水谷痢者，糟粕脓血杂下，腹中微痛，登圊频频，饮食少餐，四肢困倦，脉来细缓无力，或关部兼弦，
此因脾胃虚寒，虚则不能健运，寒则不能消化也，当用暖培卑监法治之。亦有因风木克土，土虚不运者，宜
本法内加白芍、防风；有因劳役过度，脾阳困顿者，加黄 、荷叶；有因下焦无火，不能熟腐者，加
故纸、吴萸；有因痢后中虚，饮食停积者，加陈皮、楂肉。然痢疾总不离乎脾胃为病，或木胜，或火衰，当
按法加减治之，自然应手耳。
下痢屡发屡止，久而不愈，面色痿黄，脉形濡滑者，为休息痢也。多因止涩太早，积热未尽，或不能
节饮食，戒嗜好，所以时作时止也。亦有过服寒凉而致者，肝脾内伤而致者，元气下陷而致者，肾虚不固而
致者，皆当审其因而分治之。拟用调中畅气法，俾其气机得畅，则积热自清，中州得调，则脾胃自复。
倘或腹中隐痛，宜加吴萸、姜炭，以化中焦之寒；赤痢缠绵，当佐秦皮、白芍，以清肝脾之血；肛门重坠，
更加升麻、桔梗，以升下陷之元；虚滑不禁，再入骨脂、龙骨，以固下焦之脱。凡一切
之药，不应手者，当细辨其脉象，若脉沉实，虽日远仍当攻下，切宜辨确，勿可误也。
《金鉴》云∶五色痢者，五色脓血相杂而下也，若有脏腑尸
臭之气则凶。因于用止涩太早，或因滞热下之未尽，蕴于肠胃，伤脏气也。用一切补养之药不应，则可
知初病非涩之太早，即下之未尽也。诊其脉若有力，虽日久仍当攻也。
《医通》曰∶患五色痢者，良由脏腑之气化并伤，是以五色兼见。然古人皆言肾病，以肾藏精之室，
所居之位，最下最深，深者既病，其浅而上者，安有不病之理，精室既伤，安能任蛰藏之令乎？仲景以五液
注下，脐筑痛，命将难全也。夫以精室受伤，五液不守之患，须知益火消阴，实脾堤水，兼分理其气，使
失于气化之积，随之而下，未失气化之精，统之而安，诚不出乎此法。
丰按∶二论诚痢门之要旨。前言止涩太早，滞热未尽；后言脏腑之气化并伤，归于肾病。合而论之，斯
疾有虚有实，分别治之，庶乎稳妥。如初起者为实，日久者为虚，里急后重者为实，频频虚坐者为虚，脉实
有力者为实，脉虚无力者为虚。虚则宜补，以补火生土法治之；实则宜泻，以清痢荡积法治之。
水谷痢，是指粪便、脓血混杂而下，腹部轻微疼痛，频繁如厕，食欲减退，四肢倦怠无力，脉象细缓且无力，或者关部脉兼见弦象。这是由于脾胃虚寒所致，脾虚则不能正常运化，胃寒则不能消化食物，治疗应当采用暖培卑监法。也有因风木（肝气）克制脾土，导致脾土虚弱无法运化的情况，应当在上述方法中加入白芍、防风；有因过度劳累，导致脾阳困顿的情况，加入补骨脂、荷叶；有因下焦阳气不足，不能腐熟水谷的情况，加入破故纸（补骨脂）、吴茱萸；有因痢疾之后中气虚弱，饮食停滞积聚的情况，加入陈皮、山楂肉。然而痢疾总归是脾胃的疾病，或是肝木过盛，或是心火衰微，应当按照法则加减药物治疗，自然能应手而愈。
下痢反复发作，时好时坏，长久不愈，面色萎黄，脉象濡滑的，称为休息痢。多因为过早使用收敛止涩的药物，导致积热未清；或者不能节制饮食、戒除嗜好，所以病情时发时止。也有因过服寒凉药物导致的，因肝脾内伤导致的，因元气下陷导致的，因肾虚不固导致的，都应当审察病因分别治疗。拟用调中畅气法，使气机通畅，则积热自然清除，中焦得到调理，则脾胃自然恢复。如果腹部隐痛，宜加吴茱萸、姜炭，以温化中焦之寒；赤痢缠绵难愈，当辅助秦皮、白芍，以清肝脾之血热；肛门重坠感，再加升麻、桔梗，以升提下陷之元气；虚滑不禁泄，再加入补骨脂、龙骨，以固摄下焦之脱失。凡是一切药物，若服用后不见效，应当仔细辨别脉象，如果脉象沉实，即使病程已久仍当攻下，务必辨证准确，不可误治。
《医宗金鉴》说：五色痢，是指五种颜色的脓血混杂而下，如果有脏腑腐败尸臭的气味，则预后凶险。这是因为过早使用止涩药，或因滞热用攻下法未尽，蕴结在肠胃，损伤脏气。如果使用一切补养药物无效，就可以知道初病时不是止涩太早，就是攻下未尽。诊察其脉象如果有力，即使病程日久仍应当攻下。
《医宗必读》说：患五色痢的人，确实是由于脏腑的气化功能同时受损，所以五色兼见。然而古人都说是肾病，因为肾是藏精之所，位置最下最深，深的部位既已生病，浅的上部，哪有不得病的道理？精室既然受伤，怎能胜任蛰藏的功能呢？张仲景认为五液注下，脐腹筑痛，性命难保。对于精室受伤、五液不守的病患，须知要益火消阴，实脾堤水，兼理气机，使失去气化功能的积滞随之排出，未失去气化功能的精气统摄安宁，确实离不开这种方法。
雷丰按语：以上两论确实是痢疾门的关键要点。前文提到止涩太早，滞热未尽；后文提到脏腑气化并伤，归结于肾病。综合论述，此病有虚有实，分别治疗，才稳妥。如初起者为实证，日久者为虚证，里急后重者为实证，频频虚坐努责者为虚证，脉实有力者为实证，脉虚无力者为虚证。虚证适宜补益，用补火生土法治疗；实证适宜泻下，用清痢荡积法治疗。
Shuigu Dysentery (Water and Grain Dysentery) refers to the passage of feces mixed with pus and blood, accompanied by slight abdominal pain, frequent defecation, poor appetite, fatigue in the four limbs, a fine and slow pulse that is forceless, or a wiry pulse at the Guan position. This is caused by deficiency-cold of the Spleen and Stomach; deficiency leads to failure of normal transportation and transformation, while cold leads to inability to digest food. Treatment should employ the Warm and Cultivate Inferior Supervision Method (Nuan Pei Bei Jian Fa). There are also cases due to Wind-Wood (Liver Qi) overacting on Earth (Spleen), causing Spleen-Earth deficiency and failure of transportation; in such cases, add Bai Shao (White Peony Root) and Fang Feng (Saposhnikovia Root) to the aforementioned method. For cases due to excessive labor leading to exhaustion of Spleen-Yang, add Gu Zhi (Psoralea Fruit) and He Ye (Lotus Leaf). For cases due to lack of fire in the Lower Jiao, failing to ripen and transform substances, add Po Gu Zhi (Psoralea Fruit) and Wu Yu (Evodia Fruit). For cases where middle-Jiao deficiency after dysentery leads to food stagnation, add Chen Pi (Tangerine Peel) and Zha Rou (Hawthorn Flesh). However, dysentery fundamentally involves pathology of the Spleen and Stomach, whether due to excess Wood or deficient Fire; treatment should follow these principles with modifications, ensuring effective results.
