痢者。古名滞下是也。里急后重。逼迫恼人。或脓或血。或脓血相杂。或无糟粕。或糟粕相杂。或肠垢。
或痛或不痛。或呕或不呕。或发热或不发热。当详辨其阴阳寒热虚实而施治。不可偏执一见也。
原病式云。利为湿热甚于肠胃。怫郁而成。其病皆热证也。俗以白痢为寒误也。世有用辛热药而愈者。盖
病微。得热则郁结开通。气和而愈。甚者其病转极。故治痢者。必用寒以胜热。燥以胜湿。少加辛热佐之。以
为发散开通之用。如此无不愈者。
丹溪谓仲景可下者。悉以承气汤下之。大黄之寒。其性善走。佐以浓朴之温。善行滞气。缓以甘草之甘。
饮以汤液。荡涤肠胃。滋润轻快。积行即止。禁用砒丹巴 等药。恐其暴悍毒瓦斯。有伤肠胃清纯之气。又谓局
方例用热药为主。涩药为佐。用之于下痢清白者犹可。其里急后重。经所谓下重者。皆属于火。
又加温热之药。非杀而何。按前论皆专主寒治之说。以为痢发于秋。是暑月郁热所致。其理甚着。其议论亦和
平。但不详所以致郁热者。多因暑热酷烈。过饮冰水。过食生冷。热为寒郁。久而为沉寒积冷者。亦有之。不
可泥定是热。当辨证切脉。真知其有热积。方可用大黄。若系寒积而用大黄。不惟不愈。反增痛极
而危矣。大凡下热痢用大黄。下寒痢用巴豆。有是病则服是药。详按古人之成法。不容毫发差谬。内经通因通
用。原有两条。有酒蒸大黄。有蜡丸巴豆。分析甚明。不可不考也。又谓温热之药。用于下痢清白者犹可。
则纯红血痢者。必不可用温热矣。然王海藏有云。暑月血痢。不用黄连。阴在内也。本草衍义云。有一
男子暑月患血痢。医以凉药逆治。专用黄连木香阿胶。此病始
感便治则可。病久肠虚。理不可服。逾旬几至委顿。理当别治。
（此一段论。又见证类本草序中） 海藏云。杨师三朝大醉。至醒发大渴。饮冷水三巨杯。次日又饮茶三碗。
后病便鲜血。四次约一盆。先以吴茱萸丸。翌日又以平胃五苓各半散。二大服血止。复白痢。又以感应丸。四
服白痢乃止。其安如故。或问曰。何为不用黄连之类以解毒。而所用者温热之剂乎。予曰。若用寒凉。其疾大
变难疗。寒毒内伤。复用寒凉。非其治也。况血为寒所凝。浸入大肠间而便下。得温乃行。所以用热药其血自
止。经曰。治病必求其本。此之谓也。胃既得温。其血不凝而自行。各守其乡矣。举此为例。可
见不可偏执用寒之说。倘有遇血痢者。不可偏见以为热也。
大抵后重者宜下。腹痛者宜和。身重者宜除湿。脉弦者去风。脓血稠粘者。以重药竭之。身冷自汗者。
以毒药温之。风邪内缩者。宜汗之。滑泄不及拈衣者。止涩之。 溏为利。宜温之而已。必当求其所因。辨
其阴阳而治之。斯得之矣。
世人一见滞下。不分寒热阴阳虚实。便以大黄汤荡涤之。是重剂也。其次以黄芩芍药汤和之。是轻剂也。
香莲丸是常药也。当归芍药和其血。槟榔枳壳调其气。见有血色者。红花生地地榆以凉其血。黄连黄柏以清
其火。朝夕更医。出入增减。不过如此。已濒于危。犹曰血色依然。腹痛未减。谁敢温补。死而无悔。伤哉伤哉。
凡腹痛后重。小便短少。口渴喜冷冻饮料。大肠口燥辣。是为挟热下痢。前法固宜。若腹痛口不渴。喜热饮。
小便清长。身不热。腹喜热手熨者。是为挟寒下痢。须理中姜桂温之。至于初起受病。原系热痢。迁延日久。各
证不减。或反加重。理当别治。竟作虚看。须用补中益气一升一补。倍加参 温补。如小腹重坠。切痛奔豚。此
兼属少阴症。急加吴萸肉桂破故纸肉果。甚则加附子。如有纯血者。加炒黑干姜。虚回而利自止。若必待血清利止
而后补。亦晚矣。
世间似痢非痢者多。东垣云。饮食有伤。起居不时。损其胃气。则上升清华之气。反从下降。是为飧泄。
久则太阴传少阴。而为肠 。里急后重。脓血交错。数至圊而不能即便者。专用补中益气汤为主。使升降之
道行。其痢不治而自消矣。余法东垣。凡有热者。加姜炒黄连。有寒者加姜桂。兼小腹痛者。用建中汤。
有风湿者。加防风羌活。肝气乘脾者。倍柴胡。加芍药木香。滑泄者。加粟壳诃子。如此温补不愈。又当别
治。经曰。热之不热。是无火也。无火者。益火之原。急补命门之火。以生脾土之母。此万举万全之策也。
又有一等阴虚似痢者。即五泄中大瘕泄者。是也。经曰。里急后重。数至圊而不能便。必茎中痛。褚氏
云。阴已耗而复竭之。则大小便牵痛。愈痛则愈便。愈便则愈痛。其证红白相杂。里急后重。悉似痢疾。必小
便短涩而痛。或不通而痛。或欲小便而大便先脱。或欲大便而小便自遗。两便牵引而痛。此肾虚之危证。急以
八味地黄。加补骨脂肉豆蔻阿胶。兼理中汤加升麻桂附。相继间服。庶可挽回。世以痢药致毙者。不可枚举。
其详见先天要论泄泻条内。
有一等积滞已少。但虚坐努责。此为下多亡血。倍用当归为主。生血药为佐。血生自安。此是血虚阴证。
