叶先生名仪。尝与丹溪俱从白云许先生学。其记病云。岁癸酉秋八月。予病滞下。痛作
绝不食饮。既而困惫不能起床。乃以衽席及荐。阙其中而听其自下焉。时朱彦修氏客城中
以友生之好。日过视予。饮予药。但日服而病日增。朋游哗然议之。彦修弗顾也。浃旬病
益甚。痰窒咽如絮。呻吟亘昼夜。私自虞。与二子诀。二子哭。道路相传谓予死矣。彦修闻
之曰。吁。此必传者之妄也。翌日天甫明。来视予脉。煮小承气汤饮予。药下咽。觉所苦者
自上下。凡一再行。意冷然。越日遂进粥。渐愈。朋游因问彦修治法。答曰。前诊气口脉虚
形虽实而面黄稍白。此由平素与人接言多。多言者中气虚。又其人务竟已事。恒失之饿而
伤于饱。伤于饱其流为积。积之久。为此证。夫滞下之病。谓宜去其旧而新是图。而我顾投
以参、术、陈皮、芍药等补剂十余帖。安得不日以剧。然非浃旬之补。岂能当此两帖承气哉
故先补完胃气之伤。而后去其积。则一旦霍然矣。众乃敛衽而服。
震按此与许学士治伤寒太阳病因尺脉不应用黄 建中同法。彼先补而后散。此先补而后
攻。但二公把握得定。故嫌疑不避。设麻黄承气之用于后者不能愈病。则人之归咎难辞。而
医之用药无路矣。
一人患痢久不愈。脉沉细弦促。右为甚。日夜数十行。下清涕。有紫黑血丝。食少。丹
溪曰。此瘀血痢也。凡饱食后疾走。或极力叫号殴跌。多受疼痛。大怒不泄。补塞太过。火
酒火肉。皆致此病。此人以非罪受责故也。乃以乳香、没药、桃仁、滑石。佐以木香、槟榔
大黄。神曲糊丸。米饮下百丸。再服。大下秽物而愈。
一老人年七十。面白。脉弦数。独胃脉沉滑。因饮白酒作痢。下淡水脓血。腹痛。小便
不利。里急后重。丹溪以参、术为君。甘草、滑石、槟榔、木香、苍术为佐使。煎汤下保和
丸三十粒。次日前证俱减。惟小便未利。以六一散服之而愈。
丹溪从叔。年逾五十。夏间患滞下病。腹微痛。所下褐色。后重食减。时有微热。察其
脉皆弦而涩。似数而稍长。喜不甚浮大。两手相等。视其神气大减。朱曰。此忧虑所致。心
血亏。脾气弱耳。以参、术为君。归身、陈皮为臣。川芎、白芍、茯苓为佐使。时暄热甚。
少加黄连。两月而安。此等证。若因其逼迫而用峻剂。误矣。
梅长官年三十余。奉养浓者。夏秋息痢。腹大痛。或令单煮干姜。与一帖。痛定。少顷
又作。又与之。又定。八日服干姜三斤。左脉弦而稍大。似数。右脉弦而大稍减。亦似数。
重取似紧。朱曰。此必醉饱后食寒凉太多。当作虚寒治之。因服干姜多。以四物去地黄。加
参、术、陈皮、酒红花、茯苓、桃仁煎。入姜汁饮之。一月而安。
丹溪云。赵立道年近五十。质弱而多怒。七月炎暑。大饥索饭。其家不能急具。因大怒
两日后。得滞下病。口渴。自以冷水调生蜜饮之。甚快。滞下亦渐缓。如此者五七日。召
予视。脉稍大不数。遂令止蜜水。渴时但煎人参白术汤。调益元散与之。滞下又渐收。七八
日后觉倦甚。发呃。予知其久下而阴虚也。令守前药。然滞下尚未止。又以炼蜜饮之。如此
者三日。呃犹未止。众皆尤药之未当。将用姜、附。予曰。补药效迟。附子非补阴者。服之
必死。众曰。冷水饮多。得无寒乎。予曰。炎暑如此。饮凉非寒。勿多疑。待药力到。当自
止。又四日而呃与滞下皆止。
陈宅仁年近七十。浓味人也。有久喘病而作止不常。新秋患痢。食大减。五七日。呕逆
发呃。丹溪视脉皆大豁。众以为难。朱曰。形瘦者尚可为。以黄柏炒燥研末。陈米饭丸。小
豌豆大。每服三十丸。人参、白术、茯苓三味煎浓汤下。连服三剂即愈。切不可下丁香等热
震按丹溪诸案绝不雷同。与马元仪大相悬绝。其最难及者。以服干姜至三斤而仍认为虚
以呃逆已投参、术。而一兼益元。一兼黄柏。苟非识得真。岂能不惑如此。
壶仙翁治一命妇。病滞下。腹痛腰胀。翁诊其脉。曰。此气血滞郁而然。当调血和气。
则痢自止。所以知其病者。切其脉。沉而滞。循其尺。尺涩。沉滞则气不和。涩则精血伤。
病由积郁而强食。故气血俱伤。乃投以四物、五苓、木香。痛少止。倍当归。经通而滞下已
汪石山云。予兄年逾六十。色苍素健。九月患滞下。予适出外。自用利药三帖。病减。
延至十月。后重未除。滞下未止。诊之。脉皆濡散。颇缓。初用人参二钱。归、芍、黄芩、
升麻、桃仁各一钱。槟榔五分。煎服。后重已除。再减桃仁、槟榔。加白术一钱五分。滞下
亦定。惟粪门深入寸许。近后尾闾穴傍。内生一核如梅。颇觉胀痛不爽。予曰。此因努责气
血下滞于此。耐烦数日。脓溃自安。果如所言。后服槐角丸。痔痛如故。仍用人参三钱。归
、升麻等剂而愈。
一妇年逾五十。病痢半载余。医用四物凉血之剂。及香连丸。愈增。脘腹痛甚。里急后
重。下痢频并。嗳气。亦或咳嗽。遍身烦热。石山诊之。脉皆细弱而数。曰。此肠胃下久而
虚也。医用寒凉。愈助降下之令。病何由安。经曰。下者举之。虚者补之。其治此病之法欤
遂以参、术为君。苓、芍为臣。陈皮、甘草、升麻为佐使。研末。每服二钱。清米饮调下
日二次。或三次。遂安。
吴茭山治一妇。长夏患痢。痛而急迫。其下黄黑色。诸医以薷苓汤。倍用枳壳、黄连。
其患愈剧。吴诊之。两尺脉紧而涩。知寒伤荣也。问其病由。乃行经之时。因渴饮冷水一碗
遂得此证。盖血被冷水所凝。瘀血归于大肠。热气所以坠下。遂用桃仁承气汤。加马鞭草
延胡索。一服。次早下黑血升许。痛止脏清。次用调脾活血之剂。遂痊。此乃经凝作痢。
震按此条先用薷、连。其患愈剧。再合以尺脉之紧涩。明知为寒伤营矣。乃不用温药佐
消瘀。仍以承气加逐瘀药。岂因后重急迫。宜下不宜温耶。
薛立斋治少宗伯顾东江。停食患痢。腹痛下坠。或用疏导之剂。两足浮肿。食少倦怠。
烦热作渴。脉洪数。按之微细。以六君子。加姜、桂各二钱。吴茱萸、五味子各一钱。煎成
冷冻饮料。即睡。觉而诸证顿减。此假热而治以假寒也。
立斋又云。先母年八十。仲夏患痢。腹痛。作呕不食。热渴引汤。手按腹痛稍止。脉鼓
指而有力。真气虚而邪气实也。急用人参五钱。白术、茯苓各三钱。陈皮、升麻、附子、炙
