11．俞女。肠结核之泄泻，用温阳药能治标。至于足肿，则是心脏衰弱，合并营养缺乏，古人称为脾败。附块9克，山药12克，益智仁6克，补骨脂9克，当归6克，御米壳6克，白术9克，带皮苓g克，山萸肉9克，巴戟9克，五味子6克，芡实12克。
12．陈女。服琼玉膏而泄，脾不能吸收故也。在肺病最忌有此，进一层便是肠痨。此，症有甘温、甘寒两大法，今用甘温。附块9克，土炒党参9克，云苓9克，五味6克，天竺子10克，炙甘草3克，炮姜6克，生白术9克，山药12克，百部9克，仙鹤草9克。
[按]俞、陈两案皆用温补，俞案侧重在温补脾肾，陈案侧重在温补脾阳，是其同中之异。此外，仙鹤草除能止血外，兼有止泄及强壮作用。百部除能杀菌外，配合天竺子，是用以治嗽。天竺子为小檗科植物南天竹的果实，性味酸、甘、平。功能敛肺、止咳，清肝明目。治久咳喘息，百日咳，疟疾，下疳溃烂。用量：6-12克。又"劳者温之"，是中医治本之法，可是先生于俞案却说"用温阳药能治标"，其意何在?殆因肠结核系结核杆菌为患，抗其菌方为治本。先生疑陈案为肠结核(肠痨)，方用具有抗结核菌作用的百部，即是此意。
13．潘男。壮热面红，目赤，临风洒然恶寒。所苦尤在腹痛则欲泄，次数之繁，不可胜计。平日久卧湿地，寒湿内伏，已非一朝一夕。生麻黄2．4克，炮附片9克，青陈皮各4．5克，细辛2．4克，防风6克，杭芍12克，生苍术9克，柴胡6克，生枳实9克，粉甘草3克。[按]此案壮热、面红、目赤均为假热之象，寒湿内伏方为其病之本。所以用麻黄附子细辛汤、四逆散、痛泻要方合为复方，以温阳祛寒燥湿，化滞缓急定痛。
14．孙女。腹痛则欲泄，此肠病也，不外受寒、伤食而来。荆防风各4．5克，炮姜炭2．4克，桂枝2．4克(后下)，紫苏叶6克，青皮6克，乌药4．5克，小茴香4．5克，神曲9克，生艾叶3克，枳实炭9克，杭白芍9克。[按]受寒伤食所致之腹泻，治以散寒导滞并用。
15．夏女。凡黎明泄泻者，多半是：①肠结核；②慢性痢疾；③消化不良。此三者，古人多用温脾。罂粟壳12克，益智仁9克，诃子肉9克，潞党参9克，肉豆蔻9克，升麻6克，乌梅丸9克(分3次吞服)。[按1此案以药测之，当为慢性痢疾。方从真人养脏汤加减，温中涩肠为主。
16．袁男。泄泻数月之久，初起腹中痛，历1个月后，绝不作痛；比来其次数甚于清晨，进温脾固涩之方，丝毫无效。尝见慢性痢疾有作此状者。石榴皮9克，炮姜炭4．5克，川楝子9克，伏龙肝30克(煎汤代水)，薤白头12克，生艾叶6克，炮附片9克，宣木瓜9克，陈红茶9克。另：乌梅丸9克，日服2次。[按]泄泻日久，脾阳已虚，进温脾固涩之方，本属正治；但其肾阳衰微，且肠中余滞未清，故丝毫无效。今以温固脾肾以治其本，参入薤白、红茶等调中清肠之晶，肃清余邪以治其标。
1．朱男。喻嘉言治滞下之有表证者，用逆流挽舟法。今身热，下痢日三四行，临圊有努责意，用其法表里两解。荆防各6克，玉桔梗3克，薤白头9克，前胡6克，广木香2．4克，炒扁豆衣6克，川羌活6克，枳实炭6克，杭白芍9克，干荷叶3克，赤白苓各6克。[按]此为痢疾夹表证。其方一面疏散表邪，使邪从皮毛而出；一面行气导滞，使在里之积滞下行。表里两解，其痢自愈。
2．何男。大便溏泄，日10余次，临圊腹先痛，其痛多在脐下，病在肠可知。有恶寒发热之表证，当兼治其表。粉葛根9克，淡黄芩6克，川连1．2克，炒防风6克，杭白芍9克，小青皮6克，白槿花9克，飞滑石9克(包)，生甘草3克，荷叶1角。
二诊：热退，但里急后重，泻不爽，有粘液。然则昨日之泄泻，实为滞下之前驱。油当归9克，杏仁泥16克，郁李仁9克(打)，生枳实9克，杭白芍9克，玉桔梗6克，炒防风9克，海南片9克，生艾叶4．5克。三诊：后重未除，不须用攻药，清其肠，消其炎是矣。川黄柏4．5克，苦参片6克，樗白皮9克，白头翁9克，北秦皮9克，川连1．5克，银花9克，败酱草9克，马齿苋15克，杭白芍12克，粉甘草4．5克。
[按]此案初起有恶寒发热、腹痛、泄泻，为痢疾夹表证，故用葛根芩连、痛泻要方(以青皮易陈皮)加减。二诊热退，但里急后重、大便混有粘液，为肠有湿热积滞，不可止涩，用当归、杏仁、郁李仁、枳实、槟榔通下祛邪，行气导滞。其中杏仁用量大，以疏利开达、破壅降逆，对痢之积滞而里急后重者有显效，这是先生经常推崇的经验。三诊里急除，说明积滞已大挫，不必再用行气药，转方用白头翁汤加味以清肠消炎治痢。
3．余男。痢症初起，先当荡涤，有表证者，当并及之。粉葛根9克，青防风9克，杭白芍9克，薤白头12克，生熟锦纹各6克，桔梗9克，槟榔9克，杏仁15克，荠菜花12克，香连丸4．5克(分2次吞)。二诊：通之，痢之次数减少。腹仍痛，痛则欲泄，泄不爽。熟锦纹9克，炒枳实9克，北秦皮9克，白槿花12克，白鸡冠花12克，当归9克，川楝子9克，戊己丸3克(分2次吞)。
三诊：腹痛减轻，便亦见爽，仍守原意出入。熟锦纹9克，北秦皮9克，白槿花9克，白芍9克，香连丸3克(分2次吞)，炒谷麦芽各12克。[按]痢症用泻法，即古籍所谓"通因通用"之法。方中大黄、槟榔、枳实等味，均为此而设。此法荡涤肠道积滞，清除湿热，是治疗急性痢疾的常用之法，再辅以治痢常用的香连丸、秦皮等味，多可缩短疗程，获得疗效。所以本病例三诊即见平定。白芍一味，功擅和营敛阴、缓急止痛，是治痢的要药。痢疾而腹痛者，先生常用之。
