糜。调其胃气必效。此即石莲之意也。治噤口痢。多有用黄连者。此正治湿热之药。苦而且降。
不能开提。况非胃虚所宜。不可轻用。大抵初痢噤口。为湿瘀胃口。故宜苦燥治之。若久痢口噤。
则胃气虚败。即大剂独参、理中。恐难为力也。久痢不止。诸药不应。贫人无力服参者。乌梅、
大枣各数枚。煎服屡效。
休息痢 此证多因兜涩太早。积热未尽。加以调摄失宜。不能节食戒欲。所以时止时作。补
中益气加肉果、木香。吞驻车丸。亦有阴虚多火。不能胜任升、柴、木香、白术者。只用驻车丸
加人参、肉桂、乌梅之类。有积。可加枳实、炮黑楂肉。有服补中益气数服。不应。反下鲜紫血
块者。此久风成飧泄。风气通于肝。肝伤不能藏血也。三奇汤倍防风加羌、葛、升、柴。其一切
利水破气药。皆为切禁。
蛲虫痢 其证腹大。皮肤黄粗。循循戚戚然。得之于寒湿。寒湿之气。菀笃不发。化为虫。
此九虫之一。其形极细。胃弱肠虚。则蛲虫乘之。或痒。或从谷道中溢出。仓公以芫花一撮主之。
乌梅丸、黄连犀角散亦主之。然虫尽之后。即用六君子加犀角、黄连、乌梅肉丸服。以补脾胃。
兼清湿热。庶不再发。若一味攻虫。愈攻愈盛。漫无止期也。
痢后风 因痢后不善调摄。或多行。或房劳。或感风寒。或受湿气。致两脚痿软肿痛。用大
防风汤。痢后变成痛风。皆调摄失宜所致。补中益气加羌活、续断、虎骨。
痢后呃哕 此乃胃气虚寒之极。最为恶候。急宜橘皮干姜汤主之。下痢而渴。误食冷物水果
而哕者。理中汤加丁香十五粒。柿蒂五枚。水煎热服。兼寒热往来者。小柴胡加丁香。血痢呕哕
而渴。心烦不得眠。小便不通者。猪苓汤。白痢呕哕。用五苓散。以中有肉桂可通逆气也。
〔诊〕下痢白沫。初起脉小滑。能食者易治。洪大急疾。四肢厥冷者难治。久痢脉微弱小细者
即愈。数实或虚大无根者危。下痢脓血。初起脉小滑。或弦软。身不热者易治。数实滑大而身热
者。势虽甚。犹或可治。若先不热。五六日后。反发热脉大者必死。久则脉宜芤迟虚细。不宜数
盛滑实。或身热不止。口噤不食者皆死。久痢脉结代。反骤能食。为除中者必死。大抵下利之脉。
初起虽实大不妨。六七日后最忌强盛。凡下痢脉浮身热。作风治。脉沉身重。作湿治。下痢为肠
胃病。虽频迸而能食则吉。若噤口痢。初起脉数实可治。久痢而反不能食。脉见有余者死。惟小
弱流利者。当作胃虚治之。
海藏治杨师。屡大醉后渴饮冷水冰茶。后病大便鲜血甚多。先以吴茱萸温药。次与胃苓汤。
血止后白痢。又与温下药四服乃止。或曰。何不用黄连之类以解毒。反用温热之剂。曰。血为寒
所凝。渍入肠间而便下。得温乃行。若用寒凉。即变证难疗矣。
汪石山治一妇。病痢半载余。服四物、香连愈剧。腹痛后重。咳嗽烦热。脉皆细弱而数。以
补中益气去归。加茯苓、芍
药为散。日用米饮调下。三次而安。
吴茭山治一妇。长夏患痢。痛迫。下黄黑。曾服香薷、枳壳、黄连愈剧。其脉两尺紧涩。此
寒伤血也。问其由。乃行经时渴饮冷水一碗。遂得此证。与桃仁承气加延胡索一服。次早下黑血
升许痛止。次用调脾活血之剂而痊。此盖经凝作痢。不可不察也。
李士材治屯田孙侍御夫人。久痢不止。口干发热。饮食不进。犹服香、连等药。完谷不化。尚
谓邪热不杀谷。欲进芩、连。数日不食。热甚危迫。诊之。脉大而数。按之极微。询之小便仍利。
腹痛而喜手按。此火衰不能生土。内真寒而外假热也。小便利则无热可知。腹喜按则虚寒立辨。
急进附子理中汤。待冷与服。一剂而痛止。连进二十余剂。兼进八味丸而康。
石顽治春榜项鸣先尊堂。下痢血色如苋汁。服消克苦寒芩、连、大黄之类愈甚。不时发热痞
闷。六脉瞥瞥虚大。右关独显弦象。然按之则芤。此气虚不能统血之候。与补中益气加炮姜、肉
桂。四剂而安。
又治郭然明之室。患五色痢。昼夜数十次。兼带下如崩。误服大黄、黄连之属十余剂。遂隔
塞不通。口噤不食者半月余。至夜必大发热躁渴。六脉弦细而疾。此足三阴俱虚之候。与理中加
桂、苓、木香、乌梅以调其胃。次与加减八味作汤。导其阴火而痊。
刑部郎中申勖庵高年久痢。色如苋汁。服芩、连、芍药之类二十余剂。渐加呃逆。乃甥王勤
中。邀石顽往诊。六脉弦细如丝。惟急进辛温峻补。庶合病情。遂疏理中加丁香、肉桂方。诸医
咸谓血痢无用姜、桂、人参之理。迟疑不敢服。
仍啜芩、连、芍药。迁延五日。病愈甚而骤然索粥。举家及诸医。皆以能食为庆。复邀石顽相商。
而脉至如循刀刃。此中气告竭。求救于食。除中证也。世人但知下痢能食为向愈。曷知其有除中
之例乎。因表出以为后学之鉴。
