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What is the clinical manifestation of dysentery? It is said: Regarding this syndrome of dysentery, ancients generally distinguished cold and heat patterns by red and white discharges. However, they did not realize that injury to the Qi level results in white discharge, while injury to the Blood level results in red discharge.

Danxi believed that watery diarrhea preceding pus and blood indicates the transmission of Spleen disease to the Kidney; whereas pus and blood preceding watery diarrhea indicates the transmission of Kidney disease to the Spleen. This insight had already uncovered issues previously unaddressed by predecessors. As for Sun'an, who asserted that all types of dysentery stem from damp-heat entering the Stomach, this single statement allows one to comprehend the pathological form of the disease. (The phrase "damp-heat entering the Stomach" reveals the root cause of dysentery. Since the Stomach is the sea of abundant Qi and Blood, injuries to the Qi and Blood levels should specifically refer to the Stomach. The term "injury" here refers to damage caused by the invasion of damp-heat. Dampness is a Yin pathogen; upon entering the Stomach, it damages the Yang Qi of the Stomach. Heat and summer-toxicity are toxic pathogens; upon entering the Stomach, they damage the Yin fluids of the Stomach. Ancients used red and white colors to distinguish cold and heat, likely mistaking dampness for cold. By using red and white to distinguish Qi and Blood injuries, the distinction becomes precise and definitive, establishing a timeless consensus.) Abdominal pain in dysentery must occur around and below the umbilicus, which corresponds to the region governed by the Small Intestine. When food enters the Stomach, carrying summer-toxicity, it gathers at the Zhongwan (Middle Jiao). Newly ingested food has not yet transformed into fecal matter; when subsequent food follows, the initial food, carrying toxicity, moves downward to the Xiawan (Lower Jiao). If there is no toxic pathogen in the middle, the ascending and descending movements of Qi and Blood can follow their normal course, allowing ingested food to transform into feces and pass through the Xiawan into the Small Intestine. However, if toxins and food accumulate in the Xiawan, the ascending and descending movements cannot follow the normal course. Although feces desire to move downward, they are obstructed and cannot proceed smoothly, yet they inevitably attempt to descend. This pressure forces the mucosal lining and fatty tissues of the Zang-Fu organs downward. (Here, "Zang-Fu organs" specifically refers to the Stomach.) Once these materials enter the Small Intestine, pus and blood are scraped down from the Small Intestine. (White resembles pus, red resembles blood; these are actually the mucosal lining and fatty tissues of the Zang-Fu organs, forced downward by the obstruction of feces.) If the Small Intestine contains only normal feces without toxins, it can follow its normal course; thus, despite its convoluted structure, downward movement is unimpeded. Only pus and blood, failing to follow the normal course and resisting descent, cause pain radiating around the umbilicus downward, indicating involvement of the lower opening of the Stomach. (This is the junction between the Stomach and Small Intestine, where the forcing of mucosal lining downward occurs.) Upon reaching the Small Intestine, (this is where the resistant pus and blood are scraped down.) Difficulty in urination arises because the Small Intestine is pressured by toxic pathogens, impairing its function of separating clear from turbid, resulting in oliguria. (There are also cases where the Bladder is pressured by toxic fire, causing urinary difficulty.) Anorexia-type dysentery (Jinkou Li) occurs when toxic vapors are originally strong, or when purgative medicines are overused, damaging the Zong Qi (Pectoral Qi) of the Upper and Middle Jiaos, allowing evil toxins to counterflow upward due to deficiency. (One may decoct ginger-processed Coptis Rhizoma with Ginseng Radix, taking small sips slowly.) There are cases not caused by summer-toxicity, but rather by consuming fruits and melons. (In the ninth month of the Jiawu year, my younger brother Danshan, aged seventeen, indulged in raw water chestnuts after an outburst of anger. The next day, he suffered abdominal pain, loss of appetite, and bloody-purulent stools. Village doctors treated him, unaware of the cold-raw food injury, administering various standard dysentery prescriptions for over ten doses. His condition worsened critically. I was teaching in Anyi at the time; my father sent someone to summon me urgently. Upon arrival, he exhibited symptoms such as grasping at clothes, picking at empty air, and seeing ghosts, with full manifestation of deficiency syndromes. Reviewing the medications used, they were still Bitter Orange, Magnolia Bark, Scutellaria Root, and Coptis Rhizoma. Despite changing physicians to salvage the case, he ultimately died. Grieving and depressed, I deeply resented that my brother's death was caused by incompetent medical hands. I then began studying the *Ling Shu*, *Su Wen*, *Lei Jing*, and works by Zhang Zhongjing, Li Dongyuan, Zhu Danxi, Xue Ji, and others, searching and analyzing day and night, feeling as if recalling a past life connection. Alas, the physician killed my brother, depriving him of longevity. Was there fate involved? Did it intend for me to become a doctor so that my brother might live on through this compilation? I record this to illustrate that dysentery not caused by summer-toxicity, yet treated as such, invariably leads to tragedy, joining my brother in weeping in the underworld. All my colleagues among the people, how can they fail to discriminate carefully?) Or, sleeping in high, large rooms, these conditions arise from deficiency, manifesting immediately upon exposure. The pathology remains in the Xiawan. Invasion by cold qi impairs Spleen transportation, leading to dysentery. If two to three days pass, cold transforms into heat, and the clinical presentation becomes identical to that of summer-toxicity. (It is precisely at this point that misdiagnosis often occurs; this must be understood.)

