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Those whose bodies are not hot have a mild condition; those with fever have a severe condition; those with unremitting fever will die. Those who can eat have a mild condition; those who cannot eat have a severe condition; those who completely lose their appetite will die. Those who vomit will die. Those with rectal prolapse and spontaneous defecation will die. Those with chronic dysentery who suddenly pass large amounts of dry, bound stool will die. Children who develop dysentery immediately after smallpox will die. Women who develop dysentery immediately after childbirth will die. A choppy pulse indicates blood deficiency; a faint pulse at the Chi position accompanied by cold limbs is ominous; a slippery and large pulse indicates accumulation; a floating, wiry, and rapid pulse is ominous (death); a deep and fine pulse is harmless.

My second son, Yuanxi, notes: There are three prohibitions in the recent transmission for treating dysentery. The first is sweating. Since diarrhea already damages body fluids, sweating again damages them further. When body fluids are depleted, Stomach Qi becomes empty, and turbid Qi descending from below rushes upward into the Stomach along with the sweat, resulting in difficult-to-treat distension. The second is promoting urination. Since dysentery involves tenesmus and unbearable stagnating pain, if the anterior orifice (urinary tract) is over-drained, the posterior orifice (anal tract) becomes more obstructed, making it very difficult for accumulated material to pass. The third is warming and tonifying. Since dysentery is caused by damp-heat injury, using warming herbs is like adding fire to fire, risking intestinal rot that cannot be saved; using tonics traps the pathogenic factor, often leading to lingering and difficult-to-cure conditions. These three points are the secret methods transmitted by contemporary physicians.

However, there are situations where one must not adhere rigidly to these rules. *Yixue Zhenchuan* states: Whenever dysentery begins with unremitting fever, it is either due to exterior pathogens or disharmony of the meridians. One should use warm dispersing methods to harmonize Ying and Wei; once the exterior pathogen is resolved, the dysentery will naturally loosen. If one assumes it is all heat and uses cold-cooling herbs from the start, many cases deteriorate severely. Thus, Yu Jiayan’s saying that "dysentery must be treated via sweating, resolving the exterior first, then regulating the interior" applies. First use acrid-cool herbs to release the exterior, then bitter-cold herbs to clear the interior; recovery occurs in one or two doses. (Add exterior-releasing herbs to dysentery formulas.) For those neglected in exterior resolution, the exterior pathogen can only exit from the interior; this process continues until death. Therefore, even if the disease has lasted a hundred days, the "rowing upstream against the current" method can still be used to guide the pathogen out through the exterior, turning fatal cases into curable ones and critical cases into stable ones. The main formula is Renshen Baidu San (Ginseng Decoction to Overcome Toxins). (After taking it, forced temporary dryness and heat occur; shortly after, the pathogen exits via the exterior, and heat resolves.) This shows that sweating is an essential method for treating dysentery.

Furthermore, Yu Jiayan proposed the method of "urgently opening branch rivers." He stated that when heat pathogens reside internally and rush into the Large Intestine, they inevitably stagnate in the Bladder. Bladder heat causes failure of Qi transformation, leading to short, red urine. In such cases, the "rowing upstream" method is unsuitable; instead, one should guide the pathogen out through urination. However, since water originates from the high source (Lung), it is especially appropriate to use acrid-cool herbs to clear the Lung and regulate its transforming source. *Jingui Yaolue* mentions cases of diarrhea with lung abscess, treated with Zishen Tang (illustrating the principle of "treating obstruction with unblocking"). For Qi diarrhea (passing loose stool resembling gas), Helile San (Chebula Powder) is used. (This lowers saliva, eliminates retained food, breaks up stagnation, and uses astringents to secure intestinal prolapse, demonstrating the interplay of unblocking and astringing.) This also shows that promoting urination is not taboo among ancient masters.

Regarding warming and tonifying methods, detailed explanations are found in *Jingquan Quanshu*. Are Zuoguan Jian (Auxiliary Guan Decoction) and Yifu Jian (Suppress Support Decoction) not warming agents? Is Weiguan Jian (Stomach Guan Decoction) not a tonic? Although theories correcting deviations may have biases, they suffice to remedy the abuses of those who recklessly use Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhake (Crataegi Fructus), and Houpo (Magnoliae Officinalis Cortex). Who says there are three prohibitions for treating dysentery?

Yu Jiayan said: There are cases of sudden exposure to summer-heat and dampness toxins, where food and fluids pour out, with seventy to eighty bowel movements per day and night. The patient is extremely thirsty and drinks continuously, yet hundreds of cups do not suffice. This is because the intestines and stomach are attacked by heat, rotting instantly. Using the "rowing upstream" method here would be too pedantic and distant! Instead, one usually follows the *Neijing* principle of "treating obstruction with unblocking," administering Dahuang (Rhei Radix et Rhizoma), Huanglian (Coptidis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) continuously for thirty to fifty cups in a day and night. Once diarrhea stops and thirst subsides, internal regulation begins; there is no need to "row upstream" externally. The pathogen is like rushing water or rolling stones; it should be allowed to exhaust itself with momentum and not be forcibly restrained.

He also said: The treatment of malaria should advance and retreat within the Shaoyang channel. Advancing toward Yang means treating Shaoyang as the exterior method, which is established. However, the exterior aspect of dysentery should also be sought in Shaoyang. Because food and fluid Qi enters the Stomach and moves rapidly downward into the intestines, initially the ascending and generating Qi of Shaoyang fails to extend, and subsequently, this ascending Qi sinks. Therefore, seeking broadly among the Three Yang channels is inferior to focusing specifically on Shaoyang. This allows the pure and clear Qi of Heaven to sufficiently elevate the flavors of earth and water products, naturally transforming them into essence and distributing them properly, eliminating the suffering of urgent diarrhea. Moreover, since the body fluids stored in the two Yangming channels have already been lost downwards, one must not induce sweating again. One should use harmonizing methods from Shaoyang, which is entirely different from inducing sweating. If body fluids are not yet damaged, sweating is harmless; if body fluids are damaged, slight moisture on the skin suffices to lift the sunken Qi.

