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(Commentary on the manuscript by disciple Wu Yuchun)

The clinical manifestations of dysentery are diverse. There are cases presenting only with red blood, only with white mucus, or with both red and white mixed together; however, they all involve abdominal pain and tenesmus (里急后重). The initial pathogenesis must stem from cold pathogens. During the intense heat of summer, due to indulgence in cooling off or consuming raw and cold foods, cold qi enters the intestines and stomach. When autumn arrives and the body's yang qi moves inward, it contends with the cold pathogens, resulting in abdominal pain and tenesmus; this is a disease of the qi level. It is a common principle that a disease of the qi level leads to a disease of the blood level. Cold pathogens tend to damage qi, while heat pathogens tend to damage blood. If both qi and blood are damaged, and cold and heat are intermixed, red and white discharges will alternate. This is a compromise theory, yet also an ambiguous one. Liu Hejian exclusively emphasized damp-heat as the cause, while Zhu Danxi attributed the governance of qi and blood to the large and small intestines, respectively. However, dampness and heat are paired concepts; one cannot discuss heat while ignoring dampness. Furthermore, when healthy individuals are affected by external seasonal factors, stagnant heat is predominant; when weak individuals are affected by internal or behavioral factors, yin-cold is severe. Zhang Shiwang stated that if the blood color is bright purple, it indeed belongs to heat. If the color is dull, thin, and pale, resembling fish brains, purple grass juice, or agate, it indicates yang deficiency failing to control yin. Additionally, there are numerous ways to distinguish between pulse and symptom patterns, which cannot be enumerated here. The reason for this repeated and detailed discussion is that contemporary practitioners often categorize dysentery under heat and use harsh bitter-cold herbs indiscriminately. Subsequently, it is stated: unless the qi is warmed and regulated, the blood cannot be cleared. Regulating qi is like refining gold from ore in a furnace, which is the most expedient method. Understanding that qi is yang and blood is yin, yang can command yin, but yin cannot substitute for yang; qi can command blood, but blood cannot envelop qi. Therefore, at the onset of dysentery, when white discharge exceeds red, regulation of qi should be the primary focus. Misusing blood-regulating herbs will inevitably draw pathogens into the blood level. Later, when red discharge exceeds white, although activating and nourishing blood is appropriate, regulating qi should still be concurrent to harmonize the blood. Furthermore, for various types of dysentery such as Jin Kou Dysentery (噤口痢, dysentery with inability to eat) and Five-Color Dysentery (五色痢), as well as dysentery during pregnancy in women, the method of regulating qi should be employed to manage the treatment strategy flexibly. Only in cases where the individual is genuinely robust and affected by external seasonal factors, causing heat toxins to directly enter the Ying (Nutrient) level, with the intestines and stomach feeling like burning, does Yu Jiayan's formula of Da Huang, Huang Lian, and Gan Cao apply. This uses bitter-cold herbs to directly clear yin heat. Fragrant aromatic herbs should not be used again, as they would stir up the fire. If students can clearly and meticulously distinguish the relative importance of qi and blood, and the true versus false nature of cold and heat, they will not only be able to treat dysentery but also apply these principles universally to the treatment of other diseases.