痢之一症。古名滞下。以肠胃之中。先有积滞而后下也。痢乃后人之伪名。先贤论之详矣。今则世俗通称为痢而
治痢之法。非通即涩。方书亦复如是。近洋烟入于中国。凡食洋烟而病痢者。名曰烟痢。病患先自胆怯。必求峻补
速至。医者不知此理。每以漫补止涩而坏事。故不得不辨论之。盖吸烟之大便。每多燥结。平日有五六日一更衣
者。有十余日而始一行者。而其所食。未必不与不吸烟者等。则其肠中之积垢。年深月久。可胜道哉。故必通之而
始安。余亲见一门子某。素有烟癖。瘾且甚大。后因署中事忙。不暇吸食。每以烟泡过瘾。病痢数月。形如骨立。腹痛
后重。一医主以下药。下黑粪如羊矢者甚多。视之皆未化之烟泡也。由是遂愈。而烟瘾亦不作矣。又一鲍姓者。先
自吸洋烟。后因歇业。戒而不吸。二年余矣。病痢困惫甚剧。无力医治。日求仙方。一日求得百部一两。众谓此物能
杀虱。岂可服一两之多。即服宜减之。病者坚信不摇。服之。腹大痛。众骇极。少顷登厕。下黑小虫数碗。病如失。自
是縻粥调养。亦不服药。胃气渐旺。身体壮盛。反逾于昔。然痢之宜下。不独食烟者为然也。又一宁波人。客游闽地。
一日啖鲜荔枝百余颗。而回宁已十余年矣。患痢疾久之不愈。一医视之。谓病虽久。腹痛拒按。尚有积滞。宜下之。乃
用硝黄等药。果下宿物甚多。视之皆鲜荔枝也。下后而病霍然。可知食积肠胃。虽十余年之久。而尚能不化。仍是
原物泻出。夫痢病古称滞下。其命名可想见矣。以不吸烟之人。患是症者。宜通降行气。十之八九。至有久病纯虚。
魄门不藏。而腹不痛。或便出无度而不自知者。又当别论。总之吸烟之人。肠中积宿。愈久愈坚。岂可再用止涩耶。
或曰吸烟之体多虚。若再下之。难保不暴脱也。余曰。医家病家之所误者。只在此句。盖积滞在内。脾不能为胃行
其津液。胃有陈积未去。势必不能纳新。所以肌肉日削。外现之虚象百出。若得积垢一下。胃即能纳。脾即能运。何
脱之有。但病家见此虚象。一闻宜下。无不吐舌。所以为难也。而医者当委曲开导。转危为安。亦是救人之一端。切
勿附人意漫补以杀人耳。予再请以格物之理比例之。譬如久燃一灯。油足则灯明。油枯则灯暗。此自然之理也。
乃久燃者油尚有余。因其上结。灯煤。如不从而揭去之。其灯必暗。使不知致暗之油。而徒添其油以望灯之明也
难矣。明乎此。而内本真实。外视虚象者。或峻补耶。抑降下耶。此内经所云。去菀陈则正气复是也。再小儿秋患泻痢
最
多。其症由于暑秽挟食滞者。十有七八。治以芳香醒脾逐秽。内清暑邪。佐以化积之品。一二剂而即愈。其若
日久脾虚。则佐以健脾之品。余治是症。用是药。无不应手而愈。方则每多相同。其食切忌温燥。以致胃液干枯。不
能敷布于上。而为腹硬咳嗽变成疳劳之症。如芳香则宜藿香、菖蒲、佩兰叶、佛手柑等。清暑则宜鲜荷叶。鲜青蒿、
六一散、黑山栀、条芩、川连等。苦味坚肠。且以止痢也。运气则宜广皮、木香、槟榔、腹皮等。消食则宜神曲、谷芽、
麦芽、山楂、午时茶、五谷虫、鸡内金之类。健脾则宜西洋参、茯苓、炒麦冬、炒扁豆、甘草、粳米之类。养胃阴则宜
石斛、麦冬、木瓜、乌梅之类。利小便则宜车前子、泽泻、滑石之类。杀虫则宜胡黄连、榧子、使君子、槟榔之类。然
必佐以甘药以诱之。使虫喜甘而求食也。儿医之治泻痢。每用葛根。观叶氏书。当知所忌。以上诸药。平淡无奇。善用
之变化无穷。秋间小儿诸病。或疳积腹硬。青筋突起。或疰夏不食。体日羸瘦。或肝强多怒多啼等症。皆可变化治之。
而药亦不出以上数味而已。盖小儿之病。多在肝脾二经。饮食果饵。伤其脾胃。脏腑柔弱。运化不逮。变生诸病。古云
伤食恶食是也。又云若要小儿身体安。常带三分饥与寒。真至论也。
痢疾这一病症，古时候称为“滞下”，是因为肠胃中先有积滞，然后才出现下痢的症状。痢是后人起的伪名，先贤们对此论述得很详细了。现在世俗通称为痢，而治疗痢疾的方法，不是用通利法就是使用固涩法，医书也是这样的。近来洋烟传入中国，凡是吸食洋烟而患痢疾的，叫做“烟痢”。患者往往首先自己感到胆怯，必定要求峻补以求速效。医生不了解这个道理，常常因为盲目进补和止涩而把事情搞坏，所以不得不加以辩论。
大概吸烟的人大便，大多干燥结硬，平时有的人五六天才排便一次，有的人十几天才排便一次。然而他们所吃的食物，未必比不吸烟的人少，那么他们肠道中的积垢，年深日久，哪里说得完呢？所以必须用通利法才能安宁。我亲眼看见一个门客某人，素来有吸烟的癖好，瘾头很大。后来因为官署中事务繁忙，无暇吸食，每次只用烟泡过瘾，结果患痢疾几个月，身体瘦得像骨头一样，腹痛且里急后重。一位医生主张用泻下药，排出了很多像羊屎一样的黑粪，仔细看都是未消化的烟泡。由此病就好了，而且烟瘾也不发作了。
又有一个姓鲍的人，先前吸食洋烟，后来歇业，戒掉不再吸，已经有两年多了。却患了痢疾，困倦疲惫非常严重，无力医治，每天求仙方。一天求得百部一两，众人说这东西能杀虱子，怎么可以吃一两那么多？即使吃也应该减量。病人坚信不疑，服用了它。肚子剧烈疼痛，众人非常惊恐。过了一会儿上厕所，排下了几碗黑色的小虫，病就像消失了一样。从此喝稀粥调养，也不再服药，胃气逐渐旺盛，身体强壮，反而比以前更好。
然而痢疾适宜用下法，不仅仅限于吸烟的人。又一个宁波人，客居福建地界，有一天吃了一百多颗鲜荔枝，回到宁波已经十多年了。患痢疾很久不好，一位医生诊视后说，病虽然久，但腹痛拒按，还有积滞，应该用下法。于是用了硝黄等药，果然排出了很多宿食，看那些东西都是鲜荔枝。下完之后病霍然痊愈。可知食积在肠胃，即使过了十几年，仍然不能消化，还是原物泻出。
痢病古称滞下，从命名就可以想见其意了。对于不吸烟的人，患这种病的，十分之八九适宜用通降行气法。至于有久病纯虚，肛门失禁，腹部不痛，或者大便失禁而不自知的，又当另外讨论。总之吸烟的人，肠中积宿，越久越坚硬，难道还可以再用止涩法吗？
有人说：吸烟的人体质多虚，如果再攻下，恐怕会导致暴脱。我说：医生和病人所误会的，只在于这句话。因为积滞在内，脾不能为胃输送津液，胃中有陈旧的积滞未去除，势必不能纳受新的食物，所以肌肉日渐消瘦，外表呈现出各种虚象。如果积垢一下去，胃就能纳受，脾就能运化，哪里有脱证呢？只是病人看到这些虚象，一听到宜用下法，没有不吓吐舌头的，所以很难办。而医生应当委婉开导，转危为安，这也是救人的一个方面。千万不要迎合人意盲目进补来杀人啊。
