凡腹中积聚之辨，乃以饮食之滞，留蓄于中，或结聚成块，或胀满硬痛，不化不行
，有所阻隔者，乃为之积，此皆 粕成形之属，所当逐也。今人不能辨察，但见痢如脓
垢者，皆谓之积，不知此非 粕之属，而实附肠着脏之脂膏，皆精血之属也。无论瘦人
、肥人皆有此脂，但肥者脂浓，瘦者脂薄，未有无脂者也。若果无脂，则肠脏之间，岂容单
薄赤露，非惟藩篱不固，而且脏必易伤，无是理也。今之凡患泻痢者，正以五内受伤，脂膏
不固，故日剥而下。若其脏气稍强，则随去随生，犹无足虑；若脏气至败，剥削至尽，或以
久泻久痢，但见血水，及如屋漏水者，此在庸人云∶其积聚已无，反称为善，而不知脂膏刮
尽则败竭，极危之候也。使今后医家，但识此为脂膏而本非积聚，则安之固之且不暇，而尚
敢云攻之逐之，或用苦寒以滑之利之者否。
凡五色之辨，如下痢脓垢之属，无非血气所化，但白者其来浅，浮近之脂膏也。赤者其
来深，由脂膏而切肤络也。下纯血者，多以血为热迫，故随溢随下，此其最深者也。若紫红
、紫白者，则离位稍久，其下不速，而色因以变，或未及脉络，此其稍浅者也。若红白相兼
者，此又其浅深皆及者也。大都纯血鲜红者多热证，以火性急速，迫而下也；紫红紫白者少
热证，以阴凝血败，损而然也，纯白者无热证，以脏寒气薄，滑而然也。然有以无红而亦因
热者，此以暴注之类，而非下痢之谓也；有以紫红虽多而不可言热者，此以阴络受伤，而非
暴注之比也。若辨黄黑二色，则凡黄深而秽臭者，此有热证，亦有寒证；若浅黄色淡不甚臭
，而或兼腥馊气者，此即不化之类，皆寒证也；黑而浓浓大臭者，此焦色也，多有火证；若
青黑而腥薄者，此肝肾腐败之色也，犹以为热，其谬甚矣。虽五色之辨，大约如此，然痢之
见血者，无非阴络受伤，即或寒或热，但伤络脉，则无不见血，故不可以见血者，必认为热
也。凡临此证，当必以脉色、形气、病因兼而察之，庶不致有疑似之误。
凡是辨别腹中积聚，是因为饮食停滞，留积在体内，有的结成块状，有的胀满硬痛，气机不通，有所阻隔的，这就称为“积”，这些都属于糟粕成形之物，应当采用攻逐的方法治疗。现在的人不能仔细辨别，只要看到痢疾排出像脓垢一样的东西，都称之为“积”，却不知道这并非糟粕之类，而是附着在肠道和脏腑表面的脂膏，实际上属于精血一类。无论瘦人还是肥人都有这种脂膏，只是肥人的脂膏浓厚，瘦人的脂膏稀薄，没有完全没有脂膏的情况。如果真的没有脂膏，那么肠脏之间怎么能允许单薄赤露呢？这不仅藩篱不固，而且脏腑必定容易受伤，这是不合情理的。如今凡是患有泻痢的人，正是因为五脏受损，脂膏不固，所以每天剥落而下。如果脏腑之气稍强，那么脂膏随去随生，还不足以担忧；如果脏腑之气败坏，剥削殆尽，或者因为久泻久痢，只见到血水，以及像屋漏水那样的情况，这在庸医看来说：“积聚已经没有了，反而称为好转”，却不知道脂膏刮尽则精气败竭，这是极危重的征候。希望以后的医家，能识别出这是脂膏而本非积聚，那么安抚巩固还来不及，还敢说攻逐它，或用苦寒药物来滑利它的吗？
关于五色痢疾的辨别，如下痢脓垢之类，无非是气血所化生。白色者病位较浅，是浮近的脂膏；红色者病位较深，由脂膏深入至肌肤络脉；下纯血者，多因血分受热逼迫，所以随溢随下，这是病位最深的。如果是紫红、紫白色的，则是离体时间稍久，排泄不迅速，颜色因此发生变化，或者尚未波及脉络，这是病位稍浅的。如果是红白相兼的，则是深浅都波及到了。大抵纯血鲜红的多为热证，因为火性急速，逼迫血液下行；紫红紫白的少为热证，因为阴血凝滞败坏，损伤所致；纯白色的无热证，因为脏腑寒气薄弱，滑泄所致。然而也有没有红色却因热的，这是指暴注下迫之类的病症，而非痢疾；也有紫红虽多但不能说是热的，这是指阴络受伤，而非暴注下迫可比。如果要辨别黄黑二色，凡是黄色深且秽臭的，既有热证，也有寒证；如果是浅黄色淡且不甚臭，或者兼有腥馊气的，这是消化不良之类，都属于寒证；黑色浓重且气味极大的，这是焦色，多有火证；如果是青黑且腥薄味的，这是肝肾腐败的颜色，如果还认为是热证，那就太荒谬了。虽然五色的辨别大致如此，但是痢疾见血的，无非是阴络受伤，即使或寒或热，只要伤了络脉，就无不出现出血，所以不能一见出血就必然认为是热证。凡遇到这种情况，必须结合脉象、面色、形体气息、病因综合考察，才不至于产生似是而非的错误。
Regarding the differentiation of accumulations (Ji, 积) in the abdomen, it stems from food stagnation retained within the body. If it condenses into masses or causes distension, fullness, hardness, and pain with obstruction of qi movement, this is termed "accumulation" (Ji). These belong to the category of formed waste products (Zao Po, 糟粕) and should be treated by purging (Zhu, 逐). However, contemporary practitioners often fail to distinguish them accurately; upon seeing dysentery discharging pus-like turbid matter, they indiscriminately label it as "accumulation." They do not realize that this is not waste material but rather the adipose tissue (Zhi Gao, 脂膏) adhering to the intestines and viscera, which actually belongs to the category of essence and blood (Jing Xue, 精血). Both thin and obese individuals possess this adipose tissue; the obese have thicker layers, while the thin have thinner layers, but none are devoid of it. If there were truly no adipose tissue, how could the intestinal and visceral cavities remain exposed and bare? This would not only compromise the defensive barrier (Fan Li, 藩篱) but also make the viscera susceptible to injury, which is physiologically impossible. Currently, patients suffering from diarrhea and dysentery do so because their internal organs (Wu Zang, 五内) are damaged, causing the adipose tissue to become unstable and shed daily. If the organ qi is relatively strong, the