陈良甫治一妇人，病痢疾，越四十日，服诸药不愈。召诊之，六脉沉弱。大凡下痢之脉，宜沉宜弱。但服
十全大补汤，姜、枣煎成，加白蜜半匙，再煎数沸，服之而愈。（《良方》、《医说续编》。）
一妇人泄泻不止，似痢非痢，似血非血，其色如浊酒。诊之，则六脉沉绝。众医用热药及丹药服之，则发
烦闷，乃先用败毒加陈米煎，次用胃风汤加粟米愈。
《泊宅编》云∶姚 ，自殿监迁八座，母夫人病痢，诸药不效。令李昂筮轨革有真人指灵草之语。一日登
对，上讶其色瘁，具以实奏，诏赐一散子，数服而愈。仍喻只炒椿子熟末，米饮下。
薛立斋治司马王荆山，患痢后重。服枳壳、槟榔之类，后重益甚，食少腹痛。此脾伤而虚寒也，用六君子
加木香、炮姜而愈。
祠部李宜散，患血痢，胸腹膨胀，大便欲去不去，肢体殊倦。以为脾胃虚弱，不能摄血归源，用补中益气
汤加茯苓、半夏，治之渐愈。后因怒，前症复作，左关脉弦，浮按之微弱。此肝气虚，不能藏血，用六味治之而愈。
朱丹溪治一老人，年七十，面白，脉弦数，独胃脉沉滑，因饮白酒作痢，下淡血水，圊后腹痛，小便不利，
里急后重。参、术为君，甘草、滑石、槟榔、木香、苍术为佐，下保和丸二十五丸。次日，前症俱减，独小便
不利，以益元散服之而愈。（《平治会萃》。）
宁皇患痢，召曾医（不记名。）入视。曾诊御毕，方奏病症，未有所处。慈明立御榻后，有旨呼曾防御，官
家吃得感应丸否？曾连呼吃得吃得。慈明又谕，须是多把与官家。曾承教旨，对以须进二百丸遂止。曾时坐韩
党被谴，痢止，遂于元降秩上更曾三秩。后宁皇不豫久，谓左右曰∶惟曾某知我性急。召入诊讫，呜咽不胜。上
曰∶想是脉儿不好也。曾出，自诊其脉，谓家人曰∶我脉亦不好。先宁皇一夕而逝。（《四朝闻见录》叶绍翁。）
窦材治一人，休息痢已半年，元气将脱，六脉将绝，十分危笃。为灸命关三百壮，关元三百壮，六脉已平，
痢已止。两胁刺痛，再服草神丹，霹雳汤方愈。一月后，大便二日一次矣。
一人病休息痢，窦令灸命关二百壮。病愈二日，变注下，一时五七次，命服霹雳汤，二服立止。后四肢浮
肿，乃脾虚欲成水胀也。又灸关元二百壮，服金液丹十两，一月而愈。
曾鲁公痢血百余日，国医不能疗，陈应之用盐水梅肉一枚，研烂，合蜡茶入醋服之，一啜而安。大中丞梁
庄肃公亦痢血，应之用乌梅、胡黄连、灶下土等分为末，茶调服。盖血得酸则敛，得寒则止，得苦则涩故也。
（《医说》、《本草纲目》。）
宋·张叔潜知剑州时，其阁下病血痢，一医用平胃散一两，入川续断末二钱，水煎服，即愈。绍兴壬子，
会稽时行痢疾，叔潜之子以方传人，往往有验，小儿痢尤效。（《本草纲目》。）
刘禹锡《传信方》云∶予曾苦赤白下痢，诸药服遍久不瘥，（惟久痢故可用后方。）转为白脓。令孤将军
传方，用诃黎勒三枚，两炮一生，并取皮末之，以沸浆水一合服之。若止水痢，加一钱匕甘草末。（谓加甘草末
钱也。）若微有脓血及血多，加三七，亦加甘草。（《本草纲目》。）
胡大卿一仆患痢五色，已半年，遇杭州一道人，教用大熟栝蒌一个， 存性，出火毒为末，作一服，温酒
服之，遂愈。（《本事方》同上。）
张子和曰∶一男子病脓血恶痢，痛不可忍，（有实热之毒。）忽见水浸甜瓜，心酷喜之，连皮食数枚，脓血皆已。
人言下痢无正治，是何言也？只知痢是虚冷，温之、涩之、截之，此外无术矣。岂知风、暑、火、湿、燥、寒
六者皆为痢。此水蜜甜瓜，所以效也。
潘埙曰∶予蔓孙年十二，一日内外热如火，头眩。医以为外感，汗之不解，既而腹痛，小水不行。又以为
内伤，下之不愈。后四五日变赤痢，昼夜无度，小水点滴，腹连膀胱胀闷。医乃专用痢药，而病益剧。心切忧
之，询之家人，曾食何物？以曾饮冰水告。予曰∶病坐此矣。医投四苓、六一不应。予曰∶阴气结于上，阳气
陷于下，膀胱有上口无下口，气不能化而出也。须用膀胱本经药，温以散之，升以举之。众医不敢，予用温中
丸、天水散，加干姜、茴香、升、柴，煎服一二帖，小便行，三帖痢止而愈。（诸记室。）
李时珍治华老，年五十余，病下痢，腹痛垂死，已备棺木。用延胡索三钱为末，米饮服之，病即减十之五，
调理而安。（《本草纲目》。）
薛立斋治一人，痢后呕嗤，脉洪大，按之虚细，作渴引饮，诸药到口不纳。作脾胃虚寒，不能司纳，以参、
术、炮姜等分饭丸，米饮不时送下。服至三两，闻药不呕，以六君子加炮姜，调理而安。
王 如治一人，痢如豆汁，日夜百余次。群医投以清凉下坠之药，愈危。六脉沉弱，此脾虚受湿也。以补
中益气汤加羌、防、苍术，二三剂愈。
王又逸治一人，痢后脚软难行。曰∶久痢伤气，下多亡阴，气血俱虚，不能荣养其筋骨也。用八珍汤加牛
膝、杜仲、木瓜、薏仁而愈。
陈三农治一妇患痢，所服皆清凉克伐之药，致脾胃虚弱，血无所统，日下数升，遇有所触，其下益甚。欲
补血，恐脾愈寒，欲引血归经，而血去殆尽。遂用阳生阴长之义，以益气汤温养中气而渐安。
一士勤于举业，夏末患里急泄白脓，众以痢治。曰∶非也。此积劳伤脾，脾气下陷，即东垣所谓饮食不节，
起居不时，上升精华之气反下陷云云也。用补中益气汤，二剂而安。
龚子才治刘司寇，年近七十，患痢，脓血腹痛，诸药弗效。诊之，六脉微数，此肥甘太过，内有积热，当
服酒蒸大黄一两清利之。刘曰∶吾衰老，恐不胜，用滋补平和乃可。因再四引喻，始勉从之，逾日而愈。
尤在泾曰∶痢之为病，气闭于下，而火复迫之，是以腹痛里急，糟粕不出，而便肠垢也。其源皆由于暑湿，
与疟病俱发于夏秋，盖伤于经络则成疟，而入于肠脏则为痢也。经络之邪，可散而愈，故治宜辛苦温之药。肠
脏之热，非清不愈，故治宜辛苦寒之药，亦发表不太热，攻里不太寒之意。河间之主用清寒，盖亦有见于此。
张景岳不审痢病之所从来，而以五脏五行为说，谓惟心可言火，其余均不可言火。此但足资辨论而已，岂足补
于治要哉？
痢与泄泻，其病不同，其治亦异。泄泻多起寒湿，寒则宜温，湿则宜燥也；痢病多成湿热，热则宜清，湿
则可利也。虽泄泻亦有热症，然毕竟寒多于热；痢病亦多寒症，然毕竟热多于寒。是以泄泻经久，必伤胃阳，而
肿胀喘满之变生。痢病经久，必损脾阴，而虚烦痿废之病起。痢病兜涩太早，湿热流注，多成痛痹。泄泻疏利
或过，中虚不复，多作脾劳。此余所亲历，非臆说也。或曰∶热则清而寒则温是已，均是湿也。或从利，或从
燥何欤？曰∶寒湿者，寒从湿生，故宜温燥暖其中；湿热者，湿从热化，故宜甘淡利其下。且燥性多热，利药
多寒，便利则热亦自去，中温则寒与俱消。寒湿必本中虚，不可更行渗利，湿热郁多成毒，不宜益以温燥也。
一人下痢，小腹急痛，大便欲去不去，以脾胃气虚而下陷也。用补中益气送八味丸，二剂而愈。此等症候，
