凡疹病不论何种，均以大便通利为顺，故中西医书均以泻为无妨，此症因年令太幼，气血未足，一经疹热，继又并发肺炎，因而肠及肾脏，均已涉及，发生炎症，其脑症状（惊风）更甚，实为万分危险。然服第一方三剂，而热不退，（幸而疹已全出）注射沃母纳丁，而热不退，病势进行，若按正规之肠炎、肺炎、肾炎、脑膜炎等之治法，除与泻剂外，将别无他法可循矣。然余再三寻思，此孩未满周岁，热毒缠绕已六、七日（初病之先，家人曾令服泻剂，余不知也，害即在此）其泻也，必其肠胃将失生活力，其神经痉挛，必其脑脊髓将失生活力使然，以幼穉之脏腑，元气因早服泻药已经大损，故不胜热毒久燃，而又病系热性，投药又不能不顾及病性，故余冒险而用白芍与茯苓。此二味，在疹病可谓禁用品，以白芍之收敛，茯苓之渗利，对于热邪烁津炎症纷起之病孩，实觉万分不宜。然一思此病之反面，则此孩生活力，实已渐渐缺乏，邪旺正虚，若再加以泻药泻之，余恐不但不能消炎，且恐速其死亡，盖残馀之生气，已属有限，于此时再与降下，势必津液立枯，断送生命矣。余不得已，乃于连翘二钱（重用），贝母、杏仁、桑皮各一钱之方中，大胆加入茯苓一钱以扶脾利湿，白芍一钱，以敛阴补肺，孤注一掷，初不料其果茯奇效如此也。
余本此理想，于第二剂中，去桑皮加山药，病热又重，急恢复原方，仍用茯苓、白芍，以至疹愈。可见原方第一剂中辅佐之药，亦甚得宜，而山药补性，过于茯苓，故不适用于热性病也。余治疹疾何止干百，惟此症可云反治，实有研究之价值，故特录之？无一字虚伪也。
余族孙寿龄前年来京寓病疹，余为处方（中药），意欲为其试用血清疗法，因见报广告中，有某医专用血清者，延之来，入门后接谈，此君自命精通中医，余乃出示所服方，此君见有薄荷一钱，乃竟当面大加驳斥，（询知系余之方）谓一钱薄荷，足以致命。余向不欲多辨，只得唯唯受教，及请其治疗，则仅开一枸橼酸等之普通清凉药方而去。余知此方无能为也，乃仍令服余方，嗣即痊愈。余任医官长经历有年，所实验中西药已四十馀年，虽系才浅学疏，然已薄有经验，近虽衰老，仍在求知时期中，绝不敢稍存自满之念。此君年仅三十馀岁，乃竟当面驳斥余方，可谓直入。然中医治此症，唯一妙诀，即在宣透内外，干旋清浊，常使肌肤松动，务令蕴蓄之疹毒，时有出路，未发之前，不致固闭，既发之后，不致倒隐，其重要关健，全在活动肌表，疏导腠理，此种妙用，证之实验，询称高人一筹。是以一味解毒，或过用苦寒，而不知时时注意于宣达肌肤，因势利导者，皆下工也。薄荷、菊花，对此义可谓吻合，较之葛根、芥穗等，对疹热尤觉清凉可喜。四十年来，诊治疹疾，所以未曾失败者，幸有此耳。余对医术上甚愿受人指教，即如此君，亦所心感，但此症并未服此君之药，仍由余个人治愈之。足以证明薄荷对疹疾，用量不大，实有确效，而无流弊（佐使得宜）。余更可因此君之言论，而作此段之真实的报告也。
凡对某一种学术，未经深研及实验多年，确有见地，万不可冒然批评。中医稍知一、二西药，西医稍知一、二中药，再阅几年中西医书，即自命为中西兼通，自欺欺人，为害甚大，愿高明有志之医者，不可入此歧途也。
痢（四）痢古名滞下，俗名红白痢疾，又名疫痢，（指大传染时而言）西医名之赤痢，则为急性传染病之一种，中医又有噤口痢、休息痢等名，则与慢性肠加答儿相混，不足为训。
（原因）中医大概以湿热积滞四字，为本病原因，西医则以病菌之传染为据。
（症候）本病以数次之下利，先泻稀水及全身倦怠（或呕恶）而起，排便时觉腹痛，里急后重，继则排泻粘液、脓液、血液，甚则为烂肉佯一日之间，约数十次，发热或恶寒，此为正规之赤痢。最重者热度愈高，腹极痛胀，纯泻血水极臭之物，所泻之物如西瓜汤样脉沉数者居多，危险愈甚，则脉愈细小，此时将有穿孔性腹膜炎之嫌疑，凡老人、及吸食鸦片者，俗名烟后痢患此症尤危险，若在本病大流行时，更应特别注意也。
此症除预防注射外，治疗愈早愈妙，凡在此症大流行时，一觉腹痛，大便不爽，或数次水泻，即应速服泻剂。治疗中食物禁忌生冷，及不易消化之物。凡坚硬食物及肉类均忌。只宜用稀薄米粥及藕粉、绿豆粉等流动食品，牛羊乳绝不可用。此点余由经验得来，非故与西医说法反对也。初期腹痛，所服泻药，以西药甘汞为适宜，此药有杀菌性，故较其他下剂为宜。考西医书称植物性下剂，无益于本病，此说不确。试于极重之赤痢，加入大黄不但消炎，且能退热，一试便知（参看医验）不可盲从也。
用中药，初期则宜于消导积滞之处方中神曲、麦芽、山楂之类加入枳实、木香、厚朴、槟榔之类顺气之品，腹痛后重甚者，多加之。自然收效。审其内热太盛。小便赤短，红痢渐久，口渴身热，腹痛更甚。再加苦寒清热之品黄芩、黄连、栀于之类，呕吐必重用之。病势再进，则肠热将生他变，皮肤潮热，注意此二字，痢毒菌侵袭大肠后则皮热更高。腹痛更甚，泻痢无数，日数十行精神昏蒙，所泻之物，或成烂肉样，或成西瓜汤样，脉反小数，呕恶不进饮食，危期至矣。此时必用大剂重量之苦寒、黄芩、黄柏、白头翁之类。渗利、茯苓、泽泻之类泻下之品，大黄，此时并非重要，只用熟大黄一、二钱，领导之自有神效。连服二、三剂，必能挽回险症。若在大流行时（疫痢），尤须参照温症治法，不可一味治痢，运用中药，灵活圆通，方能见中医医术之精奇。痢疾至此，人始知此症之可以致命也。死于此际者多矣但中医对痢疾稍久，习用之白芍、乌梅、甘草、生姜、当归、半夏等药，不及西药收敛剂之善，凡遇有热、腹痛之痢疾，日期未久者，万不可早用，戒之戒之。治新得之疫痢，自始至终，各方中稍加清热利湿（银花、黄芩、泽泻之品）为有效治法，不可不知，但应用西药时，不可妄行加入中药也。
重症痢疾将退（消炎）之时，往往服中药后（不必泻药即清凉药亦然）反泻甚，停止眼药则稍安，此为病不胜药，可以小剂分利消息之，或与小量西药之收敛剂等，自然痊愈。庸工见其尚有脓滞后重，于此际数数仍与以降下苦寒之药（以为前已见效）以为热仍未清，则必渐生他变，所谓噤口痢、（约十馀日，至二十馀日）休息痢等，即由此阶段演成之。又赤痢经过下剂，屡用泻药，病势已全减，为日已久，仍泻痢或有腹痛不止者，可用西药单那尔并、阿片末等收敛之自愈，但此法不可用之太早，以防弊，慎之慎之。
