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(For women's conditions, see *Nuke Cuoyao* [Essentials of Gynecology].)

The medical classics state: When pathogenic factors invade the five zang organs, the yin meridians become disharmonious; when the yin meridians are disharmonious, blood stagnates. Internal accumulation of yin qi and external injury to the yang collaterals cause blood to seep into the intestines, resulting in hematochezia (blood in stool). The *Zhenjing* (Classic of Acupuncture) states: Injury to yang collaterals causes blood to overflow outward, manifesting as epistaxis or other upper bleeding; injury to yin collaterals causes blood to overflow inward, manifesting as hematochezia. These conditions are caused by irregular diet, improper daily routine, and inappropriate responses to the seven emotions and six climatic pathogens, leading to both internal injury and external contraction. If caused by external contraction, the blood is bright red, termed Changfeng (Intestinal Wind). If caused by internal injury, the blood is turbid, termed Zangdu (Visceral Toxin).

For patients with external contraction and sufficient yuan qi (original qi), Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity) is used, added with Huaihua (Sophorae Flos) and Jingjie (Schizonepetae Herba) to dispel pathogenic factors. For patients with internal injury and deficient yuan qi, Liu Jun Zi Tang (Six Gentlemen Decoction) is also used to tonify stomach qi. For patients with sinking yuan qi, Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) is used to raise and lift it. For those whose spleen qi is injured by worry and overthinking, Jisheng Gui Pi Tang (Gui Pi Decoction from the Generation-Sustaining Hall) is used to resolve the condition. If blood appears before defecation, Wu Zhu Yu (Evodiae Fructus) is added to Yi Qi Tang (Qi-Boosting Decoction). If blood appears after defecation, Huang Lian (Coptidis Rhizoma) is added. For patients with insufficient yin blood, Si Wu Tang (Four Substances Decoction) is appropriate. Etiologies are manifold and cannot be exhaustively listed; treatment must be adapted to specific clinical presentations to avoid errors. Mr. Danxi stated: Essence, qi, and blood all originate from grain qi. In the treatment of lower gastrointestinal bleeding, the ultimate goal should be the restoration of stomach qi. Practitioners must examine this carefully!

Clinical Cases

A scholar who habitually drank alcohol frequently suffered from hematochezia, sometimes before and sometimes after defecation. He had poor appetite, physical fatigue, and a sallow complexion. This indicated deficiency and weakness of spleen qi, which failed to control the blood. He was treated with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Wu Zhu Yu (Evodiae Fructus) and Huang Lian (Coptidis Rhizoma). After more than thirty doses, the condition did not recur.

A man experienced hematochezia or hematemesis (vomiting blood) every time he became angry, and he self-administered Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). I stated: This is due to spleen deficiency failing to hold the blood; it is inadvisable to use such cold-natured medicines. He did not believe me and continued taking them. His fatigue worsened daily, and his complexion became sallow. Later, he was treated with Si Wu Tang (Four Substances Decoction) combined with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Mu Dan Pi (Moutan Cortex). This led to loss of appetite, mental restlessness, thirst, and heat sensation, followed by profuse hematemesis, ultimately resulting in death. Had Si Jun Zi Tang (Four Gentlemen Decoction) been combined with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix), along with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi), survival would have been likely.