经曰∶诸下痢，皆属于湿。又曰∶下痢稠粘，皆属于火。又曰∶下痢脓血滞下，皆实热证也。
受病之源，虽云夏感酷热，过食生冷，至秋阳气始收，金气下降而成。如冬月患者亦多，莫不因于
饮食致伤，留积肠胃，湿蒸热瘀。干于气分则白，干于血分则赤。及如尘腐屋漏、豆汁鱼脑色，里
急后重，窘迫不通，腹中绞痛者，皆属实热。不俱日数，必以苦寒药治之。医家畏缩迁延，甚至所
下纯血，兼紫血块，虽见日色、暖气、人来近皆畏，为热。渐至肛门红肿，大便不通，小便短赤，
大渴舌苔，引饮不止，腹中大痛，饮食不进。至于腰脊两旁，肾涸成窟，舌黑皱卷，前阴干缩，肛
门火逼，干吊如孔，积全不下，茶汤过多，秽水直出（有医认为大孔如竹筒，误用人参、附子杀人者
，悲痛之极，）初则烦躁，至此神昏。细察病情真确，此际仍可以主方服之。如得脏腑犹未煎熬腐坏
者，十救七、八。一服积下，顷刻回生。脉滑而沉细，身凉易安；脉洪而弦数，身热难治。又有寒
凉太过，而成大孔如竹筒者，宜固涩之。必因日久而成元气下
陷、虚坐努责，宜养血升提。有失于通导，多成休息痢，经年累月有致不起者。治法，调气则后重
自除，和血则便脓自愈。忌腥酒易安。
主方 （不拘日数） 大黄（壮人五钱，一服可安；弱人二、三钱；小儿一钱至五分量用）
黄连 黄芩（条。各二钱） 芍药（二钱） 当归 枳壳 槟榔（各一钱） 桂（二分，为寒药
之向导）
水一钟半，煎数沸去渣，化入芒硝一钱，虚人五分，磨入木香七分，调滑石（水飞，一钱），空心
热服。未畅，加黑丑一钱，车前草捣汁半杯尤妙。或以大黄、芒硝、木香、滑石另丸，药汁吞服。
香连化滞汤 痢已通畅，积未尽宜服。
黄连 黄芩（条） 当归 白芍（各一钱） 槟榔 木香（另磨） 枳实 浓朴 陈皮 青皮（
各八分） 滑石（一钱五分） 甘草（五分）
上锉，水煎成，调木香、滑石，空心热服。小便短赤加石莲、车前、香薷；不食加砂仁、神曲
、麦芽；血痢加生地、桃仁；腹痛加赤芍、倍白芍、甘草；腹胀痛加三棱、蓬术；血不止加地榆；
如积通痛止，频频空解，名虚坐努责。倍当、芍，加升麻。积尽不实，加白术、茯苓、山药、砂仁。
香连丸 治赤白、休息诸痢，已通后皆可服（黄连仍同萸炒至萸焦，去萸用连。）
川黄连（四两，切断） 吴茱萸（二两，煎汁一碗，煮黄连，干炒） 木香（八钱）
上为末，醋糊和丸绿豆大。每服百丸，空心米汤下。去木香，加白芍（二两，名戊己丸。）
驻车丸 治冷热不调，下痢，无问新久赤白，日夜无度，腹痛后重。
黄连（六两，酒炒） 阿胶（蛤粉炒成珠） 当归（酒洗） 干姜（炒。各三两）
上为细末，醋煮米糊为丸，如桐子大。每服五十丸，加至七十丸，空心米饮送下。一方就用阿
胶，醋熬化，调和为丸。
真人养脏汤 治痢积已通，日久不止，大孔如竹筒，滑脱不禁。
人参 白术 当归 白芍（酒炒） 肉果（面裹煨） 罂粟壳 诃子肉（各一钱） 木香（另
磨，七分） 肉桂 甘草（炙。各四分）次服加升麻；小便涩加茯苓；不止，龙骨、赤石脂、乌梅
、樗根皮（臭椿）；虚寒，焦姜、砂仁、丁香。
白术调中丸 治脾胃不和，心下坚满，胁腹胀痛，噫宿腐气，霍乱吐泻，完谷不化，久痢
赤白、脓血相杂，多日羸瘦不食。
白术 神曲（炒，四钱） 人参 茯苓 猪苓 泽泻（各三钱） 木香（二钱） 官桂（一钱
五分） 甘草（炙） 干姜（炮。各一钱）
上为末，面糊丸如桐子大。每服五、七十丸，空心淡姜汤下。
