妊娠痢下，因饮食生冷，脾胃不能克化，致令心腹疼痛，伤血则赤，伤气则白，气血俱伤，则赤白相
杂。盖血属阴，阴伤则受热居多。然又有阳气伤不能统阴血而痢赤，又不得不从事于辛温。故治血痢，犹当
以色之显晦验其虚实寒热，故凡积之瘀晦不鲜，清稀不稠，皆虚寒之候，即阳不统阴之血，急投人参、姜、
艾，或可保全，倘不审而误服芩、连，乃速其毙也。惟积之稠粘紫赤而光泽者，合用苦燥以坚肠胃之滑脱，
又必当佐以调气之药，则阴邪解释，非若白痢之不可杂以芩、连、芍药等味，引领滞秽袭伤阴血也。气属
阳，阳伤则受冷居多，即有火注下迫，皆阳气
郁遏，本寒标热之证，不可纯归于热，但当验其积之稠粘如糊，色白如脂，方可暂与清热治标。若汁沫如水，
色晦如尘，急须温理其气。即有热证，皆假象无疑。其虚实寒热既分，而又有三禁、三善、五审之不可
不知也。一禁涤荡肠胃，恐阳气下陷，胎气愈坠。二禁渗利膀胱，恐阴津脱亡，胎失荣养。三禁兜涩滞气，
恐浊气愈滞，后重转加。故善治妊娠之痢，惟以调气为先，使已败积沫随气而下，未伤津液统之而安。
夫调气有三善。一使胃气有常，水谷输运。二使腹满腹痛后重渐除。三使浊气开发，不致侵犯胎元。所
谓五审者，一审饮食之进与不进。夫痢乃肠胃受病，若痢势虽甚，饮食无妨者易已，故痢以噤口为最剧，
在初起浊邪全盛之时不足为虑，但要清理积滞，饮食自进矣。若七日以后尚不能食，脉反数盛，此必初
时失于清理之故，急需调气理中，则积沫渐下，饮食渐进矣。或初时能食，至一旬一气后反不能食，脉
息不振，此必涤荡太过，胃气受伤所致。亦有过用芩、连、槟、朴苦寒破气而致呃逆呕哕者，胃气大败，
最危之兆，惟峻与温补，庶可挽回。若脉见数疾
无伦，或翕翕虚大，或歇止不前，或弦细搏指者，皆胃气告匮，百不一生矣。二审溲之通与不通。下痢清
浊不分，若痢虽频而水道顺利者，胎必无虞。若月数将满，胎压尿胞，每多溲便频数、转胞胀 之患，
切忌利水伤津，急与开提自通，但须察其脉无过壮过硬之形，便宜补中益气，稍加泽泻、车前，以升
清降浊，投之无不辄应。非特妊娠为然，即平人久痢，津液大伤，而溲涩不通者，亦宜此治法也。三审腹
之痛与不痛。下痢腹痛必然之理，然间有浊湿下趋而无郁沸之火者，则不痛也。但此多见于肥白人之白
痢，若血痢与瘦人多火者罕见也。治宜调气运积，不用清火明矣。原其腹痛有寒热之分，痛有止歇，
痛则奔迫下坠，自圊不及者，火也。痛自下而攻击于上者，火也。痛而胀满，不胜摩按，热饮欲甚者，火
也，实也。痛无止歇，常时痛而无绞剌者，寒也。痛自上而奔注于下者，寒也。痛而不满，时喜温手
摩按，饮热渐缓，欲至圊而可忍须臾者，虚也，寒也。大约初痢胀痛为热、为实，久痢 痛为虚、为寒。
即初因火注切痛，痢久伤气，亦必变为虚寒也。故久痢腹痛之脉，无论大小迟数，但以按之渐渐小者，
并属虚寒，急需温补，慎勿利气。惟急
痛脉实，久按不衰者，可稍用炮黑姜连和之。四审后之重与不重。下痢后重，浊气壅滞也。夫开通壅滞，
必以调气为本，在妊娠犹为切要，调气则后重自除，而胎息自安。但初痢后重，首宜开发其滞，若久痢
后重，又当升举其阳，阳气升则胃气运，胃气运则周身中外之气皆调达，而无壅滞之患矣。故治孕妇之
后重，无问胎之大小，但脉见有余则宜调气，脉见不足便与升提，虽血痢亦宜阳药，一切滋腻血药总无
干预，以气有统血之功，则血无妄行之虑也。五审身之热与不热。下痢为里气受病，若见身热，表里俱
困，元神将何所恃而得祛邪之力哉！惟人迎之脉浮数，可先用和营透表之法分解其势，然后徐行清理。
若初痢不发热，数日、半月后发热，脉来渐小，或虚大少力者，此真阴内亡，虚阳发露于外。在平人或
可用辛温峻补敛之，以归其源。若妊娠则桂、附又难轻用，惟藉参、术、姜、萸、胶、艾之属，非大剂
浓煎峻投，难望其转日回天之绩也。或有痢久卫虚，起居不慎而感冒虚风发热者，但当察其左手三部，必
显浮数之象，又需理中汤加桂枝，合表里而治之，以内气久虚之邪，不得参、术助其中气，则客邪不得解
散也。又有病后、疟后，或本质虚羸之
人，及秋冬天令寒冷时下痢，加以胎孕扼腕，岂可与平人之痢同日而语哉！其圆机活法，因人论证，因
证立方，调治之法，在医之神圣工巧耳。考之《医通》云∶常用浓朴去干姜汤，治妊娠能食腹胀后重，
积秽稠粘之白痢。浓朴生姜甘草半夏人参汤，治妊娠腹胀后重，赤白相兼之痢。黄芩芍药汤送香连丸，治
妊娠能食后重，积秽稠粘之血痢。连理汤合千金三物胶艾汤，治妊娠少腹疼重，瘀晦不鲜，或间有
鲜血之痢。驻车丸，治妊娠发热后重，阴虚畏食之血痢。白头翁加甘草阿胶汤，治妊娠热毒内攻，噤口不
食，腹胀后重，脓血稠粘之痢。千金胶艾榴皮汤，治妊娠脓血清稀，胎动不安，久泄不止之痢。补中益气
汤，治妊娠先疟后痢，及疟痢齐作，元气下陷，胎气下坠，小便频数，或转胞不得溺之痢。以上诸方，并
加砂仁以调其气，乌梅以调其血，未尝不随手辄效也。又有用当归黄芩芍药汤者，黄连阿胶汤者，
俱录方于后，以备采用。予每用一味阿胶饮，或阿胶黄连饮，均治孕妇之痢，甚妥
获效。又用加味香连汤，亦屡验。（《大全》治妊娠下痢，赤白痢疾，绞剌疼痛，鸡子一枚，乌鸡者更
良，破孔去清留黄用，入黄丹一钱，搅匀，浓纸糊好，盐泥固济，火焙干为细末，米饮服二钱，一服
愈者是男，二服愈者是女。）
浓朴去干姜汤
