又曰∶小儿慢脾风，痰饮阻塞窍隧，星附六君汤以醒之。老人肾虚水泛，痰饮上涌，崔氏八味丸以
摄之。若脾胃虚寒，饮食不思，阴气痞塞，呕吐涎沫者，宜温其中。真阳虚者，更补其下。然热痰乘风火
上入，目暗耳鸣，多似虚证，误行温补，转锢其痰，永无出路，医之过耳。
刘宗浓曰∶滞下之病，皆由肠胃日受饮食之积余不尽，留滞于内，湿蒸热淤，郁结日深，伏而不作，
时逢炎暑大行，相火司令，又调摄失宜，复感酷热之毒，至秋阳气始收，火气下降，蒸发蓄积，而滞下之
证作矣。以其积滞之滞行，故名之曰滞下。其湿热积淤，干于血分则赤，干于气分则白，赤白兼下，气血俱
受邪矣。久而不愈，气血不运，脾积不磨，陈
积脱滑，凝若鱼脑矣。甚则肠胃空虚，关门失守，浊液并流，色非一类，错杂混下，状如豆汁矣。
脾气下陷，虚坐努力，便出色如白脓矣。其热伤血深，湿毒相淤，粘结紫色，则紫黑矣。其污浊积而欲出，
气滞而不与之俱出，所以下迫窘痛，后重里急，圊不能便，起止不安，此皆大肠经有所壅遏，窒碍不得宣
通故也。
尝见世方一偏，妄用兜涩，下以巴 ，或指湿热，与以淡渗，非其治矣。长沙论云∶痢之可下者，
悉用大黄之剂；可温用者，是姜附之类。河间亦言∶后重则宜下，腹痛则宜和，身重则除湿，脉弦则去风，
脓血稠粘以重药竭之，身冷如汗以重药导之，风邪内蓄宜汗之，骛溏为痢当温之，在表者汗之，在里者下之
，在上者涌之，在下者竭之，身表热内疏之，小便涩者分利之。用药轻重之别，又加详载。行血则便脓自
愈，调气则后重自除。而丹溪又谓∶有大虚大寒者，法当温补。观此治法，讵可胶柱鼓瑟？
又有胃弱而闭不食，此名噤口痢。内格呕逆，火起上炎之象。此则胃虚木火乘之，是土败木贼也，
多成危候。
李士材曰∶治痢之法，庸工谓痛无补法，是以百无一补。而世之病痢者，十有九虚，请悉言之。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？且曰直待痛止方补，不知因虚而痛者，
愈攻则愈虚，愈虚则愈痛矣。此皆本末未明，据有形之疾病，不思无形之元气也。是故脉来微弱者可补，形
色虚薄者可补，疾后而痢者可补，因攻而剧者可补。尤有至要者，则在脾肾两脏，如先泄而后痢者，脾传肾，
为贼邪，难治；先痢而后泄者，肾传脾，为微邪，易治。是知在
脾者病浅，在肾者病深。肾为胃关，未有久痢而肾不损，故治痢不知补肾，非其治也。凡四君、归脾、
十全、补中，皆补脾虚，未尝不善。若病在火衰，土位无母，设非桂附大补命门，以救脾家之母，则饮食
何由而进，门户何由而固哉？后重，有邪迫而后重者，至圊稍减，未几复甚；虚滑而后重者，圊后不减，
以得解愈虚故也。下后仍后重者，当甘草缓之，升麻举之。
噤口，食不得入，到口即吐。有邪在上膈，火气冲逆者，黄连、木香、桔梗、橘红、茯苓、菖蒲；
有胃虚呕逆者，治中汤；有阳气不足宿食未消者，理中汤加砂仁、木香、陈皮、豆蔻；有肝气呕吐者，
木香、黄连、茱萸、青皮、芍药之类；有积秽在下恶气熏蒸者，承气汤，石莲为末，陈米汤调下。石
莲即莲子之老者，市中皆木莲，不可用。丹溪用人参、黄连，浓煎，加姜汁，细细呷之。但得一呷下咽便开。
不治症
下纯血者死，如屋漏水者死，大孔如筒者死，唇若涂朱者死，发热不休者死。色如鱼脑、如猪肝半死
半生，脉细、皮寒、气少、前后泄痢、饮食不入，是谓五虚，死。惟用参附，十可救一。
喻嘉言曰∶治疟之法，当从少阳；治痢之表，法亦当从于少阳，盖水谷之气，由胃入肠，疾趋而下，
始焉少阳生发之气不伸，继焉少阳生发之气转陷，故泛而求之阳明，不若专而求之少阳。俾苍天清净之气，
足以升举，物产之味，自然变化精微，输泄有度，而无下痢奔迫之苦矣。况两阳所藏之精液，既以下泄，尤
不可更发其汗。在伤寒经禁，明有阳明禁汗之条，而《金匮》复申下痢发汗之禁，所以当从少阳半表之法，
缓缓逆挽其下陷之清气，俾身中行春夏之令。究
竟亦是和法，其下陷之气已举矣。
凡先泄后痢者逆也，复通之而不已者虚也。脉微迟宜温补。脉弦数为逆，主死。产后痢亦宜温补。
腹痛因肺金之气郁于大肠之间者，以苦梗发之，后用痢药。肛门痛，热留于下也。初病身热，脉洪大，
宜清之，黄芩芍药汤。病久身冷自汗，宜温之，理中汤。下血者，宜凉血活血，当归、黄芩、桃仁之类。
风邪陷下者，宜升提之。湿热伤血者，宜行湿清热。下坠异常，积中有紫黑血，而且痛甚者，此为死血，
用桃仁、滑石行之。血痢久不愈者，属阳虚阴脱，用八珍汤加升举之药。甚有阵阵自下，手足厥冷，脉渐
微缩，此为元气欲绝，急灸气海，用附子理中汤，稍迟无救。久痢血，脉沉弱，诸药不效，十全大补加姜
枣入蜜煎服。
治痢有标本先后∶以肠胃论，大肠为标，胃为本；以经脉论，手足阳明为标，少阳相火为本。故胃受
湿热，水谷从少阳之火化，变为恶浊，传入于大肠，不治少阳，但治阳明，无益也。少阳生发之气，传入土
中，因而下陷，不先以辛凉举之，而以苦寒夺之，痢无止期矣。且病情有虚实，实者邪气实，虚者正气虚也。
七实三虚，攻邪为先；七虚三实，扶正为本。十分实邪，即为壮火食气，无正可扶，急去其邪，以留其正；
十分虚邪，即为奄奄一息，无实可攻，急补其正，听邪自去可耳。
王节斋曰∶痢是湿热、食积，治者别五色以属五脏，白者伤气分，赤者伤血分，赤白相杂气血俱伤，黄
者食积。治法，泄肠胃之湿热，开郁结之气，消化积滞，通风通用。其初只是下之，下后未愈，随证调之。
痢稍久者，不可下，胃虚故也。痢多属热，亦有虚与寒者。虚者宜补，寒者宜温，年老人及虚弱者不宜下。
主方∶黄芩、黄连、白芍（此三味痢
疾必用之药）、木香、枳壳、槟榔、炙甘草。
若腹痛，加当归、砂仁，再加木香、芍药。
若后重，加滑石，再加枳壳、槟榔、白芍、生用条芩。
若白痢，加白术、茯苓、滑石、陈皮。初欲下之，加大黄。兼食积，加山楂、枳实。
若红痢，加当归、川芎、桃仁。初欲下之，加大黄。
若红白相杂，加川芎，当归、桃仁以理血，滑石、陈皮、苍术以理气，有食积亦加山楂、枳实。
若白痢久，胃弱气虚，或下后未愈，减芩、连、芍，加白术、黄 、茯苓、陈皮、砂仁，再加炙干姜。
若红痢久，胃气弱血虚，或下后未愈，减芩、连，加当归、川芎、熟地、阿胶、陈皮、白术。
若赤黑相杂，此湿胜也，小便赤涩短少，加木通、泽泻、茯苓、山栀，以分利之。
若血痢，加当归、川芎、生地、桃仁、槐花。久不愈，减芩、连、枳、槟，加阿胶、炒侧柏叶、黑干姜、
