[总诀]后阴肛脱乃为虚，以外俱将实证医。大抵燥金多燥热，即从燥气定权舆。
后阴脱出，屎后良久乃入者，中气下陷故也。宜补中益气汤。
党参（三钱） 白术（三钱） 黄 （三钱） 当归（二钱） 大枣（三枚） 柴胡（一钱） 升麻（二钱
）生姜（三片） 甘草（炙，一钱） 陈皮（一钱）
歌曰∶脱肛气陷用柴升，参术归 姜草增。
大枣陈皮调胃剂，补中益气服之灵。
（伯未按∶升麻宜醋炒，若小儿脱肛，鳖头烧灰敷之。）
后阴疮痔，一切肿痛诸苦者，阳明之血燥也。宜麻仁地榆汤。
麻仁（三钱） 地榆（三钱） 当归（三钱） 白芍（二钱） 杏仁（二钱） 银花（一钱） 黄芩（三
钱） 黄连（一钱） 槐实（二钱） 桔梗（一钱） 生地（三钱） 牛蒡子（二钱）
歌曰∶和血能将痔漏除，槐榆归芍总当储。
芩连牛蒡同麻杏，地桔银花燥热祛。
[总诀]大便无分结与溏，只将寒热细评章。至于痢证尤难治，还望医师妙主张。
大肠不通，口渴而小便黄者，阳明之燥结也。宜加味承气汤。
生地（三钱） 花粉（三钱） 大黄（二钱） 芒硝（一钱） 枳壳（一钱） 浓朴（二钱） 甘草（一
钱）
歌曰∶阳明燥结便难通，口渴硝黄枳朴攻。
甘草兼能清胃火，生津花粉地黄同。
大便不通，口和而小便清者，脾寒气凝结也。宜加味理中汤。
当归（三钱） 白芍（炒，三钱） 人参（二钱） 白术（二钱） 干姜（一钱）
甘草（一钱）
歌曰∶小便清和大便难，归参姜术治脾寒。
再加白芍和甘草，气顺肠通腹自宽。
大便溏泄，其色青白完谷者，脾经寒湿气也。宜加味胃苓汤。
苍术（二钱） 陈皮（二钱） 甘草（炙，一钱） 茯苓（三钱） 桂枝（二钱） 附子（二钱） 大枣
（四枚） 白术（三钱） 党参（二钱） 猪苓（二钱） 泽泻（二钱） 肉蔻（一钱） 干姜（一钱）
白芍（二钱）
歌曰∶大便溏时谷尚完，总宜桂附蔻姜攒。
二苓二术和陈朴，枣芍熬同泽草餐。
（伯未按∶久泻不愈，生葱杵烂，入黄丹为丸如豆大，填脐中。）
大便溏泻，其色浊垢胶腻者，肠中之湿热也。宜清热涤肠汤。
杏仁（三钱） 滑石（二钱） 木通（二钱） 浓朴（二钱） 黄芩（三钱） 车前子（一钱） 栀
子（二钱） 绿豆（三钱） 甘草（二钱） 泽泻（二钱） 生地（三钱） 白芍（三钱） 黄连
（二钱） 当归（二钱）
歌曰∶便溏浊垢法当清，杏芍芩连绿豆烹。
归地黄前同滑泽，甘和栀朴煮汤成。
大便溏泻，必在五更时分者，肾寒而侮脾也。宜加味四神丸。
附子（二钱） 肉蔻（二钱） 白术（三钱） 云苓（三钱） 大枣（四枚） 甘草（炙，一钱）
吴萸（二钱） 干姜（一钱） 人参（三钱） 五味（一钱）
生姜（三片） 粟壳（一钱）
歌曰∶五更泻泄附姜投，参术吴萸甘枣收。
肉蔻味苓姜粟壳，肠鸣无复水幽幽。
大便完谷，食入即刻利出者，肺热而暴注也。宜泻肺止利汤。
黄芩（二钱） 知母（三钱） 黄连（二钱） 大黄（一钱） 石膏（三钱） 桔梗（一钱） 葛根（
二钱） 桑皮（二钱） 人参（二钱） 生地（三钱） 白芍（二钱） 粟壳（一钱）
歌曰∶莫将完谷认虚寒，协热偏宜知地餐。
参芍芩连桑与葛，大黄粟壳桔膏攒。
便泻赤白，下部逼胀难通者，湿热郁为痢也。宜加减芍药汤。
柴胡（一钱） 当归（二钱） 白芍（三钱） 甘草（一钱） 槟榔（二钱） 葛根（三钱） 杏
仁（三钱） 桔梗（二钱） 木香（二钱） 黄芩（二钱） 黄连（二钱） 绿豆（三钱） 银花（一钱） 荷
叶（二钱）
歌曰∶痢症都缘湿热侵，兼红兼白用归芩。
槟榔银葛香柴芍，杏草连荷桔豆寻。
（伯未按∶用陈红茶叶、山楂炭、红白沙糖各三钱，煨姜一钱，极简效。）
便痢纯赤，或见口渴溺赤者，热结在血分也。宜地榆白头汤。
