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In the treatment of Shanghan (Cold Damage Syndrome), if vomiting of Ascaris (roundworms) is observed, even if there is severe internal heat, cold-natured medicines must be avoided; misuse will inevitably lead to death. This is because cold exists in the Stomach, and Yang Qi is extremely weak, causing Ascaris to rebel and move upward, which is an ominous sign of great danger. Immediately administer Paojiang Lizhong Tang (Baked Ginger Decoction for Regulating the Middle) one dose, adding two Wumei (Mume Fruit) and ten to twenty Huajiao (Sichuan Pepper grains). After administration, wait for the Ascaris to settle, then gradually treat the remaining symptoms with formulas such as Xiaochaihu Tang (Minor Bupleurum Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). This is because Ascaris becomes quiet when encountering sour flavors and settles when encountering bitter flavors. Zhang Zhongjing stated: "If a patient with cold syndrome undergoes repeated sweating, leading to coldness in the Stomach, vomiting of Ascaris is inevitable." The syndrome of Ascaris Jue (Ascaris Reversal) is described in Section 39 above.

Tao Jian'an stated: There are four types of abdominal pain caused by Shanghan. If there is hard and painful sensation around the umbilicus, solid stool, irritability, and thirst, these all belong to pain caused by dry feces (Zaoshi); immediately use cold purgatives to evacuate them. Pain caused by food stagnation is treated similarly.
First, if there is hard and painful sensation in the lower abdomen, free urination, black stool, and yellowing of the body and eyes, this belongs to pain caused by blood stasis (Xuxue); also use cold agents combined with blood-invigorating medicines. Evacuating the black material will result in spontaneous recovery.
Second, in cases of severe abdominal pain due to Shanghan, give the patient a cup of cool water to test. If the pain alleviates slightly after drinking, it belongs to heat pain, and cold medicines should be used to clear the heat. The above three points all refer to excess-heat pain. The pulse must be deep, firm, and forceful to confirm this syndrome; if the pulse is weak, careful examination is required, and treatment should be gradual.
Third, if drinking water exacerbates the pain, this is cold pain, and warm medicines should be used to harmonize. If harmonization fails and symptoms such as cold limbs, vomiting, and diarrhea appear, hot medicines must be used urgently for rescue. However, one must carefully distinguish whether the pulse is forceful or weak for this to be a sound method.

For miscellaneous diseases causing dysentery (Xili), the cause is mostly attributed to cold; however, dysentery caused by Shanghan can be either cold or heat. When pathogenic heat transmits inward, dysentery may occur, but cold dysentery is most common, while heat dysentery is rare. Practitioners must differentiate between cold and heat; misapplication causes the greatest harm.
Zhang Zhongjing's *Lun* states: "Spontaneous diarrhea without thirst belongs to Taiyin disease, due to cold in the Zang organs; it should be warmed, and Si Ni Tang (Frigid Extremities Decoction) type formulas are suitable." In Shaoyin disease, from day two or three to day four or five, if abdominal pain, difficulty in urination, persistent diarrhea, and pus/blood in stool occur, Taohua Tang (Peach Blossom Decoction) is indicated. In Shaoyin disease, with vomiting, diarrhea, cold limbs, and extreme irritability, Wuzhuyu Tang (Evodia Decoction) is indicated. For Shaoyin disease with diarrhea, Baitong Tang (White Onion Decoction) is indicated. In Shaoyin disease, if symptoms persist from day two or three to day four or five, presenting with abdominal pain, difficult urination, heavy/painful limbs, and spontaneous diarrhea, this indicates water retention; if accompanied by cough, frequent urination, diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is indicated. In Shaoyin disease, with diarrhea of undigested food, interior cold with exterior heat, cold limbs, faint pulse nearly imperceptible, absence of aversion to cold, red facial complexion, or abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse, Si Ni Tang is indicated. With profuse sweating, unrelenting heat, internal cramping, limb pain, diarrhea, cold limbs, and aversion to cold, Si Ni Tang is indicated. For diarrhea of undigested food, exterior release is contraindicated; sweating will inevitably cause abdominal fullness.
