经义
帝曰∶肠 便血何如？岐伯曰∶身热则死，寒则生。帝曰∶肠 下白沫何如？岐伯曰∶脉沉则生，浮则死。
帝曰∶肠 下脓血何如？岐伯曰∶脉悬绝则死，滑大则生。帝曰∶身不热，脉不悬绝何如？岐伯曰∶滑大者生，
悬涩者死，以脏期之。○脾脉外鼓沉为肠 ，久自已。肝脉小缓为肠 ，易治。肾脉小搏沉为肠 下血，血温
身热者死。○心肝 亦下血，二脏同病者可治。其脉小沉涩为肠 ，其身热者死。○阴阳虚，肠 死。○肾移热
于脾，传为虚，肠 死。（《素问》）
哲言
痢有赤痢、白痢、赤白痢、水谷痢、脓血痢、噤口痢、休息痢、风痢、寒痢、热痢、湿痢、气痢、虚痢、
滑痢、积痢、久痢、疫痢、虫疰痢、五色痢。（《东医宝鉴》）
按∶滞下之证，古人多与泄泻同论，至《三因方》始另立条目。夫病有从外感而得者，须分六气之异，
外既受伤，肠胃郁结，随其寒热温凉以调之。有因脏气发动，干犯肠胃而得者，须察其何脏相兼，以平治之。
又有因饮食失节而得者，则审其何物所伤，以消克之。但病有虚实，治有先后。若病气暴至，元气壮实，积
滞胶固者，宜下之；病久气脱，肠胃虚滑者，宜温之涩之。大抵可温则温，可下则下，或解表，或利小便，分
别在里、在表、挟风、挟热、挟寒等证。脓血赤白，有气病、血病之分；后重里急，有气血虚实之异，不可不
察。（刘宗浓）
下痢治法∶在表者汗之；在里者下之；在上者涌之；在下者竭之；身表热者疏之；小便涩者利之；盛者和
之去之；过者止之。（张洁古）
凡治痢，和血勿伤血，调气勿破气。（《仁斋直指》）
后重宜下，腹痛宜和，身重宜除湿，脉弦宜去风，风邪内结宜汗，身冷自汗宜温，脓血稠粘宜重剂以竭
之。（刘河间）
河间发明滞下证治，尤为切要。和血则便脓自愈，调气则后重自除。二语实盲者之日月，聋者之雷霆也。
○或问∶河间之言滞下，似无挟虚挟寒者乎？曰∶泄利之病，水谷或化或不化，并无里急后重形状。若滞下则不
然，或脓、或血、或肠垢、或无糟粕相混，虽有痛、不痛之异，然皆里急后重，逼迫恼人，皆实热证也。近年
涉历，亦有虚寒证者，如治予从叔娄长官等，皆用参、术、干姜之类是也。（朱丹溪）
河间曰∶夫治诸痢者，莫若以辛苦寒药。苦能燥湿，寒能胜热，使气宣平而已。此说相传至今，凡治痢
者，悉用寒凉，皆此说之误也。毋论其他，姑以苦能燥湿一言辨之，见大左矣。夫五味之理，悉出《内经》。
有曰以苦燥之者，盖言苦之燥者也。河间不察，便谓是苦皆燥，不知《内经》之言苦者，其性有二，其用有六。
如曰∶火生苦。曰∶其类火，其味苦。曰∶少阳在泉为苦化，少阴在泉为苦化。曰∶湿淫于内，治以苦热；燥
淫于内，治以苦温。是皆言苦之阳也。曰∶酸苦涌泄为阴。曰∶湿司于地，热反胜之，治以苦冷。曰∶湿化于
天，热反胜之，治以苦寒。是皆言苦之阴也。此其言性之二也。又曰∶以苦发之，以苦燥之，以苦温之，以苦
坚之，以苦泄之，以苦下之。此其言用之六也。盖苦之发者，麻黄、白芷、升、柴之属是也；苦之燥者，苍术、
白术、木香、补骨脂之属是也；苦之温者，附子、干姜、肉桂、吴萸之属是也；苦之坚者、续断、地榆、诃子
之属是也；苦之泄者，栀、柏、芩、连、木通、胆草之属是也；苦之下者，大黄、芒硝
之属是也。夫气化之道，惟阳则燥，惟阴则湿，岂以沉阴下降如黄连、黄柏之属，以至苦大寒之性，而犹谓其
能燥，有是理乎？是但知苦燥之一言，而不察苦发、苦温、苦坚、苦泄、苦下之五者何也？因致后人治痢，多
不分寒热虚实，动以河间之法，及其将危，犹云血色如此，何敢用温？腹痛如此，何敢用补？死而无悟，深可
哀也！（《景岳全书》）
凡治痢疾，一见表证，必先解表。若表不解，则邪将传里，难愈。故发热身疼，邪在太阳，参苏饮；寒热
往来，邪在少阳，小柴胡；身热、目痛、鼻干、不眠，邪在阳明，葛根汤。必表邪解而后无传变之患。（查了吾）
《内经》冬月伤寒，已称病热。至夏秋，热、暑、湿三气交蒸，互结之热，十倍于冬月矣。外感三气之
热而成下痢，必从汗先解其外，后调其内。首用辛凉以解表，次用苦寒以清里。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，则死证可活，危证可安祥。《金匮》有云∶
下痢脉反弦，发热身汗者，自愈。夫久痢之脉，深入阴分，沉涩微弱矣。忽然而转弦脉，浑是少阳生发之气，
非用逆挽，何以得此？久痢邪入于阴，身必不热。今因逆挽之势，逼其临时燥热，顷之邪从表出，热自无矣。
久痢阳气下陷，皮肤干涩，断然无汗，今以逆挽之法，卫外之阳领邪气同还于表而身有汗，是以腹中安静，而
其病自愈也。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，此则肠胃为热毒所攻，
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，俟其利渴之势少缓，乃始平调于内，更不必挽之于外。盖其邪如决水转石，乘势出尽，无可挽耳。更有
急开支河一法，其邪热之在里者，奔迫于大肠，必郁结于膀胱，膀胱热结，则气不化而小溲短赤，不用顺导，
而用逆挽，仍非计也。清膀胱之热，令气化行而分消热势，则甚捷
也。仲景谓下利气者，当利其小便。非急开支河之谓乎？然而水出高源，肺不热则小溲自行，肺与大肠为表里，
大肠之热，皆因肺热所移，尤宜先清肺之化源。《金匮》有下利肺痛者，紫参汤主之；气利，诃黎勒散主之。
