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第十八章.治痢方

Chapter 18. herb for dysentery

 

1.化滞汤

1. Huazhi Tang

治下痢赤白,腹疼,里急后重初起者。若服药后病未全愈,继服后方。

This formula is used for dysentery with blood and white mucus in the stool, with pain and with urgent feeling to have bowel movement. If the condition is not solved with this formua, try the formula later.


生杭芍(一两) 当归(五钱) 山楂(六钱) 莱菔子(五钱,炒捣) 甘草(二钱) 生姜(二钱)
Baishao 30 gram, Danggui 15 gram, Shanzha 18 gram, Laifuzi 15 gram (fry and grind), Gancao 6 gram, Fresh ginger 6 gram.

若身形壮实者,可加大黄、朴硝各三钱下之。
If the person is strong in body condition, add herb Dahuang 9 gram and Puxiao (mirabilite) 9 gram in the formula.

方中之意:用芍药以泄肝之热,甘草以缓肝之急,莱菔子以开气分之滞,当归山楂以化血分之滞,生姜与芍药并用又善调寒热之互相凝滞,且当归之汁液最滑,痢患滞下而以当归滑之,其滞下愈而痢自愈也。

Shaoyao in the formula is to cleanse the Liver Fire; Gancao to calm the Liver urgent; Laifuzi to open the stagnation of Liver Qi; Danggui and Shanzha to clear the stagnation in the blood. The combination of the fresh ginger and the Shaoyao works to harmony the stick of the Cold and Hot; and the Danggui is slippery, so that it can solve the stick (retention) feeling in the anus after bowel movement.

 

2.燮理汤

2. Xieli Tang (Xie here means to regulate, and to harmony)

治下痢服前药未全愈者。若下痢已数日,亦可迳服此汤。又治噤口痢。
This formula is to solve the condition, which has tried the former formula but not improved. If the dysentery has lasted for several days, this formula can be used directly. This formula can also be used to solve the dysentery with vomiting and the difficulty to eat any food.

山药(八钱) 金银花(五钱) 生杭芍(六钱) 牛蒡子(二钱,炒捣) 甘草(二钱) 黄连(钱半) 肉桂(一钱半,去粗皮将药煎至数十沸再入)
Shanyao 24 gram, Jinyinhua 15 gram, Baishao 18 gram, Niubangzi 6 gram (fry and grind), Gancao 6 gram, Huanglian 4.5 gram, Rougui 4.5 gram (remove thick peel, add it in the pot after other herbs have been cooked for ten boiling).

单赤痢加生地榆二钱,单白痢加生姜二钱,血痢加鸭蛋子二十粒(去皮),药汁送服。
If there is only blood in the stool (no white mucus- or glue-like material in the stool), add Diyu 6 gram; if there is only the white color stuff in the stool, add fresh ginger 6 gram. If there is blood in the stool, add Yadanzi 20 granules (remove peel) and drink it with herbal tea from other ingredients.

痢证古称滞下。所谓滞下者,诚以寒火凝结下焦,瘀为脓血,留滞不下,而寒火交战之力又逼迫之,以使之下也。故方中黄连以治其火,肉桂以治其寒,二药等分并用,阴阳燮理于顷刻矣。用白芍者,《伤寒论》诸方,腹疼必加芍药协同甘草,亦燮理阴阳之妙品。且痢证之噤口不食者,必是胆火逆冲胃口,后重里急者,必是肝火下迫大肠,白芍能泻肝胆之火,故能治之。矧肝主藏血,肝胆火戢,则脓血自敛也。用山药者,滞下久则阴分必亏,山药之多液,可滋脏腑之真阴。且滞下久,则气化不固,山药之收涩,更能固下焦之气化也。

In old time, the dysentery is called “stool stagnation”. It refers to a condition, in which the Cold and Fire stick and adhere each other in the Lower Jiao, and form pus-blood, which sticks in the intestine, but it is pressed to move down by the combating of the Cold and the Fire. The herb Huanglian in the formula is to clear the Fire, the Rougui, to clear the Cold. The combination of this two helps to harmony the Yin (Cold) and the Yang (Fire). The reason to use the herb Shaoyao is that, in various formulas in the book Shang Han Lun, the Shaoyao and the Gancao are used together whenever this is abdomen pain. They are also a proper herbal couple to harmony the Yin and Yang. For person with the dysentery has difficult to eat, the reason must be the rushing up of Gall bladder Fire, that press the upper opening of the stomach. The urgent feeling and retention feeling of stool in the anus is due to the Liver Fire press down in the colon. The Shaoyan can cleanse the Liver Fire, so it can solve this retention and urgent feeling. When the Liver Fire dies, the pus-blood should also disappear. After a long time dysentery, the Yin portion would be damaged. Shanyao, for its rich in juice, can nourish the organ True Yin.  After long time of dysentery, the Qi function in the body would also be infected. The Shanyao, for its restraining ability, can help the Qi function in the Lower Jiao of the body.

白芍善利小便,自小便以泻寒火之凝结。牛蒡能通大便,自大便以泻寒火之凝结。金银花甘草同用,善解热毒,可预防肠中之溃烂。单白痢则病在气分,故加生姜以行气。单赤痢则病在血分,故加生地榆以凉血。至痢中多带鲜血,其血分为尤热矣,故加鸭蛋子,以大清血分之热。拙拟此方以来,岁遇患痢者不知凡几,投以此汤,即至剧者,连服数剂亦必见效。
Baishao is good at promoting urine; it can remove the clot of the Fire-Cold through the urine. Niubangzi is good at promoting bowel movement; it clears the clot of the Fire-Cold through the stool. The Jinyinhua and Gancao, when used together, are good to clear the Fire poison, to prevent ulcer in the colon. If the dysentery is with mostly white mucus, not red color, in the stool, it suggests that the disease is mostly localized in the Qi portion of the body. The fresh ginger is used to promote the Qi movement. If the stool contains red color stuff/mucus, the disease is in the blood portion of the body. The Diyu is used to cool down the blood. If the stool has fresh blood, it suggests a very high Fire in the blood. Yadanzi is used to clear the Fire in the blood. After set up this formula, I have met numerous cases with dysentery. All are given this formula. Even in the very severe cases, several doses would show the healing effect.

痢证,多因先有积热,后又感凉而得。或饮食贪凉,或寝处贪凉,热为凉迫,热转不散。迨历日既多,又浸至有热无凉,犹伤于寒者之转病热也。所以此方虽黄连肉桂等分并用,而肉桂之热,究不敌黄连之寒。况重用白芍,以为黄连之佐使,是此汤为燮理阴阳之剂,而实则清火之剂也。
The reason for the dysentery is usually due to the accumulation of Hot first, and the Cold-attack later. The person is attacked by drinking cold or eating cold food; or staying or lying in a cold place. The Cold presses and folds the Hot; the Hot is hard to evaporate and to disperse. After a time, the body has only the Hot but no Cold, similar to the change of Cold condition into the Hot condition in a Shanghan disease. Therefore, in this formula, though it contains both Cold herb Huanglian and Hot herb Rougui, the Hot of the Rougui is less than the Cold effect from the Huanglian. In addition, there is herb Baishao in the formula, which helps the Huanglian to cool. For this reason, though it is termed Yin-Yang harmonizing formula, it works more to clear the Fire.