因利药致损元气，肢体肿胀而死者，不可枚举。
一人患痢后重，自知医，用黄芩芍药汤，后重甚，饮食少思，腹寒肢冷。龚以为脾胃亏损，用六君子汤加
木香、炮姜，二剂而愈。
赵养葵治四明徐阳泰，体素丰，多火善渴，虽盛寒床头必置茗碗，或一夕尽数瓯，又时苦喘急。质之赵，
赵言此属郁火症，常令服茱连丸，无恙也。丁巳夏，徐避暑檀州，酷甚，朝夕坐水盘间，或饮冷香薷汤，自负
清暑良剂。孟秋，痢大作，始三昼夜，下百许次，红白相杂，绝无渣滓，腹胀闷绞不可言。或谓宜下以大黄。赵
勿顾也，竟用参、术、姜、桂渐愈。犹白积不止，服感应丸而痊。后少尝蟹，复泻下，萎顿，仍服八味汤及补
中重加姜、桂而愈。寒凉太过，用参、术、姜、桂以救其偏是矣。八味之投奚为乎，此养葵之所以为养葵也。
夫一人之身，历一岁之间，黄连、苦茗不辍口，而今病以纯热瘥，向若投大黄下之，不知何状。又病咳嗽时，
喘逆不眠，用逍遥立安。又患便血不止，服补中黑姜立断，不再剂。
喻嘉言治张仲仪，初得痢疾三五行，即诊之，行动如常，然得内伤之脉，而挟少阴之邪。曰∶此症宜一表
一里，但表药中多用一参，里药中多用附子，方可无患。若用痢疾门诸药，必危之道也。张以平日深信，径取
前药不疑，然病势尚未着也。及日西，忽发大热，身重如巨石，头在枕上，两人始能扶动，人事沉困，急服完
表里二剂。次早诊视，即能起身出房，再与参附二帖，全愈。若不辨症，用痢疾门中药，何曾有此等治法乎？
周信川，年七十三，平素体坚。秋月病痢，久而不愈，至冬月成休息痢，一日夜十余行，面目浮肿，肌肤
晦黑。脉之，沉数有力，谓曰∶此阳邪陷入于阴也，吾以法治之可愈。以人参败毒散，煎好，用浓被围椅上坐
定，置火其下，更以布卷置椅褥上，殿定肛门，使内气不得下定。（内气提掇在人，岂可以物塞定？其说未免荒谬。
雄按∶提掇虽在人，以外殿亦可少助其力，然后以前药滚热与服，良久又进前药，遂觉皮间有津津微汗，再溉
以滚汤，教令努力忍便，此却有理。）前药滚热与服，良久又进前药，遂觉皮间有津津微汗，再溉以滚汤，教令努
力忍便，不可畏热，不得移身，如此约二时之久，皮间津润未干，病者心躁畏热，忍不可忍，始令连被卧于床
上。是晚，止下痢二次。后用补中益气汤，一日夜止下三次，不旬日全愈。盖内陷之邪，欲提之转从表出，不以
急流挽舟之法施之，其趋下之势，何所底哉？闻王星宰患久痢，诸药不效，苏郡老医进以人参败毒散，其势差
减，大有生机，但少此一段斡旋之法，竟无成功。故凡遇阳邪陷入阴分，如久疟、久痢、久热等症，皆当识
此意，使其里邪久久透出表外，方为合法。若急而速，则恐才出又入，徒伤其正耳。
按∶休息痢，多缘误治而成，或兜涩太早，或有表症，而骤下之。古人多以感应丸为治，法至良也。兹
用人参败毒，亦治之近理者。至以布蛋殿其肛，谓内气不下走，亦好奇之过耳。尝阅道书，见内丹将成，
欲过关时，必以物殿其谷道，夹其外肾，以防灵丹之外泄。喻氏贯通三教，其意未必不取诸此。魏君之论，
亦不免少见多怪。
朱孔阳，年二十五，形体清瘦，素享安逸。夏月因构讼奔走日中，暑湿合内郁之火，而成痢疾，日夜一二
百次，不能起床，以粗纸铺茵上，频频易置，但饮水而不进食，其痛甚厉，肛门如火烙，扬手掷足，躁扰无奈。
脉之，弦紧劲急，不为指挠，曰∶此症一团毒火，蕴结肠胃，其势如焚，救焚须在顷刻，若二三日外，肠胃朽
腐矣。乃用大黄四两，黄连、甘草各二两，入大砂锅内煎，随滚随服。服下，人事少宁片时，少顷，仍前躁扰。
一日夜服至二十余碗，大黄俱已煎化，黄连、甘草俱煎至无汁，次日脉势少和，知病可愈。但用煎法，不用急
药，改用生地、麦冬各四两，另研生汁，以花粉、丹皮、赤芍、甘草各一两，煎成和汁，大碗咽之。以其来势
暴烈，一身津液从之奔竭，待利止生津，则枯槁难回矣。今脉势既减，则火邪已退，不治痢而痢自止，岂可泥
润滞之药而不急用乎？服之果痢止，但遗些少气沫耳。略进腐浆米汁，调养旬余，始能消谷。亦见胃气之存留
一线者，不可少此焦头烂额之客也。
浦君艺病痢，初起有表邪未散，误用参、术固表，使邪气深入。又误服黄连凉解，大黄推荡，治经月余，
胃气不运，下痢日夜百余行。一夕，呕出从前黄连药汁三五碗，呕至三五次后，胃与肠遂打成一家，内中幽门、
阑门洞开无阻，不但粥饮直出，即人参浓膏才吞入喉，已 从肠奔下。用大剂四君子汤，煎调赤石脂、禹余
粮二末，连连与服。服后，势少衰，但腹中痛不可忍。浦曰∶前此痢虽多，然尚不痛，服此药而痛增，未可服
矣。喻曰∶此正所谓通则不痛，痛则不通之说也。不痛则危，痛则安，何可不痛耶？仍以前药再进，俟势已大
减，才用四君子倍茯苓，十余剂全安。
李士材治孙潇湘夫人，下痢四十日，口干发热，饮食不进，腹中胀闷，完谷不化。尚有谓邪热不杀谷者，
计用香、连、枳壳、豆蔻、浓朴等三十余剂，绝粒五日，命在须臾。诊之，脉大而数，按之豁然，询得腹痛而
喜手按，小便清利，此火衰不能生土，内真寒而外假热也。亟煎服附子理中汤，冰水与服，一剂而痛止，六剂
而热退食进。兼服八味丸，二十余日霍然起矣。
许郡侯女，痢疾腹痛，脉微而软。李曰∶此气虚不能运化精微，其窘迫后重者，乃下陷耳。用升阳散火汤
二剂，继用补中益气汤十剂而愈。
喻嘉言治陈汝明病痢，发热如蒸，昏沉不食，脉数大空虚，尺倍洪盛。此内有湿热，与时令外热相合，欲
陈良甫治疗一位妇人，患痢疾，病程已四十天，服用各种药物均未见效。请他诊治，发现六脉沉弱。一般来说，下痢的脉象，适宜表现为沉脉或弱脉。于是让他服用十全大补汤，用生姜、大枣煎煮成药液，加入半匙白蜜，再煮沸几滚后服用，病就好了。（出自《良方》、《医说续编》。）
另一位妇人泄泻不止，症状似痢非痢，似血非血，排泄物颜色像浑浊的酒。诊察时，六脉沉伏欲绝。其他医生使用热性药物及丹药服用后，患者出现烦闷症状。于是先用败毒散加陈年大米煎服，随后用胃风汤加粟米，病愈。
《泊宅编》记载：姚某从殿监升迁为八座官职，其母亲患痢疾，各种药物无效。有人让李昂占卜，得到“轨革有真人指灵草”的话语。有一天上朝应对皇帝，皇上惊讶他的面色憔悴，他便如实奏报，皇上下诏赐给他一种散剂，服用几次后痊愈。皇上还嘱咐只需用炒熟的椿子研成细末，用米汤送服。
薛立斋治疗司马王荆山，患痢疾伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）。服用枳壳、槟榔等行气导滞的药物后，后重症状更加严重，食欲减少且腹痛。这是脾脏受损导致虚寒，于是用六君子汤加木香、炮姜，病愈。
