Library

In cases of dysentery where the discharge consists purely of bright red blood, it is mostly a heat syndrome. This is because the nature of fire is rapid and urgent, forcing the blood downward. Discharge that is purple-red or white indicates less heat; this occurs due to the coagulation and deterioration of yin blood and tissue damage. Pure white discharge indicates no heat syndrome, resulting from cold qi deficiency in the zang organs and slippery collapse. However, there are cases without redness but caused by heat; these belong to the category of "Bao Zhu" (acute watery diarrhea) rather than true dysentery. Conversely, there are cases with abundant purple-red discharge that cannot be classified as heat; these result from injury to the Yin collaterals and are not comparable to Bao Zhu. Deep yellow stool with a foul odor indicates a heat syndrome. If the color is pale yellow, light, not particularly odorous, or accompanied by a fishy/sour smell, it belongs to the category of "Bu Hua" (undigested food in stool), all of which are cold syndromes. Black stool with thick pus and a strong odor indicates a scorched color, often associated with fire syndromes. If the color is cyan-black with a thin odor, it indicates the corruption of the Liver and Kidney. In all dysentery cases involving blood, it is invariably due to injury of the Yin collaterals. Whether cold or heat, once the collateral vessels are damaged, bleeding will occur. Therefore, one must not automatically assume it is a heat syndrome; instead, pulse, complexion, physical form, and Qi status should be examined comprehensively to avoid error.

Dysentery accompanied by fever seems to belong to fire syndromes, yet true excess-heat syndromes do not necessarily present with fever. It is mainly patients whose essence and blood have been damaged by dysentery, suffering from Yin deficiency and water depletion, who manifest heat syndromes. Or, if there is fire within deficiency and the pulse is forceful, the treatment should focus on preserving Yin. If the pulse is inherently weak, indicating pure deficient fire, the method should be to strengthen water and tonify Yin, using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) or Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). If Yin deficiency repels Yang, causing external false heat, then Wei Guan Jian (Stomach Gate Decoction) or You Gui Yin (Right-Restoring Decoction) should be used.

One type of Jin Kou Li (Jin Kou Dysentery, characterized by inability to eat) is the most critical condition. Danxi treated it using Huang Lian (Coptis Rhizome) and Ren Shen (Ginseng Root) assuming excessive heat in the stomach opening, unaware that Jin Kou Dysentery is not exclusively excess-heat, but predominantly deficiency-cold. If fire were depressed in the stomach, the internal organs would certainly show signs of intense heat, and the pulse would be surging and rapid. If upon examination, the stomach opening shows no distension or pathogenic fire, but only output without input (only evacuation without intake), and the Zang Qi cannot tolerate nourishment: one cause is Spleen-Stomach weakness, possibly with vomiting, nausea, aversion to food odors, or emaciation preventing eating; this is due to the failure of the Middle Jiao to transform and transport, placing responsibility on the Spleen. Another cause is Kidney Qi weakness and lack of warmth in the Ming Men (Gate of Life), leading to insecure Large Intestine and indigestion in the Small Intestine, preventing Stomach Qi from moving; this is due to the loss of control in the Lower Jiao and lack of mastery over the source of transformation, placing responsibility on the Kidney. To strengthen the Middle Jiao, herbs such as Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Sheng Jiang (Fresh Ginger), and Gan Cao (Licorice Root) are indispensable. To solidify the Lower Jiao, herbs such as Shu Di Huang (Prepared Rehmannia Root), Fu Zi (Aconite Lateral Root), Wu Zhu Yu (Evodia Fruit), and Rou Gui (Cinnamon Bark) are indispensable. Once the Spleen and Kidney are strengthened, food intake will naturally resume; the principle is very clear.