浓朴（一钱五分） 杏仁（一钱五分） 草果（一钱） 半夏（二钱） 茯苓块（三钱） 广皮（一钱）
水五杯，煮取二杯，分二次，温服。
按中焦之疟，脾胃正当其冲。偏于热者胃受之，法则偏于救胃；偏于湿者脾受之，法则偏于救
脾。胃，阳腑也，救胃必用甘寒苦寒；脾，阴脏也
救脾必用甘温苦辛。两平者，两救之。本论列疟证，寥寥数则，略备大纲，不能偏载。然于此数条
反复对勘，彼此互印，再从上焦篇究来路，下焦篇阅归路，其规矩准绳，亦可知其大略矣。
八六、湿温内蕴，夹杂饮食停滞，气不得运，血不得行，遂成滞下，俗名痢疾，古称重证，以其深
入脏腑也。初起腹痛胀者易治；日久不痛并不胀者难治。脉小弱者易治；脉实大数者难治。老年久
衰，实大小弱并难治；脉调和者易治。日数十行者易治；一、二行或有或无者难治。面色便色鲜明者
易治；秽暗者难治。噤口痢属实者尚可治；属虚者难治。先滞（俗所谓痢疾）后利（俗谓之泄泻）者易
治；先利后滞者难治。先滞后疟者易治；先疟后滞者难治。本年新受者易治；上年伏暑，酒客积热，
老年阳虚积湿者难治。季胁少腹无动气疝瘕者易治，有者难治。
此痢疾之大纲。虽罗列难治易治十数条，总不出邪机向外者易治，深入脏络者难治也。谚云∶
饿不死的伤寒，撑不死的痢疾。时人解云∶凡病伤寒者，当禁其食，令病者饿，则不至与外邪相搏而
死也。痢疾日下数十行，下者既多，肠胃空虚，必令病者多食，则不至肠胃尽空而死也。不知此二
语，乃古之贤医金针度人处，后人不审病情，不识句读，以致妄解耳。按《内经》热病禁食，在少愈之
际，不在受病之初。仲景《伤寒论》中，现有食粥却病之条，但不可食重浊肥腻耳。痢疾暑湿夹饮食
内伤，邪非一端，肠胃均受其殃！古人每云淡薄滋味，如何可以恣食，与邪气团成一片，病久不解耶！
吾见痢疾不戒口腹而死者，不可胜数。盖此二语，饿字 字，皆自为一句，谓患伤寒之人，尚知饿而
思食，是不死之证；其死者，医杀之也。盖伤寒暴发之病，自外而来，若伤卫而未及于营，病患知饿，
病机尚浅，医者助胃气，捍外侮，则愈，故云不死，若不饿则重矣。仲景谓∶“风病能食，寒病不能食”
是也。痢疾久伏之邪，由内下注，若脏气有余；不肯容留邪气，彼此互争则 ，邪机向外，医者顺水
推舟则愈，故云不死。若脏气已虚，纯逊邪气则不 而寇深矣。
八七、自利不爽，欲作滞下，腹中拘急，小便短者，四苓合芩芍汤主之。
既自利（俗谓泄泻）矣，理当快利，而又不爽者何？盖湿中藏热，气为湿热郁伤，而不得畅遂其本
性，故滞。脏腑之中，全赖此一气之转输，气既滞矣，焉有不欲作滞下之理乎！曰欲作，作而未遂
也；拘急，不爽之象，积滞之情状也；小便短者，湿注大肠，阑门（小肠之末，大肠之始）不分水，膀胱
不渗湿也。故以四苓散分阑门，通膀胱，开支河，使邪不直注大肠；合芩芍法宣气分，清积滞，预夺
其滞下之路也。此乃初起之方，久痢阴伤，不可分利，故方后云∶久利不在用之。
按浙人倪涵初，作疟痢三方，于痢疾条下，先立禁汗、禁分利、禁大下、禁温补之法，是诚见世之
妄医者，误汗、误下、误分利、误温补，以致沉 不起，痛心疾首而有是作也。然一概禁之，未免因
噎废食；且其三方，亦何能包括痢门诸证，是安于小成，而不深究大体也。瑭勤求古训，静与心谋，
以为可汗则汗，可下则下，可清则清，可补则补，一视其证之所现，而不可先有成见也。至于误之一
字，医者时刻留心，犹恐思虑不及，学术不到，岂可谬于见闻而不加察哉！
四苓合芩芍汤方（苦辛寒法）
苍术（二钱） 猪苓（二钱） 茯苓（二钱） 泽泻（二钱） 白芍（二钱） 黄芩（二钱） 广皮（一
钱五分） 浓朴（二钱） 木香（一钱）
水五杯，煮取二杯，分二次温服，久痢不在用之。
