[按]此案殆为现代医学所称之中毒性消化不良。初诊用葛根、芩、连、白槿花清肠止泻，白芍、扁豆养阴和脾，银花炭、百草霜吸附肠内毒素，辅以荷叶升清。二诊小便滴沥，为泄泻失水太多，这在幼儿最为可虑，治疗应以补液固脱为首要。先生于此复杂病情，一方面用葛根芩连汤清肠止泻，并以葛根与芍药相伍生津，顾护阴液，一方面用五苓散通阳化气、渗利小便，可称两相兼顾之法。
2．李幼。平素人工营养，消化最易障碍。今便溏日十数行，色绿质粘。色绿当予葛根芩连汤，质粘当与痛泻要方。葛根9克，姜连1．2克，炒白芍12克，黄芩6克，陈皮6克，炒防风9克，焦白术12克，陈红茶6克。[按]便溏色绿为肠有热之象，质粘为消化不良挟有食滞，用葛根、芩、连清肠消炎，痛泻要方合陈红茶健脾消导。
3．冯幼。便有溏液而努责，一昼夜数十行。即此已非稚孩所能胜任，何况再见高热。马齿苋12克，白槿花12克，白归身9克，荠菜花9克，焦六曲9克，望江南9克，鲜菖蒲9克，黄柏炭5克，广玉金5克。[按]此为湿热泄泻，多发于夏秋，乃外感暑湿，内有积滞，致传化失常所致。方以清肠消滞并用。
4．王幼。发热与泄泻，为稚孩常见之症。其特点在拥抱时反惊惕啼哭，颈项亦有强直感，深虑病邪传人神经系统。①葛根9克，黄芩5克，姜川连1．2克，白芍药9克，炒枳实6克，干荷叶1角，银柴胡6克，川贝母5克，煅珍珠母24克，蝎尾1克(研末分2次冲服)，琥珀抱龙丸1粒(化服)。②香白芷9克，升麻6克，干蟾皮9克，赤石脂30克。共研末，用葱汁调敷脐部。
[按]小儿发热不退，神志异常，项强者应防惊风，故谓"深虑病邪传人神经系统"。其为热邪致泻，故用葛根芩连汤加枳实理气行滞，芍药缓急解痉，银柴胡、川贝清热化痰；复用琥珀抱龙丸、珍珠母、蝎尾清热镇痉熄风，防患于未然。此外更配合外治法治泻，可谓照顾周到。
5．王幼。泄泻次数虽不多，但经过1星期之久，四肢厥冷，已属严重，何况又见高热，而脉沉细。心力大衰，非温药不能拨乱反正。潞党参12克，生白术9克，炮姜炭3克，炮附块9克，炙甘草3克，扁豆衣9克，绿升麻3克，陈红茶6克，焦六曲9克，川连1．8克。[按]洞泄寒中，理中汤本为恰当之方。两脉沉细，肢厥，说明不仅脾阳虚，而且心阳、肾阳亦衰，故加附子之温振阳气。虽见高热，不以清热为法，盖阳虚乃其本质。此等症若误用大剂苦寒，可导致亡阳之危。
6．蒋幼。便溏3日，面黄而瘦，无表证，脾虚也。脾虚不能运化水谷，而消化为之不良。.黑防风5克，生白术9克，扁豆衣5克，焦六曲9克，鸡内金9克，陈皮5克，焦谷芽9克，薤白头5克，陈红茶5克。[按]脾主运化，故泄泻多责诸脾；面黄肌瘦，说明脾病已久。方用白术、扁豆健脾；建曲、谷芽、鸡内金消导；陈皮、薤白理气；防风升清，叶天士每喜用之以代柴胡。据其用药，此必脾虚而挟食滞者，善后可用异功散、参苓白术散之类。
7．沈幼。腹部触痛，便多白沫，此肠炎也。白头翁9克，北秦皮6克，白槿花9克，银花炭6克，枳实炭6克，山楂炭9克，神曲6克，荷叶1角，百草霜6克，红茶6克
[按]痢疾病人便中必有粘液脓血，且里急后重明显；今腹部触痛，表示肠的某一部分有炎症，便多白沫亦是结肠炎的特征。此病系湿热泄泻，故用苦寒清肠，佐以导滞。先生治泄痢喜用红茶为引。此物上清头目，下利湿热，且具收敛作用，确系妙品。白槿花为治痢单方，先生亦喜用之。
8．仇幼。稚孩消化不良，则小溲如米泔汁状，今上吐下泄是其候也。炮附片3克，姜半夏6克，海南片5克，吴萸2．4克，陈皮5克，青皮6克，地枯萝9克，山楂肉9克。[按]用附子温阳，半、萸降逆，余药理气消积，合为安中、止吐泻之剂。
9．钱弟。大便溏而色绿，古人以溏为脾虚，绿为肝热。所谓虚，所谓热，皆是用药之假定指标。(其人腰部胀而硬)生白术9克，制香附9克，香白芷6克，川雅连0．6克，北秦皮9克，生地榆9克，云苓9克，晚蚕沙9克(包)，白槿花9克，干荷叶1角。
10．沈幼。热一来复，作弛张型，腹中雷鸣时作，此为肠不吸收使然也。不吸收之先声，如消化不良，故须节食。荆芥穗5克，山楂肉9克，黄芩2；4克，炒防风5克，地枯萝9克，杭白芍9克，净蝉衣3克，枳实炭3克，广郁金3克，谷麦芽各9克，晚蚕沙9克(包)。
11．陈幼。排便有白粘液，日四五行，历60日不稍减。炮附块3克，焦白术9克，肉豆蔻2．4克，淮山药9克，吴茱萸1．8克，潞党参9克，木香槟榔丸5克(包)，破故纸6克，粉甘草3克。
二诊：其主症在腹之膨胀，其便有粘液，将毕，兼有赤冻。古人多因症施治，肠炎或阿米巴痢，而其方皆能适应。海南片6克，石榴皮6克，五谷虫6克，川楝子5克，苦参片2．4克，山楂肉9克，杭白芍6克，莱菔子5克，生鸡金5克，神曲9克。
12．庞幼。主症热而泄泻，其泄是水，苦以坚之。粉葛根12克，川连1．5克，赤苓9克，银花炭12克，淡黄芩6克，飞滑石12克，嫩白薇9克，荷叶1角。
二诊：药后，便反秘，腹隐痛。海南片6克，郁李仁3克，杭白芍6克，生枳实5克，糖炒山楂9克，熟锦纹3克，皂角子3克，晚蚕沙5克(包)，玉桔梗2．4克，香连丸2．4克(吞服)。
三诊：下五六行，无赤粘液，亦不后重。下之，前后腹皆隐痛。小茴香5克，生艾叶6克，熟锦纹5克，杭白芍12克，六曲9克，枳实炭6克，晚蚕沙9克(包)，香连丸5克(分2次吞)。
