仲景曰∶夫六腑气绝于外者，手足寒，上气，脚缩；五脏气绝于内，利不禁，下甚者，
手足不仁。下痢腹胀满，身体疼痛者，先温其里，乃攻其表。温里宜四逆汤，攻表宜桂枝汤
。
《褚氏遗书》曰∶阴已耗而复竭之，则大小便牵疼，愈疼则愈欲大小便，愈便则愈疼。
东垣曰∶饮食有伤，起居不时，损其胃气，则上升清华之气反从下降，是为飧泄，久则
太阴传少阴而为肠 。里急后重，脓血相杂，数至圊而不能即便者，专用补中益气汤为
主，使升降之道行，其痢不治自消矣。里急者，腹中不宽快也，亦有虚坐而大便不行者，皆
血虚也，血虚则里急后重。
薛立斋曰∶若白痢久，胃弱气虚，数至圊而不能便，或少有白脓者，乃土不生金，肺与
大肠气伤而下坠也。当用补中益气汤举其阳气，则阴自降而二便自愈。若饮食不入，发热作
渴，势甚危急，用十全大补汤。如不应，送二神丸。若红痢久，胃弱血虚，脾经血热下注而
不愈者，用四物加白术、茯苓。若脾经气虚，不能统血而不愈者，用四君加川芎、当归。若
中气下陷，不能摄血而不愈者，用补中益气汤。
凡呕吐，食不得下，其或脾胃素有实热，或过食辛辣浓味而暴患者，宜开胃行滞。若胃
气虚，隔呕吐者，宜六君加生姜。凡痢，腹痛后重，怕手按腹，或脉洪实者，为积滞闭结，
宜疏通之。若腹痛后重，喜手按腹，或脉微细，为阳气虚寒，宜六君、干姜温补脾气。
凡气血虚而作痢，若脾虚血弱者，宜四君子汤。胃虚血弱者，补中益气汤。久病气血俱
虚者，八珍汤。若脾气虚寒下陷，补中益气汤加粟壳、姜、桂，如不应，急用附子。若气血
虚弱，宜十全大补汤加附子、粟壳。若命门火衰，宜八味丸以补母气。若腹痛作渴，饮汤，
手按之而痛稍止者，俱宜温补脾胃。
徐东皋曰∶凡痢疾之治，须审病者气体浓薄，曾无通泻及用攻积苦寒之药，脉之有力无
力，及正气邪气有余不足，对证施治，未有弗效。今医治痢，多峻用下剂及苦寒太过，鲜有
不致误者，况年高与体弱之人，遂致元气虚陷，反不能支。胃气既虚，其痢益甚，有阳虚陷
入阴中，则脱血阵阵而下者，医尚谓血痢不已，仍用苦寒，渐至脉绝，四肢厥冷而死者，曷
可胜纪。且今人之患痢者，多有脾胃先虚而后积滞，通滞之剂宜酌用也，稍或过之，遂致虚
脱，盖有由焉。
张仲景说：六腑的阳气在体表衰竭时，会出现手足寒冷、气逆上冲、双脚收缩的症状；五脏的阴气在体内衰竭时，会出现腹泻无法控制，若下利严重，则手足麻木不仁。出现下痢且伴有腹部胀满、身体疼痛的情况，应当先温补里虚，然后再解表邪。温补里虚适宜使用四逆汤，解表邪适宜使用桂枝汤。
《褚氏遗书》说：阴精已经耗损，如果再加以竭尽，就会导致大小便牵拉疼痛，越疼痛就越想大小便，越排便疼痛就越剧烈。
李东垣说：饮食损伤脾胃，起居作息没有规律，会损害胃气，导致上升的清阳之气反而下降，这就形成了飧泄（完谷不化的泄泻），时间久了会从太阴脾经传变至少阴肾经而成为痢疾。如果有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）、脓血混杂、频繁去厕所却无法立即排出的症状，应专门以补中益气汤为主方治疗，使气机升降的道路通畅，痢疾不治自消。所谓“里急”，是指腹中感觉不宽舒畅快，也有因虚坐努责而大便排不出来的情况，这都属于血虚，血虚就会导致里急后重。
薛立斋说：如果是白痢日久，胃弱气虚，频繁去厕所却排不出大便，或者只有少量白色脓液，这是土不生金（脾虚不能养肺），导致肺与大肠的气受损而下坠。应当使用补中益气汤提升阳气，那么阴气自然下降，二便就能自愈。如果饮食无法入口，发热口渴，病情非常危急，使用十全大补汤。如果无效，送服二神丸。如果是红痢日久，胃弱血虚，脾经血热下注而久治不愈的，使用四物汤加白术、茯苓。如果是脾经气虚，不能统摄血液而久治不愈的，使用四君子汤加川芎、当归。如果是中气下陷，不能固摄血液而久治不愈的，使用补中益气汤。
凡是呕吐，食物无法咽下，如果是脾胃素有实热，或者过食辛辣浓味食物突然患病的，宜用开胃行滞的方法。如果是胃气虚弱导致的膈噎呕吐，宜用六君子汤加生姜。凡是痢疾，腹痛后重，怕手按压腹部，或者脉象洪大有力的，属于积滞闭结，宜用疏通的方法。如果腹痛后重，喜欢手按压腹部，或者脉象微细，属于阳气虚寒，宜用六君子汤、干姜温补脾气。
凡是气血虚弱导致的痢疾，如果是脾虚血弱的，宜用四君子汤。胃虚血弱的，用补中益气汤。久病导致气血都虚弱的，用八珍汤。如果是脾气虚寒且下陷的，用补中益气汤加罂粟壳、生姜、肉桂，如果无效，紧急使用附子。如果是气血虚弱，宜用十全大补汤加附子、罂粟壳。如果是命门火衰，宜用八味丸来补益母气（补肾）。如果腹痛且口渴，喝热水或用手按压后疼痛稍缓解的，都适宜温补脾胃。