白术、陈皮。
若久利后重不去，此大肠坠下，去槟榔、枳壳，用条芩加升麻以提之。
若呕吐食不得下，加石膏、陈皮、山栀，入姜汁，缓呷之，以泄胃口之热。
如气血虚而痢者，四物汤加人参、白术、陈皮、芩、连、阿胶之类以补之，而痢自止。
若寒痢，用黄连、木香、酒芍、当归、炙干姜、砂仁、浓朴、肉桂之类。
若误服湿热之药止涩之，虽积久亦宜用前法以下之，下后方调之。若下之未愈，又用前法调理而久
不愈，此属虚寒滑脱，宜用补寒，更加龙骨、赤石脂、粟壳、乌梅等收涩之
药。
张景岳曰∶凡治痢疾，最当察虚实、辨寒热。此泄痢中最大关系，而阴阳之诊为尤急。如实症，
必形气强壮，脉息滑实，或素纵口腹，多胀满坚痛，及年少新病，脾气未损者，方可用治标之法，行之
利之泄之。若虚症，形体薄弱，颜色青白，脉虽紧数而无力无神，脉见真弦，中虚似实；或素禀
阳衰，素多痰积；或偶犯生冷，偶中雨水阴寒，总惟脾弱之辈，多有此症。
寒热之辨∶果热则必畏热而喜冷，不欲衣被，渴甚饮水，小便热涩而痛，下纯血鲜红，脉滑实有力，
形躁急多烦。若无此症而泄痢不止，必是虚寒。
至于阴阳之用，欲其相济不欲其相贼，阳贼阴则为焦枯，阴贼阳则为寂灭。盖阴常喜静而恶动，阳
常喜暖而恶寒。及其相贼，阴畏阳之亢，所以阴遇阳邪，非枯即槁；阳畏阴之毒，所以阳逢阴寇，不走即飞。
凡诸病剧而有假真疑似者，即其症也，而尤于伤寒痢疾为最。
今之痢甚者，多见上下皆有热证，而实非真热，如烦则似热非热，躁则似狂非狂，懊 不宁，莫可名
状，此非真热之证也，盖以精血败伤，火中无水，而阴失其静，故烦躁若此也。
又如飞于上则为口渴、喉疮，或面红身热；走于下则孔热、孔痛，便黄便血，此非实热症也。盖以水
火相刑，阳为阴逐而火离其位，故飞走若此也。今人但见此等症，佥曰热矣，而讵知烦躁之为阴虚，飞走之
为阳虚耶？
且如肌表皆由热症，本当恶热，而反不舍衣被，或脐腹喜暖，宜熨宜按者，此外虽热而内有寒也。
又如九窍皆有热症，必喜冷冻饮料，然口虽欲寒而腹畏之，或
寒冷下咽，反增呕恶腹疼，或噎塞不行，反生胀闷，或口苦虽有疮痛而反欲热汤，此则上下虽热而中
焦有寒也。此外有阳气素弱，脉色少神等症，若再犯寒凉，必致飞者益飞，走者益走，欲孤阳之不灭，
不可得也。
凡治此者，但能引火归源，使丹田暖则火就燥，下元固则气归精，此阴阳颠倒之神理也。
凡泄痢腹痛，有实热虚寒之辨。实热或因食积、火邪，然多胀满坚硬，痛而拒按，此属停滞，微则行
之，甚者逐之。火邪显有内热，清之利之。大都邪实于中者，必多气逆，治法无论是食是火，皆当
行气为先。
虚寒者由寒气之在脏，故腹痛也。盖元气不足于内，则虽无外受寒邪，而中气不暖，即寒症也。泄痢
不止，胃气受伤，膏血切肤，安能不痛？此其为痛，乃因剥及肠脏而然。凡寒侵脏腑，及络脉受伤，血动气
滞者，皆能为痛。但察其不实不坚，喜按熨胸腹，似饥而不欲食，胃脘作呕，而多吞酸，无实热等症，总属
虚寒。速宜温养脾胃，不得再加消伐。如痛之甚，少加木香以顺其气，或多加当归以和其血，俟痛稍
减，则当去此二味。盖又恐木香之耗气，当归之滑肠也。盖寒在下焦而作痛，必加吴茱萸。或痛不至甚，
只以温补脾肾为主，使脾胃安则痛自止。
泄痢之症，必多口渴，当审其有火无火。若火盛熏脾烁胃，津液耗竭，好饮冰水，多而不厌，随饮随
消者，此热渴，治宜凉也。若虽饮水而不至甚多，或时喜凉，复不喜凉，此即寒聚于中，而无根之火浮载
于上，不宜凉也。于喜热喜凉，即可辨其寒热。似渴者干也，非渴也。口虽干而不欲汤饮，则尤非热症。
盖水泄于下，必津涸于上，故不免于渴。渴而欲饮，正以内水不足，欲得外水以相济也，讵必皆因于火乎？
且
气为水母。其有气虚不能生水者，必补其母；土为水生，其有脾虚不能约水者，必强其主，而渴止矣
。使能不治其渴。而治其所以渴，何渴病之有？
凡痢小水必多不利，其寒热虚实，大宜详察。若暴注之泄，清浊不分，水谷并归于大肠，其不利者暂
也。若非其热，则或以中寒而逼阳于下，或泄痢亡阴而水亏色变，或下焦阳气不暖而水无以化，或妄用渗利
而涕逼汁干者，俱有之。但察其三焦无火，则虽黄虽涩，纵皆亡阴亡液之症，速当培补真阴，是为良法。
凡里急后重，病在广肠下肛，其病本则在脾胃，凡热痢、寒痢、虚痢皆有之，不得尽以为热也。盖中焦
有热，则热邪下迫；中焦有寒，则寒邪下迫；脾胃气虚，则气陷下迫。欲治此者，当散其所因，以治脾胃之
本，则无有不愈，然病在广肠，已非食积，而所留者，惟下陷之气，气本无形，故虽欲出而实无所出，是皆
气之使然耳。河间谓行血则便脓自愈，调气则后重自除，是固然矣。然调气之法，如气热者凉之，寒者温之，
虚者补之，陷者举之，皆调也，必使气和，乃为调气。若但以木香、槟榔、当归、大黄行血散气之属，谓之调
和，不知此所以行散者，皆中焦之气，气既下陷，而复行之散之，则气必更陷，其能愈乎？
痛有大孔痛者，脾胃不和，水谷之气失其正化，而浊恶难堪之味出之孔道，此痛之不能免也，又若火因
泄陷，阳为阴逐，则胃中阳气并逼于下，无从解散，此肿之所由生也。故寒痢、热痢皆为肿痛，痢多则痛多，
痢少则痛少，痛与不痛，亦由气之陷与不陷耳。治此者，但治其痢，则痛肿自散。
凡积聚之辩，果以饮食之滞，或积聚成块，或胀满硬痛，不化不行，乃谓之积，所当逐也。至于脓垢，
非糟粕之属，实
又说道：小儿慢脾风，是由于痰饮阻塞了窍道隧络，用星附六君汤来苏醒神志。老人肾虚导致水液泛滥，痰饮上涌，用崔氏八味丸来摄纳收敛。如果是脾胃虚寒，不想进食，阴气痞塞不通，呕吐涎沫的，适宜温补中焦。若是真阳虚衰的，更要补益下焦。然而热痰乘着风火之气上入头目，出现视物昏暗、耳鸣等症状，多看似虚证，如果误用温补之法，反而会禁锢痰邪，使其永远没有出路，这是医者的过错。
刘宗浓说：滞下（痢疾）这种病，都是由于肠胃每天承受饮食积滞未尽，留滞在体内，湿气蒸腾、热气淤结，郁结日益加深，潜伏而不发作。时常遇到炎暑盛行，相火当令，再加上调摄失宜，再次感受酷热之毒。到了秋天阳气开始收敛，火气下降，蒸发蓄积的热毒，于是滞下的病症就发作了。因为它是因积滞而致下行，所以名叫滞下。湿热积淤，干扰血分则便赤色，干扰气分则便白色，赤白夹杂，说明气血都受到了邪气侵害。时间久了不愈，气血运行不畅，脾脏积聚无法磨化，陈旧的积滞滑脱而出，凝结起来像鱼脑一样。严重时肠胃空虚，关门失守，浊液并流，颜色不一，错杂混下，状如豆汁。脾气下陷，虚坐努责（想排便但排不出），大便排出像白脓一样的东西。如果热邪伤血很深，湿毒淤结，粘结成紫色，那就变成紫黑色。污浊积滞想要排出，但气机阻滞不能随之一起排出，所以下迫窘迫疼痛，里急后重，想上厕所却排不出，坐立不安，这都是大肠经有所壅遏，窒碍不得宣通的原因。
