热伤阴络病便血，藏毒血黯肠风红，须辨腹痛肛肿痛，热盛湿盛要分明，
藏毒初起肿痛甚，大黄皂刺莫消停，热盛俱宜槐花散，湿盛平胃地榆灵，
日久脉微气血弱，升阳和血共养荣。
[注]
大便下血皆因小儿恣食肥甘，致生内热伤阴络也，
若血色，黯而浊，肛门肿痛，先血后粪，此为近血，名日藏毒，
若血鲜而清，腹中不痛，先粪后血此为远血，名日肠风，
藏毒肛门每多肿痛，初起宜用皂刺大黄汤消之，
大下血后，热盛微痛者，以槐花散和之，
湿盛不痛者，以平胃地榆汤和之，
肠风亦宜槐花散主之，
便血日久，脉微气血弱者，升阳和血汤和之，继以人参养荣汤补之
(皂刺大黄汤) 皂刺 生川大黄各等分
量小儿年岁大小虚实，酌其多少，水酒煎服。
(槐花散) 槐花炒 侧柏叶 枳壳麸炒 川黄连 荆芥穗炒 水煎服。
藏毒加苍术苦楝。肠风加秦艽防风。
(方歌)藏毒肠风槐花散，黄连枳壳槐柏荆，脏毒苍术苦楝人，肠风须加艽防行。
(平胃地榆汤) 苍术炒 陈皮 厚朴姜炒 甘草 地榆 引用生姜水煎服。
(方歌)便血湿盛腹不痛，须用平胃地榆汤，苍术陈皮厚朴草，地榆同煎引生姜。
(升阳和血汤) 黄耆炙 黄归酒洗 白芍炒 牡丹皮 陈皮 肉桂
秦艽 生地黄 熟地黄 生甘草 炙甘草 苍术炒 升麻 水煎服。
(方歌)下血日久腹中痛，治宜升阳和血汤，二地二草耆归芍，陈丹秦艽升桂苍。
(人参养荣汤) 人参 黄耆炙 白术土炒 白茯苓 白芍药炒 肉桂
熟地黄 当归酒洗 甘草炙 陈皮 引用姜枣水煎服。
(方歌)失血日久气血虚，人参养荣汤颇宜，参耆术苓白芍桂，地黄当归草陈皮。
%
失血门
热邪损伤阴络导致便血，脏毒所致血色黯黑，肠风所致血色鲜红，必须辨别是否有腹痛及肛门肿痛，以区分热盛与湿盛。
脏毒初起时肿痛剧烈，应使用大黄皂刺汤迅速消散；若属热盛，均适宜使用槐花散；若属湿盛，平胃地榆汤疗效显著。
若病程日久，出现脉象微弱、气血虚弱，则应采用升阳和血汤配合养荣汤进行治疗。
[注释]
大便下血皆因小儿恣意食用肥甘厚味，导致体内产生热邪，进而损伤阴络。
如果血色黯黑且浑浊，伴有肛门肿痛，先出血后排便，这称为“近血”，名为“脏毒”。
如果血色鲜红且清澈，腹部不痛，先排便后出血，这称为“远血”，名为“肠风”。
脏毒患者肛门多伴有肿痛，初起阶段宜用皂刺大黄汤来消除病邪。
大量便血后，若热盛而疼痛轻微者，用槐花散调和治疗。
若湿盛且不痛者，用平胃地榆汤调和治疗。
肠风也适宜以槐花散为主方治疗。
便血日久，脉微且气血虚弱者，用升阳和血汤调和治疗，随后用人参养荣汤进行补益。
(皂刺大黄汤) 皂角刺、生川大黄各等分。根据小儿年龄大小及体质虚实，酌情决定剂量，用水和酒煎煮后服用。
(槐花散) 炒槐花、侧柏叶、麸炒枳壳、川黄连、炒荆芥穗。水煎服。
若为脏毒，加苍术、苦楝子；若为肠风，加秦艽、防风。
(方歌)
藏毒肠风槐花散，黄连枳壳槐柏荆，
脏毒苍术苦楝人，肠风须加艽防行。
(平胃地榆汤) 炒苍术、陈皮、姜炒厚朴、甘草、地榆。引用生姜水煎服。
(方歌)
便血湿盛腹不痛，须用平胃地榆汤，
苍术陈皮厚朴草，地榆同煎引生姜。
(升阳和血汤) 炙黄芪、酒洗当归、炒白芍、牡丹皮、陈皮、肉桂、秦艽、生地黄、熟地黄、生甘草、炙甘草、炒苍术、升麻。水煎服。
(方歌)
下血日久腹中痛，治宜升阳和血汤，
二地二草耆归芍，陈丹秦艽升桂苍。
Hematochezia caused by heat damaging the Yin collaterals, with dark blood from Zang Du (visceral toxin) and bright red blood from Chang Feng (intestinal wind), requires differentiation of abdominal pain and anal swelling/pain to clearly distinguish between excess heat and excess dampness.
In the initial stage of Zang Du, when swelling and pain are severe, Dahuang Zaoci Tang (Rhubarb and Galla Chinensis Decoction) should be used without delay to dissipate the pathogen; for cases of excess heat, Huaihua San (Sophora Flower Powder) is generally suitable; for cases of excess dampness, Pingwei Diyue Tang (Pingwei and Sanguisorba Decoction) is effective.
If the condition persists for a long time, presenting with a faint pulse and deficiency of Qi and Blood, Shengyang Hexue Tang (Yang-Raising and Blood-Nourishing Decoction) combined with Yangrong Tang (Nourishing Ying Decoction) should be employed.
