血之在身，有阴有阳，阳者顺气而行，循流脉中，调和五脏，洒陈六腑，如是
者谓之荣血也。阴者居于络脉，专守脏腑，滋养神气，濡润筋骨。若其脏感内外之
邪，伤则或循经之阳血至其伤处，为邪气所阻，漏泄经外；或居络之阴血，因着留
之邪，僻裂而出，则皆渗入肠胃而泄矣。世俗每见下血，率以肠风名之，不知风乃
六淫中之一耳。或风有从肠胃经脉而入客者，或肝经风木之邪内乘于肠胃者，则可
谓之肠风。若其他不因风邪而肠胃受火热二淫，与寒燥湿怫郁其气，及饮食用力过
度，伤其阴络之血者，亦谓之肠风可乎。许学士谓下清血色鲜者，肠风也。血浊而
色黯者，脏毒也。肛门射如血线者，脉痔也。然肠风挟湿者，亦下如豆汁及紫黑瘀
血，不必尽鲜，正当以久暂为别耳。然要之皆俗名也。世医编书者，或以泻血为肠
风，或分泻血与肠风脏毒为二门，皆非也。先血而后便，此近血也。由手阳明随经
下行，渗入大肠，传于广肠而下者也。赤小豆当归散主之。先便而后血，此远血也。
由足阳明随经入胃，淫溢而下者也。黄土汤主之。下血腹中不痛，谓之湿毒下血，
血色不鲜，或紫黑，或如豆汁，黄连汤主之。下血腹中痛，谓之热毒下血，血色鲜，
芍药黄连汤主之。东垣治宿有肠血症，因五月大热吃杏，肠 下血远三四尺，散漫
如筛，腰沉沉然，腹中不痛，血色紫黑，是阳明、少阳经血证，升麻补胃汤。（湿毒）
太阴阳明腹痛，大便常溏泄，若不泄，即秘而难见，在后传作湿热毒，下鲜红血，
腹中微痛，胁下急缩，脉缓而洪弦，中指下得之，按之空虚，和中益胃汤。（湿热）肠
下血，另作一派，其血HT 出有力而远射，四散如筛下，腹中大作痛，乃阳明
气冲热毒所作也。升阳除湿和血汤。（湿热）肠 下血，红或深紫黑色，腹中痛，
腹皮恶寒，右三部脉，中指下得之俱弦，按之无力，关脉甚紧，肌表阳明分凉，腹
皮热，而喜热物熨之，内寒明矣，益智和中汤。（挟寒）夫肠 者，为水谷与血另作
一派，如HT 桶涌出也。夏湿热太甚，正当客气盛而主气弱，故肠 之病甚也。以凉
血地黄汤主之，黄柏、知母炒各一钱，青皮炒、槐子炒、当归、熟地各五分，水一
盏，煎七分，温服。如小便涩，脐下闷，或大便前后重，调木香、槟榔细末各半钱，
稍热于食前空心服。如里急后重又不去者，当下之。如腹中动摇有水声，而小便不
调者，停饮也。诊是何脏，以去水饮药泻之，假令脉洪大，用泻火利小便之类是也。
如胃虚不能食而大渴不止，不可用淡渗之药止之，乃胃中元气少故也。与七味白术
散补之。如发热恶热，烦躁，大渴不止，肌热不欲近衣，其脉洪大，按之无力，或
无目痛鼻干者，非白虎汤证也。此血虚发躁，当以黄 一两，当归二钱， 咀，水
煎服。如大便秘塞，或里急后重，数至圊而不能便，或少有白脓，或少有血，慎勿
利之，利之则必致病重及郁结不通，以升阳除湿防风汤，升其阳则阴气自降矣。《素
问》云∶结阴者，便血一升，再结二升，三结三升。骆龙吉云∶结阴之病，阴气内
结，不得外行，血无所禀，渗入肠间，故便血也，其脉虚涩者是也。因血结不行故
下，古方有结阴丹。罗谦甫治因强饮酸酒得腹痛，次传泄泻，十余日便后见血，或
红或紫，肠鸣腹痛，服凉药如故，仍不欲食，食则呕酸，心下痞，恶冷物，口干烦
躁，不得安卧，其脉弦细而微迟，手足稍冷，以平胃地榆汤，温中散寒，除湿和胃，
数服病减大半，又灸中脘二七壮，引胃气上升，次灸气海百壮，生发元气。灸则强
食生肉，又以还少丹服之，至春再灸三里二七壮，温脾壮胃生发元气，次服芳香之
剂，慎言语节饮食而愈。八物汤去生地黄、甘草，加官桂，名胃风汤，治风冷乘虚
入客肠胃，水谷不化，泄泻注下，及肠胃湿毒，下如豆汁，或下瘀血，日夜无度，
盖亦结阴之类也。为阴气内结，故去甘寒而加辛热，结者散之也。洁古云∶如下血，
防风为上使，黄连为中使，地榆为下使。若血瘀色紫者，陈血也，加熟地黄。若血
鲜色红者，新血也，加生地黄。若寒热者，加柴胡。若肌热者，加地骨皮。此证乃
甲欺戊也，风在胃口中焦，湿泄不止，湿既去尽而反生燥，庚欺甲也。本无金气，
以甲胜戊亏，庚为母复 也。故经曰亢则害承乃制，是反制胜己之化也。若脉洪实
痛甚者，加酒浸大黄。戴复庵以色鲜为热，色瘀为寒。热血，连蒲散，寒血，理物
汤。血色鲜红者，多因内蕴热毒，毒瓦斯入肠胃，或因饮酒过多，及啖糟脏炙爆，引
血入大肠，故泻鲜血，宜连蒲散吞黄连阿胶丸，及香连丸，或一味黄连煎饮。大泻
不止者，四物汤加黄连、槐花，仍取血见愁草少许，生姜捣取汁和米饮服。于血见愁
草中，加入侧柏叶、与生姜同捣汁尤好。有暑毒入肠胃下血者，一味黄连煎汤饮。
肠风下血，以香附末加百草霜，米饮调服。加入麝香少许，其应尤捷。冷气入客肠
胃下瘀血，理中汤不效，宜黑神散米饮调下，或用胶艾汤加米汤煎，吞震灵丹。
扑内损，恶血入肠胃，下出浊物如瘀血者，宜黑神散加老黄茄为末酒调。酒积下血
不止，粪后见，用神面一两半，白酒药二丸，同为末，清水调捏作饼子，慢火上炙
黄为细末。每服二钱，白汤调下。亦治泄泻。海藏治梅师大醉，醒发渴，饮水及冰
茶后，病便鲜红，先与吴茱萸丸，翌日又与平胃、五苓各半散三大服，血止复自利，
又与神应丸四服，自利乃止。或问何不用黄连之类以解毒，曰若用寒药，其疾大变，
难治。寒饮内伤，复用寒药，非其治也。况血为寒所凝，入大肠间而便下血，温之
乃行，所以得热则自止。唐生病因饮酪水及食生物，下利紫黑血十余行，脾胃受寒
湿毒，与六神平胃散半两，加白术三钱，以利腰脐间血，一服愈。《撄宁生卮言》云∶
肠风则足阳明积热久而为风，风有以动之也。脏毒则足太阴积热久而生湿，从而下
流也。风则阳受之，湿则阴受之。戴氏《要诀》云∶脏毒者，蕴积毒瓦斯久而始见；
肠风者，邪气外入随感随见。《三因方》五痔、脏毒、肠风之辩甚详，脏毒、肠风之
血出于肠脏间，五痔之血出于肛门蚀孔处，治各不同。（无择翁乌连汤，治脉痔，外无形而所下血
一线如箭，或点滴不能已，此由脉窍中来也，详见痔门。）肠风、脏毒不拘粪前粪后，并宜
米饮汤调枳壳散，下酒煮黄连丸，或枳壳散下乌梅丸。此乃因登厕粪中有血，却与泻血不同，或
用小乌沉汤和黑神散，米饮调下。血色清鲜者，以瓦松烧灰研细，米饮调服，宜减
桂五苓散加茅花半钱，吞荆梅花丸，仍以侧柏叶同姜捣烂，冷水解下，侵些米饮佳。
如血色淡浊者，胃风汤吞蒜连丸，或乌荆丸，或棕灰散，仍以米饮调香附末，或三
灰散。肠风，腹中有痛，下清血，先当解散肠胃风邪，甚者肛门肿疼，败毒散加槐
角、荆芥，或槐花汤、枳壳散。脏毒腹内略疼，浊血兼花红脓并下，或肛门肿胀，
或大肠头突出，大便难通，先以拔毒疏利之剂，追出恶血脓水，然后以内托并凉血
祛风量用，人虚兼以参、 、苓、术助养胃气。诸般肠风脏毒，并宜生银杏四十九
个，去壳膜烂研，入百药煎末，丸如弹子大。每两三丸，空心细嚼米饮下。下血久，
面色痿黄，渐成虚惫，下元衰弱，宜黄 四君子汤下断红丸，或十全大补汤，或黄
饮。
【中蛊脏腑败坏下血】如鸡肝，如烂肉，其证唾水沉，心腹绞痛者是也。治之
