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Cinnamon Twig (Rougui) 5 qian, Chen Zhike (aged Tangerine Peel, stir-fried), Areca Seed (Binglang), Magnolia Bark (Houpo, stir-fried with ginger juice), Green Citrus Peel (Qingpi) each 8 fen, Angelica Sinensis (Danggui), Licorice Root (Gancao), Sanguisorba Root (Diyu) each 5 fen, Safflower (Honghua, washed with wine) 3 fen, Southern Aromatic Costus Root (Nanmuxiang) 2 fen, Peach Kernel Paste (Taoren Ni) 1 qian. Add two bowls of water, decoct to one bowl, take warm on an empty stomach, decoct the dregs again.

This formula can be used for red dysentery, white dysentery, or mixed red and white dysentery, accompanied by tenesmus (urgent need to defecate with a feeling of heaviness in the anus) and abdominal pain with fever. For those presenting with pure bloody stool, stool resembling dust and water, or a relaxed anus like a bamboo tube—severe conditions considered incurable by ancients—taking this formula urgently can also save them. However, if treatment is delayed, the pathogenic toxin will damage the zang-fu organs, making it difficult to rescue. For patients presenting with anorexic dysentery (inability to eat due to dysentery), the toxin is obstructing the stomach opening. Decoct one dose of this medicine, divide into five or six portions, and take slowly to gradually dissipate the toxin at the stomach opening. After finishing one dose, not only will the patient tolerate the medicine, but food intake will also gradually improve; no other medicines are needed. For pure white dysentery without redness, remove Diyu and Taoren, add Chenpi (aged tangerine peel, pith removed) 4 fen, and use Nanmuxiang 3 fen. For severe stagnation and obstruction, add Rhubarb (Dahuang, stir-fried with wine) 2 qian. After taking one or two doses, remove Dahuang. This formula is highly effective when used within three to five days of onset, and also effective within ten days. Only after half a month should modifications be made as follows: Coptis Rhizome (Huanglian), Scutellaria Root (Tiaoqin/Baishao context implies Huangqin here based on standard pairing, text says Tiaoqin which is likely Huangqin), White Peony Root (Baishao), all raw, each 4 fen; wine-stir-fried each 6 fen; Hawthorn Flesh (Shanzharenrou) 1 qian; Houpo, Chenpi, Qingpi, Binglang each 4 fen; Gancao (raw and cooked) each 1.5 fen; Diyü (vinegar-stir-fried), Danggui each 5 fen; Taoren Ni 6 fen; Honghua 6 fen; Nanmuxiang 2 fen. If the condition persists for over a month and spleen/stomach deficiency with loose stools is felt, then use Huangqin, Huanglian, Baishao (wine-stir-fried) each 6 fen; Chenpi, Houpo, Nanmuxiang each 3 fen; Diyü (vinegar-stir-fried) 4 fen; Honghua 2 fen; Danggui, Ginseng (Renshen), Atractylodes Macrocephala (Baizhu), Cooked Licorice (Shu Gancao) each 5 fen. The above methods are invariably effective. Occasionally, there may be ineffective cases; this is usually because tonics like Renshen and Baizhu were administered too early initially, trapping the pathogenic heat inside. Over time, the righteous qi becomes deficient while the pathogenic qi remains strong. Tonifying and astringing would aid the pathogen, while clearing and draining would worsen the looseness, leading to untreatable conditions. I once treated a young nobleman and an official who both received warm-tonifying treatments too early, resulting in irretrievable outcomes. Therefore, these cases are recorded to warn future practitioners.

