典藏书目

Dysentery during pregnancy is caused by consuming raw and cold foods, which the Spleen and Stomach fail to transform and digest, leading to pain in the heart and abdomen. Injury to the Blood aspect results in red stools, injury to the Qi aspect results in white stools, and simultaneous injury to both Qi and Blood results in mixed red and white stools. Since Blood belongs to Yin, injury to Yin often involves heat pathogens. However, there are cases where Yang Qi is injured and fails to control Yin Blood, causing red dysentery; in such cases, acrid-warm treatments must be employed. Therefore, when treating bloody dysentery, one should verify deficiency, excess, cold, and heat based on whether the stool color is bright or dull. Accumulations that are dull and not fresh, clear and thin rather than sticky, indicate a deficiency-cold pattern, specifically Yang failing to control Yin Blood. Urgent administration of Ginseng Radix et Rhizoma (Renshen), dried Ginger Rhizome (Shengjiang), and Moxa Leaf (Aiyi) may preserve life. If examined improperly and Bupleuri Radix (Huangqin) and Coptis Rhizome (Huanglian) are mistakenly taken, death will be hastened. Only when accumulations are sticky, purple-red, and lustrous should bitter-drying herbs be used to consolidate intestinal sliding. Furthermore, Qi-regulating herbs must be assisted, so that Yin pathogens can be resolved. This differs from white dysentery, where Huangqin, Huanglian, and Paeoniae Radix Alba (Shaoyao) cannot be mixed, as they might guide stagnant filth to further injure Yin Blood. Qi belongs to Yang; injury to Yang often involves cold pathogens. Even if there is fire pouring downward with urgency, it is due to the depression of Yang Qi, representing a syndrome of root cold and branch heat. It should not be purely attributed to heat. One should examine if the stool is sticky like paste and white like fat; only then can temporary heat-clearing treatment for the branch be given. If the stool juice is watery like foam and the color is dull like dust, urgent warming and regulating of Qi is required. Even if heat symptoms appear, they are undoubtedly false manifestations. Once deficiency/excess and cold/heat are distinguished, the "Three Prohibitions," "Three Benefits," and "Five Examinations" must be known.

First Prohibition: Purging the intestines and stomach, fearing that Yang Qi will sink and fetal Qi will descend further. Second Prohibition: Promoting urination via the Bladder, fearing that Yin fluids will escape and the fetus will lose nourishment. Third Prohibition: [Text missing] astringing and stagnating Qi, fearing that turbid Qi will stagnate more and tenesmus will worsen. Thus, skillful treatment of pregnancy dysentery prioritizes regulating Qi. Even failed accumulations and foam will descend with Qi, without injuring fluids, ensuring safety by regulating Qi. Regulating Qi has three benefits: 1. It maintains normal Stomach Qi, allowing water and grain to be transported and transformed; 2. It gradually eliminates abdominal fullness, pain, and tenesmus; 3. It opens turbid Qi, preventing invasion of the fetal origin.

The "Five Examinations": First, examine food intake. Dysentery is an illness of the intestines and stomach. If the dysentery is severe but food intake is unaffected, it is easy to treat. The most severe form is anorexic dysentery (Jinkou Li). At the onset when turbid pathogens are abundant, it is not worrying; clearing accumulations allows food intake to resume. If after seven days one still cannot eat, and the pulse is rapid and vigorous, it is due to failure to clear accumulations initially. Urgent regulation of Qi and harmonization of the Middle Jiao is needed, so accumulations descend and food intake resumes. If one could eat initially but cannot after ten days or half a month, and the pulse is weak, it is due to excessive purging injuring Stomach Qi. Overuse of Huangqin, Huanglian, Areca Seed (Binglang), and Magnolia Bark (Houpo) causes bitter-cold damage to Qi, leading to hiccups and vomiting. This indicates severe defeat of Stomach Qi, a critical sign. Only vigorous warm tonification can reverse this. If the pulse is extremely rapid, floating and empty/vigorous, intermittent, or wiry and fine beating against the finger, it indicates exhaustion of Stomach Qi, with little chance of survival.

