治下痢，或赤、或白、或赤白参半，下重腹疼，周身发热，服凉药而热不休，脉象确有实热者。
生石膏（二两，捣细） 生杭芍（八钱） 生山药（六钱） 人参（五钱，用野党参按此分量，若辽东真野
参宜减半，至高丽参则断不可用） 甘草（二钱）
上五味，用水四盅，煎取清汤两盅，分二次温饮之。
此方，即《伤寒论》白虎加人参汤，以芍药代知母、山药代粳米也。痢疾身热不休，服清火药而热亦不休
者，方书多诿为不治。夫治果对证，其热焉有不休之理？此乃因痢证夹杂外感，其外感之热邪，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。惟治以此汤，以人参助石膏，能使深陷之邪，徐徐上升外
散，消解无余。加以芍药、甘草以理下重腹疼，山药以滋阴固下，连服数剂，无不热退而痢愈者。
按∶外感之热已入阳明胃腑，当治以苦寒，若白虎汤、承气汤是也。若治以甘寒，其病亦可暂愈，而恒将
余邪锢留胃中，变为骨蒸劳热，永久不愈（《世补斋医书》论之甚详）。石膏虽非苦寒，其性寒而能散，且无
汁浆，迥与甘寒粘泥者不同。而白虎汤中，又必佐以苦寒之知母。即此汤中，亦必佐以芍药，芍药亦味苦
（《神家本草经》）微寒之品，且能通利小便。故以佐石膏，可以消解阳明之热而无余也。
一叟，年六十七，于中秋得痢证，医治二十余日不效。后愚诊视，其痢赤白胶滞，下行时，觉肠中热而且
干，小便亦觉发热，腹痛下坠并迫。其脊骨尽处，亦下坠作痛。且时作眩晕，其脉洪长有力，舌有白苔甚浓。
愚曰∶此外感之热挟痢毒之热下
迫，故现种种病状，非治痢兼治外感不可。遂投以此汤，两剂，诸病皆愈。其脉犹有余热，拟再用石膏清之，
病家疑年高，石膏不可屡服，愚亦应征他往。后二十余日，痢复作。延他医治疗，于治痢药中，杂以甘寒濡润
之品，致外感之余热，永留肠胃不去，其痢虽愈，而屡次反复。延至明年仲夏，反复甚剧。复延愚延医，其脉
象、病证皆如旧。因谓之曰，去岁若肯多服石膏数两，何至有以后屡次反复，今不可再留邪矣。仍投以此汤，
连服三剂，病愈而脉亦安和。
一人，年四十二，患白痢，常觉下坠，过午尤甚，心中发热，间作寒热。医者于治痢药中，重用黄连一
两清之，热如故，而痢亦不愈。留连两月，浸至不起。诊其脉，洪长有力，亦投以此汤。为其间作寒热，加柴
胡二钱，一剂热退痢止，犹间有寒热之时。再诊其脉，仍似有力，而无和缓之致。知其痢久，而津液有伤也，
遂去白芍、柴胡，加玄参、知母各六钱，一剂寒热亦愈。
一媪，年六旬，素多疾病。于夏季晨起，偶下白痢，至暮十余次。秉烛后，忽然浑身大热，不省人事，
循衣摸床，呼之不应。其脉洪而无力，肌肤之热烙指。知系气分热痢，又兼受暑，多病之身，不能支持，故精
神昏愦如是也。急用生石膏三两、野台参四钱，煎汤一大碗，徐徐温饮下，至夜半尽剂而醒，痢亦遂愈。诘朝
煎渣再服，其病脱然。
一人，年五十余，于暑日痢而且泻，其泻与痢俱带红色，下坠腹疼，噤口不食。医治两旬，病势浸增，
精神昏愦，气息奄奄。诊其脉，细数无力，周身肌肤发热。询其心中亦觉热，舌有黄苔，知其证夹杂暑温。暑
气温热，弥漫胃口，又兼痢而且泻，虚热上逆，是以不能食也。遂用生山药两半、滑石一两、生杭芍六钱、粉
甘草三钱，一剂诸病皆见愈，可以进食。又服一剂全愈。
