〔大〕若下清水其色赤黄,或米谷不化,但欲饮冷,时时呕逆,小便不利,得热则极,
心胸烦躁,脉虚大而数,此由乘虚热入于胃,凑渗下焦,津液不分,并于大肠,谓之协热
下利。先用五苓散利小便,次以玉粉丹、四味阿胶丸。
〔薛〕前证若胃气虚弱,用补中益气汤。肝木侮脾土,用六君子汤。郁结伤脾土,用
归脾汤。命门火衰,用八味地黄丸。余参各论主之。一妇人五月间患痢,日夜无度,小
腹坠痛,发热恶寒。余以为脾气虚弱,用六君子汤送香连丸,二服渐愈,仍以前汤送四
神丸,四服全愈。至七月终,怠惰嗜卧,四肢不收,体重节痛,口舌干燥,饮食无味,大
便不实,小便频数,洒淅恶寒,凄惨不乐,此肺与脾胃虚而阳气不伸也,用升阳益胃汤而痊。
玉粉丹
蛤粉 硫黄(等分)
上同研细,白面糊和丸如梧桐子大。每服五十丸,米饮下。
四味阿胶丸
黄连 赤茯苓(去皮,各一两) 芍药(三两) 阿胶(炒燥,一两)
上先将三味为末,却以好醋熬阿胶成稀膏,丸如梧桐子大,米饮下三十丸。
《补遗》协热而利,《活人书》黄芩汤、赤石脂丸,《局方》益元散皆可。
(男女痢治无异,已详《杂病准绳》,此特摭遗耳。)
〔大〕夫赤白痢疾者,古人名之滞下是也。究疾之原,皆因外感五邪之气,内伤生
硬冷热之食。其证不一,有赤有白,有赤白相杂,有冷有热,有虚有实。大抵四时皆以
胃气为本,未有不因外感寒暑燥湿风之气而伤于脾胃,脾胃既亏,而又内伤饮食,饮食
不能克化,致令积滞而成滞下。古人云∶无积不成痢者此也。经云∶春伤于风,夏生飧
泄。盖风喜伤肝,然春时肝木正旺而不受邪,反移气克于脾土。然脾既受克,又不能忌慎
口腹,恣食生冷粘硬之物,致令脾胃不能克化,因此积滞。又夏秋之间,或再感暑湿风
冷之气,发动而成痢也。其证必先脐腹 痛,洞泄水泻,里急后重,或有或无,或赤或白,
或赤白相杂,日夜无度,如有此证,不问冷热虚湿,但当先服神术散,可以发散风冷寒
湿之气,次服五苓散分利水谷,兼用加巴感应丸,温脾胃去积滞,或六神丸,未有不安
者也。或曰∶虽古人有言无积不成痢,亦不专以去积为先,岂有一岁之内,独于夏秋之
间,人皆有积而春冬无之。盖风邪入胃,木来胜土,不为暴下则为痢疾,其神术散要药
也。又有一方一郡之内,上下传染,疾状相似,或只有一家长幼皆然,或上下邻里间相
传染,或有病同而证异,亦有证异而治同,或用温剂而安,或用凉药而愈,有如此等是毒
疫痢也。治疫毒痢者,虽当察五运六气之相胜,亦不可狎泥此说,且如运气相胜,岂独
偏于一方一郡,而偏于一家一巷者乎?如有此证,当先察其虚实冷热,首以败毒散多加
人参、甘草、陈米、姜、枣煎服,及三黄熟艾汤、黄连阿胶丸,五苓散、驻车丸,可选
而用之。如下痢赤多,或纯下鲜血,里急后重,大便不通,身体壮热,手足心热,心烦
躁渴,腹胁胀痛,小便赤涩,六脉洪大,或紧而数,或沉而实,此热痢也。宜白头翁汤
及三黄熟艾汤、五苓散,可选而用之。若风痢下血太过,宜用胃风汤加木香、黑豆煎服。
若夏秋之间,下痢或赤或白,或赤白相杂,脐腹 痛,里急后重,憎寒发热,心胸烦闷,躁
渴引饮,呕逆恶心,小便不利,及五心烦热,六脉虚弱,此等脉证,正因伏暑而得此疾,宜
服香薷散加黄连、甘草、当归,酒水浓煎,沉
冷(杂病伤暑。)顿服,仍急服酒蒸黄连丸,或小柴胡汤加人参煎服必愈。(沈内翰云∶治痢之药极
多,然无如此药之妙,盖小柴胡汤能治暑毒。)如杂证一退,而痢尚未止,则以四物汤加胶,艾
煎服,以调阴阳,未有不安者也。如水谷不分,小便不利,宜用五苓散,淡竹叶煎汤调
服。如烦渴甚者,亦宜服之。若不明伏暑之证,但以脉虚而妄投硫、附、姜、桂、丹石
之药而杀之,深可叹息。若下痢纯白,状如鱼脑,脐腹冷痛,日夜无度,手足逆冷,或
有呕逆,全不入食,饮食欲温而恶冷,六脉微细,此由脏腑虚冷之极,宜木香散加服四
味理中汤及钟乳健脾丸,甚者四肢逆冷,六脉沉绝,当一味峻补,兼灸气海、丹田二穴,
更以助胃之药,此守而不攻之意也。宜四顺附子汤、三建丹、白丹、加味参附汤、姜附
汤,皆可选用。如年尊虚弱之人,或素来禀受怯弱,亦宜以此法详酌调理。然大宜开胃
进食为先,食可得入,则脾胃运化,糟粕便聚,糟粕既成垢腻,鲜血瘀滞,不患其不陨
矣。如久痢不瘥,肠滑不禁,溏泄不止,诸药无效,方可施之涩肠止痢之剂,亦宜先以
龙骨、肉豆蔻、诃子、钟乳、胡粉之药。近人多用罂粟壳、地榆之属,然此物性太紧涩,
能损胃气,如少壮之人,壮健者服之,间奏奇效。若是疫毒受暑受湿之证,及年尊之人,
