Stomach Clear Qi has sunk, the method of ascending Clear Yang Qi is the subtle art of encouraging Spleen and Stomach function. *Nei Jing* states: Regarding difficulty in urination, regardless of root or branch, first promote urination. It also states: For various dysenteric/diarrheal conditions, if urination is difficult, first separate and drain fluids. And again: Treating Dampness without promoting urination is not the correct treatment. This is the method of "draining downward pathogens." However, this applies only to initial, acute Dampness invasion. Misuse leads to excessive descending, causing Spleen and Stomach to lose Yang harmony, making Yin-Yang separation even more difficult. Dai Shi stated: Diarrhea of watery stool without abdominal pain indicates Dampness. If the diarrhea is slow, regular in frequency, and contains undigested food, it indicates Spleen Deficiency. Watery diarrhea with abdominal pain, irregular frequency, alternating pain and diarrhea, indicates Fire. Variable amounts with loud borborygmus indicate Phlegm. Abdominal wall showing strip-like protrusions, pain with urge to defecate, relieved slightly after defecation, indicates Food Stagnation. Furthermore, Zhang Sanxi stated: The syndromes of diarrhea—Damp, Fire, Phlegm, Deficiency, Summerheat, Accumulation, Wind, Cold—are distinct. The main principle must be to leach out Dampness and dry the Spleen, modifying based on symptoms. Damp: drain it. Fire: clear it. Cold: warm it. Deficiency: tonify it. Phlegm: resolve it. Summerheat: dispel it. Accumulation: reduce it. Wind: scatter it. This is the general principle. Having clarified the eight syndromes, the three deficiencies should be discussed. The three deficiencies are Spleen Deficiency, Kidney Deficiency, and Liver Deficiency. The Spleen controls water; injury to the Spleen by diet impairs transformation of food/fluid, causing diarrhea. The Kidney governs closure; sexual excess injures the Kidney, losing its sealing power, causing diarrhea. The Liver governs discharge; anger injures the Liver, allowing Wood to overact on Earth, manifesting discharge commands. All three cause diarrhea, but Liver/Kidney syndromes are less common; Spleen-origin diarrhea is most frequent. Occasional dietary injury causes diarrhea. Regarding diarrhea, malaria, and dysentery, they share a source: summer heat injuring the Spleen. Initial injury causing diarrhea is mild; prolonged stagnation causing malaria or dysentery is severe. Malaria and dysentery differ: Dietary injury creating Phlegm filling the chest/diaphragm causes malaria; dietary accumulation sticking to intestines/stomach causes dysentery. Hence, "No Phlegm, No Malaria; No Accumulation, No Dysentery." The causes of diarrhea, malaria, and dysentery are manifold; here we only discuss those arising from dietary injury to the Spleen. Jie Zhai stated: Diarrhea belongs to Dampness, often caused by irregular diet injuring Spleen/Stomach. Treatment must consider seasonal Cold/Heat/Dryness/Dampness and the newness/chronicity and Deficiency/Excess of the disease. General principles: Leach Dampness, Tonify Spleen, Reduce Accumulation, Separate Fluids. For chronic Spleen Deficiency with sinking Qi, use Wind herbs to lift; for Spleen/Stomach deficiency with loose sliding, use tonification and astringency.