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Blood in the body is divided into Yin blood and Yang blood. Yang blood follows Qi movement, flows within the vessels, harmonizes the Zang organs, and distributes to the Fu organs; such blood is called Ying blood (Nutritive Blood). Yin blood resides in the collateral vessels, specifically guarding the Zang organs, nourishing Shen (Spirit), and moistening sinews and bones. If a Zang organ is affected by internal or external pathogenic factors, damage occurs, and the Yang blood that normally follows the meridians reaches the injury site, where it is blocked by pathogens, leaking out of the meridians; or the Yin blood residing in the collaterals, due to lingering pathogens, causes the vessels to rupture and bleed. Both situations result in blood seeping into the intestines and stomach and being discharged. Laypeople often refer to lower gastrointestinal bleeding simply as "Chang Feng" (Intestinal Wind), not realizing that "Wind" is merely one of the Six Excesses (Six Pathogenic Factors). Only when Wind pathogen enters from the intestinal and gastric meridians to lodge inside, or when Liver Meridian Wind-Wood pathogen invades internally into the intestines and stomach, can it be termed Chang Feng. If other cases are not caused by Wind pathogen but rather by Heat-Fire two excesses invading the intestines and stomach, or by Cold, Dryness, or Dampness stagnating and obstructing Qi, or by excessive diet and overexertion damaging the Yin collateral blood, can these also be called Chang Feng? Scholar Xu stated: Clear, bright red blood in stool indicates Chang Feng; turbid, dark-colored blood indicates Zang Du (Visceral Toxin); blood shooting from the anus like a thread indicates Mai Zhi (Vascular Hemorrhoid). However, Chang Feng combined with Dampness may also discharge fluid resembling bean dregs and purple-black stasis blood, not necessarily always bright red; differentiation should be based on duration. In essence, these are common folk names. Medical writers sometimes equate hematochezia with Chang Feng, or separate hematochezia from Chang Feng and Zang Du into different categories, which is incorrect. Bleeding before defecation is called Jin Xue (Close Blood). This occurs when Hand Yangming Large Intestine Meridian Qi descends along the channel, allowing blood to seep into the large intestine and transmit to the Guang Chang (rectum) for discharge. It is treated with Xiaodou Chi Dang Gui San (Adzuki Bean and Angelica Decoction). Defecation before bleeding is called Yuan Xue (Distant Blood). This occurs when Foot Yangming Stomach Meridian Qi enters the stomach, causing blood to overflow and descend. It is treated with Huang Tu Tang (Yellow Earth Decoction). Lower GI bleeding without abdominal pain is called Shi Du Xia Xue (Damp-Toxin Lower Bleeding); the blood color is not fresh, possibly purple-black or like bean dregs, treated with Huang Lian Tang (Coptis Decoction). Lower GI bleeding with abdominal pain is called Re Du Xia Xue (Heat-Toxin Lower Bleeding); the blood is bright red, treated with Shao Yao Huang Lian Tang (Peony and Coptis Decoction). Li Dongyuan treated a patient with chronic Chang Feng syndrome who, after eating apricots during the intense heat of May, experienced intestinal bleeding projecting three to four chi away, spreading like a sieve, with a heavy sensation in the waist and no abdominal pain, purple-black blood. This was a Blood Syndrome of the Yangming and Shaoyang meridians, treated with Sheng Ma Bu Wei Tang (Cimicifuga Spleen-Nourishing Decoction). (Damp-Toxin type) Taiyin and Yangming meridian abdominal pain, frequent loose stools; if not loose, then constipation difficult to pass, later transforming into Damp-Heat Toxin, discharging bright red blood, slight abdominal pain, tightness under the ribs, pulse slow, surging, and wiry, felt under the middle finger, empty upon pressure. Treated with He Zhong Yi Wei