甲、概况
痢疾亦称滞下，以大便下粘液之物，里急后重，滞而不畅
也。下赤色者，谓之赤痢，下白色者，谓之白痢，赤白兼下者，谓之赤白痢。通常下痢，大都赤白兼有，下
纯白或纯赤者则较少也。痢疾之轻者，粪中杂痢，次数不多，滞急之状，亦不甚剧；痢疾之重者，纯痢无粪，
日夜临圊常数十百次，欲下则滞痛甚剧而终于所下无几。又痢疾之轻者，常发于秋初，痢疾之重者，多
发于秋深，然痢疾之重轻，犹未可全恃乎此以为断也。痢疾之出入，恒在发热之甚否，其有初起发热而入后渐
减渐无者。纵腹痛滞下，次数极多，证状虽剧，必有可愈之道。若身热渐发渐高，旋退而又增，纵腹痛尚缓，
次数尚少，证状虽差，必有危险之虞，此昔人所以有热不休死不治之说也。又痢疾之不能饮食者谓
之噤口痢，亦属重证，偏实者为肠胃灼热所致，偏虚者为津液枯涸所致。久痢不止而不食者，常为不治。痢
之时止时作者谓之休息痢，虽非危证，然常经年累月而不愈，多由初起失于通利，致湿热之邪留舍不去所致，
若不谨慎调摄，恐其永成痼疾，皆不可以不慎也。痢疾之起源，虽由时令之偏，口腹感染所致，然必肠
中传化失职，湿热内伏先为其因，以致时邪乘之，津液受伤，遂变化为痢，成此奔迫下注之状。所以腹痛滞
下者，以湿邪胶结，气不足以引之外达，气欲行而难行故痛，湿欲去而又留故滞也。大抵湿热之邪伤其气分
者，则腐化而为白痢，湿热之邪伤其血分者，则下溃而为赤痢，气血俱伤者，赤白皆齐下。然肠中迂回细
小之地，病则气血未有不并伤者，故患痢者亦以赤白兼下为多。休息痢疾，则以瘀热留伏于膜油隐匿之地
，蒸腐日久，不复能分赤白，故多见似冻之浊物，泄下后则外结灰色之衣而已。此外有肠中发赤发肿，以致
溃烂脓血者，谓之脓血痢，亦有仅见纯血者，谓之纯血痢。然脓与血不必仅见于痢疾，如肠痈、肠风及泄
泻等证中，亦多有之，固不可混统指为痢疾，以致临证贻误也。
乙、治法
痢疾初起，概忌止涩而宜通利。盖痢为肠腑之病，湿热之
邪，非通利不能引之外出也。惟通利之法，约有数端，热重者通之以苦降，湿重者通之以分利，滞甚者通之以
攻下，而初起尚有粪便未尽化痢者，则宜以消食行滞之法为之治，更不必先用苦降也。至于痢疾经久，确为滑
脱不禁，无滞下急痛之实象而有肠腹 痛之虚象者，乃可以言止涩。故通因通用之法，治痢之新病而实
者也，塞因塞用之法，治痢之久病而虚者也。治赤痢宜和血，治白痢宜调气，赤白痢下，和血调气。通治方
有芍药汤，赤白皆治，气血并顾，为痢疾初起之主方。惟痢疾初起，尚在似痢非痢之间者，可用神曲、焦
楂肉、焦麦芽、槟榔、陈皮、枳壳之类以消食行滞，不必作痢治，而胃气一醒，腑气一通，痢疾竟有消灭
于无形者。若滞下甚急，身热亦壮，来势颇盛者，则不能不专作痢治矣。凡痢之热重积多，滞下不畅者宜木
香槟榔丸；痢之湿与热俱重，须祛湿行滞并行者，宜枳术导滞丸；痢之热甚渴甚后重滞下者，宜白头翁汤；
白痢之偏于热者，宜芍药汤加杏仁、桔梗；偏于湿者宜胃苓汤加木香、砂仁；偏于虚寒者宜二陈汤加炮
姜、焦术、浓朴、木香、砂仁；日久下痢清白，手足厥冷，腹痛不已者，宜附子理中汤；气虚滑脱不禁者，
宜用人参、黄 以补气，御米壳以固肠；由白痢而变赤白者宜戊已丸；赤痢之偏于热者，宜白头翁汤加黄
芩炭、槐花炭；偏于湿者，宜苍术地榆汤；偏于虚寒，服凉药而下愈甚者，宜四君子汤加木香、肉豆蔻、炮
姜炭、地榆炭；赤痢久而不止，虚而欲脱者，宜八珍汤加黄 、升麻之类；手足厥冷，脉渐微细者，宜附子
理中汤；休息痢疾，通治方宜驻车丸；气虚者加补中益气汤；单方用龙眼肉一枚包苦参子七粒，日日吞之，
颇为有效。凡休息痢之积滞未清者，宜香连丸加白术、枳实等以消其滞，积滞已清者，宜人参黄 加椿根白
皮、御米壳之类以塞其脱。由下痢而转下脓血者，宜阿胶梅连丸、黄连阿胶汤；虚者宜纯阳真人养脏汤；
纯血痢之稠浓鲜红而多者属热，宜用黄连、槐角、淡芩、白芍、生地、犀角之类；稀
淡色瘀而少者属寒，宜黄土汤。至时时便血，随感随发，血清而色鲜，下则四射如溅者，是为肠风便血；
下脓血而腹皮肿胀，按之则痛转侧不便者，是为肠痈。此均非痢疾而有似于痢，临证时不可不细辨之。总之
治痢之大要∶一曰初起忌温补而宜通利，盖通利则肠中胶结之邪热可去，而温补则使热愈盛使气愈滞，必至
变坏；二曰宜通利而不宜急下，盖邪热胶结，类乎沟渠之壅塞，惟宜磨凿疏通，庶可逐渐打开，若急下则徒
损胃气，无济于事也；三曰不可妄用发表，盖痢疾邪在于肠，非发表所能开泄，即有身寒发热者，乃内毒熏
蒸，自内达外，固非表邪使然也；四曰不可过于分利，盖分利乃止泻之法而非治痢之道，过于分利，湿邪虽
去而津液受伤，必致缠绵不已也。至于小儿患痢，尤多过贪口腹，及恣食瓜果生冷，积滞不行而致，若用止
涩之法，最足贻误大事。此皆不可不知者也。
附方
（一）芍药汤 治痢下脓血，及后重窘痛。
白芍（炒，二两） 当归尾 黄连（炒） 黄芩（炒。各五钱） 槟榔 木香
甘草（炙。各三钱） 每服五钱，清水煎服。
（二）木香槟榔丸 治一切滞气，心胸腹胁痞满，二便涩滞。
木香 槟壳 枳壳（麸炒） 青皮 陈皮 蓬莪术（煨切） 黄连（同吴
茱萸炒。各一两） 黄柏（酒炒） 香附（醋炒） 大黄（酒蒸。各三两） 牵牛头末（四两）
研为细末，朴硝泡水和丸，如豌豆大。
（三）枳术导滞丸 治脾胃困于湿热，不得运化，胸闷腹痛，积滞泄泻。
枳实（五钱） 白术（土炒） 黄芩（酒炒） 茯苓 黄连（姜汁炒。各三钱） 泽
泻（二钱） 神曲（五钱） 大黄（一两）
共研细末为丸。
（四）白头翁汤 治厥阴热利，下重及下利，脉沉弦，渴欲饮水者。
白头翁 黄连 黄柏 秦皮
（五）胃苓汤 见第七章第三节。
（六）二陈汤 见第六章第三节。
（七）附子理中汤 见第五章第四节。
（八）戊己丸 治脾胃受湿，下痢赤白，腹痛，米谷不化。
川黄连 吴茱萸 白芍药（各等分）
研末和丸。
