大意
饮食不节。起居不时。阴受之则入五脏。闭塞滞下。为飧泄肠癖。（内经）滞下者。谓气食滞于下焦。肠癖者。谓
湿热积于肠中。即今之痢疾也。（汇补）故曰。无积不成痢。痢乃湿热食积三者。（杂着）
内因
生冷油腻。留滞于内。湿蒸热瘀。伏而不作。偶为调摄失宜。风寒暑湿。干触秽浊。故为此疾。（指掌）其多发于
夏秋者。因脾主长夏。脾感酷暑。肺金亦病。至秋阳气收敛。火气下降。肺传大肠。并迫而为病也。（医统）
外候
或脓或血。或脓血相杂。或纯肠垢。或无糟粕。或糟粕相杂。虽有痛不痛大痛之分。然皆里急后重。逼迫恼
人。（丹溪）若初起有恶寒发热。头疼身痛者。带表症也。初起有心烦口渴。腹痛呕吐者。里实症也。（汇补）
分寒热
痢起夏秋。湿热交蒸。本乎天也。因热求凉。过吞生冷。由于人也。气壮而伤于天者。郁热为多。气弱而伤于
人者。阴寒为甚。湿土寄旺四时。或从火化。则阳土有余。而湿热为病。或从水化。则阴土不足。而寒湿为病。（必读）
辨虚实
胀满恶食。急痛惧按者。实也。烦渴引饮。喜冷畏热者。热也。脉强而实者。实也。脉数而滑者。热也。外此无非
虚寒矣。其相似之际。最当审察。如口渴而喜冷者。为热。口渴而喜热者。为寒。腹痛而胀闷者。为实。腹痛而
喜按者。为虚。溺短而赤涩者。为热。溺短而清白者。为寒。后重而新病为实。后重而久病为虚。脉大而沉实
为实。脉大而浮洪亦虚。（必读）
辨五色
湿热之积。干于血分则赤。干于气分则白。赤白兼见。气血俱病也。纯下清血者。伤风也。色如豆汁者。伤湿
也。淡黄挟白者。食积也。微红焦黄者。热毒也。紫黑血丝者。瘀血也。杂下散血者。损伤也。如鱼脑者。脾失运
而陈积不腐也。如冻胶者。肠胃冷而真液下脱也。如白脓者。虚而挟热。津液努责而结也。如屋漏水尘腐
色者。元气弱极也。如鸡肝色者。百脉皆伤也。（汇补）
辨寒热
世俗多以白为寒。赤为热。似矣。然白色亦有属热者。如谷食腐熟而成脓也。赤色赤有属寒者。因血瘀凝
泣而入肠也。不可以赤白为准。但当以脉辨之。（医统）
积分新旧
旧积者。湿热食积也。当推荡。新积者。下后又生也。当调补。不可轻攻。脾运而积自化。若因虚而痢。虽旧积
亦不可下。虚回而痢自止。丹溪有先用参术。补完胃气而后下者。亦一时之权宜也。（汇补）
邪分逆顺
先水泻。后便脓。此脾传肾之贼邪。为逆。难愈。先脓血。后水泻。此肾传脾之微邪。为顺。易愈。（丹溪）
里急分辨
里急而不及更衣者。火也。火性急速。能燥物也。里急而频见更衣者。虚也。元气滑脱。不禁固也。（汇补）
后重分辨
邪迫而后重者。至圊积减。未几复作。此大肠经积滞。不能宣通也。虚滑而复重者。至圊不减。后反加甚。此
肺脾气降。不能发升也。（医统）
身热分辨
初痢身热脉浮者。可解表。初痢身热脉沉者。可攻下。久痢身热脉虚者。正虚可治。久痢身热脉大者。邪盛
难医。（汇补）
腹痛分辨
痢疾腹痛。乃肺金之气郁在大肠。宜苦梗开之。丹溪后随症用药。因积滞者。腹必胀满。血虚者。痛必喜按。
又有虚寒作痛者。必久痢见之。（汇补）
色黑分辨
下痢色黑有三。黑而焦色者。热极反见水化也。黑而有光如漆者。瘀血也。黑如尘腐者。乃死症耳。（汇补）
呕逆分辨
痢而呕者。胃气不和也。心法有胃中火逆而呕者。有毒瓦斯上攻而呕者。有胃虚而呕者。有肝旺而呕者。大
率久痢见之为逆。（汇补）
气滞痢
七情乖乱。气不宣通。郁滞肠间。触发积物。去如蟹渤。拘急独甚。必兼胸宇不宽。首宜化气。（汇补）
食积痢
饮食过多。脾胃不运。生冷失调。湿热乃成。痢下黄色。或如鱼脑。腹痛胀满。不嗜饮食。宜消导。（汇补）
时疫痢
有一方一家之内。上下传染。长幼相似。是疫毒痢也。
当察运气之相胜。以发散疫邪。（大全）不可用克导攻下之剂。
瘀血痢
凡饱食疾走。极力叫号。跌仆受伤。郁怒不泄。以及妇人经行产后。误吞生冷。恶血不行。凝滞于内。侵入肠
间而成痢疾。纯下紫黑恶血。脉现芤细结促。治当祛瘀。（汇补）
噤口痢
痢而能食。知胃未病。有脾家湿热。熏蒸清道而成噤口者。亦有脾胃素虚者。亦有误服利药。犯其胃气者。
亦有服涩剂太早者。如胃弱气陷。绝不思食。则难治矣。如大虚大热者。以人参同姜炒黄连煎汤。时时呷
之。或单用石莲肉炒香煎服。外用田螺捣烂。入麝一分。纳入脐中。引热下行。（汇补）
休息痢
屡止屡发。经年不愈。名曰休息。多因兜涩太早。积热未清所致。亦有调理失宜。亦有过服寒凉。亦有元气
下陷。亦有肾虚不固。均能患此。（医统）
虚滑痢
劳役过度。中州衰损。四肢困倦。谷食难化。下痢糟粕。腹中微痛。但有虚坐。并无努责。六脉沉伏。或应指模
糊。治宜调补。不可以常例治之。亦有痢久不愈而变成者。治法相同。如再用寒凉行气。则恶寒厥逆自汗
昏沉等症立见矣。须大剂辛温之品补之。
阴虚痢
有素患阴虚。偶感寒邪。腹痛下痢。里急后重。赤白稠浊。或见红水。发热夜甚。烦渴不宁。胸中似饥。得食则
胀。治以清解热邪。兼滋阴血。庶可保全。设用凉血攻积补气破气治之。必死。如白芍、生地、丹皮、山药、甘、桔、
阿胶、石莲、赤苓、陈皮、风、米、泽泻之类。（寓意草）
蛲虫痢
胃弱肠虚。则蛲虫下乘。或痛或痒。从谷道中出。其形极细。乃九虫之一也。宜清热杀虫。（医统）
虫疰痢
痢下黑色。形如鸡肝。口燥大渴。五内切痛。由服金石汤丸。逼损真阴。其血自百脉经络而来。难治。（医统）
痢分轻重
凡痢身不热者轻。身热者重。能食者轻。不能食者重。绝不食者死。（汇补）
疟痢前后
疟痢二症。同因暑邪饮食失宜。致有疟后发痢者。由汗多亡阳。元气下陷。后重里急。似痢非痢也。亦有痢
后发疟者。因下多亡阴。荣卫失调。寒热交争。似疟非疟也。俱不可纯用攻剂。若疟痢兼发者。内有积滞。外
受风寒。可双解之。（医统）
死症
下痢纯血者死。如尘腐色者死。如屋漏水者死。如鱼脑如猪肝者。半死半生。气短呃逆者死。唇若涂朱者
死。大孔如竹筒者死。身热脉弦者。半生半死。脉细。皮寒。气少。泄痢前后。饮食不入。五虚者死。直肠自下者
死。久痢。忽大下结粪者死。小儿出痘。即发痢者死。妇人新产。即发痢者亦死。（汇补）
脉法
肠癖下脓血脉沉小滑利者吉。浮洪弦数者凶。又洪弦者重。浮大者未止。微弱者自愈。虽发热不死。惟弦
急者难治。（汇补）
治法
和血则便脓自愈。行气则后重自除。（内经）后重则宜下。腹痛则宜和。身重则除湿。脉弦则祛风。（东垣）因于
湿热者。去其湿热。因于积滞者。去其积滞。因于气者调之。因于血者和之。新感而实者。可以通因通用。久
病而虚者。可以塞因塞用。（必读）
初痢忌涩
初痢之法。化滞清热。直候积消毒散。脾胃已和。气血将复。方可调补。不可遽用肉蔻、诃子、白术辈。以补住
湿热。不可妄投粟壳、龙骨、乌梅等。以秘涩肠胃。恐邪得补而愈甚。腹痛欲死。变症百出。日久延迁而未已也。
（心法）
久痢忌攻
气本下陷。而再行其气。后重不益甚乎。中本虚衰。而复攻其积。元气不愈竭乎。湿热伤血者。自宜调血。若
过行推荡。血不转伤乎。津亡作渴者。自宜止泄。若但与渗利。津不转耗乎。（必读）
痢有汗法
初起发热恶寒。头疼身痛。表症见者。即宜发散。所谓风邪内结者。汗之是也。（医统）
痢有补法
脉来微弱者可补。形色虚薄者可补。病后而痢者可补。因攻而剧者可补。（必读）
痢久补脾
久痢体虚气弱滑脱。徒知止涩。竟难奏效。殊不知元气下陷。当用升提补气。如参、 、白术、升麻之属。自能
渐愈。甚者灸气海天枢百会穴。（医统）如食少者。专调脾胃。饮食进而气血和。盖痢以胃气为本也。（入门）
