痢是湿热及食积，治者别赤白青黄黑五色以属五脏。白者湿热伤气分，赤者湿热伤血分，赤白相杂气
血俱伤，黄者食积。治法∶泻肠胃之湿热，开郁结之气，消化积滞，通因通用。其初只是下，下后未愈，
随症调之。痢稍久者不可下，胃虚故也。痢多属热，然亦有虚与寒者。虚者宜补，寒者宜温。年老及虚弱
人不宜下。
主方
黄芩（炒） 黄连（炒，各五分） 白芍药（炒，二钱，以上三药乃痢疾
之必用者） 木香 枳壳（炒，各五分） 甘草（炙，三分） 槟榔（一钱） 上姜、水煎服。
若腹痛，加当归一钱五分，缩砂一钱。再加木香、芍药各五分。
愚按前症若因湿热郁结，后重不利，宜用此方。若饮食停滞，用二陈汤加山楂，送香连丸。仲景先生
云∶脉沉而有力者，属里实也，宜下之；沉而无力者，属里虚也，宜补之。元气虚滑者，宜温之、涩之。
脉滑而数者，有宿食也，当下之。脉浮大，此为虚而强下之故也。脉浮革者，因而肠鸣，当温之。下痢腹
坚者，当下之。下痢谵语有燥屎，当下之。下痢三部脉皆平，按之心下坚，急下之。下痢脉大浮弦，当自
愈。下痢腹满痛为实，当下之。治者审焉！
若后重，加滑石（炒）五分。再加枳壳、槟榔、芍药、条芩各五分。
愚按痢而便脓血者，乃气行而血止也，行血则便脓自愈，调气则后重自除。若大肠积滞，壅实而后重，
法当疏导；若大肠气虚下陷而后重，法当升补。
司马王荆山，患痢后重，服枳壳、槟榔之类，后重益甚，食少，腹痛。余以为脾胃伤而虚寒也，用六
君、木香、炮姜而愈。
太常边华泉，呕吐不食，腹痛后重，服大黄之药，腹痛益甚，自汗，发热，昏愦，脉大。余以为胃气复
伤，阳气虚寒脱陷也。以参、术各一两，炙草、炮姜各三钱，升麻一钱，一剂而苏。又用补中益气加炮姜，
二剂而愈。
若白痢，加白术、白茯苓、滑石（炒）、陈皮各一钱。初欲下之，再加大黄五钱。兼食积，加山楂、
枳实各一钱。
愚按前症若腹痛后重，怕手按腹，或脉洪实，为积滞闭结，宜用此方疏通之；若腹痛后重，喜手按
腹，或脉微细，为阳气虚寒，宜用六君、手姜温补之。
少宗伯顾东江，停食患痢，腹痛下坠，或用疏导之剂，两足肿胀，食少体倦，烦热作渴，脉洪数，按
之微细。余以六君子加姜、桂各二钱，吴茱、五味各一钱，煎熟冷服，即睡觉而诸症顿退，再剂而安。此
内真寒而外假热，治以热剂而冷冻饮料。东垣先生治假寒热之症，投以假寒热之剂。
廷评曲汝为，食后接内，患腹痛去后，似痢非痢，次日便脓血，烦热作渴，神思昏倦，用四神丸一
服顿减，又用八味丸料加吴茱、五味、骨脂、肉蔻，二剂全愈。
若红痢，加当归、川芎、桃仁各一钱五分。初欲下之，再加大黄五钱。
愚按前症若病日久，或误服疏通之药而不能愈者，当调补脾胃。大凡血症久而不愈，多因阳气虚而
不能生血，或因阳气虚而不能摄血，故丹溪先生治此
症久而不愈，用四君子汤以收其功。
判官汪天锡，患痢，腹痛后重，渴欲饮冷，饮食不进，用芍药汤，纳大黄一两。四剂稍应，仍用前
药，但大黄减半，数剂而愈。
通府薛允 ，下血，服犀角地黄汤，其血愈多，发热，少食，里急后重。予以为清气下陷，用补中益
气汤加炮姜，一剂而瘳。
若红白相杂，加川芎、当归、桃仁各一钱五分以理血；滑石、陈皮、苍术各一钱五分以理气。有食积者，
加山楂、枳实以消导。
愚按前症若气滞、食积、湿热所致，宜用此方治之。若脾虚饮食停滞，宜用六君子汤送香连丸调补
之。经云∶脾主血，肺主气。前症乃气血俱受病也。若因脾肺血伤所致，宜用四物汤加白术、茯苓，煎送
香连丸；若因脾肺气伤所致，宜用四君汤加当归、川芎，煎送香连丸。
若白痢久，胃弱气虚，或下后未愈，去槟榔、枳壳，减芩、连、芍药各七分，加白术一钱五分，黄 、
陈皮、茯苓各一钱，缩砂、干姜（炙）各五分。
愚按前症若数至圊而不能便，或少有白脓者，乃土不能生金，肺与大肠气伤而下坠也，当用升阳益胃
汤举其阳气，则阴自降而二便自愈矣。饮食不入，发热作渴，其势危甚，用十全大补汤；如不应，送二
神丸。
若红痢久，胃弱血虚，或下后未愈，减黄芩、黄连各五分，加当归、川芎、熟地、阿胶、陈皮
各一钱，白术一钱五分。
愚按前症若脾经血热下注而不愈者，用四物汤加白术、茯苓；若脾经气虚不能统血而不愈者，用四君
子加川芎、当归；若中气下陷不能摄血而不愈者，用补中益气汤。
若赤黑相杂，此湿胜也，及小便赤涩短少，加木通、泽泻、茯苓各一钱，山栀仁（炒）五分，
以分利之。
愚按初患湿盛而小便赤涩者，宜用前药；若病久而阳气下陷，或老弱者，宜用升阳除湿防风
汤；若脾土亏损，寒水来侮，先用六君子汤加姜、桂以温而补之，后用补中益气汤加茯苓、半夏以升
而补之。
若血痢，加当归、川芎、生地黄、桃仁、槐花（炒）各一钱；久不愈，减芩、连各七分，去槟
