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Make food into a soft porridge. Regulating the stomach qi will surely be effective. This is precisely the intention behind using Shi Lian Zi (Euryale Seed). In treating Jin Kou Li (Dysentery with inability to eat), many use Huang Lian (Coptis Rhizome). Huang Lian is indeed a herb for treating damp-heat, but its nature is bitter and cold, and it descends; it cannot lift and open the stomach qi. Moreover, it is not suitable for stomach deficiency, so it should not be used lightly. Generally, Jin Kou Li occurring at the onset of dysentery is due to dampness and blood stasis obstructing the stomach opening, so it is appropriate to treat it with bitter-drying herbs. If mouth closure occurs in chronic dysentery, it indicates that the stomach qi is deficient and failing; even large doses of Du Shen Tang (Single Ginseng Decoction) or Li Zhong Tang (Regulate the Middle Decoction) may struggle to be effective. For chronic dysentery that does not stop and responds to no medicines, especially when poor patients cannot afford to take Ren Shen (Ginseng Root), taking several Wu Mei (Mume Fruit) and Da Zao (Jujube Fruit), decocted and taken orally, has proven effective repeatedly.

Xiu Xi Li (Intermittent Dysentery): This condition often arises from using astringents too early, leaving accumulated heat unresolved, compounded by improper lifestyle management, failure to regulate diet, and lack of sexual restraint, causing the condition to remit and relapse intermittently. Treatment involves Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia Root), taken together with Zhu Che Wan (Stopping Travel Pill). There are also cases of yin deficiency with abundant fire, where the patient cannot tolerate the ascending and drying properties of Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Mu Xiang, and Bai Zhu (Atractylodes Macrocephala Rhizome); in such cases, only Zhu Che Wan added with Ren Shen, Rou Gui (Cinnamon Bark), and Wu Mei is used. If there is accumulation, Zhi Shi (Immature Bitter Orange) and Pao Hei Zha Rou (Charred Hawthorn Flesh) can be added. If several doses of Bu Zhong Yi Qi Tang fail to work and instead result in the passage of fresh purple blood clots, this indicates that long-standing wind pathogen has transformed into Sun Xie (Sporadic Diarrhea with undigested food). Wind qi communicates with the Liver; when the Liver is injured, it fails to store blood. San Qi Tang (Three Marvels Decoction) with doubled Fang Feng (Saposhnikovia Root), plus Qiang Huo (Notopterygium Rhizome), Ge Gen (Kudzu Root), Sheng Ma, and Chai Hu, is indicated. All diuretic and qi-breaking herbs are strictly contraindicated.

Tao Chong Li (Threadworm Dysentery): The symptoms include abdominal distension, yellow and rough skin, and a melancholic demeanor. It results from cold-dampness; the cold-damp qi stagnates deeply without manifesting immediately, transforming into parasites. This is one of the nine types of worms, extremely fine in shape. When the stomach is weak and the intestines empty, Tao Chong (Threadworms) take advantage. Symptoms may include itching or the worms overflowing from the anus. Cang Gong (Hua Tuo's teacher, Bian Que's contemporary) treated it with a pinch of Yuan Hua (Genkwa Flower). Wu Mei Wan (Mume Pill) and Huang Lian Xi Jiao San (Coptis and Rhino Horn Powder) are also indicated. However, after the worms are eliminated, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Huang Lian, and Wu Mei flesh should be made into pills and taken to tonify the spleen and stomach while clearing damp-heat, preventing recurrence. If one solely attacks the worms, the infestation will worsen endlessly.

Li Hou Feng (Wind After Dysentery): Due to improper care after dysentery, excessive walking, sexual exhaustion, exposure to wind-cold, or dampness invasion, leading to flaccidity, swelling, and pain in both legs. Da Fang Feng Tang (Major Saposhnikovia Decoction) is used. Gout developing after dysentery is also caused by improper regulation. Bu Zhong Yi Qi Tang added with Qiang Huo, Xu Duan (Dipsacus Root), and Hu Gu (Tiger Bone - *Note: Substitute with legal alternatives*) is indicated.

