无不愈。然病在广肠，已非食积。盖食积至此，泻则无留，而所留者，惟下陷之气，气本无形，故虽若欲出而
实无所出，无所出而又似欲出，皆气之使然耳。故河间之用芍药汤，谓行血则便脓自愈，调气则后重自除，是
固然矣。然调气之法，如气热者，凉之则调；气寒者，温之则调；气陷者，举之则调。必使气和，乃为调气行
血之法。若但以木香、槟榔、当归、大黄行血散气之属，谓之调和，不知广肠最远，药不易达，而所行所散者，
皆中焦之气耳。且气既下陷，而复行之、散之，则气必更陷，其能愈乎？矧痢止则后重自止，未有痢不愈而后
重能愈者乎？故凡欲治此者，但当以治痢为主。（张景岳）
虚坐努责
凡后重逼迫而得便者，为有物而然。今虚坐努责而不得便，知其血虚也。血虚则里急，宜用当归为君，以
生血药佐之。（李东垣）
脱肛
初起，里急后重脱肛者，此为邪压大肠，气不宣通而脱下也。宜木香导滞汤，内有木香、槟榔调其气，黄
芩清其热，大黄下其滞，归、芍活其血。若已推积调气之后而脱肛者，此为气虚，宜补而升之。痢久气血俱虚，
虚中有寒，滑脱不收者，宜补中加温涩之剂，如真人养脏汤之类。有湿热在大肠，因里急后重而脱肛者，宜清
之，如地榆芍药汤之类。（《赤水玄珠》）
噤口
痢疾不纳食，或汤药入口随即吐出者，俗名噤口。有因邪留，胃气伏而不宣，脾气涩而不布，故呕逆而食
不得入者；有阳气不
足，胃中宿食因之未消，则噫而食卒不下者；有肝乘脾胃，发呕，饮食不入，纵入亦反出者；有水饮所停，气
急而呕，谷不得入者；有火气炎炽，内格呕逆而食不得入者；有胃气虚冷，食入反出者；有胃中邪热，不欲食
者；有脾胃虚弱，不欲食者；有秽积在下，恶气熏蒸而呕逆，食不得入者。当各从其所因以为治。（《证治准绳》）
痢疾不纳饮食，谓之噤口，须以脉证辨之。如脾胃不弱，头疼心烦，手足温热，未尝多服凉药者，此乃毒
气上冲心肺，所以呕而不食，宜用败毒散加陈仓米、姜、枣。若脉微弱，或心腹膨胀，手足厥冷，初病不呕，
因服涩药及寒凉太过，以致闻食先呕者，此乃脾胃虚弱，宜用山药一味，锉如豆大，半炒半生，同为末，饭饮
调下；或参苓白术散亦可。（《永铃类方》）
噤口，虽属脾虚，亦热闭胸膈所致。用木香失之温，山药失之闭，惟参苓白术散加菖蒲，米饮下，胸次一
开，自然思食。（汪 庵）
噤口痢，乃胃中湿热之毒，熏蒸清道，以致胃口闭塞；亦有误服涩热之药，而邪气停于胃口者。用人参、
石莲子等分煎服，虚热即开。黄连苦降，不能开提，非胃虚所宜，不敢取用。（喻嘉言）
石莲子，真者绝无。余常以藕汁煮熟，稍加糖霜频服，兼进陈米稀糜，调其胃气，必效。○久痢不食，
胃气告匮，最为危候。较之初起噤口，尚有浊气可破，积沫未驱者，迥乎不同。非大补胃气，不能开之，宜独
参汤略加陈皮缓缓调补，但得胃气一转，饮食自进。如茯苓之淡渗，木香之耗气，葛根之行津，皆当屏去。（《张氏医通》）
噤口，乃痢疾危候，自古鲜有明辨。观丹溪云∶噤口者，胃口热甚故也。用黄连、人参煎汁，但得一呷，
下咽便好。人不知此，多用温药甘味，以火济火，以滞益滞也。但不知噤口之辨，其义最微，岂皆胃口热甚，
而总以黄连可治乎？盖噤口者，以食
不得入，虽亦有实热证，而惟脾胃虚寒者居多。若因食积胃中者，其胸腹必有胀满，或见硬痛，此当行滞去积，
积滞去而食自入。有因火郁胃中者，其脏腑必多炽热，或脉见洪数，此当泻邪去热，邪热去而食自入。凡此者，
皆以邪蓄于中，乃噤口之实证也。然实证无几，而近之病者，每察其胃口，则多无胀满；察其火邪，则亦非实
热，但见其有出无入，而胃口日穷，精神日败。盖既无胀满，本非积也；又无真热，本非火也。无积无火，而
食不能入，其故何也？以脏气不能容受也。一由脾气之弱，或呕恶吞酸，恶闻食气，而泛泛不安；或饥不能食，
而枵枵待困，此以中焦不运，故食不能入，责在脾也。一由肾气之弱，故命门不能暖，则大肠不能固；小肠不
能化，则胃气不能行，此以下焦失守，而化源无主，责在肾也。欲健中焦，非参、术、干姜、甘草之属不可；
欲实下焦，非熟地、桂、附、吴萸之属不可。脾肾强而食自入。余之活人于此者，不胜纪矣。（张景岳）
口疮
凡痢疾，口里生疮，则肠间亦有疮，犹如伤寒、热病，胃烂，身则发斑也。盖热气内结，则疮生于肠；热
气上冲，则疮生于口。然皆胃之虚热也。胃虚气弱虫动，则变成 。（余迪兹）
呕吐
痢而呕者，胃不和也。有胃火冲逆而呕者；有毒瓦斯上逆而呕者；有胃虚而呕者；有肝旺而呕者。大率久痢
见之为逆。（《证治汇补》）
呃逆
呃逆气从下冲上，属火之象。古人悉以胃弱言之，殊不知胃弱者，阴弱也。滞下之久，多见此证，乃下
多亡阴也。（朱丹溪）
痢疾口渴，多食生冷水果而呃者，理中汤加丁香、柿蒂。血痢呃逆而渴，心烦不得眠，小便不通者，猪苓
汤。白痢呃逆者，五苓散。痢后呃逆者，多属胃气败坏，最为恶候。（《张氏医通》）
休息痢
《活人书》云∶休息痢，经年不愈，缘初起失于通利，致湿热之邪留于冲任之间，久则气血愈陷，清
阳不升，故久远不休，只宜调和气血，培补脾肾为主；若专事消导，非徒无益，而又害之矣。此证冲任虽病，幸
与脾胃无碍，故饮食如常，所以久而不死，慎勿疑于积热未净，不敢用补。盖经年累月，每下皆有脓血，岂热
化为脓可以久延如此乎？总因脏气受伤，以致脂膏不固，随剥随下，若不安养脏气，再以苦寒治痢，荡涤去积，
则脏气日败，必至于死而后已也。（《痢证汇参》）
休息痢者，愈而又复，时作时止，积年累月，不能断根。此因始得之时，不曾推下，或用涩药太早，邪
不尽去，留连于肠胃之间而作者；或痢后肠胃虚弱，复为饮食所伤而作者。当看其轻重，或热、或寒，或消导、
或再为推下，然后以异功散等补剂加收涩之药。（《赤水玄珠》）
痢久，止而复作者，名休息痢。此湿热伏于肠曲之中，最难速止。余用补中益气汤加苓、芍、木香，
多验。（许宣治）
久痢不瘥，津血枯槁，肛门涩滞者，千金羊脂煎润以导之。羊脂，《本经》专主下利脱肛，腹中绞痛，
世罕知用。（《张氏医通》）
桑螵蛸，收摄肾气，久痢不止，用之甚妙。（余迪兹）
久痢滑泄不禁，用芦稷米涩之。白痢用白，红痢用赤。（《见闻录》）
冷积致痢，其积日久，渐次下坠，竟至大肠下口直肠上口交界之处，有小曲折隐匿于此，为肠脏最深之
处，药所不到之地。
证则乍轻乍重，或愈或发；便则乍红乍白，或硬或溏，总无一定，任是神丹，分毫无济。盖此积不在腹内，而
在大肠之下，诸药至此，性力已过，尽成糠 ，安能去此沉匿之积？所以多年不愈者，由此故也。古方用巴豆
丸下之，第恐久病正虚，未敢轻用，今以鸦胆子一味治之，至捷至当。（《幼幼集成》）
疫痢
夏秋疫痢，乃是疫毒致病，天灾流行，古人败毒散最妙。乙酉夏秋多雨，后发疫痢，恶寒身痛，发热呕吐，
病形相似，服寒药多有变证。余酌其方，表证甚者，用败毒散，佐以苍、朴；胸次不宽，里证甚者，用平胃散，
佐以羌、独、柴胡，随手取效。此系寒湿之邪，伤人肌表，侵入肠胃，而成疫痢也。丁卯夏秋亢旱，沿门阖境，
下痢赤积，腹痛频作，肛门如火，积滞难出，服香连丸痢势反加，因悟燥火伤血，另制当归大黄汤，清血分之
燥火，应若桴鼓。此系燥火之邪，伤人口鼻，直入肠胃，而成疫痢也。（秦皇士）
痢疾一证，非六淫之邪所感，瓜果生冷所伤，而后始有此患也。尝观古法，相传谓炎暑大行，相火司令，
酷热蓄积为痢，医家皆宗其说，不知暑乃六淫之一，中暑而发热者有之，受暑而发疟者有之，与痢证毫无关涉。
夫痢证，即疫中浊邪中下，名曰浑者是也。邪毒入胃脘之上焦，则浮越于肌表而恶寒发热；邪毒中胃脘之下焦，
而走入大小肠，则剥脂膏之脓血而后重里急。邪毒在肌表，由三阳而传入三阴，入里杀人；邪毒在肠脏，致恶
饮食而败脾胃，绝谷杀人。若下痢而兼寒热者，杀人尤速。盖天地不正之杂气，种种不一，而痢证疾速，亦杂
气所钟。一人病此，人人亦病此，始也感受于天，继也传染于人，其为气所感召，已明验矣。且《经》云∶
“夏伤于暑，秋为 疟。”未见传染也。“因于暑，汗，烦则喘喝，静则多言。”未见传染也。“脉虚身热，
得之伤暑。”未见传染也。而痢疾之传染，益信暑热之无与。况杂气所着
无方，所发无定，而暑热则每岁之所必有，瓜果每夏之所必熟，何值此痢疾不发之年，虽暑热酷烈，瓜果多食，
卒未见滞下而广行耶？如此则不辨自明，而余谓疫邪作痢之说，亦不为无据矣。此证初治，宜用黄金汤，解疫
毒而救胃气；继用四君汤，扶脾土而补元气；久则用八味加参汤，补真元而生土气。即体实受邪，于黄金汤中
加黄连一味，无不捷应。若证见脓血切肤，少腹必急痛也；赤白刮下脂膏，有浅深也；里急后重，或寒或热而
下迫，或气虚而下陷也；口渴引饮，或液少而亡阴，或胃热而火炽也。第疫气之来，有一无二，而人生禀赋不
齐，虚实寒热各异。体虚受邪，则为虚痢；体实受邪，则为实痢；体寒受邪，则为寒痢；体热受邪，则为热痢。
只缘医者误认瓜果暑热之利害，不明疫邪入肠之伤人，岂知疫痢之恶，能绝人之谷，剥人之脂，损人之脾，伤
人之胃，耗人之气血。正气为邪毒败坏如是，而医尚 于香连，切切于承气，技穷病毙，莫可如何也矣。（《会心录》）
血痢
热痢下血者，宜凉血活血；风邪下陷者宜升提之；湿热伤血者，宜利湿清热。○血痢久不愈者，属阳虚
阴脱，用八珍汤加升举之药。甚有阵阵自下，手足厥冷，脉渐微缩，此元气欲绝，急灸气海，用附子理中汤，
稍迟则死。（喻嘉言）
血色鲜红者，此属热痢，宜黄连阿胶汤，或白头翁汤。○血色如瘀，服凉药而下愈多者，当作冷痢治，宜
理中汤，或四君子汤加肉果、木香。（《证治准绳》）
古谓下痢纯血者死，此亦要看兼证，及以脉参之，未必尽死。予尝治数人皆生，方用佛手散，加阿胶、
秦皮、炮姜、地黄、黄连、地榆、蒲黄之类；或以四物汤择前所加药一、二味增入，不可纯用寒凉。（《赤水玄珠》）
地榆，性沉苦寒，热痢下血可用，虚寒下痢不可用。（《本草衍义》）
血痢色如猪肝、如紫草、如苋菜汁者，非炮姜不验。（《张氏医通》）
泻后痢
先泻后痢，曰脾传肾，为贼邪，难愈；先痢后泻，曰肾传脾，为微邪，易医。千古不易法也。以余论之，
泻为在脾固矣，而痢在肾，不能无议。泻固多由于饮食所伤，而痢独非饮食所伤乎？饮食停滞，湿热不化，遂
成稠浊，胶于肠胃，欲下不下，后重里急，明是脾病也，而以痢属肾，何谓欤？未闻饮食之入，不由于脾而由
于肾也；既云肾病，治痢常用苍术、浓朴、黄连、木香、陈皮、白术之属，鲜有用杜仲、牛膝、熟地者，以治
肾家之病而乃用脾家之药，其非肾病可知。要知先泻后痢而难愈者，因其脾土先坏，而积滞方壅也，岂脾传肾
之谓耶？先痢后泻之易愈者，以其积滞已尽，而脾尚虚也，岂肾传脾之谓耶？盖肾但能藏精，不能藏饮食，若
痢属肾，则饮食皆藏肾矣，岂理也哉！盖久痢者肾必虚，未有初痢而肾即虚者。（《证治准绳》）
疟后痢
世有疟后痢者，亦有痢后疟者。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，下多则亡阴，气又随痢散，阴阳两虚，阳虚则恶寒，阴虚则发热，故寒热
交战，似疟非疟也。皆当以虚论，俱用补中益气汤加温补药，其病自愈。（《赵氏医贯》）
蛲虫痢
