典藏书目

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: In cases of dysentery with bloody stools, if the body is hot, the prognosis is poor (death); if there is no fever, there is a chance of survival. In dysentery with white mucus discharge, a deep pulse indicates survival, while a floating pulse indicates a poor prognosis. For dysentery syndromes, if the body is not hot and the pulse does not exhibit a "suspended and extreme" quality, a slippery and large pulse indicates survival, whereas a suspended and choppy pulse indicates a poor prognosis; the time of death or recovery can be predicted based on the flourishing days of the affected Zang organs. It also states: Dysentery resulting from the exhaustion of Yin and Yang Qi is fatal. It further states: Diarrhea accompanied by prolapse, with a full and solid pulse, are all considered difficult to treat.

According to this, the statements regarding life and death are generalizations; one must combine them with other clinical manifestations for detailed examination, as is the case in the following text.

The *Mai Jing* (Pulse Classic) states: In dysentery with pus and blood discharge, a deep and small pulse that is continuous indicates survival; a rapid, frequent, and large pulse accompanied by heat indicates a poor prognosis. Additionally, in dysentery causing muscle spasms, a small and fine pulse with a calm demeanor indicates survival, whereas a floating, large, and tight pulse indicates death.

Yan Shi stated: Regarding the pulses of all types of lower diarrhea, a minute pulse indicates survival, while a floating and surging pulse is difficult to treat. In dysentery with pus and blood discharge, the pulse should be slippery and large; if it appears wiry and urgent, the prognosis is poor.

In dysentery, a deep and wiry pulse is associated with a sensation of tenesmus (heaviness in the lower abdomen). A large pulse indicates the disease has not yet ceased. A weak and rapid pulse indicates the condition is about to resolve spontaneously; even if fever is present, it will not be fatal. In dysentery with cold extremities and absent pulse, moxibustion should be applied. If the limbs remain cold after moxibustion, the pulse does not return, and slight panting occurs, the prognosis is poor. In dysentery with slight fever and thirst, a weak pulse indicates spontaneous recovery. In dysentery with a rapid pulse, slight fever, and sweating, spontaneous recovery is expected. If the pulse is tight, it indicates the pathogen has not been resolved. In dysentery with a rapid pulse and thirst, spontaneous recovery is expected; if it does not improve, pus and blood will inevitably be passed due to the presence of heat. In dysentery, if a wiry pulse appears with fever and sweating, spontaneous recovery will occur. In dysentery with qi obstruction, promoting urination is indicated. In dysentery accompanied by abdominal distension and fullness, along with body pain, the interior deficiency should first be warmed, followed by resolving the exterior; Si Ni Tang (Counterflow Decoction) is suitable for warming the interior, while Gui Zhi Tang (Cinnamon Twig Decoction) is suitable for resolving the exterior. In dysentery with a slippery and rapid pulse, there is retained food stagnation, and purgation is indicated. In dysentery with a slow and slippery pulse, it is an excess syndrome; since the dysentery has not stopped, urgent purgation is required. In dysentery, if the pulse is unexpectedly slippery, it indicates something needs to be expelled; purgation will bring peace. In dysentery with loss of appetite due to retained food, purgation is indicated. In dysentery with abdominal fullness and pain due to cold-excess, purgation is indicated. In dysentery with a hard abdomen, purgation is indicated. In dysentery with delirium due to dry fecal matter, purgation is indicated. In dysentery where the pulses at the three positions (Cun, Guan, Chi) are all level, but pressure on the epigastrium reveals hardness and tension, purgation is indicated. If dysentery has healed but recurs at a specific time, it indicates residual pathogens remain; another round of purgation will ensure safety. In dysentery with large, floating, and wiry pulses, purgation should lead to self-healing. For wind-cold induced dysentery, purgation is contraindicated; if mistaken purgation leads to hardness and pain in the epigastrium with a slow pulse, it is cold and requires warming. In dysentery with a floating and large pulse, this is due to treating a deficiency with purgation; if the pulse is floating and革 (leather-like), accompanied by borborygmus, warming is indicated. In dysentery with a slow and tight pulse and unrelenting pain, warming is indicated. In dysentery with heart pain, urgent treatment of the interior is required; Li Zhong Tang (Regulate the Middle Decoction), Si Ni Tang, or Fu Zi (Aconite Root) preparations may be used. In dysentery with anal pain, warming is indicated.

Commentary: Danxi stated that Zhang Zhongjing’s methods for treating dysentery include ten indications for purgation and five for warming, as well as methods for releasing the exterior, promoting urination, or awaiting spontaneous resolution. The distinction between easy-to-treat, difficult-to-treat, and untreatable conditions is very detailed. However, he discussed diarrhea and dysentery together without separating them. Since this is now recorded under the section on "Stagnant Downward Flow" (Dysentery), it is not repeated under the "Diarrhea and Dysentery" entry, and should be comprehensively reviewed here.