外炙膏 治一切虚寒久痢赤白，或时腹痛，肠滑不禁，用此法。
木香 附子（炮） 蛇床子 吴茱萸 胡椒 川乌（各等分）
上为细末，每三钱和面二钱，用生姜汁调，作饼贴脐中，上以油纸掩定，复以衣服、帛盖之，
以熨斗盛火熨之，痢止为度。
乌梅丸 治夏秋腹痛泄泻、后重，将欲成痢疾。或痢已通，后犹有余积，腹中鸣痛，胸
满腹胀，心疼、痔血等证，神效。
乌梅（取肉，一斤） 半夏（研） 生姜（切。各五两） 食盐（二两，同入臼捣匀，入坛包
固。春五、夏三、秋七、冬十日取出，晒燥）神曲 麦芽（各二两半） 木香 槟榔 陈皮 青皮
枳壳 三棱 蓬术（各一两）
上为细末，水丸如桐子大。每服百丸，空心姜汤下。
六一散（方见暑门）灯心汤调，多服效。痢前渴，悉尼妙；后渴，乌梅汤。
简便方 痢初起，腹大痛，后重不通，用大黄五钱，好酒一钟，浸半日，煎数沸滤服。渣
水煎，未通再服。已通，再以条黄芩、白芍煎服。
又（久滑不禁）痢后不止，日夜无度。粟壳（蜜炒）、浓朴（姜炒）等分为末，每服二钱，米
汤下。
又方（不止） 臭椿根（白皮，略炒）
上为末，糊丸如桐子大，每五十丸米汤下。
又方（血痢） 黄连（三钱） 乌梅（五个）水煎服。
又 黄连（一钱） 干姜（五分，）煎服。
又 艾叶，醋煎服。或加生姜止泻痢，心腹痛，五痔血。
又 柏叶（四两） 芍药（两半为末）每二钱，水煎服。
又 木耳（烧灰，二钱）水服，或姜、醋煮食。
又 枳实末（二钱）米汤下，小儿尤效。
又 生姜、细茶煎服。
又 红菜头绞汁服（又止血生肌，人畜伤，敷之。）
又 马齿苋煮粥，食。
又 紫苏（四钱） 防风（二钱）煎汁，调白蜜（四两）服。
又 鸡子，醋煮食。
三方止久滑痢，石榴捣汁饮。（或以皮晒，研末，枣肉丸服。）
又 五倍子、枯矾研，丸服。
又 诃子（十二个取肉，六个煨热，六个生用。）研末。赤痢，生甘草、白炙草煎汤下。
又方（日久津液枯，四肢冷）用冬瓜一枚，以黄泥五寸，煨熟去土，绞汁服。
又方（如痢大渴） 悉尼数个，去皮、心吃，捣汁顿温饮尤妙。
又 葱一握切，和米煮食。
又 蒜捣烂，贴两足心亦可。
又 百草霜（二钱，）研，米汤下。
又 赤小豆煮粥食亦可。
又方 （治噤口痢） 石莲子去壳，取肉微炒，研末，二钱，陈米汤下。
又 石莲末、香连丸（各一钱同服。）
又 木鳖子（研、） 雄黄少许，贴脐中。
又 山药锉碎，一半砂锅煮，一半生，同为末。每三钱，米汤下。
又 人参二钱，黄连一钱，石菖蒲八分，石莲肉二钱。上锉碎，煎，终日慢服，一口下即食。
又 取向东壁土炒陈皮，共为末。每服一钱，姜、枣汤下。
又 红槿花阴干为末。先用面饼二个，末掺上食，先汤灌，开胃口。
The *Yellow Emperor's Inner Canon* states: All types of dysentery are attributed to dampness. It further states: Dysentery with thick and sticky discharge is attributed to fire. It also states: Dysentery with pus and blood, accompanied by tenesmus (里急后重), belongs to excess-heat syndromes.