方，马蔺根末，水服方寸匕，随吐则出。白 荷叶，密安病患席下，勿令病患知
觉，自呼蛊主姓名。蚯蚓十四枚，以苦酒三升渍之，服其汁。 毛烧末，水服方寸
匕。（吐毒） 苦瓠一枚，水二升，煮取一升服。吐或用苦酒一升，煮瓠令消，服之。
【诊】肾脉小搏沉为肠 下血，血温身热者死。淫而夺精，身热色夭然，及酒
后下血，血笃重是逆也。心肝 亦下血，二脏同病者可治，其脉小沉涩为肠 ，其
身热者死，热见七日死。身热则死，身寒则生。脉悬绝则死，滑大则生。脉沉小留
连者生，数疾且大有热者死。腹胀便血，脉大时绝，是逆也，如此者不及一时而死
矣。胃移热于脾，传为虚，肠 ，死不治。脾脉外鼓，沉为肠 ，久自已。肝脉小
缓为肠 ，易治。
血液在人体内有阴血和阳血之分。阳血顺着气机运行，在脉管中流动，调和五脏，布散于六腑，这样的血称为营血。阴血居于络脉之中，专门守护脏腑，滋养神气，濡润筋骨。如果脏腑受到内外邪气的侵袭，受损后，原本循经运行的阳血到达损伤部位，被邪气阻滞，就会渗漏到经脉之外；或者居住在络脉中的阴血，因为留着不去的邪气，导致脉络破裂而出，这两种情况都会使血液渗入肠胃而排出体外。世俗之人每当见到下血症状，通常都称之为“肠风”，却不知道“风”只是六淫邪气中的一种。只有当风邪从肠胃经脉侵入客居体内，或者肝经的风木之邪内侵肠胃时，才可以称之为肠风。如果是其他并非因风邪引起，而是肠胃受到火热二邪侵袭，或者寒、燥、湿等邪气郁结阻碍气机，以及饮食过度、用力过猛损伤了阴络之血的情况，难道也能称之为肠风吗？许学士说：大便下清亮鲜红的血，是肠风；血色浑浊且颜色暗黑的，是脏毒；肛门出血像射出的血线一样的，是脉痔。然而，肠风夹带湿邪的，也会排出像豆汁一样的液体及紫黑色的瘀血，不一定都是鲜红色的，应当以病程的久暂来区分罢了。总之，这些都是民间俗称。世上的医家编写书籍时，有的将泻血等同于肠风，有的将泻血与肠风、脏毒分为两个门类，这都是不对的。先出血而后排便的，这叫近血。这是由手阳明大肠经随经下行，血液渗入大肠，传导至广肠（直肠）而下泄的。用赤小豆当归散主治。先排便而后出血的，这叫远血。这是由足阳明胃经随经入胃，血液溢流而下造成的。用黄土汤主治。下血但腹中不痛的，叫做湿毒下血，血色不新鲜，或紫黑，或像豆汁一样，用黄连汤主治。下血且腹中疼痛的，叫做热毒下血，血色鲜红，用芍药黄连汤主治。李东垣治疗一位素有肠风血症的患者，因为在五月大热天吃了杏子，导致肠道下血，距离三四尺远，散漫如筛孔般流出，腰部沉重感明显，腹中不痛，血色紫黑，这是阳明经、少阳经的血证，用升麻补胃汤治疗。（湿毒型）太阴、阳明经腹痛，大便经常溏泄，如果不泄，就会便秘且难以排出，后来转化为湿热毒，排出鲜红色的血，腹中微痛，胁下拘急收缩，脉象缓而洪弦，在中指下方诊得，按之空虚，用和中益胃汤治疗。（湿热型）肠道下血，另外形成一种情况，其血涌出有力且射程远，四散如筛孔般落下，腹中剧烈疼痛，这是阳明经气冲热毒所致。用升阳除湿和血汤治疗。（湿热型）肠道下血，血色红或深紫黑色，腹中痛，腹部皮肤怕冷，右手关前、关、关后三部脉，在中指下方诊得均呈弦象，按之无力，关脉特别紧，肌表属阳明分部的地方发凉，腹部皮肤发热，喜欢用热物熨烫，这显然是内部有寒。用益智和中汤治疗。（挟寒型）所谓肠风，是指水谷与血液另成一派，像从桶里涌出一样。夏季湿热太盛，正当客气强盛而主气虚弱的时候，所以肠风病发作严重。用凉血地黄汤主治：黄柏、知母炒各一钱，青皮炒、槐子炒、当归、熟地各五分，水一盏，煎至七分，温服。如果小便涩滞，脐下闷胀，或者大便前后有重坠感，调服木香、槟榔细末各半钱，稍微加热，在饭前空腹服用。如果里急后重仍然不缓解，应当攻下。如果腹中有动摇的水声，且小便不调，这是停饮（水液停滞）。诊断是哪一脏的问题，用水饮药泻除它，例如脉象洪大，就用泻火利小便的药物。如果胃虚不能进食且大渴不止，不可用淡渗利尿的药来止渴，这是因为胃中元气不足。用七味白术散来补益。如果出现发热恶热、烦躁、大渴不止、肌肤发热但不想靠近衣被，脉象洪大但按之无力，或者没有目痛鼻干等症状的，不是白虎汤证。这是血虚导致的烦躁，当用黄芪一两，当归二钱，切碎，水煎服。如果大便秘结，或者里急后重，多次去厕所却不能排便，或者仅有少量白脓，或者仅有少量血，千万不要使用泻下药，否则必然导致病情加重及郁结不通，应用升阳除湿防风汤，提升阳气则阴气自然下降。《素问》说：结阴病，便血一升，再次结阴便血二升，三次结阴便血三升。骆龙吉说：结阴的病，是阴气在内结聚，不能向外运行，血液无所禀受，渗入肠间，所以便血，其脉象虚涩的就是这种病。因为血结行不通所以下血，古方有结阴丹。罗谦甫治疗因强行饮用酸酒导致腹痛，随后转为泄泻，十余天后大便后见血，血色或红或紫，肠鸣腹痛，服用凉药后依然如故，仍然不想吃东西，吃东西就呕吐酸水，心下痞满，厌恶冷物，口干烦躁，无法安卧，脉象弦细而微迟，手脚稍冷，用平胃地榆汤，温中散寒，除湿和胃，服用几剂后病减大半，又灸中脘穴十四壮，引导胃气上升，接着灸气海穴一百壮，生发元气。艾灸后要多吃食物以生长肌肉，又服用还少丹，到了春天再灸足三里穴十四壮，温脾壮胃生发元气，接着服用芳香类药物，注意言语节制饮食而痊愈。八物汤去掉生地黄、甘草，加入官桂，名为胃风汤，治疗风冷乘虚侵入肠胃，水谷不化，泄泻注下，以及肠胃湿毒，下血像豆汁，或下瘀血，日夜无度，这也属于结阴的一类。因为是阴气在内结聚，所以去掉甘寒的药物而加入辛热的药物，目的是结者散之。洁古说：如下血，防风为上使药，黄连为中使药，地榆为下使药。如果血瘀色紫的，是陈血，加熟地黄。如果血色鲜红的，是新血，加生地黄。如果有寒热症状的，加柴胡。如果肌肤发热的，加地骨皮。此证乃是甲（风/肝木）欺戊（土/脾胃），风在胃口中焦，湿泄不止，湿气去除干净后反而产生燥，这是庚（金/肺）欺甲（木/肝）。本无金气，是因为甲胜戊亏，庚作为母亲来报复。所以经文说亢盛则有害，承制才能制约，这是反制胜己之化的表现。如果脉象洪实且疼痛严重的，加酒浸大黄。戴复庵认为血色鲜为热，血色瘀为寒。热血用连蒲散，寒血用理物汤。血色鲜红的，多因体内蕴积热毒，毒瓦斯进入肠胃，或因饮酒过多，以及吃糟粕、内脏、烤肉、油炸食品，引血入大肠，所以泻鲜血，宜吞服连蒲散、黄连阿胶丸，及香连丸，或单味黄连煎汤饮用。大泻不止的，用四物汤加黄连、槐花，仍取少许血见愁草，生姜捣取汁与米饮混合服用。在血见愁草中，加入侧柏叶，与生姜同捣取汁更好。有暑毒进入肠胃导致下血的，单味黄连煎汤饮用。肠风下血，用香附末加百草霜，米饮调服。加入少许麝香，效果尤其迅速。冷气侵入肠胃导致下瘀血，理中汤无效，宜用黑神散米饮调下，或用胶艾汤加米汤煎，吞服震灵丹。跌打内伤，恶血进入肠胃，排出浊物如瘀血的，宜用黑神散加老黄茄研末，酒调服。酒积下血不止，粪便后见血，用神面一两半，白酒药二丸，同为末，清水调捏作饼子，慢火上烤黄为细末。