痢将两月。目微黄。舌白口干唇燥赤。腹满。按之软。竟日小便不通。病者自
述肛门窒塞。努挣不已。仅得迸出粘积点滴。若有稀粪。自必倾肠而多。思夏秋
间暑湿内着为痢。轩岐称曰滞下。谓滞着气血。不独食滞一因。凡六腑属阳。以
通为用。五脏为阴。藏蓄为体。先泻后痢。脾传肾则逆。即土克水意。然必究其何
以传克之由。盖伏邪垢滞。从中不清。因而下注矣。迁延日久。正气因虚。仲景论
列三阴。至太阴篇中。始挈出腹满字样。脾为柔脏。惟刚药可以宣扬驱浊。但今
二肠窒痹。气不流行。理中等法。决难通腑。考内经二虚一实者治其实。开其一
面也。然必温其阳。佐以导气逐滞。欲图扭转机关。舍此更无他法。
制附子 生浓朴 木香 制大黄 炒黑大茴
舌白渴不欲饮。心腹热。每痢必痛。肛坠。痢又不爽。微呕有痰。口味有变。头
中空痛。两颊皆赤。此谷气蒸湿。热郁于肠胃。清浊交混。忽加烦躁。难鸣苦况。法
当苦寒泄热。辛香流气。渗泄利湿。盖积滞有形。湿与热本无形质耳。
川连 黄芩 郁金 浓朴 猪苓 槐米 秦皮
夏秋痢疾。固是湿热伤气。脾胃气滞。后重里急不爽。古方香连丸。取其清
里热。必佐理气。谓气行斯湿热积聚。无容留矣。知母生地。滋阴除热。治阴分阳
亢之火。与痢门湿热大异。盖滋则呆滞。气钝窒塞。宜乎欲便不出。究竟湿热留
邪仍在。附桂热燥。又致肛坠。痛如刀割。理中益气。东垣成法。仅仅升举下焦清
阳。未能直透肠中。再用大黄重药。兼知母生地等味。更令伤及下焦。书义谓诸
痢久都属肾伤。小腹坠忌冷。显然是下症。议用升阳。亦须下治。
人参 茯苓 泽泻 炙草 防风根 羌活 细辛 生姜 大枣
暑必挟湿。伤在气分。古称滞下。此滞字非停滞饮食。言暑湿内侵。腑中流
行阻遏而为滞矣。消导升举温补。暑邪无有出路。胸痞不饥不食。粘腻未已。而
肛门沉坠里结。三焦皆受邪蒸。上下浑如两截。延为休息痢疾。缠绵展转。岂旦
晚骤愈之病。
淡干姜 生姜 小川连 人参 枳实
泻痢两月。肢高浮肿。高年自属虚象。但胸脘痞闷。纳谷恶心。每利必先腹
痛。是夏秋暑热郁滞于中。虚体挟邪。焉有补涩可去邪扶正之理。恐交节令变
症。明是棘手重症矣。
人参 茯苓 川连 淡干姜 生白芍 枳实
脉右数左细数。面垢舌燥。白苔点点。肌肤甲错。左胁动气。伏暑当秋凉而
发。初病如疟。当从苦辛寒法。里邪炽烈。变为下痢。胃津液劫。阴液大耗。昔贤于
热病受涸。急以救阴为务。苟胃关得苏。渐以冀安。否则犯喻氏所指客邪内陷。
液枯致危之戒矣。
人参 生地 乌梅 炙草 麦冬 木瓜
泻痢起于长夏。医谓时令湿热。胃苓汤芩芍法。固非谬讹。因高年肾阳肝
阴先亏。使客气内扰。阻遏中流。乏砥柱坐镇。致狂澜滔天耳。病经两旬不减。重
阴无阳。验诸神识甚清。其外邪为少。而内损为多。八脉无权。下无收摄。漏卮不
已。理必生阳泄。下焦冷。此皆阴阳二气绝微。治病则夯。治本则宜。非置之不理。
实究天人而已。
人参 鹿茸 炒黑当归 生杜仲 生沙苑 茯苓
初起无寒热。即泻痢呕恶不食。乃噤口痢重病。夫暑邪之伤。由口鼻吸气
而入。邪与水谷交混。蒸变湿热。酿为积滞脓血。肠胃气窒。欲解不能通爽。遂致
里急后重。香连苦辛。理气导湿清热。初用颇是。皆缘劳碌之人。非膏粱温养之
质。淡薄积劳。中气易伤。四十日来。积少痛缓。医称病解。而食不下咽。不知饥饱。
诊得脉弦形衰。舌白。不渴饮水。日泻数行。全是胃倒气夺。中宫损极。下关不摄。
谷不能咽。焉能承受汤药。药味气劣。胃衰必恶。久痢久泻。务在能食。古人非醒
脾胃。即安肾摄纳。再询粉浆下咽。或呛或噎。议以上脘宜通其清阳。下焦当固
其滑脱。仿古方中参苓白术散末。当以米饮日服二次。间以不腻滑之物。食些
少勿多。以示胃之所喜为补。必须胃气渐苏。方可转危为安。
人参 焦术 茯苓 炙草 炒扁豆 苡仁 桔梗 砂仁 炮姜炭 肉豆蔻
邪陷疟后变痢。伤及厥阴。症见气上撞心。饥不能食。干呕腹痛。全是肝病。
肝为至阴之脏。相火内寄。仲景治法。不用纯刚燥热之药。以肝为刚脏故也。今
正交土HT 。土木为雠。五日内未为稳当。
人参 炒当归 炒白芍 炒乌梅肉 茯苓 淡吴萸 生香附汁 真北秦皮
当年痢久。用三神丸得效。是脾肾两困。兼由气分之滞。体质阳虚。遇冷病
加。今病起长夏。小水不通。必系夏热阻其宣化。久则气血凝着。而为肠红。先与桂苓甘露饮。分消其湿。
