肉各五钱，陈枳壳炒、槟榔、浓朴姜汁炒、青皮各八分，当归、甘草、地榆各五分，红花酒洗三分，南木香二
分，桃仁泥一钱，水二碗，煎一碗，空心温服，渣再煎。
此方，或红或白，或红白相兼，里急后重，身热腹痛者，俱可服。其有便纯血，便如尘水，大孔如竹筒
等恶症，古谓不治者，急服此亦可救，但迟缓则毒坏脏腑为难救耳。其有噤口者，毒在胃口也。此药煎一
剂，分五六次缓缓服之，令胃口毒瓦斯渐开。服完一剂后，不惟药可进，而饮食亦渐可进矣，不必另用他药
也。单白无红者，去地榆、桃仁，加去白陈皮四分，木香用三分。滞涩甚者，加酒炒大黄二钱。服一二剂，
仍除之。此方用之于三五日神效，旬日内外亦效。惟半月外则当加减如后∶黄连、条芩、白芍，三味生
用，各四分，酒炒各六分，山楂肉一钱，浓朴、陈皮、青皮、槟榔各四分，甘草生熟各一分半，地榆醋炒、
当归各五分，桃仁泥六分，红花六分，木香二分。如延至月余，觉脾胃虚滑者，则用酒炒苓、连、白芍各
六分，陈皮、浓朴、木香各三分，醋炒地榆四分，红花二分，当归、人参、白术、熟甘草各五分。以上方
法，用无不效。间有不效者，必其初投参、术等补剂太早，补塞邪热在内，久而正气已虚，邪气犹盛，欲
补而涩之则助邪，欲清而疏之则愈滑，遂致不救。予尝治一公子，一仕宦，皆早投温补，不可挽回。故表
而出之，以戒后人。
魏玉横曰∶张龙文，年三十来，九月患痢，至十二月未瘥，已无腹痛后重。服补中益气则不及至圊，且下
转数。延予治，与熟地、杞子、白芍、枣仁、米仁等，初甚逆，膈胀而痢且五色，幸彼能守药，弗更张，再进
而痢降序矣。洎岁暮，已向愈。脉之，两关滑大，重按则弦，戒之曰∶药未可停，恐立春后病再发。已而果
然。其邻医就余方加补骨脂、砂仁、木香、广皮之类与之，了不应，且昏睡而多汗。至四月中，再求诊，则以
前方加沙参、麦冬、蒌仁、黄芩，未二十剂而痊。后环跳穴及趾踵痛，流注无定所，状如痢后风，仍以前方加
知、柏、川连，数剂而安。
濮氏子住涌金门外，甚贫窘，患久痢脱肛，诸治不效，乃入城就予诊。虽相去二三里，途中必数登厕，肛
既不收，行步殊苦。与补中益气汤加熟地一两、炮姜一钱，服二剂竟愈。
范秀才年近七旬，戊子二月，患寒热。原有痢病，至是胸胁少腹无不痛楚，下痢红白，一名医治之有年。
其邀余诊，盖乘便耳。其脉弦数，所喜者滑，询其小便短赤，此纯属肝火下迫，似痢而非痢也。必多服香窜，
又值君火司天，少阳当令，于是乘其所胜，而侮其所不胜，所下皆太阴血津，阳明脂膏也。与生女贞、沙参、
麦冬、川连、蒌仁，一剂已愈其半。而名医曰∶七十之年，可服黄连之苦寒，蒌仁之滑泄乎？今下痢而不与调
气健脾，而反用滋阴润肺，此何治邪？范乃拘儒，复听之治，又一月，将毙矣。再延诊，仍前方加杞子、白芍、
甘草，数剂痢止痛除而愈。（痢原有伤燥而致者，魏君所治，皆其证也。）
裴兆期治其母，年七十，时于除夕，忽病痢，痢之频不可以数计，神昏不语，发热面赤，气奔迫而脉洪大。
以虚痢下频而滑，无里急后重之症，以人参、莲肉各一两，砂仁一钱，浓煎频服。至五日，痢减神清，遂素食
矣。自此日用补中益气汤加桂、附少许，至四十余剂，始得饮啖，神情俱如故。
一士人，冬月患痢，昼夜百余次，里急后重，恶心不能食，腹中按之硬痛，脉细数无伦，手足面鼻俱清冷。
投以人参一两，桂、附、干姜各一钱，不食顷，已再进，竟不见温补之验。后倍加挂、附，二剂手足渐温，恶
心渐止，饮食亦渐进。特痢未减，更以人参为君之大补脾丸，加入桂、附，俾旦晚服之，以扶胃气而加饮食，
此治本之第一要图也。半月中，约服人参八九两，附子三枚，脉始洪长有力，口复燥渴而思冷冻饮料。是阴已化阳，
仍用大黄、黄连、槟榔、芍药之类，涤去肠中宿垢。后以加减参苓散作丸与之，遂愈。
叶天士治徐某，夏季痢症，多是湿热食积。初起宜分消其邪，但肌柔白嫩，乃气虚之质，且性情畏药，只
宜少与勿过。槟榔汁、青皮、陈皮、浓朴、川连、黄芩、木香、炒黑山楂。又诊湿热下痢，必用苦辛寒为治。
粟壳涩肠，止泻久痢成方，当此热邪未清，宣通斯滞可去。因色白气弱，未敢峻攻耳。浓朴、黄芩、川连、木
香汁、山楂肉、炒银花、麦芽。
王某案∶痢疾古称滞下，乃是湿热气薄肠胃，阻闭气分，故利仍不爽，河间、丹溪佥用清热导气者为此。
黄芩、川连、草决明、炒黑山楂肉、生白芍、石莲、丹皮、广木香汁。
顾某得汤饮腹中漉漉，自痢稀水。平昔酒客留湿，湿热内蕴，肠胃凝积不爽。东垣清暑益气，亦为湿热伤
气而设。但脾胃久病，仍能纳食，当苦味坚阴，芳香理脾。生茅术四两，炒黑黄柏二两，炒黑地榆二两，猪苓
