三钱） 银花（炒黑，一钱五分） 赤苓（三钱） 猪苓（一钱五分）
水八杯，煮成三杯，分三次服。
六十七、下痢无度，脉微细，肢厥，不进食，桃花汤主之。
此涩阳明阳分法也。下痢无度，关闸不藏，脉微细肢厥，阳欲脱也。故以赤石脂急涩下焦，粳米
合石脂堵截阳明，干姜温里而回阳，俾痢止则阴留，阴留则阳斯变矣。
桃花方（方法见温热下焦篇）
六十八、久痢，阴伤气陷，肛坠尻酸，地黄余粮汤主之。
此涩少阴阴分法也。肛门坠而尻脉酸，肾虚而津液消亡之象。故以熟地、五味补肾而酸甘化阴；
余粮固涩下焦，而酸可除，坠可止，痢可愈也（按石脂、余粮，皆系石药而性涩，桃花汤用石脂不用余
粮，此则用余粮而不用石脂。盖石脂甘温，桃花温剂也；余粮甘平，此方救阴剂也，无取乎温，而有取乎平也）。
地黄余粮汤方（酸甘兼涩法）
熟地黄 禹余粮 五味子
六十九、久痢伤肾，下焦不固，肠腻滑下，纳谷运迟，三神丸主之。
此涩少阴阴中之阳法也。肠腻滑下，知下焦之不固；纳运谷迟，在久痢之后，不惟脾阳不运，而
肾中真阳亦衰矣。故用三神丸温补肾阳，五味兼收其阴，肉果涩自滑之脱也。
三神丸方（酸甘辛温兼涩法，亦复方也）
五味子 补骨脂 肉果（去净油）
七十、久痢伤阴，口渴舌干，微热微咳，人参乌梅汤主之。
口渴微咳于久痢之后，无湿热客邪款证，故知其阴液太伤，热病液涸，急以救阴为务。
人参乌梅汤（酸甘化阴法）
人参 莲子（炒） 炙甘草 乌梅 木瓜 山药
按此方于救阴之中，仍然兼护脾胃。若液亏甚而土无他病者，则去山药、莲子，加生地、麦冬，又一法也。
七十一、痢久阴阳两伤，少腹肛坠，腰胯脊髀酸痛，由脏腑伤及奇经，参茸汤主之。
少腹坠，冲脉虚也；肛坠，下焦之阴虚也；腰，肾之府也；胯，胆之穴也（谓环跳）；脊，太阳夹督脉
之部也；髀，阳明部也；俱酸痛者，由阴络而伤及奇经也。参补阳明，鹿补督脉，归茴补冲脉，菟丝、附
子升少阴，杜仲主腰痛，俾八脉有权，肝肾有养，而痛可止，坠可升提也。
按环跳本穴属胆，太阳少阴之络实会于此。
参茸汤（辛甘温法）
人参 鹿茸 附子 当归（炒） 茴香（炒） 菟丝子 杜仲
按此方虽曰阴阳两补，而偏于阳。若其人但坠而不腰脊痛，偏于阴伤多者，可于本方去附子加
补骨脂，又一法也。
七十二、久痢伤及厥阴，上犯阳明，气上撞心，饥不欲食，干呕腹痛，乌梅丸主之。
肝为刚脏，内寄相火，非纯刚所能折；阳明腑，
非刚药不复其体。仲景厥阴篇中，列乌梅丸治木犯阳明之吐蛔，自注曰∶又主久痢方。然久痢之症
不一，亦非可一概用之者也。叶氏于木犯阳明之疟痢，必用其法而化裁之，大抵柔则加白芍、木瓜
之类，刚则加吴萸、香附之类，多不用桂枝、细辛、黄柏，其与久痢纯然厥阴见证，而无犯阳明之呕而
不食撞心者，则又纯乎用柔，是治厥阴久痢之又一法也。按泻心寒热并用，而乌梅丸则又寒热刚柔
并用矣。盖泻心治胸膈间病，犹非纯在厥阴也，不过肝脉络胸耳。若乌梅丸则治厥阴，防少阳，护阳明之全剂。
乌梅丸方（酸甘辛苦复法。酸甘化阴，辛苦通降，又辛甘为阳，酸苦为阴）
乌梅 细辛 干姜 黄连 当归 附子 蜀椒（炒焦去汗） 桂枝 人参 黄柏
此乌梅丸本方也。独无论者，以前贤名注林立，兹不再赘。分量制法，悉载伤寒论中。
七十三、休息痢经年不愈，下焦阴阳皆短，不能收摄，少腹气结，有似 瘕，参芍汤主之。
休息痢者，或作或止，止而复作，故名休息，古称难治。所以然者，正气尚旺之人，即受暑、湿、
水、谷、血、食之邪太重，必日数十行，而为胀、为
痛、为里急后重等证，必不或作或辍也。其成休息证者，大抵有二，皆以正虚之故。一则正虚留邪在
络，至其年月日时复发，而见积滞腹痛之实证者，可遵仲景凡病至其年月日时复发者当下之例，而
用少少温下法，兼通络脉，以去其隐伏之邪；或丸药缓攻，俟积尽而即补之；或攻补兼施，中下并治，
此虚中之实证也。一则纯然虚证，以痢久滑泄太过，下焦阴阳两伤，气结似乎 瘕，而实非 瘕，舍
温补其何从！故以参、苓、炙草守补中焦，参、附固下焦之阳，白芍、五味收三阴之阴，而以少阴为主，
盖肾司二便也。汤名参芍者，取阴阳兼固之义也。
参芍汤方（辛甘为阳酸甘化阴复法）
人参 白芍 附子 茯苓 炙甘草 五味子
七十四、噤口痢，热气上冲，肠中逆阻似闭，腹痛在下尤甚者，白头翁汤主之。