于术 茯苓 猪苓 泽泻 滑石 桂心
痢疾持续了两个月。眼睛微微发黄，舌苔白，口干，嘴唇干燥且色红，腹部胀满，按压时感觉柔软。整天小便不通畅。病人自述肛门有堵塞感，用力努挣不止，只能排出少量粘稠的脓血便。如果有稀粪，必然会倾泻而出且量多。考虑是夏秋之间暑湿内蕴导致的痢疾，《黄帝内经》称之为“滞下”，意指气血阻滞，不仅仅是食积这一种原因。六腑属阳，以通畅为用；五脏属阴，以藏蓄为本。先腹泻后转为痢疾，是脾病传肾，属于逆证，即土克水的道理。然而必须探究其传变克制的缘由，大概是伏邪垢滞，中焦不清，因而向下注泄。病程迁延日久，正气因虚而受损。张仲景在论述三阴病时，到了太阴篇中，才提出腹满的症状。脾为柔脏，只有刚燥的药物才能宣发驱除浊邪。但如今大小肠闭塞不通，气机不流行，使用理中汤等温补方法，很难通利腑气。考察《内经》中“二虚一实者治其实”的原则，是打开一个突破口。然而必须温补阳气，佐以行气导滞的方法。想要扭转病情机关，除此别无他法。
舌苔白，口渴但不想喝水，心腹部发热，每次排便都疼痛，肛门下坠，痢疾排出不爽，轻微呕吐且有痰，口味改变，头部中空处疼痛，两颊发红。这是谷气蒸腾湿气，热邪郁结于肠胃，清浊之气交混。忽然加上烦躁，难以言说痛苦状况。治法应当用苦寒药泄热，辛香药行气，渗湿利水。因为积滞是有形的，湿与热原本是无形的。
夏秋季节的痢疾，固然是湿热伤及气分，导致脾胃气滞，出现里急后重、排便不爽。古方香连丸，取其清除里热，必须佐以理气药，认为气行则湿热积聚无处停留。知母、生地滋阴除热，治疗阴分阳亢之火，这与痢门湿热大不相同。因为滋腻药物会导致呆滞，气机钝涩闭塞，所以想要排便却排不出。究竟湿热留邪仍在，如果再用附子、肉桂等热燥药物，又会加重肛门下坠，疼痛如刀割。理中汤益气，是李东垣的成法，仅仅升举下焦清阳，未能直透肠中。再用大黄重药，兼用知母、生地等味，更会伤及下焦。书义说各种久痢都属于肾伤，小腹下坠怕冷，显然是下焦病症。议论使用升阳法，也必须结合下焦的治疗。
暑邪必定挟带湿气，损伤气分，古称滞下。这个“滞”字不是指停滞饮食，而是说暑湿内侵，腑中流行受阻遏而成为滞。消导、升举、温补的方法，使暑邪没有出路。胸膈痞闷，不想吃东西，粘腻症状未止，而肛门沉重下坠，里急后结，三焦都受到邪气熏蒸，上下仿佛隔绝。拖延成为休息痢疾，缠绵辗转，难道是一早晚能突然痊愈的病吗？
泻痢两个月，肢体浮肿。高龄之人自然属于虚象。但是胸脘痞闷，进食恶心，每次排便前必先腹痛，这是夏秋暑热郁滞于中焦。虚体挟带邪气，哪有通过补涩来祛邪扶正的道理？恐怕遇到节气变化会出现变症，明是棘手重症。
脉象右部数，左部细数，面色污垢，舌燥，白苔点点，肌肤甲错（皮肤粗糙如鳞甲），左胁下有动气。伏暑在秋凉时发作，初起像疟疾，应当从苦辛寒法治之。里邪炽烈，变为下痢，胃津液被劫夺，阴液大量消耗。昔贤在热病受涸时，急忙以救阴为要务。如果胃气得以复苏，渐渐期望平安，否则就会犯喻嘉言所指出的客邪内陷、液枯致危的戒律。
泻痢起于长夏，医生说是时令湿热，使用胃苓汤加芩芍法，固然没有错误。但因为高龄之人肾阳肝阴先已亏损，使得客气内扰，阻遏中流，缺乏砥柱中流的坐镇力量，导致狂澜滔天。病情经过二十天不减，重阴无阳，验证神识非常清醒，外邪较少而内损较多。八脉无权，下焦无收摄能力，漏卮（比喻漏洞）不已，理必生阳泄，下焦冷。这都是阴阳二气绝微，治病则显得笨拙，治本则适宜。不是置之不理，实在是探究天人关系罢了。
初起没有寒热，就出现泻痢呕恶不食，这是噤口痢的重病。暑邪的伤害，由口鼻吸气而入，邪气与水谷交混，蒸变湿热，酿为积滞脓血，肠胃气窒，想要解除却不能通爽，遂致里急后重。香连丸苦辛，理气导湿清热，初用颇为合适。都是因为劳碌之人，不是膏粱温养的体质，淡薄积劳，中气容易受伤。四十天来，积少痛缓，医生称病解，但食物咽不下，不知饥饱。诊得脉弦形衰，舌白，不渴饮水，每天腹泻数次，全是胃气倒败，中宫损伤至极，下关不摄，谷物不能吞咽，怎么能承受汤药？药味气劣，胃衰必然厌恶。久痢久泻，务必在于能吃饭。古人要么醒脾胃，要么安肾摄纳。再询问粉浆下咽，或呛或噎。议论以上脘宜通其清阳，下焦当固其滑脱。仿照古方参苓白术散末，应当用米饮每天服用两次，间以不腻滑的食物，吃少许不要多吃，以示胃所喜欢的即为补益。必须胃气渐渐复苏，才可以转危为安。
