痢者，古名滞下，经谓肠癖。洁古云∶壮盛人无积，虚人则有之，可见积由虚召，
皆因脾胃既虚，饮食不节，七情不适，肠胃怫郁，气血有伤，酿成脓血而为滞下也。然
卒成有五，积渐有七，有因饮食冷热不调，脾胃骤伤者，有因受暑而发者，有因风寒相
感而发者，有因吐泻失调而成者，有因误食毒物冷物，与惊恐相乘而得者，此为乍乘五
症也。其七症者何？有因食积日久而成者，有因气虚夹寒而成者，有因脾气久伤不能统
血而下血者，有因湿热伤脾而成者，有因阳气下陷，积乘脾败而成者，有因膏粱爆炙，
太过燥热蕴积者，有因疫气时行，秽毒相感者。凡伤气则白，伤血则赤，气血俱伤，赤
白乃出，黄是食伤，绿是伤湿，然总因湿热，犹脓出痈肿，虽有赤白之分，实无寒热
之别，其理其治，与妇人之赤白带同也。以痢之数而总计有八，曰冷曰热，曰疳曰
惊，曰冷热不调，曰休息，曰 痢，曰虫毒，其冷痢色白，热痢色赤，疳痢黄白下无
时度，惊痢青色，冷热不调之痢，赤白之色相兼，休息痢粪黑而如鱼肠，愈而复作，
痢肚大停积而又下，饮食不为肌肤，气臭而大便闭涩，虫毒痢则下紫黑，其治之
法，必审挟寒挟热，或虚或实，热者即可用实治，寒者盒饭同虚论也。至如痢久发热者
阴虚也。孔甚痛者热流于下也。禁口痢者，胃口热甚，或疫气秽毒，传入脏腑，毒瓦斯上
冲也。故宜黄连、石莲肉、忍冬花之类，以通心解毒主之。如后重而由肺气郁于大肠
者，以苦梗开之，实热者下之，气虚者提之，血虚者调之，然治痢虽云和血则便脓自
愈，行气则后重自除，此可加治于衰老弱幼元气之虚者。若夫壮实精盛，而当初起之
时，必须下之，即《经》所谓迎而夺之也。一至五日己后，则脾胃渐虚，又当似消导升
散行气和血矣，病久挟虚，又当以滋补气血，收涩滑脱矣。故后重则宜下，肠痛则宜
和，身重则除温，脉弦则去风，脓血稠枯，以重剂竭之，身冷自汗，以毒药温之，风邪
内缩宜汗之， 溏为利当温之，在外者发之，在里者下之，在上而未成积者涌之，在
下而已成痢者竭之，表热者内疏之，小便涩者分利之，盛者和之，去者送之，至者止
之，治痢之格言也。然脾胃为水谷之海，无物不受，常兼四脏，故五脏热毒而五液俱
下，为五色痢者。实者通利为先，虚者调血理气，至有毒瓦斯侵胃，是以饮食不餐，肛门
宽大，深黑可畏。肚腹疼痛，里急后重，频滴鲜血者，名曰刮肠。日夜频并，饭食直过
者，名曰滑肠。与前禁口五色并为恶候。《脉经》曰，肠癖便血，身热则死，寒则生，
肠癖下白沫，脉沉则生，浮则死。《脉经》
又曰∶肠癖下脓血，脉沉小，流连者生，数疾且大有热者死。及手足厥冷无脉，灸之不
温，脉去不还；及微喘者，唇如朱红者，下如鱼脑者，下如尘腐色者，下纯血者，下如
屋漏水者，下如竹筒注者，不食痢多，手足冷者；久痢身热汗出者，肠疼渴喘，体肿如
吹者，秋深久痢，呕逆昏沉，烦躁形脱者，久泻变痢，而为脾传肾者；及下痢黑色，腹
胀喘粗，唇枯目陷，瞳神散大；及生云翳赤脉者，头温足冷，口臭生痰，贪酒痢多，肚
皮陷落，面色青黑，泻如痈脓，或如臭鸡子气，其肾黑缩，唇青焦赤，汗出如雨，目闭
不开，长气鸦声，面如绯纸，胸陷口开，手足甲黑，口吐白虫或白沫青血，项软鱼口，
肚如雷鸣，泻下黑血而腥臭者；及久痢舌黑者，五脏伤也。久痢舌黄者脾气败也。并皆不治。
痢疾，古时候称为“滞下”，《内经》中称之为“肠癖”。张洁古说：身体强壮的人没有积滞，体虚的人才会有积滞，由此可见，积滞是由虚弱引起的。这都是因为脾胃已经虚弱，加上饮食不节制、七情（喜、怒、忧、思、悲、恐、惊）失调，导致肠胃气机郁结，气血受损，酝酿而成脓血，从而形成滞下痢疾。
然而，突然发作的痢疾有五种成因，逐渐形成的有七种。有的因饮食冷热不调，脾胃骤然受伤；有的因感受暑邪而发病；有的因风寒侵袭而发病；有的因呕吐腹泻调理不当而形成；有的因误食有毒或生冷食物，以及惊恐情绪叠加而得病，这叫做“乍乘五症”（突发五种证型）。那七种逐渐形成的证型是什么呢？有的因食积日久而成；有的因气虚夹杂寒邪而成；有的因脾气长期受损不能统摄血液而下血；有的因湿热损伤脾脏而成；有的因阳气下陷，积滞乘脾脏衰败而成；有的因过食肥甘厚味、辛辣炙烤之物，太过燥热蕴积而成；有的因疫疠之气流行，秽浊毒气相互感召而成。凡是伤及气分的则大便色白，伤及血分的则大便色赤，气血都受伤，则赤白相间而出。黄色是食物所伤，绿色是湿邪所伤，但总归是因为湿热，就像痈肿出脓一样，虽然有赤白之分，实际上并没有寒热的区别，其道理和治疗，与妇女带的赤白带下相同。
