内经云。贼风虚邪者。阳受之。饮食不节。起居不时者。阴受之。阳受之则入六腑。阴受之
则入五脏。入六腑。则身热不时卧。上为喘呼。入五脏。则 满闭塞。下为飧泄。久为肠 。
贼风不云实邪。而言虚邪者。以邪之所凑。其气必虚也。设阳气充盛。虽有贼邪。莫能为害
也。起居不时者。非特劳役失宜。而饮食失节。亦在其中矣。阳受之则入六腑者。言六腑之经气
受邪于外则营卫气塞。而身热不时卧上为喘呼者。邪并于气之象也。阴受之则入五脏者。言五脏
之神气受伤于内则水谷不能克运。留于肠胃而腹满飧泄也。久为肠 者。言脏气久滞。不能统运
津液。乃至移于二肠而为 积崩迫。此则阴气受伤所致也。肠 便血。身热则死。寒则生。
肠 为肠胃受病。不当更见表热。表热则内外俱困。阳无所根据。故云热则死。寒则生耳。
肠 下白沫。脉沉则生。浮则死。
肠 下白沫。为里气不守。反见脉浮。中宫无主。安得不死。
肠 下脓血。脉悬绝则死。滑大者生。肠 之属。身不热。脉不悬绝。滑大者生。弦涩者死。
以藏期之。
悬绝弦涩。皆气血殆尽之脉。故主死。滑大为邪实可攻之象。故主生。
脾脉外鼓沉。为肠 。久自已。肝脉小缓。为肠 。易治。
脾脉外鼓沉。言气口脉盛。而按之有力。虽久可治。肝脉小缓。谓人迎缓而不大。无客邪乘
脾之候。故易治。
肾脉小搏沉。为肠 下血。血温身热者死。心肝 亦下血。二脏同病者可治。其脉小沉涩。
为肠 。其身热者死。热见七日死。
肾脉小搏沉而乏阳和之气。且见血温身热。为真阴下脱。故死。心肝 亦下血。即前外鼓沉
及小缓之脉证。以脾为心之子。心为肝之子。故二脏同病者可治。若见脉小沉涩。为营血内竭。
加以血温身热。不出七日必死也。
肾移热于脾。传为虚。肠 。死。不可治。
土衰不能制水。先后天脾胃俱败也。
阴阳虚。肠 。死。
阴虚则血温身热。阳虚则支冷不食。
泄而脱血。脉实。皆曰难治。
下脱而见脉实。脉证相反。纯属邪气用事。故为难治。
仲景云。夫六腑气绝于外者。手足寒。上气脚缩。五脏气绝于内者。利不禁。下甚者。
手足、不仁。 下痢脉沉弦者。下重。脉大者为未止。脉微弱数者。为欲自止。虽发热不死。
下利手足厥冷。无脉者。灸之不温。若脉不还。反微喘者死。少阴负趺阳者为顺也。下痢有微热
而渴。脉弱者令自愈。下痢脉数。有微热。汗出令自愈。设脉紧为未解。下痢脉数而渴者。命自
愈。设不瘥。必清脓血。以有热故也。下痢脉反弦。发热身汗者自愈。下痢气者。当利其小便。
下痢寸脉反浮数。尺中自涩者。必清脓血。下痢清谷。不可攻其表。汗出必胀满。下痢脉沉而迟。
其人面少赤。身有微热。下痢清谷者。必郁冒汗出而解。病患必微厥。所以然者。其面戴阳。下虚
故也。下痢后脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。下痢腹胀满。身体疼痛者。
先温其里。乃攻其表。（以上金匮要略。）下痢脉滑而数。有宿食。当下之。下痢不欲食者。有宿
食。当下之。下痢而腹痛满。为寒实。当下之。下痢腹中肾者。当下之。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。急投之美。下痢大孔痛者。当温之。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。此为寒。但当温之。脉沉紧。下之亦然。脉大浮弦。下之当已。下痢脉浮大。此为
虚。以强温之故也。设脉浮革者。因尔肠鸣。当温之。（以上千金参补。）下痢三部脉皆平。
按之心下坚者。急下之。宜大承气汤。下痢脉迟而滑者。实也。痢未欲止。急下之宜大承气汤。下
痢脉反滑者。当有所去。下乃愈。宜大承气汤。下痢谵语者。有燥屎也。小承气汤主之。下痢便
脓血者。桃花汤主之。热痢下重者。白头翁汤主之。 下痢后更烦。按之心下濡者。为虚烦也。栀
子豉汤主之。下痢清谷。里寒外热。汗
出而厥者。通脉四逆汤主之。下痢肺痛。紫参汤主之。气痢。诃梨勒散主之。保命集云。脓血相
杂而脉浮大。慎不可以大黄下之。下之必死。谓气下竭。而阳无所附也。凡阴阳不和。惟当分利
