（附∶脱肛）
总括 痢名滞下古来言，赤白肠中痛可怜；补涩浓肠须缓用，治之当以痢为先。
脉法 《内经》曰∶肠癖下血，身热则死，寒则生。肠癖下白沫，脉沉则生，浮则死。
《内经》曰∶溲而便脓血，知气行而血止也。又曰∶少阳在泉，火淫所胜，民病注泄赤白。钱仲阳曰∶泻痢黄赤黑
皆热也。泻痢青白，米谷不化皆冷也。丹溪曰∶赤痢属血，自小肠来；白痢属气，自大肠来，皆属湿热之气。如夏秋之
间，溽暑时行，此湿热之气，生于外感者也。恣饮酒酪生冷，耽嗜肉食肥甘，此湿热之气，生于内伤者也。内外交感乃
成痢疾。若诸书概以赤为热、白为寒则误矣。其有白痢得卒热而愈者，亦原素禀虚弱，肠胃虚寒耳。然有手足指冷，时
欲饮热为验也。其有赤白兼下者，气血俱病也。下如豆汁色者，湿胜也。如五色之相染，五脏俱受病也。纯血者，热毒
入深也。鱼脑色者，脾虚不运，陈积脱滑下凝也。如鼻涕冻胶者，脏腑虚脱滑也。如白脓者，虚坐弩圊而出，气受热邪
瘀结也。如屋漏水，尘腐色者，元气惫弱之甚也。后重里急，至圊而不能便下，窘迫痛甚，大肠经气滞不通，湿热内甚
也。后重里急，初病元气未虚，里急甚者下之，下后余积未清，不可骤补，宜化滞清热荡涤之，直候积尽，方可调补气
血。今人不问新久，便行止涩，为害不浅。善治者辨明寒热虚实气血之症，而行汗下清温补涩之法可也。
丹溪曰∶泻属脾而痢属肾，先水泻而后脓血者，此脾传肾，贼邪难愈。先脓血而后水泻者，此肾传脾，微邪易愈。
凡久痢用温药止之，然须以陈皮为佐，恐涩则常作痛也。夏秋之间，忽有暴寒，折于暴热无所发散，客于皮肤之中，
发于外则为疟，发于内则为痢，内外俱发则为疟痢耳。
有初病挟外感者，发热恶寒身首俱痛，此为表症，宜以微汗而解，则痢自止。不止者以柴苓汤和之，不可遽下遽止
也。
初得而腹痛窘迫者，此肺金之气郁于大肠之间，实者必推荡之。此通因通用之法，宜大承气汤或谓胃承气汤以下之。
下后不止者，以河间芍药汤和之。
下痢赤积，身热腹痛，里急后重者，宜芍药汤调天水散；下痢白积腹痛，里急后重者，用芍药、黄连汤调天水散；
血痢久不止者，宜煎四物汤下黄连阿胶丸。有下黑积中常有紫黑色而又痛甚者，此属死血症，宜桃仁承气汤下之。如受
痛既久，气血俱伤，故缠绵而赤白兼下，脾胃气陷或经年者，名休息痢，宜阿胶梅连丸。有积毒之气上冲而呕恶者，清
解为主，人参败毒散。有胃气虚寒而呕恶者，温补为主，附子理中汤。噤口者因脾胃湿热之毒，熏蒸清道而上，以致胃
口闭塞，而成不食之症。亦有脾胃虚而不能食者，亦有误服痢药致药毒犯胃而不食者，亦有服温涩药太早邪气闭遏胃
口而不食者。或用石莲肉以通心气，败毒散以散毒邪，山药以补脾胃。果能开胃口而进饮食乎！其毒瓦斯上冲者，宜丹溪
方，以人参、黄连二味呷之，得一口下咽便好。一方加石莲肉。其脾胃虚者，用仁斋法以参苓白术散加石菖蒲末、陈粳
米汤调下。此方有莲肉、山药，胸次一开自然能食。有时疫作痢，传染相似，宜推明运气之胜负以治之。所谓胜负者，
不越六气之变也。四时疫痢，宜首用败毒散加陈皮、陈仓米，名仓廪汤，随所胜之气加减用之。
（批∶河间曰∶行血则便脓血自愈，和气则后重自除。）
《病机要》曰∶后重则宜下，腹痛则宜和，身重则宜除湿，脉弦则宜去风。
痢属湿热与食积，芩连白芍皆入此。木香枳壳佐槟榔，主方便用甘草炙。腹痛当归缩砂仁，后重生芍炒滑石。红入
桃仁芎与归，白增炒滑茯苓术。初起欲下倍大黄，食积山楂加枳实。如力倦气少恶食，此为挟虚症，宜用白术归身尾，
甚者加人参、陈皮补之，虚回而痢自止。
腹痛因肺金之气郁在大肠，实则可下，虚则桔梗发之。有积毒之气上冲而呕恶者，清解为主，人参败毒散。有胃气