八八、暑湿风寒杂感，寒热迭作，表证正盛，里证复急，腹不和而滞下者，活人败毒散主之。
此证乃伤水谷之酿湿，外受时令之风湿，中气本自不足之人，又气为湿伤，内外俱急。立方之
法，以人参为君，坐镇中州，为督战之帅；以二活、二胡合川芎从半表半里之际，领邪出外，喻氏所谓
逆流挽舟者此也；以枳壳宣中焦之气，茯苓渗中焦之湿，以桔梗开肺与大肠之痹，甘草和合诸药，乃
陷者举之之法，不治痢而治致痢之源，痢之初起，憎寒壮热者，非此不可也。若云统治伤寒温疫痹
气则不可，凡病各有所因，岂一方之所得而统之也哉！此方在风湿门中，用处甚多，若湿不兼风而兼
热者，即不合拍，奚况温热门乎！世医用此方治温病，已非一日，吾只见其害，未见其利也。
活人败毒散（辛甘温法）
羌活 独活 茯苓 川芎 枳壳 柴胡 人参 前胡 桔梗（以上各一两） 甘草（五钱）
共为细末，每服二钱，水一杯，生姜三片，煎至七分，顿服之。热毒冲胃噤口者，本方加陈仓米各
等分，名仓廪散，服法如前，加一倍，噤口属虚者勿用之。
八九、滞下已成，腹胀痛，加减芩芍汤主之。
此滞下初成之实证，一以疏利肠间湿热为主。
加减芩芍汤方（苦辛寒法）
白芍（三钱） 黄芩（二钱） 黄连（一钱五分） 浓朴（二钱） 木香（煨，一钱） 广皮（二钱）
水八杯，煮取三杯，分三次温服。忌油腻生冷。
〔加减法〕肛坠者，加槟榔二钱。腹痛甚欲便，便后痛减，再痛再便者，白滞加附子（一钱五分），酒炒
大黄（三钱）；红滞加肉桂（一钱五分），酒炒大黄（三钱），通爽后即止，不可频下。如积未净，当减其制，
红积加归尾（一钱五分），红花（一钱） 桃仁（二钱）。舌浊脉实有食积者，加楂肉（一钱五分），神曲（二
钱），枳壳（一钱五分）。湿重者，目黄舌白不渴，加茵陈（三钱），白通草（一钱），滑石一钱。
九十、滞下湿热内蕴，中焦痞结，神识昏乱，泻心汤主之。
滞下由于湿热内蕴，以致中痞，但以泻心治痞结之所由来，而滞自止矣。
泻心汤（方法并见前）
九十一、滞下红白，舌色灰黄，渴不多饮，小溲不利，滑石藿香汤主之。
此暑湿内伏，三焦气机阻窒，故不肯见积治积，乃以辛淡渗湿宣气，芳香利窍，治所以致积之
因，庶积滞不期愈而自愈矣。
滑石藿香汤方（辛淡合芳香法）
飞滑石（三钱） 白通草（一钱） 猪苓（二钱） 茯苓皮（三钱） 藿香梗（二钱） 浓朴（二钱） 白蔻仁（钱）
广皮（一钱）
水五杯，煮取二杯，分二次服。
九十二、湿温下利，脱肛，五苓散加寒水石主之。
此急开支河，俾湿去而利自止。
五苓散加寒水石方（辛温淡复寒法）
即于五苓散内加寒水石三钱，如服五苓散法，久痢不在用之。
九十三、久痢阳明不阖，人参石脂汤主之。
九窍不和，皆属胃病，久痢胃虚，虚则寒，胃气下溜，故以堵截阳明为法。
人参石脂汤方（辛甘温合涩法，即桃花汤之变法也）
人参（三钱） 赤石脂（细末，三钱） 炮姜（二钱） 白粳米（炒，一合）
水五杯，先煮人参、白米、炮姜令浓，得二杯，后调石脂细末和匀，分二次服。
九十四、自利腹满，小便清长，脉濡而小，病在太阴，法当温脏，勿事通腑，加减附子理中汤主之。
此偏于湿，合脏阴无热之证，故以附子理中汤，去甘守之人参、甘草，加通运之茯苓、浓朴。
加减附子理中汤方（苦辛温法）
白术（三钱） 附子（二钱） 干姜（二钱） 茯苓（三钱） 浓朴（二钱）
水五杯，煮取二杯，分二次温服。
九十五、自利不渴者属太阴，甚则哕（俗名呃忒），冲气逆，急救土败，附子粳米汤主之。
此条较上条更危，上条阴湿与脏阴相合，而脏之真阳未败，此则脏阳结而邪阴与脏阴毫无忌惮，
故上条犹系通补，此则纯用守补矣。扶阳抑阴之大法如此。
附子粳米汤方（苦辛热法）
人参（三钱） 附子（二钱） 炙甘草（二钱） 粳米（一合） 干姜（二钱）
