滞下之病，尝见世方以赤白而分寒热，妄用兜涩燥剂止之。或言积滞，而用巴KT 丸药攻之；或指湿热，
而与淡渗之剂利之；一偏之误，可不明辩乎。谨按原病式所论，赤白同于一理，反复陈喻，但不熟察耳。果肠
胃积滞不行，法当辛苦寒凉药，推陈致新，荡涤而去，不宜巴KT 毒热下之。否则郁结转甚，而病变危者有之
矣。若泻痢不分两证，混言湿热，不利小便，非其治也。夫泄者，水谷湿之象。滞下者，垢瘀之物同于湿热而
成。治分两岐，而药亦异。若淡渗之剂，功能散利水道，浊流得快，使泄自止。此有无之形，岂可与滞下混同
论治而用导滞行积可乎。其下痢出于大肠，传送之道，了不干于肾气。所下有形之物，或如鱼脑、或下如豆汁、
或便白脓、或下纯血、或赤或白、或赤白相杂、若此者，岂可与泻混同论治而用淡渗利之可乎。尝原其本，皆
由肠胃日受饮食之积，余不尽行，留滞于内，湿蒸热瘀，郁结日深，伏而不作；时逢炎暑，不行相火司令，又
调摄失宜，复感酷热之毒；至秋阳（气）始收，火气下降，蒸发蓄积，而滞下之证作矣以其积滞之滞行，故名
之曰滞下。其湿热瘀积干于血分则赤；干于气分则白；赤白兼下，气血俱受邪矣。久而不
愈，气血不运，脾积不磨，陈积脱滑下凝，犹若鱼脑矣。甚则肠胃空虚，关司失守，浊液并流，色非一类，错
杂混下注出，状如豆汁矣。若脾气下陷，虚坐努责，便出色如白脓矣。其热伤血深，湿毒相瘀，粘结紫色，则
紫黑矣。其污浊积而欲出，气滞而不与之出，所以下迫窘痛，后重里急，至圊而不能便，总行频并亦少，乍起
乍止而不安，此皆大肠经有所壅遏窒碍，气液不得宣通故也。众言难处，何法则可求之？长沙论云∶利之可下
者，悉用大黄之剂。可温者，悉用姜附之类。何尝以巴KT 热毒下之，紧涩重药兜之。又观河间立言∶后重则
宜下、腹痛则宜和、身重则宜温、脉弦则去风、脓血粘稠以重药竭之，身冷自汗以重药温之，风邪内束宜汗之，
溏为痢当温之，在表者汗之，在里者下之，在上者涌之，在下者竭之，身表热者内疏之，小便涩者分利之。
用药轻重之别，又加详载。行血则便脓自愈，调气则后重自除，治实治虚之要论。而丹溪又谓大虚大寒者，其
治验备载《局方发挥》。观此治法，岂可胶柱而调瑟。又有胃弱而闭不食，此名禁口痢，病七方未有详论者。
以《内经》大法推之，内格呕逆火起炎上之象。究乎此，则胃虚木火乘之，是土败木贼也，见此多成危候。
滞下（痢疾）这一病症，我常看到世俗的医方根据大便中赤色或白色的不同来区分寒热，从而胡乱使用具有收敛固涩作用的燥性药物来止泻。或者有人认为是积滞所致，便使用巴豆等丸药进行攻下；或者指为湿热所致，给予淡渗利湿的药物进行利尿治疗。这些片面之误，难道不值得明确辨析吗？
谨按照《原病式》中的论述，赤白痢疾在道理上是相同的，书中反复陈述比喻，只是人们不仔细考察罢了。如果确实是肠胃积滞不通，治法应当使用辛苦寒凉的药物，以推陈出新，荡涤积滞排出体外，不宜使用巴豆这类有毒且大热的药物强行攻下。否则会导致郁结转甚，病情变得危重。
如果将泄泻和痢疾这两种证候不加区分，笼统地说是湿热，而不通过利小便来分消湿热，这不是正确的治疗方法。所谓“泄”，是水谷混杂、湿气偏盛的征象。“滞下”则是污秽瘀浊之物与湿热结合而成。两者的治疗分为两途，用药也各不相同。如果是淡渗利湿的药物，其功能在于疏通水道，使浑浊的液体快速流出，从而使泄泻自然停止。这种针对无形之气的治法，怎么能与滞下（痢疾）混为一谈，而使用导滞行积的方法呢？
痢疾的病位在大肠，属于传导排泄之道，与肾气没有直接关系。所排出的有形之物，有的像鱼脑，有的像豆汁，有的排出白色脓液，有的纯为血液，有的赤色，有的白色，有的赤白相间。像这样的情况，怎么能与泄泻混同论治，而使用淡渗利湿的方法呢？
追溯其根本原因，都是由于肠胃每日承受饮食积滞，余留未尽，停滞在体内，湿气蒸腾，热气瘀结，郁结日益加深，潜伏而不发作；等到遇到炎热夏季，相火当令之时，又因调摄失宜，再次感受酷热之毒；到了秋季阳气开始收敛，火气下降，蒸发体内的蓄积，于是滞下的病症就发作了。因为是由于积滞导致的气机阻滞，所以命名为“滞下”。
湿热瘀积侵犯血分则见赤色；侵犯气分则见白色；赤白兼下，说明气血都受到了邪气侵害。如果久治不愈，气血运行不畅，脾脏运化无力，陈旧的积滞脱落下滑并凝结，就像鱼脑一样。严重时肠胃空虚，关门司职失守，浊液并流，颜色不一，错杂混合向下注出，状如豆汁。如果脾气下陷，出现虚坐努责（想排便但无物可排，用力挣扎），排出的颜色像白色脓液。如果热邪伤血深重，湿毒相互瘀结，粘结成紫色，则呈紫黑色。
那些污浊积滞想要排出，但气机阻滞不能随之排出，所以下腹窘迫疼痛，肛门重坠，里急后重，即使去厕所也无法排便，频繁往来却量少，时起时卧不得安宁。这都是大肠经有所壅遏窒碍，气液不得宣通造成的。
众人说法难以处理，什么法则可以寻求呢？长沙（张仲景）论述说：对于可以用下法治疗的痢疾，全部使用大黄类的方剂。对于可以用温法治疗的，全部使用干姜、附子之类的药物。何曾见过用巴豆的热毒强行攻下，或用紧涩的重药强行兜住止泻的？
