马 高年下痢，一日夜百余次。舌苔白 ，身热恶心，诊脉
细，饮食不纳，痢下五色，皆为忌款。败毒散法初起的是，然须
人参扶正和胃。若喻氏痢疾门中，五色噤口，不治者多。尚祈商政是荷。
参须 败毒散 陈米（荷叶包） 石菖蒲
苗 湿伤于下，风伤于上，热处于中。湿夹热而成痢，痢下
红血，湿热伤血分也。风夹热而咳嗽，痰稠舌白，风热伤气分也。从手太阴、阳明，一脏一腑立法。
豆豉 荆芥炭 黄芩 薄荷 焦六曲 桑叶 黑山栀 杏仁 桔梗 薤白头 赤芍 通草
孙 湿温邪陷厥阴，下痢色紫后重，左脉沉小，右脉弦大，
舌黄，晡热，是阳明积热内恋，而木来乘土。高年体虚神怯，防其厥脱。
沙参 川连 白头翁 升麻 淡芩 焦六曲 川朴 通草 楂肉 秦皮 葛根 金银花 白芍 砂仁
又 前方升阳明，泄厥阴，以提下陷之邪。今改用败毒法，祛其邪，从表解，即喻氏逆流挽舟之意也。
人参败毒散去薄荷、生姜，加神曲。陈米煎汤代水。
又 舌苔灰黄，腹痛下痢，是阳明湿热积滞。而倦怠音低，
正气大虚，饮食不纳，虑延噤口重症。仍以苦辛寒化肠胃之湿
热，而开通其气，冀其谷进、热和、痢减为妙。
北沙参 川石斛 川连 木香 石菖蒲 川朴 枳实 滑石 白芍 淡芩 焦楂肉 陈皮 荷叶 鲜藕
又 下痢不减，胃气略开。病将半月，高年元气内亏，湿热未化，深恐生变。
沙参 淡芩 川连 川朴 枳实 白芍 广木香 木瓜 西洋参 茯苓 通草 荷梗
又 痢将半月，色如败酱，腹痛后重，舌苔灰黄。湿热胶滞，肠胃不和，纳谷殊少。高年防其虚脱。
西洋参 川连 陈皮 六神曲 谷芽 青皮 当归 白芍 地榆炭 淡芩 砂仁 茯苓皮
又 考治痢方法，因于暑湿热阻滞肠胃者，不出苦辛寒药疏
通理气。若胃不纳者，谓之噤口痢，九死一生。今高年体弱，胃
不纳谷，舌色灰黄，身热腹痛，既不可补，又难用攻，只得宣通化滞，开其胃气。
白头翁汤加枳实、红曲、白芍、青皮、楂肉炭、木香、荷叶蒂、茉莉花蒂、砂仁（半生半熟炒研）、稻叶。
某 红痢日久，脾气必虚，营气必耗。前方理中汤下驻车
丸，颇验。奈轻听人言，服红曲、滑石末，致痢复剧。脉迟缓而
涩，舌薄白而底绛。渴不贪饮，口恶甜味。素体多湿，今脾阳失
运，湿又动于中矣。徐灵胎云∶血痢挟湿者，胃风汤最妙。《医
归·痢疾门》亦采是法。
八珍汤去地、草，加肉桂、升麻、粳米。
渊按∶理中汤温运中阳，驻车丸分导湿热，从脉象迟涩看出。红曲、滑石适与相反。
李 久吃洋烟，脉沉而细。病方三日，微寒微热，头略胀痛，
昼不痢，痢在夜，是属寒邪；而反色赤者，寒伤营也。当以和营散寒、温通阳气为法。勿与常痢同治。
防风根 白术 陈皮 木香 白芍（桂枝三分，煎汤炒） 炮姜 砂仁
服二剂愈，应手之至。
渊按∶脉细肢寒，昼不痢，痢在夜，乃脾阳不能统摄营阴也。
蔡 右脉细弦，木侮土也；左脉细弱，肾水亏也。病由肝气
而起，水不涵木也。兹患下痢赤白，木胜土衰，湿热不化也。华
先生用补中升阳，参入育阴，从本求治，极有见地。鄙意再参温化，乃兼顾脾肾之阳气也。
党参 茯苓 冬术 归身 阿胶 杜仲 白芍 炮姜 木香 川连 神曲 菟丝饼
尤 伏暑挟积，湿热内蕴。胸痞呕恶，发热舌燥。通腑之后，
变为下痢，痢色红白腻冻，饮食不纳，虑成噤口。须得胃开谷纳，痢减不呕为妙。高年颇为重症。
川连 淡芩 白芍 陈皮 青皮 茯苓 焦楂肉 川朴 沙参 砂仁 谷芽 玫瑰花
此病两脉虚濡，脾胃元气大弱，似宜参入扶正为善。然下痢
古称滞下，起于湿热居多，早补早敛，往往受累，此河间苦辛宣
通腑滞之法，所以为痢门必采之方。若补阴阳，治脾胃，多为久痢而设也。
宋 远行伤饥，饮酒伤胃，而成休息下痢。痢经两载不愈，许学士香茸丸最妙。今师其意，变汤服之。
杜仲 菟丝饼 丁香 当归 白芍 炮姜 鹿角霜 木香 茯苓 砂仁
陆 《脉经》云∶代则气衰，细则气少。多指阳气为言。今
下痢而得促脉，脾胃之阳微特着。况形衰畏冷，而小便清长者
乎！惟是下痢赤者属血分，腹中痛为有积，立方从此设想，寻其罅而通之补之，亦治病之机巧也。
附子枳实理中汤送下驻车丸。
薛 先患红痢，续加以疟，又变泄泻，泻止仍痢，两月有余。
脉弦硬，昼无小便，每交子后至辰便痢数次，小溲亦得稍通。此
伏暑湿热蕴于肠胃及厥阴。厥阴之表便是少阳，故先见热痢，后
兼疟象，乃厥阴、少阳表里同病也。疟后大便溏泄者，少阳木邪
侮土也。泻止而疟痢仍作者，胃气强旺，土不受邪，仍还厥、少
两经也。小便少者，阴气亏则渗愈少，当滋其化源也。今清厥阴
之热而举清阳，兼益肾之阴，运脾之湿，从白头翁合胃风汤意。
白头翁汤加防风、白术、白芍、五味子、大熟地、伏苓、神曲、谷芽、北沙参。
渊按∶议论如秋月寒潭，开后学心思不少。方亦精妙。
王 厥阴有寒，肠中有热。少腹冷痛，下痢红粘，身热肢寒，
汗出舌腻，恶心不食，虑成噤口。拟辛通厥阴之寒，苦泄肠中之
热，用姜萸当归四逆汤加香、连、芩、楂主之。
桂枝 白芍 吴茱萸 炮姜 炙甘草 木通 当归 川连 木香 黄芩 楂肉炭 砂仁
渊按∶有热深厥深之象，乃湿热积重遏肠胃，气机不得通化，宜佐通因通用法，使胶粘之邪速去。
范 肝胃不和，湿热积滞为痢。痢延半载，仍脘腹胀痛，恶心。治以苦辛泄肝和胃，佐以分消运化。
川连 茯苓 川朴 木香 楂肉 青皮 陈皮 砂仁 赤芍 白芍
另用驻车丸三钱，乌梅丸一钱，相和服。
又 痢减腹仍痛，肝胃未和也。现值经来，脉弦寒热，血虚木郁。拟养血疏肝。
八珍汤去草，加香附、木香、陈皮、神曲、砂仁。另驻车丸、乌梅丸、归脾丸各一钱，相和服。
张 便痢白腻如水晶鱼脑色，小便不利，少腹偏右板窒。诸
医以为肠痈，固以相似。然考肠痈为病，有寒有热。《金匮》并
出二方，如大黄牡丹汤，苡仁附子败酱散，概可见矣。但此症则属寒积，脉弦紧而数，面色青而不渴，宜用温通。
肉桂五苓散加楂肉、砂仁。
又 温通已效，仍从前方加炮姜、木香。
又 欲溺不爽，溺后气向下坠，便痢白腻虽稀，然腰尻酸
痛如折。全属阳虚气陷之象。仿东垣参入前法。
西党参 升麻 冬术 肉桂 茯苓 泽泻 炮姜 木香 诃子（煨） 砂仁 生鹿角