（九）苍术地榆汤 治脾经受湿下血。
苍术 地榆
（十）四君子汤 见第三章第五节。
（十一）八珍汤 见本章第二节。
（十二）驻车丸 治阴虚发热，下利脓血，及休息痢。
阿胶（捣碎，蛤粉炒成珠为末，以醋熬成膏，十五两） 黄连（一斤十四两） 当归（十五两） 干姜（十两）
研为末，捣筛，醋煮阿胶膏为丸，如梧桐子大，每服十余丸。
（十三）补中益气汤 见第四章第四节。
（十四）香连丸 见第四章第一节。
（十五）阿胶梅连丸 治阴虚下痢，至夜发热。
阿胶 黄连（各三两） 乌梅肉 黄柏（炒黑） 赤芍 当归（炒） 赤苓（各一两五钱） 干姜（一两）
研为细末，和丸如梧子大，每服十余丸。
（十六）黄连阿胶汤 治久痢不止。
黄连（炒） 阿胶（炒） 党参 白术 茯苓（各一钱） 干姜（炒） 甘草（灸。
各五分） 木香（七分） 乌梅（三个）
加生姜、大枣，清水煎，食前服。
（十七）纯阳真人养脏汤 治冷热不调，下痢赤白，或便脓
血，或如鱼脑，里急后重，脐腹 痛，及脱肛坠下，酒毒湿毒便血。
人参 白术 当归 白芍 木香（各一两六钱） 甘草 肉桂（各八
钱） 肉豆蔻（五钱） 御米壳（三两六钱） 诃子肉（一两二钱）
每服四钱，清水煎服。
（十八）黄土汤 治吐血衄血，先便后血，及妇人血崩，产后下痢。
灶中黄土 甘草（炙） 干地黄 白术 附子 阿胶 黄芩
（十九）痢疾初起方（自制） 治肠胃积滞，湿热熏蒸，身热，赤白痢下，腹痛滞急。
川朴 黄芩（炒） 白芍 郁金 槟榔 青皮 神曲 银花
加左金丸。清水煎服，咳嗽不爽，兼须开肺者加桔梗、前胡赤多于白者加当归炭、槐花炭、淡芩、银花
俱炒炭用；口渴甚者去川朴、加芦根、藕汁；小便少者，加赤苓、泽泻。
（二十）痢疾热重方（自制） 治痢疾身热不退，腹痛滞急，恶心拒食。
黄连 竹沥制半夏 白芍 石莲肉 粉菖蒲 羚羊角 枳实 淡芩炭 银花炭 花槟榔 鲜佩兰
服药后动恶心者，细呷玫瑰花露一杯以定之。
（二十一）陈莱菔菜 莱菔菜经风霜雨雪后，晒干收藏，小儿患痢疾，可取用数钱，加生姜一二片
煎汤服，有效。
A. Overview
Dysentery, also known as "Zhi Xia" (Stagnant Downward Flow), is characterized by the passage of mucus-like substances in the stool, accompanied by tenesmus (a feeling of incomplete defecation with urgent pain) and a sticky, unsmooth discharge. Discharge of red feces is called Chi Li (Red Dysentery); discharge of white feces is called Bai Li (White Dysentery); and mixed red and white discharge is called Chi Bai Li (Red-White Dysentery). Typically, dysentery presents with both red and white components, while pure white or pure red cases are less common. Mild cases involve feces mixed with dysenteric pus and blood, with infrequent bowel movements and mild tenesmus; severe cases involve pure dysenteric discharge without normal stool, requiring visits to the toilet dozens or even hundreds of times day and night, with intense abdominal pain and difficulty passing stool, yet yielding very little output. Furthermore, mild dysentery often occurs in early autumn, while severe dysentery tends to occur in late autumn; however, the severity cannot be determined solely by the time of onset. The prognosis of dysentery depends largely on the fever pattern: some patients have fever at the onset that gradually subsides and disappears. Even if abdominal pain is prominent, bowel movements are frequent, and symptoms appear severe, there is always hope for recovery. If body heat gradually rises, subsides, and then increases again, even if abdominal pain is mild, bowel movements are infrequent, and symptoms seem light, there is a definite