（附痢后风脱肛）
痢疾古名滞下。以气滞成积。积成痢。治法当以顺气为先。须当开胃。故谓无饱死痢病
也。
痢疾不问赤白而知为冷热之证。若手足和暖。则为阳。先用粟壳饮。调五苓散。进感应丸
若觉手足厥冷则为阴。当用暖剂。须常识此。
凡痢初发。不问赤白。里急后重。频欲登圊。及去而所下无多。既起而腹内复急。宜用
藿香正气散。加木香半钱。吞感应丸。或苏合香丸。吞感应丸。
赤痢血色鲜红。或如蛇虫形。而间有血鲜者。此属热痢。宜藿香正气散。加黑豆三十粒
五苓
散加木香半钱。粟米少许。下黄连丸。或黄连阿胶丸。茶梅丸。热甚服上项药未效。宜白头
翁汤。
若赤痢发热者。败毒散加陈仓米一撮煎。
若血色黯如瘀。服冷药所下愈多。去愈频者。当作冷痢。宜理中汤。或四君子汤。加肉
豆蔻
木香各半钱。若感暑气而成痢疾者。其人自汗发热。面垢呕逆。渴欲引饮。腹内攻刺。小便
不通。瘀血频并。宜香薷饮加黄连一钱。佐以五苓散。白汤调服。不愈则用蜜水调。感暑成
痢。疼甚而食不进者。六和汤藿香正气散各半帖。名木香交加散。
白痢下如冻胶。或如鼻涕。此属冷痢。先宜多饮除湿汤。加木香一钱。吞感应丸。继进
理中汤。亦有下如鱿色。或如腊茶色者。亦宜用前白痢药。
赤白杂者。宜胃苓饮加仓米一撮煎。吞驻车丸。
凡治痢须先逐去积滞。去已多。三五日后。自可兜涩。不问赤白。俱宜水煮木香丸。或
水煮
木香饮。真人养脏汤。或断下丸。如白痢久而虚甚者。养脏汤加熟附。赤痢加黑豆一小撮。
白痢加干姜一钱。赤痢亦可加黄连一钱。新下者不必加此。在人活法。
禁口痢者。有得病即不能进食者。或因冷药并药过多不食者。却不可拘于赤痢难用热药
之说。当以温中进食为先。宜治中汤。加木香半钱。或缩砂一钱。
休息痢。因兜住太早。积不尽除。或因痢愈而不善调理。以致时止时作。宜四君子汤。
加陈皮一钱。木香半钱。吞驻车丸。只缘兜住积滞。遂成休息。再投去积。却用兜剂。
劳痢。因痢久不愈。耗损积血。致肠胃虚空。变生他证。或五心发热。如劳之状。宜蓣
连饮
赤多倍莲肉。白多倍山药。痢后调补。宜四君子汤。加陈皮一钱半。即异攻散。恶甜者。
生料平胃散。加人参茯苓各半钱。诸病坏证。久下脓血。或如死猪肝色。或五色杂下。频出
无禁。有类于痢。俗名刮肠。此乃脏腑俱虚。脾气欲绝。故肠胃下脱。若投痢药则误矣。六
柱饮为稳。或可冀其万一。
痢后风。因痢后下虚。不善调将。或多行。或房劳。或感外邪。致两脚酸软。若痛若痹
遂
成风痢。独活寄生汤。吞虎骨四斤丸。或用大防风汤。将多以生樟即骨碎补。俗呼为胡孙姜
三分之一。同研取汁酒解服。外以杜仲牛膝杉木节白芷南星萆 煎汤熏洗。
脱肛一证。最难为药。热则肛门闭。寒则肛门脱。内用磁石研末。每二钱。食前米饮调
下。外用铁锈磨汤温洗。
下痢小便不通者。黄连阿胶丸为最。
（附：痢疾后引发的风证及脱肛）
痢疾在古代被称为“滞下”。这是因为气机阻滞形成积滞，积滞导致痢疾。治疗原则应当以顺气为先决条件，必须兼顾开胃。因此说，没有因饱食而死的痢疾病人。
判断痢疾是寒证还是热证，不需要看大便颜色是赤色还是白色。如果手足温暖，则属于阳证（热证），先用粟壳饮，配合调服五苓散，再服用感应丸；如果感觉手足厥冷，则属于阴证（寒证），应当使用温热的药物。这一点需要时常牢记。
凡是痢疾初发时，不论大便颜色是赤是白，出现里急后重、频繁想上厕所，但排便量很少，起身后腹部又感到紧迫的情况，适宜使用藿香正气散，加入半钱木香，吞服感应丸；或者使用苏合香丸，吞服感应丸。
大便带血且血色鲜红，或者形状像蛇虫，其中间夹杂着鲜血的，这属于热痢。适宜使用藿香正气散，加入三十粒黑豆；或者使用五苓散，加入半钱木香和少许粟米，送服黄连丸、黄连阿胶丸或茶梅丸。如果热势很盛，服用上述药物无效，适宜使用白头翁汤。
