胡太夫人。偶然肚腹不宁。泻下数行。医以痢疾药治之。其利转多。更引通因通用之法。用九蒸大黄丸三
钱下之。遂扰动胃气胀痛。全不思食。有似噤口痢状。余诊之。见六脉皆沉而伏。应指模糊。亟曰。此非痢
疾之证。乃误治之证也。今但安其胃。不必治痢。而痢自止。不必治胀痛。而胀痛自止。于是以四
君子汤为主治。少加姜蔻暖胃之药。用之二剂。痢果不作。但苦胃中胀痛不安。必欲加入行气之药。以冀胀
消痛止。而速得进食。余固争曰。宁可缓于食。不可急于药。盖以前因误治。引动
胃气作楚。如治乱民。惟有安之之法。若再加行气。则胀痛必无纪极。坚持前说。即用橘皮和中。亦须炒
而又炒。绝不惹动其气。凡五日未得大便。亦不惹动其便。听其缓缓痛止胀消。食进
便利。共七日全安。浑不见药之功。其实为无功之功也。噫。今之随主见而图可喜之功者。即生出事端。亦谓
病之所有。非医之所造。谁悬明鉴。而令丝毫莫遁耶。此所以成时医之世界也。
张仲仪初得痢疾三五行。即请往诊。行动如常。然得内伤之脉。而夹少阴之邪。余诊毕。即议云。此证
仍宜一表一里。但表药中多用人参。里药中多用附子。方可无患。若用痢疾门诸药。必危之道也。仲仪以平
日深信。径取前药不疑。然疾势尚未着也。及日西。忽发大热。身重如巨石。头在枕上。两人始能扶
动。人事沉困。举家惶乱。忙忙服完表里二剂。次早诊时。即能起身出房。再与参附药二剂全安。若不
辨证用药。痢疾门中几曾有此等治法乎。况于疾未着而早见乎。
周信川年七十三岁。平素体坚。不觉其老。秋月病痢。久而不愈。至冬月成休息痢。一昼夜十余行。面自
浮肿。肌肤晦黑。求治于余。诊其脉沉数有力。谓曰。此阳邪陷入于阴之证也。吾当以法治之。尚可痊愈。
明日吾自袖药来面治。于是以人参败毒散本方煎好。用浓被围椅上坐定。置火其下。更以布条卷成
鹅蛋状。置椅褥上。垫定肛门。使内气不得下走。然后以前药滚热与服。良久又进前药。遂觉皮间有津津微润。
再溉以滚汤。教令努力忍便。不得移身。如此约二时之久。皮间津润总未干。病者心躁畏热。忍不可忍。始
令连被卧于床上。是晚止下痢二次。以后改用补中益气汤。一昼夜止下三次。不旬日而全愈。盖内
陷之邪。欲提之转从表出。不以急流挽舟之法施之。其趋下之势。何所底哉。闻王星宰世兄。患久痢。诸药
不效。苏郡老医。进以人参败毒散。其势瘥减。大有生机。但少此一段斡旋之法。竟无成功。故凡遇阳
邪陷入阴分。如久疟久痢久热等证。当识此意。使其缓缓久久。透出表外。方为合法。若急而速。则
恐才出又入。徒伤其正耳。
朱孔阳年二十五岁。形体清瘦。素享安佚。夏月因 讼。奔走日中。暑湿合内郁之火。而成痢疾。昼夜
一二百次。不能起床。以粗纸铺于褥上。频频易置。但饮水而不进食。其痛甚厉。肛门如火烙。扬手踢足。
躁扰无奈。余诊其脉。弦紧劲急。不为指挠。谓曰。此证一团毒火。蕴结在肠胃之内。其势如焚。救焚
须在顷刻。若二三日外。肠胃朽腐矣。于是以大黄四两。黄连甘草各二两。入大砂锅内煎。随滚随服。服下
人事稍宁片刻。少顷仍前躁扰。一昼夜服至二十余碗。大黄俱已煎化。黄连甘草。俱
煎至无汁。次日病者再求前药。余诊毕。见脉势稍柔。知病可愈。但用急法。不用急药。遂改用生地麦门冬
各四两。另研生汁。而以天花粉牡丹皮赤芍甘草各一两。煎成和汁大碗咽之。
以其来势暴烈。一身津液。从之奔竭。待下痢止。然后生津养血。则枯槁一时难回。今脉势既减。则火邪
俱退。不治痢而痢自止。岂可泥润滞之药。而不急用乎。服此药。果然下痢尽止。但
遗些少气沫耳。第三日。思食豆腐浆。第四日。略进陈仓米清汁。缓缓调至旬余。方能消谷。亦见胃气之
存留一线者。不可少此焦头烂额之客耳。
陈汝明病痢。发热如蒸。昏沉不食。重不可言。至第三日。危急将绝。方请余诊。其脉数大空虚。尺脉
倍加洪盛。谓曰。此两病而凑于一时之证也。内有湿热。与时令外热相合。欲成痢证。尚不自觉。又犯房劳。
而为骤寒所乘。以故发热身重。不食昏沉。皆属少阴肾经外感。少阴受邪。原要下痢清白。此因肠中
湿热。已蒸成猪肝鱼脑败浊之形。故色虽变而下痢则同也。再用痢疾门药一剂。即刻不救矣。遂忙以麻黄
附子细辛汤一剂。与之表散外邪。得汗后热即微减。再以附子理中汤。连进二剂。
热退身轻能食。改用黄连理中汤丸。服至旬日全安。
叶茂卿幼男病痢。噤口发热十余日。呕哕连声不断。诊其关脉。上涌而无根。再诊其足脉。亦上涌而无
根。谓其父曰。此非噤口痢之证。乃胃气将绝之证也。噤口痢者。虚热在胃。壅遏不宣。故觉其饱而不思食。
治宜补虚清热两法。此因苦寒之药所伤。不能容食。治惟有颛颛温补一法而已。于是以理中汤连
投二剂。不一时痢下十余行。遍地俱污。茂卿恐药不对证。求更方。余曰。吾意在先救胃气之绝。原不治痢。