4．张男。排便是白冻，次数频繁，临圃先腹痛而努责。昨夜壮热如焚。无论其为肠炎抑为痢，总当迅速排去肠内容物。郁李仁15克，杏仁泥24克，海南片9克，杭白芍9克，防风9克，羌活6克，薤白头12克，小青皮6克，延胡索12克，山楂肉15克，地枯萝12克。二诊：畅下后，第二步治法，唯单宁与炭类善其后。乌梅4．5克，山楂炭12克，六神曲9克，枳实炭9克，百草霜12克，石榴皮9克，生艾叶4，5克，藕节5只，谷麦芽各9克。[按]本案也是用泻下剂而获效。一诊时，因白冻伴有壮热，故用大剂润下之品以导滞清肠，治壮热之本；参用白芍、青皮、防风(痛泻要方意)，以治痢泻腹痛。用石榴皮、艾叶、藕节等单宁酸类药，以保护肠道粘膜；用百草霜、山楂炭、枳实炭等炭剂，以吸收肠内的毒素。待第三次来诊，便泄已止。先生预言二诊用药为"善其后"，果是如此。
5．朱男。排便有白粘液，里急而后重不爽，其次数暮甚于昼。无论其为肠炎或痢，先当荡涤之。熟锦纹9克，杏仁泥15克，生枳实9克，全瓜蒌12克，杭白芍9克，苦参片9克，六神曲9克，山楂炭12克，粉甘草3克，陈红茶9克。
二诊：药后，大便次数反少，或者锦纹、红茶含有多量单宁之故。排便纯白者，今转为赤。凡赤，总是粘膜出血。郁李仁15克(打)，熟锦纹9克，白芍12克，荠菜花12克，秦皮9克，川黄柏9克，败酱草12克，粉甘草3克，飞滑石12克(包)，香连丸4．5克(分2次吞)，白槿花15克。三诊：便溏而爽，日一二次，色亦转黄，予香连丸、保和丸以巩固之。[按]本案初诊，用荡涤药于清热化湿之中，药后大便次数反见少，认为是锦纹、红茶含多量单宁酸而致收敛的缘故。二诊大便由白转红，为肠道湿热未清，炎症尚在，肠粘膜受损，故于前法中加重清热化湿的药物。足见泄泻、痢疾的初起，不管便之赤白，通常以通便、清热、化湿最为要着。
6．任女。数欲圊而便不爽，未痢之先腹中痛，苔垢腻，可知内有所积。熟锦纹4．5克，薤白头9克，杭白芍9克，江枳实9克，苦桔梗4．5克，花槟榔9克，莱菔子9克，焦六曲9克，焦麦芽9克。另：山楂炭9克，研细末，每服3克，1日3次。二诊：痢之次数已减，腹痛后重亦瘥；其便仍赤而粘，不可再攻。北秦皮9克，地榆炭9克，川黄柏4．5克，马齿苋12克，白槿花12克，石榴皮9克，陈红茶9克，山楂炭12克，香连丸4．5克。
[按]腹痛里急后重，乃湿热蕴结于肠，气血被阻，传导失职。初诊用大黄、槟榔、枳实等攻下以祛邪，白芍和血止痛，薤白辛通滑利，对泄痢下重者著效；并用楂、曲、麦芽、莱菔子以消导积滞。桔梗为祛痰排脓之药，金元时医家称其为诸药舟楫，医界迄今用之。然先生之用，殆为排脓。山楂为炭研吞有吸着作用，意同现代医学使用药炭之意。二诊痢减，病势已大挫，先生告诫"不可再攻"，故用药侧重清利湿热、解毒、治痢。．
7．王女。治痢大法，赤者属热当清，白者属寒当温，清者消其炎症，温者增加肠蠕动。赤白并有者，清温兼施。纯清者白头翁汤，纯温者附子理中汤。洁古之芍药汤，从二者脱胎而出。今予洁古芍药汤。杭白芍15克，海南片9克，神曲12克，熟锦纹9克，山楂肉12克，粉草4．5克，香连丸4．5克(分3次吞)，肉桂末1．5克(分3次吞)。[按]此谓治痢大法，指一般常规而言。先生曾说："赤痢未必属热，白痢未必属寒"，则指特殊情况而言。属热或属寒，不专在痢之赤白，须凭临床证候而定。
8．瞿男。临圊努责，在仲景称为后重，用苦寒以坚之。苦寒以坚之者，消炎之意也。参以金元用归芍和之之法，其力更宏。黄柏炭6克，北秦皮12克，全当归9克，苦桔梗6克，香连丸3克，白槿花15克，山楂炭12克，杭白芍12克，焦六曲12克。
二诊：后重十去八九，痢至尾声时，其便色青，消化功能尚未恢复。当以古人所称之和脾善后。焦六曲6克，白术9克，太子参9克，炒麦芽6克，橘皮6克，清炙草2．4克，炒米仁15克，玄参9克，炒扁豆衣9克，煨益智6克，木香2．4克。[按]先生所谓"仲景称为后重，用苦寒以坚之"者，系指"热利下重者，．白头翁汤主之"，所谓"金元用归芍和之"者，殆指张洁古治滞下赤白的芍药汤。此病为湿热痢，取上述二方化裁为治。药后病去十之八九，二诊改为健脾和中，以善后调理。
9．李女。下腹痛颇剧，汗多肤冷，呕恶频频，舌红，脉沉细。此数者皆为痢症所忌，高年有此，虚脱之变，指顾问事耳。炮附块、潞党参、全当归9克，杭白芍12克，杏仁18克，延胡索90克，马齿苋9克，败酱草9克，苦参片4．5克，旋覆花9克(包)，伏龙肝9克(煎汤代水)。
[按]汗多肤冷，呕恶，是阳气大伤之证；舌红，脉沉细，阴亦受劫；而痢下未止，下腹痛剧，为湿热之邪阻滞肠中。此为高龄体虚病实，故攻补两难。方用参、附振阳，补气固脱；归、芍调营，缓痛敛阴；延胡索行滞止痛；旋覆花降逆止呕；马齿苋、败酱草、苦参清肠止痢；杏仁苦降通利；灶心黄土温脾、止呕、缓泻。综观全方，有扶正救逆之力，无兜涩留邪之弊。若见病不见人，徒以苦寒清肠止痢，则病未却而正愈伤。