浓朴（去皮，姜汁炒） 陈皮（泡去浮白） 茯苓 炙草（各等分）
煎服。
浓朴生姜甘草半夏人参汤 治胃虚呕逆，痞满不食之证。
人参（随宜） 浓朴（一钱五分，姜制） 制半夏（二钱） 炙草（八分）
生姜引，煎服。
黄芩芍药汤 治伏气发温，太阳、少阳合病自利。
黄芩 白芍（各三钱） 炙草（二钱）
大枣四枚，擘，水煎服。
香连丸 治下痢赤白相兼，白多于赤者。
川黄连（六两，用吴茱萸拣去闭口者，取净一两，同黄连炒。去吴茱萸不用，只用川连） 木香（一两）
共末，醋糊丸，每服五十丸，米汤、砂仁汤任下。
连理汤 治胃虚挟食，痞满发热。
人参（随宜） 白术（一钱五分，土炒焦） 炮姜（六分） 黄连（八分） 茯苓（一钱） 炙草（六分）
水煎服。
千金三物胶艾汤（又名胶艾榴皮汤。） 治血痢，又痢下不止。
阿胶 艾叶 酸石榴皮
三味等分，煎服。
驻车丸 治阴虚下痢发热，脓血稠粘，及休息痢。
阿胶（三两） 黄连（炒黑） 当归（各五钱） 炮姜（一两）
上四味捣筛，醋煮阿胶为丸，梧子大。每服四五十丸，昼夜三服，米饮下。
白头翁加甘草阿胶汤 治挟热痢下脓血，及产后痢不止。
白头翁 黄连（炒黑） 黄柏（炒黑） 秦皮 炙草（各一钱） 阿胶（三钱）
上六味，先煮上五味，去滓，纳胶烊尽，温分三服。
当归黄芩芍药汤 治妊娠病痢，清热和胎，行气养血。凡虚坐努力者，防其损胎，此方主之。
当归 黄芩（炒） 芍药（炒） 黄连（炒） 白术（土炒） 枳壳（麸炒） 茯苓 陈皮 生地 生草
（各一钱） 木香（五分） 乌梅（一个）
水煎，空心服。
黄连阿胶汤 治妊娠痢病，日久不止。
黄连（炒） 阿胶（炒） 人参 白术（土炒） 茯苓（各一钱） 木香（七分） 干姜（炒） 炙草
（各五分） 乌梅（三个）
姜枣引，水煎食前服。
一味阿胶饮 治孕妇痢疾。
阿胶（上好真者）
不拘多少，酒化服，日数次，随意饮之自愈。
阿胶黄连饮（又名黄连阿胶汤） 治孕妇痢疾，若安胎则痢愈重，治痢则胎难全，宜服此饮。
阿胶（能止脓血之痢，且止腰痛固胎，以之为君） 黄连 芍药 甘草（皆以为佐） 枳壳（
麸炒，少加二三分，以宽其后重）
水煎服。一剂痛痢俱减，去枳壳再服。
加味香连汤 治孕妇痢证。
白芍 黄芩（各二钱） 黄连 陈皮（各一钱） 茯苓（六分） 木香（五分） 黄柏（八分）
乳香 没药（各分半）
酒煎服。
千金胶艾榴皮汤（即本门三物胶艾汤。） 补中益气汤（见本卷诸痛门。）
妊娠期间患痢疾，是因为饮食生冷，脾胃无法运化消化，导致心腹疼痛。损伤血分则下赤痢，损伤气分则下白痢，气血俱伤，则赤白相杂。血液属阴，阴分受伤则多受热邪。然而又有阳气受损不能统摄阴血而致下赤痢的情况，这时不得不采用辛温之法治疗。因此治疗血痢，应当根据排泄物颜色的鲜明或晦暗来辨别虚实寒热。凡是积滞晦暗不鲜亮、清稀不稠厚的，都是虚寒的征象，这是阳气不能统摄阴血所致，急需投用人参、干姜、艾叶等药，或许可以保全性命；如果不加审察而误服黄芩、黄连，则是加速死亡。只有积滞稠粘、紫红色且有光泽的，才适合使用苦燥药物以固涩肠胃滑脱之症，并且必须佐以调气药物，这样阴邪才能解除，不像白痢那样不可夹杂黄芩、黄连、芍药等味，以免引领滞秽之气伤害阴血。气属阳，阳分受伤则多受寒邪，即使有火热下迫的症状，也都是阳气郁遏所致，属于本寒标热的证候，不能单纯归为热证，只有当验明积滞稠粘如糊状、色白如脂时，才可以暂时给予清热治标的方法。如果是汁沫如水、色泽晦暗如尘土的，急需温理其气。即使有热证，也是假象无疑。既然虚实寒热已经分辨清楚，还有三禁、三善、五审的原则不可不知。
一禁涤荡肠胃，恐怕阳气下陷，胎气更加坠落。二禁渗利膀胱，恐怕阴津脱失，胎元失去荣养。三禁兜涩滞气，恐怕浊气更加停滞，后重症状加重。所以善于治疗妊娠痢疾，只以调气为先，使已败坏的积沫随气下行，未伤的津液得以统摄安宁。所谓调气有三善：一是使胃气正常，水谷得以输运；二是使腹胀腹痛及后重逐渐消除；三是使浊气开发，不致侵犯胎元。
所谓的五审是：一审饮食的进与不进。痢疾是肠胃受病，如果痢势虽然严重，但饮食无妨碍的容易治愈，所以痢疾中以噤口痢最为剧烈。在初起浊邪全盛之时不足为虑，只要清理积滞，饮食自然能进。如果七日以后还不能进食，脉象反而数盛，这一定是初起时失于清理的缘故，急需调气理中，则积沫渐下，饮食渐进。或者初起时能食，到十天半月后反而不能食，脉息不振，这一定是涤荡太过，胃气受伤所致。也有过用黄芩、黄连、槟榔、厚朴等苦寒破气药而导致呃逆呕吐的，这是胃气大败，是最危险的征兆，只有峻补温里，才可能挽回。如果脉见数疾无比，或浮虚大，或歇止不前，或弦细搏指，都是胃气告竭，百无一生的征象。
二审小便的通与不通。下痢清浊不分，如果痢虽频繁而水道顺利的，胎元必无危险。如果月份将满，胎压尿胞，常有多溲便频数、转胞胀痛的病患，切忌利水伤津，急需开提自通，但须察其脉无过壮过硬之形，适宜补中益气，稍加泽泻、车前子，以升清降浊，投药无不奏效。不仅妊娠如此，就是普通人久痢，津液大伤，而小便涩滞不通的，也宜用此治法。