或禀受怯弱,服此莫不受其大害。若以固秘涩肠为先,则风寒暑湿之邪,非惟涩而不去,
而胃管闭而不通,禁口不食。日见羸瘦,糟粕不入肠中,所患无由可除矣。若有此证,宜
以参苓白术散、四君子汤,及以石莲、山药之剂治之必愈。治痢欲投补药,必须有温通
之意在焉。如四君子汤、理中汤、十全汤加木香、白豆蔻、茯苓、官桂、浓朴之属,可
以散风邪,可以分水道,可以开胃管,可以治缠扰,可以通秘涩,此攻守之意两全也。大
抵治痢之法,虚者补之,实者泻之,滑者涩之,闭者通之,有积者推之,风则散之,暑
则涤之,湿则燥之,热则凉之,冷则温之,冷热者调之,以平为期,不可以过,此为大法。
祭酒林谦之说医人刘从周治病有功,议论殊不凡,且有验。云∶大凡痢疾,不问赤
白而为冷热之证,若手足和暖则为阳,只须服五苓散,用粟米饮调下,次服感应丸二十
丸即愈。若觉手足厥冷,则为阴,当服暖药,如已寒丸、附子之类。如此治痢,无不效。此
方亲曾用有效。有人夏月患痢,一日六七十行,用五苓散两服止。
〔薛〕东垣云∶太阴经受湿,水泻变脓血,脾传于肾者,谓之贼邪,难愈。先痢而
后泻者,谓之微邪,易痊。若厥阴经下痢,脉沉迟,手足厥逆,用麻黄小续命汤汗之。若
身冷自汗,小便自利,脉微呕吐,用浆水散温之。若脉疾身动,下迫声响,用白术芍药
汤。脉沉身静,饮食不入,用姜附汤。身体沉重,四肢不举,用术附汤。窃谓前证若饮
食停滞,用六君子汤以补脾胃,消饮食。若胃气下流,用补中益气汤以补脾胃,升元气。
若风伤肠胃,宜用神术散以补脾胃,解外邪。若痰积中焦,宜用六神丸以补脾胃,化痰滞。
大凡脾胃虚弱,宜补中气,调饮食。一老妇食后因怒患痢,里急后重,肛门脱下,此
脾气下陷,用大剂六君加附子、肉蔻、煨木香各一钱,吴茱五分,骨脂、五味各一钱五
分,二剂诸证悉退。惟小腹胀闷,此肝气滞于脾也,与调中益气加附子、木香五分,四
剂而愈。后口内觉咸,此肾虚水泛,与六味地黄丸二剂顿愈。又以饮食失宜,大便不实,
四肢逆冷,此脾胃复伤,与六君加附子五分及八味丸而愈。先太宜人仲夏患痢,腹痛
去后无度,烦渴饮汤,手按腹痛稍止,脉鼓指而有力,此真气虚而邪气实也,急用人参
五钱,白术、茯苓各三钱,陈皮、炙草、升麻、附子各一钱,服之即睡,觉而索食,脉
证顿退,再剂而安。此取证不取脉也。其时同患是证,服痢药者俱致不起,惜哉。
〔陈〕曾有一妇人病痢疾,阅四十日,服诸药不愈。召予诊之,六脉沉弱。大凡下
痢之脉宜沉宜弱,但以十全大补汤、姜枣煎成,加白蜜半匙,再煎数沸,服之愈。甲子
夏秋间,赵经略侄孙病痢甚重,召小方脉未至,命予诊之,六脉平细,以证观之,云是
血痢,其实非也,只是血水而已。予记调中汤治状,云治夏月初秋,忽有暴寒,折于盛
热,结入四肢,则壮热头痛,寒伤于胃,则下利或血、或水、或赤,壮热冥困脉数,宜
服此。遂合之,去大黄,服之而愈。又有一妇女泄泻不止,似痢非痢,似血非血,其
色如浊酒。召予诊之,则六脉沉绝,众用热药及丹药服之,则发烦闷。仆先用败毒散数
服,加陈米煎,次用胃风汤加粟米煎服愈。又调中汤去大黄,亦疗此证。
〔大〕白头翁汤 治热痢下血,连月不瘥。
白头翁(二两) 黄连 黄柏皮 秦皮(各三两)
上 咀,每服四钱,水一盏半,煎至七分,去滓无时温服。
神术散 治春伤于风,夏生飧泄。大治伤风头痛,项背拘急,鼻流清涕。
苍术(一斤) 本 川芎(各六两) 羌活(四两) 粉草(二两六钱) 细辛(一两六钱)
上为粗末,每服三钱,水一盏,姜三片,煎七分,要出汗加葱,去滓稍热服,无时候。
六神丸 治赤白痢疾。
神曲(别为末,留作糊) 麦芽 茯苓 枳壳 木香(煨,白痢倍之) 黄连(赤痢倍之,各等分)
为末,用神曲末作糊为丸桐子大。每服五十丸,赤痢甘草汤下,白痢干姜汤下,赤白痢
干姜甘草汤下。东山尧殿讲云∶是京城医官见传。予详此方有黄连可以解暑毒,和脏腑,浓肠胃。有
木香能温脾胃,逐邪气,止下利。有枳壳能宽肠胃。有茯苓能利水道,有神曲、麦芽,可以消滞。真痢门
之要药也。
三黄熟艾汤 治伤寒四五日大下,热痢时作,白通汤诸药多不止,宜服此汤除热止痢。
亦有人作丸子,熟水吞下四五十丸,治时行毒痢良验。
黄芩 黄连 黄柏(各二分) 熟艾(半个,鸡子大)
上 咀,每服三钱,水一盏,煎七分,去滓温服无时。
四顺附子汤
生附子(去皮脐) 白姜(炮) 甘草 人参(各一两)
上 咀,每服四钱,水二盏,煎至七分,去滓空心服,吐泻腹痛,加桂半两。小便不
利者,加茯苓半两。大凡痢疾虽体寒手足逆冷,冷汗自出,六脉沉伏,不宜轻用附子。多
