凡治痢之法，其要在虚实寒热，得其要则万无一失，失其要则为害最多，辨论如前，所
当熟察。前如泄泻门调治诸法，俱宜酌用。
一、生冷初伤，饮食失调，而胃气未损，元气未亏，或为痛、为胀、为暴泻、暴痢等证
，而食滞有未清者，宜抑扶煎、五德丸，或平胃散、胃苓汤、五苓散之类，略祛寒滞，愈之
极易。
一、脾肾虚弱之辈，但犯生冷，极易作痢。无论大人小儿，凡系脾虚致痢，别无实热等
证者，先宜佐关煎温其脾气，如或稍深而病及肝肾者，即宜胃关煎为最妙之治，勿以新病畏
而弗用也。或五德丸、四神丸之类，俱可间用。
一、病痢，凡脾肾俱虚而危剧可畏者，只宜以胃关煎为最，温胃饮次之，或相机间用亦
可。或兼用四维散、九气丹、复阳丹，庶可保全也。
一、痢疾呕恶，兀兀欲吐，或闻食气即见恶心者，此胃气虚寒不能容受而然，必宜温补
安胃，用五君子煎，或六味异功煎、温胃饮、圣术煎之类主之。呕甚者，宜六味回阳饮之属
主之。若阴中火虚，气不归原而呕者，宜胃关煎、理阴煎主之。若胃火上冲而致呕吐者，则
必有烦热胀满等证，乃可用清凉降火等药，宜大厘清饮、益元散之类主之。
一、湿热邪盛，而烦热喜冷，脉实腹满，或下痢纯红鲜血者，宜清流饮、黄芩芍药汤，
或用香连丸，或用河间芍药汤。热甚者，宜大厘清饮，或茵陈饮。此等药，若数剂不效，便
当思顾脾肾矣。
一、痢有发热者，似乎属火，宜从凉治。然实热之证，反未必发热，惟痢伤精血，阴虚
水亏者，则最多为热为躁也。如或虚中有火，脉见有力者，宜加减一阴煎，或保阴煎主之。
若脉本无力，全属虚火，则不可治火，单宜壮水补阴，如三阴煎及六味、八味等丸。若阴盛
格阳而为外热者，必宜胃关煎及右归饮之属主之。
一、痢疾初作，气禀尚强，或因纵肆口腹，食饮停滞，凡有实邪胀痛坚满等证，而形气
脉气俱实者，可先去其积，积去其痢自止。宜承气汤，或神佑丸、百顺丸主之，或用赤金豆
以微利之，此通因通用，痛随痢减之法也。但此等证候，必须确审然后用之，若以脾肾虚寒
致痢，而妄用此药及寒凉克伐等剂，再败元阳者，多致不可解救，最当慎也。
一、禁口不食，乃痢疾最危之候，而自古未有明辨。观丹溪云∶禁口痢，胃口热甚故也
，用黄连、人参煎汁，终日呷之，如吐再吃，但得一呷下咽便好，人不知此，多用温药甘味
，此以火济火，以滞益滞也。亦有误服热毒之药犯胃者，当推明而祛其毒。此丹溪之说也。
而不知禁口之辨，其义最微，岂皆胃口热甚而总以黄连可治乎？盖噤口者，以食不得入，虽
亦有实热证，而惟脾胃虚寒者居多。若因食积胃中而噤口者，其胸腹必有胀满，或见硬
痛，此当行滞去积，积滞去而食自入，如青、陈、楂、朴之属是也。有因火郁胃中而噤口者
，其脏腑必多炽热，或脉见洪数，此当泻火去热，邪热去而食自入，如芩、连、栀、柏之属
是也。凡此者，皆以邪蓄于中，乃噤口之实证也。
然实证无几，而近之病者，每察其胃口，则多无胀满等证，或察其大邪，则亦非实热等
证，但见其有出无入，而胃口日穷，精神日败。盖其既无胀满，本非积也，又无真热，本非
火也，无积无火而食不能入，其故何也？以脏气不能容受也。不能容受，其故有二∶盖一由
脾气之弱，故或为呕恶，或为吞酸，或恶闻食气而泛泛不宁，或饥不能食而枵枵待困，此以
中焦不运，故食不能入，责在脾也。一由肾气之弱，故命门不能暖，则大肠不能固，小肠不
能化，则胃气不能行，此以下焦失守而化源无主，责在肾也。欲健中焦，非人参、白术、干
姜、甘草之属不可；欲实下焦，非熟地、附子、吴茱萸、肉桂之属不可。脾肾强而食自入，
其理甚明，其应如响，余之活人于此者，不胜纪矣。如丹溪之用黄连，及以火济火，以滞益
滞之说，乃悉以实火为言，特一曲之见耳。局人意智，绝人生几，此其关系非小，不得信以
为然。
一、久痢阳虚，或因攻击、寒凉太过，致竭脾肾元神而滑脱不止者，本源已败，虽峻用
