东垣有言。凡发痢疾。白则伤气。赤则伤血。赤白相兼。气血都怫。东垣此言。千古无匹。请申论之。昭昭若揭。
惟肺主气。气伤肺遏。白由肺来。暑湿所折。惟心主血。血伤心热。赤自心来。暑湿是结。至若痢黄。乃脾胃泄。暑湿
伤土。饮食无节。黄中白垢。肺脾气郁。黄中赤秽。心脾气夺。五脏俱伤。五色痢溢。治必求本。审之贵悉。因热因寒。
斯言恍惚。痢必腹痛。后重里急。乃气不宜。津液凝涩。每一滞行。肠痛如刮。大肠既瘀。小肠亦窒。阴阳不分。虚
实更叠。内经之言。其因不一。春伤于风。夏生飧泄。少阳在泉。火淫如 。民病注泻。赤白俱出。此皆病因。非病从
发。至于噤口。至于休息。痢至于此。多死少活。审脉察症。毋少轻忽。方药所投。庶保无失。
巢元方曰。小儿痢如膏血者。名赤痢。肠气虚极。肠间脂与血俱下也。蛊毒痢者。寒暑不调。小儿解脱。为毒疠之
气所伤。邪与气血相搏。毒蕴肠胃。值大肠气虚。则其痢状。血瘀如鸡肝。此毒瓦斯甚热。状如中蛊。故名。脾毒痢歌云。
脾间有毒号纯阳。本为医人热药伤。致使大肠多结涩。多饶滴血在枯肠。如风腹闭难开眼。身热头温脚转凉。舌赤胸高
为此候。多啼喘急更如狂。先须解热并开胃。便是明医用药良。此脾受热积。失治。则毒伏。治先凉脾。次去积。若胸
骨忽高。更加喘急。不治。宜金华散、香连丸。风毒痢歌云。八痢之中风转难。形如青草汁多般。毒风豆汁添邪热。胃
败鸡肝片片全。加赤不须先下积。闭眸绝食不堪看。若归白痢还须下。脏腑频温得本源。
圣惠方曰。小儿血痢者。由热毒折于血。血入大肠也。血随气循环经络。通行脏腑。常无停滞。若为毒热所乘。遇
肠虚血渗入肠。则成血痢。小儿肠热。则痢下鲜血。如肠风一般。小儿脓血痢者。由热毒在脏。血得热则流。渗入大肠。
与肠间津液相搏。积热蕴结。血化为脓。腹虚则泄。故成脓血痢。有渴痢兼症者。小儿利兼渴候。此是水谷痢。津液枯
渴。脏腑虚燥。则引饮。若小便快者。利断渴则止。小便涩者。水不行于小肠。渗入肠胃。渴亦不止。利亦不断。凡如
此者。皆身体浮肿。脾气弱。不能克水故也。亦必眼痛生障。小儿上焦本热。今又利。下焦虚。上焦热气转盛。热气熏
肝故也。先醒脾散、匀气散。调一二日。后用调中饮。自愈。有痢后羸瘦。小儿肠胃虚弱。受风冷。或挟疳气。则下痢。
痢断后。肠胃尚虚。谷气犹少。不能荣血气。故羸瘦。桔梗丸。痢后浮肿。歌曰。冷痢日久失医治。遍身浮肿却如吹。
脉洪是气化为水。沉实还因积有之。顺气肿消为上法。气平两日定多尿。莫教食饱还忧滞。此疾先因积损脾。用止渴圣
效散。小儿赤白久痢不止。腹痛瘦弱。不思饮食。宜黄连散、肉豆蔻散。
曾氏曰。赤白之痢。世人无不曰赤为阳为热。白为阴为冷。或曰无积不成痢。至于调治。若冷热药更进。或单投去
积药。必难效。盖风木克胃土。不为暴下。则成痢疾。赤白交杂。为阴阳不分。法当分正阴阳。若既分。仍赤白同下。
则专究所因。若先白后赤。乃内伤生冷。失于盖复。又元气感于暑热。宜先救里。次解暑毒。若先赤后白。乃先伤热而
后感冷。先宜解热。后治痢。有夹热痢者。则纯下鲜血。此风能动血。宜冷服黄连香薷散。及当归散加醋炒蒸柏叶。有