因伏暑而得此疾,亦有冷汗自出,四肢逆冷,六脉虚弱,但背寒面垢,或面如涂油,齿干
烦冤,躁渴引饮,此伏暑证也。小柴胡汤、五苓散、酒蒸黄连丸必能奏效,学人宜精思耳。
三建丹
阳起石( 飞,半两) 钟乳粉(一两) 大附子(炮,取末半两,入药一半,作糊一半)
上用附子糊丸如梧桐子大,每服五丸至十丸,空心温酒下。如渴,参汤下。
加味参附汤
大附子(二两半,炮) 大人参(五两)
上二味 咀,每服四钱,水二盏,姜十片,丁香十五粒,米一撮,煎至七分,空心
温服。
香茸丸 治下痢危困。
麝香(半钱,别研,临时入) 鹿茸(一两,火燎去毛,酥炙黄为末,入麝令匀)
上以灯心煮枣肉为丸,如梧桐子大,每服五十丸,空心服。缪立夫云∶有医者每
料入滴乳香半两尤有效。绍兴中,患痢疾多往往而死,凡平时所用治痢如罂粟壳之类,不
可向口,惟服此药及没石子丸愈。
调中汤
葛根 黄芩 芍药 桔梗 本 赤茯苓 白术 甘草(炙,各等分)
上 咀,每服三钱,水一盏,煎至七分,
去滓温服,移时再服。
胃风汤 治风冷乘虚客于肠胃,以致水谷不化,泄泻注下,或肠胃湿毒,下如豆汁,
或下瘀血。
人参 白茯苓 芎 肉桂 当归 白芍药(炒) 白术(炒,各等分)
上每服三二钱,入粟米数粒,水煎空心食前热服。
水煮木香丸 治久痢里急后重,日夜无度。
罂粟壳(去幅,三两) 青皮(去白) 甘草(炒,各二两四钱) 诃子(炮,去核,八两)
当归 木香(各六两)
上为末,炼蜜丸弹子大,每服一丸,水煎化空心服。
戊己丸 治胃经受热,泄痢不止,或饮食不入,腹痛不止。
黄连(炒) 吴茱萸(去梗,炒) 白芍药(各五两)
上为末,面糊丸桐子大,每服三十丸,食前米饮下。
升阳除湿防风汤 如大便闭塞,或里急后重,数至圊而不能便,或有白脓,或兼下
血,此郁结而不通也。以此汤举其阳,则阴气自降矣,慎勿利之。
苍术(米泔浸,四钱) 防风(二钱) 白术(炒) 白茯苓 白芍药(炒,各一钱)
先将苍术用水一盅半,煎至一盅,纳诸药同煎至八分,食前热服。夫饮食入胃,其
气上升,输精心肺,然后下降。若脾胃有伤,不能上升,下流肝肾而成泄利,法宜升补中
气,不可疏下。此东垣发前人所未论也。
三黄丸 治热痢腹痛,或口舌生疮,咽喉齿痛,及一切实火之证。
黄芩 黄连 黄柏(各等分)
上各另为末,水糊丸桐子大,每服七八十丸,白汤下。
芍药汤 治热痢便血后重。经曰∶溲而便脓血,此气行而血止也。行血则便脓自愈,
调气则后重自除。
芍药(炒,一两) 当归 黄连(炒,各半两) 槟榔 木香 甘草(炙,各二钱)
桂(二钱五分) 黄芩(炒,三钱)
上每服半两,水煎。如不减,加大黄。此证外有因中气虚弱,脾气郁结者。治当审察。
[Cheng Wuji] If the discharge is clear water with a reddish-yellow color, or undigested rice and grain, with a desire only to drink cold water, frequent regurgitation, difficult urination, exacerbation upon exposure to heat, irritability in the chest and heart, and a pulse that is deficient, large, and rapid, this is due to heat pathogen entering the Stomach vacuously, gathering and seeping into the Lower Jiao, failing to separate the clear from the turbid fluids, and merging into the Large Intestine. This is called "Xie Re Xia Li" (Diarrhea accompanying fever). First use Wuling San (Five-Ingredient Polyporus Powder) to promote urination, then use Yufen Dan (Jade Powder Pill) and Siwei Ejiao Wan (Four-Ingredient Donkey-Hide Gelatin Pill).
