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(Attached: Kaiwei Zisheng Dan)

Tang Rongchuan said, "The *Neijing* (Classic of Internal Medicine) states: 'Various vomiting and acid regurgitation, sudden diarrhea with tenesmus, all belong to heat.' The mention of 'tenesmus' alongside 'acid regurgitation' indicates that this belongs to Liver Heat. Zhang Zhongjing, in discussing post-dysentery tenesmus and pus-blood stools, detailed these in the Jueyin Chapter, attributing dysentery to the Liver Meridian. Generally, dysentery often occurs in autumn due to Lung Metal failing to clear and descend, causing Liver Wood to become constrained. The Liver governs free flow and drainage; if its draining force is excessive, it leads to sudden diarrhea and abdominal urgency, creating a sense of inability to wait. However, if the Large Intestine opens, direct purging occurs. Since the Large Intestine is the Fu organ of Lung Metal, and Metal has a nature of astringency, when it commands in autumn, if it does not allow expulsion, qi stagnates and blocks, preventing smooth discharge, thus forming tenesmus. Therefore, those treating dysentery should open Lung Qi and clear Liver Fire, so that lower dysentery heals itself." This argument is extremely profound; his deduction of the causes of dysentery and methods of treatment are accurate and appropriate. I now specifically extend his theory and explain it in detail. Although Wood flourishes in Spring, its sprouting and growth actually occur in Summer. Thus, the sixth month of late summer is the Wei month; "Wei" implies heavy leaves on wood, indicating that Wood reaches its peak prosperity at this time. Since the Liver belongs to Wood, it is also extremely prosperous in June. If Liver Wood becomes overly prosperous and insults/conquers Spleen Earth, then in late summer there are many cases of sudden diarrhea, but few cases of dysentery, because Lung Metal has not yet taken command, and its astringent power is very weak. Even if someone occasionally suffers from dysentery at this time, it is mostly caused by damp-heat brewing; simply promoting urination and clearing heat can cure the disease. Therefore, Liu Yi San (Six-to-One Powder) is the fixed formula for treating summerheat dysentery, not the autumn dysentery discussed here. When entering the autumn season, Metal Qi gradually extends, and Wood Qi gradually contracts. The human viscera can originally remain stable according to the normal sequence of seasons without developing dysentery. Only if a person previously had accumulated heat within, will Liver Wood take advantage of the heat to act recklessly, failing to contract when it should. Furthermore, if they catch cold and chill through diet and daily life, Lung Metal, riding on the cold air, exerts its descending and astringent authority even more. Thus, Metal and Wood clash, pressing upon each other in the intestines, and dysentery arises. It is known that the formation of dysentery is indeed due to the conflict between Metal and Wood, and the conflict between Metal and Wood is actually stimulated by the struggle between cold and fire. Tang's method of opening the Lungs and clearing the Liver is originally a correct treatment method. However, it can only be applied at the beginning of the disease, not when dysentery has already progressed deeply. Moreover, observing ancient and modern formulas for treating dysentery, most are effective in the early stage but ineffective in the late stage. I now specifically divide dysentery into several stages and detail the condition and treatment methods below.

At the initial onset of dysentery, there is frequent passage of pus and blood, tenesmus, and intestinal pain. The discharged pus is very thick, and the blood is very bright red. Abdominal pain is not severe, and the pulse is slippery and solid. In such cases, Xiao Chengqi Tang (Minor Order the Command Decoction) can be used with added Sheng Hang Shao (Raw Paeoniae Radix Alba) 4 qian and Gancao (Licorice Root) 2 qian to purge. In this formula, Houpo (Magnolia Bark) and Zhishi (Immature Bitter Orange) can open Lung Qi; Dahuang (Rhubarb Root) and Shaoyao (Peony Root) are good at clearing Liver Fire; moreover, Houpo is warm while Dahuang and Shaoyao are cool, which can balance cold and heat to achieve the effect of cleansing the intestines and eliminating stagnation. Adding Gancao utilizes its ability to harmonize the Stomach and soothe the Liver, thereby moderating the downward-purging force of Chengqi Tang. If the pulse feels empty upon pressure, treat with my formulated Huazhi Tang (Stagnation-Transforming Decoction). If untreated at this stage, or if treated with the previous formula without success, or if delayed for weeks or months, abdominal pain gradually intensifies. Although the color of the discharge hasn't changed much, it may contain membrane-like substances. The pulse may be slightly rapid or slightly deficient. It is suitable to treat with my formulated Xieli Tang (Regulating-Decreeing Decoction). I have cured many patients with this formula throughout my life; it can be used for both new and chronic dysentery.

