便血之与肠 ，本非同类。盖便血者，大便多实而血自下也；肠 者，因泻痢
而见脓血，即痢疾也。观《内经》曰∶食饮不节，起居不时者，阴受之。阴受之则入五脏，
入五脏则 满闭塞，下为飧泄，久为肠 。此可见肠 之因飧泄，自与便血不
同，而治亦有异。且便血有夙疾，而肠 惟新邪，尤为易辨。今诸书以此类言者，皆误
也。兹列便血证治于此，而肠 之义则在痢疾门。故凡临此证者，必须详察大便之燥泄
何如，庶不致疑似误认之谬。然多酒之人，必多溏泄，亦多便血，是又不可因泄而作肠
也。
一、大便下血，多由肠胃之火。盖大肠小肠皆属于胃也。但血在便前者，其来近，近者
，或在广肠，或在肛门；血在便后者，其来远。远者，或在小肠，或在于胃。虽血之妄行，
由火者多，然未必尽由于火也。故于火证之处，则有脾胃阳虚而不能统血者，有气陷而血亦
陷者，有病久滑泄而血因以动者，有风邪结于阴分而为便血者。大都有火者多因血热。无火
者多因虚滑。故治血者，但当知虚实之要。
一、下血因火者，宜清热为主，惟约营煎最佳，次以地榆散、槐花散、黄连丸、槐角丸
之类主之。若热在脾胃小肠之间，而火之甚者，宜抽薪饮、黄连解毒汤之类主之。若素以肠
脏多火，而远年近日脏毒下血久不能愈者，宜脏连丸、猪脏丸主之。若大肠风热而血不止者
，宜防风黄芩丸主之。
一、酒毒湿热结蓄大肠下血者，宜约营煎、聚金丸，或槐角丸之类主之。若但以寒湿而
无火下血者，宜二术煎，或四君子汤主之，或葛花解酲汤亦佳。
一、脾胃气虚而大便下血者，其血不甚鲜红，或紫色，或黑色，此阳败而然，故多无热
证。而或见恶心呕吐。盖脾统血，脾气虚则不能收摄，脾化血，脾气虚则不能运化，是皆血
无所主。因而脱陷妄行，速宜温补脾胃，以寿脾煎、理中汤、养中煎、归脾汤，或十全大补
汤之类主之。
一、气陷不举而血不止者，宜补中益气汤，或寿脾煎、归脾汤主之。若微陷而兼火者，
宜东垣加减四物汤主之。若气大虚而大陷者，宜举元煎主之。
一、血滑不止者，或因病久而滑，或因年衰而滑，或因气虚而滑，或因误用攻击，以致
气陷而滑。凡动血之初，多由于火。及火邪既衰而仍有不能止者，非虚即滑也。凡此之类，
皆当以固涩为主，宜胜金丸、香梅丸之类主之。然血滑不止者，多由气虚，宜以人参汤送之
尤妙。或以补中益气汤、归脾汤、举元煎、理中汤加乌梅、文蛤、五味子之类主之。若滑甚
不能止者，惟玉关丸最佳。
一、结阴便血者，以风寒之邪结于阴分而然，此非伤寒之比，盖邪在五脏留而不去，是
谓之结阴。邪内结不得外行，则病归血分，故为便血。经曰∶结阴者，便血一升，再结二升
，三结三升，正此之谓。此宜外灸中脘、气海、三里以散风邪，内以平胃地榆汤温散之剂主
之。
一、怒气伤肝，血因气逆而下者，宜化肝煎、枳壳汤之类主之。若逆气散而微有火者，
宜黄芩芍药汤主之。若肝邪乘胃，以致脾虚失血者，自无烦热气逆等证，宜从前脾胃气虚证
治，不得平肝以再伤脾气也。
一、凡因劳倦，七情，内伤不足，而致大便动血者，非伤心脾，即伤肝肾。此其中气受
伤，故有为呕恶痞满者，有为疼痛泄泻者，有为寒热往来，饮食不进者。时医不能察本，但
见此证，非云气滞，即云痰火，而肆用寒凉，妄加攻击，伤而又伤，必致延绵日困。及其既
甚，则多有大便下紫黑败血者，此胃气大损，脾元脱竭，血无所统。故注泄下行。阳败于阴
，故色为灰黑。此危剧证也，即速用回阳等剂犹恐不及，而若辈犹云∶今既见血，安可再用
温药，必致其毙。吁！受害者殊为可悯，害人者殊为可恨。
便血与肠澼（指痢疾，因泻痢而见脓血），本不是同一种病。所谓便血，是大便通常成形而血液自行排出；肠澼，是因为腹泻痢疾而出现脓血，也就是痢疾。看《黄帝内经》说：“饮食不节制，起居没有规律的人，阴气受邪。”阴气受邪则侵入五脏，侵入五脏则导致腹部胀满闭塞，向下表现为完谷不化的泄泻，日久则发展为肠澼。这可以看出肠澼是由泄泻引起的，自然与便血不同，治疗方法也有差异。而且便血常有旧疾宿根，而肠澼多是新感外邪，尤其容易辨别。现在许多医书将这两者混为一谈，都是错误的。这里列出便血的证治方法，而肠澼的含义则在“痢疾”章节中论述。所以凡是遇到这种病症，必须详细观察大便的干燥或稀溏情况，才不至于产生疑惑和误认的错误。然而，多饮酒的人，必然多有稀溏泄泻，也多有便血，这又不能因为泄泻就当作肠澼来治疗。
一、大便下血，多由肠胃之火引起。因为大肠和小肠都隶属于胃。但是，如果血液在大便之前排出，说明病位较近，近处可能在广肠（直肠下部）或肛门；血液在大便之后排出，说明病位较远。远处可能在小肠，或在胃。虽然血液妄行大多由火引起，但未必全是由于火。所以在火证的情况之外，还有脾胃阳气虚弱不能统摄血液的，有气机下陷导致血液也随之下陷的，有病久滑泄导致血液因而动的，有风邪结聚于阴分而导致便血的。大抵有火的，多因血热；无火的，多因虚损滑脱。所以治疗出血，应当只知虚实的关键所在。
一、下血由于火邪的，应以清热为主，约营煎（方剂名，具清肠止血功效）最佳，其次用地榆散、槐花散、黄连丸、槐角丸等方主治。如果热邪在脾胃小肠之间，且火势严重的，宜用抽薪饮、黄连解毒汤等方主治。如果素来肠脏多火，且长年近日脏毒下血久治不愈的，宜用脏连丸、猪脏丸主治。如果是大肠风热导致出血不止的，宜用防风黄芩丸主治。