10．吴女。排便努责不爽，次数频，圊与否皆腹痛，重身不可猛攻。郁李仁9克(打)，熟锦纹9克，生枳实9克，花槟榔9克，白槿花12克，薤白头12克，杭白芍9克，桑寄生12克，粉甘草4．5克，炒枯赤砂糖12克。二诊：少腹剧痛，排便纯是白粘液，临圊努责甚久，怀子3个月余，猛攻虑其伤胎。杭白芍15克，白槿花15克，白头翁15克，北秦皮12克，桔梗9克，杏仁30克，全瓜蒌12克，细青皮9克，广木香3克，油当归12克，甘草4．5克，炒枯赤砂糖12克。
三诊：腹痛已不如昨日之酸楚不可耐，但仍有白粘液，不爽。白头翁15克，白槿花12克，北秦皮9克，荠菜花12克，苦参片9克，银花炭12克，桔梗9克，杭白芍15克，川楝子9克，粉甘草6克，杏仁泥15克。四诊：腹痛减轻，便亦畅爽，略带粘液。前方加减可矣。白头翁12克，白槿花12克，银花炭12克，苦参片9克，秦皮9克，白芍12克，神曲9克，粉甘草3克。[按]本案患者妊娠3个月余，所以先生不投峻猛的泻下剂。二诊时，因病势转剧，乃重用清热化湿治痢药，如白头翁、白槿花、秦皮等。其中下气润肠的杏仁，用至30克之多，而且加全瓜蒌、油当归协助通便，殆即《内经》所谓"有故无殒"之意。本案处方不用黄连、黄柏，盖因便白属寒，而今大便见有白粘液，不可多用苦寒药的缘故。
11. Female patient Yu. Diarrhea caused by intestinal tuberculosis can be treated symptomatically (treating the branch) with Yang-warming herbs. As for the edema of the feet, it is due to cardiac insufficiency combined with malnutrition, which the ancients termed "Spleen failure." Prescription: Prepared Aconite Root (Fuzi) 9g, Chinese Yam (Shanyao) 12g, Bunge's Wisdom Fruit (Yizhiren) 6g, Psoralea Fruit (Buguzhi) 9g, Angelica Sinensis Root (Danggui) 6g, Poppy Shell (Yumiqiao) 6g, Atractylodes Macrocephala Rhizome (Baizhu) 9g, Poria with Bark (Daipiling) 9g, Cornus Officinalis Fruit (Shanzhuyu) 9g, Morinda Officinalis Root (Bajitian) 9g, Schisandra Berry (Wuweizi) 6g, Euryale Seed (Qianshi) 12g.
12. Female patient Chen. Diarrhea occurred after taking Qiongyu Paste because the Spleen failed to absorb the medication. In the treatment of Lung diseases, this condition is most taboo; if it worsens, it progresses to intestinal tuberculosis (intestinal phthisis). The treatment principles for such conditions mainly include two major methods: Sweet-Warm and Sweet-Cool. Currently, the Sweet-Warm method is used. Prescription: Prepared Aconite Root (Fuzi) 9g, Codonopsis Root (Dangshen) stir-fried in soil 9g, Poria (Lingzhi/Yunling) 9g, Schisandra Berry (Wuweizi) 6g, Indian Fig Opuntia Fruit (Tianzhuzi) 10g, Honey-fried Licorice Root (Zhigancao) 3g, Processed Ginger (Paojiang) 6g, Raw Atractylodes Macrocephala Rhizome (Sheng Baizhu) 9g, Chinese Yam (Shanyao) 12g, Stemona Root (Baiibu) 9g, Agrimony Herb (Xianhecao) 9g.
