【外感休息痢之症】暴发热痢而起，后乃久久不愈，或暂好一月半月，旋复发作，缠绵
不愈，积滞不除，此外感休息痢症也。
【外感休息痢之因】外感六淫之邪，以成痢疾，或失于解表，或寒凉抑遏外邪，或早食
膏粱助其邪热，或补涩太早，邪伏肠胃，则成休息之痢矣。
【外感休息痢之脉】脉若见涩，气凝积滞。或见沉滑，食积未彻。或见沉数，内有积热
【外感休息痢之治】脉涩滞者，和气四七汤。脉沉滑者，行积香连丸。脉沉数者，泼火
散。脉沉弦者，助脾消积，枳术汤，合保和丸。久痢不止，下纯血，家秘独圣散，煎汤服。
和气四七汤 治气凝积滞。
枳壳 浓朴 陈皮 紫苏子
红积多加山楂肉。白积多加炒神曲。
泼火散 治火伤血痢之方。
川黄连 赤芍药 地榆 青皮 甘草
枳术丸 合保和丸，可治休息痢。
陈枳实 白术
保和丸 治食积痢。
莱菔子 楂肉 神曲 麦芽 陈皮 甘草
独圣汤 家秘治小儿下红积，产妇血痢，神效。
楂肉一斤，研末，每服二两，煎汤服。
【内伤休息痢之症】无外感之邪，非暴发暴痢之症，但因脾胃亏损，渐成积痢，或发或
止，经年不愈，此内伤休息痢症也。
【内伤休息痢之因】或因劳心过度，思虑伤脾，或因胃强脾弱，饮食伤损，或因寒凉不
谨，肠胃受伤，脾肾相传，则内伤休息之痢作矣。
【内伤休息痢之脉】脉见弦细，思虑所伤。或见虚大，脾气亏损。或见细涩，脾血有伤
。或见沉弦，食积伤脾。或见迟弦，寒凉伤损。
【内伤休息痢之治】思虑伤脾者，归脾汤。饮食伤脾者，枳术丸、大安丸、家秘消积散
、楂术膏。寒泻不禁者，理中汤、钱氏异功散。
归脾汤 见前七情痢。
枳术丸 见前章。
大安丸 治饮食伤脾，内伤积痢。
楂肉 神曲 半夏 白茯苓 莱菔子 陈皮 连翘 白术
家秘消积散 治饮食伤脾，积痢不止，神效。
苍术（一两，饭上蒸） 浓朴（五钱） 陈皮（五钱） 甘草（三钱） 神曲（二两，炒） 红曲
（一两） 楂肉（四两） 麦芽（一两，炒）
上为细末，白汤服。
楂术膏 治脾虚不能运化，助脾消积。
楂肉 白术 陈皮 甘草
理中汤 见前七情痢。
钱氏异功散 治脾元不足，有痢无积，久不愈者。
白术 人参 陈皮 白茯苓 炙甘草 木香 诃子 肉果
凡痢，第一要戒荤腥；外感痢不论日久，第一要先散表邪。若风寒、寒湿而见太阳表症
，羌独败毒散，兼见阳明少阳者，羌防柴葛汤。若胸次不宽，兼平胃保和散。若内伤之痢，
不带外感，则不用表药。若下纯红者，治以家秘独圣散，或煎汤频服。赤白相杂者，家秘消
积散。积滞未除，脾气已虚，大安丸作散，白汤调服。大凡病症，各有分别，例如咳嗽吐血
，水肿痛痹，筋挛痉痿，以外感为轻，内伤为重。若泄泻痢疾，则以内伤为轻，外感为重，
故发热泄痢者，常有不治。夫外感之邪，必要仍从毛窍而出，凡病一见表邪起影，即当先散
表邪。如内伤痢，兼见外邪，必当先散表邪。夫痢本于内伤，但夏秋时行疫痢，乃是疫毒致
病。内伤者，一人自作之孽，疫症者，天灾流行之病也。古人立败毒散，以治外感疫毒，最
为妙诀。乙酉年，夏秋多雨，连次风潮，后发疫痢，恶寒身痛，发热呕吐，病形相似，服寒
药多有变症；时余酌一方，表症甚者，重用败毒散，佐以苍朴，名败毒平胃散；胸次不宽，
里症甚者，重用平胃散，佐以羌、独、柴胡，名平胃败毒散，随手取效；此系寒湿之邪，伤
人肌表，侵入肠胃，而成有表邪之疫痢也。又于丁卯年，夏秋亢旱，赤日燥裂，沿门合境，
下痢赤积，腹痛频并，肛门如火，积滞难出，用香连丸等，痢势反加；余因悟燥火伤血，不
比湿火同治，香连丸治湿火伤气之药，遂化立当归大黄汤，清血分之燥火，血积潜消，顷刻
平安；此系燥火之邪，伤人口鼻，直入肠胃，而成无表之疫痢也。同一外感，而有表症无表
