周（左） 湿热未愈，肠红又至，腹痛便血，血块紫殷。良以湿蒸热腾，血遂凝结。未便止遏，宜和营化瘀。
当归炭 粉丹皮 炒槐花 川连炭 荆芥炭 南楂炭 延胡索 炒赤芍 血余炭 泻青丸 上湘军（酒炒后入）
二诊 辛以燥湿，苦以泄热，并以丸药入下，使直达病所，湿热既退三舍，则凝瘀自然默化，所以腹痛
渐定，便血大减。然肝为藏血之海，为神魂之舍，血去则肝虚，怒火则木动，此少寐多梦之所由来也。纳
不馨旺，木气盛则土气衰也。但阴络未扃，恐血再渗漏，仍须务其所急。
生于术（七分） 川连炭（四分） 荆芥炭（一钱五分） 大红鸡冠花（炒黑四钱） 防风炭（一钱）
赤白苓（各二钱） 茅术（一钱麻油炒黄） 制香附（炒透一钱五分） 黄柏炭（二钱） 泽泻（一钱五分） 猪苓
（一钱五分） 龙齿（三钱） 夜交藤（四钱）
席（左） 向是肠痔，兹则大便之后，滴沥下血。此湿热蕴结肠中。
侧柏炭 枳壳 炒槐花 荆芥炭 制半夏 丹皮炭 泽泻 炒竹茹 黄柏炭 炒防风 当归炭 广皮
陈（左） 肠红日久不止。脉细濡弱，而右关独觉弦滑。此风湿热袭入大肠营分，非沉阴苦降，不足以达肠中也。
焦苍术（一钱） 炒荆芥（一钱五分） 黄柏炭（三钱） 秦艽（一钱五分） 丹皮炭（二钱） 生白术（一
钱五分） 川连炭（五分） 泽泻（一钱五分） 炒防风（一钱） 大红鸡冠花（炙黑三钱）
远血为脾不统血，黄土汤。近血乃肠胃湿热，赤小豆当归散。此人数月便血，精神如旧。师以为非身所藏之血，
其血自痔中来，与遗泄属湿同。（正蒙志）
陆（左） 下血如注，面色浮黄，中州痞满。此风邪入于肠胃，迫损营分，风性急速，所以血来如矢。拟凉血
宽肠和中利湿。
侧柏炭 黄柏炭 苍术 枳壳 川朴 泽泻 荆芥炭 炒槐花 广皮 制半夏 白茯苓
二诊 血仍如注，气仍秽臭，散者鲜赤，瘀者如胶，良以脾土气虚，脏寒腑热，拟温脏清腑。
参须（一钱） 黄柏炭（三钱） 当归炭（二钱） 炮姜炭（三分） 炒于术（二钱） 茯苓（四钱）
川连炭（五分） 丹皮炭（二钱） 血余炭（一钱） 炒槐花（二钱） 黄芩炭（一钱五分） 上湘军（
一钱五分酒炒透后入）
某 便血四溅如筛。脉形浮大。此风邪袭入肠胃，所谓肠风是也。宜泄热化风。
侧柏炭 炒防风 当归炭 炙黑大红鸡冠花 炒槐花 炒丹皮 荆芥炭 枳壳 桔梗
某 下血如注，用断下渗湿法。
薏仁 黄柏炭 炒荆芥 苍术 炒黑樗白皮 猪苓 丹皮炭 炒防风 陈皮 地榆炭
许 大便带血，肛门作痛。湿热损伤大肠血分。宜宽肠凉血。
侧柏炭（三钱） 炒槐花（一钱五分） 酒炒白芍（一钱五分） 左秦艽（一钱五分） 丹皮炭（二钱）
黄芩炭（一钱五分）
大红鸡冠花（炙黑二钱） 枳壳（一钱） 阿胶珠（二钱）
某 风伤卫阳，咳剧自汗，今忽便血。风邪陷入肠胃，表里合病。势多变局。
荆芥炭 侧柏炭 炒槐花 茯苓 炒黄桑叶 防风炭 丹皮炭 杏仁泥 泽泻 枳壳
某 便血复发，每至圊后，气即下坠，坠则小溲欲解不爽。此气虚统摄无权，清阳沦陷也。
党参 黄柏炭 槐花炭 炙黄 醋炙柴胡 炙草 丹皮炭 炮姜炭 地榆炭 醋炙升麻 于术 当归炭
郑（左） 阴有二窍，一窍通精，一窍通水，水窍开则精窍常闭。无梦而泄，二十余年，而起居如常。其兼证
也，上则鼻红，下则便血。其脉也，滑而实。其苔也，白而腻。此皆湿热盛极，致湿扰精宫，渐至阴络内伤。经
云、阴络伤则血内溢，血内溢则后血。其病虽殊其源则一。
苍术 防风炭 炒荆芥 川连炭 川萆 米仁 黄柏炭 炒槐花 丹皮炭 猪苓 泽泻 大淡菜
黄（左） 肠红止而复来，腹中 痛。良由湿热未清。再从苦泄之中，兼和营卫。
当归炭（一钱） 荆芥炭（一钱） 左秦艽（一钱五分） 炙黑红鸡冠花（三钱） 血余炭（三钱）
炒丹皮（二钱） 炒枳壳（一钱五分） 苍术（麻油炒黄一钱） 黄柏炭（三钱） 炒槐花（二钱） 于术（
一钱五分） 川连炭（三分）
洪（左） 肛门烙热稍退，然便血仍然不止。脉象细数。的是湿热损伤营分，阴络内伤。再拟养肝滋阴壮水。
