（附∶开胃资生丹）
唐容川曰∶“《内经》云∶‘诸呕吐酸，暴注下迫，皆属于热。’下迫与吐酸同言，则知其属于肝热
也。仲景于下利后重便脓血者，亦详于厥阴篇中，皆以痢属肝经也。盖痢多发于秋，乃
肺金不清，肝木遏郁。肝主疏泄，其疏泄之力太过，则暴注里急，有不能待之势。然或大肠开通，则
直泻下矣。乃大肠为肺金之腑，金性收涩，秋日当令，而不使泻出，则滞塞不得快利，遂为后重。是以治痢
者，开其肺气，清其肝火，则下痢自愈。”，此论甚超妙，其推详痢之原因及治痢之法，皆确当。愚今特
引伸其说，复为详悉言之。盖木虽旺于春，而其发荣滋长实在于夏。故季夏六月为未月，未者，木重叶也，
言木至此旺之极也。而肝脏属木，故于六月亦极旺。肝木过旺而侮克脾土，是以季夏多暴注下泻之证，而痢证
甚少，因肺金犹未当令，其收涩之力甚微也。即其时偶有患痢者，亦多系湿热酿成，但利湿清热，病即可愈。
是以六一散为治暑痢之定方，而非所论于秋日之痢也。迨至已交秋令，金气渐伸，木气渐敛，人之脏腑原可
安于时序之常，不必发生痢证也。惟其人先有蕴热，则肝木乘热恣肆，当敛而不敛，又于饮食起居之间感受
寒凉，肺金乘寒凉之气，愈施其肃降收涩之权，则金木相犯，交迫于肠中，而痢作矣。是知痢之成也，固
由于金木相犯，而金木之相犯，实又因寒火交争之力以激动之也。若唐氏所谓开肺清肝，原为正治之法。然
止可施于病之初起，非所论于痢病之已深也。且统观古今治痢之方，大抵皆用之于初期则效，用之于末期则
不效。今特将痢证分为数期，详陈其病之情状及治法于下。
痢之初得也，时时下利脓血，后重，肠疼，而所下脓则甚稠，血则甚鲜，腹疼亦不甚剧，脉之滑实者，
可用小承气汤加生杭芍四钱，甘草二钱下之。盖方中朴、实原可开肺；大黄、芍药又善清肝；且浓朴温而黄、
芍凉，更可交平其寒热，以成涤肠荡滞之功；加甘草者，取其能调胃兼能缓肝，即以缓承气下降之力也。
其脉按之不实者，可治以拙拟化滞汤。若当此期不治，或治
以前方而仍不愈，或迁延数旬或至累月，其腹疼浸剧，所下者虽未甚改色，而间杂以脂膜，其脉或略数或
微虚，宜治以拙拟燮理汤。愚生平用此方治愈之人甚多，无论新痢、久痢皆可用。
用上方虽新痢、久痢皆可奏效，而其肠中大抵未至腐烂也。乃有腹中时时切疼后重，所下者多如烂炙，杂
以脂膜，是其肠中已腐烂矣，当治以拙拟通变白头翁汤。方中之意∶用白头翁、秦皮、芍药、生地榆以清热；
三七、鸦胆子以化瘀生新，治肠中腐烂，而又重用生山药以滋其久耗之津液，固其已虚之气化，所以奏效甚
捷也。愚在奉时，有王××下痢甚剧，曾以此方治愈，其详案载此方之后可考也。至素有鸦片嗜好者，无论
其痢之初得及日久，皆宜治以此方，用之屡建奇功。至地榆方书多炒炭用之，而此方生用者，因生用性凉，
善保人之肌肤，使不因热溃烂。是以被汤火伤肌肤者，用生地榆为末，香油调敷立愈。痢之热毒侵入肠中
肌肤，久至腐烂，亦犹汤火伤人肌肤至溃烂也，此地榆之所以生用也。至白头翁汤原方，原白头翁、秦皮
与黄连、黄柏并用，方中药品若此纯用苦寒者，诚以其方本治厥阴热痢，原挟有伤寒实
热。今用以治痢久肠中腐烂，故不得不为变通也。
上之痢证，又可治以拙拟生化丹。为其虚甚，加生怀山药一两。先用白糖水送服三七、鸦胆子各一半，再
将余四味煎汤服。至煎渣服时，仍先用白糖水送服所余之三七、鸦胆子，再煎服汤药。盖痢证至此，西人谓
之肠溃疡，不可但以痢治，宜半从疮治，是以用金银花、粉甘草以解疮家之热毒；三七、鸦胆子以化瘀生
新；而鸦胆子味至苦，且有消除之力（捣膏能点疣），又可除痢证传染之毒菌；用芍药泄肝火，以治痢之本
病；又恐其痢久伤阴，及下焦气化不固，是以又重用生山药以滋阴液固气化，此所以投之必
效也（医方篇本方后载有医案可参观）。当愚初拟此方时，犹未见西人肠溃疡之说。
及后见西书，其所载治法，但注重肠溃疡，而不知兼用药清痢之
本源，是以不如此方之效也。
有下痢日久，虚热上蒸，饮食减少，所下者形如烂炙，杂以脂膜，又兼腐败之色，腥臭异常，腹中时时
切疼益甚者，此腹中生机将断，其为病尤重矣。宜治以前方，再加潞党参、天门冬各三钱。此用参以助
其生机，即用天冬以调剂参之热也。
有原素伤烟色，肾经虚惫，复下痢日久，肠中欲腐烂，其下焦之气化愈虚脱而不能固摄者，宜治以拙拟
三宝粥。方中之意∶用三七、鸦胆子以治肠中之腐烂，用山药粥以补下焦之虚脱也。
有下痢或赤、或白、或赤白参半，后重腹疼，表里俱觉发热，服凉药而热不退，痢亦不愈，其脉确有
实热者。此等痢证原兼有外感之热，其热又实在阳明之腑，非少阴篇之桃花汤所能愈，亦非厥阴篇之白头翁汤
所能愈也。惟治以拙拟通变白虎加人参汤则随手奏效。痢证身热不休，服清火药而热亦不休者，方书多诿为
不治。然治果对证，其热焉有不休之理？此诚因外感之热邪随痢深陷，永无出路，以致痢为热邪所助，日甚
一日，而永无愈期。治以此汤，以人参助石膏，能使深陷之热邪徐徐上升外散，消解无余，加以芍药、甘草
以理后重腹疼，生山药以滋阴固下，连服数剂，热退而痢亦遂愈。方中之药原以芍药代知母，生山药代粳米，
与白虎加人参汤之原方犹相仿佛，故曰通变白虎加人参汤也。愚生平用此方治愈此等痢证甚多（医方篇本方后
载有数案可参观也）。
此外感之热与痢相并，最为险证。尝见东人×××着有《赤痢新论》，大为丁仲祜所推许。然其中载有
未治愈之案二则∶一体温至38.7℃，脉搏至百一十至，神识蒙昏，言语不清，舌肿大干燥，舌苔剥离，显然
夹杂外感之实热可知，乃东人不知以清其外感实热为要务，而惟日注射以治痢之血清，竟至不救；其二发剧
热，夜发躁狂之举动，后则时发谵语，体温达40.2℃，此又显然有外感之大热也。案中未载治法，想
其治法，亦与前同，是以亦
至不救。设此二证若治以拙拟之通变白虎加人参汤，若虑病重药轻，可将两剂并作一剂，煎汤四五茶杯，分多
次徐徐温饮下，病愈不必尽剂，其热焉有不退之理？大热既退，痢自随愈。而东人见不及此者，因东人尽弃旧
日之中学，而专尚西学也。盖中、西医学原可相助为理，而不宜偏废，吾国果欲医学之振兴，固非
沟通中、西不可也。
上所论之痢证乃外感之热已入阳明之腑者也。然痢证初得，恒有因外感束缚而激动其内伤者，临证者宜
细心体察。果其有外感束缚也，宜先用药解其外感，而后治痢；或加解表之药于治痢药中；或用治痢药煎汤
送服西药阿斯匹林瓦许亦可解表。设若忽不加察，则外感之邪随痢内陷，即成通变白虎加人参汤所主之险
证，何如早治为愈也。
痢证虽为寒热凝滞而成，而论者多谓白痢偏寒，赤痢偏热。然此为痢证之常，而又不可概论也。今
试举治愈之案以明之。同庄张××妻，年近六旬，素多疾病。于季夏晨起，偶下白痢，至暮十余次。秉烛后，
忽周身大热，昏不知人，循衣摸床，呼之不应，其脉洪而无力，肌肤之热烙手。知其痢因伤暑而成，且多病
