肾传脾，为微邪，易医。是知在脾者病浅，在肾者病深。肾为胃关，开窍于二阴，未有久痢而肾不损者，故治
痢不知补肾，非其治也。凡四君、归脾、十全、补中，皆补脾虚，未尝不善。若病在火衰，土位无母，设非桂、
附大补命门，以复肾中之阳，以救脾家之母，则饮食何由而进？门户何由而固？真元何由而复耶？若畏热不前，
仅以参、术补土，多致不起，大可伤矣！（李士材）
痢疾一证，有四时寒热之不同。土材先生所说，归重脾肾二经；不知脾传肾、肾传脾，乃论五脏相承内伤
之痢，非论夏秋热痢之条。既曰痢起夏秋，湿蒸热郁，是论夏秋之痢矣，即当从阳明燥金司令立论而归重于肠
胃，不宜牵入脾肾。夏秋之先水泻后脓血，先脓血后水泻，乃肠胃湿热之证，非脾肾相传之证也。古云∶大肠
受病，则气凝注而成白痢；小肠受病，则血凝注而成赤痢；大小肠均受病，则赤白相杂。即《经》曰；肠 下血；肠
下白沫；肠 下脓血。诸条皆以肠字立言，则知痢证当以肠字为主。先生论中，脱却肠字本题，而独重于脾
肾。夫脾泄、肾泄，脏气不足，内伤之虚，脏证也。夏秋之痢，肠胃受邪，外感之实，腑证也。内伤不足，外
感有余，二者天壤，先生言言牵带脾肾，妄存温补固涩，横格胸中，致有初痢肠胃壅滞，热郁于内，反见外寒
兼化之象，误认虚寒，妄施温补，证重者为害匪轻，证轻者迁延变重。夫治痢，过用寒凉克削，诚为不可；但
补脾、补肾，乃是后来调理法也。至痢门腹痛一证，有积滞壅塞之痛，用下药行之；有气郁大肠之痛，用苦梗
开之；有气血不和之痛，用芍药和之。今止举气郁一条，曰以桔梗开之，以芍药为主，不分二味收散不同，混
叙气郁条内，似乎腹痛之痢，再无下行之法矣。又云∶恶寒者，加干姜；恶热者，加黄连。夫证有似阴似阳兼
化之假象，宜详察脉证，未可以恶寒、恶热为据也。后肛痛一条上云∶热流于下，用槐花、木香。又云∶挟寒
者用理中汤。岂有寒热夹杂于肠胃间乎？夫肛痛初起，断无虚寒；痢久见痛，方为气陷，然止宜用补中汤升之，
未可骤用理中汤温之。盖因肛痛皆是湿热下流，燥火闭塞。即痢久，亦止宜于补，未宜于温。即令虚矣，未必
寒也；若虚而兼寒，则肛门当不禁而无痛矣。又曰∶《局方》、复庵，例用辛热；河间、丹溪，例用苦寒。何
其执而不圆？不知夏秋之痢，与四时之痢不同。夏秋之痢，本于湿热，但有湿淫、燥淫之别，从治、正治之分。
《局方》、复庵，例用辛温，深恐湿淫于内，不行辛散从治，而用苦寒正治，则寒凉抑遏有邪凝内伏之虞，是
以用辛散以治寒湿。此宗《内经》湿淫于内，治以苦热；湿淫所胜，平以苦热；而开湿淫为痢，表证居多之法
门也。河间、丹溪，例用苦寒，盖谓夏秋之痢，燥火为患，热毒壅害肠胃，此时若效从治，则燥火而遇辛温，
肠胃焚烂，是以用苦寒宣利以为正治。此宗《内经》热淫于内，治以咸寒；热淫所胜，治以苦寒；而开燥热为
痢，里证居多之法门也。用温用寒，
发表攻里，二法各别。余今较正夏秋之痢，当分燥火、湿火；四时之痢，当分外感、内伤；时行疫痢，当分六
气、岁气。深彰先生之道，而全先生之书也。（秦皇士）
发热
《内经》言肠 便血，身热则死，寒则生。此是概言，必须详其兼证，岂无热生而寒死者乎？（《心法附余》）
帝曰∶肠 便血何如？岐伯曰∶身热则死，寒则生。吴鹤皋注云∶身热则血败，而孤阳独存，故死。按∶
肠便血之身热有三∶一则表邪下陷于阳明，药中加葛根，胃气得升即愈；一则阴盛格阳，虽为危候，亦有用
温药而得生者；惟阴气已竭之身热，于法不治。鹤皋但注孤阳独存，可知阳陷与格阳不在此例。苟泥吴注，几
疑此证惟有孤阳独存，凡身热者皆死矣。（《吴医汇讲》）
伤寒厥利发热，与下利发热迥然不同。伤寒厥利，为虚寒之极，所以反能食者则死，反发热者不死。若痢
证则能食者不死，发热者多死也。○《内经》云∶下利发热者死。此论其常也。仲景云∶下利手足不逆冷，反发
热者不死。此论其暴也。盖暴病有阳则生，无阳则死。故虚寒下利，手足不逆冷，反发热者，其人脏中真阳未
漓，或得温补药，真阳随返，皆是美征。（喻嘉言）
口渴
泻痢口渴，有真渴，有似渴。真渴者，必好茶饮，但以喜热、喜凉，即可辨其寒热；似渴者，干也，非
渴也，口虽干而不欲汤饮，则非热证可知。然泻痢之证，因其水泄于下，必津涸于上，故不免于渴。渴而欲饮，
正以内水不足，欲得外水以相济也。诸如此者，必当详审其有火、无火，若火有余者自当清火，水不足者自当
滋阴，是固然矣。然气为水母，其有气虚不能生水者，不补其母，则水不能生而渴不止也；土为水主，其有脾
虚不能约水者，不强其主，则水不能蓄而渴不止也。使能不治其渴，而治其所以渴，又何渴病之有？（张景岳）
脓垢
夏月暑湿之热，客于营卫，则成疮疖；入于肠胃，则为泻痢。痢之红白，如疖之脓血，脓血不尽疖不收，
红白不尽痢不止。（许宣治）
痢疾初起，便见脓血，治宜和血。然气分药亦不可少。若但见白脓，只宜调气，不可用血药，引邪入于
血分，必变脓血也。○凡痢下脓血稠粘，发热烦渴，脐下迫痛，至夜转剧者，便属阴虚。急宜救阴为主，如阿
胶梅连丸、黄连阿胶汤、白头翁加甘草阿胶汤等方选用。（《张氏医通》）
凡泄利无已，变作白脓，点滴而下，用温脾药不愈，法当温肾。盖肾主骨髓，白脓者，骨髓之异名也。
其证面色微黑，骨力羸弱，的见肾虚，当用故纸、当归、木香、肉桂、干姜之属。（《仁斋直指》）
今人但见痢如脓垢者，皆谓之积，不知此非糟粕之属，而实附肠着脏之脂膏，皆精血之属也。无论瘦人
肥人，皆有此脂，但肥者脂浓，瘦者脂薄，未有无脂者也。凡患泻痢者，正以五内受伤，脂膏不固，故日剥而
下。若其脏气稍强，则随去随生，犹无足虑；若脏气既败，剥削既尽，久泻久痢，则见血水及如屋漏水者，使
今后医家，但识此为脂膏，而本非积聚，则安之固之且不暇，而尚敢云攻逐乎？（《景岳全书》）
五色
湿热之积，干于血分则赤，干于气分则白；赤白兼见，气血俱病也。纯下清血者，伤风也；色如豆汁者，
伤湿也；淡黄挟白者，食积也；微红焦黄者，热毒也；紫黑血色者，瘀血也；杂下散血者，损伤也；如鱼脑者，
脾失运而陈积不腐也；如冻胶者，肠胃冷而真液下脱也；如白脓者，虚而挟热，津液努责而结也；如屋漏水尘
腐色者，元气弱极也；如鸡肝色者，百脉皆伤也。○下痢色黑有三∶黑而焦色者，热极反见水化也；黑而有光如漆者，
瘀血也；黑如尘腐者，乃死证耳。（《证治汇补》）
或言下痢白为寒者，误也。若果为寒，则不能消谷，何由反化为脓？此谷肉果菜，热甚则自然腐化为水；
食入腹中，热甚则自然腐化为脓也。下痢赤白，俗言寒热相兼，其说尤误。岂知水火、阴阳、寒热犹权衡也，
一高则一下，一盛则一衰，岂能寒热俱甚于肠胃之间，而同为痢乎？如疮疡而出白脓者，岂可以白为寒欤？大
法下迫窘痛，后重里急，小便赤涩，皆属于热。而下痢白者，必多有之，然则为热明矣。○或以下痢色青为寒
者，亦误也。伤寒少阴病，下痢色纯青者，热在里也。小儿急惊，热甚，利色多青。痢色黄者脾热也；红者心
火之色也。赤者，热之甚也；黑者，由火热亢极反兼水化故也。（《原病式》）
痢白不可尽归于热，亦有因于寒者，形如冻胶、鼻涕，此缘多啖生冷，脾胃受伤，非姜、桂辛热温之不
可。又有痢久气虚，始热末寒，或过服冷药，以致脾胃虚寒者，亦宜温之。（《医学统旨》）
下痢五色，即脓垢之属，无非血气所化。但白者其来浅，附近之脂膏也；赤者其来深，由脂膏而切肤络
也。下纯血者，多以血为热迫，故随溢随下，此其最深者也。若紫红紫白者，则离位稍久，色因以变，或未及
脉络，此其稍浅者也；若红白相兼者，此又其浅深皆及者也。大都纯血鲜红者多热证，以火性急速而下也；紫
红紫白者少热证，以阴凝血败而然也；纯白者无热证，以脏寒气薄而然也。有无红而亦因热者，此暴注下迫之
类也；有红紫虽多而不可言热者，此阴络受伤之类也。若辨黄黑二色，则凡深黄而秽臭者，此有热证，亦有寒
证。若浅黄色淡不甚臭，而或兼腥馊气者，此即不化之类，皆寒证也。黑而浓浓大臭者，多有火证；若青黑而
腥薄者，此肝肾腐败之色也。虽五色之辨，大约如此，然痢之见血者，无非阴络受伤，即或寒或热，但伤络脉
无不见血，不可以见血必认为热，当以脉色、形气、病因兼而察之，庶不致误。（张景岳）
小便
凡泻痢之证，小水必多不利，或多黄赤，此其寒热虚实，不可不察。凡因于热者，必其热赤之甚，或多
涩痛，或见鲜血；然必上下皆有热证，方是真热，此宜清凉治之。若非真热，则或以中寒而逼阳于下者有之；
或以亡阳而水亏色变者有之；或以下焦阳气不暖而水无以化者有之；或以妄用渗利而逼干汁者亦有之。但察其
三焦无火，则虽黄虽涩，总皆亡阴亡液，不得通以热论，速当培补真阴，乃为良法。（张景岳）
腹痛
凡泻痢腹痛，有实热者，有虚寒者。实热者，或因食积，或因火邪。但食积之痛，必多胀满坚硬，或痛
而拒按，此必有所停滞。微者宜行其滞，甚者宜泻而逐之。○火邪之痛，必有内热等证，方宜清利。然邪实于中
者，必多气逆，故凡治痛之法，无论是火是食，皆当以行气为先。○虚寒之痛，尤所当辨。盖凡泻痢之痛，多由
寒气之在脏也。《经》曰∶痛者，寒气多也。凡人有过食生冷，或外受寒气，即能腹痛，此可知也。寒在中者，
治宜温脾；寒在下者，治宜温肾。○再若虚寒刮痛之义，人多不知。盖元气不足于内，则虽无外受寒邪，而中气
不暖，即寒证也。且泻痢不止，胃气既伤，膏血切肤，安能不痛？此其为痛，乃因剥及肠脏而然，是以痢因于
痛，痛因于痢。凡以寒侵腑脏及脉络受伤，血动气滞者，皆能为痛。但察其不实不坚，或喜揉按，或喜暖熨，
或胸腹如饥而不欲食，或胃脘作呕而多吞酸，但无实热等证，则总属虚寒，安得谓痛必因积，痛皆实证耶？凡
治虚寒之痛者，速宜温养脏气，不得再加消伐。但其痛之甚者，当于温补药中稍加木香以顺其气，或多加当归
以和其血。若寒在下焦而痛者，必加吴茱萸；其或痛不至甚，则但温补脾肾，使脾肾渐安，其痛自止。（张景岳）
《机要》云∶腹痛宜和。和之一字，总言之耳。若因气郁不
行者，宜行气开郁；因挟寒者，宜理中汤；因挟热者，宜黄芩芍药汤；因积滞者，宜木香导气汤；因血虚者，
宜当归芍药汤；因肺金之气郁在大肠之间者，宜以苦梗发之。（刘宗浓）
痢后腹痛，以甘、芍为君，归、术为佐。寒加肉桂，热加黄芩。（朱丹溪）
大孔肿痛
凡病痢疾，多有大孔肿痛者，其故何也？盖脾胃不和，则水谷之气失其正化，而浊恶难堪之味出诸孔道，
此痛楚之不能免也。又若火因泻陷，阳为阴逐，则胃中阳气并逼于下，无从解散，此肿之所由生也。所以痢多
则痛多，痢少则痛少，痛与不痛，亦由气之陷与不陷耳。故无论寒痢、热痢，大孔皆能为痛，不得谓痛必由热
