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The Kidney transmitting to the Spleen constitutes a minor pathogenic factor (Wei Xie), which is easy to treat. From this, we know that when the disease is in the Spleen, it is shallow; when it is in the Kidney, it is deep. The Kidney serves as the gate of the Stomach and opens into the two yin orifices (anterior and posterior). There is no case of chronic dysentery where the Kidney is not damaged. Therefore, treating dysentery without knowing how to tonify the Kidney is not the correct treatment. Formulas such as Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify Spleen deficiency and are by no means ineffective. However, if the pathology lies in Fire Decline (Ming Men Fire Deficiency), and the Earth position lacks its Mother (Spleen Yang rooted in Kidney Yang), unless one uses Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) to greatly tonify Ming Men (Gate of Life) to restore the Yang Qi within the Kidney and save the Mother of the Spleen, how would food and drink be ingested? How would the gates be secured? How would the True Yuan (Original Essence) be restored? If one fears heat and hesitates, relying solely on Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) to tonify Earth, it often leads to untreatable conditions, which is a great pity! (Li Shicai)

Dysentery presents with differences in cold and heat across the four seasons. Mr. Li Shicai’s discussion emphasizes the Spleen and Kidney meridians; however, he fails to recognize that "Spleen transmitting to Kidney" and "Kidney transmitting to Spleen" refer to internal injury dysentery caused by the mutual transmission of the Five Zang organs, not the summer-autumn heat dysentery described in other texts. Since it states that dysentery arises in summer and autumn due to dampness steaming and heat stagnating, this refers to summer-autumn dysentery. Thus, the discussion should be based on the command of Yangming Dryness Metal and focus on the Intestines and Stomach, rather than involving the Spleen and Kidney. Summer-autumn cases of watery diarrhea followed by pus and blood, or pus and blood followed by watery diarrhea, are syndromes of Damp-Heat in the Intestines and Stomach, not syndromes of Spleen-Kidney transmission. Ancient texts state: When the Large Intestine is diseased, Qi stagnates and condenses, resulting in white dysentery; when the Small Intestine is diseased, Blood stagnates and condenses, resulting in red dysentery; when both are diseased, red and white mix. As stated in the *Classic of Internal Medicine* (*Huangdi Neijing*): "Blood from the intestines"; "White foam from the intestines"; "Pus and blood from the intestines." All these passages use the character "Intestine," indicating that dysentery should primarily concern the Intestines. Mr. Li’s discussion omits the primary topic of the "Intestine" and focuses exclusively on the Spleen and Kidney. Pi Xie (Spleen Diarrhea) and Shen Xie (Kidney Diarrhea) result from insufficiency of Zang Qi, representing internal injury and deficiency, which are Zang syndromes. Summer-autumn dysentery results from external pathogens affecting the Intestines and Stomach, representing external contraction and excess, which are Fu syndromes. Internal injury deficiency and external contraction excess are worlds apart. Mr. Li’s comments constantly involve the Spleen and Kidney, harboring erroneous notions of warming, tonifying, astringing, and securing. This obstructs his mind, leading to misinterpretations: in early dysentery with intestinal-stomach congestion and internal heat stagnation, external cold symptoms may appear due to transformation, which might be mistaken for deficiency-cold, leading to inappropriate warming and tonification. Severe cases suffer significant harm, while mild cases prolong and worsen. Indeed, overusing cold and purgative methods in treating dysentery is inadvisable; however, tonifying the Spleen and Kidney are methods for later convalescence. Regarding abdominal pain in dysentery, there is pain due to stagnation and obstruction, treated with purgatives; pain due to Qi stagnation in the Large Intestine, treated with Jie Geng (Platycodon Root) to open it; and pain due to disharmony of Qi and Blood, treated with Shao Yao (Peony Root) to harmonize it. Now, only the Qi stagnation category is mentioned, stating that Jie Geng opens it and Shao Yao is the main herb, without