论曰∶若下利清水，其色赤黄，或米谷不化，但欲饮冷，时时呕逆，小便不利，得热则
极，心胸烦躁，脉虚大而数。此由乘虚，热入于胃，凑渗下焦，津液不分，并于大肠，谓之
协热下利。先用五苓散利小便，次以玉粉丹、四味阿胶丸。
蛤粉 硫黄（等分）
上同研细，白面糊和丸如梧桐子大，饮下五十丸。
黄连 赤茯苓（去皮，二两） 芍药（三两） 阿胶（炒燥，一两）
上先将三味为末，却以好醋熬阿胶成稀膏，丸如梧桐子大，饮下三十丸。
夫赤白痢疾者，古人名之滞下是也。究疾之源，皆因外感五邪之气，内伤生硬、冷热之
食。其证不一，有赤、有白、有赤白相杂，有冷、有热，有虚、有实。大抵四时皆以胃气为
本，未有不因外感寒、暑、燥、湿、风之气而伤于脾胃，脾胃既亏，而又内伤饮食，饮食不
能克化，致令积滞而成滞下。古人云∶无积不成痢者，此也。经云∶春伤于风，夏生飧泄。
盖风喜伤肝，然春时肝木正旺而不受邪，反移气克于脾土。然脾既受克，又不能忌慎口腹，
恣食生冷、粘硬之物，致令脾胃不能克化，因此积滞。又夏、秋之间，或再感暑湿、风冷之
气，发动而成痢也。其证必先脐腹 痛，洞泄、水泻，里急后重，或有或无，或赤或白，或
赤白相杂，日夜无度。如有此证，不问冷热、虚实，但当先服神术散，可以发散风冷、寒湿
之气；次服五苓散，分利水谷；兼用加巴感应丸，温脾胃、去积滞；或六神丸，未有不安者
也。或曰∶虽古人有言，无积不成痢。亦不专以去积为先，岂有一岁之内，独于夏秋之间人
皆有积，而春冬无之？盖风邪入胃，木来胜土，不为暴下，则为痢疾，其神术散要药也。又
有一方，一郡之内，上下传染，疾状相似。或只有一家，长幼皆然；或上下邻里间相传染；
或有病同而证异；亦有证异而治同。或用温剂而安，或用凉药而愈。有如此等，是毒疫痢也
。治疫毒痢者，虽当察五运六气之相胜，亦不可狎泥此说。且如运气相胜，岂毒偏于一方、
一郡而独于一家、二家者乎？如有此证，当先察其虚实、冷热，首以败毒散，多加人参、
甘草、陈米、姜枣煎服；及三黄熟艾汤、黄连阿胶丸、五苓散、驻车丸，可选而用之。如
下痢赤多，或纯下鲜血，里急后重，大便不通，身体壮热，手足心热，大烦燥渴，腹胁胀痛，
小便赤涩，六脉洪大，或紧而数，或沉而实，此热痢也。宜白头翁汤及三黄熟艾汤、五苓散
，可选而用之。若风痢下血太过，宜用胃风汤加木香、黑豆煎服。若夏秋之间下痢，或赤或
白，或赤白相杂，脐腹 痛，里急后重，憎寒发热，心胸烦闷，燥渴引饮，呕逆恶心，小便
不利及五心烦热，六脉虚弱。此等脉证，正因伏暑而得此疾，宜服香薷散加黄连、甘草、当
归，酒水浓煎，沉令水冷，顿服。仍兼服酒蒸黄连丸，或小柴胡汤加人参煎服必愈。（沈内
翰云∶治痢之药极多，然无如此药之妙。盖小柴胡汤能治暑毒）如杂证一退，而痢尚未止，
则以四物汤加胶、艾煎服，以调阴阳，未有不安者也。如水谷不分，小便不利，宜用五苓散
，淡竹叶煎汤调服。如烦渴甚者，亦宜服之。若不明伏暑之证，但以脉虚而妄投硫、附、姜
、桂、丹石之药而杀之，深可叹息。若下痢纯白，状如鱼脑，脐腹冷痛，日夜无度，手足逆
冷；或有呕逆，全不入食，饮食欲温而恶冷，六脉微细。此由脏腑虚冷之极，宜木香散加服
四味理中汤及钟乳健脾丸。甚者，四肢逆冷，六脉沉绝。当一味峻补，兼灸气海、丹田二穴
，更以助胃之药，此守而不攻之意也。宜四顺附子汤、三建丹、白丹、加味参附汤、姜附汤
，皆可选用。如年尊虚弱之人，或素来禀受怯弱，亦宜以此法详酌调理。然大宜开胃、进
食为先，食可得入，则脾胃运化，糟粕便聚。糟粕既成，垢腻鲜血，瘀滞不患其不除矣。
如久痢不瘥，肠滑不禁，溏泄不止，诸药无效，方可施之涩肠止痢之剂。亦宜先以龙骨、肉
豆蔻、诃子、钟乳、胡粉之药。近人多用罂粟壳、地榆之属，然此物性太紧涩，能损胃气。
如少壮之人、壮健者服之，间奏奇效；若是疫毒、受暑受湿之证及年尊之人，或禀受怯弱
，服此莫不受其大害。若以因秘涩肠为先，则风寒、暑湿之邪，非惟涩而不去。而胃管闭而
不通，禁口不食，日见羸瘦。糟粕不入肠中，所患无由可除矣。若有此证，宜以参苓白术散
、四君子汤及以石莲、山药之剂，治之必愈。治痢欲投补药，必须有温通之意在焉！如四君
子汤、理中汤、十全汤加木香、白豆蔻、茯苓、官桂、浓朴之属，可以散风邪，可以分水道
，可以开胃管，可以治缠扰，可以通秘涩。此攻守之意两全也。大抵治痢之法，虚者补之，
实者泻之，滑者涩之，闭者通之，有积者推之，风则散之，暑则涤之，湿则燥之，热则凉之
，冷则温之，冷热者调之，以平为期，不可以过，此为大法。药隐老人序。
论述说：如果下利清水，颜色赤黄，或者米谷不消化，只想喝冷水，时常呕吐逆气，小便不通利，受热则症状极度加重，心胸烦躁，脉象虚大且数。这是由于乘人体虚弱之际，热邪侵入胃中，凑聚并渗入下焦，导致津液不能分清别浊，并入大肠，称为协热下利。先用五苓散通利小便，接着用玉粉丹、四味阿胶丸。
蛤粉 硫黄（等分）
以上两味共同研成细末，用白面糊调和制成梧桐子大小的药丸，温水送服五十丸。
黄连 赤茯苓（去皮，二两） 芍药（三两） 阿胶（炒至干燥，一两）
以上先将前三味药研成粉末，然后用好醋将阿胶熬成稀膏状，再与药末混合，制成梧桐子大小的药丸，温水送服三十丸。
所谓赤白痢疾，古人称之为滞下。探究疾病的根源，都是因为外感风、寒、暑、湿、燥五种邪气，内伤生冷、坚硬或冷热不当的食物。其症状不一，有赤色的，有白色的，有赤白相杂的，有寒性的，有热性的，有虚证的，有实证的。大抵四季都以胃气为本，没有不因外感寒、暑、燥、湿、风之气而损伤脾胃，脾胃既已亏损，又因内伤饮食，饮食不能消化，导致积滞而形成滞下。古人说：“无积不成痢”，就是这个道理。经书说：“春伤于风，夏生飧泄。”大概风邪容易伤肝，然而春季肝木正当旺盛而不受邪，反而移气克制脾土。既然脾土受到克制，又不能谨慎饮食，恣意食用生冷、粘硬之物，导致脾胃不能消化，因此产生积滞。又在夏秋之间，如果再感受暑湿、风冷之气，发动而成痢疾。其症状必定先出现脐腹疼痛，洞泄、水泻，里急后重，或有或无，或赤或白，或赤白相杂，日夜无度。如果有这些症状，不论寒热虚实，都应当先服用神术散，可以发散风冷、寒湿之气；接着服用五苓散，分利水谷；兼用加巴感应丸，温补脾胃、去除积滞；或者六神丸，没有不安稳的。有人说：虽然古人说有积滞才形成痢疾，但也不专门以去除积滞为先，难道一年之内，唯独在夏秋之间人人都有积滞，而春冬就没有吗？