11．蒋女。因痢而早产，产后痢如故，入夜次数尤频。最堪注意者，身热缠绵迄于、今。夫热为痢之大忌，何况产后。白头翁9克(酒洗)，杭白芍9克，全当归12克，五灵脂12克，糖炒山楂12克，北秦皮9克，白槿花15克，姜川连0．9克，炒防风6克，荠菜花炭12克。二诊：药数服后，下痢之有20余行者减其半，呕恶亦止，胃纳稍好。如此总是佳象。凡胎前下痢，产后不止，病延时日久，正气之衰弱不言可知，改拟三奇散。生黄芪9克，蜜炙防风9克，杭白芍9克，白槿花12克，山楂炭9克，全当归9克，麸炒枳实9克，马齿苋15克，乌梅肉4．5克，伏龙肝30克，炒枯赤砂糖30克。[按]此案因下痢而早产，产后痢不止，身热缠绵。初诊以归、芍和营；五灵脂、山楂炭行滞；白头翁、秦皮、白槿花、黄连等清肠止痢。二诊病减，改用《六科准绳》治疗虚痢的三奇散(黄芪、生枳壳、防风)加味，以黄芪、归、芍补气和血扶正为主；用防风升清；枳实、山楂行滞；马齿苋、白槿花清肠；并用建曲和胃；乌梅、伏龙肝收涩止泻。
12．焦男。舌边红中腻，却不成三角，病巢在肠之症；腹痛则欲泄，其色赤，壮热连作3日。粉葛根9克，川连1克，杭白芍9克，淡黄芩6克，柴胡6克，生枳实9克，粉甘草3克，生地榆12克，白槿花9克，北秦皮9克，荷叶1角。[按]壮热，泄泻，大便色赤，乃肠道湿热蕴结证。用葛根芩连汤、四逆散二方加味，以泄热达表，降浊清肠，是治腹痛下痢之又一法门。
13．钱男。滞下纯赤，一昼夜十数行，终日腹中作痛，临圊不爽利。熟锦纹9克，海南片6克，郁李仁15克，桔梗9克，白槿花12克，北秦皮9克，败酱草9克，百草霜12克(包)，陈红茶9克，戊己丸6克(分2次吞)，山楂炭12克。二诊：服药后，即吐，其人反觉烦躁不安，痢仍不爽，且有热。白槿花24克，香连丸6克(分2次吞)，杭白芍12克，熟锦纹9克，杏仁泥30克，小青皮9克，陈红茶9克，青防风9克，百草霜12克(包)。[按]此为热痢气滞证。初诊用润下导滞，清肠治痢，因药后即吐，二诊转用木香、青皮疏调气机，用大剂量杏仁破壅降逆，配合熟大黄导下去邪；并用香连丸清肠治痢，痛泻要方(去术，青皮易陈皮)，缓痛止泻。气机通调，壅积解除，邪去肠清，则痢自止。
14．孙男。腹痛则欲泻，无后重感，所泻尽是血液，日夜达30余次，曾2次住院急诊无效。白头翁18克，北秦皮30克，川连3克，黄柏18克，马齿苋18克，白槿花18克，鱼腥草18克，延胡索18克，十灰丸12克(分2次吞)。注：此案一药而愈。[按]所泻尽是血液，日夜30余次，为邪毒扰于血分，乃湿热痢而偏重于热。"热痢下重者，白头翁汤主之。"(《伤寒论》)此由本方加味而成。白头翁清热凉血，善治热毒血痢；秦皮清热燥湿收敛，亦善治热痢下血；连、柏、马齿苋、白槿花功能清热解毒燥湿，均是治痢的常用药；鱼腥草一药，功擅散热毒痈肿，对痢疾引起的肠粘膜溃疡有效。民间常用其一味治痢。患者无后重感，故不用一般治痢之行气药，只用一味延胡活血散瘀以治腹痛。十灰丸为止血炭剂，对肠粘膜出血有直接收敛作用。药证相投，药量特重，故可一药而愈。
15．陈女。体素不足，而病痢2周之久，今腹痛努责，便纯血水，神疲四肢不温，而体力更虚。血余炭12克，阿胶珠12克，熟地黄15克，仙鹤草30克，赤石脂12克，炮附块6克，炮姜炭3克，绿升麻3克，粳米1撮，乌梅肉6克。另：别直参12克，黄芪30克，煎汤代茶。[按]此病人体素不足，下利纯血水，神疲肢冷，为气血阴阳俱虚。药用熟地、阿胶珠、仙鹤草滋阴止血；参、芪补益固气，以防气随血脱；乌梅、赤石脂收敛涩肠；升麻升清，粳米和胃；复用姜、附振奋脾肾之阳，炮姜用炭，兼能止血。此邪少虚多，治本之法，较之前案，迥然不同。
16．欧阳女。热挫，下如故。其便色赤而稀如沫，腹剧痛。白头翁12克，白槿花9克，香连丸4．5克(分2次吞)，桃仁泥24克，生枳实9克，油当归15克，杭白芍9克，延胡索12克，炒荆防各4．5克，生地榆12克。二诊：依旧腹中剧痛，痛则冷汗出，临圊努责，而无所下。熟锦纹9克，当归12克，炮附子9克，生艾叶6克，肉桂末1．2克(分2次吞)，炮姜炭4．5克，薤白头12克，延胡索15克，制香附9克，陈红茶9克，糖炒山楂18克。
三诊：滞下、痛、后重及次数皆差减，其脉虽尚数，有热象，但无需退热。炮附块9克，炮姜炭6克，生艾叶6克，薤白头12克，杏仁泥24克，延胡索12克，苦桔梗9克，海南片9克，当归15克，乌梅9克，神曲9克，陈红茶9克。四诊：滞下因努责之故，多有胸脘痛者，神经痛也。脉见平，无碍。炙乌梅9克，槟榔9克，石榴皮9克，川楝子9克，延胡索9克，山楂肉15克，神曲9克，当归12克，陈红茶9克。[按]本案因便色赤，故用香连丸、白槿花、白头翁、生地榆等清热凉血；油当归、白芍、桃仁润下和营；元胡索、枳实理气止痛；炒荆、防则协助地榆以止血。二诊时，因冷汗出，心中冷，乃加附子、肉桂、艾叶、炮姜等温药，除去白头翁、香连丸、白槿花等清热药。三诊果然病势见减，随后采用温涩、消导而见功。三诊见脉尚数，有热象，居然不用退热药，殆为"治病必求其本"。
17．潘男。泄泻3日，转成赤粘液、腹剧痛外，有高热，其舌光。夫痢之为菌为原虫，在临床颇难鉴别。腹痛者和之，高热者清之，不爽者通之。北柴胡9克，白头翁12克，金银花15克，马齿苋30克，败酱草15克，黄柏9克，苦参片9克，全当归9克，延胡索12克，桃仁泥24克，炒防风9克，陈红茶9克，香连丸9克(分2次吞)。
二诊：痢之次数频繁，外有高热者见挫，舌光红，便色赤，其质粘，腹痛不可按。此方减少其次数，而使其爽利。白头翁15克，黄柏9克，马齿苋30克，苦参片9克，北秦皮12克，败酱草24克，川雅连1．8克(研末分2次吞)，油当归15克，白芍12克，桃仁30克，陈红茶9克，炒枯.赤砂糖9克。