生地炭（五钱） 丹皮炭（二钱） 黄柏炭（一钱五分） 酒炒白芍（一钱五分） 川连炭（四分） 地
榆炭（二钱） 当归炭（一钱五分） 炒黑樗白皮（三钱） 清阿胶（二钱） 炒槐花（二钱）
二诊 育阴泄热，便血降序。药既应手，当为扩充。
炙生地（四钱） 丹皮炭（二钱） 炒槐花（二钱） 炙黑樗白皮（三钱） 清阿胶（二钱）
黄柏炭（二钱） 当归炭（二钱） 炙元武板（三钱先煎） 泽泻（一钱五分） 白芍（二钱） 茯神（三钱）
三诊 便血降序。再养血育阴，而固阴络。
清阿胶（三钱） 丹皮炭（二钱） 樗白皮（一钱炒黑） 炙龟甲心（六钱） 大生地（四钱） 地榆炭（二
钱） 建泽泻（一钱五分） 酒炒白芍（二钱） 炒槐花（二钱） 蒲黄炭（一钱） 赤小豆（二钱） 藕节（二枚）
叶（右） 向有肠红，春末夏初，渐觉肿胀，日来肠红大发，血出稀淡，脘痞腹胀，难于饮食。脉形沉细，苔白
质淡。肝为藏血之海，脾为统血之帅，今脾阳不能统摄，所以血溢下注，脾难旋运。恐肿胀日甚。
生于术（一钱） 炙黑草（三分） 砂仁（后入五分） 生熟谷芽（各二钱） 制茅术（一钱） 炮姜（五分）
大腹皮（二钱） 百草霜（一钱）
二诊 用苍术理中，便血大减，而便泄腹痛，胸脘痞满气分攻撑，腹膨肤肿。脉沉细，苔淡白，脾稍统摄，
而旋运无权，遂致肝木偏亢，气湿不能分化。前法再参以分化。
茅术（一钱五分） 木香（五分） 陈皮（一钱） 川朴（四分） 白芍（一钱五分吴萸二分同炒）
连皮苓（四钱） 炮姜（五分） 炙草（三分） 砂仁（五分） 大腹皮（一钱五分）
三诊 便血已止而脘腹仍然胀满，大便泄泻，小溲不畅。脾虚不能旋运，气湿不行，升降失司。再运土利湿。
大腹皮（二钱） 连皮苓（四钱） 猪苓（一钱五分） 生熟米仁（各二钱） 上广皮（一钱） 广木香（五分）
泽泻（一钱五分） 炙鸡内金（一钱五分） 制香附（二钱） 生姜衣（三分）
四诊 运土利湿，便血未来，而脘腹满胀，仍然不减，小溲不利，大便泄泻，两足厥逆。脉形沉细。肢体虚
浮。阳气不能敷布，以致水湿之气，泛溢肌肤。再宣布五阳，以望转机。
熟附片（五分） 淡吴萸（五分） 泽泻（二钱） 薄官桂（六分后入） 炙内金（二钱） 公丁香（三分）
白茯苓（四钱） 猪苓（二钱） 台白术（二钱）
五诊 胀由于气，肿由于湿，宣布五阳，肿胀稍定，仍然不退，咳嗽气逆。肺主一身气化。再疏肺下气，参以理湿。
砂仁（五分） 甜葶苈（六分） 大腹皮（二钱） 花槟榔（一钱） 青陈皮（各一钱） 木香（五分）
炒苏子（三钱） 制香附（二钱） 连皮苓（二钱） 炙内金（一钱五分） 姜衣（三分）
周（左） 湿热之邪尚未痊愈，肠红（便血）再次发作，伴有腹痛和便血，血色紫黑且有血块。这是因为湿气蒸腾、热气郁结，导致血液凝结。此时不宜强行止血，应当调和营血、化瘀散结。
当归炭、粉丹皮、炒槐花、川连炭、荆芥炭、南楂炭、延胡索、炒赤芍、血余炭、泻青丸、上湘军（酒炒后入药）。
二诊 用辛味药以燥湿，苦味药以泄热，并配合丸药送服，使药力直达病所。湿热已退去大半，凝滞的瘀血自然慢慢化解，所以腹痛逐渐缓解，便血大幅减少。然而肝是藏血的脏器，也是神魂的居所，失血则肝虚，怒火则肝气妄动，这就是睡眠少、多梦的原因。食欲不旺盛，是因为肝木气盛克制脾土，导致脾气衰弱。但阴络（肠道脉络）仍未闭合，恐怕血液再次渗漏，仍须处理紧急之症。
生于术（七分）、川连炭（四分）、荆芥炭（一钱五分）、大红鸡冠花（炒黑四钱）、防风炭（一钱）、赤白苓（各二钱）、茅术（一钱麻油炒黄）、制香附（炒透一钱五分）、黄柏炭（二钱）、泽泻（一钱五分）、猪苓（一钱五分）、龙齿（三钱）、夜交藤（四钱）。
席（左） 向来患有肠痔，现在大便之后，滴沥下血。这是湿热蕴结在肠道中。
侧柏炭、枳壳、炒槐花、荆芥炭、制半夏、丹皮炭、泽泻、炒竹茹、黄柏炭、炒防风、当归炭、广皮。
陈（左） 肠红（便血）日久不止。脉象细濡弱，唯独右关脉感觉弦滑。这是风湿热邪侵袭大肠营分，不用沉重阴寒、苦降的药物，不足以到达肠道深处。
