Library

In women, the discharge of feces through the urethra is called "Jiao Chang" (Crossed Intestines). If Wu Ling San (Five-Ingredient Poria Decoction) fails to fully cure the condition, one may administer the ash obtained by burning old cotton wadding. (*De Xiao Fang*) [Note: My late father stated that in cases of intestinal abscess, feces may also be discharged through the urethra; this can be treated with Yunmu Gao Pills taken with Huang Qin Tang (Scutellaria Decoction). See Wang Mingqing's *Yu Hua*.]

Xia Ziyi, in *Qi Ji Fang* (Formulas for Strange Diseases), states: In women, due to childbirth, the positions of Yin and Yang are reversed, resulting in feces being discharged from the anterior orifice (urethra), a condition named Jiao Chang disease. One should take the ash of old cotton wadding administered with wine, while continuing to take Wu Ling San (Five-Ingredient Poria Decoction) to promote diuresis and separate fluids. If cotton wadding is unavailable, any old lacquered gauze cap can serve as a substitute. [Note: *Yi Que* states: Because it has absorbed head Qi for a long time, this takes the meaning of Yang Qi rushing upward. This all derives from the principle that lacquer can move stagnant blood.] (*Ben Cao Gang Mu*)

Jia Jian Si Wu Tang (Modified Four Substances Decoction) treats women with disharmony of cold and heat, and indistinct Yin and Yang, resulting in reversed excretion of urine and feces.
Take Si Wu Tang (Four Substances Decoction) 5 qian, add Yi Yuan San 2.5 qian, decoct with one cup of water and one cup of wine until reduced to 0.8 cup, strain, and take on an empty stomach. (*Bao Jian*)

The disease of Jiao Chang involves the reversal of positions in the excretion of urine and feces, caused by Qi not following its normal pathway, leading to confusion between clear and turbid substances. It is suitable to use Wu Ling San (Five-Ingredient Poria Decoction) and Tiao Qi San (Regulate Qi Powder), each 1 qian, mixed with 0.5 qian of Ejiao powder (Donkey-hide Gelatin), and taken with decoction. Alternatively, grind Huang Lian E Jiao Wan (Coptis and Donkey-hide Gelatin Pill) into powder, add a small amount of Mu Xiang (Aucklandiae Radix), and swallow with the decoction. (*Yao Jue*) [Note: *Yi Que* cites this text saying: These are all formulas for removing damp-heat, as Qi disorder stems from stagnation, and stagnation generates damp-heat.]

A person addicted to alcohol, who drank heavily without getting drunk, suddenly had feces discharged from the anterior orifice (urethra) and urine from the posterior orifice (anus). The pulse was deep and choppy. He was given Si Wu Tang (Four Substances Decoction) added with Hai Jin Sha (Lygodii Spora), Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen), Mu Tong (Akebiae Caulis), and Tao Ren (Persicae Semen). After eight doses, he recovered. (*Dan Xi Xin Fa*)

Yu Ziben said: Reversal in the excretion of urine and feces is named Jiao Chang. It may be caused by drunkenness and overeating, or by severe anger, causing the Qi of the Zang-Fu organs to become chaotic and deviate from the normal path. The treatment method should involve inducing vomiting to lift and raise the Qi. [Note: *Yi Zong Jin Jian* adds below this: It is suitable to use Wu Ling San (Five-Ingredient Poria Decoction) with Mu Xiang (Aucklandiae Radix) to induce vomiting. For those who are obese and have much phlegm, use Er Chen Tang (Two-Aged Decoction) added with Zhi Shi (Aurantii Fructus) and Mu Xiang (Aucklandiae Radix) to induce vomiting. *Yi Que* says: Like someone who has taken a wrong turn, make them return to the original place so they will not err again. Generally, the theories of various schools are mostly speculative and not necessarily verified by personal experience; they are preserved here tentatively.] This allows the Lan Men (Gate of the Large Intestine) to become clear and restores its function of separating clear from turbid, leading to recovery. (*Liu Yao*)

Contraindicate Qi-breaking and drying-hot herbs. It is suitable to raise the clear and descend the turbid, supplement Qi, and use bland-leaching methods. (*Ben Cao Jing Jiu Shu*)

A postpartum woman had feces discharged in her urine, named Da Xiao Chang Jiao (Large and Small Intestine Cross-over). This is due to deficiency of both Qi and Blood, causing deviation from the normal path. First, administer Liu Jun Zi Tang (Six-Gentlemen Decoction) for two doses, followed by Wu Ling San (Five-Ingredient Poria Decoction) for one dose, resulting in recovery. Ordinary cases of intestinal cross-over can also be treated effectively by this method. (*Chi Shui Xuan Zhu*)

