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Dysentery, known in ancient times as "Zhi Xia" (Stagnant Downward Flow), is referred to as "Chang Pi" (Intestinal Dysentery) in the *Classic of Internal Medicine* (*Huangdi Neijing*). Zhang Jiegou stated: Robust individuals do not have accumulation, whereas deficient individuals do. This indicates that accumulation is summoned by deficiency. It all arises because the Spleen and Stomach are already deficient, combined with irregular diet and emotional imbalance (Seven Emotions), leading to Qi stagnation in the intestines and stomach, injury to Qi and Blood, which brews into pus and blood, resulting in stagnant downward flow dysentery.

However, sudden onset dysentery has five causes, while gradual onset has seven. Some arise from dietary cold and heat imbalance causing sudden injury to the Spleen and Stomach; some from contracting Summerheat; some from Wind-Cold invasion; some from improper regulation of vomiting and diarrhea; and some from ingesting toxic or cold foods compounded by fright and panic. These constitute the "Five Acute Syndromes." What are the seven gradual syndromes? Some result from long-standing food retention; some from Qi deficiency mixed with Cold; some from chronic Spleen Qi damage failing to control Blood, leading to bleeding; some from Damp-Heat injuring the Spleen; some from Yang Qi sinking, with accumulation taking advantage of Spleen failure; some from excessive consumption of rich, greasy, fried, and spicy foods causing dryness and heat accumulation; and some from epidemic pestilence qi where foul toxins interact. Injury to Qi results in white stool; injury to Blood results in red stool; injury to both yields red and white mixture. Yellow indicates food injury; green indicates Dampness injury. However, it is ultimately due to Damp-Heat, similar to pus discharging from a carbuncle. Although there is a distinction between red and white, there is essentially no distinction between Cold and Heat. The principle and treatment are the same as for leukorrhea (Vaginal Discharge) in women.

In total, there are eight types of dysentery: Cold Dysentery, Hot Dysentery, Cantharis Dysentery (associated with malnutrition/parasites), Fright Dysentery, Cold-Heat Imbalance Dysentery, Resting Dysentery (Intermittent Dysentery), Jing Kou Dysentery (Anorexic Dysentery), and Worm-Toxin Dysentery. Cold Dysentery presents with white color; Hot Dysentery with red; Cantharis Dysentery with yellow-white discharge at irregular intervals; Fright Dysentery with green color; Cold-Heat Imbalance Dysentery with mixed red and white; Resting Dysentery with black stool resembling fish intestines, recurring after remission; Abdominal Distension Dysentery with large abdominal accumulation yet continued purging, where food fails to nourish the flesh, foul odor, and constipation/stagnation; Worm-Toxin Dysentery presents with purple-black stool. Treatment must examine whether Cold or Heat is involved, and whether it is Deficiency or Excess. Heat patterns can be treated by draining excess; Cold patterns should be discussed similarly to Deficiency patterns. Prolonged dysentery with fever indicates Yin Deficiency. Severe abdominal pain indicates Heat flowing downward. Jing Kou Dysentery (inability to eat) is caused by severe Stomach Heat or epidemic foul toxins entering the Zang-Fu organs, with toxic vapors rushing upward. Therefore, herbs such as Huanglian (Coptis Rhizome), Shilian Rou (Nelumbo Nucifera Seed Endosperm), and Rendong Hua (Lonicera Flower) should be used to clear the Heart and resolve toxicity. If tenesmus is caused by Lung Qi stagnation in the Large Intestine, use Jiegeng (Platycodon Root) to open it; for Excess Heat, use purgation; for Qi Deficiency, use lifting methods; for Blood Deficiency, use harmonizing methods. Although treating dysentery often states that harmonizing Blood cures pus in stool and moving Qi relieves tenesmus, this applies only to the elderly, weak children, and those with deficient Yuan Qi. For robust individuals with abundant Essence and Qi, especially in the early stages, purgation is necessary, as stated in the *Classic*: "Meeting and seizing" (attacking the pathogen when it is strong). After one to five days, the Spleen and Stomach gradually weaken, requiring methods of digestion promotion, ascending and dispersing, Qi movement, and Blood harmonization. For prolonged disease with Deficiency, tonifying Qi and Blood and astringing leakage is required. Thus, tenesmus requires purgation; intestinal pain requires harmonizing; heavy body requires removing Damp-Warmth; wiry pulse requires dispelling Wind; thick and withered pus and blood require heavy agents to exhaust pathogens; cold body with spontaneous sweating requires toxic [potent] warming agents; internal contraction of Wind Evil requires diaphoresis; loose stools as diarrhea require warming; exterior pathogens require releasing; interior pathogens require purging; upper level without formation of accumulation requires emesis; lower level with formed dysentery requires exhausting pathogens; exterior Heat requires internal疏导 (venting); obstructed urination requires separating and draining; excess requires harmonizing; loss requires sending [tonifying]; arrival [of pathogen] requires stopping. These are maxims for treating dysentery.

The Spleen and Stomach are the sea of water and grain, receiving everything, and often involve the other four Zang organs. Thus, Heat-Toxin in the Five Zang organs causes all five fluids to descend, resulting in Five-Color Dysentery. Excess patterns prioritize unblocking and draining; Deficiency patterns focus on regulating Blood and reasoning Qi. When toxic vapors invade the Stomach, causing anorexia, wide anus, dark and frightening appearance, abdominal pain, tenesmus, and frequent dripping of fresh blood, it is named "Scraping Intestine Dysentery." Frequent day and night occurrence with food passing straight through is named "Sliding Intestine Dysentery." These, along with Jing Kou and Five-Color Dysentery, are considered ominous prognoses. The *Mai Jing* (Pulse Classic) states: In Chang Pi with bloody stool, fever indicates death, cold indicates survival; with white mucus, deep pulse indicates survival, floating pulse indicates death. The *Mai Jing* further states: With pus and blood, deep and small pulse with lingering course indicates survival; rapid, forceful pulse with heat indicates death. Also, cold limbs without pulse, unwarmed by moxibustion, pulse disappearing and not returning; slight panting; lips like vermilion; stool like fish brain; stool like dust and decay; pure blood; stool like leaking roof water; stool pouring like from a bamboo tube; anorexia with frequent dysentery and cold limbs; prolonged dysentery with fever and sweating; intestinal pain, thirst, panting, swelling like inflated bag; late autumn prolonged dysentery with vomiting, reversal, coma, restlessness, and physical depletion; chronic diarrhea turning into dysentery transmitted from Spleen to Kidney; black stool with abdominal distension and coarse breathing; dry lips and sunken eyes; dilated pupils; cloudiness and red veins in eyes; warm head and cold feet; bad breath with phlegm production; alcohol craving with frequent dysentery; sunken abdomen; blue-black complexion; discharge like abscess pus or rotten eggs; black and shriveled Kidneys; blue and scorched lips; profuse sweating like rain; closed eyes unable to open; long sighs with crow-like voice; face like crimson paper; sunken chest and open mouth; black fingernails; vomiting white worms or white foam and blue blood; soft neck and fish-mouth deformity; thunderous abdomen; black bloody stool with foul smell; black tongue in prolonged dysentery indicating Five Zang injury; yellow tongue in prolonged dysentery indicating Spleen Qi failure. All these are incurable.