（呕血 唾血 咳血 咯血 血溢 九窍出血）
缪仲淳曰。吐血有三诀。宜行血。不宜止血。血不循经络者。气逆上壅也。行血则循经络。
不止自止。止之则血凝。血凝则发热恶食。病日痼矣。宜补肝。不宜伐肝。经曰。五脏者。藏精
气而不泻者也。肝主藏血。吐血者。肝失其职也。养肝则肝气平而血有所归。伐肝则肝虚不能藏
血。血愈不止矣。宜降气。不宜降火。气有余便是火。气降则火降。火降则气不上升。血随气行。
无溢出上窍之患矣。降火必用寒凉之剂。反伤胃气。胃气伤。则脾不能统血。血愈不能归经矣。
今之疗吐血者。大患有二。一则专用寒凉之味。如芩、连、山栀、四物、知、柏之类。往往伤脾
作泻。以致不救。一则专用人参。肺热远伤肺。咳嗽愈甚。亦有用参而愈者。此是气虚喘嗽。气
属阳。不由阴虚火炽所致。然亦百中一二也。刘默生曰。吐血一证。人惟知气逆血溢。火升血泛。
不知血在脏腑。另有膈膜隔定。其血不能渗溢。夫膈膜者。极薄极脆。凡有所伤则破。破则血溢
于上矣。故有阳络伤则血上溢。阴络伤则血下渗。已伤之膜。若有复伤。其吐必多。膈膜虽伤。
伤处有瘀血凝定。血来则缓。若阴火骤冲破瘀积之血。血来如潮之上涌。自觉沥沥有声。彼时喘
息不定。面赤如醉。烦躁不宁。心神昏乱。一皆龙雷之势。脉亦急疾难凭。少顷火退神清。面白
气平。血亦渐止。方可诊切。用药须乘此时。瘀积荡尽。缓缓清理。徐徐调补。然不可骤壅。亦
不可用耗气之药。悉知此义。治血有本矣。吐血者。一吐则倾
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。如是者谓之营血也。阴
者居于络脉。专守脏腑。滋养神气。濡润筋骨。若是脏感内外之邪伤。则循经之阳血。至其伤处。
为邪气所阻。漏泄经外。或居络之阴血。因着留之邪擗裂而出。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。或有风从肠胃经脉而入客者。或外淫风木之邪内
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。与寒热燥湿。怫郁其气。及
饮食不节。用力过度。伤其阴络之血者。亦谓之肠风可乎。盖肠风所下之血。清而色鲜。四射如
溅。乃风性使然。素问所谓久风入中。则为肠风飧泄是也。先与泻青丸一二剂。后与逍遥散。加
酒煮黄连、羌、防、乌梅。虚人。人参胃风汤最捷。人所不知。若肛门射血如线。或点滴不已者。
乃五痔之血。当详本门治之。血浊而色黯者为脏毒。蕴积毒瓦斯。久而始见也。宜小乌沉汤下黑神
散。脉实便秘势盛者。脏连丸。肠风挟湿毒者。下如豆汁兼紫黑瘀血。此醇酒浓味所酿之湿。由
足阳明随经入胃。淫溢而下也。脉细有寒者。升阳除湿防风汤。脉数有热者。去二术加黄连、当
归、甘草。肠风下血。以刘寄奴半两。芽茶一两。墨灰三钱为散。分三服。乌梅汤送下。其血立
止。后宜多服归脾汤调理。肠风下血。其血另作一派溅出。远射四散如筛。肠中作痛。乃阳明气
冲热毒所作也。人参败毒散。不应。用升阳除湿和血汤。宿有血证。因时热下紫黑血。乃湿毒肠
。阳明少阳经证也。升阳益肾汤。下血久而不已。面色痿黄。下元虚惫者。四君子加黄 、归、
芍。下断红丸。虚甚。十全大补汤去茯苓加防风。洁古云。下血。防风为上使。黄连为中使。地
榆为下使。千金云。先见血后见便为远血。宜服黄土汤。先见便后见血为近血。宜服赤小豆当归
散。（金匮以先便后血为远血。先血后便为近血。传写之误。因胃中受冷不能统血。失其营运而
下。故宜黄土汤温之。若大肠受热不能摄血。营行过疾而下。故宜赤小豆当归散清之。）色鲜紫
者为热伤阴络。槐花炒研。米汤服
之。槐角煎膏尤妙。色稀淡者为脾虚。一味白术。米汤丸服。色瘀晦者为积血。以乱发二两。红
花四两。入炀成罐中 过。去红花灰。止用发灰。研细分三服。空心炒黑地榆煎汤送下。三日必
效。下血虽曰大肠积热。亦当分虚实。不可纯用寒凉。必加辛散为主。久之不愈。宜理胃气。兼
升举药。故大便下血。多以胃药收功。不可徒用苦寒也。戴复庵曰。色鲜红为热。色瘀淡为寒。