阴阳。经云。暴泄非阳。久泄非阴。大便完谷下。有寒有热。热者。脉疾。身多动。音声响亮。
暴注下迫。此阳也。寒者。脉沉而细。身不动作。目睛不了了。饮食不下。鼻准息微者。姜附汤。
若身重四肢不举。术附汤证也。
东垣云。饮食一伤。起居不时。损其胃气。则上升清阳之气。反下降而为飧泄。久则太阴传
少阴而为肠 。寒冷之物伤于中。 满而胀。传为飧泄。宜温热以消导之。湿热之物伤于中而下
脓血者。宜苦寒以疏利之。风邪下陷者升举之。湿气内盛者分利之。里急者下之。后重者调之。
腹痛者和之。洞泄肠鸣。脉细微者。温之收之。脓血稠粘。数至圊而不能便。脉洪大有力者。下
之寒之。此治痢之大法也。
张介宾曰。肠 一证。即今之所谓痢疾也。其所下者。或赤或白。或脓或血。有痛者。有不
痛者。有里急后重者。有呕恶胀满者。有噤口不食者。有寒热往来者。虽其变态多端。然总不外
乎表里寒热。而于虚实之辨。尤为切要。凡邪因表者。必有表证。但兼其表而行散之。表邪解则
痢自愈。如无表证。则必由口腹。悉属内伤。但伤于内者极多。因于表者。则间或有之。此内外
之不可不辨也。以寒热言之。则古以赤者为热。白者为寒。至刘河间而非之曰。如赤白相兼者。
岂寒热俱甚于肠胃而同为痢乎。至丹溪则因之曰。赤痢乃是小肠来。白痢乃是大肠来。皆湿热为
本。自二子之言出。则后世莫敢违之者。愚见则有不然。夫痢起夏秋。湿蒸热郁。本乎天也。因
热求凉。过吞生冷。由于人也。气壮而伤于天者。郁热居多。气弱而伤于人者。阴寒为甚。须知
寒者必虚。热者必实。更以虚实细详之。而寒热愈明矣。如头疼
身热。筋骨酸痛者。实也。胀满恶食。急痛拒按者。实也。烦渴引饮。喜冷畏热者。热也。脉强
而实者。实也。脉数而滑者。热也。外此则靡非虚寒矣。而相似之际。尤当审察。如以口渴为实
热似矣。不知凡系泻痢。必亡津液。液亡于下。则津涸于上。安得不渴。更当以喜热喜冷别虚实
也。以腹痛为实热似矣。不知痢出于内。肠胃必伤。脓血稠粘。安能不痛。更当以痛之缓急。按
之可否。脏之阴阳。腹之胀与不胀。脉之有力无力。分虚实也。以小便之黄赤短少为实热似矣。
不知水从痢去。溲必不长。溲以阴亡。溺因色变。更当以便之热与不热。液之涸与不涸。色之泽
与不泽。分虚实也。以里急后重为实热似矣。不知气陷则仓廪不藏。阴亡则门户不闭。更当以病
之新久。质之强弱。脉之盛衰。分虚实也。至于治法。须求何邪所伤。何脏受病。如因于湿热者。
去其湿热。因于积滞者。去其积滞。因于气者。调之。因于血者。和之。新感而实者。可通因通
用。久病而虚者。可塞因塞用。皆是常法。独怪世之病痢者。十有九虚。而医之治痢。百无一补。
气本下陷。而再行其气。后重不益甚乎。中本虚寒。而复攻其积。元气不愈竭乎。湿热伤血者。
自宜调血。若过欲推荡。血不转伤乎。津亡作渴者。自宜止泄。若但与渗利。津不转耗乎。世有
庸工专守痛无补法。且曰。直待痛止。方可补耳。不知因虚而痛者。愈攻则愈虚愈痛矣。脉来微
弱者可补。形色虚弱者可补。口腹素慎者可补。胸膈宽快者可补。病后而痢者可补。因攻而剧者
可补。后重之可补者。陷则升而补之。热则凉而补之。腹痛之可补者。滑泄则涩而补之。虚寒则
温而补之。然而尤有至要者。则在脾肾二脏。如泻而后痢。脾传肾为贼邪。难疗。痢而后泻。肾
传脾为微邪。易医。是知肾为胃关。开窍于二阴。未有久痢而肾不损者。故治痢不知补肾。非其
治也。凡四君子、补中益气。皆补脾虚。若病在火乘土位侮母。设非桂、附大补命门。以复肾中
之阳。以救脾家之母。则饮食何由而进。门户何由而固。真元
何因而复耶。若畏热不前。仅以参、术补土。多致不起。大可伤已。
喻嘉言曰。内经云。下痢发热者死。此论其常也。仲景云。下痢手足不逆冷。反发热者不死。
此论其暴也。盖暴病有阳则生。无阳则死。故虚寒下痢。手足不逆冷。反发热者。或其人脏中真
阳未漓。或得温补药后。真阳随返。皆是美征。此但可收拾其阳。协和其阴。若虑其发热。反如
常法。行清解之药。鲜有不杀人者矣。金匮申下痢发汗之禁。谓下痢清谷。不可攻表。汗出必胀
满。盖以下痢一伤其津液。发汗再伤其津液。津液去则胃气空。而下出之浊气。随势上入胃中。
