食积 湿热 风毒下陷 暑热 白属气 赤属血 疫痢
痢者滞下也本自脾胃所受饮食内伤留滞不行至于秋时调养失宜感受风寒暑湿之气湿热内
蒸而成痢矣其症腹痛急迫后重如厕不能纵行者是也盖肺主气与大肠通为表里因肺气留陷于大
肠不得升提是故里急而后重也然四时感受之不同必求所因而治因风而致者纯下清血因湿而得
者下黑豆汁因寒积于内而成者寒久而变热怫热内而成赤白矣又有脾胃虚弱为寒所凝以致身冷
汗利如鱼脑者治当温之此水火阴阳偏胜之不岂可执一而以热论哉治法当先疏通积滞分利阴阳
补养脾胃不可使用止涩之药况郁毒未散止涩太早而成噤口者多矣可不慎哉可不慎哉
丹溪云湿热伤气则成白痢湿热伤血则成赤痢气血俱伤则成赤白痢其症脐腹 痛或下赤白
黄黑五色者或下如黑豆汁如鱼脑如屋漏水或下清血或大孔痛频欲登厕日夜无度皆是候也
戴云痢虽有赤白二色亦无冷热之分皆是湿热但新久更量虚实与赤白带同 又云赤自小肠
来白自大肠来
内经曰身热则死身寒则生此大概之言必兼形胜察之可也岂无身热而生身寒而死者哉 又
曰先
如鱼脑者凶 如尘腐者死 纯血者凶 如屋漏水者死 肛门空陷者死 身热烦渴者死
脉诀云下痢微小却为生 脉大浮洪无瘥日
河间云行血则便脓自愈和气则后重自除宜 芍药汤
一痢病后重者宜下 腹痛者当和 身重者除湿
一痢本湿热首先除湿清热开郁化积行气和血为主
一痢病一二日间元气未虚先用推逐之药宜用 调胃承气汤加减
一三五日后脾胃渐虚当用消导化滞之药宜用 导气汤 化滞汤加减
一病久挟虚当用滋补收涩之药宜用 真人养脏汤加减
一痢初起不问阴阳赤白者宜用 胃苓汤加减
一伤暑下痢脉微细者宜用 黄连香薷散加减
一因风而痢者下如黑豆汁或如浊酒宜用 胃风汤加 木香 黑豆 陈米
一因寒下痢如鱼脑肚腹疼痛四肢逆冷口中如霜雪此为冷痢宜用 理中汤加减
一未经止涩噤口不食者是乃毒瓦斯充塞心胃之经宜用 仓廪汤 香连丸 同莲肉人参服
一大孔痛是毒瓦斯流陷于大肠也宜温之清之 久病身冷脉小者宜温之用 当归 肉豆蔻
升麻之类 暴病身热脉大者宜清之用 黄连 黄芩 木香 槟榔之类
一噤口痢用封脐法引火下行用 田螺捣烂入麝香少许封脐
一有时疫作痢一方一家大小传染相似必须明速气之胜复以治之
一后重者初起宜下日久宜升提调气经曰调气则后重除
一痢病小便不通宜用 木香 滑石 车前子 泽泻之类
一赤痢宜 香连丸 归连汤
一白痢宜 苍术芍药汤
食积、湿热、风毒下陷、暑热。白色属气分，红色属血分，疫痢（具有传染性的痢疾）。
痢疾，就是滞下，本源于脾胃所受饮食内伤，留滞不行。到了秋季，调养失宜，感受风寒暑湿之气，湿热在内蒸腾，从而形成痢疾。其症状是腹痛急迫，里急后重（想排便但排出不畅，肛门坠胀），如厕时不能舒展自如。这是因为肺主气，与大肠相表里，因肺气留陷于大肠，不得升提，所以出现里急而后重。然而，四时感受的病邪不同，必须探究病因进行治疗：因风邪所致者，纯下清血；因湿邪所致者，下黑豆汁样的便物；因寒积于内，久寒变热，怫热在内，而成赤白痢。又有脾胃虚弱，被寒邪凝滞，以致身体冰冷，泻下物如鱼脑状，治疗应当温补。这是水火阴阳偏胜的表现，岂可固执一端而只按热证论治呢？治疗方法应当先疏通积滞，分利阴阳，补养脾胃，不可使用止涩的药物。况且郁结的毒邪未散，过早止涩，导致噤口痢（无法进食）的情况很多，能不谨慎吗？能不谨慎吗？
丹溪说：湿热伤气则成白痢，湿热伤血则成赤痢，气血俱伤则成赤白痢。其症状是脐腹疼痛，或者下赤白、黄黑五色便，或者下如黑豆汁、如鱼脑、如屋漏水样的便，或者下清血，或者肛门疼痛，频频想上厕所，日夜无度，这些都是候象。
戴云说：痢疾虽有赤白二色，也没有冷热之分，都是湿热，但要根据新病久病来衡量虚实，与赤白带下相同。又说：赤痢自小肠来，白痢自大肠来。
《内经》说：身热则死，身寒则生。这是大概的说法，必须结合形体盛衰来考察，可以吗？难道没有身热而生、身寒而死的情况吗？又说：
像鱼脑一样的便凶险，像尘腐一样的便死亡，纯血的便凶险，像屋漏水的便死亡，肛门空陷的便死亡，身热烦渴的便死亡。
《脉诀》说：下痢脉微小却是生机，脉大浮洪则无痊愈之日。
- 痢病有后重感的，适宜用攻下法；腹痛的，应当调和气血；身体沉重的，应当除湿。
- 痢疾本因湿热，首先应除湿清热，开郁化积，行气和血为主。
- 痢病一二日间，元气未虚，先用推逐之药，适宜用调胃承气汤加减。
- 一三五日后，脾胃渐虚，当用消导化滞之药，适宜用导气汤、化滞汤加减。
- 病久挟虚，当用滋补收涩之药，适宜用真人养脏汤加减。
- 痢疾初起，不问阴阳赤白，适宜用胃苓汤加减。
- 伤暑下痢，脉微细者，适宜用黄连香薷散加减。
- 因风而致痢，下如黑豆汁或如浊酒，适宜用胃风汤加木香、黑豆、陈米。
- 因寒下痢，如鱼脑，肚腹疼痛，四肢逆冷，口中如霜雪，此为冷痢，适宜用理中汤加减。
- 未经止涩，噤口不食，乃是毒瓦斯充塞心胃之经，适宜用仓廪汤、香连丸同莲肉、人参服用。
- 大孔痛，是毒瓦斯流陷于大肠，适宜温之清之。久病身冷脉小者，宜温，用当归、肉豆蔻、升麻之类。暴病身热脉大者，宜清，用黄连、黄芩、木香、槟榔之类。