tissue regenerates as it is lost, posing little concern; however, if the organ qi fails completely and the tissue is exhausted, or due to chronic diarrhea/dysentery where only bloody water or fluid resembling leaking roof water is seen, quack doctors might mistakenly claim that "the accumulation has cleared up," calling it a good sign. In reality, the exhaustion of adipose tissue indicates the depletion of vital essence, representing an extremely critical condition. It is hoped that future physicians will recognize this as adipose tissue rather than true accumulation; thus, they would focus on stabilizing and securing the condition rather than daring to use purgative methods or bitter-cold herbs to induce sliding and diuresis.
Regarding the differentiation of the five colors in dysentery, such as pus-like discharge, all are transformations of qi and blood. White discharge indicates a superficial pathogenesis, involving the floating adipose tissue. Red discharge indicates a deeper pathogenesis, extending from the adipose tissue to the cutaneous collaterals (Fu Luo, 浮络). Discharge of pure blood usually results from heat forcing the blood, causing it to overflow and pass down immediately, representing the deepest level. Purple-red or purple-white discharge indicates that the blood has remained outside the vessels for a longer period, moving slowly, leading to color changes, or has not yet reached the collaterals, representing a slightly more superficial level. Mixed red and white discharge indicates involvement at both superficial and deep levels. Generally, bright red pure blood suggests a heat syndrome (Re Zheng, 热证), as fire nature is rapid and forces downward flow. Purple-red or purple-white patterns suggest less heat, resulting from yin blood coagulation and decay due to damage. Pure white discharge indicates no heat, resulting from cold qi deficiency in the organs leading to slippery discharge. However, some cases without redness may still be due to heat, specifically referring to acute sudden watery diarrhea (Bao Zhu, 暴注) rather than dysentery. Conversely, abundant purple-red discharge does not necessarily indicate heat; it may result from injury to the yin collaterals (Yin Luo, 阴络), distinct from acute sudden diarrhea. Regarding yellow and black colors: deep yellow with foul odor can indicate either heat or cold syndromes; pale yellow with mild odor, or accompanied by a fishy/sour smell, indicates indigestion and belongs to cold syndromes. Thick black with a strong odor represents scorching color, often associated with fire syndromes. Cyan-black with a thin fishy smell represents the corruption color of the liver and kidneys; considering this as heat is a grave error. Although the differentiation of the five colors follows these general principles, bleeding in dysentery invariably involves injury to the yin collaterals. Regardless of cold or heat, once the collaterals are damaged, bleeding occurs. Therefore, one cannot assume that bleeding always indicates heat. When encountering such conditions, one must comprehensively examine the pulse, complexion, physical constitution, and etiology to avoid diagnostic errors based on ambiguity.