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Dysentery with pus and blood (Bian Nong Xue) belongs to heat diseases. Among those occurring in the Taiyang (Greater Yang) channel, if a patient suffering from Lin syndrome (dysuria or strangury) is mistakenly treated with sweating methods, it may cause hematochezia (blood in stool). Zhu Ling Tang treats this as a complicated disease caused by dribbling dysuria; thus, resolving the condition through promoting urination leads to recovery. In Yangming (Yang Brightness) disease, bleeding accompanied by delirium indicates that heat has entered the Blood Chamber (Xue Shi), and puncturing Qimen (LR14) should be used to dissipate the heat. If there are no exterior or interior syndromes, but after mistaken purgation, heat-collateral diarrhea with pus and blood occurs, it is due to the downward flow of heat pathogen.

In Shaoyin (Lesser Yin) disease, diarrhea with pus and blood may occur. After four or five days, if abdominal pain and pus-bloody stool appear, Tao Hua Tang (Peach Blossom Decoction) is indicated. Cheng Wuji interpreted this as an interior cold syndrome, which is incorrect. Although Tao Hua Tang contains Gan Jiang (Dried Ginger), its dosage is minimal, while Chi Shi Zhi (Kaolin) and Jing Mi (Rice) constitute the majority. This formulation likely aims to harmonize healthy Qi, astringe intestinal slipping, and use acrid herbs to disperse pathogens. Additionally, after eight or nine days, if the whole body is hot, hematochezia will inevitably occur. For pus-bloody stools, puncturing Jueyin (Terminal Yin) channels is applicable. Furthermore, in Shanghan (Cold Damage), if chills precede fever, pus-bloody stool will inevitably follow; if chills are brief and fever mild, hematochezia will follow later. If diarrhea presents with rapid pulse and thirst, purulent bloody stool will inevitably occur. These cases all involve heat pathogens transmitted through the channels. Depending on severity, mild cooling or draining methods can be used, ensuring recovery. Misusing acrid-hot herbs rarely results in cure. People mistakenly consider this a difficult-to-treat disease, not realizing that Zhang Zhongjing did not classify pus-bloody stool as a fatal prognosis. Students should study this carefully.

In Taiyang disease, if fire moxibustion is applied and sweat does not emerge, the patient will become irritable. If the pathogen remains in the Taiyang channel unresolved, hematochezia will occur because fire pathogen forces blood downward. If Taiyang disease is mistakenly treated with purgation, a rapid pulse without chest binding indicates impending resolution; a deep-slippery pulse indicates heat-collateral diarrhea; a floating-slippery pulse indicates inevitable lower bleeding. Patients with Lin syndrome must not be sweated, as this will inevitably cause pus-bloody stool. If Taiyang exterior syndrome is resolved but only lower abdominal urgency and clumping remain, it is a Tao Ren Cheng Qi Tang (Peach Kernel Major Order the Qi Decoction) pattern (see Blood Stasis section).

In Yangming disease, patients without exterior or interior signs who have had fever for seven or eight days, even with a floating-rapid pulse, may be treated with purgation. If purgation has been performed but the rapid pulse persists and diarrhea continues, resulting in heat-collateral diarrhea with pus and blood. Yangming disease with bleeding and delirium indicates heat entering the Blood Chamber. Head-only sweating suggests puncturing Qimen. The Chong Mai (Penetrating Vessel) is the Sea of Blood, also known as the Blood Chamber, present in both men and women. Men with bleeding and delirium, and women with alternating chills and fever resembling malaria, all indicate heat entering the Blood Chamber, forcing blood downward causing heat-collateral diarrhea with blood. Pulses associated with bloody discharge may be intermittent-rough or intermittent-rapid, or deep or hidden; when blood heat intertwines, the pulse becomes surging-large. Generally, this appears on the left hand in men and the right hand in women. Conversely, diarrhea with pus and blood caused by yin-cold indicates deficiency-cold in the lower jiao, unstable intestines and stomach, and failure to separate clear from turbid, leading to purulent bloody stool. One case is blood-heat, the other is blood-cold; clinical examination must be detailed.

In Shaoyin disease, after eight or nine days, if the whole body and limbs are hot, it is because heat resides in the Bladder, inevitably causing hematochezia. Shaoyin disease with diarrhea and pus-bloody stool can be treated by puncturing...

Jueyin disease: In Shanghan, if chills precede fever, diarrhea will stop spontaneously; if it does not stop, pus-bloody stool will inevitably occur. In Shanghan with slight heat and mild chills (cold fingertips), silent demeanor, loss of appetite, and clear urine, the heat is eliminated; desire to eat indicates impending recovery. If chills, vomiting, and chest/hypochondriac fullness and irritability occur, pus-bloody stool will inevitably follow later. In Shanghan where chills are few and heat is abundant, the disease should resolve; if heat persists from day four to seven, pus-bloody stool will inevitably occur. Diarrhea with rapid pulse and thirst will self-resolve; if not, purulent bloody stool will occur. In diarrhea, if the cun pulse is unexpectedly floating-rapid and the chi pulse is naturally rough, purulent bloody stool will inevitably occur. Wu Qian pointed out that lower bleeding and pus-bloody stool differ in yin-yang and cold-heat, requiring careful differentiation. Ancients said "no cold in bleeding" and "blood moves with heat," which are generalizations. Mostly, cases belong to heat (80-90%), while cold cases are rare (10-20%); one cannot rigidly assume no cold exists. *Jingui Yaolue* states: Yang syndrome with interior heat causes fresh red blood; Yin syndrome with interior cold causes purple-black blood like pig liver. Moreover, Yang syndrome with rapid, forceful pulse indicates excess-heat, treatable with bitter-cold herbs; if rapid but weak, it is deficiency-heat, treatable with sweet-warm blood-nourishing herbs supplemented slightly with cold herbs. For Yin syndrome, slow but forceful pulse indicates vital spirit presence and is treatable; weak pulse is difficult to treat. Generally, diarrhea with pus and blood accompanied by fever and large pulse is difficult to treat; fever with small pulse is easy to treat.