初痢，身热脉浮者，可解表；身热脉沉者，可攻下。久痢，身热脉虚者，正虚可治；身热脉大者，邪盛难
医。（《证治汇补》）
选案
朱孔阳，年二十五岁，夏月奔走日中，暑湿合内郁之火，致成痢疾，昼夜一、二百次，但饮水而不进食，
痛甚，肛如火烙，躁扰无奈，诊脉弦紧劲急，不为指挠。谓曰∶此证一团毒火，蕴结肠胃之内，其势如焚，若
二、三日外，肠胃朽腐矣。以大黄四两，黄连、甘草各二两煎服，人事稍安；少顷仍前躁扰，一昼夜服至二十
余碗。次日脉势稍柔，但用急法，不用急药，改用生地、麦冬各四两研汁，花粉、丹皮、赤芍、甘草各一两，
煎成和汁，大碗咽之。以其来势暴烈，一身津液从之奔竭，若待痢止，然后生津养血，则枯槁一时难回。今脉
势既减，火邪俱退，不治痢而痢自止，岂可泥润滞之药而不用乎？○叶茂卿幼男，病痢噤口，发热十余日，哕
声不断，诊其关脉上涌而无根。谓曰∶此非噤口，乃胃气将绝也。噤口痢者，虚热在胃，壅遏不宣，故觉其饱
而不思食，治宜补虚清热两法。此因苦寒药伤，不能容食，惟有温补一法。以理中汤连投二剂，不一时，痢下
十余行。茂卿恐药不对证，余曰∶吾意在先救胃气之绝，原不治痢，即治痢，人之大小肠盘叠腹中甚远，虽神
丹不能遽变其粪，今藉
药方催之速下，正为美事，焉可疑之？仍与前药连服两日，人事大转，思食不哕，痢势亦减，四日后止便糟粕，
以补中益气汤调理而安。○浦君艺，病痢，初起有表邪未散，误用参、术固表，使邪气深入；又误服黄连凉解，
大黄推荡，治经月余，胃气不运，下痢昼夜百余行。一夕呕出从前黄连汁三、五碗，呕至二、三次，胃肠打为
一家，幽门、阑门洞开无阻，不但粥饮直出，即人参浓膏才吞入喉，已 从肠奔下。急以四君子汤煎调石脂、余
粮二末与服，痢势少衰，但腹中痛不可忍。君艺曰∶前此下痢虽多，然尚不痛，服此药痛增，未可再服。余曰∶
此正通则不痛，痛则不通之说也。仍以前药再进，势已大减，更倍茯苓，十余剂全安。○周信川，年七十余，
平素体坚，秋月病痢，久成休息，昼夜十余行，面目浮肿，肌肤晦黑，诊脉沉数有力。谓曰∶此阳邪陷入阴之
证，以法治之可愈。用人参败毒散煎好，浓被围椅坐定，置火其下，更以布条卷成鹅蛋状，垫塞肛门，使内气
不得下走，然后服药；良久，觉皮间津润，再溉以滚汤，教令努力忍便，不得移身，约二时之久，病者心躁不
可忍，令连被卧于床上，是晚止下痢二次；改用补中益气汤，一昼夜只下三次，不旬日而愈。盖内陷之邪，欲
提之转从表出，不施逆流挽舟之法，其趋下之势，何所底止哉？（喻嘉言）
太常边华泉，患痢，呕吐不食，腹痛后重，服下药腹痛益甚，自汗发热，昏愦脉大。余以为胃气复伤，阳
气虚寒，脱陷也。以参、术各一两，炙草、炮姜各三钱，升麻一钱，一剂而苏。再用补中益气汤加炮姜，二剂
而愈。（薛立斋）
一人阴虚发热，下痢不食，郭友三用猪苓汤、黄连阿胶汤治痊。二方并非痢门中药，用之辄效者何也？曰∶
世患阴虚下痢者颇多，古人从未阐发，其证未有不发热，不烦渴，不畏食，不见红，不夜甚者。盖阴气内亡，
势必虚阳外扰，故治阴虚之痢，凉血者死，攻积者死，补气者亦死；惟清解热毒，兼滋阴血，庶可
保全。此仿仲景少阴例中救热存阴之法，与《金匮》治产后下痢虚极，用白头翁加甘草阿胶汤，不殊也。（《兼证析义》）
马厨，病大发寒热似疟，痢兼红白，日夜八十余行，腹痛恶心，神倦脉大，面红汗淋。病由厨间躁热，多
食瓜果，晚又过饮御内，寝于檐下，次日即病。虽得其情，尚未融通一治法，沉思得一背水阵，用参、术、石
膏、滑石各五钱，知母、炮姜各三钱，附子、炙甘草各二钱，作一剂付之。嘱曰∶服药后倘得一睡，阴阳和则
汗可敛，而寒热呕恶可止也。明日来言，服药即睡，痢减，汗吐全无，脉亦敛矣。再用参、术、石膏、白芍、
滑石各三钱，姜、桂、知母各二钱，炙甘草、附子各一钱，服后疟止，痢又减半，饮食渐进，神气渐转；改用
白芍五钱，参、术、滑石各二钱，甘草、陈皮、姜、桂各一钱，三剂而痢全止，食加就安矣。或问寒热均投，
此为何证？而剂何名？余曰∶此滑公所谓混沌汤也。夏伤于暑，白虎、益元，皆解暑之剂。瓜果寒凉伤其中气；
酒后御色损其下元。附子理中，所以温中补下。《经》云∶实者，邪气实也。故以白虎、益元应之。虚者，正
气虚也。故以理中应之。若以寒热均用为疑，则仲景泻心汤，既用大黄、黄连，又用干姜、附子，何哉？盖假
对假，真对真也。（《赤水玄珠》）
附方
至圣丹 治休息久痢神效，并治便血。鸦胆子。此味出闽省云贵，本草未收。其味至苦，去壳取仁，用桂
圆肉包紧，捻如丸药状，空腹米饮吞下，以食压之。三、五岁儿每服二十粒，十余岁者三十粒，大人四十九粒，
两三服即愈，除根不发。
黄金汤 治疫痢。黄土、金银花、黑豆、生甘草、茯苓、扁豆、扁豆花、谷芽、白芍、五谷虫、生姜。
开噤散 治噤口痢。人参、黄连、茯苓、冬瓜仁、陈皮、丹参、石莲子、石菖蒲、陈米、荷叶蒂。
敷脐方 治痢证食入即呕。用面作饼，炙熟分作二片，以一
片中心挖空，另用木鳖子三个，去壳捣烂，加麝香少许，填饼空中，贴于脐下，软帛系定，外用软鞋底熨之，
腹中作响，喉中有香气，即思食。
又方 治痢证胃中火盛，饮食不下，恶心呕吐。用海蜇头浸酱中，周时取出，洗净切碎，再用藕丝同拌，
米醋洋糖少许和匀，食此恶吐即止。
[Medical Discourse on Dysentery]
In the initial stage of dysentery, if there is fever and a floating pulse (Fú Mài), exterior-releasing methods can be used; if there is fever and a deep pulse (Chén Mài), purgative methods can be used. In chronic dysentery, if there is fever and a deficient pulse (Xū Mài), it indicates deficiency of healthy Qi (Zhèng Qì) but is treatable; if there is fever and a large pulse (Dà Mài), it indicates excess of pathogenic factors and is difficult to treat. (From *Zhengzhi Huibu*)
[Selected Medical Cases]
