夫痢生于积滞，然积物欲下，而气滞不能与之下，日夜百度，下迫窘痛，治先通利
之，即《内经》通因通用之法，故仲景谓可下者，悉以承气汤下之，大黄之寒，其性善
走，佐以浓朴之温，善行滞气，缓以甘草之甘，饮以汤液，荡涤汤胃滋润轻快，积行即
止，禁用砒丹巴碉等药，恐其暴悍毒烈，有伤肠胃清纯之气。然前人专主寒治之说，以
痢无于秋，是暑月郁热所致，其理甚着，其议论亦和平，但不详所以致郁热者，多因暑
热酷烈，过饮冰水过食生冷，热为寒郁，久而为沉寒积冷者亦有之，不可泥定是热，当
辨症切脉，大凡下热痢用大黄，下寒痢用巴豆，有是病而服是药，详按古人之成法，不
容毫发差谬，然王海藏又云∶暑月血痢，不用黄连，阴在内，也此亦一端之见，凡腹痛
后重，小便短少，口渴喜冷冻饮料，大肠口燥结，是为挟热下痢，理当香连、大黄、芩、
芍、枳壳、槟榔，清利荡涤之剂，趁其初起，人强积重而行之，若腹痛口不渴，喜热
饮，小便清长，身不热，腹喜热手熨者，是为挟寒下痢，须理中姜桂温之。至于初起受
病，原系热痢，迁延日久，各症不减，或反加重，理当别治，竟作虚看，须用补中益
气，一升一补，倍加参 温补，如小腹重坠，切痛奔豚，此兼属少阴症，急加吴茱
萸、肉桂、破故纸、肉果，甚则加附子，如有纯血者，加（炒）黑干姜，虚回而利自
止，若必待血清利止，而后补，补亦晚矣。
夏秋泄泻疟痢，同乎一源，多由暑湿伤脾所致，饮食才伤，便作泄泻，为轻，停滞
既久，变成疟痢，为重，而疟与痢又有分别，饮食为痰，充乎胸膈，则为疟。饮食为
积，胶乎肠胃，则为痢。古云∶无痰不成疟，无积不成痢，故当初起人强积盛之时，
轻则三棱、蓬术、槟榔、枳壳、枳实、青陈木香之类，重则酒制大黄利之，不可姑息，
犹养虎遗患也。况有积者病当之无损于人也。若因循日久，元气已虚，积气独盛，攻
补莫施便成坏症，况诸痢疾，虽属里症，然多染时行，故七日前甚者，积多人壮，虽密
不死善于调理，七日后其症当渐愈，若初起不甚，人多忽略，七日之后积气逗留，人衰
胃弱，痢势大作，每多难治，不可不知，但世间似痢非痢者多。东垣云∶饮食有伤，起
居不时，损其胃气，则上升清华之气反从下降，是为飨泄，久则太阴传少阴，而为肠
，里急后重，脓血相错，数至圊而不能即便者，专用补中益气汤为主，使升降之道
行，其痢不治而自愈，又有一等阴虚似痢者，即五泄中大瘕泄是也。《经》曰∶里急
后重，数至圊而不能便，必茎中痛，其症红白相杂，里急后重，悉似痢疾，必小便短涩
而痛，或不通而痛，或欲小便而大便先脱，或欲大便而小便自遗，两便牵引而痛，此肾
虚之危证，急以八味地黄丸加补骨脂、肉豆蔻、阿胶、兼理中汤，加升麻桂附相继间
服，庶可挽回，世以痢药致毙者，不可枚
举。
有一等噤口痢者，汤药入口随出，在下缠住急迫，多因热毒炽盛，逆冲胃口。胃气
伏而不宣，急用黄连，以吴茱萸炒过，拣去茱萸，人参等分，入糯米一撮浓煎加姜汁，
细细呷之，但得二三匙咽下，便不复吐矣。如吐再服，有一等寒气逆上者，用温补之药
调之，其病易治。
有一等五色痢者，五脏蕴热，熏腐脏腑，五液俱下，故其色皆见于外，极危症
也。须用金银花、（酒炒）黄连、归芍、木香、乳香之类，清热解毒，和血主之。
有一等休息痢者，经年屡月愈而复发，此系寒积在大肠底，诸药所不到，独巴豆一
味研炒蜡丸，空腹服之，再不复发，此亦通因通用之法也。
后重有二，邪气坠下者圊后少减，未几复甚，及里急不得便者，皆实也，火也。虚
努不收者，圊后不减，以得解愈虚故也。及里急频见污衣者，皆虚也，寒也。此可以辨
虚实，然肾司闭藏，肝主疏泄，二经气虚，则各失其职，肝虚不能疏泄而后重，肾虚不
能闭藏而禁固，治宜温补肝肾，更须早晚食前服之，盖暖药虽平旦服之，至夜药力已
尽，无以敌一夜之阴寒，故独早服，亦无效也。张尝治痢症，密甚无度，里急后重，口
渴恶食，少腹倍痛，痢色或红或白，甚至血水，小便不利，其脉寸强尺弱者，俱用六味
加五味子肉桂，早晚各服而愈。
有疟后痢，有痢后疟者，夫既为疟后，发泄已尽，必无暑热之毒，复为痢疾，此是
元气下陷，脾气不能升举，似痢非痢也。既为痢后，下多亡血，气随痢散，阴阳两虚，
阳虚则恶寒，阴虚则恶热，故寒热交战，似疟非疟也，俱作虚论，用补中益气，加温补
自愈。痢因于湿，湿生于土，故或寒或热，皆能脓血，盖五行之理，热因火化，寒因水
化，憔湿土寄于四季，从乎火则阳土有余，而湿热为病，从乎水则阴土不足，而寒湿生
灾，可见湿为内主，而寒热为之外因，白者寒滞肠胃之气道，赤者热伤肠胃之血络，白
者为轻，气滞于脂膏，而未伤其血络也。赤者为重，热伤血络，而深入于阴分也。湿热
虽分气血之伤，积滞实由饮食之化，生冷炙爆，酝酿日久，湿从冷生，热从暑袭，冷热
郁遏，湿热成焉。夏月湿热太甚，客气盛而主气弱，渗入大肠，脂膜腐烂，痢疾之由，
始于此矣。红者，湿热中之热化也。白者，湿热中之冷化也。治痢大法，始当推荡，久
当温补而尤宜以顾胃气为主，盖百病以胃气为本，而于痢为尤要，故能食者轻，不能食
者重，绝不食者死，是痢之赖于胃气者，如此其重矣。而尤莫要于补肾阴，盖痢属脾肾
二经，夫肾为胃关，开窍于二阴，未有久痢而阴不亡者，未有阴亡而肾不虚者，故欲治
痢而不治肾阴者，非其治也。徒知见在者，有形之疾病，不知可虑者，无形之元气，盖
有形之疾病无期，而无形之元气易竭也。元气既虚，不补何复？补元气者，治痢之本
