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Dysentery with pus and blood (Bian Nong Xue) belongs to heat diseases. Among those occurring in the Taiyang (Greater Yang) channel, if a patient suffering from Lin syndrome (dysuria) is mistakenly treated with sweating methods, it may cause hematochezia (blood in stool). Zhu Ling Tang (Polyporus Decoction) is indicated for this type of Huai Bing (complication due to mis-treatment), which arises from dribbling urination; thus, promoting diuresis leads to recovery. In Yangming (Yang Brightness) disease, bleeding accompanied by delirium indicates that heat has entered the Blood Chamber (Xue Shi, referring to the Chong Mai or uterus related to blood circulation); puncturing Qimen (LR14) disperses the heat. If there are neither exterior nor interior excess syndromes, but dysentery with pus and blood occurs after mistaken purgation, it is because the heat pathogen flows downward.

In Shaoyin (Lesser Yin) disease, diarrhea with pus and blood may occur. If, on the fourth or fifth day, abdominal pain and dysentery with pus and blood appear, Tao Hua Tang (Peach Blossom Decoction) is used. Cheng Wuji interpreted this as a Interior Cold syndrome, which is incorrect. Although Tao Hua Tang contains Gan Jiang (Dried Ginger), its dosage is minimal, while Chi Shi Zhi (Halloysitum Rubrum) and Jing Mi (Rice) constitute the majority. This likely reflects the principle of harmonizing healthy Qi, astringing intestinal sliding/diarrhea, and using acrid herbs to disperse pathogens. Furthermore, after eight or nine days, if the whole body becomes hot, hematochezia will inevitably occur. Additionally, patients with dysentery with pus and blood can be treated by puncturing Jueyin (Terminal Yin) channels. Also, in Shanghan (Cold Damage), if cold limbs precede fever, dysentery with pus and blood will inevitably follow; or if cold limbs are brief and fever is slight, hematochezia will follow later; or if diarrhea presents with a rapid pulse and thirst, passage of pus and blood will follow. These cases are all caused by heat pathogens transmitted through the channels. Depending on severity, either mild cooling or guiding-draining methods are used, ensuring recovery. Mistaken use of acrid-hot herbs rarely results in cure. People therefore consider this a difficult-to-treat disease, not knowing that Zhang Zhongjing did not mention fatal prognoses for dysentery with pus and blood; students should study this carefully.

Taiyang disease treated with fire-moxibustion without inducing sweat causes restlessness; if the pathogen remains in the Taiyang channel unresolved, hematochezia will occur because fire-pathogens force blood downward. If Taiyang disease is mistakenly treated with purgation, and the pulse is hurried without forming Jie Xiong (chest binding), the disease is about to resolve; if the pulse is deep and slippery, it indicates Xie Re Li (diarrhea accompanying heat); if the pulse is floating and slippery, hematochezia will inevitably occur. Patients with Lin syndrome must not undergo sweating therapy, as it will inevitably lead to dysentery with pus and blood. If the exterior syndrome of Taiyang disease is resolved, but only urgency and binding in the lower abdomen remain, it is a Tao Ren Cheng Qi Tang (Peach Kernel Decocted Powder) syndrome (see Stasis of Blood section).

In Yangming disease, if there are no exterior or interior syndromes, but fever persists for seven to eight days, even with a floating and rapid pulse, purgation may be used. If purgation has been administered but the rapid pulse persists and diarrhea continues, this is Xie Re Bian Nong Xue (dysentery with pus and blood accompanying heat). Yangming disease with bleeding and delirium indicates heat entering the Blood Chamber. Head-only sweating suggests puncturing Qimen. The Chong Mai (Penetrating Vessel) is the Sea of Blood, i.e., the Blood Chamber, present in both men and women. Men with bleeding and delirium, and women with alternating chills and fever resembling malaria, all indicate heat entering the Blood Chamber, forcing blood downward, resulting in Xie Re Li (diarrhea with blood). The pulse carrying blood may be intermittent and rapid, or deep or hidden; when blood-heat intertwines, the pulse becomes surging and large. Generally, this is seen in the left hand for men and the right hand for women. Conversely, diarrhea with pus and blood caused by Yin-Cold indicates deficiency-cold in the Lower Jiao (Lower Burner) with unstable intestines and stomach, failing to separate clear from turbid, leading to passage of pus and blood. These two types—one blood-heat, one blood-cold—must be carefully distinguished clinically.

Shaoyin disease persisting for eight or nine days with heat throughout the whole body and extremities indicates heat in the Bladder, inevitably causing hematochezia. Shaoyin disease with diarrhea and dysentery with pus and blood can be treated by puncturing Jueyin channels.

Jueyin Cold Damage: If cold limbs precede fever, diarrhea will stop spontaneously; if it does not stop, dysentery with pus and blood will follow. In Cold Damage with slight heat and mild cold limbs (cold only at fingertips), silent demeanor, anorexia, and clear urine indicate the elimination of heat; desire for food indicates impending recovery. However, if cold limbs, vomiting, and chest/hypochondriac irritability/fullness occur, dysentery with pus and blood will follow later. In Cold Damage, if cold limbs are brief and heat is abundant, the disease should resolve; if heat persists from the fourth to seventh day, dysentery with pus and blood will follow. Diarrhea with a rapid pulse and thirst indicates spontaneous recovery; if not recovered, passage of pus and blood will follow. Diarrhea with a floating-rapid pulse at the Cun (distal) position and a hidden/abrupt pulse at the Chi (proximal) position indicates passage of pus and blood. Wu states: Hematochezia and dysentery with pus and blood differ in Yin/Yang and Cold/Heat, requiring careful differentiation. Ancients said "bleeding implies no cold" and "blood moves with heat," which are generalizations. Mostly, cases belong to heat (80-90%), while cold cases are rare (10-20%); one must not rigidly assume absence of cold. *Jingui Yaolue* states: Yang syndromes with internal heat pass fresh red blood; Yin syndromes with internal cold pass dark purple blood like pig liver. Regarding pulses: Yang syndromes with rapid, forceful pulses indicate excess heat, treatable with bitter-cold herbs; rapid but weak pulses indicate deficient heat, treatable with sweet-warm blood-nourishing herbs supplemented with cold herbs. For Yin syndromes, slow but forceful pulses indicate presence of Shen (vital spirit) and are treatable; weak pulses are difficult to treat. Generally, diarrhea with pus and blood accompanied by fever and a large pulse is difficult to treat; fever with a small pulse is easier to treat.