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Xue Lizhai stated: There was a woman who suffered from chronic dysentery during pregnancy. After using agents for digestion promotion and qi regulation, she experienced a heavy bearing-down sensation in the abdomen, leading to unsettled fetal qi. Subsequently, using substances such as Ejiao (Donkey-hide Gelatin) and Aiye (Mugwort Leaf) proved ineffective. This abdominal heaviness and bearing-down sensation is due to deficiency of the Qi of the lower origin. The unsettled fetus is caused by excessive internal heat. The condition was stabilized using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and complete recovery was achieved with Liujunzi Tang (Six Gentlemen Decoction).

Xue Lizhai stated: Dysentery with yellow discharge during pregnancy indicates damage to Spleen Earth and sinking of True Qi; it should be treated by raising and tonifying Middle Qi. If the discharge is yellow mixed with green, it indicates Liver Wood overacting on Spleen Earth, requiring soothing the Liver and tonifying the Spleen. If yellow mixed with white, it indicates the daughter organ (Spleen) deficiency affecting the mother organ (Lung), requiring tonification of the Spleen and Lung. If yellow mixed with black, it indicates Water counter-acting upon Earth, requiring warming and tonification of the Spleen and Kidney. If yellow mixed with red, it indicates Heart Mother benefiting the Son (Spleen), requiring only Buzhong Yiqi Tang. If the Intestines and Stomach are weak with Wind pathogen lodging within, Weifeng Tang (Stomach Wind Decoction) should be used. Or if Spleen Qi is urgently unsettled, urgently tonifying the Spleen and Stomach will bring peace. Any herbs for calming the fetus should be adapted to the specific disease condition; one should not rigidly rely on Ejiao or Aiye.

Shenzhen noted: The above four cases describe dysentery occurring before delivery. Dysentery during pregnancy can also be caused by external contraction of Summerheat pathogenic damp-heat, and should not be exclusively attributed to damage from cold and raw food. However, dysentery in pregnancy fundamentally stems from disharmony between the Spleen and Stomach, which subsequently affects Qi and Blood. Injury to Qi results in white discharge; injury to Blood results in red discharge. If one strictly adheres to Liu Hejian’s method of descending Qi, the tenesmus will naturally cease, and bloody pus will stop. However, one must ask: Can Qi really be descended during pregnancy? Descending Qi causes the fetus to drop. Can Blood really be moved during pregnancy? Moving Blood causes miscarriage. It is better to use more Muxiang (Aucklandiae Radix) to regulate Qi and more Danggui (Angelicae Sinensis Radix) to nourish Blood. These two herbs are excellent agents for treating dysentery in pregnancy. Combined with Siwu Tang (Four Substances Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix), this follows Danxi’s principle: first support the Righteous Qi to secure the fetus, then harmonize Qi and Blood, assisting with resolving accumulation and guiding out stagnation. This is the essential method for treating pregnancy dysentery.

The Daquan (Great Compendium) states: Excessive eating combined with exposure to Wind-Cold leads to disharmony of Yin and Yang and interference between Clear and Turbid Qi, termed Huoluan (Cholera-like disorder). In this condition, some vomit first, while others experience abdominal pain followed by vomiting and diarrhea, indicating Heat etiology. If accompanied by headache, body ache, and fever, it indicates concurrent Wind pathogen. If Wind constrains the skin, Qi mechanism fails to circulate freely, and Wind-Heat rushes upward causing headache. If Wind enters the Intestines and Stomach, it causes diarrhea, dysentery, and vomiting; in severe cases, cold extremities occur, indicating sudden exhaustion of Yang Qi, termed Sini (Four Coldness). When pregnant women suffer from this, it often damages the fetus.

Lizhai noted: For the aforementioned conditions, if caused by internal dietary injury and external Wind-Cold contraction, Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) should be used. If caused by food stagnation, Pingwei San (Calm the Stomach Powder) should be used. If there is indeed sudden damage to the Spleen and Stomach with Yang Qi deficiency and Cold, manifesting as cold extremities, warming and tonifying agents are required. Treatment must be carefully examined to avoid disturbing the fetus.