苦寒。戕犯胃气。为害不浅也。凡血色紫黯。屡服凉药。而所下愈多。作冷痢治。故血色如猪肝。
如紫草。如苋菜汁者。非炮姜不治。理中汤去参。加肉桂、木香、肉果、乌梅。纯下血而色鲜浓
浓者。此心脾伏热也。大黄黄连泻心汤。有食积。枳术丸加浓朴、黄连、木香、延胡索。赤痢初
起。宜加延胡。最散血积。小儿八岁已内者。作食积治。风入肠胃。纯下清血。或湿毒下血。胃
风汤加枳壳、荆、防。风入肠胃。下痢青绿杂色。神术汤。下痢腹痛异常。脉沉而紧。无热证者。
先以姜、桂之类温之。后理积滞。里急而至圊反不能即出者。气滞也。疏通为主。重则小承气。
轻则黄芩芍药汤。里急而频见污衣者。气脱也。补中益气去当归加木香。湿热下痢后重。升阳除
湿汤。虚滑而后重者。圊后不减。以得解愈虚故也。养脏汤。白痢初起。但腹痛后重。不能食。
小便却清痢者。为虚寒。二陈汤加炮姜、焦术、浓朴、木香、砂仁。能涤除痰积。宜加用之。后
重本因邪压大肠坠下。是以用大黄、槟榔辈。此实也。若久痢后重不除。此脾气下陷之故。宜升、
柴以升提之。槟榔、枳壳皆当禁用。若肺气郁在大肠。腹痛后坠。理气药中。须加桔梗以开之。
亦有积已去而过食浓味生冷复重者。建脾兼消导为主。痢如胶冻。或如鼻涕。或如鱼脑。此为冷
痢。先用木香、焦术、豆蔻、砂仁、浓朴。次用理中汤加木香。不应。更加诃子、粟壳。下痢脉
迟紧。腹痛未欲止。当温消之。枳实理中汤。下痢清白。手足厥冷。腹痛不已。附子理中汤。积
久冷痢。少腹酸痛。结滞不爽。及下久连年不止。千金
温脾汤。冷痢。去甘草。加桂心。倍香附、人参。热痢。去桂心。加大黄一钱。姜、附、人参各
减一钱。久痢不瘥。虽所下渐减。而津血枯槁。肛门涩滞者。千金羊脂煎润以导之。羊脂。本经
专主下痢脱肛。腹中绞痛。而世罕知用。惜哉。暴下积日久不止。千金附子汤。久痢虚冷滑脱。
脉细。皮寒少气。畏食不能言。或时发虚热者。附子理中汤加肉桂、肉果、诃子。下痢脐下搅痛。
桃花丸。下痢久脱。虚冷白滞。大桃花汤。热痢二三年不止者。浓朴汤。久痢。所食之物皆不化。
四肢沉重。肌肉消尽。椒艾丸。下痢发热。自汗脉弦者。是伏邪所发。法当从表解散。仓廪汤。
有一方长幼相染者。谓之时疫痢。亦宜仓廪汤。一种阴虚痢疾。切戒攻积之药。凡见痢下五色。
脓血稠粘。滑泄无度。发热烦渴。脐下急痛。至夜转剧而恶食。或下鲜血者。便属阴虚。急宜救
热存阴为主。如驻车丸、阿胶丸、归连丸、阿胶梅连丸、千金黄连汤、黄连阿胶汤、白头翁加甘
草阿胶汤等方选用。下痢至夜发热。烦渴引饮。为津液受伤。内水亏竭。燎原之火自焚。不得不
引外水以济急。切不可用香燥之药。钱氏白术散加乌梅。下痢失气者。当利小便。阴气前通。则
阳气自化矣。五苓散加木香。痢仍不止。以诃子、浓朴、橘皮等分。丸服。下痢大孔痛。宜温之。
黄建中加木香、当归。痢后大便秘涩。里急后重。数至圊而不能便。或少有白胆。此为气虚下
陷。慎勿利之。但举其阳。则阴自降矣。补中益气汤加防风。下痢后里急后重不除。风邪伤卫。
卫气不行也。非三奇散不愈。蛊注毒痢。血如鸡肝。心烦腹痛者。茜根丸。虚人。理中汤加黄连、
乌梅。不应。用乌梅丸。下利后遍身浮肿。五苓散。用生术、肉桂。加升、柴。利后虚浮。六君
子加木香、肉桂。初利脓血稠粘。势甚宜下者。一味大黄。酒蒸为丸。赤多。用温酒下百丸。白
多。用淡姜汤下七十丸。以夺其势。然后调理则易愈。冷热不调。下利赤白。兼冷食食积者。连
理汤加枳实、砂仁。下利干呕者。胃虚而寒热错杂
也。外台黄芩汤。先前白利。后变脓血者。戊己丸。先前白利。后变鲜血者。四物汤去地黄。加
炮姜、炙甘草、木香。先前脓血。后变赤白青黑。腹痛倍常者。驻车丸。先前脓血。后变白沫白
脓者。补中益气加炮姜、赤石脂。下利日百度。精神委顿。反不痛者。此邪气胜。正气微。不能
鼓激也。难治。有患利昼夜不及数度。而反发热。心下痞闷。不能食而呕。其有昼夜不止百度。
反脉静身凉而能食。何也。曰。利之邪客于下焦。由横连竟传大肠。原无反热之理。以中焦无病。
虽下利无度。不碍饮食。惟邪发于中焦。由横连入胃。以胃受病。自不欲食也。凡风寒伤于营卫
之中。则为疟。饮食伤于肠胃之内。则为利。而世有疟后痢。痢后疟者。此则表气不固。邪气内
犯而致也。若疟邪发泄已尽。必无复为利疾。皆由元气下陷。脾气不能升举。故风寒暑湿。得以
袭入而为利耳。又有利后似疟非疟。乃阴阳两虚。阳虚则恶寒。阴虚则发热。故寒热交战似疟也。
又有疟利齐发。疟止而痢甚者。皆是脾胃之气虚陷所致。并宜先与黄 建中。加木香、浓朴之类。
次与补中益气加姜、桂。若服后痢减而疟作。此阳气得补而与阴争也。再与补中益气少加桂、附。
助阳祛阴则愈。凡久痢年高。与产后病后。诸疮疽及泻后作痢。慎不可用攻伐之剂。急宜醒脾崇
土。补中益气加炮姜、木香。有血。加乌梅、芍药。下痢六七日。经尽。当有结粪。若至十三日
再经。结粪不出者。此胃气告匮也。慎不可更与攻克之剂。惟培养正气。庶有生机。下痢以胃气
为本。胃失生长。故恶物而不欲食。但得思食。无分何物。与之遂获愈者。此胃气胜故也。凡痢
下如鱼脑。或如猪肝。皆半死半生。下如尘腐色。大孔开如竹筒不收者。或如屋漏水。或纯下鲜
血。及如赤豆汁。唇如朱红者。皆不可治。
石顽曰。肠 之证。内经原有下血。下白沫。下脓血之异。推详脉证。大抵以白沫属寒。其
脉应沉。脓血属热。脉应滑大。
若见白沫而脉反浮。见脓血而脉反弦涩悬绝。为脉不应病。故皆主死。其扼要尤在身热则死。寒
则生。为大关捩。以肠胃受病。不当更见表热。表热则外内俱困。将何所恃而与攻救邪。更详脏腑
诸痢。咸以脉沉小为可治。血温身热主死。内经大义如此。再推仲景论痢。以身热手足温。为阳
回可治。厥逆不返。为阳绝主死。此盖指伤寒阴证而言。不可与夏秋肠 并列而论也。然下痢岂
无身热得生者。凡挟邪之痢。与时行疫痢。皆有身热。但当先撤表邪。自然身凉痢止。当知内经
所言血温身热。乃阴虚之本证。此则兼并客邪耳。及观先辈论痢。并以白沫隶之虚寒。脓血隶之
湿热。至守真乃有赤白相兼者。岂寒热俱甚于肠胃。而同为痢之说。丹溪从而和之。遂有赤痢从
小肠来。白痢从大肠来。皆湿热为患。此论一出。后世咸为痢皆属热。恣用苦寒攻之。蒙害至今
未已。即东垣之圣于脾胃者。犹言湿热之物。伤于中而下脓血。宜苦寒以疏利之。脓血稠粘。数
至圊而不能便。脉洪大有力者下之。亦认定脓血为热。曷知血色鲜紫浓浓者。信乎属热。若瘀晦