草各一钱。服之睡。觉索食。脉证顿退。再剂而安。此取证不取脉也。凡暴病毋论其脉。当
从其证。时石阁老太夫人。其年岁脉证皆同。彼乃专治其痢。遂致不起。
震按立斋云。暴病毋论其脉。当从其证。想先生只从虚寒之证为据。若证现实热。而脉
微细。或按之空豁者。又从脉不从证矣。多阅薛氏医案自知。
又云。一老人素以酒乳同饮。去后。似痢非痢。胸膈不宽。用痰痢等药不效。余思本草
云。酒不与乳同饮。为得酸则凝结。得苦则行散。遂以茶茗为丸。时用清茶送三五十丸。不
震按此与沈绎治肃藩同案。而以茶为丸。以茶送下更佳。
张三锡治一人。病痢。发寒热。左脉浮紧。右脉滑大。乃内伤挟外感也。先用败毒散加
姜葱一服。表证悉退。但中脘作胀闷。后重不已。以平胃散加枳壳、木香、槟榔、山楂。又
二服。胀闷移于小腹。投木香槟榔丸三钱。下粘硬物而愈。
又一妇病痢。自投承气汤二服。不愈。张诊之。左脉浮而带弦。右三部俱沉。关脉略滑
必郁闷中食物所致。病家云。素恼怒。遂以浓朴、苍术、香附、抚芎舒郁。山楂、槟、橘
木香理气。芍药调中。三服愈。
龚云林治大司寇刘春冈。年近古稀。患痢。脓血腹痛。诸医弗效。龚诊六脉微数。此肥甘太
过。内有积热。当服酒蒸大黄一两清利之。司寇曰。吾衰老。恐不胜。惟滋补平和之剂可也
龚再四宽释。遂服之。逾日而愈。
又治通府何竹峰赤白痢。昼夜无度。遍身瘙痒。心中烦躁。龚诊六脉大数。人迎偏盛。
此风邪热毒也。以人参败毒散。去人参加荆、防、黄连。二服即愈。而六脉仍前大数。龚曰
数则烦心。大为病进。将来必有痰喘之患。不起。后逾月。果如其言。
震按此二条一以年近古稀。而用大黄至一两。不可为训。一以病退脉不退。决其变证。
诚有先见之明。然何不用补阴药。以治其脉之数大也。
李士材治屯院孙潇湘夫人。下痢四十日。口干发热。饮食不进。腹中胀闷。完谷不化。
尚有谓其邪热不杀谷者。计服香、连、枳、朴、豆蔻等。三十余剂。绝谷五日。命在须臾。
李诊之。脉大而数。按之豁然。询得腹痛而喜手按。小便清利。此火衰不能生土。内真寒而
外假热也。亟煎附子理中汤。冷服一剂而痛止。六剂而热退食进。兼服八味丸。二十余日而
兵尊张 秋间患痢。凡香、连、枳、朴等剂。用之两月而病不衰。士材诊之。滑而有
力。失下之故也。用香、连、归、芍、陈皮、枳壳。加大黄三钱。下秽物颇多。诊其脉尚有
力。仍用前方。出积滞如鱼肠者约数碗。调理十余日而痊。
震按此案比前案更高。其得手处总在于能审脉也。
缪仲淳治一少年贵介。暑月出外。饮食失宜。兼以暑热。遂患滞下。途次无药。痢偶自
止。归家腹痛不已。遍尝诸医之药。药入口。痛愈甚。亦不思食。缪视之曰。此湿热尔。其
父曰。医亦以湿热治之而转剧。缪问投何药。曰。苍术、黄连、浓朴、陈皮等。缪曰。误也
术性温而燥。善闭气。郎君、阴虚人也。尤非所宜。乃以滑石一两为细末。以牡丹皮汁煮
之。别以芍药五钱。炙甘草二钱。炒黑干姜五分。煎调滑石末服之。须臾。小便如注。痛立
祝茹穹治部堂祖泽远。夏得痢疾。昼夜七八十次。疼不可言。便出仅血脓数点。饮食不
进。已月余。瘦弱已极。诸医咸虑之。以为此毒瓦斯熏蒸清道。致胃口遏塞。闻食即吐。凶兆
也。祝视之。面热身凉。脉大而滑。夫病久则邪气日盛。当身热。而今身凉。身凉不宜脉大
而今脉大。细视胃脉。乍大乍小。茹穹豁然曰。此非噤口证也。因感寒不发散。故胃以上
有积寒。冒暑不清凉。故胃以下有积热。宜以温药开胃口之寒。以凉药通谷道之热。久病虚
甚。补之。四五日即可愈耳。闻者大惊。乃以吴茱萸制黄连。姜汁炒黄芩。煨干姜、白豆蔻
各一钱。陈壁土炒白术八分。南枣包煨人参八分。煎服。是夜即减病之半。五六服而神气渐
震按丹皮汁煮滑石。少佐炮姜为从治。制方服法俱妙。祝案议论颇佳。方却平庸。其效
孙东宿治温巽桥子妇。发热恶心。小腹痛。原为怒后进食。因而成积。左脚酸痛。已十
日矣。有南浔女科。始作瘟疫治。呕哕益加。又作疟治。粒米不能进。变为滞下。里急后重
一日夜三十余行。女科技穷。乃曰。病犯逆矣。下痢身凉者生。身热者死。脉沉细者生。
洪大者死。今身热脉大而又噤口。何可为哉。因请东宿诊。两手皆滑大。尺部尤搏指。孙曰
证非逆。误认为疫为疟治者逆也。虽多日不食。而尺脉搏指。经云。在下者引而竭之。法
从下。可生也。即与当归龙荟丸一钱五分。服下。去稠积半盆。痛减大半。不食已十四日。
至此始进粥一瓯。但胸膈仍饱闷。不如饥。又与红六神丸二钱。胸膈舒而小腹软。惟两胯痛
小腹觉冷。用热砖熨之。子户中白物绵绵下。小水短涩。改用五苓散加白芷、小茴香、白
鸡冠花、柴胡服之。至夜满腹作疼。亟以五灵脂醋炒为末。酒糊丸。白汤送下三钱。通宵安
寝。次日精神清健。饮食大进。小水通利矣。而独白物仍下。再用香附炒黑存性。枯矾各一
两。面糊丸。空心。益母草煎汤送下二钱。不终剂而白物无。病全愈矣。
孙东宿治侄从明。夏初。由客邸患痢。昼夜三四十度。里急后重。口渴汗出。胸膈焦辣
手心热。腹微痛。小水少。干哕呕恶。其脉左沉弦。右滑数。孙以病患原禀薄弱。今远归
途次多劳。不敢疏下。姑以胃风汤加黄连。与二帖不效。腹稍加胀。渠嘱孙曰。古云无积
不成痢。今积势胶固。切勿用补。无以体素弱为疑。孙即改用黄芩芍药汤。三剂无进退。乃
曰。此证实实虚虚。热热寒寒。殊属难治。且谷食禁口不入。干哕可虑。须再觅高明参酌。
无知病患信任益坚。孙因图欲先开胃口。使新谷食将宿秽压出。或补或攻。视缓急以为方略
乃背嘱伊芳侄曰。令伯非人参不可。幸且勿露。俾予得以尽技。因仿丹溪法。用人参、黄连
各二钱。煎浓。细细呷之。哕恶果止。连与两日。觉胸腹胀。即以保和丸应之。觉小水不利
又以清六丸应之。里急后重。以参、术加芩、连、木香、槟榔、滑石、桃仁应之。人参皆
背加。病患不知也。每诊脉。必曰疾已渐平。幸勿遽补。恐废前功。讵知人参已服十日。计
二两许矣。此后脉仅四至。软而无力。忆丹溪云。虚回而痢自止。又云。气虚甚者。非附子
