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Treats dysentery (a condition characterized by diarrhea with pus and blood in the stool) accompanied by abdominal pain and tenesmus (a feeling of incomplete defecation, urgency to defecate, but difficulty in passing stool) at the initial stage. If the disease is not completely cured after taking this prescription, continue with the following prescription (Xiel Tang).

Raw Shaoyao (Sheng Huangshao) [30g] Danggui [15g] Shanzha [18g] Laifuzi [15g, stir-fried and crushed] Gancao [6g] Shengjiang [6g]

If the patient has a robust constitution, add Dahuang and Puxiao each [9g] to purge accumulation.

Rationale of this formula: Use Shaoyao to drain heat from the Liver channel; use Gancao to relieve Liver Qi urgency; use Laifuzi to open stagnation in the Qi level; use Danggui and Shanzha to resolve stasis in the Blood level; using Shengjiang together with Shaoyao is good at regulating mutual stagnation of cold and heat. Moreover, the juice of Danggui is most slippery. For patients with dysentery suffering from Qi and Blood stagnation causing difficult defecation, using Danggui to make it slippery will resolve the stagnation, and the dysentery will heal itself.

Treats dysentery that has not been completely cured after taking the previous prescription (Hua Zhi Tang). If dysentery has persisted for several days, one can also directly take this decoction. It also treats Jin Kou Li (Jin Kou Dysentery, a severe form of dysentery where the patient cannot eat or vomits upon seeing food).

Raw Shanyao [24g] Jinyinhua [15g] Raw Shaoyao (Sheng Huangshao) [18g] Niubangzi [6g, stir-fried and crushed] Gancao [6g] Huanglian [4.5g] Rougui [4.5g, remove coarse bark, add when the decoction has boiled dozens of times]

For pure red dysentery (pus and blood predominating), add Dihongyu [6g]; for pure white dysentery (mucus predominating), add Shengjiang [6g]; for bloody dysentery (predominantly fresh blood), add Yadanzi [20 grains, peeled], taken with the decoction.

Dysentery was called "Zhi Xia" (Stagnant Downward Flow) in ancient times. The term "Zhi Xia" indeed refers to the condensation of cold and fire pathogens in the Lower Jiao, where blood stasis transforms into pus and blood, remaining stagnant and unable to pass down, while the force of the battle between cold and fire forces it downward, causing diarrhea. Therefore, in the formula, Huanglian is used to treat fire, and Rougui is used to treat cold. Using these two herbs in equal proportions can regulate Yin and Yang within an instant. The reason for using Baishao (Shaoyao): In various formulas from Shanghan Lun, Shaoyao must be added along with Gancao for abdominal pain; this is also a wonderful method for regulating Yin and Yang. Furthermore, in dysentery cases presenting with inability to eat (Jin Kou), it is necessarily due to Gallbladder Fire counterflowing to the Stomach opening; cases with tenesmus are necessarily due to Liver Fire pressing down on the Large Intestine. Baishao can drain Liver and Gallbladder fire, thus treating these conditions. Moreover, the Liver stores Blood; when Liver and Gallbladder fire are subdued, pus and blood will naturally consolidate. The reason for using Shanyao: Prolonged stagnant downward flow inevitably depletes the Yin aspect. Shanyao, rich in fluid, can nourish the True Yin of the Zang-Fu organs. Also, prolonged stagnant downward flow leads to insecure Qi transformation; the astringent property of Shanyao can further secure the Qi transformation of the Lower Jiao. Additionally, Baishao is good at promoting urination, draining the condensation of cold and fire through urine; Niubangzi can unblock the bowels, draining the condensation of cold and fire through feces; Jinyinhua used together with Gancao is good at resolving heat toxicity, preventing intestinal ulceration. Pure white dysentery indicates pathology at the Qi level, so Shengjiang is added to move Qi; pure red dysentery indicates pathology at the Blood level, so Dihongyu is added to cool the Blood; as for dysentery with much fresh blood, the Heat in the Blood level is even more severe, so Yadanzi is added to greatly clear Heat in the Blood level. Since I formulated this prescription, I have encountered countless dysentery patients every year. Administering this decoction, even in severe cases, usually shows effect after continuous administration for a few doses.

