全当归(八钱) 生黄芩(一钱) 大白芍(八钱) 川连(一钱) 山楂肉(三钱) 莱菔子(
二钱)
车前子(一钱半) 槟榔(八分) 生大黄(二三钱) 浓朴(八分) 枳壳(八分) 甘草(五分)
大白芍(一两) 黄连(五钱) 当归(五钱) 黄芩(五钱) 大黄(三钱) 肉桂(二钱五分)
甘草(二钱) 槟榔(二钱) 木香(一钱)
上九味, 咀,每服用水二盏,煎至一盏,去渣,温服。如痢不减,渐加大黄,食后服
。喻
嘉言先生论治痢,恐阳陷于阴,用逆流挽舟之法,最重活人败毒散,于痢初起时用之。予仿
其
意,而恐羌、独过于表散,于大归芍汤中加柴胡一钱许以升少阳,葛根一钱许以升阳明,不
致清阳下陷,获效颇易。并不犯涵初发汗之忌,而可收嘉言逆挽之功。但可加于归芍汤中,
若加于涵初之方,嫌其不符合也。
痢疾经称肠 ,今称滞下,皆湿热蕴结所致。湿热干于气分则白,干于血分则红。治法
主通
,《内经》通因通用,为痢言之也。症虽日夜百行,通则自愈,不至于死。惟噤口痢实属危
险,饱不煞的痢疾,奈何汤下不下乎?其故亦由湿热熏蒸,胃口壅塞不通,非通不生,而通
胃口,颇难于通大肠。古方或用人参加石莲肉,或用败毒散加陈仓米,谓之仓廪汤,而多不
效。夫湿热之毒壅塞胃口,乃药必用参,适以助邪,安望其通耶?大抵非苦寒之品,加以通
胃降气之药不可。或云涵初之方,非苦寒为君耶?然则即服涵初方可矣。不知噤口痢连药亦
不能下,如能下,不为噤口矣。大约初起,只好以些少药缓缓投之,以生川连为君,稍加通
药
一二味,或加制军少许,但得下咽不呕,即缓缓再进;药果能进,自可渐渐纳谷,然后以大
剂
通大肠之药进之,大肠得通,胃口自不壅塞。予尝治此症,用生黄连五分,新会皮五分,鲜
竹茹三钱,煎清汁半钟,以铜匙少少进之,略停一刻再进,半日始将半钟服尽,竟得不呕,
居然胃渐开而热渐退,可进米饮,次日以涵初方加大黄三钱与服。其始便次不可数计,服药
后约三四时辰,陡然大通,便次大减,腹痛亦大减。次日只解六次,再进原方,减大黄一钱
,又再进原方,去大黄不用,而痢全止矣。因治噤口痢不易,特记此案,以见急症缓调之法
,切勿急投大剂,致胃不能受,以为无药可救矣,不知所贵在服药得法耳!我后人不可轻视
此法也。
Radix Angelicae Sinensis (Danggui, 8 qian) Raw Scutellariae Radix (Huangqin, 1 qian) Radix Paeoniae Alba (Baishao, 8 qian) Rhizoma Coptidis (Chuanlian, 1 qian) Pericarpium Crataegi (Shanzharenrou, 3 qian) Semen Raphani (Laifuzi, 2 qian)
Fructus Prunellae (Cheqianzi, 1.5 qian) Areca Seed (Binglang, 8 fen) Raw Rhei Radix et Rhizoma (Dashenghuang, 2-3 qian) Cortex Magnoliae Officinalis (Nongpou, 8 fen) Fructus Aurantii (Zhiqiao, 8 fen) Radix Glycyrrhizae (Gancao, 5 fen)
Radix Paeoniae Alba (Baishao, 1 liang) Rhizoma Coptidis (Huanglian, 5 qian) Radix Angelicae Sinensis (Danggui, 5 qian) Raw Scutellariae Radix (Huangqin, 5 qian) Raw Rhei Radix et Rhizoma (Dashenghuang, 3 qian) Cortex Cinnamomi (Rougui, 2.5 qian)
Radix Glycyrrhizae (Gancao, 2 qian) Areca Seed (Binglang, 2 qian) Radix Aucklandiae (Muxiang, 1 qian)
The above nine herbs are chopped. For each dose, use two zhan of water, decoct until one zhan remains, remove the dregs, and take warm. If dysentery does not subside, gradually increase the dosage of Raw Rhei Radix et Rhizoma (Dashenghuang) and administer after meals. Mr. Yu Jiayan discussed the treatment of dysentery, fearing that Yang Qi might sink into Yin, and advocated the method of "pulling back the boat against the current," placing great emphasis on Huoren Baidu San (Decoction to Save Lives and Eliminate Toxins), which should be used at the onset of dysentery. I imitated his intent but feared that Qianghuo (Rhizoma Notopterygii) and Duhuo (Rhizoma Angelicae Pubescentis) were too dispersing. Therefore, in Da Guishao Tang (Major Decoction of Angelica and Peony), I added Chaihu (Herba Bupleuri, approx. 1 qian) to ascend Shaoyang Qi and Gegen (Puerariae Lobatae Radix, approx. 1 qian) to ascend Yangming Qi, preventing the sinking of Clear Yang Qi, thereby achieving efficacy easily. This does not violate the taboo of sweating in the initial stage, yet it can achieve the effect of Yu Jiayan's "reverse pull." However, this modification is suitable only for Da Guishao Tang; adding it to Zhang Jieguy's (Han Chu's) formula would be inconsistent with its original principle.
