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[Scallion White Decoction]
Scallion White (Radix Allii Fistulosi, Congbai) (4 liang), Dried Ginger (Rhizoma Zingiberis Officinalis, Ganjiang) (1 liang), Prepared Aconite Root (Radix Aconiti Lateralis Preparata, Fuzi) (1 piece, used raw, skin removed, broken into eight pieces). The above three herbs are boiled in 3 sheng of water to obtain 1 sheng of decoction. Strain and divide into two warm doses. (*Neijing* states: The Kidney dislikes dryness; urgently eat pungent substances to moisten it. The pungency of Scallion White unblocks Yang Qi, while the pungency of Ginger and Aconite disperses Yin Cold.)

[Baitong Jia Zhuyedan Tang Formula]
Scallion White (Radix Allii Fistulosi, Congbai) (4 stems), Dried Ginger (Rhizoma Zingiberis Officinalis, Ganjiang) (1 liang), Prepared Aconite Root (Radix Aconiti Lateralis Preparata, Fuzi) (1 piece, used raw, skin removed, broken into eight pieces), Human Urine (Ren Niao) (5 he), Pig Bile (Zhu Danzhi) (1 he). Boil the first three herbs in 3 sheng of water to obtain 1 sheng of decoction. Strain, then add Pig Bile and Human Urine, mix well, and divide into two warm doses. If Pig Bile is unavailable, alternatives may be used. (*Neijing* states: When regulating reversed cold-heat, if cold and heat contend, taking hot medicine cold allows the cold nature to dissipate after swallowing, so the hot nature takes effect, curing the disease, stopping vomiting and hiccups, and bringing great benefit. This involves adding salty-bitter-cold substances like Human Urine and Pig Bile to the hot agent of Baitong Tang, relying on their qi to follow each other to eliminate the cold that causes rejection.)

Zhang Jingyue stated: Some ask why Baitong Tang, Baitong Jia Zhuyedan Tang, Zhenwu Tang, and Tongmai Sini Tang are all set for Shaoyin syndrome with diarrhea, yet besides using Ginger and Aconite, the remaining herbs differ greatly. This is because different diseases require different medicines. In Shaoyin diarrhea, the cold pathogen is severe; without Ginger and Aconite, it cannot be treated. However, although the mechanism of diarrhea is similar, accompanying symptoms vary, hence the different prescriptions, each chosen for appropriateness. For instance, Baitong Tang uses Ginger and Aconite to disperse cold and stop diarrhea, adding Scallion White to regulate Yang Qi. If diarrhea is accompanied by dry retching and irritability, the cold is too severe and causes internal rejection; Ginger and Aconite are unsuitable for irritability as they may induce vomiting and non-reception. Therefore, Human Urine and Pig Bile are added to Baitong Tang and taken when cool. These are salty-bitter-cold substances, so they enter without obstruction; once the cold nature dissipates, the hot nature takes effect. Zhenwu Tang treats Shaoyin syndrome where, after two or three days not resolving, by day four or five, abdominal fullness, difficult urination, heavy/painful limbs, and spontaneous diarrhea occur due to Water-Qi. Water-Qi refers to Cold-Dampness, governed by the Kidney. Kidney disease fails to control water, leading to fluid retention. Abdominal pain indicates severe internal Cold-Dampness; heavy/painful limbs indicate severe external Cold-Dampness; difficult urination and diarrhea indicate dampness overwhelming the separation of water and grain. The Classic says: The Spleen dislikes dampness; sweet flavors enter the Splein first. The sweetness of Poria (Fuling) and Atractylodes Macrocephala (Baizhu) tonifies the Spleen and expels water. For Cold-Dampness dominance, use neutral-pungent-hot drugs; for Dampness dominance, assist with sour-pungent drugs. The sour-pungency of Aconite, Peony, and Fresh Ginger warms meridians and disperses dampness. In the Taiyang chapter, Xiao Qinglong Tang syndrome also involves Water-Qi and has various variations, similar to the logic of Zhenwu Tang. Tongmai Sini Tang treats Shaoyin diarrhea with undigested food, interior cold with exterior heat, cold extremities, and faint pulse nearly imperceptible. Interior cold causes body heat, aversion to cold, and red facial color (exterior heat). This is Yin excess internally rejecting Yang externally, preventing communication. Tongmai Sini Tang disperses Yin and unblocks Yang. Its variable symptoms are treated according to modifications. These four syndromes all mention diarrhea with various accompanying symptoms, hence the major similarities but minor differences in medication. Another question: Why does Baitong Tang use Aconite, and among four syndromes, only Zhenwu Tang uses prepared Aconite while others use raw? Raw Aconite warms meridians and dispels cold, requiring Ginger's assistance; prepared Aconite tonifies Yang and removes dampness, suitably assisted by Fresh Ginger. Dried Ginger is pungent-hot, assisting raw Aconite; Fresh Ginger is pungent-warm, slightly aiding prepared Aconite. This principle applies generally. However, Baitong Tang prioritizes diarrhea, while Zhenwu Tang prioritizes Cold-Dampness, hence differences in dosage and preparation. Generally, Cold-Dampness is similar; e.g., Guizhi Fuzi Tang in Taiyang treats Cold-Damp binding, using prepared Aconite assisted by Fresh Ginger. This illustrates the principles of raw/prepared use and weight differentiation.

