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[General Principles] Zhang Zhongjing stated: In cases of diarrhea (Xia Li), if there is slight fever and thirst, and the pulse is weak, the disease will resolve spontaneously. In cases of diarrhea, if the pulse is rapid and there is thirst, the disease will resolve spontaneously. If the condition does not improve, pus and blood will inevitably appear in the stool, due to the presence of heat pathogen. In cases of diarrhea, if the pulse is rapid with slight fever and sweating, the disease will resolve spontaneously. If the pulse becomes tight again, it indicates that the pathogen has not yet been resolved. In cases of diarrhea, if the Cun (inch) position of the pulse is floating and rapid, while the Chi (cubit) position is naturally choppy (Se), pus and blood will inevitably appear in the stool.

[Commentaries] Zhang Congzheng said: When heat pathogen sinks deeply into the Yin aspect, and because there is heat within the Yin, it cannot stop by itself for a time, leading to pus and blood in the stool. A floating and rapid pulse should indicate that Yang Qi emerges from Yin and the patient recovers; however, because the Chi position is choppy, the condition progresses to pus and blood in the stool.

Ke Qin said: The previous clause refers to a predictive statement made before pus and blood appeared, due to the non-resolution of the disease. The latter clause is a speculative statement made after pus and blood appeared, based on the floating Cun and choppy Chi pulses.

[General Principles] Zhang Zhongjing stated: In Shanghan (Cold Damage) disease, if the heat is slight and cold extremities are mild, only the fingertips are cold, the patient is silent and lacks appetite, and feels irritable. After several days, if urination is smooth and the urine color is clear/white, this indicates that the heat has been eliminated. If the patient desires food, the disease is about to heal. If, however, cold extremities occur accompanied by vomiting, and there is irritability and fullness in the chest and hypochondrium, blood in the stool will inevitably follow later.

In Shanghan, if there is fever for four days, followed by cold extremities for three days, and then fever for another four days, meaning the duration of cold extremities is shorter than the duration of fever, the disease should heal. However, if from the fourth day to the seventh day the heat persists without abating, pus and blood will inevitably appear in the stool.

In Shanghan, if there are four days of cold extremities, followed by three days of fever, and then five more days of cold extremities, the disease is progressing. There is more cold and less heat, indicating the retreat of Yang Qi, hence the progression of the disease. In Shanghan, if cold extremities appear first, followed by fever and diarrhea, the diarrhea will likely stop spontaneously; if cold extremities reappear, the diarrhea will recur. In Shanghan, if cold extremities appear first, followed by fever, the lower diarrhea will likely stop spontaneously; but if sweating occurs instead, along with throat pain, Bi syndrome (obstruction) of the throat will develop. If there is fever, no sweating, and diarrhea, the diarrhea will likely stop spontaneously; if it does not stop, pus and blood will inevitably appear in the stool. In cases where pus and blood appear in the stool, Bi syndrome of the throat will not develop.

[Commentaries] Wu Shou said: Regarding hematochezia or pus and blood in the stool, there are differences in Yin/Yang and Cold/Heat natures. Ancient texts state "bleeding implies no cold" and "blood moves with heat," which is generally true. Mostly, these cases belong to Heat (80-90%), while only a few belong to Cold (10-20%). However, one cannot absolutely rule out Cold patterns. *Jin Gui Yao Lue* states: In Yang patterns with internal heat, fresh red blood is discharged; in Yin patterns with internal cold, purple-black blood resembling pig liver is discharged. Furthermore, in Yang patterns, if the pulse is rapid and forceful, it indicates Excess Heat, and bitter-cold herbs can be used. If the pulse is rapid but weak, it indicates Deficiency Heat, and cold herbs should be slightly added to sweet-warm blood-nourishing formulas. In Yin patterns, if the pulse is slow and forceful, it indicates the presence of Shen Qi (vital spirit/energy) and is treatable; if weak, it is difficult to treat. Generally, for diarrhea with pus and blood, if the body is hot and the pulse is large, it is difficult to treat; if the body is hot but the pulse is small, it is easy to treat.

Wang Kentang said: Pus and blood in the stool is a heat disease. Cases involving the Taiyang and Yangming meridians need not be discussed separately. If it involves the Shaoyin meridian, with diarrhea and pus/blood in the stool, and abdominal pain leading to pus/blood after four or five days, it is treated with Taohua Decoction (Peach Kernel Decoction). Cheng Wuji interpreted this as Interior Cold, which is incorrect. Although Taohua Decoction uses Ganjiang (Dried Ginger), its dosage is minimal, while Chishizhi (Halloysitum Rubrum) and Jingmi (Rice) constitute the majority. This formula aims to harmonize Zheng Qi (Upright Qi) and astringe slippage, using acrid herbs to disperse. Additionally, if after eight or nine days the whole body is hot, bleeding will inevitably occur. For Shaoyin diarrhea with pus and blood, acupuncture can be used. These three clauses regarding Jueyin diarrhea with pus and blood all involve heat pathogens transmitted through the meridians. Depending on the severity, either mild cooling methods or draining/dredging methods can be used, and recovery is assured. Misuse of acrid-hot herbs rarely leads to cure. The world considers this a difficult-to-treat disease, unaware that Zhang Zhongjing did not describe any fatal prognoses for pus and blood in the stool. Students should investigate this carefully.