（论一首 脉证二十四条）
（方二十六首 灸法十首）
论曰∶余立身以来，三遭热痢，一经冷痢，皆日夜百余行，乃至移床就厕，其困笃如此
，但率意自治者，寻手皆愈。乃知此疾天下易治，但中性之徒率性骄倨，良药苦口不能克己
早饵，朝遇暮过，望其自瘥，疾势日增，胃气渐弱，心力俱微，食饮与药皆不能进，既不时
愈，便称痢病难治，斯皆自误也。学人须深达斯旨。然此病随宜服一物皆使得瘥，惟须力意
苦己，服食以瘥为限，则无不愈也。又大须慎口味，重者瘥后百日，次者一月日。常哀骄恣
者，不能自慎兴言于此，以为至概矣。古今痢方千万首，不可俱载此中，但撮其效者，七八
而已。如陟厘丸、乌梅丸、松皮散等，暴痢服之，何有不瘥其温脾汤，健脾丸（方出下冷痢
篇），久下得之，焉能不愈。大凡痢有四种，谓冷热疳蛊，冷则白。热则赤。疳则赤白相杂
无复节度，多睡眼涩，蛊则纯痢瘀血。热则多益黄连，去其干姜。冷则加以热药。疳则以药
吹灌下部。蛊毒则以蛊法治之药。既主对相当，痢者复自勉励服饵，焉有不愈者也。
凡服止痢药，初服皆剧，愚人不解，即止其药不服，此特不可，但使药与病源的相主对
，虽剧但服，不过再三服，渐渐自知。非其主对者，慎勿服也。
凡痢病通忌生冷酢滑，猪鸡鱼油、乳酪酥干脯酱粉咸。所食诸食，皆须大熟烂为佳，亦
不得伤饱，此将息之大经也。若将息失所，圣医不能救。
下痢脉滑而数，有宿食，当下之。
下痢脉迟而滑者，实也。利为末止，急下之。
下痢脉反滑，当有所去下乃愈。
下痢不欲食者，有宿食，当下之。
下痢而腹痛满，为寒实，当下之。
下痢而谵语，腹内有燥屎，宜下之。
下痢腹中坚者，当下之。
下痢三部皆平（一作浮），按其心下坚者，急下之。
下痢已瘥，至其年月日时复发者，此为下不尽，更下之愈。风寒重者，不可下。下之后，
心下坚痛，脉迟（一作浮），此为寒，但当温之。脉沉紧，下之亦然。脉浮大弦，下之当已。
下痢脉浮大，此为虚，以强下之故也。设脉浮革者，因而肠鸣，当温之。
下痢脉迟紧为痛，未欲止，当温之。得冷者满而便肠垢。
下痢身躯疼痛，急救里，诸温之属，可与理中、四逆、附子汤热药辈急投之美。
下痢大孔痛者，当温暖之。
下痢腹胀满，身体疼痛者，先温其里，乃攻其表。
下痢清谷不可攻，其表汗出必胀满。
下痢气者，当利其小便。
下痢脉反浮数，尺中自涩，其人必清脓血。
下痢脉数而渴者，今自愈。设不瘥，必清脓血，有热故也。
下痢脉沉弦者下重，其脉大者为未止，脉微弱数者为欲自止，虽发热，必不死。
下痢脉沉而迟，其人面少赤，身有微热，下利清谷，必郁冒，汗出而解，病患必微厥，
所以然者，面戴阳下虚故也。
下痢有微热而渴，脉弱者今自愈。
下痢脉数，有微热，汗出今自愈。设脉紧为未解。
下痢脉弦，发热身汗者自愈。
下痢脉大浮弦，下当已。
下痢舌黄，燥而不渴，胸中实，下不止者死。
下痢后脉绝，手足厥冷， 时脉还，手足温者生，不还不温者死。生死之决，此之谓
也。
下痢手足厥冷无脉者，灸之不温，若脉不还，反微喘者死。少阴负趺阳者为顺。
凡六腑气绝于外者，手足寒，上气脚缩。五脏气绝于内者，下利不禁。下甚者，手足不
仁也。细寻取之，万不失一，下病体略例如此耳。
《素问》曰∶春伤于风，夏为脓血。凡下多滞下也。夏伤于风，秋必洞泄，秋多下水也
，患是冷也，夫积冷积热及水谷实而下者，以大黄汤下之，强人勿过两剂，皆消息五六日更
进一剂，其补涩汤不效者，三两日可进一剂。
（论述一篇，脉证二十四条）
（方剂二十六首，灸法十首）
论述说：我立身行事以来，三次遭遇热痢，一次遭遇冷痢，每天腹泻一百多次，甚至不得不搬动床铺靠近厕所，病势困顿危急到了这种地步。但我只是凭心意自行调理治疗，随手用药都痊愈了。于是知道这种病在天下是容易治疗的，只是那些性格中庸却骄傲倨傲的人，不能克制自己尽早服用良药，早上遇到晚上路过，指望它自然痊愈，结果病势日益加重，胃气逐渐虚弱，心力和体力都衰退，饮食和药物都无法进服。既然没有及时痊愈，便声称痢疾难以治疗，这都是自我误诊啊。求学之人必须深刻明白这个道理。然而这种病只要根据适宜的情况服用一味药都能使疾病痊愈，只须努力意志，刻苦约束自己，服药以病愈为限度，就没有不痊愈的。另外必须严格忌口，病情重的在痊愈后百日，轻的一个月。常常哀叹那些骄傲放纵的人，不能自我谨慎，说到此处，认为是极大的感慨。古今治痢的方剂有千万首，不可能全部记载在此书中，只选取其中有效的，大概七八个罢了。如陟厘丸、乌梅丸、松皮散等，急性痢疾服用它们，哪有不好的道理？至于温脾汤、健脾丸（方剂出自下文冷痢篇），久泻得到这些方子，怎么能不痊愈呢？大凡痢疾有四种，称为冷、热、疳、蛊。冷痢则大便白色；热痢则大便红色；疳痢则红白相杂，毫无节制，多睡且眼涩；蛊痢则纯下瘀血。热痢则多加黄连，去掉干姜；冷痢则加入热性药物；疳痢则将药物吹入或灌入下部；蛊毒则以治蛊的方法治疗药物。既然主药对症相当，痢疾患者又自我勉励服药，哪有不痊愈的呢？
凡是服用止痢药，初服时症状往往加剧，愚人不理解，就停止服药不服用，这特别不可以。只要使药物与病因相对症，虽然症状加剧也要继续服用，不过服用两三次，渐渐就会自知好转。如果不是对症的药物，千万不要服用。
凡是痢疾病人普遍禁忌生冷、酸滑食物，以及猪肉、鸡肉、鱼油、乳酪、酥油、干肉脯、酱粉、咸味食物。所吃的各种食物，都必须煮得十分熟烂为佳，也不能吃得太饱，这是调养的大原则。如果调养失当，即使是圣明的医生也不能救治。
下痢脉象滑而数，有宿食，应当攻下。
下痢脉象迟而滑，是实证。利下不止，急当攻下。
下痢脉象反滑，体内应有积滞，攻下后才会痊愈。
下痢不想吃东西的，有宿食，应当攻下。
下痢且腹痛胀满，为寒实，应当攻下。
下痢且胡言乱语，腹内有燥屎，宜用攻下法。
下痢腹部坚硬者，应当攻下。
下痢寸关尺三部脉象皆平（一说为浮），按压心下部位坚硬的，急当攻下。