distinguishing their different actions of dispersing and astringing, mixing them under the Qi stagnation category. This implies that for dysentery with abdominal pain, there is no method of descending. It further states: For aversion to cold, add Gan Jiang (Dried Ginger); for aversion to heat, add Huang Lian (Coptis Rhizome). Syndromes may present with pseudo-images of Yin-Yang combination and transformation, so pulse and symptoms must be carefully examined; one cannot rely solely on aversion to cold or heat. In the section on anal pain, it says: "Heat flowing downward" is treated with Huai Hua (Sophora Flower) and Mu Xiang (Aucklandia Root). It also says: For cases complicated by cold, use Li Zhong Tang (Regulate the Middle Decoction). Can cold and heat coexist mixed within the intestines and stomach? Anal pain at onset is certainly not deficiency-cold; pain appearing after long-standing dysentery indicates Qi sinking, but one should only use Bu Zhong Yi Qi Tang to lift it, not abruptly use Li Zhong Tang to warm it. This is because anal pain is always due to Damp-Heat flowing downward and dry-fire blocking. Even in long-standing dysentery, one should only tonify, not warm. Even if deficiency exists, cold may not necessarily be present; if deficiency is accompanied by cold, the anus would be incontinent and painless. It is also said: *Ju Fang* (Formulas of the Bureau) and Fu An typically use acrid-hot herbs; He Jian and Dan Xi typically use bitter-cold herbs. How rigid and inflexible they are! One does not realize that summer-autumn dysentery differs from dysentery in other seasons. Summer-autumn dysentery originates from Damp-Heat, differing in dampness dominance vs. dryness dominance, and following treatment vs. direct treatment. *Ju Fang* and Fu An typically use acrid-warm herbs, fearing that if dampness dominates internally, failing to use acrid-dispersing "following treatment" and instead using bitter-cold "direct treatment" would cause cold-coldness to suppress and trap pathogens inside. Hence, they use acrid-dispersing to treat cold-dampness. This follows the *Neijing*: "For dampness dominating internally, treat with bitter-hot"; "For dampness prevailing, level with bitter-hot." This opens the method for dampness-induced dysentery, where exterior syndromes are common. He Jian and Dan Xi typically use bitter-cold herbs, believing that in summer-autumn dysentery, dry-fire causes harm, and heat-toxin congests and damages the intestines and stomach. At this time, if one follows "following treatment," dry-fire meeting acrid-warm would burn and rot the intestines and stomach. Hence, they use bitter-cold to promote drainage as "direct treatment." This follows the *Neijing*: "For heat dominating internally, treat with salty-cold"; "For heat prevailing, treat with bitter-cold." This opens the method for dryness-heat-induced dysentery, where interior syndromes are common. Using warmth or cold, releasing the exterior or attacking the interior, these two methods are distinct. I now correct the summer-autumn dysentery, dividing it into dry-fire and damp-fire; dysentery in the four seasons is divided into external contraction and internal injury; epidemic dysentery is divided according to the Six Qi and annual Qi. This deeply elucidates Mr. Li’s principles and preserves his work. (Qin Huangshi)

Fever
The *Neijing* states that for intestinal bleeding, fever indicates death, while cold indicates survival. This is a general statement; one must examine accompanying symptoms. Are there cases where fever leads to survival and cold to death? (*Xin Fa Fu Yu*)
The Yellow Emperor asked: What about intestinal bleeding? Qibo replied: Fever indicates death, cold indicates survival. Wu Hegao annotated: Fever causes blood deterioration, leaving isolated Yang alone, hence death. Note: There are three types of fever in intestinal bleeding: First, exterior pathogens sink into Yangming; adding Ge Gen (Kudzu Root) to the prescription allows Stomach Qi to rise, leading to recovery. Second, Yin Excess repelling Yang; although critical, some survive with warming medicines. Only when Yin Qi is exhausted does fever become untreatable. Hegao only noted "isolated Yang alone," implying that Yang sinking and Yin repelling Yang are not covered here. If one sticks to Wu’s annotation, one might suspect that this syndrome only involves isolated Yang, and all fevers lead to death. (*Wu Yi Hui Jiang*)

