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Background Information:
Book: Bian Zheng Lu (Record of Syndrome Differentiation)
Author: Chen Shiduo
Dynasty: Qing
Chapter: Da Xie Men (Nine Cases) (1/2)
Category: Comprehensive

Translation:

There are cases where a person feels hungry and thirsty, desiring food and drink. After swallowing food, the abdomen immediately feels full and stifled. Relief is only felt after a severe diarrhea, occurring several times a day at various hours, becoming a routine. The complexion is sallow and withered, and limb muscles are emaciated. This is not due to deficiency of Stomach Qi, but rather stagnation of Spleen Qi. The Spleen and Stomach should be discussed separately: The ability to digest but inability to eat indicates deficiency of Stomach Qi, caused by cold in the Pericardium; the ability to eat but inability to digest indicates stagnation of Spleen Qi, caused by cold in the Gate of Vitality (Mingmen). Now, the patient craves food when hungry and thirsty, yet feels full after eating and stifled after drinking. This shows that the Stomach can receive but the Spleen cannot transform and transport. However, how does Spleen dysfunction lead to severe diarrhea followed by relief? It is because the Spleen belongs to Wet Earth. Lacking warm energy and burdened by food and water, dampness aids dampness. Fearing long-term retention harming the Earth, it prefers rapid transmission for relief. Consider the Yellow River flowing into the Central Plains: without high mountains as barriers or deep pools for storage, water loosens the soil and floods, easily breaching banks. Waves surge, carrying mud and water, rushing thousands of miles uncontrollably—this is the nature of the situation. Day by day, month by month, either cliffs collapse or dikes shift. The Spleen, located in the central Earth region, exhibits similar severe diarrhea patterns. Treatment should not focus on the Stomach but on the Spleen; not merely the Spleen, but also the Fire of the Kidney (Mingmen). Use Di Tu Tang (Founding Earth Decoction): Baizhu (Atractylodis Rhizoma) 30g, Fuling (Poria) 30g, Sharen (Amomi Fructus) 1.5g, Shanyao (Dioscoreae Rhizoma) 30g, Renshen (Ginseng Radix) 15g, Luobozhi (Raphani Semen) 6g, Fuzi (Aconiti Lateralis Radix Praeparata) 0.9g, Banxia (Pinelliae Rhizoma) 3g, Pogu Zhi (Psoraleae Fructus) 3g. Decoct in water and take orally.

In this formula, Baizhu, Fuling, and Renshen are sacred herbs for strengthening the Spleen; Fuzi and Pogu Zhi are divine products assisting the Mingmen Fire; Shanyao is a miraculous flavor for tonifying the Kidney; Sharen and Banxia are spiritual elixirs awakening the Spleen; and Luobozhi is a wonderful agent for separating clear from turbid. One or two doses can stop diarrhea; no need for excessive use once stopped. Even if used excessively, it causes no harm, naturally restoring Yang in critical states and generating Yin on the verge of exhaustion.

This syndrome is also effectively treated with Jia Wei Si Jun Tang (Modified Four Gentlemen Decoction): Renshen (Ginseng Radix), Xiaohuixiang (Foeniculi Fructus) each 9g, Baizhu (Atractylodis Rhizoma) 30g, Shanyao (Dioscoreae Rhizoma) 30g, Rougui (Cinnamomi Cortex) 3g, Luobozhi (Raphani Semen) 3g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Roudoukou (Myristicae Semen) one piece, Fuling (Poria) 15g. Decoct in water and take orally.

Some people suffer from chronic diarrhea, necessarily experiencing painful diarrhea two or three times during the fifth watch (early morning, around 3-7 AM), or five to six times in severe cases, but no diarrhea occurs during the day. People assume this is deficiency-cold of the Spleen and Stomach, unaware that it is actually deficiency-cold of the Kidney and Mingmen. Such diseases originate from Spleen-Stomach deficiency-cold, leading to Yin loss from prolonged diarrhea, transmitting from Spleen to Kidney. If the Mingmen Fire in the Kidney is not depleted, even if disease transmits from Spleen to Kidney, eventually it returns from Kidney to Spleen and heals itself. Only when Mingmen Fire declines, failing to steam and rot food and water, does the Spleen transmit dampness to the Kidney without return. The fifth watch corresponds to Hai-Zi hours, located North, when Kidney Water rules. Cold water without warming fire leads to massive diarrhea; this is what Nei Jing calls "Da Jia Xie" (Great Mass Diarrhea). Using agents to stop water fails; one must use agents to replenish water, rapidly regenerating lost Yin. Crucially, within Yin tonification, one must simultaneously tonify Fire, so that robust Yang can control Yin. Use Tian Kan Tang (Filling the Abyss Decoction): Shanzhuyu (Corni Fructus) 30g, Fuling (Poria) 30g, Bajitian (Morindae Officinalis Radix) 15g, Rougui (Cinnamomi Cortex) 9g, Cheqianzi (Plantaginis Semen) 9g, Bei Wuwei Zi (Schisandrae Chinensis Fructus) 9g, Renshen (Ginseng Radix) 9g, Qianshi (Euryales Semen) 30g, Baizhu (Atractylodis Rhizoma) 60g. Decoct in water and take orally. One dose reduces diarrhea, two doses reduce it further, ten consecutive doses ensure no recurrence.

