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Lady Hu, occasionally experienced abdominal discomfort and diarrhea several times. The physician treated her with medicines for dysentery, but the diarrhea worsened. The physician then applied the method of "treating unblocking with unblocking" (using purgatives to treat conditions characterized by discharge), administering three qian of Nine-Steamed Rhubarb Pills. This subsequently disturbed the Stomach Qi, causing distension and pain, and she completely lost her appetite, resembling the condition of Jin Kou Li (Dysentery with inability to eat). Upon my examination, I found all six pulses were deep and hidden, feeling vague under the fingers. I urgently stated, "This is not a dysentery syndrome, but a result of mis-treatment. Now, we only need to calm the Stomach; there is no need to specifically treat the dysentery, and it will stop on its own. There is no need to specifically treat the distension and pain, and they will cease on their own." Thus, Si Jun Zi Tang (Four Gentlemen Decoction) was used as the main prescription, with small amounts of warming Stomach herbs such as Sheng Jiang (Zingiberis Rhizoma Recens) and Dou Kou (Amomi Fructus Rotundus). After two doses, the diarrhea indeed ceased. However, the patient still suffered from gastric distension and pain, and the family insisted on adding Qi-moving herbs hoping to relieve the symptoms and restore appetite quickly. I firmly opposed this, saying, "It is better to delay eating than to rush into medication. Previously, due to mis-treatment, the Stomach Qi was agitated and caused pain. This is like governing rebels; only pacification methods apply. If we add Qi-moving herbs again, the distension and pain will have no end." Adhering to the previous approach, even when using Ju Pi (Citri Reticulatae Pericarpium) to harmonize the Middle Jiao, it had to be stir-fried repeatedly to avoid disturbing the Qi. For five days without a bowel movement, we did not intervene to induce one, allowing the pain and distension to subside slowly and the appetite to return gradually. In seven days, full recovery was achieved. The efficacy of the medicine was hardly visible; this is actually the merit of "non-action." Alas! Physicians today often follow the master's desires to seek gratifying results. Even if complications arise, they claim it is due to the disease itself, not the physician's fault. Who can hold up a bright mirror to let no flaw escape? This is how the world of mediocre physicians is formed.

Zhang Zhongyi initially contracted dysentery, having a few bowel movements daily, and invited me to examine him. He moved normally, but his pulse indicated internal injury with pathogenic factors involving the Shaoyin channel. After diagnosis, I immediately advised, "This syndrome still requires simultaneous release of the exterior and interior. However, use more Ren Shen (Ginseng Radix et Rhizoma) in the exterior-releasing formula and more Fu Zi (Aconiti Lateralis Radix Praeparata) in the interior-treating formula to avoid disaster. Using standard dysentery medications would surely lead to danger." Zhang Zhongyi deeply trusted me and took the prescribed medicine without doubt. At that time, the disease severity had not yet manifested. By evening, he suddenly developed high fever, his body felt heavy as a giant stone, requiring two people to move him from the pillow. He was lethargic and confused, causing panic in the household. After hastily taking the exterior-interior dual formulas, by the next morning, he could rise and leave the room. Two more doses of Ginseng and Aconite formulas led to complete recovery. Without syndrome differentiation, what treatment in the dysentery category could achieve such results? Especially considering the foresight applied before the disease became severe.

Zhou Xinchuan was seventy-three years old, usually robust and unaware of his age. He contracted dysentery in autumn, which persisted untreated until winter, developing into Xiu Xi Li (Intermittent Dysentery), with over ten bowel movements per day. His face and eyelids were edematous, and his skin was dark and dull. He sought my treatment. His pulse was deep, rapid, and forceful. I told him, "This is a syndrome where Yang pathogens have sunk into Yin. With proper treatment, you can recover. I will bring medicine tomorrow for direct treatment." I prepared Ren Shen Bai Du San (Ginseng Detoxifying Powder) decoction. He sat in a chair surrounded by thick quilts, with a fire placed beneath the chair. A cloth roll shaped like a goose egg was placed on the seat cushion to support the anus, preventing internal Qi from sinking downward. Then, he drank the hot decoction. After some time, he took more. Soon, he felt slight moisture on his skin. Hot water was poured over him (for external warming/steaming), and he was instructed to endure holding back stool without moving his body. This lasted about two shi (four hours). The moisture on his skin remained. The patient was irritable and afraid of heat, enduring until he could bear it no longer, at which point he lay on the bed wrapped in the quilt. That night, he had only two bowel movements. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used. Bowel movements reduced to three per day, and he recovered fully within ten days. This is because the sunken pathogens needed to be lifted out through the exterior. Without the "pulling the boat upstream in a swift current" method (lifting sunken pathogens to the surface), where would the downward momentum end? It is heard that Wang Xingzai suffered from chronic dysentery unresponsive to various drugs. An old physician in Suzhou administered Ren Shen Bai Du San, reducing the severity and showing vitality. However, lacking this specific manipulative technique, success was not achieved. Therefore, whenever Yang pathogens sink into Yin, such as in chronic malaria, chronic dysentery, or chronic fever, one must understand this principle: allow them to slowly emerge to the exterior. Rushing may cause pathogens to re-enter, merely damaging healthy Qi.