Second, examine urination. In dysentery, clear and turbid are not separated. If dysentery is frequent but urination is smooth, the fetus is safe. Near term, fetal pressure on the bladder often causes frequent urination or strangury with distension. Diuretics that injure fluids are strictly prohibited; opening and lifting Qi is urgent. Observe the pulse; if not overly strong or hard, tonifying Middle Jiao Qi with slight addition of Alisma Rhizoma (Zexie) and Plantago Seed (Cheqian) to raise clear and lower turbid works effectively. This applies not only to pregnancy but also to ordinary people with chronic dysentery, great fluid injury, and difficult urination.

Third, examine abdominal pain. Abdominal pain in dysentery is inevitable. However, sometimes turbid dampness descends without郁沸 (stagnant boiling) fire, resulting in no pain, common in white dysentery of fat individuals. Bloody dysentery is rare in thin individuals prone to fire; treatment should regulate Qi and move accumulations, clearly avoiding fire-clearing. Abdominal pain has cold and heat distinctions. Pain with urgency and inability to reach the toilet is Fire. Pain attacking upward from below is Fire. Pain with fullness, intolerance to massage, and worsening with hot drinks is Fire, indicating Excess. Pain without cessation, constant without cramping, is Cold. Pain rushing downward from above is Cold. Pain without fullness, preference for warm massage, relief with hot drinks, and ability to endure the urge to defecate briefly, is Deficiency and Cold. Generally, initial dysentery with distension and pain is Heat/Excess; chronic dysentery pain is Deficiency/Cold. Even if starting with fire-cutting pain, long-term dysentery damages Qi and becomes Deficiency-Cold. For chronic dysentery abdominal pain, regardless of pulse size or speed, if pressing makes it smaller, it is Deficiency-Cold, requiring urgent warm tonification. Do not use Qi-moving herbs. Only in acute pain, solid pulse, and unyielding to long pressure, can slightly roasted black Ginger and Coptis be used to harmonize.

Fourth, examine tenesmus. Tenesmus in dysentery is turbid Qi obstruction. Opening obstruction requires regulating Qi as the basis, crucial in pregnancy. Regulating Qi removes tenesmus and calms fetal breath. Initial tenesmus requires opening stagnation; chronic tenesmus requires raising Yang. Raising Yang moves Stomach Qi, moving Stomach Qi regulates all internal and external Qi, preventing stagnation. Treating pregnancy tenesmus, regardless of fetal size, if the pulse shows surplus, regulate Qi; if deficient, lift and raise. Even bloody dysentery benefits from Yang herbs; greasy blood-tonifying herbs should be avoided because Qi controls Blood, preventing reckless bleeding.

Fifth, examine body heat. Dysentery is an interior disease. If body heat is present, exterior and interior are both distressed; how can Yuan Shen rely on strength to dispel pathogens? If the Renying pulse is floating and rapid, first use harmonizing Ying and penetrating the exterior methods to break the momentum, then slowly clear. If no fever initially but fever appears after days or weeks, with a shrinking or empty/large weak pulse, this is Yin depletion inside with deficient Yang revealing outside. In ordinary people, acrid-warm tonics can return fire to its source. In pregnancy, Cinnamon Twig (Guizhi) and Aconite Root (Fuzi) are hard to use lightly. Rely instead on Ginseng, Atractylodes Macrocephala Rhizoma (Baizhu), Dried Ginger, Cornus Fruit (Shanzhuyu), Donkey-hide Gelatin (Ejiao), and Mugwort Leaf. Without large doses, thick decoctions, and vigorous administration, turning the tide is unlikely.