水五杯，煮取二杯，渣再煮一杯，分三次温服。
九十六、疟邪热气，内陷变痢，久延时日，脾胃气衰，面浮腹膨，里急肛坠，中虚伏邪，加减小柴胡汤主之。
疟邪在经者多，较之痢邪在脏腑者浅，痢则深于疟矣。内陷云者，由浅入深也。治之之法，不出
喻氏逆流挽舟之议，盖陷而入者，仍提而使之出也。故以柴胡由下而上，入深出浅，合黄芩两和阴
阳之邪，以人参合谷芽宣补胃阳，丹皮、归、芍内护三阴，谷芽推气分之滞，山楂推血分之滞。谷芽升
气分故推谷滞，山楂降血分故推肉滞也。
加减小柴胡汤（苦辛温法）
柴胡（三钱） 黄芩（二钱） 人参（一钱） 丹皮（一钱） 白芍（炒，二钱） 当归（土炒，一钱
五分） 谷芽（一钱五分） 山楂（炒，一钱五分）
水八杯，煮取三杯，分三次温服。
九十七、春温内陷下痢，最易厥脱，加减黄连阿胶汤主之。
春温内陷，其为热多湿少明矣。热必伤阴，故立法以救阴为主。救阴之法，岂能出育阴坚阴两
法外哉！此黄连之坚阴，阿胶之育阴，所以合而名汤也。从黄连者黄芩，从阿胶者生地、白芍也，炙
草则统甘苦而并和之。此下三条，应列下焦，以与诸内陷并观，故列于此。
加减黄连阿胶汤（甘寒苦寒合化阴气法）
黄连（三钱） 阿胶（三钱） 黄芩（二钱） 炒生地（四钱） 生白芍（五钱） 炙甘草（一钱五分）
水八杯，煮取三杯，分三次温服。
九十八、气虚下陷，门户不藏，加减补中益气汤主之。
此邪少虚多，偏于气分之证，故以升补为主。
加减补中益气汤（甘温法）
人参（二钱） 黄 （二钱） 广皮（一钱） 炙甘草（一钱） 归身（二钱） 炒白芍（三钱） 防风（
五分） 升麻（三分）
水八杯，煮取三杯，分三次温服。
九十九、内虚下陷，热利下重，腹痛，脉左小右大，加味白头翁汤主之。
此内虚湿热下陷，将成滞下之方。仲景厥阴篇，谓热利下重者，白头翁汤主之。按热注下焦，
设不瘥，必圊脓血；脉右大者，邪从上中而来；左小者，下焦受邪，坚结不散之象。故以白头翁无
风而摇者，禀甲乙之气，透发下陷之邪，使之上出；又能有风而静，禀庚辛之气，清能除热，燥能除湿，
湿热之积滞去而腹痛自止。秦皮得水木相生之气，色碧而气味苦寒，所以能清肝热。黄连得少阴
水精，能清肠 之热，黄柏得水土之精，渗湿而清热。加黄芩、白芍者，内陷之证，由上而中而下，
且右手脉大，上中尚有余邪，故以黄芩清肠胃之热，兼清肌表之热；黄连、黄柏但走中下，黄芩则走
中上，盖黄芩手足阳明、手太阴药也；白芍去恶血，生新血，且能调血中之气也。按仲景太阳篇，有表
证未罢，误下而成协热下利之证，心下痞硬之寒证，则用桂枝人参汤；脉促之热证，则用葛根黄连
黄芩汤，与此不同。
加味白头翁汤（苦寒法）
白头翁（三钱） 秦皮（二钱） 黄连（二钱） 黄柏（二钱） 白芍（二钱） 黄芩（三钱）
水八杯，煮取三杯，分三次服。
Cortex Magnoliae Officinalis (Houpo, 厚朴) (1.5 qian) Semen Armeniacae Amarum (Xingren, 杏仁) (1.5 qian) Fructus Tsaoko (Caoguo, 草果) (1 qian) Rhizoma Pinelliae Preparatum (Banxia, 半夏) (2 qian) Poria Cocos (Fulingkuai, 茯苓块) (3 qian) Exocarpium Citri Reticulatae (Guangpi, 广皮) (1 qian)
Boil five cups of water until reduced to two cups; divide into two doses and take warm.