This formula tonifies both Spleen and Kidney and acts as a diuretic to stop diarrhea, resolving dampness naturally. With Rougui warming Mingmen Qi, the Bladder easily transforms water, preventing it from flowing into the Large Intestine causing diarrhea.

This syndrome is also well-treated with Wu Shen Dan (Five Spirit Pill): Shudi (Rehmanniae Radix Preparata) 60g, Shanyu (Corni Fructus) 30g, Wuweizi (Schisandrae Chinensis Fructus) 6g, Pogu Zhi (Psoraleae Fructus) 6g, Rougui (Cinnamomi Cortex) 6g. Decoct in water and take orally.

Some experience severe abdominal pain, intolerable to touch, followed by sudden severe diarrhea. Food and drink exit immediately upon entering, undigested, like a galloping horse, unstoppable. Within moments, dozens of episodes occur; daily total may reach a hundred, life hanging by a thread. This is Da Xie (Severe Diarrhea) caused by Wind-Wood of the Liver channel harboring pathogenic factors. The disease arises from summer cooling excesses, sitting/lying facing wind, suppressing summer heat so it cannot disperse, hiding within Spleen-Stomach. When autumn arrives, cool wind penetrates, overcoming Liver Wood. Liver Wind becomes stagnant and unexpressed, attacking Spleen-Stomach downward. Stomach-Spleen heat battles wind, driving all abdominal fluids and food straight down, wanting to leave nothing behind, causing severe pain and urgency. Spleen-Stomach wants to stop, but wind refuses; wants to close, but heat prevents closure. Lower Jiao gate opens wide, Upper Jiao gate hard to close, so food exits before transformation. Treatment must urgently rescue Spleen-Stomach Qi, then guide according to momentum. Without abundant medication and rapid intervention, slow King’s Way methods will likely fail fatally. Use Ni Wan Tang (Reverse Pulling Decoction): Renshen (Ginseng Radix) 30g, Fuling (Poria) 60g, Dahuang (Rhei Radix et Rhizoma) 30g, Huanglian (Coptidis Rhizoma) 9g, Zhizi (Gardeniae Fructus) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g. Decoct in water and take orally. One dose removes abdominal pain and stops diarrhea instantly.

This formula uses Renshen to secure Spleen-Stomach Qi, preventing sudden collapse. Most remarkably, it uses Dahuang. Since this diarrhea stems from Fire滞留 (retention) in intestines/stomach, Dahuang is needed to swiftly purge; otherwise, Fire won’t scatter, Water won’t flow. However, using only Dahuang without Huanglian and Zhizi leaves intense Fire entrenched in ravines, unlikely to dry up quickly. All three together open all channels. Yet without separation methods, blockage might persist. Adding Fuling separates clear/turbid and strengthens Spleen/Stomach opening, solidifying Earth to prevent breach. Worrying about excessive purging damaging intestinal Yin, Gancao moderates speed, aiding Renshen in generating Qi. This is combining suppression and pacification, avoiding fierce struggle, ensuring calm waters return to their course, achieving quick peace.

This syndrome is also effectively treated with Shen Lian Tang (Ginseng and Coptis Decoction): Renshen (Ginseng Radix) 30g, Fuling (Poria) 30g, Baishao (Paeoniae Radix Alba) 60g, Huanglian (Coptidis Rhizoma) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g. Decoct in water and take orally until cured.

