论曰下痢里急后重者，有瘕聚也。经所谓大瘕泄者，里急后重，数至圊而不能便。茎中
痛是矣，法当和气而祛蕴滞，则脾胃和平，饮食腐化，其脓血自消，大肠自固也。
治里急后重，下痢赤白及下部 痛，当归散方
当归（切焙） 黄连（去须炒） 干姜（炮） 黄柏（去粗皮蜜炙各一两）
上四味，捣罗为散，每服三钱匕，浓煎乌梅汁调下，空心食前日二服，若腹中 痛。加
当归，下赤加黄连，下白加干姜。
治后重下痢赤白，滞下腹内结痛。当归黄连汤方
当归（切焙三分） 黄连（去须炒一两半） 赤茯苓（去黑皮三分） 地榆 犀角（屑
三分） 甘草（炙锉
上七味，粗捣筛，每服五钱匕，水一盏半，入生姜一枣大拍碎，同煎至八分，去滓空心
温服、日再。
治大病后重下赤白痢，腹中 痛。石钟乳汤方
石钟乳（别研半两） 黄连（去须炒一两） 防风（去叉） 附子（炮裂去脐皮） 黄
柏（去粗皮蜜炙） 当
上八味，除钟乳外，锉如麻豆，再同和匀，每服四钱匕，水一盏半，煎至八分，去滓温
服，空心食前日二服。
治冷热不和，下痢赤白，脐腹作痛，里急后重，圣功散方
干姜（炮） 五倍子（各一两） 诃黎勒（煨去核） 甘草（炙锉各半两）
上四味，捣罗为细散，每服二钱匕，食前米饮调下。
治肠虚冷热不和，赤白下痢，里急后重，诃黎勒汤方
诃黎勒（煨去核） 草豆蔻（去皮炒） 延胡索（各半两） 干姜（炮一分）
上四味，粗捣筛，每服三钱匕，水一盏，煎至七分，去滓食前温服。
治后重下脓血，如圣散方
臭橘 萆 （各一两）
上二味，同捣碎，炒令烟出放冷，捣罗为细末，每服二钱至三钱匕，茶清调下。
治脏气不调，里急后重，匀气汤方
苍术（米泔浸一宿去皮切曝干） 浓朴（去粗皮生姜汁炙各四两） 甘草（生锉三两） 干
姜（生锉三
上四味，粗捣筛，每服三钱匕，水一盏，煎至六分，去滓食前温服，夏末秋初最宜服。
治热痢下重者，白头翁汤方
白头翁（二两） 黄柏（去粗皮锉） 黄连（去须） 秦皮（锉各三两）
上四味，粗捣筛，每服三钱匕，水一盏，煎至六分，去滓食前温服，日二。
治冷痢里急后重，当归丸方
当归（切焙半两） 胡椒（炒一两） 黄连（去须） 浓朴（去粗皮生姜汁炙各二两） 阿
胶（炙燥一两别
上六味，除阿胶，捣罗为末，用好醋调阿胶为膏和剂，丸如梧桐子大，每服十五丸。食
前橘皮汤下，加至二十丸。
治腹痛虚滑，里急后重，心胸痞闷逆满，或伤冷暴泻，手足厥冷，脉息沉伏。诃黎勒丸
方
诃黎勒（炮去核一两） 肉豆蔻（去壳半两） 白矾（熬令汁枯一两） 木香（半两） 龙
骨（二两） 乌头
上七味，捣罗为末，粟米粥和为丸，如梧桐子大，每服二十丸，食前粟米饮下。
治脏寒下痢，脐腹撮痛，肠鸣胀满，里急后重，不思饮食。日渐羸瘦，胜金丸方
黄连（去须五两） 龙骨（四两） 草豆蔻（去皮） 赤芍药 当归（切焙） 干姜（炮）
地榆 橡实（各三
上一十二味，捣罗为细末，醋煮面糊和丸，如梧桐子大，每服二十丸，至三十丸。煎艾
醋汤下，空心食前服。
治洞泄飧泄，里急后重，姜桂散方
干姜（炮三两） 甘草（一两锉二味用沙糖二两水微化开同炒干） 桂（去粗皮一分）
上三味，捣罗为散，每服二钱匕，白汤调下，兼治腹痛，止虚渴。
治脓血杂痢，后重疼痛，日久不瘥，通神丸方
没药。五灵脂 乳香（各一钱） 巴豆霜（半钱）
上四味，各研细，再同研匀，滴水丸如黄米大，每服七丸，煎生木瓜汤下，小儿三丸，
随岁数加减，空心食前服。
治下痢赤白，日久不瘥，里急后重，取冷积，玉粉丸方
白丁香（直者研一两） 粉霜（研三分） 硫黄（研） 腻粉（研） 砂（研各半两）
乳香（熔过研一分）
上六味。再同研匀，用生姜自然汁，煮枣肉，研和作剂，每服旋丸如豌豆大，临卧煎生
姜枣汤，下七丸，未动次夜服十丸，老少以意加减。
治下痢赤白，里急后重，大肠虚滑，丹砂丸方
