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The syndrome of Xie Xie (diarrhea), food and grain may or may not be digested, without tenesmus (straining during defecation), only feeling fatigue. If it is Zhi Xia (dysentery), however, it is different; there may be pus or blood, or a mixture of pus and blood, or intestinal mucus, or no undigested food residue, or a mixture of residue. Although there are differences in pain or no pain, all involve tenesmus and a sense of urgency and heaviness in the anus, causing distress.

Jie Gu discussed: The syndromes of diarrhea and dysentery from the zang-fu organs are varied, generally discussed in terms of wind, dampness, and heat, indicating that cold syndromes are few and heat syndromes are many, and cold pathogens do not persist long. Thus it is said: Acute diarrhea is not Yin, chronic diarrhea is not Yang. The treatise states: In spring, one should keep the body relaxed; relaxation allows the Liver Wood to flourish. Conversely, remaining still and rigid resembles the action of Autumn Metal, which controls Wood. Wind Qi invades the internal organs. By Summer Solstice, Fire is prosperous and Metal recedes, leaving only Fire and Wood flourishing while Spleen Earth is damaged. Mild cases present as Can Xie (immediate postprandial diarrhea) with fever and a洪 (surging) pulse, where food cannot be digested. Severe cases present as Xia Li (dysentery) with thick, sticky pus and blood, and tenesmus. Thus it is said: All diarrhea with thick, sticky discharge belongs to Fire. The Classic says: Urine mixed with pus and blood indicates that Qi moves and Blood stops. It is appropriate to use Da Huang Tang (Rhubarb Decoction) to purge, which is a heavy formula. Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is a light formula. This follows the principle of "purging the son when excess," so if Liver Wood is weakened, Spleen Earth becomes solid. Thus the Classic says: Injury by Wind in Spring leads to Can Xie in Summer. This goes against the Qi of the four seasons and is self-inflicted. (This section discusses Heat Diarrhea, also known as Zhi Xia).

There are cases where the Taiyin Spleen Meridian is affected by Dampness, leading to watery, loose stools, heaviness of the body, slight fullness, and loss of taste for food. For example, in Spring, Yi Huang San (Benefit Yellow Powder) is suitable for tonification; in Summer, purgation is suitable. The method states: Suitable for tonification, purgation, harmonization, or astringency. Harmonization uses Shao Yao Tang (Peony Decoction); astringency uses He Zi Tang (Chebula Decoction). If prolonged, prevention of transformation into pus and blood is necessary; this is the transmission of the Spleen Meridian to the Kidney, called Zei Xie (Robber Pathogen), making it difficult to cure. If diarrhea precedes sliding incontinence, it is called Wei Xie (Minor Pathogen), making it easy to recover. These are all due to Spleen Earth being affected by Dampness, an act of Heaven. Even sages and wise men cannot escape it. Taste enters through the mouth, Qi through the nose; entering via the nose, it accumulates in the Spleen, forming watery diarrhea. (This section discusses Damp Diarrhea, also known as Xie Xie).

There are cases where the Jueyin Meridian is disturbed, causing continuous diarrhea, with a deep and slow pulse, cold limbs, and thick, sticky pus and blood; this is difficult to treat. It is appropriate to use Ma Huang Tang (Ephedra Decoction) or Xiao Xu Ming Tang (Small Continuation of Life Decoction) to induce sweating. The method states: If exterior pathogen has contracted inward, dispersing the exterior pathogen leads to self-healing. (This section discusses Wind Diarrhea, also known as Chronic Diarrhea). There are cases of sudden, silent diarrhea, cold body with spontaneous sweating, clear and profuse urination, involuntary defecation, shortness of breath, weak pulse, and vomiting; urgent treatment with heavy warming medicines is required, such as Jiang Shui San (Fermented Grain Water Powder). (This section discusses Cold Diarrhea, also known as Acute Diarrhea).

