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In cases of tenesmus (a feeling of incomplete defecation with straining), the pathology is located at the lowest part of the large intestine (rectum), but the root cause lies not in the large intestine, but in the Spleen and Kidney. This symptom occurs in heat dysentery, cold dysentery, and deficiency dysentery alike; it should not be indiscriminately attributed to heat. If there is heat in the Middle Jiao, pathogenic heat forces downward; if there is cold in the Middle Jiao, pathogenic cold forces downward; if Qi of the Spleen and Kidney is deficient, sinking Qi forces downward. To treat this condition, one must investigate the etiology and treat the root by regulating the Spleen and Kidney, ensuring a cure. However, since the disease is in the large intestine, it is no longer food stagnation. Food stagnation would be cleared upon evacuation without residue; what remains is only the sinking Qi. Since Qi is formless, although there is a sensation of wanting to defecate, there is actually nothing to pass; yet, because there is nothing to pass, the sensation persists. This is all caused by Qi dysfunction. Therefore, Liu Hejian’s use of Shaoyao Tang, stating that "regulating blood leads to self-healing of stools, and regulating Qi eliminates tenesmus," is indeed correct. However, the method of regulating Qi involves: cooling to regulate if Qi is hot, warming to regulate if Qi is cold, tonifying to regulate if Qi is deficient, and lifting to regulate if Qi is sinking. Only when Qi becomes harmonized does this constitute the true method of regulating Qi and moving Blood. Merely labeling herbs like Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Danggui (Angelicae Sinensis Radix), and Dahuang (Rhei Radix et Rhizoma) as agents for moving blood and dispersing Qi as "harmonizing" is mistaken. One fails to realize that the large intestine is distant, making drug delivery difficult, and these herbs primarily act on the Qi of the Middle Jiao. Moreover, if Qi is already sinking, using dispersing and moving agents will cause further sinking of Qi, making recovery impossible. Furthermore, once dysentery ceases, tenesmus naturally stops; it is unheard of for tenesmus to resolve while dysentery persists. Thus, treatment should primarily focus on curing the dysentery.

In most cases of dysentery, patients experience swelling and pain at the anus (Da Kong). What is the reason? When the Spleen and Stomach are disharmonious, the Qi of water and grain loses its normal transformation, producing foul and unbearable substances that exit through the orifices, inevitably causing pain. Additionally, if fire pathogens sink due to diarrhea, and Yang is driven away by Yin, the Yang Qi of the Stomach is forced into the lower body and cannot dissipate, leading to swelling. Therefore, frequent dysentery causes more pain, while less frequent dysentery causes less pain; the presence or absence of pain depends on whether Qi is sinking. Thus, regardless of whether it is cold or heat dysentery, the anus can become painful; one cannot assume pain is necessarily due to heat. To treat this, one need only treat the dysentery; once the dysentery stops, the swelling and pain will naturally subside, similar to the approach for tenesmus. Since Zhu Danxi stated that "anus pain is due to heat flowing downward," prescribing Muxiang, Binglang, Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma) plus fried Ganjiang (Zingiberis Rhizoma), he only recognized that fire causes swelling and pain, failing to recognize the sinking of Primordial Yang. Later generations followed his methods, resulting in many instances where patients with deficiency-cold constitutions could not tolerate such treatments.