也。然元气在脾肾之中，故痢之为证，多本脾肾，脾司仓禀，土为万物之母，肾主蛰
藏，水为万物之元，二脏皆根本之地也。补中气以扶脾胃，助命门以复真阴，则元气旺
而健运，得阴阳和而闭藏固，何有肠胃拂郁而为患哉？
一孕妇疟痢齐发，医治两月余疟止而痢愈，甚又加腹痛，饮食少进，养葵视之曰∶
虚寒也。以补中益气加姜桂一服，痢止大半，再一服而反疟病大作，主人惊恐。赵氏
曰∶此吉兆也。向者疟之止，乃阴盛之极，阳不敢与之争，全服补阳之剂，阳气有权，
敢与阴战，再能助阳之力，阴自退听，方中加附子五分， 疟痢齐愈，大服补剂，越三
月产一子，产后甚健，故应犯而犯，似乎无犯。
《经》曰∶下痢皆属于湿；又曰∶下痢稠粘，皆属于火，下痢脓血，滞下皆热证实
证也。然痢起于夏秋，湿蒸郁热，本乎天
也。因热求凉，过食生冷，由于人也。气壮而伤于天者，郁热居多，气弱而伤于人者，
阴寒为甚，湿土寄旺四时，或从于火，则阳土有余，而湿热为病《经》所谓敦阜是也。
或从于水，则阴土不足，而寒湿为病，《经》所谓卑监是也。言热者遗寒，言寒者废热，
岂非立言之过乎，至以赤为热，白为寒，亦非确沦，果则赤白相兼者，岂寒热同病乎，
必以见证与色脉辨之，而后寒热不淆也。须知寒者必虚，热者必实，更以虚实细详之，
而寒热愈明耳，胀满恶食，急痛惧按者实也。烦渴引饮，喜冷畏热者热也。脉强而实
者实也。脉数而滑者热也。外此则属虚寒矣。然相似之际，尤当审察，如以口渴为实
热似矣。不知凡系泻痢，必少津液，液亡于下，则津涸于上，安得不渴？更当以喜热喜
冷分虚实也。以腹痛为实热似矣。不知痢出于脏，肠胃必伤，脓血剥肤，安得不痛？更
当以痛之缓急，按之可否，腹之胀与不胀，脉之有力无力，分虚实也。以小便之黄赤短
少为实热似矣。不知水从痢去，溲必不长，液以阴耗，溺因色变，安得不小便赤少？更
当以色之泽与不泽，液之涸与不涸，分虚实也。以里急后重为实热似矣。不知气陷则传
运不健，阴亡则肠润乃粘，安得不里急后重？更当以病之新久，质之浓薄，脉之强
弱，分虚实也。细辨候之虚实，更察脉之盛衰，则病无遁情矣。
世之病痢者，十有九虚，医之治痢者，百天一补，气本下陷，而再行其气，后重不
亦甚乎，中本虚衰，而复攻其积，元气不愈竭乎，湿热伤血者自宜调血，若过行推荡，
阴血不转伤乎，津亡作渴者自宜养阴，若但与渗利，津液不转耗乎。世有庸工，专守痛
无补法，且曰不宜补早，不知因虚而痛者，愈攻则愈虚愈痛，每见有形之疾病未除，而
无形之元气先脱，悔之晚矣。故脉来微弱者可补，形色虚薄者可补，疾后而痢者可补，
因攻而剧者可补，尤有至要者，则在脾肾两脏，如先痢而后泻者，为肾传脾，微邪易
治，先泻而后痢者，为脾传肾，贼邪难医是知在脾者病浅，在肾者痛深，夫肾主禁
固，肾为胃关，未有久痢脾虚而肾阴不损，肾阳不亡者，四君归脾，十全补中皆补脾
虚，未尝不善，若病在火衰，土位无母，设非桂附大补命门，以复肾中之阳，以救脾家
之母，则饮食何由而进？门户何由而固？真元何由而复耶？如畏热不前，仅以参木补
土，多致不起，大可伤也。旧积者湿热食痰也。法当下之，新积者下后又生者也。或调
或补；不可轻攻，若因虚而痢者，虽旧积亦不可下，但用异功散虚回而痢自止。丹溪有
先用参术调补胃气，而后下者亦妙法也。虚者宜之，及至秽积既尽，糟粕未实，盒饭以
白芍、白术、茯苓固肠丸之类，调理脾胃，则新积不生，然痢必须即饮食，一切油腻肉
面痛绝之，服药乃验，若宿垢未净，又增新者，肠胃何由而清？渐渐壅塞，脾病未愈，
胃病又增，真至恶心不食，或禁口矣。
初起肠中有积，后重腹痛，又恶心，胸膈作胀，乃新饮食未曾化熟也。不可遽用凉
药及下，凉则愈结，下则伤胃，须先消导之，俟下膈不恶心不胀惫，方可攻下，如恶
心甚者，先以淡盐汤探吐，如初热有里者宜下，恶寒者忌下。泻与痢不分两证，混言湿
热而利小便非也。盖淡渗之剂，功能利水浊流得快，则泻自止，若痢疾乃垢秽之物，同
于湿热，肠胃怫郁而成，出于大肠传送之道，了不干于胃气，故不宜过用渗利之药，
以使重竭其阳，而涸其津液，是病降之，而药又降之也。但诸症小便清长，其病渐退之
兆，况于痢疾乎。李时珍曰∶血痢已通，而痛不止者，乃阴亏气郁，药中加川芎，气行
血调，其病立止，或言下痢为寒者非也。寒则不能消谷，何由反化为脓也。下痢赤白，
或言寒热相兼者，尤非也。寒热异气，岂能并行于肠胃而为痢乎？本一于湿热，但有伤
气伤血之轻重耳。大肠气虚下陷而后重者，
宜四君子加升柴，亦有无气大亏，肠中无气，而不能推送者，只须参 苓术，大补中
气，若大肠血虚后重者，四物汤加参术。丹溪曰∶里急者腹中不宽快也。亦有虚坐而大
便不行者，皆为血虚，盖肠中无津不能润运，虽当补血，亦必兼以补气，若单于补
血，徒伤脾胃，盖气有生血之功也。阴虚有火，又加暑热交攻，不宜便补，更不宜燥，
惟微寒清平之剂调之，如再不愈，方以清润之剂补之。复有毒痢一证，或痧毒内陷，下
脓血各药不效者，当于和血行气药中，加以解毒，如忍冬花，炙乳香、香连之类。产后
痢疾，积滞虽多，腹痛虽极，不可用大黄等药行之，致伤胃气，遂不可救，但用人参、
白芍、当归、红曲、醋（炒）升麻、益母草煨木香、留白、广皮、炙甘草足矣。如血虚
可加（炒）阿胶二钱。
凡胎前滞下，宜用黄芩、黄连、白芍、炙甘草、橘红、红曲、枳壳、莲肉，略用升
麻，未满七月，勿用滑石。夫冬月伤寒，己称病热，至夏秋暑热三气交蒸，互结之热，
