（《素问·通评虚实论》 附∶痢疾治法）
帝曰∶肠 便血何如？岐伯曰∶身热则死，寒则生。（肠 ，滞下也，利而不利之谓。便血，赤利也。身热者，阳胜
阴败，故死。寒则营气未伤，故生。 音匹。）帝曰∶肠 下白沫何如？岐伯曰∶脉沉则生，脉浮则死。（白沫，白利也。
病在阴而见阴脉者为顺，故生。见阳脉者为逆，故死。）帝曰∶肠 下脓血何如？岐伯曰∶脉悬绝则死，滑大则生。（下
脓血者，兼白赤而言也。悬绝者，谓太过则坚而搏，不足则微而脱，皆胃气去而真藏见也，邪实正虚，势相悬绝，故死。
滑因血盛，大以气充，血气未伤，故生。）帝曰∶肠 之属，身不热，脉不悬绝何如？岐伯曰∶滑大者曰生，悬涩者曰死，
以藏期之。（以藏期之者，肝见庚辛死，心见壬癸死，肺见丙丁死，脾见甲乙死，肾见戊己死也。愚按∶肠 一证，即今
之所谓痢疾也。自仲景而后，又谓之滞下。其所下者，或赤或白，或脓或血，有痛者，有不痛者，有里急后重者，有呕
恶胀满者，有噤口不食者，有寒热往来者。虽其变态多端，然总不外乎表里寒热，而尤于虚实之辨更为切要，知此六者，
庶不致杀人矣。若以表里言之，如《论疾诊尺》等篇曰∶春伤于风，夏为后泄肠 。《百病始生篇》曰∶虚邪之中人也，
留而不去，传舍于肠胃之间，多寒则肠鸣飧泄，食不化，多热则溏出糜。是皆由于外邪，此实时气相传之属也。凡邪因
表者必有表证，但兼其表而行散之，表邪解而痢自愈。如无表证，则必由口腹，悉属内伤。但伤于内者极多，因于表者
则间或有之，此内外之不可不辨也。若以寒热言之，则古以赤者为热，白者为寒。至刘河间而非之曰∶如赤白相兼者，
岂寒热俱甚于肠胃而同为痢乎？盖泻白者肺之色也，青者肝之色也，黄者脾之色也。赤者心之色也。至若色黑亦言为热
者，由火热过极，则反兼水化制之，故色黑也。或言痢色青白为寒者，误也。若果为寒，则不能消谷，何由反化为脓乎？
又曰∶若完谷不化而色不变，吐利腥秽，澄澈清冷，小便青白不涩，身凉不渴，脉迟细而微者，寒证也。凡谷消化者，
无问色及他证，便为热也。故其言治，则曰苦能燥湿，寒能胜热，或微加辛热以佐之。又云∶治诸痢者，黄连、黄柏为
君，以至苦大寒，正主湿热之病。又曰∶行血则便自愈，调气则后重除。是皆河间之说也。及至丹溪则因之曰∶赤痢乃
自小肠来，白痢乃自大肠来，皆湿热为本。自二子之言出，则后世莫敢违之。虽二家方书，非无从温之治，然亦不过备
立言之缺略，而其大意则专以湿热为主。故今之医家悉遵其训，一见痢证，无分寒热虚实，咸谓欲清其火，非芩、连、
栀、柏不可；欲去其积，非大黄、芒硝不可；欲行血者，必用桃仁、红花之类；欲利水除湿者，必用五苓、益元之类；
欲调气行滞者，必用木香、槟榔、枳实、浓朴之类；欲和血凉血者，必用当归、生地、芍药、地榆之类。朝更夕改，不
过如此，及至濒危，犹云湿热未除，积滞未尽，举世皆然，可胜其害。兹以愚见，则大有不然。夫疟痢发于夏秋，本因
溽暑，岂云非热？但炎蒸之令，出乎天也，苟能顺天之气，焉得为病？惟因热求凉而过于纵肆，则病由乎人耳。故凡风
寒之中于外者，其邪在经，病多为疟；生冷之伤于内者，其邪在脏，病多为痢；或表里俱伤，则疟痢并作。未有不中于
寒而为疟为痢者，此致病之本，其为寒为热可知也。若暑湿之郁，久则成热，所以痢多热证，此固自然之理；然有偶因
瓜果，过伤生冷，未及郁积，随触而痢者，岂郁热耶？又有素慎口腹，或中雨水之阴寒，或因饮食之相犯者，皆能致痢，
是又何热之有哉？至有年有衰迈，禀有素弱，则尤易于染，此等极多，岂皆热证？且凡病痢者，必有脓血，使无脓血，
焉得为痢？盖伤其脏腑之脂膏，动其肠胃之脉络，故或寒或热皆能脓血，若谓脓必因热，岂痢疾绝无寒证耶？使必待完
谷不化，痢色不变及澄彻清冷等证，始认为寒，则其阳已尽去，脾已尽败，几于危矣，岂无其渐而遽至是哉？不知致此
之始，即寒证也。矧痢因于湿，湿生于土。夫五行之理，热因火化，寒因水化，此阴阳之不易者也。惟湿土寄王于四者
之中，故从乎火，则阳土有余而湿热为病，从乎水，则阴土不足而寒湿生灾。若但言湿热而不言寒湿，岂非医家之误乎？
至以白赤分寒热，此自古法，本不为谬。而河间乃谓白者属肺，赤者属心。盖言白主于气，赤主于血，是亦理也。若以
愚见言之，则赤中岂必无白，白中岂必无赤，赤白相兼者，岂真寒热同病乎？但其清浊微甚，自有阴阳可辨耳。虽赤痢
亦有寒证，然终是热多；白痢亦有热证，然终是寒多。其有白而热者，则脉证必热，赤而寒者，则脉证必寒，亦易辨也。
若谓白必属肺，恐白痢非无血化；赤必属心，恐血痢不离乎气也。观《局方》之治痢，则例用温热，河间之治痢，则专
用苦寒，何其相去之远耶？未免各有所偏，皆失中和之道矣，此寒热之不可不辨也。再以虚实言之，如头疼身热，筋骨
酸痛者，表邪之实也；胀满恶实，急痛拒按者，里邪之实也；烦渴引饮，喜冷畏热者，阳邪之实也；举按滑数，来往有
力者，脉息之实也；火土之胜，而见敦阜、赫曦之化者，时气之实也。舍此之外，则无可言实，多属虚矣。今有以口渴
为实热者，不知凡系泻痢，必亡津液，液亡于下，则津涸于上，焉得不渴？故当以喜热喜冷分虚实也。有以腹痛为实者，
不知痢出于脏，则肠胃必有损伤，脓血切肤，安能无痛？故当以痛之缓急、按之可否、脏之阴阳、腹之胀与不胀分虚实
也。有以小水之黄赤短少为实热者，不知水从痢去，溲必不长，汁以阴亡，溺因色变，故当以便之热与不热、液之涸与
不涸分虚实也。有以里急后重为实热者，但知湿热壅于大肠，因而重坠，不知气陷则仓廪不藏，阴亡则门户不摄，故当
以病之新久、质之强弱分虚实也。若邪正不明，则祸如反掌，此虚实之不可不辨也。再以治法言之，则当必求其所感之
邪，所受之藏，以明致病之本，其他所变，皆为标也。如因于湿热者，去其湿热则愈；因于积滞者，去其积滞则愈。因
于气者调其气，因于血者和其血。新感而实者，可以通因通用；久病而虚者，当以塞因塞用。是皆常法，无待言矣。第
见今人之病痢者，虚常六七；而今之治痢者，补无一二焉。若气本陷矣，而复行其气，后重不将甚乎？中本虚矣，而再