即治痢。人之大小肠。盘叠腹中甚远。虽神丹不能遽变其粪。今藉药力催之速下。正为美事。焉可疑之。遂
与前药连服三日。人事大转。思食不哕。痢势亦减。四日后止便糟粕。以补中益气汤调理旬日全安。
此可见小儿之痢。纵啖伤胃者多。内有积热者少。尤不宜轻用痢疾门中通套治法也。
浦君艺病痢疾。初起有表邪未散。而误用参术固表。使邪
气深入。又误服黄连凉解。大黄推荡。治经月余。胃气不运。下痢一昼夜百余行。一夕呕出从前黄连药汁三五
碗。呕至二三次后。胃与肠遂打为一家。内中幽门阑门。洞开无阻。不但粥饮直出。即人参浓膏。才吞入喉。
已 从肠奔下。危急之中。诸昆玉及内戚俱探余曰。此证可无恐乎。余曰。在此用药。便有可
恃。吾岂不知病势之危。但无别人可任。姑以静镇之。而殚力以报知己耳。于是以大剂四君子汤。煎调赤石脂
禹余粮二味。连连与服。服后其下奔之势少衰。但腹中痛不可忍。君艺曰。前此下痢虽多。然尚不痛。服此药
而痛增。未可再服矣。余曰。此正所谓通则不痛。痛则不通之说也。不痛则危。痛则安。何乐而不
痛耶。仍以前药再进。俟势已大减。才用四君子倍茯苓。十余剂全安。
胡卣臣先生曰。闭门造车。出而合辙。使郡邑医学中。仿此议病。先
衡量所造高下。然后用之则可矣。
胡太夫人，偶然感到腹部不适，腹泻数次。医生用治疗痢疾的药物给她服用，结果腹泻反而更加严重。医生又采用“通因通用”（即通过通利的方法治疗具有通利症状的疾病）的治法，让她服用三钱九蒸大黄丸进行攻下。随后导致胃气被扰动，出现胀痛，完全不想进食，症状类似噤口痢（一种以呕吐不能食为特征的痢疾）。我诊察时，发现六脉都沉伏不起，指下感觉模糊不清。急忙说道：“这不是痢疾的证候，而是误治导致的证候。现在只需安顿好她的胃气，不必专门治疗痢疾，痢疾自然会停止；不必专门治疗胀痛，胀痛自然也会消除。”于是以四君子汤（由人参、白术、茯苓、甘草组成，主治脾胃气虚证）为主方，少量加入生姜、豆蔻等温暖胃气的药物。服用两剂后，腹泻果然不再发作，但患者仍苦于胃中胀痛不安，家属一定要加入行气药物，希望胀消痛止，从而尽快进食。我坚决反对说：“宁可吃饭慢一点，也不能急于用药。因为之前由于误治，引动了胃气产生痛苦，这就像治理作乱的百姓，只有安抚的办法。如果再使用行气药，那么胀痛必将没有尽头。”坚持之前的说法，即使使用橘皮来调和脾胃，也必须经过多次炒制，绝不触动其气机。凡是五天没有大便，也不去触动它的大便，听任其缓缓止痛、消除胀满、增进饮食。总共七天，身体完全康复，几乎看不出药物的功效，这其实是“无功之功”。唉！现在的医生往往顺从主人的意愿去追求令人欣喜的功效，即使因此生出事端，也说是疾病本身所致，并非医生造成。谁能像明镜一样高悬，让丝毫差错都无法遁形呢？这就是形成当今庸医世界的缘故。
张仲仪起初患痢疾，每天拉几次，就请我去诊治。他行动如常，但我诊得他是内伤之脉，且夹杂少阴经的邪气。我诊察完毕后，立即建议道：“这个证候仍然应该表里双解，但在解表的药物中多用人参，在治里的药物中多用附子，才可以避免祸患。如果使用痢疾门中的常规药物，必然是危险的道路。”张仲仪平日深信我的医术，径直取走前药，毫不怀疑。然而此时病情尚未显露严重。到了傍晚时分，他突然发高热，身体沉重得像巨石一样，头放在枕头上，需要两个人才能扶动他，人事昏沉困倦，全家惊慌混乱。匆忙服完表里两剂药后，第二天早上诊察时，他已经能起身走出房间。再给予参附类药物两剂，身体完全康复。如果不辨证用药，在痢疾门的治疗中，何曾有过这样的治法呢？更何况是在疾病尚未严重时就提前预见并处理呢？
周信川七十三岁，平时身体强健，不觉得自己老。秋季患了痢疾，久治不愈，到了冬季发展成休息痢（时发时止的慢性痢疾），一昼夜腹泻十多次，面部和眼睑浮肿，肌肤晦暗发黑，前来求治于我。我诊得他的脉象沉数有力，对他说：“这是阳邪陷入阴分的证候。我用法治它，还可以痊愈。明天我自己带着药来当面治疗。”于是用原方煎好人参败毒散，让他坐在厚被围住的椅子上，椅子下面放置火盆，再用布条卷成鹅蛋形状，垫在椅褥上托住肛门，使体内之气不得向下流失。然后用滚烫的药液让他服用。过了很久，再次服用前药。随后觉得皮肤表面有微微湿润出汗的感觉。再用滚水浇灌（此处指热敷或熏蒸辅助），教他努力忍住便意，不要移动身体。这样大约持续了两个时辰，皮肤表面的津润始终未干。病人心里烦躁怕热，忍耐到极点，才允许他连被子一起躺在床上。当晚只腹泻了两次。之后改用补中益气汤，一昼夜只腹泻三次，不到十天就完全痊愈。这是因为内陷的邪气，想要提升它转而从表而出，如果不使用“急流挽舟”（比喻将下陷之邪提举出表）的方法施治，那股趋下的势头，哪里会有尽头呢？听说王星宰世兄，患有久痢，各种药物无效。苏州的老医生给他用人参败毒散，病情有所减轻，大有生机。只是缺少这一段斡旋（调理引导）的方法，最终没有成功。所以凡是遇到阳邪陷入阴分的情况，如久疟、久痢、久热等证候，应当明白此意，使其缓缓久久地透出体表之外，这才是合法的治疗。如果急躁求快，恐怕邪气刚出来又进去，徒然损伤正气罢了。