后人疑非仲景之方，讵知肠胃有病，其所关全在于肺。又可见肺气不通而痛，则急通其壅，大肠之气坠而逼迫，
而缓调其适矣。○再按∶治疟之法，当从少阳而进退其间；乃痢疾之表，亦当从少阳半表之法，缓缓逆挽其下
陷之清气，俾身中行春夏之令，不致于收降耳。究竟亦是和法，全非发汗之意。津液未伤者，汗出无妨；津液
既伤，皮间微微得润，其下陷之气已举矣。夫岂太阳外感风寒，可正发汗之比乎？又岂太阳阳明合病下利，可
用葛根之比乎？噫！微矣。（喻嘉言）
痢证古名滞下，夏秋暑湿挟积者居多，其次则风淫、火迫、寒侵，燥气独不为患。至于暑有阴阳，必兼
乎湿。夫阴暑由于人之阳气先亏，加以贪凉喜冷，郁折生阳，故主于温；阳暑由于天之热伏，阻气化浊，则重
于清。但邪之来也，似水之流，脏腑间一有罅隙，则乘虚而着，故有在气在血之分，伤脏伤腑之异。若表之邪
郁，而气机下流不息者，喻氏论人参败毒散；里之积壅而寒热交粘者，洁古立芍药汤。在气分，有苦辛调气与
辛甘益气等法；在血分，有酸苦行血及咸柔养血诸方。若表证急，从乎三阳，有桂枝汤、葛根芩连汤、小柴胡
汤；里势实，专究脾胃，有小承气汤、温脾汤。总之，治腑以三焦见证为凭，治脏以足三阴为要领，辨其虚实
之情，酌以通涩之法。是证最难愈者，莫如休息痢，攻补之法非一。最危险者，莫如噤口痢，却有两端∶若因
暑湿邪充，格拒三焦者，气机皆逆传而闭，上下之势，浑如两截，治不得其要，则邪无出路，正立消亡。丹
溪立法最高，后世都宗其旨。先生又借用半夏泻心汤，减去守中之品，取补以运之，辛以开之，苦以降之。
又因脾肾之阳素虚，阴邪从中而下者，先伤太阴，继伤少阴，关闸大开，痛泄无度，戊癸少化火之机，命阳无蒸变之力，
此不饥不食，为呕为胀，理宜然矣。与邪多积热之候不同。参之仲景理中汤、肾气丸，及景岳理阴煎、胃关煎
等法，又以大剂苁蓉配入参、归、姜、附、桂、制白芍之类，较地黄、阿胶尤胜，与之肠膏竭尽，络脉结涩而
痛者，堪称神品。○古贤治痢，不外通涩二法，大都新痢宜通，久痢宜涩。○滞下之滞字，非停滞饮食，言暑
湿内侵，腑中流行阻遏而为滞耳。（《临证指南》）
王损庵以种种痢疾，总由湿热入胃。此一句便可悟病形矣。痢疾腹痛，必是绕脐以下，当小肠之分野；小
肠无毒，则糟粕得循其正，虽曲而顺下无碍；惟脓血则不得循其正而不肯下，故痛也。小便不利者，小肠为毒
邪所迫，不能分利，故短缩也。噤口者，乃毒瓦斯原盛，或破药太过，挟伤上中二脘宗气，毒邪乘虚而上逆也。
（《己任编》）
治痢大法，始当推荡，久当温补，而尤宜以顾胃气为主。盖百病以胃气为本，而于痢为尤要。故能食者轻，
不能食者重，绝不食者死。是痢之赖于胃气者，如此其重矣。○泻与痢，不分两证，混言湿热而利小便，非也。
盖淡渗功能利水，浊流得快，则泻自止。若痢疾乃垢秽之物，因于湿热，肠胃怫郁而成，出于大肠传送之道，
故不宜过用渗利之药，重竭其阳而涸其津液，是病降之而药又降之也。○凡治滞下与滑泄不同。滑泄有可涩之
道，故古人有用粟壳、诃子以止其滑。若滞下，本属湿热涩滞，法宜疏利，最忌兜涩。大肠为肺之腑，大肠既
有湿热留滞，则肺家亦必有郁滞不清，古人用药，每利肺气，知其性喜通利，清脏以及腑也。倘误用兜涩，则
湿热无所宣泄，肺气不得下行，非惟痢疾增剧，且恐湿热熏蒸，上干乎肺，则胀满、气逆、不眠、恶食诸证至
矣。（《冯氏锦囊》）
古人治痢，多用坠下之品，所谓通因通用，法非不善。然效者半，不效者半。其不效者，每至缠绵难愈，
或呕逆不食而成败证。仔细揣摩，偶见烛光，恍然有得，因思火性炎上，何以降于
肠间而为痢？良由积热在中，或为风寒所闭，生冷所遏，致火气不得舒伸，逼迫于下。医者更用下坠之药，则
降者愈降，而痢愈甚矣。因制治痢散以治痢证初起，方用葛根为君，鼓舞胃气上行；陈茶、苦参为臣，清湿热
也；麦芽、山楂为佐，消宿滞也；赤芍、广皮为使，所谓行血则便脓自愈，调气则后重自除也。惟于腹中胀满
拒按者，此有宿食，更佐以朴黄丸下之。若日久脾虚，食少痢多者，五味异功散加白芍、香、连清而补之。若气
虚下陷者，补中益气汤升提之；若邪热秽气塞于胃脘，呕逆不食者，开噤散启之；若久痢变为虚寒，肢冷脉微，
饮食不消者，附子理中汤加肉桂温之。（程钟龄）
痢之为证，多本脾肾。脾司仓廪，土为万物之母；肾主蛰藏，水为万物之原。二脏皆根本之地，投治少
瘥，冤沉幽冥。究其疵误，皆寒热未明，虚实不辨也。晚近不足论，即在前贤，颇有偏僻，如《局方》与复庵，
例行辛热；河间与丹溪，专用苦寒。何其执而不圆，相去天壤耶？夫痢起夏秋，湿蒸热郁，本乎天也；因热求
凉，过吞生冷，由于人也。气壮而伤于天者，郁热居多；气弱而伤于人者，阴寒为甚。湿土寄旺四时，或从于
火，则阳土有余，而湿热为病，《经》所谓敦阜是也。或从于水则阴土不足，而寒湿为病，《经》所谓卑监是
也。言热者遗寒，言寒者废热，岂非立言之过乎？至以赤为热、白为寒，亦非确论。果尔，则赤白相兼者，岂
真寒热同病乎？必以见证与色脉辨之，而后寒热不淆也。须知寒者必虚，热者必实，更以虚实细详之，而寒热
愈明矣。胀满恶食，急痛惧按者，实也；烦渴引饮，喜冷畏热者，热也。脉强而实者，实也；脉数而滑者，热
也。外此则靡非虚寒矣。而相似之际，尤当审察。如以口渴为实热，似矣；不知凡系泻痢，必亡津液，液亡于
下，则津涸于上，安得不渴？更当以喜热、喜冷分虚实也。以腹痛为实热，似矣；不知痢出于脏，肠胃必伤，