再看刘河间（刘完素）立论：肛门重坠适宜用下法，腹痛适宜调和气血，身体沉重适宜温补，脉弦适宜祛风，脓血粘稠需用重药竭尽邪气，身体寒冷自汗需用重药温补，风邪内束适宜发汗，溏泄为痢适宜温补，病在表者发汗，病在里者攻下，病在上者涌吐，病在下者竭除，身体表面发热者内部疏解，小便涩滞者分利小便。他对用药轻重的区别，又作了详细记载。“行血则便脓自愈，调气则后重自除”，这是治疗实证和虚证的精要论述。而丹溪（朱震亨自己）又认为大虚大寒的情况，其治疗验证详细记载在《局方发挥》中。
观察这些治法，怎么能拘泥固执不知变通呢？又有胃气虚弱而闭拒饮食的，这名叫“禁口痢”，以前的医方中没有详细论述的。根据《内经》的大法来推断，这是内格呕逆、火气炎上的征象。究其根源，是胃虚导致木火乘袭，即土败木贼，见到这种情况多成为危重证候。
The disease of "Zhi Xia" (Dysentery, literally "stagnant downflow"), I have often seen worldly prescriptions differentiate between cold and heat based on whether the stool is red or white, and recklessly use astringent and drying agents to stop it. Some attribute it to accumulation and stagnation, using pill medicines containing *Crotonis Fructus* (Batu, 巴豆) for purgation; others point to damp-heat, administering diaphoretic and leeching agents to promote urination. Such one-sided errors certainly warrant clear differentiation.
Respectfully consulting the *Yuan Bing Shi* (Original Treatise on Diseases), it argues that red and white dysentery share the same underlying principle, repeatedly illustrating this point, yet people fail to examine it closely. If there is indeed accumulation and stagnation in the intestines and stomach not moving forward, the method should employ bitter, acrid, cold, and cool herbs to push out the old and generate the new, sweeping away the stagnation. It is inappropriate to use toxic and hot purgatives like *Crotonis Fructus*. Otherwise, the constraint may worsen, leading to critical changes in the condition.
If diarrhea (Xie) and dysentery (Zhi Xia) are not distinguished as two separate syndromes, and both are loosely attributed to damp-heat without promoting urination to drain dampness, this is not the correct treatment. "Xie" refers to the manifestation of water and grain mixed with dampness. "Zhi Xia" refers to foul and stasis-like substances formed by combining with damp-heat. Their treatments diverge into two paths, and their medications differ. Diaphoretic and leeching agents function to disperse and benefit the water passages, allowing turbid flow to move quickly, thereby stopping diarrhea naturally. How can this treatment for "formless" conditions be confused with Zhi Xia, where guiding stagnation and moving accumulation is required?