十倍于冬月矣。外感三气之热，而成下痢，必从外而出之，是故下痢有用辛凉以解表，
次用苦寒以清里，一二剂愈矣。失于表者，外邪但从里出，不死不已，故虽百日之远，
仍用逆流挽丹之法，引其邪而出之于外，则死证可活，危证可安，金匮以下，痢脉反弦
发热身汗者自愈，夫久痢之脉，深入阴分，沉涩微弱矣。忽然而转弦脉，浑是少阳生发
之气，非逆挽之法乎。脉细皮寒，气少泄利，前后饮食不入，是谓五虚死，惟用参
附，十可救一。
痢后脚渐细而软弱，名为痢风，不治而成鹤膝风，治宜温补肝脾肾，不可仍用燥脾
之药也。
痢后痛风，遍身疼甚，系肠胃湿热，恶血未净，复还经络，所以留滞隧道作痛也。
宜四物汤，加桃仁、红花、牛膝、陈皮之类，亦有气血虚而疼痛者，不可不审。
白痢自大肠，赤痢自小肠，此丹溪以赤白分气血言也。大肠为传道之官，痢属伤肠
胃之血络。动脏腑之脂膏，故赤白俱并入大肠而下，若小肠则为出溺之所，未见小肠为
下痢之腑也。谓心主血，心与小肠表里，故赤痢本小肠之所化则可，若谓从小肠而来，
痢疾的产生源于积滞，然而积滞之物想要排出，气机却阻滞不能随之而下，导致日夜排便数十次，肛门急迫窘迫疼痛。治疗应先通利它，这就是《内经》中“通因通用”的方法。所以张仲景说可以攻下的，都用承气汤来攻下。大黄性寒，善于走窜，佐以厚朴之温，善于行滞气；缓以甘草之甘，用汤剂服用，荡涤肠胃，滋润轻快，积滞下行后即停止使用。禁用砒霜、巴豆等药物，恐怕它们暴烈毒猛，损伤肠胃清纯之气。
然而前人专门主张寒凉治疗的说法，认为痢疾没有发生在秋天的（注：此处原文可能有误或特指某种语境，通常痢多发于夏秋，但原文如此），是暑月郁热所致，道理很显著，议论也很平和。但不详细探究导致郁热的原因，大多是因为暑热酷烈，过饮冰水、过食生冷，热被寒邪郁遏，久而久之成为沉寒积冷的也有这种情况。不可固执地认定全是热证，应当辨证切脉。大凡下热痢用大黄，下寒痢用巴豆，有病而服相应的药，详细遵循古人的成法，不容许丝毫差错。
然而王海藏又说：暑月血痢，不用黄连。这也是片面之见。凡是腹痛后重，小便短少，口渴喜欢喝冷饮，大肠口燥结的，这是挟热下痢，理当用香连丸、大黄、黄芩、芍药、枳壳、槟榔等清利荡涤的方剂。趁其初起，人体强壮、积滞重时施用。如果腹痛口不渴，喜欢热饮，小便清长，身体不发热，腹部喜欢热敷的，这是挟寒下痢，须用理中汤加干姜、肉桂温补。至于初起受病，原系热痢，迁延日久，各种症状不减，或者反而加重，理当另行治疗，竟当作虚证看待，须用补中益气汤，一升一补，倍加人参温补。如小腹重坠，切痛奔豚，这兼属少阴症，急加吴茱萸、肉桂、破故纸、肉果，严重时加附子。如果有纯血便的，加炒黑干姜，虚象恢复而痢自止。如果一定要等到血清、痢止之后才进补，那就太晚了。
夏秋季节的泄泻、疟疾、痢疾，同出一源，多由暑湿伤脾所致。饮食刚受伤，就发生泄泻，为轻症；停滞既久，变成疟痢，为重症。而疟疾与痢疾又有分别：饮食化为痰，充塞胸膈，则为疟疾；饮食化为积，胶着肠胃，则为痢疾。古语说：无痰不成疟，无积不成痢。所以在初起人体强壮、积滞盛的时候，轻则用三棱、莪术、槟榔、枳壳、枳实、青木香、陈皮木香之类，重则用酒制大黄通利，不可姑息，如同养虎遗患。况且有积滞的病，病邪承受了攻击，对人无损。如果因循日久，元气已虚，积气独盛，攻补两难，就会变成坏证。况且各种痢疾，虽然属于里证，但多染时行疫气，所以七日前病情严重的，积多人壮，虽然病势紧急也不会死，善于调理即可；七日后病情应当逐渐痊愈，如果初起不严重，人多忽略，七日之后积气逗留，人衰胃弱，痢势大作，往往难以治疗，不可不知道。只是世间似痢非痢的情况很多。
李东垣说：饮食有伤，起居不时，损伤胃气，则上升的清气反从下降，这叫飧泄。久了太阴传至少阴，而为肠澼，里急后重，脓血相杂，频繁去厕所却不能立即排便的，专用补中益气汤为主，使升降之道运行，其痢不治而自愈。又有一类阴虚似痢者，就是五泄中的大瘕泄。《内经》说：里急后重，频繁去厕所却不能排便，必然茎中痛，其症红白相杂，里急后重，全像痢疾，但小便短涩而痛，或者不通而痛，或者想小便而大便先失禁，或者想大便而小便自遗，前后二便牵引疼痛，这是肾虚的危证，急用八味地黄丸加补骨脂、肉豆蔻、阿胶，兼服理中汤，加升麻、桂枝、附子相继间服，才可以挽回。世上因用治痢药致死的人，不可胜数。
有一类噤口痢，汤药入口随即吐出，在下部缠住急迫，多因热毒炽盛，逆冲胃口。胃气伏而不宣，急用黄连，用吴茱萸炒过，拣去茱萸，与人参等分，入糯米一撮浓煎，加姜汁，细细呷之，只要得二三匙咽下，就不再吐了。如果吐了再服。有一类寒气逆上的，用温补的药调治，病易治。
有一类五色痢，五脏蕴热，熏腐脏腑，五液俱下，所以颜色都见于外，是极危重的证候。须用金银花、酒炒黄连、当归、芍药、木香、乳香之类，清热解毒，和血为主治。
有一类休息痢，经年累月好了又复发，这是寒积在大肠底部，诸药所不到，独用巴豆一味研炒制成蜡丸，空腹服用，不再复发，这也是通因通用的方法。
后重有两种：邪气坠下，排便后稍减，不久又加重，以及里急不得便的，都是实证，火证。虚性努责不收，排便后不减，因为解后更虚的缘故，以及里急频见污衣的，都是虚证，寒证。这可以辨别虚实。然而肾司闭藏，肝主疏泄，二经气虚，则各失其职，肝虚不能疏泄而后重，肾虚不能闭藏而禁固，治疗宜温补肝肾，更须在早晚饭前服用。大概暖药即使清晨服用，到晚上药力已尽，无法抵御一夜的阴寒，所以只早上服，也无效。我曾治痢症，病势紧急无度，里急后重，口渴恶食，少腹加倍疼痛，痢色或红或白，甚至血水，小便不利，其脉寸强尺弱的，都用六味地黄丸加五味子、肉桂，早晚各服而愈。
