白芨散，治肺痈咳唾脓血，及肺破不愈最效。以白芨为面，每服二钱，糯米饮调，临卧服。（《医统》按∶
此本出《医说》，治咯血。）
痢之为病，与泄泻相似不同，《内经》名之肠 ，仲景则以下利括之。滞下之目亦出于汉晋，今标于篇以
与彼为别。是证此间所见多属热疫，而考之往籍，宋代之方概不过逐积、涩肠二端，明人往往本之脾肾，专务调补，
均歉于事用。今通融诸家，无所偏主，庶足以应变乎。
名义 初虞世《养生必用方》云∶古人凡奏圊频并皆谓之利，寻常水泻谓之利，米谷不化谓之米谷利，
或言下利清谷。痢谓之滞下，谓所下濡滞，脓血点滴，坐圊迟久，岂不谓之滞下也。（《万安方》）（按∶米谷疑
水谷，然《幼幼新书》引亦作米谷，且云或言下利清谷，则难得改易，姑仍其旧。）
源由诸说 水谷痢者，由体虚腠理开，血气虚，春伤于风，邪气留连在肌肉之内，后遇脾胃大肠虚弱而
邪气乘之，故为水谷痢也。脾与胃为表里。胃者脾之府也，为水谷之海。脾者胃之藏也，其候身之肌肉。而脾气
主消水谷，水谷
消，其精化为荣卫，中养脏腑，充实肌肤。大肠肺之腑也，为传导之官，化物出焉。水谷之精化为血气，行于经
脉，其糟粕行于大肠也。肺与大肠为表里，而肺主气，其候身之皮毛。春阳气虽在表，而血气尚弱，其饮食居
处，运动劳役，血气虚者，则为风邪所伤，客在肌肉之间。后因脾胃气虚，风邪又乘虚而进入于肠胃。其脾气弱
则不能克制水谷，故糟粕不结聚而变为痢也。（《病源论》）
夫赤白痢疾，古人谓之滞下，近代云无积不成痢。以仆思之，一岁之中，岂惟夏秋之间有积而春冬无之。得
非致疾之由，皆因春伤风邪。然风喜伤肝，春时肝木正旺而不受邪，移气克于脾土。脾受贼邪，故不能克化食饮，
又乃饮食不节，恣餐生硬瓜果鱼肉粘腻等物，积聚不化，更因外感五邪，如当风取凉、露卧湿地等，不为霍乱，
则成滞下必矣。其中却有冷热之分。（《管见良方》）
夫痢疾者，因夏月初秋忽有暴冷，折于盛热，无可分散，客搏肌中，发于外则为疟，发于内则为痢，内外俱
发则为疟痢。皆由荣卫不和，肠胃虚弱，冷热之气乘虚客于肠胃。又因饮食有冷，冷气在肠胃，复为热气所伤，
肠胃宿虚，故受热气，夹热则赤，夹冷则白，冷热交攻则脓血相杂。亦因沉积所作，赤痢积热，白痢积冷，赤白
痢冷热之积。若脾胃气虚，不能消化水谷，则糟粕不聚；或春间解脱，风冷所伤，肠虚胃弱，卒被寒所折，便为
下痢多矣。（《全婴方论》）
盖人日受饮食之积留滞于内，湿蒸热瘀伏而不作，偶或调摄失宜，复感酷热之毒，至秋阳气始收，火气下
降，蒸发蓄积而滞下之病作矣。（《明医指掌》）（按∶此说《医统》引戴氏，又出薛氏《平治会萃附论》，当考。）
泄泻痢疟同乎一源，多由暑月脾胃气虚、饮食伤积所致。饮食才伤便作，则为泄泻为轻；饮食停积既久，则
为疟痢为重。而疟与痢又有分别。饮食为痰，充乎胸膈则为疟疾；饮食为积，胶乎肠胃则为痢疾。古人有言曰∶
无痰不是疟，无积不是痢。良有以也。（《丹溪心法附余》）
脉候 肠 下脓血，脉沉小流连者生，数疾且大有热者死。肠 筋挛，其脉小细安静者生，浮大紧者死。
（《脉经》）
脉时小绝者生，洪大数者死。悬绝涩者死，细微而涩者生。紧大而滑者死，得代绝脉者亦死。（《病源论》）
下痢微小却为生，脉大浮洪无瘥日。（《脉诀》）
肠 频下脓血者，诊脉宜滑大也。若弦急者必死。（《济生》）（按∶此改经文悬涩为弦急。《医约》曰∶
此乃大概言之，又当审其胃气。如有胃气，则脉虽大不妨，又不可以一途而论也。）
法曰证与脉合者生，相反者死。今痢为有余之证，脉宜洪大数实，乃为脉证相符而可治，今又有不治者何？
盖痢虽属有余，而下利则伤气伤血，实为有余中不足。故脉沉小流连者生，洪大数身热者死，细小安静者生，浮
大而紧者死，阴症见阳脉者生，阳症见阴脉者死，身热脉大者半死半生。（《会解》）
下痢白沫，初起脉小滑能食者易治，洪大急疾四肢厥冷者难治。久痢脉微弱小细者即愈，数实或虚大无根者
危。下痢脓血，初起脉小滑或弦软身不热者易治；数实滑大而身热者，势虽甚犹或可治；若先不热，五六日后
反发热脉大者必死。久则脉宜芤迟虚细，不宜数盛滑实，或身热不止、口噤不食者皆死。久痢脉结代，反骤能食
为除中者必死。大抵下利之脉，初起虽实大不妨，六七日后最忌强盛。凡下利脉浮身
热作风治，脉沉身重作湿治。下利为肠胃病，虽迸进而能食则吉。若噤口痢，初起脉数实可治。久痢而反不能
食，脉见有余者死。惟小弱流利者，当作胃虚治之。（《医通》）
痢为里证，脉宜沉恶浮（有表邪者不在此论），宜细恶大（初起邪盛者不在此论），宜缓恶弦。（《医碥》）
辩证要领 其证有令人先泄泻不止变成痢疾者，亦有不泻便成痢疾者。其证心腹 痛甚不可忍，亦有不
痛者。里急后重，奏厕频迸，或有或无。宜子细看厕马中，若有一点或赤或白或赤白相杂，此即痢证无可疑者。
（按∶《和剂·指南》曰。病患登厕，才有一两点物或赤或白或如鱼脑者，此皆痢证也。此陈氏所本。）虽曰
赤色为热，白色为寒，赤白相杂为冷热不调，然不若姑以此法辨之。凡痢疾有冷热虚实，一时脉证未明，全在医
者子细详察，不可执脉。（《管见良方》）
诸有积，以肚热缠痛推之。诸有气，以状如蟹渤验之。（《直指》）
泄痢之病，水谷或化或不化，并无努责，惟觉困倦。若滞下则不然，或脓或血，或脓血相杂，或肠垢，或无