攻其积，元气不将竭乎？湿热伤血，自宜调血，若过用推陈，血愈伤矣。津亡作渴，自宜止泄，若专于渗利，津愈耗矣。
使必待血清痛止而后补，则事已无及矣。此无他，特以本末未明，故但据见在者为有形之疾病，而不知可虑者在无形之
元气也。夫元气既虚，不补将何以复？诸当补者，自有所据，请尽悉之。凡脉息微弱者可补，知其非实邪也。形体虚羸
者可补，知其不可攻也。口腹素慎者可补，知其本无所积也。胸膈宽快者可补，知其中无留滞也。因病后而偶感者可补，
以元气之有所伤也。因攻伐而愈剧者可补，以攻所不当攻也。后重之可补者，陷则升而补之，热则凉而补之。腹痛之可
补者，滑泄则涩而补之，虚寒则温而补之。凡阳邪盛则阴虚者病，非纯美甘凉之剂，不足以养藏气。阴邪胜则阳虚者病，
非辛甘温浓之剂，不足以回元阳。是皆用补之法也。然尤有其要，则在脾肾二脏，不可不辨。如《卫生宝鉴》曰∶太阴
主泻，传于少阴为痢，此正言脾肾也。盖泻因于脾，其邪犹浅；传于肾而为痢，病则甚矣。夫肾为胃关，开窍于二阴，
未有久痢而不亡阴者，亦未有阴亡而肾不虚者，欲治痢而不治阴，非其治也。故如四君、归脾、补中、十全之类，皆治
脾虚之剂，非为不善；若病在化源，势属危急，使非大补命门，以复肾中之阳，以壮脾土之母，则真阴何由以复？门户
何由以固？所谓川源不能实，漏卮不能满，将何益于事哉？近惟薛立斋独得其义，欲相资借，当并察其医按。）
黄帝问道：患肠澼（痢疾，指大便滞涩不通或下利不止的病证）而便血，预后如何？岐伯回答说：如果身体发热，预后不良；如果不发热，预后良好。（肠澼，即滞下，指里急后重、排便不畅的症状。便血，即赤痢，排出红色血液。身体发热，说明阳气亢盛而阴气败绝，所以预后不良。不发热，说明营气未受损伤，所以预后良好。“澼”音同“匹”。）
黄帝问道：患肠澼而下白沫，预后如何？岐伯回答说：脉象沉伏的预后良好，脉象浮散的预后不良。（白沫，即白痢。病在阴分而见到阴脉，属于顺证，所以预后良好。见到阳脉，属于逆证，所以预后不良。）
黄帝问道：患肠澼而下脓血，预后如何？岐伯回答说：脉象悬绝（极度异常，或过于强劲搏指，或极其微弱欲脱）的预后不良，脉象滑大（流利且宽大）的预后良好。（下脓血，是兼有白痢和赤痢而言。所谓悬绝，是指脉气太过则坚硬搏指，不足则微弱欲脱，这都是胃气已去、真脏脉现的表现，邪气实而正气虚，形势悬殊对立，所以预后不良。脉滑是因为血气旺盛，脉大是因为气机充盛，血气未受损伤，所以预后良好。）
黄帝问道：患肠澼这类疾病，如果身体不发热，脉象也不悬绝，预后如何？岐伯回答说：脉象滑大的预后良好，脉象悬而涩滞的预后不良，可以根据五脏之气衰竭的时间来推断死亡期限。（所谓根据五脏之气衰竭的时间来推断，是指肝气绝死于庚辛日，心气绝死于壬癸日，肺气绝死于丙丁日，脾气绝死于甲乙日，肾气绝死于戊己日。我按语：肠澼这一病症，就是现在所说的痢疾。自张仲景之后，又被称为滞下。所排出的东西，有的红，有的白，有的化脓，有的出血，有的腹痛，有的不痛，有的里急后重，有的呕吐恶心胀满，有的噤口不食，有的寒热往来。虽然病情变化多端，但总不外乎表里寒热，而在虚实辨别上更为关键，懂得这六个方面，大概就不会误杀人了。如果从表里来说，如《论疾诊尺》等篇说：春季伤于风邪，夏季就会发生后泄和肠澼。《百病始生篇》说：虚邪侵入人体，停留不去，传舍在肠胃之间，寒气多则肠鸣飧泄，食物不消化；热气多则排出稀烂粪便。这些都是由于外邪所致，属于时气相传的类型。凡是邪气从体表入侵的，必然有表证，只要兼解其表邪而发散之，表邪解除而痢疾自然痊愈。如果没有表证，则必定是由饮食内伤引起，都属于内伤。但是内伤的情况极多，因外感表邪引起的则间或有之，这是内外病因不可不辨别的。如果从寒热来说，古代认为红色属热，白色属寒。到了刘河间却反对这种说法，他说：如果是赤白相兼，难道寒热都严重地存在于肠胃中并共同导致痢疾吗？他认为泻出白色的是肺的颜色，青色是肝的颜色，黄色是脾的颜色，红色是心的颜色。至于说黑色也属热，是因为火热过极，反而兼有水化的制约，所以呈现黑色。有人说痢疾颜色青白属寒，这是错误的。如果真的是寒证，就不能消化谷物，怎么能反化为脓呢？他又说：如果是完谷不化且颜色不变，呕吐腹泻气味腥臭，排泄物清澈寒冷，小便清长而不涩，身体凉爽不口渴，脉象迟细而微的，才是寒证。凡是谷物能消化的，无论颜色和其余症状，都属热证。所以他提出的治法是：苦味能燥湿，寒性能胜热，或者稍微加一点辛热药来佐助。又说：治疗各种痢疾，以黄连、黄柏为君药，用极苦大寒之性，正主治湿热之病。又说：行血则便血自愈，调气则后重消除。这些都是河间的学说。等到朱丹溪，便沿袭他的说法，认为赤痢来自小肠，白痢来自大肠，都是以湿热为本。自从这两位学者的言论出现后，后世没有人敢违背。虽然两家的方书中，并非没有温补的治疗方法，但也只是补充立言的缺漏，其主要大意还是专主湿热。所以现在的医生都遵循他们的教导，一见到痢疾证候，不分寒热虚实，都认为要清除火邪，非用黄芩、黄连、栀子、黄柏不可；要去除积滞，非用大黄、芒硝不可；要行血的，必用桃仁、红花之类；要利水除湿的，必用五苓散、益元散之类；要调气行滞的，必用木香、槟榔、枳实、厚朴之类；要和血凉血的，必用当归、生地、芍药、地榆之类。早晚更替改变，不过如此，等到病情危重时，还说是湿热未除，积滞未尽，举世皆然，这种危害怎能说得尽呢？依我愚见，大有不同。疟疾和痢疾发于夏秋季节，本来是因为暑湿，难道能说不是热证吗？但是炎蒸的气候，出自天时，如果能顺应天时的气候，怎么会生病呢？只是因为贪热求凉而过于放纵肆意，才导致疾病由人自身产生。所以凡是风寒侵袭体外的，邪气在经络，病多为疟疾；生冷损伤体内的，邪气在脏腑，病多为痢疾；如果表里都受伤，则疟疾和痢疾同时发作。没有不中寒邪而得疟疾或痢疾的，这是致病的根本，其为寒为热是可以知道的。