此证有二。一是内 。一是痢疾。
一内 在上中焦者。其脓已溃。呕吐而出。在下焦者。或少腹 。小肠 。胁 。肝 。脓血均从大便泻出。初
起时。其部分必隐隐刺痛胀满。脉沉滑数。甚则痛如刀锥。欲病此者。未有口不发渴。大凡血积。均应发渴。
初起血已凝聚。故应发渴。此时急夺其血。则不酿为脓。以免溃烂之险。用丹皮汤。加乳香没药柴胡荆
芥山甲治之。如血已化脓。便宜排脓。赤豆苡仁汤。逐水即是排脓。溃后属虚。宜补养生肌。八珍汤主之。参
看吐脓门自详。
客问积血何以变而成脓。答曰。血者阴之质也。随气营运。气盛则血充。气衰则血竭。气着则血滞。气升则
血腾。故血之运。气运之。即瘀血之行。亦气之行。血瘀于经络脏腑之间。既无足能行。亦无门可出。惟赖气
运之。使从油膜达肠胃。随大便而出。是气行而血自不留也。若气不运之。而反与相结。气为血所郁则痛。
血为气所蒸则化为脓。今举外证比例。凡气盛者疮易托化。气虚者疮难托化。气即水也。气至则水至。故
血从气化。则从其水之形。而变为脓。刀伤粘水。亦从水而化脓。水即气之质。血从气化。有如此者。是故闪
跌血积。得气化之。则肿处成脓。不得气化之。则肿处仍是血。以知血从气。气运血。凡治血者必调气。使气
不为血之病。而为血之用。斯得之矣。
一痢症便脓者。其症里急后重。欲便不便。或白或赤。或赤白相半。或下痢垢浊。皆非脓而似脓者也。夫胃
肠之中。除却糟粕。只微有脂膏水液而已。膏脂属血分。水液属气分。病气分则水混而为白痢。病血分则
血扰而为赤痢。气血交病。则赤白相半。由何处酿成真脓。而从大便泄出哉。有之。则毒聚肠胃。将肠胃膏
脂血肉。蒸化为脓。或下如烂瓜。或如屋漏水。此腐肠溃胃之危候。与 疮之腐烂无异。此非寻常治痢之
法。所能克也。吾今借仲景之法证之。乃得有胆有识之术。仲景云。阳明病。脉数下不止。必协热而便脓血。
少阴病。下利便脓血者。可刺。厥阴病。脉数而渴者。必圊脓血。以有热故也。此虽无方。然曰可刺。曰有热故
也。已示人泻湿清热之法。防风通圣散。去麻黄芒硝。加赤豆防己。为表里泻实之大剂。地榆散。为清热之
通剂。仲景又曰。少阴病。下利便脓血者。桃花汤主之。此汤温涩。似与可刺有热之说。大相径庭。不知病久。
则热随脓血而泻。实变为虚。观 脓溃后属虚损。则知便脓血久而属虚症。譬之天时。其初则酷暑流金。
转瞬而凉 振落。衣夏葛者。不得不换冬裘矣。况肠胃血液。既化为脓。恐其滑脱。故主桃花汤。温涩填补
之。一服愈。余勿服者。仲景意谓此乃急时涩脱之法。止后盒饭涤除余病。无以涩伤气。无以燥伤阴也。盖
脓血乃伤阴之病。故一时权宜。而少用干姜。后仍不可多服也。吾推其意。审其病后有虚热者。逍遥散。归
脾汤。加柴胡山栀寸冬花粉。此祖桃花汤用糯米之意。审其病后有虚寒者。六君子加当归炒干姜白芍。
或人参养荣汤皆可。此祖桃花汤用干姜之意。成无己注桃花汤。谓阳证内热。则溢出鲜血。阴证内寒。则
下紫血如豚肝。是明以桃花汤。为治阴证之方。惟即鲜血分阴阳。未能的确。盖色不足凭。凡痢证。须审脉
微沉迟。手足厥冷。腹痛喜按。唇淡口和。为阴证。附子理中汤。加当归白芍木香。此乃补桃花汤所不逮者
矣。消渴口热。胸腹胀满。坚实拒按。为热证。则用三一承气汤。此乃可尽仲景有热可刺之能事矣。
至于寻常红白。则不须如此重剂。病在水分者。痢下白浊。此如暑雨不时。行潦污涨。是湿甚而伤气也。审
其脉数。身热口渴者。为热湿。宜清利之。四逆散合猪苓汤。去阿胶。再加浓朴老连枯芩
黄柏。审其脉沉弦
迟。口不渴。手足清冷者。为寒湿。胃苓汤加煨姜。有食积者。均再加麦芽神曲山楂莱菔子。白痢之故。总是
水不清之故。水即气也。吾于水火论。已详言之。故调气即是治水。导水须于上原。调气以肺为主。是治肺
乃清水之原。即是调气之本。细思此病发于秋时。秋乃肺金主气。金不清肃。是以水浊气滞而为痢。知此
理。则知迫注者肺之肃。不通者金之收也。人参泻肺汤。以导其滞。小柴胡加花粉杏仁枳壳桑皮茯苓知
母桔梗以和之。人参清肺汤以收功。此乃专为治肺立法。示医者以法门。使知所从事。非临证必用此方
