陈无择云古方风停肤腠下瘀血或下鲜血湿毒下如豆羹汁皆外所因之明文也古方有五泄因
脏气
郁结随其所发使利脓血作青黄赤白黑色一一不同即内所因也又饮食冷热酒醴醯醢纵情恣欲房
室致伤精血肠胃粘溢久积冷热遂成毒痢皆不内外因治之先推其岁运以平其外察其郁结以调其
内审其所伤以治不内外条然明白不致妄投也
按此所分三因治法其理甚当但外因六淫所伤者古方用药则多有之内因脏气郁结与夫饮食
房劳
而得者诸方则未之见也凡三因所伤皆能干犯肠胃而为痢今陈无择立论有三因之分而用药无三
因之别此又所当分而治者失于开示焉
大全良方云有一方一家之内上下传染长幼相似是疫毒痢也治法虽当察运气之相胜亦不可
狎泥当先察其虚实冷热首用败毒散加人参甘草陈皮随证用之
按时疫作痢岁常有之其谓当察其运气之相胜与病冷热虚实之不同诚为确论盖欲学人知五
运六
气有太过不及胜负之不同以分风寒暑湿燥火为病而平治之也然首专用败毒散之义何其自狎泥
也
陈无择云饮服冷热酒醴醯醢肠胃粘溢久积冷热遂成毒痢
严用和云或有饮服冷酒寒物房室劳伤精血而成久毒痢则宜化毒以保卫之
按人之饮食过伤恣食辛热寒冷之物皆能致伤肠胃肠胃一伤不能运化传送遂蓄积停滞而为
痢经
日饮食不节起居不时者阴受之阴受之则入五脏 满闭塞下为飧泄久为肠 是也治法当先消化
食毒或可攻伐然后随寒热温凉以调之此二论本诸内经而世所未言者也
陈无择说：古方中记载，风邪停滞在皮肤腠理之下，导致瘀血或下鲜血；湿毒下注，排泄物像豆羹汁一样，这些都是外因致病的明确论述。古方中有“五泄”的说法，是因为脏气郁结，随着病情的发作，出现利下脓血，颜色有青、黄、赤、白、黑等不同，这就是内因致病。又有因为饮食冷热不当、饮酒过度、食用醋和肉酱，以及纵情声色、房事不节导致精血受损，肠胃粘腻溢出，长期积累冷热之邪，最终形成毒痢，这些都属于不内外因。治疗时，先推究当年的岁运（五运六气的变化）以平复外邪，观察脏气的郁结以调理内部，审察所伤之处以治疗不内外因，这样条理清晰明白，就不会盲目用药了。
按语：陈无择所划分的三因治法，其理论非常恰当。但是，对于外因受六淫（风、寒、暑、湿、燥、火）伤害的，古方用药多有涉及；而对于内因脏气郁结以及因饮食、房劳而得病的，诸方则很少见到。凡是三因所伤，都会侵犯肠胃而导致痢疾。现在陈无择立论有三因之分，但用药却没有三因的区别，这也是应当分别治疗却失于开示的地方。
《大全良方》说：有一方一家的上下相互传染，长幼症状相似，这是疫毒痢。治疗方法虽然应当考察运气相胜的关系，也不可以拘泥不变。应当先考察其虚实冷热，首先使用败毒散加人参、甘草、陈皮，根据证候随症加减使用。
按语：当时疫引起痢疾，每年都有发生。所谓应当考察运气相胜与疾病冷热虚实之不同，确实是确切的论述。大概是想让学习者知道五运六气有过盛、不及、胜负的不同，从而区分风寒暑湿燥火致病并平和地治疗它。然而，首要专门使用败毒散的意义何在？这岂不是自己拘泥不变了吗？
陈无择说：饮用过冷或过热的酒、甜酒、醋和肉酱，导致肠胃粘腻溢出，长期积累冷热之邪，最终形成毒痢。
严用和说：有人因为饮用冷酒、吃寒凉食物、房事劳损精血而成为久毒痢，则应该用化解毒邪的方法来保卫正气。
按语：人的饮食如果过度损伤，恣意食用辛辣、热性、寒冷之物，都能导致肠胃受伤。肠胃一旦受伤，不能运化传送，于是蓄积停滞而形成痢疾。《内经》说：“经日饮食不节，起居不时者，阴受之。阴受之则入五脏。满闭塞，下为飧泄，久为肠澼。”说的就是这种情况。治疗方法应当先消化食毒，或者可以用攻伐之法，然后随寒热温凉来调理。这两种论述本源于《内经》，但在世间尚未被广泛言及。
Chen Wuyue stated: In ancient prescriptions, it is recorded that wind pathogens stagnate beneath the skin and interstices (the spaces between skin and muscles), causing blood stasis or the passage of fresh blood; damp-toxins descend, with excrement resembling bean soup juice. These are clear descriptions of diseases caused by external factors. Ancient texts mention "Five Diarrheas," which arise from the stagnation of Zang-organ Qi. Depending on where the pathology manifests, there may be diarrhea with pus and blood, varying in color to green, yellow, red, white, or black; this constitutes disease caused by internal factors. Additionally, improper dietary temperature, excessive consumption of wine and sweet beverages, intake of vinegar and fermented meats, indulgence in sexual desires, and excessive intercourse leading to damage of essence and blood can cause the intestines and stomach to become sticky and overflow. Long-term accumulation of cold and heat pathogens eventually results in toxic dysentery; these belong to the category of neither internal nor external causes. In treatment, one must first deduce the annual cosmic movements (Wu Yun Liu Qi) to pacify external pathogens, observe organ Qi stagnation to regulate the interior, and examine the specific injuries to treat neither-internal-nor-external causes. This approach is logical and clear, preventing blind medication.