此证用滑石不用石膏者，以其证兼泻也。为不用石膏，即不敢用人参，故倍用山药以增其补力。此就通变之方，
而又为通变也。
痢证，又有肝胆肠胃先有郁热，又当暑月劳苦于烈日之中，陡然下痢，多带鲜血，脉象洪数，此纯是一团
火气。宜急用大苦大寒之剂，若芩、连、知、柏、胆草、苦参之类，皆可选用。亦可治以白虎汤，方中生石膏
必用至二两，再加生白芍一两。若脉大而虚者，宜再加人参三钱。若其脉洪大甚实者，可用大承气汤下之，而
佐以白芍、知母。
有痢久而清阳下陷者，其人或间作寒热，或觉胸中短气。当于治痢药中，加生黄 、柴胡以升清阳。脉
虚甚者，亦可酌加人参。又当佐以生山药以固下焦，然用药不可失于热也。有痢初得，兼受外感者，宜于治痢
药中，兼用解表之品。其外邪不随痢内陷，而痢自易治。不然，则成通变白虎加人参汤所主之证矣。
痢证初得虽可下之，然必确审其无外感表证，方可投以下药。其身体稍弱，又宜少用参、 佐之。
痢证忌用滞泥之品，然亦不可概论。外祖母，年九旬。仲夏下痢赤白甚剧，脉象数而且弦。愚用大熟地、
生杭芍各一两煎汤，服下即愈。又服一剂，脉亦和平。
痢证间有凉者，然不过百中之一耳，且又多系纯白之痢。又必脉象沉迟，且食凉物，坐凉处则觉剧者。
治以干姜、白芍、小茴香各三钱，山楂四钱，生山药六钱，一两剂即愈。用白芍者，诚以痢证必兼下坠腹疼。
即系凉痢，其凉在肠胃，而其肝胆间必有伏热，亦防其服热药，而生热也。
凡病患酷嗜之物，不可力为禁止。尝见患痢者，有恣饮凉水而愈者，有饱食西瓜而愈者。总之，人之
资禀不齐，病之变态多端，尤在临证时，精心与之消息耳。曾治一少年，下痢，昼夜无数，里急后重。投以清
火通利之药数剂，痢已减半，而后重分毫
不除。疑其肠中应有阻隔，投以大承气汤，下燥粪长数寸而愈。设此证，若不疑其中有阻隔，则燥粪不除，病
将何由愈乎？
有奇恒痢者，张隐庵谓，其证三阳并至，三阴莫当，九窍皆塞，阳气旁溢，咽干喉塞痛，并于阴则上下无
常，薄为肠 。其脉缓小迟涩，血温身热者死，热见七日者死。盖因阳气偏盛，阴气受伤，是以脉小迟涩。此
证急宜用大承气汤泻阳养阴，缓则不救。若不知奇恒之因，见脉气平缓，而用平易之剂，必至误事。
治疗下痢，大便或呈红色、或呈白色、或红白相间，伴有肛门重坠感和腹部疼痛，全身发热，服用寒凉药物后热势不退，脉象确实表现为实热证者。
生石膏（二两，捣碎成细粉） 生杭芍（八钱） 生山药（六钱） 人参（五钱，若使用野党参则按此分量；若使用辽东真野山参宜减半剂量；至高丽参则绝对不可使用） 甘草（二钱）
以上五味药，用水四盅，煎煮取清汤两盅，分两次温服。
此方即《伤寒论》中的白虎加人参汤，以芍药代替知母、山药代替粳米而成。痢疾患者身体发热不退，服用清热泻火药后热势依然不退的，医书中多将其归为不治之症。然而，如果治疗确实对症，热势怎会有不退的道理？这是因为痢疾夹杂了外感病邪，外感的热邪随着痢疾深陷体内，永远没有出路，导致痢疾被热邪助长，病情一天比一天加重，从而永远没有痊愈的期限。只有用这个汤剂治疗，让人参辅助石膏，能使深陷的病邪徐徐上升并向外发散，彻底消解清除。再加上芍药、甘草来调理肛门重坠和腹部疼痛，山药来滋阴固摄下焦，连续服用几剂，没有不热退而痢疾痊愈的。