Dysentery is mostly caused by prior accumulated Heat followed by contraction of Cold pathogen. This may be due to dietary preference for cold foods or living in cold environments. The Heat is forced by Cold, making the Heat unable to dissipate. After many days, it gradually evolves into a state where there is only Heat and no Cold, similar to how a Cold injury transforms into a Heat disease. Therefore, although this formula uses Huanglian and Rougui in equal proportions, the Heat nature of Rougui ultimately cannot match the Cold nature of Huanglian. Moreover, heavy use of Baishao serves as an assistant and guide for Huanglian. Thus, although this decoction is a formula for regulating Yin and Yang, it is essentially a formula for clearing Fire.

Question: Using this decoction to treat dysentery, even if administered several days after onset or after taking Hua Zhi Tang, when the dysentery pathogen is still strong, suddenly using heavy doses of Shanyao for tonification, does it not risk retaining the pathogen? Answer: Although Shanyao has strong tonifying power, its nature is slightly sluggish, unlike Ginseng or Astragalus which act rapidly. In this formula, although taken with other herbs, it waits until the cooling, warming, unblocking, and draining properties of the other herbs have almost completely dissolved the dysentery pathogen, before fully exerting its tonifying effect to calmly cultivate the healthy Qi afterwards, ensuring the pathogen is removed and the healthy Qi restored. This is a complete strategy, so how could it retain the pathogen? Moreover, using Shanyao together with Baishao greatly clears deficiency Heat in the Upper Jiao, which is particularly suitable for dysentery with inability to eat. Therefore, when I use this decoction for patients with accompanying deficiency or elderly patients, I often use Shanyao up to 30g or more.

Question: Dihongyu is mostly used charred in medical books, taking advantage of black overcoming red to control reckless bleeding. Why is raw Dihongyu used alone in this formula for pure red dysentery? Answer: The nature of Dihongyu is both cooling and astringent; it can cool the Blood and stop bleeding. If charred, it loses this efficacy. Therefore, this formula must add raw Dihongyu for treating red dysentery. Furthermore, in severe cases of red dysentery, it may be due to intestinal ulceration. Linwu Shanren treated burns and scalds with skin ulceration by applying Dihongyu powder mixed with sesame oil externally with great effect. Since external application can treat skin ulceration caused by Heat, internal administration should also have this effect. Yadanzi, also known as Yadanzi (Brucea javanica), is the seed produced by Sophora flavescens (Kushen). It is not only good for treating bloody dysentery but can be used for all types of dysentery. Even for pure white dysentery, it is effective, especially with miraculous effects for Jin Kou Dysentery and Yan Hou Li (smoking-induced dysentery-like symptoms), and also treats hematochezia and hematuria caused by Heat. The method is to use single Yadanzi (peeled), selecting 50-60 mature grains, taken with sugar water, twice daily, with great miraculous effect. If hematochezia is caused by Cold, it can be used together with warming and tonifying medicines. It is good at clearing Blood Heat without being excessively cold; good at resolving Blood stasis without being harshly dispersing; having the ability to expel pathogens while also benefiting healthy Qi. It is truly a fine medicine. Shops peel Yadanzi and coat it with Yi Yuan San, treating hematochezia and hematuria effectively, named Puti Dan.