祠部郎中李宜散，患血痢，胸腹部膨胀，大便想排却排不出，肢体非常疲倦。认为是脾胃虚弱，不能统摄血液回归本源，用补中益气汤加茯苓、半夏治疗，病情逐渐好转。后来因为发怒，前症复发，左关脉弦，轻取微弱。这是肝气虚，不能藏血，用六味地黄丸治疗而愈。
朱丹溪治疗一位老人，七十岁，面色白，脉象弦数，唯独胃脉沉滑，因饮用白酒引发痢疾，排出淡红色血水，排便后腹痛，小便不利，有里急后重感。以人参、白术为君药，甘草、滑石、槟榔、木香、苍术为佐药，饭后服用保和丸二十五丸。第二天，前面的症状都减轻，唯独小便仍不利，服用益元散后痊愈。（出自《平治会萃》。）
宁王患痢疾，召曾姓医生（名字不详）入宫诊治。曾医生诊完脉后，正要奏报病症，尚未提出治疗方案。慈明太后站在御榻后面，下令呼唤曾防御使，问：“官家吃感应丸了吗？”曾医生连声回答吃了吃了。慈明太后又嘱咐，一定要多给官家服用。曾医生秉承旨意，回答说必须进服二百丸才停止。当时曾医生正坐在韩党被贬斥的位子上，痢疾止住后，便在原本降级的品秩上增加三级俸禄。后来宁王长期身体不适，对左右侍从说：“只有曾某懂我的急躁性格。”召入诊治完毕，曾医生呜咽哭泣不能自持。皇上说：“想必是脉象不好吧。”曾医生出来，自己诊脉，对家人说：“我的脉象也不好。”结果比宁王早一天去世。（出自叶绍翁《四朝闻见录》。）
窦材治疗一人，患休息痢（痢疾日久，时发时止）已有半年，元气即将脱失，六脉即将断绝，病情十分危重。为他艾灸命关穴三百壮，关元穴三百壮，六脉已平稳，痢疾已止。但两胁刺痛，再服用草神丹、霹雳汤，病才痊愈。一个月后，大便变为两天一次。
另一人患休息痢，窦材令其艾灸命关穴二百壮。病愈两天后，变为腹泻如水，一时之间五到七次，命令服用霹雳汤，两次服药后立即停止。后来四肢浮肿，这是脾虚将要形成水胀病。又艾灸关元穴二百壮，服用金液丹十两，一个月后痊愈。
曾鲁公患痢疾出血一百多天，宫廷御医无法治愈，陈应之用药一枚盐水梅肉，研烂，混合蜡茶调入醋中服用，喝一次就安稳了。大中丞梁庄肃公也患痢疾出血，陈应之用乌梅、胡黄连、灶心土等分研成末，用茶调服。这是因为血液遇到酸味则收敛，遇到寒凉则停止，遇到苦味则涩滞的缘故。（出自《医说》、《本草纲目》。）
宋代张叔潜担任剑州知州时，他下属患有血痢，一位医生用平胃散一两，加入川续断末二钱，水煎服用，立即痊愈。绍兴壬子年，会稽地区流行痢疾，张叔潜的儿子将此方传给别人，往往有效，治疗小儿痢疾尤其有效。（出自《本草纲目》。）
刘禹锡在《传信方》中说：我曾苦于赤白痢疾，各种药物都服遍了，很久不愈，（只有久痢才可用后面的方子。）转为白色脓液。令孤将军传授此方，用诃黎勒三枚，一半炮制一半生用，连同皮一起研成末，用沸浆水一合送服。如果是止水痢，加一钱匕甘草末。（即加甘草末一钱。）如果微有脓血及血多，加三七，也加甘草。（出自《本草纲目》。）
胡大卿的一个仆人患五色痢，已半年，遇到杭州一位道人，教他用大熟栝蒌一个，存性（煅烧至保留部分药性），去火毒后研成末，作为一服，用温酒送服，随即痊愈。（出自《本事方》，同上。）
张子和说：一男子患脓血恶痢，疼痛难以忍受，（有实热之毒。）忽然看见水中浸泡的甜瓜，心里非常喜欢，连皮吃了几枚，脓血都消失了。人们说下痢没有固定的治疗方法，这是什么话呢？只知道痢疾是虚冷，用温法、涩法、截断法，除此之外别无他术。哪里知道风、暑、火、湿、燥、寒六种邪气都能导致痢疾。这就是水蜜甜瓜所以有效的缘故。
潘埙说：我的侄孙十二岁时，一天内内外发热如火，头晕。医生认为是外感，发汗后不解，随后腹痛，小便不通。又认为是内伤，攻下后不愈。过了四五天后变成赤痢，昼夜无度，小便点滴，腹部连带膀胱胀闷。医生专门使用治痢药，而病情加重。我心里深切担忧，询问家人，曾吃过什么食物？被告知曾饮冰水。我说：“病就出在这里。”医生投用四苓散、六一散无效。我说：“阴气结于上部，阳气陷于下部，膀胱有上口无下口，气不能化而出。必须用膀胱本经的药物，用温药散之，用升提药举之。”众医不敢，我用温中丸、天水散，加干姜、小茴香、升麻、柴胡，煎服一二帖，小便通利，三帖后痢止而愈。（出自诸记室。）
李时珍治疗华老，五十多岁，患下痢，腹痛垂死，已经备好棺木。用延胡索三钱研成末，用米汤送服，病立刻减轻五分之二，调理后平安。（出自《本草纲目》。）
薛立斋治疗一人，痢疾后呕吐呃逆，脉象洪大，重按虚细，口渴想喝水，各种药物入口即吐。认为是脾胃虚寒，不能受纳，以人参、白术、炮姜等分制成饭丸，用米汤不时送下。服用到三两，闻到药味不再呕吐，改用六君子汤加炮姜，调理后平安。
王某如治疗一人，痢疾像豆汁一样，日夜一百多次。群医投用清凉下坠的药物，病情更加危险。六脉沉弱，这是脾虚受湿。用补中益气汤加羌活、防风、苍术，二三剂后痊愈。
王又逸治疗一人，痢疾后脚软难行。说：“久痢伤气，下利多亡阴，气血俱虚，不能荣养筋骨。”用八珍汤加牛膝、杜仲、木瓜、薏苡仁而愈。
陈三农治疗一妇患痢，所服皆清凉克伐的药物，导致脾胃虚弱，血无所统摄，每天下血数升，遇到触动，下血更甚。想补血，怕脾更寒；想引血归经，而血已流失殆尽。于是采用阳生阴长的道理，用益气汤温养中气而渐渐安定。
一位士子勤于科举学业，夏末患里急后重，排泄白色脓液，众人当作痢疾治疗。他说：“不对。这是积劳伤脾，脾气下陷，就是东垣先生所说的饮食不节，起居不时，上升的精华之气反而下陷等等情况。”用补中益气汤，二剂后平安。
龚子才治疗刘司寇，近七十岁，患痢疾，脓血腹痛，各种药物无效。诊察时，六脉微数，这是肥甘厚味太过，内有积热，应当服用酒蒸大黄一两来清利。刘说：“我衰老，恐怕承受不住，用滋补平和的药才可以。”经过反复劝导，才勉强听从，过了一天痊愈。
尤在泾说：痢疾这种病，气机闭塞于下焦，而火热又逼迫它，所以腹痛里急，糟粕不出，而排出肠垢。其根源都由于暑湿，与疟疾都发于夏秋，伤害经络则成为疟疾，进入肠脏则成为痢疾。经络的邪气，可以发散而愈，所以治疗适宜用辛苦温的药物。肠脏的热邪，不清除就不能愈，所以治疗适宜用辛苦寒的药物，这也是发表不太热，攻里不太寒的意思。河间氏主张主要使用清寒药，大概也是看到了这一点。
张景岳不审察痢病的由来，而以五脏五行来论述，认为只有心脏可言火，其余均不可言火。这只能提供辩论的资料罢了，哪里足以补充治疗的关键呢？
