脉候 关脉芤，大便去血数斗者，以膈输伤也（按∶《病源·血痢候》曰∶诊其关上脉芤，大便去血，
暴下血数升也），宜服生地黄并生竹皮汤，灸膈 。若重下去血者，针关元。甚者，宜服龙骨丸，必愈。（《脉
经》）
尺脉涩，下血不利多汗（《素问》又云∶尺涩脉滑，谓之多汗）。男子盛大，其脉阴阳微，趺阳亦微，
独少阴浮大，必便血而失精。设言淋者，当小便不利。趺阳脉弦，必肠痔下血。尺中芤，下血；微芤，小便血。
（同上）
脉来浮弱，按之带芤者，下血也。（《济生续方》）
林氏曰∶初起之脉，或沉数有力，或弦数不清，久则芤数无力，或沉涩而弱，或结阴脾虚之脉，非芤涩则虚搏。
（《疡医大全》）
源候诸说 大便下血候∶此由五脏伤损所为，脏气既伤，则风邪易入，热气在内，亦大便下血，鲜而腹
痛。冷气在内，亦大便血下，其色如小豆汁，出时疼而不甚痛。前便后下血者，血来远；前下血后便者，血来近。
远近者，言病在上焦下焦也。（《病源论》）
夫肠风下血者，由脏腑劳损，气血不调，大肠中久积风冷，中焦有虚热，冷热相攻，毒瓦斯留滞，传于下部，
致生斯疾也。皆由坐卧当于风湿，醉后房劳，恣食猪鸡果实羊面，酒食之毒滞于脏腑，脏腑停留毒瓦斯，日久不能
宣通，风冷热毒搏于大肠，大肠既虚，时时下血，故名肠风也。（《圣惠》）
大肠既虚下血，故面色痿黄，四肢消瘦，或绵连年月，诸医不瘥，故曰积年肠风下血也。（同上）
人患肠风下血者何也？人肠皆有脂裹之，浓则肠实而安。肠中本无血，血缘有风或有热以消其脂，肠遂薄，
渗入身中血。初患者必服冷药而愈，服之过当，则肠寒而脂愈不生，其血必再作。凡热者其血鲜，冷者其血青
黑，察其冷热用药可也。（《医说》引《医余》）
如下清血色鲜者，肠风也。血浊而色黯者，脏毒也。肛门射如血线者，虫痔也。亦有一种下部虚，阳气不
升，血随气而降者。仲景云∶脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，寒虚相搏，此名为革，妇
人则半产漏下，男子则亡血失精。此下部虚而下血者也。若得革脉，却宜服温补药。虫痔宜熏，《千金》用
皮、艾者佳。（《本事》）
病者大便下血，或清或浊，或鲜或黑，或在便前，或在便后，或与泄物并下。此由内外有所感伤，凝停在
胃，随气下通，亦妄行之类，故曰便血。（《三因》）
森立夫曰∶愚参诸方论，大率下血有二∶曰肠风，曰脏毒。肠风之证，起于胃感风寒，饮食起居，皆有忤
犯，致中焦气滞不宣，血从大肠中出，其色鲜而如注，或久而不止者，是其候也。又脏毒之证，因肠胃有饮食
毒，或 酒人久而积毒，致热气郁滞，血得热而流入大肠，故下如黑色，或
秽污成块作片者，是其候也。又有脾湿毒，令气血凝滞，渗入肠间而下者，必面目深黄，小便不利，胸膈膨胀，
不进饮食，又下血瘀黑，见蛊注痢门。（《万安》引《可用方》）
若风入肠胃者，其脉浮，下血必在粪前，是名近血。停积于大肠者，其脉沉滞，血在粪后，又名远血。脏
寒者，其脉沉微，下血无痛。积热者，其脉洪数，纯下鲜血，甚则兼痛。伤湿者，脉沉而迟，下血如豆汁。又
有因气郁结，酒色过度，并过食炙脍，因毒生虫，亦能令人下血。又当以五脏所伤，辨其证治。（《大成》）
血之在身，有阴有阳。阳者顺气而行，循流脉中，调和五脏，洒陈六腑，如是者谓之荣血也。阴者居于络
脉，专守脏腑，滋养神气，濡润筋骨。若其脏感内外之邪伤，则或循经之阳血，至其伤处，为邪气所阻，漏泄
经外。或居络之阴血，因着留之邪，擘裂而出，则皆渗入肠胃而泄矣。世俗每见下血，率以肠风名之，不知风
乃六淫中之一耳。或风有从肠胃经脉而入客者，或肝经风木之邪内乘于肠胃者，则可谓之肠风。若其他不因风
邪，而肠胃受火热二淫，与寒燥湿怫郁其气，及饮食用力过度，伤其阴络之血者，亦谓之肠风可乎。许学士谓
下清血色鲜者，肠风也。血浊而色黯者，脏毒也。肛门射如血线者，脉痔也。然肠风挟湿者，亦下如豆汁，及
紫黑瘀血，不必尽鲜，正当以久暂为别耳，然要之皆俗名也。世医编书者，或以泻血为肠风，或分泻血与肠风
脏毒为二门，皆非也。（《准绳》）
大便下血，多由肠胃之火，然未必尽由于火也。故于火证之外，则有脾胃阳虚而不能统血者，有气陷而血
亦陷者，有病久滑泄而血因以动者，有风邪结于阴分而为便血者。大都有火者多因血热，无火者多因虚滑，故
治血者但当知虚实之要。（《景岳》）
血滑不止者，或因病久而滑，或因年衰而滑，或因气虚而滑，或因误用攻击，以致气陷而滑。凡动血之初，
多由于火，及火邪既衰，而仍有不能止者，非虚即滑也。（同上）
证治诸说 治法大要，先当解散肠胃风邪，热者与败毒散，冷者与不换金正气散，风邪既丢，然后随其
冷热而对治之。或曰血遇热则行，止血多用凉药，如地榆散、柏皮汤、黄连阿胶丸、酒蒸黄连丸辈，施之热证，
固当然尔。其或阳虚阴走，正气不得归元，则用木香理中汤、附子理中汤、震灵丹、黑锡丹辈，如之何而废之。
要之芎归汤一剂，又调血之上品，热者加茯苓、槐花，冷者加茯苓、木香，此则自根自本之论也。虽然，精气血
气，生于谷气，是以大肠下血，大抵以胃药收功，真料四君子汤、参苓白术散，以枳壳散、小乌沉汤和之，胃气
一回，血自循于经络矣。（《直指》）
夫脏毒下血，可用调胃承气汤加当归泻讫，次用芍药柏皮丸（按∶用芍、归、柏、连）、黄连解毒汤。（《治