不能行参 。乃以胃风汤加 、附、炮姜。四剂而血止。后重亦止。再用菟丝、萸肉、故纸
叶先生名仪。曾与朱丹溪一同跟随白云许先生学习。他记录自己的病情说：癸酉年秋八月，我患了痢疾（滞下）。腹痛剧烈，完全无法进食饮水。随后身体困倦疲惫，不能起床，于是用席子和垫子中间挖个洞，让排泄物直接落下。当时朱彦修客居城中，因为朋友的情谊，每天来看望我，给我服药。但我每天服药，病情却日益加重。朋友们纷纷议论指责。朱彦修却不理会。过了十天，病更加严重。痰液阻塞咽喉像棉絮一样，呻吟声昼夜不停。我自己担心，便与两个儿子诀别。两个儿子哭泣，路人相传说我死了。朱彦修听说后说：“唉，这一定是传话的人胡言乱语。”第二天清晨，天刚亮，他来诊脉，煮了小承气汤让我喝。药咽下去后，感觉病痛从上下行。一共解了两次大便，心里顿时感到清凉舒适。过了一天就开始喝粥，逐渐痊愈。朋友们因此问朱彦修的治疗法则。他回答说：“之前诊察，气口脉虚弱，虽然形体看似充实但面色黄而稍白，这是因为平时与人交谈过多，多言导致中气虚弱。加上此人做事争强好胜，常常饿过头又吃得太饱。吃得太饱会导致积滞，积滞久了，就得了这个病。对于痢疾，按理应该去除旧积以图新愈，而我反而投以人参、白术、陈皮、芍药等补剂十几帖，病情怎么会不一天天加重呢？然而如果不是经过十天的进补，怎么能承受得住这两帖承气汤的攻下呢？所以先补完胃气的损伤，然后去除积滞，就能一下子霍然痊愈了。”众人才恭敬地信服。
俞震按语：这与许学士治疗伤寒太阳病因尺脉不宜发汗而使用黄芪建中汤的方法相同。那是先补益而后发散，这是先补益而后攻下。只是这两位医生把握得当，所以不避嫌疑。如果在后者身上使用麻黄、承气汤而不能治愈疾病，那么人的归咎难以推辞，医生的用药之路也就断绝了。
有一人患痢疾长久不愈，脉象沉细弦促，右侧更明显，日夜排便数十次，排出清稀鼻涕状物质，带有紫黑血丝，食欲少。朱丹溪说：“这是瘀血痢。凡是饱食后快跑，或极力呼喊殴打跌倒，多受疼痛，大怒不解，补塞太过，饮酒吃肉，都会导致这种病。这个人是因为无罪受责的缘故。”于是用乳香、没药、桃仁、滑石，佐以木香、槟榔、大黄，神曲糊丸，米饮送服一百丸。再服用后，大量排出秽物而痊愈。
一位七十岁的老人，面色白，脉弦数，唯独胃脉沉滑。因为饮用白酒导致痢疾，排出淡水和脓血，腹痛，小便不利，里急后重。朱丹溪以人参、白术为君药，甘草、滑石、槟榔、木香、苍术为佐使药，煎汤送服保和丸三十粒。次日各种症状都减轻，只有小便仍不通利，服用六一散而痊愈。
朱丹溪的堂叔，年龄超过五十岁。夏天患痢疾，腹部微痛，排出的粪便呈褐色，里急后重，食欲减退，时有轻微发热。诊察他的脉象都弦而涩，似数而稍长，喜欢脉不甚浮大，两手相等。观察他的神气大减。朱丹溪说：“这是忧虑所致，心血亏虚，脾气虚弱。”以人参、白术为君药，当归身、陈皮为臣药，川芎、白芍、茯苓为佐使药。当时天气非常炎热，稍微加一点黄连。两个月后安稳。这类证候，如果因为病情逼迫而使用峻猛药物，就错了。
梅长官三十多岁，生活优厚。夏秋季节患痢疾，腹部剧痛。有人让他单煮干姜，给了一帖，疼痛停止。过了一会儿又发作。又给他喝，又停止。八天服用了三斤干姜。左脉弦而稍大，似数；右脉弦而大稍减，也似数。重取感觉紧。朱丹溪说：“这一定是醉酒后吃太多寒凉食物，应当作为虚寒治疗。”因为服用了很多干姜，用四物汤去掉地黄，加入人参、白术、陈皮、酒红花、茯苓、桃仁煎煮，加入姜汁饮用。一个月后安稳。
朱丹溪说：赵立道接近五十岁，体质弱且易怒。七月酷暑，极度饥饿索要饭食。家人不能立即准备好，因此大怒。两天后，患上痢疾，口渴，自己用冷水调生蜜饮用，感觉很痛快，痢疾也逐渐缓解。这样持续了五七天，请我去看。脉稍大但不数。于是让他停止喝蜜水，口渴时只煎人参白术汤，调入益元散给他服用。痢疾又逐渐收敛。七八天后觉得非常疲倦，打呃。我知道他是久泻导致阴虚。让他坚守前面的药方。然而痢疾仍未止住。又用炼蜜饮用。这样持续三天，呃逆仍未止住。众人都责怪药不对症，打算用干姜、附子。我说：“补药效力迟缓，附子不是补阴的药，服用必死。”众人说：“喝了那么多冷水，难道不是寒吗？”我说：“如此炎热的夏天，喝凉的并不是寒，不要多疑。等待药力到达，自然会停止。”又过了四天，呃逆和痢疾都停止了。
陈宅仁接近七十岁，喜好浓味食物。有长期哮喘病，发作没有规律。初秋患痢疾，饮食大减。五七天后，呕吐逆气，打呃。朱丹溪诊察脉象都大而豁（空虚）。众人都认为难治。朱丹溪说：“形体消瘦的人还可以治。”用黄柏炒燥研末，陈米饭做丸，小豌豆大小。每次服用三十丸，用人参、白术、茯苓三味煎浓汤送下。连服三剂即痊愈。千万不要用丁香等热性药。
俞震按语：朱丹溪的这些医案绝不雷同，与马元仪大相径庭。其中最难企及的地方，在于服用干姜达到三斤仍然认定为虚证；在已经投用参、术后，一个兼用益元散，一个兼用黄柏。如果不是认识真切，怎么能不被迷惑到如此地步。
壶仙翁治疗一位命妇，患痢疾，腹痛腰胀。壶仙翁诊察她的脉象，说：“这是气血滞郁导致的，应当调和气血，那么痢疾自然停止。之所以知道是这个病，切脉发现沉而滞，循按尺部，尺脉涩。沉滞则气不和，涩则精血伤。病由积郁而强行进食导致，所以气血都受伤。”于是投以四物汤、五苓散、木香。疼痛稍微停止。加倍使用当归，经络通畅而痢疾已止。
汪石山说：我哥哥年龄超过六十岁，肤色苍老素来健康。九月患痢疾。我恰好外出。他自己用了三帖泻药，病情减轻。延续到十月，里急后重未除，痢疾未止。诊察，脉象都濡散，颇缓。初用人参二钱，当归、芍药、黄芩、升麻、桃仁各一钱，槟榔五分，煎服。里急后重已除。再减去桃仁、槟榔，加入白术一钱五分，痢疾也安定。只有肛门深入一寸左右，靠近尾闾穴旁边，内生一个核如梅子大小，颇为胀痛不爽。我说：“这是因为努责导致气血下滞于此，忍耐几天，脓溃自安。”果然如所言。后来服用槐角丸，痔疮痛如故。仍用人参三钱，当归、升麻等剂而痊愈。