稀淡。或如玛瑙色者。为阳虚不能制阴而下。非温理其气。则血不清。理气如炉冶分金。最为捷
法。设不知此。概行疏利之法。使五液尽随寒降而下。安望其有宁止之日哉。尝见屡服黄连。虚
阳迫外。而反发热发斑者。亦有虚阳内扰。忽发除中。反骤能食者。有频用大黄。开肠洞泄。甚
至发呃吐蛔者。有大黄下咽。反胀闭不通。阴气上逆。而变中满鼓胀水肿者。凡此之类。未遑枚
举。夫天气之热。四时之正令也。因热而恣伤冰水瓜果。是逆其正气。腑脏为寒物所伤而为患也。
以逆正气之病。又以逆病情之药治之。何怪变证百出乎。虽是岁之热。较他岁倍常。是以患肠
者。较他岁亦倍常。其间总轻重不同。所见之积。一皆五色。良由五脏之气化并伤。是以五色兼
见。按五色痢。古人皆为肾病。以肾为藏精之室。所居之位。最下最深。深者既病。其浅而上者。
安有不病之理。
精室既伤。安能任蛰藏之令乎。仲景所谓五液注下。脐筑湫痛。命将难全者是也。夫以精室受伤。
五液不守之患。不知益火消阴。实脾堤水。兼分理其气。使失于气化之积随之而下。未失气化之
津统之而安。即口噤不食者。亦不出乎此法。盖肠 之属。皆缘传化失职。津液受伤。而致奔迫
无度。岂可恣行攻伐。以为不易之定法乎。历观时师治痢。无高下贤愚。必用橘皮、枳壳、浓朴、
槟榔之属。稍有赤沫。即用芩、连、芍药。水道不利。便与木通、车前。口噤不食。不出黄连、
石莲。况世所谓石连者。皆粤中草实伪充。大苦大寒。与本草所言莲子堕淤泥中。经岁取出者迥
异也。凡遇五色噤口。及瘀晦清血诸痢。每用甘草、干姜。专理脾胃。肉桂、茯苓。专伐肾邪。
其效如鼓应桴。初起腹痛后重者。则兼木香、槟、朴以泄之。饮食艰进者。则兼枳实、焦术以运
之。阴气上逆。干呕不食者。则兼丁香、吴茱萸以温之。呕吐涎水者。则兼橘、半、生姜以豁之。
脓血稠粘者。则兼茜根、乌梅以理之。水道不通者。则兼升、柴以举之。身热不除者。则兼桂枝、
芍药、姜、枣以和之。阴虚至夜发热痛剧者。则兼熟地、黄 、阿胶、归、芍以济之。若数日不
已而腹痛后重转甚者。必须参、术、升、柴兼补而升之。久痢噤口不食。此胃气告匮。最为危候。
较之初起口噤。尚有浊气可破。积沫可驱。迥乎不同。非大剂参、术。佐以茯苓、甘草、藿香、
木香、煨葛根之属。大补胃气。兼行津液。不能开之。但得胃气一转。饮食稍进。便宜独参汤略
加橘皮或制香附。缓缓调补。兼疏滞气。最为合剂。如茯苓之淡渗。木香之耗气。葛根之行津。
皆当屏除。即如久痢后重用三奇散。取黄 、防风以致开阖。枳壳以破滞气。以为卓识不群。然
后重稍减。盒饭改用补中益气。转关妙用。全在乎此。若浓朴、枳、橘、砂仁等耗气之药。皆戈
戟也。凡脉见弦细小弱。或六部沉小。皆当准此。间有脉来滑大数实者。方可用芩、连、芍药、
泽泻之属。挟热后重烦渴者。当与白头翁、秦皮、黄连、白芍之类。误用大黄。变成肿胀。若其
人元气未惫。大剂人参、桂、附散其浊阴。尚可救其一二。洞泄不止。服大剂参、术。不应。用
养脏汤。亦不应。惟附子理中汤调赤石脂末。间有得生者。即发呃吐蛔。尚有四逆、参附、吴茱
萸汤、干姜黄芩黄连人参汤、乌梅丸等法。然非平日相信之真。纵有生机。亦勿许治。若至发斑
发躁。久痢不食。忽发除中。从无救治之法也。尝见痢久虚脱。六脉弦细。厥逆冷汗。烦渴躁扰。
呃逆不宁。峻用理中、四逆、白通、通脉之类。虽日进人参二三两。服之非不暂安。脉来微续。
手足渐温。稀糜稍进。去后亦稀。三四日后必然骤变。此根气已绝。灯尽复明之兆。切勿因其暂
安。轻许以治。徒为识者鄙笑耳。至于妇人临产下痢。最为危殆。郑氏有胎前下痢。产后不止。
七日必死之例。予尝用甘草干姜汤加浓朴、茯苓、木香。治妊娠白痢。千金三物胶艾汤。治妊娠
血痢。连理汤加胶、艾。治赤白相兼之利。驻车丸、千金黄连汤、白头翁加甘草阿胶汤。胎前产
后五色诸痢。皆可选用。若胎前下痢。产后不止。势莫挽回者。用伏龙肝汤丸。随证加减。未尝
不随手获效也。世医治痢。专守通因通用。痛无补法之例。不知因气病而肠中切痛。非温理其气
则痛不止。因气陷而浊气下坠。非升举其气则后重不除。因气伤而津液崩脱。非调补其气则积不
已。因阴虚而至夜微热腹痛。非峻补其阴则痢痛不息。世人见余用参、术、姜、桂温补气血之药。
以为可骇。更有用黄 、地黄滋阴腻滞之药。益怪甚矣。且有用石脂、干姜温涩固脱之药。以为
劫剂。而大诽之。不知内经中原有涩因涩用之法。盖里急后重。数至圊而不能便。非涩而何。况
因涩而过用利气。乃致滑脱不收。安得不用涩以固之耶。更有不知调气。但见下痢日久。便行止
涩。轻以粟壳、诃子投之。闭其滞气。迫痛愈加。愈劫愈甚。此与杀之无异也。
痢不纳食俗。名噤口。如因邪留胃中。胃气伏而不宣。脾气因而涩滞者。香、连、枳、朴、
橘红、茯苓之属。热毒冲心。头疼心
烦。呕而不食。手足温暖者。甘草泻心汤去大枣易生姜。此证胃口有热。不可用温药。若阳气不
足。宿食未消。噫而不食。枳实理中加砂仁、陈皮、木香、豆寇。或山楂、曲、 之类。肝乘脾
者。戊己丸加木香、肉桂。有水饮停聚者。心下必悸动不宁。五苓散加姜汁。有火炎气冲者。黄
连解毒汤去黄柏加枳壳、木香。有胃虚挟热而呕逆者。连理汤。有积秽太多。恶气熏蒸者。大黄
黄连泻心汤加木香。丹溪用人参、川连、石莲子、粳米、姜汁。煎汤细细呷之神效。如吐。再作
服之。但得一呷下咽便开。石莲子真者绝无。余常以藕汁煮熟。稍加糖霜频服。兼进多年陈米稀
Bitter-cold medicines damage the Stomach Qi, causing profound harm. Whenever the blood is purple and dark, and frequent use of cooling medicines results in increased diarrhea, it should be treated as Cold Dysentery (Leng Li). Therefore, if the blood resembles pig liver, purple grass, or amaranth juice, Pao Jiang (Processed Zingiberis Rhizoma) is indispensable. The formula is Lizhong Tang (Regulate the Middle Decoction) with Ginseng removed, and