遂成胀满。求其下痢。且不可得。宁非大戒乎。伤寒厥痢发热。与下痢发热。迥然不同。伤寒厥
而且痢。为虚寒之极。所以反能食者则死。反发热者不死。若痢证则能食者不死。发热者多死也。
周慎斋曰。凡生病处。皆为阴为火。为阳气不到。若阳气所到之处。断无生病之理。痢疾不
发于夏。而发于秋者。盖夏时阳气尽发于表。太阴主里。湿土用事。纯阴无阳。或过食生冷。积
而不化。积久成热。痢之所由起也。不发于夏者。无阳则阴不运。发于秋者。阳气入里。攻之使
然也。治法。宜以苦寒之药。燥湿涤热。佐以辛热助阳。开郁达气。故曰。行血则便红自愈。调
气则后重自除。虽然。亦有虚实之辨。浅深之别。未可以概治也。心者。血之主也。肺者。气之
主也。凝滞则伤气。郁热则伤血。气既病。则心肺亦病矣。而小肠者。心之合也。大肠者。肺之
合也。二经皆出纳水谷。转输糟粕之官也。而胃又为大小肠之总司。肺移病于大肠。则气凝涩而
成白痢。心移病于小肠。则血凝涩而成赤痢。大小俱病。则赤白互下。胃土传湿热于大小肠者。
痢色兼黄。如胃中先伤冷物。以致胃寒不能游溢精气上输于脾。脾即不能散精以上归于肺。则津
液留滞于胃。即为胃家之积。其证呕逆恶心。其状色如桃胶而不臭。右关脉沉细而紧。宜
用浓朴、木香、干姜、肉桂、吴茱萸等。虚人可用附子理中汤。非大小肠积之可比也。至于色之
黑者。分为二种。如焦黑之黑者。此热极反兼胜己之化也。黄芩芍药汤下香连丸。如漆黑之光者。
此瘀血凝久而然也。桃核承气汤。丹溪谓仲景可下者。悉以承气下之。大黄之寒。其性善走。佐
以浓朴之温。善行滞气。缓以甘草之甘。饮以汤液。荡涤肠胃。滋润轻快。积行则止。局方例用
热药为主。涩药为臣。用之于下痢清白者犹可。其里急后重者。皆属于火。又加以温热之药。非
杀而何。大凡热痢。仲景虽有用大承气者。然皆指伤寒热邪传里致病。非滞下之谓。盖大黄专攻
湿热。在所必需。芒硝专攻燥结。滞下总有里急后重。其积滞已是下注。故无复用芒硝之理。若
系寒积。又须姜、桂、吴茱萸以温之。以寒积多属于虚也。至于通因通用。原有两法。有酒蒸大
黄。有蜡丸巴豆。分析甚明。况滞下多因寒滞郁热而成。世俗恒用姜茶煎。赤。倍芽茶。白。倍
生姜。往往获效。岂可偏执为热哉。积有新旧之分。旧积者。气血食痰所化也。新积者。旧积已
去。未几而复生也。然旧积宜下。新积禁下。其故何也。盖肠胃之熟腐水谷。转输糟粕者。皆营
卫洒陈于六腑之功。今肠胃有邪。则营卫营运之度。为之阻滞。不能施化。故卫气郁而不舒。营
血涩而不行。于是饮食结痰停于胃。糟粕留于肠。与气郁血涩之积。相挟而成滞下矣。必当下之
以通其壅塞。既下之后。升降仍不行。清浊仍不分。则卫气复郁。营血复涩。又成新积。乌可复
下乎。但理卫气。和营血。以调顺阴阳。则升降合节。积亦不滞而自化矣。然旧积亦有不可下者。
或先因脾胃之虚。不能转输其食积。必当调补脾胃。兼行气之药。俾虚回而痢自止。世俗治痢。
只守清热破气攻积凉血利水等法。虽朝夕更医。出入增减。不过如此。已濒于危。犹曰血色依然。
腹痛未减。谁敢温补。死无后悔。伤哉。痢初起时。便见脓血者。宜调气和血。气分药必不可少。
若但见白脓。宜调气消积。不可用血
药。引邪入于血分。必变脓血也。白痢初起。里急后重。频欲登圊。及去而所下无多。才起而腹
中复急。皆湿热凝滞所致。胃苓汤加木香、砂仁。血痢初起。腹痛迸迫。或脉数大。身有微热者。
先与小建中汤和之。中有肉桂。伐肝和营最捷。脓血稠粘。势甚不可遏者。黄芩、芍药、延胡索、
木香、砂仁。腹痛。少加肉桂以和之。血积稠浓。可用黄连。若略见少血。或稀淡者。不可便用