一位五十多岁的女性，患痢疾半年多。医生用四物汤凉血之剂，以及香连丸，病情加重。脘腹疼痛剧烈，里急后重，下痢频繁，嗳气，有时咳嗽，遍身烦热。汪石山诊察，脉象都细弱而数。说：“这是肠胃久泻而虚。医生用寒凉药，更加助长降下之势，病怎么能够安宁？经书说：下陷的提升它，虚弱的补益它。这就是治疗此病的方法吧。”于是以人参、白术为君药，茯苓、芍药为臣药，陈皮、甘草、升麻为佐使药。研成粉末，每次服用二钱，用清米饮调下，每日二次或三次。于是安稳。
吴茭山治疗一位女性，长夏患痢疾，疼痛且急迫，排出黄黑色粪便。各位医生用薷苓汤，倍用枳壳、黄连。病情更加严重。吴茭山诊察，两尺脉紧而涩，知道是寒邪伤了营血。询问病因，是在行经期间，因为口渴喝了一碗冷水，于是得了这个病。大概血液被冷水凝结，瘀血归于大肠，热气所以坠下。于是用桃仁承气汤，加马鞭草、延胡索。一服后，第二天早上排出黑血约一升，疼痛停止，脏腑清净。接着用调理脾胃活血的药剂，于是痊愈。这是经期血凝导致痢疾。
俞震按语：这一条先用薏苡、黄连，病情加重，再结合尺脉的紧涩，明知是寒伤营血。竟然不用温药佐以消瘀，仍然用承气汤加逐瘀药，难道是因为里急后重急迫，适宜攻下而不适宜温补吗？
薛立斋治疗少宗伯顾东江，停食患痢，腹痛下坠。有人用疏导的药剂，两足浮肿，食少倦怠，烦热作渴，脉洪数，按之微细。用六君子汤，加生姜、肉桂各二钱，吴茱萸、五味子各一钱。煎好后冷冻饮用，立刻睡觉。醒来后各种症状顿减。这是假热而用假寒法治疗。
薛立斋又说：先母八十岁，仲夏患痢，腹痛，呕吐不食，热渴引水，手按腹痛稍止。脉鼓指而有力，真气虚而邪气实。紧急用人参五钱，白术、茯苓各三钱，陈皮、升麻、附子、炙甘草各一钱。服用后睡觉，醒来索要食物，脉证顿退。再剂而安。这是取证不取脉。凡是暴病不论其脉，应当从其证。当时石阁老太夫人，其年龄脉证都相同。她却是专门治疗痢疾，于是导致死亡。
俞震按语：薛立斋说：暴病不论其脉，应当从其证。想先生只是从虚寒之证为依据。如果证现实热，而脉微细，或按之空豁者，又从脉不从证了。多看薛氏医案自然知道。
薛立斋又说：一位老人平时习惯酒乳同饮，腹泻，似痢非痢，胸膈不宽。用治痰痢等药无效。我思考本草说：酒不与乳同饮，遇到酸则凝结，遇到苦则行散。于是用茶茗做丸，时常送服清茶三五十丸，（病愈）。
俞震按语：这与沈绎治疗肃藩的案例相同，而以茶做丸，以茶送下更好。
张三锡治疗一人，患痢疾，发寒热，左脉浮紧，右脉滑大，这是内伤挟外感。先用败毒散加生姜、葱白一服，表证全退。但中脘作胀闷，里急后重不止。用平胃散加枳壳、木香、槟榔、山楂。又二服，胀闷移于小腹。投木香槟榔丸三钱，排出粘硬物而痊愈。
又一女性患痢疾，自己服用承气汤二服，不愈。张三锡诊察，左脉浮而带弦，右三部俱沉，关脉略滑，必定是郁闷中食物所致。病家说：素来恼怒。于是用浓朴、苍术、香附、抚芎疏解郁结，山楂、槟榔、橘皮、木香理气，芍药调中。三服痊愈。
龚云林治疗大司寇刘春冈，接近古稀之年，患痢疾，脓血腹痛，各位医生无效。龚云林诊察六脉微数，这是肥甘太过，内有积热，应当服用酒蒸大黄一两清利。司寇说：“我衰老，恐怕承受不住。只有滋补平和的药剂可以。”龚云林再三宽慰解释，于是服用。过日而愈。
又治疗通府何竹峰赤白痢，昼夜无度，遍身瘙痒，心中烦躁。龚云林诊察六脉大数，人迎脉偏盛，这是风邪热毒。用人参败毒散，去人参加荆芥、防风、黄连。二服即愈。而六脉仍然前大数。龚云林说：数则烦心，大为病进，将来必有痰喘之患，不能存活。后过月，果然如所言。
俞震按语：这两条一条以年近古稀，而用大黄至一两，不可作为典范。一条以病退脉不退，决断其变证，诚有先见之明。然而为何不用补阴药，来治疗其脉之数大呢？
李士材治疗屯院孙潇湘夫人，下痢四十日，口干发热，饮食不进，腹中胀闷，完谷不化。还有人说这是邪热不杀谷。共计服用香、连、枳、朴、豆蔻等三十余剂，绝食五日，命在旦夕。李士材诊察，脉大而数，按之豁然。询问得知腹痛而喜手按，小便清利，这是火衰不能生土，内真寒而外假热。紧急煎附子理中汤，冷服一剂而痛止。六剂而热退食进。兼服八味丸，二十余日而痊愈。
兵尊张，秋间患痢。凡香、连、枳、朴等剂，用了两个月而病不衰。李士材诊察，滑而有力，是失下的缘故。用香、连、归、芍、陈皮、枳壳，加大黄三钱。排出秽物颇多。诊察其脉尚有力，仍用前方。排出积滞如鱼肠者约数碗。调理十余日而痊愈。
俞震按语：此案比前案更高。其得手处总在于能审脉。
缪仲淳治疗一位少年贵介，暑月外出，饮食失宜，兼以暑热，于是患痢疾。途中无药，痢疾偶然自止。回家腹痛不已，遍尝诸医的药，药入口，疼痛更甚，也不思食。缪仲淳视之曰：“这是湿热罢了。”其父说：“医生也以湿热治之而转剧。”缪仲淳问投什么药，说：苍术、黄连、浓朴、陈皮等。缪仲淳说：“错了。术性温而燥，善于闭气，郎君是阴虚之人，尤其不适合。”于是用滑石一两为细末，以牡丹皮汁煮之。另外用芍药五钱，炙甘草二钱，炒黑干姜五分，煎调滑石末服用。须臾，小便如注，疼痛立即停止。
祝茹穹治疗部堂祖泽远，夏天得痢疾，昼夜七八十次，疼不可言，便出仅血脓数点，饮食不进，已月余，瘦弱已极。各位医生都担忧，认为这是毒瓦斯熏蒸清道，致胃口遏塞，闻食即吐，凶兆也。祝茹穹视之，面热身凉，脉大而滑。病久则邪气日盛，当身热，而今身凉，身凉不宜脉大，而今脉大。细视胃脉，乍大乍小。祝茹穹豁然曰：“这不是噤口证。因为感寒不发散，所以胃以上有积寒，冒暑不清凉，所以胃以下有积热。宜以温药开胃口之寒，以凉药通谷道之热。久病虚甚，补之。四五日即可愈耳。”闻者大惊。于是用吴茱萸制黄连，姜汁炒黄芩，煨干姜、白豆蔻各一钱，陈壁土炒白术八分，南枣包煨人参八分，煎服。是夜即减半。五六服而神气渐复。
俞震按语：丹皮汁煮滑石，少佐炮姜为从治，制方服法俱妙。祝案议论颇佳，方却平庸。其效...
