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Chen Liangfu treated a woman suffering from dysentery. The disease had persisted for forty days, and various medicines had failed to cure her. Upon examination, the six pulses were deep and weak. Generally speaking, in cases of dysentery, the pulse should be deep or weak. He prescribed Shiquan Dabu Tang (Ten Significant Tonifying Decoction), decocted with ginger and jujube, adding half a spoonful of white honey, boiled for a few more turns, after which she recovered. (From *Liangfang* and *Yishuo Xubian*.)

Another woman suffered from incessant diarrhea, resembling dysentery but not quite, resembling blood but not quite, with discharge color like turbid wine. Examination revealed the six pulses were deep and nearly imperceptible. Other physicians administered hot-natured medicines and alchemical pills, causing irritability and oppression. Therefore, Baidu San (Detoxification Powder) was first used with aged rice for decoction, followed by Weifeng Tang (Stomach Wind Decoction) with millet, resulting in recovery.

*Bozhai Bian* records: Yao, promoted from Dianjian to Bashuo, had a mother suffering from dysentery unresponsive to all medicines. Someone advised Li Ang to perform divination, yielding the phrase "Gui Ge has a true person pointing to spiritual herbs." One day during an audience, the Emperor noticed his haggard complexion and asked for the truth. An edict granted a powder, which cured him after several doses. The Emperor also instructed him to simply use roasted Toona sinensis seeds ground into fine powder, taken with rice water.

Xue Lizhai treated Wang Jingshan, a Sima (Historian), who suffered from dysentery with tenesmus (urgent need to defecate with heavy sensation in the anus). After taking Zhiqiao (Bitter Orange) and Binglang (Areca Seed) to move qi and guide stagnation, the tenesmus worsened, appetite decreased, and abdominal pain occurred. This indicated spleen injury with deficiency-cold. Liu Junzi Tang (Six Gentlemen Decoction) was prescribed with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), leading to recovery.

Li Yi, a Cibu Langzhong (Director in the Bureau of Sacrifices), suffered from bloody dysentery with chest and abdominal distension, inability to pass stool despite urgency, and extreme fatigue. It was diagnosed as spleen and stomach weakness failing to control blood and return it to its source. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used with Fuling (Poria) and Banxia (Pinellia Rhizome), gradually improving the condition. Later, due to anger, symptoms recurred; the left Guan pulse was wiry, and superficial palpation felt weak. This indicated liver qi deficiency failing to store blood. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was used for treatment, resulting in recovery.

Zhu Danxi treated a seventy-year-old elderly man, pale-faced, with a wiry and rapid pulse, except for the Stomach pulse which was deep and slippery. The dysentery was caused by drinking white wine, presenting with pale bloody water discharge, post-defecation abdominal pain, difficult urination, and tenesmus. Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) served as the sovereign drugs, with Gancao (Licorice Root), Huashi (Talcum), Binglang (Areca Seed), Muxiang (Aucklandia Root), and Cangzhu (Atractylodes Lancea Rhizome) as ministering drugs. Baohe Wan (Preserve Harmony Pill) 25 pills were taken after meals. The next day, previous symptoms reduced, except for difficult urination, which was cured by Yiyuan San (Benefit Origin Powder). (From *Pingzhi Huihui*.)

The Prince Ning suffered from dysentery and summoned Doctor Zeng (name unknown) for consultation. After diagnosing the pulse, before reporting the symptoms and treatment plan, Lady Ciming stood behind the imperial bed and ordered Zeng Fangyu to be called, asking, "Has the Lord consumed Yinggan Wan?" Doctor Zeng repeatedly answered that he had. Lady Ciming further instructed to give more. Following this directive, Zeng stated that 200 pills must be administered before stopping. At that time, Zeng was seated in a position demoted due to association with the Han faction. Once the dysentery stopped, his rank was increased by three levels on top of the previous demotion. Later, when Prince Ning was ill for a long time, he told attendants, "Only Dr. Zeng understands my impatient nature." After diagnosis, Zeng wept uncontrollably. The Emperor said, "I suppose your pulse is not good." Zeng exited, diagnosed his own pulse, and told his family, "My pulse is also not good." He died one day before Prince Ning. (From Ye Shaoweng's *Sichao Wenjianlu*.)