虚寒而呕恶者，温补为主，附子理中汤。
夫痢虽有赤白之分，总是暑而成，初下皆宜利之，而以川黄连为君，川连能去心经伏热，亦去脾经湿热。条芩去大
肠经热，主治下痢脓血。白芍和脾血而治腹痛，川归益血止痛，槟榔治滞气而除后重，木香、枳壳行滞宽中，山楂、麦
芽消导食积，或加大黄芒硝，小水不利或加滑石木通，皆治痢之通剂也。白痢湿热伤气分，用白术益脾气，陈皮理滞气，
茯苓滑石渗湿热之气。久则胃弱气虚，必以四君子加黄芩为主剂。赤痢湿热伤血分，用归芎养血、地榆凉血、桃仁活血
中之滞。久亦胃弱气虚，必以四物加阿胶为主剂。如赤白相兼，气血俱伤用四君子、陈皮以理气，四物、桃仁以理血。
小便赤涩者，小肠经湿热胜也，用木通、泽泻、栀子以利之。大便燥涩者，大肠经湿热甚也，用苍术、槐花、条芩以清
之。又有久痢后重不除，此大肠下坠、气虚下陷也，用升麻、参、 以提其气，活血行气之剂断不可用。亦有寒痢者，
用理中及姜桂之类，如诸剂调理，日久不愈，此属虚寒脱滑，可于温寒补虚中，复加龙骨、赤石脂、栗壳、乌梅、诃子、
肉果收涩之药而自愈矣。
〔附方〕
柴苓汤 柴胡 茯苓 半夏 黄芩 白术 泽泻 人参 枳实 甘草
大承气汤 大黄 浓朴 枳实 芒硝
调胃承气汤 芒硝 大黄 甘草
河间芍药汤 木香 芍药 黄芩 黄连 大黄 槟榔 桂枝 归尾 甘草
天水散 滑石（六两，水飞） 甘草一两（为末）
芍药黄连汤 黄连 当归 芍药 甘草
四物汤 熟地 当归 芍药 川芎
黄连阿胶丸 黄连 阿胶 茯苓
桃仁承气汤 大黄 桂枝 芒硝 桃仁 甘草
阿胶梅连丸 阿胶 赤茯苓 乌梅 白芍 黄柏 黄连 干姜 当归
人参败毒汤 柴胡 桔梗 人参 羌活 独活 川芎 茯苓 枳壳 前胡 甘草
理中汤 见惊风症，加附子。
又方 赤芍（三钱） 山楂肉（三钱） 甘草（一钱半） 木香（七分） 槟榔（一钱）
人参白术散 人参 白术 茯苓 桔梗 黄连 藿香 苡仁 砂仁 山药 扁豆 甘草
一说治腹痛，老姜、细茶各三钱煎服。
奇方 红菱四支连壳打碎，老姜三钱，加酒一钟炖熟，和红糖服即止。
治痢久不愈者用白萝卜取汁一钟，蜜一钟共煎滚，调匀服立止。
又奇方 落帚叶煎汤，连叶服，即愈。
又旱莲汁和酒饮，立愈。
又王瓜藤灰酒下，即愈。
又服八灰散，即止。
八灰散 棕灰 发灰 莲蓬 艾 当归头 松皮 侧柏 椿根皮
又奇方 王瓜藤（连茎叶经霜者），晒干作灰，出火毒，以香油调，纳脐中即愈。
又金华散 专治红白痢，久不愈者，服之神效。椿根白皮二两，用臭者去粗皮，向东南取松花三钱、地榆二钱、
干荷叶二钱，贴水阴干，用其中段，为细末，每服三分。红痢蜜调，白痢黑糖调，红白蜜糖调，后加温汤少许，空心服。
忌面食荤腥油腻物。
(Attachment: Rectal Prolapse)
General Summary
Dysentery has been called "Zhi Xia" (Stagnation Downward) since ancient times; the patient suffers from unbearable pain in the intestines with mixed red and white pus and blood. Treatment should prioritize eliminating stagnation, while tonifying and astringent herbs must be used cautiously and slowly.
