痢疾暑热生冷成,伤气为自伤血红,后重裹急腹窘痛,寒热时痢噤口名。
[注]
痢之为证,多因外受暑热,因伤生冷而成,
伤于气者色多白,以肺与大肠为表裹也,
伤于血者色多赤,以心与小肠为表裹也,
里急者腹窘痛也,后重者频下坠也,
又有寒痢热痢时痢噤口痢之别,医者须详察之。
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痢疾门
寒伤久痢藏虚寒,肠呜切痛实难堪,面唇青自喜饮热,理中养藏效通仙。
[注]
寒痢者,寒冷伤胃,久痢不已,或藏气本虚,复为风冷所乘,伤于肠胃,
故痢时肠鸣切痛,面唇青白,口虽渴,喜饮热,此里寒虚之证也,
初宜理中汤,久则真人养藏汤治之,寒得温散而证愈矣。
(理中汤) 方见不乳。
(真人养藏汤) 人参 白术土炒 木香煨 当归土炒 白芍炒 肉桂
甘草炙 罂粟壳蜜炙 诃子肉面煨去核 肉果煨 引用乌梅水煎服。
(方歌)
寒痢须用养藏汤,人参白术广木香,归芍肉桂炙甘草,粟壳诃之肉果良。
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痢疾门
痢初实热腹窘痛,下痢无度尿短红,舌赤唇焦喜饮冷,芍药白头香连灵。
[注]
热痢者,皆因湿热凝结于肠胃,以致腹中窘痛,频频下利,
尿短色红,舌赤唇焦,喜饮冷水,此里热之证也,
重则当归芍药汤主之,轻则白头翁汤主之,或香连丸主之。
(当归芍药汤)
当归 白芍 木香 黄芩 黄连 肉桂 大黄 甘草生 槟榔 水煎服。
(方歌)
热痢当归芍药汤,里急后重服最良,归芍木香芩连桂,大黄甘草共槟榔。
(白头翁汤) 黄连 黄蘖 秦皮 白头翁 水煎服。
(方歌)
白头翁汤治热痢,腹中窘痛溺短赤,连蘖秦皮白头翁,煎服之后痢自愈。
(香连丸) 木香 川黄连各等分 共为细末,酯糊为丸,如桐子大,
量儿大小用之,空心米饮下。
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痢疾门
痢疾多由暑热之邪侵袭,或因饮食生冷所致。若病邪伤及气分,大便颜色多偏白;若病邪伤及血分,大便颜色多偏红。临床表现为肛门坠胀感(后重)、腹部拘急疼痛(里急),伴有寒热往来、频繁腹泻,或出现不能进食的“噤口痢”,这些统称为痢疾。
[注释]
痢疾这一病症,大多是因为外受暑热之邪,加之饮食生冷而引发。
损伤气分的,大便颜色多为白色,这是因为肺与大肠互为表里的关系;
损伤血分的,大便颜色多为红色,这是因为心与小肠互为表里的关系;
所谓“里急”,是指腹部拘急疼痛;
所谓“后重”,是指排便时频频有下坠感;
此外,还有寒痢、热痢、时行痢疾和噤口痢的区别,医生必须详细辨别。
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痢疾门
寒邪导致的久痢属于脏腑虚寒证,表现为肠鸣音亢进、剧烈腹痛难以忍受,面色和嘴唇青白,喜欢喝热水,治疗可用理中汤或真人养藏汤,疗效显著如同通仙一般。
[注释]
寒痢,是由于寒冷损伤胃气,导致久痢不愈;或者是脏腑之气本已虚弱,又受到风冷邪气的侵袭,损伤了肠胃。
因此,在痢疾发作时出现肠鸣音亢进、剧烈腹痛,面色和嘴唇青白,虽然口渴但喜欢喝热水,这是体内虚寒的证候。
初期适宜使用理中汤,日久则用真人养藏汤治疗,寒邪得到温散,病症即可痊愈。
(理中汤) 方剂见本书“婴儿不乳”章节。
(真人养藏汤) 组成:人参、土炒白术、煨木香、土炒当归、炒白芍、肉桂、炙甘草、蜜炙罂粟壳、面煨去核诃子肉、煨肉豆蔻。引用乌梅水煎服。
(方歌)
寒痢须用养藏汤,人参白术广木香,归芍肉桂炙甘草,粟壳诃之肉果良。
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痢疾门
痢疾初起属实热证,表现为腹部拘急疼痛,腹泻无度,小便短少且色红,舌质红赤、嘴唇焦干,喜欢喝冷水,治疗可用芍药白头汤、白头翁汤或香连丸等。
[注释]
热痢,都是由于湿热邪气凝结于肠胃,导致腹部拘急疼痛,频繁腹泻。
小便短少色红,舌质红赤嘴唇焦干,喜欢喝冷水,这是体内实热的证候。
病情重的,以当归芍药汤为主治方;病情轻的,以白头翁汤为主治方;或者使用香连丸主治。
(当归芍药汤) 组成:当归、白芍、木香、黄芩、黄连、肉桂、大黄、生甘草、槟榔。水煎服。
(方歌)
热痢当归芍药汤,里急后重服最良,归芍木香芩连桂,大黄甘草共槟榔。
(白头翁汤) 组成:黄连、黄柏、秦皮、白头翁。水煎服。
(方歌)
白头翁汤治热痢,腹中窘痛溺短赤,连蘖秦皮白头翁,煎服之后痢自愈。
(香连丸) 组成:木香、川黄连各等份。共研为细末,用醋糊制成丸药,大小如梧桐子大,根据患儿年龄大小用量,空腹时用米汤送服。
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痢疾门
Dysentery is often caused by the invasion of summer-heat pathogenic factors or due to the consumption of raw and cold foods. If the pathogen injures the Qi level, the stool color tends to be white; if it injures the Blood level, the stool color tends to be red. Clinical manifestations include tenesmus (a sensation of incomplete defecation with straining), abdominal cramping pain (urgency), accompanied by alternating chills and fever, frequent diarrhea, or an inability to eat known as "Jinkou Li" (Dysentery with Inability to Eat). These are collectively referred to as dysentery.
