凡痢绝血鲜红者多热症，以火性急速，迫而下也。紫红白者少热症，以阴凝血败，损而然也。绝白者无
热症，以脏寒气薄，滑而然也。然有以无红而亦因热者，此亦暴注之类，而非之痢之谓也。有以红紫虽多
而不可言热者，此以阴络受伤，而非暴注之比也。黄深而秽臭者，此有热症。若浅黄色淡不甚臭，或兼腥馊
气者，此即不化之类，皆寒症也。黑而脓浓大臭者，此焦色也，多有火症。若青黑而臭薄者，此肝肾腐败
之色也。凡痢之见血者，无非阴络受伤，或寒或热，但伤络脉，则无不见血，故不可必认为热，当以脉色形
气兼而察之，庶不误耳。
凡痢有发热者，似乎属火，然实热之证，反未必发热。惟痢伤精血，阴虚水亏者，多为热症。或虚中
有火，脉见有力，惟保其阴。若脉本无力，全属虚火，宜壮水补阴，六味、八味。若阴虚格阳为外热，则胃
关煎、右归饮。
一噤口不食，最危急之候。丹溪以胃口热甚用黄连、人参治之，不知噤口不皆实热，而虚寒者居多。
果火郁胃中，脏腑必多炽热，脉见洪数。若察其胃口无胀满、火邪，但见其有出无入，脏气不能容受。一
由脾胃之弱，或呕恶、恶闻食臭，或肌不能食，此以中焦不运，责在脾也，一由肾气之弱，命门不暖，则大
肠不固，小肠不化，而胃气不能行，此以下焦失守，化源无主，责在肾也。欲健中焦，非参、术、姜、草
之属不可。欲实下焦，非熟地、附子、吴茱萸、肉桂之属不
可。脾肾强而食自入，其理甚明矣。
凡是痢疾排出纯鲜红色血液的，多属于热证，因为火性急迫急速，逼迫血液下行所致。排出紫红色或白色黏液的，热证较少，这是因为阴血凝滞败坏，损伤所致。排出纯白色黏液的，没有热证，这是因为脏腑寒气薄弱，滑脱所致。然而也有没有红色却因热导致的，这属于“暴注”（急性水样腹泻）一类，而不是痢疾所说的范畴。也有虽然红紫色很多但不能说是热证的，这是因为阴络受伤，不属于暴注可比。粪便颜色深黄且气味秽臭的，这是有热证。如果是浅黄色、色淡且不太臭，或者兼有腥馊气味的，这属于“不化”（完谷不化）一类，都是寒证。黑色且脓液浓稠气味极大的，这是焦枯之色，多有火症。如果是青黑色且气味稀薄的，这是肝肾腐败的颜色。凡是痢疾见血的，无非是阴络受伤，无论是寒是热，只要伤了络脉，就无不见血，所以不能必然认为是热证，应当结合脉象、面色、形体和气息综合考察，才不会出错。
凡是痢疾伴有发热的，似乎属于火证，但真正的实热证，反而未必发热。只有痢疾损伤精血，阴虚水亏的人，才多为热证。或者是虚中有火，脉象有力，只宜保护其阴液。如果脉象本来无力，全属虚火，适宜壮水补阴，可用六味地黄丸、八味肾气丸。如果是阴虚格阳导致的外在假热，则用胃关煎、右归饮。
有一种噤口痢（痢疾患者无法进食），是最危急的证候。朱丹溪认为胃口热甚，用黄连、人参治疗，却不知道噤口痢不全是实热，而虚寒者居多。如果是火郁结在胃中，脏腑必定多有炽热，脉象洪大数急。如果观察其胃口没有胀满、没有火邪，只见有出无入（只泻不纳），脏气不能承受。一种是由于脾胃虚弱，或者呕吐恶心、厌恶食物气味，或者肌肉消瘦不能进食，这是由于中焦不运化，责任在脾；另一种是由于肾气虚弱，命门不暖，导致大肠不固摄，小肠不消化，胃气不能运行，这是由于下焦失守，化源无主，责任在肾。想要健运中焦，非人参、白术、干姜、甘草这类药物不可。想要充实下焦，非熟地黄、附子、吴茱萸、肉桂这类药物不可。脾肾强健了，饮食自然能进入，道理是很明白的。
In cases of dysentery where the discharge consists purely of bright red blood, it is mostly a heat syndrome. This is because the nature of fire is rapid and urgent, forcing the blood downward. Discharge that is purple-red or white indicates less heat; this occurs due to the coagulation and deterioration of yin blood and tissue damage. Pure white discharge indicates no heat syndrome, resulting from cold qi deficiency in the zang organs and slippery collapse. However, there are cases without redness but caused by heat; these belong to the category of "Bao Zhu" (acute watery diarrhea) rather than true dysentery. Conversely, there are cases with abundant purple-red discharge that cannot be classified as heat; these result from injury to the Yin collaterals and are not comparable to Bao Zhu. Deep yellow stool with a foul odor indicates a heat syndrome. If the color is pale yellow, light, not particularly odorous, or accompanied by a fishy/sour smell, it belongs to the category of "Bu Hua" (undigested food in stool), all of which are cold syndromes. Black stool with thick pus and a strong odor indicates a scorched color, often associated with fire syndromes. If the color is cyan-black with a thin odor, it indicates the corruption of the Liver and Kidney. In all dysentery cases involving blood, it is invariably due to injury of the Yin collaterals. Whether cold or heat, once the collateral vessels are damaged, bleeding will occur. Therefore, one must not automatically assume it is a heat syndrome; instead, pulse, complexion, physical form, and Qi status should be examined comprehensively to avoid error.
