痢疾一证，其所下者，或赤或白，或脓或血，或脓血相杂，或痛或不痛，必里急后重，数至圊而
不能便。有呕恶胀满者，有噤口不食者，有寒热往来者。景岳论此症，当分表、里、寒、热、虚、实
施治。其言曰∶凡邪因表者，必有表症，当兼解其表，表邪解而痢自愈。又嘉言谓∶外感暑、热、湿
三气之邪，而成下痢，必宜首用辛凉，以解其表，次用
苦寒，以清其里。失于表者，外邪但从里出，不死不休。故虽百日之远，仍用逆流挽舟之法，引其邪
而出之于外，则死症可活。此论治表之说也。景岳云∶痢发夏秋，本因溽暑，岂曰非热？惟因热者求
凉，而过饮冰水，纵食生冷，未及郁积，随触而痢者，岂郁热耶？又士材云∶余治一妇，下痢四十
日，口干发热，饮食不进，腹中胀闷，完谷不化、尚有谓邪热不杀谷者，计服香、连、枳、朴三十余剂，
绝谷五日。命在须臾。诊其脉大而数，按之豁然中空，询得腹痛而喜手按，小便清利。此火衰不能生
土，内真寒而外假热也。遂用附子理中汤，冷次一剂而痛止，六剂而身凉食进，兼服八味丸，二十余日
而愈。此论痢间有属寒之说也。景岳云∶今之病痢疾者，虚常六、七，而医之治痢者，补无一、二，气
本陷矣，而再行其气，后重不益甚乎？中本虚矣，而复攻其积，元气不愈竭乎？湿热伤血，自宜调血，
若过用推陈，血愈伤矣！津亡作渴，自宜生津，若专于渗利，津愈耗矣！庸工专守痛无补法，不知因虚
而痛者。愈攻则愈痛矣。且虚而当补，自有所据。凡脉息微弱者可补，形体虚羸者可补，胸膈宽快者可
补，病后而痢者可补，因攻而剧者可补。然而尤有至要者则在脾肾两脏。如先泻而后痢者，脾传肾为贼
邪，难疗，先痢而后泻者，肾传脾为微邪，易治。经曰∶肾者，胃之关也，又肾开窍于二阴，故下多则阴
亡。未有久痢而肾不伤者。故治痢不知补肾，非其治也。
凡四君、归脾、补中，皆补脾虚，未尝不善，若病火衰，设非桂、附大补命门真阳，以救脾家之母，则
饮食何由而进，门户何由而固，真元何由而复耶？又赵氏谓∶病本热痢，迁延日久，各症不减，或反加
重，理当别治，竟作虚痛，〔愚谓必先曾用通泄寒凉等药太过，症变虚寒，口不渴而喜热饮，小便清而
不赤涩，下利水谷而澄彻清冷，腹痛绵绵，而手按即止，四肢厥冷，脉微沉细，见诸脉症，方可议投温
补，又必先以温药小剂探之，如得中病而止。〕须用补中益气，一升一补。如少腹重坠，切痛奔豚，此
兼属少阴症，合四神丸，去五味，加肉桂，甚加附子。如有纯血者，加炒黑干姜，虚回而痢自止。此论痢
亦有温补之说也。余每观昔贤诸论，始则中心喜焉，诵而识焉，乃阅历久之久之而卒少见者，岂诸贤欺我
哉！因寤寐思之，久而恍然。知古人乃究病情之变幻，恐后人明于此而不明于彼，或误治遗祸，原非
常有之症。乃世之医者，不深察其旨，往往好奇自高，不辨寒、热、虚、实，一遇痢疾概用理中，桂、
附，竟为家常茶饭，不用操刃，沿门被戮，接踵死亡，乃尤谓如此大剂温补，而弗能挽回，此真天命使
然。噫！岂不谬哉。独不考之，河间云∶古以赤痢为热，白痢为寒，果尔则赤白相兼者，岂寒热同病乎！
又言白痢为寒，则当不能消谷，何由反化为脓耶？故凡谷消化者，无问色及他症，便为热也。丹溪亦
言∶赤痢自小肠来，白痢自大肠来，皆湿热为本。沈氏则辨谓∶邪伤大小肠气分则痢白，邪伤大小肠血
分则痢血，
甚为明确。戴氏云∶痢虽有赤白二色，终无寒热之分，通作湿热处治，但分新旧虚实，与赤白带同
治。《原病式》曰∶病本湿热，然竟有用辛热药而得愈。盖病之微者，得辛热则郁结开通，气和而愈，甚
者，其病转极。吕晚村言痢疾与伤寒不同，颇有口不渴，喜热饮，小便清，身不热，腹喜热手熨，而仍
属火症者。所以仲淳立论则曰∶凡治滞下与滑泄自利不同，滑泄自利不止，有可涩之道。若夫滞下，本属湿
热涩滞不行，法宜清热疏利之药，忌兜涩。大肠与肺为表里，大肠既有湿热留滞，则肺家必有热，肺气
喜通利，恶闭涩，倘误投止涩，使湿热无所宣泄，肺气不得下行，非惟滞下转增，湿热熏蒸，上干乎肺，
则胀闷气逆，不眠不食，诸症至矣。王宇泰论此症最为险恶，生死所关，不惟时医治之无术，而古今治
法千家，多不得窍，是以不能速收全效。余经二十余年，颇有妙悟，百试百效，然后能破诸家之迷障，
而为奇妙之方。论曰∶古人治痢，皆曰热则清之，寒则温之，初起热盛则下之，有表症则汗之，小便赤涩
则分利之。此五者举世信用，若规矩准绳之不易者。予独谓五者惟清热一法无忌。其四法则犯大忌，必不
可用。一忌温补。痢之为病，乃湿热蕴积，胶滞于肠胃之中，清邪热，导滞气，行瘀血。则其病速除。若
即用参、术等温补，则热愈盛，气愈滞，而血亦凝。久之正气虚，则邪气犹炽；缠绵不已，欲补而涩之，则
助邪。清而疏之，则愈滑。遂至不可救疗者，初投温补之祸也。一忌大下，痢自邪热胶滞肠胃而成，与沟
渠壅塞相似，惟用药磨刮疏通，则愈。若用承气大下之药，譬如清荡壅塞之渠，必不可去，徒伤胃
气、损元气而已。正气损伤，邪气不除，强壮者犹可，怯弱者必危矣。一忌发汗。痢有身发热汗，头
疼目眩者，此非外感，乃内毒熏蒸，自内达外，虽有表症，实非寒邪也。若发汗则泄其正气，而邪气
得以恣肆。且风剂燥热。愈助邪热，表虚于外，邪炽于内，鲜不毙矣。一忌分利小便。利小便者，治
水泻之圣法也。而以之治痢则乖，痢自邪热胶滞，津液枯涩而成，若用五苓等剂分利，津液愈枯，涩
滞愈甚，遂至缠绵不愈，则即分利之害也。若清热导滞，则痢自愈，而小便自利，安用分利为哉。
统而论之，景岳诸氏之说，尽痢疾之变也，欲以广学人之识也，河间诸氏之说，言痢疾之常也，所以适
学人之用也，能明此义，而用其常，识其变，庶治痢不致杀人矣。
王太史治痢奇方 治或红或白，或红白相兼，里急后重腹痛，或身热煮，主此加减。
黄连 黄芩〔苦能燥湿，寒能除热。〕白芍〔补脾则中气不下陷、制肝则木邪不敢犯。各
一、二、三钱。〕当归〔五分至一钱。〕桃仁〔钱许。〕红花〔行血则便脓自愈。三
分。〕枳壳〔一、二、三钱。〕青皮 槟榔 浓朴〔各钱许。孕妇去桃、红、槟、朴。〕木
香〔调气则后重自除，五分，呕恶去归、红、香、朴。〕楂肉〔消积滞，二、三钱。〕地
榆〔止血痢，一、二、三钱。〕甘草〔调胃气。五分至一钱，呕恶去之。〕如单白无红者，去桃、
红、地榆，加橘红、涩滞甚者，加〔酒煮。〕大黄；〔经曰∶暴者夺之。又曰∶通因通用。一、二