之身不禁暑热之熏蒸，所以若是昏沉也。急用生石膏三两，野台参四钱，煎汤一大碗，俾徐徐温饮下，至
夜半尽剂而醒。诘朝煎渣再服，热退痢亦遂愈。此纯系白痢而竟若是之热也。
有前后连两次病痢，其前后寒热不同者，为细诊其脉，前后迥异，始能用药各得其宜，无所差误。曾
治刘××，于初秋得痢证甚剧。其痢脓血稠粘，脉象弦细，重诊仍然有力。治以通变白头翁汤，两剂全愈。隔
旬余，痢又反复，自用原方治之，病转增剧，复来院求诊。其脉弦细兼迟，不任循按，知其已成寒痢，所
以不受原方也。俾用生怀山药细末煮粥，送服小茴香细末一钱、生硫黄细末四分，
数次全愈。又如三宝粥方后治愈卢氏妇一案亦然。
二案皆随病机之转移，而互治以凉热之药，自能随手奏效。故治之者宜于临证时细心研究，息息与病机相符也。
有痢证，上热下凉，所用之药宜上下分途，以凉治上，以热治下者。曾治天津张姓媪，年近五旬，于孟
秋患痢，两旬不愈。所下者赤痢杂以血水，后重腹疼，继则痢少泻多，亦兼泻血水，上焦烦热，噤口不食，
闻食味即恶心欲呕，头目眩晕，不能起床，其脉关前浮弦，重诊不实，两尺则微弱无根，一息五至，病患自觉
心中怔忡，精神恍惚，似难支持，此乃虚极将脱之兆也。遂急用净萸肉、生怀山药各一两，大熟地、龙眼肉、
白龙骨各五钱，生杭芍、云苓片、炙甘草各二钱，俾煎汤两盅，分两次温服下。初服一次，心神即觉安稳。尽
剂后，少进饮食，泻痢亦少止。又即原方加生地黄四钱，炙甘草改用三钱，煎汤两盅，分两
次温服下，每服一次送服生硫黄细末二分半，日服一剂，数日全愈。
至于暑天热痢，宜治以六一散，前已言之。然南方之暑热兼湿，用六一散诚为至当；北方之暑热恒
不兼湿，且有兼燥之时，若用六一散时，原当有所变通。愚尝拟得一方，用之甚效。方用滑石、生石膏各五
钱，朱砂、粉甘草细末各二钱，薄荷冰一分，共和匀，每服二钱，开水送下。热甚痢剧者，一日可服五六次。
名之曰加味益元散，盖以六一散加朱砂为益元散，兹则又加石膏、薄荷冰也。
按∶暑热之痢恒有噤口不食者，而治以加味益元散，即可振兴其食欲。若非暑热之痢而亦不思饮食者，
宜用朱砂、粉甘草细末等分，少加薄荷冰，每服一钱，竹茹煎汤送下，即可思食。盖此等证多因肝胆之火挟
胃气上逆，其人闻食味即恶心欲呕，所以不能进食，用朱砂以降胃镇肝，甘草以和胃缓肝，竹茹以平其逆
气，薄荷冰以散其郁热，所以服之即效也。因此方屡次奏功，遂
名之曰开胃资生丹。
有当暑热之时，其肝胆肠胃先有蕴热，又更奔走作劳于烈日之中，陡然下痢，多带鲜血，其脉洪大者。
宜治以大剂白虎汤，煎数盅，分数次温饮下，每次送服鸦胆子仁三十粒。若其脉虽洪大而按之虚者，宜治以大
剂白虎加人参汤，送服鸦胆子仁。
有痢久清阳下陷者，即胸中大气因痢下陷也。其病情常觉下坠腹疼（此气分下陷迫其下焦腹疼），或痢或
泻，多带虚气，呼吸短气，或兼有寒热往来，其脉象迟弱者，宜治以拙拟升陷汤，去知母，加生怀山药六钱，
白头翁三钱。盖原方之意∶原用生箭 以升补胸中大气，而以柴胡、桔梗、升麻之善升清阳者以辅之，更加
知母以调剂黄 之热也。兹因下焦泻痢频频，气化不固，故以白头翁易知母，而更以山药辅之。因知母之
性寒而滑，白头翁之性凉而涩，其凉也能解黄 之热，其涩也能固气化之脱，且为治痢要药，伍
以山药，又为止泻之要药也。
诸痢之外又有所谓休息痢者，其痢大抵皆不甚重而不易除根，治愈恒屡次反复，虽迁延日久而犹可支持，
有若阿米巴痢之轻者，至累年累月不愈而犹可支持也。或此等痢即阿米巴痢欤？须待后实验。然其所以屡次
反复者，实因有原虫伏于大小肠曲折之处，是以愈而复发，惟用药除净其原虫则不反复矣。至除之之
法，证之近于热者，可用鸦胆子仁，以治痢之药佐之；近于凉者，可用硫黄末，而以治痢之药佐之。再者，无
论或热或凉，所用药中皆宜加木贼一钱，为其性善平肝，又善去肠风止血，故后世本草谓其善治休息痢也。
其脾胃不健壮者，又宜兼用健补脾胃之药以清痢之上源，自能祓除病根也。
痢证又有日下痢频频，其肠中仍有燥结，必去其燥结而痢始愈者，此固属罕见之证，而治痢者实不可
不知也。表弟刘××，年二十四岁，于中秋下痢，脓血稠粘，一日十五六次，腹疼后重
甚剧。治以化滞汤，连服两剂，下痢次数似少减，而后重腹疼如旧。细诊其脉，尺部重按甚实，疑其肠
有结粪，投以小承气汤加生杭芍数钱，下燥粪长约四寸，后重腹疼顿愈十之八九。再与以化滞汤一剂，病若失。
治痢最要药品，其痢之偏热者，当以鸦胆子为最要之药，其痢之偏寒者，当以硫黄为最要之药，以此二药
皆有消除痢中原虫之力也。此二种药，上所录方案中已屡言之。今再论之。
鸦胆子，一名鸭蛋子，其性善凉血，止血，兼能化瘀生新。凡痢之偏于热者，用之皆有捷效，而以治
下鲜血之痢，泻血水之痢，则尤效。鸦胆子又善清胃腑之热，凡胃脘有实热充塞、噤口不食者，服之即可
进食。服时须去其硬皮，若去皮时其中仁破者，即不宜服，因破者服后易消，其苦味遽出，恒令人呕吐，是
以治痢成方，有用龙眼肉包鸦胆子仁囫囵吞服者。药局中秘方，有将鸦胆子仁用益元散为衣，名之为菩提
（附：开胃资生丹）
唐容川说：“《内经》中说：‘各种呕吐酸水，突然腹泻且肛门急迫下坠，都属于热证。’将‘后重’（里急后重，即腹痛窘迫，时时欲便，肛门重坠，便出不爽）与‘吐酸’并列论述，可知这属于肝热所致。张仲景在论述痢疾后出现里急后重、大便脓血时，也在厥阴篇中详细记载，都是将痢疾归属于肝经病变。大概痢疾多发生在秋季，这是因为肺金之气不清肃，导致肝木之气郁遏。肝主疏泄，如果其疏泄之力过强，就会出现突然腹泻和腹部拘急疼痛，有迫不及待之势。然而如果大肠通畅，就会直接泻下。因为大肠是肺金的腑，肺金本性收敛涩滞，秋季当令之时，如果不让邪气泻出，就会导致气机阻滞堵塞而不能畅快通利，于是形成里急后重。所以治疗痢疾的人，只要宣开肺气，清泻肝火，那么下痢自然痊愈。”这一论述非常精妙，他推究痢疾的原因及治疗方法，都非常确切恰当。我如今特意引申他的学说，再详细详尽地说明。大概树木虽然在春季旺盛，但其萌发繁荣生长实际上是在夏季。所以季夏六月为未月，“未”字意为木叶重叠繁茂，是说木气到了这个时候旺盛到了极点。而肝脏属木，所以在六月也极旺。肝木过旺而欺侮克制脾土，所以在季夏多发生突然腹泻的病症，而痢疾很少见，因为此时肺金尚未当令，其收敛涩滞的力量很微弱。即使那时偶尔有人患痢疾，也多是由湿热酿成，只要利湿清热，病即可愈。所以六一散是治疗暑天痢疾的固定方剂，而不是本文所讨论的秋季痢疾。等到进入秋令，金气逐渐伸展，木气逐渐收敛，人的脏腑原本可以安于时序的正常变化，不必发生痢疾。只有那人先前体内蕴藏热邪，肝木趁着热势肆意妄为，该收敛时不收敛，又在饮食起居之间感受寒凉，肺金乘着寒凉之气，更加施展其肃降收敛的权利，这样金木相互侵犯，在肠中交相逼迫，痢疾就发作了。由此可知，痢疾的形成，固然由于金木相犯，而金木的相犯，实在是因为寒火交争的力量激动它所致。像唐氏所说的开肺清肝，原本是正治之法。但只适用于疾病初起，不适用于痢疾已经深入的情况。而且纵观古今治疗痢疾的方子，大抵都用在初期有效，用在末期无效。如今特别将痢疾分为几个阶段，详细陈述其病情状况及治疗方法如下。
