古之滞下之病，即今之赤白痢疾者是也。治此者，当审贫富而别病机。贫人之妇，未有
不因外感寒、暑、燥、湿、风、火之气而伤于脾胃。脾胃既伤，而又内伤饮食劳倦，不能克化，
致令积滞而成滞下。富家妇女，尽是膏粱之变，兼受外邪，内伤生冷湿热之邪而成滞下。古人云∶
无积不成痢者，此也。凡滞下多生于秋后，何也？脾胃久伤，饮食之积至夏秋之间，复感暑湿
之邪，触动而作。其始，腹痛洞泻，泻后里急后重，欲去不去，欲下不下，故曰滞下。今概云痢，
世俗之称也。其证或红或白，或红白杂下，甚者一日一夜常行百度。其始作者，若是贫家，不论
虚实，当先用神术散，发散外感、六淫之邪气，次服感应丸、承气汤之类，逐其内邪。内邪既去，
再服平胃、五苓之类，调和中气，未有不效者也。若是富室，当先用感应丸、木香槟榔丸、山楂
神曲麦芽汤之类，消导积滞，次用香连丸、黄连解毒汤，五苓散之类调和中气，亦未有不安
者也。惟妊娠之妇，不可峻下，比之常妇，减药之半而下之，亦无伤于胎孕也。若不微下，其积
不去，而痢终莫能止，此又量人之虚实轻重而施之可也。
凡滞下，曾通利消导数次，久不已者，此为气虚滑脱。经曰∶下者举之，滑者涩之。此
时当以升提固涩之剂，如补中益气汤倍加升麻、固肠丸之类，无不速效。医者以此推治，大人、
小儿，亦无逾于此也。
神术散 治贫妇外感之邪，复伤脾胃作痢，及伤寒头痛，项背拘急，鼻流清涕，先用
此发散。
苍术（半斤） 本 川芎（各三两） 羌活（二两） 甘草 细辛（各八钱）
为末，每服三钱，水一盏，姜二片、葱一根，煎七分，稍热服，要取微汗。
六神丸 治赤白痢疾。
神曲 麦芽 茯苓 黄连（赤者加倍） 广木香 枳壳（炒。各等分）
为细末，神曲糊丸，梧桐子大，每服五十丸，赤痢，甘草汤下；白痢，干姜汤下；赤白兼
下，甘草干姜汤下。急用时，不暇丸，煎汤空心服亦可，名六神汤。
感应丸、承气汤并治滞下，积宿一服，不愈再一服，必愈。其不愈者，用和气分利药。
（方见前滞下门。）
香连丸、胃苓汤、固肠丸、斗门散（并见前门。）
调中汤 治滞下，以兼通利消导，但似泻非泻，似痢非痢宜此。
葛根 黄芩 白术 桔梗 本 赤芍药 白芍药 甘草（炙。各等分）
上咀，每服三钱，水一盏煎七分服。
参香散 治男妇小儿阴阳不和，冷热相搏，积痢赤白，日夜无度，里急后重，脐腹疼痛，
水泻肠鸣，久久注下，冷气积滞，并可治之。
罂粟壳（制） 陈皮 粉草（各一两） 浓朴（制，半两） 青皮 白姜（各一钱）
上为细末，每服二钱，空心，陈米饮调下。忌生冷油腻、酒面炙爆。
豆蔻饼 治赤白痢疾，脐腹疼痛，水泻肠鸣，久而不愈，虚寒下脱。
罂粟壳（制） 白芍药 黄 （二钱） 陈皮 青皮 木香 诃子 肉豆蔻（煨）
人参（各钱半） 羌活 当归（各一两）
上为末，炼蜜丸，弹子大。每服二丸，水一盏，煎八分，空心温服。
石莲子散 治噤口痢如神。
石莲子（半两） 石菖蒲 人参（各二钱）
上为细末，分作三服，不拘时陈米饮调下。
三黄熟艾汤 治伤寒四、五日后，大下热痢，诸药不效，宜此。
黄芩 黄柏 黄连（各一钱） 熟艾（一圆，核桃大小）
上水盏半，枣一枚，煎八分服。
古代所说的“滞下”病，就是现在所说的赤白痢疾。治疗这种病，应当根据患者的贫富情况来辨别病机。贫穷人家的妇女，大多没有不是因为外感寒、暑、燥、湿、风、火等邪气而损伤脾胃的。脾胃一旦受损，再加上内伤于饮食不节和劳倦过度，导致食物不能消化，从而形成积滞，进而引发滞下。富贵人家的妇女，多因食用肥甘厚味（膏粱之变）所致，兼受外邪侵袭，以及内伤于生冷、湿热之邪，从而形成滞下。古人说：“没有积滞就不会形成痢疾”，指的就是这种情况。凡是滞下病多发生在秋季之后，为什么呢？因为脾胃长期受损，饮食积滞在夏秋之间，又感受了暑湿之邪，触动而发病。起初表现为腹痛、水样腹泻，泻后出现里急后重（想拉拉不出，想放放不尽的感觉），欲去不去，欲下不下，所以称为“滞下”。现在一概称之为“痢”，这是世俗的叫法。其症状或为红色，或为白色，或红白相杂而下，严重的患者一天一夜排便可达百次。起初发病时，如果是贫家患者，不论虚实，应当先用神术散，发散外感和六淫邪气，接着服用感应丸、承气汤之类，驱逐体内积滞之邪。体内邪气去除后，再服用平胃散、五苓散之类，调和中和中焦之气，没有不奏效的。如果是富室患者，应当先用感应丸、木香槟榔丸、山楂神曲麦芽汤之类，消导积滞，接着用香连丸、黄连解毒汤、五苓散之类调和中和中焦之气，也没有不安稳的。只有妊娠期的妇女，不可使用峻猛攻下的药物，相比普通妇女，减少一半药量进行攻下，也不会伤害胎孕。如果不轻微攻下，积滞不去除，痢疾终究无法停止，这也是根据人的虚实轻重来施治的道理。
凡是滞下病，经过多次通利、消导治疗后，长久不愈的，这属于气虚滑脱证。《内经》说：“下陷者宜升提，滑脱者宜固涩。”此时应当使用升提固涩的方剂，如补中益气汤加倍加入升麻、固肠丸之类，无不迅速见效。医生以此类推治疗，无论是大人还是小儿，也没有超出这个范围的。
神术散：治疗贫妇外感邪气，再次损伤脾胃导致痢疾，以及伤寒引起的头痛、项背拘急、鼻流清涕，先用此方发散。
苍术（半斤）、本（川芎、羌活各三两）、甘草、细辛（各八钱）。
研为细末，每次服用三钱，用水一盏，生姜二片、葱一根，煎至七分，稍热服用，要求微微出汗。
六神丸：治疗赤白痢疾。
神曲、麦芽、茯苓、黄连（红色痢疾加倍）、广木香、枳壳（炒。各等分）。
研为细末，用神曲糊制作成梧桐子大小的丸药，每次服用五十丸，红色痢疾用甘草汤送服；白色痢疾用干姜汤送服；红白相兼用甘草干姜汤送服。紧急使用时，来不及做丸药，煎汤空腹服用也可以，名为六神汤。
感应丸、承气汤并治滞下，宿积一次服药，不愈再服一次，必定痊愈。如果不愈，使用和气分利的药物。（方剂见前文滞下门。）
调中汤：治疗滞下，以兼有通利消导作用为宜，但症状似泻非泻、似痢非痢时适宜使用此方。
葛根、黄芩、白术、桔梗、本、赤芍药、白芍药、甘草（炙。各等分）。
切碎，每次服用三钱，用水一盏煎至七分服用。
参香散：治疗男女小儿阴阳不和，冷热相搏，积滞痢疾赤白，日夜无度，里急后重，脐腹疼痛，水样腹泻肠鸣，久泻不止，冷气积滞，均可治疗。
罂粟壳（制）、陈皮、粉草（各一两）、浓朴（制，半两）、青皮、白姜（各一钱）。