Wei Yuheng said: Zhang Longwen, aged thirty, presented in September with dysentery that had not resolved by December, though abdominal pain and tenesmus had ceased. He took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which resulted in immediate diarrhea before reaching the toilet, with increased frequency. I was consulted and prescribed Shudihuang (Prepared Rehmannia Root), Gouqizi (Lycium Fruit), Baishao (White Peony Root), Zaoren (Sour Jujube Seed), Yiyiren (Coix Seed). Initially, the reaction was adverse, with chest fullness and dysentery turning multicolored. Fortunately, he persisted with the prescription without changing it. Upon subsequent administration, the dysentery gradually improved. By year-end, he was recovering. Pulse diagnosis showed slippery and large pulses at both Guan positions, becoming wiry upon heavy pressure. I warned him: do not stop the medicine, lest the disease recur after Li Chun (Start of Spring). Indeed, it did recur. His neighbor doctor added Gubuzhi (Psoralea Fruit), Sharen (Amomum Fruit), Nanmuxiang, and Guangpi to my formula, which was ineffective, causing drowsiness and excessive sweating. In mid-April, he sought consultation again. I added Shashen (Glehnia Root), Maidong (Ophiopogon Tuber), Louren (Trichosanthes Seed), and Huangqin to the previous formula. Within twenty doses, he recovered. Later, he experienced pain in the Huantiao acupoint and heels, with wandering pain resembling post-dysentery wind syndrome. Using the previous formula plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), and Chuanlianhuan (Coptis Rhizome), he stabilized after several doses.

The son of the Pu family lived outside Yongjin Gate, very poor, suffering from chronic dysentery with rectal prolapse. Various treatments failed, so he came to the city for my consultation. Although only two or three li from the city, he had to visit the toilet multiple times during the journey. His anus could not retract, making walking extremely painful. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Shudihuang 1 liang and Paojiang (Prepared Ginger) 1 qian. After two doses, he was completely cured.

Scholar Fan, nearly seventy years old, suffered from alternating chills and fever in February of the Wuzi year. He had a history of dysentery. At this time, his chest, hypochondrium, and lower abdomen were all painful, with red and white dysenteric stools. A famous physician had treated him for years. He invited me to consult, perhaps casually. His pulse was wiry and rapid, but pleasantly slippery. Inquiry revealed short, red urine. This was purely due to Liver Fire forcing downward, resembling dysentery but not being true dysentery. He must have taken many aromatic and penetrating herbs. Furthermore, with the Sovereign Fire ruling the year and Shaoyang in command, the pathogen attacked what it overcomes and insulted what it cannot overcome. The discharged material consisted of Taiyin blood fluids and Yangming fatty tissues. I prescribed Nüzhenzi (Ligustrum Fruit), Shashen, Maidong, Chuanlianhuan, and Louren. Half the symptoms resolved after one dose. However, the famous physician said: Can a seventy-year-old take the bitter cold of Huanglian and the lubricating nature of Louren? Now, with dysentery, instead of regulating qi and strengthening the spleen, you use yin-nourishing and lung-moistening herbs. What kind of treatment is this? Scholar Fan, being rigid, listened to him. After another month, he was near death. I was called again and used the previous formula plus Gouqizi, Baishao, and Gancao. After several doses, the dysentery stopped, pain ceased, and he recovered. (Note: Dysentery can also be caused by dryness injury; the cases treated by Master Wei belong to this category.)

Pei Zhaoqi treated his mother, aged seventy, who suddenly developed dysentery on New Year's Eve. The frequency was incalculable, with coma, muteness, fever, flushed face, rapid breathing, and a large pulse. Because it was deficiency dysentery with frequent, slippery stools and no tenesmus, I prescribed Renshen (Ginseng) and Lianrou (Lotus Seed) each 1 liang, and Sharen 1 qian, decocted strongly and taken frequently. By the fifth day, the dysentery decreased, consciousness cleared, and she began eating vegetarian food. From then on, daily use of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with small amounts of Guizhi (Cinnamon Twig) and Fuzi (Aconite Root). After more than forty doses, she could finally eat and drink, and her spirit and demeanor returned to normal.