Shaoyin syndrome with cough and diarrhea, accompanied by delirium, results from Fire Qi robbing fluids. Urination will certainly be difficult due to forcing sweat from Shaoyin. (Cheng Wuji notes: Cough and diarrhea indicate interior cold and loss of body fluids. Using fire therapy to force Shaoyin sweat exhausts internal fluids; combined with Fire Qi irritation, delirium occurs, and urination becomes difficult.) Shaoyin syndrome with diarrhea and pus/blood in stool can be treated with acupuncture at Shaoyin points. Shaoyin syndrome with diarrhea, faint and choppy pulse, vomiting, sweating, frequent defecation attempts but small volume, should be treated with moxibustion on the upper body. Shaoyin syndrome with tight pulse, progressing to day seven or eight with spontaneous diarrhea, sudden weak pulse, warm extremities, and disappearance of tight pulse indicates impending resolution. Despite irritability and diarrhea, self-healing is expected. Shaoyin syndrome with faint, deep, fine pulse, desire to sleep, sweating, irritability, desire to vomit, spontaneous diarrhea, restlessness, and insomnia is a death syndrome. Shaoyin syndrome where diarrhea stops but dizziness and occasional vertigo occur is a death syndrome. (Pang Anshi notes: This resembles Shaoyang vertigo with sweating; if the pulse is uniform, small, and floating, there is hope. Shaoyin syndrome typically lacks vertigo.) Shaoyin syndrome with aversion to cold, curled body posture, diarrhea, and cold extremities is untreatable.

