李易安《金石录》后序，言其夫赵明诚，因途中奔驰冒暑，至行在旅邸病 。予闻信惊怛，念渠性素急，
病患热，必服寒凉药。病可忧，遂解舟下，一日夜行三百里。比至，果大服柴胡、黄芩，疟且痢，遂以不起。
（柴、芩自是少阳药，用之不当，便能为患。然药不对病，虽甘草、茯苓亦足杀人也。）
万密斋治汪氏媳，病疟且痢，用小柴胡合桂枝汤加当归、陈皮，二十余剂疟愈。随以黄芩芍药汤加人参治
痢，不效。再思之，悟曰∶此病得之内伤，名为白蛊。乃用升阳除湿防风汤，一剂而安。
陆肖愚治王笠云，八月间患疟，服药已愈。后饮食不调，大便泻而变痢，一日夜约一二十行，皆积滞无粪，
腹痛后重，身热夜不安。医以芩、连、木香、槟榔等药投之益甚。脉之，左手浮弦而弱，右手沉数而微，曰∶
此疟之余邪也，当解经络中邪热，则大便自固。乃以《机要》防风芍药黄芩汤加柴胡二剂，身热腹痛顿止。后
以调气养荣汤数剂，精神如故。
孙文垣治董浔老家马厨，七月初旬患病，二十余日势转剧。询其症，曰∶大发寒热，寒至不惮入灶，热至
不惮入井，痢兼红白，日夜八十余行，腹痛恶心，汗多，神气倦甚。问其脉，曰∶脉不吉，下痢脉洪大者死，
细微者生，今洪大，逆也。孙曰∶痢固忌洪大寒热，亦非细微所宜，其中必有故。往诊其脉，察其症，果如所
言，面色微红，汗淋淋下。究病所由起，谓客来众，厨间燥热，食瓜果菱藕过多，晚又过饮接内，寝于檐下，
次日即寒热腹痛，因而下痢。与人参、白术、石膏、滑石各五钱，知母、炮姜各三钱，大附子、炙甘草各二钱，
大剂煎之，饮讫即睡。或问曰∶服后何状为佳？曰∶倘得一睡，则阴阳和，和则汗可敛，寒热呕恶可止也。夜
来痢减半，汗吐全无，脉亦敛矣。再用人参、石膏、白术、白芍、滑石各三钱，炮姜、肉桂、知母各二钱，炙
甘草、附子各一钱，服后，疟止痢又减半，饮食渐进，神气渐复。改用酒芍五钱，人参、白术、滑石各二钱，
甘草、陈皮、炮姜、肉桂各一钱，三剂，痢全止而痊。或问寒热均投，此何症而剂何名也？笑曰∶此滑公所谓
混沌汤也。经云夏伤于暑，秋必疟痢，白虎汤、益元散主之。瓜果寒凉伤其中气，酒后御内损其下元，附子理
中汤正所以温中补下者。经又云实者，邪气实也，故以白虎益元应之；虚者，正气虚也，故以理中汤应之。若
以寒热均用为疑，则仲景附子甘草泻心汤，既用大黄、黄连，又用干姜、附子，此何说哉？盖假对假，真对真也。
孙文垣治臧茗泉，脉左弦数，右寸弱，关大，重按则滑，右尺微。原以疟后复伤饮食，大便泻而变痢，
日夜只五六行，皆积滞无粪，腹疼后重难堪，午未后发热，天明始退，此夏伤于暑，秋成疟痢也。其热仍疟之
余邪，当先解散，然后以补剂投之，则痢自愈矣。与神授香连丸一服，腹中肠鸣，须臾大便行，较前更多，且
有粪下。改以白芍四钱，泽泻、黄连各一钱，滑石二钱，甘草、桂枝、木香各四分，山楂七分。两日后，与补
中益气汤加木香、黄连、白芍，调理半月而瘥。
张路玉治故友子，触疫疟之气，染患月余不止，左右乏人，失于调理，致愈而复发，加以五液注下，疟痢
兼作，水谷不入者半月余。乃携归斋中，日与补中益气，兼理中、六君、萸、桂之属，将养半月而愈。
李士材治一士，冒暑劳苦，患血痢，危甚，用黄连、当归、乌梅、滑石各五钱，香薷三钱，甘草一钱而愈。
（症治大合医案。）
陆祖愚治姚可仪祖母，年七十，精力过人，勤劳不倦，忽于夏月怒后，感冒风凉，兼伤饮食，头疼骨痛，
寒热大作，寒则重衾，热则冷冻饮料。或以其年高病重，攻补兼施，遂腹痛、谵语、烦躁。脉之，洪弦而紧，谓高
年而脉乃如是，病正进也，须双解表里之邪。遂用柴葛、二陈、枳、桔、楂、朴、芩、苏加生姜，二剂表症稍
减，腹仍痛，下痢红白，里急后重，日夜去积三十余次，脉亦未减。乃用润字丸一钱、香连丸和服，日夜三服。
两日后，痢减半，惟脐之上下痞满，又用槟榔、青皮、木香、泽泻、木通、芩、连、滑石之类，五六剂方得燥
矢与积同去，病又减二三。仍用香连丸二钱，日进二服，数日积除痢止。改投大补气血之剂，调理月余而安。