糟粕，或糟粕相混。虽有痛、不痛、大痛之异，然皆里急后重，逼迫恼人。考之于经，察之于证，似乎皆热证
实证也。余近年涉历，亦有大虚大寒者，不可不知。（《局方发挥》）
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。（《景岳》）
痢疾古有赤热白冷及五色分属五脏之辨，然脏腑寒热当以脉症互参，虽有前说，存之而已，若执此认病，
泥矣。（《金匮翼》）
证治总例 凡人患痢，不问赤白，脉小身凉者易安，脉
大身热者难瘥。患痢未有不腹痛者，皆缘有积也。暑积及热积多患赤痢，冷积多患白痢。亦有肠胃有风而患赤
痢者，有冷热不调而患赤白痢者。暑积痢可用黄连阿胶丸、绵煎散加滑石。白痢可用驻车丸、感应丸之类。冷热
不调用戊己丸、巴豆丸子之类。（《医说》引《医余》）
如五心烦热，唇赤烦渴引饮，心中欲冷而恶热，脐腹胀痛，六脉洪数或六脉虚弱者，便不可作虚寒治疗投之
热药，此等脉证多因中暑得之。近人多不明中暑而妄投热药，倾人性命。殊不知寒伤形而不伤气，所以脉盛；热
伤气而不伤形，所以脉虚。经云∶阳根于阴，阴本于阳。阳无阴以生，阴无阳以化。凡夏月天气热，当食以寒，
扶阴气以养阳之时也。今人以为阴气在内，反抑以热药，而成疟痢脱血者多矣。若心中有时烦躁，五心烦热，四肢
弃纵，不欲衣覆，或扬手掷足，饮食欲冷而恶温，下痢纯赤或赤黄色者，不问六脉虚弱及年高等人，便宜以性
凉之药调治，如败毒散、小柴胡汤、黄连丸是也。若下痢纯白，或如鱼脑，或如 溏，或滑泄不禁，脐腹冷痛，
四肢逆冷，口若含霜，饮食欲温而恶冷，六脉沉微，不问少壮，此是虚冷证也，宜用温热药治之，如丁香豆蔻散、
阿梨勒丸、木香散、驻车丸，或佐以四桂散、附子理中汤。若下痢赤白，或纯脓，或 溏 臭，脐腹撮痛，遇痛
则痢下，下后则痛止，此是有积作痢，宜以加巴感应丸中，加黄蜡丸如绿豆大，各十五丸兼服，其积必去。若里
急后重者，以枳实去瓤麸炒黄煎汤，吞下感应丸则愈。如未止，但以仙方断下丸或六神丸、香连丸、驻车丸服之必
愈。（《管见良方》）
大抵治痢之法，虚者补之，实者泻之，滑者涩之，闭者通之，有积者推之，风则散之，暑则涤之，湿则燥之，热则
凉之，冷则温之，冷热者调之，以平为期，不可过，此为大法。（《妇人良方》）
痢疾多因饮食停滞于肠胃所由致，倘不先以巴豆等药，以推其积滞，逐其邪秽，鲜有不致精神危困、久而
羸弱者。余尝鉴焉，每遇此证，必先荡涤肠胃，次正根本，然后辨其风冷暑湿而为之治法。故伤热而赤者则清
之，伤冷而白者则温之，伤风而纯下清血者则祛逐之，伤湿而下豆羹汁者则分利之。又如冷热交并者，则温凉以
调之；伤损而成久毒痢者（按∶上文曰，或饮服冷酒物，恣情房室，劳伤精血而成久毒痢者），则化毒以保卫
之。夫如是，药无不应而疾无不愈者矣。（《济生》）
痢出于积滞。积，物积也。滞，气滞也。物积欲出，气滞而不与之出，所以下坠里急，乍起乍止，日夜凡
百余度。病家所请，莫不求其止，孰知物积气滞致有如是之证耶。继人但见有上项证候，不论色之赤白，脉之
大小，一皆以通利行之。物积用巴豆、大黄辈，气滞用枳壳、桔梗、青皮、蓬术辈，二者兼济，必能收功。其间
佐以黄连阿胶丸，效验尤着。盖痢疾多因伤暑伏热、酒面炙 酝酿而成，其阿胶尤大肠之要药，有热毒留滞则
能疏导，无热毒留滞则能安平。市肆或无丸子，即以炒阿胶、当归、青皮、赤茯苓、黄连作剂，入乌梅、浓蜜
同煎，最能荡涤恶秽。积既去，遍数自疏。嗣是却以木香、茯苓、缩砂、白豆蔻、陈皮、甘草调之，自然喜食。
食则糟粕入于大肠，然后真人养脏汤、易简断下汤，可止则止矣。（《直指》）
法云∶后重则宜下，腹痛则宜和，身重则除湿，脉弦则去风。血脓稠粘，以重药竭之∶身冷自汗，以毒药温
之。风邪内缩，宜汗之则愈， 溏为痢，当温之。又云∶在表者发
之，在里者下之，在上者涌之，在下者竭之，身表热者内疏之，小便涩者分利之。又曰∶盛者和之，去者送之，
过者止之。兵法云∶邂其来锐，击其堕归。此之谓也。（《保命集》）
痢疾初得一二日间，以利为法，切不可便用止涩之剂。若实者，调胃承气、大小承气亦可用。有热先退热，
亦不可便用参、术；然气虚者可用，胃虚者亦用之。初得之时，元气未虚，必推荡之，此通因通用之法；稍久气
虚，则不可下。壮实初病宜下，虚弱衰老久病宜升之。（《丹溪心法类集》）
治痢十法∶其或恶寒发热，身首俱痛，此为表证，宜微汗和解，用苍术、川芎、陈皮、芍药、甘草、生姜三
片煎。其或腹痛后重，小水短，下积，此为里证，宜和中疏气，用炒枳壳、制浓朴、芍药、陈皮、滑石、甘草煎。
其或下坠异常，积中有紫黑血而又痛甚，此为死血证，法当用擂细桃仁、滑石行之；或口渴及大便口燥辣，是名
挟热，即加黄芩；或口不渴，身不热，喜热手熨荡，是名挟寒，即加干姜。其或下坠在血活之后，此气滞证，宜
于前药加槟榔一枚。其或在下则缠住，在上则呕食，此为毒积未化、胃气未平证，当认其寒则温之，热则清之，
虚则用参、术补，毒解积下食自进。其或力倦，自觉气少恶食，此为挟虚证，宜加白术、当归身，虚甚者加人参，
又十分重者止用此一条，加陈皮补之，虚回而利自止。其或气行血和积少，但虚坐努责，此为无血证，倍用当归