症，天壤各别；同一火，而湿火燥火，伤气伤血，治各不同。又如乙未年，三时雨湿，热令
阴寒，深秋多发头痛身痛，胸满寒热之症，早用寒凉生冷，则胸前凝结，不能敷布作汗，死
者比比，余亦以乙酉治痢法，用败毒平胃散，则胸宽汗出而愈。夫治痢而因雨湿阴寒，用败
毒平胃，表散取效，此从时行外感寒热病中，化出治法；今治外感寒热病，又以阴寒雨湿，
治痢之败毒平胃散散表，此因天灾流行，皆系毛窍口鼻，从外感入之表邪，必要仍从毛窍肌
表而出。痢疾与寒热，病症虽别，而发散表邪，彼此可以悟用。是以时行暑热燥火，无表邪
，有里热之症，而用清里之法，亦可化用治暑热燥火时行之痢矣。因此悟得发 之症，皆因
邪火伤血，然湿火伤血，则大便滑泄，家秘用川连、枳壳、木通，分利二便；若燥火伤血，
而大便干结，方书用当归大黄丸，清血中之火，而润大便秘结；余今以下痢纯血腹痛之痢，
化用此方以清血中燥火，反止大肠下痢，彼此互发，随处生花，以闻后人妙悟。
【外感休息痢的症状】突然发生发热性痢疾，之后久久不愈，或者暂时好转一个月或半个月，随即又发作，缠绵难愈，积滞无法清除，这是外感引起的休息痢症状。
【外感休息痢的病因】外感六淫（风、寒、暑、湿、燥、火六种外感病邪）之邪气，导致痢疾；或者未能及时解表（解除表邪），或者用寒凉药物遏制了外邪，或者过早食用肥甘厚味助长了邪热，或者过早使用补益收敛药物，导致邪气潜伏在肠胃中，从而形成休息痢。
【外感休息痢的脉象】脉象若见涩脉，说明气机凝滞、积滞内停。若见沉滑脉，说明食积未完全消除。若见沉数脉，说明体内有积热。
【外感休息痢的治疗】脉象涩滞者，使用和气四七汤。脉象沉滑者，使用行积香连丸。脉象沉数者，使用泼火散。脉象沉弦者，需健脾消积，使用枳术汤，配合保和丸。久痢不止，排出纯血者，使用家传秘制独圣散，煎汤服用。
和气四七汤：治疗气机凝滞、积滞内停。
药材：枳壳、浓朴、陈皮、紫苏子。
若红色积滞多，多加山楂肉；白色积滞多，多加炒神曲。
泼火散：治疗火热伤及血分的血痢方剂。
药材：川黄连、赤芍药、地榆、青皮、甘草。
保和丸：治疗食积引起的痢疾。
药材：莱菔子、山楂肉、神曲、麦芽、陈皮、甘草。
独圣汤：家传秘方，治疗小儿下红积、产妇血痢，效果神奇。
药材：山楂肉一斤，研成粉末，每次服用二两，煎汤服用。
【内伤休息痢的症状】没有外感邪气，不是突然暴发的急性痢疾症状，而是因为脾胃亏损，逐渐形成积滞性痢疾，时发时止，经年不愈，这是内伤引起的休息痢症状。
【内伤休息痢的病因】或者因为劳心过度，思虑损伤脾脏；或者因为胃强脾弱，饮食受损；或者因为不慎受寒凉，肠胃受伤，脾肾相互影响，从而导致内伤休息痢发作。
【内伤休息痢的脉象】脉象见弦细，是思虑所伤。或见虚大脉，是脾气亏损。或见细涩脉，是脾血受损。或见沉弦脉，是食积伤脾。或见迟弦脉，是寒凉损伤。
【内伤休息痢的治疗】思虑伤脾者，使用归脾汤。饮食伤脾者，使用枳术丸、大安丸、家传秘制消积散、楂术膏。寒泻不禁者，使用理中汤、钱氏异功散。
枳术丸：见前章。
大安丸：治疗饮食伤脾，内伤积滞性痢疾。
药材：山楂肉、神曲、半夏、白茯苓、莱菔子、陈皮、连翘、白术。
家秘消积散：治疗饮食伤脾，积滞性痢疾不止，效果神奇。
药材：苍术（一两，饭上蒸）、浓朴（五钱）、陈皮（五钱）、甘草（三钱）、神曲（二两，炒）、红曲（一两）、山楂肉（四两）、麦芽（一两，炒）。
以上研为细末，用白开水送服。
楂术膏：治疗脾虚不能运化，辅助脾脏消除积滞。
药材：山楂肉、白术、陈皮、甘草。
钱氏异功散：治疗脾元不足，有痢疾无积滞，久治不愈者。
药材：白术、人参、陈皮、白茯苓、炙甘草、木香、诃子、肉果。