朱孔阳二十五岁，形体清瘦，向来享受安逸。夏季因为诉讼，在烈日下奔走，暑湿与体内郁积的火气结合，形成了痢疾。昼夜腹泻一二百次，不能起床，用粗纸铺在褥子上，频繁更换。只喝水而不进食，疼痛非常剧烈，肛门如火烧烙一般，挥手踢脚，躁扰无奈。我诊得他的脉象弦紧劲急，不为指力所屈，对他说：“这个证候是一团毒火，蕴结在肠胃之内，气势如同焚烧。救火必须在顷刻之间，如果等到两三天后，肠胃就要腐烂了。”于是用大黄四两，黄连、甘草各二两，放入大砂锅中煎煮。随着沸腾随时服用。服下后人世稍微安宁片刻，一会儿又恢复躁扰。一昼夜服至二十多碗，大黄已经煎化，黄连、甘草也煎到没有汁液为止。第二天病人再来求要前药。我诊察完毕，见脉势稍微柔和，知道病可以痊愈。但采用急法，不用急药。于是改用生地、麦门冬各四两，另外研磨取生汁，而以天花粉、牡丹皮、赤芍、甘草各一两，煎成药液，混合生汁，大碗咽下。因为病势暴烈，全身的津液随之奔涌枯竭。等待下痢停止后，然后再生津养血，否则枯槁的状态一时难以恢复。现在脉势既然减弱，说明火邪都已退去，不治疗痢疾而痢疾自然停止，岂可拘泥于滋润滞涩的药物，而不紧急使用呢？服用这些药后，果然下痢完全停止，只遗留少许气沫而已。第三天，想吃豆腐浆。第四天，稍微喝进一些陈仓米的清汁，缓缓调养到十几天，才能消化谷物。这也可见胃气中存留的一线生机，不可缺少这位“焦头烂额”（指救急有功）的客人啊。
陈汝明患痢疾，发热如蒸笼般，昏沉不食，病情重得无法形容。到了第三天，危急将要断气，才请我去诊治。他的脉象数大而空虚，尺脉加倍洪盛。我说：“这是两种病同时凑在一起的证候。内有湿热，与时令的外热相合，想要形成痢疾证，自己尚且不觉察。又犯了房劳，被骤寒所乘。因此发热身重、不食昏沉，都属于少阴肾经的外感。少阴经受邪，原本应该下痢清白，这是因为肠中湿热，已经蒸酿成猪肝、鱼脑那样败浊的形状，所以颜色虽然变了，但下痢的症状是一样的。如果再使用痢疾门中的一剂药，立刻就不救了。”于是急忙用麻黄附子细辛汤一剂，给他发散外邪。得到汗后，热势随即轻微减退。再用附子理中汤，连续服用两剂，热退身轻能进食。改用黄连理中汤丸，服用到十天完全康复。
叶茂卿的小儿子患痢疾，噤口痢伴发热十多天，呕哕声不断。诊察他的关脉，上涌而无根。再诊察他的足脉，也是上涌而无根。对他的父亲说：“这不是噤口痢的证候，而是胃气将绝的证候。噤口痢是因为虚热在胃，壅遏不宣，所以觉得饱胀而不思饮食。治疗应该用补虚清热两法。这是因为苦寒药物所伤，不能容纳食物，治疗唯有专心温补一法而已。”于是给理中汤连续投予两剂，不一会儿，痢疾下了十多次，遍地都是污物。叶茂卿担心药不对症，请求换方。我说：“我的意图在于先挽救胃气的将绝，原本就不是为了治疗痢疾。即使是治疗痢疾，人的大小肠盘曲折叠在腹中位置很深，即使是神丹妙药也不能立刻改变其中的粪便。现在借助药力催促它快速排出，正是好事，有什么可怀疑的呢？”于是与前药连续服用三天，人事大为好转，想进食且不呕哕，痢疾势头也减轻。四天后停止排泄糟粕。用补中益气汤调理十天，完全康复。由此可见，小儿的痢疾，即使是饮食伤胃的情况较多，内有积热的情况较少，尤其不宜轻易使用痢疾门中的通套治法。
浦君艺患痢疾，初起时有表邪未散，却误用人参、白术固表，使邪气深入。又误服黄连凉解、大黄推荡，治疗经过一个多月，胃气不运，下痢一昼夜一百多次。一天晚上呕出从前服用的黄连药汁三五碗。呕到二三次后，胃与肠遂打成一家，内部的幽门、阑门洞开无阻。不但粥饮直接流出，就是人参浓膏，刚吞入喉咙，已经从肠中奔泻而下。危急之中，各位兄弟及内戚都探问我：“这个证候可以不用担心吗？”我说：“在这里用药，便有可依靠之处。我难道不知道病势的危险吗？只是没有别人可以托付，姑且以静镇之法对待，并竭尽全力报答知己之情。”于是用大剂量的四君子汤，煎好后调服赤石脂、禹余粮两味药，连连服用。服后其下奔之势稍微衰减。但腹中疼痛难忍。浦君艺说：“此前下痢虽多，然而还不痛。服用此药后疼痛增加，不能再服了。”我说：“这正是‘通则不痛，痛则不通’的说法。不痛则危，痛则安，有什么快乐而不痛呢？”仍然以前药再进。等到势头已大大减少，才用四君子汤倍加茯苓，十余剂后完全康复。