病百法》）
风湿则祛之，寒则温之，热则清之，停滞则疏涤之，气则调之，有毒者解利之。下血之证，非只一端，大
概血得热而行，遇黑而止，用药当审之。（《大成》）
下血，其法不可纯用寒凉药，必于寒凉药中加辛味为佐。久不愈者，后用温剂，必兼升举，药中加酒浸炒凉药，
如酒煮黄连丸之类，寒因热用故也。有热，四物加炒山栀子、升麻、秦艽、阿胶珠，去大肠湿热。属虚者，当温
散，四物加炮干姜、升麻。凡用血药，不可单行单止也。（《丹溪》）（按∶《金匮翼》以此说为该诸血证者。）
大便下血，曰肠风，切勿止涩，究其本末证状，先清其表，后攻其里，其血自止。如脉洪大，宜后方四物合
解毒汤调治。（《纲目》引玄）
泻血当别其色，色鲜为热，色瘀为寒。热血，连蒲散（方阙）。寒血，理物汤。血色鲜红者，多因内蕴热毒，
毒瓦斯入肠胃，或因饮酒过多，及啖糟藏炙爆，引血入大肠，故泻鲜血，宜连蒲散，吞黄连阿胶丸及香连丸，或一
味黄连煎饮。大泻不止者，四物汤加黄连、槐花。泻血色瘀者为寒，血逐气走，冷气入客肠胃，故下瘀血，理
中汤。不效，宜黑神散（据《类方》，即《和剂》妇人用方），米饮调下，中用附子者佳。或用胶艾汤加米煎，
吞震灵丹。颠扑内损，恶血入肠胃，下出浊如瘀血者，宜黑神散，加老黄茄为末，酒调下。有风入肠胃，纯下清
血，或风湿入肠胃，下如豆汁，或下瘀血，并宜胃风汤、胶艾汤。泻血或淡或浊，或鲜或瘀，亦宜胃风汤，吞驻
车丸。或独泻血，或与粪俱出，当辨其色与所感施治。有腹痛者，乃是血不循经，故尔作痛，却无里急后重及缠坠
等患，不可因痛而认为血痢。妇人因月事不通，血不循故道，从后分出者，当调其经。泻血过多，手足厥冷而眩
晕者，当审其寒热施治，不可因眩晕而便用附子热药。寒血犹可，热血为害不少。（《要诀》）
大抵此证所致之由不同，当究其所因治之。如元气有余，形黑气盛，先粪而后紫血者，更兼脉实有力，此属
有余，法当凉血止血药，应自效。至若形体瘦弱，面色痿黄，先鲜血而后粪者，更兼脉虚无力，此属不足，岂可
反用凉药止之，致伤脾胃，此证若不温中健脾，升举中气，其血不得归原，故药难效，远其根本也。（《外科正
宗》）
凡下血证，脉数有力，唇焦口燥，喜冷畏热，是为有火，宜用清魂散（荆芥、当归水煎）加黄芩、丹皮、生
地之属。若脉细无力，唇淡口和，喜热畏寒，或四肢厥冷，是为
有寒，宜用温药止之，理中加归、芍主之。若便久不止，气血大虚，宜用归脾、十全辈统血归经。血本属阴，生
于阳气，治者宜滋其化源。（《心悟》）
初则宜于升阳清热，次则清补相兼，和血解毒。结阴则当升清利浊，兼温补其血可也。（《疡医大全》引林
氏）
方书论血从下流为顺，易治。若大下数升，形肉枯槁，此为阴脱也。正所谓微则易治，甚则难痊。若先吐血，
后变为下血，则又吉矣。（《司命》）
虫痔、痔血勿误认 肠风之与虫痔，特介乎毫芒之间。肠风之血，自肠中来。虫痔之血，肛门边旁别
一小窍，射出如血线是也。迨夫肛门既脱，腐血浸淫子其间，则俱化为虫，蠹蚀肠口，滴血淋漓，自此即不能约
而收之矣。善调理者，尤当以芜荑、艾叶、苦楝根辈为之化虫。（《直指》）
近世患痔者多，而痔中出血者亦不少，多有误认肠风脏毒，而补泻尽属妄投。及余细审脉证，方知此血实从
痔疮中出，痔愈则血不治而自止。（《疡医大全》引林氏）
清凉诸方 治大便出血，及口鼻皆出血，血上胸心气急，此是劳热所致方。
生地黄（八两） 蒲黄（一升） 地骨皮（五两） 黄芩 芍药 生竹茹（各三两）
上六味 咀，以水八升，煮取二升七合，分温三服。（《千金》）
治大肠积热，下血不止，日夜度数无恒，宜服黄芩散方。
黄芩 黄柏 黄连 地榆锉 生干地黄 犀角屑（以上各一两）
上件药捣筛为散，每服三钱，以水一中盏，入青竹茹半鸡子小，煎至六分去滓，每于食前温服。（《圣惠》）
治肠风泻血如痢，腹中 痛，面色痿黄，黄连饮方。
黄连（去须一两） 干姜（炮一两） 甘草（炙半两）
上三味捣为粗末，每服三钱匕，以水一盏，生姜二片，枣一枚劈，同煎至五分，去滓温服。（《圣济》）
解毒四物汤，治大便下血，不问粪前粪后。（《寿世》）（按∶此系四物汤合黄连解毒汤，加地榆、槐花、
阿胶、侧柏叶。）
沈王府长史王庭，任国子学正时，病大便下血，势濒危殆。一日昏愦中，闻有人云∶服药误矣，吃小水好。
庭信之，饮小水一碗，顿苏，逐日饮之，病势渐退。（《菽园杂记》）
驱风诸方 治肠风下血。
荆芥穗 地黄（各二两） 甘草（半两）
上为末，每服一钱，温酒调下，食后，日三夜一。（《中藏经》）
治肠风脏毒，槐花散。
槐花（炒） 柏叶（烂杵焙） 荆芥穗 枳壳（去穣细切麸炒黄）
上修事了方秤，等分细末，用清米饮调下二钱，空心食前服。（《本事》）《济生》加减四物汤，治肠风下
血不止，于本方加生地黄、当归、川芎、甘草、生姜、乌梅，水煎。
风入肠胃，纯下清血，或湿毒下血，以胃风汤去桂，加枳壳、荆芥、防风主之。（《原病集》）
泻血诸方 治肠风，枳实丸方。
枳实（麸炒黄） 槐荚（麸炒黄） 皂荚（猪牙者涂酥炙） 大黄（炒令焦黄各一两）
上四味捣罗为末，用面糊和丸，如梧桐子大，每服二十丸，荆芥腊茶下，空心食前服。（《圣济》）
大黄槟榔丸，治便血久不可止，脐腹疼痛，里急后重，诸药无效者。
大黄（半两） 细墨（半两） 大槟榔（二个） 荞面（一钱）