孙东宿治疗温巽桥子妇，发热恶心，小腹痛。原为怒后进食，因而成积，左脚酸痛，已十日矣。有南浔女科，始作瘟疫治，呕哕益加。又作疟治，粒米不能进，变为滞下，里急后重，一日夜三十余行。女科技穷，乃曰：“病犯逆矣。下痢身凉者生，身热者死。脉沉细者生，洪大者死。今身热脉大而又噤口，何可为哉。”因请东宿诊。两手皆滑大，尺部尤搏指。孙东宿曰：“证非逆，误认为疫为疟治者逆也。虽多日不食，而尺脉搏指，经云：在下者引而竭之，法从下，可生也。”即与当归龙荟丸一钱五分，服下，去稠积半盆，痛减大半。不食已十四日，至此始进粥一瓯。但胸膈仍饱闷，不如饥。又与红六神丸二钱，胸膈舒而小腹软。惟两胯痛，小腹觉冷，用热砖熨之。子户中白物绵绵下，小水短涩。改用五苓散加白芷、小茴香、白鸡冠花、柴胡服之。至夜满腹作疼，亟以五灵脂醋炒为末，酒糊丸，白汤送下三钱，通宵安寝。次日精神清健，饮食大进，小水通利矣。而独白物仍下。再用香附炒黑存性，枯矾各一两，面糊丸，空心，益母草煎汤送下二钱，不终剂而白物无，病全愈矣。
孙东宿治疗侄从明，夏初，由客邸患痢，昼夜三四十度，里急后重，口渴汗出，胸膈焦辣，手心热，腹微痛，小水少，干哕呕恶。其脉左沉弦，右滑数。孙东宿以病患原禀薄弱，今远归途次多劳，不敢疏下。姑以胃风汤加黄连，与二帖不效，腹稍加胀。渠嘱孙曰：“古云无积不成痢，今积势胶固，切勿用补，无以体素弱为疑。”孙即改用黄芩芍药汤，三剂无进退，乃曰：“此证实实虚虚，热热寒寒，殊属难治。且谷食禁口不入，干哕可虑，须再觅高明参酌。”无知病患信任益坚。孙因图欲先开胃口，使新谷食将宿秽压出，或补或攻，视缓急以为方略。乃背嘱伊侄曰：“令伯非人参不可，幸且勿露，俾予得以尽技。”因仿丹溪法，用人参、黄连各二钱，煎浓，细细呷之，哕恶果止。连与两日，觉胸腹胀，即以保和丸应之。觉小水不利，又以清六丸应之。里急后重，以参、术加芩、连、木香、槟榔、滑石、桃仁应之。人参皆背加，病患不知也。每诊脉，必曰疾已渐平，幸勿遽补，恐废前功。讵知人参已服十日，计二两许矣。此后脉仅四至，软而无力。忆丹溪云：“虚回而痢自止。”又云：“气虚甚者，非附子不能行参。”乃以胃风汤加参、附、炮姜。四剂而血止，后重亦止。再用菟丝、萸肉、故纸...
Mr. Ye, named Yi, once studied together with Zhu Danxi under Master Xu of Baiyun. He recorded his illness as follows: In the eighth month of autumn in the year Guiyou, I suffered from dysentery (Zhi Xia). Severe abdominal pain occurred, and I could neither eat nor drink. Subsequently, my body became exhausted and weak, unable to get out of bed. Therefore, I placed a mat and a cushion with a hole in the middle to allow excrement to fall directly through. At that time, Mr. Zhu Yanxiu was staying in the city. Due to our friendship, he visited me daily and administered medicine to me. However, although I took the medicine daily, my condition worsened day by day. Friends and acquaintances loudly criticized this. Mr. Yanxiu ignored them. After ten days, the illness became even more severe. Phlegm obstructed the throat like cotton wool, and groaning continued day and night. Worried about my own fate, I bid farewell to my two sons. They cried, and rumors spread along the roads that I had died. Upon hearing this, Mr. Yanxiu said, "Alas, this must be the nonsense of those who relay messages." The next day, just as dawn broke, he came to examine my pulse, boiled Xiao Chengqi Tang (Minor Order the Qi Decoction), and gave it to me to drink. After swallowing the medicine, I felt the suffering move downwards. I defecated twice in total, and my mind suddenly felt cool and comfortable. The following day, I was able to consume porridge, and gradually recovered. My friends then asked Mr. Yanxiu about his treatment method. He replied, "Previously, upon examination, the Qi Kou pulse was deficient. Although the physical form appeared full, the complexion was yellowish and slightly pale. This is because I usually engage in much conversation; excessive speech leads to deficiency of Middle Qi. Furthermore, this person strives to complete matters himself, often starving and then overeating. Overeating leads to food stagnation; after a long time, this condition arises. Regarding dysentery, it is appropriate to remove the old accumulation to seek renewal. Yet I mistakenly administered tonifying agents such as Ginseng, Atractylodes Macrocephala, Tangerine Peel, and White Peony Root for over ten doses. How could the condition not worsen daily? However, if I had not tonified for ten days, how could the patient have tolerated these two doses of Chengqi Tang? Therefore, by first repairing the damage to Stomach Qi, and subsequently removing the accumulation, one can achieve a sudden and complete recovery." The crowd then bowed respectfully and accepted this explanation.
Yu Zhen's commentary: This is similar in method to Scholar Xu's treatment of Taiyang disease in Shanghan Lun where the Chi pulse was inappropriate for sweating, using Huangqi Jianzhong Tang (Astragalus and Middle-Warming Decoction). That case involved tonifying first and then dispersing; this case involves tonifying first and then purging. It is only because both physicians grasped the situation firmly that they did not avoid suspicion. If Mahuang (Ephedra) or Chengqi applications were used in the latter case without curing the disease, blame would be unavoidable, and the path for physicians to use medication would be blocked.
