论痢下通治 论火泻通治 论下血通治
天师曰∶通治者，因其通而通之也。如人病下痢者是。痢疾之症，多起于暑天之郁热，而又感以
水湿雨露之气以成之。红白相见，如血如脓，甚者如屋漏水，如鱼冻水，里急后重，崩迫痛疼，欲下而不
能，不下而不快，一日数十行，或一夜数百行，或日夜数千行，气息奄奄，坐而待死，此通之病也。若骤
止其邪，则死生顷刻；不止其邪，则危绝如丝；欲补其气，则邪气转加；欲清其火，则下行更甚。此时
惟有因势利导之法，可行于困顿之间。或疑人已气虚血败，更加利导，必致归阴。不知邪气一刻
不去，则正气一刻不安。古人之痢疾无止法，信不诬也。方用白芍三两，当归三两，萝卜子一两，枳壳三
钱，槟榔三钱，甘草三钱，车前子三钱，水煎服。一剂即止，二剂全安，可用饮食矣。（〔批〕此方前
已有了，止分两不同耳。多车前子一味。）此方之奇而妙者，全在用白芍、当归。盖水泻最忌当归
之滑，而痢疾最喜其滑也；芍药味酸，入肝以平木，使木不敢再侵脾土；又有枳壳、槟榔，消逐其湿热之
邪；又加车前，分利其水湿，而又不耗真阴之水，所以功胜于茯苓也。尤奇者，在用萝卜子一味，世多不
解。盖萝卜子味辣，而能逐邪去湿，而又能上下通达，消食利气，使气行于血分之中，助归、芍以生新
血，而祛荡其败瘀也。少加甘草以和中，则无过烈之患。此奏功之神奇，实有妙理耳。
张公曰∶固然奇妙通权。通因通用，痢疾立论，最为妥当。然而通因之法，不止痢疾也，水泻亦是，
下血亦是也。水泻者，人见其如潮而来，如瀑而下，皆曰急宜止之，以免亡阴之症，用粟壳、莺粟、乌梅之
类止之。其论则是，其治则非也。水泻虽不比痢疾之断不可止，然而水泻之中，亦有不可遽止之病，如疼痛
于腹中，后重于门口，皆是有火而泻，不比虚寒之直泻，俱当用通因之法治之。方用人参三钱，车前一
两，白芍三钱，槟榔一钱，甘草一钱治之。此方之妙，妙在车前以滑之，而又佐以槟榔之去积，自然有
滞皆行。况车前性虽滑而能分消水谷，则水气自然分开。第大泻之后，自然亡阴，又用人参以补气，则气
足而阴自生。又虑久泻自然亏中，又加甘草以和之。虽是通因之法，实乃扶正之方。
下血之症，其人之血虚，不言可知，似乎宜补其血矣。然而血之下也，必非无故，非湿热之相侵，即酒毒
之深结，若不逐去其湿热酒毒，而徒尚止涩之味，吾未见其下血之能止也。方用熟地一两，地榆三钱，白
芍三钱，当归三钱，黄连三钱，甘草一钱，葛根一钱，柞树枝五钱，水煎服。（〔批〕解酒散火汤。）
一剂必下血更多，二剂略少，三剂全愈。盖此病不用通因之法，永不奏功，必如此而能愈也。方中妙在用
熟地、当归、芍药以生新血，新血生则旧血必去。又妙在地榆以凉大肠，用柞木以去酒毒，所以相济而成
功也。此二方亦通因之妙用，人亦亟宜知之。
华君曰∶同。
雷公曰∶通因通用，张公补论之，尤为酣畅，我无以赞一言。虽然，尚有一说。在大泻之后，虽是火
泻，毕竟宜温补之，以生其阴。泻一止，即宜用四物汤，加人参、炮姜以温补。而不可谓水泻忌滑，而禁
用归、熟也。
（痢症按昔贤谓如屋漏水者，为不治症∶鱼冻水者，为虚寒症。后方恐宜酌用，李子永识。）
Discussion on the General Treatment of Dysentery, Discussion on the General Treatment of Fire Diarrhea, Discussion on the General Treatment of Hematochezia
The Heavenly Master said: The so-called "general treatment" (Tong Zhi) refers to treating by following and guiding the pathological trend of unblocking. This is exemplified by patients suffering from dysentery (Li Ji). Dysentery typically originates from stagnant heat in summer, compounded by the invasion of dampness from water, dew, and rain. Stools appear with red and white mixed, resembling blood and pus. In severe cases, it resembles leaking roof water or melting fish jelly, accompanied by tenesmus (Li Ji Hou Zhong), urgent and painful defecation, a desire to defecate but inability to do so, and discomfort if not defecated. It may occur dozens of times a day, hundreds of times a night, or even thousands of times day and night. The patient's breath becomes faint, sitting and awaiting death. This is a condition requiring "unblocking." If one suddenly stops the pathogenic factor, life and death hang in the balance; if the pathogen is not expelled, the condition becomes critical like a gossamer thread; if Qi is tonified, the pathogenic factor intensifies; if fire is cleared, the downward flow worsens. At this time, only the method of "following the momentum to guide" (Yin Shi Li Dao) can be applied amidst the crisis. Some doubt that since the patient already suffers from Qi deficiency and blood deterioration, adding unblocking measures will inevitably lead to death. They fail to realize that as long as the pathogen remains for a moment, Zheng Qi (Upright Qi) cannot find peace. The ancients' approach to dysentery without fixed astringent methods is indeed truthful. The prescription uses Bai Shao (Radix Paeoniae Alba) 3 liang, Dang Gui (Radix Angelicae Sinensis) 3 liang, Luo Bo Zi (Semen Raphani) 1 liang, Zhi Qiao (Pericarpium Citri Reticulatae Viride) 3 qian, Bing Lang (Areca Seed) 3 qian, Gan Cao (Radix Glycyrrhizae) 3 qian, Che Qian Zi (Semen Plantaginis) 3 qian, decocted in water and taken orally. One dose stops the symptoms, two doses ensure full recovery, and diet can be resumed. (Comment: This formula was presented earlier, differing only in dosages. It adds Che Qian Zi.) The marvel of this formula lies entirely in the use of Bai Shao and Dang Gui. Generally, water diarrhea contraindicates the slippery nature of Dang Gui, but dysentery favors its slipperiness; Shao Yao (Paeonia Root) is sour, enters the Liver channel to pacify Wood, preventing Wood from invading Spleen Earth; Zhi Qiao and Bing Lang eliminate damp-heat pathogens; Che Qian Zi separates and drains dampness without consuming True Yin fluids, thus outperforming Fu Ling (Poria). Particularly ingenious is the use of Luo Bo Zi, which many do not understand. Luo Bo Zi is pungent, expelling pathogens and dampness, promoting circulation up and down, resolving food stagnation and regulating Qi. It allows Qi to move within the Blood level, assisting Dang Gui and Shao Yao in generating new blood and sweeping away stale stasis. A small amount of Gan Cao harmonizes the Middle Jiao, preventing excessive harshness. The miraculous efficacy of this formula is based on profound principles.