Regarding pulse diagnoses for various dysenteries: lingering, fine, and small pulses indicate survival; floating, rapid, surging, and large pulses indicate death.

For dysentery in the initial three days, Baishao Yao Tang (Peony Decoction) can be used to resolve symptoms immediately. (Dongzhuang also stated that this formula yields immediate effects within the first three days; one should not fear the use of Cinnamon Twig due to its great heat.) If initially there is only abdominal pain and profuse watery diarrhea, Nongpo Tang (Magnolia Bark Decoction) is indicated. Once red and white discharges appear, it indicates that toxin intensity has condensed. At this stage, one should only resolve toxins, harmonize Blood, and nourish Qi; absolutely avoid breaking Blood or moving Qi aggressively. This is the general principle. Tiaojin Tang (Golden Regulator Decoction) is indicated. After taking Tiaojin Tang, if red and white discharges decrease and stool color gradually returns, reduce the dosage of Scutellaria Root and Coptis Rhizoma. Using one qian of Scutellaria Root is acceptable, but Coptis Rhizoma must be gradually reduced, and Ginseng Radix should be added. Dosage adjustments should be made according to clinical changes. Once red and white discharges are completely eliminated, Liu Junzi Tang (Six Gentlemen Decoction) plus Angelica Sinensis Root and White Peony Root should be used for regulation. If fever occurs at onset, this is a heat disease; administer Tiaojin Tang plus Bupleurum Root. For mild initial heat, use only Scutellaria Root; reserve Coptis Rhizoma for severe heat. Medication must be selected based on the depth of heat and the color of discharge. In chronic dysentery where the patient can eat, use Liu Junzi Tang plus Angelica Sinensis Root and White Peony Root. In chronic dysentery with fever, anorexia, and muscle wasting, the prognosis is poor (incurable).

Baishao Yao Tang (Peony Decoction)
Treats heat-dysentery with bloody stools and tenesmus. The Classic states: "Difficult urination accompanied by pus and blood in stool indicates that Qi movement stops Blood flow." Moving Blood resolves pus and blood naturally; regulating Qi eliminates tenesmus.
White Peony Root, Angelica Sinensis Root, Rhubarb, Scutellaria Root, Coptis Rhizoma, Cinnamon Twig, Areca Seed, Aucklandia Root, Licorice Root.
If symptoms do not subside, increase the dose of Rhubarb.
Note: Changzhou stated that this syndrome often results from deficient Middle Qi and constrained Spleen Qi; treatment requires careful examination.

Nongpo Tang (Magnolia Bark Decoction)
Magnolia Bark, Areca Seed, Immature Bitter Orange, Alisma Rhizome, Tangerine Peel, Scutellaria Root, Licorice Root.

Tiaojin Tang (Golden Regulator Decoction)
Scutellaria Root, Coptis Rhizoma, Alisma Rhizome, Angelica Sinensis Root, White Peony Root, Moutan Cortex, Medicated Leaven, Tangerine Peel, Magnolia Bark, Ginger as guide.

Note: Siming created Alisma Decoction and four modified formulas, which are very effective for treating dysentery. They are recorded below for clinical reference.

Alisma Decoction (Zexie Tang)
Alisma Rhizome, Moutan Cortex, Hawthorn Fruit, Talcum, Angelica Sinensis Root, White Peony Root, Scutellaria Root, Tangerine Peel, Magnolia Bark, Aucklandia Root, Licorice Root.
For red dysentery (blood-predominant), add Coptis Rhizoma 0.8–1.5 qian; for visible blood, add Rehmannia Root 2–3 qian; for early-stage severe toxicity in robust patients, add Wine-processed Rhubarb 2–3 qian; for body heat, add Bupleurum Root 1 qian.

Initial Stage Formula
Alisma Rhizome, Moutan Cortex, Hawthorn Fruit, Talcum, Angelica Sinensis Root, White Peony Root, Scutellaria Root, Tangerine Peel, Magnolia Bark, Bupleurum Root, Coptis Rhizoma, Licorice Root.

Formula for Abdominal Pain and Tenesmus After Several Days
Alisma Rhizome, Areca Seed, Magnolia Bark, Angelica Sinensis Root, White Peony Root, Ligusticum Chuanxiong Rhizome, Bupleurum Root, Scutellaria Root, Coptis Rhizoma, Peach Kernel, Talcum, Licorice Root.

Formula for More Than Half a Month Duration
Alisma Rhizome, Exocarpium Citri Reticulatae Viride, Magnolia Bark, Cimicifuga Rhizome, Angelica Sinensis Root, White Peony Root, Rehmannia Root, Scutellaria Root, Juncus Effusus, Lotus Seed, Coptis Rhizoma, Licorice Root.

Chronic Dysentery Formula
Alisma Rhizome, Poria, Ginseng Radix, Moutan Cortex, Rehmannia Root, Prepared Rehmannia Root, Scutellaria Root, Coptis Rhizoma, Angelica Sinensis Root, White Peony Root.