One person suffered from chronic dysentery that did not heal. The pulse was deep, fine, wiry, and rapid, more pronounced on the right side. He defecated dozens of times a day, passing clear mucus-like fluid with purple-black blood streaks, and had poor appetite. Zhu Danxi said, "This is dysentery due to blood stasis. Running quickly after a full meal, shouting or beating/falling heavily, enduring much pain, unrelenting anger, excessive tonification and obstruction, drinking alcohol, and eating meat can all cause this disease. This person suffered punishment unjustly." He prescribed Frankincense, Myrrh, Peach Kernel, and Talc, assisted by Costus Root, Areca Seed, and Rhubarb. These were made into pills with dough from fermented grain powder, taken with rice water, 100 pills per dose. After taking it again, large amounts of foul matter were discharged, and he recovered.
An elderly man aged seventy had a white complexion and a wiry, rapid pulse, except for the Stomach pulse which was deep and slippery. He developed dysentery after drinking white wine, passing watery stool with pus and blood, experiencing abdominal pain, difficult urination, tenesmus, and a feeling of incomplete evacuation. Zhu Danxi used Ginseng and Atractylodes Macrocephala as the sovereign drugs, Licorice, Talc, Areca Seed, Costus Root, and Atractylodes Lancea as minister and assistant drugs, decocted and taken with thirty pills of Baohe Wan (Harmonize the Stomach Pill). The next day, all symptoms decreased, except for the difficulty in urination, which was cured by Liuyi San (Six-to-One Powder).
Danxi's uncle, over fifty years old, suffered from dysentery in summer. He had slight abdominal pain, passed brown stool, experienced tenesmus and reduced appetite, and had occasional mild fever. His pulses were wiry and choppy, seemingly rapid but slightly long, and not floating and large; both hands were equal. His spirit and energy were greatly diminished. Zhu said, "This is caused by worry, leading to deficiency of Heart Blood and weakness of Spleen Qi." He used Ginseng and Atractylodes Macrocephala as sovereign drugs, Angelica Sinensis root and Tangerine Peel as minister drugs, Ligusticum Chuanxiong, White Peony Root, and Poria as assistant drugs. Given the intense heat, a small amount of Coptis Chinensis was added. He stabilized after two months. For such conditions, using harsh medicines due to the urgency of the disease would be a mistake.
Official Mei, in his thirties, lived luxuriously. He contracted dysentery in late summer and autumn with severe abdominal pain. Someone suggested boiling dried Ginger alone and giving him one dose; the pain stopped. Shortly after, it returned. He was given more, and it stopped again. He consumed three jin (approx. 1.5 kg) of dried ginger over eight days. The left pulse was wiry and slightly large, seeming rapid; the right pulse was wiry and large but slightly less so, also seeming rapid. Heavy pressure felt tight. Zhu said, "This must be due to consuming too much cold and raw food after drunkenness and overeating. It should be treated as deficiency-cold." Because he had taken so much dried ginger, Zhu prescribed Siwu Tang (Four Substance Decoction) minus Rehmannia Glutinosae, adding Ginseng, Atractylodes Macrocephala, Tangerine Peel, Wine-processed Carthamus Flower, Poria, and Peach Kernel. Decocted with Ginger Juice, he stabilized after one month.
Zhu Danxi stated: Zhao Lidao, nearing fifty, had a weak constitution and was prone to anger. In the hot July, he was extremely hungry and demanded food. His family could not prepare it quickly, causing great anger. Two days later, he developed dysentery with thirst. He drank honey mixed with cold water, feeling very relieved, and the dysentery gradually eased. This continued for five to seven days. When summoned, his pulse was slightly large but not rapid. I instructed him to stop the honey water. When thirsty, he should only drink a decoction of Ginseng and Atractylodes Macrocephala, mixed with Yiyuan San (Benefit Yuan Powder). The dysentery gradually subsided. After seven or eight days, he felt very fatigued and hiccuped. Knowing that prolonged diarrhea led to Yin deficiency, I told him to stick to the previous prescription. However, the dysentery had not stopped. We used refined honey again. This continued for three days, yet the hiccups persisted. Everyone blamed the medicine as inappropriate and planned to use Dried Ginger and Aconite. I said, "Tonifying medicines act slowly; Aconite is not for tonifying Yin. Taking it will surely cause death." They said, "He drank so much cold water; isn't it cold?" I said, "In such hot weather, drinking cold things is not cold. Do not doubt. Wait for the medicine to take effect, and it will stop naturally." Four days later, both the hiccups and dysentery ceased.
Chen Zairen, nearing seventy, enjoyed rich flavors. He had a chronic asthma condition with irregular onset and remission. In early autumn, he developed dysentery with significantly reduced appetite. After five to seven days, he vomited, hiccuped, and had a full pulse that felt empty. Everyone considered it difficult to treat. Zhu said, "For thin individuals, it is still treatable." He used Scutellaria Baicalensis stir-fried until dry and ground into powder, formed into pills with aged rice, size of small peas. Each dose was thirty pills, taken with a strong decoction of Ginseng, Atractylodes Macrocephala, and Poria. Three doses resulted in a cure. One must absolutely avoid hot herbs like Clove.
Yu Zhen's commentary: Danxi's cases are never repetitive, vastly different from Ma Yuanyi's. The most difficult aspect to emulate is recognizing deficiency even after administering three jin of dried ginger; combining Yiyuan San after using Ginseng and Atractylodes, or combining Scutellaria. Unless one has true insight, how could one remain unconfused?
Huxian Weng treated a noblewoman suffering from dysentery with abdominal pain and waist distension. Weng diagnosed her pulse as deep and sluggish, and the Chi position choppy. He said, "This is due to stagnation and depression of Qi and Blood. Regulating Blood and harmonizing Qi will stop the dysentery. I know this because the pulse is deep and sluggish (Qi disharmony) and choppy at the Chi position (injury to Essence and Blood). The disease arose from emotional stagnation followed by forced eating, injuring both Qi and Blood." He prescribed Siwu Tang (Four Substance Decoction), Wuling San (Five-Ingredient Powder with Poria), and Costus Root. Pain subsided slightly. Doubling the Angelica Sinensis allowed the meridians to flow freely, stopping the dysentery.
Wang Shishan said: My brother, over sixty, dark-complexioned and generally healthy, contracted dysentery in September. I was away. He self-medicated with three doses of purgatives, reducing the illness. By October, tenesmus remained, and dysentery persisted. Pulse was soft, scattered, and quite slow. Initially, I used Ginseng 2 qian, Angelica, White Peony, Scutellaria, Bupleurum, and Peach Kernel 1 qian each, Areca Seed 0.5 qian. Decocted and taken. Tenesmus resolved. I then removed Peach Kernel and Areca Seed, adding Atractylodes Macrocephala 1.5 qian. Dysentery stabilized. Only a nodule the size of a plum developed inside the anus, near the Weiliao acupoint, causing swelling and pain. I said, "This is due to straining causing Qi and Blood to stagnate there. Endure a few days, and it will suppurate and heal spontaneously." As predicted, he later took Huaijiao Wan (Stempryce Pill), but hemorrhoid pain persisted. Using Ginseng 3 qian, Angelica, Bupleurum, etc., he recovered.
A woman over fifty suffered from dysentery for over half a year. Doctors used Siwu Tang (Four Substance Decoction) for cooling blood and Xianglian Wan (Costus and Coptis Pill), worsening the condition. She had severe epigastric and abdominal pain, tenesmus, frequent stools, belching, occasional cough, and generalized irritability and heat. Wang Shishan diagnosed the pulse as fine, weak, and rapid. He said, "This is deficiency of the Intestines and Stomach due to prolonged downward discharge. Doctors used cold-cooling herbs, further assisting the downward direction. How can the disease settle? The Classic says: 'Lift what sinks; tonify what is deficient.' This is the method." He used Ginseng and Atractylodes Macrocephala as sovereign drugs, Poria and White Peony as minister drugs, Tangerine Peel, Licorice, and Bupleurum as assistant drugs. Ground into powder, 2 qian per dose, taken with clear rice water, twice or thrice daily. He stabilized.
