论痢下通治 论火泻通治 论下血通治
天师曰∶通治者，因其通而通之也。如人病下痢者是。痢疾之症，多起于暑天之郁热，而又感以
水湿雨露之气以成之。红白相见，如血如脓，甚者如屋漏水，如鱼冻水，里急后重，崩迫痛疼，欲下而不
能，不下而不快，一日数十行，或一夜数百行，或日夜数千行，气息奄奄，坐而待死，此通之病也。若骤
止其邪，则死生顷刻；不止其邪，则危绝如丝；欲补其气，则邪气转加；欲清其火，则下行更甚。此时
惟有因势利导之法，可行于困顿之间。或疑人已气虚血败，更加利导，必致归阴。不知邪气一刻
不去，则正气一刻不安。古人之痢疾无止法，信不诬也。方用白芍三两，当归三两，萝卜子一两，枳壳三
钱，槟榔三钱，甘草三钱，车前子三钱，水煎服。一剂即止，二剂全安，可用饮食矣。（〔批〕此方前
已有了，止分两不同耳。多车前子一味。）此方之奇而妙者，全在用白芍、当归。盖水泻最忌当归
之滑，而痢疾最喜其滑也；芍药味酸，入肝以平木，使木不敢再侵脾土；又有枳壳、槟榔，消逐其湿热之
邪；又加车前，分利其水湿，而又不耗真阴之水，所以功胜于茯苓也。尤奇者，在用萝卜子一味，世多不
解。盖萝卜子味辣，而能逐邪去湿，而又能上下通达，消食利气，使气行于血分之中，助归、芍以生新
血，而祛荡其败瘀也。少加甘草以和中，则无过烈之患。此奏功之神奇，实有妙理耳。
张公曰∶固然奇妙通权。通因通用，痢疾立论，最为妥当。然而通因之法，不止痢疾也，水泻亦是，
下血亦是也。水泻者，人见其如潮而来，如瀑而下，皆曰急宜止之，以免亡阴之症，用粟壳、莺粟、乌梅之
类止之。其论则是，其治则非也。水泻虽不比痢疾之断不可止，然而水泻之中，亦有不可遽止之病，如疼痛
于腹中，后重于门口，皆是有火而泻，不比虚寒之直泻，俱当用通因之法治之。方用人参三钱，车前一
两，白芍三钱，槟榔一钱，甘草一钱治之。此方之妙，妙在车前以滑之，而又佐以槟榔之去积，自然有
滞皆行。况车前性虽滑而能分消水谷，则水气自然分开。第大泻之后，自然亡阴，又用人参以补气，则气
足而阴自生。又虑久泻自然亏中，又加甘草以和之。虽是通因之法，实乃扶正之方。
下血之症，其人之血虚，不言可知，似乎宜补其血矣。然而血之下也，必非无故，非湿热之相侵，即酒毒
之深结，若不逐去其湿热酒毒，而徒尚止涩之味，吾未见其下血之能止也。方用熟地一两，地榆三钱，白
芍三钱，当归三钱，黄连三钱，甘草一钱，葛根一钱，柞树枝五钱，水煎服。（〔批〕解酒散火汤。）
一剂必下血更多，二剂略少，三剂全愈。盖此病不用通因之法，永不奏功，必如此而能愈也。方中妙在用
熟地、当归、芍药以生新血，新血生则旧血必去。又妙在地榆以凉大肠，用柞木以去酒毒，所以相济而成
功也。此二方亦通因之妙用，人亦亟宜知之。
华君曰∶同。
雷公曰∶通因通用，张公补论之，尤为酣畅，我无以赞一言。虽然，尚有一说。在大泻之后，虽是火
泻，毕竟宜温补之，以生其阴。泻一止，即宜用四物汤，加人参、炮姜以温补。而不可谓水泻忌滑，而禁
用归、熟也。
（痢症按昔贤谓如屋漏水者，为不治症∶鱼冻水者，为虚寒症。后方恐宜酌用，李子永识。）
天师说：所谓“通治”，就是顺应其通泄的病势而加以疏导治疗。比如人患下痢（腹泻伴有脓血）就是这样。痢疾这种病症，多起于暑天的郁热，又感受了水湿雨露之气而形成。大便中红白相间，像血又像脓，严重的像屋顶漏下的雨水，像鱼冻化的水，伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽），崩迫疼痛，想排便却排不出，不排又不痛快，一天几十次，或者一夜几百次，甚至日夜几千次，气息微弱，坐着等待死亡，这就是需要“通”的病证。如果突然强行止住邪气，则生死只在顷刻之间；如果不祛除邪气，病情就会危重如游丝；想要补气，邪气反而加重；想要清热泻火，下行症状会更严重。这个时候只有因势利导的方法，才能在困顿之中施行。有人怀疑病人已经气虚血败，再加以利导，必然导致死亡。却不知道邪气一刻不去除，正气就一刻不得安宁。古人治疗痢疾没有固定的止涩之法，确实不是虚假的。方剂用白芍三两，当归三两，萝卜子一两，枳壳三钱，槟榔三钱，甘草三钱，用水煎服。一剂就能止住，两剂完全康复，可以进食了。（批注：这个方子前面已经有了，只是分量不同罢了。多加了一味车前子。）这个方子的奇妙之处，全在于使用白芍和当归。一般来说，水泻最忌讳当归的滑利，但痢疾最喜欢它的滑利；芍药味酸，入肝经以平抑肝木，使肝木不敢再侵犯脾土；又有枳壳、槟榔，消除驱逐湿热之邪；再加上车前子，分利水湿，而且不耗损真阴之水，所以功效胜过茯苓。尤其奇妙的是，使用萝卜子这一味药，世人大多不理解。因为萝卜子味辣，能驱逐邪气去除湿气，又能上下通达，消食理气，使气行走在血分之中，辅助归、芍生成新血，从而荡涤败瘀。少加甘草来调和脾胃，就没有过于猛烈的祸患。这个方子奏效的神奇，实在是有妙理在其中。