蛲虫痢，得于胃弱脾虚，湿热郁遏化虫从谷道中出而痒。治宜乌梅丸、黄连犀角散；虫尽，再用六君子汤
加黄连、乌梅调补脾胃，兼清湿热。若一味攻虫，愈攻愈剧，漫无止期。（《张氏医通》）
败证
下痢纯血者，死；如尘腐色者，死；如屋漏水者，死；如鱼脑、如猪肝者，半死半生；气短呃逆者，死；
唇若涂朱者，死；大孔
如竹筒者，死；身热脉弦者，半生半死；直肠自下者，死；久痢忽大下结粪者，死。小儿出痘，痢者死；妇人
新产，痢者亦死。（《证治汇补》）
身热不止，口噤不食者死；久痢脉代结，反骤能食者，名曰除中，必死。（《张氏医通》）
痢疾，渴而思酒不治；呕甚作哕不治；呕出长虫亦不治。（许宣治）
脉候
诸痢疾，脉流连细小者生，浮数洪大者死。（《仁斋直指》）
无不治愈。然而病位在广肠（大肠末端），已不是食积所致。因为食物积滞到了这里，通过泻下就不会有残留，而所滞留的，只是下陷的气机。气本来是没有形体的，所以虽然感觉想要排出，但实际上并没有实质内容可排；没有东西可排却又感觉想排，这都是气机作用的结果。所以刘河间使用芍药汤，说“行血则便脓自愈，调气则后重自除”，这固然正确。但是调气的方法，如果气热，用凉法来调；气寒，用温法来调；气陷，用升提法来调。必须使气机调和，这才是调气行血的方法。如果仅仅用木香、槟榔、当归、大黄等行血散气的药物，称之为调和，却不知道广肠位置最远，药物不易到达，而且所行所散的，都是中焦的气机罢了。况且气已经下陷，如果再加以行散，气机必定更加下陷，怎么能治愈呢？况且痢疾停止后，里急后重自然也会停止，哪有痢疾不愈而里急后重能痊愈的道理呢？所以凡是想要治疗这种情况的人，应当以治疗痢疾为主。（张景岳）
虚坐努责
凡是里急后重逼迫感强烈且能排便的，是因为有实物阻滞。现在虚坐努责却排不出大便，可知是血虚所致。血虚会导致里急，适宜用当归作为主药，配合生血药物辅助治疗。（李东垣）
脱肛
初起时，出现里急后重并伴有脱肛的，这是因为邪气压迫大肠，气机不通畅而导致脱出。适宜用木香导滞汤，方中含有木香、槟榔调理气机，黄芩清解热邪，大黄攻下积滞，当归、白芍活血。如果在推荡积滞、调理气机之后仍然脱肛的，这是气虚所致，适宜用补益和升提的方法。痢疾日久导致气血两虚，虚中有寒，滑脱不能收敛的，适宜在补益中加入温涩的药物，如真人养脏汤之类。有大肠湿热，因里急后重而导致脱肛的，适宜清利湿热，如地榆芍药汤之类。（《赤水玄珠》）
噤口
痢疾患者不能进食，或者汤药入口随即吐出的，俗名叫噤口痢。有的因为邪气留滞，胃气郁伏而不能宣通，脾气涩滞而不能布散，所以呕吐逆乱而食物无法进入；有的因为阳气不足，胃中宿食因此未能消化，所以打嗝而食物突然无法下行；有的因为肝气乘犯脾胃，引发呕吐，饮食无法进入，即使进入也会反吐出来；有的因为水饮停聚，气急而呕吐，谷物无法进入；有的因为火气炎炽，内格呕逆而食物无法进入；有的因为胃气虚冷，食物进入反而吐出；有的因为胃中邪热，不想吃东西；有的因为脾胃虚弱，不想吃东西；有的因为秽浊积滞在下方，恶气熏蒸而呕吐逆乱，食物无法进入。应当根据各自的原因进行治疗。（《证治准绳》）
痢疾患者不能纳受饮食，称为噤口痢，必须通过脉象和症状来辨别。如果脾胃不弱，头痛心烦，手足温热，未曾大量服用凉药的，这是毒气上冲心肺，所以呕吐而不进食，适宜用败毒散加陈仓米、生姜、大枣。如果脉象微弱，或者心腹胀满，手足厥冷，初病时不呕吐，因为服用收涩药及寒凉药太过，以致闻到食物就呕吐的，这是脾胃虚弱，适宜单用山药一味，锉成豆粒大小，一半炒一半生，磨成粉末，用饭饮调服；或者参苓白术散也可以。（《永铃类方》）
噤口痢，虽然属于脾虚，也是热邪闭阻胸膈所致。用木香则过于温燥，用山药则过于滋腻闭塞，只有参苓白术散加石菖蒲，用米饮送服，胸中气机一开，自然会想吃东西。（汪昂）
噤口痢，是胃中湿热之毒，熏蒸清道，导致胃口闭塞；也有误服收涩热药，导致邪气停留在胃口的情况。用人参、石莲子各等分煎服，虚热即可开通。黄连苦降，不能开提，不适合胃虚的情况，不敢选用。（喻嘉言）
石莲子，真正的极少见。我常用藕汁煮熟，稍加糖霜频繁服用，同时进服陈米稀粥，调理胃气，必定有效。○久痢不进食，胃气告急，是最为危重的证候。比起初起噤口痢，那时还有浊气可以破除，积沫未驱赶的情况，截然不同。如果不大补胃气，就不能开通，适宜独参汤略加陈皮缓缓调补，只要胃气一转，饮食自然能进。像茯苓的淡渗，木香的耗气，葛根的行津，都应当摒弃不用。（《张氏医通》）
噤口痢，是痢疾的危重证候，自古以来很少有明确辨别的。看丹溪说：噤口痢，是胃口热甚的缘故。用黄连、人参煎汁，只要喝一口，咽下去就好了。人们不知道这个道理，多用温药甘味，以火济火，以滞益滞。只是不知道噤口痢的辨别，其含义最为微妙，难道都是胃口热甚，总可以用黄连治疗吗？大概噤口痢，因为食物不能进入，虽然有实热证，但多数是脾胃虚寒。如果是因为食积在胃中，胸腹必然有胀满，或者出现硬痛，这应当行滞去积，积滞去除而食物自然能入。有因为火郁在胃中的，脏腑必然多炽热，或者脉象洪数，这应当泻邪去热，邪热去除而食物自然能入。凡此种种，都是因为邪气蓄积在中焦，是噤口痢的实证。然而实证很少，近来的病人，往往观察其胃口，大多没有胀满；观察其火邪，也不是实热，只见到有出无入，而胃口日渐枯竭，精神日渐衰败。既然没有胀满，本来就不是积滞；又没有真热，本来就不是火邪。无积无火，而食物不能进入，原因是什么呢？是因为脏气不能容受。一种是由于脾气虚弱，或者呕吐恶心吞酸，厌恶闻见食气，而感到泛泛不安；或者饥饿却不能进食，空腹等待困倦，这是因为中焦不运化，所以食物不能进入，责任在脾。一种是由于肾气虚弱，命门不能温暖，则大肠不能固摄；小肠不能腐熟，则胃气不能运行，这是因为下焦失守，而化源无主，责任在肾。想要健运中焦，非人参、白术、干姜、甘草这类药物不可；想要充实下焦，非熟地黄、肉桂、附子、吴茱萸这类药物不可。脾肾强健而食物自然能入。我靠这个方法救活的人，不胜枚举。（张景岳）
口疮
凡是痢疾，嘴里生疮，那么肠间也有疮，就像伤寒、热病，胃烂，身体就会发斑一样。热气内结，疮就生在肠中；热气上冲，疮就生在口中。然而这都是胃的虚热所致。胃虚气弱，虫动，则变成……（余迪兹）
呕吐
痢疾伴随呕吐的，是胃不和。有胃火冲逆而呕吐的；有毒瓦斯上逆而呕吐的；有胃虚而呕吐的；有肝旺而呕吐的。大体上久痢出现呕吐是逆证。（《证治汇补》）
呃逆
呃逆气从下向上冲，属于火的征象。古人全都说是胃弱，殊不知胃弱，是指阴弱。滞下（痢疾）日久，多见此证，是因为下利多亡阴所致。（朱丹溪）
痢疾口渴，多吃生冷水果而引发呃逆的，用理中汤加丁香、柿蒂。血痢呃逆而口渴，心烦不得眠，小便不通的，用猪苓汤。白痢呃逆的，用五苓散。痢后呃逆的，多属胃气败坏，是最为凶险的证候。（《张氏医通》）
休息痢
《活人书》说：休息痢，经年不愈，是因为初起时失于通利，导致湿热之邪留于冲任之间，久了则气血更加下陷，清阳不升，所以久远不休，只适宜调和气血，培补脾肾为主；如果专门从事消导，不仅无益，反而有害。这个证候冲任虽病，幸好与脾胃无碍，所以饮食如常，因此长久不死，千万不要怀疑积热未净，不敢用补药。毕竟经年累月，每次排便都有脓血，难道是热化为脓可以长久延续如此吗？总因脏气受伤，导致脂膏不固，随剥随下，如果不安养脏气，再用苦寒治痢，荡涤去积，那么脏气日渐败坏，必定到死方休。（《痢证汇参》）
休息痢，好了又复发，时作时止，积年累月，不能断根。这是因为刚开始得病时，不曾推荡积滞，或者过早使用收涩药，邪气未尽去，留连于肠胃之间而发作的；或者痢疾后肠胃虚弱，又被饮食所伤而发作的。应当看其轻重，或热、或寒，或消导、或再次推荡积滞，然后用异功散等补剂加入收涩药物。（《赤水玄珠》）
痢疾日久，停止后又复发的，名叫休息痢。这是湿热伏于肠曲之中，最难迅速止住。我用补中益气汤加茯苓、白芍、木香，多次验证有效。（许宣治）
久痢不愈，津血枯槁，肛门涩滞的，用千金羊脂煎润肠导便。羊脂，《本经》专门主治下利脱肛，腹中绞痛，世人很少知道使用。（《张氏医通》）
久痢滑泄不禁，用芦稷米（高粱米）涩肠止泻。白痢用白米，红痢用赤米。（《见闻录》）
冷积导致痢疾，其积滞日久，渐渐下坠，竟至大肠下口直肠上口交界之处，有小曲折隐匿在此，为肠脏最深之处，药物到达不了的地方。
症状则忽轻忽重，或者痊愈或者发作；大便则忽红忽白，或者干硬或者稀溏，总没有一定规律，即使是神丹妙药，也分毫无效。因为这个积滞不在腹内，而在大肠之下，诸药到达这里，药性力量已经过去，全成了糠糟，怎么能去掉这种沉匿的积滞？所以多年不愈，就是这个缘故。古方用巴豆丸攻下它，只恐怕久病正气虚弱，不敢轻易使用，现在用鸦胆子一味药物治疗，极为快捷恰当。（《幼幼集成》）
疫痢
夏秋季节的疫痢，是疫毒致病，天灾流行，古人用的败毒散最妙。乙酉年夏秋多雨，后来发生疫痢，恶寒身痛，发热呕吐，病形相似，服用寒药多有变证。我斟酌其方，表证严重的，用败毒散，佐以苍术、厚朴；胸次不宽，里证严重的，用平胃散，佐以羌活、独活、柴胡，随手取效。这是寒湿之邪，伤人肌表，侵入肠胃，而成疫痢。丁卯年夏秋亢旱，沿门阖境，下痢赤积，腹痛频作，肛门如火，积滞难出，服用香连丸痢势反而加重，于是悟到燥火伤血，另外配制当归大黄汤，清血分之燥火，应验如鼓。这是燥火之邪，伤人人口鼻，直入肠胃，而成疫痢。（秦皇士）
痢疾这一证候，并非六淫之邪所感，瓜果生冷所伤，而后才产生这种祸患。曾经观察古法，相传谓炎暑大行，相火司令，酷热蓄积为痢，医家都遵循这一说法，不知道暑乃六淫之一，中暑而发热的有之，受暑而发疟疾的有之，与痢证毫无关系。夫痢证，就是疫中浊邪中下，名叫浑者是也。邪毒入胃脘之上焦，则浮越于肌表而恶寒发热；邪毒中胃脘之下焦，而走入大小肠，则剥脂膏之脓血而后重里急。邪毒在肌表，由三阳而传入三阴，入里杀人；邪毒在肠脏，致恶饮食而败脾胃，绝谷杀人。如果下痢而兼寒热的，杀人尤其迅速。盖天地不正之杂气，种种不一，而痢证疾速，也是杂气所钟。一人病此，人人亦病此，开始感受于天，接着传染于人，其为气所感召，已有明证。且《内经》说：“夏伤于暑，秋为疟。”未见传染。“因于暑，汗，烦则喘喝，静则多言。”未见传染。“脉虚身热，得之伤暑。”未见传染。而痢疾的传染，更相信暑热与之无关。何况杂气所着无方，所发无定，而暑热则是每年所必有，瓜果每夏之所必熟，何值此痢疾不发之年，虽然暑热酷烈，瓜果多食，最终未见滞下而广泛流行耶？如此则不辨自明，而我谓疫邪作痢的说法，也不是没有依据的。此证初治，适宜用黄金汤，解疫毒而救胃气；继用四君汤，扶脾土而补元气；久则用八味加参汤，补真元而生土气。即使体质强壮受邪，于黄金汤中加黄连一味，无不捷应。如果证见脓血切肤，少腹必然急痛；赤白刮下脂膏，有浅深之分；里急后重，或寒或热而下迫，或气虚而下陷；口渴引饮，或液少而亡阴，或胃热而火炽。只是疫气之来，有一无二，而人生禀赋不齐，虚实寒热各异。体虚受邪，则为虚痢；体实受邪，则为实痢；体寒受邪，则为寒痢；体热受邪，则为热痢。只缘医者误认瓜果暑热之利害，不明疫邪入肠之伤人，岂知疫痢之恶，能绝人之谷，剥人之脂，损人之脾，伤人之胃，耗人之气血。正气为邪毒败坏如是，而医尚局限于香连丸，切切于承气汤，技穷病毙，莫可如何也矣。（《会心录》）
