痢多发于秋，即《内经》之肠 也。症由胃腑湿蒸热壅，致气血凝结，挟糟粕积滞，进入大小腑，倾
刮脂液，化脓血下注，或痢白，痢红，痢瘀紫，痢五色，腹痛呕吐，口干溺涩，里急后重，气陷肛坠，因其
闭滞不利，故亦名滞下也。俗以白属寒，赤属热，不知白伤气分，赤伤血分，赤白相间，气血俱伤。伤气分
则调气，四七汤、木香化滞汤。伤血分则和血，四物地榆汤或理阴煎加减。易老所谓调气则后重除，和血则
便脓愈也。然论致痢之由，其暑湿伤胃者，郁热居多，生冷伤脾者，寒滞为甚，入手宜分。气陷则仓廪不藏，
阴亡则门户不闭。由脾伤肾，势所必然。故郁热者清之，芩连芍药汤。寒滞者温之，香砂枳术丸、香砂异功散。
湿胜者泄之，四苓散白术改苍术。宿食者消之，保和丸。
积滞者导之，小承气汤、熟大黄丸。腹痛者和之，芍药汤加木香。气陷下者举之，补中益气汤。虚滑者摄之，
赤石脂禹余粮丸。脂液涸者润之，猪脏汤、阿胶丸。久不愈者补而固之，八珍汤加炮姜、肉桂、木香、肉果、
乌梅、牡蛎。痢止后调之，参苓白术散。治法尽此矣。而症之寒热虚实，宜细审焉。凡痢挟热者多实，初起
外受暑热，内因停滞，绕脐痛胀，烦渴迸迫，下痢鲜红，脉洪滑者，宜清火导滞。导气汤、芍药汤去桂。如
挟虚感寒，生冷不节，脾失转输，因而呕逆，下痢白脓，脉弦弱者，宜温理脾胃，兼佐行气。香砂温胃饮。盖
因寒伤脏，忌用苦寒下夺也。况所痢脓垢，皆大小肠脂液所化，已非胃腑宿食，不得误认积滞，肆行攻下，
剥削殆尽，但见下利血水，或如屋漏水，即须温摄。黑豆散加苓、术、茴香、肉果。如痢纯血，鲜红成块者，
多心脾伏热。用黄连、白芍、丹皮。黑栀、黑荆芥、生地。若未止，地榆丸。其血紫黯稀淡，乃阳虚不能摄阴，
宜温调其气，非炮姜不治。理中汤加木香。痢色黑有二，焦黑者热极反兼胜己之化，芩芍汤、香连丸。光
如黑漆者为瘀血，桃仁承气汤。纯下清血者，为肠胃风袭，胃风汤加枳、荆、防。五色痢乃五脏气化并伤。
昔人以为肾损，盖不液不守，精室受伤，治必益火消阴，实脾防水，兼理其气。真人养脏汤。赤白痢由冷热
不调。驻车丸，连理汤。痢纯白乃脏寒气滑，与暴注属热不同，或如冻胶，如鱼脑，由气分致病，为脏寒滞下。
先用沉香、白蔻、木香、小茴、砂仁。次用理中汤加香、砂。白痢初起，里急后重，为湿郁化热。平胃散加香、
砂。痢稀白肢冷腹痛不已，附子理中汤。痢清谷里寒外热，汗出而厥，通脉四逆汤。先白痢，后下脓血者，
戊己丸。先白痢，后下鲜血者，阿胶四物汤。先痢脓血，后变青黑杂色，腹痛倍常者，驻车丸。先脓血，后
变白沫白脓者，补中益气汤加炮姜、赤石脂。下痢发热者，疏其邪，仓廪散。腹痛身微热者，和其营。小建中
汤。一种阴虚下血发热，烦渴至夜转剧者，急宜救液存阴。阿胶丸、阿胶梅连丸、黄连阿胶丸。下痢渐减，
津液枯燥，肛门涩滞者，猪脏汤。痢后便秘后重，由气虚下陷者，升其阳则阴自降。补中益气汤加防风。脓
血稠粘，挟热后重，烦渴脉洪者，白头翁
汤。湿热下痢后重者，升阳除湿汤。风邪伤卫，后重不除者，三奇散。虚滑而后重者，痢后不减，真人养脏汤。
虚滑而腑阳向衰者，桃花汤加人参。里急仍不得便，属气滞，苏子降气汤。里急频见污衣者，为气脱，补中益
气汤去当归、加肉果。洞泻不止，真人养脏汤。下利大孔痛，火因泻陷，升其气则痛自定，补中益气汤。
〔噤口痢〕乃热气自下冲上而犯胃口，肠中传导，皆逆阻似闭。宜人参、石莲、石菖蒲、竹茹、茯苓、
麦冬、粳米。丹溪用人参、石莲、黄连浓煎，加姜汁冲服。但得下咽便开，如胃虚呕逆，治中汤加丁香。
肝邪乘脾呕逆，吴茱萸汤加丁香、白芍、青皮、黄连、乌梅肉。久痢噤口不食，非大补胃气，兼行津液，不
能开。香砂四君汤加扁豆、薏仁、藿香、煨葛根、粳米。得胃气一醒思食，宜独参汤，少加橘皮。
〔休息痢〕屡止屡发，经久不愈，诃黎勒丸。因兜涩太早，积滞未清者，香连丸加茯苓、枳实。因饮食
失节者，香连丸加楂肉、神曲。因中气下陷者，补中益气汤。因脏寒虚滑者，大断下丸。
〔风痢〕纯下青沫，苍术防风汤。寒痢白如鸭溏，肠鸣痛坠不甚，理中汤、诃子肉汤。暑痢面垢烦冤，
燥渴引饮，薷苓汤。湿痢身重腹满，红黑混浊，除湿汤。脾湿血痢，苍术地榆汤。气痢下如蟹沫，气痢丸。
疫痢时邪传染，一方相似，人参败毒散加减。蛊蛀毒痢，血如鸡冠，乌梅丸。蛲虫痢虫形极细，从谷道溢出，
以雄黄锐散纳下部，内服芜荑丸。疟后痢，痢后疟，东坡姜茶饮。疟痢齐发，补中益气汤加减。洞泻不止，
厥逆，附子理中汤。胎前赤白痢，连理汤加胶艾。胎前痢，产后未止，最危。驻车丸，伏龙肝汤加减。
〔协热下利〕由上受温暑湿热之邪，循募原下陷肠胃，或血水，或粘腻，皆湿热传化，宜用分消，清热
利湿。如浓朴、黄芩、茯苓、滑石、猪苓、泽泻、广皮、扁豆，甚则加黄连。
凡治痢与治泻异，水泻由清浊不分，可利小便。痢则邪毒胶滞，津液枯涩，大忌分利，且痢久必伤肾，
肾阴亏，宜滋液。黑
地黄丸、六味地黄丸。肾阳虚，宜益火，如四神丸，及沉香、桂、附、益智。以肾为胃关，开窍于二阴也。
故痢久先温脾，不应，即温肾。丹溪以先泻后痢为脾传肾，为贼邪，难治；先痢后泻为肾传脾，为微邪，易愈。
故治痢以脾肾为要。
噤口痢由热气自下上冲而犯胃口，肠中传导，皆逆阻似闭，宜清解热毒。如黄连、酒炒黄芩、白芍、
石莲肉、广皮、银花、楂肉、木香汁。又方，五谷虫焙黄研末，黑糖拌匀，新汲水送下，即愈。
痢症初起，有兼外感者，身必发热，表里俱病，其症最重，宜表里并治。
痢疾初起，必兼湿热宿滞，宜用治痢散。葛根、苦参、松萝茶叶、麦芽、山楂、赤芍、陈皮研末，每服
四钱，加黄连尤效。此方出《医学心悟》，不论赤白皆效。葛根，鼓舞胃气上行也。茶叶、苦参，清湿热也。
麦芽、山楂，消宿食也。赤芍、陈皮，行血调气也。腹痛里虚者，用橘饼半个，红枣十枚，沙糖五钱，煎
汤服，立效。
《医通》曰∶痢后风者，因痢后不善调摄，或多行，或房劳，或受风寒，或感湿气，致两脚痿软肿痛。
宜大防风汤。又痢后变成痛风，皆调摄失宜所致。宜补中益气汤加羌活、续断、虎骨。
《病机沙篆》曰∶痢起夏秋，湿热郁蒸因乎天，生冷停滞由乎人，当炎暑令行，不能保摄脾胃，多食瓜
果肥甘，土气受伤，无以制湿，湿蒸热壅，气机阻逆，不得宣通，因而肠胃反窒，里急后重，小水赤涩。宜苦寒
之药，燥湿涤热，佐以辛温，便能开郁运气。故行血则便脓自愈，调气则后重自除。然虚寒实热，浅深新久
之不同，难一例治。