寒血因肠胃受冷。营行失度而下。四物加炮姜、炙甘草。热血因热毒之气。蕴于肠胃。或饮酒过
度。及啖炙爆所致。四物加茜根、槐花、酒黄连、炒黑山栀之类。因冷冻饮料中寒。或杂食生冷。血
为寒凝而下。必腹痛色晦淡。宜附子理中倍炮姜加酒连。阴结便血者。厥阴肝血内结。不得阳气
统运。渗入肠间而下。非谓阴寒内结也。补中益气倍黄 加炮姜。上二证。诸家悉采宝鉴平胃地
榆汤、结阴丹。从无言及其非者。敢力正之。内伤瘀血。胸胁小腹急痛。桃仁承气汤、代抵当汤。
随痛之高下选用。大黄俱宜童便浸透。更用韭汁制。虚人。可略加桂、附二三分。若瘀滞色晦不
鲜者。久当用温血药。始得奏效。血枯大便燥结而下鲜紫血者。此大肠燥结而下也。一味槐角膏
凉润之。又方。真麻油冲入腐花。空腹食之。三日即愈。肠风便血。一味旱莲花。浓煎葱白汤过
口。一服立效。又方。治肠风便血。刘寄奴半两。松萝茶一钱。乌梅肉一枚。煎服效。中蛊脏腑
败坏。下血如鸡肝。如烂肉。心腹绞痛者是也。治用马蔺根末。水服方寸匙。随吐而出。
李士材治一人。患肠风下血。久用四物、芩、连、槐花之属。屡发不止。面色痿黄。诊其脉。
惟脾部浮而缓。此土虚而风湿交乘也。遂用苍术三钱。茯苓、人参、黄 、升麻、柴胡、防风各
一钱。四剂而血止。改用十全大补汤。调理而愈。石顽治吴兴韩晋度春捷锦旋。患腹痛泄泻下血。
或用香连丸。遂饮食艰进。少腹急结。虽小便癃闭。而不喜汤饮。
面色痿黄。昼夜去血五十余度。邀余诊之。气口脉得沉细而紧。询其所下之血。瘀晦如苋汁。与
理中加肉桂二钱。一剂溺通。小腹即宽。再剂血减食进。四剂泄泻止三四次。去后微有白脓。与
补中益气加炮姜。四剂而康。
缪希雍（字仲淳）说：治疗吐血有三条原则。第一，宜活血，不宜单纯止血。血液不循常道运行，是因为气机逆乱上壅所致。活血则血液能循行经络，血自然停止；若强行止血，则会导致血液凝滞，血液凝滞就会引起发热和食欲不振，病情就会日益顽固。第二，宜补肝，不宜伐肝。《内经》说：五脏是贮藏精气而不妄泄的器官。肝主藏血，吐血的患者，是肝失去了其正常职能。滋养肝脏，则肝气平和，血液有所归依；伐肝则导致肝虚，不能藏血，出血会更加不止。第三，宜降气，不宜降火。气有余便是火，气降则火降，火降则气不上升，血液随气而行，就不会有从上部孔窍溢出的祸患了。降低火势必须使用寒凉药物，但这会反而损伤胃气。胃气受伤，脾就不能统摄血液，血液更加无法回归经络。
当今治疗吐血的人，主要有两大弊端。一是专门使用寒凉药物，如黄芩、黄连、山栀、四物汤、知母、黄柏之类，往往损伤脾胃导致腹泻，以致无法挽救。二是专门使用人参。肺热者远用人参会伤害肺气，使咳嗽更严重。也有用人参而痊愈的，那是气虚引起的喘嗽，气属阳，不是由阴虚火旺所致，但这种情况百中无一二。
刘默生说：吐血这一病症，人们只知道气逆血溢、火升血泛，却不知道血液在脏腑之间，另有膈膜将其隔开固定，血液不能渗透溢出。所谓膈膜，极薄极脆，凡是有损伤就会破裂，破裂则血液向上溢出。所以有“阳络伤则血上溢，阴络伤则血下渗”的说法。已经受伤的膜，如果再次受到损伤，吐血必然很多。膈膜虽然受伤，但伤处有瘀血凝结固定，血流来势较缓；如果是阴火突然冲破瘀积的血液，血流如潮水般涌上，自觉沥沥有声，此时喘息不定，面色红赤如醉，烦躁不安，心神昏乱，这都是龙雷之火（相火）肆虐的表现，脉象也急疾难以凭据。过了一会儿，火退神清，面白气平，血液也逐渐停止，这时才可以诊察切脉。用药必须趁此时机，待瘀积荡尽后，缓缓清理，徐徐调补。然而不可骤然壅补，也不可使用耗气的药物。通晓这些道理，治疗血证就有了根本。
吐血患者，一吐出来倾泻而出的血液，分为阴血和阳血。阳血顺气而行，循环于血脉之中，调和五脏，布散六腑，这样的称为营血。阴血居于络脉，专守脏腑，滋养神气，濡润筋骨。如果脏腑感受了内外的邪气伤害，那么循经运行的阳血，到达受伤之处，被邪气阻滞，漏泄于经脉之外；或者是居于络脉的阴血，因为留着的邪气搏结撕裂而出，那么都会渗入肠胃而排泄出来。
