柴胡系列

Chapter 4, Chaihu series

Chaihu is the root of plant Bupleurum chinense.

In TCM, Chaihu works to balance the Yin and Yang, the inside and the surface of the body. It works to stop the Hot-Cold shift feeling, the fullness and pain in the chest and ribs, bitter taste, deafness, headache, dizziness, malaria, diarrhea, disorders in menstruation, and more.  

Chaihu belongs to a herb associated to Liver. Liver system in the body is associated with the Wind, and the spring. In spring, the natural Qi is rise. (in autumn, the natural Qi is falling, shrinking). Therefore the herb Chaihu works to lift the body Qi up, whereas the Dahuang brings the Body Qi down. The Chaihu therefore works to bring the disease-causing factors (the Xieqi) from deep side of the body to the shallow layer of the body.

Some of the most important Chaihu containing herbal formula are: Xiao Chaihu Tang, Da Chaihu Tang, Sini San and Chaihu Guizhi Ganjiang Tang. Check here first to see how the Master used them. Later, we will introduce more in detail how to use them.

   Chaihu (Radix Bupleuri)

(1). 小柴胡汤系列

Xiao Chuihu Tang

柴胡半斤，黄芩三两， 人参三两， 半夏（洗）半升， 甘草（炙）三两， 生姜（切）三两，大枣（擘）十二枚．

Chaihu 90 gram, Huangqin 45 gram, Renshen 45 gram, Banxia (washed) 124 gram, Gancao (processed) 45 gram, Fresh ginger 45 gram, Chinese date 62 gram.

右七味，以水一斗二升，煮取六升，去滓再煎，取三升，温服一升，日三服。

加减法：若胸中烦而不呕，去半夏、人参、加栝蒌实一枚。

若渴，去半夏，加人参合前成四两半，栝蒌根四两。

若腹中痛者，去黄芩加芍药三两。

若胁下痞硬，去大枣加牡蛎四两。

若心下悸，小便不利者，去黄芩加茯苓四两。

若不渴，外有微热者，去人参加桂枝三两，温服微汗愈。

若咳者，去人参、大枣、生姜，加五味子半升，乾姜二两。

Add the herbs and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 1500 ml liquid in the pot left. Remove the herbal residue, continue the cook until there is about 750 ml left. Collect the herbal tea. Drink one third of the tea each time, three times a day.

Modification of the formula:

(1). If the person is with annoyed in chest but no nausea: remove Banxia and Renshen, add Gualushi 45 gram;

(2). If with thirsty, remove Banxia, add additional Renshen 23 gram, and add Gualougen 60 gram;

(3). If with stomach pain, remove Huangqin, but add Shaoyao 45 gram;

(4). If with fullness and hard on the side of upper stomach, remove Chinese date, but add Muli 60 gram;

(5). If with palpitation and hard in urine, remove Huangqing, but add Fuling 60 gram;

(6). If with mild hot but no thirsty, remove Renshen, but add Guizhi 45 gram, drink the tea when it is warm;

(7). If with cough, remove Renshen, fresh ginger and date, but add Ganjiang 30 gram, and Wuweizi 25 gram.

81　阳明中风，脉弦浮大而短气，腹部满，胁下及心痛，久按之气不通，鼻乾，不得汗，嗜卧，一身及目悉黄，小便难，有潮热，时时哕，耳前後肿，刺之小差，外不解，病过十日，脉续弦[1]者，与小柴胡汤。脉但浮，无馀证者，与麻黄汤，若不尿，腹满加哕者，不治。

In Wind-invasion Yangming stage, the person has floating and string and big pulse,[2] has short of breath, full stomach, pain in upper and side stomach area, stagnation feeling when pressed for a longer time, dry nose, hard to have sweat, tends and willing to lie down, yellow in color in whole body and eyes, hard in urine, wave-hot, Yue syndrome from time to time, swelling in front and in rear of the ears, and if acupuncture only helps little bit for the whole conditions but the Taiyang condition remains. If after ten days the conditions remain, the pulse is string, Xiao Chaihu Tang is used. If the pulse is only floating after the ten days, and no other new symptoms, Mahuang Tang is used. If he has no urine, feels fullness in Stomach and the Yue syndrome, it is difficult to treat. 