张公说：确实奇妙且懂得变通。“通因通用”（即用通利的方法治疗具有通泄症状的病证），针对痢疾立论，最为妥当。然而“通因”的方法，不仅仅适用于痢疾，水泻也是，下血也是。水泻的人，看到它如潮水般涌来，如瀑布般落下，都说急需止住，以免出现亡阴的症状，使用粟壳、罂粟、乌梅之类的药物来止泻。这种理论是对的，但治疗方法却是错的。水泻虽然不像痢疾那样绝对不可止，但在其中也有不能立即止住的病证，比如腹部疼痛，肛门重坠，这都是因为有火邪而导致的腹泻，不同于虚寒性的直接腹泻，都应当用“通因”的方法来治疗。方剂用人参三钱，车前子一两，白芍三钱，槟榔一钱，甘草一钱来治疗。这个方子的妙处，妙在用车前子的滑利，又辅以槟榔去除积滞，自然有停滞都能通行。况且车前子性虽滑利却能分消水谷，那么水气自然分开。只是在大泻之后，自然会亡阴，又用人参来补气，那么气充足而阴液自然生成。又担心久泻自然亏损中气，又加甘草来调和。虽然是“通因”的方法，实际上是扶正固本的方剂。
下血的病症，病人的血虚是不言自明的，似乎应该补血了。然而血之下行，必定不是无缘无故的，如果不是湿热相侵，就是酒毒深结，如果不驱逐去湿热酒毒，而仅仅崇尚止涩的药物，我没见过下血能停止的。方剂用熟地黄一两，地榆三钱，白芍三钱，当归三钱，黄连三钱，甘草一钱，葛根一钱，柞树枝五钱，用水煎服。（批注：解酒散火汤。）一剂必然下血更多，二剂略少，三剂完全痊愈。因为这个病不用“通因”的方法，永远无法奏效，必须这样才能痊愈。方中的妙处在于使用熟地、当归、芍药来生成新血，新血生成了旧血必然去除。又妙在地榆来凉血止血作用于大肠，用柞木来去除酒毒，所以相互济助而成功。这两个方子也是“通因”的妙用，人们也应当急切地了解。
华君说：相同。
雷公说：“通因通用”，张公补充论述，尤为酣畅淋漓，我没有什么可赞美的话。虽然如此，还有一说。在大泻之后，即使是火泻，毕竟适宜温补，以滋生阴液。泻一停止，就应当使用四物汤，加入人参、炮姜来温补。而不能说水泻忌讳滑利，就禁止使用当归、熟地黄。
（痢症按语：以前的贤者认为像屋漏水一样的痢疾，属于不治之症；像鱼冻水一样的，属于虚寒症。后面的方子恐怕应当斟酌使用，李子永识。）
Discussion on the General Treatment of Dysentery, Discussion on the General Treatment of Fire Diarrhea, Discussion on the General Treatment of Hematochezia
The Heavenly Master said: The so-called "general treatment" (Tong Zhi) refers to treating by following and guiding the pathological trend of unblocking. This is exemplified by patients suffering from dysentery (Li Ji). Dysentery typically originates from stagnant heat in summer, compounded by the invasion of dampness from water, dew, and rain. Stools appear with red and white mixed, resembling blood and pus. In severe cases, it resembles leaking roof water or melting fish jelly, accompanied by tenesmus (Li Ji Hou Zhong), urgent and painful defecation, a desire to defecate but inability to do so, and discomfort if not defecated. It may occur dozens of times a day, hundreds of times a night, or even thousands of times day and night. The patient's breath becomes faint, sitting and awaiting death. This is a condition requiring "unblocking." If one suddenly stops the pathogenic factor, life and death hang in the balance; if the pathogen is not expelled, the condition becomes critical like a gossamer thread; if Qi is tonified, the