- 噤口痢，用封脐法引火下行，用田螺捣烂入麝香少许封脐。
- 有时疫作痢，一方一家大小传染相似，必须明速气之胜复以治之。
- 后重者，初起宜下，日久宜升提调气。经曰：调气则后重除。
- 痢病小便不通，适宜用木香、滑石、车前子、泽泻之类。
- 赤痢适宜用香连丸、归连汤。
- 白痢适宜用苍术芍药汤。
Food stagnation, damp-heat, wind-toxin sinking downward, summer-heat. White color belongs to Qi (Vital Energy), red color belongs to Blood. Epidemic dysentery (dysentery with infectious nature).
Dysentery is also known as "stagnant discharge" (Zhi Xia). It originates from internal injury caused by diet affecting the Spleen and Stomach, leading to retention and obstruction. In autumn, improper care leads to contraction of wind-cold, summer-heat, and dampness. Damp-heat steams internally, resulting in dysentery. The symptoms include urgent abdominal pain, tenesmus (a feeling of incomplete defecation with rectal pressure), and inability to relax while using the toilet. This is because the Lung governs Qi and has a exterior-interior relationship with the Large Intestine. When Lung Qi sinks into the Large Intestine and fails to ascend, tenesmus occurs. However, pathogens contracted in different seasons vary; treatment must address the specific cause. Those caused by Wind present with pure clear blood in stool; those caused by Dampness present with stool resembling black bean juice; those caused by Cold accumulation transforming into Heat over time, with stifling heat inside, present with red and white stool. Additionally, Spleen-Stomach deficiency congealed by Cold may result in cold body and stool resembling fish brains; treatment should involve warming. This reflects an imbalance of Water-Fire and Yin-Yang; one cannot rigidly adhere to a single perspective and treat only as Heat. The therapeutic method should first unblock stagnation, differentiate and benefit Yin and Yang, and nourish the Spleen and Stomach. Astringents should not be used. Moreover, if toxic stagnation is not dispersed, early use of astringents often leads to Jing Kou Li (anorexic dysentery where the patient cannot eat). How can one not be cautious? How can one not be cautious?