钱。服一、二剂乃除之。〕腹痛甚者，加玄胡；〔时珍曾治一人下痢，腹痛垂死，一味为末，米饭调服
三钱，痛即减半。〕如发热者，加柴胡。〔痢疾纵有表症，嘉言谓当从少阳和解主治，若非表症身
热，既有芩、连，清热解毒，加柴胡亦甚合嘉言少阳生发之气，传入土中，因而下陷，当先以辛凉之说。〕
若痢至月余，脾胃弱而虚滑者，当加参、术。〔扶脾胃之元气。一切破气血之药，宜减去之。〕
此方和解清热，破结消积，调气行血，为治痢之神剂。即芍药汤之法，随痢之新久，而加减用之。
芍药黄芩汤 亦治痢之神方。
白芍〔安脾胃而和血脉，治腹痛而止泻痢。〕甘草 茯苓〔益脾胃。〕黄芩 黄连〔清
热邪。〕枳壳〔破结气。〕橘红〔通滞气。〕 赤痢加地榆〔凉血。〕红曲〔活血。〕
如痛甚者，可再加乳香、没药，〔散血通滞。〕里急甚者，加当归；〔和血。〕后重甚者加槟榔。〔降
气下行。〕积滞多者。调服滑石末。〔取其滑能利诸窍，通壅滞，下垢腻，甘能和胃气，寒能消暑热。〕
如下痢不止，佐以升麻、葛根。若呕吐者，〔忌用升提，〕加石莲子、陈松萝，〔下气降火。〕若热毒血
痢，用鲜金银藤，〔数两。〕煎汤煎药。〔取其甘能和中益血，寒能除热解毒。〕如胃弱虚人，加莲
肉。〔炒黄，三、四十粒。〕扁豆。〔炒黄，
三、四钱。〕虚甚者，加人参。〔量用至一两。要知治痢，当顾胃气为急。〕痢久者，加乌梅。〔一、二
枚，取其酸能敛血固肠。〕作渴亦用。〔取其酸能生津止渴。〕
此方亦以和脾清热，破结导滞为主，与王宇泰方大同小异。仲淳用如金丸一方，只川连一味，姜汁
浸拌，隔土瓦炒，姜汁和水泛丸，每服四钱，随症用药，煎汤送下，极称其功效之神，能挽垂绝之症。奈
庸医畏投，深惜此方之遇蹇也。每观仲淳治痢，用药不脱前方诸品。但白术燥肾闭气，为滞下家所忌，大黄
长驱直捣，非胃弱人所宜；桃仁、红花善能疏瘀血，既下行无取，又重伤之；其青皮太峻，浓朴过温，少
见用。此外，药品亦无多，因症加减，投之辄效。人称仲淳疟，痢，盖独开门户者也。
大黄丸 痢疾初起，壮实者宜之。若因误用固涩，以致邪热内蓄，积不得行，腹痛欲死者，即日
久仍可酌用。
大黄〔蜜蒸，一斤。〕枳壳〔炒。〕槟榔〔各四两。〕木香〔忌见火，一两。〕
白芍〔酒炒，六两。〕甘草〔炙，三两。炼蜜丸，绿豆大，白莱菔汤，吞三钱，重者五钱，以行
二、三次，腹中爽快为度，胃弱者禁施。〕积滞多，而元气虚者，人参汤服。孕妇，人参汤中加砂仁。
此通因通用之法，一方用大黄、韭莱拌，蒸晒九次，蜜丸，亦简便神方也。
地汁蜜浆饮 素阴虚人，里急后重者宜之。〔胸膈不宽快者，勿投。〕
生地〔二、三两，煎一、二滚，绞汁一大碗。〕生白
蜜〔半杯和汁调匀。顿饮一碗，积自润下。〕
此甘寒润下之剂，凡病后及老人津液干枯，产后亡血，致大便秘结者皆宜。
参莲汤 治噤口痢，吐不纳药者。
人参〔扶胃家之正气，一、二钱至一两。〕石莲子〔去心炒黄，五钱。〕黄连〔清
湿热之邪毒，姜汁炒，一、二钱至五钱。〕一方无黄连，〔嘉言谓其但能苦降，不能升提，况非胃虚所
宜。愚谓姜汁拌炒，则开降并行，人参同用，则补泻兼施。〕一方无人参、黄连，加陈松罗，〔五
钱。〕虞天民谓此症亦有不能用参者，以阴太虚，而阳邪太甚也。〕 随宜采用。〔若因痢久胃气伤，则
宜用参缓缓服之，但得一口下咽，虚热随开。〕外用田螺，〔捣如泥。〕加麝香〔少许。〕纳脐中。〔引
火热行下，甚妙。〕
此补虚清热噤口痢之圣药也。按噤口痢症最重。因湿热之毒，闭塞胃口，正气衰惫，莫能与争，故
滴水不进，若用丁香、砂仁之属，则杀人矣。
生地黄汤 治热痢不止。
生地〔凉血补阴。〕地榆〔凉血泄热。〕甘草〔调和胃气。〕水犀角〔凉血解
毒。〕羚羊角〔治热毒痢血，疗腹痛热满。〕龟甲 生鸡子〔皆补阴除热，能止久痢。〕黄
柏〔痢久则下焦虚，肾欲坚、急食苦以坚之。黄柏是也。〕皆可采用。宜用金银花〔二、三
两。〕煎汤
煎药。
此凉血和胃之剂，血凉胃和，痢自止矣。盖痢久则伤阴，故补阴除热之品，可议加也。
栝蒌根汤 治下虚津耗、口燥咽干，渴次烦躁，宜此救之。
花粉 麦冬〔生津。〕茯苓 甘草 大枣〔调胃。〕
此生津调胃之剂，亦痢门之一法也。
脱肛洗方
五倍子 石榴皮〔各一两。〕明矾〔四两。〕煎浓汤，再用大田螺，〔数枚，去壳
捣烂。〕猪胆〔二、三枚，取汁。〕同入汤中，先熏后洗。再用五倍子〔炙末。〕鳖头〔
末。〕田螺汁调敷肛上，用软帛托入，一日三、四次。凡治脱肛，勿论虚、实、寒、热，用药皆以
升提为主。
肠 便血，身热则死。〔阳盛阴衰故也。〕寒则生肠 ，下白沫，脉浮则死，脉沉则生。肠
下脓血，脉悬绝则死。〔脉至如丝，悬悬欲绝也，邪实正虚故死，然下痢则虚，若沉小之脉，是正象，非
死脉也。〕滑大则生。〔滑因血盛，大以气充，血气未伤，故生。然久痢而见数大、及浮大坚之脉则
死，以正已衰，而邪方盛也。〕
下痢发热不休者死，下痢唇若涂朱者死，下纯血者死，下如红苋汁者死，下如屋漏水者死，下如
鱼脑或如猪肝者，皆半死半生。
痢疾这一病证，其排泄物有的呈红色，有的呈白色，有的是脓液，有的是血液，也有的是脓血混合；有的腹痛，有的不痛，但必定伴有里急后重（腹部紧迫疼痛，排便时肛门坠胀感强烈），频繁去厕所却排不出多少粪便。有的伴有呕吐恶心、胸腹胀满，有的表现为噤口痢（因胃气衰败或邪热壅盛导致不能进食的痢疾），有的伴有寒热往来（恶寒与发热交替出现）。张景岳论述此症时指出，应当根据表证、里证、寒证、热证、虚证、实证来施治。他说：凡是外邪从体表侵入引起的，必然有表证，治疗时应兼以解表，表邪解除后痢疾自然痊愈。又有一位叫嘉言的人说：外感暑、热、湿三种邪气，导致下痢，必须首先使用辛凉药物，以解除表邪，其次使用苦寒药物，以清泄里热。如果忽视了表证的治疗，外邪只能从体内排出，不到死不休止。所以即使是长达百日的久痢，仍然可以使用“逆流挽舟”法（通过解表使内陷之邪向外透达的治疗方法），引导邪气从体外排出，那么危重的病症也可以治愈。这是关于治疗表证的理论。