四诊：下三四行，下则肛为之脱，赤白粘液尚未尽除，此可通涩并进。锦纹5克，白芍12克，五味子3克，白槿花12克，生艾叶6克，乌梅9克，诃子肉9克，海南片6克，炒防风6克，炒枯赤砂糖12克。另：罂粟壳12克、五倍子15克、石榴皮15克、陈红茶，煎汤熏洗肛门。
五诊；大便次数减少，日一二行：下则肛脱如故，带白色粘液，再守原意，佐以益气。白芍12克，乌梅9克，五味子3克，补骨脂9克，诃子肉9克，海南片6克，炒谷芽12克，炒枯赤砂糖12克，炒苡仁12克，黄芪12克，甘草5克。
六诊：便泄日仍一二行，带有粘液少许，病情已尾声，予丸剂、参苓白术散、乌梅丸交替服。
13．黄弟。凡一切痢疾皆无呕吐，呕吐是中毒反射作用，古人有噤口之说。下之开始，迄于今兹，纯系白冻，颇类西籍所说之赤痢。因其有精神症状(其来也骤)，以下方治之。全当归12克，苦参片6克，石菖蒲9克，荠菜花12克，粉甘草3克，杭白芍9克，马齿苋12克，远志肉5克，杏仁泥12克。
二诊：察其便之情态，尚难定其真性赤痢。其所以神态迷蒙，目上视，手痉，饮食中毒也。黑丑3克，马齿苋9克，苦参片6克，山楂炭9克，锦纹6克，黄柏6克，荠菜花炭9克，银花炭6克，六神曲9克，地枯萝9克。
14．马幼。多食则多泄，其排泄物依旧是红白冻，此非痢。炮附片9克，土炒党参9克，粉甘草3克，炒防风9克，炮姜炭3克，生白术9克，川雅连1克。
15．陈幼。大便溏而腹痛，感寒兼伤食积。五谷虫6克，制黑丑2克，杭白芍5克，小青皮5克，百草霜9克(包)，炒防风5克，焦白术9克。[按]外感风寒，内伤食积，为痛泻之由来。方用痛泻要方、苏梗散风寒，和胃整肠，更用黑丑通下，推荡积滞。
16．韩幼。稚孩久泄，两目必盲，盖营养缺乏故也。今左目起星，右目亦不能睁，而其泻如故。生苍术30克，绵黄芪24克，潞党参18克，青葙子15克绿升麻9克，当归15克，枸杞子15克，牡蛎30克，谷精草12克，桑叶9克。共研细末，每次3克，日3次，开水吞服。
[按]《内经》有"五脏六腑之精气，皆上注于目"之说。而脾胃为后天之本、生化之源，久病泄泻，脾失健运，则精气不能上注于目。治用参、芪健脾益气；升麻升提清阳；苍术燥脾止泄。肝开窍于目，目病多责诸肝，故用枸杞、当归养肝阴；谷精草、青葙子、桑叶凉肝明目；牡蛎既可收敛止泻，又能固涩精气。其中苍术一味，现代药理实验证实其含丰富的维生素甲。此案左目起星，右目不能睁，殆为维生素甲缺乏引起的角膜软化症，用之颇为对症。
17．冯幼。稚孩吮乳期病痢者极少，其所以便溏而后重者，炎症波及直肠故也。枳实6克，香连丸1．5克，陈红茶2．4克，白槿花6克，荠菜花炭6克，焦六曲6克，杭白芍6克，苦桔梗3克。
二诊：据述临圃依然后重，后重总是直肠炎症未消。古人于此症无热者，多用归芍以和之。全当归6克，生白芍6克，苦桔梗6克，苦杏仁12克，荠菜花炭6克，白槿花6克，焦六曲6克，薤白头12克，粉甘草2．4克，炒枯赤砂糖9克。又：陈红茶、地榆各20克，煎汤熏洗肛门。
18．虞幼。大便溏如水，有属炎症者，有属肠失吸收者。惟炎症当见腹痛，而便有粘液或白沫，今非是。升麻2．4克，神曲6克，赤石脂6克，百草霜6克，苍术6克，山楂炭9克，禹余粮6克，荷叶1角。
19，徐幼。肠炎多能引起高热，四逆散、芩连汤是标本并治之法。另用炭类，制止发酵，吸收水分。咳加苏子、橘红。柴胡2．4克，枳实3克，黄芩5克，焦楂炭6克，白芍6克，甘草1．5克，香连丸3克，百草霜5克，苏子5克，橘红2．4克。
20．沈幼。便多白沫，为肠炎之的证。假使肠热病，其便当如浆汁而稀，按其腹痛，更为肠炎之表现。
白头翁6克，白槿花6克，枳实炭3克，神曲6克，百草霜3克，北秦皮6克，银花炭6克，山楂炭6克，荷叶1角，红茶3克。
21．叶幼。肠炎之热，多起伏无定，然则仲景之小柴胡汤，其适应证亦在消化系。柴胡3克，黄芩6克，神曲6克，百草霜5克，甘草1．5克，半夏3克，党参、苦参各6克，红茶3克，生姜1片。
22．叶幼。肠炎与痢，从形态上可以鉴别；腹痛为二者所共有。今便溏有泡沫，肠炎也。熟军3克，苏梗5克，神曲6克，香连丸3克，红茶5克，杭芍6克，青皮3克，艾叶3克，百草霜5克。
23．冯幼。热3日，暮重于昼，大便鹜溏，完谷不化，腹痛而胀，此肠病也；流清涕，则为外邪所乘。防风3克，陈皮2．4克，柴胡3克，麦芽9克，白术5克，白芍5克，枳实2．4克，天浆壳3克。
24．徐幼。大便清稀，日十余行，精神疲乏异常，终日迷迷然嗜睡，面白肢冷。附子5克，白术6克，党参6克，炮姜炭2．4克，清炙草3克，扁豆衣6克。[按]张景岳说："泄泻之本，莫不由于脾胃。"然临床有寒、热、虚、实之异，治各不同。泄泻病案中，有属于脾胃虚寒，用附子理中汤的；有脾虚而挟食滞，复为风邪所乘，用四逆散合痛泻要方的；有湿热滞于胃肠，用香连丸的。皆为常法。亦有虚实兼见而融温阳、健脾、消导于一炉的；也有涩肠药与消导药、升清药同用的。对于这些病例，先生打破常规，往往补泻寒热同用，值得我们很好地体会。
25．周幼。西医诊为细菌性痢疾，服药未效，今高热不退，非白头翁汤不能。白头翁9克，川黄柏5克，川雅连1．5克，北秦皮9克，苦桔梗6克，杭白芍9克，枳实炭9克，马齿苋9克，苦参片6克，白槿花12克，荠菜花9克。[按]痢疾见高热，多为里热炽盛，邪毒肆扰。白头翁汤直清里热；苦参、马齿苋、白槿花都有解毒清热作用；白芍、枳实同用大能止痛；荠菜花用以凉血。
