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Yu Chang said: The syndrome of dysentery is truly difficult to describe. In the *Ling Shu* and *Su Wen*, it is called "Chang Pi" (Intestinal disorder with discharge), also known as "Zhi Xia" (Stagnant downward flow); in the *Jin Gui Yao Lue*, vomiting, hiccups, and diarrhea are listed in one chapter. This is because these three conditions are diseases generated by the Foot Yangming Stomach channel and Hand Yangming Large Intestine channel. As for the discussion of diarrhea therein, it refers to the primary syndromes of the Jueyin channel in the *Shang Han Lun*, which does not align well with the meaning of listing them together with vomiting and hiccups of the two Yangming channels. Observing his discussion, "Jue" (cold extremities) and "Li" (diarrhea/dysentery) are often mentioned together; initially, it states: "When the Qi of the six fu organs fails externally, the hands and feet become cold; when the Qi of the five zang organs fails internally, diarrhea becomes uncontrollable." Thus, Jue accompanied by Li indicates extreme deficiency-cold. Therefore, if the patient can eat, they will die; if they have a fever, they will not die. However, in dysentery, those who can eat do not die, while those with a fever mostly die. Why is it so contrary? It must be that in the *Jin Gui Yao Lue*, under vomiting and hiccups, the syndrome of "dysentery" was lost, and text regarding Jueyin diarrhea from the *Shang Han Lun* was inserted to supplement it. Later generations tried it repeatedly without success, causing many to panic due to misprescription. How can one excuse Zhang Zhongjing's methods by citing winter Shanghan diarrhea versus summer-autumn heat-dampness dysentery? Later practitioners, relying on their untaught wisdom, each presented biased views, some derived from what they saw or tested, spreading them widely, yet ultimately unsuitable as standards, leading to the claim that malaria and dysentery have no fixed formulas. How has medical practice become so negligent! I cautiously propose discussions based on the methods of Huang Di, Qi Bo, and Zhang Zhongjing: In the *Nei Jing*, winter Shanghan is already termed "disease-heat"; by summer and autumn, the heat, summer-heat, and dampness interact and evaporate, making the accumulated heat ten times greater than in winter! External contraction of these three pathogenic heats resulting in diarrhea/dysentery implies the pathogen must exit from the exterior. Therefore, dysentery must be treated via sweating: first resolve the exterior, then regulate the interior. Initially use acrid-cool herbs to release the exterior, followed by bitter-cold herbs to clear the interior; recovery occurs in one or two doses. If the exterior is neglected, the external pathogen only exits from the interior, ceasing not until death. Thus, even after a hundred days, the method of "rowing upstream against the current" (Ni Liu Wan Zhou) should still be used to guide the pathogen out through the exterior, turning fatal cases livable and critical cases stable. Having treated thousands, the results are clearly recorded.