血痢
热痢下血的，适宜凉血活血；风邪下陷的适宜升提；湿热伤血的，适宜利湿清热。○血痢久不愈的，属阳虚阴脱，用八珍汤加升举药物。甚至有阵阵自下，手足厥冷，脉渐微缩，这是元气欲绝，急灸气海穴，用附子理中汤，稍迟则死。（喻嘉言）
血色鲜红的，这属热痢，适宜黄连阿胶汤，或白头翁汤。○血色如瘀血，服用凉药而下血更多的，当作冷痢治疗，适宜理中汤，或四君子汤加肉果、木香。（《证治准绳》）
古时候说下痢纯血者死，这也需看兼证，并以脉象参合，未必尽死。我曾治疗数人都活了，方用佛手散，加阿胶、秦皮、炮姜、地黄、黄连、地榆、蒲黄之类；或者用四物汤选择前面所加的一、二味药增入，不可纯用寒凉。（《赤水玄珠》）
地榆，性沉苦寒，热痢下血可用，虚寒下痢不可用。（《本草衍义》）
血痢色如猪肝、如紫草、如苋菜汁的，非炮姜不验。（《张氏医通》）
泻后痢
先泻后痢，叫脾传肾，为贼邪，难愈；先痢后泻，叫肾传脾，为微邪，易医。千古不易之法。依我而论，泻为在脾固然，而痢在肾，不能没有异议。泻固多由于饮食所伤，而痢独非饮食所伤乎？饮食停滞，湿热不化，遂成稠浊，胶于肠胃，欲下不下，后重里急，明明是脾病，而以痢属肾，怎么说呢？没听说过饮食的进入，不由于脾而由于肾的；既云肾病，治痢常用苍术、浓朴、黄连、木香、陈皮、白术之类，很少有用杜仲、牛膝、熟地的，以治肾家的病而乃用脾家的药，其非肾病可知。要知道先泻后痢而难愈的，是因为脾土先坏，而积滞方壅塞，岂是脾传肾之说？先痢后泻之易愈的，是因为积滞已尽，而脾尚虚，岂是肾传脾之说？盖肾只能藏精，不能藏饮食，若痢属肾，则饮食皆藏肾了，岂有理哉！盖久痢者肾必虚，未有初痢而肾即虚的。（《证治准绳》）
疟后痢
世间有疟后痢的，也有痢后疟的。既然是疟后，发泄已尽，必无暑热之毒，复为痢疾，这是元气下陷，脾气不能升举，似痢非痢。既然是痢后，下多则亡阴，气又随痢散，阴阳两虚，阳虚则恶寒，阴虚则发热，故寒热交战，似疟非疟。都应当以虚证论治，俱用补中益气汤加温补药，其病自愈。（《赵氏医贯》）
蛲虫痢
蛲虫痢，得于胃弱脾虚，湿热郁遏化虫从谷道中出而痒。治疗适宜乌梅丸、黄连犀角散；虫尽，再用六君子汤加黄连、乌梅调补脾胃，兼清湿热。如果一味攻虫，愈攻愈剧，漫无止期。（《张氏医通》）
败证
下痢纯血的，死；如尘腐色的，死；如屋漏水的，死；如鱼脑、如猪肝的，半死半生；气短呃逆的，死；唇若涂朱的，死；大孔如竹筒的，死；身热脉弦的，半生半死；直肠自下的，死；久痢忽然大下结粪的，死。小儿出痘，痢的，死；妇人新产，痢的，也死。（《证治汇补》）
身热不止，口噤不食的，死；久痢脉代结，反骤能食的，名叫除中，必死。（《张氏医通》）
No case was not cured. However, when the disease is located in the large intestine (the distal part of the large intestine), it is no longer caused by food retention. Because if food retention reaches this point, it would be expelled without residue through diarrhea; what remains is only the Qi sinking downward. Qi is inherently formless, so although there is a sensation of wanting to defecate, there is actually nothing to pass; the feeling of wanting to pass despite having nothing to pass is all due to the movement of Qi. Therefore, Liu Hejian's use of Shaoyao Tang, stating that "moving blood will heal dysenteric pus, and regulating Qi will relieve tenesmus," is indeed correct. However, the method of regulating Qi involves: if Qi is hot, cooling it regulates it; if Qi is cold, warming it regulates it; if Qi is sinking, lifting it regulates it. Only when Qi is harmonized can one speak of the method of regulating Qi and moving blood. If one merely uses herbs like Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Danggui (Angelicae Sinensis Radix), and Dahuang (Rhei Radix et Rhizoma) to move blood and disperse Qi, calling this "harmonization," they fail to realize that the large intestine is located far away, making it difficult for medicine to reach, and what is being moved and dispersed are merely the Qi of the Middle Jiao. Moreover, since Qi has already sunk, further dispersing it will cause Qi to sink even more; how can this cure the disease? Furthermore, once dysentery stops, tenesmus naturally ceases; is there any case where tenesmus heals while dysentery persists? Therefore, anyone wishing to treat this condition should focus primarily on treating dysentery. (Zhang Jingyue)
Deficient Sitting with Straining
When tenesmus is severe and accompanied by defecation, it is due to the presence of physical matter. Now, if there is deficient sitting with straining but no stool is passed, it indicates Blood deficiency. Blood deficiency leads to tenesmus; it is appropriate to use Danggui (Angelicae Sinensis Radix) as the sovereign herb, assisted by herbs that generate Blood. (Li Dongyuan)
Rectal Prolapse
In the early stage, if tenesmus is accompanied by rectal prolapse, this is because pathogenic factors compress the large intestine, causing Qi stagnation and subsequent prolapse. It is appropriate to use Muxiang Daoshi Tang (Aucklandia Decoction for Directing Stagnation), which contains Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen) to regulate Qi, Huangqin (Scutellariae Radix) to clear heat, Dahuang (Rhei Radix et Rhizoma) to purge stagnation, and Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) to invigorate Blood. If rectal prolapse occurs after pushing out stagnation and regulating Qi, this is due to Qi deficiency, and it is appropriate to use tonification and lifting methods. In chronic dysentery leading to dual deficiency of Qi and Blood, with cold within deficiency and sliding inability to consolidate, it is appropriate to add warming and astringent agents to tonification, such as Zhenren Yangzang Tang (True Man's Decoction for Nourishing the Viscera). If damp-heat exists in the large intestine causing prolapse due to tenesmus, it is appropriate to clear and drain damp-heat, such as using Diyü Shaoyao Tang (Sanguisorba and Peony Decoction). (Shuichixuanzhu)
