大抵气与水液相冲击而成声。气多则响高，水多则响沉，或无水而有痰食
之闭塞，气闭忽通，则鸣也。气有寒有热，热则气盛，其冲击必有力。寒则气不足，
不足本不能冲击，然郁积久之，则亦必通。观寒凝腹痛者，以炒葱姜盐熨腹，
则腹响而气行痛止，可见也。是故气之和平而流畅者不鸣也，必其或热或寒，
有塞有通而后鸣。经谓热淫所胜，病腹中雷鸣，气上冲胸，治以咸寒。又谓中气不
足，肠为之鸣，脾虚腹满，肠鸣飧泄，食不化是也。胃寒泄泻肠鸣，升阳除湿汤（见
泄泻）加益智仁、半夏、枣、姜。火击水者，二陈（见痰）加芩、连、栀子。水气客于大
肠，疾行则鸣，濯濯如囊裹水之声，河间葶苈丸。
痢由湿热所致。或饮食湿热之物，或感受暑湿之气，（不论外感六淫，内伤七情，饮食劳
倦，皆能致湿热。）积于肠胃，（不论何脏腑之湿热，皆得入肠胃，以胃为中土，主容受
而传之肠也。）则正为邪
阻，脾胃之营运失常。于是饮食日益停滞，化为败浊，胶粘肠胃之中，营运之机，
益以不利。气郁为火，与所受湿热之气，混合为邪，攻刺作痛，此痢症所以腹痛也。
（旧谓肺金之气，郁于大肠间，盖以气属肺为言耳，不必泥定是肺气也。实热者，火性急迫，
不得宣通，其痛必甚。
虚寒则痛微，盖寒闭则痛甚，寒开则痛微。痢者虽滞而不畅，终是开而非闭，虚者少气，
不甚壅故痛微。）邪能伤
正，伤在血分则便血，曰赤痢。（当与肠风参看。）伤在气分则便脓，曰白痢。（脓有二∶一
则胃中津液，
一则水谷汁浆，均为邪火煎熬成脓。观饭食腐败，往往化为白脓可见。而津液稠浊，
上出为痰，下出为脓，尤其明
着。景岳谓是肠间脂膏剥刮而下。不思肠胃之里，并无脂膏，止有涎沫，观猪肠可见矣。
又大肠合肺主气，小肠合
心主血，故古谓血从小肠来，脓从大肠来，不必泥也。）若血气并伤，则赤白兼见。
又或湿盛血
败而色如豆汁，或热极而色见紫黑，（黑而光如漆者，为瘀血，有血丝者亦然。）或久
痢而元气虚
弱，湿痰败浊，色尘腐如屋漏水。（中原盖屋用泥，故漏水尘浊晦黑。）或证转虚寒，色如鱼脑，
如鼻涕，如冻胶。（色同白痢，但有初起后剧，及寒热不同。）或脏腑败坏，面色
如死猪肝鸡肝，
（其色青黯。）此痢之所以有各色也。气既郁滞肠中，则欲升不升，欲降不降，忽而下逼，
火性迫促，竟若不及更衣，然欲降而不能降，虽就圊却无所出。（气郁不宣，则胶固之积不
出，即日食之糟粕，亦销铄胶粘，所出无几。）不降而偏欲降，才净手又要更衣，急迫频并，最是
恼人，是为里急。邪迫肛门，气凝血聚，因而重坠，（亦有脱滑者，必病久乃见。）是为
后重。痢本湿热，痢久阴伤，湿热转成燥热，肛门如火，广肠血枯，虽极力努责，
（责，求也，努力以求其出也。）而糟粕干涩，欲出不能，但虚坐而无所出，是为虚坐努责。泻
痢皆由于湿，而湿有寒热，皆能作泻。痢则因湿热，（若是寒湿，即当洞泄，无结滞不通，
欲出不出等证。）谓痢有因寒湿者，谬也。均之湿热，而或泻或痢，何也？曰∶泻因湿热
骤盛，火性急速，遽迫水谷暴下，不及蒸为腐败，倾盆而出，肠胃即清，故无胶固
垢积。积滞既无，气行弗碍，浊降而清随升，故无里急后重。病发既速，则血
气未伤，故无赤白血脓。痢则初起湿热尚微，积渐乃盛，盛而后发，为日既久，
遂蕴酿出如许证候耳。有先泻后痢者，因湿少热多，湿已泻出，热尚未除，且
泻久亡阴，阴虚又复生热，湿火转成燥火，刮逼肠垢与血而下，故转而为痢也。（古
谓此为脾传肾，以脾恶湿，肾恶燥。此证先湿伤脾，后燥伤肾，故曰脾传肾也。其病为进，
贼邪也。）有先痢后
泻者，因湿多热少，痢久热去，而湿犹存。火与元气不两立，邪热既去，则正气得
复，正不容邪，所余垢积与湿，至是尽行扫荡，（热邪在中，肺气被壅，热去则肺气
下行，化水四
