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In the intercalary ninth month of the Jia Chen year, the weather was alternately cold and hot without regularity, and many people suffered from dysentery. My fourth brother, Yongmu, aged twenty-seven, suddenly developed dysentery with red discharge, abdominal pain, and tenesmus, which had persisted for three days. He came to seek medicine, and I prescribed one dose of Shaoyao Tang (Peony Decoction) and two doses of Xianglian Wan (Aromatic Coptis Pill). The dysentery did not cease; instead, he developed a sensation of knife-like pain in the epigastrium, severe pain around the umbilicus, and intense anal pain, his cries shaking the neighbors. Believing he would surely die, he bid farewell to his mother and prepared to leave for the countryside. I went to visit him there. He could not sleep day or night, the frequency of defecation was irregular, and he passed a bucketful of red blood daily. The pain was unbearable, accompanied by fever, sweating, and anorexia. Palpation revealed that all six pulse positions were large and empty (Huo), lacking strength in floating, middle, and deep pressures, with four beats per respiration (slow pulse). I said: "Although there is pain and fever, the pulse lacks strength, indicating deficiency-cold. As the ancients stated: 'For hemorrhage, tonify Qi.' This condition is precisely suitable for this approach." Thus, I used Yigong San (Extraordinary Power Powder) augmented with Shengma (Cimicifugae Rhizoma) 3 fen, Muxiang (Aucklandiae Radix) 5 fen, and Chao Ganjiang (Stir-fried Zingiberis Rhizoma) 5 fen. After one dose, bowel movements became slightly looser, and the pain became bearable. By the fifth watch (early morning), the abdominal pain returned as before. I said: "The efficacy of this medicine has worn off." I urgently decocted another dose for him. Compared to the previous one, it worked even better, reducing the pain by seven or eight parts. He then fell into a sound sleep until noon, waking up to say he felt somewhat uncomfortable. I said again: "This medicine can only sustain one sleep. Decoct another dose." He slept peacefully until evening, the pain ceased, and tenesmus improved. He continued taking the previous prescription and recovered.

A day or two later, due to eating chicken meat, the abdominal pain and anal swelling recurred, with continuous discharge of foul matter. On the third day, the condition became extremely critical, and I was summoned again. The pulse beat slightly more than three times per respiration, palpable on the surface but not at depth, becoming large when pressed. The Spleen and Mingmen pulses were faint. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was ineffective. This indicated severe collapse of deficiency. Yu Mi Ke (Papaveris Pericarpium) 1 qian was added, but still no effect. The discharge resembled hole-leak diarrhea, accompanied by sweating and restlessness. The Chi (cunimal) pulse gradually tended to contract. I was also panicked and anxious, sending someone to fetch Ginseng from the city after the second watch. Returning early in the morning, I added Ren Shen (Ginseng Radix et Rhizoma) 2 qian to Bu Zhong Yi Qi Tang. Upon swallowing, he often experienced mental confusion (Ren Shen can cause confusion, especially in cases of internal damp-heat accumulation, as verified through repeated trials). This signified that righteous Qi was about to recover and pathogenic factors were retreating. Shortly after, his spirit markedly improved, and the dysentery slowed slightly. Fearing recurrence, another dose was given. The symptoms of profuse discharge, confusion, fever, and restlessness gradually subsided, the pulse gained spirit, and the short pulse disappeared. Reflecting deeply, I recalled the ancients' saying: "For chronic diarrhea and dysentery, pills and powders are superior to decoctions." Therefore, I compounded Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for him to take. He felt loose stools, but by afternoon, restlessness and heat returned. I palpated the pulse again; the left Chi position was surging like fire shooting, indicating Yin deficiency with hyperactive fire. I administered Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) 60 pills, after which he felt refreshed. Subsequently, he took 80-90 more pills, slept until dawn, and the illness resolved by seventy percent. Only then did I believe in Master Lizhai's use of Jia Jian Ba Wei Wan to treat conditions of dried-up water (Yin fluid exhaustion). I instructed him to take these pills morning and evening, combined with Shen Ling Bai Zhu San, leading to gradual recovery. He complained of painful urination, likely due to sexual activity. Xiao Yao San (Free and Easy Wanderer Powder), Mai Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Fructus) were administered to calm the condition. (Note: This patient engaged in sexual activity yet survived, implying his constitution was solid and the pathogen was not deep-seated. The previously described symptoms seemed inconsistent. Careful examination of the contracting Chi pulse suggests phlegm generated after blood loss, lurking in the lower jiao; the surging Chi pulse suggests sudden restoration of lower Yang clashing with phlegm.)

