古以赤为热，白为冷。至金河间、李东垣始非之。刘谓诸痢皆由乎热，而以赤属之心火，黄属之
脾土，白属之肺金，青属肝木，黑乃热之极而反兼肾水之化。其诸泻利皆兼于湿，湿主于痞，以致怫
郁，气不得宣通，湿热甚于肠胃之中，因以成肠胃之燥，故里急后重，小便赤涩。谓治诸痢，莫若以
辛苦寒药而治，或微加辛热佐之。辛能开郁，苦能燥湿，寒能胜热，使气宣平而已。行血则便血自愈，
调气则后重自除。李从脾胃病者而论，则曰上逆于肺为白，下传于阴为赤。《卫生宝鉴》因谓太阴主
泻，传于少阴为痢。由泄亡津液而火就燥，肾恶燥，居下焦血分也，其受邪者，故便脓血。然亦赤黄
为热，青白为寒。丹溪谓滞下，因火热下迫而致里急后重，用刘氏之治湿热，李氏之保脾土，更复一
一较量气血虚实以施治。三家皆发前代之未发，而举其要也。予尝因是而研究之，自其五色分五脏者
言，则可见湿热之中，具有五邪之相挟。自其上逆下传气血者言，则可见五脏六腑十二经脉之气血，
诸邪皆得伤之，而为痢之赤白。本自其湿热为病者言，则可见由来致成湿热之故非
一端。自其分痢有虚实者言，则可见凡在痢病者中所有之证，如烦躁者，咽干舌黑者，哕噫后重者，
腹痛者，胀满者，脚痛肿弱之类，悉有虚实之殊。是故予于痢证，直断之种种为邪入胃以成湿热，经
脏受伤，其气伤则病于肺，血伤则传于心，心肺者，气血之主也，气血所行之方既病，安得不归所主
之脏乎。而大小肠者，心肺之合也，出纳水谷，糟粕转输之官。胃乃大小肠之总司，又是五脏六腑十
二经脉禀气之海。苟有内外之邪，凡损伤于经脏者，或移其邪入胃，胃属土，湿之化，胃受邪则湿气
不化，怫郁而成湿热矣。或心肺移气血之病，传之于合，大肠独受其病，则气凝注而成白痢，小肠独
受其病，则血凝注而成赤痢，大小肠通受其病，则赤白相混而下。胃之湿热，淫于大小肠者亦如之，
其色兼黄。若色之黑者有二，如色之焦黑，此极热兼水化之黑也。如黑之光若漆者，此瘀血也。或曰
治利从肠胃，世人所守之法也。今乃复求其初感之邪，与初受之经，将何为哉？曰∶病在肠胃者，是
其标也，所感之邪与初受之经者，是其本也。且《内经》于治标本，各有所宜，施之先后，况所传变
之法，又与伤寒表里无异，何可不求之乎，岂止此而已。至若肠
胃自感而病，亦当以邪正分，或正气先虚而受邪，或因邪而致虚，则以先者为本，后者为标。与夫积
之新旧亦如之。旧积者，停食结痰所化之积也。新积者，旧积去后而气血复郁所生者也。旧积当先下
之，新积则不宜下，其故何哉？盖肠胃之腐熟水谷，转输糟粕者，皆荣卫洒陈六腑之功。今肠胃有邪，
则荣卫营运至此，其机为之阻不能施化，故卫气郁而不舒，荣血泣而不行，于是饮食结痰停于胃，糟
粕留于肠，与所郁气泣血之积，相挟成滞下病矣。如是者必当下之，以通壅塞，利荣卫之行。至于升
降仍不行，卫气复郁，荣血复泣，又成新积，故病如初。若是者，不必求邪以治，但理卫气以开通腠
理，和荣血以调顺阴阳，阴阳调，腠理开，则升降之道行，其积不治而自消矣。然而旧积亦有不可下
者，先因荣卫之虚，不能转输其食积，必当先补荣卫，资肠胃之真气充溢，然后下之，庶无失矣。予
数见俗方，惟守十数方治利，不过攻之、涩之而已矣，安知攻病之药，皆是耗气损血之剂，用之不已，
甚至于气散血亡，五脏空虚，精惫神去而死。其固涩之，又皆足以增其气郁血泣之病，转生腹胀，下
为足肿，上为喘呼，诸疾作焉。世人之法，何足守乎。
丹溪云∶痢初得之，必用调胃承气，及大小承气。有男子五十余，下利，昼有
积，淡红色，夜无积，食自进。先吃小胃丹两服，再与四十丸，次六十丸，去积，却与断下。按此惟
实者宜之，虚者以芍药汤、益元散、保和丸之类汤积。芍药汤，治下血调气。经曰∶溲而便脓血，知
气行而血止也。行血则便血自安，调气则后重自除。益元散，治身发热，下痢赤白，小便不利，汤胃
中积聚。下痢势恶，频并窘痛，或久不愈，诸药不止，须吐下之，以开除湿热痞闷积滞，而使气液宣
行者，宜玄青丸逐之。《玄珠》利积丸亦可。《玄珠》云∶下痢赤白，腹满胀痛，里急，上渴引饮，
小水赤涩，此积滞也。宜泄其热，中用清肠丸、导气丸，推其积滞而利自止矣。凡治积聚之证，轻则
温而利之，清肠丸是也。重者天真散、舟车丸下之，下后勿便补之，其或力倦，自觉气少，恶食，此
为挟虚证，宜加白术、当归身尾，甚者加人参，若又十分重者，止用此药加陈皮补之，虚回而痢自止
矣。丹溪治叶先生患滞下，后甚逼迫，正合承气证，但气口虚，形虽实而面黄积白，此必平昔食过饱
而胃受伤，宁忍二三日辛苦，遂与参、术、陈皮、芍药等补药十余帖，至三日后胃气稍完，与承气二
帖而安。苟不先补完胃气之伤，而遽行承气，宁免后患乎。（以上汤积。）
戴云∶痢疾古名滞下。以气滞成积，积成痢，治法当以顺气为先，须当开胃，故谓无饱死痢疾也。凡
痢初发，不问赤白，里急后重，频欲登圊，及去而所下无多，既起而腹内复急，宜用藿香正气散加木
香半钱，吞感应丸，或苏合香丸、吞感应丸。（以上调气）赤痢血色鲜红，或如蛇虫形而间有血鲜者，
此属热痢。宜藿香正气散加黑豆三十粒，五苓散加木香半钱，粟米少许，下黄连丸，或黄连阿胶丸、
茶梅丸。热甚，服上项药未效，宜白头翁汤。赤痢发热者，败毒散加陈仓米一撮煎。若血色黯如瘀，
服凉药而所下愈多，去愈频者，当作冷痢，宜理中汤，或四君子汤加肉果一钱，木香半钱。加减平胃
散、青六丸、治血痢佳。诸血痢不止，宜多用地榆。《易简方》云∶血痢当服胃风汤、胶艾汤之类。
心经伏热下纯血，（色必鲜红）。用犀角生磨汁半，朱砂飞研二钱，牛黄三分，人参末三钱，和丸
如麻子大。灯心、龙眼肉煎汤，下六七分。脾经受湿下血痢，用苍术地榆汤。血痢久不止，腹中不痛，
不里急后重，槐花丸。干姜于火上烧黑，不令成灰，瓷碗合，放冷为末，每服一钱，米饮调下，治血
痢神效。仲景云∶小肠有寒者，其人下重便血，可以此治之。（以上赤痢）。东垣云∶
大便后有白脓，或只便白脓，因劳倦气虚伤大肠也，以黄 、人参补之。如里急频见污衣者，血虚也，
宜加当归。如便白脓，少有滑，频见污衣者气脱，加附子皮，甚则加御米壳。如气涩者，只以甘药补
气，当安卧不言，以养其气。戴云∶白痢下如冻胶，或如鼻涕，此属冷痢。先宜多饮除湿汤，加木香
一钱，吞感应丸，继进理中汤。亦有下如 色，或如腊茶色者，亦宜用前白痢药。白蜡治后重白脓。
（以上白痢）。若感暑气而成痢疾者，其人自汗发热，面垢，呕逆，渴欲引饮，腹内攻刺，小便不通，
痢血频并，宜香薷饮加黄连一钱，佐以五苓散、益元散，白汤调服。不愈，则用蜜水调。感暑成痢，
疼甚，食不进，六和汤、藿香正气散各半帖，名木香交加散。（以上暑痢）。老人深秋患痢，发呃逆，
呕者，黄柏炒燥研末，陈米饭为丸小豌豆大。每服三十丸，人参、白术、茯苓三味浓煎汤下，连服三
剂即愈。切不可下丁香等热药。治冷利，腹中不能食，肉豆蔻去皮，醋面裹煨熟，捣末，粥饮下二钱
匕。世俗治夏中暑痢疾，用黄连香薷饮加甘草、芍药、生姜神效者，盖夏月之痢，多属于暑。洁古治
处暑后秋冬间下痢，用浓朴丸大效者，盖秋之痢多属于寒积，经所谓必先岁气，
无伐天和者也。（以上秋痢）。《金匮》下痢腹痛，紫参汤主之。洁古云∶浓朴丸治处暑后秋冬间腹