此噤口痢之实证，而偏于热重之方也。
白头翁汤（方注见前）
七十五、噤口痢，左脉细数，右手脉弦，干呕
腹痛，里急后重，积下不爽，加减泻心汤主之。
此亦噤口痢之实证，而偏于湿热太重者也。脉细数，温热着里之象；右手弦者，木入土中之象也。
故以泻心去守中之品，而补以运之，辛以开之，苦以降之；加银花之败热毒，楂炭之克血积，木香之
通气积，白芍以收阴气，更能于土中拔木也。
加减泻心汤方（苦辛寒法）
川连 黄芩 干姜 银花 楂炭 白芍 木香汁
七十六、噤口痢，呕恶不饥，积少痛缓，形衰脉弦，舌白不渴，加味参苓白术散主之。
此噤口痢邪少虚多，治中焦之法也。积少痛缓，则知邪少；舌白者无热；形衰不渴，不饥不食，
则知胃关欲闭矣；脉弦者，《金匮》谓∶弦则为减，盖谓阴精阳气俱不足也。《灵枢》谓∶诸小脉者，阴阳
形气俱不足，勿取以针，调以甘药也。仲景实本于此而作建中汤，治诸虚不足为一切虚劳之祖方。李
东垣又从此化出补中益气、升阳益气，清暑益气等汤，皆甘温除大热法，究不若建中之纯，盖建中以
德胜，而补中以才胜者也。调以甘药者，十二经皆秉气于胃，胃复则十二经之诸虚不足，皆可复
也。叶氏治虚多脉弦之噤口痢，仿古之参苓白术
散而加之者，亦同诸虚不足调以甘药之义，又从仲景、东垣两法化出，而以急复胃气为要者也。
加味参苓白术散方（本方甘淡微苦法，加则辛甘化阳，芳香悦脾，微辛以通，微苦以降也）
人参（二钱） 白术（炒焦，一钱五分） 茯苓（一钱五分） 扁豆（炒，二钱） 薏仁（一钱五分）
桔梗（一钱） 砂仁（炒，七分） 炮姜（一钱） 肉豆蔻（一钱） 炙甘草（五分）
共为极细末，每服一钱五分，香粳米汤调服，日二次。
〔方论〕参苓白术散原方，兼治脾胃，而以胃为主者也，其功但止土虚无邪之泄泻而已。此方则通
宣三焦，提上焦，涩下焦，而以醒中焦为要者也。参、苓、白术加炙草，则成四君矣。按四君以参、苓
为胃中通药，胃者腑也，腑以通为补也；白术、炙草，为脾经守药，脾者脏也，脏以守为补也。茯苓
淡渗，下达膀胱，为通中之通；人参甘苦，益肺胃之气，为通中之守；白术苦能渗湿，为守中之通；甘草
纯甘，不兼他味，又为守中之守也，合四君为脾胃为两补之方。加扁豆、薏仁以补肺胃之体，炮姜以补
脾肾之用；桔梗从上焦开提清气，砂仁、肉蔻从下焦固涩浊气，二物皆芳香能涩滑脱，而又能通下焦
之郁滞，兼醒脾阳也。为末，取其留中也；引以香粳米，亦以其芳香悦土，以胃所喜为补也，上下斡
旋，无非冀胃气渐醒，可以转危为安也。
七十七、噤口痢，胃关不开，由于肾关不开者，肉苁蓉汤主之。
此噤口痢邪少虚多，治下焦之法也。盖噤口日久，有责在胃者，上条是也；亦有由于肾关不开，
而胃关愈闭者，则当以下焦为主。方之重用苁蓉者，以苁蓉感马精而生，精血所生之草而有肉者
也。马为火畜，精为水阴，禀少阴水火之气而归于太阴坤土之药，其性温润平和，有从容之意，故得
从容之名，补下焦阳中之阴有殊功。《本经》称其强阴益精，消 瘕，强阴者，火气也，益精者，水气也，
瘕乃气血积聚有形之邪，水火既济，中土气盛，而积聚自消。兹以噤口痢阴阳俱损，水土两伤，而
又滞下之积聚未清，苁蓉乃确当之品也；佐以附子补阴中之阳，人参、干姜补土，当归、白芍补肝肾，
芍用桂制者，恐其呆滞，且束入少阴血分也。
肉苁蓉汤（辛甘法）
肉苁蓉（泡淡，一两） 附子（二钱） 人参（二钱） 干姜炭（二钱） 当归（二钱） 白芍（肉桂汤
浸炒，三钱）
水八杯，煮取三杯，分三次缓缓服，胃稍开，再作服。
三钱）银花（炒黑，一钱五分）赤苓（三钱）猪苓（一钱五分）
用八杯水，煮成三杯，分三次服用。
六十七、下痢无度，脉微细，四肢厥冷，不能进食，用桃花汤主治。
这是固涩阳明阳分的方法。下痢无度，关门失守而不藏，脉象微细且四肢厥冷，是阳气欲脱的征象。所以用赤石脂紧急固涩下焦，粳米配合石脂堵塞阳明经气，干姜温里以回阳，使得痢止则阴液留存，阴液留存则阳气得以恢复。
桃花方（方法见温热下焦篇）
六十八、久痢，阴伤气陷，肛门坠胀，尾骶部酸痛，用地黄余粮汤主治。