中医治久泻有痢疾转来者，往往参用补养、参、芪、术、附收敛、白芍、吴萸、乌梅等等药，谓其日久正气已虚，亦自有效。
但必须泄过数月后，毫无实证时，方可用之，此症不得仍以痢疾名之，可参阅泻症篇。
后重（俗称下坠）甚者，内服中药，外用西药洗肛法为最效，洗涤液以用药皂水或硼酸水为宜，器械尤须注意消毒。
中医治此症，尤其对于极危之赤痢，可谓特效（参看医验）。愿高明西医，取此法以补西药之缺点也。久泻亦有白油样之物，亦有下坠之感，亦有腹痛，不可误认为腹痛属实，积滞未尽，此时应用中药之补剂，或西药之收敛剂方效，此理于久泻症下详述之，可参看。
中医于慢性肠炎，及慢性肠加答儿，往往与久痢混为一谈，不能分别，故有休息痢，噤口痢、久痢等等名目。现之新久不同，治法亦异，不必仍以痢名，徒乱人意，故余另列久泻一症于后。盖实证失治，日久变为虚证，由急性转为慢性不可牵连以前病名，反令初学医者，枉费脑力也。
（医验）张太夫人年七十馀岁，住德县南门东街。于民国四年夏患赤痢，前数日即倦怠，酸软渐即水泻，以后成红白下痢，腹痛，里急后重（俗称下坠），继则排泄粘液、血液、脓汁样粪便，一日夜约数十次，渐发高热，小便短赤，舌苔黄，左肠骨窝压痛尤甚，脉小数，气喘神昏（以体温太高），呕恶口不渴。经过二日，所泻之物，完全血汁（如西瓜汤样），腹奇痛，肛门因泻被刺激发炎而疼痛。高年之人，烟瘾又重，颇为危险，索阅以前所服之药，茯苓、泽泻、车前子、白芍、甘草、陈皮、神曲、木香、麦芽、山楂。消导渗利，只治普通轻痢，未能中病。余既认定此症为赤痢，且已侵及大肠，当本病未犯大肠时，体温不高及侵至回肠之下部，则呈所谓窒扶斯样症状之热型，即发高热，引起脑症状，故神昏也。有诱起腹膜炎之嫌疑，特与下方：第一次方茯苓一两盐川柏四钱白头翁四钱黄芩四钱熟军二钱丹皮二钱砂仁五分枳实一钱水煎服。分三次，一日服完。服此药二次之后，不及半日，所泻便数已减少，腹痛亦减，热亦减，精神略清醒，啜百合粉粥半碗，（已二日未进饮食）肛痛亦减，（外用硼酸水洗肛）三次服完。第二日再诊，精神清醒，热亦减退，诸症竟去其大半，可谓奇效，一日夜间只泻六次。乃与下方：第二次方茯苓一两黄芩四钱盐黄柏四钱白头翁六钱熟军一钱木香煨一钱炒银花三钱枳壳一钱水煎服。仍作三次，一日服完。此剂服完第二日再诊，热已退，只泻三次，已思饮食，能吸烟矣。嘱令以果汁盐一小茶匙，对柠檬露及开水当茶饮，以活动胃气，仍照原方，减去熟军，其馀药品分量仍旧，又连服四剂而愈。
此症中医注重湿热及食滞，确有至理，普通治痢之方，消导顺气渗利，在轻症之痢疾，自然有效，若系重笃之赤痢，专用上法，不但无效，且恐贻误病机。此一例为张太夫人，余友张松泉君之母也，当其得病之初，所服之药，即普通治痢之方，前医某君与松泉亦系至友，其人医学平妥，而极虚心，令人饮佩，此症服药数剂无效，亟劝松泉延余诊治，余见此症甚险恶，非用大剂苦降之品，不足挽救，立方之始，若非松泉有极深信仰，亦绝不敢用余之方。以庸工论调，多以年老之人及有烟瘾者对此症绝不可用下剂，且不明皮层发热，为肠将溃烂之病理，往往于普通治痢方中，加入收敛或解表等品，自命稳健，实则误人，故吾乡视烟后痢俗名为必死之症，若在老年，更无治法矣。犹忆民国七年夏，曾治一张虎臣将军之赤痢，（行营在武昌）近年治一马仲孚（住德县马家溜口街）皆烟后痢之重者，当时医案，与张太夫人之症治皆同，均获奇效。余创此痢治法，屡试屡验，其药味药量，均不可增减，特记之，以告学者。
王夫人，年三十馀岁，住县南门东，此王质斋君之夫人光绪二十六年秋间，患瘟疫并发泻痢，延余诊治。病者受孕已六个月，身体素弱，这日所泻皆血水，腹奇痛，小便不通，近已唇青，绝食，目闭，肢厥，日夜泻痢数十次。次前医皆用利湿扶脾法未效，腹痛更甚，诊脉浮洪，沉之则虚，断为暑湿久受而为热，肺金失其清虚之令，而小肠化理之源绝矣。脾为湿土，久泻愈弱，（病已二十馀日）正气愈虚，脾胃益败。前医不清肺而利小便，是谓舍本求末；不顾正气以培脾胃，是谓无米为炊，所以愈分利愈耗气，正气愈虚，邪气愈盛，以致唇青目闭、绝食肢厥，皆虚脱现象。倘再坠胎，大事去矣，为今之计，亟宜补元气以壮太阴，清肺金以理化源，庶有济耳，舌苔纯黑，乃经气散溢，未可指为实热，再议苦降也。
第二次方赤芍二钱白芍二钱赤茯苓四钱白茯苓四钱白术四钱半酒条芩四钱寸冬五钱生山栀二钱泽泻三钱猪苓二钱陈皮二钱当归二钱莲子心三钱苦参一钱盐川柏三钱砂仁三分鲜梨汁冲入煎服。此第二次方也，以此方为最效，服后每日泻只三、四次，诸症大减，小便亦通。第一方中，有高丽参五钱，白术一两，服后精神渐苏，泄泻略变稠粘，此病共服药二十六剂痊愈，立方大意，均如此，遂庆更生。第一次原方及前医原方，均详载于余著之《恫瘰集》中，以此书未在手下，无从抄录。
此胎前疫痢，为余四十年前得意之医案，原理论牵及五运六气及批评前医（此为吾乡前辈名医）之处，理解欠缺，均为余近来所不取，此症危甚，当时自信太深，大反前案，检点曩昔处方，不寒而栗。然此症确实由余治愈，故至今不忘，因录于此，俾学者与前张案对照，庶知中医对赤痢，（当时尚无赤痢名词）治法之活动圆通，真有研究之价值，而余少年行医之胆大心粗，亦可为前车之鉴也。
余治赤痢之医案极多，录不胜录，以上二则，皆赤痢重症，对于治疗上，又有特别障碍者，一有烟瘾之老人，一有坠眙之危险颇有研究之趣味，故选录之。