痢疾刚得的时候，时常排出脓血，里急后重，肠痛，排出的脓液很稠，血色很鲜红，腹痛也不十分剧烈，脉象滑实的，可以用小承气汤加生杭芍四钱，甘草二钱来攻下。因为方中的厚朴、枳实本来可以开宣肺气；大黄、芍药又善于清泻肝火；而且厚朴性温，大黄、芍药性凉，更可以平衡寒热，以达成涤荡肠道、消除积滞的功效；加入甘草，是取它能调和胃气兼能缓急柔肝，也就是用来缓和承气汤下降的力量。如果脉象按下去不实，可以用我拟定的化滞汤治疗。如果在这个阶段不治疗，或者用前方治疗仍然不好，或者拖延数十天甚至几个月，腹痛逐渐加剧，排出的东西虽然颜色没有很大改变，但间杂着脂膜，脉象或略数或微虚，适宜用我拟定的燮理汤治疗。我生平用这个方子治愈的人很多，无论是新痢还是久痢都可以使用。
使用上方虽然新痢、久痢都能奏效，但患者肠道中大多还没有腐烂。然而有的人腹中时常剧烈绞痛且有里急后重感，排出的东西多像烂肉一样，混杂着脂膜，这是肠道已经腐烂了，应当用我拟定的通变白头翁汤治疗。方中的用意：用白头翁、秦皮、芍药、生地黄榆来清热；三七、鸦胆子来化瘀生新，治疗肠道腐烂，而又重用生山药来滋养长久耗损的津液，固摄已经虚弱的气化功能，所以奏效很快。我在奉天任职时，有个王姓患者下痢非常严重，曾用此方治愈，详细医案载于此方之后可供考证。至于素有吸食鸦片嗜好的人，无论其痢疾初起还是日久，都适宜用此方治疗，使用多次都建立奇功。至于地榆，方书中多炒炭使用，而这个方子中生用的原因，是因为生用地榆性凉，善于保护人的肌肤，使其不因热毒而溃烂。所以被汤火烫伤肌肤的人，用生地黄榆研末，香油调敷立即痊愈。痢疾的热毒侵入肠道肌肤，长久导致腐烂，也像汤火伤人肌肤至溃烂一样，这就是地榆之所以生用的原因。至于白头翁汤原方，原是白头翁、秦皮与黄连、黄柏并用，方中药品如此纯用苦寒，确实是因为该方本用于治疗厥阴热痢，原本夹杂有伤寒实热。如今用它来治疗痢疾日久肠道腐烂，所以不得不进行变通。
上述痢疾证候，也可以用我拟定的生化丹治疗。如果患者虚损严重，加生怀山药一两。先用白糖水送服三七、鸦胆子各一半，再将其余四味药煎汤服用。等到煎药渣服用时，仍先用白糖水送服剩余的三七、鸦胆子，再煎服汤药。大概痢疾到了这个阶段，西医称之为肠溃疡，不能仅仅当作痢疾治疗，宜半从疮疡治疗，所以用金银花、粉甘草来解除疮家之热毒；三七、鸦胆子来化瘀生新；而鸦胆子味道极苦，且有消除之力（捣成膏能点除疣赘），又可以清除痢疾传染的毒菌；用芍药泄肝火，以治疗痢疾的根本病因；又担心痢疾日久损伤阴液，以及下焦气化不固，所以又重用生山药来滋阴液固气化，这就是投以此方必然有效的原因（医方篇本方后载有医案可参考）。当我最初拟定此方时，还未见到西医关于肠溃疡的说法。
后来见到西医书籍，其中所载的治疗方法，只注重肠溃疡，而不知道兼用药清痢的本源，所以不如这个方子有效。
有下痢日久，虚热上蒸，饮食减少，排出的东西形状像烂肉，混杂着脂膜，又有腐败的颜色，腥臭异常，腹中时常剧烈疼痛更加严重的，这是腹中生机即将断绝，病情尤其严重了。适宜用前方，再加潞党参、天门冬各三钱。这里用人参以助其生机，即用天冬来调剂人参的热性。
有原本素来伤于烟色（指长期吸食鸦片导致身体亏虚），肾经虚惫，又下痢日久，肠道想要腐烂，其下焦的气化更加虚脱而不能固摄的，适宜用我拟定的三宝粥治疗。方中的用意：用三七、鸦胆子来治疗肠道中的腐烂，用山药粥来补益下焦的虚脱。
有下痢或赤色、或白色、或赤白相间，里急后重腹痛，表里都觉得发热，服用凉药而热不退，痢疾也不愈，脉象确有实热的。这种痢疾原本兼有外感之热，其热实在阳明之腑，不是少阴篇的桃花汤所能治愈，也不是厥阴篇的白头翁汤所能治愈的。只有用我拟定的通变白虎加人参汤治疗则随手奏效。痢疾证身热不休，服用清火药而热也不休的，方书多推诿为不治之症。然而治疗如果对证，热怎么有不退的道理？这确实是因为外感的热邪随着痢疾深陷体内，永无出路，以致痢疾被热邪助长，一天比一天严重，而永远没有痊愈的日期。用此汤治疗，用人参帮助石膏，能使深陷的热邪徐徐上升外散，消解无余，加上芍药、甘草来调理后重腹痛，生山药来滋阴固下，连服数剂，热退而痢疾也就痊愈了。方中的药物原是用芍药代替知母，生山药代替粳米，与白虎加人参汤的原方还相仿佛，所以叫通变白虎加人参汤。我生平用此方治愈这类痢疾很多（医方篇本方后载有数案可参考）。
这种外感之热与痢疾相并，是最危险的证候。曾见日本人某某著有《赤痢新论》，大为丁仲祜所推崇。然而其中记载有两个未治愈的案例：一个体温达38.7℃，脉搏一百一十次/分，神识蒙昏，言语不清，舌肿大干燥，舌苔剥离，显然夹杂外感的实热可知，乃日本人不知道以清其外感实热为要务，而只是每天注射治疗痢疾的血清，竟然致死；其二发剧烈高热，夜间发躁狂举动，后来时而说胡话，体温达40.2℃，这又显然有外感的大热。案中未记载治疗方法，猜想其治疗方法，也与前相同，所以也致死。假如这两个证候用我拟定的通变白虎加人参汤治疗，如果担心病重药轻，可将两剂药合并为一剂，煎汤四五茶杯，分多次徐徐温饮下，病愈不必服完所有药，热怎么有不退的道理？大热既退，痢疾自然随之痊愈。而日本人见识不到这一点，是因为日本人完全抛弃旧日的中学，而专门崇尚西学。大概中、西医学原本可以相助为理，而不宜偏废，我国如果想要医学振兴，固然非沟通中西不可。
上面所论述的痢疾证，是外感之热已经入阳明之腑的。然而痢疾初得，常有因外感束缚而激动内伤的，临证者宜细心体察。果真有外感束缚，宜先用药解除外感，而后治痢；或在治痢药中加入解表药；或用治痢药煎汤送服少许西药阿斯匹林也可以解表。如果忽然不加察觉，则外感之邪随痢疾内陷，即成为通变白虎加人参汤所主治的危险证候，哪里比得上早治疗更好呢。
痢疾证虽然是寒热凝滞而成，但论者多谓白痢偏寒，赤痢偏热。然而这是痢疾的常法，又不可一概而论。现在试举治愈的案例来说明。同庄张某的妻子，年近六十，平时多病。在季夏早晨起床，偶然下白痢，到傍晚十余次。点蜡烛后，忽然周身大热，昏迷不知人，循衣摸床（神志不清时的无意识动作），呼叫不应，脉象洪大而无力，肌肤热得烫手。知道她的痢疾是因伤暑而成，且多病之身不禁受暑热熏蒸，所以如此昏沉。急忙用生石膏三两，野台参四钱，煎汤一大碗，让她徐徐温饮下，到半夜服完全部药而苏醒。第二天早上煎药渣再服，热退痢疾也就痊愈了。这完全是白痢却竟然如此热盛。
