汤氏云∶小儿痢疾，皆因饮食无节，或餐果食肉，不知厌足，乃脾胃尚弱，不
能克化，停积于脏，故成痢也，热搏则赤。风寒之气入于肠胃，致令津液凝滞则成白。痢或夹青者，有惊
积，或如鱼脑肚中疼甚者，大抵八痢，但冷热赤白，药性虽有不同，治法不相远矣。又有赤白相杂者，
当先去其热积，须用大黄、枳实、朴硝之类，以去其热毒，然后黄连、黄芩、黄柏解其热，痢自止，疼自
定，此妙法也。如痢不止，则用地榆熟艾等剂调理，自然平复。脾虚者，不可轻用罂粟涩滞等剂，必致危
困，须用没石子、黄连、阿胶、地榆以止之，方为尽善，其枳壳、芍药皆要药也。噤口痢不能食者，石莲
散主之，香脯散亦可。冷痢如豆汁，肚疼者，胃风汤主之。脾毒痢，脏热，当服香连丸、黄连香薷
散去桂、五苓散（惊）、茅花汤，当归、芍药、枳壳、地榆、川芎等剂，先与解毒退热，却与开胃进食，分
利水谷，宽肠定痛，先与水浸丹、《局方》败毒散（痘初热）、地榆饮、宽肠枳壳散。有热而痢不止者，
三黄熟艾汤主之。积滞不通者，神芎丸亦可用。热甚烦躁者，黄连解毒汤解之（烦躁），泼火散亦效。〔曾〕
赤白之痢，世人莫不曰赤为阳为热，白为阴为冷，或曰无积不成痢。至于调治，若以冷热之剂互进，或投
去积之药，必难取效，不究其原，何由可疗。且四时八风之中人，五运六气之相胜，夏秋人多痢疾，《内
经》曰∶春伤于风，
夏生飧泄。《至真要大论》曰∶少阳在泉，火淫所胜、民病注泄。赤白其可拘于无积不成痢之说，若专以积为
论，岂一岁之中，独于夏秋人皆有积，春冬不然。盖风邪入胃，木能胜土，不为暴下，则成痢疾赤白交杂，此为阴
阳不分，法当分正阴阳，五苓散以导其逆，理中汤以温其胃，使色归一，然后施治。若一分之后，仍赤白同
下，则当究其所患之因，若先白后赤，乃内伤生冷，失于盖覆，由元气感于暑热，治法先救其里，次解暑毒。若
先赤后白，乃先伤热而后失盖感冷，先宜解热，后治其痢。有夹热而痢者，则下纯鲜血，此风能动血，宜冷
服黄连香薷散（吐泻）川草散、及当归散（潮热）加醋炒蒸柏叶，水姜煎服，或羌活散加三和汤，水姜仓米煎。
有挟冷而痢者，则下纯白冻，或白上有粉红色，或似猪肝瘀血，皆为阴证，盖血得寒则凝涩故也，先用 咀
五苓散加守中汤（泻）煎投，次以附子理中汤带凉服，或固真汤（慢惊）。倘不辨其虚实冷热，妄行施治，
必致脾胃愈虚，不能乳食，成噤口痢者则难疗矣。又有里急后重，盖里急为阳，后重为阴，未圊前腹痛为里急，
已圊后腹痛为后重，故里急者大肠涩也，先以大顺饮加宽气饮（急惊）和解，及羌活散水姜仓米煎服，次下宽肠
丸。后重为气虚，用 咀五苓散加人参、水姜煎服，并投香连丸。若二证俱作，前
二丸子并进，或双金饮、金粟丸亦佳。然泻痢二字，自是两证，粪夹水，来多而顺者曰泻，带血冻白冻，
来三五点而痛者曰痢，轻重阴阳，于此而分，斯为治法。有脓血交杂，经久不止，昼轻夜重，或昼夜频数，
食减痛多，并用万金散、神效散、主之。有五色痢者，乃因五脏蕴热，日久不散，故有是证，盖五脏受热，
荣卫不调，五谷不化，熏腐脏腑，神气昏沉，此候已危，最苦是腹中刺痛，儿小者无治法，盖五色者，乃
五脏之色皆见于外，儿大者可用《局方》三神丸，或小来复丹以五苓散送下，或者可疗，若投药如故，不
可为也。又有风痢，多是黄褐色，与疳泻颇同，但不臭为异耳，此风毒停滞于脾，宜去脾经风毒，泻黄散
主之，若见赤白同下，久而不禁，小便少，涩痛热并作，唇裂眼赤，气促心烦，坐卧不安，狂渴饮水，谷道
倾陷，时复面容如妆，饮食不进者难治。〔薛〕钱仲阳云∶泻痢黄赤黑，皆热也。泻痢青白，米谷不化，
皆冷也。东垣云∶白者湿热伤于气分，赤者湿热伤于血分，赤白相杂，气血俱伤也。海藏用四君、芎、
归治虚弱之痢，四君、干姜治虚寒之痢。愚尝治手足指热饮冷者，为实热，用香连丸。手足指冷冻饮料热者，为
虚寒，用异功散送香连丸。若兼体重肢痛，湿热伤脾也，用升阳益胃汤。小便不利，阴阳不分也，
用五苓散。若湿热退而久痢不愈者，脾气下陷也，用补中益气汤倍加升麻、柴胡。泻痢兼呕，或腹中作痛者，
脾胃虚寒也，用异功散加炮姜、木香。或变而为疟者，肝克脾也，用六君、升麻、柴胡、钓藤钩。若积滞已
去，痢仍不止者，脾气虚也，用四君子送下香连丸。若因乳母膏粱浓味，六淫七情，致儿为患者，当各推
其因，仍兼治其母，并参冷热泻及积滞腹痛等证览之。
汤氏说：小儿痢疾，都是因为饮食没有节制，或者吃了水果肉食，不知道满足，导致脾胃尚且虚弱，不能消化食物，停滞积聚在脏腑，所以形成痢疾。热邪搏结则大便带血（赤）。风寒之气侵入肠胃，致使津液凝滞则形成白痢。痢疾中夹杂青色粪便的，是有惊积；如果像鱼脑一样，肚中疼痛严重的，大抵八种痢疾，虽然冷热赤白的性质不同，药性虽有差异，但治疗方法相差不远。又有赤白相混杂的，应当先去其热积，必须使用大黄、枳实、朴硝之类的药物，以去除热毒，然后用黄连、黄芩、黄柏来解除热邪，痢疾自然停止，疼痛自然安定，这是妙法。如果痢疾不止，就用地榆、熟艾等药剂调理，自然平复。脾虚的人，不可轻易使用罂粟壳等收敛涩滞的药物，必定会导致危险困顿，必须使用没石子、黄连、阿胶、地榆来止痢，才算尽善尽美，其中枳壳、芍药都是重要的药物。患噤口痢不能进食的，用石莲散主治，香脯散也可以。冷痢如豆汁样，肚子痛的，用胃风汤主治。脾毒痢，脏热，应当服用香连丸、黄连香薷散去桂枝、五苓散（因惊所致）、茅花汤，以及当归、芍药、枳壳、地榆、川芎等药剂，先给予解毒退热，再给予开胃进食，分利水谷，宽肠定痛，先用浸水丹、《局方》败毒散（痘疹初起发热时）、地榆饮、宽肠枳壳散。有热而痢疾不止的，用三黄熟艾汤主治。积滞不通畅的，神芎丸也可以使用。热盛烦躁的，用黄连解毒汤解除（烦躁），泼火散也有效。〔曾〕赤白痢疾，世人无不认为红色属阳属热，白色属阴属冷，或者说无积滞不成痢疾。至于调治，如果用寒热性质的药剂交替进服，或者投用去积滞的药物，必定难以见效，不探究其根源，怎么能治疗呢？况且四季八风侵袭人体，五运六气相互克制，夏秋季节人们多患痢疾，《内经》说：春伤于风，夏天发生飧泄（完谷不化的腹泻）。《至真要大论》说：少阳在泉，火气过胜，百姓发病为注泄（急骤的腹泻）。赤白痢岂能拘泥于“无积不成痢”的说法，如果专门以积滞来论述，难道一年之中，唯独夏秋季节人人都有积滞，春冬季节就没有吗？大概风邪入胃，木气克伐土气，如果不发生暴泻，就会形成赤白交杂的痢疾，这是阴阳不分，治法应当分辨正气的阴阳，用五苓散来引导逆乱之气，用理中汤来温补胃气，使大便颜色归一，然后再施治。如果服药一分之后，仍然赤白同下，就应当探究患病的原因，如果先白后赤，是内伤生冷，失于保暖，由元气感受暑热所致，治法先救里证，其次解除暑毒。