焦苍术（一钱）、炒荆芥（一钱五分）、黄柏炭（三钱）、秦艽（一钱五分）、丹皮炭（二钱）、生白术（一钱五分）、川连炭（五分）、泽泻（一钱五分）、炒防风（一钱）、大红鸡冠花（炙黑三钱）。
远血（排便前出血或血色暗黑）是由于脾不统摄血液，用黄土汤治疗。近血（排便时出血或血色鲜红）乃是肠胃湿热，用赤小豆当归散治疗。此人数月来便血，精神却如常。老师认为这不是身体内部脏腑受损出血，其血来自痔疮，与遗精滑泄属于湿邪为患的道理相同。（出自《正蒙志》）
陆（左） 下血如注，面色浮黄，中焦痞满。这是风邪侵入肠胃，逼迫损伤营分，风性急速，所以血流如箭。拟用凉血、宽肠、和中、利湿的方法。
侧柏炭、黄柏炭、苍术、枳壳、川朴、泽泻、荆芥炭、炒槐花、广皮、制半夏、白茯苓。
二诊 血仍如注，气息秽臭，散开的血色鲜红，凝结的如胶状，这是因为脾土气虚，脏寒腑热，拟用温脏清腑的方法。
参须（一钱）、黄柏炭（三钱）、当归炭（二钱）、炮姜炭（三分）、炒于术（二钱）、茯苓（四钱）、川连炭（五分）、丹皮炭（二钱）、血余炭（一钱）、炒槐花（二钱）、黄芩炭（一钱五分）、上湘军（一钱五分酒炒透后入）。
某 便血四溅如筛。脉象浮大。这是风邪袭入肠胃，所说的“肠风”病症。宜用泄热化风的方法。
侧柏炭、炒防风、当归炭、炙黑大红鸡冠花、炒槐花、炒丹皮、荆芥炭、枳壳、桔梗。
某 下血如注，用断下渗湿法。
薏仁、黄柏炭、炒荆芥、苍术、炒黑樗白皮、猪苓、丹皮炭、炒防风、陈皮、地榆炭。
许 大便带血，肛门作痛。湿热损伤大肠血分。宜宽肠凉血。
侧柏炭（三钱）、炒槐花（一钱五分）、酒炒白芍（一钱五分）、左秦艽（一钱五分）、丹皮炭（二钱）、黄芩炭（一钱五分）、大红鸡冠花（炙黑二钱）、枳壳（一钱）、阿胶珠（二钱）。
某 风邪伤及卫阳，咳嗽剧烈且自汗，如今忽然便血。风邪陷入肠胃，表里同病。病情多变。
荆芥炭、侧柏炭、炒槐花、茯苓、炒黄桑叶、防风炭、丹皮炭、杏仁泥、泽泻、枳壳。
某 便血复发，每次如厕后，气即下坠，下坠则小便欲解而不爽。这是气虚统摄无权，清阳之气沦陷。
党参、黄柏炭、槐花炭、炙黄芪、醋炙柴胡、炙甘草、丹皮炭、炮姜炭、地榆炭、醋炙升麻、于术、当归炭。
郑（左） 阴部有两个窍道，一个通精液，一个通尿液，尿窍开则精窍常闭。无梦而遗精二十余年，起居如常。其兼证是：上部鼻衄，下部便血。其脉象滑而实。其舌苔白而腻。这都是湿热极盛，导致湿邪扰动精宫，逐渐至阴络内伤。经云：“阴络伤则血内溢，血内溢则后血。”虽然病症不同，但根源一致。
苍术、防风炭、炒荆芥、川连炭、川萆薢、米仁、黄柏炭、炒槐花、丹皮炭、猪苓、泽泻、大淡菜。
黄（左） 肠红（便血）止住后又复发，腹中疼痛。良由湿热未清。再从苦泄之中，兼以调和营卫。
当归炭（一钱）、荆芥炭（一钱）、左秦艽（一钱五分）、炙黑红鸡冠花（三钱）、血余炭（三钱）、炒丹皮（二钱）、炒枳壳（一钱五分）、苍术（麻油炒黄一钱）、黄柏炭（三钱）、炒槐花（二钱）、于术（一钱五分）、川连炭（三分）。
洪（左） 肛门灼热感稍退，但便血仍然不止。脉象细数。确是湿热损伤营分，阴络内伤。再拟养肝滋阴壮水之法。
生地炭（五钱）、丹皮炭（二钱）、黄柏炭（一钱五分）、酒炒白芍（一钱五分）、川连炭（四分）、地榆炭（二钱）、当归炭（一钱五分）、炒黑樗白皮（三钱）、清阿胶（二钱）、炒槐花（二钱）。
二诊 育阴泄热，便血逐渐减少。药既见效，当扩大方剂范围。
炙生地（四钱）、丹皮炭（二钱）、炒槐花（二钱）、炙黑樗白皮（三钱）、清阿胶（二钱）、黄柏炭（二钱）、当归炭（二钱）、炙元武板（三钱先煎）、泽泻（一钱五分）、白芍（二钱）、茯神（三钱）。
三诊 便血逐渐减少。再养血育阴，以固护阴络。
清阿胶（三钱）、丹皮炭（二钱）、樗白皮（一钱炒黑）、炙龟甲心（六钱）、大生地（四钱）、地榆炭（二钱）、建泽泻（一钱五分）、酒炒白芍（二钱）、炒槐花（二钱）、蒲黄炭（一钱）、赤小豆（二钱）、藕节（二枚）。