上为细末，醋和丸，分为三丸，用灰火内烧令紫色，醋内磨开，临卧都作一服，早晨取下恶物为效。（《医
林方》）
治便血，用黄连四两，朴硝二两，同炒，地上出火毒，研为细末。用酒调服。（《经验良方》）
董龙山公夫人，年三十五而病便血，日二三下，腹不疼，诸医延医者，三年不效。予诊之，左脉沉涩，右脉
漏出关外，诊不应病。予窃谓血既久下，且当益其气而升提之，以探其证。乃用补中益气汤加阿胶、地榆、侧柏叶，
服八剂，血不下者半月，彼自喜病愈矣。偶因劳而血复下，因索前药。予语龙山公曰∶夫人之病，必有瘀血积
于经隧。前药因右脉漏关难凭，故以升提兼补兼涩者，以探虚实耳。今得病情，法当下而除其根也。龙山公曰∶
三年间便血，虽一日二三下，而月汛之期不爽，每行且五日，如此尚有瘀血停蓄耶？予曰∶此予因其日下月至，
而知其必有瘀血停蓄也。经云∶不塞不流，不行不止。今之瘀，实由塞之行也，不可再涩。古人治痢，必先下之，
亦此意也。即用桃仁承气汤，加丹参、五灵脂、荷叶蒂，水煎，夜服之，五更下黑瘀血半桶，其日血竟不来。复
令人索下药。予曰∶姑以理脾药养之，病根已动，俟五日而再下，未晚也。至期复用下剂，又下黑瘀如前者半。
继以补中益气汤、参苓白术散调理全愈。（《赤水》）
治泻血不止，决效方。
巴豆（一枚去皮）
Pulse Diagnosis: A Kou (Kou, cun-kou pulse position at the wrist) pulse that is Kong (Hollow, floating and large but empty in the center, like pressing a scallion stalk) indicates massive hematochezia (blood in stool), amounting to several dou. This is due to injury of the Ge Shu (Diaphragm-Shu, BL17) point. (Note: *Zhubing Yuanhou Lun* [Source of All Diseases] states under "Blood Dysentery": Diagnosing a hollow pulse at the Guan (Guan, middle position) indicates massive sudden hematochezia of several sheng. Treatment should involve administering Sheng Di Huang Tang (Rehmannia Root Decoction) and Sheng Zhu Pi Tang (Fresh Bamboo Bark Decoction), and moxibustion on the Ge Shu (BL17) point. If the condition is severe with greater blood loss, puncture the Guan Yuan (CV4) point. For extreme cases, Long Gu Wan (Dragon Bone Pill) should be administered for certain recovery. (*Mai Jing*)
Chi (Chi, distal position) pulse that is Se (Choppy, rough and unsmooth) indicates lower body bleeding with difficult urination and profuse sweating. (*Su Wen* adds: A Chi pulse that is Se yet slippery indicates profuse sweating.) In men, if the Yin-Yang pulses are both Wei (Weak, fine and thin), the Zu Yang (Foot-Yang, radial artery) pulse is also weak, but the Shao Yin (Kidney) pulse is Fu Da (Floating and Large), there will inevitably be hematochezia and seminal emission. If strangury is mentioned, it implies difficult urination. A Xuán (Wiry, straight and long like a guitar string) Zu Yang pulse indicates hemorrhoids with rectal bleeding. A Kong pulse at the Chi position indicates lower body bleeding; a slightly Kong pulse indicates hematuria (blood in urine). (Ibid.)