榔、枳壳，再加阿胶珠、侧柏叶、白术各一钱五分，干姜（炒黑）、陈皮各一钱。
愚按前症亦有因脾气虚弱者，有因脾气下陷者，有因肝气虚弱者，有因肝血虚热者。
祠部李宜散，患血痢，胸腹膨胀，大便欲去不去，肢体殊倦。余以为脾气虚弱，不能摄血归源，用
补中益气汤加茯苓、半夏，治之渐愈。后因怒，前症复作，左关脉弦浮，按之微弱，此肝气虚不能藏血，
用六味丸治之而愈。
若痢已久，而后重不去，此大肠坠下，去槟榔、枳壳，用条芩，加升麻一钱以升提之。
愚按前症亦有因大肠气滞者，有因大肠气陷者，有因大肠血虚者，有因脾肾虚寒者。若大肠气滞坠
下，宜用四君子送香连丸；若大肠气虚陷下，宜用四君子加柴胡、升麻送香连丸；若大肠血虚后重，宜用
四物汤加参、术送香连丸。东垣先生云∶里急者，腹中不宽快也，亦有虚坐而大便不行者，皆血虚也，血
虚则里急后重。
若呕吐食不得下，加软石膏一钱五分，陈皮一钱，山栀仁（炒）五分，生姜六分。缓呷之，以泻胃口
之热。
愚按前症若脾胃素有实热，或过食浓味辛辣而暴患之，宜用此方；若胃气虚，膈气逆而作呕吐
者，用六君子加生姜；若胃气虚寒，亦用前药加炮姜、木香。
有一样气血虚而痢者，用四物汤加人参、白术、陈皮、黄芩、黄连。
愚按前症若脾气虚而血弱，宜用四君子汤；若胃气虚而血弱，宜用补中益气汤；若久病气血俱虚，宜
用八珍汤。大凡此症久而不愈，或变症百出，但守前法，久之自愈。
有一样寒痢，用黄连、木香、芍药（酒炒）、当归、干姜
（炒）、缩砂、浓朴、肉桂。
愚按东垣先生云，前症若脉沉细而身不动作，睛不了了，饮食不下，鼻准气息者，用姜附汤；身重四
肢不举者，用术附汤；暴下无声，身冷自汗，小便自利，大便不禁，气难布息，脉微，呕吐者，用浆水散。
先太安人，年八十，仲夏患痢，腹痛，作呕，不食，渴饮汤水，按腹痛稍止，脉鼓指而有力。余谓真
气虚而邪气实也，用人参五钱。白术、茯苓各三钱，陈皮、升麻、附子、炙甘草各一钱。服之睡觉索食，脉
症顿退，再剂而安。
横金陈子复，面带赤色，吐痰，口干，或时作泻。或用二陈、黄连、枳实之类，不应。予脉之左关弦
急，右关弦大，此乃肾水挟肝木之势而克胜脾土也。不信，后交夏果患痢而亡。
若得痢而误服温热止涩之药，则虽稍久，亦宜用前法以下之，下后方调之。
若得痢便用前症法下之而未应，又用前调理法治之久而不愈，此属虚寒而滑脱，可于前补虚寒温二条
用择，更加龙骨、石脂、罂粟壳、乌梅肉等收涩之药。
愚按前症若脾气虚寒下陷，宜用补中益气汤加粟壳、姜、桂，如不应，急用附子∶若气血虚弱，宜用十全
大补汤加附子、粟壳；若命门火衰，用八味丸以补土母；若腹痛，作渴饮汤，手按腹痛稍止者，俱温补脾胃。
痢疾是由湿热和食积引起的，治疗时根据白、赤、青、黄、黑五色来归属五脏。白色表示湿热损伤了气分，红色表示湿热损伤了血分，红白相杂表示气血都受损，黄色表示有食积。治疗方法：泻除肠胃的湿热，开通郁结的气机，消化积滞，采用“通因通用”的方法。初期只需使用下法，下后若未痊愈，再随症状调整。痢疾时间稍长的不可用下法，因为胃气虚弱。痢疾多属热证，但也有虚证和寒证。虚证宜补，寒证宜温。年老及体弱之人不宜用下法。
主方：
黄芩（炒）五分，黄连（炒，各五分），白芍药（炒，二钱，以上三味药是治疗痢疾必用的），木香，枳壳（炒，各五分），甘草（炙，三分），槟榔（一钱）。上药加生姜、水煎服。
如果腹痛，加当归一钱五分，缩砂仁一钱。再加木香、芍药各五分。
我按语：前述病症若因湿热郁结，导致里急后重、排便不畅，宜用此方。若因饮食停滞，用二陈汤加山楂，送服香连丸。张仲景先生说：脉象沉而有力的，属于里实证，宜用下法；沉而无力的，属于里虚证，宜用补法。元气虚滑的，宜用温法、涩法。脉象滑而数的，有宿食，当下之。脉象浮大，这是虚证却强行攻下的缘故。脉象浮革的，伴有肠鸣，应当温之。下痢腹部坚硬的，当下之。下痢谵语且有燥屎的，当下之。下痢三部脉象皆平，但按压心下坚硬，急当下之。下痢脉象大浮弦，可能会自愈。下痢腹部满痛为实证，当下之。治疗者需仔细审察！
若里急后重严重，加滑石（炒）五分。再加枳壳、槟榔、芍药、条芩各五分。
我按语：痢疾便脓血的，是气行而血止的表现，行血则便脓自愈，调气则后重自除。若大肠积滞壅实导致后重，治法当疏导；若大肠气虚下陷导致后重，治法当升补。
司马王荆山，患痢疾后重，服用枳壳、槟榔等药，后重更甚，食少，腹痛。我认为这是脾胃受伤而虚寒，用六君子汤加木香、炮姜而愈。
太常边华泉，呕吐不食，腹痛后重，服用大黄等药，腹痛更甚，自汗，发热，昏愦，脉大。我认为这是胃气再次受伤，阳气虚寒脱陷。用人参、白术各一两，炙甘草、炮姜各三钱，升麻一钱，一剂后苏醒。又用补中益气汤加炮姜，两剂后痊愈。