痛下痢大效。丹溪曰∶初下痢腹痛，不可用参、术，然气虚胃虚者可用。初得之，亦可用大承气、调
胃承气下之，看其气病、血病，然后加减用药。腹痛者，肺经之气郁在大肠之间者，以苦梗发之，然
后用治痢药，气用气药，血用血药。其或痢后糟粕未实，或食粥稍多，或饥甚方食，肚中作疼，切不
可惊恐，当以白术、陈皮各半煎汤，和之自安。粥多及食肉作痛者，宜夺食。夺食者、减其粥食，绝其
肉味也。因伤冷水泻，变作赤白痢，腹痛减食热燥，四肢困倦无力，宜茯苓汤。下痢之后，小便利，
而腹中满痛不可忍，此名阴阳反错，不和之甚也，越桃散主之。治痢止痛如神方，拣净川连片一两，
净枳壳片一两，槐花三二两，用水浸，片时漉净，同川连先炒老黄色，次入枳壳再炒，待燥拣出槐花
不用，止将黄连五钱，枳壳五钱，作一服，水煎七分去渣，调乳香、没药净末各七分五厘服之，次照
前方再服一剂，腹痛即止，痢即稀，神效。此方有服之如醉者，乃药力行也，不妨。仲景建中汤，治
痢不分赤白久新，但腹中大痛者神效。其脉弦急或涩，浮大按之空虚，或举按皆无力者是也。下利脓
血稠粘，腹痛后重，身热久不愈，脉洪疾者，芍药黄芩
汤。脓血痢无度，小便不通，腹中痛，当归导气汤。（以上腹痛。）下利赤白，里急后重，香连丸。
亦可用连二钱，姜半钱，为末和匀，温酒下。仲景云∶热利下重者，白头翁汤主之。下利脓血，里急
后重，日夜无度，宜导气汤。大瘕泄者，里急后重，数至圊而不能便，茎中痛，用清凉饮子主之，其
泄自止。茎中痛者，属厥阴，加甘草稍。里急后重多者，属少阴，加大黄，令急推去旧物则轻矣。《内
经》曰∶因其重而减之。又云∶在下者引而竭之。里急后重，数至圊而不能便，皆宜进退大承气汤主
之。下利赤白，后重迟涩，宜感应丸。或曰治后重，疏通之剂，罗谦甫水煮木香膏，东垣白术安胃散
等方已尽矣。又有用御米壳等固涩之剂亦愈者何也？曰∶后重本因邪压大肠坠下，故大肠不能升上而
重，是以用大黄、槟榔辈，泻其所压之邪。今邪已泻，其重仍在者，知大肠虚滑不能自收而重，是以
用御米壳等涩剂固其滑，收其气，用亦愈也。然大肠为邪坠下之重，其重至圊后不减；大肠虚滑不收
之重，其重至圊后随减。以此辨之，百不失一也。其或下坠异常，积中有紫黑色，而又痛甚，此为死
血证，法当用桃仁泥、滑石粉行之。或口渴及大便口燥辣，是名挟热，即加黄芩。或口不渴，身不热，
喜热手熨汤，是名挟寒，即加干姜。后重，积与气坠下，服升
消药不愈者，用秦艽、皂角子、煨大黄、当归、桃仁、枳壳、黄连等剂，若大肠风盛，可作丸服。其
或下坠在血活之后，此为气滞证，宜前药加槟榔一枚。后重当和气。积与气坠下者，当兼升兼消。升
谓升麻之类，消谓木香、槟榔之类。《金匮》方，泄利下重者，以水五升，煮薤白三升，至二升去渣，
以四逆散方寸匕内汤中，煮取一升半，分温再服。凡用诸承气等药挨积之后，仍后重者，乃阳不升也，
药中当加升麻升其阳，其重自去也。东垣云∶里急后重，数至圊而不能便，或少有白脓，或少血者，
慎勿利之，宜升阳除湿防风汤。（以上里急后重）。其或气行血和积少，但虚坐努责，此为亡血证。
倍用当归身尾，却以生地黄、生芍药、生桃仁佐之，复以陈皮和之，血生自安。虚坐而不得大便，皆
因血虚也。血虚则里急，加当归身。凡后重逼迫而得大便者，为有物而然。今虚坐努责而不得大便，
知其血虚也。故用当归为君，生血药佐之。（以上虚坐努责）。《内经》脓血稠粘，皆属相火。夫太
阴主泻，少阴主痢，是先泄亡津液而火就燥，肾恶燥，居下焦血分，其受邪者，故便脓血。然赤黄为
热，青白为寒，治须两审。治热以坚中丸、豆蔻丸、香连丸。治寒白胶香散。或多热少寒，水煮木香
膏。虚滑频数，宜止宜涩，宜养脏汤。溲而便脓血者，小肠泄
也。脉得五至以上洪大者，宜七宣丸。脉平和者，立秋至春分，宜香连丸。春分至立秋，宜芍药柏皮
丸。四时皆宜，加减平胃散。如有七宣丸证者，亦宜服此药，去其余邪，兼平胃气。（以上脓血稠粘）。
其或缠滞，退减十之七八，秽积未尽，糟粕未实，当以炒芍药、炒白术、炙甘草、陈皮、茯苓煎汤，
下固肠丸三十粒。然固肠丸性燥，恐尚有滞气未尽行者，但当单饮此汤，固肠丸未宜遽用。盖固肠丸
者，虽有去湿实肠之功，其或久痢体虚气弱，滑泄不止，又当以诃子、肉豆蔻、白矾、半夏等药涩之，
甚者添牡蛎，可择用之。然须以陈皮为佐，恐太涩亦能作疼。又甚者，灸天枢、气海。此二穴大能止
泄。仲景云∶下利便脓血者，桃花汤主之。丹溪云∶桃花汤主病属下焦，血虚且寒，非干姜之温，石
脂之涩且重，不能止血。用粳米之甘，引入肠胃。水煮木香膏、易简断下汤、白术安胃散、养脏汤。
五倍子为丸，赤痢、甘草汤下，白痢、干姜汤下，各十丸。乌梅二个煎汤。石榴一个烧灰，用酸石榴
古人认为痢疾中粪便带红色属热证，带白色属寒证。到了金代刘完素、李东垣时才开始反对这种观点。刘完素认为所有的痢疾都是由热邪引起的，并将红色归因于心火，黄色归因于脾土，白色归因于肺金，青色归因于肝木，黑色则是热极反而兼有肾水的化象。各种泄泻和痢疾都兼夹湿邪，湿邪主要导致气机痞塞，进而引起郁结，使得气机不能宣通。湿热在肠胃之中炽盛，导致肠胃干燥，因此出现里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）、小便赤涩等症状。他认为治疗各种痢疾，不如用辛苦寒性质的药物来治疗，或者稍微加入辛热药物作为佐使。辛味能开郁结，苦味能燥湿，寒性能胜热，目的是使气机宣畅平和。调和血液则便血自止，调理气机则后重自除。李东垣从脾胃病的角度论述，认为病气上逆于肺则表现为白痢，下传于阴分则表现为赤痢。《卫生宝鉴》因此认为太阴经主司泄泻，传变到少阴经则为痢疾。由于泄泻耗亡津液而火热趋向干燥，肾脏厌恶干燥，且位于下焦血分，受邪者故排出脓血。然而也有红色、黄色属热，青色、白色属寒的说法。朱丹溪认为滞下（痢疾），是因为火热下迫而导致里急后重，采用刘完素治疗湿热的方法，结合李东垣保护脾土的理论，再进一步权衡气血的虚实来进行治疗。这三家都阐发了前代未曾阐发的理论，并抓住了要点。我曾经因此进行研究，从五色对应五脏的角度来看，可以看出在湿热之中，具有五种邪气相互夹杂的情况。从上逆下传气血的角度来看，可以看出五脏六腑十二经脉的气血，各种邪气都能伤害它们，从而形成痢疾的赤白之分。从湿热致病的角度来看，可以看出导致湿热的缘由并非只有一种。从区分痢疾有虚有实来看，可以看出凡是患痢疾的人所出现的症状，如烦躁、咽干舌黑、呃逆嗳气伴后重、腹痛、胀满、脚痛肿弱等，都有虚实的区别。因此，我对痢疾的判断是：种种情况都是邪气进入胃中形成湿热，经络脏腑受到损伤，气受伤则病在肺，血受伤则传于心，心主血，肺主气，心肺是气血的主人，气血运行的部位既然病了，怎能不归于其所主的脏腑呢？而大小肠，是心肺的外合器官，是出纳水谷、转输糟粕的官职。胃是大、小肠的总司，又是五脏六腑十二经脉禀受气的海洋。如果有内外的邪气，凡是损伤经络脏腑的，或者将邪气移入胃中，胃属土，主湿化，胃受邪则湿气不化，郁结而成湿热了。或者心肺转移气血的病，传变到其外合之腑，大肠单独受病，则气凝注而成白痢，小肠单独受病，则血凝注而成赤痢，大、小肠共同受病，则赤白相混而下。