布，有若时雨，沟浍皆盈，垢积尽荡矣。）故转为泻也。（此为肾传脾，其病为退，微邪也。）
夏时受邪，至秋病发，或疟或痢，其流虽异，其源则同。（盖夏月感受风凉，喜
食生冷，风寒客于肌肤，邪正杂处，生冷停于肠胃，湿热相蒸，其时腠理开通，未至
郁闭，胃气升发，未至遏抑。
至秋而气敛火降，邪在肌肤者，被敛而内蒸为疟，在肠胃者，被降而下迫为痢也。）
疟痢并作者，如疟止痢
甚，加腹痛，饮食少进，此虚寒也。疟之止非真止，乃阴胜而阳不敢与争耳，补中
益气汤（见气）加姜、桂。一服愈，如痢止疟复作，乃阳得补而渐伸，能与阴争，故疟复
作，吉兆也。再服前方，以助微阳之力，加附子五钱，一证并除。按此说甚是，然
岂无热陷于里，不与阴争，又岂无热胜寒衰，阴不敢争，故疟止痢甚者乎？一隅三
反，是在明者。（再按疟痢并作，必先治疟，以表有风寒，宜先解表。若先治痢，
恐虚其里，致表邪内陷也。）
疟后痢，乃余邪内伏，或脾气虚下陷使然，谓之似痢非痢。痢后疟，乃气血两
虚，气虚则恶寒，血虚则发热，故寒热交争，谓之似疟非疟。二者俱作虚
治，并用补中益气汤。
凡痢证，有身热者为重，若兼外感者，（外感风寒郁为湿热致痢。）不在此论。苟非外
感，而初起身热，是毒盛于里而达于外也。久痢身热，是阴虚而阳越于外也，故皆
为重证。
呕逆为火邪上冲，亦不宜见此，即防噤口。
噤口，有因积垢壅滞，有因宿食不消，有因热毒上冲，有因停饮上逆，有因
兜涩太早，邪反上干，有因过服寒剂，伤败胃气，以致饮食与药俱不能入，入即
吐，此为危候。胃惫气陷，绝不思食者，不治。
屡止屡发，经年不愈者，名休息痢。多因兜涩太早，积热未清。或过服寒凉，
元气下陷，肾虚不固所致。
时行疫痢，当求其时气而治之。盖必有彼此相同之证候，即其气也。（如皆见身肿，
即为时气之湿也。）
凡痢初起，必无寒证。然其人平素阳虚，元气衰弱，又复过食生冷，以致火郁
蒸成湿热，其标虽热，其本则寒，治当求本。若夫病久气虚，或过服凉剂，转为寒
证，固甚多矣，所当细察。如始见烦渴引饮，喜冷畏热，小便赤涩，面色黄赤，手
足温暖，脉见数盛。久之则心不烦，口不渴，即渴而喜热饮，小水由赤而黄，由黄
而白，面色亦转青白，手足不温而冷，脉变虚弱，则证转虚寒无疑。虚实当辨。如腹痛拒
按者为实，喜按者为虚。脓血稠粘，数至圊而不能便者为实，不及拈衣而即泄出者
为虚。未经泻荡而后重者为实，已经泻荡而仍后重者为虚。邪实之重，粪出少减，
（名粪前坠，滞也。）少顷又重；（邪未尽也。）虚滑之重，粪出愈甚，（名粪后坠。）少顷略
可。（较愈甚时略松
也，气复升故也。）凡痢中所有之证，如烦渴，咽干，舌黑，肿胀，悉有虚实之殊，无
得概指为实，当细别之。
大抵上，声音是由气与水液相互冲击而产生的。气多则声响高亢，水多则声响低沉；或者没有水液而有痰食阻塞，气机闭塞后突然通畅，就会发出鸣响。气有寒热之分，热则气盛，其冲击必然有力；寒则气不足，气本不足以产生冲击，但郁积久了，也必然会寻求通畅。观察那些因寒凝导致腹痛的人，用炒热的葱、姜、盐熨烫腹部，腹部就会作响且气行痛止，由此可见这一道理。因此，气机平和流畅的就不会鸣响，必定是或热或寒，有堵塞又有通畅之后才会鸣响。《内经》说：“热邪过胜，病见腹中雷鸣，气上冲胸”，治疗用咸寒之品。又说：“中气不足，肠为之鸣”，这是指脾虚腹满，肠鸣伴有完谷不化的泄泻（飧泄）。若是胃寒导致的泄泻、肠鸣，可用升阳除湿汤（见泄泻篇）加益智仁、半夏、大枣、生姜。若是火邪击动水液，可用二陈汤（见痰篇）加黄芩、黄连、栀子。若是水气客居于大肠，疾走时就会发出濯濯如囊裹水的声音，可用河间葶苈丸治疗。