沈朗仲曰∶痢症初起，形气尚强，胀实坚痛者，可速去积，积去痢止，此通因通用，症随痢减之法。
若烦热喜冷，脉实腹满，或下纯红鲜血者，此湿热内盛，法宜清利。若经久正伤，有伤阴伤阳两途。伤阴者精
血脂液，悉从痢去，多烦躁热渴之候，宜以清润养其阴。伤阳者脾肾元阳，悉从痢散，多滑脱厥逆之候，宜
行温补回其阳。总之暴病多实，久病多虚，滑脱者多寒，涩滞者
多热。参之脉症，合之新久，百无一失矣。
附倪涵初痢疾三方
〔初起煎方〕黄连（去芦） 黄芩 白芍 楂肉（各一钱二分） 枳壳（去穣） 浓朴（姜汁炒）
槟榔 青皮（去穣。各八分） 当归 地榆 甘草（炙。各五分） 红花（酒炒，三分） 木香（二分）
桃仁（研，一钱）
如法炮制，水二碗，煎一碗，空心服。此方治红白痢，里急后重，身热腹痛者，皆宜。如痢纯白，去地榆、
桃仁，加橘红四分，木香三分。如滞涩甚者，加酒炒大黄二钱，服一二剂，仍除之。若服过一剂，滞涩已去，
不必再服。年幼者，大黄只用一钱。
上方用之三五日神效，旬日亦效，半月后则当加减。
〔加减煎方〕黄连（酒炒，六分，生用四分） 白芍（酒炒，六分，生用四分） 楂肉（一钱） 橘红 青皮
槟榔（各四分） 炙草（三分，生用二分） 当归（五分） 地榆（四分） 桃仁（研粉，六分） 红花（三分）
木香（二分）
如法制服，延至月余，脾胃虚弱而滑泄，当补理。
〔补理煎方〕黄连（酒炒，五分） 黄芩（酒炒，六分） 白芍（酒炒，四分） 橘红（六分） 当归（五分）
人参（五分） 白术（盐炒，五分） 炙草（五分）
如法制服，以上三方，如妇人有胎，去桃仁、红花、槟榔服。
一忌温补早。痢起于湿热蕴积，胶滞肠胃，宜清热邪，导滞气，行瘀血，其病即去。若用参、术等温补药，
则热愈盛，气愈滞，血亦凝，邪何由去。
一忌大下。痢因邪热胶滞，用疏通则愈。若用大承气汤下之，胶滞未去，徒伤胃气，损元气耳。正气伤损，
邪气不可除，壮者犹可，弱者危矣。
一忌发汗。痢发寒热，头目痛眩，由内毒熏蒸，自内达外，非表邪也。若发汗，则风剂燥热，愈助热邪，
正虚于外，邪炽于内，鲜不毙矣。
一忌分利。痢因热邪胶滞，津液枯涩，若用五苓等分利其水，则津液愈枯，枯涩愈甚，缠绵不止。第清
热导滞，则痢自愈，而小便自清。安用分利为？利小便为治水泻之良法，以之治痢，则大乖矣。
痢疾多发于秋季，也就是《内经》中所说的“肠澼”病。病症由胃腑湿气蒸腾、热邪壅滞，导致气血凝结，夹杂糟粕积滞，进入大小肠，刮削脂液，化为脓血向下排出，或表现为白痢、红痢、紫黑瘀血痢、五色痢，伴有腹痛呕吐、口干尿涩、里急后重、气陷肛门坠胀等症状。因其闭滞不通利，所以也叫做“滞下”。世俗认为白痢属寒，红痢属热，却不知道白痢损伤气分，红痢损伤血分，赤白相间则是气血俱伤。损伤气分的，应当调气，用四七汤、木香化滞汤；损伤血分的，应当和血，用四物地榆汤或理阴煎加减。易老（张元素）所谓“调气则后重除，和血则便脓愈”。然而论述致痢的原因，暑湿伤胃的，郁热居多；生冷伤脾的，寒滞为甚，入手治疗时应当分辨清楚。气陷则仓廪不固藏，阴亡则门户不闭合。由脾伤及肾，是势所必然的。所以郁热的用清热法，用芩连芍药汤；寒滞的用温法，用香砂枳术丸、香砂异功散；湿胜的用泄法，用四苓散将白术改为苍术；宿食用消导法，用保和丸；积滞的用导法，用小承气汤、熟大黄丸；腹痛的用调和法，用芍药汤加木香；气陷下的用升举法，用补中益气汤；虚滑的用摄纳法，用赤石脂禹余粮丸；脂液枯竭的用滋润法，用猪脏汤、阿胶丸；久治不愈的用补益固涩法，用八珍汤加炮姜、肉桂、木香、肉豆蔻、乌梅、牡蛎。痢止后的调理，用参苓白术散。治疗方法尽在此处了。而病症的寒热虚实，应当仔细审察。凡是痢疾挟热的多属实证，初起外受暑热，内因停滞，绕脐疼痛胀满，烦渴逼迫，下痢鲜红，脉象洪滑的，宜清火导滞，用导气汤、芍药汤去桂枝。如挟虚感寒，生冷不节，脾失转输，因而呕逆，下痢白脓，脉象弦弱的，宜温理脾胃，兼佐行气，用香砂温胃饮。因为寒伤脏腑，忌用苦寒攻下之药。况且所下的脓垢，都是大小肠脂液所化，已不是胃腑的宿食，不得误认为是积滞而肆意攻下，剥削殆尽，只见到下利血水，或像屋漏水一样，就须温摄，用黑豆散加茯苓、白术、茴香、肉豆蔻。如果痢纯血，鲜红成块的，多是心脾伏热，用黄连、白芍、丹皮、黑栀子、黑荆芥、生地。如果不止，用地榆丸。如果血色紫黯稀淡，是阳虚不能摄阴，宜温调其气，非炮姜不能治愈，用理中汤加木香。痢色黑有两种情况，焦黑的是热极反兼胜己之化（热极似寒），用芩芍汤、香连丸；光亮如黑漆的是瘀血，用桃仁承气汤。纯下清血的，是肠胃风袭，用胃风汤加枳壳、荆芥、防风。五色痢是五脏气化并伤。古人认为是肾损，因为不液不守，精室受伤，治疗必须益火消阴，实脾防水，兼理其气，用人参养脏汤。赤白痢由冷热不调引起，用驻车丸、连理汤。痢纯白乃是脏寒气滑，与暴注（急性腹泻）属热不同，有的像冻胶，像鱼脑，是由气分致病，属于脏寒滞下。先用沉香、白蔻、木香、小茴香、砂仁。次用理中汤加木香、砂仁。白痢初起，里急后重，是湿郁化热，用平胃散加木香、砂仁。痢稀白肢冷腹痛不已，用附子理中汤。痢清谷（完谷不化）里寒外热，汗出而四肢厥冷，用通脉四逆汤。先下白痢，后下脓血的，用戊己丸。先下白痢，后下鲜血的，用阿胶四物汤。先痢脓血，后变青黑杂色，腹痛加倍严重的，用驻车丸。先脓血，后变白沫白脓的，用补中益气汤加炮姜、赤石脂。下痢发热的，疏解其邪，用仓廪散。腹痛身微热的，调和其营卫，用小建中汤。有一种阴虚下血发热，烦渴至夜间加剧的，急宜救液存阴，用阿胶丸、阿胶梅连丸、黄连阿胶丸。下痢渐减，津液枯燥，肛门涩滞的，用猪脏汤。痢后便秘后重，由气虚下陷引起的，升其阳气则阴气自然下降，用补中益气汤加防风。脓血稠粘，挟热后重，烦渴脉洪的，用白头翁汤。湿热下痢后重的，用升阳除湿汤。风邪伤卫，后重不除的，用三奇散。虚滑而后重的，痢后不减的，用人参养脏汤。虚滑而腑阳向衰的，用桃花汤加人参。里急仍不得便，属气滞，用苏子降气汤。里急频见污衣的，为气脱，用补中益气汤去当归、加肉豆蔻。洞泻不止的，用人参养脏汤。下利大孔痛，火因泻陷，升其气则痛自定，用补中益气汤。
【噤口痢】乃热气自下冲上而犯胃口，肠中传导，皆逆阻似闭。宜用人参、石莲、石菖蒲、竹茹、茯苓、麦冬、粳米。丹溪用人参、石莲、黄连浓煎，加姜汁冲服。但得下咽便开，如胃虚呕逆，用治中汤加丁香。肝邪乘脾呕逆，用吴茱萸汤加丁香、白芍、青皮、黄连、乌梅肉。久痢噤口不食，非大补胃气，兼行津液，不能开胃。用香砂四君汤加扁豆、薏仁、藿香、煨葛根、粳米。得胃气一醒思食，宜独参汤，少加橘皮。
