高(廿三)湿热内聚。腹痛。下痢初起。当分消兼清里邪。
青皮 煨木香 淡黄芩 炒浓朴
川连 南楂炭 槟榔
殷(七岁)腹痛。下痢无度。渴烦肛坠。议用分消。兼佐升提。
青皮(一钱) 炒白芍(一钱五分) 煨升麻(五分) 炒浓朴(一钱) 炙草(五分) 醋炒柴胡(五分) 南
楂炭(一钱五分) 广皮(一钱)
又 下痢纯血。气陷肛坠。昨用升举。原得小安。未能全退。想在里湿热未清。再当酸苦泄热。
小川连 炒焦白芍 炒当归 北蓁皮 炙甘草 石莲肉 炒黄柏 乌梅肉
陈(六三)湿热内聚。腹痛下痢。恶心眩晕。痞闷不饥。此属高年肝阴久亏。肝阳乘阳明上胃。最有身热之虞。拟
苦辛宣通。佐以和阴。
淡黄芩(一钱) 制半夏(一钱五分) 藿香叶(一钱) 川连(八分) 枳实(一钱) 飞滑石(三钱) 生白
芍(一钱五分) 淡干姜(五分)
钱(廿八)暑湿内伏。下痢腹痛。拟分消主之。
青皮(一钱) 煨木香(六分) 藿香叶(一钱) 炒浓朴(一钱) 炒广皮(一钱) 六一散(包,三钱) 南
楂炭(三钱) 淡黄芩(一钱)
冯(三二)赤痢月余。近日无度。因始病未经清理。致温热变迁。酿成厥阴下痢。今已身热腹痛。后重里急。胸痞
不食。呕恶频加。腑气欲绝之验。昔贤虽有通涩二法。凭症难施。参仲景厥阴下痢篇。勉拟连芍苦辛之属。假其降火制
肝之义。使其木得条达。则土自敦阜。俾得安谷。再商治痢。
吴萸炒川连(四分) 炒半夏(二钱) 川楝子(二钱) 淡干姜(一钱) 枳实(一钱) 茯苓(二钱) 生白
芍(一钱五分) 香粳米(三钱)
桂(三二)昨进疏泄。得汗邪解。身凉咽痛亦愈。询久卧湿地。蕴酿湿热。致腹痛下痢。并不渴饮。述嗔怒未曾发
泄。是肝阳郁勃于中。脏土早热。治宜分消。
青皮(一钱) 煨木香(五分) 赤苓(三钱) 炒浓朴(一钱) 淡黄芩(一钱) 泽泻(一钱) 楂炭(一钱)
加老姜(三分)
高姓患者(23岁),湿热之邪内聚。出现腹痛。下痢初起时,应当采用分消法兼清里邪的方法治疗。
处方:青皮、煨木香、淡黄芩、炒浓朴、川连、南楂炭、槟榔。
殷姓患者(7岁),腹痛。下痢无度(腹泻次数极多)。口渴烦躁,肛门坠胀。建议采用分消法,兼佐升提之法。
处方:青皮(一钱)、炒白芍(一钱五分)、煨升麻(五分)、炒浓朴(一钱)、炙甘草(五分)、醋炒柴胡(五分)、南楂炭(一钱五分)、广皮(一钱)。
复诊:下痢纯血。气陷导致肛门坠胀。昨日使用升举法后,症状原本得到轻微缓解,但未能完全消退。推测是体内湿热未清。再次应当采用酸苦泄热之法。
处方:小川连、炒焦白芍、炒当归、北秦皮、炙甘草、石莲肉、炒黄柏、乌梅肉。
陈姓患者(63岁),湿热内聚。腹痛下痢。恶心眩晕。痞闷不饥(胃脘部堵塞感,没有食欲)。这属于高龄患者肝阴长期亏损,肝阳乘袭阳明经上犯胃腑。最担心出现身热的情况。拟定采用苦辛宣通之法,佐以和阴之法。
处方:淡黄芩(一钱)、制半夏(一钱五分)、藿香叶(一钱)、川连(八分)、枳实(一钱)、飞滑石(三钱)、生白芍(一钱五分)、淡干姜(五分)。
钱姓患者(28岁),暑湿内伏。下痢腹痛。拟定以分消法为主进行治疗。
处方:青皮(一钱)、煨木香(六分)、藿香叶(一钱)、炒浓朴(一钱)、炒广皮(一钱)、六一散(包煎,三钱)、南楂炭(三钱)、淡黄芩(一钱)。
冯姓患者(32岁),赤痢持续月余。近日腹泻无度。因为起初患病时未经过清理治疗,导致温热病邪变迁,酿成厥阴下痢。现在已经出现身热腹痛、后重里急(肛门重坠,腹部拘急疼痛)、胸痞不食、呕吐恶心频繁加重等症状,这是腑气即将断绝的征象。古代贤人虽有通法和涩法两种治法,但根据当前症状难以施用。参考张仲景《伤寒论》中厥阴下痢篇的内容,勉强拟定连芍苦辛类的方剂,借用其降火制肝的含义,使肝木得以条达舒展,则脾土自然敦厚稳固,从而能够安谷进食,之后再商议治疗痢疾的具体方法。
处方:吴萸炒川连(四分)、炒半夏(二钱)、川楝子(二钱)、淡干姜(一钱)、枳实(一钱)、茯苓(二钱)、生白芍(一钱五分)、香粳米(三钱)。
桂姓患者(32岁),昨日服用疏泄药物后,出汗邪解,身体变凉,咽痛也痊愈了。询问得知久卧湿地,蕴酿湿热,导致腹痛下痢。并不口渴饮水。陈述说嗔怒未曾发泄,这是肝阳郁勃于中焦,脏土早已发热。治疗应当采用分消法。