每服二钱，白开水调下。也治疗泄泻。海藏治疗梅师大醉，醒来口渴，饮水及冰茶后，出现便鲜红血，先给予吴茱萸丸，第二天又给予平胃散、五苓散各半散三大服，血止后又自利，又给予神应丸四服，自利才停止。有人问为什么不用黄连之类来解毒，回答说如果用寒药，疾病会大变，难治。寒饮内伤，再用寒药，不是正确的治疗方法。况且血为寒所凝，进入大肠间而便下血，温之则行，所以得到热则自然停止。唐生病因喝酪浆水及吃生冷食物，下利紫黑血十余次，脾胃受寒湿毒，给予六神平胃散半两，加白术三钱，以通利腰脐间的血，一服即愈。《撄宁生卮言》说：肠风则是足阳明积热久而化为风，风动之所致。脏毒则是足太阴积热久而生湿，随之向下流注。风则阳受之，湿则阴受之。戴氏《要诀》说：脏毒是蕴积毒瓦斯久而始见；肠风是邪气外入随感随见。《三因方》对五痔、脏毒、肠风的辨析非常详细，脏毒、肠风的血出于肠脏之间，五痔的血出于肛门蚀孔处，治疗各不相同。（无择翁乌连汤，治疗脉痔，外部无形态变化而所下血一线如箭，或点滴不停，此由脉窍中来也，详见痔门。）肠风、脏毒不拘粪前粪后，都宜用米饮汤调服枳壳散，送服酒煮黄连丸，或枳壳散送服乌梅丸。这是因为上厕所发现粪中有血，却与泻血不同，或者用小乌沉汤和黑神散，米饮调下。血色清鲜的，用瓦松烧灰研细，米饮调服，宜减桂五苓散加茅花半钱，吞服荆梅花丸，仍以侧柏叶同姜捣烂，冷水送下，掺些米饮更佳。如果血色淡浊的，用胃风汤吞服蒜连丸，或乌荆丸，或棕灰散，仍以米饮调服香附末，或三灰散。肠风，腹中有痛，下清血，先当解散肠胃风邪，严重的肛门肿疼，用败毒散加槐角、荆芥，或槐花汤、枳壳散。脏毒腹内略疼，浊血兼花红脓并下，或肛门肿胀，或大肠头突出，大便难通，先以拔毒疏利的药剂，追出恶血脓水，然后以内托并凉血祛风的方法使用，人虚兼以参、芪、苓、术助养胃气。各种肠风脏毒，都宜用生银杏四十九个，去壳膜烂研，入百药煎末，丸如弹子大。每服两三丸，空心细嚼米饮下。下血日久，面色萎黄，渐成虚惫，下元衰弱，宜用黄芪四君子汤送服断红丸，或十全大补汤，或黄饮。
【中蛊脏腑败坏下血】如鸡肝状，如烂肉状，其症状是唾水下沉，心腹绞痛的是这种情况。治疗的方子，马蔺根末，水服方寸匕，随呕吐则毒物吐出。白荷叶，秘密安放在病人席子下面，不要让病人知道，自然会呼叫蛊主的姓名。蚯蚓十四枚，用苦酒三升浸泡，服用其汁液。[毛]烧成末，水服方寸匕。（吐毒）苦瓠一枚，水二升，煮取一升服用。催吐可用苦酒一升，煮瓠令消，服用。
【诊法】肾脉小搏沉为肠道下血，血温身热的预后不良。淫邪夺精，身体发热面色枯槁，以及酒后下血，血质稠厚沉重的属于逆证。心肝二脏也下血，二脏同病的可治，其脉小沉涩为肠道下血，其身热的预后不良，热见七日死。身热则死，身寒则生。脉悬绝则死，滑大则生。脉沉小留连者生，数疾且大有热者死。腹胀便血，脉大时而中断，是逆证，像这样的人不到一个时辰就会死亡。胃移热于脾，传变为虚，肠道下血，死不治。脾脉外鼓，沉为肠道下血，久了自己会好。肝脉小缓为肠道下血，易治。
Blood in the body is divided into Yin blood and Yang blood. Yang blood follows Qi movement, flows within the vessels, harmonizes the Zang organs, and distributes to the Fu organs; such blood is called Ying blood (Nutritive Blood). Yin blood resides in the collateral vessels, specifically guarding the Zang organs, nourishing Shen (Spirit), and moistening sinews and bones. If a Zang organ is affected by internal or external pathogenic factors, damage occurs, and the Yang blood that normally follows the meridians reaches the injury site, where it is blocked by pathogens, leaking out of the meridians; or the Yin blood residing in the collaterals, due to lingering pathogens, causes the vessels to rupture and bleed. Both situations result in blood seeping into the intestines and stomach and being discharged. Laypeople often refer to lower gastrointestinal bleeding simply as "Chang Feng" (Intestinal Wind), not realizing that "Wind" is merely one of the Six Excesses (Six Pathogenic Factors). Only when Wind pathogen enters from the intestinal and gastric meridians to lodge inside, or when Liver Meridian Wind-Wood pathogen invades internally into the intestines and stomach, can it be termed Chang Feng. If other cases are not caused by Wind pathogen but rather by Heat-Fire two excesses invading the intestines and stomach, or by Cold, Dryness, or Dampness stagnating and obstructing Qi, or by excessive diet and overexertion damaging the Yin collateral blood, can these also be called Chang Feng? Scholar Xu stated: Clear, bright red blood in stool indicates