天津袁××，年三十二岁，得大便下血证。
病因 先因劳心过度，心中时觉发热，继又因朋友宴会，饮酒过度遂得斯证。
证候 自孟夏下血，历六月不止，每日六七次，腹中觉疼即须入
厕，心中时或发热，懒于饮食。其脉浮而不实有似芤脉，而不若芤脉之硬，两尺沉分尤虚，至数微数。
诊断 此证临便时腹疼者，肠中有溃烂处也。心中时或发热者，阴虚之热上浮也。其脉近芤者，
失血过多也。其两尺尤虚者，下血久而阴亏，更兼下焦气化不固摄也。此宜用化腐生
肌之药治其肠中溃烂，滋阴固气之药固其下焦气化，则大便下血可愈矣。
处方 生怀山药（两半） 熟地黄（一两） 龙眼肉（一两） 净萸肉（六钱）
樗白皮（五钱） 金银花（四钱） 赤石脂（四钱研细） 甘草（二钱）
鸦胆子仁（八十粒成实者） 生硫黄（八分细末）
药共十味，将前八味煎汤，送服鸦胆子、硫黄各一半，至煎
渣再服时，仍送服其余一半，至于硫黄生用之理，详于敦复汤下。
方解 方中鸦胆子、硫黄并用者，因鸦胆子善治下血，而此证之脉两尺过弱，又恐单用之失于
寒凉，故少加硫黄辅之，况其肠中脂膜，因下血日久易至腐败酿毒，二药之性皆善消除毒
菌也。又其腹疼下血，已历半载不愈，有似东人×××所谓阿米巴赤痢，硫黄实又为治阿米巴赤痢
之要药也。
复诊 前药连服三剂，下血已愈，心中亦不发热，脉不若从前之
浮，至数如常。而其大便犹一日溏泻四五次，此宜投以健胃固肠之剂。
处方 炙箭 （三钱） 炒白术（三钱） 生怀山药（一两） 龙眼肉（一两）
生麦芽（三钱） 建神曲（三钱） 大云苓片（二钱）
共煎汤一大盅温服。
效果 将药连服五剂，大便已不溏泻，日下一次，遂停服汤药。
俾用生怀山药细末煮作粥，调以白糖，当点心服之以善其后。
天津袁××，三十二岁，患大便下血证。
病因 起初因用脑过度，心中时常感觉发热，随后又因朋友宴请，饮酒过量，于是得了这个病证。
证候 从初夏开始便血，持续六个月不止，每天六到七次，腹中感到疼痛就必须上厕所，心中时常或有时发热，食欲不振。其脉象浮而无力，类似芤脉（中空如葱管的脉象），但不像芤脉那样坚硬，两尺部沉取尤其虚弱，脉搏频率略微偏快。
诊断 此证在排便时腹痛，说明肠道中有溃烂之处。心中时常或有时发热，是阴虚之热上浮所致。脉象接近芤脉，是因为失血过多。两尺部尤其虚弱，是因为长期下血导致阴液亏损，再加上下焦气化功能不固摄。此证适宜使用化腐生肌的药物来治疗肠道中的溃烂，使用滋阴固气的药物来巩固下焦的气化功能，那么大便下血就可以痊愈了。
处方 生怀山药（半两） 熟地黄（一两） 龙眼肉（一两） 净山茱萸肉（六钱） 樗白皮（五钱） 金银花（四钱） 赤石脂（四钱，研细） 甘草（二钱） 鸦胆子仁（八十粒，成熟的） 生硫黄（八分，细末）
药共十味，将前八味煎汤，送服鸦胆子、硫黄各一半；等到煎煮药渣再服用时，仍送服剩余的一半。至于硫黄生用的道理，详见敦复汤方解之下。
方解 方中鸦胆子与硫黄并用，是因为鸦胆子善于治疗下血，而此证脉象两尺过弱，又担心单用鸦胆子过于寒凉，所以少加硫黄辅助它。况且肠道中的脂膜，因长期下血容易腐败酿毒，这两种药物的性质都善于消除毒菌。另外，腹痛下血，已经持续半年未愈，有点像日本人×××所说的阿米巴痢疾，硫黄实际上是治疗阿米巴痢疾的重要药物。
复诊 前面的药连续服用三剂，下血已经痊愈，心中也不发热了，脉象不像从前那样浮，脉搏频率恢复正常。但是大便仍然一天溏泻四到五次，这适宜投用健胃固肠的药剂。
处方 炙黄芪（三钱） 炒白术（三钱） 生怀山药（一两） 龙眼肉（一两） 生麦芽（三钱） 建神曲（三钱） 大云苓片（二钱）
共煎一大盅汤，温服。
效果 将药连续服用五剂，大便不再溏泻，每天一次，于是停止服用汤药。让患者用生怀山药细末煮成粥，调入白糖，作为点心服用，以善后调理。
Tianjin resident Yuan XX, aged thirty-two, suffered from hematochezia (bleeding from the rectum).