Pulse Diagnosis
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: In Chang Pi (Intestinal Dysentery) with bloody stool, if the body is hot, death ensues; if cold, life is preserved. In Chang Pi with discharge of white mucus, if the pulse is deep, life is preserved; if floating, death ensues.
The *Huangdi Neijing* also says: When urine is turbid and stool contains pus and blood, it indicates that Qi movement is smooth and bleeding will stop. It also states: When Shaoyang governs the Earthly Branch (the latter half of the year), excessive Fire causes the people to suffer from Zhu Xie (acute diarrhea) with red and white discharge. Qian Zhongyang (Qian Yi) said: Diarrhea and dysentery that are yellow, red, or black belong to Heat; those that are green or white, containing undigested food, belong to Cold. Zhu Danxi said: Red dysentery belongs to the Blood level and originates from the Small Intestine; white dysentery belongs to the Qi level and originates from the Large Intestine; both belong to Damp-Heat. If during summer and autumn, humid heat prevails, this Damp-Heat arises from external contraction; if one indulges in alcohol, dairy, raw/cold foods, and favors meat and rich/greasy foods, this Damp-Heat arises from internal injury. Internal and external factors interact to form dysentery. If all books generally consider red as Heat and white as Cold, this is an error. Those who had white dysentery but recovered due to sudden exposure to heat originally had weak constitutions and deficiency-cold in the stomach and intestines. However, coldness in the fingers and toes and a desire for hot drinks serve as verification. If red and white discharges occur together, both Qi and Blood organs are diseased. Discharge resembling bean juice indicates excess Dampness. Discharge mixed with five colors indicates disease in all five Zang organs. Pure blood discharge indicates deep penetration of Heat-Toxin. Discharge resembling fish brain indicates Spleen deficiency failing to transform, causing old accumulation to slip down and coagulate. Discharge resembling nasal mucus jelly indicates visceral deficiency leading to slipping uncontrollably. White pus discharge, occurring after tenesmus without actual defecation, indicates Qi affected by Heat-Toxin and stasis. Discharge resembling roof leak water or rotting dust indicates extreme exhaustion of Yuan Qi. Tenesmus (heavy feeling in the rectum) and urgency (straining in the lower abdomen), where one goes to the toilet but cannot pass stool easily, accompanied by severe pain, indicates stagnation and blockage of the Large Intestine channel Qi with severe internal Damp-Heat. In early-stage dysentery with tenesmus and urgency, if Yuan Qi is not yet deficient and urgency is severe, purgation is indicated. After purgation, if residual accumulation remains, immediate tonification is contraindicated; instead, methods to resolve stagnation, clear heat, and purge should be used until the accumulation is cleared, before regulating and tonifying Qi and Blood. Nowadays, people indiscriminately use astringents regardless of whether the condition is new or chronic, causing significant harm. Skilled practitioners should distinguish symptoms of Cold/Heat and Deficiency/Excess in Qi and Blood, and apply sweating, purging, clearing, warming, tonifying, and astringing methods accordingly.
Zhu Danxi said: Diarrhea belongs to the Spleen, while dysentery belongs to the Kidney. Water diarrhea preceding pus and blood indicates transmission from Spleen to Kidney (Thief Pathogen), which is difficult to cure. Pus and blood preceding water diarrhea indicates transmission from Kidney to Spleen (Minor Pathogen), which is easy to cure. For chronic dysentery, warm herbs are used to stop it, but Chen Pi (Tangerine Peel) must be added as an assistant to prevent frequent pain caused by excessive astringency. During summer and autumn, sudden cold may suppress sudden heat, preventing its dispersion; the pathogen lodges in the skin. Manifesting externally, it becomes Malaria; manifesting internally, it becomes Dysentery; manifesting both internally and externally, it becomes Malaria-Dysentery.