痢久补肾
肾为胃关。开窍于二阴。未有久痢而肾不虚。故治痢不知补肾。非其治也。盖病在火衰。土位无母。设非桂、
附大补命门。以复肾中之阳。以救脾家之母。则门户何由而固。真元何由而复。（士材）
用药
主以保和丸。赤痢。加川芎、当归。白痢。加苍术。腹痛。加当归、芍药。后重。倍槟榔、枳壳。小水赤涩。加
茯苓、木通。肛门热痛。加大黄、朴硝。此通导之法。凡实热者用之。若赤痢久而血虚者。四物汤。加阿胶、陈皮、
白术、甘草。白痢久而气虚者。四君子汤。加黄 、扁豆、木香、砂仁。痢久而后重不去。此元气下陷。补中益气汤。
痢久而积滞不化。为脾气不运。六君子汤。中焦寒者。理中汤。下焦虚者。四神丸。此温补之法。凡虚寒者用之。若血
瘀痢者。用当归、桃仁、赤芍、枳壳、甘草、黄芩、香附、陈皮、肉桂。若食积痢者。用化滞汤。加山楂、枳壳、木香、
砂仁。此疏利之法。凡内伤气食者宜之。若时疫痢者。用防风汤。加羌活、白芷、柴胡、川芎。此发散之例。凡外感风
寒者用之。若噤口痢者。香连丸。同石莲肉、竹茹、枇杷叶、苍术。徐徐呷下。此清解之例。凡虚热者宜之。若秽
尽气虚。用芍药汤。加参、 、苓、术、诃黎、粟壳、乌梅、肉果、香椿皮。此兜涩之剂。凡滑脱者宜之。若阳邪
陷入阴中。脉沉数有力。肌肤晦黑者。初则升散。用人参败毒散。后则升补。用补中益气汤。服药时外宜坐殿肛门。
努力忍便。直待药势已行。皮间汗润而止。务使内陷之邪。提之转从表出。所以挽其不趋之势也。凡初痢
腹痛。不可骤用参术。虽胃气虚弱。亦当禁之。
痢疾选方
保和丸（方见伤食） 理中汤（方见中寒）
芍药汤 治下痢脓血。里急后重诸症。
芍药（二两） 当归 黄连 黄芩（各半两） 大黄（三钱） 肉桂（二钱五分）
槟榔 甘草（各三钱） 木香（一钱）
每服五钱。水煎。加枳壳。名导气汤。
化滞汤 治下痢因于食积气滞者。
青皮 陈皮 浓朴 枳实 黄芩 黄连
当归 芍药（各二钱） 木香（五分） 槟榔（八分） 滑石（三分） 甘草（四分）
加味平胃散 治下痢因于湿蒸热郁者。
苍术 陈皮 甘草 黄芩 黄连 槟榔
茯苓 木香 泽泻 木通
加味防风汤 治下痢困于风邪时疫者。必有表症。乃可用之。
麻黄 防风 苍术 川芎 本 羌活
白芷 桔梗 芍药 甘草
香连丸（直指） 统治痢疾初起。乃和平之剂。
黄连（十两） 木香（四两）
末之。醋糊丸。淡姜汤下。（随症加入）
芩术汤 统治痢疾积去调理之剂。
白术（一两） 黄芩（七钱） 甘草（三钱）
每服三钱。水煎。
黄芩汤。
黄芩（二钱） 芍药（一钱半） 甘草（五分）
真人养脏汤（和剂） 治痢久脾肾俱虚。肠胃不固。经年不愈者。
人参 白术 当归（各六钱） 白芍 木香（各一两六钱） 甘草
肉桂（各八钱） 肉果（半两） 粟壳（蜜炙三两半） 诃子（一两二钱）
每服四钱。水煎。久病。加附子。
四神丸 治下焦不固。下痢不止。（方见泄泻）
卫生汤
即异功散 加山药、苡仁、泽泻、黄连。
钱氏白术散 治脾虚泄痢肌热。
即四君子加木香藿香、干葛。
四君子汤 治白痢久而不愈。属气虚者。
六君子汤 治痢久而积滞不减。脾气不运者。
补中益气汤 治痢久而后重不去。属脾气下陷者。（方俱见中风）
胃风汤 治中焦虚寒。下痢不止。
人参 白术 茯苓 当归 芍药 川芎（各等分） 肉桂（减半）
水煎。一方。加干葛。
四物汤 治赤痢久而不愈。属血虚者。（方见中风）
[General Principle]
Irregular diet and improper daily routine. If the Yin aspect is affected, pathogens enter the five Zang organs, causing obstruction and stagnation in defecation, resulting in Zhixia (Dysentery) or Xunxie Changpi (Diarrhea with undigested food). The *Huangdi Neijing* states: "Zhixia" refers to Qi and food stagnating in the lower Jiao; "Changpi" refers to damp-heat accumulating in the intestines. This is what we now call dysentery. Therefore, it is said: "Without accumulation, there is no dysentery." Dysentery is caused by the combined action of damp-heat and food accumulation. (From *Zazhe*)
[Internal Causes]
Consumption of raw, cold, and greasy foods leads to retention within the body. Dampness steams and heat stasis lingers without manifesting. Occasionally, due to improper care, external pathogens such as wind, cold, summer-heat, and dampness interfere with turbid qi inside, triggering this disease. (From *Zhangzhang*) This disease occurs frequently in summer and autumn because the Spleen governs late summer. When the Spleen is affected by intense summer heat, the Lung Metal also suffers. In autumn, Yang Qi converges, and Fire Qi descends. Lung Qi transmits to the Large Intestine, forcing pathology upon it. (From *Yitong*)
[External Manifestations]
Stool may contain pus, blood, a mixture of both, only intestinal mucus, no residue, or mixed with residue. Although there are differences between painful and painless, severe and mild pain, all cases feature Liji Houzhong (tenesmus: urgent abdominal pain with frequent but scanty passage), which is distressing. (From *Danxi Xinfa*) If chills, fever, headache, and body ache appear at the onset, it indicates an accompanying Exterior Syndrome. If irritability, thirst, abdominal pain, and vomiting occur at the onset, it indicates an Interior Excess Syndrome. (From *Huibu*)
