张子和曰∶乐彦刚病下血，医者以药下之，默默而死。其子企，见张而问曰∶日吾父之死，竟无人知是何
症？张曰∶病锉其心也。心主行血，故被锉则血不禁，若血溢身热者死，火数七，七日故死。治不当下，下之
不满数。企曰∶四日死，何谓病锉心？张曰∶智不足而强谋，力不足而强与，心安得不锉也？乐初与邢争屋不
胜，遂得此病。企由是大服，拜而学医。
王砺恒治张大复肠血下注，痛不可忍，胸腹滞闷，痛极，血濡缕着 袜间， 有声。曰∶此欲脱也，然
色鲜，当不害。亟取贝母一两，令细研为末，分作十剂，酒少许咽下，三舐而注者减，色昏黑，又三舐之息矣。
后作寒热，十日而愈。后数年复发，血止则左胁肿痛，有声 然达于腹。又数日， 声稍达于背，乃用沉
香酒磨饮之，不三日减。（《笔谈》。）
汪龙溪手札云∶去年得下血疾，半年有余，今春误食胡桃，胡桃能下血，则知胡桃当忌也。（《珊瑚纲》。）
龚子才治一人血痢及下血不止，以六味丸加地榆、阿胶、炒黄连、黄芩、生地而愈。
孙文垣治董龙山夫人，年三十五，病便血，日二三下，腹不疼，诸医治三年不效。诊之，左脉沉涩，右脉
漏出关外，诊不应病。谓血既久下，且当益其气而升提之，以探其病，乃用补中益气加阿胶、地榆、侧柏叶，
服八剂，血不下者半月。偶因劳，血复下，再索前药。乃谓之曰∶夫人之病，必有瘀血积于经隧，前药因脉难
凭，故以升提兼补兼涩者以探虚实耳。今得病情，法当下以除其根。董曰∶便血三年，虽二三下而月泛不爽，
且至五日，如此尚有停蓄耶？曰∶以此而知其必有瘀也。经曰，不塞不流，不行不止。今之瘀，实由塞之故也。
行则不塞，古人治痢必先下之，亦此意也。用桃仁承气汤加丹皮、五灵脂、荷叶蒂，水煎夜服之，五更下黑瘀
半桶。复索下药，曰∶姑以理脾药养之，病根已动，俟五日再下未晚。至期复用下剂，又去黑瘀如前者半，继
以补中益气汤、参苓白术散，调理全愈。
吴孚先治赖思诚，大便下血已十有六月，诸医无功。诊得右寸实数，大便如常，是实热在肺，传于大肠。
与黄芩、花粉、山栀、麦冬、桔梗，清其肺热，不数日其病如失。前治不效者，俱就肠中消息故耳。
李士材治学宪黄贞父，下血甚多，面色萎黄，发热倦怠，盗汗遗精。诊之曰∶脾虚不能统血，肾虚不能闭
藏，法当以补中益气。五帖并而进之，十日汗止，二十日血止。再以六味间服，一月而安。
卢不远云∶戊申秋，坐分水王元极家堂上，有人从外来，望其色，黄而内深青，问元极，乃族兄也。问何
病？云∶惟便血。余谓春来病必甚，春分法当死。至己酉二月果殁。或问曰∶君未尝诊候，何问之而遽断，知
之且在半年之先也？予曰∶脉者形之机，色者气之兆，尝读仓公舍人奴案，故心识其脾伤之色。至春，土不胜
木，法当死。然舍人奴以四月死者尚肥，而王之体已瘦耳。又曰∶半年之前，岂无方可治乎？曰∶君不闻扁鹊
之言乎？越人非能生死人也，当生者越人能使之起耳。且疾之所在有四∶曰络，曰经，曰腑，曰脏。络经及腑
病，尚属半死，而脏病则绝不可活，况其人脏色已外显，又乌能治哉？
陆养愚治姚天池室，素有肠红症，服山栀、丹皮、芩、连凉血之剂即止。近因恼怒饮食，遂患痞满，按之
急痛，大便不行。医以丸药下之，大便已通，按之不痛，而胸膈仍不舒，饮食不进。再以行气药投之，痞胀不
减，而便血大作，三四日不止。又以凉血药投之，血不止而反增呕恶，身体微热，旬日间，肌肉削其半。脉之，
人迎沉而涩，气口弦而急。夫沉涩者，血失也；弦急者，肝盛也。肝盛则脾虚，而痞满下血之症并作矣。用参、
术、归、芍、 、草、枯姜、阿胶，数剂血止胀宽，饮食渐进。去枯姜，加熟地，调理月余而痊。
吕东庄治孙子川，久患下血病症。夏末，忽滞下口渴，不思饮食，坐卧不宁，身体日夜发热，肛门下坠，
周遭肿痛，遍身软弱，身子羸瘦，行走懒怠，始则腹内闷痛，继而体热脉洪数。曰∶若论滞下，则诸症皆死候
也。然今在下血之后，则未可尽责之滞下，当变法治之。先用白术、茯苓、山药、神曲、苡仁、陈皮、甘草等
药，强其中以统血。次用黄连、泽泻、黄芩、丹皮等药，以解郁积之热。后用熟地、归、芍等，以复其阴。次
第进之乃痊。
薛立斋治一妇人，下血不已，面色瘦黄，四肢长冷。此中气下陷，用补中益气汤送四神丸，数服而愈。
光禄张淑人，下血烦躁作渴，大便重坠，后去稍缓，用三黄汤加大黄至四两方应，后又用三黄汤二十余剂
而愈。此等元气，百中一二。
韩地官之内，脾胃素弱，因饮食停滞，服克伐之剂，自汗身冷，气短喘急，腹痛便血。或用滋补剂皆不应。
乃用人参、炮附子各五钱，二剂稍应。却用六君子，每剂加炮附子三钱，四剂渐安。又用前汤，每加附子一钱，
数剂乃痊。
一妇人因怒胸痞，饮食少思，服消导利气之药，痰喘胸满，大便下血。用补中益气加茯苓、半夏、炮姜，
四剂，诸症顿愈。又用八珍加柴胡、炒栀全愈。