此方连三剂，大便白腻全无，脾胃已开。按此症并非肠痈，
乃寒积下痢耳。因诸医皆云肠痈，只得委曲周旋，但从肠痈有寒
有热，轻轻转笔，折入温通方法，既不碍医，又与病相合，不得
不然之事也。故志之。
某 休息痢将及五年，腹中块垒时痛，痢下仍兼干粪。脉弦
迟，苔灰白。此虚而有寒积也。《本事方》云∶痼冷在肠胃，泄
泻腹痛，宜先取去，然后调理，不可畏虚养病。此症的是。姑拟
一方备采。信则服之，疑则勿服。
参须（三钱） 熟附子（三钱） 干姜（二钱，炒） 甘草（钱半） 当归（钱半，酒炒）
大黄（三钱，酒炒） 川朴（三钱） 枳实（三钱，土炒） 元明粉（二钱）
共研细末，蜜水泛丸。每日三钱，砂仁汤送下。
渊按∶痢疾湿热未清，早服兜涩，往往延成休息，用温下法
颇为合拍。但大黄分量宜重一倍，否则不但积不去，且不敌姜、附之温燥耳。
张 症有变迁，治无一定。痢疾多由积滞，而烟客中气素
亏，肾气亦损。小溲不利，肾虚阳气不化也；舌红无苔，肾虚阴
津不升也。腹不痛，无积可稽；气下注，清阳下陷。种种虚象，
所以淹缠不易奏功。夫有胃则生，古人是训；而大烟伤气，剥削
可虞。故烟痢一症，医家难以着手。诸宜自爱，谨慎为上。
熟地炭 白芍 川芎炭 肉桂 泽泻 归身炭 党参（元米炒） 冬术 茯苓 蜜炙粟壳
渊按∶熟地不宜炒炭。
某 泄痢白腻，腹不痛，脉沉细。此寒也。宜温之。
吴茱萸 茯苓 木香 陈皮 炮姜 六神曲 焦白术 诃子 乌药 砂仁
李 河间论痢属热者多，而景岳论痢属寒者不少。此症腹不
甚痛，但肛 且胀，脉紧肢寒，并不发热，兼素有寒疝，苔白不渴，寒象为多。宗景岳论治之。
吴茱萸 茯苓 炮姜 木香 炙甘草 焦六曲 陈皮 砂仁
邢 休息痢必有积，延来两月，近今发热，湿热郁蒸于肠
胃，痢色或白或赤。化湿热以运中州，疏积滞以和气血。勿以为日既久，遽投固涩也。
白术 川连 白芍 木香 当归 茯苓 广皮 楂炭 升麻 泽泻 防风
另∶资生丸，补中益气丸、驻车丸等分，相和一处。每朝服三钱，开水送下。
徐 红痢匝月，仍腹痛后重。据云，先曾发热三次。此属中
虚表邪传里。现今脉细肢寒，太阴阳气已弱；小便艰难，膀胱气
化又钝。拟开其中焦，化其湿热，兼升阳解表，亦表里双解之法也。
柴胡 桂枝 茯苓 泽泻 川连 木香 白术 党参 砂仁 炮姜 炙甘草
张 疟后劳碌感寒，疟邪复发，更加红痢后重，此中虚气陷，湿热未楚也。用败毒散。
活人败毒散加神曲、楂炭、陈皮。
许 热伏营中，久痢纯血，腰疼腹痛。舌苔薄白，底绛，兼
有紫点。此属湿热挟瘀之候。病将一载，法以咸苦通涩兼施。
杜仲（盐水炒） 阿胶（川连炒） 川断（盐水炒） 黄柏（盐水炒） 地榆炭 白
芍防风根 炙升麻 当归 生熟砂仁
又 投咸苦通涩之剂，诸恙皆减，仍宗前法增损。
原方去黄柏、防风，加熟地、淡芩（醋炒）、荷叶蒂。
高 三疟汗少，邪不外达，饮食不节，变增泄泻。今竟下痢
红白粘腻。自来体质气虚多湿，最怕淹缠。急宜忌口为要。
羌独活 柴胡 前胡 川芎 花槟榔 莱菔子 陈皮 炙甘草 茯苓 山楂炭 焦六曲 木香 砂仁
金 红痢三年，腹左结块板硬不移，按之则痛，漉漉作声，
即便下痢。此瘀凝寒积，久留于肠腑。当以温药下之。
苍术炭 川熟附 枳实炭 地榆炭 茯苓 当归 通草 桃仁（炒黑研） 大黄（酒炒）
仁渊曰∶洁古芍药汤亦治痢要方，湿热积郁结肠胃甚者，宜
通下以开壅塞，使邪不久留，正气不致大伤，何数十证无一及之
者，或未遇此等耳。夫痢疾古名肠 ，夏秋湿热居多。邪壅肠胃
重而经络轻者成痢，肠胃轻而经络重者为疟疾、伏暑。亦有经腑
同病，寒热痛痢并作者，初宜苦辛芳淡通而化之。挟表则活人败
毒散。积重痛甚者，因而竭之，洁古芍药汤。病有寒热虚实，药
有补泻温凉，非一法所能概也。若噤口不纳者难治。乃湿热伤
胃，邪势捍格，绝不思谷，治法虽多，须中气尚有根柢，犹或可
治。烟痢亦难治，因久吸洋烟，肾精脾气先已告困，迨痢疾一
发，势即不支，故诸药不效耳。初起视其正尚可支，急为逐邪，
切勿彷徨。辗转三五日后，脏真伤而津气竭，欲攻不能，欲补不
可，即棘手矣。若邪正并急，尤宜舍邪顾正，或温补脾胃，或清
补气液，佐彻邪一二味，能受即是生机。否恐邪未化而正已脱，
但不可早用兜涩，无益而害之。盖兜涩莫过洋烟，洋烟不灵，岂
禹粮、石脂、诃、粟、榴皮能为力乎？苟元气津液可恃，邪不自
容，痢中自有去邪，邪化痢止，必然之理。虚不受补者死，且胃
气亦不可恃。平人能纳谷者，虽重可治。烟痢脾肾脏真受伤，虽
能纳谷，不过稍延时日，待胃败则死耳。盖脾为仓廪，后天之
本；肾为先天，二阴锁钥故也。根柢一坏，神丹莫挽矣。论脉弦
急大者死，缓弱者生。须看其所下何如。若虚坐努责，或紫水败
酱，虽腹痛后重，虚象大着矣。切勿再进苦寒伤胃，宜温运脾
肾，疏达肝木。木达气升，其痛自止；痢随痛减，胃气亦醒。达木用肉桂最妙，盖甘缓辛通发散为阳，最能畅达郁结也。
马先生，年事已高，患下痢（痢疾），一昼夜达百余次。舌苔白，身热伴恶心，脉象细弱，饮食无法摄入，痢下五色杂陈，均为禁忌之症。败毒散法适用于初起阶段，但必须用人参扶助正气、调和胃气。若如喻嘉言在《痢疾门》中所言，出现五色痢且噤口不食者，多属不治之症。恳请斟酌裁断为感。
药物：参须、败毒散、陈米（用荷叶包裹）、石菖蒲。
苗先生，湿邪伤于下部，风邪伤于上部，热邪居于中部。湿与热相夹而成痢疾，痢下红血，是湿热损伤血分；风与热相夹而致咳嗽，痰稠、舌苔白，是风热损伤气分。治疗应从手太阴肺经和手阳明大肠经入手，一脏一腑立法处方。
药物：豆豉、荆芥炭、黄芩、薄荷、焦六曲、桑叶、黑山栀、杏仁、桔梗、薤白头、赤芍、通草。
孙先生，湿温病邪陷入厥阴肝经，下痢色紫且有里急后重感，左脉沉小，右脉弦大，舌苔黄，傍晚发热，这是阳明积热内恋，而肝木乘克脾土所致。患者年高体虚、神气怯弱，需防止厥脱危证。
药物：沙参、川连、白头翁、升麻、淡芩、焦六曲、川朴、通草、楂肉、秦皮、葛根、金银花、白芍、砂仁。
复诊：前方旨在升提阳明之气，清泄厥阴之热，以提举下陷之邪气。现改用败毒散法，祛除邪气，从表而解，即喻嘉言“逆流挽舟”之意。