凡出疹性疾病，无论属于哪一种类型，都以大便通畅为顺证。因此，中西医书籍都认为腹泻无妨。此患儿因年龄太小，气血不足，一旦遭遇疹毒发热，又并发肺炎，导致肠道和肾脏均受波及，发生炎症，其脑部症状（惊风）更为严重，实在万分危险。然而服用第一方三剂后，热势不退。（幸好疹子已全部发出）注射沃母纳丁（Wormina Ding，一种药物），热仍不退，病情继续发展。若按照正规的肠炎、肺炎、肾炎、脑膜炎等疾病的治法，除了使用泻药外，别无其他方法可循。但我再三思考，这个孩子未满周岁，热毒缠绕已六七天了（发病前，家人曾让他服用泻药，我不知道，祸害就在这里）。他的腹泻，一定是肠胃即将失去生命力；他的神经痉挛，一定是脑脊髓即将失去生命力所致。由于脏腑幼嫩，元气因早服泻药已经大损，所以不能承受热毒的长期燃烧。而且病属热性，用药又不能不顾及病性，所以我冒险使用了白芍与茯苓。这两味药，在出疹性疾病中可以说是禁用品，因为白芍具有收敛作用，茯苓具有渗利作用，对于热邪灼伤津液、炎症纷起的患病儿童，实在觉得万分不宜。但转念一想此病的反面，则这个孩子的生命力，实际上已经逐渐缺乏，邪气旺盛而正气虚弱，如果再加以泻药攻下，我恐怕不但不能消除炎症，反而可能加速其死亡。因为残余的生气已经有限，在此时再给予降下之法，势必使津液立刻枯竭，断送生命。我不得已，便在连翘二钱（重用）、贝母、杏仁、桑皮各一钱的方剂中，大胆加入茯苓一钱以扶助脾气、利湿，白芍一钱，以收敛阴气、补益肺气，孤注一掷，没想到竟然获得了如此奇妙的疗效。
我基于这一理念，在第二剂中去掉桑皮，加入山药。病热再次加重，急忙恢复原方，仍然使用茯苓、白芍，直到疹子痊愈。可见原方第一剂中的辅助药物，也运用得非常得当，而山药的补益性质，过于茯苓，所以不适用于热性病。我治疗疹疾何止千百例，只有这个病例可以说属于“反治”，确实有研究的价值，所以特别记录下来，绝无一句虚假。
我的族孙寿龄前年来到北京寓所患疹病，我为他开了处方（中药），本想为他试用血清疗法，因为看到报纸广告中有某位医生专门使用血清，便请他来。进门后交谈，这位先生自命精通中医，我便出示他所服的方子。这位先生见到方中有薄荷一钱，竟然当面大力驳斥，（询问得知是我的方子）说一钱薄荷足以致命。我向来不想多辩解，只得唯唯诺诺地接受教导。等到请他治疗时，他只开了一副枸橼酸等普通的清凉药方就离开了。我知道这个方子无能为力，于是仍然让他服用我的方子，随后即痊愈。我担任医官长经历多年，实验中西药已有四十余年，虽然才疏学浅，但也略有经验。近来虽已衰老，仍处于求知阶段，绝不敢稍存自满的念头。这位先生年仅三十多岁，竟然当面驳斥我的方子，可谓直率。然而中医治疗此症，唯一的妙诀，就在于宣透内外，斡旋清浊，常使肌肤松动，务必让蕴蓄的疹毒，时有出路。未发之前，不致固闭；既发之后，不致倒隐。其重要的关键，全在活动肌表，疏导腠理。这种妙用，经过实验验证，确实高人一筹。因此，一味解毒，或过用苦寒，而不知时时注意于宣达肌肤，因势利导的，都是下工（低水平的医生）。薄荷、菊花，对此义可谓吻合，较之葛根、芥穗等，对疹热尤觉清凉可喜。四十年来，诊治疹疾，之所以未曾失败，幸亏有此道理。我对医术上很愿意受人指教，即使是这位先生，我也心存感激，但这症并未服用此君的药，仍由我个人治愈。足以证明薄荷对疹疾，用量不大，实有确切疗效，而无流弊（佐使得当）。我更可以借此君的言论，作此段真实的报告。
凡是对于某种学术，未经深入研究和多年实验，确有见地，万万不可贸然批评。中医稍微知道一点西药，西医稍微知道一点中药，再阅读几年中西医书籍，就自命为中西兼通，这是自欺欺人，危害很大。希望高明有志的医者，不要走入这条歧途。
痢疾（四）：痢疾古名滞下，俗名红白痢疾，又名疫痢，（指大传染时而言），西医称之为赤痢，则为急性传染病的一种。中医又有噤口痢、休息痢等名称，则与慢性肠加答儿（Enteritis，肠炎）相混，不足为训。
（原因）：中医大概以湿热积滞四字，作为本病的原因，西医则以病菌的传染为依据。
（症候）：本病以数次之下利，先泻稀水及全身倦怠（或呕恶）而起，排便时觉腹痛，里急后重，继则排泻粘液、脓液、血液，甚则为烂肉样。一日之间，约数十次，发热或恶寒，此为正规的赤痢。最重者热度愈高，腹极痛胀，纯泻血水极臭之物，所泻之物如西瓜汤样，脉沉数者居多，危险愈甚，则脉愈细小，此时将有穿孔性腹膜炎之嫌疑。凡老人、及吸食鸦片者，俗名烟后痢患此症尤其危险，若在本病大流行时，更应特别注意。
此症除预防注射外，治疗愈早愈妙。凡在此症大流行时，一觉腹痛，大便不爽，或数次水泻，即应速服泻剂。治疗中食物禁忌生冷，及不易消化之物。凡坚硬食物及肉类均忌。只宜用稀薄米粥及藕粉、绿豆粉等流动食品，牛羊乳绝不可用。此点我由经验得来，并非故意与西医说法反对。初期腹痛，所服泻药，以西药甘汞为适宜，此药有杀菌性，故较其他下剂为宜。考西医书称植物性下剂，无益于本病，此说不确。试于极重之赤痢，加入大黄不但消炎，且能退热，一试便知（参看医验），不可盲从。
用中药，初期则宜于消导积滞之处方中加入神曲、麦芽、山楂之类，再加入枳实、木香、厚朴、槟榔之类顺气之品，腹痛后重甚者，多加之，自然收效。审其内热太盛，小便赤短，红痢渐久，口渴身热，腹痛更甚，再加苦寒清热之品黄芩、黄连、栀子之类，呕吐必重用之。病势再进，则肠热将生他变，皮肤潮热，注意此二字，痢毒菌侵袭大肠后则皮热更高。腹痛更甚，泻痢无数，日数十行，精神昏蒙，所泻之物，或成烂肉样，或成西瓜汤样，脉反小数，呕恶不进饮食，危期至矣。此时必用大剂重量之苦寒、黄芩、黄柏、白头翁之类。渗利、茯苓、泽泻之类，泻下之品，大黄，此时并非重要，只用熟大黄一、二钱，领导之自有神效。连服二、三剂，必能挽回险症。若在大流行时（疫痢），尤须参照温症治法，不可一味治痢，运用中药，灵活圆通，方能见中医医术之精奇。痢疾至此，人始知此症之可以致命也。死于此际者多矣。但中医对痢疾稍久，习用之白芍、乌梅、甘草、生姜、当归、半夏等药，不及西药收敛剂之善。凡遇有热、腹痛之痢疾，日期未久者，万不可早用，戒之戒之。治新得之疫痢，自始至终，各方中稍加清热利湿（银花、黄芩、泽泻之品）为有效治法，不可不知，但应用西药时，不可妄行加入中药也。
重症痢疾将退（消炎）之时，往往服中药后（不必泻药，即清凉药亦然）反泻甚，停止眼药则稍安，此为病不胜药，可以小剂分利消息之，或与小量西药之收敛剂等，自然痊愈。庸工见其尚有脓滞后重，于此际数数仍与以降下苦寒之药（以为前已见效），以为热仍未清，则必渐生他变，所谓噤口痢、（约十馀日，至二十馀日）休息痢等，即由此阶段演成之。又赤痢经过下剂，屡用泻药，病势已全减，为日已久，仍泻痢或有腹痛不止者，可用西药单那尔并、阿片末等收敛之自愈，但此法不可用之太早，以防弊，慎之慎之。
