【脉】 脉滑按之虚绝者，必下利，寸脉反浮数，尺中自涩，必下清脓血。脉沉
弦者，下
重，其脉小大者，为未止。脉数，若微发热，汗自出者，自愈；设脉复紧者，必为未解。脉
微，若数者令自止，虽发热不死；脉反弦，发热，身汗出，自愈。脉绝手足厥，灸之手足温
者生；若脉不还，反微喘者死。脉迟而滑者，实也。利未止，当下之；数而滑者，有宿食，
当下之。肠 下白沫，沉则生，浮则死。肠 下脓血，悬绝者死，滑大生。又沉小流连者生
，数大有热者死。肠 转筋，脉极数者死。凡诸痢泄注，脉沉小者生，浮大者死。身热者死
。或谵语，或腹坚痛，脉沉紧者，可下；迟者，可温之。下痢不欲食，有宿食；肠满痛，为
寒食；肠坚心下坚，为实，皆可下。下痢脉迟，紧痛肠鸣，心急大孔痛，皆可温。伤寒下痢
，三部无脉，尺中时小见，脉再举头者，肾气也。形损脉不至者死。
【因】 风湿热论之，则火盛而金去，独木火旺而脾土损矣。轻则飧泄，身热脉
洪，谷不能化；重则下利脓血。经曰∶春伤于风，夏必飧泄。又曰∶诸下利，皆属于湿。又
曰∶下利稠粘，皆属于火。又曰∶利下脓血，皆属滞下。
【证】 前证，皆热证、实证也。忌用龙骨、石脂、粟壳等剂。虚证泄利，水谷
或化或不化，并无努责，惟觉困倦，脉弦涩者是也。宜温补之。
【治】 治法，重则大黄汤主之，轻则黄芩芍药汤主之。后重则宜下，乃有物结
坠。里
热脉洪甚，宜下；若脉洪大甚，不宜下也。又大肠经气不宣，加木通、槟榔、木香。肠痛则
宜和，胃气不和，当以茯苓、归、芍和之。身重则除湿，脉弦则去风。风气因动属于内，大
柴胡汤主之。血脓稠粘，以重药竭之，热甚故也。身冷自汗，以毒药温之。有暴下无声，身
冷自汗。小便清利，大便不禁，气难布息，脉沉微，喘吐，虽有里急后重，谓寒邪在内而气
散也。可温药而安，则浆水散是也，属少阴。风邪在内缩，宜汗之也。有厥阴下利不止，脉
沉而迟，手足厥逆，涕唾脓血，此难治，宜麻黄汤、小续命汤平之。法曰∶谓有表邪缩于内
，当散表邪而安矣。李用升举之法亦然。 溏为利，宜温之。谓利有结粪，属太阴。有里者
下之。或后重，或食积与气坠，下之。在上者涌之。或痰气在上，涌之安；在下者，竭之。
大法，去者送之，盛者和之，过者止之。假如恶寒热，腹不痛，加苓为主；痛甚，加当归，
倍芍。如见血，加连；或发热恶寒，非芩不止，上部血也。如恶寒脉沉腰痛，或白痢下痛，
或血，非连不止，中部血也。或恶寒脉沉，先血后便，非地榆不止，下部血也。
痢下，有风、湿、热、寒、虚，滞下、噤口痢、疳痢、瘵痢、湿蚀疮，病同而因异。血
痢，有瘀血、血枯、肺痿、风血酒痢，证同而因异。
泄痢是积辨 泄痢有期，或久亦然，或久神不悴亦然，宜逐去之，此名滞下。
有一人，年六十。忧患滞下褐色，腹微痛，后重频并，食大减，身微热，脉弦而涩，似
数稍长。非滞下，乃忧患所致，心血亏脾弱也。以四物、四君合而治之愈。
有一人，年三十，奉养浓。秋间患滞下，腹大痛，左脉弦大似数，右脉亦然，稍减，重
取似
紧。此乃醉饱后吃寒凉，当做虚寒治之，遂以四物，桃仁、红花，去地黄，加参、术、干姜
，煎入姜汁、茯苓，一月而安。
黄芩芍药汤 治泄痢腹痛，后重身热，脉洪疾。
芍药 黄芩（各一两） 甘草（五钱）
痛加桂少许。
大黄汤 治前证重者。
大黄一两，酒浸半日，煎服，以利为度。
芍药汤 治下痢脓血，里急后重。行血则便脓自安，调气则后重自除。
芍药（一两） 当归 黄连（各半两） 甘草（炒） 木香 槟榔 桂枝（各二钱） 黄芩（半
两） 大黄（三钱）
白术芍药汤 治脾受湿，水泄微满，困弱，暴下无数。
白术 芍药（各一两） 甘草
腹痛甚，加芩桂；脉弦头痛，加苍术、防风；下血，加苍术、地榆，痒则同上；如心下
痞满，加枳实。
黄连汤 治大便下血，腹中不痛，谓之湿毒下血；腹中痛，谓之热毒下血。
当归（半两） 大黄（二钱半，热毒加之） 芍药 桂（腹痛加之）
诃子散 治虚滑，久不已。
黄连（三钱） 木香（半两） 炙甘草（三钱） 诃子皮（生、熟各半两） 白术
芍药汤送下。
桃花汤 治冷痢腹痛，下鱼脑白物。
赤石脂（ ） 干姜（炮）
饼丸，饮下。
浆水散 治暴泄如水，身冷脉微气少，甚者加吐、急痛。
半夏（一两） 炮附子 干姜（五钱） 桂枝（五钱） 炙甘草（三钱） 良姜（二钱半）
上为末，三五钱，浆水二盏，煎半，和滓热服。
小续命汤 治风积痢。
龙芽草 刘寄奴
椿皮丸 治风邪内陷。
香连丸 止痢。
燥湿和血汤 治肠 下血，合作一派，腹中大痛。此乃阳明气冲，热毒所作也。
以下出李。
地黄（生、熟各半两） 牡丹皮（半钱） 白芍（一钱半） 当归（二钱） 甘草（生半钱，熟
一钱） 黄 （一钱） 升麻（七钱） 苍术 秦艽 肉桂（各三钱） 橘皮（二钱） 作一服。
升麻补胃汤 治前证，腹中不痛，腰沉沉然，乃阳明、少阳经血证，名湿毒下血