有前后两次患病痢疾，其前后的寒热不同的，仔细诊察其脉象，前后迥然不同，才能用药各得其宜，没有差错。曾治疗刘某，于初秋得痢疾非常严重。其痢疾脓血稠粘，脉象弦细，重按仍然有力。用通变白头翁汤治疗，两剂全愈。隔旬余，痢疾又反复，自己用原方治疗，病情反而加重，复来院求诊。其脉弦细兼迟，不耐循按，知道已成寒痢，所以不接受原方。让他用生怀山药细末煮粥，送服小茴香细末一钱、生硫黄细末四分，数次全愈。又如三宝粥方后治愈卢氏妇一案也是这样。
两个案例都是随着病机的转移，而互换使用凉热之药，自然能随手奏效。所以治疗者宜于临证时细心研究，时刻与病机相符。
有痢疾证，上热下凉，所用的药宜上下分途，以凉药治上部，以热药治下部的。曾治疗天津张姓老妇人，年近五十，于孟秋患痢，二十天不愈。排出的赤痢混杂血水，里急后重腹痛，继则痢少泻多，也兼泻血水，上焦烦热，噤口不食（不能进食），闻食物气味即恶心欲呕，头目眩晕，不能起床，其脉关前浮弦，重按不实，两尺脉微弱无根，一息五至，病患自觉心中怔忡，精神恍惚，似难支持，这是虚极将脱的征兆。于是急忙用净萸肉、生怀山药各一两，大熟地、龙眼肉、白龙骨各五钱，生杭芍、云苓片、炙甘草各二钱，让她煎汤两盅，分两次温服下。初服一次，心神即觉安稳。服完全部药后，少量进食，泻痢也稍止。又即原方加生地黄四钱，炙甘草改用三钱，煎汤两盅，分两次温服下，每次服用送服生硫黄细末二分半，日服一剂，数日全愈。
至于暑天热痢，宜用六一散治疗，前面已经说过。然而南方的暑热兼湿，用六一散确实非常恰当；北方的暑热往往不兼湿，且有兼燥的时候，如果用六一散时，原本应当有所变通。我曾拟定一方，使用非常有效。方用滑石、生石膏各五钱，朱砂、粉甘草细末各二钱，薄荷冰一分，混合均匀，每服二钱，开水送下。热甚痢剧者，一日可服五六次。命名为加味益元散，盖因六一散加朱砂为益元散，这里又加了石膏、薄荷冰。
按：暑热之痢常有噤口不食的，而用加味益元散治疗，即可振兴其食欲。如果不是暑热之痢而也不思饮食的，宜用朱砂、粉甘草细末等分，少加薄荷冰，每服一钱，竹茹煎汤送下，即可思食。大概这些证候多因肝胆之火挟胃气上逆，其人闻食物气味即恶心欲呕，所以不能进食，用朱砂以降胃镇肝，甘草以和胃缓肝，竹茹以平其逆气，薄荷冰以散其郁热，所以服用即效。因为这个方子屡次奏功，遂命名为开胃资生丹。
有在暑热之时，其肝胆肠胃先有蕴热，又奔走劳作于烈日之中，陡然下痢，多带鲜血，脉象洪大的。宜用大剂白虎汤，煎数盅，分多次温饮下，每次送服鸦胆子仁三十粒。如果脉虽洪大但按之虚的，宜用大剂白虎加人参汤，送服鸦胆子仁。
有痢疾日久清阳下陷的，即胸中大气因痢下陷。其病情常觉下坠腹痛（这是气分下陷迫使其下焦腹痛），或痢或泻，多带虚气，呼吸短气，或兼有寒热往来，脉象迟弱的，宜用我拟定的升陷汤，去知母，加生怀山药六钱，白头翁三钱。大概原方的用意：原用生黄芪以升补胸中大气，而以柴胡、桔梗、升麻善于升清阳者来辅助它，再加知母来调剂黄芪的热性。这里因为下焦泻痢频频，气化不固，所以用白头翁代替知母，而更以山药辅助它。因为知母性寒而滑，白头翁性凉而涩，其凉性能解黄芪之热，其涩性能固气化之脱，且为治痢要药，伍以山药，又是为止泻要药。
诸痢之外又有称为休息痢的，其痢大抵都不甚重而不易除根，治愈后常屡次反复，虽然迁延日久仍可支持，有点像阿米巴痢疾的轻症，直到累年累月不愈仍可支持。或许这种痢疾就是阿米巴痢疾吗？须待以后实验验证。然而其所以屡次反复的原因，实在是因为有原虫潜伏于大小肠曲折之处，所以愈而复发，只有用药除净其原虫则不反复了。至于除之的方法，证候近于热的，可用鸦胆子仁，以治痢之药佐之；近于凉的，可用硫黄末，而以治痢之药佐之。再者，无论或热或凉，所用药物中皆宜加木贼一钱，因为其性善于平肝，又善于去肠风止血，故后世本草谓其善于治疗休息痢。其脾胃不健壮者，又宜兼用健补脾胃之药以清痢之上源，自然能祛除病根。
痢疾证又有每日下痢频频，其肠中仍有燥结，必须去除其燥结而痢始愈的，这固然属于罕见的证候，而治痢者实在不可不知道。表弟刘某，年二十四岁，于中秋下痢，脓血稠粘，一日十五六次，腹痛后重非常剧烈。用化滞汤治疗，连服两剂，下痢次数似乎少减，而后重腹痛如旧。仔细诊察其脉，尺部重按甚实，怀疑其肠有结粪，投以小承气汤加生杭芍数钱，下燥粪长约四寸，后重腹痛顿时痊愈十之八九。再给予化滞汤一剂，病若失。
治疗痢疾最重要的药品，其痢疾偏热的，当以鸦胆子为最重要之药，其痢疾偏寒的，当以硫黄为最重要之药，因为这两种药都有消除痢中原虫之力。这两种药，上面记录的方案中已多次提到。现在再论述。
鸦胆子，一名鸭蛋子，其性善于凉血，止血，兼能化瘀生新。凡是痢疾偏于热的，用之皆有捷效，而以治疗下鲜血之痢，泻血水之痢，则尤其有效。鸦胆子又善于清胃腑之热，凡是胃脘有实热充塞、噤口不食的，服用即可进食。服用时必须去掉其硬皮，如果在去皮时其中仁破的，就不宜服用，因为破者服用后易消化，其苦味立刻出来，常令人呕吐，所以治疗痢疾的成方，有用龙眼肉包鸦胆子仁囫囵吞服的。药局中的秘方，有将鸦胆子仁用益元散为衣，命名为菩提
(Attached: Kaiwei Zisheng Dan)
Tang Rongchuan said, "The *Neijing* (Classic of Internal Medicine) states: 'Various vomiting and acid regurgitation, sudden diarrhea with tenesmus, all belong to heat.' The mention of 'tenesmus' alongside 'acid regurgitation' indicates that this belongs to Liver Heat. Zhang Zhongjing, in discussing post-dysentery tenesmus and pus-blood stools, detailed these in the Jueyin Chapter, attributing dysentery to the Liver Meridian. Generally, dysentery often occurs in autumn due to Lung Metal failing to clear and descend, causing Liver Wood to become constrained. The Liver governs free flow and drainage; if its draining force is excessive, it leads to sudden diarrhea and abdominal urgency, creating a sense