[Xue Ji] For the aforementioned syndrome, if it is due to deficiency of Stomach Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If Liver Wood overacts on Spleen Earth, use Liujunzi Tang (Six-Gentlemen Decoction). If constraint injures Spleen Earth, use Guipi Tang (Restore the Spleen Decoction). If Mingmen Fire declines, use Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill). Refer to other discussions for the rest. A woman suffered from dysentery in May, day and night without limit, with dragging pain in the lower abdomen, fever, and aversion to cold. I considered this deficiency of Spleen Qi, and used Liujunzi Tang administered with Xianglian Wan (Fragrant Coptis Pill). After two doses, she gradually improved; still using the former decoction administered with Sishen Wan (Four-Spirit Pill), after four doses, she was completely cured. By the end of July, she felt lethargic and sleepy, her limbs were weak and unable to hold themselves, her body was heavy with joint pain, her mouth and tongue were dry, food had no taste, her stool was unformed, urination was frequent, she shivered with aversion to cold, and felt miserable and unhappy. This was deficiency of Lung and Spleen-Stomach with Yang Qi unable to extend; she recovered using Shengyang Yizhe Tang (Raise the Yang and Tonify the Stomach Decoction).
Yufen Dan
Ge Fen (Clam Shell Powder) Liu Huang (Sulfur) (equal parts)
Grind the above together finely, mix with wheat flour paste to form pills the size of Sophora seeds. Take fifty pills each time, swallowed with rice water.
Siwei Ejiao Wan
Huang Lian (Coptidis Rhizoma) Chi Fu Ling (Red Poria with Skin Removed, each 1 liang) Bai Shao (White Peony Root, 3 liang) E Jiao (Donkey-Hide Gelatin, fried until dry, 1 liang)
First grind the first three herbs into powder. Then dissolve the E Jiao in good vinegar to form a thin paste. Form pills the size of Sophora seeds. Take thirty pills with rice water.
Supplement: For diarrhea accompanying fever, Huangqin Tang (Scutellaria Decoction) and Chishizhi Wan (Red Stone Pill) from Huoren Shu, and Yiyuan San from Ju Fang can all be used.
(The treatment of dysentery is no different for men and women, as detailed in Zabu Zhunsheng; this merely extracts omissions.)
[Cheng Wuji] The so-called red and white dysentery was named "Zhi Xia" (Stagnant Downward Flow) by the ancients. Investigating the origin of the disease, it is caused by external contraction of the five pathogenic factors and internal injury from raw, hard, cold, and hot foods. The manifestations vary: there are red, white, mixed red and white, cold, heat, deficiency, and excess syndromes. Generally, the four seasons all rely on Stomach Qi as the root. There is no case where one is not injured by external contraction of cold, heat, dryness, dampness, and wind affecting the Spleen and Stomach. Once the Spleen and Stomach are depleted, and further injured by diet, the food cannot be digested, leading to accumulation and stagnation, resulting in Zhi Xia. The ancients said, "No accumulation, no dysentery," which is what this refers to. The Classics state: "If injured by wind in spring, sunken diarrhea occurs in summer." Wind tends to injure the Liver, but in spring, Liver Wood is flourishing and does not accept pathogens; instead, the qi shifts to overact on Spleen Earth. Since Spleen Earth is overacted upon, and if one does not guard against dietary indiscretion, indulging in raw, cold, sticky, and hard foods, the Spleen and Stomach cannot digest them, thus causing accumulation. Furthermore, during summer and autumn, if one contracts summerheat, dampness, wind, or cold again, it triggers dysentery. The symptoms must first include umbilical and abdominal pain, profuse watery diarrhea, tenesmus, present or absent, red or white, or mixed red and white, day and night without limit. If such symptoms occur, regardless of cold, heat, deficiency, or dampness, one should first administer Shenzhu San (Divine Operation Powder) to disperse wind, cold, and dampness, then administer Wuling San to separate and drain water and grain, and additionally use Jiaba Yinggan Wan (Enhanced Response Pill) to warm the Spleen and Stomach and remove stagnation, or Liushen Wan (Six-God Pill). There will be no unrest. One might ask: Although the ancients said "no accumulation, no dysentery," it is not solely focused on removing accumulation at first. Is it true that within a year, everyone has accumulation only in summer and autumn but not in spring and winter? Roughly, when wind pathogen enters the Stomach, Wood overacts on Earth; it either causes sudden profuse diarrhea or dysentery. Shenzhu San is the key formula. Another scenario is within a commandery, transmission from top to bottom, with similar disease states, or only one family where elders and juniors are all affected, or transmission among neighbors. Some have the same disease but different symptoms, some have different symptoms but the same treatment; some are relieved by warming agents, some healed by cooling medicines. Such cases are Epidemic Toxic Dysentery. When treating epidemic toxic dysentery, although one should observe the mutual overcoming of the Five Movements and Six Qi, one must not rigidly adhere to this theory. After all, if the movements and qi overcome each other, how could it be biased only to one region or commandery, let alone one family or alley? If such symptoms exist, first examine deficiency/excess and cold/heat. Initially use Baidu San (Defeat Toxin Powder) with added Ginseng, Licorice, aged rice, ginger, and jujube decocted