世俗之人每见下部出血，都称之为肠风，不知道“风”只是六淫中的一种。如果有风邪从肠胃经脉侵入客居的，或者外来的风木之邪内侵于肠胃的，才可以称之为肠风。如果是其他不因风邪，而是肠胃受火热二淫，以及寒热燥湿郁结气机，加上饮食不节、用力过度，损伤了阴络之血的情况，也可以称之为肠风吗？大概肠风所下的血，清澈而颜色鲜红，四射如溅，这是风的特性所致，《素问》所说的“久风入中，则为肠风飧泄”就是这种情况。先给予泻青丸一二剂，再给予逍遥散，加酒煮黄连、羌活、防风、乌梅。体虚者，用人参胃风汤最为快捷。世人所不知的是，如果肛门射血如线，或点滴不止的，乃是五痔之血，应当详细参照痔疮门的治法。血液浑浊而颜色黯黑的是脏毒，蕴积毒瓦斯，久了才显现出来。宜用小乌沉汤送服黑神散。脉实、便秘、病势盛者，用脏连丸。肠风挟湿毒者，下血如豆汁兼紫黑瘀血，这是醇酒厚味酿成的湿邪，由足阳明经随经入胃，淫溢而下所致。脉细有寒者，用升阳除湿防风汤。脉数有热者，去掉白术、苍术，加黄连、当归、甘草。肠风下血，用刘寄奴半两，芽茶一两，墨灰三钱研为散，分三次服用，乌梅汤送下，血液立即停止。之后宜多服归脾汤调理。
肠风下血，其血另成一派溅出，远射四散如筛，肠中作痛，这是阳明气冲热毒所作。用人参败毒散，无效，用升阳除湿和血汤。素有血证，因时热下紫黑血，这是湿毒肠病，属于阳明、少阳经证。用升阳益肾汤。下血久而不已，面色萎黄，下元虚惫者，用四君子汤加黄芪、当归、芍药。用断红丸。虚甚者，用十全大补汤去茯苓加防风。洁古说：下血，防风为上使，黄连为中使，地榆为下使。千金方说：先见血后见便为远血，宜服黄土汤；先见便后见血为近血，宜服赤小豆当归散。（《金匮要略》以先便后血为远血，先血后便为近血，这是传写之误。因为胃中受冷不能统血，失去营运而下，故宜黄土汤温之；若大肠受热不能摄血，营血运行过速而下，故宜赤小豆当归散清之。）
血色鲜紫者为热伤阴络，用槐花炒研，米汤送服。槐角煎膏尤其好。血色稀淡者为脾虚，单用一味白术，米汤制成丸剂服用。血色瘀晦者为积血，用乱发二两，红花四两，放入烧红的罐中煅烧成灰，去掉红花灰，只用发灰，研细分三次服用，空腹时用炒黑的地榆煎汤送下，三天必见效。下血虽说是大肠积热，也应当分辨虚实，不可纯用寒凉，必须加入辛散药物为主。日久不愈，宜理胃气，兼用升举药。所以大便下血，多以调理胃药收功，不可徒用苦寒。
戴复庵说：血色鲜红为热，血色瘀淡为寒。寒血是因为肠胃受冷，营血运行失度而下，用四物汤加炮姜、炙甘草。热血是因为热毒之气蕴于肠胃，或因饮酒过度，及吃烤炸食物所致，用四物汤加茜根、槐花、酒黄连、炒黑山栀之类。因冷冻饮料中寒，或杂食生冷，血为寒凝而下，必定腹痛、色晦淡，宜用附子理中汤倍加炮姜，加酒黄连。阴结便血者，是厥阴肝血内结，不得阳气统运，渗入肠间而下，并非指阴寒内结。用补中益气汤倍加黄芪，加炮姜。以上两种证候，各家都采用宝鉴平胃地榆汤、结阴丹，没有指出其是非对错的人，我敢极力纠正。
内伤瘀血，胸胁小腹急痛，用桃仁承气汤、代抵当汤，根据疼痛的高低选用。大黄都宜用童便浸透，再用韭汁制。体虚者，可略加桂枝、附子二三钱。如果瘀滞颜色晦暗不鲜，久病应当用温血药，才能奏效。血枯大便燥结而下鲜紫血者，这是大肠燥结所致。单用一味槐角膏凉润之。又一方，真麻油冲入腐花，空腹食用，三天即愈。肠风便血，单用一味旱莲花，浓煎葱白汤漱口咽下，一服立效。又一方，治肠风便血，用刘寄奴半两，松萝茶一钱，乌梅肉一枚，煎服有效。中蛊导致脏腑败坏，下血如鸡肝、如烂肉，心腹绞痛的是这种病。治疗用马蔺根末，水服方寸匙，随呕吐而出。
李士材治疗一人，患肠风下血，久用四物汤、黄芩、黄连、槐花等药，屡次发作不止，面色萎黄，诊其脉，只有脾部浮而缓，这是土虚而风湿交乘所致。于是用苍术三钱，茯苓、人参、黄芪、升麻、柴胡、防风各一钱，四剂后血止。改用十全大补汤，调理而愈。
石顽治疗吴兴韩晋度春捷锦旋，患腹痛泄泻下血，有人用香连丸，导致饮食艰难，少腹急结，虽然小便癃闭，但不喜汤饮，面色萎黄，昼夜去血五十多次，邀请我诊治。气口脉得沉细而紧，询问其所下之血，瘀晦如苋菜汁，给予理中汤加肉桂二钱，一剂后溺通，小腹即宽舒，再剂后血减食进，四剂后泄泻止三四次，排便后微有白脓，给予补中益气汤加炮姜，四剂后康复。