【休息痢】屡止屡发，经久不愈，用诃黎勒丸。因兜涩太早，积滞未清的，用香连丸加茯苓、枳实。因饮食失节的，用香连丸加山楂肉、神曲。因中气下陷的，用补中益气汤。因脏寒虚滑的，用大断下丸。
【风痢】纯下青沫，用苍术防风汤。寒痢白如鸭溏，肠鸣痛坠不甚，用理中汤、诃子肉汤。暑痢面垢烦冤，燥渴引饮，用薷苓汤。湿痢身重腹满，红黑混浊，用除湿汤。脾湿血痢，用苍术地榆汤。气痢下如蟹沫，用气痢丸。疫痢时邪传染，一方相似，用人参败毒散加减。蛊蛀毒痢，血如鸡冠，用乌梅丸。蛲虫痢虫形极细，从谷道溢出，以雄黄锐散纳下部，内服芜荑丸。疟后痢，痢后疟，用东坡姜茶饮。疟痢齐发，用补中益气汤加减。洞泻不止，厥逆，用附子理中汤。胎前赤白痢，用连理汤加胶艾。胎前痢，产后未止，最危，用驻车丸，伏龙肝汤加减。
【协热下利】由上受温暑湿热之邪，循募原下陷肠胃，或血水，或粘腻，皆湿热传化，宜用分消，清热利湿。如厚朴、黄芩、茯苓、滑石、猪苓、泽泻、广皮、扁豆，甚则加黄连。
凡治痢与治泻异，水泻由清浊不分，可利小便。痢则邪毒胶滞，津液枯涩，大忌分利，且痢久必伤肾，肾阴亏，宜滋液，用黑地黄丸、六味地黄丸。肾阳虚，宜益火，如四神丸，及沉香、桂、附、益智。以肾为胃关，开窍于二阴也。故痢久先温脾，不应，即温肾。丹溪以先泻后痢为脾传肾，为贼邪，难治；先痢后泻为肾传脾，为微邪，易愈。故治痢以脾肾为要。
噤口痢由热气自下上冲而犯胃口，肠中传导，皆逆阻似闭，宜清解热毒。如黄连、酒炒黄芩、白芍、石莲肉、广皮、银花、楂肉、木香汁。又方，五谷虫焙黄研末，黑糖拌匀，新汲水送下，即愈。
痢症初起，有兼外感者，身必发热，表里俱病，其症最重，宜表里并治。
痢疾初起，必兼湿热宿滞，宜用治痢散。葛根、苦参、松萝茶叶、麦芽、山楂、赤芍、陈皮研末，每服四钱，加黄连尤效。此方出《医学心悟》，不论赤白皆效。葛根，鼓舞胃气上行也。茶叶、苦参，清湿热也。麦芽、山楂，消宿食也。赤芍、陈皮，行血调气也。腹痛里虚者，用橘饼半个，红枣十枚，沙糖五钱，煎汤服，立效。
《医通》曰：痢后风者，因痢后不善调摄，或多行，或房劳，或受风寒，或感湿气，致两脚痿软肿痛。宜大防风汤。又痢后变成痛风，皆调摄失宜所致。宜补中益气汤加羌活、续断、虎骨。
《病机沙篆》曰：痢起夏秋，湿热郁蒸因乎天，生冷停滞由乎人，当炎暑令行，不能保摄脾胃，多食瓜果肥甘，土气受伤，无以制湿，湿蒸热壅，气机阻逆，不得宣通，因而肠胃反窒，里急后重，小水赤涩。宜苦寒之药，燥湿涤热，佐以辛温，便能开郁运气。故行血则便脓自愈，调气则后重自除。然虚寒实热，浅深新久之不同，难一例治。
沈朗仲曰：痢症初起，形气尚强，胀实坚痛者，可速去积，积去痢止，此通因通用，症随痢减之法。若烦热喜冷，脉实腹满，或下纯红鲜血者，此湿热内盛，法宜清利。若经久正伤，有伤阴伤阳两途。伤阴者精血脂液，悉从痢去，多烦躁热渴之候，宜以清润养其阴。伤阳者脾肾元阳，悉从痢散，多滑脱厥逆之候，宜行温补回其阳。总之暴病多实，久病多虚，滑脱者多寒，涩滞者多热。参之脉症，合之新久，百无一失矣。
〔初起煎方〕黄连（去芦） 黄芩 白芍 楂肉（各一钱二分） 枳壳（去穣） 浓朴（姜汁炒） 槟榔 青皮（去穣。各八分） 当归 地榆 甘草（炙。各五分） 红花（酒炒，三分） 木香（二分） 桃仁（研，一钱）
如法炮制，水二碗，煎一碗，空心服。此方治红白痢，里急后重，身热腹痛者，皆宜。如痢纯白，去地榆、桃仁，加橘红四分，木香三分。如滞涩甚者，加酒炒大黄二钱，服一二剂，仍除之。若服过一剂，滞涩已去，不必再服。年幼者，大黄只用一钱。
上方用之三五日神效，旬日亦效，半月后则当加减。
〔加减煎方〕黄连（酒炒，六分，生用四分） 白芍（酒炒，六分，生用四分） 楂肉（一钱） 橘红 青皮 槟榔（各四分） 炙草（三分，生用二分） 当归（五分） 地榆（四分） 桃仁（研粉，六分） 红花（三分） 木香（二分）
〔补理煎方〕黄连（酒炒，五分） 黄芩（酒炒，六分） 白芍（酒炒，四分） 橘红（六分） 当归（五分） 人参（五分） 白术（盐炒，五分） 炙草（五分）
一忌温补早。痢起于湿热蕴积，胶滞肠胃，宜清热邪，导滞气，行瘀血，其病即去。若用参、术等温补药，则热愈盛，气愈滞，血亦凝，邪何由去。
一忌大下。痢因邪热胶滞，用疏通则愈。若用大承气汤下之，胶滞未去，徒伤胃气，损元气耳。正气伤损，邪气不可除，壮者犹可，弱者危矣。
一忌发汗。痢发寒热，头目痛眩，由内毒熏蒸，自内达外，非表邪也。若发汗，则风剂燥热，愈助热邪，正虚于外，邪炽于内，鲜不毙矣。
一忌分利。痢因热邪胶滞，津液枯涩，若用五苓等分利其水，则津液愈枯，枯涩愈甚，缠绵不止。第清热导滞，则痢自愈，而小便自清。安用分利为？利小便为治水泻之良法，以之治痢，则大乖矣。
Dysentery (Li, Dysentery) mostly occurs in autumn, which is the "Chang Pi" (Intestinal Disorder with Pus and Blood) mentioned in the *Nei Jing* (Inner Canon). The syndrome arises from dampness steaming and heat obstructing in the Stomach Fu organ, causing Qi and Blood to coagulate, carrying undigested food residues and stagnation into the Large and Small Intestines. This scrapes away the mucous membranes, transforming them into pus and blood that discharge downward. Symptoms may include white dysentery, red dysentery, purple-black bloody dysentery, or five-color dysentery, accompanied