26．王幼。测体温39．3℃，先泻粘液而赤，泻时攒眉苦目，可见其腹痛而努责。凡稚孩病痢，最能使正气衰沉。今见高热，而泪之缺少，脉之沉细，四肢之清冷，干呕，独头动摇，败象叠见，例属难瘥。全当归9克，杭白芍9克，陈阿胶18克，肉豆蔻5克，罂粟壳9克，川连2．4克，炮附块9克，潞党参9克，煅牡蛎30克(先煎)。
[按]病痢高热，一般均当凉血解毒。今脉沉细，肢冷，干呕，独头动摇，都为正气不支而出现的征象；此热正为一线孤阳，预示"阴阳离决"之危，清凉之品决非所宜。故急用参、附以回阳救脱；牡蛎、白芍、阿胶以敛阴；肉蔻、粟壳以收涩。正气得复，再思去邪，尚未为晚。况在温中少用黄连之苦寒，涩中采用当归之滑利，不徒为目下之痢疾腹痛投，亦为下一步去邪之计。
27．夏小。热与泻将及两月，腹部既不胀硬，则鉴别诊断在肺病与肠炎，病者虽咳，其外观不类结核，作肠炎论治。葛根9克，川连1．2克，干荷叶1角，白槿花9克(包)，黄芩6克，升麻3克，生地榆9克，北秦皮9克。
[Commentary] This case is likely equivalent to what modern medicine calls toxic indigestion. In the first consultation, Ge Gen (Puerariae Radix), Huang Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), and Bai Jin Hua (Hibisci Mutabilis Flos) were used to clear the intestines and stop diarrhea; Bai Shao (Paeoniae Radix Alba) and Bian Dou (Dolichoris Semen) were used to nourish yin and harmonize the spleen; Yin Hua Tan (Flos Lonicerae Carbonisatus) and Bai Cao Shuang (Carbonis Herba) were used to adsorb toxins in the intestines, assisted by He Ye (Nelumbinis Folium) to raise clear yang. In the second consultation, the patient experienced dribbling urination due to excessive fluid loss from diarrhea, which is most concerning in young children. The treatment should prioritize fluid replacement and securing collapse. Facing such a complex condition, Mr. Zhang一方面 (on one hand) used Gegen Qinlian Tang (Cinnamon Twig and Scutellaria Decoction) to clear the intestines and stop diarrhea, pairing Ge Gen with Shao Yao to generate fluids and protect yin fluids; on the other hand, he used Wuling San (Five-Ingredient Powder with Poria) to unblock yang, transform qi, and promote diuresis. This can be described as a method that balances both aspects.
2. Young Li. Normally artificially fed, digestion is prone to obstruction. Currently, stools are loose, occurring more than ten times a day, green in color and sticky in consistency. Green color warrants Gegen Qinlian Tang (Cinnamon Twig and Scutellaria Decoction); sticky consistency warrants Tongxie Yaofang (Painful Diarrhea Essential Formula). Ge Gen 9g, Jiang Lian (Ginger-processed Coptidis Rhizoma) 1.2g, Chao