凡里急后重者，病在广肠最下之处，而其病本则不在广肠，而在脾肾。凡热痢、寒痢、
虚痢皆有之，不得尽以为热也。盖中焦有热，则热邪下迫，中焦有寒，则寒邪下迫，脾肾气
虚，则气陷下迫。欲治此者，但当察其所因，以治脾肾之本，则无有不愈。然病在广肠，已
非食积，盖食积至此，泻则无留，而所留者，惟下陷之气，气本无形，故虽若欲出而实无所
出，无所出而又似欲出，皆气之使然耳。故河间之用芍药汤，谓行血则便自愈，调气则后重
除，是固然矣。然调气之法，如气热者凉之则调，气寒者温之则调，气虚者补之则调，气陷
者举之则调，必使气和，乃为调气行血之法，其义亦然。若但以木香、槟榔、当归、大黄行
血散气之属谓之调和，不知广肠最远，药不易达，而所行所散者，皆中焦之气耳。且气既下
陷，而复以行之散之，则气必更陷，其能愈乎？矧痢止则后重自止，未有痢不愈而后重能愈
者也，故凡欲治此者，但当以治痢为主。
凡病痢疾，多有大孔肿痛者，其故何也？盖脾胃不和，则水谷之气失其正化，而浊恶难
堪之味出诸孔道，此痛楚之不能免也。又若火因泻陷，阳为阴逐，则胃中阳气并逼于下，无
从解散，此肿之所由生也。所以痢多则痛多，痢少则痛少，痛与不痛，亦由气之陷与不陷耳
。故无论寒痢、热痢，大孔皆能为痛，不能谓痛必由热也。欲治此者，但治其痢，痢止则肿
痛自散，亦如后重之法也。自丹溪云∶大孔痛因热流于下，木香、槟榔、芩、连加炒干姜主
之，是但知火能为肿为痛，亦焉知元阳之下陷也。后人所宗，皆其法也，凡虚寒之辈，其不
能堪此亦多矣。
凡是出现里急后重症状的，病位在大肠（广肠）的最下端，但疾病的根本原因并不在大肠，而在于脾和肾。无论是热痢、寒痢还是虚痢，都会出现这种情况，不能一概认为是热证。如果中焦有热，热邪就会向下逼迫；中焦有寒，寒邪也会向下逼迫；脾肾气虚，正气下陷也会向下逼迫。想要治疗这种病症，应当考察其病因，从调理脾肾的根本入手，就没有治不好的。然而病位在大肠，这已经不是食积了，因为食物积滞到了这里，排泄时就不会有残留，而真正滞留的是下陷的气机。气本来是没有形状的，所以虽然感觉想排便但实际上并没有东西可排，没有东西可排却又好像想排，这都是气机紊乱所致。所以刘河间使用芍药汤，说“行血则便自愈，调气则后重除”，这固然有道理。但是调气的方法，如果是气热就用凉法来调和，气寒就用温法来调和，气虚就用补法来调和，气陷就用升提法来调和，必须使气机平和，这才是调气行血的真义。如果仅仅把木香、槟榔、当归、大黄等行血散气的药物称为调和，却不知道大肠位置较远，药物不易到达，而且这些药物所行散的都是中焦的气机。况且气已经下陷，再用行散的药物，气机必然更加下陷，怎么能痊愈呢？况且痢疾停止后，里急后重自然也会停止，从来没有痢疾没好而里急后重先好的情况，所以凡是想要治疗此症的人，都应当以治疗痢疾为主。
凡是患痢疾的病人，大多会出现肛门（大孔）肿痛的情况，这是什么缘故呢？这是因为脾胃不和，导致水谷之气失去正常的运化，产生污秽难闻的气味排出体外，这就不可避免地会引起疼痛。另外，如果火热之邪因腹泻而下陷，阳气被阴邪驱逐，胃中的阳气被迫聚集在下部，无法解散，这就是肿胀产生的原因。所以痢疾次数多则疼痛多，痢疾次数少则疼痛少，痛或不痛，也是由气机是否下陷决定的。因此，无论是寒痢还是热痢，肛门都可能疼痛，不能认为疼痛一定是由热证引起的。想要治疗这种情况，只要治疗痢疾即可，痢止则肿痛自然消散，这也与治疗里急后重的方法类似。自从朱丹溪说：“肛门疼痛是因为热流注于下部，用木香、槟榔、黄芩、黄连加上炒干姜主治”，这只是知道火能导致肿胀和疼痛，哪里知道这是元阳下陷呢？后世人所遵循的都是他的方法，对于体质虚弱寒冷的人来说，承受不了这种治疗方法的情况很多。
In cases of tenesmus (a feeling of incomplete defecation with straining), the pathology is located at the lowest part of the large intestine (rectum), but the root cause lies not in the large intestine, but in the Spleen and Kidney. This symptom occurs in heat dysentery, cold dysentery, and deficiency dysentery alike; it should not be indiscriminately attributed to heat. If there is heat in the Middle Jiao, pathogenic heat forces downward; if there is cold in the Middle Jiao, pathogenic cold forces downward; if Qi of the Spleen and Kidney is deficient, sinking Qi forces downward. To treat this condition, one must investigate the etiology and treat the root by regulating the Spleen and Kidney, ensuring a cure. However, since the disease is in the large intestine, it is no longer food stagnation. Food stagnation would be cleared upon evacuation without residue; what remains is only the sinking Qi. Since Qi is formless, although there is a sensation of wanting to defecate, there is actually nothing to pass; yet, because there is nothing to pass, the sensation persists. This