大概风邪入胃，木来胜土，如果不发生暴泻，就会成为痢疾，神术散是主要药物。又有一种方子，一郡之内，上下传染，疾病状况相似。或者只有一家，长幼皆如此；或者上下邻里间相互传染；或者有病名相同而症状不同；也有症状不同而治疗相同。有的用温剂而痊愈，有的用凉药而治愈。像这样的情况，就是毒疫痢。治疗疫毒痢，虽然应当观察五运六气的相克关系，也不可拘泥于此说。况且运气相克，难道是毒邪偏于一方、一郡，而独独影响一家、两家吗？如果有这种症状，应当先察其虚实、冷热，首先用败毒散，多加人参、甘草、陈米、姜枣煎服；以及三黄熟艾汤、黄连阿胶丸、五苓散、驻车丸，可选而用之。如下痢赤多，或纯下鲜血，里急后重，大便不通，身体壮热，手足心热，大烦躁渴，腹胁胀痛，小便赤涩，六脉洪大，或紧而数，或沉而实，这是热痢。宜用白头翁汤及三黄熟艾汤、五苓散，可选而用之。如果风痢下血太过，宜用胃风汤加木香、黑豆煎服。如果在夏秋之间下痢，或赤或白，或赤白相杂，脐腹疼痛，里急后重，憎恶寒冷发热，心胸烦闷，燥渴引饮，呕吐逆气恶心，小便不利及五心烦热，六脉虚弱。这些脉证，正是因伏暑而得的疾病，宜服香薷散加黄连、甘草、当归，酒水浓煎，沉淀令水冷，顿服。仍兼服酒蒸黄连丸，或小柴胡汤加人参煎服必愈。（沈内翰说：治痢的药物极多，然而没有比此药更妙的。大概小柴胡汤能治暑毒）如果杂证消退，而痢疾尚未停止，则以四物汤加阿胶、艾叶煎服，以调阴阳，没有不安稳的。如果水谷不分，小便不利，宜用五苓散，淡竹叶煎汤调服。如果烦渴严重的，也宜服用。如果不明白伏暑的症状，仅凭脉虚就妄投硫磺、附子、干姜、肉桂、丹石类药物而致人死亡，深可叹息。如果下痢纯白，状如鱼脑，脐腹冷痛，日夜无度，手足逆冷；或者有呕吐逆气，完全不能进食，饮食想温热而厌恶寒冷，六脉微细。这是由于脏腑虚冷到了极点，宜用木香散加服四味理中汤及钟乳健脾丸。严重的，四肢逆冷，六脉沉绝。应当一味峻补，兼灸气海、丹田二穴，再以助胃的药物，这是守而不攻的意思。宜用四顺附子汤、三建丹、白丹、加味参附汤、姜附汤，都可选用。如果是年高体弱之人，或者素来禀赋怯弱，也宜用此法详细斟酌调理。然而大宜开胃、进食为先，食物能够进入，则脾胃运化，糟粕便聚。糟粕既已形成，垢腻鲜血，瘀滞就不患其不能消除了。如果久痢不愈，肠滑不禁，溏泄不止，诸药无效，才可以施用涩肠止痢的药剂。也宜先用龙骨、肉豆蔻、诃子、钟乳、胡粉等药物。近来的人多用罂粟壳、地榆之类，然而这些药物性质太紧涩，能损伤胃气。如果是少壮之人、壮健者服用，偶尔奏效；如果是疫毒、受暑受湿的病症以及年高之人，或者禀赋怯弱，服用这些莫不受其大害。如果把因秘涩肠作为首要，那么风寒、暑湿之邪，不仅涩而不能去除，而且胃管闭塞不通，禁口不食，日渐消瘦。糟粕不入肠中，所患无法消除。如果有这种症状，宜用参苓白术散、四君子汤及以石莲、山药的药剂，治疗必愈。治疗痢疾想要投用补药，必须有温通之意在其中！如四君子汤、理中汤、十全汤加木香、白豆蔻、茯苓、官桂、厚朴之类，可以散风邪，可以分水道，可以开胃管，可以治缠扰，可以通秘涩。这是攻守之意两全。大抵治疗痢疾的方法，虚者补之，实者泻之，滑者涩之，闭者通之，有积者推之，风则散之，暑则涤之，湿则燥之，热则凉之，冷则温之，冷热者调之，以平为期，不可以过，这是大法。药隐老人序。
It is said: If there is diarrhea with clear water, the color is red and yellow, or undigested rice and grains are present, there is a strong desire to drink cold water, frequent vomiting and regurgitation, difficulty in urination, symptoms worsen significantly upon exposure to heat, restlessness in the chest and heart, and the pulse is deficient, large, and rapid. This occurs when pathogenic heat enters the Stomach due to deficiency, gathers and seeps into the Lower Jiao (Lower Burner), causing the body fluids to fail to separate into clear and turbid parts, and merging into the Large Intestine. This is called "Xie Re Xia Li" (Diarrhea accompanying fever/heat). First use Wu Ling San (Five-Ingredient Powder with Poria) to promote urination, then use Yu Fen Dan (Jade Powder Pill) and Si Wei E Jiao Wan (Four-Ingredient Donkey-Hide Gelatin Pill).
Ge Fen (Dinosaur Egg Shell Powder) and Liu Huang (Sulfur) in equal proportions.
Grind these two ingredients together into a fine powder, mix with white flour paste to form pills the size of Sophora seeds (Wu Tong Zi). Take 50 pills with warm water.
Huang Lian (Coptis Rhizome), Chi Fu Ling (Red Poria, skin removed, 2 liang), Shao Yao (Peony Root, 3 liang), E Jiao (Donkey-Hide Gelatin, stir-fried until dry, 1 liang).