研为细末，每次服用二钱，空腹时用陈米饮调服。忌食生冷油腻、酒面及烤炸食物。
豆蔻饼：治疗赤白痢疾，脐腹疼痛，水泻肠鸣，久治不愈，虚寒下脱。
罂粟壳（制）、白芍药、黄芪（二钱）、陈皮、青皮、木香、诃子、肉豆蔻（煨）、人参（各钱半）、羌活、当归（各一两）。
研为末，炼蜜制成弹子大小的丸药。每次服用二丸，用水一盏，煎至八分，空腹温服。
石莲子散：治疗噤口痢效果神奇。
石莲子（半两）、石菖蒲、人参（各二钱）。
研为细末，分作三次服用，不拘时间，用陈米饮调服。
三黄熟艾汤：治疗伤寒四五日后，严重热痢，其他药物无效时，适宜使用此方。
黄芩、黄柏、黄连（各一钱）、熟艾（一团，核桃大小）。
用水一盏半，大枣一枚，煎至八分服用。
The ancient term "Zhi Xia" (Stagnant Downward Flow) refers to what is now known as dysentery with red and white discharge. When treating this condition, one must differentiate the pathogenesis based on the patient's socioeconomic status. Women from poor families are mostly injured in the Spleen and Stomach due to external contraction of Cold, Summerheat, Dryness, Dampness, Wind, or Fire pathogens. Once the Spleen and Stomach are damaged, internal injury from improper diet and overexertion leads to an inability to digest food, resulting in accumulation and stagnation, which causes Zhi Xia. Women from wealthy families often suffer from changes caused by rich and greasy foods (Gao Liang), combined with external pathogens and internal injury from cold, raw, damp-heat evils, leading to Zhi Xia. The ancients said, "No accumulation means no dysentery," referring to this mechanism. Zhi Xia generally occurs after autumn. Why? Because long-term Spleen and Stomach damage allows food accumulation to persist until summer and autumn, when it is triggered by contracting Summerheat and Dampness pathogens. Initially, there is abdominal pain and watery diarrhea. After defecation, there is tenesmus (a feeling of incomplete evacuation), a desire to pass stool but unable to do so completely, hence the name "Zhi Xia." Today, it is generally called "Li" (Dysentery), which is a secular term. Symptoms may present as red, white, or mixed red and white discharge. Severe cases may have up to one hundred bowel movements per day. In the early stage, if the patient is from a poor family, regardless of deficiency or excess, Shen Shu San (Divine Skill Powder) should be used first to disperse external and Six Excess pathogens, followed by Gan Ying Wan (Responsive Pill) or Cheng Qi Tang (Descending Qi Decoction) to purge internal pathogens. Once internal pathogens are removed, Ping Wei San (Calm the Stomach Powder) or Wu Ling San (Five-Ingredient Powder with Poria) can be taken to harmonize the Middle Jiao Qi, which will invariably be effective. If the patient is from a wealthy family, Gan Ying Wan, Mu Xiang Bing Lang Wan (Aucklandia and Areca Nut Pill), or Shan Zhen Shen Qu Mai Ya Tang (Hawthorn, Medicated Leaven, and Malt Decoction) should be used first to resolve accumulation and guide out