身尾，却以生芍药、生地黄、生桃仁佐之，复以陈皮和之，血生自安。其或缠坠退减十之七八，秽积已尽，糟粕
未实，当炒芍药、炒白术、炙甘草、陈皮、茯苓煎汤，下固肠丸三十粒；然固肠丸性燥，恐尚有滞气未尽行者，
但当单饮此汤，固肠丸未宜进用，盖固肠丸有去湿实肠
之功。其或利后糟粕未实，或食粥稍多，或饥甚方食，腹中作痛，切不可惊恐，当以白术、陈皮各半煎汤和之
自安。其或久痢后体虚气弱，滑下不止，又当以药涩之，可用诃子肉、豆蔻、白矾、半夏，甚者添牡蛎，可择用
之；然须用陈皮为佐，恐太涩亦能作痛。又甚者灸天枢、气海。（《丹溪心法》）
久痢不愈，当观气虚血虚，并内有流连之热，或有秽血之停，审而辨之，不可一途而治。（《苍生司命》）
滑润而易出者，兜涩为主；艰涩而难出者，疏通为先。（《沙篆》）
凡痢证初起，形气尚强，胀实坚痛者，可速去其积，积去则痢自止，此通因通用、痛随利减之法也。若烦热
好冷，脉实腹满，或下纯红鲜血者，此为湿热内盛而宜清利者。若痢症经久，未有不伤其正者，但有伤阴伤阳
之两途。伤阴者，精血脂膏悉从利去，多有烦躁热渴之候，此宜亟行清润以养其阴；伤阳者，脾肾元神悉从利
散，多有滑脱厥逆之候，此宜亟行温补以回其阳。总之，暴病则多实，久病则多寒，滑脱者多寒，涩滞者多热，
参之脉症，合之新久，百无一失矣。（《病机汇论》）
白芨散，治疗肺痈咳嗽吐脓血，以及肺部破损久不愈合，效果最为显著。将白芨研成粉末，每次服用二钱，用糯米汤调服，临睡前服用。（《医统》按语：此方原本出自《医说》，用于治疗咯血。）
痢疾这种病，与泄泻相似但不同，《内经》称之为“肠澼”，张仲景则用“下利”来概括它。“滞下”这一名称也出现在汉晋时期，现在将其列在篇中以与前述病症相区别。这种证候在此地所见大多属于热疫，而考证往古籍，宋代的方剂大不过逐积、涩肠两个方面，明代人往往基于脾肾理论，专门致力于调理补益，这在临床应用中都有不足之处。如今融通各家学说，不偏执于某一家，或许足以应对变化。
名义 初虞世在《养生必用方》中说：古人凡是频繁去厕所排便都称为“利”，普通的水样腹泻称为“利”，米谷不消化称为“米谷利”，或者说下利清谷（排出未消化的食物）。痢疾称为“滞下”，是指所排出的物质濡滞不畅，脓血点滴，坐在厕所里很久才解出，这难道不叫“滞下”吗？（《万安方》）（按语：原文中的“米谷”疑似为“水谷”之误，但《幼幼新书》引用时也作“米谷”，且说“或言下利清谷”，所以难以更改，姑且保留原貌。）
源由诸说 水谷痢，是由于体质虚弱，腠理开泄，血气不足，春季感受风邪，邪气留连在肌肉之内，后来遇到脾胃和大肠虚弱，邪气趁机侵入，所以形成水谷痢。脾和胃互为表里。胃是脾的府库，是水谷的海洋。脾是胃的藏舍，其征象反映在身体的肌肉上。而脾气主司消化水谷，水谷被消化后，其精华转化为营卫之气，内养脏腑，外充肌肤。大肠是肺的府库，是传导的官职，负责转化糟粕并排出体外。水谷的精华化为血气，运行于经脉之中，其糟粕则运行于大肠。肺与大肠互为表里，而肺主气，其征象反映在身体的皮毛上。春季阳气虽然在体表，但血气尚且虚弱，如果饮食起居不当，运动劳役过度，导致血气虚者，就会被风邪所伤，邪气客居在肌肉之间。后来因为脾胃气虚，风邪又乘虚进入肠胃。脾气弱则不能制约水谷，所以糟粕不能结聚成形而变成痢疾。（《病源论》）
至于赤白痢疾，古人称之为滞下，近代人说没有积滞就不会形成痢疾。依我思考，一年之中，难道只有夏秋季节有积滞而春冬季节没有吗？恐怕致病的原因，都是因为春季伤了风邪。然而风邪容易伤害肝脏，春季时肝木正当旺盛而不受邪气侵犯，于是移气克制脾土。脾受到贼邪侵害，所以不能消化食饮，再加上饮食不节制，恣意食用生冷坚硬瓜果鱼肉粘腻等物，积聚不化，更因外感五邪，如当风取凉、露宿湿地等，如果不发生霍乱，就一定会形成滞下。其中却有冷痢和热痢的区别。（《管见良方》）
夫痢疾，是因为夏月初秋忽然遭遇暴冷，折断了盛热之气，热气无处发散，客邪搏结于肌中，发于外部则为疟疾，发于内部则为痢疾，内外同时发作则为疟痢。这都是因为营卫不和，肠胃虚弱，冷热之气乘虚客居于肠胃。又因为饮食生冷，冷气在肠胃中，再被热气所伤，肠胃素来虚弱，所以接受热气，夹杂热则呈红色，夹杂冷则呈白色，冷热交攻则脓血混杂。也是因为沉积所致，赤痢是积热，白痢是积冷，赤白痢是冷热之积。如果脾胃气虚，不能消化水谷，则糟粕不能聚结；或者春季脱卸衣物，被风冷所伤，肠虚胃弱，突然被寒气折损，就会成为下痢很多的情况。（《全婴方论》）
大概人每天摄入的饮食积滞留在体内，湿气蒸腾，热气瘀伏而不发作，偶然间调养失宜，又感受酷热之毒，到了秋季阳气开始收敛，火气下降，蒸发蓄积的热毒，于是滞下之病发作了。（《明医指掌》）（按语：此说法《医统》引用自戴氏，又出自薛氏《平治会萃附论》，应当考证。）
泄泻、痢疾、疟疾同出一源，多由暑月脾胃气虚、饮食损伤积滞所致。饮食刚受伤便发作，则为泄泻，病情较轻；饮食停积日久，则为疟痢，病情较重。而疟疾与痢疾又有分别。饮食化为痰，充满胸膈则为疟疾；饮食化为积滞，胶着于肠胃则为痢疾。古人有话说：没有痰就不是疟疾，没有积滞就不是痢疾。确实是有道理的。（《丹溪心法附余》）
