多不知。凡以寒侵腑脏，及脉络受伤，血动气滞者，皆能为痛。但察其不实不坚，或喜揉按，或喜暖熨，或胸腹如饥而
不欲食，或胃脘作呕而多吞酸，但无实热等证，则总属虚寒，安得谓痛必因积、痛皆实证耶。凡治虚寒之痛者，速宜温
养脏气，不得再加消伐，致令动者愈动，滑者愈滑，必至危矣。但其痛之甚者，当于温补药中，稍加木香以顺其气，或
多加当归以和其血。俟痛稍减，则当去此二味，盖又恐木香之耗气，当归之滑肠也。若寒在下焦而作痛者，必加吴茱萸。
其或痛不至甚，则但以温补脾肾为主，使脾肾渐安，则痛当自止，此不必治其痛也。（《景岳》）
寒闭痛甚，寒开痛微。痢开病减，故痛微也。虚者少气，气无壅滞，故亦痛微也。热者多实，性急不得舒
通，故窘痛甚也。（《金鉴》）
凡蕴热血痢，里急而痛甚，虽已疏通荡涤，然其痛不减者，非热亦非积也，荣血亏少，阳刚胜阴故尔。用
药当以川芎为佐，荣血一调，其痛自止。（《直指》）（按∶痢后腹痛，见调停方中越桃散下，宜参。）
里急后重 里急后重，脉大而洪实，为里热而甚蔽，是有物结坠也。若脉浮大甚，不宜下。虽里急后
重而脉沉细弱者，谓寒邪在内而气散也，可温养而自愈。里急后重闭者，大肠经气不宣通也，宜加槟榔、木香宣
通其气。（《保命集》）
按里急者，窘迫急痛是也。后重者，大肠坠重而下也。夫里急后重，其证不一。有因火热者，所谓火性急
速而能燥
物是也。有因气滞，此大肠经气壅而不宣通也。有因积滞壅盛者，是有物结坠也。有气虚者，此大肠气降而不
能升也。有血虚者，所谓虚坐努责是也。治法，火热者寒之清之，气滞者调之，积滞者去之，气虚而降者升之
举之，血虚者补之，各察其所因也。（《玉机》）
邪迫而后重者，至圊稍减，未几复甚（芍药汤）。虚滑而后重者，圊后不减，以得解愈虚故也（真人养脏
汤）。下后仍后重者，当甘草缓之，升麻举之。（《必读》）（按∶《医贯》曰∶后重有二∶邪气坠下者，圊后
不减；虚努不收者，圊后随减。此可辨虚实。此说 矣）
后坠下迫肛门，粪出坠止，为粪前坠，乃滞也，故曰实坠，粪出更坠，为粪后坠，非滞也，故曰虚坠。
（《金鉴》）
口中及肠内生疮 凡痢口里生疮，则肠间亦有疮也。所以知者，犹如伤寒热病，胃烂身则发疮也。此由
挟热痢，藏虚热气内结，则疮生肠间，热气上冲，则疮生口里。然肠间口里生疮，皆胃之虚热也。胃虚谷气弱，
则九虫三尸发动，则变成 。（《病源论》）
大孔痛 下利大孔痛者，当温暖之。（《千金》）
下利大孔痛者，因热流于下也，以木香、槟榔、黄连、黄芩、炒干姜。（《丹溪》）
凡病痢疾多有大孔肿痛者，其故何也？盖脾胃不和，则水谷之气失其正化，而浊恶难堪之味出诸孔道，此痛楚
之不能免也。又若火因泻陷，阳为阴逐，则胃中阳气并逼于下，无从解散，此肿之所由生也。所以痢多则痛多，
痢少则痛少，痛与不痛，亦由气之陷与不陷耳。故无论寒痢热痢，大孔皆能为痛，不得谓痛必由热也。欲治此者，
但治其痢，痢止则肿痛自散，亦如后重之法也。（《景岳》）
渴 痢则津液空竭，腑脏虚燥，故痢而兼渴也。渴而引饮，则痢不止，翻益水气，脾胃已虚，不能克
消水，水气流溢，浸渍肌肉，则变肿也。（《病源论》）
凡泻痢之证必多口渴，今人但见口渴即认为火，而不知有火者固能渴，无火者亦能渴，此不可不辨也。如火
盛于中，则熏脾烁胃，津液耗干，故酷好冰水，多而不厌，愈凉愈快，随饮随消者，此因热而渴，治宜凉也。又
如口热作渴，虽欲饮水而饮不能多者，即非真火，不宜凉也。凡口虽干渴喜凉而后不喜凉者，是即寒聚于中，而
无根之火浮戴于上，此最忌寒凉者也。（《景岳》）
小便不通 凡泻痢之证，小水必多不利，或多黄赤，此其寒热虚实大有关系，不可不察也。若暴注之泻，
以其清浊不分，水谷并归于大肠，故水有不利者，惟其暂也。若痢疾之小水，则病本不一。今人但见黄赤不利，
无不云其为热，误者多矣。凡因于热者，必其热赤之甚，或多涩痛，或见鲜血，然必上下皆有热证，方是真热，
此宜清凉治之。若非真热，则或以中寒而逼阳于下者有之，或以泻痢亡阴而水亏色变者有之，或以下焦阳气不
暖而水无以化者有之，或以妄用渗利而 逼干汁者亦有之。但察其三焦无火，则虽黄虽涩，总皆亡阴亡液之证，
不得通以热论，速当培补真阴，乃为良法。（《景岳》）
小便不通，绝无小便，此毒瓦斯并归一脏，胃干者死，山栀、赤茯苓解之，局方黄连阿胶丸挟暑尤佳。（《永
类》）（按∶黄连阿胶丸用阿胶、黄连、茯苓三味。）
下痢小便不通者，黄连阿胶丸为最。（《要诀》）
肿 今因痢，脾胃虚弱，土气衰弱，不能克制于水，致令水得妄行，不流于小肠，而浸溃脏腑，散流皮
肤，与气相搏，腠理壅闭，故痢而肿也。（《病源论》）
疫痢 外有时行疫痢一证，三十年前间或有之，今则往往夏末秋初。沿门阖境患此。其证大都发热头
疼，口渴烦躁，下痢溺涩，甚者一日夜行百次，或兼发斑疹，势甚危迫。世医妄指为漏底，殊不知此是时气使
然。因世人禀赋渐薄，积感湿热厉气所致。治法当清热解毒表散为急，如升麻、葛根、柴胡、黄连、黄芩之类。
（《广笔记》）（按∶疫毒痢，杨子建《万全护命方》、《史载之方》、《妇人良方》所说稍详，然殊少其要，
仍不繁载。杨说见《奇效良方》引。）
暑痢 大凡痢疾，虽体寒手足逆冷，冷汗自出，六脉沉伏，不宜轻用附子，多因伏暑而得此疾。亦有
冷汗自出，四肢逆冷，六脉虚弱，但背寒面垢，或面如涂油，齿干烦冤，燥渴引饮，此伏暑证也。（《妇人良
方》）
夏月下痢，或赤或白，烦渴呕逆，腹中搅痛，小便不利者，此因暑致之，可以五苓散、香茹散、小柴胡汤
之属。若以此呕症为脾胃虚寒，则误矣。（《济世全书》）
不伏水土痢 夫四方之气，温凉不同，随方嗜欲，因以成性。若移其旧土，多不习伏，必因饮食以入
肠胃，肠胃不习便为下痢，故名不伏水土痢也，即水谷痢是也。（《病源论》）