痢疾是由湿热所致。或是饮食了湿热之物，或是感受了暑湿之气，（不论外感六淫、内伤七情、饮食劳倦，都能导致湿热。）湿热积于肠胃，（不论何脏腑的湿热，都能进入肠胃，因为胃属中土，主受纳而传导至肠。）正气被邪气阻滞，脾胃的运化功能失常。于是饮食日益停滞，化为败浊，胶粘在肠胃之中，运化的机制更加不利。气郁结化为火，与所受的湿热之气混合成为邪气，攻刺肠道引起疼痛，这就是痢疾腹痛的原因。（旧说认为是肺金之气郁结在大肠之间，这只是从气属于肺的角度来说，不必拘泥于一定是肺气。实热证，火性急迫，不得宣通，疼痛必然剧烈；虚寒证则疼痛轻微，因为寒邪闭阻则痛甚，寒邪开通则痛微。痢疾虽然滞涩不畅，终究是开而非闭，虚证者少气，不甚壅塞所以疼痛轻微。）邪气能损伤正气，伤及血分则便血，称为赤痢。（应当与肠风参照参看。）伤及气分则便脓，称为白痢。（脓有两种：一种是胃中的津液，一种是水谷的汁浆，都被邪火煎熬而成脓。观察饭食腐败，往往化为白脓就可以明白。而津液稠浊，上行则为痰，下行则为脓，这尤其明显。张景岳说是肠间的脂膏剥落而下。他不知道肠胃内部并没有脂膏，只有涎沫，看猪肠就知道了。又大肠合肺主气，小肠合心主血，所以古人说血从小肠来，脓从大肠来，不必拘泥于此。）如果气血都受伤，则赤白兼见。又或者湿气盛而血败，颜色像豆汁；或者热极而颜色呈紫黑色，（黑而光亮如漆的是瘀血，有血丝的也是如此。）或者久痢导致元气虚弱，湿痰败浊，颜色像灰尘腐物如同屋漏水。（中原地区盖屋用泥，所以漏出的水浑浊晦黑。）或者证候转为虚寒，颜色像鱼脑、鼻涕、冻胶。（颜色同白痢，但有初起后加剧，以及寒热性质不同。）或者脏腑败坏，面色像死猪肝、死鸡肝，（颜色青暗。）这就是痢疾出现各种颜色的原因。气既郁滞在肠中，想升不能升，想降不能降，忽然向下逼迫，火性迫促，竟然好像来不及上厕所，然而想降却不能降，即使去了厕所也没有东西排出。（气郁不宣，则胶固的积滞排不出，即使是当天吃的糟粕，也被销铄胶粘，排出的很少。）不想降却偏想降，刚擦干净手又要上厕所，急迫频繁，最是恼人，这叫作“里急”。邪气逼迫肛门，气凝血聚，因而感觉沉重下坠，（也有脱肛滑脱的，必须是病久才见到。）这叫作“后重”。痢疾本是湿热，痢疾日久损伤阴液，湿热转而变成燥热，肛门如火烧，广肠（大肠末端）血枯，虽然极力努责用力，（责，求的意思，努力以求其出。）但糟粕干涩，想出不来，只是空坐而没有东西出来，这叫作“虚坐努责”。泄泻和痢疾都由于湿，而湿有寒热之分，都能导致泄泻。痢疾则是因湿热，（如果是寒湿，就应当是洞泄，不会有结滞不通、欲出不出等证候。）说痢疾有因寒湿引起的，是错误的。同样是湿热，有的表现为泻，有的表现为痢，为什么呢？回答说：泻是因为湿热骤盛，火性急速，立刻逼迫水谷暴下，来不及蒸腾腐败，倾盆而出，肠胃随即清利，所以没有胶固的垢积。积滞既然没有，气行不受阻碍，浊降而清随升，所以没有里急后重。病发既快，则气血未伤，所以没有赤白血脓。痢疾则初起时湿热尚微，逐渐积累才盛，盛了之后才发作，日子久了，于是酝酿出这样的证候。有先泻后痢的，是因为湿少热多，湿已泻出，热尚未除，而且泻久亡阴，阴虚又复生热，湿火转为燥火，刮逼肠垢与血而下，所以转为痢疾。（古人说这是脾传肾，因为脾恶湿，肾恶燥。此证先湿伤脾，后燥伤肾，所以叫脾传肾。病情为进，属于贼邪。）有先痢后泻的，是因为湿多热少，痢久热去，而湿犹存。火与元气不两立，邪热既去，则正气得复，正气不容邪气，剩余的垢积与湿，至此尽行扫荡，（热邪在中，肺气被壅滞，热去则肺气下行，化水四布，有如及时雨，沟渠皆满，垢积尽荡。）所以转为泻。（这是肾传脾，病情为退，属于微邪。）夏季受邪，到秋季发病，或者是疟疾或者是痢疾，其流虽异，其源则同。