胡卣臣先生说：“闭门造车，出门合辙。如果在郡县的医学界中，仿效这种议病方法，先衡量所造（诊断水平）的高低，然后使用它就可以了。”
Lady Hu, occasionally experienced abdominal discomfort and diarrhea several times. The physician treated her with medicines for dysentery, but the diarrhea worsened. The physician then applied the method of "treating unblocking with unblocking" (using purgatives to treat conditions characterized by discharge), administering three qian of Nine-Steamed Rhubarb Pills. This subsequently disturbed the Stomach Qi, causing distension and pain, and she completely lost her appetite, resembling the condition of Jin Kou Li (Dysentery with inability to eat). Upon my examination, I found all six pulses were deep and hidden, feeling vague under the fingers. I urgently stated, "This is not a dysentery syndrome, but a result of mis-treatment. Now, we only need to calm the Stomach; there is no need to specifically treat the dysentery, and it will stop on its own. There is no need to specifically treat the distension and pain, and they will cease on their own." Thus, Si Jun Zi Tang (Four Gentlemen Decoction) was used as the main prescription, with small amounts of warming Stomach herbs such as Sheng Jiang (Zingiberis Rhizoma Recens) and Dou Kou (Amomi Fructus Rotundus). After two doses, the diarrhea indeed ceased. However, the patient still suffered from gastric distension and pain, and the family insisted on adding Qi-moving herbs hoping to relieve the symptoms and restore appetite quickly. I firmly opposed this, saying, "It is better to delay eating than to rush into medication. Previously, due to mis-treatment, the Stomach Qi was agitated and caused pain. This is like governing rebels; only pacification methods apply. If we add Qi-moving herbs again, the distension and pain will have no end." Adhering to the previous approach, even when using Ju Pi (Citri Reticulatae Pericarpium) to harmonize the Middle Jiao, it had to be stir-fried repeatedly to avoid