荆芥穗 麻黄（去根） 薄荷 羌活
丝，各三分） 牵牛（半两）
以上细捣为末，每服二钱，食后，煎生姜，薄荷汤调下，和滓服，若是大府秘热，胶痰
满口，喉中咽药不快，只请去滓吃，候风气少利，即和滓吃也。若是大府秘不出后，即用大
黄一分，半夏三铢，牵牛一两半，共三味，捣罗为末，作一处，每服用上面药末三钱，牵牛
等末三钱，共计六钱，滴熟水，丸如梧子大，为一服，巳午时，葱汤下，大府尚不通，忽谷
道中通粪不下，即用皂角、牵牛二味，捣罗为细末，笔管盛，纳于谷道中，吹之，剪去指甲
，用指头谷道中拨取干粪下也。
夫痢之为病，世人所患者多，然方册所载者，未尝有必验之方，古人所谈者，未尝有卓
然之论，服饵之间，世人夭横者，莫知其数，此圣人名方为大奇，后之学人，不能思而自得
之也。若今有人得一名方，自以为神传圣惠，应效不测，然有一人服之而减，未可图其必然
之验也，此愚以方册所载者，未尝有必验之方也，以赤为热，以白为冷，医者之辞，万口一
说，此愚以为古人所谈，未尝有卓然之论也，何则，以赤为热，以白为冷，赤白为冷热不和
，独知大纲，而痢之有变化重轻之别，得其粗而不得其详，知其一不知其二者矣，夫痢之为
痢，一名而具八种，一曰白痢，二曰赤痢，三曰赤白痢，四曰水谷痢，五曰血痢，六曰疫毒
痢，七曰休息痢，八曰小儿疳痢，此皆受之不同，治之不得不异，索其详而论之，则其痢之
为病，虽变化重轻之不同，然一归之脾气之虚而已。
万物非土不生，五行非土不载，五脏非脾不养，脾者，中州之土，能化腐水谷，设滋味
于肌肤，行糟粕于大肠，脾脏温和，而诸脏之有冷热不调，即自生他病，不为之痢也，是故
赤痢虽热，本因脾肾之虚，赤白相杂，虽为冷热不和，而又有重轻之别，若今人之下赤痢，
先转数行，而后有赤痢之变，若以赤痢为热，何乃有先转之说欤，以赤白为冷热不和，而复
有赤少白多，赤多白少，能无重轻之别乎，此病有变化之不同，予得以命其祖而言之也，一
曰白痢者，五脏伤冷，脾胃极虚之所成也，其得之重，出后如鸡卵清、如鱼脑浆者，肾有所
伤也，急以补脾肾药以暖之，加以舶上硫黄丸，无问多少，空心即服，以止为度，盖病势之
重，治之不可后时也，二曰赤痢者，三焦之热血有余，而脾肾感寒之所成也，夫肝心积热之
人，多食生冷，爱吃凉水，口之所纳，都聚于脾肾，寒温之气所伤，而肝心气变，血损于中
，此肝心之血，乘脾之虚，渗入大肠而赤痢者也，先服解寒气药，次吃暖脾药，其治之如反
掌尔，三曰赤白痢者，心肝血损，而脾之与胃，脏腑皆虚之所成也，脾气之虚，则肝气相乘
，胃气之虚，则停水滞谷，凝而为涕，肝气乘脾气，则肝心之热血，乘脾之虚，渗入于大肠
，与胃中之涕，相杂而下，此所以为赤白也，忽有赤少而白多，忽有赤多而白少，忽有赤白
相等，此受病有浅深，下药有轻重，当在临时度宜，随机应变，不可差之分毫也。愚初以谓
赤多而白少者，清利肝气，而轻暖脾胃也，白多而赤少者，微清肝心之气，而甚暖脾胃也，
赤白相等者，微利肝心，平益脾胃气而自愈，但发寒热为最重，方见痢方中，四曰水谷痢，
其人多饮凉水，忽餐生冷之所成也。所下之痢，悉皆黄色，忽时下白沫，治之之法，补暖脾
胃，而其疾自愈，五曰血痢，其人多淤怒，因更相殴击忽因焦热极，骤食生冷，脾胃损虚之
成也，所下之痢，多黯赤色，无寒热者，清其肝心之气，而疾自去矣，六曰疫毒痢者，毒瓦斯
所传，一坊一境，家家户户，更相染易，无有不病，凡下痢之时，忽先发寒热，忽先转数行
，忽生冷所伤，因而下痢，所下之利浑是赤色，浓如脓涕，忽时半盏下浓血，腹中刺痛，忽
心中烦躁，三焦痞隔，全不思食，此名为疫毒痢也。然则疫毒所主五脏，从何而得，经言，
春若伤阳，夏必人多泻痢，此疫毒之根，先受之于肝也。