Bai Shao (Stir-fried Paeoniae Radix Alba) 12g, Huang Qin 6g, Chen Pi 6g, Chao Fang Feng (Stir-fried Saposhnikoviae Radix) 9g, Jiao Bai Zhu (Charred Atractylodis Macrocephalae Rhizoma) 12g, Chen Hong Cha (Aged Black Tea) 6g. [Commentary] Loose green stools indicate intestinal heat; sticky consistency indicates indigestion with food stagnation. Ge Gen, Huang Qin, and Lian clear intestinal inflammation; Tongxie Yaofang combined with Chen Hong Cha strengthens the spleen and aids digestion.
3. Young Feng. Stools contain thin liquid with straining during defecation, occurring dozens of times in twenty-four hours. This alone exceeds the capacity of a young child, let alone the presence of high fever. Chi Xin Ma (Portulacae Herba) 12g, Bai Jin Hua 12g, Gui Shen (Radix Angelicae Sinensis) 9g, Ji Cai Hua (Cardamineae Flos) 9g, Jiao Liu Qu (Charred Medicated Leaven) 9g, Wang Jiang Nan (Sophorae Flavescentis Semen) 9g, Xian Chang Pu (Fresh Acori Tatarinowii Rhizoma) 9g, Huang Bo Tan (Charred Phellodendri Cortex) 5g, Guang Yu Jin (Curcumae Radix) 5g. [Commentary] This is damp-heat diarrhea, common in summer and autumn, caused by external contraction of summerheat-dampness and internal food stagnation, leading to dysfunction of transportation and transformation. The formula combines clearing the intestines with eliminating stagnation.
4. Young Wang. Fever and diarrhea are common symptoms in children. The characteristic feature is startle crying when embraced, accompanied by stiffness in the neck. There is deep concern that the pathogen may invade the nervous system. ① Ge Gen 9g, Huang Qin 5g, Jiang Chuan Lian (Ginger-processed Coptidis Rhizoma) 1.2g, Bai Shao Yao 9g, Chao Zhi Shi (Stir-fried Aurantii Fructus Immaturus) 6g, Gan He Ye (Dried Nelumbinis Folium) 1 piece, Yin Chai Hu 6g, Chuan Bei Mu 5g, Duan Zhen Zhu Mu (Calcined Margarita Concha) 24g, Xie Wei (Scorpion Tail) 1g (powdered, taken in two doses by mixing with water), Hupo Baolong Wan (Amber Dragon-Soothing Pill) 1 pill (dissolved and taken). ② Xiang Bai Zhi 9g, Sheng Ma 6g, Gan Chan Pi (Dried Bufo Skin) 9g, Chi Shi Zhi 30g. All powdered, mixed with scallion juice and applied to the umbilicus.
