王损庵论治痢。必和营卫。其义甚精。喻嘉言逆流挽舟之法。即从此脱化。盖痢疾或由生冷内伤。胃络血痹。
或由风湿外束。暑郁血乱。无论赤白。皆湿热搏结于血分。而筋膜之力弛。气化之行滞也。湿盛则血滞而气困。热
盛则膜肿而血溢。以破血之品疏营。而邪气无伏藏之地。以发汗之品宣卫。而邪气有宣泄之路。表里之脉络既通。
其痢宜止。而有不止者。三焦筋膜之力。久为湿热熏蒸。 肿弛缓。不能自束。故为涎为血。时时淫溢自下而不固
也。以酸苦之味坚敛之。乃能收功。内经谓下利身大热者死。陈修园谓兼外感者先发之。史载之谓疫痢水邪犯心。
恶寒发热者难治。用细辛白芷肉桂附子。皆和营卫之类也。凡痢止而饮食不复者。湿热未清也。饮食如常。大便作
坠者。肠肿未消。血络痹也。肿痹之久。流为休息。休息之久。转为肠痿。休息者。血络不净。膜力不复也。噤口
者。湿热太盛。胃脘血痹而肿也。肠膜微痿。酸苦坚之。某老医治痢后脱肛。以白芍四钱为君。即上。若肠体全痿。
气不能贯。右尺中沉之分。应指丸丸。 弱无力。内经所谓按之如丸泥。大肠气予不足也。大便脱血及血痢重久者
有之。
男妇气血异体。证治亦有大端不同者。男子气壮。血不易瘀。舌黑耳聋。血络痹也。为热入血室。舌卷囊缩。
血痹之甚筋失养也。亦有未及化热。两肋血络先痹者。其证舌苔忽黄忽白。必带灰黑。小便忽闭忽通。烦躁不能安
眠。或有一边不良于眠。其脉忽长忽短。忽洪忽紧。全无定象。必得明医。善攻其血。乃可治之。未有瘀不化黑不
退。而病能愈者也。若妇人血盛。常有经水适来适断。与病相触。肝胃之络。最易停瘀。舌黑谵语。事所常有。但
耳不聋。乳不缩。不为败证。即耳微聋而谵妄狂躁者。亦邪正相搏之象。惟声息低微。不能转侧。乃在所忌。其舌
或蓝或灰或黑。有仅在一偏。有全体皆透。均不得据为凶候。故治妇科伤寒温病。起手即宜兼和血以防之。否则。
病愈而络瘀不净。积为胃痛腰疼痼疾。又世以黑而芒刺为热。湿润为寒。然瘀血舌黑。虽热而不生芒刺。有烟瘾人。
虽寒而亦见燥裂。在察其兼证以别之。盖男子之血。必因寒而瘀。因热而瘀。因温病过服寒剂。遏热闭络而瘀。女
子不必因寒因热邪。与血不必相入。而血能自瘀。故病愈。而黑不退者有之。
王损庵论述治疗痢疾，认为必须调和营卫，其道理非常精妙。喻嘉言提出的“逆流挽舟”治法，就是由此演变而来的。大概痢疾有的因为生冷食物内伤，导致胃络血脉痹阻；有的因为风湿外邪束缚，暑气郁结导致血液运行紊乱。无论大便赤白，都是湿热搏结在血分，致使筋膜的收缩力量松弛，气化运行停滞。湿气重则血液停滞而气机困顿；热势盛则肠膜肿胀而血液溢出。使用破血药物疏通营血，使邪气没有潜伏藏匿的地方；使用发汗药物宣通卫气，使邪气有宣泄排出的途径。表里脉络既然通畅，痢疾应当停止。但有不止止的，是因为三焦筋膜的力量，长久被湿热熏蒸，导致肿胀松弛，不能自我约束，所以津液和血液时时溢出向下流失而不固摄。用酸苦味的药物来坚固收敛，才能取得疗效。《内经》说下利（腹泻痢疾）身体大热的会死亡。陈修园说兼有外感的要先解表发散。史载之说疫痢水邪侵犯心脏，出现恶寒发热的难治。使用细辛、白芷、肉桂、附子，都属于调和营卫的方法。凡是痢疾停止但饮食不恢复的，是湿热未清除。饮食如常但大便有下坠感的，是肠道肿胀未消，血络痹阻。肿胀痹阻久了，流变为休息痢。休息痢久了，转为肠痿。休息痢，是血络未净，膜力不复原。噤口痢，是湿热太盛，胃脘血络痹阻而肿胀。某老医生治疗痢疾后脱肛，以四钱白芍为君药，即采用上述方法。如果肠体完全痿废，气不能贯通，右尺脉沉取时，指下感觉像丸子一样圆硬，弱而无力，《内经》所说的按之如丸泥，是大肠气予不足。大便脱血及血痢严重久病的有这种情况。
男女气血体质不同，证候治疗也有大的区别。男子气壮，血不易瘀滞。舌黑耳聋，是血络痹阻。这是热入血室。舌卷囊缩，是血痹严重，筋失养。也有尚未化热，两肋血络先痹阻的。其证候舌苔忽黄忽白，必带灰黑色，小便忽闭忽通，烦躁不能安眠，或有一边不能安眠。其脉忽长忽短，忽洪忽紧，全无定象。必须得到明医，善于攻逐瘀血，才可治疗。没有瘀血不化、黑色不退而病能痊愈的。若妇人血盛，常有月经刚来或刚断，与病邪相触，肝胃之络，最容易停瘀。舌黑谵语，是常有的事。只要耳不聋，乳头不缩，就不算败证。即使耳微聋而谵妄狂躁的，也是邪正相搏的现象。只有声音气息低微，不能转侧的，才在所禁忌。其舌色或蓝或灰或黑，有的仅在半边，有的全体皆透，都不能据此作为凶兆。所以治疗妇科伤寒温病，起手就应当兼和血以防患。否则，病愈而络中瘀血不净，积成胃痛腰疼的痼疾。世人认为舌黑而有芒刺是热，湿润是寒。然而瘀血导致的舌黑，虽有热但不生芒刺；有烟瘾的人，虽有寒也见燥裂。在于观察兼证来辨别它。大概男子的血，必定因寒而瘀，因热而瘀，或因温病过服寒凉药剂，遏热闭络而瘀。女子不必因寒因热邪，与血不一定相入，而血能自瘀。所以病愈了，而舌黑不退的情况也有。
Wang Sun'an discussed the treatment of dysentery, asserting that one must harmonize Ying (Nutritive Qi) and Wei (Defensive Qi), a principle that is extremely profound. Yu Jiayan's method of "pulling the boat against the current" evolved from this concept. Generally, dysentery may arise from internal injury caused by raw or cold foods, leading to blood stasis in the stomach collaterals; or it may result from external constraint by wind-dampness and summer-heat stagnation causing chaotic blood circulation. Regardless of whether the stool is red or white, damp-heat binds in the Blood level, causing the contractile force of the fascia to relax and the movement of Qi transformation to stagnate. When dampness is excessive, blood stagnates and Qi becomes trapped; when heat is excessive, the membranes swell and blood extravasates. Using blood-breaking herbs to unblock Ying allows no place for pathogenic factors to hide; using diaphoretic herbs to ventilate Wei provides a pathway for pathogenic factors to be excreted. Once the superficial and interior meridians are unblocked, the dysentery should cease. However, if it does not stop, it is because the power of the San Jiao (Triple Burner) fascia has been long steamed by damp-heat, resulting in swelling and relaxation, unable to self-constrain. Thus, saliva and blood overflow downwards continuously without retention. Only by using sour and bitter substances to consolidate and astringe can success be achieved. The *Neijing* states that diarrhea with high fever is fatal. Chen Xiuyuan stated that cases with concurrent exterior syndromes should first be treated by releasing the exterior. Shi Zaizhi noted that epidemic dysentery where water-pathogen invades the Heart, presenting with aversion to cold and fever, is difficult to treat. The use of Xixin (Asari Radix), Baizhi (Angelicae Dahuricae