[Distinguishing Cold and Heat]
Dysentery arising in summer and autumn is due to the interaction of damp-heat, which follows natural heavenly factors. Seeking coolness and overeating raw/cold items are human factors. Those with strong constitutions affected by heavenly factors tend to have more constrained heat. Those with weak constitutions affected by human factors tend to have severe Yin-cold. Damp Earth Qi prospers in all four seasons. If transformed into Fire, Yang Earth is excessive, leading to damp-heat pathology. If transformed into Water, Yin Earth is deficient, leading to cold-damp pathology. (From *Bidu*)
[Distinguishing Deficiency and Excess]
Abdominal distension, aversion to eating, acute pain that worsens with pressure indicate Excess. Irritability, thirst with desire for fluids, preference for cold drinks, and fear of heat indicate Heat. A forceful and solid pulse indicates Excess. A rapid and slippery pulse indicates Heat. Aside from these, it is essentially Deficiency-Cold. Careful examination is crucial in similar situations. For example, thirst with preference for cold indicates Heat; thirst with preference for hot indicates Cold. Abdominal pain with distension indicates Excess; abdominal pain relieved by pressure indicates Deficiency. Scanty, red, and painful urination indicates Heat; scanty, clear, and colorless urination indicates Cold. Tenesmus in recent illness indicates Excess; tenesmus in chronic illness indicates Deficiency. A large and deep-solid pulse indicates Excess; a large and floating-hong pulse also indicates Deficiency. (From *Bidu*)
[Distinguishing Five Colors]
Damp-heat accumulation affecting the Blood level results in red stool; affecting the Qi level results in white stool. Red and white together indicate both Qi and Blood involvement. Pure clear blood indicates Wind injury. Color like bean dregs indicates Dampness injury. Pale yellow mixed with white indicates Food accumulation. Slightly red and scorched yellow indicates Heat toxicity. Purple-black with blood threads indicates Blood stasis. Mixed discharge of scattered blood indicates Injury. Resembling fish brains indicates Spleen failure to transform, with old accumulation not rotting. Resembling frozen gel indicates Cold intestines/stomach with leakage of true fluids. Resembling white pus indicates Deficiency with constrained Heat, where fluids strain and coagulate. Resembling roof leak water or dust/rot color indicates extreme Yuan Qi weakness. Resembling chicken liver color indicates damage to all vessels. (From *Huibu*)
[Distinguishing Cold and Heat (Revisited)]