[Commentary] Both cases of Yu and Chen utilized warming tonification. Case Yu focused on warming and tonifying the Spleen and Kidney, while Case Chen focused on warming and tonifying Spleen Yang; this represents the difference within their similarity. Additionally, Agrimony Herb (Xianhecao), besides stopping bleeding, also has effects of stopping diarrhea and strengthening the body. Stemona Root (Baiibu), besides killing bacteria, when combined with Indian Fig Opuntia Fruit (Tianzhuzi), is used to treat cough. Tianzhuzi is the fruit of Nandina domestica (family Berberidaceae), with a sour, sweet, and neutral nature. Its functions are astringing the Lung, stopping cough, clearing the Liver, and improving vision. It treats chronic cough with wheezing, whooping cough, malaria, and chancre ulcers. Dosage: 6-12g. Furthermore, "For exhaustion, use warmth" is a method of treating the root in TCM. However, why did Dr. Zhang say in Case Yu that "using Yang-warming herbs treats the branch"? This is likely because intestinal tuberculosis is caused by Mycobacterium tuberculosis, so antibacterial action constitutes treating the root. Dr. Zhang suspected Case Chen was also intestinal tuberculosis, and the inclusion of Baiibu, which has anti-tubercular properties, reflects this intention.
13. Male patient Pan. High fever, red face, red eyes, and aversion to wind/cold. The main suffering is abdominal pain leading to the urge to defecate, with frequency being incalculable. Long-term lying on damp ground has led to internal stagnation of Cold-Dampness, not occurring overnight. Prescription: Raw Ephedra Herb (Sheng Mahuang) 2.4g, Processed Aconite Lateral Root (Pao Fupian) 9g, Green Tangerine Peel (Qingpi) and Dried Tangerine Peel (Chenpi) 4.5g each, Asarum Root (Xixin) 2.4g, Saposhnikovia Root (Fangfeng) 6g, White Peony Root (Hang Shaoyao) 12g, Raw Atractylodes Rhizome (Sheng Cangzhu) 9g, Bupleurum Root (Chaihu) 6g, Raw Immature Bitter Orange (Sheng Zhishi) 9g, Powdered Licorice Root (Fen Gancao) 3g. [Commentary] The high fever, red face, and red eyes in this case are all signs of false heat; the root of the disease is the internal stagnation of Cold-Dampness. Therefore, a compound formula combining Ma Huang Fu Zi Xi Xin Tang, Si Ni San, and Tong Xie Yao Fang is used to warm Yang, dispel Cold, dry Dampness, resolve stagnation, relieve spasm, and stop pain.
14. Female patient Sun. Abdominal pain leads to the urge to defecate; this is an intestinal disease, caused either by Cold invasion or food injury. Prescription: Schizonepeta Spike (Jingjie) and Saposhnikovia Root (Fangfeng) 4.5g each, Charred Processed Ginger (Pao Jiangtan) 2.4g, Cinnamon Twig (Guizhi) 2.4g (added later), Perilla Leaf (Zisuye) 6g, Green Tangerine Peel (Qingpi) 6g, Lindera Root (Wuyao) 4.5g, Small Fennel Fruit (Xiaohuixiang) 4.5g, Medicated Leaven (Shenqu) 9g, Raw Moxa Leaf (Sheng Aiye) 3g, Charred Immature Bitter Orange (Zhishi Tan) 9g, White Peony Root (Hang Shaoyao) 9g. [Commentary] Diarrhea caused by Cold invasion and food injury should be treated by simultaneously dispersing Cold and guiding out stagnation.
15. Female patient Xia. Dawn diarrhea is mostly due to: ① Intestinal tuberculosis; ② Chronic dysentery; ③ Indigestion. For these three conditions, the ancients often used Spleen-warming methods. Prescription: Poppy Shell (Yangsuhke) 12g, Bunge's Wisdom Fruit (Yizhiren) 9g, Chebula Fruit Flesh (Hezirou) 9g, Dangshen 9g, Nutmeg (Roudoukou) 9g, Cimicifuga Rhizome (Shengma) 6g, Wumei Wan (Mume Pill) 9g (swallowed in 3 doses). [Commentary] Based on the prescription, this case is likely chronic dysentery. The formula is modified from Zhenren Yangzang Tang, primarily focusing on warming the Middle and astringing the Intestines.
16. Male patient Yuan. Diarrhea has persisted for months. Initially, there was abdominal pain, but after one month, the pain completely ceased. Recently, the frequency has increased, especially in the morning. Taking formulas for warming the Spleen and astringing has been ineffective. I have seen chronic dysentery present in this manner. Prescription: Pomegranate Peel (Shiliupi) 9g, Charred Processed Ginger (Pao Jiangtan) 4.5g, Toosendan Fruit (Chuanshanzi) 9g, Longan Earth (Fulonggan) 30g (decocted as water substitute), Allii Macrostemonis Bulbus (Xiebaitou) 12g, Raw Moxa Leaf (Sheng Aiye) 6g, Processed Aconite Lateral Root (Pao Fupian) 9g, Chaenomelis Fructus (Xuan Mugua) 9g, Aged Black Tea (Chenhongcha) 9g. Additionally: Wumei Wan 9g, taken twice daily. [Commentary] Prolonged diarrhea depletes Spleen Yang; thus, warming the Spleen and astringing is the correct treatment. However, it was ineffective here because Kidney Yang is severely deficient and residual stagnation remains in the Intestines. Now, warming and consolidating the Spleen and Kidney treats the root, while adding Allii Macrostemonis Bulbus (Xiebai) and Black Tea to regulate the Middle and clear the Intestines treats the branch by eliminating residual pathogens.