[Commentary] Persistent fever, abnormal consciousness, and neck stiffness in children warrant prevention of convulsions ("Jing Feng"), hence the "deep concern about pathogen invasion into the nervous system." Since this is diarrhea caused by heat pathogens, Gegen Qinlian Tang is used with Zhi Shi to regulate qi and move stagnation, Shao Yao to relieve spasm, Yin Chai Hu and Chuan Bei Mu to clear heat and resolve phlegm. Hupo Baolong Wan, Zhen Zhu Mu, and Xie Wei are used again to clear heat, calm spasms, and extinguish wind, preventing complications proactively. Additionally, external therapy is combined for diarrhea, showing thorough care.
5. Young Wang. Although the frequency of diarrhea is not high, it has persisted for a week, with cold limbs, indicating a severe condition, especially given the high fever and deep, fine pulse. Heart qi is greatly depleted; only warming herbs can restore order. Lu Dang Shen 12g, Sheng Bai Zhu 9g, Pao Jiang Tan (Charred Zingiberis Rhizoma) 3g, Pao Fu Kuai (Processed Aconiti Lateralis Radix Praeparata) 9g, Zhi Gan Cao (Honey-processed Glycyrrhizae Radix et Rhizoma) 3g, Bian Dou Yi 9g, Lv Sheng Ma 3g, Chen Hong Cha 6g, Jiao Liu Qu 9g, Chuan Lian 1.8g. [Commentary] For severe cold-type diarrhea, Lizhong Tang (Regulate the Middle Decoction) is appropriate. Deep, fine pulses and cold limbs indicate not only spleen yang deficiency but also depletion of heart and kidney yang; thus, Fu Zi (Aconiti Lateralis Radix Praeparata) is added to warm and boost yang. Despite high fever, cooling methods are not used because yang deficiency is the root cause. Misusing large doses of bitter-cold herbs in such cases could lead to fatal yang collapse.
6. Young Jiang. Loose stools for 3 days, yellow complexion and emaciation, no exterior syndrome, indicating spleen deficiency. Spleen deficiency fails to transport and transform food and fluids, leading to poor digestion. Hei Fang Feng 5g, Sheng Bai Zhu 9g, Bian Dou Yi 5g, Jiao Liu Qu 9g, Ji Nei Jin 9g, Chen Pi 5g, Jiao Gu Ya 9g, Xie Bai Tou 5g, Chen Hong Cha 5g. [Commentary] The spleen governs transportation; thus, diarrhea is often attributed to the spleen. Yellow face and emaciation indicate long-standing spleen disease. The formula uses Bai Zhu and Bian Dou to strengthen the spleen; Jian Qu, Gu Ya, and Ji Nei Jin to aid digestion; Chen Pi and Xie Bai to regulate qi; Fang Feng to raise clear yang. Ye Tian-shi often preferred Fang Feng over Chai Hu. Based on the prescription, this is likely spleen deficiency with food stagnation. For recovery, Yigong San or Shenling Baizhu San could be used.
7. Young Shen. Abdominal tenderness on palpation, stools mostly white foam, indicating enteritis. Bai Tou Weng 9g, Bei Qin Pi 6g, Bai Jin Hua 9g, Yin Hua Tan 6g, Zhi Shi Tan 6g, Shan Zha Tan 9g, Shen Qu 6g, He Ye 1 piece, Bai Cao Shuang 6g, Hong Cha 6g.
[Commentary] Dysentery patients typically have mucus and pus/blood in stools with obvious tenesmus; abdominal tenderness here indicates inflammation in a part of the intestine, and white foam stools are characteristic of colitis. This is damp-heat diarrhea, so bitter-cold herbs are used to clear the intestines, assisted by stagnation-resolving herbs. Mr. Zhang likes using Hong Cha (Black Tea) as an guiding herb for treating diarrhea and dysentery. It clears the head and eyes above, promotes damp-heat elimination below, and has astringent properties, making it a wonderful agent. Bai Jin Hua is a single-herb remedy for dysentery, which Mr. Zhang also favors.
8. Young Qiu. Infantile indigestion leads to urine resembling rice washings; current vomiting and diarrhea are signs of this. Pao Fu Pian 3g, Jiang Ban Xia 6g, Hai Nan Pian (Arecae Semen) 5g, Wu Yu 2.4g, Chen Pi 5g, Qing Pi 6g, Di Ku Luo 9g, Shan Zha Rou 9g. [Commentary] Fu Zi warms yang; Ban Xia and Wu Yu descend rebellious qi; other herbs regulate qi and eliminate accumulation. Together, they form a formula to stabilize the middle, stop vomiting, and arrest diarrhea.
9. Brother Qian. Stools are loose and green. Ancients considered loose stools as spleen deficiency and green color as liver heat. These "deficiency" and "heat" are hypothetical indicators for medication. (The patient has a distended and hard lower back.) Sheng Bai Zhu 9g, Zhi Xiang Fu 9g, Xiang Bai Zhi 6g, Chuan Ya Lian 0.6g, Bei Qin Pi 9g, Sheng Di Yu 9g, Yun Ling 9g, Wan Can Sha 9g (wrapped), Bai Jin Hua 9g, Gan He Ye 1 piece.