褚某水尊堂。深秋久痢。口噤不食者半月余。但饮开水及爪瓤汁。啜后必呕胀肠鸣。绞痛不
已。烦渴闷乱。至夜转剧。所下皆脓血。昼夜百余次。小水涓滴不通。诸医束手告辞。始邀石顽。
切其六脉。皆弦细乏力。验其积沫。皆瘀淡色晦。询其所服。皆芩、连、槟、朴之类。因谓之曰。
所见诸证俱逆。幸久痢脉弱。尚宜温补。姑勒一方。用理中加桂、苓、紫菀调之。服后小便即通。
便得稍寐。三四日间糜粥渐进。痢亦渐减。更与理中倍参。伏龙肝汤泛丸。调理而痊。
又治同川春榜陈颖雍。触热锦旋抵家。即患河鱼腹疾。半月以来。攻克不效。遂噤口粒米不
入。且因都门久食煤火。肩背发痈。不赤不疼。陷伏不起。发呃神昏。势日濒危。内外医科。互
相推委。因命楫相邀石顽。就榻诊之。六脉弦细欲绝。面有戴阳之色。所下之物。瘀晦如烂鱼肠
脑。证虽危殆。幸脉无旺气。气无喘促。体无躁扰。可进温补。但得补而痈肿 发。便可无虞。
遂疏保元汤。每服人参三钱。生黄 二钱。甘草、肉桂各一钱。伏龙肝汤代水煎服。一啜而稀糜
稍进。再啜而后重稍轻。三啜而痈毒贲起。另延疡医敷治其外。确守前方。服十余服而安。前后
未尝更易一味也。
一大兵船上妇胎前下痢。产后三日不止。恶露不行。发热喘胀。法在不救。有同道误许可治。
与药一服。次早反加呃逆。计无所施。乃同兵丁。托言货船。拉石顽往诊。其脉三至一代。直以
难治辞之。彼则留住前医。不使上涯。方知其意原欲巧卸。恐余不往。故不明言其故。当此急迫
之际。不与解围。必致大伤体面。因谓之曰。此证虽危。尚有一
线生机。必从长计议。庶可图治。彼闻是言。始放其医抵家。而求药于余。遂与盏一枚。钱数文。
令习砂糖熬枯。白汤调服。既可治痢。又能下瘀。且不伤犯元气。急与服之。彼欣然而去。其医
得脱。闭户挈家而遁。直至数日。大兵去后宁家。即过我而谢曰。若非金蝉脱壳。不免为螳臂所执也。
飞畴治朱元臣子。患五色痢。二十余日。胸膈胀满。而粥饮不进。服药罔效。别延两医诊视。
一用大黄。一用人参。元臣不能自主。因执治于予。予曰。用大黄者。因其脉满脉大也。用人参
者。因其痢久不食也。痢久不食。大黄断断难施。膈满作胀。人参亦难遽投。今拟伏龙肝为君。
专温土脏。用以浓煎代水。煎焦术、茯苓、甘草、广藿、木香、炒乌梅。一剂痢减食进。再剂而
止。遂不药调理而起。
将食物煮成糜粥。调理好胃气必定见效。这正是石莲子（一种具有清热止痢作用的药材）的用意所在。治疗噤口痢（痢疾中饮食不进、甚至呕吐的严重症状），很多人使用黄连。黄连确实是治疗湿热证的药物，但其性味苦寒且主沉降，不能起到升提胃气的作用。况且它并不适合胃虚的患者，不可轻易使用。大抵而言，初起发生的噤口痢，是因为湿邪瘀阻在胃口，所以适宜用苦燥的药物来治疗。如果是久痢导致的口噤，则是胃气虚弱衰败所致，即使使用大剂量的独参汤或理中汤，恐怕也难以奏效。对于久痢不止，各种药物都无效，且贫穷患者无力服用人参的情况，可用乌梅和大枣各数枚，煎汤服用，屡见疗效。
休息痢：这种病症多因过早使用收敛固涩的药物，导致积热未尽，加上调养摄生不当，不能节制饮食和戒除房事，所以病情时好时坏，反复发作。治疗可用补中益气汤加肉豆蔻、木香，并吞服驻车丸。也有阴虚火旺体质，无法承受升麻、柴胡、木香、白术等升提燥烈药物的，只需用驻车丸加入人参、肉桂、乌梅之类。如果有积滞，可加枳实、炒焦的山楂肉。如果服用补中益气汤几剂后无效，反而排出鲜紫色的血块，这是久病的风邪转化为飧泄（大便稀薄夹杂未消化食物），风气通于肝，肝受伤不能藏血所致。可用三奇汤加倍防风，再加羌活、葛根、升麻、柴胡。此时一切利水破气的药物都是严格禁忌的。
蛲虫痢：其症状表现为腹部胀大，皮肤黄而粗糙，神情忧郁不快。此病得之于寒湿，寒湿之气郁结深重而不发，化为虫。这是九虫之一，形体极细小。当胃弱肠虚时，蛲虫便乘虚而入。或者感到瘙痒，或者从肛门溢出。汉代名医仓公曾用一撮芫花来主治此症。乌梅丸、黄连犀角散也用于治疗此症。然而，在虫排尽之后，应立即服用六君子汤加犀角、黄连、乌梅肉制成的丸药，以补益脾胃，兼清湿热，这样才不会再复发。如果一味地攻杀虫体，只会使虫势更盛，漫无止期。
痢后风：因为痢疾后调养不当，或多行走劳累，或房劳过度，或感受风寒，或受湿气侵袭，导致两脚痿软肿痛。可用大防风汤治疗。痢疾后变成痛风，都是因为调养失宜所致。可用补中益气汤加羌活、续断、虎骨治疗。
