分肠风、脏毒二证。（三因诸邪，皆致便血，二者特其大端耳。）肠风者，或风邪外感，或肝
风内生，风热相合，侵犯经络，血脉被阻，漏出经络之外，渗入肠胃之中，从
大便出，随感随见，血清色鲜者是。槐花汤加羌、防、秦艽。（即非外风，亦可升阳燥湿。按
内风即气也，气不顺亦可用羌、防辈升发之，但不温服取汗耳。故古方不分内外风，统用之也。）脏毒者，湿与
热合，蕴积日久，伤损阴络，血渗肠胃，积久乃下，其色黯浊者是。槐花汤加炒苦
楝、炒苍术。下血腹中痛，血色鲜红，为热毒，芍药黄连汤主之。不痛，血色不鲜，
或紫黑如豆汁，为湿毒，黄连汤主之。先血而后粪，近血也，出于大肠，槐花、条
芩、乌药。先粪而后血，远血也，出胃与小肠，石膏、山栀、乌药。又结阴便血，
（《内经》结阴者，便血一升，再结二升，三结三升。）所下纯是血，《经》不言何邪所结。景岳谓风寒
之邪，留结血分所致，宜灸中脘、气海、三里，以散风邪，服平胃地榆汤以温
散之。亦举隅之论也。下血太甚，人参、升麻、牡蛎、粟壳。瘀血不可止，待色鲜红，
略加涩药，椿皮、乌梅最妙。用寒凉药须酒煮或炒，恐血凝。便血日久，服凉药不
应，宜升补，升阳除湿和血汤。有热略加黄连，以吴萸泡水炒用，虚加人参。
此病多食干柿或生柿最效。肠风、脏毒、结阴，并血出肠中，与五痔之血出于漏孔
者不同，亦与赤痢有异。
将便血分为肠风和脏毒两种证候。（三因中的各种邪气，都能导致便血，这两种只是其中主要的方面罢了。）肠风，有的是外感风邪，有的是肝风内生，风热相结合，侵犯经络，血脉被阻滞，血液漏出经络之外，渗入肠胃之中，随大便排出，往往是刚感受病邪随即出现症状，血色清稀颜色鲜红的是。用槐花汤加入羌活、防风、秦艽。（即使不是外风，也可以用这些药来升发阳气、燥湿。按内风其实就是气机紊乱，气不顺也可以使用羌活、防风这类药物来升发气机，只不过不需要温服取汗罢了。所以古方不区分内风和外风，统一使用这些药。）脏毒，是湿与热相结合，蕴结积聚日久，损伤阴络，血液渗入肠胃，积聚久了才排下，血色暗浊的是。用槐花汤加入炒苦楝皮、炒苍术。下血且腹中疼痛，血色鲜红的，属于热毒，用芍药黄连汤主治。不疼痛，血色不鲜亮，或者紫黑如豆汁样的，属于湿毒，用黄连汤主治。先出血而后排便的，称为近血，病位在大肠，用药为槐花、黄芩、乌药。先排便而后出血的，称为远血，病位在胃和小肠，用药为石膏、山栀、乌药。又有结阴导致的便血，（《内经》中说结阴病，便血一升，再次发作便血二升，第三次发作便血三升。）所下的全是血，《内经》没有说明是何种邪气结聚。张景岳认为是由风寒之邪，留结在血分所致，适宜灸中脘、气海、足三里穴，以疏散风邪，服用平胃地榆汤以温散寒邪。这也是举一反三的论述。下血过于严重，用人参、升麻、牡蛎、罂粟壳。瘀血不可强行止住，要等到血色变鲜红时，略微加入收敛止血药，椿根皮、乌梅最好。使用寒凉药必须用酒煮或炒制，恐怕血液凝固。便血日久，服用凉药无效，宜用升补法，用升阳除湿和血汤。有热象略微加入黄连，用吴茱萸泡水后炒用，虚证加入人参。这个病多吃干柿子或生柿子最有效。肠风、脏毒、结阴，都是血液从肠道中流出，与五痔之血从肛门漏孔流出的不同，也与赤痢有所区别。
Divide hematochezia into two syndromes: Changfeng (Intestinal Wind) and Zangdu (Visceral Toxin). (Various pathogens from the Three Causes can all lead to hematochezia; these two are merely the major categories.) Changfeng refers to cases where either external wind pathogens are contracted or internal Liver Wind arises. When wind-heat combine and invade the meridians, blood vessels become obstructed, causing blood to leak out of the meridians, seep into the intestines and stomach, and exit via the stool. Symptoms appear immediately upon pathogen acquisition, and the blood is clear, thin, and bright red. This is treated with Huaihua Tang (Sophorae Flos Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Qinjiao (Gentianae Macrophyllae Radix). (Even if it is not external wind, these herbs can still raise Yang and dry dampness. Note that internal wind is essentially Qi dysfunction; when Qi is not smooth, herbs like Qianghuo and Fangfeng can be used to ascend and diffuse it, though they should not be taken warm to induce sweating. Therefore, ancient formulas did not distinguish between internal and external wind, using them uniformly.) Zangdu refers to cases where dampness and heat combine, accumulating over a long period, damaging the Yin collaterals, allowing blood to seep into the intestines and stomach. The blood is discharged only after accumulation, appearing dark