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Dysentery is caused by damp-heat and food stagnation. In treatment, the five colors—white, red, green, yellow, and black—are distinguished to correspond to the five Zang organs (Zang organs: Heart, Liver, Spleen, Lung, Kidney). White indicates damp-heat injuring the Qi level; red indicates damp-heat injuring the Blood level; a mixture of red and white indicates injury to both Qi and Blood; yellow indicates food stagnation. Treatment methods: Purge damp-heat from the intestines and stomach, resolve Qi stagnation, digest accumulations, and apply the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). Initially, purgation may be used; if not cured after purgation, adjust according to symptoms. For dysentery lasting a short while, purgation should not be used because the Stomach Qi is deficient. Dysentery is mostly heat-related, but there are also deficiency and cold patterns. Deficiency patterns require tonification; cold patterns require warming. Elderly and weak individuals should not undergo purgation.

Main Formula:
Huangqin (Scutellariae Radix, stir-fried), 5 fen; Huanglian (Coptidis Rhizoma, stir-fried), 5 fen; Baishao Yao (Paeoniae Radix Alba, stir-fried), 2 qian. (These three herbs are essential for treating dysentery.) Muxiang (Aucklandiae Radix); Zhike (Aurantii Fructus Immaturus, stir-fried), 5 fen; Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted), 3 fen; Binglang (Arecae Semen), 1 qian. Decoct these with ginger and water.
If abdominal pain occurs, add Danggui (Angelicae Sinensis Radix), 1.5 qian, and Suosha (Amomi Fructus Rotundus), 1 qian. Add further Muxiang and Shaoyao, each 5 fen.
My commentary: If the aforementioned condition is due to damp-heat stagnation causing tenesmus and difficult defecation, this formula is appropriate. If due to food stagnation, use Erchen Tang (Two-Cured Decoction) with Shanzha (Crataegi Fructus), administered with Xianglian Wan (Aucklandia and Coptis Pill). Mr. Zhang Zhongjing stated: A pulse that is deep and forceful indicates excess in the interior, requiring purgation; a pulse that is deep and weak indicates deficiency in the interior, requiring tonification. For those with deficient Yuan Qi and slippery stools, warming and astringing methods are suitable. A slippery and rapid pulse indicates retained food, requiring purgation. A floating and large pulse results from forcing purgation in a deficient state. A floating and wiry pulse accompanied by borborygmus requires warming. Hardness in the abdomen during dysentery requires purgation. Dysentery with delirium and dry feces requires purgation. If all three pulses are normal but pressure on the epigastrium reveals hardness, urgent purgation is needed. Dysentery with a large, floating, or wiry pulse may resolve spontaneously. Abdominal fullness and pain during dysentery indicate excess, requiring purgation. Practitioners must examine carefully!
For severe tenesmus, add Huashi (Talcum, stir-fried), 5 fen. Further add Zhike, Binglang, Shaoyao, and Tiaoqin (Scutellariae Radix), each 5 fen.
My commentary: Dysentery with pus and blood in the stool indicates that Qi moves while Blood stops. Promoting Blood circulation cures pus and blood; regulating Qi relieves tenesmus. If intestinal stagnation causes blockage and tenesmus, the method should be guiding out stagnation; if Qi deficiency and sinking cause tenesmus, the method should be lifting and tonifying.
Sima Wang Jingshan suffered from tenesmus after dysentery. After taking Zhike and Binglang, his tenesmus worsened, with reduced appetite and abdominal pain. I diagnosed it as Spleen and Stomach injury leading to deficiency-cold, and he recovered using Liujunzi Tang (Six-Gentlemen Decoction) with Muxiang and Paojing (Roasted Ginger).
Taichang Bian Huaquan experienced vomiting, anorexia, abdominal pain, and tenesmus. After taking Dahuang (Rhei Radix et Rhizoma), his abdominal pain worsened, accompanied by spontaneous sweating, fever, confusion, and a large pulse. I diagnosed this as further injury to Stomach Qi and sinking of deficient Yang-cold. He revived after one dose of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), each 1 liang, plus Zhigancao (Honey-fried Licorice) and Paojing, each 3 qian, and Shengma (Cimicifugae Rhizoma), 1 qian. He fully recovered after two doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Paojing.
