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Dysentery has persisted for two months. The eyes are slightly yellow, the tongue coating is white, there is dry mouth, and the lips are dry and red. The abdomen is full and distended, feeling soft upon palpation. Urination is obstructed throughout the day. The patient reports a sensation of blockage in the anus, straining incessantly, only able to expel small drops of sticky pus and blood. If there were loose stool, it would surely pour out in large quantities. It is considered that during summer and autumn, damp-heat from summer heat and dampness was internalized causing dysentery. *Huangdi Neijing* (The Yellow Emperor's Classic of Internal Medicine) calls this "Zhi Xia" (Stagnant Downward Flow), meaning stagnation of Qi and Blood, not solely due to food stagnation. The Six Fu organs belong to Yang and function through unobstructed flow; the Five Zang organs belong to Yin and function through storage. Diarrhea preceding dysentery indicates Spleen disease transmitting to Kidney, which is a counter-flow pattern, following the principle of Earth overcoming Water. However, one must investigate the reason for this transmission and overcoming. It is likely that latent pathogens and turbid residues failed to clear from the Middle Jiao, thereby flowing downward. Prolonged illness leads to deficiency of Righteous Qi. Zhang Zhongjing, in discussing the Three Yin diseases, specifically mentions abdominal fullness in the Taiyin chapter. The Spleen is a soft organ; only pungent-dry drugs can disseminate and drive out turbidity. But now, the intestines are blocked, and Qi circulation is stagnant. Methods like Lizhong Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) for warming and tonifying will hardly unblock the Fu organs. Examining the *Neijing* principle that "in cases of two deficiencies and one excess, treat the excess," this opens a pathway. However, one must warm the Yang and assist with Qi-moving and stagnation-dispelling methods. To reverse the critical juncture of the disease, there is no other method.

Prepared Fuzi (Aconite Lateral Root), Raw Houpo (Magnolia Bark), Muxiang (Costus Root), Prepared Dahuang (Rhubarb Rhizome), Stir-fried Black Dachui (Anise Fruit).

Tongue coating is white, thirst exists but there is no desire to drink. Heat in the heart and abdomen. Pain occurs with every bowel movement. Anal prolapse sensation. Dysentery discharge is unsatisfactory. Mild vomiting with phlegm. Taste perception has changed. Hollow pain in the head. Both cheeks are red. This is grain qi steaming dampness, with heat郁结 (stagnating) in the stomach and intestines, mixing clear and turbid energies. Suddenly adding irritability makes it hard to describe the suffering. The method should employ bitter-cold herbs to drain heat, pungent-aromatic herbs to circulate Qi, and diaphoretic/damp-draining herbs to promote urination. Because accumulated stagnation is有形 (substantial/formidable), while dampness and heat are inherently无形 (formless/intangible).

Chuanlian (Coptis Rhizome), Huangqin (Scutellaria Root), Yujin (Turmeric Tuber), Houpo (Magnolia Bark), Zhuling (Polyporus), Huaimi (Sophora Flower), Qinpi (Ashbark Fringe Tree Bark).

Summer and autumn dysentery is indeed caused by damp-heat injuring Qi, leading to Spleen-Stomach Qi stagnation, resulting in tenesmus and unsatisfactory defecation. The ancient formula Xianglian Wan (Aromatic Coptis Pill) takes its effect from clearing interior heat, but must be assisted with Qi-regulating herbs, as moving Qi allows damp-heat accumulations no place to remain. Zhimu (Anemarrhena Rhizome) and Shengdi (Rehmannia Root) nourish Yin and clear heat, treating fire from Yin-deficiency with Yang-hyperactivity, which is very different from damp-heat in dysentery. Nourishing herbs cause stagnation and dull Qi obstruction, hence the inability to pass stool. Ultimately, the pathogenic damp-heat remains. Using hot-dry herbs like Fuzi (Aconite) and Rougui (Cinnamon Bark) would again cause anal prolapse and knife-like pain. Lizhong Tang tonifies Qi, a established method of Li Dongyuan, merely lifting the clear Yang of the Lower Jiao, failing to penetrate directly into the intestines. Using heavy doses of Dahuang combined with Zhimu and Shengdi would further injure the Lower Jiao. Textual principles state that all chronic dysenteries belong to Kidney injury. Lower abdominal prolapse fearing cold is clearly a Lower Jiao syndrome. Discussing the use of Yang-lifting methods requires combining treatment of the Lower Jiao.

