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Dysentery is categorized into cold and heat patterns, which differ in nature. Zhang Shi (courtesy name Xin Zai, a contemporary figure who authored *Zhang Shi Yi Can*) proposed the most refined theory regarding latent pathogens (*Fu Xie*). The pathogenesis involves intestinal heat (the intestines naturally prefer warmth; prolonged exposure to heat pathogens becomes the root of disease) and gastric cold (the stomach naturally prefers coolness; prolonged exposure to cold pathogens becomes the root of disease). This presents as superficial heat and deep cold (*Biao Re Ben Han*), varying with seasonal changes such as the retreat of summer heat, the onset of autumn chill, and the lingering residual heat in early autumn. In treatment, Ginger (*Sheng Jiang*) in Lizhong Tang can counteract diseases caused by excessive cooling, while Rhubarb (*Da Huang*) in modified formulas clears stagnant fire. However, in the early stages when the condition is mild, one should not hastily apply these methods but rather weigh options using Shaoyao Tang.

Dysentery accompanied by fever burning like fire is worrying; Daogui Sini Tang can be used to trace its origin. Xiaochaihu Tang treats vomiting accompanied by alternating chills and fever, while Canglin Tang requires further study.

Even critical cases of Jin Kou Li (dysentery where the patient cannot eat) are treatable, though the efficacy of Dachengqi Tang is rarely known. The synergistic use of Scutellariae Radix (*Huang Qin*), Coptidis Rhizoma (*Huang Lian*), Puerariae Radix (*Ge Gen*), and Glycyrrhizae Radix et Rhizoma (*Gan Cao*) can open the three passes and rescue the crisis in a short time.

Zhenshi Yangzang Tang is indicated for rectal prolapse or incontinence (where food and water pass directly without stopping), used intermittently with Xianglian Wan to stop downward flow. Does Zhongjing’s Taohua Tang apply to spring? Understanding this allows one to infer other cases from similar principles.

For Yin-deficiency dysentery, dysentery with fever and thick sticky pus and blood, as well as Xiuxi Li (intermittent chronic dysentery), Chuzhu Wan should be used.

The Chuzhu Wan passed down from the *Qianjin Fang* consists of Angelicae Sinensis Radix (*Dang Gui*) and Coptidis Rhizoma (*Huang Lian*) in equal amounts of 1.5 liang each, along with Donkey-hide Gelatin (*Ejiao*) at 3 liang and Dried Ginger (*Gan Jiang*) at 1 liang. It is a spiritual elixir for treating chronic dysentery due to Yin deficiency. Preparation: Boil Ejiao (3 liang) with vinegar together with Huang Lian, Dang Gui (each 1.5 liang), and stir-fried Gan Jiang (1 liang), then form pills. Take 40–50 pills per dose, three times day and night, washed down with rice drink. The "Three Chariots" metaphorically represent the transportation of Essence, Qi, and Spirit, governing the Upper, Middle, and Lower Jiao to regulate Yin and Yang. Because excessive Yang-heat injures Yin-essence, Huang Qin/Lian is used to restrain the rapid movement of the "Deer Chariot" (metaphor for aggressive Yang/Fire), Gan Jiang to spur the sluggish "Ox Chariot" (metaphor for Spleen/Stomach Qi), Ejiao to retrieve the stuck "Ox Chariot" (metaphor for depleted Yin-blood), and Dang Gui to harmonize the scattered Essence, Qi, and Spirit. Zhang Shiwu’s commentary on this is highly insightful and is quoted in full here.

Qi Heng Li (Strange and Constant Dysentery). Zhang Yin’an stated: "Diseases arising from external contraction and internal injury are commonly known, but few understand 'Qi Heng' diseases. 'Qi Heng' means different from the constant or normal. Taking Qi Heng diarrhea/dysentery as an example, it occurs when pathogens of the Three Yang meridians arrive simultaneously, overwhelming the Three Yin meridians. Severe accumulation leads to fright; wind diseases arise rapidly, with pulse conditions hard like grinding stones, coldness in all nine orifices, and Yang qi overflowing laterally causing dry throat and laryngeal obstruction. Pain invading the Yin aspect causes irregularity above and below, pressing into the intestines to form dysentery. The pulse is slow, small, late, and choppy. If the blood is warm and the body hot, death ensues; if heat persists for seven days, death ensues. This is because Yang qi is excessively vigorous, injuring Yin qi, hence the pulse appears small, deep, and choppy. This syndrome urgently requires Dachengqi Tang to purge Yang heat and nourish Yin; delay renders it incurable. If physicians do not understand the cause of Qi Heng disease and, seeing a moderate pulse, use mild remedies, what difference is there from poison? Therefore, I say: those cured by mild medicines originally had non-lethal diseases and could have recovered without medicine; those rendered incurable after taking mild decoctions bear the fault of the physician."