通府薛允俯下血，服犀角地黄汤等药，其血愈多，形体消瘦，发热食少，里急后重。此脾气下陷，用补中
益气加炮姜一剂而愈。
一男子便血，每春间尤甚，且兼腹痛，以除温和血汤治之而愈。
薛立斋治一男子，素有温热，便血，以槐花散治之而愈。
一妇人粪后下血，面色萎黄，耳鸣嗜卧，饮食不甘，服凉血药愈甚。诊之，右关脉浮而弱，以加味四君子
汤加升麻、柴胡，数剂脾气已醒，兼进黄连丸数剂而愈。大凡下血，服凉血药不应，必因中虚，气不能摄血，
非补中升阳之药不能应，切忌寒凉之剂。亦有伤湿热之食，成肠 而下脓血者，宜苦寒之剂，以内疏之。脉弦
绝涩者难治，滑大柔和者，易治也。
一男子粪后下血，诸药久不愈，甚危。诊之，乃湿热，用黄连丸二服顿止，数服而痊。
一男子粪后下血，久而不愈，中气不足，以补中益气汤数剂，更以黄连散数服血止。又服前汤，月余不再作。
马元仪治汪氏妇，患便血症，时适澡浴，忽下血不已，遂汗出躁烦，心悸恍惚，转侧不安。诊得两脉虚涩，虚为气
虚，涩为阴伤。人身阳根于阴，阴近于阳，两相维倚者也。今阴血暴虚，阳无偶必致外越，阳越则阴愈无主，其
能内固乎？当急固其气，气充则不治血而血自守矣。先以参附理中汤，继以归脾汤及大造丸，平补气血而安。（《入
理深谈》。）
蒋氏妇便血久不愈，脉右虚微，左弦搏，此郁伤肝，肝病传脾，二经营血不守。以人参逍遥散和肝益脾，
二剂右脉稍透，症减一二。欲速愈，请用苦寒。曰∶肝脾两经为相胜之脏，木旺则土虚，用苦寒之剂则重损其
脾，惟此方益土之元，可以柔木，养肝之阴，可以安土。遂守前方，三十余剂而痊。
陆氏《续集验方》治下血不已，量脐心与脊骨平，于脊骨上灸七壮即止。如再发，即再灸七壮，永除根。
目睹数人有效。余常用此灸人肠风，皆除根，神效无比。然亦须按此骨突酸疼方灸之，不痛则不灸也。但便血
本因肠风，肠风即肠痔，不可分为三，或分三治之非也。（《医说续编》。雄按∶便血肠痔，岂可不分。）
卢州郭医云∶赵俊臣帅合肥日，其胥司马机宜，患酒毒下血，多至升斗，服四物汤，每料加炒焦槐花二两，
如常法煎服而愈。（同上。）
王嗣康为蔡昭先处浓朴煎，治积年下血。韩县尉云∶乃尊左藏服之作效。上用浓朴五两，用生姜五两同捣，
开于银石器内，炒令紫色，上为一两；大麦 、神曲，二味各一两，同炒紫色。上炒为末，白水面糊为丸如梧
桐子大。疾作，空心米饮下一百丸，平时三五十丸。嗣康云∶肠胃本无血，元气虚，肠薄，自荣卫渗入。今用
浓朴浓肠胃，神曲、麦 消酒食，于术导水，血自不作也。（《医说续编》。雄按∶肠胃本无血，一言询为卓见。）
立斋治张刑部德和，便血数年，舌下筋紫，午后唇下赤，胃肺脉洪。谓大肠之脉散舌下，大肠有热，故舌
下筋紫又便血。胃脉环口绕承浆，唇下即承浆也。午后阴火旺，故承浆发赤。盖胃为本，肺为标，乃标本有热
也，遂以防风通圣散为丸，治之而愈。后每睡忽惊跳而起，不自知其故，如是者年余，脑发一毒， 痛，左尺
脉数，此膀胱积热而然，以黄连消毒散数剂少愈。次以金银花、栝蒌、甘草节、当归，服月余而平。（此肝经血
虚而燥也。患此者颇多，以其不甚为害，故医亦莫之知耳。）
南昌郑思济传便红方∶或因酒毒发者，先用川黄连，去须切片，酒炒细末，每服三钱，空心白酒调下，忌
荤腥一月。服连末后，必腹痛去血愈多，复用白芍一两，白术五钱，甘草三钱，同炒拣开，先用白芍煎汤服，
腹痛自止。后以白术、甘草同煎服，遂愈。又一法，以粳米三分，糯米三分，煮粥空腹服，遂愈。此无他，补
胃气则阳明调，所以便红自除也。（《广笔记》。制方精妙。）
萧万舆治陈克元，年二十八，元气虚寒，面青白，肢体频冷，呕痰饱胀，小便清利，患大便下血，数月不
出，脉沉伏如无，重按着骨，方见蠕动。曰∶脉症相符，此脏气虚寒血脱也。以十全大补汤去川芎、白芍，加
熟附子、炮姜，少佐升麻，服四剂，便血顿止。若以此属热，妄投寒剂，必无生矣。
朱孝廉明耻，面色青黄，初为感寒，过饮姜汤，患内热脱血，服芩、连寒剂即愈。后因劳复发，再服不纳，
惟静养两旬方瘥。近因惊复作，仍倦怠增剧。脉之，六部皆沉缓濡弱。曰∶始受辛热，投以苦寒，宜乎即愈，
但热气既消，而广肠血窍尚未敛，血故遇劳即发。夫劳则伤脾，脾伤则不能统血，致下陷循故窍而出，此因于
劳，非由于热也。今屡发而元气愈虚，惟至静固中之剂庶可耳。以熟地为君，参、 、归、术为臣，丹皮、炙
草、知母、茯苓、阿胶为佐，引用升、柴，为丸与服，仍兼饮加减归脾汤，月余诸症如失。（虚寒积热之
外，又有此一症，但既云至静固中之剂，则当归、丹皮似尚未合法。）
彭予白病脱血，久不痊，因积劳所致。万以为劳伤脾肺，即肾家伎巧亦为之竭。曰∶得无遇事过时而失食，
热升燎于首面乎？曰∶正苦此耳，屡服芩、连清火之剂漫不应。脉之，六部沉缓，与六味加肉桂、人参、五味
子丸服，不数月沉 顿痊。