First grind the first three ingredients into powder. Then boil the E Jiao with good vinegar until it becomes a thin paste. Mix with the powder to form pills the size of Sophora seeds. Take 30 pills with warm water.
The so-called dysentery with red and white discharge was named "Zhi Xia" (Stagnant Downward Flow) by the ancients. Investigating the source of the disease, it is all caused by external contraction of the five pathogenic factors (Wind, Cold, Summer-heat, Dampness, Dryness) and internal injury from raw, hard, or improperly temperature-regulated foods. The manifestations vary: some are red, some are white, some are mixed red and white, some are cold-type, some are heat-type, some are deficiency-type, and some are excess-type. Generally, throughout the four seasons, Stomach Qi is the foundation. No one escapes injury to the Spleen and Stomach without contracting external Wind, Cold, Summer-heat, Dampness, or Dryness. Once the Spleen and Stomach are weakened, and further injured by improper diet, the food cannot be digested, leading to accumulation and stagnation, resulting in Zhi Xia. The ancients said, "No accumulation, no dysentery," which refers to this. The Classics state: "If injured by Wind in Spring, Sun-Xie (diarrhea with undigested food) arises in Summer." Wind tends to injure the Liver. However, in Spring, Liver Wood is vigorous and does not easily accept pathogens; instead, its qi shifts to overact on Spleen Earth. Since the Spleen is subjected to this constraint, if one does not exercise caution in diet and indulges in raw, cold, sticky, or hard foods, the Spleen and Stomach cannot digest them, thus causing accumulation. Furthermore, during Summer and Autumn, if one contracts Summer-heat and Dampness or Wind-Cold again, it triggers dysentery. The symptoms must initially include umbilical and abdominal pain, profuse watery diarrhea, tenesmus (feeling of incomplete defecation), which may or may not be present, with discharge that may be red, white, or mixed, occurring day and night without limit. If such symptoms occur, regardless of whether it is cold, heat, deficiency, or excess, one should first administer Shen Shu San (Divine Efficacy Powder) to disperse Wind-Cold and Cold-Dampness; then administer Wu Ling San (Five-Ingredient Powder with Poria) to separate and drain water and grain; additionally use Jia Ba Ying Xiang Wan (Enhanced Ba Ying Xiang Pill) to warm the Spleen and Stomach and remove accumulation; or Liu Shen Wan (Six-God Pill). There will be no case that does not stabilize. Some say: Although the ancients stated that accumulation leads