身不热者轻，身热者重，发热不休者死。能食者轻，不能食者重，绝食者死。发呕者死
。直肠自下者死。久痢忽大下结粪者死。小儿出痘后即发痢者死。妇人新产即发痢者死。涩
为血少，尺微厥逆，滑大主积，浮弦急死，沉细无害。
次男元犀按∶近传治痢有三禁。一曰发汗。盖以下利一伤其津液，发汗再伤其津液，津
液去则胃气空，而下出之浊气，随汗势而上入胃中，遂成胀满难治。二曰利水。盖以痢疾里
急后重，滞痛难忍，若前阴过利，而后阴愈涩，而积滞之物欲下甚难。三曰温补。盖以痢为
湿热所伤，得温则以火济火，恐致腐肠莫救。得补则截住邪气，多致流连难愈。此三者，时医传授之心法也。
然亦有不可泥者。《医学真传》曰∶凡痢疾初起，发热不休，非肌表有邪，即经络不
和。温散而调营卫，外邪一解，其痢自松。若概以为热，开手即用寒凉，多有陷入变剧者不
少。故喻嘉言所谓下痢必从汗，先解其外，后调其内。首用辛凉以解其表，次用苦寒以清其
里，一二剂愈矣。（用治痢之方再加发表之药）失于表者，外邪但从里出，不死不休，故虽百
日之远，仍用逆流挽舟之法，引其邪而出之于外，则死症可活，危症可安。人参败毒散主之
。（服后逼其临时燥，热顷之邪从表出热自解矣。）此可见发汗是治痢之要法也。
又喻嘉言有急开支河一法。谓热邪之在里者，奔逼于大肠，必郁于膀胱。膀胱结热，则
气不化而小便短赤。不可用逆挽，宜从其小便而顺导之。然而水出高源，尤宜用辛凉之药，
清肺之化源。《金匮》有下利肺痈者，紫参汤主之。（通因通用）。气利，诃藜勒散主之。（通以下
涎液，消宿食，破结气，涩以固肠脱，通塞互用之意也。）亦见利水非古人之所忌也。
至于温补法，详于《景岳全书》。如佐关抑扶二煎，非温剂乎？胃关煎非补剂乎？虽矫
枉之说，不能无偏，亦堪为肆用芩连楂朴者之救弊也，谁曰治痢有三禁乎？
喻嘉言曰∶又有骤受暑湿之毒，水谷倾囊而出，一昼夜七八十行，大渴引水自救，百杯
不止。此则肠胃为热所攻，顷刻腐烂。更用逆挽之法，迂矣！远矣！每从《内经》“通因通用”之法，
大黄、黄连、甘草，一昼夜连进三五十杯，俟其利止渴缓，乃始乎调于内，更不必挽之于外
。盖邪如决水转石，乘势出尽，勿可挽也。
又曰∶治疟之法，当从少阳而进退其间。进而从阳，则从少阳为表法固矣。乃痢疾之表
亦当从于少阳。盖水谷之气，由胃入肠，疾趋而下，始焉少阳生发之气不伸，继焉少阳生
发之气转陷。故泛而求之三阳，不若专而求之少阳。俾苍天清净之气，足以升举水土物产之
味，自然变化精微，转输有度，而无下利奔迫之苦矣。况两阳明经所藏之津液，既已下泄，
尤不可更发其汗，当从少阳用和法，全非发汗之意。津液未伤者，汗出无妨；津液既伤者，
皮间微微得润，其下陷之气已举矣。
小柴胡去半夏加栝蒌根汤（方见《金匮》）
喻嘉言曰∶此方乃少阳经半表半里之的剂。原方用半夏之辛温，半兼乎表；今改用栝蒌
之凉苦，半兼乎里。退而从阴，则可进而从阳，不胜其任矣。但不必更求他药，惟于柴胡增
一二倍用之，尤为进之之法也。
人参败毒散（方见《时方》）
喻嘉言曰∶活人此方，全不因病痢而出。但余所为逆挽之法，推重此方，盖借人参之大
力，而后能逆挽之耳。
胃关煎（见泄泻）
佐关煎（《景岳》）
治生冷伤脾，泻痢未久者，宜此汤。此胃关煎之佐也。
浓朴（炒） 陈皮（各一钱，炒） 山药 扁豆 猪苓 泽泻（各三钱） 干姜（二三钱，炒） 肉桂（一二钱）
甘草（七分，炙）
水煎服。如腹痛者，加木香、吴萸之类；泄甚者，加故纸、肉蔻之类。
抑扶煎（《景岳》）
治暴伤生冷，致成泻痢。初起血气未衰者，此胃关煎表里药也。
浓朴 陈皮 乌药（各一钱五分） 猪苓 泽泻 炮干姜（各二钱） 吴茱萸（五七分） 甘草（一钱，炙）
水煎服。
斗门秘传方（方见《时方》）
治毒痢。脏腑撮痛，脓血赤白，或下血片，日夜不息，及噤口恶痢他药所不能治者，立见神效。
附子丸（《圣济总录》） 治洞泄寒中，注下水谷，或痢赤白，食已即出，食物不消。（
春伤热风，邪气流连，至长夏发为洞泄。阴生于午，至未为甚，长夏之时脾土当旺，脾为阴
中之至阴，故阴气盛。阴气既盛则生内寒而洞泄矣。）
附子 乌梅肉（各一两，炒） 川连（二两，炒） 干姜（一两半，炒）
蜜丸桐子大。米饮下二十丸。
通圣散（《圣济总录》）
治血痢腹痛，日夜无度。
大枣 乌梅（各三枚） 甘草（三钱） 干姜（一钱五分）
水煎服。
和中散（《圣济总录》）
治冷热痢，腹痛里急。
附子（一钱四分，赤痢减半） 川连（一钱四分，白痢减半） 乳香（一分五厘）
共为末，米饮汤下。未止，用青皮再下二服。
黑豆汤（《圣济》）
治赤白痢，服药不止。
黑豆（炒，去皮，四两） 甘草（二两）
用绵裹，入湖水煎二杯，分二服。
身体不发热者病情较轻，身体发热者病情较重，持续发热不止者预后不良（主死）。能够进食者病情较轻，不能进食者病情较重，完全绝食者预后不良（主死）。出现呕吐症状者预后不良（主死）。直肠脱出且自行排便者预后不良（主死）。长期痢疾突然排出大量干结粪便者预后不良（主死）。小儿在出痘疹后立即发生痢疾者预后不良（主死）。妇女新近分娩后即发生痢疾者预后不良（主死）。脉象涩表示血少，尺脉微弱并伴有四肢厥冷者预后不良；脉象滑大主内有积滞，脉象浮弦急者预后不良（主死），脉象沉细则无大碍。
次子陈元犀按语：近来流传治疗痢疾有三项禁忌。第一是发汗。因为下利已经损伤津液，若再发汗会再次损伤津液，津液耗竭则胃气空虚，向下排出的浊气会随着汗势向上冲入胃中，从而形成胀满这种难治之症。第二是利水。因为痢疾患者有里急后重、滞痛难忍的症状，如果过度通利前阴（小便），会导致后阴（大便）更加涩滞，使得积滞之物更难排出。第三是温补。因为痢疾是由湿热邪气所伤，若用温药则是以火助火，恐怕导致肠道腐烂无法救治；若用补药则会截留邪气，多导致病程迁延难以痊愈。这三点是当时医生传授的治疗心法。
然而也有不可拘泥的情况。《医学真传》说：凡是痢疾初起，持续发热，如果不是肌表有外邪，就是经络不和。此时应用温散之法调和营卫，一旦外邪解除，痢疾自然缓解。如果一概认为是热证，一开始就用寒凉药物，往往导致病情陷入危重者不少。所以喻嘉言所说的“下痢必从汗，先解其外，后调其内”，首先用辛凉药物解表，其次用苦寒药物清里，一二剂即可痊愈。（在治疗痢疾的方剂中加入发表的药物）对于失于解表者，外邪只能从里向外透发，不死不休，所以即使病程长达百日，仍可用“逆流挽舟”之法，引导邪气从体表排出，这样死症可活，危症可安。主用人参败毒散。（服药后逼迫体内暂时燥热，片刻之后邪气从表而出，热自解。）由此可见，发汗是治疗痢疾的重要方法。
另外喻嘉言有“急开支河”一法。认为热邪在体内，奔迫于大肠，必然郁结于膀胱。膀胱结热，则气化不利而小便短赤。此时不宜用逆挽之法，宜顺着小便通路疏导它。然而水源出自高源（肺），尤其应当使用辛凉药物，清肃肺金以化生源头。《金匮要略》中有下利兼肺痈者，用紫参汤主治。（体现通因通用的治法）气利（泻下稀便如气状），用诃黎勒散主治。（通过降下涎液，消除宿食，破除结气，涩药以固肠脱，体现通塞互用的意思。）这也说明利水并非古人所忌讳的。
至于温补法，在《景岳全书》中有详细论述。如佐关煎、抑扶煎，难道不是温剂吗？胃关煎难道不是补剂吗？虽然纠正偏颇的说法可能有所偏差，但也足以补救那些肆意使用黄芩、黄连、山楂、厚朴等寒凉攻伐药物的弊端，谁说治疗痢疾有三项禁忌呢？
喻嘉言说：又有骤然感受暑湿毒邪，水谷倾囊而出，一昼夜排泄七八十次，极度口渴想喝水自救，喝上百杯也不止。这是肠胃被热邪攻击，顷刻间腐烂。此时再用逆挽之法，就太迂腐、太遥远了！通常遵循《内经》“通因通用”的方法，用大黄、黄连、甘草，一昼夜连续进服三五十杯，等到痢止渴缓，才开始调理内部，更不必去挽回外表。因为邪气如同决堤之水、滚动之石，应乘势将其排尽，不可强行挽留。
又说：治疗疟疾的方法，应当在少阳经之间进退。进而从阳，则从少阳作为表法是确定的。然而痢疾的表证也应当从少阳论治。因为水谷之气，由胃进入肠道，急速趋下，起初是少阳生发之气不能舒展，随后少阳生发之气反而下陷。所以泛泛地求治于三阳，不如专门求治于少阳。使苍天清净之气，足以升举水土物产之味，自然变化精微，转输有度，而没有下利奔迫的痛苦了。况且两阳明经所藏的津液，既然已经下泄，尤其不可再发其汗，应当从少阳用和法，这完全不是发汗的意思。津液未伤者，出汗无妨；津液既伤者，皮肤间微微湿润，其下陷之气已提升起来了。
小柴胡去半夏加栝蒌根汤（方见《金匮要略》）
喻嘉言说：此方是少阳经半表半里的对症之剂。原方用半夏的辛温，一半兼管表证；现在改用栝楼的凉苦，一半兼管里证。退而从阴，则可以进而从阳，但不胜任了。但不必再寻求其他药物，只在柴胡上增加一两倍用量，更是进达阳气的方法。
人参败毒散（方见《时方》）
喻嘉言说：《活人书》中的此方，原本不是为了治疗痢疾而设。但我推崇“逆流挽舟”之法，重用此方，大概是借助人参的大力，而后才能实施逆挽之功。
佐关煎（《景岳全书》）
治疗因生冷损伤脾脏，腹泻痢疾时间不久的情况，适宜用此汤。这是胃关煎的辅助方。
浓朴（炒） 陈皮（各一钱，炒） 山药 扁豆 猪苓 泽泻（各三钱） 干姜（二三钱，炒） 肉桂（一二钱）
甘草（七分，炙）
水煎服。如有腹痛者，加木香、吴茱萸之类；泄泻严重者，加破故纸、肉豆蔻之类。
抑扶煎（《景岳全书》）
治疗暴受生冷伤害，导致成泻痢。初起气血未衰者，这是胃关煎的表里双解药。
浓朴 陈皮 乌药（各一钱五分） 猪苓 泽泻 炮干姜（各二钱） 吴茱萸（五七分） 甘草（一钱，炙）
水煎服。
斗门秘传方（方见《时方》）
治疗毒痢。脏腑撮痛，脓血赤白，或下血片，日夜不息，以及噤口恶痢他药所不能治者，立见神效。
附子丸（《圣济总录》） 治疗洞泄寒中，注下水谷，或痢赤白，食已即出，食物不消。（春季受伤于风热，邪气流连，至长夏发作成为洞泄。阴气生于午时，至未时最盛，长夏之时脾土当旺，脾为阴中之至阴，故阴气盛。阴气既盛则产生内寒而洞泄矣。）
附子 乌梅肉（各一两，炒） 川连（二两，炒） 干姜（一两半，炒）
蜜丸如梧桐子大。米饮送下二十丸。
通圣散（《圣济总录》）
治疗血痢腹痛，日夜无度。
大枣 乌梅（各三枚） 甘草（三钱） 干姜（一钱五分）
水煎服。
和中散（《圣济总录》）
附子（一钱四分，赤痢减半） 川连（一钱四分，白痢减半） 乳香（一分五厘）
共研为末，米饮汤送下。若不止，用青皮再送下二服。
黑豆汤（《圣济总录》）
治疗赤白痢，服药不止。
Those whose bodies are not hot have a mild condition; those with fever have a severe condition; those with unremitting fever will die. Those who can eat have a mild condition; those who cannot eat have a severe condition; those who completely lose their appetite will die. Those who vomit will die. Those with rectal prolapse and spontaneous defecation will die. Those with chronic dysentery who suddenly pass large amounts of dry, bound stool will die. Children who develop dysentery immediately after smallpox will die. Women who develop dysentery immediately after childbirth will die. A choppy pulse indicates blood deficiency; a faint pulse at the Chi position accompanied by cold limbs is ominous; a slippery and large pulse indicates accumulation; a floating, wiry, and rapid pulse is ominous (death); a deep and fine pulse is harmless.
My second son, Yuanxi, notes: There are three prohibitions in the recent transmission for treating dysentery. The first is sweating. Since diarrhea already damages body fluids, sweating again damages them further. When body fluids are depleted, Stomach Qi becomes empty, and turbid Qi descending from below rushes upward into the Stomach along with the sweat, resulting in difficult-to-treat distension. The second is promoting urination. Since dysentery involves tenesmus and unbearable stagnating pain, if the anterior orifice (urinary tract) is over-drained, the posterior orifice (anal tract) becomes more obstructed, making it very difficult for accumulated material to pass. The third is warming and tonifying. Since dysentery is caused by damp-heat injury, using warming herbs is like adding fire to fire, risking intestinal rot that cannot be saved; using tonics traps the pathogenic factor, often leading to lingering and difficult-to-cure conditions. These three points are the secret methods transmitted by contemporary physicians.
However, there are situations where one must not adhere rigidly to these rules. *Yixue Zhenchuan* states: Whenever dysentery begins with unremitting fever, it is either due to exterior pathogens or disharmony of the meridians. One should use warm dispersing methods to harmonize Ying and Wei; once the exterior pathogen is resolved, the dysentery will naturally loosen. If one assumes it is all heat and uses cold-cooling herbs from the start, many cases deteriorate severely. Thus, Yu Jiayan’s saying that "dysentery must be treated via sweating, resolving the exterior first, then regulating the interior" applies. First use acrid-cool herbs to release the exterior, then bitter-cold herbs to clear the interior; recovery occurs in one or two doses. (Add exterior-releasing herbs to dysentery formulas.) For those neglected in exterior resolution, the exterior pathogen can only exit from the interior; this process continues until death. Therefore, even if the disease has lasted a hundred days, the "rowing upstream against the current" method can still be used to guide the pathogen out through the exterior, turning fatal cases into curable ones and critical cases into stable ones. The main formula is Renshen Baidu San (Ginseng Decoction to Overcome Toxins). (After taking it, forced temporary dryness and heat occur; shortly after, the pathogen exits via the exterior, and heat resolves.) This shows that sweating is an essential method for treating dysentery.
Furthermore, Yu Jiayan proposed the method of "urgently opening branch rivers." He stated that when heat pathogens reside internally and rush into the Large Intestine, they inevitably stagnate in the Bladder. Bladder heat causes failure of Qi transformation, leading to short, red urine. In such cases, the "rowing upstream" method is unsuitable; instead, one should guide the pathogen out through urination. However, since water originates from the high source (Lung), it is especially appropriate to use acrid-cool herbs to clear the Lung and regulate its transforming source. *Jingui Yaolue* mentions cases of diarrhea with lung abscess, treated with Zishen Tang (illustrating the principle of "treating obstruction with unblocking"). For Qi diarrhea (passing loose stool resembling gas), Helile San (Chebula Powder) is used. (This lowers saliva, eliminates retained food, breaks up stagnation, and uses astringents to secure intestinal prolapse, demonstrating the interplay of unblocking and astringing.) This also shows that promoting urination is not taboo among ancient masters.
Regarding warming and tonifying methods, detailed explanations are found in *Jingquan Quanshu*. Are Zuoguan Jian (Auxiliary Guan Decoction) and Yifu Jian (Suppress Support Decoction) not warming agents? Is Weiguan Jian (Stomach Guan Decoction) not a tonic? Although theories correcting deviations may have biases, they suffice to remedy the abuses of those who recklessly use Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhake (Crataegi Fructus), and Houpo (Magnoliae Officinalis Cortex). Who says there are three prohibitions for treating dysentery?
Yu Jiayan said: There are cases of sudden exposure to summer-heat and dampness toxins, where food and fluids pour out, with seventy to eighty bowel movements per day and night. The patient is extremely thirsty and drinks continuously, yet hundreds of cups do not suffice. This is because the intestines and stomach are attacked by heat, rotting instantly. Using the "rowing upstream" method here would be too pedantic and distant! Instead, one usually follows the *Neijing* principle of "treating obstruction with unblocking," administering Dahuang (Rhei Radix et Rhizoma), Huanglian (Coptidis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) continuously for thirty to fifty cups in a day and night. Once diarrhea stops and thirst subsides, internal regulation begins; there is no need to "row upstream" externally. The pathogen is like rushing water or rolling stones; it should be allowed to exhaust itself with momentum and not be forcibly restrained.
He also said: The treatment of malaria should advance and retreat within the Shaoyang channel. Advancing toward Yang means treating Shaoyang as the exterior method, which is established. However, the exterior aspect of dysentery should also be sought in Shaoyang. Because food and fluid Qi enters the Stomach and moves rapidly downward into the intestines, initially the ascending and generating Qi of Shaoyang fails to extend, and subsequently, this ascending Qi sinks. Therefore, seeking broadly among the Three Yang channels is inferior to focusing specifically on Shaoyang. This allows the pure and clear Qi of Heaven to sufficiently elevate the flavors of earth and water products, naturally transforming them into essence and distributing them properly, eliminating the suffering of urgent diarrhea. Moreover, since the body fluids stored in the two Yangming channels have already been lost downwards, one must not induce sweating again. One should use harmonizing methods from Shaoyang, which is entirely different from inducing sweating. If body fluids are not yet damaged, sweating is harmless; if body fluids are damaged, slight moisture on the skin suffices to lift the sunken Qi.
Xiaochaihu Tang Banxia Qu Gualougen Tang (Minor Bupleurum Decoction without Pinellia plus Trichosanthes Root) (Formula seen in *Jingui Yaolue*)
Yu Jiayan said: This formula is the precise agent for the half-exterior, half-interior stage of the Shaoyang channel. The original formula uses the acrid-warm nature of Banxia (Pinelliae Rhizoma), which addresses half the exterior; now, replacing it with the cool-bitter nature of Gualou (Trichosanthis Fructus), it addresses half the interior. Retreating to Yin allows advancement to Yang, but it may not be sufficient. It is not necessary to seek other herbs; simply increasing the dosage of Chaihu (Bupleuri Radix) by one or two times is the best method for advancement.
Renshen Baidu San (Ginseng Decoction to Overcome Toxins) (Formula seen in *Shifang*)
Yu Jiayan said: This formula from *Huo Ren Shu* was not originally designed for dysentery. However, I highly value it for the "rowing upstream" method, primarily relying on the great strength of Renshen (Ginseng Radix et Rhizoma) to achieve this reversal.
Weiguan Jian (Stomach Guan Decoction) (See section on Diarrhea)
Zuoguan Jian (Auxiliary Guan Decoction) (*Jingquan Quanshu*)
Indicated for spleen injury caused by raw/cold foods, with diarrhea/dysentery of short duration. This is an auxiliary formula to Weiguan Jian.
Houpo (Magnoliae Officinalis Cortex, stir-fried) and Chenpi (Citri Reticulatae Pericarpium, stir-fried) (1 qian each); Shanyao (Dioscoreae Rhizoma), Bidou (Lablab Album); Zhuling (Polyporus), Zexie (Alismatis Rhizoma) (3 qian each); Ganjiang (Zingiberis Rhizoma, stir-fried) (2-3 qian); Rougui (Cinnamomi Cortex) (1-2 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (7 fen).
Decoct in water and take orally. Add Muxiang (Aucklandiae Radix) and Wuyu (Evodiae Fructus) if abdominal pain is present; add Gubuzi (Psoraleae Fructus) and Roukou (Myristicae Semen) if diarrhea is severe.
Yifu Jian (Suppress Support Decoction) (*Jingquan Quanshu*)
Indicated for acute injury from raw/cold foods leading to diarrhea/dysentery. Used in the early stage when Qi and Blood are not yet depleted. This is a simultaneous exterior-interior formula based on Weiguan Jian.
Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Wuyao (Linderae Radix) (1.5 qian each); Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Paoganjiang (Prepared Zingiberis Rhizoma) (2 qian each); Wuzhuyu (Evodiae Fructus) (5-7 fen); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 qian).
Decoct in water and take orally.
Doumen Mitruan Fang (Secret Formula from Doumen) (Formula seen in *Shifang*)
Indicated for toxic dysentery. Symptoms include cramping pain in the viscera, pus and blood in stool (red and white), passage of bloody clots, ceaseless day and night, and "closed-mouth" malignant dysentery unresponsive to other medicines. Produces miraculous effects immediately.
Fuzi Wan (Aconite Pill) (*Shengji Zonglu*)
Indicated for profuse watery diarrhea with cold in the center, passage of undigested food/water, or red/white dysentery where food is expelled immediately after eating without digestion. (Injury from wind-heat in spring leads to lingering pathogens; manifesting as profuse diarrhea in late summer. Yin generates at Wu hour, peaking at Wei hour. Late summer is when Spleen Earth is prosperous; Spleen is the extreme Yin within Yin. Thus, Yin Qi is abundant. Abundant Yin Qi generates internal cold, causing profuse diarrhea.)
Fuzi (Aconiti Lateralis Radix Praeparata) and Wumei Rou (Mume Fructus Carapax, stir-fried) (1 liang each); Chuanlian (Coptidis Rhizoma, stir-fried) (2 liang); Ganjiang (Zingiberis Rhizoma, stir-fried) (1.5 liang).
Make pills with honey, size of Sophora seeds. Take 20 pills with rice broth.
Tongsheng San (Universal Salvation Powder) (*Shengji Zonglu*)
Indicated for bloody dysentery with abdominal pain, ceaseless day and night.
Dazao (Ziziphi Jujubae Fructus) and Wumei (Mume Fructus) (3 pieces each); Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian); Ganjiang (Zingiberis Rhizoma) (1.5 qian).
Decoct in water and take orally.
Hezhong San (Harmonize Middle Powder) (*Shengji Zonglu*)
Indicated for cold-heat dysentery with abdominal pain and tenesmus.
Fuzi (Aconiti Lateralis Radix Praeparata) (1.4 qian, reduce by half for red dysentery); Chuanlian (Coptidis Rhizoma) (1.4 qian, reduce by half for white dysentery); Xuxiang (Boswelliae Resin) (1.5 li).
Grind into powder, take with rice broth. If ineffective, administer Qingpi (Citri Reticulatae Pericarpium Viride) twice more.
Heidou Tang (Black Soybean Decoction) (*Shengji Zonglu*)
Indicated for red-white dysentery unresponsive to medication.
Heidou (Glycines Max Seed, stir-fried, peeled) (4 liang); Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang).
Wrap in silk, decoct in lake water to yield two cups. Divide into two doses.