统计起来，痢疾共有八种类型：冷痢、热痢、疳痢、惊痢、冷热不调痢、休息痢、噤口痢、虫毒痢。其中，冷痢颜色发白，热痢颜色发红，疳痢黄白杂下且无定时次数，惊痢颜色发青，冷热不调之痢赤白相间，休息痢粪便黑如鱼肠，好了又复发，痢疾肚腹大胀停积却又下痢，饮食不能化为肌肤，气臭且大便闭塞涩滞，虫毒痢则下紫黑色粪便。治疗的方法，必须审察是否兼夹寒热，或是虚证还是实证。热证就可以用泻实的方法治疗，寒证应当同虚证一起论治。至于痢疾日久发热的，是阴虚所致。腹痛剧烈的，是热邪流注于下部所致。禁口痢（指痢疾严重到无法进食），是因为胃口热甚，或疫气秽毒传入脏腑，毒气上冲所致。因此适宜用黄连、石莲肉、忍冬花等药物，以通心解毒为主进行治疗。如果后重感是由于肺气郁结在大肠引起的，用桔梗宣开肺气；实热者用攻下法；气虚者用升提法；血虚者用调和法。然而治疗痢疾虽然常说和血则便脓自愈，行气则后重自除，但这只适用于衰老、弱小、幼儿元气虚弱的人。如果是身体壮实、精气旺盛，且在初起之时，必须用攻下法，这就是《内经》所说的“迎而夺之”（趁邪气盛时直接祛除）。到了第一至第五天以后，脾胃逐渐虚弱，又应当采用消导、升散、行气、和血的方法了。病久兼夹虚证，又应当用滋补气血、收涩滑脱的方法。所以，后重感适宜用攻下，肠痛适宜用调和，身体沉重适宜祛除湿温，脉弦适宜祛风，脓血稠枯，用重剂竭尽邪气，身体寒冷自汗，用温热药温补，风邪内缩适宜发汗，大便溏泄为利应当温补，病在表者发散它，病在里者攻下它，病在上部且未成积滞的用涌吐法，病在下部已成痢疾的用竭尽邪气法，表热者从内部疏解，小便涩滞者分利水道，邪气盛的用调和法，正气去者送补法，邪气至者止截法，这是治疗痢疾的格言准则。
然而脾胃是水谷汇聚的海，无物不受，常兼涉四脏，所以五脏热毒导致五液俱下，形成五色痢。实证以通利为先，虚证以调血理气为主。至于毒瓦斯侵犯胃腑，导致饮食不进，肛门宽大，深黑可畏，肚腹疼痛，里急后重，频频滴鲜血的，名叫“刮肠痢”。日夜频繁并见，饭食直过不化的，名叫“滑肠痢”。这与前面的禁口痢、五色痢并列为恶候。《脉经》说：肠癖便血，身体发热则死，身体发寒则生；肠癖下白沫，脉沉则生，脉浮则死。《脉经》又说：肠癖下脓血，脉沉小，病情缠绵缓慢者生，脉数疾且大有热者死。以及手足厥冷无脉，艾灸后不回暖，脉象离去不再返回；以及微喘者，嘴唇像涂了朱红一样鲜艳者，下痢如鱼脑者，下痢如尘腐色者，下纯血者，下痢如屋漏水者，下痢如竹筒注水般直下者，不吃东西却痢疾频多，手足冰冷者；久痢身体发热出汗者，肠痛口渴气喘，身体肿胀如吹气者，深秋久痢，呕吐逆乱昏沉，烦躁形体脱失者，久泻变为痢疾，且为脾传肾者；以及下痢黑色，腹胀气喘粗重，嘴唇干枯眼睛凹陷，瞳孔散大；以及眼生云翳赤脉者，头温足冷，口臭生痰，贪酒痢疾频多，肚皮陷落，面色青黑，泻下如痈脓，或像臭鸡蛋气味，肾脏黑缩，嘴唇青焦赤，汗出如雨，眼睛闭合不开，长叹气声音如乌鸦叫，面如绯红纸张，胸陷口开，手足指甲变黑，口吐白虫或白沫青血，颈部软弱鱼口疳，肚子如雷鸣，泻下黑血且腥臭者；以及久痢舌苔发黑的，是五脏受伤；久痢舌苔发黄的，是脾气败坏。这些都属于不治之症。
Dysentery, known in ancient times as "Zhi Xia" (Stagnant Downward Flow), is referred to as "Chang Pi" (Intestinal Dysentery) in the *Classic of Internal Medicine* (*Huangdi Neijing*). Zhang Jiegou stated: Robust individuals do not have accumulation, whereas deficient individuals do. This indicates that accumulation