Common people often consider white as Cold and red as Heat, which seems reasonable. However, white can also belong to Heat, as when grain food rots and becomes pus. Red can also belong to Cold, as when blood stasis congeals and enters the intestines. One should not rely solely on red/white distinctions but must differentiate via pulse diagnosis. (From *Yitong*)
[Distinguishing Old and New Accumulation]
Old accumulation consists of damp-heat and food stagnation and should be purged. New accumulation arises after evacuation and should be tonified; do not attack lightly. When Spleen transformation functions, accumulation resolves naturally. If dysentery is due to Deficiency, even old accumulation should not be purged; when Zheng Qi recovers, dysentery stops. Zhu Danxi advocated using Ginseng and Atractylodes first to tonify Stomach Qi before purging, which is a temporary expedient. (From *Huibu*)
[Distinguishing Pathogenic Reversal and Smoothness]
Water diarrhea preceding pus/blood stool is a "Thief Pathogen" transmitting from Spleen to Kidney, indicating Reversal (Ni), difficult to cure. Pus/blood preceding water diarrhea is a "Minor Pathogen" transmitting from Kidney to Spleen, indicating Smoothness (Shun), easy to cure. (From *Danxi Xinfa*)
[Distinguishing Liji (Tenesmus)]
Liji with inability to reach the toilet in time indicates Fire. Fire nature is swift and drying. Liji with frequent trips to the toilet indicates Deficiency. Yuan Qi is slipping and cannot consolidate. (From *Huibu*)
[Distinguishing Houzhong (Heaviness in Rectum)]
Houzhong forced by pathogen: accumulation decreases after defecation but returns shortly; this is Large Intestine channel stagnation failing to circulate. Houzhong due to deficiency/slippage: does not decrease after defecation,反而 worsens; this is Lung and Spleen Qi descending without ascending. (From *Yitong*)
[Distinguishing Body Heat]
Onset of dysentery with body heat and floating pulse: suitable for releasing the Exterior. Onset of dysentery with body heat and deep pulse: suitable for purging the Interior. Chronic dysentery with body heat and deficient pulse: Zheng Qi is deficient but treatable. Chronic dysentery with body heat and large pulse: Pathogen is excess, difficult to treat. (From *Huibu*)
[Distinguishing Abdominal Pain]
Abdominal pain in dysentery is due to Lung Metal Qi constrained in the Large Intestine; use Bitter Leaf (Kugeng) to open. Zhu Danxi later prescribed based on symptoms: if due to stagnation, abdomen must be distended; if Blood deficient, pain prefers pressure. Pain due to Deficiency-Cold appears in chronic dysentery. (From *Huibu*)
[Distinguishing Black Color]
Black stool in dysentery has three types: black and scorched indicates extreme Heat reflecting Water transformation. Black and glossy like lacquer indicates Blood stasis. Black like dust/rot indicates a death syndrome. (From *Huibu*)
[Distinguishing Vomiting/Reverse Flow]**
Dysentery with vomiting indicates Disharmony of Stomach Qi. *Xinfa* lists: vomiting due to Fire reversal in Stomach, toxic gases attacking upward, Stomach Deficiency, and Liver Excess. Generally, vomiting in chronic dysentery is a sign of Reversal (Ni). (From *Huibu*)