Tang (Harmonize Middle and Benefit Stomach Decoction). (Damp-Heat type) Another presentation of intestinal bleeding involves blood gushing forcefully and far, scattering like a sieve, with severe abdominal pain, caused by Yangming Qi rushing Heat-Toxin. Treated with Sheng Yang Chu Shi He Xue Tang (Raise Yang, Dispel Dampness, Harmonize Blood Decoction). (Damp-Heat type) Intestinal bleeding with red or deep purple-black blood, abdominal pain, cold sensitivity of the abdominal skin, wiry pulses at all three positions on the right hand (felt under the middle finger), weak upon pressure, very tight Guan pulse, cool Yangming area on the body surface, hot abdominal skin preferring warm compresses, clearly indicating Internal Cold. Treated with Yi Zhi He Zhong Tang (Yi Zhi Harmonizing Middle Decoction). (Cold-Clasping type) "Chang Feng" refers to water/grain and blood forming a separate stream, gushing out like from a bucket. In summer, when Damp-Heat is excessive, the External Qi is strong while the Host Qi is weak, so Chang Feng disease worsens. Treated with Liang Xue Di Huang Tang (Cool Blood and Rehmannia Decoction): Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome) stir-fried, 1 qian each; Qing Pi (Aged Tangerine Peel) stir-fried, Huai Zi (Sophora Fruit) stir-fried, Dang Gui (Angelica Sinensis), and Shu Di Huang (Prepared Rehmannia Root) 0.5 qian each; decoct in one cup of water to 0.7 cup, take warm. If urine is涩 (astringent/difficult), sub-umbilical fullness, or heaviness before/after stool, mix Mu Xiang (Aucklandia) and Bing Lang (Areca Seed) fine powder, 0.5 qian each, slightly heat, take before meals on an empty stomach. If tenesmus persists, purgation is needed. If there is splashing water sound in the abdomen and irregular urination, this is Ting Yin (Fluid Retention). Diagnose which Zang organ is involved and purge the fluid retention; for example, if the pulse is surging-large, use fire-purging and diuretic herbs. If stomach deficiency prevents eating and extreme thirst persists, do not use bland-leaching drugs to stop thirst, as this is due to insufficient Yuan Qi in the stomach. Treat with Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Powder). If fever, aversion to heat, irritability, extreme thirst, hot skin desiring no clothing, surging-large pulse empty upon pressure, or absence of eye pain/nasal dryness, this is not Bai Hu Tang (White Tiger Decoction) syndrome. This is Irritability due to Blood Deficiency; treat with Huang Qi (Astragalus Root) 1 liang, Dang Gui 2 qian, chopped, decoct in water. If fecal impaction or tenesmus with frequent trips to toilet unable to pass stool, or small amounts of white pus/blood, do NOT use purgatives, as this will worsen condition and cause obstruction. Use Sheng Yang Chu Shi Fang Feng Tang (Raise Yang, Dispel Dampness, Saposhnikovia Decoction); raising Yang will naturally lower Yin. *Su Wen* states: Jie Yin (Knotted Yin) disease: first episode 1 sheng blood, second 2 sheng, third 3 sheng. Luo Longji said: Jie Yin disease involves Yin Qi knotting internally, unable to circulate externally; blood has no source, seeps into intestines causing hematochezia; pulse is deficient and choppy. Because blood knots and fails to move, it discharges; ancient formula includes Jie Yin Dan. Luo Qianfu treated a patient with abdominal pain from forcing sour wine, progressing to diarrhea, then blood after stool for 10+ days, red or purple, borborygmus, abdominal pain. Cooling herbs failed; anorexia, vomiting acid after eating, epigastric fullness, aversion to cold, dry mouth, irritability, insomnia. Pulse wiry-thin-micro-slow, hands/feet slightly cold. Treated with Ping Wei Di Yu Tang (Calm Stomach and Sanguisorba Decoction) to warm middle, scatter cold, dispel damp, harmonize stomach. After several doses, illness reduced significantly. Then moxa Zhong Wan (CV12) 14 times to raise Stomach Qi, then moxa Qi Hai (CV6) 100 times to generate