泄泻者，胃中水谷不分，并入大肠，多因脾湿不运，《内经》所谓湿多成五泄也。一曰飧泄，完谷不化，
脉弦肠鸣，湿兼风也。（平胃散加羌），独、升。柴。经云∶春伤于风，夏生飧泄。二曰溏泄，肠垢污积，
脉数溺涩，湿兼热也。清六丸、大厘清饮，或胃苓汤加黄连。经云∶暴迫下注，皆属于热。三曰 泄，大
便澄清如鸭屎，脉迟溺白，湿兼寒也。治中汤、附子理中汤加肉豆蔻。经云∶诸病水液，澄澈清冷，皆属于寒。
四曰濡泄，身重肠鸣，所下多水，脉缓，腹不痛，湿自甚也。四苓散加苍术，胃苓汤加草果。经云∶湿甚则濡
泄。五曰滑泄，洞下不禁，脉微气脱，湿兼虚也。四柱六柱饮，或四君子汤加升、柴。经云∶清气在下，则
生飧泄。
《难经》所云五泄，一曰胃泄，饮食不化，即风乘湿也。胃气汤。二曰脾泄，呕逆腹胀，即暑乘湿也。香薷饮、
参桂苓甘露饮加姜。三曰大肠泄，肠鸣切痛，即燥乘湿也。五苓散。四曰小肠泄，便脓血，小腹痛，即火乘
湿也。承气汤下之，再以黄连解毒汤加归、芍治之，次以芍药柏皮汤止之。五曰大瘕泄，里急后重，数至圊
而不能便，茎中痛，即寒湿变为热泄也。八正散加木香、槟榔，次用天水散。此外有痰泄，痰泄脉滑类弦。
积湿成痰，留于肺中，故大肠不固。二陈汤加浮石、黄芩、神曲、姜汁、竹沥。或吴茱萸汤温服。探吐痰涎，
泄自愈。有食泄，食泄脉弦紧。腹痛则泄，泄后痛减。治中汤加香、砂、枳、术、楂肉、陈皮、谷芽、麦芽。
伤酒泄，嗜酒伤湿，便青绿色，葛花解酲汤。有暑泄，暑泄脉虚。自汗面垢，暴泻如水。薷苓汤、桂苓甘露饮。
伏暑久泻，玉龙丸。有盛暑伤其外，阴冷伤其中，为内外交迫。连理汤。有肾泄，即五更泄，一名晨泄，
由命火衰，肾虚不摄。宜补骨脂、五味子、山萸、肉桂、山药、茯苓、小茴香、杜仲、菟丝。有脾肾泄，由
二经并虚，朝泄暮已，久而神悴肉削。四神丸。有饭后即便，亦由脾肾交虚，真火不能腐熟水谷，故食下
即泄。二神丸。有滑泄久而不止，固肠丸。由气虚下陷者，补中汤。或大便滑泄，小便精出者，万全丸。若
老人诸泄，不宜多用渗泄分利。以人生五十后，升气少，降气多，渗利太过是降而益降，未免重竭其阳，泻
多则亡阴，谓亡其阴中之阳。宜升提阳气。如升、柴、独、防，佐以术、附、补骨脂。士材治泄九法∶淡渗、
升提、清凉、疏利、甘缓、酸收、燥脾、温肾、固涩。治泄者，当权其轻重缓急而用之。
凡泄皆兼湿，初宜分理中焦，渗利下焦，久则升举，必脱滑不禁，然后以涩药固之。
凡泄水腹不痛者，湿也，宜燥渗。完谷不化者，气虚也，宜温补。腹痛肠鸣，水泄一阵，痛一阵者，
火也，宜清利。时泻时止，痰也，宜豁之。泻后痛减，食积也，宜消之。脾泄久宜涩，下陷宜升提。
Xie Xie (Diarrhea) refers to the condition where water and grain in the Stomach fail to be separated, mixing together and entering the Large Intestine. It is mostly caused by Spleen deficiency with dampness retention and impaired transportation. As stated in *Nei Jing* (Inner Canon), "Excess dampness leads to five types of diarrhea."
The first type is called Sun Xie (Spoon Diarrhea / Undigested Food Diarrhea), characterized by undigested food particles in the stool, a wiry pulse, and borborygmus. This indicates dampness combined with wind pathogen. (Ping Wei San [Stomach-Pacifying Powder] added with Qiang Huo [Notopterygii Rhizoma], Du Huo [Angelicae Pubescentis Radix], Sheng Ma [Cimicifugae Rhizoma], Chai Hu [Bupleuri Radix]). The Classics state: "Wind injury in spring generates Sun Xie in summer."