Note: In malaria affecting the Middle Jiao (Middle Burner), the Spleen and Stomach are at the forefront of the pathogenic attack. If the pathology leans towards Heat, the Stomach is affected, and the treatment principle focuses on rescuing the Stomach; if it leans towards Dampness, the Spleen is affected, and the treatment principle focuses on rescuing the Spleen. The Stomach is a Yang Fu Organ (Yang Bowel); rescuing the Stomach requires Sweet-Cold and Bitter-Cold herbs. The Spleen is a Yin Zang Organ (Yin Viscus); rescuing the Spleen requires Sweet-Warm and Bitter-Acrid herbs. When both are balanced, both are rescued. This treatise lists only a few clauses on malaria, outlining the general principles without exhaustive detail. However, by cross-referencing these clauses, verifying them against each other, tracing the origin from the Upper Jiao chapter, and reviewing the destination in the Lower Jiao chapter, the fundamental rules and standards can be roughly understood.
86. When Damp-Heat accumulates internally, complicated by food stagnation, Qi fails to circulate, and Blood fails to flow smoothly, Dysentery (Lixia, commonly known as Li Ji) forms. It was called a severe disease in ancient times because the pathogen has deeply penetrated the Zang-Fu organs. Cases presenting with abdominal pain and distension at onset are easy to treat; those with no pain or distension after a long duration are difficult to treat. Cases with small and weak pulses are easy to treat; those with full, large, and rapid pulses are difficult to treat. For the elderly with chronic decline, whether the pulse is full, large, small, or weak, they are difficult to treat; cases with a harmonious pulse are easy to treat. Cases with dozens of bowel movements per day are easy to treat; those with only one or two movements, or intermittent movements, are difficult to treat. Cases with bright complexion and stool color are easy to treat; those with turbid and dark colors are difficult to treat. Anorexic Dysentery (Jinkou Li, where vomiting prevents eating) due to Excess patterns is still treatable; that due to Deficiency is difficult to treat. Cases where Dysentery precedes Diarrhea (Xie Xie) are easy to treat; cases where Diarrhea precedes Dysentery are difficult to treat. Cases where Malaria precedes Dysentery are easy to treat; cases where Dysentery precedes Malaria are difficult to treat. Acute infections contracted in the current year are easy to treat; cases involving latent Summer-Heat from the previous year, heat accumulation in alcoholics, or dampness accumulation due to Yang Deficiency in the elderly are difficult to treat. Cases without moving Qi, Hernia, or Masses in the hypochondrium and lower abdomen are easy to treat; those with such conditions are difficult to treat.
This outlines the general principles of Dysentery. Although numerous difficult and easy cases are listed, they all fall under the principle that cases where the pathogenic mechanism moves outward are easy to treat, while those penetrating deep into the Zang collaterals are difficult. The proverb says: "Starvation cannot kill Shanghan (Cold Damage), but overeating can kill Dysentery." Contemporary interpretations claim that patients with Shanghan should fast to avoid fighting external pathogens, while dysentery patients should eat more because their intestines and stomachs are empty from frequent purging. This misunderstanding arises from failing to examine the condition and parse the sentences correctly. According to the *Nei Jing*, fasting for Heat diseases applies only when the patient is recovering, not at the onset. Zhang Zhongjing's *Shanghan Lun* contains provisions for consuming congee to cure disease, provided heavy and greasy foods are avoided. Dysentery involves Summer-Heat and Dampness complicated by dietary injury; the pathogen is multifaceted, harming both intestines and stomach. Ancients advised light flavors; how can one indulge in food, allowing it to merge with the pathogen and prolong the illness? I have seen countless deaths from dysentery due to lack of dietary restraint. The words "starve" and "stuff" in the proverb stand alone: "Starve" means a Shanghan patient who feels hunger and desires food shows a sign of survival; death results from medical error. Shanghan is an acute disease coming from outside; if it affects the Wei (Defensive) level without reaching the Ying (Nutritive) level, and the patient feels hungry, the pathogenesis is shallow. Assisting Stomach Qi and defending against external invasion leads to recovery, hence "not dying." If there is no hunger, the condition is severe. Zhongjing stated: "Wind diseases allow eating; Cold diseases do not." This applies here. Dysentery involves latent pathogens sinking downward from within. If Zang Qi is sufficient and rejects the pathogen, struggle ensues, pushing the pathogen outward; assisting this process leads to recovery ("not dying"). If Zang Qi is deficient and yields completely, the pathogen deepens.
87. Spontaneous diarrhea that is unsatisfactory, threatening to develop into Dysentery, with abdominal cramping and short urine, is treated with Si Ling San combined with Qin Shao Tang.
