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[Pulse]
A slippery pulse that feels empty and weak upon deep pressure indicates dysentery. A floating and rapid pulse at the cun position with a choppy pulse at the chi position indicates the passage of greenish pus and blood. A deep and wiry pulse indicates tenesmus (a feeling of incomplete defecation). A rapid pulse accompanied by slight fever and sweating will resolve spontaneously. A faint, weak, and rapid pulse indicates the dysentery will stop on its own. A deep and small pulse that persists is easy to treat; a rapid and large pulse accompanied by high body heat is difficult to treat.

[Symptoms]
Dysentery may present with pus, blood, a mixture of pus and blood, intestinal mucus, or without undigested food residue. Although there are differences in pain intensity ranging from mild to severe, all cases involve tenesmus and abdominal urgency, causing distress. This condition is termed "dysentery" and belongs to damp-heat and food stagnation. The colors green, yellow, red, white, and black correspond to the five zang organs: white indicates damp-heat injuring the qi level; red indicates damp-heat injuring the blood level; a mixture of red and white indicates injury to both qi and blood; yellow indicates food stagnation; or greenish/mixed colors indicate wind and fire pathogens. Stools resembling bean juice, mixed with red and white, indicate damp-toxin. Qian Yi stated that red, yellow, and black indicate heat, while green/white with undigested food indicates cold. Examining the root cause, all stem from dietary accumulation in the intestines and stomach that fails to transform completely, remaining stagnant internally. Dampness steams and heat turbidity accumulates, becoming deeply constrained. It lies dormant until triggered by summer heat when ministerial fire dominates, combined with improper lifestyle management and exposure to intense heat toxins. In autumn, as yang energy begins to收 (gather) and fire energy descends, the accumulated heat and stagnation trigger the onset of "stagnant discharge" (Zhi Xia), hence the name for dysentery. When damp-heat and turbid stagnation interfere with the blood level, stools are red; when interfering with the qi level, stools are white; a mixture indicates both qi and blood are affected. If chronic, qi deficiency leads to poor transport, spleen deficiency fails to grind food, and old stagnation becomes slippery yet coagulates downward like fish brains. In severe cases, spleen and stomach emptiness leads to loss of retention control, causing turbid fluids to flow freely, resulting in mixed colors resembling bean juice. Sinking of spleen and stomach qi causes false straining (feeling the need to defecate but producing nothing) with white pus-like discharge. Deep blood injury by heat and accumulation of damp-toxin can result in purple-black stools. Turbid stagnation desires to exit but is blocked by qi stagnation, causing urgent lower abdominal pain and tenesmus, frequent urges to defecate without success. This is due to obstruction in the Large Intestine meridian blocking qi and fluid flow. Careful examination is required.