休息痢 休息痢者，胃管有停饮，因痢积久，或冷气、或热气乘之，气动于饮，则饮动而肠虚受之，
故为痢也。冷热气调，其饮则静而痢亦休也。肠胃虚弱，易为冷热，其邪气或动或静，故其痢乍发乍止，谓之
休息痢也。（《病源论》）
屡止屡发久不愈者，名曰休息痢。因兜涩太早，积热未清（香连丸加参末、甘草、茯苓、枳实）。有调理
失宜者，
随证治之。有虚滑甚者，椿根白皮东引者，水浸一日去黄皮，每两配人参一两、煨木香二钱、粳米三钱煎汤饮
之（或大断下丸）。（《必读》）
五色、休息二痢，皆因用止涩药早，或因滞热下之未尽、蕴于肠胃，伤脏气也。用一切补养之药不应，则可
知初病非止涩太早，即下之未尽也。诊其脉若有力，虽日久仍当攻也。其余治法与诸痢同。（《金鉴》）
有一等休息痢，经年累月，愈而复发，此系寒积在大肠底，诸药所不到，独巴豆一味研炒，蜡丸如龙眼大，
空腹服之，再不复发，此亦通因通用之法也。（《医贯》）（按∶龙眼大可疑。）
噤口痢 下痢噤口不食，虽曰脾虚，盖亦热气闭隔心胸所致也。俗用木香则失之温，用山药则失之闭。
（《直指》）
按痢而能食，知胃未病也。若脾胃湿热之毒，熏蒸清道而上，以致胃口闭塞而成噤口之证（按∶此说本于
丹溪，宜参后调停诸方），理宜除胃口之邪热，而此云其毒上冲心肺（按∶此斥《百一选方》，其文出石莲肉方
中），其毒不知指何者之邪。然亦有脾胃虚而得者，亦有误服利剂药毒犯胃者，又有服涩热之剂太早而邪气闭
遏于胃口者，必当求责。（《玉机》）
噤口痢有二症，虚与热是也。热塞胃口，正气衰惫，莫能与争，故滴水不进。古人有用人参三钱、酒炒黄连
三钱、酒炒石莲肉一钱，频频少饮，饮而或吐，又少饮之，若得些须入胃，胃气即回而食少进矣。愚谓热胜则
川连当用四钱，人参当用二钱，虚胜则人参当用四钱，川连当用二钱，盖变通之道也。此症亦有人参不能用一分
者，以阴太虚而邪阳太盛也。（《苍生司命》）
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、豆蔻或山楂、曲、柏之类。（《医通》）（按∶
此说本于《必读》，彼更曰∶有积秽在下，恶气熏蒸者，承气汤。）
不饥而不能食者是脾病，宜香砂六君子汤及理中汤。饥而不能食者是肝病，宜乌梅丸。至于绝食频呕，即
是噤口痢。若食入即吐不利于香、砂、橘、半者，宜用干姜黄连黄芩汤，苦辛以开拒格。若胸满而吐及干呕吐涎
沫者，宜吴茱萸汤，温镇以和土木，其效如神。凡心下痞满，从仲景三泻心汤及浓朴生姜甘草半夏人参汤等择
用如神。（《时方妙用》）
疟痢兼作、痢后似疟（互见疟门。）疟痢兼作者，何重轻，分利阴阳，主以柴苓。（《医读》）
有痢后似疟非疟，乃阴阳两虚。阳虚则恶寒，阴虚则发热，故寒热交战似疟也。（《医通》）
瘀血似痢 东阳胡兄年四十岁，患痢百余日，百法治不效。时正九月初旬，予诊其六脉促急沉弦细弱
芤，左手为甚，昼夜十行，视之秽物甚少，虽下清涕，中有紫黑血丝，食全不进。予曰∶此非痢也，当作瘀血治
之。其兄问瘀血何事而致。予曰∶饱食急走，极力叫骂，欧打 扑，多受疼痛，盛怒不泄，补塞太过，大酒大
肉，皆能致之。彼云∶去岁枉受责杖，经涉两年，恐非此等瘀血。予曰∶服吾药，得瘀血下则生矣。以桃仁、
乳香。没药、滑石，佐以槟榔、木香，用神曲糊为丸，以米饮下五十粒。至夜半又不动，又根据前法下二百粒，
至天明下秽如烂鱼肠者二升半，困顿终日。
渐与粥食而安。（《医纲》引《丹溪》）
生死诀 病肠 者，下脓血，病患脉急皮热，食不入，腹胀目瞪者死；或一身厥冷，脉沉细而不生者
亦死；食如故，脉沉浮有力而不绝者生。（《中藏》）
世人初患痢时，先发寒热，投药治之，其热不退，发热太甚，食则呕逆，下痢不止，心热如火，只要入凉
处，只思吃冷水，忽思狂走，浑身肌肉疼痛，着手不得，此候十难治其三四也。（《奇效》引《万全护命方》）
不治证∶脉大、身热、鸭屎、发渴、咳逆、五色、噤口、红水，唇红、手足冷、噤口气喘。痢后烦引饮，
为心绝，小便绝不通，为肾绝。（《永类》）
下利不治之证∶下利如鱼脑者半死半生，下如尘腐色者死，下纯血者死，下如屋漏水者死。（《丹溪》）
大孔开如竹筒者，唇如朱红者，俱死。（《正传》）
口疮绽裂、脉洪急搏手者，身大热久不退者，喘而不休，大汗不止者，皆不救也。（《司命》）
湿痢腹胀身重，下如豆汁，或赤黑混浊，危症也。（《入门》）
粪以取起如系不断者生，断续不接如水泡者死。（《会解》）
凡痢身不热者轻，身热者重，能食者轻，不能食者重，绝不食者死，发呕者死，直肠自下者死，久痢忽大下
绝粪者死。小儿出痘后即发痢者死，妇人新产即发痢者死。（《订补明医指掌》）
久痢发热，不能食，肌肉减者，不治。（《己任编》）
下痢日百度，精神萎顿，反不痛者，此邪气胜，正气微，不能鼓激也，难治。（《医通》）
下利不止，水浆不入，气小脉细，皮肤寒，死于阳绝也；下利纯血噤口，呕逆藏气，身热脉大，死于阴绝
也。（《金鉴》）
治有三等 始痢宜下，夫人之所共知也，久痢宜补，亦夫人之所共知也；至如二阳合病皆下痢、太阳阳
明合病自下痢者，宜发汗，太阳少阳合病自下痢者，宜和解，阳明少阳合病自下痢者，此宜攻里，非得伤寒之
玄关者，不足以语此也。（《医方考》）
治当责积滞 至若肠胃自感而病，亦当以邪正分。或正气先虚而受邪，或因邪而致虚，则以先者为本，
后者为标，与夫积之新旧亦如之。旧积者，停食结痰所化之积也（《医通》作气血食痰所化也）。新积者，旧
积去后而气血复郁所生者也。旧积当先下之，新积则不宜下，其故何哉？盖肠胃之腐熟水谷、转输糟粕者，皆
荣卫洒陈六腑之功。今肠胃有邪，则荣卫营运至此，其机为之阻，不能施化，故卫气郁而不舒，荣血泣而不行，
于是饮食结痰停于胃，糟粕留于肠，与所郁气泣血之积，相挟成滞下病矣。如是者必当下之，以通壅塞，利荣卫
