Library

The disease of diarrhea (Xie Xie) is characterized by food and water being either digested or undigested, with stools flowing like water, but without the sensation of straining (Nu Ze) or tenesmus (Hou Zhong). If the pulse is fine (Xi), skin is cold, there is shortness of breath (Shao Qi), diarrhea (Xie Li), and inability to eat, this constitutes the "Five Deficiencies" (Wu Xu) indicating a fatal prognosis. When diarrhea presents with the Five Deficiencies, it signifies that the Spleen Earth (Zhong Tu) is exhausted, a critical condition; even Shen Fu Tang (Ginseng and Aconite Decoction) may fail to rescue it. One must add Qi Wei Bai Zhu Tang (Seven-Ingredient Atractylodes Macrocephala Decoction) to recover the lost Spleen Yang (Pi Yang) and consolidate Yuan Qi (Primal Qi); clinical trials show rapid efficacy. Using herbs such as Ren Shen (Ginseng) and Fu Zi (Aconite Root) for rescue can also result in survival. If the pulse is slow (Huan) with occasional slight knotted beats (Jie), or if mild diarrhea lingers, these are treatable. If the pulse is floating, large, surging, and rapid (Hong Shu), or tight (Jin) or wiry and urgent (Xian Ji), they are difficult to treat. A rapid (Shu) pulse indicates Heat (Re), a deep and fine (Chen Xi) pulse indicates Cold (Han), a hollow (Xu Huo) pulse indicates Qi Collapse (Qi Tuo), a choppy and excess (Se Shi) pulse indicates Stagnation (Ji Zhi), and a wiry and slow (Xian Chi) pulse indicates Qi Leakage (Qi Xie). Cessation of the Heart pulse indicates Diarrhea due to Fright (Jing Xie). Dampness (Shi) causes watery diarrhea without abdominal pain. Wind (Feng) causes undigested grain to pass completely. Fire (Huo) causes abdominal pain with watery diarrhea, borborygmus (Chang Ming), where pain occurs in bursts followed by diarrhea. Phlegm (Tan) causes intermittent diarrhea with variable amounts. Food stagnation (Shi) causes severe abdominal pain that alleviates after defecation. Kidney Deficiency (Shen Xu) causes diarrhea at dawn (Wu Geng Xie), but not at other times. Cold (Han) causes cold abdominal pain, profuse watery diarrhea ("cave-like" descent), borborygmus, and inability to digest rice or drink. The treatment principles are: Dryness for Dampness, Tonification for Deficiency, Clearing for Heat, Warming for Cold, Moving Phlegm for Phlegm, Resolving Accumulation for Stagnation, Raising for Qi Sinking, and Astringing for Qi Collapse.

Main Formula: Chao Bai Zhu (Stir-fried Rhizoma Atractylodis Macrocephalae), 2 qian, dries dampness and tonifies Spleen; Qu Pi Bai Fu Ling (Poria with coarse skin removed), promotes diuresis; Chao Bai Shao (Stir-fried Radix Paeoniae Alba), 1.5 qian each, stops abdominal pain, tonifies Spleen, and subdues Liver. Qu Bai Chen Pi (Tangerine Peel with white pith removed), 1 qian, moves Qi. Zhi Gan Cao (Honey-fried Radix Glycyrrhizae), 0.5 qian, harmonizes Middle Jiao. For confirmed Dampness injury, replace Bai Zhu with Cang Zhu (Rhizoma Atractylodis), as Bai Zhu is astringent while Cang Zhu disperses; add Qiang Huo (Rhizoma et Radix Notopterygii), 1 qian, as Wind overcomes Dampness. Zhu Ling (Polyporus), Ze Xie (Rhizoma Alismatis), 0.5 qian each; treating Dampness without promoting urination is incorrect. For Spleen Deficiency, add Ren Shen (Radix Ginseng), 1 qian, a key herb for tonifying Spleen Qi. Mu Xiang (Radix Aucklandiae), Sha Ren (Fructus Amomi), 0.5 qian each; since Spleen Deficiency leads to Qi stagnation, these acrid-warm herbs move Qi and warm the Middle to rot and ripen food. Continue taking Wu Gui Wan (Wu-Gui Pill), see Spleen section. Alternatively, add Lian Rou (Lotus Seed), 5 qian, and Chen Nu Mi (Aged Glutinous Rice), 1 he, stir-fried and powdered, mixed with Bai Sha Tang (White Rock Sugar), taken fasting every morning with plain water for superior efficacy.