Some feel thirst and drink water, then suddenly suffer severe diarrhea, ten or dozens of times a day, hundreds of times day and night, undigested food passing directly through. People assume it is Fire Diarrhea, unaware it is due to insufficient Kidney Water controlling Fire. The Stomach is the gate of the Kidney; Stomach Fire requires Kidney Water to control it. When Kidney Water declines, Stomach Fire flares. Internal Fire lacking resources seeks external water for aid. External water only briefly cools Upper Jiao inflammation, cannot fully assist Lower Jiao Water, so Kidney rejects it. Kidney and Bladder are exterior-interior; Bladder also rejects it. Water cannot transform, flows directly to Large Intestine causing diarrhea. Although Stomach Fire is strong and thirst prompts cold water intake, which should become sweat, instead it causes diarrhea because Kidney Water fails to control Stomach Fire. Stomach Fire bullies weak Kidney Water, carrying water to insult the Kidney, excreting water instead of sweat. Later, not only does water crash down, but Fire also drops sharply. Gates open, top and bottom exposed, like a waterfall crashing down. Treatment should address symptoms urgently, but stopping diarrhea without rescuing Yin leads to immediate Yin exhaustion, unable to control Fire or preserve Stomach Qi. Use Sheng Yin Zhi Xie Tang (Generate Yin Stop Diarrhea Decoction): Shanzhuyu (Corni Fructus) 60g, Cheqianzi (Plantaginis Semen) 30g, Fuling (Poria) 30g, Baishao (Paeoniae Radix Alba) 60g, Rougui (Cinnamomi Cortex) 0.9g, Baizhu (Atractylodis Rhizoma) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 15g, Shanyao (Dioscoreae Rhizoma) 60g, Yiren (Coicis Semen) 30g. Decoct in water and take orally. One dose reduces diarrhea, two doses reduce it further, three doses stop it completely.

This formula purely tonifies Kidney and Stomach, not a direct anti-diarrheal, yet its miracle lies in Yin tonification, as Yang Fire stops upon receiving Yin. Treating as Stomach deficiency with Fire might stop diarrhea temporarily, but profuse diarrhea loses Yin, which cannot recover quickly. This formula stops diarrhea while protecting both Yin and Yang, which is superior.

This syndrome is also effectively treated with Cun Yin Tang (Preserve Yin Decoction): Shudi (Rehmanniae Radix Preparata) 60g, Shanyao (Dioscoreae Rhizoma) 30g, Fuling (Poria) 30g, Cheqianzi (Plantaginis Semen) 15g, Baizhu (Atractylodis Rhizoma) 60g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Zexie (Alismatis Rhizoma) 6g. Decoct in water and take orally.

Some drink alcohol year-round without restraint, engaging in sexual activity while drunk, excessively leaking essence. Over time, Spleen Qi is severely damaged, turning into watery diarrhea. Upon catching wind-cold, diarrhea becomes unremitting, loose and accumulated-like. People attribute this to Alcohol-Damp injuring Spleen, unaware it injures the Kidney. Spleen is Wet Earth, hating dampness most. Alcohol is extremely damp, but its nature is hot, and Spleen likes heat. Heat-damp combination doesn’t severely hurt Spleen. However, people use alcohol’s heat to boost Mingmen Fire, fanning flames for prolonged intercourse. Heat cannot last, essence cannot hold; when excitement fades and essence leaks, fire dies, leaving dampness in the Kidney Palace. Fluids of all organs rely on Kidney Fire for transformation. Dampness in Kidney means Fire departs, Damp remains, accompanying for years. As Fire declines and Damp increases, Kidney cannot retain it, transmitting back to Spleen. Previous alcohol-damp remains, new alcohol-damp arrives. Damp and Heat flourish. Spleen receives no benefit from Heat, only harm from Damp, causing chronic diarrhea. Treatment must greatly tonify Spleen-Kidney, then resolve Heat-Damp toxicity. Use Jie Cheng Zhi Xie Tang (Resolve Intoxication Stop Diarrhea Decoction): Baizhu (Atractylodis Rhizoma) 30g, Shanzhuyu (Corni Fructus) 30g, Fuling (Poria) 30g, Zuomu (Quercus variabilis Bark) 15g, Huanglian (Coptidis Rhizoma) 4.5-9g, Baishao (Paeoniae Radix Alba) 15g, Fuzi (Aconiti Lateralis Radix Praeparata) 0.3g. Decoct in water and take orally.

This formula tonifies Spleen and Kidney. Zuomu and Huanglian resolve alcohol toxicity; Fuling and Baizhu eliminate water-damp; Shaoyao gathers consumed Yin; a small amount of Fuzi guides herbs into Kidney to sweep Heat-Damp, not boosting deficient Mingmen Yang. This formula requires prolonged use. Alcohol-damp diarrhea is hard to cure because Heat-Damp entering Kidney is difficult to expel. After ten doses, switch to pills, taken morning and evening for three months for full recovery.