也。欲治此者，但治其痢，痢止则肿痛自止，亦如后重之法。自丹溪云∶大孔痛，因热流于下，木香、槟榔、
芩、连主之。是但知火能为肿为痛，焉知元阳之下陷乎？后人所宗，皆其法也，虚寒之辈，不能堪此多矣。（张景岳）
下痢大孔痛，一曰清之，一曰温之。如久病，身冷脉沉小，宜温之；如暴病，身热脉浮洪，宜清之。（《心法附余》）
里急后重
里急者，窘迫急痛也；后重者，大肠坠重而下也；其证不一。有因火热者，火性急速而燥物也；有因气
滞者，大肠之气壅而不通也；有因积滞者，肠胃有物结坠也；有因气虚者，中气下陷不能升也；有因血虚者，
津枯肠燥，虚坐努责也。治法∶热者清之滞者调之，积者去之，气虚者升之，血虚者补之。（《见闻录》）
后重，本因邪压大肠，不能升上而重坠也。用大黄、槟榔者，乃泻其所坠之邪也。久痢与通荡之后，而后
重仍在者，此大肠虚滑不能自收，而重用御米壳、诃子、五倍子等涩剂，收其气而固其滑也。然大肠为邪压下
之重，圊后不减；虚滑不收之重，圊后随减，以此辨之。（朱丹溪）
气虚下陷而重者，虽用收涩之剂，仍须以升补药兼之。（《赤水玄珠》）
里急后重，病在广肠最下之处，而其病本，则不在广肠，而在脾肾。凡热痢、寒痢、虚痢皆有之，不得
尽以为热也。盖中焦有热，则热邪下迫；中焦有寒，则寒邪下迫；脾肾气虚，则气陷下迫，但当察其所因，治
肾传脾，属于微邪，容易医治。由此可知，病在脾的病情浅，病在肾的病情深。肾是胃的关口，开窍于前后二阴，没有久痢而肾不受损的，所以治疗痢疾如果不懂得补肾，就不是正确的治法。凡是四君子汤、归脾汤、十全大补汤、补中益气汤，都是补脾虚的，未尝不好。但如果病在火衰（命门火衰），土位没有母气（脾阳根于肾阳），假如不是用桂枝、附子大补命门，来恢复肾中的阳气，来救脾家的母气，那么饮食从哪里摄入？门户从哪里固摄？真元从哪里恢复呢？如果畏惧热证而不前进，仅仅用人参、白术补土，大多导致无法治愈，这太可惜了！（李士材）
痢疾这一病症，有四季寒热的不同。李士材先生所说的，归结重在脾肾两经；却不知道脾传肾、肾传脾，这是论述五脏相承内伤之痢，并非论述夏秋季节热痢的条文。既然说痢疾起于夏秋，湿蒸热郁，这是论夏秋的痢疾了，就应当从阳明燥金当令立论而归重于肠胃，不宜牵涉入脾肾。夏秋先水泻后脓血，或先脓血后水泻，乃是肠胃湿热之证，并非脾肾相传之证。古语说：大肠受病，则气凝注而成白痢；小肠受病，则血凝注而成赤痢；大小肠均受病，则赤白相杂。即《内经》所说：肠下血；肠下白沫；肠下脓血。诸条都以“肠”字立言，就知道痢证应当以“肠”字为主。李先生论述中，脱却了“肠”字本题，而独重脾肾。夫脾泄、肾泄，是脏气不足，内伤的虚证，是脏证。夏秋的痢疾，是肠胃受邪，外感的实证，是腑证。内伤不足，外感有余，二者天壤之别，先生言言牵带脾肾，妄存温补固涩的念头，横亘胸中，导致初痢肠胃壅滞，热郁于内，反而见外寒兼化之象，误认为虚寒，妄施温补，证重的为害不小，证轻的迁延变重。夫治疗痢疾，过用寒凉克削，诚然不可；但补脾、补肾，乃是后来的调理法罢了。至于痢门腹痛一证，有积滞壅塞之痛，用下药行之；有气郁大肠之痛，用桔梗开之；有气血不和之痛，用芍药和之。现在只举气郁一条，说以桔梗开之，以芍药为主，不分这两味药收散不同，混叙在气郁条内，似乎腹痛之痢，再无下行的方法了。又说：恶寒者，加干姜；恶热者，加黄连。夫证有似阴似阳兼化之假象，宜详察脉证，不可以恶寒、恶热为依据。后肛痛一条上云：热流于下，用槐花、木香。又说：挟寒的用理中汤。岂有寒热夹杂于肠胃间乎？夫肛痛初起，断无虚寒；痢久见痛，方为气陷，然而只宜用补中益气汤升提，不可骤用理中汤温补。盖因肛痛皆是湿热下流，燥火闭塞。即使痢久，也只宜于补，不宜于温。即使令虚了，未必寒也；若虚而兼寒，则肛门当不禁而无痛矣。又说：《局方》、复庵，例用辛热；河间、丹溪，例用苦寒。何其执而不圆？不知道夏秋的痢疾，与四时的痢疾不同。夏秋的痢疾，本于湿热，但有湿淫、燥淫之别，从治、正治之分。《局方》、复庵，例用辛温，深恐湿淫于内，不行辛散从治，而用苦寒正治，则寒凉抑遏有邪凝内伏的忧虑，是用辛散以治寒湿。此宗《内经》湿淫于内，治以苦热；湿淫所胜，平以苦热；而开湿淫为痢，表证居多法门。河间、丹溪，例用苦寒，盖谓夏秋的痢疾，燥火为患，热毒壅害肠胃，此时若效从治，则燥火而遇辛温，肠胃焚烂，是用苦寒宣利以为正治。此宗《内经》热淫于内，治以咸寒；热淫所胜，治以苦寒；而开燥热为痢，里证居多法门。用温用寒，发表攻里，二法各别。我现在较正夏秋的痢疾，当分燥火、湿火；四时的痢疾，当分外感、内伤；时行疫痢，当分六气、岁气。深深彰显先生的道理，而保全先生的书。（秦皇士）
发热
《内经》说肠便血，身热则死，寒则生。这是概言，必须详其兼证，难道没有热生而寒死的吗？（《心法附余》）
黄帝问：肠便血怎么样？岐伯说：身热则死，寒则生。吴鹤皋注解说：身热则血败，而孤阳独存，故死。按：肠便血的身热有三：一则表邪下陷于阳明，药中加葛根，胃气得升即愈；一则阴盛格阳，虽为危候，也有用温药而得生的；惟独阴气已竭的身热，于法不治。鹤皋只注孤阳独存，可知阳陷与格阳不在此例。如果拘泥吴注，几乎怀疑此证惟有孤阳独存，凡身热者皆死矣。（《吴医汇讲》）
伤寒厥利发热，与下利发热迥然不同。伤寒厥利，为虚寒之极，所以反能食者则死，反发热者不死。若痢证则能食者不死，发热者多死也。○《内经》说：下利发热者死。这是论其常。仲景说：下利手足不逆冷，反发热者不死。这是论其暴。盖暴病有阳则生，无阳则死。故虚寒下利，手足不逆冷，反发热者，其人脏中真阳未漓，或得温补药，真阳随返，皆是美征。（喻嘉言）
口渴
泻痢口渴，有真渴，有似渴。真渴者，必好茶饮，但以喜热、喜凉，即可辨其寒热；似渴者，干也，非渴也，口虽干而不欲汤饮，则非热证可知。然而泻痢之证，因其水泄于下，必津涸于上，故不免于渴。渴而欲饮，正以内水不足，欲得外水以相济也。诸如此者，必当详审其有火、无火，若火有余者自当清火，水不足者自当滋阴，是固然矣。然而气为水母，其有气虚不能生水者，不补其母，则水不能生而渴不止也；土为水主，其有脾虚不能约水者，不强其主，则水不能蓄而渴不止也。使能不治其渴，而治其所以渴，又何渴病之有？（张景岳）
脓垢
夏月暑湿之热，客于营卫，则成疮疖；入于肠胃，则为泻痢。痢之红白，如疖之脓血，脓血不尽疖不收，红白不尽痢不止。（许宣治）
痢疾初起，便见脓血，治宜和血。然而气分药亦不可少。若但见白脓，只宜调气，不可用血药，引邪入于血分，必变脓血也。○凡痢下脓血稠粘，发热烦渴，脐下迫痛，至夜转剧者，便属阴虚。急宜救阴为主，如阿胶梅连丸、黄连阿胶汤、白头翁加甘草阿胶汤等方选用。（《张氏医通》）
凡泄利无已，变作白脓，点滴而下，用温脾药不愈，法当温肾。盖肾主骨髓，白脓者，骨髓之异名也。其证面色微黑，骨力羸弱，的见肾虚，当用故纸、当归、木香、肉桂、干姜之属。（《仁斋直指》）
今人但见痢如脓垢者，皆谓之积，不知此非糟粕之属，而实附肠着脏之脂膏，皆精血之属也。无论瘦人肥人，皆有此脂，但肥者脂浓，瘦者脂薄，未有无脂者也。凡患泻痢者，正以五内受伤，脂膏不固，故日剥而下。若其脏气稍强，则随去随生，犹无足虑；若脏气既败，剥削既尽，久泻久痢，则见血水及如屋漏水者，使今后医家，但识此为脂膏，而本非积聚，则安之固之且不暇，而尚敢云攻逐乎？（《景岳全书》）
五色
湿热之积，干于血分则赤，干于气分则白；赤白兼见，气血俱病也。纯下清血者，伤风也；色如豆汁者，伤湿也；淡黄挟白者，食积也；微红焦黄者，热毒也；紫黑血色者，瘀血也；杂下散血者，损伤也；如鱼脑者，脾失运而陈积不腐也；如冻胶者，肠胃冷而真液下脱也；如白脓者，虚而挟热，津液努责而结也；如屋漏水尘腐色者，元气弱极也；如鸡肝色者，百脉皆伤也。○下痢色黑有三：黑而焦色者，热极反见水化也；黑而有光如漆者，瘀血也；黑如尘腐者，乃死证耳。（《证治汇补》）
或言下痢白为寒者，误也。若果为寒，则不能消谷，何由反化为脓？此谷肉果菜，热甚则自然腐化为水；食入腹中，热甚则自然腐化为脓也。下痢赤白，俗言寒热相兼，其说尤误。岂知水火、阴阳、寒热犹权衡也，一高则一下，一盛则一衰，岂能寒热俱甚于肠胃之间，而同为痢乎？如疮疡而出白脓者，岂可以白为寒欤？大法下迫窘痛，后重里急，小便赤涩，皆属于热。而下痢白者，必多有之，然则为热明矣。○或以下痢色青为寒者，亦误也。伤寒少阴病，下痢色纯青者，热在里也。小儿急惊，热甚，利色多青。痢色黄者脾热也；红者心火之色也。赤者，热之甚也；黑者，由火热亢极反兼水化故也。（《原病式》）
痢白不可尽归于热，亦有因于寒者，形如冻胶、鼻涕，此缘多啖生冷，脾胃受伤，非姜、桂辛热温之不可。又有痢久气虚，始热末寒，或过服冷药，以致脾胃虚寒者，亦宜温之。（《医学统旨》）
下痢五色，即脓垢之属，无非血气所化。但白者其来浅，附近之脂膏也；赤者其来深，由脂膏而切肤络也。下纯血者，多以血为热迫，故随溢随下，此其最深者也。若紫红紫白者，则离位稍久，色因以变，或未及脉络，此其稍浅者也；若红白相兼者，此又其浅深皆及者也。大都纯血鲜红者多热证，以火性急速而下也；紫红紫白者少热证，以阴凝血败而然也；纯白者无热证，以脏寒气薄而然也。有无红而亦因热者，此暴注下迫之类也；有红紫虽多而不可言热者，此阴络受伤之类也。若辨黄黑二色，则凡深黄而秽臭者，此有热证，亦有寒证。若浅黄色淡不甚臭，而或兼腥馊气者，此即不化之类，皆寒证也。黑而浓浓大臭者，多有火证；若青黑而腥薄者，此肝肾腐败之色也。虽五色之辨，大约如此，然痢之见血者，无非阴络受伤，即或寒或热，但伤络脉无不见血，不可以见血必认为热，当以脉色、形气、病因兼而察之，庶不致误。（张景岳）
小便
凡泻痢之证，小水必多不利，或多黄赤，此其寒热虚实，不可不察。凡因于热者，必其热赤之甚，或多涩痛，或见鲜血；然必上下皆有热证，方是真热，此宜清凉治之。若非真热，则或以中寒而逼阳于下者有之；或以亡阳而水亏色变者有之；或以下焦阳气不暖而水无以化者有之；或以妄用渗利而逼干汁者亦有之。但察其三焦无火，则虽黄虽涩，总皆亡阴亡液，不得通以热论，速当培补真阴，乃为良法。（张景岳）
腹痛