[Note]
The syndrome of dysentery is mostly caused by external contraction of summer-heat pathogens combined with dietary intake of raw and cold substances.
When the Qi is injured, the stool color is mostly white, because the Lung and Large Intestine are exterior-interiorly related.
When the Blood is injured, the stool color is mostly red, because the Heart and Small Intestine are exterior-interiorly related.
"Liji" (Urgency) refers to abdominal cramping pain.
"Houzong" (Tenesmus) refers to the frequent sensation of bearing down during defecation.
Furthermore, there are distinctions among Cold Dysentery, Heat Dysentery, Epidemic Dysentery, and Jinkou Dysentery. Physicians must examine them in detail.
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Dysentery Section
Cold-induced chronic dysentery belongs to the syndrome of deficiency-cold in the Zang organs. It presents with hyperactive bowel sounds, severe cutting pain that is unbearable, bluish-white complexion and lips, and a preference for drinking hot water. Treatment can utilize Lizhong Tang or Zhenren Yangzang Tang, which are highly effective.
[Note]
Cold dysentery occurs when cold damages the Stomach Qi, leading to chronic dysentery that does not resolve; or when the organ Qi is originally deficient, it is further attacked by wind-cold pathogens, injuring the intestines and stomach.
Therefore, during dysentery episodes, there are hyperactive bowel sounds and severe cutting pain, bluish-white complexion and lips. Although thirsty, the patient prefers hot drinks. This is a syndrome of interior deficiency-cold.
In the early stage, Lizhong Tang (Cinnamon Twig and Ginger Decoction) is suitable. For long-standing cases, Zhenren Yangzang Tang (True Human Nourishing and Securing Decoction) should be used. Once the cold is dispersed by warmth, the syndrome will heal.
(Lizhong Tang) See the section on "Infant Refusing Milk".
(Zhenren Yangzang Tang) Composition: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) stir-fried with soil, Muxiang (Aucklandiae Radix) roasted, Danggui (Angelicae Sinensis Radix) stir-fried with soil, Baishao (Paeoniae Radix Alba) stir-fried, Rougui (Cinnamomi Cortex), Gancao (Glycyrrhizae Radix et Rhizoma) honey-roasted, Yingsuke (Papaveris Pericarpium) honey-roasted, Hezi (Terminalia Chebulae Fructus) flesh roasted with flour, pitted, Roudoukou (Myristicae Semen) roasted. Decoct with water using Wumei (Mume Fructus) as a reference. Take orally.
(Song of Formula)
For cold dysentery, Yangzang Tang must be used,
Ginseng, Atractylodes, and Aucklandia root.
Angelica, Paeonia, Cinnamon bark, and honey-fried Licorice,
Poppy shell, Terminalia, and Myrobalan fruit are excellent.
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Dysentery Section
Early-stage dysentery presenting as excess-heat involves abdominal cramping pain, profuse diarrhea, short and red urine, red tongue, dry cracked lips, and a preference for drinking cold water. Treatment may employ Shaoyao Baitou Tang, Baitouweng Tang, or Xianglian Wan.
[Note]
Heat dysentery is caused by the coagulation of damp-heat pathogens in the intestines and stomach, resulting in abdominal cramping pain and frequent diarrhea.
Urine is short and red, the tongue is red, lips are dry and cracked, and the patient prefers cold water. This is a syndrome of interior heat.
For severe cases, Danggui Shaoyao Tang (Angelica and Peony Decoction) is the primary formula. For mild cases, Baitouweng Tang (Pulsatilla Decoction) is the primary formula. Alternatively, Xianglian Wan (Aucklandia and Coptis Pill) may be used.
(Danggui Shaoyao Tang) Composition: Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Muxiang (Aucklandiae Radix), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Rougui (Cinnamomi Cortex), Dahuang (Rhei Radix et Rhizoma), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Binglang (Arecae Semen). Decoct with water and take orally.
(Song of Formula)
For heat dysentery, Danggui Shaoyao Tang is best,
Effective for urgency and tenesmus.
Angelica, Peony, Aucklandia, Scutellaria, Coptis, and Cinnamon,
Together with Rheum, Licorice, and Areca nut.
(Baitouweng Tang) Composition: Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Qinpi (Fraxini Cortex), Baitouweng (Pulsatillae Radix). Decoct with water and take orally.
(Song of Formula)
Baitouweng Tang treats heat dysentery,
Abdominal cramping pain and short red urine.
Coptis, Phellodendron, Fraxin bark, and Pulsatilla root,
After decoction and ingestion, dysentery heals itself.
(Xianglian Wan) Composition: Muxiang (Aucklandiae Radix) and Chuan Huanglian (Sichuan Coptidis Rhizoma) in equal parts. Grind into fine powder, make pills with vinegar paste, size similar to Sophora seeds. Use according to the child's age and size, taken on an empty stomach with rice water.
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Dysentery Section