A scholar suffered from dysentery in winter, defecating over a hundred times a day, with tenesmus, nausea, inability to eat, hard and painful abdomen upon pressure, extremely fine and rapid pulse, and cold hands, feet, face, and nose. I administered Renshen 1 liang, Guizhi, Fuzi, and Ganjiang (Dried Ginger) each 1 qian. After a short while, a second dose was given, but no warming effect was seen. Later, the dosage of Guizhi and Fuzi was doubled. After two doses, his limbs warmed, nausea stopped, and food intake gradually improved. However, the dysentery did not decrease. I then used Da Bu Pi Wan (Great Tonify Spleen Pill) with Renshen as the chief herb, adding Guizhi and Fuzi, to be taken morning and night to support Stomach Qi and increase appetite. This is the primary strategy for treating the root. Within half a month, approximately 8-9 liang of Renshen and three Fuzi were consumed. The pulse became large, long, and forceful, and he became thirsty for cold drinks. This indicated Yin transforming into Yang. I then used Dahuang (Rhubarb), Huanglian, Binglang, and Shaoyao to purge the accumulated feces from the intestines. Finally, I gave him Ji Jian Shen Ling San (Modified Ginseng and Poria Powder) in pill form, and he recovered.

Ye Tianshi treated Xu Mou with summer dysentery, mostly due to damp-heat and food stagnation. Initially, the pathogen should be dispersed and eliminated. However, the patient had soft, white, and tender skin, indicating a Qi-deficient constitution, and feared medication. Thus, only small doses should be given. Prescription: Binglang juice, Qingpi, Chenpi, Houpo, Chuanlianhuan, Huangqin, Muxiang, and Stir-fried Black Shanzha. Another case of damp-heat dysentery requires bitter, pungent, and cold herbs. Qieke (Poppy Shell) astringes the intestines and is a established formula for stopping chronic diarrhea. However, since the heat pathogen is not yet cleared, promoting circulation to resolve stagnation is sufficient. Due to pale complexion and weak Qi, harsh purgatives were avoided. Prescription: Houpo, Huangqin, Chuanlianhuan, Muxiang juice, Shanzharenrou, Stir-fried Jinyinhua (Honeysuckle Flower), and Maiya (Malt).

Case of Wang Mou: Dysentery was anciently known as "Zhi Xia" (Stagnant Downward Flow), caused by damp-heat invading the intestines and stomach, blocking the Qi mechanism, thus causing incomplete evacuation. He Jie and Danxi both used heat-clearing and Qi-directing herbs for this. Prescription: Huangqin, Chuanlianhuan, Caojueming (Sicklepod Seed), Stir-fried Black Shanzharenrou, Raw Baishao, Shilian (Stone Lotus Seed), Danpi (Moutan Cortex), and Guangmuxiang juice.

Case of Gu Mou: Gurgling sounds in the abdomen after drinking soup, with watery dysentery. As a habitual drinker, he retained dampness, leading to internal accumulation of damp-heat and intestinal stagnation. Dong Yuan's Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction) is also designed for Qi injury due to damp-heat. However, for chronic spleen/stomach disease where appetite remains, bitter herbs to firm Yin and aromatic herbs to regulate the Spleen are appropriate. Prescription: Raw Maoshu (Atractylodes Lancea) 4 liang, Stir-fried Black Huangbai (Phellodendron Bark) 2 liang, Stir-fried Black Diyu 2 liang, Zhuling (Polyporus) 1.5 liang, Zexie (Alisma) 1.5 liang. Made into pills with water, take 3 qian. (Xu Lingtai said: This is dysentery with fluid retention; the formula is extremely ingenious.)

For red and white dysentery, avoid Chuanlianhuan. Instead, use Cheqiancao (Plantain Herb) stir-fried and powdered 2 qian, Binglang, Shanzha, Chenpi, Huashi (Talcum), Gancao each 1 qian, Hongqu (Red Yeast Rice) 3 qian, Zhishi (Immature Bitter Orange) stir-fried 1 qian, Zexie stir-fried 2 qian, Dengxin (Juncus Effusus) a pinch, Guangmuxiang 6 fen roasted. All ground into powder, take 3 qian per dose, washed down with Wu Yao (Lindera Root) decoction.

