热利下重者，白头翁汤主之。
暴注下迫属于热，热利下重，乃湿热之秽气郁遏广肠，故魄门重滞而难出也。《内经》曰∶“小肠移热于大
肠为虑瘕。”即此是也。
下利欲饮水者，以有热故也，白头翁汤主之。
下利属胃寒者多，此欲饮水，其内热可知。
下利脉沉弦者，下重也，脉大者为未止，脉微弱数者为欲自止，虽发热不死。
前条论证，此条言脉，互相发明。复出发热二字，见热利指内热，
不是协热。沉为在里，弦为少阳，此胆气不升，火邪下陷，故下重也。脉大为阳明，两阳相熏灼，大则病进，故
为未止。微弱为虚，利后而数亦为虚，故欲自止。发热者，热自里达外，阴出之阳，故不死。
下利微热而渴，脉弱者令自愈。
发热而微，表当自解矣，热利脉弱，里当自解矣，可不服白头翁而待其自愈也。乃渴欲饮水之互文。
下利脉数，有微热，汗出令自愈。设脉复紧为未解。
汗出是热从汗解、内从外解之兆。紧即弦之互文。
下利脉数而渴者令自愈。设不瘥，必圊脓血，以有热故也。
脉数有虚有实，渴亦有虚有实。若自愈，则数为虚热，渴为津液未复也。若不瘥，则数为实热，渴为邪火
正炽矣。
下利寸脉反浮数，尺中自涩者，必圊脓血。
寸为阳，沉数是阳陷阴中，故圊血。今脉反浮，是阴出之阳，利当自愈矣。涩为少血，因便脓血后见于尺
中，亦顺脉也。前条是未圊脓血，因不瘥而预料之辞，此在脓血已圊后，因寸浮尺涩而揣摩之辞，不得以必字作
一例看。
伤寒六七日不利，复发热而利，其人汗出不止者死，有阴无阳故也。
六七日当阴阳自和，复发热而利，正气虚可知。汗出不止，是阳亡而不能卫外也。有阴无阳，指内而言。此
为亡阳，与热利之发热不死、汗出自利者天渊矣。
白头翁汤∶
白头翁（二两） 黄连 黄柏 秦皮（各三两）
上四味，以水七升，煮取二升，去滓，温服一升。
四物皆苦寒除湿胜热之品也。白头翁临风偏静，长于驱风。盖脏腑之火，静则治，动则病，动则生风，风生热
也，故取其静以镇之。秦皮木小而高，得清阳之气，佐白头以升阳，协连、柏而清火。此热利下重之宣剂。
急骤腹泻且里急后重属于热证，热性痢疾伴肛门坠胀，是因为湿热秽浊之气郁结在广肠（大肠下段），导致魄门（肛门）沉重滞涩而排便困难。《黄帝内经》说：“小肠的热邪转移到大肠，会形成虑瘕（一种腹部积块病）。”指的就是这种情况。
腹泻且脉象沉弦的，会有肛门坠胀感；脉象大的，说明病势未止；脉象微弱而数的，说明病情将要自行停止，即使伴有发热也不会死亡。
前一条论述症状，这一条论述脉象，二者互相阐发。再次提出“发热”二字，是为了说明热利指的是内热，而不是表热与里热相合（协热）。沉脉主病在里，弦脉主少阳病，这是胆气不升，火邪下陷，所以出现肛门坠胀。脉大为阳明经证，两阳相互熏灼，脉大则病势进展，所以说是病未停止。脉微弱为虚证，腹泻后脉数也属虚证，所以病情将要自行停止。发热是热邪从体内达于体表，阴分之热转出阳分，所以不会死亡。
发热轻微，表证应当自行解除；热性腹泻脉象弱，里证应当自行解除，可以不服用白头翁汤而等待其自行痊愈。这与“渴欲饮水”是互文见义的说法。
腹泻脉数，伴有轻微发热，出汗的，将会自行痊愈。如果脉象重新变得紧，说明病邪未解。
出汗是热邪通过汗液排出、内热从外部解除的征兆。“紧”脉即是“弦”脉的互文说法。
腹泻脉数且口渴的，将会自行痊愈。如果不痊愈，必然排泄脓血，这是因为体内有热。
脉数有虚有实，口渴也有虚有实。如果是自愈，那么脉数是虚热，口渴是津液尚未恢复。如果不痊愈，那么脉数是实热，口渴是邪火正旺盛。
腹泻寸口脉反而浮数，尺中脉自涩的，必然排泄脓血。
寸脉属阳，沉数是阳热陷入阴中，所以便血。现在脉象反而浮，是阴分之热转出阳分，腹泻应当自行痊愈。涩脉主血少，因为便脓血后在尺部见到涩脉，也是顺应的脉象。前一条是说尚未排泄脓血，因病情未愈而预料的言辞；这一条是在已经排泄脓血之后，因寸脉浮、尺脉涩而推测的言辞，不能把“必”字当作一概而论看待。
伤寒六七天本不该腹泻，却再次发热并腹泻，其人汗出不止的，预后不良（死证），这是因为有阴无阳的缘故。
六七天时阴阳应当自然调和，却再次发热并腹泻，可知正气虚弱。汗出不止，是阳气亡失而不能固护体表。有阴无阳，是指体内而言。这属于亡阳证，与热利证的发热不死、汗出而自愈的情况有天壤之别。
以上四味药，用水七升，煮取二升，去渣，温服一升。
这四味药都是苦寒之品，能除湿胜热。白头翁临风偏静，善于驱风。大概脏腑之火，静止则受治，躁动则致病，躁动则生风，风生热，所以取其静性以镇摄它。秦皮树木小而高，得清阳之气，辅助白头翁以升发阳气，协同黄连、黄柏以清泻火邪。这是治疗热利下重的宣散剂。
Heat-type dysentery with a sensation of heaviness and tenesmus at the anus is primarily treated with *Baitouweng Tang* (White-head-pod Decoction).