有疟后痢，有痢后疟。既然为疟后，发泄已尽，必无暑热之毒，复为痢疾，这是元气下陷，脾气不能升举，似痢非痢。既然为痢后，下多亡血，气随痢散，阴阳两虚，阳虚则恶寒，阴虚则恶热，故寒热交战，似疟非疟，都作虚证论治，用补中益气加温补自愈。痢因于湿，湿生于土，所以或寒或热，都能化脓血。盖五行之理，热因火化，寒因水化。焦湿土寄于四季，从乎火则阳土有余，而湿热为病；从乎水则阴土不足，而寒湿生灾。可见湿为内主，而寒热为之外因。白者为寒滞肠胃之气道，赤者为热伤肠胃之血络。白者为轻，气滞于脂膏，而未伤其血络；赤者为重，热伤血络，而深入于阴分。湿热虽分气血之伤，积滞实由饮食之化。生冷炙爆，酝酿日久，湿从冷生，热从暑袭，冷热郁遏，湿热成焉。夏月湿热太甚，客气盛而主气弱，渗入大肠，脂膜腐烂，痢疾之由，始于此矣。红者，湿热中之热化也。白者，湿热中之冷化也。治痢大法，始当推荡，久当温补，而尤宜以顾胃气为主。盖百病以胃气为本，而于痢为尤要，故能食者轻，不能食者重，绝不食者死，是痢之赖于胃气者，如此其重矣。而尤莫要于补肾阴，盖痢属脾肾二经，夫肾为胃关，开窍于二阴，未有久痢而阴不亡者，未有阴亡而肾不虚者，故欲治痢而不治肾阴者，非其治也。徒知见在者，有形之疾病，不知可虑者，无形之元气，盖有形之疾病无期，而无形之元气易竭也。元气既虚，不补何复？补元气者，治痢之本也。然元气在脾肾之中，故痢之为证，多本脾肾，脾司仓禀，土为万物之母，肾主蛰藏，水为万物之元，二脏皆根本之地也。补中气以扶脾胃，助命门以复真阴，则元气旺而健运，得阴阳和而闭藏固，何有肠胃拂郁而为患哉？
一孕妇疟痢齐发，医治两月余疟止而痢愈，甚又加腹痛，饮食少进，养葵视之曰：虚寒也。以补中益气加姜桂一服，痢止大半，再一服而反疟病大作，主人惊恐。赵氏曰：此吉兆也。向者疟之止，乃阴盛之极，阳不敢与之争，全服补阳之剂，阳气有权，敢与阴战，再能助阳之力，阴自退听，方中加附子五分，疟痢齐愈，大服补剂，越三月产一子，产后甚健，故应犯而犯，似乎无犯。
《内经》说：下痢皆属于湿；又说：下痢稠粘，皆属于火。下痢脓血，滞下皆热证实证也。然痢起于夏秋，湿蒸郁热，本乎天也。因热求凉，过食生冷，由于人也。气壮而伤于天者，郁热居多，气弱而伤于人者，阴寒为甚。湿土寄旺四时，或从于火，则阳土有余，而湿热为病，《内经》所谓敦阜是也。或从于水，则阴土不足，而寒湿为病，《内经》所谓卑监是也。言热者遗寒，言寒者废热，岂非立言之过乎？至以赤为热，白为寒，亦非确论。果则赤白相兼者，岂寒热同病乎？必以见证与色脉辨之，而后寒热不淆也。须知寒者必虚，热者必实，更以虚实细详之，而寒热愈明耳。胀满恶食，急痛惧按者实也。烦渴引饮，喜冷畏热者热也。脉强而实者实也。脉数而滑者热也。外此则属虚寒矣。然相似之际，尤当审察，如以口渴为实热似矣。不知凡系泻痢，必少津液，液亡于下，则津涸于上，安得不渴？更当以喜热喜冷分虚实也。以腹痛为实热似矣。不知痢出于脏，肠胃必伤，脓血剥肤，安得不痛？更当以痛之缓急，按之可否，腹之胀与不胀，脉之有力无力，分虚实也。以小便之黄赤短少为实热似矣。不知水从痢去，溲必不长，液以阴耗，溺因色变，安得不小便赤少？更当以色之泽与不泽，液之涸与不涸，分虚实也。以里急后重为实热似矣。不知气陷则转运不健，阴亡则肠润乃粘，安得不里急后重？更当以病之新久，质之浓薄，脉之强弱，分虚实也。细辨候之虚实，更察脉之盛衰，则病无遁情矣。
世之病痢者，十有九虚，医之治痢者，百无一补。气本下陷，而再行其气，后重不亦甚乎？中本虚衰，而复攻其积，元气不愈竭乎？湿热伤血者自宜调血，若过行推荡，阴血不转伤乎？津亡作渴者自宜养阴，若但与渗利，津液不转耗乎？世有庸工，专守痛无补法，且曰不宜补早，不知因虚而痛者，愈攻则愈虚愈痛，每见有形之疾病未除，而无形之元气先脱，悔之晚矣。故脉来微弱者可补，形色虚薄者可补，疾后而痢者可补，因攻而剧者可补。尤有至要者，则在脾肾两脏，如先痢而后泻者，为肾传脾，微邪易治，先泻而后痢者，为脾传肾，贼邪难医。是知在脾者病浅，在肾者痛深。夫肾主禁固，肾为胃关，未有久痢脾虚而肾阴不损，肾阳不亡者。四君归脾，十全补中皆补脾虚，未尝不善，若病在火衰，土位无母，设非桂附大补命门，以复肾中之阳，以救脾家之母，则饮食何由而进？门户何由而固？真元何由而复耶？如畏热不前，仅以参木补土，多致不起，大可伤也。旧积者湿热食痰也。法当下之，新积者下后又生者也。或调或补，不可轻攻。若因虚而痢者，虽旧积亦不可下，但用异功散，虚回而痢自止。丹溪有先用参术调补胃气，而后下者亦妙法也。虚者宜之，及至秽积既尽，糟粕未实，盒饭以白芍、白术、茯苓固肠丸之类，调理脾胃，则新积不生。然痢必须忌饮食，一切油腻肉面痛绝之，服药乃验，若宿垢未净，又增新者，肠胃何由而清？渐渐壅塞，脾病未愈，胃病又增，真至恶心不食，或禁口矣。