Dysentery that recurs repeatedly, stops and starts intermittently, persists for a long time without healing, presents with sallow complexion, and a soggy-slippery pulse is termed Xiuxi Dysentery (Resting Dysentery). It is often caused by using astringents too early, leaving accumulated heat uncleaned; or by failing to regulate diet and abstain from habits, causing intermittent symptoms. It may also result from excessive intake of cold-natured herbs, internal injury to Liver and Spleen, sinking of Yuan Qi (Primal Qi), or Kidney deficiency failing to secure. Each cause requires distinct treatment based on pattern differentiation. The recommended formula is Tiao Zhong Chang Qi Method (Regulate Middle and Unblock Qi Method), which ensures smooth Qi mechanism so that accumulated heat clears naturally, and regulates the Middle Jiao so the Spleen and Stomach recover. If there is dull abdominal pain, add Wu Yu (Evodia Fruit) and Jiang Tan (Charred Ginger) to warm and transform Middle Jiao cold; if red dysentery lingers, assist with Qin Pi (Ash Bark) and Bai Shao (White Peony Root) to clear Liver and Spleen blood-heat; if there is a heavy sensation in the anus, add Sheng Ma (Cimicifuga Rhizome) and Jie Geng (Platycodon Root) to lift sinking Yuan Qi; if there is incontinence due to deficiency and slipperiness, add Gu Zhi (Psoralea Fruit) and Long Gu (Fossilized Bones) to secure Lower Jiao collapse. If any medication fails to produce an effect, carefully differentiate the pulse. If the pulse is deep and solid, even if the disease has lasted long, purgative methods should still be used. Differentiation must be accurate to avoid error.
The *Jin Jian* states: Wuse Dysentery (Five-Color Dysentery) involves the passage of pus and blood of five colors mixed together; if there is a foul odor resembling rotting organs, the prognosis is ominous. This is due to using astringents too early, or incomplete purging of stagnant heat, which accumulates in the intestines and stomach, damaging organ Qi. If all tonifying medicines fail, it indicates that initially either astringents were used too early or purgatives were insufficient. If the pulse is forceful, purgation is still indicated despite the duration of the disease.
The *Yi Tong* states: Patients with Wuse Dysentery suffer from simultaneous damage to the Qi transformation functions of the Zang-Fu organs, hence the presence of five colors. Ancients attributed this to Kidney pathology because the Kidney stores Essence and resides in the deepest, lowest position; if the deep part is diseased, how can the superficial upper parts remain healthy? Once the chamber of Essence is damaged, it cannot fulfill its function of storing and hiding. Zhang Zhongjing noted that when five fluids pour down and umbilical pain occurs, life is in danger. For patients suffering from damage to the essence chamber and loss of control over the five fluids, one must know to benefit Fire to dissipate Yin, strengthen the Spleen to dam Water, and simultaneously regulate Qi, so that accumulated substances lacking Qi transformation are expelled downward, while Essence retaining Qi transformation remains stable. This approach essentially covers the necessary treatment.
Lei Feng’s commentary: These two discussions are indeed key points in the category of dysentery. The former mentions using astringents too early and incomplete clearing of stagnant heat; the latter discusses simultaneous damage to Zang-Fu Qi transformation, attributing it to Kidney pathology. Synthesizing them, this disease has both deficiency and excess patterns requiring differentiated treatment for safety. Early onset indicates Excess; long duration indicates Deficiency. Tenesmus indicates Excess; frequent empty straining indicates Deficiency. A forceful pulse indicates Excess; a weak and forceless pulse indicates Deficiency. Deficiency patterns require tonification, treated with the Tonify Fire to Generate Earth Method; Excess patterns require purgation, treated with the Clear Dysentery and Eliminate Accumulation Method.