Renshen (Ginseng Radix), Fuling (Poria), Zexie (Alisma Rhizome), Zhi Cao (Honey-fried Licorice Root), Fangfeng Gen (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), Xixin (Asarum Root), Shengjiang (Fresh Ginger), Dazao (Jujube Fruit).

Summer heat inevitably carries dampness, injuring the Qi level. Ancient texts call this "Zhi Xia." The character "Zhi" (stagnation) does not refer to food stagnation, but rather summer-heat and dampness invading internally, obstructing the flow in the Fu organs. Digestive-promoting, lifting, and warming-tonifying methods leave no exit for the summer-heat pathogen. Chest oppression, lack of appetite, and sticky sensations persist, along with heavy anal prolapse and internal binding. The Triple Burner is affected by pathogenic steaming, separating upper and lower aspects. Prolonging this becomes Resting Dysentery (Xixie Lizhi), lingering and turning over. Is this a disease that can be cured suddenly in a morning or evening?

Dan Jiangyan (Light Dried Ginger), Shengjiang (Fresh Ginger), Xiao Chuanlian (Small Coptis Rhizome), Renshen (Ginseng Radix), Zhishi (Immature Bitter Orange).

Diarrhea and dysentery for two months, limb edema. Advanced age naturally implies a deficiency pattern. However, chest and epigastric oppression, nausea upon eating, and abdominal pain preceding each stool indicate summer-heat and dampness stagnating in the Middle Jiao. A deficient constitution carrying pathogens precludes the logic of using astringents to dispel pathogens and support righteousness. Fear of symptom changes upon seasonal transitions indicates a difficult and severe case.

Renshen (Ginseng Radix), Fuling (Poria), Chuanlian (Coptis Rhizome), Dan Jiangyan (Light Dried Ginger), Sheng Baishao (Raw White Peony Root), Zhishi (Immature Bitter Orange).

Pulse is rapid on the right, fine and rapid on the left. Face is dirty, tongue is dry, dotted white coating. Skin is rough like fish scales (Jiacuo). Qi movement in the left hypochondrium. Latent summer-heat erupts in autumn coolness. Initial presentation resembles malaria; treat with bitter-pungent-cold method. Interior pathogens are fierce, transforming into dysentery. Stomach fluids are depleted, Yin fluids largely consumed. Past sages, when heat diseases caused depletion, urgently prioritized saving Yin. If the Stomach gate revives, peace may gradually be hoped for. Otherwise, one violates Yu Jiayan's warning against pathogenic invasion sinking inward and crisis due to fluid exhaustion.

Renshen (Ginseng Radix), Shengdi (Rehmannia Root), Wumei (Mume Fruit), Zhi Cao (Honey-fried Licorice Root), Maidong (Ophiopogon Tuber), Mugua (Chaenomeles Fruit).

Dysentery began in late summer. Physicians attributed it to seasonal damp-heat. Weiling Tang (Stomach Regulating Decoction) with Huangqin and Shaoyao is not erroneous. However, due to advanced age, Kidney Yang and Liver Yin were already deficient beforehand. This allowed external pathogens to disturb internally, obstructing the middle, lacking a pillar to stabilize the raging waves. After twenty days without improvement, heavy Yin lacks Yang. Verifying that consciousness is clear suggests minor external pathogens and major internal damage. The Eight Extraordinary Vessels lack authority, Lower Jiao lacks retention. Leakage continues. Reasonably, Yang generation leakage and Lower Jiao cold occur. These are signs of extreme subtlety in Yin and Yang Qi. Treating symptoms is clumsy; treating the root is appropriate. Not ignoring it, but truly investigating Heaven and Humanity.