is all caused by Qi dysfunction. Therefore, Liu Hejian’s use of Shaoyao Tang, stating that "regulating blood leads to self-healing of stools, and regulating Qi eliminates tenesmus," is indeed correct. However, the method of regulating Qi involves: cooling to regulate if Qi is hot, warming to regulate if Qi is cold, tonifying to regulate if Qi is deficient, and lifting to regulate if Qi is sinking. Only when Qi becomes harmonized does this constitute the true method of regulating Qi and moving Blood. Merely labeling herbs like Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Danggui (Angelicae Sinensis Radix), and Dahuang (Rhei Radix et Rhizoma) as agents for moving blood and dispersing Qi as "harmonizing" is mistaken. One fails to realize that the large intestine is distant, making drug delivery difficult, and these herbs primarily act on the Qi of the Middle Jiao. Moreover, if Qi is already sinking, using dispersing and moving agents will cause further sinking of Qi, making recovery impossible. Furthermore, once dysentery ceases, tenesmus naturally stops; it is unheard of for tenesmus to resolve while dysentery persists. Thus, treatment should primarily focus on curing the dysentery.
In most cases of dysentery, patients experience swelling and pain at the anus (Da Kong). What is the reason? When the Spleen and Stomach are disharmonious, the Qi of water and grain loses its normal transformation, producing foul and unbearable substances that exit through the orifices, inevitably causing pain. Additionally, if fire pathogens sink due to diarrhea, and Yang is driven away by Yin, the Yang Qi of the Stomach is forced into the lower body and cannot dissipate, leading to swelling. Therefore, frequent dysentery causes more pain, while less frequent dysentery causes less pain; the presence or absence of pain depends on whether Qi is sinking. Thus, regardless of whether it is cold or heat dysentery, the anus can become painful; one cannot assume pain is necessarily due to heat. To treat this, one need only treat the dysentery; once the dysentery stops, the swelling and pain will naturally subside, similar to the approach for tenesmus. Since Zhu Danxi stated that "anus pain is due to heat flowing downward," prescribing Muxiang, Binglang, Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma) plus fried Ganjiang (Zingiberis Rhizoma), he only recognized that fire causes swelling and pain, failing to recognize the sinking of Primordial Yang. Later generations followed his methods, resulting in many instances where patients with deficiency-cold constitutions could not tolerate such treatments.