（肠风 脏毒附）
便血与痢血异，便血宿疾，痢血新邪，兼有脓杂。与肠风脏毒尤别。便血火淫，肠风风淫，脏毒湿热淫，兼
积毒。便血由肠胃火伤，阴络血与便下，治分血之远近虚实新久，不可概行凉血涩血。《金匮》以先便后血为
远血，黄土汤。先血后便为近血，赤小豆当归汤。其血色鲜稠为实热迫注，多醇酒浓味酿成，约营煎、地榆丸。
色浠淡为脾胃虚寒，归芍异功散加炮姜。色瘀晦为阳衰不摄。因中寒食冷，气滞血凝必腹痛呕泻，附子理中
汤倍炮姜。思伤心脾，气不统血，或年衰病久，归脾汤。惟初起血中伏火，用桂圆肉、包鸦胆子肉十枚，匀两
包，四五服效。若未止，用刘寄奴五钱，松萝茶一钱，乌梅肉一枚，煎服效。久而气陷血脱，补中益气汤。
血滑不止，举元煎下玉关丸。若面色萎黄，下元虚惫，加味六君子汤，下断红丸，或十全大补汤去茯苓，
加防
风。其结阴便血，脉必虚涩，系厥阴肝血内结，阳失统运，渗入肠间。诸家谓阴寒内结，非也。遵《医通》
补中益气汤，倍黄 ，加炮姜。宿有血症，因感湿热，血下紫黑，乃湿毒肠 。升阳益胃汤。凡便血及肠风
服药不效，山楂子散。大便燥结，肛头血出，熟地一两蒸食。
〔肠风〕血清色鲜，远射四散如筛，风性疏也，经言∶久风入中，则为肠风飧泄。加减四物汤加秦艽，
虚者人参胃风汤。肠风夹湿，下如豆汁。或瘀紫，升阳除湿防风汤，有热加黄连、当归、甘草。若湿热内蕴，
下血腹满，槐花散。初起血热，槐花饮。久则兼夹寒湿，浓朴丸。血滑不止，惜红煎。脾脉浮缓，土虚风
湿交乘，加味六君子汤，十全大补汤。肠风兼泻，米豆散。
〔脏毒〕血浊而色暗，系湿热蕴毒，轻者猪脏丸，重者脏连丸。酒毒酿湿热下血，聚金丸。若肛门血
射如线，或点滴不止，为痔血，秦艽白术丸去皂角、枳实、泽泻。加槐花、生地黄蜜丸。痔与痢血，另详本门。
（肠风 脏毒附）
便血与痢疾出血不同，便血属于宿疾，痢疾出血属于新感邪气，且常夹杂脓液。这与肠风和脏毒更是区别明显。便血多由火邪过盛引起，肠风多由风邪过盛引起，脏毒多由湿热之邪过盛引起，并兼有积滞毒素。便血是由于肠胃之火损伤了阴络，血液随大便排出，治疗需根据出血部位的远近、病证的虚实以及病程的新久来区分，不能一概使用凉血或涩血的方法。《金匮要略》认为先排便后出血为远血，用黄土汤；先出血后排便为近血，用赤小豆当归汤。如果血色鲜红稠厚，是实热逼迫血液妄行所致，多因过量饮酒和食用浓味食物酿成，可用约营煎、地榆丸。如果血色稀淡，是脾胃虚寒所致，可用归芍异功散加炮姜。如果血色瘀暗晦滞，是阳气衰微不能统摄血液所致。若因中寒或食用生冷食物，导致气滞血凝，必然伴有腹痛、呕吐、腹泻，可用附子理中汤加倍炮姜。若思虑过度损伤心脾，导致气不统血，或者年老体衰、病程长久，可用归脾汤。只有在初起时血中伏藏火邪，可用桂圆肉、包衣鸦胆子肉各十枚，分成两包，服用四五次见效。如果仍未止血，可用刘寄奴五钱，松萝茶一钱，乌梅肉一枚，煎服见效。如果病程长久导致气陷血脱，用补中益气汤。如果血液滑泄不止，用举元煎送服玉关丸。如果面色萎黄，下元虚惫，用加味六君子汤，送服断红丸，或者用十全大补汤去掉茯苓，加防风。如果是结阴证导致的便血，脉象必定虚涩，这是厥阴肝血内结，阳气失去统摄运化功能，渗入肠间。各家说法认为是阴寒内结，是不对的。应遵循《医宗必读》的说法，用补中益气汤，加倍黄芪，加炮姜。如果素来有血症，因感受湿热，血液排出呈紫黑色，这是湿毒蕴结肠道，用升阳益胃汤。凡是便血及肠风服药无效的，用山楂子散。如果大便干燥结硬，肛门处出血，可用熟地黄一两蒸熟食用。
〔肠风〕
血液清稀颜色鲜红，喷射四散如筛孔状，这是因为风性疏泄的缘故，经书说：久风入中，就会变成肠风飧泄。可用加减四物汤加秦艽，体质虚弱者用人参胃风汤。肠风夹湿，排泄物像豆汁一样。或者血色瘀紫，用升阳除湿防风汤，有热象的加黄连、当归、甘草。如果湿热内蕴，下血伴腹部胀满，用槐花散。初起血热，用槐花饮。日久则兼夹寒湿，用浓朴丸。血液滑泄不止，用惜红煎。脾脉浮缓，是土虚风湿交相侵犯，用加味六君子汤，十全大补汤。肠风兼有腹泻，用米豆散。
〔脏毒〕
血液浑浊颜色暗滞，系湿热蕴结毒气所致，轻症用猪脏丸，重症用脏连丸。酒毒酿成湿热导致下血，用聚金丸。如果肛门出血射如线状，或点滴不止，这是痔血，用秦艽白术丸去掉皂角、枳实、泽泻，加槐花、生地黄制成蜜丸。痔疮与痢疾出血，另在本门详细记载。
(Intestinal Wind [Appendix: Visceral Toxin])
Hematochezia (bleeding from the rectum) differs from bloody dysentery. Hematochezia is a chronic condition, whereas bloody dysentery arises from a recent pathogenic invasion and is often accompanied by pus. It is also distinctly different from Intestinal Wind and Visceral Toxin. Hematochezia is caused by an excess of Fire; Intestinal Wind by an excess of Wind; Visceral Toxin by an excess of Damp-Heat, compounded by accumulated toxins. Hematochezia results from intestinal and stomach fire damaging the Yin collaterals, causing blood to mix with stool. Treatment must be differentiated based on whether the bleeding site is distant or proximate, the deficiency or excess nature of the syndrome, and whether the condition is new or chronic. One cannot indiscriminately employ methods to cool the blood or astringe bleeding. *Jingui Yaolue* states that bleeding