（大概夏季感受风凉，喜食生冷，风寒客于肌肤，邪正杂处，生冷停于肠胃，湿热相蒸，此时腠理开通，未至郁闭，胃气升发，未至遏抑。到了秋季，气敛火降，邪在肌肤者，被收敛而内蒸为疟，在肠胃者，被下降而下迫为痢。）疟疾和痢疾并作的，如果疟止而痢甚，加上腹痛，饮食少进，这是虚寒证。疟疾的停止不是真正的停止，乃是阴胜而阳不敢与之争罢了，用补中益气汤（见气篇）加生姜、肉桂。一服即愈，如果痢止而疟复作，乃是阳气得到补充而渐渐伸展，能与阴争，所以疟疾复作，这是吉兆。再服前方，以助微阳之力，加附子五钱，一个证候一并消除。按：这种说法很有道理，然而难道没有热陷于里，不与阴争的吗？难道没有热胜寒衰，阴不敢争，所以疟止而痢甚的情况吗？举一反三，在于高明的人。（再按：疟痢并作，必须先治疟，因为表有风寒，宜先解表。如果先治痢，恐怕虚其里，导致表邪内陷。）
疟疾后的痢疾，是余邪内伏，或者是脾气虚下陷所致，叫做似痢非痢。痢疾后的疟疾，是气血两虚，气虚则恶寒，血虚则发热，所以寒热交争，叫做似疟非疟。这两种情况都当作虚证治疗，都用补中益气汤。
凡是痢疾病证，有身热的为重证，如果兼有外感的，（外感风寒郁而为湿热致痢。）不在此讨论。如果不是外感，而初起时身热，是毒盛于里而达于外。久痢身热，是阴虚而阳越于外，所以都是重证。
噤口痢，有因积垢壅滞的，有因宿食不消的，有因热毒上冲的，有因停饮上逆的，有因过早使用兜涩药，邪反上干的，有因过服寒剂，伤败胃气，以致饮食与药都不能入，入即吐，此为危候。胃惫气陷，完全不思饮食的，不治。
屡止屡发，经年不愈的，名叫休息痢。多因过早使用兜涩药，积热未清。或者过服寒凉，元气下陷，肾虚不固所致。
时行疫痢，应当根据时令气候来治疗。必定有彼此相同的证候，就是其气。（如都见身肿，就是时气的湿邪。）
凡是痢疾初起，必定没有寒证。然而其人平素阳虚，元气衰弱，又复过食生冷，以致火郁蒸成湿热，其标虽热，其本则寒，治疗应当求本。至于病久气虚，或者过服凉剂，转为寒证的，固然很多，应当仔细察辨。如开始见烦渴引饮，喜冷畏热，小便赤涩，面色黄赤，手足温暖，脉见数盛。久之则心不烦，口不渴，即使渴而喜热饮，小水由赤而黄，由黄而白，面色亦转青白，手足不温而冷，脉变虚弱，则证候转为虚寒无疑。虚实应当辨别。如腹痛拒按的为实，喜按的为虚。脓血稠粘，多次去厕所而不能排便的为实，不及拈衣而即泄出的为虚。未经泻荡而后重的为实，已经泻荡而仍后重的为虚。邪实之重，粪出后稍减，（名叫粪前坠，是滞涩。）片刻后又重；（邪未尽也。）虚滑之重，粪出愈甚，（名叫粪后坠。）片刻后略可。（比愈甚时略松一些，气复升的缘故。）凡痢疾中所有的证候，如烦渴，咽干，舌黑，肿胀，都有虚实的区别，不得一概指为实证，应当仔细分辨。
Generally, sounds are produced by the mutual impact of Qi (vital energy) and body fluids. When there is more Qi, the sound is high-pitched; when there is more fluid, the sound is deep. Or, in the absence of fluid but with blockage by phlegm and food retention, when the blocked Qi suddenly unblocks, it produces a rumbling sound. Qi can be either cold or hot. Heat causes Qi to flourish, making its impact