三审腹痛的痛与不痛。下痢腹痛是必然的道理，但间有浊湿下趋而无郁沸之火的，则不痛。但这多见于肥白人的白痢，若血痢与瘦人多火者罕见。治疗宜调气运积，不用清火是明确的。原究腹痛有寒热之分：痛有止歇，痛则奔迫下坠，来不及上厕所就排便的，是火证；痛自下而攻击于上的，是火证；痛而胀满，不胜按摩，喜饮热水的，是火证，实证；痛无止歇，常时痛而无绞刺感的，是寒证；痛自上而奔注于下的，是寒证；痛而不满，时常喜欢温热手按摩，饮热水渐缓，想上厕所时可以忍耐片刻的，是虚证，寒证。大约初痢胀痛为热、为实，久痢痛为虚、为寒。即使初起因火热切痛，痢久伤气，也必变为虚寒。所以久痢腹痛的脉象，无论大小迟数，只要按之渐渐变小的，都属虚寒，急需温补，切勿利气。只有急痛脉实，久按不衰的，可稍用炮黑姜连调和。
四审后重的有与无。下痢后重，是浊气壅滞。开通壅滞，必须以调气为本，在妊娠尤为切要，调气则后重自除，胎息自安。但初痢后重，首宜开发其滞，若久痢后重，又当升举其阳，阳气升则胃气运，胃气运则周身中外之气皆调达，而无壅滞之患。所以治孕妇之后重，不问胎之大小，只要脉见有余则宜调气，脉见不足便与升提，即使是血痢也宜用阳药，一切滋腻血药总无干预，因为气有统血之功，则血无妄行之虑。
五审身热的有与无。下痢为里气受病，如果见身热，表里俱困，元神将何所恃而得祛邪之力呢！只有人迎脉浮数，可先用和营透表之法分解其势，然后徐徐清理。如果初痢不发热，数日、半月后发热，脉来渐小，或虚大少力的，这是真阴内亡，虚阳发露于外。在普通人或许可用辛温峻补收敛，以归其源。若妊娠则桂枝、附子又难轻用，只有借助人参、白术、干姜、山茱萸、阿胶、艾叶之类，非大剂浓煎峻投，难望其转日回天的功效。或者有痢久卫虚，起居不慎而感冒虚风发热的，只当察其左手三部，必显浮数之象，又需理中汤加桂枝，合表里而治之，因为内气久虚之邪，不得人参、白术助其中气，则客邪不得解散。又有病后、疟后，或本质虚羸之人，以及秋冬天令寒冷时下痢，加以胎孕扼腕，岂可与平人之痢同日而语哉！其圆机活法，因人论证，因证立方，调治之法，在于医生的神圣工巧罢了。
考证《医通》云：常用浓朴去干姜汤，治妊娠能食腹胀后重，积秽稠粘之白痢。浓朴生姜甘草半夏人参汤，治妊娠腹胀后重，赤白相兼之痢。黄芩芍药汤送香连丸，治妊娠能食后重，积秽稠粘之血痢。连理汤合千金三物胶艾汤，治妊娠少腹疼重，瘀晦不鲜，或间有鲜血之痢。驻车丸，治妊娠发热后重，阴虚畏食之血痢。白头翁加甘草阿胶汤，治妊娠热毒内攻，噤口不食，腹胀后重，脓血稠粘之痢。千金胶艾榴皮汤，治妊娠脓血清稀，胎动不安，久泄不止之痢。补中益气汤，治妊娠先疟后痢，及疟痢齐作，元气下陷，胎气下坠，小便频数，或转胞不得溺之痢。以上诸方，并加砂仁以调其气，乌梅以调其血，未尝不随手辄效也。又有用当归黄芩芍药汤者，黄连阿胶汤者，俱录方于后，以备采用。我每用一味阿胶饮，或阿胶黄连饮，均治孕妇之痢，甚妥获效。又用加味香连汤，亦屡验。（《大全》治妊娠下痢，赤白痢疾，绞剌疼痛，取鸡蛋一枚，乌鸡者更佳，破孔去清留黄用，入黄丹一钱，搅匀，浓纸糊好，盐泥固济，火焙干为细末，米饮服二钱，一服愈者是男，二服愈者是女。）
浓朴去干姜汤
浓朴（去皮，姜汁炒） 陈皮（泡去浮白） 茯苓 炙草（各等分）
煎服。
浓朴生姜甘草半夏人参汤 治胃虚呕逆，痞满不食之证。
人参（随宜） 浓朴（一钱五分，姜制） 制半夏（二钱） 炙草（八分）
生姜引，煎服。
黄芩芍药汤 治伏气发温，太阳、少阳合病自利。
黄芩 白芍（各三钱） 炙草（二钱）
大枣四枚，擘，水煎服。
香连丸 治下痢赤白相兼，白多于赤者。
川黄连（六两，用吴茱萸拣去闭口者，取净一两，同黄连炒。去吴茱萸不用，只用川连） 木香（一两）
共末，醋糊丸，每服五十丸，米汤、砂仁汤任下。
连理汤 治胃虚挟食，痞满发热。
人参（随宜） 白术（一钱五分，土炒焦） 炮姜（六分） 黄连（八分） 茯苓（一钱） 炙草（六分）
水煎服。
千金三物胶艾汤（又名胶艾榴皮汤。） 治血痢，又痢下不止。
阿胶 艾叶 酸石榴皮
三味等分，煎服。
驻车丸 治阴虚下痢发热，脓血稠粘，及休息痢。
阿胶（三两） 黄连（炒黑） 当归（各五钱） 炮姜（一两）
上四味捣筛，醋煮阿胶为丸，梧子大。每服四五十丸，昼夜三服，米饮下。
白头翁加甘草阿胶汤 治挟热痢下脓血，及产后痢不止。
白头翁 黄连（炒黑） 黄柏（炒黑） 秦皮 炙草（各一钱） 阿胶（三钱）
上六味，先煮上五味，去滓，纳胶烊尽，温分三服。
当归黄芩芍药汤 治妊娠病痢，清热和胎，行气养血。凡虚坐努力者，防其损胎，此方主之。
当归 黄芩（炒） 芍药（炒） 黄连（炒） 白术（土炒） 枳壳（麸炒） 茯苓 陈皮 生地 生草（各一钱） 木香（五分） 乌梅（一个）
水煎，空心服。
黄连阿胶汤 治妊娠痢病，日久不止。
黄连（炒） 阿胶（炒） 人参 白术（土炒） 茯苓（各一钱） 木香（七分） 干姜（炒） 炙草（各五分） 乌梅（三个）
姜枣引，水煎食前服。
一味阿胶饮 治孕妇痢疾。
阿胶（上好真者）
不拘多少，酒化服，日数次，随意饮之自愈。
阿胶黄连饮（又名黄连阿胶汤） 治孕妇痢疾，若安胎则痢愈重，治痢则胎难全，宜服此饮。
阿胶（能止脓血之痢，且止腰痛固胎，以之为君） 黄连 芍药 甘草（皆以为佐） 枳壳（麸炒，少加二三分，以宽其后重）
水煎服。一剂痛痢俱减，去枳壳再服。
加味香连汤 治孕妇痢证。
白芍 黄芩（各二钱） 黄连 陈皮（各一钱） 茯苓（六分） 木香（五分） 黄柏（八分） 乳香 没药（各分半）
酒煎服。
