痢有不与世相递嬗，而名则因时而变易。方策所传，其来有自，不容不据古以准今。《素问》谓之肠 ；
《难经》谓之里急后重；汉谓之滞下；晋谓之秋燥；至唐方谓之痢。即其名而绎其义，便血曰 ，痛甚曰急，
壅塞曰滞，皱裂曰燥，不利曰痢，痢之情形已显示于称名之表。历代以来，扬HT 指陈，不啻以暮鼓晨钟，发人
深省。治是症者，顾可孟浪从事，翻欲缄滕扃 《庄子》∶“将为 箧探囊发匮之盗，而为守备，则必摄缄滕，
固扃 ，此世俗之所谓知也。然而巨盗至，则负匮揭箧， 囊而趋，惟恐缄滕扃箧之不固也。”（注∶ ，
开也），而置之死地乎？！当此暑炎方退，金 初起，土间其中（土旺于四季，五、六得天地之中，以未土
为正）。热、燥、湿汇于一时，三气凑而为病。有时行者，从皮毛入，微恶寒，腹痛，泻尽宿食方转红白。风
之所过，行于一家，则病一家；行于一境，则病一境。有传染者，从口鼻入，不恶寒，腹痛，随泻宿食即转红
白。气之所触，染于一人，则病一人，染于一方，则病一方。于斯时也，抚枕席而兴嗟，何分男女；如厕坑而
抱痛（《左传》∶晋景公有疾，将尝麦，如厕，陷而卒），莫测死生。天气阴晴，
垢闻一室；灯光明灭，呻彻五更。饫膏粱者无论已可。怜寒士当灾，朋尽返回，难邀甲戍之峙（《书·费誓》
∶甲戍峙乃糗粮），人皆掩鼻，徒传庚癸之呼（《左传》∶吴与鲁会，吴子不与士兵饥渴，大夫申叔仪乞粮于
鲁，大夫公孙有山氏对曰∶“粮则无矣，粗则有之，若登首山以呼曰‘庚癸，呼则诺。”杜注∶军中不得出粮，
故为隐语。庚，西方，主谷；癸，北方，主水”）。聚桑梓者，犹可也。最苦旅人远适，今雨不来（杜甫诗
∶“旧雨来，今雨不来”），谁恤零丁异地（文天祥诗∶“惶恐滩头说惶恐，零丁洋里叹零丁”）；闻风争避，
哪管客子离乡。儒者考古今之得失，证一己之功修，于是证而果参上乘焉。本来恻隐之心，自应以之普度也。
喻嘉言曰∶“初用辛凉以解表，次用苦寒以清里。”刘河间曰∶“调气则后重自除，行血则脓血自止”，余于
痢之时行初起者，而宗嘉言焉，疏经络而驱邪，败毒散（人参、羌活、独活、柴胡、前胡、川芎、枳壳、桔梗
、茯苓、炙草），克壮元老之猷；于痢之传染初起者而宗河间焉，和营卫而导滞，芍药汤（芍药、归尾、黄芩
、黄连、大黄、木香、槟榔、肉桂、炙草），允占大人之吉。及其归宿，郁则为热，试诊其脉，未有不数者，
所以香连丸（黄连二十两，吴萸十两同炒，木香四两八钱，不见火，共研末，醋糊为丸）为治痢之总方。顾在
表忌用者，邪犹未入于里也；久病难用者，恐重伤其生气也。昔赵养葵以六味地黄汤治伤寒，人饥为赵氏之创
见。而下多伤阴，余尝以六味汤治痢，此又余之创见也。如果脉虚自汗，赤白将尽，真人养脏汤（粟壳、诃子
、肉豆蔻、木香、肉桂、人参、白术、秦归、白芍、甘草寒。甚加附子，一方无秦归）、诃子散（粟壳、诃子、
干姜、陈皮，为末空心服），俱可斟酌而用之。夫痢不分赤白，既出于热，翻服辛热而愈者（附子、肉挂、干
姜、焦术、砂仁、炙草），此乃从治之法。盖人之禀赋，有寒有热，邪热之中人，每从其类而化。辛热药能开
郁解结，使气血得以宣通，特宜于以寒化热之人，若遇以热化热而误用之，其祸将不可胜言矣！存心济世者，
倘遇以寒化热之痢，用温补而大获其效，慎毋执以为例。
痢疾有一种情况是不随时代更替而改变本质，但其名称却因时而异。古代医籍中流传下来的记载，其来源有自，不能不依据古法来规范当今的治疗。《素问》称之为“肠澼”；《难经》称之为“里急后重”；汉代称为“滞下”；晋代称为“秋燥”；到了唐代方剂书中才称为“痢”。从这些名称推究其含义，便血称为“澼”，疼痛剧烈称为“急”，壅塞不通称为“滞”，皱裂称为“燥”，排便不畅称为“痢”，痢疾的症状表现已经显露在命名之中了。历代医家对此不断阐述，无异于晨钟暮鼓，使人深刻反省。治疗这种病症，怎么可以轻率从事，反而想要像《庄子》中所说的那样：“为了防备撬箱、掏袋、开柜的小偷，必然要收紧绳索，加固锁扣，这是世俗所谓的智慧。然而大盗来了，就背着柜子、扛着箱子、抱着袋子快步逃跑，唯恐绳索锁扣不够牢固。”（注：扃，意为关闭），而将病人置于死地呢？！
此时暑热刚退，金气（秋季燥气）初起，土气居于其中（土旺于四季，五、六月得天地之中气，以未土为正）。热、燥、湿三气汇聚于一时，三种邪气凑合而成病。有时行疫痢，从皮毛侵入，轻微恶寒，腹痛，泻尽宿食后才转为红白脓血。风邪所过之处，流行于一家，则一家患病；流行于一境，则一境患病。有传染性者，从口鼻侵入，不恶寒，腹痛，随着排泄宿食立即转为红白脓血。气机所触染，波及一人，则一人患病；波及一方，则一方患病。在这个时候，抚摸着枕席叹息，不分男女老幼；如同上厕所陷入坑中抱持痛苦（《左传》记载：晋景公生病，准备吃麦子，去厕所，掉进坑里死了），无法预测生死。天气阴晴不定，污秽气味充斥房间；灯光忽明忽暗，呻吟声彻夜直到五更天。那些饱食膏粱厚味的人暂且不论。可怜贫寒之士遭遇灾祸，朋友都返回家乡，难以邀请到粮食储备（《尚书·费誓》：“甲戌日准备好你们的干粮”），人们都掩住鼻子，只能听到军中隐语的呼救（《左传》记载：吴国与鲁国会盟，吴王不给士兵粮食，大夫申叔仪向鲁国乞粮，大夫公孙有山氏回答说：“细粮没有，粗粮还有，如果登上首山呼喊‘庚癸’，就会答应。”杜预注：军中不得公开传出粮食消息，所以用隐语。庚属西方，主谷；癸属北方，主水）。聚集在故乡的人，还可以互相照顾。最痛苦的是旅客远行他乡，老朋友不来（杜甫诗：“旧雨来，今雨不来”），谁怜悯流落异地的孤苦伶仃之人（文天祥诗：“惶恐滩头说惶恐，零丁洋里叹零丁”）；听到风声争相躲避，哪管客人是否离乡背井。儒者考证古今得失，验证自身的功修，于是诊断果然参悟到高深的境界。本来恻隐之心，自然应该用来普度众生。