丹砂（研） 草乌头（末） 乳香（研各一钱匕） 巴豆（大者去皮心研七枚）
上四味，再同研令匀细，用醋煮面糊和丸，如梧桐子大，每服一丸，冷乳香汤下，不拘
时候。
治下痢腹胀，里急后重，木瓜饮方
干木瓜（焙） 白芷 浓朴（去粗皮生姜汁炙） 白术（锉炒） 木香（各一两） 桂
（去粗皮） 黄连（去须） 当归（炙锉） 缩砂蜜（去皮） 龙骨 诃黎勒皮（煨各一两
半） 陈橘皮（去白焙三分） 杏仁（去皮尖双
上一十四味，粗捣筛，每服五钱匕，以水一盏半，煎取八分，去滓温服。
论述说：下痢伴有里急后重症状的，是因为体内有瘕聚（腹内结块）。医经中所说的“大瘕泄”，指的就是里急后重，频繁去厕所却排不出大便，尿道疼痛的情况。治疗法则应当调和气血以祛除积滞蕴结，这样脾胃功能恢复平和，饮食得以正常消化腐熟，脓血自然消除，大肠功能自然稳固。
治疗里急后重、下痢赤白以及下部疼痛的当归散方：
当归（切碎焙干）一两，黄连（去除须根炒制）一两，干姜（炮制）一两，黄柏（去除粗皮用蜜炙）一两。
以上四味药，捣碎过筛制成散剂，每次服用三钱匕，用浓煎的乌梅汁调服，空腹及进食前服用，每日两次。如果腹部疼痛，增加当归用量；下痢色红者增加黄连用量；下痢色白者增加干姜用量。
治疗后重下痢赤白，滞下且腹部结痛的当归黄连汤方：
当归（切碎焙干）三分，黄连（去除须根炒制）一两半，赤茯苓（去除黑皮）三分，地榆，犀角（锉成屑）三分，甘草（炙制锉碎）。
以上七味药，粗捣筛过，每次服用五钱匕，用水一盏半，加入一块生姜大小拍碎的生姜，一同煎煮至八分满，去渣后空腹温服，每日两次。
治疗大病后出现后重、下赤白痢疾、腹部疼痛的石钟乳汤方：
石钟乳（单独研细）半两，黄连（去除须根炒制）一两，防风（去除叉枝），附子（炮裂去除脐皮），黄柏（去除粗皮蜜炙），当归。
以上八味药，除石钟乳外，其余锉如麻豆大小，再与石钟乳混合均匀，每次服用四钱匕，用水一盏半，煎煮至八分满，去渣温服，空腹及进食前服用，每日两次。
治疗冷热之气不和，下痢赤白，脐腹部作痛，里急后重的圣功散方：
干姜（炮制）一两，五倍子一两，诃黎勒（煨制去核）一两，甘草（炙制锉碎）半两。
以上四味药，捣碎过筛制成细散，每次服用二钱匕，进食前用米汤调服。
治疗肠虚导致冷热不和，赤白下痢，里急后重的诃黎勒汤方：
诃黎勒（煨制去核）半两，草豆蔻（去皮炒制）半两，延胡索半两，干姜（炮制）一分。
以上四味药，粗捣筛过，每次服用三钱匕，用水一盏，煎煮至七分满，去渣后进食前温服。
治疗后重下脓血的如圣散方：
臭橘，萆薢（各一两）。
以上两味药，一同捣碎，炒至冒烟后放冷，再捣罗制成细末，每次服用二钱至三钱匕，用清茶调服。
治疗脏气不调，里急后重的匀气汤方：
苍术（用米泔水浸泡一夜，去皮切片晒干）四两，厚朴（去除粗皮用生姜汁炙）四两，甘草（生锉）三两，干姜（生锉）三两。
以上四味药，粗捣筛过，每次服用三钱匕，用水一盏，煎煮至六分满，去渣后进食前温服，夏末秋初时节最适合服用。
治疗热痢下重的白头翁汤方：
白头翁二两，黄柏（去除粗皮锉碎）三两，黄连（去除须根）三两，秦皮（锉碎）三两。
以上四味药，粗捣筛过，每次服用三钱匕，用水一盏，煎煮至六分满，去渣后进食前温服，每日两次。
治疗冷痢里急后重的当归丸方：
当归（切碎焙干）半两，胡椒（炒制）一两，黄连（去除须根）二两，厚朴（去除粗皮用生姜汁炙）二两，阿胶（炙干）一两（另备）。
以上六味药，除阿胶外，其余捣罗制成粉末，用好醋将阿胶调成膏状，与药末混合，制成梧桐子大小的丸剂，每次服用十五丸。进食前用橘皮汤送服，可加量至二十丸。
治疗腹痛虚滑，里急后重，心胸痞闷逆满，或受冷暴泻，手足厥冷，脉象沉伏的诃黎勒丸方：
诃黎勒（炮制去核）一两，肉豆蔻（去壳）半两，白矾（熬至汁液枯干）一两，木香半两，龙骨二两，乌头。