A pulse that comes up Floating and Weak, and feels Hollow upon deep pressure, indicates lower body bleeding. (*Jisheng Xufang*)
Lin Shi says: At the onset, the pulse may be Chen (Deep, felt only with heavy pressure) and Shu (Rapid, more than 90 beats per minute) with strength, or Xuan without clear rhythm. In chronic cases, it becomes Kong and Shu without strength, or Chen and Se and Weak, or represents Jie Yin (Yin Knotting) and Spleen Deficiency patterns, manifesting as either Kong-Se or Xu Bo (Deficient and Palpitating). (*Yangyi Daquan*)
Etiology and Pathogenesis Discussion: Hematochezia is caused by damage to the five Zang organs. Once the Zang Qi is injured, Wind pathogens easily invade. Internal Heat can also cause hematochezia with fresh red blood and abdominal pain. Internal Cold can also cause hematochezia with blood resembling mung bean juice, painful upon expulsion but not severely so. Bleeding after defecation indicates a distant source; bleeding before defecation indicates a proximate source. "Distant" and "proximate" refer to pathology in the Upper Jiao or Lower Jiao. (*Zhubing Yuanhou Lun*)
"Intestinal Wind Hematochezia" arises from Zang-Fu exhaustion and disharmony of Qi and Blood. Long-standing accumulation of Wind-Cold in the Large Intestine, combined with Deficient Heat in the Middle Jiao, leads to conflict between Cold and Heat. Toxic factors stagnate and transmit downward, causing this disease. Causes include sitting or lying exposed to Wind-Dampness, sexual activity after drunkenness, and excessive consumption of pork, chicken, fruits, mutton, and wheat products. Toxicity from food and alcohol stagnates in the Zang-Fu. Over time, these toxic factors cannot be diffused. Wind, Heat, Cold, and Toxin clash in the Large Intestine. Since the Large Intestine is deficient, frequent bleeding occurs, hence the name "Intestinal Wind." (*Taiping Shenghui Fang*)
Due to Large Intestine deficiency and bleeding, the complexion becomes sallow, limbs emaciate, and the condition may persist for years despite various medical treatments, termed "Chronic Intestinal Wind Hematochezia." (Ibid.)