Chang Feng; turbid, dark-colored blood indicates Zang Du (Visceral Toxin); blood shooting from the anus like a thread indicates Mai Zhi (Vascular Hemorrhoid). However, Chang Feng combined with Dampness may also discharge fluid resembling bean dregs and purple-black stasis blood, not necessarily always bright red; differentiation should be based on duration. In essence, these are common folk names. Medical writers sometimes equate hematochezia with Chang Feng, or separate hematochezia from Chang Feng and Zang Du into different categories, which is incorrect. Bleeding before defecation is called Jin Xue (Close Blood). This occurs when Hand Yangming Large Intestine Meridian Qi descends along the channel, allowing blood to seep into the large intestine and transmit to the Guang Chang (rectum) for discharge. It is treated with Xiaodou Chi Dang Gui San (Adzuki Bean and Angelica Decoction). Defecation before bleeding is called Yuan Xue (Distant Blood). This occurs when Foot Yangming Stomach Meridian Qi enters the stomach, causing blood to overflow and descend. It is treated with Huang Tu Tang (Yellow Earth Decoction). Lower GI bleeding without abdominal pain is called Shi Du Xia Xue (Damp-Toxin Lower Bleeding); the blood color is not fresh, possibly purple-black or like bean dregs, treated with Huang Lian Tang (Coptis Decoction). Lower GI bleeding with abdominal pain is called Re Du Xia Xue (Heat-Toxin Lower Bleeding); the blood is bright red, treated with Shao Yao Huang Lian Tang (Peony and Coptis Decoction). Li Dongyuan treated a patient with chronic Chang Feng syndrome who, after eating apricots during the intense heat of May, experienced intestinal bleeding projecting three to four chi away, spreading like a sieve, with a heavy sensation in the waist and no abdominal pain, purple-black blood. This was a Blood Syndrome of the Yangming and Shaoyang meridians, treated with Sheng Ma Bu Wei Tang (Cimicifuga Spleen-Nourishing Decoction). (Damp-Toxin type) Taiyin and Yangming meridian abdominal pain, frequent loose stools; if not loose, then constipation difficult to pass, later transforming into Damp-Heat Toxin, discharging bright red blood, slight abdominal pain, tightness under the ribs, pulse slow, surging, and wiry, felt under the middle finger, empty upon pressure. Treated with He Zhong Yi Wei Tang (Harmonize Middle and Benefit Stomach Decoction). (Damp-Heat type) Another presentation of intestinal bleeding involves blood gushing forcefully and far, scattering like a sieve, with severe abdominal pain, caused by Yangming Qi rushing Heat-Toxin. Treated with Sheng Yang Chu Shi He Xue Tang (Raise Yang, Dispel Dampness, Harmonize Blood Decoction). (Damp-Heat type) Intestinal bleeding with red or deep purple-black blood, abdominal pain, cold sensitivity of the abdominal skin, wiry pulses at