以上七味药，捣罗制成粉末，用粟米粥和合制成丸剂，如梧桐子大小，每次服用二十丸，进食前用粟米饮送服。
治疗脏腑虚寒下痢，脐腹部拘急疼痛，肠鸣胀满，里急后重，不思饮食，日渐消瘦的胜金丸方：
黄连（去除须根）五两，龙骨四两，草豆蔻（去皮），赤芍药，当归（切碎焙干），干姜（炮制），地榆，橡实（各三两）。
以上十二味药，捣罗制成细末，用醋煮面糊和合制成丸剂，如梧桐子大小，每次服用二十丸至三十丸。煎艾叶醋汤送服，空腹及进食前服用。
治疗洞泄、飧泄，里急后重的姜桂散方：
干姜（炮制）三两，甘草（一两锉碎，此二味药需用沙糖二两加水微化开同炒至干），桂枝（去除粗皮）一分。
以上三味药，捣罗制成散剂，每次服用二钱匕，用白开水调服，兼治腹痛，止虚渴。
治疗脓血杂痢，后重疼痛，日久不愈的通神丸方：
没药，五灵脂，乳香（各一钱），巴豆霜（半钱）。
以上四味药，分别研细，再共同研磨均匀，滴水制成如黄米大小的丸剂，每次服用七丸，煎生木瓜汤送服，小儿服用三丸，根据年龄增减，空腹及进食前服用。
治疗下痢赤白，日久不愈，里急后重，取冷积的玉粉丸方：
白丁香（直者研细）一两，粉霜（研细）三分，硫黄（研细），腻粉（研细），砂（研细，各半两），乳香（熔化后研细）一分。
以上六味药，再次共同研磨均匀，用生姜自然汁煮枣肉，研磨混合做成剂型，每次现搓如豌豆大小的丸剂，临睡前煎生姜枣汤送服七丸，若未排便，次晚服用十丸，老少根据情况加减。
治疗下痢赤白，里急后重，大肠虚滑的丹砂丸方：
丹砂（研细），草乌头（末），乳香（研细，各一钱匕），巴豆（大的去皮心研碎七枚）。
以上四味药，再次共同研磨令其均匀细碎，用醋煮面糊和合制成丸剂，如梧桐子大小，每次服用一丸，冷乳香汤送服，不拘时间。
治疗下痢腹胀，里急后重的木瓜饮方：
干木瓜（焙干），白芷，厚朴（去除粗皮用生姜汁炙），白术（锉碎炒制），木香（各一两），桂枝（去除粗皮），黄连（去除须根），当归（炙制锉碎），缩砂仁（去皮），龙骨，诃黎勒皮（煨制，各一两半），陈橘皮（去白焙干）三分，杏仁（去皮尖双仁）。
以上十四味药，粗捣筛过，每次服用五钱匕，用水一盏半，煎取八分，去渣温服。
Commentary states: Dysentery accompanied by tenesmus (a feeling of incomplete defecation with urgent pain in the rectum) is caused by "Jia Ju" (abdominal masses or accumulations). As stated in the medical classics regarding "Da Xia Xie" (Severe Accumulation Diarrhea), it refers to tenesmus, frequent trips to the toilet without ability to pass stool, and pain in the urethra. The treatment principle should be to harmonize Qi and dispel stagnation and accumulation, thereby restoring the harmony of the Spleen and Stomach, allowing for normal digestion and transformation of food, so that pus and blood will naturally resolve, and the Large Intestine function will stabilize.