Why is spontaneous diarrhea (commonly called Diarrhea) unsatisfactory despite the expectation of free flow? Because Dampness harbors Heat, obstructing Qi circulation and preventing its natural smooth movement, causing stagnation. The viscera rely entirely on this Qi for transport. Once Qi stagnates, progression to Dysentery is inevitable. "Threatening to develop" means it has started but not fully formed. "Cramping" indicates stagnation. "Short urine" signifies Dampness pouring into the Large Intestine, failure of the Lanmen (junction of Small and Large Intestines) to separate fluids, and Bladder's failure to secrete Dampness. Therefore, Si Ling San is used to drain the Lanmen, unblock the Bladder, and open collateral pathways, diverting pathogens away from the Large Intestine. Combined with Qin Shao method to ventilate Qi and clear stagnation, it preemptively blocks the path to Dysentery. This is a formula for early stages; it must not be used for chronic Dysentery with Yin injury, as indicated in the prescription notes.
Commentary: Ni Hanchu of Zhejiang formulated three formulas for Malaria and Dysentery, establishing prohibitions against sweating, diuresis, drastic purging, and warming tonification for Dysentery. This arose from witnessing incompetent doctors misuse these methods, leading to incurable conditions. However, blanket prohibitions are like abandoning food due to choking risks; his three formulas cannot cover all Dysentery syndromes, showing a limited scope rather than deep understanding. I, Wu Tang, study ancient teachings and reflect carefully: sweat if indicated, purge if indicated, clear if indicated, tonify if indicated. Decisions must be based on present symptoms, without preconceived notions. Doctors must remain vigilant against errors, as ignorance leads to harm.
Si Ling He Qin Shao Tang (Bitter-Acold-Hot Method)
Rhizoma Atractylodis Chinensis (Cangzhu, 苍术) (2 qian) Polyporus (Zhu Ling, 猪苓) (2 qian) Poria Cocos (Fuling, 茯苓) (2 qian) Rhizoma Alismatis (Zexie, 泽泻) (2 qian) Radix Paeoniae Alba (Baishao, 白芍) (2 qian) Cortex Phellodendri Amurensis (Huangqin, 黄芩) (2 qian) Exocarpium Citri Reticulatae (Guangpi, 广皮) (1.5 qian) Cortex Magnoliae Officinalis (Nongpu, 浓朴) (2 qian) Fructus Tsaoko (Muxiang, 木香) (1 qian)
Boil five cups of water to two cups; divide into two warm doses. Not for chronic Dysentery.
88. Mixed contraction of Summer-Heat, Dampness, Wind, and Cold, with alternating chills and fever, strong exterior signs, urgent interior signs, abdominal disharmony, and Dysentery, is treated with Huoren Baidu San.
This syndrome results from Dampness generated by food/water injury and external Wind-Dampness in seasonal changes, affecting those with inherent Middle Qi deficiency. The formula uses Ginseng as the Sovereign to stabilize the Middle Jiao. Qiang Huo, Du Huo, Chai Hu, and Qian Hu combined with Chuan Xiong lead pathogens out from the Half-Exterior/Half-Interior, a method Yu Jiazhen called "Rowing Upstream Against the Current." Zhi Ke ventilates Middle Jiao Qi; Fuling drains Middle Jiao Dampness; Jie Gai opens Lung and Large Intestine obstruction; Gan Cao harmonizes. This lifts sunken Qi, treating the root of Dysentery rather than the symptom itself. It is essential for early Dysentery with aversion to cold and high fever. It cannot be used universally for all Cold Damage or Warm Epidemics, as each disease has specific causes. While useful in Wind-Damp categories, it is unsuitable for Damp-Heat or Warm Heat categories. Its use in Warm Diseases by contemporary doctors has caused harm, not benefit.
Huoren Baidu San (Acrid-Sweet-Warm Method)
Radix Notopterygii (Qiang Huo, 羌活), Radix Saposhnikoviae (Du Huo, 独活), Poria Cocos (Fuling, 茯苓), Radix Chuanxiong (Chuan Xiong, 川芎), Fructus Aurantii (Zhi Ke, 枳壳), Radix Bupleuri (Chai Hu, 柴胡), Radix Ginseng (Renshen, 人参), Radix Peucedani (Qian Hu, 前胡), Fructus Platycodi (Jiegeng, 桔梗) (each 1 liang), Radix Glycyrrhizae (Gancao, 甘草) (5 qian)
Grind to fine powder. Take 2 qian with one cup of water and three slices of fresh Ginger, decoct to 0.7 cup, and take in one dose. For toxic Heat attacking the Stomach causing anorexic Dysentery, add equal parts of aged rice (Can Cang Mi) to form Can Lin San, double the dose. Do not use for Deficiency-type anorexic Dysentery.