A man, over fifty years old, who habitually smoked opium. During the epidemic of cholera, he suddenly felt heart pain, nausea, vomiting, and dysentery with half pus and half blood. The family was terrified, believing it must be a sudden attack of cholera. His pulse showed no obstruction, only wiry, rapid, and weak, with the Left Guan position slightly full. I said: This is not cholera, but a battle between cold and fire in the Lower Jiao, causing abdominal pain and dysentery with pus and blood. Deficiency Heat in the Upper Jiao is congested and pressing, causing nausea and vomiting. It is actually a severe case of dysentery. I prescribed Baishao [18g], Zhuru and Qing Banxia each [9g], Gancao and Shengjiang each [6g]. After one dose, vomiting ceased, abdominal pain lightened, but dysentery did not improve, and there was no appetite. He was instructed to take single Yadanzi [50 grains], twice a day. The illness vanished. Examining this case, Yadanzi is not only good for managing the Lower Jiao, but also excellent for Upper Jiao deficiency Heat. This is why it has rapid effects in treating Jin Kou Dysentery.

A man, forty-eight years old, with a constitution inherently weak, who also smoked opium. In late autumn, he suffered from persistent loose stools. Eight to nine times a day and night, with red color in the stool, palpitations, and inability to eat. Daily administration of warming and tonifying medicines had no effect. Upon my examination, his pulse was weak and faint on both sides, especially at the Chi position, indicating deficiency Cold in the Lower Jiao. Because the stool contained redness and previous warming treatments failed, I instructed him to first take Yadanzi [40 grains]. The diarrhea reduced by half, the redness decreased slightly, and appetite returned. Then, decoctions for warming and tonifying the Lower Jiao were used to deliver Yadanzi [30 grains], gradually reducing to [10 grains]. Ten doses resulted in complete recovery. Although this syndrome involved deficiency Cold in the Lower Jiao, the presence of redness in the stool indicated an accompanying dysentery syndrome. Therefore, taking Yadanzi alone reduced the loose stools by half. This proves that although Yadanzi is good at clearing Heat and resolving stasis, it does not have the drawbacks of being cold and harshly dispersing. It is indeed a fine medicine.

My friend Teng XX from Cangzhou, during the Mid-Autumn Festival in the Renyin year, suffered from red dysentery with much fresh blood. Medical treatment for two months was ineffective. When I returned from elsewhere, I visited him and agreed to treat him. His pulse was surging and full, indicating pure Heat dysentery. I told him: This is easy to treat. Buy over a hundred Kushenzi (Sophora seeds), peel them, and take them in two doses for a cure. The next day I went out again and returned twenty days later. He said he asked all nearby pharmacies but found no Kushenzi. Later the condition worsened, and someone was sent to my hometown to obtain it. Taken according to the method, it was cured in two doses. Later, when Teng XX returned home, a clan member who had just returned seriously ill from Fengtian suffered from hematochezia for over a year, with whole-body edema, and all medicines failed. Teng XX taught him this formula. Taken according to the method, it was cured in three doses.

Appendix:
Letter from Zhang XX of Qing County, Zhili:
Li XX of Lutai, forty-two years old, in May of the Renxu year, due to laborious work and summer heat, suffered from hematochezia and abdominal pain. Doctors mostly used Western Ginseng, Wild Atractylodes, Charred Dihongyu, Charred Celmisiae Herba, and other warming and astringent substances. The more he took them, the worse he became. Wang XX of Xiaozhan, my friend, sent a letter asking for a prescription on my behalf, showing me the cause of the disease and the previous prescriptions. After reading, I mailed four doses of Puti Dan. Each dose was sixty grains, taken once daily. Soon, I received a reply stating that after finishing the medication, the bleeding stopped, and the abdominal pain healed. He praised the miracle of the medicine highly. In recent years, using this pill to treat red dysentery and hematochezia/hematuria has cured many people.

Letter from Lu XX of Dezhou, Shandong:
My clan sister-in-law, due to fleeing famine and fright, combined with contracting summer heat, suffered from dysentery for over two months. Medication was ineffective, and the condition worsened. My nephew prescribed six Wumei (Mume Fructus), one and a half taels of Shanzha, decocted to deliver Yi Yuan San [12g] and peeled Yadanzi [40 grains]. The dregs of the decoction were also used to deliver the medicine in the same way. After one dose, the illness vanished.