之行。至于升降仍不行，卫气复郁，荣血复泣，又成新积，故病如故，若是者不必求邪以治，但理卫气以开通腠
理，和荣血以调顺阴阳。阴阳调，腠理开，则升降之道行，其积不治而自消矣。然而旧积亦有不可下者，先因荣
卫之虚，不能转输其食积，必当先补荣卫，资肠胃之真气充溢，然后下之，庶无失矣（《医通》作必当调补脾胃，
兼行气之药，虚回而利自止）。予数见俗方，惟守十数方治痢，不过攻之涩之而已。安知攻病之药，皆是耗气
损血之剂，用之不已，甚至于气散血亡，五脏空虚，精惫神去而死。其固涩之，又皆足以增其气郁血泣之病，转
生腹胀，下
为足肿，上为喘呼，诸疾作焉。世人之法，何足守乎。（《准绳》）
泻痢不可混治（忌利小便）痢与泄泻，其病不同，其治亦异。泄泻多起寒湿，寒则宜温，湿则宜燥也。
痢病多成湿热，热则宜清，湿则宜利也。虽泄泻亦有热症，然毕竟寒多于热；痢病亦多寒症，然毕竟热多于寒。
是以泄泻经久，必伤胃阳，而肿胀喘满之变生；痢病经久，必损其阴，而虚烦痿废之疾起。痢病兜涩太早，湿
热流注，多成痛痹。泄泻疏利或过，中虚不复，多作脾劳。此予所亲历，非臆说也。或曰∶热则清而寒则温，
是已，均是湿也，或从利或从燥何欤？曰∶寒湿者寒从湿生，故宜苦温燥其中，湿热者湿从热化，故宜甘淡利
其下。且燥性多热，利药多寒；便利则热亦自去，中温则寒与俱消。寒湿必本中虚，不可更行渗利；湿热郁多
成毒，不宜益以温燥也。（《读书记》）
泻痢不分，两证混言，湿热不利小便，非其治也。夫泄者水谷湿之象，滞下者垢瘀之物，同于湿热而成，
治分两歧而药亦异。若淡渗之剂，功能散利水道，浊流得快，使泄自止，此有无之形，岂可与滞下混同论治，而
用导滞行积可乎。其下利出于大肠传送之道，了不干于胃气，所下有形之物，或如鱼脑，或如豆汁，或便白脓，
或下纯血，或赤或白，或赤白相杂，若此者岂可与泻混同论治，而用淡渗利之可乎。（薛氏《平治会萃·附论》）
利小便者，治水泄之良法也，以之治痢则乖。痢因邪热胶滞、津液枯涩而成，若用五苓等剂分利其水，则
津液愈枯，滞涩愈甚，遂至缠绵不愈，则分利之为害也。若清热导滞，则痢自愈而小便自利，安用分利为哉。
（《活幼心法》）
治忌燥毒 观仲景可下者十法，可温者五法。谓之下者，率用承气加减，何尝以砒、丹、巴、 决烈燥热重毒
之剂；谓之温者，率用姜、附为主，何尝用钟乳、龙骨、石脂、粟壳紧涩燥毒之剂。（《局方发挥》）
治忌固涩温补 大要以散风邪、行滞气、开胃脘为先，不可遽用肉豆蔻、诃子、白术辈以补住寒邪，不
可遽投罂粟壳、龙骨、牡蛎辈以闭住肠胃。邪气得补而愈盛，补之愈盛而愈作，不为缠扰撮痛，则为里急后重，
所以日夕淹延而未已也。（《直指》）（按∶《续医说》其意相近，且曰∶世俗但知涩剂之能塞，不知通剂之
能塞也。后之学人，贵在变通，不可执一而治。此言本于张子和。）
大凡治痢疾，未可便投罂粟壳、地榆、石榴皮紧涩之药。夫罂粟壳其性紧涩，能损脾胃，留滞毒瓦斯而反增
其疾。正如沟渠停积不洁秽污之物，若不先荡涤，却窒塞其路，使秽污无路而出可乎。是以多因服此，不进食饮，
日渐羸困，强名曰噤口者多矣。如古和剂方中，未曾见用罂粟壳，多用黄连之药。然罂粟壳非无功也，而施之
久痢则可，更宜去尽筋膜穣蒂锉碎，以白蜜和水淹一宿，次日慢火炒令焦黄色，庶得稳当。若投之太早，令人毒
气闭塞心络，噤口不食，无法可施，悔将噬脐。（《管见良方》）
痢之为病，由湿热蕴积胶滞于肠胃之中。清邪热，导滞气，行滞血，则其病速除。若用参、术等温补，
则热愈盛，气愈滞，久之正气虚，邪气炽，至于不可救疗者，初投温补之祸也。（《活幼心法》）（按∶《玉
案》曰∶下痢若服黄 ，即发膨胀，多服升麻，则小便与积皆升至上焦，此速死之道也。今验升麻不必为害。）
产前后痢治例 三宝廉使仲子之妻，泰不花尚书妹也，病滞下，昼夜五七十起，后重下迫，且娠九月。
众医率为清
暑散滞，痛苦尤甚。寿至诊视曰∶须下去滞。众以娠不肯。寿曰∶《素问》有云∶有故无殒，亦无殒也。动即正
产。乃以消滞导气丸药进之，得顺利，再进滞去，继以清暑利溲苦坚之剂，病愈而孕果不动，足月乃产。（朱右撰
《撄宁生传》）
至于妇人临产下痢，最为危殆，郑氏有胎前下痢、产后不止、七日必死之例。予尝用甘草干姜汤加浓朴、
茯苓、木香，治妊娠白痢；《千金》三物胶艾汤，治妊娠血痢；连理汤加胶、艾，治赤白相间之痢。驻车丸、
千金黄连汤、白头翁加甘草阿胶汤，胎前产后五色诸痢皆可选用。若胎前下痢，产后不止，势莫挽回者，用伏
龙肝汤丸随证加减，未尝不随手获效也。（《医通》）（按∶伏龙肝汤丸用炮黑查肉、熬枯黑糖、伏龙肝三味，
宜考原书。）
士人李潜善医，曰∶蓐中下痢与他痢不同，常痢可用苦涩药止之，蓐中痢生于血不足，投涩药则血愈不行，
痢当更甚。（《苏沈》）
发表方法 初起时若有风寒表证，于治痢药中，当加发散。若不发散，径治其痢，必乱其经脉，逆其
气机，病转剧矣。（《医学真传》）
败毒散，治风邪寒邪，壮热下利。（《直指》）痢疾表热里虚者，此方主之。昔人立此方非以治痢，而医
者善用，则取之左右逢其源矣。仲景以葛根汤治太阳、阳明合病自利，亦是妙处。举此一例，余可类推。（《医
方考》）治疫痢发热，合境皆然者，神效，加白芍、黄连尤妙。（《寿世》）（按∶《选奇方后集》加陈米，
名仓廪汤，治噤口痢。《管见良方》、《岭南卫生方》并论此方治痢之妙。）
升麻汤（即升麻葛根汤）
上粗末，每三钱，姜三片同煎，吞感应丸，治伤暑下痢
缠痛。（《直指》）（按∶汗下同用，非可遵仿。）
《治要》除湿汤（即七味除湿汤，方见中湿），加官桂、木香，治风寒冷证下痢；加干姜、茯苓，治伤湿
下痢。（《直指》）
有受风湿，痢下如豆汁，例局有胃风汤。若借治脾受湿气，泄利不止，戊己丸为用亦可。秘方胃风汤用防风
半两，芍药二两，茯苓二两，官桂、羌活各半两，甘草炙一分，每服三钱，入荆芥五小穗，水一盏，煎七分，稍
热服。观其药性，合其药名，参其病因，有治风品，用果多效。（《续易简后集》）
如大便闭塞，或里急后重，数至圊而不能便，或少有白脓，或少有血，慎勿利之，利之则必致病重，反郁结
而不通也。以升阳除湿防风汤举其阳，则阴气自降矣。升阳除湿防风汤。
苍术（泔浸去皮净四两） 防风（二钱） 白术 白茯苓 白芍药（以上各一钱）
上件 咀，除苍术另作片子，水一碗半，煮至二大盏，内诸药，同煎至一大盏，去渣稍热服，空心食前。如
此证飧泄不禁，以此药导其湿。（《脾胃论》）《医经会元》加炙甘草、干葛。（按∶先教谕于此方去白术，用
屡效。）
疫痢，憎寒壮热，下痢臭秽，众人病一般者是也。必先解表发散，宜以大剂苍术为主，佐以羌活、防风、
人中黄、芍药、黄芩、黄连之类，以葱白、生姜服之。（《医镜》）
周信川，年七十三岁，平素体坚，不觉其老，秋月病痢，久而不愈，至冬月成休息痢，一昼夜十余行，面目
浮肿，肌肤晦黑，求治于余。余诊其脉沉数有力，谓曰∶此阳邪陷入于阴之症也，吾当以法治之，尚可痊愈，
明日吾自袖药
来面治。于是以人参败毒散本方煎好，用浓被围椅上坐定，置火其下，更以布条卷成鹅蛋状，置椅褥上，垫定
肛门，使内气不能下走。然后以前药滚热与服，良久又进前药，遂觉皮间有津津微润，再溉以滚汤，教令努力
忍便，不得移身。如此约二时之久，皮间津润总未干，病者心燥畏热，忍不可忍，始令连被卧于床上，是晚止
下痢二次，以后改用补中益气汤，一昼夜止下三次，不旬日而痊愈。盖内陷之邪，欲提之转从表出，不以急流
挽舟之法施之，其趋下之势何所底哉。闻王星宰世兄患久痢，诸药不效，苏郡老医进以人参败毒散，其势差减，
大有生机，但少此一段斡旋之法，竟无成功。故凡遇阳邪陷入阴分，如久疟、久痢、久热等症，皆当识此意，使
其缓缓久久透出表外，方为合法。若急而速，则恐才出又入，徒伤其正耳。（《寓意草》）（按∶原更有治
陈汝明病痢用麻黄附子细辛汤案，论理欠晰，仍不录入。）
清热方法（凉温调停诸方附）夫治诸痢者，莫若以辛苦寒药治之，或微加辛热佐之则可。盖辛热能发
散，开通郁结，苦能燥湿，寒能胜热，使气宣平而已，如钱氏香连丸之类是也（按∶钱氏香连丸有加白附子、
肉豆蔻、诃子肉三方）。故治诸痢者，黄连、黄柏为君，以至苦大寒正主湿热之病。（《原病式》）
如躁烦，或先便白脓后血，或发热，或恶寒，非黄芩不能止，此上部血也。如恶寒脉沉，或腰痛，或血痢
下痛，非黄连不能止，此中部血也。如恶寒脉沉，先血后便，非地榆不能止，此下部血也。（《保命集》）
小柴胡汤，赤白痢尤效，痢药中无如此妙，盖痢多因伏暑，此药极解暑毒。（《苏沈》）（按∶《管见良
方》亦说此汤治痢之妙，宜参。）身热挟外感者，小柴胡汤去人参。
