痢疾之病形何如。曰。痢疾一症。古人咸以赤白分寒热。殊不知伤气分为白。伤血分为赤。
丹溪以先水泻。
后脓血。为脾传肾。先脓血。后水泻。为肾传脾。此已发前人所未发。至损庵以为种种痢疾。总
由湿热入胃。此一句。便可悟病形矣。（湿热入胃一语。道尽致痢之根。盖胃为多血多气之海。
故气分血分。宜专指胃而言。所谓伤者。湿热入而伤之也。夫湿阴气也。入胃则伤胃之阳。热暑
毒也。入胃则伤胃之阴。古人以赤白分寒热。盖误以湿为寒耳。兹以赤白分气血。则的确分明。
千古论定矣。）痢疾腹痛。必是绕脐以下。当小肠之分野。饮食入胃。挟暑毒而归于中脘。初食
未成糟粕。后食以继之。则初食挟毒而归于下脘矣。夫中无毒邪。则气血升降。得以循其正。所
入之食变糟粕而从下脘归小肠矣。若毒与食在下脘。则升降不得循其正。糟粕欲行而不行。然毕
竟要行。（句）而不得行。则将脏腑脂膏逼迫而下。（此脏腑亦专指胃而言）迨交入小肠之后。脓血由小
肠而刮下。（白似脓。赤似血。即脏腑脂膏。为糟粕所逼迫而下者也。）小肠缘无毒而是糟粕。
则得循其正。故小肠虽曲。而顺下无碍。惟脓血则不得循其正而不肯下。故痛绕脐而下。属胃之
下口。（此小肠交界处。正将脂膏逼迫而下之地也。）及小肠也。（此是不得循其正而不肯下之
脓血。由此而刮下之地也。）小便不利者。小肠为毒邪所迫。不能分利。故短缩也。（又有膀胱
为毒火所逼而不利者）噤口者。乃毒瓦斯原盛。或破药太过。挟伤上中二脘宗气。邪毒乘虚而上逆
也。（姜制黄连与人参同煎。一匙一匙。细细呷之。）有不从暑毒而得者。或食瓜果（甲午九月。仲
弟丹山年甫十七。怒后纵啖生菱。逾日腹痛不食。大便脓血。迎村医治之。不知其为生冷所伤也。
杂用痢门套药十有余剂。病势垂剧。时予馆安邑。家君走人召予急归。时则循衣摸床。撮空见鬼。
虚症具见。视所用药。犹然槟朴芩连之辈也。更医回挽。卒不能起。衰毁愤抑。痛恨弟病之误杀
于庸手。始读窍素类经并张李朱薛等书。日夜寻绎。如有夙HT 。噫。医之杀吾弟而使之不寿于世也
。其中岂有天焉。欲就吾以医。而并使吾弟之得寿于是编耶。识此以见痢之不因暑毒得。而误以暑
毒治。未有不偕吾弟而同抱泣于九原者。凡吾同道。中人。其可不细。心而辨晰耶。）或卧高室大
厦。皆由虚得。但随感随发。病止在下脘。寒气所乘。脾亦不运。故为痢。如逾二
三日。寒化为热。其病形与暑毒同也。（正惟此处要误人耳。不可不知。）
诸痢疾脉。流连细小者生。浮数洪大者死。
凡痢疾初起三日内。可皆用白芍药汤立除。（东庄亦云。此方用之初起三日内。无不立效。无疑
于肉桂之大热。而畏不敢用也。）若初起但觉腹痛。水泻无度。浓朴汤主之。一见红白。毒势凝结
矣。但当解毒和血养气。切莫破血行气。是为大法。调金汤主之。如服调金汤后。红白减而渐见
粪色。盒饭减芩连分数。芩用一钱犹可。连须渐减。加人参矣。此宜相机消息之。红白尽除。六君
子汤加归芍调理。如初起发热。此热病也。竟以调金汤加柴胡与之。初热只用芩。热甚方用连。
此则必视其热之浅深。色之红白。而分别用也。久痢能食。六君子汤加归芍。久痢发热不能食。
肌肉减者不治。
白芍药汤
治热痢便血后重。经曰。溲而便脓血。此气行而血止也。行血则便脓自愈。调气则后重自除。
白芍 当归 大黄 黄芩 黄连 肉桂 槟榔
木香 甘草 如不减。加大黄。
按长洲云。此症多有因中气虚弱。脾气郁结者。治当审察。