Dou Cai treated a patient with chronic intermittent dysentery for half a year, where vital qi was about to collapse and the six pulses were nearly absent, a critical condition. He moxibusted Mingguan (Life Gate) 300 moxa cones and Guanyuan (Gate of Origin) 300 moxa cones. The six pulses stabilized, and dysentery stopped. However, stabbing pain in both flanks remained. Caoshen Dan (Grass Spirit Pill) and Pili Tang (Thunderbolt Decoction) were then administered until recovery. One month later, bowel movements occurred once every two days.

Another patient with chronic intermittent dysentery was ordered by Dou to moxibust Mingguan 200 cones. Two days after recovery, symptoms changed to profuse watery diarrhea, occurring five to seven times at once. Pili Tang was prescribed, stopping immediately after two doses. Later, limbs became edematous, indicating spleen deficiency progressing towards water swelling. Guanyuan was moxibusted again 200 cones, and Jin Ye Dan (Golden Liquid Pill) 10 liang was taken, recovering in one month.

Prime Minister Zeng suffered from bloody dysentery for over a hundred days, untreatable by court physicians. Chen Yingzhi used one salted plum meat, mashed, mixed with wax tea and vinegar, taken in one swallow, bringing immediate relief. Grand Censor Liang Zhuangsu also suffered from bloody dysentery; Chen Yingzhi used Wumei (Dark Plum), Huduanglian (Coptis Rhizome), and Zaoxia Tu (Soil from under the stove) in equal parts, powdered and taken with tea. This is because blood constricts with sourness, stops with cold, and becomes astringent with bitterness. (From *Yishuo* and *Bencao Gangmu*.)

During the Song Dynasty, when Zhang Shuqian was Prefect of Jianzhou, his subordinate suffered from bloody dysentery. A physician used Pingwei San (Calm the Stomach Powder) 1 liang mixed with Chuan Xuduan (Dipsacus Root) powder 2 qian, decocted in water and taken, resulting in immediate cure. In the Renzi year of Shaoxing, epidemic dysentery broke out in Kuaiji. Zhang Shuqian's son transmitted this formula, which was often effective, especially for pediatric dysentery. (From *Bencao Gangmu*.)

Liu Yuxi in *Chuanxin Fang* states: I once suffered severely from red and white dysentery. Various medicines were tried for a long time without success (only suitable for chronic dysentery). It transformed into white pus. General Linggu passed down this formula: use 3 Heheli (Chebula Fruit), half roasted and half raw, including the skin, powdered. Take with one he of boiling water. For watery dysentery, add one qianbi of Gancao (Licorice Root) powder. If there is slight pus/blood or excessive blood, add Sanqi (Notoginseng Root) and also add Gancao. (From *Bencao Gangmu*.)

A servant of Hu Daqing suffered from five-color dysentery for half a year. He met a Daoist priest in Hangzhou who taught him to use one large ripe Gualou (Trichosanthes Fruit), preserved nature (calcined), remove fire toxicity, powder it, take as one dose, and swallow with warm wine, resulting in immediate cure. (From *Benshi Fang*, same as above.)

Zhang Zihe said: A man suffered from severe purulent and bloody dysentery with unbearable pain (indicating excess heat toxin). He suddenly saw sweet melons soaked in water and greatly desired them. He ate several with the skin, and the pus and blood disappeared. People say there is no standard treatment for dysentery; what nonsense! They only know dysentery is deficiency-cold and apply warming, astringing, or blocking methods, believing there is no other way. How can they know that wind, summerheat, fire, dampness, dryness, and cold can all cause dysentery? This explains why water-melon honey works.