（《丹溪心法类集》）
黄芩芍药汤，治泄痢腹痛，或后重身热，久而不愈，脉洪疾者，及下痢脓血稠粘（即仲景黄芩汤）。如痛则
加桂少许。服芍药汤以和之，痢止再服黄芩汤和之，以彻其毒也。（《保命集》）
《集验》疗热水谷下痢，黄连阿胶汤方。
黄连 阿胶（炙各二两） 栀子（三十枚擘） 乌梅（二十枚碎） 黄柏（一两）
上五味切，以水七升，煮取二升半，分为再服。（《外台》）（按∶《千金》同，无方名。）又《肘后》疗
热病久下痢脓血柏皮汤，于本方去乌梅。又文仲治无问冷热及五色痢入口即定方，于本方去乌梅、栀子，加当
归、黄芩、熟艾为散，以酽醋二升煮，胶烊下药，煮令可丸，如大豆，饮服七八十丸，日二夜一服，特宜老人。
若产妇痢，加蒲黄一两，蜜和为丸神验。（《奇效》名归连丸。）
许仁则，血痢之候，小腹绞痛无期，度食不住如水，但兼血而下，有此患者，宜根据后犀角五味散方。
生犀角（末五两） 阿胶（炙四两） 黄柏（四两） 艾叶 干姜（各三两一作干蓝）
上药捣筛为散，以饮下之，初服一方寸匕，日再服，稍稍加至二三匕良。（同上）（按∶文仲治热毒痢痢
血犀角散方中有干蓝，盖此方干姜亦以干蓝为优，故次于此。）
治赤痢，腹中疼痛，小便涩，口干烦热，犀角散方。
犀角屑（三分） 木香（半两） 黄芩（一两半） 地榆（三分锉） 黄连（一两去须微炒） 当归（一两锉
微炒）
上件药捣筛为散，每服三钱，以水一中盏，煎至五分去滓，不计时候温服。（《圣惠》）
当归芍药汤，治痢腹痛因血虚者。
当归 川芎（各一钱半） 芍药（炒三钱） 生地黄 黄连（炒） 木香（各三钱）
水煎，食前服。（《统旨》）（按∶《石山医案》曰∶一人患滞下，腹痛里急后重，诊脉濡弱近驶，此热伤
血也。先用四物汤加槟榔、黄连、大黄、黄芩煎服云云。又腹痛调血，《直指》有说，既见上。）
治痢奇方，制药用药轻重分厘俱要秤过，能起死回生之神药也。
川黄连（去芦） 条黄芩 生白芍 山楂净肉（四味各一钱二分） 陈枳壳（炒） 坚槟榔 姜汁炒浓朴
浓青皮（各八分） 当归 甘草 地榆（各五分） 红花（三分酒洗） 南木香（二分） 桃仁（炒去皮尖研
如粉一钱）
水二碗，煎一碗，去滓空心服，滓再煎服。此方或红或白，或红白相兼，里急后重，身热腹痛者，俱可服。
其有便纯血，便扬尘水，大孔如竹筒等恶症，古书指为不治者，急服此药亦可救；但恐服之迟缓，则毒攻坏脏腑
难救耳。其有噤口者，毒在胃口也，将此药煎熟去滓，每一煎分五六次缓缓服之，令其胃口毒瓦斯渐开，服完一
剂后，不惟药可进，而饮食亦渐可进矣，不必另用他药也。单白无红者，去地榆、桃仁二味，木香用三分，加去
白陈皮四分。涩滞甚者，加酒炒大黄二钱，服一二剂仍除之。此方用之于三五日神效，用之于旬日内外亦效，
惟半月外则当加减，其法详于后。
黄连 条芩 白芍（三味生用各四分酒炒各六分） 山楂（一钱） 制浓朴 陈皮 青皮 槟榔（各四分）
甘草（生熟各二分半） 地榆（醋炒） 当归（各五分） 桃仁粉（六分） 红花（三分） 木香（二分）
如延至月余，觉脾胃虚滑者，用酒炒芩、连、白芍各六分，陈皮、浓朴、木香各三分，醋炒地榆四分，红花
（前文未完，接：）气机运行。如果升降依然不通，卫气再次郁结，营血再次凝涩，就会形成新的积滞，所以病情依旧。像这种情况，不必专门去攻逐邪气来治疗，只要调理卫气以开通腠理，调和营血以调顺阴阳。阴阳调和，腠理开泄，那么升降的通道就能畅通，那些积滞不治疗也会自行消除。然而，陈旧的积滞也有不可用泻下法治疗的，起初是因为营卫虚弱，不能运化传导食物积滞，必须先用补益营卫的方法，资助肠胃的真气充盈，然后再使用泻下法，这样才不会有失误。（《医通》中作“必须当调理补益脾胃，兼用行气的药物，正气恢复后腹泻自然停止”）。我多次见到世俗的医生，只死守十几种方子治疗痢疾，不过是攻伐或固涩罢了。哪里知道攻病的药物，都是耗气损血的药剂，长期使用不止，甚至导致气散血亡，五脏空虚，精气疲惫、神志离去而死亡。那些固涩的药物，又都足以加重气郁血涩的病症，转而产生腹胀，向下发展为足肿，向上发展为喘息呼叫，各种疾病随之发作。世人的治法，有什么值得坚守的呢？（《准绳》）
痢疾与泄泻不可混同治疗（忌用利小便法）。痢疾与泄泻，病因不同，治疗方法也不同。泄泻多由寒湿引起，寒则适宜温法，湿则适宜燥法。痢疾多因湿热而成，热则适宜清法，湿则适宜利法。虽然泄泻也有热证，但终究寒证多于热证；痢疾也有寒证，但终究热证多于寒证。因此，泄泻经久不愈，必然损伤胃阳，从而产生肿胀、喘息、胀满等变证；痢疾经久不愈，必然损伤阴液，从而产生虚烦、痿废等疾患。痢疾过早使用兜涩止泻药，会导致湿热流注经络，多形成痛痹。泄泻过度使用疏利通便药，会导致中气虚弱无法恢复，多演变为脾劳。这是我亲身经历的，并非凭空臆说。有人问：“热则清之，寒则温之，这是对的，同样是湿邪，有的从利法治疗，有的从燥法治疗，为什么呢？”回答说：“寒湿是寒从湿生，所以适宜用苦温药燥湿于中焦；湿热是湿从热化，所以适宜用甘淡药利湿于下焦。而且燥性多热，利药多寒；便利则热邪自去，中焦温则寒邪俱消。寒湿必定本于中焦虚寒，不可再用渗利之法；湿热郁结多成毒邪，不宜再给予温燥之品。”（《读书记》）
泻痢不分，将两种证候混为一谈，认为湿热不利小便，这不是正确的治法。所谓“泄”，是水谷混杂的象；所谓“滞下”，是垢浊瘀积之物。两者虽都由湿热造成，但治疗分为两途，用药也各异。如果是淡渗利湿的药剂，功能是疏通水道，使浊流快速排出，让泄泻自然停止，这是针对无形之邪，怎么能与滞下混同论治，而使用导滞行积的方法呢？那种下利出于大肠传送之道，完全不受胃气影响，所下的有形之物，有的像鱼脑，有的像豆汁，有的便出白脓，有的下纯血，有的赤色，有的白色，有的赤白相杂，像这样的情况，怎么能与泄泻混同论治，而使用淡渗利水的方法呢？（薛氏《平治会萃·附论》）
利小便是治疗水泻的好方法，用来治疗痢疾就错了。痢疾是因为邪热胶结阻滞、津液枯涩而形成的，如果使用五苓散等药剂分利其水，那么津液会更加枯涸，滞涩会更加严重，以至于缠绵不愈，这就是分利法的危害。如果清热导滞，那么痢疾自愈而小便自然通利，哪里用得着分利呢？（《活幼心法》）
治疗忌讳燥毒。看张仲景可下的十种方法，可温的五种方法。称为下法，大都用承气汤加减，何曾用过砒霜、丹砂、巴豆这些猛烈燥热重毒的药物？称为温法，大都用干姜、附子为主，何曾用过钟乳石、龙骨、赤石脂、罂粟壳这些紧涩燥毒的药物？（《局方发挥》）
治疗忌讳固涩温补。大要以疏散风邪、行滞气、开胃脘为先，不可急于使用肉豆蔻、诃子、白术这类药物来补住寒邪，不可急于投用罂粟壳、龙骨、牡蛎这类药物来闭塞肠胃。邪气得到补益反而更盛，补得越盛病情越发作，不是出现缠扰腹痛，就是出现里急后重，所以日夜拖延而不能痊愈。（《直指》）（按：《续医说》意思相近，并且说：“世俗只知道固涩剂能堵塞，不知道通利剂也能起到类似‘塞’的效果（指通过通利排除病邪从而止泻）。后来的学人，贵在灵活变通，不可固执一端来治疗。这话源于张子和。）
大凡治疗痢疾，不可立即投用罂粟壳、地榆、石榴皮这些紧涩的药物。罂粟壳性质紧涩，能损伤脾胃，留滞毒瓦斯反而增加疾病。这就像沟渠中停积了不洁秽污之物，如果不先荡涤清除，却堵塞其出路，使秽污无路可出，可以吗？因此很多人因为服用这些药，不能进食饮水，日渐消瘦困顿，勉强命名为“噤口痢”的情况很多。如古代和剂局方中，未曾见使用罂粟壳，多用黄连类药物。然而罂粟壳并非没有功效，但对于久痢可以使用，更应去掉尽筋膜和蒂头锉碎，用白蜜和水浸泡一夜，第二天用慢火炒至焦黄色，这样才稳妥。如果投用太早，会让人毒气闭塞心络，导致噤口不食，无药可施，后悔莫及。（《管见良方》）
痢疾这种病，是由湿热蕴积胶滞在肠胃之中造成的。清除邪热，疏导滞气，行散滞血，那么病很快就能去除。如果使用人参、白术等温补药物，那么热邪更盛，气机更滞，久而久之正气虚弱，邪气炽盛，到了不可救疗的地步，这是初起时误投温补造成的祸患。（《活幼心法》）（按：《玉案》说：“下痢如果服用黄芩，就会发生膨胀，多服升麻，则小便与积滞都会升至上焦，这是速死之道。”如今验证升麻并不一定有害。）
产前后痢疾治疗案例。三宝廉使仲子的妻子，是泰不花尚书的妹妹，患滞下痢疾，昼夜发作五七十次，有后重下迫感，且怀孕九个月。众医生都用清暑散滞的方法治疗，痛苦更加严重。寿至诊视后说：“必须下去滞积。”众人因为怀孕不肯同意。寿至说：“《素问》有云：‘有故无殒，亦无殒也。’动胎即正产。”于是用消滞导气丸药进服，获得顺利，再次进服后滞积去除，继以清暑利溲、苦坚的药剂，病愈而胎儿果然未动，足月分娩。（朱右撰《撄宁生传》）