夫春气本和，而反伤于热，此阳气所胜，肝家受热，而其气有余者也，经言五行受病，
必先传其所胜，则肝之得病，必先传之与脾，而世人于夏月之间，多食生冷，伤损脾气，脾
气虚，肝邪得以乘之，而脾受肝邪，伏而不动，莫能消水化谷，此疫毒之痢，必先转数行，
而后有赤痢之变也，先转数行者，脾受邪而脾已生病也，后有赤痢之变者，肝之血热乘脾之
虚，渗入大肠，而为赤痢也，中间忽有赤白相等者，此肝之毒血，杂胃中之寒涕也，若发寒
热，方见痢方中，有白少而赤多；或有白多而赤少，肝之邪毒，有轻重之不等也，七曰休息
痢者，盖患痢之人，其治痢之时，不能解肝邪，而肝家余毒之所成也，脾脏久受肝邪，则不
能强健消化水谷，是毒痢之所下，缠绵久远而不较，此所以为休息也，八曰小儿痢者，盖小
儿肝受热，而相刑于脾之所成也，肝之刑脾，则所下之痢，全是赤色，或赤白相杂，至脾之
自受疳气，则骨肉消瘦，所下之痢，多黄涕白沫，少有赤色相杂也，如此数端，亦治痢之大
略而已，至于医道之渊微，愚不能知其妙。
荆芥穗、麻黄（去除根部）、薄荷、羌活（切成丝，各三分）、牵牛子（半两）。
以上药材细捣成粉末，每次服用二钱，饭后，煎煮生姜和薄荷汤来调服，连同药渣一起喝；如果是大便秘结且有内热，痰液胶着满口，咽喉吞咽药物不畅，只需滤去药渣服用，等到风气稍通利后，再连同药渣一起服用。如果大便完全秘结不通，就立即使用大黄一分，半夏三铢，牵牛子一两半，共三味药，捣碎过筛成粉末，混合在一起，每次服用上述药末三钱，牵牛子等药末三钱，共计六钱，滴入熟水，制成梧桐子大小的丸剂，作为一服的量，在巳时或午时，用葱汤送下；如果大便仍然不通，忽然感觉肛门中有粪便堵塞不下，就立即使用皂角、牵牛子两味药，捣碎过筛成细末，装入笔管中，纳入肛门内，吹入药粉，剪去指甲，用手指在肛门内拨动以取出干硬粪便。
痢疾这种病，世人患病的很多，然而医书方册中所记载的，从未有过必定有效的方子；古人所谈论的，也从未有过卓越深刻的理论。在服药进补之间，世人因此夭折横死者，不知有多少。这是圣人所制定的名方非常奇妙，后来的学医者，不能通过思考而自行领悟其中的道理。如果现在有人得到一方名药，自认为是神传圣惠，疗效不可测度，然而有一个人服用后病情减轻，也不能断定其必然有效，这就是我认为医书方册中从未有过必定有效方子的原因。将赤色痢疾视为热证，将白色痢疾视为寒证，这是医者的惯常说法，万口一词，这也是我认为古人所谈未曾有卓越深刻理论的原因。为什么呢？认为赤色是热，白色是冷，赤白相间是冷热不调，这仅仅知道大概纲领，而痢疾有变化轻重之别，只知其粗浅而不知其详细，知其一不知其二罢了。痢疾作为一种疾病，一个名称却包含八种类型：一是白痢，二是赤痢，三是赤白痢，四是水谷痢，五是血痢，六是疫毒痢，七是休息痢，八是小儿疳痢。这些皆因致病原因不同，治疗方法不得不有所差异。探究其详情并论述之，那么痢疾这种病，虽然变化轻重不同，但最终都归结于脾气的虚弱而已。
万物没有土就不能生长，五行没有土就不能承载，五脏没有脾就不能滋养。脾是中州的土，能消化腐熟水谷，将滋味输送到肌肤，将糟粕传导至大肠。脾脏温和，如果其他脏腑有冷热不调的情况，就会自己产生其他疾病，而不会形成痢疾。因此，赤痢虽然是热证，根本原因在于脾肾的虚弱；赤白相杂，虽然是冷热不调，但也有轻重之别。比如现在人患赤痢，先出现几次腹泻，然后才转变为赤痢，如果认为赤痢就是热证，怎么会有先腹泻的说法呢？认为赤白相间是冷热不调，但又存在赤少白多、赤多白少的情况，难道没有轻重的区别吗？这个病有变化的不同，我得以将其根源命名并论述它。