The *Neijing* (Yellow Emperor's Inner Classic) states: External pathogenic factors such as thief wind and empty evil are first received by the Yang meridians; internal factors such as irregular diet and improper daily routine are first received by the Yin meridians. When received by the Yang meridians, the pathogen enters the Six Fu organs (gallbladder, stomach, small intestine, large intestine, urinary bladder, and sanjiao), manifesting as fever, inability to lie down at regular times, and upward rebellion of qi causing wheezing and calling. When received by the Yin meridians, the pathogen enters the Five Zang organs (heart, liver, spleen, lungs, and kidneys), manifesting as abdominal fullness and obstruction, and downward progression leading to undigested stool diarrhea (Sunxie). If prolonged, it develops into Changpi (dysentery).
The text mentions "thief wind" rather than "solid evil," calling it "empty evil," because where pathogenic factors gather, Qi must be deficient. If Yang Qi is abundant, even thief wind cannot cause harm. "Improper daily routine" includes not only overexertion but also irregular diet. "Received by Yang entering Six Fu" means that external pathogens invade the meridian Qi of the Six Fu, blocking Ying and Wei Qi, resulting in fever, restlessness, and wheezing—this is a sign of pathogen merging with Qi. "Received by Yin entering Five Zang" means that internal injury damages the Shen Qi of the Five Zang, impairing the transformation and transportation of food and fluids, leading to retention in the intestines and stomach, causing abdominal fullness and Sunxie. "Prolonged development into Changpi" indicates that long-term stagnation of Zang Qi fails to control and transport body fluids, which then shift to the intestines, forming accumulations accompanied by bloody discharge and urgency. This is caused by injury to Yin Qi.