For Kidney Deficiency, add Po Gu Zhi (Fructus Psoraleae), 1.5 qian, benefits Kidney Qi; Rou Dou Kou (Semen Myristicae), 1 qian, stops deficiency diarrhea. These two harmonize to connect Spleen and Kidney Qi to transform food and water. Continue taking Wu Gui Wan. For Heat Diarrhea, stools are red-yellow, making snapping sounds with pain, anus feels scorched, stool exits hot like boiling water, accompanied by irritability, thirst, and dysuria. Use Chi Fu Ling (Red Poria) instead of Bai Fu Ling as the Sovereign herb, as Red corresponds to Fire, facilitating entry into the channel. Since Heat has entered the Large Intestine causing diarrhea, guiding it out via the anterior opening disperses its force. Add Zhu Ling and Ze Xie (0.5 qian each) as assistants, plus Yin Chen (Herba Artemisiae Scopariae) and Shan Zhi Ren (Semen Gardeniae), 0.5 qian each, both bitter-cold, clearing pathogenic Heat and promoting urination. Also take Ru Jin Wan (Ru-Jin Pill), see later. For Phlegm Diarrhea, add Ban Xia Qu (Massa Medicata Fermentata cum Bello Arisaematis), 1.5 qian, resolves phlegm. Use Chen Pi and Bai Fu Ling, 2 qian each; treating phlegm prioritizes moving Qi, and Poria promotes fluid metabolism. For Deficiency, add Ren Shen, 1 qian, as phlegm-Qi often stems from Spleen Deficiency failing to transform. Take Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice), 1 cup. For robust patients who can eat, adding Yuan Ming Fen (Natrii Sulfas) 1 qian allows expulsion via bowels, followed by astringents.

Food Stagnation Diarrhea features belching smelling like rotten eggs. Remove Bai Shao, add Zhi Shi (Fructus Aurantii Immaturus) and Mu Xiang, ground separately, 1 qian each (Qi-moving herbs), and Sha Ren, 0.5 qian. Select herbs based on the ingested item: Shan Zha (Fructus Crataegi) for meat, Shen Qu (Massa Medicata Fermentata) for grains, Luo Bo Zi (Semen Raphani) for flour, Ge Gen (Radix Puerariae) for alcohol, all 1 qian; Ding Xiang (Flos Caryophylli) 0.5 qian for crab. Continue Bao He Wan (Preserve Harmony Pill), see Food Injury section. Alcohol Accumulation causes morning diarrhea; add Ren Shen and Ge Gen, 1 qian each, Bai Dou Kou Ren (Semen Cardamomi), Wu Zhu Yu (Fructus Evodiae), 0.5 qian each. For Cold Diarrhea, add Ren Shen, 1 qian, Shu Fu Zi (Prepared Radix Aconiti Lateralis Preparata), Ge Gen, 0.5 qian each; insufficient Yang generates Cold, so Ren Shen tonifies Qi, while Ginger and Aconite dispel Cold. For inability to eat, take Ba Wei Wan (Eight-Ingredient Pill). If originally Cold Diarrhea becomes complicated by Cold-Dryness inducing drinking, leading to more diarrhea upon drinking, remove Bai Shao, add Gan Jiang (Rhizoma Zingiberis Recens), Huang Lian (Rhizoma Coptidis), Ren Shen, 1 qian each. Gan Jiang treats initial Cold, Huang Lian resolves added Heat; otherwise, how can Cold persist? Long-standing Heat Diarrhea leads to Deficiency and Deficient Heat, requiring Ren Shen for tonification. This is Li Zhong Tang (Regulate the Middle Decoction) plus Huang Lian, named Lian Li Tang (Coptis and Atractylodes Decoction), showing miraculous effects. It is especially suitable for Summerheat-Damp cases mimicking Heat Diarrhea unresponsive to other drugs.

Wind Diarrhea features undigested food. Danxi attributed it to Spleen Deficiency; if Spleen tonification fails, treat Wind. *Su Wen* states: "Long-standing Wind entering the interior causes Sundry Diarrhea (Sun Xie)." And: "Wind injury in Spring leads to Sundry Diarrhea in Summer." *Shi Ji* calls it Hui Feng (Returning Wind). Undigested food is a sign of Hui Feng; Lian Li Tang must be assisted by Qiang Huo and Fang Feng to raise Qi; once orifices open, latent Wind departs. This is a Wind syndrome. Replace Bai Zhu with Cang Zhu in the base formula, add Qiang Huo and Fang Feng (Radix Saposhnikoviae), 1 qian each (Acrid-Warm opens orifices and expels Wind), Sheng Ma (Rhizoma Cimicifugae) and Chai Hu (Radix Bupleuri), 0.5 qian each. Classics state: "Clear Qi sinking below causes Sundry Diarrhea." These herbs assist Acrid-Sweet flavors to raise Clear Qi. Withhold food for 1-2 days; diarrhea should cease. Summerheat Diarrhea is similar to Heat Diarrhea; take Liu He Tang (Six-Harmony Decoction) and eat chilled Watermelon slices.