Yuan Qi. After moxibustion, eat more to build flesh, take Huan Shao Dan (Return to Youth Pill). In spring, moxa Zu San Li (ST36) 14 times to warm spleen/stomach, generate Yuan Qi, then take aromatic agents, regulate speech/diet to recover. Ba Wu Tang minus Sheng Di Huang and Gan Cao, plus Guan Gui (Cinnamon Bark), named Wei Feng Tang, treats Wind-Cold invading stomach/intestines due to deficiency, undigested food, projectile diarrhea, and intestinal/gastric Damp-Toxin discharging bean-dreg-like blood or stasis blood day and night uncontrollably; this belongs to Jie Yin category. Due to internal Yin knotting, remove sweet-cold herbs and add pungent-hot herbs to "scatter the knotted." Jie Gu said: For lower bleeding, Fang Feng (Saposhnikovia) is Upper Envoy, Huang Lian (Coptis) is Middle Envoy, Di Yu (Sanguisorba) is Lower Envoy. If blood is stasis-purple, it is old blood; add Shu Di Huang. If blood is fresh-red, it is new blood; add Sheng Di Huang. If chills/fever present, add Chai Hu (Bupleurum). If skin heat present, add Di Gu Pi (Lycium Bark). This syndrome is Jia (Wood/Liver) overcoming Wu (Earth/Spleen-Stomach); Wind in Middle Jiao/Stomach-Mouth, Damp-diarrhea unceasing; once Damp is gone, Dryness arises, Geng (Metal/Lung) overcoming Jia (Wood). Originally no Metal Qi, but Jia overcomes deficient Wu, so Geng (Mother) retaliates. Hence scripture says: Excess causes harm, control brings balance; this is counter-control of self-transforming phase. If pulse is surging-solid and pain severe, add Jiu Jin Da Huang (Wine-Steamed Rhubarb). Dai Fuan stated: Bright color indicates Heat, Stasis color indicates Cold. Heat-Blood uses Lian Pu San (Coptis and Nymphaea Powder), Cold-Blood uses Li Wu Tang (Regulate Matter Decoction). Bright red blood often due to internal Heat-Toxin accumulation, toxic vapors entering intestines/stomach, or excessive alcohol, or eating fermented foods/offal/roasted/fried items drawing blood into large intestine, causing bright red diarrhea. Take Lian Pu San swallow Huang Lian E Jiao Wan (Coptis and Donkey-Hide Gelatin Pill) or Xiang Lian Wan (Aucklandia-Coptis Pill), or single herb Huang Lian decoction. For severe unceasing diarrhea, Si Wu Tang plus Huang Lian and Huai Hua (Sophora Flower), plus少许 Xue Jian Chou Cao (Herba Patriniae/Juniperus? Note: Context implies specific hemostatic herb), ginger juice mixed with rice drink. Adding Ce Bai Ye (Biota Tops) to Xue Jian Chou Cao and crushing with ginger for juice is better. Summer-Toxin entering intestines/stomach causing bleeding: Single Huang Lian decoction. Chang Feng bleeding: Xiang Fu (Cyperus) powder plus Bai Cao Shuang (Soot from Chimney), rice drink. Add少许 She Xiang (Musk) for faster effect. Cold Qi lodging in intestines/stomach causing stasis bleeding: If Li Zhong Tang ineffective, use Hei Shen San (Black Divine Powder) with rice drink, or Jiao Ai Tang (Collagen and Mugwort Decoction) with rice milk, swallow Zhen Ling Dan (Authentic Spirit Pill). Blunt trauma/internal injury, evil blood entering intestines/stomach, discharging turbid stasis: Hei Shen San plus Lao Huang Qie (Old Eggplant) powder, wine mix. Alcohol accumulation bleeding unceasing, post-stool blood: Shen Mian 1.5 liang, Bai Jiu Yao (White Wine Medicament) 2 pills, powder, water paste, bake yellow, powder. 2 qian per dose, white water mix. Also treats diarrhea. Hai Zang treated Master Mei after drunkenness, waking thirsty, drinking water/iced tea, then bright red stool. First gave Wu Zhu Yu Wan (Evodia Pill), next day Ping Wei San + Wu Ling San half-doses 3 times, blood stopped but self-diarrhea returned, then Shen Ying Wan 4 doses, diarrhea stopped. Question: Why not Huang Lian to detoxify? Answer: Cold herbs change disease nature, hard to treat. Cold-fluid injury using cold herbs is wrong. Blood congeals by cold; warming makes it move; heat stops it. Tang Bing drank cheese/water and ate raw food, purged purple-black blood 10+ times, Spleen/Stomach