如果血色暗紫如瘀血，服用寒凉药物后腹泻反而更多、次数更频繁的，应当当作冷痢（寒痢）治疗。适宜使用理中汤，或者四君子汤，加入半钱肉豆蔻和半钱木香。如果是感受暑气而形成的痢疾，患者自汗、发热、面部污垢、呕吐逆气、口渴想喝水、腹部刺痛、小便不通、瘀血频繁出现，适宜使用香薷饮加入一钱黄连，佐以五苓散，用白开水调服。如果不见好转，则用蜜水调服。如果是感受暑气形成的痢疾，疼痛剧烈且无法进食的，将六和汤与藿香正气散各取半帖合用，称为“木香交加散”。
大便排出物像冻胶，或者像鼻涕一样的，这属于冷痢。先宜多饮用除湿汤，加入一钱木香，吞服感应丸。随后继服理中汤。也有排出物颜色像鱿鱼色，或者像腊茶色的，也适宜使用前文提到的治疗白痢的药物。
凡是治疗痢疾，必须先去除积滞。积滞去除较多后，过三五天，自然可以采用收敛固涩的方法。不论赤白痢，都适宜使用水煮木香丸，或者水煮木香饮，真人养脏汤，或者断下丸。如果是白痢日久且虚损严重的，在养脏汤中加入熟附子；赤痢加入一小撮黑豆；白痢加入一钱干姜；赤痢也可以加入一钱黄连。新发的痢疾不必添加这些药物。具体应用需灵活掌握。
禁口痢，是指患病后立即不能进食，或者因为过多服用寒凉药物及其他药物导致不能进食的情况。此时不可拘泥于“赤痢难用热药”的说法，应当以温中开胃进食为先。适宜使用治中汤，加入半钱木香或一钱缩砂仁。
休息痢，是因为过早使用收敛药物，积滞未能完全清除，或者痢疾痊愈后调理不当，导致病情时好时坏、反复发作。适宜使用四君子汤，加入一钱陈皮和半钱木香，吞服驻车丸。之所以形成休息痢，是因为过早收敛导致积滞滞留，再次投用去积药物后，再用收敛剂。
劳痢，是因为痢疾久治不愈，耗损气血，导致肠胃空虚，变生其他证候。或者出现五心烦热，像劳损一样的症状。适宜使用蓣连饮。如果赤痢多，加倍莲肉用量；如果白痢多，加倍山药用量。痢疾后的调理补益，适宜使用四君子汤，加入一钱半陈皮，即异攻散。如果厌恶甜味，可使用生料平胃散，加入半钱人参和半钱茯苓。各种疾病恶化出现的证候，长期下脓血，或者像死猪肝的颜色，或者五色混杂而下，频繁排出无法控制，有类似痢疾的表现，俗名“刮肠”。这是脏腑俱虚，脾气即将衰竭，导致肠胃下脱。如果投用治疗痢疾的药物则是错误的。使用六柱饮较为稳妥，或许还有一线希望。
痢后风，是因为痢疾之后下元虚弱，不善调养，或者过度劳累，或者房事不节，或者感受外邪，导致双腿酸软，若痛若痹，最终形成风痢。使用独活寄生汤，吞服虎骨四斤丸。或者使用大防风汤。用药时多用生樟脑（即骨碎补，俗称胡孙姜）三分之一，同研取汁，用酒送服。外用杜仲、牛膝、杉木节、白芷、南星、萆薢煎汤熏洗。
脱肛这一证候，最难用药。热证则肛门闭合（指内陷不收？注：此处原文逻辑较特殊，通常热闭寒脱，但原文意指热则肛门紧闭不通或收缩，寒则松弛脱出，结合下文磁石温肾固脱，此处理解为寒热病机对肛门状态的影响），寒证则肛门脱出。内服可用磁石研成末，每次二钱，饭前用米饮调服。外用铁锈磨成汤，温热清洗。
(Attached: Wind syndrome and rectal prolapse after dysentery)
Dysentery was formerly known as "Zhi Xia" (Stagnant Downward Flow). It arises because Qi stagnation forms accumulation, and accumulation leads to dysentery. The treatment principle should prioritize regulating Qi and must also open the stomach. Therefore, it is said that there are no deaths from dysentery caused by overeating.