凡是痢疾，首先要戒除荤腥；外感痢疾不论日久，首先要先疏散表邪。如果风寒、寒湿且出现太阳表证（如恶寒发热、头项强痛等），使用羌活败毒散；兼见阳明、少阳症状者，使用羌防柴葛汤。如果胸膈不畅，兼用平胃散和保和散。如果是内伤引起的痢疾，不带外感，则不用解表药。如果排出纯红色血液，用家传秘制独圣散，或煎汤频服。赤白相杂者，用家传秘制消积散。积滞未除，脾气已虚，将大安丸改为散剂，用白开水调服。大凡病症，各有区别，例如咳嗽吐血、水肿痛痹、筋挛痉痿，以外感为轻，内伤为重。如果是泄泻痢疾，则以内伤为轻，外感为重，所以发热导致的泄痢，常常难以治愈。外感的邪气，必须仍然从毛孔排出，凡是疾病一见表邪迹象，就应当先疏散表邪。如果是内伤痢疾，兼见外邪，也必须先疏散表邪。痢疾本源于内伤，但夏秋季节流行的疫痢，乃是疫毒致病。内伤者，是一人自作之孽；疫症者，是天灾流行之病。古人创立败毒散，以治疗外感疫毒，最为妙诀。乙酉年，夏秋多雨，接连遭遇风潮，随后爆发疫痢，症状为恶寒身痛、发热呕吐，病情相似，服用寒凉药物多有变症；当时我斟酌一方，表症严重者，重用败毒散，佐以苍术、厚朴，名为败毒平胃散；胸膈不畅，里症严重者，重用平胃散，佐以羌活、独活、柴胡，名为平胃败毒散，随手取效；这属于寒湿之邪，伤人肌表，侵入肠胃，而成有表邪的疫痢。又在丁卯年，夏秋亢旱，烈日干燥龟裂，沿门合境之人，下痢赤色积滞，腹痛频繁，肛门如火，积滞难出，使用香连丸等药，痢势反而加重；我因此领悟到燥火伤血，不同于湿火同治，香连丸是治疗湿火伤气的药物，于是化裁创立当归大黄汤，清血分之燥火，血积潜消，顷刻平安；这属于燥火之邪，伤人人口鼻，直入肠胃，而成无表证的疫痢。同样是外感，而有表证无表证，天壤之别；同样是火，而湿火燥火，伤气伤血，治疗方法各不相同。又如乙未年，三个季节雨湿，热令转阴寒，深秋多发头痛身痛、胸满寒热的症状，早用寒凉生冷，则胸前凝结，不能敷布作汗，死者比比皆是，我也用乙酉年治痢的方法，使用败毒平胃散，则胸宽汗出而愈。治疗痢疾因雨湿阴寒，用败毒平胃散，通过发散表邪取得疗效，这是从时行外感寒热病中化出的治法；现在治疗外感寒热病，又以阴寒雨湿为背景，用治痢的败毒平胃散来发散表邪，这是因为天灾流行，皆系毛窍口鼻，从外感入的表邪，必须仍然从毛孔肌表而出。痢疾与寒热，病症虽不同，但发散表邪的道理，彼此可以互相悟用。因此领悟到，时行暑热燥火，无表邪，有里热症状，而用清里的方法，也可以化用治疗暑热燥火时行的痢疾。由此悟得发斑之症，皆因邪火伤血，然而湿火伤血，则大便滑泄，家传秘方用川连、枳壳、木通，分利二便；若燥火伤血，而大便干结，方书用当归大黄丸，清血中之火，而润大肠便秘；我现在以下痢纯血腹痛的痢疾，化用此方以清血中燥火，反而止住大肠下痢，彼此互发，随处生花，以此闻知后人妙悟。
[Symptoms of Exogenous Resting Dysentery] It begins with a sudden onset of febrile dysentery, which then persists for a long time without healing. It may temporarily improve for a month or half a month, only to relapse immediately, lingering and refusing to heal, with accumulated stagnation not being eliminated. This is the symptom pattern of exogenous resting dysentery.
