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The key to treating dysentery lies in distinguishing between deficiency and excess, cold and heat. Grasping this key ensures success without failure; losing it causes the greatest harm. The preceding discussion has clarified this, and careful examination is required. The various treatment methods mentioned in the section on diarrhea should also be applied as appropriate.

First, if the initial injury is caused by raw and cold foods or dietary irregularities, but stomach qi is not yet damaged and primal qi is not depleted, presenting with symptoms such as pain, distension, sudden diarrhea, or acute dysentery, with food stagnation remaining, Yi Fu Jian (Supporting Decoction) or Wu De Wan (Five Virtues Pill), or formulas such as Ping Wei San (Calm the Stomach Powder), Wei Ling Tang (Stomach and Five-Li Decoction), or Wu Ling San (Five-Ingredient Powder with Poria) are suitable to slightly dispel cold and stagnation, leading to easy recovery.

Second, individuals with weak spleen and kidney qi easily develop dysentery upon consuming raw or cold foods. Whether adult or child, for dysentery caused by spleen deficiency without other signs of excess heat, Zuo Guan Jian (Assisting the Gate Decoction) is first indicated to warm spleen qi. If the condition deepens and involves the liver and kidneys, Wei Guan Jian (Stomach Gate Decoction) is the most excellent treatment; do not hesitate to use it because the disease is new. Wu De Wan (Five Virtues Pill) or Si Shen Wan (Four Spirits Pill) may also be used intermittently.

Third, for dysentery where both spleen and kidney are deficient and the condition is critical and frightening, Wei Guan Jian (Stomach Gate Decoction) is the primary choice, followed by Wen Wei Yin (Warm the Stomach Infusion). These may be used alternately according to circumstances. Alternatively, Si Wei San (Four Dimensions Powder), Jiu Qi Dan (Nine-Qi Elixir), or Fu Yang Dan (Restore Yang Elixir) may be combined to preserve life.

Fourth, dysentery accompanied by vomiting and nausea, frequent retching, or aversion to the smell of food, indicates that stomach qi is deficient and cold, unable to receive and hold food. It is essential to warm and tonify the stomach using Wu Jun Zi Jian (Five Gentlemen Decoction), Liu Wei Yi Gong Jian (Six-Ingredient Enhanced Merit Decoction), Wen Wei Yin (Warm the Stomach Infusion), or Sheng Zhu Jian (Sage Atractylodes Decoction). For severe vomiting, Liu Wei Hui Yang Yin (Six-Ingredient Restore Yang Infusion) is indicated. If vomiting results from fire deficiency within yin and qi failing to return to its source, Wei Guan Jian (Stomach Gate Decoction) or Li Yin Jian (Regulate Yin Decoction) are appropriate. If vomiting is caused by stomach fire rushing upward, accompanied by irritability, heat, and fullness, cooling and descending fire medications such as Da Li Qing Yin (Great Clearing and Purifying Infusion) or Yi Yuan San (Primary Source Powder) may be used.

Fifth, when damp-heat pathogenic factors are vigorous, presenting with irritability, preference for cold, excess pulse, abdominal fullness, or passage of pure red fresh blood, Qing Liu Yin (Clear Flow Infusion), Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction), Xiang Lian Wan (Aromatic Coptis Pill), or He Jian Shao Yao Tang (He's Peony Decoction) are suitable. For severe heat, Da Li Qing Yin (Great Clearing and Purifying Infusion) or Yin Chen Yin (Artemisia Capillaris Infusion) are indicated. If these formulas fail after several doses, consideration must turn to supporting the spleen and kidney.

Sixth, dysentery with fever might seem to belong to fire patterns and suggest cool treatments. However, true excess heat does not necessarily present with fever. Fever and restlessness are most common in cases where dysentery has damaged essence and blood, leading to yin deficiency and water depletion. If there is deficiency with internal fire and a forceful pulse, Jia Jian Yi Yin Jian (Modified One-Yin Decoction) or Bao Yin Jian (Protect Yin Decoction) are appropriate. If the pulse is inherently weak, indicating pure deficiency fire, treating the fire directly is contraindicated; instead, strengthen water and tonify yin using San Yin Jian (Three-Yin Decoction) or pills such as Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). If yang is repelled outward due to yin excess (yin repelling yang), causing external heat, Wei Guan Jian (Stomach Gate Decoction) and You Gui Yin (Right Restoration Infusion) are required.