[Treatment Principles]
Liu Wansu stated that stagnant discharge belongs to damp-heat constraining the intestines. He also said "no accumulation, no dysentery." In the initial one or two days, if vital qi is not yet deficient, purgative methods should be used, such as Zhiqiao (Bitter Orange) and Dahuang (Rhubarb). This is the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). He further stated that promoting blood circulation heals pus in stools, using Danggui (Angelica Sinensis), Baishao (White Peony Root), Taoren (Peach Kernel), and Honghua (Safflower). Regulating qi eliminates tenesmus, using Muxiang (Costus Root) and Binglang (Areca Seed). Astringents must be strictly avoided. For tenesmus, purgatives are indicated, such as Muxing Binglang Wan (Costus and Areca Pill). For abdominal pain, harmonization is needed, using Baizhu (Atractylodes Macrocephala), Baishao, Gancao (Licorice), Chenpi (Tangerine Peel), and Danggui. For heavy sensation, warming is indicated, using Jiang (Ginger) and Fu (Aconite). For thick, sticky pus and blood, strong purgatives are used. For cold limbs and spontaneous sweating, strong warming agents are used. For internal contraction of wind pathogens, diaphoresis is indicated, using Fangfeng (Saposhnikovia) and Qianghuo (Notopterygium). For loose stools (diarrhea), warming is used, such as Fuzi Lizhong Tang (Aconite and Ginger Decoction). Exterior conditions require diaphoresis; interior conditions require purgation; upper conditions require emesis; lower conditions require purgation/expulsion. For exterior heat, internal dispersal is used, such as Chaihu (Bupleurum) and Gegen (Kudzu Root). For astringent urination, separation and drainage are used, such as Wuling San (Five-Ingredient Powder with Poria). For fire-heat, cooling and clearing are used, such as Huangqin (Scutellaria) and Huanglian (Coptis). For qi stagnation, regulation is used, such as Muxiang, Binglang, and Zhiqiao. For stagnation, removal is used, such as Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), and Dahuang. For qi deficiency with sinking, lifting is used, such as Renshen (Ginseng), Huangqi (Astragalus), Baizhu, Gancao, and Shengma (Cimicifuga). For blood deficiency, tonification is used, such as Renshen, Danggui, and Shaoyao (Peony). For vomiting, harmonizing is used, such as Shengjiang (Fresh Ginger), Banxia (Pinellia), and Chenpi. For Jin Kou Li (anorexic dysentery), which is due to stomach heat, Renshen and Huanglian are used to tonify and clear. Treatments follow their respective categories. Variations are numerous and cannot be fully listed; only key points are excerpted here for experts.

[Formulas]
Jiajian Huangqin Shaoyao Tang (Modified Scutellaria and Peony Decoction) treats red and white dysentery.
Huangqin (Fried) 1.5 qian, Zhiqiao 1.5 qian, Baishao (Fried) 2 qian, Binglang 1 qian, Muxiang 0.8 qian, Gancao (Roasted) 0.3 qian, Danggui 1 qian, Cangzhu (Coix Seed/Atractylodes Lancea - *Note: Text says Cangzhu*) 1 qian, Houpo 0.8 qian, Baizhu 1.5 qian, Chenpi 0.8 qian, Huanglian (Fried) 1.3 qian. These three [Huangqin, Baishao, Huanglian] are essential medicines for dysentery.
Take as one dose. Add one slice of ginger and one jujube. Boil in two bowls of water until one bowl remains. Take after meals.
If abdominal pain occurs, add Ren (Amomum) and Muxiang (0.5 qian each). If tenesmus occurs, add Huashi (Talc) (1.5 qian).
For red dysentery, add Chuanxiong (Ligusticum) and Taoren (Peach Kernel) (1 qian each), plus additional Danggui (0.5 qian). If purgation is desired initially, add Dahuang (3-5 qian depending on deficiency/excess).
For white dysentery, add Baifuling (Poria) (fried) and Huashi (1 qian each). If purgation is desired initially, add Dahuang (5 qian, adjusted for deficiency/excess).
For mixed red and white, combine the above additions. Generally, Chuanxiong, Danggui, and Taoren regulate blood; Huashi, Fuling, and Chenpi regulate qi. If purgation is desired initially, add Dahuang (5 qian). For food stagnation, add Shanzha (Hawthorn) and Zhishi (Immature Bitter Orange) (1.5 qian each).
For chronic white dysentery with qi deficiency and weak stomach, or if unresolved after purgation, reduce Huangqin, Huanglian, and Shaoyao by half. Remove Binglang, Zhiqiao, and Houpo. Add Renshen, Huangqi (Astragalus), and Fuling (1 qian each), along with Ren and Ganjiang (Dried Ginger) (0.5 qian each).
For chronic red dysentery with blood deficiency and weak stomach, or if unresolved after purgation, reduce Huangqin, Huanglian, and Zhiqiao by one-third. Add Chuanxiong, Shudihuang (Prepared Rehmannia), and Ejiao (Donkey-hide Gelatin) (1 qian each).
For mixed red and black, indicating excess dampness, or if urination is difficult, scanty, and painful, add Mutong (Akebia), Zexie (Alisma), and Fuling (1 qian each), and Zhizi (Gardenia) (0.8 qian) to promote diuresis.
For bloody dysentery, add Chuanxiong, Shengdi (Raw Rehmannia), Huaihua (Sophora Flower), and Diyü (Sanguisorba) (1 qian each), adding extra Danggui (0.5 qian).
If chronic and unresolved, reduce Huangqin and Huanglian (0.7 qian each). Remove Binglang, Zhiqiao, Houpo, and Cangzhu. Add Ejiao, Diyü, Ce Bai Ye (Biota Tops) (1.5 qian each), Jingjie Sui (Schizonepeta Spikes) (0.5 qian), and Fried Black Ganjiang (0.7 qian).
If dysentery is chronic with persistent tenesmus due to rectal prolapse, remove Binglang and Zhiqiao. Add Shengma and Jingjie Sui (0.5 qian each).
If vomiting occurs, add Shigao (Gypsum) (1.5 qian), Banxia, and Zhizi (1 qian each). Mix in one cup of fresh ginger juice and sip slowly to clear stomach heat.
For dysentery with abdominal pain, add Ganjiang and Rougui (Cinnamon Bark) (0.7 qian each).
For chronic dysentery with incontinence and emaciation, remove Binglang, Zhiqiao, and Houpo. Reduce Huangqin and Huanglian by half. Add Hezi (Chebula), Rouguo (Nutmeg), Susu Ke (Persimmon Calyx) (1 qian each), and Wumei (Mume Fruit) (two pieces).
For chronic dysentery with dual qi and blood deficiency and sinking of yuan qi, remove Huangqin, Huanglian, Zhiqiao, Binglang, and Houpo. Add Renshen and Huangqi (1.5 qian each), Shengma and Chaihu (0.5 qian each).
For dysentery with thirst, add Maidong (Ophiopogon) and Huashi (1 qian each), Wuweizi (Schisandra) (15 berries), and Wumei (two pieces).
For autumn dysentery, add Bidou (Lablab Bean), Fried Black Ganjiang, and Banxia (0.8 qian each). Reduce Huangqin and Huanglian by one-third.
For spring/winter dysentery, add Ganjiang, Rougui (0.7 qian each), Huoxiang (Patchouli), Baodouren (Cardamom), and Ren (Amomum) (0.8 qian each), Rouguo (1 qian). Reduce Huangqin and Huanglian by one-third.
For dysentery with deep pulse, cold limbs, spontaneous sweating, loose stools, or clear/cold discharge, indicating cold, reduce Huangqin, Huanglian, Binglang, Zhiqiao, Houpo, and Cangzhu. Add Renshen, Shufuzi (Prepared Aconite), and Ganjiang (1.5 qian each) to warm.