。效过老人久痢。
升麻（一钱） 羌活（二钱） 独活 柴胡 防风（各五分） 葛根（三钱） 肉桂（少许） 白
芍（一钱半） 当归（三钱） 丹皮（半钱） 地黄（生、熟各半钱） 炙甘草（半钱） 黄 （一钱）
槐花（治湿毒） 青皮
作两服。
益智和中汤 治前证，腹中痛，皮恶寒，脉俱弦，按之无力，关甚紧弦，肌表阳
分凉，喜热熨，为内寒明矣。
升麻（一钱半） 葛根（半钱） 白芍（一钱半） 炙甘草（一钱） 桂皮（四钱） 益智（五分）
当归（一钱） 黄 （一钱） 牡丹皮（炙） 柴胡 半夏（各五分） 干姜（炒） 肉桂（一钱）
茯苓汤 治伤饮冷水，变成白痢，腹内痛，减食。
茯苓（六钱） 泽泻（一钱） 当归（四钱） 苍术（二钱） 生姜（二钱） 黄芩（三钱） 肉桂
（二钱） 猪苓（六钱） 甘草（半两，炙） 芍（一钱半） 升麻 柴胡（各二钱）
止痢神丸
川黄连 茱萸 粟壳（清泔浸三日。又酒浸七日，炒干，同上二味，同此制）
上末为丸。热则甘草汤下，寒姜汤下八十丸。
小柴胡去参汤 浑身热，挟外感。
没乳丸 治瘀血痢。
乳香 没药 桃仁 滑石
佐以木香、槟榔。苏木汤下。
保和丸 治食积痢。
噤口丹 治噤口痢，呕不纳食；亦治痢吐食。
枇杷叶（十张，蜜炙） 缩砂（十个，末）
熟蜜调，抹口上。
半夏（四钱） 人参（八钱）
姜煮干，焙末。以姜粉入香附，丸服，连多加参煎呷。
大承气汤 治下痢不欲食。
许学士云∶凡痢病腹痛，以白芍、甘草为君、归、术为佐。见血前后，以三焦热论。
凡治痢病，小便清白不涩为寒，赤涩为热。
又法，完谷不化而色不变，吐利腥秽，沉沏清冷，小便清白不涩，身凉不渴，脉微细而
迟者
，寒也。谷虽不化而色变非白，烦渴，小便赤黄而或涩者，热也。凡谷消化，无问他证及色
，便为热也。寒泄而谷化者，未之有也。
伤食，微加大黄；腹胀，川朴；渴者，白茯苓；腹痛，白芍、甘草为主。冬月，白芍药
一半、白术一半；夏月，制黄芩。先见脓血，后见大便者，黄柏为君，地榆为佐，加归尾；
先见大便而脓血者，制芩、归梢；脓血相杂下者，制连；大便腹不痛，白芍半之；身倦。目
不欲开，口不能言，黄 、人参；沉重者，制苍术；不思食者，木香，藿香。余同上。
[Pulse]
A pulse that is slippery but feels empty or imperceptible upon deep pressure indicates certain diarrhea (xià lì). If the cun position pulse is floating and rapid, while the chi position pulse is choppy, there will certainly be discharge of clear pus and blood. A sinking and wiry pulse indicates tenesmus (zhòng). If the pulse varies in size, the condition has not yet ceased. A rapid pulse accompanied by slight fever and spontaneous sweating indicates self-healing; however, if the pulse becomes tight again, the pathogen has not been resolved. A faint pulse that becomes rapid and stops diarrhea spontaneously indicates survival despite fever. A string-like pulse with fever and sweating also indicates self-healing. If the pulse disappears and the extremities are cold, life can be saved if warming moxibustion restores warmth to the hands and feet; if the pulse does not return and slight panting occurs, death ensues. A slow and slippery pulse indicates excess. If diarrhea persists, purgation is indicated. A rapid and slippery pulse indicates retained