叶（右） 向来有肠红，春末夏初，渐觉肿胀，近日肠红大发，血色稀淡，脘痞腹胀，难于饮食。脉象沉细，舌苔白，舌质淡。肝是藏血的脏器，脾是统血的帅导，如今脾阳不能统摄，所以血液溢出下注，脾难旋转运化。恐怕肿胀日益加重。
生于术（一钱）、炙黑草（三分）、砂仁（后入五分）、生熟谷芽（各二钱）、制茅术（一钱）、炮姜（五分）、大腹皮（二钱）、百草霜（一钱）。
二诊 用苍术理中，便血大减，但出现便泄腹痛，胸脘痞满，气分攻撑，腹部膨隆皮肤浮肿。脉沉细，苔淡白，脾稍能统摄，但旋转运化无权，遂致肝木偏亢，气湿不能分化。前法再参以分化气湿。
茅术（一钱五分）、木香（五分）、陈皮（一钱）、川朴（四分）、白芍（一钱五分吴萸二分同炒）、连皮苓（四钱）、炮姜（五分）、炙草（三分）、砂仁（五分）、大腹皮（一钱五分）。
三诊 便血已止但脘腹仍然胀满，大便泄泻，小便不畅。脾虚不能旋转运化，气湿不行，升降失常。再运脾土利湿。
大腹皮（二钱）、连皮苓（四钱）、猪苓（一钱五分）、生熟米仁（各二钱）、上广皮（一钱）、广木香（五分）、泽泻（一钱五分）、炙鸡内金（一钱五分）、制香附（二钱）、生姜衣（三分）。
四诊 运脾土利湿，便血未来，但脘腹满胀仍然不减，小便不利，大便泄泻，两足厥冷。脉象沉细。肢体虚浮。阳气不能敷布，以致水湿之气泛溢肌肤。再宣布五阳，以望转机。
熟附片（五分）、淡吴萸（五分）、泽泻（二钱）、薄官桂（六分后入）、炙内金（二钱）、公丁香（三分）、白茯苓（四钱）、猪苓（二钱）、台白术（二钱）。
五诊 胀由于气，肿由于湿，宣布五阳，肿胀稍定但仍不退，咳嗽气逆。肺主一身气化。再疏肺下气，参以理湿。
砂仁（五分）、甜葶苈（六分）、大腹皮（二钱）、花槟榔（一钱）、青陈皮（各一钱）、木香（五分）、炒苏子（三钱）、制香附（二钱）、连皮苓（二钱）、炙内金（一钱五分）、姜衣（三分）。
Zhou (Left) Damp-heat has not yet subsided, and intestinal bleeding (hematochezia) has recurred, accompanied by abdominal pain and blood in the stool, with dark purple clots. This is due to dampness steaming and heat rising, causing blood coagulation. It is inappropriate to forcibly stop bleeding at this time; instead, one should harmonize Ying (Nutritive) blood and resolve stasis.
Danggui Tan (Carbonized Radix Angelicae Sinensis), Fen Danpi (Moutan Cortex), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Chuanlian Tan (Carbonized Rhizoma Coptidis), Jingjie Tan (Semen Schisandrae Chinensis, carbonized), Nanzha Tan (Fructus Crataegi, carbonized), Yanhusuo (Rhizoma Corydalis), Chao Chishao (Radix Paeoniae Rubra, stir-fried), Xuyutan (Hirsutae Capillis Carbonized), Xieqing Wan (Pill Formula for Draining Blue), Shang Xiangjun (Radix et Rhizoma Rhei, wine-fried and added later).