痢疾与泄泻，病因不同，治疗也不同。泄泻多起于寒湿，寒则适宜温法，湿则适宜燥法；痢疾多成于湿热，热则适宜清法，湿则可利法。虽然泄泻也有热证，但毕竟寒多于热；痢疾也多寒证，但毕竟热多于寒。所以泄泻经久，必伤胃阳，而产生肿胀喘满的变化。痢疾经久，必损脾阴，而产生虚烦痿废的病证。痢疾兜涩太早，湿热流注，多成为痛痹。泄泻疏利过度，中气虚弱不复，多成为脾劳。这是我亲身经历，不是臆说。有人说：热则清而寒则温是对的，都是湿邪。有的从利法，有的从燥法，为什么呢？回答说：寒湿者，寒从湿生，所以适宜温燥暖其中；湿热者，湿从热化，所以适宜甘淡利其下。而且燥性多热，利药多寒，便利则热邪自然去除，中温则寒邪随之消除。寒湿必定根本在于中虚，不可再进行渗利；湿热郁结多成毒，不宜再给予温燥。
一人下痢，小腹急痛，大便想排却排不出，这是脾胃气虚而下陷。用补中益气汤送服八味丸，二剂后痊愈。这类症候，因利药导致损伤元气，肢体肿胀而死的人，不可胜数。
一人患痢疾后重，自己懂医，用黄芩芍药汤，后重更甚，饮食少思，腹寒肢冷。龚以为脾胃亏损，用六君子汤加木香、炮姜，二剂后痊愈。
赵养葵治疗四明徐阳泰，体质素来丰腴，多火善渴，即使在盛寒天气床头必放茶碗，有时一晚喝完几瓯，又时常苦于喘急。请教赵养葵，赵说这属于郁火症，常令他服用茱连丸，安然无恙。丁巳年夏天，徐避暑檀州，酷热难耐，早晚坐在水盘间，或饮冷香薷汤，自负是清暑良剂。孟秋时节，痢疾大作，开始三昼夜，下痢百余次，红白相杂，绝无渣滓，腹胀闷绞不可言状。有人说适宜用大黄攻下。赵不予理会，竟用人参、白术、干姜、肉桂渐渐痊愈。还有白积不止，服用感应丸而痊愈。后来稍微尝了点螃蟹，又腹泻，萎靡不振，仍服用八味汤及补中益气汤并重加姜、桂而愈。寒凉太过，用人参、白术、干姜、肉桂来纠正偏差是对的。为什么投用八味丸呢？这就是赵养葵之所以为赵养葵的原因啊。
一个人的一生，经历一年之间，黄连、苦茶不停口，而现在病以纯热而愈，先前若投用大黄攻下，不知会是什么样子。又病咳嗽时，喘逆不眠，用逍遥散立即安顿。又患便血不止，服用补中益气汤加黑姜立即断绝，不到两剂。
喻嘉言治疗张仲仪，初得痢疾三五天，就诊察他，行动如常，然而得了内伤的脉象，且挟带少阴之邪。说：“此症适宜表里双解，但在表药中多用人参，里药中多用附子，才可以无患。如果用痢疾门的各种药物，必然是危险的途径。”张平日深信不疑，径直取前药服用毫不怀疑，然而病势尚未显露。等到傍晚，忽然发大热，身体沉重如巨石，头在枕上，两个人才能扶动，人事昏沉困倦，急服完表里二剂。次日早晨诊视，就能起身出房，再给参附二帖，完全痊愈。若不辨症，用痢疾门中的中药，何曾有这种治法呢？
周信川，七十三岁，平时体质坚固。秋月患痢，久而不愈，到冬月变成休息痢，一日夜十余次，面目浮肿，肌肤晦暗发黑。诊脉，沉数有力，说：“这是阳邪陷入于阴分，我用法治它可以痊愈。”用人参败毒散，煎好后，用厚被子围在椅子上坐定，在下面置火，再用布卷放在椅褥上，垫住肛门，使内气不得向下走。（内气的提掇靠人自身，岂能用物体塞住？这种说法未免荒谬。雄按：提掇虽靠人，但外部垫堵也可以稍助其力，然后用前面滚烫的药服下，许久又进前药，遂觉得皮肤间有津津微汗，再用滚汤浇灌，教他努力忍住便意，这却是有道理的。）前面滚烫的药服下，许久又进前药，遂觉得皮肤间有津津微汗，再用滚汤浇灌，教他努力忍住便意，不要畏热，不得移动身体，这样大约两个时辰之久，皮肤间津润未干，病人心中烦躁畏热，忍无可忍，才让他连被卧在床上。当晚，只下痢二次。后用补中益气汤，一日夜只下三次，不到十天完全痊愈。因为内陷的邪气，想要提转从表而出，如果不施以急流挽舟之法，那趋向下的势头，到底在哪里呢？听说王星宰患久痢，各种药物无效，苏州郡的老医进用人参败毒散，其势稍减，大有生机，但缺少这一段斡旋的方法，最终没有成功。所以凡是遇到阳邪陷入阴分，如久疟、久痢、久热等症，都应当认识这个意思，使其里邪久久透出表外，才是合法。如果急而速，则恐怕刚出来又进去，徒然损伤正气罢了。
按语：休息痢，多缘误治而成，或兜涩太早，或有表症，而骤下之。古人多以感应丸为治，法至良也。兹用人参败毒，亦治之近理者。至以布蛋殿其肛，谓内气不下走，亦好奇之过耳。尝阅道书，见内丹将成，欲过关时，必以物殿其谷道，夹其外肾，以防灵丹之外泄。喻氏贯通三教，其意未必不取诸此。魏君之论，亦不免少见多怪。
朱孔阳，二十五岁，形体清瘦，素享安逸。夏月因打官司奔走日中，暑湿合内郁之火，而成痢疾，日夜一二百次，不能起床，用粗纸铺在席上，频频更换，只饮水而不进食，疼痛非常剧烈，肛门如火烙，扬手掷足，躁扰无奈。诊脉，弦紧劲急，不为指挠，说：“此症一团毒火，蕴结肠胃，其势如焚，救焚须在顷刻，若二三日外，肠胃腐朽了。”于是用大黄四两，黄连、甘草各二两，放入大砂锅内煎，随滚随服。服下，人事稍安宁片刻，一会儿，仍然前躁扰。一日夜服至二十余碗，大黄都已煎化，黄连、甘草都煎至无汁，次日脉势稍和，知道病可愈。但用煎法，不用急药，改用生地、麦冬各四两，另研生汁，以花粉、丹皮、赤芍、甘草各一两，煎成和汁，大碗咽下。因为其来势暴烈，一身津液随之奔竭，待利止生津，则枯槁难回了。现在脉势既减，则火邪已退，不治痢而痢自止，岂可拘泥于润滞的药而不急用呢？服用后果然痢止，但遗留些少气沫而已。略进腐浆米汁，调养旬余，始能消谷。也可见胃气之存留一线者，不可少此焦头烂额之客也。
浦君艺患痢，初起有表邪未散，误用人参、白术固表，使邪气深入。又误服黄连凉解，大黄推荡，治疗经月余，胃气不运，下痢日夜百余行。一夕，呕出从前黄连药汁三五碗，呕至三五次后，胃与肠遂打成一家，内中幽门、阑门洞开无阻，不但粥饮直出，即人参浓膏才吞入喉，已从肠奔下。用大剂四君子汤，煎调赤石脂、禹余粮二末，连连与服。服后，势少衰，但腹中痛不可忍。浦说：“此前痢虽多，然尚不痛，服此药而痛增，未可服矣。”喻说：“此正所谓通则不痛，痛则不通之说也。不痛则危，痛则安，何可不痛耶？”仍以前药再进，俟势已大减，才用四君子倍茯苓，十余剂全安。
李士材治疗孙潇湘夫人，下痢四十日，口干发热，饮食不进，腹中胀闷，完谷不化。尚有谓邪热不杀谷者，计用香、连、枳壳、豆蔻、浓朴等三十余剂，绝粒五日，命在须臾。诊之，脉大而数，按之豁然，询得腹痛而喜手按，小便清利，此火衰不能生土，内真寒而外假热也。亟煎服附子理中汤，冰水与服，一剂而痛止，六剂而热退食进。兼服八味丸，二十余日霍然起矣。
许郡侯女，痢疾腹痛，脉微而软。李说：“此气虚不能运化精微，其窘迫后重者，乃下陷耳。”用升阳散火汤二剂，继用补中益气汤十剂而愈。
