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Regarding the differentiation of accumulations (Ji, 积) in the abdomen, it stems from food stagnation retained within the body. If it condenses into masses or causes distension, fullness, hardness, and pain with obstruction of qi movement, this is termed "accumulation" (Ji). These belong to the category of formed waste products (Zao Po, 糟粕) and should be treated by purging (Zhu, 逐). However, contemporary practitioners often fail to distinguish them accurately; upon seeing dysentery discharging pus-like turbid matter, they indiscriminately label it as "accumulation." They do not realize that this is not waste material but rather the adipose tissue (Zhi Gao, 脂膏) adhering to the intestines and viscera, which actually belongs to the category of essence and blood (Jing Xue, 精血). Both thin and obese individuals possess this adipose tissue; the obese have thicker layers, while the thin have thinner layers, but none are devoid of it. If there were truly no adipose tissue, how could the intestinal and visceral cavities remain exposed and bare? This would not only compromise the defensive barrier (Fan Li, 藩篱) but also make the viscera susceptible to injury, which is physiologically impossible. Currently, patients suffering from diarrhea and dysentery do so because their internal organs (Wu Zang, 五内) are damaged, causing the adipose tissue to become unstable and shed daily. If the organ qi is relatively strong, the tissue regenerates as it is lost, posing little concern; however, if the organ qi fails completely and the tissue is exhausted, or due to chronic diarrhea/dysentery where only bloody water or fluid resembling leaking roof water is seen, quack doctors might mistakenly claim that "the accumulation has cleared up," calling it a good sign. In reality, the exhaustion of adipose tissue indicates the depletion of vital essence, representing an extremely critical condition. It is hoped that future physicians will recognize this as adipose tissue rather than true accumulation; thus, they would focus on stabilizing and securing the condition rather than daring to use purgative methods or bitter-cold herbs to induce sliding and diuresis.

Regarding the differentiation of the five colors in dysentery, such as pus-like discharge, all are transformations of qi and blood. White discharge indicates a superficial pathogenesis, involving the floating adipose tissue. Red discharge indicates a deeper pathogenesis, extending from the adipose tissue to the cutaneous collaterals (Fu Luo, 浮络). Discharge of pure blood usually results from heat forcing the blood, causing it to overflow and pass down immediately, representing the deepest level. Purple-red or purple-white discharge indicates that the blood has remained outside the vessels for a longer period, moving slowly, leading to color changes, or has not yet reached the collaterals, representing a slightly more superficial level. Mixed red and white discharge indicates involvement at both superficial and deep levels. Generally, bright red pure blood suggests a heat syndrome (Re Zheng, 热证), as fire nature is rapid and forces downward flow. Purple-red or purple-white patterns suggest less heat, resulting from yin blood coagulation and decay due to damage. Pure white discharge indicates no heat, resulting from cold qi deficiency in the organs leading to slippery discharge. However, some cases without redness may still be due to heat, specifically referring to acute sudden watery diarrhea (Bao Zhu, 暴注) rather than dysentery. Conversely, abundant purple-red discharge does not necessarily indicate heat; it may result from injury to the yin collaterals (Yin Luo, 阴络), distinct from acute sudden diarrhea. Regarding yellow and black colors: deep yellow with foul odor can indicate either heat or cold syndromes; pale yellow with mild odor, or accompanied by a fishy/sour smell, indicates indigestion and belongs to cold syndromes. Thick black with a strong odor represents scorching color, often associated with fire syndromes. Cyan-black with a thin fishy smell represents the corruption color of the liver and kidneys; considering this as heat is a grave error. Although the differentiation of the five colors follows these general principles, bleeding in dysentery invariably involves injury to the yin collaterals. Regardless of cold or heat, once the collaterals are damaged, bleeding occurs. Therefore, one cannot assume that bleeding always indicates heat. When encountering such conditions, one must comprehensively examine the pulse, complexion, physical constitution, and etiology to avoid diagnostic errors based on ambiguity.