凡杂证之痢，皆由暑湿之积邪，或挟食积所致。伤于气分则痢白，伤于血分则痢赤，气血俱伤赤白兼下。
至产后患此则有不同，治法亦有异，盖多由中气虚而停积也。如产后七日内外，患赤白痢疾、后重频并
最为难治。欲调气行血而推荡痢邪，犹虑产后之元气方虚；欲滋荣益气而大补产虚，又恐反助痢初之邪
盛。其行不损元，补不助邪，惟生化汤去干姜，加以木香、茯苓，名香苓生化汤为善，以其能消恶露，
兼行痢滞也。如痢在七日之外，可酌加芍、连、莲、朴等药。如伤面食、谷食泻痢，先服生化汤加炒神曲。
块痛止，服六君子加麦芽一撮，或炒神曲一钱。如伤肉食泻痢，先服生化汤加山楂、砂仁。块痛止，服
六君子汤加山楂四五枚，砂仁四分，炒神曲一钱。如半月外患赤痢后重，归芍连壳饮。如脾气虚弱泻痢，
四肢浮肿，宜六
君子汤加木香、肉果面煨，合五皮散。如泻痢黄色，乃脾土正气虚耳，宜补中益气汤加木香四分，肉果
一枚，煨。如胃气虚弱泻痢，完谷不化，当温助胃气，及产后泻痢日久后重者，并宜服加味六君子汤。
大凡产后赤痢去血多，姜、砂、木香之类不可多用，热则血愈行。倘血痢日久不止者，血虚也，宜四物
汤加荆芥、人参，或用人参五钱，香连丸一钱，同为末下。凡诸证兼呕吐，皆宜加藿香五分。痰，加制
半夏八分。兼小便短涩，引加灯心三十寸。且灯心利水而不伤阴，况产后津液已亏，兼之泻痢伤阴复伤
津液，小便理宜短少，故止用灯心足矣，不可用利水伤阴之药也。如胎前下痢，产后不止，伏龙肝汤丸
治之。又有白头翁加甘草阿胶汤，治产后痢不止。冯氏云∶产后腹痛泻痢，若非外因所伤，乃属肾气亏
损，阳虚不能生土，阴虚不能闭藏耳，必用四神、八味补肾。倘误投分利导水之剂，是益其虚。但泻痢
之证，非脾即肾。如病在肾，所谓补脾不如补肾。如病在脾，自又补肾不如补脾也。圆机活法，在临
证定之耳。
香苓生化汤 治产后七日内患赤白痢。
川芎（二钱） 当归（五钱） 炙草（五分） 桃仁（十粒，去皮尖） 茯苓（一钱） 陈皮（四
分） 木香（一分）
水煎服。如红痢腹痛，加砂仁三分。七日外，可加白芍、黄连、炒莲肉、制浓朴各五分。
归芍连壳饮 治产后半月外，患赤痢后重。
川芎（一钱五分） 当归（三钱） 白芍（酒炒） 茯苓（各一钱） 黄连（六分，姜汁炒）
枳壳（五分，麸炒） 甘草（四分） 木香（三分）
水煎服。
五皮散 治产后风湿伤脾，气血凝滞，以致面目虚浮，四肢肿胀气喘。
陈皮 桑皮 姜皮 茯苓皮 大腹皮（黑豆水制净。各一钱）
水煎服。
香连丸 治下痢赤白，脓血相杂，里急后重。
黄连（二十两，吴萸十两，同炒，去吴萸） 木香（四两八钱，不见火）
醋糊丸，米饮下。一方等分，蜜丸。一方加甘草八两，黄连用蜜水炒，蒸晒九次，入木香为丸。
伏龙肝汤丸 治胎前下痢产后不止，及元气大虚，瘀积小腹结痛，不胜攻击者。
山楂肉（一两，炮黑） 黑糖（二两，熬枯）
二味，一半为丸，一半为末，用伏龙肝二两，煎汤代水。煎前末二钱，送前丸二钱，日三夜二服，
一昼夜令尽。气虚，加人参二三钱驾驭之。虚热，加炮姜、肉桂、茯苓、炙甘草。兼感风寒，加葱白、香豉。
膈气不舒，磨沉香数匙，调服。
生化汤（见本卷生化汤论后。） 六君子汤 补中益气汤（俱见上卷诸痛门。） 加味
六君子汤（见本卷泄泻门。） 四物汤（见上卷安胎门。） 白头翁加甘草阿胶汤（见上卷
痢门。） 四神丸（见上卷腹痛门。） 八味丸（见上卷诸痛门，附六味地黄汤下。）
凡是非产后的杂病痢疾，都是由暑湿之邪积聚，或者夹杂食积所导致。伤及气分则排出白色脓液，伤及血分则排出红色血液，气血俱伤则赤白脓血兼下。