Jinkou Li (Dysentery with Inability to Eat)
When a patient with dysentery cannot eat, or vomits immediately after swallowing liquids or medicines, it is commonly known as Jinkou Li (Dysentery with Inability to Eat). Some cases are due to pathogenic retention causing Stomach Qi to be stagnant and unable to diffuse, and Spleen Qi to be obstructed and unable to distribute, resulting in vomiting and inability to ingest food. Some cases are due to insufficient Yang Qi, causing retained food in the Stomach to remain undigested, leading to belching and sudden inability to swallow food. Some cases are due to Liver Qi invading the Spleen and Stomach, causing vomiting and inability to ingest food, or regurgitation even if ingested. Some cases are due to fluid retention causing Qi urgency and vomiting, preventing grain intake. Some cases are due to blazing Fire causing internal obstruction, vomiting, and inability to ingest food. Some cases are due to deficient-cold Stomach Qi, causing food to be regurgitated after ingestion. Some cases are due to pathogenic heat in the Stomach causing loss of appetite. Some cases are due to Spleen and Stomach weakness causing loss of appetite. Some cases are due to foul accumulation in the lower jiao, with malignant Qi steaming upward causing vomiting and inability to ingest food. Treatment should be based on the specific cause. (Zhengzhi Zhunsheng)
Dysentery patients who cannot retain food or drink are called Jinkou Li; differentiation must be made based on pulse and symptoms. If the Spleen and Stomach are not weak, and the patient has headache, irritability, warm hands and feet, and has not taken excessive cooling medicines, this is toxic Qi rushing up to the Heart and Lungs, causing vomiting and anorexia; it is appropriate to use Baidu San (Decoction for Resisting Toxins) added with Chen Cangmi (aged rice), Shengjiang (Fresh Ginger), and Dazao (Jujube). If the pulse is weak or faint, or there is abdominal distension, cold hands and feet, no initial vomiting, but vomiting at the smell of food due to excessive use of astringents and cold medicines, this is Spleen and Stomach deficiency; it is appropriate to use single-shan Yao (Dioscoreae Rhizoma), cut into bean-sized pieces, half fried and half raw, ground into powder, and taken with rice water; or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) may also be used. (Yongling Leifang)
Jinkou Li, although belonging to Spleen deficiency, is also caused by Heat closing the chest and diaphragm. Using Muxiang (Aucklandiae Radix) is too warming, and using Shan Yao (Dioscoreae Rhizoma) is too cloying and obstructive; only Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) added with Shichangpu (Acori Tatarinowii Rhizoma), taken with rice water, opens the chest, and appetite returns naturally. (Wang Ang)
Jinkou Li is caused by damp-heat toxin in the Stomach steaming the clear pathways, blocking the gastric opening; it can also result from mistakenly taking astringent-hot medicines, causing pathogenic factors to stay at the gastric opening. Taking equal parts of Renshen (Ginseng Radix) and Shilianzi (Nelumbinis Semen) decocted and taken orally will open the deficient heat. Huanglian (Coptidis Rhizoma) is bitter and descending, unable to lift and open, and is not suitable for Stomach deficiency; thus, I dare not use it. (Yu Jiayan)
True Shilianzi (Nelumbinis Semen) is extremely rare. I often use lotus root juice boiled, with a little sugar added, taken frequently, along with aged rice congee to regulate Stomach Qi; this is invariably effective. ○ Chronic dysentery with anorexia indicates exhaustion of Stomach Qi, which is a critical condition. It is completely different from initial Jinkou Li, where turbid Qi could still be broken down and accumulated phlegm-fluids driven out. Without greatly tonifying Stomach Qi, it cannot be opened; it is appropriate to use Dushen Tang (Single Ginseng Decoction) with a little Chenpi (Citri Reticulatae Pericarpium) for slow tonification. Once Stomach Qi turns, food intake resumes naturally. Herbs like Fuling (Poria), which is light and leaching; Muxiang (Aucklandiae Radix), which consumes Qi; and Gegen (Puerariae Lobatae Radix), which moves fluids, should all be discarded. (Zhangshi Yitong)