Although the above formula is effective for both new and chronic dysentery, the intestines generally have not yet ulcerated. However, some patients experience constant cutting abdominal pain and tenesmus, with discharges resembling rotting meat mixed with membranes, indicating that the intestines have already ulcerated. In such cases, treat with my formulated Tongbian Baitouweng Tang (Modified Baitouweng Decoction). The intent of the formula: use Baitouweng (Pulsatilla Root), Qinpi (Ash Bark), Shaoyao (Peony Root), and Sheng Diyu (Raw Sanguisorba Root) to clear heat; Sanqi (Notoginseng Root) and Yadanszi (Brucea Fruit) to resolve stasis and generate new tissue, treating intestinal ulceration; and heavily use Sheng Shanyao (Raw Dioscorea Rhizome) to nourish fluids long consumed and secure the already weakened Qi transformation, thus achieving rapid results. While serving in Fengtian, I had a patient surnamed Wang who suffered from severe dysentery and was cured by this formula; the detailed case record follows this formula for reference. For those with a habit of opium smoking, regardless of whether the dysentery is recent or chronic, this formula is suitable and has repeatedly achieved miraculous results. Regarding Diyu (Sanguisorba Root), medical texts usually recommend using it charred; however, in this formula, it is used raw because raw Diyu is cool and protects the body's tissues from heat-induced ulceration. Therefore, for skin burns from hot liquids or fire, applying raw Diyu powder mixed with sesame oil cures immediately. The heat toxin of dysentery invading intestinal tissues and causing long-term ulceration is similar to skin burns; this is why Diyu is used raw here. The original Baitouweng Tang consists of Baitouweng, Qinpi, Huanglian (Coptis Rhizome), and Huangbai (Phellodendron Bark). The purely bitter-cold nature of these drugs is indeed because the formula originally treats Jueyin Heat Dysentery, which involves excess heat from Cold Damage. Now, using it to treat chronic dysentery with intestinal ulceration necessitates modification.

The aforementioned dysentery syndromes can also be treated with my formulated Shenghua Dan (Life-Generating Pill). If the deficiency is severe, add Sheng Huaishan (Raw Chinese Yam) 1 liang. First, send down half of the Sanqi (Notoginseng Root) and Yadanszi (Brucea Fruit) with white sugar water, then decoct and drink the remaining four herbs. When taking the dregs, again first send down the remaining Sanqi and Yadanszi with white sugar water, then decoct and drink the liquid. By this stage of dysentery, Western medicine calls it intestinal ulceration. It cannot be treated merely as dysentery; it should be treated partially as a sore. Therefore, use Jinyinhua (Honeysuckle Flower) and Fen Gancao (Powdered Licorice Root) to resolve heat toxins of sores; Sanqi and Yadanszi to resolve stasis and generate new tissue; Yadanszi is extremely bitter and has resolving power (paste can remove warts), and can also eliminate infectious bacteria of dysentery; Shaoyao drains Liver Fire to treat the root cause of dysentery; fearing that chronic dysentery damages Yin fluids and fails to secure Lower Jiao Qi transformation, heavily use Sheng Shanyao to nourish Yin fluids and secure Qi transformation. This is why it is effective (see medical cases after this formula in the Medical Formulas section for reference). When I first formulated this, I had not yet seen the Western concept of intestinal ulceration. Later, seeing Western books, their treatments focused only on intestinal ulceration, ignoring the need to clear the root source of dysentery with medication, hence less effective than this formula.

For chronic dysentery with deficiency heat steaming upward, reduced appetite, discharges resembling rotting meat mixed with membranes, having a rotten color and abnormal foul odor, and increasingly severe cutting abdominal pain, the vital energy in the abdomen is about to cease, and the condition is particularly critical. Treat with the previous formula, adding Luzhushen (Codonopsis Root) and Tianmendong (Asparagus Tuber) each 3 qian. Ginseng is used to assist vital energy, and Asparagus Tuber is used to moderate the heat of Ginseng.

For those originally damaged by opium smoke, with Kidney Meridian exhaustion, complicated by chronic dysentery where intestines are about to ulcerate, and Lower Jiao Qi transformation is too depleted to hold, treat with my formulated Sanbao Zhou (Three Treasures Porridge). The intent: use Sanqi and Yadanszi to treat intestinal ulceration, and Shanyao porridge to tonify Lower Jiao depletion.