One person with Yin deficiency and fever, passing red and white dysentery, became restless and thirsty at night, died after using blood-cooling and stagnation-expelling drugs. One person with Yin deficiency and fever, passing multicolored dysentery, felt hungry in the chest but bloated after eating, died after using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). One person with Yin deficiency, fever, dysentery, and anorexia, recovered using Zhu Ling Tang (Poria Decoction) and Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) prescribed by Guo Yousan. Zhang Feichou said: Many people suffer from Yin-deficiency dysentery. It is rare to find cases without fever, thirst, aversion to food, red stool, or worsening at night. Since internal Yin is depleted, deficient Yang inevitably disturbs externally. Therefore, treating Yin-deficiency dysentery with blood-cooling leads to death, with stagnation-expelling leads to death, and with Qi-tonifying also leads to death. Only by clearing heat toxins and simultaneously nourishing Yin and Blood can life be preserved. This uses the method of saving heat and preserving Yin from Zhang Zhongjing's Shaoyin examples. It is no different from the treatment of postpartum dysentery with extreme deficiency using Baitouweng Tang plus Gancao and Ejiao in the *Jingui Yaolue*.

*Guang Biji* states: Treating "Zhi Xia" (dysentery with stagnation) is different from simple colonic slippage and spontaneous diarrhea. Simple slippage and diarrhea can be astringed. Thus, ancients occasionally used Qieke (Poppy Shell) and Hezi (Chebulic Myrobalan) to stop it. However, "Zhi Xia" is fundamentally due to damp-heat stagnation and obstruction; the method should be to promote drainage, and astringents are contraindicated. The Large Intestine is the腑 (Fu organ) of the Lung. If damp-heat stagnates in the Large Intestine, the Lung must also have heat. The Lung is the canopy organ. The Classics state: The Spleen scatters essence, sending it up to the Lung, which regulates water passages and sends them down to the Bladder. Thus, Lung Qi prefers free flow and dislikes obstruction. Hence, ancient materia medica often mentions benefiting Lung Qi, revealing this intent. If astringent herbs are mistakenly used, dampness has no outlet, Lung Qi cannot descend. Not only will dysentery worsen, but damp-heat steaming upward will harass the Lung, causing distension, oppression, rebellious Qi, insomnia, and anorexia.

Additionally, there is epidemic dysentery ("Shixing Yili"), often occurring in late summer and early autumn, affecting entire communities. Symptoms generally include fever, headache, thirst, irritability, dysentery, and difficult urination. Severe cases may pass stool a hundred times a day or develop macules and papules, posing a critical danger. Physicians wrongly diagnose this as "Lou Di" (leaky bottom). They fail to realize this is caused by seasonal pathogens. The treatment priority is to clear heat, detoxify, and release the exterior, using herbs like Shengma (Cimicifuga), Gegen (Pueraria), Chaihu (Bupleurum), Huanglian, and Huangqin. If heat and thirst are severe, Hanshuishi (Calcitum) can be added to the previous herbs. Other symptoms require modification based on judgment. Strictly avoid descending, Qi-breaking, and astringent herbs such as Dahuang, Mangxiao (Mirabilite), Binglang, Zhishi, Wumei (Mume Fruit), and Qieke. Violating this often leads to untreatable conditions.

Formula for Toxic Dysentery and Dysentery with Eruption/Exanthems: Fresh Jinyinteng (Honeysuckle Stem) several liang, decocted strongly to make three large bowls. Add Diyü 5 qian, Chuanlianhuan and Huaihua (Sophora Flower) moist-stir-fried 4 qian, Huangbai 2 qian, Huangqin 2 qian, Baishao wine-stir-fried 3 qian, Zhi Gancao (Honey-fried Licorice) 2 qian, Lüshengma (Green Cimicifuga) vinegar-stir-fried 6 fen. Decoct together to one bowl. Mix with 5 qian of refined Huashi (Talcum) powder. Take at any time.