一方∶黄连、黄柏末浓煎车前子汤,空心调服二钱,少加蜜汁。
一方∶侧柏叶为末,空心酒调二钱服。
一方∶五倍炒为末,乌梅肉捣膏丸,梧桐子大,空心酒下五十丸。
一方∶当归二两,酒二升,煎一升,空心顿服效。
一方∶郁金为末,葱白汤调服二钱。
《内经》曰∶下血为内伤络脉所致。帝曰∶肠 便血何如?岐伯曰∶身热则死,寒则生。
曰∶肠 下白沫何如?脉沉则生,脉浮则死。曰∶肠 下脓血何如?脉悬绝则死,滑大则生。
曰∶肠 之属,身不热,脉不悬绝何如?滑者生,悬涩者死,以藏期之。
仁斋云∶肠胃不虚,邪气无从而入。人惟醉饱房劳,坐卧风湿,恣食生冷,酒面积热,
以致荣血失道,渗入大肠,此肠风脏毒之所由行也。
《原病式》曰∶诸血溢泄,皆属于热。肠风脏毒,富贵之人,浓味过多,酒色所致。
藜藿之人,必是劳役过
甚,热积于中,风生于内,以致血溢泛流,尽是挟热。久则胃气渐虚,或服寒凉药多,
胃气伤损,于是时可以温补脾胃,使正气复完,而血自循于经矣。谓挟冷者,大误也。《三因》
论下血,或清,或浊,或鲜,或黑,或便前便后,或与泄物并下。由内外有所感伤,凝积
于胃,随气下通,亦妄行之一类。云清者属荣,浊者属卫。热与湿鲜者属火,黑下火极,与泄
物并下为积。先便后血者,其来远;先血后便者,其来近。
一方:将黄连、黄柏研成细末,用浓煎的车前子汤,在空腹时调服二钱,稍微加入一点蜜汁。
另一方:将五倍子炒后研成细末,与乌梅肉捣成的膏混合制成丸药,大小如梧桐子,在空腹时用酒送服五十丸。
另一方:取当归二两,用酒二升,煎煮至一升,在空腹时一次性服用,效果显著。
《黄帝内经》说:便血是由于内部损伤络脉所致。黄帝问:肠道出血导致便血情况如何?岐伯回答:如果身体发热则预后不良(主死),如果不发热则预后良好(主生)。
又问:肠道排出白色粘液情况如何?脉象沉伏则预后良好,脉象浮越则预后不良。
又问:肠道排出脓血情况如何?脉象悬绝(极度微弱或异常)则预后不良,脉象滑大则预后良好。
又问:属于肠道出血的病症,如果身体不发热,脉象也不悬绝,情况如何?脉象滑利则预后良好,脉象悬而涩滞则预后不良,可以根据脏腑气机的盛衰周期来推断预后。
仁斋(杨士瀛)说:肠胃如果没有虚损,邪气就没有入侵的途径。人如果因为醉酒饱食、房事过度,久坐卧于风湿之中,放纵食用生冷食物,或者长期饮酒积聚内热,导致营血运行失道,渗入大肠,这就是肠风和脏毒产生的原因。
《原病式》说:各种血液溢出泄漏的症状,都归属于热证。肠风和脏毒,富贵之人多因过食肥甘厚味、饮酒色欲过度所致;贫贱劳作者多因过度劳累,热气积结于体内,风气生于内部,导致血液溢出泛滥流动,都是挟带热邪。时间久了,胃气逐渐虚弱,或者因为服用过多寒凉药物,损伤了胃气,此时应当温补脾胃,使正气恢复完整,血液自然就能循行于经脉之中。如果说这是挟带冷邪,那是极大的错误。《三因方》论述便血,有的清稀,有的浑浊,有的鲜红,有的黑紫,有的在排便之前,有的在排便之后,有的与排泄物一起排出。这是由于内外因素有所感伤,凝积在胃,随着气机下行通达,也属于妄行的一类。书中说清稀的属于营血,浑浊的属于卫气。热与湿结合且颜色鲜红的属于火邪,黑色的是火极的表现,与排泄物一起排出的属于积滞。先排便后出血的,病位较远;先出血后排便的,病位较近。
One prescription: Grind Coptis Rhizoma (Huanglian) and Phellodendron Bark (Huangbai) into fine powder. Decoct Plantago Seed (Cheqianzi) to make a strong decoction. Take two qian of the powder mixed with this decoction on an empty stomach, adding a small amount of honey juice.