[Note]
Hematochezia in children is often due to excessive consumption of rich and sweet foods, generating internal heat that damages the Yin collaterals.
If the blood is dark and turbid, accompanied by anal swelling and pain, with bleeding occurring before defecation, this is termed "Jin Xue" (near blood) and named "Zang Du" (visceral toxin).
If the blood is bright red and clear, without abdominal pain, with bleeding occurring after defecation, this is termed "Yuan Xue" (far blood) and named "Chang Feng" (intestinal wind).
Patients with Zang Du often experience anal swelling and pain; in the early stage, Zaoci Dahuang Tang (Galla Chinensis and Rhubarb Decoction) is indicated to eliminate the pathogen.
After massive hematochezia, if heat is prominent with mild pain, Huaihua San (Sophora Flower Powder) is used to harmonize the treatment.
If dampness is prominent without pain, Pingwei Diyue Tang (Pingwei and Sanguisorba Decoction) is used to harmonize the treatment.
Chang Feng (intestinal wind) is also primarily treated with Huaihua San (Sophora Flower Powder).
For prolonged hematochezia with a faint pulse and Qi-Blood deficiency, Shengyang Hexue Tang (Yang-Raising and Blood-Nourishing Decoction) is used for harmonization, followed by Buren Yangrong Tang (Ginseng Nourishing Ying Decoction) for tonification.
(Galla Chinensis and Rhubarb Decoction) Zaoci (Spina Gleditsiae) and Sheng Chuan Dahuang (Raw Radix et Rhizoma Rhei) in equal parts. The dosage should be adjusted according to the child's age and constitutional strength/weakness, decocted in water and wine, and taken orally.
(Sophora Flower Powder) Chao Huaihua (Flos Sophorae, fried), Ce Bai Ye (Cacumen Platycladi), Fu Chao Zhike (Pericarpium Citri Reticulatae, bran-fried), Chuan Huanglian (Rhizoma Coptidis), Chao Jingjie Sui (Semen Artemisiae Scopariae, fried). Decoct in water and take orally.
For Zang Du, add Cangzhu (Rhizoma Atractylodis Lanceae) and Kulian (Cortex Meliae); for Chang Feng, add Qinjiao (Radix Gentianae Macrophyllae) and Fangfeng (Radix Saposhnikoviae).
(Prescription Verse)
Zang Du and Chang Feng: Huaihua San,
Huanglian, Zhike, Huaihua, Baie, Jingjie.
For Zang Du, add Cangzhu and Kulian;
For Chang Feng, add Qinjiao and Fangfeng.
(Pingwei and Sanguisorba Decoction) Chao Cangzhu (Rhizoma Atractylodis Lanceae, fried), Chenpi (Pericarpium Citri Reticulatae), Jiang Chao Houpo (Cortex Magnoliae Officinalis, ginger-fried), Gancao (Radix Glycyrrhizae), Diyue (Radix Sanguisorbae). Use Shengjiang (Rhizoma Zingiberis Recens) as a guide, decoct in water, and take orally.
(Prescription Verse)
For hematochezia with excess dampness and no abdominal pain,
Pingwei Diyue Tang is required.
Cangzhu, Chenpi, Houpo, Gancao,
Diyue decocted together with Shengjiang as a guide.
(Yang-Raising and Blood-Nourishing Decoction) Zhi Huangqi (Radix Astragali, honey-fried), Jiu Xi Danggui (Radix Angelicae Sinensis, wine-washed), Chao Baishao (Radix Paeoniae Alba, fried), Mudanpi (Cortex Moutan), Chenpi (Pericarpium Citri Reticulatae), Rougui (Cortex Cinnamomi), Qinjiao (Radix Gentianae Macrophyllae), Sheng Dihuang (Radix Rehmanniae Praeparata, raw), Shu Dihuang (Radix Rehmanniae Praeparata, prepared), Sheng Gancao (Radix Glycyrrhizae, raw), Zhi Gancao (Radix Glycyrrhizae, honey-fried), Chao Cangzhu (Rhizoma Atractylodis Lanceae, fried), Shengma (Rhizoma Cimicifugae). Decoct in water and take orally.
(Prescription Verse)
For prolonged hematochezia with abdominal pain,
Shengyang Hexue Tang is appropriate.
Two Dihuangs, two Garcias, Huangqi, Danggui, Baishao,
Chenpi, Mudanpi, Qinjiao, Shengma, Rougui, Cangzhu.
(Ginseng Nourishing Ying Decoction) Ren Shen (Radix Ginseng), Zhi Huangqi (Radix Astragali, honey-fried), Tu Chao Baizhu (Rhizoma Atractylodis Macrocephalae, soil-fried), Baifuling (Poria), Chao Baishaoyao (Radix Paeoniae Alba, fried), Rougui (Cortex Cinnamomi), Shu Dihuang (Radix Rehmanniae Praeparata, prepared), Jiu Xi Danggui (Radix Angelicae Sinensis, wine-washed), Zhi Gancao (Radix Glycyrrhizae, honey-fried), Chenpi (Pericarpium Citri Reticulatae). Use Shengjiang (Rhizoma Zingiberis Recens) and Dazao (Fructus Jujubae) as guides, decoct in water, and take orally.
(Prescription Verse)
For prolonged blood loss causing Qi and Blood deficiency,
Buren Yangrong Tang is highly suitable.
Renshen, Huangqi, Baizhu, Fuling, Baishao, Rougui,
Dihuang, Danggui, Gancao, Chenpi.