According to the *Jin Gui Yao Lue*: "Diarrhea/dysentery with a wiry pulse, accompanied by fever and sweating, heals spontaneously." In chronic diarrhea/dysentery, the pulse enters the yin level, becoming deep, choppy, and weak. A sudden shift to a wiry pulse reflects the generating qi of Shaoyang. Without the method of counter-current pulling, how could such a pulse arise? In chronic diarrhea/dysentery, pathogens enter yin, and the body is typically not hot; if there is yin-deficiency heat, the fever persists. Now, due to the force of counter-current pulling, temporary dry-heat is forced out, and soon the pathogen exits the surface, eliminating the heat. Chronic diarrhea/dysentery involves sinking of yang qi, dry and rough skin, and definitely no sweat. Now, using the counter-current method, the defensive yang leads the pathogen back to the surface, resulting in sweating; thus the abdomen becomes quiet, and the disease heals spontaneously. How dare I rely on untaught wisdom? Furthermore, sudden exposure to summer-heat and dampness toxins causes water and grain to pour out, seven or eight dozen times a day, with intense thirst seeking water self-rescue, drinking hundreds of cups without relief. This means the intestines and stomach are attacked by heat toxins, rotting instantly. This is ten times more violent than ingesting croton seed or lead powder; applying the counter-current method here would be too circuitous and distant! Instead, follow the *Nei Jing* principle of "treating obstruction with unblocking agents" (Tong Yin Tong Yong): Rhubarb, Coptis, and Licorice, administered continuously over 24 hours in large quantities. Wait until the intensity of diarrhea and thirst subsides, then begin to harmonize the interior; there is no need to pull from the exterior. The pathogen is like bursting water or rolling stones, exiting completely with momentum, leaving nothing to pull. There is another method: "urgently opening branch rivers." Heat pathogens inside rush to the Large Intestine and stagnate in the Bladder. Bladder heat-stagnation prevents qi transformation, causing scanty dark urine. Using counter-current pulling instead of guiding downward is not the best plan. Clearing Bladder heat allows qi transformation to proceed and disperses heat quickly. Zhang Zhongjing stated that diarrhea with qi stagnation should be treated by promoting urination. Qi is the function of Bladder transformation; if it exits via the Large Intestine, promoting urination is indeed urgently opening branch rivers. Water originates from the high source (Lung); if the Lung is not hot, urination proceeds normally. Lung and Large Intestine are exterior-interior pairs; Large Intestine heat stems from Lung heat transfer, so acrid-cool herbs should be used first to clear the Lung's transformation source. The *Jin Gui Yao Lue* mentions dysentery with lung pain, treated with Zi Can Tang. Qi-type diarrhea is treated with He Li Le San. Later generations doubted these were not Zhang Zhongjing's formulas, failing to realize that intestinal diseases relate entirely to the Lung. Materia Medica states Zi Can treats abdominal accumulations, clears intestinal heat, opens nine orifices, and promotes urination/defecation; Zhang Zhongjing used it, embodying the principle of treating obstruction with unblocking. He Li Le has both unblocking and astringent properties: unblocking to descend phlegm, digest retained food, and break qi stagnation; astringing to secure intestinal prolapse. Zhang Zhongjing used it, embodying mutual use of unblocking and securing. This shows that when Lung qi is blocked causing pain, urgency requires unblocking congestion; when Large Intestine qi sinks and presses, mutual use of unblocking/securing provides gradual comfort. Alas! When the *Nei Jing* methods offer no entry point, seek the *Jin Gui Yao Lue*. When *Jin Gui* methods offer no entry point, seek the divine insight of one's own mind; suddenly, *Jin Gui* methods become as clear as seeing one's palm. Regrettably, my youth was wasted in official duties; now old, I cannot advance further. I reveal these humble words to assist later generations in deeper study.

Furthermore: Treating malaria should involve advancing and retreating within the Shaoyang channel. Advancing toward Yang implies using Shaoyang as an exterior-releasing method, which is correct. However, the exterior aspect of dysentery should also be sought in Shaoyang. Roughly, water and grain qi moves from Stomach to Intestine, rushing downward. Initially, Shaoyang generating qi fails to extend; subsequently, it sinks. Thus, broadly seeking among the Three Yang channels is inferior to specifically seeking Shaoyang. This allows the pure qi of Heaven to rise sufficiently, and the flavors of earth and water transform into essence and subtlety, with regulated transmission and excretion, avoiding the suffering of urgent dysentery. Moreover, the fluids stored in the two Yangming channels are already lost through downward discharge; one must not induce sweating again. The *Shang Han Lun* explicitly forbids sweating in Yangming, and the *Jin Gui Yao Lue* reiterates the prohibition of sweating in diarrhea, stating that diarrhea with undigested food precludes attacking the exterior; sweating will cause abdominal fullness. Since diarrhea damages fluids, sweating damages them again. Loss of fluids empties Stomach qi, allowing turbid qi from below to ascend into the Stomach with the sweating momentum, forming fullness. Seeking even diarrhea becomes impossible; is this not a major warning? Therefore, one should use the half-exterior method of Shaoyang to slowly counter-currently pull the sinking clear qi, ensuring the body maintains spring-summer functions without descending/retracting. Ultimately, this is a harmonizing method, not a sweating intent. If fluids are undamaged, sweating is harmless; if fluids are damaged, slight moisture on the skin indicates the sinking qi has been raised. How is this comparable to Taiyang exterior wind-cold requiring direct sweating? Or Taiyang-Yangming combined disease diarrhea using Kudzu Root? Ah, subtle! Subtle!