也。且病无单见。未有肺病而余脏不病者。故临证时尚须变化。病在血分者。则利下纯红。口渴便短。里急
后重。脉滑大者。地榆散加酒军枳壳浓朴苡仁泽泻。脉细数者。不必下之。但用原方。若血黯黑。脉迟。手足
冷者。属虚寒。黄土汤治之。红痢之故。总是血分为病。血生于心火。而下藏于肝。肝木内寄相火。血足则能
济火。火平则能生血。如火太旺。则逼血妄行。故血痢多痛如刀锥。乃血痛也。肺金当秋。克制肝木。肝不得
达。故郁结不解。而失其疏泄之令。是以塞而不通。调肝则木火得疏泄。而血分自宁。达木火之郁。宜小柴
胡去半夏。加当归白芍。白头翁汤。或四物汤加蒲黄五灵脂延胡索黄柏龙胆草黄芩柴胡桑寄生。肝风
不扇。则火息。钩藤青蒿白头翁柴胡桑寄生。皆清风之品。僵蚕蝉蜕亦能祛风。肝气不遏则血畅。香附槟
榔橘核青皮沉香牡蛎。皆散利肝气之品。茯苓胆草秦皮枯芩。又清肝火之品。当归生地阿胶白芍。又滋
肝血之品。桃仁地榆五灵脂川芎。又行肝血之品。知理肝之法。而治血痢无难。肝藏血。即一切血证。一总
不外理肝也。各书痢证门。无此论说。予从各书。旁通会悟而出。实先从吾阴阳水火血气论。得其原委。故
此论精确。不似他书捉影。客曰。凡泻泄皆脾胃所主。痢亦泄泻之类。何以不主脾胃哉。答曰。渗泻洞泻。诚
属脾胃。故内经曰。长夏善病洞泻寒中。以长夏为脾主气故也。痢发则多在秋天。而其情理脉证。亦与洞
泻不同。虽关于脾胃。而要以肝肺为主。乃得致病之原。
噤口者。下痢不食。是火热浊攻。胃气被伤而不开。各书俱遵丹溪。用石莲汤。金鉴谓内热盛。上冲心作呕
噤口者。用大黄黄连。好酒煎服以攻之。按肠胃所以能食者。以胃有津液。清和润泽。是以思食。西洋医虽
滞于迹。亦间有可信处。言谷入于胃。即有胃津注之。将谷浑化如糜。常探胃津搅饭。顷刻亦化为糜。据此
论说。则胃之思食。全是胃津使然。试观犬欲得肉。则涎出于口。此涎即欲食之本也。人之胃津。其思食之
情亦类乎此。今胃为邪热浊气所攻踞。其清和之津。尽化而为浊滞。下注于大肠。则为痢。停聚胃中。则拒
不纳食。丹溪石莲汤。虽知清火补胃。然石莲是莲米有黑壳者。今医用石莲子。不知何物。断不可用。即莲
米性亦带涩。痢证宜滑以去着。涩乃所忌。且胃中浊滞。非洗涤变化不为功。此方虽寒热未差。然未能洗
涤其滞。变化其浊。非起死回生之方也。清温败毒饮。竹叶石膏汤。人参白虎汤。麦冬养荣汤。出入加减。庶
可以洗胃变津。为开胃进食之良法。至呕不食。金鉴用二黄好酒。取其峻快以攻逆。然治逆洵为得法。而
不知化生胃津。终未得进食之本也。吾意以为宜用大柴胡汤。加石膏花粉人参。则攻逆生津。开胃进食。
两面俱到。治噤口者。从无此论。吾今悟出切实之理。为斯人大声疾呼。海始欲以文章报国。令已自分不
能。庶几发明此道。稍有补于斯民欤。
查对各书。言痢证者。说法不一。张景岳主温。朱丹溪主凉。喻嘉言主发汗利水。陈修园主寒热合治。皆有
至理。景岳谓夏月贪凉。过食生冷。至秋伏阴内动。应时而为下痢。佐关煎治之。此即仲景下利不止。用四
逆汤桃花汤之意。乃虚寒治法。然必须有虚寒实据。乃用此法。朱丹溪谓湿热蒸灼。气血为粘腻。用黄连
解毒汤。是即仲景白头翁汤意也。此类最多。然必有热证之实据。乃用此法。喻嘉言谓宜从汗先解其外。
外邪内陷而为痢。必用逆流挽舟之法。引其邪而出于外。人参败毒散主之。此即仲景协热下痢。用葛根
黄连黄芩汤之意。第仲景升发邪气。兼清其热。而喻则辛温升散。未能两面俱到。即如仲景白头翁汤。亦
取白头翁。能升达其气。知开提疏发。为治下迫后重之良方。喻嘉言自以逆流挽舟。独得其秘。而未能根
柢仲景。是以得半遗全。吾拟用柴胡汤。去半夏加花粉当归白芍枳壳粉葛。自谓升发清降。两得其治。喻
氏又谓若热已奔迫大肠者。毋庸更从外解。急开支河。从小便而顺导之。金匮紫参汤。诃黎勒散主之。此
即仲景利不止者。当利其小便之意。大清凉散。药彻内外。最有力。从高原导水。使不浸渍肠胃。拟用甘桔
汤。加桑皮杏仁枳壳防己木通石膏云苓苡仁柴胡薄荷生姜白芍治之。斯于喻氏发表利水之法。或更
