治痢久，脓血腥臭，肠中欲腐，兼下焦虚惫，气虚滑脱者。
生山药（一两，轧细） 三七（二钱，轧细） 鸭蛋子（五十粒，去皮）
上药三味，先用水四盅，调和山药末煮作粥。煮时，不住以箸搅之，一两沸即熟，约得粥一大碗。即用其
粥送服三七末、鸭蛋子。
己巳之岁，愚客居德州，有卢姓妇，年五十六。于季夏下痢赤白，迁延至仲冬不愈。延医十余人，服药百
剂，皆无效验，亦以为无药可医矣。后求愚延医，脉象微弱，至数略数，饮食减少，头目时或眩晕，心中微觉
烦热，便时下坠作疼，然不甚剧。询其平素，下焦畏凉。是以从前服药，略加温补，上即烦热，略为清理，下
又腹疼泄泻也。为拟此方，一日连服两次，其病遂愈。后旬余，因登楼受凉，旧证陡然反复，日下十余次，腹
疼觉剧。其脉象微弱如前，至数不数。俾仍用山药粥，送服生硫黄末三分，亦一日服两次，病愈强半。翌日又
服一次，心微觉热。继又改用前方，两剂全愈。
戊午秋日，愚初至奉天，有李××，年二十八。下痢四十余日，脓血杂以脂膜，屡次服药，病益增剧，羸弱
已甚。诊其脉，数而细弱，两尺尤甚。亦治以此方。服后两点钟腹疼一阵，下脓血若干。病家言∶从前腹疼不
若是之剧，所下者亦不若是之多，似疑药不对证。愚曰∶腹中瘀滞下尽即愈矣。伸再用白蔗糖化水，送服去皮
鸭蛋子五十粒。此时已届晚九点钟，一夜安睡，至明晨，大便不见脓血矣。后间日大便，又少带紫血，俾仍用
山药粥送服鸭蛋子二十粒，数次全愈。
又∶斯秋中元节后，有刘××者，下痢两月不愈，求为延医。
其脉近和平，按之无力，日便五六次，血液腐败，便时不甚觉疼，后重亦不剧。亦治以此方，一剂病愈强半。
翌日将行，嘱以再接原方服两剂当愈。后至奉，接其来函言∶服第二剂，效验不如从前；至三剂，病转似增重。
因恍悟，此证下痢两月，其脉毫无数象，且按之无力，其下焦当系寒凉。俾仍用山药粥送服炒熟小茴香末一钱，
连服数剂全愈。
或问∶西人谓痢为肠中生炎。所谓炎者，红热肿疼，甚则腐烂也。观此案与治卢姓之案，皆用热药成功，
亦可谓之肠炎乎？既非肠炎，何以其肠亦欲腐烂乎？答曰∶痢证，原有寒有热。热证不愈，其肠可至腐烂。寒
证久不愈，其肠亦可腐烂。譬如疮疡，红肿者阳而热，白硬者阴而寒，其究竟皆可变为脓血。赏观《 园随笔
录》，言其曾患牙疳，医者治以三黄犀角纯寒之品，满口肉烂尽，而色白不知疼。后医者，改用肉桂、附子等
品，一服知疼，连服十余剂而愈。夫人口中之肌肉，犹肠中之肌肉也。口中之肌肉，可因寒而腐烂，肠中之肌
肉，独不可因寒而腐烂乎？曾治一人，因久居潮湿之地，致下痢，三月不愈。所下者紫血杂以脂膜，腹疼后重。
或授以龙眼肉包鸭蛋子方，服之，下痢与腹疼益剧。后愚诊视，其脉微弱而沉，左部几不见。俾用生硫黄研细，
掺熟面少许，作丸。又重用生山药、熟地、龙眼肉煎浓汤送服。连服十余剂，共计服生硫黄两许，其痢始愈。
由是观之，即纯系赤痢，亦诚有寒者，然不过百中之二三耳。且尝实验痢证，若因寒者，虽经久不愈，犹可支
持。且其后重、腹疼，较因热者亦轻也。且《伤寒论》有桃花汤，治少阴病下利、便脓血者，原赤石脂与干姜
并用，此为以热药治寒痢之权舆。注家不知，谓少阴之火伤阴络所致，治以桃花汤，原系从治之法。又有矫诬
药性，谓赤石脂性凉，重用至一斤，干姜虽热，止用一两，其方仍以凉论者。今试取其药十分之一，煎汤服之，
果凉乎热
乎？此皆不知《伤寒论》此节之义，而强为注解者也。
治疗痢疾日久，排出脓血且气味腥臭，肠道内部似乎将要腐烂，同时伴有下焦虚衰疲惫、气虚导致滑脱不禁的患者。
生山药（一两，碾成细粉） 三七（二钱，碾成细粉） 鸭蛋子（五十粒，去皮）
以上三味药，先取水四盅，将山药末调和入水中煮成粥。煮的时候，要不停地用筷子搅拌，煮沸一次后即可熟透，大约能煮出一大碗粥。立即用这碗粥送服三七粉和鸭蛋子。
己巳年，我客居德州时，有一位姓卢的妇女，五十六岁。在夏末出现赤白痢疾，拖延到仲冬仍未痊愈。请了十多位医生诊治，服用了一百多剂药，都没有疗效，大家都认为无药可医了。后来求我诊治，脉象微弱，脉搏次数略微偏快，饮食减少，头部和眼睛时常感到眩晕，心中微微觉得烦热，排便时下坠作痛，但疼痛并不剧烈。询问她平素的情况，下腹部怕冷。因此之前服药时，稍微加一点温补的药，上面就会感到烦热；稍微用一点清热理气的药，下面又会腹痛泄泻。于是我为她拟定此方，一天连续服用两次，病就痊愈了。过了十多天，因为登楼受凉，旧病突然复发，每天腹泻十多次，腹痛感觉加剧。她的脉象依然像以前一样微弱，脉搏次数不再偏快。让她继续用山药粥送服生硫黄粉三分，也是一天服用两次，病情好了大半。第二天又服用一次，心里微微觉得发热。接着又改用前面的方子，两剂药后完全痊愈。
戊午年秋天，我刚到奉天时，有一位李某某，二十八岁。患痢疾四十多天，脓血中混杂着脂膜，屡次服药，病情反而加重，身体极度消瘦虚弱。诊察他的脉象，脉搏快而细弱，两尺部尤其明显。也用这个方子治疗。服药后两个时辰，腹痛一阵，排出了若干脓血。家属说：以前的腹痛没有这么剧烈，排出的东西也没有这么多，似乎怀疑药不对症。我说：腹中的瘀滞排尽后病就好了。随后再用白糖化水，送服去皮的鸭蛋子五十粒。此时已经是晚上九点钟，一夜安睡，到了第二天早晨，大便里已经不见脓血了。后来隔两天大便，又少量带有紫血，让他继续用山药粥送服鸭蛋子二十粒，经过几次服用后完全痊愈。
另外：这一年中元节过后，有一位刘某某，患痢疾两个月未愈，请求我为他诊治。
他的脉象接近平和，但按下去无力，每天大便五六次，血液腐败，排便时不太觉得痛，肛门重坠感也不剧烈。也用这个方子治疗，一剂药后病情好了大半。第二天我要出发，嘱咐他接着原方再服两剂应当痊愈。后来回到奉天，接到他的来信说：服用第二剂，效果不如从前；到第三剂，病情反而好像加重了。我突然醒悟，这个证候痢疾两个月，脉象完全没有数的迹象，而且按之无力，其下焦应当是寒凉所致。让他继续用山药粥送服炒熟的小茴香粉一钱，连续服用几剂后完全痊愈。