Master Zhang said: Indeed, it is marvelous and flexible. "Treating obstruction with unblocking" (Tong Yin Tong Yong), when established for dysentery, is most appropriate. However, the method of "Tong Yin" is not limited to dysentery; it also applies to water diarrhea and hematochezia. In water diarrhea, seeing it surge like a tide and fall like a waterfall, people say it must be stopped immediately to prevent Yin collapse, using substances like Su Ke (Cortex Pyri), Ying Su (Papaveris Fructus), and Wu Mei (Fructus Mume). While the theory is correct, the treatment is flawed. Although water diarrhea is not absolutely non-astringent like dysentery, there are cases where immediate cessation is inadvisable, such as abdominal pain and rectal tenesmus, indicating diarrhea caused by Fire rather than deficiency-cold straight diarrhea. These should all be treated with the "Tong Yin" method. The prescription uses Ren Shen (Radix Ginseng) 3 qian, Che Qian Zi 1 liang, Bai Shao 3 qian, Bing Lang 1 qian, Gan Cao 1 qian. The妙 (wonder) of this formula lies in using Che Qian Zi's slipperiness, assisted by Bing Lang to remove accumulation, ensuring natural movement of stagnation. Moreover, although Che Qian Zi is slippery, it separates and dissipates water and grain, naturally separating water qi. After severe diarrhea, Yin loss is inevitable; Ren Shen tonifies Qi, so sufficient Qi generates Yin. Concerning chronic diarrhea depleting the Middle, Gan Cao is added to harmonize. Though it is a "Tong Yin" method, it is essentially a formula to support Zheng Qi.
Regarding hematochezia, the patient's Blood deficiency is self-evident, suggesting Blood tonification is needed. However, bleeding does not occur without cause; it is either due to damp-heat invasion or deep accumulation of alcohol toxicity. If one does not expel damp-heat and alcohol toxins but merely relies on astringents, I have never seen hematochezia stop. The prescription uses Shu Di Huang (Radix Rehmanniae Preparata) 1 liang, Di Yu (Sanguisorbae Radix) 3 qian, Bai Shao 3 qian, Dang Gui 3 qian, Huang Lian (Rhizoma Coptidis) 3 qian, Gan Cao 1 qian, Ge Gen (Puerariae Lobatae Radix) 1 qian, Zao Zhi (Ramulus Quercus Mongolicae) 5 qian, decocted in water and taken orally. (Comment: Jie Jiu San Huo Tang.) One dose causes more bleeding, two doses reduce it slightly, three doses cure completely. This disease will never respond without the "Tong Yin" method; only thus can it heal. The formula's brilliance lies in using Shu Di, Dang Gui, and Shao Yao to generate new blood; once new blood is generated, old blood is expelled. Also brilliant is Di Yu cooling the Large Intestine and Zao Mu removing alcohol toxins, working in synergy. These two formulas are also masterful applications of "Tong Yin," which people should urgently understand.
Master Hua said: Agreed.
Master Lei said: "Treating obstruction with unblocking," supplemented by Master Zhang, is particularly thorough; I have nothing to add. Nevertheless, there is another point. After severe diarrhea, even if it is fire diarrhea, warm tonification is suitable to generate Yin. Once diarrhea stops, Si Wu Tang (Four Substances Decoction) should be used, added with Ren Shen and Pao Jiang (Prepared Ginger Rhizome) for warm tonification. One should not claim that water diarrhea contraindicates slipperiness and thus forbid the use of Dang Gui and Shu Di.
(Note on Dysentery: Ancient sages considered dysentery resembling "leaking roof water" as incurable; that resembling "fish jelly water" as deficiency-cold. The latter formulas should probably be used with discretion. Recorded by Li Zi Yong.)