浓朴汤
浓朴 槟榔 枳实 泽泻 青皮 黄芩 甘草
调金汤
黄芩 黄连 泽泻 当归 白芍 丹皮 神曲
陈皮 浓朴 姜引
按四明自造泽泻汤并加减四方。治痢甚验。今录于下。以备临是症者之采用。
泽泻汤
泽泻 丹皮 楂肉 滑石 当归 白芍 黄芩
青皮 浓朴 木香 甘草
红积加川连八分至一钱五分。见血加生地二三钱。初起毒盛。人如壮实者。加酒制大黄二三
钱。如身热。加柴胡一钱。
初起方
泽泻 丹皮 楂肉 滑石 当归 白芍 黄芩
青皮 浓朴 柴胡 黄连 甘草
起数日腹痛后重方
泽泻 槟榔 浓朴 当归 白芍 川芎 柴胡
黄芩 黄连 桃仁 滑石 甘草
半月余方
泽泻 橘红 浓朴 升麻 当归 白芍 生地
黄芩 灯心 莲肉 黄连 甘草
久痢方
泽泻 茯神 人参 丹皮 生地 熟地 黄芩
黄连 当归 白芍
痢疾的病症表现是怎样的？回答说：痢疾这一病症，古人都用赤色和白色来区分寒证与热证。却不知道伤及气分则便白脓，伤及血分则便赤血。
丹溪认为，先出现水样腹泻，后出现脓血，是脾病传变至肾；先出现脓血，后出现水样腹泻，是肾病传变至脾。这已经阐发了前人未曾发现的问题。至于损庵认为各种痢疾，总归是由湿热进入胃腑所致。仅这一句话，就可以领悟痢疾的病形了。（“湿热入胃”这句话，道尽了导致痢疾的根本原因。因为胃是多血多气的脏腑之海，所以气分和血分的损伤，应当专指胃而言。所谓“伤”，就是湿热侵入而伤害了它。湿属于阴气，进入胃中就会损伤胃的阳气；热暑属于毒邪，进入胃中就会损伤胃的阴液。古人用赤白来区分寒热，大概是错误地把湿当作寒邪了。现在用赤白来区分气血，那就确切分明，千古定论了。）痢疾腹痛，必定是在肚脐周围以下，这是小肠所主的部位。饮食进入胃中，挟带着暑毒汇聚在中脘。刚吃下去的食物尚未变成糟粕，后面的食物接着进来，那么前面的食物就挟带毒素向下运行到下脘。如果中没有毒邪，那么气血的升降就能遵循正常规律，进入的食物变成糟粕，从而通过下脘归于小肠。如果毒邪与食物在下脘，那么升降就不能遵循正常规律，糟粕想要下行却无法下行，但终究还是要下行。（句）而且无法顺利下行，这将逼迫脏腑的脂膏向下排出。（这里的脏腑也专指胃而言）等到进入小肠之后，脓血从小肠被刮削而下。（白色像脓，红色像血，其实就是脏腑的脂膏，是被糟粕逼迫而排出的。）小肠如果没有毒邪而是正常的糟粕，就能遵循正常规律，所以虽然小肠弯曲，但顺行向下没有阻碍。只有脓血不能遵循正常规律而不肯下行，所以疼痛环绕肚脐向下，这属于胃的下口。（这里是大小肠交界处，正是将脂膏逼迫向下的地方。）到了小肠。（这里是不遵循正常规律而不肯下行的脓血，由此被刮削而下的地方。）小便不利的，是因为小肠被毒邪逼迫，不能分清泌浊，所以尿量短少。（也有膀胱被毒火逼迫而导致小便不利的情况。）噤口痢（不能进食），是因为毒瓦斯原本强盛，或者攻伐药物太过，挟带损伤了上、中二脘的宗气，邪毒乘虚而上逆。（可用姜制黄连与人参同煎，一匙一匙地细细呷服。）有不因暑毒而得病的，或者是吃了瓜果（甲午年九月，我的弟弟丹山年仅十七岁，发怒后放纵吃了生菱角，第二天腹痛不食，大便脓血。请村里医生医治，不知道他是被生冷所伤，杂用治疗痢疾的常规药物十多种剂型，病情危重。当时我在安邑馆舍教书，家父派人急召我回家。此时他出现循衣摸床、撮空见鬼的症状，虚证全部显现。