大意
结阴者。便血一升。再结二升。三结三升。（内经）盖因邪犯五脏。内伤三阴。或循经之阳血。阻结不
和。漏泄于外。或居络之阴血。着留不运。僻裂而出。（准绳）
内因
皆由七情六淫。饮食不节。起居不时。或坐卧湿地。或醉饱行房。或生冷停寒。或酒面积热。触动脏腑。以致
荣血失道。渗入大肠。（入门）
外候
纯下清血者。风也。色如烟尘者。湿也。色黯者。寒也。鲜红者。热也。糟粕相混者。食积也。遇劳频发者。内伤
元
气也。后重便减者。湿毒蕴滞也。后重便增者。脾元下陷也。跌伤便黑者。瘀也。先吐后便者。顺也。（汇补）
粪前粪后
先血后便。此近血。也由手阳明随经入肠渗透而出也。先便后血。此远血也。由足阳明随经入胃。淫溢而
下也。（准绳）
挟寒挟热
富贵之人。酒色浓味。藜藿之人。劳役忧思。均致热积于中。风生于内。血溢流走。尽属于热。惟病久真气渐
虚。或过服凉药。脾胃伤损。然后可用温补。（原病式）
脉法
尺脉芤涩。关脉微缓。俱为便血。脉小留连者生。数疾浮大者死。右关沉紧。是饮食伤脾。不能摄血而下走
也。右寸浮洪。是积热肺经。下传大肠而便血也。（汇补）
治法
大要初起当清解肠胃之湿热。久则调和中焦之气血。服凉药不愈者。必佐以辛味。服辛味不愈者。必治
以温中。（医统）下陷既久。升提可用。（汇补）益精气血气。皆生于谷气。胃气一复。血自循轨。（入门）
用药
主以四物汤。风加荆芥、防风。湿加苍术、秦艽。热加槐角、芩、连。寒加木香、干姜。气加香附、枳壳。瘀加桃
仁、韭汁。久虚者。加参、 、术、草。下陷者。加升麻、柴胡。虚热者。加阿胶、生地。虚寒者。加附子、炮姜。古
方。阴结用平胃地榆汤。（汇补）
【附肠风】
肠风者。自外感而得。邪气内客。随感随见。（戴氏）属足阳明经。（卮言）或外风从肠胃经络而入客。或内风因
肝木过旺而下乘。故曰肠风。风有以动之也。外症腹中有痛。所下清血纯血。当先解肠胃之风邪。次分内
外以调理。内风用胃风汤。外风用槐角丸。（准绳）
【附脏毒】
脏毒者。自内伤而得。蕴积毒瓦斯。血色浊黯。久而始见。（戴氏）属大肠经积热。久而生湿。湿从而下流也。（卮言）
外症腹内略疼。浊血兼脓。或肛门肿胀。或肠头突出。或大便难通。先以拔毒疏利之剂。逐出恶血。然后以
凉血祛风之剂。兼助胃气。（准绳）二黄柏叶主之。或用干柿烧灰。每朝米饮调下。以其能消宿血。解热毒。且
健脾敛肺故也。（汇补）
【附肠癖】
肠癖者。原因胃风飧泄。久则湿热成癖。注于大肠。传于少阴。名曰肠癖。俗呼血箭。因其便血唧出。有似于
箭也。又有如节。四散漏下。（入门）有恒发于长夏者。因湿热令行。客气盛而主气弱。故肠癖之病甚也。宜升
阳防风汤。加炒柏、酒芩、当归、陈皮主之。（准绳）
【附蛊毒】
脏腑败坏。下血如猪肝。如烂肉。心腹绞痛。涎唾沉水。嚼豆不腥者。中盅也。（准绳）在膈者。以胆矾溶化。升
麻煎汤探吐。在下者。以郁金为末。米饮调下。取泻后。以平胃散将养之。（入门）
【附血痔】
血痔者。湿毒留于脏腑。注于大肠。既有病根。复遇劳思饮酒。后即下血。由内热而妄行也。宜四物汤。加芩、
柏、槐花治之。如年高气弱。或误用攻下。血来不止者。四君子主之。劳役即发。觉重坠者。补中益气。加黄芩、
槐花。又有脓汁浊液化生虫物。蠹食肛门。傍生小窍。滴血淋沥。射如血线。当以芜荑、艾叶、楝根等物化虫
可耳。外以血竭末敷之。或以鳗鲤骨。烧烟熏亦效。（汇补）
便血选方
胃风汤（方见痢疾）
黄连汤（洁古）
黄连 当归（各五钱） 炙草（二钱半）
每服五钱。水煎加大黄一钱。芍药五钱。淡桂五分。名芍药黄连汤。水煎。调木香、槟榔末五钱。
胶艾汤（和剂）
即四物汤 加阿胶、艾叶、甘草。
平胃地榆汤（谦甫） 治阴结便血。
即异功散加炮姜、附子、苍术、浓朴、神曲、益智、升麻、干葛、当归、白芍、姜、枣。
槐花丸 治肠风痔血。
槐角 地榆 黄芩 当归 防风 枳壳
加秦艽、升麻。
黄连阿胶丸
黄连（三两） 阿胶（一两） 茯苓（二两）
以连、苓为末。水煮阿胶膏为丸。空心米饮下。
黄土汤（金匮）
甘草 白术 黄芩 阿胶 熟地 附子（炮各二两） 伏龙肝半升煮。分服。
三黄补血汤
黄 （一钱半） 生地（二钱） 熟地 川芎（各一钱） 芍药 丹皮 柴胡 升麻（各五分）
柏叶散 治脏毒。
侧柏叶（二两） 黄芩（一两半） 大黄（五钱）
米饮下。
升阳防风汤（东垣） 治肠风。
苍术（酒浸炒四钱） 白术 茯苓 芍药（各一钱） 防风（二钱）
理物汤
即理中四物汤合用。
四物汤 六君子汤 补中益气汤 四君子汤（四方俱见中风） 理中汤（方见中寒）
棕灰散
败棕 存性。每服二钱。或酒或米饮下。
[General Principle]
Jieyin (Yin Knotting) disease: Initial onset involves the passage of one sheng of blood; a second episode involves two sheng; a third episode involves three sheng. (*Huangdi Neijing* [Yellow Emperor's Inner Canon]) posits that this is primarily due to pathogenic factors invading the five Zang organs, causing internal injury to the three Yin meridians. Alternatively, Yang blood following the meridians may become obstructed and knotted, failing to harmonize, leading to leakage outside; or Yin blood residing in the collaterals may stagnate and fail to circulate, causing rupture and bleeding. (*Yixue Gangmu* [Compendium of Medical Classics])
[Internal Causes]
All arise from the seven emotions (joy, anger, worry, thought, sadness, fear, fright), six excesses (wind, cold, summer-heat, dampness, dryness, fire), irregular diet, improper daily routine, sitting or lying on wet ground, sexual intercourse after drunkenness or full meals, accumulation of cold from raw and cold foods, or accumulation of heat from excessive alcohol consumption. These factors disturb the Zang-Fu organs, causing Ying (Nutritive) blood to deviate from its normal pathway and seep into the Large Intestine. (*Yizong Rumen* [Gateway to Medical Practice])