痢后呃哕：这是胃气极度虚寒的表现，属于最凶险的证候。急需用橘皮干姜汤主治。如果是下痢口渴，误食冷物或水果而导致呃逆的，用理中汤加丁香十五粒、柿蒂五枚，水煎热服。如果伴有寒热往来症状的，用小柴胡汤加丁香。如果是血痢伴随呕哕且口渴、心烦不得眠、小便不通的，用猪苓汤。如果是白痢伴随呕哕的，用五苓散，因为方中含有肉桂可以通达逆气。
〔诊法〕下痢白色泡沫，初起脉象小滑，能进食的容易治疗；若脉象洪大急疾，四肢厥冷的则难治。久痢脉象微弱细小的即会痊愈；若脉象数实或虚大无根的则危险。下痢脓血，初起脉象小滑，或弦软，身体不发热的容易治疗；若脉象数实滑大且身体发热的，虽然病势很猛，或许还可以治疗。如果起初不发热，过了五六天反而发热且脉大的，必然死亡。病程久了，脉象应当是芤迟虚细，不应当是数盛滑实。或者身体发热不止，口噤不能进食的，也都属死证。久痢脉象出现结代，反而突然能吃，这是“除中”（胃气绝前的回光返照现象），必然死亡。大抵下利的脉象，初起虽然实大不要紧，但六七日后最忌讳脉象强盛。凡下痢脉浮身热的，按风邪治疗；脉沉身重的，按湿邪治疗。下痢虽然是肠胃的病，虽然频繁排便但能进食则是吉兆。若是噤口痢，初起脉数实尚可治疗，久痢反而不能进食，脉象显得有余（实大有力）的属死证。只有脉象小弱流利的，才当作胃虚来治疗。
海藏治疗杨师，多次在大醉后渴饮冷水冰茶，后来患病大便鲜血很多。先用吴茱萸温性药物，接着给予胃苓汤。血止后出现白痢，又给予温下药四服才停止。有人问：“为什么不用黄连之类来解毒，反而用温热药剂？”回答说：“血液被寒气凝结，渗入肠间而下出，得到温暖才能运行。如果用寒凉药，就会变生其他证候难以治疗了。”
汪石山治疗一位妇人，患痢疾半年多，服用四物汤、香连丸后病情加重，腹痛里急后重，咳嗽烦热，脉象皆细弱而数。用补中益气汤去掉当归，加茯苓、芍药制成散剂，每天用米汤调服，三次后病情安定。
吴茭山治疗一位妇人，长夏季节患痢疾，疼痛紧迫，排泄物黄黑色，曾服用香薷、枳壳、黄连后病情加重。其脉象两尺部紧涩，这是寒邪伤了血分。询问病因，是在行经期间喝了一碗冷水，于是得了这个病。给予桃仁承气汤加延胡索，一服药后，次日早晨排出黑血约一升，疼痛停止。接着用调脾活血的药剂而痊愈。这大概是经血凝滞化作痢疾，不可不仔细考察。
李士材治疗屯田孙侍御夫人，久痢不止，口干发热，饮食不进，还服用香连等药，完谷不化（大便中有未消化的食物），还说是邪热不能腐熟水谷，想要进用黄芩、黄连。几天不吃东西，热势危急迫近。诊察脉象大而数，重按极其微弱。询问小便仍然通畅。腹痛且喜欢用手按压。这是火衰不能生土，内真寒而外假热的表现。小便通利说明体内无热，腹部喜欢按压说明是虚寒，一目了然。紧急进服附子理中汤，待药液冷却后服用，一剂后疼痛停止。连续进服二十余剂，同时进服八味丸而康复。
石顽治疗春榜项鸣先的母亲，下痢血色像苋菜汁一样，服用消导克伐的苦寒药如黄芩、黄连、大黄等后病情加重。不时发热痞闷，六脉飘忽不定、虚大，右关脉单独显现弦象，然而重按则空豁如葱管。这是气虚不能统摄血液的征候。给予补中益气汤加炮姜、肉桂，四剂后病情安定。
又治疗郭然明的妻子，患五色痢，昼夜数十次，兼带下如崩漏。误服大黄、黄连等药十余剂，导致膈塞不通，口噤不能进食达半月余，每到夜晚必然大发热躁渴，六脉弦细而疾速。这是足三阴经都虚弱的征候。给予理中汤加肉桂、茯苓、木香、乌梅来调理胃气，接着用加减八味丸作汤剂，引导阴火而痊愈。
刑部郎中申勖庵年老久痢，颜色像苋菜汁。服用黄芩、黄连、芍药等药二十余剂，逐渐加重呃逆。于是外甥王勤中邀请石顽前往诊视。六脉弦细如丝，只有紧急进用辛温峻补之法，才符合病情。于是开具理中汤加丁香、肉桂的方子。众医生都说血痢没有使用姜、桂、人参的道理，迟疑不敢服用。
仍然饮用黄芩、黄连、芍药等药，拖延五日，病情更加严重，却突然索要粥喝。全家及众医生，都以能进食为庆幸，再次邀请石顽商量。而脉象到来如同触摸刀刃般锋利，这是中气告竭，向食物求救，属于“除中”证。世人只知道下痢能进食是向愈的迹象，哪里知道有除中的情况呢？因此列出此案作为后学的借鉴。
褚某水的母亲，深秋久痢，口噤不能进食达半月余。只喝开水和西瓜瓤汁，喝完后必定呕吐腹胀肠鸣，绞痛不已，烦渴闷乱，到了夜晚加剧。所排泄的都是脓血，昼夜一百多次，小便点滴不通。众医生束手无策告辞离去，这才邀请石顽。切按其六脉，皆弦细乏力。检验其积存的泡沫，都是瘀淡色晦暗。询问其所服用的药物，都是黄芩、黄连、槟榔、厚朴之类。于是对他说：“所见诸证均属逆证，幸好久痢脉弱，尚宜温补。暂且拟定一方，用理中汤加肉桂、茯苓、紫菀来调理。服用后小便即通，大便得以稍睡。三四日间糜粥逐渐进食，痢疾也逐渐减少。再给予理中汤倍用人参，用伏龙肝汤泛丸，调理而痊愈。