有人问：西方人认为痢疾是肠道发炎。所谓的炎症，是指红、热、肿、痛，严重时会腐烂。看这个病例和治疗卢姓妇女的病例，都使用热性药物取得成功，也可以称之为肠炎吗？既然不是肠炎，为什么肠道也会想要腐烂呢？回答说：痢疾病证，本来就有寒证和热证之分。热证久治不愈，肠道可以发展到腐烂。寒证久治不愈，肠道也可以腐烂。比如疮疡，红肿的是阳证而属热，色白坚硬的是阴证而属寒，最终都可以化为脓血。欣赏《园随笔录》中的记载，说他曾经患有牙疳，医生用三黄、犀角等纯寒性的药物治疗，满口肉烂殆尽，但颜色发白不知道疼痛。后来的医生，改用肉桂、附子等药物，吃第一副药就知道疼了，连续服用十几剂后痊愈。人口腔中的肌肉，就像肠道中的肌肉一样。口腔中的肌肉，可以因为寒邪而腐烂，肠道中的肌肉，难道就不能因为寒邪而腐烂吗？我曾经治疗一个人，因为长期居住在潮湿的地方，导致下痢，三个月未愈。排出的东西是紫血混杂着脂膜，腹痛且有肛门重坠感。有人传授他用龙眼肉包裹鸭蛋子的方子，服用后，痢疾和腹痛更加剧烈。后来我诊视，他的脉象微弱而沉，左部的脉几乎摸不到。让他用生硫黄研成细粉，掺入少许熟面粉，做成丸药。又重用生山药、熟地黄、龙眼肉煎浓汤送服。连续服用十几剂，共计服用生硫黄一两左右，痢疾才痊愈。
由此看来，即使是纯粹的赤痢，也确实有寒证，不过占百分之二三罢了。而且我曾实验过痢疾病证，如果是因寒引起的，虽然经久不愈，还能够支撑。而且其肛门重坠感和腹痛，比因热引起的也要轻一些。而且《伤寒论》中有桃花汤，治疗少阴病下利、便脓血的，原本就是赤石脂与干姜并用，这是用热药治疗寒痢的开端。注家不了解，说是少阴之火损伤阴络所致，治疗用桃花汤，原本是“从治”的方法。又有歪曲药性的说法，说赤石脂性凉，重用至一斤，干姜虽然热，只用一两，认为这个方子整体还是凉的。现在试着取十分之一的药量，煎汤服用，到底是凉的还是热的呢？这都是不了解《伤寒论》这一节的含义，而强行注解的人。
Treating chronic dysentery where pus and blood are discharged with a fishy, foul odor, the intestines seem to be on the verge of rotting, accompanied by deficiency and exhaustion of the Lower Jiao (Lower Burner), Qi deficiency leading to incontinence or slipping down.
Raw Dioscoreae Rhizoma (Shanyao) (1 liang, finely ground) [Dioscorea opposita]
Notoginseng Radix et Rhizoma (Sanqi) (2 qian, finely ground) [Panax notoginseng]
Strychni Semen (Yadanzi) (50 grains, peeled) [Strychnos nux-vomica]
Take the above three herbs. First, use four bowls of water to mix the powdered Shanyao and boil it into a porridge. While boiling, stir constantly with chopsticks. It is cooked after just one boil, yielding approximately one large bowl of porridge. Immediately use this porridge to administer the Sanqi powder and the peeled Strychni Semen.
In the year Jisi, while residing as a guest in Dezhou, there was a woman surnamed Lu, aged fifty-six. In late summer, she suffered from bloody and white dysentery, which persisted until mid-winter without healing. More than ten physicians were consulted, and over a hundred doses of medicine were taken, all without effect; it was thought that no medicine could cure her. Later, she sought my treatment. Her pulse was weak and faint, with a slightly rapid rate. Her food intake decreased, and she occasionally experienced dizziness in the head and eyes. She felt slight internal irritability and