赤白之痢，世人莫不曰赤为阳为热，白为阴为冷。或曰无积不成痢。至于调治，若
以冷热之剂互进，或投去积之药，必难取效。不究其原，何由可疗？且四时八风之中人，五
运六气之相胜，夏秋人多痢疾。《内经》曰∶春伤于风，夏生飧泄。至真要大论曰∶少阳
在泉，火湿所胜，民病注泄赤白，其可拘于无积不成痢之说。若专以积为论，岂一岁之
中，独于夏秋人皆有积，春冬不然，盖风邪入胃，木能胜土，不为暴下，则成痢疾，赤
白交杂，此为阴阳不分。法当分正阴阳，五苓散以导其逆，理中汤以温其胃，使色归一，
然后施治。若一分之后，仍赤白同下，则当究其所患之因。若先白后赤，乃内伤生冷，外
失于盖，由元气感于暑热。治法先救其里，次解暑毒。若先赤后白，乃先伤热而后失盖感
冷，先宜解热，后治其痢。有夹热而痢者，则下纯鲜血，此风能动血，宜冷服黄连香薷散、
川草散，以当归散加醋炒蒸柏叶，水、姜煎服，或羌活散加三和汤，水、姜、仓米煎。有
人冷而痢者，则下纯白冻，或白上有粉红色，或似猪肝瘀血，皆为阴证。盖血得寒则凝泣
（音涩）故也，先用 咀五苓散加守中汤煎投，次以附子理中汤带凉服，或固真汤。倘不辨其
虚实冷热，妄行施治，必致脾胃愈虚，不能乳食，成噤口痢者，则难疗矣。又有里急后
重，盖里急为阳，后重为阴，未圊（音清，厕也）前腹痛为里急，已圊后腹痛为后重，故里急者，
大肠涩也。先以大顺饮加宽气饮和解及羌活散，水、姜、仓米煎服，次下宽肠丸。后重
者，为气虚，用 咀五苓散加人参，水、姜煎服，并投香连丸。若二证俱作，前二丸子
并进，或双金饮、金粟丸亦效。然泻痢二字，自是两证，粪夹水来，多而顺者曰泻；带血
冻白冻，来三五点而痛者曰痢。轻重阴阳，于此而分，斯为治法。有脓血交杂，经久不止，
昼轻夜重，或昼夜频数，食减痛多，并用万金散、神效散主之。有五色痢者，乃因五脏
蕴热，日久不散，故有是证，盖五脏受热，荣卫不调，五谷不化，熏腐脏腑，神气昏沉，此
候已危，最苦是腹中刺痛，儿小者无治法。盖五色者，乃五脏之色，皆见于外，儿大者，可
用《局方》三神丸，或小来复丹，以五苓散送下。或者可疗。若投药如故，不可为也。又
有风痢，多是黄褐色，与疳泻颇同，但不臭为异耳。此风毒停滞于脾，宜去脾经风毒，泻
黄散主之。若见赤白同下，久而不禁，小便涩少，痛热并作，唇裂眼赤，气促心烦，坐
卧不安，狂渴饮水，谷道倾陷，时复面容如妆，饮食不进者，难治。
赤白痢疾，世人无不认为红色属阳、属热，白色属阴、属寒。有人说“无积不成痢”。至于治疗调理，如果冷热药交替使用，或者投用去积的药物，必定难以见效。不探究其根本原因，如何能治愈？况且四季八风侵袭人体，五运六气相互克制，夏秋季节人们多患痢疾。《内经》说：“春季伤于风邪，夏季发生飧泄（完谷不化的腹泻）。”《素问·至真要大论》说：“少阳在泉之时，火湿之气偏胜，民众患病出现注泄赤白痢，这怎么能拘泥于‘无积不成痢’的说法呢？”如果专门以积滞来论述，难道一年之中，唯独夏秋季节人人都有积滞，而春冬季节没有吗？这是因为风邪侵入胃腑，木气克制土气，如果不表现为暴泻，就会形成痢疾，赤白混杂，这是阴阳不分。治法应当分辨正气的阴阳，用五苓散（利水渗湿方剂）来引导逆乱之气，用理中汤（温中祛寒方剂）来温暖胃腑，使大便颜色归于单一，然后再施以治疗。如果服药一分时间后，仍然赤白同下，就应当探究患病的起因。如果是先白后赤，乃是内伤生冷，外受风寒失于遮盖，导致元气感受暑热。治疗方法应先救里虚，其次解除暑毒。如果是先赤后白，乃是先伤热而后失于遮盖感受寒冷，先宜解热，后治痢疾。有夹热而痢者，则排出纯鲜血，这是风邪扰动血分所致，宜冷服黄连香薷散、川草散，或用当归散加醋炒蒸柏叶，用水、生姜煎服；或用羌活散加三和汤，用水、生姜、仓米煎服。有人因寒而痢者，则排出纯白冻状物，或白中有粉红色，或像猪肝瘀血，都属于阴证。因为血液得寒则凝涩（音涩），所以先用咀碎的五苓散加守中汤煎服，其次用附子理中汤（温阳健脾方剂）带凉服用，或用固真汤。倘若不辨别虚实冷热，妄行治疗，必定导致脾胃更加虚弱，不能乳食，形成噤口痢（痢疾重症，饮食不进），那就难治了。又有里急后重，其中里急属阳，后重属阴，未排便前腹痛为里急，已排便后腹痛为后重，所以里急者，是大肠涩滞。先用大顺饮加宽气饮和解，以及羌活散，用水、生姜、仓米煎服，其次服用宽肠丸。后重者，是气虚所致，用咀碎的五苓散加人参，用水、生姜煎服，并投用香连丸（清热燥湿、行气止痛方剂）。如果两种症状同时出现，前两种丸子并进，或用双金饮、金粟丸也有效。然而“泻”和“痢”二字，自然是两种病证，粪便夹杂水液，量多且顺畅的称为泻；带有血冻白冻，每次仅出三五点且疼痛的称为痢。轻重阴阳，由此区分，这才是治法。有脓血交杂，经久不止，白天轻晚上重，或昼夜频繁，食欲减退疼痛增多，均用万金散、神效散主治。有五颜六色痢疾者，是因为五脏蕴藏热邪，日久不散，所以有此证候，盖因五脏受热，营卫不调，五谷不化，熏腐脏腑，神气昏沉，此候已经危险，最痛苦的是腹中刺痛，幼儿较小者无治法。因为五色，乃五脏之色，皆见于外，幼儿较大者，可用《局方》三神丸，或小来复丹，用五苓散送下。或许可以疗愈。如果用药如故，不可救治了。又有风痢，多是黄褐色，与疳泻颇为相似，只是气味不臭作为区别。这是风毒停滞于脾经，宜去除脾经风毒，用泻黄散（清泻脾伏火方剂）主治。如果见赤白同下，久而不禁，小便涩少，痛热并作，嘴唇干裂眼睛红赤，气促心烦，坐卧不安，狂渴饮水，肛门坠陷，时常面容如妆（假性红润），饮食不进者，难治。
Dysentery with red and white stools: People generally believe that red indicates Yang and heat, while white indicates Yin and cold. Some say that "dysentery cannot occur without accumulation." Regarding treatment, if hot and cold remedies are administered alternately, or if drugs for removing accumulation are used, efficacy will likely be difficult to achieve. Without investigating the root cause, how can it be cured? Moreover, when the eight winds of the four seasons invade the human body, and the Five Movements and Six Qi interact in mutual overcoming, dysentery is common in summer and autumn. The *Neijing* states: "Wind injury in spring leads to undigested diarrhea in summer." The *Suwen: Zhi Zhen Yao Da Lun* states: "When Shaoyang governs the lower half of the year, fire and dampness prevail, causing the people to suffer from urgent diarrhea with red and white stools." How can one rigidly adhere to the theory that "no accumulation means no dysentery"? If one argues exclusively based on accumulation, does it mean that only in summer and autumn do people have accumulation, but not in spring and winter? This is because wind pathogens enter the Stomach, Wood (Liver) overcomes Earth (Spleen). If this does not result in violent watery diarrhea, it becomes dysentery. Red and white mixed together indicates a failure to distinguish Yin and Yang. The method should be to differentiate the Zheng (Righteous) Yin and Yang. Use Wuling San (Five-Ingredient Poria Decoction) to guide rebellious Qi, and Lizhong Tang (Regulate the Middle Decoction) to warm the Stomach, so that the stool color returns to uniformity before further treatment. If after one dose, red and white still pass together, one must investigate the cause. If white appears first followed by red, it is due to internal injury from raw/cold food and external exposure to cold due to lack of covering, leading to Yuan Qi being affected by summer heat. The treatment should first rescue the interior, then resolve summer toxicity. If red appears first followed by white, it is due to initial heat injury followed by cold exposure from lack of covering. One should first resolve heat, then treat the dysentery. In cases complicated by heat, pure bright blood is passed; this is wind moving blood. It is appropriate to take Huanglian Xiangru San (Coptis and Mosla Decoction) and Chuancao San (Chuanxiong and Licorice Powder) cold. Alternatively, use Danggui San (Angelica Decoction) added with vinegar-fried steamed Coptis leaf (Baiye), decocted with water and ginger. Or use Qianghuo San (Notopterygium Decoction) added with Sanhe Tang (Three-Harmony Decoction), decocted with water, ginger, and Cangmi (aged rice). In cases caused by cold, pure white mucus/frozen-like substance is passed, or white with pinkish tinge, or resembling pig liver blood stasis; these are all Yin syndromes. This is because blood coagulates and stagnates when exposed to cold. First, use Jucui Wuling San (Crushed Wuling San) added with Shouzhong Tang (Guard the Center Decoction) to drink. Next, take Fuzi Lizhong Tang (Aconite Regulate-Middle Decoction) taken cool, or Guzhen Tang (Solidify Truth Decoction). If deficiency/excess and cold/heat are not distinguished, and treatment is reckless, the Spleen and Stomach will become increasingly deficient, unable to digest milk and food, resulting in Jin Kou Li (Jin Kou Dysentery, where the patient refuses food/vomits upon seeing food), which is difficult to cure. There