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Dysentery arises from stagnation and accumulation. However, although the accumulated matter desires to be expelled downward, qi stagnation prevents it from descending with it, resulting in frequent bowel movements day and night accompanied by urgency, distress, and pain. Treatment should first focus on promoting unobstructed flow, which is the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong) described in the *Nei Jing* (*Inner Canon*). Therefore, Zhang Zhongjing stated that cases suitable for purgation should all be treated with Chengqi Tang (Cinnamon Twig and Rhubarb Decoction). The cold nature of Da Huang (Rhubarb Root and Rhizome) is good at moving freely; assisted by the warm nature of Hou Po (Magnolia Bark), which is good at moving stagnant qi; and moderated by the sweet nature of Gan Cao (Licorice Root), administered as a decoction, it sweeps away impurities, moistens and nourishes, and provides light relief. Once the accumulation is cleared, administration should cease. Drugs such as Pi Dan (Arsenic Pill) and Ba Dou (Croton Seed) are strictly forbidden, fearing their violent toxicity may damage the pure qi of the stomach and intestines.

However, predecessors exclusively advocated cold-natured treatments, arguing that dysentery mostly occurs in autumn due to summer heat and depression. This reasoning is clear and the arguments are moderate, but they fail to detail why heat becomes depressed. Often, due to intense summer heat, excessive consumption of ice water or raw/cold foods causes heat to be constrained by cold, leading to deep-seated cold and accumulated cold over time. One cannot rigidly assume it is always heat; one must differentiate symptoms and palpate the pulse. Generally, for heat-type dysentery, use Da Huang (Rhubarb Root and Rhizome); for cold-type dysentery, use Ba Dou (Croton Seed). Administer the appropriate medicine for the specific disease, carefully following ancient established methods without any deviation.

However, Wang Haicang also stated: For blood dysentery in summer months, do not use Huang Lian (Coptis Rhizome). This is also a partial view. Whenever there is abdominal pain, tenesmus (feeling of incomplete defecation), scanty urine, thirst preferring cold drinks, and dryness/constipation in the large intestine, this is dysentery complicated by heat. It is appropriate to use clearing and draining agents such as Xiang Lian (Costus and Coptis), Da Huang (Rhubarb Root and Rhizome), Huang Qin (Scutellaria Root), Bai Shao (White Peony Root), Zhi Qiao (Immature Bitter Orange), and Bing Lang (Areca Seed). Use these while the condition is in its early stages and the patient's constitution is strong despite heavy accumulation. If there is abdominal pain but no thirst, preference for hot drinks, clear and copious urine, no fever, and a abdomen that prefers warmth, this is dysentery complicated by cold. It requires warming with Lizhong Tang (Regulate the Middle Decoction) plus Jiang (Ginger) and Gui Zhi (Cinnamon Twig).

If the initial pathogen was heat-type dysentery, but after prolonged duration symptoms do not subside or worsen, treatment must change, viewing it as a deficiency syndrome. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift and tonify, doubling the dosage of Ren Shen (Ginseng Root) for warming tonification. If there is heaviness and bearing-down sensation in the lower abdomen with severe pain, resembling Ben Tun (Running Piglet Qi), this involves the Shaoyin channel. Urgently add Wu Zhu Yu (Evodia Fruit), Rou Gui (Cinnamon Bark), Po Gu Zhi (Astragalus Complanatus Seed), and Rou Guo (Nutmeg). In severe cases, add Fu Zi (Aconite Lateral Root). If there is pure blood, add Chao Hei Gan Jiang (Charred Dried Ginger). When deficiency recovers, dysentery stops naturally. If one waits until blood clears and diarrhea stops before tonifying, it will be too late.