这是固涩少阴阴分的方法。肛门坠胀而尾骶部酸痛，是肾虚且津液消亡的现象。所以用熟地黄、五味子补肾而使酸甘化生阴液；禹余粮固涩下焦，从而使酸痛消除，坠胀停止，痢疾痊愈。（按：赤石脂、禹余粮，都是石类药物且性质涩滞，桃花汤用石脂而不用余粮，此方用余粮而不用石脂。大概因为石脂味甘性温，桃花汤是温剂；余粮味甘性平，此方是救阴剂，不需要温性，而取用平性。）
地黄余粮汤方（酸甘兼涩法）
熟地黄 禹余粮 五味子
六十九、久痢伤肾，下焦不固，肠道滑腻下泄，饮食运化迟缓，用三神丸主治。
这是固涩少阴阴中之阳的方法。肠道滑腻下泄，可知下焦不固；饮食运化迟缓，是在久痢之后，不仅脾阳不运，而且肾中真阳也衰败了。所以用三神丸温补肾阳，五味子兼收其阴，肉豆蔻涩止自滑之脱泄。
三神丸方（酸甘辛温兼涩法，也是复方）
五味子 补骨脂 肉果（去净油）
七十、久痢伤阴，口渴舌干，微热微咳，用人参乌梅汤主治。
在久痢之后出现口渴微咳，没有湿热客邪的证候，所以知道其阴液大伤，热病导致津液枯竭，急需以救阴为务。
人参乌梅汤（酸甘化阴法）
人参 莲子（炒） 炙甘草 乌梅 木瓜 山药
按：此方在救阴之中，仍然兼顾保护脾胃。如果津液亏损严重而脾胃没有其他病变的，可以去掉山药、莲子，加生地、麦冬，这是另一种方法。
七十一、痢疾日久阴阳两伤，少腹及肛门坠胀，腰胯脊髀酸痛，由脏腑损伤波及奇经八脉，用参茸汤主治。
少腹坠胀，是冲脉虚损；肛门坠胀，是下焦阴虚；腰部，是肾之府；胯部，是胆之穴位（指环跳穴）；脊柱，是太阳经夹督脉的部位；大腿，是阳明经部位；都出现酸痛，是因为阴络受伤进而波及奇经八脉。人参补阳明，鹿茸补督脉，当归、小茴香补冲脉，菟丝子、附子提升少阴之气，杜仲主治腰痛，使得八脉有权能统摄，肝肾得到滋养，而疼痛可止，坠胀可升提。
按：环跳本穴属胆经，但太阳、少阴的络脉实际交会于此。
参茸汤（辛甘温法）
人参 鹿茸 附子 当归（炒） 茴香（炒） 菟丝子 杜仲
按：此方虽然说是阴阳双补，但偏重于补阳。如果其人只有坠胀而没有腰脊痛，偏于阴伤较多的，可以在本方中去掉附子加补骨脂，这是另一种方法。
七十二、久痢伤及厥阴肝经，上犯阳明胃腑，气上撞心，饥饿但不想进食，干呕腹痛，用乌梅丸主治。
肝是刚脏，内寄相火，不是纯刚猛的药物所能折服；阳明腑，非刚药不能恢复其体。张仲景在《伤寒论·厥阴篇》中，列出乌梅丸治疗木邪犯阳明引起的吐蛔虫，自己注释说：又主治久痢方。然而久痢的症状不一，也不是可以一概使用的。叶天士对于木邪犯阳明的疟痢，必定使用其法并加以化裁，大致柔性的加白芍、木瓜之类，刚性的加吴茱萸、香附之类，大多不用桂枝、细辛、黄柏，这与久痢纯粹是厥阴见证，而没有犯阳明导致的呕吐、不食、气上撞心的情况不同，那就纯粹使用柔润之法，这是治疗厥阴久痢的另一种方法。按：泻心汤寒热并用，而乌梅丸则是寒热、刚柔并用。大概泻心汤治疗胸膈间的病，还不完全在厥阴，不过是肝脉络于胸耳。若乌梅丸则是治疗厥阴，预防少阳，保护阳明的全备之剂。
乌梅丸方（酸甘辛苦复法。酸甘化阴，辛苦通降，又辛甘为阳，酸苦为阴）
乌梅 细辛 干姜 黄连 当归 附子 蜀椒（炒焦去汗） 桂枝 人参 黄柏
这是乌梅丸的本方。独自没有人论述它，因为前贤的名注林立，这里不再赘述。分量制法，全部记载在《伤寒论》中。
七十三、休息痢经年不愈，下焦阴阳皆短，不能收摄，少腹气结，有似瘕块，用参芍汤主治。
休息痢，有时发作有时停止，停止后又发作，所以叫休息，古称难治。之所以这样，正气尚旺的人，即使感受暑、湿、水、谷、血、食之邪太重，必定一天数十次排便，而出现胀、痛、里急后重等证，必定不会时作时止。形成休息证的，大体有两种原因，都是因为正虚。一种是正虚留邪在络脉，到了年月日时复发，出现积滞腹痛的实证，可以遵循张仲景凡病至其年月日时复发者当下之例，而用少量的温下法，兼通络脉，以去除隐伏之邪；或用丸药缓攻，等到积滞尽除即予以补益；或攻补兼施，中下并治，这是虚中之实证。一种是纯然虚证，因为痢久滑泄太过，下焦阴阳两伤，气结似乎像瘕块，而实际上不是瘕块，除了温补还有什么办法！所以用人参、茯苓、炙甘草守补中焦，人参、附子固下焦之阳，白芍、五味子收敛三阴之阴，而以少阴为主，因为肾主管二便。汤名叫参芍，是取阴阳兼固的意思。
参芍汤方（辛甘为阳酸甘化阴复法）
人参 白芍 附子 茯苓 炙甘草 五味子