张景岳又说：痢疾多发于夏秋季节，本是因为湿热之气，怎么能说不是热证呢？只是由于患者因为怕热而求凉，过度饮用冰水，纵食生冷食物，尚未形成郁积，一接触就引发痢疾的，这难道是郁热吗？又有一位叫士材的人说：我治疗过一个妇女，下痢四十天，口干发热，饮食不进，腹中胀闷，完谷不化（大便中含有未消化的食物），还有人说是因为邪热不能腐熟水谷，计算下来服用了香连丸、枳实、厚朴等药三十多剂，导致绝食五天，生命垂危。诊察她的脉象大而数，按下去豁然中空，询问得知她腹痛且喜欢用手按压，小便清长通畅。这是火衰不能生土（肾阳不足不能温煦脾土），内里是真寒而外表是假热的表现。于是使用附子理中汤，冷服一剂后疼痛停止，六剂后身体凉爽、食欲恢复，同时服用八味丸，二十多天后痊愈。这是论述痢疾中偶尔属于寒证的理论。
张景岳说：现在患痢疾的人，虚证占六七成，而医生治疗痢疾，补法的只用一二成。正气本来已经下陷，如果再行气破气，后重症状不是更加严重吗？中焦本来虚弱，如果再攻伐积滞，元气不是更加枯竭吗？湿热损伤血分，自然应该调血，如果过度使用推陈致新的药物，血分会更加受伤！津液亡失导致口渴，自然应该生津，如果专门使用渗湿利水的药物，津液会更加耗损！庸医死守“痛无补法”的说法，不知道因为虚而导致的疼痛，越攻伐疼痛越厉害。况且虚证应当补益，自有依据。凡是脉象微弱者可补，形体虚弱消瘦者可补，胸膈宽舒畅快者可补，病后患痢者可补，因为攻伐而病情加重者可补。然而尤其重要的是在于脾肾两脏。如先腹泻而后患痢的，是脾传肾，称为贼邪，难治；先患痢而后腹泻的，是肾传脾，称为微邪，易治。《内经》说：肾是胃的关口，又肾开窍于二阴（前阴和后阴），所以下痢过多会导致阴液亡失。没有久痢而不伤及肾脏的。所以治疗痢疾如果不懂得补肾，就不是正确的治疗方法。
凡是用四君子汤、归脾汤、补中益气汤，都是补脾虚，未曾不好，但如果病属火衰，如果不是桂枝、附子大补命门真阳，来救脾土之母（火生土），那么饮食从哪里摄入，门户从哪里固摄，真元从哪里恢复呢？又赵氏说：病本是热痢，拖延日久，各种症状不减，或者反而加重，理应另外治疗，竟然当作虚痛来治。（我认为必须先曾用通泄、寒凉等药太过，症状变为虚寒，口不渴而喜欢热饮，小便清亮而不赤涩，下利水谷且清澈寒冷，腹痛绵绵不绝，手按即止，四肢厥冷，脉微沉细，见到这些脉症，才可以讨论投用温补药，而且必须先用小剂量的温药试探，如果对症就停止。）须用补中益气汤，一升一补。如果少腹沉重坠痛，切痛如奔豚（一种自觉有气从少腹上冲心胸的病症），这兼属少阴病，合用四神丸，去掉五味子，加入肉桂，甚者加入附子。如果有纯血便的，加入炒黑的干姜，虚象回复而痢疾自然停止。这是论述痢疾也有温补的理论。
我每次观察前贤的各种论述，开始时心中欢喜，诵读并记住它们，然而阅历久了之后，发现很少见到适用的情况，难道是先贤欺骗我吗？我在睡梦中思考，久而久之恍然大悟。知道古人是为了探究病情的变幻莫测，恐怕后人明白这一点却不明白那一点，或者误治留下祸患，原本并不是经常见到的病症。然而世间的医生，不深入考察其中的旨意，往往好奇自高，不辨别寒、热、虚、实，一遇到痢疾一概使用理中汤、桂枝、附子，竟然成为家常便饭，不用动刀，却沿门杀戮，死亡接踵而至，他们还声称如此大剂量的温补都不能挽回，这真是天命使然。唉！难道不荒谬吗？
为什么不考察一下，刘河间说：古时候认为赤痢为热，白痢为寒，果真如此，那么赤白相兼的，难道是寒热同病吗？又说白痢为寒，则应当不能消化谷物，为什么反而化为脓液呢？所以凡是能消化谷物的，无论颜色和其他症状，都算是热证。朱丹溪也说：赤痢来自小肠，白痢来自大肠，都是以湿热为本。沈氏则辨析说：邪气伤害大小肠的气分则痢下白色，邪气伤害大小肠的血分则痢下血色，非常明确。戴氏说：痢疾虽然有赤白两种颜色，最终没有寒热之分，通通作为湿热处理，只区分新久虚实，与赤白带下同治。《原病式》说：病本源于湿热，然而竟有用辛热药而治愈的。大概病情轻微的，得到辛热药则郁结开通，气和而愈；严重的，病情会转为极重。吕晚村说痢疾与伤寒不同，颇有口不渴，喜欢热饮，小便清，身不热，腹部喜欢热手熨烫，但仍然属于火症的。所以仲淳立论说：凡是治疗滞下（痢疾）与滑泄自利（腹泻不止）不同，滑泄自利不止，有可以收敛固涩的方法。至于滞下，本属湿热涩滞不行，法宜使用清热疏利的药物，忌讳兜涩（收敛固涩）。大肠与肺互为表里，大肠既有湿热留滞，则肺家必有热，肺气喜欢通利，厌恶闭涩，倘若误投止涩药，使湿热无处宣泄，肺气不得下行，不仅滞下症状增加，湿热熏蒸，上干犯肺，那么胀闷气逆，不眠不食，各种症状都会到来。王宇泰论述此症最为险恶，关乎生死，不仅当时医生治疗无术，而且古今治法千家，大多不得要领，所以不能迅速收到全效。我经过二十多年，颇有妙悟，百试百效，然后能破除诸家的迷障，创制奇妙的方剂。论述说：古人治疗痢疾，都说热则清之，寒则温之，初起热盛则下之（泻下），有表证则汗之（发汗），小便赤涩则分利之（利尿）。这五种方法举世信任，像规矩准绳一样不可改变。我唯独认为这五种方法中只有清热一法无忌讳。其他四种法则犯了大忌，必定不可用。
一忌温补。痢疾这种病，是湿热蕴积，胶滞于肠胃之中，清除邪热，疏导滞气，运行瘀血，则病速除。如果立即使用人参、白术等温补药，则热更盛，气更滞，血也凝滞。时间久了正气虚，邪气依然炽盛；缠绵不已，想补而涩之，则助长邪气；清而疏之，则更加滑脱。以至于不可救疗的，是初投温补药的祸害。
一忌大下。痢疾自邪热胶滞肠胃而成，与沟渠壅塞相似，只有用药磨刮疏通，才能痊愈。如果使用承气汤等大下之药，譬如清理荡涤壅塞的渠道，必不可去，徒伤胃气、损元气而已。正气损伤，邪气不除，强壮者还可以，怯弱者必危险。
一忌发汗。痢疾有身体发热出汗，头疼目眩的，这不是外感，而是内毒熏蒸，自内达外，虽有表证，实非寒邪也。如果发汗则泄其正气，而邪气得以恣肆。且风剂燥热，愈助邪热，表虚于外，邪炽于内，鲜有不死的。
一忌分利小便。利小便是治疗水泻的圣法。用来治疗痢疾则乖谬，痢疾自邪热胶滞，津液枯涩而成，如果使用五苓散等剂分利，津液更枯，涩滞更甚，遂至缠绵不愈，这就是分利的危害。如果清热导滞，则痢疾自愈，而小便自利，哪里用得着分利呢。
综合来说，张景岳等人的说法，讲尽了痢疾的变化，想要扩大学人的见识；刘河间等人的说法，讲的是痢疾的常理，所以适合学人的应用。能明白这个道理，运用其常理，识别其变化，差不多治疗痢疾就不会杀人了。