In Cold Damage, Jue-Li (cold limbs with diarrhea) with fever is completely different from Liu-Xia (diarrhea) with fever. Cold Damage Jue-Li represents extreme deficiency-cold; thus, if the patient can eat, it indicates death, but if they have fever, it indicates survival. In dysentery, if the patient can eat, it indicates survival; if they have fever, it often indicates death. ○ The *Neijing* states: "Diarrhea with fever indicates death." This discusses the usual pattern. Zhang Zhongjing states: "Diarrhea with cold-free limbs and fever indicates survival." This discusses acute patterns. Acute diseases with Yang lead to survival, without Yang lead to death. Therefore, in deficiency-cold diarrhea, if limbs are not cold and fever appears, the person’s True Yang in the viscera has not dissipated, or with warming-tonifying medicine, True Yang returns; these are auspicious signs. (Yu Jiayan)

Thirst
Diarrhea and dysentery thirst includes true thirst and apparent thirst. True thirst involves a desire for tea/water; preference for hot or cold distinguishes cold from heat. Apparent thirst is dryness, not true thirst; although the mouth is dry, there is no desire for drinks, indicating it is not a heat syndrome. However, in diarrhea and dysentery, since fluids drain downward, upper fluids dry up, causing unavoidable thirst. Thirst with desire to drink occurs because internal fluids are insufficient and seek external fluids to supplement. In such cases, one must carefully examine the presence or absence of Fire. If Fire is excessive, clear it; if Water is insufficient, nourish Yin. This is certain. However, Qi is the mother of Water; if Qi deficiency fails to generate Water, failing to tonify the mother means Water cannot generate and thirst persists. Earth is the master of Water; if Spleen deficiency fails to control Water, failing to strengthen the master means Water cannot accumulate and thirst persists. If one treats the cause of thirst rather than thirst itself, why would thirst disease exist? (Zhang Jingyue)

Pus and Filth
In summer, heat from summer-dampness lodging in Ying and Wei causes boils; entering the intestines and stomach causes diarrhea and dysentery. The red and white in dysentery are like pus and blood in boils; until pus and blood are cleared, boils do not heal; until red and white are cleared, dysentery does not stop. (Xu Xuanzhi)

At the onset of dysentery, if pus and blood appear immediately, treatment should harmonize Blood. However, Qi-moving herbs should not be omitted. If only white pus is seen, one should only regulate Qi and avoid Blood-invigorating herbs, lest they draw pathogens into the Blood level, transforming into pus and blood. ○ Whenever dysentery presents with thick, sticky pus and blood, fever, irritability, thirst, suprapubic urgency/pain, worsening at night, it belongs to Yin Deficiency. Urgently prioritize saving Yin, selecting formulas such as E Jiao Mei Lian Wan (Donkey-Hide Gelatin, Plum, and Coptis Pill), Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction), or Bai Tou Weng Tang plus Gan Cao and E Jiao (Pulsatilla Decoction plus Licorice and Donkey-Hide Gelatin). (*Zhang Shi Yi Tong*)

Whenever diarrhea/loose stools persist, transforming into white pus dripping drop by drop, if warming Spleen medicines fail, the method should be to warm the Kidney. The Kidney governs Marrow; white pus is another name for Marrow. Symptoms include slightly dark complexion and weak bones/muscles, clearly indicating Kidney Deficiency. Use seeds of Psoralea (Gu Zhi), Dang Gui (Angelica Sinensis), Mu Xiang (Aucklandia), Rou Gui (Cinnamon Bark), and Gan Jiang (Dried Ginger). (*Ren Zhai Zhi Zhi*)