Why do people suffer from Intestinal Wind Hematochezia? Intestines are wrapped in fatty tissue; thick fat ensures intestinal integrity. The intestines naturally contain no blood; blood enters because Wind or Heat consumes the fat, thinning the intestine walls, allowing blood from the body to seep in. Initially, cold-natured herbs cure it. Overuse causes intestinal Cold, preventing fat regeneration, leading to recurrent bleeding. Hot conditions yield bright red blood; cold conditions yield dark blue-black blood. Medication should be chosen based on observing Cold vs. Heat. (*Yi Shuo* citing *Yiyu*)
Clear, bright red blood indicates Intestinal Wind. Turbid, dark blood indicates Visceral Toxin (Zang Du). Blood shooting from the anus like a thread indicates Worm Hemorrhoids (Chong Zhi). Another type involves Lower Jiao deficiency where Yang Qi fails to ascend, and blood descends with Qi. Zhang Zhongjing stated: "A pulse that is Wiry and Large... Wiry indicates reduction [of Yang], Large indicates Hollow... Reduction is Cold, Hollow is Deficiency. Cold and Deficiency clashing is called Ge (Leather-like) pulse. Women experience miscarriage and dripping blood; men experience loss of blood and essence." This describes Lower Jiao deficiency bleeding. If a Ge pulse appears, warm tonification is indicated. Worm Hemorrhoids should be fumigated; *Qianjin Fang* recommends using Snake Bed Seed (Suo Chuang Zi) and Mugwort (Ai Ye). (*Benshi Fang*)
Patients with hematochezia may have clear or turbid, bright or dark blood, occurring before or after stool, or mixed with diarrhea. This results from internal or external pathogenic invasion, coagulation/stagnation in the Stomach, descending with Qi, representing abnormal flow, thus named "Bian Xue" (Rectal Bleeding). (*Sanyin Ji Yi Bing Zheng Fang Lun*)
Sen Rifu states: Reviewing various theories, lower bleeding generally falls into two categories: Intestinal Wind and Visceral Toxin. Intestinal Wind originates from the Stomach contracting Wind-Cold, violating diet and lifestyle, causing Middle Jiao Qi stagnation. Blood flows from the Large Intestine, bright red and gushing, or persistent over time. Visceral Toxin arises from dietary toxins in the intestines/stomach, or accumulated toxicity from chronic alcoholism, causing Heat stagnation. Blood enters the Large Intestine due to Heat, resulting in black, foul, clotted, or sheet-like blood. Spleen Damp-Toxin causes Qi-Blood stagnation seeping into the intestines, presenting with deep yellow face/eyes, difficult urination, chest/diaphragm distension, anorexia, and dark bloody stools. (*Wan'an Fang* citing *Keyong Fang*)
Wind entering the intestines presents with a Floating pulse; bleeding precedes stool, called "Near Bleeding." Stagnation in the Large Intestine presents with a Deep/Stagnant pulse; bleeding follows stool, called "Distant Bleeding." Cold in the Zang presents with a Deep/Wei pulse; bleeding is painless. Heat accumulation presents with a Hong/Shu pulse; pure bright red blood, possibly painful. Dampness injury presents with a Deep/Chi pulse; bleeding resembles mung bean juice. Qi stagnation, excessive sex/alcohol, and overconsumption of roasted foods can generate toxins/worms causing bleeding. Differentiation must consider Five Zang injuries. (*Yixue Rumeng*)