一、酒毒湿热结蓄在大肠导致下血的，宜用约营煎、聚金丸，或槐角丸等方主治。如果只是寒湿而无火邪导致下血的，宜用二术煎，或四君子汤主治，葛花解酲汤也很好。
一、脾胃气虚导致大便下血的，其血色不甚鲜红，或是紫色，或是黑色，这是阳气败坏所致，所以多没有热证。或者见到恶心呕吐。因为脾统血，脾气虚弱则不能收摄，脾化生血液，脾气虚弱则不能运化，这些都是血液失去主宰。因而脱陷妄行，应迅速温补脾胃，以寿脾煎、理中汤、养中煎、归脾汤，或十全大补汤等方主治。
一、气机下陷不举导致出血不止的，宜用补中益气汤，或寿脾煎、归脾汤主治。如果轻微下陷兼有火邪的，宜用东垣加减四物汤主治。如果气大虚且严重下陷的，宜用举元煎主治。
一、血液滑脱不止的，有的因病久滑脱，有的因年老体衰滑脱，有的因气虚滑脱，有的因误用攻伐药物，导致气陷而滑脱。凡动血之初，多由于火。等到火邪衰退后仍有不能止血的，不是虚就是滑脱。凡此类情况，都应当以固涩为主，宜用胜金丸、香梅丸等方主治。然而血液滑脱不止的，多由气虚引起，用人参汤送服尤为妙法。或者用补中益气汤、归脾汤、举元煎、理中汤加乌梅、文蛤、五味子等方主治。如果滑脱非常严重不能止住的，只有玉关丸最佳。
一、结阴便血，是由于风寒之邪结聚于阴分所致，这与伤寒不同，因为邪气在五脏停留不去，这就叫做结阴。邪气内结不能向外发散，则病归于血分，所以出现便血。经书说：“结阴者，一次便血一升，再次结阴便血二升，三次结阴便血三升”，正是说的这种情况。此症宜外用灸法灸中脘、气海、足三里以疏散风邪，内服平胃地榆汤等温散剂主治。
一、怒气伤肝，血液因气逆而下行的，宜用化肝煎、枳壳汤等方主治。如果逆气消散而微有火邪的，宜用黄芩芍药汤主治。如果肝邪侵犯胃，导致脾虚失血的，自然没有烦热、气逆等症状，应按前述脾胃气虚证的治法处理，不可平抑肝木以免再伤脾气。
一、凡是因劳倦、七情（喜、怒、忧、思、悲、恐、惊）、内伤不足而导致大便动血的，不是伤心脾，就是伤肝肾。这是因为中气受伤，所以有的出现呕吐恶心、痞闷胀满，有的出现疼痛泄泻，有的出现寒热往来、饮食不进。当时的医生不能察明根本，只要见到这些症状，不是说气滞，就是说痰火，于是肆意使用寒凉药物，妄加攻伐，损伤了又损伤，必定导致病情缠绵日重。等到病情严重时，往往有大便排出紫黑败血的情况，这是胃气大损，脾元枯竭，血液失去统摄，因而注泄下行。阳气败坏于阴寒之中，所以血色呈灰黑色。这是危急重症，即使迅速使用回阳救逆等药剂恐怕都来不及，而那些庸医还说：“现在已经见血，怎么还能再用温药，必定导致死亡。”唉！受害者实在可怜，害人者实在可恨。
Hematochezia (bleeding from the rectum) and Changpi (dysentery, characterized by pus and blood in stool due to diarrhea) are fundamentally different conditions. Hematochezia refers to bleeding that occurs spontaneously while the stool is generally formed; Changpi refers to the presence of pus and blood resulting from dysenteric diarrhea, which is essentially dysentery. As stated in the *Neijing* (Inner Canon): "Those who do not regulate their diet or maintain irregular daily routines will suffer Yin pathogenic invasion." When Yin is invaded, the pathogen enters the Five Zang organs. Once inside the Zang organs, it causes abdominal fullness and obstruction, manifesting downward as undigested food diarrhea (Sunxie). If prolonged, it develops into Changpi. This demonstrates that Changpi originates from diarrhea and is distinct from hematochezia, with different treatment approaches. Furthermore, hematochezia often involves chronic underlying conditions, whereas Changpi is typically caused by new external