Zhu Kongyang, aged twenty-five, ran in the sun during summer. Summer-heat and dampness combined with internally stagnant fire, leading to dysentery. He had one or two hundred bowel movements per day and night, drank only water and ate nothing, suffered severe abdominal pain, his anus felt like burning烙铁 (branding iron), and he was restless and unbearable. His pulse was wiry, tight, forceful, and urgent, resisting finger pressure. I said: This condition involves a mass of toxic fire accumulating within the intestines and stomach, its momentum like burning. If not treated within two or three days, the intestines and stomach will rot. I prescribed four liang of Da Huang (Rhubarb Root and Rhizome), two liang each of Huang Lian (Coptis Rhizome) and Gan Cao (Licorice Root), decocted and administered. The patient's mental state calmed slightly; however, after a short while, restlessness returned. Over twenty bowls were consumed in one day and night. The next day, the pulse momentum softened slightly. We adopted an urgent strategy but did not use harsh medicines. Instead, we used Si Di (Rehmannia Root) and Mai Dong (Ophiopogon Tuber), four liang each, ground for juice; Hua Fen (Trichosanthes Root), Dan Pi (Moutan Bark), Chi Shao (Red Peony Root), and Gan Cao (Licorice Root), one liang each. These were decocted and mixed with the juice, taken in large bowls. Because the onset was violent, the body's fluids rushed and depleted. If we waited until the dysentery stopped to generate fluids and nourish blood, the withered state would be hard to restore at once. Now that the pulse momentum has decreased and fire pathogens have retreated, treating the dysentery specifically is unnecessary as it stops naturally. How can we stick to the taboo against using moistening/stagnation-relieving drugs? ○ Ye Maoqing's young son suffered from dysentery complicated by Jin Kou Li (Jin Kou Dysentery - inability to eat due to dysentery). He had a fever for over ten days and constant hiccups. Palpating the Guan position (Cun-Guan-Chi pulse positions), the pulse surged upward without root. I said: This is not ordinary Jin Kou Dysentery, but impending exhaustion of Stomach Qi (Wei Qi). Jin Kou Dysentery is caused by deficient heat in the stomach, obstructing and failing to diffuse, causing a feeling of fullness and loss of appetite. Treatment should involve both tonifying deficiency and clearing heat. However, this case resulted from damage by bitter-cold medicines, making the stomach unable to accept food. Only warming and tonifying methods remain. I administered Li Zhong Tang (Regulate the Middle Decoction) continuously for two doses. Soon, he had more than ten bowel movements. Maoqing feared the medicine was incorrect. I said: My intent was first to save the exhaustion of Stomach Qi, not originally to treat the dysentery. Even if treating dysentery, the small and large intestines are coiled deep in the abdomen; even divine medicine cannot instantly change feces. Now, using medicine to urge rapid discharge is actually a good thing, why doubt it? Continue the previous medicine for two more days. The patient's condition improved significantly, he desired food, hiccupping stopped, and dysentery decreased. After four days, stool normalized. He was regulated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and recovered. ○ Pu Junyi suffered from dysentery. Initially, exterior pathogens had not dispersed. Mistakenly using Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) to consolidate the exterior allowed pathogens to penetrate