(Ohematemesis, spitting blood, coughing blood, expectorating blood, blood extravasation, bleeding from the nine orifices)
Miu Zhongchun (Zi: Zhongchun) said: There are three principles for treating hematemesis. First, it is advisable to promote blood circulation rather than merely stop bleeding. When blood does not follow its normal pathways, it is due to rebellious Qi obstructing upwards. Promoting blood circulation allows the blood to return to the meridians, and the bleeding will stop spontaneously; if one forcibly stops the bleeding, blood stasis occurs. Blood stasis leads to fever and loss of appetite, causing the disease to become chronic and stubborn. Second, it is advisable to tonify the Liver rather than attack it. The Classics state: The five Zang organs store essence and Qi without leaking them. The Liver governs the storing of blood. In patients with hematemesis, the Liver has lost its proper function. Nourishing the Liver calms the Liver Qi, allowing blood to have a place to return; attacking the Liver causes Liver deficiency, leading to an inability to store blood, resulting in even more profuse bleeding. Third, it is advisable to direct Qi downward rather than clear fire. Excess Qi generates fire. Directing Qi downward lowers fire; once fire is lowered, Qi no longer rises, and blood follows Qi, preventing the hazard of overflowing from the upper orifices. Lowering fire requires cold and cool agents, but this often damages Stomach Qi. Damaged Stomach Qi impairs the Spleen's ability to control blood, making it even harder for blood to return to the meridians.