Dysentery accompanied by fever seems to belong to fire syndromes, yet true excess-heat syndromes do not necessarily present with fever. It is mainly patients whose essence and blood have been damaged by dysentery, suffering from Yin deficiency and water depletion, who manifest heat syndromes. Or, if there is fire within deficiency and the pulse is forceful, the treatment should focus on preserving Yin. If the pulse is inherently weak, indicating pure deficient fire, the method should be to strengthen water and tonify Yin, using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) or Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). If Yin deficiency repels Yang, causing external false heat, then Wei Guan Jian (Stomach Gate Decoction) or You Gui Yin (Right-Restoring Decoction) should be used.
One type of Jin Kou Li (Jin Kou Dysentery, characterized by inability to eat) is the most critical condition. Danxi treated it using Huang Lian (Coptis Rhizome) and Ren Shen (Ginseng Root) assuming excessive heat in the stomach opening, unaware that Jin Kou Dysentery is not exclusively excess-heat, but predominantly deficiency-cold. If fire were depressed in the stomach, the internal organs would certainly show signs of intense heat, and the pulse would be surging and rapid. If upon examination, the stomach opening shows no distension or pathogenic fire, but only output without input (only evacuation without intake), and the Zang Qi cannot tolerate nourishment: one cause is Spleen-Stomach weakness, possibly with vomiting, nausea, aversion to food odors, or emaciation preventing eating; this is due to the failure of the Middle Jiao to transform and transport, placing responsibility on the Spleen. Another cause is Kidney Qi weakness and lack of warmth in the Ming Men (Gate of Life), leading to insecure Large Intestine and indigestion in the Small Intestine, preventing Stomach Qi from moving; this is due to the loss of control in the Lower Jiao and lack of mastery over the source of transformation, placing responsibility on the Kidney. To strengthen the Middle Jiao, herbs such as Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Sheng Jiang (Fresh Ginger), and Gan Cao (Licorice Root) are indispensable. To solidify the Lower Jiao, herbs such as Shu Di Huang (Prepared Rehmannia Root), Fu Zi (Aconite Lateral Root), Wu Zhu Yu (Evodia Fruit), and Rou Gui (Cinnamon Bark) are indispensable. Once the Spleen and Kidney are strengthened, food intake will naturally resume; the principle is very clear.