In cases where initial illness involves concurrent external contraction, symptoms include fever, aversion to cold, and pain in the head and body, indicating a Exterior Syndrome. Mild diaphoresis (sweating) should be induced to resolve it, after which dysentery stops naturally. If it does not stop, Chai Ling Tang (Bupleurum and Poria Decoction) is used to harmonize it; abrupt purging or astringing is contraindicated.
For recent onset with abdominal pain and urgency, this indicates Lung Metal Qi stagnating in the Large Intestine. Excess patterns require pushing out (purging). This is the method of "treating obstruction with unblocking agents." Da Cheng Qi Tang (Major Order the Qi Decoction) or Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) are suitable for purging. If dysentery persists after purging, He Jian Shao Yao Tang (He Jing's Peony Decoction) is used to harmonize.
For dysentery with red accumulation, fever, abdominal pain, tenesmus, and urgency, Shao Yao Tang (Peony Decoction) combined with Tian Shui San (Heavenly Water Powder) is appropriate. For dysentery with white accumulation, abdominal pain, tenesmus, and urgency, Shao Yao Huang Lian Tang (Peony and Coptis Decoction) combined with Tian Shui San is appropriate. For persistent bloody dysentery, Si Wu Tang (Four Substances Decoction) decocted to swallow Huang Lian E Jiao Wan (Coptis and Donkey-Hide Gelatin Pill) is recommended. If black accumulation often contains purple-black material with severe pain, this belongs to Dead Blood Syndrome; Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) is used for purging. If pain persists for a long time, damaging both Qi and Blood, resulting in lingering mixed red and white discharge, or Spleen/Stomach Qi sinking lasting years, it is named Xiu Xi Li (Resting Dysentery); E Jiao Mei Lian Wan (Donkey-Hide Gelatin, Smoked Plum, and Lotus Seed Pill) is appropriate. If toxic accumulation rises upward causing nausea and vomiting, clearing and resolving is primary; Ren Shen Bai Du San (Ginseng and Imperata Decoction) is used. For nausea and vomiting due to Stomach Qi deficiency and cold, warming and tonifying is primary; Fu Zi Li Zhong Tang (Aconite and Magnolia Decoction) is used. Jin Kou Li (Closed-Mouth Dysentery) occurs because Damp-Heat toxin in the Spleen and Stomach steams upward through the clear pathways, closing the stomach gate and causing inability to eat. Some cannot eat due to Spleen/Stomach deficiency; some due to misusing dysentery medicines causing drug toxicity to offend the Stomach; some due using warming/astringent herbs too early, trapping pathogenic Qi and closing the stomach gate. Shi Lian Rou (Stone Lotus Seed Flesh) can be used to open Heart Qi, Bai Du San to scatter toxic pathogens, and Shan Yao (Chinese Yam) to tonify Spleen and Stomach. Can this truly open the stomach gate and allow eating? For rising toxic vapors, Zhu Danxi's formula using Ren Shen (Ginseng) and Huang Lian (Coptis) to be sipped and swallowed is effective; even one mouthful helps. Another formula adds Shi Lian Rou. For Spleen/Stomach deficiency, Ren Zhai's method uses Ren Shen Bai Zhu San (Ginseng and Atractylodes Macrocephala Decoction) plus Shi Chang Pu powder, taken with aged rice soup. This formula contains lotus seed and Chinese yam; once the chest opens, eating becomes natural. In epidemic dysentery cases with similar contagious symptoms, treatment should follow the principles of Luck (Yun Qi) victory and defeat. Victory and defeat refer to changes in the Six Qi. For seasonal epidemic dysentery, start with Bai Du San plus Chen Pi and Chen Cang Mi (aged rice), named Cang Lin Tang (Granary Decoction), adjusting based on the prevailing Qi.
(Commentary: Liu Hejian said: Moving blood heals pus and blood in stool; harmonizing Qi eliminates tenesmus.)
*Bing Ji Yao* states: Tenesmus requires purging; abdominal pain requires harmonizing; heaviness requires removing dampness; wiry pulse requires dispelling wind.
