夏日多炎，阴邪易入。暑热是主，风寒是客，身不被风，疟从何致？口不受寒，痢从何
得？治必求本，轩岐金石。志此微言，可为医则。
凡治痢疾，最当察虚实，辨寒热，此泻痢中最大关系，若四者不明，则杀人甚易也。
一、实证之辨，必其形气强壮，脉息滑实，或素纵口腹，或多胀满坚痛，及年少新病，
脾气未损者，方可用治标之法，微者行之，利之，甚者泻之。
一、虚证之辨，有形体薄弱者，有颜色清白者，有脉虽紧数而无力无神者，有脉见真弦
而中虚似实者，有素禀阳衰者，有素多淡素者，有偶犯生冷者，有偶中雨水阴寒者，有偶因
饮食不调者，有年衰脾弱者。以上诸证，凡其素无纵肆，而忽患泻痢，此必以或瓜或果，或
饮食稍凉，偶伤胃气而然，果何积之有？又何热之有？总惟脾弱之辈，多有此证。故治此者，
只宜温调脾肾，但使脾温则寒去，即所以逐邪也。且邪本不多，即用温补健脾，原无妨碍，
不过数剂，自当全愈。切不可妄云补住邪气，而先用攻积、攻滞及清火等药，倘使脾气再伤
，则轻者反重，重者必危矣。
凡泻痢寒热之辨，若果是热，则必畏热喜冷，不欲衣被，渴甚饮水，多亦无碍，或小便
热涩而痛，或下痢纯血鲜红，脉息必滑实有力，形气必躁急多烦。若热证果真，即宜放手凉
解，或兼分利，但使邪去，其病自愈。若无此实热诸证，而泻痢有不止者，必是虚寒，若非
温补脾肾，必不能愈，即有愈者，亦必其元气有根，待其来复而然。勿谓虚寒之证，有不必
温补而可以愈者，或治痢必宜寒凉，而寒凉亦可无害者，皆见有未真也。
【背景信息】
书名：景岳全书 作者：张介宾 朝代：明 章节：俚词曰 / 论泻痢虚实（共三条） / 论泻痢寒热 类别：综合
【待处理原文】
夏日多炎，阴邪易入。暑热是主，风寒是客，身不被风，疟从何致？口不受寒，痢从何得？治必求本，轩岐金石。志此微言，可为医则。
翻译：
夏天天气炎热，阴寒之邪容易侵入人体。暑热之气是主要致病因素，风寒之气是次要或兼夹因素。如果身体没有受到风邪侵袭，疟疾（一种以寒战、高热、汗出为特征的疾病）是如何产生的呢？如果口腔和脾胃没有受到寒邪侵害，痢疾（以腹痛、里急后重、下痢脓血为特征的疾病）又是如何得到的呢？治疗疾病必须探求根本原因，这是黄帝（轩辕氏）和岐伯（中医理论奠基人之一）留下的宝贵经验与准则。记住这些精微的言论，可以作为行医的准则。
凡治痢疾，最当察虚实，辨寒热，此泻痢中最大关系，若四者不明，则杀人甚易也。
翻译：
凡是治疗痢疾，最重要的是辨别虚证和实证，区分寒证和热证，这是治疗泄泻和痢疾中最关键的关系。如果这四个方面（虚、实、寒、热）不明确，那么导致病人死亡就非常容易了。
一、实证之辨，必其形气强壮，脉息滑实，或素纵口腹，或多胀满坚痛，及年少新病，脾气未损者，方可用治标之法，微者行之，利之，甚者泻之。
翻译：
第一，对实证进行辨别，必须是患者形体壮实、气息充沛，脉搏滑利而有力；或者是平时饮食放纵不节制，经常感到腹部胀满且坚硬疼痛；以及年轻人新近患病，脾胃之气尚未受损的情况。只有在这种情况下，才可以采用治疗标症（针对症状本身的治疗）的方法。病情轻微的，用疏通导滞的方法；病情严重的，用攻下泻实的方法。
二、虚证之辨，有形体薄弱者，有颜色清白者，有脉虽紧数而无力无神者，有脉见真弦而中虚似实者，有素禀阳衰者，有素多淡素者，有偶犯生冷者，有偶中雨水阴寒者，有偶因饮食不调者，有年衰脾弱者。以上诸证，凡其素无纵肆，而忽患泻痢，此必以或瓜或果，或饮食稍凉，偶伤胃气而然，果何积之有？又何热之有？总惟脾弱之辈，多有此证。故治此者，只宜温调脾肾，但使脾温则寒去，即所以逐邪也。且邪本不多，即用温补健脾，原无妨碍，不过数剂，自当全愈。切不可妄云补住邪气，而先用攻积、攻滞及清火等药，倘使脾气再伤，则轻者反重，重者必危矣。
翻译：