Wang Chuanyuan's two sons, only seven years old, had suffered from bloody dysentery for a long time. They had taken excessive amounts of digestive and accumulative-resolving agents, which later transformed into white discharge resembling mucus, with no feces. Diagnosing the symptoms, warming and tonifying the Spleen and Stomach to generate Lung Metal was appropriate. Bu Zhong Yi Qi Tang was used with Pao Jiang (Prepared Zingiberis Rhizoma) and Guan Gui (Cinnamomi Cortex) each 2 fen. Ren Shen (Ginseng Radix et Rhizoma) was limited to 3 fen, and the material was stale and inferior. After four doses, his hands and feet became slightly soft, and his speech strengthened, though his body remained cold. The white discharge did not decrease. This was also a critical condition of deficiency-cold with slipping and unconsolidation, requiring tonification, astringency, and warming. The previous prescription was reused with high-quality Ren Shen 5 fen, Da Fu Zi (Aconiti Lateralis Radix Praeparata) 2.5 fen, and Yu Mi Ke 1 fen. After one dose, his feet warmed, feces appeared in the stool, and the white discharge reduced by eighty percent. From then on, his hands and feet were warm and soft, and diarrhea stopped completely. He continued the previous formula, removing Yu Mi Ke and Fu Zi. Upon my return, I instructed that if the body temperature normalized, Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Cortex) should also be removed, followed by Shen Ling Bai Zhu San to cultivate central Qi, preventing the Wood Qi of Jueyin in the coming Yisi year from overacting, and advising strict dietary caution.

My friend Xue Lihuan's servant, having traveled far while enduring hunger, and subsequently beaten to the point of exhaustion, developed fever and delirious speech in early May. Bu Zhong Yi Qi Tang and Wu Ling San (Five-Ingredient Poria Decoction) failed after several doses. I was called to diagnose him. All six pulses were absent; occasionally appearing, they were very fine. External symptoms included a red face, delirious speech, and oral ulcers. A friend remarked: "Yang syndrome presenting with Yin pulse indicates a fatal case." I said: "We must treat based on the pulse, disregarding the symptoms, considering Yang deficiency." Thus, I prescribed Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle) to be taken cold. After two doses, the pulse slightly appeared; after four doses, the pulse gained spirit, and oral ulcers healed; after six doses, the pulse was normal, but delirious speech persisted. I said: "The pulse energy has fully recovered, but persistent delirium indicates dry feces in the Stomach. It is appropriate to use a gallbladder suppository method." Indeed, dry feces were discharged, and the delirium subsided. (Note: If the stool were slippery and easy to pass, it would indicate blood stasis. Ma Jianyuan had weak spirit inherently, suffered severe fatigue, and ate a piece of cold meat while hungry, leading to discomfort, fever, delirium, and madness. This is a case of injury from diet and overexertion. Phlegm expectorated in rural areas stems from internal injury to the lung and stomach fascia, mostly caused by diet and overexertion. One should strengthen the fascia to restore its power. Phlegm originates from the fascia; if injured and trapped by dampness, phlegm is abundant; if injured and agitated by fire, phlegm gushes violently. To eliminate the root of phlegm, one must nourish blood and strengthen the fascia. When the fascia is strong, fluids will not leak externally.) Profuse downward discharge leads to Yin depletion, due to severe deficiency of Central Qi. Upon my diagnosis, all six pulses had four beats per respiration, surging and slow but lacking strength. [Missing text] By midnight, vomiting of phlegm worsened. Rising for a re-diagnosis, all six pulses were fine. This indicated that pathogenic factors had departed, true Yin was returning, and Yang deficiency manifested as restlessness. Urgently, Liu Jun Tang (Six-Gentleman Decoction) with Jiang and Gui each 3 fen was administered. He fell asleep immediately and woke up at noon the next day. Another dose made him sleepy and unwilling to wake, with apparent lethargy, indicating complete departure of pathogens and recovery of righteous Qi. In the afternoon, he drank a bowl of rice soup, recognized the taste of grain, and Bu Zhong Yi Qi Tang was used again with Gan Jiang (Zingiberis Rhizoma), Gui (Cinnamomi Cortex), and Men Dong (Asparagi Radix)...