若是白痢，加白术、白茯苓、滑石（炒）、陈皮各一钱。初起想用下法，再加加大黄五钱。兼有食积，加山楂、枳实各一钱。
我按语：前述病症若腹痛后重，怕手按压腹部，或脉象洪实，为积滞闭结，宜用此方疏通；若腹痛后重，喜欢手按压腹部，或脉象微细，为阳气虚寒，宜用六君子汤加干姜温补。
少宗伯顾东江，停食患痢，腹痛下坠，或用疏导之剂，两足肿胀，食少体倦，烦热作渴，脉象洪数，但按之微细。我用六君子汤加干姜、肉桂各二钱，吴茱萸、五味子各一钱，煎熟冷服，服药即睡觉而诸症顿退，再服两剂而安。这是内真寒而外假热，用热剂治疗而采取冷冻饮料的方式服用。李东垣先生治疗假寒热的症状，投以假寒热的药剂。
廷评曲汝为，食后行房事，患腹痛腹泻，似痢非痢，次日便脓血，烦热作渴，神思昏倦，用四神丸一服顿减，又用八味丸料加吴茱萸、五味子、骨碎补、肉豆蔻，两剂全愈。
若是红痢，加当归、川芎、桃仁各一钱五分。初起想用下法，再加加大黄五钱。
我按语：前述病症若病程日久，或误服疏通之药而不能愈者，当调补脾胃。大凡血症久而不愈，多因阳气虚而不能生血，或因阳气虚而不能摄血，所以朱丹溪先生治疗此症久而不愈，用四君子汤收功。
判官汪天锡，患痢，腹痛后重，渴欲饮冷，饮食不进，用芍药汤，纳大黄一两。四剂稍应，仍用前药，但大黄减半，数剂而愈。
通府薛允，下血，服犀角地黄汤，其血愈多，发热，少食，里急后重。我认为这是清气下陷，用补中益气汤加炮姜，一剂而愈。
若红白相杂，加川芎、当归、桃仁各一钱五分以理血；滑石、陈皮、苍术各一钱五分以理气。有食积者，加山楂、枳实以消导。
我按语：前述病症若由气滞、食积、湿热所致，宜用此方治之。若脾虚饮食停滞，宜用六君子汤送香连丸调补。经云：脾主血，肺主气。前述病症乃气血俱受病也。若因脾肺血伤所致，宜用四物汤加白术、茯苓，煎送香连丸；若因脾肺气伤所致，宜用四君汤加当归、川芎，煎送香连丸。
若白痢日久，胃弱气虚，或下后未愈，去槟榔、枳壳，减黄芩、黄连、芍药各七分，加白术一钱五分，黄芪、陈皮、茯苓各一钱，缩砂仁、干姜（炙）各五分。
我按语：前述病症若数次如厕而不能便，或少有白脓者，乃土不能生金，肺与大肠气伤而下坠也，当用升阳益胃汤举其阳气，则阴自降而二便自愈矣。饮食不入，发热作渴，其势危甚，用十全大补汤；如不应，送二神丸。
若红痢日久，胃弱血虚，或下后未愈，减黄芩、黄连各五分，加当归、川芎、熟地、阿胶、陈皮各一钱，白术一钱五分。
我按语：前述病症若脾经血热下注而不愈者，用四物汤加白术、茯苓；若脾经气虚不能统血而不愈者，用四君子加川芎、当归；若中气下陷不能摄血而不愈者，用补中益气汤。
若赤黑相杂，此湿胜也，及小便赤涩短少，加木通、泽泻、茯苓各一钱，山栀仁（炒）五分，以分利之。
我按语：初患湿盛而小便赤涩者，宜用前药；若病久而阳气下陷，或老弱者，宜用升阳除湿防风汤；若脾土亏损，寒水来侮，先用六君子汤加姜、桂以温而补之，后用补中益气汤加茯苓、半夏以升而补之。
若血痢，加当归、川芎、生地黄、桃仁、槐花（炒）各一钱；久不愈，减黄芩、黄连各七分，去槟榔、枳壳，再加阿胶珠、侧柏叶、白术各一钱五分，干姜（炒黑）、陈皮各一钱。
我按语：前述病症亦有因脾气虚弱者，有因脾气下陷者，有因肝气虚弱者，有因肝血虚热者。
祠部李宜散，患血痢，胸腹膨胀，大便欲去不去，肢体殊倦。我认为这是脾气虚弱，不能摄血归源，用补中益气汤加茯苓、半夏，治之渐愈。后因怒，前症复作，左关脉弦浮，按之微弱，此肝气虚不能藏血，用六味丸治之而愈。
若痢已久，而后重不去，此大肠坠下，去槟榔、枳壳，用条芩，加升麻一钱以升提之。
我按语：前述病症亦有因大肠气滞者，有因大肠气陷者，有因大肠血虚者，有因脾肾虚寒者。若大肠气滞坠下，宜用四君子送香连丸；若大肠气虚陷下，宜用四君子加柴胡、升麻送香连丸；若大肠血虚后重，宜用四物汤加参、术送香连丸。李东垣先生说：里急者，腹中不宽快也，亦有虚坐而大便不行者，皆血虚也，血虚则里急后重。
若呕吐食不得下，加软石膏一钱五分，陈皮一钱，山栀仁（炒）五分，生姜六分。缓呷之，以泻胃口之热。
我按语：前述病症若脾胃素有实热，或过食浓味辛辣而暴患之，宜用此方；若胃气虚，膈气逆而作呕吐者，用六君子加生姜；若胃气虚寒，亦用前药加炮姜、木香。
有一种气血虚而痢者，用四物汤加人参、白术、陈皮、黄芩、黄连。
我按语：前述病症若脾气虚而血弱，宜用四君子汤；若胃气虚而血弱，宜用补中益气汤；若久病气血俱虚，宜用八珍汤。大凡此症久而不愈，或变症百出，但守前法，久之自愈。
有一种寒痢，用黄连、木香、芍药（酒炒）、当归、干姜（炒）、缩砂仁、厚朴、肉桂。