Diarrhea, malaria, and dysentery in summer and autumn share the same origin, mostly caused by summer-dampness injuring the Spleen. If dietary injury occurs, diarrhea ensues immediately, which is mild. If stagnation persists for a long time, it transforms into malaria or dysentery, which is severe. Malaria and dysentery differ: if food transforms into phlegm filling the chest and diaphragm, it becomes malaria; if food transforms into accumulation sticking to the stomach and intestines, it becomes dysentery. Ancients said: "No phlegm, no malaria; no accumulation, no dysentery." Thus, at the onset when the patient is strong and accumulation is abundant, for mild cases use San Leng (Burreed Tuber), Peng Ze (Curcuma Zedoaria Rhizome), Bing Lang (Areca Seed), Zhi Qiao (Immature Bitter Orange), Zhi Shi (Immature Bitter Orange), Qing Mu Xiang (Vladimiria Root), and Chen Pi (Tangerine Peel). For severe cases, use Jiu Zhi Da Huang (Wine-processed Rhubarb Root and Rhizome) to purge. Do not show leniency, as this is like nurturing a tiger that leaves trouble. Moreover, if there is accumulation, the disease bears the burden, and attacking it does not harm the person. However, if delayed for days, Yuan Qi (Primal Qi) becomes deficient while accumulation qi remains strong, making attack and tonification difficult, leading to a disastrous syndrome.

Furthermore, although various dysenteries belong to interior syndromes, they often involve epidemic pathogens. If severe within seven days, there is much accumulation and strong constitution; even if critical, death is unlikely with proper care. After seven days, symptoms should gradually improve. If initially mild and ignored, after seven days accumulation lingers, vitality declines, stomach qi weakens, and dysentery worsens, becoming hard to treat. Note that many conditions resemble dysentery but are not. Li Dongyuan said: Dietary injury and irregular lifestyle damage Stomach qi, causing ascending clear yang to descend instead, called Xun Xie (undigested food diarrhea). Over time, Taiyin transmits to Shaoyin, causing Chang Pi (intestinal disorder) with tenesmus and mixed pus/blood, frequent trips to the toilet without immediate passage. Exclusively use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) as the main formula to restore ascending-descending mechanisms, curing dysentery without direct anti-dysentery drugs.

Another type resembles dysentery due to yin deficiency, known as Da Xia Xie (Great Filth Diarrhea) among the Five Diarrheas. The *Jing* says: Tenesmus, frequent trips without passage, necessarily with penile pain. Symptoms include mixed red and white discharge, tenesmus, similar to dysentery, but with scanty, painful, or obstructed urination, or involuntary stool during urge to urinate, or involuntary urination during urge to defecate, with traction pain in both orifices. This is a critical kidney deficiency syndrome. Urgently use Shui Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) plus Gu Zhi (Psoralea Fruit), Dou Kou (Cardamom Seed), E Jiao (Donkey-hide Gelatin), combined with Lizhong Tang (Regulate the Middle Decoction), adding Sheng Ma (Cimicifuga Rhizome), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateral Root) in alternating doses to potentially save the patient. Many die from misusing dysentery medicines.

One type is Jin Kou Li (Closed-Mouth Dysentery), where medicine is vomited immediately upon entry, with urgent retention below. This is mostly due to blazing heat-toxin rushing upward against the stomach gate. Stomach qi is trapped and not diffusing. Urgently use Huang Lian (Coptis Rhizome) stir-fried with Wu Zhu Yu (Evodia Fruit), discarding the Evodia, mixed equally with Ren Shen (Ginseng Root). Add a pinch of Mi (Rice), decoct strongly, add Ginger Juice, and sip slowly. Swallowing two or three spoonfuls stops vomiting. If vomiting recurs, administer again. For cold qi rushing upward, use warming tonics; the disease is easy to treat.

One type is Wu Se Li (Five-Color Dysentery), where heat accumulates in the five zang organs, corroding them, causing five fluids to descend, appearing externally. This is extremely critical. Use Jin Yin Hua (Honeysuckle Flower), Jiu Chao Huang Lian (Wine-processed Coptis Rhizome), Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Mu Xiang (Aucklandia Root), Ru Xiang (Frankincense) to clear heat, detoxify, and harmonize blood.

One type is Xiu Xi Li (Resting Dysentery), recurring annually or monthly after remission. This is cold accumulation at the bottom of the large intestine, unreachable by most herbs. Only Ba Dou (Croton Seed), ground and stir-fried into wax pills, taken on an empty stomach, prevents recurrence. This is also the method of "treating obstruction with unblocking agents."