The source of the disease, although said to arise from summer heat exposure or excessive consumption of cold/raw foods, manifests in autumn when Yang Qi begins to收敛 (contract) and Metal Qi (Lung Qi) descends. However, many cases occur in winter, invariably caused by dietary injury leading to accumulation in the intestines and stomach, where dampness steams and heat stagnates. If the pathogen affects the Qi level, white mucus is discharged; if it affects the Blood level, red blood is discharged. Discharges resembling dust, leaking rotting roofs, bean juice, or fish brains, combined with tenesmus, urgency, obstruction, and severe abdominal colic, all indicate excess-heat syndromes. Regardless of the duration of illness, bitter-cold herbs must be used for treatment. If physicians hesitate or delay treatment, patients may pass pure blood mixed with purple clots. They may fear sunlight, warmth, or even human proximity due to intense heat toxicity. Symptoms may progress to swollen and red anus, constipation, scanty dark urine, extreme thirst with abnormal tongue coating, incessant drinking, severe abdominal pain, and inability to eat. Eventually, the kidneys may become depleted ("hollowed out"), the tongue black, wrinkled, and curled, the external genitalia dry and shrunken, the anus feeling as if burned and tightly constricted like a hole, with complete retention of fecal matter despite excessive intake of fluids, resulting only in the passage of foul water. (Some physicians mistakenly treated "anus like a bamboo tube" with Ren Shen [Ginseng] and Fu Zi [Aconite], causing death, which is deeply tragic.) Initially, there is restlessness; at this stage, consciousness may be clouded. Upon careful examination confirming the diagnosis, the main formula can still be administered. If the Zang-Fu organs have not yet been cauterized and rotted by heat, seven or eight out of ten patients can be saved. One dose expelling the accumulation can bring about immediate recovery. A slippery and deep-thin pulse with a cool body indicates ease of cure; a surging, wiry, and rapid pulse with fever indicates difficulty in treatment. Conversely, excessive use of cold-cooling herbs may lead to "anus like a bamboo tube" (incontinence), requiring astringent therapy. Chronic cases often result in sinking of Yuan Qi (Primordial Qi) and Xu Zuo Nu Ze (straining with empty stool sensation), requiring nourishment of Blood and lifting of Qi. Failure to unblock accumulation early often leads to Xiu Xi Li (resting dysentery/chronic intermittent dysentery), which can be fatal over years. The treatment principle is: regulating Qi eliminates tenesmus; harmonizing Blood heals pus in stool. Avoid greasy foods and alcohol for easier recovery.
Main Formula (regardless of duration): Da Huang (Rhubarb Root and Rhizome) – 5 qian for robust adults (one dose stabilizes); 2-3 qian for weak adults; 1-0.5 qian for children. Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root, specifically Tiao Qin) – 2 qian each. Shao Yao (Peony Root) – 2 qian. Dang Gui (Angelica Sinensis Root). Zhi Ke (Bitter Orange Fruit). Bing Lang (Areca Seed) – 1 qian each. Gui Zhi (Cinnamon Twig) – 2 fen (acts as a guide for cold herbs). Add 1.5 zhong of water, boil briefly, strain, dissolve Mang Xiao (Mirabilite) – 1 qian (0.5 qian for deficient persons). Grind Mu Xiang (Aucklandia Root) – 7 fen. Mix Hua Shi (Talcum Powder, water-flown) – 1 qian. Take hot on an empty stomach. If defecation is not smooth, add Hei Qiu (Morning Glory Seed) – 1 qian; Che Qian Cao (Plantago Leaf/Stem) juice – half cup is excellent. Alternatively, make pills of Da Huang, Mang Xiao, Mu Xiang, and Hua Shi, and swallow with the decoction.