Blood in the body has Yin and Yang aspects. Yang blood follows Qi, circulates in vessels, harmonizes Zang, spreads to Fu, termed Ying Blood (Nutritive Blood). Yin blood resides in collateral vessels, nourishes Zang, spirit, sinews, and bones. If Zang are injured by pathogens, Yang blood may leak outside vessels at injury sites due to obstruction, or Yin blood in collaterals may rupture due to lingering pathogens, both seeping into intestines. Laypeople often call all bleeding "Intestinal Wind," unaware Wind is just one of Six Evils. Only if Wind enters via intestinal meridians or Liver Wind attacks intestines is it truly Intestinal Wind. If caused by Fire-Heat, Cold-Dryness, or Dampness stagnation, or physical exertion damaging Yin collaterals, calling it Intestinal Wind is incorrect. Xu Xueshi said: Bright clear blood is Intestinal Wind; turbid dark blood is Visceral Toxin; thread-like shooting blood is Pulse Hemorrhoids. However, Intestinal Wind with Dampness can also present as mung-bean-like or purple-black clotted blood, not always bright. Duration distinguishes them. These are common names. Dividing bleeding into separate categories for Intestinal Wind and Visceral Toxin is erroneous. (*Yixue Zhunsheng*)
Hematochezia usually stems from Stomach-Intestine Fire, but not exclusively. Besides Fire patterns, there are Spleen-Stomach Yang Deficiency failing to control blood, Qi sinking dragging blood down, chronic loose stools triggering bleeding, and Wind knotting in Yin levels causing bleeding. Generally, Fire causes Blood Heat; non-Fire causes Deficiency/Slippage. Treatment must focus on Deficiency vs. Excess. (*Jingyue Quanshu*)
Persistent slippery bleeding may result from chronic illness, aging, Qi deficiency, or misuse of attacking drugs causing Qi sinking. Initial bleeding is often Fire-related. After Fire subsides, persistent bleeding indicates Deficiency or Slippage. (Ibid.)
Treatment Principles: First, resolve Intestinal Wind. For Heat, use Baidu San (Resolving Toxin Powder); for Cold, use Buhuanjin Zhengqi San (Non-Changing Metal Upright Qi Powder). Once Wind is resolved, treat according to Cold/Heat. Some argue: Blood moves with Heat; stop bleeding with cooling herbs like Diyú San (Sanguisorba Powder), Bai Pi Tang (Phellodendron Decoction), Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill), or Wine-Steamed Coptis Pill. These suit Heat patterns. For Yang Deficiency with Yin leakage and lost Zheng Qi, use Muxiang Lizhong Tang (Costus Regulating Middle Decoction), Fuzi Lizhong Tang (Aconite Regulating Middle Decoction), Zhenling Dan (Shaking Spirit Cinnabar Pill), or Heixi Dan (Black Tin Pill). Do not discard these. Xiong Gui Tang (Ligusticum and Angelica Decoction) is a premier blood-regulating formula. Add Fuling and Huaihua for Heat; add Fuling and Muxiang for Cold. This addresses root causes. Essence, Qi, and Blood derive from Grain Qi. Thus, treating Large Intestine bleeding often succeeds with Stomach-tonifying herbs. Zhenliao Sijunzi Tang (True Material Four Gentlemen Decoction) and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), combined with Zhike San and Xiao Wuchen Tang, restore Stomach Qi, allowing blood to return to vessels. (*Zhizhi Fang*)
For Visceral Toxin bleeding, use Tiaowei Chengqi Tang (Regulate the Stomach Order Qi Decoction) plus Danggui to purge, followed by Shaoyao Bai Pi Wan (Peony and Phellodendron Pill) and Huanglian Jiedu Tang (Coptis Detoxification Decoction). (*Zhibai Baifa*)
Resolve Wind-Damp, Warm Cold, Clear Heat, Purge Stagnation, Regulate Qi, Detoxify. Bleeding causes vary; blood moves with Heat and stops when blackened. Observe carefully. (*Yixue Rumeng*)
Do not use purely cold/cooling herbs for bleeding; add acrid flavors as assistants. For chronic cases, use warm agents later, incorporating lifting actions. Use wine-fried cooling herbs (e.g., Wine-Boiled Coptis Pill) to apply heat to cold (Han Yin Re Yong). For Heat, Siwu Tang plus Chao Shanzhizi, Shengma, Qinjiao, Ejiao Zhu clears Large Intestine Damp-Heat. For Deficiency, warm and disperse: Siwu Tang plus Pao Ganjiang, Shengma. Blood herbs should not be used singly for movement or stopping. (*Danxi Xinfa*) (*Jingui Yifang* cites this as general theory for blood disorders.)
