经曰∶饮食不节，起居不时，阴受之则入五脏，填满闭塞，下为飧泄，久为肠癖。夫飧泄者，水谷不化
也；肠癖者，下痢是也。小儿之病，伤食最多，内有宿食停积，更受外感，则成痢矣。古今方书，以其闭滞不
利，故
又谓之滞下，其证里急后重，或垢或血，或见五色，或多红紫，或痛或不痛，或呕或不呕，或为发热，或为恶
寒。此证之阴阳虚实，最宜详审，庶不致误。仍当以脉证辨之∶凡身热作渴，脉数有力而能食者，为热；身凉
不渴，脉沉无力而不能食者，为寒。
初起腹中苦痛，里急后重者为实，宜急下之，集成沆瀣丹、集成三仙丹二药同服，立应。
如兼外感者，必身有寒热，不可遽下。凡痢由外感而发者最多，急宜发散。若下之早，必致引邪入里，而为
绵延之证，以仓廪散疏解之。
因伤风得之者，则纯下清血。盖风伤其阴络，致血不循经，所以血妄下，宜胃风汤。
赤白相兼者∶心主血，因伤热得之，则心移热于小肠，故赤者从小肠来；肺主气，因伤热得之，则肺移热
于大肠，故白者从大肠来。皆以芍药汤治之，调血则便脓愈，行气则后重除。此治痢之要法也。又法，以黄连
阿胶丸加当归、木香治血痢，于血中行气；以胃苓丸加当归、白芍治白痢，于气中养血。有积者，治痢保和丸。
痢久不止，名休息痢，切不可止涩，和中丸最妙。后有集成至圣丹，专治久痢，百不失一。
有泄泻变痢者，有痢变泄泻者。先泻后变痢者，脾传肾也，为贼邪，难治；先痢后变泻者，肾传脾也，为
微邪，易治。盖初泻变痢者，此气病传入血中，宜养血为主，加调气之药，不可误下，以伤胃气；初痢变泻
者，血病传入气中，以调气为主，加养血之药，不可收涩，恐毒瓦斯留而不去，复成痢也。泻变痢者，加味四物
汤；痢变泻者，加味四君子汤。
痢久不止，脾胃受伤，中气下陷，则为脱肛，热毒上逆，则食入便吐，不思乳食，谓之噤口；久痢阴伤，肾
气虚败，则两膝红肿，谓之鹤膝。
脱肛者，胃气下陷，后重不除，努挣太过，故肠头脱出，宜养血调气，微加升提之品，则痢止肛自收矣，
升麻汤。外用洗法、托法。
噤口者，乃胃虚逆气上冲而吐也，有不思饮食，皆虚损也，宜参苓白术散米汤调服。凡痢疾能食者吉，
不能食者凶。
鹤膝者，两膝红肿，如鹤之膝。小儿痢后多有此证，乃肾虚之极，宜补肾地黄丸加牛膝、鹿茸。
痢疾腹胀，中气虚也，胃苓丸调之。倘因毒瓦斯未尽，庸流误服涩药而致腹胀者，为实也，不可作虚治，保
和丸消导之。
痢疾不治证∶痢见五色，五脏俱败；痢如烟尘水，如屋漏水；下痢久，肛门如竹筒；如鱼腥；久痢唇红
舌胎，气促心烦，坐卧不安，大渴饮水，面容似朱者。皆死证也。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: If diet is unregulated and daily life lacks regularity, pathogenic factors entering through the Yin aspects will penetrate the Five Zang organs, causing them to become full and obstructed. Downward, this manifests as *sunxie* (stool containing undigested food), and over time, it develops into *changpi* (dysentery). *Sunxie* refers to the inability to digest food and water; *changpi* refers to dysentery. Among children's diseases, food injury is most common. If there is accumulated retained food internally, compounded by external pathogenic invasion, dysentery results. Ancient and modern medical texts, noting the obstruction and lack of free flow, also call this condition "Zhi Xia" (Stagnant Downward Flow). Its symptoms include tenesmus (urgent need to defecate with a feeling of incomplete evacuation), stool containing mucus or blood, mixed colors, predominantly red-purple, pain or no pain, vomiting or no vomiting, fever or aversion to cold. The Yin-Yang and deficiency-excess nature of this condition must be carefully examined to avoid misdiagnosis. Differentiation should be based on pulse and symptoms: if the body is hot, thirsty, the pulse is rapid and forceful, and the patient can eat, it is a Heat syndrome; if the body is cool, not thirsty, the pulse is deep and weak, and the patient cannot eat, it is a Cold syndrome.