第二，对虚证进行辨别，有的患者形体瘦弱，面色苍白无华，脉搏虽然紧张快速但无力且缺乏神气，有的脉搏呈现真正的弦脉但中焦空虚而看似实证，有的先天阳气衰弱，有的平时饮食清淡寡味，有的偶然吃了生冷食物，有的偶然遭受雨水阴寒之气侵袭，有的偶然因为饮食不规律，有的年老体衰且脾胃虚弱。以上各种情况，凡是平时没有饮食放纵行为，却突然患上泄泻或痢疾的，这一定是因为吃了瓜果、水果，或者饮食稍微偏凉，偶然损伤了胃气所致，哪里有什么积滞呢？又哪里有热邪呢？总之，这类体质脾虚的人，大多会出现这种情况。所以治疗这类患者，只应当温和地调理脾肾，只要使脾脏温暖，寒气自然消除，这就是驱逐邪气的方法。而且邪气本来就不多，即使使用温补健脾的药物，原本也没有妨碍，只需服用几副药，自然就会痊愈。千万不要胡乱说“补药会留住邪气”，从而先使用攻逐积滞、消导停滞以及清热泻火等药物，倘若因此再次损伤脾胃之气，那么轻的病反而会加重，重的病必定陷入危险境地。
凡泻痢寒热之辨，若果是热，则必畏热喜冷，不欲衣被，渴甚饮水，多亦无碍，或小便热涩而痛，或下痢纯血鲜红，脉息必滑实有力，形气必躁急多烦。若热证果真，即宜放手凉解，或兼分利，但使邪去，其病自愈。若无此实热诸证，而泻痢有不止者，必是虚寒，若非温补脾肾，必不能愈，即有愈者，亦必其元气有根，待其来复而然。勿谓虚寒之证，有不必温补而可以愈者，或治痢必宜寒凉，而寒凉亦可无害者，皆见有未真也。
翻译：
关于泄泻和痢疾寒证与热证的辨别，如果确实是热证，那么患者一定怕热喜欢寒冷，不喜欢穿盖衣物被子，口渴严重想喝水，喝得多也没有妨碍，或者小便灼热涩痛，或者下痢全是鲜红的血液，脉搏一定滑利有力，形体气息一定急躁且多烦躁不安。如果热证确实存在，就应当放手使用清凉解表或清热的方法，或者兼用分利小便的方法，只要使邪气去除，疾病自然痊愈。如果没有这些实热的各种症状，而泄泻痢疾仍然不止的，必定是虚寒证，如果不是通过温补脾肾的方法治疗，必定不能痊愈；即使有痊愈的，也一定是因为患者元气尚存根基，等待正气恢复才好的。不要认为虚寒证有不需温补就能痊愈的情况，也不要认为治疗痢疾一定要用寒凉药，且寒凉药也不会造成伤害，这些都是见识不够真切的表现。
Background Information:
Book: Jingyue Quanshu (Complete Works of Zhang Jingyue)
Author: Zhang Jiebin (Zhang Jingyue)
Dynasty: Ming Dynasty
Chapter: Colloquial Words / Discussion on Deficiency and Excess in Diarrhea and Dysentery (3 items) / Discussion on Cold and Heat in Diarrhea and Dysentery
Category: Comprehensive
[Original Text]
Summer days are often hot, allowing Yin pathogens to easily enter. Summer-heat and dryness are the primary factors, while wind and cold are secondary guests. If the body is not exposed to wind, how can malaria arise? If the mouth and throat are not exposed to cold, how can dysentery be contracted? Treatment must seek the root cause; this is the golden standard left by Xuanyuan (Yellow Emperor) and Qibo. Memorize these subtle words, for they can serve as medical principles.