如果先赤后白，是先伤热而后失于保暖感受寒冷，先宜解热，后治痢疾。有夹热而痢的，则排出纯鲜血，这是风能动血，宜冷服黄连香薷散（用于吐泻）、川草散、及当归散（用于潮热）加醋炒蒸柏叶，用水和生姜煎服，或者羌活散加三和汤，用水、生姜、仓米煎服。有挟冷而痢的，则排出纯白冻，或者白上有粉红色，或者像猪肝瘀血，都属于阴证，因为血液得寒则凝涩的缘故，先用咀五苓散加守中汤（用于泻）煎服，次用附子理中汤带凉服，或者固真汤（用于慢惊风）。倘若不辨别虚实冷热，妄行施治，必定导致脾胃更加虚弱，不能乳食，形成噤口痢的就难治疗了。又有里急后重，大概里急属阳，后重属阴，未排便前腹痛为里急，已排便后腹痛为后重，所以里急是大肠涩滞，先用大顺饮加宽气饮（用于急惊风）和解，以及羌活散用水、生姜、仓米煎服，其次用宽肠丸。后重是气虚，用咀五苓散加人参、用水、生姜煎服，并投用香连丸。如果两个症状都出现，前两种丸子同时服用，或者双金饮、金粟丸也很好。然而“泻”和“痢”两个字，自然是两种病证，粪便夹杂水，量多而顺畅的叫泻，带有血冻白冻，每次只来三五点而且疼痛的叫痢，轻重阴阳，由此区分，这才是治法。有脓血交杂，经久不止，白天轻晚上重，或者昼夜频繁，食欲减退疼痛增多，都用万金散、神效散主治。有五色的痢疾，是因为五脏蕴藏热邪，日久不散，所以有此证候，大概五脏受热，营卫不调，五谷不化，熏腐脏腑，神气昏沉，此候已经危重，最痛苦的是腹中刺痛，幼儿小的没有治法，大概五色，是五脏的颜色都显露于外，幼儿大的可以用《局方》三神丸，或者小来复丹用五苓散送下，或许可以治疗，如果用药照旧，就不行了。又有风痢，多是黄褐色，与疳泻颇为相同，只是不臭作为区别罢了，这是风毒停滞在脾，应当去除脾经风毒，用泻黄散主治，如果见到赤白同下，久而不禁，小便少，涩痛热并作，嘴唇裂开眼睛红，气促心烦，坐卧不安，狂渴饮水，肛门脱出，时常面容如妆饰一般，饮食不进的就难治。〔薛〕钱仲阳说：泻痢黄赤黑，都是热证。泻痢青白，米谷不化，都是冷证。东垣说：白色是湿热伤于气分，红色是湿热伤于血分，赤白相杂，气血都受伤。海藏用四君子汤、川芎、当归治疗虚弱的痢疾，四君子汤、干姜治疗虚寒的痢疾。我曾经治疗手指头热想喝冷饮的，为实热，用香连丸。手指头冷冻想喝热饮的，为虚寒，用异功散送服香连丸。如果兼身体沉重肢体疼痛，是湿热伤脾，用升阳益胃汤。小便不利，阴阳不分，用五苓散。如果湿热退去而久痢不愈，是脾气下陷，用补中益气汤倍加升麻、柴胡。泻痢兼呕吐，或者腹中作痛的，是脾胃虚寒，用异功散加炮姜、木香。或者变而为疟疾的，是肝克脾，用六君子汤、升麻、柴胡、钓藤钩。如果积滞已去，痢仍不止，是脾气虚，用四君子汤送下香连丸。如果因为乳母吃膏粱浓味，六淫七情，导致孩子患病的，应当各自推究其原因，仍然兼治其母亲，并参考冷热泻及积滞腹痛等证候阅览。
Tang stated: Pediatric dysentery is all caused by unregulated diet, such as consuming fruits and meat without satiety. Since the spleen and stomach are still weak and cannot digest the food, it stagnates and accumulates in the zang-fu organs, thus forming dysentery. When heat pathogens contend, the stool contains blood (red). When wind-cold qi enters the intestines and stomach, causing body fluids to coagulate and stagnate, white dysentery forms. Dysentery with greenish stool indicates fright accumulation; if the stool resembles fish brains and abdominal pain is severe, these generally fall under the eight types of dysentery. Although the nature of cold, heat, red, and white differs and medicinal properties vary, the treatment methods are not far apart. For mixed red and white dysentery, one should first eliminate heat accumulation using herbs like Rhubarb (Da Huang), Immature Bitter Orange (Zhi Shi), and Mirabilite (Piao Xiao) to remove heat toxins, then use Coptis (Huang Lian), Scutellaria (Huang Qin), and Phellodendron (Huang Bai) to resolve heat. The dysentery will naturally stop, and pain will subside; this is a brilliant method. If dysentery persists, regulate with preparations containing Sanguisorba (Di Yu) and Prepared Mugwort (Shu Ai), and recovery will occur naturally. For those with spleen deficiency, do not lightly use astringent agents like Poppy Shell (Ying Su Ke), which must lead to critical danger. Instead, use Stone Galla (Mo Shi Zi), Coptis (Huang Lian), Donkey-hide Gelatin (E