by abdominal pain, vomiting, dry mouth, difficult urination, tenesmus (Li Ji Hou Zhong), sinking of Qi with anal prolapse. Because of this obstruction and lack of free flow, it is also called "Zhi Xia" (Stagnant Downward Discharge). Folk belief holds that white indicates cold and red indicates heat; however, they do not know that white injury affects the Qi level, red injury affects the Blood level, and mixed red and white injures both Qi and Blood. If the Qi level is injured, regulate Qi using Si Qi Tang (Four Seven Decoction) or Mu Xiang Hua Zhi Tang (Aucklandia Decoction for Transforming Stagnation). If the Blood level is injured, harmonize Blood using Si Wu Di Yu Tang (Tetrad Decoction with Sanguisorba) or Li Yin Jian (Decoction for Nourishing Yin) with modifications. Yi Lao (Zhang Yuansu) stated: "Regulating Qi eliminates tenesmus; harmonizing Blood cures pus discharge." However, regarding the causes of dysentery: those caused by summer-heat and dampness injuring the Stomach mostly involve stagnant heat; those caused by raw/cold foods injuring the Spleen mostly involve severe cold stagnation. Treatment must distinguish between these at the outset. If Qi sinks, the Granary (Spleen/Stomach) cannot store; if Yin perishes, the gates (Anus/Urethra) cannot close. Injury to the Spleen inevitably leads to Kidney injury. Therefore, for stagnant heat, clear it using Qin Lian Shao Yao Tang (Scutellaria, Coptis, and Peony Decoction); for cold stagnation, warm it using Xiang Sha Zhi Zhu Wan (Aucklandia and Amomum Pill for Fortifying the Spleen) or Xiang Sha Yi Gong San (Aucklandia and Amomum Powder for Extraordinary Efficacy); for excessive dampness, drain it using Si Ling San (Four Poria Powder) replacing Bai Zhu with Cang Zhu; for retained food, resolve it using Bao He Wan (Preserve Harmony Pill); for accumulation and stagnation, guide it out using Xiao Cheng Qi Tang (Minor Order the Qi Decoction) or Shu Da Huang Wan (Prepared Rhubarb Pill); for abdominal pain, harmonize using Shao Yao Tang (Peony Decoction) added with Mu Xiang; for sinking Qi below, lift it using Bu Zhong Yi Qi Tang (Decoction for Supplementing the Middle and Augmenting the Qi); for deficiency and slipping, secure it using Chi Shi Zhi Yu Liang Wan (Red Stone and Hematite Pill); for dried-up mucous membranes, moisten them using Zhu Zang Tang (Pig Intestine Decoction) or E Jiao Wan (Donkey-Hide Gelatin Pill); for chronic non-healing cases, tonify and consolidate using Ba Zhen Tang (Eight Treasures Decoction) added with Pao Jiang (Roasted Ginger), Rou Gui (Cinnamon Bark), Mu Xiang, Rou Dou Kou (Nutmeg), Wu Mei (Mume