喻嘉言说：“初期用辛凉药解表，后期用苦寒药清里。”刘河间说：“调气则后重自然消除，行血则脓血自然停止。”对于时行痢疾初起者，我遵循喻嘉言的方法，疏通经络驱除邪气，使用败毒散（人参、羌活、独活、柴胡、前胡、川芎、枳壳、桔梗、茯苓、炙甘草），可壮大元老般的谋略；对于传染性痢疾初起者，我遵循刘河间的方法，调和营卫导除积滞，使用芍药汤（芍药、当归尾、黄芩、黄连、大黄、木香、槟榔、肉桂、炙甘草），确实占得大人的吉祥。等到病情归宿阶段，郁结化为热，诊察其脉象，没有不是数脉的，所以香连丸（黄连二十两，吴茱萸十两同炒，木香四两八钱，不经过火制，共研为末，醋糊为丸）是治疗痢疾的总方。但是在表证阶段忌用此方，因为邪气尚未入里；久病难用此方，恐怕重伤病人的生气。过去赵养葵用六味地黄汤治疗伤寒，被人认为是赵氏的创见。而下利过多损伤阴液，我曾经用六味地黄汤治疗痢疾，这又是我的创见。如果脉象虚弱自汗，赤白脓血即将排尽，真人养脏汤（罂粟壳、诃子、肉豆蔻、木香、肉桂、人参、白术、秦归、白芍、甘草。寒甚加附子，一方无秦归）、诃子散（罂粟壳、诃子、干姜、陈皮，研为末空腹服用），都可以斟酌使用。痢疾不分赤白，既然出于热证，反而服用辛热药而痊愈的（附子、肉桂、干姜、焦白术、砂仁、炙甘草），这是从治的方法。大概人的禀赋，有寒有热，邪热中人，往往从其体质属性而转化。辛热药能开郁解结，使气血得以宣通，特别适合以寒化热体质的人，如果遇到以热化热体质而误用，其祸害将不可胜言！存心济世的人，倘若遇到以寒化热的痢疾，用温补法获得大效，千万不要固执地以此为常规例子。
Dysentery is a condition whose essence does not change with the passage of time, yet its name varies according to the era. The records transmitted in ancient medical texts have their origins and cannot but use ancient standards to regulate contemporary treatment. *Suwen* (Plain Questions) refers to it as "Changpi" (Intestinal discharge); *Nanjing* (Classic of Difficult Issues) calls it "Liji Houzhong" (Tenesmus and urgency); the Han Dynasty termed it "Zhixia" (Stagnant downward flow); the Jin Dynasty called it "Qiuzao" (Autumn dryness); and by the Tang Dynasty, it was named "Li" (Dysentery). Interpreting the meaning from these names: bloody stool is "Pi", severe pain is "Ji" (Urgency), obstruction is "Zhi" (Stagnation), wrinkling/cracking is "Zao" (Dryness), and difficulty in defecation is "Li" (Dysentery). The manifestations of dysentery are already revealed in its nomenclature. Throughout history, physicians have elaborated on this, akin to morning bells and evening drums, prompting deep reflection. How can one treat this disease rashly, instead of guarding against it like the thief-prevention metaphor in *Zhuangzi*: "To prepare for thieves who pry boxes and open chests, one must tighten ropes and secure locks, which worldly wisdom considers smart. Yet when a great thief arrives, he carries the chest and runs away, worrying only that the ropes and locks were not secure enough." (Note: Jiong means to lock/close), thereby leaving the patient to die?!