黄连（二钱） 黄芩（二钱） 黄柏（二钱） 秦皮（三钱） 地榆（二钱） 白头翁（三钱） 当归（
二钱） 白芍（三钱） 银花炭（一钱） 丹皮（二钱）
歌曰∶红痢当从血分医，丹秦榆柏芍归随。
白头翁与芩连共，再入银花病自离。
（伯未按∶或用一味白头翁煎服，或用鸦胆子七粒，桂圆肉包，吞服。）
下痢纯白，但见里急下重者，热郁在气分也。宜膏芩清痢散。
黄芩（二钱） 石膏（二钱） 兜铃（二钱） 防己（二钱） 银花（二钱） 知母（三钱） 杏仁（三
钱） 滑石（二钱） 枳壳（一钱） 荷梗（三钱） 芍药（三钱） 甘草（一钱）
歌曰∶痢如纯白治如何，膏杏银防枳与荷。
滑草兜铃知共芍，服之病气渐调和。
下痢禁口，其人饮食不纳者，邪热伤中气也。宜人参开禁汤。
人参（三钱） 黄连（二钱） 黄芩（三钱） 石膏（三钱） 知母（三钱） 连翘（二钱） 木香（一钱
）花粉（三钱） 麦冬（三钱） 桔梗（一钱） 葛根（二钱） 银花（一钱） 荷梗（二钱） 甘草（一
钱）
歌曰∶禁口多缘津液枯，膏冬参粉极滋濡。
银翘葛根芩连共，知桔香荷甘草俱。
大便久痢，诸药不能禁止者，寒热之错杂也，宜姜连四神丸。
干姜（二钱） 黄连（二钱） 乌梅（四枚） 白芍（三钱） 甘草（一钱）
歌曰∶久痢诸汤治不灵，姜连梅芍草梢增。
症兼寒热宜斟酌，漫借经方炫己能。
[General Principle] Prolapse of the posterior orifice (anus) is due to deficiency, yet it is often mistakenly treated as an excess syndrome. Generally, the Metal element associated with dryness tends to manifest as dryness-heat; therefore, treatment should be determined based on the characteristics of dryness-qi.
Prolapse of the posterior orifice (anus), where stool remains outside for a long time after defecation before retracting, is caused by sinking of Middle Qi (Spleen Qi). The appropriate formula is Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Codonopsis Radix (Dangshen, 3 qian), Atractylodis Rhizoma (Baizhu, 3 qian), Astragali Radix (Huangqi, 3 qian), Angelicae Sinensis Radix (Danggui, 2 qian), Jujubae Fructus (Dazao, 3 pieces), Bupleuri Radix (Chaihu, 1 qian), Cimicifugae Rhizoma (Shengma, 2 qian), Zingiberis Rhizoma Recens (Shengjiang, 3 slices), Glycyrrhizae Radix et Rhizoma Preparata (Gancao, 1 qian), Citri Reticulatae Pericarpium (Chenpi, 1 qian).