Jueyin syndrome: Cold damage begins with fever for six days, followed by nine days of coldness and diarrhea. Usually, coldness and diarrhea imply inability to eat; the ability to eat now suggests "Chu Zhong" (stomach energy exhaustion). Feeding wheat cakes: if no fever follows, stomach energy remains, and recovery is expected; otherwise, it may be a fleeting heat returning and leaving. Three days later, if pulse shows sustained heat, recovery is expected at midnight of the next day. This is because initial fever (6 days) + coldness (9 days) + subsequent fever (3 days) equals 9 days, matching the coldness duration, predicting recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. (See Jueyin chapter.) Cold damage starting with coldness then fever: diarrhea will stop spontaneously. If sweating and sore throat follow, throat bi occurs. If fever, no sweat, and diarrhea stop spontaneously, but continue, pus/blood in stool will occur. Pus/blood in stool precludes throat bi. Diarrhea with floating-rapid cun pulse and choppy chi pulse indicates pus/blood in stool. (Huanglian Ejiao Tang, Huangqin Tang. Cheng Wuji notes: Diarrhea pulse should be deep-slow; floating-rapid indicates interior heat. Choppy indicates blood deficiency; choppy chi pulse indicates intestinal blood dispersion. Heat follows diarrhea, causing pus/blood stool. "Qing" means toilet.) Hot diarrhea with tenesmus is treated with Baiteng Wang Tang. (Diarrhea depletes fluids; heat damages Qi. Qi deficiency causes tenesmus. Baiteng Wang Tang disperses Qi and thickens intestines.) Diarrhea with thirst indicates heat; treat with Baiteng Wang Tang. (Thirst with diarrhea is not organ cold, unlike Sini Tang warming organs. Thirst with diarrhea indicates heat, cooled by Baiteng Wang Tang. Note: Shaoyin spontaneous diarrhea with thirst is lower jiao deficiency-cold, treated with Sini Tang. Do not distinguish heat/cold solely by thirst; use urine color.)

[Baiteng Wang Tang Formula]
Baiteng Wang (Radix Pulsatillae, Baitengwang) (2 liang), Huangbai (Cortex Phellodendri, Huangbai), Qinpi (Cortex Fraxini, Qinpi), Huanglian (Rhizoma Coptidis, Huanglian) (each 3 liang). Boil these four herbs in 7 sheng of water to obtain 2 sheng. Strain, take 1 sheng warm. If ineffective, take another 1 sheng. (*Neijing* states: The Kidney desires firmness; urgently eat bitter substances to firm it. Diarrhea causes lower jiao deficiency, so pure bitter agents are used to firm it.)

Diarrhea with rapid pulse, slight fever, and sweating indicates self-resolution. If pulse becomes tight again, unresolved. (Ganjiang Huanglian Renshen Tang) Diarrhea with rapid pulse and thirst indicates self-resolution. If not resolved, pus/blood in stool will occur due to heat. (Huanglian Tang) Diarrhea with deep-choppy pulse indicates tenesmus. Large pulse indicates progression/unresolved. Weak-rapid pulse indicates impending resolution. Fever alone is not fatal. (Cheng Wuji notes: Deep indicates interior; choppy indicates tension/deficiency, causing tenesmus. Large pulse indicates disease progression. Weak-rapid indicates declining pathogen and recovering Yang. Fever here is due to Yang victory, not adverse. Deep-choppy pulse relates to Sini Tang types; large pulse relates to Gegen Huangqin Huanglian Tang.) Cold damage after six-seven days and drastic purgation: deep-slow cun pulse, cold extremities, absent lower pulses, blocked throat, spitting pus/blood, uncontrollable diarrhea is difficult to treat. Treat with Mahuang Shengma Tang. (Cheng Wuji notes: At day six-seven, pathogen enters Jueyin. Drastic purgation empties lower jiao Qi, sinking Yang. Deep-slow cun pulse and cold extremities reflect this. Jueyin meridian passes through diaphragm to lung and throat. Fluid loss causes Lung萎 (flaccidity), throat blockage, and pus/blood sputum. *Jingui Yaolue* states: Lung flaccidity comes from harsh purgatives causing severe fluid loss. Uncontrollable diarrhea means severe interior deficiency, hence difficult. Mahuang Shengma Tang regulates Liver-Lung Qi.)