To determine whether dysentery is a Cold or Heat pattern, one does not need to observe whether the stool is red or white. If the hands and feet are warm, it indicates a Yang pattern (Heat); use Shuke Yin (Poppy Shell Drink) first, combined with Wuling San (Five-Ingredient Poria Powder), followed by Yinggan Wan (Miraculous Response Pill). If the hands and feet feel cold, it indicates a Yin pattern (Cold); warm agents should be used. This point must be kept in mind constantly.
Whenever dysentery first appears, regardless of whether the stool is red or white, if there is tenesmus (urgent desire to defecate with little output), frequent urges to visit the toilet, scanty discharge despite straining, and abdominal urgency returning after rising, Huoxiang Zhengqi San (Agaricus Powder for Regulating the Qi and Correcting the Stomach) is suitable, added with Ban Qian (half qian) of Muxiang (Aucklandiae Radix), taken with Yinggan Wan; or Suhexiang Wan (Styrax Pill), taken with Yinggan Wan.
If the blood in the stool is bright red, or shaped like snakes or insects, with intermittent fresh blood, this belongs to Heat Dysentery. Huoxiang Zhengqi San is suitable, added with thirty Heidou (Black Soybeans); or Wuling San is suitable, added with Ban Qian of Muxiang and a small amount of Sumi (Millet), taken with Huanglian Wan (Coptis Pill), Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill), or Chamei Wan (Tea Plum Pill). If the heat is severe and the above medicines are ineffective, Baitouweng Tang (Pulsatilla Decoction) is suitable.
If red dysentery is accompanied by fever, Baidu San (Deficiency-Resisting Powder) decocted with a pinch of Chen Cang Mi (Aged Warehouse Rice) is suitable.
If the blood color is dark purple like stasis, and taking cold medicines results in more frequent and profuse diarrhea, it should be treated as Cold Dysentery. Lizhong Tang (Regulate the Middle Decoction) or Sijunzi Tang (Four Gentlemen Decoction) added with Ban Qian of Roudoukou (Nutmeg) and Ban Qian of Muxiang is suitable. If dysentery is caused by contracting Summerheat, the patient experiences spontaneous sweating, fever, greasy face, vomiting and reverse flow of Qi, thirst with desire to drink, stabbing abdominal pain, inability to urinate, and frequent presence of blood stasis. Xiangru Yin (Elsholtzia Drink) added with Yi Qian (one qian) of Huanglian, assisted by Wuling San, taken with plain water, is suitable. If not cured, take it mixed with honey water. For dysentery caused by Summerheat, where pain is severe and food intake is impossible, combining half portions of Liuhe Tang (Six Harmonies Decoction) and Huoxiang Zhengqi San, named Muxiang Jiaojia San (Aucklandia Mixed Powder), is suitable.
Discharge resembling gelatin or mucus belongs to Cold Dysentery. First, drink much Chushi Tang (Dampness-Removing Decoction) added with Yi Qian of Muxiang, taken with Yinggan Wan. Subsequently, proceed with Lizhong Tang. There are also cases where discharge resembles cuttlefish ink color or wax-tea color; these are also suitable for the previously mentioned medicines for white dysentery.
For mixed red and white dysentery, Weiling Yin (Gastrointestinal Regulation Drink) decocted with a pinch of Cangmi (Warehouse Rice), taken with Zhuche Wan (Stopping Station Pill), is suitable.