Thus the method states: For tenesmus, use purgation; for abdominal pain, use harmonization; for heaviness, use dampness removal; for wiry pulse, use wind expulsion. For thick, sticky pus and blood, use heavy purgatives. For cold body and spontaneous sweating, use toxic warming agents. For contracted wind pathogen, sweating leads to recovery. Loose stools indicate Li (diarrhea), suitable for warming only. It is also said: Exterior pathogens are released via sweating; interior pathogens are purged; upper pathogens are vomited; lower pathogens are exhausted. For exterior heat, clear internally; for astringent urination, separate and promote diuresis. It is also said: For excess, harmonize; for deficiency, support; for excess, stop. As military strategy says: Avoid their sharp onset, strike when they are tired and returning. This is what is meant. Whenever disease involves diarrhea and aversion to cold, it is Taiyin transmitting to Shaoyin, where Earth overcomes Water. Use Chu Shi Bai Zhu (Damp-Removing Atractylodes), Fu Ling (Poria), An Pi Shao Yao (Spleen-Calming Peony), Gui Zhi (Cinnamon Twig), and Huang Lian (Coptis) to break blood stasis. If Fire pathogen cannot overcome Water, Taiyin cannot transmit to Shaoyin, but instead aids Fire pathogen to ascend to the Lung Meridian, resulting in white pus in dysentery; adding Dang Gui (Angelica Sinensis) and Shao Yao (Peony) addresses this. Also, tenesmus with a large, surging, and solid pulse indicates interior excess syndrome, and severe pain indicates physical obstruction; purgation is suitable. If the pulse is floating and large, purgation must be avoided. Although there is tenesmus, if the pulse is deep, fine, and weak, it indicates interior cold pathogen and scattered Qi; warming and nourishing will lead to recovery. Tenesmus with blockage indicates lack of circulation in Large Intestine Qi. Adding Bing Lang (Areca Seed) and Mu Xiang (Aucklandia Root) promotes Qi circulation. If limbs are lethargic, urine is scanty or obstructed, stool is frequent and heavy, and appetite is reduced, regulate Stomach Qi and remove dampness using Bai Zhu (Atractylodes Macrocephala), Shao Yao (Peony), and Fu Ling (Poria) decocted in water. Bai Zhu removes Spleen-Stomach dampness; Shao Yao removes Stomach damp-heat; Fu Ling unblocks water passages to drain dampness. If fever and aversion to cold occur without abdominal pain, add Huang Qin (Scutellaria) as the chief herb. If no pus is seen but aversion to cold exists, Taiyin is about to transmit to Shaoyin; add Huang Lian as chief, Gui Zhi as assistant. If abdominal pain is severe, add Dang Gui and double Shao Yao. If blood appears, add Huang Lian as chief, Gui Zhi and Dang Gui as assistants. If irritability occurs, or white pus precedes blood, or fever/aversion to cold exist, only Huang Lian can stop upper bleeding. If aversion to cold with deep pulse, blood precedes stool, only Di Yu (Sanguisorba Root) can clear lower bleeding. If aversion to cold with deep pulse, or backache, or umbilical pain, only Huang Qin can clear middle bleeding. If pus and blood are mixed with a floating-large pulse, strictly avoid Da Huang (Rhubarb) purgation; purgation will cause death due to exhaustion of Qi and loss of Yang containment. For Yin-Yang disharmony, only methods separating Yin and Yang should be used. It is also said: Acute diarrhea is not Yin, chronic diarrhea is not Yang. Heat syndromes have rapid pulses, restless bodies, loud voices, acute pouring diarrhea; these are Yang. Cold syndromes have deep-fine pulses, heavy bodies, faint nasal breathing; treat with Jiang Fu Tang (Ginger and Aconite Decoction). Heavy body unable to move is treated with Shu Fu Tang (Atractylodes and Aconite Decoction). Thirst with drinking indicates heat above the diaphragm; excessive water enters from chest/diaphragm to Stomach; Stomach originally has no heat but cannot withstand the water, so water and grain descend rapidly. Moxibustion on Da Zhui (GV14) 3-5 moxa cones cures this immediately; this is Du Meridian heat clearance. If using herbs, Che Qian Zi (Plantago Seed), Lei