一是白痢，是由于五脏受寒，脾胃极度虚弱所形成的。病情严重的，排便如鸡蛋白、如鱼脑浆状，这是肾脏受到损伤的表现，应立即用补脾肾的药来温暖它，加上舶上硫黄丸，无论多少剂量，空腹即服，以停止排便为限度。因为病势严重，治疗不可延误时机。
二是赤痢，是三焦热血有余，而脾肾感受寒邪所形成的。凡是肝心积热的人，多吃生冷食物，爱吃凉水，入口的食物都聚集在脾肾，被寒温之气所伤，导致肝心之气变化，血液在中焦受损。这是肝心之血，趁着脾虚，渗入大肠而形成赤痢。先服用解除寒气的药，其次服用温暖脾脏的药，治疗起来易如反掌。
三是赤白痢，是心肝血液受损，而脾与胃脏腑皆虚所形成的。脾气虚弱，则肝气乘虚侵袭；胃气虚弱，则停水滞留谷物，凝结而成涕。肝气乘袭脾气，则肝心的热血，趁着脾虚，渗入大肠，与胃中的涕混杂而下，这就是赤白相间的原因。有时赤少白多，有时赤多白少，有时赤白相等，这是因为受病有深浅之分，下药有轻重之别，应当根据当时情况适宜处理，随机应变，不可差错分毫。我起初认为赤多白少者，应清利肝气，轻微温暖脾胃；白多赤少者，轻微清利肝心之气，强烈温暖脾胃；赤白相等者，轻微疏利肝心，平和补益脾胃之气即可自愈。但出现寒热症状最为严重，详见治痢方中。
四是水谷痢，是因为人多饮凉水，突然进食生冷所形成的。所下的痢疾全是黄色，偶尔时下白沫，治疗方法是补暖脾胃，疾病自然痊愈。
五是血痢，是因为人多郁怒，互相殴打，忽然因焦热极盛，骤然进食生冷，导致脾胃损伤虚弱所形成的。所下的痢疾多为暗红色，没有寒热症状的，清利肝心之气，疾病自然去除。
六是疫毒痢，是由毒瓦斯传播，一坊一境，家家户户，互相传染，无不患病。凡是在下痢的时候，忽然先发寒热，或者先转泻数次，或者因生冷所伤因而下痢，所下的痢疾完全是赤色，浓稠如脓涕，偶尔半盏下浓血，腹中刺痛，忽然心中烦躁，三焦痞塞阻隔，完全不想吃东西，这叫做疫毒痢。那么疫毒主要影响五脏，是从哪里得到的呢？经书说，春天如果伤阳，夏天必定很多人患泻痢，这是疫毒的根源，先受之于肝。
春天的气本应温和，反而被热邪所伤，这是阳气过胜，肝脏受热，而其气有余。经书说，五行受病，必须先传其所克制的脏器，那么肝脏得病，必须先传给脾。而世人在夏季之间，多吃生冷，损伤脾气，脾气虚弱，肝邪得以乘虚侵袭，脾受肝邪，潜伏而不活动，不能消水化谷，这就是疫毒痢，必须先转泻数次，然后才有赤痢的变化。先转泻数次，是脾受邪而脾已经生病；后有赤痢的变化，是肝的血热乘着脾虚，渗入大肠，而形成赤痢。中间忽然有赤白相等的，这是肝的毒血，夹杂胃中的寒涕。如果发寒热，详见痢方中。有白少而赤多；或有白多而赤少，这是肝的邪毒，有轻重的不等同。
七是休息痢，大概是患痢疾的人，在治疗痢疾时，不能解除肝邪，而由肝家余毒所形成的。脾脏长久受肝邪侵袭，则不能强健消化水谷，所以毒痢所下的症状，缠绵久远而不能好转，这就是所谓的休息。
八是小儿痢，大概是小儿肝脏受热，而相刑于脾所形成的。肝刑脾，则所下的痢疾，全是赤色，或赤白相杂。至于脾自身受疳气，则骨肉消瘦，所下的痢疾，多黄涕白沫，少有赤色相杂。像这几方面，也是治痢的大略而已。至于医道的深奥微妙，我不能知晓其妙处。
Jingjie Sui (Schizonepetae Spica), Mahuang (Ephedrae Herba, 麻黄 - removed roots), Bohe (Menthae Haplocalycis Herba), Qianghuo (Notopterygii Rhizoma et Radix, 羌活 - sliced into threads, each 3 fen), Qianniu (Pharbitidis Semen, 牵牛子 - 0.5 liang).
