《通评虚实论》帝曰∶肠 便血何如？岐伯曰∶身热则死，寒则生。帝曰∶肠
下白沫何如？岐伯曰∶脉沉则生，脉浮则死。帝曰∶肠 下浓血何如？曰∶脉悬绝则
死，滑大则生。帝曰∶肠 之属，身不热，脉不悬绝何如？曰∶滑大者曰生，悬涩者曰
死，以脏期之。
《百病始生篇》曰∶阳络伤则血外溢，血外溢则衄血；阴络伤则血内溢，血内溢则后血
。
《太阴阳明论》曰∶食饮不节，起居不时者，阴受之，阴受之则入五脏，入五脏则
满闭塞，下为飧泄，久为肠 。
《大奇论》曰∶脾脉外鼓，沉为肠 ，久自已。肝脉小缓为肠 ，易治。肾脉
小搏沉。为肠 下血，血温身热者死。心肝 亦下血，二脏同病者可治，其脉小沉
涩为肠 ，其身热者死，热见七日死。
《论疾诊尺篇》曰∶大便赤瓣飧泄，脉小，手足寒者，难已。飧泄，脉小，手足温，泄
易已。春伤于风，夏生后泄肠 。
《经脉篇》曰∶肾所生病为肠 。
《阴阳别论》曰∶阴阳虚肠 死。
《气厥论》曰∶肾移热于脾，传为虚，肠 死。
《玉机真藏论》曰∶泄而脉大，脱血而脉实，皆难治。
痢疾一证，即《内经》之肠 也，古今方书，因其闭滞不利，故又谓之滞下。其证
则里急后重，或垢或血，或见五色，或多红紫，或痛或不痛，或呕或不呕，或为发热，或为
恶寒。此证之阴阳虚实，最宜博审详察，庶不致于差失，若见有不确，则大致误人。前泄泻
门诸法，本与此通，必互相参酌用之为善。
一、痢疾之病，多病于夏秋之交，古法相传，皆谓炎暑大行，相火司令，酷热之毒蓄积
为痢，今人所宗，皆此一说。夫痢因于暑而言其为热，岂不宜然，然炎热者，天之常令也，
当热不热，必反为灾；因热贪凉者，人之常事也，过食生冷，所以致痢。多见人之慎疾者，
虽经盛暑，不犯寒凉，则终无泻痢之患，岂其独不受热乎？此其病在寒邪，不在暑热，病在
人事，不在天时，从可知矣。但胃强气实者，虽日用水果之类，而阳气能胜，故不致疾。其
次之者，虽未即病，而日用日积，迨夫大火流西，新凉得气，则伏阴内动，乘机而起，故寒
湿得以犯脾者，多在七八月之间，此阳消阴长之征，最易见也。再其次者，多以脾肾本弱，
则随犯随病，不必伏寒，亦不必待时，尤为易见。夫以生冷下咽，泻痢随起，岂即化而为热
乎？奈何近代医流，止见此时之天热，不见此人之脏寒，但见痢证，开口便言热毒，反以寒
凉治生冷，是何异雪上加霜乎！俗见相同，死者不可胜言矣。
或曰∶然亦有用寒药而愈者何也？曰∶以胃强阳盛之人，而得湿成热者，亦有之；以元
气壮实，而邪不胜正者，亦有之，此皆可以寒治而愈，亦可以通利而愈，而此辈极少。以胃
弱阳虚而因寒伤脏者，此辈极多，若再用寒凉，或妄加荡涤，则无有不死，凡今以痢疾而致
死者，皆此类也。观丹溪曰∶泻痢一证，属热者多，属寒者少。戴原礼曰∶以酷热之毒，至
秋阳气始收，火气下降，因作滞下之证，皆大谬之言也，不可信之，因作俚词以志其戒。
《素问·通评虚实论》中，黄帝问道：患痢疾并便血的情况如何？岐伯回答：身体发热则预后不良（死），体温正常或偏寒则预后良好（生）。黄帝又问：痢疾下白沫的情况如何？岐伯回答：脉象沉伏则预后良好，脉象浮大则预后不良。黄帝再问：痢疾下脓血的情况如何？岐伯说：脉象悬绝（极细弱或断绝）则预后不良，脉象滑大则预后良好。黄帝问：属于痢疾一类病症，若身体不发热，脉象也不悬绝，情况如何？岐伯回答：脉象滑大的主生，脉象悬涩的主死，可根据脏腑气绝的日期来推断死亡时间。
《素问·百病始生篇》说：阳络受损则血液外溢，血液外溢表现为鼻衄（鼻出血）；阴络受损则血液内溢，血液内溢表现为后阴出血（便血）。
《素问·太阴阳明论》说：饮食不节制，起居没有规律，会导致阴经受邪，阴经受邪则病邪传入五脏，传入五脏则出现腹部胀满闭塞，向下发展为完谷不化的泄泻，日久则演变为痢疾。
《素问·大奇论》说：脾脉在外鼓动而按之沉，是痢疾的表现，日久可自行痊愈。肝脉小且缓，也是痢疾，容易治疗。肾脉小且搏指而沉，是痢疾下血的表现，若血色温热且身体发热则预后不良（死）。心和肝经病变也可见下血，若两脏同时患病尚可治疗，若脉象小、沉、涩且伴有身体发热的则预后不良（死），发热持续七天则死亡。
《素问·论疾诊尺篇》说：大便排出赤色瓣状物且伴完谷不化的泄泻，脉象小，手足寒冷者，难以治愈。若是完谷不化的泄泻，脉象小但手足温暖者，泄泻容易治愈。春季感受风邪，夏季会发展为后泄和痢疾。
《素问·气厥论》说：肾中的热邪移传于脾，转化为虚证，导致痢疾，预后不良（死）。
《素问·玉机真藏论》说：泄泻而脉象大，脱血而脉象实，都属于难治之症。
痢疾这一证候，就是《内经》中所说的“肠澼”。古今方书因为患者排便闭滞不通，所以又称之为“滞下”。其症状表现为里急后重，排泄物或是污秽粘液，或是血液，或者五色杂下，或者多为红紫色，或者腹痛或者不痛，或者呕吐或者不呕吐，或者发热或者恶寒。此证的阴阳虚实，最宜广泛审察、详细辨析，以免出现差错失误，如果诊断不确切，就会大致误人。前文泄泻门的各种治法，本与此相通，必须互相参考斟酌使用才好。