02 　少阳中风，两耳无所闻，目赤，胸中满而烦者，不可吐下，吐下则悸而惊。(小柴胡汤主之).

In Wind-invasion Shaoyang stage, if the person feels deafness in the ear, red eyes, fullness in chest and annoyed/impatience, vomiting therapy or bowel-cleansing therapy should not be used. Other wise, he will have palpitation and panic syndrome.[3] (Xiao Chaihu Tang should be used.)

04 　伤寒五、六日，中风，往来寒热，胸胁苦满，默默不欲饮食，心烦，喜呕，或胸中烦而不呕，或渴，或腹中痛，或胁下痞硬，或心下悸，小便不利，或不渴，身有微热，或咳者，小柴胡汤主之。

If the Cold-invasion Shanghan disease lasts for five to six days, and if it is a Wind-invasion type, the person feels cold-hot shift, fullness in chest and side of the upper stomach, no-willing silent[4] and no appetite, annoyed/impatience, easy to nausea, or annoyed feeling in chest but no nausea, or feels thirsty, or pain in Stomach, or hard and full in the side of upper stomach, or palpitation in the upper stomach with difficulty in urine, or no thirst but hot, or cough. For all, use Xiao Chaihu Tang. [5]

07    伤寒四、五日，身热恶风，颈项强，胁下满，手足（他觉）温而渴者，小柴胡汤主之。

With Cold-invasion Shanghan disease for four to five days, if the person feels hot and dislike wind, has stiff in neck (back and side of the neck), fullness in the side of the upper stomach, thirsty and warm hands and feet (when touch), Xao Chaihu Tang is to be used. [6]

08    阳明病，发潮热，大便溏，小便自可，胸胁满不去者，与小柴胡汤。

When in Yangming stage and Shaoyang stage, if the person has wave-hot, loss bowel movement and easy urine, and has fullness in the chest and side of the upper stomach, use Xiao Chaihu Tang. [7]

09　阳明病，胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤，上焦得通，津液得下，胃气因和，身濈然汗出而解。

When in Yangming stage and Shaoyang stage, if the person has no bowel movement (Yangming stage), but also has hard and fullness in the side of the upper stomach (not in whole Stomach area), has nausea and white tongue covering, use Xiao Chaihu Tang. [8]　This herb harmonize the Upper Jiao (the chest part), so the Jingye can move down to humidify the bowel tract, and to create sweat to solve the disease.

10　凡柴胡汤病证而下之，若柴胡证不罢者，复与柴胡汤，必蒸蒸而振，却发热汗出而解。

If it is originally a Chaihu Tang condition, but a bowel-cleansing therapy is given and the Chaihu Tang condition remains, give the Chaihu Tang again. The person will have continuous and mild sweat to cure.

15　伤寒五、六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉沉细者[9]，此为阳微结，必有表复有里也，脉沉亦在里也。汗出为阳微，假令纯阴结，不得复有外证，悉入在里，此为半在里半在外也。脉虽沉细[10]，不得为少阴病，所以然者，阴不得有汗，今头汗出，故知非少阴也，可与小柴胡汤，设不了了者，得屎而解。

In the Cold-invasion Shanghan disease for five to six days, if the person has sweat but only on the head, feels mild chilly, cold in hands and feet, fullness in the upper stomach, no appetite, and has hard bowel movement and deep and thin pulse, his condition belongs to mild Yangjie condition. It indicates the Xieqi moves from the surface into the inside, so the pulse becomes deep, deep pulse suggesting the disease is in inside of the body. Sweat is due to short of Yangqi. On the other hands, if the condition belongs to a pure Yinjie condition, the person should have no surface symptoms and the person’s symptoms all indicate an inside condition. Now the symptoms suggest the condition half in the surface and half in the inside. It should not be regarded as Shaoyin stage, though the pulse is deep and thin, since there should have no sweat in Shaoyin stage. In this Shaoyang condition, use Xiao Chaihu Tang. If this herbal formula work not so satisfied, try bowel-cleaning therapy to remove dead stool in the stomach. [11]

16　伤寒阳脉涩，阴脉弦，法当腹中急痛者，先与小建中汤，不差者，与小柴胡汤主之。

With Shanghan disease, if the pulse is harsh when pressed slight, but string when pressed deeper, the person should have acute pain in stomach. Xiao Jianzhong Tang should be used first. If it does not work, try Xiao Chaihu Tang.