凡泻痢腹痛，有实热者，有虚寒者。实热者，或因食积，或因火邪。但食积之痛，必多胀满坚硬，或痛而拒按，此必有所停滞。微者宜行其滞，甚者宜泻而逐之。○火邪之痛，必有内热等证，方宜清利。然邪实于中者，必多气逆，故凡治痛之法，无论是火是食，皆当以行气为先。○虚寒之痛，尤所当辨。盖凡泻痢之痛，多由寒气之在脏也。《经》曰：痛者，寒气多也。凡人有过食生冷，或外受寒气，即能腹痛，此可知也。寒在中者，治宜温脾；寒在下者，治宜温肾。○再若虚寒刮痛之义，人多不知。盖元气不足于内，则虽无外受寒邪，而中气不暖，即寒证也。且泻痢不止，胃气既伤，膏血切肤，安能不痛？此其为痛，乃因剥及肠脏而然，是以痢因于痛，痛因于痢。凡以寒侵腑脏及脉络受伤，血动气滞者，皆能为痛。但察其不实不坚，或喜揉按，或喜暖熨，或胸腹如饥而不欲食，或胃脘作呕而多吞酸，但无实热等证，则总属虚寒，安得谓痛必因积，痛皆实证耶？凡治虚寒之痛者，速宜温养脏气，不得再加消伐。但其痛之甚者，当于温补药中稍加木香以顺其气，或多加当归以和其血。若寒在下焦而痛者，必加吴茱萸；其或痛不至甚，则但温补脾肾，使脾肾渐安，其痛自止。（张景岳）
《机要》说：腹痛宜和。和之一字，总言之耳。若因气郁不行者，宜行气开郁；因挟寒者，宜理中汤；因挟热者，宜黄芩芍药汤；因积滞者，宜木香导气汤；因血虚者，宜当归芍药汤；因肺金之气郁在大肠之间者，宜以桔梗发之。（刘宗浓）
痢后腹痛，以甘、芍为君，归、术为佐。寒加肉桂，热加黄芩。（朱丹溪）
大孔肿痛
凡病痢疾，多有大孔肿痛者，其故何也？盖脾胃不和，则水谷之气失其正化，而浊恶难堪之味出诸孔道，此痛楚之不能免也。又若火因泻陷，阳为阴逐，则胃中阳气并逼于下，无从解散，此肿之所由生也。所以痢多则痛多，痢少则痛少，痛与不痛，亦由气之陷与不陷耳。故无论寒痢、热痢，大孔皆能为痛，不得谓痛必由热也。欲治此者，但治其痢，痢止则肿痛自止，亦如后重之法。自丹溪说：大孔痛，因热流于下，木香、槟榔、芩、连主之。是但知火能为肿为痛，焉知元阳之下陷乎？后人所宗，皆其法也，虚寒之辈，不能堪此多矣。（张景岳）
下痢大孔痛，一曰清之，一曰温之。如久病，身冷脉沉小，宜温之；如暴病，身热脉浮洪，宜清之。（《心法附余》）
里急后重
里急者，窘迫急痛也；后重者，大肠坠重而下也；其证不一。有因火热者，火性急速而燥物也；有因气滞者，大肠之气壅而不通也；有因积滞者，肠胃有物结坠也；有因气虚者，中气下陷不能升也；有因血虚者，津枯肠燥，虚坐努责也。治法：热者清之滞者调之，积者去之，气虚者升之，血虚者补之。（《见闻录》）
后重，本因邪压大肠，不能升上而重坠也。用大黄、槟榔者，乃泻其所坠之邪也。久痢与通荡之后，而后重仍在者，此大肠虚滑不能自收，而重用御米壳、诃子、五倍子等涩剂，收其气而固其滑也。然大肠为邪压下之重，圊后不减；虚滑不收之重，圊后随减，以此辨之。（朱丹溪）
气虚下陷而重者，虽用收涩之剂，仍须以升补药兼之。（《赤水玄珠》）
里急后重，病在广肠最下之处，而其病本，则不在广肠，而在脾肾。凡热痢、寒痢、虚痢皆有之，不得尽以为热也。盖中焦有热，则热邪下迫；中焦有寒，则寒邪下迫；脾肾气虚，则气陷下迫，但当察其所因，治
The Kidney transmitting to the Spleen constitutes a minor pathogenic factor (Wei Xie), which is easy to treat. From this, we know that when the disease is in the Spleen, it is shallow; when it is in the Kidney, it is deep. The Kidney serves as the gate of the Stomach and opens into the two yin orifices (anterior and posterior). There is no case of chronic dysentery where the Kidney is not damaged. Therefore, treating dysentery without knowing how to tonify the Kidney is not the correct treatment. Formulas such as Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify Spleen deficiency and are by no means ineffective. However, if the pathology lies in Fire Decline (Ming Men Fire Deficiency), and the Earth position lacks its Mother (Spleen Yang rooted in Kidney Yang), unless one uses Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) to greatly tonify Ming Men (Gate of Life) to restore the Yang Qi within the Kidney and save the Mother of the Spleen, how would food and drink be ingested? How would the gates be secured? How would the True Yuan (Original Essence) be restored? If one fears heat and hesitates, relying solely on Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) to tonify Earth, it often leads to untreatable conditions, which is a great pity! (Li Shicai)
Dysentery presents with differences in cold and heat across the four seasons. Mr. Li Shicai’s discussion emphasizes the Spleen and Kidney meridians; however, he fails to recognize that "Spleen transmitting to Kidney" and "Kidney transmitting to Spleen" refer to internal injury dysentery caused by the mutual transmission of the Five Zang organs, not the summer-autumn heat dysentery described in other texts. Since it states that dysentery arises in summer and autumn due to dampness steaming and heat stagnating, this refers to summer-autumn dysentery. Thus, the discussion should be based on the command of Yangming Dryness Metal and focus on the Intestines and Stomach, rather than involving the Spleen and Kidney. Summer-autumn cases of watery diarrhea followed by pus and blood, or pus and blood followed by watery diarrhea, are syndromes of Damp-Heat in the Intestines and Stomach, not syndromes of Spleen-Kidney transmission. Ancient texts state: When the Large Intestine is diseased, Qi stagnates and condenses, resulting in white dysentery; when the Small Intestine is diseased, Blood stagnates and condenses, resulting in red dysentery; when both are diseased, red and white mix. As stated in the *Classic of Internal Medicine* (*Huangdi Neijing*): "Blood from the intestines"; "White foam from the intestines"; "Pus and blood from the intestines." All these passages use the character "Intestine," indicating that dysentery should primarily concern the Intestines. Mr. Li’s discussion omits the primary topic of the "Intestine" and focuses exclusively on the Spleen and Kidney. Pi Xie (Spleen Diarrhea) and Shen Xie (Kidney Diarrhea) result from insufficiency of Zang Qi, representing internal injury and deficiency, which are Zang syndromes. Summer-autumn dysentery results