我曾经看到世间的方子偏执一端，胡乱使用兜涩止泻的方法；或者用巴豆攻下；或者指着说是湿热，给予淡渗利湿的药物，这些都不是正确的治法。长沙（张仲景）论述说：痢疾可以攻下的，全部使用大黄类的方剂；适合温补的，是干姜、附子之类的药物。河间（刘完素）也说：里急后重适宜攻下，腹痛适宜调和，身体沉重适宜除湿，脉弦适宜祛风，脓血稠粘用重药竭尽邪气，身体冷得像出汗一样用重药引导，风邪内蓄适宜发汗，鸭溏（稀便）为痢应当温补，在表证的发汗，在里证的攻下，在上部的催吐，在下部的竭除，体表发热内部疏导，小便涩滞的分利。用药轻重的区别，又有详细记载。行血则便脓自然痊愈，调气则后重自然消除。而丹溪又说：有大虚大寒的，法度应当温补。看这些治法，怎么能拘泥固执不知变通呢？
又有胃气虚弱而闭拒饮食的，这名叫噤口痢。内格呕逆，是火气向上冲炎的征象。这是因为胃虚，木火之气乘袭，属于土败木贼，多形成危重证候。
李士材说：治疗痢疾的方法，庸医认为“痛无补法”，所以百次治疗没有一次用补法。而世间患痢疾的人，十有九个是虚证，请让我详细说明。气本来下陷，如果再行气，里急后重不是更加严重吗？中气本来虚衰，如果再攻伐积滞，元气不是更加枯竭吗？湿热伤血的固然适宜调血，如果过度推荡攻下，血不是更加受伤吗？津液亡失导致口渴的固然适宜止泄，如果只给以渗利，津液不是更加耗损吗？况且说一定要等到痛止才补，不知道因为虚而痛的，越攻伐就越虚，越虚就越痛。这些都是本末不明，只根据有形的疾病，不考虑无形的元气。所以脉来微弱的可以补，形体面色虚薄的可以补，痢疾之后出现的可以补，因为攻伐而加重的可以补。尤其重要的是，在于脾肾两脏。如先泄泻而后痢疾的，是脾传肾，称为贼邪，难治；先痢疾而后泄泻的，是肾传脾，称为微邪，易治。由此可知病在脾者浅，病在肾者深。肾是胃的关口，没有久痢而肾不损伤的，所以治疗痢疾不知道补肾，就不是正确的治法。凡是四君子汤、归脾汤、十全大补汤、补中益气汤，都是补脾虚的，未尝不好。但如果病在火衰，土位没有母气（火生土），如果不是桂枝、附子大补命门，来救脾家的母亲（火），那么饮食从哪里进来，门户从哪里固守呢？里急后重，有邪气逼迫导致的后重，到厕所稍减，不久又加重；虚滑导致的后重，上厕所后不减，因为解除了反而更虚的缘故。攻下后仍然后重的，应当用甘草缓急，升麻升举。
噤口痢，食物吃不下，到了嘴边就吐。有邪气在上膈，火气冲逆的，用黄连、木香、桔梗、橘红、茯苓、石菖蒲；有胃虚呕逆的，用治中汤；有阳气不足、宿食未消的，用理中汤加砂仁、木香、陈皮、豆蔻；有肝气呕吐的，用木香、黄连、吴茱萸、青皮、芍药之类；有积秽在下、恶气熏蒸的，用承气汤，石莲研末，陈米汤调服。石莲就是老莲子，市面卖的常是木莲，不可用。丹溪用人参、黄连，浓煎，加姜汁，细细呷服。只要有一口咽下去就能开通。
不治症（死证）：下纯血的死，像屋漏水一样的死，肛门直筒样扩张的死，嘴唇像涂了朱砂一样的死，发热不止的死。颜色像鱼脑、像猪肝半死半生的，脉细、皮寒、气少、前后泄痢、饮食不入，这叫五虚，死。只有用人参、附子，十人可以救活一个。
喻嘉言说：治疗疟疾的方法，应当从少阳论治；治疗痢疾的表证，法度也应当从少阳论治，因为水谷之气，由胃进入肠，急速趋下。起初少阳生发之气不能伸展，随后少阳生发之气转而陷入，所以广泛地去求治阳明，不如专门去求治少阳。使得苍天清净之气，足以升举，万物的滋味，自然变化精微，输泄有度，就没有下痢奔迫的痛苦了。何况两阳所藏的津液，既然已经向下泄出，尤其不可以再发其汗。在伤寒经中有明确禁止阳明发汗的条文，而《金匮要略》又重申下痢发汗的禁忌，所以应当从少阳半表半里的方法，缓缓逆挽其下陷的清气，使得身体中具备春夏的生发之气。究其实质也是和法，其下陷的气已经升举了。
凡是先泄泻后痢疾的是逆证，反复通利而不止的是虚证。脉微迟适宜温补。脉弦数是逆证，主死。产后痢疾也适宜温补。
腹痛是因为肺金之气郁结在大肠之间的，用苦梗（桔梗）发散它，后用治痢的药。肛门痛，是热邪留在下部。初病身热，脉洪大，适宜清解，用黄芩芍药汤。病久身冷自汗，适宜温补，用理中汤。下血的，适宜凉血活血，用当归、黄芩、桃仁之类。风邪陷入下部的，适宜升提。湿热伤血的，适宜行湿清热。下坠异常，积中有紫黑血，而且痛得很厉害的，这是死血，用桃仁、滑石行之。血痢久不愈的，属于阳虚阴脱，用八珍汤加升举的药物。甚至有阵阵自下，手足厥冷，脉逐渐微缩的，这是元气欲绝，急灸气海穴，用附子理中汤，稍微迟缓就无法救治了。久痢血，脉沉弱，各种药物无效，用十全大补汤加姜枣入蜜煎服。
治疗痢疾有标本先后：以肠胃论，大肠为标，胃为本；以经脉论，手足阳明为标，少阳相火为本。所以胃受湿热，水谷从少阳之火化，变为恶浊，传入于大肠，如果不治少阳，只治阳明，是没有益处的。少阳生发之气，传入土中，因而下陷，不先用辛凉举升它，而用苦寒攻夺它，痢疾就没有停止的时候了。况且病情有虚实，实者是邪气实，虚者是正气虚。七实三虚，攻邪为先；七虚三实，扶正为本。十分实邪，就是壮火食气，没有正气可扶，急去其邪，以保留正气；十分虚邪，就是奄奄一息，没有实邪可攻，急补其正气，听任邪气自然去除即可。
王节斋说：痢疾是湿热、食积，治疗者辨别五色以归属五脏，白色者伤气分，赤色者伤血分，赤白相杂气血俱伤，黄色者食积。治法，泄肠胃之湿热，开郁结之气，消化积滞，通风通用。其初只是攻下，攻下后未愈，随证调理。痢疾稍久的，不可攻下，因为胃虚的缘故。痢疾多属热，也有虚与寒的。虚的适宜补，寒的适宜温，老年人及虚弱者不宜攻下。
主方：黄芩、黄连、白芍（这三味是痢疾必用的药）、木香、枳壳、槟榔、炙甘草。
如果白痢，加白术、茯苓、滑石、陈皮。初起想要攻下的，加大黄。兼有食积，加山楂、枳实。
如果红白相杂，加川芎、当归、桃仁以理血，滑石、陈皮、苍术以理气，有食积也加山楂、枳实。
