Those who have spontaneous diarrhea without thirst belong to Taiyin, as there is cold stored within. It should be warmed, and it is appropriate to take the Four Counterflow category.

bubble_chart Note

• All those who have spontaneous diarrhea with thirst have internal heat, belonging to Yang.
• If there is spontaneous diarrhea without thirst, then there is internal cold, belonging to Yin.
• Now, with spontaneous diarrhea without thirst, it is known to be Taiyin Bencang with cold, thus it should be warmed.
• The Four Counterflow category refers to decoctions such as Four Counterflow, Regulate the Middle, and Aconite Lateral Root.

bubble_chart Collected Annotations

• Cheng Zhi said: "It is said that Taiyin's spontaneous diarrhea is due to cold and should be warmed. Shaoyin belongs to kidney water; when heat enters and consumes its water, there is spontaneous diarrhea with thirst. Taiyin belongs to spleen earth; when cold enters and follows its dampness, there is no thirst but diarrhea, thus Taiyin's spontaneous diarrhea should be warmed."
• Cheng Yingmao said: "The three Yin all belong to stored cold. Shaoyin has thirst symptoms, while Taiyin uniquely lacks thirst symptoms because its cold is in the middle energizer, unrelated to the dragon and thunder fire. Shaoyin contains dragon fire; when the base is very cold, the dragon rises, hence spontaneous diarrhea with thirst. Jueyin contains thunder fire, hence there is consumptive thirst. When the great Yang shines, the thunder and rain cease, hence fever stops diarrhea, and when there is reversal, diarrhea returns."
• Wei Li-tong said: "The term 'spontaneous diarrhea' refers to cases that have not been caused by mistaken purging, sweating, or vomiting, hence it is known that there is inherent cold stored within."

bubble_chart Formula

Regulate the Middle Pill Formula
Ginseng, White Atractylodes Rhizome, Liquorice Root (roasted), Dried Ginger, each three taels
The above four ingredients are pounded and sieved, mixed with honey to form pills the size of an egg yolk. Several he of boiling water are used to dissolve one pill, which is then crushed and taken warm, three to four times during the day and twice at night. If the abdomen does not feel warm, increase to three or four pills, but deficient decoction. The decoction method uses the four ingredients, cut according to the number of taels, boiled in eight sheng of water to obtain three sheng, strained, and taken warm, one sheng at a time, three times a day.

Modification method:

• If there is a sensation of building above the navel, it is due to kidney qi movement; remove Atractylodes and add four taels of Cinnamon.
• If there is excessive vomiting, remove Atractylodes and add three taels of Fresh Ginger Rhizome.
• If there is excessive diarrhea, continue to use Atractylodes;
• If there is palpitation, add two taels of Poria.
• If there is thirst and desire for water, add Atractylodes, making a total of four and a half taels.
• If there is abdominal pain, add Ginseng, making a total of four and a half taels.
• If there is cold, add Dried Ginger, making a total of four and a half taels.
• If there is abdominal distension and fullness, remove Atractylodes and add one piece of Aconite Lateral Root.

bubble_chart Collected Explanations

• Cheng Yingmao said: "The movement of yang begins with warmth. When the warmth is obtained, the essence of grain circulates; when the grain qi rises, the middle qi is nourished. Therefore, it is called 'Regulating the Middle,' which actually refers to the function of harmonizing and regulating, benefiting the yang of the middle energizer. It is said that yang deficiency leads to the loss of middle qi, the inability of the chest to disperse and promote, and the failure of the six fu organs to perform their functions of spreading and distributing. This is like a pot losing its flame, resulting in the lower part producing clear grain and the upper part losing its taste, leading to the disruption of the five zang organs and the emergence of various symptoms. Ginseng, Atractylodes, and roasted licorice are used to protect the middle region, while dried ginger, with its pungent nature, warms the middle. It is necessary to rely on these to ignite the flame of the pot and elevate yang qi. Thus, grain enters the yin, and qi grows in the yang, ascending to nourish the upper body and descending to govern the lower regions, ensuring that the five zang and six fu organs all receive qi. This is the essence of 'Regulating the Middle.' If water and cold contend with each other, it is necessary to warm both the spleen and kidneys, adding aconite lateral root to strengthen the life gate and warm the earth mother. White Atractylodes Rhizome tonifies the spleen, but when combined with ginseng, it may cause qi stagnation. Therefore, in cases of moving qi below the navel, excessive vomiting, or abdominal distension and fullness, Atractylodes should be removed. Cinnamon is added to subdue kidney pathogens, fresh ginger rhizome to stop vomiting, and aconite lateral root to dispel yin. If there is excessive diarrhea, it indicates dampness predominance, and Atractylodes should be used to dry dampness. If there is thirst and a desire to drink water, Atractylodes is added to transform the fluid and generate fluids. If there is palpitation below the heart due to retained water, Poria is added to guide the water. For abdominal pain, ginseng is doubled to address deficiency pain. If there is cold, dried ginger is added to address severe cold."