有发明。陈修园谓。此证有脏寒腑热。胃寒肠热之辨。仲景泻心汤。择用如神。余谓寒热合病。必有寒热兼
见之实证。不得笼统言之。而混用寒热杂方也。即如仲景乌梅丸。所治之证。消渴气上冲心。心中疼热。饥
不欲食。此热证之实据也。食即吐蛔。下之利不止。此寒证之实据也。惟其有此腑热脏寒之实据。故用乌
梅丸。兼寒热治之。又如仲景生姜泻心汤。所治之证云。心下痞硬。干噫食臭。此火证也。胁下有水气。腹中
雷鸣。此水病也。惟其有此火在胃中。水在肠间之实据。故用生姜泻心汤治之。初头硬。大便后半溏者。此
胃中有寒。肠中有热。陈修园拟用理中汤。加大黄。此皆有寒热兼见之实据。医者辨证必如是之严。而后
用药处方。不失铢黍。以上四家治法。合而用之。而治痢不虞束手矣。
黄坤载曰。人之大便。所以不失其常者。以肺主传送。而肠不停。肝主疏泄。而肛不闭。宜用参术以助肺之
传送。用桂枝以助肝之疏泄。此黄氏论大便秘结之语也。吾从此语旁通之。而因得痢证之原。以知痢者。
肺气传送太力。故暴注大肠。肝气郁而不疏。故肛门闭塞。欲便不便。而为逼胀。此从黄氏之论推求之。而
痢证迫而不通之故。诚可识矣。第桂枝参术。与痢证不合。痢证肺气之奔迫。以其火热暴注也。故伤寒论
饮食入胃。即下利。清水完谷者。乃肺之传送太急。热之至也。宜急下之。据此则治奔迫者。当以清火为主。
人参清肺泻肺二汤治之。肝气不得疏泄。亦由木郁为火。结而不畅。桂枝温木。是益其火。得毋虑不戢自
焚乎。观仲景白头翁汤。用秦皮白头翁。以凉达肝木。四逆散。里急后重者。加薤白以疏郁。则知助肝疏泄
之法矣。当归芦荟丸。泻肝汤。丹栀逍遥散。加减治之。至于和肝调肺。止奔迫。解郁闭。一方而肝肺并治者。
自古无之。余拟用白头翁汤。加石膏知母杏仁桔梗枳壳槟榔柴胡麦芽当归白芍甘草治之。轻剂则用
小柴胡。加归芍杏仁桔梗枳壳槟榔麦芽花粉。调和肺肝。则肺气不迫注。肝气得开利矣。又或肝气欲泄
而下注。肺气欲收而不开。故痢多发于秋。秋金肺气闭而不开。肝气决裂而不遏。是以迫痛。此又从黄氏
之义。另翻一解。而各书均不载者也。治宜甘桔汤。加白芍。以桔梗开提肺气。以白芍平治肝木。本此意以
为加减。则鳖甲龙胆草青皮秦皮芦荟。皆平肝之药。当归生地桃仁五灵脂延胡索。皆治肝经血分之药。
黄芩麦门冬桑皮知母。皆清肺之药。枳壳贝母杏仁陈皮。皆肺经调气之药。随宜致用。变化在人。乌有不
治之痢哉。
调血则便脓自愈。调气则后重自除。此二语。为千古治痢之定法。而亦相沿治痢之套法耳。盖泛言调血。
则归芍地榆用尽而不效。泛言调气。而陈皮木香多服而无功。不知木香陈皮。乃调脾气之药。痢虽脾病。
而其所以逼迫者。肝肺之咎也。知调肝肺。则善调气矣。血乃血海所总司。血海居大肠之间。故痢症脐下
极痛者。必有脓血。痛不甚者无脓血。以脐下血海之血痛故也。知理血海。则善治血矣。
普明子谓痢证多兼食积。宜用枳壳浓朴大黄。轻则用山楂神曲莱菔子麦芽。此论最浅而中肯。
久痢不止。肺气下泄。则魄随之陷。而魄脱则死。肺藏魄。治宜调补肺气。人参清肺汤以固之。如寒滑者。桃
花汤治之。仲景诃黎勒散。即是清肺固脱之方。四神丸。乌梅丸。皆是桃花汤之义。方难尽举。升提固涩。总
须分寒热用药。斯无差爽。
休息痢者。止而复作。乃固涩太早。留邪在内。故时复发作。治宜按上治痢之法。视何经见证。则用何经之
药。以消除其邪。伏邪既去。而邪自不作。如羊脂白蜜黄连末服。不过取滑去着。寒去火之义。尤未若视其
邪所发见之情。而分经用药。更为对证。
又补论曰。凡噤口痢。上噤下痢。法宜和中。此与霍乱对看自明。霍乱上吐下泻。必以和中而愈。则知噤口
痢。上噤下痢。亦必以和中而愈。第霍乱是中寒而发。为上下俱脱之证。法主理中汤以温之。噤口痢上闭
This syndrome has two types. One is internal abscess (a purulent lesion occurring in the internal organs). The other is dysentery.