中医治久泻有痢疾转来者，往往参用补养、参、芪、术、附收敛、白芍、吴萸、乌梅等等药，谓其日久正气已虚，亦自有效。但必须泄过数月后，毫无实证时，方可用之，此症不得仍以痢疾名之，可参阅泻症篇。
后重（俗称下坠）甚者，内服中药，外用西药洗肛法为最效，洗涤液以用药皂水或硼酸水为宜，器械尤须注意消毒。
中医治此症，尤其对于极危之赤痢，可谓特效（参看医验）。愿高明西医，取此法以补西药之缺点也。久泻亦有白油样之物，亦有下坠之感，亦有腹痛，不可误认为腹痛属实，积滞未尽，此时应用中药之补剂，或西药之收敛剂方效，此理于久泻症下详述之，可参看。
中医于慢性肠炎，及慢性肠加答儿，往往与久痢混为一谈，不能分别，故有休息痢、噤口痢、久痢等等名目。现之新久不同，治法亦异，不必仍以痢名，徒乱人意，故余另列久泻一症于后。盖实证失治，日久变为虚证，由急性转为慢性，不可牵连以前病名，反令初学医者，枉费脑力也。
（医验）张太夫人年七十馀岁，住德县南门东街。于民国四年夏患赤痢，前数日即倦怠，酸软渐即水泻，以后成红白下痢，腹痛，里急后重（俗称下坠），继则排泄粘液、血液、脓汁样粪便，一日夜约数十次，渐发高热，小便短赤，舌苔黄，左肠骨窝压痛尤甚，脉小数，气喘神昏（以体温太高），呕恶口不渴。经过二日，所泻之物，完全血汁（如西瓜汤样），腹奇痛，肛门因泻被刺激发炎而疼痛。高年之人，烟瘾又重，颇为危险，索阅以前所服之药，茯苓、泽泻、车前子、白芍、甘草、陈皮、神曲、木香、麦芽、山楂。消导渗利，只治普通轻痢，未能中病。余既认定此症为赤痢，且已侵及大肠，当本病未犯大肠时，体温不高及侵至回肠之下部，则呈所谓窒扶斯样症状之热型，即发高热，引起脑症状，故神昏也。有诱起腹膜炎之嫌疑，特与下方：第一次方茯苓一两盐川柏四钱白头翁四钱黄芩四钱熟军二钱丹皮二钱砂仁五分枳实一钱水煎服。分三次，一日服完。服此药二次之后，不及半日，所泻便数已减少，腹痛亦减，热亦减，精神略清醒，啜百合粉粥半碗，（已二日未进饮食）肛痛亦减，（外用硼酸水洗肛）三次服完。第二日再诊，精神清醒，热亦减退，诸症竟去其大半，可谓奇效，一日夜间只泻六次。乃与下方：第二次方茯苓一两黄芩四钱盐黄柏四钱白头翁六钱熟军一钱木香煨一钱炒银花三钱枳壳一钱水煎服。仍作三次，一日服完。此剂服完第二日再诊，热已退，只泻三次，已思饮食，能吸烟矣。嘱令以果汁盐一小茶匙，对柠檬露及开水当茶饮，以活动胃气，仍照原方，减去熟军，其馀药品分量仍旧，又连服四剂而愈。
此症中医注重湿热及食滞，确有至理，普通治痢之方，消导顺气渗利，在轻症之痢疾，自然有效，若系重笃之赤痢，专用上法，不但无效，且恐贻误病机。此一例为张太夫人，余友张松泉君之母也，当其得病之初，所服之药，即普通治痢之方，前医某君与松泉亦系至友，其人医学平妥，而极虚心，令人饮佩，此症服药数剂无效，亟劝松泉延余诊治，余见此症甚险恶，非用大剂苦降之品，不足挽救，立方之始，若非松泉有极深信仰，亦绝不敢用余之方。以庸工论调，多以年老之人及有烟瘾者对此症绝不可用下剂，且不明皮层发热，为肠将溃烂之病理，往往于普通治痢方中，加入收敛或解表等品，自命稳健，实则误人，故吾乡视烟后痢俗名为必死之症，若在老年，更无治法矣。犹忆民国七年夏，曾治一张虎臣将军之赤痢，（行营在武昌）近年治一马仲孚（住德县马家溜口街）皆烟后痢之重者，当时医案，与张太夫人之症治皆同，均获奇效。余创此痢治法，屡试屡验，其药味药量，均不可增减，特记之，以告学者。
王夫人，年三十馀岁，住县南门东，此王质斋君之夫人光绪二十六年秋间，患瘟疫并发泻痢，延余诊治。病者受孕已六个月，身体素弱，这日所泻皆血水，腹奇痛，小便不通，近已唇青，绝食，目闭，肢厥，日夜泻痢数十次。次前医皆用利湿扶脾法未效，腹痛更甚，诊脉浮洪，沉之则虚，断为暑湿久受而为热，肺金失其清虚之令，而小肠化理之源绝矣。脾为湿土，久泻愈弱，（病已二十馀日）正气愈虚，脾胃益败。前医不清肺而利小便，是谓舍本求末；不顾正气以培脾胃，是谓无米为炊，所以愈分利愈耗气，正气愈虚，邪气愈盛，以致唇青目闭、绝食肢厥，皆虚脱现象。倘再坠胎，大事去矣，为今之计，亟宜补元气以壮太阴，清肺金以理化源，庶有济耳，舌苔纯黑，乃经气散溢，未可指为实热，再议苦降也。
第二次方赤芍二钱白芍二钱赤茯苓四钱白茯苓四钱白术四钱半酒条芩四钱寸冬五钱生山栀二钱泽泻三钱猪苓二钱陈皮二钱当归二钱莲子心三钱苦参一钱盐川柏三钱砂仁三分鲜梨汁冲入煎服。此第二次方也，以此方为最效，服后每日泻只三、四次，诸症大减，小便亦通。第一方中，有高丽参五钱，白术一两，服后精神渐苏，泄泻略变稠粘，此病共服药二十六剂痊愈，立方大意，均如此，遂庆更生。第一次原方及前医原方，均详载于余著之《恫瘰集》中，以此书未在手下，无从抄录。
此胎前疫痢，为余四十年前得意之医案，原理论牵涉五运六气及批评前医（此为吾乡前辈名医）之处，理解欠缺，均为余近来所不取，此症危甚，当时自信太深，大反前案，检点曩昔处方，不寒而栗。然此症确实由余治愈，故至今不忘，因录于此，俾学者与前张案对照，庶知中医对赤痢，（当时尚无赤痢名词）治法之活动圆通，真有研究之价值，而余少年行医之胆大心粗，亦可为前车之鉴也。
余治赤痢之医案极多，录不胜录，以上二则，皆赤痢重症，对于治疗上，又有特别障碍者，一有烟瘾之老人，一有坠眙之危险颇有研究之趣味，故选录之。