For dysentery presenting as red, white, or mixed red-and-white stool, with tenesmus and abdominal pain, feeling feverish inside and out, where fever does not subside with cooling medicines and dysentery does not heal, and the pulse clearly indicates excess heat: These dysentery syndromes originally involve external pathogenic heat, which resides in the Yangming Fu organs. They cannot be cured by Taohua Tang (Peach Kernel Decoction) from the Shaoyin Chapter nor by Baitouweng Tang from the Jueyin Chapter. Only treating with my formulated Tongbian Baihu Jiarenshen Tang (Modified White Tiger Plus Ginseng Decoction) yields immediate results. When dysentery presents with persistent fever unresponsive to cooling herbs, texts often dismiss it as incurable. However, if the treatment matches the syndrome, how can the fever persist? This is truly because external heat pathogens sink deeply with the dysentery, having no exit, aiding the dysentery day by day, leading to no hope of recovery. Treating with this decoction, Ginseng assists Gypsum to slowly rise and dissipate the deeply sunk heat pathogens, eliminating them completely. Add Shaoyao and Gancao to regulate tenesmus and abdominal pain, and Sheng Shanyao to nourish Yin and secure the Lower Jiao. Taking several doses, the fever subsides and dysentery heals. The formula uses Shaoyao instead of Zhimu (Anemarrhena Rhizome) and Sheng Shanyao instead of Jingmi (Rice), resembling the original Baihu Jiarenshen Tang, hence the name. I have cured many such dysentery cases with this formula (see cases after this formula in the Medical Formulas section).

This combination of external heat and dysentery is the most dangerous syndrome. I once saw a Japanese author, XXX, write "New Theory on Red Dysentery," highly praised by Ding Zhonghu. However, it recorded two uncured cases: One had a temperature of 38.7°C, pulse 110 beats/min, confused consciousness, unclear speech, swollen dry tongue, peeled coating, obviously involving external excess heat. The Japanese doctors failed to prioritize clearing external excess heat, instead injecting dysentery serum daily, resulting in death. The second had severe fever, nocturnal mania, delirium, and temperature 40.2°C, obviously involving severe external heat. The case did not record treatment methods, presumably similar to the first, also resulting in death. If these two cases were treated with my Tongbian Baihu Jiarenshen Tang, fearing the disease is severe and the dose light, one could combine two doses into one, decoct into 4-5 teacups, and drink slowly in multiple portions. Recovery need not require finishing all doses; how could the fever not subside? Once high fever subsides, dysentery naturally heals. The Japanese failed to see this because they abandoned traditional Chinese learning entirely for Western studies. Chinese and Western medicine should assist each other, not be neglected. If our country wishes to revitalize medicine, it is essential to integrate Chinese and Western practices.

The dysentery discussed above involves external heat entering the Yangming Fu organs. However, at the onset of dysentery, there are often cases where external constraints stimulate internal damage. Clinicians must carefully observe. If there is external constraint, first use medication to release the exterior, then treat dysentery; or add exterior-releasing herbs to dysentery formulas; or use dysentery decoction to send down a small amount of Aspirin to release the exterior. If overlooked, external pathogens sink inward with dysentery, becoming the critical syndrome managed by Tongbian Baihu Jiarenshen Tang. Is it not better to treat early?

Although dysentery is formed by cold-heat stagnation, commentators often say white dysentery leans cold and red dysentery leans heat. This is the general rule, but cannot be generalized. I will cite cured cases to clarify. The wife of Zhang XX from Tongzhuang, nearly sixty years old, prone to illness. One morning in late summer, she suddenly passed white dysentery, over ten times by evening. After lighting candles, she suddenly developed high fever, became unconscious, exhibited aimless hand movements (clutching clothes and bed), and did not respond to calls. Her pulse was surging but powerless, and her skin was burning hot. Knowing her dysentery was caused by summerheat injury, and her debilitated body could not withstand summerheat steaming, causing such coma. Urgently use Sheng Shigao (Raw Gypsum) 3 liang and Yetaishen (Wild Codonopsis) 4 qian, decoct into a large bowl, and let her drink slowly. By midnight, after finishing the dose, she woke up. The next morning, decoct the dregs and take again; fever subsided and dysentery healed. This was purely white dysentery yet presented with such intense heat.

