叙曰∶始痢宜下，夫人之所共知也；久痢宜补，亦夫人之所共知也。至如二阳合病皆下
痢，太阳、阳明合病自下痢者宜发汗，太阳、少阳合病自下痢者宜和解，阳明、少阳合病自
下痢者宜攻里，非得伤寒之玄关者，不足以语此也。今考十方于后，大都口耳之见而已。
白芍药（二钱） 当归尾 黄连 黄芩（各一钱） 木香（不见火） 桂心 槟榔 甘
草（各
五分） 大黄（七分） 芒硝（一钱）
痢疾便脓血，里急后重者，此方主之。
痢，滞下也。患痢大都责于湿热，热伤气，故下白；热伤血，故下赤；热伤大肠，则大
肠燥涩，故里急后重。河间云∶行血则便脓自愈，故用归、芍、硝、黄以行血；和气则后重
自除，故用木香、槟榔、甘草以和气；苦能坚肠，寒能胜热，故用芩、连浓肠胃而去热；有
假其气，则无禁也，故假桂心之辛热为反佐。
桃仁（二十五枚，去皮尖） 桂枝（七分，炒） 大黄（五钱，酒浸） 芒硝（五钱） 甘
草（
二钱）
痢疾初起，质实者，此方主之。若初间失下，反用固涩之药，以致邪热内蓄，血不得行
，腹痛欲死者，急以此方主之。
《内经》曰∶通因通用；又曰∶暴者夺之。故用大黄、芒硝之咸寒以荡涤邪热；用桃仁
之苦以逐败血；甘草之甘以调胃气。乃桂枝则辛热物也，用之者何？经曰∶微者逆之，甚者
从之，故用其引大黄、芒硝直达瘀热之巢穴，乃向导之兵也。
叙曰：初患痢疾适宜使用攻下法，这是大家都知道的道理；久患痢疾适宜使用补益法，这也是大家都知道的道理。至于像阳明经与太阴经（注：原文“二阳”通常指阳明，但结合后文太阳、少阳语境及痢疾病机，此处多指湿热蕴结肠道，或特指某种合病情况，依原文直译）合并发病都出现痢疾的情况，如果是太阳经与阳明经合并发病而自利（腹泻/痢疾）的，适宜用发汗法治疗；如果是太阳经与少阳经合并发病而自利的，适宜用和解法治疗；如果是阳明经与少阳经合并发病而自利的，适宜用攻里法治疗。如果不是精通伤寒辨证关键的人，不足以谈论这些内容。现在考证以下十个方剂，大多只是听闻所见罢了。
白芍药（二钱） 当归尾 黄连 黄芩（各一钱） 木香（不经过火炒） 桂心 槟榔 甘草（各五分） 大黄（七分） 芒硝（一钱）
对于痢疾导致大便带脓血，伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）症状的，此方主治。
痢疾，就是滞下。患痢疾大多归咎于湿热，热邪伤气，所以排出白色黏液；热邪伤血，所以排出红色血液；热邪损伤大肠，导致大肠干燥涩滞，所以出现里急后重。刘河间说：活血则脓血自愈，所以用当归、白芍、芒硝、大黄来活血；调气则后重自除，所以用木香、槟榔、甘草来调气；苦味能坚固肠道，寒性能胜热，所以用黄芩、黄连浓稠肠胃并清除热邪；借助其气味，就没有禁忌了，所以借用桂心的辛热之性作为反佐（引导药性或防止格拒）。
桃仁（二十五枚，去皮和尖） 桂枝（七分，炒制） 大黄（五钱，酒浸泡） 芒硝（五钱） 甘草（二钱）
对于痢疾初起，体质壮实者，此方主治。如果在初期未能及时攻下，反而使用固涩的药物，导致邪热内蓄积，血液运行不畅，腹痛剧烈如死一般的，紧急时以此方主治。
《黄帝内经》说：通因通用（以通治通）；又说：病势急猛的要用夺法（泻下祛邪）。所以用大黄、芒硝的咸寒之性来荡涤邪热；用桃仁的苦味来驱逐败血；用甘草的甘味来调和胃气。至于桂枝则是辛热的药物，为什么使用它呢？经文说：病情轻微的逆其病性治疗，病情严重的顺从其病性治疗（从治），所以用它引导大黄、芒硝直达瘀热聚集的地方，它是向导般的军队。
Preface: It is common knowledge that initial dysentery should be treated with purgation; it is also common knowledge that chronic dysentery should be treated with tonification. However, regarding cases where two Yang meridians combine to cause dysentery, if Taiyang and Yangming combined disease presents with spontaneous diarrhea/dysentery, sweating (diaphoresis) is appropriate; if Taiyang and Shaoyang combined disease presents with spontaneous diarrhea/dysentery, harmonization is appropriate; if Yangming and Shaoyang combined disease presents with spontaneous diarrhea/dysentery, attacking the interior (purging) is appropriate. Only those who have mastered the key principles of Cold Damage (Shanghan) are qualified to discuss this. The following ten formulas are examined here, mostly based on hearsay and observation.
