典藏书目

Gonghan Wu Shaoweng suffered from dysentery, with both red (blood) and white (pus/mucus) stools passing simultaneously, accompanied by tenesmus (a feeling of incomplete defecation with urgency and heaviness in the rectum). Local physicians treated him for half a month, but the tenesmus persisted, and his appetite gradually decreased. His most distressing symptoms were afternoon fever and vomiting. He sent an envoy to invite me from Tiaoxi (modern-day Huzhou, Zhejiang). Upon hearing the condition, I was alarmed and immediately braved the dangers to cross Lake Tai, arriving in Jingxi after one day and night. Mr. Wu had been confined to bed for twenty days. Observing his complexion, his lips were red and his face emaciated; listening to his voice, it was weak and indistinct, losing breath after only a few words. He experienced tidal fever (fever that occurs at a specific time each day) in the afternoon, which subsided only during the Chou hour (1:00–3:00 AM). Both his physical form and spirit were extremely weak. Palpating his pulse, both hands showed a large but forceless pulse, while the right Guan position was slightly slippery. I said, "Based on these signs, this is a pattern of mixed deficiency and excess, where insufficiency coexists with surplus pathogenic factors. Treatment should focus on tonification, combined with clearing heat and promoting digestion, administered gently over time, so that he may recover safely." Mr. Wu deeply agreed.

I prescribed Sijunzi Tang (Four Gentlemen Decoction), adding Baishao Yao (Radix Paeoniae Alba), Huanglian (Rhizoma Coptidis), Shanzha (Fructus Crataegi), Huashi (Talcum), Chenpi (Pericarpium Citri Reticulatae), and Chaihu (Radix Bupleuri). After two doses, the tidal fever ceased, and vomiting stopped. I removed Chaihu because the patient continued to suffer from excessive thirst, adding Gegen (Puerariae Lobatae Radix). After six additional doses, his diet gradually improved, and the bloody stool stopped, although the white purulent discharge remained. I then changed the prescription to Ren Shen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae), each 2 qian; Bai Fuling (Poria), Baishao Yao (Radix Paeoniae Alba), Danggui (Radix Angelicae Sinensis), and Shenqu (Massa Medicata Fermentata), each 1 qian; Jiuhuanglian (Rhizoma Coptidis processed with wine), Chenpi (Pericarpium Citri Reticulatae), and Zexie (Rhizoma Alismatis), each 7 fen; and Huashi (Talcum) and Shanzha (Fructus Crataegi), each 1.5 qian. Simultaneously, I used pill preparations to adjust according to the fluctuation of the disease, providing nourishment for half a month. Consequently, his spirit and qi recovered, his appetite increased significantly, and his muscles gradually regenerated.

Shao Zhongzai Jian Weng asked, "The other physicians initially stated that tonification is contraindicated for elderly patients with dysentery. Furthermore, vomiting and inability to eat are termed 'Jinkou Li' (Dysentery with Inability to Eat). Additionally, body heat and a large pulse are contraindications for dysentery. How is it that you achieved success in less than ten days? Are all the contraindications cited by the other physicians illusory and absurd?" I replied, "What your colleagues said constitutes profound truth, but they failed to apply treatment according to the timing and specific circumstances. My view is that the Spleen and Stomach are the granaries and storeshouses of the five zang organs and six fu organs; hence, it is said that 'those who can ingest grain prosper.' It is also said that within the human body, Gu Qi (Grain Qi/Nutritional Essence) is precious. I temporarily set aside the direct treatment of dysentery and first focused on opening the stomach appetite, enabling food intake. This allows new food residues to press down and expel old filth. Once feces are passed, the tenesmus will be relieved, and the dysentery will heal easily. However, one must also observe the appropriate mechanism: if abdominal distension and pain occur after eating, slight unblocking methods should be applied proportionally; if qi deficiency with sinking sensation follows unblocking, slight lifting methods should be applied according to the trend. Generally, regulating the Spleen, opening the stomach, and promoting food intake take precedence. This is akin to the strategy of 'befriending distant states and attacking nearby ones'; although it takes more days, the outcome can be completely secure. This is my humble opinion, which has been tested repeatedly with consistent efficacy. If we do not first open the stomach appetite, fail to assess the weakness of the elderly, ignore the urgency or chronicity of the condition, and treat dysentery uniformly regardless of context, even if there are some gains, there will inevitably be losses. How could such an approach guarantee victory?" Mr. Wu said, "Excellent."