E Yue After Dysentery: This represents extreme deficiency-cold of the stomach qi, a most ominous sign. Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction) is urgently indicated. If hiccups occur after dysentery with thirst due to mistakenly eating cold foods or fruits, Li Zhong Tang added with 15 Ding Xiang (Clove Buds) and 5 Shi Di (Persimmon Calyx), decocted in water and taken hot, is used. If accompanied by alternating chills and fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Ding Xiang is used. For bloody dysentery with hiccups, thirst, irritability, insomnia, and urinary obstruction, Zhu Ling Tang (Polyporus Decoction) is indicated. For white dysentery with hiccups, Wu Ling San (Five-Ingredient Powder with Poria) is used because it contains Rou Gui to unblock rebellious qi.

[Diagnosis] Passing white mucus in dysentery: If the pulse is small and slippery at the onset and the patient can eat, it is easy to treat. If the pulse is surging, large, rapid, and urgent, with cold limbs, it is difficult to treat. In chronic dysentery, if the pulse is weak, minute, and fine, recovery is imminent. If the pulse is rapid and excess or void and large without root, it is critical. Passing pus and blood in dysentery: If the pulse is small and slippery, or wiry and soft at the onset, and the body is not hot, it is easy to treat. If the pulse is rapid, excess, slippery, and large with fever, although the condition is severe, it may still be treatable. If there was no fever initially, but fever develops after five or six days with a large pulse, death is certain. In prolonged cases, the pulse should be knotted, slow, void, and fine, not rapid, full, slippery, and excess. Or if fever persists and the mouth is closed with inability to eat, death is certain. In chronic dysentery, if the pulse shows intermission (Jie Dai) but the patient suddenly gains an appetite, this is Chu Zhong (False Appetite indicating stomach qi exhaustion), and death is certain. Generally, for diarrhea pulses, although excess and large at the onset is acceptable, it is most taboo for the pulse to remain strong after six or seven days. For dysentery with floating pulse and fever, treat as wind; with sinking pulse and heavy body, treat as damp. Dysentery is a disease of the intestines and stomach; frequent evacuation with ability to eat is auspicious. For Jin Kou Li, if the pulse is rapid and excess at onset, it is treatable; if chronic and unable to eat with a seemingly excess pulse, it is fatal. Only if the pulse is small, weak, and smooth should it be treated as stomach deficiency.

Hai Zang treated Master Yang, who frequently drank cold water and iced tea after heavy drunkenness. Later, he suffered from profuse bright red blood in stool. First, warm herbs like Wu Zhu Yu (Evodia Fruit) were used, followed by Wei Ling Tang (Stomach and Five-Ingredients Decoction). After bleeding stopped, white dysentery appeared, which ceased after four doses of warm purgatives. Someone asked, "Why not use Huang Lian to detoxify, but rather use warm agents?" The reply was, "Blood coagulated by cold seeps into the intestines and passes down; it flows only when warmed. Using cold-cooling herbs would lead to complicated syndromes difficult to treat."

Wang Shi Shan treated a woman who had dysentery for over half a year. Taking Si Wu Tang (Four Substances Decoction) and Xiang Lian Wan (Costus and Coptis Pill) worsened her condition, causing abdominal pain, tenesmus, cough, and irritability. Her pulse was fine, weak, and rapid. Bu Zhong Yi Qi Tang without Dang Gui (Angelica Sinensis Root), added with Fu Ling (Poria) and Shao Yao (Peony Root), was made into a powder and taken daily with rice water. She recovered after three doses.