如果白痢日久，胃弱气虚，或攻下后未愈，减少黄芩、黄连、白芍，加白术、黄芪、茯苓、陈皮、砂仁，再加炙干姜。
如果红痢日久，胃气弱血虚，或攻下后未愈，减少黄芩、黄连，加当归、川芎、熟地、阿胶、陈皮、白术。
如果赤黑相杂，这是湿胜，小便赤涩短少，加木通、泽泻、茯苓、山栀，以分利之。
如果血痢，加当归、川芎、生地、桃仁、槐花。久不愈，减少黄芩、黄连、枳壳、槟榔，加阿胶、炒侧柏叶、黑干姜、白术、陈皮。
如果久利后重不去，这是大肠坠下，去掉槟榔、枳壳，用条芩加升麻以提之。
如果呕吐食不得下，加石膏、陈皮、山栀，入姜汁，缓呷之，以泄胃口之热。
如气血虚而痢的，用四物汤加人参、白术、陈皮、黄芩、黄连、阿胶之类以补之，而痢自止。
如果寒痢，用黄连、木香、酒芍、当归、炙干姜、砂仁、厚朴、肉桂之类。
如果误服湿热之药止涩的，虽然积久也适宜用前法以下之，攻下后再调理。如果攻下后未愈，又用前法调理而久不愈，这属于虚寒滑脱，适宜用补涩，更加龙骨、赤石脂、罂粟壳、乌梅等收涩的药物。
张景岳说：凡是治疗痢疾，最应当察虚实、辨寒热。这是泄痢中最大的关键，而阴阳的诊断尤为紧急。如实证，必定形气强壮，脉息滑实，或者平素放纵口腹，多胀满坚痛，以及年少新病，脾气未损的，才可以采用治标的方法，行之、利之、泄之。若虚证，形体薄弱，颜色青白，脉虽紧数而无力无神，脉见真弦，中虚似实；或者平素禀赋阳衰，平素多痰积；或者偶犯生冷，偶中雨水阴寒，总归是脾弱之辈，多有此症。
寒热之辨：果真是热，必定畏热喜冷，不欲衣被，渴甚饮水，小便热涩而痛，下纯血鲜红，脉滑实有力，形躁急多烦。如果没有这些症状而泄痢不止，必定是虚寒。
至于阴阳之用，希望它们相互济助不希望相互克制，阳克阴则为焦枯，阴克阳则为寂灭。大概阴常喜欢静而厌恶动，阳常喜欢暖而厌恶寒。等到它们相互克制，阴畏惧阳的亢盛，所以阴遇到阳邪，不是干枯就是槁朽；阳畏惧阴的毒害，所以阳遇到阴寇，不是走散就是飞越。凡诸病剧烈而有假真疑似的，就是这个症状，而在伤寒痢疾中最为明显。
现在的痢疾严重的，多见上下皆有热证，而实际上并非真热，如烦躁则似热非热，躁动则似狂非狂，懊恼不宁，莫可名状，这不是真热的证候，大概是因为精血败伤，火中无水，而阴失去宁静，所以烦躁如此。
又如飞于上则为口渴、喉疮，或面红身热；走于下则孔热、孔痛，便黄便血，这不是实热症。大概是因为水火相刑，阳被阴驱逐而火离开其位，所以飞走如此。现在的人只见这些症状，都说热了，哪里知道烦躁是阴虚，飞走是阳虚呢？
况且如肌表皆由热症，本当恶热，而反不舍衣被，或脐腹喜暖，宜熨宜按的，这是外虽热而内有寒。
又如九窍皆有热症，必喜冷冻饮料，然口虽欲寒而腹畏之，或寒冷下咽，反增呕恶腹疼，或噎塞不行，反生胀闷，或口苦虽有疮痛而反欲热汤，这是上下虽热而中焦有寒。此外有阳气素弱，脉色少神等症，如果再犯寒凉，必致飞的更飞，走的更远，想要孤阳不灭，是不可能的。
凡是治疗这些，只要能引火归源，使丹田暖则火就燥，下元固则气归精，这是阴阳颠倒的神理。
凡是泄痢腹痛，有实热虚寒之辨。实热或因食积、火邪，然多胀满坚硬，痛而拒按，这属于停滞，轻微的行气，严重的逐邪。火邪显有内热，清之利之。大都邪实于中的，必多气逆，治法无论是食是火，都当行气为先。
虚寒者由寒气在脏，所以腹痛。大概元气不足于内，则虽无外受寒邪，而中气不暖，即是寒症。泄痢不止，胃气受伤，膏血切肤，安能不痛？这个疼痛，是因为剥蚀及肠脏而然。凡寒侵脏腑，及络脉受伤，血动气滞的，都能为痛。但察其不实不坚，喜按熨胸腹，似饥而不欲食，胃脘作呕，而多吞酸，无实热等症，总属虚寒。速宜温养脾胃，不得再加消伐。如痛得很厉害，少加木香以顺其气，或多加当归以和其血，等到痛稍减，则应当去掉这两味药。大概又恐怕木香耗气，当归滑肠。大概寒在下焦而作痛，必加吴茱萸。或痛不至于很厉害，只以温补脾肾为主，使脾胃安则痛自止。
泄痢的症状，必多口渴，应当审察有火无火。如果火盛熏脾烁胃，津液耗竭，好饮冰水，多而不厌，随饮随消的，这是热渴，治宜凉。如果虽饮水而不至很多，或时喜凉，复不喜凉，这就是寒聚于中，而无根之火浮载于上，不宜凉。于喜热喜凉，即可辨其寒热。似渴的是干，不是渴。口虽干而不欲汤饮，则更不是热症。大概水泄于下，必津涸于上，故不免于渴。渴而欲饮，正是以内水不足，欲得外水以相济，难道都是因为火吗？
且气为水之母。有气虚不能生水的，必补其母；土为水之主，有脾虚不能约水的，必强其主，而渴止矣。如果能不治其渴，而治其所以渴，有什么渴病呢？
凡是痢疾小水必多不利，其寒热虚实，大宜详察。如果暴注之泄，清浊不分，水谷并归于大肠，其不利者是暂时的。如果不是热，则或以中寒而逼阳于下，或泄痢亡阴而水亏色变，或下焦阳气不暖而水无以化，或妄用渗利而涕逼汁干的，都有这种情况。但察其三焦无火，则虽黄虽涩，纵皆是亡阴亡液的症，速当培补真阴，这是良法。
凡是里急后重，病在广肠下肛，其病本则在脾胃，凡热痢、寒痢、虚痢皆有之，不得尽以为热。大概中焦有热，则热邪下迫；中焦有寒，则寒邪下迫；脾胃气虚，则气陷下迫。想要治疗这个，应当散其所因，以治脾胃之本，则无不愈。然而病在广肠，已非食积，而所留者，惟下陷之气，气本无形，故虽欲出而实无所出，这都是气使之然耳。河间说行血则便脓自愈，调气则后重自除，这是固然。然而调气之法，如气热者凉之，寒者温之，虚者补之，陷者举之，都是调，必须使气和，才是调气。如果只以木香、槟榔、当归、大黄行血散气的类，叫做调和，不知道这些之所以行散的，都是中焦之气，气既下陷，而复行之散之，则气必更陷，能痊愈吗？
痛有大孔痛的，脾胃不和，水谷之气失其正化，而浊恶难堪之味出于孔道，这个痛是不能免的，又若火因泄陷，阳为阴逐，则胃中阳气并逼于下，无从解散，这个是肿之所由生。所以寒痢、热痢皆为肿痛，痢多则痛多，痢少则痛少，痛与不痛，也由气之陷与不陷耳。治疗这个，只要治其痢，则痛肿自散。
凡是积聚之辨，果以饮食之滞，或积聚成块，或胀满硬痛，不化不行，乃谓之积，所当逐也。至于脓垢，非糟粕之属，实……