Currently, there are two major pitfalls in treating hematemesis. One is the exclusive use of cold and cool herbs, such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Siwu Tang (Four Substances Decoction), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex). These often damage the Spleen, causing diarrhea, leading to untreatable conditions. The other is the exclusive use of Renshen (Ginseng Radix et Rhizoma). For those with Lung heat, using Renshen harms Lung Qi, worsening cough. There are cases where Renshen cures the condition, but these are cases of Qi deficiency causing wheezing and coughing. Qi belongs to Yang and is not caused by Yin deficiency with blazing fire; such cases are rare, one or two in a hundred.
Liu Mosheng said: Regarding hematemesis, people only know that rebellious Qi causes blood extravasation and rising fire causes blood flooding. They do not realize that within the Zang-Fu organs, there are diaphragmatic membranes that separate and fix the blood, preventing it from permeating and overflowing. The so-called diaphragm is extremely thin and fragile; any injury causes it to rupture, leading to upward bleeding. Thus, "injury to the Yang collaterals causes blood to overflow upwards, while injury to the Yin collaterals causes blood to seep downwards." If an already injured membrane suffers further injury, the vomiting of blood will be severe. Although the diaphragm is injured, blood stasis forms at the site, slowing the flow. However, if sudden Yin fire breaks through the accumulated blood stasis, blood surges like a tide, accompanied by audible gurgling sounds. At this moment, breathing is irregular, the face is red as if drunk, restlessness prevails, and the mind is chaotic. This is the manifestation of Dragon-Lei Fire (Ministerial Fire) raging, and the pulse is rapid and difficult to assess. After a short while, when the fire subsides and clarity returns, the face becomes pale, breathing stabilizes, and bleeding gradually stops. Only then can the pulse be palpated. Medication should be administered at this time, after the stasis has been cleared, followed by gradual regulation and slow tonification. However, one must avoid sudden cloying tonification and must not use herbs that consume Qi. Understanding these principles provides the foundation for treating blood disorders.
Blood vomited by the patient consists of Yin blood and Yang blood. Yang blood moves with Qi, circulating within the vessels, harmonizing the Five Zang organs, and distributing to the Six Fu organs; this is called Ying blood (Nutritive Blood). Yin blood resides in the collaterals, guarding the Zang organs, nourishing Shen (Spirit), and moistening sinews and bones. If the Zang organs are injured by internal or external pathogens, the Yang blood traveling along the meridians reaches the injury site, is blocked by the pathogen, and leaks out of the meridians. Or, the Yin blood residing in the collaterals, due to lingering pathogens causing tearing, enters the intestines and stomach and is excreted.
The laypeople often refer to lower bleeding as Changfeng (Intestinal Wind), unaware that "Wind" is merely one of the Six Evils. If Wind pathogen invades and lodges in the intestinal and gastric meridians, or if external Wood-Wind pathogen attacks the intestines and stomach internally, it may be called Changfeng. But what if the bleeding is not caused by Wind, but by Heat and Fire evils affecting the intestines and stomach, combined with stagnation of Qi due to Cold, Heat, Dryness, or Dampness, along with irregular diet and excessive exertion damaging the Yin collaterals? Can this also be called Changfeng? Generally, blood from Changfeng is clear and bright red, spraying like splashes, which is characteristic of Wind nature, as stated in Suwen: "Long-standing Wind entering the interior leads to Intestinal Wind and undigested stool diarrhea." Initially administer Xieqing Wan (Drain Green Pill) for one or two doses, then Xiaoyao San (Free and Easy Wanderer Powder) with Jiu Zhu Huanglian (Wine-processed Coptidis Rhizoma), Qianghuo (Notopterygii Rhizoma), Fangfeng (Saposhnikoviae Radix), and Wumei (Mume Fructus). For deficient individuals, Renshen Weifeng Tang (Ginseng Stomach Wind Decoction) is most effective. What people do not know is that if blood shoots from the anus like a thread or drips continuously, it is blood from the Five Hemorrhoids (Wu Zhi) and should be treated according to the Hemorrhoid chapter. Blood that is turbid and dark black indicates Zangdu (Visceral Toxin), where toxic vapors accumulate over time before manifesting. Use Xiaowuchen Tang (Minor Black Still Water Decoction) to deliver Heishen San (Black Divine Powder). For cases with excess pulse, constipation, and vigorous pathology, use Zanglian Wan (Visceral Connection Pill). For Changfeng complicated by damp-toxin, where stool resembles bean curd dregs mixed with purple-black stasis, this is dampness brewed from rich wine and heavy flavors, entering the Stomach via the Foot-Yangming Meridian and overflowing downward. For fine pulses indicating Cold, use Shengyang Chushi Fangfeng Tang (Raise Yang Drain Dampness Saposhnikovia Decoction). For rapid pulses indicating Heat, remove Baizhu (Atractylodis Macrocephalae Rhizoma) and Cangzhu (Atractylodis Rhizoma), add Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), and Gancao (Glycyrrhizae Radix). For Changfeng lower bleeding, use Liuji Nu (Artemisiae Anomfoliae Herba) half liang, Yacha (Sprouted Tea) one liang, and Meihui (Ink Ash) three qian, ground into powder, divided into three doses, taken with Wumei Tang (Mume Decoction); bleeding stops immediately. Afterwards, take Guipi Tang (Restore the Spleen Decoction) frequently for regulation.