药物：人参败毒散去薄荷、生姜，加神曲。用陈米煎汤代水。
又诊：舌苔灰黄，腹痛下痢，此为阳明湿热积滞。而倦怠、声音低微，显示正气大虚，饮食不纳，担心发展为噤口痢重症。仍以苦辛寒之法化除肠胃之湿热，开通气机，希望谷食能进、热势缓和、痢疾减轻为妙。
药物：北沙参、川石斛、川连、木香、石菖蒲、川朴、枳实、滑石、白芍、淡芩、焦楂肉、陈皮、荷叶、鲜藕。
又诊：下痢未减，但胃气略有恢复。患病将半月，年高元气内亏，湿热尚未化解，深恐发生变故。
药物：沙参、淡芩、川连、川朴、枳实、白芍、广木香、木瓜、西洋参、茯苓、通草、荷梗。
又诊：痢疾将半月，痢色如败酱，腹痛且有里急后重，舌苔灰黄。湿热胶结阻滞，肠胃不和，进食极少。年高者防其虚脱。
药物：西洋参、川连、陈皮、六神曲、谷芽、青皮、当归、白芍、地榆炭、淡芩、砂仁、茯苓皮。
又诊：考察治疗痢疾的方法，因暑湿热阻滞肠胃者，不出用苦辛寒药疏通理气的范围。若胃不纳食者，称为噤口痢，九死一生。如今患者年高体弱，胃不纳谷，舌色灰黄，身热腹痛，既不可补益，又难用攻下，只得宣通化滞，开启胃气。
药物：白头翁汤加枳实、红曲、白芍、青皮、楂肉炭、木香、荷叶蒂、茉莉花蒂、砂仁（半生半熟炒研）、稻叶。
某患者，红痢日久，脾气必然虚弱，营气必然耗损。前方用理中汤送服驻车丸，颇为有效。无奈轻信他人之言，服用红曲、滑石末，导致痢疾再次加重。脉象迟缓而涩，舌薄白而底绛。口渴但不贪饮，口中厌恶甜味。素体多湿，如今脾阳失运，湿气又动于中矣。徐灵胎曾说：血痢挟湿者，用胃风汤最妙。《医归·痢疾门》也采纳此法。
药物：八珍汤去地黄、甘草，加肉桂、升麻、粳米。
渊按：理中汤温运中阳，驻车丸分导湿热，从脉象迟涩可以看出。红曲、滑石与此法适相反对。
李先生，长期吸食洋烟，脉象沉而细。发病才三天，微恶寒微发热，头部略胀痛，白天不痢，夜间痢，属于寒邪；而反见痢色赤者，是寒伤营分。当以和营散寒、温通阳气为治法。不要与普通痢疾同治。
药物：防风根、白术、陈皮、木香、白芍（用桂枝三分煎汤炒制）、炮姜、砂仁。
服两剂痊愈，效果显著。
蔡先生，右脉细弦，为肝木侮脾土；左脉细弱，为肾水亏虚。病由肝气而起，乃水不涵木所致。现患下痢赤白，乃木胜土衰，湿热不化。华先生用补中升阳法，参入育阴法，从本求治，极有见地。我的意见再参入温化法，以兼顾脾肾之阳气。
药物：党参、茯苓、冬术、归身、阿胶、杜仲、白芍、炮姜、木香、川连、神曲、菟丝饼。
尤先生，伏暑挟带积滞，湿热内蕴。胸痞呕恶，发热舌燥。通腑之后，变为下痢，痢色红白腻冻，饮食不纳，担心形成噤口痢。须得胃开谷纳，痢减不呕为妙。年高者属重症。
药物：川连、淡芩、白芍、陈皮、青皮、茯苓、焦楂肉、川朴、沙参、砂仁、谷芽、玫瑰花。
此病两脉虚濡，脾胃元气大弱，似宜参入扶正之法为善。然而下痢古称滞下，起于湿热居多，早补早敛，往往受累，这是刘河间苦辛宣通腑滞之法，所以为痢疾门必采之方。若补阴阳，治脾胃，多为久痢而设。
宋先生，远行伤饥，饮酒伤胃，而成休息痢。痢疾经过两年不愈，许学士的香茸丸最为妙用。今师从其意，改为汤剂服用。
药物：杜仲、菟丝饼、丁香、当归、白芍、炮姜、鹿角霜、木香、茯苓、砂仁。
陆先生，《脉经》说：代脉则气衰，细脉则气少。多指阳气而言。如今下痢而得促脉，说明脾胃之阳微弱至极。况且形体衰败畏冷，小便清长！只是下痢色赤属血分，腹中痛为有积滞，立方从此设想，寻其缝隙而通之补之，这也是治病的机巧。
药物：附子枳实理中汤送下驻车丸。
薛先生，先患红痢，继而又患疟疾，又变为泄泻，泻止后仍痢，两个多月了。脉弦硬，白天无小便，每到子时后至辰时便痢数次，小便也稍通。此乃伏暑湿热蕴于肠胃及厥阴肝经。厥阴之表便是少阳胆经，故先见热痢，后又兼疟象，乃厥阴、少阳表里同病。疟后大便溏泄者，是少阳木邪侮土所致。泻止而疟痢仍作，是因为胃气强旺，土不受邪，病邪仍还归于厥阴、少阳两经。小便少者，阴气亏则渗利愈少，当滋其化源。现清厥阴之热而举清阳，兼益肾之阴，运脾之湿，取白头翁汤合胃风汤之意。
药物：白头翁汤加防风、白术、白芍、五味子、大熟地、茯苓、神曲、谷芽、北沙参。
王先生，厥阴有寒，肠中有热。少腹冷痛，下痢红粘，身热肢寒，汗出舌腻，恶心不食，担心形成噤口痢。拟用辛通厥阴之寒，苦泄肠中之热，用姜萸当归四逆汤加香、连、芩、楂主之。
药物：桂枝、白芍、吴茱萸、炮姜、炙甘草、木通、当归、川连、木香、黄芩、楂肉炭、砂仁。
渊按：有热深厥深的现象，乃湿热积重遏阻肠胃，气机不得通化，宜佐以通因通用法，使胶粘之邪速去。
范先生，肝胃不和，湿热积滞为痢。痢疾延续半年，仍脘腹胀痛，恶心。治以苦辛泄肝和胃，佐以分消运化。
药物：川连、茯苓、川朴、木香、楂肉、青皮、陈皮、砂仁、赤芍、白芍。
另用驻车丸三钱，乌梅丸一钱，混合服用。
又诊：痢减腹仍痛，肝胃未和。现值经期，脉弦寒热，血虚木郁。拟养血疏肝。
药物：八珍汤去甘草，加香附、木香、陈皮、神曲、砂仁。另驻车丸、乌梅丸、归脾丸各一钱，混合服用。
张先生，便痢白腻如水晶鱼脑色，小便不利，少腹偏右板窒。诸医认为是肠痈，确实相似。但考肠痈为病，有寒有热。《金匮要略》并出二方，如大黄牡丹汤，苡仁附子败酱散，概可见矣。但此症则属寒积，脉弦紧而数，面色青而不渴，宜用温通法。
药物：肉桂五苓散加楂肉、砂仁。
又诊：欲溺不爽，溺后气向下坠，便痢白腻虽稀，然腰尻酸痛如折。全属阳虚气陷之象。仿李东垣法参入前法。
药物：西党参、升麻、冬术、肉桂、茯苓、泽泻、炮姜、木香、诃子（煨）、砂仁、生鹿角。
此方连服三剂，大便白腻全无，脾胃已开。按此症并非肠痈，乃寒积下痢耳。因诸医皆云肠痈，只得委曲周旋，但从肠痈有寒有热，轻轻转笔，折入温通方法，既不碍医，又与病相合，不得不如此之事也。故志之。
某患者，休息痢将及五年，腹中块垒时痛，痢下仍兼干粪。脉弦迟，苔灰白。此虚而有寒积也。《本事方》说：痼冷在肠胃，泄泻腹痛，宜先取去，然后调理，不可畏虚养病。此症确实如此。姑拟一方备采。信则服之，疑则勿服。