of inability to wait. However, if the Large Intestine opens, direct purging occurs. Since the Large Intestine is the Fu organ of Lung Metal, and Metal has a nature of astringency, when it commands in autumn, if it does not allow expulsion, qi stagnates and blocks, preventing smooth discharge, thus forming tenesmus. Therefore, those treating dysentery should open Lung Qi and clear Liver Fire, so that lower dysentery heals itself." This argument is extremely profound; his deduction of the causes of dysentery and methods of treatment are accurate and appropriate. I now specifically extend his theory and explain it in detail. Although Wood flourishes in Spring, its sprouting and growth actually occur in Summer. Thus, the sixth month of late summer is the Wei month; "Wei" implies heavy leaves on wood, indicating that Wood reaches its peak prosperity at this time. Since the Liver belongs to Wood, it is also extremely prosperous in June. If Liver Wood becomes overly prosperous and insults/conquers Spleen Earth, then in late summer there are many cases of sudden diarrhea, but few cases of dysentery, because Lung Metal has not yet taken command, and its astringent power is very weak. Even if someone occasionally suffers from dysentery at this time, it is mostly caused by damp-heat brewing; simply promoting urination and clearing heat can cure the disease. Therefore, Liu Yi San (Six-to-One Powder) is the fixed formula for treating summerheat dysentery, not the autumn dysentery discussed here. When entering the autumn season, Metal Qi gradually extends, and Wood Qi gradually contracts. The human viscera can originally remain stable according to the normal sequence of seasons without developing dysentery. Only if a person previously had accumulated heat within, will Liver Wood take advantage of the heat to act recklessly, failing to contract when it should. Furthermore, if they catch cold and chill through diet and daily life, Lung Metal, riding on the cold air, exerts its descending and astringent authority even more. Thus, Metal and Wood clash, pressing upon each other in the intestines, and dysentery arises. It is known that the formation of dysentery is indeed due to the conflict between Metal and Wood, and the conflict between Metal and Wood is actually stimulated by the struggle between cold and fire. Tang's method of opening the Lungs and clearing the Liver is originally a correct treatment method. However, it can only be applied at the beginning of the disease, not when dysentery has already progressed deeply. Moreover, observing ancient and modern formulas for treating dysentery, most are effective in the early stage but ineffective in the late stage. I now specifically divide dysentery into several stages and detail the condition and treatment methods below.