risk of danger. This is why ancient texts state, "If fever does not cease, death is untreatable." Additionally, when dysentery patients cannot eat, it is called Jin Kou Li (Jin Kou Dysentery), which is also a severe condition. In excess patterns, it is caused by scorching heat in the stomach and intestines; in deficiency patterns, it is caused by exhaustion of body fluids. Chronic dysentery with inability to eat is generally considered incurable. Dysentery that stops and recurs is called Xiu Xi Li (Resting Dysentery). Although not critical, it often persists for years due to failure to clear stagnation at the onset, allowing damp-heat pathogens to linger. Without careful regulation and diet, it may become a chronic stubborn disease, so caution is essential. The origin of dysentery lies in seasonal abnormalities and dietary infection, but fundamentally requires dysfunction of intestinal transportation and transformation with internal latent damp-heat, allowing seasonal pathogens to invade, damage body fluids, and transform into dysentery, causing urgent downward flow. Abdominal pain and stagnation occur because dampness binds tightly, and righteous qi is insufficient to guide pathogens outward; qi desires to move but cannot, causing pain; dampness desires to leave but remains, causing stagnation. Generally, damp-heat damaging the Qi level results in Bai Li (White Dysentery); damaging the Blood level results in Chi Li (Red Dysentery); damaging both results in mixed discharge. Since the small, winding intestines are affected, Qi and Blood are usually both injured, hence mixed discharge is common. In Resting Dysentery, stagnant heat lingers in hidden areas like the membrane source, steaming and rotting over time, losing distinction between red and white, resulting in turbid, jelly-like matter and gray films after defecation. Additionally, intestinal redness, swelling, ulceration, and pus-blood discharge constitute Nong Xue Li (Pus-Blood Dysentery); pure blood discharge constitutes Chun Xue Li (Pure Blood Dysentery). However, pus and blood are not exclusive to dysentery; they also appear in Chang Yong (Intestinal Abscess), Chang Feng (Intestinal Wind/Bleeding), and Xie Xie (Diarrhea), so they must not be confused with dysentery to avoid misdiagnosis.
B. Treatment Methods