脉候 肠澼下脓血，脉象沉小流连的预后良好，脉数疾且大有热象的预后不良。肠澼伴有筋挛，脉象小细安静的预后良好，脉浮大紧的预后不良。（《脉经》）
脉象微小绝少的预后良好，洪大数的预后不良。脉象悬绝涩的预后不良，细微而涩的预后良好。脉紧大而滑的预后不良，出现代绝脉的也预后不良。（《病源论》）
下痢脉微小却预后良好，脉大浮洪则无痊愈之日。（《脉诀》）
肠澼频繁下脓血的，诊脉宜见滑大脉。如果是弦急脉则必死。（《济生》）（按语：此处将经文中的“悬涩”改为“弦急”。《医约》说：这是大概而言，还应当审察胃气。如果有胃气，那么脉虽大也无妨，不可以单一途径而论断。）
医法说：证候与脉象相符的预后良好，相反的预后不良。如今痢疾属于有余之证，脉象宜洪大数实，这才是脉证相符而可治，如今又有不可治的是为什么呢？大概痢疾虽然属于有余，但下利则伤气伤血，实为有余中之不足。所以脉沉小流连的预后良好，洪大数身热的预后不良，细小安静的预后良好，浮大而紧的预后不良，阴证见阳脉的预后良好，阳证见阴脉的预后不良，身热脉大的半死半生。（《会解》）
下痢白沫，初起脉小滑能进食的易治，脉洪大急疾四肢厥冷的难治。久痢脉微弱小细的即愈，脉数实或虚大无根的危重。下痢脓血，初起脉小滑或弦软身不热的易治；脉数实滑大而身热的，势态虽重犹或可治；如果起初不发热，五六日后反而发热脉大的必死。病程久了脉宜芤迟虚细，不宜数盛滑实，或者身热不止、口噤不食的皆死。久痢脉结代，反而突然能进食的是“除中”证，必死。大致下利的脉象，初起虽实大也无妨，六七日后最忌脉象强盛。凡下利脉浮身热按风邪治疗，脉沉身重按湿邪治疗。下利是肠胃病，虽然频频进厕但能进食则是吉兆。如果是噤口痢，初起脉数实可治。久痢反而不能进食，脉见有余的预后不良。只有脉小弱流利的，当作胃虚来治疗。（《医通》）
痢疾属于里证，脉象宜沉恶浮（有表邪者不在此论），宜细恶大（初起邪盛者不在此论），宜缓恶弦。（《医碥》）
辩证要领 其证候有让人先泄泻不止变成痢疾的，也有不泻直接变成痢疾的。其证有心腹绞痛剧烈不可忍受的，也有不痛的。有里急后重，频繁去厕所的，也有没有的。应当仔细查看马桶中，如果有一点或红或白或赤白相杂的物质，这就是痢疾证候无疑。（按语：《和剂局方·指南》说：病人登厕，刚有一两点物质或红或白或像鱼脑的，这些都是痢疾证候。这是陈氏所依据的。）虽然说红色属热，白色属寒，赤白相杂属冷热不调，但不如暂且用这种方法辨别。凡痢疾有冷热虚实之分，一时脉证不明，全在于医者仔细详察，不可固执于脉象。（《管见良方》）
凡有积滞，以腹部发热缠绕疼痛来推究。凡有气滞，以状如蟹渤（形容大便形状）来验证。（《直指》）
泄痢之病，水谷有的消化有的不消化，并没有努责用力，只感觉困倦。如果是滞下则不然，或有脓或有血，或脓血相杂，或肠垢，或无糟粕，或糟粕相混。虽然有痛、不痛、剧痛的区别，但都有里急后重，逼迫恼人。考证于经典，观察于证候，似乎都是热证实证。我近年经历，也有大虚大寒的，不可不知道。（《局方发挥》）
凡治疗痢疾，最应当察辨虚实，分辨寒热，这是泻痢中最大的关键。如果这四者不明确，则杀人很容易。（《景岳全书》）
痢疾古时有赤色属热、白色属冷及五色分属五脏的辨析，然而脏腑寒热应当以脉症互参，虽然有前人说，保留而已，如果执着于此认病，就拘泥了。（《金匮翼》）
证治总例 凡人患痢，不问赤白，脉小身凉的易安，脉大身热的难愈。患痢没有不腹痛的，都是因为因为有积滞。暑积及热积多患赤痢，冷积多患白痢。也有肠胃有风而患赤痢的，有冷热不调而患赤白痢的。暑积痢可用黄连阿胶丸、绵煎散加滑石。白痢可用驻车丸、感应丸之类。冷热不调用戊己丸、巴豆丸子之类。（《医说》引《医余》）
如果出现五心烦热，嘴唇红赤烦躁口渴想喝水，心中想冷而厌恶热，脐腹胀痛，六脉洪数或六脉虚弱的，就不可以当作虚寒治疗投用热药，这些脉证多因中暑引起。近世人多不明白中暑而妄投热药，致使人性命。殊不知寒伤形而不伤气，所以脉盛；热伤气而不伤形，所以脉虚。经书说：阳根于阴，阴本于阳。阳无阴不生，阴无阳不化。凡夏天天气热，应当吃寒凉食物，扶持阴气以养阳的时候。今人认为阴气在内，反而用热药抑制，而成疟痢脱血的很多。如果心中有时烦躁，五心烦热，四肢弃纵（松弛无力），不想穿衣盖被，或者扬手掷足，饮食想冷而厌恶温，下痢纯赤或赤黄色的，不问六脉虚弱及年高等人，便宜用性凉的药物调治，如败毒散、小柴胡汤、黄连丸是也。如果下痢纯白，或像鱼脑，或像溏薄，或滑泄不禁，脐腹冷痛，四肢逆冷，口若含霜，饮食想温而厌恶冷，六脉沉微，不问少壮，这是虚冷证，宜用温热药治疗，如丁香豆蔻散、阿梨勒丸、木香散、驻车丸，或佐以四桂散、附子理中汤。如果下痢赤白，或纯脓，或溏臭，脐腹撮痛，遇痛则痢下，下后则痛止，这是有积作痢，宜在加巴感应丸中，加黄蜡丸如绿豆大，各十五丸兼服，其积必去。如果里急后重的，用枳实去瓤麸炒黄煎汤，吞下感应丸则愈。如果未止，只用仙方断下丸或六神丸、香连丸、驻车丸服之必愈。（《管见良方》）
大致治疗痢疾的方法，虚者补之，实者泻之，滑者涩之，闭者通之，有积者推之，风则散之，暑则涤之，湿则燥之，热则凉之，冷则温之，冷热者调之，以平衡为期限，不可过激，这是大法。（《妇人良方》）
