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Input: Under red and white "etc. Professor Zhou Zhongying believes that when treating dysentery, it is important to pay attention to the following three aspects: First, the obstruction of intestinal tissues by damp-heat and epidemic toxins is a key factor leading to dysentery, as stated in “Shen’s Zunsheng Book” by Shen Jin’ao of the Qing Dynasty: “All types of dysentery are caused by summer heat and dampness; generally speaking, the root cause of dysentery lies in dampness that rises and heats up, causing stagnation of qi and blood, gradually leading to diseases of the intestines.” Similarly, Lei Feng of the Qing Dynasty wrote in “Treatise on Common Diseases” about “Heat Dysentery”: “Heat dysentery arises at the transition between summer and autumn, where heat accumulates with dampness, affecting the spleen and stomach. The spleen fails to transport qi properly, the stomach does not digest food effectively, heat combines with dampness and food, creating stagnation in the middle region of the body, ultimately leading to diarrhea.” Therefore, when treating dysentery, it is crucial to emphasize the use of herbs that clear heat, promote diuresis, eliminate dampness, and detoxify. Famous formulas for treating dysentery, such as Shaoyao Tang, Bai Tou Weng Tang, and Ge Gen Qin Lian Tang, all primarily rely on herbs that clear heat, promote diuresis, eliminate dampness, and detoxify. In addition to the commonly used herbs like Huanglian, Baisuan Cao, Fengwei Cao, and Chun Gen Bai Pi mentioned in this case, Zhou also frequently employed Huangqin, Huangbai, Hongteng, Ma Shi Xian, Bai Tou Weng, Qin Pi, Jinying Hua, Da Huang Tan, Deyu, and Sheng Di. Second, the fundamental pathogenic mechanisms of this disease mainly include damp-heat, epidemic toxins, cold-dampness, and food accumulation—dampness and impurities that become trapped in the intestines, clashing with qi and blood within the gut, leading to impaired intestinal motility, damage to the intestinal lipid membranes and blood vessels, stagnation of qi and blood, and eventual decomposition into pus and blood, thus resulting in dysentery. Because the pathogenic factors obstruct the intestines, qi and blood become stagnant, the lipid membranes are damaged, and decomposition leads to pus and blood, patients often present with red and white, purulent, bloody diarrhea. When there is stagnation in the intestines, the qi mechanism of the intestinal tract is impaired, causing abdominal pain and tenesmus. As Lin Peiqin of the Qing Dynasty wrote in “Classified Diagnosis and Treatment”: “The symptoms arise from damp heat and stagnation in the stomach and intestines, leading to the coagulation of qi and blood, along with the accumulation of waste products, which enter the small and large intestines, scraping away fat and fluid, transforming them into pus and blood, either white or red, purple, or even mixed in various colors. Patients experience abdominal pain, vomiting, dry mouth, and bitter urine, along with tenesmus and rectal discomfort. Because the obstruction prevents proper flow, this condition is also known as ‘stagnant diarrhea.’ Therefore, it can be said that without stagnation, there can be no dysentery; when treating dysentery, it is essential to focus on using drugs that promote circulation and relieve stagnation.” In addition to the commonly used herbs for promoting circulation and relieving stagnation—such as Chishao, Danggui, Muxiang, and Houpu mentioned in this case—Zhou also utilized qi-regulating herbs like Zhishi, Zhike, Dabu Pi, Binlang, and Laifuzi, as well as drugs that promote the expulsion of accumulated substances like Da Huang and Mangxiao, and herbs that aid digestion and resolve stagnation like Shan Zha, Gu Ya, Mai Ya, and Liu Qu. Third, it is important to pay attention to the use of warming herbs. As described in “Dysentery Collection,” “Tenesmus… whether it is cold or hot, real or false, all exhibit these symptoms; one should not assume it is merely due to heat. When the middle burner is hot, heat invades downward; when the middle burner is cold, cold invades downward; when the spleen and kidney are deficient, qi deficiency causes heat to invade downward.” Thus, even if infected with the same dysentery bacillus, individuals with a naturally yang-dominant constitution often develop damp-heat dysentery, while those with a naturally yin-deficient constitution often develop cold-damp dysentery. Therefore, when treating dysentery, we must not simply assume that because modern pharmacological research has shown that Huanglian, Huangqin, Ma Shi Xian, Hongteng, and Baisuan Cao possess antibacterial and antimicrobial