又治疗同川春榜陈颖雍，触热骑马回家，立即患上腹泻痢疾。半个月以来，攻下消导无效，于是噤口粒米不入。而且因为长期居住京城食用煤火，肩背发生痈肿，不红不痛，陷伏不起，发出呃逆神志昏蒙，形势日益濒危。内外各科医生互相推诿责任，于是命人邀请石顽，到床边诊视。六脉弦细欲绝，面色有戴阳（虚阳上浮）之色。所排泄之物，瘀晦如烂鱼肠脑。证候虽然危殆，幸好脉象没有旺气，气息没有喘促，身体没有躁扰，可以进用温补。只要通过补益使痈肿发出，就可以无忧虑了。于是开具保元汤，每服人参三钱，生黄芪二钱，甘草、肉桂各一钱，用伏龙肝汤代替水煎服。喝一次后稀糜粥稍微能进食，再喝一次后里急后重稍微减轻，第三次喝后痈毒隆起，另外延请外科医生敷治外部。确守前方，服用十余服后安定。前后未曾更换一味药。
一大兵船上的妇女，产前下痢，产后三天不止，恶露不行，发热喘胀，按照医理属于不治之症。有同道错误地许诺说可以治疗，给了一服药，第二天早上反而增加呃逆，计谋穷尽无法施展。于是同士兵一起，借口是货船，拉着石顽去诊视。其脉象三至一止（代脉），直接以难治推辞。那人却留住前医，不让上岸，才知道他的原意是想巧妙地卸责，恐怕我不去，所以不明言其中的缘故。在这紧急迫切之际，如果不解围，必定大伤面子。于是对他说：“这个证候虽然危险，尚有一线生机，必须从长计议，才可以图谋治疗。”那人听到这话，才放前医回家，向我求药。于是给他一个盏子和几文钱，让他练习熬砂糖至枯焦，用白开水调服。既可治痢，又能下瘀血，且不损伤元气。急忙让他服用。那人高兴地离开，前医得以脱身，关门带着家人逃遁。直到几天后，大兵离开后回到家乡，就来过我这里道谢说：“如果不是金蝉脱壳之计，不免被螳臂所阻挡（指被前医纠缠或报复）。”
飞畴治疗朱元臣的儿子，患五色痢，二十多天，胸膈胀满，而粥饮不进，服药无效。另外延请两位医生诊视，一位用大黄，一位用人参。朱元臣不能自主，于是委托给我治疗。我说：“用大黄的人，是因为他脉满脉大；用人参的人，是因为他痢久不进食。痢久不进食，大黄绝对难以施用；膈满作胀，人参也难以立刻投用。现在拟定以伏龙肝为君药，专门温补土脏，用来浓煎代替水，煎煮焦白术、茯苓、甘草、广藿香、木香、炒乌梅。一剂后痢减食进，再剂后停止，于是停药调理而起身康复。”
Make food into a soft porridge. Regulating the stomach qi will surely be effective. This is precisely the intention behind using Shi Lian Zi (Euryale Seed). In treating Jin Kou Li (Dysentery with inability to eat), many use Huang Lian (Coptis Rhizome). Huang Lian is indeed a herb for treating damp-heat, but its nature is bitter and cold, and it descends; it cannot lift and open the stomach qi. Moreover, it is not suitable for stomach deficiency, so it should not be used lightly. Generally, Jin Kou Li occurring at the onset of dysentery is due to dampness and blood stasis obstructing the stomach opening, so it is appropriate to treat it with bitter-drying herbs. If mouth closure occurs in chronic dysentery, it indicates that the stomach qi is deficient and failing; even large doses of Du Shen Tang (Single Ginseng Decoction) or Li Zhong Tang (Regulate the Middle Decoction) may struggle to be effective. For chronic dysentery that does not stop and responds to no medicines, especially when poor patients cannot afford to take Ren Shen (Ginseng Root), taking several Wu Mei (Mume Fruit) and Da Zao (Jujube Fruit), decocted and taken orally, has proven effective repeatedly.
Xiu Xi Li (Intermittent Dysentery): This condition often arises from using astringents too early, leaving accumulated heat unresolved, compounded by improper lifestyle management, failure to regulate diet, and lack of sexual restraint, causing the condition to remit and relapse intermittently. Treatment involves Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia Root), taken together with Zhu Che Wan (Stopping Travel Pill). There are also cases of yin deficiency with abundant fire, where the patient cannot tolerate the ascending and drying properties of Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Mu Xiang, and Bai Zhu (Atractylodes Macrocephala Rhizome); in such cases, only Zhu Che Wan added with Ren Shen, Rou Gui (Cinnamon Bark), and Wu Mei is used. If there is accumulation, Zhi Shi (Immature Bitter Orange) and Pao Hei Zha Rou (Charred Hawthorn Flesh) can be added. If several doses of Bu Zhong Yi Qi Tang fail to work and instead result in the passage of fresh purple blood clots, this indicates that long-standing wind pathogen has transformed into Sun Xie (Sporadic Diarrhea with undigested food). Wind qi communicates with the Liver; when the Liver is injured, it fails to store blood. San Qi Tang (Three Marvels Decoction) with doubled Fang Feng (Saposhnikovia Root), plus Qiang Huo (Notopterygium Rhizome), Ge Gen (Kudzu Root), Sheng Ma, and Chai Hu, is indicated. All diuretic and qi-breaking herbs are strictly contraindicated.