Wu Jiaoshan treated a woman with dysentery in mid-summer. Pain was urgent, passing yellow-black stool. Other doctors used Ruling Tang (Artemisia and Poria Decoction) with doubled Zhiqiao (Bitter Orange) and Huanglian (Coptis). The condition worsened. Wu diagnosed both Chi pulses as tight and choppy, knowing Cold injured the Ying (Nutritive) level. Asking the cause, she drank a bowl of cold water while menstruating due to thirst. Blood coagulated from the cold water, blood stasis returned to the Large Intestine, and Heat descended. He used Tao Ren Chengqi Tang (Peach Kernel Order the Qi Decoction) plus Marsdenia Vine and Corydalis Rhizome. After one dose, she passed about one sheng (approx. 1 liter) of black blood the next morning. Pain stopped, intestines cleared. Then, a formula to regulate Spleen and invigorate Blood was used, and she recovered. This was dysentery caused by menstrual blood coagulation.
Yu Zhen's commentary: This case first used Artemisia and Coptis, worsening the condition. Combined with the tight and choppy Chi pulse, it was clearly Cold injuring Ying. Why not use warm herbs to assist in resolving stasis? Instead, Chengqi Tang plus stasis-resolving herbs was used. Was it because tenesmus required purging rather than warming?
Xue Lizhai treated Gu Dongjiang, Vice Minister of Rites, who had food stagnation leading to dysentery with abdominal pain and bearing down. Others used draining agents, causing swollen legs, poor appetite, fatigue, irritability, thirst, and a flooding, rapid pulse that felt fine and subtle upon heavy pressure. He used Liu Junzi Tang (Six-Gentlemen Decoction) plus Dried Ginger and Cinnamon Twig (2 qian each), Evodia Fruit and Schisandra Berry (1 qian each). Decocted and served chilled. He slept immediately. Upon waking, symptoms drastically reduced. This was treating false heat with false cold.
Lizhai also said: My mother, aged eighty, contracted dysentery in mid-summer with abdominal pain, vomiting, refusal to eat, thirst for fluids, and abdominal pain relieved by pressure. The pulse was forceful and strong, indicating Deficiency of True Qi and Excess of Pathogenic Qi. Urgently, I used Ginseng 5 qian, Atractylodes Macrocephala and Poria 3 qian each, Tangerine Peel, Bupleurum, Aconite, and Honey-fried Licorice 1 qian each. After taking it, she slept, woke up asking for food, and pulse/symptoms retreated. Two more doses brought stability. This is relying on symptoms over pulse. For acute diseases, regardless of the pulse, follow the symptoms. At that time, Lady Shi Ge had the same age, pulse, and symptoms. However, she was treated specifically for dysentery, leading to her demise.
Yu Zhen's commentary: Lizhai said: For acute diseases, do not judge by pulse alone; follow the symptoms. I assume Mr. Xue based this on deficiency-cold patterns. If symptoms show excess heat but the pulse is fine/subtle or empty upon pressure, then follow the pulse over symptoms. Reading Xue's medical records reveals this.
Lizhai also said: An elderly man habitually drank wine and milk together. He had diarrhea, resembling dysentery but not quite. Chest and diaphragm felt uncomfortable. Medicines for phlegm-dysentery failed. I recalled the Materia Medica stating: Wine and milk should not be drunk together; acid causes coagulation, bitterness causes dispersion. Thus, I made pills with tea leaves, sending them down with clear tea, 30-50 pills at a time. (Cured).
Yu Zhen's commentary: This matches Shen Yi's case treating the Prince of Su, but making pills with tea and administering with tea is superior.
Zhang Sanxi treated a man with dysentery accompanied by chills and fever. Left pulse floating and tight, right pulse slippery and large. This was internal injury complicated by external contraction. First, Baidu San (Rescue the Hundred Decoction) plus Dried Ginger and Scallion was given. Exterior symptoms resolved completely. However, epigastric distension and fullness persisted, along with tenesmus. Pingwei San (Regulate the Stomach Powder) plus Bitter Orange, Costus Root, Areca Seed, and Hawthorn Fruit was used. After two doses, distension moved to the lower abdomen. Muxiang Binglang Wan (Costus and Areca Seed Pill) 3 qian was administered, discharging sticky hard matter, curing the disease.
Another woman with dysentery self-administered Chengqi Tang twice without success. Zhang diagnosed the left pulse as floating with a wiry quality, right three positions deep, Guan position slightly slippery. It must be caused by food retention due to depression. The family said she was prone to anger. Thus, Magnolia Bark, Atractylodes Lancea, Cyperus Rotundus, and Ligusticum Chuanxiong were used to soothe depression; Hawthorn, Areca Seed, Tangerine Peel, and Costus Root to regulate Qi; White Peony to harmonize the middle. Three doses cured her.
Gong Yunlin treated Grand Coordinator Liu Chungang, nearing seventy, with dysentery involving pus, blood, and abdominal pain. Other doctors failed. Gong diagnosed six pulses as slightly rapid, indicating excessive rich food and internal accumulated heat. He advised taking 1 liang of wine-steamed Rhubarb to clear and drain. The Coordinator said, "I am old and frail; I fear I cannot tolerate it. Only mild tonifying agents are acceptable." Gong explained repeatedly, and he took it. He recovered the next day.
He also treated Prefect He Zhufeng with red-and-white dysentery, occurring day and night without limit, generalized itching, and mental restlessness. Gong diagnosed six pulses as large and rapid, with the Renying (Carotid) pulse dominant. This was Wind-Evil and Heat-Toxin. He used Renshen Baidu San (Ginseng Rescue the Hundred Decoction), removing Ginseng, adding Schizonepeta, Saposhnikovia, and Coptis Chinensis. Two doses cured it, but the six pulses remained large and rapid. Gong said, "Rapid indicates vexation; large indicates disease progression. There will likely be Phlegm-Asthma complications, and he will not survive." Over a month later, it happened as predicted.
Yu Zhen's commentary: One case uses 1 liang of Rhubarb for someone nearing seventy; this cannot serve as a model. The other predicts complications from persistent rapid/large pulses despite symptom resolution, showing foresight. However, why not use Yin-tonifying herbs to address the rapid/large pulse?
Li Shicai treated Sun Xiaoxiang, wife of the Military Commissioner, with dysentery for forty days. She had dry mouth, fever, inability to eat, abdominal distension, and undigested food in stool. Some claimed this was "evil heat failing to digest grain." She had taken over thirty doses of aromatics, Coptis, Bitter Orange, Magnolia, and Cardamom. She had been fasting for five days, life hanging by a thread. Li diagnosed a large, rapid pulse that felt hollow upon pressure. Inquiry revealed abdominal pain relieved by pressure and clear urine. This was Fire deficiency failing to generate Earth, true internal cold with false external heat. Urgently, Fuzi Lizhong Tang (Aconite and Middle-Warming Decoction) was decocted and taken cold. One dose stopped pain; six doses reduced fever and restored appetite. Combined with Bawei Wan (Eight-Ingredient Pill), she recovered after twenty-plus days.