Chen Liangfu treated a woman suffering from dysentery. The disease had persisted for forty days, and various medicines had failed to cure her. Upon examination, the six pulses were deep and weak. Generally speaking, in cases of dysentery, the pulse should be deep or weak. He prescribed Shiquan Dabu Tang (Ten Significant Tonifying Decoction), decocted with ginger and jujube, adding half a spoonful of white honey, boiled for a few more turns, after which she recovered. (From *Liangfang* and *Yishuo Xubian*.)
Another woman suffered from incessant diarrhea, resembling dysentery but not quite, resembling blood but not quite, with discharge color like turbid wine. Examination revealed the six pulses were deep and nearly imperceptible. Other physicians administered hot-natured medicines and alchemical pills, causing irritability and oppression. Therefore, Baidu San (Detoxification Powder) was first used with aged rice for decoction, followed by Weifeng Tang (Stomach Wind Decoction) with millet, resulting in recovery.
*Bozhai Bian* records: Yao, promoted from Dianjian to Bashuo, had a mother suffering from dysentery unresponsive to all medicines. Someone advised Li Ang to perform divination, yielding the phrase "Gui Ge has a true person pointing to spiritual herbs." One day during an audience, the Emperor noticed his haggard complexion and asked for the truth. An edict granted a powder, which cured him after several doses. The Emperor also instructed him to simply use roasted Toona sinensis seeds ground into fine powder, taken with rice water.
Xue Lizhai treated Wang Jingshan, a Sima (Historian), who suffered from dysentery with tenesmus (urgent need to defecate with heavy sensation in the anus). After taking Zhiqiao (Bitter Orange) and Binglang (Areca Seed) to move qi and guide stagnation, the tenesmus worsened, appetite decreased, and abdominal pain occurred. This indicated spleen injury with deficiency-cold. Liu Junzi Tang (Six Gentlemen Decoction) was prescribed with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), leading to recovery.
Li Yi, a Cibu Langzhong (Director in the Bureau of Sacrifices), suffered from bloody dysentery with chest and abdominal distension, inability to pass stool despite urgency, and extreme fatigue. It was diagnosed as spleen and stomach weakness failing to control blood and return it to its source. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used with Fuling (Poria) and Banxia (Pinellia Rhizome), gradually improving the condition. Later, due to anger, symptoms recurred; the left Guan pulse was wiry, and superficial palpation felt weak. This indicated liver qi deficiency failing to store blood. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was used for treatment, resulting in recovery.