Xiang Lian Hua Zhi Tang (Fragrant Coptis Stagnation-Resolving Decoction): Suitable after dysentery has opened up but accumulation remains. Huang Lian, Huang Qin (Tiao Qin), Dang Gui, Bai Shao (White Peony Root) – 1 qian each. Bing Lang, Mu Xiang (grind separately), Zhi Shi (Immature Bitter Orange), Nong Po (Magnolia Bark), Chen Pi (Aged Tangerine Peel), Qing Pi (Green Tangerine Peel) – 0.8 qian each. Hua Shi – 1.5 qian. Gan Cao (Licorice Root) – 0.5 qian. Decoct, mix in Mu Xiang and Hua Shi, take hot on an empty stomach. For scanty dark urine, add Shi Lian (Stone Lotus Seed), Che Qian, Xiang Ru (Elsholtzia). For poor appetite, add Sha Ren (Amomum Fruit), Shen Qu (Medicated Leaven), Mai Ya (Malt). For bloody dysentery, add Sheng Di (Rehmannia Root), Tao Ren (Peach Seed). For abdominal pain, add Chi Shao (Red Peony Root), double Bai Shao, and Gan Cao. For abdominal distension and pain, add San Leng (Burreed Tuber), Peng Zhu (Curcuma Zedoaria Rhizome). For persistent bleeding, add Di Yu (Sanguisorba Root). If accumulation is cleared and pain stops, but frequent empty straining occurs (Xu Zuo Nu Ze), double Dang Gui and Shao Yao, add Sheng Ma (Cimicifuga Rhizome). If accumulation is gone but deficiency persists, add Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Shan Yao (Dioscorea Rhizome), Sha Ren.
Xiang Lian Wan (Fragrant Coptis Pill): Treats red-white dysentery and resting dysentery; usable after accumulation is cleared. Huang Lian is stir-fried with Wu Zhu Yu (Evodia Fruit) until Wu Zhu Yu is charred, then remove Wu Zhu Yu and use only Huang Lian. Chuan Huang Lian – 4 liang (cut into pieces). Wu Zhu Yu – 2 liang (decoct in one bowl of water, boil Huang Lian, then dry-fry). Mu Xiang – 8 qian. Grind into powder, mix with vinegar paste to form pills the size of mung beans. Take 100 pills per dose with rice soup on an empty stomach. Remove Mu Xiang and add Bai Shao (2 liang) to create Wu Ji Wan.
Zhu Che Wan (Chariot-Stopping Pill): Treats dysentery due to cold-heat disharmony, regardless of new/old or red/white nature, occurring day and night without limit, with abdominal pain and tenesmus. Huang Lian – 6 liang (wine-fried). E Jiao (Donkey-Hide Gelatin) (fried with clam powder into pearls). Dang Gui (wine-washed). Gan Jiang (Dried Ginger) (fried) – 3 liang each. Grind into fine powder, use vinegar-boiled rice paste to form pills the size of paulownia seeds. Take 50 pills per dose, increasing to 70, with rice drink on an empty stomach. Another method: melt E Jiao in vinegar, mix to form pills.