In treating dysentery, one must first eliminate accumulation. After much accumulation has been removed, after three to five days, astringent methods can naturally be employed. Regardless of red or white dysentery, Shuizhu Muxiang Wan (Water-Boiled Aucklandia Pill), Shuizhu Muxiang Yin (Water-Boiled Aucklandia Drink), Zhenren Yangzang Tang (True Man's Nourishing Viscera Decoction), or Duansha Wan (Stopping Downfall Pill) are suitable. For long-standing white dysentery with severe deficiency, add Shu Fuzi (Prepared Aconite) to Yangzang Tang; for red dysentery, add a small pinch of Heidou; for white dysentery, add Yi Qian of Ganjiang (Dried Ginger); for red dysentery, Yi Qian of Huanglian may also be added. These additions are not necessary for newly onset cases. Application depends on flexible clinical judgment.
Jinkou Li (Forbidden Mouth Dysentery) refers to cases where the patient cannot eat immediately upon falling ill, or due to excessive intake of cold medicines and other drugs leading to anorexia. One should not rigidly adhere to the saying that "red dysentery is difficult to treat with hot medicines." Instead, warming the middle and promoting appetite should be prioritized. Zhizhong Tang (Regulate the Middle Decoction) added with Ban Qian of Muxiang or Yi Qian of Suosha (Amomi Fructus Rotundus) is suitable.
Xiuxi Li (Resting Dysentery) occurs because astringents were used too early, leaving accumulation unremoved, or due to poor regulation after recovery, causing symptoms to cease and recur intermittently. Sijunzi Tang added with Yi Qian of Chenpi (Tangerine Peel) and Ban Qian of Muxiang, taken with Zhuche Wan, is suitable. The reason for becoming Resting Dysentery is that premature astringency trapped accumulation; thus, one must again use elimination methods, followed by astringents.
Lao Li (Labor Dysentery) occurs because prolonged dysentery consumes Qi and Blood, leaving the intestines and stomach empty, generating other syndromes. Or it presents with five-palm heat, resembling consumptive disease. Yulian Yin (Dioscorea and Coptis Drink) is suitable. If red dysentery predominates, double the amount of Lianrou (Lotus Seed Flesh); if white dysentery predominates, double the amount of Shanyao (Chinese Yam). For post-dysentery tonification, Sijunzi Tang added with Yi Qian Ban (one and a half qian) of Chenpi, i.e., Yigong San (Assisting Attack Powder), is suitable. If the patient dislikes sweet tastes, Shengliao Pingwei San (Raw Material Stomach-Calming Powder) added with Ban Qian of Renshen (Ginseng) and Ban Qian of Fuling (Poria) is suitable.
For deteriorated syndromes of various diseases, chronic discharge of pus and blood, or discharge resembling dead pig liver color, or mixed five colors, discharging frequently without control, resembling dysentery but commonly called "Gua Chang" (Scraping Intestines): this is due to deficiency of both Zang and Fu organs, with Spleen Qi nearing exhaustion, causing intestinal prolapse. Administering dysentery medicines would be a mistake. Liuzhu Yin (Six Pillars Drink) is stable and steady, perhaps offering a slim hope.
Li Hou Feng (Wind after Dysentery) occurs due to lower deficiency after dysentery, poor recuperation, excessive exertion, sexual indiscretion, or contraction of external pathogens, leading to soreness and weakness in both legs, pain or numbness, eventually forming Wind Dysentery. Duhuo Jisheng Tang (Angelicae Pubescentis and Taxillus Decoction) taken with Hugu Sijin Wan (Tiger Bone Four-Jin Pill) is suitable. Or Dafangfeng Tang (Great Wind-Expelling Decoction) is suitable. In usage, use Sheng Zhangnao (Borneol, specifically referring to Gusuibu/Drynariae Rhizoma here, colloquially Husun Jiang) one-third part, grind together to extract juice, and take with wine. Externally, decoct Duzhong (Eucommiae Cortex), Niuxi (Achyranthis Bidentatae Radix), Shanmujie (Cunninghamiae Caulis Nodes), Baizhi (Angelicae Dahuricae Radix), Nanxing (Arisae Tuber), and Biboa (Dioscoreae Hypoglaucae Rhizoma) for fumigation and washing.
Rectal prolapse is the most difficult condition to medicate. Heat causes the anus to close tightly; Cold causes the anus to prolapse. Internally, use Ci Shi (Magnetitum) ground into powder, two Qian each time, taken before meals with rice water. Externally, use iron rust ground into soup for warm washing.
For dysentery accompanied by inability to urinate, Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill) is the most suitable.