或问:以此汤治痢,虽在数日之后,或服化滞汤之后,而此时痢邪犹盛,遽重用山药补之,独无留邪之患乎?答曰:山药虽饶有补力,而性略迟钝,与参、 之迅速者不同。在此方中,虽与诸药同服,约必俟诸药之凉者、热者、通者、利者,将痢邪消融殆尽,而后大发其补性,以从容培养于诸药之后,俾邪去而正已复,此乃完全之策,又何至留邪乎?且山药与芍药并用,大能泻上焦之虚热,与痢之噤口者尤宜。是以愚用此汤,遇痢之挟虚与年迈者,山药恒用至一两,或至一两强也。
It may be asked: this formula is used when the dysentery has been there for several days, or after drink of previous Huazhe Tang. At this time, the dysentery is on its peak and severe condition. Would the use of Shanyao to nourish the body cause adhere of the Xie Qi in the body? Answer: The Shanyao can nourish the Yin, but its ability is kind of slow. It is not as the same fast nourishing effect by the Dangshen or Renshen. In this formula, it is used together with other herbs, it would start the nourishing effect after other herbs worked to clear the Hot, and after the Xie Qi is solved. So, no worry it would cause the stick of the Xie Qi in the body. Also, when the Shanyao is used together with the Shaoyao, the combination of which could clear the asthenic Fire in the Upper Jiao of the body, so to be good in the treatment of dysentery with hard to eat. For this reason, for old and weak person, I always use Shanyao up to 30 gram or even more.

或问:地榆方书多炒炭用之,取其黑能胜红,以制血之妄行。此方治单赤痢加地榆,何以独生用乎?
It might also be asked: the herb Diyu is usually used as its charcoal form, since the black can combat against the red (blood), to stop the bleeding. Why use the non-processed, the original form of Diyu?

答曰:地榆之性,凉而且涩,能凉血兼能止血,若炒之则无斯效矣,此方治赤痢所以必加生地榆也。且赤痢之证,其剧者,或因肠中溃烂。林屋山人治汤火伤,皮肤溃烂,用生地榆末和香油敷之甚效。夫外敷能治皮肤因热溃烂,而内服亦当有此效可知也。鸭蛋子一名鸦胆子苦参所结之子也。不但善治血痢,凡诸痢证皆可用之。即纯白之痢,用之亦有效验,而以治噤口痢、烟后痢、尤多奇效,并治大小便因热下血。其方单用鸭蛋子(去皮),择成实者五六十粒,白沙糖化水送服,日两次,大有奇效。若下血因凉者,亦可与温补之药同用。其善清血热,而性非寒凉,善化瘀滞,而力非开破,有祛邪之能,兼有补正之功,诚良药也。坊间将鸭蛋子去皮,用益元散为衣,治二便下血如神,名曰菩提丹。
Answer: the herb Diyu is cool and puckery. It can cool the blood and stop bleeding. This effect would be lost after process (fry). This is the reason to use the non-processed Diyu in this formula. The severe case of dysentery could be due to the ulcer in the intersine/colon. Mr. Linwushanren, when treated skin burning damage, used the non-processed Diyu and sesame oil to apply on the skin. It works very fast. If its application outside on the skin can heal the ulcer, it would work too after oral intake.Yandanzi is the seeds of Kushen. It can be used in various dysentery, not only on the bleeding dysentery. It works well in the pure white dysentery too. It works extremely well in dysentery with hard to eat, or dysentery after cigarette smoke. It also works bleeding in urine and stool due to Hot in the body. There is a formula that uses the Yadanzi alone: Yandanzi 50 ro 60 granules. Drink it with white sugar water to swallow, twice a day. It works fantastic. If the urine bleeding or stool bleeding are due to Cold in the body, use it together with warming herbs. It is good to clear the blood Hot, but its nature is not cooling. It is good to break the stagnation, but it is not to break it. It has ability to expel Xie Qi, but it has also ability to improve body defense system. It is really fantastic herb. In the folk, someone peel the Yadanzi, fold it with herbal powder Yiyuan San, for the treatment of bleeding in the urine and/or stool. It works very well.

一人,年五十余,素吸鸦片。当霍乱盛行之时,忽然心中觉疼、恶心呕吐、下痢脓血参半。病家惧甚,以为必是霍乱暴证。诊其脉毫无闭塞之象,惟弦数无力,左关稍实。愚曰:此非霍乱,乃下焦寒火交战,故腹中作疼,下痢脓血。上焦虚热壅迫,故恶心呕吐,实系痢证之剧者。遂投以白芍六钱,竹茹、清半夏各三钱,甘草生姜各二钱,一剂呕吐即愈,腹疼亦轻,而痢独不愈,不思饮食。俾单用鸭蛋子五十粒,一日连服两次,病若失。审斯,鸭蛋子不但善理下焦,即上焦虚热,用之亦妙,此所以治噤口痢而有捷效也。
A man, 50 years of old, smoked opium for long time. In a time when the cholera spreaded, he suddenly felt pain in the heart, nausea and vomit, and had dysentery with half white and half red color mucus in the stool. The family was scared very much, since they thought that he got severe cholera. His pulse was string and frequent and weak, but no any sign of blocking in the pulse feeling. I told them: this is not cholera. It is due to the Cold and Hot combat in the Lower Jiao of the body to cause pain in the abdomen and dysentery with pus and blood. The asthenic Fire accumulated in the Upper Jiao to cause the nausea and vomit. It is the severe condition of a dysentery. In the prescription I gave to him, it contained Baishao 18 gram, Zhuru 9 gram, Banxia 9 gram, Gancao 6 gram, Fresh ginger 6 gram. After one dose, his vomit stopped and abdomen pain reduced, but dysentery remained no change and he had no desire to eat. Then I used the Yadanzi alone, letting him drink it twice each time 50 granules.  The dysentery almost disappeared. You see, the Yandanzi can not only work on the Lower Jiao, but also work on the Upper Jiao asthenic Fire. This is why it works well in the dysentery with difficulty to eat.

一人,年四十八,资禀素弱,亦吸鸦片。于季秋溏泻不止。一日夜八九次,且带红色,心中怔忡,不能饮食。日服温补之药,分毫无效。延愚延医,其脉左右皆微弱,而尺脉尤甚,知系下焦虚寒。为其便带红色,且从前服温补之药无效,俾先服鸭蛋子四十粒,泻愈其半,红色亦略减,思饮食。继用温补下焦之药煎汤,送服鸭蛋子三十粒,后渐减至十粒,十剂全愈。盖此证虽下焦虚寒,而便带红色,实兼有痢证也。故单服鸭蛋子,而溏泻已减半。然亦足征鸭蛋子虽善清热化瘀,而实无寒凉开破之弊,洵良药也。
A man, 48 years of old, was slim and weak for long time. He also smoked opium. One autumn, he had continuous diarrhea, 8 to 9 times per day, with red color in the stool. He felt palpitation and hard to eat. He was given warming herbs by other doctors but no effect. When I saw him, his pulse was weak on both sides, especially on the Chi position, indicating that he had asthenic Cold in the Lower Jiao of the body. For his stool was with red color, and the warming herd did not work, I asked him to drink the Yadanzi 40 granules. The diarrhea stopped half, the red color reduced little bit and he started to be able to eat some.  Then he was given the warming herbs again and drink the Yadanzi, 30 granules, with the herbal tea. Later, the Yadanzi was reduced to 10 granules. After ten days, the condition was solved. For this case, though it is asthenic Cold in the Lower Jiao, the stool was with red color, indicating that the condition is combined with the dysentery. For this reason, the Yadanzi can solve the diarrhea half, suggesting that the Yadanzi can clear the Fire and Stagnation/clotted blood, but no way to cause too Cold side effect. It is really good herb.