夹冷痢者。则下纯白冻。或白上有粉红色。或似猪肝瘀血。皆为阴症。盖血得寒则凝也。先五苓散加守中汤。次固真汤。
倘不辨虚实冷热妄治。必脾胃愈虚。或成噤口。又有里急为阳。后重为阴。未圊前腹痛为里急。已圊后腹痛为后重。里
急大肠涩也。先大顺饮加宽气散。利解宽肠丸。后重为气虚。五苓散加人参送香连丸。若二症俱作。双金饮。然泻痢二
字。自是两症。粪夹水。来多而顺者。曰泻。带血纯白冻。来三五点而疼者。曰痢。轻重阴阳。于此而分。斯为治法。
有脓血交杂。经久不止。日轻夜重。或日夜频数。食减痛多。并用万金散、神效散。有五色痢者。乃因五脏蕴热。荣卫
不调。五谷不化。熏腐脏腑。神气昏沉。日久不散。此候已危。最苦是腹中利痛。儿小者无治法。盖五色者。乃五脏之
色。皆见于外。儿大者。可用局方三神丸。或小来复丹。煎五苓散送下。或可疗。又有风痢。多是黄褐色。与疳泻颇同。
但不臭为异。此风毒停滞于脾。泻黄散。若赤白同下不禁。小便少涩。痛热并作。唇裂眼赤。气促心烦。坐卧不安。狂
渴饮水。谷道倾陷。饮食不进者。难治。
薛己曰。海藏用四君芎归治虚弱之痢。四君干姜治虚寒之痢。愚尝治手足指热饮冷者。为实热。用香连丸。手足指
冷冻饮料
热者。为虚寒。用异功散。送香连丸。若兼体重肢痛。湿热伤脾也。升阳益胃汤。小便不利。阴阳不分也。五苓散。若
湿热退而久痢不止者。脾气下陷也。补中益气汤倍升柴。泻痢兼呕。或腹痛。脾胃虚寒也。异功散。加木香、炮姜。或
变为疟者。肝克脾也。六君加升、柴、钩藤。若积去仍痢。脾气虚也。四君送香连丸。若因母膏粱六淫七情。致儿为患
者。当兼治其母。
叶桂曰。脓血痢。 痛后重。初用宣通驱热。如芩、连、大黄。必加甘草缓之。非如伤寒屎坚。须用芒硝咸以 坚
直
走。破泄至阴。此不过苦能胜湿。寒以逐热。足可却病。噤口痢都因热升浊攻。必用大苦。如芩、连、石莲清热。人参
辅胃益气。热气一开。即能进食。药宜频频进二三口。小儿休息久痢。变为粪后下血。最难速愈。有因气弱下陷。补中
益气。虚寒若饮食不化。益黄散。湿热未净。气分延虚。清暑益气汤。胃强善食者。苦寒清热。更节饮食。须善调经月。
久泻久痢。必伤肾。肾司二便也。必肛门后坠。与初病湿热里急下重不同。治以摄阴液。或佐疏补。久则纯与摄纳。
Li Dongyuan once said: "Whenever dysentery occurs, white discharge indicates injury to Qi (vital energy), red discharge indicates injury to Blood, and mixed red and white indicates stagnation of both Qi and Blood." Li's words are unmatched since ancient times. Let me elaborate further; the principles are clear as day, like a torch held high.