food, for which purgation is indicated. Discharge of white mucus from the intestine with a sinking pulse suggests survival, while a floating pulse suggests death. Discharge of pus and blood with an extreme or "hanging" pulse suggests death, while a slippery and large pulse suggests survival. A sinking, small, and continuous pulse suggests survival, whereas a rapid, large, and hot pulse suggests death. Intestinal cramping with an extremely rapid pulse suggests death. In all types of dysentery and projectile diarrhea, a sinking and small pulse suggests survival, while a floating and large pulse suggests death. Fever indicates death. Delirium or abdominal hardness and pain with a sinking and tight pulse can be treated with purgation; a slow pulse can be treated with warming methods. Dysentery with loss of appetite indicates retained food; fullness and pain in the intestines indicate cold-food retention; hardness in the intestines and epigastrium indicates excess, all of which can be treated with purgation. Dysentery with a slow pulse, abdominal pain, borborygmus, heart anxiety, and anal pain can be treated with warming methods. Dysentery caused by cold damage, where all three positions lack a pulse but the chi position occasionally shows a faint pulse that beats strongly when lifted, indicates that kidney qi remains. If the physical form is damaged and the pulse is absent, death ensues.
[Etiology]
From the perspective of wind-damp-heat, excessive fire damages metal (lungs), leaving wood (liver) overly vigorous and damaging earth (spleen). Mild cases present as undigested stool diarrhea with fever and a洪 (hóng) pulse, where food cannot be transformed; severe cases present with dysentery containing pus and blood. The Classics state: Wind injury in spring leads to undigested stool diarrhea in summer. Also: All diarrhea belongs to dampness. Also: Thick and sticky diarrhea belongs to fire. Also: Diarrhea with pus and blood belongs to dysentery (zhì xià).