Jinkou Li is a critical sign of dysentery, rarely clearly differentiated since ancient times. Looking at Danxi's statement: Jinkou Li is due to extreme heat in the stomach opening. Using Huanglian (Coptidis Rhizoma) and Renshen (Ginseng Radix) decocted, just one sip swallowed brings improvement. People do not understand this, often using warm and sweet medicines, adding fire to fire and stagnation to stagnation. They do not know that the differentiation of Jinkou Li is subtle; is it always extreme heat in the stomach opening, treatable solely with Huanglian (Coptidis Rhizoma)? Generally, Jinkou Li, characterized by inability to eat, although there are excess heat patterns, is mostly due to Spleen and Stomach deficiency-cold. If due to food retention in the Stomach, the chest and abdomen must be distended, or hard and painful; this requires moving stagnation and removing retention, after which food intake resumes. If due to Fire depression in the Stomach, the viscera must be excessively hot, or the pulse surging and rapid; this requires purging pathogenic factors and clearing heat, after which food intake resumes. All these are excess patterns of Jinkou Li due to pathogenic accumulation in the middle jiao. However, excess patterns are few; recent patients often show no abdominal distension upon examination of the stomach opening, nor true heat signs. They only exhibit output without input, with the stomach opening daily exhausted and spirit daily declining. Since there is no distension, it is not retention; since there is no true heat, it is not Fire. With no retention and no Fire, why can food not enter? It is because the visceral Qi cannot accept it. One cause is weak Spleen Qi, leading to vomiting, nausea, acid regurgitation, aversion to food smells, and uneasiness; or hunger without ability to eat, waiting in emptiness for fatigue. This is due to Middle Jiao failure to transport, so food cannot enter; the responsibility lies with the Spleen. Another cause is weak Kidney Qi, so the Gate of Life cannot warm, causing the Large Intestine to fail to secure; the Small Intestine fails to transform, causing Stomach Qi to fail to move. This is due to Lower Jiao failure to hold, with the source of transformation lacking mastery; the responsibility lies with the Kidney. To strengthen the Middle Jiao, herbs like Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) are indispensable; to solidify the Lower Jiao, herbs like Shudihuang (Rehmanniae Radix Praeparata), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), and Wuyu (Evodiae Fructus) are indispensable. When Spleen and Kidney are strong, food intake resumes naturally. The number of people I have saved using this method is countless. (Zhang Jingyue)
Mouth Sores
Whenever dysentery occurs with mouth sores, there are also sores in the intestines, similar to Shanghan (Cold Damage) or febrile diseases where Stomach rot causes skin macules. Internal binding of Heat causes sores in the intestines; upward rushing of Heat causes sores in the mouth. However, these are all due to deficient Heat in the Stomach. When Stomach Qi is deficient and weak, worms move, transforming into... (Yu Dizhi)
Vomiting
Dysentery accompanied by vomiting indicates Disharmony of the Stomach. There are cases of vomiting due to Stomach Fire rushing upward; cases of vomiting due to toxic gases rushing upward; cases of vomiting due to Stomach deficiency; and cases of vomiting due to Liver hyperactivity. Generally, vomiting appearing in chronic dysentery is a adverse sign. (Zhengzhi Huibu)
Hiccups
Hiccups involve Qi rushing upward from below, indicating a Fire pattern. Ancients attributed this entirely to weak Stomach, not realizing that weak Stomach refers to Yin deficiency. Chronic dysentery often presents this syndrome, resulting from excessive downward discharge depleting Yin. (Zhu Danxi)
For dysentery with thirst, hiccups induced by excessive consumption of raw/cold fruits: Lizhong Tang (Regulate the Middle Decoction) added with Dingxiang (Caryophylli Flos) and Shidi (Diospyros Fructus). For bloody dysentery with hiccups, thirst, irritability, insomnia, and urinary difficulty: Zhuling Tang (Polyporus Decoction). For white dysentery with hiccups: Wuling San (Five-Ingredient Powder with Poria). Hiccups after dysentery usually indicate destruction of Stomach Qi, which is a very ominous sign. (Zhangshi Yitong)
Xiuxi Li (Intermittent Dysentery)