一、痢疾这种病，多发生在夏秋交替之际。古法相传，都认为炎暑盛行，相火当令，酷热之毒蓄积而成痢疾，今人所尊崇的，都是这一种说法。如果说痢疾是因为暑热而言其为热证，这难道不是理所当然的吗？然而炎热是天气的正常规律，应当热而不热，必定反而成为灾害；因天热而贪凉的人情是常事，过食生冷食物，所以才导致痢疾。多见那些谨慎防病的人，虽然经过盛夏，不触犯寒凉之物，最终就没有泄痢的祸患，难道他们独自不受热邪侵害吗？这说明病在寒邪，不在暑热；病在人为因素，不在天时气候，由此可以知道了。但是胃气强盛、正气充足的人，即使每天食用水果之类寒凉食物，阳气也能胜之，所以不会致病。其次之人，虽然当时不立即发病，但日用日积，等到七月流火、新凉之气到来时，潜伏的阴寒之气在内发动，乘机而起，所以寒湿得以侵犯脾脏的，多在七八月之间，这是阳气消退、阴气增长的征兆，最容易见到。再次之人，多以脾肾本来虚弱，所以随犯随病，不必等待潜伏的寒邪，也不必等待特定季节，更为常见。既然生冷食物咽下，泄痢随即发生，难道立刻就会化为热证吗？为何近代医家，只看到此时天气炎热，看不到人体内脏的寒凉，只要见到痢疾病证，开口便说是热毒，反而用寒凉药去治疗因生冷引起的疾病，这何尝不是雪上加霜呢！世俗见解相同，死者不可胜数了。
有人说：那么也有用寒凉药而痊愈的，为什么呢？回答说：对于胃强阳盛之人，因湿气郁结而化热的，也有这种情况；对于元气壮实，邪气不能战胜正气的，也有这种情况，这些人都可以用寒凉法治愈，也可以用通利法治愈，但这类人极少。而对于胃弱阳虚、因寒邪损伤脏腑的人，这类人极多，如果再使用寒凉药，或者妄加攻下荡涤，则没有不死人的，凡是现在因痢疾而导致死亡的，都是这类情况。看朱丹溪说：泄痢这一证候，属热的多，属寒的少。戴原礼说：因为酷热之毒，到了秋天阳气开始收敛，火气下降，因而产生滞下之证，这都是极其荒谬的话，不可相信，因此写下通俗词句以作告诫。
In the *Tong Ping Xu Shi Lun* (Discussion on Excess and Deficiency in General) of the *Su Wen*, the Yellow Emperor asked: What is the prognosis for dysentery with bloody stools? Qibo replied: If the body is hot, death ensues; if the body is cold (or normal temperature), life is preserved. The Yellow Emperor asked: What is the prognosis for dysentery with white mucus discharge? Qibo replied: If the pulse is deep (*Chen*), life is preserved; if the pulse is floating (*Fu*), death ensues. The Yellow Emperor asked: What is the prognosis for dysentery with purulent and bloody discharge? Qibo said: If the pulse is suspended and severed (*Xuan Jue*), death ensues; if the pulse is slippery and large (*Hua Da*), life is preserved. The Yellow Emperor asked: Regarding conditions belonging to dysentery, if the body is not hot and the pulse is not suspended and severed, what is the situation? Qibo replied: A slippery and large pulse indicates survival; a suspended and choppy pulse indicates death, which can be predicted according to the timing of organ qi exhaustion.
The *Bai Bing Shi Sheng Pian* (Chapter on the Origin of All Diseases) states: Injury to the Yang collaterals causes blood to overflow externally, resulting in epistaxis (*Nu Xue*); injury to the Yin collaterals causes blood to overflow internally, resulting in bleeding from the lower orifice (*Hou Xue*).
