（评门人吴玉纯稿）
痢之见证不一，有但赤者，有但白者，有赤白兼见者，而不外乎腹痛后重。其受病之始，必由于寒，当夏
日酷暑熏蒸，贪凉食冷，寒气入于肠胃，至秋阳气内入，与之相争，腹痛后重，气之病也。由气病而致血
病，理之常也。寒则伤气，热则伤血，气血俱伤，寒热错杂，则赤白互下。此折衷之论，亦模棱之论也。河间
专主湿热，丹溪以大小肠分主气血。然湿之与热，本是对举，未可言热而忘湿。且气壮而伤于天者，郁
热居多，气弱而伤于人者，阴寒为甚。石顽张氏谓血色鲜紫者，信乎属热，若瘀晦稀淡，或如鱼脑，如紫
草汁，或如玛瑙色者，为阳虚不能制阴。此外脉症之间，辨别多端未遑枚举。诚因当世多以痢属于热，
峻用苦寒，故不惮反复详论也。继之曰，非温理其气，则血不清，理气如炉冶分金，最为捷法。明乎气为
阳，血为阴，阳可以统阴，阴不可以兼阳，气可以统血，血不可以包气。故痢之始起，白多赤少，调气为主，
误用血药，必致引邪入于血分。其后赤多白少者，虽宜活血养血，仍宜兼理其气，以和其血。此外噤口
五色诸痢，及妇人妊娠下痢，皆当以调气之法，操纵而进退之。惟实系气壮而伤于天者，其热毒直入
营分，肠胃如焚，喻氏有大黄黄连甘草法，苦寒直清其阴，不可再用芳香之品，以动其火也学人诚能
于气血之孰轻孰重，寒热之为真为假，详晰而明辨之，不但可以治痢，其于诸病之治法，可一以贯之矣。
痢疾的表现症状多种多样，有仅见赤色脓血的，有仅见白色黏液的，有赤白相兼出现的，但都不外乎伴有腹痛和里急后重。其发病之初，必定是由于寒邪所致。在夏日酷暑熏蒸之时，因贪凉或食用生冷食物，寒气侵入肠胃；到了秋季，人体阳气内收，与寒气相互抗争，导致腹痛、里急后重，这是气分受病的表现。由气分病变进而导致血分病变，是常理。寒邪容易损伤气分，热邪容易损伤血分，若气血俱伤，寒热错杂，则出现赤白脓血便交替而下。这是一种折衷的说法，也是一种模棱两可的说法。刘河间专门主张湿热致病，朱丹溪则以大小肠分别主司气血。然而湿与热本是相对的概念，不能只谈热而忽略湿。况且，正气壮实而感受外界天时之邪者，多为郁热；正气虚弱而感受人为因素（如饮食起居不慎）之邪者，阴寒更为严重。张石顽认为血色鲜红紫暗的，确实属于热证；如果血色晦暗稀淡，或者像鱼脑，像紫草汁，或者像玛瑙色的，则是阳虚不能制约阴寒所致。此外，在脉象和症状之间，辨别的方法很多，这里来不及一一列举。实在是因为当今世人多将痢疾归属于热证，峻猛地使用苦寒药物，所以我才不怕反复详细论述。接着说，如果不温理气机，血液就无法清净；调理气机就像冶炼中分离金银一样，是最为快捷的方法。明白了气属阳，血属阴，阳可以统帅阴，阴不可以兼代阳，气可以统帅血，血不可以包裹气。所以痢疾初起时，白多赤少，应以调气为主，误用治血药物，必然会导致引邪深入血分。其后赤多白少时，虽然适宜活血养血，但仍应兼顾调理气机，以调和血液。此外，对于噤口痢、五色痢等各种痢疾，以及妇女妊娠期间下痢，都应当运用调气的方法，根据病情灵活掌握进退。只有确实是正气壮实而感受外界天时之邪者，热毒直接侵入营分，肠胃如火烧一般，此时喻嘉言有大黄黄连甘草法，用苦寒药物直接清泻阴分之热，不可再用芳香类药物，以免助长火势。学习者如果能详细清晰地辨别气血的孰轻孰重，寒热的真假虚实，不但可以治疗痢疾，对于其他各种疾病的治疗原则，也可以融会贯通了。
(Commentary on the manuscript by disciple Wu Yuchun)
The clinical manifestations of dysentery are diverse. There are cases presenting only with red blood, only with white mucus, or with both red and white mixed together; however, they all involve abdominal pain and tenesmus (里急后重). The initial pathogenesis must stem from cold pathogens. During the intense heat of summer, due to indulgence in cooling off or consuming raw and cold foods, cold qi enters the intestines and stomach. When autumn arrives and the body's yang qi moves inward, it contends with the cold pathogens, resulting in abdominal pain and tenesmus; this is a disease of the qi level. It is a common principle that a disease of the qi level leads to a disease of the blood level. Cold pathogens tend to damage qi, while heat pathogens tend to damage blood. If both qi and blood are damaged, and cold and heat are intermixed, red and white discharges will alternate. This is a compromise theory, yet also an ambiguous one. Liu Hejian exclusively emphasized damp-heat as the cause, while Zhu Danxi attributed the governance of qi and blood to the large and small intestines, respectively. However, dampness and heat are paired concepts; one cannot discuss heat while ignoring dampness. Furthermore, when healthy individuals are affected by external seasonal factors, stagnant heat is predominant; when weak individuals are affected by internal or behavioral factors, yin-cold is severe. Zhang Shiwang stated that if the blood color is bright purple, it indeed belongs to heat. If the color is dull, thin, and pale, resembling fish brains, purple grass juice, or agate, it indicates yang deficiency failing to control yin. Additionally, there are numerous ways to distinguish between pulse and symptom patterns, which cannot be enumerated here. The reason for this repeated and detailed discussion is that contemporary practitioners often categorize dysentery under heat and use harsh bitter-cold herbs indiscriminately. Subsequently, it is stated: unless the qi is warmed and regulated, the blood cannot be cleared. Regulating qi is like refining gold from ore in a furnace, which is the most expedient method. Understanding that qi is yang and blood is yin, yang can command yin, but yin cannot substitute for yang; qi can command blood, but blood cannot envelop qi. Therefore, at the onset of dysentery, when white discharge exceeds red, regulation of qi should be the primary focus. Misusing blood-regulating herbs will inevitably draw pathogens into the blood level. Later, when red discharge exceeds white, although activating and nourishing blood is appropriate, regulating qi should still be concurrent to harmonize the blood. Furthermore, for various types of dysentery such as Jin Kou Dysentery (噤口痢, dysentery with inability to eat) and Five-Color Dysentery (五色痢), as well as dysentery during pregnancy in women, the method of regulating qi should be employed to manage the treatment strategy flexibly. Only in cases where the individual is genuinely robust and affected by external seasonal factors, causing heat toxins to directly enter the Ying (Nutrient) level, with the intestines and stomach feeling like burning, does Yu Jiayan's formula of Da Huang, Huang Lian, and Gan Cao apply. This uses bitter-cold herbs to directly clear yin heat. Fragrant aromatic herbs should not be used again, as they would stir up the fire. If students can clearly and meticulously distinguish the relative importance of qi and blood, and the true versus false nature of cold and heat, they will not only be able to treat dysentery but also apply these principles universally to the treatment of other diseases.