all three positions on the right hand (felt under the middle finger), weak upon pressure, very tight Guan pulse, cool Yangming area on the body surface, hot abdominal skin preferring warm compresses, clearly indicating Internal Cold. Treated with Yi Zhi He Zhong Tang (Yi Zhi Harmonizing Middle Decoction). (Cold-Clasping type) "Chang Feng" refers to water/grain and blood forming a separate stream, gushing out like from a bucket. In summer, when Damp-Heat is excessive, the External Qi is strong while the Host Qi is weak, so Chang Feng disease worsens. Treated with Liang Xue Di Huang Tang (Cool Blood and Rehmannia Decoction): Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome) stir-fried, 1 qian each; Qing Pi (Aged Tangerine Peel) stir-fried, Huai Zi (Sophora Fruit) stir-fried, Dang Gui (Angelica Sinensis), and Shu Di Huang (Prepared Rehmannia Root) 0.5 qian each; decoct in one cup of water to 0.7 cup, take warm. If urine is涩 (astringent/difficult), sub-umbilical fullness, or heaviness before/after stool, mix Mu Xiang (Aucklandia) and Bing Lang (Areca Seed) fine powder, 0.5 qian each, slightly heat, take before meals on an empty stomach. If tenesmus persists, purgation is needed. If there is splashing water sound in the abdomen and irregular urination, this is Ting Yin (Fluid Retention). Diagnose which Zang organ is involved and purge the fluid retention; for example, if the pulse is surging-large, use fire-purging and diuretic herbs. If stomach deficiency prevents eating and extreme thirst persists, do not use bland-leaching drugs to stop thirst, as this is due to insufficient Yuan Qi in the stomach. Treat with Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Powder). If fever, aversion to heat, irritability, extreme thirst, hot skin desiring no clothing, surging-large pulse empty upon pressure, or absence of eye pain/nasal dryness, this is not Bai Hu Tang (White Tiger Decoction) syndrome. This is Irritability due to Blood Deficiency; treat with Huang Qi (Astragalus Root) 1 liang, Dang Gui 2 qian, chopped, decoct in water. If fecal impaction or tenesmus with frequent trips to toilet unable to pass stool, or small amounts of white pus/blood, do NOT use purgatives, as this will worsen condition and cause obstruction. Use Sheng Yang Chu Shi Fang Feng Tang (Raise Yang, Dispel Dampness, Saposhnikovia Decoction); raising Yang will naturally lower Yin. *Su Wen* states: Jie Yin (Knotted Yin) disease: first episode 1 sheng blood, second 2 sheng, third 3 sheng. Luo Longji said: Jie Yin disease involves Yin Qi knotting internally, unable to circulate externally; blood has no source, seeps into intestines causing hematochezia; pulse is deficient and choppy. Because blood knots and fails to move, it discharges; ancient formula includes Jie Yin Dan. Luo Qianfu treated a patient with abdominal pain