[Syndrome Differentiation]
The aforementioned syndromes are all heat and excess patterns. It is contraindicated to use astringents such as Longgu (Fossilized Bones), Shizhi (Lithosi Fragment), and Qiaoke (Poppy Shell). Deficiency-type diarrhea involves water and grain that may or may not be digested, without straining efforts, only feeling fatigue and weakness, with a wiry and choppy pulse. This should be treated with warming and tonifying methods.
[Treatment]
For treatment, severe cases are primarily managed with Dahuang Tang (Rhubarb Decoction), and mild cases with Huangqin Shaoyao Tang (Scutellaria and Peony Decoction). Tenesmus requires purgation because it is caused by tangible pathogens causing obstruction and heaviness. Internal heat with a very 洪 pulse requires purgation; however, if the pulse is excessively 洪 and large, purgation is contraindicated. If the Large Intestine meridian qi is obstructed, add Mutong (Akebia Caulis), Binglang (Areca Seed), and Muxiang (Vladimiria Root). Intestinal pain requires harmonization; stomach qi disharmony is treated with Fuling (Poria), Danggui (Angelica Sinensis), and Shaoyao (Peony). Heaviness in the body requires dispelling dampness; a wiry pulse requires dispelling wind. If wind pathogen moves inward due to agitation, Dachaihu Tang (Minor Bupleurum Decoction) is used. Thick and sticky bloody pus requires heavy medication to exhaust it due to intense heat. Cold body with spontaneous sweating requires warming with toxic/hot medicines. Sudden profuse watery diarrhea without sound, cold body, spontaneous sweating, clear and frequent urination, involuntary defecation, difficult breathing, faint and sinking pulse, panting, and vomiting, even with tenesmus, indicates cold pathogen inside causing qi dispersion. Warming medicines like Jiangshui San (Fermented Grain Powder Powder) can stabilize this, belonging to the Shaoyin category. If wind pathogen contracts inward, sweating method is indicated. Jueyin dysentery with unceasing diarrhea, sinking and slow pulse, cold extremities, and pus/blood in sputum is difficult to treat; Mahuang Tang (Ephedra Decoction) and Xiao Xuming Tang (Minor Rescue Life Decoction) can be used to calm it. The method states: If exterior pathogen is trapped inside, disperse the exterior pathogen to resolve it. Li Dongyuan's lifting method is similar. Loose stools require warming. If diarrhea contains hard feces, it belongs to Taiyin. Interior excess requires purgation. Tenesmus, food stagnation, or qi sinking require purgation. Pathogens above require emesis. Phlegm-qiu above requires emesis to resolve; pathogens below require exhaustion/clearing. The general principle is: send off what goes (treat excess with draining), harmonize what is abundant, stop what is excessive. If aversion to cold/fever without abdominal pain, use Fuling as chief; severe pain adds Danggui and doubles Shaoyao. Blood presence adds Huanglian (Coptis); fever/aversion to cold requires Huangqin (Scutellaria) to stop, indicating upper jiao blood. Aversion to cold, sinking pulse, lower back pain, white dysentery pain, or blood requires Huanglian to stop, indicating middle jiao blood. Aversion to cold, sinking pulse, blood before stool requires Diyü (Sanguisorba) to stop, indicating lower jiao blood.
Dysentery involves wind, damp, heat, cold, and deficiency; dysentery (zhì xià), anorectic dysentery (jìn kǒu lì), childhood malnutrition dysentery (gān lì), consumption dysentery (zhài lì), and wet erosion sores share symptoms but differ in etiology. Bloody dysentery involves blood stasis, blood depletion, lung atrophy, wind-blood, and alcohol dysentery; they share symptoms but differ in etiology.
Differentiating Accumulation in Diarrhea/Dysentery: Diarrhea/dysentery with a specific duration, or chronic but spirit remains intact, requires expelling accumulation, named "Zhixia" (Stagnant Down).
Case 1: A 60-year-old man suffered brown stagnant dysentery due to worry, with slight abdominal pain, frequent tenesmus, reduced appetite, slight fever, and a wiry, choppy, slightly rapid and long pulse. This was not typical dysentery but caused by worry leading to heart blood deficiency and spleen weakness. Treated with Siwu Tang (Four Substances Decoction) and Sijunzi Tang (Four Gentlemen Decoction) combined, resulting in cure.
