（论一首 脉证二十四条）
（方二十六首 灸法十首）
论曰∶余立身以来，三遭热痢，一经冷痢，皆日夜百余行，乃至移床就厕，其困笃如此
，但率意自治者，寻手皆愈。乃知此疾天下易治，但中性之徒率性骄倨，良药苦口不能克己
早饵，朝遇暮过，望其自瘥，疾势日增，胃气渐弱，心力俱微，食饮与药皆不能进，既不时
愈，便称痢病难治，斯皆自误也。学人须深达斯旨。然此病随宜服一物皆使得瘥，惟须力意
苦己，服食以瘥为限，则无不愈也。又大须慎口味，重者瘥后百日，次者一月日。常哀骄恣
者，不能自慎兴言于此，以为至概矣。古今痢方千万首，不可俱载此中，但撮其效者，七八
而已。如陟厘丸、乌梅丸、松皮散等，暴痢服之，何有不瘥其温脾汤，健脾丸（方出下冷痢
篇），久下得之，焉能不愈。大凡痢有四种，谓冷热疳蛊，冷则白。热则赤。疳则赤白相杂
无复节度，多睡眼涩，蛊则纯痢瘀血。热则多益黄连，去其干姜。冷则加以热药。疳则以药
吹灌下部。蛊毒则以蛊法治之药。既主对相当，痢者复自勉励服饵，焉有不愈者也。
凡服止痢药，初服皆剧，愚人不解，即止其药不服，此特不可，但使药与病源的相主对
，虽剧但服，不过再三服，渐渐自知。非其主对者，慎勿服也。
凡痢病通忌生冷酢滑，猪鸡鱼油、乳酪酥干脯酱粉咸。所食诸食，皆须大熟烂为佳，亦
不得伤饱，此将息之大经也。若将息失所，圣医不能救。
下痢脉滑而数，有宿食，当下之。
下痢脉迟而滑者，实也。利为末止，急下之。
下痢脉反滑，当有所去下乃愈。
下痢不欲食者，有宿食，当下之。
下痢而腹痛满，为寒实，当下之。
下痢而谵语，腹内有燥屎，宜下之。
下痢腹中坚者，当下之。
下痢三部皆平（一作浮），按其心下坚者，急下之。
下痢已瘥，至其年月日时复发者，此为下不尽，更下之愈。风寒重者，不可下。下之后，
心下坚痛，脉迟（一作浮），此为寒，但当温之。脉沉紧，下之亦然。脉浮大弦，下之当已。
下痢脉浮大，此为虚，以强下之故也。设脉浮革者，因而肠鸣，当温之。
下痢脉迟紧为痛，未欲止，当温之。得冷者满而便肠垢。
下痢身躯疼痛，急救里，诸温之属，可与理中、四逆、附子汤热药辈急投之美。
下痢大孔痛者，当温暖之。
下痢腹胀满，身体疼痛者，先温其里，乃攻其表。
下痢清谷不可攻，其表汗出必胀满。
下痢气者，当利其小便。
下痢脉反浮数，尺中自涩，其人必清脓血。
下痢脉数而渴者，今自愈。设不瘥，必清脓血，有热故也。
下痢脉沉弦者下重，其脉大者为未止，脉微弱数者为欲自止，虽发热，必不死。
下痢脉沉而迟，其人面少赤，身有微热，下利清谷，必郁冒，汗出而解，病患必微厥，
所以然者，面戴阳下虚故也。
下痢有微热而渴，脉弱者今自愈。
下痢脉数，有微热，汗出今自愈。设脉紧为未解。
下痢脉弦，发热身汗者自愈。
下痢脉大浮弦，下当已。
下痢舌黄，燥而不渴，胸中实，下不止者死。
下痢后脉绝，手足厥冷， 时脉还，手足温者生，不还不温者死。生死之决，此之谓
也。
下痢手足厥冷无脉者，灸之不温，若脉不还，反微喘者死。少阴负趺阳者为顺。
凡六腑气绝于外者，手足寒，上气脚缩。五脏气绝于内者，下利不禁。下甚者，手足不
仁也。细寻取之，万不失一，下病体略例如此耳。
《素问》曰∶春伤于风，夏为脓血。凡下多滞下也。夏伤于风，秋必洞泄，秋多下水也
，患是冷也，夫积冷积热及水谷实而下者，以大黄汤下之，强人勿过两剂，皆消息五六日更
进一剂，其补涩汤不效者，三两日可进一剂。
(One Treatise, Twenty-Four Pulse and Symptom Conditions)
(Twenty-Six Formulas, Ten Moxibustion Methods)
The treatise states: Since I began my life, I have suffered from heat-dysentery three times and cold-dysentery once. In all instances, I had more than a hundred bowel movements per day, to the extent that I had to move my bed close to the toilet. The condition was so critical and debilitating. However, by treating myself according to my own judgment, I recovered quickly with simple remedies. Thus, I realized that this disease is easy to cure worldwide. The problem lies with those of moderate constitution who are arrogant and proud; they cannot restrain themselves to take bitter medicine early. They pass by morning encounters and evening opportunities, hoping for spontaneous recovery. Consequently, the disease worsens daily, stomach qi gradually weakens, and both mental and physical strength decline until food and medicine cannot be taken. When not cured in time, they claim that dysentery is difficult to treat. This is all self-mismanagement. Students must deeply understand this principle. However, for this disease, taking just one suitable herb can lead to recovery, provided one exerts strong willpower, disciplines oneself, and continues medication until cured. There will be no failure to recover. Furthermore, one must strictly observe dietary restrictions: for severe cases, abstain for one