For all exanthematous diseases, regardless of the specific type, smooth bowel movements are considered a favorable sign. Therefore, both Chinese and Western medical texts consider diarrhea to be harmless. In this case, due to the infant's young age and insufficient Qi and Blood, once exposed to the heat of the rash toxin, it was complicated by pneumonia, involving the intestines and kidneys, leading to inflammation. The cerebral symptoms (convulsions) were even more severe, making the situation extremely dangerous. However, after taking three doses of the first prescription, the fever did not subside. (Fortunately, the rash had fully erupted.) After injection of Wormina Ding, the fever persisted, and the condition progressed. If treated according to standard methods for enteritis, pneumonia, nephritis, or meningitis, there would be no method other than using purgatives. But I pondered repeatedly: this child is less than one year old, entangled by heat-toxin for six or seven days (before the onset, family members had administered purgatives, which I was unaware of; this caused the harm). His diarrhea indicates that the gastrointestinal vitality is about to fail; his nerve spasms indicate that the brain and spinal cord vitality are about to fail. Due to the tenderness of the Zang-Fu organs and the significant damage to Yuan Qi from early purgative use, he cannot withstand the prolonged burning of heat-toxin. Moreover, since the disease is of a heat nature, medication must account for this nature. Thus, I took the risk of using Bai Shao (White Peony Root) and Fu Ling (Poria). These two herbs are considered contraindicated in exanthematous diseases because Bai Shao has an astringent property and Fu Ling has a draining property, which seems extremely unsuitable for a child suffering from heat-toxin scorching body fluids and widespread inflammation. However, considering the opposite aspect of this disease, the child's vital energy was actually gradually depleting. With pathogenic factors strong and healthy Qi weak, if we add more purgatives, I feared not only failing to reduce inflammation but potentially accelerating death. The remaining vital energy was limited; administering descending agents at this time would surely cause immediate depletion of body fluids and lead to death. Reluctantly, I boldly added Fu Ling (1 qian) to support Spleen Qi and drain dampness, and Bai Shao (1 qian) to astringe Yin and tonify Lung Qi, into a formula containing Lian Qiao (2 qian, heavily used), Bei Mu, Xing Ren, and Sang Bai Pi (each 1 qian). It was a desperate gamble, but unexpectedly, it yielded such miraculous results.
