下痢秽浊胶粘似脓似血。小腹隐痛。欲便不便的里急后重是也。旧说偏寒偏热。主补主
攻。皆不可拘执。唯所列死证数条。缘时医治不得法流连致死。或过信前医之说。弃而不治。
坐视其死。余目击心伤。日夜焦心。从内经仲景言外之旨。及散见于各条之下。一一体认。
而参以所治之症。大有所悟。药到病瘳。厥效彰彰可纪。请先言救逆之道。而次及恒法。
一医书云。脉沉小者易治。脉浮大者难疗。又云发热不休者死。此遵内经肠 一论。执
一不通之过也。余别有所悟。脉浮为表邪。浮而兼大。是表邪浸于阳明之界而下利。仲景有
葛根汤。等治法发热不休。非感冒风寒。即是经络不和。宜用桂枝汤当归四逆汤。祛风寒以
调经络。人参败毒散加老米。名仓廪汤亦是此意。但药力轻薄。不能速效耳。大抵初病治法。
发热恶寒者。香苏饮加防风川芎。以取微汗则愈。重必用桂枝汤当归四逆汤之类。若寒热往
来多呕者。必用小柴胡汤。若热多而口渴者。小柴胡汤去半夏加栝蒌根主之。若发热不恶寒
里急后重者。以葛根黄芩黄连甘草汤。照古法先煎葛根。后煎诸药。日服二三剂。必愈。若
用痢门方。如芍药汤之类。其邪无不陷入变危者。余深恨倪氏痢疾三方。为杀人主具。
一医书云。腹痛不休者死。按其治法。不过用木香槟榔砂仁及消食行滞之品。安能以救
死症。若果消渴。口中热。胸腹胀满坚实而拒按。为实症。三承气汤可以择用。或以三一承
气汤代之。若果不渴。口中和。脉迟小而无力。或手足冷。腹痛而喜按。为虚寒症。非四逆
汤不可。若腹痛而下痢重滞者。再加生白芍三钱。如腹痛不止。虚烦而喜按。脉弦者。为肝
邪克土。宜小建中汤。服一时许。即以小柴胡汤。去黄芩加白芍药继之。神效。
一医书云下痢纯血者死。下痢如屋漏水者死。按其治法。不过用阿胶地榆槐花苍术之类。
安能以救死症。如果下奔鲜血。口渴便短。里急后重。脉盛者为火症。宜白头翁汤。一日二
服。虚人及产后。加阿胶甘草。亦有下鲜血而非火症者。若血带黯而成块者。属热者少。属
寒者多。俱宜从脉症细辨之。若口中和。脉细。小便长。手足冷者。属虚寒无疑。宜以理中
汤。加灶心土八钱主之。下血多者。宜间服黄土汤。一日二服。三日渐愈。盖以脾胃如分金
之炉。理中汤分其清浊。是治其本源也。屋漏水。即血水之黯滞不稠者。为虚寒症。误用寒
凉攻破所致。若见咽痛。语言无序。半日必死。亦用理中汤救之。
一医书云能食者轻。不能者重。绝食者死。发呕者死。盖不能食。有食滞。即宜以平胃
散加消导之药。若脾胃虚弱。即宜用香砂六君子汤及理中汤。健脾以运胃。又有辨于其微者。
不
即是噤口痢。丹溪用人参石莲肉黄连煎汤。入生姜汁。徐徐呷之。只认作湿热上冲之症。故
不效。宜参上诸法治之。若食入即吐不利于香砂橘半者。宜用干姜黄连黄芩汤。苦辛以开拒
格。若胸满而吐。及干呕吐涎沫者。宜吴茱萸汤。温镇以和土木。其效如神。○凡心下痞满
。从仲景三泻心汤。及浓朴生姜甘草半夏人参汤等。择用如神。
一医书云。妇人新产即发痢者死。余放金匮白头翁汤加甘草阿胶之例。可知产后宜照病
用药。毫无顾忌。又云小儿出痘后即发痢者死。余以为不尽然。大抵产后失于过温致死痘后
失于过寒致死。俱因病而药之。不必泥于一说。
下痢排出秽浊、黏稠胶结，状似脓血。小腹隐隐作痛。想排便却排不出，伴有里急后重感，这就是痢疾的症状。旧时的说法有的偏重于寒证，有的偏重于热证；治疗上有的主张补益，有的主张攻下。这些都不可拘泥固执。只有所列出的几条死证，是因为当时医生治疗不得法，导致病情拖延致死；或者是过分相信前一位医生的说法，放弃治疗，坐视病人死亡。我亲眼目睹，心中伤痛，日夜焦虑。从《内经》和仲景著作中言外之意，以及散见于各条之下的内容，一一仔细体会，并结合我所治疗的病症，大有领悟。用药后疾病痊愈，疗效显著，值得记录。请先讲述急救逆证的方法，然后再讲常规治法。
有一本医书说：脉象沉小的容易治疗，脉象浮大的难治。又说：发热不止的会死。这是遵循《内经·肠澼论》，执守一端而不通变通的过错。我有不同的领悟。脉浮表示有表邪，浮而兼大，是表邪侵入阳明经界而下利。仲景有葛根汤等治疗方法。发热不止，如果不是感冒风寒，就是经络不和。宜用桂枝汤或当归四逆汤，祛除风寒以调和经络。人参败毒散加老米（炒米），名为仓廪汤，也是这个意思。只是药力轻薄，不能迅速见效罢了。大体上初病的治疗法则：如果发热恶寒，用香苏饮加防风、川芎，取微汗即可痊愈。病情重的必用桂枝汤、当归四逆汤之类。如果寒热往来且多呕吐，必用小柴胡汤。如果热多且口渴，用小柴胡汤去掉半夏，加入栝蒌根为主方。如果发热不恶寒且有里急后重，用葛根黄芩黄连甘草汤，按照古法先煎葛根，后煎其他药物，每天服用二三剂，必定痊愈。如果使用痢疾门的方子，如芍药汤之类，邪气无不陷入体内变为危重症的。我深深痛恨倪氏痢疾三方，它们是杀人的主要工具。
有一本医书说：腹痛不止的会死。看它的治疗法则，不过是用木香、槟榔、砂仁及消食行滞的药物，怎么能救治死症呢？如果真的口渴，口中感觉热，胸腹胀满坚实且拒按，这是实证。三承气汤可以选择使用。或者用三一承气汤替代。如果真的不渴，口中平和，脉象迟小而无力，或者手脚冷，腹痛且喜欢按压，这是虚寒证。非四逆汤不可。如果腹痛且下痢沉重滞涩，再加生白芍三钱。如果腹痛不止，心烦且喜欢按压，脉弦，这是肝邪克制脾土。宜用小建中汤。服药约一小时后，接着用小柴胡汤去掉黄芩，加入白芍药继服。效果神奇。
有一本医书说：下痢纯血的会死。下痢像屋漏水的会死。看它的治疗法则，不过是用阿胶、地榆、槐花、苍术之类的药物，怎么能救治死症呢？如果是下奔鲜血，口渴，小便短少，里急后重，脉象盛大，这是火证。宜用白头翁汤。一天服用两次。体虚人及产后妇女，加阿胶、甘草。也有下鲜血而非火证的。如果血色暗红而成块，属热的少，属寒的多。都应当根据脉症仔细辨别。如果口中平和，脉细，小便长，手脚冷的，属虚寒无疑。宜用理中汤，加灶心土八钱为主方。下血多的，宜间服黄土汤。一天服用两次，三天逐渐痊愈。因为脾胃如同分金的炉子，理中汤分清浊，这是治其本源。屋漏水，即血色暗滞不稠厚的，属于虚寒证，是误用寒凉攻破药物所致。如果出现咽痛，言语无序，半天内必死。也用理中汤来抢救。
