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The original text of the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: "For hot dysentery accompanied by tenesmus, Baitouweng Tang (Pulsatilla Decoction) is the primary treatment."

[Formula of Baitouweng Tang] Baitouweng (Pulsatillae Radix) two liang, Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), and Qinpi (Aceris Cortex) each three liang.
Take these four ingredients, add seven sheng of water, boil to obtain two sheng, remove the dregs, and take one sheng warm. If not cured, take another sheng.

The commentary in *Yizong Jinjian* (Golden Mirror of Medical Tradition) notes: "All three Yin meridians (Taiyin, Shaoyin, Jueyin) present with diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only for Jueyin diarrhea, if it belongs to cold, there is cold extremities without thirst, and diarrhea of undigested food; if it belongs to heat, there is excessive thirst, diarrhea with tenesmus, and passage of pus and blood. This 'hot dysentery with tenesmus' is caused by stagnant heat forcing its way into the large intestine and anus, causing heavy stagnation and difficulty in evacuation. For initial onset of dysentery, this method uses cold-natured herbs to treat heat; for chronic dysentery, Wumei Wan (Mume Pill) should be used instead, treating according to the condition to regulate qi and restore balance."

The hot dysentery with tenesmus treated by Baitouweng Tang should have transmitted from Shaoyin disease; otherwise, it is latent pathogenic qi transforming into heat and invading the Jueyin meridian. Although the syndrome presents heat signs, it is not an exterior excess heat from external contraction, so Baitouweng Tang can adequately address it. However, when a disease is in the Yangming stage, half the pathogen enters the fu organs, and half transmits from the channels to Shaoyang, subsequently entering Jueyin from Shaoyang, forming transmission between zang and fu organs. In such cases, the Jueyin pathology may form Jueyin hot dysentery with tenesmus, while the retained heat in the Yangming fu organs assists and exacerbates the condition. This situation exceeds the capacity of Baitouweng Tang alone. When I encounter such syndromes, I frequently add Baitouweng (Pulsatillae Radix) and Qinpi (Aceris Cortex) to Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction), which invariably yields immediate results.

I once treated a middle-aged woman who contracted wind-cold in early spring. Four or five days later, a physician was summoned. Her left pulse was wiry and forceful, her right pulse was surging and forceful, her tongue coating was white with slight yellow, she felt internal heat and thirst, had dysentery with mixed pus and blood, tenesmus, and defecated more than twenty times a day. Based solely on the pulse conditions of both sides, I diagnosed it as a combined syndrome of Yangming and Jueyin diseases. A physician present doubted and asked, "In all diseases involving Jueyin, the hands and feet are usually cold and inverted; why are this patient's hands and feet very warm?" I replied, "This is precisely because it is a combined syndrome with Yangming. Yangming governs the muscles; since there is heat in the Yangming fu organs, the whole body is hot, so the cold inversion of the limbs cannot manifest externally when the whole body is hot. Moreover, even if Jueyin disease does not mix with Yangming, do not assume the limbs must always be cold and inverted?" The physician deeply agreed with my words, and the patient's family requested a prescription immediately. Thus, I formulated the following:

Raw Shigao (Gypsum Fibrosum) (three liang, crushed finely)
Raw Hongsao (Paeoniae Radix Alba) (eight qian)
Raw Huaishanyao (Dioscoreae Rhizoma) (eight qian)
Ye Taishen (Codonopsis Radix / Wild Ginseng substitute) (four liang)
Baitouweng (Pulsatillae Radix) (eight qian)
Qinpi (Aceris Cortex) (six qian)
Tianhuafen (Trichosanthis Radix) (eight qian)
Gancao (Glycyrrhizae Radix et Rhizoma) (three qian)

These eight herbs were decocted together into three bowls, divided into three doses, taken warm.

The intent of this formula combines Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction) and Baitouweng Tang (Pulsatilla Decoction) into one, adding other herbs according to the syndrome. Baizhu Tang (White Tiger Decoction) typically contains Zhimu (Anemarrhenae Rhizoma); here, Shaoyao (Paeoniae Radix) replaces Zhimu. Shaoyao can clear heat and nourish yin like Zhimu, and it is particularly effective in treating tenesmus after dysentery. Baizhu Tang typically contains Jingmi (Oryza Sativa Germ); here, Raw Shanyao (Dioscoreae Rhizoma) replaces Jingmi. Shanyao has rich juice, harmonizing the stomach like Jingmi, and its warming and tonifying nature helps Renshen (Ginseng Radix et Rhizoma) secure and stop diarrhea. As for Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) originally in Baitouweng Tang, they are omitted here because, used concurrently with Baizhu Tang, the cooling property of Shigao (Gypsum Fibrosum) suffices, making Huanglian and Huangbai unnecessary. Additionally, Tianhuafen (Trichosanthis Radix) is added externally because the patient also suffers from thirst; Tianhuafen paired with Renshen is most effective at generating fluids and quenching thirst. After completing these three doses, all symptoms reduced by two-thirds. Upon re-examination, the pulse still indicated unclarified excess heat. Therefore, Huashi (Talcum) five qian was added to the original formula to promote urination, which effectively stops diarrhea. The decoction method remained the same. Besides taking the herbal medicine, fresh Baimaogen (Imperatae Rhizoma) half a jin was decocted in water and drunk as tea. The illness was completely cured.