At the onset of dysentery, astringents are strictly contraindicated, and purgatives/drainage methods are preferred. Dysentery is an intestinal disease; damp-heat pathogens cannot be expelled without promoting drainage. Purging methods include: bitter-cold descending for heat-dominant cases; separating and draining for damp-dominant cases; and attacking/purgation for severe stagnation. If undigested food remains at onset, resolving food stagnation is appropriate before using bitter-cold methods. For chronic dysentery with incontinence, lacking excess signs of tenesmus but showing deficiency signs of abdominal pain, astringents may be used. Thus, "Tong Yin Tong Yong" (Treating obstruction with draining methods) applies to new, excess dysentery; "Sai Yin Sai Yong" (Treating blockage with consolidating methods) applies to old, deficient dysentery. Treating Chi Li requires harmonizing blood; treating Bai Li requires regulating Qi; treating Chi Bai Li requires both. Shao Yao Tang (Peony Decoction) is a general formula for initial dysentery, harmonizing Qi and Blood. If dysentery is in its early, ambiguous stage, use Shen Qu, Jiao Zha Rou, Jiao Mai Ya, Bing Lang, Chen Pi, Zhi Qiao to resolve stagnation; once Stomach Qi recovers and Fu organs unblock, dysentery may vanish spontaneously. If stagnation is urgent with high fever, treat specifically as dysentery. For heat-dominant, stagnant dysentery, use Mu Xiang Bing Lang Wan (Costus and Areca Pill); for damp-heat combined, use Zhi Zhu Dao Zhi Wan (Immature Bitter Orange and Atractylodes Drainage Pill); for severe heat, thirst, and tenesmus, use Bai Tou Weng Tang (Pulsatilla Decoction); for heat-dominant Bai Li, add Xing Ren, Jie Geng to Shao Yao Tang; for damp-dominant Bai Li, use Wei Ling Tang plus Mu Xiang, Sha Ren; for cold-deficiency Bai Li, use Er Chen Tang plus Pao Jiang, Jiao Zhu, Hou Po, Mu Xiang, Sha Ren; for chronic clear dysentery with cold limbs and pain, use Fu Zi Li Zhong Tang; for Qi deficiency with incontinence, use Ren Shen, Huang Qi to tonify Qi, and Yu Mi Ke to secure the intestine; for transition from Bai to Chi Bai Li, use Wu Ji Wan; for heat-dominant Chi Li, add Huang Qin Tan, Huai Hua Tan to Bai Tou Weng Tang; for damp-dominant Chi Li, use Cang Zhu Di Yu Tang; for cold-deficiency worsened by cooling herbs, use Si Jun Zi Tang plus Mu Xiang, Rou Dou Kou, Pao Jiang Tan, Di Yu Tan; for chronic Chi Li with collapse, use Ba Zhen Tang plus Huang Qi, Sheng Ma; for cold limbs and faint pulse, use Fu Zi Li Zhong