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Treatment for dysentery, where the stool is either red, or white, or a mixture of both, accompanied by tenesmus (a feeling of incomplete defecation with rectal pressure) and abdominal pain, generalized fever, and fever that does not subside after taking cooling medicines, with a pulse indicating definite excess heat.

Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, finely crushed)
Sheng Hangshao (Raw Paeoniae Radix Alba, 8 qian)
Sheng Shanyao (Raw Dioscoreae Rhizoma, 6 qian)
Renshen (Ginseng Radix et Rhizoma, 5 qian; if using Yedangshen [Codonopsis Radix], use this dosage; if using Liaodong Zhenyeshanren [Wild Panax Ginseng Root], reduce the dosage by half; Korean Ginseng [Korensis Ginseng Radix] must absolutely not be used)
Gancao (Licorice Root, 2 qian)

The above five herbs are decocted in four cups of water to obtain two cups of clear decoction, taken warm in two divided doses.

This formula is based on Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), substituting Shaoyao (Paeoniae Radix) for Zhimu (Anemarrhenae Rhizoma) and Shanyao (Dioscoreae Rhizoma) for Jingmi (Oryza Sativa). In cases of dysentery with persistent fever that does not resolve with antipyretic or clearing-heat medicines, medical texts often deem it incurable. However, if the treatment is correctly indicated, why would the fever not subside? This occurs because the dysentery is complicated by an exogenous pathogen; the exogenous heat pathogen sinks deeply into the interior along with the dysentery, having no outlet, thereby assisting the dysentery pathology, worsening day by day, and leading to a chronic course without recovery. Only by treating with this decoction can Renshen assist Shigao to slowly lift and disperse the deeply sunk pathogen outward, eliminating it completely. The addition of Shaoyao and Gancao regulates tenesmus and abdominal pain, while Shanyao nourishes yin and secures the lower jiao. Continuous administration for several doses invariably results in the subsidence of fever and cure of dysentery.

Note: When exogenous heat has entered the Yangming Stomach fu organ, it should be treated with bitter-cold herbs, such as those in Baihu Tang (White Tiger Decoction) or Chengqi Tang (Order the Qi Decoction). If treated with sweet-cold herbs, the disease may temporarily improve, but residual pathogens often remain trapped in the stomach, transforming into bone-steaming consumptive fever (a type of chronic deficiency heat), which remains incurable (*Shibu Zhai Yishu* discusses this in detail). Although Shigao is not bitter-cold, its nature is cold and dispersing, and it lacks sticky juices, differing significantly from sweet-cold cloying herbs. Furthermore, Baihu Tang requires the assistance of bitter-cold Zhimu. Similarly, this formula requires the assistance of Shaoyao, which is also bitter (as recorded in *Shennong Bencao Jing*) and slightly cold, and promotes urination. Thus, assisting Shigao with Shaoyao allows for the complete resolution of Yangming heat.

An elderly man, aged 67, contracted dysentery during the Mid-Autumn Festival. After more than twenty days of ineffective treatment, I examined him. His stool was a sticky mixture of red and white. During defecation, he felt heat and dryness in the intestines, and his urine felt hot. He experienced abdominal pain with a sensation of bearing down and urgency. There was also pain and a bearing-down sensation at the end of his spine. He suffered from occasional vertigo. His pulse was surging, long, and forceful; his tongue coating was thick and white. I stated: "This is exogenous heat forcing downward together with dysentery toxins, causing these various symptoms. It is necessary to treat both the dysentery and the exogenous condition." I administered this decoction. After two doses, all symptoms resolved. However, his pulse still showed signs of residual heat, so I intended to use Shigao again to clear it. The patient's family doubted whether a high-dose cold herb like Shigao could be taken frequently by an elderly person. I also had to attend another appointment elsewhere. More than twenty days later, the dysentery recurred. Other physicians treated him, adding sweet-cold moistening herbs to the dysentery formula. This caused the residual exogenous heat to remain permanently in the gastrointestinal tract. Although the dysentery initially improved, it repeatedly relapsed. By midsummer of the following year, the relapses were severe. I was called back to treat him; his pulse and symptoms were identical to the previous year. I told him, "If you had taken more Shigao last year, how could there have been subsequent relapses? Now we cannot leave the pathogen behind." I prescribed the same decoction again. After three consecutive doses, the illness cured and the pulse became harmonious.

A man, aged 42, suffered from white dysentery with frequent sensations of bearing down, worse after noon. He felt heat in his heart and intermittent chills and fever. A physician used a heavy dose of Huanglian (Coptidis Rhizoma, 1 liang) to clear heat within the dysentery formula, but the heat persisted and the dysentery did not improve. After two months of lingering illness, he became bedridden. His pulse was surging, long, and forceful. I prescribed this decoction. Due to the intermittent chills and fever, I added Chaihu (Bupleuri Radix, 2 qian). After one dose, the fever subsided and dysentery stopped, though intermittent chills and fever occasionally remained. Upon re-examination, his pulse was still forceful but lacked a gentle quality. I determined that prolonged dysentery had damaged his body fluids. Therefore, I removed Baishao (White Peony Root) and Chaihu, and added Xuanshen (Scrophulariae Radix) and Zhimu (Anemarrhenae Rhizoma), each 6 qian. After one dose, the chills and fever also resolved.

An elderly woman, aged 60, who was generally prone to illness, suddenly developed white dysentery early one summer morning, progressing to more than ten episodes by evening. After nightfall, she suddenly developed high fever throughout her body, lost consciousness, exhibited picking at clothes and bedsides (a sign of delirium), and did not respond to calls. Her pulse was surging but weak, and her skin was burning hot to the touch. I diagnosed this as qi-level heat dysentery complicated by summerheat, where her frail constitution could not withstand the pathogen, resulting in mental confusion. I urgently prepared a large bowl of decoction using Raw Shigao (3 liang) and Ye Taishen (Wild Codonopsis Radix, 4 qian), administering it slowly while warm. By midnight, after finishing the dose, she woke up, and the dysentery ceased. The next morning, she took the dregs of the decoction, and the illness completely resolved.