我按语：李东垣先生说，前述病症若脉沉细而身不动作，睛不了了，饮食不下，鼻准气息者，用姜附汤；身重四肢不举者，用术附汤；暴下无声，身冷自汗，小便自利，大便不禁，气难布息，脉微，呕吐者，用浆水散。
先太安人，年八十，仲夏患痢，腹痛，作呕，不食，渴饮汤水，按腹痛稍止，脉鼓指而有力。我认为这是真气虚而邪气实，用人参五钱，白术、茯苓各三钱，陈皮、升麻、附子、炙甘草各一钱。服之睡觉索食，脉症顿退，再剂而安。
横金陈子复，面带赤色，吐痰，口干，或时作泻。或用二陈、黄连、枳实之类，不应。我诊其脉左关弦急，右关弦大，此乃肾水挟肝木之势而克胜脾土也。不信，后交夏果患痢而亡。
若得痢而误服温热止涩之药，则虽稍久，亦宜用前法以下之，下后方调之。
若得痢便用前症法下之而未应，又用前调理法治之久而不愈，此属虚寒而滑脱，可于前补虚寒温二条用择，更加龙骨、石脂、罂粟壳、乌梅肉等收涩之药。
我按语：前述病症若脾气虚寒下陷，宜用补中益气汤加粟壳、姜、桂，如不应，急用附子；若气血虚弱，宜用十全大补汤加附子、粟壳；若命门火衰，用八味丸以补土母；若腹痛，作渴饮汤，手按腹痛稍止者，俱温补脾胃。
Dysentery is caused by damp-heat and food stagnation. In treatment, the five colors—white, red, green, yellow, and black—are distinguished to correspond to the five Zang organs (Zang organs: Heart, Liver, Spleen, Lung, Kidney). White indicates damp-heat injuring the Qi level; red indicates damp-heat injuring the Blood level; a mixture of red and white indicates injury to both Qi and Blood; yellow indicates food stagnation. Treatment methods: Purge damp-heat from the intestines and stomach, resolve Qi stagnation, digest accumulations, and apply the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). Initially, purgation may be used; if not cured after purgation, adjust according to symptoms. For dysentery lasting a short while, purgation should not be used because the Stomach Qi is deficient. Dysentery is mostly heat-related, but there are also deficiency and cold patterns. Deficiency patterns require tonification; cold patterns require warming. Elderly and weak individuals should not undergo purgation.
Main Formula:
Huangqin (Scutellariae Radix, stir-fried), 5 fen; Huanglian (Coptidis Rhizoma, stir-fried), 5 fen; Baishao Yao (Paeoniae Radix Alba, stir-fried), 2 qian. (These three herbs are essential for treating dysentery.) Muxiang (Aucklandiae Radix); Zhike (Aurantii Fructus Immaturus, stir-fried), 5 fen; Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted), 3 fen; Binglang (Arecae Semen), 1 qian. Decoct these with ginger and water.