三诊：病势已呈尾声，除药调理外，宜慎饮食。炒白术9克，茯苓9克，桔梗6克，焦神曲9克，焦山楂12克，苡仁9克，陈皮6克，炒谷麦芽各12克。[按]本案初诊，用白头翁汤加减，先生认为柴胡既能清热，又能泄下。二诊因热见退，即去柴胡，加重清化湿热之品，仍以润、涩兼用。三诊病势已呈尾声，乃予健脾助运法以善其后。
18．肖男。便有红白粘液，临圊腹痛后重，予验方通痢散。炮附子6克，杏仁泥15克，羌活6克，生熟锦纹各4．5克，苍术9克，海南片6克，粉草3克。[按]此先生博采众方之一例。验方通痢散出自章回小说《镜花缘》。此用原方加槟榔，以附子易川乌而成。方中寒温并用，荡涤积垢，能导滞、散结、止痛、安中，可治疗多种痢疾和腹泻。羌活一味，非为祛风解表而设，意在协同附子，增强止痛作用。
19．胡女。下赤白痢，日10余行，努责不爽，初起以油类下之。郁李仁24克，杏仁泥30克，生枳实9克，油当归9克，槟榔9克，青皮6克，延胡索12克，川楝子9克，白芍9克，旋覆花9克(包)，粉甘草3克，陈红茶9克。
二诊：药后痛大定，红粘液亦除，但依旧临圊欠爽。郁李仁18克，桔梗9克，杏仁泥24克，生枳实9克，熟大黄9克，槟榔9克，川楝子9克，白芍9克，陈红茶9克。三诊：大便色已转黄而质鹜溏，临圊见爽，日仅一二行。病十去八九，以下方调之。白术9克，炒枳壳4．5克，槟榔6克，川楝子9克，白芍9克，茯苓9克，陈皮6克，焦六曲9克，焦山楂12克，陈红茶12克。[按]先生治痢，初起总是主张下其积滞，用硝、黄峻下，或用含油类药物润肠，视病人体质而定。可见油类润下剂，不仅适用于年老、体弱者便秘，而且可治痢疾而肠有积滞之证。
20．汪男。泄泻转为白冻，有肠炎者，有痢者，古人不加区别，因其证候而治之。熟锦纹9克，海南片6克，杏仁泥15克，生枳实9克，生艾叶4．5克，炮姜炭4．5克，薤白头9克，青防风6克，山楂肉炭12克，香连丸4．5克(分2次吞)。
21．卢男。排便色白而粘，一昼夜十数行，临圊腹痛而有努责意。前人有白痢属寒，用温下者。温者，镇其痛；下者，去其肠所积。炮附块9克，青防风9克，当归9克，薤白头12克，炮姜4．5克，白芥子9克，生熟锦纹各4．5克，槟榔9克，黑丑6克，杏仁泥9克，炒枯赤砂糖9克。
二诊：药两服，得效者，质之厚而粘者已稀，数之频繁者亦减；其未见验者，腹痛，里急后重。炮附块9克，延胡索9克，杭白芍9克，杏仁泥18克，生艾叶6克，青防风6克，薤白头12克，川黄柏4．5克，陈红茶9克。另：山楂炭调赤砂糖吞服。
三诊：腹痛、里急后重顿减，病势既好，用药则不改弦更张。炮附块6克，薤白头9克，生艾叶4．5克，杭白芍9克，黄柏9克，防风6克，杏仁泥12克，山楂炭12克，陈红茶9克。[按]本案开始因白痢属寒，用温脾法。二诊时下痢质稠转稀，次数减少，但腹痛、里急后重如故，于是除用原方中的附子、薤白、防风温里疏调外，加用黄柏清化湿热，延胡索、白芍理气止痛，并重用杏仁降气导滞，再加红茶、艾叶收敛涩肠。三诊时果然病势大好，为防反复，仍予前法加减。
22．谷弟。古人有红痢属热，白痢属寒；白属气，而赤属血，其说不可拘。赤痢有用附子者，白痢有用黄连者。前者镇痛，后者消炎，拘泥寒热便不可通。大黄9克(酒炒)，炮附子6克，当归12克，白芍9克，地榆9克，炮姜炭3克，杏仁24克，香连丸3克(分2次吞)。[按]方用《千金》温脾汤去参、草，取姜、附振奋脾阳，大黄攻下积滞，香、连清热调气，归、芍、地榆和血凉血。用大量杏仁者，是取其通利行滞，破壅降逆。先生案中治痢，不拘泥于古人传统之说，而坚持从临床实际经验出发的精神，对后学颇有启示。
23．杨男。痢下如脓，腹不痛，不后重。往日服乌梅丸有效，今则否，改以温涩。炮附块9克，熟锦纹9克，杭白芍9克，生艾叶9克，炮姜炭3克，宣木瓜9克，川黄柏4．5克，诃子肉9克，生地榆9克，石榴皮9克，败酱草12克。另：脏连丸6克，早晚分服。二诊：痢下如脓者，转为泄泻，次数亦大为减少，但完谷不化。前方去苦寒药。炮附块9克，肉豆蔻4．5克，煨益智仁9克，炮姜炭4．5克，生苍术6克，云茯苓12克，诃子肉9克，百草霜9克(包)。
[按]乌梅丸寒温并用，标本兼顾，以安蛔止痛。近人用之治胆道蛔虫病有显效；对慢性痢疾、慢性肠炎之属于寒热错杂而正气已虚的，亦可加减使用。此患者过去服用有效，今服之无效，故改用《千金》温脾汤去参、草加诃子、石榴皮等以治其本，唯恐留邪，仍少佐苦寒以清肠。二诊一因转为泄泻；二因次数减少；三为完谷不化。故去苦寒治"病"，而用温脾重"人"。方中诃子、石榴皮，过去称为收敛止涩药，今知其有抗菌作用。先生处方常参以现代医学知识，随证应变，而极少通套陈规。
24．于女。每年秋令必作痢，今年发作如前状。病已一来复，依然腹部胀满，里急后重。此为休息痢。高年脉弱，攻之无益。炮附块6克，全当归9克，延胡索9克，海南片9克，杭白芍12克，川楝子9克，晚蚕沙9克(包)，生艾叶4．5克，陈红茶9克。[按]休息痢即慢性痢疾，其症时发时止，迁延日久不愈，多为正虚邪恋。此高年脉弱，不可用攻法。方用炮附子温壮真阳，归、芍和营养阴，槟榔行滞去积，延胡、川楝子调气活血止痛，蚕沙、陈红茶除湿收敛，艾叶祛内寒调气而止腹痛。
25．王男。8年前曾病滞下，从此排便形扁而不爽，疑是斑痕性肠狭窄。今少腹胀硬，按之剧痛。海南片9克，生鸡金12克，五灵脂9克(包)，川楝子9克，薤白头12克，莱菔子12克，小青皮9克，山楂肉12克，谷麦芽各9克。二诊：考其满腹胀硬，按之痛，痛无定所，转矢气则舒。疑其气体蓄积，但气体蓄积之原因亦甚繁。其便色黑而粘，量甚少。熟锦纹9克，制香附9克，川楝子9克，蓬莪术9克，小青皮9克，薤白头12克，苦参片9克，莱菔子12克，山楂肉15克，谷麦芽各9克。