胃中的湿热，浸淫到大、小肠也是如此，颜色兼黄。如果颜色发黑的有两种情况，如像烧焦一样的黑，这是极热兼有水化的黑；如果是黑得像漆一样光亮，这是瘀血。有人说：治疗痢疾从肠胃入手，这是世人所遵守的方法。现在又要追溯最初感受的邪气和最初受邪的经络，这有什么用呢？我说：病在肠胃，这是标；所感受的邪气和最初受邪的经络，这是本。况且《内经》对于治标治本，各有适宜之处，施行有先后顺序，何况传变的法则，又与伤寒的表里没有不同，怎么能不探究它呢？岂止于此而已。至于肠胃自身感受邪气而发病，也应当以邪正来区分，或者是正气先虚而受邪，或者是因为邪气而导致虚，那么先发生的为本，后发生的为标。积滞的新旧也是这样。旧积，是由停食结痰所形成的积滞。新积，是旧积去除后气血再次郁结所产生的。旧积应当先用攻下法，新积则不宜攻下，这是什么原因呢？因为肠胃腐熟水谷、转输糟粕的功能，都是营卫洒陈六腑的功效。现在肠胃有邪气，那么营卫运行到这里，其机制被阻碍不能施化，所以卫气郁结而不舒展，营血凝涩而不运行，于是饮食结痰停在胃中，糟粕留在肠中，与郁结的气血之积，相互挟持形成滞下病。像这种情况必须用攻下法，以疏通壅塞，利于营卫的运行。至于升降仍然不行，卫气再次郁结，营血再次凝涩，又形成新的积滞，所以病情如初。像这种情况，不必寻求邪气来治疗，只要调理卫气以开通腠理，调和营血以调顺阴阳，阴阳调和，腠理开通，那么升降的道路就能通行，积滞不治而自然消除。然而旧积也有不可攻下的，先前因为营卫虚弱，不能转输食积，必须先用补益营卫的方法，资助肠胃的真气充溢，然后才能攻下，这样才不会失误。我多次见到世俗的方子，只守着十多个方子治疗痢疾，不过是攻伐或固涩罢了，哪里知道攻病的药，都是耗气损血的药剂，使用不停，甚至导致气散血亡，五脏空虚，精疲力竭神志离去而死。那些固涩的药，又都足以增加气郁血涩的病，转而产生腹胀，下为足肿，上为喘呼，各种疾病发作。世人的方法，有什么值得坚守的呢？
朱丹溪说：痢疾初得，必须用调胃承气汤，以及大承气汤、小承气汤。有个五十多岁的男子，下利，白天有积滞物，呈淡红色，晚上没有积滞物，食欲正常。先吃小胃丹两服，再给四十丸，接着六十丸，去除了积滞，然后再给予断下（止痢）的药物。按此法只有实证适宜，虚证应该用芍药汤、益元散、保和丸之类化解积滞。芍药汤，治疗下血调气。经文说：小便不利且便脓血，知道气行则血止。调和血液则便血自安，调理气机则后重自除。益元散，治疗身体发热，下痢赤白，小便不利，清除胃中积聚。下痢势头凶猛，频繁且窘迫疼痛，或者久治不愈，诸药无效，需要吐下法，以开除湿热痞闷积滞，而使气液宣行的，宜用玄青丸驱逐它。《玄珠》的利积丸也可以。《玄珠》说：下痢赤白，腹满胀痛，里急，口渴引饮，小便赤涩，这是积滞。宜泄其热，中间用清肠丸、导气丸，推荡其积滞而痢自止。凡治疗积聚的病症，轻则温而利之，清肠丸就是这类。重的用天真散、舟车丸攻下，攻下后不要立即进补，如果出现乏力，自觉气少，恶食，这是挟虚证，宜加白术、当归身尾，严重的加人参，如果又十分严重的，只用这些药加陈皮补益，虚回而痢自止。丹溪治疗叶先生患滞下，后重非常逼迫，正符合承气汤证，但气口脉虚，形体虽实但面色黄且有白积，这一定是平时吃得过饱而胃受伤，宁可忍受二三天辛苦，于是给予参、术、陈皮、芍药等补药十余帖，到第三天后胃气稍复，给予承气汤二帖而安。如果不先补完胃气的损伤，而匆忙使用承气汤，难道能避免后患吗？（以上为化解积滞。）
戴原礼说：痢疾古名滞下。因为气滞成积，积成痢，治法应当以顺气为先，必须开胃，所以说没有吃饱会死于痢疾的。凡是痢疾初发，不问赤白，里急后重，频繁想上厕所，去了却排出的不多，起来后腹内又急，宜用藿香正气散加木香半钱，吞服感应丸，或者苏合香丸、吞服感应丸。（以上为调理气机）赤痢血色鲜红，或者像蛇虫形状且间有鲜血的，这属于热痢。宜用藿香正气散加黑豆三十粒，五苓散加木香半钱，粟米少许，送服黄连丸，或者黄连阿胶丸、茶梅丸。热甚，服用上述药物无效，宜用白头翁汤。赤痢发热的，用败毒散加陈仓米一撮煎服。如果血色暗紫像瘀血，服用凉药后所下更多，去得更频的，当作冷痢处理，宜用理中汤，或者四君子汤加肉果一钱，木香半钱。加减平胃散、青六丸，治疗血痢效果好。各种血痢不止，宜多用用地榆。《易简方》说：血痢应当服用胃风汤、胶艾汤之类。心经伏热下纯血，（颜色必鲜红）。用水牛角生磨汁半杯，朱砂飞研二钱，牛黄三分，人参末三钱，和丸如麻子大。灯心、龙眼肉煎汤，送服六七分。脾经受湿下血痢，用苍术地榆汤。血痢久不止，腹中不痛，不里急后重，用槐花丸。干姜在火上烧黑，不让成灰，用瓷碗盖住，放冷为末，每服一钱，米饮调下，治疗血痢神效。张仲景说：小肠有寒的，其人下重便血，可以用此法治。（以上为赤痢）。李东垣说：大便后有白脓，或者只便白脓，因为劳倦气虚伤及大肠，用黄芪、人参补益。如果里急频繁弄脏衣服，是血虚，宜加当归。如果便白脓，稍有滑脱，频繁弄脏衣服，是气脱，加附子皮，严重的加御米壳（罂粟壳）。如果气涩，只用甘药补气，应当安静卧床不言语，以养其气。戴原礼说：白痢下如冻胶，或者如鼻涕，这属于冷痢。先宜多饮除湿汤，加木香一钱，吞服感应丸，继服理中汤。也有下如脂膏色，或者如腊茶色的，也宜用前面白痢的药。白蜡治疗后重白脓。（以上为白痢）。如果感受暑气而成痢疾的，其人自汗发热，面垢，呕逆，渴欲引饮，腹内攻刺，小便不通，痢血频繁，宜用香薷饮加黄连一钱，佐以五苓散、益元散，白开水调服。不愈，则用蜜水调服。感暑成痢，疼痛严重，进食不进，六和汤、藿香正气散各半帖，名为木香交加散。（以上为暑痢）。老人在深秋患痢，发呃逆，呕吐的，用黄柏炒燥研末，陈米饭为丸如小豌豆大。每服三十丸，人参、白术、茯苓三味浓煎汤送下，连服三剂即愈。切不可下丁香等热药。治疗冷利，腹中不能进食，用肉豆蔻去皮，醋面裹煨熟，捣末，粥饮送下二钱匕。世俗治疗夏天中暑痢疾，用黄连香薷饮加甘草、芍药、生姜神效的，大概夏天的痢疾，多属于暑。洁古治疗处暑后秋冬间下痢，用浓朴丸大效的，大概秋天的痢疾多属于寒积，经书所说必须先顺应岁气，不要破坏天和的道理。（以上为秋痢）。《金匮要略》下痢腹痛，用紫参汤主治。洁古说：浓朴丸治疗处暑后秋冬间腹痛下痢大效。丹溪说：初下痢腹痛，不可用参、术，但是气虚胃虚者可用。初得的，也可以用大承气、调胃承气攻下，看它是气病还是血病，然后加减用药。腹痛的，是肺经之气郁在大肠之间，用桔梗发散它，然后用治痢药，气病用气药，血病用血药。或者痢后糟粕未实，或者喝粥稍多，或者饥饿严重时才吃饭，肚中作疼，切不可惊恐，当用白术、陈皮各半煎汤，调和之后自安。粥多及吃肉作痛的，宜夺食。夺食，就是减少粥食，断绝肉味。因为伤冷水泻，变作赤白痢，腹痛减食热燥，四肢困倦无力，宜用茯苓汤。下痢之后，小便利，而腹中满痛不可忍，这名叫阴阳反错，不和之甚，越桃散主治。治痢止痛如神方，拣净川连片一两，净枳壳片一两，槐花三二两，用水浸，片刻捞出洗净，同川连先炒至老黄色，次入枳壳再炒，待干燥拣出槐花不用，只将黄连五钱，枳壳五钱，作一服，水煎七分去渣，调乳香、没药净末各七分五厘服之，其次照前方再服一剂，腹痛即止，痢即稀，神效。