Commentary: The three-etiology treatment method proposed by Chen Wuyue is theoretically sound. However, while ancient prescriptions frequently address injuries caused by the six external climatic pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire), they rarely provide specific formulas for conditions arising from internal Zang-organ stagnation or those caused by diet and sexual fatigue. Since all three etiologies invade the intestines and stomach to cause dysentery, Chen’s theoretical distinction of three etiologies lacks corresponding differentiation in pharmacological application. This is an area where separate treatments should have been elucidated but were omitted.
*Daquan Liangfang* states: When a household experiences mutual transmission among members, with symptoms similar across ages, this is epidemic toxic dysentery. Although treatment should consider the interaction of cosmic movements, one must not adhere rigidly to them. One must first assess deficiency/excess and cold/heat patterns. Initially, use Baidu San (Detoxification Powder) supplemented with Renshen (Ginseng Root), Gancao (Licorice Root), and Chenpi (Aged Tangerine Peel), adjusting according to specific syndromes.
Commentary: Epidemic dysentery occurs annually. It is indeed correct to assert that one must consider the superiority/inferiority of cosmic movements and the variations in cold/heat and deficiency/excess of the disease. The intent is likely to teach practitioners that Wu Yun Liu Qi exhibits excess, deficiency, and competitive dynamics, allowing for the differentiation of Wind, Cold, Summerheat, Dampness, Dryness, and Fire pathologies for balanced treatment. However, why insist primarily on Baidu San? Is this not a form of rigid adherence?
Chen Wuyue stated: Consuming excessively hot or cold wine, sweet beverages, vinegar, and fermented meats causes intestinal and gastric stickiness and overflow. Long-term accumulation of cold and heat leads to toxic dysentery.
Yan Yonghe stated: Some individuals develop chronic toxic dysentery due to drinking cold wine, consuming cold foods, or sexual fatigue damaging essence and blood. In such cases, one should employ methods to resolve toxins and protect healthy Qi.
Commentary: Excessive dietary injury, particularly the indiscriminate consumption of pungent, hot, or cold substances, damages the intestines and stomach. Once injured, their ability to transform and transport nutrients fails, leading to accumulation and stagnation, resulting in dysentery. The *Neijing* states: "Irregular diet and untimely rest injure the Yin. Injury to Yin enters the Five Zang organs. Fullness and obstruction result in loose stools (Sunxie); prolonged, it becomes Changpi (intestinal disorder with discharge)." This describes the condition. Treatment should first focus on digesting food toxicity or using purgative methods, followed by regulation based on cold, heat, warmth, or coolness. These two theories originate from the *Neijing* but have not been widely discussed in later times.