At the initial onset of dysentery, there is frequent passage of pus and blood, tenesmus, and intestinal pain. The discharged pus is very thick, and the blood is very bright red. Abdominal pain is not severe, and the pulse is slippery and solid. In such cases, Xiao Chengqi Tang (Minor Order the Command Decoction) can be used with added Sheng Hang Shao (Raw Paeoniae Radix Alba) 4 qian and Gancao (Licorice Root) 2 qian to purge. In this formula, Houpo (Magnolia Bark) and Zhishi (Immature Bitter Orange) can open Lung Qi; Dahuang (Rhubarb Root) and Shaoyao (Peony Root) are good at clearing Liver Fire; moreover, Houpo is warm while Dahuang and Shaoyao are cool, which can balance cold and heat to achieve the effect of cleansing the intestines and eliminating stagnation. Adding Gancao utilizes its ability to harmonize the Stomach and soothe the Liver, thereby moderating the downward-purging force of Chengqi Tang. If the pulse feels empty upon pressure, treat with my formulated Huazhi Tang (Stagnation-Transforming Decoction). If untreated at this stage, or if treated with the previous formula without success, or if delayed for weeks or months, abdominal pain gradually intensifies. Although the color of the discharge hasn't changed much, it may contain membrane-like substances. The pulse may be slightly rapid or slightly deficient. It is suitable to treat with my formulated Xieli Tang (Regulating-Decreeing Decoction). I have cured many patients with this formula throughout my life; it can be used for both new and chronic dysentery.
Although the above formula is effective for both new and chronic dysentery, the intestines generally have not yet ulcerated. However, some patients experience constant cutting abdominal pain and tenesmus, with discharges resembling rotting meat mixed with membranes, indicating that the intestines have already ulcerated. In such cases, treat with my formulated Tongbian Baitouweng Tang (Modified Baitouweng Decoction). The intent of the formula: use Baitouweng (Pulsatilla Root), Qinpi (Ash Bark), Shaoyao (Peony Root), and Sheng Diyu (Raw Sanguisorba Root) to clear heat; Sanqi (Notoginseng Root) and Yadanszi (Brucea Fruit) to resolve stasis and generate new tissue, treating intestinal ulceration; and heavily use Sheng Shanyao (Raw Dioscorea Rhizome) to nourish fluids long consumed and secure the already weakened Qi transformation, thus achieving rapid results. While serving in Fengtian, I had a patient surnamed Wang who suffered from severe dysentery and was cured by this formula; the detailed case record follows this formula for reference. For those with a habit of opium smoking, regardless of whether the dysentery is recent or chronic, this formula is suitable and has repeatedly achieved miraculous results. Regarding Diyu (Sanguisorba Root), medical texts usually recommend using it charred; however, in this formula, it is used raw because raw Diyu is cool and protects the body's tissues from heat-induced ulceration. Therefore, for skin burns from hot liquids or fire, applying raw Diyu powder mixed with sesame oil cures immediately. The heat toxin of dysentery invading intestinal tissues and causing long-term ulceration is similar to skin burns; this is why Diyu is used raw here. The original Baitouweng Tang consists of Baitouweng, Qinpi, Huanglian (Coptis Rhizome), and Huangbai (Phellodendron Bark). The purely bitter-cold nature of these drugs is indeed because the formula originally treats Jueyin Heat Dysentery, which involves excess heat from Cold Damage. Now, using it to treat chronic dysentery with intestinal ulceration necessitates modification.
The aforementioned dysentery syndromes can also be treated with my formulated Shenghua Dan (Life-Generating Pill). If the deficiency is severe, add Sheng Huaishan (Raw Chinese Yam) 1 liang. First, send down half of the Sanqi (Notoginseng Root) and Yadanszi (Brucea Fruit) with white sugar water, then decoct and drink the remaining four herbs. When taking the dregs, again first send down the remaining Sanqi and Yadanszi with white sugar water, then decoct and drink the liquid. By this stage of dysentery, Western medicine calls it intestinal ulceration. It cannot be treated merely as dysentery; it should be treated partially as a sore. Therefore, use Jinyinhua (Honeysuckle Flower) and Fen Gancao (Powdered Licorice Root) to resolve heat toxins of sores; Sanqi and Yadanszi to resolve stasis and generate new tissue; Yadanszi is extremely bitter and has resolving power (paste can remove warts), and can also eliminate infectious bacteria of dysentery; Shaoyao drains Liver Fire to treat the root cause of dysentery; fearing that chronic dysentery damages Yin fluids and fails to secure Lower Jiao Qi transformation, heavily use Sheng Shanyao to nourish Yin fluids and secure Qi transformation. This is why it is effective (see medical cases after this formula in the Medical Formulas section for reference). When I first formulated this, I had not yet seen the Western concept of intestinal ulceration. Later, seeing Western books, their treatments focused only on intestinal ulceration, ignoring the need to clear the root source of dysentery with medication, hence less effective than this formula.
For chronic dysentery with deficiency heat steaming upward, reduced appetite, discharges resembling rotting meat mixed with membranes, having a rotten color and abnormal foul odor, and increasingly severe cutting abdominal pain, the vital energy in the abdomen is about to cease, and the condition is particularly critical. Treat with the previous formula, adding Luzhushen (Codonopsis Root) and Tianmendong (Asparagus Tuber) each 3 qian. Ginseng is used to assist vital energy, and Asparagus Tuber is used to moderate the heat of Ginseng.