七十四、噤口痢，热气上冲，肠中逆阻似闭，腹痛在下部尤其严重的，用白头翁汤主治。
这是噤口痢的实证，而且是偏于热重的方子。
白头翁汤（方注见前）
七十五、噤口痢，左脉细数，右手脉弦，干呕腹痛，里急后重，积滞下出不爽，用加减泻心汤主治。
这也是噤口痢的实证，而且是偏于湿热太重的。脉细数，是温热着里的现象；右手脉弦，是木入土中的现象。所以用泻心汤去掉守中之品，而补以运之，辛味以开之，苦味以降之；加银花败热毒，山楂炭克血积，木香通气积，白芍收阴气，更能于土中拔木。
加减泻心汤方（苦辛寒法）
川连 黄芩 干姜 银花 楂炭 白芍 木香汁
七十六、噤口痢，呕恶不饥，积少痛缓，形体衰瘦脉弦，舌白不渴，用加味参苓白术散主治。
这是噤口痢邪少虚多，治疗中焦的方法。积少痛缓，就知道邪气少；舌白就没有热；形体衰瘦不渴，不饥不食，就知道胃关要关闭了；脉弦，《金匮要略》说：弦则为减，是说阴精阳气都不足。《灵枢》说：诸小脉者，阴阳形气俱不足，不要用针刺，用甘药调理。张仲景实基于此而作成建中汤，治疗各种虚不足，是一切虚劳的祖方。李东垣又从此化出补中益气、升阳益气、清暑益气等汤，都是甘温除大热法，终究不如建中汤纯正，大概建中汤以德胜，而补中益气汤以才胜。调以甘药，是因为十二经都禀受气于胃，胃气恢复则十二经的各种虚不足，都可以恢复。叶天士治疗虚多脉弦的噤口痢，仿照古代的参苓白术散而加以变化的，也是同诸虚不足调以甘药的意义，又从张仲景、李东垣两法化出，而以急复胃气为关键。
加味参苓白术散方（本方甘淡微苦法，加则辛甘化阳，芳香悦脾，微辛以通，微苦以降也）
人参（二钱） 白术（炒焦，一钱五分） 茯苓（一钱五分） 扁豆（炒，二钱） 薏仁（一钱五分）
桔梗（一钱） 砂仁（炒，七分） 炮姜（一钱） 肉豆蔻（一钱） 炙甘草（五分）
共研为极细末，每次服用一钱五分，用香粳米汤调服，每日二次。
〔方论〕参苓白术散原方，兼治脾胃，而以胃为主，其功效只限于土虚无邪的泄泻而已。此方则通宣三焦，提上焦，涩下焦，而以醒中焦为关键。人参、茯苓、白术加炙甘草，就成四君子汤了。按：四君子汤以人参、茯苓为胃中通药，胃是腑，腑以通为补；白术、炙甘草，为脾经守药，脾是脏，脏以守为补。茯苓淡渗，下达膀胱，为通中之通；人参甘苦，益肺胃之气，为通中之守；白术苦能渗湿，为守中之通；甘草纯甘，不兼他味，又为守中之守，合四君子为脾胃两补之方。加扁豆、薏仁以补肺胃之体，炮姜以补脾肾之用；桔梗从上焦开提清气，砂仁、肉蔻从下焦固涩浊气，这两物都芳香能涩滑脱，而又能通下焦之郁滞，兼醒脾阳。为末，取其留中；引以香粳米，也是因为其芳香悦土，以胃所喜为补，上下斡旋，无非希望胃气渐醒，可以转危为安。
七十七、噤口痢，胃关不开，由于肾关不开的，用肉苁蓉汤主治。
这是噤口痢邪少虚多，治疗下焦的方法。大概噤口日久，有责任在胃的，上一条是；也有由于肾关不开，而胃关更加闭塞的，则应当以下焦为主。方中重用苁蓉，是因为苁蓉感马精而生，是精血所生之草而有肉的。马为火畜，精为水阴，禀受少阴水火之气而归于太阴坤土的药，其性温润平和，有从容之意，所以得名为从容，补下焦阳中之阴有殊功。《神农本草经》称其强阴益精，消瘕，强阴，是火气的作用，益精，是水气的作用，瘕乃气血积聚有形之邪，水火既济，中土气盛，而积聚自消。现在用治噤口痢阴阳俱损，水土两伤，而又滞下之积聚未清，苁蓉确实是恰当的药物；佐以附子补阴中之阳，人参、干姜补土，当归、白芍补肝肾，白芍用肉桂汤浸炒，是怕其呆滞，且束入少阴血分。
肉苁蓉汤（辛甘法）
肉苁蓉（泡淡，一两） 附子（二钱） 人参（二钱） 干姜炭（二钱） 当归（二钱） 白芍（肉桂汤浸炒，三钱）
用八杯水，煮取三杯，分三次缓缓服用，胃稍开，再作服。
(3 qian) Yin Hua (Silver Flower, *Flos Lonicerae Japonicae*, stir-fried until black, 1.5 qian); Chi Ling (Red Poria, *Poria Cocos* with red skin, 3 qian); Zhu Ling (Polyporus, *Polyporus Umbellatus*, 1.5 qian).