Treating dysentery with the principle of "treating obstruction with unblocking agents" also has golden needles. Fire, heat, and dampness pathogens rush out; only bitter-cold herbs like Da Cheng Qi Tang or Xiao Cheng Qi Tang are suitable. Formulary books often mix in warm-middle and thickening-intestine herbs, effectively setting up banners for fire-heat-dampness; who can distinguish this?

The *Nei Jing* says: "Chang Pi with blood stool, fever indicates death, cold indicates survival." Also: "Chang Pi with white mucus, deep pulse indicates survival, floating pulse indicates death." Signs of Chang Pi: body not hot, pulse not suspended/extreme; slippery-large pulse indicates survival, suspended-choppy pulse indicates death, judged by zang organ timing. Also: "Yin-yang deficiency collapse, Chang Pi, death; diarrhea with blood loss, deep-micro pulse, cold extremities, all difficult to treat."

The *Mai Jing* says: "Chang Pi with pus and blood, deep-small lingering pulse indicates survival, rapid-large with fever indicates death." Also Chang Pi with muscle cramps: fine-small quiet pulse indicates survival, floating-large firm pulse indicates death.

Jin Kou Li (Dysentery with inability to swallow/open mouth) is caused by heat-dampness toxin in the Stomach steaming upward along the clear pathways, blocking the gastric opening. It can also result from mistakenly taking astringent-hot herbs, trapping pathogens at the gastric opening. Use equal parts Ginseng and Stone Lotus Seed, decocted and forcibly swallowed; once a mouthful goes down, deficient-heat opens. Then take these two herbs as powder frequently.

Treating Jin Kou Li often uses Coptis, which treats heat-dampness, is bitter and descending, unable to lift; moreover, it is unsuitable for Stomach deficiency, so I dare not use it. Using crushed river snail applied to the umbilicus to draw fire-heat downward is excellent. But stagnant heat requires both opening and descending; relying on one method alone is insufficient. Using Clove and Amomum, adding fire to fire, is a killing act.

Xiu Xi Li (Intermittent Dysentery) comes and goes intermittently, either because pathogens were not fully cleared and stopped abruptly before recurring, or due to indulging in rich foods or excessive labor immediately after initial recovery.

The *Jin Gui Yao Lue* states: "If diarrhea recurs at the same time/year/day after recovery, it is because the disease was not exhausted. It should be purged; Da Cheng Qi Tang is appropriate."

In Xiu Xi Li, if it stops but recurs, Zheng qi is deficient, and pathogens remain; purging cannot be discussed yet. If this syndrome has stopped for a long time, Zheng qi has recovered, but accumulation remains; thus purging is necessary.

The *Yuan Bing Shi* asks: "White dysentery is not a cold syndrome; why do acrid-hot herbs sometimes cure it?" Acrid-hot herbs can open gastrointestinal stagnation, promote qi-fluid circulation, moisten dryness, and harmonize qi; this is just one aspect. In cases where purgatives were previously used excessively or cold herbs were overused, resulting in micro-deep-fine pulse and cold limbs, warming-tonifying, raising yang, benefiting Stomach, and Li Zhong Tang category herbs are appropriate. To say heat herbs are generally unusable is not the essence of flexibility.

The *Ji Yao* states: "Tenesmus requires purging; abdominal pain requires harmonizing; heavy body requires removing dampness; wiry pulse requires expelling wind; thick sticky pus/blood requires heavy dosage to exhaust; cold body with spontaneous sweating requires warming with hot herbs; internal wind-pathogen binding requires sweating; loose stool with dysentery requires warming."