到了产后患此病则情况不同，治疗方法也有差异，大多是因为中气虚弱导致积滞停留。比如产后七日内外，患上赤白痢疾、里急后重频繁发作，是最难治疗的。想要调气行血以推荡痢疾邪气，又担心产后元气刚刚虚弱；想要滋养营血益气以大补产后虚损，又恐怕反而助长痢疾初起时的邪气亢盛。那种既损伤元气、又不助长邪气的治法，只有用生化汤去掉干姜，加入木香、茯苓，名为香苓生化汤最为妥当，因为它能消除恶露，同时通行痢疾积滞。如果痢疾在七日之后，可以酌情加入芍药、黄连、莲子肉、厚朴等药物。如果是食用面食、谷食导致的泻痢，先服用生化汤加炒神曲。块状疼痛停止后，服用六君子汤加一撮麦芽，或者加一钱炒神曲。如果是食用肉食导致的泻痢，先服用生化汤加山楂、砂仁。块状疼痛停止后，服用六君子汤加山楂四五枚，砂仁四分，炒神曲一钱。如果在半月后患上赤痢且伴有里急后重，使用归芍连壳饮。如果是脾气虚弱导致的泻痢，四肢浮肿，适宜用六君子汤加木香、煨肉豆蔻，配合五皮散。如果泻痢颜色发黄，这是脾土正气虚弱所致，适宜用补中益气汤加木香四分，肉豆蔻一枚，煨制。如果是胃气虚弱导致的泻痢，完谷不化，应当温补助益胃气，以及产后泻痢日久伴有里急后重的，都适宜服用加味六君子汤。
大凡产后赤痢失血较多，生姜、砂仁、木香之类不可多用，因为热性会使血液运行加速。倘若血痢日久不止，是血虚的表现，适宜用四物汤加荆芥、人参，或者用人参五钱，香连丸一钱，共同研为细末冲服。凡是各种证候兼有呕吐的，都适宜加藿香五分。有痰的，加制半夏八分。兼有小便短少涩滞的，另加灯心草三十寸。而且灯心草利水而不伤阴，何况产后津液已经亏损，再加上泻痢伤阴又伤津液，小便理应短少，所以只用灯心草就足够了，不可使用利水而伤阴的药物。如果是胎前下痢，产后仍不止，用伏龙肝汤丸治疗。又有白头翁加甘草阿胶汤，治疗产后痢疾不止。冯氏说：产后腹痛泻痢，如果不是外因所伤，属于肾气亏损，阳虚不能生养脾土，阴虚不能固摄闭藏，必须用四神丸、八味丸补肾。如果误投分利导水的药剂，是更加其虚。但泻痢之证，不是脾就是肾。如果病在肾，所谓补脾不如补肾。如果病在脾，自然又是补肾不如补脾。圆机活法，在于临证时根据具体情况决定罢了。
香苓生化汤 治疗产后七日内患赤白痢。
川芎（二钱） 当归（五钱） 炙甘草（五分） 桃仁（十粒，去皮尖） 茯苓（一钱） 陈皮（四分） 木香（一分）
水煎服。如果是红痢腹痛，加砂仁三分。七日之后，可加白芍、黄连、炒莲子肉、制厚朴各五分。
归芍连壳饮 治疗产后半月外，患赤痢伴里急后重。
川芎（一钱五分） 当归（三钱） 白芍（酒炒） 茯苓（各一钱） 黄连（六分，姜汁炒） 枳壳（五分，麸炒） 甘草（四分） 木香（三分）
水煎服。
五皮散 治疗产后风湿伤脾，气血凝滞，以致面目虚浮，四肢肿胀气喘。
陈皮 桑白皮 生姜皮 茯苓皮 大腹皮（黑豆水制净。各一钱）
水煎服。
香连丸 治疗下痢赤白，脓血相杂，里急后重。
黄连（二十两，吴茱萸十两，同炒，去吴茱萸） 木香（四两八钱，不见火）
醋糊为丸，米饮送下。另一配方等分，蜜丸。另一配方加甘草八两，黄连用蜜水炒，蒸晒九次，入木香为丸。
伏龙肝汤丸 治疗胎前下痢产后不止，及元气大虚，瘀积小腹结痛，不胜攻伐者。
山楂肉（一两，炮黑） 黑糖（二两，熬枯）
这两味药，一半制成丸剂，一半制成散剂，用伏龙肝二两，煎汤代水。煎前散剂二钱，送服前丸剂二钱，日服三次夜服两次，一昼夜服完。气虚，加人参二三钱驾驭之。虚热，加炮姜、肉桂、茯苓、炙甘草。兼感风寒，加葱白、香豉。膈气不舒，磨沉香数匙，调服。
生化汤（见本卷生化汤论后。） 六君子汤 补中益气汤（俱见上卷诸痛门。） 加味六君子汤（见本卷泄泻门。） 四物汤（见上卷安胎门。） 白头翁加甘草阿胶汤（见上卷痢门。） 四神丸（见上卷腹痛门。） 八味丸（见上卷诸痛门，附六味地黄汤下。）
All dysenteries arising from miscellaneous diseases are caused by the accumulation of summerheat-dampness pathogens, or by food stagnation. When the qi level is injured, white discharge occurs; when the blood level is injured, red discharge occurs; when both qi and blood are injured, red and white discharges occur together.