Boil in eight cups of water to obtain three cups; divide into three doses and take orally.
67. Profuse dysentery without restraint, pulse is faint and fine, limbs are cold, inability to eat: Taohua Tang (Peach Blossom Decoction) is the primary treatment.
This is a method of astringing the Yang aspect of the Yangming channel. Profuse dysentery indicates that the gate is open and failing to store; a faint and fine pulse with cold limbs indicates impending collapse of Yang. Therefore, Chishizhi (Red Kaolin, *Kaolinitum Rubrum*) is used to urgently astringe the Lower Jiao; Jing Mi (Rice, *Oryza Sativa*) combined with Shizhi blocks the Qi of the Yangming; Gan Jiang (Dried Ginger, *Zingiberis Rhizoma*) warms the interior to restore Yang. This ensures that when dysentery stops, Yin fluids are retained; once Yin is retained, Yang can transform and recover.
Taohua Tang Formula (Method see Warm-Heat Lower Jiao Chapter)
68. Chronic dysentery with Yin injury and Qi sinking, anal prolapse, soreness in the sacral region: Dihuang Yuliang Tang (Rehmannia and Halloysitum Decoction) is the primary treatment.
This is a method of astringing the Yin aspect of the Shaoyin channel. Anal prolapse and sacral soreness indicate Kidney deficiency and depletion of body fluids. Therefore, Shu Dihuang (Prepared Rehmannia Root, *Rehmanniae Radix Preparata*) and Wuweizi (Schisandra Fruit, *Schisandrae Chinensis Fructus*) are used to tonify the Kidney, allowing Sour-Sweet to generate Yin; Yuliang (Halloysitum, *Halloysitum*) astringes the Lower Jiao, thereby eliminating soreness, stopping prolapse, and curing dysentery. (Note: Both Shizhi and Yuliang are mineral drugs with astringent properties. Taohua Tang uses Shizhi but not Yuliang, whereas this formula uses Yuliang but not Shizhi. This is because Shizhi is Sweet and Warm, making Taohua Tang a warming formula; Yuliang is Sweet and Neutral, making this formula a Yin-nourishing one where neutrality is preferred over warmth.)
Dihuang Yuliang Tang Formula (Sour-Sweet combined with Astringent method)
Shu Dihuang (Prepared Rehmannia Root, *Rehmanniae Radix Preparata*); Yuliang (Halloysitum, *Halloysitum*); Wuweizi (Schisandra Fruit, *Schisandrae Chinensis Fructus*).
69. Chronic dysentery injuring the Kidney, instability of the Lower Jiao, slippery discharge from intestines, delayed digestion of food: Sanshen Wan (Three Gods Pill) is the primary treatment.
This is a method of astringing the Yang within the Yin of the Shaoyin channel. Slippery intestinal discharge indicates Lower Jiao instability; delayed digestion after chronic dysentery shows not only Spleen Yang failure to transport but also decline of the True Yang in the Kidney. Therefore, Sanshen Wan is used to warm and tonify Kidney Yang; Wuweizi simultaneously collects Yin; Rougu (Nutmeg, *Myristicae Semen*) astringes the slipping loss.
Sanshen Wan Formula (Sour-Sweet-Pungent-Warm combined with Astringent method, also a compound formula)
Wuweizi (Schisandra Fruit, *Schisandrae Chinensis Fructus*); Buguzhi (Kochia Fruit, *Kochiae Fructus*); Rougu (Nutmeg, *Myristicae Semen*, free of oil).
70. Chronic dysentery injuring Yin, thirst, dry tongue, slight fever, slight cough: Renshen Wumei Tang (Ginseng and Smoked Plum Decoction) is the primary treatment.
Thirst and slight cough following chronic dysentery, without signs of damp-heat or pathogenic factors, indicate severe injury to Yin fluids. In heat diseases where fluids are exhausted, urgent priority must be given to restoring Yin.
Renshen Wumei Tang Formula (Sour-Sweet to generate Yin method)
Renshen (Ginseng Root, *Panacis Quinquefolii Radix*); Lianzi (Lotus Seed, *Nelumbinis Semen*, stir-fried); Zhi Gancao (Honey-fried Licorice Root, *Glycyrrhizae Radix et Rhizoma Preparata*); Wumei (Smoked Plum, *Mume Fructus*); Mugua (Chaenomeles Fruit, *Chaenomelis Fructus*); Shanyao (Chinese Yam Rhizome, *Dioscoreae Rhizoma*).
Note: This formula protects the Spleen and Stomach while restoring Yin. If fluid depletion is severe but the Spleen/Stomach has no other pathology, remove Shanyao and Lianzi, add Shengdi (Raw Rehmannia Root, *Rehmanniae Radix*) and Maidong (Ophiopogon Tuber, *Ophiopogonis Tuber*); this is another method.
71. Long-standing dysentery causing dual injury to Yin and Yang, distension/prolapse of the lower abdomen and anus, soreness/aching in waist, hips, spine, and thighs: due to organ damage affecting the奇经 (Extraordinary Vessels), Shenrong Tang (Ginseng and Deer Antler Decoction) is the primary treatment.