[External Manifestations]
Passage of pure clear blood indicates Wind. Blood color resembling smoke or dust indicates Dampness. Dark color indicates Cold. Bright red color indicates Heat. Blood mixed with feces indicates Food Stagnation. Frequent episodes triggered by exertion indicate Internal Injury to Yuan (Original) Qi. Tenesmus (heavy sensation in the rectum) that decreases after defecation indicates Damp-Toxin accumulation and stagnation. Tenesmus that increases after defecation indicates Spleen Qi sinking. Black stool following trauma indicates Blood Stasis. Hematemesis followed by hematochezia is considered a favorable progression (Shun). (*Zhengzhi Huibu* [Compilation of Syndrome Differentiation and Treatment])
[Blood Before or After Stool]
Blood appearing before stool is called "Near Blood" (Jin Xue). It also results from Hand-Yangming Large Intestine Meridian pathology, where blood penetrates and exits via the intestines. Blood appearing after stool is called "Far Blood" (Yuan Xue). It results from Foot-Yangming Stomach Meridian pathology, where blood overflows and descends from the stomach. (*Yixue Gangmu* [Compendium of Medical Classics])
[Accompanied by Cold or Heat]
Wealthy individuals, indulging in alcohol, sex, and rich flavors; and laborers, suffering from overwork, worry, and anxiety, both lead to heat accumulation internally and wind generation within. Blood溢 (overflowing) and flowing away all belong to Heat syndromes. Only when the disease has persisted for a long time, causing gradual deficiency of True Qi, or due to excessive use of cooling medicines damaging the Spleen and Stomach, can Warm Tonification methods be applied. (*Yuanbingshi* [Treatise on Original Diseases])
[Pulse Diagnosis]
Chi (Cun Cun) pulse being Kou (hollow like a green onion stalk) and Se (choppy), and Guan pulse being Wei (faint) and Huan (slow), are all signs of hematochezia. A pulse that is small and lingering indicates survival; a pulse that is Shu (rapid) and Ji (urgent), or Fu (floating) and Hong (surging), indicates death. Right Guan pulse Chen (deep) and Jin (tight) indicates dietary injury to Spleen Qi, failing to control blood, causing it to flow downward. Right Cun pulse Fu (floating) and Hong (surging) indicates accumulated heat in the Lung Meridian transmitting downward to the Large Intestine, causing hematochezia. (*Zhengzhi Huibu* [Compilation of Syndrome Differentiation and Treatment])
[Treatment Principles]