If the internal abscess occurs in the Upper and Middle Jiao, its pus has already ruptured and is vomited out. If it occurs in the Lower Jiao, the pus and blood from the lower abdomen, small intestine, hypochondrium, and liver will all be excreted through the stool. At the initial stage, the affected area must have a dull, stabbing pain and fullness, with a pulse that is deep, slippery, and rapid. In severe cases, the pain feels like being stabbed by a knife or awl. Anyone prone to this condition invariably experiences thirst. Generally, blood stasis should cause thirst. Because at the beginning, the blood has coagulated, thirst should occur. At this time, it is urgent to purge the blood so that it does not turn into pus, thereby avoiding the danger of ulceration. Use Danpi Tang (Moutan Decoction), adding Rush Xiang (Frankincense), Mo Yao (Myrrh), Chai Hu (Bupleurum Root), Jing Jie (Schizonepeta Spike), and Shan Jia (Pangolin Scales) for treatment. If the blood has already turned into pus, it is appropriate to drain the pus. Chidou Yiren Tang (Red Bean and Coix Seed Decoction) expels water, which is equivalent to draining pus. After rupture, it belongs to deficiency, and it is appropriate to tonify and nourish to generate flesh, primarily using Bazhen Tang (Eight Treasure Decoction). Refer to the section on vomiting pus for details.
A guest asked: Why does blood stasis transform into pus? I answered: Blood is the substance of Yin. It circulates with Qi. When Qi is vigorous, blood is abundant; when Qi is weak, blood is depleted; when Qi stagnates, blood stasis occurs; when Qi ascends, blood surges. Therefore, the movement of blood is driven by Qi. Even the movement of blood stasis depends on the movement of Qi. When blood stasis lodges between the meridians and Zang-Fu organs, it has no feet to walk and no gate to exit. It relies solely on Qi to move it, allowing it to reach the intestines and stomach via the fatty membranes and be excreted with the stool. This means that when Qi moves, blood naturally does not remain. If Qi does not move it but instead binds with it, pain occurs because Qi is constrained by blood, and pus forms because blood is steamed by Qi. Now, taking external sores as an analogy: when Qi is strong, sores easily push out toxins and suppurate; when Qi is weak, sores struggle to push out toxins and suppurate. Qi is essentially Water. Where Qi arrives, Water arrives. Thus, when blood follows Qi transformation, it takes the form of Water and becomes pus. A knife wound exposed to water also suppurates due to water. Water is the substance of Qi. Blood following Qi transformation is like this. Therefore, in traumatic blood stasis, if Qi transforms it, swelling turns into pus; if Qi does not transform it, swelling remains as blood. From this, we know that blood follows Qi, and Qi moves blood. Whenever treating blood disorders, one must regulate Qi, ensuring that Qi serves blood rather than becoming diseased by blood. This is the key.
In cases of dysentery with pus in the stool, symptoms include tenesmus (urgent desire to defecate with heavy sensation in the anus), difficulty in passing stool, white discharge, red discharge, mixed red and white, or turbid foul discharge. These are not true pus but resemble it. Inside the stomach and intestines, apart from waste, there is only a small amount of lipid fluid and aqueous fluid. Lipids belong to the Blood aspect, and aqueous fluids belong to the Qi aspect. Disease in the Qi aspect causes turbid water leading to white dysentery; disease in the Blood aspect causes disturbed blood leading to red dysentery. When both Qi and Blood are diseased, red and white mix. How can true pus be brewed and excreted from the large intestine? There is a case where toxic pathogens gather in the intestines and stomach, steaming the lipids, flesh, and blood into pus. The discharge may look like rotten melon or leaking roof water. This is a critical sign of intestinal corrosion and gastric ulceration, indistinguishable from the rotting of external sores. This cannot be cured by ordinary methods for treating dysentery. I now use Zhang Zhongjing’s methods to verify this, gaining bold and insightful techniques. Zhang Zhongjing stated: In Yangming disease, if the pulse is rapid and diarrhea persists, heat must accompany it, causing pus and blood in the stool. In Shaoyin disease, if there is diarrhea with pus and blood, acupuncture may be used. In Jueyin disease, if the pulse is rapid and there is thirst, pus and blood will certainly be passed due to heat. Although no formulas were provided here, saying "acupuncture may be used" and "due to heat" indicates methods for draining dampness and clearing heat. Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder), removing Mahuang (Ephedra Herb) and Mangxiao (Mirabilite), adding Chidou (Red Bean) and Fangji (Stephania Root), serves as a major formula for releasing exterior and interior excess. Diyü San (Sanguisorba Powder) is a general formula for clearing heat. Zhang Zhongjing also said: In Shaoyin disease, if there is diarrhea with pus and blood, Taohua Tang (Peach Flower Decoction) is indicated. This decoction is warming and astringent, seemingly contradicting the statements about acupuncture and heat. However, prolonged illness leads to heat being expelled with pus and blood, transforming excess into deficiency. Observing that internal abscesses become deficient after pus rupture, we know that prolonged pus and blood in stool also indicate deficiency. Like weather, initially scorching hot, suddenly cooling winds shake leaves. Those wearing summer linen must change to winter furs. Moreover, since gastrointestinal blood has turned to pus, fearing slippage, Taohua Tang is used to warm, astringe, and fill. One dose cures; do not take more. Zhang Zhongjing’s intent was that this is an emergency method to stop slippage; after stopping, residual diseases should be cleared without injuring Qi with astringents or Yin with dryness. Pus and blood injure Yin, so dried Ginger is used sparingly as a temporary measure, and it should not be taken in large amounts later. Inferring his intent, if deficiency-heat exists after the illness, Xiaoyao San (Free and Easy Wanderer Powder) or Guipi Tang (Restore the Spleen Decoction) added with Chai Hu, Zhizi (Gardenia Fruit), Maidong (Ophiopogon Tuber), and Huafen (Trichosanthes Root) should be used. This follows the intent of using Glutinous Rice in Taohua Tang. If deficiency-cold exists, Liujunzi Tang (Six Gentlemen Decoction) added with Danggui (Angelica Sinensis), fried Ganjiang (Dried Ginger), and Baishao (White Peony Root), or Renshen Yangrong Tang (Ginseng Nourishing Courage Decoction) can be used. This follows the intent of using Dried Ginger in Taohua Tang. Cheng Wuji annotated Taohua Tang, stating that Yang syndromes with internal heat overflow fresh blood, while Yin syndromes with internal cold pass purple blood like pig liver. This clearly positions Taohua Tang as a formula for Yin syndromes. However, distinguishing Yin and Yang solely by fresh blood is not precise, as color alone is unreliable. For dysentery, one must examine if the pulse is faint, deep, slow, with cold extremities, abdominal pain relieved by pressure, pale lips, and a neutral mouth; these indicate a Yin syndrome. Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) added with Danggui, Baishao, and Muxiang (Aucklandia Root) supplements what Taohua Tang lacks. Thirst, oral heat, chest and abdominal fullness, firmness, and refusal to press indicate a Heat syndrome. Then Sanyi Chengqi Tang (Three Ones Downward-Purgative Decoction) is used. This exhausts the capabilities of Zhang Zhongjing’s "heat allows acupuncture."
For ordinary red and white dysentery, such heavy formulas are unnecessary. If the disease is in the Water aspect, white turbid discharge occurs. This is like irregular summer rains causing muddy floods, indicating severe dampness injuring Qi. If the pulse is rapid, with fever and thirst, it is damp-heat, suitable for clearing and draining. Six Commanders Powder combined with Zhuling Tang (Polyporus Decoction), removing Ejiao (Donkey-Hide Gelatin), plus Houpo (Magnolia Bark), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), and Huangbai (Phellodendron Bark). If the pulse is deep, wiry, and slow, with no thirst and cold extremities, it is cold-damp. Weiling Tang (Gastrointestinal Regulation Decoction) plus roasted Ginger. With food retention, add Maiya (Barley Sprout), Shenqu (Medicated Leaven), Shanzha (Hawthorn Fruit), and Laifuzi (Radish Seed). The cause of white dysentery is always unclear water. Water is Qi, as detailed in my Treatise on Water and Fire. Thus, regulating Qi is treating Water, and guiding Water starts from the source. Regulating Qi focuses on the Lung. Treating the Lung clears the water source, which is the root of regulating Qi. Carefully considering this disease occurs in Autumn, when Lung Metal governs Qi. If Metal is not clear and serene, water becomes turbid and Qi stagnates, causing dysentery. Knowing this, we understand that urgency stems from Lung failure to descend, and obstruction from Metal failure to contract. Renshen Xiefei Tang (Ginseng Draining Lung Decoction) guides stagnation. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Huafen, Xingren (Apricot Seed), Zhike (Aurantium Fruit), Sangbupi (Mulberry Root Bark), Fuling (Poria), Zhimu (Anemarrhena Rhizome), and Jiegeng (Platycodon Root) harmonizes. Renshen Qingfei Tang (Ginseng Clearing Lung Decoction) concludes treatment. This establishes legislation specifically for treating the Lung, showing doctors the method to follow, not implying these formulas must be used in every clinical case. Diseases rarely appear alone; lung disease always involves other organs. Thus, clinical application requires flexibility. If the disease is in the Blood aspect, pure red discharge, thirst, short urine, tenesmus, and a slippery, large pulse occur. Diyü San added with Jiujun (Wine-processed Rhubarb), Zhike, Houpo, Yiren (Coix Seed), and Zexie (Alisma Rhizome). If the pulse is fine and rapid, purgatives are unnecessary; use the original formula. If blood is dark black, pulse is slow, and extremities are cold, it belongs to deficiency-cold, treated with Huangtu Tang (Yellow Earth Decoction). The cause of red dysentery is always a Blood aspect disorder. Blood is born from Heart Fire and stored in the Liver. Liver Wood houses Ministerial Fire. Abundant blood controls fire; balanced fire generates blood. If fire is too strong, it forces blood to run recklessly, causing dysentery with stabbing