People today see dysentery resembling pus and filth and call it accumulation (Ji), not knowing this is not fecal matter but the fat/grease adhering to the intestines and viscera, belonging to Essence and Blood. Whether thin or fat, everyone has this fat; fat people have dense fat, thin people have thin fat, but none lack it. Those suffering from diarrhea/dysentery have injured internal organs, causing fat/grease to be unstable, thus peeling off daily. If Zang Qi is slightly strong, it regenerates as it goes, causing little worry; if Zang Qi fails and depletion is complete, long-term diarrhea/dysentery reveals bloody water and fluid resembling leaking roof water. May future physicians recognize this as fat/grease, not accumulation, and focus on stabilizing and securing it, rather than daring to speak of purging. (*Jing Quan Quan Shu*)

Five Colors
Accumulation of Damp-Heat affects the Blood level turning red, and the Qi level turning white; seeing both red and white indicates Qi and Blood are both diseased. Pure clear blood indicates Wind Injury; color like bean juice indicates Dampness Injury; pale yellow mixed with white indicates Food Accumulation; slightly red and scorched yellow indicates Heat-Toxin; purple-black blood indicates Blood Stasis; scattered blood indicates Trauma/Damage; like fish brain indicates Spleen failure to transport and old accumulation not rotting; like frozen gel indicates Cold intestines/stomach and leakage of true fluids; like white pus indicates Deficiency with Heat, where fluids strain and knot; like leaking roof water/dust color indicates extremely weak Yuan Qi; like chicken liver color indicates damage to all vessels. ○ Black stool in dysentery has three types: Scorched black indicates Extreme Heat manifesting as Water transformation; Glossy black like lacquer indicates Blood Stasis; Dust-like black indicates a fatal syndrome. (*Zheng Zhi Hui Bu*)

Some say white dysentery is Cold; this is an error. If it were truly Cold, it could not digest grain, so how could it transform into pus? Grain, meat, fruits, and vegetables naturally rot into water when heat is severe; food entering the abdomen naturally rots into pus when heat is severe. The popular saying that red-white dysentery is a mix of Cold and Heat is even more erroneous. Do you not know that Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; when one rises, the other falls; when one excels, the other declines. How can Cold and Heat both be severe in the intestines and stomach simultaneously, causing dysentery? If a sore produces white pus, can white be considered Cold? Generally, tenesmus, urgency, and painful defecation, along with red/scanty urination, belong to Heat. White dysentery often accompanies these, clearly indicating Heat. ○ Some say green dysentery is Cold; this is also an error. In Cold Damage Shaoyin disease, pure green stool indicates Heat in the interior. In pediatric acute convulsion, severe Heat often results in green-colored stool. Yellow dysentery indicates Spleen Heat; Red indicates Heart Fire. Red indicates severe Heat; Black indicates Fire/Heat reaching extremity, counteracting with Water transformation. (*Yuan Bing Shi*)

White dysentery cannot be entirely attributed to Heat; some are due to Cold, resembling frozen gel or mucus, caused by excessive consumption of raw/cold foods injuring the Spleen/Stomach, requiring acrid-hot warming with Ginger and Cinnamon. Also, long-standing dysentery with Qi deficiency starting with Heat and ending with Cold, or overuse of cold medicines causing Spleen/Stomach deficiency-cold, also requires warming. (*Yi Xue Tong Zhi*)

