痢，古滞下也。水谷为泻，下脓血为痢。赤属血，自小肠来，白属气自大肠来，皆属湿热。积者食积，滞者气
滞，物欲出而气滞不出，则下坠，故先急后重。河间论行血则便自安，调气则后重自除，此法甚妙。仲景率以承气
汤下之，量病加减。小儿先用小黑丸下之，后用芩连芍药汤，仍看其血病气病而为佐使，不可用涩药止之，久而虚
者方可。
芩连芍药汤
芍药 茯苓 陈皮 浓朴 甘草 黄连 黄芩 枳壳 槟榔 山楂 木通
有血加当归或生地，血紫加桃仁、归梢，腹痛加砂仁，甚则少加木香，血痢不宜。噤口加连肉或乌梅，后重
甚加升麻、柴胡，痢久亦加，恐元气下陷也。痢下青草汁者，风毒也，加防风或干葛；腹痛甚加乳香、没药，亦
治痰血。痢久加地榆、蒲黄。腹痛，肺金之气郁于大肠，以苦参、桔梗；痢如豆汁，湿甚也，加防风，九制苍术
亦可。滑石亦可能利湿，小便少亦加之。积尽用白术健脾，调理气分，发呃用柿蒂、枇杷叶（去毛蜜炙）、丁香，
久而虚者加诃子、肉蔻。力倦气少恶食，此挟虚也，宜当归（身尾）、白术、陈皮，虚极加人参补虚，虚回而痢
自止；血痢久不止属阴虏，四物汤为主；痢久不瘥，脾气下陷，补中益气汤倍升麻、柴胡；痢久不瘥，后变为疟，
身肿面黄腹痛或泻臭水，目无神，用余家大黑丸、木香饼相间服。前方加人参、白术、木香、肉蔻煎服。
小儿七八岁下纯血，勿以食积治，前方加当归或生地、地榆、蒲黄（醋炒）、荆芥、乌梅等敛血。血紫，先
用归尾、桃仁行之，气血俱虚神弱，人参、白术、当归、白芍、茯神、黄连服之，并大黑丸及木香饼间服。疟变
为痢，邪自外而深入五脏，此症难治。噤口痢，胃热甚也，用黄连一钱，人参三分，煎汁终日呷之；如吐，再吃
一口，下咽便有生意。又用田螺捣碎，次下麝香再捣，合脐中缚紧，引下其热。休息痢，既息复作，当以虚治。下
如尘腐者，如屋漏水者，下纯血者，大孔如竹筒者，唇如朱红者，如鱼脑色者，身热脉大者，俱不治。此论其大
概耳。
大黑丸（又名保和丸）
炒香附（一两） 炒浓朴 醋炒青皮 陈皮 使君子 槟榔 醋炒三棱 炒甘草（各五钱） 炒神曲
姜汁炒黄连 炒麦芽 土炒白术 醋炒蓬术（各一两） 山楂（一两半）
蜜丸，圆眼大，每服一丸，空心米汤送下。
木香饼
木香（五钱） 炒陈皮（二两） 炒神曲（一两） 炒麦芽（一两） 煨肉蔻（一两） 人参（五钱） 浓朴
（五钱） 煨诃子肉 炒扁豆（各一两） 炒甘草（五钱）
蜜丸，圆眼大，每服一丸，空心米饮下。
痢疾，古称“滞下”。大便稀溏为泄泻，排出脓血则为痢疾。便血色赤属血分病变，病源来自小肠；便色白属气分病变，病源来自大肠；二者皆由湿热所致。“积”指食积，“滞”指气机阻滞。邪物欲出而气机阻滞不通，导致肛门坠胀感，因此出现腹痛急迫、排便不畅且伴有里急后重的症状。刘河间论述道：调和血液则大便自然安和，调理气机则里急后重自然消除，此法非常精妙。张仲景通常采用承气汤（Chengqi Tang, 攻下热结之剂）通腑泄热，并根据病情轻重加减药味。小儿患者先用小黑丸（Xiaohei Wan, 一种儿科专用泻下药）通便，随后服用芩连芍药汤（Qinlian Shaoyao Tang, 清热燥湿、调和气血之方），仍需根据是血病还是气病来调整佐使药，不可轻易使用收敛固涩的药物止痢，除非病程日久导致正气虚弱者方可使用。
芩连芍药汤
组成：芍药、茯苓、陈皮、厚朴、甘草、黄连、黄芩、枳壳、槟榔、山楂、木通。
若有出血症状，加当归或生地黄；若血色紫暗，加桃仁、当归梢；若腹痛，加砂仁；若疼痛剧烈，可少量加入木香，但血痢患者不宜使用。若患噤口痢（Jinkou Li, 痢疾中不能进食者），加肉桂或乌梅；若里急后重严重，加升麻、柴胡，痢疾日久者也可加入，以防元气下陷。若痢下如青草汁，此为风毒所致，加防风或干葛（Gan Ge, 即葛根）；若腹痛剧烈，加乳香、没药，此二药亦能治疗痰血。痢疾日久，加地榆、蒲黄。若因腹痛，系肺金之气郁结于大肠，可用苦参、桔梗；若痢下如豆汁，说明湿气极重，加防风，九制苍术亦可。滑石也能利湿，若小便量少也可加入。待积滞排尽后，用白术健脾，调理气分。若出现呃逆，用柿蒂、枇杷叶（去毛后用蜂蜜炙烤）、丁香；若病程久且体虚，加诃子、肉豆蔻。若乏力、气短、厌恶饮食，此为兼夹虚证，宜用当归（身尾并用）、白术、陈皮；若极度虚弱，加人参以补虚，正气恢复则痢疾自止；若血痢日久不止，属阴寒内盛（阴虏），以四物汤（Siwu Tang, 补血调血之剂）为主方；若痢疾日久不愈，脾气下陷，用补中益气汤（Buzhong Yiqi Tang, 补中益气、升阳举陷之方）并倍用升麻、柴胡；若痢疾日久不愈，后来转变为疟疾，出现身体浮肿、面色发黄、腹痛或排泄臭秽水样便、眼神无光等症状，使用余家大黑丸与木香饼交替服用。前方（指上述基础方）加入人参、白术、木香、肉豆蔻煎服。
七八岁小儿若下纯血，不要按食积治疗，前方加入当归或生地黄、地榆、蒲黄（醋炒）、荆芥、乌梅等以收敛止血。若血色紫暗，先用当归尾、桃仁活血行瘀；若气血俱虚、精神萎靡，用人参、白术、当归、白芍、茯神、黄连服用，并交替服用大黑丸及木香饼。若疟疾转变为痢疾，说明邪气由外深入五脏，此症难治。对于噤口痢，因胃热甚，用黄连一钱、人参三分，煎取汁液终日少量频服；若呕吐，再吃一口，咽下后便有生机。另用田螺捣碎，再加入麝香继续捣烂，敷贴于脐中并缚紧，以引热下行。休息痢（Xiuxi Li, 时发时止的痢疾）既已停止又复发，应当按虚证治疗。若大便如尘腐状、如屋漏水状、下纯血、肛门直如竹筒、嘴唇如朱红色、大便如鱼脑色、身体发热脉象洪大者，均属不治之症。以上仅为大概论述。
大黑丸（又名保和丸）