查看所用的药物，还是槟榔、厚朴、黄芩、黄连之类的药。更换医生挽回，最终没能救活。我哀毁骨立，愤懑压抑，痛恨弟弟的病被庸医误杀，才开始研读《灵枢》《素问》《类经》以及张仲景、李东垣、朱丹溪、薛己等医家的书籍，日夜寻思推演，好像有前世的因缘。唉，医生杀了我的弟弟使他不能长寿于世。其中难道有天意吗？想让我学医，并使我的弟弟能在这个编著中得以长寿呢？记下此事以说明痢疾不是因暑毒引起，却误用治暑毒的方法治疗，没有不和我弟弟一起在九泉之下哭泣的。凡是我的同道中人，怎么能不细心辨别呢？）或者是睡在高大的房屋里，都是由虚证引起的，只是随感随发，病位在下脘。寒气侵袭，脾也不运化，所以发生痢疾。如果超过两三天，寒邪转化为热邪，其病形就和暑毒一样了。（正因为这里容易误人，不可不知道。）
凡是痢疾初起的三日内，都可以用白芍药汤立即消除。（东庄也说，此方在初起三日内使用，没有不立刻见效的，不要因为肉桂的大热而畏惧不敢使用。）如果初起只感觉腹痛，水泻无度，用浓朴汤主治。一见红白脓血，说明毒势凝结了。只应当解毒、和血、养气，千万不要破血、行气，这是大法。用调金汤主治。如果服用调金汤后，红白脓血减少并逐渐见到粪便颜色，应当减少黄芩、黄连的分量。黄芩用一钱还可以，黄连必须逐渐减量，加入人参。这应该根据情况灵活掌握。红白脓血完全去除后，用六君子汤加当归、白芍调理。如果初起发热，这是热病，直接用调金汤加柴胡给他。初起热轻只用黄芩，热甚才用黄连。这必须视热的深浅、色的红白来分别用药。久痢能进食，用六君子汤加当归、白芍。久痢发热不能进食，肌肉消瘦的，属不治之症。
白芍药汤
治疗热痢便血、里急后重。经文说：小便涩滞且大便脓血，这是气行而血止的意思。行血则便脓自愈，调气则后重自除。
白芍 当归 大黄 黄芩 黄连 肉桂 槟榔 木香 甘草
如果症状不减，加大黄。
按：长洲说，此症多有因中气虚弱、脾气郁结者，治疗应当审察。
调金汤
黄芩 黄连 泽泻 当归 白芍 丹皮 神曲 陈皮 浓朴 生姜为引
按：四明自创泽泻汤及其加减四方，治疗痢疾非常有效，现记录在下面，以备临证时采用。
泽泻汤
泽泻 丹皮 山楂肉 滑石 当归 白芍 黄芩 青皮 浓朴 木香 甘草
如果是红积（赤痢），加川连八分至一钱五分；见血加生地二三钱；初起毒盛，人体如壮实者，加酒制大黄二三钱；如果有身热，加柴胡一钱。
初起方
泽泻 丹皮 山楂肉 滑石 当归 白芍 黄芩 青皮 浓朴 柴胡 黄连 甘草
起数日腹痛后重方
泽泻 槟榔 浓朴 当归 白芍 川芎 柴胡 黄芩 黄连 桃仁 滑石 甘草
What is the clinical manifestation of dysentery? It is said: Regarding this syndrome of dysentery, ancients generally distinguished cold and heat patterns by red and white discharges. However, they did not realize that injury to the Qi level results in white discharge, while injury to the Blood level results in red discharge.