Five colors in dysentery belong to pus/filth, all transformed from Blood and Qi. White comes from shallow levels, nearby fat/grease; Red comes from deep levels, penetrating skin collaterals from fat/grease. Pure blood discharge is mostly due to Heat forcing blood, overflowing and discharging immediately, representing the deepest level. Purple-red or purple-white indicates staying away from the source longer, changing color, or not yet reaching collaterals, representing a shallower level; Red-white mixture indicates involvement of both shallow and deep levels. Mostly, bright red pure blood indicates Heat syndromes due to the rapid nature of Fire; purple-red/white indicates fewer Heat syndromes due to Yin coagulation and blood deterioration; pure white indicates no Heat syndromes due to Cold Zang and thin Qi. There are red cases due to Heat, such as sudden pouring and urgent pressure; there are red-purple cases too numerous to call Heat, such as Yin collateral injury. Regarding yellow and black colors: Deep yellow with foul odor indicates Heat or Cold syndromes. Pale yellow, light, not very odorous, or with fishy/sour smell indicates indigestion, all Cold syndromes. Thick black with strong odor indicates many Fire syndromes; blue-black with thin fishy smell indicates Liver/Kidney corruption. Although differentiation of five colors is roughly as above, blood in dysentery is non-other than Yin collateral injury. Whether Cold or Heat, damaging collaterals inevitably causes bleeding. One cannot assume bleeding is always Heat; one must examine pulse, color, form, Qi, and etiology together to avoid error. (Zhang Jingyue)

Urine
In diarrhea and dysentery, urination is often difficult, or yellow/red. One must not fail to observe Cold, Heat, Deficiency, and Excess. Cases due to Heat必然 present with intense redness, frequent painful urination, or visible fresh blood; however, only when both upper and lower bodies show Heat signs is it True Heat, treated with cooling methods. If not True Heat, it may be due to Middle Cold forcing Yang downward; or Yang exhaustion causing Water deficiency and color change; or Lower Jiao Yang Qi failing to warm, preventing Water transformation; or improper use of diuretics drying up juices. If one observes no Fire in the Three Jiao, then despite yellowness or difficulty, it is total Yin/Juice loss, not generally discussed as Heat. Quickly tonifying True Yin is the good method. (Zhang Jingyue)

Abdominal Pain
Abdominal pain in diarrhea/dysentery includes Excess-Heat and Deficiency-Cold. Excess-Heat is due to Food Accumulation or Fire Pathogen. Pain from Food Accumulation必然 involves bloating, hardness, or refusal to pressure, indicating stagnation. Mild cases move stagnation; severe cases purge and drive it out. ○ Pain from Fire Pathogen必然 involves internal Heat signs, suitable for clearing and draining. However, pathogens solidified in the middle必然 cause Qi rebellion. Thus, in treating pain, whether Fire or Food, moving Qi must come first. ○ Deficiency-Cold pain requires particular distinction. Pain in diarrhea/dysentery mostly stems from Cold Qi in the Zang. The Classic states: "Pain is due to much Cold." Anyone overeating raw/cold or contracting external Cold experiences abdominal pain, proving this. Cold in the middle is treated by warming the Spleen; Cold in the lower is treated by warming the Kidney. ○ Furthermore, few understand the meaning of deficiency-cold scraping pain. If Yuan Qi is insufficient internally, even without external Cold, Middle Qi is not warm, constituting a Cold syndrome. Moreover, persistent diarrhea/dysentery injures Stomach Qi; fat/blood touching the skin, how can there be no pain? This pain arises from depletion reaching intestines/viscera, hence dysentery causes pain, and pain causes dysentery. Any invasion of Cold into Fu/Zang or damage to collaterals causing Blood movement and Qi stagnation can cause pain. But if one observes it is not solid/hard, or likes rubbing/pressing, or likes warmth, or chest/abdomen feels hungry but no desire to eat, or epigastric vomiting with acid regurgitation, and lacks Excess-Heat signs, it all belongs to Deficiency-Cold. How can one say pain is always due to accumulation and is always an Excess syndrome? In treating Deficiency-Cold pain, quickly warm and nourish Zang Qi, do not add reducing/draining methods. But for severe pain, add slight Mu Xiang to warming-tonifying herbs to smooth Qi, or add more Dang Gui to harmonize Blood. If Cold is in the Lower Jiao causing pain, add Wu Zhu Yu (Evodia Fruit); if pain is not severe, simply warm and tonify Spleen/Kidney, allowing gradual peace, and pain stops naturally. (Zhang Jingyue)