11. Female patient, surnamed Jiang. Premature birth occurred due to dysentery; postpartum dysentery persisted, with frequency increasing at night. Most notably, fever has lingered until now. Fever is a major contraindication for dysentery, especially in the postpartum state. *Baitouweng* (Flos Pulmonariae) 9g (washed with wine), Hang Baishao (Radix Paeoniae Alba) 9g, Quan Danggui (Radix Angelicae Sinensis) 12g, Wulingzhi (Trogopteri Dung) 12g, Tang Chao Shanzha (Fructus Crataegi Saccharatus) 12g, Bei Qinpi (Cortex Fraxini) 9g, Bai Jinhua (Flos Hibisci Mutabilis) 15g, Jiang Chuanlian (Rhizoma Coptidis Ginger-processed) 0.9g, Chao Fangfeng (Radix Saposhnikoviae Stir-fried) 6g, Qicaihua Tan (Flos Capsellae Charred) 12g. Second visit: After several doses, bowel movements decreased from over 20 times daily by half; nausea and vomiting ceased, and appetite slightly improved. This is always a favorable sign. Dysentery before pregnancy that persists postpartum, lasting a long time, indicates obvious deficiency of healthy qi. Modified prescription: Sanqi San (Three Marvels Powder). Sheng Huangqi (Radix Astragali Raw) 9g, Mi Zhi Fangfeng (Radix Saposhnikoviae Honey-processed) 9g, Hang Baishao (Radix Paeoniae Alba) 9g, Bai Jinhua (Flos Hibisci Mutabilis) 12g, Shanzha Tan (Fructus Crataegi Charred) 9g, Quan Danggui (Radix Angelicae Sinensis) 9g, Fu Chao Zhishi (Fructus Aurantii Immaturus Bran-stir-fried) 9g, Machixian (Herba Portulacae) 15g, Wumei Rou (Semen Pruni Mume) 4.5g, Fulonggan (Ligutum Ustums) 30g, Chao Ku Chishatang (Saccharum Rubrum Charred and Stir-fried) 30g. [Commentary] This case involved premature birth due to dysentery, persistent postpartum dysentery, and lingering fever. Initial treatment used Danggui and Baishao to harmonize Ying (nutritive) level; Wulingzhi and Shanzha Tan to move stagnation; Baitouweng, Qinpi, Bai Jinhua, and Huanglian to clear intestines and stop dysentery. On the second visit, as symptoms improved, Sanqi San from *Liuke Zhunsheng* (Standard Diagnosis of Six Departments) for deficiency-type dysentery was modified. The main focus was tonifying Qi and blood with Huangqi, Danggui, and Baishao; Fangfeng to raise clear Yang; Zhishi and Shanzha to move stagnation; Machixian and Bai Jinhua to clear intestines; Jianqu to harmonize stomach; Wumei and Fulonggan to astringe intestines and stop diarrhea.