按语：外感的热邪已经传入阳明胃腑，应当用苦寒药物治疗，如白虎汤、承气汤等。如果用甘寒药物治疗，病情虽然可以暂时好转，但往往会将残余的病邪禁锢在胃中，转变为骨蒸劳热（一种慢性虚热病），永久不愈（《世补斋医书》对此论述得很详细）。石膏虽然不是苦寒之品，但其性寒且能散邪，而且没有黏腻的汁浆，与那些甘寒黏腻的药物截然不同。而在白虎汤中，又必须佐以苦寒的知母。在这个方子中，也必须佐以芍药，芍药也是味苦（《神农本草经》记载）、微寒的药物，并且能通利小便。所以用芍药辅助石膏，可以彻底消解阳明的热邪。
有一位老翁，六十七岁，在中秋节时患上痢疾，医治二十多天无效。后来我诊治，他的大便红白胶滞，排便时感觉肠中热且干燥，小便也感觉发热，腹痛且有下坠紧迫之感。他的尾椎骨尽头处，也有下坠作痛的感觉。并且时常发生眩晕，脉象洪大、长而有力，舌苔白厚浓密。我说：这是外感的热邪挟带痢毒的热邪向下逼迫，所以出现种种病症，必须治疗痢疾的同时兼治外感。于是投以此汤，服用两剂，所有病症都痊愈了。但他的脉象仍有余热，打算再用石膏清解，病人家属怀疑他年事已高，不敢让石膏频繁服用，我也正好应邀去别处行医。二十多天后，痢疾复发。请其他医生治疗，在治疗痢疾的药中，混杂了甘寒濡润的药物，导致外感的余热永远留在肠胃不去，虽然痢疾好了，但屡次反复。直到第二年仲夏，反复发作非常剧烈。再次请我去诊治，脉象和病症都与去年一样。我对他说：“去年如果肯多服用几两石膏，何至于有以后屡次反复的情况，现在不能再留邪气了。”仍然投以此汤，连续服用三剂，病愈且脉象平和。
有一人，四十二岁，患白痢，常觉肛门下坠，午后尤其严重，心中发热，间歇性出现寒热往来。医生在治疗痢疾的药中，重用黄连一两来清热，但热势依旧，痢疾也不见好。拖延两个月，逐渐发展到卧床不起。诊其脉象，洪大、长而有力，也投以此汤。因为其间有寒热往来的症状，加入柴胡二钱，一剂后热退痢止，但仍偶尔有寒热之时。再诊其脉，仍然显得有力，但没有和缓之象。知道他是痢疾日久，津液受到损伤，于是去掉白芍、柴胡，加入玄参、知母各六钱，一剂后寒热也痊愈了。
有一位老妇人，六十岁，平时多病。夏季早晨起床时，偶然拉出白痢，到傍晚已达十多次。点蜡烛后，忽然浑身大热，不省人事，手循摸衣被床沿，呼叫不应。脉象洪大而无力，肌肤烫手。知道这是气分热痢，又兼受暑邪，加上身体多病，不能支撑，所以精神昏乱如此。急忙用生石膏三两、野台参四钱，煎汤一大碗，慢慢温服，到半夜药尽而苏醒，痢疾也随之痊愈。第二天早上煎药渣再服一次，病完全脱除。
有一人，五十多岁，在暑天既痢疾又腹泻，泻下物和痢疾都带有红色，下坠腹痛，噤口不食（无法进食）。医治二十天，病情逐渐加重，精神昏乱，气息微弱。诊其脉象，细数而无力，周身肌肤发热。询问他心中也觉得热，舌苔黄，知道是证候夹杂暑温。暑气温热，弥漫胃口，又兼有痢疾和腹泻，虚热上逆，所以不能进食。于是用生山药一两半、滑石一两、生杭芍六钱、粉甘草三钱，一剂后各种病症都见好转，可以进食。又服一剂完全痊愈。
此证用滑石而不用石膏的原因，是因为证候兼有腹泻。因为不用石膏，就不敢用人参，所以加倍使用山药以增加补益之力。这是在通变方的基础上，又进行了通变。