Tenesmus has two types: If sinking of pathogenic qi reduces slightly after defecation but worsens soon, and urgency prevents passage, this is excess and fire. If straining fails to retain, reduction does not occur after defecation because relief leads to greater deficiency, and frequent soiling occurs with urgency, this is deficiency and cold. This distinguishes excess from deficiency. Kidney governs closure/storage; Liver governs dispersal/drainage. Qi deficiency in these two meridians causes loss of function. Liver deficiency fails to disperse, causing tenesmus; Kidney deficiency fails to store, causing incontinence. Treatment should warm and tonify Liver and Kidney, taken before morning and evening meals. Warm herbs taken only at dawn lose potency by night, unable to counteract night Yin-cold. I once treated severe dysentery with extreme tenesmus, thirst, aversion to food, severe lower abdominal pain, red or white or bloody stools, difficulty urinating, and strong cun pulse with weak chi pulse. All recovered with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Wu Wei Zi (Schisandra Berry) and Rou Gui (Cinnamon Bark), taken morning and evening.

There is dysentery following malaria, and malaria following dysentery. After malaria, excretion is complete, so summer-heat toxin should not remain to cause dysentery; this is sinking of Yuan Qi (Primal Qi) and failure of Spleen qi to ascend, resembling dysentery but not being it. After dysentery, profuse discharge loses blood, qi scatters with discharge, leading to dual deficiency of Yin and Yang. Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat, resulting in cold-heat conflict, resembling malaria but not being it. Treat both as deficiency using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with warming tonics for self-healing.

Dysentery stems from dampness, dampness from Earth. Thus, cold or heat can produce pus and blood. In Five Elements theory, heat transforms via Fire, cold via Water. Damp Earth exists in all seasons. Following Fire, Yang Earth is excessive, causing damp-heat disease ("Dun Fu"). Following Water, Yin Earth is insufficient, causing cold-damp disease ("Bei Jian"). Blaming heat ignores cold; blaming cold ignores heat—is this not an error in expression? Regarding red as heat and white as cold, this is also not definitive. Mixed red and white implies simultaneous cold and heat? One must differentiate based on symptoms, tongue, and pulse to avoid confusion. Know that cold implies deficiency; heat implies excess. Further analyze excess/deficiency to clarify cold/heat. Distension, aversion to food, acute pain fearing pressure indicates excess. Restlessness, thirst seeking drinks, preference for cold and fear of heat indicates heat. Strong and solid pulse indicates excess. Rapid and slippery pulse indicates heat. Otherwise, it belongs to deficiency-cold. At similar junctures, careful examination is needed. Thirst seems like excess-heat, but all diarrhea/dysentery consumes fluids; fluid loss below dries fluids above, causing thirst. Differentiate by preference for hot/cold. Abdominal pain seems like excess-heat, but dysentery injures viscera/intestines, skin/flesh peels, causing pain. Differentiate by pain severity, response to pressure, abdominal distension, and pulse strength. Yellow/red/scanty urine seems like excess-heat, but water leaves via dysentery, urine shortens, Yin fluids consumed, color changes. Differentiate by moisture/dryness of complexion and fluids. Tenesmus seems like excess-heat, but qi sinking impairs transport, Yin loss makes intestines sticky, causing tenesmus. Differentiate by disease duration, constitution thickness, and pulse strength. Carefully distinguishing excess/deficiency and observing pulse prosperity/decline reveals the true nature of the disease.