The *Tai Yin Yang Ming Lun* (Discussion on Taiyin and Yangming) states: Irregular diet and improper daily routine cause injury to the Yin meridians. When the Yin meridians are injured, the pathogen enters the Five Zang organs. Entering the Zang organs leads to abdominal fullness and obstruction, manifesting downward as undigested stool diarrhea (*Sun Xie*), and over time evolving into dysentery (*Chang Pi*).
The *Da Qi Lun* (Discussion on Great Anomalies) states: A Spleen pulse that beats outwardly but is deep upon pressure indicates dysentery, which will heal itself after a long period. A Liver pulse that is small and slow indicates dysentery, which is easy to treat. A Kidney pulse that is small, thready, and deep indicates dysentery with bloody discharge; if the blood is warm and the body is hot, death ensues. Pathologies of the Heart and Liver also involve bloody discharge; if both organs are diseased simultaneously, it is treatable. However, if the pulse is small, deep, and choppy accompanied by body heat, death ensues; if heat persists for seven days, death occurs.
The *Lun Ji Zhen Chi Pian* (Chapter on Diagnosing Diseases by Inspecting the Forearm) states: Stool containing red clots with undigested stool diarrhea, a small pulse, and cold hands and feet indicate a difficult-to-treat condition. Undigested stool diarrhea with a small pulse but warm hands and feet indicates that the diarrhea is easily curable. Wind injury in spring generates post-diarrhea and dysentery in summer.
The *Jing Mai Pian* (Chapter on Meridians) states: Diseases generated by the Kidney include dysentery.
The *Yin Yang Bie Lun* (Discussion on Differences between Yin and Yang) states: Dysentery caused by deficiency of both Yin and Yang leads to death.
The *Qi Jue Lun* (Discussion on Qi Reversal) states: Heat transferring from the Kidney to the Spleen transforms into deficiency, leading to dysentery, which results in death.
The *Yu Ji Zhen Cang Lun* (Discussion on the Jade Machine and True Organ Pulses) states: Diarrhea with a large pulse, and blood loss with an excess pulse, are both difficult to treat.
Dysentery (*Li Ji*) is the condition referred to as "Chang Pi" in the *Nei Jing*. Ancient and modern medical texts, due to the blockage and difficulty in defecation associated with this condition, call it "Zhi Xia" (Stagnant Downward). Its symptoms include tenesmus (*Li Ji Hou Zhong*), excretion of foul matter or blood, mixed colors (five colors), predominantly red or purple, with or without pain, with or without vomiting, with or without fever, or with or without aversion to cold. The yin-yang and excess-deficiency nature of this condition must be carefully and thoroughly examined to avoid errors; inaccurate diagnosis leads to grave mistakes. The methods described in the preceding section on diarrhea are fundamentally applicable here and should be consulted and used in conjunction for best results.
1. Dysentery often occurs during the transition between summer and autumn. Traditional methods attribute it to the prevalence of intense heat and the command of Ministerial Fire, where toxic heat accumulates to cause dysentery. This view is widely accepted today. While it seems logical to attribute dysentery to summer heat as a heat syndrome, intense heat is the normal climate. When heat fails to arrive when expected, it becomes a disaster. Conversely, seeking coolness due to heat is a common human behavior; excessive consumption of raw and cold foods causes dysentery. Many prudent individuals who avoid cold and raw foods even during peak summer escape diarrhea and dysentery. Does this mean they alone are unaffected by heat? This indicates that the disease lies in cold pathogens, not summer heat; it lies in human conduct, not celestial timing. Those with strong Stomach qi and robust constitution can consume fruits and cold foods daily without illness because their Yang qi prevails. Others may not fall ill immediately, but as raw/cold intake accumulates, when the autumn coolness arrives (around July/August), latent Yin-cold activates and rises. Thus, Spleen invasion by cold-dampness is most common in the seventh and eighth lunar months, reflecting the decline of Yang and growth of Yin. For those with inherent Spleen-Kidney weakness, illness follows exposure immediately, without needing latent cold or specific seasons, making it very common. Since diarrhea and dysentery arise immediately after swallowing cold/raw food, how can it instantly transform into heat? Why do modern physicians only see the external heat of the season and ignore the internal cold of the viscera? Upon seeing dysentery, they immediately label it "heat toxin" and treat cold-induced pathology with cold-natured herbs. Is this not adding frost to snow? Following this common misconception, countless have died.
Some ask: Are there cases cured by cold-natured herbs? I reply: Yes, for those with strong Stomach and abundant Yang who develop damp-heat, or for those with robust Yuan Qi where evil cannot overcome righteousness, cold treatment or purgative treatment can cure them. However, such cases are extremely rare. For the vast majority—those with weak Stomach and deficient Yang injured by cold—if cold herbs are used or purgatives are recklessly applied, death is inevitable. Most deaths from dysentery today fall into this category. Zhu Danxi stated that diarrhea and dysentery are mostly heat syndromes and rarely cold syndromes. Dai Yuanli claimed that due to toxic heat, when autumn arrives and Yang qi recedes while Fire qi descends, stagnant downward dysentery occurs. These are grossly erroneous statements and should not be believed. I write these vernacular warnings to caution against them.