Dang Gui San Formula for treating tenesmus, dysentery with red and white discharge, and lower body pain:
Dang Gui (Radix Angelicae Sinensis, cut and roasted) 1 liang, Huang Lian (Rhizoma Coptidis, remove roots and stir-fry) 1 liang, Gan Jiang (Rhizoma Zingiberis, processed) 1 liang, Huang Bo (Cortex Phellodendri, remove rough bark and honey-fry) 1 liang.
The above four ingredients are crushed, sifted into a powder. Take 3 qian bi per dose, mixed with thick decoction of Wu Mei (Fructus Mume) juice, taken on an empty stomach and before meals, twice daily. If abdominal pain occurs, increase Dang Gui; if red discharge, increase Huang Lian; if white discharge, increase Gan Jiang.
Dang Gui Huang Lian Tang Formula for treating tenesmus, dysentery with red and white discharge, stagnation, and internal abdominal knotting pain:
Dang Gui (Radix Angelicae Sinensis, cut and roasted) 3 fen, Huang Lian (Rhizoma Coptidis, remove roots and stir-fry) 1.5 liang, Chi Fu Ling (Poria Cocos with black skin removed) 3 fen, Di Yu (Sanguisorbae Radix), Xi Jiao (Cornu Rhinocerotis, shaved) 3 fen, Gan Cao (Radix Glycyrrhizae, honey-roasted and chopped).
The above seven ingredients are coarsely crushed and sifted. Take 5 qian bi per dose, with 1.5 sheng of water, add ginger piece size one jujube, smashed, decoct together until 0.8 sheng remains, strain and take warm on an empty stomach, twice daily.
Shi Zhong Ru Tang Formula for treating post-illness tenesmus, dysentery with red and white discharge, and abdominal pain:
Shi Zhong Ru (Gypsum Fibrosum, separately ground) 0.5 liang, Huang Lian (Rhizoma Coptidis, remove roots and stir-fry) 1 liang, Fang Feng (Radix Saposhnikoviae, remove forked branches), Fu Zi (Radix Aconiti Lateralis Preparata, processed, cracked, remove umbilical scar and bark), Huang Bo (Cortex Phellodendri, remove rough bark and honey-fry), Dang Gui (Radix Angelicae Sinensis).
The above eight ingredients, except Shi Zhong Ru, are chopped like hemp seeds, then mixed evenly with Shi Zhong Ru. Take 4 qian bi per dose, with 1.5 sheng of water, decoct until 0.8 sheng remains, strain and take warm, on an empty stomach and before meals, twice daily.
Sheng Gong San Formula for treating disharmony of cold and heat, dysentery with red and white discharge, umbilical and abdominal pain, and tenesmus:
Gan Jiang (Rhizoma Zingiberis, processed) 1 liang, Wu Bei Zi (Galla Chinensis) 1 liang, He Li Le (Fructus Chebulae, baked, remove pits) 1 liang, Gan Cao (Radix Glycyrrhizae, honey-roasted and chopped) 0.5 liang.
The above four ingredients are crushed, sifted into a fine powder. Take 2 qian bi per dose, mixed with rice drink before meals.
