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Sun Wenyuan treated Pan Dasima, who frequently suffered from Changfeng (intestinal wind, a type of rectal bleeding often caused by wind pathogen). During the Ding sacrifice in August, the Xuebo presented him with deer blood. After consuming it, he experienced sudden and massive lower gastrointestinal bleeding. Sun prescribed Huaijiao Zi (Fructus Acanthopanacis Senticosi) 5 qian, along with Huanglian (Rhizoma Coptidis), Zhike (Pericarpium Citri Reticulatae), Diyü (Radix Sanguisorbae), and Guanzhong (Rhizoma Cyperi Rotundi), each 3 qian. One dose stopped the bleeding. Pan praised the prescription and posted it on his wall. Whenever someone else suffered from hematochezia, they followed this prescription and achieved immediate efficacy.

Chen Lutang originally suffered from Changfeng and Zangdu (intestinal toxin, a severe form of intestinal damp-heat toxicity causing bleeding or dysentery). His stools were dry and hard, unable to pass for several days, causing extreme pain. This indicated cold in the stomach and heat in the intestines. His pulse was rapid at both Cun positions, wiry and weak at both Guan positions, and surging and slippery at both Chi positions, especially on the left side. After long-term ineffective treatment, he recalled Li Dongyuan’s saying: “The large intestine prefers coolness and dislikes heat; the spleen and stomach prefer warmth and dislike cold,” because the stomach belongs to Earth and the intestines to Metal. Thus, he formulated a prescription primarily using herbs for treating Changfeng and Zangdu, wrapped externally with blood-nourishing herbs to prevent damage to stomach Qi. Since the medicine enters the stomach first and then the large intestine, the wrapping remains intact in the stomach and dissolves only upon reaching the large intestine, allowing the main ingredients to act there without interfering with the stomach. He used Jiuzhi Dahuang (Nine-processed Rhizoma et Radix Rhei) 2 liang, Huaihua (Flos Sophorae) 3 liang, Mu'er (Sporophorus Auriculariae Judae) 2 liang, Yuliren (Semen Pruni) 1 liang, Zhaojiao Zi (Fructus Gleditsiae Sinensis) 1 liang, Xiangyasui (Dens Elephantis) 1 liang, and Tiaoxin (Radix Scutellariae) 1 liang, plus Xuerou (Cortex Cornus) 5 qian, Shengma (Rhizoma Cimicifugae) 5 qian, and Jingjisui (Flos Chrysanthemi Indici) 5 qian. These were ground into powder, mixed with refined honey to make pills the size of Adzuki beans, coated with Siwu Tang (Four Substances Decoction) plus Puhuang (Pollen Typhae) 1 liang each. Taken with rice water, 2 qian on an empty stomach and in the afternoon. The bleeding stopped, stools softened, appetite improved, and he recovered.

Wang Zuquan suffered from tenesmus and abdominal pain, passing purple, thick, sticky stool 30–40 times day and night. Treated as dysentery for three months with no effect. He became emaciated, lost appetite, and kept his eyes closed due to fatigue. Everyone deemed it incurable. Pulse diagnosis revealed weak and soggy pulses in all six positions. The discharged blood was dark and resembled taro juice. He stated: “This is not dysentery, but Zangdu bleeding.” The Ren Shen Chu Pi San (Ginseng and Chinese Toona Powder) recorded in *Yi Shuo* precisely matches this condition. He prepared and administered it. That night, bleeding halved, and after completing the course, he fully recovered. The formula consisted of Ren Shen (Radix Ginseng) and Chu Gen Bai Pi (Cortex Toosendan Fructus), each 2 liang, powdered and taken with rice water, 2 qian on an empty stomach. Avoid meat broth, raw vegetables, and fishy foods.

Tang Fengjun Jian’an had excessive heat in the blood level, leading to Changfeng due to heavy drinking, accompanied by Heart-Kidney non-interaction. He took Siwu Tang (Four Substances Decoction) supplemented with Zaoren (Semen Ziziphi Spinosae), Cebei Ye (Folium Platycladi), Huaihua (Flos Sophorae), and Lianqiao (Fructus Forsythiae), made into honeyed pills, which cured him immediately.

Wu Fuxian treated Zhang Dongming, who had chronic hemorrhoids with tenesmus, resembling dysentery but not quite. He felt urgent discomfort during defecation, walked like riding a horse, and sat painfully. All six pulses were slightly excessive but lacked spirit, indicating Qi and Blood deficiency with damp-heat. He used Xiong (Radix Chuanxiong), Gui (Radix Angelicae Sinensis), Qin (Radix Scutellariae), Lian (Rhizoma Coptidis), Shengdi (Radix Rehmanniae Preparata), Huaijiao (Fructus Acanthopanacis Senticosi), Zhari Rou (Sarcocarp Crataegi), and Shengma (Rhizoma Cimicifugae), adding 2 liang of Ren Shen (Radix Ginseng), made into pills. When the patient omitted Ren Shen, it failed. Upon re-including Ren Shen, half a dose cured him completely.