[Mahuang Shengma Tang Formula]
Mahuang (Ephedrae Herba, Mahuang, removed nodes, 2.5 liang), Shengma (Cimicifugae Rhizoma, Shengma), Danggui (Angelicae Sinensis Radix, Danggui) (each 1.25 liang), Zhimu (Anemarrhenae Rhizoma, Zhimu), Huangqin (Scutellariae Radix, Huangqin), Weirui (Polygonati Odorati Rhizoma, Weirui) (each 18 zhu), Shigao (Gypsum Fibrosum, Shigao, crushed, wrapped in silk), Baizhu (Atractylodis Macrocephalae Rhizoma, Baizhu), Ganjiang (Zingiberis Rhizoma, Ganjiang), Shaoyao (Paeoniae Radix Alba, Shaoyao), Tianmendong (Asparagi Radix, Tianmendong, removed heart), Guizhi (Cinnamomi Ramulus, Guizhi), Fuling (Poria, Fuling), Gancao (Glycyrrhizae Radix et Rhizoma, Gancao, honey-fried) (each 6 zhu).
Boil these fourteen herbs in 1 dou of water. First boil Mahuang until boiling, remove foam. Add other herbs, boil to obtain 3 sheng. Strain, divide into three warm doses. Take doses spaced by the time it takes to cook three dou of rice. Sweating indicates cure. (Cheng Wuji notes: *Yuhan Jing* states: Great heat is taken by cold; extreme heat is released by sweat. Mahuang and Shengma's sweetness disperses floating heat. For deficient Zheng Qi, use pungent-moistening herbs: Danggui, Guizhi, Jiang's pungency disperses cold. For upper heat, use bitter-draining herbs: Zhimu, Huangqin's bitterness-coolness clears Heart heat. For low fluids, use sweet-moistening herbs: Fuling, Baizhu's sweetness soothes Spleen and generates fluids. For Lung dryness/heat, use sour-astringent and sweet-soothing herbs: Shaoyao's sourness restrains rebellious Qi. Weirui, Tianmendong, Shigao, Gancao's sweetness moistens Lung and clears heat.)

Jueyin syndrome: Excessive thirst, Qi rushing up to the heart, painful heat in the chest, hunger without desire to eat, vomiting roundworms upon eating, and worsening diarrhea after purgation. (See Jueyin chapter.) Cold damage on day four-five with abdominal pain and gas moving toward the lower abdomen indicates impending diarrhea. (See Abdominal Pain chapter.) Floating-slow pulse with exterior heat, interior heat, and diarrhea with undigested food requires Sini Tang. Profuse sweating with persistent heat, internal cramping, limb pain, plus diarrhea, cold extremities, and aversion to cold requires Sini Tang. Diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities requires Tongmai Sini Tang. Profuse sweating or drastic diarrhea with cold extremities requires Sini Tang. Diarrhea with undigested food: do not attack the exterior; sweating will cause abdominal fullness. Use Sini Tang. Cold damage starting with coldness then fever: diarrhea stops spontaneously; return of coldness brings back diarrhea. Use Sini Tang. Diarrhea with deep-slow pulse, slightly red face, slight body heat, and diarrhea with undigested food leads to depression/dizziness and sweating for resolution due to lower deficiency. Use Sini Tang. After diarrhea, if pulse vanishes and extremities are cold, pulse returning within one shichen (2 hours) with warm extremities indicates life; no return indicates death. (Use Baitong Tang or Tongmai Sini Tang.) After diarrhea, increased irritability with soft epigastrium indicates empty irritability; treat with Zhizi Chi Tang. Diarrhea with delirium indicates dry feces; use Xiaochengqi Tang. Diarrhea with cold extremities and no pulse: moxibustion if not warming. If pulse doesn't return and shallow panting occurs, death. If Shaoyin pulse is weaker than Fuyang pulse, it is favorable. (Shaoyin is Kidney Water; Fuyang is Spleen Earth. Diarrhea implies Kidney evil attacking Spleen; Water failing to overcome Earth is mild evil, hence favorable.) Diarrhea with slight fever, thirst, and weak pulse indicates self-resolution. Cold damage with fever, severe diarrhea, cold extremities, restlessness, and inability to lie down is death. Cold damage with fever, severe diarrhea, and persistent cold extremities is death. (*Jingui Yaolue* states: Six Fu organs failing externally cause cold hands/feet; Five Zang organs failing internally cause uncontrollable diarrhea.) Cold damage on day six-seven without prior diarrhea suddenly developing fever, diarrhea, and unstoppable sweating is death due to Yin excess and Yang absence. (Day seven is struggle between pathogen and healthy Qi. Victory of healthy Qi brings life; pathogen victory brings death. Sudden fever, diarrhea, and sweating indicate pathogen victory and Yang collapse.) Diarrhea occurring ten-plus times daily with strong pulse is death. (Diarrhea indicates interior deficiency; pulse should be weak/faint. Strong pulse indicates pathogen victory, hence death. *Nanjing* states: Pulse not matching disease, disease not matching pulse, is death.) Fever with coldness for seven days, followed by diarrhea, is difficult to treat. (Fever with coldness indicates pathogen entering interior. By day seven, transmission completes; healthy Qi should defeat pathogen via sweating. Diarrhea indicates pathogen victory and interior deficiency, hence difficult.)