Many (physicians) do not understand. Whenever cold pathogen invades the zang-fu organs, or meridians and collaterals are injured, causing blood to move recklessly and qi mechanism to stagnate, pain can result. As long as examination reveals that the abdomen is neither full nor hard, or the patient prefers rubbing and pressing, or prefers warm compresses, or feels hunger in the chest and abdomen but has no desire to eat, or experiences epigastric nausea with excessive acid regurgitation, provided there are no excess-heat patterns, it generally belongs to deficiency-cold. How can one say that pain must be due to accumulation and that all pain is an excess pattern? Generally, when treating pain caused by deficiency-cold, one should quickly warm and nourish the zang qi, and must not add resolving and purging drugs, lest the moving blood move more recklessly and the slippery discharge become more severe, inevitably leading to danger. However, for those with severe pain, slightly adding Xiang Mu (Costus Root) to smooth qi, or adding more Dang Gui (Angelica Sinensis) to harmonize blood, within warming and tonifying formulas is appropriate. Once the pain subsides slightly, these two herbs should be removed, for one fears that Xiang Mu may consume qi and Dang Gui may cause loose stools. If cold in the lower jiao causes pain, Wu Zhu Yu (Evodia Fruit) must be added. If the pain is not severe, the main treatment should be warming and tonifying the spleen and kidney; once the spleen and kidney gradually stabilize, the pain will stop on its own. This is a method where treating the pain specifically is unnecessary. (From *Jing Yue Quan Shu*)
When cold closes off, pain is severe; when cold opens up, pain is mild. When dysentery attacks, the disease burden lessens, so pain is mild. In deficiency cases, there is little qi, and qi does not obstruct, so pain is also mild. In heat cases, there is much excess, nature is irritable and cannot relax or flow freely, so distressing pain is severe. (From *Yi Zong Jin Jian*)
In cases of bloody dysentery harboring heat, with tenesmus and severe pain, even after clearing and purging, if pain does not decrease, it is neither heat nor accumulation, but rather a deficiency of Ying blood, with Yang overcoming Yin. Medication should use Chuan Xiong (Sichuan Lovage Rhizome) as an assistant; once Ying blood is regulated, the pain will cease. (From *Zhi Zhi Fang*) (Note: Abdominal pain after dysentery is discussed under Yue Tao San in the regulating formulas section; refer to it.)