下痢已经痊愈，到了原来的年月日时复发的，这是因为病邪未除尽，再次攻下即可痊愈。风寒重者，不可攻下。攻下之后，心下坚硬疼痛，脉迟（一说为浮），这是寒证，只应当温补。脉沉紧，攻下也是如此（指若属寒实可下，若属虚寒则禁下，此处语境偏向于辨证后的处理，结合后文“脉沉紧，下之亦然”可能指特定实证，但前文强调寒者温之，此处需结合上下文，通常脉沉紧主痛主实，若确认为实寒积滞可下，若为虚寒则不可。原文逻辑稍显跳跃，依字面译）。脉浮大弦，攻下后应当痊愈。
下痢脉象浮大，这是虚证，是因为强行攻下导致的。假如脉象浮革，因而肠鸣，应当温补。
下痢脉象迟紧为疼痛，病势未止，应当温补。受冷者腹胀且大便排出肠垢。
下痢身躯疼痛，急救里证，诸温补类方药，可与理中汤、四逆汤、附子汤等热性药物紧急投用，效果很好。
下痢肛门疼痛者，应当温暖局部。
下痢腹胀满，身体疼痛的，先温补其里，然后攻解其表。
下痢清谷（完谷不化）不可攻下，如果此时发汗，必然导致胀满。
下痢伴有气滞感（里急后重或矢气频作），应当通利小便。
下痢脉象反浮数，尺中脉自涩，此人必定排泄脓血。
下痢脉数且口渴的，现在将要自愈。假如不愈，必定排泄脓血，因为有热的缘故。
下痢脉象沉弦者，有里急后重；脉象大的为病势未止；脉微弱数的为病势欲自止，即使发热，也必不死。
下痢脉象沉而迟，其人面部微红，身体有微热，下利清谷，必定出现郁冒（头晕目眩昏蒙），出汗后痊愈。病患必定手足轻微厥冷，之所以这样，是因为面戴阳（虚阳上浮）、下焦虚寒的缘故。
下痢有微热且口渴，脉弱的，现在将要自愈。
下痢脉数，有微热，出汗的，现在将要自愈。假如脉紧，为病未解。
下痢脉弦，发热且身体出汗的，自愈。
下痢脉大浮弦，攻下后应当痊愈。
下痢舌苔黄，干燥但不口渴，胸中实邪阻滞，下痢不止的，死证。
下痢后脉象绝灭，手足厥冷，片刻后脉象恢复，手足转温的，生；脉象不恢复、手足不温的，死。生死的决断，说的就是这种情况。
下痢手足厥冷无脉的，施灸后若不转温，若脉象不恢复，反而轻微喘息的，死。少阴脉弱于趺阳脉的为顺证。
凡是六腑之气在外衰竭的，手足寒冷，气逆上冲，脚部收缩。五脏之气在内衰竭的，下利不禁。下利严重的，手足麻木不仁。仔细寻究探求，万无一失，下病的体略大抵如此罢了。
《素问》说：春天伤于风邪，夏天化为脓血痢。凡是下利多表现为滞下。夏天伤于风邪，秋天必定发生洞泄（水样泻），秋天多下水泻，患的是冷证。如果是积冷、积热及水谷实邪导致的下痢，用大黄汤攻下。强壮的人不要超过两剂，都要斟酌考虑，五六日后再进一剂。那些补益固涩的汤药无效的，三两日可进一剂。
(One Treatise, Twenty-Four Pulse and Symptom Conditions)
(Twenty-Six Formulas, Ten Moxibustion Methods)
The treatise states: Since I began my life, I have suffered from heat-dysentery three times and cold-dysentery once. In all instances, I had more than a hundred bowel movements per day, to the extent that I had to move my bed close to the toilet. The condition was so critical and debilitating. However, by treating myself according to my own judgment, I recovered quickly with simple remedies. Thus, I realized that this disease is easy to cure worldwide. The problem lies with those of moderate constitution who are arrogant and proud; they cannot restrain themselves to take bitter medicine early. They pass by morning encounters and evening opportunities, hoping for spontaneous recovery. Consequently, the disease worsens daily, stomach qi gradually weakens, and both mental and physical strength decline until food and medicine cannot be taken. When not cured in time, they claim that dysentery is difficult to treat. This is all self-mismanagement. Students must deeply understand this principle. However, for this disease, taking just one suitable herb can lead to recovery, provided one exerts strong willpower, disciplines oneself, and continues medication until cured. There will be no failure to recover. Furthermore, one must