乙丑岁，萧寓楚中时，适有仆妇每患便血，投以脏连丸，随服随愈。
刘友善属文病便血，服香连丸，经岁不愈，饮食如常。冬娶妇辍药，却愈。次夏患痢，且能健啖，起居不
倦，投香连丸四剂，至夜发厥而死。此症全属肝火，于此可见。大都此积服寒凉，脾气渐伤，又娶亲后，精血
日耗，元气不支，故遇血即仆，理可知也。祸非旦夕，有由来矣。
钱国宾治戴思云妻，得病年余，大便下血如腐，或紫或红，身体昏晕，久病虚且损矣。其脉浮滑沉滞，脾
部更甚。细思血脉病久，当见芤虚数涩，此痰脉也。以导痰汤加九制大黄，二三服愈。
蒋仲芳治徐万寿，年二十余，七月中，下血不止，遍医不效。至十月初，屡次昏晕，事急矣。诊之，右寸
独得洪数，是必实热在肺，传于大肠也。用麦冬、花粉、桔梗、元参、黄芩、山栀、五味、沙参，服数剂而愈。
近见一症，寒热微渴，胸满微烦，小便利，大便稀而少，状如鸡粪，其色黑。蒋谓大便黑者，血之瘀，稀
者，中之寒。血瘀间寒，积在下焦，不得不下，遂用当归活血汤加熟大黄，温而行之，下尽黑物而愈。盖瘀血
在下，兼热者多，兼寒者少，故古人未有陈案，此又出古法之外也。
吴桥治婺源令君，入府城乃病溲血，昼夜凡百行，溲皆纯血，咳逆绝食且昏沉。医者以为新病也，请宣之。
姚令君曰∶不然，公止中道宿，就近召吴医乃可。桥暮至，六脉沉微，乃曰∶明府下元极虚，误下且不救。甲
夜进温补之剂，熟寐至夜分，觉乃啜粥汤，病去十七八，惊自语曰∶何速也？试再诊之。曰∶明府无忧，脉归
矣。再剂而起，三剂乃归。（《太函集》。）
程氏兄弟并溲血，兄瘥弟剧，则以弟逆桥入中庭，必由兄室，见兄在室烦乱，其言支离，户外徐视之，死
气黪黪。弟妇速桥未入，则弟自房内号 。桥作而叹曰∶异哉，两君子俱死矣。然瘥者顾急，则予望而知之；
剧者顾缓，则予闻而知之。长君色有死征，次君声有余响故也。既而诊之，兄脉将绝，病得之内，重以误下伤
阴，家人以为然。病者始病而内，以故里急浓重乘之，族医递为之下，急重乃通。今绝水浆，四肢逆冷，法曰∶
下痢烦躁者死，语言错乱者死，四肢厥冷者死，水浆不入者死。四端皆在不治中者，兄死。诊其弟病，视乃兄
为轻，或当小愈，第多嗜多怒，亦必不终。旬日溲血平，寻以过饱，淫怒伤脾，未几卒。（《太函集》。）
Zhang Zihe said: Le Yegang suffered from lower gastrointestinal bleeding. The physician treated him with purgatives, and he died in silence. His son, Le Qi, saw Zhang Zihe and asked, "My father's death, no one knew what disease it was." Zhang Zihe said, "The disease damaged the Heart. The Heart governs the circulation of blood; thus, when damaged, blood cannot be controlled. If blood overflows and the body becomes feverish, death ensues. Fire corresponds to the number seven, so he died on the seventh day. Treatment should not have involved purgation; had purgatives not been used, he would not have died in less than seven days." Le Qi said, "He died on the fourth day. Why do you say the Heart was damaged?" Zhang Zihe said, "His wisdom was insufficient yet he forced himself to plan; his strength was insufficient yet he forced himself to act. How could his Heart not be damaged? Initially, Le Yegang competed with Xing over a house and lost, which led to this illness." Le Qi was greatly convinced and bowed to learn medicine.