Tao Chong Li (Threadworm Dysentery): The symptoms include abdominal distension, yellow and rough skin, and a melancholic demeanor. It results from cold-dampness; the cold-damp qi stagnates deeply without manifesting immediately, transforming into parasites. This is one of the nine types of worms, extremely fine in shape. When the stomach is weak and the intestines empty, Tao Chong (Threadworms) take advantage. Symptoms may include itching or the worms overflowing from the anus. Cang Gong (Hua Tuo's teacher, Bian Que's contemporary) treated it with a pinch of Yuan Hua (Genkwa Flower). Wu Mei Wan (Mume Pill) and Huang Lian Xi Jiao San (Coptis and Rhino Horn Powder) are also indicated. However, after the worms are eliminated, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Huang Lian, and Wu Mei flesh should be made into pills and taken to tonify the spleen and stomach while clearing damp-heat, preventing recurrence. If one solely attacks the worms, the infestation will worsen endlessly.
Li Hou Feng (Wind After Dysentery): Due to improper care after dysentery, excessive walking, sexual exhaustion, exposure to wind-cold, or dampness invasion, leading to flaccidity, swelling, and pain in both legs. Da Fang Feng Tang (Major Saposhnikovia Decoction) is used. Gout developing after dysentery is also caused by improper regulation. Bu Zhong Yi Qi Tang added with Qiang Huo, Xu Duan (Dipsacus Root), and Hu Gu (Tiger Bone - *Note: Substitute with legal alternatives*) is indicated.
E Yue After Dysentery: This represents extreme deficiency-cold of the stomach qi, a most ominous sign. Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction) is urgently indicated. If hiccups occur after dysentery with thirst due to mistakenly eating cold foods or fruits, Li Zhong Tang added with 15 Ding Xiang (Clove Buds) and 5 Shi Di (Persimmon Calyx), decocted in water and taken hot, is used. If accompanied by alternating chills and fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Ding Xiang is used. For bloody dysentery with hiccups, thirst, irritability, insomnia, and urinary obstruction, Zhu Ling Tang (Polyporus Decoction) is indicated. For white dysentery with hiccups, Wu Ling San (Five-Ingredient Powder with Poria) is used because it contains Rou Gui to unblock rebellious qi.
[Diagnosis] Passing white mucus in dysentery: If the pulse is small and slippery at the onset and the patient can eat, it is easy to treat. If the pulse is surging, large, rapid, and urgent, with cold limbs, it is difficult to treat. In chronic dysentery, if the pulse is weak, minute, and fine, recovery is imminent. If the pulse is rapid and excess or void and large without root, it is critical. Passing pus and blood in dysentery: If the pulse is small and slippery, or wiry and soft at the onset, and the body is not hot, it is easy to treat. If the pulse is rapid, excess, slippery, and large with fever, although the condition is severe, it may still be treatable. If there was no fever initially, but fever develops after five or six days with a large pulse, death is certain. In prolonged cases, the pulse should be knotted, slow, void, and fine, not rapid, full, slippery, and excess. Or if fever persists and the mouth is closed with inability to eat, death is certain. In chronic dysentery, if the pulse shows intermission (Jie Dai) but the patient suddenly gains an appetite, this is Chu Zhong (False Appetite indicating stomach qi exhaustion), and death is certain. Generally, for diarrhea pulses, although excess and large at the onset is acceptable, it is most taboo for the pulse to remain strong after six or seven days. For dysentery with floating pulse and fever, treat as wind; with sinking pulse and heavy body, treat as damp. Dysentery is a disease of the intestines and stomach; frequent evacuation with ability to eat is auspicious. For Jin Kou Li, if the pulse is rapid and excess at onset, it is treatable; if chronic and unable to eat with a seemingly excess pulse, it is fatal. Only if the pulse is small, weak, and smooth should it be treated as stomach deficiency.