Fruit), and Mu Li (Oyster Shell). For post-dysentery regulation, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). These are the complete treatment methods. One must carefully examine the cold, heat, deficiency, and excess of the syndrome. Generally, dysentery with heat is mostly excess: initial onset involves external summer-heat and internal stagnation, causing periumbilical pain and distension, irritability, thirst, urgency, bright red stool, and a洪 (Surging) and Hua (Slippery) pulse. Clear fire and guide out stagnation using Dao Qi Tang (Qi-Guiding Decoction) or Shao Yao Tang removing Gui Zhi. If deficient and affected by cold due to improper diet of raw/cold foods, leading to Spleen failure in transformation and transportation, causing vomiting and white purulent stool with a Xian (Wiry) and Ruo (Weak) pulse, warm and regulate the Spleen and Stomach, assisting with Qi-moving herbs, using Xiang Sha Wen Wei Yin (Aucklandia and Amomum Decoction for Warming the Stomach). Because cold injures the Zang organs, bitter-cold purgatives are contraindicated. Moreover, the discharged pus and filth are transformed from the intestinal mucous membranes, not stomach food residue; do not mistake it for stagnation and blindly use purgatives, which would deplete the body's essence. If only bloody water or "leaking roof water" appears, immediately use warming and securing methods, such as Hei Dou San (Black Soybean Powder) added with Fu Ling, Bai Zhu, Hui Xiang, and Rou Dou Kou. If pure blood, bright red and clotted, it is mostly latent heat in the Heart and Spleen; use Huang Lian, Bai Shao, Dan Pi, Hei Zhi Zi, Hei Jing Jie, and Sheng Di. If it does not stop, use Di Yu Wan. If the blood is purple-dark and thin, it is Yang deficiency failing to control Yin; warm and regulate Qi, treating with Pao Jiang is essential, using Li Zhong Tang added with Mu Xiang. There are two types of black stool: scorched black indicates extreme heat mimicking its controlling element (Heat Extreme turning Cold-like), treat with Qin Shao Tang and Xiang Lian Wan; glossy black like lacquer indicates blood stasis, treat with Tao Ren Cheng Qi Tang. Pure clear blood indicates Wind attacking the intestines and stomach, treat with Wei Feng Tang added with Zhi Ke, Jing Jie, and Fang Feng. Five-color dysentery indicates injury to the Qi transformation of all five Zang organs. Ancients considered this Kidney damage, where fluids are not stored and essence chamber is injured; treatment must benefit Fire to eliminate Yin, fortify Spleen to control Water, and regulate Qi, using Zhen Ren Yang Zang Tang. Red and white dysentery