Nineteen out of twenty dysentery patients are deficient, yet doctors rarely tonify. Qi is already sinking; moving it further worsens tenesmus. Middle is already weak; attacking accumulation exhausts Yuan Qi (Primal Qi). Heat-damp injuring blood should regulate blood; excessive purging harms Yin blood. Fluid loss causing thirst should nourish Yin; using diuretics consumes fluids. Quack doctors adhere to "no tonification for pain," saying early tonification is inappropriate. Not knowing that pain due to deficiency worsens with attack. Often, visible disease remains while invisible Yuan Qi (Primal Qi) escapes, regretting too late. Thus, weak pulse, deficient appearance, post-fever dysentery, or worsening after attack are indications for tonification. Most importantly, focus on Spleen and Kidney. Dysentery followed by diarrhea is Kidney transmitting to Spleen; minor pathogen, easy to treat. Diarrhea followed by dysentery is Spleen transmitting to Kidney; hostile pathogen, hard to treat. Disease in Spleen is shallow; in Kidney is deep. Kidney governs closure; Kidney is the Stomach gate. Long-term dysentery with Spleen deficiency inevitably damages Kidney Yin and Yang. Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Ten Significant Tonification Decoction), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify Spleen deficiency and are good. But if Fire is weak and Earth lacks its Mother, unless Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Lateral Root) greatly tonify Ming Men (Gate of Life) to restore Kidney Yang and save Spleen Mother, how will food enter? How will the gate close? How will True Yuan recover? Fear of heat leading to using only Ren Shen (Ginseng Root) and Mu Xiang (Aucklandia Root) to tonify Earth often leads to death, very harmful. Old accumulation is damp-heat, food, and phlegm; method is to purge. New accumulation arises after purging; adjust or tonify, do not lightly attack. If dysentery is due to deficiency, even old accumulation should not be purged; use Yi Gong San (Extraordinary Power Powder), and when deficiency recovers, dysentery stops. Danxi used tonifying Stomach qi with Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) before purging, also a wonderful method. Suitable for deficiency. Once filth is gone and feces not solid, it is appropriate to use Bai Shao (White Peony Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria) Guochang Wan (Intestinal Consolidating Pill) to regulate Spleen/Stomach, preventing new accumulation. Dysentery patients must avoid diet; strictly ban oily, meat, and noodle foods; medication works only then. If old filth remains and new accumulates, how can intestines/stomach clear? Gradual blockage worsens Spleen disease and adds Stomach disease, leading to nausea, anorexia, or closed-mouth state.

Initially, accumulation in intestines causes tenesmus, abdominal pain, nausea, and chest/diaphragm distension, indicating fresh food/drink not yet digested. Do not abruptly use cold or purgative drugs; cold causes more binding, purging injures Stomach. First resolve and guide out. Wait until lower diaphragm is free of nausea/distension before purging. If nausea is severe, first induce vomiting with light salt water. If initial heat has interior signs, purging is suitable; if aversion to cold, purging is contraindicated. Confusing diarrhea and dysentery, mixing damp-heat and promoting urination is incorrect. Clear and leaching agents promote rapid water flow, stopping diarrhea. But dysentery is foul matter, similar to damp-heat, formed by Stomach/Intestine oppression, exiting via Large Intestine transmission, unrelated to Stomach qi. Thus, overusing leaching drugs exhausts Yang and dries fluids, lowering the disease and the medicine. Clear, copious urine in various symptoms indicates gradual recovery, especially in dysentery. Li Shizhen said: For blood dysentery where pain continues after passage, it is Yin deficiency and qi stagnation. Add Chuan Xiong (Sichuan Lovage Rhizome) to medicine; as qi moves and blood harmonizes, pain stops immediately. Saying dysentery is cold is incorrect. Cold cannot digest grain, how does it turn to pus? Saying mixed red/white dysentery is cold-heat combination is also incorrect. Cold and heat are different qi, how can they coexist in intestines to cause dysentery? It is fundamentally damp-heat, differing only in degree of qi vs. blood injury. Large Intestine qi deficiency sinking causing tenesmus: use Si Jun Zi Tang (Four Gentlemen Decoction) plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root). Also cases of severe qi deficiency, no qi in intestines unable to push: only need Ren Shen (Ginseng Root), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) to greatly tonify Middle qi. Large Intestine blood deficiency causing tenesmus: use Si Wu Tang (Four Substance Decoction) plus Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome). Danxi said: Li Ji (urgency) means abdomen is not comfortable. Also cases of false sitting with no stool passage are all blood deficiency, as intestines lack fluids to lubricate. Although tonifying blood is needed, must also tonify qi, for qi generates blood. Single blood tonification injures Spleen/Stomach. Yin deficiency with fire, plus summer heat attack, should not tonify immediately, nor use drying herbs. Only use mild cold, clear, peaceful agents to regulate. If still unresolved, then use clearing/moistening tonics.