strictly observe dietary restrictions: for severe cases, abstain for one hundred days after recovery; for milder cases, for one month. I often lament those who are arrogant and indulgent and cannot exercise self-restraint. Speaking of this, I consider it a profound observation. There are tens of thousands of formulas for dysentery in ancient and modern texts, which cannot all be recorded here. I have only selected the most effective ones, about seven or eight. For example, Zhili Wan (Step Lichen Pill), Wumei Wan (Mume Fruit Pill), and Songpi San (Pine Bark Powder). If taken for acute dysentery, how could they fail? As for Wenpi Tang (Spleen-Warming Decoction) and Jianpi Wan (Spleen-Strengthening Pill) (formula found in the Cold Dysentery section below), if obtained for chronic diarrhea, how could one not recover? Generally, there are four types of dysentery: cold, heat, gan (malnutrition/toxin), and gu (parasitic/poison). Cold dysentery presents with white stool; heat dysentery with red stool; gan dysentery with mixed red and white stool without restraint, accompanied by excessive sleepiness and dry, gritty eyes; gu dysentery presents with pure bloody stool. For heat dysentery, add Coptidis Rhizoma (Huanglian, 黄连) and remove Zingiberis Rhizoma Recens (Ganjiang, 干姜). For cold dysentery, add hot-natured herbs. For gan dysentery, blow or irrigate the lower part with medicine. For gu poison, treat with gu-removal methods. Once the primary herb corresponds to the condition, and the patient encourages themselves to take the medication, how could they not recover?
Whenever taking anti-dysentery medicine, symptoms may initially worsen. Fools do not understand this and stop taking the medicine immediately. This is particularly inadvisable. As long as the medicine corresponds to the cause, even if symptoms worsen, continue taking it. After two or three doses, one will gradually realize improvement. Do not take medicines that do not correspond to the condition.
Patients with dysentery generally must avoid raw, cold, sour, and slippery foods, as well as pork, chicken, fish oil, dairy products like cheese and butter, dried meat jerky, sauces, powders, and salty foods. All consumed food should be cooked thoroughly and be soft. One must also avoid overeating. These are the major principles of convalescence. If convalescence is mismanaged, even sage physicians cannot save the patient.