Generally, initial onset requires clearing Damp-Heat from the Stomach and Intestines; chronic cases require regulating Qi and Blood in the Middle Jiao. If cooling medicines fail, acrid flavors must be added as assistants; if acrid medicines fail, warming the Middle Jiao is necessary. (*Yitong*) For prolonged sinking, lifting methods can be used. (*Zhengzhi Huibu*) Essence, Qi, and Blood all originate from Gu Qi (Grain Qi). Once Stomach Qi recovers, blood naturally returns to its proper course. (*Yizong Rumen* [Gateway to Medical Practice])
[Medication]
The primary formula is Siwu Tang (Four Substances Decoction). Add Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix) for Wind; Cangzhu (Atractylodis Rhizoma) and Qinjiao (Gentianae Macrophyllae Radix) for Dampness; Huaijiao (Staphyleae Fructus), Huangqin (Scutellariae Radix), and Lianlian (Coptidis Rhizoma) for Heat; Muxiang (Aucklandiae Radix) and Ganjiang (Zingiberis Rhizoma) for Cold; Xiangfu (Cyperi Rhizoma) and Zhike (Aurantii Fructus) for Qi stagnation; Taoren (Persicae Semen) and Jiuji Zhi (Juice of Allium Tuberosum) for Blood Stasis; Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) for chronic deficiency; Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) for sinking; Ejiao (Asini Corii Colla) and Shengdi (Rehmanniae Radix) for deficient heat; Fuzi (Aconiti Lateralis Radix Praeparata) and Paojiang (Prepared Zingiberis Rhizoma) for deficient cold. Ancient formulas use Pingwei Diyutang (Pingwei Earthworm Decoction) for Yin knotting. (*Zhengzhi Huibu* [Compilation of Syndrome Differentiation and Treatment])
[Appendix: Changfeng (Intestinal Wind)]
Changfeng arises from external contraction; pathogenic factors invade internally, manifesting immediately upon exposure. (Dai Shi) It belongs to the Foot-Yangming Meridian. (Zhiyan) Either external wind enters and lodges in the Stomach and Intestine meridians, or internal wind, due to excessive Liver Wood overacting, sinks downward. Hence it is called Intestinal Wind, driven by Wind movement. External symptoms include abdominal pain and passage of pure, clear blood. One should first resolve Wind pathogens in the Stomach and Intestines, then differentiate internal vs. external for regulation. Internal Wind uses Weifeng Tang (Stomach Wind Decoction); External Wind uses Huaijiao Wan (Sophora Pill). (*Yixue Gangmu* [Compendium of Medical Classics])
[Appendix: Zangdu (Visceral Toxin)]
Zangdu arises from internal injury; toxins accumulate, blood is turbid and dark, manifesting only after a long time. (Dai Shi) It belongs to accumulated heat in the Large Intestine Meridian, generating Dampness over time, which flows downward. (Zhiyan) External symptoms include slight abdominal pain, passage of turbid blood mixed with pus, anal swelling, prolapse of the rectum, or difficulty passing stool. First, use detoxifying and purgative agents to expel evil blood; then use blood-cooling and wind-dispersing agents while supporting Stomach Qi. (*Yixue Gangmu* [Compendium of Medical Classics]). Erhuang Baiye San (Two-Yellow Cinnabar Leaf Powder) is indicated. Alternatively, burn dried persimmon to ash, mix with rice water each morning. It eliminates old blood, clears heat-toxin, strengthens the Spleen, and astringes the Lung. (*Zhengzhi Huibu* [Compilation of Syndrome Differentiation and Treatment])