Hai Zang treated Master Yang, who frequently drank cold water and iced tea after heavy drunkenness. Later, he suffered from profuse bright red blood in stool. First, warm herbs like Wu Zhu Yu (Evodia Fruit) were used, followed by Wei Ling Tang (Stomach and Five-Ingredients Decoction). After bleeding stopped, white dysentery appeared, which ceased after four doses of warm purgatives. Someone asked, "Why not use Huang Lian to detoxify, but rather use warm agents?" The reply was, "Blood coagulated by cold seeps into the intestines and passes down; it flows only when warmed. Using cold-cooling herbs would lead to complicated syndromes difficult to treat."
Wang Shi Shan treated a woman who had dysentery for over half a year. Taking Si Wu Tang (Four Substances Decoction) and Xiang Lian Wan (Costus and Coptis Pill) worsened her condition, causing abdominal pain, tenesmus, cough, and irritability. Her pulse was fine, weak, and rapid. Bu Zhong Yi Qi Tang without Dang Gui (Angelica Sinensis Root), added with Fu Ling (Poria) and Shao Yao (Peony Root), was made into a powder and taken daily with rice water. She recovered after three doses.
Wu Jiao Shan treated a woman who contracted dysentery in midsummer with urgent pain and yellow-black discharge. Taking Xiang Ru (Mosla Herb), Zhi Ke (Aurantium Fructus), and Huang Lian worsened it. Her two Chi positions were tight and choppy, indicating cold injuring the blood. Inquiry revealed she drank a bowl of cold water during menstruation. Tao Ren Cheng Qi Tang (Peach Kernel and Major Order the Qi Decoction) added with Yan Hu Suo (Corydalis Rhizome) was given. The next morning, she passed about one sheng of black blood, and pain ceased. Then, spleen-regulating and blood-invigorating agents cured her. This was menstrual blood stasis transforming into dysentery, which must be carefully observed.
Li Shi Cai treated the wife of Supervisor Sun of the Land Reclamation Bureau. She had chronic dysentery, dry mouth, fever, and inability to eat. She continued taking Xiang Lian agents, resulting in undigested food in stool. She claimed "pathogenic heat fails to digest grain" and wanted to add Huang Qin (Scutellaria Root) and Huang Lian. After days of not eating, high fever became critical. Pulse was large and rapid but extremely faint upon deep pressure. Urination was clear, abdominal pain preferred pressure. This indicated fire deficiency failing to generate earth, true internal cold with false external heat. Clear urination confirmed absence of heat; preference for pressure confirmed deficiency-cold. Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) was urgently administered cool. Pain ceased after one dose. After twenty-plus doses and concurrent Ba Wei Wan (Eight-Ingredient Pill), she recovered.
Shi Wan treated the mother of Xiang Mingxian, a spring examination graduate. Bloody dysentery resembled amaranth juice. Taking dispersing, attacking, bitter-cold herbs like Huang Qin, Huang Lian, and Da Huang (Rhubarb Root) worsened it. Intermittent fever and stifling sensation occurred. Six pulses were fleeting and void-large, with the right Guan position showing a wiry image, yet hollow upon pressure. This indicated qi deficiency failing to control blood. Bu Zhong Yi Qi Tang added with Pao Jiang (Prepared Ginger) and Rou Gui cured her in four doses.
He also treated the wife of Guo Ranming, who suffered from five-color dysentery dozens of times day and night, accompanied by leukorrhea like a gush. Misusing Da Huang and Huang Lian for over ten doses caused blockage, mouth closure, and inability to eat for over half a month. Severe fever and thirst occurred nightly. Six pulses were wiry, fine, and rapid. This indicated deficiency of all three foot yin meridians. Li Zhong Tang added with Gui, Ling, Mu Xiang, and Wu Mei regulated the stomach. Subsequently, Jia Jian Ba Wei (Modified Eight-Ingredient) decoction guided out yin fire, leading to recovery.
Ministry of Justice Director Shen Xu'an, elderly with chronic dysentery resembling amaranth juice, took Huang Qin, Huang Lian, and Shao Yao for over twenty doses, gradually developing hiccups. His nephew Wang Qinzhong invited Shi Wan. Six pulses were wiry and fine as silk. Only urgent administration of pungent-warm vigorous tonification fit the condition. Li Zhong Tang added with Ding Xiang and Rou Gui was prescribed. Other physicians argued against using Jiang, Gui, and Ren Shen for bloody dysentery, hesitating to administer it.