后重有二。邪气坠下者。圊后不减。虚努不收者。圊后随减。此可以辨虚实。
有一等噤口痢者。汤药入口随出。在下缠住急迫。多因热毒炽盛。逆冲胃口。胃气伏而不宣。急用黄连
以吴茱萸炒过。拣去茱萸。共人参等分。加糯米一撮。浓煎一盏。细口一匙一匙润
下。但得二三匙咽下。便不复吐矣。如吐再服。有一等寒气逆上者。用温补之药调之。其病易治。
有一等休息痢者。经年累月。愈而复发。此系寒积在大肠底。诸药所不到。独巴豆一味研炒。蜡丸如龙眼
大。空腹服之。再不复发。此亦通因通用之法也。
不肖体素丰。多火善渴。虽盛寒。床头必置茗碗。或一夕尽数瓯。又时苦喘急。质之先生。为言此属郁火
证。常令服茱连丸。无恙也。丁巳之夏。避暑檀州酷甚。朝夕坐冰盘间。或饮冷香薷汤。自负清暑良剂。孟秋
痢大作。初三昼夜下百许。次红白相杂。绝无渣滓。腹胀闷。绞痛不可言。或谓宜下以大黄。先生弗顾也。
竟用参术姜桂渐愈。犹白积不止。服感应丸而痊。后少尝蟹螯。复泻下委顿。仍服八味汤。及补剂中重加姜桂
而愈。夫一身历一岁间耳。黄连苦茗。曩不辍口。而今病以纯热瘥。向非先生。或投大黄凉药下之。不知竟作
何状。又病室孕时。喘逆不眠。用逍遥散立安。又患便血不止。服补中黑姜立断。不再剂。种种奇妙。未易殚
述。噫。先生隔垣见人。何必饮上池水哉。闻之善赠人者以言。其永矢勿谖者。亦以言。不肖侏儒未足为
先生重。窃以识明德云尔。四明弟子徐阳泰顿首书状。
世有疟后痢。有痢后疟者。夫既为疟后发泄已尽。必无暑热之毒。复为痢疾。此是元气下陷。脾气不能升
举。似痢非痢也。既为痢后下多则亡血。气又随痢散。阴阳两虚。阳虚则恶寒。阴虚则恶热。故寒热交战。
似疟非疟也。俱作虚论。俱用补中益气加温补。其病自愈。
有一孕妇疟痢齐发。医治两月余。疟止而痢愈甚。又加腹痛饮食少进。延余视之。余曰虚寒也。以补中
益气加姜桂。一服痢止太半。再一服而反加疟病大作。主人惊恐。余曰此吉兆也。向者疟之止。乃阴盛之极。
阳不敢与之争。今服补阳之剂。阳气有权。敢与阴战。再能助阳之力。阴自退听。方中加附子五分。
疟痢齐愈。大服补剂。越三月产一子。产后甚健。
大黄汤
用大黄（一两锉碎） 好酒二大盏。浸半日。煎至一盏半。去渣
分作二服。痢止勿服。如未止再服。取利为度。
芍药汤
芍药（一两） 当归 黄连 黄芩（各五钱） 肉桂（二钱半） 大黄 甘草 槟榔 木香（一钱）
上九味。每服五钱。水二钟。煎至一钟。
香莲丸
黄连（净二十两用吴茱萸十两同炒焦检去茱萸不用） 木香（五两不见火） 上为细末。醋糊丸。如桐
子大。每服三十丸。米饮下。
感应丸 新旧冷积并可治。此方神妙不可言。虽有巴豆不令人泻下。其积自然消化。
南木香 肉豆蔻 丁香（各一两半） 干姜（炮一两） 百草霜（二两） 巴豆（七十粒去皮心膜研去油
）杏仁（一百四十粒去皮尖） 上前四味为末。外入百草霜研。巴豆与杏仁另研细末同和匀。用好黄蜡六两。
溶化成汁。以重绢滤去渣。更以好酒一升。于砂锅内。煮蜡数沸倾出。酒冷其蜡自浮于上。取蜡称用。丸用
清油一两。铫内熬令香熟。次下蜡四两。同化成汁。就铫内乘热拌和前药末。捏作锭子。丸如豆大。每服三
十丸。姜汤空心送下。
杨子建云。世人有患疫毒痢。初得时。先发寒热。忽头痛壮热。思入凉室。思吃冷水。狂言狂走。浑身
肌肉疼痛。手不可着。忽下痢。或白或赤。或赤白相杂。此证难治。此系太岁在中。其年春夏之内。多有寒
肃之化。阳光少见。寒热二气。更相交争。忽于夏月多寒热之化。寒邪犯心。水火相战。所以先发寒热。水
火相犯。血变于中。所以多下赤痢。如紫草色。如苋菜色者。寒邪犯心之重也。白色者尚轻。赤色者渐重。
赤白相杂者。气血相等。寒热之气相搏也。治诸证之法。先夺其寒。以后随证调理。
万全护命方
麻黄（去根节） 官桂（去粗皮各七钱半） 大川芎 白术（各二两）
本独活 桔梗 防风 芍药 白芷（各半两） 丹皮 甘草（各二钱半） 细辛（三钱三分） 牵牛（一钱
七分） 上为细末。每服二钱。热汤调下。和渣热服。若服此药后。寒热已退。赤痢已消减。便修合第二方。
诃子（五枚） 用面裹火煨热。去核为细末。每服二钱匕。以米汤一盏半。煎取一盏。空心和渣服。
服前二方药病势已减。所下之物止余些小。或下清水。或如鸭溏。或只余些小红色。宜修合第三方。以
牢固大肠。还复真气。
舶上硫黄（一两去砂细研为末） 薏苡仁（二两炒研为末） 上二味和匀。滴熟水为丸。如桐子大。每
服五十丸。空心米汤下。
