〔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）
【戴元礼论述】妇女因脏腑受损，风邪容易侵入。凡是体内有热气，会导致下部出血；体内有风气，也会导致大便下血，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（在直肠或结肠深处）；在排便之前就有血出来的，说明病位较近（在肛门附近）。“远近”是指疾病发生在消化道的上端或下端。如果妇女面色苍白无血色，时而发冷时而发热，脉象浮而弱，重按则感觉脉搏消失的，这是下部出血的症状。
【薛己论述】上述病症，或者由于饮食起居不当，或者由于六淫（风、寒、暑、湿、燥、火）和七情（喜、怒、忧、思、悲、恐、惊）失调，导致元气亏损，阳络（位于上部的脉络，此处泛指体表或上部易受伤的血管/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。
有一个妇人下血不止，面色萎黄，四肢畏寒怕冷，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，便后稍缓，我用三黄汤加大黄至四两才见效，后来继续用三黄汤又服二十多剂才痊愈。这类元气大虚的病例，百中难遇一二。韩地官的妻子脾胃素来虚弱，因为饮食停滞，服用了攻伐消导的药物，导致自汗、身体冰冷、气短喘急、腹痛便血。有人使用各种补药，都不见效。我用人参、炮附子各五钱，服用两剂后稍有起色，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，服用数剂后才彻底康复。另一个妇人因为愤怒导致胸膈痞闷，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，所有症状顿时痊愈，后来又用八珍汤加柴胡、炒栀子，完全康复。
加减四物汤：治疗肠风下血。
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）。
以上药材用生姜水煎服。
肠风黑神散：治疗肠风下血，腹痛后重，或肛门脱出。
败棕（烧焦）、木馒头（烧焦）、乌梅（去核）、粉草（炙，各一钱）。
以上药材用水煎服。
愚按：前两种证候如果病程长久且中气虚弱者，必须以培补脾胃为主。
地榆汤：治疗阴结便血。（骆龙吉方）
地榆（四两）、甘草（炒，一两半）、缩砂仁（四十七粒）。
以上每次服用三钱，用水煎服。
[ Dai Yuanli's Discussion ] Women, due to damage to their Zang-Fu organs, are susceptible to invasion by Wind pathogenic factors. Whenever Heat Qi resides internally, it causes bleeding from the lower orifices; when Wind Qi resides internally, it also leads to blood in the stool, which may resemble bean juice, accompanied by abdominal pain. If bleeding occurs after defecation, the source is distant (located higher up in the intestines); if bleeding occurs before defecation, the source is near (located close to the anus). "Distant" and "near" refer to whether the disease is located in the upper or lower parts of the tract. If a woman presents with a pale complexion lacking luster, alternating chills and fever, a floating and weak pulse that disappears upon deep pressure, this indicates bleeding from the lower orifices.
[Xue Ji's Discussion] The aforementioned syndromes may result from improper diet and lifestyle, or from disharmony of the Six Exogenous Pathogens (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Overthinking, Sorrow, Fear, Fright), leading to depletion of 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) plus Chai Hu (Bupleuri Radix), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (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 overthinking 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) plus Ce Bai Ye (Biota Top Leaf), Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), and Zhi Ke (Aurantii Fructus Immaturus). If caused by Blood-Heat in the Large Intestine, use Si Wu Tang (Four Substances Decoction) plus 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) plus 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 bleeding, a sallow complexion, and cold intolerance in the four limbs; this was 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. Lady Zhang of the Guanglu Temple suffered from bleeding, irritability, thirst, and a sensation of heaviness and bearing down during defecation, which relieved slightly after passing stool. I used San Huang Tang (Three Yellows Decoction) with Da Huang (Rhei Radix et Rhizoma) increased to four liang, which only took effect at this dosage; subsequently, she continued taking San Huang Tang (Three Yellows Decoction) for more than twenty additional doses until recovery. Such cases of severe Original Qi depletion are rare, occurring perhaps once in a hundred. The wife of Official Han had inherently 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 without success. I used Ren Shen (Ginseng Radix) and Pao Fu Zi (Prepared Aconiti Lateralis Radix), each five qian. 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. I then used the previous formula, adding one qian of Fu Zi (Aconiti Lateralis Radix Praeparata) per dose, and she recovered after several doses. Another woman developed chest oppression and poor appetite due to anger. After taking herbs for digestion and moving Qi, she developed phlegm-wheezing, chest fullness, and bloody stool. I used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma), and Pao Jiang (Zingiberis Rhizoma Preparatum). After four doses, all symptoms resolved abruptly. She then took Ba Zhen Tang (Eight Treasures Decoction) plus Chai Hu (Bupleuri Radix) and Chao Zhi Zi (Gardeniae Fructus Preparatus) for complete recovery.
Jia Wei Si Wu Tang (Modified Four Substances Decoction): Treats Chang Feng (Intestinal Wind) bloody stool.
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 Ke (Aurantii Fructus Immaturus, bran-fried), Sheng Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma, each 1 qian).
Decoct these ingredients with water infused with fresh ginger and take orally.
Chang Feng Hei Shen San (Intestinal Wind Black Spirit Powder): Treats Chang Feng (Intestinal Wind) bloody stool, abdominal pain with tenesmus, or prolapse of the anus.
Bai Zong (Burnt Palm Fiber), Mu Man Tou (Burnt Adenophorae Radix), Wu Mei (Mume Fruit, pitted), Fen Cao (Licorice Root, honey-fried, each 1 qian).
Decoct these ingredients with water and take orally.
Commentary: For the aforementioned two conditions, if the disease has been prolonged and Middle Qi is deficient, treatment must primarily focus on fortifying the Spleen and Stomach.
Di Yu Tang (Sanguisorba Decoction): Treats Yin-Jie (Yin Knot) bloody stool. (Formula from Luo Longji)
Di Yu (Sanguisorbae Radix, 4 liang), Gan Cao (Licorice Root, stir-fried, 1.5 liang), Suo Sha Ren (Amomi Fructus Rotundus, 47 grains).
Take 3 qian per dose, decoct with water.
Fang Feng Ru Shen San (Saferwind Like-God Powder): Treats Wind-Heat and Qi stagnation causing bloody stool after defecation.
Fang Feng (Saposhnikoviae Radix), Zhi Ke (Aurantii Fructus Immaturus, bran-fried, equal parts).
Take 3 qian per dose, decoct with water.
Miao Xiang San (Miraculous Fragrance Powder): Treats Heart-Qi bloody stool. Take mixed with warm wine. (See Miscellaneous Diseases: Heart Pain)