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Input: Under the red and white "etc." Professor Zhou Zhongying believes that when treating dysentery, three key aspects should be considered: First, the accumulation of damp-heat and epidemic toxins in the intestinal tract is a crucial factor leading to dysentery, as stated in Qing Dynasty scholar Shen Jin’ao’s “Shen Shi Zun Sheng Shu” – “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, which gradually leads to diseases of the intestines.” Similarly, Qing Dynasty physician Lei Feng’s “Shi Bing Lun” also notes: “Heat-related dysentery arises around the transition from summer to 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, and heat combined with dampness and food stasis brews within the middle region of the body, ultimately resulting in intestinal obstruction.” Therefore, treating dysentery requires emphasizing the use of herbs that clear heat, promote diuresis, eliminate dampness, and detoxify. Famous dysentery treatments such as Shaoyao Tang, Bai Tou Weng Tang, and Ge Gen Qin Lian Tang all primarily rely on herbs that clear heat, promote diuresis, and detoxify. In addition to the commonly used herbs like Huang Lian, Baishang Cao, Feng Wei Cao, and Chun Gen Bai Pi mentioned in this case, Zhou often employed Huang Qin, Huang Bo, Hong Teng, Ma Chi Xuan, Bai Tou Weng, Qin Pi, Jin Yin Hua, Da Huang Tan, Di Yu, and Sheng Di. Second, the fundamental pathogenic mechanisms of this disease mainly involve damp-heat, epidemic toxins, cold-dampness, and food stagnation and impurities that accumulate in the intestines, clashing with the 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 giving rise to dysentery. Because the pathogenic factors accumulate in the intestines, qi and blood become stagnant, the lipid membranes are damaged, and decomposition results in pus and blood, patients often present with red and white, purulent, bloody diarrhea. Stagnation in the intestines disrupts the normal flow of qi and blood, causing abdominal pain and tenesmus. As Qing Dynasty physician Lin Peiqin wrote in “Lai Zheng Zhi Cai”: “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 then enter the small and large intestines, scraping away fat and fluid, transforming into pus and blood that flows downward—sometimes manifesting as white dysentery, red dysentery, purple dysentery, or even dysentery with five different colors. Patients experience abdominal pain, vomiting, dry mouth, and bitter urine, along with tenesmus and a feeling of rectal pressure due to the obstruction and stagnation. Because these conditions are blocked and unbalanced, they are also known as ‘stagnant diarrhea.’” Therefore, it can be said that without stagnation, there can be no true dysentery; treating dysentery requires prioritizing the use of drugs that “clear stagnation.” In addition to the commonly used herbs in this case—such as Chishao, Danggui, Muxiang, and Houpo—which help regulate qi, promote blood circulation, and clear stagnation—Zhou also employed herbs like Zhishi, Zhike, Da Fu Pi, Binlang, and Laifuzi to regulate qi, as well as herbs like Da Huang and Mangxiao to dispel stagnation. Furthermore, herbs like Shan Zha, Gu Ya, Mai Ya, and Liu Qu were used to aid digestion and resolve stagnation. Third, it is important to pay attention to the use of warming herbs. As described in “Li Ji Hou Chong” in “Di Qi Hui Can,” “Tenesmus and a feeling of needing to go to the toilet… regardless of whether the condition is cold, hot, or both, if it presents with these symptoms, one must not assume it is merely due to heat. When the middle burner is hot, heat invades the lower part of the body; when the middle burner is cold, cold invades the lower part of the body; and when the spleen and kidney qi are weak, qi deficiency causes stagnation in the lower part of the body.” Consequently, individuals who are naturally yang-dominant may often exhibit damp-heat dysentery when infected with the same dysentery bacteria, while those who are naturally yin-deficient may often develop cold-damp dysentery. Therefore, when treating dysentery, we should not simply assume that because modern pharmacological research has shown that herbs like Huang Lian, Huang Qin, Ma Chi Xuan, Hong Teng, and Baishang Cao possess antibacterial and antimicrobial properties, we should solely prescribe these medications without considering the fundamental 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 detoxify, appropriately pairing them with warming herbs like Gui Xiang can not only prevent the harsh, cooling properties of these herbs from harming the stomach but also leverage their pungent, warming 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—using what is needed for clarity, using what is warming, and applying both clearing and warming therapies when necessary—to ensure that the medication reaches the target 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 formulas for treating bacterial dysentery in recent years as follows: Formula 1: 60–120g of fresh Ma Chi Xuan, 1 head of garlic. Preparation: Mash the ingredients together and take once, three times daily. Formula 2: 9g of Bai Tou Weng, 6g of Huang Bo, 3g of Huang Lian, 9g of Qin Pi. Preparation: Brew the herbs in water, taking one dose daily, divided into two doses—morning and evening. Formula 3: 9g of Ge Gen, 6g of Huang Qin, 3g of Huang Lian, 3g of Gan Cao. Preparation: Brew the herbs in water, taking one dose daily, divided into two doses—morning and evening. Formula 4: 60g of Di Jin Cao. Preparation: 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 therapeutic 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 Bo, 5g of Nuo Su Ke, 15g of Ma Chi Xuan. ② Method of use: 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 about 10–20cm deep—and adjust 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, for a total of 4 days per course. 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 Bo have a bitter, cold nature, functioning to clear heat, dry dampness, and reduce fire while detoxifying; both herbs possess strong antibacterial effects. Qin Pi has a bitter, astringent, and cold nature, with the effects of clearing heat, drying dampness, astringency, and improving vision—modern pharmacological studies have confirmed its anti-inflammatory and analgesic properties. Ma Chi Xuan has a cold nature and a sour taste, possessing the functions of clearing heat, detoxifying, cooling the blood, and stopping bleeding; modern pharmacological research has demonstrated its broad-spectrum antipathogenic activity against various microorganisms. Nuo Su Ke has a sour, astringent, and neutral taste, is toxic, and enters the lung, large intestine, and kidney meridians, with the functions of consolidating the lungs, astringing the intestines, and relieving pain. Together, these herbs work synergistically to clear heat, detoxify, astringe the intestines, and stop dysentery. By employing the rectal infusion method, the rate at which the medication is administered can be controlled; the drugs are absorbed through the rectal mucosa, reducing adverse reactions on the liver and kidneys, improving patient compliance, and ensuring reliable therapeutic efficacy. This method is simple, convenient, inexpensive, and highly effective, making it worthy of clinical application. (Chinese Journal of External Medicine, 2009.6)

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