Wan (Ascaris), Bai Zhu, Fu Ling, etc., or Wu Ling San (Five-Ingredient Powder with Poria) are suitable. There is also cold diarrhea with great abdominal fullness. There is also loose stool, which is cold diarrhea. Wu Tang (duck feces-like stool) is like water with small formed feces. Such cases require Tian Ma (Gastrodia Rhizome), Fu Zi (Aconite Lateralis Preparata), Gan Jiang (Zingiberis Rhizoma), etc. Another method states: Diarrhea has deficiency/excess and cold/heat. Deficiency presents with weakness, inability to lift clothes, leakage before defecation, indicating inability to secure. Excess presents with frequent trips to toilet without passage, commonly called false tenesmus. Tenesmus follows previous methods, using Da Cheng Qi Tang (Major Order the Qi Decoction) with modifications. Taiyang syndrome with heat-carrying dysentery is treated with Liang Ge San (Cooling Chest Powder). (Exterior syndrome mistakenly purged leads to continuous diarrhea, called heat-carrying diarrhea). Yangming syndrome with fixed masses is treated with Da Cheng Qi Tang with modifications. Taiyin syndrome with dampness-dominant soft diarrhea cannot be purged but warmed; Si Ni Tang (Frigid Extremities Decoction) is used. Shaoyin syndrome with dormant wind immobility requires astringency; Chi Shi Zhi Wan (Halloysitum Pill) and Gan Jiang Tang (Zingiber Decoction) are used. Jueyin wind diarrhea is treated for wind; Xiao Xu Ming Tang and Xiao Feng Tang (Wind-Expelling Decoction) are used. Shaoyang wind qi moving automatically is treated with Da Chai Hu Tang (Major Bupleurum Decoction). Wei Xie (Stomach Diarrhea): undigested food, yellow color. (Cheng Qi Tang.) Pi Xie (Spleen Diarrhea): abdominal fullness, pouring diarrhea, vomiting after eating. (Jian Zhong Tang, Li Zhong Tang.) Da Chang Xie (Large Intestine Diarrhea): urgency after eating, white stool, loud bowel sounds and cutting pain. (Gan Jiang Fu Zi Tang.) Xiao Chang Xie (Small Intestine Diarrhea): turbid urine with pus/blood stool, lower abdominal pain. (Cheng Qi Tang.) Da Jia Xie (Great Mass Diarrhea): tenesmus, frequent toilet visits without passage, penile pain. For the five diarrhea diseases, Stomach, Small Intestine, and Great Mass syndromes are all treated with Qing Liang Yin Zi (Cooling Drink), stopping the diarrhea. Jueyin syndrome adds Gan Cao (Licorice) to moderate. Shaoyin syndrome with tenesmus adds Da Huang. Taiyin and Yangming syndromes use Da Cheng Qi Tang with modifications. Taiyin syndrome is inability to eat; tonify first, then purge (advancing medicine). First decoct Hou Po (Magnolia Bark) 0.5 liang (processed) in water, take 2-3 doses. If unresolved, indicating undigested food, add Zhi Shi (Immature Bitter Orange) 2 qian, decoct together, take 2-3 doses. If diarrhea persists and slight intake reveals heat toxin, add Da Huang 3 qian to push out, stop medicine when diarrhea stops. If diarrhea persists due to old dirt/slime in intestines, add Mang Xiao (Mirabilite) 0.5 he; once old filth is gone, cure is achieved. Yangming syndrome is ability to eat; purge first, then tonify (retreating medicine). First use Da Cheng Qi Tang 5 qian decocted in water. If purgation is excessive and diarrhea continues, remove Mang Xiao. When heat slightly subsides, reduce Da Huang by half, decoct and take 2 doses. If heat clears but abdominal fullness remains, further reduce Da Huang, combine with Zhi Shi and Hou Po decoction, take 2-3 doses. If fullness resolves, diarrhea heals; follow with several doses of Hou Po decoction. According to the advancing/retreating Cheng Qi method, one must examine pulse and symptoms, know of accumulated heat, and confirm both form and pathogen are excess before purging. Although this comes from *Jie Gu Jia Zhen* and Dong Yuan's *Huo Fa Ji Yao*, much originates from Liu He Jian's *Bao Ming Ji*. Their medication is mostly purgative/draining; readers should grasp the intent, not stick to the words. Dong Yuan said: When Stomach Qi is peaceful, food enters Stomach, essence is transported to Spleen, returns to Lung, circulates in hundred vessels, nourishing