痢下五色，脓血稠粘，滑泄无度，发热烦渴，脐下急痛，至夜转剧而恶食，或下鲜血者，便属阴虚，急宜救热
存阴为主，如驻车丸、阿胶丸、归连丸、阿胶梅连丸、千金黄连汤、黄连阿胶汤、白头翁加甘草阿胶汤等方选
用。（《医通》）
为治之法，慎之于初者易愈，失之分利者难治，若误医传藏者必死，及以外感为内伤者必死。（《证治百问》）
大抵初病治法，发热恶寒者，香苏散加防风、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。（《时方妙用》）
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，一日两服，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。（同上）
虚实 实证之辨，必其形气强壮，脉息滑实，或素纵口腹，或多胀满坚痛，及年少新病，脾气未损者，
方可用治标之法，微者行之利之，甚者泻之。虚证之辨，有形体薄弱者，有颜色青白者，有脉虽紧数而无力无
神者，有脉见真弦而中虚似实者，有素禀阳衰者，有素多淡素者，有偶犯生冷者，有偶中雨水阴寒者，有偶因
饮食不调者，有年衰脾弱者。以上诸证，凡其素无纵肆而忽患泻痢，此必以或瓜或果，或饮食稍凉，偶伤胃气
而然，果何积之有，又何热之有。总惟脾弱之辈多有此证，故治此者只宜温调脾肾，但使脾温则寒去，即所以
逐邪也。（《景岳》）
至以赤为热，白为寒，亦非确论。果尔则赤白相兼者，岂真寒热同病乎。必以见证与色脉辨之，而后寒热不
淆也。须知寒者必虚，热者必实，更以虚实细详之，而寒热愈明耳。胀满恶食，急痛惧按者，实也；烦渴引饮，
喜冷畏热者，热也；脉强而实者，实也；脉数而滑者，热也。外此则靡非虚寒矣，而相似之际尤当审查。如以口
渴为实热，似矣；不知凡系泻痢，必亡津液，液亡于下则津涸于上，安得不渴，更当以喜热喜冷分虚实也。以腹
痛为实热，似矣；不知痢出于脏，肠胃必伤，脓血剥肤，安得不痛，更当以痛之缓急、按之可否、藏之阴阳、腹
之胀与不胀、脉之有力无力分虚实也。以小便黄赤短少为实热，似矣；不知水从痢去，溲必不长，液以阴亡，溺
因色变，更当以便之热与不热、液之涸与不涸、色之泽与不泽分虚实也。以里急后重为实热，似矣；不知气陷则
仓廪不藏，阴亡则门户不闭，更当以病之新久、质之强弱、脉之盛衰分虚实也。（《必读》）
虚实当辨。如腹痛拒按者为实，喜按者为虚。脓血稠粘、数至圊而不能便者为实，不及拈衣而即泄出者为虚。
未经泻荡而后重者为实，已经泻荡而仍后重者为虚。邪实之重，粪出少减（名粪前坠滞也），少顷又重（邪未尽也）；
虚滑之重，粪出愈甚（名粪后重），少顷略可（较愈甚时略松也，气复升故）。凡痢中所有之证，如烦渴、咽干、
舌黑、肿胀之类，悉有虚实之殊，无得概指为实，当细别之。（《医碥》）
冷热 冷痢者，由肠胃虚弱，受于寒气，肠虚则泄，故为冷痢也。凡痢色青、色白、色黑并皆为冷痢，
色黄、色赤并是热也。故痢色白，食不消，谓之寒中也。诊其脉，沉则生，浮则死也。（《病源论》）（按∶脉
候是经文。）
久冷痢者，由肠虚而寒积，故冷痢久不断也。而廪丘公说云∶诸下悉寒也。凡人肠中大便，有寒则常鸭溏，
有热则傧 。人见病身体发热而下，便谓热下，非也。平常恒自将节饮食，衣被调适，其人无宿寒者，大便自调。
强人适发越，薄衣冷冻饮料食，表有热不觉里冷，而胃内潜冷，冷即下也，今始发热而下，当与理中汤，加大附子
一枚，连服三四剂，重复令微汗出，微汗出则热除，不复思冷，胃气温暖，下与发热俱瘳矣。宿寒之家，其人常
自患，冷蹑湿地，若足蹈冻地，或衣被薄皆发。风下最恶。何谓风下？当风吹腰腹，冷气彻里而暴下者，难治也。
（同上）
热痢候，此由肠胃虚弱，风邪挟热乘之，肠虚则泄，故为热痢也。其色黄，若热甚，黄而赤也。（同上）
祭酒林谦之说∶韶州医人刘从周治病有功，议论殊不凡，且有验，云∶大凡痢疾，不问赤白而后为冷热之证。
若手足和暖则为阳，只须先服五苓散，用粟米饮调下，次服感应丸二十粒即愈。若觉手足厥冷则为阴，当服暖
药，如已寒元、附子之类。如此治痢无不效。此方亲曾用有效。有人夏月患痢，一日六七十行，用五苓散者两服
立止。（《百一选方》）（按∶此治法难信，姑存之。）
凡腹痛后重，小便短少，口渴喜冷冻饮料，大肠口燥结，是为挟热下痢。若腹痛，口不渴，喜热饮，小便清长，
身不热，腹喜热手熨者，（评曰∶痢疾与伤寒不同，颇有不渴喜热饮，便清身不热，腹喜热熨而仍属火症者，此
不可以为据也，）是为挟寒下痢。（《医贯》）
凡泻痢寒热之辨，若果是热，则必畏热喜冷，不欲衣被，渴甚饮水，多亦无碍，或小便赤涩而痛，或下痢纯
血鲜红，脉息必滑实有力，形气必躁急多烦。若无此实热诸证，
而泻痢有不止者，必是虚寒。（《景岳》）
其症之冷热，不在论粪色之赤白，有赤者亦冷而白者亦热，惟在审粪色之淡薄稠浓与手足之温凉。盖四肢
为诸阳之本，阳虚则身虽温，手足必冷，脐下必寒，口不渴，利久或渴，不喜饮食，安静自卧，小便自利，或
肠鸣，或腹痛，粪水淡薄，或数至圊而不去，或血水，或黑血，脉必沉迟细小者，阴也。热以胜寒，阳平阴也。
阳盛则身大热，手足温暖，脐下必热，干呕口渴引饮，或大热，或脓血，或紫血，脉必浮洪实数者，阳也。寒
以胜热，阴和阳也。（《会解》）
若血色黯如瘀，服凉药而所下愈多、去愈频者，当作冷痢，宜理中汤，或四君子汤加肉豆蔻、木香各半钱。
（《要诀》）（按∶《医通》曰∶凡血色紫黯，屡服凉药而所下愈多，作冷痢治。故血色如猪肝、如紫草、如苋
菜汁者，非炮姜不治。又《三因》曰∶凡血得热则淖溢故鲜，得寒则凝泣故瘀。此戴氏所本。）
赤白（血痢） 凡痢皆由荣卫不足，肠胃虚弱，冷热之气，乘虚入客于肠间，虚则泄，故为痢也。然
其痢而赤白者，是热乘于血，血渗肠内则赤也。冷气入肠，搏肠间津液凝滞则白也。冷热相交，故赤白相杂。
重者状如脓涕而血杂之。轻者白脓上有赤脉薄血，状如脂脑，世谓之鱼脑痢也。（《病源论》）
血痢者，热毒折于血，入大肠故也。血之随气循环经络，通行脏腑，常无停积。毒热气乘之，遇肠虚者，
血渗入于肠，肠虚则泄，故为血痢也。身热者死，身寒者生。诊其关上脉芤大，便去血，暴下血数升也。（同
上）
以赤为热，以白为冷，医者之辞，万口一说，此愚以为古人所谈，未尝有卓然之论也。何则？以赤为热，
以白为
冷，赤白为冷热不和，独知大纲，而痢之有变化轻重之别，得其粗而不得其详，知其一不知其二者矣。（《史
载之方》）
下痢赤白，俗言寒热相兼，其说犹误。岂知水火阴阳寒热者，犹权衡耳，一高则必一下，一盛则必一衰，岂
能寒热俱甚于肠胃而同为痢乎。大法下迫窘痛，后重里急，小便赤涩，皆属燥热，而下痢白者必多有之，然则为
热明矣。（《原病式》）
湿热瘀积，干于血分则赤，干于气分则白，赤白兼下，气血俱受邪矣。久而不愈，气弱不运，脾积不磨，陈
积脱滑，下凝犹若鱼脑矣。甚则肠胃空虚，关司失守，浊液并流，色非一类，错杂混下，注出状如豆汁矣。若
脾气下陷，虚坐努责，便出色如白脓矣。其热伤血深，湿毒相瘀，粘结紫色，则紫黑矣。其污浊积而欲出，气滞
而不与之出，所以下迫窘痛，后重里急，至圊而不能便，总行频并亦少，乍止乍起而不安，此皆大肠经有所壅遏
窒碍，气液不得宣通故也。（薛氏《平治会萃·附论》）
