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The *Mai Jue* (Pulse Classic) states: In dysentery, if the pulse is deep and fine, prognosis is good; if the pulse is surging and large, prognosis is poor. This refers to chronic cases. At the onset of the disease, the Yuan Qi (Original Qi) has not yet become deficient, and the Gu Qi (Grain Qi/Nutritional Energy) is still strong, so the pulse invariably presents as slippery and large.
Only after a long illness, when the Yuan Qi has become deficient and food intake is reduced, should the pulse be deep and fine, rather than surging and large.
The onset of dysentery results from summerheat and dietary injury to the Spleen and Stomach, impairing their transportation and transformation functions, allowing pathogenic factors to merge into the Blood level, thereby forming dysentery. Stools that are red in color result from the transformation of heat within the food stagnation; those that are white result from the transformation of cold within the food stagnation. One cannot simply equate red with Heat syndrome and white with Cold syndrome. Treatment must distinguish between Exterior and Interior patterns. Zhu Danxi stated: If accompanied by aversion to cold, fever, and pain in the head and body, the pathogen is in the Exterior. When the pathogen is in the Exterior, one should disperse summerheat. Pathogens entering the Interior necessarily move from skin and flesh to sinews and bones, and then from sinews and bones into the Intestines and Stomach. The current presence of alternating chills and fever, along with body pain, indicates that Exterior pathogens have not been cleared. If one merely clears the Stomach and resolves stagnation without addressing the Exterior, the pathogens in the Exterior will inevitably all shift to the Interior, and how can the condition ever resolve? Chai Hu Hua Zhi Tang (Bupleurum Decoction to Resolve Stagnation) is indeed an excellent formula for resolving both Exterior and Interior simultaneously. (It yields rapid and reliable effects in treating dysentery complicated by Exterior symptoms. Yu Jia Yan's "Reverse Flow Pulling the Boat" method is based on modifications of this formula.) Ancient formulas used Renshen Baidu San (Ginseng Powder to Overcome Toxins), attributing it to the Taiyang (Greater Yang) channel while neglecting the Shaoyang (Lesser Yang) channel, which is somewhat seeking too far away. As for tenesmus (heavy sensation in the rectum) and abdominal pain with urgent bearing down, this indicates the pathogen is in the Interior. When the pathogen is in the Interior, purgative methods should be employed. Puhuang Wan (Magnolia Bark and Rhubarb Pill) is suitable for purgation. However, to use purgatives, it must be within two or three days of onset, when the Yuan Qi is not yet deficient and the pulse is still forceful, before purgation can be applied. If the dysentery has persisted for a long time with frequent stools and a weak pulse, even if there is tenesmus, it is due to Qi deficiency with sinking, which differs from the initial stage, and reckless purgation must be avoided.
If there are no exterior symptoms such as headache and body pain, and no interior symptoms such as tenesmus, Qín Sháo Tiáo Zhōng Tang (Scutellaria and Peony Decoction to Regulate the Middle) is appropriate. Huang Qin (Scutellaria Root) can consolidate the Qi of the Large Intestine, and Bai Shao (White Peony Root) can consolidate the Blood of the Large Intestine. Dysentery with bloody stools cannot heal without this formula. However, patients with dysentery often suffer from irregular diet, where old stagnation remains and new food intake is excessive. If the chest feels uncomfortable, Qín Sháo Tiáo Zhōng Tang should not be used abruptly, as its astringent properties may retain food and worsen the dysentery. After regulating and unblocking, one should strongly tonify the Yuan Qi. Nevertheless, while Qi deficiency is common in dysentery patients, Yin deficiency is also frequent. Excessive purging leads to loss of Yin, causing deficiency and dryness of the Zang-Fu organs, intense thirst with desire to drink, and a fine and rapid pulse. In such cases, Shao Yao Jian Pi Tang (Peony Decoction to Strengthen the Spleen) is suitable. Merely taking this decoction will allow the dysentery to heal spontaneously. If it is Yang deficiency, the pulse will likely be surging, large, and forceless. In such cases, Qin Shao Bu Zhong Tang (Scutellaria and Peony Decoction to Tonify the Middle) or Zi Sheng Wan (Life-Nourishing Pill) should be used. If tonification fails to cure the condition, astringent methods can then be employed. One must not abruptly use drugs like Yingsuke (Poppy Shell), lest residual stagnation cause distension and fullness, worsening the disease. (Cases turning into chronic intermittent dysentery are often due to premature use of astringents.)
Although, the Kidney serves as the gate of the Stomach; in prolonged dysentery, the Stomach cannot remain undamaged. Formulas such as Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify Spleen deficiency and are not ineffective. However, if the pathology lies in Fire deficiency, with Earth lacking its Mother (Kidney Yang failing to warm Spleen Earth), unless Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) are used to strongly tonify the Ming Men (Gate of Life) and restore Kidney Yang to rescue the Spleen (Mother of Earth), how can food intake resume? How can the anal sphincter close? How can the True Yuan be restored? If one fears heat and hesitates to proceed, using only Renshen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Root) to tonify Earth, dysentery is rarely cured. These are methods for treating Heat-type dysentery, but Cold-type dysentery also exists. One must not rigidly assume it is always Heat. Patients with平日里 weak Yuan Qi who consume raw, cold, or cool foods may develop Stomach Cold leading to dysentery, characterized by a deep, fine, and forceless pulse and cold limbs. This can be differentiated. Li Zhong Hua Zhi Tang (Regulating Middle Decoction to Resolve Stagnation) is suitable. This applies not only to Cold dysentery but also to cases where Heat syndromes transform into Cold. Li Dongyuan stated: For persistent dysentery (emphasizing the term "persistent"), if various symptoms do not decrease or instead worsen, treat it as a deficiency syndrome using Bu Zhong Yi Qi Tang, adding Pao Jiang (Prepared Ginger) 1 sheng 1 qian to tonify. Once deficiency returns, the dysentery stops spontaneously. For heavy bearing down and cutting pain in the lower abdomen, or Ben Tun (Rushing Pig) qi attacks, add Rou Gui (Cinnamon Bark) and Po Gu Zhi (Psoralea Fruit); this is indeed an accurate discussion. Dysentery patients need not strictly restrict diet, but should only consume light, soft, and well-cooked foods, eating small amounts. Raw, cold, and wheat-based foods are unsuitable, and rich flavors are especially prohibited. Regarding Wu Se Li (Five-Color Dysentery), such as discharging substances resembling fish brain marrow, or smoke/dust-like water leaking from a house, with an anus relaxed like a bamboo tube and lips painted red like cinnabar, these are all difficult-to-treat conditions.
There is also Re Du Li (Heat-Toxin Dysentery), where food and fluids are expelled entirely, with bowel movements occurring 80–90 times a day. This occurs because the Intestines and Stomach are disturbed by heat toxins, requiring treatment from the Interior. If there is tenesmus, a large dose of Da Huang (Rhubarb Root), Huang Lian (Goldthread Rhizome), and Gan Cao (Licorice Root) should be used to purge. If there is no tenesmus, Qín Sháo Tiáo Zhōng Tang with added Huang Lian and Rou Gui is suitable. Because summerheat pathogens occupy the Intestines and Stomach, cold medicines may be rejected upon entry. Adding a small amount of Rou Gui guides the cold medicine directly to the site of heat, acting like a vanguard soldier, a concept unknown to many. If the pulse is deep, fine, and forceless, with 80–90 bowel movements per day, it indicates Qi deficiency with sinking, which is not treatable by the previous methods.
In dysentery presenting with Jin Kou (Closed Mouth/Anorexia), damp-heat toxins in the Stomach steam upward through the clear pathways, causing closure and coldness at the stomach opening, leading to loss of appetite. The ancient formula Cang Lin Tang (Granary Decoction) disperses internal heat toxins, not Exterior pathogens. Subsequently, Cang Lian Ren Shen Tang (Granary, Goldthread, and Ginseng Decoction) should be given frequently. If there is no response to medication, death is mostly indicated. Initial discomfort in the chest and loss of appetite due to phlegm and food retention in the Stomach do not constitute Jin Kou dysentery.
There is also Xue Li (Bloody Dysentery), characterized by pure red blood discharged separately, not mixed with feces. If blood is present along with feces, it is called Bian Xue (Blood in Stool), not Bloody Dysentery. This results from dietary injury to the Spleen, causing stagnation in the Middle Jiao, preventing the containment of blood, so blood flows out from the anus. Qín Sháo Tiáo Zhōng Tang is also used here. If the pulse is fine and rapid, and the chest condition remains unchanged (no obvious exterior or interior excess heat), Chai Hu Si Wu Tang (Bupleurum Four Substance Decoction) with added Di Yu (Sanguisorba Root) and Wu Mei (Mume Fruit) is suitable. Do not be constrained by the label of "Bloody Dysentery."
Zhu Danxi said: Water diarrhea followed by pus and blood indicates transmission from Spleen to Kidney, termed Zei Xie (Robber Evil), which is difficult to cure. Pus and blood followed by water diarrhea indicates transmission from Kidney to Spleen, termed Wei Xie (Minor Evil), which is easy to cure. Although this theory holds, severity must be assessed. Diarrhea preceding dysentery is indeed difficult to treat, but if the dysentery is mild, is it truly difficult? Dysentery preceding diarrhea is indeed easy to treat, but if diarrhea persists excessively, is it truly curable easily? In cases where dysentery is combined with malaria, treatment should focus primarily on dysentery, not malaria. If dysentery develops after malaria, having exhausted the pathogenic factors, there is likely no remaining summerheat toxin, and Zi Sheng Wan is suitable for regulation. Cases caused by indulgent eating leading to dysentery do not adhere to this example.

