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Background Information:
Book: Jingyue Quanshu (Complete Works of Zhang Jingyue)
Author: Zhang Jiebin (Zhang Jingyue)
Dynasty: Ming Dynasty
Chapter: Colloquial Words / Discussion on Deficiency and Excess in Diarrhea and Dysentery (3 items) / Discussion on Cold and Heat in Diarrhea and Dysentery
Category: Comprehensive

[Original Text]
Summer days are often hot, allowing Yin pathogens to easily enter. Summer-heat and dryness are the primary factors, while wind and cold are secondary guests. If the body is not exposed to wind, how can malaria arise? If the mouth and throat are not exposed to cold, how can dysentery be contracted? Treatment must seek the root cause; this is the golden standard left by Xuanyuan (Yellow Emperor) and Qibo. Memorize these subtle words, for they can serve as medical principles.

Translation:
In summer, the weather is frequently hot, making it easy for Yin-type pathogens (such as cold or dampness) to invade the body. Summer-heat is the predominant pathogenic factor, whereas wind and cold are secondary or concurrent factors. If the body does not suffer exposure to wind pathogens, how would malaria (a disease characterized by alternating chills and fever) occur? If the mouth and digestive tract do not suffer exposure to cold pathogens, how would dysentery (a disease characterized by abdominal pain, tenesmus, and passage of pus and blood) be acquired? Medical treatment must always seek the fundamental cause; this wisdom was established by Xuanyuan (the Yellow Emperor) and Qibo (a legendary physician). Commit these profound teachings to memory, as they can serve as guiding principles for medical practice.

Whenever treating dysentery, one must carefully distinguish between deficiency and excess, and differentiate between cold and heat. This is of paramount importance in the treatment of diarrhea and dysentery. If these four aspects are not clearly understood, causing death becomes very easy.

Translation:
When treating dysentery, it is most crucial to examine whether the condition is a Deficiency syndrome (Xu Zheng) or an Excess syndrome (Shi Zheng), and to differentiate between Cold syndromes (Han Zheng) and Heat syndromes (Re Zheng). This distinction is the most critical aspect in managing diarrhea and dysentery. If these four categories are not clearly identified, the risk of fatal outcomes increases significantly.

First, regarding the differentiation of Excess syndromes: The patient must have a strong physique and robust vital energy, with a slippery and solid pulse. Alternatively, the patient may have a history of dietary indulgence, frequent abdominal distension with hard and painful sensations, or be a young person suffering from a recent onset of illness where the Spleen Qi has not yet been damaged. Only in such cases can methods targeting the branch symptoms (treatment of acute manifestations) be employed. For mild cases, use methods to promote circulation and unblock stagnation; for severe cases, use purgative methods to drain excess.

Translation:
First, the differentiation of Excess syndromes requires that the patient possesses a strong physical constitution and robust Qi, accompanied by a slippery and forceful pulse. Alternatively, the patient may have a history of dietary excess, frequent abdominal fullness with hard and painful distension, or be a young individual with a recent onset of disease where Spleen Qi remains undamaged. Only under these conditions should branch-treatment methods (therapies aimed at relieving acute symptoms) be applied. In mild cases, use methods to promote movement and resolve stagnation; in severe cases, use purgative methods to evacuate excess.

Second, regarding the differentiation of Deficiency syndromes: There are those with a frail physique, those with pale and clear complexion, those whose pulses are tight and rapid but weak and lacking spirit, those whose pulses appear truly wiry but indicate central deficiency mimicking excess, those with innate Yang deficiency, those who habitually eat bland food, those who accidentally consumed raw or cold foods, those who were accidentally exposed to rain and yin-cold, those who accidentally suffered from irregular diet, and those who are elderly with weak Spleens. Among all these conditions, if a person who usually does not indulge suddenly suffers from diarrhea or dysentery, it is certainly due to eating melons, fruits, or slightly cool foods, which accidentally injured Stomach Qi. Where is the accumulation? Where is the heat? Generally, only those with weak Spleens frequently present with such syndromes. Therefore, treatment for these cases should only involve warming and regulating the Spleen and Kidney. Once the Spleen is warmed, the cold will dissipate, which is essentially expelling the pathogen. Since the pathogen is minimal, using warming and tonifying methods to strengthen the Spleen causes no harm. After just a few doses, recovery should naturally occur. One must absolutely not recklessly claim that tonification will trap the pathogen, thereby using drugs to attack accumulation, resolve stagnation, or clear fire first. If Spleen Qi is injured again, mild cases will become severe, and severe cases will become critical.