It is also said: In pediatric slow spleen wind (Xiao'er Man Pi Feng, a condition characterized by chronic deficiency and phlegm obstruction in children), phlegm-fluids block the orifices and collaterals; Xingfu Liujun Tang (Star Aconite Six Gentlemen Decoction) is used to awaken the spirit. In the elderly, kidney deficiency leads to water overflowing, with phlegm-fluids surging upward; Cui's Bawei Wan (Cui's Eight-Ingredient Pill) is used to secure and contain them. If there is spleen-stomach deficiency-cold, loss of appetite, qi stagnation causing obstruction, and vomiting of saliva/foam, warming the middle jiao is appropriate. For true yang deficiency, tonifying the lower jiao is additionally required. However, when hot phlegm rides on wind-fire qi to ascend into the head and eyes, causing dim vision and tinnitus, it often resembles a deficiency syndrome. Mistakenly applying warming and tonifying methods will instead imprison the phlegm, leaving it no outlet; this is the fault of the physician.
Liu Zongnong stated: The disease of Zhixia (Li Xia, dysentery) arises because the intestines and stomach daily receive dietary accumulation that is not fully digested, remaining stagnant inside. Dampness steams and heat stasis condenses, deepening the郁结 (depression/stagnation) day by day. It lies dormant until the summer heat prevails, with ministerial fire commanding. If regulation is improper and one again contracts severe heat toxins, then in autumn when yang qi begins to收敛 (to gather/constrain) and fire qi descends, it evaporates the accumulated heat, causing Zhixia to manifest. Because it is caused by stagnation leading to downward movement, it is named Zhixia. When damp-heat stasis interferes with the blood level, stools are red; when it interferes with the qi level, stools are white. Red and white mixed indicate both qi and blood are affected by pathogenic factors. If prolonged and unhealed, qi and blood circulation fails, spleen accumulation cannot be ground down, old accumulations slip out, coagulating like fish brains. In severe cases, the intestines and stomach become empty, the gate loses control, turbid fluids flow together, colors vary, mixing杂乱ly, resembling bean juice. Spleen qi sinking causes tenesmus with empty straining (Xu Zuo Nu Li), passing stool resembling white pus. If heat injures blood deeply and damp-toxin stasis binds purple, it becomes purple-black. Turbid accumulations desire to exit, but qi stagnation prevents them from exiting together, resulting in urgent pressing pain, tenesmus (Hou Zhong Li Ji), inability to defecate despite urgency, and restlessness. All these occur because the large intestine meridian is obstructed, blocked and unable to circulate freely.