大人小儿泄痢无已，其后变作白脓点滴而下，或于粪尾见之，为之温脾不愈，法当温肾。盖肾主骨髓，白脓
者骨髓之异名也。要之始作白痢，其气 臭；已经转下，而且淹延日久，无所谓痢矣。今之白脓全无 臭，面
色微黑，骨力羸弱，的见肾虚，合用炒故纸、当归、木香、干姜、官桂主之。
（《直指》）
所下之物 肠垢者，肠间津汁垢腻也。由热痢蕴积，肠间虚滑，所以因下痢而便肠垢也。（《病源论》）
亦有不及成肿，而五脏伤败，水血并下，而五脏五色随之而出，谓之五液俱下也。凡如此者多死。（同上）（按∶
《辨脉法》曰∶阴阳俱厥，脾气孤弱，五液注下。此巢氏所本。《金鉴》曰∶五色痢者，五色脓血相杂而下也。
若有藏腐尸臭之气，则凶。）
凡腹中积聚之辨，乃以饮食之滞，留蓄于中，或结聚成块，或胀满硬痛，不化不行，有所阻隔者，乃为之积，
此皆渣粕成形之属，所当逐也。今人不能辨察，但见痢如脓垢者皆谓之积，不知此非渣粕之属，而实附肠着脏之
脂膏，皆精血之属也。无论瘦人肥人皆有此脂，但肥者脂浓，瘦者脂薄，未有无脂者也。若果无脂，则肠脏之间，
岂容单薄赤露，非惟藩篱不固，而且脏必易伤，无是理也。今之凡患泻痢者，正以五内受伤，脂膏不固，故日剥
而下。若其脏气稍强，则随去随生，犹无足虑。若脏气至败，剥削至尽，或以久泻久痢，但见血水及如屋漏水者，
此在庸人，云其积聚已无，反称为善，而不知脂膏刮尽，则败竭极危之候也。使今后医家，但识此为脂膏而本非
积聚，则安之固之且不暇，而尚敢云攻之逐之或用苦寒以滑之利之者否。（《景岳》）
凡五色之辨，如下痢脓垢之属，无非血气所化。但白者其来浅，浮近之脂膏也。赤者其来深，由脂膏而切肤
络也。下纯血者，多以血为热迫，故随溢随下，此其最深者也。若紫红紫白者，则离位梢久，其下不速而色因以变，
或未及脉络，此其稍浅者也。若红白相兼者，此又其浅深皆及者也。大都纯血鲜红者多热证，以火性急速，迫而
下也。紫红紫白者少热证，以阴凝血败，损而然也。纯白者无热证，以脏寒气薄，滑而然也。然有以无红而亦因
热者，此以暴注之类，而非下痢之谓也。有以紫红虽多而不可言热者，此以阴络受伤，而非暴注之比也。若辨黄
黑二色，则凡黄深而秽臭者，此有热证，亦有寒证。若浅黄色淡不甚臭而或兼腥馊气者，此
即不化之类，皆寒证也。黑而浓浓大臭者，此焦色也，多有火证。若青黑而腥薄者，此肝肾腐败之色也，犹以
为热，其谬甚矣。虽五色之辨大约如此，然痢之见血者，无非阴络受伤，即或寒或热，但伤络脉则无不见血，故
不可以见血者必认为热也。凡临此证，当必以脉色形气病因兼而察之，庶不致有疑似之误。（同上）
色黑有二∶焦黑者，热极反兼胜己之化（芍药汤）；黑如漆之光者，瘀血也（桃仁承气汤）。（《必读》）
豆汁色者，湿胜也。纯血者，热毒入深也。鱼脑色者，脾虚不运，陈积脱滑下凝也。如鼻涕冻胶者，脏腑
虚冷滑脱也。如白脓者，虚坐努责而出，气受热邪瘀结也。如屋漏水尘腐色者，元气惫弱之甚也。（《指掌》）
（按∶前证治总例及后死证，宜互参。）
经云∶肠 下血，身热则死。谓余血下泄，阳热外浮。阴阳离脱也。若痢后下血水，其身发热，亦为死证。
痢后则肠垢已竭，下血水乃从阳入阴，胞中并伤。世有下屋漏水之说，则血水其渐也。若色如鱼脑，此热毒入
肠，当清热和血也。色如酱褐，乃下焦虚寒，亦非善证，当温经散寒。如白沫冻汁，则为寒积。（《医学真传》）
发热 初痢身热脉浮者，可解表；初痢身热脉沉者，可攻下。久痢身热脉虚者，正虚可治；久痢身热
脉大者，邪盛难医。（《汇补》）
下痢不止发热者属阴虚，用寒凉药必兼升药、热药。（《丹溪》）
腹痛 凡泻痢腹痛，有实热者，有虚寒者。实热者，或因食积，或因火邪。但食积之痛，必多胀满坚硬，或痛
而拒按，此必有所停滞，微者宜行其滞，甚者宜泻而逐之。火邪之痛，必有内热等证，方宜清之利之。然邪实于中者必
多气逆，故凡治痛之法，无论是火是实，皆当以行气为先，但当察药性之寒热，择而用之可也。若虚寒刮痛之义，则人
痢疾排出五色脓血，质地稠厚黏腻，滑脱失禁无度，伴有发热、心烦口渴，脐下拘急疼痛，夜间症状加重且厌恶进食，或者排出鲜血的，属于阴虚证，应当紧急救治热邪以保存阴液为主。可选用驻车丸、阿胶丸、归连丸、阿胶梅连丸、千金黄连汤、黄连阿胶汤、白头翁加甘草阿胶汤等方剂。（出自《医宗金鉴·医通》）
治疗的方法，如果在初期谨慎施治则容易痊愈，如果错误地使用了分利（利尿）的方法则难以治愈，如果误治导致病邪传入脏腑则必然死亡，以及将外感病误认为内伤病治疗的也必然死亡。（出自《证治百问》）
大体上初起痢疾的治疗方法：如果有发热恶寒症状的，用香苏散加防风、川芎以取微汗即可痊愈，病情重的必须用桂枝汤、当归四逆汤之类的方剂。如果有寒热往来、频繁呕吐的，必须用小柴胡汤。如果热多而口渴的，用小柴胡汤去掉半夏，加入栝蒌根主治。如果发热不恶寒，有里急后重症状的，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。（出自《时方妙用》）
医书说：下痢纯血的会死，下痢像屋漏水的也会死。按照治疗方法，不过是用阿胶、地榆、槐花、苍术之类的药物，怎么能救治这种死症呢？如果是下奔鲜血、口渴、小便短少、里急后重、脉象盛大有力的，这是火症，宜用白头翁汤，一天服两次，体虚人和产后妇女加阿胶、甘草，也有下鲜血但不是火症的。如果血色暗红且有血块的，属热的少，属寒的多，都应当根据脉象和症状仔细辨别。如果口中平和、脉细、小便长、手脚冷的，属于虚寒无疑，宜用理中汤加灶心土八钱主治；下血多的，宜间服黄土汤，一天两次，三天逐渐痊愈。这是因为脾胃如同分金的炉子，理中汤分清浊，是治疗其本源啊。屋漏水即血色暗滞不稠厚的，是由于虚寒证误用寒凉攻破药所致。如果出现咽痛、言语无序，半天必死，也用理中汤来抢救。（同上）
虚实辨证：实证辨别，一定是形体气力强壮，脉象滑实，或者平素放纵口腹之欲，或者多有胀满坚痛，以及年少新病，脾气未受损的，才可以采用治标的办法，轻微的行之利之，严重的泻之。虚证辨别，有形体薄弱的，有面色青白的，有脉虽紧数但无力无神的，有脉见真弦而中间虚弱看似实证的，有平素禀赋阳气衰弱的，有平素饮食清淡寡味的，有偶然触犯生冷食物的，有偶然遭受雨水阴寒侵袭的，有偶然因饮食不调的，有年老脾弱的。以上各种证候，凡是平素没有放纵行为却忽然患腹泻痢疾的，这必定是因为吃了瓜果或食物稍凉，偶然伤了胃气而造成的，哪里有积滞呢，又哪里有热邪呢？总之只有脾弱的人多有此证，所以治疗这种人只适宜温调脾肾，只要使脾温暖则寒气去除，这就是驱逐邪气的方法。（出自张景岳《景岳全书》）
至于认为红色为热，白色为寒，也不是确切的论断。果真如此，那么赤白相兼的，难道真是寒热同病吗？必须以见证与色脉来辨别，然后寒热才不会混淆。须知寒者必虚，热者必实，再根据虚实详细分析，寒热就更加明确了。胀满厌恶进食，急痛害怕按压的，是实证；心烦口渴想喝水，喜欢冷食怕热的，是热证；脉强而实的，是实证；脉数而滑的，是热证。除此之外都不是虚寒了，但在相似的情况下尤其应当审查。比如把口渴当作实热，似乎有理；不知道凡是泻痢，必然损耗津液，津液在下部亡失则上部津液枯竭，怎么会不渴呢？更应当根据喜热还是喜冷来区分虚实。把腹痛当作实热，似乎有理；不知道痢疾出于脏腑，肠胃必然受伤，脓血剥蚀肌肤，怎么会不痛呢？更应当根据疼痛的缓急、是否可按压、脏腑的阴阳、腹部是否胀满、脉象有力无力来区分虚实。把小便黄赤短少当作实热，似乎有理；不知道水从痢疾而去，小便必然不长，津液因阴分亡失，尿液因此变色，更应当根据大便的热与不热、津液的枯与不枯、色泽的光泽与暗淡来区分虚实。把里急后重当作实热，似乎有理；不知道气陷则仓廪不藏，阴亡则门户不闭，更应当根据疾病的新久、体质的强弱、脉象的盛衰来区分虚实。（出自《必读》）