如果暑湿郁结，久了会变成热，所以痢疾多属热证，这固然是自然的道理；然而也有偶尔因为瓜果，过度损伤生冷，来不及郁积，随即接触就发病的，难道是郁热吗？又有平时注意饮食节制，或者中了雨水的阴寒，或者因为饮食相互冲突的，都能导致痢疾，这又有什么热呢？至于年老体衰，禀赋素来虚弱的人，更容易感染，这种情况很多，难道都是热证吗？而且凡是患痢疾的，必然有脓血，如果没有脓血，怎么能叫痢疾呢？这是因为损伤了脏腑的脂膏，动摇了肠胃的脉络，所以无论是寒证还是热证都能出现脓血，如果说脓血必定是因为热，那难道痢疾绝无寒证吗？如果一定要等到完谷不化、痢色不变以及排泄物清澈寒冷等症状出现，才开始认为是寒证，那么此时阳气已经耗尽，脾气已经完全败坏，几乎处于危险境地了，难道没有渐进的过程而突然达到这种地步吗？不知道导致这种结果的开始，就是寒证。况且痢疾因为湿气，湿气生于土。五行的道理，热因火化，寒因水化，这是阴阳不变的规律。只有湿土寄旺于四季之中，所以随火化，则阳土有余而成为湿热病；随水化，则阴土不足而产生寒湿灾祸。如果只说湿热而不说寒湿，岂不是医家的错误吗？至于用白色和红色来区分寒热，这是自古以来的方法，本来不算错误。而河间却说白色属肺，红色属心。大概意思是白色主气，红色主血，这也是合理的道理。依我愚见来看，红色中难道一定没有白色吗？白色中难道一定没有红色吗？赤白相兼的，难道真是寒热同病吗？只是清浊的轻重程度不同，自有阴阳可以辨别罢了。虽然赤痢也有寒证，但终究热多；白痢也有热证，但终究寒多。其中有白色而属热的，则脉证必然表现为热；有红色而属寒的，则脉证必然表现为寒，也容易辨别。如果说白色必定属肺，恐怕白痢并非没有血的转化；如果说红色必定属心，恐怕血痢离不开气的运行。看《局方》治疗痢疾，则例用温热药；河间治疗痢疾，则专用苦寒药，为什么相差这么远呢？未免各有所偏颇，都失去了中和之道，这是寒热不可不辨别的。再从虚实来说，如头疼身热，筋骨酸痛，是表邪实证；胀满恶实，急痛拒按，是里邪实证；烦渴引饮，喜冷畏热，是阳邪实证；举按滑数，来往有力，是脉息实证；火土之气胜，而出现敦阜、赫曦的变化，是时气实证。除了这些之外，就没有什么可说是实证的，大多属于虚证。现在有把口渴当作实热的，不知道凡是泻痢，必然亡失津液，津液亡失于下，则津液枯竭于上，怎么会不渴呢？所以应当以喜欢热饮还是冷饮来区分虚实。有把腹痛当作实证的，不知道痢疾出于脏腑，则肠胃必然有损伤，脓血切割肌肤，怎么能不痛呢？所以应当以疼痛的缓急、按压是否舒适、脏腑的阴阳、腹部的胀与不胀来区分虚实。有把小便黄赤短少当作实热的，不知道水分随着痢疾流失，小便必然不长，汁液因为阴液亡失，尿液因此变色，所以应当以大便的热与不热、津液的枯竭与不枯竭来区分虚实。有把里急后重当作实热的，只知道湿热壅塞于大肠，因而沉重坠胀，不知道气陷则仓廪不能藏纳，阴亡则门户不能摄持，所以应当以病程的新久、体质的强弱来区分虚实。如果邪正不明，则祸患如反掌之间，这是虚实不可不辨别的。再从治法来说，则必须探求所感受的邪气，所受损的脏腑，以明确致病的根本，其他的变化，都是标症。如果是因湿热引起的，去除湿热就好了；因积滞引起的，去除积滞就好了。因气滞的调理气机，因血伤的调和血液。新感而属实证的，可以用通因通用的方法；久病而属虚证的，应当用塞因塞用的方法。这些都是常规法则，无需多言。只是看到现在人患痢疾的，虚证常占六七成；而现在治疗痢疾的，补法的运用却不到一二成。如果气本已下陷，反而再行气，后重不是更加严重吗？中气本已虚弱，反而再攻伐积滞，元气不是将要竭尽吗？湿热损伤血液，自然应该调血，如果过分使用推陈致新的药物，血液会更加受伤。津液亡失导致口渴，自然应该止泻，如果专门使用渗利药物，津液会更加耗损。如果一定要等到血清痛止之后才进行补益，那就已经来不及了。这没有其他原因，特别是不明白本末，所以只根据现有的有形疾病，而不知道值得忧虑的是无形的元气。既然元气已经虚弱，不补又将靠什么恢复呢？所有应当补益的情况，自然有其依据，请让我详细列举。凡是脉象微弱的可以补，知道这不是实邪。形体虚弱的可以补，知道不可以攻伐。口腹素来谨慎的可以补，知道本无积滞。胸膈宽畅舒适的可以补，知道其中没有留滞。因病后偶然感染的可以补，因为元气有所损伤。因攻伐治疗后病情加重的可以补，因为攻伐了不该攻伐的地方。后重可以补的，气陷则升提而补之，有热则清凉而补之。腹痛可以补的，滑泄则收敛而补之，虚寒则温补而补之。凡是阳邪盛导致阴虚的，如果不是纯美甘凉的药剂，不足以滋养脏气。阴邪胜导致阳虚的，如果不是辛甘温厚的药剂，不足以回复元阳。这些都是用补的方法。然而尤其重要的是，在于脾肾二脏，不可不辨别。如《卫生宝鉴》说：太阴主泻，传变到少阴成为痢疾，这正是指脾肾。因为泻因于脾，邪气尚浅；传变到肾成为痢疾，病势就严重了。肾是胃的关口，开窍于前后二阴，没有久痢而不亡阴的，也没有阴亡而肾不虚的，想要治疗痢疾而不治肾阴，不是正确的治疗方法。所以像四君子汤、归脾汤、补中益气汤、十全大补汤之类的，都是治疗脾虚的药剂，并非不好；但是如果病在化源，形势危急，如果不是大补命门，以恢复肾中的阳气，以壮脾土之母，那么真阴从哪里恢复？门户从哪里固摄？所谓源头不能充实，漏斗不能装满，这对事情有什么益处呢？近来只有薛立斋独自领悟了这个义理，想要相互借鉴，应当一并参考他的医案。）
(Su Wen: Treatise on Reviewing Excess and Deficiency in General, Appendix: Treatment Methods for Dysentery)