药物：参须（三钱）、熟附子（三钱）、干姜（二钱，炒）、甘草（钱半）、当归（钱半，酒炒）、大黄（三钱，酒炒）、川朴（三钱）、枳实（三钱，土炒）、元明粉（二钱）。
共研细末，蜜水泛丸。每日三钱，砂仁汤送下。
渊按：痢疾湿热未清，早服兜涩，往往延成休息痢，用温下法颇为合拍。但大黄分量宜重一倍，否则不但积不去，且不敌姜、附之温燥耳。
张先生，症有变迁，治无一定。痢疾多由积滞，而烟客中气素亏，肾气亦损。小溲不利，肾虚阳气不化也；舌红无苔，肾虚阴津不升也。腹不痛，无积可稽；气下注，清阳下陷。种种虚象，所以淹缠不易奏功。夫有胃则生，古人是训；而大烟伤气，剥削可虞。故烟痢一症，医家难以着手。诸宜自爱，谨慎为上。
药物：熟地炭、白芍、川芎炭、肉桂、泽泻、归身炭、党参（元米炒）、冬术、茯苓、蜜炙粟壳。
某患者，泄痢白腻，腹不痛，脉沉细。此寒也。宜温之。
药物：吴茱萸、茯苓、木香、陈皮、炮姜、六神曲、焦白术、诃子、乌药、砂仁。
李先生，河间论痢属热者多，而景岳论痢属寒者不少。此症腹不甚痛，但肛 且胀，脉紧肢寒，并不发热，兼素有寒疝，苔白不渴，寒象为多。宗景岳论治之。
药物：吴茱萸、茯苓、炮姜、木香、炙甘草、焦六曲、陈皮、砂仁。
邢先生，休息痢必有积，延来两月，近今发热，湿热郁蒸于肠胃，痢色或白或赤。化湿热以运中州，疏积滞以和气血。勿以为日既久，遽投固涩也。
药物：白术、川连、白芍、木香、当归、茯苓、广皮、楂炭、升麻、泽泻、防风。
另：资生丸，补中益气丸、驻车丸等分，相和一处。每朝服三钱，开水送下。
徐先生，红痢匝月，仍腹痛后重。据云，先曾发热三次。此属中虚表邪传里。现今脉细肢寒，太阴阳气已弱；小便艰难，膀胱气化又钝。拟开其中焦，化其湿热，兼升阳解表，亦表里双解之法也。
药物：柴胡、桂枝、茯苓、泽泻、川连、木香、白术、党参、砂仁、炮姜、炙甘草。
张先生，疟后劳碌感寒，疟邪复发，更加红痢后重，此中虚气陷，湿热未楚也。用败毒散。
药物：活人败毒散加神曲、楂炭、陈皮。
许先生，热伏营中，久痢纯血，腰疼腹痛。舌苔薄白，底绛，兼有紫点。此属湿热挟瘀之候。病将一载，法以咸苦通涩兼施。
药物：杜仲（盐水炒）、阿胶（川连炒）、川断（盐水炒）、黄柏（盐水炒）、地榆炭、白芍、防风根、炙升麻、当归、生熟砂仁。
又诊：投咸苦通涩之剂，诸恙皆减，仍宗前法增损。
原方去黄柏、防风，加熟地、淡芩（醋炒）、荷叶蒂。
高先生，三疟汗少，邪不外达，饮食不节，变增泄泻。今竟下痢红白粘腻。自来体质气虚多湿，最怕淹缠。急宜忌口为要。
药物：羌独活、柴胡、前胡、川芎、花槟榔、莱菔子、陈皮、炙甘草、茯苓、山楂炭、焦六曲、木香、砂仁。
金先生，红痢三年，腹左结块板硬不移，按之则痛，漉漉作声，即便下痢。此瘀凝寒积，久留于肠腑。当以温药下之。
药物：苍术炭、川熟附、枳实炭、地榆炭、茯苓、当归、通草、桃仁（炒黑研）、大黄（酒炒）。
仁渊曰：洁古芍药汤亦治痢要方，湿热积郁结肠胃甚者，宜通下以开壅塞，使邪不久留，正气不致大伤，何数十证无一及之者，或未遇此等耳。夫痢疾古名肠 ，夏秋湿热居多。邪壅肠胃重而经络轻者成痢，肠胃轻而经络重者为疟疾、伏暑。亦有经腑同病，寒热痛痢并作者，初宜苦辛芳淡通而化之。挟表则活人败毒散。积重痛甚者，因而竭之，洁古芍药汤。病有寒热虚实，药有补泻温凉，非一法所能概也。若噤口不纳者难治。乃湿热伤胃，邪势捍格，绝不思谷，治法虽多，须中气尚有根柢，犹或可治。烟痢亦难治，因久吸洋烟，肾精脾气先已告困，迨痢疾一发，势即不支，故诸药不效耳。初起视其正尚可支，急为逐邪，切勿彷徨。辗转三五日后，脏真伤而津气竭，欲攻不能，欲补不可，即棘手矣。若邪正并急，尤宜舍邪顾正，或温补脾胃，或清补气液，佐彻邪一二味，能受即是生机。否恐邪未化而正已脱，但不可早用兜涩，无益而害之。盖兜涩莫过洋烟，洋烟不灵，岂禹粮、石脂、诃、粟、榴皮能为力乎？苟元气津液可恃，邪不自容，痢中自有去邪，邪化痢止，必然之理。虚不受补者死，且胃气亦不可恃。平人能纳谷者，虽重可治。烟痢脾肾脏真受伤，虽能纳谷，不过稍延时日，待胃败则死耳。盖脾为仓廪，后天之本；肾为先天，二阴锁钥故也。根柢一坏，神丹莫挽矣。论脉弦急大者死，缓弱者生。须看其所下何如。若虚坐努责，或紫水败酱，虽腹痛后重，虚象大着矣。切勿再进苦寒伤胃，宜温运脾肾，疏达肝木。木达气升，其痛自止；痢随痛减，胃气亦醒。达木用肉桂最妙，盖甘缓辛通发散为阳，最能畅达郁结也。
Mr. Ma, of advanced age, suffers from dysentery (Li Ji), occurring over a hundred times in a day and night. The tongue coating is white, accompanied by fever and nausea; the pulse is fine and weak. Food intake is impossible, and the stool contains five colors mixed together, all indicating contraindicated conditions. The Baidu San method is suitable for the initial stage, but Ginseng Radix must be used to support healthy Qi and harmonize Stomach Qi. As Yu Jiayan stated in the "Dysentery Chapter," cases presenting with five-colored dysentery and inability to eat (Jinkou Li) are mostly incurable. I respectfully request your deliberation.
