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When blood exits from the urethra, it is termed hematuria (Niao Xue); when it exits from the anus, it is termed hematochezia (Bian Xue). Collectively, these are referred to as lower bleeding (Xia Xue). However, there is a distinction between Yin meridians and Yang meridians, but no difference between cold syndromes and heat syndromes; ultimately, all return to being heat syndromes. Although *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) contains clauses regarding lower bleeding in Shaoyin and Jueyin diseases, these are all conditions where Yang-heat pathogen has transmitted into the Yin meridians. Although the meridians belong to Yin, the symptoms manifest as Yang syndromes. Tao Hua (Tao Shi) correctly identified some cases as "co-existing heat" (Xie Re), but erroneously identified others as caused by Yin-cold. This error arose because in years of excessive rain and dampness, dampness dominates, and damp-toxin attacks the skin and hair externally while invading the blood level internally. This causes chills and fever, hematochezia, and notably, abdominal pain is absent. In such cases, one should use Cangzhu Baidu San (Atractylodes Decoction for Overcoming Toxicity) with acrid-warm properties to disperse the exterior pathogen, avoiding cold-cooling herbs that might suppress the pathogen. This follows the principle from *Neijing* (Inner Canon): "For excess dampness, treat with acrid-warm methods." It is not treating Yin-cold with warm methods. Tao Shi, observing the use of acrid-warm herbs, mistakenly labeled it as Yin-cold, failing to consider the *Neijing* statement: "When Fire Qi is excessive in the year, the people suffer from blood overflowing and leaking." When Shaoyin Fire Qi erupts internally, it causes blood overflow and leakage. Blood flows recklessly when heated; therefore, regardless of whether the bleeding is due to external contraction or internal injury, heat is the primary treatment target. For internal injuries, if Heart Heat transfers to the Small Intestine causing hematuria, Daochi Geban Tang (Half Daochi Decoction) is used. If the Small Intestine meridian itself suffers from heat, Huofu Dan (Fire Mansion Pill) added with Tongcao (Caulis Akebiae) and Huashi (Talcum) is used. If Lung Heat transfers to the Large Intestine causing hematochezia, Liangge San (Cooling the Diaphragm Powder) is used. If the Large Intestine meridian itself suffers from heat, Danggui Dahuang Tang (Angelica and Rhubarb Decoction) added with Zhizi (Fructus Gardeniae), Huanglian (Rhizoma Coptidis), and Shaoyao (Radix Paeoniae Rubra/Alba) is used. If Bladder Lower-Jiao heat accumulation causes hematuria, Mutong Cheqian Tang (Akebia and Plantago Seed Decoction) added with Zhimu (Rhizoma Anemarrhenae), Huangbai (Cortex Phellodendri), Zhizi, and Huanglian is used. If Liver meridian Blood Chamber harbors latent fire causing lower bleeding, Zhibai Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction) combined with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is used. None of these can be described as Yin-cold syndromes.

In Taiyang disease, if moxibustion or fire fumigation is applied and sweat does not occur, the patient will inevitably become irritable. If the disease course exceeds its expected duration without resolution, rectal bleeding (Qing Xue) will definitely occur; this is termed Fire Evil (Huo Xie).

Taiyang disease should be resolved through sweating. However, if the patient's fluids are exhausted and blood is dry, preventing sweating, and the physician uses fire coercion to induce sweating, damaging Yin, irritability ensues. When rectal bleeding occurs, one must clear the Fire Evil.

In Taiyang disease, after mistaken purgation, if the pulse is rapid (Cu) and chest binding (Jie Xiong) has not formed, recovery is desired. If the pulse is deep and slippery (Chen Hua), it indicates co-existing heat diarrhea (Xie Re Xia Li); if the pulse is floating and slippery (Fu Hua), lower bleeding will definitely occur.

Mistaken purgation in Taiyang disease risks forming chest binding. If the pulse is floating and rapid, the exterior pathogen has not yet sunk inward, and chest binding has not formed, so recovery is indicated. If the pulse is deep and slippery, the pathogen lingers in the Large Intestine, causing co-existing heat diarrhea. If the pulse is floating and slippery, heat in the blood overflows, leading to definite hematochezia.

Patients with stranguria (Lin Jia) should not undergo sweating therapy. If sweating is induced, rectal bleeding may result.

"Lin Jia" refers to heat accumulation in the Bladder with frequent urination. If the Bladder is not cleared and promoted, but sweating is instead induced, urinary bleeding will certainly occur.