Second visit: Acrid herbs are used to dry dampness, bitter herbs to drain heat, and pills are taken to direct the medicinal power to the disease site. As damp-heat has retreated significantly, the stagnant stasis naturally dissolves gradually; thus, abdominal pain has eased, and hematochezia has decreased substantially. However, the Liver stores blood and houses the Shen (Spirit); loss of blood leads to Liver deficiency, and fire anger causes Wood Qi to move recklessly, which explains the insomnia and frequent dreaming. Poor appetite indicates that excess Wood Qi suppresses Earth Qi. Since the Yin collaterals are not yet sealed, there is fear of further leakage; urgent matters must still be addressed.
Sheng Baizhu (Atractylodis Macrocephalae Rhizoma, raw, 0.7 qian), Chuanlian Tan (Carbonized Rhizoma Coptidis, 0.4 qian), Jingjie Tan (Semen Schisandrae Chinensis, carbonized, 1.5 qian), Dahong Jiguanhua (Coronilla Variabilis, stir-fried black, 4 qian), Fangfeng Tan (Radix Saposhnikoviae, carbonized, 1 qian), Chi Bai Ling (Albiziae Cortex and Polyporus, 2 qian each), Maoyi Zhu (Atractylodis Rhizoma, fried in sesame oil, 1 qian), Zhi Xiangfu (Cyperi Rhizoma, processed, 1.5 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 2 qian), Zexie (Alismatis Rhizoma, 1.5 qian), Zhuling (Polypori Sclerotium, 1.5 qian), Longchi (Dracois Os, 3 qian), Yejiaoteng (Caulis Polygoni Multiflori, 4 qian).
Xi (Left) Previously suffered from intestinal hemorrhoids; now, after defecation, dripping blood occurs. This is damp-heat accumulating in the intestines.
Cebai Tan (Platycladi Cacumen, carbonized), Zhiqiao (Aurantii Fructus), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Jingjie Tan (Semen Schisandrae Chinensis, carbonized), Zhi Banxia (Pinelliae Tuber, processed), Danpi Tan (Moutan Cortex, carbonized), Zexie (Alismatis Rhizoma, 1.5 qian), Chao Zhuru (Bambusae Caulis in Taeniam, stir-fried), Huangbai Tan (Phellodendri Cortex, carbonized), Chao Fangfeng (Radix Saposhnikoviae, stir-fried), Danggui Tan (Carbonized Radix Angelicae Sinensis), Guangpi (Citri Reticulatae Pericarpium).
Chen (Left) Intestinal bleeding has persisted for a long time without stopping. The pulse is fine, soggy, and weak, but the Right Guan position feels wiry and slippery. This indicates wind-damp-heat invading the Ying level of the Large Intestine. Without heavy, yin-nourishing, and bitter-descending herbs, it is insufficient to reach the interior of the intestine.
Jiao Cangzhu (Atractylodis Rhizoma, scorched, 1 qian), Chao Jingjie (Semen Schisandrae Chinensis, stir-fried, 1.5 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 3 qian), Qinjiao (Radix Gentianae Macrophyllae, 1.5 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Sheng Baizhu (Atractylodis Macrocephalae Rhizoma, raw, 1.5 qian), Chuanlian Tan (Carbonized Rhizoma Coptidis, 0.5 qian), Zexie (Alismatis Rhizoma, 1.5 qian), Chao Fangfeng (Radix Saposhnikoviae, stir-fried, 1 qian), Dahong Jiguanhua (Coronilla Variabilis, roasted black, 3 qian).
Yuanxue (bleeding before defecation or dark blood) is caused by the Spleen's failure to control blood, treated with Huangtu Tang. Jin xue (fresh bright red blood during defecation) is due to damp-heat in the stomach and intestines, treated with Chixiaodou Danggui San. This patient has had hematochezia for months but remains energetic. The master believes this is not internal organ damage but bleeding from hemorrhoids, similar in nature to seminal emission caused by dampness (from *Zhengmeng Zhi*).
Lu (Left) Bleeding flows like a torrent, complexion is floating yellow, and the middle jiao is obstructed and full. Wind pathogen has entered the stomach and intestines, forcing damage to the Ying level. Wind is swift, hence the blood flows rapidly. Plan to cool blood, widen intestines, harmonize middle, and promote diuresis.
Cebai Tan (Platycladi Cacumen, carbonized), Huangbai Tan (Phellodendri Cortex, carbonized), Cangzhu (Atractylodis Rhizoma), Zhiqiao (Aurantii Fructus), Chunghou (Magnoliae Officinalis Cortex), Zexie (Alismatis Rhizoma), Jingjie Tan (Semen Schisandrae Chinensis, carbonized), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Guangpi (Citri Reticulatae Pericarpium), Zhi Banxia (Pinelliae Tuber, processed), Bai Fuling (Poria, 4 qian).