处方:青皮(一钱)、煨木香(五分)、赤苓(三钱)、炒浓朴(一钱)、淡黄芩(一钱)、泽泻(一钱)、楂炭(一钱)。加老姜(三分)。
Gao (23 years old): Damp-heat gathers internally. Abdominal pain. In the early stage of dysentery, one should employ the method of separating and eliminating (Fen Xiao) combined with clearing interior pathogens.
Prescription: Qingpi (Green Tangerine Peel), Wei Muxiang (Baked Aromatic Tuber), Dan Huangqin (Light Scutellaria Root), Chao Nongpu (Stir-fried Magnolia Bark), Chuanlian (Coptis Rhizome), Nan Zha Tan (Charred Hawthorn Fruit), Binglang (Areca Seed).
Yin (7 years old): Abdominal pain. Dysentery without limit (profuse diarrhea). Thirst, irritability, anal prolapse. It is proposed to use the method of separating and eliminating, assisted by lifting methods.
Prescription: Qingpi (1 qian), Chao Baishao (Stir-fried White Peony Root), Wei Shengma (Baked Cimicifuga Rhizome), Chao Nongpu (Stir-fried Magnolia Bark), Zhigancao (Honey-fried Licorice Root), Cu Chao Chaihu (Vinegar-stir-fried Bupleurum Root), Nan Zha Tan (Charred Hawthorn Fruit, 1.5 qian), Guangpi (Broad-leaved Mandarin Peel, 1 qian).
Re-examination: Dysentery consisting purely of blood. Qi sinking causing anal prolapse. Yesterday, lifting measures were used, providing slight relief but not complete resolution. This suggests that interior damp-heat has not yet been cleared. Again, sour and bitter methods to drain heat should be employed.
Prescription: Xiao Chuanlian (Small Coptis Rhizome), Chao Jiao Baishao (Stir-fried Scorched White Peony Root), Chao Danggui (Stir-fried Angelica Sinensis Root), Bei Qinpi (Northern Phellodendron Bark), Zhigancao (Honey-fried Licorice Root), Shilianrou (Stone Lotus Seed Flesh), Chao Huangbai (Stir-fried Phellodendron Bark), Wumei Rou (Dark Plum Flesh).