Another Formula: Jiawei Xianglian Wan (Modified Costus and Coptis Pill) treats red and white dysentery with tenesmus and thick, sticky pus/blood.
Huanglian (cleaned, 1 jin): Soak with Banxia (Evodia) (0.5 jin) and Shengjiu (Brewing Wine) (0.5 jin) for one shichen (2 hours), stir-fry dry, discard Evodia.
Muxiang (4 liang, avoid high heat).
Rouguo (Nutmeg) (6 liang): Stir-fry thoroughly with egg white.
Huashi (Talc) (6 liang): Boil with Mudanpi (Tree Peony Bark) (3 liang) for half a day, discard Tree Peony Bark.
Danggui (2 liang): Soak in wine, bake dry.
Zhiqiao (2 liang): Bran-fried.
Gancao (Licorice) (1 liang): Roasted.
Grind into powder. Form pills using millet paste, size of mung beans. Adults take 80 pills per dose; children take 50 pills. For red dysentery, take with Dengxin (Juncus) and Wumei decoction. For white dysentery, take with Fresh Ginger and Millet decoction.

Another Formula: Shenling Baizhu San is excellent for post-dysentery recovery. (See Internal Injury category for formula).
Add this base formula with Shichangpu (Acorus) (1 liang) and Muxiang (5 qian). Grind into powder. Take 2 qian with warm water on an empty stomach.