Herbs: Shensu (Ginseng Radicle), Baidu San, Chenmi (aged rice wrapped in lotus leaf), Shichangpu (Acori Tatarinowii Rhizoma).
Mr. Miao, dampness pathogen injures the lower part, wind pathogen injures the upper part, and heat pathogen resides in the middle. Dampness combined with heat forms dysentery, with red blood in the stool, indicating damp-heat injuring the Blood level. Wind combined with heat causes coughing, with thick phlegm and white tongue coating, indicating wind-heat injuring the Qi level. Treatment should target the Hand-Taiyin Lung Meridian and Hand-Yangming Large Intestine Meridian, prescribing based on one Zang organ and one Fu organ.
Herbs: Douchi (Fermented Soybean), Jingjie Tan (Charred Schizonepetae Spica), Huangqin (Scutellariae Radix), Bohe (Menthae Haplocalycis Herba), Jiao Liuqu (Charred Medicated Leaven), Sangye (Mori Folium), Heishanzhi (Charred Gardeniae Fructus), Xingren (Armeniacae Semen Amarum), Jiegeng (Platycodonis Radix), Xiebatou (Allii Macrostemonis Bulbus), Chishao (Paeoniae Radix Rubra), Tongcao (Tetrapanacis Medulla).
Mr. Sun, the damp-warmth pathogen has sunk into the Jueyin Liver Meridian, causing purple dysentery with tenesmus. The left pulse is deep and small, the right pulse is wiry and large, the tongue coating is yellow, and there is afternoon fever. This indicates accumulation of heat in the Yangming with internal entanglement, while Wood (Liver) overacts on Earth (Spleen/Stomach). Given his advanced age, physical weakness, and timid spirit, prevention of Jueyin collapse is necessary.
Herbs: Shashen (Glehniae Radix), Chuanlian (Coptidis Rhizoma), Baitouweng (Pulsatillae Radix), Shengma (Cimicifugae Rhizoma), Danqin (Scutellariae Radix), Jiao Liuqu (Charred Medicated Leaven), Chunghou (Magnoliae Officinalis Cortex), Tongcao (Tetrapanacis Medulla), Zharon (Crataegi Fructus), Qinpi (Fraxini Cortex), Gegen (Puerariae Lobatae Radix), Jinyinhua (Lonicerae Japonicae Flos), Baishao (Paeoniae Radix Alba), Sharen (Amomi Fructus Rotundus).
Second visit: The previous prescription aimed to raise Yangming Qi and clear Jueyin Heat to lift the sinking pathogen. Now changing to the Baudu San method to expel the pathogen via the exterior, following Yu Jiayan's concept of "pulling the boat upstream against the current."
Formula: Renshen Baibu San minus Bohe (Menthae Haplocalycis Herba) and Shengjiang (Zingiberis Rhizoma Recens), plus Shenqu (Medicated Leaven). Decoct aged rice in water as the solvent.
Third visit: Tongue coating is gray-yellow, abdominal pain with dysentery, indicating Yangming damp-heat accumulation. Fatigue and low voice indicate severe deficiency of healthy Qi. Inability to eat raises concern for progression to severe Jinkou Li (incurable dysentery). Use bitter, acrid, and cold methods to transform damp-heat in the intestines and stomach, opening the Qi mechanism, hoping for food intake, reduction of fever, and alleviation of dysentery.
Herbs: Beishashen (Glehniae Radix), Chuanshihu (Dendrobii Caulis), Chuanlian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Chunghou (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Huashi (Talcum), Baishao (Paeoniae Radix Alba), Danqin (Scutellariae Radix), Jiao Zharon (Charred Crataegi Fructus), Chenpi (Citri Reticulatae Pericarpium), Heteye (Nelumbinis Folium), Xianou (Nymphaeae Nelumbinis Rhizoma).
Fourth visit: Dysentery persists, but Stomach Qi has slightly recovered. The disease has lasted nearly half a month. Advanced age implies internal depletion of Yuan Qi, and damp-heat remains unresolved, fearing further complications.
Herbs: Shashen (Glehniae Radix), Danqin (Scutellariae Radix), Chuanlian (Coptidis Rhizoma), Chunghou (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Baishao (Paeoniae Radix Alba), Guangmuxiang (Aucklandiae Radix), Mugua (Chaenomelis Fructus), Xiyangshen (Panacis Quinquefolii Radix), Fuling (Poria), Tongcao (Tetrapanacis Medulla), Hegeng (Nelumbinis Nodus).
Fifth visit: Dysentery has lasted nearly half a month, stool color like spoiled sauce, abdominal pain with tenesmus, tongue coating gray-yellow. Damp-heat is sticky and obstructive, intestines and stomach disharmonious, food intake very low. Advanced age requires prevention of collapse.
Herbs: Xiyangshen (Panacis Quinquefolii Radix), Chuanlian (Coptidis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Liushenqu (Six-Ingredient Medicated Leaven), Guya (Oryzae Germen), Qingpi (Citri Reticulatae Pericarpium Viride), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Diyu Tan (Charred Sanguisorbae Radix), Danqin (Scutellariae Radix), Sharen (Amomi Fructus Rotundus), Fulingpi (Poria Cum Ligno et Ligno).
Sixth visit: Examining treatment methods for dysentery caused by summer-heat, dampness, and heat obstructing the intestines and stomach, it does not go beyond using bitter, acrid, and cold herbs to unblock and regulate Qi. If the Stomach cannot accept food, it is called Jinkou Li (incurable dysentery), with nine deaths to one survival. Now, the patient is elderly and weak, Stomach rejects food, tongue is gray-yellow, body hot, abdominal pain. Tonification is contraindicated, purgation is difficult. One must promote circulation, resolve stagnation, and open Stomach Qi.
Formula: Baitouweng Tang plus Zhishi (Aurantii Fructus Immaturus), Hongqu (Red Yeast Rice), Baishao (Paeoniae Radix Alba), Qingpi (Citri Reticulatae Pericarpium Viride), Zharon Tan (Charred Crataegi Fructus), Muxiang (Aucklandiae Radix), Hetedi (Lotus Pedunculus), Molihuadi (Jasmine Flower Peduncle), Sharen (Amomi Fructus Rotundus - half raw, half cooked and ground), Daoye (Rice Leaf).