此方有服之如醉的，是药力行的缘故，不妨碍。张仲景建中汤，治疗痢不分赤白久新，但腹中大痛的，神效。其脉弦急或涩，浮大按之空虚，或者举按皆无力的就是这种。下利脓血稠粘，腹痛后重，身热久不愈，脉洪疾的，用芍药黄芩汤。脓血痢无度，小便不通，腹中痛，用当归导气汤。（以上为腹痛。）下利赤白，里急后重，用香连丸。也可用黄连二钱，姜半钱，为末和匀，温酒送下。张仲景说：热利下重的，白头翁汤主治。下利脓血，里急后重，日夜无度，宜用导气汤。大瘕泄，里急后重，数至厕所而不能便，茎中痛，用清凉饮子主治，其泄自止。茎中痛的，属厥阴，加甘草梢。里急后重多的，属少阴，加大黄，令急推去旧物则轻矣。《内经》说：因其重而减之。又说：在下者引而竭之。里急后重，数至厕所而不能便，都宜用进退大承气汤主治。下利赤白，后重迟涩，宜用感应丸。或者说治疗后重，疏通的剂型，罗谦甫的水煮木香膏，东垣的白术安胃散等方已经穷尽了。又有用御米壳等固涩的剂型也痊愈的，为什么呢？我说：后重本来是因为邪气压迫大肠坠下，所以大肠不能升上而重，因此用大黄、槟榔辈，泻下其所压之邪。现在邪已泻，其重仍在的，知道大肠虚滑不能自收而重，因此用御米壳等涩剂固其滑，收其气，用也能痊愈。然而大肠为邪坠下之重，其重至厕所后不减；大肠虚滑不收之重，其重至厕所后随减。以此辨别，百不失一。或者下坠异常，积中有紫黑色，而又痛甚，此为死血证，法当用桃仁泥、滑石粉行之。或者口渴及大便口燥辣，这名叫挟热，即加黄芩。或者口不渴，身不热，喜热手熨烫，这名叫挟寒，即加干姜。后重，积与气坠下，服用升消药不愈的，用秦艽、皂角子、煨大黄、当归、桃仁、枳壳、黄连等剂，如果大肠风盛，可作丸服。或者下坠在血活之后，此为气滞证，宜前药加槟榔一枚。后重应当和气。积与气坠下的，应当兼升兼消。升谓升麻之类，消谓木香、槟榔之类。《金匮》方，泄利下重的，以水五升，煮薤白三升，至二升去渣，以四逆散方寸匕内汤中，煮取一升半，分温再服。凡用诸承气等药挨积之后，仍后重的，乃阳不升也，药中当加升麻升其阳，其重自去也。李东垣说：里急后重，数至厕所而不能便，或少有白脓，或少血的，慎勿利之，宜升阳除湿防风汤。（以上为里急后重）。或者气行血和积少，但虚坐努责，此为亡血证。倍用当归身尾，却以生地黄、生芍药、生桃仁佐之，复以陈皮和之，血生自安。虚坐而不得大便，皆因血虚也。血虚则里急，加当归身。凡后重逼迫而得大便的，为有物而然。今虚坐努责而不得大便，知其血虚也。故用当归为君，生血药佐之。（以上为虚坐努责）。《内经》说脓血稠粘，皆属相火。夫太阴主泻，少阴主痢，是先泄亡津液而火就燥，肾恶燥，居下焦血分，其受邪者，故便脓血。然而赤黄为热，青白为寒，治须两审。治热以坚中丸、豆蔻丸、香连丸。治寒白胶香散。或多热少寒，水煮木香膏。虚滑频数，宜止宜涩，宜养脏汤。溲而便脓血的，是小肠泄也。脉得五至以上洪大的，宜七宣丸。脉平和的，立秋至春分，宜香连丸。春分至立秋，宜芍药柏皮丸。四时皆宜，加减平胃散。如有七宣丸证的，也宜服此药，去其余邪，兼平胃气。（以上为脓血稠粘）。或者缠滞，退减十之七八，秽积未尽，糟粕未实，当以炒芍药、炒白术、炙甘草、陈皮、茯苓煎汤，下固肠丸三十粒。然而固肠丸性燥，恐尚有滞气未尽行者，但当单饮此汤，固肠丸未宜遽用。盖固肠丸者，虽有去湿实肠之功，其或久痢体虚气弱，滑泄不止，又当以诃子、肉豆蔻、白矾、半夏等药涩之，严重的添牡蛎，可择用之。然而须以陈皮为佐，恐太涩亦能作疼。又严重的，灸天枢、气海。这两个穴位大能止泄。张仲景说：下利便脓血的，桃花汤主治。朱丹溪说：桃花汤主病属下焦，血虚且寒，非干姜之温，石脂之涩且重，不能止血。用粳米之甘，引入肠胃。水煮木香膏、易简断下汤、白术安胃散、养脏汤。五倍子为丸，赤痢、甘草汤下，白痢、干姜汤下，各十丸。乌梅二个煎汤。石榴一个烧灰，用酸石榴……
Ancient practitioners believed that red stool in dysentery indicated heat, while white stool indicated cold. It was not until the Jin Dynasty, with Liu Wansu and Li Dongyuan, that this view was challenged. Liu argued that all dysenteries originate from heat, attributing red to Heart Fire (Xin Huo), yellow to Spleen Earth (Pi Tu), white to Lung Metal (Fei Jin), green to Liver Wood (Gan Mu), and black to extreme heat counteracting with Kidney Water (Shen Shui) transformation. All types of diarrhea and dysentery are accompanied by dampness (Shi). Dampness primarily causes qi stagnation (Qi Zhi), leading to constraint (Fu Yu), preventing the free flow of qi. When damp-heat (Shi Re) becomes severe within the intestines and stomach, it causes dryness in these organs, resulting in tenesmus (Li Ji Hou Zhong - urgent need to defecate with a feeling of incomplete evacuation) and dark, scanty urination. He suggested that treating various dysenteries is best achieved with bitter, pungent, and cold herbs, or slightly adding pungent-hot herbs as adjuncts. Pungency opens constraint, bitterness dries dampness, and coldness overcomes heat, thereby allowing qi to flow freely and smoothly. Regulating blood stops bloody stools; regulating qi relieves tenesmus. Li Dongyuan discussed this from the perspective of spleen and stomach