Dysentery during pregnancy is caused by consuming raw and cold foods, which the spleen and stomach cannot transform and digest, leading to pain in the heart and abdomen. Injury to the blood results in red dysentery; injury to the qi results in white dysentery; injury to both blood and qi results in a mixture of red and white. Blood belongs to yin; when yin is injured, it is mostly affected by heat. However, there are cases where yang qi is injured and fails to control yin blood, causing red dysentery, in which case acrid-warm methods must be employed. Therefore, when treating bloody dysentery, one should verify deficiency-excess and cold-heat based on whether the discharge color is bright or dull. Any accumulation that is dull and not fresh, clear and thin rather than thick, indicates a deficiency-cold pattern, specifically yang failing to control yin blood. Urgent administration of Ginseng Radix (Renshen), dried ginger (Shengjiang), and mugwort leaf (Aiyè) may preserve life; if examined improperly and Coptis Rhizome (Huanglian) or Scutellaria Root (Huangqin) are mistakenly taken, death will be hastened. Only when the accumulation is sticky, purple-red, and lustrous is it appropriate to use bitter-drying herbs to consolidate intestinal slipperiness, and these must be assisted with qi-regulating herbs so that yin pathogens can be resolved. This differs from white dysentery, where Coptis Rhizome (Huanglian), Scutellaria Root (Huangqin), and White Peony Root (Baishao) should not be mixed in, as they might lead stagnant filth to invade and injure yin blood. Qi belongs to yang; when yang is injured, it is mostly affected by cold. Even if there is a sensation of fire pressing downward, it is due to the constraint of yang qi, representing a syndrome of root cold and branch heat. It cannot be purely attributed to heat. Only when the accumulation is verified to be sticky like paste and white like fat can clearing heat for branch symptoms be temporarily used. If the discharge is frothy like water and dull like dust, warming and regulating qi is urgently required. Any heat signs are undoubtedly false appearances. Once deficiency-excess and cold-heat are distinguished, the three prohibitions, three benefits, and five examinations must be known.