The verse states: For anal prolapse due to Qi sinking, use Chaihu and Shengma; augment with Dangshen, Baizhu, Danggui, Shengjiang, and Gancao.
Jujubae Fructus and Citri Reticulatae Pericarpium regulate the Stomach; taking Buzhong Yiqi Tang yields effective results.
(Note by Bo: Shengma should be stir-fried with vinegar. For pediatric anal prolapse, apply ash from burnt turtle head externally.)
Sores and hemorrhoids at the posterior orifice, causing all kinds of swelling, pain, and suffering, are due to dryness-heat in the Blood aspect of the Yangming channel. The appropriate formula is Maren Diyutang (Hemp Seed and Sanguisorba Decoction).
Cannabis Semen (Maren, 3 qian), Sanguisorbae Radix (Diyu, 3 qian), Angelicae Sinensis Radix (Danggui, 3 qian), Paeoniae Radix Alba (Baishao, 2 qian), Armeniacae Semen (Xingren, 2 qian), Lonicerae Flos (Yinhua, 1 qian), Scutellariae Radix (Huangqin, 3 qian), Coptidis Rhizoma (Huanglian, 1 qian), Sophorae Fructus (Huaishi, 2 qian), Platycodonis Radix (Jiegeng, 1 qian), Rehmanniae Radix Preparata (Shengdi, 3 qian), Arctii Fructus (Niubangzi, 2 qian).
The verse states: Harmonizing the Blood can eliminate hemorrhoids and fistulas; Huaishi, Diyu, Danggui, and Baishao should always be stocked.
Scutellariae Radix, Coptidis Rhizoma, and Arctii Fructus together with Cannabis Semen and Armeniacae Semen dispel dryness-heat.
[General Principle] Whether stool is constipated or loose, one must carefully evaluate cold and heat patterns. Dysentery is particularly difficult to treat, relying on the physician's skillful judgment.
Obstruction of the Large Intestine, accompanied by thirst and yellow urine, is due to dryness-consolidation in the Yangming channel. The appropriate formula is Jiawei Chengqi Tang (Modified Chengqi Decoction).
Rehmanniae Radix Preparata (Shengdi, 3 qian), Trichosanthis Radix (Huafen, 3 qian), Rhei Radix et Rhizoma (Dahuang, 2 qian), Natrii Sulfas (Mangxiao, 1 qian), Aurantii Fructus Immaturus (Zhiqiao, 1 qian), Magnoliae Officinalis Cortex (Houpo, 2 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian).
The verse states: Yangming dryness-consolidation makes bowel movement difficult; thirst requires Mangxiao and Dahuang combined with Zhiqiao and Houpo to purge.
Glycyrrhizae Radix et Rhizoma also clears Stomach fire; for generating fluids, combine with Trichosanthis Radix and Rehmanniae Radix Preparata.
Bowel obstruction without thirst (mouth feels normal) and clear urine is due to Cold-Qi stagnation in the Spleen. The appropriate formula is Jiawei Lizhong Tang (Modified Lizhong Decoction).
Angelicae Sinensis Radix (Danggui, 3 qian), Paeoniae Radix Alba Stir-fried (Baishao, 3 qian), Ginseng Radix (Renshen, 2 qian), Atractylodis Rhizoma (Baizhu, 2 qian), Zingiberis Rhizoma (Ganjiang, 1 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian).
The verse states: Clear urine and difficult bowel movement are treated with Danggui, Renshen, Ganjiang, and Baizhu for Spleen Cold.
Adding Baishao and Gancao smooths Qi and unblocks the intestines, naturally relieving abdominal distension.
Loose stools with greenish-white color and undigested food indicate Cold-Dampness in the Spleen channel. The appropriate formula is Jiawei Weiling Tang (Modified Weiling Decoction).