For white dysentery, add Baizhu, Baifuling (Poria), Huashi (stir-fried), and Chenpi (Citri Reticulatae Pericarpium), each 1 qian. If initially intending to purge, add Dahuang, 5 qian. If combined with food stagnation, add Shanzha and Zhishi (Aurantii Fructus Immaturus), each 1 qian.
My commentary: If the aforementioned condition presents with abdominal pain and tenesmus, aversion to abdominal pressure, or a surging and solid pulse, it indicates blocked stagnation, and this formula should be used to unblock it. If abdominal pain and tenesmus are relieved by pressure, or the pulse is faint and fine, it indicates deficient Yang-cold, and Liujunzi Tang with Ganjiang (Dried Ginger) should be used for warming and tonifying.
Shaozonge Gu Dongjiang had food retention leading to dysentery, abdominal pain, and bearing down. After using draining and guiding agents, his legs swelled, he had reduced appetite, fatigue, irritability, thirst, a surging and rapid pulse, yet it was faint upon deep pressure. I used Liujunzi Tang with Ganjiang and Rougui (Cinnamon Twig), each 2 qian, Wuzhuyu (Evodiae Fructus) and Wuweizi (Schisandrae Fructus), each 1 qian. Taken cold after decoction, he slept immediately, symptoms subsided, and he recovered after two more doses. This is true internal cold with false external heat; treating with hot medicine served cold is called "freezing drink." Mr. Li Dongyuan treated false cold-heat symptoms with false cold-heat agents.
Tingping Qu Ruwei engaged in intercourse after eating, suffering from abdominal pain and diarrhea resembling dysentery. The next day, pus and blood appeared, with irritability, thirst, and mental fatigue. One dose of Sishen Wan (Four-Spirit Pill) reduced symptoms significantly. He fully recovered after two doses of Bawei Wan material added with Wuzhuyu, Wuweizi, Gubujie (Drynariae Rhizoma), and Roukou (Myristicae Semen).
For red dysentery, add Danggui, Chuanxiong (Ligustici Chuanxiong Rhizoma), and Taoren (Persicae Semen), each 1.5 qian. If initially intending to purge, add Dahuang, 5 qian.
My commentary: If the aforementioned condition has persisted for a long time or failed to improve after mistaken use of draining agents, the Spleen and Stomach should be regulated and tonified. Generally, chronic bleeding disorders often result from deficient Yang failing to generate Blood or failing to control Blood. Therefore, Mr. Zhu Danxi used Sijunzi Tang (Four-Gentlemen Decoction) to achieve success in such chronic cases.
Panguan Wang Tianxi suffered from dysentery with abdominal pain, tenesmus, thirst for cold drinks, and inability to eat. He took Shaoyao Tang (Peony Decoction) with 1 liang of Dahuang. After four doses, there was slight improvement. Continuing the same formula but halving the Dahuang, he recovered after several doses.
Tongfu Xue Yun suffered from bloody stool. After taking Xijiao Dihuang Tang (Rhinohorn and Rehmannia Decoction), bleeding increased, accompanied by fever, reduced appetite, and tenesmus. I diagnosed this as sinking of Clear Qi and used Buzhong Yiqi Tang with Paojing, recovering him after one dose.
For mixed red and white dysentery, add Chuanxiong, Danggui, and Taoren, each 1.5 qian to regulate Blood; add Huashi, Chenpi, and Cangzhu (Atractylodis Rhizoma), each 1.5 qian to regulate Qi. If food stagnation exists, add Shanzha and Zhishi to digest and guide.
My commentary: If the aforementioned condition is caused by Qi stagnation, food stagnation, or damp-heat, this formula is appropriate. If caused by Spleen deficiency and food stagnation, use Liujunzi Tang administered with Xianglian Wan for regulation and tonification. The Classics state: The Spleen governs Blood, and the Lung governs Qi. The aforementioned condition involves both Qi and Blood pathology. If caused by injury to Spleen and Lung Blood, use Siwu Tang (Four-Materials Decoction) with Baizhu and Fuling (Poria), taken with Xianglian Wan; if caused by injury to Spleen and Lung Qi, use Sijunzi Tang with Danggui and Chuanxiong, taken with Xianglian Wan.
