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Chen Wuyue stated: In ancient prescriptions, it is recorded that wind pathogens stagnate beneath the skin and interstices (the spaces between skin and muscles), causing blood stasis or the passage of fresh blood; damp-toxins descend, with excrement resembling bean soup juice. These are clear descriptions of diseases caused by external factors. Ancient texts mention "Five Diarrheas," which arise from the stagnation of Zang-organ Qi. Depending on where the pathology manifests, there may be diarrhea with pus and blood, varying in color to green, yellow, red, white, or black; this constitutes disease caused by internal factors. Additionally, improper dietary temperature, excessive consumption of wine and sweet beverages, intake of vinegar and fermented meats, indulgence in sexual desires, and excessive intercourse leading to damage of essence and blood can cause the intestines and stomach to become sticky and overflow. Long-term accumulation of cold and heat pathogens eventually results in toxic dysentery; these belong to the category of neither internal nor external causes. In treatment, one must first deduce the annual cosmic movements (Wu Yun Liu Qi) to pacify external pathogens, observe organ Qi stagnation to regulate the interior, and examine the specific injuries to treat neither-internal-nor-external causes. This approach is logical and clear, preventing blind medication.

Commentary: The three-etiology treatment method proposed by Chen Wuyue is theoretically sound. However, while ancient prescriptions frequently address injuries caused by the six external climatic pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire), they rarely provide specific formulas for conditions arising from internal Zang-organ stagnation or those caused by diet and sexual fatigue. Since all three etiologies invade the intestines and stomach to cause dysentery, Chen’s theoretical distinction of three etiologies lacks corresponding differentiation in pharmacological application. This is an area where separate treatments should have been elucidated but were omitted.

*Daquan Liangfang* states: When a household experiences mutual transmission among members, with symptoms similar across ages, this is epidemic toxic dysentery. Although treatment should consider the interaction of cosmic movements, one must not adhere rigidly to them. One must first assess deficiency/excess and cold/heat patterns. Initially, use Baidu San (Detoxification Powder) supplemented with Renshen (Ginseng Root), Gancao (Licorice Root), and Chenpi (Aged Tangerine Peel), adjusting according to specific syndromes.

Commentary: Epidemic dysentery occurs annually. It is indeed correct to assert that one must consider the superiority/inferiority of cosmic movements and the variations in cold/heat and deficiency/excess of the disease. The intent is likely to teach practitioners that Wu Yun Liu Qi exhibits excess, deficiency, and competitive dynamics, allowing for the differentiation of Wind, Cold, Summerheat, Dampness, Dryness, and Fire pathologies for balanced treatment. However, why insist primarily on Baidu San? Is this not a form of rigid adherence?

Chen Wuyue stated: Consuming excessively hot or cold wine, sweet beverages, vinegar, and fermented meats causes intestinal and gastric stickiness and overflow. Long-term accumulation of cold and heat leads to toxic dysentery.

Yan Yonghe stated: Some individuals develop chronic toxic dysentery due to drinking cold wine, consuming cold foods, or sexual fatigue damaging essence and blood. In such cases, one should employ methods to resolve toxins and protect healthy Qi.

Commentary: Excessive dietary injury, particularly the indiscriminate consumption of pungent, hot, or cold substances, damages the intestines and stomach. Once injured, their ability to transform and transport nutrients fails, leading to accumulation and stagnation, resulting in dysentery. The *Neijing* states: "Irregular diet and untimely rest injure the Yin. Injury to Yin enters the Five Zang organs. Fullness and obstruction result in loose stools (Sunxie); prolonged, it becomes Changpi (intestinal disorder with discharge)." This describes the condition. Treatment should first focus on digesting food toxicity or using purgative methods, followed by regulation based on cold, heat, warmth, or coolness. These two theories originate from the *Neijing* but have not been widely discussed in later times.