温补诸药，亦必不能奏效矣。宜速灸百会、气海、天枢、神阙等穴以回其阳，庶或有可望生
者。
凡是治疗痢疾的方法，关键在于辨别虚实和寒热。掌握了这个关键，就万无一失；失去了这个关键，就会造成最大的危害。前面的辨论已经讲得很清楚，应当仔细考察。前面泄泻门中提到的各种调治方法，也都应当酌情使用。
第一、如果是生冷食物初伤脾胃，饮食失调，但胃气尚未受损，元气也未亏损，或者出现疼痛、胀满、暴泻、暴痢等症状，且食积尚未清除的，适宜用抑扶煎、五德丸，或者平胃散、胃苓汤、五苓散之类的方剂，稍微祛除寒邪和食滞，很容易痊愈。
第二、脾肾虚弱的人，只要触犯生冷食物，极易引发痢疾。无论是大人还是小孩，凡是因脾虚导致的痢疾，如果没有实热等其他症状的，先适宜用佐关煎来温补脾气；如果病情稍深，波及肝肾，那就适宜用胃关煎作为最妙的治疗方法，不要因为病是新发的而害怕使用它。或者五德丸、四神丸之类的方剂，也可以交替使用。
第三、患痢疾，凡是脾肾都虚弱且病情危重可怕的，只适宜以胃关煎为最佳，温胃饮次之，或者根据情况交替使用也可以。或者兼用四维散、九气丹、复阳丹，这样才能保全生命。
第四、痢疾伴有呕吐恶心，频频想吐，或者闻到食物的气味就感到恶心的，这是胃气虚寒不能容纳受纳食物所致，必须适宜温补安胃，用五君子煎，或者六味异功煎、温胃饮、圣术煎之类的方剂主治。呕吐严重的，适宜用六味回阳饮之类的方剂主治。如果是阴中火虚，气不归元而导致呕吐的，适宜用胃关煎、理阴煎主治。如果是胃火上冲导致呕吐的，那么一定会有烦热、胀满等症状，这时才可以用清凉降火的药物，适宜用大厘清饮、益元散之类的方剂主治。
第五、湿热邪气旺盛，出现烦热喜冷、脉象实、腹部胀满，或者下痢纯红鲜血的，适宜用清流饮、黄芩芍药汤，或者用香连丸，或者用河间芍药汤。热势严重的，适宜用大厘清饮，或者茵陈饮。这些药物，如果服用几剂没有效果，就应当考虑顾护脾肾了。
第六、痢疾伴有发热的，似乎属于火证，适宜从凉性角度治疗。然而实热证反而未必发热，只有痢疾损伤精血，阴虚水亏的人，则最多表现为热和躁动。如果虚中有火，脉象有力的，适宜用加减一阴煎，或者保阴煎主治。如果脉象本来无力，完全属于虚火，那么就不可以治火，单适宜壮水补阴，如三阴煎及六味地黄丸、八味地黄丸等丸剂。如果阴盛格阳而导致外热的，必须适宜用胃关煎及右归饮之类的方剂主治。
第七、痢疾刚发作，体质尚强，或者因为放纵口腹，饮食停滞，凡是有实邪引起的胀痛坚满等症状，而且形体、气息、脉气都实的，可以先去除积滞，积滞去除了痢疾自然停止。适宜用承气汤，或者神佑丸、百顺丸主治，或者用赤金豆轻微通利大便，这是“通因通用”，痛随痢减的方法。但是这种证候，必须确切审察后然后使用，如果是因脾肾虚寒导致的痢疾，而妄用这些药物及寒凉克伐等剂型，再次败坏元阳的，大多导致无法解救，最为谨慎啊。
第八、禁口不食，是痢疾最危险的征候，自古以来没有明确辨析。看朱丹溪说：禁口痢，是因为胃口热甚的缘故，用黄连、人参煎汁，整天小口喝着，如果吐了再吃，只要有一口咽下去就好了。人们不知道这个道理，多用温药甘味，这是以火救火，以滞增滞。也有误服热毒药物伤害胃气的，应当推究明白并祛除其毒。这是丹溪的说法。却不知道禁口的辨析，其中的意义非常微妙，难道都是胃口热甚而总可以用黄连治疗吗？大概噤口症，是因为食物不能进入，虽然也有实热证，但大多是脾胃虚寒。如果是因为食积在胃中导致噤口的，胸腹一定有胀满，或者见到硬痛，这应当行滞去积，积滞去除了食物自然能进入，如青皮、陈皮、山楂、厚朴之类的药物。有因为火郁在胃中导致噤口的，脏腑一定多炽热，或者脉象洪数，这应当泻火去热，邪热去除了食物自然能进入，如黄芩、黄连、栀子、黄柏之类的药物。所有这些，都是因为邪气蓄积在中焦，是噤口的实证。
