血从小便出者，名尿血；从大便出者，名便血。总其名曰下血。但有阴经阳经之分，并无寒
热之异，同归于热而已。《伤寒论》虽有少阴厥阴下血之条，皆是阳热传入阴经之症，经虽属
阴，症则阳症。陶氏一以为协热，是矣；一以为阴寒，误也。此因雨湿之年，湿淫用事，湿
毒外袭皮毛，内侵血分，令人身发寒热，大便下血，腹反不痛，且用苍独败毒散辛温散表，
忌用寒凉抑遏，此宗《内经》湿淫所胜，治以辛温之法，非阴寒而温之也。陶氏以其用辛温，
故误认阴寒而名之，不思《内经》云岁火太过，民病血溢血泄。少阴火气内发，血溢血泄，夫
血得热则妄行，故无论外感诸血，以热主治，即内伤。亦有心移热于小肠而尿血，用导赤各
半汤者。小肠本经自热而病，用火府丹加木通、滑石者。肺移热于大肠为便血，用凉膈散
者。大肠本经自热而病，用当归大黄汤加栀、连、芍药者。膀胱下焦热结而尿血，用木通车
前汤加知、柏、栀、连者。肝经血室伏火，而施泄下血，用知柏四物汤合龙胆泻肝汤者。未
可以阴寒言之也。
太阳病，以火薰之不得汗，其人必躁，到经不解，必圊血，名为火邪。
太阳病当汗解，因其人津竭血燥，不得作汗，医以火劫汗伤阴故发躁。下圊血，当清火邪。
太阳病，下之，其脉促，不结胸者，为欲愈。脉沉滑者，协热下利，脉浮滑者，必下血。
太阳病误下，怕成结胸，其脉浮促，表邪尚未内陷，未成结胸，故为欲愈。若脉沉滑，则
邪遗大肠，而为协热下利。若脉浮滑者，则血热流溢，必大便下血。
淋家不可发汗，发汗则便血。
淋家即热结膀胱，小便频数。不清利膀胱，反发其汗，必小便出血。
阳明病，下血谵语者，此为热入血室，但头汗出者，刺期门，随其实而泻之， 然汗出则
愈。此条详注热入血室。
少阴病，八九日，一身手足尽热者，以热在膀胱，必便血也。
此少阴热邪，外传太阳，则一身尽热，热结膀胱，必小便下血。
当归大黄汤
当归 大黄 生地 甘草
此方本治燥火下血，家秘以此治吐血嗽血，大便干结。良以凉血则不上升，且大黄与当归
同用，其血当归经矣。
黄芩芍药汤 见衄血。
肝家有火，则施泄不藏。脾受火乘，则土崩而不裹。今以白芍与芩连同用，则肝脾之火皆
清，而藏裹之令皆得矣。
苍术败毒散
熟苍术 羌活 独活 柴胡 前胡 防风 荆芥 枳壳 广皮 甘草
寒湿伤于太阳，内传阳明，有湿毒下血之症。以毛窍所入之邪，必要仍从毛窍而出，故不
用血药，而以此方散寒湿。若误用寒凉，毒邪伏而不散。
桃核承气汤 即桃仁承气汤。
寒湿伤表，用败毒散。里热下血，以此方清里热，下淤血。一表一里，两大法也。
导赤各半汤 见谵语发热。
凉膈散 见谵语。
火府丹 治二便。
当归 赤芍药 黄连 大黄 甘草 滑石
桃仁承气汤下淤血者，此方清血热者，同用大黄，有清下之分，有大小便之别。
当归大黄汤
当归 大黄 广皮 甘草
火府丹，兼治二便，此方专清大肠。
木通车前汤
木通 车前子 山栀 川连 知母 黄柏 生地 甘草
此方清小肠之热，通利膀胱。家秘治下焦热结，小便淋秘。
知柏四物汤
知母 黄柏 当归 白芍药 生地 丹皮
龙胆泻肝汤 见胁痛。
胆草 柴胡 黄芩 山栀 川连 知母 麦冬 人参 甘草
血从尿道排出的，称为尿血；从肛门排出的，称为便血。总称其为下血。但这其中有阴经和阳经的区别，并没有寒证与热证的差异，归根结底都归属于热证。《伤寒论》中虽然有条文论述少阴病和厥阴病的下血，但这些都是阳热之邪传入阴经所导致的病症，经脉虽属阴，症状却表现为阳证。陶华（陶氏）有的观点认为是协热下利，这是正确的；有的观点认为是阴寒所致，则是错误的。这是因为在雨湿之年，湿气盛行，湿毒外袭皮毛，内侵血分，导致人体出现寒热往来、大便下血的症状，且腹部反而不痛。此时应使用苍术败毒散等辛温药物发散表邪，忌用寒凉药物遏制病势。这是遵循《内经》中“湿淫所胜，治以辛温”的原则，并非因为阴寒而用温法。陶氏因为他使用了辛温药物，就错误地将其认定为阴寒证并以此命名，却不思考《内经》所说：“岁火太过，民众易患血溢、血泄之病。”少阴君火之气在内发动，导致血溢、血泄。血液遇热则妄行，因此无论是外感引起的各种出血，都以清热为主治原则；即使是内伤，也有心移热于小肠导致尿血，使用导赤各半汤治疗的；小肠本经自热致病，使用火府丹加木通、滑石治疗的；肺移热于大肠导致便血，使用凉膈散治疗的；大肠本经自热致病，使用当归大黄汤加栀子、黄连、芍药治疗的；膀胱下焦热结导致尿血，使用木通车前汤加知母、黄柏、栀子、黄连治疗的；肝经血室伏火，导致施泄下血，使用知柏四物汤合龙胆泻肝汤治疗的。这些都不能说是阴寒证。
太阳病，用火熏法治疗却未能出汗，病人必定烦躁，若病程超过预期仍未解除，必然会出现大便下血，这称为火邪。
太阳病应当通过发汗来解表，但因病人津液枯竭、血液干燥，无法作汗，医生用火劫迫汗的方法损伤了阴液，所以引发烦躁。出现大便下血时，应当清解火邪。
太阳病，经过误下之后，脉象急促，没有形成结胸证的，是病情将要痊愈的表现。如果脉象沉滑，则是协热下利；如果脉象浮滑，则必然出现下血。
太阳病误用攻下法，恐怕会形成结胸证。如果脉象浮促，说明表邪尚未内陷，未形成结胸，所以判断为欲愈。如果脉象沉滑，则邪气遗留在大肠，形成协热下利。如果脉象浮滑，则血热流溢，必然导致大便下血。
淋家即指热结膀胱，小便频数。不清利膀胱，反而发其汗，必然导致小便出血。
阳明病，出现下血且谵语的，这是热入血室，只有头部出汗的，针刺期门穴，随其实证而泻之，周身汗出则病愈。此条详细注解了热入血室的情况。
少阴病，到了第八九日，全身及手足都发热，是因为热邪在膀胱，必然会出现小便下血。
这是少阴的热邪，向外传变至太阳经，则全身发热，热结于膀胱，必然导致小便下血。
当归大黄汤
组成：当归、大黄、生地、甘草。
此方原本治疗燥火引起的下血，家父秘以此方治疗吐血、嗽血，以及大便干结。良因凉血则血不上升，且大黄与当归同用，能使血液归于经络。
黄芩芍药汤 （见衄血章节）
肝家有火，则疏泄过度而不能藏血。脾受火邪乘侮，则土崩而不能统摄血液。现在用白芍与黄芩、黄连同用，则肝脾之火皆被清除，而藏血和统摄的功能都能恢复。
苍术败毒散
组成：熟苍术、羌活、独活、柴胡、前胡、防风、荆芥、枳壳、广皮、甘草。