Wang Liheng treated Zhang Dafu, who suffered from intestinal bleeding pouring downwards, unbearable pain, chest and abdominal stagnation and oppression, extreme pain, with blood moistening and adhering to his socks like threads, making sounds. Wang Liheng said, "This is a sign of impending collapse. However, the blood color is bright red, so it should not be fatal." He urgently prescribed one tael of Fritillariae Bulbus (Beimu), ground finely into powder, divided into ten doses, taken with a little wine. After three doses, the bleeding decreased, and the color became dark. After another three doses, the bleeding stopped. Later, he developed alternating chills and fever, recovering in ten days. Years later, the condition recurred. After the bleeding stopped, swelling and pain occurred in the left hypochondrium, with sound radiating to the abdomen. A few days later, the sound slightly radiated to the back. He then drank Chinasmos Semen (Chenxiang) prepared with wine, and symptoms reduced within three days. (From *Bi Tan*.)
Wang Longxi recorded in his letters: Last year, I contracted lower gastrointestinal bleeding, lasting over half a year. This spring, I mistakenly consumed walnuts. Walnuts can induce lower bleeding; thus, walnuts should be avoided. (From *Bencao Gangmu*.)
Gong Zicai treated a patient suffering from bloody dysentery and persistent lower gastrointestinal bleeding. He cured him using Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Sanguisorbae Radix (Diyu), Euphorbiae Pekinensis Radix (Ejiao - note: usually refers to Donkey-hide gelatin, but context implies hemostatic herb, likely Ejiao/Donkey-hide Gelatin), stir-fried Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), and Rehmanniae Radix Recens (Shengdi).
Sun Wen Yuan treated Mrs. Dong Longshan, aged thirty-five, who suffered from rectal bleeding two or three times daily without abdominal pain. Other physicians had treated her for three years without effect. Pulse diagnosis revealed a deep and choppy left pulse, and a right pulse leaking beyond the Guan position, inconsistent with the disease. Sun said, "Since blood has been flowing downward for a long time, we must tonify Qi and lift it to probe the condition." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Ejiao, Diyu, and Platycladi Cacumen (Cebaiye). After eight doses, bleeding ceased for half a month. Accidentally due to exertion, bleeding resumed, and she requested the previous prescription again. Sun said, "Your illness must involve blood stasis accumulated in the collaterals. The previous prescription, relying on an unreliable pulse, used lifting, tonifying, and astringent methods to probe deficiency and excess. Now that the condition is understood, the method should be purgation to remove the root cause." Dong said, "Rectal bleeding for three years, though two or three times daily, occurs monthly without fail. Is there still accumulation after five days?" Sun said, "This indicates stasis. The Classics state: 'If blocked, flow stops; if stagnant, movement ceases.' Current stasis is caused by excessive astringency. Movement prevents blockage. Ancients treated dysentery first with purgation, for the same reason." He used Taoren Chengqi Tang (Peach Kernel and Da Huang Decoction) added with Moutan Cortex (Danpi), Trogopterori Faeces (Wulingzhi), and Nelumbinis Plumula (Hetiaodi), decocted in water and taken at night. At dawn, half a bucket of black stasis was evacuated. She requested more purgatives. Sun said, "Temporarily use spleen-regulating herbs to nourish. The root cause is stirred; waiting five days before purging is not too late." On the appointed day, purgatives were used again, evacuating half as much black stasis as before. Subsequently, Buzhong Yiqi Tang and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) were used for regulation, leading to complete recovery.
Wu Fuxian treated Lai Sicheng, who had suffered from rectal bleeding for sixteen months with no effect from other physicians. The right Cun pulse was full and rapid, while bowel movements were normal. This indicated excess heat in the Lung transmitting to the Large Intestine. He prescribed Scutellariae Radix (Huangqin), Trichosanthis Radix (Huafen), Gardeniae Fructus (Shanzhi), Ophiopogonis Radix (Maidong), and Platycodonis Radix (Jiegeng) to clear Lung heat. Within a few days, the illness disappeared. Previous failures resulted from focusing solely on the intestines.
