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Food stagnation, damp-heat, wind-toxin sinking downward, summer-heat. White color belongs to Qi (Vital Energy), red color belongs to Blood. Epidemic dysentery (dysentery with infectious nature).

Dysentery is also known as "stagnant discharge" (Zhi Xia). It originates from internal injury caused by diet affecting the Spleen and Stomach, leading to retention and obstruction. In autumn, improper care leads to contraction of wind-cold, summer-heat, and dampness. Damp-heat steams internally, resulting in dysentery. The symptoms include urgent abdominal pain, tenesmus (a feeling of incomplete defecation with rectal pressure), and inability to relax while using the toilet. This is because the Lung governs Qi and has a exterior-interior relationship with the Large Intestine. When Lung Qi sinks into the Large Intestine and fails to ascend, tenesmus occurs. However, pathogens contracted in different seasons vary; treatment must address the specific cause. Those caused by Wind present with pure clear blood in stool; those caused by Dampness present with stool resembling black bean juice; those caused by Cold accumulation transforming into Heat over time, with stifling heat inside, present with red and white stool. Additionally, Spleen-Stomach deficiency congealed by Cold may result in cold body and stool resembling fish brains; treatment should involve warming. This reflects an imbalance of Water-Fire and Yin-Yang; one cannot rigidly adhere to a single perspective and treat only as Heat. The therapeutic method should first unblock stagnation, differentiate and benefit Yin and Yang, and nourish the Spleen and Stomach. Astringents should not be used. Moreover, if toxic stagnation is not dispersed, early use of astringents often leads to Jing Kou Li (anorexic dysentery where the patient cannot eat). How can one not be cautious? How can one not be cautious?

Danxi stated: Damp-heat injuring Qi results in white dysentery; damp-heat injuring Blood results in red dysentery; simultaneous injury to Qi and Blood results in red-and-white dysentery. Symptoms include umbilical and abdominal pain, or passage of red, white, yellow, black, or five-colored stools; or stool resembling black bean juice, fish brains, or leaking roof water; or pure clear blood; or anal pain with frequent urges to defecate, day and night without limit. These are all signs.

Dai Yun stated: Although dysentery presents with red and white colors, there is no distinction between cold and heat; it is always damp-heat. One must assess deficiency and excess based on whether the disease is new or chronic, similar to leukorrhea. He further stated: Red dysentery originates from the Small Intestine; white dysentery originates from the Large Intestine.

The *Nei Jing* (Inner Canon) states: Fever indicates death; cold body indicates survival. This is a general statement; one must examine the constitution's strength. Are there not cases of survival with fever and death with cold? It also states:

Stool resembling fish brains is ominous; stool resembling dust and rot indicates death; pure blood is ominous; stool resembling leaking roof water indicates death; sunken and empty anus indicates death; fever with irritability and thirst indicates death.

The *Mai Jue* (Pulse Classic) states: Dysentery with minute and small pulses suggests life; large, floating, and surging pulses indicate no days of recovery.

Hejian stated: Moving Blood heals pus in stool; regulating Qi eliminates tenesmus. Shaoyao Tang (Peony Decoction) is suitable.

- For dysentery with tenesmus, purgation is suitable; for abdominal pain, harmonizing is appropriate; for heavy body, removing dampness is required.
- Dysentery is fundamentally due to damp-heat; initially, remove dampness and clear heat, open depression, resolve accumulation, regulate Qi, and move Blood as the main approach.
- In the first one to two days of dysentery, when Yuan Qi (Primal Energy) is not yet deficient, use pushing/draining medicines first. Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) modified is suitable.
- After three to five days, as Spleen and Stomach gradually weaken, use resolving and guiding medicines to transform stagnation. Daoqi Tang (Directing Qi Decoction) and Huazhi Tang (Transforming Stagnation Decoction) modified are suitable.
- For chronic disease complicated by deficiency, use tonifying and astringent medicines. Zhenren Yangzang Tang (True Person Nourishing Viscera Decoction) modified is suitable.
- At the onset of dysentery, regardless of Yin/Yang or red/white, Weiling Tang (Stomach and Bladder Decoction) modified is suitable.
- For summer-heat injury causing dysentery with minute and fine pulses, Huanglian Xiangru San (Coptis and Elsholtzia Powder) modified is suitable.
- For dysentery caused by Wind, with stool like black bean juice or turbid wine,weifeng Tang (Wind Guarding Decoction) added with Muxiang (Aucklandiae Radix), Heidou (Black Soybean), and Chenmi (Aged Rice) is suitable.
- For cold-induced dysentery with stool like fish brains, abdominal pain, cold limbs, and a mouth feeling like frost/snow, this is Cold Dysentery. Lizhong Tang (Regulate the Middle Decoction) modified is suitable.
- If astringents have not been used, and the patient suffers from Jing Kou (inability to eat) due to toxic vapors obstructing the Heart and Stomach meridians, Canglin Tang (Granary Decoction) and Xianglian Wan (Aucklandia and Coptis Pill) taken with Lotus Seeds and Renshen (Ginseng) are suitable.
- Anal pain indicates toxic vapors sinking into the Large Intestine; warm and clear it. For chronic cases with cold body and small pulse, warm using Danggui (Angelicae Sinensis Radix), Roudoukou (Myristicae Semen), Shengma (Cimicifugae Rhizoma), etc. For acute cases with fever and large pulse, clear using Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), etc.
- For Jing Kou Dysentery, use the Umbilical Sealing Method to guide Fire downward: crush Tianluo (Snail) and apply a small amount of Shexiang (Musk) to the umbilicus.
- During epidemic dysentery outbreaks, where families are similarly infected, one must clearly understand the victory and return of Qi phases to treat accordingly.
- For tenesmus, purgation is suitable at onset; for long-standing cases, lifting and raising Qi regulation is needed. The Classics state: Regulating Qi eliminates tenesmus.
- For dysentery with urinary obstruction, Muxiang (Aucklandiae Radix), Huashi (Talcum), Cheqianzi (Plantaginis Semen), and Zexie (Alismatis Rhizoma) are suitable.
- Red dysentery is suitable for Xianglian Wan (Aucklandia and Coptis Pill) and Guilian Tang (Angelica and Coptis Decoction).
- White dysentery is suitable for Cangzhu Shaoyao Tang (Atractylodis Rhizoma and Peony Decoction).