10. Young Shen. Upon recurrence of fever, it presents as remittent type; borborygmus occurs frequently, caused by intestinal malabsorption. Malabsorption precedes symptoms like indigestion, so dietary restriction is necessary. Jing Jie Sui 5g, Shan Zha Rou 9g, Huang Qin 2.4g, Chao Fang Feng 5g, Di Ku Luo 9g, Hang Bai Shao 9g, Jing Chan Yi 3g, Zhi Shi Tan 3g, Guang Yu Jin 3g, Gu Mai Ya 9g each, Wan Can Sha 9g (wrapped).
11. Young Chen. Stools contain white mucus, 4-5 times daily, persisting for 60 days without reduction. Pao Fu Kuai 3g, Jiao Bai Zhu 9g, Rou Dou Kou 2.4g, Huai Shan Yao 9g, Wu Zhu Yu 1.8g, Lu Dang Shen 9g, Mu Lang Bin Lang Wan 5g (wrapped), Po Gu Zhi 6g, Fen Gan Cao 3g.
Second Consultation: Main symptoms are abdominal distension and mucus in stools, ending with red mucus ("Chi Dong"). Ancients treated based on symptoms; formulas adapt to both enteritis and amoebic dysentery. Hai Nan Pian 6g, Shi Liu Pi 6g, Wu Gu Chong 6g, Chuan Lian Zi 5g, Ku Shen Pian 2.4g, Shan Zha Rou 9g, Hang Bai Shao 6g, Lai Fu Zi 5g, Sheng Ji Jin 5g, Shen Qu 9g.
12. Young Pang. Main symptoms are fever and diarrhea; the diarrhea is watery. Bitter herbs firm and dry dampness. Fen Ge Gen 12g, Chuan Lian 1.5g, Chi Ling 9g, Yin Hua Tan 12g, Dan Huang Qin 6g, Fei Hua Shi 12g, Nen Bai Wei 9g, He Ye 1 piece.
Second Consultation: After medication, stool became constipated with dull abdominal pain. Hai Nan Pian 6g, Yu Li Ren 3g, Hang Bai Shao 6g, Sheng Zhi Shi 5g, Tang Chao Shan Zha 9g, Shu Jin Wen (Prepared Rheum Palmatum) 3g, Zao Jiao Zi 3g, Wan Can Sha 5g (wrapped), Yu Jie Geng 2.4g, Xiang Lian Wan 2.4g (swallowed).
Third Consultation: Defecated 5-6 times, no red mucus, no tenesmus. Dull pain in abdomen before and after defecation. Xiao Hui Xiang 5g, Sheng Ai Ye 6g, Shu Jin Wen 5g, Hang Bai Shao 12g, Liu Qu 9g, Zhi Shi Tan 6g, Wan Can Sha 9g (wrapped), Xiang Lian Wan 5g (taken in 2 doses).
Fourth Consultation: Defecated 3-4 times, rectal prolapse upon defecation, red and white mucus not fully cleared. Both purging and astringing can be used together. Jin Wen 5g, Bai Shao 12g, Wu Wei Zi 3g, Bai Jin Hua 12g, Sheng Ai Ye 6g, Wu Mei 9g, He Zi Rou 9g, Hai Nan Pian 6g, Chao Fang Feng 6g, Chao Ku Chi Sha Tang 12g. Additionally: Ying Su Ke 12g, Wu Bei Zi 15g, Shi Liu Pi 15g, Chen Hong Cha, decocted for fumigation and washing of the anus.
Fifth Consultation: Defecation frequency reduced to 1-2 times daily; rectal prolapse persists with white mucus. Continue original strategy, assisting with qi-tonifying herbs. Bai Shao 12g, Wu Mei 9g, Wu Wei Zi 3g, Bu Gu Zhi 9g, He Zi Rou 9g, Hai Nan Pian 6g, Chao Gu Ya 12g, Chao Ku Chi Sha Tang 12g, Chao Yi Yi Ren 12g, Huang Qi 12g, Gan Cao 5g.
Sixth Consultation: Diarrhea continues at 1-2 times daily with slight mucus; condition is nearing resolution. Prescribe pills, Shenling Baizhu San, and Wu Mei Wan alternately.
13. Brother Huang. All dysentery cases typically lack vomiting; vomiting is a toxic reflex action. Ancients referred to this as "Jinkou Li" (Throat-Closed Dysentery). From the initial purging treatment until now, stools are purely white mucus, resembling Western descriptions of bacillary dysentery. Due to mental symptoms (sudden onset), the following formula is used. Quan Dang Gui 12g, Ku Shen Pian 6g, Shi Chang Pu 9g, Ji Cai Hua 12g, Fen Gan Cao 3g, Hang Bai Shao 9g, Chi Xin Ma 12g, Yuan Zhi Rou 5g, Xing Ren Ni 12g.