pain, which is blood pain. Lung Metal governs Autumn and controls Liver Wood. If Liver Qi cannot flow freely, it becomes stagnant, losing its dispersing function, causing blockage. Regulating the Liver allows Wood and Fire to disperse, calming the Blood aspect. To resolve Wood and Fire stagnation, use Xiao Chaihu Tang removing Banxia (Pinellia Tuber), adding Danggui and Baishao. Baitouweng Tang (Pulsatilla Decoction) or Siwu Tang (Four Substance Decoction) added with Puhuang (Pollen Typhae), Wulingzhi (Trogopterus Dung), Yanhusuo (Corydalis Rhizome), Huangbai, Longdancao (Gentian Root), Huangqin, Chai Hu, and Sangjisheng (Taxillus Stem) can be used. If Liver Wind does not blow, Fire extinguishes. Gouteng (Uncaria Vine), Qinghao (Artemisia Annua), Baitouweng, Chai Hu, and Sangjisheng are wind-clearing agents. Jiangcan (Silkworm) and Chantui (Cicada Slough) also dispel wind. If Liver Qi is not constrained, blood flows smoothly. Xiangfu (Cyperus Rhizome), Binglang (Areca Seed), Juhe (Tangerine Kernel), Qingpi (Green Tangerine Peel), Chenxiang (Aquilaria Wood), and Muli (Oyster Shell) are agents that scatter and promote Liver Qi. Fuling, Dancao (Gentian Root), Qinpi (Fraxinus Bark), and Huangqin clear Liver Fire. Danggui, Shengdi (Rehmannia Root), Ejiao, and Baishao nourish Liver Blood. Taoren (Peach Kernel), Diyü (Sanguisorba Root), Wulingzhi, and Chuanxiong (Ligusticum Rhizome) move Liver Blood. Understanding Liver regulation makes treating bloody dysentery easy. The Liver stores blood; thus, all blood disorders ultimately involve regulating the Liver. No previous books discuss this in the dysentery section. I derived this from synthesizing various texts, originating from my Treatise on Yin-Yang, Water-Fire, Blood, and Qi. Hence, this discussion is precise, unlike others that grasp at shadows. A guest asked: All diarrhea is governed by the Spleen and Stomach. Dysentery is a type of diarrhea. Why is it not governed by the Spleen and Stomach? I replied: Seepage and洞泻 (cavity diarrhea) indeed belong to the Spleen and Stomach. Thus, the Neijing states: During late Summer, cavity diarrhea and cold center are common because late Summer is governed by the Spleen. Dysentery often occurs in Autumn, and its pathology, pulse, and symptoms differ from cavity diarrhea. Although related to the Spleen and Stomach, it primarily involves the Liver and Lung to identify the root cause.
Jinkou Li (Closed-Mouth Dysentery) involves inability to eat despite diarrhea. This is due to fire-heat and turbid qi attacking, injuring Stomach Qi so it cannot open. Most books follow Zhu Danxi, using Shilian Tang (Lotus Seed Pod Decoction). *Yizong Jinjian* (Golden Mirror of Medical Tradition) states that for severe internal heat rushing up to the heart causing vomiting and closed mouth, use Dahuang (Rhubarb Rhizome) and Huanglian with good wine decocted to attack it. Note: The ability of the stomach and intestines to accept food depends on Stomach Jin Ye (Body Fluids), which are clear, harmonious, moist, and lubricating, prompting appetite. Western medicine, though sometimes rigid, has credible points: grain entering the stomach is infused with Stomach fluids, turning it into mush. Stirring rice with saliva quickly turns it to mush. Thus, the desire to eat is entirely due to Stomach fluids. Observe dogs wanting meat; saliva flows from their mouths. This saliva is the basis of appetite. Human Stomach fluids similarly drive the desire to eat. Now, the Stomach is occupied by pathogenic heat and turbid qi. Its clear fluids turn to turbid stagnation. Flowing down to the large intestine, it causes dysentery; staying in the Stomach, it rejects food. Danxi’s Shilian Tang knows to clear fire and tonify the Stomach, but Shilian refers to lotus seeds with black shells. Modern doctors use Shilian Lianzi, whose identity is unknown, and it should absolutely not be used. Even lotus seeds have astringent properties. Dysentery requires slipperiness to remove adherence; astringency is contraindicated. Moreover, Stomach turbid stagnation requires washing and transformation to work. This formula fails to wash stagnation and transform turbidity, despite addressing cold and heat imbalance. It is not a miracle cure. Qingwen Baidu Yin (Clear Warmth Eliminate Toxin Decoction), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), Renshen Baitou Tang (Ginseng White Tiger Decoction), and Maidong Yangrong Tang (Ophiopogon Nourishing Courage Decoction), modified appropriately, can wash the Stomach and transform fluids, serving as excellent methods to open the Stomach and promote eating. For vomiting and inability to eat, *Jinjian* uses Erhuang (Dahuang and Huanglian) with wine for rapid attack against rebellion. While treating rebellion is correct, it fails to generate Stomach fluids, missing the root of eating. My opinion suggests using Da Chaihu Tang (Major Bupleurum Decoction) added with Shigao (Gypsum), Huafen, and Renshen (Ginseng). This attacks rebellion and generates fluids, opening the Stomach and promoting eating, addressing both aspects. No previous literature discusses this for Jinkou Li. I have realized this practical truth and shout it aloud. I originally sought to serve the country through writing, but realizing I cannot, perhaps inventing this principle will benefit the people.