Xiaochaihu Tang Banxia Qu Gualougen Tang (Minor Bupleurum Decoction without Pinellia plus Trichosanthes Root) (Formula seen in *Jingui Yaolue*)

Yu Jiayan said: This formula is the precise agent for the half-exterior, half-interior stage of the Shaoyang channel. The original formula uses the acrid-warm nature of Banxia (Pinelliae Rhizoma), which addresses half the exterior; now, replacing it with the cool-bitter nature of Gualou (Trichosanthis Fructus), it addresses half the interior. Retreating to Yin allows advancement to Yang, but it may not be sufficient. It is not necessary to seek other herbs; simply increasing the dosage of Chaihu (Bupleuri Radix) by one or two times is the best method for advancement.

Renshen Baidu San (Ginseng Decoction to Overcome Toxins) (Formula seen in *Shifang*)

Yu Jiayan said: This formula from *Huo Ren Shu* was not originally designed for dysentery. However, I highly value it for the "rowing upstream" method, primarily relying on the great strength of Renshen (Ginseng Radix et Rhizoma) to achieve this reversal.

Weiguan Jian (Stomach Guan Decoction) (See section on Diarrhea)

Zuoguan Jian (Auxiliary Guan Decoction) (*Jingquan Quanshu*)

Indicated for spleen injury caused by raw/cold foods, with diarrhea/dysentery of short duration. This is an auxiliary formula to Weiguan Jian.

Houpo (Magnoliae Officinalis Cortex, stir-fried) and Chenpi (Citri Reticulatae Pericarpium, stir-fried) (1 qian each); Shanyao (Dioscoreae Rhizoma), Bidou (Lablab Album); Zhuling (Polyporus), Zexie (Alismatis Rhizoma) (3 qian each); Ganjiang (Zingiberis Rhizoma, stir-fried) (2-3 qian); Rougui (Cinnamomi Cortex) (1-2 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (7 fen).
Decoct in water and take orally. Add Muxiang (Aucklandiae Radix) and Wuyu (Evodiae Fructus) if abdominal pain is present; add Gubuzi (Psoraleae Fructus) and Roukou (Myristicae Semen) if diarrhea is severe.

Yifu Jian (Suppress Support Decoction) (*Jingquan Quanshu*)

Indicated for acute injury from raw/cold foods leading to diarrhea/dysentery. Used in the early stage when Qi and Blood are not yet depleted. This is a simultaneous exterior-interior formula based on Weiguan Jian.

Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Wuyao (Linderae Radix) (1.5 qian each); Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Paoganjiang (Prepared Zingiberis Rhizoma) (2 qian each); Wuzhuyu (Evodiae Fructus) (5-7 fen); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 qian).
Decoct in water and take orally.

Doumen Mitruan Fang (Secret Formula from Doumen) (Formula seen in *Shifang*)

Indicated for toxic dysentery. Symptoms include cramping pain in the viscera, pus and blood in stool (red and white), passage of bloody clots, ceaseless day and night, and "closed-mouth" malignant dysentery unresponsive to other medicines. Produces miraculous effects immediately.

Fuzi Wan (Aconite Pill) (*Shengji Zonglu*)

Indicated for profuse watery diarrhea with cold in the center, passage of undigested food/water, or red/white dysentery where food is expelled immediately after eating without digestion. (Injury from wind-heat in spring leads to lingering pathogens; manifesting as profuse diarrhea in late summer. Yin generates at Wu hour, peaking at Wei hour. Late summer is when Spleen Earth is prosperous; Spleen is the extreme Yin within Yin. Thus, Yin Qi is abundant. Abundant Yin Qi generates internal cold, causing profuse diarrhea.)

Fuzi (Aconiti Lateralis Radix Praeparata) and Wumei Rou (Mume Fructus Carapax, stir-fried) (1 liang each); Chuanlian (Coptidis Rhizoma, stir-fried) (2 liang); Ganjiang (Zingiberis Rhizoma, stir-fried) (1.5 liang).
Make pills with honey, size of Sophora seeds. Take 20 pills with rice broth.

Tongsheng San (Universal Salvation Powder) (*Shengji Zonglu*)

Indicated for bloody dysentery with abdominal pain, ceaseless day and night.

Dazao (Ziziphi Jujubae Fructus) and Wumei (Mume Fructus) (3 pieces each); Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian); Ganjiang (Zingiberis Rhizoma) (1.5 qian).
Decoct in water and take orally.

Hezhong San (Harmonize Middle Powder) (*Shengji Zonglu*)

Indicated for cold-heat dysentery with abdominal pain and tenesmus.

Fuzi (Aconiti Lateralis Radix Praeparata) (1.4 qian, reduce by half for red dysentery); Chuanlian (Coptidis Rhizoma) (1.4 qian, reduce by half for white dysentery); Xuxiang (Boswelliae Resin) (1.5 li).
Grind into powder, take with rice broth. If ineffective, administer Qingpi (Citri Reticulatae Pericarpium Viride) twice more.

Heidou Tang (Black Soybean Decoction) (*Shengji Zonglu*)

Indicated for red-white dysentery unresponsive to medication.

Heidou (Glycines Max Seed, stir-fried, peeled) (4 liang); Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang).
Wrap in silk, decoct in lake water to yield two cups. Divide into two doses.