I have seen worldly prescriptions biased toward one aspect, recklessly using astringents to stop diarrhea; or using Croton seed (Ba Dou) for purgation; or pointing to damp-heat and giving diaphoretic/diuretic drugs. These are incorrect treatments. Changsha (Zhang Zhongjing) discussed: Dysentery suitable for purgation should all use Rhubarb (Da Huang) formulas; those suitable for warming should use Ginger (Gan Jiang) and Aconite (Fu Zi) types. Hejian (Liu Wansu) also said: Tenesmus is suitable for purgation; abdominal pain is suitable for harmonizing; heavy body is suitable for removing dampness; wiry pulse is suitable for dispelling wind; thick sticky pus and blood require heavy medicines to exhaust the pathogen; cold body with sweating requires heavy medicines to guide; internal accumulation of wind pathogens requires sweating; watery diarrhea as dysentery requires warming; exterior patterns require sweating; interior patterns require purgation; upper patterns require emesis; lower patterns require exhausting; exterior heat requires internal dispersion;涩滞 (obstructed) urination requires separation and promotion. The distinction between light and heavy medication is detailed further. Promoting blood circulation makes bloody pus heal naturally; regulating qi removes tenesmus naturally. Danxi also stated: For great deficiency and great cold, the method should be warming and tonifying. Observing these treatment methods, how can one be rigid and inflexible?
There is also Jingkou Li (Jin Kou Li, anorectic dysentery), where weak stomach qi closes off food intake. Internal rejection and vomiting are signs of fire qi flaring upward. This is due to stomach deficiency allowing wood-fire to invade, representing earth failure and wood attacking; it often becomes a critical condition.
Li Shicai said: The method of treating dysentery, mediocre practitioners claim "pain has no tonification method," so rarely is tonification used. Yet among worldly dysentery patients, nine out of ten are deficient. Let me explain fully. Qi is originally sinking; if we further move qi, will tenesmus not increase? Middle qi is originally deficient; if we further attack accumulation, will yuan qi not deplete further? Damp-heat injuring blood should naturally be treated by regulating blood; if we over-push and purge, will blood not be injured further? Fluid loss causing thirst should naturally be treated by stopping diarrhea; if we only use diuretics, will fluids not be consumed further? Moreover, saying "wait until pain stops before tonifying" ignores that pain due to deficiency becomes more deficient with attack, and more deficient means more pain. These are failures to understand root and branch, focusing only on有形 (formative/material) disease while ignoring无形 (formless/spiritual) yuan qi. Therefore, weak pulses allow tonification; thin complexion allows tonification; dysentery appearing after illness allows tonification; worsening after attack allows tonification. Most importantly lies in the spleen and kidney. Diarrhea preceding dysentery is spleen transmitting to kidney, called thief evil, difficult to treat; dysentery preceding diarrhea is kidney transmitting to spleen, called minor evil, easy to treat. Thus, disease in spleen is shallow, disease in kidney is deep. Kidney is the gate of the stomach; there is no long-term dysentery without kidney damage. Therefore, treating dysentery without knowing to tonify the kidney is incorrect. Si Jun Zi Tang (Four Gentlemen Decoction), Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) all tonify spleen deficiency and are not bad. But if the disease is fire decline, with earth lacking its mother (fire generates earth), unless Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) greatly tonify Ming Men (Gate of Life) to save the spleen's mother, how will food enter and how will the gate remain firm? Tenesmus caused by pathogen pressing reduces slightly after defecation but worsens soon after; tenesmus due to deficiency and slipping does not reduce after defecation because relief leads to greater deficiency. Tenesmus persisting after purgation should be treated with Gan Cao (Licorice Root) to relax and Sheng Ma (Cimicifuga Rhizome) to lift.
Jingkou Li, food cannot enter, vomited immediately upon reaching the mouth. If pathogen is in upper chest with fire qi rushing up, use Huang Lian (Coptis Rhizome), Mu Xiang (Costus Root), Jie Geng (Platycodon Root), Ju Hong (Tangerine Peel), Fu Ling (Poria), and Shi Chang Pu (Acorus Rhizome). If stomach deficiency causes vomiting, use Zhi Zhong Tang (Regulate the Middle Decoction). If yang qi is insufficient and retained food remains, use Li Zhong Tang (Regulate the Middle Decoction) added with Sha Ren (Amomum Fruit), Mu Xiang, Chen Pi (Tangerine Peel), and Dou Kou (Cardamom). If liver qi causes vomiting, use Mu Xiang, Huang Lian, Zhu Yu (Evodia Fruit), Qing Pi (Bitter Tangerine Peel), and Shao Yao (Peony Root). If filth accumulates below and foul qi steams upward, use Cheng Qi Tang (Descending the Qi Decoction) with Shi Lian (Nelumbo Seed) powder mixed in aged rice soup. Shi Lian refers to old lotus seeds; market goods are often Wood Lotus, which should not be used. Danxi used Ren Shen (Ginseng Root) and Huang Lian, decocted strongly, added with ginger juice, sipped slowly. Just one sip going down opens the throat.
Incurable conditions: Passing pure blood indicates death; leaking like a dripping roof indicates death; anus dilated like a tube indicates death; lips painted like cinnabar indicate death; unremitting fever indicates death. Color like fish brain or half-dead/half-alive pig liver, fine pulse, cold skin, shortness of breath, anterior/posterior discharge, inability to eat—this is called Five Deficiencies, indicating death. Only using Ren Shen and Fu Zi may save one in ten.
Yu Jiayan said: Treating malaria should follow Shaoyang; treating the exterior aspect of dysentery should also follow Shaoyang. Water and grain qi enter the intestines from the stomach and rush downward. Initially, Shaoyang's generating qi does not extend; subsequently, Shaoyang's generating qi sinks. Therefore, seeking broadly in Yangming is inferior to seeking specifically in Shaoyang. This allows the clear qi of Heaven to rise sufficiently, transforming flavors into essence and micro-elements, ensuring regulated transport and excretion, eliminating the suffering of urgent dysentery. Moreover, since fluids stored by two yangs have already leaked downward, sweating must not be induced again. The Shanghan Jing explicitly forbids sweating in Yangming, and the Jingui Yaolue reiterates the prohibition of sweating in dysentery. Thus, one should follow the Shaoyang half-exterior method, slowly reversing and lifting the sunken clear qi, allowing the body to embody the functions of spring and summer. Ultimately, this is a harmonizing method; the sunken qi has been lifted.
Diarrhea preceding dysentery is adverse; repeated purgation without cessation indicates deficiency. Weak and slow pulses suit warming and tonifying. Wiry and rapid pulses are adverse, indicating death. Postpartum dysentery also suits warming and tonifying.