[Qi-Stagnation Dysentery]
Emotional disorder causes Qi blockage, stagnating in intestines, triggering accumulation. Stool resembles crab foam, with severe cramping, accompanied by chest tightness. First, resolve Qi stagnation. (From *Huibu*)
[Food-Accumulation Dysentery]
Overeating causes Spleen/Stomach failure to transform. Raw/cold imbalance creates damp-heat. Stool is yellow or like fish brains, with abdominal pain/distension and loss of appetite. Use digestion-promoting methods. (From *Huibu*)
[Epidemic Dysentery]
When infection spreads within a household among all ages, it is Epidemic Toxin Dysentery. Observe the interaction of climatic factors to disperse epidemic pathogens. Do not use harsh purgatives. (From *Daquan*)
[Blood-Stasis Dysentery]
Caused by running after full meals, shouting strenuously, falls/injuries, unexpressed anger, or women during menstruation/postpartum swallowing raw/cold items. Evil blood fails to move, stagnates internally, invades intestines. Stool is pure purple-black evil blood; pulse is Kou, fine, knotted, or intermittent. Treatment requires removing blood stasis. (From *Huibu*)
[Anorexic Dysentery (Jinkou Li)]
Dysentery with ability to eat indicates Stomach is not diseased. It can arise from Spleen damp-heat steaming clear pathways, constitutional Spleen/Stomach Deficiency, misuse of purgatives damaging Stomach Qi, or premature use of astringents. If Stomach Qi is weak and sinking with complete anorexia, it is hard to treat. For severe Deficiency-Heat, decoct Ginseng with Ginger-fried Coptis, sip slowly. Or decoct roasted Lotus Seed Endocarp alone. Externally, apply crushed Field Snail with one fen of Musk to the umbilicus to draw heat downward. (From *Huibu*)
[Intermittent Dysentery (Xiuxi Li)]
Repeatedly stopping and recurring, lasting years, called Intermitent Dysentery. Often caused by premature astringency leaving accumulated heat uncleared. Also due to improper regulation, overuse of cold herbs, sinking of Yuan Qi, or Kidney Deficiency failing to consolidate. (From *Yitong*)
[Deficiency-Slipping Dysentery]
Overwork damages the Middle Jiao. Limbs are fatigued, grains hard to digest. Stool contains residue, slight abdominal pain. Only false urge to defecate (Xu Zuo), no straining (Nu Ze). Six pulses are deep and hidden or vague. Treatment requires modulation and tonification, not standard protocols. If cold/dispersing herbs are used, chills, cold limbs, spontaneous sweating, and coma will appear. Must use large doses of Acrid-Warm tonics.
[Yin-Deficiency Dysentery]
Constitutional Yin Deficiency compounded by cold invasion causes abdominal pain, dysentery, tenesmus, thick red/white discharge or red water, night fever, irritability/thirst, hunger sensation in chest but bloating after eating. Treat by clearing Heat and nourishing Yin Blood. Using cooling-blood/purging-accumulation/Qi-tonifying/Breaking-Qi methods will cause death. Herbs include White Peony, Rehmannia, Moutan, Chinese Yam, Licorice, Platycodon, Donkey-hide Gelatin, Lotus Seed Endocarp, Alisma, Tangerine Peel, Saposhnikovia, Coix Seed, and Alisma. (From *Yuyi Cao*)