The above herbs are finely pounded into powder. Each dose is 2 qian. After meals, decoct Shengjiang (Zingiberis Rhizoma Recens, 生姜) and Bohe in water to take the medicine with the liquid, including the dregs. If there is constipation with internal heat, sticky phlegm filling the mouth, and discomfort swallowing medicine in the throat, only the filtered liquid should be taken. Once the pathogenic wind qi is slightly relieved, then take it with the dregs. If stool is completely constipated and cannot pass, immediately use Dahuang (Rhei Radix et Rhizoma, 大黄 - 1 fen), Banxia (Pinelliae Rhizoma, 半夏 - 3 zhu), and Qianniu (Pharbitidis Semen, 牵牛子 - 1.5 liang). These three herbs are crushed and sifted into powder, mixed together. For each dose, take 3 qian of the aforementioned powder and 3 qian of the Qianniu mixture, totaling 6 qian. Add boiled water to form pills the size of wutong seeds as one dose. Take at Si or Wu hours (9 AM - 1 PM) with Congtang (Scallion Decoction). If stool still does not pass, and suddenly feces are blocked in the anus, immediately use Zaojiao (Gleditsiae Fructus, 皂角) and Qianniu (Pharbitidis Semen, 牵牛子). Crush and sift them into fine powder, load into a pen tube, insert into the anus, and blow the powder in. Trim fingernails and use fingers to manipulate inside the anus to extract dry feces.
Dysentery (Li Ji, 痢疾) is a disease suffered by many people, yet no formula recorded in medical texts has ever been absolutely effective; nor have ancient discussions provided profound theories. Countless people die prematurely due to improper medication. This shows that the famous formulas created by sages are truly miraculous, and later practitioners fail to comprehend their essence through reflection. If someone today obtains a famous formula, believing it to be divinely transmitted and infallible, yet one person's condition improves after taking it, one cannot guarantee its universal efficacy. This supports my view that no formula in books is absolutely effective. The common medical assertion that red dysentery indicates heat and white dysentery indicates cold is a uniform opinion among physicians. This supports my view that ancient discussions lack profound theory. Why? Because identifying red as heat, white as cold, and mixed as cold-heat disharmony only grasps the general outline. Dysentery varies in severity and presentation; knowing only the basics without details means knowing one aspect but missing another. Dysentery, under one name, encompasses eight types: 1. White Dysentery (Bai Li, 白痢); 2. Red Dysentery (Chi Li, 赤痢); 3. Red-and-White Dysentery (Chi Bai Li, 赤白痢); 4. Water-and-Grain Dysentery (Shui Gu Li, 水谷痢); 5. Blood Dysentery (Xue Li, 血痢); 6. Epidemic Toxin Dysentery (Yi Du Li, 疫毒痢); 7. Resting Dysentery (Xiu Xi Li, 休息痢); 8. Pediatric Malnutrition Dysentery (Xiao Er Gan Li, 小儿疳痢). These differ in etiology and thus require different treatments. Analyzing them in detail reveals that despite variations in severity, all ultimately归结 to Spleen Qi deficiency (Pi Qi Xu, 脾气虚).