痢疾，古时候称为“滞下”。其症状表现为腹部急迫、肛门重坠感，令人感到逼迫和烦恼。大便中或带有脓液，或带有血液，或脓血混杂，或没有食物残渣，或有食物残渣混杂，或仅有肠垢。有的疼痛，有的不痛；有的呕吐，有的不吐；有的发热，有的不发热。治疗时必须详细辨别其阴阳、寒热、虚实的性质来施治，不可片面固执于一种见解。
《原病式》中说：泄利是由于湿热在肠胃中郁结而成，这些病症都属于热证。世俗之人误以为白痢是寒证。世上有用辛热药物治愈的案例，这是因为病情轻微，得到热药后郁结开通，气机调和而痊愈。如果病情严重，用热药会使病情转为极端恶化。因此，治疗痢疾的人，必须用寒凉药来胜热，用燥湿药来胜湿，稍微加入一点辛热药作为辅助，用于发散和开通气机。像这样没有不能治愈的。
朱丹溪认为，张仲景指出可以攻下的情况，全部用承气汤（Chengqi Tang, Cinnamon Twig and Rhubarb Decoction）来攻下。大黄（Rhei Radix et Rhizoma, 大黄）性寒，善于走窜，佐以厚朴（Magnoliae Officinalis Cortex, 厚朴）的温性，善于行滞气；辅以甘草（Glycyrrhizae Radix et Rhizoma, 甘草）的甘缓；服用汤剂，荡涤肠胃，滋润轻快，积滞排尽即停止。严禁使用砒霜、丹砂、巴豆等药物，恐怕它们暴烈有毒，会损伤肠胃清纯之气。他又说，《局方》通常以热药为主，涩药为辅，用于下痢清白者还可以。但如果是里急后重，正如《内经》所说“下重者皆属于火”，如果再添加温热药物，岂不是加速死亡吗？
按上述论述，都专门主张用寒凉法治痢，认为痢疾发于秋季，是暑月郁热所致，道理很显著，议论也很平和。只是没有详细说明导致郁热的原因，大多是因为暑热酷烈，过饮冰水，过食生冷，热被寒邪郁遏，久而久之成为沉寒积冷的情况，也是有的。不能固执地认定全是热证，应当辨证切脉，真正确认有热积存在，方可使用大黄。如果是寒积而用大黄，不仅不能痊愈，反而会增加剧痛甚至危及生命。大凡下热痢用大黄，下寒痢用巴豆（Crotonis Fructus, 巴豆），有病则服相应的药，详细遵循古人的成法，不容许丝毫差错。《内经》提出的“通因通用”原则，原有两条记载，一条是用酒蒸的大黄，一条是用蜡丸包裹的巴豆，分析得很清楚，不可不考察。又说温热药物用于下痢清白者还可以，那么纯红色的血痢，就绝对不可用温热药了。
然而王海藏曾说：暑月的血痢，不用黄连，因为阴气在内。《本草衍义》记载：有一个男子在暑月患血痢，医生用凉药逆治，专用黄连、木香、阿胶。如果在病初起时治疗还可以，但病久则肠道虚弱，按理不可再服用。过了十天几乎导致身体衰败，理应改变治疗方法。
（这一段论述，又见于《见证类本草》序言中）王海藏说：杨师三次大醉，醒来后大发口渴，喝了三巨杯冷水。第二天又喝了三碗茶。后来患病排出鲜血，四次大约一盆。先用吴茱萸丸，第二天又用平胃散和五苓散各半，两大服药后血止，但随后出现白痢，又服用感应丸，四次后白痢才停止，身体恢复如常。有人问：为什么不用黄连之类解毒，而所用的是温热药剂呢？我说：如果用寒凉药，疾病会发生巨大变化难以治疗。寒毒内伤，再用寒凉，不是正确的治法。况且血液被寒邪凝滞，渗入大肠间而便下，得到温暖才能运行。所以用热药，血液自然停止。经书说：治病必求其本，说的就是这个道理。胃得到温暖，血液不凝滞而自行运行，各自守在其部位。举这个例子，可见不可偏执用寒凉的说法。如果遇到血痢患者，不可偏见地认为是热证。
大体上，里急后重者适宜攻下，腹痛者适宜调和，身体沉重者适宜除湿，脉弦者宜祛风，脓血稠粘者用重药竭除，身冷自汗者用毒药温补，风邪内缩者宜发汗，滑泄不止连衣服都抓不住的，宜固涩止泻。大便稀溏为泄利，适宜温补而已。必须探求病因，辨别阴阳而治疗，这样才能得当。
世人一见滞下，不分寒热阴阳虚实，就用大黄汤荡涤，这是重剂。其次用黄芩芍药汤调和，这是轻剂。香莲丸是常用药。当归、芍药调和血液，槟榔、枳壳调理气机。见到有血色者，用红花、生地、地榆凉血，黄连、黄柏清火。早晚更换医生，出入增减，不过如此。已经濒临危险，还说血色依旧，腹痛未减，谁敢温补？至死无悔，可悲啊可悲。
凡是腹痛后重，小便短少，口渴喜欢冷冻饮料，大肠口燥辣，这是挟热下痢，前面的方法固然适宜。如果腹痛口不渴，喜欢热饮，小便清长，身体不热，腹部喜欢热手熨烫，这是挟寒下痢，须用理中汤加干姜、肉桂温补。至于初起受病，原是热痢，迁延日久，各种症状不减，或者反而加重，理应另外治疗，完全当作虚证看待。须用补中益气汤一升一补，倍加人参温补。如果小腹重坠，切痛如奔豚状，这兼属少阴症，急加吴茱萸、肉桂、破故纸、肉果。严重时加附子。如果有纯血者，加炒黑的干姜。虚象恢复而痢疾自然停止。如果一定要等到血清痢止后再补，也晚了。
