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The Large Intestine is the official responsible for conduction, where transformed substances exit. This means that the Large Intestine receives the transformed matter from the Spleen and Stomach, acting as the conduit for the Middle Jiao (Spleen and Stomach). Therefore, it is called the "Earthly Way," which is the outlet for metabolic waste within the body.

Its meridian is exterior-interior related to the Lung. The Lung belongs to Clear Metal, while the Large Intestine belongs to Dry Metal; in the Five Elements theory, they belong to the same family. Thus, pulse diagnosis can assess the Large Intestine by examining the Lung position. The ability of the Large Intestine to transport waste relies entirely on Qi. Qi is governed by the Lung. Not only does the Large Intestine rely on Lung Qi for transportation, but the transformation and movement of urine also depend on Lung Qi. This is the function of Metal restraining and regulating. The Qi transformation of the Large Intestine harmonizes with the Metal pathway. Therefore, treating diseases often involves treating the Lung. The Large Intestine is located in the lower part of the body and is also controlled by the Kidney. The *Neijing* states: "The Kidney opens into the two yin orifices" and "The Kidney is the gate of the Stomach." Thus, sufficient Kidney Yin is required for the Large Intestine to be moist and lubricated. The Jueyin Liver meridian circles the posterior orifice, and the intestines reside adjacent to the uterus (Bao Palace) in the same region, so the Liver meridian also interferes with the intestines. Consequently, diseases of the Large Intestine may arise from: deficiency and sinking of Middle Qi with damp-heat pouring downward; residual heat from the Lung meridian transmitting to the Large Intestine; Yin deficiency of the Kidney meridian failing to moisten the intestines; or Blood heat in the Liver meridian leaking into the intestines. This illustrates the connection between the Large Intestine and various Zang organs. However, since the origin of the disease lies in these organs, once the pathology is established in the intestine, it cannot simply revert to the organs for treatment. One must first treat the intestine to eliminate the branch symptoms (biao), and then treat the respective organs to clear the root source (ben). Only then will the disease heal without recurrence.

Bleeding before stool is called "Near Bleeding" (Jin Xue), meaning the blood accumulates in the Large Intestine, close to the anus. There are two types of syndromes and treatments: Zang Du bleeding and Chang Feng bleeding.
Zang Du refers to swelling and hardness of the anus, pain, and bleeding, resembling hemorrhoids and fistulas. Zhang Zhongjing uses Chidou Danggui San (Red Bean and Angelica Decoction) as the main formula. Red bean sprouts are used to vent stagnation, and Danggui (Angelica Sinensis) harmonizes the blood vessels. Red beans promote diuresis and resolve dampness; when sprouted and red, they enter the Blood level to help resolve stasis and heat. Danggui moistens and nourishes Blood, lubricating the Large Intestine to prevent constipation. Zhang Zhongjing merely indicates the principle that treating Zang Du requires resolving damp-heat and harmonizing the blood vessels. This does not imply that no other methods exist beyond these two herbs. Extending from this formula: if there is severe swelling, pain, and bowel obstruction, Jiedu Tang (Detoxification Decoction) should be used. Fangfeng (Saposhnikovia) and Zhike (Aurantii Fructus) regulate Qi, reflecting the action of red bean sprouts. Dahuang (Rhei Radix et Rhizoma) and Chishao (Paeoniae Radix Rubra) lubricate and move Blood, reflecting Zhang Zhongjing's use of Danggui. If stools are not dry and swelling/pain are mild, heavy doses are unnecessary. Use Siwu Tang (Four Substances Decoction) plus Diyú (Sanguisorbae Radix), Jingjie (Schizonepetae Herba), Huaijiao (Sophorae Tonkinensis Fructus), Danpi (Moutan Cortex), Huangqin (Scutellariae Radix), Tufuling (Smilacis Glabrae Rhizoma), Difuzi (Kochiae Fructus), Yiren (Coicis Semen), and Binglang (Arecae Semen). Siwu Tang reflects Zhang Zhongjing's principle of nourishing Blood with Danggui. The added herbs reflect the use of red bean sprouts to drain damp-heat and resolve Blood stagnation. While Zhang Zhongjing focused on nourishing Blood and venting stagnation, I add clearing herbs because damp-heat may be difficult to resolve alone. To stop bleeding, Duanshi San (Calcined Stone Powder) can be taken concurrently.
For chronic Zang Du that does not heal, the Liver and Stomach must be treated. Blood is governed by the Liver, and the intestines are the gate of the Stomach. If the Stomach does not transport damp-heat to the intestines, how would it accumulate to form Zang Du? If the Liver's Blood level lacks wind-fire, it would not force blood to accumulate at the anus. To treat the Stomach, use Qingwei San (Clear Stomach Powder) plus Jinyinhua (Lonicerae Japonicae Flos), Tufuling, Fangji (Stephaniae Tetrandrae Radix), Huangbo (Phellodendri Cortex), Yiren, and Cheqianzi (Plantaginis Semen) to raise the clear and descend the turbid, preventing Yangming damp-heat from pouring downward, thus healing Zang Du. To treat the Liver, use Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) or Xiaoyao San (Free and Easy Wanderer Powder).