occurring after defecation is "distant blood," treated with Huangtu Tang (Yellow Earth Decoction); bleeding occurring before defecation is "proximate blood," treated with Chixiaodou Danggui Tang (Adzuki Bean and Angelica Decoction). If the blood color is bright red and thick, it indicates excess heat forcing blood to flow recklessly, often caused by excessive consumption of rich wine and strong flavors; Yueying Jian (Restraining Bleeding Decoction) and Diyuan Wan (Sanguisorba Pill) are indicated. If the blood is thin and pale, it indicates spleen-stomach deficiency-cold; Guishao Yigong San (Angelica and Paeonia Modified Six Gentlemen Powder) with roasted Shengjiang (Prepared Ginger) is indicated. If the blood is dark and dull, it indicates yang deficiency failing to control the blood. If caused by cold invading the middle jiao or consuming cold foods, leading to qi stagnation and blood coagulation, abdominal pain, vomiting, and diarrhea will necessarily occur; Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) with doubled roasted Shengjiang is indicated. If excessive thinking damages the heart and spleen, leading to qi failing to control blood, or if due to old age and chronic illness, Guipi Tang (Restore the Spleen Decoction) is indicated. Only in the initial stage where latent fire resides in the blood can one use Longyan Rou (Longan Aril) and Yakudanzi Rou (Buckthorn Seed Aril, coated), ten pieces each, divided into two doses, effective after four to five administrations. If bleeding does not stop, Liuji Nu (Lysimachiae Herba), 5 qian, Songluo Cha (Usnea Tea), 1 qian, and Wumei Rou (Mume Fruit Aril), one piece, decocted and taken orally, is effective. If prolonged illness leads to qi sinking and blood depletion, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used. If blood slips out uncontrollably, Juyuan Jian (Raise the Source Decoction) administered with Yuguan Wan (Jade Gate Pill) is used. If the complexion is sallow and the lower origin is deficient and exhausted, Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction) is used, or Duanhong Wan (Stop Red Pill) is administered; alternatively, Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with Fuling (Poria) removed and Fangfeng (Saposhnikovia Root) added is used. In cases of Jieyin hematochezia, the pulse is necessarily deficient and choppy. This is due to liver blood binding internally in the Jueyin channel, with yang losing its controlling and transforming function, allowing blood to seep into the intestines. Various schools claim this is internal binding of yin-cold, which is incorrect. Following *Yitong*, Buzhong Yiqi Tang with doubled Huangqi (Astragalus Root) and roasted Shengjiang