虚实应当辨别。如腹痛拒绝按压的是实证，喜欢按压的是虚证。脓血稠粘，多次去厕所却不能排便的是实证，来不及整理衣物就泄出的是虚证。未经泻下而后重的是实证，已经泻下之后重仍在的是虚证。邪实导致的后重，粪便排出后减轻一点（名叫粪前坠滞），过了一会儿又觉得重（邪气未尽）；虚滑导致的后重，粪便排出越多越重（名叫粪后重），过了一会儿稍微缓解一些（比刚才重的时候略松，因为气回升的缘故）。凡痢疾中所有的证候，如烦渴、咽干、舌黑、肿胀之类，都有虚实的区别，不能一概指为实证，应当仔细辨别。（出自《医碥》）
冷热辨别：冷痢，是由于肠胃虚弱，受于寒气，肠虚则泄，所以称为冷痢。凡是痢色青、色白、色黑都属于冷痢，色黄、色赤都属于热。所以痢色白，食物不消化，称为寒中。诊察其脉象，沉则生，浮则死。（出自《诸病源候论》）（按：脉候是经文内容。）
久冷痢，是由于肠虚而寒积，所以冷痢久久不断。而廪丘公说：所有的下痢都是寒证。大凡人肠中的大便，有寒则常呈鸭溏状，有热则呈稀糊状。人们看到病人身体发热而下痢，便认为是热痢，这是不对的。平常人如果能节制饮食，衣被调适，体内没有宿寒的，大便自然调和。强壮之人如果过度发散，穿薄衣喝冷冻饮料食物，体表有热不觉体内冷，而胃内潜藏寒冷，寒冷就会导致下痢，现在才开始发热而下痢，应当给予理中汤，加大附子一枚，连续服用三四剂，再次令其微微出汗，微微出汗则热除，不再想吃冷的，胃气温暖，下痢与发热一起痊愈。有宿寒的家庭，其人常常自己患病，冷脚踩湿地，或者脚踩冻地，或者衣被单薄都会发作。风下痢最恶劣。什么是风下痢？当风吹腰腹，冷气彻入体内而突然下痢的，难治。（同上）
热痢候，这是由于肠胃虚弱，风邪挟热乘虚而入，肠虚则泄，所以称为热痢。其色黄，如果热甚，黄中带赤。（同上）
祭酒林谦之说：韶州医生刘从周治病有功，议论不凡，且有疗效，他说：大凡痢疾，不问赤白而后判断冷热证。如果手足温暖则为阳证，只需先服五苓散，用粟米饮调下，接着服感应丸二十粒即愈。如果感觉手足厥冷则为阴证，应当服暖药，如已寒元、附子之类。这样治痢没有不有效的。这个方子我自己曾用过有效。有人夏天患痢，一天六七十次，用两服五苓散立刻停止。（出自《百一选方》）（按：此治法难以相信，姑且保留它。）
凡是腹痛后重，小便短少，口渴喜欢冷冻饮料，大肠口燥结的，是为挟热下痢。如果腹痛，口不渴，喜欢热饮，小便清长，身体不热，腹部喜欢热手熨烫的，（评曰：痢疾与伤寒不同，颇有不渴喜热饮，便清身不热，腹部喜欢热熨而仍属火症的，这不可以作为依据，）是为挟寒下痢。（出自《医贯》）
凡是泻痢寒热的辨别，如果确实是热，则一定畏热喜冷，不想穿衣盖被，口渴严重饮水，多喝也无妨碍，或者小便赤涩而痛，或者下痢纯血鲜红，脉象必滑实有力，形气必躁急多烦。如果没有这些实热诸证，而泻痢不止的，必定是虚寒。（出自张景岳《景岳全书》）
其症状的冷热，不在于讨论粪便颜色的赤白，有赤色的也可能是冷，白色的也可能是热，只在审察粪便颜色的淡薄稠浓与手足的温凉。因为四肢是诸阳之本，阳虚则身体虽然温，手足必冷，脐下必寒，口不渴，痢久或渴，不喜欢饮食，安静自卧，小便自利，或者肠鸣，或者腹痛，粪水淡薄，或者多次去厕所却排不出，或者血水，或者黑血，脉必沉迟细小，这是阴证。热以胜寒，阳平阴。阳盛则身体大热，手足温暖，脐下必热，干呕口渴引饮，或者大热，或者脓血，或者紫血，脉必浮洪实数，这是阳证。寒以胜热，阴和阳。（出自《会解》）
如果血色暗如瘀血，服用凉药后所下的更多、去的更频的，应当当作冷痢，宜用理中汤，或者四君子汤加肉豆蔻、木香各半钱。（出自《要诀》）（按：《医通》说：凡是血色紫黯，屡服凉药而所下愈多，作冷痢治。所以血色如猪肝、如紫草、如苋菜汁的，非炮姜不能治。又《三因方》说：凡是血得热则淖溢故鲜，得寒则凝泣故瘀。这是戴氏学说的本意。）
赤白（血痢）：凡是痢疾都是由营卫不足，肠胃虚弱，冷热之气，乘虚侵入肠间，虚则泄，所以为痢。然而痢疾赤白相杂的，是热乘于血，血渗入肠内则赤。冷气入肠，搏结肠间津液凝滞则白。冷热相交，所以赤白相杂。重的像脓涕而混杂血液。轻的白脓上有赤脉薄血，状如脂脑，世人称之为鱼脑痢。（出自《诸病源候论》）
血痢，是热毒折于血，进入大肠的缘故。血随气循环经络，通行脏腑，常无停积。毒热气乘之，遇到肠虚的，血渗入于肠，肠虚则泄，所以为血痢。身体发热的会死，身体寒的能活。诊察其关上脉芤大，便去血，暴下血数升。（同上）
以赤为热，以白为冷，是医者的言辞，万口一说，我认为这是古人谈论的，未曾有卓越的论断。为什么呢？以赤为热，以白为冷，赤白为冷热不和，只知道大纲，而痢疾有变化轻重之别，得其粗而不得其详，知其一不知其二罢了。（出自史载之《史载之方》）
下痢赤白，俗言寒热相兼，这种说法也是错误的。哪里知道水火阴阳寒热，如同权衡一样，一高则必一下，一盛则必一衰，岂能寒热俱甚于肠胃而同为痢呢？大法下迫窘痛，后重里急，小便赤涩，都属于燥热，而下痢白色的很多，然而为热是明确的。（出自刘完素《原病式》）
湿热瘀积，干扰血分则赤，干扰气分则白，赤白兼下，气血都受邪了。久而不愈，气弱不运，脾积不磨，陈积脱滑，下凝犹如鱼脑。甚至肠胃空虚，关司失守，浊液并流，颜色不是一类，错杂混下，注出状如豆汁。如果脾气下陷，虚坐努责，便出色如白脓。其热伤血深，湿毒相瘀，粘结紫色，则紫黑了。其污浊积而欲出，气滞而不与之出，所以下迫窘痛，后重里急，至厕所而不能便，总行频繁并亦少，乍止乍起而不安，这都是大肠经有所壅遏窒碍，气液不得宣通缘故。（薛氏《平治会萃·附论》）
大人小儿泄痢不已，其后变作白脓点滴而下，或者在粪尾见到，为之温脾不愈，法当温肾。因为肾主骨髓，白脓是骨髓的异名。总之开始作白痢，其气臭；已经转下，而且淹延日久，无所谓痢了。现在的白脓全无臭，面色微黑，骨力羸弱，的确见到肾虚，合用炒故纸、当归、木香、干姜、官桂主治。（出自《直指方》）
所下之物：肠垢，是肠间津汁垢腻。由热痢蕴积，肠间虚滑，所以因下痢而便肠垢。（出自《诸病源候论》）
也有不及成肿，而五脏伤败，水血并下，而五脏五色随之而出，叫做五液俱下。凡是这样的多死。（同上）（按：《辨脉法》说：阴阳俱厥，脾气孤弱，五液注下。这是巢氏的本意。《医宗金鉴》说：五色痢是五色脓血相杂而下。如果有脏腐尸臭之气，则凶。）