王太史治疗痢疾的奇方：治疗或红或白，或红白相兼，里急后重腹痛，或身热煮（高热），主治此方加减。
黄连、黄芩〔苦能燥湿，寒能除热〕、白芍〔补脾则中气不下陷，制肝则木邪不敢侵犯，各一、二、三钱〕、当归〔五分至一钱〕、桃仁〔约一钱〕、红花〔行血则便脓自愈，三分〕、枳壳〔一、二、三钱〕、青皮、槟榔、浓朴〔各约一钱，孕妇去掉桃仁、红花、槟榔、厚朴〕、木香〔调气则后重自除，五分，呕恶去掉当归、红花、木香、厚朴〕、楂肉〔消积滞，二、三钱〕、地榆〔止血痢，一、二、三钱〕、甘草〔调胃气，五分至一钱，呕恶去掉〕。如单白无红的，去掉桃仁、红花、地榆，加橘红；涩滞严重的，加〔酒煮〕大黄〔经曰：暴者夺之。又说：通因通用。一、二钱，服一、二剂乃除之〕。腹痛严重的，加玄胡索〔时珍曾治疗一人下痢，腹痛垂死，一味研末，米饭调服三钱，痛即减半〕。如发热的，加柴胡〔痢疾纵有表证，嘉言谓当从少阳和解主治，若非表症身热，既有黄芩、黄连清热解毒，加柴胡亦甚合嘉言少阳生发之气，传入土中，因而下陷，当先以辛凉之说〕。若痢疾持续月余，脾胃弱而虚滑的，应当加人参、白术〔扶脾胃之元气。一切破气血的药，宜减去〕。此方和解清热，破结消积，调气行血，为治疗痢疾的神剂。即芍药汤的法度，随痢疾的新久，而加减使用。
芍药黄芩汤：也是治疗痢疾的神方。
白芍〔安脾胃而和血脉，治腹痛而止泻痢〕、甘草、茯苓〔益脾胃〕、黄芩、黄连〔清热邪〕、枳壳〔破结气〕、橘红〔通滞气〕。赤痢加地榆〔凉血〕、红曲〔活血〕。如痛严重的，可再加乳香、没药〔散血通滞〕。里急严重的，加当归〔和血〕。后重严重的加槟榔〔降气下行〕。积滞多的，调服滑石末〔取其滑能利诸窍，通壅滞，下垢腻，甘能和胃气，寒能消暑热〕。如下痢不止，佐以升麻、葛根。若呕吐的，〔忌用升提〕，加石莲子、陈松萝〔下气降火〕。若热毒血痢，用鲜金银藤〔数两〕，煎汤煎药〔取其甘能和中益血，寒能除热解毒〕。如胃弱虚人，加莲肉〔炒黄，三、四十粒〕、扁豆〔炒黄，三、四钱〕。虚严重的，加人参〔量用至一两。要知道治痢，当顾胃气为急〕。痢久的，加乌梅〔一、二枚，取其酸能敛血固肠〕。作渴也用〔取其酸能生津止渴〕。
此方也以和脾清热，破结导滞为主，与王宇泰方大同小异。仲淳用如金丸一方，只用川连一味，姜汁浸拌，隔土瓦炒，姜汁和水泛丸，每服四钱，随症用药，煎汤送下，极称其功效之神，能挽垂绝之症。无奈庸医畏惧投用，深惜此方之遇蹇也。每次看仲淳治痢，用药不脱离前方诸品。但白术燥肾闭气，为滞下家所忌，大黄长驱直捣，非胃弱人所宜；桃仁、红花善能疏瘀血，既下行无取，又重伤之；其青皮太峻，浓朴过温，少见用。此外，药品亦无多，因症加减，投之辄效。人称仲淳疟，痢，盖独开门户者也。
大黄丸：痢疾初起，壮实者适宜。如果因误用固涩，以致邪热内蓄，积不得行，腹痛欲死的，即日久仍可酌情使用。
大黄〔蜜蒸，一斤〕、枳壳〔炒〕、槟榔〔各四两〕、木香〔忌见火，一两〕、白芍〔酒炒，六两〕、甘草〔炙，三两〕。炼蜜丸，绿豆大，白莱菔汤吞服三钱，重者五钱，以行二、三次，腹中爽快为度，胃弱者禁施。积滞多，而元气虚者，人参汤送服。孕妇，人参汤中加砂仁。此通因通用的方法，一方用大黄、韭菜拌，蒸晒九次，蜜丸，亦简便神方也。
地汁蜜浆饮：素体阴虚人，里急后重者适宜。〔胸膈不宽快的，勿投〕。
生地〔二、三两，煎一、二滚，绞汁一大碗〕、生白蜜〔半杯和汁调匀。顿饮一碗，积自润下〕。此甘寒润下之剂，凡病后及老人津液干枯，产后亡血，致大便秘结者皆宜。
参莲汤：治疗噤口痢，吐不纳药者。
人参〔扶胃家之正气，一、二钱至一两〕、石莲子〔去心炒黄，五钱〕、黄连〔清湿热之邪毒，姜汁炒，一、二钱至五钱〕。一方无黄连，〔嘉言谓其但能苦降，不能升提，况非胃虚所宜。愚谓姜汁拌炒，则开降并行，人参同用，则补泻兼施〕。一方无人参、黄连，加陈松罗，〔五钱。虞天民谓此症亦有不能用参者，以阴太虚，而阳邪太甚也〕。随宜采用。〔若因痢久胃气伤，则宜用参缓缓服之，但得一口下咽，虚热随开〕。外用田螺，〔捣如泥〕，加麝香〔少许〕，纳脐中。〔引火热行下，甚妙〕。此补虚清热噤口痢之圣药也。按噤口痢症最重。因湿热之毒，闭塞胃口，正气衰惫，莫能与争，故滴水不进，若用丁香、砂仁之属，则杀人矣。
生地黄汤：治疗热痢不止。
生地〔凉血补阴〕、地榆〔凉血泄热〕、甘草〔调和胃气〕、水犀角〔凉血解毒〕、羚羊角〔治热毒痢血，疗腹痛热满〕、龟甲、生鸡子〔皆补阴除热，能止久痢〕、黄柏〔痢久则下焦虚，肾欲坚、急食苦以坚之。黄柏是也〕。皆可采用。宜用金银花〔二、三两〕，煎汤煎药。此凉血和胃之剂，血凉胃和，痢自止矣。盖痢久则伤阴，故补阴除热之品，可议加也。
栝蒌根汤：治疗下虚津耗、口燥咽干，渴次烦躁，宜此救之。
花粉、麦冬〔生津〕、茯苓、甘草、大枣〔调胃〕。此生津调胃之剂，亦痢门之一法也。
脱肛洗方：
五倍子、石榴皮〔各一两〕、明矾〔四两〕。煎浓汤，再用大田螺，〔数枚，去壳捣烂〕、猪胆〔二、三枚，取汁〕，同入汤中，先熏后洗。再用五倍子〔炙末〕、鳖头〔末〕、田螺汁调敷肛上，用软帛托入，一日三、四次。凡治脱肛，勿论虚、实、寒、热，用药皆以升提为主。
肠 便血，身热则死。〔阳盛阴衰故也〕。寒则生肠 ，下白沫，脉浮则死，脉沉则生。肠下脓血，脉悬绝则死。〔脉至如丝，悬悬欲绝也，邪实正虚故死，然下痢则虚，若沉小之脉，是正象，非死脉也〕。滑大则生。〔滑因血盛，大以气充，血气未伤，故生。然久痢而见数大、及浮大坚之脉则死，以正已衰，而邪方盛也〕。
