大凡治疟之法。宜先缓而后急。治痢之法。宜先急而后缓。何哉。疟之始发
也。其势猛悍。而遽欲以止之。则邪不伏而反炽。使及其既衰。即须急以培
焉。除邪养正。乃不至于迁延。所谓避其来锐。击其惰归。此一法也。痢之始
作也。其来弥漫。而不急以夺之。则浸淫而溃决。即当其少缓。尤须有以调
焉。邪尽气和。庶不成乎休息。所谓及锋而用。善刀而藏。此又一法也。盖痢
古称滞下。又名肠 。分明指湿热伤手太阳小肠。手阳明大阳。蕴酿而成。
丙火自焚。庚金受囚。化物传道之令俱废。脓血稠粘。后重逼迫。滞而不舒
也。仲景用大黄汤涤之。取其滋润轻快。一洗而空。诚妙法也。特恐元气有不胜耳。河间芍药汤。用芩连清火。
归芍调血。木香槟榔。理气止痛。甘草和中。或加肉桂为引。所云调血则便血自愈。理气则后重自除。无论赤
白。皆当遵此为法。若夫虚寒一症。腹痛频迸。下积纯白。或时兼赤。滑而不禁。脉微弱而畏寒。则人参附子
理中汤。必不可少。至于久痢。元气衰惫。下痢不止。肢体浮肿。脉来虚微。补中益气。倍参加桂附肉果粟壳。
又岂容须臾缓哉。更有下多亡阴。大肠不行收令。虚坐弩责。则于升提中。兼以滋阴为主。迨食积宜消。感寒
宜发。暑湿宜清。又在临症变通。难以执一见也。
治验
一徐太夫人六旬患痢。噤口不食。服开胃等药转剧。六脉虚数。余以人参二钱。黄连一钱。连进四五次。遂
能食而痢止。
一人年五旬。向有冷积痛。一日患痢。初起便滑。下积纯白。诊其脉微细。余即以人参理中汤。连进而愈。
此不可以常格拘也。
一儒者场后患痢。医与解表消导清热罔效。余切其脉软弱。两尺倍甚。以八味汤四剂渐减。后以人参调理。
盖痢未有不伤肾。况年少不禁者乎。
芍药汤
芍药（一钱半） 当归 黄连 黄芩（各八分） 炙甘草（三分） 槟榔（一钱） 木香（五分）
水煎服。痛不止或加桂五分。痢不减渐加大黄。
真人养脏汤 治虚寒痢疾。久而不愈。
人参（三钱） 白术（一钱半，土炒） 当归（一钱） 白芍药（一钱半） 木香（八分） 炙甘草（三分） 肉
桂（八分） 肉果（面裹煨） 粟壳（醋炙） 诃子肉（面煨各一钱）
水煎服。
浓朴汤 治饮食停滞下积者。
浓朴（一钱姜制） 枳实（一钱麸炒） 莱菔子（一钱焙研） 木香（五分） 黄芩（一钱） 广皮（一钱） 山
楂（一钱半） 豆豉（一钱） 炙甘草（三分） 柴胡（七分） 槟榔（一钱）
加砂仁末七分。姜一片。水煎。
Generally, the treatment of malaria should be gentle first and urgent later. The treatment of dysentery should be urgent first and gentle later. Why? When malaria first starts, its momentum is fierce and violent. If one tries to stop it immediately, the pathogenic factor will not subside but instead flare up. One must wait until it subsides, then urgently tonify the healthy qi, eliminate the pathogen, and nourish the righteous qi, so as not to let the condition drag on. This is what is meant by "avoiding their sharpness when they arrive, striking their laziness when they retreat." This is one method.
When dysentery first occurs, its onset is pervasive. If one does not urgently attack and drain it, the damp-heat will gradually infiltrate and eventually burst forth. Even when the symptoms temporarily ease, there must be a way to regulate it. Only when the pathogen is exhausted and the qi and blood are harmonious can it prevent becoming a chronic, relapsing dysentery (xiuxi). This is what is meant by "using the weapon while it is sharp, and sheathing it well afterwards." This is another method.
Dysentery was anciently called "zhixia" (stagnant discharge) and also known as "changpi" (intestinal disorder with pus and blood), clearly indicating that damp-heat injures the Hand-Taiyang Small Intestine and Hand-Yangming Large Intestine, brewing into disease. The Bing Fire (Small Intestine fire) burns itself, the Geng Metal (Large Intestine metal) is imprisoned, and the functions of transformation and transmission are abolished. This results in thick, sticky pus and blood, tenesmus (feeling of incomplete defecation), and stagnation without relief. Zhang Zhongjing used Dahuang Tang (Rhubarb Decoction) to purge it, taking advantage of its moistening and light, brisk action to wash everything away. It is indeed a wonderful method, though one must fear that the yuanqi (original qi) may not withstand it. Liu Hejian's Shaoyao Tang (Peony Decoction) uses Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) to clear fire, Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) to regulate blood, Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen) to regulate qi and relieve pain, Gancao (Glycyrrhizae Radix et Rhizoma) to harmonize the middle jiao, or adding Rougui (Cinnamomi Cortex) as a guiding herb. It is said that "regulating the blood makes hematochezia heal spontaneously, regulating qi removes tenesmus spontaneously." Whether red or white dysentery, one should follow this method.