Atractylodis Macrocephalae Rhizoma (Cangzhu, 2 qian), Citri Reticulatae Pericarpium (Chenpi, 2 qian), Glycyrrhizae Radix et Rhizoma Preparata (Gancao, 1 qian), Poria (Fuling, 3 qian), Cinnamomi Ramulus (Guizhi, 2 qian), Aconiti Lateralis Radix Preparata (Fuzi, 2 qian), Jujubae Fructus (Dazao, 4 pieces), Atractylodis Rhizoma (Baizhu, 3 qian), Codonopsis Radix (Dangshen, 2 qian), Polyporus (Zhuling, 2 qian), Alismatis Rhizoma (Zexie, 2 qian), Myristicae Semen (Roudoukou, 1 qian), Zingiberis Rhizoma (Ganjiang, 1 qian), Paeoniae Radix Alba (Baishao, 2 qian).
The verse states: When stools are loose and food remains undigested, Guizhi, Fuzi, Roudoukou, and Ganjiang are essential.
Polyporus and Atractylodis Rhizoma (two Ling and two Zhu) combined with Chenpi and Houpo, boiled with Jujubae Fructus, Paeoniae Radix Alba, Alismatis Rhizoma, and Glycyrrhizae Radix.
(Note by Bo: For chronic diarrhea that does not heal, mash fresh scallions, mix with Minium (Huandan), form pills the size of beans, and insert into the umbilicus.)
Loose stools with turbid, greasy, and sticky appearance indicate Damp-Heat in the intestines. The appropriate formula is Qingre Dichang Tang (Clear Heat and Purge Intestines Decoction).
Armeniacae Semen (Xingren, 3 qian), Talcum (Huashi, 2 qian), Akebiae Caulis (Mutong, 2 qian), Magnoliae Officinalis Cortex (Houpo, 2 qian), Scutellariae Radix (Huangqin, 3 qian), Plantaginis Semen (Cheqianzi, 1 qian), Gardeniae Fructus (Zhizi, 2 qian), Phaseoli Radiatus (Lvdou, 3 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 2 qian), Alismatis Rhizoma (Zexie, 2 qian), Rehmanniae Radix Preparata (Shengdi, 3 qian), Paeoniae Radix Alba (Baishao, 3 qian), Coptidis Rhizoma (Huanglian, 2 qian), Angelicae Sinensis Radix (Danggui, 2 qian).
The verse states: For loose, turbid, and greasy stools, clearing heat is indicated; Xingren, Baishao, Huangqin, Huanglian, and Lvdou are cooked.
Angelicae Sinensis Radix, Rehmanniae Radix Preparata, and Plantaginis Semen together with Talcum and Alismatis Rhizoma, harmonized with Gancao, Zhizi, and Houpo, make the decoction.
Loose stools occurring specifically at dawn (fifth watch) indicate Kidney Cold invading the Spleen. The appropriate formula is Jiawei Sishen Wan (Modified Four Spirits Pill).
Aconiti Lateralis Radix Preparata (Fuzi, 2 qian), Myristicae Semen (Roudoukou, 2 qian), Atractylodis Rhizoma (Baizhu, 3 qian), Poria (Yunling, 3 qian), Jujubae Fructus (Dazao, 4 pieces), Glycyrrhizae Radix et Rhizoma Preparata (Gancao, 1 qian), Evodiae Fructus (Wuyu, 2 qian), Zingiberis Rhizoma (Ganjiang, 1 qian), Ginseng Radix (Renshen, 3 qian), Schisandrae Fructus (Wuweizi, 1 qian), Zingiberis Rhizoma Recens (Shengjiang, 3 slices), Papaveris Capsula (Yangsuke, 1 qian).
The verse states: For dawn diarrhea, administer Fuzi and Ganjiang; Renshen, Baizhu, Wuyu, Gancao, and Dazao gather and secure.
Myristicae Semen, Schisandrae Fructus, Poria, Zingiberis Rhizoma Recens, and Papaveris Capsula stop intestinal murmurs and watery sounds.
Undigested food in stool, expelled immediately after eating, indicates violent diarrhea due to Lung Heat. The appropriate formula is Xiefei Zhili Tang (Drain Lung and Stop Diarrhea Decoction).
