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To treat malaria presenting with fever, yellowing of the body, and difficult urination.
Chifuling (Poria with Hostis removed) Baishaoyao (Radix Paeoniae Alba) Qumaisui (Sper Spermatum Dianthi) [each one liang] Baizhu (Rhizoma Atractylodis Macrocephalae) [three fen]
Coarsely crush and sieve the above herbs. For each dose, take five qian, add one dan and a half of water, three cun of Congbai (Scallion White), and one fen of Shengjiang (Fresh Ginger), break them apart, and decoct together until seven parts remain. Strain the dregs and take warm before meals.

Dysentery was called "Zhixia" (Stagnant Downward Flow) in ancient times and is now called Liji (Dysentery). The *Maijing* (Pulse Classic) states: If pus and blood are discharged from the intestines, and the pulse is deep, small, and lingering, the patient will survive; if the pulse is rapid, full, and accompanied by significant heat, the patient will die. It also states: If there is intestinal spasm and the pulse is fine and small, with the patient being calm, survival is possible; if the pulse is floating, large, and tight, death ensues. Yan Yonghe stated: In dysentery, a minute or small pulse indicates survival, while a surging pulse is difficult to treat. If pus and blood are discharged, the pulse should be slippery and large; if it is wiry and rapid, death occurs. Zhang Zhongjing's methods for differentiated treatment state: In dysentery, a deep and wiry pulse indicates heaviness in the rectum (Li Ji Hou Zhong); a large pulse indicates the disease has not ceased; a weak and rapid pulse indicates it is about to stop spontaneously, and even with fever, death is unlikely. In dysentery with cold extremities and no palpable pulse, if moxibustion does not warm the limbs and the pulse remains absent, accompanied by slight panting, death occurs. If there is slight fever and thirst with a weak pulse, the condition may resolve on its own; if the pulse is rapid with slight fever and sweating occurs, it may resolve on its own. If the pulse is tight, the disease is unresolved. If dysentery presents with a rapid pulse and thirst, it may resolve on its own. If it does not improve, pus and blood will likely be discharged due to heat. The *Bingji Yao* (Essentials of Pathogenesis) states: Li Ji Hou Zhong requires purgation; abdominal pain requires harmonization; heavy body requires dampness removal; wiry pulse requires wind expulsion. Thick and sticky pus and blood require strong purgatives; cold body with spontaneous sweating requires warming medicines; internal contraction of wind pathogens requires diaphoresis; loose stools classified as dysentery require warming. Furthermore: Exterior conditions require dispersal; interior conditions require purgation; upper conditions require emesis; lower conditions require astringency or draining; exterior heat with interior stagnation requires ventilation; difficult urination requires separation and drainage. Also: Excess conditions require draining; deficiency conditions require tonifying; rising qi requires descending. The *Lanshi Micang* (Secrets of the Chamber of the Blue Room) states: In cases of Shanghan (Cold Damage) where diet causes fullness and transmits to undigested diarrhea (Xunxie), warm and hot agents should be used for digestion and guidance; if pus and blood result from damaging damp-heat substances, bitter-cold agents should be used for internal purgation. Sunken wind pathogens require lifting; internal excess dampness requires separation and drainage; urgency requires purgation; tenesmus requires regulation; abdominal pain requires harmonization. Profuse diarrhea with borborygmus and weakness, so severe that one cannot lift clothes, with a wiry, fine, and weak pulse, requires warming and astringing. Thick and sticky pus and blood, inability to defecate despite urgency, with a surging, large, and forceful pulse, requires cold purgation. The *Bingji Yao* further states: Dampness invading the Taiyin meridian leads to watery, loose stools, heavy body, slight fullness, and loss of appetite; prolonged, this may transform into pus and blood. Transmission from Spleen to Kidney