In cases of Changpi with bloody stool, if the body is hot, the prognosis is poor (death); if cold, it is good (survival). Changpi is an intestinal and stomach disease and should not present with exterior heat. Exterior heat implies both interior and exterior are compromised, leaving Yang without support; thus, heat indicates death, while cold indicates survival.
In Changpi with white mucus discharge, a deep pulse indicates survival, while a floating pulse indicates death. White mucus discharge signifies failure of interior Qi to secure, and a floating pulse suggests the Middle Jiao has no master, leading to death.
In Changpi with pus and blood discharge, a suspended-extreme pulse (Xuanjue) indicates death, while a slippery-large pulse indicates survival. For dysentery-type diseases, if there is no fever and the pulse is not suspended-extreme, a slippery-large pulse indicates survival, while a wiry-choppy pulse indicates death. This is deduced from the condition of the Zang organs.
Suspended-extreme and wiry-choppy pulses indicate near-exhaustion of Qi and Blood, hence death. Slippery-large pulses indicate excess pathogen amenable to purgation, hence survival.
A Spleen pulse that bulges outward and is deep indicates Changpi, which may resolve spontaneously after a long time. A Liver pulse that is small and slow indicates Changpi, which is easy to treat.
"Spleen pulse bulging outward and deep" refers to a vigorous Qi Kou pulse that is forceful upon pressure; although chronic, it is treatable. "Liver pulse small and slow" refers to a Ren Ying pulse that is slow and not large, indicating no exogenous pathogen attacking the Spleen, hence easy treatment.
A Kidney pulse that is small, bounding, and deep indicates Changpi with bloody stool. If the blood is warm and the body is hot, the prognosis is poor (death). Heart and Liver disorders also present with bloody stool; if these two Zang are affected simultaneously, it is treatable. However, if the pulse is small, deep, and choppy, indicating Changpi, and the body is hot, the prognosis is poor, with death occurring within seven days.
A small, bounding, and deep Kidney pulse lacking Yang harmony, combined with warm blood and fever, indicates sinking of True Yin, leading to death. Heart and Liver disorders with bloody stool correspond to the previously mentioned outward-bulging-deep and small-slow pulses. Since Spleen is the child of Heart, and Heart is the child of Liver, simultaneous involvement of these two Zang is treatable. But if the pulse is small, deep, and choppy, indicating exhaustion of Ying Blood, plus warm blood and fever, death will occur within seven days.
Kidney transferring heat to the Spleen transforms into deficiency and Changpi, which is untreatable and fatal. This represents Earth failing to control Water, with failure of both Pre-Heaven and Post-Heaven Spleen-Stomach.
Deficiency of both Yin and Yang leads to Changpi, which is fatal. Yin deficiency causes warm blood and fever; Yang deficiency causes cold limbs and anorexia.
Diarrhea with hemorrhage and a solid pulse are all considered difficult to treat. Hemorrhagic discharge with a solid pulse represents a contradiction between pulse and symptoms, dominated purely by pathogen, hence difficult.
Zhang Zhongjing stated: When Qi of the Six Fu fails externally, there is cold in the hands and feet, rebellious Qi, and retracted legs. When Qi of the Five Zang fails internally, there is incontinence of stool. Severe cases involve numbness of hands and feet. In dysentery, a deep-wiry pulse indicates heaviness in the anus; a large pulse indicates the disease has not stopped; a weak-rapid pulse indicates the disease is about to stop spontaneously, and death will not occur even with fever.