Danxi believed that watery diarrhea preceding pus and blood indicates the transmission of Spleen disease to the Kidney; whereas pus and blood preceding watery diarrhea indicates the transmission of Kidney disease to the Spleen. This insight had already uncovered issues previously unaddressed by predecessors. As for Sun'an, who asserted that all types of dysentery stem from damp-heat entering the Stomach, this single statement allows one to comprehend the pathological form of the disease. (The phrase "damp-heat entering the Stomach" reveals the root cause of dysentery. Since the Stomach is the sea of abundant Qi and Blood, injuries to the Qi and Blood levels should specifically refer to the Stomach. The term "injury" here refers to damage caused by the invasion of damp-heat. Dampness is a Yin pathogen; upon entering the Stomach, it damages the Yang Qi of the Stomach. Heat and summer-toxicity are toxic pathogens; upon entering the Stomach, they damage the Yin fluids of the Stomach. Ancients used red and white colors to distinguish cold and heat, likely mistaking dampness for cold. By using red and white to distinguish Qi and Blood injuries, the distinction becomes precise and definitive, establishing a timeless consensus.) Abdominal pain in dysentery must occur around and below the umbilicus, which corresponds to the region governed by the Small Intestine. When food enters the Stomach, carrying summer-toxicity, it gathers at the Zhongwan (Middle Jiao). Newly ingested food has not yet transformed into fecal matter; when subsequent food follows, the initial food, carrying toxicity, moves downward to the Xiawan (Lower Jiao). If there is no toxic pathogen in the middle, the ascending and descending movements of Qi and Blood can follow their normal course, allowing ingested food to transform into feces and pass through the Xiawan into the Small Intestine. However, if toxins and food accumulate in the Xiawan, the ascending and descending movements cannot follow the normal course. Although feces desire to move downward, they are obstructed and cannot proceed smoothly, yet they inevitably attempt to descend. This pressure forces the mucosal lining and fatty tissues of the Zang-Fu organs downward. (Here, "Zang-Fu organs" specifically refers to the Stomach.) Once these materials enter the Small Intestine, pus and blood are scraped down from the Small Intestine. (White resembles pus, red resembles blood; these are actually the mucosal lining and fatty tissues of the Zang-Fu organs, forced downward by the obstruction of feces.) If the Small Intestine contains only normal feces without toxins, it can follow its normal course; thus, despite its convoluted structure, downward movement is unimpeded. Only pus and blood, failing to follow the normal course and resisting descent, cause pain radiating around the umbilicus downward, indicating involvement of the lower opening of the Stomach. (This is the junction between the Stomach and Small Intestine, where the forcing of mucosal lining downward occurs.) Upon reaching the Small Intestine, (this is where the resistant pus and blood are scraped down.) Difficulty in urination arises because the Small Intestine is pressured by toxic pathogens, impairing its function of separating clear from turbid, resulting in oliguria. (There are also cases where the Bladder is pressured by toxic fire, causing urinary difficulty.) Anorexia-type dysentery (Jinkou Li) occurs when toxic vapors are originally strong, or when purgative medicines are overused, damaging the Zong Qi (Pectoral Qi) of the Upper and Middle Jiaos, allowing evil toxins to counterflow upward due to deficiency. (One may decoct ginger-processed Coptis Rhizoma with Ginseng Radix, taking small sips slowly.) There are cases not caused by summer-toxicity, but rather by consuming fruits and melons. (In the ninth month of the Jiawu year, my younger brother Danshan, aged seventeen, indulged in raw water chestnuts after an outburst of anger. The next day, he suffered abdominal pain, loss of appetite, and bloody-purulent stools. Village doctors treated him, unaware of the cold-raw food injury, administering various standard dysentery prescriptions for over ten doses. His condition worsened critically. I was teaching in Anyi at the time; my father sent someone to summon me urgently. Upon arrival, he exhibited symptoms such as grasping at clothes, picking at empty air, and seeing ghosts, with full manifestation of deficiency syndromes. Reviewing the medications used, they were still Bitter Orange, Magnolia Bark, Scutellaria Root, and Coptis Rhizoma. Despite changing physicians to salvage the case, he ultimately died. Grieving and depressed, I deeply resented that my brother's death was caused by incompetent medical hands. I then began studying the *Ling Shu*, *Su Wen*, *Lei Jing*, and works by Zhang Zhongjing, Li Dongyuan, Zhu Danxi, Xue Ji, and others, searching and analyzing day and night, feeling as if recalling a past life connection. Alas, the physician killed my brother, depriving him of longevity. Was there fate involved? Did it intend for me to become a doctor so that my brother might live on through this compilation? I record this to illustrate that dysentery not caused by summer-toxicity, yet treated as such, invariably leads to tragedy, joining my brother in weeping in the underworld. All my colleagues among the people, how can they fail to discriminate carefully?) Or, sleeping in high, large rooms, these conditions arise from deficiency, manifesting immediately upon exposure. The pathology remains in the Xiawan. Invasion by cold qi impairs Spleen transportation, leading to dysentery. If two to three days pass, cold transforms into heat, and the clinical presentation becomes identical to that of summer-toxicity. (It is precisely at this point that misdiagnosis often occurs; this must be understood.)
Regarding pulse diagnoses for various dysenteries: lingering, fine, and small pulses indicate survival; floating, rapid, surging, and large pulses indicate death.