All things cannot grow without Earth; the Five Elements cannot be sustained without Earth; the Five Zang organs cannot be nourished without the Spleen. The Spleen is the Earth of the Central Region, capable of transforming and transporting food and fluids, distributing flavors to the skin and muscles, and conveying waste to the Large Intestine. When the Spleen is warm and mild, other organs may suffer from cold-heat disharmony and develop other diseases, but not dysentery. Therefore, although Red Dysentery is a heat syndrome, its root lies in Spleen and Kidney deficiency. Mixed red and white indicates cold-heat disharmony, but also varies in severity. For instance, some patients experience diarrhea several times before developing red dysentery. If red dysentery were purely heat, why would initial diarrhea occur? Although mixed red/white suggests cold-heat disharmony, the ratio of red to white varies (more red than white, or vice versa), indicating differences in severity. I categorize these variations by their origin.
First, White Dysentery arises from Cold injuring the Five Zang organs and extreme Spleen-Stomach deficiency. Severe cases present with stools resembling egg whites or fish brain paste, indicating Kidney injury. Immediately treat with formulas warming and tonifying Spleen and Kidney, such as Boshang Liuhuang Wan (Bo Shang Liu Huang Wan, 舶上硫黄丸 - imported Sulfur Pill), taken on an empty stomach until defecation stops. Due to the severity, timely treatment is crucial.
Second, Red Dysentery results from excess hot blood in the San Jiao combined with Cold invading the Spleen and Kidney. Individuals with accumulated Heat in the Liver and Heart who consume excessive raw/cold foods or cold water accumulate this burden in the Spleen and Kidney. The Cold-Warm qi injures them, altering Liver-Heart qi and damaging blood in the Middle Jiao. Liver-Heart hot blood, taking advantage of Spleen deficiency, infiltrates the Large Intestine, causing Red Dysentery. Treat first with formulas resolving Cold, then with formulas warming the Spleen. Treatment is straightforward.
Third, Red-and-White Dysentery results from damaged Heart-Liver blood and deficiency of both Spleen and Stomach. Spleen deficiency allows Liver Qi to invade; Stomach deficiency causes fluid retention and grain stagnation, condensing into mucus. Liver Qi invading Spleen allows Liver-Heart hot blood to infiltrate the Large Intestine, mixing with Stomach mucus, resulting in red-and-white discharge. Variations in color ratios reflect depth of pathology and dosage needs. One must adapt dynamically. Initially, I believed more red than white requires clearing Liver Qi and mildly warming Spleen/Stomach; more white than red requires mildly clearing Heart/Liver and strongly warming Spleen/Stomach; equal amounts require mildly draining Heart/Liver and balancing Spleen/Stomach Qi. However, presence of Chills and Fever indicates severe cases (see specific formulas).
Fourth, Water-and-Grain Dysentery is caused by drinking cold water and eating raw/cold foods. Stools are yellow with occasional white foam. Treatment involves warming and tonifying Spleen and Stomach for spontaneous recovery.
Fifth, Blood Dysentery is caused by anger/stress, physical trauma, extreme heat, and sudden consumption of raw/cold foods, damaging Spleen-Stomach. Stools are dark red without chills/fever. Clear Liver-Heart Qi for resolution.
Sixth, Epidemic Toxin Dysentery spreads via toxic vapors within communities. Symptoms include initial chills/fever, frequent loose stools, or onset after cold injury. Stools are entirely red, thick like pus/mucus, sometimes containing half a cup of thick blood, with stabbing abdominal pain, restlessness, San Jiao blockage, and loss of appetite. Etiologically, classics state spring Yang injury leads to summer dysentery; the root originates in the Liver. Spring Qi should be mild but is injured by Heat, causing Liver Heat excess. According to Five Element transmission, Liver disease transmits to Spleen. Summer consumption of raw/cold foods damages Spleen Qi, allowing Liver Pathogen to invade. Spleen becomes stagnant, unable to transform fluids/grains. Thus, epidemic dysentery begins with loose stools (Spleen pathology) followed by red dysentery (Liver Hot Blood invading deficient Spleen and entering Large Intestine). Mixed colors indicate Liver Toxic Blood mixing with Stomach Cold Mucus. Severity varies.
Seventh, Resting Dysentery occurs when Liver Pathogens are not fully resolved during treatment, leaving residual toxins. Long-term Liver invasion weakens Spleen digestion, leading to chronic, lingering symptoms.
Eighth, Pediatric Malnutrition Dysentery results from Liver Heat punishing the Spleen. Stools are pure red or mixed. If Spleen suffers from Malnutrition Qi, emaciation occurs, and stools contain yellow mucus/white foam with little red.
These points summarize major dysentery treatments. The profound subtleties of medical Dao remain beyond my comprehension.