典藏书目

*Yuan Bing Shi* (Treatise on the Original Causes of Disease) states: Someone asked, "Since white dysentery is a heat disease, why are there cases where administering acrid-hot medicines also result in recovery?" This is because acrid-hot medicines can open up stagnation and knotting in the stomach and intestines, allowing the qi and fluids to circulate freely, moisten dryness, and harmonize the dry qi. If the pathogen is mild, recovery is possible; however, if the condition is severe and the stagnation cannot be resolved, the disease will worsen, leading to death. The same principle applies to treating vomiting and diarrhea caused by extreme heat.

Generally, when treating various types of dysentery, it is best to use bitter, acrid, and cold medicines, or slightly add acrid-hot medicines as adjuvants. Acrid flavors can disperse and open stagnation; bitter flavors can dry dampness; cold properties can overcome heat. This allows the qi to circulate smoothly and peacefully. For example, Qian Yi's *Xianglian Wan* (Fragrant Coptis Pill) belongs to this category. Therefore, for treating various dysenteries, *Huanglian* (Coptidis Rhizoma) and *Huangbai* (Phellodendri Cortex) serve as sovereign drugs, as their extreme bitterness and great coldness directly address damp-heat conditions. As for the worldly practice of using acrid-hot mineral and metal toxic drugs to treat various vomiting, diarrhea, and dysentery, some may recover because these substances are good at opening stagnation. However, although some show efficacy, if they fail to work, they may cause further harm.

In analysis: Treating dysentery with bitter, acrid, and cold formulas encompasses three methods: resolving stagnation, drying dampness, and overcoming heat. It is indeed incorrect for physicians of the world to use acrid-hot mineral and metal toxic drugs. Nevertheless, for patients with chronic dysentery resulting in deficiency and slipping of the stomach and intestines, other treatment approaches should be sought.

Zi He said: For dysentery with pus and blood accompanied by unceasing abdominal pain, one may use *Tiaowei Chengqi Tang* (Regulate the Stomach Order Qi Decoction) added with ginger and jujube, decocted, followed by the administration of *Zangyong Wan* (Store Use Pill) to induce purgation. Thereafter, administer *Wuling San* (Five-Ingredient Powder with Poria) combined with *Yiyuan San* (Benefit Origin Powder) mixed with water. In another case, a male patient suffered from incessant diarrhea and dysentery, flowing like a pour, and dared not sit on cold surfaces. All physicians treated it as a cold syndrome, delaying care for twenty years. His pulses at both cun positions were slippery. I did not consider it a cold syndrome. What is considered 'cold' here is actually water retention. Thus, I used *Chatiao San* (Tea Regulation Powder) to induce emesis, expelling five to seven sheng of cold water, and then used *Wuyou San* (Carefree Powder) to drain accumulated water, resulting in dozens of bowel movements. This is the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong). Subsequently, bland diuretic formulas were used to benefit the water passages.

Analysis: Using emesis and purgation to treat dysentery originates from the *Neijing*'s (Classic of Internal Medicine) concept of "treating obstruction with unblocking agents." Can purgation be used for patients with deficient and slipping stomach and intestines? Can emesis be used for those with weak middle qi? When it is stated that purgation is applicable, it refers to cases where accumulation and stagnation block the stomach and intestines, preventing free flow. When it is stated that emesis is applicable, it refers to cases where phlegm-fluids reside above the diaphragm, preventing qi descent, thereby causing the large intestine to lose its ability to consolidate.

Danxi said: Accumulated dampness transforms into phlegm residing in the lungs, which predisposes to instability of the large intestine. Clearing the source ensures the flow becomes clear naturally. This embodies the correct meaning.

Danxi said: Regarding the syndrome of diarrhea and dysentery, *Ju Fang* (Formulas of the Bureau of Medical Relief) employs medicines such as *Zhongru Jianpi Wan* (Oyster Shell Spleen-Strengthening Pill), *Zhaozhen Dan*, *Helile Wan*, and *Da Wenpi Wan*. These primarily use hot medicines as sovereigns and astringent medicines as assistants. These prescriptions seem designed for cases of intestinal deficiency compounded by cold invasion leading to slipping. Do patients with diarrhea and dysentery lack heat syndromes? Do they lack accumulation and stagnation? The *Neijing* states: Dysentery with pus and blood mostly belongs to *Lixia* (Dysentery with tenesmus). The categories of diarrhea and dysentery are numerous. Ancient sages stated: "Excessive dampness leads to diarrhea," which is an accurate conclusion. However, cases complicated by wind pathogens certainly cannot be treated uniformly. Moreover, beyond wind and dampness, there are complex combinations of pathogenic factors, making it difficult to uniformly apply astringent and hot medicines. *Ju Fang* addresses syndromes including urgency (*lijí*), heaviness in the rectum (*houchong*), or both. Are these not *Lixia* (dysentery)? Now, equating diarrhea/dysentery with *Lixia* in treatment leads to the error of reinforcing excess and depleting deficiency (*Shi Shi Xu Xu*), a disaster that will not wait long. The Classics state: "Violent diarrhea and downward pressure belong to heat." Also: "Violent diarrhea belongs to fire." Also: "Clear and white dysentery belongs to cold." Two categories belong to fire/heat, one to water/cold. In the syndrome of diarrhea and dysentery, heat seems more common than cold. *Ju Fang* specializes in astringent and hot applications. If used for clear, white dysentery attributed to cold, it might be acceptable. However, what is called "downward pressure" refers to urgency and heaviness in the rectum. This pathology belongs to fire, specifically ministerial fire, whose toxicity is greater than ordinary heat. Administering astringent medicines in such cases is tantamount to killing.