The first prohibition is purging the intestines and stomach, lest yang qi sink further and fetal qi descend more. The second prohibition is promoting diuresis through the bladder, lest yin fluids escape and the fetus lose nourishment. The third prohibition is using astringents that stagnate qi, lest turbid qi become more stagnant and tenesmus worsen. Thus, skillful treatment of pregnancy dysentery prioritizes regulating qi, allowing failed accumulation and foam to descend with the qi, while un-injured fluids remain controlled and peaceful. Regulating qi has three benefits: first, it maintains normal stomach qi and the transport of water and grain; second, it gradually eliminates abdominal fullness, pain, and tenesmus; third, it develops turbid qi, preventing it from invading the fetal origin.
The so-called five examinations are: First, examine food intake. Dysentery is an illness of the intestines and stomach. If the dysentery is severe but food intake is unaffected, it is easy to cure. Thus, anorexic dysentery (Jinkou Li) is the most severe. When turbid pathogens are abundant at the onset, it is not worrying; simply clearing accumulation allows food intake to resume. If after seven days one still cannot eat, and the pulse is rapid and vigorous, this is due to failure to clear accumulation initially. Urgently regulate qi and harmonize the middle; then accumulation will descend, and food intake will gradually return. If one could eat initially but cannot after ten days or half a month, and the pulse is weak, this is due to excessive purging injuring stomach qi. There are also cases of hiccups and vomiting caused by overusing bitter-cold qi-breaking herbs like Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Areca Seed (Binglang), and Magnolia Bark (Houpo). This indicates severe defeat of stomach qi, a critical sign. Only vigorous warming and tonification can reverse it. If the pulse is extremely rapid, or floating and empty-large, or intermittent, or wiry and fine and beating against the finger, these indicate exhaustion of stomach qi, with little chance of survival.