forceful. Cold causes Qi deficiency; although deficient Qi cannot inherently produce impact, after long-term stagnation, it will inevitably seek an outlet. Observing those with abdominal pain due to cold coagulation, applying fried scallion, ginger, and salt to the abdomen causes abdominal rumbling, allowing Qi to flow and pain to cease, which illustrates this principle. Therefore, when Qi is peaceful and flows smoothly, there is no rumbling; rumbling occurs only when there is heat or cold, obstruction and unblocking. The *Classic* states: "When heat pathogen prevails excessively, disease manifests as abdominal thunder-like rumbling and Qi rushing up to the chest," treated with salty-cold substances. It also states: "When Middle Qi is insufficient, the intestines rumble," referring to Spleen deficiency with abdominal fullness, intestinal rumbling, and diarrhea with undigested food (*Sun Xie*). For diarrhea and intestinal rumbling due to Stomach cold, *Sheng Yang Chu Shi Tang* (Yang-Raising Damp-Resolving Decoction, see Diarrhea) added with *Yi Zhi Ren* (Alpinia Oxyphylla Fructus), *Ban Xia* (Pinelliae Rhizoma), dates, and ginger should be used. If Fire strikes Water, *Er Chen Tang* (Two-Cured Decoction, see Phlegm) added with *Huang Qin* (Scutellariae Radix), *Lian Zi* (Coptidis Rhizoma), and *Zhi Zi* (Gardeniae Fructus) is indicated. If Water-Qi lodges in the Large Intestine, rapid movement produces a gurgling sound like water in a bag, treated with He Jian's *Ting Li Wan* (Descurainiae Semen Pill).