In cases of Jiao Chang disease in women, where feces are discharged via urine and urine via feces, with turbidity undifferentiated, it must be caused by latent summer-heat from the summer season. One must use Wu Ling San (Five-Ingredient Poria Decoction) added with Niu Xi (Achyranthis Bidentatae Radix), Hai Jin Sha (Lygodii Spora), Mu Tong (Akebiae Caulis), and Tong Cao (Tetrapanacis Medulla). As long as urine and feces return to their respective organs, peace will be restored. Master Xi Yuan cured the mother of Xu Shaoyong of Linying with this prescription, later adding Che Qian Zi (Plantaginis Semen). (*Ji Shi Quan Shu*)

Huo Ren Li Wu Tang (Living Person Regulating Matter Decoction), which is Si Wu Tang (Four Substances Decoction) combined with Li Zhong Tang (Regulate the Middle Decoction), treats Jiao Chang. (*He Ji Ju Fang*)

Regarding Jiao Chang presenting as diarrhea: The answer is that this condition is almost invariably fatal, implying ulceration of the Fu-Zang organs, with excreta not following the normal paths. (*Yi Wan She Cao*) [Note: The question text has missing pages, so it is not recorded.]

If feces are discharged from the urethra and urine from the anus, this is a summer-heat syndrome in summer. People treat it with Wu Ling San (Five-Ingredient Poria Decoction), which is effective. However, I have an even more miraculous formula: use only 3 liang of Che Qian Zi (Plantaginis Semen), decoct in three bowls of water, and drink all at once for immediate recovery. (*Shi Shi Mi Lu*)

The syndrome of Jiao Chang appears in medical texts but is rarely seen in practice. The wife of stone mason Zhan from Lvshi Mountain, five or six days after childbirth, had no lochia discharge, abdominal distension, and fullness of the chest with panting, and feces were discharged from the anterior orifice. Investigating the cause, she had previously been extremely fond of tobacco and alcohol, and the child she delivered was soft-boned. Due to fright, she developed this syndrome. I used Xiong Gui Tang (Angelica and Ligusticum Decoction) added with E Zhu (Curcumae Rhizoma), Rou Gui (Cinnamomi Cortex), and charred Shan Zha (Crataegi Fructus). After one dose, lochia flowed freely, and bowel and bladder functions returned to normal. Another case: Lu Shengxiang’s four-year-old daughter suffered from bloody dysentery in early autumn, with loose stool discharging from the anterior orifice. Treated as disharmony of cold and heat with food stagnation, she was given Wu Ling San (Five-Ingredient Poria Decoction) combined with Xiang Lian Wan (Costus and Coptis Pill), recovering after two doses. Another case: Qian Jifu’s thirteen-year-old daughter, who was obese with abundant phlegm, developed fever, headache, vomiting, and cyanosis of the face due to fear from a neighbor's robbery. Her six pulses were wiry and rapid, and excretion of urine and feces was reversed. This was caused by fright disturbing the Qi and phlegm invading the orifices. She was given Si Qi Tang (Four-Substance Decoction) to deliver Meng Shi Gun Tan Wan (Fluorite Rolling Phlegm Pill), opening the phlegm-Qi obstruction, leading to calmness. (*Yi Zong Jin Jian*)

The syndrome of Jiao Chang is characterized by feces exiting the anterior orifice and urine exiting the posterior orifice. When urine exits the posterior orifice, it is because water Qi merges into the Large Intestine and cannot separate clear from turbid at the Lan Men (Gate of the Large Intestine); thus, it can be discussed in terms of unclear Lan Men. However, when feces exit the anterior orifice, it indicates rupture of both the intestines and the bladder. If the intestine does not perforate, from what orifice would feces emerge? If the bladder does not rupture, from what orifice would feces enter? It must be that both intestine and bladder are perforated for feces and urine to reverse their paths. Furthermore, the ruptured sites of the intestine and bladder must be adherent for such exchange to occur without error. If they are not adherent, even if the intestine perforates and feces exit, they would merely flow into the space between the muscle layers outside the intestine. Even if the bladder is damaged, if the orifices are not connected, feces cannot exit from the anterior orifice. Therefore, the theory of "unclear Lan Men" is indeed a vague and unsubstantiated explanation that cannot be logically understood. (*Yi Ji*)

I treated four or five cases of Jiao Chang, all in women, most occurring after difficult or breech deliveries. Thus, internal damage to the bladder and intestines goes without saying. (Same source)

There is also an elderly person with dry Yin Blood and constipation of the Large Intestine, where both stool and urine discharge from the anterior orifice. This is not Jiao Chang, but a sign of dried-up blood and a symptom of declining Qi and Blood. Taking large doses of Ba Zhen Tang (Eight-Treasure Decoction) might slightly prolong life. (*Yi Yu Cao*) [Note: Refer to the strange case of Jiang Yiren in *Yi Yu Cao*.]