Scutellariae Radix (Huangqin, 2 qian), Anemarrhenae Rhizoma (Zhimu, 3 qian), Coptidis Rhizoma (Huanglian, 2 qian), Rhei Radix et Rhizoma (Dahuang, 1 qian), Gypsum Fibrosum (Shigao, 3 qian), Platycodonis Radix (Jiegeng, 1 qian), Puerariae Radix (Gegen, 2 qian), Mori Cortex (Sangpi, 2 qian), Ginseng Radix (Renshen, 2 qian), Rehmanniae Radix Preparata (Shengdi, 3 qian), Paeoniae Radix Alba (Baishao, 2 qian), Papaveris Capsula (Yangsuke, 1 qian).
The verse states: Do not mistake undigested food for Deficiency-Cold;協热 (collateral heat) diarrhea suits Anemarrhenae Rhizoma and Rehmanniae Radix Preparata.
Ginseng Radix, Paeoniae Radix Alba, Scutellariae Radix, Coptidis Rhizoma, Mori Cortex, and Puerariae Radix, along with Rhei Radix et Rhizoma, Papaveris Capsula, Platycodonis Radix, and Gypsum Fibrosum.
Stools mixed with red and white mucus, with tenesmus and lower abdominal fullness, indicate Dysentery due to Damp-Heat stagnation. The appropriate formula is Jiawei Shaoyao Tang (Modified Peony Decoction).
Bupleuri Radix (Chaihu, 1 qian), Angelicae Sinensis Radix (Danggui, 2 qian), Paeoniae Radix Alba (Baishao, 3 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian), Arecae Semen (Binglang, 2 qian), Puerariae Radix (Gegen, 3 qian), Armeniacae Semen (Xingren, 3 qian), Platycodonis Radix (Jiegeng, 2 qian), Aquilariae Lignum Resinatum (Muxiang, 2 qian), Scutellariae Radix (Huangqin, 2 qian), Coptidis Rhizoma (Huanglian, 2 qian), Phaseoli Radiatus (Lvdou, 3 qian), Lonicerae Flos (Yinhua, 1 qian), Nelumbinis Folium (Heye, 2 qian).
The verse states: Dysentery arises from Damp-Heat invasion; when red and white are present, use Angelicae Sinensis Radix and Scutellariae Radix.
Arecae Semen, Lonicerae Flos, Puerariae Radix, Aquilariae Lignum Resinatum, Bupleuri Radix, and Paeoniae Radix Alba; Armeniacae Semen, Glycyrrhizae Radix et Rhizoma, Coptidis Rhizoma, Nelumbinis Folium, Platycodonis Radix, and Phaseoli Radiatus are sought.
(Note by Bo: Use aged black tea leaves, Charred Crataegi Fructus, and red/white rock sugar, each 3 qian, with stir-fried ginger 1 qian; this is extremely simple and effective.)
Pure red dysentery, or accompanied by thirst and red urine, indicates Heat binding in the Blood aspect. The appropriate formula is Diyutang Bai Touweng Tang (Sanguisorba and Pulsatilla Decoction).
Coptidis Rhizoma (Huanglian, 2 qian), Scutellariae Radix (Huangqin, 2 qian), Phellodendri Cortex (Huangbai, 2 qian), Fraxini Cortex (Qinpi, 3 qian), Sanguisorbae Radix (Diyu, 2 qian), Pulsatillae Radix (Baitouweng, 3 qian), Angelicae Sinensis Radix (Danggui, 2 qian), Paeoniae Radix Alba (Baishao, 3 qian), Carbonized Lonicerae Flos (Yinhua Tan, 1 qian), Moutan Cortex (Danpi, 2 qian).
The verse states: Red dysentery should be treated from the Blood aspect; follow with Moutan Cortex, Fraxini Cortex, Sanguisorbae Radix, Phellodendri Cortex, Paeoniae Radix Alba, and Angelicae Sinensis Radix.