Pan Xun said: My nephew, aged twelve, experienced intense internal and external heat like fire and dizziness in one day. Physicians thought it was exterior contraction and induced sweating, which failed. Then abdominal pain and urinary retention occurred. Thought to be interior damage, purgatives were used without success. Four or five days later, it turned into red dysentery, day and night without limit, with only drops of urine and abdominal/bladder distension. Physicians used specific dysentery medicines, worsening the condition. Worried, I asked the family what he had eaten. They reported he drank ice water. I said, "The illness arises from this." Physicians used Siling San (Four-Powder Decoction) and Liuyi San (Six-to-One Powder) without effect. I said, "Yin qi is knotted above, yang qi is sunken below. The bladder has an upper opening but no lower opening; qi cannot transform and exit. Must use herbs from the Bladder meridian, warm to disperse, and lift to raise." Physicians dared not try. I used Wenzhong Wan (Warm the Middle Pill) and Tianshui San (Heavenly Water Powder), adding Ganjiang (Dried Ginger), Huixiang (Fennel), Shengma (Cimicifuga Rhizome), and Chaihu (Bupleurum Root). After one or two doses, urination started; after three doses, dysentery stopped and he recovered. (From *Zhujishi*.)

Li Shizhen treated Old Hua, fifty-plus years old, suffering from dysentery with abdominal pain near death, coffins already prepared. Yanhusuo (Corydalis Rhizome) 3 qian was powdered and taken with rice water. Symptoms reduced by half immediately, and he recovered with conditioning. (From *Bencao Gangmu*.)

Xue Lizhai treated a patient with vomiting and hiccupping after dysentery. Pulse was large and rapid but empty upon deep pressure. Thirsty with desire to drink, yet all medicines were vomited upon entry. Diagnosed as spleen-stomach deficiency-cold unable to receive and hold. Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), and Paojiang (Prepared Ginger) in equal parts were made into rice pills and given frequently with rice water. After taking 3 liang, nausea ceased. Liu Junzi Tang (Six Gentlemen Decoction) with Paojiang was used for conditioning, leading to safety.

Wang Ru treated a patient with dysentery resembling bean curd residue, over a hundred times day and night. Group physicians administered cooling and descending medicines, worsening the danger. Six pulses were deep and weak, indicating spleen deficiency with dampness. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used with Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Cangzhu (Atractylodes Lancea Rhizome), recovering in two to three doses.

Wang Youyi treated a patient with weak legs difficult to walk after dysentery. He said, "Chronic dysentery injures qi; excessive downward flow loses yin. Both qi and blood are deficient, unable to nourish tendons and bones." Bazhen Tang (Eight-Treasure Decoction) was used with Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), Mugua (Chaenomeles Fruit), and Yiren (Coix Seed), resulting in recovery.

Chen Sansan treated a woman with dysentery. She had taken cooling and attacking medicines, causing spleen-stomach weakness and loss of blood control, losing several sheng daily. Touching exacerbated bleeding. Wanting to tonify blood feared worsening spleen cold; wanting to guide blood back to vessels found blood nearly exhausted. Adopting the principle of "yang generates yin," Yiqi Tang (Qi-Augmenting Decoction) was used to warm and nourish middle qi, leading to gradual stability.

A scholar diligent in exams suffered from tenesmus and white pus discharge in late summer. Others treated it as dyscentry. He said, "Incorrect. This is accumulation of labor injuring the spleen, spleen qi sinking. As Dongyuan said: irregular diet and lifestyle cause ascending essence qi to sink instead." Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, recovering in two doses.

Gong Zicai treated Liu Sikou, nearly seventy, suffering from dysentery with pus, blood, and abdominal pain, unresponsive to medicines. Pulse was slightly rapid. This indicated excessive rich food causing internal accumulated heat. He should have taken Jiuzheng Dahuang (Wine-Steamed Rhubarb) 1 liang to clear and drain. Liu said, "I am old and frail, afraid I cannot tolerate it. Mild tonic medicines would be better." After repeated persuasion, he reluctantly agreed and recovered the next day.