世间类似痢疾而非痢疾的情况很多。李东垣说：饮食损伤，起居不时，损害了胃气，那么上升的清气反而下降，这就是飧泄。久了太阴传至少阴，而为肠澼。里急后重，脓血交错，频繁去厕所却不能立即排便的，专用补中益气汤为主，使升降之道运行，其痢疾不治而自消。其余方法依从李东垣，凡有热者，加姜炒黄连；有寒者，加干姜、肉桂；兼小腹痛者，用建中汤；有风湿者，加防风、羌活；肝气乘脾者，倍加柴胡，加芍药、木香；滑泄者，加粟壳、诃子。如果这样温补仍不愈，又当另外治疗。经书说：热之不热，是无火也。无火者，益火之原，急补命门之火，以生脾土之母，这是万无一失的策略。
又有一种阴虚似痢疾的情况，就是五泄中的大瘕泄。经书说：里急后重，频繁去厕所却不能排便，必然茎中疼痛。褚氏说：阴精已耗损而又进一步枯竭，则大小便牵拉疼痛。越痛越想排便，越排便越痛。其证候红白相杂，里急后重，全似痢疾。必然小便短涩而痛，或者不通而痛，或者想小便而大便先脱出，或者想大便而小便自遗，两便牵引而痛，这是肾虚的危重证候。急用八味地黄丸，加补骨脂、肉豆蔻、阿胶，兼理中汤加升麻、桂枝、附子，相继交替服用，或许可以挽回。世间因用痢药致死的，不可枚举。详见《先天要论》泄泻条内。
有一种情况是积滞已少，但虚坐努责，这是因为下利多亡血。倍用当归为主，生血药为辅，血生则自安。这是血虚阴证。
后重有两种：邪气坠下者，排便后不减；虚努不收者，排便后随即减轻。这可以用来辨别虚实。
有一种噤口痢，汤药入口随即吐出，在下部缠住急迫。多因热毒炽盛，逆冲胃口，胃气伏而不宣。急用黄连用吴茱萸炒过，拣去茱萸，与人参等分，加糯米一撮，浓煎一盏，细细一口一口润下。只要得二三匙咽下，就不再吐了。如果吐了再服。有一种寒气逆上的，用温补药物调治，其病易治。
有一种休息痢，经年累月，好了又复发。这是寒积在大肠底部，诸药所不到。独用巴豆一味研炒，制成蜡丸如龙眼大，空腹服用，不再复发。这也是通因通用的方法。
我体质素来丰满，多火善渴，即使在严寒，床头必置茶碗，有时一晚喝完数碗。又时常苦于喘急，请教先生，先生说这属于郁火证，常令服用茱连丸，安然无恙。丁巳年夏天，避暑檀州非常酷热，早晚坐在冰盘间，或者饮用冷香薷汤，自以为这是清暑良剂。孟秋时节痢疾大作，初三日夜下痢百余次，接着红白相杂，绝无渣滓，腹胀闷，绞痛无法形容。有人说宜用大黄攻下，先生不顾，竟用人参、白术、干姜、肉桂逐渐痊愈。仍有白积不止，服用感应丸而痊愈。后来稍尝蟹螯，又腹泻身体衰败，仍服用八味汤，及补剂中重加干姜、肉桂而愈。这一生经历的一年间罢了，黄连苦茗，从前不停口，而今病以纯热痊愈。如果不是先生，或者投用大黄凉药攻下，不知会变成什么样子。又病室怀孕时，喘逆不眠，用逍遥散立刻安宁。又患便血不止，服用补中益气汤加黑干姜立刻断绝，不再服药。种种奇妙，不易详尽叙述。唉，先生隔墙见人，何必饮上池水呢？听说善于赠人者以言语，我永远铭记不忘的，也是以言语。我不肖如侏儒，不足以让先生看重，私下记录先生的明德罢了。四明弟子徐阳泰顿首呈状。
世间有疟疾后患痢疾的，有痢疾后患疟疾的。既然疟疾后发泄已尽，必定没有暑热之毒，再患痢疾，这是元气下陷，脾气不能升举，似痢非痢。既然痢疾后下利多亡血，气又随痢散，阴阳两虚，阳虚则恶寒，阴虚则恶热，所以寒热交战，似疟非疟。都当作虚证论治，都用补中益气汤加温补，其病自愈。
有一位孕妇疟痢齐发，医治两个多月，疟疾止而痢疾更甚，又加腹痛饮食少进，请我去诊治。我说这是虚寒，用补中益气汤加干姜、肉桂，一服痢止大半，再一服反而疟疾大作。主人惊恐，我说这是吉兆。先前疟疾止，是阴盛之极，阳气不敢与之争。现在服用补阳之剂，阳气有权，敢与阴战，再能助阳之力，阴自退听。方中加入附子五分，疟痢齐愈。大量服用补剂，过了三个月产下一子，产后非常健康。
大黄汤
用大黄（一两锉碎），好酒二大盏，浸泡半天，煎至一盏半，去渣，分作两次服用。痢止勿服，如未止再服，以通便为度。
芍药汤
芍药（一两），当归、黄连、黄芩（各五钱），肉桂（二钱半），大黄、甘草、槟榔、木香（一钱）。
以上九味，每服五钱，水二钟，煎至一钟。
香莲丸
黄连（净二十两用吴茱萸十两同炒焦，检去茱萸不用），木香（五两不见火）。上为细末，醋糊丸，如梧桐子大。每服三十丸，米饮送下。
感应丸
新旧冷积均可治疗，此方神妙不可言。虽有巴豆但不令人泻下，其积自然消化。