Dysentery
1. Male patient Zhu. Yu Jiayan used the "Reverse Current Boat-Pulling Method" for dysentery with exterior syndrome. Currently, the patient has fever, passes stool 3-4 times a day, and feels tenesmus during defecation. This method is used to resolve both exterior and interior. Prescription: Schizonepeta Spike (Jingjie) and Saposhnikovia Root (Fangfeng) 6g each, Magnolia Flower Bud (Yujiegeng) 3g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, Peucedanum Root (Qianhu) 6g, Aucklandia Root (Guangmuxiang) 2.4g, Stir-fried Vigna Angularis Seed Coat (Chao Biandouyi) 6g, Notopterygium Rhizome (Chuanqianghuo) 6g, Charred Immature Bitter Orange (Zhishi Tan) 6g, White Peony Root (Hang Shaoyao) 9g, Dried Lotus Leaf (Gan Heye) 3g, Red Poria (Chifuling) and White Poria (Baifuling) 6g each. [Commentary] This is dysentery complicated by an exterior syndrome. The formula disperses exterior pathogens to exit through the skin/hair while promoting Qi movement and resolving stagnation to allow internal accumulation to descend. Resolving both exterior and interior allows the dysentery to heal spontaneously.
2. Male patient He. Loose stools, more than 10 times a day. Abdominal pain precedes defecation, mostly below the umbilicus, indicating intestinal pathology. There is an exterior syndrome of aversion to cold and fever, which should be treated concurrently. Prescription: Kudzu Root (Fengegen) 9g, Scutellaria Root (Dan Huangqin) 6g, Coptis Rhizome (Chuanlian) 1.2g, Stir-fried Saposhnikovia Root (Chao Fangfeng) 6g, White Peony Root (Hang Shaoyao) 9g, Small Green Tangerine Peel (Xiao Qingpi) 6g, Hibiscus Flower (Baijinhua) 9g, Calcined Gypsum (Fei Huashi) 9g (wrapped), Raw Licorice Root (Sheng Gancao) 3g, Lotus Leaf 1 corner.
Second visit: Fever subsided, but tenesmus persists, defecation is unsatisfactory, and mucus is present. Thus, yesterday's diarrhea was actually a precursor to dysentery. Prescription: Oil-soaked Angelica Sinensis Root (You Danggui) 9g, Almond Paste (Xingrenni) 16g, Prunus Marginata Seed (Yuliren) 9g (crushed), Raw Immature Bitter Orange (Sheng Zhishi) 9g, White Peony Root (Hang Shaoyao) 9g, Magnolia Flower Bud (Yujiegeng) 6g, Stir-fried Saposhnikovia Root (Chao Fangfeng) 9g, Hainan Areca Nut (Hainan Pian) 9g, Raw Moxa Leaf (Sheng Aiye) 4.5g. Third visit: Tenesmus persists, no need for purgatives; clearing the Intestines and reducing inflammation is sufficient. Prescription: Phellodendron Bark (Chuan Huangbo) 4.5g, Sophora Flavescens Root (Kushenpian) 6g, Tree-of-Heaven Bark (Chubaipi) 9g, Pulsatilla Root (Baitouweng) 9g, Birch Bark (Beiqinpi) 9g, Coptis Rhizome (Chuanlian) 1.5g, Chrysanthemum Flower (Yinhua) 9g, Patrinia Herb (Baijiangcao) 9g, Purslane (Machixian) 15g, White Peony Root (Hang Shaoyao) 12g, Powdered Licorice Root (Fen Gancao) 4.5g.
[Commentary] Initially, aversion to cold, fever, abdominal pain, and diarrhea indicated dysentery with exterior syndrome, so Gegen Qinlian Tang and Tongxie Yao Fang (replacing Chenpi with Qingpi) were used. After fever subsided at the second visit, tenesmus and mucous stools indicated damp-heat stagnation in the Intestines; astringents are contraindicated. Danggui, Xingren, Yuliren, Zhishi, and Binglang were used to purge pathogenic factors and promote Qi movement. The large dose of Xingren helps to unblock congestion and direct rebellious Qi downward, showing significant efficacy for dysentery with tenesmus, an experience highly valued by the doctor. At the third visit, the resolution of tenesmus indicates that stagnation has been significantly reduced, so Qi-moving herbs are no longer needed. The formula switched to Baitouweng Tang with modifications to clear the Intestines, reduce inflammation, and treat dysentery.
3. Male patient Yu. At the onset of dysentery, purging is necessary first; if there is an exterior syndrome, it should be addressed simultaneously. Prescription: Kudzu Root (Fengegen) 9g, Green Saposhnikovia Root (Qing Fangfeng) 9g, White Peony Root (Hang Shaoyao) 9g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Raw and Prepared Rheum Palmatum Rhizome (Sheng Shu Jinwen) 6g each, Magnolia Flower Bud (Jiegeng) 9g, Areca Nut (Binglang) 9g, Almond (Xingren) 15g, Shepherd's Purse Flower (Qicaihua) 12g, Xianglian Wan 4.5g (taken in 2 doses). Second visit: After purging, the frequency of dysentery decreased. Abdominal pain persists, with urge to defecate upon pain, but defecation is unsatisfactory. Prescription: Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, Stir-fried Immature Bitter Orange (Chao Zhishi) 9g, Birch Bark (Beiqinpi) 9g, Hibiscus Flower (Baijinhua) 12g, White Cockcomb Flower (Bai Jiguanhua) 12g, Angelica Sinensis Root (Danggui) 9g, Toosendan Fruit (Chuanshanzi) 9g, Wuji Wan 3g (taken in 2 doses).