Wu Jiao Shan treated a woman who contracted dysentery in midsummer with urgent pain and yellow-black discharge. Taking Xiang Ru (Mosla Herb), Zhi Ke (Aurantium Fructus), and Huang Lian worsened it. Her two Chi positions were tight and choppy, indicating cold injuring the blood. Inquiry revealed she drank a bowl of cold water during menstruation. Tao Ren Cheng Qi Tang (Peach Kernel and Major Order the Qi Decoction) added with Yan Hu Suo (Corydalis Rhizome) was given. The next morning, she passed about one sheng of black blood, and pain ceased. Then, spleen-regulating and blood-invigorating agents cured her. This was menstrual blood stasis transforming into dysentery, which must be carefully observed.

Li Shi Cai treated the wife of Supervisor Sun of the Land Reclamation Bureau. She had chronic dysentery, dry mouth, fever, and inability to eat. She continued taking Xiang Lian agents, resulting in undigested food in stool. She claimed "pathogenic heat fails to digest grain" and wanted to add Huang Qin (Scutellaria Root) and Huang Lian. After days of not eating, high fever became critical. Pulse was large and rapid but extremely faint upon deep pressure. Urination was clear, abdominal pain preferred pressure. This indicated fire deficiency failing to generate earth, true internal cold with false external heat. Clear urination confirmed absence of heat; preference for pressure confirmed deficiency-cold. Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) was urgently administered cool. Pain ceased after one dose. After twenty-plus doses and concurrent Ba Wei Wan (Eight-Ingredient Pill), she recovered.

Shi Wan treated the mother of Xiang Mingxian, a spring examination graduate. Bloody dysentery resembled amaranth juice. Taking dispersing, attacking, bitter-cold herbs like Huang Qin, Huang Lian, and Da Huang (Rhubarb Root) worsened it. Intermittent fever and stifling sensation occurred. Six pulses were fleeting and void-large, with the right Guan position showing a wiry image, yet hollow upon pressure. This indicated qi deficiency failing to control blood. Bu Zhong Yi Qi Tang added with Pao Jiang (Prepared Ginger) and Rou Gui cured her in four doses.

He also treated the wife of Guo Ranming, who suffered from five-color dysentery dozens of times day and night, accompanied by leukorrhea like a gush. Misusing Da Huang and Huang Lian for over ten doses caused blockage, mouth closure, and inability to eat for over half a month. Severe fever and thirst occurred nightly. Six pulses were wiry, fine, and rapid. This indicated deficiency of all three foot yin meridians. Li Zhong Tang added with Gui, Ling, Mu Xiang, and Wu Mei regulated the stomach. Subsequently, Jia Jian Ba Wei (Modified Eight-Ingredient) decoction guided out yin fire, leading to recovery.

Ministry of Justice Director Shen Xu'an, elderly with chronic dysentery resembling amaranth juice, took Huang Qin, Huang Lian, and Shao Yao for over twenty doses, gradually developing hiccups. His nephew Wang Qinzhong invited Shi Wan. Six pulses were wiry and fine as silk. Only urgent administration of pungent-warm vigorous tonification fit the condition. Li Zhong Tang added with Ding Xiang and Rou Gui was prescribed. Other physicians argued against using Jiang, Gui, and Ren Shen for bloody dysentery, hesitating to administer it.

Continuing with Huang Qin, Huang Lian, and Shao Yao, the condition worsened over five days until he suddenly craved porridge. Family and doctors rejoiced at his ability to eat, inviting Shi Wan again. The pulse felt like touching a knife edge, indicating middle qi exhaustion seeking rescue from food—Chu Zhong syndrome. People know dysentery patients eating is a sign of recovery, but few know of Chu Zhong. This case is recorded as a warning for future students.