12. Male patient, surnamed Jiao. Red edges on the tongue, greasy coating in the center but not forming a triangle; pathology located in the intestines. Abdominal pain precedes defecation; stool is red; high fever persisted for 3 days. Fen Gegen (Radix Puerariae Lobatae) 9g, Chuanlian (Rhizoma Coptidis) 1g, Hang Baishao (Radix Paeoniae Alba) 9g, Dan Huangqin (Scutellariae Radix) 6g, Chaihu (Radix Bupleuri) 6g, Sheng Zhishi (Fructus Aurantii Immaturus Raw) 9g, Fen Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Sheng Diyü (Sanguisorbae Radix) 12g, Bai Jinhua (Flos Hibisci Mutabilis) 9g, Bei Qinpi (Cortex Fraxini) 9g, Heye (Folium Nelumbinis) one corner. [Commentary] High fever, diarrhea, and red stool indicate damp-heat accumulation in the intestines. Ge Gen Qin Lian Tang combined with Si Ni San, modified, to vent heat to the exterior, descend turbidity, and clear the intestines. This is another method for treating abdominal pain and dysentery.
13. Male patient, surnamed Qian. Dysentery consisting purely of red blood, occurring more than ten times a day; constant abdominal pain; difficult and incomplete defecation. Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Hainan Pian (Arecae Semen) 6g, Yuliren (Pruni Semen) 15g, Jiegeng (Platycodonis Radix) 9g, Bai Jinhua (Flos Hibisci Mutabilis) 12g, Bei Qinpi (Cortex Fraxini) 9g, Baijiangcao (Patriniae Herba) 9g, Baicaoshuang (Carbonized Fomes Officinalis Spores) 12g (wrapped), Chen Hongcha (Aged Black Tea) 9g, Wuji Wan (Wuji Pill) 6g (taken in two doses), Shanzha Tan (Fructus Crataegi Charred) 12g. Second visit: Immediate vomiting after medication; patient felt restless and irritable; dysentery remained unsmooth with heat signs. Bai Jinhua (Flos Hibisci Mutabilis) 24g, Xianglian Wan (Xianglian Pill) 6g (taken in two doses), Hang Baishao (Radix Paeoniae Alba) 12g, Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Xingren Ni (Paste of Armeniacae Semen Amarum) 30g, Xiao Qingpi (Citri Reticulatae Pericarpium Viride) 9g, Chen Hongcha (Aged Black Tea) 9g, Qing Fangfeng (Radix Saposhnikoviae) 9g, Baicaoshuang (Carbonized Fomes Officinalis Spores) 12g (wrapped). [Commentary] This is heat-dysentery with Qi stagnation. Initial treatment used moistening purgatives to guide out stagnation and clear intestines. Due to immediate vomiting, the second visit shifted to Muxiang and Qingpi to regulate Qi mechanism, large dose of Xingren to break congestion and direct rebellious Qi downward, combined with Shu Dahuang to purge pathogens. Xianglian Wan cleared intestines; Tongxie Yaofang (without Baizhu, Qingpi replacing Chenpi) relieved pain and stopped diarrhea. Once Qi mechanism is regulated and congestion resolved, pathogens expelled and intestines cleared, dysentery stops naturally.
14. Male patient, surnamed Sun. Abdominal pain precedes defecation, no tenesmus; stool consists entirely of blood, occurring over 30 times day and night; hospitalized twice for emergency treatment without effect. Baitouweng (Flos Pulmonariae) 18g, Bei Qinpi (Cortex Fraxini) 30g, Chuanlian (Rhizoma Coptidis) 3g, Huangbai (Phellodendri Cortex) 18g, Machixian (Herba Portulacae) 18g, Bai Jinhua (Flos Hibisci Mutabilis) 18g, Yuxingcao (Houttuyniae Herba) 18g, Yanhusuo (Corydalis Rhizoma) 18g, Shihui Wan (Shihui Pill) 12g (taken in two doses). Note: Cured with one dose. [Commentary] Stool consisting entirely of blood, over 30 times daily, indicates pathogenic toxins disturbing the Blood level, specifically damp-heat dysentery leaning towards heat. "For heat dysentery with heaviness/tenesmus, Baitouweng Tang governs." (*Shanghan Lun*). This formula is modified from that source. Baitouweng clears heat and cools blood, effective for heat-toxin bloody dysentery; Qinpi clears heat, dries dampness, and astringes, also effective for heat dysentery with bleeding; Lian (Huanglian), Bo (Huangbai), Machixian, and Bai Jinhua clear heat, detoxify, dry dampness, and are common dysentery herbs; Yuxingcao disperses heat-toxin and abscesses, effective for intestinal mucosal ulcers caused by dysentery. Folk medicine often uses it singly for dysentery. Since there is no tenesmus, typical Qi-moving herbs for dysentery were omitted; only Yanhusuo was used to invigorate blood and dissipate stasis for abdominal pain. Shihui Wan is a hemostatic carbon agent with direct astringent action on intestinal mucosal bleeding. Precise syndrome differentiation and heavy dosage led to cure with one dose.