初起肠中有积，后重腹痛，又恶心，胸膈作胀，乃新饮食未曾化熟也。不可遽用凉药及下，凉则愈结，下则伤胃，须先消导之，俟下膈不恶心不胀惫，方可攻下。如恶心甚者，先以淡盐汤探吐，如初热有里者宜下，恶寒者忌下。泻与痢不分两证，混言湿热而利小便非也。盖淡渗之剂，功能利水浊流得快，则泻自止，若痢疾乃垢秽之物，同于湿热，肠胃怫郁而成，出于大肠传送之道，了不干于胃气，故不宜过用渗利之药，以使重竭其阳，而涸其津液，是病降之，而药又降之也。但诸症小便清长，其病渐退之兆，况于痢疾乎。李时珍曰：血痢已通，而痛不止者，乃阴亏气郁，药中加川芎，气行血调，其病立止。或言下痢为寒者非也。寒则不能消谷，何由反化为脓也？下痢赤白，或言寒热相兼者，尤非也。寒热异气，岂能并行于肠胃而为痢乎？本一于湿热，但有伤气伤血之轻重耳。大肠气虚下陷而后重者，宜四君子加升柴，亦有无气大亏，肠中无气，而不能推送者，只须参苓术，大补中气。若大肠血虚后重者，四物汤加参术。丹溪曰：里急者腹中不宽快也。亦有虚坐而大便不行者，皆为血虚，盖肠中无津不能润运，虽当补血，亦必兼以补气，若单于补血，徒伤脾胃，盖气有生血之功也。阴虚有火，又加暑热交攻，不宜便补，更不宜燥，惟微寒清平之剂调之，如再不愈，方以清润之剂补之。复有毒痢一证，或痧毒内陷，下脓血各药不效者，当于和血行气药中，加以解毒，如忍冬花，炙乳香、香连之类。产后痢疾，积滞虽多，腹痛虽极，不可用大黄等药行之，致伤胃气，遂不可救，但用人参、白芍、当归、红曲、醋炒升麻、益母草煨木香、留白、广皮、炙甘草足矣。如血虚可加炒阿胶二钱。
凡胎前滞下，宜用黄芩、黄连、白芍、炙甘草、橘红、红曲、枳壳、莲肉，略用升麻，未满七月，勿用滑石。夫冬月伤寒，己称病热，至夏秋暑热三气交蒸，互结之热，十倍于冬月矣。外感三气之热，而成下痢，必从外而出之，是故下痢有用辛凉以解表，次用苦寒以清里，一二剂愈矣。失于表者，外邪但从里出，不死不已，故虽百日之远，仍用逆流挽丹之法，引其邪而出之于外，则死证可活，危证可安。金匮以下，痢脉反弦发热身汗者自愈，夫久痢之脉，深入阴分，沉涩微弱矣。忽然而转弦脉，浑是少阳生发之气，非逆挽之法乎？脉细皮寒，气少泄利，前后饮食不入，是谓五虚死，惟用参附，十可救一。
痢后脚渐细而软弱，名为痢风，不治而成鹤膝风，治宜温补肝脾肾，不可仍用燥脾之药也。
痢后痛风，遍身疼甚，系肠胃湿热，恶血未净，复还经络，所以留滞隧道作痛也。宜四物汤，加桃仁、红花、牛膝、陈皮之类，亦有气血虚而疼痛者，不可不审。
白痢自大肠，赤痢自小肠，此丹溪以赤白分气血言也。大肠为传道之官，痢属伤肠胃之血络，动脏腑之脂膏，故赤白俱并入大肠而下，若小肠则为出溺之所，未见小肠为下痢之腑也。谓心主血，心与小肠表里，故赤痢本小肠之所化则可，若谓从小肠而来，
Dysentery arises from stagnation and accumulation. However, although the accumulated matter desires to be expelled downward, qi stagnation prevents it from descending with it, resulting in frequent bowel movements day and night accompanied by urgency, distress, and pain. Treatment should first focus on promoting unobstructed flow, which is the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong) described in the *Nei Jing* (*Inner Canon*). Therefore, Zhang Zhongjing stated that cases suitable for purgation should all be treated with Chengqi Tang (Cinnamon Twig and Rhubarb Decoction). The cold nature of Da Huang (Rhubarb Root and Rhizome) is good at moving freely; assisted by the warm nature of Hou Po (Magnolia Bark), which is good at moving stagnant qi; and moderated by the sweet nature of Gan Cao (Licorice Root), administered as a decoction, it sweeps away impurities, moistens and nourishes, and provides light relief. Once the accumulation is cleared, administration should cease. Drugs such as Pi Dan (Arsenic Pill) and Ba Dou (Croton Seed) are strictly forbidden, fearing their violent toxicity may damage the pure qi of the stomach and intestines.