from external pathogens affecting the Intestines and Stomach, representing external contraction and excess, which are Fu syndromes. Internal injury deficiency and external contraction excess are worlds apart. Mr. Li’s comments constantly involve the Spleen and Kidney, harboring erroneous notions of warming, tonifying, astringing, and securing. This obstructs his mind, leading to misinterpretations: in early dysentery with intestinal-stomach congestion and internal heat stagnation, external cold symptoms may appear due to transformation, which might be mistaken for deficiency-cold, leading to inappropriate warming and tonification. Severe cases suffer significant harm, while mild cases prolong and worsen. Indeed, overusing cold and purgative methods in treating dysentery is inadvisable; however, tonifying the Spleen and Kidney are methods for later convalescence. Regarding abdominal pain in dysentery, there is pain due to stagnation and obstruction, treated with purgatives; pain due to Qi stagnation in the Large Intestine, treated with Jie Geng (Platycodon Root) to open it; and pain due to disharmony of Qi and Blood, treated with Shao Yao (Peony Root) to harmonize it. Now, only the Qi stagnation category is mentioned, stating that Jie Geng opens it and Shao Yao is the main herb, without distinguishing their different actions of dispersing and astringing, mixing them under the Qi stagnation category. This implies that for dysentery with abdominal pain, there is no method of descending. It further states: For aversion to cold, add Gan Jiang (Dried Ginger); for aversion to heat, add Huang Lian (Coptis Rhizome). Syndromes may present with pseudo-images of Yin-Yang combination and transformation, so pulse and symptoms must be carefully examined; one cannot rely solely on aversion to cold or heat. In the section on anal pain, it says: "Heat flowing downward" is treated with Huai Hua (Sophora Flower) and Mu Xiang (Aucklandia Root). It also says: For cases complicated by cold, use Li Zhong Tang (Regulate the Middle Decoction). Can cold and heat coexist mixed within the intestines and stomach? Anal pain at onset is certainly not deficiency-cold; pain appearing after long-standing dysentery indicates Qi sinking, but one should only use Bu Zhong Yi Qi Tang to lift it, not abruptly use Li Zhong Tang to warm it. This is because anal pain is always due to Damp-Heat flowing downward and dry-fire blocking. Even in long-standing dysentery, one should only tonify, not warm. Even if deficiency exists, cold may not necessarily be present; if deficiency is accompanied by cold, the anus would be incontinent and painless. It is also said: *Ju Fang* (Formulas of the Bureau) and Fu An typically use acrid-hot herbs; He Jian and Dan Xi typically use bitter-cold herbs. How rigid and inflexible they are! One does not realize that summer-autumn dysentery differs from dysentery in other seasons. Summer-autumn dysentery originates from Damp-Heat, differing in dampness dominance vs. dryness dominance, and following treatment vs. direct treatment. *Ju Fang* and Fu An typically use acrid-warm herbs, fearing that if dampness dominates internally, failing to use acrid-dispersing "following treatment" and instead using bitter-cold "direct treatment" would cause cold-coldness to suppress and trap pathogens inside. Hence, they use acrid-dispersing to treat cold-dampness. This follows the *Neijing*: "For dampness dominating internally, treat with bitter-hot"; "For dampness prevailing, level with bitter-hot." This opens the method for dampness-induced dysentery, where exterior syndromes are common. He Jian and Dan Xi typically use bitter-cold herbs, believing that in summer-autumn dysentery, dry-fire causes harm, and heat-toxin congests and damages the intestines and stomach. At this time, if one follows "following treatment," dry-fire meeting acrid-warm would burn and rot the intestines and stomach. Hence, they use bitter-cold to promote drainage as "direct treatment." This follows the *Neijing*: "For heat dominating internally, treat with salty-cold"; "For heat prevailing, treat with bitter-cold." This opens the method for dryness-heat-induced dysentery, where interior syndromes are common. Using warmth or cold, releasing the exterior or attacking the interior, these two methods are distinct. I now correct the summer-autumn dysentery, dividing it into dry-fire and damp-fire; dysentery in the four seasons is divided into external contraction and internal injury; epidemic dysentery is divided according to the Six Qi and annual Qi. This deeply elucidates Mr. Li’s principles and preserves his work. (Qin Huangshi)