Second Consultation: Observing the stool characteristics, true bacillary dysentery is hard to confirm. Mental confusion, upward gaze, and hand spasms suggest food poisoning. Hei Chou 3g, Chi Xin Ma 9g, Ku Shen Pian 6g, Shan Zha Tan 9g, Jin Wen 6g, Huang Bo 6g, Ji Cai Hua Tan 9g, Yin Hua Tan 6g, Liu Shen Qu 9g, Di Ku Luo 9g.
14. Young Ma. Overeating leads to frequent diarrhea; excreta remain red and white mucus-like, but this is not dysentery. Pao Fu Pian 9g, Tu Chao Dang Shen 9g, Fen Gan Cao 3g, Chao Fang Feng 9g, Pao Jiang Tan 3g, Sheng Bai Zhu 9g, Chuan Ya Lian 1g.
15. Young Chen. Loose stools with abdominal pain, caused by cold invasion and food stagnation. Wu Gu Chong 6g, Zhi Hei Chou 2g, Hang Bai Shao 5g, Xiao Qing Pi 5g, Bai Cao Shuang 9g (wrapped), Chao Fang Feng 5g, Jiao Bai Zhu 9g. [Commentary] External cold-wind and internal food stagnation cause painful diarrhea. The formula uses Tongxie Yaofang and Su Geng to dispel cold-wind, harmonize the stomach, and regulate the intestines; Hei Chou is used to purge and expel stagnation.
16. Young Han. Chronic diarrhea in infants leads to blindness due to nutritional deficiency. Now, star-shaped opacities appear in the left eye, and the right eye cannot open, while diarrhea persists. Sheng Cang Zhu 30g, Mian Huang Qi 24g, Lu Dang Shen 18g, Qing Yang Zi 15g, Lv Sheng Ma 9g, Dang Gui 15g, Gou Qi Zi 15g, Mu Li 30g, Gu Jing Cao 12g, Sang Ye 9g. All powdered finely, 3g per dose, 3 times daily, taken with boiled water.
[Commentary] The *Neijing* states: "The essence of all zang and fu organs ascends to the eyes." The spleen and stomach are the foundation of acquired constitution and source of production/transformation. Chronic diarrhea impairs spleen function, preventing essence from ascending to the eyes. Treatment uses Ren Shen and Huang Qi to tonify spleen qi; Sheng Ma to raise clear yang; Cang Zhu to dry spleen and stop diarrhea. The liver opens into the eyes; eye diseases are often attributed to the liver. Thus, Gou Qi Zi and Dang Gui nourish liver yin; Gu Jing Cao, Qing Yang Zi, and Sang Ye cool the liver and brighten the eyes; Mu Li astringes diarrhea and consolidates essence. Cang Zhu contains abundant Vitamin A according to modern pharmacology. The symptoms suggest vitamin A deficiency-induced keratomalacia, making Cang Zhu highly appropriate.
17. Young Feng. Dysentery during breastfeeding is rare; loose stools with tenesmus result from inflammation involving the rectum. Zhi Shi 6g, Xiang Lian Wan 1.5g, Chen Hong Cha 2.4g, Bai Jin Hua 6g, Ji Cai Hua Tan 6g, Jiao Liu Qu 6g, Hang Bai Shao 6g, Ku Jie Geng 3g.
Second Consultation: Tenesmus persists after defecation, always indicating unresolved rectal inflammation. In non-heat cases, ancients often used Dang Gui and Bai Shao to harmonize. Quan Dang Gui 6g, Sheng Bai Shao 6g, Ku Jie Geng 6g, Ku Xing Ren 12g, Ji Cai Hua Tan 6g, Bai Jin Hua 6g, Jiao Liu Qu 6g, Xie Bai Tou 12g, Fen Gan Cao 2.4g, Chao Ku Chi Sha Tang 9g. Also: Chen Hong Cha and Di Yu 20g each, decocted for fumigation and washing of the anus.
18. Young Yu. Watery loose stools may stem from inflammation or intestinal malabsorption. Inflammation presents with abdominal pain and mucus/white foam; this case does not. Sheng Ma 2.4g, Shen Qu 6g, Chi Shi Zhi 6g, Bai Cao Shuang 6g, Cang Zhu 6g, Shan Zha Tan 9g, Yu Yu Liang 6g, He Ye 1 piece.
19. Young Xu. Enteritis often causes high fever; Six Reversals Powder (Sini San) and Qinlian Tang treat both root and branch. Charcoal agents are used separately to inhibit fermentation and absorb moisture. Add Zi Su Zi and Ju Hong for cough. Chai Hu 2.4g, Zhi Shi 3g, Huang Qin 5g, Jiao Zha Tan 6g, Bai Shao 6g, Gan Cao 1.5g, Xiang Lian Wan 3g, Bai Cao Shuang 5g, Zi Su Zi 5g, Ju Hong 2.4g.
20. Young Shen. White foam stools are a definitive sign of enteritis. If it were intestinal heat disease, stools would be watery like slurry; abdominal pain on pressure further confirms enteritis.