Li Shicai treated Huang Zhenfu, an Academic Commissioner, who suffered from severe lower gastrointestinal bleeding, sallow complexion, fever, fatigue, night sweats, and seminal emission. Diagnosis indicated Spleen deficiency failing to control blood and Kidney deficiency failing to secure essence. The treatment method was Buzhong Yiqi (Tonify the Middle and Augment the Qi). Five doses were administered together. Sweating stopped in ten days, and bleeding stopped in twenty days. Liuwei Wan (Six-Ingredient Rehmannia Pill) was taken intermittently thereafter, resulting in stability within a month.
Lu Bu Yuan stated: In autumn of the Wushen year, sitting in the hall of Wang Yuanji from Fenshui, someone entered from outside. Observing his complexion—yellow with deep blue inside—and asking Wang Yuanji, it turned out to be his clan brother. Asked about his illness, he replied, "Only rectal bleeding." I told him, "In spring, the illness will worsen; by the Spring Equinox, he will die." Indeed, he died in February of the Jiyi year. Someone asked, "You did not take his pulse. How could you diagnose so quickly, knowing even six months in advance?" I said, "The pulse is the mechanism of form; complexion is the omen of Qi. Having read the case of Cang Gong's slave, I memorized the complexion of Spleen injury. In spring, Earth fails to overcome Wood, so death is expected according to pattern. However, the slave died in April while still plump, whereas Mr. Wang was already emaciated." Another asked, "Was there no prescription available six months prior?" I said, "Have you not heard Bian Que? Yu Ren (Bian Que) cannot make the dead live, but for those destined to live, he can help them recover. Disease locations are four: Collaterals, Channels, Fu Organs, and Zang Organs. Diseases in Collaterals, Channels, and Fu organs are semi-curative, but Zang organ diseases are incurable. Moreover, the Zang complexion is already manifest externally; how can it be treated?"
Lu Yangyu treated the wife of Yao Tianchi, who had a history of intestinal bleeding (Changhong). It stopped upon taking Gardeniae Fructus (Shanzhi), Moutan Cortex (Danpi), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian) to cool blood. Recently, due to anger and dietary indiscretion, she developed epigastric fullness, acute pain on pressure, and constipation. A physician used pill laxatives. Bowel movements opened, pain on pressure ceased, but chest and diaphragm remained uncomfortable, and appetite was absent. Qi-moving herbs were given, but fullness persisted, and severe rectal bleeding erupted, lasting three to four days. Cooling-blood herbs were then used, but bleeding continued, accompanied by vomiting, nausea, slight fever, and half-body muscle wasting within ten days. Pulse diagnosis showed the Renying pulse deep and choppy, and the Qikou pulse wiry and rapid. Deep and choppy indicates blood loss; wiry and rapid indicates Liver excess. Liver excess leads to Spleen deficiency, causing simultaneous epigastric fullness and rectal bleeding. Ginseng, Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Licorice Root (Gancao), dried Ginger (Kujang), and Ejiao were used. After several doses, bleeding stopped, distension eased, and appetite improved. Dried Ginger was removed, and Rehmanniae Radix Preparata (Shudihuang) added. Regulation for over a month led to recovery.
Lv Dongzhuang treated Sun Zichuan, who suffered from chronic lower gastrointestinal bleeding. Late summer, sudden dysentery with thirst, loss of appetite, restlessness, constant day-and-night fever, anal prolapse sensation, surrounding swelling and pain, generalized weakness, emaciation, and lethargy began. Initially, abdominal闷痛 (stuffy pain), followed by fever and a flooding, rapid pulse. Lv said, "Regarding dysentery, these are all ominous signs of death. However, occurring after lower bleeding, they cannot be entirely blamed on dysentery. Treatment must change." First, Baizhu, Poria (Fuling), Dioscoreae Rhizoma (Shanyao), Medicated Leaven (Shenqu), Coicis Semen (Yiren), Tangerine Peel (Chenpi), and Licorice Root (Gancao) were used to strengthen the Middle and control blood. Next, Coptidis Rhizoma (Huanglian), Alismatis Rhizoma (Zexie), Scutellariae Radix (Huangqin), and Moutan Cortex (Danpi) were used to resolve stagnant heat. Finally, Rehmanniae Radix Preparata (Shudihuang), Danggui, and Baishao were used to restore Yin. Sequential administration led to recovery.
Xue Lizhai treated a woman with persistent lower bleeding, sallow and thin complexion, and chronically cold limbs. This was sinking of Middle Qi. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used to deliver Sishen Wan (Four Miracles Pill). Several doses led to recovery.
Guanglu Temple Official Lady Zhang suffered from lower bleeding, irritability, thirst, heavy sensation in defecation, and slow post-defecation relief. Sanhuang Tang (Three Yellow Decoction) with up to four taels of Rheum Palmatum (Dahuang) was required for effect. Later, over twenty doses of Sanhuang Tang cured her. Such patients retain only one or two in a hundred.
Han Diguan's wife had inherently weak Spleen and Stomach. Due to food stagnation, she took attacking herbs, resulting in spontaneous sweating, cold body, shortness of breath, rapid panting, abdominal pain, and rectal bleeding. Tonics failed. Then, Ginseng (Renshen) and Prepared Aconite Root (Paofuzi), each five qian, were used for two doses with slight effect. Six Junzi Tang (Six Gentlemen Decoction) with three qian of Paofuzi per dose was used for four doses, gradually stabilizing. The previous decoction with one qian of Fuzi added per dose was used for several doses until recovery.
A woman suffered from chest fullness due to anger, poor appetite. Digestive and Qi-moving herbs caused phlegm, panting, chest fullness, and rectal bleeding. Buzhong Yiqi Tang added with Poria (Fuling), Pinelliae Tuber (Banxia), and Prepared Ginger (Paojiang) for four doses resolved all symptoms. Bazhen Tang (Eight Treasure Decoction) added with Bupleuri Radix (Chaihu) and stir-fried Gardeniae Fructus (Zhizhi) completed the cure.
Tongzheng Shi Xue Yunfu suffered from lower bleeding. After taking Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), bleeding increased, body emaciated, fever and poor appetite appeared, along with tenesmus. This was Spleen Qi sinking. Buzhong Yiqi Tang added with Prepared Ginger cured it in one dose.
A man suffered from rectal bleeding, worse in spring, accompanied by abdominal pain. Chuwen Heshue Tang (Remove Warmth and Harmonize Blood Decoction) cured him.
Xue Lizhai treated a man with chronic warm-heat and rectal bleeding. Huaihua San (Sophora Flower Powder) cured him.
A woman suffered from post-defecation bleeding, sallow complexion, tinnitus, drowsiness, and poor taste in mouth. Cooling-blood herbs worsened it. Pulse: Right Guan floating and weak. Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction) added with Bupleuri Radix (Chaihu) and Cimicifugae Rhizoma (Shengma) woke the Spleen Qi after several doses. Combined with Huanglian Wan (Coptis Pill) for several doses, she recovered. Generally, for lower bleeding unresponsive to cooling-blood herbs, it is due to Middle deficiency where Qi cannot hold blood. Only Middle-tonifying and Yang-lifting herbs work; cold-cold herbs are strictly contraindicated. Some cases involve damp-heat food injury forming intestinal hemorrhoids with pus and blood, requiring bitter-cold herbs for internal drainage. Wiry, cut-off, or choppy pulses indicate difficult cases; slippery, large, and soft pulses indicate easy cases.
A man suffered from post-defecation bleeding, unresponsive to many drugs, critically ill. Diagnosis: Damp-heat. Huanglian Wan (Coptis Pill) stopped it in two doses, curing in several.
Another man suffered from chronic post-defecation bleeding, Middle Qi deficiency. Buzhong Yiqi Tang for several doses, followed by Huanglian San (Coptis Powder) to stop bleeding. Taking the previous decoction again prevented recurrence for over a month.
Ma Yuanyi treated Madam Wang, who suffered from rectal bleeding. After bathing, sudden continuous bleeding ensued, with sweating, irritability, palpitations, confusion, and restlessness. Pulses were deficient and choppy. Deficiency indicates Qi deficiency; choppy indicates Yin injury. Yang roots in Yin; Yin is close to Yang; they support each other. Sudden Yin blood loss leaves Yang without a partner, causing it to escape outward. Yang escaping means Yin has no master, unable to secure internally. Urgent Qi consolidation is needed. When Qi is sufficient, blood self-regulates without direct treatment. Shenfu Lizhong Tang (Ginseng, Aconite, and Zhuga Decoction) was used first, followed by Guipi Tang (Restore the Spleen Decoction) and Dazao Wan (Great Creation Pill) to peacefully tonify Qi and Blood, resulting in peace. (From *Ruli Shentan*.)
Madam Jiang suffered from chronic rectal bleeding. Right pulse deficient and faint; Left pulse wiry and forceful. This is depression injuring the Liver, Liver disease transmitting to the Spleen, with Nutritive and Blood failing to remain in the channels for two months. Renshen Xiaoyao San (Ginseng and Free Wanderer Powder) harmonizes Liver and benefits Spleen. After two doses, the right pulse became slightly visible, symptoms reduced slightly. Desiring quick recovery, she requested bitter-cold herbs. I said, "Liver and Spleen are mutually overcoming organs. Wood excess causes Earth deficiency. Bitter-cold herbs severely damage the Spleen. Only this formula benefits Earth's origin, softens Wood, nourishes Liver Yin, and calms Earth." Adhering to the original prescription for over thirty doses led to recovery.
Lu's *Continued Collection of Effective Prescriptions* treats persistent lower bleeding by measuring from the navel center level with the spine, moxibustion on the spine for seven moxa cones stops it. If it recurs, moxa seven cones again, permanently removing the root. Witnessed effective in several people. I often use this for Changfeng (Intestinal Wind), always removing the root, extremely effective. However, moxa only if the bone protrusion is sore and painful; if not painful, do not moxa. Rectal bleeding is originally due to Changfeng; Changfeng is Changzhi (Intestinal Hemorrhoids). They should not be separated into three, nor treated separately. (From *Yishuo Xubian*. Xiong notes: Rectal bleeding and intestinal hemorrhoids, how can they not be distinguished?)
Doctor Guo from Luzhou said: When Zhao Junchen governed Hefei, his clerk Sima Jiyi suffered from alcohol-toxin lower bleeding, losing liters. Siwu Tang (Four Substance Decoction) with two taels of stir-fried Sophorae Flavescentis Flos (Huaihua) per dose, decocted normally, cured him. (Same source.)
Wang Sikang prescribed Nongpo Jian (Thick Bark Decoction) for Cai Zhaoxian for chronic lower bleeding. County Magistrate Han said: His father, Zuozang, found it effective. Recipe: Thick Bark (Nongpu/Houpo) five taels, fresh Ginger five taels, pounded together, stir-fried in silver/copper vessel until purple, take one tael. Barley bran (Damai Mai) and Medicated Leaven (Shenqu), one tael each, stir-fried until purple. Ground to powder, made into pills the size of wutong seeds with wheat paste. Take 100 pills on an empty stomach with rice drink when sick; 30-50 pills normally. Sikang said: The intestines and stomach naturally have no blood. Qi deficiency makes intestines thin, allowing Ying and Wei to seep in. Now, Houpo thickens the intestines, Shenqu and barley bran digest wine and food, Baizhu guides water, and blood production ceases. (From *Yishuo Xubian*. Xiong notes: "Intestines and stomach naturally have no blood" is indeed a profound insight.)
Xue Lizhai treated Zhang Dehe, a Penal Department official, with years of rectal bleeding, purple veins under the tongue, redness below the lips in the afternoon, and flooding pulses in Stomach and Lung meridians. He said: Large Intestine meridian disperses under the tongue; Large Intestine heat causes purple veins and rectal bleeding. Stomach meridian circles the mouth and Chengjiang point; below the lips is Chengjiang. Afternoon Yin fire is strong, causing Chengjiang redness. Stomach is Root, Lung is Branch; both Root and Branch have heat. Fangfeng Tongsheng San (Wind-Dispersing and Unblocking Great Powder) in pill form cured him. Later, he suddenly jumped up in sleep for over a year, unaware why. A boil appeared on the head, painful, with rapid Left Chi pulse, indicating Bladder heat accumulation. Huanglian Xiaodu San (Coptis Detoxification Powder) for several doses improved it slightly. Then, Honeysuckle (Jinyinhua), Trichosanthes Fruit (Gualou), Licorice Joint (Gancao Jie), and Angelicae Sinensis Radix (Danggui) for over a month brought peace. (Note: This is Liver channel blood deficiency with dryness. Many suffer this, but since it is not severe, physicians ignore it.)
Nanchang Zheng Siji passed down a prescription for rectal bleeding: If caused by alcohol toxin, first use Sichuan Coptidis Rhizoma (Huanglian), remove whiskers, slice, wine-fry, grind to fine powder. Take three qian with white wine on an empty stomach. Avoid meat/fish for one month. After taking Coptis powder, abdominal pain and increased bleeding may occur. Use one tael White Peony Root (Baishao), five qian Baizhu, three qian Gancao, stir-fry together and separate. First, decoct Baishao in water; abdominal pain stops spontaneously. Then, decoct Baizhu and Gancao together to cure. Another method: Cook three parts Japonica Oryzae Semen (Jingmi) and three parts Glutinous Rice (Nuomi) into porridge, eat on empty stomach to cure. This works because tonifying Stomach Qi regulates Yangming, so rectal bleeding removes itself. (From *Guang Biji*. Prescription is exquisite.)
Xiao Wanyu treated Chen Ke Yuan, aged twenty-eight, with deficient-cold Yuan Qi, blue-white face, frequent cold limbs, vomiting phlegm, fullness, clear urination, and rectal bleeding for months without exit. Pulse deep and hidden, almost imperceptible, only moving when pressed to bone. He said: Pulse and symptoms match. This is Zang Qi deficient-cold with blood depletion. Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) minus Chuanxiong and Baishao, plus Prepared Aconite (Shufu) and Prepared Ginger (Paojiang), with a little Shengma, cured bleeding in four doses. If attributed to heat and wrongly given cold herbs, death would surely follow.
Zhu Mingchi, a Xiao Lian, had blue-yellow face. Initially caught cold, drank too much Ginger Soup, developed internal heat and blood loss. Cooled by Huangqin and Huanglian immediately. Relapsed due to exertion; cold herbs rejected. Rest for twenty days cured. Recently relapsed due to shock, worsening fatigue. Pulse: All six positions deep, slow, soggy, and weak. He said: Initially exposed to pungent-warm, treated with bitter-cold, so immediate cure was expected. But after heat cleared, the rectal blood vessels had not closed, so bleeding recurs with exertion. Exertion injures Spleen; Spleen injury fails to control blood, causing sinking through old vessels. This is due to exertion, not heat. Now recurrent, Yuan Qi increasingly deficient. Only quiet, Middle-stabilizing formulas will work. Rehmanniae Radix Preparata (Shudihuang) as Sovereign, Ginseng, Astragali Radix (Huangqi), Danggui, and Baizhu as Ministers, Moutan Cortex (Danpi), Roasted Licorice (Zhigancao), Anemarrhenae Rhizoma (Zhimu), Poria (Fuling), and Ejiao as Assistants, with Shengma and Chaihu as Guides, made into pills. Also drank modified Guipi Tang. Over a month, symptoms vanished. (Note: Besides deficient-cold and accumulated heat, there is this syndrome. But since it requires "quiet Middle-stabilizing," Danggui and Danpi seem inappropriate.)
Peng Yubai suffered from blood loss, chronic due to accumulated labor. I believed labor injured Spleen and Lung, exhausting Kidney ingenuity. I asked: "Do you miss meals due to overwork, with heat rising to head and face?" He replied: "Exactly. Repeatedly taking Huangqin and Huanglian clearing-fire herbs failed." Pulse: Six positions deep and slow. Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Rougui (Cinnamon Bark), Renshen (Ginseng), and Wuweizi (Schisandra) in pill form cured deep-rooted illness in months.
In Yichou year, while Xiao resided in Chu, a maid servant suffered from rectal bleeding. Zanglian Wan (Intestine-Connected Pill) cured her immediately upon taking.
Liu Youshan's subordinate Wen suffered from rectal bleeding. Xianglian Wan (Fragrant Coptis Pill) failed for a year despite normal diet. He married in winter, stopped medication, and recovered. Next summer, he had dysentery, ate well, lived actively, took four doses of Xianglian Wan, and died of syncope at night. This syndrome belongs entirely to Liver Fire. Generally, accumulated cold-cold herbs injure Spleen Qi. After marriage, Essence and Blood consumed daily, Yuan Qi unsupported, so collapse upon bleeding is logical. Disaster does not happen overnight; it has origins.
Qian Guobin treated Mrs. Dai Siyun, ill for over a year. Rectal bleeding like rot, purple or red, dizzy body, chronic deficiency and damage. Pulse floating-slippery, deep-choppy, worse in Spleen area. Thinking deeply, chronic blood disease should show Kou (hollow), Xu (deficient), Shu (rapid), or Se (choppy) pulses. This is a Phlegm pulse. Daotan Tang (Phlegm-Guiding Decoction) added with Nine-Processed Dahuang (Rhubarb) cured in two or three doses.
Jiang Zhongfang treated Xu Wanshou, over twenty, bleeding continuously in July, ineffective treatments. By early October, repeated fainting, critical. Pulse: Right Cun alone flooding and rapid. Must be excess heat in Lung transmitting to Large Intestine. Maidong, Huafen, Jiegeng, Xuanshen, Huangqin, Shanzhi, Wuweizi, and Shashen cured in several doses.
Recently seen a case: Mild chills/fever, slight thirst, chest fullness, slight irritability, free urination, scant loose stool like chicken dung, black color. Jiang said: Black stool is blood stasis; loose is Middle cold. Blood stasis mixed with cold, accumulated in Lower Jiao, must be purged. Danggui Huoxue Tang (Angelica Blood-Invigorating Decoction) added with Prepared Dahuang, warmed and moved, evacuated all black matter, cured. Blood stasis in Lower Jiao is mostly combined with heat, rarely with cold. Thus, ancients left no such records. This goes beyond ancient methods.
Wu Qiao treated Prefect of Wuyuan. Ill with hematuria upon entering prefectural city, urinating pure blood a hundred times day and night, coughing, refusing food, comatose. Physicians thought it new disease, requested venting. Prefect Yao said: No, stay halfway, summon local Wu doctor. Wu arrived evening, six pulses deep and faint. Said: My Lord, Lower Yuan extremely deficient. Purging wrongly would be incurable. Night of Jia, warm-tonic administered. Slept soundly until midnight, woke to sip rice soup, illness gone 70-80%. Surprised, said: How fast? Re-pulse. Said: Do not worry, pulse returned. Two doses stood up, three doses returned home. (From *Taihan Ji*.)
Brothers Cheng both had hematuria. Elder recovered, younger worsened. Younger invited Wu Qiao into courtyard, passing elder's room. Saw elder restless, disjointed speech. Looked from outside, death aura dark. Younger's wife hurried Wu, not yet entered, younger cried from room. Wu sighed: Strange, both gentlemen will die. But the recovering one urgent, I saw and knew; the worsening one slow, I heard and knew. Elder has death signs in color; younger has lingering sound in voice. Then pulsed: Elder pulse near extinction, disease internal, aggravated by wrong purging injuring Yin. Family agreed. Initially internal disease, so tenesmus attacked. Clan doctors repeatedly purged, tenesmus relieved. Now refuses fluids, cold limbs. Law says: Dysentery with irritability dies; confused speech dies; cold limbs die; fluid refusal dies. Four ends indicate untreatable; elder dies. Younger's disease lighter than elder, might improve slightly, but loves pleasure and anger, will not finish life. Ten days later hematuria flat, soon died of overeating and excessive anger injuring Spleen. (From *Taihan Ji*.)