Dysentery originates in the Large Intestine, which is the pathway of transmission and excretion, and has nothing to do with Kidney Qi. The tangible matter expelled may resemble fish brain, bean curd juice, white pus, pure blood, red, white, or a mixture of red and white. In such cases, how can it be treated identically to diarrhea using diaphoretic and leeching methods?
Tracing its root cause, all stem from the intestines and stomach receiving dietary accumulations daily. What is not fully digested remains stagnant inside, steaming with dampness and瘀结 (stasis) with heat. The constraint deepens day by day, lying dormant without manifesting. When encountering the hot summer season, when Ministerial Fire (Xiang Huo, 相火) commands, combined with improper lifestyle management and re-exposure to severe heat toxins, by autumn when Yang Qi begins to收 (contract/gather) and Fire Qi descends, it evaporates the accumulated stagnation, causing the syndrome of Zhi Xia to arise. Because it is named after the stagnation of accumulations, it is called "Zhi Xia."
When damp-heat and stasis invade the Blood Level (Xue Fen, 血分), redness appears; when invading the Qi Level (Qi Fen, 气分), whiteness appears. Red and white mixed discharge indicates that both Qi and Blood are affected by pathogenic factors. If prolonged and unhealed, Qi and Blood circulation fails, Spleen accumulation fails to grind/digest, and old accumulations detach, slide down, and coagulate, resembling fish brain. In severe cases, the intestines and stomach become empty, the sphincters lose control, turbid fluids flow together, colors vary, mixing and descending chaotically, resembling bean curd juice. If Spleen Qi sinks, causing tenesmus with empty straining (Xu Zuo Nu Ze, 虚坐努责), the stool color resembles white pus. If heat injures blood deeply and damp-toxins stasis bind together, turning purple-black, the stool becomes dark purple or black.
When foul turbidity accumulates and desires to exit, but Qi stagnation prevents it from exiting smoothly, lower abdominal urgency and pain occur, accompanied by heaviness in the anus and tenesmus (Hou Zhong Li Ji, 后重里急). One goes to the toilet but cannot defecate; frequent trips yield little output; rising and lying down restlessly. These are all due to obstruction and blockage in the Large Intestine Meridian, preventing the free flow of Qi and fluids.
Given the conflicting opinions, what principles can be sought? Changsha (Zhang Zhongjing) stated: For dysentery suitable for purgation, use formulas containing *Rhei Radix et Rhizoma* (Dahuang, 大黄); for those suitable for warming, use items like *Zingiberis Rhizoma* (Jiang, 干姜) and *Aconiti Lateralis Radix Praeparata* (Fuzi, 附子). Where did he ever use the toxic heat of *Crotonis Fructus* for forced purgation, or tight astringents to forcefully stop discharge?
Furthermore, observing Liu Hejian's (Liu Wansu) statements: Tenesmus requires purgation; abdominal pain requires harmonizing; body heaviness requires warming; wiry pulse requires dispelling wind; sticky pus and blood require heavy drugs to exhaust pathogens; cold body and spontaneous sweating require heavy drugs to warm; internal binding by wind pathogens requires sweating; loose stools as dysentery require warming; exterior pathogens require sweating; interior pathogens require purgation; upper level pathogens require emesis; lower level pathogens require exhausting; surface heat requires internal clearing; difficult urination requires separating and draining. He detailed the distinctions in light and heavy medication usage. "Moving Blood heals pus in stool; regulating Qi removes tenesmus," this is the essential theory for treating excess and deficiency. Danxi also stated that for extreme deficiency and cold, treatment validations are recorded in *Ju Fang Fa Hui*. Observing these treatments, how can one be rigid and inflexible?
There is also "Jin Kou Li" (Forbidden Mouth Dysentery), characterized by weak Stomach Qi, refusal to eat, and vomiting, which was not discussed in detail in previous prescriptions. Inferring from the general principles of *Nei Jing*, this presents as internal rejection, vomiting, and counterflow, indicative of Fire flaring upward. Investigating this, it is Stomach Deficiency allowing Wood-Fire to overact, representing Earth failing and Wood attacking. Seeing this often leads to critical conditions.