deeply. Then, mistakenly taking Huang Lian (Coptis Rhizome) for cooling resolution and Da Huang (Rhubarb Root and Rhizome) for purging, treatment lasted over a month. Stomach Qi failed to transport, resulting in over a hundred bowel movements per day and night. One night, he vomited three to five bowls of the previously ingested Huang Lian decoction. After two or three vomits, the stomach and intestines became one, the pylorus and ileocecal valve opened widely without obstruction. Not only porridge and drinks flowed out directly, but even thick Ginseng paste, once swallowed, rushed down through the intestines. Urgently, I prepared Si Jun Zi Tang (Four Gentlemen Decoction) decocted with mixed powders of Shi Zhi (Hematite) and Yu Liang (Illite Clay) for him to take. The dysentery momentum subsided slightly, but abdominal pain became unbearable. Junyi said: Although I had many bowel movements before, there was no pain. Taking this medicine increased the pain; do not take it again. I said: This illustrates the principle that "patency prevents pain, pain indicates blockage." Administer the previous medicine again. The momentum reduced greatly. Increase Fu Ling (Poria) dosage. After more than ten doses, complete recovery occurred. ○ Zhou Xinchuan, over seventy years old, usually robust, contracted dysentery in autumn, which became Xiuxi Li (Resting Dysentery - intermittent chronic dysentery), with ten-plus bowel movements daily. His face and eyes were swollen, skin dark and dull. Pulse was deep, rapid, and forceful. I said: This is Yang pathogens sinking into Yin levels. With proper treatment, it can be cured. Decoct Ren Shen Bai Du San (Ginseng Powder to Overcome Toxins). Have the patient sit firmly wrapped in thick blankets on a chair. Place a fire below the chair. Roll cloth strips into egg shapes and plug the anus to prevent internal Qi from descending. Then administer the medicine. After a long time, feel moisture on the skin. Pour boiling water over him. Instruct him to exert effort to retain stool, not moving his body, for about two hours. The patient became intolerably restless. Let him lie on the bed wrapped in blankets. That night, only two bowel movements occurred. Switch to Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Only three bowel movements in a day and night. Recovered in less than ten days. The internal-sunk pathogens want to be lifted and emerge from the exterior. Without employing the "Retreating the Counter-Current to Pull the Boat Upstream" method, where would the downward momentum end? (Yu Jiayan)
Taishe Qing Bian Huaquan suffered from dysentery, vomiting, inability to eat, abdominal pain with tenesmus. After taking purgatives, abdominal pain worsened, spontaneous sweating, fever, confusion, and large pulse. I believed this was further injury to Stomach Qi, Yang Qi deficiency and cold, sinking and collapsing. Use Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome), one liang each; Zhi Gan Cao (Prepared Licorice Root) and Pao Jiang (Prepared Ginger), three qian each; Sheng Ma (Cimicifuga Rhizome), one qian. One dose revived him. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Pao Jiang (Prepared Ginger) for two doses, and he recovered. (Xue Lizhai)