韩延年长子，初患咳嗽已久，至七月患疟，复变痢，疟仍未止。或以尺脉短涩，投养阴清补之剂。诊之，
拟加参、附，前医不以为然。后更数医，仍不外温补止塞出入加减。服参及四斤，病虽减而元气犹未复如故。
高丽医人治疾，用药只一味两味，至三味则极多矣，未有至四味者。盖药惟性专则达，二则调，四则参与
制，再多则相牵而不能奏功。偶传治痢二方，甚简而验，今录于此∶治痢止二味，色白者患寒，（其说未是。）
用生姜一两，细茶五钱。色赤者患热，用细茶一两，生姜五钱。赤白杂者，姜、茶各五钱，青皮三钱，陈皮
二钱，酒一碗，河水一碗，煎至一碗，温服即愈。（李日华《六研斋偶笔》。）
魏玉横曰∶汪绍兄室人，年五十余，新秋患淋秘，小愈即勿药。初冬即自汗两日，遂寒热成胎疟，医略与
消散不效。将半月，复增滞下，腹痛后重，日一二十行。因见其脉如蛛丝，声微气乏，疑属虚寒，乃用二陈汤、
香、砂、苍、朴温胃燥脾之剂。十余日，舌苔尽黑，多汗不眠，遂辞去。诊之，脉果沉微，语殊轻怯，然小便
热短，胸膈痞闷，疟则热多于寒，痢则红少于白。此伏气所发，陈 郁积，大腑为病也。在《金匮》法宜下之，
但其禀赋甚弱，三阴素亏，不可峻治。且前所服，类皆温燥，故令积滞不行，宜以润滑甘寒之品导之。用生地、
杞子、麦冬、蒌仁、当归、木通、白芍、黄芩、枳壳、桔梗，数剂，觉去宿垢甚多，又数剂而痢止。疟仍间日
一作，加痰嗽甚频，此肠胃既通，余热挟虚火上窜也。前方去枳壳、当归、木通，加沙参、熟地、地骨、首乌
之属，十余剂，黑苔始尽，而寒热除。又数剂，痰嗽亦止。后因劳疟复作，用补中益气去人参，内熟地一两，
一剂而愈。愈后，左关尺仍细弱，向若峻下，必生变矣。当病甚时，一专科与木香、白术、炮姜、补骨脂等，
亦幸而未服。
Li Yi'an, in the postscript to *Jinshi Lu* (Record of Metal and Stone), mentioned that her husband, Zhao Mingcheng, fell ill upon arriving at a temporary lodging after traveling and being exposed to summer heat. Hearing this news, I was shocked and grieved. Knowing his naturally impatient temperament, I feared he would take cold-natured medicines for his feverish illness. Worried about his condition, I set sail immediately, traveling three hundred li in one day and night. Upon arrival, I indeed found that he had taken large doses of Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix), leading to concurrent malaria and dysentery, from which he ultimately died. (Chaihu and Huangqin are herbs for treating Shaoyang syndrome; improper use can cause harm. However, if the medicine does not match the disease, even Gancao (Licorice Root) and Fuling (Poria) can be fatal.)
