引翁年将花甲，秋季患痢，缠绵日久，清利过剂，肛如竹筒，直下无度，卧床不起，诊
脉细
濡，望色憔悴，知为脾肾两亏，元气下夺，所幸尚能纳谷，胃气未败。仿胃关煎，调石脂余
粮末，与服两日，其痢稍减。再加桑螵蛸，晚间参服四神丸，治疗匝月始。
安波按∶痢者利也，不可以通利治痢之常药，以医老人久痢之不固。其法不一，医师
胸有成竹耳。
予弟倚兰，服贾庐江。戊辰冬，予自中州回，道经彼地，羁留信宿，有王策勋先生者，
与予
弟善，抱其幼孙，恳为延医。视其体热面黄，肢细腹大，发焦目暗，颈起结核，予曰∶此乃
疳疾。疳者干也，小儿肠胃柔脆，乳食失调，运化不及，停积发热，热久津干，故名曰疳。
又谓之丁奚哺露。丁奚者，言奚童枯瘠如丁，哺露者，言愈哺而骨愈露。但是疾，每多生虫
，虫 日滋，侵蚀脏腑，非寻常药饵所能去病。古方有布袋丸，治此证多验。药用人参、白
术
、茯苓、使君子肉各一两，芦荟、夜明沙、芜荑、甘草各五钱，共为末，蒸饼糊丸，每粒约
重三钱，日用一丸，以夏布袋盛之。另切精猪肉二两，同煮汁服，肉亦可食。如法制就，服
完一料而愈。
安波按∶布袋丸名亦奇，方亦奇，故治亦奇。沈姓幼童五龄者，余之内戚也，患腹膨
形黑
，善食作泻，虽骨支床已半载矣，余宗是丸服半料，沉 霍然。盖意布袋者，今人之胃，如
物之袋，病久致疳，虫蚀已空，故其胃必虚，津液必涸，赖以猪肉汁充养胃阴，而从药得以
各司其司，同心共济，以奏凯歌也。
【背景信息】
书名：程杏轩医案 作者：程杏轩 朝代：清 章节：曹引泉翁竹筒痢 / 王策勋先生幼孙疳疾 类别：医论
【待处理原文】
曹引泉老先生年近六十，秋季患痢疾（以腹痛、里急后重、下痢赤白脓血为主要表现的病证），病程缠绵日久。因过度使用清热利湿的药物，导致肛门松弛如竹筒一般，大便直泻无度，卧床不起。诊其脉象细弱而软，望其面色憔悴，判断为脾肾两虚，元气下陷脱失。所幸尚能进食，说明胃气尚未败绝。仿照《景岳全书》中的胃关煎方义，调配禹余粮石脂散（由禹余粮、赤石脂组成的散剂）粉末服用。服药两日后，痢疾症状稍减。再加用桑螵蛸（桑螵蛸科昆虫大刀螂、小刀螂或巨斧螳螂的卵鞘），晚间配合服用四神丸（由补骨脂、肉豆蔻、吴茱萸、五味子组成的温肾暖脾、固肠止泻方剂）。治疗一个月后才痊愈。
安波按语：痢者，利也。不能用通常用于通利治疗的药物来治疗痢疾，尤其不能用此类常药去医治老人久痢不固之症。治疗方法不一，关键在于医师心中要有明确的策略和把握。
我的弟弟倚兰，在庐江经商。戊辰年冬天，我从中州返回，途经此地，停留了两晚。有一位王策勋先生，与我弟弟交好，抱着他年幼的孙子，恳请我延请医生诊治。观察患儿身体发热、面色发黄、四肢纤细、腹部膨大、头发焦枯、目光暗淡、颈部出现结核（淋巴结肿大），我说：这是疳疾（小儿脾胃受损、形体消瘦、面黄发焦、饮食异常的慢性消耗性疾病）。疳者，干也。小儿肠胃柔嫩脆弱，乳食失调，运化功能不及，导致食物停积发热，热久伤津液干枯，所以名叫疳。又叫做丁奚哺露。丁奚者，是说瘦小的童仆枯瘦如柴；哺露者，是说越是喂养，骨头越显露出来。但是疾病，往往多生虫，虫子日益滋生，侵蚀脏腑，不是寻常药物所能去除病邪的。古方中有布袋丸，治疗此证大多有效。药物用人参、白术、茯苓、使君子肉各一两，芦荟、夜明沙、芜荑、甘草各五钱，共研为末，用蒸饼糊制成丸剂，每粒约重三钱，每日服用一丸，装在布袋中。另切精猪肉二两，同煮取汁服用，肉也可以吃。按照这种方法制作，服完一料便痊愈了。
安波按语：布袋丸名字奇特，方剂奇特，所以疗效也奇特。沈姓幼童五岁，是我的内戚，患有腹部膨大、形体黑瘦、食欲旺盛但腹泻的症状，虽然骨骼支撑着床铺已经半年了，我遵循这个方子服用半料，沈姓孩童立刻霍然痊愈。大概意思是，布袋者，如同今人的胃，像装东西的袋子，病久导致疳疾，虫子侵蚀已空，所以他的胃必然虚弱，津液必然枯竭，依靠猪肉汁来充养胃阴，从而让药物各司其职，同心协力，以取得胜利的凯歌。
[Background Information]
Book: *Cheng Xingxuan's Medical Cases* | Author: Cheng Xingxuan | Dynasty: Qing | Chapter: Old Man Cao Yinquan's Bamboo-Tube Dysentery / Mr. Wang Cexun's Young Grandson's Gan Disease | Category: Medical Discussion
[Original Text to Process]
Old Man Cao Yinquan was approaching sixty years of age when he contracted dysentery (a disease characterized by abdominal pain, tenesmus, and passage of bloody or purulent stool) in autumn. The condition lingered for a long time. Due to the excessive use of clearing-heat and draining-dampness medications, his anus became lax like a bamboo tube, with uncontrolled direct diarrhea, leaving him bedridden. His pulse was fine and soggy (Xì Rú), and his complexion was haggard. It was determined that this was a deficiency of both Spleen and Kidney, with Yuan Qi (Primordial Qi) sinking and escaping. Fortunately, he could still take food, indicating that Stomach Qi had not yet collapsed. I modeled the prescription after Wei Guan Jian (Stomach-Guarding Decoction), compounded with Yu Liang Shi Zhi San (Powder of Yu Yu Liang and Chi Shi Zhi), and administered it. After two days, the dysentery slightly decreased. Then, Sang Piao Xiao (Mantis Egg-case) was added, and Si Shen Wan (Four Spirits Pill) was taken in the evening. The treatment lasted a month before he recovered.