Zhu Danxi treated a seventy-year-old elderly man, pale-faced, with a wiry and rapid pulse, except for the Stomach pulse which was deep and slippery. The dysentery was caused by drinking white wine, presenting with pale bloody water discharge, post-defecation abdominal pain, difficult urination, and tenesmus. Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) served as the sovereign drugs, with Gancao (Licorice Root), Huashi (Talcum), Binglang (Areca Seed), Muxiang (Aucklandia Root), and Cangzhu (Atractylodes Lancea Rhizome) as ministering drugs. Baohe Wan (Preserve Harmony Pill) 25 pills were taken after meals. The next day, previous symptoms reduced, except for difficult urination, which was cured by Yiyuan San (Benefit Origin Powder). (From *Pingzhi Huihui*.)
The Prince Ning suffered from dysentery and summoned Doctor Zeng (name unknown) for consultation. After diagnosing the pulse, before reporting the symptoms and treatment plan, Lady Ciming stood behind the imperial bed and ordered Zeng Fangyu to be called, asking, "Has the Lord consumed Yinggan Wan?" Doctor Zeng repeatedly answered that he had. Lady Ciming further instructed to give more. Following this directive, Zeng stated that 200 pills must be administered before stopping. At that time, Zeng was seated in a position demoted due to association with the Han faction. Once the dysentery stopped, his rank was increased by three levels on top of the previous demotion. Later, when Prince Ning was ill for a long time, he told attendants, "Only Dr. Zeng understands my impatient nature." After diagnosis, Zeng wept uncontrollably. The Emperor said, "I suppose your pulse is not good." Zeng exited, diagnosed his own pulse, and told his family, "My pulse is also not good." He died one day before Prince Ning. (From Ye Shaoweng's *Sichao Wenjianlu*.)
Dou Cai treated a patient with chronic intermittent dysentery for half a year, where vital qi was about to collapse and the six pulses were nearly absent, a critical condition. He moxibusted Mingguan (Life Gate) 300 moxa cones and Guanyuan (Gate of Origin) 300 moxa cones. The six pulses stabilized, and dysentery stopped. However, stabbing pain in both flanks remained. Caoshen Dan (Grass Spirit Pill) and Pili Tang (Thunderbolt Decoction) were then administered until recovery. One month later, bowel movements occurred once every two days.
Another patient with chronic intermittent dysentery was ordered by Dou to moxibust Mingguan 200 cones. Two days after recovery, symptoms changed to profuse watery diarrhea, occurring five to seven times at once. Pili Tang was prescribed, stopping immediately after two doses. Later, limbs became edematous, indicating spleen deficiency progressing towards water swelling. Guanyuan was moxibusted again 200 cones, and Jin Ye Dan (Golden Liquid Pill) 10 liang was taken, recovering in one month.
Prime Minister Zeng suffered from bloody dysentery for over a hundred days, untreatable by court physicians. Chen Yingzhi used one salted plum meat, mashed, mixed with wax tea and vinegar, taken in one swallow, bringing immediate relief. Grand Censor Liang Zhuangsu also suffered from bloody dysentery; Chen Yingzhi used Wumei (Dark Plum), Huduanglian (Coptis Rhizome), and Zaoxia Tu (Soil from under the stove) in equal parts, powdered and taken with tea. This is because blood constricts with sourness, stops with cold, and becomes astringent with bitterness. (From *Yishuo* and *Bencao Gangmu*.)
During the Song Dynasty, when Zhang Shuqian was Prefect of Jianzhou, his subordinate suffered from bloody dysentery. A physician used Pingwei San (Calm the Stomach Powder) 1 liang mixed with Chuan Xuduan (Dipsacus Root) powder 2 qian, decocted in water and taken, resulting in immediate cure. In the Renzi year of Shaoxing, epidemic dysentery broke out in Kuaiji. Zhang Shuqian's son transmitted this formula, which was often effective, especially for pediatric dysentery. (From *Bencao Gangmu*.)
Liu Yuxi in *Chuanxin Fang* states: I once suffered severely from red and white dysentery. Various medicines were tried for a long time without success (only suitable for chronic dysentery). It transformed into white pus. General Linggu passed down this formula: use 3 Heheli (Chebula Fruit), half roasted and half raw, including the skin, powdered. Take with one he of boiling water. For watery dysentery, add one qianbi of Gancao (Licorice Root) powder. If there is slight pus/blood or excessive blood, add Sanqi (Notoginseng Root) and also add Gancao. (From *Bencao Gangmu*.)
A servant of Hu Daqing suffered from five-color dysentery for half a year. He met a Daoist priest in Hangzhou who taught him to use one large ripe Gualou (Trichosanthes Fruit), preserved nature (calcined), remove fire toxicity, powder it, take as one dose, and swallow with warm wine, resulting in immediate cure. (From *Benshi Fang*, same as above.)
Zhang Zihe said: A man suffered from severe purulent and bloody dysentery with unbearable pain (indicating excess heat toxin). He suddenly saw sweet melons soaked in water and greatly desired them. He ate several with the skin, and the pus and blood disappeared. People say there is no standard treatment for dysentery; what nonsense! They only know dysentery is deficiency-cold and apply warming, astringing, or blocking methods, believing there is no other way. How can they know that wind, summerheat, fire, dampness, dryness, and cold can all cause dysentery? This explains why water-melon honey works.
Pan Xun said: My nephew, aged twelve, experienced intense internal and external heat like fire and dizziness in one day. Physicians thought it was exterior contraction and induced sweating, which failed. Then abdominal pain and urinary retention occurred. Thought to be interior damage, purgatives were used without success. Four or five days later, it turned into red dysentery, day and night without limit, with only drops of urine and abdominal/bladder distension. Physicians used specific dysentery medicines, worsening the condition. Worried, I asked the family what he had eaten. They reported he drank ice water. I said, "The illness arises from this." Physicians used Siling San (Four-Powder Decoction) and Liuyi San (Six-to-One Powder) without effect. I said, "Yin qi is knotted above, yang qi is sunken below. The bladder has an upper opening but no lower opening; qi cannot transform and exit. Must use herbs from the Bladder meridian, warm to disperse, and lift to raise." Physicians dared not try. I used Wenzhong Wan (Warm the Middle Pill) and Tianshui San (Heavenly Water Powder), adding Ganjiang (Dried Ginger), Huixiang (Fennel), Shengma (Cimicifuga Rhizome), and Chaihu (Bupleurum Root). After one or two doses, urination started; after three doses, dysentery stopped and he recovered. (From *Zhujishi*.)
Li Shizhen treated Old Hua, fifty-plus years old, suffering from dysentery with abdominal pain near death, coffins already prepared. Yanhusuo (Corydalis Rhizome) 3 qian was powdered and taken with rice water. Symptoms reduced by half immediately, and he recovered with conditioning. (From *Bencao Gangmu*.)