The Lung governs Qi. When Qi is injured, Lung Qi is obstructed, so white discharge originates from the Lung, caused by the constraint of Summer-heat and Dampness. The Heart governs Blood. When Blood is injured, Heart Heat arises, so red discharge originates from the Heart, resulting from the accumulation of Summer-heat and Dampness. As for yellow discharge, it stems from Spleen and Stomach damage due to Summer-heat and Dampness injuring Earth (Spleen/Stomach) and irregular diet. Yellow with white mucus indicates Qi and Blood stagnation in the Lung and Spleen; yellow with bloody residue indicates deficiency of Qi and Blood in the Heart and Spleen. If all five Zang organs are damaged, Five-Color Dysentery appears. Treatment must seek the root cause, and examination must be thorough. Etiologies may involve Heat or Cold, making such descriptions seem ambiguous. However, dysentery invariably involves abdominal pain and tenesmus (urgent desire to defecate with little output), caused by Qi malfunction and condensation/stagnation of body fluids. Each attempt to defecate causes intestinal pain as if scraping. Since the Large Intestine is blocked, the Small Intestine also becomes obstructed, Yin and Yang fail to distinguish, and deficiency and excess alternate. The *Neijing* states various causes for dysentery: Wind injury in Spring leads to undigested diarrhea (Sun Xie) in Summer; when Shaoyang Fire is in control, excessive Fire causes people to suffer from urgent watery diarrhea with both red and white discharges. These are etiologies, not direct origins of disease. Regarding Jin Kou Dysentery (dysentery with inability to eat) and Resting Dysentery (intermittent dysentery), progression to these stages often results in death rather than survival. One must carefully examine pulse and symptoms without negligence. Proper prescription ensures safety.
Chao Yuanfang stated: "When children pass stool resembling paste and blood, it is named Red Dysentery. This is due to extreme deficiency of Intestinal Qi, causing intestinal fat and blood to descend together." Gu Du Dysentery (Gu-toxin dysentery) arises from imbalance of Cold and Summer-heat; children exposed to cold are injured by toxic epidemic Qi. Pathogenic factors contend with Qi and Blood, toxin accumulates in the intestines, and when Large Intestine Qi is deficient, the dysentery presents with blood clots resembling chicken liver. This toxin is extremely hot, resembling gu-poisoning, hence the name. The *Song on Spleen Toxin Dysentery* says: "Toxin in the Spleen is called Pure Yang, originally caused by doctors using hot medicines incorrectly. This leads to constipation and dryness in the Large Intestine, with many drops of blood falling into the withered intestine. Like wind closing the abdomen, eyes hard to open; body heat, warm head, cooling feet. Red tongue, elevated chest indicate this syndrome; frequent crying, panting, urgency, and madness-like behavior. First resolve heat and open the stomach; this is the good medicine of wise doctors." This is Spleen Heat accumulation. If untreated, toxin lies latent. Treatment first cools the Spleen, then removes accumulation. If sternum suddenly elevates with worsening panting, it is incurable. Use Jinhua San (Golden Flower Powder) and Xianglian Wan (Coptis and Cinnamon Pill). The *Song on Wind Toxin Dysentery* says: "Among eight types of dysentery, wind type is hardest to treat. Shape resembles green grass juice in various forms. Toxic wind and bean juice add pathogenic heat; stomach failure shows chicken-liver-like pieces. With red color, do not first purge accumulation; closed eyes and anorexia are distressing. If turning to white dysentery, purging is still needed; frequent warming of zang-fu retrieves the source."