At the onset, if there is severe abdominal pain and tenesmus, it is an Excess syndrome, requiring urgent purgation. Taking *Jicheng Hangxie Dan* and *Jicheng Sanxian Dan* together yields immediate results. If accompanied by external contraction, there will be alternating chills and fever, and purgation should not be rushed. Most cases of dysentery are triggered by external pathogens, requiring prompt dispersing methods. Premature purgation will draw pathogens inward, leading to lingering chronic conditions; in such cases, *Canglin San* should be used for dispersion and resolution.
If contracted from wind injury, pure clear blood is passed. This is because wind damages the Yin collaterals, causing blood to fail to follow its normal pathways and bleed recklessly downward; *Weifeng Tang* is appropriate.
When red and white discharge are mixed: The Heart governs Blood. Injury by heat causes the Heart to transfer heat to the Small Intestine, hence the red component originates from the Small Intestine. The Lung governs Qi. Injury by heat causes the Lung to transfer heat to the Large Intestine, hence the white component originates from the Large Intestine. Both are treated with *Shaoyao Tang*. Harmonizing the blood resolves pus in the stool; moving Qi eliminates tenesmus. This is a key method for treating dysentery. Another method uses *Huanglian Ejiao Wan* added with *Danggui* and *Muxiang* to treat bloody dysentery, moving Qi within the Blood; *Weiling Wan* added with *Danggui* and *Baishao* treats white dysentery, nourishing Blood within Qi. If there is accumulation, *Zhili Baohe Wan* is used.
Dysentery that persists for a long time is called "Resting Dysentery." Astringents must strictly be avoided; *Hezhong Wan* is excellent. Later, *Jicheng Zhisheng Dan* was developed specifically for chronic dysentery, with high efficacy.
Some cases involve diarrhea transforming into dysentery, or dysentery transforming into diarrhea. Diarrhea transforming into dysentery represents the Spleen transmitting disease to the Kidney, termed "Thief Evil," which is difficult to treat. Dysentery transforming into diarrhea represents the Kidney transmitting disease to the Spleen, termed "Minor Evil," which is easy to treat. Generally, initial diarrhea transforming into dysentery indicates a Qi-level pathology penetrating into the Blood level; treatment should focus on nourishing Blood with Qi-moving herbs, avoiding mistaken purgation that would damage Stomach Qi. Initial dysentery transforming into diarrhea indicates a Blood-level pathology penetrating into the Qi level; treatment should focus on regulating Qi with Blood-nourishing herbs, avoiding astringents that might trap pathogens and cause recurrence. For diarrhea transforming into dysentery, use *Jiawei Siwu Tang*; for dysentery transforming into diarrhea, use *Jiawei Sijunzi Tang*.
Chronic dysentery injures the Spleen and Stomach, causing Middle Qi to sink, leading to rectal prolapse. Heat toxins rising upward cause food to be vomited immediately upon ingestion and loss of appetite for milk/food, known as "Jinkou Li" (Clamped-Mouth Dysentery). Chronic dysentery damaging Yin and failing Kidney Qi leads to redness and swelling of both knees, known as "Crane Knee" (Knee deformity).
Rectal prolapse occurs due to sinking Stomach Qi, unresolved tenesmus, and excessive straining, causing the intestine to protrude. Treatment involves nourishing Blood and regulating Qi, with mild lifting herbs, so that when dysentery stops, the anus retracts naturally. *Shengma Tang* is used. External washing and supporting methods are also applied.
"Clamped-Mouth Dysentery" results from Stomach deficiency and rebellious Qi rushing upward causing vomiting, accompanied by loss of appetite, all indicating deficiency and damage. *Shenling Baizhu San* administered with rice soup is indicated. Ability to eat in dysentery patients is auspicious; inability to eat is ominous.
"Crane Knee" presents as redness and swelling of both knees, resembling a crane's knee. Children often develop this after dysentery, indicating extreme Kidney deficiency. *Bushen Dihuang Wan* added with *Niuxi* and *Lurong* is prescribed.
Abdominal distension in dysentery indicates deficiency of Middle Qi, treated with *Weiling Wan*. However, if distension results from residual pathogens and misuse of astringents by incompetent physicians, it is an Excess syndrome and should not be treated as deficiency; *Baohe Wan* is used to resolve stagnation.
Untreatable signs of dysentery: Passage of five-colored stool indicates failure of all Five Zang organs. Stool resembling dust/smoke water or leaking roof water. Prolonged dysentery with an anus like a bamboo tube. Foul odor like fish. Chronic dysentery with red lips, abnormal tongue coating, shortness of breath, restlessness, intense thirst, and a face red as cinnabar. All these are fatal signs.