18　太阳病，十日以去，脉浮细而嗜卧者，外已解也。设胸满胁痛者，与小柴胡汤；脉但浮者，与麻黄汤。

With Shanghan disease in Taiyang stage for more than ten days, the person has a willingness to lie down, has floating and thin pulse, suggesting the surface Xieqi has been released. If the person still feels fullness and pain in the chest and in the side of upper stomach, use Xiao Chaihu Tang. If the person has floating pulse and has a willingness to lie down, use Mahuang Tang. [12]

20　太阳病，过经十馀日，反二、三下之，後四、五日，柴胡证仍在者，先与小柴胡汤。呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤下之则愈。

Previously in Taiyang stage, the disease has passed for more than ten days, the bowel-cleansing therapy has been repeated two to three times. After additional four to five days, if the Chinhu Tang condition remains, use Xiao Chaihu Tang. If the person has continuous vomiting, feels urgent feeling in the upper stomach, mild but continuous annoyed/impatience, use Da Chaihu Tang.

22　伤寒十三日不解，胸胁满而呕，日晡所发潮热，已而微利，此本柴胡证，下之而不得利。今反利者，知医以丸药下之，非其治也。潮热者，实也，先宜小柴胡汤以解外，後以柴胡加芒硝汤主之。

With a Cold-invasion Shanghan disease for thirteen days, the person feels fullness in the chest and side of upper stomach, nausea, wave-hot around sunset time, followed by a mild diarrhea. This is condition for Chaihu Tang. If he is given bowel-cleansing therapy, he will have clear diarrhea. It is a wrong treatment. Wave-hot suggests a Shi condition, Xiao Chaihu Tang should be used to release Xieqi from body surface, then use Chaihu jia Manxiao Tang to deplete it through bowel movement.

27　妇人中风，七、八日续得寒热，发作有时，经水适断者，此为热入血室，其血必结，故使如疟状，发作有时，小柴胡汤主之。

If a woman got Wind-invasion, after seven to eight days, she feels hot and chilly again and again, and the period stops. This condition suggests that the invaded Fire has invaded into the uterus. The blood must be clotted[13], so to make the hot-cold repeat as a malaria. Xiao Chaihu Tang is to be used. [14]

产妇郁冒，其脉微弱，不能食，大便反坚，但头汗出。所以然者，血虚而厥，厥而必冒，冒家欲解，必大汗出；以血虚下厥，孤阳上出，故头汗出。所以产妇喜汗出者，亡阴血虚，阳气独盛，故当汗出，阴阳乃复，大便坚，呕不能食，小柴胡汤主之。病解能食，七、八日更发热者，此为胃实，大承气汤主之。

For woman with Yumao disease, her pulse is weak, cannot eat, the stool is hard, but there is sweat on head. This is because the blood deficiency, which causes reverse cold in hands and feet. The later condition then causes the Yumao condition. Person with the Yumao will have sweat before the condition is to solve. The sweat is due to the floating Yangqi in the head (the cold in residue in the lower part of the body: cold feet). Woman who has easy sweat depleted the Yin and causes blood deficiency. If the woman has nausea and hard to eat, has hard stool, use Xiao Chaihu Tang. If the disorder has been solved but she has fever again after seven to eight days, this condition is fullness condition in the abdomen, use Da Chengqi Tang to solve it.  

29　血弱气尽，腠理开，邪气因入，与正气相抟，结於胁下，正邪分争，往来寒热，休作有时，默默不欲饮食，藏府相连，其痛必下，邪高痛下 (一云：藏府相连，其病必下，胁膈中痛)，故使呕也，小柴胡汤主之。

If a person has weakness in blood, short in Qi, his out defense system is weak too. This allows Xieqi come in, stick in the side of the upper stomach. The body defense Qi and the Xieqi combat each other, making the person feels hot-cold repeatedly with a fixed pattern. The person feels silent/quiet/no desire to eat. The Xieqi comes down into the stomach, makes him feel nausea. In this case, use Xiao Chaihu Tang.