沧州友人滕××,壬寅之岁,于中秋下赤痢,且多鲜血。医治两旬不愈。适愚他出新归。过访之,求为诊治。其脉象洪实,知其纯系热痢。遂谓之曰:此易治。买苦参子百余粒,去皮,分两次服下即愈矣。翌日愚复他出,二十余日始归。又访之,言曾遍问近处药坊,皆无苦参子。后病益剧,遣人至敝州取来,如法服之,两次果愈。后滕××旋里,其族人有适自奉天病重归来者,大便下血年余,一身悉肿,百药不效。滕××授以此方,如法服之,三次全愈。

My friend, Mr. Ten in Cangzhou city, had red dysentery in a middle autumn. His dysentery had fresh blood. Doctors treated him for two months without any improvement. He had went out for a traveling and returned home and asked me to help him. His pulse was big as a wave, and sthenic strong. I thought that he got Hot dysentery. I told him there was chance to solve his problem. I asked him to buy Yadanzi 100 granules and peel the Yadanzi, to drink it twice, 50 granules each time. I told him that his condition should be better after two days. The next day, I had to go out and I returned after twenty days. He came back to me again and said he had tried many places to buy the herb, but no where had it, and his condition became worse during that time. I asked someone get the Yadanzi in other city to him and let him drink it as I asked. It was true that after two days treatment with that Yadanzi, his condition was cured. Later, Mr. Ten returned home. There was a relative also returned home from Fengtian city due to severe disease, who suffered from bleeding diarrhea for years, with whole body swelling, and no herbal therapy had helped him. Mr. Ten let him drink the Yadanzi the same way. After three times, the condition was solved.

 

附录:

Appendix:

直隶青县张××来函:

Letter from Mr. Zhang, Qing city, Zhili province:


芦台李××,年四十二岁,壬戌五月间,因劳碌暑热,大便下血,且腹疼。医者多用西洋参、野于术、地榆炭、柏叶炭温涩之品投之,愈服愈危。小站王××,余友也,代寄函询方,并将病源暨前方开示。余阅毕,遂为邮去菩提丹四服。每服六十粒,日服一次。未几,接复函,谓服毕血止,腹疼亦愈,极赞药之神妙。近年用此丹治赤痢及二便下血,愈者甚多。
Mr. Li, lived in Lutai city, was 42 years of old. In May of a year, he got summer-Hot condition due to heavy labor work. He had bleeding in stool with pain in abdomen. Doctors used herbs with more Renshen, and Baizhu in it, and with addition of other herbs, such as Diyu charcoal, Boye charcoal. The herbal therapies made the condition worse. Mr. Wang, my friend, send a letter to me for help and told me the patient’s condition. After read the letter, I asked to send him Poti Dan four doses. I asked to let the patient take 60 pills each time, once a day. After no many days later, I got letter again. It said that the bleeding stopped, and the pain was cured too. The patient and family admired the herbal formula so marvelous. In recent years, I have used this formula to treat dysentery with blood or the bleeding-urine and bleeding-stool conditions. Many patients were cured.

山东德州卢××来函:
Letter from Mr. Lu in Dezhou city, Shandong province:

××族嫂,因逃荒惊恐,又兼受暑,致患痢两月余,服药无效,益加沉重。侄为开乌梅六个,山楂两半,煎汤送服益元散四钱,去皮鸭蛋子四十粒。煎药渣时,亦如此送服。一剂病若失。

A lady got dysentery, due to scare during begging and to hot summer weather. She had this disease for two months and drinked many herbs but the condition was worse. My nephew prescribed her: Wumei 6, Shanzha 45 gram. Cook them into herbal tea and drink herb Yiyuan San 12 gram and Yadanzi 40 granules, with this tea. One dose solved her problem.

 

3.解毒生化丹

3. Jiedu Shenhua Dan (Jiedu here means to detoxify in Chinese; Shenhua means to promote function; Dan means big pill).

治痢久郁热生毒,肠中腐烂,时时切疼,后重,所下多似烂炙,且有腐败之臭。
This formula is used for a condition, in which a long term of dysentery causes accumulation of Fire and poison in the body. The intestine became rotten. The patient feels pain in the abdomen from time to time, and feels stool-retention feeling in anus. The stool is more with the rotten tissue/stuff with rotten odor.

金银花(一两) 生杭芍(六钱) 甘草(三钱) 三七(二钱捣细) 鸭蛋子(六十粒,去皮拣成实者)
Yinyinhua 30 gram, Baishao 18 gram, Gancao 9 gram, Sanqi 6 gram (grind), Yadanzi 60 granules (peel).

上药五味,先将三七、鸭蛋子,用白沙糖化水送服。次将余药煎汤服。病重者,一日须服两剂始能见效。
Cook the Jinyinhua, Baoshao and Gancao into herbal tea. Drink the Sanqi and Yadanzi with the help of the herbal tea for swallow. In severe case, drink the two doses of the formula a day.

此证,乃痢之最重者。若初起之时,气血未亏,用拙拟化滞汤,或加大黄、朴硝下之即愈。若未全愈,继服燮理汤数剂,亦可全愈。若失治迁延日久,气血两亏,浸至肠中腐烂,生机日减,致所下之物,色臭皆腐败,非前二方所能愈矣。此方则重在化腐生肌,以救肠中之腐烂,故服之能建奇效也。
This condition is the most severe one in the dysentery. In the beginning, when the body condition is not so weak, herbal formula Huazhi Tang can be used, or with addition of Dahuang and Poxiao (vitriol). If the disease is not under control, use the Xueli Tang several doses. If the condition has been delayed for a long time, and if the body has become weak in both Qi and blood portion, and if the colon has become rotten with the stool as rotten material in it, these two formulas are no longer strong enough to cure. The formula here, the Jiedu Huashen Dan should be used.

一人,年五十二,因大怒之后,中有郁热,又寝于冷屋之中,内热为外寒所束,愈郁而不散,大便下血。延医调治,医者因其得于寒凉屋中,谓系脾寒下陷,投以参、 温补之药,又加升麻提之。服药两剂,病益增重,腹中切疼,常常后重,所便之物,多如烂炙。更延他医,又以为下元虚寒,而投以八味地黄丸,作汤服之,病益加重。后愚诊视,其脉数而有力,两尺愈甚。确知其毒热郁于肠中,以致肠中腐烂也。为拟此方,两剂而愈。
A man was 52 years of old. He had very angry, which made Hot accumulated in the body, and he also stayed in a cold room. The inside Hot was blocked by outside Cold, and it became more difficult to escape, which eventually caused bleeding in stool. He went to a doctor. The doctor thought that he was stayed in cold room, so the condition should belong to Spleen-cold condition, in which the Spleen Qi shrink. He was given Renshen and warm-nourishing herbs, as well as herb Shenma to raise the Spleen Qi. Two doses made his condition worse. The pain in abdomen was more severe, with retention feeling in the anus. The stool looked as rotten material. The second doctor believed his condition as asthenic Cold in the Lower Jiao, so used Bawei Dihuang Wan that was cooked to drink. The disease was much worse. When I saw him, his pulse was frequent and strong, especially in the Chi position. It was considered to be the accumulation of poisoning Fire in the intestine, that caused the rotten in the intestine. I used this formula. Two doses solved his problem.

一妇人,年五十许,素吸鸦片。又当恼怒之余,初患赤痢,滞下无度。因治疗失宜,渐至血液腐败,间如烂炙,恶心懒食,少腹切疼。其脉洪数,纯是热象。亦治以此汤,加知母白头翁各四钱,煎汤服。又另取鸭蛋子六十粒、三七二钱,送服。每日如此服药两次,三日全愈。

A woman was 50 years of old, and she smoked opium. After angry one time, she got red-dysentery with endless retention feeling in the anus. Due to improper treatment, her condition developed into rotten in the intestine. The stool was rotten tissue. She felt nausea and disliked to eat. She felt sharp and cutting pain in abdomen. Her pulse was big and frequent, appearing as pure Fire condition. I gave her this formula, used Zhimu 12 gram, Baitaowen 12 gram to cook as herbal tea. Let her drink Yandanzi 60 granules and Sanqi 6 gram with this herbal tea. The herbal tea was drinked twice a day. After three days, all the condition were improved.  