痢疾多因饮食停滞于肠胃所致，倘若不先用巴豆等药，来推荡积滞，驱逐邪秽，很少有不至于精神危困、久而羸弱的。我曾以此为鉴，每遇到此证，必先荡涤肠胃，其次扶正根本，然后辨其风冷暑湿而为之治法。所以伤热而呈红色的则清之，伤冷而呈白色的则温之，伤风而纯下清血的则祛逐之，伤湿而下如豆羹汁的则分利之。又如冷热交并的，则温凉以调之；伤损而成久毒痢的（按：上文说，或饮用冷酒物，恣情房事，劳伤精血而成久毒痢的），则化毒以保卫之。像这样，药无不应验而疾病无不痊愈的了。（《济生方》）
痢出于积滞。积，是物积。滞，是气滞。物积欲出，气滞而不与之出，所以下坠里急，乍起乍止，日夜共百余次。病人的请求，无不要求止痢，谁知道物积气滞导致有这样的证候呢？后人只见有上述证候，不论颜色赤白，脉象大小，一概用通利行之法。物积用巴豆、大黄辈，气滞用枳壳、桔梗、青皮、蓬术辈，二者兼济，必能收功。其间佐以黄连阿胶丸，效验尤其显著。大概痢疾多因伤暑伏热、酒面炙煿酝酿而成，其阿胶尤是大肠的要药，有热毒留滞则能疏导，无热毒留滞则能安平。市肆如果没有丸子，就用炒阿胶、当归、青皮、赤茯苓、黄连作剂，入乌梅、浓蜜同煎，最能荡涤恶秽。积既去，遍数自然稀疏。此后却用木香、茯苓、缩砂、白豆蔻、陈皮、甘草调之，自然喜食。食则糟粕入于大肠，然后真人养脏汤、易简断下汤，可止则止矣。（《直指方》）
医法说：后重则宜下，腹痛则宜和，身重则除湿，脉弦则去风。血脓稠粘，用重药竭之；身冷自汗，用毒药温之。风邪内缩，宜汗之则愈，溏为痢，当温之。又说：在表者发之，在里者下之，在上者涌之，在下者竭之，身表热者内疏之，小便涩者分利之。又说：盛者和之，去者送之，过者止之。兵法说：避其锐气，击其惰归。说的就是这个道理。（《保命集》）
痢疾初得一二日间，以利为法，切不可便用止涩之剂。如果是实证，调胃承气汤、大小承气汤也可用。有热先退热，也不可便用人参、白术；然而气虚者可用，胃虚者也用之。初得之时，元气未虚，必推荡之，这是通因通用的方法；稍久气虚，则不可下。壮实初病宜下，虚弱衰老久病宜升之。（《丹溪心法类集》）
治痢十法：其或恶寒发热，身首俱痛，此为表证，宜微汗和解，用苍术、川芎、陈皮、芍药、甘草、生姜三片煎。其或腹痛后重，小水短，下积，此为里证，宜和中疏气，用炒枳壳、制浓朴、芍药、陈皮、滑石、甘草煎。其或下坠异常，积中有紫黑血而又痛甚，此为死血证，法当用擂细桃仁、滑石行之；或口渴及大便口燥辣，是名挟热，即加黄芩；或口不渴，身不热，喜热手熨荡，是名挟寒，即加干姜。其或下坠在血活之后，此气滞证，宜于前药加槟榔一枚。其或在下则缠住，在上则呕食，此为毒积未化、胃气未平证，当认其寒则温之，热则清之，虚则用人参、白术补，毒解积下食自进。其或力倦，自觉气少恶食，此为挟虚证，宜加白术、当归身，虚甚者加人参，又十分重者止用此一条，加陈皮补之，虚回而利自止。其或气行血和积少，但虚坐努责，此为无血证，倍用当归身尾，却以生芍药、生地黄、生桃仁佐之，复以陈皮和之，血生自安。其或缠坠退减十之七八，秽积已尽，糟粕未实，当炒芍药、炒白术、炙甘草、陈皮、茯苓煎汤，下固肠丸三十粒；然固肠丸性燥，恐尚有滞气未尽行者，但当单饮此汤，固肠丸未宜进用，盖固肠丸有去湿实肠之功。其或利后糟粕未实，或食粥稍多，或饥甚方食，腹中作痛，切不可惊恐，当以白术、陈皮各半煎汤和之自安。其或久痢后体虚气弱，滑下不止，又当以药涩之，可用诃子肉、豆蔻、白矾、半夏，甚者添牡蛎，可择用之；然须用陈皮为佐，恐太涩亦能作痛。又甚者灸天枢、气海。（《丹溪心法》）
久痢不愈，应当观察气虚血虚，并内有流连之热，或有秽血之停，审而辨之，不可一途而治。（《苍生司命》）
滑润而易出者，兜涩为主；艰涩而难出者，疏通为先。（《沙篆》）
凡痢证初起，形气尚强，胀实坚痛者，可速去其积，积去则痢自止，这是通因通用、痛随利减的方法。如果烦热好冷，脉实腹满，或下纯红鲜血者，此为湿热内盛而宜清利者。如果痢症经久，未有不伤其正者，但有伤阴伤阳的两途。伤阴者，精血脂膏悉从利去，多有烦躁热渴之候，此宜亟行清润以养其阴；伤阳者，脾肾元神悉从利散，多有滑脱厥逆之候，此宜亟行温补以回其阳。总之，暴病则多实，久病则多寒，滑脱者多寒，涩滞者多热，参之脉症，合之新久，百无一失矣。（《病机汇论》）
Baiji San (White Rhizome of Bletilla Powder) is most effective for treating lung abscess (pulmonary carbuncle) with coughing up of pus and blood, as well as non-healing pulmonary rupture. Grind Baiji (Rhizoma Bletillae) into powder; take two qian per dose, mixed with rice gruel, taken before bedtime. (Note from *Yitong*: This formula originally comes from *Yishuo*, used to treat hemoptysis.)