For those originally damaged by opium smoke, with Kidney Meridian exhaustion, complicated by chronic dysentery where intestines are about to ulcerate, and Lower Jiao Qi transformation is too depleted to hold, treat with my formulated Sanbao Zhou (Three Treasures Porridge). The intent: use Sanqi and Yadanszi to treat intestinal ulceration, and Shanyao porridge to tonify Lower Jiao depletion.
For dysentery presenting as red, white, or mixed red-and-white stool, with tenesmus and abdominal pain, feeling feverish inside and out, where fever does not subside with cooling medicines and dysentery does not heal, and the pulse clearly indicates excess heat: These dysentery syndromes originally involve external pathogenic heat, which resides in the Yangming Fu organs. They cannot be cured by Taohua Tang (Peach Kernel Decoction) from the Shaoyin Chapter nor by Baitouweng Tang from the Jueyin Chapter. Only treating with my formulated Tongbian Baihu Jiarenshen Tang (Modified White Tiger Plus Ginseng Decoction) yields immediate results. When dysentery presents with persistent fever unresponsive to cooling herbs, texts often dismiss it as incurable. However, if the treatment matches the syndrome, how can the fever persist? This is truly because external heat pathogens sink deeply with the dysentery, having no exit, aiding the dysentery day by day, leading to no hope of recovery. Treating with this decoction, Ginseng assists Gypsum to slowly rise and dissipate the deeply sunk heat pathogens, eliminating them completely. Add Shaoyao and Gancao to regulate tenesmus and abdominal pain, and Sheng Shanyao to nourish Yin and secure the Lower Jiao. Taking several doses, the fever subsides and dysentery heals. The formula uses Shaoyao instead of Zhimu (Anemarrhena Rhizome) and Sheng Shanyao instead of Jingmi (Rice), resembling the original Baihu Jiarenshen Tang, hence the name. I have cured many such dysentery cases with this formula (see cases after this formula in the Medical Formulas section).
This combination of external heat and dysentery is the most dangerous syndrome. I once saw a Japanese author, XXX, write "New Theory on Red Dysentery," highly praised by Ding Zhonghu. However, it recorded two uncured cases: One had a temperature of 38.7°C, pulse 110 beats/min, confused consciousness, unclear speech, swollen dry tongue, peeled coating, obviously involving external excess heat. The Japanese doctors failed to prioritize clearing external excess heat, instead injecting dysentery serum daily, resulting in death. The second had severe fever, nocturnal mania, delirium, and temperature 40.2°C, obviously involving severe external heat. The case did not record treatment methods, presumably similar to the first, also resulting in death. If these two cases were treated with my Tongbian Baihu Jiarenshen Tang, fearing the disease is severe and the dose light, one could combine two doses into one, decoct into 4-5 teacups, and drink slowly in multiple portions. Recovery need not require finishing all doses; how could the fever not subside? Once high fever subsides, dysentery naturally heals. The Japanese failed to see this because they abandoned traditional Chinese learning entirely for Western studies. Chinese and Western medicine should assist each other, not be neglected. If our country wishes to revitalize medicine, it is essential to integrate Chinese and Western practices.
The dysentery discussed above involves external heat entering the Yangming Fu organs. However, at the onset of dysentery, there are often cases where external constraints stimulate internal damage. Clinicians must carefully observe. If there is external constraint, first use medication to release the exterior, then treat dysentery; or add exterior-releasing herbs to dysentery formulas; or use dysentery decoction to send down a small amount of Aspirin to release the exterior. If overlooked, external pathogens sink inward with dysentery, becoming the critical syndrome managed by Tongbian Baihu Jiarenshen Tang. Is it not better to treat early?
Although dysentery is formed by cold-heat stagnation, commentators often say white dysentery leans cold and red dysentery leans heat. This is the general rule, but cannot be generalized. I will cite cured cases to clarify. The wife of Zhang XX from Tongzhuang, nearly sixty years old, prone to illness. One morning in late summer, she suddenly passed white dysentery, over ten times by evening. After lighting candles, she suddenly developed high fever, became unconscious, exhibited aimless hand movements (clutching clothes and bed), and did not respond to calls. Her pulse was surging but powerless, and her skin was burning hot. Knowing her dysentery was caused by summerheat injury, and her debilitated body could not withstand summerheat steaming, causing such coma. Urgently use Sheng Shigao (Raw Gypsum) 3 liang and Yetaishen (Wild Codonopsis) 4 qian, decoct into a large bowl, and let her drink slowly. By midnight, after finishing the dose, she woke up. The next morning, decoct the dregs and take again; fever subsided and dysentery healed. This was purely white dysentery yet presented with such intense heat.
There are cases of consecutive dysentery episodes with different cold-heat presentations. Carefully diagnose the pulse; if significantly different, prescribe medications appropriately without error. I once treated Liu XX who suffered severe dysentery in early autumn. His dysentery consisted of thick, sticky pus and blood, with a wiry and fine pulse that remained forceful upon deep pressure. Treated with Tongbian Baitouweng Tang, cured in two doses. Ten days later, dysentery recurred. He self-medicated with the original formula, but the condition worsened. He returned for consultation. His pulse was wiry, fine, and slow, intolerant to pressure. Knowing it had become cold dysentery, he could not tolerate the original formula. Prescribed Sheng Huaishan (Raw Chinese Yam) powder cooked as porridge, sent down with Xiaohuixiang (Fennel Seed) powder 1 qian and Sheng Liuhuang (Native Sulfur) powder 4 fen. Cured in several doses. Similarly, the case of Mrs. Lu cured after the Sanbao Zhou formula.
Both cases followed the shift in pathology, alternating cool and hot medications, achieving immediate results. Therefore, practitioners must study carefully during clinical practice, ensuring every moment aligns with the pathology.
There are dysentery cases with upper heat and lower cold, requiring separate treatment for upper and lower parts: cool herbs for the upper, hot herbs for the lower. I once treated an elderly woman surnamed Zhang in Tianjin, nearly fifty, who suffered dysentery in early autumn, lasting twenty days without relief. Discharge was red dysentery mixed with bloody water, tenesmus, and abdominal pain. Later, dysentery decreased and diarrhea increased, also mixed with bloody water. Upper jiao was烦热 (restless heat), unable to eat (Jinkou), nausea upon smelling food, dizziness, unable to get out of bed. Pulse at Guan position was floating and wiry, empty upon deep pressure; Chi positions were weak and rootless, five breaths per minute. Patient felt palpitations, mental confusion, seemingly near collapse. This indicated extreme deficiency approaching collapse. Urgently use Yu Rou (Cornus Fruit) and Sheng Huaishan each 1 liang, Da Shudi (Prepared Rehmannia Root), Longyan Rou (Longan Aril), and Bailonggu (Fossilized Bone) each 5 qian, Sheng Hang Shao (Raw Paeoniae Radix Alba), Yunling Pian (Poria Slice), and Zhi Gancao (Honey-fried Licorice Root) each 2 qian. Decoct into two bowls, divide into two warm doses. After the first dose, mind and spirit stabilized. After finishing the dose, ate slightly, diarrhea and dysentery stopped somewhat. Added Sheng Dihuang (Raw Rehmannia Root) 4 qian, changed Zhi Gancao to 3 qian, decoct into two bowls, divide into two warm doses. Each dose sent down with Sheng Liuhuang (Native Sulfur) powder 2.5 fen. One dose daily, cured in several days.