 

4.天水涤肠汤

4. Tianshui Jichang Tang (Tian here means sky; Shui means water; Ji means to wash; the Chang means intestine in Chinese).

治久痢不愈,肠中浸至腐烂,时时切疼,身体因病久羸弱者。
This formula is used to solve long term dysentery, in which the intestine was rotten. The patient feels cutting pain in abdomen from time to time. The body is very slim and weak due to long time disease.

山药(一两) 滑石(一两) 生杭芍(六钱) 党参(三钱) 白头翁(三钱) 甘草(二钱)
Shanyao 30 gram, Huashi 30 gram, Baishao 18 gram, Dangshen 9 gram, Baitouwen 9 gram, and Gancao 6 gram.

一媪,年六十一岁,于中秋痢下赤白,服药旋愈,旋又反复。如此数次,迁延两月。因少腹切疼,自疑寒凉,烧砖熨之。初熨时稍觉轻,以为对证。遂日日熨之,而腹中之疼益甚。昼夜呻吟,噤口不食。所下者痢与血水相杂,且系腐败之色。其脉至数略数,虽非洪实有力,实无寒凉之象。舌上生苔,黄而且浓。病患自谓下焦凉甚,若用热药温之疼当愈。愚曰:前此少腹切疼者,肠中欲腐烂也,今为热砖所熨而腹疼益甚,败血淋漓,则肠中真腐烂矣。再投以热药,危可翘足而待。病患亦似会悟,为制此方。因河间天水散(即六一散),原为治热痢之妙药,此方中重用滑石甘草,故名之天水涤肠汤。连服四剂,疼止,痢亦见愈。减去滑石四钱,加赤石脂四钱,再服数剂,病愈十之八九。因上焦气微不顺,俾用鲜藕四两,切细丝煎汤,频频饮之,数日而愈。
An old lady, 61 years of old, got red-white dysentery. Her condition was improved after drinking herbs, but it becomes worse after stop of the herbal tea. By this manner, her condition continued for two months. Since she felt cutting pain in lower stomach, she suspected that she had cold in the abdomen, so she tried to warm the abdomen with hot bricks. In the beginning, she felt better, she believed she was right, so she repeated this way every day, but the stomach pain became worse and worse later. She cried day and night, had difficult to eat anything. The stool was the mixture of water and blood, with rotten color. Her pulse was frequent or slight frequent, no Cold sign though the pulse was not big or strong. Her tongue covering was thick and yellow in color. She said that she felt very cold in her lower abdomen. If warm herbs were used, the pain should have gone. I said: previously, when you felt cutting pain in the abdomen, it was due to intestine to rot. After use of hot brick application, the pain was worse and the rotten blood showed in the stool, indicating that the rot had occurred. If hot and warm herbs were to use, the life would go away. The patient seemed understand little bit. For her, the herbal formula I used was the Tianshui San by Dr. Liu Hejian (e.g. the Liuyi San). It is a very good formula to treat Hot dysentery. In this formula, large amount of Huashi (talc) and Gancao are used, so it is termed Tianshui Jichang Tang. After four days with one dose each day, the diarrhea stopped, as well as the pain in abdomen. Then the Huashe was reduced by 12 gram, but added Chishizhi 12 gram. After several doses, the disease was improved to about 80% to 90%. Since her Qi in the Upper Jiao was not smooth, she was given to drink from time to time, the tea prepared from fresh lotus root 120 gram (cut into thin pieces). After several days, her condition was cured.

此证亦痢中至险之证。而方中用党参者,因痢久体虚,所下者又多腐败,故于滋阴清火解毒药中,特加党参以助其生机。而其产于潞者,性平不热,于痢证尤宜也。
This condition is also most severe on in dysentery. Due to body weakness after long time disease, Dangsheng was used in the formula. Due to the presence of rotten material in the stool, the Danshen, among the Fire-cleansing and poison-cleansing herbs, can promote the defending ability of the body. The Dangshen, that was produced in the Lou city has calm nature and no Hot nature, is more suit in the dysentery.

此证若服此汤不效,则前方之三七、鸭蛋子、金银花亦可酌加,或加生地榆亦可。试观生地榆为末、香油调,涂汤火伤神效,其能治肠中因热腐烂可知也。

In this case, if this formula does not work, add Sanqi and Yadanzi and Jinyinhua in the formula, or add Diyu (not processed). The addition of Diyu can be evidenced in the treatment of Hot-rotten intestine by using Diyu powder and sesame oil.

 

5.通变白头翁汤

5. Tongbian Baitouwen Tang (Tongbian here means to be modified; Baitouwen: the name of a herb).

治热痢下重腹疼,及患痢之人,从前曾有鸦片之嗜好者。
This formula is for Hot dysentery with pain in abdomen and stool-retention feeling in anus. It is also used for person with dysentery and has craving for opium before.

山药(一两) 白头翁(四钱) 秦皮(三钱) 地榆(三钱) 生杭芍(四钱) 甘草(二钱) 三七(三钱,轧细) 鸭蛋子(六十粒,去皮拣成实者)
Shanyao 30 gram, Baitouwen 12 gram, Qinpi 9 gram, Diyu 9 gram, Baishao 12 gram, Gancao 6 gram, Sanqi 9 gram (grind), Yadanzi 60 granule (peel).

上药共八味,先将三七、鸭蛋子,用白蔗糖水送服一半,再将余煎汤服。其相去之时间,宜至点半钟。所余一半,至煎汤药渣时,仍如此服法。
Drink half of the Sanqi and Yadanzi with help of white suger. Cook the other herbs into tea. After one and half hour, drink the another half of the Sanqi and Yadanzi, during the time to cook the residue of the other herbs. After the tea is ready, drink it.

《伤寒论》治厥阴热痢下重者,有白头翁汤。其方,以白头翁为主,而以秦皮黄连黄柏佐之。
 There is a formula called the Baitouwen Tang in the book
Shan Han Lunfor the treatment of Hot dysentery. In the formula, the main ingredient is herb Baitouwen, beside Qinpi, Huanglian and Huangpo.

愚用此方,而又为之通变者,因其方中尽却病之药,而无扶正之药,于证之兼虚者不宜。且连、柏并用,恐其苦寒之性妨碍脾胃,过侵下焦也。矧《伤寒论》白头翁汤,原治时气中初得之痢,如此通变之,至痢久而肠中腐烂者,服之亦可旋愈也。
When I used this formula, I usually modified it, since the formula contains mostly the Xie-depleting herbs, no defense-improving herbs, so it is not so suit for person with asthenic condition. Again, the use of the Huanglian and Huangqin together may, due to their bitter-Cold herbal nature, may affect the Spleen-Stomach digestion function and to damage the Lower Jiao. Originally, the Baitouwen Tang in that book is introduced to solve the early dysentery of a seasonal disease. By modification as such here, it can be used for the long term of dysentery with rotten damage in the intestine.