组成：炒香附（一两）、炒厚朴、醋炒青皮、陈皮、使君子、槟榔、醋炒三棱、炒甘草（各五钱）、炒神曲、姜汁炒黄连、炒麦芽、土炒白术、醋炒蓬术（各一两）、山楂（一两半）。
制成蜜丸，大小如龙眼核，每次服用一丸，空腹时用米汤送服。
木香饼
组成：木香（五钱）、炒陈皮（二两）、炒神曲（一两）、炒麦芽（一两）、煨肉豆蔻（一两）、人参（五钱）、厚朴（五钱）、煨诃子肉、炒扁豆（各一两）、炒甘草（五钱）。
制成蜜丸，大小如龙眼核，每次服用一丸，空腹时用米饮送服。
Dysentery, known in ancient times as "Zhi Xia" (Stagnant Downward Discharge). Loose stools constitute diarrhea (Xie Xie), while the discharge of pus and blood constitutes dysentery (Li). Red color indicates a blood-level pathology originating from the Small Intestine; white color indicates a Qi-level pathology originating from the Large Intestine; both are attributed to Damp-Heat. "Ji" refers to Food Stagnation, while "Zhi" refers to Qi Stagnation. When pathogenic matter desires to exit but is obstructed by Qi stagnation, it causes a sensation of bearing down, thus resulting in tenesmus (Li Ji Hou Zhong) characterized by urgent abdominal pain followed by incomplete evacuation. Liu Hejian discussed that harmonizing the Blood leads to natural ease of defecation, and regulating Qi eliminates tenesmus; this method is excellent. Zhang Zhongjing typically employed Chengqi Tang (Cathartic Decoction) to purge via the bowels, modifying the formula according to the severity of the illness. For pediatric patients, Xiaohei Wan (Little Black Pill) is used first to purge, followed by Qinlian Shaoyao Tang (Scutellaria and Coptis Peony Decoction). One must still adjust the assistant and guide herbs based on whether the pathology is in the Blood or Qi. Astringent medicines should not be used to stop dysentery unless the condition has persisted for a long time leading to deficiency.
Qinlian Shaoyao Tang (Scutellaria and Coptis Peony Decoction)
Ingredients: Shaoyao (Paeoniae Radix), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Houpo (Magnoliae Officinalis Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhiqiao (Aurantii Fructus Immaturus), Binglang (Arecae Semen), Shanzha (Crataegi Fructus), Mutong (Akebiae Caulis).
If there is bleeding, add Danggui (Angelicae Sinensis Radix) or Shengdihuang (Rehmanniae Radix); if the blood is dark purple, add Taoren (Persicae Semen) and Danggui shao (the tail of Angelicae Sinensis Radix); if there is abdominal pain, add Sharen (Amomi Fructus); if severe, add a small amount of Muxiang (Aucklandiae Radix), though this is unsuitable for bloody dysentery. If suffering