disturbing the Qi. For five days without a bowel movement, we did not intervene to induce one, allowing the pain and distension to subside slowly and the appetite to return gradually. In seven days, full recovery was achieved. The efficacy of the medicine was hardly visible; this is actually the merit of "non-action." Alas! Physicians today often follow the master's desires to seek gratifying results. Even if complications arise, they claim it is due to the disease itself, not the physician's fault. Who can hold up a bright mirror to let no flaw escape? This is how the world of mediocre physicians is formed.
Zhang Zhongyi initially contracted dysentery, having a few bowel movements daily, and invited me to examine him. He moved normally, but his pulse indicated internal injury with pathogenic factors involving the Shaoyin channel. After diagnosis, I immediately advised, "This syndrome still requires simultaneous release of the exterior and interior. However, use more Ren Shen (Ginseng Radix et Rhizoma) in the exterior-releasing formula and more Fu Zi (Aconiti Lateralis Radix Praeparata) in the interior-treating formula to avoid disaster. Using standard dysentery medications would surely lead to danger." Zhang Zhongyi deeply trusted me and took the prescribed medicine without doubt. At that time, the disease severity had not yet manifested. By evening, he suddenly developed high fever, his body felt heavy as a giant stone, requiring two people to move him from the pillow. He was lethargic and confused, causing panic in the household. After hastily taking the exterior-interior dual formulas, by the next morning, he could rise and leave the room. Two more doses of Ginseng and Aconite formulas led to complete recovery. Without syndrome differentiation, what treatment in the dysentery category could achieve such results? Especially considering the foresight applied before the disease became severe.
