（附∶暑痢）
热痢者，起于夏秋之交，热郁湿蒸，人感其气，内干脾胃，脾不健运，胃不消导，热挟湿食，酝酿中
州，而成滞下矣。盖热痢之为病，脉滑数而有力，里急后重，烦渴引饮，喜冷畏热，小便热赤，痢下赤色，
或如鱼脑，稠粘而秽者是也。治宜清痢荡积法，益以楂肉、槟榔治之，如体弱者，以生军改为制军最妥。
时贤谓热痢即暑痢也，丰细考之则非。《准绳》云∶暑气成痢者，其人自汗发热，面垢呕逆，渴欲引饮，腹
内攻痛，小便不通，痢血频迸者是也。拟以清凉涤暑法去青蒿、瓜翠，加黄连、荷叶治之，临证之间，亦当辨治。
刘河间论痢，总不外乎湿热。孔以立非之，乃谓六淫之邪，俱可兼伤，不独在乎湿热也。然古有湿痢之
名，决不可废。窃谓河间专言湿热，似乎太偏；以立为不然，似乎太过。据丰论湿痢，有寒热之分焉。盖夫
寒湿之为痢也，腹绵痛而后坠，胸痞闷而不渴，不思谷食，小便清白，或微黄，痢下色白，或如豆汁，脉缓近
迟之象，宜用温化湿邪法加木香治之。热湿之为痢也，里急后重、忽思饮，饮亦不多，忽思食，食亦乏味，
小便热涩，痢下赤色，或淡红焦黄，脉来濡数之形，当用通利州都法去苍术，加木香、黄连治之。又有阴虚
患痢，里急欲便，坐久而仍不得便者，谓之虚坐努责，不可偏言乎湿，而投渗利，利之益伤
其阴，如当归、白芍、生地、丹皮、阿胶、泽泻及石莲等品，随证加减可也。
程曦曰∶以立论痢，谓六淫之邪，俱可兼伤，由是观之，岂非一岁俱有痢疾耶？须知风痢
虽伤于风，但发于夏，寒痢因热
贪凉而受寒，亦发于夏，非冬令之寒而致痢也。热痢发于相火之令，湿痢发于湿土之令。其实痢疾虽有风、
寒、热、湿之殊，然总发于夏秋之令，而春冬罕见是病，以立谓六淫俱伤，岂不贸贸哉！
（附注：暑痢）
热痢，发生于夏秋交替之时，因热邪郁结、湿气蒸腾，人体感受此气，内伤脾胃。脾失健运，胃失消导，热邪挟带湿浊与食积，在中焦酝酿，从而形成滞下（痢疾）。热痢这种病证，脉象滑数而有力，伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽），心烦口渴想喝水，喜冷恶热，小便短赤灼热，大便下痢呈红色，或像鱼脑一样稠粘且气味秽臭。治疗宜采用清痢荡积法，加入山楂肉、槟榔来治疗；如果患者体质虚弱，将生大黄改为制大黄最为妥当。
当时的名医认为热痢就是暑痢，我仔细考证后发现并非如此。《医宗必读·准绳》记载：由暑气引起的痢疾，患者自汗发热，面色垢腻，呕吐逆气，口渴想喝水，腹部攻冲作痛，小便不通畅，痢下鲜血频繁迸出。拟用清凉涤暑法，去掉青蒿、瓜翠（西瓜翠衣），加入黄连、荷叶来治疗。临证时，也应当辨别施治。
刘河间论述痢疾，总离不开湿热。孔以立反对他的观点，认为六淫之邪都可以兼夹受伤，不仅仅在于湿热。然而古代有“湿痢”的名称，决不能废弃。我认为河间专言湿热，似乎过于偏颇；以立认为不然，似乎又过于极端。据我雷丰对湿痢的论述，有寒湿和热湿之分。寒湿导致的痢疾，腹部绵绵作痛且有下坠感，胸脘痞闷且不口渴，不想进食，小便清白或微黄，痢下颜色白色，或像豆汁一样，脉象缓近迟，宜用温化湿邪法加木香治疗。热湿导致的痢疾，里急后重，忽然想喝水但喝得不多，忽然想吃东西但食物无味，小便热涩，痢下红色或淡红焦黄色，脉象濡数，当用通利州都（膀胱）法，去掉苍术，加入木香、黄连治疗。又有阴虚患痢疾者，里急想排便，坐久了仍然排不出，称为虚坐努责（因阴血亏虚，肠道失润，虽无实邪却强行努责排便），不可片面地说是湿邪而投用渗利药物，否则利水会进一步损伤阴液，如使用当归、白芍、生地、丹皮、阿胶、泽泻及石莲等药材，随证加减即可。
程曦说：以立论痢疾，认为六淫之邪都可兼夹受伤，由此看来，难道一年中都有痢疾吗？须知风痢虽然伤于风邪，但发于夏季；寒痢因为贪凉受寒，也发于夏季，并非冬季寒冷所致痢疾。热痢发于相火主令之时，湿痢发于湿土主令之时。其实痢疾虽然有风、寒、热、湿的不同，但总是发于夏秋季节，而春冬罕见此病，以立说六淫俱伤，岂不是糊涂吗！
(Attachment: Summerheat Dysentery)
Re-Li (Heat Dysentery) occurs during the transition between summer and autumn. It arises from heat stagnation and dampness steaming; when humans contract this pathogenic factor, it internally affects the Spleen and Stomach. The Spleen fails in its transportation and transformation functions, and the Stomach fails in its digestion and guidance functions. Heat combines with dampness and food retention, fermenting in the Middle Jiao (Middle Burner), resulting in Li Xia (Dysentery). Regarding Re-Li as a disease, the pulse is slippery, rapid, and forceful; symptoms include tenesmus (urgent need to defecate with heavy sensation in the anus), irritability, thirst with desire to drink, preference for cold and aversion to heat, hot and red urine, and dysenteric stools that are red or resemble fish brains—thick, sticky, and foul-smelling. Treatment should employ the method of Clearing Dysentery and Sweeping Away Accumulation, supplemented with Shan Zha Rou (Hawthorn Flesh) and Bing Lang (Areca Seed). If the patient's constitution is weak, replacing Sheng Jun (Raw Rhubarb) with Zhi Jun (Prepared Rhubarb) is most appropriate.
