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Dispersed (exterior syndrome resolved), with vexation, heat, and profuse sweating, where summer-heat is not yet cleared, and Qi deficiency prevails, use Renshen Yangying Tang (Ginseng Nourishing the Constitution Decoction); for Blood deficiency, use Heshouwu San (Polygonum Multiflorum Powder) (differentiate based on presence or absence of sweating, acute or chronic onset, and deficiency or excess patterns). If malaria pathogen lingers for a long time without dispersing, it privately forms an accumulation in the Liver channel region, termed Malaria Mass (Nodule), suitable for Biejian Wan (Softshell Turtle Pill). If a mass frequently forms in the left hypochondrium, and the prolonged course leads to Qi and Blood depletion with alternating chills and fever, termed Malaria Consumption (Malaria Labor), treatment should still focus on tonifying from the perspective of Yin-Yang imbalance.

Question: The disease known as "Zhi Xia" (dysentery with tenesmus) was anciently called Chang Pi (Intestinal Dysentery), and later named Li (Dysentery). The character 'Li' implies smoothness, yet why is it named 'Li' implying obstruction? What causes this obstruction? Why is the stool red? White? Mixed red and white? Black? Green? Pure blood? Thin pus and blood? Resembling bean curd dregs? Like leaking roof water? Among the renowned physicians who have discussed dysentery since antiquity, which of their precise and appropriate theories can be detailed? Most schools attribute it to Damp-Heat Fire, but Zhang Jingyue and Shiwan alone propose a Cold type; what is the reason? Loss of appetite is termed Jin Kou Li (Closed-Mouth Dysentery), and intermittent recurrence is termed Xiu Xi Li (Resting Dysentery). The etiology and treatment must be detailed, especially for pregnant women, requiring careful differentiation.

The Classics state: "Irregular diet and improper daily routine cause Yin channels to receive pathogens, entering internally until the Zang organs are filled and blocked, manifesting downward as Sun Xie (undigested food diarrhea), and over time becoming Chang Pi." This refers to "long-term stagnation of Zang Qi failing to circulate, causing body fluids to shift to the Large and Small Intestines, resulting in accumulation and urgent expulsion, caused by injury to Yin Qi." If it is indeed dysentery, anciently named Chang Pi, now called Li, it is an error in transmission. To understand the cause of obstruction and the five colors, one must consult the masters. Li Dongyuan said: "Irregular diet and routine damage the Stomach Qi; instead of ascending, Clear Yang descends causing Sun Xie. Over time, Taiyin injures Shaoyin leading to Chang Pi. Cold injuring the Middle causing distension is Sun Xie, treated with warming and guiding out. Damp-Heat injuring the Lower causing pus and blood requires bitter-cold draining. Wind pathogen sinking requires lifting. For internal Damp-Heat excess, differentiate: urgency requires purging, heaviness requires regulating, clear diarrhea with bowel sounds and fine pulse requires warming and astringing, thick sticky obstruction with forceful pulse requires cold purging." Commentary: This section cites the Classics then summarizes dysentery theory, most clearly. Zhu Danxi said: "Red dysentery originates from the Small Intestine, white from the Large Intestine, both rooted in Damp-Heat." Commentary: This clarifies that metal color is white and fire color is red. Wang Yutai said: "Damp-Heat in the Stomach stifles transformation; Qi condenses into the Large Intestine forming white dysentery, Blood condenses into the Small Intestine forming red dysentery. When both intestines are affected, red and white discharge together because Large Intestine connects to Lung and Small Intestine to Heart. Early excess stages require purging, using 'treat obstruction with unblocking.' If purgatives are missed, after five to six days Spleen-Stomach becomes deficient and cannot tolerate purging. For white dysentery, use Pingwei San plus Hawthorn, Betel Nut, Immature Bitter Orange, Peony, Scutellaria, Coptis, Talc, Saccharomyces, Angelica, Ginger; for red, use Shaoyao Tang plus Peach Kernel, Talc, Immature Bitter