一两半，泽泻一两半，水泛丸，服三钱。（徐灵胎曰∶此挟饮之痢，方极灵妙。）
治红白痢，忌用川连，宜用车前草炒研二钱，槟榔、山楂、陈皮、滑石、甘草各一钱，红曲三钱，枳实
炒一钱，泽泻炒二钱，灯心一撮，广木香六分煨，共为末，每服三钱，乌药煎汤冲服。
一人阴虚发热，下痢赤白，至夜烦渴不宁，或用凉血攻积药而死。一人阴虚发热，下痢五色，胸中常觉饥
状，得食则胀，或用补中益气汤而死。一人阴虚发热，下痢不食，郭友三用猪苓汤、黄连阿胶汤而痊。张飞畴
曰∶世患阴虚下痢者颇多，未有不发热，不烦渴，不畏食，不见红，不夜甚者。盖阴气内亡，势必虚阳外扰，
故治阴虚之痢，凉血死，攻积死，补气亦死。惟清解热毒，兼滋阴血，庶可保全。此用仲景少阴例中，救热存
阴之法。与《金匮》治产后下痢，虚极用白头翁加甘草阿胶汤不殊也。
《广笔记》曰∶凡治滞下，与大肠滑泄自利不同。滑泄自利不止，有可涩之道。故古人有间用粟壳、诃子以
止之者。若夫滞下，本属湿热涩滞不行，法宜疏利，药忌兜涩。大肠者，肺之腑也。大肠既有湿热留滞，则肺
家亦必有热。肺乃华盖之脏，经曰∶脾气散精，上归于肺，通调水道，下输膀胱。是肺气喜通利，恶闭涩，故
古人药性中，每云利肺气，其意概可见矣。倘误用涩药，使湿气无所宣泄，肺气不得下降，非惟滞下增剧，而
湿热熏蒸，上干乎肺，则胀闷气逆，不得眠，不思食，诸证至矣。
外有时行疫痢一症，往往夏末初秋，沿门阖境患此。其症大都发热头痛，口渴烦躁，下痢溺涩。甚者，一
日夜行百次，或兼发斑疹，势甚危迫。世医妄指为漏底，殊不知此是时气使然。治法当清热解毒表散为急，如
升麻、葛根、柴胡、黄连、黄芩之类。或热甚渴甚，前药中可加寒水石。更有别证，以意加减。切忌下行破气
收涩，如大黄、芒硝、槟榔、枳实、乌梅、粟壳等。犯此者，多致不救。
治毒痢及发疹时疹毒下痢方∶鲜金银藤数两，煎浓汁三大碗，入地榆五钱，川黄连槐花湿拌炒四钱，黄柏
二钱，黄芩二钱，白芍酒炒三钱，炙甘草二钱，绿升麻醋炒六分。同煎至一碗，调飞过滑石末五钱，不拘时服。
肉桂五钱，陈枳壳（炒）、槟榔、厚朴（姜汁炒）、青皮各八分，当归、甘草、地榆各五分，红花（酒洗）三分，南木香二分，桃仁泥一钱。加水两碗，煎至一碗，空腹温服，药渣再煎。
此方，无论是红痢、白痢，还是红白相兼的痢疾，伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）、身热腹痛者，均可服用。那些出现纯下鲜血、大便如尘土污水、肛门松弛如竹筒等危重症状，古人认为无法治愈的，紧急服用此方也可以挽救，但如果延误时机，则毒邪败坏脏腑，就难以救治了。那些出现噤口痢（痢疾而不能进食，或呕不能食）的患者，是毒邪阻滞在胃口。此药煎好一剂，分五六次缓缓服用，使胃口的毒邪逐渐消散。服完一剂后，不仅药物可以接受，饮食也逐渐可以进补了，不必另外使用其他药物。如果是纯白无红的痢疾，去掉地榆、桃仁，加入去白陈皮四分，木香用三分。如果滞涩严重的，加入酒炒大黄二钱。服用一二剂后，仍要去除大黄。此方用于发病三到五天，效果显著；十天内外也有效。只有超过半个月，才应当加减如下：黄连、黄芩、白芍，这三味生用各四分，酒炒各六分，山楂肉一钱，厚朴、陈皮、青皮、槟榔各四分，甘草生用和熟用各一分半，地榆（醋炒）、当归各五分，桃仁泥六分，红花六分，木香二分。如果拖延到一个月以上，感觉脾胃虚弱滑泄的，则用酒炒黄芩、黄连、白芍各六分，陈皮、厚朴、木香各三分，醋炒地榆四分，红花二分，当归、人参、白术、熟甘草各五分。以上方法，使用没有不有效的。间或有无效的，一定是因为初期过早投用参、术等补益剂，导致补塞邪热在内，时间久了正气已经虚弱，邪气仍然强盛，想要补益而固涩则会助长邪气，想要清热而疏利则会更加滑泄，于是导致无法救治。我曾经治疗一位公子，还有一位做官的人，都是过早投用温补药物，结果不可挽回。所以列出这些案例，以告诫后人。
魏玉横说：张龙文，三十岁来就诊，九月患痢疾，到十二月仍未痊愈，已经没有腹痛和后重感。服用补中益气汤后，甚至来不及上厕所就腹泻，且次数增多。请我诊治，给予熟地黄、枸杞子、白芍、酸枣仁、薏苡仁等药，起初反应很剧烈，胸膈胀满且痢疾变为五色，幸好他能够坚持服药，不再更改方案，再次进药后痢疾逐渐好转。到了年底，病情向愈。诊脉，两关部滑大，重按则弦，告诫他说：药不可停，恐怕立春后病会复发。后来果然如此。他的邻居医生在我的方子上加入补骨脂、砂仁、木香、广陈皮之类给他服用，完全无效，反而昏睡且多汗。到四月中，再次求诊，我在前方中加入沙参、麦冬、瓜蒌仁、黄芩，不到二十剂就好了。后来环跳穴及脚后跟疼痛，流注不定，状如痢后风（痢疾后遗症引起的肢体疼痛），仍用前方加知母、黄柏、川黄连，几剂后安定。