奉天王××,年四十许。己未孟秋,自郑州病归,先泻后痢,腹疼重坠,赤白稠粘,一日夜十余次。先入奉天东人所设医院中,东人甚畏此证,处以隔离所,医治旬日无效。遂出院归寓,求为延医。其脉弦而有力,知其下久阴虚,肝胆又蕴有实热也。投以此汤,一剂痢愈。仍变为泻,日四五次,自言腹中凉甚。愚因其疾原先泻,此时痢愈又泻,且恒以温水袋自熨其腹,疑其下焦或有伏寒,遂少投以温补之药。才服一剂,又变为痢,下坠腹疼如故,惟次数少减。知其病原无寒,不受温补。仍改用通变白头翁汤。一剂痢又愈,一日犹泻数次。继用生山药一两,龙眼、莲子各六钱,生杭芍三钱,甘草茯苓各二钱,又少加酒曲、麦芽、白蔻消食之品,调补旬日全愈。
Mr. Wang in Fengtian city was 40 years of old. In an autumn, he returned from Zhenzhou city due to sickness. He had diarrhea first then dysentery. He felt pain in abdomen and stool-retention feeling in the anus. There was red and white color mucus/material in the stool. The dysentery was tens of times per day. He was first accepted by a hospital operated by Japanese. The doctors feared this disease very much, so isolated him and treated him without any improvement. He so returned home and asked my help. His pulse was string and strong, indicating that he had Yin deficiency due to long time diarrhea and had accumulated sthenic Fire in the Liver-Gall bladder. I gave him this modified formula. After one dose, his dysentery stopped but the diarrhea continued, which was four to five times a day. He complained very cold in his abdomen. Because he had diarrhea before the dysentery, now, the dysentery stopped but the diarrhea started again, and he liked to put warm water bag upon his stomach to release pain, I thought that he might have hidden Cold in the Lower Jiao of the body, so I used little bit warm-nourishing herbs. After one drinking, the dysentery recurred again, as well as the stool-retention feeling, though not as frequent as before. So, I realized that, he had no Cold in the abdomen, so that he could no tolerate the warm-nourishing therapy. I changed to the use of this Tongbian Baitouwen Tang. After one dose, the dysentery stopped again, but still had diarrhear several times a day. Then, I used Shanyao 30 gram, Longyanrou 18 gram, Lianzi 18 gram, Baishao 9 gram, Gancao 6 gram, and Fuling 6 gram, with little Jiuqu (distilled yeast), Maiya (malt), Baidoukou to help digestion. After several days with such modicication, the condition was cured.

奉天李××,年近四旬。因有事,连夜废寝。陡然腹疼,继而泄泻,兼下痢。其痢赤多于白,上焦有热,不能饮食。其脉弦而浮,按之不实。先投以三宝粥方,腹疼与泻痢皆见轻,仍不能饮食。继用通变白头翁汤方,连服两剂,痢愈可进饮食,腹疼泄泻犹未全愈。后仍用三宝粥方,去鸭蛋子,日服两次,数日病全愈。

Mr. Li, lived in Fengtian city and about 40 years of old. For some reasons, he had to worked day and night. He suddenly felt abdomen pain, followed by diarrhea with dysentery. In his dysentery, the red color was more than the white color. He had Fire in the Upper Jiao of the body. He could not eat or drink. His pulse was string and floating. It was not sthenic when pressed. He was given Sanbao Zhou first, the pain, diarrhea and dysentery all were reduced, but still could not eat. So, the Tongbian Baitouwen Tang was used for two doses. The dysentery stopped and he could eat and drink, but the pain and diarrhea were not completely stopped yet. Later, the Sanbao Zhou was used again, with removal of Yadanzi from the soup, twice a day. After several days, the condition was cured.

 

6.三宝粥

6. Sanbao Zhou (San here means number three in Chinese; Bao: valuable things; and Zhou: soup).

治痢久,脓血腥臭,肠中欲腐,兼下焦虚惫,气虚滑脱者。
This formula is used for chronic dysentery. The stool is with pus and blood and with rotten odor, e.g. the intestine was to rotten. His Lower Jiao was weak: he had slippery in urine and anus due to Qi deficiency.

山药(一两,轧细) 三七(二钱,轧细) 鸭蛋子(五十粒,去皮)
Shanyao 30 gram (powder), Sanqi 6 gram (grind), Yadanzi 50 granules (peel).

上药三味,先用水四盅,调和山药末煮作粥。煮时,不住以箸搅之,一两沸即熟,约得粥一大碗。即用其粥送服三七末、鸭蛋子。
Cook the Shanyao in water first to make a soup. Stir the soup from time to time, until there is one to two boiling. Use this soup to drink Sanqi and Yadanzi.

己巳之岁,愚客居德州,有卢姓妇,年五十六。于季夏下痢赤白,迁延至仲冬不愈。延医十余人,服药百剂,皆无效验,亦以为无药可医矣。后求愚延医,脉象微弱,至数略数,饮食减少,头目时或眩晕,心中微觉烦热,便时下坠作疼,然不甚剧。询其平素,下焦畏凉。是以从前服药,略加温补,上即烦热,略为清理,下又腹疼泄泻也。为拟此方,一日连服两次,其病遂愈。后旬余,因登楼受凉,旧证陡然反复,日下十余次,腹疼觉剧。其脉象微弱如前,至数不数。俾仍用山药粥,送服生硫黄末三分,亦一日服两次,病愈强半。翌日又服一次,心微觉热。继又改用前方,两剂全愈。
In one year, I lived in Dezhou city. In summer, a lady, 56 years of old, got dysentery with white and red in stool, Her dysentery lasted to winter. She had visited several doctors, drinked herbs hundreds of doses without any help. It was thought that no way to help her. Later, she came to me for help. Her pulse was mild and weak, with little frequent. She ate little, felt dizziness from time to time, slight annoying hot in the heart, falling feeling in anus when passing stool, though which was not so very severe. She answered that she usually felt cold in the lower abdomen. For this reason, with little warm-nourishing herbs in a formula, she would feel annoying hot; if with little cooling herbs, she would feel pain and diarrhea. So, I used this formula here to her, twice a day. The disease was cured. Months later, her condition recurred due to Cold-attack when she clamp up to high building. She had diarrhea tens of times a day with very much pain in abdomen. Her pulse was mild weak as before, some times frequent and some times not. I asked her to drink Liuhuang powder (brimstone powder) 0.9 gram, with the help of Shanyao soup, twice a day. The disease solved half. The next day, the treatment was repeated. She felt slight hot in heart. Then the previous formula was used again. After two doses, the condition was solved.

 

戊午秋日,愚初至奉天,有李××,年二十八。下痢四十余日,脓血杂以脂膜,屡次服药,病益增剧,羸弱已甚。诊其脉,数而细弱,两尺尤甚。亦治以此方。服后两点钟腹疼一阵,下脓血若干。病家言:从前腹疼不若是之剧,所下者亦不若是之多,似疑药不对证。愚曰:腹中瘀滞下尽即愈矣。伸再用白蔗糖化水,送服去皮鸭蛋子五十粒。此时已届晚九点钟,一夜安睡,至明晨,大便不见脓血矣。后间日大便,又少带紫血,俾仍用山药粥送服鸭蛋子二十粒,数次全愈。
In an autumn, I just came to the Fengtian city. Mr. Li, 28 years of old, had dysentery for 40 days. His stool was with pus, blood and white color oily membrane material. He had tried herbal therapy several times, but the condition was worse and he was very slim and weak. His pulse was frequent, thin and weak, especially on the Chi position on both sides. He was given this Sanbao Zhou. Two hours later, he felt pain in abdomen with little pus-blood in stool. The family said: he did not have so much pain or so much more blood and pus, so doubt the formula. I said: the condition should be solved after removal of stagnation in the intestine. I asked the sick person drink Yadanzi 50 granules with the help of white sugar water. At that time, it was 9 o’clock at night. He slept well all night. The next morning, the pus-blood stopped. Later, he had bowel movement once every other day with little purple blood. I still asked him to drink Yadanzi 20 gramules, with help of the Shanyao soup drinking. After several times, the condition was solved.  