[Appendix: Changpi (Intestinal Stricture/Dysentery-like condition)]
Changpi originates from Weifeng Sundxie (Stomach Wind diarrhea with undigested food); over time, Damp-Heat forms Pi (accumulation), pouring into the Large Intestine and transmitting to the Shaoyin Kidney Meridian. Named Changpi, commonly called "Blood Arrow," because blood spurts out like an arrow. Sometimes it leaks out in segments. (*Yizong Rumen* [Gateway to Medical Practice]). It often occurs in late summer due to dominant Damp-Heat, where guest Qi is strong and host Qi is weak, exacerbating the disease. Use Shengyang Fengfang Tang (Raise Yang Saposhnikovia Decoction) with fried Huangbai (Phellodendri Cortex), wine-fried Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), and Chenpi (Citri Reticulatae Pericarpium). (*Yixue Gangmu* [Compendium of Medical Classics])
[Appendix: Guduo (Gu Poison)]
Decay of Zang-Fu organs, passage of blood resembling pig liver or rotten meat, severe colic, saliva sinking in water, beans losing their fishy smell upon chewing—this is Zhong Gu (Gu Poison). (*Yixue Gangmu* [Compendium of Medical Classics]). If located above the diaphragm, dissolve Danfan (Alumen) and induce vomiting with Shengma (Cimicifugae Rhizoma) decoction. If located below, administer powdered Yujin (Curcumae Radix) with rice water. After purgation, nourish with Pingwei San (Pingwei Powder). (*Yizong Rumen* [Gateway to Medical Practice])
[Appendix: Xuemi (Bloody Hemorrhoids)]
Xuemi results from Damp-Toxin lingering in Zang-Fu, pouring into the Large Intestine. With an existing root cause, exacerbated by fatigue, worry, and alcohol, blood follows due to internal heat acting recklessly. Use Siwu Tang (Four Substances Decoction) with Huangqin (Scutellariae Radix), Huangbai (Phellodendri Cortex), and Huaihua (Sophorae Flos). For elderly with weak Qi, or after mistaken purgation causing continuous bleeding, use Sijunzi Tang (Four Gentlemen Decoction). If triggered by labor with a feeling of heaviness/dragging, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Huangqin (Scutellariae Radix) and Huaihua (Sophorae Flos). If pus and turbid fluid generate parasites that burrow into the anus, creating small openings with dripping blood like a line, use Wuyi (Macleaya Cordata Caulis), Aiyè (Artemisiae Argyi Folium), and Lian Gen (Meliae Cortex) to eliminate parasites. Externally apply Xuexie (Draconis Sanguis) powder, or fumigate with burned Manli Gu (Bone of Anguilla Chinensis). (*Zhengzhi Huibu* [Compilation of Syndrome Differentiation and Treatment])
Selected Formulas for Hematochezia
Weifeng Tang (See Dysentery section)
Huanglian Tang (Jiegu Formula)
Huanglian (Scutellariae Radix), Danggui (Angelicae Sinensis Radix) (5 qian each), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma) (2.5 qian).