89. Established Dysentery with abdominal distension and pain is treated with Jia Jian Qin Shao Tang.
This is an Excess pattern of early Dysentery, primarily focusing on draining and regulating Damp-Heat in the intestines.
Jia Jian Qin Shao Tang (Bitter-Acold-Hot Method)
Radix Paeoniae Alba (Baishao, 白芍) (3 qian) Cortex Phellodendri Amurensis (Huangqin, 黄芩) (2 qian) Rhizoma Coptidis (Huanglian, 黄连) (1.5 qian) Cortex Magnoliae Officinalis (Nongpu, 浓朴) (2 qian) Fructus Tsaoko (Muxiang, 木香) roasted (1 qian) Exocarpium Citri Reticulatae (Guangpi, 广皮) (2 qian)
Boil eight cups of water to three cups; divide into three warm doses. Avoid greasy and raw/cold foods.
[Modifications]: For anal prolapse, add Areca Seed (Binglang, 槟榔) 2 qian. For severe abdominal pain urging defecation, relieved after stool but recurring: for White Dysentery, add Prepared Aconite Root (Fuzi, 附子) 1.5 qian and Wine-fried Rhubarb (Dahuang, 大黄) 3 qian; for Red Dysentery, add Cinnamon Bark (Rougui, 肉桂) 1.5 qian and Wine-fried Rhubarb 3 qian. Stop once bowel movements normalize; do not purge frequently. If stagnation remains, reduce dosage: for Red Stagnation, add Angelica Sinensis Tail (Guiwei, 归尾) 1.5 qian, Safflower (Honghua, 红花) 1 qian, and Peach Kernel (Taoren, 桃仁) 2 qian. For turbid tongue coating, full pulse, and food stagnation, add Hawthorn Fruit (Shazha Rou, 楂肉) 1.5 qian, Medicated Leaven (Shenqu, 神曲) 2 qian, and Fructus Aurantii (Zhi Ke, 枳壳) 1.5 qian. For heavy Dampness (yellow eyes, white tongue, no thirst), add Coiropsis Herb (Yinchen, 茵陈) 3 qian, White Akebia Stem (Baitongcao, 白通草) 1 qian, and Talcum (Huashi, 滑石) 1 qian.
90. Dysentery with internal Damp-Heat accumulation, Middle Jiao blockage, and confused consciousness is treated with Xiexin Tang.
Dysentery caused by internal Damp-Heat leads to Middle Jiao痞 (fullness/blockage). Treating the blockage with Xiexin Tang stops the Dysentery naturally.
Xiexin Tang (Method see previous)
91. Dysentery with red and white discharge, grey-yellow tongue coating, thirst with little desire to drink, and difficult urination is treated with Huashi Huoxiang Tang.
This is latent Summer-Heat and Dampness obstructing the Triple Burner Qi mechanism. Instead of treating the stagnation directly, use Acrid-Light herbs to leach Dampness and ventilate Qi, and aromatic herbs to open orifices, addressing the cause so the stagnation resolves spontaneously.
Huashi Huoxiang Tang (Acrid-Light combined with Aromatic Method)
Calcined Talcum (Fei Huashi, 飞滑石) (3 qian) White Akebia Stem (Baitongcao, 白通草) (1 qian) Polyporus (Zhu Ling, 猪苓) (2 qian) Pericarpium Vitis Viniferae (Fulingpi, 茯苓皮) (3 qian) Stem Agastache (Huoxiang geng, 藿香梗) (2 qian) Cortex Magnoliae Officinalis (Nongpu, 浓朴) (2 qian) Seed Cardamomi Rotundae (Baikouren, 白蔻仁) (1 qian) Exocarpium Citri Reticulatae (Guangpi, 广皮) (1 qian)
Boil five cups of water to two cups; divide into two doses.
92. Damp-Heat Diarrhea with rectal prolapse is treated with Wuling San plus Hanshui Shi.
This urgently opens collateral pathways to eliminate Dampness and stop diarrhea.
Wuling San Plus Hanshui Shi (Acrid-Warm-Light restoring Cold Method)
Add Calcined Aragonite (Hanshui Shi, 寒水石) 3 qian to Wuling San. Administer as Wuling San. Not for chronic Dysentery.
93. Chronic Dysentery with Yangming closure failure is treated with Renshen Shizhi Tang.
Disharmony of the nine orifices belongs to Stomach disease. Chronic Dysentery causes Stomach Deficiency, leading to Cold and descending Stomach Qi. The method is to secure the Yangming channel.