Zhang Zhongjing treated diarrhea/dysentery suitable for purging with Cheng Qi Tang. Rhubarb's cold nature moves well; assisted by Magnolia Bark's warmth, it moves stagnant qi gently. Licorice's sweetness moderates it; taken as decoction, it irrigates and cleanses intestines/stomach, moisturizes and lightens, stopping once accumulation moves.

Preceding diarrhea followed by dysentery is adverse; continuing purgation without cessation indicates deficiency. Micro-slow pulse requires warming-tonifying. Wiry-rapid pulse is adverse, indicating death. Postpartum dysentery also requires warming-tonifying.

Abdominal pain due to Metal-of-Lung qi stagnating in the Large Intestine should be treated with Platycodon to disperse, followed by dysentery herbs.

Anal pain indicates heat lingering below. Initial illness with fever and large pulse requires clearing; Huang Qin Shao Yao Tang. Patient with cold body and spontaneous sweating requires warming; Li Zhong Tang.

Hematochezia requires cooling-blood and activating-blood herbs like Angelica Sinensis, Scutellaria, and Peach Kernel. Sunken wind-pathogen requires lifting. Damp-heat damaging blood requires moving-dampness and clearing-heat. Abnormal bearing-down sensation with purple-black blood in stool and severe pain indicates dead blood; use Peach Kernel and Talc to move it.

Chronic bloody dysentery not healing belongs to yang-deficiency and yin-collapse; use Ba Zhen Tang with lifting herbs. Cases with periodic defecation, cold extremities, and gradually shrinking micro-pulse indicate yuan qi about to perish; urgently moxa Qihai acupoint, use Fu Zi Li Zhong Tang; delay slightly and death ensues.

Pure blood in dysentery, color like dust/rot, like roof-leak water, anus open and unretracting like a bamboo tube, lips vermilion-red, all indicate death. Color like fish brain matter, fever, large pulse, indicate half-death half-life.

Chronic bloody dysentery with deep-weak pulse, unresponsive to other herbs: use Shi Quan Da Bu Tang with ginger, jujube, and a little honey decocted and taken.

[Three Laws]

1. Any physician who treats dysentery indiscriminately with bitter-cold herbs without distinguishing root/branch or sequence commits a medical error. Regarding the gastrointestinal tract, Large Intestine is branch, Stomach is root; regarding channels, Hand/Foot Yangming are branch, Shaoyang Ministerial Fire is root. Thus, Stomach receives heat-dampness, water/grain transforms via Shaoyang fire into foul turbidity, transmitting to Large Intestine. Treating only Yangming without addressing Shaoyang is useless. If Shaoyang generating qi transmits to Earth and sinks, failing to first lift with acrid-cool herbs and directly draining with bitter-cold herbs ensures dysentery never ceases.

2. Any physician who treats dysentery without assessing deficiency/excess, clinging to standard methods and relying on specialized knowledge alone commits a medical error. Excess refers to pathogen excess; deficiency refers to Zheng qi deficiency. Seven parts excess, three parts deficiency: attack pathogen first. Seven parts deficiency, three parts excess: support Zheng qi as root. Ten parts excess pathogen consumes Zheng qi via fierce fire; no Zheng qi to support, urgently remove pathogen to preserve Zheng qi. Ten parts deficiency pathogen leaves barely a breath; no excess to attack, urgently tonify Zheng qi, letting pathogen depart naturally. Thus, physicians who do not know flexibility and cling to family traditions cause greatest harm.

3. Any physician who prescribes compounded pill medicines for dysentery regardless of heat-dampness quantity, misleading patients, commits a medical error. Dysentery stems from internal heat-dampness accumulation; bitter-cold purgation is不得已 (unavoidable). Decoctions are preferred over pills. Pills cannot purge effectively and often contain Croton Seed, Calomel, Lead Powder, Sulfur, Ammonium Chloride, Kansui, Genkwa, Euphorbia, Pharbitis Seed, Chinese Plum, Poppy Shell, etc. Even if the disease resolves but medicine remains, harm is great. Worse, if disease persists, toxicity deepens, making rescue difficult. Must one not be cautious?