cold-damp toxin. Given Liu Shen Ping Wei San 0.5 liang + Bai Zhu 3 qian to benefit lumbar-umbilical blood, cured in one dose. *Ying Ning Sheng Zhi Yan* states: Chang Feng is Foot Yangming accumulated heat turning to Wind over time, moved by Wind. Zang Du is Foot Taiyin accumulated heat generating Dampness over time, flowing downward. Wind affects Yang, Damp affects Yin. Dai's *Yao Jue* states: Zang Du is toxin accumulation seen late; Chang Feng is external pathogen seen immediately. *San Yin Fang* details differentiation: Zang Du/Chang Feng blood from between intestine/viscera; Five Hemorrhoids blood from anal erosion holes; treatments differ. (Wu Ze Weng Wu Lian Tang treats Mai Zhi, no external shape, blood line like arrow or dripping endlessly, from vessel orifice, see Hemorrhoid section.) Chang Feng/Zang Du regardless of pre/post stool: Rice soup mix Zhi Ke San (Citrus Aurantium Powder), swallow Jiu Zhu Huang Lian Wan (Wine-Boiled Coptis Pill) or Zhi Ke San swallow Wu Mei Wan (Mume Pill). Different from simple hematochezia; or Xiao Wu Chen Tang + Hei Shen San, rice mix. Clear-bright blood: Wa Song (Tile Moss) burnt ash powder, rice mix; Jian Gui Wu Ling San + Mao Hua (Reed Catkin) 0.5 qian, swallow Jing Mei Hua Wan (Magnolia Flower Pill), Ce Bai Ye + Ginger crushed, cold water wash, add rice drink. Pale-turbid blood: Wei Feng Tang swallow Suan Lian Wan (Garlic-Coptis Pill), or Wu Jing Wan, or Zong Hui San; rice mix Xiang Fu powder or San Hui San. Chang Feng with abdominal pain, clear blood: First resolve intestinal Wind pathogen; severe anal swelling/pain: Bai Du San + Huai Jiao (Sophora Twig), Jing Jie (Schizonepeta), or Huai Hua Tang, Zhi Ke San. Zang Du slight internal pain, turbid blood + flower-red pus, anal swelling/prolapse, difficult stool: First poison-resolving/dredging agents to expel evil blood/pus/water, then internal-supporting/cooling-blood/dispelling-wind methods; if deficient, add Ren Shen, Huang Qi, Fu Ling, Bai Zhu to support Stomach Qi. All Chang Feng/Zang Du: Raw Yin Guo (Ginkgo Nut) 49 pcs, shell/membrane removed, pounded, mixed with Bai Yao Jian (Galla Chinensis) powder, pill size of bullet. 2-3 pills, chewed empty stomach with rice drink. Chronic bleeding, sallow complexion, gradual deficiency/exhaustion, lower origin weakness: Huang Qi Si Jun Zi Tang swallow Duan Hong Wan (Stop Red Pill), or Shi Quan Da Bu Tang, or Huang Yin.

[Gu Poison Viscera Destruction Bleeding] Like chicken liver, like rotten meat, symptoms include sinking saliva, heart/abdominal colic. Treatment: Ma Lin Gen (Rhizoma Marantae) powder, water fu Fang Cun Bi, vomit out poison. Bai He Ye (Lotus Leaf) secretly under patient's mat, let patient know not, self-call Gu Master name. Earthworms 14 pieces, soak in Ku Jiu (Bitter Wine/Vinegar) 3 sheng, drink juice. [Hair?] Burnt powder, water fu Fang Cun Bi. (Vomit Toxicity) Ku Hu (Bitter Bottle Gourd) 1 piece, water 2 sheng, boil to 1 sheng, drink. Or Ku Jiu 1 sheng, boil gourd until dissolved, drink.

[Diagnosis] Kidney pulse small, pulsating, deep indicates intestinal bleeding; blood warm, body hot is death.淫 (Excess) stealing Essence, body hot, sallow complexion, post-alcohol bleeding, thick/heavy blood is Reverse. Heart/Liver also bleed; both Zang diseased is treatable; pulse small-deep-choppy indicates intestinal bleeding; body hot is death, heat seen 7 days death. Body hot = death, body cold = life. Pulse Xuan Jue (Hanging Absolute) = death, Hua Da (Slippery-Large) = life. Pulse Chen Xiao Liu Lian (Deep-Small Lingering) = life, Shu Ji Qie Da You Re (Rapid-Fast Large-Heat) = death. Abdominal distension, bloody stool, pulse large intermittent, is Reverse, dies within one hour. Stomach transfers Heat to Spleen, transmits to Deficiency, intestinal bleeding, death untreatable. Spleen pulse external drumming, deep indicates intestinal bleeding, long time self-heals. Liver pulse small-slow indicates intestinal bleeding, easy to treat.