However, dysentery occurring postpartum differs in nature, and its treatment methods also vary, as it is mostly due to deficiency of middle qi leading to stagnation. For instance, within seven days after delivery, if one suffers from red-and-white dysentery with frequent tenesmus (a feeling of incomplete defecation), it is extremely difficult to treat. If one attempts to regulate qi and move blood to expel the dysenteric pathogen, there is concern that the postpartual yuan qi (vital energy) is too deficient; if one attempts to nourish blood and tonify qi to greatly supplement postpartual deficiency, there is fear that this might exacerbate the initial excess of the dysenteric pathogen. The method that neither damages the yuan qi nor aids the pathogen is to use Shenghua Tang (Life-Restoring Decoction) without Dried Ginger, adding Xiangxiang (Aucklandiae Radix) and Fuling (Poria), named Xiangling Shenghua Tang. This is considered optimal because it can eliminate lochia while promoting the movement of dysenteric stagnation. If dysentery persists beyond seven days, Shaoyao (Paeoniae Radix Alba), Huanglian (Coptidis Rhizoma), Lianrou (Lotus Seed Cotyledon), and Houpo (Magnoliae Officinalis Cortex) may be added according to discretion. If diarrhea and dysentery result from consuming wheat products or grains, first administer Shenghua Tang with Chao Shenqu (Fried Medicated Leaven). Once cramping pain subsides, administer Liujunzi Tang (Six Gentlemen Decoction) with a pinch of Maiya (Hordei Fructus Germinatus) or one qian of Chao Shenqu. If diarrhea and dysentery result from consuming meat, first administer Shenghua Tang with Shanzha (Crataegi Fructus) and Sharen (Amomi Fructus). Once cramping pain subsides, administer Liujunzi Tang with four or five Shanzha fruits, four fen of Sharen, and one qian of Chao Shenqu. If red dysentery with tenesmus occurs more than half a month later, use Guishao Lianqiao Yin (Angelica and Peony with Coptis Decoction). If diarrhea and dysentery are due to spleen qi deficiency accompanied by edema of the four limbs, Liujunzi Tang with Xiangxiang and Wei Rougu (Baked Myristica Semen) combined with Wupi San (Five Peel Powder) is appropriate. If the stool is yellow, this indicates deficiency of spleen earth qi; Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction) with four fen of Xiangxiang and one baked Rougu is suitable. If diarrhea and dysentery are due to stomach qi deficiency resulting in undigested food in stool, warming and assisting stomach qi is required. For postpartual diarrhea and dysentery persisting for a long time with tenesmus, Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction) is appropriate.