又:斯秋中元节后,有刘××者,下痢两月不愈,求为延医。其脉近和平,按之无力,日便五六次,血液腐败,便时不甚觉疼,后重亦不剧。亦治以此方,一剂病愈强半。翌日将行,嘱以再接原方服两剂当愈。后至奉,接其来函言:服第二剂,效验不如从前;至三剂,病转似增重。因恍悟,此证下痢两月,其脉毫无数象,且按之无力,其下焦当系寒凉。俾仍用山药粥送服炒熟小茴香末一钱,连服数剂全愈。
Again: After middle august, Mr. Liu had dysentery for two months and asked me to help. His pulse was near calm, but weak when press heavier. He had diarrhea five to six times a day with blood and rotten material. He did not feel very pain when passing stool, neither very heavy in stool-retention feeling. I gave him this Sanbao Zhou to drink, One dose solved his problem. The next day before I departed, I asked him to continue the formula for two more doses. Later, after returned back to Dengtian city, I got his letter. It said: after the second dose, the condition was not as good as before. After the third dose, the condition seemed worse. I suddenly realized that, he had dysentery for two months but the pulse had no any sign of Fire and it was weak when pressed heavier. It should be a Cold condition in the Lower Jiao of the body. So, I asked him to drink fried Xiaohuixiang (cumin) powder with the drink of Shanyao soup. After several doses, his condition was solved completely.

或问:西人谓痢为肠中生炎。所谓炎者,红热肿疼,甚则腐烂也。观此案与治卢姓之案,皆用热药成功,亦可谓之肠炎乎?既非肠炎,何以其肠亦欲腐烂乎?答曰:痢证,原有寒有热。热证不愈,其肠可至腐烂。寒证久不愈,其肠亦可腐烂。譬如疮疡,红肿者阳而热,白硬者阴而寒,其究竟皆可变为脓血。赏观《 园随笔录》,言其曾患牙疳,医者治以三黄犀角纯寒之品,满口肉烂尽,而色白不知疼。后医者,改用肉桂附子等品,一服知疼,连服十余剂而愈。夫人口中之肌肉,犹肠中之肌肉也。口中之肌肉,可因寒而腐烂,肠中之肌肉,独不可因寒而腐烂乎?曾治一人,因久居潮湿之地,致下痢,三月不愈。所下者紫血杂以脂膜,腹疼后重。
It might be asked: the western medicine thinks that, the dysentery is the inflammation in the intestine. The so called inflammation means the red color, the hot, the swelling and the pain. In severe cases of inflammation, the affected area would be rotten and ulcer. If we look this case as well as the case of Mr. Lu, both were cured with warming herbs, could they be regarded as intestine inflammation? Answer: the dysentery can be separated in to the Hot or the Cold condition in Chinese medicine. If the Hot dysentery is not cured, it would cause rotten in the intestine, so is the Cold dysentery. For example for a skin ulcer, the red and swelling one belongs to a Yang and a Hot ulcer, but is white and hard one belongs to Yin and Cold. Both can develop into pus-blood. There is a case introduction in book
Yuan Shuui Bi Lu, in which a man had Yagan (inflammation in gum). Doctors used Sanhuang Xijiao, such pure Cold herbs for the treatment. The person felt ulcer in whole mouth. Its color was white, and the person did not feel pain. Later, doctor used herb Rougui and Fuzi, such Hot herbs. After one dose, the person started to feel pain. After ten doses, the condition was completely cured. The muscle in the mouth is similar to that in the intestine. The muscle in the mouth can be broken due to Cold condition, the muscle in the intestine too. I treated one man, who had dysentery due to lived for long time in wet condition. It bothered him for three months. In the stool, there was purple blood with white color membrane. He also felt pain in abdomen and stool-retention feeling in the anus.

或授以龙眼肉包鸭蛋子方,服之,下痢与腹疼益剧。后愚诊视,其脉微弱而沉,左部几不见。俾用生硫黄研细,掺熟面少许,作丸。又重用生山药、熟地、龙眼肉煎浓汤送服。连服十余剂,共计服生硫黄两许,其痢始愈。
I tried to fold the Yandanzi with Longyanrou and let him to drink. The pain and dysentery was worse. Later, when I saw him, his pulse was weak and deep. The pulse on the left side was almost not touched. He was given Liuhuang (brimstone) poweder, which was mixed with wheat flour to make as pills. In addition, large amount of Shanyao, Shoudi and Longyanrou were used as herbal tea to drink for ten doses. Totally, the Liuhuang used was about 30 gram. The dysentery was cured.

由是观之,即纯系赤痢,亦诚有寒者,然不过百中之二三耳。且尝实验痢证,若因寒者,虽经久不愈,犹可支持。且其后重、腹疼,较因热者亦轻也。且《伤寒论》有桃花汤,治少阴病下利、便脓血者,原赤石脂干姜并用,此为以热药治寒痢之权舆。注家不知,谓少阴之火伤阴络所致,治以桃花汤,原系从治之法。又有矫诬药性,谓赤石脂性凉,重用至一斤,干姜虽热,止用一两,其方仍以凉论者。今试取其药十分之一,煎汤服之,果凉乎热乎?此皆不知《伤寒论》此节之义,而强为注解者也。

Clearly, though most of the dysentery is Hot, but there is also Cold dysentery, though it is about 2% to 3% only. It is also experienced that, for the Cold dysentery, though it may last for a long time, the person’s body condition is still endurable. The level of pain in abdomen, and the level of the stool-retention feeling are not severe severe. Furthermore, there is a formula called Taohua Tang in the book Shang Han Lunto treat diarrhea with pus and blood in stool, in Shaoyin disease. In the formula, the Chishizhi and Ganjiang are used together. It is to use Hot herb to solve Cold diarrhea. The translators do not know this, so they said that the diarrhea is due to damage by Shaoyin Fire and the Taohua Tang is to following the way of clearing Fire. Someone even mis-adjust the herbal nature of the Chishizhi as Cold in herbal nature. To them, when Chishizhi is used to 250 gram and the Ganjian is used to only 15 gram, the whole formula is still Cold formula. Now, if we take only one tenth of the dose, try to drink it, see if it is Cold or Hot herbal tea?

 

7.通变白虎加人参汤

7. Tongbian Baihu jia Renshen Tang (Tongbian here means to modify; Baihu is the name of a herbal formula; jia means to add.)

 治下痢,或赤、或白、或赤白参半,下重腹疼,周身发热,服凉药而热不休,脉象确有实热者。
This formula is used for dysentery, with either red, or white or half-red-half-white stool, with pain in abdomen, stool-retention feeling, and with fever in body. The person has continuous fever though Cold herbs have been drunk and the pulse clearly suggests the presence of the sthenic Fire in the body.

石膏(二两,捣细) 生杭芍(八钱) 山药(六钱) 人参(五钱,用野党参按此分量,若辽东真野参宜减半,至高丽参则断不可用) 甘草(二钱)
Shigao 60 gram (grind), Baishao 24 gram, Shanyao 18 gram, Renshen 15 gram (if use whild Dangshen, keep the same amount; if use Liaodong true wild Renshen, use half of the amount; the Korea Renshen should not be used at all), Gancao 6 gram.

上五味,用水四盅,煎取清汤两盅,分二次温饮之。
Cook the herbs drink the herbal tea twice a day.