added with Rou Gui (Cinnamon Twig), Mu Xiang (Aucklandiae Radix), Rou Dou Kou (Myristicae Semen), and Wu Mei (Mume Fructus). If pure fresh blood is passed with a bright red and thick color, this indicates latent heat in the Heart and Spleen. Use Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium). If there is food stagnation, use Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) added with Hou Po (Magnoliae Officinalis Cortex), Huang Lian (Coptidis Rhizoma), Mu Xiang, and Yan Hu Suo (Corydalis Rhizoma). In the early stage of red dysentery, Yan Hu Suo is suitable to add, as it best disperses blood stasis. For children under eight years old, treat as food stagnation. When Wind pathogen invades the Intestines and Stomach, resulting in pure clear blood discharge, or when Damp-Toxin causes bloody stool, use Wei Feng Tang (Stomach Wind Decoction) added with Zhi Qiao (Immature Bitter Orange), Jing Jie (Schizonepetae Herba), and Fang Feng (Saposhnikoviae Radix). When Wind enters the Intestines and Stomach, causing dysentery with green and mixed colors, use Shen Shu Tang (Divine Efficacy Decoction). For dysentery with abnormal abdominal pain, pulse deep and tight, without heat signs, first warm with Ginger and Cinnamon, then regulate stagnation. Tenesmus but inability to defecate upon reaching the toilet indicates Qi stagnation; prioritize unblocking. Severe cases use Xiao Cheng Qi Tang (Minor Order the Qi Decoction); mild cases use Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction). Frequent soiling of clothes due to tenesmus indicates Qi collapse (deficiency sinking); use Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) with Dang Gui removed and Mu Xiang added. For damp-heat dysentery with heaviness, use Sheng Yang Chu Shi Tang (Raise Yang and Dispel Dampness Decoction). For deficiency slipping with heaviness, where symptoms do not decrease after defecation due to further depletion of Qi, use Yang Zang Tang (Nourish the Viscera Decoction). In early white dysentery, with only abdominal pain and heaviness, anorexia, and clear urine, it is Deficient-Cold; use Er Chen Tang (Two-Cured Decoction) added with Pao Jiang, Jiao Bai Zhu (Fried Atractylodis Macrocephalae Rhizoma), Hou Po, Mu Xiang, and Sha Ren (Amomi Fructus). These herbs can cleanse phlegm accumulation and are suitable to add. Heaviness originally stems from pathogenic pressure on the Large Intestine causing descent, hence Da Huang (Rhei Radix et Rhizoma) and Bing Lang (Arecae Semen) are used for excess patterns. If long-term dysentery heaviness persists, it is due to Spleen Qi sinking; use Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) to