典藏书目

Dysentery is what was anciently called "Chang Pi" (Intestinal Dysentery), and since Zhang Zhongjing, it has also been referred to as "Zhi Xia" (Stagnant Downward Discharge). The excrement may be red or white, purulent or bloody; there may be abdominal pain or no pain; there may be tenesmus (urgent need to defecate with little output), vomiting, nausea, abdominal distension and fullness, anorexia (Jin Kou Li - inability to eat), or alternating chills and fever. Although the manifestations are diverse, they ultimately do not go beyond exterior/interior and cold/heat patterns. Among these, the differentiation between deficiency (Xu) and excess (Shi) is particularly crucial.

If analyzed from the perspective of exterior and interior: As stated in the *Neijing* (Classic of Internal Medicine): "Wind pathogen injuring in spring leads to incomplete digestion diarrhea or intestinal dysentery in summer." It also states: "When deficient pathogens invade the body and remain without departing, they lodge between the intestines and stomach. If cold predominates, there will be borborygmus, incomplete digestion diarrhea, and undigested food in stool. If heat predominates, the stool will be loose like porridge." All these arise from external pathogens and belong to the category of seasonal epidemic transmission. Whenever the pathogen is at the exterior level, there must be exterior syndrome signs. By employing dispersing methods that address both the exterior and the pathogen, once the pathogen is resolved, the dysentery heals itself. If there are no exterior signs, it must stem from dietary indiscretion and belongs entirely to internal injury. However, internal injuries are extremely common, while cases caused by external exterior pathogens occur only occasionally. This is why the distinction between exterior and interior cannot be neglected.

If analyzed from the perspective of cold and heat: Ancient practitioners believed that red stool indicates heat, while white stool indicates cold. Liu Wansu later refuted this, asking: If red and white are mixed, does it mean both cold and heat are flourishing in the intestines and stomach simultaneously causing dysentery? He posited that white corresponds to the color of the Lung, green to the Liver, yellow to the Spleen, and red to the Heart. Regarding black color being attributed to heat, it is because excessive fire counteracts its controlling element's transformation (Water controls Fire; extreme Fire mimics Water), thus appearing black. Some claim that green and white dysentery indicates cold; this is erroneous. If it were truly cold, it would fail to digest grains, so how could it transform into pus? He further stated: "If there is undigested food, unchanged color, foul-smelling vomit and diarrhea, clear and cold excrement, clear and non-acerbic urination, cool body without thirst, and a slow, fine, and faint pulse, this is a cold syndrome."

Whenever grain digestion occurs, regardless of stool color or other symptoms, it is classified as heat.

Regarding treatment principles, Liu Wansu stated: "Bitter flavors can dry dampness, and cold natured herbs can overcome heat, perhaps slightly adding acrid-hot herbs to assist." He also said: "Regulating blood resolves pus in stool; regulating Qi eliminates tenesmus." These are Liu Wansu's views. Zhu Danxi cited and expanded upon them: "Red dysentery originates from the Small Intestine, white dysentery from the Large Intestine; the root cause in both is Damp-Heat." Since these two masters proposed these theories, subsequent generations have rarely deviated from them. Although their medical texts did contain warming treatments, these merely supplemented omissions in their discourse. Their main emphasis was exclusively on Damp-Heat. Modern physicians all revere this doctrine. Upon seeing any dysentery case, without distinguishing cold, heat, deficiency, or excess, some argue that to clear fire, one must use Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma); to remove stagnation, one must use Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma); to move blood, one must use Dang Gui (Angelicae Sinensis Radix) and Yan Hu Suo (Corydalis Rhizoma); to promote urination and dispel dampness, one must use Wu Ling San (Poria Pill) and Yi Yuan San (Benefiting Origin Powder); to tonify the middle and move stagnation, one must use Bing Lang (Arecae Semen), Mu Xiang (Aucklandiae Radix), and Zhi Shi (Aurantii Fructus Immaturus); to harmonize and cool blood, one must use Mu Dan Pi (Moutan Cortex), Bai Shao (Paeoniae Radix Alba), and Di Yu (Sanguisorbae Radix). Prescriptions change morning and night, but essentially remain the same. When patients reach critical condition, doctors still claim Damp-Heat is not cleared and stagnation is not removed. This is universal, yet the harm inflicted is incalculable.

My view differs significantly. Malaria and dysentery occur in summer and autumn, originally due to humid heat. How can we say it is not heat? However, the scorching climate follows natural heavenly laws. If one could follow these natural laws, how could illness arise? Illness arises because people seek coolness excessively and indulge recklessly (such as overeating raw/cold foods). Therefore, when Wind-Cold invades externally, the pathogen is in the meridians, and the disease is often malaria. When raw/cold damages internally, the pathogen is in the zang-fu organs, and the disease is often dysentery. If both exterior and interior are injured, malaria and dysentery may occur together. There is no malaria or dysentery that does not originate from Cold invasion. This is the fundamental cause of the disease, making its nature (cold or heat) evident. If Summer Heat pathogen remains stagnant for a long time and transforms into heat, then dysentery mostly presents as heat syndromes; this is indeed natural logic. However, if someone greedily eats melons and fruits, excessively damaging themselves with raw/cold items, and develops dysentery immediately upon contact before any stagnation accumulates, is this Stagnant Heat? Furthermore, those who are careful with their diet, or contract Yin-Cold from rainwater, or suffer from conflicting dietary combinations, can all develop dysentery. Where is the heat in such cases?