Seventh, at the onset of dysentery, if the constitution is strong, or due to indulgence in food and drink causing stagnation, presenting with excess pathogenic signs such as pain, distension, hardness, and fullness, along with robust form, qi, and pulse, the accumulation should be removed first; once the accumulation is gone, the dysentery will stop naturally. Cheng Qi Tang (Order Qi Decoction), Shen You Wan (Divine Protection Pill), or Bai Shun Wan (Hundred Compliance Pill) are suitable, or Chi Jin Dou (Red Gold Bean) can be used for mild purgation. This follows the principle of "treating obstruction with unblocking agents" (tong yin tong yong), where pain decreases with the passage of stool. However, this approach must only be used after precise diagnosis. If dysentery is caused by spleen-kidney deficiency and cold, the reckless use of these drugs or cold-cooling purgatives will further damage primal yang, often leading to untreatable conditions. Extreme caution is required.

Eighth, "forbidden mouth" (an inability to eat), is the most critical sign of dysentery, yet historically lacks clear differentiation. Zhu Danxi stated: Forbidden mouth dysentery is due to excessive heat in the stomach opening; he prescribed decoctions of Huang Lian (Coptis Rhizome) and Ren Shen (Ginseng Root), sipped throughout the day. If vomited, continue drinking; even one swallow brings improvement. People misunderstood this, often using warm and sweet medicines, which is adding fire to fire and stagnation to stagnation. Some cases involve damage from mistakenly ingested hot-toxic drugs, requiring identification and detoxification. This is Danxi's view. However, the differentiation of forbidden mouth is subtle; it is not always due to stomach heat treatable solely with Huang Lian. Generally, forbidden mouth occurs because food cannot enter. While some cases involve excess heat, most are due to spleen-stomach deficiency and cold. If caused by food accumulation in the stomach, chest and abdomen will be full or painful/hard; treat by moving stagnation and removing accumulation using Qing Pi (Citrus Peel), Chen Pi (Aged Tangerine Peel), Shan Zha (Hawthorn Fruit), and Hou Po (Magnolia Bark), so that food enters naturally. If caused by fire depression in the stomach, organs will show intense heat or surging-rapid pulses; treat by draining fire and clearing heat using Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit), and Huang Bo (Phellodendron Bark), so that food enters naturally. All these represent excess patterns of forbidden mouth due to pathogenic accumulation in the middle jiao.

However, excess patterns are rare. In recent patients, observing the stomach opening reveals little fullness or other excess heat signs. There is output without input, leading to daily depletion of the stomach opening and spirit. Since there is no fullness, it is not accumulation; since there is no true heat, it is not fire. Why can food not enter? Because the zang organs cannot receive it. There are two reasons for this inability to receive: First, spleen qi weakness leads to vomiting, acid regurgitation, aversion to food smells, or hunger without ability to eat. This is due to middle jiao failure to transform, placing responsibility on the spleen. Second, kidney qi weakness fails to warm the Ming Men (Gate of Life), leading to large intestine insecurity, small intestine digestion failure, and stomach qi stagnation. This is lower jiao failure and lack of control over the source of transformation, placing responsibility on the kidney. To strengthen the middle jiao, Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Gan Jiang (Dried Ginger), and Gan Cao (Licorice Root) are indispensable. To solidify the lower jiao, Shu Di Huang (Prepared Rehmannia Root), Fu Zi (Aconite Lateral Root), Wu Zhu Yu (Evodia Fruit), and Rou Gui (Cinnamon Bark) are indispensable. When spleen and kidney are strong, food enters naturally; the principle is clear and the response immediate. I have saved countless lives using this method. Danxi’s use of Huang Lian and his theory of "adding fire to fire" apply only to excess fire patterns and represent a partial view. Such limited thinking destroys human vitality; the implications are significant, and one must not accept them as correct.

Ninth, in chronic dysentery with yang deficiency, or due to excessive attacking or cold-cooling treatments exhausting the primal spirit of spleen and kidney, resulting in incontinence and sliding discharge, the root source is already ruined. Even vigorous use of warming and tonifying drugs will be ineffective. Immediate moxibustion on Bai Hui (GV20), Qi Hai (CV6), Tian Shu (ST25), and Shen Que (CV8) is indicated to restore yang, offering a chance of survival.