Note: These discussions all address the warming treatment for cold dysentery. Symptoms such as cold limbs, aversion to cold, abdominal pain, faint pulse, and diarrhea of undigested food indicate extreme Yin-cold. Differentiation is crucial: Dysentery caused by heat pathogens in Shanghan must present with irritability, high fever, craving for cold water, and pulses that are surging, slippery, strong, rapid, and excess. Only when both interior and exterior are clearly hot should it be treated as a Fire syndrome. If the pulse is rapid but weak, or if there is external heat without aversion to heat, or internal thirst without preference for cold drinks, the interior is fundamentally not hot. Such dysentery belongs to deficiency-cold and should be treated with Si Ni Tang, Lizhong Tang, Wenwei Yin (Warm the Stomach Drink), Weiguan Jian (Stomach Gate Frying/Decoction), or Wuling San (Five-Ingredient Powder with Poria), selected according to circumstances. If exterior and interior cold pathogens are both severe, combining Mahuang Guizhi Yin (Ephedra and Cinnamon Twig Drink) is most appropriate. Mistaking cold dysentery for heat dysentery and recklessly using cold-cooling medicines will damage Stomach Qi further, leading inevitably to death.
The *Lun* states: "With dysentery, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Warm the interior with Si Ni Tang, attack the exterior with Guizhi Tang (Cinnamon Twig Decoction)."
Note: This passage addresses dysentery with simultaneous exterior and interior involvement. Although exterior signs exist, the interior urgency takes precedence. If the interior is deficient, exterior pathogens sink deeper; even attempting exterior release fails due to weak Middle Qi. Therefore, for dysentery with Middle Qi deficiency, one must urgently warm the interior first. Once the interior is solid and Qi is strong, exterior pathogens resolve spontaneously. Warming the middle dispels cold, which is the principle here.
The *Lun* states: "For heat dysentery with a feeling of heaviness/restriction in the anus, Baitouweng Tang (Pulsatilla Decoction) is indicated. For dysentery with a rapid pulse and desire to drink water, indicating heat, Baitouweng Tang is indicated. In Shaoyin disease, with dysentery lasting six or seven days, accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhuling Tang (Polyporus Decoction) is indicated."
Note: These three passages address the clearing treatment for heat dysentery. A rapid pulse and desire to drink indeed indicate heat. However, cold pathogens in the exterior also cause rapid pulses; a rapid pulse with force indicates Yang syndrome, while a rapid pulse without force indicates Yin syndrome. Diarrhea/dysentery depletes fluids, causing thirst. Thirst with a strong desire to drink large amounts quickly indicates Yang syndrome; thirst with no desire to swallow indicates non-Yang syndrome. Additionally, a desire for tea or soup is a normal consequence of fluid loss from diarrhea and should not be universally considered a heat syndrome. First, for Shanghan where exterior pathogens remain unresolved, with excess/slippery/rapid pulse, robust constitution, interior/exterior heat, and dysentery, Chaiqin Jian (Bupleurum and Scutellaria Frying/Decoction) is indicated.
The *Lun* states: "In Shaoyin disease, spontaneous discharge of clear water, pure green color,必 (must) have heart epigastrium pain, and dry mouth; urgent evacuation is required, Da Chengqi Tang (Major Order the Qi Decoction) is indicated. For dysentery where all three pulse positions are level, but palpation reveals hardness in the heart epigastrium; urgent evacuation is required, Da Chengqi Tang is indicated. For dysentery with delirious speech, there are dry feces; Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated."
Note: These three passages address the purgative treatment for dysentery. Shanghan dysentery is typically not Yangming excess pathology and should not involve delirium; the presence of delirium indicates dry feces that must be removed. Similarly, Shaoyin dysentery with pain and hardness in the epigastrium indicates accumulation requiring purgation.
First, for patients with spontaneous dysentery, a cool body and fine pulse indicate a favorable prognosis (Shun), while a hot body and large pulse indicate an unfavorable prognosis (Ni). This refers to cases without exterior syndromes, affecting the internal organs. Dysentery occurring more than ten times a day with a surprisingly excess pulse indicates death. Fever with severe dysentery and unrelenting cold limbs indicates death. Fixed gaze, delirium, and dysentery indicate death. Dysentery with absent pulse, cold limbs, unwarmed by moxibustion, and pulse only felt after prolonged pressure indicates death. Shaoyin disease with spontaneous dysentery, irritability, and inability to lie down indicates death. Generally, dysentery represents a critical depletion of Qi; among the Five Depletions (Wu Duo), this is the most severe. *Jingui Yaolue* states: "When Qi of the Six Fu organs fails externally, hands and feet are cold; when Qi of the Five Zang organs fails internally, dysentery is uncontrollable. Once organ Qi has collapsed, it cannot be treated."