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The *Bingji* (Pathogenesis) states: Tenesmus and heaviness in the rectum with a pulse that is large, surging, and solid indicates excessive heat in the interior accompanied by constipation, caused by the accumulation of tangible pathogenic factors causing a dragging sensation. If the pulse is floating and large, purgation should not be used. Although tenesmus and heaviness are present, if the pulse is deep, fine, and weak, it indicates cold in the interior and dispersion of qi; self-healing can be achieved through warming and nourishing. Tenesmus and heaviness with constipation result from the failure of the Large Intestine meridian qi to circulate freely; it is appropriate to add Areca Seed (Binglang, 槟榔) and Costus Root (Muxiang, 木香) to promote qi circulation. The *Yuanbing Shi* (Treatise on Original Pathogenesis) states: The urgency to defecate, tenesmus, and severe abdominal pain are due to the nature of fire being rapid and drying.

Commentary: "Li ji" (tenesmus/urgency) refers to abdominal distress and acute pain. "Hou zhong" (heaviness in the rectum) refers to the sensation of heaviness and dragging in the Large Intestine. The syndrome of tenesmus and heaviness varies in etiology: some are caused by fire-heat, as described by the rapid and drying nature of fire; some are caused by qi stagnation, where the qi of the Large Intestine meridian is obstructed and fails to circulate; some are caused by excessive accumulation of stagnant products, resulting in tangible obstruction; some are caused by qi deficiency, where the qi of the Large Intestine descends but fails to ascend; some are caused by blood deficiency, known as "xu zuo nu ze" (straining during empty defecation attempts). Treatment methods: for fire-heat, use cold herbs to clear it; for qi stagnation, regulate the qi; for accumulated stagnation, remove the stagnation; for qi deficiency with sinking, lift and raise the qi; for blood deficiency, tonify the blood. One must carefully examine the underlying cause. I observe that the preceding discussion is not sufficiently comprehensive.

The *Bingji* states: In cases of dysentery or diarrhea accompanied by vomiting, it is due to disharmony of qi in the stomach. For disharmony in the Upper Jiao, treat with Fresh Ginger (Shengjiang, 生姜) and Tangerine Peel (Chenpi, 橘皮); for disharmony in the Middle Jiao, treat with White Peony Root (Shaoyao, 芍药), Angelica Sinensis (Danggui, 当归), Cinnamon Twig (Guizhi, 桂枝), and Poria (Fuling, 茯苓); for disharmony in the Lower Jiao with cold, use mild hot herbs; for severe heat, use potent hot herbs.

Commentary: The mention of vomiting accompanying diarrhea and dysentery here attributes it to stomach qi disharmony. However, vomiting can also result from rebellious stomach fire rushing upward, stomach deficiency, toxic stagnant products attacking upward, or yin deficiency. How can one solely attribute it to stomach qi disharmony while ignoring other causes?

The *Jiyao* (Essentials) states: For abdominal pain, harmonize it. If accompanied by fever and aversion to cold, use Scutellaria Root (Huangqin, 黄芩) as the principal herb; for severe abdominal pain, add Angelica Sinensis and double the dosage of White Peony Root.

Commentary: Abdominal pain accompanying diarrhea and dysentery presents many syndromes, all caused by the internal stagnation and blockage of qi. It is appropriate to prioritize promoting qi circulation and dissipating stagnation. However, there are also cases involving cold, fire-heat, accumulated stagnation, and blood deficiency, so treatment should be tailored to the specific syndrome. The term "harmonize" in the *Jiyao* serves as a general summary. The method of adding Angelica Sinensis and doubling White Peony Root is applicable only to cases of blood deficiency.