Renshen Shizhi Tang (Acrid-Sweet-Warm combined with Astringent Method, a variation of Taohua Tang)
Radix Ginseng (Renshen, 人参) (3 qian) Red Halloysitum (Chishizhi, 赤石脂) finely powdered (3 qian) Prepared Ginger (Paojiang, 炮姜) (2 qian) White Glutinous Rice (Baijngmi, 白粳米) fried (1 he)
Boil five cups of water, first decocting Ginseng, Rice, and Prepared Ginger until concentrated to two cups. Then mix in the Red Halloysitum powder evenly. Divide into two doses.
94. Spontaneous diarrhea with abdominal fullness, clear abundant urine, soggy and small pulse, indicating Taiyin disease, should be treated by warming the Zang organs, avoiding purging the Fu organs. Use Jia Jian Fuzi Lizhong Tang.
This leans towards Dampness and Cold-Zang patterns. Thus, Fuzi Lizhong Tang is used, removing Sweet-Stabilizing Ginseng and Licorice, adding Moving Poria and Magnolia Bark.
Jia Jian Fuzi Lizhong Tang (Bitter-Acrid-Warm Method)
Rhizoma Atractylodis Macrocephalae (Baizhu, 白术) (3 qian) Radix Aconiti Lateralis Preparata (Fuzi, 附子) (2 qian) Rhizoma Zingiberis Recens (Ganjiang, 干姜) (2 qian) Poria Cocos (Fuling, 茯苓) (3 qian) Cortex Magnoliae Officinalis (Nongpu, 浓朴) (2 qian)
Boil five cups of water to two cups; divide into two warm doses.
95. Spontaneous diarrhea without thirst indicates Taiyin. Severe cases may involve belching (E Te), rebellious Qi, requiring emergency rescue of failing Earth. Use Fuzi Jingmi Tang.
This case is more critical than the previous. The previous involved Yin-Damp combining with Zang-Yin but preserved True Yang; this involves Zang-Yang knotting with unchecked Pathogenic Yin and Zang-Yin. Thus, the previous used tonifying-movement, while this uses pure stabilizing-tonification. This is the major method of supporting Yang and suppressing Yin.
Fuzi Jingmi Tang (Bitter-Acrid-Hot Method)
Radix Ginseng (Renshen, 人参) (3 qian) Radix Aconiti Lateralis Preparata (Fuzi, 附子) (2 qian) Honey-fried Radix Glycyrrhizae (Zhigancao, 炙甘草) (2 qian) Glutinous Rice (Jingmi, 粳米) (1 he) Rhizoma Zingiberis Recens (Ganjiang, 干姜) (2 qian)
Boil five cups of water to two cups. Decoct dregs again for one cup. Divide into three warm doses.
96. Malaria pathogenic Heat sinking inward transforming into Dysentery, lingering for days, causing Spleen/Stomach Qi decline, facial edema, abdominal distension, tenesmus, and anal prolapse due to Middle Deficiency and latent pathogen, is treated with Jia Jian Xiaochaihu Tang.
Malaria pathogens usually reside in the meridians, shallower than Dysentery pathogens in the Zang-Fu. "Sinking inward" means progressing from shallow to deep. Treatment follows Yu Jiazhen's "Rowing Upstream Against the Current," lifting the sunk pathogen out. Chai Hu ascends from below, exiting deep to shallow, combined with Huang Qin to harmonize Yin/Yang pathogens. Renshen and Gu Ya ventilate/tonify Stomach Yang. Dan Pi, Dang Gui, and Bai Shao protect the Three Yin internally. Gu Ya pushes Qi-level stagnation; Shan Zha pushes Blood-level stagnation. Gu Ya rises Qi to push grain stagnation; Shan Zha descends Blood to push meat stagnation.
Jia Jian Xiaochaihu Tang (Bitter-Acrid-Warm Method)
Radix Bupleuri (Chai Hu, 柴胡) (3 qian) Cortex Phellodendri Amurensis (Huangqin, 黄芩) (2 qian) Radix Ginseng (Renshen, 人参) (1 qian) Cortex Moutan (Danpi, 丹皮) (1 qian) Radix Paeoniae Alba (Baishao, 白芍) fried (2 qian) Radix Angelicae Sinensis (Danggui, 当归) earth-fried (1.5 qian) Sprouted Rice (Guya, 谷芽) (1.5 qian) Hawthorn Fruit (Shanzha, 山楂) fried (1.5 qian)
Boil eight cups of water to three cups; divide into three warm doses.
97. Spring-Warmth sinking inward causing Dysentery, prone to Jue collapse, is treated with Jia Jian Huanglian Ejiao Tang.