Take 5 qian per dose, decoct in water, add Dahuang (Rhei Radix et Rhizoma) 1 qian, Shaoyao (Paeoniae Radix) 5 qian, Dan Gui (Cinnamomi Ramulus) 0.5 fen. Named Shaoyao Huanglian Tang. Decoct, mix with Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen) powder 5 qian.
Jiao'ai Tang (Heji Ju Fang)
Siwu Tang (Four Substances Decoction) plus Ejiao (Asini Corii Colla), Aiye (Artemisiae Argyi Folium), Gancao (Glycyrrhizae Radix et Rhizoma).
Pingwei Diyutang (Qianfu Formula) Treats Yin-knotting hematochezia.
Yigong San (Yigong Powder) plus Paojiang (Prepared Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Cangzhu (Atractylodis Rhizoma), Nongpo (Magnoliae Officinalis Cortex), Shenqu (Massa Medicata Fermentata), Yizhi (Alpiniae Oxyphyllae Fructus), Shengma (Cimicifugae Rhizoma), Gange (Puerariae Lobatae Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Jiang (Zingiberis Rhizoma), Zao (Jujubae Fructus).
Huaihua Wan Treats Intestinal Wind and hemorrhoidal bleeding.
Huaijiao (Staphyleae Fructus), Diyü (Edwardsiae Squama), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), Fangfeng (Saposhnikoviae Radix), Zhike (Aurantii Fructus).
Add Qinjiao (Gentianae Macrophyllae Radix), Shengma (Cimicifugae Rhizoma).
Huanglian Ejiao Wan
Huanglian (Coptidis Rhizoma) (3 liang), Ejiao (Asini Corii Colla) (1 liang), Fuling (Poria) (2 liang).
Powder Huanglian and Fuling. Boil Ejiao into a paste to form pills. Take on an empty stomach with rice water.
Huangtu Tang (Jinkui Yaolue)
Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqin (Scutellariae Radix), Ejiao (Asini Corii Colla), Shudi (Rehmanniae Radix Preparata), Fuzi (Aconiti Lateralis Radix Praeparata) (each 2 liang). Fulonggan (Dragon's House Earth) half sheng, decoct in water, take in divided doses.
Sanhuang Buxue Tang
Huangqi (Astragali Radix) (1.5 qian), Shengdi (Rehmanniae Radix) (2 qian), Shudi (Rehmanniae Radix Preparata), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 1 qian), Shaoyao (Paeoniae Radix), Danpi (Moutan Cortex), Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma) (each 0.5 fen).
Baiye San Treats Visceral Toxin.
Cebaiye (Platycladi Cacumen) (2 liang), Huangqin (Scutellariae Radix) (1.5 liang), Dahuang (Rhei Radix et Rhizoma) (5 qian).
Take with rice water.
Shengyang Fengfang Tang (Dongyuan Formula) Treats Intestinal Wind.
Cangzhu (Atractylodis Rhizoma) (wine-soaked, stir-fried, 4 qian), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Shaoyao (Paeoniae Radix) (each 1 qian), Fangfeng (Saposhnikoviae Radix) (2 qian).
Li Wu Tang
Combination of Lizhong Tang (Regulate the Middle Decoction) and Siwu Tang (Four Substances Decoction).
Siwu Tang (Four Substances Decoction), Liujunzi Tang (Six Gentlemen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Sijunzi Tang (Four Gentlemen Decoction) (See Stroke section for formulas), Lizhong Tang (Regulate the Middle Decoction) (See Cold Damage section for formula).
Zonghui San
Baizong (Decayed Palm Fiber) preserved in nature. Take 2 qian per dose, with wine or rice water.