Library

Dysentery presents with foul, sticky, and glue-like discharge resembling pus and blood. There is a dull pain in the lower abdomen. The sensation of urgency to defecate but inability to do so, accompanied by tenesmus (里急后重), characterizes this condition. Old theories tend to bias towards cold or heat patterns; treatments either advocate tonification or purgation. None of these should be rigidly adhered to. The few death cases listed are often due to improper treatment by contemporary physicians leading to prolonged illness and death, or due to abandoning treatment based on previous doctors' opinions, resulting in passive observation of death. I have witnessed this with heartache, anxious day and night. Drawing from the implicit meanings in the *Neijing* (Classic of Internal Medicine) and Zhang Zhongjing's works, as well as scattered insights under various sections, I carefully examined them and combined them with my clinical cases, gaining profound understanding. Medications led to recovery, with evident and recordable efficacy. I will first discuss methods for saving critical conditions, followed by standard methods.

One medical text states: A deep and small pulse indicates an easy-to-treat case; a floating and large pulse indicates a difficult-to-treat case. It also states: Unremitting fever leads to death. This follows the *Changpi Lun* (Treatise on Intestinal Abscess) in the *Neijing*, representing the error of sticking to one aspect without flexibility. I have different insights. A floating pulse indicates exterior pathogenic factors. If floating and large, it suggests exterior pathogens invading the Yangming channel boundary causing diarrhea. Zhang Zhongjing provided treatments such as Gegen Tang (Pueraria Decoction). Unremitting fever, if not due to wind-cold common cold, implies disharmony of the channels and collaterals. One should use Guizhi Tang (Cinnamon Twig Decoction) or Danggui Sini Tang (Angelica Sinensis Cold-Nourishing Decoction) to dispel wind-cold and harmonize the channels. Renshen Baidu San (Ginseng Detoxifying Powder) added with roasted rice, named Canglin Tang (Granary Decoction), shares this principle. However, the medicinal force is light and cannot produce rapid effects. Generally, for early-stage disease: if there is fever and aversion to cold, Xiangsu Yin (Fragrant Perilla Infusion) added with Fangfeng (Saposhnikovia Root) and Chuanxiong (Ligusticum Rhizome) can induce mild sweating for cure. For severe cases, Guizhi Tang or Danggui Sini Tang should be used. If there are alternating chills and fever with frequent vomiting, Xiaochaihu Tang (Minor Bupleurum Decoction) must be used. If heat predominates with thirst, Xiaochaihu Tang with Banxia (Pinellia Tuber) removed and Gualougen (Trichosanthes Root) added is indicated. If there is fever without aversion to cold and with tenesmus, Gegen Huangqin Huanglian Gancao Tang (Pueraria, Scutellaria, Coptis, and Licorice Decoction) should be used. Following ancient methods, Gegen is decocted first, followed by other herbs. Taking two to three doses daily ensures recovery. Using formulas from the dysentery section, such as Shaoyao Tang (Peony Decoction), often causes pathogens to sink inward, becoming critical. I deeply regret Ni's Three Formulas for Dysentery, which serve as primary tools for killing patients.

One medical text states: Unremitting abdominal pain leads to death. Its treatment method merely uses Muxiang (Aucklandia Root), Binglang (Areca Seed), Sharen (Amomum Fruit), and other digestive and qi-moving agents. How can this save dying patients? If there is genuine thirst, a hot sensation in the mouth, chest and abdominal distension that is firm and resists pressure, it is a excess pattern. Among the three Chengqi Decoctions (Chengqi Formulas), one may choose appropriately, or substitute with Sanyi Chengqi Tang (Three-One Chengqi Decoction). If there is no thirst, a neutral mouth feel, a slow, small, and weak pulse, or cold extremities, with abdominal pain that prefers pressure, it is a deficiency-cold pattern. Sizni Tang (Four Reversal Decoction) is indispensable. If abdominal pain is accompanied by heavy and sluggish dysentery, add 3 qian of raw Baishao (White Peony Root). If abdominal pain persists, with vexation and preference for pressure, and a wiry pulse, it indicates Liver pathogen attacking Spleen Earth. Xiaojianzhong Tang (Minor Construct the Middle Decoction) is suitable. After about one hour of administration, follow with Xiaochaihu Tang with Huangqin (Scutellaria Root) removed and Baishao added. The effect is miraculous.