Jiao), and Sanguisorba (Di Yu) to stop dysentery, making the prescription perfect. Among these, Bitter Orange (Zhi Qiao) and White Peony Root (Bai Shao) are essential herbs. For clenched-mouth dysentery where eating is impossible, Lotus Seed Powder (Shi Lian San) is the primary treatment, and Fragrant Meat Powder (Xiang Fu San) is also suitable. For cold dysentery resembling bean curd dregs with abdominal pain, Stomach Wind Decoction (Wei Feng Tang) is indicated. For spleen toxin dysentery with internal heat, take Coptis and Pinellia Pill (Xiang Lian Wan), Coptis and Mosla Decoction minus Cinnamon Twig (Huang Lian Xiang Ru San), Five Ingredient Powder with Poria (Wu Ling San - for cases due to fright), or Thatch Flower Decoction (Mao Hua Tang). Use preparations of Angelica Sinensis (Dang Gui), White Peony Root (Bai Shao), Bitter Orange (Zhi Qiao), Sanguisorba (Di Yu), and Ligusticum (Chuan Xiong). First, clear heat and detoxify, then open the stomach and promote appetite, separate turbid from clear, widen the intestines and relieve pain. Initially use Water-Soaked Pill (Shui Jin Dan), Bureau Formula's Detoxifying Powder (Ju Fang Bai Du San - for early stage of smallpox fever), Sanguisorba Drink (Di Yu Yin), or Intestine-Widening Bitter Orange Powder (Kuan Chang Zhi Qiao San). For dysentery persisting due to heat, Three-Yellow Prepared Mugwort Decoction (San Huang Shu Ai Tang) is indicated. For stagnation and blockage, Spirit-Xiong Pill (Shen Xiong Wan) can be used. For severe heat with restlessness, Coptis Decoction for Resolving Toxins (Huang Lian Jie Du Tang) resolves it (restlessness); Fire-Sprinkling Powder (Po Huo San) is also effective. [Zeng] Regarding red and white dysentery, people generally say red is yang and heat, white is yin and cold, or that no accumulation means no dysentery. In treatment, alternating cold and hot medicines or using accumulation-dispersing drugs will likely fail. Without investigating the root cause, how can it be cured? Moreover, when the eight winds of four seasons invade the human body, and the five movements and six qi interact, many people suffer dysentery in summer and autumn. The *Neijing* states: "Wind injury in spring leads to unsolidified diarrhea in summer." The *Zhizhen Dayao Lun* states: "When Shaoyang governs, excessive fire causes the people to suffer from pouring diarrhea." Can red and white dysentery be confined to the theory of "no accumulation, no dysentery"? If discussing solely based on accumulation, does it mean only in summer and autumn do people have accumulation, but not in spring and winter? Generally, wind evil enters the stomach, wood overacts on earth. If not violent diarrhea, it becomes dysentery with mixed red