治久痢不愈，肠中浸至腐烂，时时切疼，身体因病久羸弱者。
生山药（一两） 滑石（一两） 生杭芍（六钱） 潞党参（三钱） 白头翁（三钱） 粉甘草（二钱）
一媪，年六十一岁，于中秋痢下赤白，服药旋愈，旋又反复。如此数次，迁延两月。因少腹切疼，自疑寒
凉，烧砖熨之。初熨时稍觉轻，以为对证。遂日日熨之，而腹中之疼益甚。昼夜呻吟，噤口不食。所下者痢与
血水相杂，且系腐败之色。其脉至数略数，虽非洪实有力，实无寒凉之象。舌上生苔，黄而且浓。病患自谓下
焦凉甚，若用热药温之疼当愈。愚曰∶前此少腹切疼者，肠中欲腐烂也，今为热砖所熨而腹疼益甚，败血淋漓，
则肠中真腐烂矣。再投以热药，危可翘足而待。病患亦似会悟，为制此方。因河间天水散（即六一散），原为
治热痢之妙药，此方中重用滑石、甘草，故名之天水涤肠汤。连服四剂，疼止，痢亦见愈。减去滑石四钱，加
赤石脂四钱，再服数剂，病愈十之八九。因上焦气微不顺，俾用鲜藕四两，切细丝煎汤，频频饮之，数日而愈。
此证亦痢中至险之证。而方中用党参者，因痢久体虚，所下者又多腐败，故于滋阴清火解毒药中，特加党
参以助其生机。而其产于潞者，性平不热，于痢证尤宜也。
此证若服此汤不效，则前方之三七、鸭蛋子、金银花亦可酌加，或加生地榆亦可。试观生地榆为末、香油
调，涂汤火伤神效，其能治肠中因热腐烂可知也。
治疗久痢不愈，肠道内部已经侵蚀至腐烂程度，时常出现剧烈疼痛，身体因病程长久而虚弱消瘦的患者。
生山药（一两） 滑石（一两） 生杭芍（六钱） 潞党参（三钱） 白头翁（三钱） 粉甘草（二钱）
有一位老妇人，六十一岁，在中秋节期间患痢疾，排出赤白相间的脓血便，服药后暂时痊愈，但随即又反复发作。如此反复多次，拖延了两个月。因为小腹部剧烈疼痛，自己怀疑是受寒凉所致，于是烧红砖头熨烫腹部。刚开始熨烫时感觉稍轻，认为对症。于是每天坚持熨烫，结果腹中的疼痛更加严重。昼夜呻吟，无法进食。排出的粪便与血水混杂，且呈现腐败的颜色。其脉搏频率略快，虽然脉象并非洪大有力，但实际上并没有寒凉的征象。舌苔黄而且厚腻。病人自述下焦非常寒冷，如果用热药温补，疼痛应当缓解。我说：之前小腹部剧烈疼痛，是因为肠道即将腐烂；现在被热砖熨烫后腹痛加剧，败血淋漓，说明肠道真的已经腐烂了。如果再投以热药，死亡就在眼前了。病人似乎也领悟了，于是制定了这个方子。因为河间天水散（即六一散），原本是治疗热痢的妙药，此方中重用滑石、甘草，所以命名为天水涤肠汤。连续服用四剂，疼痛停止，痢疾也见好转。减去滑石四钱，加入赤石脂四钱，再服用数剂，病情痊愈了八九成。因为上焦气机轻微不顺，让病人用鲜藕四两，切成细丝煎汤，频繁饮用，几天后就痊愈了。
这个证候也是痢疾中极其危险的证候。方中使用党参的原因，是因为痢疾日久导致体质虚弱，所排泄的多为腐败之物，所以在滋阴清火解毒的药物中，特别加入党参以助长生机。而且产自潞州的党参，性质平和而不燥热，对于痢疾病证尤其适宜。
如果这个证候服用此汤无效，那么前文提到的三七、鸭蛋子、金银花也可以酌情加入，或者加入生地榆也可以。试看生地榆研成粉末，用香油调和，涂抹于烫伤和火烧伤处效果神奇，可知它也能治疗因热毒导致的肠道腐烂。
Treats chronic dysentery that has not healed, where the intestines have eroded to the point of putrefaction, accompanied by frequent severe pain, and a body weakened and emaciated due to the prolonged illness.
Raw Dioscoreae Rhizoma (Shanyao) (1 liang), Talcum (Huashi) (1 liang), Raw Paeoniae Radix Alba (Hangshaoyao) (6 qian), Codonopsis Radix (Ludangshen) (3 qian), Pulsatillae Radix (Baitouweng) (3 qian), Glycyrrhizae Radix et Rhizoma Purificata (Fenggancao) (2 qian).
An elderly woman, aged sixty-one, suffered from dysentery with red and white discharge during the Mid-Autumn Festival. After taking medicine, she recovered temporarily but relapsed repeatedly. This cycle occurred several times, dragging on for two months. Due to severe cramping pain in the lower abdomen, she suspected cold pathogen invasion and applied hot bricks to her abdomen for warming. Initially, she felt slight relief, believing it was appropriate. She continued this daily, but the abdominal pain worsened significantly. She moaned day and night and refused food. Her stools were mixed with blood and water, exhibiting a putrid color. Her pulse rate was slightly rapid; although not forceful or surging, there were no signs of cold. The tongue coating was yellow and thick. The patient claimed her lower jiao was extremely cold and believed that using hot herbs to warm it would relieve the pain. I said: "The previous severe cramping pain in the lower abdomen indicated that the intestines were about to rot. Now, after being warmed by hot bricks, the pain has intensified, and bloody discharge is profuse, indicating that the intestines have truly begun to rot. If hot herbs are administered again, death is imminent." The patient seemed to understand, so this formula was prepared. Since Hejian's Tianshui San (i.e., Liuyi San [Six-to-One Powder]) is originally an excellent remedy for heat dysentery, and this formula heavily uses Talcum and Glycyrrhizae Radix et Rhizoma, it is named Tianshui Dichang Tang (Heavenly Water Intestine-Cleansing Decoction). After taking four doses consecutively, the pain ceased, and the dysentery improved. Four qian of Talcum were reduced, and four qian of Halloysitum Rubrum (Chishizhi) were added. After taking a few more doses, the illness was cured by eighty to ninety percent. Because there was slight stagnation of qi in the upper jiao, fresh lotus root (4 liang), sliced finely and decocted in water, was prescribed to be drunk frequently. She recovered within a few days.
This syndrome is one of the most dangerous forms of dysentery. The reason for using Codonopsis Radix in this formula is that prolonged dysentery leads to constitutional deficiency, and the discharged material is largely putrid. Therefore, Codonopsis Radix is specifically added among the yin-nourishing, fire-clearing, and detoxifying herbs to boost vital energy. Moreover, Codonopsis Radix produced in Lu region has a neutral nature without heat, making it particularly suitable for dysentery syndromes.
If this syndrome does not respond to this decoction, then Sanqi (Notoginseng Radix), Yadanzi (Strychnos Semen), or Jinyinhua (Lonicerae Japonicae Flos) mentioned earlier can be酌情 (discretionarily) added, or Shengdiyuyu (Sanguisorbae Radix) can also be added. Observe that Sanguisorbae Radix powder mixed with sesame oil applies miraculously to burns and scalds; thus, its ability to treat intestinal rot caused by heat toxicity is evident.