He Li Le Tang Formula for treating intestinal deficiency causing disharmony of cold and heat, dysentery with red and white discharge, and tenesmus:
He Li Le (Fructus Chebulae, baked, remove pits) 0.5 liang, Cao Dou Kou (Cardamomi Fructus, remove peel and stir-fry) 0.5 liang, Yan Hu Suo (Corydalis Rhizoma) 0.5 liang, Gan Jiang (Rhizoma Zingiberis, processed) 1 fen.
The above four ingredients are coarsely crushed and sifted. Take 3 qian bi per dose, with 1 sheng of water, decoct until 0.7 sheng remains, strain and take warm before meals.
Ru Sheng San Formula for treating tenesmus with purulent blood discharge:
Chou Ju (Aurantii Fructus Fetens), Bi Xie (Dioscoreae Hypoglaucae Rhizoma) (each 1 liang).
The above two ingredients are crushed together, stir-fried until smoke appears, cooled, then crushed and sifted into a fine powder. Take 2 to 3 qian bi per dose, mixed with clear tea.
Yun Qi Tang Formula for treating organ Qi disharmony and tenesmus:
Cang Zhu (Atractylodis Rhizoma, soaked in rice wash overnight, peeled, sliced, and dried) 4 liang, Hou Po (Magnoliae Officinalis Cortex, remove rough bark and fry with ginger juice) 4 liang, Gan Cao (Radix Glycyrrhizae, raw and chopped) 3 liang, Gan Jiang (Rhizoma Zingiberis, raw and chopped) 3 liang.
The above four ingredients are coarsely crushed and sifted. Take 3 qian bi per dose, with 1 sheng of water, decoct until 0.6 sheng remains, strain and take warm before meals. Most suitable for late summer and early autumn.
Bai Tou Weng Tang Formula for treating heat dysentery with heaviness/tenesmus:
Bai Tou Weng (Pulsatillae Radix) 2 liang, Huang Bo (Cortex Phellodendri, remove rough bark and chop) 3 liang, Huang Lian (Rhizoma Coptidis, remove roots) 3 liang, Qin Pi (Cortex Fraxini, chopped) 3 liang.
The above four ingredients are coarsely crushed and sifted. Take 3 qian bi per dose, with 1 sheng of water, decoct until 0.6 sheng remains, strain and take warm before meals, twice daily.
Dang Gui Wan Formula for treating cold dysentery with tenesmus:
Dang Gui (Radix Angelicae Sinensis, cut and roasted) 0.5 liang, Hu Jiao (Piperis Longi Fructus, stir-fried) 1 liang, Huang Lian (Rhizoma Coptidis, remove roots) 2 liang, Hou Po (Magnoliae Officinalis Cortex, remove rough bark and fry with ginger juice) 2 liang, E Jiao (Colla Corii Asini, honey-roasted dry) 1 liang (prepared separately).
The above six ingredients, except E Jiao, are crushed and sifted into powder. Mix E Jiao with good vinegar to form a paste, combine with the powder, and make pills the size of paulownia seeds. Take 15 pills per dose, with Tangerine Peel Decoction before meals, can increase to 20 pills.
He Li Le Wan Formula for treating abdominal pain with deficiency and slipping, tenesmus, chest and heart stuffiness with rebellious fullness, or sudden diarrhea from cold injury, cold limbs, and deep/fixed pulse:
He Li Le (Fructus Chebulae, processed, remove pits) 1 liang, Rou Dou Kou (Myristicae Semen, remove shell) 0.5 liang, Bai Fan (Alumen, boiled until juice is dry) 1 liang, Mu Xiang (Aucklandiae Radix) 0.5 liang, Long Gu (Os Draconis) 2 liang, Wu Tou (Aconiti Radix).
The above seven ingredients are crushed and sifted into powder. Mix with millet porridge to make pills the size of paulownia seeds. Take 20 pills per dose, with millet drink before meals.
Sheng Jin Wan Formula for treating visceral cold dysentery, umbilical and abdominal cramping pain, borborygmus and fullness, tenesmus, loss of appetite, and gradual emaciation:
Huang Lian (Rhizoma Coptidis, remove roots) 5 liang, Long Gu (Os Draconis) 4 liang, Cao Dou Kou (Cardamomi Fructus, remove peel), Chi Shao Yao (Paeoniae Radix Rubra), Dang Gui (Radix Angelicae Sinensis, cut and roasted), Gan Jiang (Rhizoma Zingiberis, processed), Di Yu (Sanguisorbae Radix), Xiang Shi (Quercus Glandis) (each 3 liang).