and white, indicating yin and yang are undifferentiated. The method should differentiate righteous yin and yang, use Wu Ling San to guide rebellious qi, and Lizhong Tang to warm the stomach, making the color uniform before further treatment. If after one dose, red and white still pass together, investigate the cause. If white precedes red, it is internal injury from cold/raw food and lack of covering, with primordial qi affected by summer heat. Treat by first saving the interior, then resolving summer heat toxicity. If red precedes white, it is heat injury followed by cold exposure from lack of covering. First resolve heat, then treat dysentery. For dysentery with heat, pure fresh blood is passed; this is wind moving blood. Cold administration of Coptis and Mosla Decoction (for vomiting/diarrhea), Chuancao Powder, and Danggui San (for tidal fever) plus Vinegar-processed Steamed Cuscuta Leaf (Bai Ye), decocted with water and ginger, is suitable. Or Qianghuo San plus Sanhe Tang, decocted with water, ginger, and warehouse rice. For dysentery with cold, pure white jelly is passed, or white with pinkish hue, or resembling pig liver blood stasis; these are all yin syndromes because blood coagulates and stagnates when cold. First, administer Ju Wu Ling San plus Shouzhong Tang (for diarrhea) decocted and given, then Fuzi Lizhong Tang taken cool, or Guzhen Tang (for slow convulsion). If deficiency/excess and cold/heat are not distinguished and treatment is reckless, spleen and stomach will become more deficient, unable to digest milk and food, leading to clenched-mouth dysentery which is hard to cure. There is also tenesmus (li ji) and heaviness of the rectum (hou zhong). Tenesmus is yang, heaviness is yin. Abdominal pain before defecation is tenesmus; abdominal pain after defecation is heaviness. Thus, tenesmus is large intestine涩 (stagnation/stickiness). First use Dashun Yin plus Kuanqi Yin (for acute convulsion) to harmonize, and Qianghuo San decocted with water, ginger, and warehouse rice, followed by Kuan Chang Wan. Heaviness is qi deficiency; use Ju Wu Ling San plus Ginseng (Ren Shen), decocted with water and ginger, and administer Xiang Lian Wan. If both symptoms occur, take the two pills together, or Shuangjin Yin or Jin Su Wan are also good. However, "diarrhea" (xie) and "dysentery" (li) are two different conditions. Stool mixed with water, coming in large amounts smoothly, is diarrhea. Stool with blood/jelly, coming in small amounts with pain, is dysentery. Severity and yin/yang are distinguished here, which is the treatment method. For pus and blood mixed, persisting for a long time, lighter by day and heavier by night, or frequent day and night, with reduced appetite