此方,即《伤寒论》白虎加人参汤,以芍药代知母山药代粳米也。痢疾身热不休,服清火药而热亦不休者,方书多诿为不治。夫治果对证,其热焉有不休之理?此乃因痢证夹杂外感,其外感之热邪,随痢深陷,永无出路,以致痢为热邪所助,日甚一日而永无愈期。惟治以此汤,以人参石膏,能使深陷之邪,徐徐上升外散,消解无余。加以芍药、甘草以理下重腹疼,山药以滋阴固下,连服数剂,无不热退而痢愈者。
This formula is modified from Baihu jia Renshen Tang in the book
Shang Han Lun, with the Shaoyao to replace Zhimu and Shanyao to replace Gengmi. If person with continuous fever, which could not be cooled down with Fire-killing herbs, medical books commonly said it is impossible to treat. However, if the therapy is correct, why it is impossible to treat? This is a condition, in which the dysentery is mixed with out-coming common cold. The out-coming Xie Qi invaded deep into the body, following the dysentery, so that the dysentery is helped by the Fire Xie Qi, and the condition becomes worse and worse every day. Only if use this formula, use the Renshen to help Shigao, to allow the deep-sink Xie Qi raising up to expel; and use Shaoyao and Gancao to clear the stool-retention feeling and pain in abdomen; and use Shanyao to enhance the Lower Jiao. After several days, the Fire should be expelled off and the dysentery should be cured.

按:外感之热已入阳明胃腑,当治以苦寒,若白虎汤、承气汤是也。若治以甘寒,其病亦可暂愈,而恒将余邪锢留胃中,变为骨蒸劳热,永久不愈(《世补斋医书》论之甚详)。石膏虽非苦寒,其性寒而能散,且无汁浆,迥与甘寒粘泥者不同。而白虎汤中,又必佐以苦寒之知母。即此汤中,亦必佐以芍药,芍药亦味苦(《神家本草经》)微寒之品,且能通利小便。故以佐石膏,可以消解阳明之热而无余也。
Comments: If the out-invading Fire comes into the Yangming Stomach area, and the condition should be treated with bitter-Cold herbs, such as Baihu Tang and Chenqi Tang. If it is treated with sweet-Cold, the disease can be improved for a short time, but the Xie Qi would be left in the Stomach to develop into Bone fever and exhausting fever condition without hope to cure later. Though herb Shigao is not bitter-Cold, its herbal nature is Cold and dispersing. Also, it contains no juice, which is different from stick of the sweet-Cold herbs. In the original Baihu Tang, the Shigao is used together with bitter-Cold herb Zhimu, so in this formula here, it should be accompanied by Shaoyao. Shaoyao is also a bitter and mild Cold herb, with ability to smooth urine. Use the Shaoyao to help the Shigao could solve the Yangming Hot without any side effect.

一叟,年六十七,于中秋得痢证,医治二十余日不效。后愚诊视,其痢赤白胶滞,下行时,觉肠中热而且干,小便亦觉发热,腹痛下坠并迫。其脊骨尽处,亦下坠作痛。且时作眩晕,其脉洪长有力,舌有白苔甚浓。
A old man, 67 years of old, got dysentery in a middle autumn. He visited doctor for twenty days without improvement. Later when I saw him, his stool is red, white in color and stick and glue. When passing the stool, he felt hot and dryness inside the intestine. His urine was also hot. He felt pain in abdomen with stool-retention feeling. At the end of his spine bone, he also felt falling pressure and pain. He had dizziness from time to time. His pulse was big, long and strong. His tongue covering is very thick.

愚曰:此外感之热挟痢毒之热下迫,故现种种病状,非治痢兼治外感不可。遂投以此汤,两剂,诸病皆愈。其脉犹有余热,拟再用石膏清之,病家疑年高,石膏不可屡服,愚亦应征他往。后二十余日,痢复作。延他医治疗,于治痢药中,杂以甘寒濡润之品,致外感之余热,永留肠胃不去,其痢虽愈,而屡次反复。延至明年仲夏,反复甚剧。复延愚延医,其脉象、病证皆如旧。因谓之曰,去岁若肯多服石膏数两,何至有以后屡次反复,今不可再留邪矣。仍投以此汤,连服三剂,病愈而脉亦安和。
I said, this was the dysentery with out-invading Hot. The symptoms were caused by the combination of the dysentery Hot and the out-invading Hot. Both reasons should be solved. He was given this formula for two doses, the symptoms stopped, but the pulse was still showing kind of Hot. I was to use Shigo to clear the Hot, but the family worried that the patient was old and the Shigao should not be continued for a long time. Also, I myself had to go somewhere for some time. After 20 days, her condition recurred. She visited other doctor, who used sweet-Cold herbs in the formula, so that the out-invading Hot sticked in the body. The dysentery stopped, but it recurred again and again, until to the summer next year, her condition was worse. I was invited again to have a look at her. Her pulse and symptoms were the same as before. I so said to the family, if she had willing to take Shigao little bit more amount, how would she had such recurrence again? Now, the Xie Qi should not be left in the body any longer. So, I gave her this formula for three doses and her disease was cured completely.

一人,年四十二,患白痢,常觉下坠,过午尤甚,心中发热,间作寒热。医者于治痢药中,重用黄连一两清之,热如故,而痢亦不愈。留连两月,浸至不起。诊其脉,洪长有力,亦投以此汤。为其间作寒热,加柴胡二钱,一剂热退痢止,犹间有寒热之时。再诊其脉,仍似有力,而无和缓之致。知其痢久,而津液有伤也,遂去白芍柴胡,加玄参知母各六钱,一剂寒热亦愈。
A man, 42 years of old, got white dysentery, felt falling feeling in the anus, hot feeling in the heart and had cold-hot shift feeling. Doctor added Huanglian 30 gram in the main formula, but her hot was the same, and the dysentery remained no stop. Such condition lasted for two months, until she could even not be able to get up. Her pulse was big-waving and strong. She was given this formula. For her cold-hot shifting feeling, Chaihu 6 gram was added. After one dose, the hot and dysentery stopped, but he still had some cold-hot shifting feeling. The pulse seemed still strong, no calm feeling. It was considered the damage of the Jinye of the body liquid portion for the long term diarrhea. So, Baishao and Chaihu were removed, but Xuanshen and Zhimu were added in the formula. One dose solved all problem.

一媪,年六旬,素多疾病。于夏季晨起,偶下白痢,至暮十余次。秉烛后,忽然浑身大热,不省人事,循衣摸床,呼之不应。其脉洪而无力,肌肤之热烙指。知系气分热痢,又兼受暑,多病之身,不能支持,故精神昏愦如是也。急用生石膏三两、野台参四钱,煎汤一大碗,徐徐温饮下,至夜半尽剂而醒,痢亦遂愈。诘朝煎渣再服,其病脱然。
A old lady, 60 years of old, suffered from disease for a long time. In a summer, she started to have white-dysentery in the morning, it was tens of times until the later evening. After dark, she suddenly felt very hot in the body, and lost consciousness, with hands touching here and there, and had no response upon calling. Her pulse was waving but not strong, and her body is hot even burning hands when touch. It was considered to be Hot dysentery in the Qi portion of the body, together with the summer Hot-attack, and with the long time of disease, her body crashed, so as to lose the consciousness. It was urgent to use Shigao 90 gram, wild Taishen 12 gram to cook herbal tea to let her to drink gradually. Until the middle night with the half tea drunk, the lady waked up and the dysentery stopped. The remaining herbal residue was cooked again and the tea was drunk again. Her condition was completely well then.