Reviewing various books, opinions on dysentery vary. Zhang Jingyue advocates warming; Zhu Danxi advocates cooling; Yu Jiayan advocates sweating and diuresis; Chen Xiuyuan advocates combining cold and heat treatments. All have merit. Zhang Jingyue says summer cooling and excessive raw/cold food lead to latent Yin moving internally in Autumn, causing dysentery. Zuoguan Jian (Support the Gate Decoction) treats this. This aligns with Zhang Zhongjing’s use of Sini Tang (Frigid Extremities Decoction) and Taohua Tang for persistent diarrhea, representing a deficiency-cold method. It must be used only with confirmed deficiency-cold evidence. Zhu Danxi says damp-heat steams and burns, making Qi and Blood sticky. He uses Huanglian Jiedu Tang (Coptis Detoxification Decoction), aligning with Zhang Zhongjing’s Baitouweng Tang. Many such formulas exist but require confirmed heat evidence. Yu Jiayan says exterior release via sweating is first necessary; if exterior pathogens sink inward causing dysentery, use "Retrieving the Boat Against the Current" method to guide pathogens outward using Renshen Baidusan (Ginseng Dispersing Cold Powder). This aligns with Zhang Zhongjing’s Ge Gen Huang Lian Huang Qin Tang (Kudzu Coptis Scutellaria Decoction) for heat-accompanied diarrhea. However, Zhang Zhongjing raises pathogens and clears heat, while Yu uses acrid-warm ascending dispersion, failing to address both. Even Baitouweng Tang uses Baitouweng (Pulsatilla Root) to raise Qi, knowing that lifting and dispersing treats tenesmus. Yu claimed exclusive secret knowledge in "Retrieving the Boat," yet failed to fully grasp Zhang Zhongjing, obtaining half and losing the whole. I propose using Chaihu Tang removing Banxia, adding Huafen, Danggui, Baishao, Zhike, and Fenge (Kudzu Root), believing this achieves both ascending/clearing and descending. Yu also said if heat rushes to the Large Intestine, do not release from the exterior; instead, open side channels and guide via urination. *Jingui Yaolue*’s Zishen Tang (Purple Ginseng Decoction) and Helile San (Chebulic Myrobalan Powder) treat this. This aligns with Zhang Zhongjing’s "for persistent diarrhea, promote urination." Daqingliang San (Great Cooling Powder) penetrates interior and exterior with strong power. Guiding water from high sources prevents intestinal soaking. I propose Ganjie Tang (Licorice and Platycodon Decoction) added with Sangbupi, Xingren, Zhike, Fangji, Mutong (Akebia Caulis), Shigao, Yunling (Poria), Yiren, Chai Hu, Bohe (Mint), Shengjiang (Fresh Ginger), and Baishao. This may further innovate Yu’s exterior-releasing and diuretic methods. Chen Xiuyuan distinguishes Zang-cold and Fu-heat, Stomach-cold and Intestine-heat. Zhang Zhongjing’s Xiexin Tang (Drain Epigastrium Decoctions) are chosen effectively. I argue that combined cold-heat disease requires simultaneous cold-heat evidence, preventing vague mixing of cold-heat formulas. For example, Wu Mei Wan (Mume Pill) treats thirst, Qi rushing to the heart, epigastric burning pain, hunger without desire to eat (heat evidence), and vomiting roundworms after eating with diarrhea upon purgation (cold evidence). Due to Fu-heat and Zang-cold evidence, Wu Mei Wan treats both cold and heat. Similarly, Shengjiang Xiexin Tang treats epigastric hardness, belching with food odor (Fire syndrome), fluid under costal margin, and borborygmus (Water disease). Due to Fire in Stomach and Water in Intestines evidence, Shengjiang Xiexin Tang is used. Initial hard stool followed by loose stool indicates Stomach cold and Intestine heat. Chen Xiuyuan proposes Lizhong Tang (Regulate the Middle Decoction) added with Dahuang. These are examples of simultaneous cold-heat evidence. Physicians must diagnose strictly to prescribe accurately. Combining these four masters' methods ensures effective dysentery treatment.