stagnation, followed by Xiang Lian Wan (Fragrant Coptis Pill), Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), or Wu Ling San to harmonize the Middle Jiao Qi, which will also ensure stability. For pregnant women, harsh purgatives are contraindicated; compared to non-pregnant women, the dosage should be halved for purging, which will not harm the fetus. If mild purging is not performed, the accumulation remains, and the dysentery cannot stop. This illustrates treatment based on the severity and constitution of the individual.
For Zhi Xia that persists despite multiple treatments with purgative and resolving methods, this indicates Qi deficiency with slipping and prolapse. The Classics state: "For sinking conditions, use lifting methods; for slipping conditions, use astringent methods." At this time, formulas for lifting and astringing, such as Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Sheng Ma (Cimicifugae Rhizoma) and Gu Chang Wan (Intestine-Solidifying Pill), should be used, which will yield rapid results. Physicians applying this principle to both adults and children will find no deviation from this approach.
Shen Shu San (Divine Skill Powder): Treats dysentery caused by external pathogens injuring the Spleen and Stomach in poor women, as well as headache, stiffness of the neck and back, and clear nasal discharge due to Taiyang Cold Damage. Use this first to disperse pathogens.
Cang Zhu (Rhizoma Atractylodis Macrocephalae, 8 liang), Ben Cao (Ligustici Chuanxiong Rhizoma, 3 liang), Qiang Huo (Notopterygii Rhizoma et Radix, 3 liang), Gan Cao (Radix Glycyrrhizae Preparata, 2 liang), Xi Xin (Asari Radix et Rhizoma, 0.8 liang).
Grind into powder. Take 3 qian per dose with 1 cup of water, 2 slices of fresh ginger, and 1 stalk of green onion. Decoct to 0.7 cup. Drink warm to induce slight sweating.
Liu Shen Wan (Six Divine Pills): Treats red and white dysentery.
Shen Qu (Massa Medicata Fermentata, equal parts), Mai Ya (Fructus Hordei Germinatus, equal parts), Fu Ling (Sclerotium Poriae cocos, equal parts), Huang Lian (Coptidis Rhizoma, double dose for red dysentery), Guang Mu Xiang (Radix Aucklandiae, equal parts), Zhi Ke (Pericarpium Citri Reticulatae Viride, stir-fried, equal parts).
Grind into fine powder. Make pills using Shen Qu paste, size of Sophora japonica seeds. Take 50 pills per dose. For red dysentery, take with Gan Cao decoction; for white dysentery, with Gan Jiang decoction; for mixed, with Gan Cao and Gan Jiang decoction. For urgent use, decoct as tea and take on an empty stomach, named Liu Shen Tang (Six Divine Decoction).
