施左 身热六七日不退，大便脓血，脉郁数，苔黄。伏邪蕴蒸气分，湿郁化热入营，血渗大肠，肠有瘀
浊，大便脓血，职是故也。今拟白头翁汤加味，清解伏邪，苦化湿热。
白头翁（三钱） 炒黄芩（一钱五分） 地榆炭（一钱五分） 杜赤豆（五钱） 北秦皮（一钱五分）
炒赤芍（一钱五分） 焦楂炭（三钱） 淡豆豉（三钱） 川雅连（四分） 炒当归（二钱） 炙甘草（五分）
沈左 身热不扬，大便脓血色紫，脉沉苔腻。脾为阴土之脏，统血之经，赖阳气以营运。脾阳不健，瘀浊
留恋，血不循经而下溢，经所谓阴络伤则血下溢是也。身热不扬，阴盛而格阳于外也。当宜温运脾阳，而化瘀
浊，以冀火土相生，阳气得以上升，阴血不致下走矣。
肉桂心（三分） 炒于术（一钱五分） 焦楂炭（三钱） 熟附子（八分） 炮姜炭（六分） 陈广皮（一钱）
炒当归（二钱） 炙甘草（五分） 大砂仁（八分） 炒赤芍（一钱五分）
丁左 便血色紫，腑行不实，纳谷衰少，此远血也。近血病在腑，远血病在脏，脏者肝与脾也。血生于
心，而藏统之职，司于肝脾。肝为刚脏，脾为阴土，肝虚则生热，热迫血以妄行；脾虚则生寒，寒泣血而失道，藏
统失职，血不归经，下渗大肠，则为便血。便血之治，寒者温之，热者清之，肝虚者柔润之，脾虚者温运之，一方
而擅刚柔温清之长，惟金匮黄土汤最为合拍，今宗其法图治。
土炒于术（一钱五分） 阿胶珠（二钱） 炒条芩（一钱五分） 灶心黄土（荷叶包煎，四钱） 陈广皮
（一钱） 炙甘草（五分） 炒白芍（一钱五分） 抱茯神（三钱） 炮姜炭（五分） 炙远志（一钱）
葛左 肾阴不足，肝火有余，小溲频数，肛门坠胀，内痔便血。拟清养肺肾，取金水相生之义。
细生地（三钱） 西洋参（一钱五分） 炒槐花（包，三钱） 朱
灯心（二扎） 粉丹皮（二钱） 大麦冬（二钱） 京赤芍（二钱） 脏连丸（包，八分） 黑山栀（一钱
五分） 生草梢（六分） 淡竹茹（一钱五分）
王左 内痔便血又发，气虚不能摄血，血渗大肠，兼湿热内蕴所致。拟益气养阴，而化湿热。
潞党参（一钱五分） 全当归（二钱） 荆芥炭（八分） 杜赤豆（一两） 炙黄 （二钱） 大白芍（一钱五分）
侧柏炭（一钱五分） 清炙草（六分） 生地炭（三钱） 槐花炭（包，三钱）
孙右 脾脏受寒，不能摄血，肝虚有热，不能藏血，血渗大肠，肠内有热，经事不调。拟黄土汤两和肝脾，
而化湿浊。
炮姜炭（八分） 炒白芍（一钱五分） 炒于术（一钱五分） 陈皮（一钱） 阿胶珠（二钱） 炙甘草（六分）
灶心黄土（包煎，四钱）
复诊 肠红大减，未能尽止，经事愆期，胸闷纳少，脾胃薄弱，运化失常。再拟和肝脾、化湿热，佐以调经。
原方加大砂仁（八分，研）、生熟谷芽（各三钱）。
施左：身体发热六七天不退，大便排出脓血，脉象郁滞而数，舌苔黄。伏邪蕴结在气分，湿邪郁久化热进入营分，血液渗入大肠，肠道内有瘀浊，导致大便脓血，就是这个原因。现在拟定白头翁汤加味，以清解伏邪，苦寒燥化湿热。
白头翁（三钱） 炒黄芩（一钱五分） 地榆炭（一钱五分） 杜赤豆（五钱） 北秦皮（一钱五分）
炒赤芍（一钱五分） 焦楂炭（三钱） 淡豆豉（三钱） 川雅连（四分） 炒当归（二钱） 炙甘草（五分）
沈左：身体发热而不显扬（自觉发热但体温不高或摸之不太烫），大便脓血色紫，脉沉苔腻。脾是阴土之脏，是统摄血液的经络，依赖阳气来运行营运。脾阳不健运，瘀浊留恋不去，血液不循常道而下溢，这就是经书所说的“阴络受伤则血液下溢”。身体发热而不显扬，是因为阴盛格拒阳气于外所致。应当温运脾阳，化解瘀浊，希望火土相生，阳气得以升发，阴血不至于向下流失。
肉桂心（三分） 炒于术（一钱五分） 焦楂炭（三钱） 熟附子（八分） 炮姜炭（六分） 陈广皮（一钱）
炒当归（二钱） 炙甘草（五分） 大砂仁（八分） 炒赤芍（一钱五分）
丁左：便血色紫，排便不成形，食欲减退，这是远血。近血病在腑，远血病在脏，脏指的是肝与脾。血由心生，而藏血和统血的职能，由肝脾掌管。肝为刚脏，脾为阴土，肝虚则生热，热迫血妄行；脾虚则生寒，寒使血液凝涩而失道，藏统失职，血液不归经，下渗大肠，就成为便血。治疗便血，寒者用温法，热者用清法，肝虚者用柔润法，脾虚者用温运法，一方之中兼具刚、柔、温、清之长处的，只有《金匮要略》的黄土汤最为合适，现在遵循其法治疗。
土炒于术（一钱五分） 阿胶珠（二钱） 炒条芩（一钱五分） 灶心黄土（荷叶包煎，四钱） 陈广皮（一钱）
炙甘草（五分） 炒白芍（一钱五分） 抱茯神（三钱） 炮姜炭（五分） 炙远志（一钱）
葛左：肾阴不足，肝火有余，小便频数，肛门坠胀，内痔便血。拟定清养肺肾之法，取金水相生的意义。
细生地（三钱） 西洋参（一钱五分） 炒槐花（包煎，三钱） 朱灯心（二扎） 粉丹皮（二钱） 大麦冬（二钱）
京赤芍（二钱） 脏连丸（包煎，八分） 黑山栀（一钱五分） 生草梢（六分） 淡竹茹（一钱五分）