有一本医书说：能进食的轻，不能吃的重，绝食的会死。发呕的会死。大概不能进食，如果有食积停滞，就宜用平胃散加消导药物。如果脾胃虚弱，就宜用香砂六君子汤及理中汤，健脾以运化胃气。又有在细微处辨别的，这不就是噤口痢吗？丹溪用人参、石莲肉、黄连煎汤，加入生姜汁，慢慢呷服。只认为是湿热上冲的病症，所以无效。宜参考上述各种方法治疗。如果食入即吐，不利于香砂橘半者，宜用干姜黄连黄芩汤，苦辛并用以开通格拒。如果胸满而吐，以及干呕吐涎沫的，宜用吴茱萸汤，温镇以调和土木。效果如神。○凡是心下痞满，从仲景的三泻心汤，以及浓朴生姜甘草半夏人参汤等中选择使用，效果如神。
有一本医书说：妇人新产后立即发痢的会死。我效法《金匮要略》中白头翁汤加甘草、阿胶的先例，可知产后应当照病用药，毫无顾忌。又说小儿出痘后立即发痢的会死。我认为不尽然。大体上产后因失于过温而死，痘后因失于过寒而死，都是因病而用药，不必拘泥于一说。
Dysentery presents with foul, sticky, and glue-like discharge resembling pus and blood. There is a dull pain in the lower abdomen. The sensation of urgency to defecate but inability to do so, accompanied by tenesmus (里急后重), characterizes this condition. Old theories tend to bias towards cold or heat patterns; treatments either advocate tonification or purgation. None of these should be rigidly adhered to. The few death cases listed are often due to improper treatment by contemporary physicians leading to prolonged illness and death, or due to abandoning treatment based on previous doctors' opinions, resulting in passive observation of death. I have witnessed this with heartache, anxious day and night. Drawing from the implicit meanings in the *Neijing* (Classic of Internal Medicine) and Zhang Zhongjing's works, as well as scattered insights under various sections, I carefully examined them and combined them with my clinical cases, gaining profound understanding. Medications led to recovery, with evident and recordable efficacy. I will first discuss methods for saving critical conditions, followed by standard methods.
One medical text states: A deep and small pulse indicates an easy-to-treat case; a floating and large pulse indicates a difficult-to-treat case. It also states: Unremitting fever leads to death. This follows the *Changpi Lun* (Treatise on Intestinal Abscess) in the *Neijing*, representing the error of sticking to one aspect without flexibility. I have different insights. A floating pulse indicates exterior pathogenic factors. If floating and large, it suggests exterior pathogens invading the Yangming channel boundary causing diarrhea. Zhang Zhongjing provided treatments such as Gegen Tang (Pueraria Decoction). Unremitting fever, if not due to wind-cold common cold, implies disharmony of the channels and collaterals. One should use Guizhi Tang (Cinnamon Twig Decoction) or Danggui Sini Tang (Angelica Sinensis Cold-Nourishing Decoction) to dispel wind-cold and harmonize the channels. Renshen Baidu San (Ginseng Detoxifying Powder) added with