[Pinworm Dysentery]
Weak Stomach and empty Intestines allow pinworms to descend. Pain or itching, emerging from anus. Very thin, one of the nine worms. Clear Heat and kill parasites. (From *Yitong*)
[Insect-Infection Dysentery]
Black stool resembling chicken liver, dry mouth/thirst, internal cutting pain. Caused by ingesting mineral pills damaging True Yin, with blood coming from all vessels/channels. Difficult to treat. (From *Yitong*)
[Distinguishing Severity]
No body heat: mild. Body heat: severe. Can eat: mild. Cannot eat: severe. Absolutely cannot eat: death. (From *Huibu*)
[Malaria and Dysentery Sequence]
Both caused by summer-heat and dietary irregularity. Malaria followed by dysentery results from sweat depleting Yang and sinking Yuan Qi, presenting as tenesmus resembling dysentery. Dysentery followed by malaria results from excessive drainage depleting Yin and disharmonying Ying/Wei, presenting as chills/fever resembling malaria. Neither should be treated purely with purgatives. If simultaneous, with interior accumulation and exterior wind-cold, use dual resolution. (From *Yitong*)
[Death Syndromes]
Pure blood stool: death. Dust/rot color: death. Roof leak water color: death. Fish brain/liver color: half-death/half-life. Short breath/hiccup: death. Lips painted red: death. Anus like bamboo tube (prolapse): death. Body heat/wiry pulse: half-life/half-death. Pulse fine, skin cold, Qi scarce, diarrhea/vomiting, no intake (Five Deficiencies): death. Rectal prolapse: death. Chronic dysentery suddenly passing large hardened feces: death. Smallpox rash followed immediately by dysentery: death. Postpartum dysentery: death. (From *Huibu*)
[Pulse Method]
Dysentery with pus/blood: Deep, small, slippery, smooth pulses are auspicious. Floating, hong, wiry, rapid pulses are ominous. Hong/Wiry is heavy. Floating/Large means unceasing. Weak/Micro means self-healing. Fever with micro pulse is not fatal. Wiry/Rapid is difficult to treat. (From *Huibu*)
[Treatment Methods]
Harmonize Blood, and pus/blood heals naturally. Move Qi, and tenesmus removes itself. (From *Neijing*) Tenesmus requires purging; abdominal pain requires harmonizing; heavy body requires removing dampness; wiry pulse requires dispelling wind. (From *Dongyuan*) Remove damp-heat if due to damp-heat. Remove accumulation if due to stagnation. Regulate if due to Qi. Harmonize if due to Blood. Recent/excess patterns: use "Tong Yin Yong Tong" (treat obstruction with draining). Chronic/deficient patterns: use "Sai Yin Sai Yong" (treat deficiency with astringing). (From *Bidu*)
[Initial Dysentery: Avoid Astringents]
Initial treatment: resolve stagnation, clear heat. Only after accumulation dissipates, Stomach/Spleen harmonize, and Qi/Blood recover, should tonification begin. Do not abruptly use Myristica, Terminalia, or Atractylodes to trap damp-heat. Do not recklessly use Poppy Shell, Dragon Bone, or Sour Plum to seal intestines. Fear that pathogens gain strength from tonification, causing severe pain and myriad complications. (From *Xinfa*)
