〔大〕妇人脏腑损伤，风邪易入，凡热气在内，令人下血，风气在内，亦大便血色，
或如豆汁，腹中疼痛。若粪后下血者，其来远，粪前有血者，其来近。远近者，言病在
上下也。妇人面无血色，时寒时热，脉浮弱，按之绝者，为下血也。
〔薛〕前证或饮食起居，或六淫七情失宜，以致元气亏损，阳络外伤。若膏粱积热，
加味清胃散。怒气伤肝，六君、柴、芍、芎、归。郁结伤脾，加味归脾汤。脾气虚弱，六
君子汤。思虑伤心，妙香散。大肠风热，四物、侧柏、荆、防、枳壳。大肠血热，四物、
丹皮、柴胡。中气下陷，补中益气、茯苓、半夏。心脾不能摄血，必补脾肺之源，举下陷
之气。一妇人下血不已，面色痿黄，四肢畏冷，此中气下陷，用补中益气汤送四神丸，
数服而愈。光禄张淑人下血，烦躁作渴，大便重坠，后去稍缓，用三黄汤加大黄至四两
方应，后用三黄汤又二十余剂而愈。此等元气，百中一二。韩地官之内脾胃素弱，因
饮食停滞，服克伐之剂，自汗身冷，气短喘急，腹痛便血。或用诸补剂，皆不应。余用
人参、炮附子各五钱，二剂稍应，却用六君子，每剂加炮附子三钱，四剂渐安。又用前
汤，每加附子一钱，数剂乃瘥。一妇人因怒胸痞，饮食少思，服消导利气之药，痰喘
胸满，大便下血。余用补中益气汤加茯苓、半夏、炮姜四剂，诸证顿愈，又用八珍加柴胡、
炒栀全愈。
加减四物汤 治肠风下血。
侧柏叶（炒） 荆芥 槐花（炒） 甘草（炒，各五分） 枳壳（麸炒） 生地黄 当归
川芎（各一钱）
上姜水煎服。
肠风黑神散 治肠风下血，腹疼后重，或肛门脱出。
败棕（烧） 木馒头（烧） 乌梅（去核） 粉草（炙，各一钱）
上水煎服。
愚按∶前二证若病久中气虚弱者，必用培补脾胃为主。
地榆汤 治阴结便血。（骆龙吉方）
地榆（四两） 甘草（炒，一两半） 缩砂仁（四十七粒）
上每服三钱，水煎。
防风如神散 治风热气滞，粪后下血。
防风 枳壳（麸炒，各等分）
上每服三钱，水煎。
妙香散 治心气下血，温酒调下。（见杂病心痛）
【戴元礼】妇人因脏腑受损，风邪容易侵入。凡是体内有热气，会导致下血；若风气在体内，也会导致大便出血，血色有时像豆汁一样，伴有腹部疼痛。如果在排便之后才出血的，说明病位较远（病在上部或深处）；如果在排便之前就有血出来的，说明病位较近（病在下部或浅处）。所谓远近，是指病变部位在上下的区别。如果妇人面色苍白无华，时而发冷时而发热，脉象浮而弱，重按则感觉脉搏消失的，这是下血的证候。
【薛己】上述病症，或因饮食起居不当，或因六淫（风、寒、暑、湿、燥、火）七情（喜、怒、忧、思、悲、恐、惊）失调，导致元气亏损，阳络（位于上部的脉络）受到外伤。如果是膏粱厚味积热所致，用加味清胃散。如果是怒气伤肝，用六君子汤加柴胡、白芍、川芎、当归。如果是郁结伤脾，用加味归脾汤。如果是脾气虚弱，用六君子汤。如果是思虑伤心，用妙香散。如果是大肠风热，用四物汤加侧柏叶、荆芥、防风、枳壳。如果是大肠血热，用四物汤加牡丹皮、柴胡。如果是中气下陷，用补中益气汤加茯苓、半夏。如果是心脾不能统摄血液，必须补益脾肺之源，提升下陷之气。有一位妇人下血不止，面色萎黄，四肢畏冷，这是中气下陷，我用补中益气汤送服四神丸，服用几剂后痊愈。光禄寺张淑人下血，烦躁口渴，大便时有重坠感，后来症状稍缓，我用三黄汤加大黄至四两才见效，之后又用三黄汤服用二十多剂而痊愈。这类元气大虚的病人，百中难遇一二。韩地官的妻子脾胃素来虚弱，因饮食停滞，服用了攻伐的药物，出现自汗、身冷、气短喘急、腹痛便血。有人用各种补药，都不见效。我用五钱人参、五钱炮附子，服用两剂后稍有好转，随后改用六君子汤，每剂加炮附子三钱，服用四剂后逐渐安定。接着再用前面的方剂，每剂加附子一钱，服用数剂后才康复。另一位妇人因愤怒导致胸中痞闷，饮食减少，服用了消导利气的药物，导致痰喘、胸满、大便下血。我用补中益气汤加茯苓、半夏、炮姜，服用四剂，诸症顿愈，后又用八珍汤加柴胡、炒栀子，完全治愈。
加减四物汤：治疗肠风下血。
药材：侧柏叶（炒）、荆芥、槐花（炒）、甘草（炒，各五分）、枳壳（麸炒）、生地黄、当归、川芎（各一钱）。
用法：以上药物用生姜水煎服。
肠风黑神散：治疗肠风下血，腹痛后重，或肛门脱出。
药材：败棕（烧焦）、木馒头（烧焦）、乌梅（去核）、粉草（炙，各一钱）。
用法：以上药物用水煎服。
愚按：上述两种证候，如果病程较长且中气虚弱者，必须以培补脾胃为主。
地榆汤：治疗阴结便血。（骆龙吉方）
药材：地榆（四两）、甘草（炒，一两半）、缩砂仁（四十七粒）。
用法：每次服用三钱，用水煎服。
[Dai Yuanli] When a woman's zang-fu organs are damaged, wind pathogens easily invade. Whenever there is internal heat, it causes lower bleeding; if wind qi is internal, it also causes blood in the stool, which may resemble bean juice, accompanied by abdominal pain. If bleeding occurs after defecation, the source of the disease is distant (located higher or deeper); if blood appears before defecation, the source is near (located lower or shallower). The terms "distant" and "near" refer to the location of the pathology being either upper or lower. If a woman presents with a pale complexion without luster, alternating chills and fever, and a pulse that is floating and weak, disappearing upon deep pressure, this indicates lower bleeding.