Pulsatillae Radix combined with Scutellariae Radix and Coptidis Rhizoma, plus Carbonized Lonicerae Flos, will cause the disease to depart.
(Note by Bo: Alternatively, decoct single-herb Pulsatillae Radix, or swallow seven seeds of Brucina (Yadanzi) wrapped in Longan aril.)
Pure white dysentery, characterized only by tenesmus and heaviness in the lower abdomen, indicates Heat stagnation in the Qi aspect. The appropriate formula is Gaoqin Qingli San (Gypsum and Scutellaria Dysentery Powder).
Scutellariae Radix (Huangqin, 2 qian), Gypsum Fibrosum (Shigao, 2 qian), Stemonae Radix (Douling, 2 qian), Stephaniae Tetrandrae Radix (Fangji, 2 qian), Lonicerae Flos (Yinhua, 2 qian), Anemarrhenae Rhizoma (Zhimu, 3 qian), Armeniacae Semen (Xingren, 3 qian), Talcum (Huashi, 2 qian), Aurantii Fructus Immaturus (Zhiqiao, 1 qian), Nelumbinis Costopetiolus ( Hegeng, 3 qian), Paeoniae Radix (Shaoyao, 3 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian).
The verse states: How to treat pure white dysentery? Use Gypsum, Armeniacae Semen, Lonicerae Flos, Stephaniae Tetrandrae Radix, Aurantii Fructus Immaturus, and Nelumbinis Costopetiolus.
Talcum, Glycyrrhizae Radix et Rhizoma, Stemonae Radix, Anemarrhenae Rhizoma, and Paeoniae Radix together; upon ingestion, pathogenic Qi gradually harmonizes.
Dysentery with inability to eat (forbidden mouth), where the patient cannot take food, indicates Evil Heat damaging Middle Qi. The appropriate formula is Renshen Kaijin Tang (Ginseng Opening Forbidden Decoction).
Ginseng Radix (Renshen, 3 qian), Coptidis Rhizoma (Huanglian, 2 qian), Scutellariae Radix (Huangqin, 3 qian), Gypsum Fibrosum (Shigao, 3 qian), Anemarrhenae Rhizoma (Zhimu, 3 qian), Forsythiae Fructus (Lianqiao, 2 qian), Aquilariae Lignum Resinatum (Muxiang, 1 qian), Trichosanthis Radix (Huafen, 3 qian), Ophiopogonis Radix (Maidong, 3 qian), Platycodonis Radix (Jiegeng, 1 qian), Puerariae Radix (Gegen, 2 qian), Lonicerae Flos (Yinhua, 1 qian), Nelumbinis Costopetiolus (Hegeng, 2 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian).
The verse states: Forbidden mouth dysentery is mostly due to fluid depletion; Gypsum, Ophiopogonis Radix, Ginseng Radix, and Trichosanthis Radix provide extreme nourishment.
Lonicerae Flos, Forsythiae Fructus, Puerariae Radix, Scutellariae Radix, and Coptidis Rhizoma together; Anemarrhenae Rhizoma, Platycodonis Radix, Aquilariae Lignum Resinatum, Nelumbinis Costopetiolus, and Glycyrrhizae Radix et Rhizoma are all included.
Chronic dysentery that resists all other medications is due to a mixture of Cold and Heat. The appropriate formula is Jianglian Sishen Wan (Ginger and Coptidis Four Spirits Pill).
Zingiberis Rhizoma (Ganjiang, 2 qian), Coptidis Rhizoma (Huanglian, 2 qian), Pruni Mume Fructus (Wumei, 4 pieces), Paeoniae Radix Alba (Baishao, 3 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian).
The verse states: Various decoctions fail for chronic dysentery; add Ganjiang, Huanglian, Pruni Mume Fructus, Paeoniae Radix Alba, and Glycyrrhizae Radix et Rhizoma tip.
When symptoms involve both Cold and Heat, careful consideration is needed; do not casually borrow classic formulas to show off one's ability.