to dysentery, treatment does not exclusively focus on removing accumulation at first. Is it true that within a year, everyone has accumulation only in Summer and Autumn, but not in Spring and Winter? Actually, when Wind pathogen enters the Stomach, Wood overacts on Earth. If it does not cause sudden severe diarrhea, it becomes dysentery. Shen Shu San is the key formula for this. There is also another prescription where, within a county, transmission occurs among people above and below, with similar clinical presentations. Or within a single family, affecting both elders and children; or transmitted among neighbors; or diseases with the same name but different symptoms; or different symptoms but identical treatments. Some recover with warming agents, others with cooling medicines. Such cases are referred to as Du Yi Li (Toxic Epidemic Dysentery). In treating Toxic Epidemic Dysentery, although one should observe the mutual overcoming relationships of the Five Movements and Six Qi, one must not rigidly adhere to this theory. After all, if the movements and qi overcome each other, how can the toxin be confined to one region or county, affecting only one or two families? If such symptoms exist, first assess deficiency/excess and cold/heat. Initially use Bai Du San (Eliminate Toxin Powder), adding extra Ren Shen (Ginseng), Gan Cao (Licorice), Chen Mi (Aged Rice), Jiang (Ginger), and Zao (Jujube) for decoction. Also consider San Huang Shu Ai Tang (Three Yellows and Cooked Mugwort Decoction), Huang Lian E Jiao Wan (Coptis and Donkey-Hide Gelatin Pill), Wu Ling San (Five-Ingredient Powder with Poria), or Zhu Che Wan (Chariot-Stopping Pill), selecting as appropriate. If dysentery presents with predominantly red discharge, or pure fresh blood, tenesmus, constipation, high fever, heat in the palms and soles, severe restlessness and thirst, distending pain in the abdomen and hypochondrium, dark and scanty urine, and the six pulses are flooding, or tight and rapid, or deep and solid, this is Re Li (Heat Dysentery). It is suitable to use Bai Tou Weng Tang (Pulsatilla Decoction), San Huang Shu Ai Tang (Three Yellows and Cooked Mugwort Decoction), or Wu Ling San (Five-Ingredient Powder with Poria), selecting as appropriate. If Feng Li (Wind Dysentery) involves excessive bleeding, use Wei Feng Tang (Stomach Wind Decoction) added with Mu Xiang (Aucklandia) and Hei Dou (Black Soybean) for decoction. If dysentery occurs in Summer and Autumn, with red, white, or mixed discharge, umbilical and abdominal pain, tenesmus, aversion to cold with fever, chest restlessness, dry thirst with desire to drink, vomiting