hundred days after recovery; for milder cases, for one month. I often lament those who are arrogant and indulgent and cannot exercise self-restraint. Speaking of this, I consider it a profound observation. There are tens of thousands of formulas for dysentery in ancient and modern texts, which cannot all be recorded here. I have only selected the most effective ones, about seven or eight. For example, Zhili Wan (Step Lichen Pill), Wumei Wan (Mume Fruit Pill), and Songpi San (Pine Bark Powder). If taken for acute dysentery, how could they fail? As for Wenpi Tang (Spleen-Warming Decoction) and Jianpi Wan (Spleen-Strengthening Pill) (formula found in the Cold Dysentery section below), if obtained for chronic diarrhea, how could one not recover? Generally, there are four types of dysentery: cold, heat, gan (malnutrition/toxin), and gu (parasitic/poison). Cold dysentery presents with white stool; heat dysentery with red stool; gan dysentery with mixed red and white stool without restraint, accompanied by excessive sleepiness and dry, gritty eyes; gu dysentery presents with pure bloody stool. For heat dysentery, add Coptidis Rhizoma (Huanglian, 黄连) and remove Zingiberis Rhizoma Recens (Ganjiang, 干姜). For cold dysentery, add hot-natured herbs. For gan dysentery, blow or irrigate the lower part with medicine. For gu poison, treat with gu-removal methods. Once the primary herb corresponds to the condition, and the patient encourages themselves to take the medication, how could they not recover?
Whenever taking anti-dysentery medicine, symptoms may initially worsen. Fools do not understand this and stop taking the medicine immediately. This is particularly inadvisable. As long as the medicine corresponds to the cause, even if symptoms worsen, continue taking it. After two or three doses, one will gradually realize improvement. Do not take medicines that do not correspond to the condition.
Patients with dysentery generally must avoid raw, cold, sour, and slippery foods, as well as pork, chicken, fish oil, dairy products like cheese and butter, dried meat jerky, sauces, powders, and salty foods. All consumed food should be cooked thoroughly and be soft. One must also avoid overeating. These are the major principles of convalescence. If convalescence is mismanaged, even sage physicians cannot save the patient.
Dysentery with a slippery and rapid pulse indicates retained food; purgation is indicated.
Dysentery with a slow and slippery pulse indicates excess. If diarrhea does not stop, urgent purgation is indicated.
Dysentery with a surprisingly slippery pulse suggests internal retention; purgation leads to recovery.
Dysentery with loss of appetite indicates retained food; purgation is indicated.
Dysentery with abdominal pain and fullness indicates cold-excess; purgation is indicated.