人参、焦白术、茯苓、炙甘草、炒扁豆、苡仁、桔梗、砂仁、炮姜炭、肉豆蔻。
邪气陷入疟疾后变成痢疾，伤及厥阴，症状见气上撞心，饥饿但不能进食，干呕腹痛，全是肝病。肝为至阴之脏，相火内寄，张仲景治法，不用纯刚燥热的药物，因为肝为刚脏的缘故。现在正值土壅木郁，土木为仇敌，五日内尚未稳妥。
人参、炒当归、炒白芍、炒乌梅肉、茯苓、淡吴茱萸、生香附汁、真北秦皮。
当年痢疾日久，使用三神丸见效，是脾肾两困，兼由气分之滞，体质阳虚，遇冷病加重。现在病起于长夏，小便不通，必定是夏热阻其宣化，久了则气血凝着，而为肠红。先给予桂苓甘露饮，分消其湿。
Dysentery has persisted for two months. The eyes are slightly yellow, the tongue coating is white, there is dry mouth, and the lips are dry and red. The abdomen is full and distended, feeling soft upon palpation. Urination is obstructed throughout the day. The patient reports a sensation of blockage in the anus, straining incessantly, only able to expel small drops of sticky pus and blood. If there were loose stool, it would surely pour out in large quantities. It is considered that during summer and autumn, damp-heat from summer heat and dampness was internalized causing dysentery. *Huangdi Neijing* (The Yellow Emperor's Classic of Internal Medicine) calls this "Zhi Xia" (Stagnant Downward Flow), meaning stagnation of Qi and Blood, not solely due to food stagnation. The Six Fu organs belong to Yang and function through unobstructed flow; the Five Zang organs belong to Yin and function through storage. Diarrhea preceding dysentery indicates Spleen disease transmitting to Kidney, which is a counter-flow pattern, following the principle of Earth overcoming Water. However, one must investigate the reason for this transmission and overcoming. It is likely that latent pathogens and turbid residues failed to clear from the Middle Jiao, thereby flowing downward. Prolonged illness leads to deficiency of Righteous Qi. Zhang Zhongjing, in discussing the Three Yin diseases, specifically mentions abdominal fullness