results from imbalance of cold and heat; use Zhu Che Wan or Lian Li Tang. Pure white dysentery indicates Cold and Slippage of the Zang organs, different from acute watery diarrhea which is Heat. Some resemble frozen glue or fish brain, originating from Qi-level pathology, belonging to Cold stagnation in Zang organs. First use Chen Xiang, Bai Kou, Mu Xiang, Xiao Hui Xiang, and Sha Ren. Then use Li Zhong Tang added with Mu Xiang and Sha Ren. White dysentery at onset with tenesmus indicates Dampness transforming into Heat; use Ping Wei San added with Mu Xiang and Sha Ren. Thin white dysentery with cold limbs and persistent abdominal pain requires Fu Zi Li Zhong Tang. Dysentery with undigested food, interior cold with exterior heat, sweating, and cold extremities requires Tong Mai Si Ni Tang. White dysentery followed by pus and blood requires Wu Ji Wan. White dysentery followed by fresh blood requires E Jiao Si Wu Tang. Pus and blood dysentery turning blue-black mixed color with doubled abdominal pain requires Zhu Che Wan. Pus and blood turning into white foam/pus requires Bu Zhong Yi Qi Tang added with Pao Jiang and Chi Shi Zhi. Dysentery with fever requires dispersing pathogenic factors using Cang Lin San. Abdominal pain with slight body heat requires harmonizing Ying and Wei using Xiao Jian Zhong Tang. Yin deficiency with bloody discharge and fever, worsening irritability and thirst at night, urgently requires saving fluids and preserving Yin using E Jiao Wan, E Jiao Mei Lian Wan, or Huang Lian E Jiao Wan. As dysentery decreases but fluids dry up and anus feels obstructed, use Zhu Zang Tang. Post-dysentery constipation and tenesmus due to Qi deficiency and sinking requires lifting Yang so Yin descends naturally, using Bu Zhong Yi Qi Tang added with Fang Feng. Thick sticky pus and blood with heat, tenesmus, irritability, thirst, and Surging pulse requires Bai Tou Weng Tang. Damp-heat dysentery with tenesmus requires Sheng Yang Chu Shi Tang. Wind pathogen injuring Wei defense with persistent tenesmus requires San Qi San. Deficiency-slippery with tenesmus unrelieved after dysentery requires Zhen Ren Yang Zang Tang. Deficiency-slippery with declining Fu-Yang requires Tao Hua Tang added with Ren Shen. Urgency with inability to defecate indicates Qi stagnation, using Su Zi Jiang Qi Tang. Frequent soiling indicating Qi collapse requires Bu Zhong Yi Qi Tang removing Dang Gui and adding Rou Dou Kou. Profuse diarrhea unceasing requires Zhen Ren Yang Zang Tang. Pain in the large intestine orifice due to Fire sinking with diarrhea requires lifting Qi to settle pain, using Bu Zhong Yi Qi Tang.