pathogens, making them relatively easy to distinguish. Many medical texts erroneously conflate these two conditions. Here, the syndrome differentiation and treatment for hematochezia are listed, while the discussion on Changpi is reserved for the Dysentery chapter. Therefore, when encountering such cases, one must carefully observe whether the stool is dry or loose to avoid misdiagnosis. However, individuals who consume excessive alcohol often suffer from loose stools and may also experience hematochezia; this should not be mistaken for Changpi simply because diarrhea is present.
1. Blood in the stool is mostly caused by Fire in the Stomach and Intestines. The Large Intestine and Small Intestine both belong to the Stomach. If blood appears before the stool, the source is near, located either in the Guangchang (lower rectum) or the anus. If blood appears after the stool, the source is distant, located either in the Small Intestine or the Stomach. Although reckless bleeding is mostly due to Fire, it is not exclusively so. Besides Fire syndromes, there are cases where Spleen and Stomach Yang deficiency fails to control the blood, cases where Qi sinking causes blood to sink with it, cases where chronic slippery diarrhea triggers bleeding, and cases where Wind pathogen knots in the Yin aspect causing hematochezia. Generally, bleeding due to Fire stems from Blood Heat, while bleeding without Fire stems from Deficiency and Slipperiness. Thus, treating bleeding requires understanding the key principles of Excess and Deficiency.
2. For bleeding caused by Fire, clearing heat is the primary method. Yueying Decoction (Yueying Jian) is the best choice, followed by Diyush San, Huaihua San, Huanglian Wan, and Huaijiao Wan. If heat resides between the Stomach, Spleen, and Small Intestine with severe Fire, Chouxin Yin or Huanglian Jiedu Tang should be used. For those with inherent intestinal Fire suffering from long-term internal toxin bleeding that does not heal, Zanglian Wan or Zhuzang Wan are indicated. For bleeding due to Wind-Heat in the Large Intestine that does not stop, Fangfeng Huangqin Wan is appropriate.