is summoned by deficiency. It all arises because the Spleen and Stomach are already deficient, combined with irregular diet and emotional imbalance (Seven Emotions), leading to Qi stagnation in the intestines and stomach, injury to Qi and Blood, which brews into pus and blood, resulting in stagnant downward flow dysentery.
However, sudden onset dysentery has five causes, while gradual onset has seven. Some arise from dietary cold and heat imbalance causing sudden injury to the Spleen and Stomach; some from contracting Summerheat; some from Wind-Cold invasion; some from improper regulation of vomiting and diarrhea; and some from ingesting toxic or cold foods compounded by fright and panic. These constitute the "Five Acute Syndromes." What are the seven gradual syndromes? Some result from long-standing food retention; some from Qi deficiency mixed with Cold; some from chronic Spleen Qi damage failing to control Blood, leading to bleeding; some from Damp-Heat injuring the Spleen; some from Yang Qi sinking, with accumulation taking advantage of Spleen failure; some from excessive consumption of rich, greasy, fried, and spicy foods causing dryness and heat accumulation; and some from epidemic pestilence qi where foul toxins interact. Injury to Qi results in white stool; injury to Blood results in red stool; injury to both yields red and white mixture. Yellow indicates food injury; green indicates Dampness injury. However, it is ultimately due to Damp-Heat, similar to pus discharging from a carbuncle. Although there is a distinction between red and white, there is essentially no distinction between Cold and Heat. The principle and treatment are the same as for leukorrhea (Vaginal Discharge) in women.