30　呕而发热者，小柴胡汤主之（衍文，已见太阳中篇半夏泻心汤条上）。少阳病，欲解时，从寅至辰上。

If a person has nausea and hot, Xiao Chaihu Tang is the main formula to use.

02　伤寒差已，後更发热，小柴胡汤主之。脉浮者，以汗解之 (注：枳实栀子鼓汤)，脉沉实者，以下解之（注：枳实栀子鼓汤加大黄）。

After recovery from Shanghan disease, the person has fever again, use Xiao Chaihu Tang. If the pulse is floating, use sweat therapy (Zhishi Zhizi Chi Tang). If it is deep and strong, use bowel-cleansing therapy (Zhishi Zhizi Chi Tang jia Dahuang.  

02  本太阳病不解，转入少阳者，胁下硬满，乾呕不能食，往来寒热，尚未吐下，脉沉弦[15]者，与小柴胡汤。若已吐、下、发汗、温针，谵语，柴胡汤证罢，此为坏病，知犯何逆，以法治之。

The Xieqi in the Taiyang stage has not been fully depleted but also develops into the Shaoyang stage. The person feels hard and fullness in the side of upper abdomen, dry nausea and hard to eat, has cold-hot shift. If he has not been given vomiting or bowel-cleansing therapy, and if his pulse is deep and string, use Xiao Chaihu Tang. If he has been given vomiting therapy, bowel-cleansing therapy, sweat therapy, warm-acupuncture therapy, and if he has Chattering syndrome, the use of Xiao Chaihu Tang doesn’t work. This condition now belongs to wrong-treated condition.

(2). 柴胡加芒硝汤

Chaihu jia Manxiao Tang

於小柴胡汤方内，加芒硝六两，馀依前法服，不解更服。

Add Manxiao 90 gram into the previous Xiao Chaihu Tang.

22　伤寒十三日不解，胸胁满而呕，日晡所发潮热，已而微利，此本柴胡证，下之而不得利。今反利者，知医以丸药下之，非其治也。潮热者，实也，先宜小柴胡汤以解外，後以柴胡加芒硝汤主之。

With a Cold-invasion Shanghan disease for thirteen days, the person feels fullness in the chest and side of upper stomach, nausea, wave-hot around sunset time, followed by a mild diarrhea. This is condition for Chaihu Tang. If he is given bowel-cleansing therapy, he will have clear diarrhea. It is a wrong treatment. Wave-hot suggests a Shi condition, Xiao Chaihu Tang should be used to release Xieqi from body surface, then use Chaihu jia Manxiao Tang to deplete it through bowel movement.

(3). 柴胡去半夏加栝蒌汤

Chaihu qui Banxia jia Gualu Tang

柴胡（八两）， 人参， 黄芩 ，甘草（各三两）， 栝蒌根（四两）， 生姜（二两）， 大枣（十二枚）

Chaihu 125 gram, Renshen 45 gram, Huangqin 45 gram, Gancao 45 gram, Gualugen 60 gram, fresh ginger 30 gram, Chinese date 12 badges.

右七味，以水一斗二升，煮取六升，去滓，再煎取三升。温服一升，日二服。

Add the herbs and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 1500 ml water left in the pot. Remove the herbal residues and continue the boiling of the herbal tea until the liquid in the pot is about 750 ml. Drink one third of the tea each time, three times a day.

柴胡去半夏加栝蒌汤 治疟病发渴者，亦治劳疟。

(4). 柴胡桂枝干姜汤

Chaihu Guizhi Ganjiang Tang

柴胡（半斤）， 桂枝（三两，去皮）， 干姜（二两）， 栝蒌根（四两）， 黄芩（三两）， 牡蛎（三两，熬）， 甘草（二两，炙）

Chaihu 90 gram, Guizhi 45 gram, Ganjiang 30 gram, Gualugen 60 gram, Huangqin 45 gram, Muli (processed) 45 gram, Gancao (processed) 30 gram.
       