For Changfeng lower bleeding, if blood sprays out separately, shooting far and wide like a sieve, accompanied by abdominal pain, this is caused by Yangming Qi rushing with heat-toxin. Use Renshen Baidu San (Ginseng Detoxifying Powder). If ineffective, use Shengyang Chushi Hexue Tang (Raise Yang Drain Dampness Harmonize Blood Decoction). For chronic blood disorders, if purple-black blood is passed due to seasonal heat, this is damp-toxin intestinal disease, involving Yangming and Shaoyang meridian syndromes. Use Shengyang Yishen Tang (Raise Yang Tonify Kidney Decoction). For prolonged lower bleeding with sallow complexion and deficiency of the lower origin, use Sizijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix). Use Duanhong Wan (Stop Red Pill). For severe deficiency, use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) minus Fuling (Poria) plus Fangfeng (Saposhnikoviae Radix). Jiegu said: For lower bleeding, Fangfeng (Saposhnikoviae Radix) is the upper envoy, Huanglian (Coptidis Rhizoma) is the middle envoy, and Diyü (Sanguisorbae Radix) is the lower envoy. Qianjin Fang states: Bleeding appearing before stool is distant blood (Yuanxue), suitable for Huangtu Tang (Yellow Earth Decoction); bleeding appearing after stool is near blood (Jinxue), suitable for Chixiaodou Danggui San (Adzuki Bean and Angelica Powder). (Note: Jingui Yaolüe states stool before bleeding is distant blood and bleeding before stool is near blood, which is a transcription error. Because Cold in the Stomach fails to control blood, losing its transport function, it descends, thus Huangtu Tang is used to warm it. If Heat in the Large Intestine fails to hold blood, causing Ying blood to move too fast and descend, Chixiaodou Danggui San is used to clear it.) Bright purple-red blood indicates Heat injuring Yin collaterals; use fried and powdered Huaihua (Sophorae Flavescentis Flos) taken with rice soup. Huaijiao paste (Fructus Sophorae) is especially good. Pale, thin blood indicates Spleen deficiency; use single herb Baizhu (Atractylodis Macrocephalae Rhizoma) made into pills with rice soup. Dark, dull blood indicates accumulated stasis; use 2 liang of human hair (Luankou) and 4 liang of Honghua (Carthami Flos), calcined in a red-hot jar until ash, discard Honghua ash, keep only hair ash, grind finely, divide into three doses, taken on an empty stomach with decoction of fried black Diyü (Sanguisorbae Radix); effect seen in three days. Although lower bleeding is said to be due to Large Intestine accumulation of Heat, one must distinguish deficiency and excess, avoiding pure cold agents, and must add acrid-dispersing herbs as the main component. For chronic cases, regulate Stomach Qi and add lifting herbs. Therefore, lower gastrointestinal bleeding is often resolved by treating the Stomach, not merely using bitter-cold herbs.