For dysentery in the initial three days, Baishao Yao Tang (Peony Decoction) can be used to resolve symptoms immediately. (Dongzhuang also stated that this formula yields immediate effects within the first three days; one should not fear the use of Cinnamon Twig due to its great heat.) If initially there is only abdominal pain and profuse watery diarrhea, Nongpo Tang (Magnolia Bark Decoction) is indicated. Once red and white discharges appear, it indicates that toxin intensity has condensed. At this stage, one should only resolve toxins, harmonize Blood, and nourish Qi; absolutely avoid breaking Blood or moving Qi aggressively. This is the general principle. Tiaojin Tang (Golden Regulator Decoction) is indicated. After taking Tiaojin Tang, if red and white discharges decrease and stool color gradually returns, reduce the dosage of Scutellaria Root and Coptis Rhizoma. Using one qian of Scutellaria Root is acceptable, but Coptis Rhizoma must be gradually reduced, and Ginseng Radix should be added. Dosage adjustments should be made according to clinical changes. Once red and white discharges are completely eliminated, Liu Junzi Tang (Six Gentlemen Decoction) plus Angelica Sinensis Root and White Peony Root should be used for regulation. If fever occurs at onset, this is a heat disease; administer Tiaojin Tang plus Bupleurum Root. For mild initial heat, use only Scutellaria Root; reserve Coptis Rhizoma for severe heat. Medication must be selected based on the depth of heat and the color of discharge. In chronic dysentery where the patient can eat, use Liu Junzi Tang plus Angelica Sinensis Root and White Peony Root. In chronic dysentery with fever, anorexia, and muscle wasting, the prognosis is poor (incurable).
Baishao Yao Tang (Peony Decoction)
Treats heat-dysentery with bloody stools and tenesmus. The Classic states: "Difficult urination accompanied by pus and blood in stool indicates that Qi movement stops Blood flow." Moving Blood resolves pus and blood naturally; regulating Qi eliminates tenesmus.
White Peony Root, Angelica Sinensis Root, Rhubarb, Scutellaria Root, Coptis Rhizoma, Cinnamon Twig, Areca Seed, Aucklandia Root, Licorice Root.
If symptoms do not subside, increase the dose of Rhubarb.
Note: Changzhou stated that this syndrome often results from deficient Middle Qi and constrained Spleen Qi; treatment requires careful examination.
Nongpo Tang (Magnolia Bark Decoction)
Magnolia Bark, Areca Seed, Immature Bitter Orange, Alisma Rhizome, Tangerine Peel, Scutellaria Root, Licorice Root.
Tiaojin Tang (Golden Regulator Decoction)
Scutellaria Root, Coptis Rhizoma, Alisma Rhizome, Angelica Sinensis Root, White Peony Root, Moutan Cortex, Medicated Leaven, Tangerine Peel, Magnolia Bark, Ginger as guide.
Note: Siming created Alisma Decoction and four modified formulas, which are very effective for treating dysentery. They are recorded below for clinical reference.
Alisma Decoction (Zexie Tang)
Alisma Rhizome, Moutan Cortex, Hawthorn Fruit, Talcum, Angelica Sinensis Root, White Peony Root, Scutellaria Root, Tangerine Peel, Magnolia Bark, Aucklandia Root, Licorice Root.
For red dysentery (blood-predominant), add Coptis Rhizoma 0.8–1.5 qian; for visible blood, add Rehmannia Root 2–3 qian; for early-stage severe toxicity in robust patients, add Wine-processed Rhubarb 2–3 qian; for body heat, add Bupleurum Root 1 qian.
Initial Stage Formula
Alisma Rhizome, Moutan Cortex, Hawthorn Fruit, Talcum, Angelica Sinensis Root, White Peony Root, Scutellaria Root, Tangerine Peel, Magnolia Bark, Bupleurum Root, Coptis Rhizoma, Licorice Root.
Formula for Abdominal Pain and Tenesmus After Several Days
Alisma Rhizome, Areca Seed, Magnolia Bark, Angelica Sinensis Root, White Peony Root, Ligusticum Chuanxiong Rhizome, Bupleurum Root, Scutellaria Root, Coptis Rhizoma, Peach Kernel, Talcum, Licorice Root.
Formula for More Than Half a Month Duration
Alisma Rhizome, Exocarpium Citri Reticulatae Viride, Magnolia Bark, Cimicifuga Rhizome, Angelica Sinensis Root, White Peony Root, Rehmannia Root, Scutellaria Root, Juncus Effusus, Lotus Seed, Coptis Rhizoma, Licorice Root.
Chronic Dysentery Formula
Alisma Rhizome, Poria, Ginseng Radix, Moutan Cortex, Rehmannia Root, Prepared Rehmannia Root, Scutellaria Root, Coptis Rhizoma, Angelica Sinensis Root, White Peony Root.