One person with Yin deficiency and fever, suffering from dysentery and inability to eat, was cured by Guo Yousan using Zhu Ling Tang (Polyporus Decoction) and Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction). These two formulas are not typically used in dysentery cases, yet they were effective. Why? Answer: Many people suffer from Yin-deficiency dysentery, but ancients never elucidated it. Symptoms invariably include fever, vexation and thirst, aversion to eating, red blood in stool, and worsening at night. Because Yin Qi is lost internally, deficient Yang inevitably disturbs externally. Therefore, treating Yin-deficiency dysentery with blood-cooling methods leads to death; with purging accumulation methods leads to death; with Qi-tonifying methods also leads to death. Only clearing and resolving heat toxins, while simultaneously nourishing Yin and blood, can preserve life. This imitates Zhang Zhongjing's method in the Shaoyin chapter of saving heat and preserving Yin. It is no different from *Jingui Yaolue*'s treatment of extreme postpartum deficiency with dysentery using Bai Tou Weng Tang (Pulsatilla Decoction) plus Gan Cao (Licorice Root) and E Jiao (Donkey-Hide Gelatin). (From *Jianzheng Xiyi*)
Chef Ma suffered from severe chills and fever resembling malaria, dysentery with red and white pus/blood, eighty-plus bowel movements daily, abdominal pain, nausea, fatigue, large pulse, red face, and profuse sweating. Cause: Working in a hot kitchen, eating much fruit/raw vegetables, drinking excessively and engaging in sexual activity at night, sleeping under the eaves. Illness started the next day. Although the cause was known, the treatment method was unclear. After deep thought, I devised a "desperate battle array" formula: Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Shi Gao (Gypsum Fibrosum), Hua Shi (Talcum), five qian each; Zhi Mu (Anemarrhenae Rhizome), Pao Jiang (Prepared Ginger), three qian each; Fu Zi (Aconite Lateral Root), Zhi Gan Cao (Prepared Licorice Root), two qian each. One dose administered. Instruction: If sleep follows medication, Yin and Yang harmonize, sweat converges, and chills/fever/nausea stop. Next day report: Slept immediately after taking medicine. Dysentery reduced, sweating/vomiting ceased completely, pulse converged. Use Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Shi Gao (Gypsum Fibrosum), Bai Shao (White Peony Root), Hua Shi (Talcum), three qian each; Jiang (Ginger), Gui (Cinnamon Twig), Zhi Mu (Anemarrhenae Rhizome), two qian each; Zhi Gan Cao (Prepared Licorice Root), Fu Zi (Aconite Lateral Root), one qian each. After taking, malaria stopped, dysentery halved, diet gradually increased, spirit recovered. Switch to Bai Shao (White Peony Root), five qian; Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Hua Shi (Talcum), two qian each; Gan Cao (Licorice Root), Chen Pi (Citrus Reticulatae Pericarpium), Jiang (Ginger), Gui (Cinnamon Twig), one qian each. Three doses, dysentery completely stopped, diet increased, stable. Someone asked: Chills and heat treated together, what syndrome is this? What is the formula name? I said: This is what Hua Shou called Hun Dun Tang (Chaos Decoction). Summer injury by summer-heat: Bai Hu Tang (White Tiger Decoction) and Yi Yuan San (Benefit Origin Powder) are summer-heat resolving agents. Cold/raw fruits damaged Middle Qi; alcohol and sex damaged Lower Yuan. Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) warms the middle and tonifies the lower. *Jing* says: Excess refers to pathogenic excess. Hence Bai Hu Tang and Yi Yuan San address it. Deficiency refers to healthy Qi deficiency. Hence Li Zhong Tang addresses it. If doubting the use of cold and heat together, consider Zhang Zhongjing's Xie Xin Tang (Drain the Epigastrium Decoction), which uses Da Huang (Rhubarb Root and Rhizome) and Huang Lian (Coptis Rhizome) alongside Gan Jiang (Dried Ginger) and Fu Zi (Aconite Lateral Root). Why? It is false matching false, true matching true. (From *Chishui Xuanzhu*)
[Attached Formulas]
Zhi Sheng Dan (Supreme Holy Pill) Highly effective for resting chronic dysentery, also treats hematochezia. Ya Dan Zi (Brucea Fructus). This herb originates from Fujian, Yunnan, Guizhou, not recorded in Materia Medica. Taste extremely bitter. Remove shell, take kernel. Wrap tightly in Long Yan Rou (Longan Aril), roll into pill shape. Swallow on empty stomach with rice water, press with food. Children aged 3-5: 20 pills per dose. Teenagers: 30 pills. Adults: 49 pills. Two or three doses cure, eliminating root cause preventing recurrence.
Huang Jin Tang (Golden Decoction) Treats epidemic dysentery. Huang Tu (Yellow Earth), Jin Yin Hua (Lonicerae Japonicae Flos), Hei Dou (Black Soybean), Sheng Gan Cao (Raw Licorice Root), Fu Ling (Poria), Bian Dou (Lablab Seed), Bian Dou Hua (Lablab Flower), Gu Ya (Sprouted Grain), Bai Shao (White Peony Root), Wu Gu Chong (Ground Beetle), Sheng Jiang (Fresh Ginger).
Kai Jin San (Open the Lock Powder) Treats Jin Kou Dysentery. Ren Shen (Ginseng Root), Huang Lian (Coptis Rhizome), Fu Ling (Poria), Dong Gua Ren (Winter Melon Seed), Chen Pi (Citrus Reticulatae Pericarpium), Dan Shen (Salvia Miltiorrhizae Radix et Rhizoma), Shi Lian Zi (Nelumbinis Plumula), Shi Chang Pu (Acori Tatarinowii Rhizoma), Chen Mi (Old Rice), He Ye Di (Lotus Leaf Stalk Base).
Fu Qi Fang (Umbilical Application Formula) Treats dysentery with immediate vomiting upon eating. Make flour cake, roast熟 (cooked), divide into two pieces. Hollow out center of one piece. Take Mu Bie Zi (Strychnos Nux-vomica Seed), remove shell, pound into paste. Add a little She Xiang (Musk). Fill hollow center of cake. Apply to lower umbilicus. Secure with soft silk. Iron externally with soft shoe sole. Abdomen makes sounds, fragrance in throat, desire for food arises.
Another Formula Treats dysentery with excessive stomach fire, inability to eat/drink, nausea/vomiting. Soak Hai Zhe Tou (Metapenaeus ensis) in sauce for a week. Remove, wash, chop finely. Mix with Ou Si (Lotus Root Fiber). Add a little Mi Cu (Rice Vinegar) and Bai Tang (White Sugar). Mix well. Eating this stops nausea/vomiting.