and nausea, difficulty in urination, and five-palm heat, with weak six pulses, these pulse and symptom patterns indicate the disease was obtained due to latent Summer-heat. One should take Xiang Ru San (Elsholtzia Powder) added with Huang Lian (Coptis), Gan Cao (Licorice), and Dang Gui (Angelica Sinensis), decocted strongly with wine and water, allowed to settle and cool, then taken in one dose. Additionally take Jiu Zheng Huang Lian Wan (Wine-Steamed Coptis Pill), or Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Ren Shen (Ginseng) for decoction; recovery is certain. (Hanlin Scholar Shen stated: There are many drugs for treating dysentery, but none are as effective as this. Essentially, Xiao Chai Hu Tang can treat Summer-heat toxicity.) If miscellaneous symptoms subside but dysentery persists, use Si Wu Tang (Four Substances Decoction) added with E Jiao (Donkey-Hide Gelatin) and Ai Ye (Mugwort Leaf) for decoction to harmonize Yin and Yang; there will be no case that does not stabilize. If water and grain are not separated and urination is difficult, use Wu Ling San (Five-Ingredient Powder with Poria), administered with decoction of Dan Zhu Ye (Lophatherum Leaf). If thirst and irritability are severe, this is also suitable. If the signs of latent Summer-heat are not understood, and one recklessly administers sulfur, Aconite, Ginger, Cinnamon, and mineral stones based solely on a deficient pulse, causing death, it is deeply lamentable. If dysentery presents with pure white discharge resembling fish brains, cold pain in the umbilical and abdominal regions, occurring day and night without limit, cold limbs, vomiting, inability to eat, preference for warm food and aversion to cold, and faint and thin six pulses, this is due to extreme deficiency-cold of the Zang-Fu organs. One should use Mu Xiang San (Aucklandia Powder) combined with Si Wei Li Zhong Tang (Four-Ingredient Regulate the Middle Decoction) and Zhong Ru Jian Pi Wan (Calcium Carbonate Spleen-Strengthening Pill). In severe cases with cold limbs and imperceptible pulses, one should employ potent tonification alone, combined with moxibustion on Qi Hai (CV6) and Dan Tian (CV8) acupoints, along with stomach-assisting herbs. This reflects the strategy of defense without attack. Suitable formulas include Si Shun Fu Zi Tang (Four-Smooth Aconite Decoction), San Jian Dan (Three Establishments Pill), Bai Dan (White Pill), Jia Wei Shen Fu Tang (Modified Ginseng-Aconite Decoction), and Jiang Fu Tang (Ginger-Aconite Decoction), selecting as appropriate. For elderly and weak individuals, or those with inherent constitutional weakness, this