15. Female patient, surnamed Chen. Constitutionally deficient; dysentery lasted 2 weeks. Now abdominal pain with straining, passing pure bloody water, mental fatigue, cold limbs, further physical weakness. Xuyutan (Carbonized Human Hair) 12g, Ejiaozhu (Colla Corii Asini Beaded) 12g, Shu Dihuang (Rehmanniae Radix Praeparata) 15g, Xianhecao (Agrimoniae Herba) 30g, Chishizhi (Kaolin) 12g, Pao Fu ku (Aconiti Lateralis Radix Praeparata) 6g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 3g, Lv Shengma (Cimicifugae Rhizoma Green) 3g, Jingmi (Oryzae Semen) a pinch, Wumei Rou (Semen Pruni Mume) 6g. Additionally: Biezhi Shen (Panax Ginseng Radix White) 12g, Huangqi (Astragali Radix) 30g, decocted as tea substitute. [Commentary] Patient constitutionally deficient, passing pure bloody water, mental fatigue, cold limbs indicates deficiency of Qi, Blood, Yin, and Yang. Shudi, Ejiaozhu, and Xianhe nourish Yin and stop bleeding; Shen and Huangqi tonify and consolidate Qi to prevent Qi collapse following blood loss; Wumei and Chishizhi astringe intestines; Shengma raises clear Yang; Jingmi harmonizes stomach; Jiang and Fu stimulate Spleen and Kidney Yang; Pao Jiang (charred) also stops bleeding. Pathogens are few, deficiency is predominant; treating the root differs significantly from previous cases.
16. Female patient, surnamed Ouyang. High fever subsided, but dysentery persists. Stool is red, thin like foam, severe abdominal pain. Baitouweng (Flos Pulmonariae) 12g, Bai Jinhua (Flos Hibisci Mutabilis) 9g, Xianglian Wan (Xianglian Pill) 4.5g (taken in two doses), Taoren Ni (Paste of Persicae Semen) 24g, Sheng Zhishi (Fructus Aurantii Immaturus Raw) 9g, You Danggui (Angelicae Sinensis Radix Oil-treated) 15g, Hang Baishao (Radix Paeoniae Alba) 9g, Yanhusuo (Corydalis Rhizoma) 12g, Chao Jingfang (Saposhnikoviae Radix and Ligustici Rhizoma Stir-fried) each 4.5g, Sheng Diyü (Sanguisorbae Radix) 12g. Second visit: Severe abdominal pain persists, sweating cold sweat during pain, straining at stool with nothing coming out. Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Danggui (Angelicae Sinensis Radix) 12g, Pao Fuzi (Aconiti Lateralis Radix Praeparata) 9g, Sheng Aye (Mugwort Folium Raw) 6g, Rougui Mo (Cinnamomi Cortex Powder) 1.2g (taken in two doses), Pao Jiangtan (Zingiberis Rhizoma Carbonized) 4.5g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Yanhusuo (Corydalis Rhizoma) 15g, Zhi Xiangfu (Cyperi Rhizoma Processed) 9g, Chen Hongcha (Aged Black Tea) 9g, Tang Chao Shanzha (Fructus Crataegi Saccharatus Stir-fried) 18g.
Third visit: Dysentery, pain, tenesmus, and frequency all reduced. Pulse still rapid with heat signs, but antipyretics unnecessary. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 9g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 6g, Sheng Aye (Mugwort Folium Raw) 6g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Xingren Ni (Paste of Armeniacae Semen Amarum) 24g, Yanhusuo (Corydalis Rhizoma) 12g, Ku Jiegeng (Platycodonis Radix Bitter) 9g, Hainan Pian (Arecae Semen) 9g, Danggui (Angelicae Sinensis Radix) 15g, Wumei (Semen Pruni Mume) 9g, Shenqu (Massa Medicata Fermentata) 9g, Chen Hongcha (Aged Black Tea) 9g. Fourth visit: Dysentery due to straining causes chest/epigastric pain (nerve pain). Pulse normalized, no concern. Zhi Wumei (Semen Pruni Mume Roasted) 9g, Binglang (Arecae Semen) 9g, Shiliupi (Punicae Granati Pericarpium) 9g, Chuan Lianzi (Meliosmae Fructus) 9g, Yanhusuo (Corydalis Rhizoma) 9g, Shanzha Rou (Fructus Crataegii Flesh) 15g, Shenqu (Massa Medicata Fermentata) 9g, Danggui (Angelicae Sinensis Radix) 12g, Chen Hongcha (Aged Black Tea) 9g. [Commentary] Due to red stool, Xianglian Wan, Bai Jinhua, Baitouweng, and Sheng Diyü were used to clear heat and cool blood; You Danggui, Baishao, and Taoren to moisten bowels and harmonize Ying; Yanhusuo and Zhishi to regulate Qi and relieve pain; Chao Jing and Fang assisted Diyü in stopping bleeding. Second visit: Cold sweat and cold sensation inside prompted addition of warming herbs (Fuzi, Rougui, Aye, Pao Jiang) and removal of cooling herbs (Baitouweng, Xianglian Wan, Bai Jinhua). Third visit: Symptoms improved; warming and astringing plus digestion-promoting methods proved effective. Despite rapid pulse and heat signs, antipyretics were omitted, adhering to "treat disease seeking its root."