至于妇人临产时下痢，最为危殆，郑氏有胎前下痢、产后不止、七日必死的案例。我曾用人参干姜汤加浓朴、茯苓、木香，治疗妊娠白痢；《千金》三物胶艾汤，治疗妊娠血痢；连理汤加阿胶、艾叶，治疗赤白相间之痢。驻车丸、千金黄连汤、白头翁加甘草阿胶汤，胎前产后五色诸痢都可以选用。如果胎前下痢，产后不止，势态无法挽回的，用伏龙肝汤丸随证加减，未尝不随手获效。（《医通》）（按：伏龙肝汤丸用炮黑山楂肉、熬枯黑糖、伏龙肝三味，宜考证原书。）
士人李潜善于医术，说：“蓐中（产后）下痢与其他痢疾不同，常痢可用苦涩药止之，蓐中痢生于血不足，投用涩药则血更不行，痢疾应当更严重。”（《苏沈》）
发表方法。初起时如果有风寒表证，在治疗痢疾的药中，应当加入发散药。如果不发散，直接治疗痢疾，必然扰乱经脉，逆乱气机，病情转剧。（《医学真传》）
败毒散，治疗风邪寒邪，壮热下利。（《直指》）痢疾表热里虚者，此方主治。古人创立此方并非为了治痢，但医者善用，则取之左右逢源。张仲景用葛根汤治疗太阳、阳明合病自利，也是妙处。举这一例，其余可类推。（《医方考》）治疗疫痢发热，全境皆然者，神效，加白芍、黄连尤其好。（《寿世》）（按：《选奇方后集》加陈米，名仓廪汤，治疗噤口痢。《管见良方》、《岭南卫生方》并论述此方治痢之妙。）
升麻汤（即升麻葛根汤）
上药为粗末，每服三钱，加生姜三片同煎，吞服感应丸，治疗伤暑下痢缠痛。（《直指》）（按：汗法与下法同用，不可盲目仿效。）
《治要》除湿汤（即七味除湿汤，方见中湿），加官桂、木香，治疗风寒冷证下痢；加干姜、茯苓，治疗伤湿下痢。（《直指》）
有受风湿，痢下如豆汁，例局有胃风汤。如果借用于治疗脾受湿气，泄利不止，戊己丸也可使用。秘方胃风汤用防风半两，芍药二两，茯苓二两，官桂、羌活各半两，甘草炙一分，每服三钱，入荆芥五小穗，水一盏，煎至七分，稍热服。观察其药性，结合其药名，参考其病因，有治风的药品，用果多有疗效。（《续易简后集》）
如大便闭塞，或里急后重，多次去厕所却不能排便，或稍有白脓，或稍有血，切勿使用泻下法，泻下则必然致病加重，反而郁结而不通。用升阳除湿防风汤提升阳气，则阴气自然下降。升阳除湿防风汤。
苍术（泔水浸去皮净四两） 防风（二钱） 白术 白茯苓 白芍药（以上各一钱）
上件药捣碎，除苍术另作片子，用水一碗半，煮至两大盏，加入其他药，同煎至一大盏，去渣稍热服，空腹食前。如果此类证候飧泄不禁，以此药引导其湿。（《脾胃论》）《医经会元》加炙甘草、干葛。（按：先教谕在此方中去掉白术，用屡效。）
疫痢，憎寒壮热，下痢臭秽，众人病一般的是疫痢。必须先解表发散，宜以大剂量苍术为主，佐以羌活、防风、人中黄、芍药、黄芩、黄连之类，用葱白、生姜送服。（《医镜》）
周信川，年七十三岁，平素身体坚固，不觉其老，秋月患痢，久而不愈，至冬月成为休息痢，一昼夜十余次，面目浮肿，肌肤晦暗，求治于我。我诊其脉沉数有力，对他说：“这是阳邪陷入阴分的症状，我当依法治疗，尚可痊愈，明天我自袖药来面治。”于是用人参败毒散本方煎好，用厚被围在椅子上坐定，在椅下放火，再用布条卷成鹅蛋状，放在椅褥上，垫定肛门，使内气不能下走。然后用前面的药滚热与服，良久又进前药，遂觉皮肤间有津津微润，再浇以滚汤，教令努力忍住不便，不得移动身体。如此约两个时辰之久，皮肤间津润总未干，病人心燥畏热，忍无可忍，才令连被卧于床上，当晚仅下痢二次，以后改用补中益气汤，一昼夜仅下三次，不到十天而痊愈。大概内陷之邪，想要提之转从表出，不以急流挽舟之法施之，其趋下之势到哪里为止呢？听说王星宰世兄患久痢，诸药不效，苏州郡老医用人参败毒散，其势稍减，大有生机，但缺少这一段斡旋之法，竟无成功。所以凡是遇到阳邪陷入阴分，如久疟、久痢、久热等症，都应当识得此意，使其缓缓久久透出表外，方为合法。如果急而速，则恐怕刚出来又进去，徒伤正气罢了。（《寓意草》）（按：原文还有治陈汝明病痢用麻黄附子细辛汤案，论理欠清晰，仍不录入。）
清热方法（凉温调停诸方附）。治疗各种痢疾，不如用辛苦寒药治疗，或微加辛热药佐使即可。盖辛热能发散，开通郁结，苦能燥湿，寒能胜热，使气宣平而已，如钱氏香连丸之类是也（按：钱氏香连丸有加白附子、肉豆蔻、诃子肉三方）。所以治疗各种痢疾，黄连、黄柏为君药，以至苦大寒正主湿热之病。（《原病式》）
如躁烦，或先便白脓后血，或发热，或恶寒，非黄芩不能止，这是上部血证。如恶寒脉沉，或腰痛，或血痢下痛，非黄连不能止，这是中部血证。如恶寒脉沉，先血后便，非地榆不能止，这是下部血证。（《保命集》）
小柴胡汤，对赤白痢尤其有效，痢药中没有比这更妙的，盖痢多因伏暑，此药极解暑毒。（《苏沈》）（按：《管见良方》也说此汤治痢之妙，宜参看。）身热挟外感者，小柴胡汤去人参。（《丹溪心法类集》）
黄芩芍药汤，治疗泄痢腹痛，或后重身热，久而不愈，脉洪疾者，及下痢脓血稠粘（即仲景黄芩汤）。如痛则加桂少许。服芍药汤以和之，痢止再服黄芩汤和之，以彻其毒也。（《保命集》）
《集验》疗热水谷下痢，黄连阿胶汤方。
黄连 阿胶（炙各二两） 栀子（三十枚擘） 乌梅（二十枚碎） 黄柏（一两）
上五味切，以水七升，煮取二升半，分为再服。（《外台》）（按：《千金》同，无方名。）又《肘后》疗热病久下痢脓血柏皮汤，于本方去乌梅。又文仲治无问冷热及五色痢入口即定方，于本方去乌梅、栀子，加当归、黄芩、熟艾为散，以酽醋二升煮，胶烊下药，煮令可丸，如大豆，饮服七八十丸，日二夜一服，特宜老人。若产妇痢，加蒲黄一两，蜜和为丸神验。（《奇效》名归连丸。）
许仁则，血痢之候，小腹绞痛无期，度食不住如水，但兼血而下，有此患者，宜根据后犀角五味散方。
生犀角（末五两） 阿胶（炙四两） 黄柏（四两） 艾叶 干姜（各三两一作干蓝）
上药捣筛为散，以饮下之，初服一方寸匕，日再服，稍稍加至二三匕良。（同上）（按：文仲治热毒痢痢血犀角散方中有干蓝，盖此方干姜亦以干蓝为优，故次于此。）
治赤痢，腹中疼痛，小便涩，口干烦热，犀角散方。
犀角屑（三分） 木香（半两） 黄芩（一两半） 地榆（三分锉） 黄连（一两去须微炒） 当归（一两锉微炒）
上件药捣筛为散，每服三钱，以水一中盏，煎至五分去滓，不计时候温服。（《圣惠》）
当归芍药汤，治疗痢腹痛因血虚者。
当归 川芎（各一钱半） 芍药（炒三钱） 生地黄 黄连（炒） 木香（各三钱）
水煎，食前服。（《统旨》）（按：《石山医案》曰：“一人患滞下，腹痛里急后重，诊脉濡弱近驶，此热伤血也。先用四物汤加槟榔、黄连、大黄、黄芩煎服云云。又腹痛调血，《直指》有说，既见上。”）
治痢奇方，制药用药轻重分厘俱要秤过，能起死回生之神药也。
川黄连（去芦） 条黄芩 生白芍 山楂净肉（四味各一钱二分） 陈枳壳（炒） 坚槟榔 姜汁炒浓朴 浓青皮（各八分） 当归 甘草 地榆（各五分） 红花（三分酒洗） 南木香（二分） 桃仁（炒去皮尖研如粉一钱）
水二碗，煎一碗，去滓空心服，滓再煎服。此方或红或白，或红白相兼，里急后重，身热腹痛者，俱可服。其有便纯血，便扬尘水，大孔如竹筒等恶症，古书指为不治者，急服此药亦可救；但恐服之迟缓，则毒攻坏脏腑难救耳。其有噤口者，毒在胃口也，将此药煎熟去滓，每一煎分五六次缓缓服之，令其胃口毒瓦斯渐开，服完一剂后，不惟药可进，而饮食亦渐可进矣，不必另用他药也。单白无红者，去地榆、桃仁二味，木香用三分，加去白陈皮四分。涩滞甚者，加酒炒大黄二钱，服一二剂仍除之。此方用之于三五日神效，用之于旬日内外亦效，惟半月外则当加减，其法详于后。
黄连 条芩 白芍（三味生用各四分酒炒各六分） 山楂（一钱） 制浓朴 陈皮 青皮 槟榔（各四分） 甘草（生熟各二分半） 地榆（醋炒） 当归（各五分） 桃仁粉（六分） 红花（三分） 木香（二分）
如延至月余，觉脾胃虚滑者，用酒炒芩、连、白芍各六分，陈皮、浓朴、木香各三分，醋炒地榆四分，红花