You Zaijing said: Dysentery involves qi blockage in the lower jiao and fire pressing upon it, causing abdominal pain, tenesmus, and passage of intestinal mucus. Its origin lies in summerheat-dampness, appearing in summer and autumn like malaria. Pathogens damaging meridians become malaria; entering intestines and viscera becomes dysentery. Meridian pathogens can be dispersed to heal, so treatment suits bitter-acrid warm medicines. Intestinal heat requires clearing to heal, so treatment suits bitter-acrid cold medicines. This reflects the intent of not being too hot in releasing the exterior and not too cold in purging the interior. Hejian's emphasis on clearing cold likely stems from this insight.

Zhang Jingyue did not examine the origin of dysentery but discussed it via five zang organs and five elements, claiming only the Heart relates to fire, others do not. This merely aids debate and does not supplement essential treatment principles.

Dysentery and diarrhea differ in pathology and treatment. Diarrhea often starts from cold-dampness; cold requires warming, dampness requires drying. Dysentery often forms from damp-heat; heat requires clearing, dampness requires draining. Although diarrhea can have heat patterns, cold predominates; although dysentery can have cold patterns, heat predominates. Thus, prolonged diarrhea damages stomach yang, leading to swelling, wheezing, and fullness. Prolonged dysentery damages spleen yin, leading to deficiency vexation and flaccidity/paralysis. Astringing dysentery too early allows damp-heat to flow into collaterals, forming painful obstruction. Over-draining diarrhea causes middle deficiency and failure to recover, becoming spleen勞 (chronic spleen disorder). These are my personal experiences, not speculation. Some ask: Clearing heat and warming cold is correct, but both involve dampness. Why sometimes drain and sometimes dry? Answer: In cold-dampness, cold arises from dampness, so warming and drying the middle is suitable. In damp-heat, dampness transforms from heat, so sweet-bland draining the lower is suitable. Moreover, drying agents are often warm, draining agents often cold. Draining removes heat naturally; warming the middle eliminates cold together. Cold-dampness roots in middle deficiency, so further draining is contraindicated. Damp-heat stagnation often becomes toxic, so adding warmth and dryness is inappropriate.

One patient had dysentery with lower abdominal urgent pain and inability to pass stool, due to spleen-stomach qi deficiency and sinking. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used to deliver Bawei Wan (Eight-Ingredient Pill), recovering in two doses. Such cases, where purgatives damage vital qi leading to limb edema and death, are countless.

One patient had tenesmus after dysentery, self-medicated with Huangqin Shaoyao Tang (Scutellaria and Peony Decoction), worsening tenesmus, poor appetite, cold abdomen, and cold limbs. Gong diagnosed spleen-stomach damage and used Liu Junzi Tang (Six Gentlemen Decoction) with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), recovering in two doses.

Zhao Yangkui treated Xu Yangtai from Siming, who was robust, prone to fire and thirst, keeping tea bowls by the bed even in severe cold, sometimes finishing several bowls a night, and suffering from asthma. Zhao diagnosed depression-fire syndrome and prescribed Zhulian Wan (Evodia and Coptis Pill), ensuring safety. In summer of Ding Si year, Xu avoided heat in Tanzhou, sitting in water basins or drinking cold Xiangru Tang (Elsholtzia Decoction), considering it a good summerheat remedy. In early autumn, severe dysentery erupted. Initially, over a hundred times in three days, red and white mixed, no residue, unbearable abdominal distension and twisting pain. Some suggested purging with Dahuang (Rhubarb). Zhao ignored this, using Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark) to gradually recover. White residue persisted, cured by Yinggan Wan (Inducing Response Pill). Later, eating crab caused relapse and collapse, cured by Bawei Tang (Eight-Ingredient Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ganjiang and Rougui. Using Renshen, Baizhu, Ganjiang, and Rougui to correct excessive cold was correct. Why use Bawei Wan? This is why Zhao Yangkui is Zhao Yangkui.