濮氏的儿子住在涌金门外，非常贫穷困窘，患久痢脱肛，各种治疗无效，于是进城找我诊治。虽然离城只有二三里路，途中必须多次上厕所，肛门既不收纳，行走特别痛苦。给予补中益气汤加熟地黄一两、炮姜一钱，服用两剂竟然痊愈。
范秀才年近七十，戊子年二月，患寒热往来。原有痢疾病史，至此胸胁少腹无不疼痛，下痢红白，一名医生医治多年。他邀请我诊治，大概是顺便罢了。他的脉象弦数，可喜的是带滑象，询问他小便短赤，这纯属肝火下迫所致，似痢疾而非痢疾。必定是多服了香窜之药，又值君火司天，少阳当令，于是乘其所胜，而侮其所不胜，所下的都是太阴血津和阳明脂膏。给予女贞子、沙参、麦冬、川黄连、瓜蒌仁，一剂后病愈一半。而那位名医说：七十岁的人，可服用黄连的苦寒、瓜蒌仁的滑泄吗？现在下痢却不与调气健脾的药，反而用滋阴润肺的药，这是什么治法？范秀才是个拘谨的书生，又听从了他的治疗，又过一个月，将要死了。再次延请诊治，仍用前方加枸杞子、白芍、甘草，几剂后痢止痛除而痊愈。（痢疾原本有因伤燥而致的，魏君所治的，都是这类证候。）
裴兆期治疗他的母亲，七十岁，时在除夕，忽然患痢疾，痢疾频繁无法计数，神志昏迷不语，发热面赤，气促紧迫而脉洪大。因为虚痢下频而滑，没有里急后重的症状，用人参、莲子肉各一两，砂仁一钱，浓煎频服。到第五天，痢疾减轻神志清醒，就开始吃素食了。从此每天用补中益气汤加少许桂枝、附子，到四十多剂，才开始能吃喝，神情都恢复如常。
一位读书人，冬天患痢疾，昼夜一百多次，里急后重，恶心不能进食，腹部按压硬痛，脉细数无比，手足面部鼻子都清冷。投用人参一两，桂枝、附子、干姜各一钱，不久，已再进药，竟然不见温补的效果。后来加倍桂枝、附子，两剂后手足渐温，恶心渐止，饮食也渐进步。只是痢疾未减，更以人参为君药的大补脾丸，加入桂枝、附子，让早晚服用，以扶助胃气而增加饮食，这是治本的第一要务。半个月内，约服用人参八九两，附子三枚，脉始变洪长有力，口复干燥口渴想喝冷冻饮料。这是阴已化阳，仍用大黄、黄连、槟榔、芍药之类，涤荡去除肠中宿垢。后用加减参苓散做成丸药给他，于是痊愈。
叶天士治疗徐某，夏季痢症，多是湿热食积。初起宜分消其邪，但患者肌柔白嫩，是气虚的体质，且性情畏药，只宜少量给予不要过量。槟榔汁、青皮、陈皮、厚朴、川黄连、黄芩、木香、炒黑山楂。又诊湿热下痢，必用苦辛寒为治。粟壳涩肠，是止泻久痢的成方，当此时热邪未清，宣通滞气即可去除。因为面色白气弱，不敢峻猛攻伐。厚朴、黄芩、川黄连、木香汁、山楂肉、炒银花、麦芽。
王某案：痢疾古称滞下，乃是湿热气薄肠胃，阻闭气分，故利仍不爽，河间、丹溪都用清热导气的药为此。黄芩、川黄连、草决明、炒黑山楂肉、生白芍、石莲、丹皮、广木香汁。
顾某得汤饮腹中漉漉作响，自下稀水痢。平素是酒客留湿，湿热内蕴，肠胃凝积不爽。东垣的清暑益气汤，也是为湿热伤气而设。但脾胃久病，仍能纳食，当用苦味坚阴，芳香理脾。生茅术四两，炒黑黄柏二两，炒黑地榆二两，猪苓一两半，泽泻一两半，水泛丸，服三钱。（徐灵胎说：这是挟饮之痢，方子极灵妙。）
治疗红白痢，忌用川黄连，宜用车前草炒研二钱，槟榔、山楂、陈皮、滑石、甘草各一钱，红曲三钱，枳实炒一钱，泽泻炒二钱，灯心一撮，广木香六分煨，共为末，每服三钱，乌药煎汤冲服。
一人阴虚发热，下痢赤白，至夜烦渴不宁，或用凉血攻积药而死。一人阴虚发热，下痢五色，胸中常觉饥状，得食则胀，或用补中益气汤而死。一人阴虚发热，下痢不食，郭友三用猪苓汤、黄连阿胶汤而痊愈。张飞畴说：世上患阴虚下痢者颇多，没有不发热、不烦渴、不畏食、不见红、不夜甚的。盖因阴气内亡，势必虚阳外扰，所以治疗阴虚之痢，凉血死，攻积死，补气亦死。惟清解热毒，兼滋阴血，庶可保全。此用仲景少阴例中，救热存阴之法。与《金匮》治产后下痢，虚极用白头翁加甘草阿胶汤不殊也。
《广笔记》说：凡治疗滞下，与大肠滑泄自利不同。滑泄自利不止，有可涩之道。所以古人有间用粟壳、诃子以止之者。若夫滞下，本属湿热涩滞不行，法宜疏利，药忌兜涩。大肠者，肺之腑也。大肠既有湿热留滞，则肺家亦必有热。肺乃华盖之脏，经曰：脾气散精，上归于肺，通调水道，下输膀胱。是肺气喜通利，恶闭涩，故古人药性中，每云利肺气，其意概可见矣。倘误用涩药，使湿气无所宣泄，肺气不得下降，非惟滞下增剧，而湿热熏蒸，上干乎肺，则胀闷气逆，不得眠，不思食，诸证至矣。