If abdominal pain occurs, add Danggui (Angelicae Sinensis Radix), 1.5 qian, and Suosha (Amomi Fructus Rotundus), 1 qian. Add further Muxiang and Shaoyao, each 5 fen.
My commentary: If the aforementioned condition is due to damp-heat stagnation causing tenesmus and difficult defecation, this formula is appropriate. If due to food stagnation, use Erchen Tang (Two-Cured Decoction) with Shanzha (Crataegi Fructus), administered with Xianglian Wan (Aucklandia and Coptis Pill). Mr. Zhang Zhongjing stated: A pulse that is deep and forceful indicates excess in the interior, requiring purgation; a pulse that is deep and weak indicates deficiency in the interior, requiring tonification. For those with deficient Yuan Qi and slippery stools, warming and astringing methods are suitable. A slippery and rapid pulse indicates retained food, requiring purgation. A floating and large pulse results from forcing purgation in a deficient state. A floating and wiry pulse accompanied by borborygmus requires warming. Hardness in the abdomen during dysentery requires purgation. Dysentery with delirium and dry feces requires purgation. If all three pulses are normal but pressure on the epigastrium reveals hardness, urgent purgation is needed. Dysentery with a large, floating, or wiry pulse may resolve spontaneously. Abdominal fullness and pain during dysentery indicate excess, requiring purgation. Practitioners must examine carefully!
For severe tenesmus, add Huashi (Talcum, stir-fried), 5 fen. Further add Zhike, Binglang, Shaoyao, and Tiaoqin (Scutellariae Radix), each 5 fen.
My commentary: Dysentery with pus and blood in the stool indicates that Qi moves while Blood stops. Promoting Blood circulation cures pus and blood; regulating Qi relieves tenesmus. If intestinal stagnation causes blockage and tenesmus, the method should be guiding out stagnation; if Qi deficiency and sinking cause tenesmus, the method should be lifting and tonifying.