Xue Lizhai treated a patient with vomiting and hiccupping after dysentery. Pulse was large and rapid but empty upon deep pressure. Thirsty with desire to drink, yet all medicines were vomited upon entry. Diagnosed as spleen-stomach deficiency-cold unable to receive and hold. Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), and Paojiang (Prepared Ginger) in equal parts were made into rice pills and given frequently with rice water. After taking 3 liang, nausea ceased. Liu Junzi Tang (Six Gentlemen Decoction) with Paojiang was used for conditioning, leading to safety.
Wang Ru treated a patient with dysentery resembling bean curd residue, over a hundred times day and night. Group physicians administered cooling and descending medicines, worsening the danger. Six pulses were deep and weak, indicating spleen deficiency with dampness. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used with Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Cangzhu (Atractylodes Lancea Rhizome), recovering in two to three doses.
Wang Youyi treated a patient with weak legs difficult to walk after dysentery. He said, "Chronic dysentery injures qi; excessive downward flow loses yin. Both qi and blood are deficient, unable to nourish tendons and bones." Bazhen Tang (Eight-Treasure Decoction) was used with Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), Mugua (Chaenomeles Fruit), and Yiren (Coix Seed), resulting in recovery.
Chen Sansan treated a woman with dysentery. She had taken cooling and attacking medicines, causing spleen-stomach weakness and loss of blood control, losing several sheng daily. Touching exacerbated bleeding. Wanting to tonify blood feared worsening spleen cold; wanting to guide blood back to vessels found blood nearly exhausted. Adopting the principle of "yang generates yin," Yiqi Tang (Qi-Augmenting Decoction) was used to warm and nourish middle qi, leading to gradual stability.
A scholar diligent in exams suffered from tenesmus and white pus discharge in late summer. Others treated it as dyscentry. He said, "Incorrect. This is accumulation of labor injuring the spleen, spleen qi sinking. As Dongyuan said: irregular diet and lifestyle cause ascending essence qi to sink instead." Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, recovering in two doses.
Gong Zicai treated Liu Sikou, nearly seventy, suffering from dysentery with pus, blood, and abdominal pain, unresponsive to medicines. Pulse was slightly rapid. This indicated excessive rich food causing internal accumulated heat. He should have taken Jiuzheng Dahuang (Wine-Steamed Rhubarb) 1 liang to clear and drain. Liu said, "I am old and frail, afraid I cannot tolerate it. Mild tonic medicines would be better." After repeated persuasion, he reluctantly agreed and recovered the next day.
You Zaijing said: Dysentery involves qi blockage in the lower jiao and fire pressing upon it, causing abdominal pain, tenesmus, and passage of intestinal mucus. Its origin lies in summerheat-dampness, appearing in summer and autumn like malaria. Pathogens damaging meridians become malaria; entering intestines and viscera becomes dysentery. Meridian pathogens can be dispersed to heal, so treatment suits bitter-acrid warm medicines. Intestinal heat requires clearing to heal, so treatment suits bitter-acrid cold medicines. This reflects the intent of not being too hot in releasing the exterior and not too cold in purging the interior. Hejian's emphasis on clearing cold likely stems from this insight.
Zhang Jingyue did not examine the origin of dysentery but discussed it via five zang organs and five elements, claiming only the Heart relates to fire, others do not. This merely aids debate and does not supplement essential treatment principles.
Dysentery and diarrhea differ in pathology and treatment. Diarrhea often starts from cold-dampness; cold requires warming, dampness requires drying. Dysentery often forms from damp-heat; heat requires clearing, dampness requires draining. Although diarrhea can have heat patterns, cold predominates; although dysentery can have cold patterns, heat predominates. Thus, prolonged diarrhea damages stomach yang, leading to swelling, wheezing, and fullness. Prolonged dysentery damages spleen yin, leading to deficiency vexation and flaccidity/paralysis. Astringing dysentery too early allows damp-heat to flow into collaterals, forming painful obstruction. Over-draining diarrhea causes middle deficiency and failure to recover, becoming spleen勞 (chronic spleen disorder). These are my personal experiences, not speculation. Some ask: Clearing heat and warming cold is correct, but both involve dampness. Why sometimes drain and sometimes dry? Answer: In cold-dampness, cold arises from dampness, so warming and drying the middle is suitable. In damp-heat, dampness transforms from heat, so sweet-bland draining the lower is suitable. Moreover, drying agents are often warm, draining agents often cold. Draining removes heat naturally; warming the middle eliminates cold together. Cold-dampness roots in middle deficiency, so further draining is contraindicated. Damp-heat stagnation often becomes toxic, so adding warmth and dryness is inappropriate.
One patient had dysentery with lower abdominal urgent pain and inability to pass stool, due to spleen-stomach qi deficiency and sinking. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used to deliver Bawei Wan (Eight-Ingredient Pill), recovering in two doses. Such cases, where purgatives damage vital qi leading to limb edema and death, are countless.
One patient had tenesmus after dysentery, self-medicated with Huangqin Shaoyao Tang (Scutellaria and Peony Decoction), worsening tenesmus, poor appetite, cold abdomen, and cold limbs. Gong diagnosed spleen-stomach damage and used Liu Junzi Tang (Six Gentlemen Decoction) with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), recovering in two doses.
Zhao Yangkui treated Xu Yangtai from Siming, who was robust, prone to fire and thirst, keeping tea bowls by the bed even in severe cold, sometimes finishing several bowls a night, and suffering from asthma. Zhao diagnosed depression-fire syndrome and prescribed Zhulian Wan (Evodia and Coptis Pill), ensuring safety. In summer of Ding Si year, Xu avoided heat in Tanzhou, sitting in water basins or drinking cold Xiangru Tang (Elsholtzia Decoction), considering it a good summerheat remedy. In early autumn, severe dysentery erupted. Initially, over a hundred times in three days, red and white mixed, no residue, unbearable abdominal distension and twisting pain. Some suggested purging with Dahuang (Rhubarb). Zhao ignored this, using Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark) to gradually recover. White residue persisted, cured by Yinggan Wan (Inducing Response Pill). Later, eating crab caused relapse and collapse, cured by Bawei Tang (Eight-Ingredient Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ganjiang and Rougui. Using Renshen, Baizhu, Ganjiang, and Rougui to correct excessive cold was correct. Why use Bawei Wan? This is why Zhao Yangkui is Zhao Yangkui.
In one life, consuming Huanglian (Coptis Rhizome) and bitter tea constantly throughout the year, yet now cured by pure heat. Had Dahuang been used for purging, who knows the outcome? When coughing with asthma and insomnia, Xiaoyao San (Free and Easy Wanderer Powder) brought immediate peace. When hematochezia persisted, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Heijiang (Blackened Ginger) stopped it in less than two doses.
Yu Jiayan treated Zhang Zhongyi, who had dysentery for three to five days. He moved normally, but the pulse indicated interior damage with Shaoyin pathogen involvement. He said, "This case requires simultaneous exterior release and interior resolution. Use more Renshen (Ginseng) in exterior-releasing herbs and more Fuzi (Aconite Lateral Root) in interior-resolving herbs to avoid disaster. Using standard dysentery medicines would be dangerous." Zhang trusted him and took the medicine without doubt, though symptoms were not yet severe. By evening, high fever erupted, body heavy as stone, requiring two people to move him, unconscious and confused. Urgently administered complete exterior-interior formulas. Next morning, he could rise and leave the room. Two more doses of Ginseng and Aconite led to full recovery. Without differentiating symptoms, how could such treatment exist in standard dysentery protocols?