Tang; for Resting Dysentery, use Zhu Che Wan; for Qi deficiency, add Bu Zhong Yi Qi Tang; a single remedy of Long Yan Rou wrapping Ku Shen Zi is effective. For Resting Dysentery with residual stagnation, use Xiang Lian Wan plus Bai Zhu, Zhi Shi; for cleared stagnation, use Ren Shen, Huang Qi plus Chun Gen Bai Pi, Yu Mi Ke. For dysentery turning to pus-blood, use E Jiao Mei Lian Wan, Huang Lian E Jiao Tang; for deficiency, use Chun Yang Zhen Ren Yang Zang Tang. For thick, bright red Chun Xue Li (heat), use Huang Lian, Huai Jiao, Dan Qin, Bai Shao, Sheng Di, Xi Jiao; for thin, dark, scant blood (cold), use Huang Tu Tang. Frequent fresh bleeding spraying upon defecation is Chang Feng Bian Xue; pus-blood with swollen abdomen and tenderness is Chang Yong. These mimic dysentery but are distinct. Key principles: 1. Avoid warming tonics initially; use draining methods to remove heat. 2. Use gentle draining, not harsh purgation, to avoid damaging Stomach Qi. 3. Do not use exterior-releasing methods, as pathogens are internal. 4. Do not over-drain urine, as it damages fluids. Pediatric dysentery is often caused by dietary indiscretion; astringents are dangerous here.
Attached Formulas
(1) Shao Yao Tang: Treats dysentery with pus-blood, tenesmus, and pain.
Bai Shao (fried, 2 liang), Dang Gui Wei, Huang Lian (fried), Huang Qin (fried, 5 qian each), Bing Lang, Mu Xiang, Gan Cao (roasted, 3 qian each). Take 5 qian, decoct in water.
(2) Mu Xiang Bing Lang Wan: Treats all stagnation, chest/abdominal fullness, and difficult urination/defecation.
Mu Xiang, Bing Qiao, Zhi Qiao (bran-fried), Qing Pi, Chen Pi, Peng E Zhu (roasted/sliced), Huang Lian (fried with Wu Zhu Yu, 1 liang each), Huang Bo (wine-fried), Xiang Fu (vinegar-fried), Da Huang (wine-steamed, 3 liang each), Qian Niu Tou Mo (4 liang). Powder, mix with Xiao Shuo water, pill size of peas.
(3) Zhi Zhu Dao Zhi Wan: Treats Spleen/Stomach trapped by damp-heat, chest/abdominal distension/pain, stagnation diarrhea.
Zhi Shi (5 qian), Bai Zhu (earth-fried), Huang Qin (wine-fried), Fu Ling, Huang Lian (ginger juice-fried, 3 qian each), Ze Xie (2 qian), Shen Qu (5 qian), Da Huang (1 liang). Powder, pill.
(4) Bai Tou Weng Tang: Treats Jueyin heat dysentery, tenesmus, diarrhea, deep-stringy pulse, thirst.
Bai Tou Weng, Huang Lian, Huang Bo, Qin Pi.
(5) Wei Ling Tang: See Chapter 7, Section 3.
(6) Er Chen Tang: See Chapter 6, Section 3.