Third visit: Abdominal pain reduced, stool passage improved, maintaining the original principle with adjustments. Prescription: Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, Birch Bark (Beiqinpi) 9g, Hibiscus Flower (Baijinhua) 9g, White Peony Root (Baishao) 9g, Xianglian Wan 3g (taken in 2 doses), Stir-fried Rice Sprout and Barley Sprout (Chao Guyamaiya) 12g each. [Commentary] Using purgation for dysentery follows the ancient principle of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). Herbs like Dahuang, Binglang, and Zhishi in the formula serve this purpose. This method clears intestinal stagnation and damp-heat, commonly used for acute dysentery. Combined with common dysentery herbs like Xianglian Wan and Qinpi, it shortens the course and improves efficacy, leading to stabilization by the third visit in this case. Baishao harmonizes the nutritive level, astringes Yin, and relieves spasmodic pain, making it a key herb for dysentery, frequently used by the doctor for painful dysentery.
4. Male patient Zhang. Stool consists of white mucus, frequent, preceded by abdominal pain and tenesmus. Last night, high fever like burning fire. Regardless of whether it is enteritis or dysentery, intestinal contents must be expelled quickly. Prescription: Prunus Marginata Seed (Yuliren) 15g, Almond Paste (Xingrenni) 24g, Hainan Areca Nut (Hainan Pian) 9g, White Peony Root (Hang Shaoyao) 9g, Saposhnikovia Root (Fangfeng) 9g, Notopterygium Rhizome (Qianghuo) 6g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, Small Green Tangerine Peel (Xiao Qingpi) 6g, Corydalis Rhizome (Yanhusuo) 12g, Hawthorn Flesh (Shanzhourou) 15g, Radish Root (Dikuluó) 12g. Second visit: After smooth purging, the next step is to use tannin-containing and charred herbs for consolidation. Prescription: Mume Fruit (Wumei) 4.5g, Charred Hawthorn (Shanzhutan) 12g, Medicated Leaven (Liushenqu) 9g, Charred Immature Bitter Orange (Zhishi Tan) 9g, Herbal Ash (Baicaoshuang) 12g, Pomegranate Peel (Shiliupi) 9g, Raw Moxa Leaf (Sheng Aiye) 4.5g, Lotus Node (Oujie) 5 pieces, Rice Sprout and Barley Sprout (Guyamaiya) 9g each. [Commentary] This case also achieved success with purgatives. At the first visit, due to white mucus accompanied by high fever, a large dose of moistening purgatives was used to guide stagnation and clear the Intestines, treating the root of the fever. Baishao, Qingpi, and Fangfeng (from Tongxie Yao Fang) were added to treat abdominal pain from dysentery. Tannin-rich herbs like Shiliupi, Aiye, and Oujie protect the intestinal mucosa; charred herbs like Baicaoshuang, Shanzhutan, and Zhishi Tan absorb intestinal toxins. By the third visit, diarrhea had stopped. The doctor's prediction that the second visit's prescription was for "consolidation" proved accurate.
5. Male patient Zhu. Stool contains white mucus, tenesmus with unsatisfactory passage, frequency worse at night than day. Regardless of enteritis or dysentery, purging is the first step. Prescription: Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, Almond Paste (Xingrenni) 15g, Raw Immature Bitter Orange (Sheng Zhishi) 9g, Whole Trichosanthes Fruit (Quangualou) 12g, White Peony Root (Hang Shaoyao) 9g, Sophora Flavescens Root (Kushenpian) 9g, Medicated Leaven (Liushenqu) 9g, Charred Hawthorn (Shanzhutan) 12g, Powdered Licorice Root (Fen Gancao) 3g, Aged Black Tea (Chenhongcha) 9g.
Second visit: After medication, stool frequency decreased, possibly due to the high tannin content in Jinwen and Hongcha. Pure white stool now turns red. Red always indicates mucosal bleeding. Prescription: Prunus Marginata Seed (Yuliren) 15g (crushed), Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, White Peony Root (Baishao) 12g, Shepherd's Purse Flower (Qicaihua) 12g, Birch Bark (Qinpi) 9g, Phellodendron Bark (Chuan Huangbo) 9g, Patrinia Herb (Baijiangcao) 12g, Powdered Licorice Root (Fen Gancao) 3g, Calcined Gypsum (Fei Huashi) 12g (wrapped), Xianglian Wan 4.5g (taken in 2 doses), Hibiscus Flower (Baijinhua) 15g. Third visit: Stool is loose but smooth, 1-2 times daily, color turned yellow. Given Xianglian Wan and Baohe Wan to consolidate. [Commentary] At the first visit, purgatives were used within the context of clearing heat and transforming dampness. The subsequent decrease in stool frequency was attributed to the astringent effect of tannins in Jinwen and Hongcha. The change from white to red stool at the second visit indicates unresolved damp-heat, persistent inflammation, and damaged intestinal mucosa, hence increasing heat-clearing and damp-transforming herbs. This shows that in the early stages of diarrhea or dysentery, regardless of red or white stool, promoting bowel movement, clearing heat, and transforming dampness are crucial.