Zhou Xinchuan, seventy-three, usually robust. Autumn dysentery persisted, becoming chronic intermittent dysentery in winter, ten+ times day and night, facial edema, dark complexion. Pulse was deep, rapid, and forceful. He said, "Yang pathogen has sunk into yin. I can cure it with proper method." Ren Shen Bai Du San (Ginseng Detoxification Powder) was decocted. Patient sat wrapped in thick blankets on a chair, heated underneath, with cloth rolled under buttocks to block anus, preventing internal qi from sinking downward. (Internal qi lifting relies on the person; blocking externally is absurd. Note: While lifting depends on the person, external support helps slightly. Then administer hot decoction. After a while, another dose. Sweat appears on skin. Pour hot water. Instruct to endure urge to defecate. This is reasonable.) Hot decoction administered. After a while, another dose. Sweat appeared. Hot water poured. Instructed to endure heat and urge, not moving for about two hours. Skin moist but not dry. Patient anxious and fearful of heat, unbearable, finally allowed to lie in bed with blanket. That night, only two dysentery episodes. Later, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) reduced frequency to three times day and night. Recovered fully in ten days. The sunken pathogen wants to emerge from the exterior. Without the "saving the boat in a rapid current" method, where would the downward trend end? Heard that Wang Xingzai had chronic dysentery unresponsive to medicines. Suzhou old doctor used Ren Shen Bai Du San (Ginseng Detoxification Powder), reducing severity and showing vitality, but lacked this maneuvering method, failing ultimately. Thus, for any case of yang pathogen sinking into yin, such as chronic malaria, chronic dysentery, chronic fever, one must recognize this intent, allowing interior pathogens to slowly emerge to the exterior. If rushed, fear re-entry, merely injuring healthy qi.
Commentary: Chronic intermittent dysentery often results from mis-treatment, either astringing too early or purging abruptly when exterior signs exist. Ancients often used Yinggan Wan (Inducing Response Pill), a good method. Using Ren Shen Bai Du San (Ginseng Detoxification Powder) here is also logically sound. Blocking the anus with cloth/egg to prevent internal qi sinking is overly curious. Reading Daoist texts, I saw that when inner elixir is formed and needs to pass the gate, objects are placed in the anus and testicles pinched to prevent spirit elixir leakage. Yu integrated the three teachings; his intent might derive from this. Mr. Wei's criticism is perhaps seeing little and marveling much.
Zhu Kongyang, twenty-five, thin, accustomed to comfort. In summer, running in the sun for litigation, summerheat-dampness combined with internal depressed fire, causing dysentery, 100-200 times day and night, unable to get up, changing coarse paper mats frequently, drinking only water, severe pain, anus burning like iron, tossing limbs, restless. Pulse was wiry, tight, strong, and urgent, unyielding to pressure. He said, "This is a mass of toxic fire accumulating in intestines and stomach, burning fiercely. Saving from fire requires instant action. In two or three days, intestines and stomach will rot." Used Dahuang (Rhubarb) 4 liang, Huanglian (Coptis Rhizome) and Gancao (Licorice Root) 2 liang each, decocted in large clay pot, taken as it boils. After taking, consciousness calmed briefly, then restlessness returned. Took over twenty bowls in one day and night. Dahuang dissolved completely, Huanglian and Gancao boiled to no juice. Next day, pulse softened, indicating recovery possible. But used decoction method, not emergency medicine. Changed to Shengdi (Rehmannia Root) and Maidong (Ophiopogon Tuber) 4 liang each, crushed for fresh juice, mixed with Huafen (Trichosanthes Root), Danpi (Moutan Cortex), Chishao (Red Peony Root), and Gancao (Licorice Root) 1 liang each, decocted and mixed with juice, swallowed in large bowls. Due to violent onset, body fluids rushed out. Waiting for dysentery to stop to generate fluids would make withering hard to reverse. Now pulse softened, fire pathogen retreated. Not treating dysentery directly, it stopped itself. How can one stick to cloying/stagnating medicines and not use urgently? Dysentery indeed stopped, leaving only slight qi foam. Consumed fermented rice soup, conditioned for ten days, digestion resumed. Shows that even a thread of stomach qi remaining cannot lack this "burnt head and broken forehead" guest.
Pu Junyi had dysentery. Initially, exterior pathogen undissipated, mistakenly treated with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) to consolidate exterior, driving pathogen deep. Mistakenly cooled with Huanglian (Coptis Rhizome) and purged with Dahuang (Rhubarb). Treatment lasted over a month, stomach qi stagnant, dysentery 100+ times day and night. One night, vomited 3-5 bowls of previous Huanglian decoction. After 3-5 vomits, stomach and intestine merged,幽门 (Pylorus) and 阑门 (Ileocecal valve) opened unrestricted. Porridge and drinks flowed straight out. Even thick Renshen paste swallowed went straight down intestine. Large dose of Sijunzi Tang (Four Gentlemen Decoction) decocted with Chishizhi (Halloysitum Rubrum) and Yuyuliang (Hematitum) powders, continuously administered. Condition slightly declined, but unbearable abdominal pain. Pu said, "Previous dysentery was frequent but painless. Pain increased after this medicine, should not continue." Yu said, "This is exactly 'smoothness brings no pain, pain indicates blockage.' No pain is dangerous, pain is safe. How can there be no pain?" Continued previous medicine. Once severity greatly reduced, switched to Sijunzi Tang with doubled Fuling (Poria), recovering fully in ten-plus doses.
Li Shicai treated Madam Sun Xiaoxiang, dysentery for forty days, dry mouth, fever, no appetite, abdominal distension, undigested food in stool. Some attributed undigested food to evil heat not killing grain. Used Xiangru (Costus Root), Huanglian (Coptis Rhizome), Zhiqiao (Bitter Orange), Doukou (Cardamom), Houpo (Magnolia Bark) etc., over thirty doses, fasting for five days, life hanging by a thread. Pulse large and rapid, empty upon pressure. Abdominal pain relieved by pressure, clear urination. This indicated fire decline failing to generate earth, true interior cold with false exterior heat. Urgently decocted Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), taken with ice water. One dose stopped pain, six doses reduced fever and restored appetite. Combined with Bawei Wan (Eight-Ingredient Pill), recovered fully in twenty-plus days.
Lady of Marquis Xu, dysentery with abdominal pain, pulse faint and soft. Li said, "Qi deficiency fails to transport essence and micro. Urgency and tenesmus are due to sinking." Shengyang Sanhuo Tang (Raise Yang Dispel Fire Decoction) two doses, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) ten doses, recovered.
Yu Jiayan treated Chen Ruming with dysentery, steaming fever, coma, no eating, pulse rapid-large-empty, Chi pulse twice as full. Interior damp-heat combined with seasonal exterior heat, desiring...