[Xue Ji] The aforementioned syndromes may result from improper diet and lifestyle, or from disharmony of the six climatic factors (wind, cold, summer-heat, dampness, dryness, fire) and seven emotions (joy, anger, worry, overthinking, sorrow, fear, fright), leading to deficiency of yuan qi (original qi) and external injury to yang collaterals. If caused by accumulation of heat from rich and greasy foods, use Jia Wei Qing Wei San (Modified Clearing Stomach Powder). If caused by anger injuring the liver, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chai Hu (Bupleuri Radix), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dang Gui (Angelicae Sinensis Radix). If caused by emotional constraint injuring the spleen, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction). If caused by spleen qi deficiency, use Liu Jun Zi Tang (Six Gentlemen Decoction). If caused by excessive thinking injuring the heart, use Miao Xiang San (Miraculous Fragrance Powder). If caused by wind-heat in the large intestine, use Si Wu Tang (Four Substances Decoction) added with Ce Bai Ye (Biota Top Leaf), Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), and Zhi Qiao (Aurantii Fructus Immaturus). If caused by blood-heat in the large intestine, use Si Wu Tang (Four Substances Decoction) added with Mu Dan Pi (Moutan Cortex) and Chai Hu (Bupleuri Radix). If caused by sinking of middle qi, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fu Ling (Poria) and Ban Xia (Pinelliae Rhizoma). If the heart and spleen fail to control the blood, one must tonify the source of the spleen and lung, and lift the sinking qi. A certain woman suffered from incessant lower bleeding, a sallow complexion, and aversion to cold in the four limbs; this was due to sinking of middle qi. I used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) administered with Si Shen Wan (Four Spirits Pill), and she recovered after several doses. Zhang Shuren, an official of the Guanglu Temple, suffered from lower bleeding, irritability, thirst, and a sensation of heaviness and bearing down during defecation. His symptoms eased slightly later. I used San Huang Tang (Three Yellows Decoction) with Da Huang (Rhei Radix et Rhizoma) increased to four liang, which proved effective, and he recovered after taking another twenty-plus doses of San Huang Tang (Three Yellows Decoction). Such cases of severe yuan qi (original qi) deficiency are rare, occurring in only one or two out of a hundred. The wife of Han Diguan had always had weak spleen and stomach. Due to food stagnation, she took purgative drugs, resulting in spontaneous sweating, cold body, shortness of breath, rapid breathing, abdominal pain, and bloody stool. Various tonics were tried but ineffective. I used five qian of Ren Shen (Ginseng Radix) and five qian of Pao Fu Zi (Prepared Aconiti Lateralis