In Yangming disease, lower bleeding accompanied by delirium indicates Heat Entering the Blood Chamber (Re Ru Xue Shi). If only the head sweats, puncture Qimen (LR14) to drain the excess according to the syndrome. Generalized sweating will lead to cure. This clause details Heat Entering the Blood Chamber.

In Shaoyin disease, on the eighth or ninth day, if the whole body and hands and feet are hot, it is because the heat resides in the Bladder, and urinary bleeding will definitely occur.

This describes Shaoyin heat pathogen transmitting outward to the Taiyang meridian, causing generalized heat. Heat accumulates in the Bladder, leading to hematuria.

Danggui Dahuang Tang (Angelica and Rhubarb Decoction)
Ingredients: Danggui (Radix Angelicae Sinensis), Dahuang (Radix et Rhizoma Rhei), Shengdi (Radix Rehmanniae Preparata), Gancao (Radix Glycyrrhizae).
This formula originally treats lower bleeding due to dry-fire. My father secreted this formula to treat vomiting blood and coughing blood, along with dry stool. The rationale is that cooling blood prevents upward rising, and using Dahuang together with Danggui guides the blood back to the meridians.

Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) (See section on Epistaxis)
If the Liver house has fire, it leads to excessive dispersion and failure to store blood. If the Spleen is attacked by fire, the Earth collapses and fails to contain blood. By using Baishao (Radix Paeoniae Alba) together with Huangqin (Radix Scutellariae), Huanglian, and Huangbo, the fire in both Liver and Spleen is cleared, restoring their functions of storing and containing blood.

Cangzhu Baidu San (Atractylodes Decoction for Overcoming Toxicity)
Ingredients: Shu Cangzhu (Rhizoma Atractylodis Macrocephalae Prepared), Qianghuo (Rhizoma Notopterygii), Duhuo (Radix Angelicae Pubescentis), Chaihu (Radix Bupleuri), Qianhu (Radix Peucedani), Fangfeng (Radix Saposhnikoviae), Jingjie (Herba Schizonepetae), Zhike (Fructus Aurantii Immaturus), Guangpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae).
When cold-dampness injures the Taiyang meridian and transmits internally to the Yangming meridian, symptoms of damp-toxin lower bleeding appear. Since pathogens enter through the hair pores, they must exit through the hair pores. Therefore, blood-invigorating herbs are not used; instead, this formula disperses cold-dampness. If cold-cooling herbs are mistakenly used, the toxic pathogen will lie dormant and fail to dissipate.

Taohé Chengqi Tang (Peach Kernel Decoction to Direct the Qi) Also known as Taoren Chengqi Tang.
For cold-dampness injuring the exterior, use Baidu San. For interior heat causing lower bleeding, use this formula to clear interior heat and purge stasis. Exterior and Interior represent two major therapeutic approaches.

Daochi Geban Tang (Half Daochi Decoction) (See section on Delirium and Fever)
Liangge San (Cooling the Diaphragm Powder) (See section on Delirium)
Huofu Dan (Fire Mansion Pill) Treats disorders of both urine and feces.
Ingredients: Danggui, Chishaoyao (Radix Paeoniae Rubra), Huanglian, Dahuang, Gancao, Huashi.
Taoren Chengqi Tang purges stasis; this formula clears blood heat. Both use Dahuang, distinguishing between clearing (Qing) and purging (Xia), and targeting large versus small intestines.

Danggui Dahuang Tang (Angelica and Rhubarb Decoction)
Ingredients: Danggui, Dahuang, Guangpi, Gancao.
Huofu Dan treats both urine and feces; this formula specifically clears Large Intestine heat.

Mutong Cheqian Tang (Akebia and Plantago Seed Decoction)
Ingredients: Mutong (Caulis Akebiae), Cheqianzi (Semen Plantaginis), Shanzhi (Fructus Gardeniae), Chuanlian (Rhizoma Coptidis), Zhimu, Huangbai, Shengdi, Gancao.
This formula clears Small Intestine heat and promotes bladder function. My father secreted this formula to treat Lower-Jiao heat accumulation causing stranguria and retention of urine.

Zhibai Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction)
Ingredients: Zhimu, Huangbai, Danggui, Baishao, Shengdi, Danpi (Cortex Moutan).
Longdan Xiegan Tang (Gentian Liver-Draining Decoction) (See section on Hypochondriac Pain)
Ingredients: Dancao (Radix Gentianae), Chaihu, Huangqin, Shanzhi, Chuanlian, Zhimu, Maidong (Radix Ophiopogonis), Renshen (Radix Ginseng), Gancao.