The *Shenghui Fang* states: "Children's blood dysentery is caused by heat toxin injuring blood, which enters the Large Intestine. Blood circulates through meridians via Qi, passing through zang-fu without stagnation normally. If attacked by toxic heat and encountering intestinal deficiency, blood seeps into the intestine, forming blood dysentery. Children's intestinal heat causes passage of fresh blood, similar to Intestinal Wind. Children's pus-and-blood dysentery is caused by heat toxin in the zang organs. Blood flows when heated, seeping into the Large Intestine, contending with intestinal fluids. Accumulated heat binds, blood transforms into pus. Abdominal deficiency causes diarrhea, thus forming pus-and-blood dysentery." For cases with thirst accompanying dysentery: children having diarrhea with thirst have Water-Grain Dysentery. Fluids are depleted, causing thirst; zang-fu are deficient and dry, leading to drinking desire. If urination is smooth, diarrhea stops and thirst ceases. If urination is difficult, water does not flow in the Small Intestine but seeps into gastrointestinal tract; thirst persists, diarrhea continues. Such cases present with generalized edema because Spleen Qi is weak and cannot control water. Eye pain and cataracts also occur. Children's Upper Jiao is naturally hot; now with diarrhea, Lower Jiao is deficient, Upper Jiao heat intensifies, steaming the Liver. First use Xianxing Pi San (First Awaken Spleen Powder) and Yunqi San (Harmonize Qi Powder) for one to two days, then Tiaozhong Yin (Regulate Middle Decoction) for natural recovery. Post-dysentery emaciation occurs because children's gastrointestinal tract is weak, affected by wind-cold or carrying Gan Qi (parasitic/deficiency condition), leading to dysentery. After dysentery stops, gastrointestinal tract remains weak, grain Qi is scarce, unable to nourish Blood and Qi, resulting in emaciation. Use Jiegeng Wan (Platycodon Pill). Post-dysentery edema: Song says, "Cold dysentery long untreated loses medical care; whole body swells like blown up. Pulse surging indicates Qi transforming into water; pulse deep-solid indicates presence of accumulation. Regulating Qi and reducing swelling is the best method; after Qi calms for two days, urine increases greatly. Do not overeat to worry about stagnation. This disease first damages Spleen via accumulation. Use Zhike Shengxiao San (Thirst-Quenching Miraculous Effect Powder)." For children with chronic red-white dysentery not stopping, abdominal pain, emaciation, and loss of appetite, use Huanglian San (Coptis Powder) and Roudoukou San (Nutmeg Powder).
Zeng Shi said: "Regarding red-white dysentery, everyone says red is Yang/Heat, white is Yin/Cold. Or they say no accumulation means no dysentery. In treatment, alternating cold and hot medicines or solely using accumulation-resolving drugs will likely fail. Wood (Liver/Wind) attacks Earth (Stomach/Spleen); if not violent diarrhea, it becomes dysentery. Mixed red and white indicates Yin-Yang confusion; method requires distinguishing correct Yin and Yang. If distinguished but red and white still mix, investigate the cause specifically. White first then red indicates internal injury from cold/raw food, lack of covering/warmth, plus Yuan Qi affected by Summer-heat. Save the interior first, then resolve Summer-heat toxin. Red first then white indicates heat injury first, cold sensation later. Resolve heat first, then treat dysentery. Heat-clasping dysentery presents with pure fresh blood; wind moves blood. Take Huanglian Xiangru San (Coptis and Mosla Powder) cold, or Danggui San (Angelica Powder) with vinegar-processed Cinnamomi Cortex (Bai Zhu Ye - note: text says Bai Ye, likely referring to specific processing or herb variant, context implies cooling hemostatic). Cold-clasping dysentery presents with pure white jelly, or pinkish tint on white, or pig-liver-like clots; all are Yin syndromes because blood congeals with cold. First use Wuling San (Five-Ingredient Powder with Poria) plus Shouzhong Tang (Guard Middle Decoction), then Guzhen Tang (Solidify True Decoction). If failing to distinguish deficiency/excess and cold/heat leads to reckless treatment, Spleen and Stomach become more deficient, potentially becoming Jin Kou Dysentery. Tenesmus is Yang, heaviness in rectum is Yin. Abdominal pain before defecation is tenesmus; abdominal pain after defecation is heaviness. Tenesmus is Large Intestine dryness/stagnation; first Dashun Yin plus Kuanqi San (Widen Qi Powder), Lijie Kuan Chang Wan (Relieve and Widen Intestine Pill). Heaviness is Qi deficiency; Wuling San with Ren Shen (Ginseng) delivers Xianglian Wan. If both symptoms occur, use Shuangjin Yin (Double Gold Decoction). Diarrhea and Dysentery are two different conditions. Feces mixed with water, abundant and smooth flow is Diarrhea. Blood or pure white jelly, scanty (3-5 drops) and painful is Dysentery. Severity and Yin-Yang are distinguished here; this is the treatment principle. Pus and blood mixed, lasting long, lighter by day heavier by night, or frequent day and night, reduced food intake, increased pain: use Wanjinsan (Ten Thousand Gold Powder) and Shenxiao San (Miraculous Effect Powder). Five-Color Dysentery is caused by heat accumulating in five Zang organs, Ying and Wei (Nutritive and Defensive Qi) imbalanced, grains undigested, steaming and corrupting zang-fu, spirit dull. Long-lasting and unresolved, this condition is critical. Most painful is abdominal dysenteric pain. Infants have no treatment method because five colors represent five Zang organs manifesting externally. Older children can use Ju Fang Sanshen Wan (Three Spirits Pill from Bureau Formulas) or Xiao Laifu Dan (Small Return to Life Pellet), taken with Wuling San decoction; this might cure. Wind Dysentery is mostly yellow-brown, similar to Gan Diarrhea, differing only by lack of foul odor. Wind toxin stagnates in Spleen; use Xiehuang San (Drain Yellow Powder). If red and white flow uncontrollably, scanty/difficult urination, pain and heat combined, cracked lips, red eyes, shortness of breath, irritability, restlessness, wild thirst for water, prolapsed anus, anorexia: difficult to treat."