Moreover, anyone suffering from dysentery must have pus and blood. Without pus and blood, it cannot be called dysentery. This is because the essence of the zang-fu organs is damaged, and the collaterals of the intestines and stomach are disturbed. Thus, whether cold or heat, pus and blood form. If one claims pus and blood must result from heat, does that mean dysentery absolutely has no cold syndromes? If one waits until undigested food, unchanging color, and clear/cold excrement appear before diagnosing cold, then Yang Qi is already exhausted and Spleen Qi is completely failed, approaching a critical state. Does one suddenly reach this point without gradual progression? The reason for reaching this stage is precisely a cold syndrome. Besides, dysentery arises from Dampness generated by Earth. According to the Five Elements theory, heat transforms via Fire, and cold transforms via Water; this is an immutable principle of Yin and Yang. Only Damp-Earth flourishes amidst the four seasons. Following Fire results in excess Yang Earth, leading to Damp-Heat pathology. Following Water results in insufficient Yin Earth, leading to Cold-Damp pathology. Therefore, discussing only Damp-Heat while ignoring Cold-Damp is indeed a physician's error.

As for using red and white to distinguish cold and heat, this ancient method was not inherently flawed. Liu Wansu claimed white belongs to the Lung and red to the Heart, implying white governs Qi and red governs Blood, which is also reasonable. However, from my perspective, red stool may contain white, and white stool certainly does not exclude red. Does mixed red and white indicate simultaneous cold and heat? It merely reflects differences in clarity and turbidity, allowing for Yin-Yang differentiation. Although red dysentery can have cold syndromes, heat usually predominates. Although white dysentery can have heat syndromes, cold usually predominates. White dysentery presenting with heat will necessarily show heat signs in symptoms and pulse. Red dysentery presenting with cold will necessarily show cold signs in symptoms and pulse; this is easy to differentiate. To claim white definitely belongs to the Lung might imply white dysentery is not derived from blood transformation; to claim red definitely belongs to the Heart might imply blood dysentery is inseparable from Qi influence. Thus, cold and heat must be distinguished.

Analyzing from deficiency and excess: Headache, fever, and soreness/pain in bones and sinews indicate Excess of Exterior Pathogen. Abdominal distension/fullness, aversion to food, urgent pain, and tenderness/refusal to press indicate Excess of Interior Pathogen. Pulse that is slippery, rapid, forceful upon lifting and pressing, and unyielding indicates Excess of Pulse. Irritability, thirst with desire to drink, preference for cold, and aversion to heat indicate Excess of Yang Pathogen. Outside of these, nothing else qualifies as excess. Some attribute thirst to heat, not realizing that all diarrhea and dysentery consume Body Fluids. Fluid loss below leads to dryness above; how can there be no thirst? Therefore, one should distinguish deficiency/excess based on preference for hot versus cold drinks. Some attribute abdominal pain to excess, not realizing that dysentery originating from zang-fu causes damage to intestines and stomach. Pus and blood cutting into the skin naturally cause pain. Therefore, one should distinguish deficiency/excess based on the severity of pain, comfort upon pressure, yin/yang status of zang-fu, and presence/absence of abdominal distension. Some attribute yellow/red, scanty urine to Excess Heat, not realizing water is lost through dysentery, leading to short urination; Yin fluid loss changes urine color. Thus, one should distinguish deficiency/excess based on whether stool is hot or not, and whether fluids are depleted or not. Some attribute tenesmus to Excess Heat, knowing only that Damp-Heat obstructs the Large Intestine causing heaviness, unaware that Qi sinking prevents containment of the granary, and Yin loss fails to secure the gate. Therefore, one should distinguish deficiency/excess based on the duration of the disease and the strength of the constitution. If pathogenic factor and healthy Qi are unclear, disaster strikes instantly; thus, deficiency and excess must be distinguished.

Regarding treatment methods, one must seek the invading pathogen and affected organ to clarify the root cause; other variations are branch symptoms. If caused by Damp-Heat, eliminate Damp-Heat. If caused by stagnation, eliminate stagnation. If caused by Qi disorder, regulate Qi. If caused by Blood disorder, harmonize Blood. For new-onset excess cases, the "Treat obstruction with unblocking" (Tong Yin Tong Yong) method can be used. For chronic deficiency cases, the "Treat deficiency with astringency/nourishment" (Sai Yin Sai Yong) method should be employed. These are standard methods requiring no elaboration.

However, observing current dysentery patients, deficiency accounts for 60-70%, yet treating physicians use tonification less than 10-20%. Qi is already sinking; administering Qi-moving herbs will worsen tenesmus. Middle Jiao is already deficient; attacking stagnation again will exhaust Yuan Qi. Damp-Heat injures Blood, so regulating Blood is appropriate. Overusing purgatives to push out old material will further injure Blood. Fluid loss causes thirst, so stopping thirst is appropriate. Exclusively using diuretics will further deplete fluids. Waiting until blood harmonizes and pain stops before tonifying is too late. This is not due to anything else, but because root and branch are unclear; focusing only on present有形 (form/material) diseases while neglecting the intangible Yuan Qi. If one does not examine cold/heat and new/chronic nature, and treats indiscriminately, how can one avoid the error of "making deficiency more deficient and excess more excess"?