Dysentery is referred to as "Changpi" (Intestinal Disorder) in ancient classics and "Zhixia" (Stagnant Downward Flow) in modern times; both are caused by the accumulation and binding of Damp-Heat. When Damp-Heat affects the Qi level, white mucus appears in the stool; when it affects the Blood level, red blood appears. The treatment principle focuses on unblocking. As stated in Nei Jing (The Inner Canon), "Treat obstruction with unblocking methods" (Tong Yin Tong Yong), specifically referring to dysentery. Although the patient may defecate over a hundred times a day, once unblocked, self-healing occurs, and death is avoided. Only Jin Kou Li (Anorexic Dysentery) is truly dangerous—dysentery so severe that food cannot be swallowed, let alone medicine. The cause is also steaming and steaming of Damp-Heat, leading to blockage of the Stomach orifice. Without unblocking, there is no life; however, unblocking the Stomach orifice is more difficult than unblocking the Large Intestine. Ancient formulas sometimes used Renshen (Radix Ginseng) plus Shilianrou (Sarcotesta Nelumbinis) or Baidu San (Decoction to Eliminate Toxins) plus Chen Cangmi (Aged Rice), called Canlin Tang (Granary Decoction), but these were often ineffective. If Damp-Heat toxicity blocks the Stomach orifice, using Renshen (Radix Ginseng) merely aids the pathogen; how can one expect unblocking? Generally, bitter-cold herbs combined with herbs that unblock the Stomach and direct Qi downward are necessary. Some argue that Han Chu's formula already uses bitter-cold herbs as the sovereign agent. In that case, simply administering Han Chu's formula would suffice. However, in Anorexic Dysentery, even medicine cannot be taken; if it could be taken, it would not be Anorexic Dysentery. At the onset, only small doses should be administered slowly. Use Sheng Chuanlian (Raw Rhizoma Coptidis) as the sovereign herb, add one or two unblocking herbs, or a small amount of Zhijun (Processed Rhei Radix et Rhizoma). As long as the medicine is swallowed without vomiting, continue administering slowly; if the medicine is retained, appetite will gradually return, allowing for larger doses of herbs that unblock the Large Intestine. Once the Large Intestine is unblocked, the Stomach orifice will naturally cease to be blocked. I once treated this condition using Sheng Huanglian (Raw Rhizoma Coptidis, 5 fen), Xinhui Pi (Pericarpium Citri Reticulatae, 5 fen), and Xian Zhuru (Fresh Bamboo Shavings, 3 qian), decocted to obtain half zhong of clear juice. Administered drop by drop with a copper spoon, pausing briefly before each subsequent dose, the entire half zhong was consumed within half a day, resulting in no vomiting. Gradually, the stomach opened, heat subsided, and rice water could be ingested. The next day, Han Chu's formula with an additional 3 qian of Dashenghuang (Raw Rhei Radix et Rhizoma) was administered. Initially, bowel movements were countless. Approximately three to four shichen (6-8 hours) after medication, a massive evacuation occurred, significantly reducing bowel frequency and abdominal pain. On the second day, there were only six movements. The original formula was continued, reducing Dashenghuang by 1 qian. It was administered again, then the original formula was given without Dashenghuang, and the dysentery completely ceased. Because treating Anorexic Dysentery is difficult, I recorded this case to demonstrate the method of slow regulation for acute conditions. Do not hastily administer large doses, causing gastric intolerance and leading to the false conclusion that the case is incurable. The key lies in proper administration methods. My descendants must not underestimate this approach.