One medical text states: Pure blood in dysentery leads to death. Dysentery resembling roof leak water leads to death. Its treatment merely uses Ejiao (Donkey-hide Gelatin), Diyü (Sanguisorba Root), Huaihua (Sophora Flower), Cangzhu (Atractylodes Rhizome), etc. How can this save dying patients? If there is rushing bright red blood, thirst, short urine, tenesmus, and a full pulse, it is a fire pattern. Baitouweng Tang (Pulsatilla Decoction) is indicated, taken twice daily. For deficient individuals and postpartum women, add Ejiao and Gancao (Licorice Root). There are also cases of bright red blood not due to fire. If the blood is dark and clotted, heat patterns are rare, while cold patterns are common. These must be carefully distinguished by pulse and symptoms. If the mouth feels neutral, the pulse is fine, urination is long, and extremities are cold, it is undoubtedly a deficiency-cold pattern. Lizhong Tang (Regulate the Middle Decoction) added with 8 qian of Zaoxintu (Stove Heart Soil) is indicated. For excessive bleeding, intersperse with Huangtu Tang (Yellow Earth Decoction), taken twice daily. Recovery occurs gradually over three days. Since the spleen and stomach are like a furnace for refining metals, Lizhong Tang separates clear from turbid, treating the root cause. "Roof leak water" refers to dark, stagnant, non-viscous blood-water mixture, belonging to deficiency-cold, caused by misuse of cold-cooling and breaking-purgative drugs. If throat pain and disordered speech appear, death occurs within half a day. Lizhong Tang is also used to rescue such cases.

One medical text states: Ability to eat indicates mildness; inability to eat indicates severity; complete loss of appetite leads to death. Vomiting leads to death. Inability to eat may be due to food stagnation, requiring Pingwei San (Peace the Stomach Powder) added with digestive herbs. If spleen and stomach are weak, Xiangsha Liujunzi Tang (Fragrant Amomum Six Gentlemen Decoction) and Lizhong Tang should be used to strengthen the spleen and transform stomach qi. There are subtle distinctions. Is this not Jin Kou Li (Jammed Mouth Dysentery)? Danxi used Renshen (Ginseng Root), Shilian Rou (Lotus Seed Embryo), and Huanglian (Coptis Rhizome) decocted, adding fresh ginger juice, administered slowly by sipping. He only recognized it as damp-heat rushing upward, hence ineffective. One should refer to the aforementioned methods. If food is vomited immediately upon ingestion, making Xiangsha Ju Ban unsuitable, Ganjiang Huanglian Huangqin Tang (Dried Ginger, Coptis, and Scutellaria Decoction) should be used, employing bitter and acrid flavors to open obstruction. If there is chest fullness with vomiting, or dry heaving with salivary regurgitation, Wuzhuyu Tang (Evodia Decoction) is indicated to warm and calm, harmonizing wood and earth. The effect is divine. ○ For epigastric fullness and stuffiness, choose among Zhongjing's Three Xiexin Decoctions (Drain Epigastrium Decoctions) or Nongpu Shengjiang Gancao Banxia Renshen Tang (Atractylodes Macrocephala, Ginger, Licorice, Pinellia, and Ginseng Decoction) as appropriate. The effect is divine.

One medical text states: Dysentery occurring immediately after childbirth in women leads to death. I follow the example in *Jinkui Yaolue* of adding Gancao and Ejiao to Baitouweng Tang. It shows that postpartum cases should be treated according to the disease without hesitation. It also states: Dysentery occurring immediately after smallpox in children leads to death. I believe this is not entirely true. Generally, death after childbirth results from excessive warming, while death after smallpox results from excessive cooling. Treatment should be based on the disease, not bound by a single theory.