Library

Lin stated: One may ask, how does wind pathogen enter the large intestine? Why does toxic qi accumulate in the zang and fu organs? Is there a distinction between this "wind" and "toxicity"? The answer is: This "wind" is not the wind of external contraction of wind-cold; this "toxicity" is not the toxicity of carbuncles and sores with pus and blood. Generally, one should view it through the concept of Qi (vital energy). The term "Chang Feng" (Intestinal Wind) is similar to the meaning of being injured by wind in spring. It originates from the clear Qi of the Foot-Yangming Stomach Meridian failing to ascend and penetrate to the limbs and interstices, instead sinking into the large intestine. The blood vessels of the large intestine also sink due to this Qi deficiency. After prolonged sinking, Qi and Blood stagnate and transform into Damp-Heat. Consequently, blood follows the stagnant Qi. Whenever one defecates with Qi sinking and Fire forcing, the blood appears before the stool, and the amount is small and clear. Initially called "Chang Feng," people suspect it is external wind because formulas often use wind-dispelling herbs like Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), and Shengma (Cimicifugae Rhizoma) to raise the Clear Yang. Even if it is wind, it is wind transformed from Blood Heat; how could external wind enter the large intestine! As for "Zang Du" (Visceral Toxicity), it arises because Chang Feng persists for a long time, leading to dual deficiency of Qi and Blood. The sinking Qi becomes more severe daily, and the Damp-Heat accumulation in the large intestine deepens. The Hand-Yangming Large Intestine is the site of accumulated blood; its tendency is to sink with the Qi and emerge before or after the stool. Although painless upon emergence, the color is often dark black and clotted, hence the name "toxicity," but in reality, it lacks the toxicity of hemorrhoids, fistulas, intestinal abscesses, pus, blood, and pain. If the disease lingers, Qi and Blood become increasingly deficient, then the Yuan Qi of the Spleen and Stomach must first be depleted. Unable to control and circulate the blood vessels throughout the body, it sinks into the large intestine, forming the syndrome of Jie Yin (Knotted Yin) with hematochezia. Lowerly, with failure to raise Clear Qi, hematochezia is accompanied by undigested food diarrhea; upperly, with turbid Qi condensation, fullness is accompanied by wheezing and coughing. Eventually, limb edema, chest and abdominal distension lead to death. This condition should be divided into three: mild is Chang Feng, severe is Zang Du, and critical is Jie Yin (from *Huoren Lu Huibian*). It is also said: In the early stage, the pulse may be deep and rapid with force, or wiry and uncountable. In chronic stages, it becomes hollow and rapid without force, or deep, choppy, and weak, or shows the pulse of Jie Yin with Spleen deficiency. If not hollow or choppy, it indicates transmission of deficiency. Early treatment should focus on raising Yang and clearing heat; subsequently, clearing and tonifying should be combined to harmonize Blood and detoxify; in the Jie Yin stage, one should raise Clear Qi and drain Turbid Qi, combined with warming and tonifying the Blood. It is also said: Recently, many suffer from hemorrhoids, and bleeding is common. Many mistakenly diagnose Chang Feng or Zang Du and use cold-natured medicines repeatedly. Then they try lifting methods, which fail again. Finally, they use warm-tonifying methods. However, this is irrelevant to hemorrhoidal bleeding, and both tonification and purgation are misapplied. Upon careful examination of pulse and symptoms, I realized this blood actually comes from the hemorrhoids. Once the hemorrhoids heal, the bleeding stops spontaneously without specific treatment. The patient was greatly enlightened, sought specialized treatment, and indeed the hemorrhoids healed completely, stopping the bleeding. Physicians must observe carefully; I elaborate this to instruct future learners.

*Yi Lun Xuan Yao* states: Chang Pi (intestinal dysentery/bloody stool) refers to bloody stool in defecation. The Classics say: When wind lodges and disrupts Qi, essence is lost, as evil damages the Liver. Following overeating, sinews and vessels relax, leading to Chang Pi becoming hemorrhoids. This is because wind Qi connects to the Liver; the Liver generates wind, wind generates heat. Wind lodging disrupts Qi and damages essence; essence loss allows evil heat to damage the Liver. Overeating followed by sexual intercourse causes sinews and vessels to relax, generating Chang Pi, hemorrhoids, and fistulas. People who do not avoid wind-toxicity, indulge in rich wine and roasted foods, have excessive desires, and experience irregular emotions cause organ depression. Excessive diet injures the intestines and stomach. Yin and Yang become disharmonious, Guan Ge (obstruction) stagnates, heat-toxicity sinks downward, blood seeps into the large intestine, forming Chang Pi, hemorrhoids, and fistulas. This is commonly called Chang Feng and Zang Du. Prognosis: Body cold and pulse deep indicates survival; body hot and pulse floating indicates death. Treatment should focus on dispelling wind and detoxifying, clearing heat and cooling viscera, harmonizing blood and moistening dryness.

Qian Qinglun stated: For Chang Feng with lower bleeding, it is crucial to abstain from desire and alcohol to eradicate the root.