Tenesmus: A pulse that is large, surging, and solid indicates severe internal heat obstruction, caused by tangible matter knotting and weighing down. If the pulse is floating and large to an extreme, downward purging is contraindicated. Although tenesmus is present, if the pulse is deep, fine, and weak, it indicates cold pathogen inside with dissipating qi; it can heal itself through warming and nourishing. Tenesmus with blockage indicates non-circulation of Qi in the Large Intestine meridian; adding Bing Lang (Areca Seed) and Xiang Mu (Costus Root) to promote circulation is suitable. (From *Bao Ming Ji*)
"Tense urgency" refers to distressing, urgent pain. "Heaviness after defecation" refers to the sensation of heaviness and downward bearing in the Large Intestine. Tenesmus presents differently depending on the cause. It can be caused by fire-heat, where the nature of fire is rapid and drying. It can be caused by qi stagnation, where Qi in the Large Intestine meridian is congested and not circulating. It can be caused by excessive accumulation, where tangible matter knots and weighs down. It can be caused by qi deficiency, where Qi descends but cannot ascend. It can be caused by blood deficiency, known as empty straining. Treatment methods: for fire-heat, use cold and clearing; for qi stagnation, regulate qi; for accumulation, remove it; for qi deficiency with sinking, lift and raise; for blood deficiency, tonify. Each case requires investigating the specific cause. (From *Yu Ji Wei Yi*)
Tenesmus caused by pathogenic pressure decreases slightly after defecation but worsens again shortly after (Shao Yao Tang). Tenesmus caused by deficiency and slipping does not decrease after defecation because resolution further depletes qi (Zhen Ren Yang Zang Tang). Tenesmus persisting after purgation should be treated with Gan Cao (Licorice) to moderate and Sheng Ma (Cimicifuga) to lift. (From *Yi Xue Ru Men*) (Note: *Yi Guan* states: There are two types of tenesmus: pathogenic sinking, which does not improve after defecation; deficiency straining without retention, which improves after defecation. This distinguishes excess from deficiency. This view is excellent.)