Patient: Chronic red dysentery leads to Spleen Qi deficiency and Ying (Nutrient) Qi consumption. The previous formula, Lizhong Tang administered with Zhuche Wan, was effective. However, trusting others' advice, he took Hongqu (Red Yeast Rice) and Huashi (Talcum) powder, causing dysentery to worsen. Pulse is slow and choppy, tongue thin white with crimson base. Thirst without desire to drink, mouth dislikes sweet taste. Constitution is prone to dampness; now Spleen Yang fails to transport, and dampness moves within. Xu Lingtai said: For bloody dysentery with dampness, Weifeng Tang is best. "Yi Gui · Dysentery Chapter" also adopts this method.
Formula: Bazhen Tang minus Dihuang (Rehmanniae Radix Preparata) and Gancao (Glycyrrhizae Radix et Rhizoma), plus Rougui (Cinnamomi Cortex), Shengma (Cimicifugae Rhizoma), Jingmi (Oryzae Fructus).
Note by Yuan: Lizhong Tang warms and transports Middle Yang; Zhuche Wan separates and guides damp-heat, evident from the slow and choppy pulse. Hongqu and Huashi are contrary to this approach.
Mr. Li, long-term opium smoking results in a deep and fine pulse. Disease began three days ago with slight chills and fever, slight head distension and pain. No dysentery during the day, only at night, indicating Cold pathogen; yet the stool is red, indicating Cold injuring the Ying (Blood) level. Treatment should harmonize Ying, scatter Cold, and warm/unblock Yang Qi. Do not treat as ordinary dysentery.
Herbs: Fangfenggen (Saposhnikoviae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Baishao (Paeoniae Radix Alba - stir-fried with decoction of Guizhi/Cinnamomi Ramulus), Paojiang (Zingiberis Rhizoma Preparatum), Sharen (Amomi Fructus Rotundus).
Cured after two doses, highly effective.
Note by Yuan: Fine pulse, cold limbs, no dysentery by day, only by night, indicates Spleen Yang failing to control Ying Yin.
Mr. Cai, Right pulse is fine and wiry, indicating Liver Wood insulting Spleen Earth; Left pulse is fine and weak, indicating Kidney Water deficiency. The disease originates from Liver Qi, due to Water failing to nourish Wood. Now suffering from red and white dysentery, Wood excess and Earth decline, damp-heat not transforming. Mr. Hua used Bu Zhong Yi Qi Tang to raise Yang, incorporating Yin-nourishing methods, treating the root, which is insightful. My opinion adds warming transformation methods to care for Spleen and Kidney Yang.
Herbs: Dangshen (Codonopsis Radix), Fuling (Poria), Dongzhu (Atractylodis Rhizoma), Guishen (Angelicae Sinensis Radix), Ejiao (Asini Corii Colla), Duzhong (Eucommiae Cortex), Baishao (Paeoniae Radix Alba), Paojiang (Zingiberis Rhizoma Preparatum), Muxiang (Aucklandiae Radix), Chuanlian (Coptidis Rhizoma), Shenqu (Medicated Leaven), Tusibing (Cuscutae Semen).
Mr. You, latent summer-heat with retention, damp-heat internally stored. Chest fullness, vomiting, fever, dry tongue. After purging the bowels, it turned into dysentery, red and white sticky stool, inability to eat, fearing Jinkou Li. Goal is to open Stomach, allow food intake, reduce dysentery, stop vomiting. Elderly patients are critical.
Herbs: Chuanlian (Coptidis Rhizoma), Danqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Chenpi (Citri Reticulatae Pericarpium), Qingpi (Citri Reticulatae Pericarpium Viride), Fuling (Poria), Jiao Zharon (Charred Crataegi Fructus), Chunghou (Magnoliae Officinalis Cortex), Shashen (Glehniae Radix), Sharen (Amomi Fructus Rotundus), Guya (Oryzae Germen), Meiguihua (Rosae Rugosae Flos).
The pulses are deficient and soggy, Spleen and Stomach Yuan Qi is greatly weakened, so adding supportive methods is advisable. However, dysentery, anciently called "Zhi Xia," mostly arises from damp-heat. Early tonification and astringency often cause lingering issues. This is why Liu Hejian's bitter-acrid unblocking method is essential for dysentery. Tonifying Yin/Yang or treating Spleen/Stomach is usually for chronic dysentery.
Mr. Song, travel-induced hunger and alcohol-induced Stomach injury led to intermittent dysentery. Dysentery persisted for two years without cure. Xu Xueshi's Xiangrong Wan is excellent. Now adopting its intent, changed to decoction.
Herbs: Duzhong (Eucommiae Cortex), Tusibing (Cuscutae Semen), Dingxiang (Eugeniae Flos), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Paojiang (Zingiberis Rhizoma Preparatum), Lu jiaoshuang (Cornu Cervi Pantotrichum Preparatum), Muxiang (Aucklandiae Radix), Fuling (Poria), Sharen (Amomi Fructus Rotundus).
Mr. Lu, "Mai Jing" states: Dai pulse indicates Qi decay, Xi pulse indicates Qi scarcity, mostly referring to Yang Qi. Now dysentery with Cu pulse indicates extreme weakness of Spleen and Stomach Yang. Moreover, emaciated form, aversion to cold, and clear abundant urination confirm this. Red dysentery belongs to Blood level; abdominal pain indicates retention. Prescribing from this perspective, finding gaps to unblock and tonify is a clever treatment strategy.
Formula: Fuzi Zhishi Lizhong Tang administered with Zhuche Wan.
Mr. Xue, initially suffered red dysentery, then malaria, then diarrhea. After diarrhea stopped, dysentery returned, lasting over two months. Pulse is wiry and hard, no urination during the day, multiple dysenteric episodes from Zi hour to Chen hour, slight urination passage. This is latent summer-heat and damp-heat storing in intestines/stomach and Jueyin Liver Meridian. Jueyin exterior is Shaoyang Gallbladder Meridian, hence initial hot dysentery followed by malaria symptoms, indicating simultaneous Jueyin and Shaoyang interior-exterior disease. Loose stools after malaria indicate Shaoyang Wood insulting Earth. Cessation of diarrhea with return of malaria/dysentery indicates strong Stomach Qi, Earth not accepting pathogen, pathogen returning to Jueyin/Shaoyang meridians. Scanty urination indicates Yin deficiency reducing permeation, requiring nourishment of the source. Now clearing Jueyin heat and raising clear Yang, supplementing Kidney Yin, transforming Spleen dampness, combining Baitouweng Tang and Weifeng Tang concepts.
Formula: Baitouweng Tang plus Fangfeng (Saposhnikoviae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Wuweizi (Schisandrae Chinensis Fructus), Dashudi (Rehmanniae Radix Preparata), Fuling (Poria), Shenqu (Medicated Leaven), Guya (Oryzae Germen), Beishashen (Glehniae Radix).
Note by Yuan: The discussion is clear as autumn moon and cold pool, inspiring students significantly. The formulas are also exquisite.
Mr. Wang, Jueyin Cold, intestinal Heat. Cold pain in lower abdomen, red sticky dysentery, body heat with cold limbs, sweating, greasy tongue, nausea, anorexia, fearing Jinkou Li. Plan to use acrid-unblocking for Jueyin Cold, bitter-draining for intestinal Heat, using Jiangyu Danggui Sini Tang plus Muxiang, Chuanlian, Huangqin, Zharon.