Dai Fu'an said: Bright red color indicates Heat; dark, pale color indicates Cold. Cold blood results from Cold in the intestines and stomach disrupting Ying blood transport, descending abnormally; treat with Siwu Tang (Four Substances Decoction) plus Paojiang (Processed Ginger) and Zhigancao (Honey-fried Licorice). Hot blood results from Heat-toxin accumulating in the intestines and stomach, or from excessive alcohol consumption and eating fried/roasted foods; treat with Siwu Tang plus Qianggen (Rubiae Radix), Huaihua (Sophorae Flavescentis Flos), Jiu Huanglian (Wine-processed Coptidis Rhizoma), and Chaohei Shanzhi (Stir-fried Black Gardeniae Fructus). If bleeding is caused by cold drinks or raw/cold foods congealing the blood, abdominal pain and dull-pale color occur; treat with Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) with doubled Paojiang (Processed Ginger) and Jiu Lian (Wine-processed Coptidis Rhizoma). Yin-constriction hematochezia refers to Jueyin Liver blood constricting internally, unable to be transported by Yang Qi, seeping into the intestines and descending; this is not internal Yin-Cold constriction. Treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Huangqi (Astragali Radix) and Paojiang (Processed Ginger). For the above two syndromes, various schools adopt Baogjian Pingwei Diyü Tang (Treasure Mirror Calm Stomach Sanguisorba Decoction) and Jieyin Dan (Bind Yin Pill). I dare to correct those who fail to discern their validity.
For internal injury with blood stasis, presenting with acute pain in the chest, hypochondrium, and lower abdomen, use Taoren Chengqi Tang (Peach Kernel Downward-Pursuing Decoction) or Dai Didang Tang (Iron Mortar Replacing Dandang Decoction), selecting based on pain location. Dahuang (Rhei Radix et Rhizoma) should be soaked in Tongbian (Child Urine) and processed with Jiuzhi (Leek Juice). For deficient individuals, add a small amount (2-3 fen) of Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata). If stasis is dark and not fresh, long-term treatment requires warming-blood herbs to achieve efficacy. For blood depletion with dry stool and passage of bright-purple blood, this is due to Large Intestine dryness. Use single herb Huaijiao Gao (Sophora Fruit Paste) to cool and moisten. Another prescription: Mix real sesame oil with rotten flowers, eat on an empty stomach; cured in three days. For Changfeng hematochezia, use single herb Hanlian Hua (Ecliptae Herba), decoct strongly with Congbai (Scallion White), rinse mouth and swallow; effective in one dose. Another prescription for Changfeng hematochezia: Liuji Nu (Artemisiae Anomfoliae Herba) half liang, Songluo Cha (Songluo Tea) one qian, Wumei Rou (Mume Flesh) one piece, decoct and take; effective. For poisoning by Gu (worms) causing organ failure, passing blood like chicken liver or rotting meat, with severe heart-abdominal colic, treat with Maligen Mo (Marli Root Powder), taken with water using a square-inch spoon, expelled via vomiting.
Li Shicai treated a man suffering from Changfeng lower bleeding. Having used Siwu Tang, Huangqin, Huanglian, and Huaihua for a long time without success, with recurrent episodes and sallow complexion, his pulse was floating and moderate only in the Spleen position. This indicated Earth deficiency with concurrent Wind-Dampness. He prescribed Cangzhu (Atractylodis Rhizoma) 3 qian, Fuling (Poria), Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), and Fangfeng (Saposhnikoviae Radix) each 1 qian. After four doses, bleeding stopped. Switched to Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) for regulation, resulting in recovery.
Shiwan treated Wu Xing Han Jin Du Chunjie Jin Xuan, who suffered from abdominal pain, diarrhea, and lower bleeding. After using Xianglian Wan (Fragrant Coptis Pill), food intake became difficult, lower abdomen felt tight and knotted, urinary retention occurred, yet there was no desire for hot drinks. The complexion was sallow, and he passed blood more than fifty times day and night. Upon consultation, the Qi Kou pulse was deep, fine, and tight. The blood passed was dark and turbid like amaranth juice. Prescribed Lizhong Tang (Regulate the Middle Decoction) with Rougui (Cinnamomi Cortex) 2 qian. After one dose, urination resumed, and the lower abdomen relaxed. After two doses, bleeding decreased and appetite improved. After four doses, diarrhea reduced to three or four times daily, with slight white pus in the stool. Prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Paojiang (Processed Ginger). After four doses, he recovered.