Zhou Xinchuan was seventy-three years old, usually robust and unaware of his age. He contracted dysentery in autumn, which persisted untreated until winter, developing into Xiu Xi Li (Intermittent Dysentery), with over ten bowel movements per day. His face and eyelids were edematous, and his skin was dark and dull. He sought my treatment. His pulse was deep, rapid, and forceful. I told him, "This is a syndrome where Yang pathogens have sunk into Yin. With proper treatment, you can recover. I will bring medicine tomorrow for direct treatment." I prepared Ren Shen Bai Du San (Ginseng Detoxifying Powder) decoction. He sat in a chair surrounded by thick quilts, with a fire placed beneath the chair. A cloth roll shaped like a goose egg was placed on the seat cushion to support the anus, preventing internal Qi from sinking downward. Then, he drank the hot decoction. After some time, he took more. Soon, he felt slight moisture on his skin. Hot water was poured over him (for external warming/steaming), and he was instructed to endure holding back stool without moving his body. This lasted about two shi (four hours). The moisture on his skin remained. The patient was irritable and afraid of heat, enduring until he could bear it no longer, at which point he lay on the bed wrapped in the quilt. That night, he had only two bowel movements. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used. Bowel movements reduced to three per day, and he recovered fully within ten days. This is because the sunken pathogens needed to be lifted out through the exterior. Without the "pulling the boat upstream in a swift current" method (lifting sunken pathogens to the surface), where would the downward momentum end? It is heard that Wang Xingzai suffered from chronic dysentery unresponsive to various drugs. An old physician in Suzhou administered Ren Shen Bai Du San, reducing the severity and showing vitality. However, lacking this specific manipulative technique, success was not achieved. Therefore, whenever Yang pathogens sink into Yin, such as in chronic malaria, chronic dysentery, or chronic fever, one must understand this principle: allow them to slowly emerge to the exterior. Rushing may cause pathogens to re-enter, merely damaging healthy Qi.
Zhu Kongyang, twenty-five years old, was thin and accustomed to comfort. In summer, due to litigation, he ran in the sun. Summerheat-dampness combined with internal stagnant fire to form dysentery. He had 100-200 bowel movements daily, unable to get out of bed, changing coarse paper sheets frequently. He drank water but ate nothing. The pain was severe, the anus felt like burning, and he kicked and waved in distress. His pulse was wiry, tight, and tense, resisting finger pressure. I said, "This syndrome involves a mass of toxic fire accumulated in the intestines and stomach, burning fiercely. Saving from fire requires immediate action; otherwise, in two or three days, the intestines and stomach will rot." I used Da Huang (Rhei Radix et Rhizoma) four liang, Huang Lian (Coptidis Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma) two liang each, decocted in a large clay pot. Administered while boiling. After ingestion, he rested briefly, then became restless again. Over twenty bowls were consumed in a day; the rhubarb dissolved, and the coptis and licorice boiled down to no juice. The next day, he requested more. My examination showed the pulse had softened slightly, indicating recovery was possible. However, I used an urgent method but not urgent herbs. I switched to Di Huang (Rehmanniae Radix) and Mai Men Dong (Ophiopogonis Radix) four liang each, ground fresh for juice. Tian Hua Fen (Trichosanthis Radix), Mu Dan Pi (Moutan Cortex), Chi Shao (Paeoniae Radix Rubra), and Gan Cao one liang each were decocted and mixed with the fresh juice in large bowls. Because the onset was violent, body fluids were depleted rapidly. Only after stopping dysentery should one nourish fluids and blood, as dryness cannot be restored instantly. Since the pulse weakened, fire pathogens receded. Treating the dysentery directly was unnecessary; it stopped naturally. Why cling to cloying/nourishing herbs and delay urgent use? After taking this medicine, dysentery stopped completely, leaving only minor frothy stools. On the third day, he desired tofu milk. On the fourth day, he drank clear rice soup from aged grain. Slow conditioning continued for over ten days until digestion normalized. This shows that even a trace of Stomach Qi remaining requires such "heroic" intervention.