Translation:
In summer, the weather is frequently hot, making it easy for Yin-type pathogens (such as cold or dampness) to invade the body. Summer-heat is the predominant pathogenic factor, whereas wind and cold are secondary or concurrent factors. If the body does not suffer exposure to wind pathogens, how would malaria (a disease characterized by alternating chills and fever) occur? If the mouth and digestive tract do not suffer exposure to cold pathogens, how would dysentery (a disease characterized by abdominal pain, tenesmus, and passage of pus and blood) be acquired? Medical treatment must always seek the fundamental cause; this wisdom was established by Xuanyuan (the Yellow Emperor) and Qibo (a legendary physician). Commit these profound teachings to memory, as they can serve as guiding principles for medical practice.
Whenever treating dysentery, one must carefully distinguish between deficiency and excess, and differentiate between cold and heat. This is of paramount importance in the treatment of diarrhea and dysentery. If these four aspects are not clearly understood, causing death becomes very easy.
Translation:
When treating dysentery, it is most crucial to examine whether the condition is a Deficiency syndrome (Xu Zheng) or an Excess syndrome (Shi Zheng), and to differentiate between Cold syndromes (Han Zheng) and Heat syndromes (Re Zheng). This distinction is the most critical aspect in managing diarrhea and dysentery. If these four categories are not clearly identified, the risk of fatal outcomes increases significantly.
First, regarding the differentiation of Excess syndromes: The patient must have a strong physique and robust vital energy, with a slippery and solid pulse. Alternatively, the patient may have a history of dietary indulgence, frequent abdominal distension with hard and painful sensations, or be a young person suffering from a recent onset of illness where the Spleen Qi has not yet been damaged. Only in such cases can methods targeting the branch symptoms (treatment of acute manifestations) be employed. For mild cases, use methods to promote circulation and unblock stagnation; for severe cases, use purgative methods to drain excess.
Translation:
First, the differentiation of Excess syndromes requires that the patient possesses a strong physical constitution and robust Qi, accompanied by a slippery and forceful pulse. Alternatively, the patient may have a history of dietary excess, frequent abdominal fullness with hard and painful distension, or be a young individual with a recent onset of disease where Spleen Qi remains undamaged. Only under these conditions should branch-treatment methods (therapies aimed at relieving acute symptoms) be applied. In mild cases, use methods to promote movement and resolve stagnation; in severe cases, use purgative methods to evacuate excess.
Second, regarding the differentiation of Deficiency syndromes: There are those with a frail physique, those with pale and clear complexion, those whose pulses are tight and rapid but weak and lacking spirit, those whose pulses appear truly wiry but indicate central deficiency mimicking excess, those with innate Yang deficiency, those who habitually eat bland food, those who accidentally consumed raw or cold foods, those who were accidentally exposed to rain and yin-cold, those who accidentally suffered from irregular diet, and those who are elderly with weak Spleens. Among all these conditions, if a person who usually does not indulge suddenly suffers from diarrhea or dysentery, it is certainly due to eating melons, fruits, or slightly cool foods, which accidentally injured Stomach Qi. Where is the accumulation? Where is the heat? Generally, only those with weak Spleens frequently present with such syndromes. Therefore, treatment for these cases should only involve warming and regulating the Spleen and Kidney. Once the Spleen is warmed, the cold will dissipate, which is essentially expelling the pathogen. Since the pathogen is minimal, using warming and tonifying methods to strengthen the Spleen causes no harm. After just a few doses, recovery should naturally occur. One must absolutely not recklessly claim that tonification will trap the pathogen, thereby using drugs to attack accumulation, resolve stagnation, or clear fire first. If Spleen Qi is injured again, mild cases will become severe, and severe cases will become critical.