Lower abdominal distension indicates deficiency of the Chong Mai (Penetrating Vessel); anal prolapse indicates Yin deficiency of the Lower Jiao; the waist is the mansion of the Kidney; the hip is the acupoint of the Gallbladder (referring to Huantiao GB30); the spine is the area of the Taiyang channel flanking the Du Mai (Governing Vessel); the thigh belongs to the Yangming channel. Soreness and aching in all these areas result from injury to Yin collaterals extending to the Extraordinary Vessels. Renshen tonifies Yangming; Lurong (Deer Antler Glue, *Cornu Cervi Pantotrichum*) tonifies Du Mai; Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) and Huixiang (Fennel Fruit, *Foeniculi Fructus*) tonify Chong Mai; Tusizi (Dodder Seed, *Cuscutae Semen*) and Fuzi (Aconite Root, *Aconiti Lateralis Radix Preparata*) ascend Shaoyin; Duzhong (Eucommia Bark, *Eucommiae Cortex*) treats waist pain. This empowers the Eight Extraordinary Vessels, nourishes Liver and Kidney, stops pain, and lifts prolapse.
Note: Although Huantiao GB30 belongs to the Gallbladder channel, the collaterals of Taiyang and Shaoyin actually converge here.
Shenrong Tang Formula (Pungent-Sweet-Warm method)
Renshen (Ginseng Root, *Panacis Quinquefolii Radix*); Lurong (Deer Antler Glue, *Cornu Cervi Pantotrichum*); Fuzi (Aconite Root, *Aconiti Lateralis Radix Preparata*); Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*, stir-fried); Huixiang (Fennel Fruit, *Foeniculi Fructus*, stir-fried); Tusizi (Dodder Seed, *Cuscutae Semen*); Duzhong (Eucommia Bark, *Eucommiae Cortex*).
Note: Although this formula claims to tonify both Yin and Yang, it leans towards Yang. If the patient presents only with prolapse without back/spine pain, indicating predominant Yin injury, remove Fuzi and add Buguzhi (Kochia Fruit, *Kochiae Fructus*); this is another method.
72. Chronic dysentery injuring the Jueyin Liver channel, invading the Yangming Stomach channel: sensation of Qi rushing to the heart, hunger but no desire to eat, dry heaving, abdominal pain: Wumei Wan (Smoked Pill) is the primary treatment.
The Liver is a rigid organ harboring Ministerial Fire, which cannot be subdued by purely rigid/hot herbs; the Yangming Fu organs require rigid/hot herbs to restore their function. In the Jueyin chapter of Zhang Zhongjing's *Shanghan Lun*, Wumei Wan is listed for treating vomiting of roundworms caused by Wood invading Yangming, with his own note stating it also treats chronic dysentery. However, symptoms of chronic dysentery vary and cannot be treated uniformly with this formula. Ye Tianshi, for malaria/dysentery caused by Wood invading Yangming, always used its method with modifications: generally adding soft/yin-nourishing herbs like Baishao (White Peony Root, *Paeoniae Radix Alba*) and Mugua if softness is needed, or Wuyu (Evodia Fruit, *Evodiae Fructus*) and Xiangfu (Cyperus Rhizome, *Cyperi Rhizoma*) if rigidity is needed, mostly avoiding Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*), Xixin (Asarum Root, *Asari Radix et Rhizoma*), and Huangbai (Phellodendron Bark, *Phellodendri Chinensis Cortex*). This differs from pure Jueyin chronic dysentery presenting with vomiting, anorexia, and Qi rushing to the heart without Yangming invasion, which requires purely soft/yin-nourishing methods; this is another approach for treating Jueyin chronic dysentery. Note: Xiexin Tang uses simultaneous Cold and Heat; Wumei Wan uses simultaneous Cold/Heat and Rigidity/Softness. Xiexin Tang treats disorders between the chest and diaphragm, not purely Jueyin, merely involving Liver collaterals passing through the chest. Wumei Wan, however, is a comprehensive formula treating Jueyin, preventing Shaoyang involvement, and protecting Yangming.
Wumei Wan Formula (Sour-Sweet-Pungent-Bitter complex method. Sour-Sweet generates Yin; Pungent-Bitter unblocks and descends; Pungent-Sweet constitutes Yang; Sour-Bitter constitutes Yin).
Wumei (Smoked Plum, *Mume Fructus*); Xixin (Asarum Root, *Asari Radix et Rhizoma*); Ganjiang (Dried Ginger, *Zingiberis Rhizoma*); Huanglian (Coptis Rhizome, *Coptidis Rhizoma*); Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*); Fuzi (Aconite Root, *Aconiti Lateralis Radix Preparata*); Shuzhuo (Sichuan Pepper, *Zanthoxyli Pericarpium*, stir-fried until charred, sweat removed); Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*); Renshen (Ginseng Root, *Panacis Quinquefolii Radix*); Huangbai (Phellodendron Bark, *Phellodendri Chinensis Cortex*).
This is the original Wumei Wan formula. It stands alone without commentary as previous famous annotations are abundant; details on dosage and preparation are fully recorded in *Shanghan Lun*.
73. Xiexi Li (Resting Dysentery) persisting for years without cure, deficiency of both Yin and Yang in the Lower Jiao, inability to retain, Qi knot in the lower abdomen resembling a mass (Jia): Shenshao Tang (Ginseng and Peony Decoction) is the primary treatment.
