天津施××，五十六岁，得噤口痢证。
病因 举家数口，寄食友家不能还乡，后友家助以资斧令还乡，道路又复不通，日夜焦思，频
动肝火，时当孟秋，心热贪凉，多食瓜果，致患下痢。
证候 一日夜下痢十五六次，多带鲜血，后重甚剧，腹偶觉疼即须入厕，便后移时疼始稍愈，
病已五日，分毫不能进食，唯一日之间强饮米汤数口。其脉左部弦而硬，右部弦而浮，其
搏五至，心中发热常觉恶心。
诊断 此肝火炽盛，肝血虚损，又兼胃气挟热上逆，是以下痢甚
剧，而又噤口不食也。当治以滋阴、清热、平肝、降胃之品。
处方 生杭芍（一两） 生怀山药（一两） 滑石（七钱） 白头翁（五钱）
秦皮（三钱） 碎竹茹（三钱） 甘草（三钱） 鸦胆子（成实者五十粒去皮）
先用白糖水囫囵送服鸭胆子仁，再将余药煎汤一大盅，温服下。
复诊 将药如法服两剂，痢中已不见鲜血，次数减去三分之二。其脉左部较前和平，右部则
仍有浮弦之象，仍然不能饮食，心中仍然发热，然不若从前之恶心，此宜用药再清其胃腑必然能食矣。
处方 生怀山药（两半） 生石膏（两半捣细） 生杭芍（六钱） 白头翁（四钱）
秦皮（二钱） 甘草（二钱）
共煎汤一大盅，分两次温服。
效果 将药煎服一剂，即能进食，痢已不见，变作泄泻，日四五
次，俾用生怀山药细末煮作粥，少调以白糖服之，三日全愈。
或问 石膏为治外感实热之药，今此证未夹杂外感，何以方中亦用之？答曰∶石膏为治阳明胃
腑有实热者之圣药，初不论其为外感非外感也。盖阳明胃气以息息下行为顺，若有热则其气多不下行
而上逆，因其胃气挟热上逆，所以多恶心呕吐不思饮食，若但知清其热而不知降其气，治之恒不易见效。
惟石膏性凉质重（虽煎为汤，仍有沉重之力），其凉也能清实热，其重也能镇气逆，是以凡胃气
挟实热上逆令人不思饮食者，服之可须臾奏效。若必谓石膏专治外感实热，不可用治内伤实热，则近
代名医徐氏、吴氏医案中皆有重用石膏治愈内伤实热之案，何妨取以参观乎？
Shi XX from Tianjin, aged fifty-six, suffered from Jin Kou Li (dysentery with inability to eat).
Etiology: The whole family, consisting of several members, was staying as guests at a friend's house and could not return home. Later, the friend provided funds for their return, but the roads were again impassable. Day and night, they were anxious and worried, frequently stirring up Liver Fire (pathogenic fire arising from Liver dysfunction). It was early autumn; due to internal heat and a desire for coolness, he consumed many melons and fruits, which led to dysentery.
Symptoms: He had fifteen to sixteen episodes of dysenteric diarrhea per day and night, mostly accompanied by fresh blood. The tenesmus (urgency and pain in defecation) was extremely severe. Whenever his abdomen felt occasional pain, he had to rush to the toilet; the pain would only slightly subside some time after defecation. The illness had lasted five days, during which he could not eat anything at all, managing only to force down a few mouthfuls of rice gruel throughout the day. His pulse on the left side was wiry and hard, while on the right side it was wiry and floating. The pulse rate was five beats per respiration (approximately 90-100 bpm). He experienced heat in the heart region and frequent nausea.
Diagnosis: This is a case of blazing Liver Fire and deficiency of Liver Blood, complicated by Stomach Qi rebelling upward carrying heat. Hence, the dysentery is severe, accompanied by the symptom of being unable to eat (Jin Kou). Treatment should employ herbs that nourish Yin, clear Heat, calm the Liver, and direct Stomach Qi downward.
Prescription: Raw Hang Shao Yao (Paeoniae Radix Alba), 1 liang; Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), 1 liang; Hua Shi (Talcum), 7 qian; Bai Tou Weng (Pulsatillae Radix), 5 qian; Qin Pi (Fraxini Cortex), 3 qian; Sui Zhu Ru (Bambusae Caulis in Taenia), 3 qan; Gan Cao (Glycyrrhizae Radix et Rhizoma), 3 qian; Ya Dan Zi (Brucea Fructus), 50 ripe seeds, peeled.
First, swallow the Ya Dan Zi kernels whole with water mixed with white sugar. Then, decoct the remaining herbs in one large bowl of water, and take warm.
Follow-up Visit: After taking two doses according to the method, no fresh blood was seen in the stool, and the frequency decreased by two-thirds. The pulse on the left side became more peaceful compared to before, but the right side still showed floating and wiry characteristics. He still could not eat, and heat in the heart region persisted, though the nausea was less severe than before. It is appropriate to use medication to further clear Heat from the Stomach Fu organ; eating capacity will likely be restored.
Prescription: Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), 1.5 liang; Raw Shi Gao (Gypsum Fibrosum), 1.5 liang, crushed fine; Raw Hang Shao Yao (Paeoniae Radix Alba), 6 qian; Bai Tou Weng (Pulsatillae Radix), 4 qian; Qin Pi (Fraxini Cortex), 2 qian; Gan Cao (Glycyrrhizae Radix et Rhizoma), 2 qian.
Decoct together in one large bowl of water, divide into two doses, and take warm.
Outcome: After taking one dose, he was able to eat. The dysentery disappeared, transforming into loose stools (diarrhea), occurring four or five times a day. He was instructed to consume congee made from finely powdered Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) with a small amount of white sugar. He recovered completely within three days.
Inquiry: Shi Gao (Gypsum Fibrosum) is a herb used to treat Excess Heat from external contraction. Since this case does not involve external contraction, why is it included in the formula?
Reply: Shi Gao (Gypsum Fibrosum) is the supreme herb for treating Excess Heat in the Yangming Stomach Fu organ, regardless of whether it stems from external or internal causes. Generally, Yangming Stomach Qi flows smoothly downward with each breath. If Heat is present, the Qi tends not to descend but rebels upward. Because Stomach Qi carries Heat upward, it often causes nausea, vomiting, and loss of appetite. If treatment focuses solely on clearing Heat without directing the rebellious Qi downward, efficacy is often poor. Shi Gao (Gypsum Fibrosum) is cold in nature and heavy in substance (even when decocted, it retains its heavy property). Its coldness clears Excess Heat, and its heaviness anchors rebellious Qi. Therefore, for cases where Stomach Qi carrying Excess Heat rebels upward causing anorexia, administration yields rapid results. If one insists that Shi Gao (Gypsum Fibrosum) is exclusively for Excess Heat from external contraction and cannot be used for Excess Heat from internal injury, one may refer to medical records of renowned modern physicians Xu and Wu, who successfully treated Excess Heat from internal injury using high doses of Shi Gao (Gypsum Fibrosum). Why not consult these cases?