Gan Ying Wan (Responsive Pill) and Cheng Qi Tang (Descending Qi Decoction) both treat Zhi Xia. One dose resolves accumulated feces; if ineffective, repeat. If still ineffective, use harmonizing and diuretic herbs. (See formulas in previous Zhi Xia section.)
Xiang Lian Wan (Fragrant Coptis Pill), Wei Ling Tang (Stomach and Five-Ling Decoction), Gu Chang Wan (Intestine-Solidifying Pill), Dou Men San (Dou Gate Powder). (See respective sections.)
Tiao Zhong Tang (Regulate the Middle Decoction): Treats Zhi Xia with mild purgative and resolving effects, suitable for symptoms resembling diarrhea but not quite, or resembling dysentery but not quite.
Ge Gen (Puerariae Lobatae Radix, equal parts), Huang Qin (Scutellariae Radix, equal parts), Bai Zhu (Atractylodis Macrocephalae Rhizoma, equal parts), Jie Geng (Platycodonis Radix, equal parts), Ben Cao (Ligustici Chuanxiong Rhizoma, equal parts), Chi Shao Yao (Paeoniae Radix Rubra, equal parts), Bai Shao Yao (Paeoniae Radix Alba, equal parts), Zhi Gan Cao (Prepared Licorice Root, equal parts).
Cut into pieces. Take 3 qian per dose with 1 cup of water, decoct to 0.7 cup.
Shen Xiang San (Ginseng and Fragrant Powder): Treats Yin-Yang disharmony in men, women, and children, clashing of cold and heat, accumulated dysentery with red and white discharge, frequent bowel movements day and night, tenesmus, umbilical and abdominal pain, watery diarrhea with borborygmus, chronic leakage, and cold qi accumulation. All can be treated.
Ying Su Ke (Papaveris Pericarpium, processed, 1 liang), Chen Pi (Citri Reticulatae Pericarpium, 1 liang), Fen Cao (Licorice Root, 1 liang), Hou Po (Magnoliae Officinalis Cortex, processed, 0.5 liang), Qing Pi (Citri Reticulatae Pericarpium Viride, 0.1 liang), Bai Jiang (Zingiberis Rhizoma Recens, 0.1 liang).
Grind into fine powder. Take 2 qian per dose on an empty stomach, mixed with aged rice water. Avoid cold, raw, greasy foods, alcohol, noodles, and roasted/fried items.
Dou Kou Bing (Cardamom Cake): Treats red and white dysentery, umbilical and abdominal pain, watery diarrhea with borborygmus, chronic non-healing cases, and deficiency-cold with downward slipping.
Ying Su Ke (Papaveris Pericarpium, processed, 2 qian), Bai Shao Yao (Paeoniae Radix Alba, 2 qian), Huang Qi (Astragali Radix, 2 qian), Chen Pi (Citri Reticulatae Pericarpium, 1.5 qian), Qing Pi (Citri Reticulatae Pericarpium Viride, 1.5 qian), Mu Xiang (Aucklandiae Radix, 1.5 qian), He Zi (Terminalia Chebulae Fructus, 1.5 qian), Rou Dou Kou (Myristicae Semen, roasted, 1.5 qian), Ren Shen (Ginseng Radix et Rhizoma, 1.5 qian), Qiang Huo (Notopterygii Rhizoma et Radix, 1 liang), Dang Gui (Angelicae Sinensis Radix, 1 liang).
Grind into powder. Make pills with refined honey, size of a walnut. Take 2 pills per dose with 1 cup of water, decoct to 0.8 cup. Take warm on an empty stomach.
Shi Lian Zi San (Stone Lotus Seed Powder): Treats Jin Kou Li (Jin Kou Dysentery - inability to eat/drink due to dysentery) with miraculous effect.
Shi Lian Zi (Nelumbinis Plumula, 0.5 liang), Shi Chang Pu (Acori Tatarinowii Rhizoma, 2 qian), Ren Shen (Ginseng Radix et Rhizoma, 2 qian).
Grind into fine powder. Divide into three doses. Take at any time with aged rice water.
San Huang Shu Ai Tang (Three Yellows and Cooked Mugwort Decoction): Treats severe heat dysentery occurring four to five days after Taiyang Cold Damage, when other medicines fail.
Huang Qin (Scutellariae Radix, 1 qian), Huang Bo (Phellodendri Cortex, 1 qian), Huang Lian (Coptidis Rhizoma, 1 qian), Shu Ai Ye (Artemisiae Argyi Folium cooked, one ball size of walnut).
Decoct with 1.5 cups of water and one jujube to 0.8 cup.