6. Female patient Ren. Frequent urge to defecate with unsatisfactory passage, abdominal pain before dysentery, greasy tongue coating, indicating internal accumulation. Prescription: Prepared Rheum Palmatum Rhizome (Shu Jinwen) 4.5g, Allii Macrostemonis Bulbus (Xiebaitou) 9g, White Peony Root (Hang Shaoyao) 9g, Jiang Zhishi 9g, Bupleurum Flower Bud (Ku Jiegeng) 4.5g, Areca Nut (Huabinglang) 9g, Radish Seed (Laifuzi) 9g, Charred Medicated Leaven (Jiao Liuqu) 9g, Charred Barley Sprout (Jiao Maiya) 9g. Additionally: Charred Hawthorn (Shanzhutan) 9g, powdered, 3g per dose, 3 times daily. Second visit: Dysentery frequency reduced, abdominal pain and tenesmus improved; stool remains red and sticky, no further purging allowed. Prescription: Birch Bark (Beiqinpi) 9g, Sanguisorba Root (Diyutan) 9g, Phellodendron Bark (Chuan Huangbo) 4.5g, Purslane (Machixian) 12g, Hibiscus Flower (Baijinhua) 12g, Pomegranate Peel (Shiliupi) 9g, Aged Black Tea (Chenhongcha) 9g, Charred Hawthorn (Shanzhutan) 12g, Xianglian Wan 4.5g.
[Commentary] Abdominal pain and tenesmus result from damp-heat accumulating in the Intestines, obstructing Qi and Blood, and impairing transportation. At the first visit, Dahuang, Binglang, and Zhishi were used to purge pathogens, Baishao to harmonize blood and stop pain, Xiebai to unblock and lubricate (effective for heavy sensation in diarrhea/dysentery), and Hawthorn, Liushenqu, Maiya, and Laifuzi to digest stagnation. Jiegeng is used for expelling phlegm and pus; although called the "vessel of all herbs" by Jin-Yuan physicians, the doctor uses it primarily for expelling pus. Charred and powdered Hawthorn has adsorbent properties, similar to modern medicinal charcoal. At the second visit, dysentery decreased, indicating the pathogen was largely subdued. The doctor warned "no further purging," so the focus shifted to clearing damp-heat, detoxifying, and treating dysentery.
7. Female patient Wang. General principles for treating dysentery: Red indicates Heat, requiring clearing; White indicates Cold, requiring warming. Clearing reduces inflammation; warming increases intestinal motility. When red and white are mixed, both clearing and warming are applied. Pure Heat is treated with Baitouweng Tang; pure Cold with Fuzi Lizhong Tang. Jiegu's Shaoyao Tang evolved from these two. Prescribing Jiegu's Shaoyao Tang. Prescription: White Peony Root (Hang Shaoyao) 15g, Hainan Areca Nut (Hainan Pian) 9g, Medicated Leaven (Shenqu) 12g, Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, Hawthorn Flesh (Shanzhourou) 12g, Powdered Licorice Root (Fencao) 4.5g, Xianglian Wan 4.5g (taken in 3 doses), Cinnamon Bark Powder (Rouguimo) 1.5g (taken in 3 doses). [Commentary] These general principles refer to routine cases. The doctor once said, "Red dysentery is not necessarily Heat, White dysentery is not necessarily Cold," referring to special cases. Determining Heat or Cold depends on clinical manifestations, not just the color of the stool.
8. Male patient Qu. Tenesmus during defecation, termed "houzhong" by Zhang Zhongjing, treated with bitter-cold herbs to "firm" it. "Firming with bitter-cold" means reducing inflammation. Combining this with the Jin-Yuan method of harmonizing with Danggui and Baishao enhances efficacy. Prescription: Charred Phellodendron Bark (Huangbo Tan) 6g, Birch Bark (Beiqinpi) 12g, Whole Angelica Sinensis Root (Quan Danggui) 9g, Magnolia Flower Bud (Ku Jiegeng) 6g, Xianglian Wan 3g, Hibiscus Flower (Baijinhua) 15g, Charred Hawthorn (Shanzhutan) 12g, White Peony Root (Hang Shaoyao) 12g, Charred Medicated Leaven (Jiao Liuqu) 12g.
Second visit: Tenesmus reduced by 80-90%. As dysentery nears its end, stool is greenish, and digestive function has not recovered. Use the ancient method of harmonizing the Spleen for consolidation. Prescription: Charred Medicated Leaven (Jiao Liuqu) 6g, Atractylodes Macrocephala Rhizome (Baizhu) 9g, Pseudoginseng Root (Taizishen) 9g, Stir-fried Barley Sprout (Chao Maiya) 6g, Tangerine Peel (Jupi) 6g, Clear Honey-fried Licorice Root (Qing Zhigancao) 2.4g, Stir-fried Coix Seed (Chao Yiren) 15g, Scrophularia Root (Xuanshen) 9g, Stir-fried Vigna Angularis Seed Coat (Chao Biandouyi) 9g, Roasted Bunge's Wisdom Fruit (Wei Yizhi) 6g, Aucklandia Root (Muxiang) 2.4g. [Commentary] The doctor's reference to "Zhang Zhongjing's houzhong treated with bitter-cold to firm" refers to "For hot dysentery with tenesmus, Baitouweng Tang governs." The reference to "Jin-Yuan harmonizing with Danggui and Baishao" refers to Zhang Jiegu's Shaoyao Tang for red and white dysentery. This case is damp-heat dysentery, treated by modifying the aforementioned two formulas. After symptoms improved by 80-90%, the second visit shifted to strengthening the Spleen and harmonizing the Middle for recovery.