At this time, summer heat recedes, Metal Qi (autumnal dryness) begins, and Earth Qi resides within (Earth prospers in all four seasons; the fifth and sixth months represent the middle of heaven and earth, centered on Wei Earth). Heat, Dryness, and Dampness converge simultaneously, and these three pathogens combine to cause disease. In epidemic dysentery, pathogens enter via the skin and hair, causing slight aversion to cold and abdominal pain; red and white pus/blood appears only after residual food is expelled. Where wind pathogens pass, if they spread through one family, the whole family falls ill; if they spread through a region, the whole region falls ill. In contagious cases, pathogens enter via the mouth and nose, without aversion to cold, with abdominal pain; red and white pus/blood appears immediately upon expelling residual food. Where Qi touches, if it infects one person, one person falls ill; if it infects a locality, the locality falls ill. At such times, sighing while touching pillows and mats, regardless of gender; or suffering pain like falling into a latrine pit (as recorded in *Zuo Zhuan*: Duke Jing of Jin fell ill, attempted to eat wheat, went to the toilet, fell into the pit, and died), unable to predict life or death. Weather fluctuates between cloudy and clear, foul odors fill the room; lights flicker on and off, groans last until the fifth watch. Those indulging in rich foods need not be discussed. Pity the poor scholars suffering disaster, whose friends return home, making it hard to invite grain reserves (*Shangshu: Fei Shi*: "On Jiaxu day, prepare your rations"); people cover their noses, only hearing military code calls (*Zuo Zhuan*: During the meeting between Wu and Lu, King Wu did not provide grain to soldiers;大夫 Shen Shuyi begged for grain from Lu;大夫 Gongsun Youshan replied: "No fine grain, but coarse grain exists. If you climb Shoushan Mountain and call 'Geng Gui', help will come." Du Yu's commentary: Military rules forbid openly distributing grain, so coded language is used. Geng belongs to West, governing grain; Gui belongs to North, governing water). Those gathered in their hometowns can still support each other. Most painful is the traveler far from home, where old friends do not come (Du Fu's poem: "Old rain comes, new rain does not come"), who pities the lonely stranger in a foreign land (Wen Tianxiang's poem: "Speaking of fear at Konghuang Beach, sighing over loneliness in Lingding Ocean"); hearing rumors, everyone avoids, caring not if the guest has left home. Scholars examine gains and losses of past and present, verifying their own moral cultivation, thus achieving profound diagnostic insight. Originally, the heart of compassion should naturally be used to save all beings.