凡是腹中积聚的辨别，乃是以饮食之滞，留蓄于中，或者结聚成块，或者胀满硬痛，不化不行，有所阻隔的，才称为积，这些都是渣粕成形之物，应当驱逐。今人不能辨察，只见痢如脓垢的都称为积，不知道这不是渣粕之物，而是附着肠脏的脂膏，都是精血之物。无论瘦人肥人都有此脂，但肥者脂浓，瘦者脂薄，没有无脂的。如果果无脂，则肠脏之间，岂容单薄赤露，不仅藩篱不固，而且脏必易伤，没有这个道理。现在的凡患泻痢的，正是由于五内受伤，脂膏不固，所以日剥而下。如果其脏气稍强，则随去随生，还无足虑。如果脏气至败，剥削至尽，或者以久泻久痢，只见血水及如屋漏水的，这在庸人看来，说其积聚已无，反而称为善，而不知道脂膏刮尽，则是败竭极危的征候。假使今后医家，只识此为脂膏而本非积聚，则安之固之尚且来不及，还敢说攻之逐之或用苦寒以滑之利之的吗？（出自张景岳《景岳全书》）
凡是五色的辨别，如下痢脓垢之类，无非血气所化。但白色的来得浅，是浮近的脂膏。红色的来得深，由脂膏而切肤络。下纯血的，多以血为热迫，所以随溢随下，这是最深的。如果紫红紫白的，则离位梢久，其下不速而色因以变，或者未及脉络，这是稍浅的。如果红白相兼的，这是又深浅皆及的。大都纯血鲜红的多热证，以火性急速，迫而下也。紫红紫白的少热证，以阴凝血败，损而然也。纯白的无热证，以脏寒气薄，滑而然也。然而有无红而也因热的，这是以暴注之类，而非下痢之谓。有以紫红虽多而不可言热的，这是以阴络受伤，而非暴注之比。如果辨别黄黑二色，则凡黄深而秽臭的，此有热证，也有寒证。如果浅黄色淡不甚臭而或兼腥馊气的，这就是不化之类，皆寒证。黑而浓浓大臭的，这是焦色，多有火证。如果青黑而腥薄的，这是肝肾腐败之色，还以为是热，其谬误很严重了。虽然五色的辨别大约如此，然而痢疾见血的，无非阴络受伤，即使或寒或热，但伤络脉则无不见血，所以不可以见血的必认为热。凡临此证，当必以脉色形气病因兼而察之，才不至于有疑似之误。（同上）
色黑有两种：焦黑的，是热极反兼胜己之化（芍药汤）；黑如漆光的，是瘀血（桃仁承气汤）。（出自《必读》）
豆汁色的，是湿胜。纯血的，是热毒入深。鱼脑色的，是脾虚不运，陈积脱滑下凝。如鼻涕冻胶的，是脏腑虚冷滑脱。如白脓的，是虚坐努责而出，气受热邪瘀结。如屋漏水尘腐色的，是元气惫弱之甚。（出自《指掌》）（按：前证治总例及后死证，宜互参。）
经文说：肠澼下血，身热则死。谓余血下泄，阳热外浮。阴阳离脱。如果痢后下血水，其身发热，也为死证。痢后则肠垢已竭，下血水乃从阳入阴，胞中并伤。世有下屋漏水的说法，则血水是其渐近。如果色如鱼脑，这是热毒入肠，当清热和血。色如酱褐，乃下焦虚寒，也不是善证，当温经散寒。如白沫冻汁，则为寒积。（出自《医学真传》）
发热：初痢身热脉浮的，可解表；初痢身热脉沉的，可攻下。久痢身热脉虚的，正虚可治；久痢身热脉大的，邪盛难医。（出自《汇补》）
下痢不止发热者属阴虚，用寒凉药必兼升药、热药。（出自朱丹溪《丹溪心法》）
腹痛：凡是泻痢腹痛，有实热的，有虚寒的。实热的，或因食积，或因火邪。但食积之痛，必多胀满坚硬，或者痛而拒按，这必有所停滞，轻微的宜行其滞，严重的宜泻而逐之。火邪之痛，必有内热等证，方宜清之利之。然而邪实于中者必多气逆，所以凡治痛之法，无论是火是实，皆当以行气为先，但当察药性之寒热，择而用之可也。若虚寒刮痛之义，则人
Dysentery presenting with the discharge of five-colored pus and blood, thick and sticky in consistency, with uncontrolled slipping and leakage, accompanied by fever, restlessness, and thirst, urgent pain below the navel, worsening at night, aversion to food, or the passage of bright red blood, belongs to Yin deficiency. Urgent treatment should focus on rescuing heat and preserving Yin. Formulas such as Zhuche Wan (Parked Pill), Ejiao Wan (Donkey-hide Gelatin Pill), Guilian Wan (Angelica and Coptis Pill), Ejiao Meilian Wan (Donkey-hide Gelatin, Plum, and Coptis Pill), Qianjin Huanglian Tang (Thousand-Gold Coptis Decoction), Huanglian Ejiao Tang (Coptis and Donkey-hide Gelatin Decoction), and Baitouweng Jia Gancao Ejiao Tang (Baitouweng Decoction with Added Licorice and Donkey-hide Gelatin) may be selected for use. (From *Yitong*)
The method of treatment: if careful measures are taken at the beginning, recovery is easy; if diuretic methods are mistakenly used, it becomes difficult to treat. If misdiagnosis leads to the transmission of pathogens to the zang-organs, death is inevitable; similarly, mistaking an external contraction for an internal injury also leads to death. (From *Zhengzhi Baiwen*)
Generally, for initial dysentery: if there is fever and aversion to cold, Xiangsu San (Fragrant Perilla Powder) added with Fangfeng (Saposhnikovia Root) and Chuanxiong (Ligusticum Rhizome) to induce slight sweating will lead to cure. For severe cases, Guizhi Tang (Cinnamon Twig Decoction) or Danggui Sini Tang (Angelica Decoction for Cold Extremities) should be used. If there is alternating chills and fever with frequent vomiting, Xiaochaihu Tang (Minor Bupleurum Decoction) is required. 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, along with tenesmus, Gegen Qinlian Huanglian Gancao Tang (Kudzu, Scutellaria, Coptis, and Licorice Decoction) should be used. Following ancient methods, Gegen (Kudzu Root) must be decocted first, followed by other herbs. Taking two to three doses daily will ensure recovery. (From *Shifang Miaoyong*)