There are cases of consecutive dysentery episodes with different cold-heat presentations. Carefully diagnose the pulse; if significantly different, prescribe medications appropriately without error. I once treated Liu XX who suffered severe dysentery in early autumn. His dysentery consisted of thick, sticky pus and blood, with a wiry and fine pulse that remained forceful upon deep pressure. Treated with Tongbian Baitouweng Tang, cured in two doses. Ten days later, dysentery recurred. He self-medicated with the original formula, but the condition worsened. He returned for consultation. His pulse was wiry, fine, and slow, intolerant to pressure. Knowing it had become cold dysentery, he could not tolerate the original formula. Prescribed Sheng Huaishan (Raw Chinese Yam) powder cooked as porridge, sent down with Xiaohuixiang (Fennel Seed) powder 1 qian and Sheng Liuhuang (Native Sulfur) powder 4 fen. Cured in several doses. Similarly, the case of Mrs. Lu cured after the Sanbao Zhou formula.

Both cases followed the shift in pathology, alternating cool and hot medications, achieving immediate results. Therefore, practitioners must study carefully during clinical practice, ensuring every moment aligns with the pathology.

There are dysentery cases with upper heat and lower cold, requiring separate treatment for upper and lower parts: cool herbs for the upper, hot herbs for the lower. I once treated an elderly woman surnamed Zhang in Tianjin, nearly fifty, who suffered dysentery in early autumn, lasting twenty days without relief. Discharge was red dysentery mixed with bloody water, tenesmus, and abdominal pain. Later, dysentery decreased and diarrhea increased, also mixed with bloody water. Upper jiao was烦热 (restless heat), unable to eat (Jinkou), nausea upon smelling food, dizziness, unable to get out of bed. Pulse at Guan position was floating and wiry, empty upon deep pressure; Chi positions were weak and rootless, five breaths per minute. Patient felt palpitations, mental confusion, seemingly near collapse. This indicated extreme deficiency approaching collapse. Urgently use Yu Rou (Cornus Fruit) and Sheng Huaishan each 1 liang, Da Shudi (Prepared Rehmannia Root), Longyan Rou (Longan Aril), and Bailonggu (Fossilized Bone) each 5 qian, Sheng Hang Shao (Raw Paeoniae Radix Alba), Yunling Pian (Poria Slice), and Zhi Gancao (Honey-fried Licorice Root) each 2 qian. Decoct into two bowls, divide into two warm doses. After the first dose, mind and spirit stabilized. After finishing the dose, ate slightly, diarrhea and dysentery stopped somewhat. Added Sheng Dihuang (Raw Rehmannia Root) 4 qian, changed Zhi Gancao to 3 qian, decoct into two bowls, divide into two warm doses. Each dose sent down with Sheng Liuhuang (Native Sulfur) powder 2.5 fen. One dose daily, cured in several days.

Regarding summer heat dysentery, treating with Liu Yi San was mentioned earlier. Southern summer heat often combines with dampness, making Liu Yi San appropriate. Northern summer heat often lacks dampness and may combine with dryness; thus, Liu Yi San requires modification. I formulated a highly effective prescription: Huashi (Talcum) and Sheng Shigao (Raw Gypsum) each 5 qian, Zhusha (Cinnabar) and Fen Gancao (Powdered Licorice Root) each 2 qian, Bohe Bing (Mint Ice) 1 fen. Mix evenly, take 2 qian with boiled water. For severe heat and dysentery, take 5-6 times daily. Named Jiawei Yiyuan San (Added-Ingredient Yiyuan Powder), as Liu Yi San plus Cinnabar is Yiyuan San, here further adding Gypsum and Mint Ice.

Note: Summer heat dysentery often presents with inability to eat. Treating with Jiawei Yiyuan San revitalizes appetite. If non-summer heat dysentery also presents with loss of appetite, use equal parts Zhusha (Cinnabar) and Fen Gancao (Powdered Licorice Root), add a little Bohe Bing (Mint Ice), take 1 qian sent down with Zhuru (Bamboo Shavings) decoction. Appetite returns. Such conditions are often due to Liver/Gallbladder fire carrying Stomach Qi rebellion; smelling food causes nausea/vomiting, preventing eating. Zhusha descends Stomach Qi and calms Liver; Gancao harmonizes Stomach and soothes Liver; Zhuru pacifies rebellious Qi; Bohe Bing disperses constrained heat. Hence, immediate efficacy. Due to repeated success, named Kaiwei Zisheng Dan (Appetite-Opening Nourishing Pill).