is also Tenesmus (Li Ji Hou Zhong). Li Ji (urgent desire to defecate with abdominal pain) is Yang; Hou Zhong (heavy sensation in the rectum) is Yin. Abdominal pain before defecation is Li Ji; abdominal pain after defecation is Hou Zhong. Thus, Li Ji indicates dryness/stagnation in the Large Intestine. First, use Dashun Yin added with Kuanqi Yin for harmonization, and Qianghuo San, decocted with water, ginger, and Cangmi, then administer Kuan Chang Wan (Widen Intestine Pill). Hou Zhong is due to Qi deficiency; use Jucui Wuling San added with Renshen (Ginseng), decocted with water and ginger, and administer Xianglian Wan (Cinnamon and Coptis Pill). If both conditions occur simultaneously, administer the two pills together, or Shuangjin Yin (Double Gold Drink) and Jin Su Wan (Golden Millet Pill) are also effective. However, "Xie" (Diarrhea) and "Li" (Dysentery) are naturally two different conditions. Stool mixed with water, coming in large amounts and smoothly, is called Xie; stool with blood and white mucus, coming in small amounts (three to five drops) with pain, is called Li. Severity and Yin/Yang differentiation are determined here, which constitutes the therapeutic method. If pus and blood are mixed, persisting for a long time, lighter during the day and heavier at night, or frequent day and night, with reduced appetite and increased pain, use Wanjing San (Ten-Thousand-Gold Powder) and Shenxiao San (Divine-Efficacy Powder) as main treatments. Dysentery with five colors arises because heat accumulates in the Five Zang organs and does not dissipate over time. Because the Five Zang are heated, Ying and Wei (Nutritive and Defensive Qi) are disordered, grains are not digested, viscera are corroded, and spirit/mind is dull. This condition is critical. The most painful symptom is stabbing abdominal pain. For young children, there is no treatment. The "five colors" refer to the colors of the Five Zang manifesting externally. For older children, Sanshen Wan (Three-God Pill) from *Ju Fang* (Formulas of the Bureau) or Xiaolaifu Dan (Small Return-to-Life Pill) can be used, delivered with Wuling San. This might be curable. If medication remains ineffective, it is incurable. There is also Feng Li (Wind Dysentery), mostly yellow-brown, similar to Gan Xie (Malnutrition Diarrhea), differing only in odor. This is wind-toxin stagnating in the Splei channel; one should remove wind-toxin from the Spleen, using Xiehuang San (Drain Yellow Decoction) as the main treatment. If red and white pass together, uncontrollably for a long time, urine is scanty and difficult, pain and heat occur together, lips are cracked, eyes are red, breathing is rapid, irritability occurs, restlessness in sitting and lying, extreme thirst for drinking water, prolapse of the anus, occasional flushed face like makeup, and inability to eat, these are difficult to treat.