The Huoren Shu states: Intermittent dysentery, lasting years without cure, occurs because initial treatment failed to promote free flow, allowing damp-heat pathogens to remain between the Chong and Ren vessels. Over time, Qi and Blood sink further, Clear Yang fails to ascend, hence the prolonged persistence. Treatment should focus on harmonizing Qi and Blood, and tonifying Spleen and Kidney; focusing solely on digestion-promoting methods is not only ineffective but harmful. Although the Chong and Ren vessels are involved, fortunately the Spleen and Stomach are unaffected, so diet remains normal, allowing survival for long periods. Do not hesitate to use tonics due to suspicion of residual heat-toxin. After all, months of passing pus and blood—can heat turning into pus last this long? It is fundamentally due to damage to visceral Qi, causing the intestinal lining (fat/grease) to become unstable and shed continuously. If one does not nourish the visceral Qi but instead uses bitter-cold dysentery treatments to scour and remove accumulation, visceral Qi will decline daily until death ensues. (Lizheng Huican)
Intermittent dysentery recurs after remission, occurring intermittently over years without eradication. This is because initially, purgation was not performed, or astringents were used too early, leaving pathogenic factors lingering in the intestines; or because post-dysentery intestinal weakness was re-injured by diet. Treatment depends on severity: whether heat or cold, whether to promote digestion or purge again, followed by tonics like Yigong San (Extraordinary Efficacy Powder) combined with astringents. (Shuichixuanzhu)
Chronic dysentery that stops and then recurs is named Xiuxi Li (Intermittent Dysentery). This is damp-heat hiding in the intestinal curves, hardest to stop quickly. I use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria), Shaoyao (Paeoniae Radix), and Muxiang (Aucklandiae Radix); it has proven effective many times. (Xu Xuanzhi)
For chronic dysentery unhealed, with dryness and depletion of fluids and Blood, and sticky anus: Qianjin Yangzhi Jian (Thousand Gold Mutton Fat Decoction) moistens and guides. Yangzhi (Mutton Fat) is specified in Benjing for treating diarrhea, rectal prolapse, and abdominal colic, yet rarely used today. (Zhangshi Yitong)
Sangpiaoxiao (Mantis Egg Case) secures Kidney Qi; it is excellent for chronic dysentery that does not stop. (Yu Dizhi)
For chronic dysentery with slippery incontinence, use Luji Mi (Sorghum Grain) to astringe. Use white grain for white dysentery, red grain for red dysentery. (Jianwenlu)
Cold accumulation causing dysentery, where the accumulation has been present for a long time, gradually sinks to the junction of the lower large intestine and upper rectum, a hidden fold in the deepest part of the intestines, unreachable by medicine.
Symptoms fluctuate in severity or recurrence; stools vary between red/white, hard/loose, with no fixed pattern. Even divine medicines offer no help. Because this accumulation is not in the abdomen but below the large intestine, where drug potency dissipates before reaching it, becoming useless chaff, how can it remove such deep-seated accumulation? This is why it persists for years. Ancient formulas used Badou Wan (Croton Pill) to purge it, but fearing deficiency in chronic illness, I dared not use it lightly. Now, using Yadanszi (Brucea Fructus) alone treats it swiftly and appropriately. (Youyou Jicheng)
Yi Li (Epidemic Dysentery)
Summer-autumn epidemic dysentery is caused by epidemic toxins, a natural disaster. The ancients' Baidu San (Decoction for Resisting Toxins) was best. In the summer and autumn of Yiyou year, heavy rains preceded epidemic dysentery with aversion to cold, body pain, fever, and vomiting; presentations were similar, but cold medicines caused transformations. I adjusted the formula: for severe exterior signs, use Baidu San (Decoction for Resisting Toxins) with Cangzhu (Atractylodis Rhizoma) and Houpo (Magnoliae Officinalis Cortex); for poor chest comfort and severe interior signs, use Pingwei San (Peace the Stomach Powder) with Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), and Chaihu (Bupleuri Radix); results were immediate. This is cold-damp pathogens injuring the muscle layer, invading the intestines and stomach, forming epidemic dysentery. In the summer and autumn of Dingmao year, drought prevailed throughout the region, with bloody dysentery, frequent abdominal pain, burning anus, and difficult expulsion of accumulation; Xianglian Wan (Coptis and Aucklandia Pill) worsened the dysentery. I realized dry-fire injures Blood and formulated Danggui Dahuang Tang (Angelica and Rhubarb Decoction) to clear dry-fire in the Blood level; results were prompt. This is dry-fire pathogens entering via mouth/nose, directly invading intestines/stomach, forming epidemic dysentery. (Qin Huangshi)