Based on this concept, in the second dose, I removed Sang Bai Pi and added Shan Yao. The fever worsened again, so I urgently reverted to the original formula, continuing to use Fu Ling and Bai Shao until the rash resolved. This shows that the auxiliary drugs in the first dose were also appropriately applied. Shan Yao's tonifying nature is stronger than Fu Ling's, making it unsuitable for heat-type diseases. I have treated hundreds of cases of exanthematous diseases, but this case can be described as "contrary treatment" (treating with methods contrary to the apparent syndrome), which indeed has research value. Therefore, I recorded it specifically, without a single false word.
My clan grandson, Shouling, came to Beijing last year to reside and contracted a rash disease. I prescribed Chinese medicine for him, intending to try serum therapy. Seeing an advertisement in the newspaper for a doctor specializing in serum, I invited him. Upon entering and conversing, this gentleman claimed proficiency in Traditional Chinese Medicine (TCM). I showed him the prescription I had given. Seeing Bo He (Mint) 1 qian in the formula, he openly refuted it strongly, stating that 1 qian of Mint could be fatal. I usually avoid lengthy debates and merely accepted his teaching politely. When asked to treat the patient, he only prescribed a common cooling formula containing Citric Acid and left. Knowing this prescription was ineffective, I instructed him to continue taking my formula, and he subsequently recovered. Having served as a Chief Medical Officer for many years and experimented with both Chinese and Western medicines for over forty years, although my talent is shallow and learning sparse, I have gained some experience. Though now aged and frail, I remain in a period of seeking knowledge and dare not harbor any complacency. This gentleman, only in his thirties, dared to refute my prescription face-to-face, which can be called straightforward. However, the unique secret of TCM in treating this condition lies in venting and transmitting internally and externally, mediating between clear and turbid, keeping the skin loose, and ensuring the accumulated rash toxin has outlets. Before eruption, it should not be closed; after eruption, it should not retract. The key lies in activating the muscle layer and unblocking the interstices. This subtle application, verified by experiments, proves superior. Therefore, those who merely use detoxification or excessively employ bitter-cold herbs, without paying attention to venting through the skin and guiding according to circumstances, are inferior practitioners. Bo He and Ju Hua align well with this principle, feeling cooler and more pleasant for rash-heat compared to Ge Gen (Kudzu Root) and Jie Geng (or Jie Sui/Schizonepeta). For forty years, my success in diagnosing and treating rash diseases owes much to this understanding. I am willing to accept guidance on medical skills, and I appreciate this gentleman's input, although this case was cured solely by me without his medication. This proves that Mint, when used in small amounts, is effective for rash diseases without adverse effects (when used appropriately as an assistant herb). I can further make this truthful report based on this gentleman's remarks.
One should never rashly criticize an academic field without deep research and years of experimentation yielding genuine insights. TCM practitioners knowing a little Western medicine, or Western doctors knowing a little TCM, who then read a few books on both and claim mastery of both systems, are deceiving themselves and causing great harm. I hope enlightened and aspiring physicians do not fall into this trap.
Dysentery (4): Dysentery was anciently known as "Zhi Xia" (Stagnant Downward Flow), commonly called Red-White Dysentery, or Epidemic Dysentery (referring to large-scale contagion). Western medicine calls it Bacillary Dysentery (Chi Li), a type of acute infectious disease. TCM also names it Jin Kou Li (Closed-Mouth Dysentery) and Xiu Xi Li (Resting Dysentery), which are often confused with Chronic Enteritis, which is not instructive.
(Causes): TCM generally attributes this disease to Damp-Heat and Food Stagnation, while Western medicine bases its etiology on bacterial infection.
(Symptoms): The disease begins with several episodes of diarrhea, initially watery stools accompanied by general fatigue (or nausea/vomiting). Defecation causes abdominal pain, tenesmus (feeling of incomplete evacuation), followed by the discharge of mucus, pus, and blood, sometimes resembling rotten meat. There may be dozens of episodes per day, with fever or chills. This is typical Bacillary Dysentery. The most severe cases present with higher fever, extreme abdominal pain and distension, and pure discharge of foul-smelling bloody water. The discharged material resembles watermelon soup. The pulse is mostly deep and rapid. The greater the danger, the finer the pulse. At this stage, there is suspicion of perforative peritonitis. Elderly people and opium smokers, commonly referred to as having "Smoker's Dysentery," are especially at risk. Special attention is needed during epidemics.
Besides preventive vaccination, earlier treatment is better. During an epidemic, upon feeling abdominal pain, irregular bowel movements, or several watery diarrheas, purgatives should be taken immediately. Dietary restrictions during treatment include avoiding raw/cold foods and hard-to-digest items. Hard foods and meats are forbidden. Only thin rice porridge, lotus root powder, mung bean powder, and other liquid foods are suitable. Cow and sheep milk must absolutely be avoided. This point comes from my experience and is not intended to oppose Western medical views. For initial abdominal pain, Calomel (Mercurous Chloride) is the most suitable purgative due to its bactericidal properties, making it preferable to other laxatives. Western medical texts claim plant-based laxatives are useless for this disease, which is incorrect. Adding Da Huang (Rhubarb) to severe Bacillary Dysentery reduces inflammation and fever, as proven by trial (see Medical Cases). Do not follow blindly.