Medical texts state: Dysentery with pure blood indicates death; dysentery resembling water leaking from a roof indicates death. However, according to treatment methods, one merely uses herbs like Ejiao (Donkey-hide Gelatin), Diyu (Sanguisorba Root), Huaihua (Sophora Flower), and Cangzhu (Atractylodes Rhizome). How can these save a fatal condition? If there is profuse bright red blood, thirst, short urine, tenesmus, and a full, forceful pulse, this is a Fire syndrome. Baitouweng Tang (Baitouweng Decoction) should be administered twice daily. For deficient individuals or postpartum women, add Ejiao and Gancao (Licorice Root). There are also cases of bright red blood that are not due to Fire. If the blood is dark and clotted, it is rarely Heat but mostly Cold. One must carefully distinguish based on pulse and symptoms. If the mouth feels neutral, the pulse is fine, urine is long, and hands and feet are cold, it is undoubtedly Deficient-Cold. Lizhong Tang (Regulate the Middle Decoction) with 8 qian of Zaoxintu (Caolan Hearth Earth) is indicated. For heavy bleeding, intersperse with Huangtu Tang (Yellow Earth Decoction), twice daily, improving over three days. The spleen and stomach are like a furnace for refining gold; Lizhong Tang separates clear from turbid, treating the root cause. "Water leaking from a roof" refers to dark, stagnant, non-viscous blood-water, caused by mistakenly using cold-purgative drugs for a Deficient-Cold syndrome. If throat pain and disordered speech occur, death follows within half a day; Lizhong Tang can still be used to rescue. (Ibid.)
Differentiation of Excess and Deficiency: An Excess pattern is identified by strong physique and qi, slippery and solid pulses, or a history of indulgence in food and drink, frequent bloating and hard pain, young age with recent onset, and undamaged spleen qi. Only then can symptomatic treatment be applied: mild cases require moving and draining, severe cases require purging. A Deficiency pattern is identified by weak physique, blue-white complexion, tight/rapid pulses that are weak and spiritless, true wiry pulses with central deficiency mimicking excess, innate yang deficiency, bland diet habits, accidental exposure to raw/cold foods, accidental exposure to rain/cold, accidental dietary irregularity, or old age with weak spleen. In all these cases, where sudden diarrhea/dysentery occurs without prior indulgence, it is due to melons, fruits, or slightly cool food accidentally injuring stomach qi. Where is the accumulation? Where is the heat? Generally, only those with weak spleens have this syndrome. Therefore, treatment should only warm and regulate the spleen and kidney. Warming the spleen dispels cold, which is how evil is expelled. (From Zhang Jingyue's *Jingyue Quanshu*)