Second, examine urination. In dysentery, clear and turbid are not separated. If dysentery is frequent but urination is smooth, the fetus is safe. If near term, the fetus presses on the bladder, often causing frequent urination or strangury with distension. Avoid diuretics that injure fluids; urgently use lifting methods to restore free flow. Observe that the pulse is not overly strong or hard; if so, tonify the middle and boost qi, adding Alisma Rhizome (Zexie) and Plantago Seed (Cheqian) slightly to raise clear and lower turbid. This method works invariably. This applies not only to pregnancy but also to ordinary people with chronic dysentery who have severely injured fluids and difficult urination.
Third, examine abdominal pain. Abdominal pain is inevitable in dysentery, but sometimes turbid dampness descends without constrained fire, resulting in no pain. This is mostly seen in white dysentery among fat, pale individuals; bloody dysentery is rare among them, and rare among thin individuals prone to fire. Treatment should regulate qi and move accumulation, clearly avoiding clearing fire. Regarding the differentiation of cold and heat in pain: Pain that stops and starts, with urgent bearing down and inability to reach the toilet in time, is fire. Pain attacking upward from below is fire. Pain with fullness, intolerance to pressure, and desire for hot drinks is fire, excess. Pain without stopping, constant pain without cramping, is cold. Pain rushing downward from above is cold. Pain without fullness, preference for warm massage, relief with hot drinks, and ability to endure the urge to defecate for a moment, is deficiency and cold. Generally, initial dysentery with distension and pain is heat and excess; chronic dysentery pain is deficiency and cold. Even if initial sharp pain was due to fire, long-term dysentery injures qi and becomes deficiency-cold. Thus, for chronic dysentery abdominal pain, regardless of pulse size or speed, if it diminishes upon pressure, it belongs to deficiency-cold. Urgently warm and tonify; do not move qi. Only if acute pain has a solid pulse that does not weaken with prolonged pressure can slightly roasted Coptis Rhizome (Huanglian) and Ginger (Shengjiang) be used to harmonize.
Fourth, examine tenesmus. Tenesmus in dysentery is due to turbid qi obstruction. Opening obstruction must be based on regulating qi, which is crucial in pregnancy. Regulating qi removes tenesmus and calms fetal breath. For initial tenesmus, opening stagnation is primary; for chronic tenesmus, raising yang is necessary. When yang rises, stomach qi moves; when stomach qi moves, qi throughout the body is regulated without obstruction. Treating tenesmus in pregnant women, regardless of fetal size, if the pulse indicates excess, regulate qi; if deficient, lift and raise. Even bloody dysentery should use yang-tonifying herbs; greasy blood-nourishing herbs are generally avoided because qi controls blood, preventing reckless bleeding.
Fifth, examine body heat. Dysentery is an internal illness. If body heat is present, both interior and exterior are distressed; how can the primordial spirit rely on strength to expel pathogens? If the Renying pulse (pulse at the carotid artery) is floating and rapid, first use harmonizing Ying and penetrating the exterior methods to resolve the condition, then slowly clear. If there is no fever initially but fever appears after several days or half a month, with a pulse becoming smaller or empty-large and weak, this indicates internal loss of true yin and exposure of deficient yang. In ordinary people, acrid-warm vigorous tonification might be used to gather the source. In pregnancy, however, Cinnamon Twig (Guizhi) and Aconite Root (Fuzi) are difficult to use lightly. Rely instead on Ginseng Radix (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), dried ginger (Shengjiang), Cornus Fruit (Shanzhuyu), Donkey-hide Gelatin (Ejiao), and Mugwort Leaf (Aiyè). Without large doses decocted strongly, reversing the situation is unlikely. If卫qi is deficient due to long-term dysentery, and improper living leads to contraction of deficient wind with fever, examine the left hand three positions; if floating and rapid signs appear, use Lizhong Decoction (Lizhong Tang) plus Cinnamon Twig (Guizhi) to treat both interior and exterior. Internal deficiency pathogens require Ginseng Radix (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu) to assist middle qi, otherwise external pathogens cannot be resolved. Also, dysentery occurring after illness or malaria, in emaciated constitutions, or during cold autumn/winter seasons, combined with pregnancy, cannot be compared to ordinary dysentery. Flexible methods depend on individual differentiation and prescription formulation; treatment relies on the physician's divine skill.
