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Hematochezia caused by epidemic febrile diseases indicates that heat pathogens have penetrated deeply into the interior. Initially, one must distinguish the color of the blood. If the blood is bright red, the primary treatment is to clear heat, using formulas such as Huangqin Tang (Scutellaria Decoction), Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If the blood is purplish-dark and forms clots upon discharge, the primary treatment is to expel blood stasis, using formulas such as Tao Ren Chengqi Tang (Peach Kernel and Rhubarb Decoction) or Didang Tang (Wait-and-See Decoction); these should only be used definitively when tenderness is present upon palpation of the abdomen and hypochondrium. In hematochezia from epidemic febrile diseases, if the stool contains darkish blood mixed with salivous fluid, it indicates deficiency of the Spleen and Stomach and injury to the Zang-Fu organs; formulas such as Guipi Tang (Restore the Spleen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), or Bazhen Tang (Eight Treasure Decoction) may be borrowed, with Wumei (Mume Fruit) added.

Following hematochezia in epidemic febrile diseases, Yin exhaustion syndromes often occur, manifesting as coma, deafness, a tongue without coating and dry, body pain preventing turning over, etc. These can be treated with Shengmai San (Generate the Pulse Powder) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Ejiao (Donkey-Hide Gelatin) to vigorously tonify Yin, though prognosis is often poor.

There is a distinction between dryness and dampness in hematochezia versus dysentery-like pus and blood in stools during epidemics. Hematochezia belongs to dry-heat and is primarily treated with cooling and moistening methods; dysentery-like pus and blood belong to damp-heat and are primarily treated with clearing heat and promoting diuresis to separate dampness. At the onset of an epidemic, if headache, fever, and dysentery-like pus and blood appear, this corresponds to what ancients called "epidemic dysentery." There is no need to specifically treat the pus and blood; simply resolve the exterior syndrome. Once the exterior is resolved, the frequency of defecation will naturally decrease. One must absolutely avoid administering interior-clearing and purgative drugs early on, and even diuretic or cooling agents should be used with caution. This is because the pathogen is still at the exterior; clearing the interior would cause the pathogen to sink deeper inward, making subsequent treatment extremely difficult. Moreover, once dysentery-like pus and blood appear in epidemics, the intense heat of irritability and thirst often subsides, as heat diminishes with evacuation. Therefore, bitter-cold substances should not be used indiscriminately; Canglin Tang (Granary Lin Decoction) should be the primary formula (see details under the section on complicated dysentery). If the epidemic transmits to the half-exterior half-interior stage presenting with dysentery-like pus and blood, Chai Ge Jie Ji Tang (Bupleurum and Kudzu Release Muscle Decoction) with Fuling (Poria), Zexie (Alisma), Mutong (Akebia Stem), and Huangqin (Scutellaria Root) should be used. If the epidemic transmits into the interior, accompanied by irritability, thirst, delirium, and dysentery-like pus and blood, choose between Huangqin Tang (Scutellaria Decoction) or Gegen Qinlian Tang (Kudzu and Scutellaria-Coptis Decoction). If accompanied by tenesmus and abdominal resistance to pressure, add Binglang (Areca Seed) and Dahuang (Rhubarb Root). If dysentery-like pus and blood persist and become slippery despite multiple purgations, the primary treatment should be nourishing the middle, regulating Qi, and nourishing blood, with clearing heat as an adjunct. The elderly and the debilitated should follow this pattern.

Epidemics characterized by damp-heat rarely present with constipation. When constipation does occur, it is usually due to strong Stomach Yang and inherent dryness. Since the constitution is already Yang-excess, contracting an epidemic transforms damp-heat into dry-heat. Even if exterior symptoms exist without sweating, purgation may be indicated. This differs from Cold Damage (Shanghan): in Cold Damage, pathogens enter from the exterior, and if exterior symptoms persist without sweating, interior purgation is strictly contraindicated; in epidemics, pathogens originate from within. Although exterior symptoms may exist, releasing the exterior often fails to produce sweat; one must wait for the interior to unblock before the exterior can release via sweat. Therefore, once constipation occurs in epidemics, even with exterior symptoms, purgation is required without hesitation. If the exterior has not been released initially, Sanxiao Yin (Three Eliminations Decoction) should be used for purgation. If exterior symptoms allow for purgation, and symptoms such as irritability, thirst, delirium, yellow-black dry and short tongue coating, and hardness/pain in the chest and abdomen are all present, purgation should definitely be administered according to severity.

In cases of constipation where repeated purgations fail to relieve blockage, there is likely a complicating pathogen that must be examined. If water retention is involved: if water is in the intestines, diarrhea may occur spontaneously without constipation; if water is above the epigastrium, the pulse is often wiry or slow, often presenting with vomiting but no diarrhea, white tongue coating, and a resonant sound upon pressing below the heart; although Chengqi Decoctions cannot descend, purgation fails. In such cases, use Banxia (Pinellia Tuber), Fuling (Poria), and Cangzhu (Atractylodes Rhizome) to eliminate water first, then purge. Dadixiong Tang (Great Chest-Sinking Decoction) may also be used if there is severe pain in the upper chest that cannot be touched, indicating the medicine is confronting the pathogen. If Qi stagnation is involved: Qi stagnates in the chest and diaphragm, rising upward rather than descending, causing wandering pain in the chest and abdomen with a deep pulse. Use Suzi (Perilla Seed), Laifuzi (Radish Seed), Muxiang (Costus Root), and Binglang (Areca Seed) to regulate Qi first, then purge.

If purgation fails due to Qi deficiency, typically seen in the elderly or debilitated, the pulse will be weak, complexion sallow, muscles flaccid, and spirit scattered. If full purgative indications are present, give Dachengqi Tang (Major Order the Qi Decoction) plus Renshen (Ginseng Root); after one dose, accumulated feces should evacuate immediately. Alternatively, Taoshi Huanglong Tang (Dr. Tao's Yellow Dragon Decoction) or Mahuan Wan (Hemp Seed Pill) taken with Renshen decoction can be used, adjusted based on the extent of interior excess. If purgation fails due to Blood deficiency, typically seen postpartum in women, after ulceration of carbuncles/sores, or in those with chronic Yin deficiency or blood loss, the pulse will be choppy. Choose Siwu Tang (Four Substance Decoction), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Shengmai San (Generate the Pulse Powder), Wu’s various Yingnong (Nourish the Nutritive) formulas, or Mahuan Wan (Hemp Seed Pill), and still employ honey-prepared pig bile suppositories for guidance.

Generally, in epidemics, once constipation occurs, purgation is indicated. However, one must inquire about the patient's distress. If there is little distress, purgation can be delayed; if there is distress and purgation fails, one must check for complicating pathogens or deficiency. About 50% require immediate purgation, 30% can be delayed, and 10% involve complicating pathogens. This applies to epidemics, not other diseases. As the ancient saying goes: "For Cold Damage, purgation is never too late; for epidemics, purgation is never too early." This statement is indeed true!