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Zhang Zhongjing stated: When the Yang Qi of the Six Fu Organs fails at the exterior, symptoms include cold hands and feet, rebellious Qi ascending, and contracted legs; when the Yin Qi of the Five Zang Organs fails at the interior, symptoms include uncontrollable diarrhea, and if the downward flow is severe, numbness of the hands and feet. In cases of dysentery accompanied by abdominal distension and fullness, and body pain, one should first warm the interior, then attack the exterior. To warm the interior, Si Ni Tang (Four Reversal Decoction) is appropriate; to attack the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.

*Chu Shi Yi Shu* (Remnants of the Book by Chu Shaosu) states: If Yin Essence has already been depleted and is further exhausted, it leads to pulling pain in the large and small intestines during defecation; the more painful it is, the more one desires to defecate, and the more one defecates, the more painful it becomes.

Li Dongyuan stated: Damage from diet and irregular daily routines impair Stomach Qi, causing the clear Yang Qi that should ascend to instead descend, resulting in *Sun Xie* (diarrhea with undigested food). Over time, this may transmit from the Taiyin Spleen channel to the Shaoyin Kidney channel, becoming Li Ji (dysentery). In cases of *Li Ji Hou Zhong* (tenesmus—urgent abdominal discomfort with frequent urges to defecate but difficulty passing stool), mixed pus and blood, and frequent visits to the toilet without immediate passage, one should primarily use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to facilitate the smooth flow of Qi ascent and descent, thereby resolving the dysentery spontaneously. "Li Ji" refers to a feeling of discomfort and lack of ease in the abdomen. There are also cases of false sitting strain where stool cannot be passed, which all belong to Blood Deficiency; Blood Deficiency leads to tenesmus.

Xue Lizhai stated: If white dysentery persists for a long time due to weak Stomach and deficient Qi, with frequent urges to defecate but inability to pass stool, or only small amounts of white pus, this indicates Earth failing to generate Metal (Spleen deficiency failing to nourish Lung), damaging the Qi of the Lung and Large Intestine, causing sinking. One should use Bu Zhong Yi Qi Tang to raise the Yang Qi, so that Yin will naturally descend and bowel movements will heal themselves. If food cannot be taken in, accompanied by fever and thirst, indicating critical condition, Shi Quan Da Bu Tang (Ten Great Tonifying Decoction) should be used. If ineffective, administer Er Shen Wan (Two Spirit Pill). If red dysentery persists for a long time due to weak Stomach and Blood Deficiency, with Heat in the Spleen channel pouring downward and failing to heal, Si Wu Tang (Four Substances Decoction) added with Bai Zhu (Atractylodis Rhizoma) and Fu Ling (Poria) should be used. If Spleen channel Qi deficiency fails to control Blood, Si Jun Zi Tang (Four Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) should be used. If Middle Qi sinks and fails to secure Blood, Bu Zhong Yi Qi Tang should be used.

In cases of vomiting where food cannot be swallowed, if there is pre-existing Excess Heat in the Spleen and Stomach, or sudden onset due to overconsumption of spicy and rich flavors, methods to open the stomach and promote stagnation resolution are suitable. If caused by weak Stomach Qi leading to diaphragm obstruction and vomiting, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sheng Jiang (Zingiberis Rhizoma Recens) is suitable. In cases of dysentery with abdominal pain and tenesmus, aversion to abdominal pressure, or a洪 (Hong/Full) and solid pulse, this indicates accumulation and closure; dredging and unblocking methods are suitable. If abdominal pain and tenesmus are relieved by abdominal pressure, or the pulse is micro (Wei) and fine (Xi), this indicates Yang Qi deficiency and Cold; Liu Jun Zi Tang combined with Gan Jiang (Zingiberis Rhizoma) to warm and tonify Spleen Qi is suitable.

In cases of dysentery caused by Qi and Blood deficiency: if Spleen deficiency and Blood weakness prevail, Si Jun Zi Tang (Four Gentlemen Decoction) is suitable; if Stomach deficiency and Blood weakness prevail, Bu Zhong Yi Qi Tang is suitable; if chronic illness leads to both Qi and Blood deficiency, Ba Zhen Tang (Eight Treasures Decoction) is suitable. If Spleen Qi deficiency and Cold lead to sinking, Bu Zhong Yi Qi Tang added with Yu Ke (Papaveris Pericarpium), Sheng Jiang, and Rou Gui (Cinnamomi Cortex) is suitable; if ineffective, Fu Zi (Aconiti Lateralis Radix Praeparata) should be used urgently. If Qi and Blood are weak, Shi Quan Da Bu Tang added with Fu Zi and Yu Ke is suitable. If Ming Men Fire (Gate of Life Fire) declines, Ba Wei Wan (Eight-Ingredient Pill) should be used to tonify the maternal Qi (Kidney). In cases of abdominal pain with thirst, where drinking hot water or pressing the abdomen provides slight relief, warming and tonifying the Spleen and Stomach are suitable.

Xu Donggao stated: In treating dysentery, one must examine the patient's constitution (thick or thin), whether purgatives or bitter-cold drugs for attacking accumulations have been used previously, whether the pulse is forceful or feeble, and the surplus or deficit of Righteous Qi versus Pathogenic Qi. Treatment based on syndrome differentiation is invariably effective. However, current physicians often use harsh purgatives and excessively bitter-cold drugs to treat dysentery, rarely avoiding error. This is especially detrimental to the elderly and the weak, causing Righteous Qi to sink and fail to sustain life. Once Stomach Qi is weak, dysentery worsens. In cases of Yang deficiency sinking into Yin, resulting in episodic hemorrhage, physicians still consider the bloody dysentery unceasing and continue using bitter-cold drugs, gradually leading to pulse disappearance, cold limbs, and death. Such cases are countless. Moreover, many current patients with dysentery suffer from prior Spleen and Stomach deficiency followed by accumulation; therefore, agents for dredging stagnation should be used cautiously. Slight excess can lead to collapse from deficiency, which has its reasons.