(Continuing from the previous text:) Qi mechanism operation. If the ascending and descending functions remain unobstructed, Wei Qi (Defensive Qi) becomes stagnant again, Ying Blood (Nutritive Blood) becomes coagulated again, leading to the formation of new accumulations; thus, the condition remains unchanged. In such cases, there is no need to specifically attack the pathogenic factors for treatment. Instead, one should regulate Wei Qi to open the Cou Li (interstitial spaces), and harmonize Ying Blood to balance Yin and Yang. When Yin and Yang are balanced and Cou Li are open, the pathways of ascending and descending will become smooth, and the existing accumulations will resolve spontaneously without direct treatment. However, old accumulations may also be unsuitable for purgative therapy. Initially, due to the deficiency of Ying and Wei, the body cannot transport and transform food stagnation. It is necessary to first tonify Ying and Wei, replenish the true Qi of the intestines and stomach until it is abundant, and then apply purgatives, so as to avoid errors. (*Yi Tong* states: "It is necessary to regulate and tonify the Spleen and Stomach, and simultaneously use Qi-moving herbs; once the healthy Qi recovers, the diarrhea will stop on its own.") I have often seen folk practitioners rigidly adhering to a dozen or so formulas for treating dysentery, merely using attacking or astringent methods. How could they know that drugs used to attack diseases are all agents that consume Qi and damage Blood? Prolonged use can lead to the dissipation of Qi and loss of Blood, emptiness of the Five Zang organs, exhaustion of Essence, departure of Spirit, and ultimately death. Furthermore, astringent drugs tend to exacerbate Qi stagnation and Blood coagulation, leading to abdominal distension, edema of the lower limbs progressing downward, and panting/calling out progressing upward, with various diseases arising. What value is there in adhering to the methods of the world? (*Zhun Sheng*)
Dysentery and diarrhea must not be treated indiscriminately (avoid promoting urination). Dysentery and diarrhea differ in pathology and treatment. Diarrhea often arises from Cold-Dampness; Cold requires warming, and Dampness requires drying. Dysentery often results from Damp-Heat; Heat requires clearing, and Dampness requires draining. Although diarrhea can present with Heat syndromes, Cold predominates over Heat; although dysentery can present with Cold syndromes, Heat predominates over Cold. Therefore, prolonged diarrhea inevitably damages Stomach Yang, leading to complications such as swelling, panting, and fullness; prolonged dysentery inevitably damages Yin fluids, leading to conditions like vexation and flaccidity/paralysis. Premature use of astringents in dysentery causes Damp-Heat to flow into the collaterals, often resulting in painful obstruction. Excessive use of draining/purgative methods in diarrhea leads to middle Jiao deficiency that fails to recover, often evolving into Spleen劳 (Spleen exhaustion). This is based on my personal experience, not speculation. Someone asked: "Clearing Heat and warming Cold is correct. Regarding Dampness, why is it sometimes treated by draining and sometimes by drying?" The answer is: Cold-Dampness arises from Cold generating Dampness, so Bitter-Warm herbs are suitable to dry Dampness in the Middle Jiao. Damp-Heat arises from Heat transforming Dampness, so Sweet-Light herbs are suitable to drain Dampness from the Lower Jiao. Moreover, drying herbs tend to be warm/hot, while draining herbs tend to be cold; promoting urination eliminates Heat naturally, and warming the Middle eliminates Cold naturally. Cold-Dampness is rooted in Middle Jiao deficiency, so渗利 (percolating/draining) methods should not be used further. Damp-Heat stagnation often forms toxins, so Warm-Dry methods should not be added. (*Du Shu Ji*)