For Intestinal Wind hematochezia, do not merely astringe. Investigate root/symptoms. Clear exterior first, then attack interior; bleeding stops. If pulse is Hongda, use Siwu Tang combined with Jiedu Tang. (*Bencao Gangmu* citing Xuan)
Differentiate bleeding color: Bright = Heat; Dark/Clotted = Cold. For Heat blood, Lianpu San (formula missing). For Cold blood, Liwu Tang. Bright red blood often stems from internal Heat-Toxin, alcohol excess, or greasy/spicy foods drawing blood to Large Intestine. Use Lianpu San, swallow Huanglian Ejiao Wan or Xianglian Wan, or decoct Huanglian alone. For severe persistent bleeding, Siwu Tang plus Huanglian, Huaihua. Dark/clotted blood indicates Cold; Qi chases blood, Cold invades intestines, causing clotted bleeding. Use Lizhong Tang. If ineffective, use Heishen San (based on *Leifang*, same as *Heji Jufang* women's formula), taken with rice water; those containing Fuzi are best. Or decoct Jiao'ai Tang with rice, swallow Zhenling Dan. For traumatic internal injury with evil blood entering intestines, use Heishen San plus Lao Huangqie (Old Yellow Eggplant) powder, wine-administered. Wind/Damp invading intestines causing clear blood, mung-bean-like discharge, or clots: use Weifeng Tang or Jiao'ai Tang. Pale/turbid/bright/clotted bleeding: use Weifeng Tang, swallow Zhuche Wan. Whether pure bleeding or mixed with stool, differentiate by color and pathogen. Abdominal pain indicates blood not following meridians, not necessarily dysentery (no tenesmus/heaviness). For women with amenorrhea, bleeding from posterior, regulate menstruation. Profuse bleeding with cold limbs/dizziness requires Cold/Heat differentiation; do not blindly use Fuzi/Hot herbs for dizziness. Cold bleeding is manageable; Heat bleeding is dangerous. (*Yaoke*)
Causes vary; investigate etiology. Excess pattern: robust, dark complexion, stool before purple blood, strong pulse. Treat with Cooling Blood/Stopping Bleeding herbs. Deficiency pattern: emaciated, sallow, bright blood before stool, weak pulse. Do not use cooling herbs; they damage Spleen-Stomach. Must Warm Middle, Tonify Spleen, Lift Middle Qi, or blood won't return. (*Waike Zhengzong*)
Excess Heat pattern: Rapid/Strong pulse, dry lips/thirst, preference for cold/fear of heat. Use Qinghun San (Schizonepeta and Angelica decoction) plus Huangqin, Mudanpi, Shengdi. Cold pattern: Fine/Weak pulse, pale lips, preference for heat/fear of cold, cold limbs. Use Warm herbs: Lizhong Tang plus Danggui, Shaoyao. Chronic bleeding with severe Qi/Blood deficiency: use Guipi Tang or Shiquan Dabu Tang to unify blood. Blood is Yin, born from Yang; nourish the source of transformation. (*Xinwu*)
Initial treatment: Lift Yang, Clear Heat. Later: Clear and Tonify simultaneously, Harmonize Blood, Detoxify. For Jie Yin (Yin Knotting): Lift Clear, Drain Turbid, Warm/Tonify Blood. (*Yangyi Daquan* citing Lin)
Formulas state downward bleeding is favorable/easy. Massive bleeding with emaciation indicates Yin Collapse (minor is easy, severe is hard). Vomiting blood turning into rectal bleeding is auspicious. (*Siming Pian*)
Differentiate Worm Hemorrhoids from Intestinal Wind. Intestinal Wind blood comes from inside intestines. Worm Hemorrhoids have a small opening beside anus shooting thread-like blood. If prolapse occurs, rotting blood breeds worms eroding intestinal opening, causing dripping blood that cannot be controlled. Good management uses Wu Ti, Ai Ye, Ku Lian Gen to eliminate worms. (*Zhizhi Fang*)
Modern hemorrhoid bleeding is often misdiagnosed as Intestinal Wind/Visceral Toxin, leading to wrong tonification/purging. Careful pulse/symptom analysis reveals blood originates from hemorrhoids; curing hemorrhoids stops bleeding spontaneously. (*Yangyi Daquan* citing Lin)
Cooling Formulas: For rectal/nasal bleeding, blood rising to chest/heart with urgency, caused by Labor Heat.
Sheng Di Huang (8 liang), Pu Huang (1 sheng), Digupi (5 liang), Huangqin, Shaoyao, Sheng Zhuru (3 liang each).