Sima Wang Jingshan suffered from tenesmus after dysentery. After taking Zhike and Binglang, his tenesmus worsened, with reduced appetite and abdominal pain. I diagnosed it as Spleen and Stomach injury leading to deficiency-cold, and he recovered using Liujunzi Tang (Six-Gentlemen Decoction) with Muxiang and Paojing (Roasted Ginger).
Taichang Bian Huaquan experienced vomiting, anorexia, abdominal pain, and tenesmus. After taking Dahuang (Rhei Radix et Rhizoma), his abdominal pain worsened, accompanied by spontaneous sweating, fever, confusion, and a large pulse. I diagnosed this as further injury to Stomach Qi and sinking of deficient Yang-cold. He revived after one dose of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), each 1 liang, plus Zhigancao (Honey-fried Licorice) and Paojing, each 3 qian, and Shengma (Cimicifugae Rhizoma), 1 qian. He fully recovered after two doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Paojing.
For white dysentery, add Baizhu, Baifuling (Poria), Huashi (stir-fried), and Chenpi (Citri Reticulatae Pericarpium), each 1 qian. If initially intending to purge, add Dahuang, 5 qian. If combined with food stagnation, add Shanzha and Zhishi (Aurantii Fructus Immaturus), each 1 qian.
My commentary: If the aforementioned condition presents with abdominal pain and tenesmus, aversion to abdominal pressure, or a surging and solid pulse, it indicates blocked stagnation, and this formula should be used to unblock it. If abdominal pain and tenesmus are relieved by pressure, or the pulse is faint and fine, it indicates deficient Yang-cold, and Liujunzi Tang with Ganjiang (Dried Ginger) should be used for warming and tonifying.
Shaozonge Gu Dongjiang had food retention leading to dysentery, abdominal pain, and bearing down. After using draining and guiding agents, his legs swelled, he had reduced appetite, fatigue, irritability, thirst, a surging and rapid pulse, yet it was faint upon deep pressure. I used Liujunzi Tang with Ganjiang and Rougui (Cinnamon Twig), each 2 qian, Wuzhuyu (Evodiae Fructus) and Wuweizi (Schisandrae Fructus), each 1 qian. Taken cold after decoction, he slept immediately, symptoms subsided, and he recovered after two more doses. This is true internal cold with false external heat; treating with hot medicine served cold is called "freezing drink." Mr. Li Dongyuan treated false cold-heat symptoms with false cold-heat agents.
Tingping Qu Ruwei engaged in intercourse after eating, suffering from abdominal pain and diarrhea resembling dysentery. The next day, pus and blood appeared, with irritability, thirst, and mental fatigue. One dose of Sishen Wan (Four-Spirit Pill) reduced symptoms significantly. He fully recovered after two doses of Bawei Wan material added with Wuzhuyu, Wuweizi, Gubujie (Drynariae Rhizoma), and Roukou (Myristicae Semen).
For red dysentery, add Danggui, Chuanxiong (Ligustici Chuanxiong Rhizoma), and Taoren (Persicae Semen), each 1.5 qian. If initially intending to purge, add Dahuang, 5 qian.
My commentary: If the aforementioned condition has persisted for a long time or failed to improve after mistaken use of draining agents, the Spleen and Stomach should be regulated and tonified. Generally, chronic bleeding disorders often result from deficient Yang failing to generate Blood or failing to control Blood. Therefore, Mr. Zhu Danxi used Sijunzi Tang (Four-Gentlemen Decoction) to achieve success in such chronic cases.
Panguan Wang Tianxi suffered from dysentery with abdominal pain, tenesmus, thirst for cold drinks, and inability to eat. He took Shaoyao Tang (Peony Decoction) with 1 liang of Dahuang. After four doses, there was slight improvement. Continuing the same formula but halving the Dahuang, he recovered after several doses.
Tongfu Xue Yun suffered from bloody stool. After taking Xijiao Dihuang Tang (Rhinohorn and Rehmannia Decoction), bleeding increased, accompanied by fever, reduced appetite, and tenesmus. I diagnosed this as sinking of Clear Qi and used Buzhong Yiqi Tang with Paojing, recovering him after one dose.
For mixed red and white dysentery, add Chuanxiong, Danggui, and Taoren, each 1.5 qian to regulate Blood; add Huashi, Chenpi, and Cangzhu (Atractylodis Rhizoma), each 1.5 qian to regulate Qi. If food stagnation exists, add Shanzha and Zhishi to digest and guide.