The Yellow Emperor asked: What is the prognosis for Changpi (Intestinal Turbidity/Dysentery) presenting with hematochezia (blood in stool)? Qibo replied: If the body is hot, death ensues; if the body is cold (afebrile), life is preserved. (Changpi refers to "Zhi Xia" (stagnant downward flow), characterized by tenesmus or difficult defecation. Hematochezia refers to red dysentery. Body heat indicates yang excess and yin exhaustion, hence death. Afebrile condition indicates that Ying Qi (nutritive energy) remains undamaged, hence survival. The character Pi is pronounced 'pi'.)
The Yellow Emperor asked: What is the prognosis for Changpi presenting with white mucus? Qibo replied: A sinking pulse indicates survival; a floating pulse indicates death. (White mucus refers to white dysentery. When the disease is in the Yin aspect and presents with a Yin pulse, it is a favorable sign, hence survival. Presenting with a Yang pulse is an unfavorable sign, hence death.)
The Yellow Emperor asked: What is the prognosis for Changpi presenting with pus and blood? Qibo replied: A hanging and severed pulse (extreme abnormality) indicates death; a slippery and large pulse indicates survival. (Pus and blood refer to a combination of white and red dysentery. "Hanging and severed" means either excessively strong and hard/beating, or extremely weak and fading; both indicate the departure of Stomach Qi and the appearance of the True Zang pulse. With pathogenic excess and healthy deficiency, the situation is diametrically opposed, hence death. A slippery pulse indicates abundant blood; a large pulse indicates abundant Qi. Since blood and Qi are not damaged, survival is indicated.)
The Yellow Emperor asked: In cases of Changpi, if the body is not hot and the pulse is not hanging/severed, what is the prognosis? Qibo replied: A slippery and large pulse indicates survival; a hanging and choppy pulse indicates death. One can predict the time of death based on the Zang organs. (Predicting based on Zang organs means: Liver failure occurs on Geng/Xin days; Heart failure on Ren/Gui days; Lung failure on Bing/Ding days; Spleen failure on Jia/Yi days; Kidney failure on Wu/Ji days. My commentary: The syndrome of Changpi is what is now called dysentery. Since Zhang Zhongjing, it has also been called "Zhi Xia". The excretions may be red or white, purulent or bloody; there may be pain or no pain, tenesmus, vomiting, nausea, abdominal distension, inability to eat due to throat constriction ("Jin Kou"), or alternating chills and fever. Although manifestations are varied, they ultimately fall