Downward bearing pressing the anus, stopping after stool passage, is pre-stool bearing, caused by stagnation, hence called excess bearing. Worsening after stool passage is post-stool bearing, not caused by stagnation, hence called deficiency bearing. (From *Yi Zong Jin Jian*)
Sores in Mouth and Intestines: Whenever mouth sores occur with dysentery, sores also exist in the intestines. We know this just as in typhoid fever, where stomach rot leads to body sores. This arises from dysentery with heat, where deficient heat in the zang-fu knots internally, causing sores in the intestines; rising heat causes sores in the mouth. Sores in both intestines and mouth are due to deficient heat in the stomach. Weak stomach qi and grain qi allow the nine parasites and three corpses to activate, transforming into... (text missing here). (From *Bing Yuan Lun*)
Anal Pain: Lowering accompanied by anal pain should be warmed. (From *Qian Jin Fang*)
Lowering with anal pain is due to heat flowing downward; use Mu Xiang (Aucklandia), Bing Lang (Areca Seed), Huang Lian (Coptis), Huang Qin (Scutellaria), and fried Gan Jiang (Dried Ginger). (From *Dan Xi Xin Fa*)
Why do most dysentery cases involve painful swelling of the anus? Roughly, when spleen and stomach are disharmonious, the qi of water and grain loses normal transformation, and foul, unbearable flavors exit through the orifices, making this pain inevitable. Furthermore, if fire sinks due to diarrhea, and yang is driven down by yin, stomach yang is forced downward with nowhere to disperse, causing swelling. Thus, more dysentery means more pain, less dysentery means less pain; pain depends on whether qi sinks or not. Therefore, regardless of cold or heat dysentery, the anus can hurt; one cannot say pain is always due to heat. To treat this, simply treat the dysentery; when dysentery stops, swelling and pain dissipate naturally, similar to treating tenesmus. (From *Jing Yue Quan Shu*)
Thirst: Dysentery empties fluids, causing zang-fu deficiency and dryness, hence thirst accompanies dysentery. Thirst with drinking leads to persistent dysentery, increasing water qi. With already deficient spleen and stomach unable to transform water, water flows溢出, soaking muscles, leading to edema. (From *Bing Yuan Lun*)
Diarrhea and dysentery cases often feature thirst. Modern physicians see thirst and assume fire, not knowing that while fire causes thirst, absence of fire can also cause thirst; this must be distinguished. If fire is excessive in the center, scorching spleen and stomach, consuming fluids, the patient craves ice water, drinks much without satiety, finds cooling refreshing, and digestion is immediate; this is thirst due to heat, treated with cooling. If mouth feels hot and thirsty, desiring water but unable to drink much, it is not true fire, and cooling is inappropriate. If mouth is dry and thirsty, preferring cool initially but later rejecting cool, cold has gathered in the center, and rootless fire floats upward; this strictly forbids cold medicines. (From *Jing Yue Quan Shu*)
Urination Obstruction: In diarrhea and dysentery, urination is often difficult or yellow/red. This relates significantly to cold, heat, excess, and deficiency, requiring careful observation. In acute watery diarrhea, due to confusion of clear and turbid, water and grain return to the Large Intestine, causing temporary urinary difficulty. In dysentery, however, the root causes vary. Modern physicians see yellow/red difficult urination and universally attribute it to heat, leading to many errors. Heat-caused cases feature intense redness/heat, frequent painful urination, or visible fresh blood, and crucially, heat signs throughout upper and lower jiao; these require cooling. Non-true heat cases include: middle cold forcing yang downward; fluid loss from diarrhea/dysentery causing yin deficiency and color change; lower jiao yang failing to warm, preventing water transformation; or reckless use of diuretics drying fluids. Examining that there is no fire in the three jiao, even if yellow or difficult, these are total yin/fluid depletion patterns, not heat; rapidly tonifying true yin is the good method. (From *Jing Yue Quan Shu*)
Complete urinary obstruction indicates toxic vapors converging on one organ; stomach dryness implies death. Shan Zhi (Gardenia) and Chi Fu Ling (Red Poria) resolve it; Ju Fang Huang Lian E Jiao Wan is especially good for summerheat. (From *Yong Lei Qian Fang*) (Note: Huang Lian E Jiao Wan uses E Jiao, Huang Lian, and Fu Ling.)