17. Male patient, surnamed Pan. Diarrhea for 3 days, turning into red mucus, severe abdominal pain, high fever, glossy tongue. Differentiating bacterial vs. protozoal dysentery clinically is difficult. For abdominal pain, harmonize; for high fever, clear; for unsmooth defecation, unblock. Bei Chaihu (Radix Bupleuri) 9g, Baitouweng (Flos Pulmonariae) 12g, Jinyinhua (Lonicerae Japonicae Flos) 15g, Machixian (Herba Portulacae) 30g, Baijiangcao (Patriniae Herba) 15g, Huangbai (Phellodendri Cortex) 9g, Kushen Pian (Sophorae Flavescentis Radix Slice) 9g, Quan Danggui (Radix Angelicae Sinensis) 9g, Yanhusuo (Corydalis Rhizoma) 12g, Taoren Ni (Paste of Persicae Semen) 24g, Chao Fangfeng (Radix Saposhnikoviae Stir-fried) 9g, Chen Hongcha (Aged Black Tea) 9g, Xianglian Wan (Xianglian Pill) 9g (taken in two doses).
Second visit: Frequent dysentery, external high fever subsiding, tongue glossy red, stool red and viscous, abdominal pain intolerable to pressure. Formula reduces frequency and promotes smoothness. Baitouweng (Flos Pulmonariae) 15g, Huangbai (Phellodendri Cortex) 9g, Machixian (Herba Portulacae) 30g, Kushen Pian (Sophorae Flavescentis Radix Slice) 9g, Bei Qinpi (Cortex Fraxini) 12g, Baijiangcao (Patriniae Herba) 24g, Chuan Yalian (Rhizoma Coptidis Elegant) 1.8g (powder, taken in two doses), You Danggui (Angelicae Sinensis Radix Oil-treated) 15g, Baishao (Radix Paeoniae Alba) 12g, Taoren (Persicae Semen) 30g, Chen Hongcha (Aged Black Tea) 9g, Chao Ku Chishatang (Saccharum Rubrum Charred and Stir-fried) 9g.
Third visit: Disease nearing end. Besides medication, diet must be cautious. Chao Baizhu (Atractylodis Macrocephalae Rhizoma Stir-fried) 9g, Fuling (Poria) 9g, Jiegeng (Platycodonis Radix) 6g, Jiao Shenqu (Massa Medicata Fermentata Charred) 9g, Jiao Shanzha (Crataegi Fructus Charred) 12g, Yiren (Coicis Semen) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Chao Gumaicha (Hordei Fructus Germinatus and Maydis Fructus Germinatus Stir-fried) each 12g. [Commentary] Initial visit used modified Baitouweng Tang. Mr. Zhang believed Chaihu both clears heat and purges. Second visit: Heat receded, Chaihu removed, damp-heat clearing agents increased, using both moistening and astringing. Third visit: Disease ending, Spleen-tonifying and transport-promoting method used to conclude treatment.
18. Male patient, surnamed Xiao. Stool contains red and white mucus, abdominal pain and tenesmus at stool. Prescribed empirical formula Tongli San. Pao Fuzi (Aconiti Lateralis Radix Praeparata) 6g, Xingren Ni (Paste of Armeniacae Semen Amarum) 15g, Qianghuo (Notopterygii Rhizoma et Radix) 6g, Sheng Shu Jinwen (Rhei Radix et Rhizoma Raw and Cooked) each 4.5g, Cangzhu (Atractylodis Rhizoma) 9g, Hainan Pian (Arecae Semen) 6g, Fen Cao (Glycyrrhizae Radix et Rhizoma) 3g. [Commentary] An example of Mr. Zhang collecting various formulas. Tongli San comes from the novel *Jing Hua Yuan*. Original formula modified with Binglang, substituting Fuzi for Chuanwu. Cold and warm herbs used together, scouring accumulated filth, guiding stagnation, resolving nodules, relieving pain, and stabilizing middle. Treats various dysenteries and diarrheas. Qianghuo here is not for releasing exterior wind, but to synergize with Fuzi to enhance pain relief.
19. Female patient, surnamed Hu. Red and white dysentery, >10 times daily, straining unsmooth. Initially treated with oily purgatives. Yuliren (Pruni Semen) 24g, Xingren Ni (Paste of Armeniacae Semen Amarum) 30g, Sheng Zhishi (Fructus Aurantii Immaturus Raw) 9g, You Danggui (Angelicae Sinensis Radix Oil-treated) 9g, Binglang (Arecae Semen) 9g, Qingpi (Citri Reticulatae Pericarpium Viride) 6g, Yanhusuo (Corydalis Rhizoma) 12g, Chuan Lianzi (Meliosmae Fructus) 9g, Baishao (Radix Paeoniae Alba) 9g, Xuanfuhua (Inulae Flore Wrapped) 9g (wrapped), Fen Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Chen Hongcha (Aged Black Tea) 9g.