脓血剥肤，安得不痛？更当以痛之缓急、按之可否、脏之阴阳、腹之胀
与不胀、脉之有力无力分虚实也。以小便之黄赤短少为实热，似矣；不知水从痢去，溲必不长，液以阴亡，溺
因色变，更当以便之热与不热、液之涸与不涸、色之泽与不泽分虚实也。以里急后重为实热，似矣；不知气陷
则仓廪不藏，阴亡则门户不固，更当以病之新久、质之强弱、脉之盛衰分虚实也。至于治法，须求何邪所伤？
何脏受病？如因于湿热者，去其湿热；因于积滞者，去其积滞。因于气者调之；因于血者和之。新感而实者，
可以通因通用；久病而虚者，可以塞因塞用。独怪世之病痢者，十有九虚，而医之治痢者，百无一补。气本下
陷，而再行其气，后重不益甚乎？中本虚衰，而复攻其积，元气不愈竭乎？湿热伤血者，自宜调血，若过行推
荡，血不转伤乎？津亡作渴者，自宜止泄，若但与渗利，津不转耗乎？世有庸工，专守痛无补法，不知因虚而
痛者，愈攻则愈虚愈痛矣。请以宜补之证悉言之∶脉来微弱者可补；形色虚薄者可补；疾后而痢者可补；因攻
而剧者可补。然而尤有至要者，则在脾肾两脏。如先泻而后痢者，脾传肾，为贼邪，难疗；先痢而后泻者，
【经文要义】
黄帝问：患痢疾便血，预后如何？岐伯回答：若身体发热则预后不良（死），若身体不发热则预后良好（生）。黄帝问：患痢疾下白沫，预后如何？岐伯回答：脉象沉伏则预后良好（生），脉象浮大则预后不良（死）。
黄帝问：患痢疾下脓血，预后如何？岐伯回答：脉象悬绝（极度微弱或无根）则预后不良（死），脉象滑大则预后良好（生）。黄帝问：若身体不发热，脉象也不悬绝，预后如何？岐伯回答：脉象滑大的可生，脉象悬而涩滞的必死，可根据脏腑气绝的日期来推断死亡时间。○脾脉向外鼓动且沉，为患痢疾之象，日久可自行痊愈。肝脉小且缓，为患痢疾之象，容易治疗。肾脉小、搏指且沉，为患痢疾下血之象，若血色温热且身体发热则预后不良（死）。○心与肝经病变也可见下血，若两脏同病尚可治疗。若脉象小、沉、涩，为患痢疾之象，若身体发热则预后不良（死）。○阴阳俱虚者，患痢疾则预后不良（死）。○肾热转移至脾，传变为虚证，患痢疾则预后不良（死）。（出自《素问》）
【哲人言论】
痢疾分为赤痢、白痢、赤白痢、水谷痢、脓血痢、噤口痢（饮食难进）、休息痢（时发时止）、风痢、寒痢、热痢、湿痢、气痢、虚痢、滑痢、积痢、久痢、疫痢、虫疰痢、五色痢。（出自《东医宝鉴》）
按语：滞下（痢疾）这一病症，古人多将其与泄泻一同论述，直到《三因方》才单独设立条目。疾病有因外感邪气而得的，必须区分六淫（风、寒、暑、湿、燥、火）的不同，体表既受邪伤，肠胃郁结，需根据其寒热温凉性质进行调理。有因内脏之气发动，干扰肠胃而得的，必须察明是哪一脏受累兼夹，以平调为主。又有因饮食不节而得的，则需审察是何种食物所伤，以消导攻伐为主。但疾病有虚实之分，治疗有先后次序。若病势暴急发作，元气壮实，积滞胶固难解的，适宜用攻下法；若病程长久导致气脱，肠胃虚弱滑脱的，适宜用温补固涩法。大致原则是：可温则温，可下则下，或解表，或利小便，分别辨别是在里、在表、挟风、挟热、挟寒等证候。脓血赤白，有气分病、血分病的区别；后重里急（肛门坠胀、腹痛窘迫），有气血虚实的差异，不可不仔细考察。（刘宗浓）
下痢治法：病在表的用汗法；病在里的用下法；病在上的用涌吐法；病在下的用竭尽（通利或固涩）法；身体表面发热的用疏解法；小便涩滞的用通利法；邪气盛的用和解法以祛除病邪；正气过衰的用收敛法。（张洁古）
凡是治疗痢疾，调和血液不要损伤血液，调理气体不要破耗气体。（《仁斋直指方》）
肛门坠重（后重）适宜用攻下法，腹痛适宜用调和法，身体沉重适宜祛除湿邪，脉弦适宜祛风，风邪内结适宜发汗，身体寒冷自汗适宜温补，脓血稠粘适宜用重剂以通利排邪。（刘河间）
刘河间阐明了滞下（痢疾）的证治，尤为切中要害。调和血液则便脓自愈，调理气体则后重自除。这两句话对于盲人如同日月般光明，对于聋人如同雷霆般警醒。○有人问：刘河间关于滞下的论述，似乎没有涉及挟虚、挟寒的情况吗？回答说：泄利类的疾病，水谷有的能消化有的不能，并没有里急后重的症状形态。如果是滞下（痢疾）则不然，或是脓、或是血、或是肠垢、或没有糟粕相混，虽然有痛或不痛的区别，但都有里急后重，逼迫恼人，都属于实热证。近年来临床经历中，也有虚寒证的病例，如治疗我的堂叔娄长官等人，都使用人参、白术、干姜之类的药物。（朱丹溪）
刘河间说：治疗各种痢疾，不如使用辛苦寒性质的药物。苦能燥湿，寒能胜热，使气机宣畅平和罢了。这种说法流传至今，凡治疗痢疾的人，都用寒凉药，都是被这种说法误导了。不论其他，单就“苦能燥湿”这一句话来辨析，就看出其谬误很大了。五味的道理，都出自《内经》。其中有说“以苦燥之”，是说苦味具有燥性。刘河间没有细察，便认为所有苦味都能燥湿，不知道《内经》中说苦味，其性质有两种，其作用有六种。比如说道：火生苦。说：其类属火，其味苦。说：少阳在泉主气化苦，少阴在泉主气化苦。说：湿邪盛于内，用苦热药治疗；燥邪盛于内，用苦温药治疗。这些都是说苦味的阳性属性。又说：酸苦涌泄为阴。说：湿气主令于地，热气反胜，用苦冷药治疗。说：湿气化生于天，热气反胜，用苦寒药治疗。这些都是说苦味的阴性属性。这是说其性质的两种。又说道：用苦味发散，用苦味燥湿，用苦味温中，用苦味坚阴，用苦味泄热，用苦味通便。