Dysentery is a syndrome characterized by the passage of stool that may be red, white, purulent, bloody, or a mixture of pus and blood; it may or may not be accompanied by abdominal pain, but always features tenesmus (a feeling of incomplete defecation with urgent lower abdominal pain) and frequent trips to the toilet with little output. Some cases present with nausea, vomiting, and abdominal distension; some manifest as "Jinkou Li" (dysentery with inability to eat due to stomach qi failure or pathogenic heat obstruction); others exhibit alternating chills and fever. Zhang Jingyue discussed this syndrome, stating that treatment should be differentiated according to exterior/interior, cold/heat, deficiency/excess. He said: For cases where pathogens enter from the exterior, there must be exterior symptoms, and treatment should include releasing the exterior; once the exterior pathogen is resolved, the dysentery will heal itself. Another scholar, Jiayan, stated: Dysentery caused by external contraction of summer-heat, heat, and dampness pathogens must first be treated with acrid-cool herbs to release the exterior, followed by bitter-cold herbs to clear interior heat. If the exterior stage is neglected, the external pathogen can only exit from the interior, leading to death if not stopped. Therefore, even in chronic dysentery lasting a hundred days, the "counter-current boat-pulling" method (a technique to draw internal pathogens outward through the exterior) can still be used to guide pathogens out, potentially saving critical cases. This discusses the theory of treating the exterior stage.
Zhang Jingyue also said: Dysentery often occurs in summer and autumn, originally due to muggy heat, so how can it not be considered a heat syndrome? However, when patients seek coolness due to heat, over-drinking ice water, or indulging in raw/cold foods without prior accumulation, triggering dysentery upon contact, is this truly stagnant heat? Scholar Shicai reported: I treated a woman with dysentery for forty days, presenting with dry mouth, fever, anorexia, abdominal fullness and oppression, and undigested food in stool. Others attributed this to pathogenic heat failing to digest grain. After taking thirty doses of Xianglian Wan, Zhi Shi, and Hou Po, she fasted for five days and was near death. Her pulse was large and rapid, but hollow upon deep pressure. Inquiry revealed abdominal pain relieved by pressure and clear, profuse urination. This indicated fire deficiency failing to generate earth (kidney yang deficiency failing to warm spleen earth), true cold inside with false heat outside. An Fuzi Lizhong Tang was administered, taken cold. Pain ceased after one dose, body temperature normalized and appetite returned after six doses. Concurrently, Bawei Wan was taken, and she recovered in over twenty days. This discusses the rare cold-type dysentery.
