《伤寒论》原文∶热利下重者，白头翁汤主之。
【白头翁汤方】白头翁二两，黄连、黄柏、秦皮各三两。
上四味，以水七升，煮取二升，去滓，温服一升，不愈更服一升。
《医宗金鉴》注曰∶三阴俱有下利证，自利不渴属太阴，自利渴属少阴。惟厥阴下利，属寒者厥而不渴，
下利清谷；属热者消渴，下利后重，便利脓血。此热利下重，乃郁热奔逼广肠、魄门重滞难
出。初痢用此法以寒治热，久痢则宜用乌梅丸，随所利而从治之，调其气使之平也。
白头翁汤所主之热利下重，当自少阴传来，不然则为伏气化热窜入厥阴，其证虽热，而仍非外感大实之
热，故白头翁汤可以胜任。乃有病在阳明之时，其病一半入府，一半由经而传于少阳，即由少阳入厥阴而为腑
脏之相传。则在厥阴者既可成厥阴热利之下重，而阳明府中稽留之热，更与之相助而为虐，此非但用白头
翁汤所能胜任矣。愚遇此等证，恒将白头翁、秦皮加于白虎加人
参汤中，则莫不随手奏效也。
曾治一中年妇人，于孟春感冒风寒，四、五日间延为延医。其左脉弦而有力，右脉洪而有力，舌苔白而
微黄，心中热而且渴，下利脓血相杂，里急后重，一昼夜二十余次，即其左右之脉象论之，断为阳明、厥阴合
并病。有一医者在座，疑而问曰∶凡病涉厥阴，手足多厥逆，此证则手足甚温何也？答曰∶此其所以与阳明
并病也，阳明主肌肉，阳明府中有热，是以周身皆热，而四肢之厥逆，自不能于周身皆热时外现也。况厥阴之
病，即非杂以阳明，亦未必四肢皆厥逆乎？医者深韪愚言，与病家皆求速为疏方，遂为立方如下∶
生石膏（三两捣细） 生杭芍（八钱） 生怀山药（八钱） 野台参（四两）
白头翁（八钱） 秦皮（六钱） 天花粉（八钱） 甘草（三钱）
上药八味，共煎三盅，分三次温饮下。
方中之义，是合白虎加人参汤与白头翁汤为一方，而又因证加他药也。白虎汤中无知母者，方中芍药可
代知母也。盖芍药既能若知母之退热滋阴，而又善治下利者之后重也。无粳米者，方中生山药可代粳米也，盖
山药汁浆浓郁，既可代粳米和胃，而其温补之性，又能助人参固下也，至于白头翁汤中无黄连、黄柏者，
因与白虎汤并用，有石膏之寒凉，可省去连、柏也。又外加天花粉者，因其病兼渴，天花粉偕同人参最善
生津止渴。将此药三次服完，诸病皆减三分之二。再诊其脉仍有实热未清，遂于原方中加滑石五钱，利其小
便，正所以止其大便，俾仍如从前煎服，于服汤药之外，又用鲜白茅根半斤煎汤当茶，病遂全愈。
《伤寒论》原文：患有热性痢疾且伴有肛门坠胀感的，用白头翁汤主治。
【白头翁汤方】白头翁二两，黄连、黄柏、秦皮各三两。
以上四味药，用水七升，煎煮至剩余二升，滤去药渣，温服一升，若未痊愈，再服一升。
《医宗金鉴》注释说：三阴经（太阴、少阴、厥阴）都有下利的证候，自发性腹泻且不口渴的属于太阴病，自发性腹泻且口渴的属于少阴病。只有厥阴病的下利，属于寒证的，会出现四肢厥冷且不口渴，泻下完谷不化；属于热证的，会出现消渴（极度口渴），下利伴有肛门坠胀感，排便时夹杂脓血。这种热性痢疾伴肛门坠胀，是由于郁热逼迫大肠和肛门，导致气机重滞难以排出。初起患痢疾时用此法以寒凉药治疗热证，久痢则适宜用乌梅丸，根据病情顺势而治，调理气机使其平衡。
白头翁汤所主治的热性痢疾伴肛门坠胀，应当是从少阴病传变而来，否则就是伏邪之气化热窜入厥阴经。其证候虽然表现为热象，但并非外感实热之证，所以白头翁汤可以胜任治疗。然而，有疾病在阳明经阶段时，病邪一半传入腑，一半由经传入少阳，随即由少阳传入厥阴，形成脏腑之间的相传。那么在厥阴经的病证既可形成厥阴热利导致的肛门坠胀，而阳明腑中滞留的热邪，更与之相互助长为害，这就不仅仅是单用白头翁汤所能胜任的了。我遇到这类证候，常常将白头翁、秦皮加入白虎加人参汤中，没有不随手见效的。
曾诊治一位中年妇女，在早春时节感冒风寒，四五天后才请医生诊治。其左脉弦而有力，右脉洪大且有力，舌苔白而微黄，心中烦热且口渴，下利脓血混杂，里急后重（腹痛急于排便，排便后仍有便意），一昼夜二十多次。仅从左右脉象判断，断定为阳明病与厥阴病合并症。有一位医生在场，怀疑并问道：“凡是涉及厥阴的病，手足大多厥冷逆乱，此证为何手足很温暖呢？”回答说：“这正是它与阳明病合并的原因。阳明主肌肉，阳明腑中有热，所以周身发热，那么四肢的厥冷逆乱自然不能在周身皆热的时候表现出来。况且厥阴的病，即使不夹杂阳明病，也未必四肢都厥冷逆乱呢？”那位医生深深赞同我的话，病人家属也要求尽快开方，于是我为其拟定如下处方：
生石膏（三两，捣碎） 生杭芍（八钱） 生怀山药（八钱） 野台参（四两）
白头翁（八钱） 秦皮（六钱） 天花粉（八钱） 甘草（三钱）
以上八味药，共煎煮成三碗，分三次温服。
方剂的用意，是将白虎加人参汤与白头翁汤合为一剂，又因证候加入了其他药物。白虎汤中通常含有知母，本方中用芍药代替知母。因为芍药既能像知母一样退热滋阴，又善于治疗下利后的肛门坠胀感。白虎汤中通常含有粳米，本方中生山药可代替粳米，因为山药汁液浓郁，既能代替粳米调和胃气，其温补的性质又能帮助人参固摄止泻。至于白头翁汤中原本有黄连、黄柏，这里没有使用，是因为与白虎汤并用，已有石膏的寒凉之性，可以省去黄连、黄柏。另外外加天花粉，是因为患者兼有口渴症状，天花粉配合人参最善于生津止渴。将此药分三次服完，所有病症减轻了三分之二。再次诊察，脉象显示仍有实热未清，于是在原方中加入滑石五钱，通利小便，这正可以用来止住大便，仍然按照之前的方法煎服。除了服用汤药外，又用鲜白茅根半斤煎汤当茶喝，病于是完全痊愈。
The original text of the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: "For hot dysentery accompanied by tenesmus, Baitouweng Tang (Pulsatilla Decoction) is the primary treatment."
[Formula of Baitouweng Tang] Baitouweng (Pulsatillae Radix) two liang, Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), and Qinpi (Aceris Cortex) each three liang.
Take these four ingredients, add seven sheng of water, boil to obtain two sheng, remove the dregs, and take one sheng warm. If not cured, take another sheng.
The commentary in *Yizong Jinjian* (Golden Mirror of Medical Tradition) notes: "All three Yin meridians (Taiyin, Shaoyin, Jueyin) present with diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only for Jueyin diarrhea, if it belongs to cold, there is cold extremities without thirst, and diarrhea of undigested food; if it belongs to heat, there is excessive thirst, diarrhea with tenesmus, and passage of pus and blood. This 'hot dysentery with tenesmus' is caused by stagnant heat forcing its way into the large intestine and anus, causing heavy stagnation and difficulty in evacuation. For initial onset of dysentery, this method uses cold-natured herbs to treat heat; for chronic dysentery, Wumei Wan (Mume Pill) should be used instead, treating according to the condition to regulate qi and restore balance."