Sudden diarrhea with tenesmus belongs to heat. Heat-type dysentery accompanied by rectal heaviness is caused by damp-heat and turbid qi stagnating in the large intestine, causing the anal sphincter to feel heavy and difficult to evacuate. The *Neijing* states: "Heat transferring from the small intestine to the large intestine results in *lvjia* (abdominal masses)." This refers to that condition.
Diarrhea accompanied by a desire to drink water is due to internal heat; it is primarily treated with *Baitouweng Tang* (White-head-pod Decoction).
Most cases of diarrhea belong to stomach cold. Here, the desire to drink water indicates internal heat.
In diarrhea, if the pulse is deep and wiry, there is a sensation of rectal heaviness. If the pulse is large, the disease has not yet ceased. If the pulse is weak, thready, and rapid, the disease is about to stop spontaneously; even if fever is present, death will not occur.
The previous clause discusses symptoms, while this clause discusses pulses; they elucidate each other. The repetition of "fever" emphasizes that heat-type dysentery refers to internal heat, not combined exterior-heat (*xie re*). A deep pulse indicates disease in the interior; a wiry pulse relates to Shaoyang. This implies that the gallbladder qi fails to ascend, and fire pathogen sinks downward, causing rectal heaviness. A large pulse indicates Yangming; when two Yangs scorch each other, a large pulse signifies disease progression, hence indicating the disease has not ceased. Weakness indicates deficiency; after diarrhea, a rapid pulse also indicates deficiency, hence the disease is about to stop spontaneously. Fever here means heat radiating from the interior to the exterior, transforming from Yin to Yang, thus ensuring survival.
If diarrhea is accompanied by slight fever and thirst, and the pulse is weak, spontaneous recovery will occur.
Slight fever suggests the exterior syndrome should resolve itself; heat-type dysentery with a weak pulse suggests the interior syndrome should resolve itself. One may wait for spontaneous recovery without taking *Baitouweng Tang*. This is mutually explanatory with the phrase "desire to drink water."
If diarrhea presents with a rapid pulse, slight fever, and sweating, spontaneous recovery will occur. If the pulse becomes tight again, the pathogen has not been resolved.
Sweating is a sign that heat is resolving through perspiration and the interior is resolving from the outside. "Tight" is mutually explanatory with "wiry."
If diarrhea presents with a rapid pulse and thirst, spontaneous recovery will occur. If it does not improve, pus and blood will inevitably appear in the stool, due to internal heat.
A rapid pulse can indicate either deficiency or excess; thirst can also be due to deficiency or excess. If spontaneous recovery occurs, the rapid pulse indicates deficient heat, and thirst indicates that body fluids have not yet recovered. If it does not improve, the rapid pulse indicates excess heat, and thirst indicates that pathogenic fire is raging.
If, during diarrhea, the Cun (inch) pulse is unexpectedly floating and rapid, while the Chi (cubit) pulse is choppy, pus and blood will inevitably appear in the stool.
The Cun position corresponds to Yang. A deep and rapid pulse indicates Yang heat sinking into Yin, leading to bloody stool. Now, if the pulse is unexpectedly floating, it indicates heat emerging from Yin to Yang, so the diarrhea should resolve spontaneously. A choppy pulse indicates blood deficiency. Seeing a choppy pulse in the Chi position after passing pus and blood is also a favorable indication. The previous clause describes the prediction before pus and blood appear, based on non-improvement; this clause describes speculation after pus and blood have appeared, based on a floating Cun and choppy Chi pulse. The word "inevitably" (*bi*) should not be taken as an absolute rule in all cases.
In Shanghan (Cold Damage), if after six or seven days there was no diarrhea, but suddenly fever and diarrhea recur, and the patient sweats incessantly, the prognosis is fatal. This is because there is Yin but no Yang.
By six or seven days, Yin and Yang should naturally harmonize. The recurrence of fever and diarrhea indicates deficiency of healthy Qi. Incessant sweating indicates the loss of Yang Qi and its inability to protect the exterior. "Yin without Yang" refers to the interior state. This is a case of Yang collapse, which is worlds apart from heat-type dysentery where fever does not lead to death, or cases where sweating leads to spontaneous recovery.
*Baitouweng Tang* (White-head-pod Decoction):
*Baitouweng* (Radix Pulsatillae) (2 liang), *Huanglian* (Rhizoma Coptidis), *Huangbai* (Cortex Phellodendri), *Qinpi* (Cortex Fraxini) (each 3 liang).
Take these four ingredients, add seven sheng of water, boil to obtain two sheng, remove the dregs, and take one sheng warm.
All four herbs are bitter and cold, capable of draining dampness and overcoming heat. *Baitouweng* tends to remain still in the wind and is good at dispelling wind. Generally, fire in the zang-fu organs is controlled when still, but causes disease when active; activity generates wind, and wind generates heat. Therefore, its stilling property is used to suppress it. *Qinpi* grows tall despite being small, absorbing clear Yang qi. It assists *Baitouweng* in ascending Yang, and cooperates with *Huanglian* and *Huangbai* to clear fire. This is a dispersing formula for treating heat-type dysentery with tenesmus.