Dysentery is caused by Damp-Heat. It may result from consuming Damp-Heat-inducing foods or contracting summer-Dampness. (Regardless of external contraction of the Six Excesses, internal injury from the Seven Emotions, dietary irregularities, or overwork, all can lead to Damp-Heat.) Damp-Heat accumulates in the intestines and stomach. (Regardless of which Zang-Fu organs' Damp-Heat it originates from, it enters the intestines and stomach because the Stomach belongs to Central Earth, governing reception and transmission to the intestines.) Thus, Righteous Qi is obstructed by Pathogenic factors, and the transportation functions of the Spleen and Stomach become abnormal. Consequently, food and drink increasingly stagnate, transforming into foul turbidity that adheres within the intestines and stomach, further impairing the mechanism of transportation. Qi stagnation transforms into Fire, which mixes with the contracted Damp-Heat to form pathogenic factors that attack and pierce, causing pain; this is why dysentery involves abdominal pain. (Old theories attributed this to Lung Metal Qi stagnating in the Large Intestine, speaking merely from the perspective that Qi belongs to the Lung; one need not rigidly adhere to Lung Qi alone. In excess-heat patterns, the urgent nature of Fire prevents free circulation, resulting in severe pain. In deficiency-cold patterns, pain is mild because cold closure causes severe pain, while cold opening causes mild pain. Although dysentery involves stagnation and lack of smoothness, it is ultimately an opening rather than a closure; in deficiency cases, there is little Qi and less congestion, hence mild pain.) Pathogens can injure Righteous Qi. Injury to the Blood level results in bloody stools, called Red Dysentery. (This should be compared with Intestinal Wind.) Injury to the Qi level results in purulent stools, called White Dysentery. (Pus has two sources: one is the fluids of the Stomach, the other is the juices of food and drink, both boiled down by pathogenic fire into pus. Observing that spoiled food often turns into white pus makes this clear. Moreover, thickened fluids rising become phlegm, while descending become pus, which is quite evident. Zhang Jingyue claimed this was the shedding of intestinal fat. However, he did not realize that the interior of the intestines and stomach contains no fat, only saliva and mucus, as seen in pig intestines. Furthermore, the Large Intestine combines with the Lung to govern Qi, and the Small Intestine combines with the Heart to govern Blood; thus, ancient texts stated blood comes from the Small Intestine and pus from the Large Intestine, which need not be taken literally.) If both Qi and Blood are injured, red and white stools appear together. Alternatively, if Dampness is excessive and Blood deteriorates, the color resembles bean juice; if Heat is extreme, the color appears purple-black. (Black and glossy like lacquer indicates blood stasis; the same applies to stool with blood threads.) Or, in chronic dysentery where Yuan Qi is weak, damp-phlegm and foul turbidity cause the color to resemble dusty, decaying roof leak water. (In central China, roofs are made with mud, so leaked water is muddy and dark.) Or, if the pattern shifts to deficiency-cold, the color resembles fish brain, snot, or jelly. (The color is similar to white dysentery, but differs in onset severity and cold-heat nature.) Or, if Zang-Fu organs deteriorate, the complexion resembles dead pork or chicken liver. (The color is blue-dark.) These explain the various colors seen in dysentery. Since Qi is stagnant in the intestines, it cannot ascend nor descend properly. Suddenly, it forces downward. The urgent nature of Fire creates a sense of urgency, as if one cannot reach the toilet in time, yet despite trying to defecate, nothing comes out. (When Qi stagnation is not resolved, the sticky accumulation cannot exit; even today's waste is dissolved and stuck, with very little output.) Reluctant to descend but forced to descend, one must use the toilet immediately after cleaning hands. This urgency and frequency are most distressing, known as *Li Ji* (Tenesmus). Pathogens press on the anus, causing Qi and Blood to congeal and gather, leading to a sensation of heaviness and bearing down. (There are also cases of prolapse and slipping, which occur only after prolonged illness.) This is known as *Hou Zhong* (Posterior heaviness). Dysentery is fundamentally Damp-Heat. Prolonged dysentery damages Yin, transforming Damp-Heat into Dry-Heat. The anus feels like fire, and the blood in