Dysentery is not caused solely by Six Excesses or injury from raw/cold fruits. Observing ancient methods, it is said that intense summer heat and Ministerial Fire command, accumulating酷热 (excessive heat) causes dysentery, a view followed by physicians. However, Summer Heat is one of the Six Excesses; those struck by Summer Heat may have fever or malaria, but it has no relation to dysentery. Dysentery is essentially turbid Qi from epidemics sinking downward, called Hun. Pathogenic toxin entering the Upper Jiao of the Stomach floats to the muscle layer causing aversion to cold and fever; toxin entering the Lower Jiao of the Stomach moves into the Small and Large Intestines, stripping the intestinal lining (pus/blood) causing tenesmus. Toxin in the muscle layer transmits from Three Yang to Three Yin, killing internally; toxin in the intestines causes aversion to food, damaging Spleen/Stomach, cutting off grain supply, killing. Dysentery with alternating chills and fever kills especially fast. The irregular Qi of Heaven and Earth is varied, and the speed of dysentery is also concentrated from this irregular Qi. One person gets it, everyone gets it; initially contracted from Heaven, subsequently transmitted among humans, proving its contagious nature. The Classic says: "Summer injury by Summer Heat, Autumn becomes Malaria." No transmission mentioned. "Due to Summer Heat, sweating, panting when restless, talking much when quiet." No transmission mentioned. "Pulse empty, body hot, due to Summer Heat injury." No transmission mentioned. The contagion of dysentery confirms Summer Heat is unrelated. Moreover, irregular Qi has no fixed location or timing, whereas Summer Heat is annual and fruits are seasonal; in years without dysentery outbreaks, despite intense heat and fruit consumption, widespread dysentery did not occur. Thus, it is self-evident, and my assertion that epidemic pathogens cause dysentery is well-founded. Initial treatment should use Huangjin Tang (Golden Yellow Decoction) to resolve epidemic toxin and save Stomach Qi; follow with Sijun Zi Tang (Four Gentlemen Decoction) to support Spleen Earth and tonify Original Qi; long-term use of Bawei Jia Shen Tang (Eight Ingredients plus Ginseng Decoction) to tonify True Yuan and generate Earth Qi. Even for robust individuals infected, adding Huanglian (Coptidis Rhizoma) to Huangjin Tang yields swift results. If pus/blood cuts into the flesh, lower abdomen must be urgent/painful; red/white stripping of lining varies in depth; tenesmus with cold/heat or sinking Qi; thirst with drinking, fluid depletion/Yin collapse, or Stomach Heat/Fire blazing. Epidemic Qi comes singly, but human constitutions vary in deficiency/excess and cold/heat. Deficient constitution + pathogen = Deficient Dysentery; Robust constitution + pathogen = Excess Dysentery; Cold constitution + pathogen = Cold Dysentery; Hot constitution + pathogen = Hot Dysentery. Physicians mistakenly attribute harm to fruits/summer heat, failing to understand epidemic toxin injuring intestines. They do not realize the evil of epidemic dysentery: cutting off grain, stripping fat, damaging Spleen, injuring Stomach, consuming Qi/Blood. When Righteous Qi is ruined by toxin thus, yet physicians cling to Xianglian Wan or Chengqi Tang, skills exhausted, patients die, helpless. (Huixinlu)
Xue Li (Bloody Dysentery)
For heat dysentery with bleeding: cool Blood and invigorate Blood. For Wind pathogen sinking: lift and raise. For damp-heat injuring Blood: drain dampness and clear heat. ○ Bloody dysentery unhealed long-term belongs to Yang deficiency and Yin collapse; use Bazhen Tang (Eight Treasures Decoction) with lifting herbs. In severe cases with periodic passage, cold hands/feet, and shrinking pulse, Original Qi is about to collapse; urgently moxa Qihai (CV6), use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); delay means death. (Yu Jiayan)
Bright red blood indicates heat dysentery; use Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) or Baitouweng Tang (Pulsatilla Decoction). ○ Blood like clots, worsening with cold medicines: treat as cold dysentery; use Lizhong Tang (Regulate the Middle Decoction) or Sijun Zi Tang (Four Gentlemen Decoction) added with Rouguo (Myristicae Semen) and Muxiang (Aucklandiae Radix). (Zhengzhi Zhunsheng)