under exterior-interior and cold-heat categories, with the distinction between excess and deficiency being particularly crucial. Understanding these six aspects will prevent fatal errors. Regarding exterior-interior: As stated in chapters like "Diagnosing Disease by Observing the Forearm", wind injury in spring leads to late diarrhea and Changpi in summer. In "Chapter on the Origin of All Diseases", it says when deficient pathogens enter and remain, transmitting to the intestines and stomach, excessive cold causes borborygmus and un-digested stool, while excessive heat causes loose, mushy stools. These result from external pathogens, belonging to seasonal transmission. Any pathogen entering via the exterior must have exterior signs; resolving the exterior pathogen allows the dysentery to heal spontaneously. Without exterior signs, it must stem from dietary/internal injury. Internal injuries are common; external ones are rare. Thus, distinguishing internal from external causes is essential. Regarding cold-heat: Ancient texts held red as heat and white as cold. Liu Hejian refuted this, asking if mixed red-and-white implies both cold and heat severely affecting the intestines simultaneously. He argued white represents Lung color, green Liver, yellow Spleen, red Heart. Black is also considered heat because extreme fire mimics water transformation. Claiming green/white dysentery is cold is erroneous; true cold cannot digest grain into pus. He further stated: Complete undigested food with unchanged color, foul vomiting/diarrhea, clear/cold excretions, clear urine without strangury, cool body without thirst, and slow/thin/fine pulse indicate cold syndrome. Digestion of grain indicates heat regardless of other signs. His treatment principle: Bitterness dries dampness, cold overcomes heat, occasionally aided by acrid-warm herbs. He prescribed Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) as sovereign drugs for their bitter-cold nature to treat damp-heat. He also said: Moving blood heals bleeding; regulating Qi relieves tenesmus. These are Hejian's views. Zhu Danxi followed, stating red dysentery originates from the Small Intestine, white from the Large Intestine, both rooted in damp-heat. Since their words, later generations dared not deviate. Though their formularies contained warm treatments, these were mere supplements; the main theme was damp-heat. Consequently, modern physicians follow this dogma: seeing