Chop six ingredients, boil in 8 sheng water to 2.7 sheng. Divide into three warm doses. (*Qianjin Fang*)
For Large Intestine Accumulated Heat, persistent unpredictable bleeding: Huangqin San.
Huangqin, Huangbai, Huanglian, Diyü (cut), Sheng Gan Dihuang, Xi Jiao xie (1 liang each).
Grind to powder. Take 3 qian, boil with 1 zhong water and bamboo rush (egg-size) to 6 fen. Strain, take warm before meals. (*Taiping Shenghui Fang*)
For Intestinal Wind dysentery-like bleeding, abdominal pain, sallow face: Huanglian Yin.
Huanglian (1 liang), Ganjiang (1 liang), Gancao (0.5 liang).
Coarse powder. Take 3 qian, boil with 1 zhan water, 2 slices ginger, 1 split jujube to 5 fen. Strain, take warm. (*Shengji Zonglu*)
Jiedu Siwu Tang: For hematochezia, regardless of pre/post stool. (*Shoushi Bao yuan*) (Note: Siwu Tang + Huanglian Jiedu Tang + Diyü, Huaihua, Ejiao, Ce Baiye.)
Case: Wang Ting, Secretary to Prince of Shen, serving as Guozixue Zheng, suffered severe hematochezia. In delirium, heard advice: "Medicine was wrong; drink urine." He drank a bowl of urine, recovered instantly, continued daily, and improved. (*Shuyuan Zaji*)
Wind-Expelling Formulas: For Intestinal Wind bleeding.
Jingjie Sui, Dihuang (2 liang each), Gancao (0.5 liang).
Powder. Take 1 qian, wine-administered after meals, 3x day, 1x night. (*Zhongzang Jing*)
For Intestinal Wind/Visceral Toxin: Huaihua San.
Huaihua (fried), Baiye (pounded/baked), Jingjie Sui, Zhike (bran-fried yellow).
Equal parts powder. Take 2 qian with rice water, fasting before meals. (*Benshi Fang*)
*Jisheng Fang* Modified Siwu Tang: Add Sheng Di, Danggui, Chuanxiong, Gancao, Shengjiang, Wumei, decoct.
Wind/Damp-Toxin in intestines: Weifeng Tang minus Guizhi, add Zhike, Jingjie, Fangfeng. (*Yuanbing Ji*)
Bleeding Formulas: For Intestinal Wind, Zhishi Wan.
Zhishi (bran-fried), Huaijia (bran-fried), Zaojia (pig-tooth type, butter-roasted), Dahuang (fried焦黄) (1 liang each).
Powder, paste pills (walnut size). Take 20 pills with Jingjie/Laba tea, fasting. (*Shengji Zonglu*)
Dahuang Binglang Wan: For chronic stubborn hematochezia, umbilical/abdominal pain, tenesmus, unresponsive to other meds.
Dahuang (0.5 liang), Xi Mo (0.5 liang), Dalang (2 pieces), Qiaomian (1 qian).
Powder, pill with vinegar into 3 pills. Roast in ash until purple. Grind in vinegar. Take at bedtime. Evacuate evil matter in morning. (*Yilin Fang*)
Treat bleeding: Huanglian (4 liang), Poxiao (2 liang), stir-fry together, bury in ground to remove fire toxin, grind fine. Take with wine. (*Jingyan Liangfang*)
Case: Mrs. Dong Longshan, 35, chronic hematochezia (2-3 times/day), no pain, 3 years untreated. Pulse: Left Chen-Se, Right leaking past Guan. I suspected Qi deficiency needing lifting. Prescribed Buzhong Yiqi Tang + Ejiao, Diyü, Ce Baiye. 8 doses stopped bleeding for half month. Relapse after fatigue. I told husband: "Stasis exists in collaterals. Previous pulse unreliable; used lifting/astringent to test. Now confirm stasis; must purge root." Husband asked about regular periods. I replied: "Regular menstruation confirms stasis retention. 'No blockage, no flow.' Ancient dysentery treatment purges first." Prescribed Taoren Chengqi Tang + Danshen, Wulingzhi, Hetiaidi. Night dose. Morning evacuation: half bucket black stasis. Bleeding stopped next day. Asked for more purge. I advised: "Nourish Spleen first. Wait 5 days." Next purge: half amount. Finally cured with Buzhong Yiqi Tang and Shenling Baizhu San. (*Chishui Xuanzhu*)
Decisive Formula for Persistent Bleeding:
Badou (1 piece, peeled)