Regarding the belief that red indicates Heat and white indicates Cold, this is not an absolute truth. If so, mixed red-and-white dysentery would imply simultaneous Cold and Heat diseases. One must differentiate based on manifestations, color, and pulse to avoid confusion. Know that Cold implies Deficiency, and Heat implies Excess. Further detailed analysis of Excess and Deficiency clarifies Cold and Heat. Bloating, aversion to food, urgent pain fearing pressure indicates Excess. Restlessness, thirst, preference for cold and fear of heat indicates Heat. Strong and solid pulse indicates Excess. Rapid and slippery pulse indicates Heat. Everything else is likely Deficient-Cold, requiring careful examination of similarities. For example, taking thirst as Excess-Heat seems plausible; however, all diarrhea/dysentery consumes body fluids. Fluid loss below leads to dryness above, causing thirst. Differentiate by preference for hot vs. cold drinks. Taking abdominal pain as Excess-Heat seems plausible; however, dysentery injures organs and intestines, peeling skin with pus and blood causes pain. Differentiate by pain severity, response to pressure, yin/yang of organs, abdominal distension, and pulse strength. Taking yellow/red/scanty urine as Excess-Heat seems plausible; however, water loss via dysentery leads to short urine, and fluid loss changes urine color. Differentiate by heat of stool, presence of fluid dryness, and luster of color. Taking tenesmus as Excess-Heat seems plausible; however, qi sinking prevents storage, yin loss prevents closure. Differentiate by disease duration, constitution strength, and pulse vigor. (From *Bidu*)
Excess and Deficiency must be distinguished. Abdominal pain refusing pressure is Excess; preferring pressure is Deficiency. Thick, sticky pus and blood with frequent trips to the toilet unable to pass stool is Excess; involuntary leakage before wiping is Deficiency. Tenesmus before purgation is Excess; tenesmus persisting after purgation is Deficiency. In Excess tenesmus, stool output reduces slightly (called pre-stool heaviness), then heaviness returns (pathogen remains); in Deficient slipping tenesmus, stool output increases heaviness (called post-stool heaviness), then relaxes slightly later (qi rises). All symptoms in dysentery, such as restlessness, thirst, dry throat, black tongue, swelling, etc., have Excess and Deficiency distinctions; do not generalize as Excess, but differentiate carefully. (From *Yi Que*)
Cold and Heat differentiation: Cold dysentery arises from weak intestines and stomach receiving cold pathogen; intestinal deficiency leads to diarrhea, hence Cold Dysentery. Green, white, or black stool colors indicate Cold Dysentery; yellow or red indicate Heat. White stool with undigested food is called Cold Center. Pulse diagnosis: deep pulse indicates survival, floating pulse indicates death. (From *Zhubing Yuanhou Lun*) [Note: Pulse prognosis is from classic texts.]