During summer heat, if Liver/Gallbladder and Intestines/Stomach have pre-existing heat, and one runs/work under the scorching sun, sudden dysentery ensues, often with fresh blood, and pulse is surging and large. Treat with large dose of Baihu Tang (White Tiger Decoction), decoct several bowls, drink warm in portions. Send down 30 Yadanszi Ren (Brucea Seeds) each time. If pulse is surging/large but empty upon pressure, treat with large dose of Baihu Jiarenshen Tang (White Tiger Plus Ginseng Decoction), sending down Yadanszi Ren.

For chronic dysentery with sinking of Clear Yang, i.e., Chest Middle Qi sinking due to dysentery. Symptoms often include sensation of heaviness/dragging and abdominal pain (Qi sinking pressing on Lower Jiao), either dysentery or diarrhea, often passing flatus, shortness of breath, or alternating chills and fever. Pulse is slow and weak. Treat with my formulated Shengxian Tang (Ascending the Fallen Decoction), remove Zhimu (Anemarrhena Rhizome), add Sheng Huaishan (Raw Chinese Yam) 6 qian and Baitouweng (Pulsatilla Root) 3 qian. Original intent: Use Sheng Huangqi (Raw Astragalus Root) to ascend and tonify Chest Middle Qi, assisted by Chaihu (Bupleurum Root), Jiegeng (Platycodon Root), and Shengma (Cimicifuga Rhizome) which ascend Clear Yang; add Zhimu to moderate Huangqi's heat. Here, due to frequent Lower Jiao diarrhea/dysentery and insecure Qi transformation, replace Zhimu with Baitouweng and assist with Shanyao. Zhimu is cold and slippery; Baitouweng is cool and astringent. Its coolness resolves Huangqi's heat; its astringency secures Qi transformation leakage; it is a key herb for dysentery. Combined with Shanyao, another key herb for stopping diarrhea.

Besides various dysenteries, there is "Resting Dysentery" (Xixi Li). It is generally not severe but hard to eradicate, recurring frequently even after cure. Though prolonged, it can be sustained, resembling mild Amebic Dysentery, lasting years without fatal outcome. Perhaps this is amebic dysentery? Requires future experimental verification. The reason for recurrence is likely protozoa hiding in the twists of the large/small intestines. Healing and relapsing occur until protozoa are eliminated. To eliminate: For heat-type syndromes, use Yadanszi Ren assisted by dysentery herbs; for cold-type syndromes, use Liuhuang (Sulfur) powder assisted by dysentery herbs. Furthermore, regardless of heat or cold, add Mu Zei (Equisetum Ramulum) 1 qian to the formula, as it soothes the Liver and stops intestinal wind bleeding. Hence, later Materia Medica states it treats resting dysentery well. For those with weak Spleen/Stomach, additionally use herbs to strengthen and tonify Spleen/Stomach to clear the upper source of dysentery, naturally removing the root cause.

Dysentery cases sometimes present with frequent daily stools but dry fecal impaction remaining in the intestines. The impaction must be removed for dysentery to heal. This is rare but must be known by dysentery practitioners. My cousin Liu XX, aged 24, suffered dysentery at Mid-Autumn Festival. Thick, sticky pus and blood, 15-16 times daily, severe abdominal pain and tenesmus. Treated with Huazhi Tang (Stagnation-Transforming Decoction), two doses. Frequency seemed reduced, but tenesmus/pain remained. Deep pulse at Chi position was very solid. Suspected intestinal fecal impaction. Administered Xiao Chengqi Tang (Minor Order the Command Decoction) with added Sheng Hang Shao (Raw Paeoniae Radix Alba) several qian. Passed dry feces approx. 4 cun long. Tenesmus and pain relieved 80-90%. Given one more dose of Huazhi Tang, disease vanished.

The most important drug for treating dysentery: For heat-leaning dysentery, Yadanszi (Brucea Fruit) is paramount; for cold-leaning dysentery, Liuhuang (Sulfur) is paramount, as both have power to eliminate protozoa in dysentery. These two drugs were mentioned frequently in previous cases. Discussing them again:

Yadanszi, also known as Yadan Zi, has properties of cooling blood, stopping bleeding, and resolving stasis to generate new tissue. Effective for heat-leaning dysentery, especially for fresh blood dysentery and bloody water diarrhea. Also clears Stomach Fire; effective for fullness of excess heat in epigastrium and inability to eat (Jinkou), restoring appetite. Must remove hard skin before use. If kernel breaks during peeling, do not use, as broken kernels digest easily, releasing bitter taste quickly, often causing vomiting. Hence, some dysentery formulas use Longan Aril to wrap intact Yadanszi kernels for swallowing whole. Pharmacy secret recipe coats Yadanszi kernels with Yiyuan San, naming it Puti...