lift, while Bing Lang and Zhi Qiao must be prohibited. If Lung Qi is stagnant in the Large Intestine, causing abdominal pain and bearing-down sensation, add Jie Geng (Platycodonis Radix) to open among Qi-regulating herbs. There are also cases where accumulation has cleared but recurs due to overeating rich, cold, or raw foods; prioritize strengthening the Spleen and aiding digestion. Dysentery resembling jelly, mucus, or fish brain indicates Cold Dysentery. First use Mu Xiang, Jiao Bai Zhu, Dou Kou (Cardamomi Fructus), Sha Ren, and Hou Po; subsequently use Lizhong Tang with Mu Xiang. If ineffective, add He Zi (Terminalia Chebulae Fructus) and Su Ke (Papaveris Pericarpium). Dysentery with slow and tight pulse, unceasing abdominal pain, requires warming and dissipating; use Zhi Shi Lizhong Tang (Immature Bitter Orange and Regulate the Middle Decoction). Dysentery with clear-white stool, cold extremities, and unceasing abdominal pain requires Fuzi Lizhong Tang (Aconite and Regulate the Middle Decoction). For chronic cold dysentery with lower abdominal soreness, stagnation, and multi-year persistence, use Qianjin Wen Pi Tang (Thousand Gold Warming Spleen Decoction). For cold dysentery, remove Gan Cao (Licorice Root), add Gui Xin (Cinnamon Heart), double Xiang Fu (Cyperi Rhizoma) and Ren Shen (Ginseng Radix et Rhizoma). For heat dysentery, remove Gui Xin, add 1 qian Da Huang, and reduce Jiang (Ginger), Fu Zi (Aconiti Lateralis Radix Praeparata), and Ren Shen by 1 qian each. For long-term dysentery that does not heal, although discharge decreases, dryness and blood exhaustion cause anal stiffness; use Qianjin Yang Zhi Jian (Thousand Gold Mutton Fat Preparation) to moisten and guide. Yang Zhi (Mutton Fat) is specified in Ben Jing for dysentery with rectal prolapse and colic, yet rarely used today, which is regrettable. For acute dysentery with long-standing accumulation, use Qianjin Fuzi Tang (Thousand Gold Aconite Decoction). For long-term dysentery with deficiency-cold slipping, fine pulse, cold skin, shortness of breath, aversion to eating, inability to speak, or occasional deficient heat, use Fuzi Lizhong Tang added with Rou Gui, Rou Dou Kou, and He Zi. For dysentery with umbilical churning pain, use Tao Hua Wan (Peach Kernel Pill). For long-term dysentery with deficiency-cold white turbidity, use Da Tao Hua Tang (Major Peach Kernel Decoction). For heat dysentery persisting for two to three years, use Hou Po Tang (Magnolia Bark Decoction). For long-term dysentery where ingested food is undigested, heavy limbs, and emaciation, use Jiao Ai Wan (Pepper and Mugwort Pill). For dysentery