and increased pain, use Wanjing San and Shenxiao San. For five-color dysentery, it is caused by heat accumulating in the five zang organs for a long time. Because the five zang are heated, Ying and Wei are unregulated, grains are not digested, steaming and rotting the zang-fu, spirit and qi become dull. This condition is critical. The most painful symptom is stabbing abdominal pain. For young children, there is no treatment, as five colors indicate the colors of the five zang appearing externally. For older children, Ju Fang's Sanshen Wan or Xiaolaifudan sent down with Wu Ling San may be curable. If medication remains unchanged, it is useless. There is also wind dysentery, mostly yellow-brown, similar to gan diarrhea, differing only in odor. This is wind-toxin stagnating in the spleen; remove spleen meridian wind-toxin with Xiehuang San. If red and white pass together, uncontrollably for a long time, with little urine, strangury/pain/heat, cracked lips, red eyes, shortness of breath, restlessness, inability to sit or lie comfortably, extreme thirst for water, anal prolapse, occasional flushed face, and inability to eat, it is difficult to treat. [Xue] Qian Zhongyang said: Yellow, red, black diarrhea/dysentery are all heat. Green, white diarrhea/dysentery with undigested grain are all cold. Dongyuan said: White is damp-heat injuring qi level; red is damp-heat injuring blood level; mixed red and white injures both qi and blood. Haizang uses Sijunzi Tang, Chuanxiong, and Danggui to treat weak dysentery; Sijunzi Tang and Ganjiang to treat deficient-cold dysentery. I once treated cases where fingers were hot and desired cold drinks as excess heat, using Xiang Lian Wan. Cases where fingers were frozen and desired hot drinks as deficient cold, using Yigong San to send down Xiang Lian Wan. If accompanied by heavy body and limb pain, it is damp-heat injuring spleen, use Shengyang Yizhe Tang. If urination is difficult, yin and yang are undifferentiated, use Wu Ling San. If damp-heat recedes but chronic dysentery persists, it is spleen qi sinking, use Buzhong Yiqi Tang doubling Shengma and Chaihu. Diarrhea/dysentery with vomiting or abdominal pain is spleen-stomach deficient cold, use Yigong San plus Pao Jiang and Muxiang. If transforming into malaria, liver overacting on spleen, use Liujunzi Tang, Shengma, Chaihu, and Gouteng. If accumulation is gone but dysentery continues, it is spleen qi deficiency, use Sijunzi Tang sending down Xiang Lian Wan. If caused by the nursing mother's rich/greasy diet, or six excesses/seven emotions affecting the child, deduce the cause individually, treat the mother concurrently, and refer to cold/heat diarrhea and accumulation abdominal pain patterns.