Fever
The *Neijing* states that for intestinal bleeding, fever indicates death, while cold indicates survival. This is a general statement; one must examine accompanying symptoms. Are there cases where fever leads to survival and cold to death? (*Xin Fa Fu Yu*)
The Yellow Emperor asked: What about intestinal bleeding? Qibo replied: Fever indicates death, cold indicates survival. Wu Hegao annotated: Fever causes blood deterioration, leaving isolated Yang alone, hence death. Note: There are three types of fever in intestinal bleeding: First, exterior pathogens sink into Yangming; adding Ge Gen (Kudzu Root) to the prescription allows Stomach Qi to rise, leading to recovery. Second, Yin Excess repelling Yang; although critical, some survive with warming medicines. Only when Yin Qi is exhausted does fever become untreatable. Hegao only noted "isolated Yang alone," implying that Yang sinking and Yin repelling Yang are not covered here. If one sticks to Wu’s annotation, one might suspect that this syndrome only involves isolated Yang, and all fevers lead to death. (*Wu Yi Hui Jiang*)
In Cold Damage, Jue-Li (cold limbs with diarrhea) with fever is completely different from Liu-Xia (diarrhea) with fever. Cold Damage Jue-Li represents extreme deficiency-cold; thus, if the patient can eat, it indicates death, but if they have fever, it indicates survival. In dysentery, if the patient can eat, it indicates survival; if they have fever, it often indicates death. ○ The *Neijing* states: "Diarrhea with fever indicates death." This discusses the usual pattern. Zhang Zhongjing states: "Diarrhea with cold-free limbs and fever indicates survival." This discusses acute patterns. Acute diseases with Yang lead to survival, without Yang lead to death. Therefore, in deficiency-cold diarrhea, if limbs are not cold and fever appears, the person’s True Yang in the viscera has not dissipated, or with warming-tonifying medicine, True Yang returns; these are auspicious signs. (Yu Jiayan)
Thirst
Diarrhea and dysentery thirst includes true thirst and apparent thirst. True thirst involves a desire for tea/water; preference for hot or cold distinguishes cold from heat. Apparent thirst is dryness, not true thirst; although the mouth is dry, there is no desire for drinks, indicating it is not a heat syndrome. However, in diarrhea and dysentery, since fluids drain downward, upper fluids dry up, causing unavoidable thirst. Thirst with desire to drink occurs because internal fluids are insufficient and seek external fluids to supplement. In such cases, one must carefully examine the presence or absence of Fire. If Fire is excessive, clear it; if Water is insufficient, nourish Yin. This is certain. However, Qi is the mother of Water; if Qi deficiency fails to generate Water, failing to tonify the mother means Water cannot generate and thirst persists. Earth is the master of Water; if Spleen deficiency fails to control Water, failing to strengthen the master means Water cannot accumulate and thirst persists. If one treats the cause of thirst rather than thirst itself, why would thirst disease exist? (Zhang Jingyue)
Pus and Filth
In summer, heat from summer-dampness lodging in Ying and Wei causes boils; entering the intestines and stomach causes diarrhea and dysentery. The red and white in dysentery are like pus and blood in boils; until pus and blood are cleared, boils do not heal; until red and white are cleared, dysentery does not stop. (Xu Xuanzhi)
At the onset of dysentery, if pus and blood appear immediately, treatment should harmonize Blood. However, Qi-moving herbs should not be omitted. If only white pus is seen, one should only regulate Qi and avoid Blood-invigorating herbs, lest they draw pathogens into the Blood level, transforming into pus and blood. ○ Whenever dysentery presents with thick, sticky pus and blood, fever, irritability, thirst, suprapubic urgency/pain, worsening at night, it belongs to Yin Deficiency. Urgently prioritize saving Yin, selecting formulas such as E Jiao Mei Lian Wan (Donkey-Hide Gelatin, Plum, and Coptis Pill), Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction), or Bai Tou Weng Tang plus Gan Cao and E Jiao (Pulsatilla Decoction plus Licorice and Donkey-Hide Gelatin). (*Zhang Shi Yi Tong*)