Chen Ruming suffered from dysentery with steaming fever, lethargy, and refusal to eat, becoming critically ill by the third day. His pulse was rapid, large, and empty, with the chi position being exceptionally surging. I said, "This is a combination of two diseases occurring simultaneously. Internal damp-heat combines with seasonal external heat, predisposing to dysentery, though unnoticed. Intercourse further weakened him, allowing sudden cold to invade. Thus, fever, heaviness, and lethargy belong to Shaoyin Kidney channel external contraction. Shaoyin invasion typically presents with clear/white dysentery. Here, intestinal damp-heat has fermented into a foul, pig-liver/fish-brain-like substance, changing color but maintaining the dysenteric nature. Another dose of standard dysentery medicine would be fatal." I urgently prescribed Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to disperse external pathogens. Sweating followed, and fever decreased slightly. Then, Fu Zi Li Zhong Tang (Aconite and Poria Decoction) was given for two consecutive doses. Fever subsided, body felt light, and appetite returned. Huang Lian Li Zhong Wan (Coptis and Poria Pills) was then used for ten days until full recovery.
Ye Maoqing's young son suffered from Jin Kou Li (Dysentery with inability to eat) and fever for over ten days, with continuous vomiting and hiccups. His guan pulse surged upward without root. The foot pulses also surged upward without root. I told his father, "This is not Jin Kou Li, but impending collapse of Stomach Qi. Jin Kou Li is caused by deficient heat obstructing the Stomach, leading to fullness and anorexia, treated by tonifying deficiency and clearing heat. This case resulted from damage by bitter-cold herbs, rendering the Stomach unable to accept food. The only treatment is exclusive warming and tonification." Li Zhong Tang (Regulate the Middle Decoction) was administered for two doses. Soon, over ten bowel movements occurred, soiling everything. Ye Maoqing feared incorrect prescription and asked for a change. I said, "My intent was to save the collapsing Stomach Qi, not primarily to treat dysentery. Even if treating dysentery, the intestines are deep in the abdomen; even divine medicine cannot instantly alter feces. Now, using medicine to accelerate expulsion is beneficial. Why doubt it?" The medicine was taken for three days. Condition improved significantly; appetite returned, vomiting ceased, and dysentery lessened. After four days, normal stooling stopped. Bu Zhong Yi Qi Tang was used for ten days for recovery. This demonstrates that pediatric dysentery is often due to dietary injury rather than internal accumulated heat, and standard dysentery protocols should rarely be used lightly.
Pu Junyi suffered from dysentery. Initially, exterior pathogens were present but not resolved. Misuse of Ren Shen and Bai Zhu to consolidate the exterior drove pathogens deeper. Mistaken administration of Huang Lian (cooling/clearing) and Da Huang (purgative) continued for over a month, stagnating Stomach Qi. He had over a hundred bowel movements daily. One night, he vomited three to five bowls of previously ingested Huang Lian decoction. After two or three episodes, the Stomach and Intestines merged; the幽门 (pylorus) and 阑门 (ileocecal valve) opened wide. Porridge and drinks flowed out directly; even concentrated Ginseng paste passed straight through the intestines upon swallowing. Amidst crisis, relatives asked if there was hope. I replied, "With proper medication here, there is reliance. I know the danger, but no one else can take responsibility. I will stabilize with tranquility and repay my confidant's trust." Large doses of Si Jun Zi Tang were decocted and mixed with Chi Shi Zhi (Halloysitum Rubrum) and Yu Yu Liang (Yuccae Fossilia). Continuous administration slowed the downward flow. However, unbearable abdominal pain ensued. Pu Junyi said, "Previously, frequent diarrhea was painless. Now pain increased; do not continue." I said, "This illustrates 'unblocked means no pain, pain means blockage.' No pain indicates danger; pain indicates safety. Why fear pain?" The same medicine was continued. Once the severity greatly diminished, Si Jun Zi Tang with doubled Fu Ling (Poria) was used. Over ten doses led to full recovery.
Mr. Hu Youchen said, "Build a cart behind closed doors, and it fits the tracks outside. If physicians in counties emulate this diagnostic reasoning, assessing their level first, then applying it, it would be effective."