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In cases of diarrhea and dysentery accompanied by abdominal pain, there are patterns of excess-heat and deficiency-cold. Excess-heat may arise from food stagnation or fire pathogenic factors. Pain due to food stagnation is invariably associated with abdominal distension, fullness, and hardness, or pain that refuses pressure; this indicates the presence of retained pathogenic material. In mild cases, promoting qi movement to resolve stagnation is appropriate; in severe cases, purging to drive out the retention is indicated. Pain caused by fire pathogenic factors must present with signs of internal heat, warranting clearing and draining methods. However, when pathogens are excessive in the middle jiao, qi rebellion often occurs. Therefore, regardless of whether the cause is fire or food, treating pain should prioritize regulating qi. One must observe the cold or hot nature of the medicinal properties and select accordingly.

Pain due to deficiency-cold requires particular differentiation. Generally, pain in diarrhea and dysentery stems from cold pathogens residing in the zang-fu organs. The *Classic of Difficult Issues* states: "Pain is due to an abundance of cold; because there is cold, there is pain." It also states: "Painful conditions belong to yin." Thus, if one consumes excessive raw or cold foods, or contracts external cold, abdominal pain ensues, which is evident. When cold resides in the middle jiao, treatment should warm the spleen; when cold resides in the lower jiao, treatment should warm the kidney.

Furthermore, the concept of "scraping pain due to deficiency-cold" is often misunderstood. This occurs because internal yuan qi (original qi) is insufficient. Even without external cold invasion, if the middle qi lacks warmth, it constitutes a cold pattern. Consequently, diarrhea and dysentery cannot cease, food cannot be transformed, and the disease cannot resolve, primarily due to yang deficiency generating internal cold. Moreover, persistent diarrhea and dysentery damage stomach qi, causing the essence and blood to adhere closely to the intestinal walls; how can there be no pain? This type of pain arises from depletion affecting the intestines and viscera. Thus, dysentery exacerbates pain, and pain generates dysentery. Any condition where cold invades the fu organs, meridians are injured, blood moves recklessly, and qi stagnates can cause pain. If the abdomen is not firm or hard, or if the patient prefers rubbing/massage, warming compresses, feels hungry but has no appetite, or experiences epigastric vomiting with acid regurgitation, provided there are no signs of excess-heat, it belongs entirely to deficiency-cold. How can one claim that pain is always due to accumulation and that all accumulations are excess patterns?

When treating pain due to deficiency-cold, one must quickly warm and nourish the zang-fu qi. One must not add dispersing or attacking herbs, lest they cause moving qi to move further and sliding bowels to slide more, leading to critical danger. Some argue that tonification is contraindicated for all pains until the pain subsides; however, this leads to daily depletion of yuan qi with no fixed time for recovery. I have seen physicians claim that for dysentery, tonification should only be used after seven days, unaware that the patient may die on the sixth day. Such obstinate ignorance is foolish. However, if pain is severe, a small amount of *Aucklandiae Radix* (Muxiang) may be added to the warming and tonifying formula to smooth qi, or *Angelicae Sinensis Radix* (Danggui) may be increased to harmonize blood. Once pain subsides slightly, these two herbs should be removed, as *Aucklandiae Radix* may consume qi and *Angelicae Sinensis Radix* may cause loose stools. If pain arises from cold in the lower jiao, *Evodiae Fructus* (Wuzhuyu) must be added. If pain is not severe, the primary approach should be warming and tonifying the spleen and kidney. As the spleen and kidney gradually stabilize, the pain will cease naturally; this is known as treating the root rather than the symptom directly.