A man, over 50 years old, suffered from both dysentery and diarrhea during a hot summer day. Both stools contained blood. He experienced bearing down, abdominal pain, and inability to eat (anorexia due to nausea/obstruction). After twenty days of treatment, his condition worsened progressively. He was mentally confused, with faint breathing. His pulse was fine, rapid, and weak. His entire body was hot to the touch. He reported feeling heat in his chest, and his tongue coating was yellow. I diagnosed the condition as complicated by summerheat-warmth. The summerheat-warmth pathogen was diffuse in the stomach area, combined with dysentery and diarrhea, causing deficient heat to rebel upward, hence the inability to eat. I prescribed Raw Shanyao (1.5 liang), Huashi (Talcum, 1 liang), Raw Hangshao (6 qian), and Fen Gancao (Prepared Licorice Root, 3 qian). After one dose, all symptoms improved, and he could eat. After another dose, he fully recovered.

I used Huashi instead of Shigao in this case because the condition included diarrhea. Since Shigao was omitted, I dared not use Renshen, so I doubled the amount of Shanyao to enhance tonification. This represents a further modification of the modified formula.

In cases of dysentery where there is pre-existing stagnant heat in the Liver, Gallbladder, Intestines, and Stomach, compounded by labor under the scorching sun during summer months, sudden onset of dysentery with fresh blood is common. The pulse is typically surging and rapid, indicating pure fire toxin. Urgent treatment with major bitter-cold herbs is required, such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Longdancao (Gentianae Radix), or Kushen (Sophorae Flavescentis Radix). Baihu Tang (White Tiger Decoction) can also be used, requiring Raw Shigao (2 liang) plus Raw Baishao (1 liang). If the pulse is large and deficient, add Renshen (3 qian). If the pulse is surging, large, and very solid, Da Chengqi Tang (Major Order the Qi Decoction) can be used to purge, assisted by Baishao and Zhimu.

In cases of prolonged dysentery with sinking of clear yang, the patient may experience intermittent chills and fever or shortness of breath in the chest. Add Sheng Huangqi (Astragali Radix) and Chaihu (Bupleuri Radix) to the dysentery formula to raise clear yang. If the pulse is very deficient, Renshen can be酌情 (discretionarily) added. Assist with Sheng Shanyao to secure the lower jiao, but avoid overly warming herbs. In early-stage dysentery complicated by exogenous pathogens, include exterior-resolving herbs in the dysentery formula. If the exogenous pathogen does not sink inward with the dysentery, the dysentery becomes easier to treat. Otherwise, it becomes the syndrome indicated by Modified Baihu Jia Renshen Tang.

Although purgatives can be used in early-stage dysentery, they must only be administered after confirming the absence of exogenous exterior syndromes. For patients with slightly weak constitutions, small amounts of Renshen and Huangqi can be added as assistants.

Dysentery generally contraindicates cloying/stagnating herbs, but this is not an absolute rule. My maternal grandmother, aged 90, suffered from severe bloody and white dysentery in midsummer with a rapid and wiry pulse. I prescribed Da Shudi (Rehmanniae Radix Preparata, 1 liang) and Raw Hangshao (1 liang) decocted in water. She recovered immediately after taking it. After one more dose, her pulse became harmonious.

Occasionally, dysentery may be of a cold nature, but this accounts for less than 1% of cases, and usually presents as pure white dysentery. It must be accompanied by a deep, slow pulse, aggravation after consuming cold foods or sitting in cold places. Treat with Ganjiang (Zingiberis Rhizoma, 3 qian), Baishao (3 qian), Xiaohuixiang (Foeniculi Fructus, 3 qian), Shanzha (Crataegi Fructus, 4 qian), and Sheng Shanyao (6 qian). One to two doses will cure it. Baishao is used because dysentery inevitably involves bearing down and abdominal pain. Even in cold dysentery, while the cold is in the intestines and stomach, latent heat exists in the Liver and Gallbladder, preventing the generation of heat from warming herbs.

Do not forcibly prohibit foods that patients crave. I have seen patients recover from dysentery by drinking large amounts of cold water or eating watermelon freely. Ultimately, individual constitutions vary, and disease manifestations are diverse. Careful observation and adjustment during clinical practice are essential. I once treated a young man with severe dysentery, numerous times day and night, with tenesmus. After several doses of heat-clearing and draining herbs, the dysentery halved, but tenesmus persisted completely. Suspecting intestinal obstruction, I administered Da Chengqi Tang (Major Order the Qi Decoction). He passed dry feces several inches long and recovered. Had I not suspected obstruction, the dry feces would not have been expelled, and the illness would not have resolved.

There is a rare form of dysentery described by Zhang Yin'an: "Three Yang meridians' pathogens arrive simultaneously, Three Yin meridians cannot resist, nine orifices become blocked, yang qi overflows sideways, causing dry throat, obstructed painful throat, and irregular upper/lower movements when affecting yin meridians, pressing into the intestines to form Changpi (intestinal dysentery)." The pulse is slow, small, delayed, and choppy. Death occurs if the blood is warm and the body is hot, or if heat persists for seven days. This is due to excessive yang damaging yin, resulting in a small, delayed, choppy pulse. Urgent treatment with Da Chengqi Tang (Major Order the Qi Decoction) is required to purge yang and nourish yin; delay leads to fatality. If the cause of this rare dysentery is unknown, and mild formulas are used merely because the pulse appears calm, serious errors will occur.