(7) Fu Zi Li Zhong Tang: See Chapter 5, Section 4.
(8) Wu Ji Wan: Treats Spleen/Stomach dampness, red-white dysentery, abdominal pain, undigested food.
Chuan Huang Lian, Wu Zhu Yu, Bai Shao Yao (equal parts). Powder, pill.
(9) Cang Zhu Di Yu Tang: Treats Spleen channel dampness with bleeding.
Cang Zhu, Di Yu.
(10) Si Jun Zi Tang: See Chapter 3, Section 5.
(11) Ba Zhen Tang: See Section 2 of this chapter.
(12) Zhu Che Wan: Treats Yin deficiency fever, pus-blood dysentery, Resting Dysentery.
E Jiao (crushed, fried with Ge Fen, boiled with vinegar to paste, 15 liang), Huang Lian (1 jin 14 liang), Dang Gui (15 liang), Gan Jiang (10 liang). Powder, mix with vinegar paste, pill size of paulownia seeds, take ~10 pills.
(13) Bu Zhong Yi Qi Tang: See Chapter 4, Section 4.
(14) Xiang Lian Wan: See Chapter 4, Section 1.
(15) E Jiao Mei Lian Wan: Treats Yin deficiency dysentery with night fever.
E Jiao, Huang Lian (3 liang each), Wu Mei Rou, Huang Bo (charred), Chi Shao, Dang Gui (fried), Chi Ling (1.5 liang each), Gan Jiang (1 liang). Powder, pill size of paulownia seeds, take ~10 pills.
(16) Huang Lian E Jiao Tang: Treats chronic dysentery.
Huang Lian (fried), E Jiao (fried), Dang Shen, Bai Zhu, Fu Ling (1 qian each), Gan Jiang (fried), Gan Cao (roasted, 0.5 qian each), Mu Xiang (0.7 qian), Wu Mei (3 pieces). Add Sheng Jiang, Da Zao, decoct in water, take before meals.
(17) Chun Yang Zhen Ren Yang Zang Tang: Treats cold-heat imbalance, red-white dysentery, pus-blood, fish-brain stool, tenesmus, umbilical pain, rectal prolapse, alcohol/damp toxicity bleeding.
Ren Shen, Bai Zhu, Dang Gui, Bai Shao, Mu Xiang (1.6 liang each), Gan Cao, Rou Gui (0.8 liang each), Rou Dou Kou (0.5 liang), Yu Mi Ke (3.6 liang), He Zi Rou (1.2 liang). Take 4 qian, decoct in water.
(18) Huang Tu Tang: Treats hematemesis, epistaxis, melena, menorrhagia, postpartum dysentery.
Zao Zhong Huang Tu, Gan Cao (roasted), Gan Di Huang, Bai Zhu, Fu Zi, E Jiao, Huang Qin.
(19) Initial Dysentery Formula (Self-made): Treats intestinal stagnation, damp-heat steaming, fever, red-white dysentery, abdominal pain.
Chuan Pu, Huang Qin (fried), Bai Shao, Yu Jin, Bing Lang, Qing Pi, Shen Qu, Yin Hua. Add Zuo Jin Wan. Decoct in water. Modifications: Add Jie Geng, Qian Hu for cough; add Dang Gui Tan, Huai Hua Tan, Dan Qin, Yin Hua (charred) for more red than white; remove Chuan Pu, add Lu Gen, Ou Zhi for severe thirst; add Chi Ling, Ze Xie for low urine.
(20) Heat-Dominant Dysentery Formula (Self-made): Treats persistent fever, abdominal pain, nausea.
Huang Lian, Zhu Li Ban Xia, Bai Shao, Shi Lian Rou, Fen Chang Pu, Ling Yang Jiao, Zhi Shi, Dan Qin Tan, Yin Hua Tan, Hua Bing Lang, Xian Pei Lan. Drink Rose Dew if nausea occurs.
(21) Aged Radish Greens: Dried radish greens after frost/rain. For pediatric dysentery, take a few qian, add 1-2 slices of Sheng Jiang, decoct and drink. Effective.