Ying and Wei. If diet is injured, daily life irregular, damaging Stomach Qi, ascending clear Qi descends instead, becoming Can Xie; long-term Taiyin transmits to Shaoyin becoming Chang Pi. If injured by cold drinks/food, abdominal fullness transforms into Can Xie; treat with warm agents to digest. If injured by damp-heat foods forming pus/blood, treat with bitter-cold agents to clear internally. Sunken wind pathogen is lifted. Internal excess dampness is separated and drained. Tenesmus is purged. Heaviness is regulated. Abdominal pain is harmonized. Hole diarrhea with bowel sounds and weakness, unable to lift clothes, fine-weak pulse, is warmed and secured. Thick sticky pus/blood, frequent toilet without passage, surging-strong pulse, is purged and cooled. Generally, treating disease seeks the cause, observes which Qi is excessive, uses counteracting drugs to balance, facilitates according to benefit, aiming for balance. This is the general method. Long-standing or acute diarrhea involves Taiyin pathology; do not depart from Gan Cao and Shao Yao. Without removing dampness, there is no relief, so Bai Zhu is necessary. Thus sages established laws: For seasonal diarrhea within Shao Yao and Bai Zhu base, add Fang Feng (Saposhnikovia) in Spring, Huang Qin in Summer, Hou Po in Autumn, Gui Zhi and Fu Zi in Winter. However, detail external cold/heat signs: for tenesmus, add Da Huang; for body heaviness, use Bai Zhu; for spontaneous sweating, cold limbs, faint breath, add Gui Zhi and Fu Zi to warm. If tenesmus, thick pus/blood, even in deep winter, add Da Huang to warm medicines.

[Diagnosis] Weak Stomach pulse causes diarrhea. Slippery pulse that feels empty upon pressing indicates definite diarrhea. Very small Lung pulse indicates diarrhea (small means Qi and Blood are deficient). Very small Kidney pulse indicates hole diarrhea (small means Qi and Blood are scarce; Kidney governs closure; now Qi/Blood are scarce, unable to close, hence diarrhea). Cold chi pulse fine indicates posterior diarrhea. Cold chi skin with small pulse indicates diarrhea and shortness of breath. Diarrhea with deep-wiry pulse indicates heaviness in anus. Diarrhea with floating-rapid cunkou pulse and stagnant chi pulse indicates pus/blood stool. Disease with large abdomen and diarrhea should have fine-weak-choppy pulse; tight-large-sliding pulse indicates death. Diarrhea with large pulse is difficult to treat. Diarrhea with surging-large pulse is adverse. Pouring diarrhea with slow pulse, occasionally small knot, indicates survival; floating-large-rapid indicates death. Diarrhea with large pulse indicates non-stop. Diarrhea >10 times/day with real pulse indicates death. Red瓣 stool, Can Xie with small pulse, cold extremities, difficult to cure. Can Xie with small pulse, warm extremities, easy to cure. Bowel sounds with fullness, cold limbs with diarrhea, large pulse, is adverse; death within 15 days. Large abdominal distension, cold extremities, emaciation with severe diarrhea, is adverse; death within one shichen (2 hours). Diarrhea with cold limbs and no pulse, moxibustion does not warm, pulse does not return, slight panting indicates death. After diarrhea, pulse vanishes, cold limbs, pulse returns occasionally, warm limbs indicates survival; pulse does not return indicates death. Patient with sallow complexion, dry but not thirsty, cold chest with continuous diarrhea indicates death. If diarrhea, cunkou/guan/chizi pulses all absent, but chi pulse occasionally appears small, pulse rises twice, indicates Kidney Qi remains. If damaged pulse appears, difficult to treat. Diarrhea like fish brain: half dead, half alive. Diarrhea like dust/rotten color: death. Pure blood: death. Like roof leak juice: death. Diarrhea like bamboo tube pouring: incurable. Fine pulse, cold skin, shortness of breath, anterior/posterior diarrhea, no food/drink intake, called Five Deficiencies, incurable. Early rescue with Shen Zhu Gao (Ginseng and Atractylodes Paste) may yield survival. Downward diarrhea, upward phlegm vomiting, both unceasing, indicates upper/lower collapse, death.