我再请用格物的道理来比喻。比如长久点燃一盏灯，油足则灯亮，油枯则灯暗，这是自然的道理。然而长久燃烧的灯，油尚有余，只是因为上面结了灯煤，如果不顺势揭去它，灯必然变暗。如果不明白导致灯暗的是那层结垢，而只是徒劳地添油希望灯亮，那就难了。明白了这一点，就知道内本真实、外视虚象的情况，是用峻补呢，还是用降下法呢？这就是《内经》所说的“去菀陈莝则正气复”的道理。
另外，小儿在秋季患泻痢最多，其症状由于暑秽挟带食滞的，十有七八。治疗用芳香醒脾逐秽，内清暑邪，佐以化积的药物，一二剂就能痊愈。如果是日久脾虚，则佐以健脾的药物。我治疗这类病症，用这些药，没有不随手而愈的。方子大多相同。其中饮食切忌温燥，以免导致胃液干枯，不能敷布于上，从而变成腹硬咳嗽，演变为疳劳之症。如芳香类药物适宜用藿香、石菖蒲、佩兰叶、佛手柑等；清暑适宜用鲜荷叶、鲜青蒿、六一散、黑山栀、条芩、川连等；苦味能坚肠，且能止痢；调理气机适宜用广皮、木香、槟榔、大腹皮等；消食适宜用神曲、谷芽、麦芽、山楂、午时茶、五谷虫、鸡内金之类；健脾适宜用西洋参、茯苓、炒麦冬、炒扁豆、甘草、粳米之类；养胃阴适宜用石斛、麦冬、木瓜、乌梅之类；利小便适宜用车前子、泽泻、滑石之类；杀虫适宜用胡黄连、榧子、使君子、槟榔之类。但是必须佐以甘味药物来诱导，使虫子喜欢甜味而求食。儿科医生治疗泻痢，每用葛根，观察叶天士的书，应当知道禁忌。以上诸药，平淡无奇，善于运用则变化无穷。秋季小儿的各种疾病，或者是疳积腹硬、青筋突起，或者是疰夏不食、身体日渐消瘦，或者是肝强多怒多啼等症状，都可以变化治疗。而药物也不超出以上这几味罢了。大概小儿的疾病，多在肝脾二经，饮食果饵损伤脾胃，脏腑柔弱，运化能力不足，变生各种疾病。古话说“伤食恶食”就是这个意思。又说“若要小儿身体安，常带三分饥与寒”，真是至理名言。
Dysentery, in ancient times known as "Zhi Xia" (Stagnant Downward Discharge), refers to the condition where there is initially accumulation and stagnation in the intestines and stomach before the discharge of dysenteric stool occurs. The term "Li" (Dysentery) is a later false name, which has been discussed in detail by sages of old. Nowadays, it is commonly referred to as Li, and the methods for treating dysentery are either purgative or astringent, as stated in medical texts. Recently, opium smoke entered China. Those who consume opium smoke and suffer from dysentery are said to have "Yan Li" (Opium Dysentery). Patients often feel timid and insist on vigorous tonification for rapid results. Doctors who do not understand this principle often cause harm by indiscriminately using tonics and astringents. Therefore, it is necessary to discuss this matter.
Generally, bowel movements in smokers are often dry and constipated. Some may defecate once every five or six days, while others may take ten or more days. Yet their food intake is not necessarily less than that of non-smokers. Thus, the accumulated filth in their intestines over years cannot be fully described. Hence, only through purgation can peace be restored. I personally witnessed a servant who had a strong addiction to smoking. Due to busy official duties, he could not smoke regularly and satisfied his craving with cigarette butts. He suffered from dysentery for several months, becoming emaciated like a skeleton, experiencing abdominal pain and tenesmus. A physician prescribed purgatives, and he passed many black stools resembling sheep dung upon examination, which were undigested cigarette butts. Consequently, he recovered, and his smoking addiction also ceased.
