Library

In ancient times, there was no name for "dysentery" (Li Ji). It was only called "Zhi Xia" (stagnant downward discharge). Today, based on the pathology and the nature of diarrhea, it is named "Li". However, the formation of this syndrome is not due to causes occurring overnight.

It is generally caused by irregular diet in daily life. Indulging in greasy and raw/cold foods without restraint, or eating at irregular intervals, or choosing food without regard to temperature. These substances stagnate and accumulate in the middle jiao, failing to digest over time. Alternatively, one may be externally affected by summerheat-dampness, internally injured by the seven emotions (joy, anger, worry, thought, grief, fear, fright), engage in sexual intercourse after excessive drinking, or exert oneself after being overly full. The accumulated matter undergoes transformation into a sticky consistency, presenting as a mixture of red and white, or purely yellow. Normal feces are not seen, only the accumulated exudate. This occurs because the matter is transformed through the influence of Qi and Blood. Injury to the Blood results in red color; injury to the Qi results in white color; injury to both Qi and Blood results in a mixture of red and white. Yellow indicates that the Spleen is also injured. Cases of purely red and white discharge are not necessarily unrelated to Spleen injury.

If the stool contains no red or white but is purely yellow, it specifically injures the Spleen Earth, while Qi and Blood are not yet severely disturbed. As for dysentery resembling black dust or leaking roof water, these are incurable conditions. Those suffering from "Jin Kou Li" (dysentery with inability to eat) often die because they lack Stomach Qi, and pathogenic heat is solely constrained in the upper jiao. The general treatment principle is: in the early stage, one should first purge and eliminate stagnation, followed by regulation. In chronic cases, tonification and astringency should be employed cautiously. One must absolutely avoid using astringent herbs abruptly. If astringents are used in initial dysentery, the accumulated pathogens will not be expelled, often leading to death. Furthermore, one should not recklessly prescribe Huang Qi (Astragali Radix) and Sheng Ma (Cimicifugae Rhizoma) simply because chronic dysentery leads to insecure Qi and Blood. If a patient with dysentery takes Huang Qi, abdominal distension will occur. Excessive use of Sheng Ma causes urine and accumulated pathogens to ascend to the upper jiao, which is a rapid path to death. If Blood is injured, regulate the Blood; if Qi is injured, regulate the Qi; if the Spleen is injured, nourish the Spleen. Apply cold-natured herbs when appropriate, warm-natured herbs when appropriate, drying herbs when appropriate, and clearing-heat herbs when appropriate. Medication must be tailored to the disease; how can one adhere rigidly to a single method?

The pulse in dysentery should be fine and small; floating and surging pulses are contraindicated. Slippery and large pulses are acceptable; wiry and rapid pulses are contraindicated. It is said that those with a cool body and fine pulse will survive, while those with a hot body and large pulse will die. Shuhe (Wang Shuhe) stated: "Dysentery with a fine/small pulse may recover; with large, floating, or surging pulses, there is no day of recovery."