Bai Shao Yao (White Peony Root, 2 qian), Dang Gui Wei (Tail of Angelica Sinensis), Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root) (each 1 qian), Mu Xiang (Aucklandia Root, not roasted over fire), Gui Xin (Cinnamon Heart), Bing Lang (Areca Seed), Gan Cao (Licorice Root) (each 5 fen), Da Huang (Rhubarb Root and Rhizome, 7 fen), Mang Xiao (Mirabilite, 1 qian).
This formula is indicated for dysentery presenting with pus and blood in the stool, accompanied by tenesmus (urgent desire to defecate with a feeling of incomplete evacuation).
Dysentery is also known as "Zhi Xia" (stagnant discharge). Dysentery is generally attributed to Damp-Heat. Heat injuring Qi leads to white discharge; Heat injuring Blood leads to red discharge; Heat damaging the Large Intestine causes dryness and obstruction in the Large Intestine, resulting in tenesmus. He-Jian (Liu Wansu) stated: "Moving blood heals pus and blood naturally," therefore Dang Gui and Bai Shao are used to move blood; Mang Xiao and Da Huang are used to purge accumulation. "Harmonizing Qi eliminates tenesmus," therefore Mu Xiang, Bing Lang, and Gan Cao are used to harmonize Qi. Bitter flavors can firm the intestines, and cold natured herbs overcome heat; thus Huang Qin and Huang Lian are used to thicken the intestinal fluids and clear heat. By borrowing its qi, there are no contraindications; thus, the acrid-hot nature of Gui Xin is borrowed as a counter-agent (anti-toxin or guiding agent to prevent rejection).
Tao Ren (Peach Kernel, 25 pieces, skin and tip removed), Gui Zhi (Cinnamon Twig, 7 fen, stir-fried), Da Huang (Rhubarb Root and Rhizome, 5 qian, soaked in wine), Mang Xiao (Mirabilite, 5 qian), Gan Cao (Licorice Root, 2 qian).
This formula is indicated for early-stage dysentery in patients with robust constitution. If purgation was missed in the initial stage and astringent drugs were instead used, causing pathogenic heat to accumulate internally and blood circulation to stagnate, leading to severe abdominal pain resembling death, this formula should be urgently employed.
The *Nei Jing* (Inner Canon) states: "Use unblocking methods for unblocking symptoms" (Tong Yin Tong Yong); it also states: "For acute conditions, use draining methods." Therefore, Da Huang and Mang Xiao are used for their salty-cold nature to cleanse pathogenic heat; Tao Ren is used for its bitter nature to expel stagnant blood; Gan Cao is used for its sweet nature to harmonize Stomach Qi. As for Gui Zhi, which is an acrid-hot substance, why is it used? The Classics state: "For mild conditions, treat contrary to the disease; for severe conditions, treat according to the disease" (Cong Zhi). Therefore, it is used to guide Da Huang and Mang Xiao directly to the nest of stasis and heat, acting as vanguard troops.