properties, we should solely prescribe these medications without considering the basic principle of “differentiation based on syndrome.” For patients who present with cold-damp dysentery or who also exhibit cold-damp symptoms, it is essential to incorporate warming herbs such as Gui Xiang, Fuzi, Pao Jiang, Wu Yu, and other herbs that warm yang and strengthen the spleen. Moreover, cold primarily causes contraction and restraint; when using large doses of herbs that clear heat, promote diuresis, and eliminate dampness, appropriately pairing them with warming herbs like Gui Xiang not only helps mitigate the adverse effects of overly harsh herbs that can irritate the stomach, but also leverages their pungent, warm nature to unblock qi and blood, dissipate stagnation in the intestines. In summary, when treating dysentery, we must still prioritize differentiation-based treatment, combining traditional medicine with modern approaches—clearing heat when needed, warming when needed, and applying both clearly and warmly when necessary—to ensure that the medication reaches the affected area and the patient recovers fully, with remarkable efficacy. (Jiangsu Traditional Chinese Medicine, 2007.4) Bao Xinhua and others introduced four commonly used single-herb prescriptions for treating bacterial dysentery in recent years as follows: Prescription 1: 60–120g of fresh Ma Shi Xian, 1 head of garlic. Preparation method: Mash the ingredients together and take one dose at a time, three times daily. Prescription 2: 9g of Bai Tou Weng, 6g of Huang Bai, 3g of Huang Lian, 9g of Qin Pi. Preparation method: Brew the herbs in water, taking one dose daily, divided into two doses—morning and evening. Prescription 3: 9g of Ge Gen, 6g of Huang Qin, 3g of Huang Lian, 3g of Gan Cao. Preparation method: Brew the herbs in water, taking one dose daily, divided into two doses—morning and evening. Prescription 4: 60g of Dijin Cao. Preparation method: Brew the herbs in water, taking one dose daily, divided into two doses—morning and evening. (China Folk Therapy, 2007.12) Yin Shiyou treated 60 cases of bacterial dysentery using the classic Bai Tou Weng Tang formula with modifications, achieving satisfactory results, which are reported below. Herbal composition: ① Bai Tou Weng Tang with additions: 15g of Bai Tou Weng, 9g of Qin Pi, 9g of Huang Lian, 9g of Huang Bai, 5g of Nuo Su Ke, 15g of Ma Shi Xian. ② Usage: After brewing the above herbs in water, allow the temperature to drop to 35–38°C, pour the solution into an infusion bottle, hang the infusion set on an infusion stand, remove the infusion set’s filter and needle, connect a disposable urinary catheter, vent the system, apply a small amount of petroleum jelly to the front end, instruct the patient to empty their bowels, then slowly insert the catheter into the anus—generally inserting 10–20cm, adjusting the infusion rate to 60 drops per minute. Afterwards, advise the patient to remain in a lateral position for more than 30 minutes. Treat once daily, with 4 days constituting one course of treatment. Treatment outcomes: Among the 60 cases, 40 were cured, accounting for 66.67%; 15 showed improvement, representing 25.00%; and 5 remained untreated, accounting for 8.33%. The overall effective rate was 91.67%. The author believed that Huang Lian and Huang Bai have a bitter, cold nature, clearing heat, drying dampness, and resolving fire and detoxifying; both herbs possess strong antibacterial properties. Qin Pi has a bitter, astringent, cold nature, clearing heat, drying dampness, astringing, and improving vision; modern pharmacological studies have confirmed its anti-inflammatory and analgesic effects. Ma Shi Xian has a cold nature and a sour taste, clearing heat, detoxifying, cooling the blood, and stopping bleeding; modern pharmacological studies have demonstrated its broad-spectrum antipathogenic activity. Nuo Su Ke has a sour, astringent, neutral taste, is toxic, and enters the lung, large intestine, and kidney meridians, with functions of astringing the lungs, astringing the intestines, and relieving pain. Together, these herbs work synergistically to clear heat, detoxify, astringe the intestines, and stop dysentery. By using the rectal infusion route, the drug delivery rate can be controlled, allowing the medication to be absorbed through the rectal mucosa and exert its effects, reducing adverse reactions on the liver and kidneys, improving patient compliance, and ensuring reliable therapeutic outcomes. This method is simple, convenient, inexpensive, and highly effective, making it worthy of clinical application. (Chinese Journal of External Treatment, 2009.6)

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