For chronic white dysentery with weak Stomach and deficient Qi, or if not cured after purgation, remove Binglang and Zhike, reduce Huangqin, Huanglian, and Shaoyao by 7 fen each, add Baizhu, 1.5 qian, Huangqi (Astragali Radix), Chenpi, and Fuling, each 1 qian, and Suosha and Ganjiang (honey-roasted), each 5 fen.
My commentary: If the aforementioned condition presents with frequent trips to the toilet without passage, or small amounts of white pus, it indicates Earth failing to generate Metal, with injury to Lung and Large Intestine Qi causing sinking. Use Shengyang Yiwetang (Raise Yang and Benefit Stomach Decoction) to lift Yang Qi, so Yin naturally descends and bowel/bladder functions normalize. If unable to eat, with fever and thirst, the condition is critical; use Shiquan Dabu Tang (Perfect Ten Great Tonification Decoction). If ineffective, administer Ershen Wan (Two-Genius Pill).
For chronic red dysentery with weak Stomach and deficient Blood, or if not cured after purgation, reduce Huangqin and Huanglian by 5 fen each, add Danggui, Chuanxiong, Shudi (Rehmanniae Radix Preparata), Ejiao (Donkey-hide Gelatin), and Chenpi, each 1 qian, and Baizhu, 1.5 qian.
My commentary: If the aforementioned condition persists due to Heat in the Spleen channel pouring downward, use Siwu Tang with Baizhu and Fuling. If it persists due to Spleen Qi deficiency failing to control Blood, use Sijunzi Tang with Chuanxiong and Danggui. If it persists due to Middle Qi sinking failing to control Blood, use Buzhong Yiqi Tang.
For mixed red and black dysentery, indicating excessive Dampness, and scanty, dark, and painful urination, add Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), and Fuling, each 1 qian, and Zhiren (Gardeniae Semen, stir-fried), 5 fen, to separate and drain.
My commentary: For initial Dampness excess with dark and painful urination, use the previous herbs. For chronic illness with sinking Yang or in the elderly/weak, use Shengyang Chushi Fangfeng Tang (Raise Yang, Drain Dampness, and Saposhnikovia Decoction). If Spleen Earth is damaged and Cold Water insults it, first use Liujunzi Tang with Jiang and Gui to warm and tonify, then use Buzhong Yiqi Tang with Fuling and Banxia (Pinelliae Rhizoma) to lift and tonify.
For bloody dysentery, add Danggui, Chuanxiong, Shengdihuang (Rehmanniae Radix), Taoren, and Huaihua (Sophorae Flos, stir-fried), each 1 qian. If chronic and uncured, reduce Huangqin and Huanglian by 7 fen each, remove Binglang and Zhike, add Ejiaozhu (Prepared Donkey-hide Gelatin), Cebeiye (Platycladi Cacumen), and Baizhu, each 1.5 qian, and Ganjiang (black stir-fried) and Chenpi, each 1 qian.
My commentary: The aforementioned condition can also be caused by Spleen Qi deficiency, Spleen Qi sinking, Liver Qi deficiency, or Liver Blood deficiency with heat.
Cibu Li Yisan suffered from bloody dysentery with chest and abdominal distension, difficulty defecating, and extreme limb fatigue. I diagnosed Spleen Qi deficiency failing to control Blood and return it to its source, treating him with Buzhong Yiqi Tang plus Fuling and Banxia, leading to gradual recovery. Later, anger triggered recurrence; the left Guan pulse was wiry and floating, weak upon pressure, indicating Liver Qi deficiency failing to store Blood. He recovered after treatment with Liuwei Wan (Six-Ingredient Pill with Cornus and Eucommia).
For chronic dysentery with persistent tenesmus, indicating Large Intestine prolapse, remove Binglang and Zhike, use Tiaoqin, and add Shengma, 1 qian, to lift.
My commentary: The aforementioned condition can also be caused by Large Intestine Qi stagnation, Large Intestine Qi sinking, Large Intestine Blood deficiency, or Spleen-Kidney deficiency-cold. For Large Intestine Qi stagnation with prolapse, use Sijunzi Tang with Xianglian Wan. For Large Intestine Qi sinking, use Sijunzi Tang with Chaihu (Bupleuri Radix) and Shengma with Xianglian Wan. For Large Intestine Blood deficiency with tenesmus, use Siwu Tang with Renshen and Baizhu with Xianglian Wan. Mr. Li Dongyuan stated: Tenesmus refers to abdominal discomfort. There are cases of empty straining without defecation, all due to Blood deficiency; Blood deficiency causes tenesmus.