Also toxic dysentery: if sha toxin sinks inward, discharging pus/blood, ineffective with other drugs, add detoxifying herbs to blood-harmonizing/qi-moving formulas, like Jin Yin Hua (Honeysuckle Flower), Zhi Ru Xiang (Processed Frankincense), Xiang Lian (Costus and Coptis). Postpartum dysentery, despite much accumulation and extreme pain, do not use Da Huang (Rhubarb Root and Rhizome) etc., to avoid injuring Stomach qi, which becomes incurable. Use Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Dang Gui (Angelica Sinensis Root), Hong Qu (Red Yeast Rice), Cu Chao Sheng Ma (Vinegar-processed Cimicifuga Rhizome), Yi Mu Cao (Motherwort Herb), Wei Mu Xiang (Stir-fried Aucklandia Root), Liu Bai (Pericarpium Citri Reticulatae with pith removed), Guang Pi (Tangerine Peel), Zhi Gan Cao (Honey-fried Licorice Root). If blood deficiency, add Chao E Jiao (Charred Donkey-hide Gelatin) 2 qian.

For pre-partum dysentery, use Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Bai Shao (White Peony Root), Zhi Gan Cao (Honey-fried Licorice Root), Ju Hong (Red Tangerine Peel), Hong Qu (Red Yeast Rice), Zhi Qiao (Immature Bitter Orange), Lian Rou (Lotus Seed), slightly use Sheng Ma (Cimicifuga Rhizome). Under seven months, do not use Hua Shi (Talcum). Winter Shang Han (Cold Damage) is already considered heat disease. Summer/Autumn summer-heat three qi intersect and steam, mutual knotting heat is ten times that of winter. External contraction of three qi heat causing dysentery must exit from outside. Thus, dysentery can use Xin Liang (Acrid-Cool) to release exterior, then Ku Han (Bitter-Cold) to clear interior, cured in one or two doses. Missing exterior release, external pathogen exits only from interior, not dying until resolved. Even after a hundred days, still use Ni Liu Wan Dan (Reverse Current Pulling Pill) method to draw pathogen out externally, saving critical cases. *Jin Gui* says: Dysentery pulse reverses to Xian (Wiry), fever, body sweat—self-heals. Long-term dysentery pulse enters Yin, deep, choppy, weak. Suddenly turning Xian pulse is entirely Shaoyang generating qi, is this not reverse pulling method? Pulse fine, skin cold, little qi, diarrhea, no food/drink entering front/back, called Five Deficiencies Death. Only use Ren Shen (Ginseng Root) and Fu Zi (Aconite Lateral Root), ten can save one.

Post-dysentery legs become thin and weak, named Li Feng (Dysentery Wind), untreated becomes He Xi Feng (Crane Knee Wind). Treatment should warm tonify Liver, Spleen, Kidney, do not continue using drying Spleen drugs.

Post-dysentery gout, whole body severe pain, is intestinal/stomach damp-heat, evil blood not cleared, returning to collaterals, lingering in tunnels causing pain. Use Si Wu Tang (Four Substance Decoction) plus Tao Ren (Peach Kernel), Hong Hua (Carthamus Flower), Niu Xi (Achyranthes Root), Chen Pi (Tangerine Peel). Also cases of pain due to qi/blood deficiency, must examine carefully.

White dysentery from Large Intestine, red dysentery from Small Intestine, this is Danxi dividing red/white by qi/blood. Large Intestine is official of transmission; dysentery injures intestinal/stomach blood vessels, moves organ fat/grease, so red/white both enter Large Intestine and descend. Small Intestine is outlet for urine, never seen as organ for dysentery. Heart governs blood, Heart and Small Intestine are exterior-interior, so red dysentery originating from Small Intestine transformation is acceptable, but saying it comes from Small Intestine...