and taken, as well as Sanhuang Shuai Ai Tang (Three-Yellow Cooked Mugwort Decoction), Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill), Wuling San, and Zhuche Wan (Park the Cart Pill), selecting as appropriate. If dysentery is predominantly red, or purely bright red blood, with tenesmus, constipation, high fever, heat in the palms and soles, irritability and thirst, distending pain in the abdomen and hypochondrium, dark and scanty urine, and the six pulses are surging, or tight and rapid, or deep and solid, this is Heat Dysentery. Use Baitouweng Tang (Pulsatilla Decoction) and Sanhuang Shuai Ai Tang, Wuling San, selecting as appropriate. If wind dysentery involves excessive bleeding, use Weifeng Tang (Stomach Wind Decoction) with added Aucklandia and black soybeans. If during summer and autumn, dysentery is red or white, or mixed, with umbilical pain, tenesmus, aversion to cold and fever, chest irritability, restless thirst with desire to drink, nausea and vomiting, difficult urination, and five-palm heat, with weak six pulses, these pulse and symptom patterns indicate the disease was obtained due to latent summerheat. Use Xiangru San (Elsholtzia Powder) with added Coptis, Licorice, and Angelica Sinensis, decocted strongly with wine and water, cooled and taken in one dose. Still urgently take Jiuzheng Huanglian Wan (Wine-Steamed Coptis Pill), or Xiaochaihu Tang (Minor Bupleurum Decoction) with added Ginseng decocted and taken; recovery is certain. (Shen Neihan said: There are many drugs for treating dysentery, but none is as wonderful as this one, for Xiaochaihu Tang can treat summerheat toxin.) If miscellaneous symptoms recede but dysentery persists, use Siwu Tang (Four-Material Decoction) with added gelatin and mugwort decocted and taken to harmonize Yin and Yang; there will be no unrest. If water and grain are not separated and urination is difficult, use Wuling San, adjusted with light bamboo leaf decoction. If thirst is severe, it is also suitable to take this. If one does not understand the syndrome of latent summerheat, but blindly administers sulfur, aconite, ginger, cinnamon, and cinnabar/mineral drugs based on a deficient pulse, killing the patient, this is deeply lamentable. If dysentery is purely white, resembling fish brain, with cold pain in the umbilical and abdominal regions, day and night without limit, cold extremities, possibly with nausea and vomiting, complete inability to eat, preference for warm food and aversion to cold, and fine and subtle six pulses, this is extreme deficiency-cold of the Zang-Fu organs. Use Muxiang San (Aucklandia Powder) with added Siwei Lizhong Tang (Four-Ingredient Center-Regulating Decoction) and Zhonglu Jianpi Wan (Stalagmite Spleen-Strengthening Pill). In severe cases with cold extremities and imperceptible six pulses, one should use a single potent tonic, moxa Qihai and Dantian acupoints, and use stomach-assisting medicines. This is the intention of defending without attacking. Use Sishun Fuzi Tang (Four-Compliant Aconite Decoction), Sanjian Dan (Three-Establishments Pill), Bai Dan (White Pill), Jiawei Shenfu Tang (Modified Ginseng-Aconite Decoction), Jiangfu Tang (Ginger-Aconite Decoction), selecting as appropriate. For elderly and weak individuals, or those constitutionally frail, this method should also be carefully considered for regulation. However, opening the appetite and promoting eating should be prioritized. If food can enter, the Spleen and Stomach transport and transform, feces accumulate. Once feces become greasy, fresh blood stasis forms, and one need not worry about it not resolving. If chronic dysentery does not heal, intestinal sliding and incontinence, loose stools persist, and various medicines are ineffective, only then should intestinal-astringing and dysentery-stopping agents be applied. Also, initially use Longgu (Dragon Bone), Roudoukou (Nutmeg), Hezi (Chebula Fruit), Zhonglu (Stalagmite), and Hufen (Lead White) medicines. Recently, people often use Ying Sus Ke (Poppy Shell) and Diyu (Sanguisorba Root), but these substances are too astringent and can damage Stomach Qi. If taken by young and strong people, they occasionally achieve miraculous effects. However, for epidemic toxin contracted from summerheat and dampness, the elderly, or the constitutionally frail, taking these will surely cause great harm. If solidifying and astringing the intestines is prioritized, the wind, cold, summerheat, and dampness pathogens will not only remain trapped but also close the gastric tube, leading to anorexia. Day by day wasting away, with no food entering the intestines, the disease cannot be removed. If such symptoms exist, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Sijunzi Tang (Four-Gentlemen Decoction), and formulas with Shi Lian (Nelumbo Seed) and Shan Yao (Dioscorea Rhizome); recovery is certain. When administering tonics for dysentery, there must be the intention of warming and unblocking. For example, Sijunzi Tang, Lizhong Tang, Shiquan Tang with added Aucklandia, White Cardamom, Poria, Cinnamon Bark, and Magnolia Bark can dispel wind pathogens, separate water passages, open the gastric tube, treat entanglement, and unblock constipation. This achieves both attacking and defending. Generally, the method for treating dysentery is: tonify the deficient, purge the excess, astringe the slipping, unblock the closed, push out accumulations, disperse wind, wash away summerheat, dry dampness, cool heat, warm cold, regulate cold and heat, aiming for balance, avoiding excess. This is the general principle.