这是说其作用的六种。所谓苦味发散的，是麻黄、白芷、升麻、柴胡这类药；苦味燥湿的，是苍术、白术、木香、补骨脂这类药；苦味温中的，是附子、干姜、肉桂、吴茱萸这类药；苦味坚阴的，是续断、地榆、诃子这类药；苦味泄热的，是栀子、黄柏、黄芩、黄连、木通、龙胆草这类药；苦味通便的，是大黄、芒硝这类药。气化之道，只有阳气才能燥，只有阴气才能湿，难道像黄连、黄柏这样沉降下降、大苦大寒的药物，还说它们能燥湿，有这样的道理吗？这仅仅是知道“苦燥”这一句话，而不考察“苦发、苦温、苦坚、苦泄、苦下”这五种情况啊！因此导致后人治疗痢疾，大多不分寒热虚实，动不动就用刘河间的方法，等到病情危急时，还说“血色如此，怎么敢用温药？腹痛如此，怎么敢用补药？”至死都不醒悟，实在令人悲哀！（《景岳全书》）
凡是治疗痢疾，一见有表证，必须先解表。如果表证不解，邪气将传入体内，难以治愈。所以发热身疼，邪气在太阳经，用参苏饮；寒热往来，邪气在少阳经，用小柴胡汤；身热、目痛、鼻干、不眠，邪气在阳明经，用葛根汤。必须表邪解除后才不会有传变的祸患。（查了吾）
《内经》提到冬季伤寒，已经称为病热。到了夏秋季节，热、暑、湿三气交蒸，互结的热邪，比冬季多十倍。因外感这三气之热而形成的下痢，必须先从汗法解其外邪，然后调理内部。首先用辛凉药解表，其次用苦寒药清里。如果失于解表，外邪只能从里出，不死不休，所以即使是病程长达百日的久痢，仍要用“逆流挽舟”之法，引导邪气从体表排出，则死证可活，危证可安。《金匮要略》说：下痢脉象反弦，发热出汗的，会自愈。久痢的脉象，深入阴分，已是沉涩微弱的。忽然转为弦脉，全是少阳生发之气，不用逆挽之法，怎么能得到这种脉象？久痢邪气入于阴分，身体必然不热。现在因为逆挽之势，逼迫临时的燥热，一会儿邪气从体表排出，热自然就没有了。久痢阳气下陷，皮肤干涩，绝对没有汗，现在用逆挽之法，卫外的阳气带领邪气一同回到体表而出汗，因此腹中安静，病也就自愈了。又有突然感受暑湿毒邪，水谷倾囊而出，一昼夜排便七八十次，大渴引水自救，这是肠胃被热毒攻击，顷刻腐烂，再用逆挽之法，就太迂腐了！太远了！这时应从《内经》“通因通用”的方法，使用大黄、黄连、甘草，一昼夜连续服用几十杯，等待其利渴之势稍缓，才开始内部平调，更不必强行挽之于外。因为邪气如决堤之水转动巨石，乘着势头排尽，无法挽回。还有“急开支河”一法，邪热在体内的，奔迫于大肠，必然郁结于膀胱，膀胱热结，则气化不行而小便短赤，不顺导而用逆挽，也不是好办法。清利膀胱之热，令气化运行而分消热势，就非常快捷了。仲景说下利气者，当利其小便。不就是急开支河的意思吗？然而水出高源，肺不热则小便自行，肺与大肠相表里，大肠之热，皆因肺热转移所致，尤其应当先清肺的化源。《金匮要略》有下利伴肺痛的，用紫参汤主治；气利，用诃黎勒散主治。后人怀疑这不是仲景的方子，怎知肠胃有病，所关联的全在于肺。又可见肺气不通而痛，则急需通其壅塞，大肠之气下坠而逼迫，则缓缓调适其状态。○再按：治疗疟疾的方法，应当从少阳经进退其间；那么痢疾的表证，也应当从少阳半表半里的方法，缓缓逆挽其下陷的清气，使身体中行春夏的生发之令，不至于收降。归根结底也是和法，完全不是发汗的意思。津液未受伤的，出汗无妨；津液已伤的，皮间微微湿润，其下陷之气已举起。这难道是太阳外感风寒，可以正发汗相比的吗？这难道是太阳阳明合病下利，可以用葛根汤相比的吗？唉！微妙啊！（喻嘉言）
痢证古名滞下，夏秋季节暑湿挟带积滞的居多，其次是风淫、火迫、寒侵，燥气独不为患。至于暑分阴阳，必定兼乎湿。阴暑是由于人的阳气先亏，加上贪凉喜冷，郁折生阳，所以主治以温；阳暑是由于天的热伏，阻气化浊，则重于清。但邪气来袭，似水流淌，脏腑间一旦有缝隙，就乘虚而入附着，所以有在气分、在血分的区别，伤脏、伤腑的差异。若表邪郁结，而气机下流不息的，喻氏论用人参败毒散；里的积滞壅塞而寒热交粘的，洁古立芍药汤。在气分，有苦辛调气与辛甘益气等方法；在血分，有酸苦行血及咸柔养血诸方。若表证急，从乎三阳经，有桂枝汤、葛根芩连汤、小柴胡汤；里势实，专究脾胃，有小承气汤、温脾汤。总之，治腑以三焦见证为依据，治脏以足三阴经为要领，辨明虚实之情，斟酌以通涩之法。这个病最难治愈的，莫过于休息痢，攻补的方法不止一种。最危险的，莫过于噤口痢，却有两端：若因暑湿邪气充塞，格拒三焦的，气机皆逆传而闭，上下之势，浑然如两截，治疗不得要领，则邪无出路，正气立刻消亡。丹溪立法最高，后世都尊崇他的宗旨。先生又借用半夏泻心汤，减去守中之品，取补以运之，辛以开之，苦以降之。又因脾肾之阳素虚，阴邪从中而下的，先伤太阴，继伤少阴，关闸大开，痛泄无度，戊癸（脾胃）少化火之机，命门之火无蒸变之力，这不饥不食，为呕为胀，理所当然。这与邪多积热之候不同。参考仲景理中汤、肾气丸，及景岳理阴煎、胃关煎等法，又以大剂肉苁蓉配入人参、当归、干姜、附子、肉桂、制白芍之类，较地黄、阿胶尤胜，与之肠膏竭尽，络脉结涩而痛的，堪称神品。○古贤治疗痢疾，不外乎通、涩二法，大都新痢宜通，久痢宜涩。○滞下之“滞”字，并非停滞饮食，而是说暑湿内侵，腑中流行阻遏而为滞耳。（《临证指南医案》）