Second visit: Pain greatly stabilized, red mucus removed, but defecation still unsmooth. Yuliren (Pruni Semen) 18g, Jiegeng (Platycodonis Radix) 9g, Xingren Ni (Paste of Armeniacae Semen Amarum) 24g, Sheng Zhishi (Fructus Aurantii Immaturus Raw) 9g, Shu Dahuang (Rhei Radix et Rhizoma Cooked) 9g, Binglang (Arecae Semen) 9g, Chuan Lianzi (Meliosmae Fructus) 9g, Baishao (Radix Paeoniae Alba) 9g, Chen Hongcha (Aged Black Tea) 9g. Third visit: Stool color turned yellow, consistency duck-dung-like (loose), defecation smooth, 1-2 times daily. Disease 80-90% resolved, regulating with next formula. Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Chao Zhike (Aurantii Fructus Immaturus Stir-fried) 4.5g, Binglang (Arecae Semen) 6g, Chuan Lianzi (Meliosmae Fructus) 9g, Baishao (Radix Paeoniae Alba) 9g, Fuling (Poria) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Jiao Liuqu (Massa Medicata Fermentata Charred) 9g, Jiao Shanzha (Crataegi Fructus Charred) 12g, Chen Hongcha (Aged Black Tea) 12g. [Commentary] Mr. Zhang advocates purging accumulation initially in dysentery, using strong purgatives like Xiaoshi/Huanglian or oily laxatives depending on constitution. Oily laxatives apply not only to elderly/weak constipation but also dysentery with intestinal accumulation.
20. Male patient, surnamed Wang. Diarrhea turned into white jelly. Ancient texts did not distinguish enteritis from dysentery, treating based on symptoms. Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Hainan Pian (Arecae Semen) 6g, Xingren Ni (Paste of Armeniacae Semen Amarum) 15g, Sheng Zhishi (Fructus Aurantii Immaturus Raw) 9g, Sheng Aye (Mugwort Folium Raw) 4.5g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 4.5g, Xie Baiou (Allii Macrostemonis Bulbus) 9g, Qing Fangfeng (Radix Saposhnikoviae) 6g, Shanzha Rou Tan (Fructus Crataegii Flesh Charred) 12g, Xianglian Wan (Xianglian Pill) 4.5g (taken in two doses).
21. Male patient, surnamed Lu. Stool white and viscous, >10 times daily, abdominal pain with straining urge. Ancients considered white dysentery cold, using warm purgatives. Warmth suppresses pain; purgation removes intestinal accumulation. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 9g, Qing Fangfeng (Radix Saposhnikoviae) 9g, Danggui (Angelicae Sinensis Radix) 9g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Pao Jiang (Zingiberis Rhizoma Prepared) 4.5g, Baijiezi (Sinapis Semen) 9g, Sheng Shu Jinwen (Rhei Radix et Rhizoma Raw and Cooked) each 4.5g, Binglang (Arecae Semen) 9g, Heichou (Calabar Bean) 6g, Xingren Ni (Paste of Armeniacae Semen Amarum) 9g, Chao Ku Chishatang (Saccharum Rubrum Charred and Stir-fried) 9g.
Second visit: Two doses effective: thick/viscous quality thinned, frequency reduced; ineffective aspects: abdominal pain, tenesmus persist. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 9g, Yanhusuo (Corydalis Rhizoma) 9g, Hang Baishao (Radix Paeoniae Alba) 9g, Xingren Ni (Paste of Armeniacae Semen Amarum) 18g, Sheng Aye (Mugwort Folium Raw) 6g, Qing Fangfeng (Radix Saposhnikoviae) 6g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Chuan Huangbai (Phellodendri Chinensis Cortex) 4.5g, Chen Hongcha (Aged Black Tea) 9g. Additionally: Shanzha Tan mixed with Chishatang swallowed.
Third visit: Abdominal pain and tenesmus suddenly reduced. Condition improving, formula unchanged. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 6g, Xie Baiou (Allii Macrostemonis Bulbus) 9g, Sheng Aye (Mugwort Folium Raw) 4.5g, Hang Baishao (Radix Paeoniae Alba) 9g, Huangbai (Phellodendri Cortex) 9g, Fangfeng (Radix Saposhnikoviae) 6g, Xingren Ni (Paste of Armeniacae Semen Amarum) 12g, Shanzha Tan (Fructus Crataegi Charred) 12g, Chen Hongcha (Aged Black Tea) 9g. [Commentary] Initially, white dysentery treated as cold with Spleen-warming method. Second visit: Stool changed from thick to thin, frequency decreased, but pain/tenesmus persisted. Added Huangbai to clear damp-heat, Yanhusuo and Baishao to regulate Qi and relieve pain, heavy Xingren to descend Qi and guide stagnation, Hongcha and Aye to astringe intestines. Third visit: Condition greatly improved, maintaining previous method to prevent relapse.
22. Younger brother, surnamed Gu. Ancients said red dysentery is heat, white is cold; white relates to Qi, red to Blood. These views should not be rigidly applied. Fuzi used for red dysentery; Huanglian for white. Former relieves pain, latter reduces inflammation; rigid adherence prevents flexibility. Dahuang (Rhei Radix et Rhizoma Wine-fried) 9g, Pao Fuzi (Aconiti Lateralis Radix Praeparata) 6g, Danggui (Angelicae Sinensis Radix) 12g, Baishao (Radix Paeoniae Alba) 9g, Diyü (Sanguisorbae Radix) 9g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 3g, Xingren (Armeniacae Semen) 24g, Xianglian Wan (Xianglian Pill) 3g (taken in two doses). [Commentary] Formula modifies Wen Pi Tang from *Qianjin Fang*, removing Renshen and Gancao, using Jiang and Fu to stimulate Spleen Yang, Dahuang to purge accumulation, Xiang and Lian to clear heat and regulate Qi, Danggui, Baishao, and Diyü to harmonize and cool blood. Large dose of Xingren used for moving stagnation and descending rebellious Qi. Mr. Zhang’s dysentery treatment ignores ancient dogma, relying on clinical experience, inspiring future students.
