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The Heart Fire transfers heat to the Small Intestine (Xiaochang), and the heat from the Small Intestine enters the Bladder (Pangguang). If the Bladder is afflicted with intense heat causing redness and dysuria (red, painful, difficult urination), blood will follow. Furthermore, if the Lung (Fei) is constrained by Fire Evil, toxic vapors cannot be excreted normally due to the failure of Lung Qi to descend. Some patients may experience irritability and restlessness; in such cases, there is no need to focus solely on promoting diuresis. The key is to clear the Metal element and reduce Fire Qi. One should use Dao Chi San (Guide Out the Red Powder Decoction) added with Sheng Shan Zhi (Raw Gardenia Fruit), Chuan Lian (Coptis Rhizome), and Sheng Ma (Cimicifugae Rhizoma), among other herbs. Once the Fire Qi is expelled, urination will naturally become clear and smooth.

Dao Chi San Formula:
Tong Cao (Akebia Caulis), Mai Dong (Ophiopogonis Radix), Che Qian Zi (Plantaginis Semen), Sheng Di Huang (Rehmanniae Radix), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma - 1 qian), Chi Fu Ling (Poria Cocos with Red Core), Sheng Zhi Zi (Gardeniae Fructus), Sheng Huang Qin (Scutellariae Radix), Hua Shi (Talcum), Ze Xie (Alismatis Rhizoma), Chuan Bai (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), decocted with Deng Xin Cao (Junci Medullia) (all others at 2 qian each).

Hematuria is generally caused by fierce toxins attacking internally, especially since the blood originates from the Small Intestine. Therefore, among the Five Types of Strangury (Wu Lin), those accompanied by turbid blood are particularly severe. Only extremely cooling medicines can alleviate the flow and clarify the source. Strangury (Lin Zheng) discharges from the urinary orifice, while turbidity (Zhuo Zheng) discharges from the essence orifice; Bei Mu Liu Yi San (Fritillaria Six-to-One Powder) can separate the water pathways. Hematuria is equivalent to Blood Strangury (Xue Lin); strangury involving blood is due to Excess Heat in the Heart and Small Intestine. In such cases, one may add Bei Mu (Fritillariae Bulbus), Qian Hu (Peucedani Radix), Shi Wei (Pyrrosiae Folium), and Niu Xi (Achyranthis Bidentatae Radix), each at 2 qian.

When Qi and Blood descend smoothly, stool faces no obstruction. However, if hot qi causes dryness and accumulation in the lower jiao, and toxic fire stagnates in the Large Intestine (Dachang), body fluids become dry and lose lubrication, leading to constipation. If the Stomach (Wei) excess is not purged, Stomach excess will arise, potentially causing delirium, abdominal distension, and red eyes. The Classic states: "When toxins return to the Stomach and Stomach Qi becomes blocked, panting, urgency, and irritability are inevitable." Urgently use Da Huang (Rhei Radix et Rhizoma), Gua Lou Ren (Trichosanthis Semen), and Zhi Ke (Aurantii Fructus Immaturus) to moisten and purge to remove toxins. External suppository methods are also acceptable; adding Sheng Ma to lift Qi is even better, as lifting Clear Qi allows Turbid Qi to descend naturally.

Diarrhea occurring between the fifth and sixth day after fever, rash appearance, and resolution indicates the purging of Fire Toxin without damaging Yuan Qi; do not attempt to stop it abruptly. The Classic states: "Toxins are loosened through purgation, and pain is relieved through unblocking." If diarrhea persists for more than eight or nine days after resolution, Si Ling San (Four-Poria Powder) should be used with additions of Sheng Ma, Huai Hua (Sophorae Flos), Jie Geng (Platycodonis Radix), Chai Hu (Bupleuri Radix), Zhi Zi, Huang Lian, Che Qian Zi, Liu Yi San (Six-to-One Powder), Xing Ren (Armeniacae Semen Amarum), Tiao Qin (Scutellariae Radix), Dou Gen (Phaseoli Caulis), and Gua Lou Ren. Do not use Bai Zhu (Atractylodis Macrocephalae Rhizoma) or Mu Xiang (Vladimiriae Radix) to strengthen the Spleen. If the discharged material smells like rotten eggs, it indicates food stagnation. Use Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus), Bing Lang (Arecae Semen), and Chuan Po (Magnoliae Officinalis Cortex) to resolve food accumulation.

The Classic states: "In diarrhea, pathogens enter the Large Intestine and exit as they entered because pathogenic heat fails to transform grain." This occurs because the nature of Fire is boiling and turbulent, leaving no time for separation and digestion, resulting in direct expulsion. When diarrhea is severe, all cold and cooling resolving medicines are contraindicated. However, this does not apply generally to treating dysentery caused by Heat Toxin. If Heat Toxin is too severe, it cannot fully vent onto the skin surface; instead, it tends to cause congestion, slippage, and stagnation. Fortunately, if the interior is solid and resists pathogens, the toxin invades and pours into the Large Intestine. The Large Intestine is the official of transmission; unless the toxin forces its way through causing frequent dysentery, which resembles diarrhea but is fundamentally different. Dysentery presents with slippery incontinence, whereas diarrhea presents with hardness and blockage; dysentery involves loose, unformed stools, while diarrhea involves coagulation like glue or lacquer. Some cases involve pure watery discharge, some have little foul odor, some involve fecal impaction difficult to pass, and some feature abdominal pain and irritability. In these cases, heavily use Qin (Scutellariae Radix) and Lian (Coptidis Rhizoma) to clear Fire, and slightly add Da Huang to attack the toxin, so dysentery will cease. Treating this as simple diarrhea would be a grave error. The Classic states: "Heat Toxin rushing to the intestines causes frequent bowel movements; the intestines transmit toxins making invasion difficult. Frequent urges remain hard to control; mistaking it for Spleen Deficiency leads to internal attack." In chronic diarrhea, food stagnates in the middle, obstructing Middle Qi, failing in transportation duties, and exhausting the Spleen. Even in favorable cases, recovery is delayed. For internal injury, resolve accumulation and stop diarrhea/vomiting; after heat subsides and stool becomes blocked, add Sheng Ma to lift Qi, ensuring both upper and lower passages become smooth.