王损庵认为种种痢疾，总由湿热入胃。这一句便可领悟病形了。痢疾腹痛，必定是绕脐以下，正当小肠的分野；小肠无毒，则糟粕得循其正道，虽然曲折顺下无碍；唯有脓血则不得循其正道而不肯下，所以痛也。小便不利者，小肠为毒邪所迫，不能分利，所以短缩。噤口痢，乃是毒瓦斯原盛，或破药太过，挟伤上中二脘宗气，毒邪乘虚而上逆也。（《己任编》）
治疗痢疾的大法，开始应当推荡（攻下），日久应当温补，而尤其应当以顾护胃气为主。盖百病以胃气为本，而对于痢疾尤为重要。所以能食的轻，不能食的重，绝不食的死的。痢疾依赖胃气，竟到如此重要的地步。○泄泻与痢疾，不分两证，混言湿热而利小便，是不对的。盖淡渗功能利水，浊流得快，则泻自止。若痢疾乃垢秽之物，因于湿热，肠胃怫郁而成，出于大肠传送之道，故不宜过用渗利之药，重竭其阳而涸其津液，这是病势向下而药势又向下啊。○凡是治疗滞下与滑泄不同。滑泄有可涩之道，所以古人有用粟壳、诃子以止其滑。若滞下，本属湿热涩滞，法宜疏利，最忌兜涩。大肠为肺之腑，大肠既有湿热留滞，则肺家亦必有郁滞不清，古人用药，每利肺气，知其性喜通利，清脏以及腑也。倘误用兜涩，则湿热无所宣泄，肺气不得下行，非惟痢疾增剧，且恐湿热熏蒸，上干乎肺，则胀满、气逆、不眠、恶食诸证至矣。（《冯氏锦囊秘录》）
古人治疗痢疾，多用坠下之品，所谓通因通用，法非不善。然而有效者一半，无效者一半。那些无效的，往往缠绵难愈，或呕逆不食而成败证。仔细揣摩，偶见烛光，恍然有得，因而思考火性炎上，何以降于肠间而为痢？良由积热在中，或为风寒所闭，生冷所遏，致火气不得舒伸，逼迫于下。医者更用下坠之药，则降者愈降，而痢愈甚矣。因此制成治痢散以治痢证初起，方用葛根为君，鼓舞胃气上行；陈茶、苦参为臣，清湿热也；麦芽、山楂为佐，消宿滞也；赤芍、广皮为使，所谓行血则便脓自愈，调气则后重自除也。惟于腹中胀满拒按者，此有宿食，更佐以朴黄丸下之。若日久脾虚，食少痢多者，五味异功散加白芍、香连清而补之。若气虚下陷者，补中益气汤升提之；若邪热秽气塞于胃脘，呕逆不食者，开噤散启之；若久痢变为虚寒，肢冷脉微，饮食不消者，附子理中汤加肉桂温之。（程钟龄）
痢之为证，多本脾肾。脾司仓廪，土为万物之母；肾主蛰藏，水为万物之原。二脏皆根本之地，投治稍有不慎，冤沉幽冥。究其疵误，皆寒热未明，虚实不辨也。晚近不足论，即在前贤，颇有偏僻，如《局方》与复庵，例行辛热；河间与丹溪，专用苦寒。何其执而不圆，相去天壤耶？夫痢起夏秋，湿蒸热郁，本乎天也；因热求凉，过吞生冷，由于人也。气壮而伤于天者，郁热居多；气弱而伤于人者，阴寒为甚。湿土寄旺四时，或从于火，则阳土有余，而湿热为病，《经》所谓敦阜是也。或从于水则阴土不足，而寒湿为病，《经》所谓卑监是也。言热者遗寒，言寒者废热，岂非立言之过乎？至以赤为热、白为寒，亦非确论。果尔，则赤白相兼者，岂真寒热同病乎？必以见证与色脉辨之，而后寒热不淆也。须知寒者必虚，热者必实，更以虚实细详之，而寒热愈明矣。胀满恶食，急痛惧按者，实也；烦渴引饮，喜冷畏热者，热也。脉强而实者，实也；脉数而滑者，热也。外此则靡非虚寒矣。而相似之际，尤当审察。如以口渴为实热，似矣；不知凡系泻痢，必亡津液，液亡于下，则津涸于上，安得不渴？更当以喜热、喜冷分虚实也。以腹痛为实热，似矣；不知痢出于脏，肠胃必伤，脓血剥肤，安得不痛？更当以痛之缓急、按之可否、脏之阴阳、腹之胀与不胀、脉之有力无力分虚实也。以小便之黄赤短少为实热，似矣；不知水从痢去，溲必不长，液以阴亡，溺因色变，更当以便之热与不热、液之涸与不涸、色之泽与不泽分虚实也。以里急后重为实热，似矣；不知气陷则仓廪不藏，阴亡则门户不固，更当以病之新久、质之强弱、脉之盛衰分虚实也。至于治法，须求何邪所伤？何脏受病？如因于湿热者，去其湿热；因于积滞者，去其积滞。因于气者调之；因于血者和之。新感而实者，可以通因通用；久病而虚者，可以塞因塞用。独怪世之病痢者，十有九虚，而医之治痢者，百无一补。气本下陷，而再行其气，后重不益甚乎？中本虚衰，而复攻其积，元气不愈竭乎？湿热伤血者，自宜调血，若过行推荡，血不转伤乎？津亡作渴者，自宜止泄，若但与渗利，津不转耗乎？世有庸工，专守痛无补法，不知因虚而痛者，愈攻则愈虚愈痛矣。请以宜补之证悉言之∶脉来微弱者可补；形色虚薄者可补；疾后而痢者可补；因攻而剧者可补。然而尤有至要者，则在脾肾两脏。如先泻而后痢者，脾传肾，为贼邪，难疗；先痢而后泻者，
[Scriptural Principles]
The Yellow Emperor asked: What is the prognosis for dysentery with bloody stools? Qibo replied: If the body is hot, the prognosis is poor (death); if the body is not hot, the prognosis is good (survival). The Yellow Emperor asked: What is the prognosis for dysentery with white mucus? Qibo replied: If the pulse is deep, the prognosis is good (survival); if the pulse is floating, the prognosis is poor (death).