Herbs: Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Wuzhuyu (Evodiae Fructus), Paojiang (Zingiberis Rhizoma Preparatum), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Mutong (Akebiae Caulis), Danggui (Angelicae Sinensis Radix), Chuanlian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), Huangqin (Scutellariae Radix), Zharon Tan (Charred Crataegi Fructus), Sharen (Amomi Fructus Rotundus).
Note by Yuan: Signs of deep heat causing deep cold reversal. Severe damp-heat accumulation obstructs intestines/stomach, Qi mechanism fails to circulate. Should assist with "treat obstruction with unblocking" method to quickly eliminate sticky pathogens.
Mr. Fan, Liver-Stomach disharmony, damp-heat retention causes dysentery. Disease lasts half a year, still epigastric/abdominal distension/pain, nausea. Treat with bitter-acrid draining Liver and harmonizing Stomach, assisting with separation and transformation.
Herbs: Chuanlian (Coptidis Rhizoma), Fuling (Poria), Chunghou (Magnoliae Officinalis Cortex), Muxiang (Aucklandiae Radix), Zharon (Crataegi Fructus), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus Rotundus), Chishao (Paeoniae Radix Rubra), Baishao (Paeoniae Radix Alba).
Separately: Zhuche Wan 3 qian, Wumei Wan 1 qian, mix and take.
Second visit: Dysentery reduced, abdominal pain persists, Liver-Stomach not harmonized. Menstruation present, wiry pulse with chills/fever, Blood deficiency with Liver constraint. Plan to nourish Blood and soothe Liver.
Formula: Bazhen Tang minus Gancao (Glycyrrhizae Radix et Rhizoma), plus Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), Shenqu (Medicated Leaven), Sharen (Amomi Fructus Rotundus). Separately: Zhuche Wan, Wumei Wan, Guipi Wan each 1 qian, mix and take.
Mr. Zhang, Stool is white and sticky like crystal fish brain, urination difficult, right lower abdomen stiff and blocked. Physicians suspect intestinal abscess, which is similar. However, intestinal abscess can be Cold or Heat. "Jin Gui Yao Lue" provides two formulas: Dahuang Mudan Tang and Yiren Fuzi Baijiang San, illustrating this. But this case is Cold retention, pulse wiry-tight-rapid, complexion green, no thirst, suitable for warming and unblocking.
Formula: Rougui Wuling San plus Zharon (Crataegi Fructus), Sharen (Amomi Fructus Rotundus).
Second visit: Warming/unblocking effective, continue previous formula plus Paojiang (Zingiberis Rhizoma Preparatum), Muxiang (Aucklandiae Radix).
Third visit: Difficulty urinating, sensation of Qi sinking after urination, white sticky stool even if loose, but waist/sacrum soreness like breaking. Entirely signs of Yang deficiency and Qi sinking. Borrowing Li Dongyuan's method, add to previous formula.
Herbs: Xidangshen (Codonopsis Radix), Shengma (Cimicifugae Rhizoma), Dongzhu (Atractylodis Rhizoma), Rougui (Cinnamomi Cortex), Fuling (Poria), Zexie (Alismatis Rhizoma), Paojiang (Zingiberis Rhizoma Preparatum), Muxiang (Aucklandiae Radix), Hezi (Arecae Semen Preparatum - roasted), Sharen (Amomi Fructus Rotundus), Shenglujiao (Raw Cornu Cervi Pantotrichum).
After three doses, white sticky stool completely gone, Spleen/Stomach opened. This case is not intestinal abscess, but Cold retention dysentery. Since other physicians insisted on intestinal abscess, I had to accommodate them gently, shifting from the concept that intestinal abscess has Cold/Heat types to warming/unblocking methods, satisfying both medical propriety and pathology. Hence recorded.
Patient: Intermittent dysentery nearing five years, abdominal masses with pain, stool mixed with dry feces. Pulse wiry-slow, coating gray-white. Deficiency with Cold retention. "Ben Shi Fang" states: Stubborn cold in intestines/stomach causing diarrhea/abdominal pain should first be expelled, then regulated; do not fear deficiency and nurture disease. This case fits. Tentative formula for consideration. Take if believing, do not take if doubting.
Herbs: Shensu (Ginseng Radicle) 3 qian, Shufuzi (Prepared Aconiti Lateralis Radix) 3 qian, Ganjiang (Zingiberis Rhizoma) 2 qian (roasted), Gancao (Glycyrrhizae Radix et Rhizoma) 1.5 qian, Danggui (Angelicae Sinensis Radix) 1.5 qian (wine-fried), Dahuang (Rhei Radix et Rhizoma) 3 qian (wine-fried), Chunghou (Magnoliae Officinalis Cortex) 3 qian, Zhishi (Aurantii Fructus Immaturus) 3 qian (earth-fried), Yuanmingfen (Natrii Sulfas) 2 qian.
Grind to fine powder, make pills with honey water. Take 3 qian daily, delivered with Sharen decoction.
Note by Yuan: When damp-heat in dysentery is not cleared, early use of astringents often prolongs it into intermittent dysentery. Using warming purgation is appropriate. However, Dahuang dosage should be doubled; otherwise, retention will not be removed, nor will it counteract the warming-drying nature of Jiang/Fuzi.
Mr. Zhang, Symptoms change, treatment is not fixed. Dysentery mostly from retention, but opium smokers have inherent Middle Qi deficiency and Kidney Qi damage. Scanty urination indicates Kidney Yang failing to transform; red tongue without coating indicates Kidney Yin/Jin failing to rise. Abdominal pain absent, no retention to trace; Qi sinks downward, Clear Yang falls. Various deficiency signs explain the lingering ineffectiveness. "Having Stomach Qi means life" is ancient wisdom; opium damages Qi, exploitation is feared. Thus, opium-dysentery is difficult for physicians. Patients should cherish themselves and be cautious.
Herbs: Shuditan (Charred Rehmanniae Radix Preparata), Baishao (Paeoniae Radix Alba), Chuanxiongtan (Charred Chuanxiong Rhizoma), Rougui (Cinnamomi Cortex), Zexie (Alismatis Rhizoma), Guishentan (Charred Angelicae Sinensis Radix), Dangshen (Codonopsis Radix - fried with Job's tears), Dongzhu (Atractylodis Rhizoma), Fuling (Poria), Mizhisuqiao (Honey-fried Poppy Capsule).
Note by Yuan: Shudi should not be charred.
Patient: White sticky diarrhea/dysentery, no abdominal pain, deep-fine pulse. This is Cold. Suitable for warming.
Herbs: Wuzhuyu (Evodiae Fructus), Fuling (Poria), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), Paojiang (Zingiberis Rhizoma Preparatum), Liushenqu (Six-Ingredient Medicated Leaven), Jiao Baizhu (Charred Atractylodis Macrocephalae Rhizoma), Hezi (Arecae Semen Preparatum), Wuyao (Linderae Radix), Sharen (Amomi Fructus Rotundus).
Mr. Li, Hejian discusses many heat-type dysenteries, while Jingyue discusses many cold-type dysenteries. This case: abdominal pain not severe, anal distension, tight pulse, cold limbs, no fever, history of Cold Hernia, white coating, no thirst, mostly Cold signs. Follow Jingyue's treatment.
Herbs: Wuzhuyu (Evodiae Fructus), Fuling (Poria), Paojiang (Zingiberis Rhizoma Preparatum), Muxiang (Aucklandiae Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Jiao Liuqu (Charred Medicated Leaven), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus Rotundus).