*Ji Yao* states: Abdominal pain should be harmonized. "Harmonize" is a general term. If due to Qi stagnation, move Qi and open depression; if complicated by Cold, use Li Zhong Tang; if complicated by Heat, use Huang Qin Shao Yao Tang; if due to stagnation, use Mu Xiang Dao Qi Tang; if due to Blood Deficiency, use Dang Gui Shao Yao Tang; if Lung Metal Qi is stagnant in the Large Intestine, use Jie Geng to vent it. (Liu Zongnong)

Post-dysentery abdominal pain uses Gan Cao and Shao Yao as Sovereign, Dang Gui and Bai Zhu as Ministers. Add Rou Gui for Cold, add Huang Qin for Heat. (Zhu Danxi)

Anal Swelling and Pain
In dysentery, many have anal swelling and pain. Why? Because Spleen/Stomach disharmony causes water/grain Qi to lose proper transformation, and foul, unbearable flavors exit through the orifice, making pain inevitable. Also, if Fire sinks due to diarrhea, and Yang is driven by Yin, Stomach Yang Qi is forced downward with nowhere to dissipate, causing swelling. Thus, more dysentery means more pain, less dysentery means less pain; pain or no pain depends on Qi sinking or not. Therefore, regardless of Cold or Heat dysentery, the anus can hurt; one cannot say pain is always due to Heat. To treat this, just treat the dysentery; when dysentery stops, swelling and pain stop, similar to tenesmus. Since Danxi said: "Anal pain is due to heat flowing downward," treated with Mu Xiang, Bing Lang (Areca Seed), Qin (Scutellaria), and Lian (Coptis), he only knew Fire causes swelling/pain, ignoring the sinking of Primordial Yang. Later generations followed this method; those with Deficiency-Cold could hardly endure it. (Zhang Jingyue)

Anal pain in dysentery: one clears it, one warms it. In chronic illness, with cold body and deep/small pulse, warm it; in acute illness, with hot body and floating/excessive pulse, clear it. (*Xin Fa Fu Yu*)

Tenesmus
"Tenesmus" (Li Ji) refers to urgent, cramped pain; "Heaviness" (Hou Zhong) refers to the Large Intestine feeling heavy and descending. Syndromes vary. Due to Fire/Heat: Fire nature is rapid and dries substances. Due to Qi Stagnation: Large Intestine Qi is congested and blocked. Due to Accumulation: Substances knot and weigh down intestines/stomach. Due to Qi Deficiency: Middle Qi sinks and cannot ascend. Due to Blood Deficiency: Fluids dry, intestines parch, false straining. Treatment: Clear Heat, regulate stagnation, remove accumulation, lift Qi Deficiency, tonify Blood Deficiency. (*Jian Wen Lu*)

Heaviness originally stems from pathogens pressing the Large Intestine, preventing ascending and causing heaviness. Using Da Huang (Rhubarb Root) and Bing Lang is to purge the descending pathogens. After long-standing dysentery or purging, if heaviness remains, this is Large Intestine deficiency-slipperiness unable to contract; heavily using Yu Mi Ke (Poppy Shell), He Zi (Chebula Fruit), Wu Bei Zi (Gallnut) and other astringents gathers Qi and secures slipperiness. However, heaviness from pathogen pressing does not decrease after defecation; heaviness from deficiency-slipperiness decreases after defecation; distinguish by this. (Zhu Danxi)

For heaviness due to Qi Deficiency sinking, even using astringents, one must combine with lifting-tonifying herbs. (*Chi Shui Xuan Zhu*)

Tenesmus disease is located at the lowest part of the Broad Intestine (Chang Geng), but its root is not in the Broad Intestine, but in the Spleen and Kidney. It occurs in Heat, Cold, and Deficiency dysentery; it cannot be entirely considered Heat. If Middle Jiao has Heat, Heat pathogens press downward; if Middle Jiao has Cold, Cold pathogens press downward; if Spleen/Kidney Qi is deficient, Qi sinks and presses downward. One should only examine the cause and treat accordingly.