Xiexi Li alternates between attacks and remissions, hence the name "resting," historically considered difficult to treat. This occurs because even if a person with strong Zheng Qi (Upright Qi) is heavily infected by Summer-heat, Dampness, Water, Grain, Blood, or Food pathogens, they will defecate dozens of times daily, presenting with distension, pain, tenesmus, etc., and will not alternate intermittently. The formation of resting syndrome is largely due to deficiency of Zheng Qi. One type is Zheng deficiency leaving pathogens in collaterals, recurring at specific times, presenting as excess symptoms of stagnation and abdominal pain; follow Zhang Zhongjing's example of purging such recurring diseases, using mild warming purgatives to unblock collaterals and eliminate latent pathogens; or use slow-acting pills to attack, tonifying immediately after stagnation clears; or combine attacking and tonifying, treating Middle and Lower Jiao simultaneously. This is an Excess pattern within Deficiency. The other type is purely Deficiency, caused by excessive sliding discharge from long-term dysentery, injuring Yin and Yang of the Lower Jiao; Qi knots resembling a mass (Jia) but not truly being a mass; aside from warming and tonifying, what else can be done? Therefore, Renshen, Fuling (Poria, *Poria Cocos*), and Zhi Gancao tonify the Middle Jiao; Renshen and Fuzi secure Yang of the Lower Jiao; Baishao and Wuweizi collect Yin of the Three Yin channels, focusing on Shaoyin, as the Kidney governs urination and defecation. The decoction is named Shenshao to signify securing both Yin and Yang.
Shenshao Tang Formula (Pungent-Sweet for Yang, Sour-Sweet for Yin complex method)
Renshen (Ginseng Root, *Panacis Quinquefolii Radix*); Baishao (White Peony Root, *Paeoniae Radix Alba*); Fuzi (Aconite Root, *Aconiti Lateralis Radix Preparata*); Fuling (Poria, *Poria Cocos*); Zhi Gancao (Honey-fried Licorice Root, *Glycyrrhizae Radix et Rhizoma Preparata*); Wuweizi (Schisandra Fruit, *Schisandrae Chinensis Fructus*).
74. Jin Kou Li (Closed-Mouth Dysentery) with rising heat Qi, reverse obstruction in intestines resembling closure, severe abdominal pain especially in the lower part: Baitouweng Tang (Pulsatilla Decoction) is the primary treatment.
This is an Excess pattern of Closed-Mouth Dysentery, specifically a formula for severe Heat.
Baitouweng Tang (Formula note see previous)
75. Jin Kou Li (Closed-Mouth Dysentery), Left pulse fine and rapid, Right pulse wiry, dry heaving, abdominal pain, tenesmus, incomplete evacuation of stool: Jiajian Xiexin Tang (Modified Heart-Draining Decoction) is the primary treatment.
This is also an Excess pattern of Closed-Mouth Dysentery, specifically where Damp-Heat is excessively heavy. Fine and rapid pulse indicates Heat settling in the interior; wiry Right pulse indicates Wood entering Earth. Therefore, Xiexin Tang removes stabilizing herbs and adds those to promote movement; Pungent herbs to open, Bitter herbs to descend; add Yinhua (Silver Flower, *Flos Lonicerae Japonicae*) to defeat heat toxins; Zhata (Charred Hawthorn, *Crataegi Fructus Carbonisatum*) to break blood stasis; Muxiang (Aucklandia Root, *Aucklandiae Radix*) juice to move Qi stagnation; Baishao (White Peony Root, *Paeoniae Radix Alba*) to collect Yin Qi, further extracting Wood from Earth.
Jiajian Xiexin Tang Formula (Bitter-Pungent-Cold method)
Chuanlian (Coptis Rhizome, *Coptidis Rhizoma*); Huangqin (Scutellaria Root, *Scutellariae Radix*); Ganjiang (Dried Ginger, *Zingiberis Rhizoma*); Yinhua (Silver Flower, *Flos Lonicerae Japonicae*); Zhata (Charred Hawthorn, *Crataegi Fructus Carbonisatum*); Baishao (White Peony Root, *Paeoniae Radix Alba*); Muxiangzhi (Aucklandia Juice, *Aucklandiae Radix Succus*).
76. Jin Kou Li (Closed-Mouth Dysentery), nausea/vomiting, no hunger, little stool, mild pain, emaciation, wiry pulse, white tongue coating, no thirst: Jiawei Shenling Baizhu San (Modified Ginseng, Poria, and Atractylodes Macrocephala Powder) is the primary treatment.
This is a method for treating the Middle Jiao in Closed-Mouth Dysentery where Pathogens are few and Deficiency is dominant. Little stool and mild pain indicate few pathogens; white tongue indicates absence of Heat; emaciation, no thirst, no hunger, no appetite indicate the Stomach Gate is about to close; wiry pulse, as stated in *Jingui Yaolue*: "Wiry implies reduction," meaning both Yin Essence and Yang Qi are insufficient. *Ling Shu* states: "For all small pulses, Yin-Yang, Form, and Qi are all insufficient; do not use needles, regulate with Sweet medicines." Zhang Zhongjing based Jianzhong Tang on this to treat various deficiencies, making it the ancestral formula for all consumptive diseases. Li Dongyuan derived Buchong Yiqi, Shengyang Yiqi, and Qingshu Yiqi decoctions from this, all employing Sweet-Warm to remove Great Heat, though none are as pure as Jianzhong Tang; Jianzhong wins by virtue, Buchong wins by talent. Regulating with Sweet medicines works because the Twelve Channels derive Qi from the Stomach; once Stomach Qi recovers, deficiencies in all Twelve Channels can be restored. Ye Tianshi's modification of Shenling Baizhu San for Closed-Mouth Dysentery with many deficiencies and wiry pulse follows the ancient principle of regulating deficiencies with Sweet medicines, deriving from Zhang Zhongjing and Li Dongyuan, emphasizing urgent restoration of Stomach Qi.