heat. During defecation, she felt a bearing-down sensation and pain, though not severe. Upon inquiry, she usually feared cold in the lower abdomen. Therefore, when previous medicines included even slight warming and tonifying agents, upper irritability occurred; when slight clearing and purging agents were used, lower abdominal pain and diarrhea ensued. I prescribed this formula for her, administered twice daily, and the illness was cured. Over ten days later, due to catching a chill while climbing stairs, the old symptoms suddenly recurred, with more than ten bowel movements per day and intensified abdominal pain. Her pulse remained weak and faint as before, but the rate was no longer rapid. I instructed her to continue using the Shanyao porridge to administer 3 fen of raw Realgar (Shihuang) powder [Auripigmentum], also twice daily. The condition improved significantly. The next day, she took it once more and felt slight heart heat. Subsequently, she reverted to the original formula, taking two doses, and was completely cured.
In the autumn of the year Wuwu, upon my initial arrival in Fengtian, there was a patient named Li XX, aged twenty-eight. He had suffered from dysentery for over forty days, discharging pus and blood mixed with mucous membranes. Repeated medication only exacerbated the condition, leaving him extremely emaciated and weak. His pulse was rapid, fine, and weak, particularly at the Chi positions (Kidney positions) on both sides. This same formula was used for treatment. Two hours after ingestion, he experienced an episode of abdominal pain and discharged some pus and blood. The family remarked that previous abdominal pain was not so severe, nor was the volume of discharge so great, suspecting the medicine did not match the syndrome. I stated: "Once the stasis and stagnation in the intestines are expelled, the disease will heal." Subsequently, I instructed him to dissolve white rock sugar in water and take it with fifty peeled Strychni Semen grains. It was then 9 PM. He slept peacefully through the night. By the next morning, his stool no longer contained pus or blood. Later, on alternate days, his stool still showed traces of purple blood. I instructed him to continue using the Shanyao porridge to administer twenty grains of Strychni Semen. After several doses, he was fully recovered.