Chronic Cold Dysentery arises from intestinal deficiency and cold accumulation, leading to persistent cold dysentery. Lin Qiu Gong stated: All lower dysentery is Cold. Normally, bowel movements are duck-dung-like in Cold, and mushy in Heat. People see fever with dysentery and assume Heat Dysentery, which is wrong. If one regulates diet and clothing, avoiding internal cold, bowels remain normal. Strong people who overexert, wear thin clothes, and consume cold drinks/food may have surface heat masking internal cold. Stomach cold causes diarrhea. Now presenting with fever and diarrhea, give Lizhong Tang with one Fuzi (Prepared Aconite Root), taken continuously for 3-4 doses, inducing slight sweating. Slight sweating removes heat, stops craving for cold, warms stomach qi, and cures both diarrhea and fever. Those with chronic cold often suffer when walking on wet/frozen ground or wearing thin clothes. Wind Dysentery is worst: wind blowing on waist/abdomen driving cold inward causing sudden diarrhea is difficult to treat. (Ibid.)
Heat Dysentery syndrome arises from weak intestines and stomach, with wind pathogen carrying heat invading; intestinal deficiency leads to diarrhea, hence Heat Dysentery. Color is yellow; if heat is severe, yellow turns red. (Ibid.)
Lin Qianshi (Jijiu) said: Liu Congzhou, a physician from Shaozhou, was effective and insightful. He stated: For dysentery, regardless of red or white, determine Cold or Heat. If hands and feet are warm, it is Yang; first give Wuling San (Five-Ingredient Poria Powder) mixed with millet drink, then take 20 pills of Yinggan Wan (Miraculous Response Pill) for cure. If hands and feet are cold, it is Yin; take warming medicines like Yihan Yuan or Fuzi. This method is always effective. I have used it successfully. A patient in summer had dysentery 60-70 times a day; two doses of Wuling San stopped it immediately. (From *Baiyi Xuanfang*) [Note: This treatment is dubious, retained for reference.]
Abdominal pain with tenesmus, scanty urine, thirst for cold drinks, dry constipated large intestine indicates Dysentery with Heat. Abdominal pain without thirst, preference for hot drinks, clear long urine, no fever, abdomen preferring warmth indicates Dysentery with Cold. (From *Yi Guan*) [Comment: Dysentery differs from Cold Damage; some cases are Fire despite no thirst, clear urine, etc. Do not rely solely on this.]
Differentiating Cold and Heat in diarrhea/dysentery: True Heat involves fear of heat, preference for cold, desire to uncover, severe thirst drinking much, red/painful urine, or pure bright red bloody stool, slippery/solid/forceful pulse, restless/agitated qi. Without these Excess-Heat signs, persistent diarrhea/dysentery is Deficient-Cold. (From Zhang Jingyue)
Cold/Heat symptoms depend not on stool color (red can be Cold, white can be Heat), but on stool thickness/thinness and hand/foot temperature. Limbs are the root of Yang; Yang deficiency means body may be warm but hands/feet cold, umbilicus cold, no thirst (or thirst after long diarrhea), no appetite, quiet lying down, free urination, borborygmus, abdominal pain, thin watery stool, frequent inability to pass stool, blood water, or black blood, deep/slow/fine/small pulse = Yin/Cold. Heat conquers Cold, balancing Yin/Yang. Yang excess means high fever, warm hands/feet, hot umbilicus, dry retching, thirst, high fever, pus/blood, purple blood, floating/huge/solid/rapid pulse = Yang/Heat. Cold conquers Heat, harmonizing Yin/Yang. (From *Huijie*)
If blood is dark like stasis and increases with cold-cooling meds, treat as Cold Dysentery. Use Lizhong Tang, or Sijunzi Tang (Four Gentlemen Decoction) with Rou Doukou (Nutmeg) and Muxiang (Aucklandia Root). (From *Yaojue*) [Note: *Yitong* says purple-dark blood worsening with cold meds is Cold Dysentery. Blood like pig liver, purple grass, or amaranth juice requires Paojiang (Prepared Ginger). *Sanyin Fang* says blood is fresh when heated, clotted when cooled. Dai’s theory follows this.]
Red and White (Blood Dysentery): All dysentery stems from insufficient Ying and Wei, weak intestines/stomach, allowing Cold/Heat pathogens to invade empty intestines, causing deficiency diarrhea. Red-white mix: Heat affects blood, seeping into intestines causes red. Cold air enters intestines, condensing fluids causes white. Cold/Heat interact, mixing red and white. Severe cases resemble pus and blood. Mild cases show red veins on white pus, resembling brain fat, called Fish Brain Dysentery. (From *Zhubing Yuanhou Lun*)
Blood Dysentery: Heat toxin affects blood, entering the large intestine. Blood circulates via meridians/organs without stagnation. Heat toxin invades weak intestines, blood seeps in, causing diarrhea. Fever indicates death; cold body indicates survival. Guan pulse hollow/large with sudden massive blood loss. (Ibid.)