Mother of Mr. Chu Mou, late autumn chronic dysentery, mouth closed unable to eat for over half a month. Drank only boiling water and watermelon rind juice, vomiting and bloating with bowel sounds afterward. Unceasing colic, irritability, thirst, confusion, worsening at night. Discharged pus and blood over a hundred times day and night. Urine completely blocked. Doctors gave up. Shi Wan was invited. Six pulses were wiry, fine, and powerless. Stool foam was pale, dark, and dull. Medications taken were Huang Qin, Huang Lian, Bing Lang (Areca Seed), Hou Po (Magnolia Bark). Shi Wan said, "All signs are adverse, but fortunately the chronic dysentery pulse is weak, suitable for warming and tonifying." Prescribed Li Zhong Tang added with Gui, Ling, and Zi Wan (Aster Root). Urine flowed after ingestion, sleep improved slightly. Porridge intake increased in three to four days, dysentery decreased. Further treatment with Li Zhong Tang doubled with Ren Shen, pills rolled in Fu Long Gan (Household Hearth Soil), led to recovery.

He also treated Chen Yingyong, a spring examination graduate from Tongchuan. Returning home after heat exposure, he developed river-fish belly disease (severe diarrhea/dysentery). For half a month, purgatives failed, leading to mouth closure and inability to eat. Living in the capital with coal heating caused a carbuncle on the shoulder/back, non-red, non-painful, sunken, accompanied by hiccups and coma, critically ill. Physicians shifted blame. Shi Wan was summoned. Six pulses were wiry, fine, nearly absent. Face showed Dai Yang (floating yang) color. Discharge was dark and muddy like rotten fish intestines. Although critical, the pulse lacked vigorous energy, breathing was not panting, body was not restless, so warming tonification was possible. If tonification induced the carbuncle to surface, safety could be ensured. Bao Yuan Tang (Protect the Origin Decoction) was prescribed: Ren Shen 3 qian, Sheng Huang Qi (Raw Astragalus Root) 2 qian, Gan Cao (Licorice Root) and Rou Gui 1 qian each, decocted in Fu Long Gan water. After one dose, thin porridge was accepted; after two, tenesmus lightened; after three, carbuncle rose. External surgeon applied dressings. Strict adherence to the formula for over ten doses brought stability. Not a single herb was changed throughout.

A woman on a soldier's ship had dysentery before pregnancy, continuing three days postpartum. Lochia did not flow, fever, wheezing, and distension occurred. Medically hopeless. A colleague wrongly promised cure, gave one dose, causing hiccups the next morning. Desperate, they disguised themselves as cargo traders and dragged Shi Wan to diagnose. Pulse was three beats with one intermission (Dai pulse). Shi Wan declared it untreatable. The colleague kept the previous doctor ashore, revealing his intent to shift responsibility. To save face in this emergency, Shi Wan said, "Though critical, there is a thread of life. We must plan carefully." The colleague released the previous doctor to seek medicine from Shi Wan. Shi Wan gave a cup and coins, instructing to boil sugar until charred, mix with plain water. This treats dysentery, moves blood stasis, and does not damage yuan qi. Taken urgently, the colleague left happily, the previous doctor fled, and returned days later to thank Shi Wan, saying, "Without the 'Golden Cicada Sheds Its Shell' stratagem, I would have been trapped by the mantis's arm."

Fei Chou treated the son of Zhu Yuanchen, suffering five-color dysentery for over twenty days, chest oppression, inability to eat porridge or drink, ineffective medication. Two other doctors were consulted: one prescribed Da Huang, the other Ren Shen. Zhu Yuanchen sought my advice. I said, "The Da Huang prescriber saw full/large pulse; the Ren Shen prescriber saw chronic dysentery with no intake. Chronic dysentery with no intake makes Da Huang absolutely unsuitable; chest fullness makes immediate Ren Shen difficult. I propose Fu Long Gan as the sovereign herb to warm the earth organ, decocted thickly as water substitute. Added are Jiao Bai Zhu, Fu Ling, Gan Cao, Guang Huo Xiang (Patchouli), Mu Xiang, and Chao Wu Mei. One dose reduced dysentery and increased appetite; two doses stopped it. Recovery followed with dietary regulation."