In one life, consuming Huanglian (Coptis Rhizome) and bitter tea constantly throughout the year, yet now cured by pure heat. Had Dahuang been used for purging, who knows the outcome? When coughing with asthma and insomnia, Xiaoyao San (Free and Easy Wanderer Powder) brought immediate peace. When hematochezia persisted, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Heijiang (Blackened Ginger) stopped it in less than two doses.

Yu Jiayan treated Zhang Zhongyi, who had dysentery for three to five days. He moved normally, but the pulse indicated interior damage with Shaoyin pathogen involvement. He said, "This case requires simultaneous exterior release and interior resolution. Use more Renshen (Ginseng) in exterior-releasing herbs and more Fuzi (Aconite Lateral Root) in interior-resolving herbs to avoid disaster. Using standard dysentery medicines would be dangerous." Zhang trusted him and took the medicine without doubt, though symptoms were not yet severe. By evening, high fever erupted, body heavy as stone, requiring two people to move him, unconscious and confused. Urgently administered complete exterior-interior formulas. Next morning, he could rise and leave the room. Two more doses of Ginseng and Aconite led to full recovery. Without differentiating symptoms, how could such treatment exist in standard dysentery protocols?

Zhou Xinchuan, seventy-three, usually robust. Autumn dysentery persisted, becoming chronic intermittent dysentery in winter, ten+ times day and night, facial edema, dark complexion. Pulse was deep, rapid, and forceful. He said, "Yang pathogen has sunk into yin. I can cure it with proper method." Ren Shen Bai Du San (Ginseng Detoxification Powder) was decocted. Patient sat wrapped in thick blankets on a chair, heated underneath, with cloth rolled under buttocks to block anus, preventing internal qi from sinking downward. (Internal qi lifting relies on the person; blocking externally is absurd. Note: While lifting depends on the person, external support helps slightly. Then administer hot decoction. After a while, another dose. Sweat appears on skin. Pour hot water. Instruct to endure urge to defecate. This is reasonable.) Hot decoction administered. After a while, another dose. Sweat appeared. Hot water poured. Instructed to endure heat and urge, not moving for about two hours. Skin moist but not dry. Patient anxious and fearful of heat, unbearable, finally allowed to lie in bed with blanket. That night, only two dysentery episodes. Later, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) reduced frequency to three times day and night. Recovered fully in ten days. The sunken pathogen wants to emerge from the exterior. Without the "saving the boat in a rapid current" method, where would the downward trend end? Heard that Wang Xingzai had chronic dysentery unresponsive to medicines. Suzhou old doctor used Ren Shen Bai Du San (Ginseng Detoxification Powder), reducing severity and showing vitality, but lacked this maneuvering method, failing ultimately. Thus, for any case of yang pathogen sinking into yin, such as chronic malaria, chronic dysentery, chronic fever, one must recognize this intent, allowing interior pathogens to slowly emerge to the exterior. If rushed, fear re-entry, merely injuring healthy qi.

Commentary: Chronic intermittent dysentery often results from mis-treatment, either astringing too early or purging abruptly when exterior signs exist. Ancients often used Yinggan Wan (Inducing Response Pill), a good method. Using Ren Shen Bai Du San (Ginseng Detoxification Powder) here is also logically sound. Blocking the anus with cloth/egg to prevent internal qi sinking is overly curious. Reading Daoist texts, I saw that when inner elixir is formed and needs to pass the gate, objects are placed in the anus and testicles pinched to prevent spirit elixir leakage. Yu integrated the three teachings; his intent might derive from this. Mr. Wei's criticism is perhaps seeing little and marveling much.