[Etiology of Exogenous Resting Dysentery] Pathogenic factors of the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade externally, leading to dysentery. If the exterior is not resolved in time, or if cold-cooling herbs suppress the external pathogens, or if rich and greasy foods are consumed early on, aggravating the pathogenic heat, or if tonifying and astringent herbs are used too early, causing pathogens to lie dormant in the intestines and stomach, resting dysentery results.
[Pulse Patterns of Exogenous Resting Dysentery] If the pulse is choppy (Se), it indicates Qi stagnation and internal accumulation. If the pulse is deep and slippery (Chen Hua), it indicates incomplete elimination of food accumulation. If the pulse is deep and rapid (Chen Shu), it indicates internal accumulated heat.
[Treatment of Exogenous Resting Dysentery] For a choppy and stagnant pulse, use Heqi Siqu Decoction (Harmonizing Qi Seven-Ingredient Decoction). For a deep and slippery pulse, use Xingji Xianglian Pill (Move Stagnation Coptis and Phellodendron Pill). For a deep and rapid pulse, use Pohuo San (Extinguish Fire Powder). For a deep and wiry pulse, strengthen the Spleen and eliminate accumulation using Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction) combined with Baohe Wan (Preserve Harmony Pill). For chronic dysentery that does not stop, passing pure blood, use Jiamidusheng San (Family Secret Single-Holy Powder), decocted and taken as a soup.
Heqi Siqu Decoction: Treats Qi stagnation and accumulation.
Ingredients: Aurantii Fructus Immaturus (Zhike), Magnoliae Officinalis Cortex (Noupu), Citri Reticulatae Pericarpium (Chenpi), Perillae Fructus (Zisu Zi).
If red accumulation predominates, add more Hawthorn Fruit (Shanzha Rou); if white accumulation predominates, add more Medicated Leaven (Shenqu).
Pohuo San: A formula for treating bloody dysentery caused by Fire injuring the Blood.
Ingredients: Coptidis Rhizoma (Chuan Huanglian), Paeoniae Radix Rubra (Chishaoyao), Sanguisorbae Radix (Diyu), Tangerine Green Peel (Qingpi), Glycyrrhizae Radix et Rhizoma (Gancao).
Zhizhu Wan combined with Baohe Wan can treat resting dysentery.
Ingredients: Aurantii Fructus (Chenzhishi), Atractylodis Macrocephalae Rhizoma (Baizhu).
Baohe Wan: Treats dysentery due to food accumulation.
Ingredients: Raphani Semen (Laifuzi), Hawthorn Fruit (Zharou), Medicated Leaven (Shenqu), Hordeum Vulgare Sprout (Maiya), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao).
Dusheng Tang: Family secret prescription, highly effective for children with red accumulation in stool and postpartum bloody dysentery.
Ingredients: One jin of Hawthorn Fruit, ground into powder. Take two liang per dose, decocted in water.