Whenever diarrhea/loose stools persist, transforming into white pus dripping drop by drop, if warming Spleen medicines fail, the method should be to warm the Kidney. The Kidney governs Marrow; white pus is another name for Marrow. Symptoms include slightly dark complexion and weak bones/muscles, clearly indicating Kidney Deficiency. Use seeds of Psoralea (Gu Zhi), Dang Gui (Angelica Sinensis), Mu Xiang (Aucklandia), Rou Gui (Cinnamon Bark), and Gan Jiang (Dried Ginger). (*Ren Zhai Zhi Zhi*)
People today see dysentery resembling pus and filth and call it accumulation (Ji), not knowing this is not fecal matter but the fat/grease adhering to the intestines and viscera, belonging to Essence and Blood. Whether thin or fat, everyone has this fat; fat people have dense fat, thin people have thin fat, but none lack it. Those suffering from diarrhea/dysentery have injured internal organs, causing fat/grease to be unstable, thus peeling off daily. If Zang Qi is slightly strong, it regenerates as it goes, causing little worry; if Zang Qi fails and depletion is complete, long-term diarrhea/dysentery reveals bloody water and fluid resembling leaking roof water. May future physicians recognize this as fat/grease, not accumulation, and focus on stabilizing and securing it, rather than daring to speak of purging. (*Jing Quan Quan Shu*)
Five Colors
Accumulation of Damp-Heat affects the Blood level turning red, and the Qi level turning white; seeing both red and white indicates Qi and Blood are both diseased. Pure clear blood indicates Wind Injury; color like bean juice indicates Dampness Injury; pale yellow mixed with white indicates Food Accumulation; slightly red and scorched yellow indicates Heat-Toxin; purple-black blood indicates Blood Stasis; scattered blood indicates Trauma/Damage; like fish brain indicates Spleen failure to transport and old accumulation not rotting; like frozen gel indicates Cold intestines/stomach and leakage of true fluids; like white pus indicates Deficiency with Heat, where fluids strain and knot; like leaking roof water/dust color indicates extremely weak Yuan Qi; like chicken liver color indicates damage to all vessels. ○ Black stool in dysentery has three types: Scorched black indicates Extreme Heat manifesting as Water transformation; Glossy black like lacquer indicates Blood Stasis; Dust-like black indicates a fatal syndrome. (*Zheng Zhi Hui Bu*)
Some say white dysentery is Cold; this is an error. If it were truly Cold, it could not digest grain, so how could it transform into pus? Grain, meat, fruits, and vegetables naturally rot into water when heat is severe; food entering the abdomen naturally rots into pus when heat is severe. The popular saying that red-white dysentery is a mix of Cold and Heat is even more erroneous. Do you not know that Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; when one rises, the other falls; when one excels, the other declines. How can Cold and Heat both be severe in the intestines and stomach simultaneously, causing dysentery? If a sore produces white pus, can white be considered Cold? Generally, tenesmus, urgency, and painful defecation, along with red/scanty urination, belong to Heat. White dysentery often accompanies these, clearly indicating Heat. ○ Some say green dysentery is Cold; this is also an error. In Cold Damage Shaoyin disease, pure green stool indicates Heat in the interior. In pediatric acute convulsion, severe Heat often results in green-colored stool. Yellow dysentery indicates Spleen Heat; Red indicates Heart Fire. Red indicates severe Heat; Black indicates Fire/Heat reaching extremity, counteracting with Water transformation. (*Yuan Bing Shi*)
White dysentery cannot be entirely attributed to Heat; some are due to Cold, resembling frozen gel or mucus, caused by excessive consumption of raw/cold foods injuring the Spleen/Stomach, requiring acrid-hot warming with Ginger and Cinnamon. Also, long-standing dysentery with Qi deficiency starting with Heat and ending with Cold, or overuse of cold medicines causing Spleen/Stomach deficiency-cold, also requires warming. (*Yi Xue Tong Zhi*)