Zhen Ren Yang Zang Tang (True Man Nourishing the Viscera Decoction): Treats dysentery where accumulation is cleared but diarrhea persists for a long time, with "anus like a bamboo tube" and incontinence. Ren Shen (Ginseng Root), Bai Zhu, Dang Gui, Bai Shao (wine-fried), Rou Guo (Nutmeg, baked in flour), Ying Su Ke (Poppy Capsule), He Zi Rou (Chebula Fruit Flesh) – 1 qian each. Mu Xiang (grind separately) – 7 fen. Rou Gui (Cinnamon Bark), Gan Cao (Honey-fried Licorice) – 4 fen each. In subsequent doses, add Sheng Ma. For astringent urine, add Fu Ling. If still not stopping, add Long Gu (Fossilized Bones), Chi Shi Zhi (Halloysitum Rubrum), Wu Mei (Mume Fruit), Chu Gen Pi (Toona Root Bark). For deficiency-cold, add Jiao Jiang (Charred Ginger), Sha Ren, Ding Xiang (Clove).
Bai Zhu Tiao Zhong Wan (Atractylodes Harmonizing the Middle Pill): Treats spleen-stomach disharmony, fullness/hardness below the heart, hypochondriac/abdominal distension and pain, belching of stale/foul gas, cholera-like vomiting/diarrhea, undigested food in stool, chronic red-white dysentery with pus/blood, emaciation, and anorexia after many days. Bai Zhu, Shen Qu (medicated leaven, fried, 4 qian), Ren Shen, Fu Ling, Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome) – 3 qian each. Mu Xiang – 2 qian. Guan Gui (Cinnamon Bark) – 1.5 qian. Gan Cao (fried), Gan Jiang (Pounded Dried Ginger) – 1 qian each. Grind into powder, form pills with flour paste the size of paulownia seeds. Take 50-70 pills per dose with light ginger soup on an empty stomach.
Wai Zhi Gao (External Moxibustion Paste): Treats all deficiency-cold chronic red-white dysentery, occasional abdominal pain, and intestinal incontinence. Mu Xiang, Fu Zi (Prepared Aconite Root), She Chuang Zi (Cnidium Fruit), Wu Zhu Yu, Hu Jiao (Black Pepper), Chuan Wu (Sichuan Aconite Root) – equal parts. Grind into fine powder. Mix 3 qian powder with 2 qian flour, adjust with fresh ginger juice to make cakes. Apply to the umbilicus, cover with oiled paper, then cloth/garment. Heat with a moxibustion iron containing fire until dysentery stops.
Wu Mei Wan (Mume Pill): Treats abdominal pain, diarrhea, and tenesmus in summer/autumn preceding dysentery formation. Or treats residual accumulation after dysentery opens, with borborygmus, abdominal pain, chest/fullness, abdominal distension, heart pain, hemorrhoids, etc. Extremely effective. Wu Mei (flesh, 1 jin). Ban Xia (Pinellia Tuber, ground). Sheng Jiang (Fresh Ginger, sliced) – 5 liang each. Shi Yan (Salt, 2 liang, pounded together, sealed in jar. Spring: 5 days; Summer: 3 days; Autumn: 7 days; Winter: 10 days, then take out and dry). Shen Qu, Mai Ya (Malt) – 2.5 liang each. Mu Xiang, Bing Lang, Chen Pi, Qing Pi, Zhi Ke, San Leng, Peng Zhu – 1 liang each. Grind into powder, form water pills the size of paulownia seeds. Take 100 pills per dose with ginger soup on an empty stomach.
Liu Yi San (Six-to-One Powder) (see Summer Chapter): Take with Deng Xin Tang (Juncus Decoction); multiple doses are effective. Thirst before dysentery: Xi Ni (specific herb/local remedy) is good; thirst after dysentery: Wu Mei Tang (Mume Decoction).
Simple Prescriptions:
For early dysentery with severe abdominal pain and tenesmus: Soak Da Huang (5 qian) in good wine (1 zhong) for half a day, boil briefly, filter, and drink. Boil residue again; if not relieved, take again. Once relieved, decojie Tiao Huang Qin (Scutellaria) and Bai Shao.
For chronic incontinence: After dysentery persists day and night, equal parts Mi Chao Yu Lu Ke (Honey-fried Poppy Shell) and Jiang Chao Nong Po (Ginger-fried Magnolia Bark), grind to powder. Take 2 qian with rice soup.