Dysentery is similar yet distinct from diarrhea. The *Neijing* calls it "Changpi" (intestinal discharge), while Zhang Zhongjing uses "Xiali" (lower purging/diarrhea) to summarize it. The term "Zhixia" (stagnant downward flow) also appears in the Han and Jin periods; it is listed here to distinguish it from the aforementioned conditions. In this region, such cases are mostly seen as heat epidemics. Examining ancient texts, Song dynasty prescriptions generally focused only on expelling accumulation and astringing the intestines. Ming dynasty physicians often based their treatment on the spleen and kidney, specifically focusing on regulation and tonification, which were insufficient in clinical practice. Today, by integrating various schools of thought without bias, we may be able to adapt to changes.
**Etymology**: Chu Yushi in *Yangsheng Biyong Fang* states: "Ancients referred to frequent defecation as 'Li' (benefit/flow). Ordinary watery diarrhea was called 'Li', undigested grain was called 'Migu Li' (grain benefit), or said to be 'Xiali Qinggu' (passing clear undigested food). Dysentery is called 'Zhixia' because the discharged material is sticky and stagnant, with drops of pus and blood, and the patient sits on the toilet for a long time. Is this not called 'Zhixia'?" (*Wan'an Fang*) (Note: "Migu" might be a typo for "Shuigu" [water and grain], but *Youyou Xinshu* also cites it as "Migu", mentioning "or said to be Xiali Qinggu", so it is difficult to change; we retain the original text.)
**Etiology and Pathogenesis**: Water-grain dysentery arises from weak constitution, open pores, and deficiency of blood and qi. Wind pathogen injures in spring, lingering within the muscles. Later, when the spleen, stomach, and large intestine become weak, the pathogen takes advantage. Thus, water-grain dysentery forms. Spleen and stomach are interior-exterior partners. Stomach is the mansion of spleen and the sea of water and grain. Spleen is the storage of stomach, manifesting in the body's muscles. Spleen governs the digestion of water and grain; after digestion, its essence transforms into Ying and Wei (nutritive and defensive qi), nourishing internal organs and filling the skin and muscles. Large intestine is the mansion of lung, the official of conduction, transforming waste and excreting it. The essence of water and grain transforms into blood and qi, circulating in the meridians, while waste circulates in the large intestine. Lung and large intestine are interior-exterior partners; lung governs qi, manifesting in the skin and hair. Although spring yang qi is on the surface, blood and qi are still weak. Improper diet, lifestyle, or overexertion leading to blood and qi deficiency allows wind pathogen to invade and lodge between muscles. Subsequently, due to spleen and stomach qi deficiency, wind pathogen enters the intestines and stomach. Weak spleen qi cannot control water and grain, so waste does not consolidate and becomes dysentery. (*Bingyuan Lun*)
Regarding red and white dysentery, ancients called it Zhixia. Moderns say "no accumulation, no dysentery." I ponder: Is there really no accumulation in spring and winter? Perhaps the cause is spring wind injury. Wind tends to injure liver. In spring, liver wood is strong and resists pathogen, shifting energy to attack spleen earth. Spleen suffers from thief pathogen, failing to digest food and drink. Combined with irregular diet, indulgence in raw, hard, fruits, fish, meat, and sticky foods causing accumulation, plus external exposure to five pathogens (e.g., cooling off in wind, sleeping on damp ground), if not Huoluan (cholera-like vomiting and diarrhea), then Zhixia will surely occur. There are distinctions between cold and hot types. (*Guanjian Liangfang*)
Dysentery occurs when sudden cold in early autumn interrupts intense summer heat. Heat has nowhere to dissipate, lodging in the muscles. Externally it manifests as malaria; internally as dysentery; both as malaria-dysentery. This results from disharmony of Ying and Wei, weakness of intestines and stomach, allowing cold and heat pathogens to invade. Dietary coldness combined with internal heat injury to previously weak intestines and stomach leads to mixing: heat makes it red, cold makes it white, cold-heat conflict mixes pus and blood. Red dysentery is heat accumulation; white is cold accumulation; mixed is both. If spleen and stomach qi are weak, unable to digest food, waste does not consolidate. Or, if exposed to wind-cold in spring, intestinal and gastric weakness leads to severe lower purging. (*Quanying Fanglun*)
Generally, dietary accumulation stays inside. Dampness steams, heat stasis lies dormant until improper care triggers a feeling of extreme heat toxin. In autumn, yang qi recedes, fire qi descends, evaporating accumulated heat, causing Zhixia. (*Mingyi Zhizhang*) (Note: This view is cited from Dai Shi in *Yitong* and also from Xue Shi's *Pingzhi Huicui Fulun*; verification is needed.)