Five colors in dysentery belong to pus/filth, all transformed from Blood and Qi. White comes from shallow levels, nearby fat/grease; Red comes from deep levels, penetrating skin collaterals from fat/grease. Pure blood discharge is mostly due to Heat forcing blood, overflowing and discharging immediately, representing the deepest level. Purple-red or purple-white indicates staying away from the source longer, changing color, or not yet reaching collaterals, representing a shallower level; Red-white mixture indicates involvement of both shallow and deep levels. Mostly, bright red pure blood indicates Heat syndromes due to the rapid nature of Fire; purple-red/white indicates fewer Heat syndromes due to Yin coagulation and blood deterioration; pure white indicates no Heat syndromes due to Cold Zang and thin Qi. There are red cases due to Heat, such as sudden pouring and urgent pressure; there are red-purple cases too numerous to call Heat, such as Yin collateral injury. Regarding yellow and black colors: Deep yellow with foul odor indicates Heat or Cold syndromes. Pale yellow, light, not very odorous, or with fishy/sour smell indicates indigestion, all Cold syndromes. Thick black with strong odor indicates many Fire syndromes; blue-black with thin fishy smell indicates Liver/Kidney corruption. Although differentiation of five colors is roughly as above, blood in dysentery is non-other than Yin collateral injury. Whether Cold or Heat, damaging collaterals inevitably causes bleeding. One cannot assume bleeding is always Heat; one must examine pulse, color, form, Qi, and etiology together to avoid error. (Zhang Jingyue)
Urine
In diarrhea and dysentery, urination is often difficult, or yellow/red. One must not fail to observe Cold, Heat, Deficiency, and Excess. Cases due to Heat必然 present with intense redness, frequent painful urination, or visible fresh blood; however, only when both upper and lower bodies show Heat signs is it True Heat, treated with cooling methods. If not True Heat, it may be due to Middle Cold forcing Yang downward; or Yang exhaustion causing Water deficiency and color change; or Lower Jiao Yang Qi failing to warm, preventing Water transformation; or improper use of diuretics drying up juices. If one observes no Fire in the Three Jiao, then despite yellowness or difficulty, it is total Yin/Juice loss, not generally discussed as Heat. Quickly tonifying True Yin is the good method. (Zhang Jingyue)
Abdominal Pain
Abdominal pain in diarrhea/dysentery includes Excess-Heat and Deficiency-Cold. Excess-Heat is due to Food Accumulation or Fire Pathogen. Pain from Food Accumulation必然 involves bloating, hardness, or refusal to pressure, indicating stagnation. Mild cases move stagnation; severe cases purge and drive it out. ○ Pain from Fire Pathogen必然 involves internal Heat signs, suitable for clearing and draining. However, pathogens solidified in the middle必然 cause Qi rebellion. Thus, in treating pain, whether Fire or Food, moving Qi must come first. ○ Deficiency-Cold pain requires particular distinction. Pain in diarrhea/dysentery mostly stems from Cold Qi in the Zang. The Classic states: "Pain is due to much Cold." Anyone overeating raw/cold or contracting external Cold experiences abdominal pain, proving this. Cold in the middle is treated by warming the Spleen; Cold in the lower is treated by warming the Kidney. ○ Furthermore, few understand the meaning of deficiency-cold scraping pain. If Yuan Qi is insufficient internally, even without external Cold, Middle Qi is not warm, constituting a Cold syndrome. Moreover, persistent diarrhea/dysentery injures Stomach Qi; fat/blood touching the skin, how can there be no pain? This pain arises from depletion reaching intestines/viscera, hence dysentery causes pain, and pain causes dysentery. Any invasion of Cold into Fu/Zang or damage to collaterals causing Blood movement and Qi stagnation can cause pain. But if one observes it is not solid/hard, or likes rubbing/pressing, or likes warmth, or chest/abdomen feels hungry but no desire to eat, or epigastric vomiting with acid regurgitation, and lacks Excess-Heat signs, it all belongs to Deficiency-Cold. How can one say pain is always due to accumulation and is always an Excess syndrome? In treating Deficiency-Cold pain, quickly warm and nourish Zang Qi, do not add reducing/draining methods. But for severe pain, add slight Mu Xiang to warming-tonifying herbs to smooth Qi, or add more Dang Gui to harmonize Blood. If Cold is in the Lower Jiao causing pain, add Wu Zhu Yu (Evodia Fruit); if pain is not severe, simply warm and tonify Spleen/Kidney, allowing gradual peace, and pain stops naturally. (Zhang Jingyue)