In total, there are eight types of dysentery: Cold Dysentery, Hot Dysentery, Cantharis Dysentery (associated with malnutrition/parasites), Fright Dysentery, Cold-Heat Imbalance Dysentery, Resting Dysentery (Intermittent Dysentery), Jing Kou Dysentery (Anorexic Dysentery), and Worm-Toxin Dysentery. Cold Dysentery presents with white color; Hot Dysentery with red; Cantharis Dysentery with yellow-white discharge at irregular intervals; Fright Dysentery with green color; Cold-Heat Imbalance Dysentery with mixed red and white; Resting Dysentery with black stool resembling fish intestines, recurring after remission; Abdominal Distension Dysentery with large abdominal accumulation yet continued purging, where food fails to nourish the flesh, foul odor, and constipation/stagnation; Worm-Toxin Dysentery presents with purple-black stool. Treatment must examine whether Cold or Heat is involved, and whether it is Deficiency or Excess. Heat patterns can be treated by draining excess; Cold patterns should be discussed similarly to Deficiency patterns. Prolonged dysentery with fever indicates Yin Deficiency. Severe abdominal pain indicates Heat flowing downward. Jing Kou Dysentery (inability to eat) is caused by severe Stomach Heat or epidemic foul toxins entering the Zang-Fu organs, with toxic vapors rushing upward. Therefore, herbs such as Huanglian (Coptis Rhizome), Shilian Rou (Nelumbo Nucifera Seed Endosperm), and Rendong Hua (Lonicera Flower) should be used to clear the Heart and resolve toxicity. If tenesmus is caused by Lung Qi stagnation in the Large Intestine, use Jiegeng (Platycodon Root) to open it; for Excess Heat, use purgation; for Qi Deficiency, use lifting methods; for Blood Deficiency, use harmonizing methods. Although treating dysentery often states that harmonizing Blood cures pus in stool and moving Qi relieves tenesmus, this applies only to the elderly, weak children, and those with deficient Yuan Qi. For robust individuals with abundant Essence and Qi, especially in the early stages, purgation is necessary, as stated in the *Classic*: "Meeting and seizing" (attacking the pathogen when it is strong). After one to five days, the Spleen and Stomach gradually weaken, requiring methods of digestion promotion, ascending and dispersing, Qi movement, and Blood harmonization. For prolonged disease with Deficiency, tonifying Qi and Blood and astringing leakage is required. Thus, tenesmus requires purgation; intestinal pain requires harmonizing; heavy body requires removing Damp-Warmth; wiry pulse requires dispelling Wind; thick and withered pus and blood require heavy agents to exhaust pathogens; cold body with spontaneous sweating requires toxic [potent] warming agents; internal contraction of Wind Evil requires diaphoresis; loose stools as diarrhea require warming; exterior pathogens require releasing; interior pathogens require purging; upper level without formation of accumulation requires emesis; lower level with formed dysentery requires exhausting pathogens; exterior Heat requires internal疏导 (venting); obstructed urination requires separating and draining; excess requires harmonizing; loss requires sending [tonifying]; arrival [of pathogen] requires stopping. These are maxims for treating dysentery.
The Spleen and Stomach are the sea of water and grain, receiving everything, and often involve the other four Zang organs. Thus, Heat-Toxin in the Five Zang organs causes all five fluids to descend, resulting in Five-Color Dysentery. Excess patterns prioritize unblocking and draining; Deficiency patterns focus on regulating Blood and reasoning Qi. When toxic vapors invade the Stomach, causing anorexia, wide anus, dark and frightening appearance, abdominal pain, tenesmus, and frequent dripping of fresh blood, it is named "Scraping Intestine Dysentery." Frequent day and night occurrence with food passing straight through is named "Sliding Intestine Dysentery." These, along with Jing Kou and Five-Color Dysentery, are considered ominous prognoses. The *Mai Jing* (Pulse Classic) states: In Chang Pi with bloody stool, fever indicates death, cold indicates survival; with white mucus, deep pulse indicates survival, floating pulse indicates death. The *Mai Jing* further states: With pus and blood, deep and small pulse with lingering course indicates survival; rapid, forceful pulse with heat indicates death. Also, cold limbs without pulse, unwarmed by moxibustion, pulse disappearing and not returning; slight panting; lips like vermilion; stool like fish brain; stool like dust and decay; pure blood; stool like leaking roof water; stool pouring like from a bamboo tube; anorexia with frequent dysentery and cold limbs; prolonged dysentery with fever and sweating; intestinal pain, thirst, panting, swelling like inflated bag; late autumn prolonged dysentery with vomiting, reversal, coma, restlessness, and physical depletion; chronic diarrhea turning into dysentery transmitted from Spleen to Kidney; black stool with abdominal distension and coarse breathing; dry lips and sunken eyes; dilated pupils; cloudiness and red veins in eyes; warm head and cold feet; bad breath with phlegm production; alcohol craving with frequent dysentery; sunken abdomen; blue-black complexion; discharge like abscess pus or rotten eggs; black and shriveled Kidneys; blue and scorched lips; profuse sweating like rain; closed eyes unable to open; long sighs with crow-like voice; face like crimson paper; sunken chest and open mouth; black fingernails; vomiting white worms or white foam and blue blood; soft neck and fish-mouth deformity; thunderous abdomen; black bloody stool with foul smell; black tongue in prolonged dysentery indicating Five Zang injury; yellow tongue in prolonged dysentery indicating Spleen Qi failure. All these are incurable.