However, predecessors exclusively advocated cold-natured treatments, arguing that dysentery mostly occurs in autumn due to summer heat and depression. This reasoning is clear and the arguments are moderate, but they fail to detail why heat becomes depressed. Often, due to intense summer heat, excessive consumption of ice water or raw/cold foods causes heat to be constrained by cold, leading to deep-seated cold and accumulated cold over time. One cannot rigidly assume it is always heat; one must differentiate symptoms and palpate the pulse. Generally, for heat-type dysentery, use Da Huang (Rhubarb Root and Rhizome); for cold-type dysentery, use Ba Dou (Croton Seed). Administer the appropriate medicine for the specific disease, carefully following ancient established methods without any deviation.
However, Wang Haicang also stated: For blood dysentery in summer months, do not use Huang Lian (Coptis Rhizome). This is also a partial view. Whenever there is abdominal pain, tenesmus (feeling of incomplete defecation), scanty urine, thirst preferring cold drinks, and dryness/constipation in the large intestine, this is dysentery complicated by heat. It is appropriate to use clearing and draining agents such as Xiang Lian (Costus and Coptis), Da Huang (Rhubarb Root and Rhizome), Huang Qin (Scutellaria Root), Bai Shao (White Peony Root), Zhi Qiao (Immature Bitter Orange), and Bing Lang (Areca Seed). Use these while the condition is in its early stages and the patient's constitution is strong despite heavy accumulation. If there is abdominal pain but no thirst, preference for hot drinks, clear and copious urine, no fever, and a abdomen that prefers warmth, this is dysentery complicated by cold. It requires warming with Lizhong Tang (Regulate the Middle Decoction) plus Jiang (Ginger) and Gui Zhi (Cinnamon Twig).
If the initial pathogen was heat-type dysentery, but after prolonged duration symptoms do not subside or worsen, treatment must change, viewing it as a deficiency syndrome. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift and tonify, doubling the dosage of Ren Shen (Ginseng Root) for warming tonification. If there is heaviness and bearing-down sensation in the lower abdomen with severe pain, resembling Ben Tun (Running Piglet Qi), this involves the Shaoyin channel. Urgently add Wu Zhu Yu (Evodia Fruit), Rou Gui (Cinnamon Bark), Po Gu Zhi (Astragalus Complanatus Seed), and Rou Guo (Nutmeg). In severe cases, add Fu Zi (Aconite Lateral Root). If there is pure blood, add Chao Hei Gan Jiang (Charred Dried Ginger). When deficiency recovers, dysentery stops naturally. If one waits until blood clears and diarrhea stops before tonifying, it will be too late.
Diarrhea, malaria, and dysentery in summer and autumn share the same origin, mostly caused by summer-dampness injuring the Spleen. If dietary injury occurs, diarrhea ensues immediately, which is mild. If stagnation persists for a long time, it transforms into malaria or dysentery, which is severe. Malaria and dysentery differ: if food transforms into phlegm filling the chest and diaphragm, it becomes malaria; if food transforms into accumulation sticking to the stomach and intestines, it becomes dysentery. Ancients said: "No phlegm, no malaria; no accumulation, no dysentery." Thus, at the onset when the patient is strong and accumulation is abundant, for mild cases use San Leng (Burreed Tuber), Peng Ze (Curcuma Zedoaria Rhizome), Bing Lang (Areca Seed), Zhi Qiao (Immature Bitter Orange), Zhi Shi (Immature Bitter Orange), Qing Mu Xiang (Vladimiria Root), and Chen Pi (Tangerine Peel). For severe cases, use Jiu Zhi Da Huang (Wine-processed Rhubarb Root and Rhizome) to purge. Do not show leniency, as this is like nurturing a tiger that leaves trouble. Moreover, if there is accumulation, the disease bears the burden, and attacking it does not harm the person. However, if delayed for days, Yuan Qi (Primal Qi) becomes deficient while accumulation qi remains strong, making attack and tonification difficult, leading to a disastrous syndrome.
Furthermore, although various dysenteries belong to interior syndromes, they often involve epidemic pathogens. If severe within seven days, there is much accumulation and strong constitution; even if critical, death is unlikely with proper care. After seven days, symptoms should gradually improve. If initially mild and ignored, after seven days accumulation lingers, vitality declines, stomach qi weakens, and dysentery worsens, becoming hard to treat. Note that many conditions resemble dysentery but are not. Li Dongyuan said: Dietary injury and irregular lifestyle damage Stomach qi, causing ascending clear yang to descend instead, called Xun Xie (undigested food diarrhea). Over time, Taiyin transmits to Shaoyin, causing Chang Pi (intestinal disorder) with tenesmus and mixed pus/blood, frequent trips to the toilet without immediate passage. Exclusively use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) as the main formula to restore ascending-descending mechanisms, curing dysentery without direct anti-dysentery drugs.
Another type resembles dysentery due to yin deficiency, known as Da Xia Xie (Great Filth Diarrhea) among the Five Diarrheas. The *Jing* says: Tenesmus, frequent trips without passage, necessarily with penile pain. Symptoms include mixed red and white discharge, tenesmus, similar to dysentery, but with scanty, painful, or obstructed urination, or involuntary stool during urge to urinate, or involuntary urination during urge to defecate, with traction pain in both orifices. This is a critical kidney deficiency syndrome. Urgently use Shui Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) plus Gu Zhi (Psoralea Fruit), Dou Kou (Cardamom Seed), E Jiao (Donkey-hide Gelatin), combined with Lizhong Tang (Regulate the Middle Decoction), adding Sheng Ma (Cimicifuga Rhizome), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateral Root) in alternating doses to potentially save the patient. Many die from misusing dysentery medicines.
One type is Jin Kou Li (Closed-Mouth Dysentery), where medicine is vomited immediately upon entry, with urgent retention below. This is mostly due to blazing heat-toxin rushing upward against the stomach gate. Stomach qi is trapped and not diffusing. Urgently use Huang Lian (Coptis Rhizome) stir-fried with Wu Zhu Yu (Evodia Fruit), discarding the Evodia, mixed equally with Ren Shen (Ginseng Root). Add a pinch of Mi (Rice), decoct strongly, add Ginger Juice, and sip slowly. Swallowing two or three spoonfuls stops vomiting. If vomiting recurs, administer again. For cold qi rushing upward, use warming tonics; the disease is easy to treat.