Danxi stated: Damp-heat injuring Qi results in white dysentery; damp-heat injuring Blood results in red dysentery; simultaneous injury to Qi and Blood results in red-and-white dysentery. Symptoms include umbilical and abdominal pain, or passage of red, white, yellow, black, or five-colored stools; or stool resembling black bean juice, fish brains, or leaking roof water; or pure clear blood; or anal pain with frequent urges to defecate, day and night without limit. These are all signs.
Dai Yun stated: Although dysentery presents with red and white colors, there is no distinction between cold and heat; it is always damp-heat. One must assess deficiency and excess based on whether the disease is new or chronic, similar to leukorrhea. He further stated: Red dysentery originates from the Small Intestine; white dysentery originates from the Large Intestine.
The *Nei Jing* (Inner Canon) states: Fever indicates death; cold body indicates survival. This is a general statement; one must examine the constitution's strength. Are there not cases of survival with fever and death with cold? It also states:
Stool resembling fish brains is ominous; stool resembling dust and rot indicates death; pure blood is ominous; stool resembling leaking roof water indicates death; sunken and empty anus indicates death; fever with irritability and thirst indicates death.
The *Mai Jue* (Pulse Classic) states: Dysentery with minute and small pulses suggests life; large, floating, and surging pulses indicate no days of recovery.
Hejian stated: Moving Blood heals pus in stool; regulating Qi eliminates tenesmus. Shaoyao Tang (Peony Decoction) is suitable.
- For dysentery with tenesmus, purgation is suitable; for abdominal pain, harmonizing is appropriate; for heavy body, removing dampness is required.
- Dysentery is fundamentally due to damp-heat; initially, remove dampness and clear heat, open depression, resolve accumulation, regulate Qi, and move Blood as the main approach.
- In the first one to two days of dysentery, when Yuan Qi (Primal Energy) is not yet deficient, use pushing/draining medicines first. Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) modified is suitable.
- After three to five days, as Spleen and Stomach gradually weaken, use resolving and guiding medicines to transform stagnation. Daoqi Tang (Directing Qi Decoction) and Huazhi Tang (Transforming Stagnation Decoction) modified are suitable.
- For chronic disease complicated by deficiency, use tonifying and astringent medicines. Zhenren Yangzang Tang (True Person Nourishing Viscera Decoction) modified is suitable.
- At the onset of dysentery, regardless of Yin/Yang or red/white, Weiling Tang (Stomach and Bladder Decoction) modified is suitable.
- For summer-heat injury causing dysentery with minute and fine pulses, Huanglian Xiangru San (Coptis and Elsholtzia Powder) modified is suitable.
- For dysentery caused by Wind, with stool like black bean juice or turbid wine,weifeng Tang (Wind Guarding Decoction) added with Muxiang (Aucklandiae Radix), Heidou (Black Soybean), and Chenmi (Aged Rice) is suitable.
- For cold-induced dysentery with stool like fish brains, abdominal pain, cold limbs, and a mouth feeling like frost/snow, this is Cold Dysentery. Lizhong Tang (Regulate the Middle Decoction) modified is suitable.
- If astringents have not been used, and the patient suffers from Jing Kou (inability to eat) due to toxic vapors obstructing the Heart and Stomach meridians, Canglin Tang (Granary Decoction) and Xianglian Wan (Aucklandia and Coptis Pill) taken with Lotus Seeds and Renshen (Ginseng) are suitable.
- Anal pain indicates toxic vapors sinking into the Large Intestine; warm and clear it. For chronic cases with cold body and small pulse, warm using Danggui (Angelicae Sinensis Radix), Roudoukou (Myristicae Semen), Shengma (Cimicifugae Rhizoma), etc. For acute cases with fever and large pulse, clear using Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), etc.
- For Jing Kou Dysentery, use the Umbilical Sealing Method to guide Fire downward: crush Tianluo (Snail) and apply a small amount of Shexiang (Musk) to the umbilicus.
- During epidemic dysentery outbreaks, where families are similarly infected, one must clearly understand the victory and return of Qi phases to treat accordingly.
- For tenesmus, purgation is suitable at onset; for long-standing cases, lifting and raising Qi regulation is needed. The Classics state: Regulating Qi eliminates tenesmus.
- For dysentery with urinary obstruction, Muxiang (Aucklandiae Radix), Huashi (Talcum), Cheqianzi (Plantaginis Semen), and Zexie (Alismatis Rhizoma) are suitable.
- Red dysentery is suitable for Xianglian Wan (Aucklandia and Coptis Pill) and Guilian Tang (Angelica and Coptis Decoction).
- White dysentery is suitable for Cangzhu Shaoyao Tang (Atractylodis Rhizoma and Peony Decoction).