For dysentery with urinary obstruction, Huang Lian E Jiao Wan is best. (From *Yao Jue*)
Edema: Currently due to dysentery, spleen and stomach are weak, earth qi declines, failing to control water, allowing water to act recklessly. Instead of flowing to Small Intestine, it infiltrates zang-fu, spreads to skin, combats qi, blocks pores, causing edema with dysentery. (From *Bing Yuan Lun*)
Epidemic Dysentery: There is an epidemic dysentery syndrome, rare thirty years ago, now common in late summer/early autumn. Spreading door-to-door. Symptoms mostly include fever, headache, thirst, irritability, dysentery with difficult urination, sometimes 100+ times day/night, or accompanied by macules/rashes, critically dangerous. Physicians wrongly call it "leaky bottom," unaware this is due to seasonal qi. Due to weakening constitutions and accumulated damp-heat miasma, treatment urgently requires clearing heat, detoxifying, and releasing exterior, using Sheng Ma (Cimicifuga), Ge Gen (Pueraria), Chai Hu (Bupleurum), Huang Lian (Coptis), Huang Qin (Scutellaria), etc. (From *Guang Bi Ji*) (Note: Epidemic toxin dysentery is detailed in Yang Zijian's *Wan Quan Hu Ming Fang*, *Shi Zai Zhi Fang*, *Fu Ren Liang Fang*, though lacking key points, so not fully recorded. Yang's view cited in *Qi Xiao Liang Fang*.)
Summerheat Dysentery: Generally, dysentery presenting with cold body, cold limbs, cold sweat, and deep/faint six pulses should not lightly use Fu Zi (Aconite); it is often due to hidden summerheat. Cases with cold sweat, cold limbs, weak six pulses, but cold back, greasy face, or oily face, dry teeth, vexation, dry thirst craving drink, indicate hidden summerheat. (From *Fu Ren Liang Fang*)
Summer dysentery, red or white, with vexation/thirst, vomiting/reversal, abdominal twisting pain, difficult urination, is caused by summerheat; use Wu Ling San (Five Ingredient Powder with Poria), Xiang Ru San (Mint Powder), Xiao Chai Hu Tang (Minor Bupleurum Decoction), etc. Mistaking vomiting for spleen/stomach deficiency-cold is an error. (From *Ji Shi Quan Shu*)
Acclimatization Dysentery: Qi varies by region, warmth/cold differ, habits form character. Moving to new land, one often fails to adapt; food enters stomach/intestines, which are unaccustomed, causing diarrhea, named Acclimatization Dysentery, i.e., Grain-Water Dysentery. (From *Bing Yuan Lun*)
Intermittent Dysentery: Intermittent dysentery involves retained fluid in the stomach tube. Long-standing dysentery allows cold or heat qi to attack; qi moves the fluid, fluid moves, empty intestine receives it, causing dysentery. When cold/heat qi balances, fluid settles, dysentery rests. Weak stomach/intestines easily affected by cold/heat, pathogenic qi moves/rests, so dysentery flares/stops intermittently, called Intermittent Dysentery. (From *Bing Yuan Lun*)
Repeatedly stopping and recurring, long-lasting, is named Intermittent Dysentery. Caused by astringents used too early, residual heat not cleared (Xiang Lian Wan plus Ginseng powder, Gan Cao, Fu Ling, Zhi Shi). Improper regulation requires symptom-based treatment. Severe deficiency/slipping uses Dong Yin Chun Pi Bai Pi (East-rooted Cinnamon Bark), soaked in water one day, peeled, mixed 1 liang with 1 liang Ginseng, 2 qian roasted Mu Xiang, 3 qian Jing Mi, decocted and drunk (or Da Duan Xia Wan). (From *Yi Xue Ru Men*)
Five-Color and Intermittent dysenteries are caused by early astringents or incomplete purging of stagnant heat accumulating in stomach/intestines, damaging zang qi. If tonics fail, it confirms initial error was early astringents or incomplete purging. If pulse is forceful despite duration, purging is still indicated. Other treatments align with other dysenteries. (From *Yi Zong Jin Jian*)
Some intermittent dysenteries last years, recurring after healing. This is cold accumulation at the bottom of Large Intestine, unreachable by other herbs. Only Ba Dou (Croton Seed), roasted and ground, made into wax pills size of longan, taken fasting, prevents recurrence. This is also "treating similarity with similarity." (From *Yi Guan*) (Note: Size of longan is doubtful.)