Orange, Tangerine Peel, Atractylodes, to guide blood and regulate Qi. Pure blood with wiry pulse indicates Wind injuring Liver (Liver governs Blood), use Fangfeng Baishao Tang; dysentery resembling bean curd dregs indicates severe Yuan Qi deficiency, use Xiangshen San plus Danggui and Poppy Shell; mixed red-black indicates Dampness excess." Commentary: This discussion on dysentery is very clear. Xue Lizhai said: "Long-term dysentery yellow with green indicates Liver Wood attacking Spleen Earth, treat by tonifying Spleen and soothing Liver, use Six Gentlemen Decoction plus Peony; yellow with white indicates Son complete but Mother deficient, tonify Spleen-Stomach, use Yi Huang San; yellow with black indicates Kidney Water insulting Earth, tonify Earth to control Water, use Six Gentlemen Decoction plus Ginger and Cinnamon." Commentary: This explains the origin of green and black colors. Zhang Jingyue said: "Dysentery arises in Summer-Autumn from steaming Dampness and stagnant Heat, originating from Heaven (climate). Seeking cold due to heat and consuming excessive raw/cold items originates from Man. Those strong constitutionally injured by Heaven have mostly stagnant heat; those weak constitutionally injured by Man have severe Yin-Cold. Cold implies deficiency, Heat implies excess." Commentary: This suggests a Yin-Cold type of dysentery. Zhou Shenzhai said: "In Summer, Taiyin dominates; excessive raw/cold consumption accumulates and fails to transform, eventually generating heat. In Autumn, Yang Qi enters the interior and attacks, triggering eruption. Treatment uses bitter-cold to dry Dampness and purge Heat, assisted by acrid-hot to open depression and move Qi. Thus: moving Blood stops pus/blood, regulating Qi relieves tenesmus. Also: Lung governs Qi, stagnation injures Qi, transferring Heat to Large Intestine causes Qi stagnation and white dysentery. Heart governs Blood, stagnant Heat injures Blood, transferring Heat to Small Intestine causes Blood stagnation and red dysentery. This is accumulated Heat in two Zang and two Fu organs. If Stomach is injured by cold items, Stomach Cold results; Essence/Qi does not transmit to Spleen, Spleen cannot scatter Essence to Lung, fluids stagnate in Stomach forming Stomach Accumulation. Symptoms include vomiting, nausea, stool like peach gum odorless, Right Guan pulse deep-thin-tight, use Magnolia Bark, Cinnamon, Cornus, Ginger, Aucklandia; deficiency use Fuzi Lizhong Tang, not comparable to intestinal accumulation." Commentary: This differentiates Cold as Stomach Accumulation and Heat as Intestinal Accumulation. Also: "Black has two types. Scorched black indicates extreme Heat mimicking the controlling element, use Huangqin Shaoyao Tang with Xianglian Wan; lacquer-like shiny black indicates old Blood stasis, use Taohe Chengqi Tang." Commentary: This differentiates black color more clearly. Zhang Shiwan said: "Liu, Li, and Zhu all attribute dysentery to Damp-Heat, recklessly using bitter-cold, causing harm to this day. They do not know that bright purple-rich blood truly belongs to Heat. If dull, thin, pale, or agate-colored, it is Yang Deficiency failing to control Yin descending; without warming and regulating Qi, Blood will not clarify. Regulating Qi is like refining gold in a furnace, the most rapid method. Whenever I encounter five-color closed-mouth dysentery or dull-clear blood dysentery, I use Gancao Ganjiang Tang to regulate Spleen-Stomach, Rougui Fuling to attack Kidney pathogen, with miraculous effect. Abdominal pain and tenesmus add Aucklandia and Betel Nut to drain; difficulty eating adds Immature Bitter Orange and fried Atractylodes to transport; Yin Qi reversing upward causing dry heaves adds Aucklandia and Evodia to warm; vomiting saliva adds Tangerine Peel, Pinellia, Ginger to resolve; thick sticky pus-blood adds Rubia and Mume to regulate." Commentary: This combines warming methods. Qin Yuangong said: "In Autumn, Lung Metal Qi desires to descend, but Small Intestine Fire prevents reaching the Large Intestine. Small Intestine Bing Fire controls Geng Metal, Autumn Metal is dry, causing abdominal pain, tenesmus, and Qi obstruction. Correct treatment uses brown sugar to benefit Small Intestine, radish juice