is called "Zei Xie" (Robber Evil) and is difficult to cure; if dysentery is followed by looseness, it is called "Wei Xie" (Minor Evil) and is easy to heal. These are all caused by Spleen Earth receiving dampness. Chen Wuyue stated: The syndrome of Zhixia, described in the *Neijing* as blood overflow, blood discharge, or bloody stool, was formerly called clearing pus and blood, now called dysentery; essentially, they are the same. This mostly arises from Spleen-Stomach disharmony, excessive diet causing stagnation in the intestines and stomach, inability to digest, compounded by invasion of wind, cold, summer-heat, and dampness. Injury by heat results in red stool; injury by cold results in white stool; injury by wind results in clear blood; injury by dampness results in stool like bean dregs. Cold and heat mixing result in mixed red and white discharge. Treatment should use unblocking and draining medicines to cleanse the zang-fu. Yan Yonghe used Radix Crotonis Fructus (Badou) and similar agents to push out accumulated heat, later differentiating cold, heat, wind, and dampness for treatment: Red-heat cleared with cooling agents; white-cold warmed with warming agents; wind-injury with clear blood dispelled; dampness-injury with bean-dreg stool drained. Mixed cold and heat regulated with warm-cool agents. One must first regulate Stomach Qi and strictly avoid sudden use of Poppy Seed (Yingsu) or Chinese Olive (Hezi) to astringe, which would trap pathogenic factors and lead to danger. Chen Wuyue further stated: Wind stagnating in the skin and pores causing dark or fresh blood discharge, and damp-toxin causing bean-dreg stool, are external causes. Ancient formulas describe Five Diarrheas caused by organ qi stagnation leading to pus/blood discharge of varying colors (green, yellow, red, white, black), which are internal causes. Greasy, hot foods, wine, meat, and sauces, along with unrestrained desire and sexual exhaustion damaging essence and blood, cause intestinal stickiness and overflow. Long-term accumulation of cold and heat forms toxic dysentery; these are neither-internal-nor-external causes. Treatment first assesses the annual fortune to balance the exterior, observes stagnation to regulate the interior, and examines the specific injury to treat neither-internal-nor-external causes clearly, avoiding blind prescribing. This divides into Three Causes, and treatment should seek within these causes. The *Daquan Liangfang* states: There is a formula where one family is infected internally and externally, with elders and children showing similar symptoms; this is Epidemic Toxic Dysentery. Although treatment should consider the mutual overcoming of fortunes, one must not be rigid. First assess deficiency/excess and cold/heat, initially using Baidu San (Decoction to Overcome Toxins) with doubled Ginseng, Licorice, and Tangerine Peel, adjusted according to symptoms. Chen Wuyue also stated: Cold/hot diet, wine/meat/sauces causing intestinal stickiness and long-term cold/heat accumulation form toxic dysentery. Yan Yonghe stated: Drinking cold wine/cold food or sexual exhaustion causing chronic dysentery requires detoxification to protect healthy qi. The *Bingji* states: Li Ji Hou Zhong with a large, surging, full pulse indicates interior heat obstruction and physical blockage. If the pulse is large, purgation is highly inadvisable; although there is urgency, a deep, fine, weak pulse indicates internal cold and scattered qi, which can heal with warming and nourishing. Closure with Li Ji Hou Zhong indicates non-circulation of Large Intestine meridian qi; add Areca Seed (Binglang) and Costus Root (Muxiang) to circulate qi. The *Yuanbing Shi* states: Tenesmus and urgency are acute pains caused by the rapid and drying nature of Fire. The *Jiyao* states: Harmonize abdominal pain; if fever/chills without abdominal pain, use more Scutellaria Root (Huangqin). Severe abdominal pain adds Angelica Sinensis (Danggui) and double Peony Root (Shaoyao). The *Baiyi Xuanfang* states: Anorexic dysentery (Jinkou Li) is caused by toxic vapors rushing to Heart and Lung; use Stone Lotus Seed (Shilian Rou) to open Heart qi. Zhu Danxi stated: The