Furthermore: After the Zhongyuan Festival that autumn, a patient named Liu XX suffered from dysentery for two months without recovery and sought my medical attention.
His pulse was near normal but forceless upon pressure. He had five to six bowel movements daily, with putrefied blood, little pain during defecation, and mild tenesmus (bearing-down sensation). This formula was also prescribed. After one dose, the condition improved significantly. On the second day, as I was about to depart, I advised him to continue the original prescription for two more doses for full recovery. Upon returning to Fengtian, I received a letter stating: "The efficacy of the second dose was inferior to the first; by the third dose, the condition seemed to worsen." I suddenly realized: Given that this case of dysentery had lasted two months, the pulse showed no signs of rapidity and was forceless upon pressure, the Lower Jiao must be cold. I instructed him to continue using the Shanyao porridge to administer 1 qian of roasted Foeniculum Fructus (Xiaohuixiang) powder [Foeniculum vulgare], taken continuously for several doses, resulting in complete recovery.
Someone asked: Westerners consider dysentery to be enteritis (intestinal inflammation).所谓炎 (inflammation) refers to redness, heat, swelling, and pain, potentially progressing to ulceration/rotting. Observing these cases, including the treatment of Ms. Lu, where hot-natured drugs succeeded, can this still be called enteritis? If not enteritis, why do the intestines appear to rot? I answered: Dysentery syndromes inherently include both Cold and Heat patterns. If the Heat pattern persists untreated, the intestines may rot. If the Cold pattern persists untreated, the intestines may also rot. Consider abscesses: red and swollen lesions are Yang and Heat; white and hard lesions are Yin and Cold. Ultimately, both can transform into pus and blood. Referencing *Yuan Suibi Lulu*, it records a case of periodontal gangrene treated with purely cold herbs like Sanhuang (Three Yellows) and Xijiao (Rhinoceros Horn - now banned/substituted), resulting in total oral tissue necrosis with white coloration and no pain. A subsequent physician switched to Rougui (Cinnamon Bark) and Fuzi (Prepared Aconite Root), and upon the first dose, pain returned; after十余 doses, the patient healed. The muscles in the mouth are akin to those in the intestines. If oral muscles can rot due to Cold, why should intestinal muscles not rot due to Cold? I once treated a patient who developed dysentery after long-term residence in a damp environment, lasting three months. Discharges consisted of purple blood mixed with mucous membranes, accompanied by abdominal pain and tenesmus. Another practitioner prescribed Strychni Semen wrapped in Longan Aril (Longyanrou). After ingestion, dysentery and abdominal pain worsened. My examination revealed a weak, deep pulse, with the Left position barely perceptible. I prescribed pills made from finely ground Raw Realgar (Shihuang) mixed with a small amount of cooked flour. Additionally, I prescribed a strong decoction of Raw Dioscoreae Rhizoma (Shanyao), Prepared Rehmanniae Radix (Shudi), and Longan Aril (Longyanrou) to administer the pills. After more than ten doses, having consumed approximately 1 liang of Raw Realgar in total, the dysentery finally resolved.
From this, we see that even pure bloody dysentery can indeed stem from Cold, though this accounts for only two or three percent of cases. Furthermore, clinical experience shows that if dysentery is caused by Cold, although it may persist chronically, the patient can still sustain their condition. Moreover, the tenesmus and abdominal pain are milder compared to Heat-induced cases. Additionally, *Shanghan Lun* (Treatise on Cold Damage) contains Taohua Tang (Peach Blossom Decoction) for Shaoyin disease presenting with diarrhea and bloody/purulent stools, originally combining Chishizhi (Red Halloysite) with Ganjiang (Dried Ginger). This marks the beginning of using hot herbs to treat Cold dysentery. Commentators failed to understand this, attributing the condition to Shaoyin Fire damaging the Yin collaterals, and claiming Taohua Tang represents a "following treatment" (treating with similar nature) method. Others distorted herb properties, claiming Chishizhi is cool-natured; since it is used in heavy dosage (one jin) versus only one liang of hot Ganjiang, they argued the formula remains cool. Now, if one takes one-tenth of this prescription, decocts it, and ingests it, is it cool or hot? These individuals simply do not comprehend the meaning of this section in *Shanghan Lun* and provide forced interpretations.