3. For bleeding caused by Wine-Toxin and Damp-Heat accumulating in the Large Intestine, Yueying Jian, Ju Jin Wan, or Huaijiao Wan should be used. For bleeding caused solely by Cold-Dampness without Fire, Erzhu Jian or Sijunzi Tang is suitable, and Gegua Jiecheng Tang is also excellent.
4. For bleeding due to Spleen and Stomach Qi Deficiency, the blood is rarely bright red; it may be purple or black, indicating Yang failure. Consequently, Heat signs are usually absent, though nausea and vomiting may occur. Since the Spleen controls blood, Spleen Qi deficiency leads to an inability to contain blood. Since the Spleen transforms blood, Spleen Qi deficiency leads to an inability to metabolize it, leaving blood without a master. This results in leakage and reckless movement. Immediate warming and tonification of the Spleen and Stomach are required, using Shoupi Jian, Lizhong Tang, Yangzhong Jian, Guipi Tang, or Shiquan Dabu Tang.
5. For bleeding due to Qi sinking and failing to rise, Buzhong Yiqi Tang, Shoupi Jian, or Guipi Tang should be used. If there is mild sinking accompanied by Fire, Dongyuan's Modified Siwu Tang is indicated. For severe Qi Deficiency with significant sinking, Juyuan Jian is appropriate.
6. For slippery, unceasing bleeding, whether due to chronic illness, aging, Qi deficiency, or misuse of attacking drugs leading to Qi sinking and slipperiness: Initially, bleeding is mostly due to Fire. Once the Fire pathogen subsides but bleeding continues, it is either Deficiency or Slipperiness. Such cases require astringency as the main approach, using Shengjin Wan or Xiangmei Wan. However, since slippery bleeding is often due to Qi deficiency, administering it with Renshen Tang is particularly effective. Alternatively, Buzhong Yiqi Tang, Guipi Tang, Juyuan Jian, or Lizhong Tang combined with Wumei, Wen Ge, and Wuweizi can be used. For extremely severe slipperiness that cannot be stopped, Yuguan Wan is the best option.
7. Jieyin Hematochezia (Knotting Yin Bleeding) is caused by Wind-Cold pathogen knotting in the Yin aspect. This differs from Shanghan (Cold Damage), as the pathogen remains lodged in the Five Zang organs without departing, termed "Jieyin." When pathogen knots internally and cannot move outward, the disease returns to the Blood aspect, causing hematochezia. The Classics state: "In Jieyin, one episode yields one sheng of blood, a second knot yields two sheng, a third knot yields three sheng," referring precisely to this condition. Treatment involves external moxibustion at Zhongwan, Qihai, and Zusanli to disperse Wind pathogen, and internally using Pingwei Diyutang or similar warming-dispersing formulas.
8. Anger injuring the Liver, causing blood to descend due to rebellious Qi, should be treated with Huagan Jian or Zhike Tang. If the rebellious Qi dissipates but slight Fire remains, Huangqin Shaoyao Tang is indicated. If Liver Pathogen invades the Stomach, causing Spleen Deficiency and blood loss, there will naturally be no irritability, heat, or rebellious Qi symptoms. In such cases, treat according to the aforementioned Spleen-Stomach Qi Deficiency protocols; do not soothe the Liver to further injure Spleen Qi.
9. Bleeding caused by fatigue, Seven Emotions, or internal injury leading to insufficiency affects either the Heart and Spleen or the Liver and Kidneys. Because the Middle Qi is injured, symptoms may include nausea, epigastric fullness, pain, diarrhea, alternating chills and fever, or loss of appetite. Contemporary physicians often fail to identify the root cause. Upon seeing these symptoms, they attribute them to Qi stagnation or Phlegm-Fire, indiscriminately using cold-natured herbs and aggressive attacks. This double injury leads to lingering and worsening conditions. Eventually, large amounts of dark purple-black spoiled blood may appear in the stool, indicating severe damage to Stomach Qi and exhaustion of Spleen Yuan, causing blood to lose its control and flow downward. Yang failure within Yin results in gray-black coloration. This is a critical condition; even immediate use of Yang-restoring agents may be insufficient. Yet, such practitioners claim, "Since bleeding is present, how can warm medicines be used? It will surely cause death." Alas, the victims are pitiable, and those who harm others are detestable.