Huang Kunzai said: Normal bowel movement depends on the Lung governing transmission and intestines not retaining, and the Liver governing dispersal and anus not closing. Use Renshen and Baizhu to assist Lung transmission, and Guizhi (Cinnamon Twig) to assist Liver dispersal. This is Huang’s theory on constipation. I extended this to find the origin of dysentery: Dysentery results from excessive Lung transmission force causing sudden flooding into the Large Intestine, and Liver Qi stagnation failing to disperse, causing anal closure and tenesmus. Deriving from Huang’s theory, the obstructive nature of dysentery is understood. However, Guizhi, Renshen, and Baizhu are unsuitable for dysentery. Lung urgency in dysentery is due to violent heat flooding. Thus, *Shanghan Lun* states that food entering the stomach immediately causes diarrhea of clear water and undigested food due to overly rapid Lung transmission, the extreme of heat. Urgent purgation is needed. Based on this, treating urgency requires clearing fire, using Renshen Qingfei Tang and Xiefei Tang. Liver Qi failure to disperse is due to Wood stagnation turning to Fire, knotting without smooth flow. Guizhi warms Wood, increasing Fire, risking self-immolation. Observing Zhang Zhongjing’s Baitouweng Tang uses Qinpi (Ash Bark) and Baitouweng to cool and reach Liver Wood; Six Commanders Powder adds Xiebai (Macrostemon Bulb) for tenesmus to disperse stagnation, revealing methods to assist Liver dispersal. Danggui Lu Hui Wan (Angelica Aloe Pill), Xiegan Tang (Drain Liver Decoction), and Danzhi Xiaoyao San (Moutan and Gardenia Free Wanderer Powder) treat this with modifications. Harmonizing Liver and Lung, stopping urgency, resolving stagnation in one formula treating both has never existed. I propose Baitouweng Tang added with Shigao, Zhimu, Xingren, Jiegeng, Zhike, Binglang, Chai Hu, Maiya, Danggui, Baishao, and Gancao. For mild cases, Xiao Chaihu Tang added with Danggui, Baishao, Xingren, Jiegeng, Zhike, Binglang, Maiya, and Huafen harmonizes Lung and Liver, preventing Lung urgency and enabling Liver dispersal. Alternatively, Liver Qi desires discharge but sinks downward, while Lung Qi desires contraction but fails to open, causing frequent Autumn dysentery. Autumn Metal Lung Qi closes and fails to open; Liver Qi ruptures and fails to restrain, causing urgency and pain. This offers another interpretation based on Huang’s meaning, unrecorded in other books. Treatment uses Ganjie Tang added with Baishao. Jiegeng lifts Lung Qi; Baishao pacifies Liver Wood. Modifications include Biejia (Turtle Shell), Longdancao, Qingpi, Qinpi, and Luhui (Aloe) for Liver; Danggui, Shengdi, Taoren, Wulingzhi, and Yanhusuo for Liver Blood; Huangqin, Maidong, Sangbupi, and Zhimu for Lung; Zhike, Beimu (Fritillaria Bulb), Xingren, and Chenpi (Tangerine Peel) for Lung Qi. Application varies by case. How could dysentery remain untreatable?
Regulating Blood heals pus in stool; regulating Qi removes tenesmus. These two phrases are eternal laws for treating dysentery but have become clichés. Vaguely regulating Blood renders Danggui, Baishao, and Diyü ineffective; vaguely regulating Qi renders Chenpi and Muxiang useless over time. Muxiang and Chenpi regulate Spleen Qi. Although dysentery involves the Spleen, the urgency stems from the Liver and Lung. Knowing to regulate Liver and Lung is true Qi regulation. Blood is controlled by the Blood Sea, located between the Large Intestine. Extreme pain below the navel in dysentery indicates pus and blood; less pain indicates none, due to Blood Sea pain. Knowing to regulate the Blood Sea is true Blood treatment.
Pumingzi said dysentery often accompanies food retention, suitable for Zhike, Houpo, and Dahuang. Mild cases use Shanzha, Shenqu, Laifuzi, and Maiya. This view is simple yet accurate.
Chronic dysentery depletes Lung Qi, causing Po (Corporeal Soul) to sink; Po loss leads to death. The Lung stores Po; treatment tonifies Lung Qi with Renshen Qingfei Tang. For cold-slippery types, Taohua Tang is used. Zhang Zhongjing’s Helile San is a Lung-clearing and consolidation formula. Sishen Wan (Four Spirits Pill) and Wu Mei Wan follow Taohua Tang’s principles. Formulas are numerous; lifting and consolidating must distinguish cold and heat to avoid error.
Xiu Xi Li (Resting Dysentery) stops and recurs due to premature astringency trapping pathogens. Treatment follows standard dysentery methods, using meridian-specific herbs to eliminate pathogens. Once latent pathogens are gone, recurrence ceases. Using Sheep Fat, White Honey, and Huanglian powder merely uses slipperiness to remove adherence and cold to remove fire. It is inferior to targeting specific pathogen manifestations with meridian-specific herbs.
Supplementary discussion: Jinkou Li (upper closure, lower diarrhea) requires harmonizing the Middle. Comparing with Huoluan (Vomiting and Diarrhea) clarifies this. Huoluan involves upper vomiting and lower diarrhea, cured by harmonizing the Middle. Thus, Jinkou Li is also cured by harmonizing the Middle. However, Huoluan arises from Middle Cold with upper/lower collapse, treated with Lizhong Tang to warm. Jinkou Li involves upper closure...