Yu Jiayan said: "In the initial stage, use acrid-cool herbs to release the exterior; subsequently, use bitter-cold herbs to clear the interior." Liu Hejian said: "Regulating Qi eliminates tenesmus; moving Blood stops pus and blood." For early-stage epidemic dysentery, I follow Yu Jiayan’s approach, unblocking meridians and driving out pathogens using Baidu San (Ginseng Radix et Rhizoma, Notopterygii Rhizoma et Radix, Angelicae Pubescentis Radix, Bupleuri Radix, Peucedani Radix, Chuanxiong Rhizoma, Aurantii Fructus Immaturus, Platycodonis Radix, Poria, Glycyrrhizae Radix et Rhizoma Preparata), strengthening strategies like those of senior statesmen; for early-stage contagious dysentery, I follow Liu Hejian’s approach, harmonizing Ying and Wei and guiding out stagnation using Shaoyao Tang (Paeoniae Radix Rubra, Angelicae Sinensis Radix Caulis, Scutellariae Radix, Coptidis Rhizoma, Rheum Palmati Radix et Rhizoma, Aquari Fructus, Arecae Semen, Cinnamomi Cortex, Glycyrrhizae Radix et Rhizoma Preparata), ensuring auspicious outcomes for great persons. As the condition resolves, stagnation transforms into Heat; palpating the pulse reveals no exception to being Rapid (Shu). Therefore, Xianglian Wan (Coptidis Rhizoma 20 liang, Evodiae Fructus 10 liang stir-fried together, Aucklandiae Radix 4.8 liang, not processed by fire, ground into powder, pillified with vinegar paste) serves as the general formula for treating dysentery. However, it is contraindicated in exterior stages because pathogens have not entered the interior; it is difficult to use in chronic cases to avoid severely damaging vital Qi. Zhao Yangkui previously used Liuwei Dihuang Tang to treat Cold Damage, considered his innovation. Since excessive diarrhea damages Yin, I once used Liuwei Tang to treat dysentery, which is my innovation. If the pulse is Deficient with spontaneous sweating, and red/white discharge is nearly exhausted, Zhenren Yangzang Tang (Papaveris Pericarpium, Terminalia Chebula Retzii Fructus, Myristicae Semen, Aquari Fructus, Cinnamomi Cortex, Ginseng Radix et Rhizoma, Atractodis Macrocephalae Rhizoma, Angelicae Sinensis Radix, Paeoniae Radix Alba, Glycyrrhizae Radix et Rhizoma. Add Aconiti Lateralis Radix Preparata if cold is severe; one variation lacks Angelicae Sinensis Radix) and Hezi San (Papaveris Pericarpium, Terminalia Chebula Retzii Fructus, Zingiberis Rhizoma Recens, Citri Reticulatae Pericarpium, ground into powder, taken on an empty stomach) can be used with discretion. Dysentery, whether red or white, originates from Heat; recovery after taking acrid-hot herbs (Aconiti Lateralis Radix Preparata, Cinnamomi Cortex, Zingiberis Rhizoma Recens, Fried Atractodis Macrocephalae Rhizoma, Amomi Fructus, Glycyrrhizae Radix et Rhizoma Preparata) employs the method of "following treatment" (treating symptoms that mimic the disease nature). Human constitutions vary, having Cold or Heat tendencies; pathogenic Heat often transforms according to the host's constitution. Acrid-hot herbs can resolve stagnation and knots, promoting Qi and Blood circulation, suitable for those whose Cold transforms into Heat. If mistakenly used for those whose Heat transforms into Heat, the disaster would be incalculable! Those intending to save the world, if they encounter dysentery where Cold transforms into Heat and achieve great results with warm-tonifying methods, must not rigidly adhere to this as a standard rule.