1.大瘕小肠大肠泻, 肠癖滞下古痢名, 外因风暑湿蒸气, 内因不谨
饮食生. 白痢伤气赤伤血, 寒虚微痛热窘疼, 实坠粪前虚坠后, 湿热
寒虚初久称.
【注】大瘕泻者, 里急后重, 数至圊而不能便, 茎中痛也. 小肠泻者
,溲涩而便脓血, 少腹痛也. 大肠泻者, 食己窘迫, 大便色白, 肠呜
切痛也. 肠癖者, 饮食不节, 起居不时, 阴受之, 则入五脏,?? 胀闭
塞,下为飧泻, 久为肠癖, 腹痛下血也. 滞下者, 积汁垢腻, 与湿热
滞于肠中, 因而下也. 此皆古痢之名也. 然痢之为病, 里急后重, 下
痢脓血, 小便赤涩. 里急者, 腹痛积滞也. 后重者, 下坠气滞也. 小
便赤涩者, 湿热郁滞也. 皆因外受风暑湿蒸之气, 内伤生冷饮食过度
而生也. 白痢自大肠来. 大肠与肺为表里, 肺主气, 故属伤气也. 赤
痢自小肠来, 小肠与心为表里, 心主血, 故属伤血也. 寒闭痛甚, 寒
开痛微, 痢开痛减, 故痛微也. 虚者少气, 气无壅滞, 故亦痛微也.
热者多实, 性急不得舒通, 故窘痛甚也. 后坠下迫肛门, 粪出坠止,
为粪前坠, 乃滞也, 故曰实坠. 粪出更坠, 为粪后坠, 非滞也, 故曰
虚坠. 初痢多属湿热, 久痢多属寒虚也.
噤口痢 水谷痢 风痢 休息痢 热痢 寒痢 湿痢 五色痢
2.噤口饮食俱不纳, 水谷糟粕杂血脓, 风痢坠重圊清血, 休息时作
复时停, 热痢鱼脑稠粘秽, 寒痢稀澥白清腥, 湿痢黑豆汁浑浊, 五色
相杂脏气凶.
【注】噤口痢者, 下痢不食, 或呕不能食也. 水谷痢者, 糟粕脓血杂
下也. 风痢者, 似肠风下清血而有坠痛也. 休息痢者, 时发作时停止
也.五色痢者, 五色脓血相杂而下也, 若有脏腐尸臭之气则凶.
1. 大瘕泻、小肠泻和大肠泻，以及肠癖、滞下，是古代对痢疾的称呼。外因感受风、暑、湿、蒸（湿热熏蒸）之气，内因饮食不节制而生成。白痢损伤气分，赤痢损伤血分；寒证和虚证疼痛轻微，热证和实证疼痛剧烈窘迫；实证表现为便前坠痛，虚证表现为便后坠痛；初起多属湿热，久病多属寒虚。
【注】大瘕泻的症状是里急后重（腹痛急于排便但排便不畅），频繁去厕所却排不出大便，尿道疼痛。小肠泻的症状是小便涩痛且大便带脓血，少腹疼痛。大肠泻的症状是进食后立即感到窘迫紧迫，大便颜色发白，肠鸣音明显且腹部绞痛。肠癖是由于饮食无节制、起居无规律，邪气从阴经侵入，进而影响五脏，导致腹胀闭塞，向下发展为完谷不化的飧泻，日久则形成肠癖，出现腹痛和下血。滞下是指积滞的汁液垢腻，与湿热之邪滞留于肠道中，因而向下排出。这些都是古代对痢疾的称呼。然而，痢疾这种病症，主要表现为里急后重，排出脓血样大便，小便赤黄涩痛。所谓“里急”，是指腹痛且有积滞；所谓“后重”，是指肛门下坠感且气机阻滞；所谓“小便赤涩”，是指湿热郁结阻滞。这些症状都是由于外受风、暑、湿、蒸之气，内伤生冷饮食过度而产生的。白痢源于大肠。大肠与肺相表里，肺主气，所以白痢属于伤气。赤痢源于小肠，小肠与心相表里，心主血，所以赤痢属于伤血。寒邪闭阻则疼痛剧烈，寒邪散去则疼痛轻微；痢疾发作时疼痛减轻，所以称为痛微。虚证患者元气不足，气机没有壅滞，所以疼痛也轻微。热证多为实证，性质急躁不得舒展通畅，所以疼痛剧烈窘迫。后坠感压迫肛门，粪便排出后坠感停止，称为便前坠，这是实邪积滞所致，所以叫实坠。粪便排出后坠感依然存在，称为便后坠，这不是实邪积滞，所以叫虚坠。初起痢疾多属于湿热，久痢多属于寒虚。
2. 噤口痢表现为饮食完全无法摄入，水谷糟粕混杂着脓血一起排出；风痢表现为肛门坠胀沉重，排出清稀血液；休息痢表现为时发时止，反复发作；热痢表现为大便像鱼脑一样稠粘秽臭；寒痢表现为大便稀薄清冷带有腥味；湿痢表现为大便像黑豆汁一样浑浊；五色痢表现为五种颜色的脓血混杂，提示脏腑之气衰败，预后凶险。
【注】噤口痢的症状是下痢且不能进食，或者呕吐无法进食。水谷痢的症状是糟粕、脓血混杂而下。风痢的症状类似肠风（一种便血病症），排出清血并伴有坠痛。休息痢的症状是时而发作，时而停止。五色痢的症状是五种颜色的脓血混杂而下，如果伴有脏腑腐败或尸臭的气味，则预后凶险。
1. Da Jia Xie (Great Mass Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), and Da Chang Xie (Large Intestine Diarrhea), along with Chang Pi (Intestinal Dysentery) and Zhi Xia (Stagnant Downward Discharge), are ancient names for Li Ji (Dysentery). The external causes involve contracting Wind, Summerheat, Dampness, and Steaming-Heat pathogens; the internal causes arise from improper diet. White dysentery damages Qi (Vital Energy); red dysentery damages Blood. Cold and Deficiency patterns present with mild pain, while Heat and Excess patterns present with severe, distressing pain. In Excess patterns, tenesmus occurs before defecation; in Deficiency patterns, it occurs after defecation. Early-stage dysentery is mostly attributed to Damp-Heat, while chronic dysentery is mostly attributed to Cold and Deficiency.