Radix), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) all belong to methods of harmonizing Ying and Wei. Whenever dysentery stops but appetite does not recover, it indicates that damp-heat has not been cleared. If diet is normal but defecation feels heavy/tenesmic, it indicates intestinal swelling has not subsided and blood collaterals are bi-obstructed. Prolonged swelling and obstruction lead to Xie Xi Li (Resting Dysentery). Prolonged Resting Dysentery transforms into Chang Wei (Intestinal Atrophy). Resting Dysentery implies incomplete clearing of blood collaterals and failure of membrane strength to restore. Jin Kou Li (Anorexic Dysentery) implies excessive damp-heat causing bi-obstruction and swelling of the stomach collaterals. An old physician treated post-dysentery rectal prolapse using four qian of Shaoyao (Paeoniae Radix Alba) as the sovereign herb, following the aforementioned principles. If the intestinal body is completely atrophic and Qi cannot penetrate, the Right Chi pulse at the deep level feels like small balls under the finger, weak and powerless. As the *Neijing* describes, pressing feels like mud pellets, indicating insufficiency of Da Chang (Large Intestine) Qi. Cases of massive bloody stool or severe, chronic bloody dysentery do occur.
Men and women have different constitutions of Qi and Blood, so their syndrome differentiation and treatment have major differences. Men have robust Qi, and Blood is less prone to stasis. Black tongue and deafness indicate blood collateral bi-obstruction, representing Heat entering the Blood Chamber. Tongue curling and testicular retraction indicate severe blood bi-obstruction where tendons lose nourishment. There are also cases where heat has not yet transformed, but blood collaterals in the hypochondrium are obstructed first. Symptoms include tongue coating fluctuating between yellow and white, inevitably with gray-black hues; urination alternating between retention and free flow; irritability and insomnia, sometimes on one side only. The pulse may be long or short, surging or tight, lacking any fixed pattern. Only a skilled physician capable of aggressively resolving blood stasis can treat this effectively. No disease can heal without the resolution of stasis and the fading of black discoloration. In women, who have abundant Blood, menstruation arriving or ceasing coincidentally with illness often causes contact with pathogens. The Liver and Stomach collaterals are most prone to stasis. Black tongue and delirium are common. However, if ears are not deaf and nipples are not retracted, it is not a critical condition. Even if ears are slightly deaf and there is delirious mania, it is merely a sign of struggle between Pathogenic and Healthy Qi. Only low voice and breath, inability to turn over, are contraindications. Tongue color may be blue, gray, or black, localized to one side or penetrating the whole surface; none of these alone constitute an ominous sign. Therefore, in treating gynecological Shang Han (Cold Damage) and Wen Bing (Warm Diseases), one should harmonize Blood from the outset to prevent complications. Otherwise, after recovery, residual collateral stasis may accumulate into chronic stomach pain or lower back pain. The world generally considers black tongue with prickles as Heat and moist tongue as Cold. However, stasis-induced black tongue, even with Heat, does not produce prickles; smokers' tongues, even with Cold, show dryness and cracking. One must distinguish based on accompanying symptoms. Generally, men's Blood stasis arises from Cold, from Heat, or from excessive use of cold-natured medicines in Warm Diseases which suppress Heat and close collaterals. Women's Blood stasis need not arise from Cold or Heat pathogens interacting with Blood; Blood can spontaneously stagnate. Thus, even after recovery, black tongue discoloration may persist.