Renshen (Ginseng Radix), Lurong (Deer Antler Glue), Stir-fried Black Danggui (Angelica Sinensis Radix), Sheng Duzhong (Eucommia Bark), Sheng Shayuan (Astragalus Complanatus Seed), Fuling (Poria).

Initial onset had no chills or fever, immediately presenting with diarrhea, dysentery, vomiting, and anorexia. This is a severe case of Jin Kou Li (Closed-Mouth Dysentery). Summer-heat pathogen enters via nose and mouth breathing. Pathogens mix with food and water, steaming into damp-heat, brewing into accumulated pus and blood. Intestinal Qi is blocked, unable to resolve smoothly, leading to tenesmus. Xianglian (Aromatic Coptis) is bitter-pungent, regulating Qi, guiding dampness, and clearing heat. Initially used appropriately. All because the patient is laborious, not of a rich diet constitution. Thin diet and accumulated fatigue easily injure Middle Qi. For forty days, accumulation decreased, pain eased. Physician declared recovery. Yet food cannot be swallowed, hunger and satiety unknown. Pulse is wiry, form is emaciated, tongue is white, no thirst for water. Daily diarrhea several times. Entirely Stomach Qi collapse, Middle Palace severely damaged, Lower Gate fails to retain. Grain cannot be swallowed, how can it tolerate decoctions? Medicinal taste is inferior, weak Stomach rejects it. Chronic dysentery and diarrhea require ability to eat. Ancients either awakened Spleen and Stomach or anchored Kidney to retain. Further inquiry: rice water causes choking or blocking. Discussion: Upper Jiao should unblock clear Yang, Lower Jiao should secure slippage. Imitate ancient Shenling Baizhu San powder, take twice daily with rice water. Intermittently consume non-greasy foods in small amounts to show what the Stomach likes is tonification. Must wait for Stomach Qi to gradually revive before turning danger to safety.

Renshen (Ginseng Radix), Jiao Zhu (Charred Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhi Cao (Honey-fried Licorice Root), Chao Bian Dou (Stir-fried Lablab Bean), Yiren (Coix Seed), Jiegeng (Platycodon Root), Sharen (Amomum Fruit), Pao Jiangtan (Charred Ginger), Roudoukou (Nutmeg).

Pathogen sank after malaria, transforming into dysentery, injuring Jueyin. Symptoms include Qi rushing up to strike the heart, hunger but inability to eat, dry heaving, and abdominal pain. Entirely Liver pathology. Liver is a Zang organ of extreme Yin, housing Minister Fire. Zhang Zhongjing's treatment avoids purely pungent-dry-hot drugs because the Liver is a rigid organ. Now Earth is congested, Wood is constrained. Earth and Wood become enemies. Within five days, it is not yet stable.

Renshen (Ginseng Radix), Chao Danggui (Stir-fried Angelica Sinensis Radix), Chao Baishao (Stir-fried White Peony Root), Chao Wumei Rou (Stir-fried Mume Flesh), Fuling (Poria), Dan Wuyu (Light Evodia Fruit), Sheng Xiangfu Zhi (Raw Cyperus Juice), Zhen Bei Qinpi (Authentic Northern Ashbark Fringe Tree Bark).

In previous years, chronic dysentery responded to Sanshen Wan (Three Divine Pills). This indicated dual Spleen-Kidney distress, compounded by Qi-level stagnation. Constitution is Yang-deficient, worsening with cold. Now disease begins in late summer, urine is obstructed. Likely summer heat obstructed diffusion and transformation. Over time, Qi and Blood coagulated, causing intestinal bleeding. First administer Guiling Ganlu Yin (Cassia Twig, Polyporus, and Talcum Decoction) to separate and eliminate dampness.

Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome), Huashi (Talcum), Guixin (Cinnamon Twig).