Wan Mizhai treated the daughter-in-law of the Wang family, who suffered from malaria accompanied by dysentery. Wan used Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction), augmented with Danggui (Angelicae Sinensis Radix) and Chenpi (Citri Reticulatae Pericarpium). After more than twenty doses, the malaria resolved. Subsequently, he prescribed Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) with Renshen (Ginseng Root) to treat the dysentery, but it was ineffective. Reconsidering, he realized: "This illness stems from internal injury, known as 'White Gu'." He then switched to Shengyang Chushi Fangfeng Tang (Decoction to Raise Yang and Drain Dampness with Saposhnikovia), and the patient stabilized after one dose.
Lu Xiaoyu treated Wang Liyun, who contracted malaria in August and recovered after medication. Later, due to irregular diet, diarrhea transformed into dysentery, occurring about ten to twenty times a day and night. The stools consisted only of stagnant matter without feces, accompanied by abdominal pain and tenesmus, fever, and restlessness at night. Physicians administered Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), and Binglang (Arecae Semen), which worsened the condition. Pulse diagnosis revealed a floating, wiry, and weak pulse on the left, and a deep, rapid, and faint pulse on the right. Lu stated: "This is residual pathogenic factor from malaria. One must resolve the heat in the meridians, and the bowels will naturally consolidate." He prescribed Fangfeng Shaoyao Huangqin Tang (Saposhnikovia, Peony, and Scutellaria Decoction) from *Jiyao*, augmented with Chaihu (Bupleuri Radix). After two doses, the fever and abdominal pain ceased abruptly. Thereafter, using Tiaoqi Yangrong Tang (Regulating Qi and Nourishing Blood Decoction) for several doses, his spirit returned to normal.
Sun Wen Yuan treated a stable hand at Dong Xun Lao's residence. The illness began in early July and worsened after twenty days. Symptoms included severe chills and fever; feeling so cold he dared enter a stove, and so hot he dared jump into a well. Dysentery with red and white pus/blood, defecating over eighty times day and night, abdominal pain, nausea, profuse sweating, and extreme fatigue. Regarding the pulse, Sun noted: "The pulse is ominous. In dysentery, a洪大 (Hóng Dà - Surging and Large) pulse indicates death, while a细微 (Xì Wēi - Fine and Faint) pulse indicates survival. A洪大 pulse here is contrary." Sun added: "While a洪大 pulse is contraindicated in dysentery, a细微 pulse is also unsuitable for chills and fever; there must be a specific cause." Upon examination, the patient had a slightly red face and dripping sweat. Investigating the etiology, it was found that numerous guests caused heat in the kitchen, excessive consumption of melons and lotus roots, late-night drinking and sexual activity, and sleeping under the eaves. The next day, chills, fever, abdominal pain, and dysentery ensued. Sun prescribed Renshen (Ginseng Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Shigao (Gypsum Fibrosum), Huashi (Talcum) each 5 qian; Zhimu (Anemarrhenae Rhizoma), Paojiang (Prepared Ginger) each 3 qian; Dafuzi (Aconiti Lateralis Radix Praeparata), Zhi Gancao (Honey-fried Licorice Root) each 2 qian. Decocted in large quantity, the patient slept immediately after ingestion. When asked what a good outcome would look like, Sun replied: "If he sleeps, Yin and Yang will harmonize, sweat will cease, and chills, fever, and nausea will stop." That night, dysentery halved, sweating and vomiting ceased, and the pulse became restrained. The second prescription contained Renshen, Shigao, Baizhu, Baishao (White Peony Root), Huashi each 3 qian; Paojiang, Rougui (Cinnamon Bark), Zhimu each 2 qian; Zhi Gancao, Fuzi each 1 qian. After taking this, malaria stopped, dysentery halved again, appetite improved, and spirit recovered. The third prescription used Jiushaoyao (Wine-processed White Peony Root) 5 qian; Renshen, Baizhu, Huashi each 2 qian; Gancao, Chenpi, Paojiang, Rougui each 1 qian. After three doses, dysentery completely stopped, and the patient recovered. Asked why both cold and hot herbs were used and what the formula was named, Sun smiled and said: "This is what Hua Tuo called Hundun Tang (Chaotic Decoction)." The Classics state: "Summer injury by heat leads to malaria and dysentery in autumn," treated with Baihu Tang (White Tiger Decoction) and Yiyuan San. Cold fruits damaged the Middle Qi; alcohol and sex damaged the Lower Yuan. Fuzi Lizhong Tang (Aconite and Gastrodia Decoction) warms the middle and tonifies the lower. The Classics also say: "Excess refers to pathogenic excess," hence Baihu and Yiyuan address it; "Deficiency refers to healthy Qi deficiency," hence Lizhong Tang addresses it. If one doubts the combination of cold and hot, consider Zhang Zhongjing's Fuzi Gancao Xiexin Tang (Aconite and Licorice Heart-Guarding Decoction), which uses Dahuang (Rhei Radix et Rhizoma), Huanglian alongside Ganjiang (Dried Ginger) and Fuzi. This is matching false with false, and true with true.
Sun Wen Yuan treated Zang Mingquan. The left pulse was wiry and rapid; the right Cun (Inch) position was weak, Guan (Bar) position was large, and heavy pressure revealed slippery quality; the right Chi (Cubit) position was faint. Originally, due to dietary injury following malaria, diarrhea turned into dysentery, occurring five to six times daily, consisting of stagnant matter without feces, unbearable abdominal pain and tenesmus, fever starting around noon and subsiding at dawn. This was summer heat injury transforming into autumn malaria and dysentery. The heat was residual malaria pathogen, requiring initial resolution before tonification to heal dysentery. Shen Shou Xianglian Wan (Shen Shou Coptis Pill) was given once, causing borborygmus and subsequent bowel movement with more stool than before. The prescription changed to Baishao (White Peony Root) 4 qian, Zexie (Alismatis Rhizoma), Huanglian (Coptidis Rhizoma) each 1 qian, Huashi (Talcum) 2 qian, Gancao (Licorice Root), Guizhi (Cinnamon Twig), Muxiang (Aucklandiae Radix) each 4 fen, Shanzha (Crataegi Fructus) 7 fen. Two days later, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) with Muxiang, Huanglian, and Baishao was used for half a month until recovery.
Zhang Luyu treated the son of a deceased friend. Infected with epidemic malaria qi, the illness persisted for over a month. With no one to care for him and lack of proper management, the illness recurred after apparent recovery. Complicated by depletion of the five fluids, concurrent malaria and dysentery, and inability to ingest food or water for over half a month, Zhang brought him home. Daily treatment involved Buzhong Yiqi Tang combined with Lizhong Tang (Gastrodia and Atractylodes Decoction), Liujunzi Tang (Six Gentlemen Decoction), Shan Zhu Yu (Corni Fructus), and Rougui (Cinnamon Bark). After half a month of nursing care, the patient recovered.
Li Shicai treated a scholar who suffered from bloody dysentery due to summer heat exposure and hard labor, in critical condition. He used Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), Wumei (Mume Fructus), Huashi (Talcum) each 5 qian, Xiangru (Moslae Herba) 3 qian, and Gancao (Licorice Root) 1 qian, resulting in recovery. (The symptoms and treatment align perfectly with medical cases.)
Lu Zuyu treated the grandmother of Yao Keyi, aged seventy, who was vigorous and diligent. Suddenly, in summer, after anger, she caught wind-cold and injured her diet. Symptoms included headache, bone pain, severe chills and fever; covering with thick quilts when cold, drinking ice-cold beverages when hot. Due to her age and severe illness, some physicians attempted simultaneous attack and tonification, leading to abdominal pain, delirium, and irritability. Pulse was洪弦而紧 (Surging, wiry, and tight). Lu stated: "For an elderly person, such a pulse indicates advancing disease. One must simultaneously resolve exterior and interior pathogens." He used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Erchen Tang (Two Aged Decoction), Zhishi (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Shanzha (Crataegi Fructus), Houpo (Magnoliae Officinalis Cortex), Huangqin (Scutellariae Radix), Zisu (Perillae Folium), and Shengjiang (Fresh Ginger). After two doses, exterior symptoms slightly decreased, but abdominal pain persisted, with red and white dysentery, tenesmus, and over thirty evacuations of stagnant matter daily; the pulse remained unchanged. He then administered Runzi Wan (Moistening Pill) 1 qian mixed with Xianglian Wan (Coptis Pill), taken three times day and night. After two days, dysentery halved, leaving fullness above and below the navel. He then used Binglang (Arecae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Muxiang (Aucklandiae Radix), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), Huangqin, Huanglian, and Huashi. After five to six doses, dry stool and stagnant matter were expelled together, reducing the illness by two or three parts. Xianglian Wan 2 qian was taken twice daily for several days until stagnation cleared and dysentery stopped. Finally, strong Qi and Blood tonics were used for a month until stability.