Dysentery with delirium indicates dry feces in the abdomen; purgation is appropriate.
Dysentery with a hard abdomen indicates purgation is needed.
Dysentery where the pulse at all three positions (cun, guan, chi) is level (or floating), but pressing the epigastrium reveals hardness, requires urgent purgation.
If dysentery has healed but recurs at the same time of year/month/day, it is because the pathogen was not fully expelled; another purgative dose will cure it. If wind-cold is heavy, do not purge. After purgation, if the epigastrium becomes hard and painful with a slow (or floating) pulse, it indicates cold; warm only. With a deep-tight pulse, the approach is similar [contextually implies caution or specific indication]. With a floating-large-wiry pulse, purgation should resolve it.
Dysentery with a floating-large pulse indicates deficiency, caused by forced purgation. If the pulse is floating and革 (leather-like), accompanied by borborygmus, warming is indicated.
Dysentery with a slow-tight pulse indicates pain; the disease has not ceased, warming is indicated. Those who caught cold experience fullness and pass intestinal mucus.
Dysentery with body aches requires urgent treatment of the interior. Warm-natured formulas such as Lizhong Tang (Regulate the Middle Decoction), Sini Tang (Frigid Extremities Decoction), or Fuzi Tang (Aconite Decoction) should be administered urgently for good effect.
Dysentery with anal pain requires local warming.
Dysentery with abdominal distension and body aches: first warm the interior, then attack the exterior.
Dysentery with undigested food (clear谷物) should not be purged; sweating in this state will certainly cause distension.
Dysentery with gas sensation (tenesmus/frequent flatus): promote urination.
Dysentery with a surprisingly floating-rapid pulse, and a choppy chi pulse, indicates the patient will likely pass pus and blood.
Dysentery with a rapid pulse and thirst indicates impending recovery. If it does not heal, pus and blood will appear due to heat.
Dysentery with a deep-wiry pulse indicates tenesmus; a large pulse means the disease has not stopped; a weak-rapid pulse means it is about to stop spontaneously. Even with fever, death is unlikely.
Dysentery with a deep-slow pulse, slight facial redness, slight body heat, and passage of undigested food indicates impending "Yu Mao" (dizziness and confusion). Recovery occurs through sweating. The patient will likely have slightly cold extremities. This is due to floating deficient yang on the face and deficiency/cold in the lower jiao.
Dysentery with slight fever and thirst, and a weak pulse, indicates impending recovery.
Dysentery with a rapid pulse, slight fever, and sweating indicates impending recovery. A tight pulse indicates unresolved disease.
Dysentery with a wiry pulse, fever, and sweating indicates spontaneous recovery.
Dysentery with a large-floating-wiry pulse: purgation should resolve it.
Dysentery with yellow tongue coating, dryness without thirst, and chest fullness, with persistent diarrhea, is a fatal case.
After dysentery, if the pulse vanishes and extremities are cold, but the pulse returns and extremities become warm, the patient lives. If the pulse does not return and extremities remain cold, the patient dies. This determines life and death.
For dysentery with cold extremities and absent pulse, if moxibustion does not warm them, and the pulse does not return but slight panting occurs, the patient dies. If Shaoyin pulse is weaker than Duyang pulse, it is a favorable sign.
When the qi of the six fu organs fails externally, there is coldness in the hands and feet, upward rushing of qi, and curling up of the legs. When the qi of the five zang organs fails internally, there is incontinence of diarrhea. Severe diarrhea leads to numbness in the hands and feet. Careful examination ensures accuracy; this summarizes the general principles of lower-jiao diseases.
Suwen states: Wind injury in spring leads to pus-and-blood dysentery in summer. Generally, excessive downward flow results in tenesmus (Zhi Xia). Wind injury in summer leads to watery diarrhea in autumn. Autumn diarrhea is mostly water-type, indicating cold syndrome. For dysentery caused by accumulated cold, accumulated heat, or food stagnation, use Dahuang Tang (Rhubarb Decoction) for purgation. Strong individuals should not exceed two doses. Adjust dosage carefully; administer another dose every five to six days. If tonifying and astringent decoctions are ineffective, administer one dose every two to three days.