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In the "Xu Lao" (Deficiency and Emaciation) chapter of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), it is recorded that when men suffer from Xu Lao disease, the pulse is floating and large, there is vexation and heat in the hands and feet, the condition worsens in spring and summer, and improves in autumn and winter. Due to yin-cold, essence spontaneously slips out; the limbs feel sore and emaciated, making walking impossible. Commentary by Xu Lingtai: "Suanxiao" should be read as "Suanshao," meaning soreness, hoarseness, and dejection. Marrow resides in the head and connects with the Juegu acupoint. The Juegu point is located on the lateral side of the tibia; therefore, those with insufficient brain marrow experience headache and inability to walk in the lower legs. The reason the condition worsens in spring and summer is that spring diseases manifest in the head. *Zhou Li* (Rites of Zhou) · Ji Yi (Physicians) records that in spring there are "Shouji" (head ailments). Zheng Xuan's commentary states: "Suanxiao"; Shouji refers to head diseases. Here, "Xiao" should also be written as "Xiao," serving as a phonetic loan for reduplication. *Shuowen Jiezi* explains: "Suanxiao" means headache. *Zhou Li* says: "In spring there are Suanxiao Shouji." This shares the same meaning as Zheng's commentary. Zheng's annotation separately explains the meaning of the three characters "Suanxiao Shouji," rather than dividing them into two separate symptom names. The five-character phrase in *Shuowen Jiezi*, "Suanxiao [is] headache," comprehensively describes the state. Jia Gongyan's subcommentary claims that besides headache, there is another ailment called Suanxiao, which is likely a misunderstanding of Zheng's intent. In *Shudu Fu*, it mentions "Wei Juan Li Suanxiao." The annotation states: "Suanxiao" means headache. This is also a misunderstanding of Xu Shen's original meaning. Through my own clinical observation of patients with Spring Warmth syndromes or catching wind in spring who suffered from headaches, none lacked accompanying soreness in the lower legs. The three characters "Suanxiao Shouji" in *Zhou Li* are indeed excellent descriptors of the pathological state. Xu Shen spoke from the perspective of the head, while Zhang Zhongjing spoke from the perspective of the lower legs; they differed only in the anatomical focus!

Ancient texts frequently mention "Xiali" (lower purging/diarrhea). "Xia" is the character for "Xie" (purging); "Li" implies smoothness or ease, and adding the "bing" (disease) radical creates the character "Li" (dysentery). The term Xiali shares its etymology with Tuli (vomiting and purging). If Tuli refers to forceful vomiting, then Xiali refers to forceful purging. Two classics sometimes refer to severe cases as "Dongxie" (cavity diarrhea) or "Changpi" (intestinal disorder). Wang Bing's commentary states that Changpi implies the opening of the anal gate, indicating the original character was "Pi," pronounced as such, referring to this disease as Xiali. What is described as Changpi discharging white mucus corresponds to modern white dysentery; Changpi discharging pus and blood corresponds to modern red-and-white dysentery; Changpi discharging blood corresponds to modern red dysentery or intestinal bleeding. In recent times, "Xia" has been differentiated as diarrhea, and "Li" as dysentery, so modern dysentery differs from ancient "Li." How could one know that modern dysentery is precisely the "Da Jia Xie" (Great Mass Diarrhea) among the Five Diarrheas in *Nanjing* (Classic of Difficult Issues)? *Nanjing* groups it with four other types under the general term "Xie," indicating that ancient "Xia" encompassed modern "Li." Zhang Zhongjing's works merely add the term "Houzhong" (tenesmus/feeling of incomplete evacuation) to distinguish it, without establishing a new name. During the Sui and Tang dynasties, it was sometimes called "Zhixia" (stagnant downward flow) or "Chongxia" (heavy downward flow), never departing from the character "Xia," thus preserving ancient meanings. Xu's *Guifan* generally equates Changpi with intestinal bleeding, categorizes all Five Diarrheas from *Nanjing* under simple diarrhea, and categorizes all of Zhang Zhongjing's Xiali under dysentery. At this, one cannot help but sigh at the difficulty of discussing ancient medical concepts!