Spring-Warmth sinking inward implies more Heat than Dampness. Heat injures Yin, so the method prioritizes rescuing Yin. Rescuing Yin employs nourishing and firming Yin methods. Huang Lian firms Yin; E Jiao nourishes Yin. Hence the name. Huang Qin follows Huang Lian; Sheng Di and Bai Shao follow E Jiao. Zhi Gan Cao harmonizes Sweet and Bitter. These three clauses belong in the Lower Jiao section to observe internal sinking together, hence placed here.
Jia Jian Huanglian Ejiao Tang (Sweet-Cold combined with Bitter-Cold to transform Yin Qi Method)
Rhizoma Coptidis (Huanglian, 黄连) (3 qian) Colla Corii Asini (Ejiao, 阿胶) (3 qian) Cortex Phellodendri Amurensis (Huangqin, 黄芩) (2 qian) Fried Radix Rehmanniae Praeparata (Chao Shengdi, 炒生地) (4 qian) Raw Radix Paeoniae Alba (Sheng Baishao, 生白芍) (5 qian) Honey-fried Radix Glycyrrhizae (Zhigancao, 炙甘草) (1.5 qian)
Boil eight cups of water to three cups; divide into three warm doses.
98. Qi Deficiency sinking, failing to contain the orifices, is treated with Jia Jian Buzhong Yiqi Tang.
This is a pattern with little pathogen and much Deficiency, leaning towards Qi level, so lifting and tonifying is primary.
Jia Jian Buzhong Yiqi Tang (Sweet-Warm Method)
Radix Ginseng (Renshen, 人参) (2 qian) Radix Astragali Membranacei (Huangqi, 黄芪) (2 qian) Exocarpium Citri Reticulatae (Guangpi, 广皮) (1 qian) Honey-fried Radix Glycyrrhizae (Zhigancao, 炙甘草) (1 qian) Radix Angelicae Sinensis (Guishen, 归身) (2 qian) Fried Radix Paeoniae Alba (Chao Baishao, 炒白芍) (3 qian) Radix Saposhnikoviae (Fangfeng, 防风) (0.5 qian) Rhizoma Cimicifugae (Shengma, 升麻) (0.3 qian)
Boil eight cups of water to three cups; divide into three warm doses.
99. Internal Deficiency with sinking, Heat Diarrhea with heaviness, abdominal pain, left small right large pulse, is treated with Jia Wei Baitouweng Tang.
This is Internal Deficiency with Damp-Heat sinking, forming Dysentery. Zhang Zhongjing's *Jueyin* chapter states: "Heat Diarrhea with heaviness is treated with Baitouweng Tang." Heat pouring into Lower Jiao, if unresolved, leads to pus/blood in stool. Right large pulse indicates pathogen coming from Upper/Middle; Left small indicates Lower Jiao pathogen with firm stagnation. Baitouweng, possessing Jia/Yi Wood Qi, vents sunk pathogens upward; possessing Geng/Xin Metal Qi, clears Heat and dries Dampness, stopping pain. Qinpi, with Water/Wood generating Qi, clears Liver Heat. Huanglian, receiving Shaoyin Water essence, clears Intestinal Heat. Huangbai, receiving Water/Earth essence, leaches Dampness and clears Heat. Added Huang Qin and Bai Shao: Internal sinking progresses Top-Middle-Bottom; Right large pulse indicates residual Upper/Middle pathogens. Huang Qin clears Intestinal/Stomach and Surface Heat (acting on Hand Foot Yangming and Hand Taiyin). Huanglian/Huangbai act Middle/Lower; Huang Qin acts Middle/Upper. Bai Shao removes bad blood, generates new blood, and regulates Blood Qi. Note: *Taiyang* chapter mentions Exterior signs unresolved, mistaken purging causing協熱下利 (collateral Heat Diarrhea). Cold pattern with epigastric hardness uses Guizhi Renshen Tang; Rapid pulse Heat pattern uses Gegen Huanglian Huangqin Tang. These differ.
Jia Wei Baitouweng Tang (Bitter-Cold Method)
Radix Pulsatillae (Baitouweng, 白头翁) (3 qian) Cortex Fraxini (Qinpi, 秦皮) (2 qian) Rhizoma Coptidis (Huanglian, 黄连) (2 qian) Cortex Phellodendri Amurensis (Huangbai, 黄柏) (2 qian) Radix Paeoniae Alba (Baishao, 白芍) (2 qian) Cortex Phellodendri Amurensis (Huangqin, 黄芩) (3 qian)
Boil eight cups of water to three cups; divide into three doses.