Anorexic Dysentery: Dysentery with inability to eat, though attributed to spleen deficiency, is also caused by heat closing chest/heart. Folk use of Mu Xiang is too warming; use of Shan Yao is too cloying. (From *Zhi Zhi Fang*)
Note: Ability to eat during dysentery indicates stomach is unaffected. If damp-heat toxin of spleen/stomach steams upward, blocking appetite, causing Anorexic Dysentery (based on Dan Xi, refer to regulating formulas below), proper treatment removes pathogenic heat from appetite. The text claims toxin rushes to heart/lungs (critiquing *Bai Yi Xuan Fang*, text from Shi Lian Rou formula), but doesn't specify which toxin. However, some arise from spleen/stomach deficiency, some from mistaken purgative toxicity offending stomach, some from early astringent/heat agents closing pathogen at appetite; causes must be investigated. (From *Yu Ji Wei Yi*)
Anorexic Dysentery has two patterns: deficiency and heat. Heat blocks appetite, righteous qi is exhausted, unable to contend, so not even drops of water enter. Ancients used 3 qian Ren Shen, 3 qian wine-fried Huang Lian, 1 qian wine-fried Shi Lian Rou, sipped frequently; if vomited, sip less; if any enters stomach, stomach qi returns, eating resumes. I propose: if heat dominates, use 4 qian Chuan Lian, 2 qian Ren Shen; if deficiency dominates, use 4 qian Ren Shen, 2 qian Chuan Lian; this is flexibility. Some cannot tolerate even 1 fen Ren Shen due to extreme yin deficiency and rampant evil yang. (From *Cang Sheng Si Ming*)
Dysentery with inability to eat is vulgarly Anorexic Dysentery. If pathogen stays in stomach, stomach qi hides not circulating, spleen qi becomes stagnant, use Xiang, Lian, Zhi, Po, Ju Hong, Fu Ling, etc. If heat toxin rushes to heart, headache/vexation, vomiting/no eating, warm hands, use Gan Cao Xie Xin Tang minus Da Zao, replace with Sheng Jiang. This pattern has heat in appetite; warm medicine is forbidden. If yang qi insufficient, undigested food remains, belching/no eating, use Zhi Shi Li Zhong plus Sha Ren, Chen Pi, Mu Xiang, Dou Kou, or Shan Zha, Qu, Bai, etc. (From *Yi Tong*) (Note: Based on *Bi Du*, which adds: if filth accumulates below, foul qi steams, use Cheng Qi Tang.)
No hunger but inability to eat is spleen disease, use Xiang Sha Liu Jun Zi Tang and Li Zhong Tang. Hunger but inability to eat is liver disease, use Wu Mei Wan. Total food refusal with frequent vomiting is Anorexic Dysentery. If vomiting immediately after eating makes Xiang, Sha, Ju, Ban unsuitable, use Gan Jiang Huang Lian Huang Qin Tang, bitter-pungent to open rejection. If chest fullness/vomiting or dry heaving/saliva, use Wu Zhu Yu Tang, warming/calming to harmonize wood/earth, effective as spirit. For epigastric fullness, choose from Zhang Zhongjing's Three Xie Xin Tangs or Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang as appropriate. (From *Shi Fang Miao Yong*)
Malaria-Dysentery Combined, Post-Dysentery Malaria-like (See Malaria Section): In combined malaria-dysentery, assess severity, separate/benefit yin/yang, main treatment Chai Ling. (From *Yi Du*)
Post-dysentery malaria-like but not malaria is dual yin/yang deficiency. Yang deficiency causes aversion to cold, yin deficiency causes fever, thus cold/heat交战 resembles malaria. (From *Yi Tong*)
Blood Stasis Mimicking Dysentery: Brother Hu from Dongyang, age 40, suffered dysentery over 100 days, hundred remedies failed. Early September, I diagnosed six pulses: hurried, deep, string-taut, fine, weak, hollow, worse on left. Ten movements day/night, scanty feces, clear mucus with purple-black blood threads, total food refusal. I said: Not dysentery, treat as blood stasis. Brother asked cause. I said: Overeating then running fast, shouting, beating/pushing, pain, unrelenting anger, excessive tonification/sealing, heavy alcohol/meat. He said: Wrongly beaten last year, two years passed, doubt this stasis. I said: Take my medicine, if stasis passes, life saved. Use Tao Ren, Ru Xiang, Mo Yao, Hua Shi, assisted by Bing Lang, Mu Xiang, pilled with Shen Qu paste, 50 pills with rice water. Midnight no movement, repeated dose 200 pills. Dawn passed 2.5 sheng foul matter like rotten fish intestines, exhausted all day. Gradually given porridge, stabilized. (From *Yi Gang* citing *Dan Xi Xin Fa*)