一人,年五十余,于暑日痢而且泻,其泻与痢俱带红色,下坠腹疼,噤口不食。医治两旬,病势浸增,精神昏愦,气息奄奄。诊其脉,细数无力,周身肌肤发热。询其心中亦觉热,舌有黄苔,知其证夹杂暑温。暑气温热,弥漫胃口,又兼痢而且泻,虚热上逆,是以不能食也。遂用生山药两半、滑石一两、生杭芍六钱、粉甘草三钱,一剂诸病皆见愈,可以进食。又服一剂全愈。
A man, 50 years of old, got summer dysentery and diarrhea, with red color in the stool. He felt falling feeling in the anus and pain in the abdomen, and felt hard to eat. Doctors had tried for two months, but the condition was worse. His mode was cloudy, the breath was very weak, and the pulse was thin, frequent but no force. Her body was very hot and she told that she also felt hot inside body. Her tongue covering was yellow in color. It was considered that his dysentery was mixed with summer Wen disease. The summer Qi and the Wen Hot overwhelmed over the stomach, the dysentery and diarrhea pressed the asthenic Fire up, all of which blocked his appetite to eat. So, for him, I used Shanyao 45 gram, Huashi 30 gram, Baishao 18 gram, and Gancao 9 gram. After one dose, the disease was much improved and he started to eat. After the second dose, the condition was completely solved.

此证用滑石不用石膏者,以其证兼泻也。为不用石膏,即不敢用人参,故倍用山药以增其补力。此就通变之方,而又为通变也。
In this case, I used Huashi but not Shigao, for his dysentery was accompanied with diarrhea. For no Shigao, so dared not to used Renshen, so doubled the amount of Shanyao to supply its nourishing ability. This is the modification of the modified formula.

痢证,又有肝胆肠胃先有郁热,又当暑月劳苦于烈日之中,陡然下痢,多带鲜血,脉象洪数,此纯是一团火气。宜急用大苦大寒之剂,若芩、连、知、柏、胆草、苦参之类,皆可选用。亦可治以白虎汤,方中生石膏必用至二两,再加生白芍一两。若脉大而虚者,宜再加人参三钱。若其脉洪大甚实者,可用大承气汤下之,而佐以白芍知母

The dysentery can also be caused by previous accumulated and stagnated Hot in the Liver, Gall bladder, Stomach and Intestine. Then together with the summer, heavy labor work, the person got the dysentery suddenly, most of times with fresh blood in the stool. The pulse was waving and frequent, showing a mass of Fire in the body. It should be used urgently the strong bitter and strong Cold herbs, such as Huangqin, Huanglian, Zhimu, Huangpo, Longdancao, and Kushen, all of which can be chosen to use. Herb Baihu Tang can also be used, in which the Shigao must be used up to 60 gram, with Baishao 30 gram. If the pulse was big but asthenic, add Renshen 9 gram. If the pulse was waving, big and sthenic, Dachenqi Tang can be used with help of Baishao and Zhimu in it.

有痢久而清阳下陷者,其人或间作寒热,或觉胸中短气。当于治痢药中,加生黄芪、柴胡以升清阳。脉虚甚者,亦可酌加人参。又当佐以生山药以固下焦,然用药不可失于热也。有痢初得,兼受外感者,宜于治痢药中,兼用解表之品。其外邪不随痢内陷,而痢自易治。不然,则成通变白虎加人参汤所主之证矣。
In some cases, the long time dysentery causes sink of pure Yang Qi. The person has cold and hot from time to time, or feels short of breath in chest. To the herbs for the dysentery, herb Huangqi and Chaihu should be added in. If the pulse is very asthenic, add Renshen. The Shanyao also is needed to fix and hold the Lower Jiao, so that the herbs should not be too Hot. In same cases, the dysentery is just started, but accompanied with out-invading common cold. To the herbs for dysentery, add herbs to expel the invading Xie Qi too, so that the Xie Qi would not sink with the dysentery Fire, and the dysentery should be easier to solve later. Other wise, the condition would turn into that that needs the Tongbian Baihu Tang for the treatment.

痢证初得虽可下之,然必确审其无外感表证,方可投以下药。其身体稍弱,又宜少用参、 佐之。
Though the bowel-cleansing therapy and herbs can be used in person with early stage of dysentery, it must be carefully checked no common cold. If the body is slight weak, there should be little herb Renshen in the formula to support the body defense system.

痢证忌用滞泥之品,然亦不可概论。外祖母,年九旬。仲夏下痢赤白甚剧,脉象数而且弦。愚用大熟地、生杭芍各一两煎汤,服下即愈。又服一剂,脉亦和平。
Commonly, stick herbs should not be used in the treatment of dysentery, but this principle is not exclusive. My grand mother-in-law, 90 years of old, got white-red dysentery in a summer. Her pulse was frequent and string. I used Shoudi and Baishao 30 gram each, cooked tea for her. One dose solved the problem. The second tea calmed down the pulse too.

痢证间有凉者,然不过百中之一耳,且又多系纯白之痢。又必脉象沉迟,且食凉物,坐凉处则觉剧者。治以干姜白芍小茴香各三钱,山楂四钱,生山药六钱,一两剂即愈。用白芍者,诚以痢证必兼下坠腹疼。

The Cold-dysentery is rare, about 1%. The Cold-dysentery is usually pure white dysentery. The pulse is deep and late. The person likes to eat cold food, but the condition was worse if sit down on cold place. For the treatment of the Cold-dysentery, use herb Ganjian 9 gram, Baishao 9 gram, Xiaohuixiang 9 gram, Shanzha 12 gram, Shanyao 18 gram. One to two doses can solve the problem. The use of Baishao is due to the falling feeling in the anus and pain in the abdomen.

即系凉痢,其凉在肠胃,而其肝胆间必有伏热,亦防其服热药,而生热也。
For the Cold-dysentery, the Cold is in the intestine and stomach, but there must be hidden Fire/Hot in the liver and gall bladder. It should be prevented to cause Hot due to take of Hot herbs.

凡病患酷嗜之物,不可力为禁止。尝见患痢者,有恣饮凉水而愈者,有饱食西瓜而愈者。总之,人之资禀不齐,病之变态多端,尤在临证时,精心与之消息耳。曾治一少年,下痢,昼夜无数,里急后重。投以清火通利之药数剂,痢已减半,而后重分毫不除。疑其肠中应有阻隔,投以大承气汤,下燥粪长数寸而愈。设此证,若不疑其中有阻隔,则燥粪不除,病将何由愈乎?
If the dysentery is caused by the food or some other things that the person usually craves for, it should not be prohibited. There is some case, in which the patient craved for cold water drink and cured, and some craved for water melon and he was given the water melon and got cured.

有奇恒痢者,张隐庵谓,其证三阳并至,三阴莫当,九窍皆塞,阳气旁溢,咽干喉塞痛,并于阴则上下无常,薄为肠 。其脉缓小迟涩,血温身热者死,热见七日者死。盖因阳气偏盛,阴气受伤,是以脉小迟涩。此证急宜用大承气汤泻阳养阴,缓则不救。若不知奇恒之因,见脉气平缓,而用平易之剂,必至误事。

There another kind of dysentery called Qihen Li (special kind of dysentery), in which the three Yang meridian are involved and affected. All of the openings of the body are blocked and lost function. The throat is dry and block and pain. Upon attack to the Yin meridians, the function in the upper and lower body is in disorder. The pulse was late, small, and astringent. In this condition, the person with warm blood and hot body will die, and the person who has up to seven days’ fever will also die. When the Yang Qi is overwhelming, the Yin would be damaged, so as the pulse was small, late and astringent. This condition should be saved by urgent use of Da Chenqi Tang to expel the Yang and to nourish the Yin. If the treatment is delayed, there would no chance to save the life. If not knowing the reason for such Qihen dysentery, and seeing that the pulse was calm, so to use calm herbs, the life would be lost.