*Ji Yao* states: Abdominal pain should be harmonized. "Harmonize" is a general term. If due to Qi stagnation, move Qi and open depression; if complicated by Cold, use Li Zhong Tang; if complicated by Heat, use Huang Qin Shao Yao Tang; if due to stagnation, use Mu Xiang Dao Qi Tang; if due to Blood Deficiency, use Dang Gui Shao Yao Tang; if Lung Metal Qi is stagnant in the Large Intestine, use Jie Geng to vent it. (Liu Zongnong)
Post-dysentery abdominal pain uses Gan Cao and Shao Yao as Sovereign, Dang Gui and Bai Zhu as Ministers. Add Rou Gui for Cold, add Huang Qin for Heat. (Zhu Danxi)
Anal Swelling and Pain
In dysentery, many have anal swelling and pain. Why? Because Spleen/Stomach disharmony causes water/grain Qi to lose proper transformation, and foul, unbearable flavors exit through the orifice, making pain inevitable. Also, if Fire sinks due to diarrhea, and Yang is driven by Yin, Stomach Yang Qi is forced downward with nowhere to dissipate, causing swelling. Thus, more dysentery means more pain, less dysentery means less pain; pain or no pain depends on Qi sinking or not. Therefore, regardless of Cold or Heat dysentery, the anus can hurt; one cannot say pain is always due to Heat. To treat this, just treat the dysentery; when dysentery stops, swelling and pain stop, similar to tenesmus. Since Danxi said: "Anal pain is due to heat flowing downward," treated with Mu Xiang, Bing Lang (Areca Seed), Qin (Scutellaria), and Lian (Coptis), he only knew Fire causes swelling/pain, ignoring the sinking of Primordial Yang. Later generations followed this method; those with Deficiency-Cold could hardly endure it. (Zhang Jingyue)
Anal pain in dysentery: one clears it, one warms it. In chronic illness, with cold body and deep/small pulse, warm it; in acute illness, with hot body and floating/excessive pulse, clear it. (*Xin Fa Fu Yu*)
Tenesmus
"Tenesmus" (Li Ji) refers to urgent, cramped pain; "Heaviness" (Hou Zhong) refers to the Large Intestine feeling heavy and descending. Syndromes vary. Due to Fire/Heat: Fire nature is rapid and dries substances. Due to Qi Stagnation: Large Intestine Qi is congested and blocked. Due to Accumulation: Substances knot and weigh down intestines/stomach. Due to Qi Deficiency: Middle Qi sinks and cannot ascend. Due to Blood Deficiency: Fluids dry, intestines parch, false straining. Treatment: Clear Heat, regulate stagnation, remove accumulation, lift Qi Deficiency, tonify Blood Deficiency. (*Jian Wen Lu*)
Heaviness originally stems from pathogens pressing the Large Intestine, preventing ascending and causing heaviness. Using Da Huang (Rhubarb Root) and Bing Lang is to purge the descending pathogens. After long-standing dysentery or purging, if heaviness remains, this is Large Intestine deficiency-slipperiness unable to contract; heavily using Yu Mi Ke (Poppy Shell), He Zi (Chebula Fruit), Wu Bei Zi (Gallnut) and other astringents gathers Qi and secures slipperiness. However, heaviness from pathogen pressing does not decrease after defecation; heaviness from deficiency-slipperiness decreases after defecation; distinguish by this. (Zhu Danxi)
For heaviness due to Qi Deficiency sinking, even using astringents, one must combine with lifting-tonifying herbs. (*Chi Shui Xuan Zhu*)
Tenesmus disease is located at the lowest part of the Broad Intestine (Chang Geng), but its root is not in the Broad Intestine, but in the Spleen and Kidney. It occurs in Heat, Cold, and Deficiency dysentery; it cannot be entirely considered Heat. If Middle Jiao has Heat, Heat pathogens press downward; if Middle Jiao has Cold, Cold pathogens press downward; if Spleen/Kidney Qi is deficient, Qi sinks and presses downward. One should only examine the cause and treat accordingly.