in the Taiyin chapter. The Spleen is a soft organ; only pungent-dry drugs can disseminate and drive out turbidity. But now, the intestines are blocked, and Qi circulation is stagnant. Methods like Lizhong Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) for warming and tonifying will hardly unblock the Fu organs. Examining the *Neijing* principle that "in cases of two deficiencies and one excess, treat the excess," this opens a pathway. However, one must warm the Yang and assist with Qi-moving and stagnation-dispelling methods. To reverse the critical juncture of the disease, there is no other method.
Prepared Fuzi (Aconite Lateral Root), Raw Houpo (Magnolia Bark), Muxiang (Costus Root), Prepared Dahuang (Rhubarb Rhizome), Stir-fried Black Dachui (Anise Fruit).
Tongue coating is white, thirst exists but there is no desire to drink. Heat in the heart and abdomen. Pain occurs with every bowel movement. Anal prolapse sensation. Dysentery discharge is unsatisfactory. Mild vomiting with phlegm. Taste perception has changed. Hollow pain in the head. Both cheeks are red. This is grain qi steaming dampness, with heat郁结 (stagnating) in the stomach and intestines, mixing clear and turbid energies. Suddenly adding irritability makes it hard to describe the suffering. The method should employ bitter-cold herbs to drain heat, pungent-aromatic herbs to circulate Qi, and diaphoretic/damp-draining herbs to promote urination. Because accumulated stagnation is有形 (substantial/formidable), while dampness and heat are inherently无形 (formless/intangible).
Chuanlian (Coptis Rhizome), Huangqin (Scutellaria Root), Yujin (Turmeric Tuber), Houpo (Magnolia Bark), Zhuling (Polyporus), Huaimi (Sophora Flower), Qinpi (Ashbark Fringe Tree Bark).