Abdominal pain due to Lung Metal qi stagnating in the large intestine should be dispersed with Ku Jing (Jie Geng/Osthol), followed by dysentery medicine. Anal pain indicates heat lingering below. Initial fever with洪大 (surging-large) pulse suits clearing, using Huang Qin (Scutellaria Root) and Shao Yao (Peony Root) Decoction. Prolonged illness with cold body and spontaneous sweating suits warming, using Li Zhong Tang. Hematochezia suits cooling and invigorating blood, using Dang Gui (Angelica Sinensis), Huang Qin, and Tao Ren (Peach Kernel). Wind pathogens sinking below suit lifting. Damp-heat injuring blood suits promoting dampness and clearing heat. Abnormal bearing-down with purple-black blood in accumulation and severe pain indicates dead blood; use Tao Ren and Hua Shi (Talcum) to move it. Chronic bloody dysentery belongs to yang deficiency and yin collapse; use Ba Zhen Tang (Eight Treasure Decoction) with lifting herbs. Frequent spontaneous passage with cold limbs and gradually shrinking pulse indicates impending yuan qi exhaustion; urgently moxa Qihai (CV6), use Fuzi Lizhong Tang. Delay brings no rescue. Chronic bloody dysentery with deep-weak pulse and ineffective medications: use Shi Quan Da Bu Tang with ginger, dates, and honey.
Treating dysentery involves root and branch, priority and sequence: Regarding organs, large intestine is branch, stomach is root; regarding meridians, hand-foot Yangming are branch, Shaoyang Minister Fire is root. Thus, stomach receiving damp-heat transforms water/grain via Shaoyang fire into foul matter, transmitting to large intestine. Not treating Shaoyang, only treating Yangming, is useless. Shaoyang's generating qi enters earth and sinks; if not first lifted with acrid-cool herbs, but attacked with bitter-cold purgatives, dysentery will never cease. Furthermore, conditions have excess and deficiency. Excess is pathogen excess; deficiency is healthy qi deficiency. Seven parts excess, three parts deficiency: attack pathogen first. Seven parts deficiency, three parts excess: support healthy qi as root. Ten parts excess pathogen consumes qi like strong fire; no healthy qi to support, urgently remove pathogen to preserve healthy qi. Ten parts deficiency pathogen leaves barely breathing; no excess to attack, urgently tonify healthy qi, letting pathogen depart naturally.
Wang Jiezhai said: Dysentery is damp-heat and food stagnation. Practitioners distinguish five colors belonging to five zang organs: white injures qi level, red injures blood level, red-white mixed injures both qi and blood, yellow indicates food stagnation. Treatment: drain damp-heat from intestines/stomach, open depressed qi, digest stagnation, ventilate and promote circulation. Initially, just purge; if unhealed after purging, adjust according to symptoms. Prolonged dysentery should not be purged due to stomach deficiency. Dysentery mostly belongs to heat, but also has deficiency and cold. Deficiency suits tonification, cold suits warming. Elderly and weak should not be purged. Main Formula: Huang Qin, Huang Lian, Bai Shao (these three are essential for dysentery), Mu Xiang, Zhi Ke (Immature Bitter Orange), Bing Lang (Areca Nut), Zhi Gan Cao (Honey-fried Licorice).
If abdominal pain, add Dang Gui, Sha Ren, plus Mu Xiang, Shao Yao.
If tenesmus, add Hua Shi, plus Zhi Ke, Bing Lang, Bai Shao, raw Tiao Qin (Scutellaria).
If white dysentery, add Bai Zhu (Atractylodes Macrocephala), Fu Ling, Hua Shi, Chen Pi. If initial purging desired, add Da Huang. With food stagnation, add Shan Zha (Hawthorn), Zhi Shi (Immature Bitter Orange).
If red dysentery, add Dang Gui, Chuan Xiong (Sichuan Lovage Rhizome), Tao Ren. If initial purging desired, add Da Huang.
If red-white mixed, add Chuan Xiong, Dang Gui, Tao Ren to regulate blood; Hua Shi, Chen Pi, Cang Zhu (Atractylodes Lancea) to regulate qi; with food stagnation also add Shan Zha, Zhi Shi.
If white dysentery is prolonged, with weak stomach/qi, or unhealed after purging, reduce Huang Qin, Huang Lian, Shao Yao; add Bai Zhu, Huang Qi (Astragalus), Fu Ling, Chen Pi, Sha Ren, plus Zhi Gan Jiang (Fried Ginger).
If red dysentery is prolonged, with weak stomach qi/blood deficiency, or unhealed after purging, reduce Huang Qin, Huang Lian; add Dang Gui, Chuan Xiong, Shu Di (Prepared Rehmannia), E Jiao (Donkey-hide Gelatin), Chen Pi, Bai Zhu.
If red-black mixed, this is damp predominance; with red/scanty painful urination, add Mu Tong (Akebia Stem), Ze Xie (Alisma), Fu Ling, Shan Zhi (Gardenia) to separate and promote.
If bloody dysentery, add Dang Gui, Chuan Xiong, Sheng Di (Rehmannia), Tao Ren, Huai Hua (Sophora Flower). If prolonged/unhealed, reduce Huang Qin, Huang Lian, Zhi Shi, Bing Lang; add E Jiao, Chao Ce Bai Ye (Fried Biota Leaf), Hei Gan Jiang (Blackened Ginger), Bai Zhu, Chen Pi.
If chronic dysentery tenesmus persists, this is large intestine prolapse; remove Bing Lang, Zhi Ke; use Tiao Qin with Sheng Ma to lift.
If vomiting preventing food intake, add Shi Gao (Gypsum), Chen Pi, Shan Zhi, add ginger juice, sip slowly to drain stomach heat.
If qi-blood deficiency causing dysentery, use Si Wu Tang (Four Substances Decoction) added with Ren Shen, Bai Zhu, Chen Pi, Huang Qin, Huang Lian, E Jiao to tonify, and dysentery will stop.
If cold dysentery, use Huang Lian, Mu Xiang, Jiu Shao Yao (Wine-processed Peony), Dang Gui, Zhi Gan Jiang, Sha Ren, Hou Po (Magnolia Bark), Rou Gui (Cinnamon Bark).
If mistakenly using damp-heat/astringent drugs to stop it, even if accumulated long, should use previous methods to purge, then adjust after purging. If purging doesn't heal, and adjusting doesn't heal, this belongs to deficiency-cold slipping; use tonifying-astringing, adding Long Gu (Dragon Bone), Chi Shi Zhi (Red Halloysite), Ying Su Ke (Poppy Shell), Wu Mei (Mume Fruit) and other astringents.