Another type involves residual heat from the Lung meridian transmitting to the Large Intestine, persisting for a long time. Symptoms include floating, rapid, surging, and choppy pulses at the Cun position, thirst, yellow urine, cough, and counterflow qi. In such cases, Renshen Qingfei Tang (Ginseng Lung-Clearing Decoction) is used. Wumei (Mume Fructus) and Susuke (Papaveris Pericarpium) are sour and astringent to converge Lung Qi, while other herbs calm the Lung, preventing residual heat from being transmitted to the intestines. If these two are removed and replaced with Bohe (Menthae Haplocalycis Herba) and Jiegeng (Platycodonis Radix), the intent shifts to dispersing pathogens, depending on the physician's flexibility.

Chang Feng (Intestinal Wind) is characterized by no swelling or pain at the anus, only bleeding. Zang Du bleeding is often turbid, while Chang Feng bleeding is often clear. Zhang Zhongjing's texts do not mention "Chang Feng." However, the *Shanghan Lun* states: "In Taiyang disease, if fire therapy is applied and sweat is not obtained, the patient becomes irritable. If the disease duration passes without resolution, bloody stool will occur." "In Taiyang disease, if purgatives are misused and the pulse is floating and slippery, bloody stool will definitely occur." Both passages describe Taiyang external pathogens sinking inward causing bleeding. It also states: "In Yangming disease, bloody stool with delirium indicates Heat entering the Blood Chamber." The *Jueyin* chapter states: "If there is cold extremities, vomiting, and fullness/irritability in the chest and hypochondrium, bloody stool will follow." These correspond to the modern concept of Chang Feng bleeding. The intestines are in the lower jiao; how does wind invade? Externally, Taiyang wind pathogens transmit to Yangming, combining with heat to cause bleeding. Internally, Jueyin Liver Wood generates wind due to deficient heat; the wind agitation causes blood to descend. Wind is a Yang pathogen that transforms into Fire over time; treating Fire is treating Wind. Generally, treating Chang Feng bleeding focuses on clearing Fire and nourishing Blood. When Fire is cleared and Blood is calmed, Wind extinguishes itself. *Shoushi Baoyuan* uses Huaijiao Wan (Sophora Pill) to treat all cases but does not explain the rationale. I propose that in this formula, Jingjie and Fangfeng treat wind transmitted from Taiyang and Yangming; Wumei and Chuanxiong treat internal wind stirring in Liver Wood; other herbs calm Blood and clear Fire, achieving efficacy. For external wind combined with heat, one should adopt the principle of Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) by Zhang Zhongjing, to lift and release trapped pathogens outward, preventing downward pressure, thereby stopping bleeding. The therapeutic principle is: suppress what is high, elevate what is low. Hematemesis and epistaxis require descending Qi; hematochezia requires elevating Qi. Elevation is not just Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); lifting and dispersing are also forms of elevation. Use Gegen Huanglian Huangqin Tang plus Jingjie, Danggui, Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Huaihua (Sophorae Flos), Diyu, and Jiegeng. If Liver Wind-Heat stirs internally causing bleeding, symptoms include distension/fullness in costal and abdominal regions, bitter taste, irritability, or alternating chills and fever. Use Xieqing Wan (Drain Green Pill). Xiaoyao San and Xiao Chaihu Tang (Minor Bupleurum Decoction) can be modified. Note: Why can Liver Wind cause bleeding? The Liver governs Blood, and the Blood Chamber resides between the Large Intestine and Bladder. Thus, Heat entering the Blood Chamber presents with hematuria; internal blood stasis presents with black stool. If Liver Blood rebels upward, it vomits via the turbid orifice or nosebleeds via the clear orifice. If Liver Blood seeps downward, it causes hematuria via the clear orifice or hematochezia via the turbid orifice. The Liver is the organ of Wind-Wood, storing Blood. When Wind moves, Blood cannot be stored, resulting in Chang Feng bleeding. The aforementioned formulas have sufficient strength to pacify this. Alternatively, Jisheng Wumei Wan (Wumei Pill from the Hall of Generosity) is excellent: Wumei converges Liver Wind, Jiangcan (Bombyx Batryticatus) extinguishes Liver Wind. When Wind is calm and Fire subsides, Blood settles. However, for Liver Wind moving Blood, one should adopt the principle of Baitouweng Tang (Pulsatilla Decoction) by Zhang Zhongjing, as it is more potent in clearing Fire and eliminating Wind. Or combine Siwu Tang with Baitouweng Tang to tonify Blood simultaneously. "To treat Wind, first treat Blood; when Blood moves, Wind self-extinguishes." If Baitouweng is unavailable, substitute with Chaihu, Qinghao (Artemisiae Annuae Herba), or Baiwei (Clehemiae Radix). Sangjisheng (Taxilli Caulis), born of Wind-Qi, is an even better substitute for Baitouweng. Furthermore, Liver Qi rebellion occurs because the Lung fails to control Wood. Since Lung and Large Intestine are exterior-interior related, treating the Lung is an indirect method. Deficiency patterns use Renshen Qingfei Tang; Excess patterns use Renshen Xiegan Tang (Ginseng Liver-Draining Decoction).

