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(The character "Li" in the ancient text is written as "Di" in the modern text.)

Dysentery (lower abdominal pain with bloody stool) has three causes: those caused by external contraction of Wind, Cold, Summer-heat, and Dampness, resulting in dysentery with pus and blood, may result in death or survival, involve Qi or Blood, and require tonification or purgation, cold or hot treatments. These are detailed in *Shanghan Lun* (Treatise on Cold Damage), *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), and various formulas in *Qianjin Fang* (Thousand Gold Formulas); physicians should treat them according to specific patterns. There are also cases where Yang is invaded by mist and dew, and Yin is invaded by turbid pathogens, causing blood coagulation and downward discharge resembling pig liver, with both Yin and Yang Qi experiencing Jue (reversal), isolated and weak Spleen Qi, leakage of the Five Fluids downward, failure of the Lower Jiao to close, clear stool with a sensation of heaviness, frequent but difficult defecation, rumbling and mild pain in the navel area, leading to a life-threatening condition; this is discussed in detail in the *Bian Mai Pian* (Chapter on Pulse Differentiation). This is dysentery caused by external factors. There are also cases caused by irregular diet and improper daily routine, where pathogens enter through the Yin aspect into the Zang organs, causing fullness and blockage, manifesting downward as undigested food diarrhea (Sun Xie), and over time developing into Chang Pi (dysentery/intestinal inflammation); this is dysentery caused by internal factors. There are also atypical forms of dysentery, where the Three Yang meridians arrive simultaneously and cannot be resisted by the Three Yin meridians; accumulation and confluence cause fright, onset is sudden like fierce wind, rapid like thunderbolts, all nine orifices are blocked, Yang Qi overflows excessively, causing dry throat and obstruction, and if pathogens merge with Yin, movement becomes erratic, pressing into the intestines to form Chang Pi. The pulse is slow, small, deep, and choppy; if blood is warm and body temperature is high, it indicates death; if heat persists for seven days, it also indicates death. This is because Yang Qi is excessively vigorous while Yin Qi is injured, hence the pulse is small, deep, and choppy. This condition urgently requires Da Cheng Qi Tang (Major Order the Qi Decoction) to purge Yang and nourish Yin; delay will lead to untreatable conditions. If physicians do not understand the cause of atypical dysentery and, seeing a harmonious pulse, use mild formulas, it is no different from using poison. Therefore, I say: those who recover after taking mild formulas had illnesses that were originally non-fatal and could have recovered without medicine; those who become untreatable after taking mild formulas bear the fault of the physician.

Pathogens invading humans vary in depth among skin, flesh, sinews, bones, Fu, and Zang organs, and differ in their transformation according to Yin-Yang, Cold-Heat, Dryness, and Dampness. Moreover, since Wind moves freely and changes frequently, invasion of skin and hair results in mild symptoms such as headache, fever, cough, and rhinorrhea; invasion of blood vessels leads to insensitivity of skin and flesh, leprosy-like ulcers, or swelling; pathogens in muscles and sinews cause painful Bi syndrome, spasms, or hemiplegia; pathogens entering the abdomen cause Sun Xie or dryness and constipation; pathogens entering the Fu organs cause loss of consciousness; pathogens entering the Zang organs cause stiff tongue and inability to speak, with saliva and phlegm dribbling from the mouth. Thus, the depth of pathogen entry determines the severity and prognosis of the disease. Heaven has Six Excesses (Six Evils); Wind undergoes transformations of Six Qi. Pathogens attacking Yang transform into Heat; those striking Yin transform into Cold-Damp. Excess Dampness causes phlegm-saliva to obstruct upwards; excess Dryness causes binding downwards in the intestines and stomach. When pathogens are strong, both pathological Qi and formative Qi are excessive; when healthy Qi is deficient, both pathological Qi and formative Qi are deficient. Ultimately, these are Heavenly Wind pathogens, but within the human body, they transform into Cold, Heat, Dryness, Dampness, Deficiency, and Excess. Therefore, Liu Hejian stated that stroke is primarily due to Fire; Zhu Danxi stated it is primarily due to Phlegm; Li Dongyuan stated it is primarily due to Qi. It is also said that stroke occurs only in the elderly. All these views fail to understand the Dao of Yin-Yang Qi transformation. Facial deviation and spasms in children constitute Ji Man Jing Feng (Acute and Chronic Convulsions); in young adults, they constitute Stroke (Zhong Feng) with sudden onset. My niece, in her twenties, was very robust and vigorous. In midsummer, she often sought coolness, sleeping by the window exposed to the air. Suddenly, one day she suffered severe headache, fever, anhidrosis, thirstlessness but irritability, limb spasms, and facial deviation. I diagnosed her pulse as deep and fine in all six positions. I said, "The pathogen has entered the Zang organs; this is a critical condition." The next day she became aphasic, dribbled saliva, could not tolerate medication, and died three days later. Such presentations are common among the young and vigorous, not exclusive to the elderly. The Classics state: "Summer injury by Summer-heat, Winter injury by Cold." In summer, there is only Wind and Summer-heat, no Cold pathogen. Even if Cold-damp symptoms appear requiring hot herbs like Ginger (Sheng Jiang) and Aconite (Fu Zi), it is because the pathogen struck the interior Yin without receiving Yang-heat transformation, not due to Heavenly Cold. (In summer, Yang Qi is fully dispersed outward, leaving the interior deficient and cold.) Contemporary scholars mistakenly label this as Zhong Han (Cold Stroke). I smile faintly and say: "You certainly know that the young do not get stroke. But if you claim that young and vigorous people, with abundant Qi and Blood, are immune to Wind pathogens, then they should also be immune to Cold and Summer-heat injuries." This is a stubborn custom, unbreakable. Someone asks: "Then why do the elderly suffer more from stroke?" I reply: "The elderly have exhausted Tian Gui (essence related to reproduction), their Qi and Blood are deficient, their Cou Li (pores/interstices) are loose, making them susceptible to Wind. Moreover, essence is depleted while Phlegm-Fire is rampant, giving rise to theories attributing stroke to Phlegm, Fire, or Qi. Guest pathogens and evil winds can kill upon invasion. If the Five Zang organs are harmonious and Yuan Zhen (original true Qi) flows smoothly, preventing physical decline, pathogens cannot enter the Cou Li. The *Ling Shu Jing* states: 'Eight Winds come from the direction of deficiency, causing disease.' When Three Deficiencies combine, sudden death occurs. With Two Excesses and One Deficiency, dampness and cold-heat disorders occur. With Three Deficiencies and partial strike by Wind, collapse and hemiplegia result. Thus, sages avoid wind as they would arrows and stones. Does sage teaching distinguish between old and young? No!"