徐东皋说：凡是治疗痢疾，必须审察患者的体质强弱，是否曾经用过通泻及攻积苦寒的药物，脉象有力还是无力，以及正气和邪气的有余不足，对症施治，没有无效的。现在医生治疗痢疾，大多峻猛地使用泻下药及过于苦寒的药物，很少有不致误诊的，何况对于年高体弱的人，会导致元气虚陷，反而无法支撑。胃气既然虚弱，痢疾会更加严重，有阳虚陷入阴中的，就会出现阵发性脱血，医生还认为血痢不止，继续使用苦寒药物，逐渐导致脉绝、四肢厥冷而死，这种情况不胜枚举。况且现在患痢疾的人，多有脾胃先虚而后产生积滞的情况，通滞的药物应该酌情使用，稍微过度，就会导致虚脱，这是有原因的。
Zhang Zhongjing stated: When the Yang Qi of the Six Fu Organs fails at the exterior, symptoms include cold hands and feet, rebellious Qi ascending, and contracted legs; when the Yin Qi of the Five Zang Organs fails at the interior, symptoms include uncontrollable diarrhea, and if the downward flow is severe, numbness of the hands and feet. In cases of dysentery accompanied by abdominal distension and fullness, and body pain, one should first warm the interior, then attack the exterior. To warm the interior, Si Ni Tang (Four Reversal Decoction) is appropriate; to attack the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
*Chu Shi Yi Shu* (Remnants of the Book by Chu Shaosu) states: If Yin Essence has already been depleted and is further exhausted, it leads to pulling pain in the large and small intestines during defecation; the more painful it is, the more one desires to defecate, and the more one defecates, the more painful it becomes.
Li Dongyuan stated: Damage from diet and irregular daily routines impair Stomach Qi, causing the clear Yang Qi that should ascend to instead descend, resulting in *Sun Xie* (diarrhea with undigested food). Over time, this may transmit from the Taiyin Spleen channel to the Shaoyin Kidney channel, becoming Li Ji (dysentery). In cases of *Li Ji Hou Zhong* (tenesmus—urgent abdominal discomfort with frequent urges to defecate but difficulty passing stool), mixed pus and blood, and frequent visits to the toilet without immediate passage, one should primarily use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to facilitate the smooth flow of Qi ascent and descent, thereby resolving the dysentery spontaneously. "Li Ji" refers to a feeling of discomfort and lack of ease in the abdomen. There are also cases of false sitting strain where stool cannot be passed, which all belong to Blood Deficiency; Blood Deficiency leads to tenesmus.