Summer and autumn dysentery is indeed caused by damp-heat injuring Qi, leading to Spleen-Stomach Qi stagnation, resulting in tenesmus and unsatisfactory defecation. The ancient formula Xianglian Wan (Aromatic Coptis Pill) takes its effect from clearing interior heat, but must be assisted with Qi-regulating herbs, as moving Qi allows damp-heat accumulations no place to remain. Zhimu (Anemarrhena Rhizome) and Shengdi (Rehmannia Root) nourish Yin and clear heat, treating fire from Yin-deficiency with Yang-hyperactivity, which is very different from damp-heat in dysentery. Nourishing herbs cause stagnation and dull Qi obstruction, hence the inability to pass stool. Ultimately, the pathogenic damp-heat remains. Using hot-dry herbs like Fuzi (Aconite) and Rougui (Cinnamon Bark) would again cause anal prolapse and knife-like pain. Lizhong Tang tonifies Qi, a established method of Li Dongyuan, merely lifting the clear Yang of the Lower Jiao, failing to penetrate directly into the intestines. Using heavy doses of Dahuang combined with Zhimu and Shengdi would further injure the Lower Jiao. Textual principles state that all chronic dysenteries belong to Kidney injury. Lower abdominal prolapse fearing cold is clearly a Lower Jiao syndrome. Discussing the use of Yang-lifting methods requires combining treatment of the Lower Jiao.
Renshen (Ginseng Radix), Fuling (Poria), Zexie (Alisma Rhizome), Zhi Cao (Honey-fried Licorice Root), Fangfeng Gen (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), Xixin (Asarum Root), Shengjiang (Fresh Ginger), Dazao (Jujube Fruit).
Summer heat inevitably carries dampness, injuring the Qi level. Ancient texts call this "Zhi Xia." The character "Zhi" (stagnation) does not refer to food stagnation, but rather summer-heat and dampness invading internally, obstructing the flow in the Fu organs. Digestive-promoting, lifting, and warming-tonifying methods leave no exit for the summer-heat pathogen. Chest oppression, lack of appetite, and sticky sensations persist, along with heavy anal prolapse and internal binding. The Triple Burner is affected by pathogenic steaming, separating upper and lower aspects. Prolonging this becomes Resting Dysentery (Xixie Lizhi), lingering and turning over. Is this a disease that can be cured suddenly in a morning or evening?
Dan Jiangyan (Light Dried Ginger), Shengjiang (Fresh Ginger), Xiao Chuanlian (Small Coptis Rhizome), Renshen (Ginseng Radix), Zhishi (Immature Bitter Orange).
Diarrhea and dysentery for two months, limb edema. Advanced age naturally implies a deficiency pattern. However, chest and epigastric oppression, nausea upon eating, and abdominal pain preceding each stool indicate summer-heat and dampness stagnating in the Middle Jiao. A deficient constitution carrying pathogens precludes the logic of using astringents to dispel pathogens and support righteousness. Fear of symptom changes upon seasonal transitions indicates a difficult and severe case.
Renshen (Ginseng Radix), Fuling (Poria), Chuanlian (Coptis Rhizome), Dan Jiangyan (Light Dried Ginger), Sheng Baishao (Raw White Peony Root), Zhishi (Immature Bitter Orange).
Pulse is rapid on the right, fine and rapid on the left. Face is dirty, tongue is dry, dotted white coating. Skin is rough like fish scales (Jiacuo). Qi movement in the left hypochondrium. Latent summer-heat erupts in autumn coolness. Initial presentation resembles malaria; treat with bitter-pungent-cold method. Interior pathogens are fierce, transforming into dysentery. Stomach fluids are depleted, Yin fluids largely consumed. Past sages, when heat diseases caused depletion, urgently prioritized saving Yin. If the Stomach gate revives, peace may gradually be hoped for. Otherwise, one violates Yu Jiayan's warning against pathogenic invasion sinking inward and crisis due to fluid exhaustion.
Renshen (Ginseng Radix), Shengdi (Rehmannia Root), Wumei (Mume Fruit), Zhi Cao (Honey-fried Licorice Root), Maidong (Ophiopogon Tuber), Mugua (Chaenomeles Fruit).
Dysentery began in late summer. Physicians attributed it to seasonal damp-heat. Weiling Tang (Stomach Regulating Decoction) with Huangqin and Shaoyao is not erroneous. However, due to advanced age, Kidney Yang and Liver Yin were already deficient beforehand. This allowed external pathogens to disturb internally, obstructing the middle, lacking a pillar to stabilize the raging waves. After twenty days without improvement, heavy Yin lacks Yang. Verifying that consciousness is clear suggests minor external pathogens and major internal damage. The Eight Extraordinary Vessels lack authority, Lower Jiao lacks retention. Leakage continues. Reasonably, Yang generation leakage and Lower Jiao cold occur. These are signs of extreme subtlety in Yin and Yang Qi. Treating symptoms is clumsy; treating the root is appropriate. Not ignoring it, but truly investigating Heaven and Humanity.