南木香、肉豆蔻、丁香（各一两半），干姜（炮一两），百草霜（二两），巴豆（七十粒去皮心膜研去油），杏仁（一百四十粒去皮尖）。上前四味为末，外入百草霜研。巴豆与杏仁另研细末同和匀。用好黄蜡六两，溶化成汁，以重绢滤去渣。再以好酒一升，于砂锅内，煮蜡数沸倾出，酒冷其蜡自浮于上，取蜡称用。丸用清油一两，铫内熬令香熟，次下蜡四两，同化成汁，就铫内乘热拌和前药末，捏作锭子，丸如豆大。每服三十丸，姜汤空心送下。
杨子建说：世人有患疫毒痢的，初得病时，先发寒热，忽然头痛壮热，想进入凉室，想吃冷水，狂言狂走，浑身肌肉疼痛，手不可触碰，忽然下痢，或白或赤，或赤白相杂。此证难治。此系太岁在中，该年春夏之内，多有寒肃之化，阳光少见，寒热二气，更相交争，忽然于夏月多寒热之化，寒邪犯心，水火相战，所以先发寒热。水火相犯，血变于中，所以多下赤痢，如紫草色，如苋菜色者，是寒邪犯心之重也。白色者尚轻，赤色者渐重，赤白相杂者，气血相等，寒热之气相搏也。治疗诸证之法，先夺其寒，以后随证调理。
万全护命方
麻黄（去根节）、官桂（去粗皮各七钱半），大川芎、白术（各二两），本独活、桔梗、防风、芍药、白芷（各半两），丹皮、甘草（各二钱半），细辛（三钱三分），牵牛（一钱七分）。上为细末，每服二钱，热汤调下，和渣热服。若服此药后，寒热已退，赤痢已消减，便修合第二方。
诃子（五枚），用面裹火煨热，去核为细末，每服二钱匕，以米汤一盏半，煎取一盏，空心和渣服。
服前二方药病势已减，所下之物止余些小，或下清水，或如鸭溏，或只余些小红色，宜修合第三方，以牢固大肠，还复真气。
Dysentery, known in ancient times as "Zhi Xia" (Stagnant Downward Flow), is characterized by tenesmus (a painful feeling of incomplete defecation) and a sense of heaviness in the anus, causing distress. The stool may contain pus, blood, both mixed together, no food residue, food residue mixed in, or only intestinal mucus. There may be pain or no pain; vomiting or no vomiting; fever or no fever. Treatment must be administered based on a detailed differentiation of Yin/Yang, Cold/Heat, and Deficiency/Excess patterns. One must not adhere rigidly to a single perspective.
The *Yuan Bing Shi* states that diarrhea/dysentery arises from damp-heat stagnating in the intestines and stomach, and these diseases are all heat patterns. It is a common misconception to regard white dysentery as a cold pattern. There are cases cured with acrid-hot medicines because the disease was mild, and the hot medicine opened the stagnation, harmonizing the Qi for recovery. However, if the disease is severe, using hot medicine will exacerbate it to an extreme. Therefore, treating dysentery requires using cold medicines to overcome heat and drying medicines to overcome dampness, with a small addition of acrid-hot medicines as adjuvants to disperse and open the pathways. Such treatment is invariably curative.