Dysentery belongs to Damp-Heat and Food Stagnation; Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Bai Shao (White Peony Root) enter these channels. Mu Xiang (Aucklandia Root) and Zhi Ke (Bitter Orange) assist Bing Lang (Areca Seed); Gan Cao (Licorice Root), honey-fried, is used conveniently in the main formula. For abdominal pain, add Dang Gui (Angelica Sinensis) and Suo Sha Ren (Amomum Fruit); for tenesmus, use fried Bai Shao and Hua Shi (Talcum). For red discharge, add Tao Ren (Peach Kernel), Chuan Xiong (Ligusticum Rhizome), and Dang Gui; for white discharge, increase fried Hua Shi, Fu Ling (Poria), and Bai Zhu (Atractylodes Rhizome). At onset, if purging is desired, double the Da Huang (Rhubarb); for food stagnation, add Shan Zha (Hawthorn Fruit) and Zhi Shi (Immature Bitter Orange). If fatigue, shortness of breath, and anorexia occur, this is a concurrent deficiency syndrome; use Bai Zhu and Dang Gui Wei (tail of Angelica Sinensis); for severe cases, add Ren Shen and Chen Pi to tonify. Once deficiency returns, dysentery stops naturally.
Abdominal pain due to Lung Metal Qi stagnating in the Large Intestine: Excess allows purging; deficiency requires Jie Geng (Platycodon Root) to diffuse. For rising toxic gas causing nausea/vomiting, clear/resolve with Ren Shen Bai Du San. For Stomach Qi deficiency-cold causing nausea/vomiting, warm/tonify with Fu Zi Li Zhong Tang.
Although dysentery is divided into red and white, it always results from Summer-Heat. Initially, all cases benefit from draining, with Chuan Huang Lian as the Sovereign herb. Chuan Huang Lian removes latent Heat from the Heart and Damp-Heat from the Spleen. Tiao Qin (Scutellaria Root) clears Large Intestine Heat, treating dysenteric pus and blood. Bai Shao harmonizes Spleen Blood and treats abdominal pain; Chuan Gui (Angelica Sinensis) nourishes Blood and stops pain; Bing Lang resolves Qi stagnation and relieves tenesmus; Mu Xiang and Zhi Ke move Qi and broaden the middle; Shan Zha and Mai Ya digest food stagnation; optionally add Da Huang and Mang Xiao (Mirabilite); for difficult urination, add Hua Shi and Mu Tong (Akebia Stem). These are general formulas for dysentery. White dysentery damages Qi via Damp-Heat; use Bai Zhu to tonify Spleen Qi, Chen Pi to regulate stagnant Qi, and Fu Ling and Hua Shi to leach out Damp-Heat. Over time, Stomach weakness and Qi deficiency occur; Si Jun Zi Tang (Four Gentlemen Decoction) plus Huang Qin becomes the main formula. Red dysentery damages Blood via Damp-Heat; use Dang Gui and Chuan Xiong to nourish Blood, Di Yu (Sanguisorba Root) to cool Blood, and Tao Ren to invigorate Blood stasis. Over time, Stomach weakness and Qi deficiency occur; Si Wu Tang plus E Jiao becomes the main formula. For mixed red and white, affecting both Qi and Blood, use Si Jun Zi Tang and Chen Pi to regulate Qi, and Si Wu Tang and Tao Ren to regulate Blood. Red, astringent urine indicates excess Damp-Heat in the Small Intestine; use Mu Tong, Ze Xie (Alisma Rhizome), and Zhi Zi (Gardenia Fruit) to drain. Dry, astringent stool indicates severe Damp-Heat in the Large Intestine; use Cang Zhu (Atractylodes Lancea Rhizome), Huai Hua (Sophora Flower), and Tiao Qin to clear. For chronic dysentery with persistent tenesmus, this is Large Intestine prolapse and sinking Qi deficiency; use Sheng Ma (Cimicifuga Rhizome), Ren Shen, and Huang Qi (Astragalus Root) to lift Qi; blood-invigorating and Qi-moving agents are strictly contraindicated. For Cold Dysentery, use Li Zhong Tang and Ginger/Cinnamon. If various formulas fail over a long period, this belongs to deficiency-cold slipping; add Long Gu (Fossilized Bones), Chi Shi Zhi (Red Halloysite), Li Ke (Persimmon Calyx), Wu Mei (Mume Fruit), He Zi (Chebula Fruit), and Rou Dou Kou (Nutmeg) for astringency within warming and tonifying treatments, leading to self-healing.