When using Chinese medicine, early stages should focus on resolving stagnation. Add Shen Qu, Mai Ya, and Shan Zha to formulas, along with Qi Shi, Mu Xiang, Hou Po, and Bing Lang to regulate Qi. Increase dosage for severe abdominal pain and tenesmus for natural efficacy. If internal heat is excessive, with dark scanty urine, prolonged red dysentery, thirst, fever, and worsening abdominal pain, add bitter-cold heat-clearing herbs like Huang Qin, Huang Lian, and Zhi Zi. Use heavily if vomiting occurs. As the condition progresses, intestinal heat may cause complications. Skin feels hot/muggy; note these two words: after dysentery bacteria invade the large intestine, skin heat increases further. Abdominal pain worsens, dysentery occurs countless times (dozens daily), mental confusion ensues, stool resembles rotten meat or watermelon soup, pulse becomes slightly fine and rapid, vomiting prevents food intake—this marks the critical phase. At this time, heavy doses of bitter-cold herbs like Huang Qin, Huang Bai, and Bai Tou Weng are essential. Diuretics like Fu Ling and Ze Xie are used. Da Huang is not crucial here; only 1-2 qian of Shu Da Huang (Prepared Rhubarb) is used to lead the action, yielding miraculous effects. Two to three doses can reverse the critical condition. During epidemics (Epidemic Dysentery), refer to Warm Disease treatment methods. Do not treat dysentery alone. Flexible and comprehensive use of Chinese medicine demonstrates its sophistication. Only at this stage do people realize dysentery can be fatal. Many die at this juncture. However, for chronic dysentery, TCM habitually uses Bai Shao, Wu Mei, Gan Cao, Sheng Jiang, Dang Gui, and Ban Xia, which are inferior to Western astringents. For dysentery with heat and abdominal pain of short duration, these must absolutely not be used early. Beware! Treating new-onset epidemic dysentery effectively requires adding heat-clearing and damp-draining herbs (Jin Yin Hua, Huang Qin, Ze Xie) throughout all prescriptions. This must be known. However, when using Western medicine, do not arbitrarily add Chinese herbs.
During the resolution phase of severe dysentery (anti-inflammatory), patients often experience increased diarrhea after taking Chinese medicine (even non-purgative cooling herbs). Symptoms ease when stopping eye drops (likely a typo for medication), indicating the disease cannot tolerate the drug strength. Small doses of diuretics or small amounts of Western astringents can naturally lead to recovery. Incompetent doctors, seeing residual pus and tenesmus, repeatedly administer purgative bitter-cold herbs (believing previous efficacy), thinking heat is not cleared. This inevitably leads to complications like Jin Kou Li (approx. 10-20 days) or Xiu Xi Li (Resting Dysentery). Also, if Bacillary Dysentery has been treated with purgatives repeatedly, disease intensity has decreased significantly, yet diarrhea persists or abdominal pain continues after many days, Western astringents like Tannalbin or Opium Powder can induce self-healing. However, this method must not be used too early to prevent side effects. Be cautious.
TCM treats chronic diarrhea turning into dysentery by incorporating tonics like Ren Shen, Huang Qi, Bai Zhu, Fu Zi, astringents like Bai Shao, Wu Zhu Yu, and Wu Mei, arguing that long-standing illness depletes healthy Qi, which is also effective. However, they can only be used after months of diarrhea with no excess syndromes. This condition should no longer be named dysentery; refer to the Diarrhea chapter.
For severe tenesmus (commonly called bearing down sensation), internal Chinese medicine combined with external Western enema/washing is most effective. Washing fluid should be medicated soap water or Boric Acid water. Instruments must be sterilized.
TCM treatment for this condition, especially for critical Bacillary Dysentery, can be called highly effective (see Medical Cases). I hope eminent Western doctors adopt this method to supplement Western medicine's shortcomings. Chronic diarrhea may also present with white oily substances, bearing down sensation, and abdominal pain. Do not mistakenly attribute abdominal pain to excess and incomplete stagnation. At this time, Chinese tonics or Western astringents are effective. This theory is detailed under Chronic Diarrhea; refer to it.
TCM often conflates Chronic Enteritis and Chronic Enteritis with chronic dysentery, unable to distinguish them, hence names like Resting Dysentery, Closed-Mouth Dysentery, etc. Current understanding distinguishes new vs. old conditions with different treatments. There is no need to keep naming them dysentery, which confuses people. Therefore, I list Chronic Diarrhea separately later. Excess syndromes untreated for long become deficiency syndromes, transitioning from acute to chronic. Do not link to previous disease names, which wastes the mental effort of novice physicians.
(Medical Case 1): Mrs. Zhang, over seventy years old, lived on Dong Street South Gate, De County. In summer of the 4th Year of the Republic of China, she suffered Bacillary Dysentery. A few days prior, she felt fatigued and sore, progressing to watery diarrhea, then red-white dysentery, abdominal pain, and tenesmus. She discharged mucus, blood, and pus-like feces, dozens of times a day. High fever developed, urine became short and dark, tongue coating yellow, left iliac fossa tenderness severe, pulse slightly fine and rapid, panting and coma (due to high temperature), vomiting, no thirst. After two days, discharged material was entirely bloody juice (like watermelon soup), extreme abdominal pain, anal pain from irritation and inflammation. Being elderly with a heavy smoking habit, the situation was perilous. Reviewing previous medications: Fu Ling, Ze Xiang, Che Qian Zi, Bai Shao, Gan Cao, Chen Pi, Shen Qu, Mu Xiang, Mai Ya, Shan Zha. These focused on digestion and draining, treating only ordinary mild dysentery, missing the mark. I identified this as Bacillary Dysentery invading the large intestine. Before invading the large intestine, temperature is not high. If it invades the lower ileum, it presents as Typhoid-like fever patterns, causing high fever and cerebral symptoms (coma). Suspected risk of peritonitis. Prescribed below:
First Prescription: Fu Ling 1 liang, Yan Chuan Bai 4 qian, Bai Tou Weng 4 qian, Huang Qin 4 qian, Shu Jun (Da Huang) 2 qian, Dan Pi 2 qian, Sha Ren 5 fen, Zhi Shi 1 qian. Decoct in water, divide into three doses, take within one day.