to unblock Large Intestine, add aged Songluo tea 4-5 qian to drain Fire, plain cuttlefish bone to moisten dryness. For severe Fire with constipation, use Betel Nut 2-3 qian decocted to administer Heijin Wan 3-4 qian, or wine-steamed Rhubarb rice pills 3-4 qian. If the person consumes excessive rich/sweet foods, fruits, roasted/fried items leaving heat-toxin residue in intestines, Lung Qi descending follows Small Intestine Fire rushing to Large Intestine, burning like fire, causing severe abdominal pain, incessant dysentery, irritability, thirst. Urgently use large doses of Scutellaria, Coptis, Betel Nut, Phellodendron to save. Pulse must be rapid and forceful; if slow, intestines/stomach rot. If accompanied by fever and floating pulse, exterior pathogen exists, use Baidu Sanre to induce slight sweat. If accompanied by malaria, treat malaria first. Ancestors' theory of Spleen transmitting to Stomach is pedantic and incorrect; this abdominal pain is Bing Fire controlling Geng Metal, different from Wood controlling Earth. Use unblocking methods, avoid Peony, Licorice, Angelica. If pure red, Heat entered Blood level, use Liangxue Tang: Diyu, Sophora Flower, Saccharomyces (wine-fried) each 3 qian, decoct to 70%, mix with 1 cup lotus root juice and brown sugar." Commentary: This is clear and superior to predecessors. Traditionally, dysentery is attributed to Fire, but Shiwan and Jingyue mention Cold types resulting from misusing cold herbs, not the original disease. Because they did not urgently unblock the Large Intestine initially, but used Gardenia, Phellodendron, Scutellaria, Coptis, the intestines remained blocked while the Stomach became cold. Or repeatedly using aromatic/drying agents depleted Qi before removing Fire. No dysentery starts with primary deficiency-cold. This is Bing Fire Small Intestine blockage causing Kidney dryness; Congrong is the specific remedy. Others like nausea/loss of appetite is Jin Kou Li, caused by Damp-Heat blocking the Stomach opening. If no evacuation yet and pulse is forceful, still use Rhubarb; lower unblocks, upper relaxes. If post-evacuation pulse is weak, use Yangwei Tang: Jasmine, Lablab Flower, Lotus Seed, Acorus Root, Immature Bitter Orange, Rice, Fried Millet, Mung Bean Skin, Ginseng. Soak in Old Perilla Stem hot water, boil briefly, take warm. Add a small amount of Coptis for thirst; Silver Flower Dew taken warm is also good. If unresponsive, Stomach Qi is severely deficient, use Shengma 1 qian, Fried Lotus Seed 5 qian, Ginseng 3 qian, decoct and take. This treats Closed-Mouth Syndrome. Also, intermittent episodes over years is Xiu Xi Li, caused by premature astringency leaving residue. Re-administer resolving-residue drugs, then regulate Spleen-Stomach. For deficiency, add mild resolving drugs during tonification. Zhongjing said: "If dysentery resolves but recurs months/years later, it is due to incomplete residue. After purging remaining residue, use Buzhong Yiqi Tang with Myrobalan decocted to send Chuche Wan, often effective. For pregnant women with dysentery, urgency and tenesmus are most difficult. Use only Perilla Stem, Apricot Seed, Immature Bitter Orange; avoid Betel Nut. Huangqin can be used heavily; if Middle Qi disharmony, add little Aucklandia; use Sandaren heavily; Silver Flower Dew should be taken abundantly. If pure blood like dust/rotten color, like leaking roof water, anus like bamboo tube, lips vermilion, body fever, forceful large pulse, limb swelling/cold, and hiccups, these are untreatable."

Question: Stroke is an emergency; first differentiate Bi (Closure) and Tuo (Collapse) syndromes. What are the symptoms? What causes Collapse? What causes Closure? Secondly, there are Exterior-Internal Wind symptoms, Internal Wind symptoms, Wind entering Intestines/Stomach symptoms, Wind entering Collaterals symptoms, Pseudo-Stroke symptoms, Phlegm-Jue symptoms, Summerheat symptoms, External Intrusion symptoms, and sudden Wind emergence without prior illness. These ten syndromes require distinct formulas. Regarding Wind, only Phlegm is external; Phlegm transforms via Fire or Dampness, requiring clear differentiation. Initially, patients often cannot speak; pulse diagnosis is crucial, detail this separately.