"Red is Heat, White is Cold" is a common medical cliché, lacking profound insight. It knows the general rule but misses variations and severity. Knowing one aspect but not the other is incomplete. (From Shi Zaizhi's *Shi Zaizhi Fang*)
"Red and white mix implies Cold-Heat combination" is erroneous. Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; one rises, the other falls. They cannot both be excessive in intestines simultaneously. Generally, urgency, pain, tenesmus, red/scanty urine belong to Dryness-Heat. Yet white dysentery is common, proving Heat is the primary factor. (From Liu Wansu's *Yuanbing Shi*)
Damp-Heat stasis affecting Blood branch causes red; affecting Qi branch causes white. Mixed red/white means both Qi and Blood are affected. Chronic cases with weak Qi, poor spleen transport, and accumulated waste slipping out resemble fish brain. Severe cases involve empty intestines, failing sphincters, mixing turbid fluids of various colors like bean curd dregs. Spleen qi sinking with false straining produces white pus-like stool. Deep heat injuring blood with damp-toxin stasis creates purple/black clots. Accumulated filth trying to exit but blocked by Qi stagnation causes urgency, tenesmus, inability to pass stool, frequent small amounts, restlessness. This is due to Large Intestine meridian obstruction preventing Qi/fluid circulation. (From Xue’s *Pingzhi Huicui*)
Adults/children with endless diarrhea/dysentery developing dripping white pus, or seen at fecal tail, if warming Spleen fails, warm Kidney is needed. Kidney governs marrow; white pus is a synonym for marrow. Initially, white dysentery has odor; chronic cases lose odor. Current white pus is odorless, face slightly black, weak bones/knees, indicating Kidney Deficiency. Use Chao Guye (Fried Psoralea Fruit), Danggui (Angelica Sinensis), Muxiang (Aucklandia), Ganjiang (Dried Ginger), Guirou (Cinnamon Bark). (From *Zhizhi Fang*)
Discharged matter: Changgou (Intestinal Mucus) is greasy intestinal fluid. Caused by Heat Dysentery accumulation and intestinal deficiency/slippage, leading to mucus discharge. (From *Zhubing Yuanhou Lun*)
Severe cases may lack swelling but have damaged five zang-organs, with water and blood discharging together, accompanied by five zang colors, called "Five Fluids Discharge." Most die. (Ibid.) [Note: *Bimai Fa* says Yin/Yang collapse, weak spleen qi, five fluids discharge. *Yizong Jinjian* says Five-Color Dysentery is mixed pus/blood. Putrid smell indicates凶 (ominous).]
Differentiation of abdominal accumulations: Food stagnation retained internally forms masses, bloating, hard pain, indigestion, blockage—this is Accumulation (Ji), consisting of formed waste, requiring expulsion. Moderns mistake dysentery mucus for Accumulation. This is not waste, but fat/grease adhering to intestines/organs, part of essence/blood. Everyone has this fat; thick in obese, thin in lean. Without it, organs would be exposed and injured. Dysentery damages internal organs, causing fat/grease to slough off daily. If organ qi is strong, it regenerates. If organ qi fails and exhaustion is complete, seeing blood/water or "roof leak" indicates extreme danger. Laypeople think "accumulation is gone," but fat/grease depletion is critical. Physicians should recognize this as fat, not accumulation, and secure/nourish rather than purge or use bitter-cold draining herbs. (From Zhang Jingyue)
Differentiation of Five Colors: Pus/mucus is transformed from Qi/Blood. White is superficial (floating fat); Red is deep (fat reaching skin vessels). Pure blood is deepest, forced by Heat. Purple-red/white is slightly shallower, delayed exit changes color. Red-white mix covers both depths. Pure bright red blood is mostly Heat (Fire moves fast). Purple-red/white has less Heat (Yin coagulation/destruction). Pure white has no Heat (Organ Cold/thin Qi, slipping). No red but Heat exists in acute watery diarrhea, not typical dysentery. Purple-red abundance isn't always Heat (Yin vessel injury). Yellow/Black differentiation: Deep yellow/foul odor = Heat or Cold. Pale yellow/light odor/rancid smell = Indigestion/Cold. Dark black/heavy foul odor = Scorched color, mostly Fire. Blue-black/thin rancid = Liver/Kidney corruption, mistaken for Heat is error. Although five-color differentiation is generally as above, blood in dysentery implies Yin vessel injury. Whether Cold or Heat, vessel injury causes blood. Do not assume blood equals Heat. Observe pulse, color, physique, etiology comprehensively to avoid error. (Ibid.)
Two types of Black: Scorched black = Extreme Heat mimicking controlling element (Shaoyao Tang); Black like lacquer = Blood stasis (Taoren Chengqi Tang). (From *Bidu*)
Bean curd dregs color = Dampness excess. Pure blood = Heat toxin deep. Fish brain color = Spleen deficiency, poor transport, accumulated waste slipping. Mucus jelly color = Organ/Stomach Cold, slipping. White pus = False straining, Qi constrained by Heat toxin. Roof leak/dusty color = Extreme Yuan Qi exhaustion. (From *Zhizhang*) [Note: Cross-reference general treatment principles and fatal signs.]
Classic says: Intestinal dysentery with blood, fever indicates death. Residual blood drains, Yang heat floats outward, Yin/Yang separation. Dysentery followed by blood water with fever is also fatal. After dysentery, intestinal mucus is exhausted; blood water comes from Yang entering Yin, damaging uterus/bladder. "Roof leak" is the progression. Color like fish brain = Heat toxin in intestines, clear Heat and harmonize Blood. Color like soy sauce brown = Lower Jiao Deficient-Cold, not auspicious, warm meridians and dispel Cold. White foam/frozen juice = Cold accumulation. (From *Yixue Zhenchuan*)
Fever: Initial dysentery with fever and floating pulse = release exterior. Initial dysentery with fever and deep pulse = purge interior. Chronic dysentery with fever and deficient pulse = correct deficiency, treatable. Chronic dysentery with fever and large pulse = pathogen excess, difficult to treat. (From *Huibu*)
Persistent dysentery with fever belongs to Yin deficiency; cold-cooling meds must include lifting and warming agents. (From Zhu Danxi)
Abdominal Pain: Dysentery abdominal pain can be Excess-Heat or Deficient-Cold. Excess-Heat: due to food stagnation or Fire pathogen. Food stagnation pain involves bloating, hardness, refusal to pressure, indicating stagnation. Mild: move stagnation; Severe: purge. Fire pathogen pain involves internal heat signs; clear and drain. Pathogenic excess in middle causes Qi rebellion. Thus, treating pain, whether Fire or Excess, prioritize moving Qi. Select herbs based on Cold/Heat nature. As for Deficient-Cold scraping pain...