After two doses (less than half a day), frequency of stool decreased, abdominal pain reduced, fever subsided, spirit slightly clarified. Drank half bowl of Lily bulb powder porridge (had not eaten for two days). Anal pain reduced (externally washed anus with boric acid). Finished three doses.
Second Day Re-examination: Spirit clear, fever subsided, most symptoms gone by more than half. Miraculous effect. Only six stools overnight. Prescribed below:
Second Prescription: Fu Ling 1 liang, Huang Qin 4 qian, Yan Huang Bai 4 qian, Bai Tou Weng 6 qian, Shu Jun 1 qian, Mu Xiang (roasted) 1 qian, Chao Yin Hua 3 qian, Zhi Qiao 1 qian. Decoct in water, divide into three doses, take within one day.
Finished this dose, re-examined next day: Fever gone, only three stools, appetite returned, able to smoke. Instructed to drink fruit juice salt mixed with lemonade and boiling water to activate Stomach Qi. Follow original formula, remove Shu Jun, keep other dosages same. Took four more doses and recovered.
TCM focuses on Damp-Heat and Food Stagnation for this condition, which is reasonable. Ordinary dysentery formulas focusing on digestion, Qi regulation, and draining are effective for mild cases. For severe Bacillary Dysentery, using only these methods is ineffective and risks delaying treatment. This case is Mrs. Zhang, mother of my friend Mr. Zhang Songquan. At onset, she took ordinary dysentery formulas. The previous doctor was a close friend of Songquan, medically sound and humble, admirable. After several ineffective doses, he urgently advised Songquan to invite me. Seeing the severity, I knew only heavy bitter-descending agents could save her. At the start, unless Songquan had deep faith, I would not have dared use my formula. According to incompetent dogma, elderly people and smokers should absolutely not receive purgatives for this condition. They also misunderstand skin heat as a sign of impending intestinal ulceration pathology. Often, they add astringents or exterior-releasing herbs to ordinary formulas, claiming prudence, but actually harming patients. Hence, in my hometown, "Smoker's Dysentery" is considered fatal, with no treatment for the elderly. I recall summer of the 7th Year of the Republic, treating General Zhang Huchen's Bacillary Dysentery (field hospital in Wuhan). Recently treated Ma Zhongfu (living on Majialiu Kou Street, De County), both severe smoker's dysentery. Medical records show identical treatment to Mrs. Zhang's case, all achieving miraculous results. I created this dysentery treatment method, tested repeatedly with success. Dosages and ingredients must not be altered. I record this to inform scholars.
Mrs. Wang, over thirty years old, lived East of South Gate, County. Wife of Mr. Wang Zhizhai. In autumn of the 26th Year of Guangxu, she contracted Plague complicated with diarrhea/dysentery, sought my treatment. She was six months pregnant, constitutionally weak. That day, she passed bloody water, extreme abdominal pain, urinary retention, blue lips, anorexia, closed eyes, cold limbs, dozens of dysenteric episodes day and night. Previous doctors used damp-draining and Spleen-supporting methods without effect, abdominal pain worsened. Pulse floating and surging, empty upon deep pressure. Diagnosed as long-standing Summer-Heat and Dampness transforming into Heat. Lung Metal lost its clearing function, cutting off the source of Small Intestine transformation. Spleen is Damp Earth; chronic diarrhea weakens it further. (Ill for over 20 days) Healthy Qi increasingly deficient, Spleen and Stomach deteriorating. Previous doctors failed to clear Lung before promoting urination (seeking end over root); ignored Healthy Qi to nourish Spleen/Stomach (cooking without rice). Thus, more draining consumed Qi, Healthy Qi weakened, Pathogenic factors strengthened, leading to blue lips, closed eyes, anorexia, cold limbs—all signs of collapse. If abortion occurred, it would be disastrous. Current plan: Urgently tonify Yuan Qi to strengthen Taiyin, clear Lung Metal to regulate transformation sources, hoping for benefit. Tongue coating purely black indicates meridian Qi scattering, not solid heat; bitter-descending is premature.
Second Prescription: Chi Shao 2 qian, Bai Shao 2 qian, Chi Fu Ling 4 qian, Bai Fu Ling 4 qian, Bai Zhu 4.5 qian, Jiu Tiao Qin 4 qian, Cun Dong 5 qian, Sheng Shan Zhi 2 qian, Ze Xie 3 qian, Zhu Ling 2 qian, Chen Pi 2 qian, Dang Gui 2 qian, Lian Zi Xin 3 qian, Ku Shen 1 qian, Yan Chuan Bai 3 qian, Sha Ren 3 fen. Fresh Pear Juice added to decoction. This second prescription was most effective. After taking, diarrhea reduced to 3-4 times daily, symptoms greatly reduced, urination resumed. First prescription contained Gao Li Shen 5 qian, Bai Zhu 1 liang. After taking, spirit gradually revived, stool became slightly thick/sticky. Total 26 doses cured the disease. General principles of formulation were similar, celebrating rebirth. Original first prescription and previous doctor's prescription are detailed in my book *Tong Luo Ji*. Since the book is not at hand, I cannot copy it.
This prenatal epidemic dysentery case is my得意 (pride) medical case from forty years ago. The original theory involved Five Movements and Six Qi, and criticized previous doctors (senior famous doctors in my hometown). My understanding was lacking, and I no longer endorse these aspects. The condition was critical; I was overly confident then, completely reversing previous cases. Reviewing past prescriptions makes me shudder. However, this case was indeed cured by me, so I have not forgotten it. I record it here so scholars can compare it with the previous Zhang case, realizing the flexible and comprehensive treatment of Bacillary Dysentery by TCM (the term "Bacillary Dysentery" did not exist then), which truly has research value. My youthful boldness and carelessness in practicing medicine can serve as a warning.
I have many medical cases of treating Bacillary Dysentery, too numerous to record. The above two are severe cases with special obstacles in treatment: one involves an elderly smoker, the other carries the risk of abortion. Both have research interest, so I selected them.