Dai Yuanli stated: Spontaneous diarrhea must distinguish Yin and Yang. Three Yang spontaneous diarrhea manifests in their respective meridians. Taiyang-Yangming combined syndrome with diarrhea, headache, backache, muscle heat, eye pain, nasal dryness: Gegen Tang. Taiyang-Shaoyang combined syndrome with diarrhea, body heat, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, nasal dryness: Da Chaihu Tang. Generally, Yang-heat diarrhea differs from Yin-cold diarrhea. Yang diarrhea stools are dark yellow, hot-smelling, noisy, with warm umbilicus; relieved by cool meds, worsened by hot meds. Yin diarrhea presents as clear undigested food, white/pale yellow stools, cold umbilicus; treated with warming/astringent agents. "Yin/Yang diarrhea" refers to Qi natures, not meridians. Yin can have Yang diarrhea; do not assume all diarrhea is Yin. Internal deficiency with heat invasion causing hot diarrhea, warm umbilicus, dark yellow stools, or greasy intestinal fluids is called "Li Chang"; treat with Baiteng Wang Tang or Huangqin Tang. Note: Spontaneous diarrhea with normal body temperature and warm extremities is Taiyin; cold extremities are Shaoyin/Jueyin. Other heat-diarrhea cases belong to Yang meridians. However, Yin diarrhea may have rebound fever, post-diarrhea fever, or initial fever followed by diarrhea; this is not Yang transmitting to Yin. See previous Fever chapter. Also, prolonged laxative use causing unremitting diarrhea requires extreme hot meds to resolve. Yang has both diarrhea and constipation; differentiate by other signs. Exterior heat with interior irritability, diarrhea, thirst, oppression, pain, or vomiting often uses Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang is more appropriate. Wendan Tang with Huanglian, adjusting Zhike based on judgment.

Wu Qiu stated: Spontaneous diarrhea not caused by purgation is俗称 "Lou Di Shang Han". Differentiate heat-assisted vs. cold-assisted. *Yuan Bing Shi* states: White discharge is cold; green/yellow/red/black is heat. Generally, undigested food, unchanged color, loose stools, or foul vomiting/diarrhea, clear cold urine, no oral thirst, deep/faint/slow/weak pulse, or body heat with cold extremities/aversion to cold/curled posture indicates Cold syndrome. Heat syndrome features oral thirst, yellow/scanty/difficult urine, greasy discharge, rapid/floating/sliding/tight/large/hyperactive pulse, or undigested food due to heat. Differentiate by pulse/symptoms. Stomach deficiency with interior heat/thirst/diarrhea/weak pulse: Qiwei Renshen Baizhu San. With fever: Shenhu Sanbai Tang minus Huangqin, add fried Huanglian. With abdominal fullness/difficult urination: Wuling San combined with Lizhong Tang. With vomiting: add Huoxiang, Banxia, Shengjiang, Chenpi. With excessive dampness/unremitting diarrhea: add Cangzhu, Baizhu. With abdominal distension: Houpo. With persistent abdominal pain: fried Shaoyao, Rougui, Muxiang to warm. For cold damage with diarrhea, floating pulse, unresolved exterior: Zhang Zhongjing uses Xiao Qinglong Tang minus Mahuang, add 2 qian roasted Ruahua to scatter exterior pathogen and manage water. If difficult urination and watery diarrhea: Wuling San. If severe, add 1 qian Ruahua to move water; water movement stops diarrhea. Diarrhea should not be treated with sweating; treat diarrhea first. Once interior is solid, Qi recovers, pathogen resolves, and sweating occurs naturally. Diarrhea stems from interior deficiency; sweating causes dual deficiency, making complications difficult.