Continuing with Huang Qin, Huang Lian, and Shao Yao, the condition worsened over five days until he suddenly craved porridge. Family and doctors rejoiced at his ability to eat, inviting Shi Wan again. The pulse felt like touching a knife edge, indicating middle qi exhaustion seeking rescue from food—Chu Zhong syndrome. People know dysentery patients eating is a sign of recovery, but few know of Chu Zhong. This case is recorded as a warning for future students.
Mother of Mr. Chu Mou, late autumn chronic dysentery, mouth closed unable to eat for over half a month. Drank only boiling water and watermelon rind juice, vomiting and bloating with bowel sounds afterward. Unceasing colic, irritability, thirst, confusion, worsening at night. Discharged pus and blood over a hundred times day and night. Urine completely blocked. Doctors gave up. Shi Wan was invited. Six pulses were wiry, fine, and powerless. Stool foam was pale, dark, and dull. Medications taken were Huang Qin, Huang Lian, Bing Lang (Areca Seed), Hou Po (Magnolia Bark). Shi Wan said, "All signs are adverse, but fortunately the chronic dysentery pulse is weak, suitable for warming and tonifying." Prescribed Li Zhong Tang added with Gui, Ling, and Zi Wan (Aster Root). Urine flowed after ingestion, sleep improved slightly. Porridge intake increased in three to four days, dysentery decreased. Further treatment with Li Zhong Tang doubled with Ren Shen, pills rolled in Fu Long Gan (Household Hearth Soil), led to recovery.
He also treated Chen Yingyong, a spring examination graduate from Tongchuan. Returning home after heat exposure, he developed river-fish belly disease (severe diarrhea/dysentery). For half a month, purgatives failed, leading to mouth closure and inability to eat. Living in the capital with coal heating caused a carbuncle on the shoulder/back, non-red, non-painful, sunken, accompanied by hiccups and coma, critically ill. Physicians shifted blame. Shi Wan was summoned. Six pulses were wiry, fine, nearly absent. Face showed Dai Yang (floating yang) color. Discharge was dark and muddy like rotten fish intestines. Although critical, the pulse lacked vigorous energy, breathing was not panting, body was not restless, so warming tonification was possible. If tonification induced the carbuncle to surface, safety could be ensured. Bao Yuan Tang (Protect the Origin Decoction) was prescribed: Ren Shen 3 qian, Sheng Huang Qi (Raw Astragalus Root) 2 qian, Gan Cao (Licorice Root) and Rou Gui 1 qian each, decocted in Fu Long Gan water. After one dose, thin porridge was accepted; after two, tenesmus lightened; after three, carbuncle rose. External surgeon applied dressings. Strict adherence to the formula for over ten doses brought stability. Not a single herb was changed throughout.
A woman on a soldier's ship had dysentery before pregnancy, continuing three days postpartum. Lochia did not flow, fever, wheezing, and distension occurred. Medically hopeless. A colleague wrongly promised cure, gave one dose, causing hiccups the next morning. Desperate, they disguised themselves as cargo traders and dragged Shi Wan to diagnose. Pulse was three beats with one intermission (Dai pulse). Shi Wan declared it untreatable. The colleague kept the previous doctor ashore, revealing his intent to shift responsibility. To save face in this emergency, Shi Wan said, "Though critical, there is a thread of life. We must plan carefully." The colleague released the previous doctor to seek medicine from Shi Wan. Shi Wan gave a cup and coins, instructing to boil sugar until charred, mix with plain water. This treats dysentery, moves blood stasis, and does not damage yuan qi. Taken urgently, the colleague left happily, the previous doctor fled, and returned days later to thank Shi Wan, saying, "Without the 'Golden Cicada Sheds Its Shell' stratagem, I would have been trapped by the mantis's arm."
Fei Chou treated the son of Zhu Yuanchen, suffering five-color dysentery for over twenty days, chest oppression, inability to eat porridge or drink, ineffective medication. Two other doctors were consulted: one prescribed Da Huang, the other Ren Shen. Zhu Yuanchen sought my advice. I said, "The Da Huang prescriber saw full/large pulse; the Ren Shen prescriber saw chronic dysentery with no intake. Chronic dysentery with no intake makes Da Huang absolutely unsuitable; chest fullness makes immediate Ren Shen difficult. I propose Fu Long Gan as the sovereign herb to warm the earth organ, decocted thickly as water substitute. Added are Jiao Bai Zhu, Fu Ling, Gan Cao, Guang Huo Xiang (Patchouli), Mu Xiang, and Chao Wu Mei. One dose reduced dysentery and increased appetite; two doses stopped it. Recovery followed with dietary regulation."