痢疾病证，又有肝胆肠胃先有郁热，又在暑月烈日下劳作辛苦，突然下痢，多带有鲜血，脉象洪数，这纯粹是一团火气。应当紧急使用大苦大寒的药剂，如黄芩、黄连、知母、黄柏、龙胆草、苦参之类，都可以选用。也可以用白虎汤治疗，方中生石膏必须用到二两，再加生白芍一两。如果脉象大而虚，宜再加人参三钱。如果脉象洪大非常实，可以用大承气汤攻下，并佐以白芍、知母。
有痢疾日久导致清阳下陷的，其人可能间歇性出现寒热，或觉得胸中短气。应当在治疗痢疾的药中，加入生黄芪、柴胡以提升清阳。脉象虚弱的，也可以酌情加入人参。又当佐以生山药以固护下焦，然而用药不可过于温热。有痢疾初起，兼受外感的，宜在治疗痢疾的药中，兼用解表的药物。如果外邪不随痢疾内陷，那么痢疾自然容易治疗。否则，就会变成通变白虎加人参汤所主治的证候了。
痢疾初起虽然可以使用攻下法，但必须确切审查其没有外感表证，才可以投用下药。身体稍弱的，宜少用人参、黄芪佐助。
痢疾病证忌讳使用滋腻碍胃的药物，但也不能一概而论。我的外祖母，九十多岁。仲夏时节下痢赤白非常严重，脉象数而且弦。我用大熟地黄、生杭芍各一两煎汤，服用后即痊愈。又服一剂，脉象也平和了。
痢疾病证间或有属寒凉的，但这不过是百中之一罢了，而且又多属于纯白色的痢疾。并且必须脉象沉迟，且吃了凉物、坐在凉处则觉得病情加剧者。用干姜、白芍、小茴香各三钱，山楂四钱，生山药六钱，一两剂即可痊愈。使用白芍的原因，诚然因为痢疾病证必然兼有下坠腹痛。即使是凉痢，其寒冷在肠胃，而其肝胆之间必有伏热，也要防止服用热药而生热。
凡是病人特别喜爱的食物，不可强行禁止。曾见过患痢疾的人，有恣意喝凉水而痊愈的，有饱吃西瓜而痊愈的。总之，人的资质禀赋不同，病情的变化多端，尤其在临证时，需要精心观察斟酌罢了。曾治疗一个少年，下痢，昼夜无数次，里急后重。投以清热泻火通利的药物几剂，痢疾已减半，但后重感丝毫未除。怀疑他肠中应有阻隔，投以大承气汤，排出长数寸的燥粪而痊愈。假如这个证候，不怀疑其中有阻隔，那么燥粪不除，病将如何痊愈呢？
有一种奇恒痢，张隐庵说，这种证候是三阳经的病邪并至，三阴经抵挡不住，九窍闭塞，阳气旁溢，咽干喉塞疼痛，并于阴经则上下无常，迫注肠道形成肠澼（痢疾）。其脉象缓小迟涩，血温身热的预后不良，热象持续七天的预后不良。大概是因为阳气偏盛，阴气受伤，所以脉象小迟涩。此证应当紧急使用大承气汤泻阳养阴，迟缓则无法救治。如果不知道奇恒痢的成因，见到脉气平缓，而使用平淡普通的药剂，必定会误事。
Treatment for dysentery, where the stool is either red, or white, or a mixture of both, accompanied by tenesmus (a feeling of incomplete defecation with rectal pressure) and abdominal pain, generalized fever, and fever that does not subside after taking cooling medicines, with a pulse indicating definite excess heat.
Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, finely crushed)
Sheng Hangshao (Raw Paeoniae Radix Alba, 8 qian)
Sheng Shanyao (Raw Dioscoreae Rhizoma, 6 qian)
Renshen (Ginseng Radix et Rhizoma, 5 qian; if using Yedangshen [Codonopsis Radix], use this dosage; if using Liaodong Zhenyeshanren [Wild Panax Ginseng Root], reduce the dosage by half; Korean Ginseng [Korensis Ginseng Radix] must absolutely not be used)
Gancao (Licorice Root, 2 qian)
The above five herbs are decocted in four cups of water to obtain two cups of clear decoction, taken warm in two divided doses.
This formula is based on Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), substituting Shaoyao (Paeoniae Radix) for Zhimu (Anemarrhenae Rhizoma) and Shanyao (Dioscoreae Rhizoma) for Jingmi (Oryza Sativa). In cases of dysentery with persistent fever that does not resolve with antipyretic or clearing-heat medicines, medical texts often deem it incurable. However, if the treatment is correctly indicated, why would the fever not subside? This occurs because the dysentery is complicated by an exogenous pathogen; the exogenous heat pathogen sinks deeply into the interior along with the dysentery, having no outlet, thereby assisting the dysentery pathology, worsening day by day, and leading to a chronic course without recovery. Only by treating with this decoction can Renshen assist Shigao to slowly lift and disperse the deeply sunk pathogen outward, eliminating it completely. The addition of Shaoyao and Gancao regulates tenesmus and abdominal pain, while Shanyao nourishes yin and secures the lower jiao. Continuous administration for several doses invariably results in the subsidence of fever and cure of dysentery.
Note: When exogenous heat has entered the Yangming Stomach fu organ, it should be treated with bitter-cold herbs, such as those in Baihu Tang (White Tiger Decoction) or Chengqi Tang (Order the Qi Decoction). If treated with sweet-cold herbs, the disease may temporarily improve, but residual pathogens often remain trapped in the stomach, transforming into bone-steaming consumptive fever (a type of chronic deficiency heat), which remains incurable (*Shibu Zhai Yishu* discusses this in detail). Although Shigao is not bitter-cold, its nature is cold and dispersing, and it lacks sticky juices, differing significantly from sweet-cold cloying herbs. Furthermore, Baihu Tang requires the assistance of bitter-cold Zhimu. Similarly, this formula requires the assistance of Shaoyao, which is also bitter (as recorded in *Shennong Bencao Jing*) and slightly cold, and promotes urination. Thus, assisting Shigao with Shaoyao allows for the complete resolution of Yangming heat.
An elderly man, aged 67, contracted dysentery during the Mid-Autumn Festival. After more than twenty days of ineffective treatment, I examined him. His stool was a sticky mixture of red and white. During defecation, he felt heat and dryness in the intestines, and his urine felt hot. He experienced abdominal pain with a sensation of bearing down and urgency. There was also pain and a bearing-down sensation at the end of his spine. He suffered from occasional vertigo. His pulse was surging, long, and forceful; his tongue coating was thick and white. I stated: "This is exogenous heat forcing downward together with dysentery toxins, causing these various symptoms. It is necessary to treat both the dysentery and the exogenous condition." I administered this decoction. After two doses, all symptoms resolved. However, his pulse still showed signs of residual heat, so I intended to use Shigao again to clear it. The patient's family doubted whether a high-dose cold herb like Shigao could be taken frequently by an elderly person. I also had to attend another appointment elsewhere. More than twenty days later, the dysentery recurred. Other physicians treated him, adding sweet-cold moistening herbs to the dysentery formula. This caused the residual exogenous heat to remain permanently in the gastrointestinal tract. Although the dysentery initially improved, it repeatedly relapsed. By midsummer of the following year, the relapses were severe. I was called back to treat him; his pulse and symptoms were identical to the previous year. I told him, "If you had taken more Shigao last year, how could there have been subsequent relapses? Now we cannot leave the pathogen behind." I prescribed the same decoction again. After three consecutive doses, the illness cured and the pulse became harmonious.