Zhang Jingyue said: Treating dysentery most requires examining excess/deficiency and distinguishing cold/heat. This is the greatest concern in diarrhea/dysentery, with yin-yang diagnosis being especially urgent. For excess patterns, constitution is strong, pulse is slippery-solid, or history of gluttony, fullness/pain, young/new onset, spleen qi undamaged—only then can branch-treatment methods (promoting, draining, purging) be used. For deficiency patterns, constitution is thin, complexion greenish-white, pulse tight-rapid but powerless/lifeless, true wiry pulse appearing, middle deficiency mimicking excess; or innate yang decline, chronic phlegm-stagnation; or accidental exposure to cold/raw foods/rainwater—all belong to weak spleen constitutions.
Distinguishing Cold/Heat: True heat implies aversion to heat/liking cold, refusing covers, extreme thirst drinking water, hot/painful scanty urine, pure bright red blood, slippery-solid forceful pulse, restless/agitated irritability. Without these symptoms but with unremitting diarrhea/dysentery, it must be deficiency-cold.
Regarding yin-yang usage, they should assist rather than harm each other. Yang harming yin leads to scorching/drying; yin harming yang leads to silence/extinction. Yin prefers stillness/dislikes movement; yang prefers warmth/dislikes cold. When harming each other, yin fears yang's hyperactivity, so yin encountering yang pathogens dries or withers; yang fears yin's toxicity, so yang encountering yin invaders scatters or flies. Severe diseases with false/true similarities exhibit these symptoms, especially in Shanghan and dysentery.
Current severe dysentery often shows heat signs above and below, but not true heat. Irritability seems heat but isn't; restlessness seems mania but isn't; inner vexation/restlessness indescribable—this is not true heat. It is due to essence/blood destruction, fire without water, yin losing stillness, hence such irritability.
Flaring upward causes thirst/throat ulcers/red face/body heat; moving downward causes orifice heat/pain/yellow/red stool—this is not excess heat. It is due to water/fire conflict, yang driven by yin, fire leaving its position, hence such flaring/moving. People seeing these say "heat," not knowing irritability is yin deficiency and flaring/moving is yang deficiency.
Moreover, surface heat usually dislikes heat, but refusing covers or preferring warmth/massage at navel/abdomen indicates external heat but internal cold.
Nine orifices showing heat usually like cold drinks, but mouth desires cold while abdomen fears it; cold swallowing increases vomiting/abdominal pain or blockage/bloating; bitter mouth with ulcers yet desiring hot soup indicates upper/lower heat but middle jiao cold. Additionally, innate weak yang, pulse/complexion lacking spirit—if cold-cooling herbs are used again, flying will fly more, moving will move more, making solitary yang extinguish is impossible.
Treating these requires guiding fire back to its source; warming Dantian makes fire seek dryness; securing lower yuan makes qi return to essence. This is the divine principle of yin-yang inversion.
Diarrhea/dysentery abdominal pain distinguishes excess-heat and deficiency-cold. Excess-heat due to food stagnation/fire evil often presents with fullness/hardness, pain refusing pressure, indicating stagnation; mild cases move qi, severe cases expel evil. Fire evil showing internal heat requires clearing/draining. Mostly, pathogen excess in middle causes qi rebellion; treatment regardless of food or fire prioritizes moving qi.
Deficiency-cold stems from cold qi in zang organs causing pain. Yuan qi insufficient internally means even without external cold, middle qi not warm constitutes cold pattern. Unremitting diarrhea damages stomach qi, flesh touches skin, how can it not hurt? This pain results from erosion of intestines/zang. Cold invading zang/collaterals, blood moving/qi stagnating causes pain. Examining non-hard/non-full, preferring massage/warmth, hunger without desire to eat, epigastric nausea/acid regurgitation, no excess-heat signs—all belong to deficiency-cold. Urgently warm/nourish spleen/stomach, do not add dispersing/draining. If pain severe, add little Mu Xiang to smooth qi, or more Dang Gui to harmonize blood; once pain lessens, remove these two. Fear Mu Xiang consuming qi and Dang Gui sliding intestines. Cold in lower jiao causing pain requires adding Wu Zhu Yu (Evodia Fruit). If pain not severe, primarily warm/tonify spleen/kidney; stabilizing spleen/stomach stops pain naturally.
Diarrhea/dysentery often involves thirst; examine presence/absence of fire. Fire flourishing scorching spleen/stomach, fluid depletion, liking ice water, drinking much without satiety, instant consumption—this is heat-thirst, treat with cooling. Drinking little, sometimes liking cold then disliking—this is cold gathering in middle, rootless fire floating above, do not cool. Liking hot/cold distinguishes cold/heat. "Like-thirst" is dryness, not thirst. Mouth dry but no desire for soup/water is definitely not heat. Water leaking below causes fluid drying above, hence thirst. Thirst desiring drink is due to internal water insufficiency seeking external water aid; why must it always be fire?
Qi is mother of water. Qi deficiency failing to generate water requires tonifying the mother. Earth is master of water; spleen deficiency failing to control water requires strengthening the master, then thirst stops. If one treats not the thirst, but the cause of thirst, what thirst disease exists?
Dysentery small urination is mostly obstructed; cold/heat/excess/deficiency requires careful examination. Sudden violent diarrhea, unclear/turbid mixed, water/grain returning to large intestine, temporary obstruction. If not heat, then middle cold forcing yang below, or diarrhea/dysentery yin loss causing water deficiency/color change, or lower jiao yang not warming causing water transformation failure, or reckless diuretics causing fluid drying—all occur. Examining three jiao without fire, though yellow/astringent, even if yin/fluid loss, urgently tonify true yin is good method.
Tenesmus disease is in broad intestine/anal region, root in spleen/stomach. Heat/cold/deficiency dysentery all have it, cannot assume all heat. Middle jiao heat forces heat pathogen down; middle jiao cold forces cold pathogen down; spleen/stomach qi deficiency causes qi sinking forcing down. To treat, scatter causes, treat spleen/stomach root, then all heal. However, disease in broad intestine is not food stagnation, but sunken qi. Qi is formless, thus desiring exit but having nothing to exit, all caused by qi. Hejian said promoting blood heals bloody pus, regulating qi removes tenesmus—this is true. But regulating qi methods: heat qi cooled, cold qi warmed, deficiency qi tonified, sunken qi lifted—all are regulation. Must make qi harmonious to be regulating qi. Using only Mu Xiang, Bing Lang, Dang Gui, Da Huang to move blood/disperse qi as "harmonizing" ignores these move/disperse middle jiao qi. If qi is sunken, further moving/dispersing makes qi sink more, how can it heal?
Anal pain: spleen/stomach disharmony, water/grain qi losing proper transformation, foul taste exiting orifice, pain unavoidable. Also fire sinking due to diarrhea, yang driven by yin, stomach yang forced below, unable to dissipate, causing swelling. Thus cold/heat dysentery both cause swelling/pain. More dysentery more pain, less dysentery less pain. Pain/no pain depends on qi sinking/not sinking. Treat dysentery, swelling/pain dissipates naturally.
Accumulation differentiation: Food stagnation forming lumps, fullness/hard pain, indigestion/immobility is called accumulation, should be expelled. As for pus/filth, not part of chaff/waste, actually...