Case 2: A 30-year-old man with rich diet suffered autumnal stagnant dysentery with severe abdominal pain. Left pulse wiry-large-slightly rapid, right pulse similar but slightly less, heavy pressure felt tight. Caused by eating cold foods after drunken/full meals. Treated as deficiency-cold using Siwu Tang, removing Dihuang, adding Renshen (Ginseng), Baizhu (Atractylodes), Ganjiang (Dried Ginger), decocted with Jiangzhi (Ginger Juice) and Fuling, resolving in one month.
Huangqin Shaoyao Tang: Treats diarrhea/dysentery with abdominal pain, tenesmus, fever, and rapid洪 pulse.
Shaoyao, Huangqin (each 1 liang), Gancao (5 qian).
Add Gui (Cinnamon Twig) for severe pain.
Dahuang Tang: Treats severe cases of the above.
Dahuang (1 liang), soaked in wine for half a day, decocted and taken until diarrhea occurs.
Shaoyao Tang: Treats dysentery with pus/blood and tenesmus. Moving blood stabilizes pus/blood; regulating qi removes tenesmus.
Shaoyao (1 liang), Danggui, Huanglian (each 0.5 liang), Gancao (stir-fried), Muxiang, Binglang, Guizhi (each 2 qian), Huangqin (0.5 liang), Dahuang (3 qian).
Baizhu Shaoyao Tang: Treats spleen dampness, watery diarrhea with slight fullness, fatigue, sudden frequent diarrhea.
Baizhu, Shaoyao (each 1 liang), Gancao.
Severe pain adds Huangqin, Guizhi; wiry pulse/headache adds Cangzhu, Fangfeng; bleeding adds Cangzhu, Diyü; itching uses same; epigastric fullness adds Zhishi.
Huanglian Tang: Treats rectal bleeding without abdominal pain (wet-toxin bleeding); with abdominal pain (heat-toxin bleeding).
Danggui (0.5 liang), Dahuang (2.5 qian, add for heat-toxin), Shaoyao, Gui (add for pain).
Hezi San: Treats deficiency slipperiness and chronic unceasing diarrhea.
Huanglian (3 qian), Muxiang (0.5 liang), Zhi Gancao (3 qian), Hezi Pi (raw/cooked 0.5 liang each), Baizhu.
Take with Shaoyao Tang.
Taohua Tang: Treats cold dysentery with abdominal pain and fish-brain-like white discharge.
Chishizhi, Ganjiang (roasted).
Make into pill cakes, take with water.
Jiangshui San: Treats sudden watery diarrhea, cold body, faint pulse, short breath, severe cases with vomiting/acute pain.
Banxia (1 liang), Pao Fuzi, Ganjiang (5 qian), Guizhi (5 qian), Zhi Gancao (3 qian), Liangjiang (2.5 qian).
Powder, take 3-5 qian, decoct with 2 cups fermented grain juice until half remains, take hot with dregs.
Xiao Xuming Tang: Treats wind-accumulation dysentery.
Longyacao, Liu Jinu.
Chunpi Wan: Treats internal contraction of wind pathogen.
Xianglian Wan: Stops dysentery.
Zaoshi Hexue Tang: Treats intestinal bleeding, combined symptoms, severe abdominal pain. Caused by Yangming qi rushing and heat-toxin. From Li Dongyuan.
Dihuang (raw/cooked 0.5 liang each), Mudanpi (0.5 qian), Baishao (1.5 qian), Danggui (2 qian), Gancao (raw 0.5 qian, cooked 1 qian), Huangqi (1 qian), Shengma (7 qian), Cangzhu, Qinjiao, Rougui (each 3 qian), Jupi (2 qian). One dose.
Shengma Bugeng Tang: Treats above syndrome, no abdominal pain, heavy sensation in waist, Yangming/Shaoyang meridian blood syndrome, named wet-toxin bleeding. Effective for elderly chronic dysentery.