from forcing sour wine, progressing to diarrhea, then blood after stool for 10+ days, red or purple, borborygmus, abdominal pain. Cooling herbs failed; anorexia, vomiting acid after eating, epigastric fullness, aversion to cold, dry mouth, irritability, insomnia. Pulse wiry-thin-micro-slow, hands/feet slightly cold. Treated with Ping Wei Di Yu Tang (Calm Stomach and Sanguisorba Decoction) to warm middle, scatter cold, dispel damp, harmonize stomach. After several doses, illness reduced significantly. Then moxa Zhong Wan (CV12) 14 times to raise Stomach Qi, then moxa Qi Hai (CV6) 100 times to generate Yuan Qi. After moxibustion, eat more to build flesh, take Huan Shao Dan (Return to Youth Pill). In spring, moxa Zu San Li (ST36) 14 times to warm spleen/stomach, generate Yuan Qi, then take aromatic agents, regulate speech/diet to recover. Ba Wu Tang minus Sheng Di Huang and Gan Cao, plus Guan Gui (Cinnamon Bark), named Wei Feng Tang, treats Wind-Cold invading stomach/intestines due to deficiency, undigested food, projectile diarrhea, and intestinal/gastric Damp-Toxin discharging bean-dreg-like blood or stasis blood day and night uncontrollably; this belongs to Jie Yin category. Due to internal Yin knotting, remove sweet-cold herbs and add pungent-hot herbs to "scatter the knotted." Jie Gu said: For lower bleeding, Fang Feng (Saposhnikovia) is Upper Envoy, Huang Lian (Coptis) is Middle Envoy, Di Yu (Sanguisorba) is Lower Envoy. If blood is stasis-purple, it is old blood; add Shu Di Huang. If blood is fresh-red, it is new blood; add Sheng Di Huang. If chills/fever present, add Chai Hu (Bupleurum). If skin heat present, add Di Gu Pi (Lycium Bark). This syndrome is Jia (Wood/Liver) overcoming Wu (Earth/Spleen-Stomach); Wind in Middle Jiao/Stomach-Mouth, Damp-diarrhea unceasing; once Damp is gone, Dryness arises, Geng (Metal/Lung) overcoming Jia (Wood). Originally no Metal Qi, but Jia overcomes deficient Wu, so Geng (Mother) retaliates. Hence scripture says: Excess causes harm, control brings balance; this is counter-control of self-transforming phase. If pulse is surging-solid and pain severe, add Jiu Jin Da Huang (Wine-Steamed Rhubarb). Dai Fuan stated: Bright color indicates Heat, Stasis color indicates Cold. Heat-Blood uses Lian Pu San (Coptis and Nymphaea Powder), Cold-Blood uses Li Wu Tang (Regulate Matter Decoction). Bright red blood often due to internal Heat-Toxin accumulation, toxic vapors entering intestines/stomach, or excessive alcohol, or eating fermented foods/offal/roasted/fried items drawing blood into large intestine, causing bright red diarrhea. Take Lian Pu San swallow Huang Lian E Jiao Wan (Coptis and Donkey-Hide Gelatin Pill) or Xiang Lian Wan (Aucklandia-Coptis Pill), or single herb Huang Lian decoction. For severe unceasing diarrhea, Si Wu Tang plus Huang Lian and Huai