Renshen (Ginseng Radix), Lurong (Deer Antler Glue), Stir-fried Black Danggui (Angelica Sinensis Radix), Sheng Duzhong (Eucommia Bark), Sheng Shayuan (Astragalus Complanatus Seed), Fuling (Poria).
Initial onset had no chills or fever, immediately presenting with diarrhea, dysentery, vomiting, and anorexia. This is a severe case of Jin Kou Li (Closed-Mouth Dysentery). Summer-heat pathogen enters via nose and mouth breathing. Pathogens mix with food and water, steaming into damp-heat, brewing into accumulated pus and blood. Intestinal Qi is blocked, unable to resolve smoothly, leading to tenesmus. Xianglian (Aromatic Coptis) is bitter-pungent, regulating Qi, guiding dampness, and clearing heat. Initially used appropriately. All because the patient is laborious, not of a rich diet constitution. Thin diet and accumulated fatigue easily injure Middle Qi. For forty days, accumulation decreased, pain eased. Physician declared recovery. Yet food cannot be swallowed, hunger and satiety unknown. Pulse is wiry, form is emaciated, tongue is white, no thirst for water. Daily diarrhea several times. Entirely Stomach Qi collapse, Middle Palace severely damaged, Lower Gate fails to retain. Grain cannot be swallowed, how can it tolerate decoctions? Medicinal taste is inferior, weak Stomach rejects it. Chronic dysentery and diarrhea require ability to eat. Ancients either awakened Spleen and Stomach or anchored Kidney to retain. Further inquiry: rice water causes choking or blocking. Discussion: Upper Jiao should unblock clear Yang, Lower Jiao should secure slippage. Imitate ancient Shenling Baizhu San powder, take twice daily with rice water. Intermittently consume non-greasy foods in small amounts to show what the Stomach likes is tonification. Must wait for Stomach Qi to gradually revive before turning danger to safety.
Renshen (Ginseng Radix), Jiao Zhu (Charred Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhi Cao (Honey-fried Licorice Root), Chao Bian Dou (Stir-fried Lablab Bean), Yiren (Coix Seed), Jiegeng (Platycodon Root), Sharen (Amomum Fruit), Pao Jiangtan (Charred Ginger), Roudoukou (Nutmeg).
Pathogen sank after malaria, transforming into dysentery, injuring Jueyin. Symptoms include Qi rushing up to strike the heart, hunger but inability to eat, dry heaving, and abdominal pain. Entirely Liver pathology. Liver is a Zang organ of extreme Yin, housing Minister Fire. Zhang Zhongjing's treatment avoids purely pungent-dry-hot drugs because the Liver is a rigid organ. Now Earth is congested, Wood is constrained. Earth and Wood become enemies. Within five days, it is not yet stable.
Renshen (Ginseng Radix), Chao Danggui (Stir-fried Angelica Sinensis Radix), Chao Baishao (Stir-fried White Peony Root), Chao Wumei Rou (Stir-fried Mume Flesh), Fuling (Poria), Dan Wuyu (Light Evodia Fruit), Sheng Xiangfu Zhi (Raw Cyperus Juice), Zhen Bei Qinpi (Authentic Northern Ashbark Fringe Tree Bark).
In previous years, chronic dysentery responded to Sanshen Wan (Three Divine Pills). This indicated dual Spleen-Kidney distress, compounded by Qi-level stagnation. Constitution is Yang-deficient, worsening with cold. Now disease begins in late summer, urine is obstructed. Likely summer heat obstructed diffusion and transformation. Over time, Qi and Blood coagulated, causing intestinal bleeding. First administer Guiling Ganlu Yin (Cassia Twig, Polyporus, and Talcum Decoction) to separate and eliminate dampness.
Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome), Huashi (Talcum), Guixin (Cinnamon Twig).