Radix). After two doses, there was slight improvement. Then I switched to Liu Jun Zi Tang (Six Gentlemen Decoction), adding three qian of Pao Fu Zi (Prepared Aconiti Lateralis Radix) per dose. After four doses, she gradually stabilized. Subsequently, I used the previous decoction, adding one qian of Fu Zi (Aconiti Lateralis Radix Praeparata) per dose, and she recovered after several doses. Another woman developed chest stuffiness and poor appetite due to anger. After taking drugs for promoting digestion and moving qi, she developed phlegm-wheezing, chest fullness, and lower bleeding. I used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma), and Pao Jiang (Zingiberis Rhizoma Preparatum). After four doses, all symptoms resolved suddenly. She then took Ba Zhen Tang (Eight Treasures Decoction) added with Chai Hu (Bupleuri Radix) and Chao Zhi Zi (Gardeniae Fructus Preparatus), achieving complete recovery.
Jia Wei Si Wu Tang (Modified Four Substances Decoction): Treats intestinal wind causing lower bleeding.
Ingredients: Ce Bai Ye (Biota Top Leaf, stir-fried), Jing Jie (Schizonepetae Spica), Huai Hua (Sophorae Flos, stir-fried), Gan Cao (Licorice Root, stir-fried, each 5 fen), Zhi Qiao (Aurantii Fructus Immaturus, bran-stir-fried), Sheng Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma, each 1 qian).
Administration: Decoct with ginger water and take orally.
Chang Feng Hei Shen San (Intestinal Wind Black Spirit Powder): Treats intestinal wind causing lower bleeding, abdominal pain with tenesmus, or prolapse of the anus.
Ingredients: Bai Zong (Decayed Palm Fiber, burnt), Mu Man Tou (Ficus Hirta Fruit, burnt), Wu Mei (Mume Fructus, pitted), Fen Cao (Glycyrrhiza Radix et Rhizoma, honey-fried, each 1 qian).
Administration: Decoct with water and take orally.
Commentary: For the above two syndromes, if the condition has been chronic and middle qi is deficient, treatment must primarily focus on fortifying the spleen and stomach.
Di Yu Tang (Sanguisorba Decoction): Treats yin obstruction causing bloody stool. (Formula from Luo Longji)
Ingredients: Di Yu (Sanguisorbae Radix, 4 liang), Gan Cao (Licorice Root, stir-fried, 1.5 liang), Suo Sha Ren (Amomi Fructus Rotundus, 47 grains).
Administration: Take 3 qian per dose, decoct with water.
Fang Feng Ru Shen San (Saposhnikovia Divine-like Powder): Treats wind-heat and qi stagnation causing lower bleeding after defecation.
Ingredients: Fang Feng (Saposhnikoviae Radix), Zhi Qiao (Aurantii Fructus Immaturus, bran-stir-fried, equal parts).
Administration: Take 3 qian per dose, decoct with water.
Miao Xiang San (Miraculous Fragrance Powder): Treats heart qi causing lower bleeding. Administer with warm wine. (See Miscellaneous Diseases: Heart Pain)