外有时行疫痢一症，往往夏末初秋，沿门阖境患此。其症大都发热头痛，口渴烦躁，下痢溺涩。甚者，一日一夜行百次，或兼发斑疹，势甚危迫。世医妄指为漏底，殊不知此是时气使然。治法当清热解毒表散为急，如升麻、葛根、柴胡、黄连、黄芩之类。或热甚渴甚，前药中可加寒水石。更有别证，以意加减。切忌下行破气收涩，如大黄、芒硝、槟榔、枳实、乌梅、粟壳等。犯此者，多致不救。
治疗毒痢及发疹时疹毒下痢方：鲜金银藤数两，煎浓汁三大碗，入地榆五钱，川黄连槐花湿拌炒四钱，黄柏二钱，黄芩二钱，白芍酒炒三钱，炙甘草二钱，绿升麻醋炒六分。同煎至一碗，调飞过滑石末五钱，不拘时服。
Cinnamon Twig (Rougui) 5 qian, Chen Zhike (aged Tangerine Peel, stir-fried), Areca Seed (Binglang), Magnolia Bark (Houpo, stir-fried with ginger juice), Green Citrus Peel (Qingpi) each 8 fen, Angelica Sinensis (Danggui), Licorice Root (Gancao), Sanguisorba Root (Diyu) each 5 fen, Safflower (Honghua, washed with wine) 3 fen, Southern Aromatic Costus Root (Nanmuxiang) 2 fen, Peach Kernel Paste (Taoren Ni) 1 qian. Add two bowls of water, decoct to one bowl, take warm on an empty stomach, decoct the dregs again.
This formula can be used for red dysentery, white dysentery, or mixed red and white dysentery, accompanied by tenesmus (urgent need to defecate with a feeling of heaviness in the anus) and abdominal pain with fever. For those presenting with pure bloody stool, stool resembling dust and water, or a relaxed anus like a bamboo tube—severe conditions considered incurable by ancients—taking this formula urgently can also save them. However, if treatment is delayed, the pathogenic toxin will damage the zang-fu organs, making it difficult to rescue. For patients presenting with anorexic dysentery (inability to eat due to dysentery), the toxin is obstructing the stomach opening. Decoct one dose of this medicine, divide into five or six portions, and take slowly to gradually dissipate the toxin at the stomach opening. After finishing one dose, not only will the patient tolerate the medicine, but food intake will also gradually improve; no other medicines are needed. For pure white dysentery without redness, remove Diyu and Taoren, add