Dysentery with a slippery and rapid pulse indicates retained food; purgation is indicated.
Dysentery with a slow and slippery pulse indicates excess. If diarrhea does not stop, urgent purgation is indicated.
Dysentery with a surprisingly slippery pulse suggests internal retention; purgation leads to recovery.
Dysentery with loss of appetite indicates retained food; purgation is indicated.
Dysentery with abdominal pain and fullness indicates cold-excess; purgation is indicated.
Dysentery with delirium indicates dry feces in the abdomen; purgation is appropriate.
Dysentery with a hard abdomen indicates purgation is needed.
Dysentery where the pulse at all three positions (cun, guan, chi) is level (or floating), but pressing the epigastrium reveals hardness, requires urgent purgation.
If dysentery has healed but recurs at the same time of year/month/day, it is because the pathogen was not fully expelled; another purgative dose will cure it. If wind-cold is heavy, do not purge. After purgation, if the epigastrium becomes hard and painful with a slow (or floating) pulse, it indicates cold; warm only. With a deep-tight pulse, the approach is similar [contextually implies caution or specific indication]. With a floating-large-wiry pulse, purgation should resolve it.
Dysentery with a floating-large pulse indicates deficiency, caused by forced purgation. If the pulse is floating and革 (leather-like), accompanied by borborygmus, warming is indicated.
Dysentery with a slow-tight pulse indicates pain; the disease has not ceased, warming is indicated. Those who caught cold experience fullness and pass intestinal mucus.
Dysentery with body aches requires urgent treatment of the interior. Warm-natured formulas such as Lizhong Tang (Regulate the Middle Decoction), Sini Tang (Frigid Extremities Decoction), or Fuzi Tang (Aconite Decoction) should be administered urgently for good effect.
Dysentery with anal pain requires local warming.
Dysentery with abdominal distension and body aches: first warm the interior, then attack the exterior.
Dysentery with undigested food (clear谷物) should not be purged; sweating in this state will certainly cause distension.
Dysentery with gas sensation (tenesmus/frequent flatus): promote urination.
Dysentery with a surprisingly floating-rapid pulse, and a choppy chi pulse, indicates the patient will likely pass pus and blood.
Dysentery with a rapid pulse and thirst indicates impending recovery. If it does not heal, pus and blood will appear due to heat.
Dysentery with a deep-wiry pulse indicates tenesmus; a large pulse means the disease has not stopped; a weak-rapid pulse means it is about to stop spontaneously. Even with fever, death is unlikely.
Dysentery with a deep-slow pulse, slight facial redness, slight body heat, and passage of undigested food indicates impending "Yu Mao" (dizziness and confusion). Recovery occurs through sweating. The patient will likely have slightly cold extremities. This is due to floating deficient yang on the face and deficiency/cold in the lower jiao.
Dysentery with slight fever and thirst, and a weak pulse, indicates impending recovery.
Dysentery with a rapid pulse, slight fever, and sweating indicates impending recovery. A tight pulse indicates unresolved disease.
Dysentery with a wiry pulse, fever, and sweating indicates spontaneous recovery.
Dysentery with a large-floating-wiry pulse: purgation should resolve it.
Dysentery with yellow tongue coating, dryness without thirst, and chest fullness, with persistent diarrhea, is a fatal case.
After dysentery, if the pulse vanishes and extremities are cold, but the pulse returns and extremities become warm, the patient lives. If the pulse does not return and extremities remain cold, the patient dies. This determines life and death.
For dysentery with cold extremities and absent pulse, if moxibustion does not warm them, and the pulse does not return but slight panting occurs, the patient dies. If Shaoyin pulse is weaker than Duyang pulse, it is a favorable sign.
When the qi of the six fu organs fails externally, there is coldness in the hands and feet, upward rushing of qi, and curling up of the legs. When the qi of the five zang organs fails internally, there is incontinence of diarrhea. Severe diarrhea leads to numbness in the hands and feet. Careful examination ensures accuracy; this summarizes the general principles of lower-jiao diseases.
Suwen states: Wind injury in spring leads to pus-and-blood dysentery in summer. Generally, excessive downward flow results in tenesmus (Zhi Xia). Wind injury in summer leads to watery diarrhea in autumn. Autumn diarrhea is mostly water-type, indicating cold syndrome. For dysentery caused by accumulated cold, accumulated heat, or food stagnation, use Dahuang Tang (Rhubarb Decoction) for purgation. Strong individuals should not exceed two doses. Adjust dosage carefully; administer another dose every five to six days. If tonifying and astringent decoctions are ineffective, administer one dose every two to three days.