The Yellow Emperor asked: What is the prognosis for dysentery with pus and blood? Qibo replied: If the pulse is suspended and severed (extremely weak or rootless), the prognosis is poor (death); if the pulse is slippery and large, the prognosis is good (survival). The Yellow Emperor asked: What if the body is not hot and the pulse is not suspended and severed? Qibo replied: A slippery and large pulse indicates survival; a suspended and choppy pulse indicates death. One can predict the time of death based on the cycle of the Zang organs. ○ If the Spleen pulse beats outwardly and is deep, it indicates dysentery, which will heal itself after a long time. If the Liver pulse is small and slow, it indicates dysentery, which is easy to treat. If the Kidney pulse is small, bounding, and deep, it indicates dysentery with bloody stools; if the blood is warm and the body is hot, the prognosis is poor (death). ○ Pathologies of the Heart and Liver meridians may also present with bloody stools; if both Zang organs are diseased simultaneously, it is treatable. If the pulse is small, deep, and choppy, indicating dysentery, and the body is hot, the prognosis is poor (death). ○ When both Yin and Yang are deficient, dysentery leads to death. ○ When Kidney heat transfers to the Spleen, transforming into a deficiency syndrome, dysentery leads to death. (From *Su Wen*)
[Philosophical Statements]
Dysentery is classified into red dysentery, white dysentery, red-and-white dysentery, water-and-grain dysentery, pus-and-blood dysentery, Jin Kou dysentery (inability to eat/drink), Xiu Xi dysentery (intermittent/recurrent), Wind dysentery, Cold dysentery, Heat dysentery, Dampness dysentery, Qi dysentery, Deficiency dysentery, Slippery dysentery, Accumulation dysentery, Chronic dysentery, Epidemic dysentery, Worm/Zhu dysentery, and Five-Color dysentery. (From *Dong Yi Bao Jian*)
Commentary: The condition known as "Zhi Xia" (dysentery/stagnant discharge) was historically discussed together with diarrhea by ancient physicians. It was only in the *San Yin Fang* that it was established as a separate category. Diseases acquired from external pathogens require differentiation according to the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Once the exterior is injured and the intestines and stomach become stagnant, treatment must be adjusted according to their cold, heat, warmth, or coolness. Diseases arising from internal organ dysfunction interfering with the intestines and stomach require identifying which Zang organ is involved and treating to restore balance. Diseases caused by dietary irregularities require identifying the specific food injury and using digestion-promoting or purgative methods. However, diseases have excess and deficiency patterns, and treatment has a sequence. If the pathogenic qi arrives suddenly and the Yuan Qi is strong, with stubborn accumulation, purgation is appropriate; if the disease is chronic leading to Qi collapse, with weak and slipping intestines and stomach, warming and astringing are appropriate. Generally, one warms when suitable, purges when suitable, releases the exterior, or promotes urination, distinguishing between interior/exterior locations and combinations with Wind, Heat, or Cold. Pus and blood being red or white distinguishes between Qi-level and Blood-level diseases; tenesmus and abdominal urgency distinguish between Qi/Blood excess/deficiency, which must be carefully observed. (Liu Zongnong)
Treatment methods for dysentery: For exterior conditions, use sweating; for interior conditions, use purging; for upper conditions, use emesis; for lower conditions, use draining or securing; for surface heat, use dispersing; for difficult urination, use promoting diuresis; for excess conditions, use harmonizing to remove the pathogen; for depletion, use astringing. (Zhang Jiegou)
In treating dysentery, harmonize the Blood without damaging it, and regulate the Qi without breaking it. (*Ren Zhai Zhi Zhi Fang*)
Tenesmus (heavy sensation in the rectum) is suitable for purging; abdominal pain is suitable for harmonizing; heavy body requires removing dampness; wiry pulse requires dispelling wind; internal binding of Wind evil requires sweating; cold body with spontaneous sweating requires warming; thick and sticky pus and blood require heavy doses to drain them. (Liu Hejian)
Liu Hejian elucidated the syndrome and treatment of "Zhi Xia" (dysentery), which is particularly crucial. Harmonizing the Blood makes pus in stool heal spontaneously; regulating the Qi removes tenesmus spontaneously. These two statements are like the sun and moon for the blind, and thunder for the deaf. ○ Someone asked: Liu Hejian's discussion on dysentery seems to lack mention of combined deficiency or cold. I reply: In diarrhea and loose stools, food and water may or may not digest, but there is no tenesmus. Dysentery is different; it presents with pus, blood, intestinal mucus, or undigested matter. Whether painful or not, all feature tenesmus and distress, belonging to Excess-Heat syndromes. In recent clinical experience, there are also Deficiency-Cold cases, such as treating my cousin Lou Changguan, using Ginseng, Atractylodes, and dried Ginger. (Zhu Danxi)
Liu Hejian stated: To treat various dysenteries, nothing is better than bitter, pungent, and cold herbs. Bitterness dries dampness, cold overcomes heat, thereby making the Qi flow smoothly. This theory has been passed down, causing all dysentery treatments to use cold-cooling herbs, which is a mistake derived from this theory. Let us analyze just the phrase "bitterness dries dampness" to see its great flaw. The principles of the five flavors come from the *Nei Jing*. It says "use bitterness to dry," referring to the drying nature of bitterness. Liu Hejian failed to observe this, assuming all bitter herbs dry dampness. He did not know that the *Nei Jing* states bitterness has two natures and six functions. For example: Fire generates bitterness. Its class is Fire, its flavor is bitter. Shaoyang in the泉 position transforms into bitterness; Shaoyin in the quan position transforms into bitterness. Dampness overflowing internally is treated with bitter-hot; Dryness overflowing internally is treated with bitter-warm. These refer to the Yang aspect of bitterness. Sour and bitter inducing vomiting and purging are Yin. Dampness ruling the earth with counteracting Heat is treated with bitter-cold. Dampness transforming from heaven with counteracting Heat is treated with bitter-cold. These refer to the Yin aspect of bitterness. Thus, two natures. Also: Use bitterness to disperse, dry, warm, firm, drain, and purge. These are the six functions. Bitter-dispersing includes Ephedrae Herba (Mahuang), Angelicae Dahuricae Radix (Baizhi), Bupleuri Radix (Chaihu), and Cimicifugae Rhizoma (Shengma). Bitter-drying includes Atractylodis Macrocephalae Rhizoma (Cangzhu), Atractylodis Rhizoma (Baizhu), Aucklandiae Radix (Muxiang), and Psoraleae Fructus (Buguzhi). Bitter-warming includes Aconiti Lateralis Radix Praeparata (Fuzi), Zingiberis Rhizoma (Ganjiang), Cinnamomi Cortex (Rougui), and Evodiae Fructus (Wuyu). Bitter-firming includes Dipsaci Radix (Xuduan), Sanguisorbae Radix (Diyu), and Terminalia Chebulae Fructus (Hezi). Bitter-draining includes Gardeniae Fructus (Zhizi), Phellodendri Cortex (Huangbai), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Akebiae Caulis (Mutong), and Gentianae Radix (Longdancao). Bitter-purging includes Rhei Radix et Rhizoma (Dahuang) and Natrii Sulfas (Mangxiao). The way of Qi transformation is that only Yang dries, and only Yin moistens. How can sinking, descending herbs like Coptidis Rhizoma (Huanglian) and Phellodendri Cortex (Huangbai), which are extremely bitter and cold, be said to dry dampness? Is this logical? They only know "bitter dries" and ignore the other five functions: bitter-dispersing, bitter-warming, bitter-firming, bitter-draining, and bitter-purging! This causes later generations to treat dysentery without distinguishing cold/heat or excess/deficiency, blindly applying Liu Hejian's method. By the time patients are critical, they say, "The blood looks like this, how dare I use warming?" "The abdomen hurts like this, how dare I use tonification?" Dying without awakening is deeply lamentable! (*Jing Quan Shu*)