Chenpi (aged tangerine peel, pith removed) 4 fen, and use Nanmuxiang 3 fen. For severe stagnation and obstruction, add Rhubarb (Dahuang, stir-fried with wine) 2 qian. After taking one or two doses, remove Dahuang. This formula is highly effective when used within three to five days of onset, and also effective within ten days. Only after half a month should modifications be made as follows: Coptis Rhizome (Huanglian), Scutellaria Root (Tiaoqin/Baishao context implies Huangqin here based on standard pairing, text says Tiaoqin which is likely Huangqin), White Peony Root (Baishao), all raw, each 4 fen; wine-stir-fried each 6 fen; Hawthorn Flesh (Shanzharenrou) 1 qian; Houpo, Chenpi, Qingpi, Binglang each 4 fen; Gancao (raw and cooked) each 1.5 fen; Diyü (vinegar-stir-fried), Danggui each 5 fen; Taoren Ni 6 fen; Honghua 6 fen; Nanmuxiang 2 fen. If the condition persists for over a month and spleen/stomach deficiency with loose stools is felt, then use Huangqin, Huanglian, Baishao (wine-stir-fried) each 6 fen; Chenpi, Houpo, Nanmuxiang each 3 fen; Diyü (vinegar-stir-fried) 4 fen; Honghua 2 fen; Danggui, Ginseng (Renshen), Atractylodes Macrocephala (Baizhu), Cooked Licorice (Shu Gancao) each 5 fen. The above methods are invariably effective. Occasionally, there may be ineffective cases; this is usually because tonics like Renshen and Baizhu were administered too early initially, trapping the pathogenic heat inside. Over time, the righteous qi becomes deficient while the pathogenic qi remains strong. Tonifying and astringing would aid the pathogen, while clearing and draining would worsen the looseness, leading to untreatable conditions. I once treated a young nobleman and an official who both received warm-tonifying treatments too early, resulting in irretrievable outcomes. Therefore, these cases are recorded to warn future practitioners.