the Large Intestine dries up. Despite straining greatly, (Strain means seeking, exerting effort to expel,) the dry and rough feces cannot exit, resulting in empty straining without output, known as *Xu Zuo Nu Ze* (Empty Straining). Both diarrhea and dysentery arise from Dampness, and Dampness can be cold or hot, both capable of causing diarrhea. Dysentery, however, is due to Damp-Heat. (If it were Cold-Damp, it would present as profuse watery diarrhea, without signs of stagnation, blockage, or difficulty in expulsion.) Claiming that dysentery can be caused by Cold-Damp is erroneous. Why do some present with diarrhea and others with dysentery given the same Damp-Heat? The answer is: Diarrhea occurs because Damp-Heat surges suddenly. The urgent nature of Fire rapidly forces food and water downward before they can ferment and rot, pouring out like a rainstorm, clearing the intestines and stomach, thus leaving no sticky residue. With no accumulation, Qi flows freely, turbidity descends and clarity ascends, so there is no tenesmus or posterior heaviness. Because the disease onset is rapid, Qi and Blood are not yet injured, so there is no bloody or purulent stool. Dysentery begins with mild Damp-Heat, which gradually accumulates until it becomes excessive and then manifests. After many days, such symptoms brew forth. Some have diarrhea first, then dysentery, because there is little Dampness and much Heat. The Dampness is expelled via diarrhea, but Heat remains. Prolonged diarrhea consumes Yin, and Yin deficiency generates further Heat, turning Damp-Fire into Dry-Fire, which scrapes intestinal residue and blood downward, transforming into dysentery. (Ancient theory calls this Spleen transmitting to Kidney, as Spleen dislikes Dampness and Kidney dislikes Dryness. This pattern first injures Spleen with Dampness, then Kidney with Dryness, hence Spleen transmitting to Kidney. The disease progresses, representing a "robber pathogen.") Some have dysentery first, then diarrhea, because there is much Dampness and little Heat. After prolonged dysentery, Heat dissipates, but Dampness remains. Fire and Original Qi cannot coexist. Once pathogenic Heat is gone, Righteous Qi recovers. Righteous Qi does not tolerate pathogens, sweeping away remaining residue and Dampness. (With Heat pathogen in the middle, Lung Qi is congested. When Heat clears, Lung Qi descends, distributing fluids like timely rain, filling ditches, and washing away all residue.) Thus, it transforms into diarrhea. (This is Kidney transmitting to Spleen; the disease retreats, representing a "minor pathogen.") Pathogens contracted in Summer manifest in Autumn, as either malaria or dysentery. Though their manifestations differ, their source is the same. (Generally, in Summer, one contracts wind-cold and enjoys raw/cold foods. Wind-cold lodges in the skin and muscles, mixing with righteous Qi, while raw/cold foods stop in the intestines and stomach. Damp-Heat steams together. At this time, pores are open, not yet closed; Stomach Qi rises and is not suppressed. By Autumn, Qi converges and Fire descends. Pathogens in the skin/muscles are drawn inward and steam to become malaria; pathogens in the intestines/stomach are driven downward to become dysentery.) When malaria and dysentery occur together, if malaria stops but dysentery worsens, accompanied by abdominal pain and poor appetite, this is a deficiency-cold pattern. The cessation of malaria is not true cessation, but rather Yin prevailing while Yang dares not contend. Use *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction, see Qi) added with ginger and cinnamon. One dose cures it. If dysentery stops but malaria recurs, it means Yang has been tonified and is gradually extending, able to contend with Yin, so malaria recurs. This is an auspicious sign. Take the previous formula again to assist the weak Yang, adding five qian of *Fu Zi* (Aconiti Lateralis Radix Praeparata), curing both conditions. Note: This explanation is sound, but are there not cases where Heat sinks into the interior and does not contend with Yin? Are there not cases where Heat exceeds and Cold declines, so Yin dares not contend, causing malaria to stop and dysentery to worsen? Draw inferences about other cases from this one instance; this depends on the wisdom of the practitioner. (Note again: When malaria and dysentery occur together, treat malaria first because there is wind-cold in the exterior, requiring exterior resolution. If dysentery is treated first, it may weaken the interior, causing exterior pathogens to sink inward.)