23. Male patient, surnamed Yang. Dysentery like pus, no abdominal pain, no tenesmus. Previously effective with Wumei Wan, now ineffective. Switched to warming and astringing. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 9g, Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Hang Baishao (Radix Paeoniae Alba) 9g, Sheng Aye (Mugwort Folium Raw) 9g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 3g, Xuan Mugua (Chaenomelis Fructus) 9g, Chuan Huangbai (Phellodendri Chinensis Cortex) 4.5g, Hezi Rou (Terminalia Chebulae Fructus Flesh) 9g, Sheng Diyü (Sanguisorbae Radix) 9g, Shiliupi (Punicae Granati Pericarpium) 9g, Baijiangcao (Patriniae Herba) 12g. Additionally: Zanglian Wan (Zanglian Pill) 6g, morning and evening. Second visit: Pus-like dysentery turned to diarrhea, frequency greatly reduced, but undigested food present. Removed bitter-cold herbs from previous formula. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 9g, Roudoukou (Myristicae Semen) 4.5g, Wei Yizhiren (Alpiniae Oxyphyllae Fructus Baked) 9g, Pao Jiangtan (Zingiberis Rhizoma Carbonized) 4.5g, Sheng Cangzhu (Atractylodis Rhizoma Raw) 6g, Yun Fuling (Poria Cloud) 12g, Hezi Rou (Terminalia Chebulae Fructus Flesh) 9g, Baicaoshuang (Carbonized Fomes Officinalis Spores) 9g (wrapped).
[Commentary] Wumei Wan combines cold/warm, treats root/branch, calms roundworms and relieves pain. Modern use effective for biliary ascariasis; modified for chronic dysentery/colitis with cold-heat complex and deficiency. Patient previously responded to Wumei Wan, now does not. Switched to Wen Pi Tang (modified) with Hezi and Shiliupi to treat root, fearing pathogen retention, adding slight bitter-cold to clear intestines. Second visit: Changed to diarrhea, reduced frequency, undigested food. Removed bitter-cold "disease" treatment, focused on warming Spleen "person". Hezi and Shiliupi, traditionally astringents, have antibacterial properties. Mr. Zhang integrates modern medical knowledge, adapting to syndromes, avoiding rigid conventions.
24. Female patient, surnamed Yu. Dysentery recurs every autumn, same pattern this year. Relapsed, abdominal distension and tenesmus persist. This is Resting Dysentery (Chronic Dysentery). Elderly with weak pulse, purging is useless. Pao Fu ku (Aconiti Lateralis Radix Praeparata) 6g, Quan Danggui (Radix Angelicae Sinensis) 9g, Yanhusuo (Corydalis Rhizoma) 9g, Hainan Pian (Arecae Semen) 9g, Hang Baishao (Radix Paeoniae Alba) 12g, Chuan Lianzi (Meliosmae Fructus) 9g, Wan Can Sha (Bombyx Batryticatus) 9g (wrapped), Sheng Aye (Mugwort Folium Raw) 4.5g, Chen Hongcha (Aged Black Tea) 9g. [Commentary] Resting dysentery is chronic, intermittent, prolonged, usually deficiency with lingering pathogen. Elderly weak pulse precludes purging. Formula uses Pao Fuzi to warm True Yang, Danggui/Baishao to nourish Ying/Yin, Binglang to move stagnation, Yanhusuo/Chuan Lianzi to regulate Qi/blood and relieve pain, Can Sha/Chen Hongcha to remove dampness/astringe, Aye to dispel internal cold/regulate Qi and stop pain.
25. Male patient, surnamed Wang. Had dysentery 8 years ago, since then stool flat and unsmooth, suspected scar tissue intestinal stenosis. Now lower abdomen distended/hard, severe pain on pressure. Hainan Pian (Arecae Semen) 9g, Sheng Jijin (Galli Gigerii Endothelium Corneum Raw) 12g, Wulingzhi (Trogopteri Dung) 9g (wrapped), Chuan Lianzi (Meliosmae Fructus) 9g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Laifuzi (Radish Seed) 12g, Xiao Qingpi (Citri Reticulatae Pericarpium Viride) 9g, Shanzha Rou (Fructus Crataegii Flesh) 12g, Gumaicha (Hordei Fructus Germinatus and Maydis Fructus Germinatus) each 9g. Second visit: Full abdominal distension/hardness, painful on pressure, pain location不定 (uncertain), relief after passing gas. Suspected gas accumulation, causes varied. Stool black/viscous, scanty amount. Shu Jinwen (Rhei Radix et Rhizoma Cooked) 9g, Zhi Xiangfu (Cyperi Rhizoma Processed) 9g, Chuan Lianzi (Meliosmae Fructus) 9g, Peng Ezhu (Curcumae Rhizoma) 9g, Xiao Qingpi (Citri Reticulatae Pericarpium Viride) 9g, Xie Baiou (Allii Macrostemonis Bulbus) 12g, Kushen Pian (Sophorae Flavescentis Radix Slice) 9g, Laifuzi (Radish Seed) 12g, Shanzha Rou (Fructus Crataegii Flesh) 15g, Gumaicha (Hordei Fructus Germinatus and Maydis Fructus Germinatus) each 9g.