Hua (Sophora Flower), plus少许 Xue Jian Chou Cao (Herba Patriniae/Juniperus? Note: Context implies specific hemostatic herb), ginger juice mixed with rice drink. Adding Ce Bai Ye (Biota Tops) to Xue Jian Chou Cao and crushing with ginger for juice is better. Summer-Toxin entering intestines/stomach causing bleeding: Single Huang Lian decoction. Chang Feng bleeding: Xiang Fu (Cyperus) powder plus Bai Cao Shuang (Soot from Chimney), rice drink. Add少许 She Xiang (Musk) for faster effect. Cold Qi lodging in intestines/stomach causing stasis bleeding: If Li Zhong Tang ineffective, use Hei Shen San (Black Divine Powder) with rice drink, or Jiao Ai Tang (Collagen and Mugwort Decoction) with rice milk, swallow Zhen Ling Dan (Authentic Spirit Pill). Blunt trauma/internal injury, evil blood entering intestines/stomach, discharging turbid stasis: Hei Shen San plus Lao Huang Qie (Old Eggplant) powder, wine mix. Alcohol accumulation bleeding unceasing, post-stool blood: Shen Mian 1.5 liang, Bai Jiu Yao (White Wine Medicament) 2 pills, powder, water paste, bake yellow, powder. 2 qian per dose, white water mix. Also treats diarrhea. Hai Zang treated Master Mei after drunkenness, waking thirsty, drinking water/iced tea, then bright red stool. First gave Wu Zhu Yu Wan (Evodia Pill), next day Ping Wei San + Wu Ling San half-doses 3 times, blood stopped but self-diarrhea returned, then Shen Ying Wan 4 doses, diarrhea stopped. Question: Why not Huang Lian to detoxify? Answer: Cold herbs change disease nature, hard to treat. Cold-fluid injury using cold herbs is wrong. Blood congeals by cold; warming makes it move; heat stops it. Tang Bing drank cheese/water and ate raw food, purged purple-black blood 10+ times, Spleen/Stomach cold-damp toxin. Given Liu Shen Ping Wei San 0.5 liang + Bai Zhu 3 qian to benefit lumbar-umbilical blood, cured in one dose. *Ying Ning Sheng Zhi Yan* states: Chang Feng is Foot Yangming accumulated heat turning to Wind over time, moved by Wind. Zang Du is Foot Taiyin accumulated heat generating Dampness over time, flowing downward. Wind affects Yang, Damp affects Yin. Dai's *Yao Jue* states: Zang Du is toxin accumulation seen late; Chang Feng is external pathogen seen immediately. *San Yin Fang* details differentiation: Zang Du/Chang Feng blood from between intestine/viscera; Five Hemorrhoids blood from anal erosion holes; treatments differ. (Wu Ze Weng Wu Lian Tang treats Mai Zhi, no external shape, blood line like arrow or dripping endlessly, from vessel orifice, see Hemorrhoid section.) Chang Feng/Zang Du regardless of pre/post stool: Rice soup mix Zhi Ke San (Citrus Aurantium Powder), swallow Jiu Zhu Huang Lian Wan (Wine-Boiled Coptis Pill) or Zhi Ke San swallow Wu Mei Wan (Mume Pill). Different from simple hematochezia; or Xiao Wu Chen Tang + Hei Shen San, rice mix. Clear-bright