In treating dysentery, if exterior symptoms appear, release the exterior first. If the exterior is not resolved, the pathogen will transmit inward, making cure difficult. Thus, fever and body ache indicate pathogen in Taiyang; use Shen Su Yin. Alternating chills and fever indicate pathogen in Shaoyang; use Xiao Chai Hu Tang. Fever, eye pain, dry nose, and insomnia indicate pathogen in Yangming; use Gegen Tang. Only after resolving exterior pathogens is there no risk of transmission. (Cha Liaowu)
The *Nei Jing* mentions that winter cold damage already involves heat. By summer and autumn, Heat, Summerheat, and Dampness steam and mix, creating heat ten times greater than in winter. Lower dysentery caused by external Heat, Summerheat, and Dampness must first be resolved via sweating from the exterior, then the interior regulated. First use acrid-cool herbs to release the exterior, then bitter-cold herbs to clear the interior. If exterior release is missed, the external pathogen can only exit from the interior, refusing to cease until death. Therefore, even for chronic dysentery lasting a hundred days, one should still use the "Rowing Upstream Against the Current" (Ni Liu Wan Zhou) method to guide the pathogen out through the exterior, turning death into life and danger into safety. The *Jin Gui Yao Lue* states: Dysentery with a wiry pulse, fever, and sweating will heal spontaneously. The pulse of chronic dysentery has entered the Yin level, becoming deep, choppy, and weak. A sudden shift to a wiry pulse indicates the generating Qi of Shaoyang. Without the reverse-warding method, how could this occur? Chronic dysentery with pathogen in Yin usually lacks fever. Now, due to the reverse-warding momentum, temporary dry heat is forced out; soon the pathogen exits via the exterior, and the heat disappears. Chronic dysentery causes Yang Qi to sink, skin becomes dry, and sweating is impossible. The reverse-warding method leads the defensive Yang and pathogen back to the exterior to sweat, calming the abdomen and healing the disease. However, sudden exposure to Summerheat-Dampness toxin causing massive watery diarrhea (70-80 times/day) with extreme thirst indicates intestinal rotting from heat toxin. Using the reverse-warding method here is too slow and inappropriate. Instead, follow the *Nei Jing*'s "Treat obstruction with unblocking" (Tong Yin Yong Tong) method: use Rhei Radix et Rhizoma (Dahuang), Coptidis Rhizoma (Huanglian), and Glycyrrhizae Radix et Rhizoma (Gancao), administering dozens of cups in a day. Wait for the intense diarrhea and thirst to subside, then regulate the interior. Do not attempt to ward it out externally, as the pathogen flows like bursting water and rolling stones, exhausting itself naturally. Another method is "Urgently Opening Side Channels": Internal heat rushing to the Large Intestine stagnates in the Bladder. Bladder heat stagnation prevents Qi transformation, causing short, red urine. Using reverse-warding instead of guiding downward is ineffective. Clearing Bladder heat allows Qi transformation and dissipates heat quickly. Zhang Zhongjing said for dysentery with Qi disturbance, promote urination. Isn't this opening side channels? Water originates from the Lung source. If the Lung is not hot, urination proceeds normally. Lung and Large Intestine are exterior-interior pairs; Large Intestine heat often stems from Lung heat transfer, so clearing the Lung source is priority. The *Jin Gui* mentions dysentery with lung pain, treated with Zi Shen Tang; Qi dysentery, treated with Helile San. Later generations doubted these were not Zhang Zhongjing's formulas, failing to realize that intestinal diseases relate entirely to the Lung. When Lung Qi is blocked causing pain, urgently unblock the congestion; when Large Intestine Qi sinks causing pressure, slowly regulate comfort. ○ Further note: Treating malaria should advance and retreat via Shaoyang. Similarly, the exterior aspect of dysentery should use the Shaoyang half-exterior/half-interior method to slowly reverse-ward the sinking clear Qi, allowing the body to maintain Spring-Summer generating functions rather than contracting. Ultimately, this is a harmonizing method, not sweating. If fluids are intact, sweating is harmless; if fluids are damaged, slight moisture suffices to lift sinking Qi. This is not comparable to Taiyang exterior Wind-Cold requiring strong sweating, nor Taiyang-Yangming combined disease dysentery using Gegen Tang. Ah! Subtle indeed. (Yu Jiayan)
Dysentery, anciently named "Zhi Xia," is mostly caused by Summerheat-Dampness with accumulation in summer/autumn, followed by Wind, Fire, and Cold; Dryness alone does not cause it. Summerheat has Yin and Yang aspects, always involving Dampness. Yin Summerheat arises from pre-existing Yang deficiency plus cold indulgence, suppressing Yang generation, thus treated with warming. Yang Summerheat arises from heavenly heat obstructing Qi transformation, thus treated with cooling. Pathogens enter like flowing water, lodging where organs have gaps, affecting Qi or Blood, Zang or Fu. If exterior pathogen stagnates causing continuous downward Qi flow, Yu's Ren Shen Bai Du San applies. If internal accumulation binds with mixed cold/heat, Jiegou's Shao Yao Tang applies. In the Qi level, use bitter-pungent Qi regulation or acrid-sweet Qi tonification. In the Blood level, use sour-bitter Blood moving or salty-soft Blood nourishing. If exterior symptoms are urgent, involve the Three Yangs: Guizhi Tang, Gegen Qinlian Tang, Xiao Chai Hu Tang. If interior excess is solid, focus on Spleen/Stomach: Xiao Chengqi Tang, Wen Pi Tang. In summary, treat Fu organs based on Sanjiao manifestations, treat Zang organs focusing on the Three Foot Yin meridians, differentiate excess/deficiency, and choose unblocking/astringing methods. The hardest to cure is Xiu Xi dysentery (recurrent), requiring varied attack/tonify methods. The most dangerous is Jin Kou dysentery (inability to eat), having two types: If Summerheat-Dampness blocks the Sanjiao, Qi reverses and closes, separating upper and lower. Poor treatment leaves no path for pathogens, destroying Zheng Qi. Danxi's legislation is supreme, followed by later generations. The author borrows Ban Xia Xie Xin Tang, removing stabilizing herbs, using tonification to move, pungency to open, bitterness to descend. If Spleen/Kidney Yang is deficient, Yin evil descends, injuring Taiyin then Shaoyin, opening gates wide with painful diarrhea. Spleen/Stomach fire mechanism is weak, Mingmen steaming power is lost, causing anorexia, vomiting, distension. This differs from excess heat/toxin. Reference Zhang Zhongjing's Lizhong Tang, Shenqi Wan, Jingyue's Liyin Jian, Weiguan Jian. Add large doses of Cistanche Herba (Rongsu) with Ginseng, Angelicae Sinensis Radix (Danggui), Ginger, Aconite, Cinnamon, processed White Peony. This surpasses Rehmannia and Donkey-hide Gelatin for exhausted intestinal essence and knotted collaterals. ○ Ancient sages treated dysentery with only unblocking or astringing: new dysentery needs unblocking, chronic needs astringing. ○ "Zhi" (stagnation) in Zhi Xia does not mean food stagnation, but Summerheat-Dampness invading and blocking intestinal circulation. (*Lin Zheng Zhi Nan*)