The hot dysentery with tenesmus treated by Baitouweng Tang should have transmitted from Shaoyin disease; otherwise, it is latent pathogenic qi transforming into heat and invading the Jueyin meridian. Although the syndrome presents heat signs, it is not an exterior excess heat from external contraction, so Baitouweng Tang can adequately address it. However, when a disease is in the Yangming stage, half the pathogen enters the fu organs, and half transmits from the channels to Shaoyang, subsequently entering Jueyin from Shaoyang, forming transmission between zang and fu organs. In such cases, the Jueyin pathology may form Jueyin hot dysentery with tenesmus, while the retained heat in the Yangming fu organs assists and exacerbates the condition. This situation exceeds the capacity of Baitouweng Tang alone. When I encounter such syndromes, I frequently add Baitouweng (Pulsatillae Radix) and Qinpi (Aceris Cortex) to Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction), which invariably yields immediate results.
I once treated a middle-aged woman who contracted wind-cold in early spring. Four or five days later, a physician was summoned. Her left pulse was wiry and forceful, her right pulse was surging and forceful, her tongue coating was white with slight yellow, she felt internal heat and thirst, had dysentery with mixed pus and blood, tenesmus, and defecated more than twenty times a day. Based solely on the pulse conditions of both sides, I diagnosed it as a combined syndrome of Yangming and Jueyin diseases. A physician present doubted and asked, "In all diseases involving Jueyin, the hands and feet are usually cold and inverted; why are this patient's hands and feet very warm?" I replied, "This is precisely because it is a combined syndrome with Yangming. Yangming governs the muscles; since there is heat in the Yangming fu organs, the whole body is hot, so the cold inversion of the limbs cannot manifest externally when the whole body is hot. Moreover, even if Jueyin disease does not mix with Yangming, do not assume the limbs must always be cold and inverted?" The physician deeply agreed with my words, and the patient's family requested a prescription immediately. Thus, I formulated the following:
Raw Shigao (Gypsum Fibrosum) (three liang, crushed finely)
Raw Hongsao (Paeoniae Radix Alba) (eight qian)
Raw Huaishanyao (Dioscoreae Rhizoma) (eight qian)
Ye Taishen (Codonopsis Radix / Wild Ginseng substitute) (four liang)
Baitouweng (Pulsatillae Radix) (eight qian)
Qinpi (Aceris Cortex) (six qian)
Tianhuafen (Trichosanthis Radix) (eight qian)
Gancao (Glycyrrhizae Radix et Rhizoma) (three qian)
These eight herbs were decocted together into three bowls, divided into three doses, taken warm.
The intent of this formula combines Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction) and Baitouweng Tang (Pulsatilla Decoction) into one, adding other herbs according to the syndrome. Baizhu Tang (White Tiger Decoction) typically contains Zhimu (Anemarrhenae Rhizoma); here, Shaoyao (Paeoniae Radix) replaces Zhimu. Shaoyao can clear heat and nourish yin like Zhimu, and it is particularly effective in treating tenesmus after dysentery. Baizhu Tang typically contains Jingmi (Oryza Sativa Germ); here, Raw Shanyao (Dioscoreae Rhizoma) replaces Jingmi. Shanyao has rich juice, harmonizing the stomach like Jingmi, and its warming and tonifying nature helps Renshen (Ginseng Radix et Rhizoma) secure and stop diarrhea. As for Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) originally in Baitouweng Tang, they are omitted here because, used concurrently with Baizhu Tang, the cooling property of Shigao (Gypsum Fibrosum) suffices, making Huanglian and Huangbai unnecessary. Additionally, Tianhuafen (Trichosanthis Radix) is added externally because the patient also suffers from thirst; Tianhuafen paired with Renshen is most effective at generating fluids and quenching thirst. After completing these three doses, all symptoms reduced by two-thirds. Upon re-examination, the pulse still indicated unclarified excess heat. Therefore, Huashi (Talcum) five qian was added to the original formula to promote urination, which effectively stops diarrhea. The decoction method remained the same. Besides taking the herbal medicine, fresh Baimaogen (Imperatae Rhizoma) half a jin was decocted in water and drunk as tea. The illness was completely cured.