[Note] Da Jia Xie is characterized by Li Ji Hou Zhong (tenesmus: urgent abdominal pain with a feeling of incomplete evacuation), frequent trips to the toilet with inability to pass stool, and pain in the urethra. Xiao Chang Xie presents with painful, difficult urination accompanied by pus and blood in the stool, and pain in the lower abdomen. Da Chang Xie presents with immediate urgency after eating, white-colored stool, prominent borborygmus, and colicky abdominal pain. Chang Pi results from irregular diet and lifestyle, where pathogens enter through the Yin meridians, affecting the Five Zang Organs, leading to abdominal distension and obstruction, progressing downward to Sun Xie (diarrhea with undigested food), and eventually becoming Chang Pi, characterized by abdominal pain and hematochezia. Zhi Xia refers to the downward discharge of stagnant, greasy fluids mixed with Damp-Heat pathogens retained in the intestines. These are all ancient terms for dysentery. However, the disease of Li Ji primarily manifests as tenesmus, passage of pus and blood in the stool, and dark, scanty, painful urination. "Li Ji" refers to abdominal pain due to stagnation; "Hou Zhong" refers to the sensation of rectal heaviness due to Qi stagnation; "dark, scanty urination" refers to the stagnation of Damp-Heat. All these conditions arise from external contraction of Wind, Summerheat, Dampness, and Steaming-Heat, combined with internal injury from excessive consumption of raw or cold foods. White dysentery originates from the Large Intestine. The Large Intestine and Lung are exterior-interiorly related; the Lung governs Qi, thus white dysentery is associated with Qi damage. Red dysentery originates from the Small Intestine. The Small Intestine and Heart are exterior-interiorly related; the Heart governs Blood, thus red dysentery is associated with Blood damage. When Cold obstructs, pain is severe; when Cold dissipates, pain is mild; when dysentery episodes subside, pain decreases, hence "mild pain." In Deficiency patterns, there is shortness of breath and lack of Qi stagnation, hence pain is also mild. In Heat patterns, there is often Excess; the nature is irritable and lacks smooth flow, hence severe, distressing pain. Tenesmus pressing on the anus, which stops after stool passage, is called pre-defecation tenesmus, indicating stagnation, thus termed "Excess tenesmus." Tenesmus that persists after stool passage is called post-defecation tenesmus, indicating no stagnation, thus termed "Deficiency tenesmus." Early dysentery mostly belongs to Damp-Heat; chronic dysentery mostly belongs to Cold and Deficiency.
Jin Kou Li (Anorexic Dysentery), Shui Gu Li (Water and Grain Dysentery), Feng Li (Wind Dysentery), Xiu Xi Li (Intermittent Dysentery), Re Li (Heat Dysentery), Han Li (Cold Dysentery), Shi Li (Damp Dysentery), Wu Se Li (Five-Color Dysentery).
2. Jin Kou Li presents with complete inability to ingest food or water, with feces mixed with pus and blood being discharged. Feng Li presents with heavy tenesmus and passage of clear blood. Xiu Xi Li presents with intermittent attacks and remissions. Re Li presents with thick, sticky, foul-smelling stool resembling fish brains. Han Li presents with thin, watery, clear stool with a fishy odor. Shi Li presents with turbid stool resembling black bean juice. Wu Se Li presents with a mixture of five colors of pus and blood, indicating fierce pathological changes in the Zang Organs.
[Note] Jin Kou Li is characterized by dysentery accompanied by anorexia or vomiting preventing food intake. Shui Gu Li is characterized by the simultaneous discharge of feces, pus, and blood. Feng Li resembles Chang Feng (a type of hemorrhoidal bleeding), presenting with clear blood and tenesmus pain. Xiu Xi Li is characterized by periodic exacerbations and remissions. Wu Se Li is characterized by the discharge of pus and blood in five different colors; if accompanied by a smell of rotting organs or corpse-like odor, the prognosis is ominous.