with fever, spontaneous sweating, and wiry pulse, indicating latent pathogen emergence, resolve from the exterior using Cang Lin Tang (Granary Decoction). For contagious dysentery among family members, termed Epidemic Dysentery (Shi Yi Li), Cang Lin Tang is also suitable. For Yin-deficiency dysentery, strictly avoid purgatives. Symptoms include passage of five colors, thick sticky pus and blood, uncontrollable slipping, fever, thirst, urgent lower abdominal pain worsening at night, anorexia, or fresh blood, indicate Yin deficiency; urgently save heat and preserve Yin. Select from Zhu Che Wan (Stopping Cart Pill), E Jiao Wan (Donkey-hide Gelatin Pill), Gui Lian Wan (Angelica and Coptis Pill), E Jiao Mei Lian Wan (Donkey-hide Gelatin, Mume, and Stone Lotus Pill), Qianjin Huang Lian Tang (Thousand Gold Coptis Decoction), Huang Lian E Jiao Tang (Coptis and Donkey-hide Gelatin Decoction), or Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Plus Licorice and Donkey-hide Gelatin Decoction). Nightly fever and thirst during dysentery indicate fluid injury and internal water depletion; do not use aromatic-dry herbs. Use Qian Shi Bai Zhu San (Child's Atractylodes Powder) with Wu Mei. Dysentery with flatus requires promoting urination; when Yin Qi opens anteriorly, Yang Qi transforms naturally. Use Wu Ling San (Five-Ingredient Powder with Poria) with Mu Xiang. If dysentery persists, take equal parts He Zi, Hou Po, and Ju Pi as pills. Anal pain in dysentery requires warming; use Huang Qi Jian Zhong Tang (Astragalus Establish the Middle Decoction) with Mu Xiang and Dang Gui. Post-dysentery constipation with tenesmus and frequent unsuccessful urges, or scant white mucus, indicates Qi deficiency sinking; avoid purgatives. Lift Yang, and Yin will descend naturally. Use Bu Zhong Yi Qi Tang with Fang Feng. Persistent tenesmus post-dysentery due to Wind damaging Wei Qi requires San Qi San (Three-Uncommon Powder). Gu Zhu toxic dysentery with chicken-liver-colored blood, heart vexation, and abdominal pain uses Qian Gen Wan (Qian Gen Pill). For deficient persons, use Lizhong Tang with Huang Lian and Wu Mei; if ineffective, use Wu Mei Wan (Mume Pill). Generalized edema after diarrhea uses Wu Ling San with Sheng Bai Zhu and Rou Gui, plus Sheng Ma and Chai Hu. Post-diarrhea floating deficiency uses Liu Jun Zi Tang (Six-Gentlemen Decoction) with Mu Xiang and Rou Gui. Early thick sticky pus and blood requiring strong purgation uses single Da Huang steamed in wine into pills. Take 100 pills with warm wine for red dominance; 70 pills with light ginger soup for white dominance, to seize the momentum, then regulate. For