[Chronic Dysentery: Avoid Purging]
Qi is already sinking; moving Qi further worsens tenesmus. Middle is already deficient; purging accumulation further exhausts Yuan Qi. Damp-heat injuring Blood requires harmonizing Blood; excessive purging injures Blood more. Fluid depletion causing thirst requires stopping diarrhea; excessive diuresis consumes Fluids more. (From *Bidu*)
[Sweating Method for Dysentery]
Onset with chills, fever, headache, body ache (Exterior signs): immediate dispersal is needed. This is "Wind pathogen constrained internally, treat with sweating." (From *Yitong*)
[Tonification Method for Dysentery]
Weak pulse: tonify. Deficient appearance/form: tonify. Dysentery post-illness: tonify. Dysentery worsened by purging: tonify. (From *Bidu*)
[Long-term Dysentery: Tonify Spleen]
Chronic dysentery with deficiency, weakness, and slippage: mere astringency fails. Yuan Qi is sinking; use lifting and Qi-tonifying herbs like Ginseng, Astragalus, Atractylodes, and Cimicifuga. Severe cases: moxa Qihai, Tianshu, Baihui. If poor appetite, focus on regulating Spleen/Stomach; as intake improves, Qi/Blood harmonize. Dysentery relies on Stomach Qi as its root. (From *Rumen*)
[Long-term Dysentery: Tonify Kidney]
Kidney is the Gate of Stomach, opening at two yin orifices. Chronic dysentery always involves Kidney Deficiency. Treating dysentery without tonifying Kidney is incorrect. Disease lies in Fire Deficiency; Earth lacks Mother. Without Cinnamon and Aconite greatly tonifying Mingmen to restore Kidney Yang and save Spleen Mother, how can the gate be secured and True Yuan restored? (From *Shicai*)
[Medication]
Main formula: Baohe Wan. Red dysentery: add Chuanxiong, Angelica Sinensis. White dysentery: add Atractylodes. Abdominal pain: add Angelica Sinensis, White Peony. Tenesmus: double Areca Nut, Aurantium. Scanty/red urine: add Poria, Tetrapanax. Hot/painful anus: add Rhubarb, Mirabilite. This is the Draining method for Excess-Heat.
For chronic red dysentery with Blood Deficiency: Siwu Tang + Donkey-hide Gelatin, Tangerine Peel, Atractylodes, Licorice.
For chronic white dysentery with Qi Deficiency: Sijunzi Tang + Astragalus, Coix Seed, Aucklandia, Amomum.
For chronic tenesmus due to sinking Qi: Buzhong Yiqi Tang.
For chronic stagnation due to Spleen failure: Liujunzi Tang.
For Middle Jiao Cold: Lizhong Tang.
For Lower Jiao Deficiency: Sishen Wan. This is the Warm-Tonify method for Deficiency-Cold.
For Blood Stasis Dysentery: Angelica Sinensis, Peach Kernel, Red Peony, Aurantium, Licorice, Scutellaria, Cyperus, Tangerine Peel, Cinnamon.
For Food Accumulation Dysentery: Huazhi Tang + Hawthorn, Aurantium, Aucklandia, Amomum. This is the Dispersing-Regulating method for Internal Injury Qi/Food.
For Epidemic Dysentery: Fangfeng Tang + Notopterygium, Angelica Dahurica, Bupleurum, Chuanxiong. This is the Dispersing method for External Wind-Cold.