然而实证很少，近来的患者，每观察他们的胃口，大多没有胀满等症状，或者观察他们的大邪，也不是实热等症状，只见他们有出无入（只拉不吃），胃口日渐枯竭，精神日渐衰败。大概既然没有胀满，本来就不是积滞，又没有真热，本来就不是火，没有积滞没有火却食物不能进入，原因是什么呢？是脏气不能容纳受纳。不能容纳受纳，原因有两个：一是由于脾气虚弱，所以有时呕吐恶心，有时吞酸，有时厌恶闻见食物气味而泛泛不安，有时饥饿却不能进食而空虚等待困倦，这是因为中焦不运化，所以食物不能进入，责任在脾。一是由于肾气虚弱，所以命门不能温暖，大肠不能固摄，小肠不能消化，胃气不能运行，这是因为下焦失守而化源无主，责任在肾。想要健运中焦，非人参、白术、干姜、甘草之类的药物不可；想要充实下焦，非熟地黄、附子、吴茱萸、肉桂之类的药物不可。脾肾强健而食物自然能进入，道理很明白，反应像回声一样迅速，我靠这种方法救活的人，不胜枚举。至于丹溪使用黄连，以及以火救火、以滞增滞的说法，完全是针对实火而言的，只是片面的见解。局限人的智慧，断绝人生机，这关系不是小问题，不能相信认为是正确的。
第九、久痢阳虚，或者因为攻伐、寒凉太过，导致竭尽脾肾元神而滑脱不止的，本源已经败坏，虽然峻烈地用温补各种药物，也一定不能奏效了。适宜速灸百会、气海、天枢、神阙等穴位来回复阳气，或许还有希望生存。
The key to treating dysentery lies in distinguishing between deficiency and excess, cold and heat. Grasping this key ensures success without failure; losing it causes the greatest harm. The preceding discussion has clarified this, and careful examination is required. The various treatment methods mentioned in the section on diarrhea should also be applied as appropriate.
First, if the initial injury is caused by raw and cold foods or dietary irregularities, but stomach qi is not yet damaged and primal qi is not depleted, presenting with symptoms such as pain, distension, sudden diarrhea, or acute dysentery, with food stagnation remaining, Yi Fu Jian (Supporting Decoction) or Wu De Wan (Five Virtues Pill), or formulas such as Ping Wei San (Calm the Stomach Powder), Wei Ling Tang (Stomach and Five-Li Decoction), or Wu Ling San (Five-Ingredient Powder with Poria) are suitable to slightly dispel cold and stagnation, leading to easy recovery.
