【湿热痢之症】初起先水泻，后两三日，便下脓血，湿气胜，腹不痛，热气胜，腹大
痛，肛门重滞，里急后重，此外感湿热症也。若呕吐不食，目痛口渴，湿热伤阳明也。恶寒发
热，身痛头疼，湿热伤太阳也。寒热往来，胁痛口苦，湿热伤少阳也。如三阳不解，则湿热
内陷，传里而成痢矣。
【湿热痢之因】湿土之年，君相二火行令，天之湿气下临，地之湿气上升，当长夏火
令司政，人在气交之中，受其蒸酿，则日饮水谷，不能运化，与天行湿热之气，互相郁蒸，
则成赤白深黄三色之积。湿郁主否，反似其燥，而里急后重、努责不宣之症作矣。
【湿热痢之脉】脉必数大，浮数表热，沉数里热，表热宜汗，里热宜下，洪大伤气，细数伤血。
【湿热痢之治】若恶寒头痛，身热有表邪者，荆防解毒汤解表。如无表邪，当清里，腹
后重，酒煎大黄汤、黄连枳壳汤、香连丸、六一散、八正散、通苓散，分利等药。古人云∶
湿热下结，分利甚捷，不比燥热痢，禁发汗利小便者，当遵流湿润燥之法。凡下痢红积而腹
不痛者，湿伤血分也，宜服河间黄连汤。
荆防解毒汤 治湿热痢初起，表未解者。
荆芥 防风 薄荷 连翘 枳壳 桔梗 木通 甘草
加淡竹叶。
如有太阳症加羌活。阳明症加干葛。少阳症加柴胡。湿气胜，腹不痛，加川芎、
苍术。热气胜，腹大痛，加川连、枳壳。
酒煎大黄汤 治湿热痢无表邪者。
川大黄
酒煎，去大黄服酒。
黄连枳壳汤 治湿火伤于气分。
川黄连 枳壳 陈皮 甘草
香连丸 治湿火伤气分下痢。
川黄连 木香
如肛门后重加枳壳。小便不利加滑石。呕吐平胃散各半服之。
六一散
滑石 甘草
八正散
瞿麦 滑石 山栀 木通 甘草 车前子 泽泻 赤苓
加淡竹叶。
通苓散 治湿热结于膀胱，小水不利之症。
麦门冬 淡竹叶 车前子
河间黄连汤 治下痢血积，腹反不痛，湿热伤于血分者。
川黄连 当归 甘草
此方用当归，似治燥伤血分矣。不知用川连者，乃治湿火也。加当归，不过引川连以入
血分耳。若是燥火，当用大黄润燥之药，岂用川连苦燥之药乎。同一火痢也，当分燥湿。同
一湿火之痢也，当分伤气伤血。如湿火伤气分，则用香连丸。湿火伤血分，则用河间黄连汤
。余以大黄枳壳汤，治燥火伤气分之痢，用大黄当归汤，治燥火伤血分之痢，桢岂无师忆见
哉。盖因湿火伤于气分，则 炼而成白积，故用川连枳壳汤。湿火伤于血分，则 炼而成血
积，故用川连当归汤。
[Symptoms of Damp-Heat Dysentery] At the onset, watery diarrhea occurs first. After two or three days, pus and blood are passed in the stool. When dampness is predominant, there is no abdominal pain; when heat is predominant, there is severe abdominal pain. There is a heavy and stagnant sensation in the anus, accompanied by tenesmus (the feeling of incomplete defecation). This is an external contraction of damp-heat syndrome. If accompanied by vomiting, loss of appetite, eye pain, and thirst, it indicates that damp-heat has injured the Yangming channel. If there is aversion to cold and fever, body ache, and headache, it indicates that damp-heat has injured the Taiyang channel. If there is alternating chills and fever, hypochondriac pain, and bitter taste in the mouth, it indicates that damp-heat has injured the Shaoyang channel. If the pathogens in the three Yang channels are not resolved, damp-heat will sink inward, transmit to the interior, and form dysentery.
[Causes of Damp-Heat Dysentery] In years governed by wet earth, the Sovereign Fire and Ministerial Fire exert their influence. Heavenly dampness descends, and earthly dampness rises. During the late summer when fire governs, humans exist within the intersection of heaven and qi, subjected to steaming and brewing by these forces. Consequently, daily intake of water and food cannot be transformed and transported. This interacts with the heavenly damp-heat qi, leading to mutual stagnation and steaming, resulting in accumulations of red, white, and deep yellow colors. Dampness stagnation causes obstruction, resembling dryness, thereby triggering symptoms such as tenesmus and straining without relief.
[Pulse of Damp-Heat Dysentery] The pulse must be rapid and large. A floating and rapid pulse indicates exterior heat; a sinking and rapid pulse indicates interior heat. Exterior heat is suitable for diaphoresis (sweating method); interior heat is suitable for purgation. A surging and large pulse indicates injury to Qi; a fine and rapid pulse indicates injury to Blood.