Stroke requires distinguishing Bi and Tuo syndromes first. Collapse symptoms: mouth open, eyes closed, spontaneous sweating, urinary incontinence, panting. This is due to True Yin deficiency failing to secure Yang externally. Added to worry/thought/mental labor, stagnant Fire persists; once alcohol/sex are excessive or anger strikes, Yang from Kan (Kidney) and Liver/Gallbladder Fire surge upward simultaneously, causing sudden collapse. Spleen failure opens mouth, Kidney failure causes incontinence, Liver failure closes eyes, Heart failure causes sweating, Lung failure causes panting. Emergency treatment uses Diankun Tang. This is Collapse, like earthquake/mountain collapse; many are untreatable, though some die after seven days if one Zang remains intact (Above: Collapse). These are all Bi syndromes. Closure symptoms: clenched hands, locked jaw, eyes open, vertigo, coma. This is Stroke. There is Exterior/Internal distinction. Exterior-Internal Wind presents with Six Channels symptoms: floating pulse, aversion to cold, fever, stiffness, numbness. Use Luyuan Xuming Tang (Da Qing Long plus Chuanxiong, Danggui, Renshen); Hejian's Xiao Xuming Tang adds Shudi, Fuzi, Huangqin, Ji Feng, Fangfeng; if complicated by food retention with fullness/constipation, use Sanhua Tang (Xiao Cheng Qi plus Qianghuo). These are pure excess syndromes, rare south of the Yangtze (Above: Exterior Wind). Internal Wind involves Liver/Gallbladder Fire depression surging upward; Fire generates Wind, fierce and rigid, disrupting Qi/Blood. Wind/Fire rise directly, converting Stomach fluids into Phlegm instantly, obstructing Upper Jiao, confusing Heart Qi. Difficulty speaking indicates tongue dryness; coma indicates internal Qi/Blood chaos; stiff/shaking limbs indicate Wind scorching True Yin; facial deviation indicates Wind entering collaterals; numbness indicates Blood Bi; hemiplegia indicates lack of Blood in collaterals. All are Wind from Fire, termed Internal Wind, located in Zhen/Xun, Left Guan/Cun pulses wiry-rapid-slippery or rapid. If Wood insults Metal, Right Cun is also wiry-rapid-slipping-large. *Shiji* Cang Gong biography states: "Revolving Wind pulse is slippery; slippery indicates Internal Wind eruption." When Xun Wind is vigorous, assisting Metal to calm Wood is key; nourishing Blood to moisten Wood is correct treatment, use Huanfeng Tang. If undigested food is forced by Wind causing Phlegm-Food knotting and chest pain, induce vomiting with salt water. If mouth won't open, use Shengjin Dan or Ce Bai Ye Tang (Above: Internal Wind). If Internal Wind enters Intestines/Stomach, *Jingui* offers Fengyin Tang and Houshi Heisan, utilizing stones belonging to Metal to calm the Root. Using cold food for ten days allows medicine to accumulate in abdomen filling cavities; treatment surpasses antiquity (Above: Wind entering Intestines/Stomach). If Internal Wind enters collaterals, Wind stops Blood returning to vessels, tendons dried by Wind, limbs paralyzed, hemiplegia, nourish Blood to moisten, use Runku Tang and Zhujing Fang (Wind entering collaterals). If fat persons have Phlegm-Damp, pulse slow/deep-choppy, heavy painful joints, soft tendons, Phlegm-Damp accumulates in collaterals, use Sangzhi Tang (Phlegm entering collaterals). Pseudo-Stroke must be differentiated. Persons with Phlegm-Damp suddenly experience Qi reversal/Phlegm obstruction, tight jaw, termed Phlegm-Jue Stroke, Left pulse floating-wiry. If Right pulse deep-choppy, Left peaceful, or hidden, use Danxing and Muxiang powder insufflated, then Shunqi Tang. After drunkenness/anger, sudden coma with tight-full Right pulse, urgently use Chenpi Ginger Salt Water with digestive/Spleen-tonifying agents (Above: Phlegm-Food). Summer heat fainting, unconscious, cold sweat, cold limbs, vomiting/diarrhea, panting/fullness is Summerheat. Urgently use Sichuan Pepper ash with Licorice in fresh water. Mild cases use Xiangru Yin cold; severe thirst/heat use Maoyu Baihu Tang (Above: Summerheat). Flying Corpse, Ghost Strike, sudden Syncope, External Intrusion, or attending funerals, sudden blue face, confused speech, tight jaw, coma is Zhong E (Evil Strike). Urgently suffocate with Suhe Xiang Wan (Above: External Intrusion). Seeming mild but actually severe, no discomfort, sudden heaviness in one arm/leg unable to lift, mind drunk then normal, pulse deep-slow, is not Wind, but Spleen/Kidney Yang Deficiency with Stomach Phlegm failing to transport occasionally, root of future Collapse. Urgently use Liu Jun to cultivate (Above: Yang Deficiency). Additionally, Internal Wind with Phlegm transforming via Fire, mental vexation, slurred speech, Classics say "Wind harassing inside, treat with sweet-cool." This affects Yin-deficient thin persons, Liver Fire stagnant generating Phlegm attracting Wind, first