Second, individuals with weak spleen and kidney qi easily develop dysentery upon consuming raw or cold foods. Whether adult or child, for dysentery caused by spleen deficiency without other signs of excess heat, Zuo Guan Jian (Assisting the Gate Decoction) is first indicated to warm spleen qi. If the condition deepens and involves the liver and kidneys, Wei Guan Jian (Stomach Gate Decoction) is the most excellent treatment; do not hesitate to use it because the disease is new. Wu De Wan (Five Virtues Pill) or Si Shen Wan (Four Spirits Pill) may also be used intermittently.
Third, for dysentery where both spleen and kidney are deficient and the condition is critical and frightening, Wei Guan Jian (Stomach Gate Decoction) is the primary choice, followed by Wen Wei Yin (Warm the Stomach Infusion). These may be used alternately according to circumstances. Alternatively, Si Wei San (Four Dimensions Powder), Jiu Qi Dan (Nine-Qi Elixir), or Fu Yang Dan (Restore Yang Elixir) may be combined to preserve life.
Fourth, dysentery accompanied by vomiting and nausea, frequent retching, or aversion to the smell of food, indicates that stomach qi is deficient and cold, unable to receive and hold food. It is essential to warm and tonify the stomach using Wu Jun Zi Jian (Five Gentlemen Decoction), Liu Wei Yi Gong Jian (Six-Ingredient Enhanced Merit Decoction), Wen Wei Yin (Warm the Stomach Infusion), or Sheng Zhu Jian (Sage Atractylodes Decoction). For severe vomiting, Liu Wei Hui Yang Yin (Six-Ingredient Restore Yang Infusion) is indicated. If vomiting results from fire deficiency within yin and qi failing to return to its source, Wei Guan Jian (Stomach Gate Decoction) or Li Yin Jian (Regulate Yin Decoction) are appropriate. If vomiting is caused by stomach fire rushing upward, accompanied by irritability, heat, and fullness, cooling and descending fire medications such as Da Li Qing Yin (Great Clearing and Purifying Infusion) or Yi Yuan San (Primary Source Powder) may be used.
Fifth, when damp-heat pathogenic factors are vigorous, presenting with irritability, preference for cold, excess pulse, abdominal fullness, or passage of pure red fresh blood, Qing Liu Yin (Clear Flow Infusion), Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction), Xiang Lian Wan (Aromatic Coptis Pill), or He Jian Shao Yao Tang (He's Peony Decoction) are suitable. For severe heat, Da Li Qing Yin (Great Clearing and Purifying Infusion) or Yin Chen Yin (Artemisia Capillaris Infusion) are indicated. If these formulas fail after several doses, consideration must turn to supporting the spleen and kidney.
Sixth, dysentery with fever might seem to belong to fire patterns and suggest cool treatments. However, true excess heat does not necessarily present with fever. Fever and restlessness are most common in cases where dysentery has damaged essence and blood, leading to yin deficiency and water depletion. If there is deficiency with internal fire and a forceful pulse, Jia Jian Yi Yin Jian (Modified One-Yin Decoction) or Bao Yin Jian (Protect Yin Decoction) are appropriate. If the pulse is inherently weak, indicating pure deficiency fire, treating the fire directly is contraindicated; instead, strengthen water and tonify yin using San Yin Jian (Three-Yin Decoction) or pills such as Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). If yang is repelled outward due to yin excess (yin repelling yang), causing external heat, Wei Guan Jian (Stomach Gate Decoction) and You Gui Yin (Right Restoration Infusion) are required.