Etiology Initially, due to excessive mental labor, he felt heat in his heart at times. Subsequently, following a banquet hosted by friends and excessive alcohol consumption, he contracted this condition.
Symptoms The bleeding began in early summer and persisted for six months without cessation, occurring six to seven times daily. He experienced abdominal pain necessitating immediate defecation, occasional heat sensation in the chest, and loss of appetite. His pulse was floating but deficient, resembling a Kou pulse (hollow pulse like a scallion stem) but not as hard; the deep palpation at both Chi positions (Kidney positions) was particularly deficient, with a slightly rapid frequency.
Diagnosis Abdominal pain during defecation indicates ulceration within the intestines. The occasional heat sensation in the chest is due to deficiency-heat floating upward caused by Yin deficiency. The pulse approaching the Kou type results from excessive blood loss. The particular deficiency at both Chi positions stems from prolonged bleeding leading to Yin depletion, compounded by the failure of Qi transformation in the Lower Jiao (Lower Burner) to secure and retain. This condition should be treated with herbs that resolve putrefaction and generate flesh to heal intestinal ulcers, combined with herbs that nourish Yin and consolidate Qi to secure Qi transformation in the Lower Jiao, thereby curing the hematochezia.
Prescription Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1.5 liang), Shu Di Huang (Rehmanniae Radix Praeparata, 1 liang), Long Yan Rou (Longan Aril, 1 liang), Jing Yu Rou (Corni Fructus, 6 qian), Chu Bai Pi (Stemonae Radix Cortex, 5 qian), Jin Yin Hua (Lonicerae Japonicae Flos, 4 qian), Chi Shi Zhi (Halloysit Rubra, 4 qian, finely ground), Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian), Ya Dan Zi Ren (Bruceae Semen, 80 mature kernels), Sheng Liu Huang (Sulfur, 8 fen, fine powder).
The prescription contains ten ingredients. Decoct the first eight ingredients to make a decoction, taken with half of the Ya Dan Zi and Liu Huang. When the dregs are decocted for the second dose, take the remaining half of these two substances. The rationale for using raw Liu Huang is detailed under the explanation of Dun Fu Tang.
Formula Analysis The combination of Ya Dan Zi and Liu Huang is used because Ya Dan Zi is effective for treating lower bleeding. However, given the excessively weak pulse at both Chi positions, there is concern that using Ya Dan Zi alone might be too cooling; thus, a small amount of Liu Huang is added to assist it. Moreover, the intestinal mucosa, due to prolonged bleeding, is prone to putrefaction and toxin generation; both herbs possess properties capable of eliminating toxic bacteria. Furthermore, the abdominal pain and bleeding had persisted for half a year without resolution, resembling what Japanese scholars refer to as amoebic dysentery; Liu Huang is indeed a key herb for treating amoebic dysentery.
Follow-up Visit After taking the previous prescription for three doses, the bleeding ceased, the heat sensation in the chest disappeared, and the pulse was no longer floating, with frequency returning to normal. However, loose stools still occurred four to five times daily. It is appropriate to administer a formula that strengthens the stomach and consolidates the intestines.
Prescription Zhi Huang Qi (Astragali Radix, prepared, 3 qian), Chao Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 3 qian), Raw Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang), Long Yan Rou (Longan Aril, 1 liang), Sheng Mai Ya (Hordei Fructus Germinatus, 3 qian), Jian Shen Qu (Massae Medicatae Fermentatae, 3 qian), Da Yun Ling Pian (Poria Cocos, sliced, 2 qian).
Decoct together in a large cup of water and take warm.
Outcome After taking the medicine continuously for five doses, loose stools ceased, bowel movements normalized to once daily, and the decoction was discontinued. The patient was instructed to consume porridge made from fine powder of Raw Huai Shan Yao mixed with white sugar as a snack for convalescence.