（第七）
小儿痢疾大抵多由脾胃不和，饮食过伤、停滞不能克化；又为乳母恣食生冷、热毒、浓
味以传之；又为风寒、温热之邪以干之，故有此疾。有里急、窘迫、急痛者，火性急速而能燥
物故也。或夏末、秋初，忽有暴寒折于盛热，无所发散，客搏肌肤之中，发于外则为疟，发于
内则为痢，内外俱发则为疟痢。凡痢久则令肿满，下焦偏冷，上焦热结，则为上实下虚。若脾
胃湿热之毒熏蒸清道而上，以致胃口闭塞而成噤口之证。又有一方、一家之内，上下传染，长
幼相似，是疫毒痢也。当先推其岁运，以平其外；察郁结，以调其内，审其所伤，别其虚实、
冷热以治之。条然明白，不致妄投也。
《内经》曰∶肠 下血，身热则死，寒则生。肠 下白沫，脉沉则生，浮则死。仲景云∶
下痢脉滑而数者，有宿食也，当下之。
治痢大法与大人同，惟剂轻重耳。赤痢积热窘迫者，宜通之，次用黄连解毒自止，如
不止，用香连丸、地榆散之属。秋后痢疾多因夏伤暑，宜调中五苓，黄连、枳壳。或下如豆汁，
如瘀血，宜胃风汤。噤口不能食，宜石莲、香橘之属。
治痢，生姜助胃为阳，茶叶助胃为阴。平调阴阳，蜜治痢，生姜作片，好茶各一钱半，
蜜水煎服。虫毒痢，阿胶、黄 各二钱，用水同煎服。痢疾不能饮食，邪气、疫毒不能发泄，
传入脏腑，肠胃折叠以噤口，九死一生。脾虚胃弱，有热气关闭胸中。噤口服参苓白术散加
石菖蒲、枳壳、粳米一撮同煎，食前服。心气通，胃脘开，便能食。
痢疾不治证
小儿下痢如尘腐色者死，如屋漏水者死，肛门如竹筒不敛者死，下血如败血不收者死。
凡小儿赤白大下而不禁，小水无，腹疼，发热，唇红，舌胎，气促，心烦，狂躁不安，面色
变易如妆，饮食全不进，谷道倾陷者，并不治。
(Seventh)
Pediatric dysentery is mostly caused by disharmony of the Spleen and Stomach, excessive dietary injury leading to food stagnation that cannot be digested; it can also be transmitted because the wet nurse recklessly consumes raw, cold, hot-toxic, or rich and greasy foods; furthermore, invasion by Wind-Cold or Warm-Thermal pathogens causes this disease. The presence of tenesmus (urgency with painful defecation), distress, and acute abdominal pain occurs because the nature of Fire is rapid and drying. Alternatively, at the end of summer or beginning of autumn, a sudden cold snap suppresses intense heat, leaving no outlet for dispersion. This pathogen lodges in the skin and muscles; manifesting externally, it becomes Malaria; manifesting internally, it becomes Dysentery; manifesting both internally and externally, it becomes Malaria-Dysentery. If dysentery persists for a long time, it leads to swelling and fullness, coldness in the Lower Jiao (Lower Burner), and heat accumulation in the Upper Jiao (Upper Burner), resulting in a pattern of Excess above and Deficiency below. If toxic damp-heat from the Spleen and Stomach steams upward through the clear pathways, causing the stomach opening to close, it forms the syndrome of Jin Kou Li (Dysentery with inability to eat). Another scenario involves transmission within a single area or household, where adults and children infect each other with similar symptoms, known as Yi Du Li (Epidemic Toxic Dysentery). Treatment should first deduce the annual climate influence (Sui Yun) to pacify external pathogens; examine internal stagnation to regulate internal organs; investigate the cause of injury, differentiate between Deficiency/Excess and Cold/Heat to treat accordingly. This approach is clear and orderly, preventing blind medication.
The *Nei Jing* (Inner Canon) states: In intestinal bleeding, if the body is hot, death ensues; if the body is cold, survival is possible. In the discharge of white mucus from the intestine, if the pulse is Deep (Chen), survival is possible; if Floating (Fu), death ensues. Zhang Zhongjing stated: In dysentery, if the pulse is Slippery (Hua) and Rapid (Shu), there is retained food (Su Shi), and purgation should be employed.
The general principles for treating dysentery are the same as for adults, differing only in dosage strength. For red dysentery with accumulated heat and severe distress, unblocking/purging is appropriate, followed by Huang Lian Jie Du Tang (Coptis Decoction for Relieving Toxicity) to stop it spontaneously. If it does not stop, Xiang Lian Wan (Fragrant Coptis Pill) or Di Yu San (Sanguisorba Powder) may be used. Dysentery occurring after autumn is often due to Summerheat injury sustained in summer; Tiao Zhong Wu Ling San (Regulate Middle Five-Ling Powder) combined with Huang Lian (Coptidis Rhizoma) and Zhi Ke (Aurantii Fructus) is suitable. If stool resembles bean curd juice or looks like blood stasis, Wei Feng Tang (Stomach Wind Decoction) is suitable. For Jin Kou (inability to eat due to nausea/vomiting), Shi Lian (Nelumbinis Semen) and Xiang Ju (Citri Reticulatae Pericarpium) are appropriate.
In treating dysentery, Sheng Jiang (Zingiberis Rhizoma Recens) assists Stomach Yang, while Cha Ye (Camelliae Sinensis Folium) assists Stomach Yin. To harmonize Yin and Yang, honey is used to treat dysentery: slice Sheng Jiang, take one qian and half of good tea leaves, decoct with honey water, and administer orally. For Chong Du Li (Toxic Worm Dysentery), use E Jiao (Colla Corii Asini) and Huang Qin (Scutellariae Radix), two qian each, decoct together with water and administer. When dysentery prevents eating, pathogenic factors and epidemic toxins cannot be excreted, entering the Zang-Fu organs, causing intestinal folding and Jin Kou; this condition has nine chances of death and one of survival. If Spleen Deficiency and Stomach Weakness exist with Heat closing the chest, Jin Kou can be treated with Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) added with Shi Chang Pu (Acori Tatarinowii Rhizoma), Zhi Ke, and a pinch of Jing Mi (Oryza Sativa Germless), decocted together and taken before meals. When Heart Qi flows freely and the Stomach opening opens, eating becomes possible.
Untreatable Syndromes of Dysentery
If a child's dysenteric stool is colored like dust or rotting flesh, death ensues; if like leaking roof water, death ensues; if the anus remains open like a bamboo tube without contracting, death ensues; if bloody discharge resembles failed blood and cannot be controlled, death ensues.
Any pediatric case of profuse red-and-white dysentery that is uncontrollable, accompanied by absence of urination, abdominal pain, fever, red lips, thick tongue coating, shortness of breath, irritability, restlessness, facial color changes resembling makeup, complete refusal of food, and sinking of the anal sphincter, are all untreatable.