[Jin Kou Li] (Dysentery with Inability to Eat): Heat rises from below to invade the stomach opening, reversing and obstructing intestinal transmission, resembling closure. Use Ren Shen, Shi Lian, Shi Chang Pu, Zhu Ru, Fu Ling, Mai Dong, and Geng Mi. Dan Xi used Ren Shen, Shi Lian, and Huang Lian decocted strongly, taken with Ginger Juice. Once swallowed, appetite opens. If Stomach deficiency causes vomiting, use Zhi Zhong Tang added with Ding Xiang. Liver pathogen invading Spleen causing vomiting uses Wu Zhu Yu Tang added with Ding Xiang, Bai Shao, Qing Pi, Huang Lian, and Wu Mei Rou. Chronic dysentery with inability to eat requires greatly tonifying Stomach Qi and moving fluids to open appetite; use Xiang Sha Si Jun Tang added with Bian Dou, Yi Ren, Huo Xiang, Wei Ge Gen, and Geng Mi. Once Stomach Qi awakens and appetite returns, use Du Shen Tang with a little Ju Pi.
[Xiu Xi Li] (Intermittent Dysentery): Repeatedly stopping and recurring, chronic and unhealed, use He Li Le Wan. If caused by premature astringency leaving stagnation, use Xiang Lian Tang added with Fu Ling and Zhi Shi. If caused by dietary irregularity, use Xiang Lian Tang added with Shan Zha and Shen Qu. If caused by middle Qi sinking, use Bu Zhong Yi Qi Tang. If caused by Zang cold and deficiency-slipperiness, use Da Duan Xia Wan.
[Feng Li] (Wind Dysentery): Pure discharge of green mucus, use Cang Zhu Fang Feng Tang. Cold dysentery white like duck droppings, with mild borborygmus and pain/prolapse, use Li Zhong Tang or He Zi Rou Tang. Summer-heat dysentery with greasy face, irritability, dry thirst, use Ru Ling Tang. Damp dysentery with heavy body and abdominal fullness, red-black turbid discharge, use Chu Shi Tang. Spleen-damp blood dysentery, use Cang Zhu Di Yu Tang. Qi dysentery discharging like crab foam, use Qi Li Wan. Epidemic dysentery contagious with similar symptoms in one area, use Ren Shen Bai Du San with modifications. Gu/Zhu toxic dysentery with blood like chicken comb, use Wu Mei Wan. Oxyuris dysentery with very fine worms overflowing from anus, apply Xiong Huang Rui San externally to the lower part, internally take Wu Yi Wan. Post-malaria dysentery or post-dysentery malaria, use Dong Po Jiang Cha Yin. Simultaneous malaria and dysentery, use Bu Zhong Yi Qi Tang with modifications. Profuse diarrhea unceasing with cold extremities, use Fu Zi Li Zhong Tang. Pre-natal red/white dysentery, use Lian Li Tang added with Jiao Ai. Pre-natal dysentery continuing post-partum is critical; use Zhu Che Wan or Fu Long Gan Tang with modifications.
[Xie Re Xia Li] (Collateral Heat Lower Purge): Caused by upper exposure to warm-summer damp-heat pathogens sinking through Mo Yuan into intestines/stomach, presenting as bloody water or sticky matter, all due to damp-heat transmission/transformation. Use separation and elimination, clearing heat and promoting diuresis. Use Hou Po, Huang Qin, Fu Ling, Hua Shi, Zhu Ling, Ze Xie, Guang Pi, Bian Dou, adding Huang Lian if severe.
Treating dysentery differs from treating diarrhea. Watery diarrhea stems from unclear separation of turbid and clear, treatable by promoting urination. Dysentery involves pathogenic toxins adhering and stagnating, with dried fluids; separation/diuresis is strictly contraindicated. Long-term dysentery injures the Kidney; if Kidney Yin is deficient, nourish fluids using Hei Di Huang Wan or Liu Wei Di Huang Wan. If Kidney Yang is deficient, benefit Fire using Si Shen Wan, plus Chen Xiang, Gui, Fu, and Yi Zhi. Since the Kidney is the gate of the Stomach and opens to the two yin openings, long-term dysentery first warms the Spleen; if ineffective, warm the Kidney. Dan Xi stated: Diarrhea followed by dysentery is Spleen transmitting to Kidney (Thief Pathogen), difficult to treat; dysentery followed by diarrhea is Kidney transmitting to Spleen (Minor Pathogen), easy to cure. Thus, treating dysentery focuses on Spleen and Kidney.
Jin Kou Li (Inability to Eat Dysentery) is caused by heat rising from below to invade the stomach, reversing intestinal transmission. Clear and resolve heat toxins using Huang Lian, Jiu Chao Huang Qin, Bai Shao, Shi Lian Rou, Guang Pi, Yin Hua, Shan Rou, and Mu Xiang Zhi. Another prescription: Wu Gu Chong roasted yellow, powdered, mixed with dark sugar, taken with fresh well water, cures immediately.
Early-stage dysentery with concurrent external contraction presents with fever, involving both exterior and interior, most severe; treat both simultaneously. Early-stage dysentery must combine damp-heat and retained stagnation; use Zhi Li San. Ge Gen, Ku Shen, Song Luo Cha Ye, Mai Ya, Shan Zha, Chi Shao, Chen Pi powdered, 4 qian per dose, adding Huang Lian is more effective. From *Yi Xue Xin Wu*, effective for both red and white. Ge Gen stimulates Stomach Qi ascending; Tea/Ku Shen clear damp-heat; Mai Ya/Shan Xiao resolve retained food; Chi Shao/Chen Pi move blood and regulate Qi. For abdominal pain with interior deficiency, half orange peel cake, 10 red dates, 5 qian brown sugar decocted in water, taken immediately for effect.