Zhu Danxi stated: Chang Feng occurs uniquely in the Stomach and Large Intestine. For bleeding accompanied by wind, herbs such as Cangzhu (Atractylodis Rhizoma), Qinjiao (Gentianae Macrophyllae Radix), Xiangfu (Cyperi Rhizoma), and Shaoyao (Paeoniae Radix Alba/Rubra) are suitable.

Feng Luzhan stated: Chang Feng involves external pathogenic factors entering; symptoms appear immediately upon contraction, hence the blood is clear. Zang Du involves accumulated toxicity manifesting only after a long time, hence the blood is turbid. Treating Chang Feng requires dispersing wind and drying dampness; treating Zang Du requires clearing heat and cooling blood. One must also assess deficiency/excess and new/chronic nature. New and excess cases require descending and purging; deficient and chronic cases require ascending and tonifying. Blood in the body has Yin and Yang aspects. Yang blood follows Qi, flows in meridians, harmonizes five Zang organs, distributes to six Fu organs, and is called Ying Blood (Nutritive Blood). Yin blood resides in collateral vessels, guards Zang organs, nourishes Shen Qi (Spiritual Energy), and moistens sinews and bones. If injured by internal or external pathogens, either Yang blood following meridians reaches the injury site, is blocked by evil, and leaks outside the meridians; or Yin blood in collaterals ruptures due to lingering evil. Both seep into intestines and stomach and discharge. Secular practice generally names this Chang Feng, not knowing wind is merely one of the Six Excesses. If intestines and stomach are affected by Fire and Heat, or constrained by Cold, Dryness, and Dampness, plus diet and labor injuring Yin collateral blood, can this also be called Chang Feng? *Zhen Jing* states: Injury to Yang collaterals causes blood to overflow externally resulting in hematemesis or epistaxis; injury to Yin collaterals causes blood to overflow internally resulting in hematochezia or hematuria. One must not use purely cold-cooling medicines; acrid-dispersing agents must be added as assistants. For chronic non-healing cases, regulating Stomach Qi and using ascending drugs is appropriate. Since Essence and Qi/Blood are generated from Grain Qi, lower bleeding often resolves with Stomach-regulating medicines. Using only bitter-cold drugs without regulating Spleen and Stomach is the work of inferior physicians who cut off Qi and endanger life.

It is also said: The intestines and stomach naturally do not contain blood; lower bleeding is a disease of the large intestine. Why does the large intestine bleed? Because it is affected by pathogens. If Yin collaterals are not injured and intestines/stomach are not deficient, even with external pathogens, disease cannot occur. Only drunkenness, overeating, sexual fatigue, sitting/lying in wind-dampness, and indulgence in raw/cold foods cause Damp-Heat to injure Yin collaterals, allowing external pathogens to take advantage. The Classics state: Injury to Yin collaterals causes blood to overflow internally resulting in bloody stool. It also states: In Jie Yin, one sheng of blood is passed; if knotted again, two sheng; if knotted thrice, three sheng. This means Yin Qi knots internally, cannot move outward, seeps into intestines, causing disaster from Cold-Damp and dominance of Yin Evil. What are external pathogens? Wind, Cold, Summer-heat, Dampness, and Heat. Wind easily damages the Liver; liver damage fails to store blood, causing downward flow. Drinking cold liquids after intoxication injures interior with Cold, congealing blood, which seeps into the large intestine and flows down. Internal/external Dampness damages the Stomach, flowing down with Qi. Rich diet, alcohol, and sex among the wealthy, or excessive labor among the poor, cause Heat accumulation in the Lower Jiao, leading to bleeding. However, bleeding from Damp-Toxicity involves no abdominal pain; bleeding from Heat-Toxicity involves much abdominal pain. There is also insufficient Interior Yang, where Lower Jiao Yin lacks Yuan Yang support, leading to bleeding. Books describe patients with pale faces, floating and weak pulses, or absent pulses upon gentle palpation, presenting with lower bleeding. Spleen deficiency with sinking Yang Qi fails to control blood, causing blood to descend with Qi. Since Yin follows Yang, and Blood follows Qi, and the Spleen is the source of Qi and Blood production, one must rely on tonifying the Middle and raising Yang, resolving with Stomach medicines. Passing stool before blood is called "Remote Bleeding," originating from the Foot-Yangming Stomach Meridian entering the Stomach. Passing blood before stool is called "Near Bleeding," originating from the Hand-Yangming Large Intestine Meridian seeping downward. Some consider Heart/Lung as Remote Bleeding (Yang) and Liver/Kidney as Near Bleeding (Yin). Regarding the terms Chang Feng and Zang Du used by commentators, they do not refer to external wind or swelling/heat toxicity. Rather, Yangming Qi fails to ascend, sinking into the large intestine. Vessels of intestines/stomach sink with Qi deficiency. Prolonged sinking leads to Damp-Heat accumulating toxicity, arriving first with sinking Qi. Abdomen is painless, blood is clear and bright red; this is named Chang Feng. This is external pathogen entry, appearing upon contraction, called bleeding with Cold. Later generations, seeing ancient formulas use Jingjie and Fangfeng for dispersion, assumed it was Wind-Cold, but it is not wind.

It is also said: In all cases of lower bleeding, if the body is cool and blood is cold, survival is indicated; if the body is hot and blood is warm, death is indicated.