Lin Qianshuo, the Sacrificial Wine Official, spoke of the physician Liu Congzhou, who achieved merit in treating diseases, with extraordinary and effective discussions. He said: Generally for dysentery, whether red or white, indicating cold or heat: if hands and feet are warm, it is a Yang syndrome; simply take Wuling San, adjusted with millet drink, then take Yinggan Wan twenty pills, and it will cure. If hands and feet feel cold, it is a Yin syndrome; take warming medicines, such as Yihan Wan or Aconite. Treating dysentery this way is invariably effective. This prescription was personally used effectively. Someone suffered dysentery in summer, sixty to seventy times a day; two doses of Wuling San stopped it.
[Xue Ji] Dongyuan said: When the Taiyin Meridian accepts dampness, watery diarrhea changes to pus and blood; when Spleen transmits to Kidney, it is called Thief Evil, difficult to cure. When dysentery precedes diarrhea, it is called Minor Evil, easy to recover. If Jueyin Meridian dysentery presents with deep and slow pulse, and cold extremities, use Mahuang Xiao Xuming Tang (Ephedra Minor Continuation of Life Decoction) to induce sweating. If body is cold with spontaneous sweating, urination is free, pulse is faint with vomiting, use Jiangshui San (Well Water Powder) to warm. If pulse is rapid with body movement, urgency and loud sounds, use Baizhu Shaoyao Tang (Atractylodes and Peony Decoction). If pulse is deep with body stillness and inability to eat, use Jiangfu Tang (Ginger-Aconite Decoction). If body is heavy and limbs cannot move, use Zhufu Tang (Atractylodes-Aconite Decoction). I consider that for the aforementioned syndromes, if there is food stagnation, use Liujunzi Tang to tonify Spleen and Stomach and digest food. If Stomach Qi sinks, use Buzhong Yiqi Tang to tonify Spleen and Stomach and raise Yuan Qi. If wind injures the intestines and stomach, use Shenzhu San to tonify Spleen and Stomach and resolve exterior pathogens. If phlegm accumulates in the Middle Jiao, use Liushen Wan to tonify Spleen and Stomach and resolve phlegm stagnation. Generally, for Spleen and Stomach weakness, one should tonify Middle Qi and regulate diet. An old woman developed dysentery after eating due to anger, with tenesmus and prolapse of the anus; this was sinking of Spleen Qi. Use a large dose of Liujunzi plus Aconite, Nutmeg, and baked Aucklandia each 1 qian, Evodia 5 fen, Drynaria and Schisandra each 1.5 qian. After two doses, all symptoms retreated. Only lower abdominal fullness remained; this was Liver Qi stagnating in the Spleen. Administer Tiaozhong Yiqi plus Aconite and 5 fen Aucklandia; after four doses, she recovered. Later, she felt saltiness in the mouth; this was Kidney deficiency with water flooding. Administer Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) for two doses, and she recovered instantly. Again, due to improper diet, unformed stools, and cold extremities, this was recurrence of Spleen-Stomach injury. Administer Liujunzi plus 5 fen Aconite and Bawei Wan (Eight-Ingredient Pill), and she recovered. My late mother suffered dysentery in midsummer, with abdominal pain and endless defecation, irritability and thirst for soup, slight relief of abdominal pain when pressed, and a pulsating, forceful pulse. This was deficiency of True Qi and excess of pathogenic factor. Urgently use 5 qian Ginseng, 3 qian each of Atractylodes and Poria, 1 qian each of Tangerine Peel, Roasted Licorice, Bupleurum, and Aconite. After taking it, she slept; waking up, she asked for food, and pulse and symptoms retreated instantly. After another dose, she was safe. This is taking symptoms rather than pulse. At that time, others suffering the same condition who took dysentery medicines all died; what a pity.
[Chen Wenzhong] Once, a woman suffered dysentery for forty days, and various medicines failed to cure her. I summoned her for diagnosis; the six pulses were deep and weak. Generally, the pulse for dysentery should be deep and weak. Use Shiquan Dabu Tang (Ten-Thousand Great Tonification Decoction) decocted with ginger and jujube, add half a spoon of white honey, boil a few more times, and take it; she recovered. In the summer and autumn of the Jiazi year, the nephew of Marshal Zhao suffered severe dysentery. The pediatrician had not arrived, so I diagnosed him. The six pulses were flat and fine. Observing the symptoms, he said it was blood dysentery, but actually it was just bloody water. I recalled the indications for Tiaozhong Tang, which treats early summer to early autumn, sudden cold striking intense heat, knotting into the four limbs causing high fever and headache, cold injuring the Stomach causing diarrhea with blood, water, or redness, high fever, drowsiness, and rapid pulse. It is suitable to take this. So I compounded it, removed Rhubarb, and she recovered after taking it. Another woman had incessant diarrhea, resembling dysentery but not quite, resembling blood but not quite, the color like turbid wine. I diagnosed her; the six pulses were imperceptible. Others used hot medicines and mineral pills, causing irritability. I first used Baidu San several doses, decocted with aged rice, then Weifeng Tang with millet decocted and taken; she recovered. Tiaozhong Tang without Rhubarb also treats this condition.