Military Commander Zhang contracted dysentery in autumn. Formulas containing Coptis, Costus, Bitter Orange, and Magnolia were used for two months without improvement. Li diagnosed a slippery, forceful pulse, indicating missed purgation. He used Coptis, Costus, Angelica, White Peony, Tangerine Peel, Bitter Orange, plus 3 qian Rhubarb. Much foul matter was discharged. The pulse remained forceful, so the previous formula was continued. Several bowls of fish-intestine-like excrement were expelled. After ten days of regulation, he recovered.
Yu Zhen's commentary: This case is superior to the previous one. Its success lies entirely in accurate pulse diagnosis.
Miu Zhongchun treated a young nobleman. During summer travel, improper diet combined with summer heat led to dysentery. No medicine was available en route; dysentery stopped temporarily. Upon returning home, abdominal pain persisted. He tried various doctors' prescriptions; upon ingestion, pain worsened, and appetite vanished. Miu said, "This is Damp-Heat." The father said, "Doctors also treated it as Damp-Heat, but it worsened." Miu asked what was prescribed: Atractylodes, Coptis, Magnolia, Tangerine Peel. Miu said, "Wrong. Atractylodes is warm and drying, closing Qi. The young master is Yin-deficient; this is unsuitable." He used 1 liang of Talc ground finely, cooked in Peony Tree Bark juice. Separately, 5 qian White Peony, 2 qian Honey-fried Licorice, and 0.5 qian Stir-fried Black Ginger were decocted to mix with the Talc powder. Soon, urination flowed like a stream, and pain stopped instantly.
Zhu Ruqiong treated Department Head Zu Zeyuan. Summer dysentery, 70-80 times day and night, unbearable pain, passing only a few drops of bloody pus, no food intake for over a month, extreme emaciation. Doctors feared toxic vapors blocking the stomach opening, causing vomiting upon smelling food—a bad omen. Zhu observed a warm face but cool body, large and slippery pulse. Long illness implies increasing pathogen, usually with fever; now body is cool, yet pulse is large. Examining the Stomach pulse, it fluctuated between large and small. Zhu realized, "This is not Jin Kou Dysentery (Dysentery with inability to eat). Cold was contracted but not dispersed, causing accumulated cold above the Stomach. Summer heat was not cleared, causing accumulated heat below the Stomach. Use warm herbs to open the cold in the stomach opening, and cool herbs to clear heat in the bowel. The illness is very deficient from duration; tonify it. Recovery in four to five days." Listeners were shocked. He used Evodia-treated Coptis, Scutellaria stir-fried with Ginger Juice, baked Ginger, and White Cardamom (1 qian each), Atractylodes Macrocephala stir-fried with wall soil (0.8 qian), Ginseng wrapped in Southern Jujube and baked (0.8 qian). Decocted and taken. That night, illness halved. Five to six doses restored spirit.
Yu Zhen's commentary: Cooking Talc in Peony Tree Bark juice with a little roasted Ginger as an adjunct is excellent formulation and administration. Zhu's discussion is good, but the formula is mediocre. Its efficacy...
Sun Dongsu treated the wife of Wen Xunqiao. Fever, nausea, lower abdominal pain. Originally caused by eating after anger, forming accumulation, left leg soreness for ten days. Nanxun gynecologists first treated it as plague, worsening vomiting/hiccup. Then treated as malaria, unable to eat, turning into dysentery with tenesmus, 30+ times day/night. Gynecologists exhausted options, saying, "The disease has turned adverse. Dysentery with cool body lives; fever dies. Deep/fine pulse lives; flooding/large pulse dies. Now fever, large pulse, and inability to eat—what can be done?" Sun Dongsu was consulted. Both hands slippery and large, Chi particularly forceful. Sun said, "The syndrome is not adverse; misdiagnosing as plague/malaria is adverse. Though not eating for many days, the Chi pulse is forceful. The Classic says: 'What is below, draw it out and exhaust it.' Treatment follows downward expulsion; survival is possible." He gave 1.5 qian of Danggui Longhui Wan (Angelica and Gardenia Pill). Thick accumulation half a basin was discharged; pain reduced largely. Not eating for fourteen days, he finally drank a bowl of porridge. Chest/diaphragm still full/stuffy, not hungry. Red Liushen Wan (Red Six-Spirit Pill) 2 qian was given; chest relaxed, lower abdomen soft. Only hip pain and cold lower abdomen remained. Hot bricks were applied. White discharge continuously from the uterus, scanty urination. Formula changed to Wuling San (Five-Ingredient Powder with Poria) plus Angelica Dahurica, Fennel, White Celosia Flower, and Bupleurum. At night, whole abdomen hurt urgently. Wuling脂 (Trogopterus Dung) vinegar-fried to powder, wine-paste pills, taken with plain water 3 qian. Slept peacefully all night. Next day, spirit clear, appetite increased, urination free. Only white discharge remained. Smoked Cyperus and Alum (1 liang each), paste pills, taken on empty stomach with Motherwort decoction 2 qian. Before finishing the dose, white discharge ceased, fully recovered.
Sun Dongsu treated nephew Congming. Early summer, contracted dysentery from guest lodging, 30-40 times day/night, tenesmus, thirst, sweating, burning chest/diaphragm, hot palms, slight abdominal pain, scanty urine, dry retching/nausea. Left pulse deep/wiry, right slippery/rapid. Sun noted the patient's originally weak constitution and fatigue from travel, dared not use purgatives lightly. Tentatively used Weifeng Tang (Wind-Stomach Decoction) plus Coptis. Two doses ineffective, slight abdominal distension. Patient urged Sun: "Ancients say no accumulation, no dysentery. Accumulation is stubborn; absolutely no tonification. Do not let inherent weakness confuse you." Sun switched to Huangqin Shaoyao Tang (Scutellaria and White Peony Decoction). Three doses showed no progress. Sun said, "This syndrome presents both excess and deficiency, heat and cold, very difficult to treat. Food is rejected, dry retching is worrying. Must find a higher expert to consult." Patient trusted Sun more firmly. Sun planned to open the stomach opening first, letting new food press out old filth, then decide tonification or purgation based on urgency. Secretly told nephew: "Your uncle absolutely needs Ginseng. Do not reveal this, so I can exert my skill." Mimicking Danxi, he used Ginseng and Coptis (2 qian each), decocted strongly, sipped slowly. Retching stopped. Continued for two days, chest/abdomen became full. Responded with Baohe Wan (Harmonize Stomach Pill). Urination became difficult; responded with Qingliu Wan (Clear Six Pill). Tenesmus: Ginseng, Atractylodes, Scutellaria, Coptis, Costus, Areca, Talc, Peach Kernel. Ginseng was secretly added; patient unaware. Every pulse check, Sun said, "Disease is calming; do not rush tonification, fearing wasted effort." Unbeknownst to patient, Ginseng had been taken for ten days, totaling approx. 2 liang. Afterwards, pulse was only four beats per breath, soft and weak. Recalling Danxi: "When deficiency returns, dysentery stops." And: "For severe Qi deficiency, only Aconite can move Ginseng." Used Weifeng Tang plus Ginseng, Aconite, Baked Ginger. Four doses stopped bleeding and tenesmus. Then used Cuscuta, Cornus, Psoralea...