Dysentery with cold limbs and no pulse: if moxibustion does not warm the limbs and the pulse does not return, accompanied by slight asthma, death ensues. If the Shao Yin pulse is weaker than the Du Yang pulse, it is favorable. Dysentery with slight fever and thirst, and a weak pulse, will heal spontaneously. Dysentery with a rapid pulse, slight fever, and sweating will heal spontaneously. If the pulse is tight, the pathogen remains unresolved. Dysentery with a rapid pulse and thirst usually heals spontaneously; if not, pus and blood will appear due to heat. Dysentery with a wiry pulse, fever, and sweating will heal spontaneously. Dysentery with gas sensation should be treated by promoting urination. Dysentery with a floating-rapid pulse at the Cun position and a choppy pulse at the Chi position will definitely produce pus and blood. Dysentery with undigested food should not be treated by releasing the exterior; sweating will cause abdominal fullness. Dysentery with a deep-slow pulse, slight facial redness, slight body heat, and undigested food will resolve through sweating after a period of dizziness and oppression, due to floating Yang and lower deficiency. After dysentery, if the pulse disappears and limbs are cold, but the pulse returns and limbs warm up, survival is indicated; if the pulse does not return, death ensues. Dysentery with abdominal fullness and body pain requires warming the interior first, then treating the exterior. (From *Jin Gui Yao Lue*)
Dysentery with a slippery-rapid pulse and retained food should be purged. Dysentery with loss of appetite and retained food should be purged. Dysentery with abdominal pain and fullness indicates cold-solid excess and should be purged. Dysentery with borborygmus should be purged. Dysentery with a slow-tight pulse indicates persistent pain and should be warmed. Cold-induced dysentery with fullness and expulsion of intestinal residue should be treated with warming methods. Dysentery with body pain requires urgent warming of the interior; formulas like Lizhong Tang, Sini Tang, or Fuzi Tang are suitable. Dysentery with anal pain should be warmed. Dysentery with a large-floating-wiry pulse indicates impending resolution. Dysentery with yellow tongue coating, dryness without thirst, and chest fullness with unrelenting dysentery is fatal. Recurrence of dysentery at the same time of year/day/hour after recovery indicates incomplete resolution and requires further purgation. Heavy wind-cold contraindicates purgation; post-purgation epigastric hardness/pain with slow pulse indicates cold, requiring warming. Deep-tight pulse also requires warming. Large-floating-wiry pulse indicates resolution after purgation. Floating-large pulse in dysentery indicates deficiency caused by forced warming; floating-leather pulse with borborygmus requires warming. (From *Qian Jin Fang*)
If all three positions of the pulse are normal but epigastric palpation reveals hardness, urgent purgation with Dachengqi Tang is indicated. Slow-slippery pulse in dysentery indicates excess; urgent purgation with Dachengqi Tang is needed. Slippery pulse indicates material to be removed; purgation leads to cure. Delirium in dysentery indicates dry feces; Xiao Chengqi Tang is indicated. Pus and blood in stool require Taohua Tang. Heat-dysentery with tenesmus requires Baitouweng Tang. Restlessness after dysentery with soft epigastrium indicates empty irritability; Zhizi Chi Tang is indicated. Undigested food, interior cold/exterior heat, sweating, and cold limbs require Tongmai Sini Tang. Lung pain with dysentery requires Zican Tang. Qi-dysentery requires Helile San.
*Bao Ming Ji* states: Pus and blood mixed with a floating-large pulse contraindicates Dahuang purgation; purgation leads to death due to Qi exhaustion and Yang detachment. For Yin-Yang disharmony, separate and benefit Yin and Yang. Acute diarrhea is not purely Yang; chronic diarrhea is not purely Yin. Undigested food in stool can be cold or heat. Heat presents with rapid pulse, frequent movement, loud voice, and acute watery diarrhea (Yang). Cold presents with deep-thin pulse, immobility, dull eyes, anorexia, and faint nasal breathing; Jiangfu Tang is indicated. Heaviness and limb paralysis indicate Shufu Tang syndrome.
Li Dongyuan stated: Dietary injury and irregular routine damage Stomach Qi, causing clear Yang to descend instead of ascending, leading to Sunxie. Prolonged cases transmit from Taiyin to Shaoyin, becoming Changpi. Cold injury causes fullness and Sunxie, treated with warming and guiding. Damp-heat injury causing pus/blood requires bitter-cold draining. Wind sinking requires lifting; damp abundance requires separation/drainage. Urgency requires purgation; tenesmus requires regulation. Abdominal pain requires harmonizing. Watery diarrhea with borborygmus and fine-slow pulse requires warming/astringing. Thick pus/blood with frequent unsuccessful urges and forceful large pulse requires purging/cooling. This is the general method for dysentery.