cold-heat imbalance with red-white diarrhea and cold food stagnation, use Lian Li Tang (Connected Regulate Decoction) with Zhi Shi and Sha Ren. Dry retching with diarrhea indicates Stomach deficiency with cold-heat complexity; use Waitai Huang Qin Tang (External Platform Scutellaria Decoction). White diarrhea turning to pus-blood uses Wu Ji Wan (Wu Ji Pill). White turning to fresh blood uses Si Wu Tang (Four Substances Decoction) with Di Huang removed, plus Pao Jiang, Zhi Gan Cao, and Mu Xiang. Pus-blood turning to red-white-green-black with doubled abdominal pain uses Zhu Che Wan. Pus-blood turning to white foam/pus uses Bu Zhong Yi Qi Tang with Pao Jiang and Chi Shi Zhi (Red Halloysite). Frequent stools with lethargy but no pain indicates excess pathogen and weak Zheng Qi; difficult to treat. Few daily stools with fever, epigastric fullness, anorexia, and vomiting contrast with hundreds of daily stools with quiet pulse, cool body, and appetite. Pathogen in Lower Jiao transmitting to Large Intestine causes no fever; pathogen in Middle Jiao entering Stomach causes anorexia. Wind-cold in Ying-Wei causes Malaria; dietary injury in Intestines-Stomach causes Dysentery. Malaria-followed-by-dysentery or vice versa occurs due to insecure exterior allowing internal invasion. If Malaria pathogen is exhausted, it won't recur as dysentery; it's due to sinking Yuan Qi and failing Spleen lifting, allowing Wind-Cold-Damp-Heat invasion. Post-dysentery malaria-like symptoms indicate Yin-Yang dual deficiency. Simultaneous Malaria and Dysentery with severe dysentery after Malaria stops indicates Spleen-Stomach Qi sinking. Treat first with Huang Qi Jian Zhong Tang plus Mu Xiang and Hou Po, then Bu Zhong Yi Qi Tang plus Jiang and Gui. If dysentery reduces but Malaria appears after medication, Yang is replenished and fighting Yin; use Bu Zhong Yi Qi Tang with slight Gui and Fu Zi to assist Yang and dispel Yin. Elderly long-term dysentery, post-partum/post-illness, ulcer-related, or post-diarrhea dysentery must not use attacking agents; awaken Spleen and fortify Earth with Bu Zhong Yi Qi Tang plus Pao Jiang and Mu Xiang. Add Wu Mei and Shao Yao for blood. After 6-7 days of dysentery, menstruation ends, expecting formed stool; if none by day 13 with next menstruation, Stomach Qi is exhausted; do not attack, cultivate Zheng Qi. Dysentery relies on Stomach Qi; loss of growth leads to aversion to food. Appetite return indicates winning Stomach Qi. Dysentery like fish brain or pig liver is half-dead/half-alive; dust-like color, open anus, roof-leak appearance, pure fresh blood, red bean juice, or vermilion lips are untreatable.