The second type is called Tang Xie (Loose Stool Diarrhea), characterized by foul, sticky loose stools, a rapid pulse, and dysuria. This indicates dampness combined with heat pathogen. Qing Liu Wan [Clear Six Pill] or Da Li Qing Yin [Great Clarification Decoction], or Wei Ling Tang [Stomach-Astringent Decoction] added with Huang Lian [Coptidis Rhizoma]. The Classics state: "Violent downward pouring all belongs to heat."
The third type is referred to as Xie Xie (Cold-Damp Diarrhea), characterized by clear, watery stools resembling duck feces, a slow pulse, and clear urine. This indicates dampness combined with cold pathogen. Zhi Zhong Tang [Regulate Middle Decoction] or Fu Zi Li Zhong Tang [Aconite Regulate-Middle Decoction] added with Rou Dou Kou [Myristicae Semen]. The Classics state: "All fluid discharges that are clear and cold belong to cold."
The fourth type is called Ru Xie (Damp-Heavy Diarrhea), characterized by heavy body sensation, borborygmus, profuse watery stools, a moderate pulse, and absence of abdominal pain. This indicates excessive dampness. Si Ling San [Four-Ling Powder] added with Cang Zhu [Atractylodis Rhizoma], or Wei Ling Tang added with Cao Guo [Tsaoko Fructus]. The Classics state: "Excessive dampness causes Ru Xie."
The fifth type is called Hua Xie (Slippery Diarrhea), characterized by uncontrollable洞泄 (cavity diarrhea/profuse discharge), a faint pulse, and Qi exhaustion. This indicates dampness combined with deficiency. Si Zhu Yin [Four-Pillar Drink] or Liu Zhu Yin [Six-Pillar Drink], or Si Jun Zi Tang [Four Gentlemen Decoction] added with Sheng Ma and Chai Hu. The Classics state: "When clear Qi sinks below, Sun Xie occurs."
The Five Diarrheas mentioned in *Nan Jing* (Classic of Difficult Issues):
1. Wei Xie (Stomach Diarrhea): Indigestion, caused by Wind invading Dampness. Use Wei Qi Tang [Stomach-Qi Decoction].
2. Pi Xie (Spleen Diarrhea): Vomiting, regurgitation, abdominal distension, caused by Summerheat invading Dampness. Use Xiang Ru Yin [Elsholtzia Decoction] or Shen Gui Ling Gan Lu Yin [Ginseng-Cinnamon-Spore-Gourd Sweet Dew Decoction] added with Sheng Jiang [Zingiberis Rhizoma Recens].
3. Da Chang Xie (Large Intestine Diarrhea): Severe borborygmus and cutting pain, caused by Dryness invading Dampness. Use Wu Ling San [Five-Ingredient Powder with Poria].
4. Xiao Chang Xie (Small Intestine Diarrhea): Pus and blood in stool, lower abdominal pain, caused by Fire invading Dampness. First purge with Cheng Qi Tang [Order the Qi Decoction], then treat with Huang Lian Jie Du Tang [Coptis Detoxification Decoction] added with Dang Gui [Angelicae Sinensis Radix] and Bai Shao [Paeoniae Radix Alba], followed by Zhi Zhi by Shao Yao Bai Pi Tang [Peony-Bark Decoction].
5. Da Jia Xie (Great Mass Diarrhea): Tenesmus, frequent visits to the toilet with inability to pass stool, penile pain. This is Cold-Damp transforming into Heat Diarrhea. Use Ba Zheng San [Eight-Righteousness Powder] added with Mu Xiang [Aucklandiae Radix] and Bing Lang [Arecae Semen], followed by Tian Shui San [Heaven-Water Powder].
Additionally, there is Tan Xie (Phlegm Diarrhea), where the pulse is slippery and resembles a wiry pulse. Accumulated dampness transforms into phlegm, lodging in the Lung, causing the Large Intestine to lose its securing function. Use Er Chen Tang [Two-Chen Decoction] added with Fu Shi [Pumice], Huang Qin [Scutellariae Radix], Shen Qu [Massa Medicata Fermentata], Jiang Zhi [Zingiberis Juice], and Zhu Li [Bambusae Succus]. Or take Wu Zhu Yu Tang [Evodia Decoction] warm. Provoking vomiting to expel phlegm and saliva will cure the diarrhea spontaneously.