One type is Wu Se Li (Five-Color Dysentery), where heat accumulates in the five zang organs, corroding them, causing five fluids to descend, appearing externally. This is extremely critical. Use Jin Yin Hua (Honeysuckle Flower), Jiu Chao Huang Lian (Wine-processed Coptis Rhizome), Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Mu Xiang (Aucklandia Root), Ru Xiang (Frankincense) to clear heat, detoxify, and harmonize blood.
One type is Xiu Xi Li (Resting Dysentery), recurring annually or monthly after remission. This is cold accumulation at the bottom of the large intestine, unreachable by most herbs. Only Ba Dou (Croton Seed), ground and stir-fried into wax pills, taken on an empty stomach, prevents recurrence. This is also the method of "treating obstruction with unblocking agents."
Tenesmus has two types: If sinking of pathogenic qi reduces slightly after defecation but worsens soon, and urgency prevents passage, this is excess and fire. If straining fails to retain, reduction does not occur after defecation because relief leads to greater deficiency, and frequent soiling occurs with urgency, this is deficiency and cold. This distinguishes excess from deficiency. Kidney governs closure/storage; Liver governs dispersal/drainage. Qi deficiency in these two meridians causes loss of function. Liver deficiency fails to disperse, causing tenesmus; Kidney deficiency fails to store, causing incontinence. Treatment should warm and tonify Liver and Kidney, taken before morning and evening meals. Warm herbs taken only at dawn lose potency by night, unable to counteract night Yin-cold. I once treated severe dysentery with extreme tenesmus, thirst, aversion to food, severe lower abdominal pain, red or white or bloody stools, difficulty urinating, and strong cun pulse with weak chi pulse. All recovered with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Wu Wei Zi (Schisandra Berry) and Rou Gui (Cinnamon Bark), taken morning and evening.
There is dysentery following malaria, and malaria following dysentery. After malaria, excretion is complete, so summer-heat toxin should not remain to cause dysentery; this is sinking of Yuan Qi (Primal Qi) and failure of Spleen qi to ascend, resembling dysentery but not being it. After dysentery, profuse discharge loses blood, qi scatters with discharge, leading to dual deficiency of Yin and Yang. Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat, resulting in cold-heat conflict, resembling malaria but not being it. Treat both as deficiency using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with warming tonics for self-healing.
Dysentery stems from dampness, dampness from Earth. Thus, cold or heat can produce pus and blood. In Five Elements theory, heat transforms via Fire, cold via Water. Damp Earth exists in all seasons. Following Fire, Yang Earth is excessive, causing damp-heat disease ("Dun Fu"). Following Water, Yin Earth is insufficient, causing cold-damp disease ("Bei Jian"). Blaming heat ignores cold; blaming cold ignores heat—is this not an error in expression? Regarding red as heat and white as cold, this is also not definitive. Mixed red and white implies simultaneous cold and heat? One must differentiate based on symptoms, tongue, and pulse to avoid confusion. Know that cold implies deficiency; heat implies excess. Further analyze excess/deficiency to clarify cold/heat. Distension, aversion to food, acute pain fearing pressure indicates excess. Restlessness, thirst seeking drinks, preference for cold and fear of heat indicates heat. Strong and solid pulse indicates excess. Rapid and slippery pulse indicates heat. Otherwise, it belongs to deficiency-cold. At similar junctures, careful examination is needed. Thirst seems like excess-heat, but all diarrhea/dysentery consumes fluids; fluid loss below dries fluids above, causing thirst. Differentiate by preference for hot/cold. Abdominal pain seems like excess-heat, but dysentery injures viscera/intestines, skin/flesh peels, causing pain. Differentiate by pain severity, response to pressure, abdominal distension, and pulse strength. Yellow/red/scanty urine seems like excess-heat, but water leaves via dysentery, urine shortens, Yin fluids consumed, color changes. Differentiate by moisture/dryness of complexion and fluids. Tenesmus seems like excess-heat, but qi sinking impairs transport, Yin loss makes intestines sticky, causing tenesmus. Differentiate by disease duration, constitution thickness, and pulse strength. Carefully distinguishing excess/deficiency and observing pulse prosperity/decline reveals the true nature of the disease.
Nineteen out of twenty dysentery patients are deficient, yet doctors rarely tonify. Qi is already sinking; moving it further worsens tenesmus. Middle is already weak; attacking accumulation exhausts Yuan Qi (Primal Qi). Heat-damp injuring blood should regulate blood; excessive purging harms Yin blood. Fluid loss causing thirst should nourish Yin; using diuretics consumes fluids. Quack doctors adhere to "no tonification for pain," saying early tonification is inappropriate. Not knowing that pain due to deficiency worsens with attack. Often, visible disease remains while invisible Yuan Qi (Primal Qi) escapes, regretting too late. Thus, weak pulse, deficient appearance, post-fever dysentery, or worsening after attack are indications for tonification. Most importantly, focus on Spleen and Kidney. Dysentery followed by diarrhea is Kidney transmitting to Spleen; minor pathogen, easy to treat. Diarrhea followed by dysentery is Spleen transmitting to Kidney; hostile pathogen, hard to treat. Disease in Spleen is shallow; in Kidney is deep. Kidney governs closure; Kidney is the Stomach gate. Long-term dysentery with Spleen deficiency inevitably damages Kidney Yin and Yang. Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Ten Significant Tonification Decoction), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify Spleen deficiency and are good. But if Fire is weak and Earth lacks its Mother, unless Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Lateral Root) greatly tonify Ming Men (Gate of Life) to restore Kidney Yang and save Spleen Mother, how will food enter? How will the gate close? How will True Yuan recover? Fear of heat leading to using only Ren Shen (Ginseng Root) and Mu Xiang (Aucklandia Root) to tonify Earth often leads to death, very harmful. Old accumulation is damp-heat, food, and phlegm; method is to purge. New accumulation arises after purging; adjust or tonify, do not lightly attack. If dysentery is due to deficiency, even old accumulation should not be purged; use Yi Gong San (Extraordinary Power Powder), and when deficiency recovers, dysentery stops. Danxi used tonifying Stomach qi with Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) before purging, also a wonderful method. Suitable for deficiency. Once filth is gone and feces not solid, it is appropriate to use Bai Shao (White Peony Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria) Guochang Wan (Intestinal Consolidating Pill) to regulate Spleen/Stomach, preventing new accumulation. Dysentery patients must avoid diet; strictly ban oily, meat, and noodle foods; medication works only then. If old filth remains and new accumulates, how can intestines/stomach clear? Gradual blockage worsens Spleen disease and adds Stomach disease, leading to nausea, anorexia, or closed-mouth state.