Second visit: Blood still flows like a torrent, breath is foul, scattered blood is bright red, coagulated blood is gelatinous. This is due to Spleen Earth Qi deficiency, cold in the zang organs, and heat in the fu organs. Plan to warm the zang and clear the fu.
Renshen Xu (Ginseng Radix et Rhizoma tips, 1 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 3 qian), Danggui Tan (Carbonized Radix Angelicae Sinensis, 2 qian), Paojiang Tan (Zingiberis Rhizoma Preparatum, carbonized, 0.3 qian), Chao Yuzhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 2 qian), Fuling (Poria, 4 qian), Chuanlian Tan (Carbonized Rhizoma Coptidis, 0.5 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Xuyutan (Hirsutae Capillis Carbonized, 1 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 2 qian), Huangqin Tan (Scutellariae Radix, carbonized, 1.5 qian), Shang Xiangjun (Radix et Rhizoma Rhei, 1.5 qian wine-fried and added later).
Certain Patient Hematochezia sprays like a sieve. Pulse is floating and large. Wind pathogen has invaded the stomach and intestines, known as "Intestinal Wind." Plan to drain heat and transform wind.
Cebai Tan (Platycladi Cacumen, carbonized), Chao Fangfeng (Radix Saposhnikoviae, stir-fried), Danggui Tan (Carbonized Radix Angelicae Sinensis), Zhihei Dahong Jiguanhua (Coronilla Variabilis, roasted black), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Chao Danpi (Moutan Cortex, stir-fried), Jingjie Tan (Semen Schisandrae Chinensis, carbonized), Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix).
Certain Patient Lower bleeding flows like a torrent. Use method to stop bleeding and leach out dampness.
Yiren (Coicis Semen), Huangbai Tan (Phellodendri Cortex, carbonized), Chao Jingjie (Semen Schisandrae Chinensis, stir-fried), Cangzhu (Atractylodis Rhizoma), Chaohei Chubaipi (Periplocae Cortex, stir-fried black), Zhuling (Polypori Sclerotium), Danpi Tan (Moutan Cortex, carbonized), Chao Fangfeng (Radix Saposhnikoviae, stir-fried), Chenpi (Citri Reticulatae Pericarpium), Diyutan (Sanguisorbae Radix, carbonized).
Xu Blood in stool with anal pain. Damp-heat damages the blood level of the Large Intestine. Plan to widen intestines and cool blood.
Cebai Tan (Platycladi Cacumen, carbonized, 3 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 1.5 qian), Jiuchao Baishao (Paeoniae Radix Alba, wine-fried, 1.5 qian), Zuo Qinjiao (Radix Gentianae Macrophyllae, 1.5 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Huangqin Tan (Scutellariae Radix, carbonized, 1.5 qian), Dahong Jiguanhua (Coronilla Variabilis, roasted black, 2 qian), Zhiqiao (Aurantii Fructus, 1 qian), Ejiaozhu (Colla Corii Asini, pearl form, 2 qian).
Certain Patient Wind damages Wei Yang, severe cough with spontaneous sweating, suddenly followed by hematochezia. Wind pathogen sinks into stomach and intestines, affecting both exterior and interior. Condition may change drastically.
Jingjie Tan (Semen Schisandrae Chinensis, carbonized), Cebai Tan (Platycladi Cacumen, carbonized), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Fuling (Poria, 4 qian), Chao Huang Sangye (Mori Folium, stir-fried), Fangfeng Tan (Radix Saposhnikoviae, carbonized), Danpi Tan (Moutan Cortex, carbonized), Xingren Ni (Armeniacae Semen Amarum, paste), Zexie (Alismatis Rhizoma, 1.5 qian), Zhiqiao (Aurantii Fructus).
Certain Patient Hematochezia recurs; after defecation, Qi sinks downward, causing difficulty in urination. This is Qi deficiency failing to control, with Clear Yang sinking.
Dangshen (Codonopsis Radix), Huangbai Tan (Phellodendri Cortex, carbonized), Huaihua Tan (Flos Sophorae Immaturus, carbonized), Zhi Huangqi (Astragali Radix, honey-roasted), Cu Zhi Chaihu (Bupleuri Radix, vinegar-processed), Zhi Cao (Glycyrrhizae Radix et Rhizoma, honey-roasted), Danpi Tan (Moutan Cortex, carbonized), Paojiang Tan (Zingiberis Rhizoma Preparatum, carbonized), Diyutan (Sanguisorbae Radix, carbonized), Cu Zhi Shengma (Cimicifugae Rhizoma, vinegar-processed), Yuzhu (Atractylodis Macrocephalae Rhizoma), Danggui Tan (Carbonized Radix Angelicae Sinensis).