右七味，以水一斗二升，煮取六升，去滓，再煎取三升。温服一升，日三服。初服微烦，复服汗出便愈。

Add the herbs and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 1500 ml. Remove the herbal residue, continue to cook the herbal tea until there is 750 ml left in the pot. Drink one third of the tea. Three times a day. After the first drinking, the person will feel slight annoyed, repeated drink causes sweat to recover.

13　伤寒五、六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝乾姜汤主之。

With Cold-invasion Shanghan disease for five to six days, the person has had sweat therapy, had sweat, but given bowel-cleansing therapy again. He now feels fullness in the side of the upper stomach, difficulty in urine, thirsty (no nausea), sweat only on head, cold-hot shift, annoyed/impatience. Chaihu Guizhi Ganjiang Tang is used. [17]

柴胡桂姜汤 治疟寒多，微有热，或但寒不热。
       

Chaihu Guizhi Ganjiang Tang for the treatment of Nue disease with more cold than hot, or only cold but no hot.

(5). 柴胡桂枝汤

Chaihu Guizhi Tang should be used. [18]

柴胡 四两, 桂枝  一两半, 人参  一两半, 甘草（炙）一两, 半夏（洗）二合半, 黄芩  一两半, 芍药 一两半, 大枣（擘）六枚, 生姜（切）一两半.

Chaihu 60 gram, Guizhi 23 gram, Renshen 23 gram, Gancao (processed) 15 gram, Banxia (washed) 50 gram, Huangqin 23 gram, Shaoyao 23 gram, Chinese date 30 gram, Fresh ginger 23 gram.

右九味，以水七升，煮取三升，去滓，温服一升。

Add the herbs and 1750 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea each time, three times a day.

12　伤寒六、七日，发热微恶寒，支节烦疼，微呕，心下支结，外证未去者，柴胡桂枝汤主之。

When Cold-incation Shanghan has been for six to seven days, the person feels hot and slight chilly, continuous pain in the joints, mild nausea, little fullness in the upper stomach. Chaihu Guizhi Tang should be used. [19]

80　发汗多，亡阳谵语者，不可下，与柴胡桂枝汤和其荣卫，以通津液後自愈。

If the person has too much sweat after a sweat therapy, has depleted Yanggi and Chattering syndrome, bowel-cleansing therapy should not be used. In this case, use Chaihu Guizhi Tang to harmonize his Rongqi and Weiqi, to harmonize his Jingye to cure.

(6). 大柴胡汤

Da Chaihu Tang

柴胡　半斤，黄芩　三两， 半夏（洗）半升， 芍药　三两， 枳实（炙）四枚， 大黄　二两， 生姜（切）五两， 大枣（擘）十二枚．

Chaihu 90 gram, Huangqin 45 gram, Banxia (washed) 62 gram, Shaoyao 45 gram, Zhishi (processed) 60 gram, Dahuang 30 gram, Fresh ginger 75 gram, Chinese date 62 gram.

右八味，以水一斗二升，煮取六升，去滓再煎，温服一升，日三服。

Add the herbs and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 1500 ml.  Remove the herb residue, continue to boiling until there is about 250 ml left. Collect the herbal tea. Drink one third of the tea each time, three times a day.

19    伤寒发热，汗出��解，心中痞硬，呕吐而不下利者[20]，大柴胡汤主之。(太阳病发热汗出不解，心下痞硬，下利不呕吐者，此表里俱虚，桂枝人参汤证也。)

With Cold-invasion Shanghan disease, the person feels hot and sweat but the symptoms remains, and he feels fullness and hard in the stomach, nausea and vomiting with difficult bowel movement[21], use Da Chaihu Tang.

20　太阳病，过经十馀日，反二、三下之，後四、五日，柴胡证仍在者，先与小柴胡汤。呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤下之则愈。

Previously in Taiyang stage, the disease has passed for more than ten days, the bowel-cleansing therapy has been repeated two to three times. After additional four to five days, if the Chinhu Tang condition remains, use Xiao Chaihu Tang. If the person has continuous vomiting, feels urgent feeling in the upper stomach, mild but continuous annoyed/impatience, use Da Chaihu Tang.

