古无痢疾之名。惟曰滞下。今从病从利。故名之曰痢。然其为症。岂一朝一夕之故哉。
盖因
平素饮食不节。油腻生冷恣食无忌。或饥饱不时。或冷热不择。停蓄于中。久而不化。又或
外感暑湿。内伤七情。行房于既醉之余。努力于过饱之后。所积之物。 炼稠粘。有赤白相
杂。与纯黄之异。不见其粪。而惟见其积者。盖籍气血而变成也。伤于血则变为赤。伤于气
则变为白。气血俱伤。则赤白兼。黄则脾家亦伤。而纯于赤白者。亦未。必非伤脾之所致也
。
使其无赤白。而其色纯黄。则专伤脾土。而气与血犹未甚动焉。至若下痢如黑尘之色。及屋
漏水者。皆不治之症。而噤口者亦多死。以其无胃
气。而邪热独结于上也。大法初起当先推荡。而后调理。病久则带补带收。切不可骤用涩药
。初痢一涩。积蓄不去多致死亡。又不可因久利之人气血不摄。妄投黄 升麻之类。下痢若
服黄 。即发膨胀。多服升麻则小便与积皆升至上焦。此速死之道也。但伤血则调血。伤气
则调气。伤脾则养脾当寒而寒。当温而温。当燥而燥。当清而清。因病用药。其可以执一乎
古代没有“痢疾”这个名称，只称为“滞下”。现在根据病症特点，从“病”字旁和“利”字，所以命名为“痢”。然而这种病症的形成，难道是一朝一夕的原因吗？
大概是因为平时饮食不节制。恣意食用油腻、生冷食物毫无顾忌，或者饥饱无常，或者冷热不分。这些食物停滞蓄积在体内，时间久了无法消化。又或者外感暑湿邪气，内伤七情（喜、怒、忧、思、悲、恐、惊）。在醉酒之后行房事，在过饱之后用力劳作。所积存的食物，经过煎熬变得粘稠，出现赤白相杂，以及纯黄色的不同表现。看不见正常的粪便，只能看到积滞物。这是因为借助气血的变化而形成的。损伤了血分就变为红色，损伤了气分就变为白色，气血都损伤，就赤白兼有。黄色则是脾脏也受到了损伤，而纯赤白的情况，也未必不是伤脾所致。
如果大便中没有赤白，颜色纯黄，那就是专门损伤了脾土，而气和血还没有严重动荡。至于下痢像黑尘的颜色，以及像屋漏水的样子，都是不治之症。而出现“噤口痢”（不能进食）的也多会死亡，这是因为没有胃气，而邪热独自结聚在上部。治疗的大法，初起时应当先推荡积滞，然后再进行调理。病程久了则要在治疗中兼顾补益和收敛，切不可突然使用涩肠止泻的药物。初次患痢疾如果使用涩药，积滞不去，多会导致死亡。也不可不因久痢导致人气血不固，就胡乱投用黄芪、升麻之类的药物。下痢患者如果服用黄芪，就会引发腹胀；多服升麻则会使小便和积滞都升至上焦，这是快速致死的方法。只要损伤了血就调和血，损伤了气就调和气，损伤了脾就滋养脾。该用寒凉就用寒凉，该用温补就用温补，该用燥湿就用燥湿，该用清热就用清热。因病用药，怎么能固执一端呢？
下痢的脉象宜微小，忌浮洪。宜滑大，忌弦急。所谓身体凉爽、脉象细弱的可以生，身体发热、脉象大的会死。王叔和说：“下痢脉象微小反而能回生，脉象大、浮、洪就没有痊愈的日子。”
In ancient times, there was no name for "dysentery" (Li Ji). It was only called "Zhi Xia" (stagnant downward discharge). Today, based on the pathology and the nature of diarrhea, it is named "Li". However, the formation of this syndrome is not due to causes occurring overnight.
It is generally caused by irregular diet in daily life. Indulging in greasy and raw/cold foods without restraint, or eating at irregular intervals, or choosing food without regard to temperature. These substances stagnate and accumulate in the middle jiao, failing to digest over time. Alternatively, one may be externally affected by summerheat-dampness, internally injured by the seven emotions (joy, anger, worry, thought, grief, fear, fright), engage in sexual intercourse after excessive drinking, or exert oneself after being overly full. The accumulated matter undergoes transformation into a sticky consistency, presenting as a mixture of red and white, or purely yellow. Normal feces are not seen, only the accumulated exudate. This occurs because the matter is transformed through the influence of Qi and Blood. Injury to the Blood results in red color; injury to the Qi results in white color; injury to both Qi and Blood results in a mixture of red and white. Yellow indicates that the Spleen is also injured. Cases of purely red and white discharge are not necessarily unrelated to Spleen injury.
If the stool contains no red or white but is purely yellow, it specifically injures the Spleen Earth, while Qi and Blood are not yet severely disturbed. As for dysentery resembling black dust or leaking roof water, these are incurable conditions. Those suffering from "Jin Kou Li" (dysentery with inability to eat) often die because they lack Stomach Qi, and pathogenic heat is solely constrained in the upper jiao. The general treatment principle is: in the early stage, one should first purge and eliminate stagnation, followed by regulation. In chronic cases, tonification and astringency should be employed cautiously. One must absolutely avoid using astringent herbs abruptly. If astringents are used in initial dysentery, the accumulated pathogens will not be expelled, often leading to death. Furthermore, one should not recklessly prescribe Huang Qi (Astragali Radix) and Sheng Ma (Cimicifugae Rhizoma) simply because chronic dysentery leads to insecure Qi and Blood. If a patient with dysentery takes Huang Qi, abdominal distension will occur. Excessive use of Sheng Ma causes urine and accumulated pathogens to ascend to the upper jiao, which is a rapid path to death. If Blood is injured, regulate the Blood; if Qi is injured, regulate the Qi; if the Spleen is injured, nourish the Spleen. Apply cold-natured herbs when appropriate, warm-natured herbs when appropriate, drying herbs when appropriate, and clearing-heat herbs when appropriate. Medication must be tailored to the disease; how can one adhere rigidly to a single method?
The pulse in dysentery should be fine and small; floating and surging pulses are contraindicated. Slippery and large pulses are acceptable; wiry and rapid pulses are contraindicated. It is said that those with a cool body and fine pulse will survive, while those with a hot body and large pulse will die. Shuhe (Wang Shuhe) stated: "Dysentery with a fine/small pulse may recover; with large, floating, or surging pulses, there is no day of recovery."