Confusing diarrhea and dysentery and discussing them together, believing that Damp-Heat does not require promoting urination, is incorrect. "Xie" (diarrhea) refers to the image of water and grain mixed; "Zhi Xia" (dysentery) refers to foul and stasis matter. Although both result from Damp-Heat, their treatments diverge, and their medications differ. If light percolating/drainage agents are used, their function is to disperse and drain the water passages, allowing turbid flows to clear quickly, stopping diarrhea naturally. This targets formless pathogens; how can it be confused with dysentery and treated with methods that guide stagnation and move accumulation? Dysentery originates from the transmission pathway of the Large Intestine, unrelated to Stomach Qi. The tangible matter passed may resemble fish brains, bean curd dregs, white pus, pure blood, red color, white color, or a mixture of red and white. Such cases cannot be confused with diarrhea and treated with light percolating/drainage methods. (Xue Shi's *Ping Zhi Hui Cui · Appendix*)
Promoting urination is an excellent method for treating watery diarrhea but is inappropriate for dysentery. Dysentery forms due to pathogenic heat sticking and stagnating, causing fluid depletion and dryness. Using formulas like Wu Ling San to separate and drain water will further deplete fluids and worsen stagnation, leading to lingering, incurable conditions. This demonstrates the harm of separation-drainage methods. If Heat is cleared and stagnation guided, dysentery heals naturally, and urination becomes smooth; why use separation-drainage? (*Huo You Xin Fa*)
Treatment taboos: Avoid Aromatic-Toxic herbs. Examining Zhang Zhongjing's ten methods for purging and five methods for warming: For purging, Cheng Qi Tang variations are generally used; where were Arsenic (Pi), Cinnabar (Dan), Croton Seed (Ba Dou), and other fierce, hot, toxic agents used? For warming, Ginger (Jiang) and Aconite (Fu Zi) are primarily used; where were Cloud Stone (Zhong Ru), Dragon Bone (Long Gu), Red Clay Rock (Shi Zhi), and Poppy Shell (Su Ke)—tight-astringent, aromatic-toxic agents—used? (*Ju Fang Fa Hui*)
Treatment taboos: Avoid premature astringency and warming-tonification. The general principle is to first disperse Wind pathogens, move stagnant Qi, and open the Stomach and Epigastrium. One should not hastily use Nutmeg (Rou Dou Kou), Chebula (He Zi), or Atractylodes (Bai Zhu) to tonify and trap Cold pathogens. One should not hastily administer Poppy Shell (Ying Su Ke), Dragon Bone (Long Gu), or Oyster Shell (Mu Li) to close the intestines and stomach. Pathogenic factors, aided by tonification, become stronger; the more they are tonified, the more severe the symptoms become, manifesting as entangling abdominal pain or tenesmus. Thus, the disease lingers day and night without cessation. (*Zhi Zhi*) (Note: *Xu Yi Shuo* has similar meaning, stating: "The vulgar only know that astringents can block, but do not know that unblocking agents can also achieve a 'blocking' effect [by removing pathogens]. Later scholars should value flexibility and not treat rigidly. This view originates from Zhang Zi He.")
