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Dysentery, a condition known in ancient times as "Zhi Xia" (Stagnant Downward Discharge), occurs because turbid stagnation exists within the intestines, leading to difficult excretion. However, this stagnation may reside in the Qi level or the Blood level; it may result from cold injury or heat injury, so the causes of stagnation are not singular. Modern practitioners often equate "stagnation" solely with food retention, employing only digestive-promoting methods and dietary restrictions.

Both malaria and dysentery typically arise in summer and autumn due to the郁蒸 (decoction and steaming) of damp-heat, which impairs the Spleen and Stomach's ability to transform and transport water and grain. Damp-heat scalds the Qi and Blood, forming sticky substances, manifesting as abdominal pain preceding dysentery, and a feeling of incomplete evacuation (Li Ji Hou Zhong) after defecation. If illness is triggered by occasionally consuming melons, fruits, or ice-cold items, it does not necessarily immediately transform into heat. In such cases, one should initially use acrid-warm agents to disperse and promote flow. If there are dozens of episodes of pus and blood stools accompanied by abdominal pain and tenesmus, initial treatment should employ agents that vent and dispel heat, such as Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Da Huang (Rhei Radix et Rhizoma). However, Gan Cao (Glycyrrhizae Radix et Rhizoma) must be added to moderate the action. This differs from constipation in Shang Han (Cold Damage) syndrome, where Mang Xiao (Natrii Sulfas) is used for its salty nature to soften hardness and directly attack the Yin levels to purge accumulation. Here, the bitter flavor overcomes dampness, and the cold nature expels heat, which is sufficient to eliminate the disease. As the ancients said: "Moving the Blood heals pus and blood in the stool; directing the Qi removes tenesmus." Agents to move and cool the Blood include Dan Pi (Moutan Cortex), Tao Ren (Persicae Semen), Yan Hu Suo (Corydalis Rhizoma), Hei Zha (Fructus Crataegi Preparatus), Gui Wei (Radix Angelicae Sinensis Cauda), and Hong Hua (Carthami Flos). Agents to direct Qi include Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen), Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Shi (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), and Guang Pi (Citri Reticulatae Pericarpium). The common secular approach is merely this. Generally, malaria injures the meridians and can be delayed; dysentery affects the Zang organs, and misdiagnosis leads to danger. The fundamental principle of diagnosis is to first ascertain the strength of constitution and whether the skin is rough or tender, and further inquire about living habits and the cause of illness. In acute onset with solid constitution and excess symptoms, the aforementioned methods can be followed. In chronic illness with depleted Qi and spirit, even if abdominal pain and tenesmus exist, careful examination is required; one must not indiscriminately apply purgative or clearing-draining treatments. I briefly record one verified case for reference.

The seven-year-old son of a patient surnamed Shi. On July 23rd, after prolonged rainy and gloomy weather, he suffered from profuse diarrhea several times. The next day, he had abdominal pain and passed red and white dysenteric stools. Two pediatricians treated him for five or six days. On the second day of the following month, I examined him. He was vomiting, unable to eat, and had unceasing dysentery consisting entirely of bloody fluid. His abdominal pain was relentless day and night. Both pulses were fine, and the right pulse was choppy with occasional pauses. Sitting, he smelled the odor of medicine, specifically Da Huang (Rhei Radix et Rhizoma), and I instructed him not to take it. Mr. Shi said, "There are two doctors here; would you please consult with them?" I agreed. Entering the study to request the prescription, one doctor said, "Since the dysentery began, there has been no normal feces. Unless we purge and remove the accumulation, there is no other method." I replied, "Limbs are cold, dysentery is pure blood, lasting seven or eight days, abdominal pain without thirst. Observing the complexion, it is withered and pale with extremely dark qi. The pulse is fine and weak, non-resilient upon pressure. This is clearly Cold-Damp invading the Taiyin Spleen. Zhang Zhongjing's nine methods for Taiyin indicate no purgation." Therefore, I urgently decocted Ren Shen (Ginseng Radix et Rhizoma), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Pao Jiang (Prepared Zingiberis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), with a small addition of Rou Gui (Cinnamomi Cortex). After two doses, the turbid accumulation was discharged, and abdominal pain and dysentery significantly decreased. Subsequently, using Guo Shao Yi Gong San (Modified Yi Gong San with Peony and Angelica) and Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), he fully recovered within half a month.

Jin Kou Li (Closed-Mouth Dysentery), characterized by the inability to ingest water and grain, is caused by rising heat and attacking turbidity. It requires major bitter-cold herbs, such as Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Shi Lian Zi (Nelumbinis Nuculus), to clear heat, while Ren Shen (Ginseng Radix et Rhizoma) assists the Stomach and benefits Qi. Once the pathogenic heat dissipates, eating becomes possible. Medication should be administered frequently, in small amounts of two or three mouthfuls at a time.

Pediatric Xiu Xi Li (Resting Dysentery) that persists for a long time and transforms into post-defecation bleeding is difficult to cure quickly. If caused by Qi deficiency and sinking, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used. If caused by deficiency-cold leading to undigested food, Qian Shi Yi Huang San (Master Qian's Yellow-Enhancing Powder) is applied. If damp-heat remains but Qi is already deficient, Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) is employed. If the Stomach is strong and appetite good, bitter-cold herbs clear heat, combined with dietary restraint. Long-term regulation is necessary.

Chronic diarrhea and dysentery inevitably injure the Kidney, as the Kidney governs the two orifices. There is invariably persistent anal prolapse/tenesmus, differing from the urgency and heaviness of early-stage damp-heat. Treatment focuses on securing Yin fluids, possibly assisted by dispersing and tonifying. Over time, purely securing and grasping methods are used.

Children suffer most from heat diseases because their constitution is "Pure Yang." When the Six Evils invade, Qi and Blood transform into heat. Undigested food accumulates and steams internally, also transforming into heat. However, some cases feature recurrent fever after releasing the exterior, after purging the interior, or after promoting urination. Even nourishing Yin and clearing heat may fail to remove the fever. Zhang Jiming stated that when Yuan Qi (Primal Qi) has no place to reside, floating Yang causes sudden heat. Liu Shen Tang (Six Spirits Decoction) is the primary formula.