Appendix

Huoren Shu stated: Cold toxin entering stomach causes cold umbilicus, abdominal fullness, yellow/white/green/black stools or clear undigested food diarrhea: Sini Tang, Lizhong Tang, Baitong Jia Fuzi Tang, Sini Jia Xiebai San. Heat-associated diarrhea causes warm umbilicus, dark yellow stools, greasy intestinal fluids: Huangqin Tang, Baiteng Wang Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, Chishizhi Wan.

[Sanhuang Shuai Ai Tang] Treats cold damage after drastic purgation on day four, intermittent hot diarrhea unresponsive to Baitong Tang. Clears heat, stops diarrhea.
Huangqin, Huanglian, Huangbai, Shuai Ai (half egg size). Chop, decoct in water, take warm.

[Xiebai Tang] Treats cold damage diarrhea resembling rotten meat juice, bloody discharge, latent Qi abdominal pain, and various heats.
Douchi (half he, wrapped in silk), Xiebai (one handful), Shanzhi (seven fruits). Chop, boil in 2.5 sheng water. First boil Shanzhi for ten boils, add Xiebai, boil to 2 sheng, add Douchi, boil to 1.2 sheng. Take warm.

[Chishizhi Wan] Treats cold damage hot diarrhea.
Chishizhi, Pao Ganjiang (each 1 liang), Huanglian, Danggui (each 2 liang). Powder, honey pills like wattle seeds. 30 pills per dose, rice water, three times daily. For severe damp-toxin with abdominal pain and pus/blood-like stools: Taohua Tang, Diyü San, Huanglian Ejiao Tang.

[Diyü San] Treats unresolved cold damage heat-toxin, evening high fever, abdominal pain, pus/blood diarrhea.
Diyü, Xijiao Xie, Fried Huanglian, Gegen (each 1 liang), Shanzhi (0.5 liang), Huangqin (1 liang). Chop. 5 qian per dose, 1 cup water, add 5 cun Xiebai, decoct, take warm.

Haizang stated: [Huanglian Ejiao Tang] Treats cold damage heat-toxin entering stomach, pus/blood diarrhea.
Fried Huangqin (2 liang), Shanzhi (0.5 liang), Fried Ejiao, Huangbai (each 1 liang). Chop. 4 qian per dose, decoct in water.

Yunqi Zi stated: After cold damage sweating/purgation, free urination/defecation with abdominal pain: Zaochang Wan.
Pao Fuzi (1 piece), Longgu (0.5 liang), Ganjiang (1 liang), Wuzhuyu, Susuke, Helipi (each 0.5 liang). Fine powder, wine paste pills, wattle seed size. 30 pills per dose, warm water. Stop when diarrhea ceases.

After cold damage sweating/purgation, tenesmus and diarrhea: Qixuan Wan.
Dahuang (1 liang), Muxiang, Binglang, Chaihu, Hezipi, Gancao (each 0.5 liang), Taoren (30 kernels, peeled/cored). Fine powder, honey pills, wattle seed size. 50 pills per dose, warm water.

After cold damage sweating/purgation, rebellious Qi and unremitting diarrhea due to cold: Zhishi Shaoyao Gancao Tang.
Shaoyao, Gancao, Fried Zhishi, Pao Ganjiang (each 0.5 liang). Chop. 3 qian per dose, decoct in water.