Another case involved a Mr. Bao who had smoked opium for years but quit after closing his business for over two years. He then suffered from severe dysentery, exhaustion, and lack of resources for treatment, seeking miraculous remedies daily. One day, he obtained one tael of Radix Stemostemonis (Bubai, 百部). Others warned that this herb kills lice and questioned if such a large dose was safe, suggesting a reduction. However, the patient firmly insisted on taking it. After ingestion, he experienced severe abdominal pain, causing great alarm. Shortly after, he went to the toilet and passed several bowls of small black worms. His illness vanished instantly. From then on, he nourished himself with congee without further medication. His stomach qi gradually strengthened, his body became robust, surpassing his previous health.
However, the suitability of purgation for dysentery is not limited to smokers. Another case involved a man from Ningbo who traveled to Fujian and consumed over a hundred fresh lychees in one day. Returning to Ningbo, he suffered from chronic dysentery for years. A physician examined him and noted that despite the long duration, his abdominal pain and tenderness indicated remaining stagnation, recommending purgation. Using Rhubarb (Da Huang, 大黄) and Mirabilite (Mang Xiao, 芒硝), he expelled a significant amount of retained food, which turned out to be the fresh lychees eaten years prior. The illness resolved abruptly. This demonstrates that food stagnation in the intestines and stomach, even after decades, may remain undigested and be expelled in its original form.
The ancient name "Zhi Xia" reflects this nature. For non-smokers suffering from this condition, eight or nine out of ten cases are suitable for descending and promoting qi movement. In cases of prolonged illness with pure deficiency, where the anus fails to retain stool, abdominal pain is absent, or defecation is uncontrollable and unnoticed, different considerations apply. Generally, for smokers, intestinal accumulations become harder over time; thus, astringents should not be used.
Some argue that smokers often have deficient constitutions, and purgation might lead to sudden collapse. I reply that this misconception affects both doctors and patients. Internal stagnation prevents the Spleen from transporting fluids for the Stomach. With old accumulations remaining, the Stomach cannot accept new food, leading to muscle wasting and apparent deficiency symptoms. Once the filth is cleared, the Stomach can accept food, and the Spleen can transport nutrients. Where would collapse come from? However, seeing these deficiency signs, patients are terrified at the suggestion of purgation, making treatment difficult. Physicians must guide them tactfully to turn danger into safety, which is another way to save lives. Do not blindly follow patient preferences with tonics that may kill them.