Zhang Jingyue stated: Changpi is modern dysentery. Discharge varies (red, white, pus, blood), with or without pain, tenesmus, vomiting, anorexia, or alternating chills/fever. Though varied, it involves exterior-interior and cold-heat, with differentiation of deficiency-excess being crucial. Exterior pathogens have exterior signs; resolving the exterior cures the dysentery. No exterior signs imply internal injury from diet/lifestyle. Internal injury is common; external origin is rare. Differentiating internal/external is vital.
Regarding cold/heat: Ancient texts claimed red=heat, white=cold. Liu Wansu refuted this, asking if mixed red/white implies equal cold/heat in intestines. Zhu Danxi followed, stating red comes from Small Intestine, white from Large Intestine, both rooted in damp-heat. I disagree. Dysentery arises in summer/autumn from damp-heat heaven influence, or cold/raw food human influence. Strong constitutions suffer more郁热 (stagnant heat); weak constitutions suffer more Yin-cold. Cold implies deficiency; heat implies excess. Detailed differentiation clarifies cold/heat. Headache, fever, bone ache = excess. Fullness, aversion to food, sharp pain refusing pressure = excess. Thirst for cold drinks, fear of heat = heat. Forceful/solid pulse = excess. Rapid/slippery pulse = heat. Otherwise, it is deficiency-cold. Caution in similar cases: Thirst in dysentery is due to fluid loss, not necessarily excess heat; distinguish by preference for hot/cold. Abdominal pain is due to intestinal injury, not necessarily excess heat; distinguish by pain severity, pressure response, organ Yin/Yang, abdominal distension, and pulse strength. Yellow/scanty urine is due to fluid loss via stool, not necessarily excess heat; distinguish by stool temperature, fluid status, and urine luster. Tenesmus is due to Qi sinking or Yin loss, not necessarily excess heat; distinguish by disease duration, constitution strength, and pulse vigor.
Treatment must address the specific pathogen and affected Zang. Damp-heat: drain damp-heat. Retention: remove retention. Qi disorder: regulate Qi. Blood disorder: harmonize Blood. New/excess: use "treat obstruction with unblocking" (Tong Yin Tong Yong). Old/deficiency: use "treat deficiency with tonification" (Sai Yin Sai Yong). Most dysentery patients are deficient (90%), yet doctors rarely tonify. Sinking Qi aggravated by Qi-moving herbs worsens tenesmus. Deficient-cold middle aggravated by purgation exhausts Yuan Qi. Blood injury from damp-heat needs harmonizing, not harsh purgation. Fluid loss thirst needs stopping diarrhea, not diuretics. Quacks say "no tonification for pain"; true deficiency pain worsens with attack. Weak pulse, weak appearance, cautious diet, comfortable chest, post-illness dysentery, or worsening after attack—all indicate need for tonification. Sinking tenesmus: lift and tonify. Heat tenesmus: cool and tonify. Slippery diarrhea: astringe and tonify. Deficient-cold pain: warm and tonify.
Crucially, focus on Spleen and Kidney. Diarrhea followed by dysentery (Spleen to Kidney) is difficult (Thief Evil). Dysentery followed by diarrhea (Kidney to Spleen) is easy (Minor Evil). Kidney is the gate of Stomach, opening to two yins; chronic dysentery always damages Kidney. Treating dysentery without tonifying Kidney is incorrect. Sijunzi Tang and Buzhong Yiqi Tang tonify Spleen deficiency. If Fire attacks Earth/Mother, Guizhi and Fuzi are needed to tonify Mingmen and restore Spleen Mother. Fear of heat and using only Renshen/Baizhu often fails.
Yu Jiayan stated: *Neijing* says dysentery with fever is fatal (general rule). Zhang Zhongjing says dysentery with non-cold limbs and fever is not fatal (acute case). Acute diseases with Yang survive; without Yang, they die. In deficiency-cold dysentery, non-cold limbs and fever indicate remaining True Yang or return after warming meds—a good sign. Harmonize Yin/Yang; do not use clearing/cooling meds fearing fever, or you will kill. *Jin Gui* forbids sweating in dysentery with undigested food; sweating causes fullness by damaging fluids and allowing turbid Qi to rise. Cold-dysentery fever differs from simple dysentery fever. Cold-dysentery with ability to eat is fatal; fever is not. Simple dysentery with ability to eat is not fatal; fever is often fatal.