Chen (63 years old): Damp-heat gathers internally. Abdominal pain and dysentery. Nausea, vertigo. Epigastric fullness and stifling sensation, lack of appetite. This belongs to elderly patients with long-term deficiency of Liver Yin, where Liver Yang attacks the Yangming meridian and invades the Stomach. There is great concern regarding the onset of fever. It is planned to use bitter and acrid methods to diffuse and unblock, assisted by harmonizing Yin methods.
Prescription: Dan Huangqin (Light Scutellaria Root, 1 qian), Zhi Banxia (Prepared Pinellia Tuber, 1.5 qian), Huoxiangye (Agastache Leaf, 1 qian), Chuanlian (Coptis Rhizome, 0.8 qian), Zhishi (Immature Bitter Orange, 1 qian), Fei Huashi (Flying Talcum, 3 qian), Sheng Baishao (Raw White Peony Root, 1.5 qian), Dan Ganjiang (Light Dried Ginger, 0.5 qian).
Qian (28 years old): Summer-heat and dampness lie hidden internally. Dysentery with abdominal pain. It is planned to primarily use the method of separating and eliminating.
Prescription: Qingpi (Green Tangerine Peel, 1 qian), Wei Muxiang (Baked Aromatic Tuber, 0.6 qian), Huoxiangye (Agastache Leaf, 1 qian), Chao Nongpu (Stir-fried Magnolia Bark, 1 qian), Chao Guangpi (Stir-fried Broad-leaved Mandarin Peel, 1 qian), Liuyisan (Six-to-One Powder, wrapped, 3 qian), Nan Zha Tan (Charred Hawthorn Fruit, 3 qian), Dan Huangqin (Light Scutellaria Root, 1 qian).
Feng (32 years old): Bloody dysentery for over a month. Recently, diarrhea without limit. Because the initial illness was not cleared properly, warm-heat pathogens changed, brewing into Jueyin dysentery. Now there is fever, abdominal pain, tenesmus (heavy feeling in the rectum with urgent need to defecate), epigastric fullness, anorexia, and frequent worsening of vomiting and nausea. These are signs of impending exhaustion of Fu organ Qi. Although ancient sages had both purgative and astringent methods, it is difficult to apply them based on current symptoms. Referencing Zhang Zhongjing's chapter on Jueyin dysentery in the *Shanghan Lun*, I tentatively prescribe a formula of Coptis and White Peony with bitter and acrid properties, borrowing the meaning of descending fire and restraining Liver. This allows Wood to flow smoothly, so Earth becomes firm and stable, enabling the patient to digest food, after which further treatment for dysentery can be discussed.
Prescription: Wu Yu Chao Chuanlian (Coptis Rhizome stir-fried with Evodia Fruit, 0.4 qian), Chao Banxia (Stir-fried Pinellia Tuber, 2 qian), Chuanlianzi (Toosendan Fruit, 2 qian), Dan Ganjiang (Light Dried Ginger, 1 qian), Zhishi (Immature Bitter Orange, 1 qian), Fuling (Poria, 2 qian), Sheng Baishao (Raw White Peony Root, 1.5 qian), Xiang Jingmi (Aromatic Rice, 3 qian).
Gui (32 years old): Yesterday, after administering dispersing and draining herbs, sweating occurred, pathogens resolved, body temperature normalized, and sore throat healed. Inquiry revealed prolonged lying on wet ground, breeding damp-heat, leading to abdominal pain and dysentery. There is no thirst or desire to drink. The patient states that anger was not vented; this indicates Liver Yang stagnating and surging in the middle jiao, with internal organs and spleen earth already heated. Treatment should adopt the method of separating and eliminating.
Prescription: Qingpi (Green Tangerine Peel, 1 qian), Wei Muxiang (Baked Aromatic Tuber, 0.5 qian), Chi Ling (Red Poria, 3 qian), Chao Nongpu (Stir-fried Magnolia Bark, 1 qian), Dan Huangqin (Light Scutellaria Root, 1 qian), Zexie (Alisma Rhizome, 1 qian), Zha Tan (Charred Hawthorn Fruit, 1 qian). Add Lao Jiang (Old Ginger, 0.3 qian).