Mr. Xing: Intermittent dysentery must have retention. Lasting two months, recent fever, damp-heat steaming in intestines/stomach, stool red or white. Transform damp-heat to move Middle Jiao, unblock retention to harmonize Qi/Blood. Do not assume long duration warrants immediate astringency.
Herbs: Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanlian (Coptidis Rhizoma), Baishao (Paeoniae Radix Alba), Muxiang (Aucklandiae Radix), Danggui (Angelicae Sinensis Radix), Fuling (Poria), Guangpi (Citri Reticulatae Pericarpium), Zhatan (Charred Crataegi Fructus), Shengma (Cimicifugae Rhizoma), Zexie (Alismatis Rhizoma), Fangfeng (Saposhnikoviae Radix).
Separately: Zisheng Wan, Buzhong Yiqi Wan, Zhuche Wan in equal parts, mix. Take 3 qian every morning with boiled water.
Mr. Xu: Red dysentery for a month, still abdominal pain and tenesmus. Claims three fevers initially. This is Middle deficiency with exterior pathogen transmitting inward. Now fine pulse, cold limbs, Taiyang Yang Qi weak; difficult urination, Bladder Qi transformation dull. Plan to open Middle Jiao, transform damp-heat, raise Yang and release exterior, a simultaneous interior-exterior resolution.
Herbs: Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Zexie (Alismatis Rhizoma), Chuanlian (Coptidis Rhizoma), Muxiang (Aucklandiae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Dangshen (Codonopsis Radix), Sharen (Amomi Fructus Rotundus), Paojiang (Zingiberis Rhizoma Preparatum), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma).
Mr. Zhang: Post-malaria labor and cold invasion, malaria relapse, plus red dysentery with tenesmus. Middle deficiency with Qi sinking, damp-heat unresolved. Use Baodu San.
Formula: Huoren Baodu San plus Shenqu (Medicated Leaven), Zharon Tan (Charred Crataegi Fructus), Chenpi (Citri Reticulatae Pericarpium).
Mr. Xu: Heat hidden in Ying level, chronic pure bloody dysentery, backache, abdominal pain. Thin white tongue coating, crimson base with purple spots. Damp-heat with Blood stasis. Disease nearing one year, method combines salty-bitter unblocking and astringency.
Herbs: Duzhong (Eucommiae Cortex - salt-water fried), Ejiao (Asini Corii Colla - fried with Chuanlian), Chuanduan (Dioscoreae Nipponicae Rhizoma - salt-water fried), Huangbai (Phellodendri Cortex - salt-water fried), Diyu Tan (Charred Sanguisorbae Radix), Baishao (Paeoniae Radix Alba), Fangfenggen (Saposhnikoviae Radix), Zhi Shengma (Prepared Cimicifugae Rhizoma), Danggui (Angelicae Sinensis Radix), Sheng/Shu Sharen (Raw/Cooked Amomi Fructus Rotundus).
Second visit: Salty-bitter unblocking/astringent agents reduced symptoms, continue previous method with modifications.
Original formula minus Huangbai (Phellodendri Cortex), Fangfeng (Saposhnikoviae Radix), plus Shudi (Rehmanniae Radix Preparata), Danqin (Scutellariae Radix - vinegar-fried), Hetedi (Lotus Pedunculus).
Mr. Gao: Third-stage malaria with little sweat, pathogen not reaching exterior, irregular diet leading to increased diarrhea. Now red and white sticky dysentery. Naturally Qi-deficient and damp-prone constitution,最怕 lingering. Strict diet restriction is urgent.
Herbs: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Chuanxiong (Chuanxiong Rhizoma), Huabinglang (Areca Seed), Laifuzi (Radish Seed), Chenpi (Citri Reticulatae Pericarpium), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Fuling (Poria), Shanhutan (Charred Hawthorn Fruit), Jiao Liuqu (Charred Medicated Leaven), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus Rotundus).
Mr. Jin: Red dysentery for three years, hard immobile mass in left abdomen, painful on pressure, gurgling sound, immediately followed by dysentery. Blood stasis congealed with Cold retention, lingering in intestines. Should use warming purgatives.
Herbs: Cangzhutan (Charred Atractylodis Rhizoma), Chushufu (Cooked Prepared Aconiti Lateralis Radix), Zhishitan (Charred Aurantii Fructus Immaturus), Diyu Tan (Charred Sanguisorbae Radix), Fuling (Poria), Danggui (Angelicae Sinensis Radix), Tongcao (Tetrapanacis Medulla), Taoren (Pruni Persicae Semen - black-fried and ground), Dahuang (Rhei Radix et Rhizoma - wine-fried).
Ren Yuan says: Jiegu's Shaoyao Tang is also an important formula for dysentery. For severe damp-heat retention binding intestines/stomach, purgation opens blockage, preventing pathogen retention and healthy Qi damage. Why did none of the dozens of cases mention it? Perhaps such cases were not encountered. Dysentery, anciently named Chang Pi, is mostly damp-heat in summer/autumn. Pathogen heavy in intestines/stomach, light in meridians forms dysentery; light in intestines/stomach, heavy in meridians forms malaria/latent summer-heat. Sometimes meridians and fu organs simultaneously diseased, with cold/heat/pain/dysentery, initially use bitter-acrid-aromatic-light to unblock and transform. With exterior involvement, Huoren Baodu San. With severe retention and pain, exhaust it with Jiegu Shaoyao Tang. Diseases have cold/heat/deficiency/excess, medicines have tonifying/draining/warming/cooling, not one method covers all. Jinkou Li (inability to eat) is difficult to treat. Damp-heat injures Stomach, pathogen resists, no desire for food. Though many treatments exist, if Middle Qi has foundation, it may be curable. Opium-dysentery is also difficult; long-term opium smoking exhausts Kidney Essence and Spleen Qi first. Once dysentery starts, condition collapses, drugs fail. Initially, if healthy Qi supports, urgently expel pathogen, do not hesitate. After 3-5 days, Zang true Qi injured, Jin/Qi exhausted, cannot purge, cannot tonify, becomes tricky. If pathogen and healthy Qi both urgent, prioritize protecting healthy Qi over expelling pathogen, either warm-tonify Spleen/Stomach or clear-nourish Qi/Jin, assist with 1-2 pathogen-expelling herbs. If tolerated, there is hope. Otherwise, pathogen untransformed, healthy Qi collapses. Do not use astringents early, it is harmful. No astringent is stronger than opium; if opium fails, how can Yuliang, Shizhi, Kewei, Susu, Liupi help? If Yuan Qi and Jin liquid are reliable, pathogen cannot stay, dysentery naturally expels pathogen, pathogen transforms, dysentery stops, inevitable logic. Those unable to tolerate tonification die, and Stomach Qi cannot be relied upon. Healthy people who can eat, even severe cases are treatable. Opium-dysentery injures Spleen/Kidney true Qi; even if eating, only delays death until Stomach fails. Spleen is granary, post-heaven root; Kidney is pre-heaven, key to two yin. Once foundation breaks, divine medicine cannot save. Discussing pulse: wiry-tight-large indicates death, slow-weak indicates life. Must observe what is discharged. If empty straining or purple water/spoiled sauce, even with pain/tenesmus, deficiency signs are prominent. Do not advance bitter-cold damaging Stomach, instead warm-transport Spleen/Kidney, soothe-reach Liver Wood. Wood reaches, Qi rises, pain stops; dysentery follows pain reduction, Stomach Qi wakes. Reaching Wood with Rougui is best, as sweet-slow/acrid-unblocking/dispersing is Yang, best at unblocking depression.