Zheng (Left) The yin region has two orifices: one for essence, one for urine. When the urine orifice opens, the essence orifice usually closes. Nocturnal emission without dreams for over twenty years, yet daily life remains normal. Accompanying symptoms: upper epistaxis, lower hematochezia. Pulse is slippery and solid. Tongue coating is white and greasy. All indicate extreme damp-heat disturbing the essence palace, gradually injuring the Yin collaterals. The Classic states: "When Yin collaterals are injured, blood overflows internally; when blood overflows internally, there is posterior bleeding." Though diseases differ, their source is one.
Cangzhu (Atractylodis Rhizoma), Fangfeng Tan (Radix Saposhnikoviae, carbonized), Chao Jingjie (Semen Schisandrae Chinensis, stir-fried), Chuanlian Tan (Carbonized Rhizoma Coptidis), Chuan Bi (Dioscoreae Hypoglaucae Rhizoma), Miren (Coicis Semen), Huangbai Tan (Phellodendri Cortex, carbonized), Chao Huaihua (Flos Sophorae Immaturus, stir-fried), Danpi Tan (Moutan Cortex, carbonized), Zhuling (Polypori Sclerotium), Zexie (Alismatis Rhizoma), Da Dancai (Mytilus Edulis).
Huang (Left) Intestinal bleeding stopped then returned, with abdominal pain. Due to unresolved damp-heat. From bitter-draining methods, additionally harmonize Ying and Wei.
Danggui Tan (Carbonized Radix Angelicae Sinensis, 1 qian), Jingjie Tan (Semen Schisandrae Chinensis, carbonized, 1 qian), Zuo Qinjiao (Radix Gentianae Macrophyllae, 1.5 qian), Zhihei Hong Jiguanhua (Coronilla Variabilis, roasted black, 3 qian), Xuyutan (Hirsutae Capillis Carbonized, 3 qian), Chao Danpi (Moutan Cortex, stir-fried, 2 qian), Chao Zhiqiao (Aurantii Fructus, stir-fried, 1.5 qian), Cangzhu (Atractylodis Rhizoma, sesame oil fried, 1 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 3 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 2 qian), Yuzhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Chuanlian Tan (Carbonized Rhizoma Coptidis, 0.3 qian).
Hong (Left) Anal burning sensation slightly subsided, but hematochezia continues. Pulse is fine and rapid. Indeed, damp-heat damaged Ying level, injuring Yin collaterals internally. Plan to nourish Liver, yin-nourish, and strengthen Water.
Sheng Dizitan (Rehmanniae Radix Preparata, carbonized, 5 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 1.5 qian), Jiuchao Baishao (Paeoniae Radix Alba, wine-fried, 1.5 qian), Chuanlian Tan (Carbonized Rhizoma Coptidis, 0.4 qian), Diyutan (Sanguisorbae Radix, carbonized, 2 qian), Danggui Tan (Carbonized Radix Angelicae Sinensis, 1.5 qian), Chaohei Chubaipi (Periplocae Cortex, stir-fried black, 3 qian), Qing Ejiao (Colla Corii Asini, clear, 2 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 2 qian).
Second visit: Nourish yin and drain heat; hematochezia decreases sequentially. Medicine is effective; expand the formula.
Zhi Shengdi (Rehmanniae Radix Preparata, honey-roasted, 4 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 2 qian), Zhihei Chubaipi (Periplocae Cortex, roasted black, 3 qian), Qing Ejiao (Colla Corii Asini, clear, 2 qian), Huangbai Tan (Phellodendri Cortex, carbonized, 2 qian), Danggui Tan (Carbonized Radix Angelicae Sinensis, 2 qian), Zhi Yuanwu Ban (Testudinis Carapax et Plastrum, honey-roasted, 3 qian decoct first), Zexie (Alismatis Rhizoma, 1.5 qian), Baishao (Paeoniae Radix Alba, 2 qian), Fushen (Poria with Hostwood, 3 qian).
Third visit: Hematochezia decreases. Further nourish blood and yin to secure Yin collaterals.
Qing Ejiao (Colla Corii Asini, clear, 3 qian), Danpi Tan (Moutan Cortex, carbonized, 2 qian), Chubaipi (Periplocae Cortex, 1 qian stir-fried black), Zhi Guijia Xin (Testudinis Carapax et Plastrum heart, honey-roasted, 6 qian), Da Shengdi (Rehmanniae Radix Preparata, raw, 4 qian), Diyutan (Sanguisorbae Radix, carbonized, 2 qian), Jian Zexie (Alismatis Rhizoma, 1.5 qian), Jiuchao Baishao (Paeoniae Radix Alba, wine-fried, 2 qian), Chao Huaihua (Flos Sophorae Immaturus, stir-fried, 2 qian), Puhuang Tan (Pollinis Typhae, carbonized, 1 qian), Chixiaodou (Vigna Angularis Seed, 2 qian), Oujie (Nymphaeae Rhizomatis Node, 2 pieces).
Ye (Right) Previously had intestinal bleeding. Late spring/early summer, swelling began. Recently, severe intestinal bleeding with pale, thin blood. Epigastric fullness and abdominal distension, difficult to eat. Pulse is deep and fine; tongue coating white, substance pale. Liver stores blood; Spleen commands blood. Now Spleen Yang fails to control, so blood overflows downward; Spleen cannot rotate and transport. Fear worsening swelling.