My commentary: If the aforementioned condition is caused by Qi stagnation, food stagnation, or damp-heat, this formula is appropriate. If caused by Spleen deficiency and food stagnation, use Liujunzi Tang administered with Xianglian Wan for regulation and tonification. The Classics state: The Spleen governs Blood, and the Lung governs Qi. The aforementioned condition involves both Qi and Blood pathology. If caused by injury to Spleen and Lung Blood, use Siwu Tang (Four-Materials Decoction) with Baizhu and Fuling (Poria), taken with Xianglian Wan; if caused by injury to Spleen and Lung Qi, use Sijunzi Tang with Danggui and Chuanxiong, taken with Xianglian Wan.
For chronic white dysentery with weak Stomach and deficient Qi, or if not cured after purgation, remove Binglang and Zhike, reduce Huangqin, Huanglian, and Shaoyao by 7 fen each, add Baizhu, 1.5 qian, Huangqi (Astragali Radix), Chenpi, and Fuling, each 1 qian, and Suosha and Ganjiang (honey-roasted), each 5 fen.
My commentary: If the aforementioned condition presents with frequent trips to the toilet without passage, or small amounts of white pus, it indicates Earth failing to generate Metal, with injury to Lung and Large Intestine Qi causing sinking. Use Shengyang Yiwetang (Raise Yang and Benefit Stomach Decoction) to lift Yang Qi, so Yin naturally descends and bowel/bladder functions normalize. If unable to eat, with fever and thirst, the condition is critical; use Shiquan Dabu Tang (Perfect Ten Great Tonification Decoction). If ineffective, administer Ershen Wan (Two-Genius Pill).
For chronic red dysentery with weak Stomach and deficient Blood, or if not cured after purgation, reduce Huangqin and Huanglian by 5 fen each, add Danggui, Chuanxiong, Shudi (Rehmanniae Radix Preparata), Ejiao (Donkey-hide Gelatin), and Chenpi, each 1 qian, and Baizhu, 1.5 qian.
My commentary: If the aforementioned condition persists due to Heat in the Spleen channel pouring downward, use Siwu Tang with Baizhu and Fuling. If it persists due to Spleen Qi deficiency failing to control Blood, use Sijunzi Tang with Chuanxiong and Danggui. If it persists due to Middle Qi sinking failing to control Blood, use Buzhong Yiqi Tang.
For mixed red and black dysentery, indicating excessive Dampness, and scanty, dark, and painful urination, add Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), and Fuling, each 1 qian, and Zhiren (Gardeniae Semen, stir-fried), 5 fen, to separate and drain.
My commentary: For initial Dampness excess with dark and painful urination, use the previous herbs. For chronic illness with sinking Yang or in the elderly/weak, use Shengyang Chushi Fangfeng Tang (Raise Yang, Drain Dampness, and Saposhnikovia Decoction). If Spleen Earth is damaged and Cold Water insults it, first use Liujunzi Tang with Jiang and Gui to warm and tonify, then use Buzhong Yiqi Tang with Fuling and Banxia (Pinelliae Rhizoma) to lift and tonify.
For bloody dysentery, add Danggui, Chuanxiong, Shengdihuang (Rehmanniae Radix), Taoren, and Huaihua (Sophorae Flos, stir-fried), each 1 qian. If chronic and uncured, reduce Huangqin and Huanglian by 7 fen each, remove Binglang and Zhike, add Ejiaozhu (Prepared Donkey-hide Gelatin), Cebeiye (Platycladi Cacumen), and Baizhu, each 1.5 qian, and Ganjiang (black stir-fried) and Chenpi, each 1 qian.
My commentary: The aforementioned condition can also be caused by Spleen Qi deficiency, Spleen Qi sinking, Liver Qi deficiency, or Liver Blood deficiency with heat.
Cibu Li Yisan suffered from bloody dysentery with chest and abdominal distension, difficulty defecating, and extreme limb fatigue. I diagnosed Spleen Qi deficiency failing to control Blood and return it to its source, treating him with Buzhong Yiqi Tang plus Fuling and Banxia, leading to gradual recovery. Later, anger triggered recurrence; the left Guan pulse was wiry and floating, weak upon pressure, indicating Liver Qi deficiency failing to store Blood. He recovered after treatment with Liuwei Wan (Six-Ingredient Pill with Cornus and Eucommia).
For chronic dysentery with persistent tenesmus, indicating Large Intestine prolapse, remove Binglang and Zhike, use Tiaoqin, and add Shengma, 1 qian, to lift.
