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The *Yuan Bing Shi* (Treatise on the Original Causes of Disease) states: Some say that dysentery with white discharge indicates a cold syndrome; this is an error. If it were truly cold, digestion of grains would be impaired, and how could it transform into pus? The so-called transformation of grain into pus and blood in dysentery is akin to how grains, meats, fruits, and vegetables in the world naturally rot, disintegrate, and transform into pus and blood when subjected to excessive damp-heat. The redness is due to heat, which belongs to Heart Fire; yellowness is due to dampness, which belongs to Spleen Earth; whiteness is due to dryness and stagnation, which belongs to Lung Metal. The Classics state: "All conditions involving qi frustration and stagnation belong to the Lung," referring to the transformation of Dry Metal. However, all types of diarrhea and dysentery involve dampness. To claim qi dryness here implies that damp-heat is severe within the intestines and stomach, causing them to become obstructed and stagnant. Coupled with dampness blocking flow, qi and fluids fail to circulate freely, resulting in intestinal dryness and incessant thirst and irritability.

If dysentery presents with both red and white discharge, the common belief that this indicates a mixture of cold and heat is even more erroneous. Water and fire, yin and yang, cold and heat are like the beam and weights of a scale; if one side rises, the other must fall; if one prevails, the other must decline. How can cold and heat both be excessively severe in the intestines and stomach simultaneously to cause dysentery? For instance, hot sores may produce white pus; can we consider it cold simply because it is white? This is because it is located in the skin layer, associated with Metal, hence white. Next, in the blood vessels, it is associated with Heart Fire, hence blood. In the muscles, it is associated with Spleen Earth, hence yellow pus. In the tendons, it is associated with Liver Wood, hence pus tinged with bluish-green. Deep in the bones, it is associated with Kidney Water, hence purple-black blood. Each color appears according to the location corresponding to the Five Zang organs; these are the manifestations, while the root cause is always heat, differing only in depth. Generally, symptoms such as tenesmus, urgency, rectal heaviness, and dark, scanty urine belong to dryness-heat. Since white dysentery often accompanies these, it is clearly a heat syndrome.

Liu Wansu (Hejian) argued that red and white discharge should not be distinguished by cold or heat, but rather attributed to the transformations of Lung Metal and Heart Fire. He further stated that the five colors correspond to the Five Zang organs, yet their root origin is heat; his theory is highly appropriate. However, in clinical practice, mixed red and white cases are prevalent. If treatment ignores the distinction between cold and heat and solely employs pungent, bitter, and cold herbs to clear heat, this addresses the root cause. Regarding the transformations of Heart Fire and Lung Metal, there may be distinct nuances. The Heart governs blood, and the Lung governs qi. White discharge relates to Lung Metal, indicating a disease of qi; red discharge relates to Heart Fire, indicating a disease of blood; mixed red and white indicates disease affecting both qi and blood. Understanding this allows for a mutual clarification of the theories regarding Liver (green), Spleen (yellow), and Kidney (black).