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Dysentery is a type of diarrhea. Smooth and frequent bowel movements are normal. Dysentery refers to the sensation of tenesmus (urgency to defecate) combined with a feeling of heaviness or bearing down in the rectum, yet unable to pass stool effectively. "Tenesmus" implies a downward dragging sensation. When dysentery occurs, the body experiences alternating chills and fever, accompanied by vomiting, mental restlessness and oppression, inability to take in fluids or food, abdominal pain, and passage of dysenteric discharge which may be red, white, or mixed red and white. The patient suffers from tenesmus and may defecate dozens of times day and night. This represents severe dysentery; if treated correctly, even severe cases can be cured.

In the early stage, if there are exterior syndromes caused by wind-cold, dispersing agents should be added to the dysentery-treating formula. If dispersing is not performed and treatment focuses solely on dysentery, it will inevitably disrupt the meridians and reverse the flow of qi, causing the disease to worsen.

Once external pathogens are eliminated, treatment should focus only on dysentery, further distinguishing between cold, heat, deficiency, and excess patterns. One must attend to both the root (zhengqi/healthy qi) and the branch (pathogenic factors). Merely using draining methods, treating the branch first and the root later, is inferior to a strategy that treats both root and branch simultaneously, combining tonification and purgation.

If the discharge consists purely of blood, with persistent fever and inability to ingest food, this is a death sign. The Classics state: "Bleeding from the intestines with fever indicates death." This is because residual blood is leaking out while yang-heat floats externally, leading to the separation and collapse of yin and yang.

If bloody water is passed after dysentery, accompanied by fever, this is also a death sign. After dysentery, the intestinal turbidity has been exhausted; passing bloody water indicates the pathogen has moved from the yang level to the yin level, damaging the lower jiao (lower burner). The world describes this as "water leaking from the bottom house," referring to the gradual loss of blood and fluids.

If the color resembles fish brains, this indicates heat-toxin entering the intestines; one should clear heat and harmonize the blood. If the color resembles dark brown sauce, this indicates deficiency-cold in the lower jiao, which is also an unfavorable sign; one should warm the meridians and dispel cold. If the discharge consists of white froth or jelly-like substances, this indicates accumulation of cold.

Some physicians claim that red indicates fire and white indicates cold. While this seems plausible, if the discharge is red but the spleen-earth is deficient and stomach qi is weak, one should use warm medicines to treat according to the nature of the disease (conforming treatment), rather than using cooling medicines for opposing treatment.

Generally, vomiting at the onset of dysentery is harmless. However, if vomiting occurs due to long-standing spleen deficiency and cold in the three jiao, the condition will become critical.

Furthermore, dysentery is always painful; painful cases are treatable because they indicate the presence of stagnation. Painless cases are known as Kidney Diarrhea and are difficult to treat; immediate warm tonification is appropriate, avoiding moving and draining methods. If draining is used first followed by warm tonification, survival is unlikely.

For dysentery belonging to the Yang meridians, where spirit is not exhausted and appetite remains, treatment should distinguish between new and old conditions, employing purgation, tonification, or a combination of both. For dysentery belonging to the Yin meridians, characterized by physical fatigue and inability to eat, only warm tonification is suitable, avoiding draining methods.

There are also cases of dysentery without stagnation, occurring more than ten times a day with slight pain during defecation, known as Spleen Diarrhea or Hole Diarrhea; these also require warm tonification and avoid draining.

When there is excess in the spleen requiring the expulsion of rotten filth, this applies only to new diseases, not chronic ones.

Some patients suffer from deficiency-cold dysentery in summer and autumn; if treated correctly, they may improve slightly in winter and fully recover in the following spring. Others suffer from excess-heat dysentery in summer and autumn; if treated improperly, their condition fluctuates, and they may die in the following spring.

In early-stage dysentery with scanty, difficult passage, tenesmus, and heaviness, purgatives like Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) are suitable, following the principle that "free flow eliminates pain."

Mild dysentery is called "Accumulation," caused by improper diet and cold accumulation in the lower jiao. Sudden abdominal pain, borborygmus (rumbling in the intestines), and violent watery diarrhea are called "Water Diarrhea," resulting from the failure to separate clear and turbid fluids, flowing down from the small intestine.

Generally, dysentery with feces is mild, while dysentery without feces is severe. Feces originate from within the intestines, while accumulations originate from outside. What comes from within is easy to expel; what comes from outside is difficult to expel, hence the tenesmus and pain.