Zhu Danxi argued that for conditions where Zhang Zhongjing indicated purgation, one should use Chengqi Tang (Cinnamon Twig and Rhubarb Decoction). Dahuang (Rhei Radix et Rhizoma, Rhubarb) is cold and moves freely; it is assisted by Houpo (Magnoliae Officinalis Cortex, Magnolia Bark) which is warm and moves stagnant Qi; Gancao (Glycyrrhizae Radix et Rhizoma, Licorice) provides sweetness to moderate; taken as a decoction, it sweeps the intestines and stomach, providing moistening and light relief. Purging stops once accumulation is cleared. Medicines like Pishuang (Arsenic), Dansha (Cinnabar), and Badou (Crotonis Fructus, Croton Seed) are strictly forbidden, as their violent toxicity would damage the pure Qi of the intestines and stomach. He further stated that the *Ju Fang* typically uses hot medicines as the main component and astringents as assistants. This is acceptable for clear/white dysentery. However, regarding tenesmus, as the *Neijing* states, "heaviness below belongs to Fire." Adding hot medicines in such cases would be fatal.
These preceding arguments all specifically advocate cold treatment for dysentery, attributing its onset in autumn to summer heat stagnation. While the reasoning is sound and the discussion balanced, it fails to detail why heat stagnation occurs. Often, due to intense summer heat, excessive consumption of ice water or raw/cold foods, heat is constrained by cold, leading over time to deep-seated cold accumulation. Thus, one cannot rigidly assume all cases are heat. Pulse diagnosis and pattern differentiation are essential to confirm heat accumulation before using Dahuang. Using Dahuang for cold accumulation will not cure the disease but will increase severe pain and danger. Generally, Dahuang is used for heat dysentery, while Badou is used for cold dysentery. One must follow ancient precedents precisely without error. The *Neijing*'s principle of "Tong Yin Tong Yong" (Treating obstruction with unblocking methods) has two specific applications: wine-steamed Dahuang and wax-pill Badou. These distinctions must be studied. Furthermore, while hot medicines may be suitable for clear dysentery, they are absolutely contraindicated for pure red bloody dysentery.
However, Wang Haicang stated that for bloody dysentery in summer, Huanglian (Coptidis Rhizoma, Coptis) should not be used because Yin is internal. *Bencao Yan Yi* records a case of a man with bloody dysentery in summer treated with cooling medicines (Huanglian, Muxiang, Ejiao). This approach is viable only at the onset; if the disease persists, the intestines become deficient, and continued use is inappropriate. After ten days, the patient nearly collapsed, necessitating a change in treatment.
(Wang Haicang also noted this argument in the preface of *Zhengjian Lei Bencao*): He recounted that Master Yang drank heavily three times, woke up extremely thirsty, and drank three large cups of cold water. The next day he drank three bowls of tea. Later, he passed bright red blood four times, totaling about a basin. He was first given Wuzhuyu Wan (Evodia Pill). The next day, Pingwei San (Regulate the Stomach Powder) and Wuling San (Five-Ingredient Powder with Poria) were combined. After two large doses, bleeding stopped, but white dysentery appeared. Yingshan Wan (Miraculous Response Pill) was then administered, stopping the white dysentery after four doses, restoring him to health. When asked why cooling agents like Huanglian were not used for detoxification, he replied: "Using cold medicines would drastically alter the disease, making it difficult to treat. Cold toxins have injured internally; adding more cold is incorrect. Blood coagulates due to cold and seeps into the large intestine; warmth allows it to flow. Hence, hot medicines stop the bleeding naturally. As the Classics say, 'In treating disease, seek the root.' The stomach warms, blood flows freely, and returns to its proper place. This illustrates that one must not bias towards cold treatments. If encountering bloody dysentery, do not prejudge it as heat."
Generally, tenesmus requires purging; abdominal pain requires harmonizing; heavy body requires resolving dampness; wiry pulse requires dispelling wind; thick sticky pus/blood requires heavy medication to exhaust it; cold body with spontaneous sweating requires toxic medicines to warm it; contracted wind pathogens require diaphoresis; incontinence requiring holding onto clothes requires astringents; loose stools require warming. One must investigate the cause and differentiate Yin/Yang.
People often see "Zhi Xia" and indiscriminately use Dahuang Tang (Rhubarb Decoction) as a heavy purge, or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) as a lighter harmonizer. Xianglian Wan (Coptis Pill) is a common remedy. Danggui (Angelicae Sinensis Radix, Dong Quai) and Shaoyao (Paeoniae Radix, Peony) harmonize blood; Binglang (Arecae Semen, Betel Nut) and Zhike (Aurantii Fructus Immaturus, Bitter Orange) regulate Qi. For blood signs, Honghua (Carthami Flos, Safflower), Shengdi (Rehmanniae Radix, Rehmannia), and Diyü (Sanguisorbae Radix, Great Burnet) cool blood; Huanglian and Huangbai (Phellodendri Cortex, Amur Cork Tree Bark) clear fire. Doctors change prescriptions frequently, but the outcome remains critical. Patients suffer until death, refusing warming tonics. How tragic!