dysentery, regardless of cold/heat/excess/deficiency, they insist on clearing fire with Huangqin (Scutellariae Radix), Huanglian, Zhizi (Gardeniae Fructus), Huangbai; removing stagnation with Dahuang (Rhei Radix et Rhizoma), Mangxiao (Natrii Sulfas); moving blood with Taoren (Persicae Semen), Honghua (Carthami Flos); draining dampness with Wuling San (Five-Ingredient Powder with Poria) and Yiyuan San; regulating Qi with Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex); harmonizing/cooling blood with Danggui (Angelicae Sinensis Radix), Shengdi (Rehmanniae Radix), Shaoyao (Paeoniae Radix), Diyu (Sanguisorbae Radix). They change prescriptions frequently but achieve little, yet at the brink of death, still claim damp-heat and stagnation persist. This universal error causes immense harm. I disagree. Malaria and dysentery occur in summer/autumn due to humid heat; surely this is heat? However, if one follows heavenly climate naturally, illness does not arise. Illness comes from human behavior: seeking coolness excessively leads to pathology. External wind-cold affects meridians, causing malaria; internal cold-damage affects viscera, causing dysentery; simultaneous damage causes both. No malaria or dysentery arises without cold invasion; thus, the root is often cold, though long-standing damp-heat turns to heat, making many cases appear hot. But sudden onset from raw fruits/vegetables isn't necessarily stagnant heat. Those who guard their diet may catch dysentery from rainy season cold or conflicting foods—where is the heat here? Elderly or weak individuals are susceptible; are all cases hot? Dysentery always involves pus/blood due to damage to visceral fat and intestinal vessels; thus, both cold and heat can produce pus/blood. To say pus implies only heat denies cold dysentery exists. Waiting for undigested food, unchanged color, or clear/cold excretions to diagnose cold means Yang is already exhausted and Spleen ruined; this is a late stage. Early stages are often cold. Dampness generates from Earth. Heat transforms via Fire; Cold via Water. Wet Earth participates in all four seasons; following Fire yields Yang excess and damp-heat; following Water yields Yin deficiency and cold-damp. Ignoring cold-damp is a medical error. Differentiating cold/heat by white/red is ancient and valid. Hejian linked white to Lung (Qi) and red to Heart (Blood), which is reasonable. However, red may contain white, and white may