method should be carefully considered for regulation. However, opening the appetite and promoting food intake should be prioritized. Once food enters, the Spleen and Stomach can transform and transport, allowing waste to accumulate. Once waste is formed, the foul matter, blood, and stasis will naturally be eliminated. If chronic dysentery does not heal, with intestinal slipping and incontinence, loose stools persisting, and all other medicines ineffective, only then should astringent herbs for stopping dysentery be applied. One should initially use Long Gu (Fossilized Bones), Rou Dou Kou (Nutmeg), He Zi (Chebula Fruit), Zhong Ru (Calcium Carbonate), and Hu Fen (Lead White). Recently, people often use Ying Su Ke (Poppy Capsule) and Di Yu (Sanguisorba Root), but these substances are too astringent and can damage Stomach Qi. If taken by young, strong, and robust individuals, they may occasionally yield miraculous effects; however, if taken by those with toxic epidemic, summer-heat/dampness conditions, the elderly, or those with constitutional weakness, they will inevitably suffer great harm. If the priority is to astringe the intestines due to constipation, the Wind-Cold, Summer-heat, and Dampness pathogens will not only remain trapped but also cause the Stomach tube to close and become obstructed, leading to anorexia and daily emaciation. Without waste entering the intestines, the pathology cannot be resolved. If such symptoms arise, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Si Jun Zi Tang (Four Gentlemen Decoction), or formulas containing Shi Lian (Lotus Seed Plumule) and Shan Yao (Dioscorea Rhizome); treatment will surely succeed. When administering tonics for dysentery, there must be an intention of warmth and unblocking! Formulas like Si Jun Zi Tang (Four Gentlemen Decoction), Li Zhong Tang (Regulate the Middle Decoction), and Shi Quan Tang (Complete Ten Thousand Things Decoction) added with Mu Xiang (Aucklandia), Bai Dou Kou (Cardamom), Fu Ling (Poria), Guan Gui (Cassia Bark), and Hou Po (Magnolia Bark) can disperse Wind pathogens, separate water passages, open the Stomach tube, relieve entanglement/distress, and unblock constipation. This achieves a balance of attack and defense. Generally, the methods for treating dysentery are: tonify the deficient, purge the excess, astringe the slipping, unblock the closed, push out accumulation, disperse Wind, wash away Summer-heat, dry Dampness, cool Heat, warm Cold, and regulate Cold-Heat combinations. The goal is equilibrium; do not overdo it. This is the general principle. Preface by Yaoyin Laoren (Old Man Medicine Hidden).