Another prescription for persistence: Chou Chun Gen (Toona Root Bark, white skin, lightly fried), grind to powder, form pills with paste the size of paulownia seeds. Take 50 pills with rice soup.
For bloody dysentery: Huang Lian (3 qian), Wu Mei (5 fruits), decoct in water.
Another: Huang Lian (1 qian), Gan Jiang (0.5 fen), decoct.
Another: Ai Ye (Mugwort Leaf), decoct in vinegar. Adding Sheng Jiang (Fresh Ginger) stops diarrhea/dysentery, heart/abdominal pain, and five types of hemorrhoidal bleeding.
Another: Bai Ye (Cupressus Leaf, 4 liang), Shao Yao (half liang, ground). Take 2 qian, decoct in water.
Another: Mu Er (Wood Ear Mushroom, burnt to ash, 2 qian), take with water, or cook with ginger/vinegar.
Another: Zhi Shi Mo (Immature Bitter Orange Powder, 2 qian), take with rice soup; especially effective for children.
Another: Sheng Jiang, Xi Cha (Fine Tea), decoct.
Another: Hong Cai Tou (Beetroot) juice, taken orally. Also stops bleeding, generates flesh; apply to human/animal wounds.
Another: Ma Chi Xian (Purslane) porridge, eat.
Another: Zi Su (Perilla Leaf, 4 qian), Fang Feng (Saposhnikovia Root, 2 qian), decoct, mix with Bai Mi (White Honey, 4 liang) to take.
Another: Ji Zi (Egg), cooked in vinegar.
Three prescriptions for chronic loose stools: Shi Liu (Pomegranate) juice, drunk. Or sun-dry peel, grind to powder, form pills with jujube flesh.
Another: Wu Bei Zi (Gallnut), Ku Fan (Alum), grind, form pills.
Another: He Zi (Chebula Fruit, 12 total: 6 roasted hot, 6 raw). Grind to powder. For red dysentery, take with Sheng Gan Cao (Raw Licorice) and Bai Zhi Gan Cao (Honey-fried Licorice) decoction.
Another for prolonged fluid depletion and cold limbs: Use one winter melon, wrap in 5 cun of yellow mud, bake熟 (cooked), remove mud, squeeze juice, and drink.
Another for extreme thirst: Xi Ni fruits, remove peel/core, eat, or grind to juice and drink warm.
Another: Cong (Scallion, one handful), chopped, cook with rice and eat.
Another: Suan (Garlic), mashed, applied to both soles.
Another: Bai Cao Shuang (Soot from various herbs, 2 qian), grind, take with rice soup.
Another: Chi Xiao Dou (Adzuki Bean) porridge, eat.
For Jin Kou Li (Dysentery with inability to eat): Shi Lian Stone Lotus Seed, remove shell, lightly fry flesh, grind to powder. Take 2 qian with aged rice soup.
Another: Shi Lian Mo (Stone Lotus Powder), Xiang Lian Wan (1 qian each, taken together).
Another: Mu Bie Zi (Momordica Seed, ground), small amount of Xiong Huang (Realgar), applied to umbilicus.
Another: Shan Yao (Dioscorea Rhizome), cut into pieces. Half boiled in clay pot, half raw. Grind together to powder. Take 3 qian with rice soup.
Another: Ren Shen (2 qian), Huang Lian (1 qian), Shi Chang Pu (Acorus Rhizome, 0.8 fen), Shi Lian Rou (Stone Lotus Flesh, 2 qian). Cut, decoct, sip slowly throughout the day, swallowing immediately.
Another: Earth from east-facing wall, stir-fried with Chen Pi (Aged Tangerine Peel), grind to powder. Take 1 qian with ginger/jujube soup.
Another: Hong Jin Hua (Hibiscus Rosea Flower), dried in shade, ground to powder. First eat two wheat pancakes sprinkled with powder, then pour soup to open the stomach/appetite.