Diarrhea, dysentery, and malaria share a common source, mostly caused by spleen-stomach qi deficiency in summer months and dietary injury/accumulation. Immediate onset after dietary injury is mild diarrhea; long-standing accumulation leads to severe malaria-dysentery. Malaria and dysentery differ: phlegm filling chest/diaphragm causes malaria; accumulation sticking to intestines/stomach causes dysentery. Ancients said: "No phlegm, no malaria; no accumulation, no dysentery." Indeed. (*Danxi Xinfa Fuyu*)
**Pulse Diagnosis**: Changpi with pus/blood discharge: pulse sinking, small, and continuous indicates survival; rapid, frequent, large, and hot indicates death. Changpi with muscle cramps: pulse small, fine, and quiet indicates survival; floating, large, and tight indicates death. (*Maijing*)
Pulse small and absent indicates survival; surging, large, rapid indicates death. Pulse hanging, abrupt, choppy indicates death; fine, small, and choppy indicates survival. Pulse tight, large, and slippery indicates death; Dai (intermittent) or abrupt pulse indicates death. (*Bingyuan Lun*)
Lower purging with small/micro pulse indicates survival; large, floating, surging pulse indicates no recovery day. (*Maijue*)
Frequent pus/blood discharge in Changpi: pulse should be slippery and large. String-tight pulse implies certain death. (*Jisheng*) (Note: Here "hanging/choppy" is changed to "string-tight". *Yiyue* says: This is general; one must examine stomach qi. If stomach qi exists, large pulse is acceptable; do not judge by one method alone.)
Medical law states: Symptoms matching pulse indicate survival; opposite indicates death. Dysentery is an excess syndrome; pulse should be surging, large, rapid, and solid for treatability. Why are some untreatable? Although dysentery is excess, purging damages qi and blood, making it "excess with underlying deficiency." Thus, sinking/small/continuous pulse survives; surging/large/rapid with fever dies; fine/small/quiet survives; floating/large/tight dies. Yin syndrome with yang pulse survives; yang syndrome with yin pulse dies. Fever with large pulse is half-dead/half-alive. (*Huijie*)
Passing white mucus: early stage, small/slippery pulse with appetite is easy to treat; surging/large/rapid with cold limbs is difficult. Chronic dysentery with weak/fine pulse heals; rapid/solid or empty/large rootless pulse is critical. Pus/blood discharge: early stage, small/slippery or string-soft pulse without fever is easy to treat; rapid/solid/slippery/large with fever is serious but potentially treatable; no initial fever but fever/pulse large after 5-6 days implies death. Long-term: pulse should be hollow, slow, empty, fine; not rapid/prosperous/slippery/solid. Continuous fever, locked jaw, inability to eat implies death. Chronic dysentery with knotted/intermittent pulse, suddenly able to eat, is "Chu Zhong" (false appetite), implying death. Generally, early large/solid pulse is acceptable, but after 6-7 days, strong pulse is taboo. Floating pulse + fever treated as wind; sinking pulse + heaviness treated as damp. Lower purging is intestinal disease; frequent stools with appetite is auspicious. For Jin Kou Li (locked mouth dysentery), early rapid/solid pulse is treatable. Chronic dysentery with inability to eat and excess pulse implies death. Only small/weak/smooth pulse suggests treating stomach deficiency. (*Yitong*)
Dysentery is a interior syndrome; pulse should be sinking (not floating if exterior pathogen exists), fine (not large if early excess pathogen), and slow (not string-tight). (*Yique*)
**Key Differentiation**: Some start with unceasing diarrhea turning into dysentery; others go straight to dysentery. Severe heart/abdominal pain is common, but not always present. Tenesmus (feeling of incomplete evacuation) and frequent toilet visits vary. Carefully check the toilet: any trace of red, white, or mixed substance confirms dysentery. (Note: *Heji Juzheng Fang* says: Even one or two drops of red/white or fish-brain-like substance confirm dysentery. This is based on Chen Shi.) While red indicates heat, white indicates cold, and mixed indicates imbalance, it is better to use this method for differentiation. Dysentery has cold/heat/excess/deficiency types. When pulse/symptoms are unclear, the physician must observe carefully, not relying solely on pulse. (*Guanjian Liangfang*)
Accumulation is identified by abdominal heat and wrapping pain. Qi stagnation is verified by stool shape resembling crab bubbles. (*Zhizhi Fang*)
Diarrhea/dysentery: food digests or not, no straining, just fatigue. Dysentery (Zhixia) is different: pus, blood, mixed, intestinal mucus, or mixed with waste. Regardless of pain level, tenesmus is distressing. Classics suggest these are heat/excess syndromes. However, my recent experience shows cases of extreme deficiency/cold; this must be known. (*Jufang Fahui*)
Treating dysentery requires distinguishing excess/deficiency and cold/heat; this is crucial. Failure to clarify these four aspects kills easily. (*Jingyue Quanshu*)
Ancient theories link red to heat, white to cold, and five colors to five organs. However, organ cold/heat must be cross-referenced with pulse/symptoms. Keep these theories but do not rigidly apply them. (*Jinkui Yi*)
**General Treatment Principles**: Dysentery patients with small pulse and cool body heal easily; large pulse and fever are hard to cure. All dysentery involves abdominal pain due to accumulation. Summer/heat accumulation causes red dysentery; cold accumulation causes white dysentery. Wind in intestines/stomach causes red dysentery; cold-heat imbalance causes mixed dysentery. Summer accumulation: Huanglian Ejiao Wan, Mianjian San plus Shihui. White dysentery: Zhuche Wan, Ganying Wan. Cold-heat imbalance: Wuji Wan, Badou Wan. (*Yishuo* citing *Yiyu*)
Five centers heat, red lips, thirst, desire for cold, aversion to heat, abdominal distension/pain, surging/rapid pulse or weak pulse: Do NOT treat as deficiency-cold with hot herbs. These signs often stem from summerheat. Moderns misunderstand summerheat and misuse hot herbs, causing death. Remember: Cold injures form (pulse strong); heat injures qi (pulse weak). Classic: Yang roots in Yin; Yin originates from Yang. Summer is time to eat cold to support yin and nourish yang. People mistakenly suppress internal yin with hot herbs, causing malaria/dysentery/hemorrhage. If irritability, five centers heat, limb relaxation, aversion to covering, tossing limbs, desire for cold food, pure red/yellow dysentery: Use cool herbs like Baidu San, Xiao Chaihu Tang, Huanglian Wan, regardless of pulse weakness or age. Pure white dysentery, fish-brain texture, loose stools, incontinence, cold abdomen/limbs, frosty mouth, desire for warm food, deep/micro pulse: Treat as deficiency-cold with warm herbs like Dingxiang Doukou San, Ali Le Wan, Muxiang San, Zhuche Wan, or Si Gui San, Fuzi Lizhong Tang. Mixed pus/blood, colic relieved by defecation: Accumulation dysentery. Take Jiaban Ganying Wan plus Huangla Wan (bean-sized, 15 pills each) to remove accumulation. Tenesmus: Zhi Shi decoction to swallow Ganying Wan. If unresolved, Xianfang Duania Wan, Liushen Wan, Xianglian Wan, or Zhuche Wan will cure. (*Guanjian Liangfang*)