Ancient texts say pure blood dysentery is fatal, but this depends on accompanying signs and pulse; it is not always fatal. I treated several cases successfully using Foshou San (Buddha's Hand Powder) added to Ejiao (Donkey-Hide Gelatin), Qinpi (Fraxini Cortex), Paojiang (Fried Ginger), Dihuang (Rehmanniae Radix), Huanglian (Coptidis Rhizoma), Diyü (Sanguisorbae Radix), and Puhuang (Typhae Pollen); or Siwu Tang (Four Substances Decoction) with one or two of the above added. Do not use purely cold medicines. (Shuichixuanzhu)
Diyü (Sanguisorbae Radix) is heavy, bitter, and cold; usable for heat dysentery with bleeding, but contraindicated for deficiency-cold dysentery. (Bencao Yan yi)
Bloody dysentery looking like pig liver, purple grass, or amaranth juice: requires Paojiang (Fried Ginger) to be effective. (Zhangshi Yitong)
Xie Hou Li (Diarrhea Followed by Dysentery)
Diarrhea followed by dysentery is Spleen transmitting to Kidney, termed Thief Evil, difficult to cure; dysentery followed by diarrhea is Kidney transmitting to Spleen, termed Minor Evil, easy to treat. This is an unchanging law for millennia. In my opinion, diarrhea belongs to Spleen, certainly; but attributing dysentery to Kidney is debatable. Diarrhea is indeed often due to dietary injury, but is dysentery not also due to dietary injury? Food stagnation, damp-heat failing to transform, becomes thick/turbid, sticking to intestines/stomach, wanting to pass but unable, causing tenesmus—clearly a Spleen disease. Why attribute dysentery to Kidney? Never heard of food entering not via Spleen but Kidney. Since claiming Kidney disease, yet treating dysentery commonly uses Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Huanglian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma)—rarely using Duzhong (Eucommiae Cortex), Niuxi (Achyranthis Bidentatae Radix), Shudihuang (Rehmanniae Radix Praeparata). Using Spleen herbs to treat Kidney disease proves it is not a Kidney disease. Know that diarrhea followed by dysentery is difficult because Spleen Earth is damaged first, then accumulation blocks; this is not Spleen transmitting to Kidney. Dysentery followed by diarrhea is easy because accumulation is gone, Spleen is still weak; this is not Kidney transmitting to Spleen. Kidney stores Essence, not food; if dysentery belonged to Kidney, food would be stored in Kidney—absurd! Chronic dysentery inevitably involves Kidney deficiency, but initial dysentery does not immediately involve Kidney deficiency. (Zhengzhi Zhunsheng)
Ma Hou Li (Post-Malaria Dysentery)
There is post-malaria dysentery, and post-dysentery malaria. Since it is post-malaria, release is complete; there is no Summer Heat toxin remaining to cause dysentery. This is Original Qi sinking, Spleen Qi failing to lift, resembling dysentery but not truly dysentery. Since it is post-dysentery, excessive downward discharge depletes Yin, Qi scatters with dysentery, leading to dual deficiency of Yin and Yang. Yang deficiency causes aversion to cold; Yin deficiency causes fever; thus cold-heat battle, resembling malaria but not truly malaria. Both should be treated as deficiency, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with warming/tonifying herbs; the disease heals itself. (Zhao Shi Yi Guan)
Tao Chong Li (Pinworm Dysentery)
Pinworm dysentery arises from weak Stomach and deficient Spleen, with damp-heat stagnating and transforming into worms exiting the anus causing itching. Treatment: Wumei Wan (Mume Pill), Huanglian Xijiao San (Coptis and Rhinoceros Horn Powder); after worms are gone, use Liujunzi Tang (Six Gentlemen Decoction) added with Huanglian (Coptidis Rhizoma) and Wumei (Mume Fructus) to tonify Spleen/Stomach and clear damp-heat. If attacking worms exclusively, attacks become worse endlessly. (Zhangshi Yitong)
Bai Zheng (Failure Syndromes)
Pure blood dysentery: death; dust-rot color: death; roof-leak color: death; fish-brain/pig-liver color: half-death half-life; shortness of breath/hiccups: death; lips painted vermilion: death; anus like bamboo tube: death; body heat/wiry pulse: half-life half-death; spontaneous rectal prolapse: death; chronic dysentery suddenly passing hard stool: death. Children with smallpox getting dysentery: death; women postpartum getting dysentery: death. (Zhengzhi Huibu)
Unceasing body heat, locked jaw/anorexia: death; chronic dysentery with intermittent/knotted pulse, suddenly able to eat: named Chu Zhong (Eliminating Center), must die. (Zhangshi Yitong)
Dysentery with thirst craving wine: untreatable; severe vomiting with hiccups: untreatable; vomiting long worms: untreatable. (Xu Xuanzhi)
Mai Hou (Pulse Signs)
Various dysenteries: pulse lingering and fine/small indicates life; floating, rapid, full, large indicates death. (Ren Zhi Zhi Zhi)