For dysentery with abdominal pain, tenesmus, scanty urine, thirst for cold drinks, and burning dryness in the large intestine, this is dysentery with heat. The above methods are appropriate. For dysentery with abdominal pain, no thirst, preference for hot drinks, clear abundant urine, no fever, and abdomen preferring warmth, this is dysentery with cold. It requires Lizhong Tang (Regulate the Middle Decoction) with Ganjiang (Zingiberis Rhizoma, Dried Ginger) and Rougui (Cinnamomi Cortex, Cinnamon Bark) to warm. If a heat dysentery persists for a long time without improvement or worsens, it should be treated as deficiency. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with increased Renshen (Ginseng Radix, Ginseng) for warming tonification. If there is lower abdominal heaviness and sharp pain resembling "Ben Tun" (Running Piglet), it involves the Shaoyin pattern. Urgently add Wuzhuyu (Evodiae Fructus, Evodia), Rougui, Pogu Zhi (Crotonis Fructus, Croton Seed), and Rouguo (Myristicae Semen, Nutmeg). In severe cases, add Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root). For pure blood, add Chao Heiganjiang (Charred Black Dried Ginger). Once deficiency recovers, dysentery stops. Waiting for blood and dysentery to cease before tonifying is too late.
Many conditions resemble dysentery but are not. Li Dongyuan stated that dietary injury or irregular lifestyle damages Stomach Qi, causing clear Yang to descend instead of ascending, resulting in Sundry Diarrhea (Sun Xie). Over time, Taiyin transmits to Shaoyin, becoming Chang Pi (Intestinal Dysentery) with tenesmus, mixed pus/blood, and frequent urges without immediate passage. Treat primarily with Buzhong Yiqi Tang to restore ascending/descending dynamics, curing dysentery spontaneously. Modify according to Li Dongyuan: add Jiang Chao Huanglian for heat; Jiang/Ganjiang/Rougui for cold; Jianzhong Tang for lower abdominal pain; Fangfeng/Saoren for wind-damp; increase Chaihu (Bupleuri Radix, Bupleurum) plus Shaoyao/Muxiang for Liver invading Spleen; Juhua (Poppy Shell) and Hezi (Terminalia Chebula Retusa Fruit) for incontinence. If warming tonification fails, reconsider. The Classics state: "If warming does not produce warmth, there is no Fire." In such cases, benefit the source of Fire by urgently tonifying Mingmen Fire (Gate of Life Fire) to generate Spleen Earth. This is the safest strategy.
Another condition resembling dysentery is Yin Deficiency, specifically Da Jia Xie (Great Abdominal Mass Diarrhea) among the Five Diarrheas. The Classics state: Tenesmus, frequent urges without passage, and penile pain indicate this. Chu Shi said: "When Yin is depleted and further exhausted, urination and defecation cause pulling pain. The more painful, the more one strains; the more one strains, the more painful." Symptoms include mixed red/white discharge, tenesmus, scanty/painful urination, or inability to urinate, or involuntary urination during defecation. This is a critical Kidney Deficiency pattern. Urgently use Shenqi Wan (Eight-Ingredient Pill with Rehmannia) plus Gubuzhi (Psoraleae Fructus, Psoralea), Roudoukou (Myristicae Semen, Nutmeg), and Ejiao (Asini Corii Colla, Donkey-Hide Gelatin), alternating with Lizhong Tang plus Shengma (Cimicifugae Rhizoma, Black Cohosh), Guizhi (Cinnamomi Ramulus, Cinnamon Twig), and Fuzi. Many die from misusing dysentery medicines. See *Xiantian Yaolun* for details.
When accumulation is minimal but there is straining with empty bowels, it is due to blood loss from excessive purging. Increase Danggui as the primary herb, assisted by blood-generating herbs. This is a Blood Deficiency Yin pattern.
Tenesmus has two types: Excess type (pathogenic descent) does not improve after defecation; Deficiency type (weak straining) improves immediately after defecation. This distinguishes excess from deficiency.
Jinkou Li (Closed-Mouth Dysentery) involves vomiting everything ingested, with urgency below. Caused by fierce heat-toxin rushing upward, suppressing Stomach Qi. Use Huanglian stir-fried with Wuzhuyu (remove Wuzhuyu), equal parts Renshen, plus a pinch of Nuomi (Oryzae Sativum Granum, Rice). Decoct strongly. Administer slowly spoon by spoon. If 2-3 spoons stay down, vomiting stops. Repeat if necessary. For reverse-flow of cold Qi, use warming tonics; this is easy to treat.
Xiuxi Li (Resting Dysentery) recurs annually due to cold accumulation deep in the large intestine, inaccessible to other medicines. Use Badou alone, fried and ground, made into wax pills the size of a longan. Take on an empty stomach to prevent recurrence. This applies the "Tong Yin Tong Yong" method.