[Attached Formulas]
Chai Ling Tang: Chai Hu, Fu Ling, Ban Xia, Huang Qin, Bai Zhu, Ze Xie, Ren Shen, Zhi Shi, Gan Cao.
Da Cheng Qi Tang: Da Huang, Nong Po, Zhi Shi, Mang Xiao.
Tiao Wei Cheng Qi Tang: Mang Xiao, Da Huang, Gan Cao.
He Jian Shao Yao Tang: Mu Xiang, Shao Yao, Huang Qin, Huang Lian, Da Huang, Bing Lang, Gui Zhi, Gui Wei, Gan Cao.
Tian Shui San: Hua Shi (6 liang, water-flown), Gan Cao 1 liang (powdered).
Shao Yao Huang Lian Tang: Huang Lian, Dang Gui, Shao Yao, Gan Cao.
Si Wu Tang: Shu Di, Dang Gui, Shao Yao, Chuan Xiong.
Huang Lian E Jiao Wan: Huang Lian, E Jiao, Fu Ling.
Tao Ren Cheng Qi Tang: Da Huang, Gui Zhi, Mang Xiao, Tao Ren, Gan Cao.
E Jiao Mei Lian Wan: E Jiao, Chi Fu Ling, Wu Mei, Bai Shao, Huang Bo, Huang Lian, Gan Jiang, Dang Gui.
Ren Shen Bai Du Tang: Chai Hu, Jie Geng, Ren Shen, Qiang Huo, Du Huo, Chuan Xiong, Fu Ling, Zhi Ke, Qian Hu, Gan Cao.
Li Zhong Tang: See Epilepsy section, add Fu Zi.
Another Formula: Chi Shao (3 qian), Shan Zha Rou (3 qian), Gan Cao (1.5 qian), Mu Xiang (0.7 fen), Bing Lang (1 qian).
Ren Shen Bai Zhu San: Ren Shen, Bai Zhu, Fu Ling, Jie Geng, Huang Lian, Huo Xiang, Yi Yi Ren, Sha Ren, Shan Yao, Bian Dou, Gan Cao.
One theory for treating abdominal pain: Lao Jiang (Old Ginger) and Xi Cha (Fine Tea) each 3 qian, decocted and taken.
Miraculous Formula: Hong Ling (Red Water Chestnut) 4 pieces, crushed with shell; Lao Jiang 3 qian; add 1 zhong of wine, stew until cooked, mix with brown sugar and take to stop immediately.
For chronic dysentery not healing: Take 1 zhong of white radish juice and 1 zhong of honey, boil together, mix well, and take to stop immediately.
Another Miraculous Formula: Luo Zhou Ye (Leucosceptris Leaf) decocted in soup, taken with leaves, cures immediately.
Also: Han Lian Cao (Eclipta Juice) mixed with wine, cures immediately.
Also: Wang Gua Teng Ash taken with wine, cures immediately.
Also: Ba Hui San (Eight Ashes Powder) taken, stops immediately.
Ba Hui San: Zong Hui, Fa Hui, Lian Peng, Ai, Dang Gui Tou, Song Pi, Ce Bai, Chun Gen Pi.
Another Miraculous Formula: Wang Gua Teng (with stems and leaves after frost), dried and made into ash, remove fire toxicity, mix with sesame oil, apply to umbilicus, cures immediately.
Jin Hua San: Specifically treats red and white dysentery, chronic cases, miraculous effect. Chun Gen Bai Pi 2 liang (use smelly ones, remove coarse bark); collect Song Hua (Pine Pollen) 3 qian facing southeast, Di Yu 2 qian, Gan He Ye (Dried Lotus Leaf) 2 qian; dry in shade against water, use only the middle section, grind to fine powder. Take 3 fen per dose. Red dysentery with honey; white dysentery with brown sugar; mixed with honey and sugar. Add a little warm soup, take on an empty stomach. Avoid wheat products, meat, and greasy foods.