Wei Yuheng said: Zhang Longwen, aged thirty, presented in September with dysentery that had not resolved by December, though abdominal pain and tenesmus had ceased. He took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which resulted in immediate diarrhea before reaching the toilet, with increased frequency. I was consulted and prescribed Shudihuang (Prepared Rehmannia Root), Gouqizi (Lycium Fruit), Baishao (White Peony Root), Zaoren (Sour Jujube Seed), Yiyiren (Coix Seed). Initially, the reaction was adverse, with chest fullness and dysentery turning multicolored. Fortunately, he persisted with the prescription without changing it. Upon subsequent administration, the dysentery gradually improved. By year-end, he was recovering. Pulse diagnosis showed slippery and large pulses at both Guan positions, becoming wiry upon heavy pressure. I warned him: do not stop the medicine, lest the disease recur after Li Chun (Start of Spring). Indeed, it did recur. His neighbor doctor added Gubuzhi (Psoralea Fruit), Sharen (Amomum Fruit), Nanmuxiang, and Guangpi to my formula, which was ineffective, causing drowsiness and excessive sweating. In mid-April, he sought consultation again. I added Shashen (Glehnia Root), Maidong (Ophiopogon Tuber), Louren (Trichosanthes Seed), and Huangqin to the previous formula. Within twenty doses, he recovered. Later, he experienced pain in the Huantiao acupoint and heels, with wandering pain resembling post-dysentery wind syndrome. Using the previous formula plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), and Chuanlianhuan (Coptis Rhizome), he stabilized after several doses.
The son of the Pu family lived outside Yongjin Gate, very poor, suffering from chronic dysentery with rectal prolapse. Various treatments failed, so he came to the city for my consultation. Although only two or three li from the city, he had to visit the toilet multiple times during the journey. His anus could not retract, making walking extremely painful. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Shudihuang 1 liang and Paojiang (Prepared Ginger) 1 qian. After two doses, he was completely cured.
Scholar Fan, nearly seventy years old, suffered from alternating chills and fever in February of the Wuzi year. He had a history of dysentery. At this time, his chest, hypochondrium, and lower abdomen were all painful, with red and white dysenteric stools. A famous physician had treated him for years. He invited me to consult, perhaps casually. His pulse was wiry and rapid, but pleasantly slippery. Inquiry revealed short, red urine. This was purely due to Liver Fire forcing downward, resembling dysentery but not being true dysentery. He must have taken many aromatic and penetrating herbs. Furthermore, with the Sovereign Fire ruling the year and Shaoyang in command, the pathogen attacked what it overcomes and insulted what it cannot overcome. The discharged material consisted of Taiyin blood fluids and Yangming fatty tissues. I prescribed Nüzhenzi (Ligustrum Fruit), Shashen, Maidong, Chuanlianhuan, and Louren. Half the symptoms resolved after one dose. However, the famous physician said: Can a seventy-year-old take the bitter cold of Huanglian and the lubricating nature of Louren? Now, with dysentery, instead of regulating qi and strengthening the spleen, you use yin-nourishing and lung-moistening herbs. What kind of treatment is this? Scholar Fan, being rigid, listened to him. After another month, he was near death. I was called again and used the previous formula plus Gouqizi, Baishao, and Gancao. After several doses, the dysentery stopped, pain ceased, and he recovered. (Note: Dysentery can also be caused by dryness injury; the cases treated by Master Wei belong to this category.)