9. Female patient Li. Severe lower abdominal pain, profuse sweating, cold skin, frequent nausea/vomiting, red tongue, deep-thready pulse. These are contraindications for dysentery; in an elderly patient, this indicates imminent collapse. Prescription: Prepared Aconite Block (Pao Fu Kuai), Dangshen, Whole Angelica Sinensis Root (Quan Danggui) 9g each, White Peony Root (Hang Shaoyao) 12g, Almond (Xingren) 18g, Corydalis Rhizome (Yanhusuo) 9g, Purslane (Machixian) 9g, Patrinia Herb (Baijiangcao) 9g, Sophora Flavescens Root (Kushenpian) 4.5g, Inula Flower (Xuanfuhua) 9g (wrapped), Longan Earth (Fulonggan) 9g (decocted as water substitute).
[Commentary] Profuse sweating and cold skin, along with nausea/vomiting, indicate severe damage to Yang Qi; red tongue and deep-thready pulse indicate Yin depletion. Persistent dysentery and severe lower abdominal pain indicate damp-heat pathogens blocking the Intestines. This is a case of elderly weakness with excess pathogen, making attack and tonification difficult. The formula uses Renshen and Fuzi to boost Yang and secure collapse; Danggui and Baishao to harmonize Ying, relieve pain, and astringe Yin; Yanhusuo to move stagnation and stop pain; Xuanfuhua to direct rebellious Qi downward and stop vomiting; Machixian, Baijiangcao, and Kushen to clear the Intestines and stop dysentery; Xingren to descend and unblock; Zaixin Tu (Kitchen Hearth Soil) to warm the Spleen, stop vomiting, and moderate diarrhea. Overall, the formula supports healthy Qi and rescues deviation without retaining pathogens. Seeing only the disease and not the patient, using only bitter-cold herbs to clear the Intestines would harm healthy Qi further without curing the disease.
10. Female patient Wu. Unsatisfactory passage with straining, frequent, abdominal pain regardless of defecation. Pregnancy precludes aggressive purging. Prescription: Prunus Marginata Seed (Yuliren) 9g (crushed), Prepared Rheum Palmatum Rhizome (Shu Jinwen) 9g, Raw Immature Bitter Orange (Sheng Zhishi) 9g, Areca Nut (Huabinglang) 9g, Hibiscus Flower (Baijinhua) 12g, Allii Macrostemonis Bulbus (Xiebaitou) 12g, White Peony Root (Hang Shaoyao) 9g, Mulberry Root Bark (Sangjisheng) 12g, Powdered Licorice Root (Fen Gancao) 4.5g, Stir-fried Brown Sugar (Chao Ku Chishatang) 12g. Second visit: Severe lower abdominal pain, pure white mucus stool, prolonged straining. Pregnant for over 3 months, aggressive purging risks harming the fetus. Prescription: White Peony Root (Hang Shaoyao) 15g, Hibiscus Flower (Baijinhua) 15g, Pulsatilla Root (Baitouweng) 15g, Birch Bark (Beiqinpi) 12g, Magnolia Flower Bud (Jiegeng) 9g, Almond (Xingren) 30g, Whole Trichosanthes Fruit (Quangualou) 12g, Fine Green Tangerine Peel (Xi Qingpi) 9g, Aucklandia Root (Guangmuxiang) 3g, Oil-soaked Angelica Sinensis Root (You Danggui) 12g, Licorice Root (Gancao) 4.5g, Stir-fried Brown Sugar (Chao Ku Chishatang) 12g.
Third visit: Abdominal pain less severe than yesterday's unbearable soreness, but white mucus persists, unsatisfactory passage. Prescription: Pulsatilla Root (Baitouweng) 15g, Hibiscus Flower (Baijinhua) 12g, Birch Bark (Beiqinpi) 9g, Shepherd's Purse Flower (Qicaihua) 12g, Sophora Flavescens Root (Kushenpian) 9g, Charred Chrysanthemum Flower (Yinhua Tan) 12g, Magnolia Flower Bud (Jiegeng) 9g, White Peony Root (Hang Shaoyao) 15g, Toosendan Fruit (Chuanshanzi) 9g, Powdered Licorice Root (Fen Gancao) 6g, Almond Paste (Xingrenni) 15g. Fourth visit: Abdominal pain reduced, stool smooth with slight mucus. Adjust previous formula. Prescription: Pulsatilla Root (Baitouweng) 12g, Hibiscus Flower (Baijinhua) 12g, Charred Chrysanthemum Flower (Yinhua Tan) 12g, Sophora Flavescens Root (Kushenpian) 9g, Birch Bark (Qinpi) 9g, White Peony Root (Baishao) 12g, Medicated Leaven (Shenqu) 9g, Powdered Licorice Root (Fen Gancao) 3g. [Commentary] Since the patient was pregnant for over 3 months, the doctor avoided harsh purgatives. At the second visit, due to worsening condition, heat-clearing and damp-transforming dysentery herbs like Baitouweng, Baijinhua, and Qinpi were heavily used. Xingren, which descends Qi and moistens the Intestines, was used up to 30g, assisted by Quangualou and You Danggui to facilitate bowel movement, reflecting the Nei Jing principle "If there is a cause, there will be no destruction." The prescription omitted Huanglian and Huangbo because white stool suggests Cold, and the presence of white mucus contraindicates excessive use of bitter-cold herbs.