roasted rice, named Canglin Tang (Granary Decoction), shares this principle. However, the medicinal force is light and cannot produce rapid effects. Generally, for early-stage disease: if there is fever and aversion to cold, Xiangsu Yin (Fragrant Perilla Infusion) added with Fangfeng (Saposhnikovia Root) and Chuanxiong (Ligusticum Rhizome) can induce mild sweating for cure. For severe cases, Guizhi Tang or Danggui Sini Tang should be used. If there are alternating chills and fever with frequent vomiting, Xiaochaihu Tang (Minor Bupleurum Decoction) must be used. If heat predominates with thirst, Xiaochaihu Tang with Banxia (Pinellia Tuber) removed and Gualougen (Trichosanthes Root) added is indicated. If there is fever without aversion to cold and with tenesmus, Gegen Huangqin Huanglian Gancao Tang (Pueraria, Scutellaria, Coptis, and Licorice Decoction) should be used. Following ancient methods, Gegen is decocted first, followed by other herbs. Taking two to three doses daily ensures recovery. Using formulas from the dysentery section, such as Shaoyao Tang (Peony Decoction), often causes pathogens to sink inward, becoming critical. I deeply regret Ni's Three Formulas for Dysentery, which serve as primary tools for killing patients.
One medical text states: Unremitting abdominal pain leads to death. Its treatment method merely uses Muxiang (Aucklandia Root), Binglang (Areca Seed), Sharen (Amomum Fruit), and other digestive and qi-moving agents. How can this save dying patients? If there is genuine thirst, a hot sensation in the mouth, chest and abdominal distension that is firm and resists pressure, it is a excess pattern. Among the three Chengqi Decoctions (Chengqi Formulas), one may choose appropriately, or substitute with Sanyi Chengqi Tang (Three-One Chengqi Decoction). If there is no thirst, a neutral mouth feel, a slow, small, and weak pulse, or cold extremities, with abdominal pain that prefers pressure, it is a deficiency-cold pattern. Sizni Tang (Four Reversal Decoction) is indispensable. If abdominal pain is accompanied by heavy and sluggish dysentery, add 3 qian of raw Baishao (White Peony Root). If abdominal pain persists, with vexation and preference for pressure, and a wiry pulse, it indicates Liver pathogen attacking Spleen Earth. Xiaojianzhong Tang (Minor Construct the Middle Decoction) is suitable. After about one hour of administration, follow with Xiaochaihu Tang with Huangqin (Scutellaria Root) removed and Baishao added. The effect is miraculous.