and turbid. This is treated with Huaihua Tang (Sophorae Flos Decoction) added with Chao Kuchenshen (Fructus Toosendanii, stir-fried) and Chao Cangzhu (Atractylodis Rhizoma, stir-fried). If bleeding is accompanied by abdominal pain and the blood is bright red, it is due to Heat Toxin, treated primarily with Shaoyao Huanglian Tang (Peony and Coptis Decoction). If there is no pain, and the blood is not bright, or is purple-black like bean juice, it is due to Damp Toxin, treated primarily with Huanglian Tang (Coptis Decoction). Bleeding before defecation is called Jin Xue (Near Blood), originating from the Large Intestine; use Huaihua (Sophorae Flos), Tiaohuangqin (Scutellariae Radix), and Wuyao (Linderae Radix). Defecation before bleeding is called Yuan Xue (Far Blood), originating from the Stomach and Small Intestine; use Shigao (Gypsum Fibrosum), Shanzhi (Gardeniae Fructus), and Wuyao (Linderae Radix). There is also Jieyin Hematochezia (Constrained Yin Bleeding). (The *Neijing* states that in Jieyin disease, one sheng of blood is passed, then two shengs upon recurrence, and three shengs upon a third recurrence.) The discharge consists purely of blood, and the *Jing* does not specify which pathogen is constrained. Zhang Jingyue attributed it to Cold and Wind pathogens lingering and constraining the Blood level. It is suitable to moxa Zhongwan (CV12), Qihai (CV6), and Zusanli (ST36) to disperse wind pathogens, and take Pingwei Diyutang (Stomach-Pacifying Cudrania Bark Decoction) to warm and disperse. This is also an illustrative argument. For severe hemorrhage, use Renshen (Ginseng Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), Muli (Ostreae Concha), and Sukesh (Papaveris Pericarpium). Stasis blood cannot be forcibly stopped; wait until the blood color becomes bright red, then slightly add astringent herbs such as Chunpi (Toosendan Cortex) and Wumei (Mume Fructus), which are best. Cold-natured herbs must be decocted with wine or stir-fried to prevent blood coagulation. For chronic hematochezia unresponsive to cold-natured herbs, use ascending and tonifying methods, specifically Shengyang Chushi Hehe Tang (Yang-Raising, Damp-Removing, and Blood-Harmonizing Decoction). If there is heat, add a small amount of Huanglian (Coptidis Rhizoma), stir-fried with water infused from Wuzhuyu (Evodiae Fructus). For deficiency, add Renshen (Ginseng Radix et Rhizoma). Consuming dried persimmons or fresh persimmons is most effective for this condition. Changfeng, Zangdu, and Jieyin all involve blood exiting from the intestines, which differs from the blood leaking from the anal aperture in the Five Hemorrhoids (Wu Zhi), and also differs from Chi Li (Dysentery with Blood).