Zhou Shenzhai stated: Disease occurs where Yang does not reach. Dysentery starts in Autumn, not Summer. Summer Yang is exterior; Taiyin dominates interior with damp-earth, pure Yin no Yang. Raw food accumulation turns to heat, causing dysentery. Summer lacks Yang to move Yin. Autumn Yang enters interior, triggering it. Treatment: bitter-cold to dry damp/clear heat, assisted by acrid-hot to assist Yang/open depression. "Move Blood, red stool heals; Regulate Qi, tenesmus resolves." Differentiate deficiency/excess and depth/shallow. Heart governs Blood; Lung governs Qi. Stagnation injures Qi; stagnant heat injures Blood. Small Intestine is Heart's partner; Large Intestine is Lung's partner. They transport water/grain/waste. Stomach is their commander. Lung disease to Large Intestine causes Qi stagnation/white dysentery. Heart disease to Small Intestine causes Blood stagnation/red dysentery. Both diseased causes mixed red/white. Stomach transmitting damp-heat causes yellow color. Cold injury to Stomach prevents Essence transmission to Spleen/Lung, causing fluid retention/stomach accumulation (vomiting, peach-jam-like non-foul discharge, deep-thin-tight Right Guan pulse). Use Houpo, Muxiang, Ganjiang, Rougui, Wuzhuyu. Deficient patients use Fuzi Lizhong Tang. Black color: scorched black indicates extreme heat transforming to counteracting nature (Huangqin Shaoyao Tang + Xianglian Wan); glossy black indicates old blood stasis (Taoheng Chengqi Tang).
Zhu Danxi noted Zhang Zhongjing uses Chengqi for purgeable cases. Dahuang is cold/moving; Houpo is warm/moving; Gancao is sweet/soothing. Decoction cleans intestines smoothly. Bureau formulas use hot meds primarily, astringents secondarily; okay for clear/white dysentery. But tenesmus belongs to Fire; adding hot meds is lethal. Zhang Zhongjing used Dachengqi for cold-damage heat-transmission, not typical dysentery. Dahuang clears damp-heat; Mangxiao clears dry-stickiness. Dysentery already has downward flow/tenesmus, so Mangxiao is unnecessary. Cold-stasis needs Ginger/Cinnamon/Wuzhuyu. "Treat obstruction with unblocking" has two methods: wine-steamed Dahuang or wax-pill Ban Dou. Common folk use Ginger-tea (more芽茶 for red, more Shengjiang for white) effectively; do not assume all is heat.
Accumulation has new/old distinction. Old accumulation (Qi/Blood/Food/Phlegm) should be purged. New accumulation (recurrence after old cleared) should NOT be purged. Why? Gut function relies on Ying/Wei distribution. Pathogens block Ying/Wei movement, causing Qi stagnation/Blood stasis, leading to food/phlegm retention and waste accumulation. Purge to open blockage. Post-purge, if升降 (ascending/descending) and 清浊 (clear/turbid) remain disordered, Qi/Blood stagnate again, creating new accumulation. Do not purge again. Regulate Qi/Blood, harmonize Yin/Yang, and accumulation resolves naturally. Some old accumulations shouldn't be purged if due to Spleen/Stomach deficiency; tonify Spleen/Stomach with Qi-moving herbs. Folk doctors only use clearing/purging/drying methods; even when critical, they refuse warming/tonifying due to persistent pain/blood, leading to death. Regretfully.
Early dysentery with pus/blood: regulate Qi/harmonize Blood; Qi meds essential. Pure white pus: regulate Qi/remove accumulation; avoid Blood meds to prevent pathogen entering Blood level (turning to pus/blood). Early white dysentery with tenesmus/frequent urges/small output/repeated urgency: damp-heat stagnation. Weiling Tang + Muxiang, Sharen. Early blood dysentery with pain/rapid-large pulse/slight fever: Xiaojianzhong Tang to harmonize (Rougui harmonizes Liver/Blood). Thick pus/blood/uncontrollable: Huangqin, Shaoyao, Yanhusuo, Muxiang, Sharen. Abdominal pain: add Rougui. Thick blood accumulation: Huanglian. Scanty/thin blood: do not use...