pathogenic factor intensifies; if fire is cleared, the downward flow worsens. At this time, only the method of "following the momentum to guide" (Yin Shi Li Dao) can be applied amidst the crisis. Some doubt that since the patient already suffers from Qi deficiency and blood deterioration, adding unblocking measures will inevitably lead to death. They fail to realize that as long as the pathogen remains for a moment, Zheng Qi (Upright Qi) cannot find peace. The ancients' approach to dysentery without fixed astringent methods is indeed truthful. The prescription uses Bai Shao (Radix Paeoniae Alba) 3 liang, Dang Gui (Radix Angelicae Sinensis) 3 liang, Luo Bo Zi (Semen Raphani) 1 liang, Zhi Qiao (Pericarpium Citri Reticulatae Viride) 3 qian, Bing Lang (Areca Seed) 3 qian, Gan Cao (Radix Glycyrrhizae) 3 qian, Che Qian Zi (Semen Plantaginis) 3 qian, decocted in water and taken orally. One dose stops the symptoms, two doses ensure full recovery, and diet can be resumed. (Comment: This formula was presented earlier, differing only in dosages. It adds Che Qian Zi.) The marvel of this formula lies entirely in the use of Bai Shao and Dang Gui. Generally, water diarrhea contraindicates the slippery nature of Dang Gui, but dysentery favors its slipperiness; Shao Yao (Paeonia Root) is sour, enters the Liver channel to pacify Wood, preventing Wood from invading Spleen Earth; Zhi Qiao and Bing Lang eliminate damp-heat pathogens; Che Qian Zi separates and drains dampness without consuming True Yin fluids, thus outperforming Fu Ling (Poria). Particularly ingenious is the use of Luo Bo Zi, which many do not understand. Luo Bo Zi is pungent, expelling pathogens and dampness, promoting circulation up and down, resolving food stagnation and regulating Qi. It allows Qi to move within the Blood level, assisting Dang Gui and Shao Yao in generating new blood and sweeping away stale stasis. A small amount of Gan Cao harmonizes the Middle Jiao, preventing excessive harshness. The miraculous efficacy of this formula is based on profound principles.