from Jinkou Li (Throat-Closing Dysentery, inability to eat), add Rougui (Cinnamomi Cortex) or Wumei (Mume Fructus); if tenesmus is severe, add Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix); these may also be added if dysentery persists for a long time, to prevent the sinking of Yuan Qi (Primary Qi). If the stool resembles green grass juice, this is due to Wind-Toxin; add Fangfeng (Saposhnikoviae Radix) or Gange (Puerariae Lobatae Radix, i.e., Gegen). If abdominal pain is severe, add Ruxiang (Olibanum) and Moyao (Myrrha), which also treat Phlegm-Blood stasis. For chronic dysentery, add Diyü (Sanguisorbae Radix) and Puhuang (Typhae Pollen). If abdominal pain occurs due to Lung Metal Qi stagnating in the Large Intestine, use Kushen (Sophorae Flavescentis Radix) and Jiegeng (Platycodonis Radix). If the discharge resembles bean curd dregs, dampness is severe; add Fangfeng, or Jiuzhi Cangzhu (Atractylodis Rhizoma processed nine times). Huashi (Talcum) can also promote diuresis to drain dampness and may be added if urine volume is low. Once stagnation is cleared, use Baizhu (Atractylodis Macrocephalae Rhizoma) to strengthen the Spleen and regulate Qi. If hiccups occur, use Shidi (Diospyri Fructus), Pipaye (Eriobotryae Folium, de-haired and honey-fried), and Dingxiang (Syzygii Flos); if chronic and deficient, add Hezi (Terminalia Chebulae Fructus) and Roudoukou (Myristicae Semen). If fatigue, shortness of breath, and anorexia occur, this indicates accompanying deficiency; use Danggui (body and tail), Baizhu, and Chenpi. If extremely deficient, add Renshen (Ginseng Radix et Rhizoma) to tonify deficiency; once Qi recovers, dysentery will cease naturally. If bloody dysentery persists for a long time, it belongs to Yin Cold (Yin Lu), treated primarily with Siwu Tang (Four Substances Decoction). If dysentery does not heal after a long time due to Spleen Qi sinking, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Shengma and Chaihu. If dysentery persists and later transforms into malaria, presenting with body edema, sallow complexion, abdominal pain, or foul-smelling watery diarrhea, and dull eyesight, use Yu Jia Dahei Wan (Master Yu's Large Black Pill) and Muxiang Bing (Aucklandia Cake) alternately. The previous formula should be decocted with Renshen, Baizhu, Muxiang, and Roudoukou.