For Anorexic Dysentery: Xianglian Wan + Lotus Seed Endocarp, Bamboo Shavings, Loquat Leaf, Atractylodes, sip slowly. This is the Clear-Resolve method for Deficiency-Heat.
For Exhaustion/Qi Deficiency: Shaoyao Tang + Ginseng, Astragalus, Poria, Atractylodes, Terminalia, Poppy Shell, Sour Plum, Myristica, Toona Bark. This is the Astringent method for Slippage.
For Yang Pathogen sinking into Yin (deep/rapid-strong pulse, dark skin): Initially disperse/lift with Renshen Baidu San. Later lift/tonify with Buzhong Yiqi Tang. During medication, sit to hold anus, endure stool until medicine acts and skin sweats slightly. Goal: lift sunk pathogen out through Exterior.
Note: Initial dysentery with abdominal pain: do not abruptly use Ginseng/Atractylodes, even if Stomach Qi is weak.
[Selected Formulas for Dysentery]
Baohe Wan (See Food Stagnation) Lizhong Tang (See Middle Cold)
Shaoyao Tang: Treats dysentery with pus/blood, tenesmus.
Peony (2 liang), Angelica, Coptis, Scutellaria (each 0.5 liang), Rhubarb (3 qian), Cinnamon (2.5 qian).
Areca Nut, Licorice (each 3 qian), Aucklandia (1 qian).
Take 5 qian, decoct in water. Add Aurantium, named Daoqi Tang.
Huazhi Tang: Treats dysentery due to food accumulation/Qi stagnation.
Green Tangerine Peel, Tangerine Peel, Magnolia Bark, Immature Bitter Orange, Scutellaria, Coptis.
Angelica, Peony (each 2 qian), Aucklandia (0.5 qian), Areca Nut (0.8 qian), Talc (0.3 qian), Licorice (0.4 qian).
Jiawei Pingwei San: Treats dysentery due to damp-steaming/heat-constraint.
Atractylodes, Tangerine Peel, Licorice, Scutellaria, Coptis, Areca Nut.
Poria, Aucklandia, Alisma, Tetrapanax.
Jiawei Fangfeng Tang: Treats dysentery constrained by Wind/Epidemic. Must have Exterior signs.
Ephedra, Saposhnikovia, Atractylodes, Chuanxiong, Ligusticum, Notopterygium.
Angelica Dahurica, Platycodon, Peony, Licorice.
Xianglian Wan (Zhizhi): General for initial dysentery, a gentle formula.
Coptis (10 liang), Aucklandia (4 liang).
Powder, pill with vinegar paste, take with light ginger soup. (Add based on symptoms).
Qinzhu Tang: General for regulating after accumulation clears.
Atractylodes (1 liang), Scutellaria (7 qian), Licorice (3 qian).
Take 3 qian, decoct.
Huangqi Tang.
Scutellaria (2 qian), Peony (1.5 qian), Licorice (0.5 qian).
Zhenren Yangzang Tang (Heji): Treats chronic dysentery with Spleen/Kidney deficiency, insecure intestines, lasting years.
Ginseng, Atractylodes, Angelica (each 6 qian), White Peony, Aucklandia (each 1.6 liang), Licorice.
Cinnamon (each 8 qian), Myristica (0.5 liang), Poppy Shell (honey-fried 3.5 liang), Terminalia (1.2 liang).
Take 4 qian, decoct. For chronic illness, add Aconite.
Sishen Wan: Treats Lower Jiao insecurity, continuous dysentery. (See Diarrhea)
Weisheng Tang
Is Yigong San + Chinese Yam, Coix Seed, Alisma, Coptis.
Qian's Baizhu San: Treats Spleen Deficiency diarrhea/dysentery with muscle heat.
Is Sijunzi + Aucklandia, Patchouli, Kudzu Root.
Sijunzi Tang: Treats chronic white dysentery due to Qi Deficiency.
Liujunzi Tang: Treats chronic dysentery with persistent stagnation due to Spleen failure.
Buzhong Yiqi Tang: Treats chronic tenesmus due to Spleen Qi sinking. (See Stroke)
Weifeng Tang: Treats Middle Jiao Deficiency-Cold, continuous dysentery.
Ginseng, Atractylodes, Poria, Angelica, Peony, Chuanxiong (equal parts), Cinnamon (half dose).
Decoct. One variation adds Kudzu Root.
Siwu Tang: Treats chronic red dysentery due to Blood Deficiency. (See Stroke)