Another prescription: Grind Biota Leaf (Cebaiye) into fine powder. Take two qian mixed with wine on an empty stomach.
Another prescription: Stir-fry Chinese Gallnut (Wubeizi), grind into powder, mix with paste made from Oligocarpus Plum Flesh (Wumei Rou), and form pills the size of Sophora Seed (Wutongzi). Take fifty pills with wine on an empty stomach.
Another prescription: Use Angelica Sinensis Root (Danggui) two liang, and wine two sheng. Decoct until one sheng remains. Take it all at once on an empty stomach for effective results.
Another prescription: Grind Curcuma Aromatica Rhizome (Yujin) into powder. Take two qian mixed with decoction of Scallion White (Congbai Tang).
(Attached: Changfeng [Intestinal Wind] and Zangdu [Visceral Toxin])
The *Neijing* (Inner Canon) states: Hematochezia is caused by internal injury to the collaterals. The Yellow Emperor asked: What about hematochezia due to intestinal bleeding? Qibo replied: If the body has fever, death ensues; if there is no fever, survival ensues.
He asked: What about passing white mucus from the intestines? If the pulse is deep, survival ensues; if the pulse is superficial, death ensues. He asked: What about passing pus and blood from the intestines? If the pulse is suspended and absolute (extreme/abnormal), death ensues; if the pulse is slippery and large, survival ensues.
He asked: Regarding conditions belonging to intestinal bleeding, if the body is not hot and the pulse is not suspended and absolute, what happens? If the pulse is slippery, survival ensues; if the pulse is suspended and choppy, death ensues. Prognosis can be determined according to the cycles of the zang organs.
Renzhai (Yang Shiyin) said: If the intestines and stomach are not deficient, evil qi has no way to enter. People who indulge in drunkenness and overeating, excessive sexual activity, sitting or lying in wind and dampness, freely consume raw and cold foods, or accumulate heat from long-term alcohol consumption, cause Ying Blood (Nutritive Blood) to lose its proper course and seep into the large intestine. This is how Changfeng and Zangdu arise.
The *Yuanbing Shi* (Original Treatise on Disease Mechanisms) states: All types of overflowing and leaking blood belong to Heat. Changfeng and Zangdu result from rich people consuming too much rich and greasy food and indulging in wine and sex; they result from poor laborers suffering from excessive physical exertion, causing heat to accumulate internally and wind to generate internally, leading to blood overflowing and flowing wildly, all involving Heat. Over time, Stomach Qi gradually becomes deficient, or damage occurs to Stomach Qi from taking too many cold-natured medicines. At this time, one should warm and tonify the Spleen and Stomach so that Righteous Qi recovers completely, and blood will naturally circulate within the meridians. To say it involves Cold is a great error. The *Sanyin Fang* discusses hematochezia: it may be clear or turbid, fresh red or black, occurring before or after defecation, or mixed with excrement. This is due to internal and external injuries causing stagnation in the Stomach, which then follows Qi downward, representing another category of reckless flow. It states that clear blood belongs to Ying, while turbid blood belongs to Wei (Defensive) Qi. Fresh blood with heat and dampness belongs to Fire; black blood indicates extreme Fire; blood mixed with excrement indicates accumulation. Bleeding after defecation indicates a distant source; bleeding before defecation indicates a near source.