For children aged seven or eight who pass pure blood, do not treat as Food Stagnation. Add Danggui or Shengdihuang, Diyü, Puhuang (vinegar-fried), Jingjie (Schizonepetae Herba), and Wumei to the previous formula to astringe blood. If the blood is dark purple, first use Dangguiwei (the tail of Angelicae Sinensis Radix) and Taoren to invigorate blood circulation. If both Qi and Blood are deficient and spirit is weak, administer Renshen, Baizhu, Danggui, Baishao (Paeoniae Radix Alba), Fushen (Poria cum Radix), and Huanglian, alternating with Dahei Wan and Muxiang Bing. If malaria transforms into dysentery, indicating pathogenic factors have penetrated deeply from the exterior into the Five Zang Organs, this condition is difficult to treat. For Jinkou Li caused by severe Stomach Heat, use one qian of Huanglian and three fen of Renshen, decocted in water to be sipped throughout the day; if vomiting occurs, take another sip, and upon swallowing, vitality returns. Alternatively, crush fresh snails, add Moshe (Moschus), grind together, apply to the umbilicus, and bind tightly to draw heat downward. For Xiuxi Li (Intermittent Dysentery), which stops and recurs, treat as a deficiency pattern. Cases where stool resembles dust/rotten matter, like leaking roof water, passing pure blood, anus straight as a bamboo tube, lips vermilion red, stool resembling fish brain, accompanied by fever and a large pulse, are all untreatable. This is a general discussion.
Dahei Wan (Also known as Baohe Wan)
Ingredients: Chao Xiangfu (Cyperi Rhizoma, stir-fried, 1 liang), Chao Houpo (stir-fried, 1 liang), Cu Qingpi (Citri Reticulatae Pericarpium Viride, vinegar-fried, 1 liang), Chenpi (1 liang), Shijunzi (Quisqualis Fructus, 1 liang), Binglang (1 liang), Cu Sanleng (Sparganii Rhizoma, vinegar-fried, 1 liang), Chao Gancao (stir-fried, 5 qian), Chao Shenqu (Medicated Leaven, stir-fried, 5 qian), Jiangzhi Huanglian (Coptidis Rhizoma, ginger-juice fried, 5 qian), Chao Maiya (Hordei Fructus Germinatus, stir-fried, 5 qian), Tu Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 1 liang), Cu Pengzhu (Curcumae Rhizoma, vinegar-fried, 1 liang), Shanzha (1.5 liang).
Make into honey pills, size of a longan seed. Take one pill per dose, swallowed with rice soup on an empty stomach.
Muxiang Bing (Aucklandia Cake)
Ingredients: Muxiang (1 qian), Chao Chenpi (stir-fried, 2 liang), Chao Shenqu (stir-fried, 1 liang), Chao Maiya (stir-fried, 1 liang), Wei Roudoukou (roasted Myristicae Semen, 1 liang), Renshen (0.5 liang), Houpo (0.5 liang), Wei Hezi Rou (roasted Terminalia Chebulae Fructus flesh, 1 liang), Chao Biandou (Vigna Cochinchinensis Seed, stir-fried, 1 liang), Chao Gancao (stir-fried, 0.5 liang).
Make into honey pills, size of a longan seed. Take one pill per dose, swallowed with rice drink on an empty stomach.