Han Yannian's eldest son had chronic cough, then contracted malaria in July, which transformed into dysentery, with malaria persisting. Some physicians, noting a short and choppy Chi pulse, prescribed Yin-nourishing and clearing/tonifying agents. Sun diagnosed and intended to add Renshen (Ginseng Root) and Fuzi (Aconiti Lateralis Radix Praeparata), but previous doctors disagreed. Several other doctors followed, sticking to warming, tonifying, and astringent methods. Although symptoms reduced after taking Renshen and Sijin Tang (Four Gold Decoction), vital energy did not recover.
Korean physicians typically use one or two herbs; three is considered very many, and four is unheard of. The rationale is that single-natured herbs act directly, two harmonize, four interfere with each other, and more lead to mutual obstruction preventing efficacy. Two simple and effective formulas for dysentery were recorded: For white dysentery (cold type), use 1 liang of Shengjiang (Fresh Ginger) and 5 qian of fine tea. For red dysentery (heat type), use 1 liang of fine tea and 5 qian of Shengjiang. For mixed red and white, use 5 qian each of Ginger and Tea, 3 qian Qingpi (Citri Reticulatae Pericarpium Viride), 2 qian Chenpi (Citri Reticulatae Pericarpium), decocted in one bowl of wine and one bowl of river water until one bowl remains. Take warm for cure. (From Li Rihua's *Liuyan Zhai Oubi*.)
Wei Yuheng stated: The wife of Wang Shao's elder brother, over fifty years old, suffered from strangury (difficulty/painful urination) in early autumn. She stopped medication upon slight improvement. In early winter, she sweated spontaneously for two days, developing chills and fever characteristic of regular intermittent malaria. Doctors tried dispersing agents without effect. Nearly half a month later, dysentery developed with abdominal pain and tenesmus, occurring ten to twenty times daily. Observing her spider-silk-like pulse, faint voice, and lack of breath, suspicion of deficiency-cold arose. Erchen Tang (Two Aged Decoction) with Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), Cangzhu (Atractylodis Rhizoma), and Houpo (Magnoliae Officinalis Cortex) was used to warm the stomach and dry the spleen. After ten days, the tongue coating turned entirely black, with profuse sweating and insomnia, leading to discontinuation of treatment. Diagnosis confirmed deep and faint pulse, soft speech, yet hot and short urination, chest oppression, malaria with more heat than cold, and dysentery with less red than white. This was latent qi manifesting, old accumulation, affecting the Large Intestine Fu organ. According to *Jingui Yaolue*, purgation was indicated, but her constitution was weak with inherent Three Yin deficiency, precluding harsh treatment. Previous warm-dry herbs had failed to move stagnation. Thus, moistening, sweet, and cold herbs were used to guide. Prescription: Shengdi (Rehmanniae Radix), Gouqi (Lycii Fructus), Maidong (Ophiopogonis Tuber), Louren (Trichosanthis Semen), Danggui (Angelicae Sinensis Radix), Mutong (Akebiae Caulis), Baishao (White Peony Root), Huangqin (Scutellariae Radix), Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix). After several doses, much old turbid matter was expelled; after more doses, dysentery stopped. Malaria continued every other day, accompanied by frequent phlegm-cough, indicating residual heat rising with deficiency fire after intestinal patency. Zhiqiao, Danggui, and Mutong were removed from the previous formula; Shashen (Glehniae Radix), Shudi (Rehmanniae Radix Preparata), Digupi (Lycii Cortex), and Shouwu (Polygoni Multiflori Radix) were added. After ten-plus doses, black coating disappeared, and chills/fever ceased. After more doses, phlegm-cough stopped. Later, malaria recurred due to fatigue. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) without Renshen, plus 1 liang of Shudi (Prepared Rehmannia Root), cured her in one dose. Post-recovery, the left Guan and Chi pulses remained fine and weak. Had harsh purgation been used initially, complications would surely have arisen. At the height of illness, a specialist prescribed Muxiang, Baizhu, Paojiang, and Buguzhi (Psoraleae Fructus); fortunately, these were not taken.