Zhu Kongyang, twenty-five years old, was thin and accustomed to comfort. In summer, due to litigation, he ran in the sun. Summerheat-dampness combined with internal stagnant fire to form dysentery. He had 100-200 bowel movements daily, unable to get out of bed, changing coarse paper sheets frequently. He drank water but ate nothing. The pain was severe, the anus felt like burning, and he kicked and waved in distress. His pulse was wiry, tight, and tense, resisting finger pressure. I said, "This syndrome involves a mass of toxic fire accumulated in the intestines and stomach, burning fiercely. Saving from fire requires immediate action; otherwise, in two or three days, the intestines and stomach will rot." I used Da Huang (Rhei Radix et Rhizoma) four liang, Huang Lian (Coptidis Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma) two liang each, decocted in a large clay pot. Administered while boiling. After ingestion, he rested briefly, then became restless again. Over twenty bowls were consumed in a day; the rhubarb dissolved, and the coptis and licorice boiled down to no juice. The next day, he requested more. My examination showed the pulse had softened slightly, indicating recovery was possible. However, I used an urgent method but not urgent herbs. I switched to Di Huang (Rehmanniae Radix) and Mai Men Dong (Ophiopogonis Radix) four liang each, ground fresh for juice. Tian Hua Fen (Trichosanthis Radix), Mu Dan Pi (Moutan Cortex), Chi Shao (Paeoniae Radix Rubra), and Gan Cao one liang each were decocted and mixed with the fresh juice in large bowls. Because the onset was violent, body fluids were depleted rapidly. Only after stopping dysentery should one nourish fluids and blood, as dryness cannot be restored instantly. Since the pulse weakened, fire pathogens receded. Treating the dysentery directly was unnecessary; it stopped naturally. Why cling to cloying/nourishing herbs and delay urgent use? After taking this medicine, dysentery stopped completely, leaving only minor frothy stools. On the third day, he desired tofu milk. On the fourth day, he drank clear rice soup from aged grain. Slow conditioning continued for over ten days until digestion normalized. This shows that even a trace of Stomach Qi remaining requires such "heroic" intervention.

Chen Ruming suffered from dysentery with steaming fever, lethargy, and refusal to eat, becoming critically ill by the third day. His pulse was rapid, large, and empty, with the chi position being exceptionally surging. I said, "This is a combination of two diseases occurring simultaneously. Internal damp-heat combines with seasonal external heat, predisposing to dysentery, though unnoticed. Intercourse further weakened him, allowing sudden cold to invade. Thus, fever, heaviness, and lethargy belong to Shaoyin Kidney channel external contraction. Shaoyin invasion typically presents with clear/white dysentery. Here, intestinal damp-heat has fermented into a foul, pig-liver/fish-brain-like substance, changing color but maintaining the dysenteric nature. Another dose of standard dysentery medicine would be fatal." I urgently prescribed Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to disperse external pathogens. Sweating followed, and fever decreased slightly. Then, Fu Zi Li Zhong Tang (Aconite and Poria Decoction) was given for two consecutive doses. Fever subsided, body felt light, and appetite returned. Huang Lian Li Zhong Wan (Coptis and Poria Pills) was then used for ten days until full recovery.

Ye Maoqing's young son suffered from Jin Kou Li (Dysentery with inability to eat) and fever for over ten days, with continuous vomiting and hiccups. His guan pulse surged upward without root. The foot pulses also surged upward without root. I told his father, "This is not Jin Kou Li, but impending collapse of Stomach Qi. Jin Kou Li is caused by deficient heat obstructing the Stomach, leading to fullness and anorexia, treated by tonifying deficiency and clearing heat. This case resulted from damage by bitter-cold herbs, rendering the Stomach unable to accept food. The only treatment is exclusive warming and tonification." Li Zhong Tang (Regulate the Middle Decoction) was administered for two doses. Soon, over ten bowel movements occurred, soiling everything. Ye Maoqing feared incorrect prescription and asked for a change. I said, "My intent was to save the collapsing Stomach Qi, not primarily to treat dysentery. Even if treating dysentery, the intestines are deep in the abdomen; even divine medicine cannot instantly alter feces. Now, using medicine to accelerate expulsion is beneficial. Why doubt it?" The medicine was taken for three days. Condition improved significantly; appetite returned, vomiting ceased, and dysentery lessened. After four days, normal stooling stopped. Bu Zhong Yi Qi Tang was used for ten days for recovery. This demonstrates that pediatric dysentery is often due to dietary injury rather than internal accumulated heat, and standard dysentery protocols should rarely be used lightly.

Pu Junyi suffered from dysentery. Initially, exterior pathogens were present but not resolved. Misuse of Ren Shen and Bai Zhu to consolidate the exterior drove pathogens deeper. Mistaken administration of Huang Lian (cooling/clearing) and Da Huang (purgative) continued for over a month, stagnating Stomach Qi. He had over a hundred bowel movements daily. One night, he vomited three to five bowls of previously ingested Huang Lian decoction. After two or three episodes, the Stomach and Intestines merged; the幽门 (pylorus) and 阑门 (ileocecal valve) opened wide. Porridge and drinks flowed out directly; even concentrated Ginseng paste passed straight through the intestines upon swallowing. Amidst crisis, relatives asked if there was hope. I replied, "With proper medication here, there is reliance. I know the danger, but no one else can take responsibility. I will stabilize with tranquility and repay my confidant's trust." Large doses of Si Jun Zi Tang were decocted and mixed with Chi Shi Zhi (Halloysitum Rubrum) and Yu Yu Liang (Yuccae Fossilia). Continuous administration slowed the downward flow. However, unbearable abdominal pain ensued. Pu Junyi said, "Previously, frequent diarrhea was painless. Now pain increased; do not continue." I said, "This illustrates 'unblocked means no pain, pain means blockage.' No pain indicates danger; pain indicates safety. Why fear pain?" The same medicine was continued. Once the severity greatly diminished, Si Jun Zi Tang with doubled Fu Ling (Poria) was used. Over ten doses led to full recovery.

Mr. Hu Youchen said, "Build a cart behind closed doors, and it fits the tracks outside. If physicians in counties emulate this diagnostic reasoning, assessing their level first, then applying it, it would be effective."