This syndrome is also effectively treated with Yu Zuo Tang (Cornus and Quercus Decoction): Shanzhuyu (Corni Fructus) 3g, Zuomu Zhi (Quercus variabilis Branch) 6g, Rougui (Cinnamomi Cortex) 6g, Wuweizi (Schisandrae Chinensis Fructus) 6g, Shanyao (Dioscoreae Rhizoma) 30g, Fuling (Poria) 30g. Decoct in water and take orally. Ten doses cure.

Some experience sudden, unprovoked diarrhea with unbearable abdominal pain, blue face, black lips, near death, anus feeling like knife-cutting, diarrhea pouring like rain. People assume Fire Diarrhea, unaware it is Toxic Diarrhea. Toxins have sources: eating melons/fruits, drinking cold water, overnight tea, outdoor wine, visiting cold temple spots, exploring dark caves, sleeping in damp places, eating tree fruits, consuming dead cattle/sheep, or indigestible bird meat. Though toxin enters abdomen and diarrhea exits intestine, it’s not necessarily fatal. But severe pain demands rescue. Method: detoxify while aiding toxin expulsion, guiding momentum for superior results. Use Hua Du Shen Dan (Transform Toxin Divine Pill): Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 15g, Dahuang (Rhei Radix et Rhizoma) 30g, Danpi (Moutan Cortex) 15g, Danggui (Angelicae Sinensis Radix) 30g, Leiwan (Omphalophaga Melli Fermentum) 9g, Pugongying (Taraxaci Herba) 15g. Decoct in water and take orally. One dose expels all toxins and cures; no second dose needed.

Sheng Gancao and Pugongying detoxify; combined with Dahuang and Leiwan, they purge toxins without excessive harshness or stagnation risk. Danggui and Danpi assist,驱逐 (expelling) toxin filth without damaging intestinal Yin. Not reckless usage.

This syndrome is also miraculously treated with Lei Hong Dan (Thunder Bomb Pill): Leiwan (Omphalophaga Melli Fermentum) 6g, Honghua (Carthami Flos) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Baishao (Paeoniae Radix Alba) 15g, Cheqianzi (Plantaginis Semen) 15g, Zexie (Alismatis Rhizoma) 6g, Zhuling (Polyporus) 6g. Decoct in water and take orally.

Some have sallow faces, thin bodies, good appetite, easy hunger, pain if not eating, daily routine. Suddenly severe diarrhea passes worms in clumps, blood-wrapped pus packets. People assume Worm Diarrhea. Worms arise from dampness, nourished by food/water. Good appetite means worms eat, digestion speeds up; easy hunger means worms starve, human feels hungry; pain without eating means worms lack food, gnawing intestines. Years pass, worms multiply, turning gut into nests, refusing to scatter despite feeding. Food supplies worms but fails to generate fluids/nourish organs. Organ Qi declines, Stomach Qi weakens. Weak Stomach leads to Weak Spleen; weak Stomach reduces intake; weak Spleen impedes output. Long-term leads to Cold Stomach/Spleen. Cold environment makes worms seek warmth, escaping via hot water decoctions causing severe diarrhea. Once one worm moves, others follow, forming groups in pus/blood, inevitable outcome. Treatment: attack heavily during worm migration to clear gut erosion. However, excessive purging damages Spleen-Stomach. Combine attack with tonification to support Righteous Qi and eliminate worms, a dual benefit. Use Sao Chong Tang (Sweep Worms Decoction): Renshen (Ginseng Radix) 15g, Baizhu (Atractylodis Rhizoma) 30g, Dahuang (Rhei Radix et Rhizoma) 9g, Baiwei (Cleome Herba) 9g, Baibu (Stemonae Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Wumei (Mume Fructus) one piece. Decoct in water and take orally. One dose causes massive diarrhea expelling all worms; no second dose needed. Follow with Si Jun Zi Tang (Four Gentlemen Decoction) for regulation and safety.

Though called Sweep Worms, this actually tonifies Spleen-Stomach to generate Qi. Worm infestation damages Spleen-Stomach over time. One might think pure tonification suffices, but if worms exit heavily without purgatives, only tonics used, Spleen-Stomach Qi recovers, but worms also recover, causing future harm. Thus, use vermifuges when worms self-expel, preventing them from lingering on tonics. Attack contains tonification, expelling worms without depleting Qi. Attack and tonify together, proper aftercare ensures complete success.