If it is a deficiency-cold syndrome, with frequent abdominal pain, pure white stool, sometimes mixed with red, slippery and incontinence, weak pulse, and aversion to cold, then Renshen Fuzi Lizhong Tang (Ginseng, Aconite, and Pinellia Decoction for the Middle Jiao) is indispensable. As for chronic dysentery, where yuanqi is exhausted and debilitated, continuous diarrhea, edema of limbs, and a deficient, minute pulse occur, one must tonify the middle and augment qi, doubling the dose of Renshen (Panacis Ginseng Radix), and adding Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), Roudoukou (Myristicae Semen), and Yingsuke (Papaveris Pericarpium). How could such urgency be delayed for a moment? Furthermore, if excessive purging leads to yin exhaustion, and the Large Intestine loses its astringent function, resulting in xu zuo nu ze (straining at stool with empty rectum), one must combine lifting and raising with nourishing yin as the main approach. Regarding food stagnation, it should be resolved; regarding cold invasion, it should be dispersed; regarding summerheat-dampness, it should be cleared. These require flexible adaptation during clinical practice and cannot be rigidly adhered to a single view.
Clinical Cases:
1. An elderly lady surnamed Xu, aged sixty, suffered from dysentery and could not eat (jinkou). After taking medicines to open the stomach, her condition worsened. Her six pulses were deficient and rapid. I administered two qian of Renshen (Panacis Ginseng Radix) and one qian of Huanglian (Coptidis Rhizoma), given four or five times consecutively. She was then able to eat, and the dysentery stopped.
2. A man of fifty years old, who previously had cold accumulation pain, contracted dysentery one day. Initially, his bowels were loose, and he passed pure white stool. His pulse was minute and fine. I immediately administered Renshen Lizhong Tang (Ginseng and Pinellia Decoction for the Middle Jiao) continuously, and he recovered. This case cannot be bound by standard rules.
3. A scholar developed dysentery after the imperial examinations. Physicians treated him with exterior-releasing, digestion-promoting, and heat-clearing methods without effect. I palpated his pulse as weak and soft, especially in the chi positions of both wrists. I prescribed Bawei Wan (Eight-Ingredient Pill) for four doses, after which symptoms gradually decreased. Later, I regulated him with Renshen (Panacis Ginseng Radix). Generally, dysentery always injures the Kidney, especially in young men who lack restraint.
Shaoyao Tang (Peony Decoction)
Shaoyao (Paeoniae Radix, 1.5 qian), Danggui (Angelicae Sinensis Radix), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix) (each 0.8 qian), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 0.3 qian), Binglang (Arecae Semen, 1 qian), Muxiang (Aucklandiae Radix, 0.5 qian). Decoct in water and take orally. If pain does not cease, add Rougui (Cinnamomi Cortex, 0.5 qian); if dysentery does not decrease, gradually add Dahuang (Rhei Radix et Rhizoma).
Zhenren Yangzang Tang (True Man's Nourishment of the Viscera Decoction)
Treats deficiency-cold dysentery that persists for a long time.
Renshen (Panacis Ginseng Radix, 3 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian, stir-fried with earth), Danggui (Angelicae Sinensis Radix, 1 qian), Baishaoyao (Paeoniae Radix Alba, 1.5 qian), Muxiang (Aucklandiae Radix, 0.8 qian), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 0.3 qian), Rougui (Cinnamomi Cortex, 0.8 qian), Roudoukou (Myristicae Semen, baked in flour), Yingsuke (Papaveris Pericarpium, vinegar-processed), Hezi Rou (Terminalia Chebulae Fructus, baked in flour, each 1 qian). Decoct in water and take orally.
Nongpo Tang (Magnolia Bark Decoction)
Treats dysentery caused by food stagnation.
Houpo (Magnoliae Officinalis Cortex, 1 qian, processed with ginger), Zhishi (Aurantii Fructus Immaturus, 1 qian, bran-fried), Laifuzi (Raphani Semen, 1 qian, roasted and ground), Muxiang (Aucklandiae Radix, 0.5 qian), Huangqin (Scutellariae Radix, 1 qian), Guangpi (Citri Reticulatae Pericarpium, 1 qian), Shanzha (Crataegi Fructus, 1.5 qian), Douchi (Sojae Semen Preparatum, 1 qian), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 0.3 qian), Chaihu (Bupleuri Radix, 0.7 qian), Binglang (Arecae Semen, 1 qian). Add Shaoren powder (Amomi Fructus Rotundus, 0.7 qian) and one slice of Jiang (Zingiberis Rhizoma Recens). Decoct in water.