Shi Wen states: Chang Pi (Intestinal Dysentery) in Nei Jing distinguishes bloody stool, white foam, and pus-blood. Generally, white foam is Cold (pulse deep); pus-blood is Heat (pulse slippery-large). White foam with floating pulse, or pus-blood with wiry-rare pulse, indicates pulse-disease mismatch, prognostic of death. Key is fever implies death, cold implies survival. Intestinal disease shouldn't show exterior heat; exterior heat traps interior/exterior. All organ dysenteries are treatable with small-deep pulses; warm blood with fever implies death. This is Nei Jing principle. Zhang Zhongjing treats dysentery: fever with warm extremities indicates Yang recovery (treatable); cold reversal indicates Yang extinction (death), referring to Taiyang Cold Damage Yin syndrome, not summer-autumn Chang Pi. However, some dysentery with fever survives. Exogenous-pathogen and epidemic dysentery have fever; resolve exterior first, then fever subsides and dysentery stops. Nei Jing's "warm blood with fever" refers to Yin deficiency root, here combined with exogenous pathogen. Predecessors attributed white foam to deficiency-cold, pus-blood to damp-heat. Liu Shouzhen noted red-white mixture, asking if cold-heat both extreme in intestines causes dysentery. Dan Xi harmonized this, stating red from Small Intestine, white from Large Intestine, both damp-heat. This led to universal belief that all dysentery is heat, leading to excessive bitter-cold purgation, harming people to this day. Even Dong Yuan stated damp-heat injuring middle causes pus-blood, treating with bitter-cold for thick sticky pus, frequent urges, large-forceful pulse. Who knows bright-purple-thick blood is truly heat? Dark-dilute or agate-colored blood is Yang deficiency failing to control Yin; must warm-regulate Qi, otherwise blood won't clear. Regulating Qi is like refining gold in furnace, most effective. Without this, indiscriminate purgation drains fluids, never stopping. Seen repeated Huang Lian causing deficient Yang forcing outward (fever/rash), or disturbing inward (Chu Zhong/sudden appetite), or Da Huang causing intestinal leakage, hiccups, worm vomiting, or bloating/ascites/edema from Yin rebellion. Weather heat is normal season; indulging ice/fruit violates Zheng Qi, injuring organs with cold. Treating violation-of-Qi disease with violation-of-symptom medicine causes myriad changes. Yearly heat doubles illness; five-colors in accumulation indicate Five Zang Qi injury. Ancients linked five-color dysentery to Kidney, deepest storehouse of Essence. If deep is diseased, shallow upper parts must be too. Essence damaged cannot store; Zhongjing's "five fluids pouring down, umbilical pain, life endangered" applies. For essence damage and fluid loss, benefit Fire to melt Yin, solidify Spleen to dam Water, regulate Qi to drain non-transformed accumulation while preserving transformed fluids. Even anorexia follows this. Chang Pi involves failed transformation and fluid injury causing urgency; cannot blindly attack. Observing contemporary doctors, all use Ju Pi, Zhi Qiao, Hou Po, Bing Lang; add Huang Qin, Huang Lian, Shao Yao for red foam; Mu Tong, Che Qian for poor urination; Huang Lian, Shi Lian for anorexia. World's Shi Lian is often fake Cantonese herb, bitter-cold, unlike true lotus seed. For five-color anorexia and dark-clear blood dysentery, use Gan Cao, Gan Jiang for Spleen-Stomach, Rou Gui, Fu Ling for Kidney, effective instantly. Early pain/heaviness adds Mu Xiang, Bing Lang, Hou Po to drain; hard eating adds Zhi Shi, Jiao Bai Zhu to move; rebellious Yin with retching adds Ding Xiang, Wu Zhu Yu to warm; salivary vomit adds Ju Pi, Ban Xia, Sheng Jiang to resolve; sticky pus-blood adds Qian Gen, Wu Mei to regulate; blocked urination adds Sheng Ma, Chai Hu to lift; persistent fever adds Gui