Initially, accumulation in intestines causes tenesmus, abdominal pain, nausea, and chest/diaphragm distension, indicating fresh food/drink not yet digested. Do not abruptly use cold or purgative drugs; cold causes more binding, purging injures Stomach. First resolve and guide out. Wait until lower diaphragm is free of nausea/distension before purging. If nausea is severe, first induce vomiting with light salt water. If initial heat has interior signs, purging is suitable; if aversion to cold, purging is contraindicated. Confusing diarrhea and dysentery, mixing damp-heat and promoting urination is incorrect. Clear and leaching agents promote rapid water flow, stopping diarrhea. But dysentery is foul matter, similar to damp-heat, formed by Stomach/Intestine oppression, exiting via Large Intestine transmission, unrelated to Stomach qi. Thus, overusing leaching drugs exhausts Yang and dries fluids, lowering the disease and the medicine. Clear, copious urine in various symptoms indicates gradual recovery, especially in dysentery. Li Shizhen said: For blood dysentery where pain continues after passage, it is Yin deficiency and qi stagnation. Add Chuan Xiong (Sichuan Lovage Rhizome) to medicine; as qi moves and blood harmonizes, pain stops immediately. Saying dysentery is cold is incorrect. Cold cannot digest grain, how does it turn to pus? Saying mixed red/white dysentery is cold-heat combination is also incorrect. Cold and heat are different qi, how can they coexist in intestines to cause dysentery? It is fundamentally damp-heat, differing only in degree of qi vs. blood injury. Large Intestine qi deficiency sinking causing tenesmus: use Si Jun Zi Tang (Four Gentlemen Decoction) plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root). Also cases of severe qi deficiency, no qi in intestines unable to push: only need Ren Shen (Ginseng Root), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) to greatly tonify Middle qi. Large Intestine blood deficiency causing tenesmus: use Si Wu Tang (Four Substance Decoction) plus Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome). Danxi said: Li Ji (urgency) means abdomen is not comfortable. Also cases of false sitting with no stool passage are all blood deficiency, as intestines lack fluids to lubricate. Although tonifying blood is needed, must also tonify qi, for qi generates blood. Single blood tonification injures Spleen/Stomach. Yin deficiency with fire, plus summer heat attack, should not tonify immediately, nor use drying herbs. Only use mild cold, clear, peaceful agents to regulate. If still unresolved, then use clearing/moistening tonics.
Also toxic dysentery: if sha toxin sinks inward, discharging pus/blood, ineffective with other drugs, add detoxifying herbs to blood-harmonizing/qi-moving formulas, like Jin Yin Hua (Honeysuckle Flower), Zhi Ru Xiang (Processed Frankincense), Xiang Lian (Costus and Coptis). Postpartum dysentery, despite much accumulation and extreme pain, do not use Da Huang (Rhubarb Root and Rhizome) etc., to avoid injuring Stomach qi, which becomes incurable. Use Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Dang Gui (Angelica Sinensis Root), Hong Qu (Red Yeast Rice), Cu Chao Sheng Ma (Vinegar-processed Cimicifuga Rhizome), Yi Mu Cao (Motherwort Herb), Wei Mu Xiang (Stir-fried Aucklandia Root), Liu Bai (Pericarpium Citri Reticulatae with pith removed), Guang Pi (Tangerine Peel), Zhi Gan Cao (Honey-fried Licorice Root). If blood deficiency, add Chao E Jiao (Charred Donkey-hide Gelatin) 2 qian.
For pre-partum dysentery, use Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Bai Shao (White Peony Root), Zhi Gan Cao (Honey-fried Licorice Root), Ju Hong (Red Tangerine Peel), Hong Qu (Red Yeast Rice), Zhi Qiao (Immature Bitter Orange), Lian Rou (Lotus Seed), slightly use Sheng Ma (Cimicifuga Rhizome). Under seven months, do not use Hua Shi (Talcum). Winter Shang Han (Cold Damage) is already considered heat disease. Summer/Autumn summer-heat three qi intersect and steam, mutual knotting heat is ten times that of winter. External contraction of three qi heat causing dysentery must exit from outside. Thus, dysentery can use Xin Liang (Acrid-Cool) to release exterior, then Ku Han (Bitter-Cold) to clear interior, cured in one or two doses. Missing exterior release, external pathogen exits only from interior, not dying until resolved. Even after a hundred days, still use Ni Liu Wan Dan (Reverse Current Pulling Pill) method to draw pathogen out externally, saving critical cases. *Jin Gui* says: Dysentery pulse reverses to Xian (Wiry), fever, body sweat—self-heals. Long-term dysentery pulse enters Yin, deep, choppy, weak. Suddenly turning Xian pulse is entirely Shaoyang generating qi, is this not reverse pulling method? Pulse fine, skin cold, little qi, diarrhea, no food/drink entering front/back, called Five Deficiencies Death. Only use Ren Shen (Ginseng Root) and Fu Zi (Aconite Lateral Root), ten can save one.
Post-dysentery legs become thin and weak, named Li Feng (Dysentery Wind), untreated becomes He Xi Feng (Crane Knee Wind). Treatment should warm tonify Liver, Spleen, Kidney, do not continue using drying Spleen drugs.
Post-dysentery gout, whole body severe pain, is intestinal/stomach damp-heat, evil blood not cleared, returning to collaterals, lingering in tunnels causing pain. Use Si Wu Tang (Four Substance Decoction) plus Tao Ren (Peach Kernel), Hong Hua (Carthamus Flower), Niu Xi (Achyranthes Root), Chen Pi (Tangerine Peel). Also cases of pain due to qi/blood deficiency, must examine carefully.
White dysentery from Large Intestine, red dysentery from Small Intestine, this is Danxi dividing red/white by qi/blood. Large Intestine is official of transmission; dysentery injures intestinal/stomach blood vessels, moves organ fat/grease, so red/white both enter Large Intestine and descend. Small Intestine is outlet for urine, never seen as organ for dysentery. Heart governs blood, Heart and Small Intestine are exterior-interior, so red dysentery originating from Small Intestine transformation is acceptable, but saying it comes from Small Intestine...