寒湿伤害太阳经，内传阳明经，有湿毒引起下血的症候。因为邪气是从毛窍进入的，必要仍从毛窍排出，所以不用血分药，而用此方散发寒湿。如果误用寒凉药物，毒邪就会潜伏而不能消散。
桃核承气汤 即桃仁承气汤。
寒湿伤表，用败毒散。里热下血，用此方清里热，下瘀血。一表一里，是两大治法。
导赤各半汤 （见谵语发热章节）
凉膈散 （见谵语章节）
火府丹 治疗二便。
组成：当归、赤芍药、黄连、大黄、甘草、滑石。
桃仁承气汤用于下瘀血，此方用于清血热，两者同用大黄，有清法和下法的区别，也有大、小便的不同侧重。
当归大黄汤
组成：当归、大黄、广皮、甘草。
火府丹兼治大小便，此方专清大肠之热。
木通车前汤
组成：木通、车前子、山栀、川连、知母、黄柏、生地、甘草。
此方清小肠之热，通利膀胱。家父秘以此方治疗下焦热结，小便淋漓闭塞。
知柏四物汤
组成：知母、黄柏、当归、白芍药、生地、丹皮。
龙胆泻肝汤 （见胁痛章节）
组成：胆草、柴胡、黄芩、山栀、川连、知母、麦冬、人参、甘草。
When blood exits from the urethra, it is termed hematuria (Niao Xue); when it exits from the anus, it is termed hematochezia (Bian Xue). Collectively, these are referred to as lower bleeding (Xia Xue). However, there is a distinction between Yin meridians and Yang meridians, but no difference between cold syndromes and heat syndromes; ultimately, all return to being heat syndromes. Although *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) contains clauses regarding lower bleeding in Shaoyin and Jueyin diseases, these are all conditions where Yang-heat pathogen has transmitted into the Yin meridians. Although the meridians belong to Yin, the symptoms manifest as Yang syndromes. Tao Hua (Tao Shi) correctly identified some cases as "co-existing heat" (Xie Re), but erroneously identified others as caused by Yin-cold. This error arose because in years of excessive rain and dampness, dampness dominates, and damp-toxin attacks the skin and hair externally while invading the blood level internally. This causes chills and fever, hematochezia, and notably, abdominal pain is absent. In such cases, one should use Cangzhu Baidu San (Atractylodes Decoction for Overcoming Toxicity) with acrid-warm properties to disperse the exterior pathogen, avoiding cold-cooling herbs that might suppress the pathogen. This follows the principle from *Neijing* (Inner Canon): "For excess dampness, treat with acrid-warm methods." It is not treating Yin-cold with warm methods. Tao Shi, observing the use of acrid-warm herbs, mistakenly labeled it as Yin-cold, failing to consider the *Neijing* statement: "When Fire Qi is excessive in the year, the people suffer from blood overflowing and leaking." When Shaoyin Fire Qi erupts internally, it causes blood overflow and leakage. Blood flows recklessly when heated; therefore, regardless of whether the bleeding is due to external contraction or internal injury, heat is the primary treatment target. For internal injuries, if Heart Heat transfers to the Small Intestine causing hematuria, Daochi Geban Tang (Half Daochi Decoction) is used. If the Small Intestine meridian itself suffers from heat, Huofu Dan (Fire