Zhang Jingyue noted: Among current dysentery patients, deficiency constitutes 60-70%, yet physicians use tonification in only 10-20% of cases. Qi has already sunk; further moving qi will worsen tenesmus. The middle jiao is already deficient; attacking stagnation will further deplete yuan qi. Damp-heat damaging blood requires blood regulation; excessive use of purgatives damages blood further. Fluid loss causing thirst requires generating fluids; exclusive use of diuretics consumes fluids more! Quacks adhere rigidly to "pain admits no tonification," ignoring that pain due to deficiency worsens with attack. Tonification has its basis: weak pulse, emaciated form, comfortable chest/diaphragm, post-illness dysentery, or worsening after attack all indicate need for tonification. Crucially, the spleen and kidney are key. Diarrhea preceding dysentery indicates spleen transmitting to kidney (treacherous evil), difficult to treat. Dysentery preceding diarrhea indicates kidney transmitting to spleen (minor evil), easier to treat. The Classic states: The kidney is the gate of the stomach, opening to the two yin (anus and urethra); thus, excessive downward discharge leads to yin depletion. No chronic dysentery spares the kidney. Therefore, treating dysentery without nourishing the kidney is incorrect.
Formulas like Sijunzi Tang, Guipi Tang, and Buzhong Yiqi Tang tonify spleen deficiency and are effective. However, in fire deficiency, unless Guizhi and Fuzi greatly tonify Mingmen true yang to save the mother of spleen earth (fire generates earth), how will diet enter, how will the gate secure, how will yuan yuan recover? Zhao stated: If a heat-dysentery persists long without improvement or worsens, it should be treated differently, mistakenly viewed as deficiency pain. [I believe this results from excessive use of purgative/cold herbs transforming the condition into deficiency-cold: no thirst preferring hot drinks, clear non-acrid urine, watery stools clear and cold, continuous dull pain relieved by pressure, cold limbs, faint/deep/thin pulse. Only then consider warm tonification, starting with small doses.] Use Buzhong Yiqi Tang to lift and tonify. If lower abdominal heaviness/pain resembling Ben Tun (Qi rushing upward) occurs, it involves Shaoyin; combine with Sishen Wan, remove Wuweizi, add Rougui, or Fuzi if severe. For pure blood stools, add Chao Heiganjiang; as deficiency returns, dysentery stops. This discusses warm tonification for dysentery.