For vomiting and inability to eat, add Ruangua (likely referring to Gua Lou or similar, here interpreted as Soft Gypsum based on context "Ruanshigao"), 1.5 qian, Chenpi, 1 qian, Zhiren (stir-fried), 5 fen, and Shengjiang (Fresh Ginger), 6 fen. Sip slowly to clear heat in the Stomach opening.
My commentary: If the aforementioned condition is due to existing excess heat in Spleen and Stomach or sudden onset from overeating rich/spicy foods, use this formula. If due to Stomach Qi deficiency and rebellious Diaphragm Qi causing vomiting, use Liujunzi Tang with Shengjiang. If due to Stomach Qi deficiency-cold, use the previous formula plus Paojing and Muxiang.
For a pattern of Qi and Blood deficiency with dysentery, use Siwu Tang with Renshen, Baizhu, Chenpi, Huangqin, and Huanglian.
My commentary: If Spleen Qi is deficient and Blood is weak, use Sijunzi Tang. If Stomach Qi is deficient and Blood is weak, use Buzhong Yiqi Tang. If chronic illness leads to dual Qi and Blood deficiency, use Bazhen Tang (Eight-Treasures Decoction). Generally, if this condition persists or manifests various complications, adhering to the previous methods will lead to self-healing over time.
For a pattern of cold dysentery, use Huanglian, Muxiang, Shaoyao (wine-stir-fried), Danggui, Ganjiang (stir-fried), Suosha, Houpo (Magnoliae Officinalis Cortex), and Rougui.
My commentary: Mr. Li Dongyuan stated: For the aforementioned condition, if the pulse is deep and fine, body movement is restricted, eyes are unclear, food cannot be swallowed, and breath is detected at the nose tip, use Jiangfu Tang (Ginger and Aconite Decoction). If the body is heavy and limbs cannot move, use Zhufu Tang (Atractylodes and Aconite Decoction). If sudden diarrhea is silent, body is cold with spontaneous sweating, urination is free, defecation is uncontrollable, breathing is difficult, pulse is faint, and vomiting occurs, use Jiangshui San (River Water Powder).
My late grandmother, aged eighty, suffered from dysentery in mid-summer with abdominal pain, vomiting, anorexia, thirst for warm liquids, and abdominal pain relieved by pressure. Her pulse was forceful and strong. I diagnosed true Qi deficiency with pathogenic excess, prescribing Renshen, 5 qian, Baizhu and Fuling, each 3 qian, Chenpi, Shengma, Fuzi (Aconiti Lateralis Radix Preparata), and Zhigancao, each 1 qian. After taking it, she slept, requested food, and her pulse and symptoms subsided. She recovered after two more doses.
Hengjin Chen Zifu had a reddish face, expectorated phlegm, dry mouth, and occasional diarrhea. After taking Erchen Tang, Huanglian, and Zhishi, there was no response. His pulse was wiry and rapid at the left Guan, and wiry and large at the right Guan. This indicated Kidney Water borrowing the momentum of Liver Wood to overcome Spleen Earth. He did not believe this, and indeed died of dysentery when summer arrived.
If dysentery is contracted and mistakenly treated with warm-hot astringent drugs, even if prolonged, the previous method of purgation should be used, followed by regulation.
If purgation using the previous method fails, and subsequent regulatory treatment fails over a long period, this belongs to deficiency-cold with slipping and loss of control. Choose from the previous deficiency-cold and warming sections, adding Longgu (Fossilia Ossis Mastodi), Shizhi (Halloysitum Rubrum), Yingkesuo (Papaveris Pericarpium), and Wumei Rou (Mume Semen) and other astringent drugs.
My commentary: If Spleen Qi deficiency-cold with sinking occurs, use Buzhong Yiqi Tang plus Yingkesuo, Jiang, and Gui. If ineffective, urgently use Fuzi. If Qi and Blood are weak, use Shiquan Dabu Tang plus Fuzi and Yingkesuo. If Mingmen Fire declines, use Bawei Wan to tonify the Mother of Earth. If abdominal pain, thirst for warm drinks, and relief of pain by pressure occur, all indicate warming and tonifying the Spleen and Stomach.