瘴后调摄。较之他病。其难百倍。善养生者。于饮食起居之际。兢兢业业。无一毫差忒。谨
慎百日。待脾胃元气复常。方可免变症之患。若瘴后懈怠。起居不时。恣意饮食与夫沽酒市脯。色
气无忌。当此脾胃之元气未复。不能消化。岂
不积而作痢。聚而作痰。浮而作肿乎。此难以立方施治。盖谓瘴后元气常虚。是无根本。将何以
当病耶。今摄数方法于后。以备审用。当其临时可权衡虚实而补泻之。
下痢之因。由元气脾胃衰弱。饮食不节。积而不化。遂致湿热伤于气分则白。伤于血分则赤。
气血俱伤则赤白相杂。其青黄黑色者。由湿热兼伤各脏。故见各经之色也。脉沉小流连有胃气者生。
洪大而数者死。身凉脉静者生。身热脉大者死。
治法。初起腹痛里急。后重而痢者。当审元气何如。元气未虚者。先服苏感丸以下之。去其积滞。
更兼有实热者。量用木香槟榔丸下之。盖谓无积不成痢。故先宜荡涤以去其积。若兼伏暑。以香茹
饮送下。小便不利。五苓散送之。次
用消导和气行血药。后服香连丸。或变乱丸。久不止。断下汤。真人养脏饮。斟酌选用。若元气
虚弱者。不可更行荡涤。先用六君子汤。随所伤物加药。送保和丸。如伤米食。加谷芽神曲。谷
食伤加麦芽神曲。肉食伤加山楂神曲。酒食伤加干葛神曲。兼呕吐加砂仁藿香。次用香连丸及四
神丸。如渴甚。用七味白术散送之。如元气下陷。用补中益气汤送下。若兼脾胃虚寒。用理中汤。又
有噤口者。卫生方云。噤口乃下痢不纳饮食是也。医者但知危笃。而乃畏缩不究其所致之由。故
多不救。良可悲哉。易简方谓宜四柱汤理中汤茯苓散加肉蔻木香。或咽震灵丹等药。何乃王德肤
知其一未知其二耶。盖古方有清心莲子饮及压毒药者。有用生胃进食药。岂可执一物以治之耶。
如诊视而知其脾胃脉不弱。问知其心烦头痛。手足温热。未尝多服凉药。此乃毒瓦斯上冲心肺。所
以呕而不食。宜用败毒散。每服四钱。陈仓米百粒姜枣煎服。又
一方石莲子捶碎去壳留心。研为细末。用陈仓米饮调下。若其脉微弱或心腹虚膨。或手足厥冷。
初病不呕。因服粟壳乌梅及诸苦涩凉剂。或饮草药过多。早晨未食先呕。不思饮食。此乃脾胃虚弱。
却可信简易方之言。又有一方犹为简易。用山药一味。 小豆大。一半银石器内炒熟。一半生用。
同为末。米饮调下。甚有奇效。又尝观前辈痈疽方。治呕逆不食者。亦有一说。毒瓦斯攻心者。以乳
香绿豆粉作内托散服之。脾气虚弱者。嘉禾散山药丸治之。胸中当存活法。裁其方法。为噤口痢。
用何患不收功于危笃耶。大都瘴后痢疾。极难施治。如前数药。虽是良剂。特准绳耳。至于临时变通。
在医者尽望闻问切之功。极精巧以别其虚实寒热。然后施治。庶可为人之司命。
瘴疾之后的调养护理，比其他疾病要难得百倍。善于养生的人，在饮食起居方面，必须兢兢业业，丝毫不能有差错失误。谨慎小心一百天，等到脾胃的元气恢复常态，才可以避免发生变症的危害。如果在瘴疾之后懈怠放松，起居没有定时，放纵饮食以及购买酒类肉脯，纵欲无度，此时脾胃的元气尚未恢复，不能消化食物，难道不会积聚而成痢疾，聚结而成痰饮，浮泛而成水肿吗？这很难制定固定的方剂来治疗，是因为说瘴疾后元气常常虚弱，这是没有根本，将用什么来承受病邪呢？现在列举几种摄养方法在后面，以备审慎使用。当临时可根据虚实情况权衡而进行补泻治疗。
下痢的原因，是由于元气和脾胃衰弱，饮食不节制，积滞而不能消化，于是导致湿热伤及气分则大便白色，伤及血分则大便红色，气血都受伤则红白相杂。那些青色、黄色、黑色的，是由于湿热兼伤各脏腑，所以出现各经络对应的颜色。脉象沉小且连绵有胃气的可以生，脉象洪大且数急的会死亡。身体凉爽脉象平静的可以生，身体发热脉象大的会死亡。
治疗方法：初起时腹痛、里急后重而下痢的，应当审察元气如何。元气未虚的，先服用苏感丸以攻下积滞。如果同时伴有实热，酌情使用木香槟榔丸攻下。这是因为没有积滞就不会形成痢疾，所以先宜荡涤以去除积滞。如果兼有伏暑，用香薷饮送服；小便不利，用五苓散送服。其次使用消导、和气、行血的药物，然后服用香连丸，或者变乱丸。久治不止的，选用断下汤、真人养脏饮，斟酌选用。如果元气虚弱，不可再进行荡涤攻下。先用六君子汤，根据所伤的食物种类加入相应药物，送服保和丸。如伤米食，加谷芽、神曲；伤谷食，加麦芽、神曲；伤肉食，加山楂、神曲；伤酒食，加干葛、神曲。兼有呕吐的，加砂仁、藿香。其次使用香连丸及四神丸。如果口渴严重，用七味白术散送服。如果元气下陷，用补中益气汤送服。如果兼有脾胃虚寒，用理中汤。又有患噤口痢的，《卫生方》说：噤口痢就是下痢不能进食。医生只知道病情危重，却畏缩不前不探究其产生的原因，所以大多救不活，实在可悲啊！《易简方》说适宜用四柱汤、理中汤、茯苓散加肉豆蔻、木香，或者咽震灵丹等药。为什么王德肤只知其一不知其二呢？古代方剂中有清心莲子饮及压毒药（解毒药），有用生胃进食药的，怎么能执着于一种药物来治疗呢？如果诊视得知其脾胃脉象不弱，询问得知其心烦头痛，手足温热，未曾多服凉药，这是毒瓦斯上冲心肺，所以呕吐而不进食。适宜用败毒散，每服四钱，用陈仓米一百粒，加生姜、大枣煎服。又一方：石莲子捶碎去壳留莲心，研为细末，用陈仓米饮调服。如果脉象微弱或心腹虚胀，或者手足厥冷，初病不呕，因为服用粟壳、乌梅及各种苦涩凉剂，或者饮用草药过多，早晨未进食先呕吐，不思饮食，这是脾胃虚弱，这时可以相信《简易方》的说法。又有一方更为简易，只用山药一味药，如小豆大小，一半在银石器内炒熟，一半生用，同为细末，用米饮调服，很有奇效。我又曾观察前辈治疗痈疽的方子，治疗呕吐逆气不进食的，也有一种说法：毒瓦斯攻心的，以内托散（乳香、绿豆粉制成）服用；脾气虚弱的，用嘉禾散、山药丸治疗。胸中应当存留活法，裁减选择方法，对于噤口痢，还担心什么不能在危重情况下取得疗效呢？大抵瘴后痢疾，极难治疗。如前面几种药物，虽然是良剂，只是准则罢了。至于临时的变通，在于医生充分发挥望闻问切的功效，极其精巧地辨别虚实寒热，然后施治，才可以成为人的救命恩人。