Generally, in postpartual red dysentery where blood loss is significant, ginger, Sharen, and Xiangxiang should not be used excessively, as heat promotes blood flow. If bloody dysentery persists for a long time without stopping, it indicates blood deficiency; Siwu Tang (Four Substances Decoction) with Jingjie (Schizonepetae Herba) and Renshen (Ginseng Radix et Rhizoma) is suitable, or five qian of Renshen mixed with one qian of Xianglian Wan (Aucklandia and Coptis Pill) taken as powder. For any syndrome accompanied by vomiting, add Huoxiang (Agastaches Herba) five fen. For phlegm, add Zhi Banxia (Prepared Pinellia Tuber) eight fen. For short and scanty urination, add Dengxincao (Junci Medulla) thirty cun. Dengxincao promotes diuresis without damaging yin. Moreover, postpartual fluids are already depleted, and diarrhea/dysentery further damages yin and fluids; thus, urine should naturally be scanty. Therefore, using only Dengxincao is sufficient; diuretics that damage yin should not be used. If dysentery occurred during pregnancy and continues postpartum, Fulonggan Tang Wan (Dragon's House Soil Decoction Pills) is used. Additionally, Baitouweng Jia Gancao Ejiao Tang (Baitouweng Decoction with Licorice and Donkey-Hide Gelatin) treats persistent postpartual dysentery. Feng Shi stated: Postpartual abdominal pain with diarrhea and dysentery, if not caused by external factors, belongs to kidney qi deficiency. Yang deficiency fails to generate spleen earth, and yin deficiency fails to secure and store. Thus, Sishen Wan (Four Miracles Pill) and Bawei Wan (Eight Flavor Pill) must be used to tonify the kidney. If misdiagnosed and treated with draining and water-guiding agents, the deficiency will worsen. Dysentery syndromes involve either the spleen or the kidney. If the disease is in the kidney, "tonifying the kidney is better than tonifying the spleen." If the disease is in the spleen, "tonifying the spleen is better than tonifying the kidney." Flexible application depends on clinical judgment.
Xiangling Shenghua Tang treats red-and-white dysentery within seven days postpartum.
Chuanxiong (2 qian), Danggui (5 qian), Zhigancao (0.5 qian), Taoren (10 kernels, peeled and deseeded), Fuling (1 qian), Chenpi (0.4 qian), Muxiang (0.1 qian).
Decoct in water and take orally. For red dysentery with abdominal pain, add Sandoukou (3 fen). Beyond seven days, add Baishao, Huanglian, Chao Lianrou, and Zhi Houpo (each 5 fen).
Guishao Lianqiao Yin treats red dysentery with tenesmore than half a month postpartum.
Chuanxiong (1.5 qian), Danggui (3 qian), Baishao (wine-fried), Fuling (each 1 qian), Huanglian (6 fen, fried with ginger juice), Zhike (5 fen, bran-fried), Gancao (4 fen), Muxiang (3 fen).
Decoct in water and take orally.
Wupi San treats postpartual wind-damp injuring the spleen, causing qi-blood stagnation, resulting in facial puffiness, limb swelling, and asthma.
Chenpi, Sangbipi, Jiangpi, Fulingpi, Dafupi (processed with black bean water until clean. Each 1 qian).
Decoct in water and take orally.
Xianglian Wan treats dysentery with red and white discharge, mixed pus and blood, and tenesmus.
Huanglian (20 liang, stir-fried with 10 liang of Wuzhuyu, then discard Wuzhuyu), Muxiang (4.8 liang, not exposed to fire).
Form pills with vinegar paste, take with rice water. Another formula uses equal parts, formed into honey pills. Another formula adds 8 liang of Gancao; Huanglian is stir-fried with honey water, steamed and sun-dried nine times, then mixed with Muxiang to form pills.
Fulonggan Tang Wan treats dysentery starting prenatally and continuing postpartum, as well as severe yuan qi deficiency, blood stasis accumulating in the lower abdomen causing painful masses, which cannot withstand aggressive treatment.
Shanzharou (1 liang, charred), Heitang (2 liang, boiled until dry).
These two ingredients: half are made into pills, half into powder. Use 2 liang of Fulonggan (Dragon's House Soil) decocted in water as the vehicle. Take 2 qian of the powder with 2 qian of the pills, three times daily and twice at night, completing the dose within one day and night. For qi deficiency, add 2-3 qian of Renshen to guide the action. For deficiency heat, add Paojiang (Charred Ginger), Rougui (Cinnamon Bark), Fuling, and Zhigancao. For concurrent wind-cold, add Congbai (Scallion White) and Xiangchi (Fermented Soybean). For chest oppression, grind Chenxiang (Aquilaria Wood) and take with the mixture.
Shenghua Tang (see discussion on Shenghua Tang in this volume).
Liujunzi Tang (Six Gentlemen Decoction).
Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction) (both see Volume Upper, Section on Various Pains).
Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction) (see Section on Diarrhea in this volume).
Siwu Tang (Four Substances Decoction) (see Volume Upper, Section on Fetal Protection).
Baitouweng Jia Gancao Ejiao Tang (Baitouweng Decoction with Licorice and Donkey-Hide Gelatin) (see Volume Upper, Section on Dysentery).
Sishen Wan (Four Miracles Pill) (see Volume Upper, Section on Abdominal Pain).
Bawei Wan (Eight Flavor Pill) (see Volume Upper, Section on Various Pains, attached under Liuwei Dihuang Tang).