Master Zhang said: Indeed, it is marvelous and flexible. "Treating obstruction with unblocking" (Tong Yin Tong Yong), when established for dysentery, is most appropriate. However, the method of "Tong Yin" is not limited to dysentery; it also applies to water diarrhea and hematochezia. In water diarrhea, seeing it surge like a tide and fall like a waterfall, people say it must be stopped immediately to prevent Yin collapse, using substances like Su Ke (Cortex Pyri), Ying Su (Papaveris Fructus), and Wu Mei (Fructus Mume). While the theory is correct, the treatment is flawed. Although water diarrhea is not absolutely non-astringent like dysentery, there are cases where immediate cessation is inadvisable, such as abdominal pain and rectal tenesmus, indicating diarrhea caused by Fire rather than deficiency-cold straight diarrhea. These should all be treated with the "Tong Yin" method. The prescription uses Ren Shen (Radix Ginseng) 3 qian, Che Qian Zi 1 liang, Bai Shao 3 qian, Bing Lang 1 qian, Gan Cao 1 qian. The妙 (wonder) of this formula lies in using Che Qian Zi's slipperiness, assisted by Bing Lang to remove accumulation, ensuring natural movement of stagnation. Moreover, although Che Qian Zi is slippery, it separates and dissipates water and grain, naturally separating water qi. After severe diarrhea, Yin loss is inevitable; Ren Shen tonifies Qi, so sufficient Qi generates Yin. Concerning chronic diarrhea depleting the Middle, Gan Cao is added to harmonize. Though it is a "Tong Yin" method, it is essentially a formula to support Zheng Qi.
Regarding hematochezia, the patient's Blood deficiency is self-evident, suggesting Blood tonification is needed. However, bleeding does not occur without cause; it is either due to damp-heat invasion or deep accumulation of alcohol toxicity. If one does not expel damp-heat and alcohol toxins but merely relies on astringents, I have never seen hematochezia stop. The prescription uses Shu Di Huang (Radix Rehmanniae Preparata) 1 liang, Di Yu (Sanguisorbae Radix) 3 qian, Bai Shao 3 qian, Dang Gui 3 qian, Huang Lian (Rhizoma Coptidis) 3 qian, Gan Cao 1 qian, Ge Gen (Puerariae Lobatae Radix) 1 qian, Zao Zhi (Ramulus Quercus Mongolicae) 5 qian, decocted in water and taken orally. (Comment: Jie Jiu San Huo Tang.) One dose causes more bleeding, two doses reduce it slightly, three doses cure completely. This disease will never respond without the "Tong Yin" method; only thus can it heal. The formula's brilliance lies in using Shu Di, Dang Gui, and Shao Yao to generate new blood; once new blood is generated, old blood is expelled. Also brilliant is Di Yu cooling the Large Intestine and Zao Mu removing alcohol toxins, working in synergy. These two formulas are also masterful applications of "Tong Yin," which people should urgently understand.
Master Hua said: Agreed.
Master Lei said: "Treating obstruction with unblocking," supplemented by Master Zhang, is particularly thorough; I have nothing to add. Nevertheless, there is another point. After severe diarrhea, even if it is fire diarrhea, warm tonification is suitable to generate Yin. Once diarrhea stops, Si Wu Tang (Four Substances Decoction) should be used, added with Ren Shen and Pao Jiang (Prepared Ginger Rhizome) for warm tonification. One should not claim that water diarrhea contraindicates slipperiness and thus forbid the use of Dang Gui and Shu Di.
(Note on Dysentery: Ancient sages considered dysentery resembling "leaking roof water" as incurable; that resembling "fish jelly water" as deficiency-cold. The latter formulas should probably be used with discretion. Recorded by Li Zi Yong.)