One medical text states: Pure blood in dysentery leads to death. Dysentery resembling roof leak water leads to death. Its treatment merely uses Ejiao (Donkey-hide Gelatin), Diyü (Sanguisorba Root), Huaihua (Sophora Flower), Cangzhu (Atractylodes Rhizome), etc. How can this save dying patients? If there is rushing bright red blood, thirst, short urine, tenesmus, and a full pulse, it is a fire pattern. Baitouweng Tang (Pulsatilla Decoction) is indicated, taken twice daily. For deficient individuals and postpartum women, add Ejiao and Gancao (Licorice Root). There are also cases of bright red blood not due to fire. If the blood is dark and clotted, heat patterns are rare, while cold patterns are common. These must be carefully distinguished by pulse and symptoms. If the mouth feels neutral, the pulse is fine, urination is long, and extremities are cold, it is undoubtedly a deficiency-cold pattern. Lizhong Tang (Regulate the Middle Decoction) added with 8 qian of Zaoxintu (Stove Heart Soil) is indicated. For excessive bleeding, intersperse with Huangtu Tang (Yellow Earth Decoction), taken twice daily. Recovery occurs gradually over three days. Since the spleen and stomach are like a furnace for refining metals, Lizhong Tang separates clear from turbid, treating the root cause. "Roof leak water" refers to dark, stagnant, non-viscous blood-water mixture, belonging to deficiency-cold, caused by misuse of cold-cooling and breaking-purgative drugs. If throat pain and disordered speech appear, death occurs within half a day. Lizhong Tang is also used to rescue such cases.
One medical text states: Ability to eat indicates mildness; inability to eat indicates severity; complete loss of appetite leads to death. Vomiting leads to death. Inability to eat may be due to food stagnation, requiring Pingwei San (Peace the Stomach Powder) added with digestive herbs. If spleen and stomach are weak, Xiangsha Liujunzi Tang (Fragrant Amomum Six Gentlemen Decoction) and Lizhong Tang should be used to strengthen the spleen and transform stomach qi. There are subtle distinctions. Is this not Jin Kou Li (Jammed Mouth Dysentery)? Danxi used Renshen (Ginseng Root), Shilian Rou (Lotus Seed Embryo), and Huanglian (Coptis Rhizome) decocted, adding fresh ginger juice, administered slowly by sipping. He only recognized it as damp-heat rushing upward, hence ineffective. One should refer to the aforementioned methods. If food is vomited immediately upon ingestion, making Xiangsha Ju Ban unsuitable, Ganjiang Huanglian Huangqin Tang (Dried Ginger, Coptis, and Scutellaria Decoction) should be used, employing bitter and acrid flavors to open obstruction. If there is chest fullness with vomiting, or dry heaving with salivary regurgitation, Wuzhuyu Tang (Evodia Decoction) is indicated to warm and calm, harmonizing wood and earth. The effect is divine. ○ For epigastric fullness and stuffiness, choose among Zhongjing's Three Xiexin Decoctions (Drain Epigastrium Decoctions) or Nongpu Shengjiang Gancao Banxia Renshen Tang (Atractylodes Macrocephala, Ginger, Licorice, Pinellia, and Ginseng Decoction) as appropriate. The effect is divine.
One medical text states: Dysentery occurring immediately after childbirth in women leads to death. I follow the example in *Jinkui Yaolue* of adding Gancao and Ejiao to Baitouweng Tang. It shows that postpartum cases should be treated according to the disease without hesitation. It also states: Dysentery occurring immediately after smallpox in children leads to death. I believe this is not entirely true. Generally, death after childbirth results from excessive warming, while death after smallpox results from excessive cooling. Treatment should be based on the disease, not bound by a single theory.