A man, aged 42, suffered from white dysentery with frequent sensations of bearing down, worse after noon. He felt heat in his heart and intermittent chills and fever. A physician used a heavy dose of Huanglian (Coptidis Rhizoma, 1 liang) to clear heat within the dysentery formula, but the heat persisted and the dysentery did not improve. After two months of lingering illness, he became bedridden. His pulse was surging, long, and forceful. I prescribed this decoction. Due to the intermittent chills and fever, I added Chaihu (Bupleuri Radix, 2 qian). After one dose, the fever subsided and dysentery stopped, though intermittent chills and fever occasionally remained. Upon re-examination, his pulse was still forceful but lacked a gentle quality. I determined that prolonged dysentery had damaged his body fluids. Therefore, I removed Baishao (White Peony Root) and Chaihu, and added Xuanshen (Scrophulariae Radix) and Zhimu (Anemarrhenae Rhizoma), each 6 qian. After one dose, the chills and fever also resolved.
An elderly woman, aged 60, who was generally prone to illness, suddenly developed white dysentery early one summer morning, progressing to more than ten episodes by evening. After nightfall, she suddenly developed high fever throughout her body, lost consciousness, exhibited picking at clothes and bedsides (a sign of delirium), and did not respond to calls. Her pulse was surging but weak, and her skin was burning hot to the touch. I diagnosed this as qi-level heat dysentery complicated by summerheat, where her frail constitution could not withstand the pathogen, resulting in mental confusion. I urgently prepared a large bowl of decoction using Raw Shigao (3 liang) and Ye Taishen (Wild Codonopsis Radix, 4 qian), administering it slowly while warm. By midnight, after finishing the dose, she woke up, and the dysentery ceased. The next morning, she took the dregs of the decoction, and the illness completely resolved.
A man, over 50 years old, suffered from both dysentery and diarrhea during a hot summer day. Both stools contained blood. He experienced bearing down, abdominal pain, and inability to eat (anorexia due to nausea/obstruction). After twenty days of treatment, his condition worsened progressively. He was mentally confused, with faint breathing. His pulse was fine, rapid, and weak. His entire body was hot to the touch. He reported feeling heat in his chest, and his tongue coating was yellow. I diagnosed the condition as complicated by summerheat-warmth. The summerheat-warmth pathogen was diffuse in the stomach area, combined with dysentery and diarrhea, causing deficient heat to rebel upward, hence the inability to eat. I prescribed Raw Shanyao (1.5 liang), Huashi (Talcum, 1 liang), Raw Hangshao (6 qian), and Fen Gancao (Prepared Licorice Root, 3 qian). After one dose, all symptoms improved, and he could eat. After another dose, he fully recovered.
I used Huashi instead of Shigao in this case because the condition included diarrhea. Since Shigao was omitted, I dared not use Renshen, so I doubled the amount of Shanyao to enhance tonification. This represents a further modification of the modified formula.
In cases of dysentery where there is pre-existing stagnant heat in the Liver, Gallbladder, Intestines, and Stomach, compounded by labor under the scorching sun during summer months, sudden onset of dysentery with fresh blood is common. The pulse is typically surging and rapid, indicating pure fire toxin. Urgent treatment with major bitter-cold herbs is required, such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Longdancao (Gentianae Radix), or Kushen (Sophorae Flavescentis Radix). Baihu Tang (White Tiger Decoction) can also be used, requiring Raw Shigao (2 liang) plus Raw Baishao (1 liang). If the pulse is large and deficient, add Renshen (3 qian). If the pulse is surging, large, and very solid, Da Chengqi Tang (Major Order the Qi Decoction) can be used to purge, assisted by Baishao and Zhimu.