王左：内痔便血复发，气虚不能摄血，血液渗入大肠，兼有湿热内蕴所致。拟定益气养阴，并化解湿热。
潞党参（一钱五分） 全当归（二钱） 荆芥炭（八分） 杜赤豆（一两） 炙黄芪（二钱） 大白芍（一钱五分）
侧柏炭（一钱五分） 清炙草（六分） 生地炭（三钱） 槐花炭（包煎，三钱）
孙右：脾脏受寒，不能摄血，肝虚有热，不能藏血，血液渗入大肠，肠内有热，月经不调。拟定黄土汤两和肝脾，并化解湿浊。
炮姜炭（八分） 炒白芍（一钱五分） 炒于术（一钱五分） 陈皮（一钱） 阿胶珠（二钱） 炙甘草（六分）
灶心黄土（包煎，四钱）
复诊：肠红（便血）大幅减少，未能完全止住，月经延期，胸闷纳少，脾胃薄弱，运化失常。再拟定调和肝脾、化解湿热，佐以调经。
原方加大砂仁（八分，研碎）、生熟谷芽（各三钱）。
Patient Shi (Left): Body heat persists for six or seven days without subsiding; stool contains pus and blood. The pulse is constrained and rapid, with a yellow tongue coating. Latent pathogens are accumulated in the Qi level; dampness stagnates and transforms into heat, entering the Ying (Nutritive) level. Blood seeps into the large intestine, where there is stasis and turbidity, resulting in purulent bloody stools—this is the cause. Currently, we propose modified Baitouweng Tang (Baitouweng Decoction) to clear and resolve latent pathogens, using bitter herbs to dry and transform damp-heat.
Baitouweng (3 qian), Fried Huangqin (1.5 qian), Diyu Tan (1.5 qian), Duchidou (5 qian), Bei Qinpi (1.5 qian),
Chao Chishao (1.5 qian), Jiao Zhaca (3 qian), Dan Douchi (3 qian), Chuan Yalian (0.4 qian), Chao Danggui (2 qian), Zhi Gancao (0.5 qian).
Patient Shen (Left): Body heat is not prominent (feverish sensation without high temperature); stool contains purulent blood of dark purple color. The pulse is deep, and the tongue coating is greasy. The Spleen is an organ of Yin Earth, governing the channels that control blood, relying on Yang Qi for circulation and operation. When Spleen Yang is weak, stasis and turbidity linger, causing blood to overflow downward instead of following its normal course. This corresponds to the classic saying: "When the Yin collaterals are injured, blood overflows downward." The non-prominent body heat indicates Yin excess repelling Yang to the exterior. Treatment should focus on warming and moving Spleen Yang, resolving stasis and turbidity, hoping for the mutual generation of Fire and Earth, allowing Yang Qi to ascend, so that Yin blood does not leak downward.