diseases, stating that when pathogenic qi rebels upward to the Lung, it manifests as white dysentery, and when it transmits downward to the yin aspect, it manifests as red dysentery. *Wei Sheng Bao Jian* therefore stated that the Taiyin channel governs diarrhea, which transmits to the Shaoyin channel to become dysentery. Due to fluid loss from diarrhea, fire tends toward dryness; since the Kidney dislikes dryness and resides in the lower jiao blood level, those affected thus pass pus and blood. However, there are also views that red and yellow indicate heat, while green and white indicate cold. Zhu Danxi considered "Zhi Xia" (dysentery/stagnant downflow) to be caused by fire-heat forcing downward, leading to tenesmus. He employed Liu’s methods for treating damp-heat and Li’s methods for protecting Spleen Earth, further weighing the deficiency and excess of qi and blood to administer treatment. These three masters elucidated theories previously unexplored and grasped the essentials. I have studied this based on their insights: regarding the five colors corresponding to the five zang organs, one can see that among damp-heat, five types of pathogens intermingle. Regarding upward rebellion and downward transmission of qi and blood, one can see that the qi and blood of the five zang organs, six fu organs, and twelve meridians can all be injured by various pathogens, resulting in red and white dysentery. From the perspective of damp-heat as the disease cause, one can see that the origins of damp-heat are manifold. Regarding the differentiation of deficiency and excess in dysentery, one can see that symptoms such as irritability, dry throat with a black tongue, hiccups/belching with tenesmus, abdominal pain, distension, and painful/swollen/weak legs all exhibit differences between deficiency and excess. Therefore, my judgment on dysentery is that various cases involve pathogens entering the Stomach to form damp-heat, injuring the meridians and zang-fu. Qi injury affects the Lung; blood injury transmits to the Heart. The Heart and Lung are the masters of blood and qi, respectively. Since the sites where qi and blood circulate are diseased, how could they not return to their master organs? The Large and Small Intestines are the exterior-interior pairs of the Heart and Lung, serving as officials for receiving/excreting water and grain and transporting waste. The Stomach is the general manager of the Large and Small Intestines and the sea of qi for the five zang organs, six fu organs, and twelve meridians. If external or internal pathogens injure meridians and zang-fu, or transfer pathogens to the Stomach, the Stomach (Earth element, governing damp transformation) will fail to transform dampness upon pathogen invasion, leading to constraint and the formation of damp-heat. Or, if the Heart/Lung transmit qi-blood pathology to their paired fu organs, and only the Large Intestine is affected, qi condenses