Life and Death Rules: Disease Chang Pi (dysentery), passing pus/blood, patient pulse hurried, skin hot, food not entering, abdominal distension, staring eyes = death; or whole body cold, pulse deep/fine, no recovery = death; food same as usual, pulse floating/deep forceful, uninterrupted = life. (From *Zhong Zang Jing*)
When people first get dysentery, chills/fever start, medication given, heat doesn't retreat, fever too severe, eating causes vomiting, dysentery persists, heart hot as fire, seeking cool places, craving cold water, sudden urge to run madly, whole body muscle pain, touch impossible, this prognosis: 10 cases, 3-4 recoverable. (From *Qi Xiao Liang Fang* citing *Wan Quan Hu Ming Fang*)
Incurable Signs: Pulse large, body hot, duck-shit stool, thirst, cough/reversal, five-color stool, anorexia, red water, red lips, cold hands/feet, anorexia/wheezing. Post-dysentery vexation/craving drink = Heart exhaustion; absolute urinary obstruction = Kidney exhaustion. (From *Yong Lei Qian Fang*)
Incurable Lowering: Stool like fish brain = half dead/half alive; dust/rotten color = death; pure blood = death; roof leak water = death. (From *Dan Xi Xin Fa*)
Anus open like bamboo tube, lips vermilion red = death. (From *Yi Xue Zheng Chuan*)
Mouth sores cracked, pulse surging/hurried striking hand, body high heat long unretracted, wheezing unceasing, great sweat unceasing = incurable. (From *Cang Sheng Si Ming*)
Damp dysentery, abdominal distension, body heaviness, stool like bean curd juice, or red/black turbid = critical. (From *Yi Xue Ru Men*)
Stool lifted, continuous thread = life; broken/disconnected like water bubble = death. (From *Yi Zong Hui Jie*)
Dysentery without body heat = mild; with body heat = severe; able to eat = mild; unable to eat = severe; absolutely unable to eat = death; vomiting = death; rectal prolapse = death; long dysentery suddenly massive cessation of stool = death. Children developing measles then dysentery = death; women newly postpartum then dysentery = death. (From *Ding Bu Ming Yi Zhi Zhang*)
Long dysentery with fever, unable to eat, muscle wasting = incurable. (From *Ji Ren Bian*)
Dysentery 100+ times/day, spirit listless, surprisingly no pain = pathogen wins, righteous qi weak, unable to stimulate, difficult to treat. (From *Yi Tong*)
Unstopping lowering, no liquid intake, small breath, fine pulse, cold skin = death from Yang exhaustion; pure blood dysentery/anorexia, vomiting/zang qi, body heat, large pulse = death from Yin exhaustion. (From *Yi Zong Jin Jian*)
Three Levels of Treatment: Initial dysentery should be purged, everyone knows; long dysentery should be tonified, everyone knows; but Taiyang-Yangming combined disease with spontaneous dysentery should be sweated; Taiyang-Shaoyang combined disease with spontaneous dysentery should be harmonized; Yangming-Shaoyang combined disease with spontaneous dysentery should be purged interior; only those grasping Shang Han mysteries can discuss this. (From *Yi Fang Kao*)
Treatment Must Address Accumulation: If stomach/intestines self-infected illness, distinguish pathogen/righteousness. If righteousness first deficient then infected, or infection causes deficiency, former is root, latter is branch; old/new accumulation follows similarly. Old accumulation is formed by retained food/knotting phlegm (*Yi Tong* says blood/qi/food/phlegm). New accumulation forms after old removal, blood/qi re-congesting. Old accumulation should be purged first; new accumulation should not be purged. Why? Stomach/intestine digesting grain/transmitting waste relies on Ying/Wei distributing to six fu organs. Now pathogen in stomach/intestine blocks Ying/Wei operation, hindering transformation, so Wei qi stagnates not soothing, Ying blood stagnates not flowing, thus food/phlegm stops in stomach, waste stays in intestine, combining with stagnant qi/blood accumulation to form dysentery. Such cases must be purged to open blockage, benefit Ying/Wei.