Jiawei Shenling Baizhu San Formula (Original formula is Sweet-Light-Slightly Bitter; additions make it Pungent-Sweet to generate Yang, aromatic to please Spleen, slightly pungent to unblock, slightly bitter to descend).
Renshen (Ginseng Root, *Panacis Quinquefolii Radix*, 2 qian); Baizhu (Atractylodes Macrocephala Rhizome, *Atractylodis Macrocephalae Rhizoma*, stir-fried until scorched, 1.5 qian); Fuling (Poria, *Poria Cocos*, 1.5 qian); Bian Dou (Lablab Bean, *Lablab Album*, stir-fried, 2 qian); Yiren (Coix Seed, *Coicis Semen*, 1.5 qian); Jiegeng (Platycodon Root, *Platycodi Radix*, 1 qian); Sharen (Amomum Fruit, *Amomi Fructus*, stir-fried, 0.7 fen); Paojiang (Roasted Ginger, *Zingiberis Rhizoma Preparatum*, 1 qian); Roudoukou (Nutmeg, *Myristicae Semen*, 1 qian); Zhi Gancao (Honey-fried Licorice Root, *Glycyrrhizae Radix et Rhizoma Preparata*, 0.5 fen).
Grind into extremely fine powder. Take 1.5 qian per dose, mixed with Fragrant Rice Decoction (*Oryza Sativa*), twice daily.
[Formula Commentary] The original Shenling Baizhu San treats both Spleen and Stomach, focusing on the Stomach, functioning only for diarrhea due to Spleen Empty-Deficiency without pathogens. This modified formula unblocks and circulates the Triple Burner, lifts the Upper Jiao, astringes the Lower Jiao, with awakening the Middle Jiao as key. Renshen, Fuling, Baizhu plus Zhi Gancao form Sijunzi Tang (Four Gentlemen Decoction). Sijunzi uses Renshen and Fuling as unblocking agents for the Stomach (Fu organ, tonified by unblocking); Baizhu and Zhi Gancao as stabilizing agents for the Spleen (Zang organ, tonified by stabilizing). Fuling is light and leaching, descending to Bladder, unblocking within unblocking; Renshen is Sweet-Bitter, benefiting Lung/Stomach Qi, stabilizing within unblocking; Baizhu is Bitter and leaching, unblocking within stabilizing; Gancao is purely Sweet, stabilizing within stabilizing. Together they tonify both Spleen and Stomach. Bian Dou and Yiren tonify Lung/Stomach substance; Paojiang tonifies Spleen/Kidney function. Jiegeng lifts clear Qi from Upper Jiao; Sharen and Roudoukou astringe turbid Qi from Lower Jiao; both are aromatic, astringing slippage yet unblocking Lower Jiao stagnation, awakening Spleen Yang. Powder form retains action in the Middle; Fragrant Rice guides to please Earth, tonifying what the Stomach likes. Upward and downward manipulation aims to gradually awaken Stomach Qi to turn danger into safety.
77. Jin Kou Li (Closed-Mouth Dysentery), Stomach Gate closed due to Kidney Gate closure: Rongrong Tang (Cistanche Decoction) is the primary treatment.
This is a method for treating the Lower Jiao in Closed-Mouth Dysentery where Pathogens are few and Deficiency is dominant. Long-standing Closed-Mouth Dysentery may be due to Stomach issues (previous item) or Kidney Gate closure causing Stomach Gate to close further; in the latter, focus on the Lower Jiao. Cistanche is used heavily because it grows from horse essence, a herb born of essence and blood with flesh. Horses are Fire animals, essence is Water Yin; Cistanche receives Qi from Shaoyin Water-Fire and returns to Taiyin Kun Earth. Its nature is warm, moist, peaceful, and "cangrong" (leisurely/composed), hence the name. It excels at tonifying Yang-within-Yin of the Lower Jiao. *Shennong Ben Cao Jing* states it strengthens Yin, benefits essence, and dissipates masses. Strengthening Yin is Fire Qi; benefiting essence is Water Qi; masses are tangible accumulations of Qi and Blood. When Water and Fire interact and Central Earth Qi prospers, accumulations dissipate. Here, treating Closed-Mouth Dysentery with dual Yin-Yang injury and Water-Earth damage, with lingering stagnation, Cistanche is indeed appropriate. Fuzi tonifies Yang-within-Yin; Renshen and Ganjiang tonify Earth; Danggui and Baishao tonify Liver-Kidney. Baishao is stir-fried in Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) decoction to prevent stagnation and guide into Shaoyin Blood aspect.
Rongrong Tang Formula (Pungent-Sweet method)
Rongrong (Cistanche Stem, *Cistanches Herba*, soaked in light water, 1 liang); Fuzi (Aconite Root, *Aconiti Lateralis Radix Preparata*, 2 qian); Renshen (Ginseng Root, *Panacis Quinquefolii Radix*, 2 qian); Ganjiang Tan (Charred Dried Ginger, *Zingiberis Rhizoma Carbonisatum*, 2 qian); Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*, 2 qian); Baishao (White Peony Root, *Paeoniae Radix Alba*, soaked in Guizhi decoction and stir-fried, 3 qian).
Boil in eight cups of water to obtain three cups; divide into three doses and take slowly. If Stomach opens slightly, continue administration.