阜城杜××，年四十五岁，得大便下血证。
病因 因劳心过度，每大便时下血，服药治愈。因有事还籍，值夏季暑热过甚，又复劳心过度，
旧证复发，屡治不愈。遂来津入西医院治疗，西医为其血在便后，谓系内痔，服药血仍
不止，因转而求治于愚。
证候 血随便下，且所下甚多，然不觉疼坠，心中发热懒食，其脉左部弦长，右部洪滑。
诊断 此因劳心生内热而牵动肝经所寄相火，致肝不藏血而兼与溽暑之热相并，所以血妄行也。
宜治以清心凉肝兼消暑热之剂，而少以培补脾胃之药佐之。
处方 生怀地黄（一两） 白头翁（五钱） 龙眼肉（五钱） 生怀山药（五钱）
知母（四钱） 秦皮（三钱） 黄柏（二钱） 龙胆草（二钱） 甘草（二钱）
共煎汤一大盅，温服。
复诊 上方煎服一剂，血已不见，服至两剂，少腹觉微凉。再诊其脉，弦长与洪滑之象皆减退，
遂为开半清半补之方以善其后。
处方 生怀山药（一两） 熟怀地黄（八钱） 净萸肉（五钱） 龙眼肉（五钱）
白头翁（五钱） 秦皮（三钱） 生杭芍（三钱） 地骨皮（三钱）
甘草（二钱）
共煎汤一大盅，温服。
效果 将药煎服一剂后，食欲顿开，腹已不疼，俾即原方多服数剂，下血病当可除根。
Fucheng resident Du XX, aged forty-five, suffered from hematochezia (blood in stool).
Etiology Due to excessive mental exertion, he experienced bleeding during defecation, which was cured by medication. Later, due to matters requiring his return to his hometown, coinciding with extreme summer heat and dampness, and again suffering from excessive mental exertion, the old condition relapsed. Despite multiple treatments, it remained uncured. He then came to Tianjin for treatment at a Western hospital. The Western physicians noted that the blood appeared after defecation and diagnosed internal hemorrhoids. However, medication failed to stop the bleeding, so he turned to seek my treatment.
Symptoms Blood passed with the stool, and the volume of bleeding was substantial; however, there was no sensation of pain or tenesmus (painful straining). He felt heat in the heart region and had a poor appetite. His pulse was wiry and long on the left side, and large and slippery on the right side.
Diagnosis This condition arises because mental overexertion generates internal heat, which agitates the Ministerial Fire (Xiang Huo, the fire associated with the Liver and Kidney meridians) residing within the Liver meridian. Consequently, the Liver fails to store blood properly, and this pathological state combines with the humid and hot pathogenic factor of summer-heat, leading to reckless bleeding. Treatment should employ a formula that clears the Heart, cools the Liver, and dissipates summer-heat, supplemented with a small amount of herbs to tonify the Spleen and Stomach.
Prescription Raw Shenghuai Rehmanniae Radix (1 liang), Pulsatillae Radix (5 qian), Longan Arillus (5 qian), Raw Shenghuai Dioscoreae Rhizoma (5 qian), Anemarrhenae Rhizoma (4 qian), Phellodendri Cortex (3 qian), Phellodendri Amurensis Cortex (2 qian), Gentianae Radix (2 qian), Glycyrrhizae Radix et Rhizoma (2 qian).
Decoct together in one large cup of water, take warm.
Second Visit After taking one dose of the above prescription, the bleeding ceased. After two doses, he felt a slight coolness in the lower abdomen. Upon re-examination, both the wiry-long and large-slippery pulse qualities had subsided. Therefore, I prescribed a formula that is half-clearing and half-tonifying to consolidate the recovery.
Prescription Raw Shenghuai Dioscoreae Rhizoma (1 liang), Cooked Shenghuai Rehmanniae Radix (8 qian), Clean Corni Fructus (5 qian), Longan Arillus (5 qian), Pulsatillae Radix (5 qian), Phellodendri Cortex (3 qian), Raw Hangbai Paeoniae Radix (3 qian), Lycii Cortex (3 qian), Glycyrrhizae Radix et Rhizoma (2 qian).
Decoct together in one large cup of water, take warm.
Outcome After taking one dose, his appetite immediately improved, and abdominal pain disappeared. Advised him to continue taking several more doses of the original prescription, and the hematochezia should be eradicated.