use Zhuli Tang. Stomach-Spleen Heat use Dihuang Jian. If Evil enters collaterals combining with Phlegm-Qi, sudden coma, abrupt pulse disappearance, only aromatic herbs reach collaterals and open Spirit. However, Cold/Heat differ. Deep-slow/hidden pulse requires Huitian Zaizao Wan or Dihuang Yinzi. Rapid-large-forceful or floating-slippery pulse requires Suhe Xiang Wan and Zhibao Dan. Same opening method differs by Cold/Heat; deficiency sent with Sijun Tang (Above: Phlegm with Fire/Damp). Dead Blood/Damp Phlegm in collaterals use Huoluo Dan. Many theories exist, citing a few. Yu Jiayan said: "Hejian points to Fire as root, Dongyuan to Qi, Danxi to Phlegm. Why not say Yang Deficiency allowing Evil to harm orifices is root, and Wind entering externally supports inherent Fire/Qi/Phlegm as branch? Thus, deficiency-complex tonifies deficiency to remove Wind, Fire-complex clears Heat to remove Wind, Qi-complex opens depression to remove Wind, Phlegm-complex resolves Phlegm to remove Wind." Commentary: This summary is comprehensive, yet still distinguishes Exterior Wind. Xue Lizhai said: "Yang governs Qi, named Wind like heaven's gale, not necessarily external sensation. Left half houses Liver/Kidney. Liver stores Blood, governs tendons; Kidney stores Essence, governs bones. Essence/Blood exhaustion fails to nourish, so bones/tendons fail." Miao Zhongchun said: "Southern constitutions are fragile, prone to Heat/Phlegm. True Yin deficient, internal Heat intense, boiling fluids into Phlegm, blocking airways. Extreme Heat generates Wind, causing sudden collapse." Commentary: Both discuss Internal Wind. Zhang Jingyue said: "Human root is True Yin. Yin Deficiency has two: Water deficiency in Yin affects Essence/Blood; Fire deficiency in Yin affects Spirit/Mind. Yang decline means Qi loss, spirit confusion, is not Fire deficiency! Yin loss means form destruction, limb flaccidity, is not Water deficiency! For signs of spirit departing/form breaking, seek source rather than treating Wind. Cultivate True Yin to save root. Only for excess syndromes, check Phlegm/Qi cause and temporarily open." Commentary: This clearly prioritizes Yin tonification. Zhang Shiwan said: "Stroke pulses all show internal True Qi deficiency. Even Southern Phlegm cases stem from Kidney Qi decline failing to control, hence pulse cannot sink, appearing floating-slow driven by defunct Wind." Ancients said: Stroke pulse hidden, or pulse surging forcefully under finger. Know stroke patients are often fat with Phlegm, exterior excess but interior deficiency, compounded by sexual indulgence. Interior Qi closure pulse hidden, soon Qi returns pulse surges, all Wind/Fire/Phlegm/Damp acting. Generally, stroke pulse floating-small-slow-weak indicates survival, firm-large-rapid indicates danger. Floating-slow is fundamental stroke pulse; combined tight indicates exterior pathogen, combined large indicates Qi deficiency, combined slow indicates deficiency-cold, combined rapid indicates deficiency-heat, combined slippery indicates Phlegm-Damp, all treatable. Combined choppy indicates pulse mismatching disease, usually dangerous. Choppy pulse in Phlegm syndrome indicates true deficiency/Qi decline/collateral blockage, hard to search out. Thus, stroke pulse fears hidden/choppy, especially firm-large-rapid.

Question: Xu Lao (Deficiency Consumption) in Zhongjing's *Jingui* seven formulas mostly emphasize Yang Deficiency; Danxi uses cold/cooling; later Xue Lizhai, Zhang Jingyue, Li Shicai criticize Danxi's cold/cool favoring warm-tonic, yet don't necessarily use Zhongjing's formulas. Modern practitioners following Lizhai/Jingyue methods often lack efficacy. Why? Diseases have Cold/Heat/Deficiency/Excess, how can they be predetermined? Since Song/Yuan, various schools' deviations and correctness can be detailed? Can modern experts treat this with finer, steadier methods surpassing predecessors? Or innovate symptom-based treatments to supplement predecessors? Medicine values practical effect, do not stick to ancestors, please study carefully.

Xu Lao treatments differ古今. Zhongjing's seven methods are exemplary. For loss-of-essence patients with lower abdominal urgency, cold genitalia, vertigo, use Guizhi Longmu Tang. Zhang Shiwan said: "Body Qi/Blood rely on Post-Heaven Grain/Water for generation. Grain/Water enter Stomach, clear becomes Ying (Nutritive), turbid becomes Wei (Defensive). If Ying fails to nourish upper, Hot Blood overflows; if Wei fails to guard lower, Cold Essence escapes. Ying/Wei and Sanjiao perform duties, Fire returns to root. Heat doesn't behave thus, Cold doesn't behave thus. Grain/Water essence transformation relies on this for Essence/Blood source. Due to collapse/confusion fearing Lower Jiao deficiency/slippage, add Longgu/Muoli to secure/astringe, to..."