In cases of prolonged dysentery with sinking of clear yang, the patient may experience intermittent chills and fever or shortness of breath in the chest. Add Sheng Huangqi (Astragali Radix) and Chaihu (Bupleuri Radix) to the dysentery formula to raise clear yang. If the pulse is very deficient, Renshen can be酌情 (discretionarily) added. Assist with Sheng Shanyao to secure the lower jiao, but avoid overly warming herbs. In early-stage dysentery complicated by exogenous pathogens, include exterior-resolving herbs in the dysentery formula. If the exogenous pathogen does not sink inward with the dysentery, the dysentery becomes easier to treat. Otherwise, it becomes the syndrome indicated by Modified Baihu Jia Renshen Tang.
Although purgatives can be used in early-stage dysentery, they must only be administered after confirming the absence of exogenous exterior syndromes. For patients with slightly weak constitutions, small amounts of Renshen and Huangqi can be added as assistants.
Dysentery generally contraindicates cloying/stagnating herbs, but this is not an absolute rule. My maternal grandmother, aged 90, suffered from severe bloody and white dysentery in midsummer with a rapid and wiry pulse. I prescribed Da Shudi (Rehmanniae Radix Preparata, 1 liang) and Raw Hangshao (1 liang) decocted in water. She recovered immediately after taking it. After one more dose, her pulse became harmonious.
Occasionally, dysentery may be of a cold nature, but this accounts for less than 1% of cases, and usually presents as pure white dysentery. It must be accompanied by a deep, slow pulse, aggravation after consuming cold foods or sitting in cold places. Treat with Ganjiang (Zingiberis Rhizoma, 3 qian), Baishao (3 qian), Xiaohuixiang (Foeniculi Fructus, 3 qian), Shanzha (Crataegi Fructus, 4 qian), and Sheng Shanyao (6 qian). One to two doses will cure it. Baishao is used because dysentery inevitably involves bearing down and abdominal pain. Even in cold dysentery, while the cold is in the intestines and stomach, latent heat exists in the Liver and Gallbladder, preventing the generation of heat from warming herbs.
Do not forcibly prohibit foods that patients crave. I have seen patients recover from dysentery by drinking large amounts of cold water or eating watermelon freely. Ultimately, individual constitutions vary, and disease manifestations are diverse. Careful observation and adjustment during clinical practice are essential. I once treated a young man with severe dysentery, numerous times day and night, with tenesmus. After several doses of heat-clearing and draining herbs, the dysentery halved, but tenesmus persisted completely. Suspecting intestinal obstruction, I administered Da Chengqi Tang (Major Order the Qi Decoction). He passed dry feces several inches long and recovered. Had I not suspected obstruction, the dry feces would not have been expelled, and the illness would not have resolved.
There is a rare form of dysentery described by Zhang Yin'an: "Three Yang meridians' pathogens arrive simultaneously, Three Yin meridians cannot resist, nine orifices become blocked, yang qi overflows sideways, causing dry throat, obstructed painful throat, and irregular upper/lower movements when affecting yin meridians, pressing into the intestines to form Changpi (intestinal dysentery)." The pulse is slow, small, delayed, and choppy. Death occurs if the blood is warm and the body is hot, or if heat persists for seven days. This is due to excessive yang damaging yin, resulting in a small, delayed, choppy pulse. Urgent treatment with Da Chengqi Tang (Major Order the Qi Decoction) is required to purge yang and nourish yin; delay leads to fatality. If the cause of this rare dysentery is unknown, and mild formulas are used merely because the pulse appears calm, serious errors will occur.