[Cheng Wuji] Baitouweng Tang Treats heat dysentery with bleeding, lasting months without healing.
Baitouweng (Pulsatillae Radix, 2 liang) Huang Lian (Coptidis Rhizoma) Huangbai (Phellodendri Cortex) Qinpi (Fraxini Cortex) (each 3 liang)
Coarsely crush the above. Take 4 qian each time, with 1.5 cups of water, decoct to 0.7 cup, strain, and take warm at any time.
Shenzhu San Treats wind injury in spring causing sunken diarrhea in summer. Greatly treats wind-cold headache, stiffness of neck and back, runny nose.
Cangzhu (Atractodis Rhizoma, 1 jin) Gaoben (Ligustici Wallichii Rhizoma et Radix) Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 6 liang) Qianghuo (Notopterygii Rhizoma et Radix, 4 liang) Fencǎo (Licorice, 2.6 qian) Xixin (Asari Radix et Rhizoma, 1.6 qian)
Make into coarse powder. Take 3 qian each time, with 1 cup of water and 3 slices of ginger, decoct to 0.7 cup. To induce sweating, add scallion. Strain and take slightly warm at any time.
Liushen Wan Treats red and white dysentery.
Shenqu (Massa Medicata Fermentata, make into powder separately, reserve for paste) Maiya (Hordei Fructus Germinatus) Fuling (Poria) Zhike (Aurantii Fructus) Muxiang (Aucklandiae Radix) (baked, double for white dysentery) Huanglian (Coptidis Rhizoma) (double for red dysentery, equal parts)
Make into powder. Use Shenqu powder to make paste and form pills the size of Sophora seeds. Take fifty pills each time. For red dysentery, swallow with Licorice decoction; for white dysentery, with dried ginger decoction; for mixed red and white, with dried ginger and licorice decoction. Dongshan Yaodian Jiang said: This was transmitted by capital physicians. I detail that this formula contains Huanglian to resolve summerheat toxin, harmonize Zang-Fu, and thicken intestines and stomach. Muxiang warms Spleen and Stomach, expels pathogens, and stops diarrhea. Zhike broadens intestines and stomach. Fuling promotes water passage. Shenqu and Maiya digest stagnation. Truly a key medicine for the dysentery category.
Sanhuang Shuai Ai Tang Treats cold-heat for four or five days with severe purging, intermittent heat dysentery; Baibotong Tang and other medicines often fail to stop it. It is suitable to take this decoction to remove heat and stop dysentery. Some make it into pills, swallowing forty to fifty pills with cooked water; it is effective for epidemic toxic dysentery.
Huangqin (Scutellariae Radix) Huanglian (Coptidis Rhizoma) Huangbai (Phellodendri Cortex) (each 2 fen) Shuai Ai (Artemisiae Argyi Folium, half, egg-sized)
Coarsely crush the above. Take 3 qian each time, with 1 cup of water, decoct to 0.7 cup, strain, and take warm at any time.
Sishun Fuzi Tang
Sheng Fuzi (Aconiti Lateralis Radix Preparata, peeled and de-navelled) Baijiang (Zingiberis Rhizoma Preparatum) Gancao (Licorice) Renshen (Ginseng) (each 1 liang)
Coarsely crush the above. Take 4 qian each time, with 2 cups of water, decoct to 0.7 cup, strain, and take on an empty stomach. For vomiting, diarrhea, and abdominal pain, add 0.5 liang Cinnamon. For difficult urination, add 0.5 liang Poria. Generally, for dysentery, even if the body is cold with cold extremities, spontaneous cold sweat, and deep-hidden six pulses, do not lightly use Aconite. It is mostly due to latent summerheat contracting this disease. There are also cases of spontaneous cold sweat, cold extremities, and weak six pulses, but with cold back and dirty face, or face like painted oil, dry teeth, irritability, and thirst with desire to drink; this is a latent summerheat syndrome. Xiaochaihu Tang, Wuling San, and Jiuzheng Huanglian Wan will certainly be effective. Students should ponder carefully.
Sanjian Dan
Yangqishi (Aquinitus Semen, flown, 0.5 liang) Zhonglu Fen (Stalactitum Pulvis, 1 liang) Da Fuzi (Aconiti Lateralis Radix Preparata, baked, take powder 0.5 liang, use half for medicine, half for paste)
Use Aconite paste to form pills the size of Sophora seeds. Take five to ten pills each time, with warm wine on an empty stomach. If thirsty, take with Ginseng decoction.
Jiawei Shenfu Tang
Da Fuzi (Aconiti Lateralis Radix Preparata, 2.5 liang, baked) Da Renshen (Ginseng, 5 liang)
Coarsely crush the above two. Take 4 qian each time, with 2 cups of water, 10 slices of ginger, 15 cloves, and a pinch of rice, decoct to 0.7 cup, take warm on an empty stomach.