According to *Yitong*: Commonly use Houpo Qu Ganjiang Tang (Magnolia Bark Decoction without Dried Ginger) for pregnancy dysentery with appetite, abdominal distension, tenesmus, and sticky white discharge. Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Ginger, Licorice, Pinellia, and Ginseng Decoction) for pregnancy abdominal distension, tenesmus, and mixed red-white dysentery. Huangqin Shaoyao Tang (Scutellaria and White Peony Decoction) administered with Xianglian Wan (Costus and Coptis Pills) for pregnancy dysentery with appetite, tenesmus, and sticky bloody discharge. Lianli Tang (Coagulating and Harmonizing Decoction) combined with Qianjin Sanwu Jiao'ai Tang (Thousand Gold Three-Ingredient Donkey-hide Gelatin and Mugwort Decoction) for pregnancy lower abdominal pain and heaviness, dull bloody discharge, or occasional fresh blood. Zhuche Wan (Parking Stop Pill) for pregnancy fever, tenesmus, and bloody dysentery with yin deficiency and aversion to eating. Baitouweng Jia Gancao Ejiao Tang (Belleriphora Plus Licorice and Donkey-hide Gelatin Decoction) for pregnancy internal attack of heat-toxin, anorexia, abdominal distension, tenesmus, and sticky pus-blood discharge. Qianjin Jiao'ai Liupi Tang (Thousand Gold Donkey-hide Gelatin and Pomegranate Peel Decoction) for pregnancy clear-thin pus discharge, restless fetus, and chronic diarrhea-dysentery. Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) for pregnancy malaria followed by dysentery, simultaneous malaria and dysentery, sinking of primal qi, descending fetal qi, frequent urination, or strangury unable to urinate. All above formulas add Amomum Fruit (Sharen) to regulate qi and Chinese Plum (Wumei) to regulate blood, achieving immediate effect. Also used are Danggui Huangqin Shaoyao Tang (Angelica, Scutellaria, and White Peony Decoction) and Huanglian Ejiao Tang (Coptis and Donkey-hide Gelatin Decoction); recipes are recorded below for reference. I often use Yiwei Ejiao Yin (Single-ingredient Donkey-hide Gelatin Drink) or Ejiao Huanglian Yin (Donkey-hide Gelatin and Coptis Drink) for pregnant women's dysentery, which is effective. Jiawei Xianglian Tang (Modified Costus and Coptis Decoction) is also frequently effective. (*Daquan* treats pregnancy dysentery, red-white dysentery, cramping pain: Take one chicken egg, preferably from a black hen, break a hole, remove white, keep yolk. Add one qian of Yellow Dan [Lead Monoxide], mix well, seal with thick paper and salt mud, bake dry, grind to fine powder. Take two qian with rice drink. Cured in one dose indicates male; two doses indicates female.)
Houpo Qu Ganjiang Tang (Magnolia Bark Decoction without Dried Ginger)
Magnolia Bark (Houpo) (peeled, stir-fried with ginger juice)
Tangerine Peel (Chenpi) (soaked, scraped clean)
Poria (Fuling)
Licorice Root (Gancao) (roasted) (equal parts)
Decoct and take orally.
Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Ginger, Licorice, Pinellia, and Ginseng Decoction)
Treats stomach deficiency with vomiting/reversal, epigastric fullness, and anorexia.
Ginseng Radix (Renshen) (as needed)
Magnolia Bark (Houpo) (1.5 qian, prepared with ginger)
Pinellia Tuber (Banxia) (prepared, 2 qian)
Licorice Root (Gancao) (roasted, 0.8 qian)
Use fresh ginger as guide, decoct and take orally.
Huangqin Shaoyao Tang (Scutellaria and White Peony Decoction)
Treats latent pathogen generating warmth, Taiyang-Shaoyang combined disease with spontaneous diarrhea.
Scutellaria Root (Huangqin)
White Peony Root (Baishao) (3 qian each)
Licorice Root (Gancao) (roasted, 2 qian)
Four Jujubes (Dazao), split, decoct in water and take orally.
Xianglian Wan (Costus and Coptis Pills)
Treats mixed red-white dysentery, white predominating.
Coptis Rhizome (Huanglian) (6 liang, pick out closed-mouth Evodia Fruit [Wuzhuyu], take pure 1 liang, stir-fry with Coptis. Discard Evodia, use only Coptis)
Costus Root (Muxiang) (1 liang)
Grind to powder, make pills with vinegar paste. Take 50 pills per dose, with rice soup or Amomum soup.
Lianli Tang (Coagulating and Harmonizing Decoction)
Treats stomach deficiency with food retention, epigastric fullness, and fever.
Ginseng Radix (Renshen) (as needed)
Atractylodes Macrocephala Rhizome (Baizhu) (1.5 qian, stir-fried with soil until scorched)
Roasted Ginger (Pao Jiang) (0.6 qian)
Coptis Rhizome (Huanglian) (0.8 qian)
Poria (Fuling) (1 qian)
Licorice Root (Gancao) (roasted, 0.6 qian)
Decoct in water and take orally.
Qianjin Sanwu Jiao'ai Tang (Thousand Gold Three-Ingredient Donkey-hide Gelatin and Mugwort Decoction) (Also named Jiao'ai Liupi Tang)
Treats bloody dysentery and persistent dysentery.