[Symptoms of Endogenous Resting Dysentery] There are no external pathogenic factors; it is not a sudden acute dysentery. Instead, it arises gradually from Spleen and Stomach deficiency, forming an accumulation-type dysentery that comes and goes, persisting for years without healing. This is the symptom pattern of endogenous resting dysentery.
[Etiology of Endogenous Resting Dysentery] It may be caused by excessive mental labor and overthinking damaging the Spleen; or by a strong Stomach and weak Spleen leading to dietary injury; or by careless exposure to cold and dampness injuring the intestines and stomach, with transmission between Spleen and Kidney, triggering endogenous resting dysentery.
[Pulse Patterns of Endogenous Resting Dysentery] A wiry and thin pulse indicates damage from overthinking. A deficient and large pulse indicates Spleen Qi deficiency. A fine and choppy pulse indicates Spleen Blood injury. A deep and wiry pulse indicates food accumulation injuring the Spleen. A slow and wiry pulse indicates damage from cold and dampness.
[Treatment of Endogenous Resting Dysentery] For Spleen damage due to overthinking, use Guipi Tang (Restore the Spleen Decoction). For Spleen damage due to diet, use Zhizhu Wan, Da'an Wan, Jiemiaoxiaojisan (Family Secret Eliminate Accumulation Powder), and Zhazhu Gao (Hawthorn and Atractylodes Paste). For uncontrollable cold diarrhea, use Lizhong Tang (Regulate the Middle Decoction) and Qianshi Yigong San (Master Qian's Extraordinary Merit Powder).
Guipi Tang: See previous section on Seven Emotions Dysentery.
Zhizhu Wan: See previous chapter.
Da'an Wan: Treats Spleen damage from diet and endogenous accumulation dysentery.
Ingredients: Hawthorn Fruit, Medicated Leaven, Pinelliae Tuber (Banxia), Poria (Baifuling), Raphani Semen (Laifuzi), Citri Reticulatae Pericarpium (Chenpi), Forsythiae Fructum (Lianqiao), Atractylodis Macrocephalae Rhizoma (Baizhu).
Jiemiaoxiaojisan: Highly effective for Spleen damage from diet and persistent accumulation dysentery.
Ingredients: Atractylodis Rhizoma (Cangzhu, 1 liang, steamed over rice), Magnoliae Officinalis Cortex (Noupu, 5 qian), Citri Reticulatae Pericarpium (Chenpi, 5 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 3 qian), Medicated Leaven (Shenqu, 2 liang, stir-fried), Red Yeast Rice (Hongqu, 1 liang), Hawthorn Fruit (Zharou, 4 liang), Hordeum Vulgare Sprout (Maiya, 1 liang, stir-fried).
Grind all into fine powder and take with warm boiled water.
Zhazhu Gao: Treats Spleen deficiency failing to transform and transport, assisting the Spleen to eliminate accumulation.
Ingredients: Hawthorn Fruit, Atractylodis Macrocephalae Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao).
Lizhong Tang: See previous section on Seven Emotions Dysentery.
Qianshi Yigong San: Treats insufficient Spleen Yuan Qi, presenting with dysentery but no accumulation, persisting for a long time.
Ingredients: Atractylodis Macrocephalae Rhizoma (Baizhu), Ginseng Radix et Rhizoma (Renshen), Citri Reticulatae Pericarpium (Chenpi), Poria (Baifuling), Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao), Aucklandiae Radix (Muxiang), Terminalia Chebula Retzii Fructus (Hezi), Myristicae Semen (Rouguo).