This syndrome is also miraculously treated with Zhui Chong Dan (Chase Worms Pill): Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Zhike (Aurantii Fructus Immaturus) 3g, Leiwan (Omphalophaga Melli Fermentum) 3g, Huanglian (Coptidis Rhizoma) 6g, Baibu (Stemonae Radix) 6g, Binglang (Arecae Semen) 6g, Renshen (Ginseng Radix) 9g, Shijunzi Rou (Quisqualis Semen Endocarpium) 9g, Baizhu (Atractylodis Rhizoma) 15g. Decoct in water and take orally.

Some have disharmonious organs, chronic unresolved diarrhea, assumed to be Hole Diarrhea, but actually caused by Liver overcoming Spleen Earth, descending dampness. Liver belongs to Wood, best at overcoming Earth. But if Earth is robust, Wood cannot overcome; if Wood is balanced, Earth is not harmed. Only when Liver Wood is hyperactive and Earth is severely deficient does Wood overcome Earth, making Earth’s dampness unstable. Human Spleen Earth easily declines, Liver Wood easily rises. Liver rise isn’t just from Kidney Water nourishment, mostly from anger and overthinking. Great anger opens Liver lobes; excessive deliberation lacks decisiveness, generating restless thoughts, all causing Liver Qi hyperactivity. Hyperactive Qi cannot vent, attacks Spleen. Spleen is Wet Earth, fearing Wood attack, Qi descends instead of rising, causing diarrhea. Anger is intermittent, thinking endless, so Liver cannot balance, diarrhea has no end. Treatment: calm Liver to drain water, stopping diarrhea. Ancients used inducing vomiting or purging methods successfully, but neither is ideal. Use Ping Xie Tang (Calm Drain Decoction): Shaoyao (Paeoniae Radix) 60g, Fuling (Poria) 30g, Baizhu (Atractylodis Rhizoma) 60g. Decoct in water and take orally. One dose calms Liver Qi, two doses stop hole diarrhea, three doses prevent recurrence.

Shaoyao calms Liver; Baizhu and Fuling strengthen Spleen to remove damp. Calmed Liver doesn’t punish Earth; Spleen nurtured, fears no Wood attack. Damp removal dries Earth, no waves rise, no diarrhea. Why use vomiting to damage Qi or purging to damage Yin, using coercive drugs to win?

This syndrome is also excellently treated with Tiao Pi Yin (Regulate Spleen Drink): Baishao (Paeoniae Radix Alba) 15g, Fuling (Poria) 15g, Baizhu (Atractylodis Rhizoma) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Chenpi (Citri Reticulatae Pericarpium) 1.5g, Shenqu (Massae Medicatae Fermentatae) 6g, Baidoukou (Amomi Fructus Rotundus) two grains. Decoct in water and take orally.

Some infected by ghosts/spirits suffer sudden severe diarrhea, Yin Qi invading Spleen Earth. Spleen is Taiyin, inherently Yin organ, but Yin contains Yang, allowing Spleen Earth to circulate and change, avoiding excessive dampness. Taiyin Wet Earth relies entirely on Kidney’s Supreme Yang Qi for transformation. Ghosts are Supreme Yin Qi. Prolonged contact steals Supreme Yang, leaving Yin without Yang, unable to digest food/water. Ghost Qi is also Evil Qi; evil strength comes from righteous weakness. Righteousness fails evil, Yin wins, Yang weakens, diarrhea unstoppable. Treatment: tonify Yang to remove damp, assist Righteousness to eliminate Yin, otherwise diarrhea never ends. Use Xiao Yin Zhi Xie Dan (Eliminate Yin Stop Diarrhea Pill): Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Rhizoma) 30g, Fuzi (Aconiti Lateralis Radix Praeparata) 0.9g, Ganjiang (Zingiberis Rhizoma) 3g, Shanyao (Dioscoreae Rhizoma) 30g. Decoct in water and take orally. Ten consecutive doses stop diarrhea and restore spirit.

Cangzhu dispels evil, Baizhu promotes dampness, Ginger/Aconite generate Yang sufficiently. Why add Shanyao for Yin tonification? Being ghost-infected consumes not only Yang but secretly drains Yin Essence. Shanyao tonifies True Yin Essence, not Evil Yin Water. True Yang needs True Yin to generate; tonifying True Yin speeds Yang generation. Yang receiving Yin prevents Ginger/Aconite from being too excessive, helping Er Zhu generate Supreme Yang. Moreover, Shanyao is a divine object for strengthening Spleen/drainage, not purely Yin without Yang. Combined, they achieve novelty.

This syndrome is also well-treated with Zhu Chi Dan (Expel Demon Pill).