is used. For those with a history of blood disorders who contract damp-heat, resulting in purple-black blood discharge, this is damp-toxin binding in the intestines; Shengyang Yizhe Tang (Raise Yang and Benefit Stomach Decoction) is used. For any hematochezia or Intestinal Wind unresponsive to medication, Shanlizhi San (Hawthorn Seed Powder) is indicated. For dry and hard stools with bleeding from the anus, Shudi (Rehmannia Root), 1 liang, steamed and eaten, is used.
[Intestinal Wind]
The blood is clear and bright red, shooting out in all directions like a sieve, reflecting the dispersing nature of wind. The classics state: "When wind remains long and enters the interior, it becomes Intestinal Wind with undigested food diarrhea." Jiawei Siwu Tang (Modified Four Substances Decoction) with Qinjiao (Gentiana Macrophylla Root) is used; for deficiency, Renshen Weifeng Tang (Ginseng Defending Against Wind Decoction) is used. When Intestinal Wind combines with dampness, the discharge resembles bean curd dregs. If the blood is dark purple, Shengyang Chushi Fangfeng Tang (Raise Yang, Drain Dampness, and Saposhnikovia Decoction) is used; if there is heat, add Huanglian (Coptis Rhizome), Danggui (Angelica Sinensis Root), and Gancao (Licorice Root). If damp-heat is internally accumulated, causing bloody discharge with abdominal fullness, Huaihua San (Sophora Flower Powder) is used. For initial blood heat, Huaihua Yin (Sophora Flower Drink) is used. Over time, cold-dampness may combine; Nongpo Wan (Magnolia Bark Pill) is used. If blood slips out uncontrollably, Xihong Jian (Cherishing Red Decoction) is used. A floating and moderate spleen pulse indicates earth deficiency with wind-dampness attacking; Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction) or Shiquan Dabu Tang (Ten Complete Tonifying Decoction) are used. When Intestinal Wind is accompanied by diarrhea, Midou San (Rice and Bean Powder) is used.
[Visceral Toxin]
The blood is turbid and dark, caused by damp-heat accumulating into toxin. For mild cases, Zhuzang Wan (Pig Viscera Pill) is used; for severe cases, Zalian Wan (Intestine-Lining Pill) is used. For bloody discharge caused by alcohol toxicity generating damp-heat, Ju Jin Wan (Gathering Metal Pill) is used. If blood shoots from the anus like a thread or drips continuously without stopping, this is hemorrhoidal bleeding. Use Qinjiao Baizhu Wan (Gentiana and Atractylodes Macrocephala Pill) removing Zaocis (Zaocis), Zhishi (Immature Bitter Orange), and Zexie (Alisma Rhizome), adding Huaihua (Sophora Flower) and Shengdi Huang (Rehmannia Root), formed into honey pills. Hemorrhoids and bloody dysentery are detailed separately in their respective sections.