Regarding summer heat dysentery, treating with Liu Yi San was mentioned earlier. Southern summer heat often combines with dampness, making Liu Yi San appropriate. Northern summer heat often lacks dampness and may combine with dryness; thus, Liu Yi San requires modification. I formulated a highly effective prescription: Huashi (Talcum) and Sheng Shigao (Raw Gypsum) each 5 qian, Zhusha (Cinnabar) and Fen Gancao (Powdered Licorice Root) each 2 qian, Bohe Bing (Mint Ice) 1 fen. Mix evenly, take 2 qian with boiled water. For severe heat and dysentery, take 5-6 times daily. Named Jiawei Yiyuan San (Added-Ingredient Yiyuan Powder), as Liu Yi San plus Cinnabar is Yiyuan San, here further adding Gypsum and Mint Ice.
Note: Summer heat dysentery often presents with inability to eat. Treating with Jiawei Yiyuan San revitalizes appetite. If non-summer heat dysentery also presents with loss of appetite, use equal parts Zhusha (Cinnabar) and Fen Gancao (Powdered Licorice Root), add a little Bohe Bing (Mint Ice), take 1 qian sent down with Zhuru (Bamboo Shavings) decoction. Appetite returns. Such conditions are often due to Liver/Gallbladder fire carrying Stomach Qi rebellion; smelling food causes nausea/vomiting, preventing eating. Zhusha descends Stomach Qi and calms Liver; Gancao harmonizes Stomach and soothes Liver; Zhuru pacifies rebellious Qi; Bohe Bing disperses constrained heat. Hence, immediate efficacy. Due to repeated success, named Kaiwei Zisheng Dan (Appetite-Opening Nourishing Pill).
During summer heat, if Liver/Gallbladder and Intestines/Stomach have pre-existing heat, and one runs/work under the scorching sun, sudden dysentery ensues, often with fresh blood, and pulse is surging and large. Treat with large dose of Baihu Tang (White Tiger Decoction), decoct several bowls, drink warm in portions. Send down 30 Yadanszi Ren (Brucea Seeds) each time. If pulse is surging/large but empty upon pressure, treat with large dose of Baihu Jiarenshen Tang (White Tiger Plus Ginseng Decoction), sending down Yadanszi Ren.
For chronic dysentery with sinking of Clear Yang, i.e., Chest Middle Qi sinking due to dysentery. Symptoms often include sensation of heaviness/dragging and abdominal pain (Qi sinking pressing on Lower Jiao), either dysentery or diarrhea, often passing flatus, shortness of breath, or alternating chills and fever. Pulse is slow and weak. Treat with my formulated Shengxian Tang (Ascending the Fallen Decoction), remove Zhimu (Anemarrhena Rhizome), add Sheng Huaishan (Raw Chinese Yam) 6 qian and Baitouweng (Pulsatilla Root) 3 qian. Original intent: Use Sheng Huangqi (Raw Astragalus Root) to ascend and tonify Chest Middle Qi, assisted by Chaihu (Bupleurum Root), Jiegeng (Platycodon Root), and Shengma (Cimicifuga Rhizome) which ascend Clear Yang; add Zhimu to moderate Huangqi's heat. Here, due to frequent Lower Jiao diarrhea/dysentery and insecure Qi transformation, replace Zhimu with Baitouweng and assist with Shanyao. Zhimu is cold and slippery; Baitouweng is cool and astringent. Its coolness resolves Huangqi's heat; its astringency secures Qi transformation leakage; it is a key herb for dysentery. Combined with Shanyao, another key herb for stopping diarrhea.
Besides various dysenteries, there is "Resting Dysentery" (Xixi Li). It is generally not severe but hard to eradicate, recurring frequently even after cure. Though prolonged, it can be sustained, resembling mild Amebic Dysentery, lasting years without fatal outcome. Perhaps this is amebic dysentery? Requires future experimental verification. The reason for recurrence is likely protozoa hiding in the twists of the large/small intestines. Healing and relapsing occur until protozoa are eliminated. To eliminate: For heat-type syndromes, use Yadanszi Ren assisted by dysentery herbs; for cold-type syndromes, use Liuhuang (Sulfur) powder assisted by dysentery herbs. Furthermore, regardless of heat or cold, add Mu Zei (Equisetum Ramulum) 1 qian to the formula, as it soothes the Liver and stops intestinal wind bleeding. Hence, later Materia Medica states it treats resting dysentery well. For those with weak Spleen/Stomach, additionally use herbs to strengthen and tonify Spleen/Stomach to clear the upper source of dysentery, naturally removing the root cause.
Dysentery cases sometimes present with frequent daily stools but dry fecal impaction remaining in the intestines. The impaction must be removed for dysentery to heal. This is rare but must be known by dysentery practitioners. My cousin Liu XX, aged 24, suffered dysentery at Mid-Autumn Festival. Thick, sticky pus and blood, 15-16 times daily, severe abdominal pain and tenesmus. Treated with Huazhi Tang (Stagnation-Transforming Decoction), two doses. Frequency seemed reduced, but tenesmus/pain remained. Deep pulse at Chi position was very solid. Suspected intestinal fecal impaction. Administered Xiao Chengqi Tang (Minor Order the Command Decoction) with added Sheng Hang Shao (Raw Paeoniae Radix Alba) several qian. Passed dry feces approx. 4 cun long. Tenesmus and pain relieved 80-90%. Given one more dose of Huazhi Tang, disease vanished.
The most important drug for treating dysentery: For heat-leaning dysentery, Yadanszi (Brucea Fruit) is paramount; for cold-leaning dysentery, Liuhuang (Sulfur) is paramount, as both have power to eliminate protozoa in dysentery. These two drugs were mentioned frequently in previous cases. Discussing them again:
Yadanszi, also known as Yadan Zi, has properties of cooling blood, stopping bleeding, and resolving stasis to generate new tissue. Effective for heat-leaning dysentery, especially for fresh blood dysentery and bloody water diarrhea. Also clears Stomach Fire; effective for fullness of excess heat in epigastrium and inability to eat (Jinkou), restoring appetite. Must remove hard skin before use. If kernel breaks during peeling, do not use, as broken kernels digest easily, releasing bitter taste quickly, often causing vomiting. Hence, some dysentery formulas use Longan Aril to wrap intact Yadanszi kernels for swallowing whole. Pharmacy secret recipe coats Yadanszi kernels with Yiyuan San, naming it Puti...