Zhang Hezi said: A man suffered from Zangdu bleeding in the sweltering heat of June, believing death was inevitable. Suddenly craving honey water, he drank a large bowl desperately. Pain ceased, and bleeding stopped.

Wanyan Junbao, Vice Commissioner of Runan Jiedu, suffered from Zangdu, with bleeding, thirst, alternating chills and fever, lasting six years. He became increasingly weak and yellow-faced. Zhang diagnosed deep pulses in both hands and a cool body. *Neijing* states that if cold indicates Ying Qi is present, life can be sustained. First, seven Xuan Wan (Seven Promoting Pills) were given to induce bowel movements five to seven times. Then, Huanglian Jiedu Tang (Coptis Decoction for Detoxification) plus Danggui (Radix Angelicae Sinensis), Chishao (Radix Paeoniae Rubra), and Diyü San (Sanguisorba Powder) were decocted together and taken. He recovered in one month.

Fang Shuo in *Bozhai Bian* wrote: His cousin Liu Yuan suffered from Zangdu bleeding for half a month, expecting death. He obtained a prescription using dried persimmon ash, taken with rice, 2 qian, which cured him. Wang’s *Baiyi Fang* also records a case of a son of Zeng Tongpan suffering from bleeding for ten years, cured by one dose of this prescription. It can be made into pills or powder. (From *Bencao Gangmu*)

Xue Lizhai treated a man with Zangdu bleeding. Cooling and detoxifying herbs failed to stop the bleeding and worsened his appetite and fatigue. Pulses were rapid but choppy on pressure. He first used Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi) for several doses, slightly stopping the bleeding. Then, Liujunzi Tang (Six Gentlemen Decoction) plus Shengma (Rhizoma Cimicifugae) and Paojiang (Prepared Rhizoma Zingiberis) stopped it in four doses. Paojiang was removed, and Xiong (Radix Chuanxiong) and Gui (Radix Angelicae Sinensis) added. After over a month, his spleen and stomach recovered. For cases of accumulated heat or wind-heat bleeding, Baidu San (Detoxification Powder) is used first. For cold-stomach weakness, Sijunzi Tang (Four Gentlemen Decoction) or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) tonifies effectively.

A man with weak spleen Qi suffered from Zangdu bleeding. Liujunzi Tang plus Xiong, Gui, Zhike, Diyü, and Huaihua cured him. Later, mental stress caused recurrence, unresponsive to other drugs. Recognizing it as spleen injury from worry, Guipi Tang (Restore the Spleen Decoction) for four doses healed him. Generally, causes vary, so treatment must address the root. Danxi said: Xionggui Tang (Chuanxiong and Angelica Decoction) is a premier blood regulator. Add Fuling (Poria) and Huaihua for heat; add Fuling and Muxiang (Radix Aucklandiae) for cold. This is a fundamental theory. Although essence, Qi, and blood derive from grain Qi, lower GI bleeding is ultimately resolved by treating the stomach. Using Sijunzi Tang, Shenling Baizhu San, Zhike San (Citrus Peel Powder), and Xiao Wuchen Tang (Minor Black Stagnation Decoction) harmonizes the system. Once Stomach Qi returns, blood flows normally in the collaterals. Changfeng arises from external pathogens appearing immediately; Zangdu results from accumulated toxins manifesting later. Sitting in wind/warmth, overindulgence in sex/diet, cold/raw food retention, and alcohol-induced heat cause Ying blood to deviate and seep into the large intestine. Heat-associated bleeding is clear and bright red with abdominal pain; cold-associated bleeding is turbid and dark with slight pain. Clear indicates Changfeng; turbid indicates Zangdu. Bleeding after stool implies distant origin; bleeding before stool implies near origin. Folk theories about pre/post-stool bleeding are incorrect. General treatment involves resolving intestinal wind first: Baidu San for heat, Huanjin Zhengqi San (Golden Change Upright Qi Decoction) plus Xiong and Gui for cold, followed by heat/cold differentiation. Liu Hejian said: Irregular lifestyle and excessive strain injure collaterals. Yang collateral injury causes external bleeding (epistaxis); Yin collateral injury causes internal bleeding (hematochezia). Intestinal collateral injury leads to blood overflow. Cold fluids outside the intestine mix with blood, forming stagnation. *Neijing* states: Dysentery with pus/blood, wiry/absent pulse means death; slippery/large pulse means survival. Hemorrhage with fever means death; cool body means survival. Most formulas attribute this to wind-heat invading the large intestine. If diet and lifestyle are regulated, and the interior is strong, how can pathogens enter?

Wang Zhizhong said: Professor Tang Bo suffered from Changfeng for years without cure. Moxibustion on Qionggu (Tailbone), specifically the Guwei point (GV1), once eliminated the root. Tang Bo transmitted this method. Later, *Jiu Jing* noted this point treats pediatric prolapse and bloody diarrhea, originating from Qibo’s pediatric moxibustion methods, later applied to adults. Adult and pediatric diseases share similar origins. For five types of hemorrhoids with bleeding/incontinence, moxa 100 zhuang at the junction above the tailbone where red meets white.