10　伤寒後脉沉，沉者内实也，下之解，宜大柴胡汤。

After a Shanghan disease, if the person has a deep pulse, the deep pulse means an inside Fullness condition. Use Da Chaihu Tang. 

46　伤寒十馀日，热结在 里，复往来寒热者，与大柴胡汤。但结胸无大热者，此为水结在胸肋也，但头微汗出者，大陷胸汤主之。

If the Cold-invasion Shanghan disease has existed for more than ten days, the hot Jiexiong remains with repeated fever and chilly, Da Chaihu Tang should be used. If there is the Jiexiong syndrome, but no strong fever, it means a situation of water-condensed in the upper stomach area. In this case, if there is slight sweat in only the head, Da Xianxiong Tang is the main herbal formula. [22]

按之心下满痛者，「有潮热」,  此为实也，当下之，宜大柴胡汤。

If the person has fullness and pain on his upper stomach upon pressing, (and he has wave-hot), the condition belongs to Fullness, should use depletion therapy, use Da Chaihu Tang

(7). 柴胡加龙骨牡蛎汤

Chaihu jia Longgu Muli Tang

柴胡　四两， 半夏（洗）二合， 龙骨　一两半， 人参　一两半， 大黄　二两， 牡蛎　一两半， 茯苓　一两半， 铅丹　一两半， 桂枝　一两半， 生姜　一两半， 大枣（擘）二枚

Chaihu 60 gram, Banxia (washed) 26 gram, Longgu 23 gram, Renshen 23 gram, Dahuang 30 gram, Muli 23 gram, Fuling 23 gram, Qiandan 23 gram, Guizhi 23 gram, Fresh ginger 23 gram, Chinese date 2 badges.

右十一味，以水八升，煮取四升，内大黄切如棋子，更煮一、二沸，去滓，温服一升。

Add the herbs (except Dahuang) and 2000 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is half of the volume. Add the Dahuang in. Continue to cook for several minutes. Collect the herbal tea. Drink one quarter of the tea.

09  伤寒八、九日，下之，胸满烦惊，小便不利，谵语，一身尽重，不可转侧者，柴胡加龙骨牡蛎汤主之。

With Shanghan disease for eight to nine days, the bowel-cleansing therapy is give. The person feels fullness in chest, scared/phobia feeling, hard in urine, Chattering syndrome, feels heavy in the whole body so that it is hard to turn the body. In this case, use Chaihu jia Longgu Muli Tang. [23]

(8). 四逆散

Sini San

甘草（炙） 枳实（破，水渍，炙乾） 柴胡 芍药

Gancao (processed); Zhishi (processed, water rinsed and then dried); Chaihu; Shaoyao.

右四味，各十分，捣筛，白饮和服方寸匕，日三服。

Make the above herbs into powder, mix 40 gram each of the herbs. Drink the powder, three times a day.

咳者，加五味子、乾姜各五分，并主下利。悸者，加桂枝五分。小便不利者，加茯苓五分。腹中痛者，加附子一枚，炮令折。泻利下重者，先以水五升，煮薤白三升，煮取三升，去滓，以散三方寸匕，纳汤中，煮取一升半，分温再服。

If with cough or diarrhea, add Wuweizi 20 gram, Ganjiang 20 gram; If with palpitation, add Guizhi 20 gram; If with difficult in urine, add Fuling 20 gram; If with pain in stomach, add Fuzi 45 gram; if the diarrhea is very heavy, cook Xiebai 150 gram in 1250 ml water until the liquid in the herbal pot is about 750 ml. Collect the herbal tea, mixed with 4.5 gram the Sini San powder, continue to cook until the herbal tea becomes about 300 ml. Separate the tea into several parts, drink one part each times, repeat 3 to 5 times a day.

30　少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。

In Shaoyin stage, the person has reverse cold in hands and feet, he may have cough, or palpitation, or difficult in urine, or pain in stomach, or diarrhea with pressure feelings inside anus, use Sini San. [24]