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Someone asked me: "Liu Hejian stated that Zhang Zhongjing, when treating dysentery (Li), often used Chengqi Tang (Cure Qi Decoction) and conflated 'Li' with 'Zhi Xia' (Dysentery with Obstruction) in his theoretical discussions without distinguishing between them. Examining various medical formulas, I see no record of separate treatments for them. Is Liu Hejian's theory unreliable?" I replied: "Predecessors have briefly addressed this. Although the classics lack explicit text, one can understand it by considering the names. The Book of Documents states: 'Summer injury by summer-heat leads to malaria and dysentery in autumn.' 'Li' (Dysentery) shares its meaning with 'Li' (to flow freely/pass), indicating a seasonal disease. It may arise from diarrhea or present directly as pus and blood in the stool. This is because in autumn, the qi descends, causing foul accumulations in the abdomen to move downward due to the seasonal influence, resulting in Li. On the other hand, 'Zhi Xia' refers to obstruction; 'Zhi' means stagnation or accumulation. It occurs regardless of season and does not stem from diarrhea. Instead, it presents with tenesmus (urgent need to defecate with little output) and frequent passage of dirty, greasy matter. How can these two be discussed as if they were the same? Therefore, in the early stage of Zhi Xia, methods such as eliminating the old to generate the new, or intercepting and seizing the pathogenic factor, are commonly used. In contrast, treating Li may involve tonification, astringency, drying dampness, lifting and raising, resolving accumulation, warming, separating clear from turbid via urination, or purging: however, at the onset, one dares not rashly use purgatives. Treatment must adapt to the time and condition; only after confirming excess heat and solid accumulation in the stomach/intestines should one dare to use pushing and荡 (purging) methods. Thus, I say: 'Li' involves seasonal qi; 'Zhi Xia' can occur in all four seasons. Since the names differ, the treatment methods must also differ significantly." The person said, "Indeed."

Ancient texts state: If watery diarrhea precedes pus and blood in the stool, it is Spleen transmitting to Kidney, representing a destructive pathogen (Zei Xie) that is difficult to cure; if pus and blood precede watery diarrhea, it is Kidney transmitting to Spleen, representing a mild pathogen (Wei Xie) that is easy to cure. The traditional distinction between mild and destructive pathogens is a generalization. In reality, there are cases where watery diarrhea precedes pus/blood yet is hard to cure, or vice versa. I believe: Watery diarrhea preceding pus/blood indicates initial Spleen deficiency followed by accumulation, hence difficult to cure; pus/blood preceding watery diarrhea indicates that the accumulation has been cleared and no pathogen remains, hence easy to cure. Wise practitioners should observe this carefully.

Another person asked me: "In *Ju Fang Fa Hui*, Danxi states: Fan Wei (Revolving Stomach/Regurgitation) is identical to Ye Ge (Choking and Diaphragm Obstruction); Ye Ge is merely the gradual progression of Fan Wei. This view implies that fire qi flares upward, steaming body fluids into phlegm. One must absolutely avoid aromatic-drying herbs; taking them will lead to death. He also states: Elderly patients cannot be cured. This is because youth possesses un-depleted qi and blood; medication can seize and eliminate phlegm-fire, preventing recurrence. In old age, qi and blood are already deficient, so the illness will not improve. Based on this: saying Fan Wei is Ye Ge suggests one disease; saying Ye Ge is the precursor to Fan Wei suggests two diseases. Regarding medication, he claims aromatic-dosing agents cause death. Yet today, some recover using aromatic-drying herbs. Why?" I replied: "Although ancient texts did not distinguish Ye Ge and Fan Wei, their named definitions seem different, and thus their treatment methods likely differ as well. However, *Ju Fang Fa Hui* was written primarily to refute warm-tonifying practices and warn against dry-heat herbs, with earnest admonitions, leaving no room for semantic辨析 (analysis). My opinion is that Ye, Ge, and Fan Wei are three distinct diseases. Throughout history, no one has analyzed their meanings. 'Ye' (Choking): Food enters the Ye region but cannot pass through, immediately regurgitating, turning back from the Ye. Hence 'Ye'. 'Ge' (Diaphragm): Refers to the diaphragm membrane, not separation/blockage. Food passes the Ye but reaches the Ge region, cannot descend further, slowly regurgitates, turning back from the Ge. Hence 'Ge'. 'Fan Wei' (Revolving Stomach): Food has entered the Stomach but fails to transform/digest, and the lower writhing is dry and obstructed. Morning food vomited in evening, evening food vomited in morning, clearly pouring out from the Stomach. Hence 'Fan Wei'. All are vomiting disorders, but divided into Upper, Middle, and Lower Jiao. For thousands of years, only Jieguc Laoren (Elder Jiegu) discussed vomiting with an Upper/Middle/Lower framework. He stated: Vomiting from the Upper Jiao is governed by Qi; Middle Jiao by Accumulation; Lower Jiao by Cold. Therefore, some are cured today using aromatic-drying herbs, actually due to Cold pathogen. One must discern this in the human body. As for the elderly, indeed efficacy is difficult to achieve; would Danxi deceive us?"

Zhang Jifeng said: "Ge syndrome is a disorder of the mind/spirit. Only through introspection and self-nourishment can it be overcome. These are also good words."