My commentary: The aforementioned condition can also be caused by Large Intestine Qi stagnation, Large Intestine Qi sinking, Large Intestine Blood deficiency, or Spleen-Kidney deficiency-cold. For Large Intestine Qi stagnation with prolapse, use Sijunzi Tang with Xianglian Wan. For Large Intestine Qi sinking, use Sijunzi Tang with Chaihu (Bupleuri Radix) and Shengma with Xianglian Wan. For Large Intestine Blood deficiency with tenesmus, use Siwu Tang with Renshen and Baizhu with Xianglian Wan. Mr. Li Dongyuan stated: Tenesmus refers to abdominal discomfort. There are cases of empty straining without defecation, all due to Blood deficiency; Blood deficiency causes tenesmus.
For vomiting and inability to eat, add Ruangua (likely referring to Gua Lou or similar, here interpreted as Soft Gypsum based on context "Ruanshigao"), 1.5 qian, Chenpi, 1 qian, Zhiren (stir-fried), 5 fen, and Shengjiang (Fresh Ginger), 6 fen. Sip slowly to clear heat in the Stomach opening.
My commentary: If the aforementioned condition is due to existing excess heat in Spleen and Stomach or sudden onset from overeating rich/spicy foods, use this formula. If due to Stomach Qi deficiency and rebellious Diaphragm Qi causing vomiting, use Liujunzi Tang with Shengjiang. If due to Stomach Qi deficiency-cold, use the previous formula plus Paojing and Muxiang.
For a pattern of Qi and Blood deficiency with dysentery, use Siwu Tang with Renshen, Baizhu, Chenpi, Huangqin, and Huanglian.
My commentary: If Spleen Qi is deficient and Blood is weak, use Sijunzi Tang. If Stomach Qi is deficient and Blood is weak, use Buzhong Yiqi Tang. If chronic illness leads to dual Qi and Blood deficiency, use Bazhen Tang (Eight-Treasures Decoction). Generally, if this condition persists or manifests various complications, adhering to the previous methods will lead to self-healing over time.
For a pattern of cold dysentery, use Huanglian, Muxiang, Shaoyao (wine-stir-fried), Danggui, Ganjiang (stir-fried), Suosha, Houpo (Magnoliae Officinalis Cortex), and Rougui.
My commentary: Mr. Li Dongyuan stated: For the aforementioned condition, if the pulse is deep and fine, body movement is restricted, eyes are unclear, food cannot be swallowed, and breath is detected at the nose tip, use Jiangfu Tang (Ginger and Aconite Decoction). If the body is heavy and limbs cannot move, use Zhufu Tang (Atractylodes and Aconite Decoction). If sudden diarrhea is silent, body is cold with spontaneous sweating, urination is free, defecation is uncontrollable, breathing is difficult, pulse is faint, and vomiting occurs, use Jiangshui San (River Water Powder).
My late grandmother, aged eighty, suffered from dysentery in mid-summer with abdominal pain, vomiting, anorexia, thirst for warm liquids, and abdominal pain relieved by pressure. Her pulse was forceful and strong. I diagnosed true Qi deficiency with pathogenic excess, prescribing Renshen, 5 qian, Baizhu and Fuling, each 3 qian, Chenpi, Shengma, Fuzi (Aconiti Lateralis Radix Preparata), and Zhigancao, each 1 qian. After taking it, she slept, requested food, and her pulse and symptoms subsided. She recovered after two more doses.
Hengjin Chen Zifu had a reddish face, expectorated phlegm, dry mouth, and occasional diarrhea. After taking Erchen Tang, Huanglian, and Zhishi, there was no response. His pulse was wiry and rapid at the left Guan, and wiry and large at the right Guan. This indicated Kidney Water borrowing the momentum of Liver Wood to overcome Spleen Earth. He did not believe this, and indeed died of dysentery when summer arrived.
If dysentery is contracted and mistakenly treated with warm-hot astringent drugs, even if prolonged, the previous method of purgation should be used, followed by regulation.
If purgation using the previous method fails, and subsequent regulatory treatment fails over a long period, this belongs to deficiency-cold with slipping and loss of control. Choose from the previous deficiency-cold and warming sections, adding Longgu (Fossilia Ossis Mastodi), Shizhi (Halloysitum Rubrum), Yingkesuo (Papaveris Pericarpium), and Wumei Rou (Mume Semen) and other astringent drugs.
My commentary: If Spleen Qi deficiency-cold with sinking occurs, use Buzhong Yiqi Tang plus Yingkesuo, Jiang, and Gui. If ineffective, urgently use Fuzi. If Qi and Blood are weak, use Shiquan Dabu Tang plus Fuzi and Yingkesuo. If Mingmen Fire declines, use Bawei Wan to tonify the Mother of Earth. If abdominal pain, thirst for warm drinks, and relief of pain by pressure occur, all indicate warming and tonifying the Spleen and Stomach.