Xue Lizhai stated: If white dysentery persists for a long time due to weak Stomach and deficient Qi, with frequent urges to defecate but inability to pass stool, or only small amounts of white pus, this indicates Earth failing to generate Metal (Spleen deficiency failing to nourish Lung), damaging the Qi of the Lung and Large Intestine, causing sinking. One should use Bu Zhong Yi Qi Tang to raise the Yang Qi, so that Yin will naturally descend and bowel movements will heal themselves. If food cannot be taken in, accompanied by fever and thirst, indicating critical condition, Shi Quan Da Bu Tang (Ten Great Tonifying Decoction) should be used. If ineffective, administer Er Shen Wan (Two Spirit Pill). If red dysentery persists for a long time due to weak Stomach and Blood Deficiency, with Heat in the Spleen channel pouring downward and failing to heal, Si Wu Tang (Four Substances Decoction) added with Bai Zhu (Atractylodis Rhizoma) and Fu Ling (Poria) should be used. If Spleen channel Qi deficiency fails to control Blood, Si Jun Zi Tang (Four Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) should be used. If Middle Qi sinks and fails to secure Blood, Bu Zhong Yi Qi Tang should be used.
In cases of vomiting where food cannot be swallowed, if there is pre-existing Excess Heat in the Spleen and Stomach, or sudden onset due to overconsumption of spicy and rich flavors, methods to open the stomach and promote stagnation resolution are suitable. If caused by weak Stomach Qi leading to diaphragm obstruction and vomiting, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sheng Jiang (Zingiberis Rhizoma Recens) is suitable. In cases of dysentery with abdominal pain and tenesmus, aversion to abdominal pressure, or a洪 (Hong/Full) and solid pulse, this indicates accumulation and closure; dredging and unblocking methods are suitable. If abdominal pain and tenesmus are relieved by abdominal pressure, or the pulse is micro (Wei) and fine (Xi), this indicates Yang Qi deficiency and Cold; Liu Jun Zi Tang combined with Gan Jiang (Zingiberis Rhizoma) to warm and tonify Spleen Qi is suitable.
In cases of dysentery caused by Qi and Blood deficiency: if Spleen deficiency and Blood weakness prevail, Si Jun Zi Tang (Four Gentlemen Decoction) is suitable; if Stomach deficiency and Blood weakness prevail, Bu Zhong Yi Qi Tang is suitable; if chronic illness leads to both Qi and Blood deficiency, Ba Zhen Tang (Eight Treasures Decoction) is suitable. If Spleen Qi deficiency and Cold lead to sinking, Bu Zhong Yi Qi Tang added with Yu Ke (Papaveris Pericarpium), Sheng Jiang, and Rou Gui (Cinnamomi Cortex) is suitable; if ineffective, Fu Zi (Aconiti Lateralis Radix Praeparata) should be used urgently. If Qi and Blood are weak, Shi Quan Da Bu Tang added with Fu Zi and Yu Ke is suitable. If Ming Men Fire (Gate of Life Fire) declines, Ba Wei Wan (Eight-Ingredient Pill) should be used to tonify the maternal Qi (Kidney). In cases of abdominal pain with thirst, where drinking hot water or pressing the abdomen provides slight relief, warming and tonifying the Spleen and Stomach are suitable.
Xu Donggao stated: In treating dysentery, one must examine the patient's constitution (thick or thin), whether purgatives or bitter-cold drugs for attacking accumulations have been used previously, whether the pulse is forceful or feeble, and the surplus or deficit of Righteous Qi versus Pathogenic Qi. Treatment based on syndrome differentiation is invariably effective. However, current physicians often use harsh purgatives and excessively bitter-cold drugs to treat dysentery, rarely avoiding error. This is especially detrimental to the elderly and the weak, causing Righteous Qi to sink and fail to sustain life. Once Stomach Qi is weak, dysentery worsens. In cases of Yang deficiency sinking into Yin, resulting in episodic hemorrhage, physicians still consider the bloody dysentery unceasing and continue using bitter-cold drugs, gradually leading to pulse disappearance, cold limbs, and death. Such cases are countless. Moreover, many current patients with dysentery suffer from prior Spleen and Stomach deficiency followed by accumulation; therefore, agents for dredging stagnation should be used cautiously. Slight excess can lead to collapse from deficiency, which has its reasons.