Translation:
Second, the differentiation of Deficiency syndromes includes patients with a thin and weak physique, those with a pale complexion, those with pulses that are tight and rapid yet weak and devoid of spirit, those with wiry pulses indicating central deficiency that mimics excess, those with congenital Yang deficiency, those accustomed to a bland diet, those who accidentally ingested raw or cold foods, those accidentally exposed to rainy and yin-cold environments, those affected by dietary irregularities, and the elderly with weak Spleens. In all these scenarios, if a person who typically does not overindulge suddenly develops diarrhea or dysentery, it is invariably due to the accidental consumption of melons, fruits, or slightly cool foods, which inadvertently injured Stomach Qi. What accumulation exists? What heat exists? Essentially, individuals with weak Spleens are prone to such conditions. Therefore, treatment should focus solely on warming and regulating the Spleen and Kidney. By warming the Spleen, cold is eliminated, which constitutes the expulsion of pathogens. Given that the pathogenic factor is minimal, employing warming and tonifying strategies to strengthen the Spleen poses no obstruction. Recovery will naturally occur after merely a few doses. One must strictly avoid the erroneous notion that tonification traps pathogens, leading to the premature use of purgatives for accumulation, agents for resolving stagnation, or herbs for clearing fire. Should this further injure Spleen Qi, mild conditions will worsen, and severe conditions will become life-threatening.
Regarding the differentiation of cold and heat in diarrhea and dysentery: If it is indeed a Heat syndrome, the patient will fear heat and prefer cold, dislike clothing and bedding, experience severe thirst and desire to drink water (with no harm even if drinking large amounts), have hot, astringent, and painful urination, or pass pure bright red blood in stool. The pulse will be slippery, solid, and forceful, and the physical state and Qi will be restless, irritable, and烦 (agitated). If the Heat syndrome is confirmed, one should boldly employ cooling and resolving methods, or combine them with diaphoretic/diuretic methods to separate and drain. As long as the pathogen is removed, the disease will heal itself. If these signs of excess heat are absent, yet diarrhea and dysentery persist, it must be a Deficiency-Cold syndrome. Without warming and tonifying the Spleen and Kidney, it cannot be cured. Even if some recover, it is only because their Yuan Qi (Primary Qi) has roots and recovers spontaneously. Do not claim that Deficiency-Cold syndromes can heal without warming and tonification, nor argue that treating dysentery necessarily requires cold-natured herbs and that cold herbs are harmless. Such views demonstrate a lack of true understanding.
Translation:
Concerning the differentiation of Cold and Heat in diarrhea and dysentery: If the condition is genuinely a Heat syndrome, the patient will inevitably fear heat and prefer cold, refuse to wear clothes or cover themselves with blankets, suffer from intense thirst and desire to drink copious amounts of water without adverse effects, experience burning, astringent, and painful urination, or pass pure, bright red blood in the stool. The pulse will be slippery, solid, and forceful, and the physical demeanor and Qi will be restless, agitated, and irritable. If the Heat syndrome is confirmed, one should confidently apply cooling and resolving therapies, possibly combined with methods to separate turbidity and promote urination. Provided the pathogen is expelled, the disease will resolve spontaneously. If these signs of excess heat are absent, yet diarrhea and dysentery continue, the condition must be Deficiency-Cold. Unless treated with warming and tonifying methods targeting the Spleen and Kidney, recovery is impossible. Any apparent recovery in such cases occurs only because the patient's Primary Qi (Yuan Qi) remains rooted and regenerates naturally. Do not assert that Deficiency-Cold syndromes can heal without warming and tonification, nor contend that dysentery treatment necessitates cold-natured herbs and that such herbs are harmless. These perspectives reflect an incomplete understanding of the pathology.