Generally, when treating dysentery, one should not immediately administer tight-astringent herbs like Poppy Shell (Ying Su Ke), Sanguisorba (Di Yu), or Pomegranate Peel (Shi Liu Pi). Poppy shell is tightly astringent, damages the Spleen and Stomach, retains toxic vapors, and aggravates the disease. This is like a ditch filled with filth; if one does not first cleanse it but instead blocks the outlet, preventing the filth from exiting, is this acceptable? Therefore, many patients who take these drugs cannot eat or drink, become emaciated and weak day by day, and are loosely termed "Jin Kou Li" (Dysentery with inability to swallow). Ancient official formulas rarely used Poppy Shell, preferring Coptis (Huang Lian). However, Poppy Shell is not without merit; it can be used for chronic dysentery. It should be prepared by removing all membranes and stems, chopping finely, soaking overnight in honey-water, and slowly stir-frying until dark yellow for safety. If administered too early, it may cause toxic vapors to block the Heart collaterals, leading to inability to swallow and eat, leaving no remedy, resulting in regret. (*Guan Jian Liang Fang*)
Dysentery is caused by Damp-Heat accumulating and sticking in the intestines and stomach. Clearing pathogenic Heat, guiding stagnant Qi, and moving stagnant Blood will rapidly eliminate the disease. If Ginseng (Ren Shen) and Atractylodes (Bai Zhu) and other warming-tonifying herbs are used, Heat will intensify, and Qi stagnation will worsen. Over time, Healthy Qi becomes deficient, and Pathogenic Qi becomes rampant, leading to untreatable conditions. This disaster stems from initial misapplication of warming-tonification. (*Huo You Xin Fa*) (Note: *Yu An* states: "If dysentery patients take Huang Qin, bloating occurs; if they take too much Cimicifuga (Sheng Ma), urine and stool rise to the Upper Jiao, which is a fast track to death." Modern verification shows Sheng Ma is not necessarily harmful.)
Treatment examples for dysentery before and after childbirth. The wife of the second son of Vice-Commissioner San Bao, sister of Minister Tai Bu Hua, suffered from dysentery, occurring 50-70 times day and night, with tenesmus and urgency, while nine months pregnant. Most doctors treated her with formulas for clearing summer-heat and resolving stagnation, worsening her pain. Shou Zhi examined her and said, "Stagnation must be removed." Others refused due to pregnancy. Shou Zhi said, "*Su Wen* states: 'If there is a cause, there is no injury [to the fetus], nor injury [to the mother].' Movement will lead to normal delivery." He administered pills for resolving stagnation and guiding Qi. After successful passage, he repeated the dose to remove stagnation, followed by formulas for clearing summer-heat, promoting urination, and bitter-hardening. The illness resolved, the pregnancy remained intact, and she delivered at term. (Zhu You, *Ying Ning Sheng Zhuan*)
For women suffering dysentery during labor, the situation is most critical. Zheng Shi recorded a case of pre-natal dysentery continuing post-partum, leading to death within seven days. I have used Renshen Ganjiang Tang plus Hou Po, Fu Ling, and Mu Xiang to treat white dysentery in pregnancy; *Qian Jin* San Wu Jiao Ai Tang for bloody dysentery in pregnancy; Lian Li Tang plus E Jiao and Ai Ye for mixed red-and-white dysentery. Zhu Che Wan, Qian Jin Huang Lian Tang, and Bai Tou Weng Tang plus Gan Cao and E Jiao can be selected for various colors of dysentery before or after childbirth. If pre-natal dysentery continues post-partum and the condition is irreversible, Fu Long Gan Tang Wan adjusted according to syndrome has always been effective. (*Yi Tong*) (Note: Fu Long Gan Tang Wan uses charred Hawthorn fruit, burnt brown sugar, and Huoxi Argillae [Dragon's House Soil]; consult original texts.)