to form white dysentery; if only the Small Intestine is affected, blood condenses to form red dysentery; if both are affected, red and white mix. Damp-heat from the Stomach flooding into the intestines produces similar results, with yellow coloration. Black color has two forms: scorched-black indicates extreme heat combined with water transformation; glossy black like lacquer indicates blood stasis. Some say treating dysentery via the intestines and stomach is the standard method. Why trace back to the initial pathogen and meridian? I reply: Disease in the intestines and stomach is the branch (biao); the initial pathogen and meridian are the root (ben). The *Neijing* specifies appropriate treatments for root and branch with specific sequences. Moreover, the transmission laws are no different from exterior-interior dynamics in Cold Damage (*Shanghan*). How can we not investigate them? This goes beyond mere symptom management. For intestinal-stomach self-infection, differentiate by pathogen vs. healthy qi: if healthy qi is deficient first, then invaded, deficiency is root, pathogen is branch; if pathogen causes deficiency, pathogen is root, deficiency is branch. Similarly for accumulation (Ji): old accumulation arises from retained food and phlegm; new accumulation arises from renewed qi-blood constraint after old accumulation clears. Old accumulation requires purgation; new accumulation does not. Why? Because the Stomach and Intestines’ functions of rotting/ripening food and transporting waste rely on Ying and Wei (Nutritive and Defensive qi) distributing through the six fu organs. Pathogens in the intestines/stomach block Ying/Wei circulation, causing Wei qi constraint and Ying blood stasis. Food/phlegm stagnate in the Stomach, waste remains in the Intestines, mixing with constrained qi/stagnant blood to form dysentery. Such cases require purgation to open blockages and facilitate Ying/Wei flow. If ascending/descending still fails, with renewed Wei constraint and Ying stasis forming new accumulation, the condition recurs. In such cases, do not seek the pathogen directly; instead, regulate Wei qi to open cou li (pores/skin layers), harmonize Ying blood to balance yin-yang. Once yin-yang balances and cou li opens, ascending/descending flows, and accumulation resolves spontaneously. However, some old accumulations cannot be purged; if initially due to Ying/Wei deficiency failing to transport food, tonify Ying/Wei first to充盈 (fill) Stomach/Intestine true qi before purging. I often see folk prescriptions sticking to a dozen formulas for dysentery, merely using purgatives or astringents. They do not know that purgatives consume qi and damage blood; prolonged use leads to qi dispersion, blood loss, empty zang organs, exhaustion of essence, and death. Astringents exacerbate qi constraint and blood stasis, causing abdominal distension, leg edema, and wheezing. Are folk methods worth adhering to?