Dysentery following malaria is due to residual pathogens lurking internally or Spleen Qi deficiency sinking, termed "pseudo-dysentery." Malaria following dysentery is due to dual deficiency of Qi and Blood. Qi deficiency causes aversion to cold; Blood deficiency causes fever. Thus, alternating chills and fever occur, termed "pseudo-malaria." Both are treated as deficiency patterns using *Bu Zhong Yi Qi Tang*.
In all dysentery cases, those with fever are serious. If accompanied by external contraction (external wind-cold constrained transforming into Damp-Heat causing dysentery), this is not discussed here. If not externally contracted, initial fever indicates abundant toxins in the interior reaching the exterior. Fever in chronic dysentery indicates Yin deficiency with Yang floating outward; thus, both are serious patterns.
Vomiting and belching indicate Fire pathogen rushing upward; seeing this symptom warns against impending "Jin Kou" (closed-mouth) dysentery.
"Jin Kou" dysentery (anorexia/nausea preventing intake) arises from: accumulation blocking stagnation; retained food not digesting; toxic heat rushing upward; retained fluids reversing upward; premature use of astringents causing pathogens to rise; or excessive use of cold medicines damaging Stomach Qi, rendering both food and medicine intolerable, leading to immediate vomiting upon ingestion—a critical condition. If Stomach fatigue and Qi sinking result in complete loss of appetite, it is incurable.
Dysentery that repeatedly stops and recurs, lasting years, is named "Resting Dysentery." It is often caused by premature astringency leaving accumulated heat uncleared, or excessive use of cold herbs causing Yuan Qi to sink and Kidney deficiency failing to secure.
Epidemic dysentery occurring in specific seasons should be treated according to the seasonal Qi. There must be identical symptoms among patients, indicating the specific pathogenic Qi. (For example, if everyone presents with edema, it indicates seasonal Dampness.)
All initial dysentery cases lack cold patterns. However, if a person is constitutionally Yang-deficient with weak Yuan Qi and consumes excessive raw/cold foods, Fire constraint steams to create Damp-Heat. Although the branch is heat, the root is cold; treatment must address the root. Conversely, prolonged illness with Qi deficiency or excessive use of cooling agents may transform into cold patterns, which are common and require careful differentiation. Initial signs include irritability, thirst with desire for cold drinks, aversion to cold, red/scanty urine, yellow-red complexion, warm extremities, and rapid/full pulse. Over time, irritability ceases, thirst disappears (or desire for hot drinks emerges), urine changes from red to yellow to white, complexion turns blue-white, extremities become cool/cold, and pulse becomes weak/deficient. The pattern undoubtedly shifts to deficiency-cold. Differentiate between deficiency and excess. Abdominal pain that rejects pressure indicates excess; pain relieved by pressure indicates deficiency. Thick, sticky pus and blood with frequent trips to the toilet unable to pass indicates excess; involuntary leakage without wiping indicates deficiency. Posterior heaviness before evacuation indicates excess; posterior heaviness persisting after evacuation indicates deficiency. In excess-type heaviness, stool output slightly relieves the sensation (called "pre-stool bearing-down"), but heaviness returns shortly after (pathogen not exhausted). In deficiency-slippery heaviness, stool output worsens the sensation (called "post-stool bearing-down"), but it relaxes slightly after a moment (Qi rises again). All symptoms in dysentery, such as irritability/thirst, dry throat, black tongue, and swelling, have deficiency/excess distinctions. Do not generally label them all as excess; differentiate carefully.