Contemporary physicians claim that Re-Li is identical to Shu-Li (Summerheat Dysentery). After careful examination by Feng (the author), this is incorrect. *Zhun Sheng* states: Dysentery caused by Summerheat involves spontaneous sweating and fever, a greasy complexion, vomiting and regurgitation, thirst with desire to drink, abdominal pain radiating inward, obstruction of urination, and frequent bursting of bloody stools. The proposed formula is Qing Liang Di Shu Tang (Clearing Coolness and Washing Away Summerheat Decoction), removing Qing Hao (Artemisiae Annuae Herba) and Gua Cui (Citrulli Exocarpium), and adding Huang Lian (Coptidis Rhizoma) and He Ye (Nelumbinis Folium). In clinical practice, differentiation and treatment are also necessary.
Liu Hejian discussed dysentery, generally attributing it to Damp-Heat. Kong Yili disagreed, asserting that all Six Excesses (Six Pathogenic Factors) can jointly injure the body, not just Damp-Heat. However, since ancient times there has been the term "Shi-Li" (Damp Dysentery), which must not be discarded. I consider Liu's exclusive focus on Damp-Heat to be somewhat biased; Yili's denial of it seems somewhat excessive. According to my discussion on Shi-Li, there is a distinction between Cold-Damp and Heat-Damp.
Cold-Damp causing dysentery presents with lingering abdominal pain and a sense of bearing down, chest and epigastric fullness without thirst, lack of appetite, clear or slightly yellow urine, and white stools resembling bean soup. The pulse is slow and approaching sluggishness. Treatment should use the method of Warming and Transforming Dampness, adding Mu Xiang (Aucklandiae Radix).
Heat-Damp causing dysentery presents with tenesmus, sudden desire to drink but drinking little, sudden desire to eat but finding food tasteless, hot and difficult urination, and red or pale red scorched-yellow stools. The pulse is soggy and rapid. Treatment should employ the method of Promoting Urination and Unblocking the Zhou Du (Bladder), removing Cang Zhu (Atractylodis Rhizoma), and adding Mu Xiang and Huang Lian.
Furthermore, there are cases of Yin Deficiency leading to dysentery, characterized by tenesmus and urgency to defecate, yet inability to pass stool despite prolonged sitting. This is called Xu Zuo Nu Ze (Deficiency Tenesmus). One cannot simply attribute it to Dampness and administer diuretic/damp-draining herbs, as draining will further injure the Yin. Formulas may include Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Sheng Di Huang (Rehmanniae Radix), Dan Pi (Moutan Cortex), E Jiao (Colla Corii Asini), Ze Xie (Alismatis Rhizoma), and Shi Lian (Nelumbinis Semen), adjusted according to the syndrome.
Cheng Xi stated: Yili argued that dysentery can be caused by any of the Six Excesses. From this perspective, does it mean dysentery occurs throughout the year? It must be understood that Feng-Li (Wind Dysentery), though injured by Wind, manifests in summer. Han-Li (Cold Dysentery) results from greed for coolness and contracting cold, also manifesting in summer, not due to winter cold. Re-Li manifests during the period governed by Ministerial Fire, and Shi-Li manifests during the period governed by Damp Earth. In reality, although dysentery differs in Wind, Cold, Heat, and Dampness, it always occurs in summer and autumn, rarely appearing in spring and winter. To say that all Six Excesses cause it is indeed confused!