Zhi, Shao Yao, Jiang, Zao to harmonize; Yin deficiency night fever/pain adds Shu Di, Huang Bo, E Jiao, Dang Gui, Shao Yao to nourish. If worsening after days, must use Ren Shen, Bai Zhu, Sheng Ma, Chai Hu to tonify and lift. Long-term anorexia is critical Stomach Qi exhaustion; unlike early stage, requires large dose Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Huo Xiang, Mu Xiang, Wei Ge Gen to tonify Qi and move fluids. Once stomach turns, use Du Shen Tang with Ju Pi or Zhi Xiang Fu to slowly tonify and disperse stagnation. Avoid Fu Ling's leaching, Mu Xiang's Qi consumption, Ge Gen's fluid movement. Using San Qi San for long-term heaviness with Huang Qi, Fang Feng, Zhi Qiao is insightful, but switch to Bu Zhong Yi Qi Tang once heaviness lessens. Hou Po, Zhi, Ju, Sha Ren are weapons. String-small-weak or six-position deep-small pulses follow this. Slippery-large-rapid-solid pulses allow Huang Qin, Huang Lian, Shao Yao, Ze Xie. Heat-heaviness-thirst uses Bai Tou Weng, Qin Pi, Huang Lian, Bai Shao; mistaken Da Huang causes swelling. If Yuan Qi intact, large Ren Shen, Gui, Fu Zi can save. Profuse diarrhea unresponsive to Ren Shen, Bai Zhu, Yang Zang Tang requires Fuzi Lizhong Tang with Chi Shi Zhi powder. Hiccups/worms allow Si Ni, Shen Fu, Wu Zhu Yu Tang, Gan Jiang Huang Qin Huang Lian Ren Shen Tang, Wu Mei Wan. Requires genuine trust; otherwise don't treat. Rash/agitation/anorexia/Chu Zhong are untreatable. Seen long-term dysentery collapse with wiry-fine pulse, cold reversal, sweat, thirst, restlessness, hiccups; aggressive Li Zhong, Si Ni, Bai Tong, Tong Mai with 2-3 liang Ren Shen temporarily calms, pulse returns, hands warm, gruel intake, loose stool, but sudden change after 3-4 days indicates root Qi extinction (lamp relighting); do not treat lightly. Pregnant women with dysentery are critical. Zheng's case: pre-natal dysentery continuing post-partum dies in 7 days. I used Gan Cao Gan Jiang Tang + Hou Po, Fu Ling, Mu Xiang for white dysentery; Qianjin San Wu Jiao Ai Tang for bloody dysentery; Lian Li Tang + E Jiao, Ai Ye for red-white; Zhu Che Wan, Qianjin Huang Lian Tang, Bai Tou Weng Jia Gan Cao E Jiao Tang for five-color. Uncontrollable post-partum uses Fu Long Gan Tang Wan. Doctors stick to "treat obstruction with unblocking" and "pain has no tonification," ignoring that Qi disease pain needs warming Qi, sinking Qi needs lifting Qi, Qi injury fluid loss needs tonifying Qi, Yin deficiency night fever needs tonifying Yin. People are shocked by my Ren Shen, Bai Zhu, Jiang, Gui, Huang Qi, Di Huang, Chi Shi Zhi, Gan Jiang, calling them harsh or criticizing astringents. Nei Jing has "astringe according to astringency." Tenesmus requires astringency. Overusing Qi-moving causes slipping, needing astringency. Blindly using Su Ke, He Zi closes stagnation, worsening pain, equivalent to killing.
Anorexic dysentery (Jin Kou) due to pathogen in Stomach blocking Qi uses Mu Xiang, Huang Lian, Zhi Shi, Hou Po, Ju Hong, Fu Ling. Heat-toxin rushing Heart with headache, vexation, vomiting, warm extremities uses Gan Cao Xie Xin Tang minus Da Zao, replace with Sheng Jiang (stomach heat, no warm meds). Yang deficiency with retained food, belching, no eating uses Zhi Shi Lizhong Tang + Sha Ren, Chen Pi, Mu Xiang, Dou Kou, Shan Zha, Qu. Liver invading Spleen uses Wu Ji Wan + Mu Xiang, Rou Gui. Fluid retention with palpitations uses Wu Ling San + Jiang Zhi. Fire rising with Qi衝 uses Huang Lian Jie Du Tang minus Huang Bo + Zhi Qiao, Mu Xiang. Stomach deficiency with heat/vomiting uses Lian Li Tang. Too much filth/stench uses Da Huang Huang Lian Xie Xin Tang + Mu Xiang. Dan Xi uses Ren Shen, Chuan Lian, Shi Lian Zi, Jing Mi, Jiang Zhi, sipped slowly; repeat if vomited. One sip opens. True Shi Lian is rare; I use cooked Lotus Root Juice with sugar and aged rice gruel.