Translation:
Second, the differentiation of Deficiency syndromes includes patients with a thin and weak physique, those with a pale complexion, those with pulses that are tight and rapid yet weak and devoid of spirit, those with wiry pulses indicating central deficiency that mimics excess, those with congenital Yang deficiency, those accustomed to a bland diet, those who accidentally ingested raw or cold foods, those accidentally exposed to rainy and yin-cold environments, those affected by dietary irregularities, and the elderly with weak Spleens. In all these scenarios, if a person who typically does not overindulge suddenly develops diarrhea or dysentery, it is invariably due to the accidental consumption of melons, fruits, or slightly cool foods, which inadvertently injured Stomach Qi. What accumulation exists? What heat exists? Essentially, individuals with weak Spleens are prone to such conditions. Therefore, treatment should focus solely on warming and regulating the Spleen and Kidney. By warming the Spleen, cold is eliminated, which constitutes the expulsion of pathogens. Given that the pathogenic factor is minimal, employing warming and tonifying strategies to strengthen the Spleen poses no obstruction. Recovery will naturally occur after merely a few doses. One must strictly avoid the erroneous notion that tonification traps pathogens, leading to the premature use of purgatives for accumulation, agents for resolving stagnation, or herbs for clearing fire. Should this further injure Spleen Qi, mild conditions will worsen, and severe conditions will become life-threatening.

Regarding the differentiation of cold and heat in diarrhea and dysentery: If it is indeed a Heat syndrome, the patient will fear heat and prefer cold, dislike clothing and bedding, experience severe thirst and desire to drink water (with no harm even if drinking large amounts), have hot, astringent, and painful urination, or pass pure bright red blood in stool. The pulse will be slippery, solid, and forceful, and the physical state and Qi will be restless, irritable, and烦 (agitated). If the Heat syndrome is confirmed, one should boldly employ cooling and resolving methods, or combine them with diaphoretic/diuretic methods to separate and drain. As long as the pathogen is removed, the disease will heal itself. If these signs of excess heat are absent, yet diarrhea and dysentery persist, it must be a Deficiency-Cold syndrome. Without warming and tonifying the Spleen and Kidney, it cannot be cured. Even if some recover, it is only because their Yuan Qi (Primary Qi) has roots and recovers spontaneously. Do not claim that Deficiency-Cold syndromes can heal without warming and tonification, nor argue that treating dysentery necessarily requires cold-natured herbs and that cold herbs are harmless. Such views demonstrate a lack of true understanding.

Translation:
Concerning the differentiation of Cold and Heat in diarrhea and dysentery: If the condition is genuinely a Heat syndrome, the patient will inevitably fear heat and prefer cold, refuse to wear clothes or cover themselves with blankets, suffer from intense thirst and desire to drink copious amounts of water without adverse effects, experience burning, astringent, and painful urination, or pass pure, bright red blood in the stool. The pulse will be slippery, solid, and forceful, and the physical demeanor and Qi will be restless, agitated, and irritable. If the Heat syndrome is confirmed, one should confidently apply cooling and resolving therapies, possibly combined with methods to separate turbidity and promote urination. Provided the pathogen is expelled, the disease will resolve spontaneously. If these signs of excess heat are absent, yet diarrhea and dysentery continue, the condition must be Deficiency-Cold. Unless treated with warming and tonifying methods targeting the Spleen and Kidney, recovery is impossible. Any apparent recovery in such cases occurs only because the patient's Primary Qi (Yuan Qi) remains rooted and regenerates naturally. Do not assert that Deficiency-Cold syndromes can heal without warming and tonification, nor contend that dysentery treatment necessitates cold-natured herbs and that such herbs are harmless. These perspectives reflect an incomplete understanding of the pathology.