Whenever Chang Feng or Zang Du causes excessive bleeding, leading to Yin deficiency and chronic non-healing, the Kidney meridian must be deficient. Use Ziyang Zanglian Wan (Nourish Yin Intestine-Lotus Pill) to activate Kidney Yin to reach the Large Intestine, which is optimal. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Rongrong (Cynomorii Fructus) and Huaijiao is also suitable.

Bleeding after stool is called "Far Bleeding" (Yuan Xue), meaning the blood originates in the Stomach, far from the anus, hence appearing after stool. This is the ancient "Yin Knot Bleeding." It is treated with Huangtu Tang (Yellow Earth Decoction). The name "Yellow Earth Decoction" explicitly indicates that this syndrome results from the Middle Jiao failing to secure Blood, causing it to pour downward. Fuzi (Aconiti Lateralis Radix Praeparata) is added because Yang Qi has sunk and requires this herb to lift it. Huangqin is used because Blood deficiency generates Fire, which Huangqin clears. Zhang Zhongjing's original intent was to warm the Middle Jiao; the Huangqin serves to moderate the drying and hot nature of Fuzi, preventing damage to Yin Blood. Pumingzi states this syndrome presents with fine, weak pulses, pale lips, neutral mouth sensation, and cold limbs, recommending Lizhong Tang (Middle-Regulating Decoction) plus Danggui and Baishao, or Guipi Tang (Restore the Spleen Decoction), Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Modern physicians often use Buzhong Yiqi Tang to lift Qi, following the logic of Huangtu Tang. For any case where the Earth element fails to control Blood, these formulas can be selected. However, Zhang Zhongjing used warming herbs alongside clearing herbs, recognizing that Blood instability is often caused by Fire disturbance. Excess Qi rebels upward; Deficient Qi sinks downward. Current physicians use only warming, tonifying, and lifting herbs, addressing Qi deficiency but ignoring Blood disturbance. Expanding on Zhang Zhongjing's principles: If Yin deficiency with Hyperactive Fire consumes Qi, Spleen Yin deficiency, and Lung Qi dryness lead to loss of astringency, use Renshen Qingfei Tang. If Liver Fire and Lung Depression cause failure to store Blood, use Guipi Tang plus Chao Zhizi (Fried Gardenia), Maidong (Ophiopogonis Radix), Ejiao (Asini Corii Colla), and Wuweizi (Schisandrae Fructus), or Danshi Xiaoyao San plus Ejiao, Sangjisheng, and Diyu. This reflects the rationale for using Huangqin in Huangtu Tang. If deficiency exhaustion leads to excessive bleeding, Spleen Qi insecurity, Kidney Qi weakness, sallow complexion, cold extremities, and faint, floating pulses, greatly tonify the Liver, Spleen, and Kidney meridians. Renshen Yangrong Tang tonifies the Spleen; Jiao'ai Siwu Tang plus Bajitian (Morindae Officinalis Radix) and Gancao (Glycyrrhizae Radix) tonifies the Liver; Duanhong Wan (Stop Red Pill) tonifies the Kidney. This reflects the rationale for using Fuzi in Huangtu Tang. Expanding upon this yields many variations beyond mere textual description.

Note: This syndrome is identical to metrorrhagia and metrostaxis in women. Female metrorrhagia belongs to deficiency-sinking; this male condition also belongs to deficiency-sinking. Female metrorrhagia is primarily deficiency-cold but may involve deficiency-heat; this male condition is also deficiency-cold with potential deficiency-heat. Women have menstrual cycles; men have their own blood pathways. Both involve blood leaving its normal vessel and flowing downward, hence the similar pathology. However, the orifices differ. Metrorrhagia exits the anterior orifice, so treatment focuses on the Liver to harmonize the Blood Chamber. Hematochezia exits the posterior orifice, so treatment combines Lung and Kidney regulation to secure Intestinal Qi. The Kidney governs the Lower Jiao and transforms Qi to ascend; sufficient Kidney Qi prevents sinking. The Lung and Intestine are exterior-interior related; Lung Qi convergence secures Intestinal Qi. Understanding this and applying female metrorrhagia methods allows for comprehensive management.

Furthermore: This syndrome and hematemesis/epistaxis are both Blood disorders. However, one involves ascending Qi, the other descending Qi, so the treatment principles for excess and deficiency differ slightly.