热伤阴络病便血，脏毒血黯肠风红，须辨腹痛肛肿痛，热盛湿盛要分明。脏毒初起肿痛甚，大黄皂
刺莫稍停，热盛俱宜槐花散，湿盛平胃地榆
灵，日久脉微气血弱，升阳和血共养荣。
【注】大便下血，皆因小儿恣食肥甘，致生内热伤阴络也。若血色黯而浊，肛门肿痛，
先血后粪，此为近血，名曰脏毒；若血鲜而清，腹中不痛，先粪后血，此为远血，名曰
肠风。脏毒肛门每多肿痛，初起宜用皂刺大
黄汤消之；大下血后，热盛微痛者，以槐花散和之；湿盛不痛者，以平胃地榆汤和之。肠
风亦宜以槐花散主之。便血日久，脉微气血弱者，升阳和血汤和之，继以人参养荣汤补之。
皂刺大黄汤
皂刺 生川大黄（各等分）
量小儿年岁大小虚实，酌其多少，水酒煎服。
槐花散
槐花（炒） 侧柏叶 枳壳（麸炒） 川黄连 荆芥穗（炒）
水煎服，脏毒加苍术、苦楝；肠风加秦艽、防风。
【方歌】脏毒肠风槐花散，黄连枳壳槐柏荆，脏毒苍术苦楝入，肠风须加艽防风。
平胃地榆汤
苍术（炒） 陈皮 浓朴（姜炒） 甘草 地榆
引用生姜，水煎服。
【方歌】便血湿盛腹不痛，须用平胃地榆汤，苍术陈皮浓朴草，地榆同煎引生姜。
升阳和血汤
黄 （炙） 当归（酒洗） 白芍（炒） 牡丹皮 陈皮 肉桂 秦艽 生地黄 熟地黄 生甘
草炙甘草 苍术（炒） 升麻
水煎服。
【方歌】下血日久腹中痛，治宜升阳和血汤，二地二草 归芍，陈丹秦艽升桂苍。
人参养荣汤
人参 黄 （炙） 白术（土炒） 白茯苓 白芍药（炒） 肉桂 熟地黄 当归（酒洗） 甘
草（炙） 陈皮
引用姜枣，水煎服。
【方歌】失血日久气血虚，人参养荣汤颇宜，参 术草白芍桂，地黄当归草陈皮。
Hematochezia caused by heat damaging the Yin collaterals: blood from Zangdu (Visceral Toxin) is dark, while blood from Changfeng (Intestinal Wind) is bright red. It is necessary to differentiate whether abdominal pain and anal swelling/pain are present to clearly distinguish between excessive heat and excessive dampness. When Zangdu first appears with severe swelling and pain, Dahuang Zaoci Decoction should be used without delay; for cases of excessive heat, Huaihua San is generally suitable; for cases of excessive dampness, Pingwei Diyü Tang is effective. If the condition persists for a long time, presenting with a faint pulse and deficiency of Qi and Blood, Shengyang Hexue Tang combined with Renshen Yangrong Tang should be employed.
[Note] Hematochezia in children is often due to indulging in rich and sweet foods, generating internal heat that damages the Yin collaterals. If the blood is dark and turbid, accompanied by anal swelling and pain, with bleeding occurring before defecation, this is called "Jin Xue" (Near Bleeding), named "Zangdu" (Visceral Toxin); if the blood is fresh and clear, without abdominal pain, with bleeding occurring after defecation, this is called "Yuan Xue" (Far Bleeding), named "Changfeng" (Intestinal Wind). Zangdu often involves anal swelling and pain; initially, Zaoci Dahuang Tang should be used to dissipate it. After massive bleeding, if heat is predominant with mild pain, Huaihua San is used to harmonize; if dampness is predominant without pain, Pingwei Diyü Tang is used to harmonize. Changfeng is also primarily treated with Huaihua San. For prolonged hematochezia with a faint pulse and Qi/Blood deficiency, Shengyang Hexue Tang is used first to harmonize, followed by Renshen Yangrong Tang to tonify.
Dahuang Zaoci Decoction
Zaocis Spina (Spine of Black Boar Thorn), Sheng Chuan Dahuang (Raw Rhizoma et Radix Rhei) (equal parts).
Based on the child's age and constitution (deficiency or excess), determine the dosage appropriately. Decoct in water and wine, then administer.
Huaihua San
Huaihua (Stir-fried), Ce Bai Ye (Arborvitae Leaf), Zhike (Bran-fried), Chuan Huanglian (Rhizoma Coptidis), Jingjie Sui (Stir-fried).
Decoct in water. For Zangdu, add Cangzhu and Kulián; for Changfeng, add Qinjiao and Fangfeng.
[Formula Song] For Zangdu and Changfeng, use Huaihua San, containing Huanglian, Zhike, Huaihua, Ce Baiye, and Jingjie. Add Cangzhu and Kulián for Zangdu; add Qinjiao and Fangfeng for Changfeng.
Pingwei Diyü Tang
Cangzhu (Stir-fried), Chenpi (Tangerine Peel), Nongpo (Ginger-stir-fried), Gancao (Licorice Root), Diyü (Sanguisorba Root).
Use Shengjiang (Fresh Ginger) as a guide. Decoct in water and administer.
[Formula Song] For hematochezia with dampness predominance and no abdominal pain, use Pingwei Diyü Tang, containing Cangzhu, Chenpi, Nongpo, Gancao, and Diyü, decocted together with Shengjiang as a guide.
Shengyang Hexue Tang
Huangqi (Honey-fried), Danggui (Wine-rinsed), Baishao (Stir-fried), Mudanpi (Tree Peony Bark), Chenpi, Rougui (Cinnamon Bark), Qinjiao (Gentian Macrophylla Root), Sheng Dihuang (Rehmannia Root), Shu Dihuang (Prepared Rehmannia Root), Sheng Gancao (Raw Licorice), Zhi Gancao (Honey-fried Licorice), Cangzhu (Stir-fried), Shengma (Cimicifuga Rhizome).
Decoct in water and administer.
[Formula Song] For prolonged lower bleeding with abdominal pain, treat with Shengyang Hexue Tang, containing Er Di (Sheng Dihuang, Shu Dihuang), Er Cao (Sheng Gancao, Zhi Gancao), Danggui, Baishao, Chenpi, Mudanpi, Qinjiao, Shengma, Rougui, and Cangzhu.
Renshen Yangrong Tang
Renshen (Ginseng), Huangqi (Honey-fried), Baizhu (Earth-stir-fried), Baifuling (Poria), Baishaoyao (Stir-fried), Rougui, Shu Dihuang, Danggui (Wine-rinsed), Gancao (Honey-fried), Chenpi.
Use Shengjiang (Fresh Ginger) and Dazao (Jujube) as guides. Decoct in water and administer.
[Formula Song] For prolonged blood loss leading to Qi and Blood deficiency, Renshen Yangrong Tang is very suitable, containing Renshen, Baizhu, Gancao, Baishaoyao, Rougui, Dihuang, Danggui, and Chenpi.