Observing past masters' theories, I initially rejoiced and memorized them, but experience showed they were rarely applicable. Did they deceive me? After deep reflection, I realized ancients explored pathological variations to prevent misdiagnosis, not describing common presentations. Modern doctors, lacking deep understanding, boastfully apply Lizhong Tang, Guizhi, and Fuzi indiscriminately to all dysentery, causing widespread death while blaming fate. Absurd!
Consider Liu Hejian: Ancients said red dysentery is heat, white is cold. If so, mixed red/white implies simultaneous cold/heat? White being cold implies inability to digest grain, yet it turns to pus? Thus, if grain is digested, it is heat regardless of color. Zhu Danxi said: Red comes from Small Intestine, white from Large Intestine, both rooted in damp-heat. Shen distinguished: Pathogens affecting Qi level cause white dysentery; Blood level causes bloody dysentery—very clear. Dai said: Regardless of color, dysentery is never cold/heat differentiated but treated as damp-heat, distinguishing new/old and deficiency/excess, similar to leukorrhea. *Yuan Bing Shi* states: Rooted in damp-heat, yet cured by acrid-hot herbs in mild cases (opens stagnation); severe cases worsen. Lv Wancun noted dysentery differs from Shanghan; cases exist with no thirst, preference for hot drinks, clear urine, no fever, abdomen preferring warmth, yet still heat syndromes. Zhongchun argued: Treating Zhixia (dysentery) differs from Huaxie (loose stools). Huaxie allows astringents; Zhixia is damp-heat stagnation, requiring clearing heat and promoting drainage, avoiding astringents. Large Intestine and Lung are exterior-interior pairs; LI damp-heat implies Lung heat. Lung prefers free flow, hates obstruction. Misusing astringents traps damp-heat, obstructs Lung Qi descending, worsening dysentery, steaming heat upward to Lung, causing distension, rebellion, insomnia, anorexia. Wang Yutai deemed this syndrome perilous, life-or-death, with many ineffective methods. After 20 years of study, I achieved efficacy, breaking misconceptions.
Ancient rules: Heat clears, cold warms, excess purges, exterior releases, fluid retention drains. These five are universally trusted. I argue only "clearing heat" is safe; the other four are major taboos.
1. Taboo Warm Tonification: Dysentery is damp-heat stuck in intestines. Clear heat, move qi/blood. Using Renshen/Baizhu early increases heat/stagnation/clotting. Long-term deficiency with persistent pathogen leads to failed tonification/astringency (feeding pathogen) or purging (causing slipperiness). Initial warm tonification causes disaster.
2. Taboo Strong Purging: Dysentery resembles clogged drains; needs gentle scraping/clearing. Chengqi formulas are too harsh, damaging Stomach/Yuan qi without removing pathogens. Weak patients die.
3. Taboo Sweating: Fever/sweat/headache in dysentery is internal toxin steaming outward, not exterior cold. Sweating leaks Zheng Qi, allowing pathogens to rage. Wind herbs are drying/hot, aiding pathogen heat, leaving exterior empty and interior blazing—fatal.
4. Taboo Diuresis: Diuresis treats watery diarrhea, not dysentery. Dysentery involves fluid depletion and stickiness. Siwu San etc. deplete fluids further, worsening stagnation. Clearing heat and guiding stagnation heals dysentery naturally, making diuresis unnecessary.
In summary, Jingyue et al. cover dysentery variations to expand knowledge; Hejian et al. cover constants for practical application. Understanding both prevents fatal errors.
Wang Taishi's Miracle Formula for Dysentery: For red/white/mixed stools, tenesmus, abdominal pain, fever.
Huanglian, Huangqin [Bitter dries damp, cold removes heat], Baishao [Tonifies spleen preventing sinking, controls Liver preventing invasion] (1-3 qian), Danggui (0.5-1 qian), Taoren (~1 qian), Honghua [Moves blood, heals pus/blood stools] (0.3 qian), Zhike (1-3 qian), Qingpi, Binglang, Houpo (~1 qian each; omit Taoren, Honghua, Binglang, Houpo in pregnancy), Muxiang [Regulates Qi, relieves tenesmus] (0.5 qian; omit Danggui, Honghua, Muxiang, Houpo if vomiting), Shanrou [Resolves stagnation] (2-3 qian), Diyü [Stops bloody dysentery] (1-3 qian), Gancao [Harmonizes Stomach] (0.5-1 qian; omit if vomiting).
If white only, omit Taoren, Honghua, Diyü, add Juhong. If severe stagnation, add Jiuzhu Dahuang [Acute cases require draining; "Treat obstruction with unblocking"] (1-2 qian, 1-2 doses). If severe pain, add Xuanhusu [Shizhen cured severe pain with 3 qian powder]. If fever, add Chaihu [Jiayan suggests Shaoyin harmonization; Chaihu aids Shaoyang rising Qi trapped in Earth].
If dysentery >1 month with weak/slippery spleen/stomach, add Renshen, Baizhu [Support Yuan Qi; reduce blood-moving herbs]. This formula harmonizes, clears heat, breaks knots, resolves stagnation, regulates Qi/blood. Based on Shaoyao Tang, adjusted for duration.
Shaoyao Huangqin Tang: Another miracle formula.
Baishao [Calms spleen/stomach, harmonizes blood, stops pain/diarrhea], Gancao, Fuling [Benefits spleen/stomach], Huangqin, Huanglian [Clears heat], Zhike [Breaks knot Qi], Juhong [Unblocks stagnant Qi].