Donkey-hide Gelatin (Ejiao)
Mugwort Leaf (Aiyè)
Acid Pomegranate Peel (Suan Shiliupi)
Equal parts, decoct and take orally.
Zhuche Wan (Parking Stop Pill)
Treats yin-deficiency dysentery with fever, sticky pus-blood, and lingering dysentery.
Donkey-hide Gelatin (Ejiao) (3 liang)
Coptis Rhizome (Huanglian) (charred)
Angelica Sinensis Root (Danggui) (5 qian each)
Roasted Ginger (Pao Jiang) (1 liang)
Pulverize the four ingredients. Dissolve Donkey-hide Gelatin in vinegar to make pills the size of walnut seeds. Take 40-50 pills per dose, three times day and night, with rice drink.
Baitouweng Jia Gancao Ejiao Tang (Belleriphora Plus Licorice and Donkey-hide Gelatin Decoction)
Treats dysentery with pus-blood due to heat, and postpartum dysentery that does not stop.
Belleriphora Fruit (Baitouweng)
Coptis Rhizome (Huanglian) (charred)
Phellodendron Bark (Huangbai) (charred)
Ash Bark (Qinpi)
Licorice Root (Gancao) (roasted, 1 qian each)
Donkey-hide Gelatin (Ejiao) (3 qian)
Boil the first five ingredients, strain, dissolve gelatin into the liquid, divide into three warm doses.
Danggui Huangqin Shaoyao Tang (Angelica, Scutellaria, and White Peony Decoction)
Treats pregnancy dysentery, clears heat, harmonizes fetus, moves qi, and nourishes blood. Mainly for those with straining without passage, to prevent fetal damage.
Angelica Sinensis Root (Danggui)
Scutellaria Root (Huangqin) (fried)
Peony Root (Shaoyao) (fried)
Coptis Rhizome (Huanglian) (fried)
Atractylodes Macrocephala Rhizome (Baizhu) (soil-fried)
Bitter Orange (Zhiqiao) (bran-fried)
Poria (Fuling)
Tangerine Peel (Chenpi)
Rehmannia Root (Shengdi)
Raw Licorice Root (Sheng Cao) (1 qian each)
Costus Root (Muxiang) (0.5 qian)
Chinese Plum (Wumei) (one fruit)
Decoct in water, take on an empty stomach.
Huanglian Ejiao Tang (Coptis and Donkey-hide Gelatin Decoction)
Treats pregnancy dysentery persisting for a long time.
Coptis Rhizome (Huanglian) (fried)
Donkey-hide Gelatin (Ejiao) (fried)
Ginseng Radix (Renshen)
Atractylodes Macrocephala Rhizome (Baizhu) (soil-fried)
Poria (Fuling) (1 qian each)
Costus Root (Muxiang) (0.7 qian)
Dried Ginger (Gan Jiang) (fried)
Licorice Root (Gancao) (roasted, 0.5 qian each)
Chinese Plum (Wumei) (three fruits)
Use ginger and jujube as guide, decoct in water, take before meals.
Yiwei Ejiao Yin (Single-ingredient Donkey-hide Gelatin Drink)
Treats pregnancy dysentery.
Donkey-hide Gelatin (Ejiao) (high quality authentic)
Any amount, dissolve in wine and take. Several times a day, drink freely until cured.
Ejiao Huanglian Yin (Donkey-hide Gelatin and Coptis Drink) (Also named Huanglian Ejiao Tang)
Treats pregnancy dysentery. If focusing on calming the fetus, dysentery worsens; if treating dysentery, fetus is hard to protect. This drink is suitable.
Donkey-hide Gelatin (Ejiao) (stops pus-blood dysentery, relieves backache, secures fetus, used as sovereign herb)
Coptis Rhizome (Huanglian)
Peony Root (Shaoyao)
Licorice Root (Gancao) (used as minister/herald herbs)
Bitter Orange (Zhiqiao) (bran-fried, add small amount 0.2-0.3 qian to relieve tenesmus)
Decoct in water and take orally. One dose reduces pain and dysentery; remove Zhiqiao and continue taking.
Jiawei Xianglian Tang (Modified Costus and Coptis Decoction)
Treats pregnancy dysentery.
White Peony Root (Baishao)
Scutellaria Root (Huangqin) (2 qian each)
Coptis Rhizome (Huanglian)
Tangerine Peel (Chenpi) (1 qian each)
Poria (Fuling) (0.6 qian)
Costus Root (Muxiang) (0.5 qian)
Phellodendron Bark (Huangbai) (0.8 qian)
Frankincense (Ruxiang)
Myrrh (Moyao) (0.5 fen each)
Decoct in wine and take orally.
Qianjin Jiao'ai Liupi Tang (Thousand Gold Donkey-hide Gelatin and Pomegranate Peel Decoction) (Same as Sanwu Jiao'ai Tang in this section.)
Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) (See various pain section in this volume.)