Xiangrong Wan Treats critical dysentery.
Shexiang (Musk, 0.5 qian, ground separately, add at time of use) Lurong (Cervi Cornu Pantotrichum, 1 liang, fire-burned to remove hair, fried in butter until yellow, made into powder, mix with musk evenly)
Boil jujube flesh with rapeseed stem to form pills the size of Sophora seeds. Take fifty pills each time on an empty stomach. Miu Lifu said: Physicians adding 0.5 liang of Frankincense per batch are especially effective. During the Shaoxing era, many died from dysentery. Any usual dysentery medicines like Poppy Shell should not be taken orally; only taking this medicine and Meizi Wan (Myrobalan Pill) cured them.
Tiaozhong Tang
Gegen (Puerariae Lobatae Radix) Huangqin (Scutellariae Radix) Shaoyao (Paeoniae Radix) Jiegeng (Platycodonis Radix) Gaoben (Ligustici Wallichii Rhizoma et Radix) Chi Fuling (Red Poria) Baizhu (Atractodis Rhizoma) Gancao (Licorice, roasted, equal parts)
Coarsely crush the above. Take 3 qian each time, with 1 cup of water, decoct to 0.7 cup, strain, take warm, and take again after a while.
Weifeng Tang Treats wind-cold invading intestines and stomach vacuously, causing undigested food and water, projectile diarrhea, or intestinal-stomach damp-toxin, passing bean-jelly-like substance, or passing blood stasis.
Renshen (Ginseng) Baifuling (White Poria) Xiong (Angelicae Sinensis Radix) Rougui (Cinnamomi Cortex) Danggui (Angelicae Sinensis Radix) Baishaoyao (White Peony Root, fried) Baizhu (Atractodis Rhizoma, fried, equal parts)
Take 2-3 qian each time, add a few millet grains, decoct in water, take hot on an empty stomach before meals.
Shuizhu Muxiang Wan Treats chronic dysentery with tenesmus, day and night without limit.
Yingsuke (Pericarpium Papaveris, remove skin, 3 liang) Qingpi (Citri Reticulatae Pericarpium Viride, remove white pith) Gancao (Licorice, roasted, each 2.4 liang) Hezi (Terminaliae Chebulae Fructus, baked, remove core, 8 liang) Danggui (Angelicae Sinensis Radix) Muxiang (Aucklandiae Radix) (each 6 liang)
Make into powder. Refine honey to form pills the size of quail eggs. Take one pill each time, dissolve in water, take on an empty stomach.
Wuji Wan Treats Stomach Meridian heat, incessant diarrhea and dysentery, inability to eat, incessant abdominal pain.
Huanglian (Coptidis Rhizoma, fried) Wuzhuyu (Evodiae Fructus, remove stem, fried) Baishaoyao (White Peony Root) (each 5 liang)
Make into powder. Form pills the size of Sophora seeds with wheat flour paste. Take thirty pills each time before meals with rice water.
Shengyang Chushi Fangfeng Tang If stool is blocked, or tenesmus, frequent trips to the toilet but inability to pass stool, or white pus, or accompanied by bleeding, this is constraint and blockage. Use this decoction to raise Yang, then Yin Qi will descend naturally. Do not use purgatives.
Cangzhu (Atractodis Rhizoma, soaked in rice water, 4 qian) Fangfeng (Saposhnikoviae Radix, 2 qian) Baizhu (Atractodis Rhizoma, fried) Baifuling (White Poria) Baishaoyao (White Peony Root, fried, each 1 qian)
First decoct Cangzhu in 1.5 cups of water to 1 cup. Add other herbs and decoct to 0.8 cup. Take hot before meals. Food entering the Stomach, its Qi rises, transports to Heart and Lungs, then descends. If Spleen and Stomach are injured, unable to rise, it flows down to Liver and Kidney causing diarrhea and dysentery. The method should be to raise and tonify Middle Qi, not to drain downwards. This is Dongyuan's development of theories not previously discussed.
Sanhuang Wan Treats heat dysentery with abdominal pain, or mouth and tongue ulcers, throat and tooth pain, and all excess fire syndromes.
Huangqin (Scutellariae Radix) Huanglian (Coptidis Rhizoma) Huangbai (Phellodendri Cortex) (equal parts)
Make each into powder separately. Form pills the size of Sophora seeds with water paste. Take seventy to eighty pills each time with plain water.
Shaoyao Tang Treats heat dysentery with bleeding and tenesmus. The Classics say: "Urine and stool with pus and blood, this is when Qi moves and Blood stops." Moving Blood makes pus and blood heal spontaneously; regulating Qi removes tenesmus spontaneously.
Shaoyao (Paeoniae Radix, fried, 1 liang) Danggui (Angelicae Sinensis Radix) Huanglian (Coptidis Rhizoma, fried, each 0.5 liang) Binglang (Arecae Semen) Muxiang (Aucklandiae Radix) Gancao (Licorice, roasted, each 2 qian) Gui (Cinnamomi Ramulus, 2.5 qian) Huangqin (Scutellariae Radix, fried, 3 qian)
Take 0.5 liang each time, decoct in water. If not reduced, add Rhubarb. Besides this syndrome, there are cases due to Middle Qi weakness and Spleen Qi constraint. Treatment requires careful examination.