Xue Ji said: "Haizang used Sizijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong and Danggui to treat deficient dysentery; Sizijunzi Tang plus Ganjiang (Dried Ginger) to treat deficient-cold dysentery. I treated children with hot fingers/toes desiring cold drinks as Excess Heat, using Xianglian Wan. Children with cold fingers/toes desiring hot drinks as Deficient-Cold, using Yigong San (Extraordinary Work Powder) delivering Xianglian Wan. If accompanied by heavy body and limb pain, it is Damp-Heat injuring Spleen; use Shengyang Yizhe Tang (Raise Yang Benefit Stomach Decoction). Difficult urination indicates Yin-Yang confusion; use Wuling San. If Damp-Heat recedes but chronic dysentery persists, it is Spleen Qi sinking; use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) doubling Shengma and Chaihu. Dysentery/diarrhea with vomiting or abdominal pain indicates Spleen-Stomach deficient-cold; use Yigong San plus Muxiang (Aucklandia) and Paogjiang (Prepared Ginger). If transforming into malaria, Liver attacks Spleen; use Liujunzi Tang plus Shengma, Chaihu, and Gouteng (Uncaria). If accumulation removed but dysentery persists, it is Spleen Qi deficiency; use Sizijunzi Tang delivering Xianglian Wan. If illness caused by mother's rich diet, six excesses, or seven emotions affecting the child, treat the mother simultaneously."
Ye Gui said: "Pus-and-blood dysentery with abdominal pain and tenesmus. Initially use dispersing and clearing heat methods, such as Huangqin (Scutellaria), Huanglian (Coptis), Dahuang (Rhubarb), must add Gancao (Licorice) to moderate. Unlike Taiyang disease hardened stool requiring Mangxiao (Mirabilite) to soften hardness and drain downward breaking Yin extremity. This merely uses bitter to overcome dampness and cold to drive out heat, sufficient to cure disease. Jin Kou Dysentery is caused by heat rising and turbid attacking; must use great bitter herbs like Huangqin, Huanglian, Shilian (Nelumbo Seed) to clear heat, Renshen (Ginseng) assists Stomach and benefits Qi. Once heat opens, eating resumes. Medicine should be taken frequently in small amounts (two or three mouthfuls). Children's resting chronic dysentery transforming into post-stool bleeding is hardest to cure quickly. Caused by Qi weakness and sinking: use Buzhong Yiqi Tang. Deficient-cold with undigested food: use Yihuang San (Benefit Yellow Powder). Damp-Heat not cleared, Qi level extending to deficiency: use Qingshu Yiqi Tang. Strong Stomach good appetite: bitter-cold clears heat, regulate diet, manage months well. Chronic diarrhea/dysentery inevitably injures Kidney; Kidney governs two passages (urinary and anal). Anus prolapses posteriorly, different from initial Damp-Heat tenesmus/heaviness. Treat by preserving Yin fluids, or assist with dispersing and tonifying. Long-term: purely use astringing and grasping methods."