[Treatment of Damp-Heat Dysentery] If there are exterior pathogenic signs such as aversion to cold, headache, and fever, Jingfang Jiedu Tang (Jingjie and Fangfeng Decoction for Resolving Toxins) should be used to release the exterior. If there are no exterior signs, the interior should be cleared. For symptoms like abdominal heaviness and tenesmus, herbs for separating and draining dampness can be used, such as Jiujian Dahuang Tang (Wine-Boiled Rhubarb Decoction), Huanglian Zhike Tang (Coptis and Magnolia Bark Decoction), Xianglian Wan (Costus and Coptis Pill), Liuyi San (Six-to-One Powder), Bazheng San (Eight-Ingredient Powder for Rectification), and Tongling San (Tongling Powder). As the ancients said: For damp-heat binding downward, separating and draining dampness is very effective. This differs from dry-heat dysentery, where diaphoresis and promoting urination are contraindicated. One should follow the method of "flowing to moisten dryness." Whenever bloody accumulation is passed without abdominal pain, it indicates dampness injuring the Blood level; Hejian Huanglian Tang (Hejian Coptis Decoction) is appropriate.
Jingfang Jiedu Tang (Jingjie and Fangfeng Decoction for Resolving Toxins): Treats early-stage damp-heat dysentery with unresolved exterior syndrome.
Ingredients: Schizonepetae Herba (Jingjie), Saposhnikoviae Radix (Fangfeng), Menthae Haplocalycis Herba (Bohe), Forsythiae Fructus (Lianqiao), Aurantii Fructus Immaturus (Zhike), Platycodonis Radix (Jiegeng), Akebiae Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao).
Add Lophatheri Herba (Dan Zhuye).
If Taiyang symptoms are present, add Notopterygii Rhizoma et Radix (Qianghuo). If Yangming symptoms are present, add Puerariae Radix (Gegen). If Shaoyang symptoms are present, add Bupleuri Radix (Chaihu). If dampness is predominant with no abdominal pain, add Ligustici Chuanxiong Rhizoma (Chuanxiong) and Atractylodis Macrocephalae Rhizoma (Cangzhu). If heat is predominant with severe abdominal pain, add Coptidis Rhizoma (Chuanlian) and Aurantii Fructus Immaturus (Zhike).
Jiujian Dahuang Tang (Wine-Boiled Rhubarb Decoction): Treats damp-heat dysentery without exterior signs.
Ingredients: Rheomi Radix et Rhizoma (Chuan Dahuang).
Decoct with wine, remove the rhubarb, and drink the wine.
Huanglian Zhike Tang (Coptis and Magnolia Bark Decoction): Treats damp-fire injuring the Qi level.
Ingredients: Coptidis Rhizoma (Chuan Huanglian), Aurantii Fructus Immaturus (Zhike), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao).
Xianglian Wan (Costus and Coptis Pill): Treats dysentery caused by damp-fire injuring the Qi level.
Ingredients: Coptidis Rhizoma (Chuan Huanglian), Aucklandiae Radix (Muxiang).
If there is severe anal tenesmus, add Aurantii Fructus Immaturus (Zhike). If urination is difficult, add Talcum (Huashi). If vomiting occurs, take Pingwei San (Pingwei Powder) and Xianglian Wan in equal halves.
Liuyi San (Six-to-One Powder)
Ingredients: Talcum (Huashi), Glycyrrhizae Radix et Rhizoma (Gancao).
Bazheng San (Eight-Ingredient Powder for Rectification)
Ingredients: Dianthi Herba (Qumai), Talcum (Huashi), Gardeniae Fructus (Shanzhi), Akebiae Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao), Plantaginis Semen (Cheqianzi), Alismatis Rhizoma (Zexie), Poria (Chiling).
Add Lophatheri Herba (Dan Zhuye).
Tongling San (Tongling Powder): Treats symptoms of damp-heat binding in the Bladder causing difficult urination.
Ingredients: Ophiopogonis Tuber (Maimendong), Lophatheri Herba (Dan Zhuye), Plantaginis Semen (Cheqianzi).
Hejian Huanglian Tang (Hejian Coptis Decoction): Treats bloody dysentery with absent abdominal pain, indicating damp-heat injuring the Blood level.
Ingredients: Coptidis Rhizoma (Chuan Huanglian), Angelicae Sinensis Radix (Danggui), Glycyrrhizae Radix et Rhizoma (Gancao).
The use of Danggui in this formula seems to treat dryness injuring the Blood level. However, the use of Chuan Huanglian is to treat damp-fire. Adding Danggui merely guides Chuan Huanglian into the Blood level. If it were dry-fire, one would use drying-moistening drugs like Dahuang, not bitter-drying drugs like Chuan Huanglian. Although both are fire-dysentery, one must distinguish between dryness and dampness. Even among damp-fire dysenteries, one must distinguish whether Qi or Blood is injured. If damp-fire injures the Qi level, use Xianglian Wan. If damp-fire injures the Blood level, use Hejian Huanglian Tang. I use Dahuang Zhike Tang to treat dry-fire dysentery injuring the Qi level, and Dahuang Danggui Tang to treat dry-fire dysentery injuring the Blood level. Do I lack teacher-guided insights? Generally, when damp-fire injures the Qi level, it refines into white accumulation, hence the use of Chuanlian Zhike Tang. When damp-fire injures the Blood level, it refines into bloody accumulation, hence the use of Chuanlian Danggui Tang.