For red dysentery, add Diyü [Cool blood], Hongqu [Invigorate blood]. Severe pain: add Rushi, Moyao [Disperse blood/unblock]. Severe tenesmus: add Danggui [Harmonize blood]. Severe heaviness: add Binglang [Descend Qi]. Heavy stagnation: take Huashi powder [Slippery opens orifices, unblocks, descends filth, sweet harmonizes stomach, cold clears summer-heat]. If unstoppable diarrhea, assist with Shengma, Gegen. If vomiting, [avoid lifting], add Shilianzi, Chen Songluo [Descend Qi/fire]. For heat-toxin bloody dysentery, use fresh Jinyinhua Teng [Several liang] decocted with medicine [Sweet harmonizes/nourishes blood, cold clears heat/toxins]. Weak/stomach-deficient: add Lianrou [Fried yellow, 30-40 grains], Bidou [Fried yellow, 3-4 qian]. Severe deficiency: add Renshen [Up to 1 liang; protecting Stomach Qi is urgent]. Chronic: add Wumei [1-2 pieces, sour astringes blood/intestines]; also for thirst [generates fluids].
This formula harmonizes spleen, clears heat, breaks knots, guides stagnation. Similar to Wang Yutai's formula. Zhongchun's Rujin Wan uses only Chuanlian, processed with Ginger Juice and soil-fired, pilled with Ginger juice/water, 4 qian per dose with decoction. Highly effective for critical cases, but quacks fear using it. Zhongchun's dysentery prescriptions generally avoid Baizhu (drying/closing), Dahuang (too harsh for weak stomach), Taoren/Honghua (descending/redundant), Qingpi (too harsh), Houpo (too warm). Adjustments yield quick results. Zhongchun is praised for opening new paths for malaria/dysentery.
Dahuang Wan: For initial dysentery in robust patients. Or if astringents caused heat/stagnation retention with severe pain, usable even later.
Dahuang [Honey-steamed, 1 jin], Zhike [Fried], Binglang [4 liang each], Muxiang [Avoid fire, 1 liang], Baishao [Wine-fried, 6 liang], Gancao [Roasted, 3 liang]. Honey pills, mung bean size. Take 3 qian (5 qian severe) with Radish soup, until 2-3 bowel movements with relief. Contraindicated in weak stomach. Deficiency with stagnation: take with Ginseng soup. Pregnancy: add Chenxiang to Ginseng soup. This is "treat obstruction with unblocking." Alternative: Dahuang mixed with Chinese Chives, steamed/dried 9 times, honey pills. Simple and miraculous.
Dizhi Mixi Jiang Yin: For yin-deficient patients with tenesmus. [Do not use if chest/diaphragm is not open].
Shengdi [2-3 liang, boiled briefly, strained to 1 bowl], Sheng Baimi [Half cup, mixed with juice, drink at once]. Stool moistens and passes. Sweet-cold lubricating formula. Suitable for post-illness/elderly fluid dryness, postpartum blood loss causing constipation.
Shenlian Tang: For Jinkou Li (inability to eat), vomiting meds.
Renshen [Support Stomach Zheng Qi, 1-2 qian to 1 liang], Shilianzi [Remove heart, fry yellow, 5 qian], Huanglian [Clear damp-heat toxin, ginger-fry, 1-2 qian to 5 qian]. One formula omits Huanglian [Jiayan says it only descends, doesn't lift, unsuitable for stomach deficiency. I say ginger-frying allows ascending/descending together; combined with Renshen, tonifies/drains simultaneously]. One formula omits Renshen/Huanglian, adds Chen Songluo [5 qian]. Yu Tianmin notes some cannot use Renshen due to extreme yin deficiency and strong yang pathogen. Choose appropriately. [If chronic dysentery damaged Stomach Qi, use Renshen slowly; even one swallow opens deficiency heat]. External: Field Snail [Mashed] + Shexiang [A little] applied to navel [Guides fire down, excellent]. This is the holy medicine for deficiency-heat Jinkou Li. Jinkou Li is severe: damp-heat toxin blocks stomach gate, Zheng Qi exhausted, unable to fight, refusing even water. Using Dingxiang/Sharen kills.
Shengdihuang Tang: For unremitting heat dysentery.
Shengdi [Cool blood/nourish yin], Diyü [Cool blood/draining heat], Gancao [Harmonize Stomach], Shuixijiao [Cool blood/resolve toxin], Lingyangjiao [Treat heat-toxin bloody dysentery, relieve pain/fullness], Guijia, Sheng Jizi [Nourish yin/remove heat, stop chronic dysentery], Huangbai [Chronic dysentery lowers jiao deficiency; Kidney desires firmness, eat bitter to firm it. Huangbai does this]. All selectable. Prefer Jinyinhua [2-3 liang] decocted with medicine. Cool-blood harmonize-stomach formula. Blood cools, stomach harmonizes, dysentery stops. Chronic dysentery injures yin, so yin-nourishing/heat-removing items are appropriate.
Gualougen Tang: For lower deficiency/fluid consumption, dry mouth/throat, thirst/restlessness.
Huafen, Maidong [Generate fluids], Fuling, Gancao, Dazao [Harmonize stomach]. Generate fluids/harmonize stomach formula, another method for dysentery.
Tuogang Wash Formula:
Wubeizi, Shiliupi [1 liang each], Mingfan [4 liang]. Boil thick decoction. Add large field snails [Several, shelled/mashed], Zhudan [2-3, juice]. Soak/wash externally. Then Wubeizi [Roasted powder], Bietou [Powder], Tiansnail juice applied to anus, pushed in with soft cloth, 3-4 times daily. Treat prolapse regardless of deficiency/excess/cold/heat with lifting herbs primarily.
Chang [Intestinal Bleeding]: Body heat means death [Yang excess/Yin decline]. Cold means survival. Passing white foam, floating pulse means death, deep pulse means survival. Passing pus/blood, hanging-extreme pulse means death [Pulse like thread, about to vanish; excess pathogen/deficient Zheng Qi dies. But dysentery is deficiency; deep/small pulse is normal, not death]. Slippery/large pulse means survival [Slippery due to abundant blood, large due to充盈 Qi, blood/Qi not injured, so survival. But chronic dysentery with rapid/large or floating/large/firm pulse means death, as Zheng declines while pathogen rises].
Unremitting fever with dysentery: death. Lips painted red: death. Pure blood: death. Like amaranth juice: death. Like roof leak water: death. Like fish brain or pig liver: half-dead/half-alive.