An Bo’s Commentary: Dysentery (Li) implies discharge. One cannot use the usual purgative or draining herbs intended for treating dysentery to manage the non-retention caused by chronic dysentery in the elderly. The methods vary; the key lies in the physician having a clear strategy in mind.
My younger brother, Yi Lan, was engaged in commerce in Lujiang. In the winter of the Wuchen year, upon returning from Zhongzhou, I passed through that area and stayed for two nights. There was a Mr. Wang Cexun who was on good terms with my brother. He brought his young grandson and earnestly requested I arrange medical care. Observing the child’s body heat, yellowish complexion, thin limbs, distended abdomen, dry and brittle hair, dim eyes, and cervical tubercles (swollen lymph nodes), I said: This is Gan disease (a chronic wasting syndrome in children characterized by spleen-stomach damage, emaciation, sallow complexion, dry hair, and abnormal diet). "Gan" means dryness. Children’s intestines and stomach are tender and fragile. If milk and food intake are irregular, transportation and transformation fail, leading to stagnation and heat accumulation. Prolonged heat dries up body fluids, hence the name Gan. It is also called Ding Xi Bu Lu. "Ding Xi" refers to a skinny servant boy looking as lean as a peg; "Bu Lu" means the more one feeds him, the more his bones protrude. However, this disease often involves parasites. As parasites multiply daily, they erode the Zang-Fu organs, and ordinary medicines cannot eliminate the pathogen. An ancient formula, Bu Dai Wan (Cloth-Bag Pill), is effective for this condition. The ingredients are Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Fu Ling (Poria), and Shi Jun Zi Rou (Quisqualis Seed Flesh), each at one tael; Lu Hui (Aloe), Ye Ming Sha (Trogopterus Dung), Wu Yi (Chaulmoogra Seed), and Gan Cao (Licorice Root), each at five qian. These are ground into powder, mixed with steamed bread paste to form pills, each weighing approximately three qian. One pill is taken daily, stored in a cloth bag. Additionally, cut two liang of lean pork, boil it together to extract the juice for administration; the meat may also be eaten. Following this method, completing one course resulted in a cure.
An Bo’s Commentary: Bu Dai Wan has a peculiar name, a peculiar formula, and thus a peculiar efficacy. A five-year-old child surnamed Shen, who is my relative, suffered from abdominal distension, darkened emaciation, voracious appetite but diarrhea. Although his bones were supporting his bed for half a year, I followed this pill, administering half a course, and Shen recovered instantly. My interpretation is that the "cloth bag" represents the modern human stomach, like a sack holding items. Chronic illness leads to Gan disease, where parasites have hollowed out the interior, so the Stomach must be deficient, and body fluids depleted. Relying on pork juice to nourish Stomach Yin allows the medicinal herbs to perform their respective functions, working in concert to achieve victory.