sensation of food/qi rushing upward belongs to Fire. Ancient formulas attributed this to weak Stomach, not realizing that weak Stomach implies Yin deficiency and extreme deficiency. Dysentery often presents this way due to prolonged downward flow causing Yin deficiency. The *Yuanbing Shi* states: Saying white dysentery is cold is wrong. If it were truly cold, grain could not be digested, let alone transformed into pus. As grain/meat/fruit/vegetables rot and decompose under intense damp-heat into foul liquid, so too does dysentery turn to pus/blood. Heat manifests as red (Heart Fire); dampness as yellow (Spleen Earth); dryness/stagnation as white (Lung Metal). The Classics state: All qi stagnation and depression belong to the Lung, referring to the transformation of Dry Metal. However, all diarrhea/dysentery involves dampness. When speaking of dry qi, it refers to intense damp-heat in the intestines causing obstruction, leading to a state where qi and fluids cannot circulate, resulting in intestinal dryness and incessant thirst/pain. The common saying that red-and-white dysentery means mixed cold and heat is erroneous. Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; one high means the other low, one excess means the other deficit. How can cold and heat both be excessive in the intestines simultaneously? Just as hot sores may produce white pus, does white mean cold? Skin belongs to Metal (white); blood vessels to Heart Fire (red); muscles to Spleen Earth (yellow); tendons to Liver Wood (bluish-green); bones to Kidney Water (purple-black). Colors vary by organ location (manifestations), but the root is always Heat, differing only in depth. Generally, tenesmus, urgency, painful defecation, and dark/scanty urine belong to Dryness-Fire. White dysentery is often present, yet clearly heat. Why do some recover taking pungent-hot medicines? Because pungent-hot medicines can open intestinal stagnation, circulate qi/fluids, moisten dryness, and harmonize qi. Mild cases heal; severe cases with unopened stagnation worsen and die. This applies to vomiting/diarrhea from intense heat. Treating dysentery is best done with pungent-bitter-cold medicines, perhaps slightly aided by pungent-hot ones. Pungent disperses and opens stagnation; bitter dries dampness; cold overcomes heat, ensuring smooth qi circulation, as seen in Qian Yi's Xianglian Wan. Thus, Coptis Rhizome (Huanglian) and Phellodendron Bark (Huangbai) are commonly used for their extreme bitterness and great cold, directly addressing damp-heat. While folk remedies use pungent-hot mineral poisons for vomiting/dysentery, sometimes healing due to opening stagnation, they may fail or cause harm. Danxi asked: Hejian said dysentery rarely involves cold? I replied: Diarrhea involves undigested food, varying in deficiency/excess, causing fatigue. Dysentery differs: pus, blood, mixed pus/blood, intestinal mucus, or mixed with residue, with varying pain levels, but all feature Li Ji Hou Zhong, pressing painfully, seeming like heat-excess syndromes. The *Yuanbing Shi* states: Red and white dysentery both involve heat; heat in Qi level is white, heat in Blood level is red, mixed indicates both Qi and Blood are diseased. Anciently, Zhixia was discussed with diarrhea, but the *Sanyin Fang* separated them as they differ. Diseases from external invasion require distinguishing the Six Qi; after external injury, intestinal stagnation causes red/white symptoms, treated by regulating Qi/Blood deficiency/excess. Diseases from organ qi attacking intestines require identifying the offending organ to balance. Diseases from dietary irregularity require identifying the injuring substance to digest. The causes of this disease indeed do not exceed these three, but after infection, intestinal obstruction, thick pus/blood, and Li Ji Hou Zhong occur. Although theories exist on cold/heat/deficiency/excess, Liu Wansuo considered it Heat; the *Neijing* noted more heat than cold; Danxi considered it mixed with deficiency-cold. Predecessors established theories and prescriptions based on etiology and symptoms. Later students must examine deeply; how can one fear dysentery lightly when human life is at stake!