Mansion Pill) added with Tongcao (Caulis Akebiae) and Huashi (Talcum) is used. If Lung Heat transfers to the Large Intestine causing hematochezia, Liangge San (Cooling the Diaphragm Powder) is used. If the Large Intestine meridian itself suffers from heat, Danggui Dahuang Tang (Angelica and Rhubarb Decoction) added with Zhizi (Fructus Gardeniae), Huanglian (Rhizoma Coptidis), and Shaoyao (Radix Paeoniae Rubra/Alba) is used. If Bladder Lower-Jiao heat accumulation causes hematuria, Mutong Cheqian Tang (Akebia and Plantago Seed Decoction) added with Zhimu (Rhizoma Anemarrhenae), Huangbai (Cortex Phellodendri), Zhizi, and Huanglian is used. If Liver meridian Blood Chamber harbors latent fire causing lower bleeding, Zhibai Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction) combined with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is used. None of these can be described as Yin-cold syndromes.
In Taiyang disease, if moxibustion or fire fumigation is applied and sweat does not occur, the patient will inevitably become irritable. If the disease course exceeds its expected duration without resolution, rectal bleeding (Qing Xue) will definitely occur; this is termed Fire Evil (Huo Xie).
Taiyang disease should be resolved through sweating. However, if the patient's fluids are exhausted and blood is dry, preventing sweating, and the physician uses fire coercion to induce sweating, damaging Yin, irritability ensues. When rectal bleeding occurs, one must clear the Fire Evil.
In Taiyang disease, after mistaken purgation, if the pulse is rapid (Cu) and chest binding (Jie Xiong) has not formed, recovery is desired. If the pulse is deep and slippery (Chen Hua), it indicates co-existing heat diarrhea (Xie Re Xia Li); if the pulse is floating and slippery (Fu Hua), lower bleeding will definitely occur.
Mistaken purgation in Taiyang disease risks forming chest binding. If the pulse is floating and rapid, the exterior pathogen has not yet sunk inward, and chest binding has not formed, so recovery is indicated. If the pulse is deep and slippery, the pathogen lingers in the Large Intestine, causing co-existing heat diarrhea. If the pulse is floating and slippery, heat in the blood overflows, leading to definite hematochezia.
Patients with stranguria (Lin Jia) should not undergo sweating therapy. If sweating is induced, rectal bleeding may result.
"Lin Jia" refers to heat accumulation in the Bladder with frequent urination. If the Bladder is not cleared and promoted, but sweating is instead induced, urinary bleeding will certainly occur.