Chai Hu Hua Zhi Tang (Bupleurum Decoction to Resolve Stagnation)
Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Gan Cao (Licorice Root), Dan Shen (Salvia Miltiorrhiza Root), Dang Gui (Angelica Sinensis Root), Zhi Ke (Aurantium Fructus Immaturus), Hou Po (Magnolia Bark), Shan Zha (Hawthorn Fruit), Mu Xiang (Costus Root), Bing Lang (Areca Seed).
Chai Hu, Huang Qin, and Gan Cao are used to treat summerheat. Zhi Ke, Hou Po, and Shan Zha are used to digest food. Liu Hejian stated: Promoting Blood circulation heals pus and blood in stool spontaneously, hence Dan Shen and Dang Gui are used. Regulating Qi eliminates tenesmus spontaneously, hence Mu Xiang and Bing Lang are used. This formula is suitable not only for early-stage disease but also for chronic dysentery with body heat. The *Jin Gui Yao Lue* states: Dysentery with a string-like (Xian) pulse, accompanied by fever and sweating, will heal spontaneously. The pulse in chronic dysentery, having penetrated the Yin level, is typically deep, fine, and weak. A sudden shift to a string-like pulse indicates the generating Qi of Shaoyang. Using this formula to "pull the boat against the current" allows pathogens to scatter from the Exterior. Will it not heal? If the pulse is deep, fine, and slippery, with no heat in the Exterior or Interior, and Spleen Qi stagnation, add Huo Xiang (Patchouli Herb) 1 qian for special efficacy.