Sheng Baizhu (Atractylodis Macrocephalae Rhizoma, raw, 1 qian), Zhihei Cao (Glycyrrhizae Radix et Rhizoma, roasted black, 0.3 qian), Sharen (Amomi Fructus, added later, 0.5 qian), Sheng Shu Guya (Hordei Fructus Germinatus, raw and cooked, 2 qian each), Zhi Maoyi Zhu (Atractylodis Rhizoma, processed, 1 qian), Paojiang (Zingiberis Rhizoma Preparatum, 0.5 qian), Dafupi (Arecae Pericarpium, 2 qian), Baicaoshuang (Carbonized Herb Powder, 1 qian).
Second visit: Used Cangzhu to regulate Middle Jiao; hematochezia greatly reduced, but diarrhea, abdominal pain, chest/epigastric fullness, Qi attacking and distending, abdominal bloating and skin edema occurred. Pulse deep and fine, coating pale white. Spleen slightly controls but lacks rotational power, leading to Liver Wood hyperactivity and inability to differentiate Qi and Dampness. Previous method plus differentiation of Qi and Dampness.
Maoyi Zhu (Atractylodis Rhizoma, 1.5 qian), Muxiang (Aucklandiae Radix, 0.5 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Chunghou (Magnoliae Officinalis Cortex, 0.4 qian), Baishao (Paeoniae Radix Alba, 1.5 qian fried with Wuzhuyu 0.2 qian), Lianpi Ling (Poria with skin, 4 qian), Paojiang (Zingiberis Rhizoma Preparatum, 0.5 qian), Zhi Cao (Glycyrrhizae Radix et Rhizoma, honey-roasted, 0.3 qian), Sharen (Amomi Fructus, 0.5 qian), Dafupi (Arecae Pericarpium, 1.5 qian).
Third visit: Hematochezia stopped, but epigastric/abdominal fullness persists, diarrhea, poor urination. Spleen deficiency fails to rotate and transport; Qi and Dampness do not move; ascending/descending functions lost. Re-invigorate Earth and promote diuresis.
Dafupi (Arecae Pericarpium, 2 qian), Lianpi Ling (Poria with skin, 4 qian), Zhuling (Polypori Sclerotium, 1.5 qian), Sheng Shu Miren (Coicis Semen, raw and cooked, 2 qian each), Shang Guangpi (Citri Reticulatae Pericarpium, 1 qian), Guang Muxiang (Aucklandiae Radix, 0.5 qian), Zexie (Alismatis Rhizoma, 1.5 qian), Zhi Jineijin (Galli Gigerii Endothelium Corneum, processed, 1.5 qian), Zhi Xiangfu (Cyperi Rhizoma, 2 qian), Shengjiangyi (Zingiberis Rhizoma outer layer, 0.3 qian).
Fourth visit: Invigorated Earth and promoted diuresis; no hematochezia, but epigastric/abdominal fullness unchanged, poor urination, diarrhea, cold feet. Pulse deep and fine. Limbs flaccid and floating. Yang Qi cannot distribute, causing water-dampness flooding skin. Announce Five Yangs to seek turnaround.
Shu Fupian (Aconiti Lateralis Radix Preparata, 0.5 qian), Dan Wuzhu (Evodiae Fructus, mild, 0.5 qian), Zexie (Alismatis Rhizoma, 2 qian), Bo Guigui (Laurae Cassiae Cortex, thin, 0.6 qian added later), Zhi Neijin (Galli Gigerii Endothelium Corneum, honey-roasted, 2 qian), Gong Dingxiang (Caryophylli Flos, male, 0.3 qian), Bai Fuling (Poria, 4 qian), Zhuling (Polypori Sclerotium, 2 qian), Tai Baizhu (Atractylodis Macrocephalae Rhizoma, 2 qian).
Fifth visit: Distension due to Qi, edema due to Dampness. Announcing Five Yangs slightly stabilized swelling but did not eliminate it; cough and rebellious Qi. Lung governs Qi transformation of the body. Disperse Lung and descend Qi, combined with resolving Dampness.
Sharen (Amomi Fructus, 0.5 qian), Tian Tingli (Descurainiae Semen seu Lepidii Semen, sweet, 0.6 qian), Dafupi (Arecae Pericarpium, 2 qian), Hua Binglang (Arecae Semen, flower type, 1 qian), Qing Chenpi (Citri Reticulatae Pericarpium, 1 qian each), Muxiang (Aucklandiae Radix, 0.5 qian), Chao Suzi (Perillae Fructus, stir-fried, 3 qian), Zhi Xiangfu (Cyperi Rhizoma, 2 qian), Lianpi Ling (Poria with skin, 2 qian), Zhi Neijin (Galli Gigerii Endothelium Corneum, honey-roasted, 1.5 qian), Jiangyi (Zingiberis Rhizoma outer layer, 0.3 qian).