In Yangming disease, lower bleeding accompanied by delirium indicates Heat Entering the Blood Chamber (Re Ru Xue Shi). If only the head sweats, puncture Qimen (LR14) to drain the excess according to the syndrome. Generalized sweating will lead to cure. This clause details Heat Entering the Blood Chamber.
In Shaoyin disease, on the eighth or ninth day, if the whole body and hands and feet are hot, it is because the heat resides in the Bladder, and urinary bleeding will definitely occur.
This describes Shaoyin heat pathogen transmitting outward to the Taiyang meridian, causing generalized heat. Heat accumulates in the Bladder, leading to hematuria.
Danggui Dahuang Tang (Angelica and Rhubarb Decoction)
Ingredients: Danggui (Radix Angelicae Sinensis), Dahuang (Radix et Rhizoma Rhei), Shengdi (Radix Rehmanniae Preparata), Gancao (Radix Glycyrrhizae).
This formula originally treats lower bleeding due to dry-fire. My father secreted this formula to treat vomiting blood and coughing blood, along with dry stool. The rationale is that cooling blood prevents upward rising, and using Dahuang together with Danggui guides the blood back to the meridians.
Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) (See section on Epistaxis)
If the Liver house has fire, it leads to excessive dispersion and failure to store blood. If the Spleen is attacked by fire, the Earth collapses and fails to contain blood. By using Baishao (Radix Paeoniae Alba) together with Huangqin (Radix Scutellariae), Huanglian, and Huangbo, the fire in both Liver and Spleen is cleared, restoring their functions of storing and containing blood.
Cangzhu Baidu San (Atractylodes Decoction for Overcoming Toxicity)
Ingredients: Shu Cangzhu (Rhizoma Atractylodis Macrocephalae Prepared), Qianghuo (Rhizoma Notopterygii), Duhuo (Radix Angelicae Pubescentis), Chaihu (Radix Bupleuri), Qianhu (Radix Peucedani), Fangfeng (Radix Saposhnikoviae), Jingjie (Herba Schizonepetae), Zhike (Fructus Aurantii Immaturus), Guangpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae).
When cold-dampness injures the Taiyang meridian and transmits internally to the Yangming meridian, symptoms of damp-toxin lower bleeding appear. Since pathogens enter through the hair pores, they must exit through the hair pores. Therefore, blood-invigorating herbs are not used; instead, this formula disperses cold-dampness. If cold-cooling herbs are mistakenly used, the toxic pathogen will lie dormant and fail to dissipate.
Taohé Chengqi Tang (Peach Kernel Decoction to Direct the Qi) Also known as Taoren Chengqi Tang.
For cold-dampness injuring the exterior, use Baidu San. For interior heat causing lower bleeding, use this formula to clear interior heat and purge stasis. Exterior and Interior represent two major therapeutic approaches.
Daochi Geban Tang (Half Daochi Decoction) (See section on Delirium and Fever)
Liangge San (Cooling the Diaphragm Powder) (See section on Delirium)
Huofu Dan (Fire Mansion Pill) Treats disorders of both urine and feces.
Ingredients: Danggui, Chishaoyao (Radix Paeoniae Rubra), Huanglian, Dahuang, Gancao, Huashi.
Taoren Chengqi Tang purges stasis; this formula clears blood heat. Both use Dahuang, distinguishing between clearing (Qing) and purging (Xia), and targeting large versus small intestines.
Danggui Dahuang Tang (Angelica and Rhubarb Decoction)
Ingredients: Danggui, Dahuang, Guangpi, Gancao.
Huofu Dan treats both urine and feces; this formula specifically clears Large Intestine heat.
Mutong Cheqian Tang (Akebia and Plantago Seed Decoction)
Ingredients: Mutong (Caulis Akebiae), Cheqianzi (Semen Plantaginis), Shanzhi (Fructus Gardeniae), Chuanlian (Rhizoma Coptidis), Zhimu, Huangbai, Shengdi, Gancao.
This formula clears Small Intestine heat and promotes bladder function. My father secreted this formula to treat Lower-Jiao heat accumulation causing stranguria and retention of urine.
Zhibai Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction)
Ingredients: Zhimu, Huangbai, Danggui, Baishao, Shengdi, Danpi (Cortex Moutan).
Longdan Xiegan Tang (Gentian Liver-Draining Decoction) (See section on Hypochondriac Pain)
Ingredients: Dancao (Radix Gentianae), Chaihu, Huangqin, Shanzhi, Chuanlian, Zhimu, Maidong (Radix Ophiopogonis), Renshen (Radix Ginseng), Gancao.