In all cases of dysentery, the first priority is to abstain from meat and fish. For exogenous dysentery, regardless of duration, the first priority is to dissipate the exterior pathogen. If Wind-Cold or Cold-Damp presents with Taiyang exterior symptoms, use Qianghuo Baidu San (Notopterygium and Toosendan Dispel Toxin Powder); if Yangming and Shaoyang symptoms are also present, use Qiangfang Chaige Tang (Notopterygium, Saposhnikovia, Bupleurum, and Kudzu Decoction). If the chest feels constrained, combine with Pingwei San (Regulate the Stomach Powder) and Baohe Wan. For endogenous dysentery without external invasion, exterior-resolving herbs should not be used. If passing pure red blood, treat with Jiemiaidusheng San (Family Secret Single-Holy Powder) or decoct and take frequently. If red and white are mixed, use Jiemiaoxiaojisan (Family Secret Eliminate Accumulation Powder). If accumulation remains but Spleen Qi is already deficient, use Da'an Wan as a powder, mixed with warm boiled water. Generally, diseases have distinct differences. For example, in coughing blood, edema, painful obstruction, muscle spasms, and paralysis, exogenous causes are mild while endogenous causes are severe. However, in diarrhea and dysentery, endogenous causes are mild while exogenous causes are severe. Therefore, dysentery accompanied by fever is often incurable. External pathogens must exit through the hair follicles. Whenever exterior pathogen signs appear, one must first dissipate the exterior pathogen. If endogenous dysentery is complicated by external pathogens, the exterior must still be dissipated first. Dysentery originates from endogenous deficiency, but epidemic dysentery in summer and autumn is caused by epidemic toxins. Endogenous disease is like self-inflicted karma; epidemic disease is like natural disaster. The ancients created Baidu San to treat exogenous epidemic toxins, which is a brilliant method. In the year Yiyi, during summer and autumn, there was much rain and consecutive wind tides, followed by an outbreak of epidemic dysentery with symptoms of aversion to cold, body pain, fever, and vomiting. The conditions were similar, but taking cold-natured herbs led to complications. I formulated a prescription: for severe exterior symptoms, heavily use Baidu San assisted by Cangzhu and Houpo, named Baidu Pingwei San; for severe interior symptoms with chest constraint, heavily use Pingwei San assisted by Qianghuo, Duhuo, and Chaihu, named Pingwei Baidu San, yielding immediate results. This is Cold-Damp invading the muscle layer and entering the intestines and stomach, creating epidemic dysentery with exterior symptoms. In the year Dingmao, during summer and autumn, there was drought and scorching sun, causing widespread red accumulation dysentery, frequent abdominal pain, burning anus, and difficult expulsion of accumulation. Using Xianglian Wan aggravated the condition. I realized that Dry-Fire injuring Blood differs from Wet-Fire treatment. Xianglian Wan treats Wet-Fire injuring Qi. Thus, I modified Danggui Dahuang Tang (Angelica and Rheum Decoction) to clear Dry-Fire in the Blood level, allowing blood accumulation to dissolve quietly and restoring peace instantly. This is Dry-Fire invading via mouth and nose, directly entering the intestines and stomach, creating epidemic dysentery without exterior symptoms. Both are exogenous, yet one has exterior symptoms and the other does not—a world of difference. Both involve Fire, but Wet-Fire and Dry-Fire injure Qi and Blood respectively, requiring different treatments. Again, in the year Yiwei, rain and dampness persisted through three seasons, turning hot weather cold. Late autumn saw many cases of headache, body pain, chest fullness, and alternating chills and fever. Early use of cold-natured raw foods caused chest condensation, preventing sweating, leading to many deaths. I used the Yiyi dysentery method, applying Baidu Pingwei San, resulting in chest relief, sweating, and recovery. Treating dysentery caused by rain-damp-cold with Baidu Pingwei San achieves efficacy through exterior dispersion. This method was derived from seasonal exogenous cold-heat diseases. Now, treating exogenous cold-heat diseases with background rain-damp-cold, we use Baidu Pingwei San to disperse the exterior. This is because natural disasters involve exterior pathogens entering via hair follicles and nose/mouth, which must exit via the same route. Although dysentery and cold-heat differ in presentation, the principle of dispersing exterior pathogens allows mutual application. Therefore, for seasonal Summer-heat and Dry-Fire with interior heat but no exterior pathogen, clearing interior methods can be adapted to treat seasonal dysentery caused by Summer-heat and Dry-Fire. From this, I realized that macules/rashes result from Evil-Fire injuring Blood. When Wet-Fire injures Blood, stools are loose; my family secret uses Huanglian, Zhike, and Mutong to separate the two bowels. When Dry-Fire injures Blood, stools are dry; formularies use Danggui Dahuang Wan to clear Fire from Blood and moisten constipation. I now apply this formula to treat bloody dysentery with abdominal pain, clearing Dry-Fire from Blood, which surprisingly stops the dysentery. These mutually generating effects bloom everywhere, sharing this profound insight with future generations.