There is Shi Xie (Food Stagnation Diarrhea), where the pulse is wiry and tight. Abdominal pain triggers diarrhea, and pain subsides after defecation. Treat with Zhi Zhong Tang added with Mu Xiang, Sha Ren [Amomi Fructus], Zhi Shi [Aurantii Fructus Immaturus], Bai Zhu [Atractylodis Macrocephalae Rhizoma], Shan Zha [Crataegi Fructus], Chen Pi [Citri Reticulatae Pericarpium], Gu Ya [Oryzae Germinatus], and Mai Ya [Hordei Fructus Germinatus].
There is Shang Jiu Xie (Alcohol Injury Diarrhea), caused by excessive drinking damaging dampness, with greenish-green stools. Use Ge Hua Jie Cheng Tang [Kudzu Flower Relieving Intoxication Decoction].
There is Shu Xie (Summerheat Diarrhea), where the pulse is deficient. Symptoms include spontaneous sweating, greasy complexion, and sudden watery diarrhea. Use Ru Ling Tang [Elsholtzia-Poria Decoction] or Gui Ling Gan Lu Yin.
For prolonged diarrhea due to latent summerheat, use Yu Long Wan [Jade Dragon Pill].
If severe summerheat damages the exterior and yin-cold damages the interior, creating internal and external pressure, use Lian Li Tang [Coptis-Modified Atractylodes Decoction].
There is Shen Xie (Kidney Diarrhea), also known as Wengeng Xie (Fifth Watch Diarrhea) or Chen Xie (Morning Diarrhea), caused by Ming Huo (Mingmen Fire) decline and Kidney deficiency failing to secure. Suitable herbs include Bu Gu Zhi [Psoraleae Fructus], Wu Wei Zi [Schisandrae Fructus], Shan Yu [Corni Fructus], Rou Gui [Cinnamomi Cortex], Shan Yao [Dioscoreae Rhizoma], Fu Ling [Poria], Xiao Hui Xiang [Foeniculi Fructus], Du Zhong [Eucommiae Cortex], and Tu Si Zi [Cuscutae Semen].
There is Pi Shen Xie (Spleen-Kidney Diarrhea), caused by deficiency in both meridians, with morning diarrhea resolving by evening. In chronic cases, spirit declines and flesh wastes away. Use Si Shen Wan [Four Spirits Pill].
If defecation occurs immediately after meals, it is also due to Spleen-Kidney dual deficiency, where True Fire cannot rot and ripen water and grain, so food is excreted immediately upon ingestion. Use Er Shen Wan [Two Spirits Pill].
For prolonged slippery diarrhea that does not stop, use Gu Chang Wan [Intestine-Securing Pill].
For those caused by Qi deficiency sinking, use Bu Zhong Yi Qi Tang [Tonify the Middle and Augment the Qi Decoction]. For those with slippery stools and seminal emission, use Wan Quan Wan [Perfect Safety Pill].
For elderly patients with various diarrheas, diuretic and draining-dampness methods should not be overused. After age fifty, ascending Qi decreases while descending Qi increases. Excessive draining is descending upon descending, which inevitably exhausts Yang further. Profuse diarrhea destroys Yin, specifically referring to the loss of Yang within Yin. Therefore, one should lift and raise Yang Qi, using Sheng Ma, Chai Hu, Du Huo, Fang Feng [Saposhnikoviae Radix], assisted by Bai Zhu, Fu Zi [Aconiti Lateralis Radix Praeparata], and Bu Gu Zhi.
Shi Cai (Li Zhongzi) outlined nine methods for treating diarrhea: Dan Shen (Light Leaching), Sheng Ti (Lifting and Raising), Qing Liang (Cooling and Clearing), Shu Li (Dispersing and Unblocking), Gan Huan (Sweet and Relaxing), Suan Shou (Sour and Astringing), Zao Pi (Drying the Spleen), Wen Shen (Warming the Kidney), and Gu Se (Securing and Astringing). Practitioners should weigh the severity and urgency to apply these methods appropriately.
All diarrhea involves dampness. Initially, one should regulate the Middle Jiao and drain-dampness from the Lower Jiao. In chronic cases, one must lift and raise Qi. Only when there is complete prolapse and uncontrollable slipping should astringent medicines be used to secure.
For diarrhea with water but no abdominal pain, it is due to dampness; use drying and draining methods. For undigested food in stool, it is due to Qi deficiency; use warming and tonifying methods. For abdominal pain, borborygmus, and alternating episodes of watery diarrhea and pain, it is due to fire; use clearing and draining methods. For intermittent diarrhea, it is due to phlegm; use phlegm-resolving methods. For pain relief after diarrhea, it is due to food stagnation; use digestion-promoting methods. For chronic Spleen diarrhea, use astringents; for sinking Qi, use lifting methods.