*Yi Tong* states: Post-dysentery wind syndrome, due to poor care after dysentery, overwalking, sexual exhaustion, wind-cold exposure, or dampness, causing flaccidity, swelling, and pain in legs. Use Da Fang Feng Tang. Post-dysentery becoming gouty pain is also due to improper care; use Bu Zhong Yi Qi Tang added with Qiang Huo, Xu Duan, and Hu Gu.
*Bing Ji Sha Zhuan* states: Dysentery starts in summer/autumn; damp-heat steaming is due to Heaven (climate), raw/cold stagnation is due to Man (diet). During hot weather, failing to protect Spleen/Stomach, eating too many melons/fruits/greasy/sweet foods injures Earth Qi, unable to control dampness. Damp steams, heat obstructs, Qi mechanism reverses, cannot circulate, causing intestinal obstruction, tenesmus, and dark/scanty urine. Use bitter-cold herbs to dry dampness and wash away heat, assisted by acrid-warm herbs to open depression and move Qi. Thus, moving blood heals pus discharge; regulating Qi removes tenesmus. However, deficiency-cold and excess-heat vary in depth and duration; cannot be treated uniformly.
Shen Langzhong said: Early dysentery with strong constitution, fullness, hardness, and sharp pain can quickly remove accumulation; once removed, dysentery stops. This is "Tong Yin Tong Yong" (Using Unblocking for Obstruction), symptoms decrease with dysentery reduction. If irritability, heat, preference for cold, solid pulse, abdominal fullness, or pure red fresh blood, this is internal excess damp-heat; method should clear and promote diuresis. If prolonged damaging healthy Qi, there are two paths: Yin injury or Yang injury. Yin injury loses essence/blood/fluids via dysentery, often with irritability, heat, thirst; clear and moisten to nourish Yin. Yang injury loses Spleen/Kidney primal Yang via dysentery, often with slipping/dejection/cold extremities; warm and tonify to restore Yang. In short, acute diseases are mostly excess; chronic diseases are mostly deficiency. Slippery is mostly cold; obstructive is mostly heat. Consult pulse and symptoms, combine with new/old duration, rarely fail.
Appendix: Ni Hanchu's Three Dysentery Formulas
[Initial Onset Decoction]: Huang Lian (remove rhizome), Huang Qin, Bai Shao, Shan Rou (each 1.2 qian); Zhi Ke (remove pith), Hou Po (fried with ginger juice), Bing Lang, Qing Pi (remove pith, each 0.8 qian); Dang Gui, Di Yu, Gan Cao (roasted, each 0.5 qian); Hong Hua (wine-fried, 0.3 qian); Mu Xiang (0.2 qian); Tao Ren (ground, 1 qian). Prepare as directed, decoct 2 bowls of water to 1 bowl, take on empty stomach. Suitable for red/white dysentery with tenesmus, fever, abdominal pain. For pure white dysentery, remove Di Yu and Tao Ren, add Ju Hong (0.4 qian), Mu Xiang (0.3 qian). For severe stagnation, add Jiu Chao Da Huang (2 qian), take 1-2 doses until cleared. If stagnation clears after one dose, do not continue. Children use only 1 qian Da Huang. Effective miraculously in 3-5 days, effective in 10 days, modify after half a month.
[Modification Decoction]: Huang Lian (wine-fried 0.6 qian, raw 0.4 qian); Bai Shao (wine-fried 0.6 qian, raw 0.4 qian); Shan Rou (1 qian); Ju Hong, Qing Pi, Bing Lang (each 0.4 qian); Zhi Cao (0.3 qian, raw 0.2 qian); Dang Gui (0.5 qian); Di Yu (0.4 qian); Tao Ren (ground powder, 0.6 qian); Hong Hua (0.3 qian); Mu Xiang (0.2 qian). Take as prepared. If extending over a month with Spleen/Stomach weakness and slippery diarrhea, tonify and regulate.
[Tonify and Regulate Decoction]: Huang Lian (wine-fried 0.5 qian); Huang Qin (wine-fried 0.6 qian); Bai Shao (wine-fried 0.4 qian); Ju Hong (0.6 qian); Dang Gui (0.5 qian); Ren Shen (0.5 qian); Bai Zhu (salt-fried 0.5 qian); Zhi Cao (0.5 qian). Take as prepared. For pregnant women, remove Tao Ren, Hong Hua, Bing Lang.
Taboo 1: Early warming tonification. Dysentery starts with damp-heat accumulation adhering to intestines/stomach; clear heat, guide stagnation, move blood stasis to cure. Using Ren Shen/Bai Zhu etc. warms tonics increases heat, stagnates Qi, coagulates blood, how will pathogen leave?
Taboo 2: Major purgation. Dysentery due to pathogenic heat adhesion heals with unblocking. Using Da Cheng Qi Tang purges without removing adhesion, only injuring Stomach Qi and Yuan Qi. Healthy Qi damaged, pathogen cannot be removed; strong patients survive, weak patients perish.
Taboo 3: Sweating. Dysentery with chills/fever, head/eye pain/dizziness is due to internal toxin steaming outward, not exterior pathogen. Sweating uses acrid-warm agents increasing heat, weakening exterior Zheng Qi, intensifying interior pathogen, rarely surviving.
Taboo 4: Separation/Diuresis. Dysentery due to heat adhesion dries fluids. Using Wu Ling San etc. to separate water further dries fluids, worsening stickiness and chronicity. Simply clearing heat and guiding stagnation cures dysentery and clears urine naturally. Why use diuresis? Promoting urination is good for watery diarrhea, but disastrous for dysentery.