Scholar Li Qian, skilled in medicine, stated: "Post-partum dysentery differs from ordinary dysentery. Ordinary dysentery can be stopped with bitter-astringent herbs, but post-partum dysentery arises from Blood deficiency; administering astringents makes Blood flow even worse, and dysentery becomes more severe." (*Su Shen*)
Exterior-releasing methods. If exterior Wind-Cold signs are present at the onset, dispersing herbs should be added to dysentery treatment. Without dispersing, directly treating dysentery will disrupt meridians and reverse Qi mechanisms, worsening the disease. (*Yi Xue Zhen Chuan*)
Baidu San treats Wind-Cold pathogens, high fever, and dysentery. (*Zhi Zhi*) This formula is indicated for dysentery with exterior Heat and interior deficiency. Although originally established not for dysentery, skilled physicians can utilize it effectively. Zhang Zhongjing used Gegen Tang for spontaneous diarrhea in combined Taiyang and Yangming diseases, which is also brilliant. Taking this example, others can be inferred. (*Yi Fang Kao*) For epidemic dysentery with fever affecting the whole region, this formula is miraculous; adding Bai Shao and Huang Lian is especially good. (*Shou Shi*) (Note: *Xuan Qi Fang Hou Ji* adds aged rice, named Cang Lin Tang, for treating Jin Kou Li. *Guan Jian Liang Fang* and *Ling Nan Wei Sheng Fang* discuss the efficacy of this formula for dysentery.)
Shengma Tang (i.e., Shengma Gegen Tang)
Coarsely powdered. Take 3 qian per dose, decoct with 3 slices of ginger, swallow with Yinggan Wan. Treats summer-heat injury causing dysentery with entangling pain. (*Zhi Zhi*) (Note: Combining sweating and purging methods; do not blindly imitate.)
*Zhi Yao* Chu Shi Tang (i.e., Qi Wei Chu Shi Tang, see Dampness section), plus Guan Gui and Mu Xiang, treats Wind-Cold-Cold syndrome dysentery; plus Gan Jiang and Fu Ling, treats dampness-injury dysentery. (*Zhi Zhi*)
For Wind-Damp invasion with dysentery resembling bean curd dregs, Ju Fang has Wei Feng Tang. If borrowed for treating Spleen affected by Dampness with continuous diarrhea, Wu Ji Wan is also applicable. Secret recipe Wei Feng Tang uses Fang Feng 0.5 liang, Bai Shao 2 liang, Fu Ling 2 liang, Guan Gui and Qiang Huo 0.5 liang each, Zhi Gan Cao 1 fen. Take 3 qian per dose, add 5 small spikes of Jing Jie, decoct in 1 sheng water to 0.7 sheng, take slightly warm. Observing its properties, name, and etiology, it contains Wind-dispersing ingredients and yields good results. (*Xu Yi Jian Hou Ji*)
If bowel obstruction exists, or tenesmus is present, with frequent trips to the toilet but inability to pass stool, or slight white pus/blood, do NOT use purgatives. Purging will worsen the disease, causing further stagnation and obstruction. Use Sheng Yang Chu Shi Fang Feng Tang to raise Yang, so Yin Qi descends naturally. Sheng Yang Chu Shi Fang Feng Tang:
Cang Zhu (soaked in rice water, peeled, cleaned 4 liang) Fang Feng (2 qian) Bai Zhu Bai Fu Ling Bai Shao Yao (each 1 qian)
Crush the above ingredients. Prepare Cang Zhu separately as slices. Decoct in 1.5 sheng water until reduced to 2 large cups. Add other herbs, decoct together until 1 large cup. Strain, take slightly warm on an empty stomach before meals. For cases of undigested food diarrhea, this herb guides out Dampness. (*Pi Wei Lun*) *Yi Jing Hui Yuan* adds Zhi Gan Cao and Ge Gen. (Note: Former Instructor removed Bai Zhu from this formula with frequent success.)
Epidemic dysentery presents with aversion to cold, high fever, foul-smelling dysentery, affecting everyone similarly. First, release the exterior and disperse. Use a large dose of Cang Zhu as the chief herb, assisted by Qiang Huo, Fang Feng, Ren Zhong Huang, Bai Shao, Huang Qin, Huang Lian, etc., taken with Cong Bai and Sheng Jiang. (*Yi Jing*)
Zhou Xinchuan, aged 73, usually robust, did not feel old. In autumn, he contracted dysentery, which persisted untreated until winter, becoming chronic/resting dysentery, occurring >10 times/day. His face and eyes were swollen, skin dull/black. He sought my treatment. Pulse was deep, rapid, and forceful. I said: "This is Yang pathogen sinking into Yin. I will treat it according to method; recovery is possible. I will bring medicine tomorrow." I decocted Renshen Baidu San. He sat wrapped in thick blankets on a chair, with fire underneath. A cloth roll shaped like a goose egg was placed under his anus on the cushion to prevent Qi from sinking. Then, the hot decoction was administered. After some time, another dose was given. He felt slight moisture on his skin. Hot water was poured on him, and he was instructed to hold back stool and not move. This lasted about two hours. Skin remained moist. Patient became irritable and feared heat, unable to endure. Finally allowed to lie in bed covered. That night, dysentery occurred only twice. Subsequently switched to Buzhong Yiqi Tang. Dysentery reduced to 3 times/day. Recovered in less than 10 days. The internal-sunk pathogen needs to be lifted and released via the exterior. Without the "pulling the boat upstream against the current" method, where would the downward momentum end? I heard Wang Xingzai suffered from chronic dysentery, unresponsive to other medicines. An old doctor in Suzhou used Renshen Baidu San, reducing severity significantly, showing vitality, but lacked this maneuvering technique, so it failed. Thus, for Yang pathogen sinking into Yin (chronic malaria, chronic dysentery, chronic fever), one must understand this principle, allowing slow, gradual emergence to the exterior. Rushing may cause re-entry, damaging Healthy Qi. (*Yu Yi Cao*) (Note: Original text includes a case of Chen Ruming treated with Mahuang Fuzi Xixin Tang, but reasoning was unclear, so excluded.)