Pei Zhaoqi treated his mother, aged seventy, who suddenly developed dysentery on New Year's Eve. The frequency was incalculable, with coma, muteness, fever, flushed face, rapid breathing, and a large pulse. Because it was deficiency dysentery with frequent, slippery stools and no tenesmus, I prescribed Renshen (Ginseng) and Lianrou (Lotus Seed) each 1 liang, and Sharen 1 qian, decocted strongly and taken frequently. By the fifth day, the dysentery decreased, consciousness cleared, and she began eating vegetarian food. From then on, daily use of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with small amounts of Guizhi (Cinnamon Twig) and Fuzi (Aconite Root). After more than forty doses, she could finally eat and drink, and her spirit and demeanor returned to normal.
A scholar suffered from dysentery in winter, defecating over a hundred times a day, with tenesmus, nausea, inability to eat, hard and painful abdomen upon pressure, extremely fine and rapid pulse, and cold hands, feet, face, and nose. I administered Renshen 1 liang, Guizhi, Fuzi, and Ganjiang (Dried Ginger) each 1 qian. After a short while, a second dose was given, but no warming effect was seen. Later, the dosage of Guizhi and Fuzi was doubled. After two doses, his limbs warmed, nausea stopped, and food intake gradually improved. However, the dysentery did not decrease. I then used Da Bu Pi Wan (Great Tonify Spleen Pill) with Renshen as the chief herb, adding Guizhi and Fuzi, to be taken morning and night to support Stomach Qi and increase appetite. This is the primary strategy for treating the root. Within half a month, approximately 8-9 liang of Renshen and three Fuzi were consumed. The pulse became large, long, and forceful, and he became thirsty for cold drinks. This indicated Yin transforming into Yang. I then used Dahuang (Rhubarb), Huanglian, Binglang, and Shaoyao to purge the accumulated feces from the intestines. Finally, I gave him Ji Jian Shen Ling San (Modified Ginseng and Poria Powder) in pill form, and he recovered.
Ye Tianshi treated Xu Mou with summer dysentery, mostly due to damp-heat and food stagnation. Initially, the pathogen should be dispersed and eliminated. However, the patient had soft, white, and tender skin, indicating a Qi-deficient constitution, and feared medication. Thus, only small doses should be given. Prescription: Binglang juice, Qingpi, Chenpi, Houpo, Chuanlianhuan, Huangqin, Muxiang, and Stir-fried Black Shanzha. Another case of damp-heat dysentery requires bitter, pungent, and cold herbs. Qieke (Poppy Shell) astringes the intestines and is a established formula for stopping chronic diarrhea. However, since the heat pathogen is not yet cleared, promoting circulation to resolve stagnation is sufficient. Due to pale complexion and weak Qi, harsh purgatives were avoided. Prescription: Houpo, Huangqin, Chuanlianhuan, Muxiang juice, Shanzharenrou, Stir-fried Jinyinhua (Honeysuckle Flower), and Maiya (Malt).
Case of Wang Mou: Dysentery was anciently known as "Zhi Xia" (Stagnant Downward Flow), caused by damp-heat invading the intestines and stomach, blocking the Qi mechanism, thus causing incomplete evacuation. He Jie and Danxi both used heat-clearing and Qi-directing herbs for this. Prescription: Huangqin, Chuanlianhuan, Caojueming (Sicklepod Seed), Stir-fried Black Shanzharenrou, Raw Baishao, Shilian (Stone Lotus Seed), Danpi (Moutan Cortex), and Guangmuxiang juice.
Case of Gu Mou: Gurgling sounds in the abdomen after drinking soup, with watery dysentery. As a habitual drinker, he retained dampness, leading to internal accumulation of damp-heat and intestinal stagnation. Dong Yuan's Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction) is also designed for Qi injury due to damp-heat. However, for chronic spleen/stomach disease where appetite remains, bitter herbs to firm Yin and aromatic herbs to regulate the Spleen are appropriate. Prescription: Raw Maoshu (Atractylodes Lancea) 4 liang, Stir-fried Black Huangbai (Phellodendron Bark) 2 liang, Stir-fried Black Diyu 2 liang, Zhuling (Polyporus) 1.5 liang, Zexie (Alisma) 1.5 liang. Made into pills with water, take 3 qian. (Xu Lingtai said: This is dysentery with fluid retention; the formula is extremely ingenious.)