Post-miasma recovery is a hundred times more difficult than other diseases. Those skilled in health preservation must be diligent and cautious regarding diet and daily routine, allowing for not the slightest error. They should exercise caution for one hundred days until the primordial qi of the spleen and stomach recovers to its normal state, thereby avoiding complications. If one becomes lax after miasma, fails to maintain regular daily routines, indulges in diet, consumes purchased alcohol and cured meats, or acts without restraint in sexual activities, while the primordial qi of the spleen and stomach has not yet recovered and cannot digest food, will it not lead to accumulation resulting in dysentery, gathering resulting in phlegm, and floating resulting in edema? It is difficult to prescribe fixed formulas for treatment because post-miasma primordial qi is often deficient, lacking a foundation; how can one withstand disease under such conditions? The following methods of care are listed for prudent use. At the time of treatment, one should weigh deficiency and excess to apply tonification or purgation accordingly.
The cause of dysentery lies in the weakness of primordial qi and the spleen and stomach, combined with irregular diet leading to accumulation that fails to transform. Consequently, if damp-heat injures the Qi level, the stool is white; if it injures the Blood level, the stool is red; if both Qi and Blood are injured, red and white mix. Stools of green, yellow, or black colors result from damp-heat injuring various zang organs, manifesting the colors associated with their respective meridians. A pulse that is deep, small, continuous, and retains the Stomach Qi indicates survival; a pulse that is surging, large, and rapid indicates death. Cool body temperature with a calm pulse indicates survival; feverish body with a large pulse indicates death.