Zhu Kongyang, twenty-five, thin, accustomed to comfort. In summer, running in the sun for litigation, summerheat-dampness combined with internal depressed fire, causing dysentery, 100-200 times day and night, unable to get up, changing coarse paper mats frequently, drinking only water, severe pain, anus burning like iron, tossing limbs, restless. Pulse was wiry, tight, strong, and urgent, unyielding to pressure. He said, "This is a mass of toxic fire accumulating in intestines and stomach, burning fiercely. Saving from fire requires instant action. In two or three days, intestines and stomach will rot." Used Dahuang (Rhubarb) 4 liang, Huanglian (Coptis Rhizome) and Gancao (Licorice Root) 2 liang each, decocted in large clay pot, taken as it boils. After taking, consciousness calmed briefly, then restlessness returned. Took over twenty bowls in one day and night. Dahuang dissolved completely, Huanglian and Gancao boiled to no juice. Next day, pulse softened, indicating recovery possible. But used decoction method, not emergency medicine. Changed to Shengdi (Rehmannia Root) and Maidong (Ophiopogon Tuber) 4 liang each, crushed for fresh juice, mixed with Huafen (Trichosanthes Root), Danpi (Moutan Cortex), Chishao (Red Peony Root), and Gancao (Licorice Root) 1 liang each, decocted and mixed with juice, swallowed in large bowls. Due to violent onset, body fluids rushed out. Waiting for dysentery to stop to generate fluids would make withering hard to reverse. Now pulse softened, fire pathogen retreated. Not treating dysentery directly, it stopped itself. How can one stick to cloying/stagnating medicines and not use urgently? Dysentery indeed stopped, leaving only slight qi foam. Consumed fermented rice soup, conditioned for ten days, digestion resumed. Shows that even a thread of stomach qi remaining cannot lack this "burnt head and broken forehead" guest.

Pu Junyi had dysentery. Initially, exterior pathogen undissipated, mistakenly treated with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) to consolidate exterior, driving pathogen deep. Mistakenly cooled with Huanglian (Coptis Rhizome) and purged with Dahuang (Rhubarb). Treatment lasted over a month, stomach qi stagnant, dysentery 100+ times day and night. One night, vomited 3-5 bowls of previous Huanglian decoction. After 3-5 vomits, stomach and intestine merged,幽门 (Pylorus) and 阑门 (Ileocecal valve) opened unrestricted. Porridge and drinks flowed straight out. Even thick Renshen paste swallowed went straight down intestine. Large dose of Sijunzi Tang (Four Gentlemen Decoction) decocted with Chishizhi (Halloysitum Rubrum) and Yuyuliang (Hematitum) powders, continuously administered. Condition slightly declined, but unbearable abdominal pain. Pu said, "Previous dysentery was frequent but painless. Pain increased after this medicine, should not continue." Yu said, "This is exactly 'smoothness brings no pain, pain indicates blockage.' No pain is dangerous, pain is safe. How can there be no pain?" Continued previous medicine. Once severity greatly reduced, switched to Sijunzi Tang with doubled Fuling (Poria), recovering fully in ten-plus doses.

Li Shicai treated Madam Sun Xiaoxiang, dysentery for forty days, dry mouth, fever, no appetite, abdominal distension, undigested food in stool. Some attributed undigested food to evil heat not killing grain. Used Xiangru (Costus Root), Huanglian (Coptis Rhizome), Zhiqiao (Bitter Orange), Doukou (Cardamom), Houpo (Magnolia Bark) etc., over thirty doses, fasting for five days, life hanging by a thread. Pulse large and rapid, empty upon pressure. Abdominal pain relieved by pressure, clear urination. This indicated fire decline failing to generate earth, true interior cold with false exterior heat. Urgently decocted Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), taken with ice water. One dose stopped pain, six doses reduced fever and restored appetite. Combined with Bawei Wan (Eight-Ingredient Pill), recovered fully in twenty-plus days.

Lady of Marquis Xu, dysentery with abdominal pain, pulse faint and soft. Li said, "Qi deficiency fails to transport essence and micro. Urgency and tenesmus are due to sinking." Shengyang Sanhuo Tang (Raise Yang Dispel Fire Decoction) two doses, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) ten doses, recovered.

Yu Jiayan treated Chen Ruming with dysentery, steaming fever, coma, no eating, pulse rapid-large-empty, Chi pulse twice as full. Interior damp-heat combined with seasonal exterior heat, desiring...