Seventh, at the onset of dysentery, if the constitution is strong, or due to indulgence in food and drink causing stagnation, presenting with excess pathogenic signs such as pain, distension, hardness, and fullness, along with robust form, qi, and pulse, the accumulation should be removed first; once the accumulation is gone, the dysentery will stop naturally. Cheng Qi Tang (Order Qi Decoction), Shen You Wan (Divine Protection Pill), or Bai Shun Wan (Hundred Compliance Pill) are suitable, or Chi Jin Dou (Red Gold Bean) can be used for mild purgation. This follows the principle of "treating obstruction with unblocking agents" (tong yin tong yong), where pain decreases with the passage of stool. However, this approach must only be used after precise diagnosis. If dysentery is caused by spleen-kidney deficiency and cold, the reckless use of these drugs or cold-cooling purgatives will further damage primal yang, often leading to untreatable conditions. Extreme caution is required.
Eighth, "forbidden mouth" (an inability to eat), is the most critical sign of dysentery, yet historically lacks clear differentiation. Zhu Danxi stated: Forbidden mouth dysentery is due to excessive heat in the stomach opening; he prescribed decoctions of Huang Lian (Coptis Rhizome) and Ren Shen (Ginseng Root), sipped throughout the day. If vomited, continue drinking; even one swallow brings improvement. People misunderstood this, often using warm and sweet medicines, which is adding fire to fire and stagnation to stagnation. Some cases involve damage from mistakenly ingested hot-toxic drugs, requiring identification and detoxification. This is Danxi's view. However, the differentiation of forbidden mouth is subtle; it is not always due to stomach heat treatable solely with Huang Lian. Generally, forbidden mouth occurs because food cannot enter. While some cases involve excess heat, most are due to spleen-stomach deficiency and cold. If caused by food accumulation in the stomach, chest and abdomen will be full or painful/hard; treat by moving stagnation and removing accumulation using Qing Pi (Citrus Peel), Chen Pi (Aged Tangerine Peel), Shan Zha (Hawthorn Fruit), and Hou Po (Magnolia Bark), so that food enters naturally. If caused by fire depression in the stomach, organs will show intense heat or surging-rapid pulses; treat by draining fire and clearing heat using Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit), and Huang Bo (Phellodendron Bark), so that food enters naturally. All these represent excess patterns of forbidden mouth due to pathogenic accumulation in the middle jiao.
However, excess patterns are rare. In recent patients, observing the stomach opening reveals little fullness or other excess heat signs. There is output without input, leading to daily depletion of the stomach opening and spirit. Since there is no fullness, it is not accumulation; since there is no true heat, it is not fire. Why can food not enter? Because the zang organs cannot receive it. There are two reasons for this inability to receive: First, spleen qi weakness leads to vomiting, acid regurgitation, aversion to food smells, or hunger without ability to eat. This is due to middle jiao failure to transform, placing responsibility on the spleen. Second, kidney qi weakness fails to warm the Ming Men (Gate of Life), leading to large intestine insecurity, small intestine digestion failure, and stomach qi stagnation. This is lower jiao failure and lack of control over the source of transformation, placing responsibility on the kidney. To strengthen the middle jiao, Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Gan Jiang (Dried Ginger), and Gan Cao (Licorice Root) are indispensable. To solidify the lower jiao, Shu Di Huang (Prepared Rehmannia Root), Fu Zi (Aconite Lateral Root), Wu Zhu Yu (Evodia Fruit), and Rou Gui (Cinnamon Bark) are indispensable. When spleen and kidney are strong, food enters naturally; the principle is clear and the response immediate. I have saved countless lives using this method. Danxi’s use of Huang Lian and his theory of "adding fire to fire" apply only to excess fire patterns and represent a partial view. Such limited thinking destroys human vitality; the implications are significant, and one must not accept them as correct.
Ninth, in chronic dysentery with yang deficiency, or due to excessive attacking or cold-cooling treatments exhausting the primal spirit of spleen and kidney, resulting in incontinence and sliding discharge, the root source is already ruined. Even vigorous use of warming and tonifying drugs will be ineffective. Immediate moxibustion on Bai Hui (GV20), Qi Hai (CV6), Tian Shu (ST25), and Shen Que (CV8) is indicated to restore yang, offering a chance of survival.