Qi Diarrhea features borborygmus, moving Qi, chest oppression, acute abdominal pain relieving temporarily after defecation then returning, with Qi blockage. This stems from Middle Jiao stagnation, failed Qi flow, and failure to separate clear/turbid. Replace Bai Zhu with Cang Zhu, remove Bai Shao (due to sour astringency). Add Zhi Hou Po (Magnolia Bark processed with ginger), Da Fu Pi (Pericarp Arecae), 1 qian each (dissipates knotting Qi, attacks heart/abdominal Qi), Bai Kou Ren (Cardamom Seed), 0.5 qian (Acrid-Warm descends Qi and regulates Middle). Grind in Mu Xiang juice (treats stagnant abdominal Qi; roasted Mu Xiang solidifies Large Intestine). If dysuria, add Zhu Ling and Ze Xiang, 0.5 qian each, and Che Qian Zi San (Plantago Seed Powder). If thirsty, add Ren Shen and Mai Dong (Radix Ophiopogonis), 1 qian each (tonify Spleen/Lung to generate fluids); Sheng Ma, 0.5 qian (guides Clear Qi to mouth); Wu Mei Rou (Pericarpium Mume), 5 pieces (sour stops thirst). For long-term diarrhea with Qi Collapse, add Ren Shen, 1 qian, Ying Su Ke (Pericarpium Papaveris), 5 pieces (astringes collapsing Qi); He Zi Pi (Pericarpium Terminaliae), Rou Dou Kou, Mu Xiang (roasted/ground), Sha Ren, 0.5 qian each (Rou Dou Kou is key for stopping diarrhea/astringing collapse; roasted Mu Xiang solidifies intestine; Sha Ren regulates Qi). Long-term diarrhea sinks Qi; use lifting herbs: Sheng Ma, Chai Hu, 1 qian each; Qiang Huo, Fang Feng, 0.5 qian each (Wind herbs inspire Yuan Qi to rise). For chronic diarrhea or recurrence after remission, there is residual accumulation. Add San Leng (Rhizoma Sparganii) and E Zhu (Rhizoma Curcumae), vinegar-boiled and dried, 1 qian each (resolve accumulation); Mu Xiang, Sha Ren, 0.5 qian each (regulate Qi). Take Bao He Wan.

If taking Li Zhong Tang causes diarrhea despite normal urination, or if dysuria accompanies diarrhea, one ignores the error of failed Qi transformation. Originally, Lung fails to transmit; using pure Heat herbs worsens diarrhea (less dose stops it, more increases Heat). Use Chen Pi and Qing Pi (Exocarpium Citri Reticulatae Viride) instead. Classics: "Bladder is the mansion of fluids; only through Qi transformation can they exit."

*Rumen Shiqin* records: Mr. Yang from Shandong treated a governor's persistent Profuse Diarrhea (Dong Xie). Instead of prescribing immediately, he discussed astronomy and weather from Chen to Wei hours. The patient listened and forgot to defecate. Yang said: Treat Profuse Diarrhea by first asking about the patient's hobbies. (Good doctors adapt treatments creatively, not rigidly relying on herbs; their wisdom surpasses mediocre physicians. Give chess to chess lovers, music to music lovers.) Commentary: This method applies not only to diarrhea but also to Seven Emotions and Consumption. Like Chu Crown Prince curing illness through Wu Guest's debate (*Qi Fa*), though allegorical, it holds truth. Few understand such subtleties today, let alone find them among mediocre doctors. Regrettable!

*Bai Yun Ji*: Huang Zinong, a Jiangxi physician, treated a neighbor's wealthy man with year-long diarrhea. After ten days of ineffectual treatment, he requested leave to study. Reading *I Ching*, Qian Hexagram "Heaven's movement is vigorous," Zhu Xi noted: Heaven's rotation supports Earth like a spinning bowl; if it stops, it falls. Huang realized the patient's Qi failed to lift, causing downward collapse. Observing water dripping: covering the top keeps water in; releasing lets it drain. He cured the old man by moxibustion on Bai Hui (GV20); after 30-40 moxa cones, diarrhea stopped.

Case 1: Internal-pushing herbs caused severe diarrhea and urinary retention. Wu Ling San (Five-Ingredient Powder with Poria) caused complete retention; Chen Pi and Fu Ling restored Qi transformation and efficacy. Case 2: Deficiency patient taking Fu Zi (Heat herbs) developed urinary retention. Other herbs failed; Huang Lian and Huang Qin (Scutellaria Root) were effective.