According to *YiTong*: Nongpu Qu Ganjiang Tang treats pregnancy dysentery with appetite, abdominal distension, tenesmus, and sticky white stools; Nongpu Shengjiang Gancao Banxia Renshen Tang treats pregnancy abdominal distension, tenesmus, and mixed red-white dysentery; Huangqin Shaoyao Tang with Xianglian Wan treats pregnancy dysentery with appetite, tenesmus, and sticky bloody stools; Lianli Tang combined with *Qianjin* Sanwu Jiao'ai Tang treats pregnancy lower abdominal pain, dull bloody stools, or occasional fresh blood dysentery; Zhuche Wan treats pregnancy fever, tenesmus, and Yin-deficient anorexic bloody dysentery; Baitouweng Jia Gancao Ejiao Tang treats pregnancy internal attack of heat-toxin, anorexic dysentery, abdominal distension, tenesmus, and sticky pus-blood dysentery; *Qianjin* Jiaoai Liupi Tang (same as Sanwu Jiao'ai Tang) treats pregnancy clear pus-blood dysentery, restless fetus, and chronic diarrhea; Buzhong Yiqi Tang treats pregnancy malaria followed by dysentery, simultaneous malaria and dysentery, sinking Yuan Qi, descending fetal Qi, frequent urination, or strangury-induced dysentery. All these formulas add Amomum Fruit (Sharen) to regulate Qi and Chinese Plum Fruit (Wumei) to regulate Blood, achieving immediate effects. I often use single-herb Ejiao Yin or Ejiao Huanglian Yin for pregnant women's dysentery, which is appropriate and effective.

Nongpu Qu Ganjiang Tang: Magnolia Bark (Houpo, peeled, stir-fried with ginger juice), Tangerine Peel (Chenpi, soaked to remove white pith), Alisma Rhizoma (Fuling), Prepared Licorice Root (Zhigancao) (equal parts). Decoct and take.

Nongpu Shengjiang Gancao Banxia Renshen Tang: Treats Stomach deficiency with vomiting/reversal, epigastric fullness, and anorexia. Ginseng (as needed), Magnolia Bark (1.5 qian, ginger-processed), Processed Pinellia Tuber (Banxia, 2 qian), Prepared Licorice Root (0.8 qian), Fresh Ginger as guide.

Huangqin Shaoyao Tang: Coptis Rhizome (Huangqin), White Peony Root (Baishao) (3 qian each), Prepared Licorice Root (2 qian).

Xianglian Wan: Treats mixed red-white dysentery, more white than red. Coptis Rhizome (6 liang, stir-fried with 1 liang Evodia Fruit/Wuzhuyu, discard Wuzhuyu), Aucklandia Root (Muxiang, 1 liang). Grind to powder, make pills with vinegar paste, take 50 pills per dose, with rice soup or Amomum soup.

Lianli Tang: Treats Stomach deficiency with food retention, epigastric fullness, and fever. Ginseng (as needed), Atractylodes Macrocephala Rhizoma (1.5 qian, earth-roasted until scorched), Roasted Ginger (0.6 qian), Coptis Rhizome (0.8 qian), Alisma Rhizoma (1 qian), Prepared Licorice Root (0.6 qian).

*Qianjin* Sanwu Jiao'ai Tang: Treats bloody dysentery and persistent dysentery. Donkey-hide Gelatin (Ejiao), Mugwort Leaf (Aiyi), Sour Pomegranate Peel (Suan Shiliu Pi). Equal parts, decoct and take.

Zhuche Wan: Treats Yin-deficiency dysentery, fever, sticky pus-blood, and lingering dysentery. Donkey-hide Gelatin (3 liang), Coptis Rhizome (roasted black), Angelica Sinensis Radix (Danggui) (5 qian each), Roasted Ginger (1 liang). Pound and sieve, boil Ejiao in vinegar to make pills the size of walnut seeds. Take 40-50 pills per dose, three times day and night, with rice drink.

Baitouweng Jia Gancao Ejiao Tang: Treats heat-clinging dysentery with pus-blood, and postpartum persistent dysentery. Pulsatilla Root (Baitouweng), Coptis Rhizome (roasted black), Phellodendron Bark (Huangbai, roasted black), Birch Bark (Qinpi), Prepared Licorice Root (1 qian each), Donkey-hide Gelatin (3 qian). Decoct the first five ingredients, remove dregs, dissolve Ejiao in the liquid, take warm in three divided doses.

Ejiao Huanglian Yin (also named Huanglian Ejiao Tang): Treats pregnancy dysentery; if focusing on calming the fetus, dysentery worsens; if treating dysentery, the fetus is hard to preserve. Donkey-hide Gelatin (stops pus-blood dysentery, stops lower back pain, secures fetus as Sovereign herb), Coptis Rhizome, Peony Root, Licorice Root (all as Ministers/Accomplices), Bitter Orange Fructus (Zhike, bran-fried, add small amount 2-3 fen to relieve tenesmus, reduce if painful dysentery).