General rules: Tonify deficiency, purge excess, astringe slipping, open closure, push accumulation, scatter wind, wash summerheat, dry dampness, cool heat, warm cold, regulate cold-heat. Aim for balance, do not overdo. This is the great method. (*Funren Liangfang*)
Dysentery stems from dietary stagnation. Without using Badou etc. to push accumulation and purge filth, patients become weak and emaciated. I learn from this: First purge intestines/stomach, then correct root, then treat wind/cold/summerheat/dampness. Heat-red: Clear. Cold-white: Warm. Wind-clear blood: Dispel. Damp-bean-soup juice: Separate/drains. Cold-heat mix: Regulate with warm/cool. Injury/toxic chronic dysentery: Resolve toxin and protect. Thus, medicines work and diseases heal. (*Jisheng Fang*)
Dysentery comes from accumulation (material) and stagnation (qi). Material wants to exit, qi stagnates preventing exit, causing tenesmus and frequent stops/startups. Patients want cessation, unaware of the cause. Later doctors see symptoms and indiscriminately use purgatives. Material accumulation: Badou, Dahuang. Qi stagnation: Zhiqiao, Jiegeng, Qingpi, Pengru. Using both works. Adding Huanglian Ejiao Wan enhances efficacy. Dysentery often stems from summerheat/latent heat, alcohol/wheat/grill fermentation. Ejiao is key for large intestine: guides out heat toxin, calms if none. If pills unavailable, use fried Ejiao, Danggui, Qingpi, Chifuling, Huanglian with Wumei and honey to purge filth. Once accumulation clears, frequency decreases. Then regulate with Muxiang, Fuling, Suosha, Baudoukou, Chenpi, Gancao to restore appetite. Once food enters large intestine, Zhenren Yangzang Tang or Yijian Duania Tang can stop it. (*Zhizhi Fang*)
Law: Tenesmus -> purge; Abdominal pain -> harmonize; Heaviness -> remove damp; String-tight pulse -> dispel wind. Thick pus/blood -> heavy drugs to exhaust; Cold sweat -> toxic drugs to warm. Internal wind contraction -> sweat to cure. Loose stool dysentery -> warm. Exterior -> release; Interior -> purge; Upper -> vomit; Lower -> exhaust/astringe. Surface heat -> internal drain; Scanty urine -> separate/drains. Full -> harmonize; Going -> send; Excess -> stop. Military strategy: Avoid sharp arrival, strike returning exhaustion. (*Baoming Ji*)
Early dysentery (1-2 days): Use purgatives, do NOT use astringents immediately. Excess: Tiaowei Chengqi, Da/Xiao Chengqi. Clear heat first, do not immediately use Renshen/Baizhu; however, qi deficiency can use them. Early stage, yuan qi not yet weak, must purge (Tong Yin Tong Yong - treat obstruction with purgative). Later qi deficiency, do not purge. Strong/young acute: Purge. Weak/elderly chronic: Lift. (*Danxi Xinfa Leiji*)
Ten Methods for Treating Dysentery:
1. Chills/fever, head/body pain (Exterior): Mild sweating/harmonizing. Cangzhu, Chuanxiong, Chenpi, Shaoyao, Gancao, Shengjiang.
2. Abdominal pain/tenesmus, scanty urine, accumulation (Interior): Harmonize middle/ventilate qi. Fried Zhiqiao, Zhi Houpo, Shaoyao, Chenpi, Shihui, Gancao.
3. Extreme prolapse, purple/black blood in accumulation, severe pain (Dead Blood): Pounded Taoren, Shihui. Thirst/dry burning stool (Heat): Add Huangqin. No thirst/no heat/warm hands preferred (Cold): Add Ganjiang.
4. Prolapse after blood moves (Qi Stagnation): Add Binglang.
5. Lower blockage, upper vomiting (Toxin accumulation/unbalanced stomach): Warm cold, clear heat, tonify deficiency (Renshen/Baizhu). Toxin resolves, appetite returns.
6. Fatigue, shortness of breath, aversion to food (Deficiency): Add Baizhu, Danggui Shen. Severe: Add Renshen. Very severe: Add Chenpi. Deficiency returns, diarrhea stops.
7. Qi moves, blood harmonizes, little accumulation, false straining (Blood Deficiency): Double Danggui Shen/Tail, add raw Shaoyao, Shengdihuang, raw Taoren, harmonize with Chenpi. Blood generates, peace returns.
8. Prolapse reduced 70-80%, filth gone, waste not solid: Fried Shaoyao, Baizhu, Roasted Gancao, Chenpi, Fuling decoction + Guchang Wan (30 pills). Guchang Wan is drying; if qi stagnation remains, drink decoction only. Guchang Wan dries damp/firms intestine.
9. Post-diarrhea unsolid waste, overeating porridge, hunger eating, abdominal pain: Do not panic. Banxia/Baizhu decoction harmonizes.
10. Chronic dysentery, weak body/qi, continuous slipping: Astringe with Hezi Rou, Doukou, Baifan, Banxia. Severe: Add Muli. Use Chenpi as assistant to prevent excessive astringency causing pain. Severe cases: Moxibustion at Tianshu, Qihai. (*Danxi Xinfa*)
Chronic dysentery: Observe qi/blood deficiency, lingering heat, or retained filth/blood. Differentiate carefully; do not use one method. (*Cangsheng Siming*)
Slippery/easy discharge: Astringe primarily. Difficult/hard discharge: Unblock primarily. (*Shazhao*)
Early dysentery, strong form/qi, distension/fullness/pain: Quickly remove accumulation; diarrhea stops naturally (Tong Yin Tong Yong, pain reduces with relief). Irritability/cold preference, solid pulse, full abdomen, pure red blood: Damp-heat excess, clear/drains. Long-term dysentery always injures healthy qi: Yin or Yang injury. Yin injury (essence/blood lost): Restlessness/thirst/heat -> Clear/moisten to nourish yin. Yang injury (spleen/kidney spirit lost): Slipping/deviation -> Warm/tonify to restore yang. Acute = mostly excess; Chronic = mostly cold; Slipping = mostly cold; Stagnant = mostly heat. Combine pulse/symptoms/new-old duration; rarely fail. (*Bingji Huilun*)