秦子曰∶痢疾之症,便下脓血,或赤或白或黄或三色杂下,里急后重,欲便而不得
便,既便而复登厕,逼迫恼人。若但泻水谷,不滞脓血,此名水泻,而非痢疾矣。痢疾要分
外感内伤,天行自感。盖夏秋外感时行之痢,手足阳明肠胃二经主病者也;三时内伤,一人
独病之痢,三阴脾肾主病者也。从来前书,混而立论,未曾分别。故余详别外感四条,内伤
【寒湿痢之症】初起恶寒发热,身痛头疼,呕吐不食,不作渴,痢下脓血,或下黑水,
腹
吐饱闷,感于阳明,寒热往来,感于少阳,三阳不解,传入于里,在伤寒曰传经之邪,在痢
疾曰风邪内缩,从阳经传入于里之症也。
【寒湿痢之因】寒水湿土之政,流衍卑监,寒湿时行,内气不足,乘虚感入,郁遏营卫
,卫郁营泣,内传肠胃,则水谷不化,气血与糟粕互相蒸酿,而痢下赤白之症作矣。
【寒湿痢之脉】左脉浮紧,太阳寒湿,右脉浮大,阳明寒湿。寒湿内伏,脉乃沉紧。若
【寒湿痢之治】身痛发热,脉浮紧者,宜用败毒散,辛温散表。呕吐饱闷,脉长者,干
平胃散和胃宽胸。小水不利者,散表利湿五苓散。不比燥热痢,禁利小便。又不同燥热痢,
妄用大黄。又不可同湿热痢,误用川连。若寒凉大早,则寒湿不散,抑遏内缩,传入
于内,仍要先治外邪,使之从表而出,故寒湿痢必要先用表散者也。
败毒散 治风寒湿痢。
人参 羌活 独活 川芎 柴胡 前胡 陈皮 桔梗
无汗加防风。胸满去人参加枳壳。若饱闷不食,呕吐恶心,此兼阳明胃病,加后
方平胃散,家秘名败毒平胃散。
干葛平胃散 治寒湿痢胸满。
干葛 苍术 浓朴 广皮 甘草
寒热加柴胡。头痛身疼恶寒加羌活。若恶寒身痛头疼发热,此兼表邪者也,加
前方败毒散,家秘名平胃败毒散。
五苓散
白术 猪苓 泽泻 桂枝 白茯苓
积痢不必利小便,今因湿痢,且五苓中有桂枝。
秦子说:痢疾的症状,是大便排出脓血,颜色或红、或白、或黄,或三种颜色混杂而下,伴有里急后重(腹痛窘迫,时时欲便,肛门重坠,便出不爽),想排便却排不出,刚排完又想再去厕所,这种症状逼迫恼人。如果只是腹泻水谷,没有脓血停滞,这名叫水泻,而不是痢疾。痢疾必须区分外感和内伤,天行时气自感而得的病证。大概夏秋季节外感时行邪气的痢疾,是手足阳明经和肠胃二经受病;其他三个季节因内伤导致的、只有一个人患病的痢疾,是三阴经中的脾肾受病。以前的书籍,混淆地立论,未曾分别清楚。所以我详细辨别外感的四条,内伤的……
【寒湿痢的症状】初起时恶寒发热,身体疼痛,头痛,呕吐,不想吃东西,不口渴,痢下脓血,或者下黑水,腹部胀满闷痛。感受于阳明经,出现寒热往来;感受于少阳经,三阳经的病邪不解,传入体内,在伤寒中叫传经之邪,在痢疾中叫风邪内缩,是从阳经传入体内的症状。
【寒湿痢的病因】寒水和湿土的政令流行,气候卑湿,寒湿时行邪气盛行,人体内部正气不足,乘虚感入,郁遏营卫之气,卫气郁滞,营血凝涩,内传肠胃,导致水谷不能消化,气血与糟粕互相蒸酿,于是痢下赤白的症状就产生了。
【寒湿痢的脉象】左脉浮紧,是太阳寒湿;右脉浮大,是阳明寒湿。寒湿潜伏在内,脉象就会沉紧。如果……
【寒湿痢的治疗】身体疼痛发热,脉浮紧的,适宜用败毒散,辛温发散表邪。呕吐饱闷,脉长的,用干葛平胃散调和胃气,宽胸理气。小便不利的,用散表利湿的五苓散。不像燥热痢,禁止利小便。又不同于燥热痢,妄用大黄。也不可同湿热痢一样,误用黄连。如果遇到大旱寒冷天气,那么寒湿就不会消散,反而抑遏内缩,传入体内,仍然要先治疗外邪,使它们从体表排出,所以寒湿痢一定要先用解表散邪的方法。
败毒散:治疗风寒湿痢。
人参、羌活、独活、川芎、柴胡、前胡、陈皮、桔梗。
无汗加防风。胸满去掉人参,加枳壳。如果饱闷不想吃东西,呕吐恶心,这是兼有阳明胃病,加上方中的平胃散,家传秘名为败毒平胃散。
干葛平胃散:治疗寒湿痢引起的胸满。
干葛、苍术、浓朴、广皮、甘草。
寒热加柴胡。头痛身疼恶寒加羌活。如果恶寒身痛头疼发热,这是兼有表邪,加上前方的败毒散,家传秘名为平胃败毒散。
Qin Zi said: The symptoms of dysentery include the passage of pus and blood in the stool, which may be red, white, yellow, or a mixture of all three colors. It is accompanied by tenesmus (a feeling of incomplete defecation with urgency and pain), where one feels the urge to defecate but cannot, or feels the need to return to the toilet immediately after defecating. This condition is oppressive and distressing. If there is only diarrhea of water and undigested food without pus or blood, it is called watery diarrhea, not dysentery. Dysentery must be distinguished into external contraction and internal injury. Epidemic dysentery contracted from heavenly qi is primarily related to the Foot-Yangming and Hand-Yangming meridians and the intestines and stomach. Dysentery occurring in other seasons due to internal injury, affecting only one individual, is primarily related to the Three Yin meridians, specifically the Spleen and Kidney. Previous texts have confused these concepts without clear distinction. Therefore, I have detailed four types of external contraction dysentery, and internal injury...