Shengma (1 qian), Qianghuo (2 qian), Duhuo, Chaihu, Fangfeng (each 0.5 fen), Gegen (3 qian), Rougui (slight), Baishao (1.5 qian), Danggui (3 qian), Danpi (0.5 qian), Dihuang (raw/cooked 0.5 qian each), Zhi Gancao (0.5 qian), Huangqi (1 qian), Huaihua (for wet-toxin), Qingpi. Two doses.
Yizhi Hezhong Tang: Treats above syndrome, abdominal pain, skin aversion to cold, wiry pulse, weak on pressure, especially tight/wiry at Guan position, cool superficial yang, prefers heat application, clearly internal cold.
Shengma (1.5 qian), Gegen (0.5 qian), Baishao (1.5 qian), Zhi Gancao (1 qian), Guipi (4 qian), Yizhi (0.5 fen), Danggui (1 qian), Huangqi (1 qian), Mudanpi (roasted), Chaihu, Banxia (each 0.5 fen), Ganjiang (roasted), Rougui (1 qian).
Fuling Tang: Treats injury from cold water drinking turning into white dysentery, abdominal pain, reduced appetite.
Fuling (6 qian), Zexie (1 qian), Danggui (4 qian), Cangzhu (2 qian), Shengjiang (2 qian), Huangqin (3 qian), Rougui (2 qian), Zhuling (6 qian), Gancao (0.5 liang, roasted), Shaoyao (1.5 qian), Shengma, Chaihu (each 2 qian).
Zhili Shenwan
Chuan Huanglian, Zhu Yu, Sushe (soaked in rice water 3 days, then wine 7 days, stir-fried dry, processed same as above two).
Powder into pills. Heat pattern: Gancao Tang; Cold pattern: Ginger Tang, 80 pills.
Xiao Chaihu Qu Shen Tang: Whole body fever, with external contraction.
Muru Wan: Treats blood-stasis dysentery.
Ruxiang, Moyao, Taoren, Huashi.
Assist with Muxiang, Binglang. Take with Sumu Tang.
Baohe Wan: Treats food-stagnation dysentery.
Jinkou Dan: Treats anorectic dysentery (vomiting, inability to eat); also treats dysentery with vomiting.
Pipaye (10 sheets, honey-roasted), Suosha (10 pieces, powdered).
Mix with熟蜜 (cooked honey), apply to mouth.
Banxia (4 qian), Renshen (8 qian).
Boil in ginger until dry, roast and powder. Add Jiangfen (ginger powder) and Xiangfu, make pills. If vomiting is frequent, add more Renshen and decoct for sipping.
Da Chengqi Tang: Treats dysentery with loss of appetite.
Xu Xueshi said: For dysentery with abdominal pain, use Baishao and Gancao as chief, Danggui and Baizhu as assistants. For blood before/after stool, discuss based on Sanjiao heat.
Generally, treating dysentery: Clear urine without astringency indicates cold; red/astringent urine indicates heat.
Another method: Undigested food with unchanged color, foul vomit/stool, clear/cold urine, cool body/no thirst, faint/small/slow pulse indicates cold. Undigested food with color change (not white), irritability/thirst, red/yellow/astringent urine indicates heat. Digestion of food regardless of other symptoms/color indicates heat. Cold diarrhea with digestion of food is unheard of.
Food injury: slightly add Dahuang; abdominal distension: Chuanpu (Magnolia Bark); thirst: Baifuling (White Poria); abdominal pain: Baishao, Gancao as chief. Winter: half Baishaoyao, half Baizhu; Summer: Zhi Huangqin. Blood/pus first, stool later: Huangbai as chief, Diyü as assistant, add Guiwei; Stool first, blood/pus later: Zhi Huangqin, Guishao; Mixed blood/pus: Zhi Huanglian; Stool without abdominal pain: half Baishao; Fatigue, eyes closed, speechless: Huangqi, Renshen; Heaviness: Zhi Cangzhu; Anorexia: Muxiang, Huoxiang. Rest same as above.