Bai Tou Weng 6g, Bai Jin Hua 6g, Zhi Shi Tan 3g, Shen Qu 6g, Bai Cao Shuang 3g, Bei Qin Pi 6g, Yin Hua Tan 6g, Shan Zha Tan 6g, He Ye 1 piece, Hong Cha 3g.
21. Young Ye. Enteritis fever fluctuates irregularly. However, Zhongjing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) is also indicated for digestive disorders. Chai Hu 3g, Huang Qin 6g, Shen Qu 6g, Bai Cao Shuang 5g, Gan Cao 1.5g, Ban Xia 3g, Dang Shen and Ku Shen 6g each, Hong Cha 3g, Sheng Jiang 1 slice.
22. Young Ye. Enteritis and dysentery can be distinguished morphologically; abdominal pain is common to both. Loose stools with foam indicate enteritis. Shu Jun (Prepared Rheum) 3g, Su Geng 5g, Shen Qu 6g, Xiang Lian Wan 3g, Hong Cha 5g, Hang Shao 6g, Qing Pi 3g, Ai Ye 3g, Bai Cao Shuang 5g.
23. Young Feng. Fever for 3 days, worse in evening than day, duck-like loose stools with undigested food, abdominal pain and distension, indicating intestinal disease; clear nasal discharge suggests external pathogen invasion. Fang Feng 3g, Chen Pi 2.4g, Chai Hu 3g, Mai Ya 9g, Bai Zhu 5g, Bai Shao 5g, Zhi Shi 2.4g, Tian Jiang Qiao 3g.
24. Young Xu. Clear, watery stools, more than ten times daily, extreme fatigue, drowsiness, pale face, and cold limbs. Fu Zi 5g, Bai Zhu 6g, Dang Shen 6g, Pao Jiang Tan 2.4g, Qing Zhi Gan Cao 3g, Bian Dou Yi 6g. [Commentary] Zhang Jing-yue said: "The root of diarrhea lies in the spleen and stomach." Clinically, there are differences in cold, heat, deficiency, and excess, requiring different treatments. Cases include spleen-stomach cold-deficiency treated with Fuzi Lizhong Tang; spleen deficiency with food stagnation and wind invasion treated with Sini San combined with Tongxie Yaofang; and damp-heat stagnation in stomach/intestines treated with Xianglian Wan. These are standard methods. Some cases combine tonification, purging, warming, and cooling. Mr. Zhang breaks conventions, often combining these approaches, which deserves careful study.
25. Young Zhou. Diagnosed with bacterial dysentery by Western medicine; medication ineffective. Persistent high fever requires Bitongwang Tang. Bai Tou Weng 9g, Chuan Huang Bo 5g, Chuan Ya Lian 1.5g, Bei Qin Pi 9g, Ku Jie Geng 6g, Hang Bai Shao 9g, Zhi Shi Tan 9g, Chi Xin Ma 9g, Ku Shen Pian 6g, Bai Jin Hua 12g, Ji Cai Hua 9g. [Commentary] High fever in dysentery indicates intense interior heat and rampant toxin. Bitongwang Tang directly clears interior heat; Ku Shen, Chi Xin Ma, and Bai Jin Hua detoxify and clear heat; Bai Shao and Zhi Shi together effectively relieve pain; Ji Cai Hua cools blood.
26. Young Wang. Temperature 39.3°C. Initial passage of bloody mucus, with grimacing and distress during defecation, indicating abdominal pain and straining. Dysentery in children severely depletes healthy qi. Current high fever, scant tears, deep/fine pulse, cold limbs, dry retching, and isolated head tremor indicate multiple signs of collapse, suggesting a difficult prognosis. Quan Dang Gui 9g, Hang Bai Shao 9g, Chen E Jiao 18g, Rou Dou Kou 5g, Ying Su Ke 9g, Chuan Lian 2.4g, Pao Fu Kuai 9g, Lu Dang Shen 9g, Duan Mu Li 30g (decocted first).
[Commentary] High fever in dysentery usually warrants cooling blood and detoxifying. However, deep/fine pulse, cold limbs, dry retching, and head tremor indicate failing healthy qi; this heat represents a lone strand of yang, presaging "separation of yin and yang." Cooling herbs are inappropriate. Therefore, Ren Shen and Fu Zi are urgently used to rescue yang from collapse; Mu Li, Bai Shao, and E Jiao to consolidate yin; Rou Kou and Ying Su Ke to astringe. Once healthy qi recovers, eliminating pathogens can be considered. Using small amounts of bitter-cold Lian in warming formulas, and slippery Dang Gui in astringent formulas, serves not only immediate symptom relief but also prepares for subsequent pathogen elimination.
27. Young Xia. Fever and diarrhea approaching two months. Abdomen is neither distended nor hard; differential diagnosis lies between lung disease and enteritis. Although coughing, appearance does not resemble tuberculosis; treated as enteritis. Ge Gen 9g, Chuan Lian 1.2g, Gan He Ye 1 piece, Bai Jin Hua 9g (wrapped), Huang Qin 6g, Sheng Ma 3g, Sheng Di Yu 9g, Bei Qin Pi 9g.