[Symptoms of Cold-Damp Dysentery] At the onset, there is aversion to cold and fever, body ache, headache, vomiting, anorexia, absence of thirst, passage of pus and blood in the stool, or passage of black fluid, abdominal distension and fullness. Contraction in the Yangming channel presents with alternating chills and fever; contraction in the Shaoyang channel involves the unresolved pathogenic factors of the Three Yang channels transmitting inward. In Shanghan (Cold Damage), this is called transmitted pathogenic factors; in dysentery, it is called wind pathogen retreating inward, representing symptoms transmitted from the Yang channels into the interior.
[Etiology of Cold-Damp Dysentery] When the policies of Cold Water and Damp Earth prevail, leading to damp and low-lying climatic conditions, epidemic cold-damp pathogens are prevalent. If the internal Qi is insufficient, pathogens enter through deficiency, stagnating and obstructing Ying and Wei Qi. With Wei Qi stagnated and Ying Blood congealed, the pathogen transmits inward to the intestines and stomach, causing failure of digestion of water and grain. The Qi and Blood ferment and brew with waste matter, resulting in the symptom of passing red and white discharge in dysentery.
[Pulse Signs of Cold-Damp Dysentery] A floating and tight pulse on the left indicates Taiyang Cold-Damp; a floating and large pulse on the right indicates Yangming Cold-Damp. If Cold-Damp lies latent within, the pulse becomes deep and tight. If...
[Treatment of Cold-Damp Dysentery] For body ache, fever, and a floating-tight pulse, Baidu San (Decoction for Rescuing from Ten Thousand Perils) should be used to release the exterior with acrid-warm herbs. For vomiting, fullness, and a long pulse, Gan Ge Pingwei San (Pueraria and Pingwei Powder) should be used to harmonize the Stomach and broaden the chest. For difficulty in urination, Wuling San (Five-Ingredient Powder with Poria) should be used to release the exterior and promote diuresis to resolve dampness. Unlike dry-heat dysentery, diuresis is contraindicated. Unlike dry-heat dysentery, Da Huang (Rhubarb Root and Rhizome) should not be used recklessly. Nor should Chuan Lian (Fruit of Sichuan Chinaberry) be mistakenly used as in damp-heat dysentery. If severe drought and cold occur, cold-damp will not dissipate but rather retreat inward; thus, the exterior pathogen must first be treated to allow it to exit via the surface. Therefore, releasing the exterior is essential in treating cold-damp dysentery.
Baidu San: Treats Wind-Cold-Damp Dysentery.
Ren Shen (Ginseng Radix et Rhizoma), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), Chen Pi (Citri Reticulatae Pericarpium), Jie Geng (Platycodonis Radix).
Add Fang Feng (Saposhnikoviae Radix) if there is no sweat. Remove Ren Shen and add Zhi Ke (Aurantii Fructus) if there is chest fullness. If there is abdominal fullness, anorexia, vomiting, and nausea, indicating concurrent Stomach disease of the Yangming channel, add Pingwei San below. My family secret name is Baidu Pingwei San.
Gan Ge Pingwei San: Treats chest fullness caused by Cold-Damp Dysentery.
Gan Ge (Puerariae Lobatae Radix), Cang Zhu (Atractylodis Rhizoma), Nong Po (Magnoliae Officinalis Cortex), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Add Chai Hu for alternating chills and fever. Add Qiang Huo for headache, body ache, and aversion to cold. If there is aversion to cold, body ache, headache, and fever, indicating concurrent exterior pathogen, add Baidu San above. My family secret name is Pingwei Baidu San.
Wuling San:
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Gui Zhi (Cinnamomi Ramulus), Bai Fu Ling (Poria).
Dysentery with accumulation does not require promoting diuresis. However, in this case of damp dysentery, and since Gui Zhi is present in Wuling San...