Zhu Danxi stated: For early dysentery, use Tiao Wei Cheng Qi Tang, Da Cheng Qi Tang, or Xiao Cheng Qi Tang. A man over fifty had dysentery with daytime fecal matter showing pale red residue but none at night, with normal appetite. He took Xiao Wei Dan twice, then 40 pills, then 60 pills to clear accumulation, followed by anti-dysentery drugs. This suits excess patterns; deficiency patterns should use Shao Yao Tang, Yi Yuan San, or Bao He Wan to resolve accumulation. Shao Yao Tang regulates qi to stop bleeding. The Classics state: "If urine is difficult and pus/blood pass, know that moving qi stops blood." Moving blood calms bleeding; moving qi removes tenesmus. Yi Yuan San treats fever, red/white dysentery, and difficult urination by clearing gastric accumulation. For severe, frequent, painful dysentery unresponsive to other drugs, emetic/purgative methods are needed to remove damp-heat constraint and allow qi/fluid flow; Xuan Qing Wan is suitable. *Xuan Zhu*'s Li Ji Wan is also effective. *Xuan Zhu* states: Red/white dysentery with abdominal fullness/pain, tenesmus, thirst, and dark/scanty urine indicates accumulation. Clear heat using Qing Chang Wan or Dao Qi Wan to push out accumulation. For mild accumulation, warm and promote flow (e.g., Qing Chang Wan); for severe cases, Tian Zhen San or Zhou Che Wan to purge. Do not tonify immediately after purging. If fatigue, shortness of breath, and anorexia occur, it indicates mixed deficiency; add Bai Zhu, Dang Gui (body/tail), or Ren Shen for severe cases. If extremely severe, add Chen Pi to tonify; as deficiency returns, dysentery stops. Danxi treated Mr. Ye with severe dysentery matching Cheng Qi indications, but his Qi Kou pulse was deficient, and although his body was solid, his face was sallow with white accumulation, indicating prior overeating damaging the Stomach. He endured hardship for two days, then received ten+ doses of tonics (Ren Shen, Bai Zhu, Chen Pi, Shao Yao). After three days, Stomach qi recovered, and two doses of Cheng Qi brought relief. Without first repairing Stomach qi, rushing into Cheng Qi would invite disaster. (Above: Resolving Accumulation.)
Dai Yuanli stated: Dysentery was anciently called "Zhi Xia" (Stagnant Downflow). Qi stagnation forms accumulation, which becomes dysentery. Treatment must prioritize smoothing qi and opening the Stomach; hence, one does not die of dysentery from hunger. For early dysentery, regardless of color, with tenesmus, frequent urge to defecate with little output, and recurrent abdominal urgency, use Huo Xiang Zheng Qi San plus Mu Xiang (0.5 qian), swallowed with Yin Gan Wan, or Su He Xiang Wan with Yin Gan Wan. (Above: Regulating Qi.) Bright red blood or snake-like shapes in stool indicate Heat Dysentery. Use Huo Xiang Zheng Qi San plus 30 black beans, Wu Ling San plus Mu Xiang (0.5 qian) and millet, taken with Huang Lian Wan, Huang Lian E Jiao Wan, or Cha Mei Wan. If heat is severe and these fail, use Bai Tou Weng Tang. For red dysentery with fever, Bai Du San plus aged rice (1 cuo) decocted. If blood is dark like stasis and cooling herbs increase frequency/output, treat as Cold Dysentery: Li Zhong Tang or Si Jun Zi Tang plus Rou Guo (1 qian) and Mu Xiang (0.5 qian). Jia Jian Ping Wei San and Qing Liu Wan are excellent for bloody dysentery. For persistent bloody dysentery, use lots of Yu Zhu. *Yi Jian Fang* suggests Wei Feng Tang or Jiao Ai Tang. For Heart channel latent heat causing pure bright red blood: grind fresh Xi Jiao (Rhinoceros Horn substitute) juice (0.5 cup), Fei Yan Zhu Sha (2 qian), Niu Huang (0.3 qian), Ren Shen powder (3 qian); make pills size of hemp seeds. Take 0.6–0.7 qian with Deng Xin Cao and Long Yan Rou decoction. For Spleen channel dampness causing bloody dysentery: Cang Zhu Di Yu Tang. For chronic bloody dysentery without pain/tenesmus: Huai Hua Wan. Burn Gan Jiang (blackened, not ash), cool in porcelain bowl, powder; take 1 qian with rice drink—miraculous for bloody dysentery. Zhang Zhongjing said: Cold in Small Intestine causes heaviness and bloody stool; treat accordingly. (Above: Red Dysentery.) Li Dongyuan stated: White pus after stool or only white pus indicates Damaged Large Intestine from fatigue/qi deficiency; tonify with Huang Qi and Ren Shen. Frequent soiling indicates blood deficiency; add Dang Gui. Slippage with soiling indicates qi collapse; add Fu Zi Pi, or Yu Mi Ke for severe cases. For qi stagnation, use sweet herbs to tonify qi; rest silently. Dai Yuanli stated: White dysentery resembling jelly or mucus indicates Cold Dysentery. First drink Chu Shi Tang plus Mu Xiang (1 qian) with Yin Gan Wan, then Li Zhong Tang. Also, paste-like or tea-colored discharge responds to white dysentery formulas. Bai La (White Beeswax) treats tenesmus with white pus. (Above: White Dysentery.) Summerheat-induced dysentery presents with spontaneous sweating, fever, greasy face, vomiting, thirst, stabbing abdominal pain, urinary retention, and frequent bloody stools. Use Xiang Ru Yin plus Huang Lian (1 qian), assisted by Wu Ling San and Yi Yuan San, taken with plain water. If ineffective, use honey water. Severe summerheat dysentery with pain/anorexia: Liu He Tang and Huo Xiang Zheng Qi San (half dose each), named Mu Xiang Jiao Jia San. (Above: Summerheat Dysentery.) Elderly autumn dysentery with hiccups/vomiting: Chao Huang Bo powder formed into pills with aged rice (pea-sized). Take 30 pills with strong decoction of Ren Shen, Bai Zhu, Fu Ling. Three doses cure. Do NOT use hot herbs like Ding Xiang. For cold diarrhea with inability to eat: Roasted Dou Kou (meat nutmeg) powder in rice gruel (2 qian). Folk efficacy for summer dysentery uses Huang Lian Xiang Ru Yin plus Gan Cao, Shao Yao, Sheng Jiang. Autumn