（妇人症见《女科撮要》）
经云∶邪在五脏，则阴脉不和；阴脉不和，则血留之。阴气内结，阳络外伤，渗入肠间
，故便血也。《针经》云∶阳络伤则血外溢而衄血，阴络伤则血内溢而便血。皆因饮食失节，而
起居不时，七情六淫失宜，内伤外感所致。若外感则血鲜，名肠风。内伤则血浊，名脏毒。
外感而元气实者，人参败毒散，加槐花、荆芥，以祛邪气。内伤而元气虚者，亦用六君子汤
，以补胃气。元气下陷者，补中益气汤，以升举之。忧思伤脾者，济生归脾汤以解之。粪前
见血者，益气汤加吴茱萸。粪后见血者加黄连。阴血不足者，宜用四物汤。病因多端，不能
尽述，当临症制宜，庶无误矣。丹溪先生云∶精气血气，出于谷气。惟大便下血，当以胃气
收功。治者审之！
治验
一儒者素善饮，不时便血，或在粪前，或在粪后，食少体倦，面色痿黄，此脾气弱虚，
而不能统血。以补中益气汤加吴茱萸、黄连，三十余剂而再不发。
一男子每怒必便血，或吐血，即服犀角地黄汤之类。余曰∶此脾虚不能摄血，恐不宜用
此寒凉之药。彼不信，仍服之，日加倦怠，面色痿黄。更用四物、芩、连、丹皮之剂，饮食少思
，心烦渴热，吐血如涌，竟至不起。若用四君、芎、归、补中益气汤，多有得生者。
（妇女的相关病症详见《女科撮要》）
医经记载：邪气侵犯五脏，就会导致阴脉不和；阴脉不和，血液就会停滞积聚。阴气在体内结聚，阳络受到外伤，血液渗入肠道之间，从而引起便血。《针经》说：阳络受伤则血液向外溢出而表现为鼻衄或肌衄等出血症状，阴络受伤则血液向内溢出而表现为便血。这些情况都是由于饮食不节制，起居没有规律，以及七情（喜、怒、忧、思、悲、恐、惊）和六淫（风、寒、暑、湿、燥、火）失调，导致内伤和外感共同作用所致。如果是外感引起的，血色鲜红，称为肠风。如果是内伤引起的，血色浑浊，称为脏毒。
对于外感且元气充实的患者，使用人参败毒散，加入槐花、荆芥，以祛除邪气。对于内伤且元气虚弱的患者，也使用六君子汤，以补益胃气。对于元气下陷的患者，使用补中益气汤，以提升举陷。对于因忧思损伤脾气的患者，使用济生归脾汤以解除病证。如果在排便前见血，在益气汤中加入吴茱萸。如果在排便后见血，加入黄连。对于阴血不足的患者，适宜使用四物汤。病因多种多样，无法一一列举，应当根据具体症状灵活施治，这样才不至于出错。丹溪先生曾说：精、气、血都源于谷气。唯独大便下血的治疗，应当以恢复胃气作为最终目标。治疗者务必仔细审察！
治疗案例
有一位读书人平时喜欢饮酒，经常便血，有时在粪便之前，有时在粪便之后，食欲减退，身体疲倦，面色萎黄，这是脾气虚弱，不能统摄血液。使用补中益气汤加入吴茱萸、黄连，服用三十多剂后，病情不再复发。
有一位男子每次发怒必然便血，或者吐血，就自行服用犀角地黄汤之类的药物。我说：这是脾虚不能摄血，恐怕不适合使用这种寒凉的药物。他不相信，仍然服用，结果每天更加倦怠，面色萎黄。后来改用四物汤配合黄芩、黄连、牡丹皮的药剂，导致饮食减少，心烦口渴发热，吐血如涌，最终死亡。如果当时使用四君子汤配合川芎、当归，以及补中益气汤，大多可以存活。
(For women's conditions, see *Nuke Cuoyao* [Essentials of Gynecology].)
The medical classics state: When pathogenic factors invade the five zang organs, the yin meridians become disharmonious; when the yin meridians are disharmonious, blood stagnates. Internal accumulation of yin qi and external injury to the yang collaterals cause blood to seep into the intestines, resulting in hematochezia (blood in stool). The *Zhenjing* (Classic of Acupuncture) states: Injury to yang collaterals causes blood to overflow outward, manifesting as epistaxis or other upper bleeding; injury to yin collaterals causes blood to overflow inward, manifesting as hematochezia. These conditions are caused by irregular diet, improper daily routine, and inappropriate responses to the seven emotions and six climatic pathogens, leading to both internal injury and external contraction. If caused by external contraction, the blood is bright red, termed Changfeng (Intestinal Wind). If caused by internal injury, the blood is turbid, termed Zangdu (Visceral Toxin).
For patients with external contraction and sufficient yuan qi (original qi), Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity) is used, added with Huaihua (Sophorae Flos) and Jingjie (Schizonepetae Herba) to dispel pathogenic factors. For patients with internal injury and deficient yuan qi, Liu Jun Zi Tang (Six Gentlemen Decoction) is also used to tonify stomach qi. For patients with sinking yuan qi, Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) is used to raise and lift it. For those whose spleen qi is injured by worry and overthinking, Jisheng Gui Pi Tang (Gui Pi Decoction from the Generation-Sustaining Hall) is used to resolve the condition. If blood appears before defecation, Wu Zhu Yu (Evodiae Fructus) is added to Yi Qi Tang (Qi-Boosting Decoction). If blood appears after defecation, Huang Lian (Coptidis Rhizoma) is added. For patients with insufficient yin blood, Si Wu Tang (Four Substances Decoction) is appropriate. Etiologies are manifold and cannot be exhaustively listed; treatment must be adapted to specific clinical presentations to avoid errors. Mr. Danxi stated: Essence, qi, and blood all originate from grain qi. In the treatment of lower gastrointestinal bleeding, the ultimate goal should be the restoration of stomach qi. Practitioners must examine this carefully!
Clinical Cases
A scholar who habitually drank alcohol frequently suffered from hematochezia, sometimes before and sometimes after defecation. He had poor appetite, physical fatigue, and a sallow complexion. This indicated deficiency and weakness of spleen qi, which failed to control the blood. He was treated with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Wu Zhu Yu (Evodiae Fructus) and Huang Lian (Coptidis Rhizoma). After more than thirty doses, the condition did not recur.
A man experienced hematochezia or hematemesis (vomiting blood) every time he became angry, and he self-administered Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). I stated: This is due to spleen deficiency failing to hold the blood; it is inadvisable to use such cold-natured medicines. He did not believe me and continued taking them. His fatigue worsened daily, and his complexion became sallow. Later, he was treated with Si Wu Tang (Four Substances Decoction) combined with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Mu Dan Pi (Moutan Cortex). This led to loss of appetite, mental restlessness, thirst, and heat sensation, followed by profuse hematemesis, ultimately resulting in death. Had Si Jun Zi Tang (Four Gentlemen Decoction) been combined with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix), along with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi), survival would have been likely.