Treatment methods: In the early stage, characterized by abdominal pain, tenesmus, and dysentery, one must assess the state of the primordial qi. If the primordial qi is not yet deficient, administer Su Gan Wan (Su Gan Pill) first to purge the accumulation. If accompanied by excess heat, use Mu Xiang Bing Lang Wan (Aucklandia and Betel Nut Pill) for purgation according to the condition. This is because "no accumulation means no dysentery," so initial treatment should focus on cleansing to remove stagnation. If complicated by latent summerheat, administer with Xiang Ru Yin (Elsholtzia Decoction); if urination is difficult, administer with Wu Ling San (Five-Ingredient Powder with Poria). Subsequently, use herbs that promote digestion, harmonize Qi, and invigorate Blood, followed by Xiang Lian Wan (Coptis and Aucklandia Pill) or Bian Luan Wan. For chronic cases that do not stop, select Duan Xia Tang (Stop Dysentery Decoction) or Zhen Ren Yang Zang Yin (True Person's Nourishing Viscera Decoction) as appropriate. If the primordial qi is weak, do not use purgative methods. Instead, first use Liu Jun Zi Tang (Six-Gentlemen Decoction), adding herbs based on the ingested food, and administer with Bao He Wan (Preserve Harmony Pill). For rice injury, add Gu Ya (Sprouted Rice) and Shen Qu (Medicated Leaven); for grain injury, add Mai Ya (Sprouted Wheat) and Shen Qu; for meat injury, add Shan Zha (Hawthorn) and Shen Qu; for wine injury, add Gan Ge (Kudzu Root) and Shen Qu. If vomiting is present, add Sha Ren (Amomum Fruit) and Huo Xiang (Pogostemon Herb). Next, use Xiang Lian Wan and Si Shen Wan (Four Spirits Pill). If thirst is severe, administer with Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder). If primordial qi sinks, administer with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If complicated by spleen and stomach deficiency-cold, use Li Zhong Tang (Regulate the Middle Decoction).
Regarding Jinkou Li (Jin Kou Dysentery/Anorexic Dysentery), *Wei Sheng Fang* states that this condition involves dysentery with an inability to take food. Physicians often recognize the critical nature but shrink back without investigating the cause, leading to frequent failure in rescue, which is truly lamentable. *Yi Jian Fang* suggests using Si Zhu Tang (Four Pillar Decoction), Li Zhong Tang, Fu Ling San (Poria Powder) added with Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia), or Yan Zhen Ling Dan. Why does Wang Defu know only half the truth? Ancient formulas include Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction) and Ya Du Yao (Poison-Suppressing Drugs), or herbs that generate the stomach and promote intake. How can one rely on a single herb for treatment? If examination reveals the spleen and stomach pulse is not weak, and inquiry reveals irritability, headache, warm hands and feet, and no history of excessive cold medicine use, this is toxic vapors rushing upward to the heart and lungs, causing vomiting and refusal to eat. Use Bai Du San (Eliminate Toxins Powder), four qian per dose, decocted with one hundred grains of Chen Cang Mi (Stored Grain Rice), ginger, and jujube. Another formula: crush Shi Lian Zi (Stone Lotus Seed), remove the shell but keep the plumule, grind into fine powder, and take with Chen Cang Mi water. If the pulse is faint, or there is abdominal distension, or cold extremities, and initially no vomiting occurred but was induced by consuming Poppy Shell, Chinese Bayberry, bitter-astringent cold agents, or excessive herbal teas, leading to morning vomiting before eating and loss of appetite, this is spleen and stomach deficiency. In this case, trust *Yi Jian Fang*. An even simpler method uses only Shan Yao (Dioscorea Rhizome): take pieces the size of a mung bean, half stir-fried in silver/copper ware until cooked, half raw; grind together into powder and take with rice water. This has remarkable effects. I have also observed predecessors' formulas for carbuncles and sores treating vomiting and refusal to eat: if toxic vapors attack the heart, use Nei Tuo San (Internal Support Powder) made of Ru Xiang (Frankincense) and Lu Dou Fen (Mung Bean Powder); if spleen qi is weak, use Jia He San (Harvest Abundance Powder) or Shan Yao Wan. One must retain flexible principles in mind, selecting methods appropriately. For Jin Kou Dysentery, why worry about failing to achieve success in critical conditions? Generally, post-miasma dysentery is extremely difficult to treat. Although the aforementioned formulas are excellent, they serve only as guidelines. Temporary adjustments depend on the physician's mastery of inspection, auscultation/olfaction, inquiry, and palpation, skillfully distinguishing deficiency/excess and cold/heat before applying treatment, thus becoming a true savior of lives.