contain red; mixed colors don't necessarily mean simultaneous cold-heat pathology, but rather varying degrees of clarity/turbidity distinguish Yin/Yang. Red dysentery can be cold (though usually more heat); white dysentery can be heat (though usually more cold). White with heat shows heat pulses/symptoms; red with cold shows cold pulses/symptoms—these are easy to distinguish. Attributing white solely to Lung ignores blood transformation; attributing red solely to Heart ignores Qi dynamics. *Ju Fang* uses warm herbs for dysentery; Hejian uses bitter-cold. Their approaches differ vastly, each biased, missing the Mean. Thus, cold-heat must be distinguished. Regarding excess-deficiency: Headache, body heat, bone/joint ache indicate exterior excess. Distension, fullness, aversion to pressure, acute pain indicate interior excess. Restlessness, thirst, preference for cold, fear of heat indicate Yang excess. Slippery/rapid, forceful pulses indicate pulse excess. Dominance of Fire/Earth elements indicates seasonal excess. Outside these, most are deficiency. Some mistake thirst for excess-heat, forgetting dysentery loses fluids; lower loss causes upper dryness/thirst. Distinguish by preference for hot/cold drinks. Some mistake abdominal pain for excess, forgetting dysentery damages intestines; pus/blood cutting flesh causes pain. Distinguish by pain severity, tenderness, Zang/Yang status, and abdominal distension. Some mistake dark/scanty urine for excess-heat, forgetting fluid loss via dysentery reduces urine volume and changes color. Distinguish by stool temperature and fluid hydration. Some mistake tenesmus for excess-heat, attributing it only to damp-heat obstruction in Large Intestine. Actually, Qi sinking prevents storage; Yin loss prevents closure. Distinguish by disease duration and constitution strength. Confusing pathogen and healthy Qi leads to rapid disaster; thus, excess-deficiency must be distinguished. Regarding treatment: Seek the pathogen and affected Zang to identify the root; other symptoms are branches. Remove damp-heat if caused by damp-heat; remove stagnation if caused by stagnation. Regulate Qi for Qi issues; harmonize Blood for Blood issues. New/excess cases may use "treat obstruction with purgatives" (Tong Yin Yong Tong); old/deficient cases use "treat obstruction with tonification" (Sai Yin Sai Sai). These are standard. However, modern dysentery patients are 60-70% deficient, yet doctors rarely