Wang Sun'an attributed all dysenteries to Damp-Heat entering the Stomach. This single sentence reveals the pathology. Dysentery abdominal pain occurs below the umbilicus, in the Small Intestine region. If the Small Intestine is free of toxin, waste follows the normal path, curving down without obstruction. Pus and blood cannot follow the normal path and refuse to pass, causing pain. Difficult urination occurs because the Small Intestine is pressured by toxic pathogens, unable to separate and diffuse, leading to scant urine. Jin Kou dysentery occurs when toxin vapors are excessive or medicines are too harsh, injuring the Zong Qi of the Upper/Middle Jiao, allowing toxic pathogens to reverse upward. (*Ji Ren Bian*)
General rules for treating dysentery: Initially push away (purge), later warm and tonify, but primarily protect Stomach Qi. All diseases depend on Stomach Qi, especially dysentery. Those who can eat are mild; those who cannot eat are severe; those who absolutely cannot eat die. Dysentery relies heavily on Stomach Qi. ○ Diarrhea and dysentery are distinct; mixing them and treating Damp-Heat by promoting urination is incorrect. Diaphoretic/drainage herbs promote water flow; if turbid flow clears, diarrhea stops. But dysentery involves foul matter formed by Damp-Heat stagnating in intestines, exiting via Large Intestine transmission. Overusing drainage herbs exhausts Yang and dries fluids, compounding the downward trend of disease and medicine. ○ Treating Zhi Xia differs from Slippery Diarrhea. Slippery diarrhea can be astringed (using Poppy Shell, Chebula); Zhi Xia is inherently Damp-Heat stagnation, requiring draining/unblocking, strictly avoiding astringents. Large Intestine is the Fu organ of the Lung. If Large Intestine has Damp-Heat stagnation, Lung Qi must also be stagnant. Ancients used herbs to benefit Lung Qi, knowing it prefers free flow, clearing Zang to benefit Fu. Mistaken astringing traps Damp-Heat, prevents Lung Qi descent, worsening dysentery and potentially causing Lung invasion with distension, Qi reversal, insomnia, and anorexia. (*Feng Shi Jin Nang*)
Ancients used descending/purgative herbs for dysentery, following "Treat obstruction with unblocking." The method is sound, but efficacy is split. Ineffective cases become chronic or lead to vomiting/refusal to eat (failure syndrome). Reflecting on this, I realized Fire rises; why does it descend to intestines causing dysentery? Due to accumulated heat in the middle, closed by Wind-Cold or suppressed by raw/cold foods, preventing Qi expansion, forcing it downward. Physicians using descending herbs make it worse. Thus, I formulated Zhi Li San for early dysentery: Gegen Tang (Puerariae Radix) as Sovereign to boost Stomach Qi upward; Chen Cha (Aged Tea), Kushen (Sophorae Flavescentis Radix) as Ministers to clear Damp-Heat; Maiya (Hordei Fructus Germinatus), Shanzha (Crataegi Fructus) as Assistants to digest old accumulation; Chi Shao (Paeoniae Radix Rubra), Guangpi (Citri Reticulatae Pericarpium) as Envoys: "Move Blood, pus heals; Regulate Qi, tenesmus resolves." For abdominal fullness/rejection of pressure (old food accumulation), add Puhuang Wan to purge. For chronic Spleen deficiency with little food/much dysentery, use Wuwei Yigong San + Baishao, Xianglian to clear and tonify. For Qi sinking, use Buzhong Yiqi Tang to lift. For heat/toxicity blocking Stomach with vomiting, use Kaijin San to open. For chronic dysentery turning Deficiency-Cold with cold limbs/thready pulse, use Fuzi Lizhong Tang + Rougui to warm. (Cheng Zhongling)
Dysentery roots in Spleen and Kidney. Spleen stores grain, Earth is mother of all; Kidney stores essence, Water is origin of all. Both are fundamental. Misdiagnosis leads to tragedy. Errors stem from unclear Cold/Heat and unverified Excess/Deficiency. Recent physicians vary, but even ancients had biases: *Ju Fang* and Fu An used acrid-hot; Hejian and Danxi used bitter-cold. How rigid and divergent! Dysentery arises in Summer/Autumn from Heaven's Damp-Heat steaming; humans exacerbate by seeking coolness/eating raw/cold. Strong constitutions injured by Heaven have much郁热 (stagnant heat); weak constitutions injured by humans have much Yin Cold. Wet Earth exists in all seasons. Following Fire yields Yang Earth excess (Damp-Heat, "Dunfu"); following Water yields Yin Earth deficiency (Cold-Damp, "Beijian"). Emphasizing heat ignores cold; emphasizing cold ignores heat. Claiming Red=Heat, White=Cold is inaccurate. If so, mixed red/white implies simultaneous Cold/Heat? Must differentiate by symptoms and pulse-color. Know: Cold implies Deficiency, Heat implies Excess. Detail Excess/Deficiency to clarify Cold/Heat. Distension, aversion to food, acute pain fearing pressure = Excess. Restlessness/thirst, preference for cold/fear of heat = Heat. Strong/solid pulse = Excess. Rapid/slipping pulse = Heat. Otherwise, it is Deficiency-Cold. Similarities require care. Thirst suggests Excess-Heat, but diarrhea/dysentery loses fluids, drying upper Jiao, causing thirst. Differentiate by preference for hot/cold. Abdominal pain suggests Excess-Heat, but dysentery injures Zang/intestines, peeling flesh, causing pain. Differentiate by pain severity, pressure tolerance, Zang/Yin-Yang, abdominal distension, pulse strength. Dark/scanty urine suggests Excess-Heat, but fluid loss reduces urine volume/color change. Differentiate by urine temperature, fluid status, color luster. Tenesmus suggests Excess-Heat, but Qi sinking fails to store, Yin loss fails to secure gates. Differentiate by disease duration, constitution strength, pulse vigor. Treatment: Identify pathogen and affected Zang. Remove Damp-Heat or accumulation. Regulate Qi, harmonize Blood. New Excess can use "Treat obstruction with unblocking"; Chronic Deficiency can use "Treat blockage with sealing." Strange that 9/10 dysentery patients are Deficient, yet doctors rarely tonify. Qi is already sinking; moving Qi worsens tenesmus. Middle is already weak; attacking accumulation exhausts Yuan Qi. Damp-Heat injuring Blood needs harmonizing; over-purging damages Blood. Fluid loss causing thirst needs stopping diarrhea; promoting urination consumes fluids. Quacks stick to "No tonification for pain," not knowing deficiency pain worsens with attack. List indications for tonification: Weak pulse, deficient appearance, post-fever dysentery, aggravated by attack—all need tonification. Crucially, focus on Spleen/Kidney. Diarrhea followed by dysentery: Spleen transmits to Kidney, "Thief Evil," hard to treat. Dysentery followed by diarrhea: