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(Interchanging Intestines syndrome also occurs in men.)

Zhang Luyu treated the wife of a stonemason named Zhan. Five or six days postpartum, lochia (postpartum vaginal discharge) failed to flow, accompanied by abdominal distension and fullness with panting. Stool was discharged from the anterior orifice (vagina). Upon inquiry into the cause, it was found that she had a strong habit of smoking and drinking alcohol. The newborn child was soft-bodied without bones, causing fright, which led to this condition. A decoction of Xiong Gui Tang (Safflower and Angelica Decoction) was prescribed with added Ezhu (Curcuma zedoaria Rhizome), Rougui (Cinnamon Twig Bark), and charred Shan Zha (Crataegus Fruit). After one dose, lochia flowed freely, and urination and defecation returned to normal.

Lu Shengxiang’s daughter, aged four, suffered from bloody dysentery in early autumn, with loose stool discharging from the anterior orifice. It was treated as disharmony of cold and heat combined with food stagnation. Wuling San (Five-Ingredient Poria Decoction) was administered, followed by Xianglian Wan (Coptis Pill), resulting in recovery after two doses.

Qian Jifu’s daughter, aged thirteen, was obese with abundant phlegm. Due to a burglary at her neighbor's house, she developed fever, headache, vomiting, and a greenish complexion. Her six pulses were wiry and rapid. Urination and defecation had swapped positions. This was attributed to qi chaos caused by fright, with phlegm invading the ends of the orifices. Siqi Tang (Four-Substance Decoction) was given, along with Mengshi Guntan Wan (Fluorite Rolling Phlegm Pill) to open the phlegm and regulate qi, thereby stabilizing the condition.

Yu Jiayan treated Jiang Yiren who presented with a bizarre symptom. Reviewing *Bencao Jing Shulou* (Elucidations on Materia Medica), which suggested using Wuling San for Interchanging Intestines, Yu considered it mysterious. Yu stated: "Interchanging Intestines" refers to the swapping of urinary and fecal outlets. Ancient use of Wuling San was specifically designed to promote urination. If the posterior orifice is blocked and both urine and stool exit via the anterior orifice, naming it 'Interchanging Intestines' is indeed somewhat misleading. Moreover, Interchanging Intestines is an acute disease characterized by sudden qi chaos in the middle jiao. This case, however, is a chronic illness involving gradual depletion of blood internally, differing by miles. The disease originated from worry and thought damaging the Spleen. Spleen damage impairs its ability to control blood, leading to erratic downward bleeding resembling metrorrhagia, actually termed 'Tuoying' (Depleted Camp). It requires vigorous tonification and consolidation. Instead, cooling blood and clearing fire treatments were mistakenly used, exacerbating the loss of blood until the blood of the Hand-Yangming Large Intestine channel gradually vanished. Thus, after blood exhaustion, qi became chaotic; due to qi chaos, food and water abandoned their old pathways and merged into one. The Large Intestine dried up, the pylorus suddenly closed, and food no longer underwent separation of clear and turbid substances, causing both to exit via the anterior orifice. Only by restoring patency to the Large Intestine, allowing waste to follow its original path, would treatment be correct. What relevance does Wuling San have? Furthermore, Wuling San’s potential to deplete yin is strictly contraindicated for those with blood loss. During initial diagnosis, I asked if the patient cried frequently. She replied, "Constantly." I realized that patients with Zang Zao (Organ Dryness) often cry. When the Large Intestine function fails, this is not Interchanging Intestines! The pulse of the Large Intestine appeared prominent and knotted under my fingers, indicating a critical time. Prediction: symptoms would resolve when jujube leaves sprout in spring. Indeed, they did. (Note: This remains Interchanging Intestines syndrome, but differs from cases of sudden qi chaos.)

I propose treating this with Jiling Gao (Jiling Paste), heavily dosed with Renshen (Ginseng Root) to tonify and moisten the Lung. The Lung and Large Intestine are exterior-interior pairs governing qi. The Lung is the official of transmission, where regulation arises. Nourishing the Lung clears Large Intestine dryness. Adding Gouqi (Lycium Fruit), Donghua (Winter Date Palm Flower/Leaves - likely referring to Tian Dong/Mai Dong contextually or specific herbs like Dong Gua Ren/Zi Xia, but here likely Tian Dong/Mai Dong for yin), and Mai Dong (Ophiopogon Tuber) nourishes the dryness from blood loss. Then the old paths restore, and clear/turbid separate naturally.

Xue Lizhai treated a puerperal woman whose urine contained feces, named Da Xiao Chang Jiao (Great and Small Intestine Interchange). This resulted from deficiency of both qi and blood, causing deviation from normal pathways. Six Junzi Tang (Six-Gentleman Decoction) was given for two doses, followed by Wuling San (Five-Ingredient Poria Decoction) for two doses, resulting in cure. (*Fu Ren Liang Fang* records: Wuling San for two doses first, then Buzhong Yiqi Tang for stabilization.)

Shen Mingsheng treated the wife of Ye Weihe. On a moonlit night visiting relatives, her mother kept her for dinner. Spring chill was sharp; on the way back, she felt severe chills. The next morning, combing hair by the window, she contracted another pathogen. Symptoms included aversion to cold without fever and chest/diaphragmatic oppression. One physician, noting no surface heat, diagnosed Food Injury to the Taiyin and abruptly used Dahuang (Rhubarb Root) to purge. Not only did defecation fail, but urination also became obstructed. More strangely, white, foul-smelling matter resembling creamy gonorrhea discharge emerged continuously from the Large Intestine. The body grew emaciated and skeletal. Pulse was deep and choppy, indicating deficiency-cold. The method must be warming the middle and benefiting yuan qi. However, fearing constipation and urinary retention might cause distension, Shen first used Wuling San (Five-Ingredient Poria Decoction) with doubled Rougui (Cinnamon Twig Bark). After one dose, urination flowed; after two, retained feces passed. Subsequently, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) was given for three to four doses, stopping the white discharge. Finally, Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) was used for one month for recovery. Baiyin and Baiwo (White Leukorrhea/Gonorrhea) are recorded in *Linglan Zhidian*, originating from the anterior orifice. Why transfer to the posterior? This disease is fundamentally cold. Initially, food remained above the stomach due to deficient fire failing to cook it. Premature purging prevented有形 (solid) matter from descending, while无形 (intangible) cold oppressed the Lanmen (Gate of Separation between small and large intestines). Clear and turbid mixed, flowing incessantly, mimicking leukorrhea/gonorrhea but distinct. First, Wuling San separated yin and yang; doubled Rougui expelled cold via urine, unblocking upper and lower. Then Lizhong formulas removed residual pathogens and boosted yang, drying spleen dampness and controlling turbid flow. Efficacy was swift. Initially, purgatives failed to move bowels and worsened urinary burning. Now, diuretics promoted urination and simultaneously moved bowels. Compare the gain and loss.

Dong Weiru stated: The Bladder has a lower orifice but no upper orifice. The lower orifice connects to the Zongjin (Confluence Vessels). Zongjin serves as the spermatic channel, yet urine also exits here. Thus, although Zongjin is one opening, internally it comprises two channels: spermatic and urinary. Although the Bladder lies beside the intestines, it does not connect to them. Discussions on Interchanging Intestines attribute it to unclear Lanmen causing mixed clear/turbid and swapped outlets. But Lanmen is the junction of Small and Large Intestines. Even if unclear, each outlet has its own path; how can they swap? I believe Interchanging Intestines involves stool exiting the anterior orifice and urine the posterior. Urine from the posterior implies water qi merging into the Large Intestine, failing to separate clear/turbid at Lanmen—this fits 'unclear Lanmen'. However, stool from the anterior orifice indicates rupture of both intestine and bladder. Without intestinal perforation, where does stool come from? Without bladder rupture, where does stool enter? Both must rupture for swapping. The rupture sites must be adjacent for seamless exchange. Examining animal bladders, they attach near the Dachang (Large Intestine) Mu point and connect to the Guangchang (Rectum). Thus, intestinal-bladder connection allows swapping. I treated 4-5 cases post-difficult labor, implying intestinal-bladder rupture. My sedan-chair bearer, surnamed Zhu, aged 30+, suffered Blood Hernia twice yearly, triggered by cold, relieved by warming-descending herbs. Attacks caused abdominal/flank pain radiating to chest, sometimes hematemesis (Hand-Foot Jueyin signs). In winter, sudden attack caused stone-hard scrotal swelling. He took 1-2 doses before New Year. By Jan, hernia resolved, but Scrotal Carbuncle formed. Days later, it ulcerated, discharging feces from the scrotum. Bowel obstruction ensued. Abdominal angles swelled red, forming Du Jiao Yong (Abdominal Angle Carbuncle), ulcerating in 3-5 days with pus and feces. Six holes connected scrotum and abdomen. Though emaciated, speech and appetite remained normal. Testicular cords connect to Rectum; cord damage affects intestine; membrane rupture expels feces (recorded in texts). If abdominal carbuncle ulcerates with fecal discharge, Small/Large Intestines must have abscessed internally first, then ruptured externally. Otherwise, external rupture without internal intestinal break cannot expel feces. This case ulcerated Jan 7th. Anorexia started Mar 17th. Feces vomited Mar 18th. Death occurred 3 days later. Conclusion: Intestinal severance causes immediate death; intestinal rupture does not. Thus, Interchanging Intestines and Scrotal Carbuncle cases often recover.