use tonification. If Qi is sunk, moving Qi worsens tenesmus. If Middle is deficient, attacking stagnation exhausts Yuan Qi. Damp-heat damaging Blood requires blood harmonization; overusing purgatives harms Blood further. Fluid loss causing thirst requires stopping diarrhea; overusing diuretics depletes fluids further. Waiting for blood purification and pain cessation before tonifying is too late. This stems from confusing root and branch, focusing on visible disease while ignoring invisible Yuan Qi. Once Yuan Qi is deficient, how else to restore it? Tonification indications are clear: Weak pulse indicates non-excess, so tonify. Emaciation indicates inability to withstand attack, so tonify. Dietary caution suggests no accumulation, so tonify. Comfortable chest/diaphragm suggests no retention, so tonify. Post-illness infection indicates injured Qi, so tonify. Worsening after attack indicates inappropriate attack, so tonify. Tenesmus amenable to tonification: Sink it, lift and tonify; Heat it, cool and tonify. Abdominal pain amenable to tonification: Loose stool, astringe and tonify; Deficient-cold, warm and tonify. Yang excess leading to Yin deficiency requires sweet-cool agents to nourish Zang Qi. Yin excess leading to Yang deficiency requires acrid-sweet-warm agents to restore Yuan Yang. These are tonification methods. Crucially, focus on Spleen and Kidney. *Weisheng Baojian* states Taiyin governs diarrhea, transmitting to Shaoyin as dysentery, referring to Spleen/Kidney. Diarrhea from Spleen is shallow; progression to Kidney as dysentery is severe. Kidney is the Gate of Stomach, opening to two yin orifices. Long-term dysentery inevitably depletes Yin; Yin depletion inevitably weakens Kidney. Treating dysentery without treating Kidney Yin is incorrect. Formulas like Sijunzi Tang (Four-Gentlemen Decoction), Guipi Tang (Restore the Spleen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and Shiquan Dabu Tang (Ten-Increment Great Tonic Decoction) treat Spleen deficiency and are good; however, if the disease originates in the Source (Kidney) and is critical, merely tonifying Spleen is insufficient. One must greatly tonify Mingmen (Gate of Life) to restore Kidney Yang, strengthening the Mother of Spleen Earth. Otherwise, how can True Yin recover? How can the gate be secured? If the source is not filled, the leak cannot be stopped. Only Xue Lizhai grasped this principle; consult his case records for reference.)