Pu Huang Wan (Magnolia Bark and Rhubarb Pill)
Da Huang (Rhubarb Root, 4 liang, boiled in wine), Hou Po (Magnolia Bark, 2 liang, stir-fried with ginger juice).

Qin Shao Tiao Zhong Tang (Scutellaria and Peony Decoction to Regulate the Middle)
Zhi Ke, Hou Po, Shan Zha, Huang Qin, Bai Shao, Dan Shen, Jie Geng (Platycodon Root), Bing Lang, Ze Xie (Alisma Rhizome).
Add Jiu Chao Huang Lian (Wine-fried Goldthread Rhizome) for severe heat.

Shao Yao Jian Pi Tang (Peony Decoction to Strengthen the Spleen)
Shan Yao (Chinese Yam Rhizome), Bian Dou (Lablab Bean), Shi Hu (Dendrobium Stem), Wei Ru (Polygonatum Odoratum Rhizome), Sha Shen (Glehnia Root), Bai Shao, Chen Pi (Tangerine Peel), Bai Fu Ling (Poria), Shan Zha, Shen Qu (Medicated Leaven), Hua Fen (Trichosanthes Root).

Lian Shao Bu Zhong Tang (Goldthread and Peony Decoction to Tonify the Middle)
Renshen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Gan Cao (Licorice Root), Huang Qi (Astragalus Root), Chen Pi, Sheng Ma (Cimicifuga Rhizome), Chai Hu, Bai Shao, Huang Lian.
For chronic dysentery, avoid Dang Gui due to its lubricating and downward-moving nature. Removing Sheng Ma and Chai Hu, and adding E Jiao (Donkey-Hide Gelatin) and Di Yu is particularly effective.

Zi Sheng Wan (Life-Nourishing Pill)
Renshen (3 liang), Bai Zhu (2 liang), Gan Cao (1 liang), Bai Fu Ling (1.5 liang), Shan Zha (2 liang), Shen Qu (2 liang), Mai Ya (Malt, 1.5 liang), Chen Pi (1.5 liang), Jie Geng (5 qian), Shan Yao (1.5 liang), Bian Dou (3 liang), Yi Yi Ren (Coix Seed, 3 liang), Huo Xiang (5 qian), Qian Shi (Euryale Seed, 1.5 liang), Ze Xie (5 qian), Huang Lian (3.5 qian), Bai Kou (White Cardamom Seed, 3.5 qian).
Pill size of a bullet, made with honey.

Li Zhong Hua Zhi Tang (Regulating Middle Decoction to Resolve Stagnation)
Renshen, Bai Zhu, Pao Jiang (Prepared Ginger), Gan Cao, Sha Ren (Amomum Fruit), Hou Po, Huo Xiang, Chen Pi.
Add Rou Gui (Cinnamon Bark) for severe cold.

Cang Lin Tang (Granary Decoction)
Renshen, Bai Fu Ling, Gan Cao, Qiang Huo (Notopterygium Rhizome), Du Huo (Angelica Pubescens Root), Chai Hu, Qian Hu (Peucedani Radix), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Zhi Ke, Jie Geng, Chen Cang Mi (Aged Rice), Shi Lian Rou (Lotus Seed Embryo).
This formula is ineffective without Renshen. For deep pulses, add Huo Xiang.

Cang Lian Ren Shen Tang (Granary, Goldthread, and Ginseng Decoction)
Huang Lian (7 qian), Chen Cang Mi (3 qian), Renshen (5 qian).
For surging and solid pulses, remove Renshen, naming it Cang Lian Jian (Granary and Goldthread Decoction).

External Treatment Method
Use one large river snail, mash into a paste, add 1 li of She Xiang (Musk), apply to the umbilicus to guide heat downward, opening the Stomach. (This method has been tested and yields rapid results.)

Xiang Lian Wan (Costus and Goldthread Pill)
Mu Xiang (1 liang), Huang Lian (2 liang).