Clearing Heat Methods (Including Balanced Cool/Warm Formulas). Treating various dysenteries is best done with Bitter-Pungent-Cold herbs, or slightly assisted by Pungent-Hot herbs. Pungent-Hot disperses and opens stagnation; Bitter dries Dampness; Cold overcomes Heat, ensuring smooth Qi circulation. Examples include Qian Shi's Xiang Lian Wan (Note: Qian Shi's Xiang Lian Wan has variants with Bai Fu Zi, Rou Dou Kou, He Zi Rou). Thus, for various dysenteries, Huang Lian and Huang Bo are the Sovereign herbs, using extreme bitterness and great cold to address Damp-Heat. (*Yuan Bing Shi*)
For restlessness/vexation, or passing white pus then blood, or fever/aversion to cold, only Huang Qin can stop it; this indicates Upper Jiao Blood involvement. For aversion to cold, deep pulse, lower back pain, or painful bloody dysentery, only Huang Lian can stop it; this indicates Middle Jiao Blood involvement. For aversion to cold, deep pulse, blood before stool, only Di Yu can stop it; this indicates Lower Jiao Blood involvement. (*Bao Ming Ji*)
Xiao Chai Hu Tang is especially effective for red-and-white dysentery; no dysentery formula is superior, as dysentery often stems from latent summer-heat, and this formula resolves summer-heat toxicity excellently. (*Su Shen*) (Note: *Guan Jian Liang Fang* also praises this formula for dysentery; refer to it.) For body heat with exterior contraction, use Xiao Chai Hu Tang minus Ren Shen. (*Dan Xi Xin Fa Lei Ji*)
Huang Qin Shao Yao Tang treats diarrhea/dysentery with abdominal pain, tenesmus, body heat, chronic non-healing, rapid/huge pulse, and sticky pus-blood discharge (i.e., Zhang Zhongjing's Huang Qin Tang). If painful, add a little Gui Zhi. Take Shao Yao Tang to harmonize; after dysentery stops, take Huang Qin Tang to harmonize and eliminate toxin. (*Bao Ming Ji*)
*Ji Yan* Formula for Hot Water-Grain Dysentery: Huang Lian E Jiao Tang.
Huang Lian E Jiao (roasted, 2 liang each) Zhi Zi (30 pods, split) Wu Mei (20 pieces, crushed) Huang Bo (1 liang)
Cut the five herbs. Decoct in 7 sheng water until 2.5 sheng remains. Divide into two doses. (*Wai Tai*) (Note: *Qian Jin* same, no formula name. *Zhou Hou* Bai Pi Tang for long-term hot dysentery pus-blood removes Wu Mei from this base. Wen Zhong's formula for any temperature/color dysentery stops upon entry removes Wu Mei and Zhi Zi, adds Dang Gui, Huang Qin, Shu Ai, made into powder, boiled in strong vinegar with melted gelatin, formed into pill-sized beans, taken 70-80 pills twice day/night, suitable for elderly. For post-partum dysentery, add Pu Huang 1 liang, honey-pilled, miraculous. (*Qi Xiao* names it Gui Lian Wan.)
Xu Ren Ze: Symptom of bloody dysentery, intermittent severe lower abdominal cramping, food passes through like water, mixed with blood. Patients with this should use the following Xi Jiao Wu Wei San.
Raw Xi Jiao (powder 5 liang) E Jiao (roasted 4 liang) Huang Bo (4 liang) Ai Ye Gan Jiang (each 3 liang, alternatively Gan Lan)
Pulverize and sieve. Take with drink. Initial dose: 1 fang cun bi. Twice daily. Gradually increase to 2-3 bi. (Same source) (Note: Wen Zhong's Xi Jiao San for hot-toxin bloody dysentery uses Gan Lan; thus Gan Jiang in this formula is better replaced by Gan Lan, hence listed here.)
Formula for Red Dysentery, abdominal pain, difficult urination, dry mouth, vexatious heat: Xi Jiao San.
Xi Jiao屑 (3 fen) Mu Xiang (0.5 liang) Huang Qin (1.5 liang) Di Yu (3 fen, cut) Huang Lian (1 liang, remove roots, lightly fried) Dang Gui (1 liang, cut, lightly fried)
Pulverize and sieve. Take 3 qian per dose. Decoct in 1 zhong zhan water until 0.5 zhong zhan remains. Strain, take warm anytime. (*Sheng Hui*)
Dang Gui Shao Yao Tang treats dysentery abdominal pain due to Blood deficiency.
Dang Gui Chuan Xiong (each 1.5 qian) Shao Yao (stir-fried 3 qian) Sheng Di Huang Huang Lian (fried) Mu Xiang (each 3 qian)
Decoct in water, take before meals. (*Tong Zhi*) (Note: *Shi Shan Yi An*: "A patient had dysentery, abdominal pain, tenesmus. Pulse was soggy, weak, rapid. This is Heat injuring Blood. First use Si Wu Tang plus Bing Lang, Huang Lian, Da Huang, Huang Qin..." Also, regulating Blood for abdominal pain is discussed in *Zhi Zhi*, see above.)
Miraculous Formula for Dysentery: Precise weighing of herbs is crucial; it is a divine agent capable of reviving the dead.
Chuan Huang Lian (remove rhizome) Tiao Huang Qin Sheng Bai Shao Shan Zha clean flesh (each 1.2 qian) Chen Zhi Qiao (fried) Jian Bing Lang Jiang Zhi Hou Po Nong Qing Pi (each 0.8 qian) Dang Gui Gan Cao Di Yu (each 0.5 qian) Hong Hua (0.3 qian, wine-washed) Nan Mu Xiang (0.2 qian) Tao Ren (fried, peeled, pitted, ground to powder 1 qian)
Decoct in 2 bowls of water until 1 bowl remains. Strain, take on empty stomach. Residue decoct again and take. This formula is suitable for red, white, mixed red-white dysentery, tenesmus, body heat, abdominal pain. For severe symptoms like pure blood, flying dust-like water, or anus like a bamboo tube (considered untreatable in ancient texts), urgent administration can save lives; delay allows toxin to destroy organs, making rescue impossible. For Jin Kou (inability to swallow), toxin is at the stomach gate. Decoct, strain, divide one dose into 5-6 small sips slowly, gradually opening the stomach gate. After finishing one dose, not only can medicine be taken, but food intake gradually improves; no other medicine needed. For white-only (no red), remove Di Yu and Tao Ren, use 0.3 qian Mu Xiang, add 0.4 qian Chen Pi (peeled). For severe stagnation/astringency, add 2 qian wine-fried Da Huang, take 1-2 doses then stop. This formula is miraculous if used within 3-5 days, effective within 10 days. After half a month, modifications are needed, detailed below.
Huang Lian Tiao Qin Bai Shao (raw 0.4 qian each, wine-fried 0.6 qian each) Shan Zha (1 qian) Zhi Hou Po Chen Pi Qing Pi Bing Lang (each 0.4 qian) Gan Cao (raw/cooked 0.25 qian each) Di Yu (vinegar-fried) Dang Gui (each 0.5 qian) Tao Ren powder (0.6 qian) Hong Hua (0.3 qian) Mu Xiang (0.2 qian)
If lasting over a month, feeling Spleen/Stomach deficiency and slipping, use wine-fried Qin, Lian, Bai Shao each 0.6 qian, Chen Pi, Hou Po, Mu Xiang each 0.3 qian, vinegar-fried Di Yu 0.4 qian, Hong Hua