Library

Dysentery was anciently known as "Zhi Xia" (Stagnant Downward Flow), also called "Chang Pi" (Intestinal Mucus Discharge). This is because the stagnation and涩滞 (astringency/stagnation) of the intestinal organs result in frequent but unsatisfactory defecation accompanied by borborygmus (bowel sounds). The stool may be red, white, or a mixture of both; it may consist of intestinal mucus without undigested food, or mixed with undigested food. Although there are differences regarding the presence or absence of pain, all cases present with tenesmus (urgent desire to defecate with heavy sensation in the anus and incomplete evacuation), which is distressing and aggravating.

Ancient texts distinguished dysentery based on the principle that red indicates heat and white indicates cold, and further categorized five colors corresponding to the five Zang organs. However, the cold-heat nature of the Zang and Fu organs should be determined by correlating pulse and symptoms. While these previous theories exist for reference, rigidly adhering to them to diagnose diseases is limiting.

The *Zhun Sheng* (Standard for Medical Practice) states that tenesmus caused by pathogenic factors pressing down on the large intestine should be treated with substances like Da Huang (Rhubarb Rhizome) and Bing Lang (Areca Seed). Examples include Luo Qianfu's Shui Zhu Mu Xiang Gao (Boiled Aromatic Wood Paste) and Li Dongyuan's Bai Zhu An Wei San (Atractylodes Macrocephala Stomach-Calming Powder). By purging the compressing pathogens, tenesmus will naturally resolve. If the pathogens have been purged but the heaviness remains, it indicates deficiency and slipping of the large intestine, unable to contract itself, causing heaviness. In such cases, astringents like Yu Mi Ke (Pericarpium Papaveris) should be used to secure the slipping and gather the Qi. Such treatment can also lead to recovery. Although this reasoning is sound, one must note that both Shui Zhu Mu Xiang Gao and Bai Zhu An Wei San use Yu Mi Ke as the sovereign drug and contain Wu Mei (Mume Fruit), Wu Wei Zi (Schisandra Berry), Bai Shao (White Peony Root), and He Zi (Chebula Fruit), but do not contain Bing Lang or Da Huang. To claim they require Da Huang and Bing Lang suggests a lack of careful examination.

It is further stated: Tenesmus due to pathogenic sinking does not decrease after defecation; tenesmus due to large intestine deficiency and slipping decreases immediately after defecation. I argue: Tenesmus from pathogenic sinking should decrease after defecation; tenesmus from deficiency and slipping should not decrease. The original text reverses this, which is an error.

It is also stated: Rest dysentery often results from prematurely using astringents to trap accumulated stagnation, leading to intermittent episodes. It is suitable to take Zhu Che Wan (Stop Dysentery Pill) swallowed with Si Jun Zi Tang (Four Gentlemen Decoction), then administer drugs to remove accumulation, and finally use astringents. Note: Neither Si Jun Zi Tang nor Zhu Che Wan are formulas for removing accumulation, although the reasoning is fundamentally correct.

Bai Du San (Detoxification Powder) disperses wind-dampness, and Yi Yuan San (Benefit Primordial Powder) clears and benefits against heat pathogens; therefore, both treat fever accompanied by diarrhea/dysentery.

General principles for treating dysentery: For tenesmus, use purgation; for abdominal pain, use harmonization; for heavy body, eliminate dampness; for wiry pulse, dispel wind; for thick and sticky pus and blood, use heavy agents to exhaust the pathogen; for cold body and spontaneous sweating, use toxic/warm agents to warm; for internal contraction of wind pathogens, induce sweating for cure; for watery stools indicating diarrhea, apply warming. Furthermore: For exterior conditions, use diaphoresis; for interior conditions, use purgation; for upper conditions, use emesis; for lower conditions, use exhaustion/clearance; for internal heat manifesting externally, use internal drainage; for astringent urination, use differentiation and promotion of urination; for excess conditions, use harmonization; for depleted conditions, use support; for excessive conditions, use astringency.

Furthermore: For injuries from cold and raw foods, use warm and hot agents to digest and guide out; for injuries from damp-heat, use bitter-cold agents to internally drain; for internal depression of wind pathogens, use lifting and raising; for internal abundance of dampness, use differentiation and promotion of urination; for urgency, use purgation; for tenesmus, regulate Qi; for abdominal pain, harmonize; for profuse diarrhea with bowel sounds, weakness, inability to lift clothes, and fine, thin, weak pulses, use warming and astringing; for thick and sticky pus and blood, frequent visits to the toilet with inability to pass stool, and surging, large, and forceful pulses, use purgation and cooling.