Let me use an analogy based on investigating things. Consider a lamp burning for a long time: when oil is sufficient, the light is bright; when oil is exhausted, the light dims. This is natural law. Even if oil remains, soot forms on top. If not removed, the light dims. Not understanding that the soot causes dimness, merely adding oil hoping for brightness is futile. Understanding this clarifies whether to use vigorous tonification or purgation for conditions appearing deficient externally but being internally real. This aligns with the *Neijing* saying: "Removing accumulated decay restores healthy qi."
Furthermore, children frequently suffer from diarrhea and dysentery in autumn, mostly due to summer heat, turbidity, and food stagnation (seven or eight out of ten cases). Treatment involves aromatic herbs to awaken the Spleen and expel turbidity, clearing summer heat internally, assisted by herbs to resolve stagnation. Recovery often occurs within one or two doses. If spleen deficiency persists due to long duration, spleen-tonifying herbs are added. My treatments for such cases using these methods are consistently effective, with similar prescriptions. Diet must avoid warm and drying foods to prevent stomach fluid depletion, which can lead to abdominal hardness, cough, and eventually malnutrition syndromes (Gan Lao).
Aromatic herbs suitable for this include Agastache Herba (Huoxiang, 藿香), Rhizoma Acori Tatarinowii (Shichangpu, 石菖蒲), Pogostemonis Herba (Peilan Ye, 佩兰叶), and Citri Reticulatae Pericarpium Flavum (Foshou Gan, 佛手柑). For clearing summer heat: Fresh Lotus Leaf (Xian Heye, 鲜荷叶), Fresh Artemisia Annua Herb (Xian Qinghao, 鲜青蒿), Liu Yi San (Six-One Powder), Gardenia Fruit (Hei Shanzhi, 黑山栀), Scutellaria Baicalensis Root (Tiao Qin, 条芩), and Coptis Chinensis Rhizome (Chuan Lian, 川连). Bitter flavors strengthen the intestines and stop dysentery. For regulating qi: Tangerine Peel (Guang Pi), Aucklandiae Radix (Muxiang, 木香), Areca Seed (Binglang, 槟榔), and Areca Pericarpium (Fupi, 腹皮). For digesting food: Medicated Leaven (Shen Qu), Sprouted Millet (Guya, 谷芽), Sprouted Barley (Maiya, 麦芽), Hawthorn Fruit (Shanzha, 山楂), Wushi Cha (Noontime Tea), Guwu Chong (Five-Grain Worm), and Gallus Gallus Domesticus Gigerium Endothelium Corneum (Jineijin, 鸡内金). For strengthening the Spleen: American Ginseng (Xiyangshen, 西洋参), Poria (Fuling, 茯苓), Ophiopogon Japonicus Root (Chao Maidong, 炒麦冬), Fried Lablab Seed (Chao Bian Dou, 炒扁豆), Licorice Root (Gancao, 甘草), and Rice (Jingmi, 粳米). For nourishing Stomach Yin: Dendrobium Nobile Stem (Shihu, 石斛), Ophiopogon Japonicus Root (Maidong, 麦冬), Chinese Quince Fruit (Mu Gua, 木瓜), and Mume Fruit (Wumei, 乌梅). For promoting urination: Plantago Seed (Cheqian Zi, 车前子), Alisma Rhizome (Zexie, 泽泻), and Talcum (Huashi, 滑石). For killing parasites: Coptis Chinensis Rhizome (Huhuanglian, 胡黄连), Torrey Seed (Feizi, 榧子), Crataeva Nurvala Seed (Shijunzi, 使君子), and Areca Seed (Binglang, 槟榔). These must be assisted by sweet herbs to attract parasites seeking food. Pediatricians often use Kudzu Root (Gegen, 葛根) for diarrhea and dysentery; studying Ye Tianshi's works reveals contraindications. The aforementioned herbs are plain but versatile. They can treat various autumn pediatric conditions such as gan accumulation with abdominal hardness and prominent veins, summer fatigue with anorexia and emaciation, or liver hyperactivity with irritability and crying. The drugs remain within the listed categories. Pediatric diseases primarily affect the Liver and Spleen meridians. Improper diet damages the Spleen and Stomach. Since children's organs are delicate and transformation functions are weak, various illnesses arise. As the ancients said, "Food injury leads to aversion to eating." Also, "To keep a child healthy, maintain a state of slight hunger and coolness," is truly profound wisdom.