blood: Wa Song (Tile Moss) burnt ash powder, rice mix; Jian Gui Wu Ling San + Mao Hua (Reed Catkin) 0.5 qian, swallow Jing Mei Hua Wan (Magnolia Flower Pill), Ce Bai Ye + Ginger crushed, cold water wash, add rice drink. Pale-turbid blood: Wei Feng Tang swallow Suan Lian Wan (Garlic-Coptis Pill), or Wu Jing Wan, or Zong Hui San; rice mix Xiang Fu powder or San Hui San. Chang Feng with abdominal pain, clear blood: First resolve intestinal Wind pathogen; severe anal swelling/pain: Bai Du San + Huai Jiao (Sophora Twig), Jing Jie (Schizonepeta), or Huai Hua Tang, Zhi Ke San. Zang Du slight internal pain, turbid blood + flower-red pus, anal swelling/prolapse, difficult stool: First poison-resolving/dredging agents to expel evil blood/pus/water, then internal-supporting/cooling-blood/dispelling-wind methods; if deficient, add Ren Shen, Huang Qi, Fu Ling, Bai Zhu to support Stomach Qi. All Chang Feng/Zang Du: Raw Yin Guo (Ginkgo Nut) 49 pcs, shell/membrane removed, pounded, mixed with Bai Yao Jian (Galla Chinensis) powder, pill size of bullet. 2-3 pills, chewed empty stomach with rice drink. Chronic bleeding, sallow complexion, gradual deficiency/exhaustion, lower origin weakness: Huang Qi Si Jun Zi Tang swallow Duan Hong Wan (Stop Red Pill), or Shi Quan Da Bu Tang, or Huang Yin.
[Gu Poison Viscera Destruction Bleeding] Like chicken liver, like rotten meat, symptoms include sinking saliva, heart/abdominal colic. Treatment: Ma Lin Gen (Rhizoma Marantae) powder, water fu Fang Cun Bi, vomit out poison. Bai He Ye (Lotus Leaf) secretly under patient's mat, let patient know not, self-call Gu Master name. Earthworms 14 pieces, soak in Ku Jiu (Bitter Wine/Vinegar) 3 sheng, drink juice. [Hair?] Burnt powder, water fu Fang Cun Bi. (Vomit Toxicity) Ku Hu (Bitter Bottle Gourd) 1 piece, water 2 sheng, boil to 1 sheng, drink. Or Ku Jiu 1 sheng, boil gourd until dissolved, drink.
[Diagnosis] Kidney pulse small, pulsating, deep indicates intestinal bleeding; blood warm, body hot is death.淫 (Excess) stealing Essence, body hot, sallow complexion, post-alcohol bleeding, thick/heavy blood is Reverse. Heart/Liver also bleed; both Zang diseased is treatable; pulse small-deep-choppy indicates intestinal bleeding; body hot is death, heat seen 7 days death. Body hot = death, body cold = life. Pulse Xuan Jue (Hanging Absolute) = death, Hua Da (Slippery-Large) = life. Pulse Chen Xiao Liu Lian (Deep-Small Lingering) = life, Shu Ji Qie Da You Re (Rapid-Fast Large-Heat) = death. Abdominal distension, bloody stool, pulse large intermittent, is Reverse, dies within one hour. Stomach transfers Heat to Spleen, transmits to Deficiency, intestinal bleeding, death untreatable. Spleen pulse external drumming, deep indicates intestinal bleeding, long time self-heals. Liver pulse small-slow indicates intestinal bleeding, easy to treat.