The above twelve ingredients are crushed and sifted into a fine powder. Mix with wheat paste boiled in vinegar to make pills the size of paulownia seeds. Take 20 to 30 pills per dose. Take with Mugwort Vinegar Decoction, on an empty stomach and before meals.
Jiang Gui San Formula for treating profuse watery diarrhea, undigested food diarrhea, and tenesmus:
Gan Jiang (Rhizoma Zingiberis, processed) 3 liang, Gan Cao (Radix Glycyrrhizae, chopped 1 liang; these two ingredients are stir-fried with 2 liang of rock sugar dissolved in a little water until dry), Gui Zhi (Ramulus Cinnamomi, remove rough bark) 1 fen.
The above three ingredients are crushed and sifted into a powder. Take 2 qian bi per dose, mixed with plain hot water. Also treats abdominal pain and stops deficiency thirst.
Tong Shen Wan Formula for treating mixed pus and blood dysentery, tenesmus and pain, chronic non-healing:
Mo Yao (Resina Boswelliae), Wu Ling Zhi (Trogopterori Faeces), Ru Xiang (Resina Frankincense) (each 1 qian), Ba Dou Shuang (Seminar Crotonis Puratum) 0.5 qian.
The above four ingredients are each finely ground, then mixed evenly. Add drops of water to make pills the size of millet grains. Take 7 pills per dose, with Raw Papaya Decoction. Children take 3 pills, adjusted by age. Take on an empty stomach and before meals.
Yu Fen Wan Formula for treating dysentery with red and white discharge, chronic non-healing, tenesmus, removing cold accumulation:
Bai Ding Xiang (Stool of White Sparrow, straight ones ground) 1 liang, Fen Shuang (Hydrargyri Oxydum Rubrum, ground) 3 fen, Liu Huang (Sulfur, ground), Ni Fen (Calomelas, ground), Sha (Realgar, ground) (each 0.5 liang), Ru Xiang (Resina Frankincense, melted and ground) 1 fen.
The above six ingredients are mixed evenly again. Use natural ginger juice and boiled jujube meat, grind and mix to form the base. Roll into pills the size of peas as needed. Before sleep, take 7 pills with Ginger Jujube Decoction. If no bowel movement, take 10 pills the next night. Adjust according to age and condition.
Dan Sha Wan Formula for treating dysentery with red and white discharge, tenesmus, Large Intestine deficiency and slipping:
Dan Sha (Cinnabar, ground), Cao Wu Tou (Aconiti Kusnezoffii Radix, powdered), Ru Xiang (Resina Frankincense, ground) (each 1 qian bi), Ba Dou (Seminar Crotonis, large ones, remove skin and heart, ground 7 seeds).
The above four ingredients are mixed and ground finely. Mix with wheat paste boiled in vinegar to make pills the size of paulownia seeds. Take 1 pill per dose, with cold Ru Xiang (Frankincense) Tea. No specific time restriction.
Mu Gua Yin Formula for treating dysentery with abdominal distension and tenesmus:
Gan Mu Gua (Fructus Chaenomelis, roasted), Bai Zhi (Angelicae Dahuricae Radix), Hou Po (Magnoliae Officinalis Cortex, remove rough bark and fry with ginger juice), Bai Zhu (Atractylodis Macrocephalae Rhizoma, chopped and stir-fried), Mu Xiang (Aucklandiae Radix) (each 1 liang), Gui Zhi (Ramulus Cinnamomi, remove rough bark), Huang Lian (Rhizoma Coptidis, remove roots), Dang Gui (Radix Angelicae Sinensis, honey-roasted and chopped), Suo Sha Mi (Amomi Fructus, remove peel), Long Gu (Os Draconis), He Li Le Pi (Pericarpium Chebulae, baked) (each 1.5 liang), Chen Ju Pi (Citri Reticulatae Pericarpium, remove white pith and roast) 3 fen, Xing Ren (Armeniacae Semen Amarum, remove skin and pointed tips, double kernel).
The above fourteen ingredients are coarsely crushed and sifted. Take 5 qian bi per dose, with 1.5 sheng of water, decoct until 0.8 sheng remains, strain and take warm.