I am naturally robust with excess fire and thirst, drinking tea even in winter. I suffered from wheezing. The Master diagnosed it as Depressed Fire and prescribed Zhulian Wan (Evodia-Coptis Pill), which kept me well. In the summer of Ding Si, I avoided heat in Tanzhou, sitting on ice plates and drinking cold Xiangru Tang (Elsholtzia Decoction). In early autumn, severe dysentery broke out. I passed over 100 stools daily, red and white without residue, with severe bloating and colic. Some suggested Dahuang purgation, but the Master refused, using Renshen, Baizhu (Atractylodis Macrocephalae Rhizoma, White Atractylodes), Ganjiang, and Rougui gradually. White residue persisted until Yingshan Wan cured it. After eating crab, I relapsed into diarrhea and collapse. I recovered again with Shenqi Wan and tonics with added Ganjiang/Rougui. Previously, I consumed Huanglian and tea constantly; now, my illness was purely heat-related. Had I not met the Master, and had I taken Dahuang cooling purges, the outcome would have been dire. During my wife's pregnancy, she suffered wheezing and insomnia, cured instantly by Xiaoyao San (Free and Easy Wanderer Powder). She also had persistent rectal bleeding, stopped instantly by Buzhong Yiqi Tang with Heiganjiang. These miracles are countless. The Master sees through walls; why drink water from the upper pool? I record his virtue. Disciple Xu Yangtai bows.
Malaria followed by dysentery, or dysentery followed by malaria, often results from exhaustion. Post-malaria dysentery is due to Yuan Qi sinking and Spleen Qi failing to ascend, resembling but not being true dysentery. Post-dysentery malaria is due to blood loss and Qi dispersion, causing Yin/Yang deficiency (Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat), resulting in chills and fever resembling malaria. Both are treated as deficiency with Buzhong Yiqi Tang plus warming tonics.
A pregnant woman suffered simultaneous malaria and dysentery for two months. Malaria ceased, but dysentery worsened with abdominal pain and poor appetite. I diagnosed deficiency-cold and prescribed Buzhong Yiqi Tang with Ganjiang/Rougui. Dysentery improved significantly after one dose, but malaria flared severely after the second. The family panicked. I explained this was a good sign: previous cessation of malaria indicated extreme Yin dominance suppressing Yang. The warming tonic empowered Yang to fight Yin. Adding Fuzi (5 fen) resolved both. She delivered a healthy baby three months later.
**Dahuang Tang (Rhubarb Decoction)**
Dahuang (1 liang, crushed), Haojiu (Good Wine, 2 large cups). Soak for half a day, decoct to 1.5 cups. Strain. Divide into two doses. Stop when dysentery ceases.
**Shaoyao Tang (Peony Decoction)**
Shaoyao (1 liang), Danggui, Huanglian, Huangqin (each 5 qian), Rougui (2.5 qian), Dahuang, Gancao, Binglang, Muxiang (each 1 qian). Nine ingredients. Take 5 qian per dose, decoct in 2 zhong of water to 1 zhong.
**Xianglian Wan (Coptis Pill)**
Huanglian (20 liang, stir-fried with 10 liang Wuzhuyu, remove Wuzhuyu), Muxiang (5 liang, not exposed to fire). Powder, pill with vinegar paste, size of wutong seeds. Take 30 pills with rice water.
**Yingshan Wan (Miraculous Response Pill)**
Treats old and new cold accumulation. Contains Badou but does not cause purging; digestion occurs naturally.
Nanmuxiang, Roudoukou, Dingxiang (each 1.5 liang), Ganjiang (processed, 1 liang), Baicaoshuang (2 liang), Badou (70 grains, peeled/husked/oil removed), Xingren (140 grains, peeled/spurs removed). First four powders mixed with Baicaoshuang. Badou and Xingren ground separately and mixed in. Melt 6 liang Huangla (Yellow Beeswax) with 1 sheng of wine, filter, let wax float, weigh wax. Use 1 liang Qingyou (Clear Oil) to fry, add 4 liang wax, melt, mix with powder while hot. Shape into bean-sized pills. Take 30 pills with ginger water on an empty stomach.
**Yang Zijian on Epidemic Toxic Dysentery**
Initial symptoms: chills/fever, severe headache/fever, desire for cool rooms/cold water, delirium/wandering, muscle pain, sudden dysentery (white/red/mixed). Difficult to treat. Caused by Tai Sui influence, cold/heat conflict in spring/summer. Cold pathogen attacks Heart, Water/Fire battle. Red stool (like purple grass or amaranth) indicates severe Heart attack; white is mild; mixed indicates equal Qi/Blood and Cold/Heat struggle. Treat by first overcoming cold, then adjusting symptoms.
**Wanquan Huming Fang (Ten Thousand Completions Life Protection Formula)**
Mahuang (root/joints removed), Guanzi Gui (bark removed, each 7.5 qian), Dachuanxiong, Baizhu (each 2 liang), Benduhuo, Jiegeng, Fangfeng, Shaoyao, Baizhi (each 0.5 liang), Danpi, Gancao (each 2.5 qian), Xixin (3.3 qian), Qianniú (1.7 qian). Powder. Take 2 qian with hot water, dregs included. If chills/fever subside and red dysentery reduces, prepare Formula 2.
**Formula 2**
Hezi (5 fruits), wrapped in flour, roasted hot, pitted, powdered. Take 2 qian bo bits, decoct in 1.5 cups rice water to 1 cup. Take with dregs on empty stomach.
If symptoms reduce and discharge becomes scanty/clear/duck-like/thin red, prepare Formula 3 to secure intestines and restore True Qi.
**Formula 3**
Bo Shang Huhuang (Desulfurized, finely ground, 1 liang), Yiyiren (stir-fried/ground, 2 liang). Mix, pellet with boiled water, size of wutong seeds. Take 50 pills with rice water on empty stomach.