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Fifth-watch diarrhea

五更泄 〔五更泄〕wǔ gēng xiè [wǔ jīng xiè]

Also early morning diarrhea. Described in Prolonging Life and Preserving the Origin (寿世保元 shòu shì bǎo yuán, xiè xiè). Diarrhea during the 5th watch (4–6 a.m.), i.e., before daybreak, heralded by pain. Fifth-watch diarrhea is usually caused by kidney yáng failing to warm the spleen; hence the term is often considered synonymous with kidney diarrhea. Strictly speaking, however, it may also be caused by food accumulation, liquor accumulation, and liver fire.

Patterns

Food accumulation (食积 shí jī) causes attacks of pain before daybreak relieved slightly by diarrhea. The pulse is sunken and slippery.

Medicinal therapy: Use variations of Harmony-Preserving Pill (保和丸 bǎo hé wán).

Liquor accumulation (酒积 jiǔ jī) fifth-watch diarrhea is heralded by pain before daybreak and is characterized by yellow foamy diarrhea, reddish urine or urine like rice water, and a rapid surging or rapid wiry pulse.

Medicinal therapy: Sichuan Coptis and Bitter Orange Decoction (川连枳壳汤 chuān lián zhǐ ké tāng).

Liver fire (肝火 gān huǒ) fifth-watch diarrhea is characterized by continual pain in the chest and rib-side that reaches into the lesser abdomenand is associated with reduced sleep. Before daybreak, there is pain in the left lower abdomen with a desire to go to the toilet, that is is relieved by defecation. The pulse is stringlike and rapid.

Medicinal therapy: Use Gentian Liver-Draining Decoction (龙胆泻肝汤 lóng dǎn xiè gān tāng). See kidney diarrhea; diarrhea.

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