dysentery post-Chu Shu responds well to Hou Po Wan (cold accumulation). This aligns with "respect seasonal qi, do not disrupt natural harmony." (Above: Autumn Dysentery.) *Jin Gui*: Dysentery with abdominal pain treated by Zi Shen Tang. Ji Gu: Hou Po Wan effective for post-Chu Shu autumn/winter dysentery pain. Danxi: Early dysentery pain contraindicates Ren Shen/Bai Zhu unless qi/Stomach deficient. Early stage may use Da/Xiao Cheng Qi depending on qi/blood involvement. Abdominal pain due to Lung qi constraint in Large Intestine: use Jie Geng to disperse, then treat dysentery (qi herbs for qi, blood herbs for blood). Post-dysentery abdominal pain from overeating porridge/meat or hunger-eating: calm down, use Ban Ban Tang (Bai Zhu + Chen Pi). Reduce food intake ("Du Shi") for meat/porridge-induced pain. Cold water injury turning into red/white dysentery with fatigue: Fu Ling Tang. Post-dysentery clear urine with unbearable abdominal fullness/pain: Yin Yang Fan Cuo, treated by Yue Tao San. Miraculous Pain Relief Formula: Chuan Lian (1 liang), Zhi Qiao (1 liang), Huai Hua (2–3 liang). Soak, rinse, stir-fry Chuan Lian until golden-brown, add Zhi Qiao, fry dry, remove Huai Hua. Take 5 qian Chuan Lian + 5 qian Zhi Qiao per dose, decoct, strain, mix with Ru Xiang and Mo Yao powder (0.75 qian each). Repeat next day. Analgesic effect is rapid. Feeling "drunk" is drug action. Zhang Zhongjing’s Jian Zhong Tang is miraculous for severe abdominal pain in dysentery (pulse wiry/rough or floating-large/empty). Shao Yao Huang Qin Tang for sticky pus/blood, tenesmus, fever, rapid pulse. Dang Gui Dao Qi Tang for profuse pus/blood, urinary obstruction, abdominal pain. (Above: Abdominal Pain.) Red/white dysentery with tenesmus: Xiang Lian Wan. Or Huang Lian (2 qian) + Sheng Jiang (0.5 qian) powder with warm wine. Zhang Zhongjing: Heat dysentery with tenesmus → Bai Tou Weng Tang. Pus/blood dysentery, day/night frequency → Dao Qi Tang. Da Xia Xie (severe tenesmus/frequency/penile pain) → Qing Liang Yin Zi. Penile pain (Jueyin) → add Gan Cao Shao. Severe tenesmus (Shaoyin) → add Da Huang. *Neijing*: "Reduce what is heavy," "Drain what is below." Tenesmus/frequency → Jin Tui Da Cheng Qi Tang. Slow/sluggish tenesmus → Yin Gan Wan. Why do astringents work for tenesmus after purgatives fail? Tenesmus originates from pathogen pressing down on Large Intestine. Da Huang/Bing Lang expel pathogen. If tenesmus persists after expulsion, it is Large Intestine deficiency/slippage; Yu Mi Ke astringes and lifts qi. Differentiation: Pathogen-induced tenesmus persists after defecation; Deficiency-induced tenesmus lessens after defecation. Purple-black stool with severe pain indicates dead blood stasis; use Tao Ren Ni and Hua Shi. Thirst/dry burning stool indicates mixed heat → add Huang Qin. No thirst/fever, preference for warmth indicates mixed cold → add Gan Jiang. Persistent tenesmus despite Sheng Xiao (lifting/dispersing) herbs: Qin Jiao, Zao Jiao Zi, Wei Da Huang, Dang Gui, Tao Ren, Zhi Qiao, Huang Lian. Wind in Large Intestine → pills. Post-hemostasis tenesmus indicates qi stagnation → add Bing Lang. Harmonize qi for tenesmus. Combine lifting (Sheng Ma) and dispersing (Mu Xiang, Bing Lang). *Jin Gui*: Dysentery with heaviness: Decoct Xie Bai (3 sheng) in water (5 sheng) to 2 sheng, strain. Add Si Ni San (1 fang cun bi) to soup, boil to 1.5 sheng. Divide into two doses. After Cheng Qi purgation, if tenesmus remains due to yang failure to ascend, add Sheng Ma. Li Dongyuan: Tenesmus/frequency/small amount of pus/blood → DO NOT purge. Use Sheng Yang Chu Shi Fang Feng Tang. (Above: Tenesmus.) Qi/blood harmonized, accumulation light, but straining in void indicates blood loss. Double Dang Gui, assist with Sheng Di Huang, Sheng Shao Yao, Sheng Tao Ren, harmonize with Chen Pi. Blood generation restores peace. Void straining without stool is blood deficiency causing tenesmus; add Dang Gui. True tenesmus with stool passage involves physical matter; void straining indicates blood deficiency. Dang Gui as sovereign, supported by blood-generating herbs. (Above: Void Straining.) *Neijing*: Sticky pus/blood belongs to Minister Fire. Taiyin governs diarrhea, Shaoyin dysentery; fluid loss leads to fire drying, kidney dislikes dryness, lower jiao blood level affected → pus/blood. Red/yellow heat, green/white cold. Treat heat with Jian Zhong Wan, Dou Kou Wan, Xiang Lian Wan. Treat cold with Bai Jiao Xiang San. Mixed heat/cold → Shui Zhu Mu Xiang Gao. Deficient/slipping frequent → Yang Zang Tang. Urine difficulty with pus/blood = Small Intestine leakage. Pulse洪大 (>5 beats/fast) → Qi Xuan Wan. Normal pulse: Aug-Mar → Xiang Lian Wan; Mar-Aug → Shao Yao Bai Pi Wan. Year-round: Jia Jian Ping Wei San. If Qi Xuan Wan pattern exists, use it to clear residual pathogen and calm Stomach qi. (Above: Sticky Pus/Blood.) When dysentery improves 70–80% but秽积 (filthy accumulation) remains, use Chao Shao Yao, Chao Bai Zhu, Zhi Gan Cao, Chen Pi, Fu Ling decoction with Gu Chang Wan (30 pills). Gu Chang Wan is drying; if dampness remains, use decoction alone first. For chronic weak dysentery with slippage, astringe with He Zi, Dou Kou, Bai Fan, Ban Xia, or Mu Li if severe. Add Chen Pi to prevent excessive astringency causing pain. Moxibustion on Tian Shu and Qi Hai stops diarrhea. Zhang Zhongjing: Pus/blood dysentery → Tao Hua Tang. Danxi: Tao Hua Tang targets lower jiao blood deficiency/cold; Gan Jiang warms, Shi Zhi astringes/heavy, Jing Mi guides to gut. Other formulas: Shui Zhu Mu Xiang Gao, Yi Jian Duan Xia Tang, Bai Zhu An Wei San, Yang Zang Tang. Wu Bei Zi pills: Red dysentery with Gan Cao Tang, White with Gan Jiang Tang, 10 pills each. Wu Mei (2) decocted. Shi Liu (1) burnt to ash...