Rouguixin (0.3 qian), Chao Baizhu (1.5 qian), Jiao Zhaca (3 qian), Shu Fuzi (0.8 qian), Pao Jiangtan (0.6 qian), Chen Guangpi (1 qian),
Chao Danggui (2 qian), Zhi Gancao (0.5 qian), Da Sharen (0.8 qian), Chao Chishao (1.5 qian).
Patient Ding (Left): Stool contains dark purple blood; bowel movements are unformed; appetite is poor. This is classified as distant bleeding (Yuanxue). Proximal bleeding involves the Fu organs, while distant bleeding involves the Zang organs, specifically the Liver and Spleen. Blood is generated by the Heart, but its storage and governance are managed by the Liver and Spleen. The Liver is a rigid organ; deficiency leads to internal heat, forcing blood to move recklessly. The Spleen is Yin Earth; deficiency leads to internal cold, causing blood to congeal and lose its path. With loss of storage and governance functions, blood fails to return to its vessels, seeping into the large intestine, resulting in hematochezia. In treating hematochezia, cold patterns are treated with warmth, heat patterns with clearing, Liver deficiency with moistening/nourishing, and Spleen deficiency with warming/moving. Among all formulas, only Huangtu Tang from the *Jin Gui Yao Lue* excels in combining rigid/moistening and warming/clearing properties. We now follow this method for treatment.
Tu Chao Baizhu (1.5 qian), Ejiao Zhu (2 qian), Chao Tiao Qin (1.5 qian), Zaoxin Huangtu (wrapped in lotus leaf, decocted, 4 qian), Chen Guangpi (1 qian),
Zhi Gancao (0.5 qian), Chao Baishao (1.5 qian), Bao Fushen (3 qian), Pao Jiangtan (0.5 qian), Zhi Yuanzhi (1 qian).
Patient Ge (Left): Kidney Yin is insufficient, while Liver Fire is excessive. There is frequent urination, a feeling of heaviness/prolapse in the anus, and hematochezia due to internal hemorrhoids. The prescription aims to clear and nourish the Lung and Kidney, adopting the principle of Metal and Water generating each other.
Xi Shengdi (3 qian), Xiyangshen (1.5 qian), Chai Huaihua (wrapped, 3 qian), Zhu Dengxin (2 bundles), Fen Danpi (2 qian), Da Maidong (2 qian),
Jing Chishao (2 qian), Zanglian Wan (wrapped, 0.8 qian), Hei Shanzhi (1.5 qian), Sheng Caoshao (0.6 qian), Dan Zhuru (1.5 qian).
Patient Wang (Left): Internal hemorrhoid bleeding has recurred. Qi deficiency fails to hold blood, causing it to seep into the large intestine, compounded by internal accumulation of damp-heat. The strategy is to tonify Qi and nourish Yin, while transforming damp-heat.
Lu Dangshen (1.5 qian), Quan Danggui (2 qian), Jingjie Tan (0.8 qian), Duchidou (1 liang), Zhi Huangqi (2 qian), Da Baishao (1.5 qian),
Cebai Tan (1.5 qian), Qing Zhi Cao (0.6 qian), Shengdi Tan (3 qian), Huaihua Tan (wrapped, 3 qian).
Patient Sun (Right): The Spleen organ is affected by cold, failing to control blood; Liver deficiency with heat prevents blood storage. Blood seeps into the large intestine, intestinal heat causes irregular menstruation. The prescription uses Huangtu Tang to harmonize the Liver and Spleen, while transforming damp-turbidity.
Pao Jiangtan (0.8 qian), Chao Baishao (1.5 qian), Chao Baizhu (1.5 qian), Chenpi (1 qian), Ejiao Zhu (2 qian), Zhi Gancao (0.6 qian),
Zaoxin Huangtu (wrapped, decocted, 4 qian).
Follow-up Visit: Intestinal bleeding (hematochezia) has significantly decreased but not completely stopped. Menstruation is delayed. There is chest tightness and poor appetite due to weak Spleen and Stomach and impaired transformation and transportation. The new prescription continues to harmonize the Liver and Spleen, transform damp-heat, and assist in regulating menstruation.
Add to the original formula: Da Sharen (0.8 qian, crushed), Raw and Fried Guya (3 qian each).