For red and white dysentery, avoid Chuanlianhuan. Instead, use Cheqiancao (Plantain Herb) stir-fried and powdered 2 qian, Binglang, Shanzha, Chenpi, Huashi (Talcum), Gancao each 1 qian, Hongqu (Red Yeast Rice) 3 qian, Zhishi (Immature Bitter Orange) stir-fried 1 qian, Zexie stir-fried 2 qian, Dengxin (Juncus Effusus) a pinch, Guangmuxiang 6 fen roasted. All ground into powder, take 3 qian per dose, washed down with Wu Yao (Lindera Root) decoction.
One person with Yin deficiency and fever, passing red and white dysentery, became restless and thirsty at night, died after using blood-cooling and stagnation-expelling drugs. One person with Yin deficiency and fever, passing multicolored dysentery, felt hungry in the chest but bloated after eating, died after using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). One person with Yin deficiency, fever, dysentery, and anorexia, recovered using Zhu Ling Tang (Poria Decoction) and Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) prescribed by Guo Yousan. Zhang Feichou said: Many people suffer from Yin-deficiency dysentery. It is rare to find cases without fever, thirst, aversion to food, red stool, or worsening at night. Since internal Yin is depleted, deficient Yang inevitably disturbs externally. Therefore, treating Yin-deficiency dysentery with blood-cooling leads to death, with stagnation-expelling leads to death, and with Qi-tonifying also leads to death. Only by clearing heat toxins and simultaneously nourishing Yin and Blood can life be preserved. This uses the method of saving heat and preserving Yin from Zhang Zhongjing's Shaoyin examples. It is no different from the treatment of postpartum dysentery with extreme deficiency using Baitouweng Tang plus Gancao and Ejiao in the *Jingui Yaolue*.
*Guang Biji* states: Treating "Zhi Xia" (dysentery with stagnation) is different from simple colonic slippage and spontaneous diarrhea. Simple slippage and diarrhea can be astringed. Thus, ancients occasionally used Qieke (Poppy Shell) and Hezi (Chebulic Myrobalan) to stop it. However, "Zhi Xia" is fundamentally due to damp-heat stagnation and obstruction; the method should be to promote drainage, and astringents are contraindicated. The Large Intestine is the腑 (Fu organ) of the Lung. If damp-heat stagnates in the Large Intestine, the Lung must also have heat. The Lung is the canopy organ. The Classics state: The Spleen scatters essence, sending it up to the Lung, which regulates water passages and sends them down to the Bladder. Thus, Lung Qi prefers free flow and dislikes obstruction. Hence, ancient materia medica often mentions benefiting Lung Qi, revealing this intent. If astringent herbs are mistakenly used, dampness has no outlet, Lung Qi cannot descend. Not only will dysentery worsen, but damp-heat steaming upward will harass the Lung, causing distension, oppression, rebellious Qi, insomnia, and anorexia.
Additionally, there is epidemic dysentery ("Shixing Yili"), often occurring in late summer and early autumn, affecting entire communities. Symptoms generally include fever, headache, thirst, irritability, dysentery, and difficult urination. Severe cases may pass stool a hundred times a day or develop macules and papules, posing a critical danger. Physicians wrongly diagnose this as "Lou Di" (leaky bottom). They fail to realize this is caused by seasonal pathogens. The treatment priority is to clear heat, detoxify, and release the exterior, using herbs like Shengma (Cimicifuga), Gegen (Pueraria), Chaihu (Bupleurum), Huanglian, and Huangqin. If heat and thirst are severe, Hanshuishi (Calcitum) can be added to the previous herbs. Other symptoms require modification based on judgment. Strictly avoid descending, Qi-breaking, and astringent herbs such as Dahuang, Mangxiao (Mirabilite), Binglang, Zhishi, Wumei (Mume Fruit), and Qieke. Violating this often leads to untreatable conditions.
Formula for Toxic Dysentery and Dysentery with Eruption/Exanthems: Fresh Jinyinteng (Honeysuckle Stem) several liang, decocted strongly to make three large bowls. Add Diyü 5 qian, Chuanlianhuan and Huaihua (Sophora Flower) moist-stir-fried 4 qian, Huangbai 2 qian, Huangqin 2 qian, Baishao wine-stir-fried 3 qian, Zhi Gancao (Honey-fried Licorice) 2 qian, Lüshengma (Green Cimicifuga) vinegar-stir-fried 6 fen. Decoct together to one bowl. Mix with 5 qian of refined Huashi (Talcum) powder. Take at any time.