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HEMAFECIA, HEMATOCHEZIA, BLOOD IN THE STOOLS, RECTAL BLEEDING

WIND-HEAT IN THE STOMACH AND INTESTINES (INTESTINAL WIND)

Clinical Manifestations	Bleeding of fresh Blood from the bowel which often precedes the bowel movement The bleeding may follow the passage of stool The bleeding may be alarmingly copious Abdominal pain or Absence of pain, itching, swelling or distention or A burning sensation in the rectum and anus Dry mouth Tendency toward constipation Dry or difficult stools T: Red C: Yellow P: Slippery and rapid or Thready and rapid
Treatment Principle	Clear Heat from the Intestines Cool the Blood Stop bleeding
Herb Formulas	Huai Jiao Wan modified Huai Hua San modified Topical: Mix 3g Alumen Ming Fan in a little water, dissolve 30g petroleum jelly and mix in the Ming Fan. Place on sterile gauze and insert into the anal canal. Chinese Patent Medicines: Yi Zi Tang Zheng Gan Zhi Gen Duan To stop bleeding: Yun Nan Bai Yao Shen Tian Qi Pian For Intestinal bleeding with Heat: Zhong Gan Zhi Gen Dan For Damp-Heat: Huang Lian Jie Du Wan With Spleen and Stomach Deficiency: Xiang Sha Yang Wei Wan
Points	Ahshi points, DU-1, Erbai, SP-1, ST-25, ST-37, UB-30, UB-32, UB-57 With pain in the rectum or lower Intestine: + UB-2, UB-52 With severe bleeding: + PC-4, SP-10 Ear: 1. Large Intestine, Small Intestine, Distal Segment Rectum, Subcortex, Shenmen 2. Hemorrhoids, Large Intestine, Distal Segment Rectum, Shenmen

XUE STAGE HEAT

Clinical Manifestations	High fever Confusion of mind Delirium Mania Dark yellow urine Excessive skin rashes all over body Hemorrhage: Hematemesis Hemoptysis Epistaxis Hemafecia Hematuria T: Deep red, dry or Purple red C: None P: Rapid or Thready and rapid or Thready and feeble
Treatment Principle	Cool the Blood Dispel Heat and Toxins from the Xue Stage Promote Blood Circulation
Herb Formulas	Xi Jiao Di Huang Tang Da Huang Zhi Xue Jiao Nang Xi Jiao San
Points	To clear Heat and Toxins: Bleed the Jing Well points, DU-14, LI-11, ST-44 To promote Blood circulation: SP-10, UB-17 To treat hemafecia: SP-1, ST-25, ST-37 To restore consciousness: DU-26, K-1 To nourish Yin: KI-3, SP-6 To calm the Shen: HT-7

DAMP-HEAT IN THE LARGE INTESTINE

Clinical Manifestations	Difficulty passing stools Diarrhea with tenesmus which intensifies after defecation Frequent stools which are small in quantity Stools are yellow or brown, thin, watery, with foul smell or sticky and pasty like jam or sticky fluid or containing pus and Blood The stools may be loose or firm depending on the ratio of Dampness to Heat Burning hot sensation in anus Abdominal pain, fullness and distention Urine short and red Sustained fever despite profuse perspiration or Raging fever in the afternoon Severe cases: High fever and coma Mouth dry but no desire to drink A sticky sensation in the mouth A bitter taste in the mouth Body heavy Limbs tired Fullness in chest Lump in epigastrium Anorexia Vomiting T: Red C: Yellow and greasy P: Slippery and rapid or Soft and rapid
Treatment Principle	Clear Heat Transform Dampness Cool the Blood Stop bleeding
Herb Formulas	Di Yu San Er Hao Shao Yao Tang For lingering Damp-Heat with mild Yin and Blood Deficiency: Zhu Ju Wan modified For lingering Damp-Heat with marked Yin Deficiency: Zhu Ju Wan+ Liu Wei Di Huan Wan modified Chinese Patent Medicines: For Damp-Heat: Huang Lian Jie Du Pian For Damp or Toxic Heat: Chuan Xin Lian For Damp-Heat with a tendency toward constipation or sluggish stools: Niu Huang Qing Huo Wan For bleeding from Internal Heat: Zhong Guo Zhi Gen Duan For bleeding : Yun Nan Bai Yao Sheng Tian Qi Pian
Points	Acupuncture must be given frequently for good results. 1 to 2 times daily is appropriate in severe cases. LI-4, LI-11, SP-9, ST-25, ST-37, ST-44, UB-25 Ah Shi Points, LI-4, LI-11, SP-15, ST-25, UB-25, UB-57 With rectal or lower Intestinal pain: + UB-2, UB-54 With a high fever: + DU-14 With nausea: + PC-6, REN-12 With tenesmus: + DU-1, REN-4 With Dampness prominent: + SP-9 With Yin Deficiency: + REN-4, SP-6 Ear: Large Intestine, Small Intestine, Stomach, Kidney, Subcortex, Shenmen

SPLEEN NOT GOVERNING BLOOD

Clinical Manifestations	Mild bleeding of dark, purplish Blood or, less commonly, red Blood preceding or following defecation or Black, tarry, sticky stools or occult Blood discovered in testing Intermittent dull abdominal pain, alleviated by pressure Easily satiated Nausea Waxy, sallow or pale complexion Anorexia Fatigue Weakness Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools or Diarrhea Shortness of breath Spontaneous sweating Dizziness Light-headedness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have toothmarks With Blood Deficiency: Pale and thin C: White P: Thready and weak or Moderate
Treatment Principle	Strengthen the Spleen Benefit Qi Nourish the Blood Stop bleeding
Herb Formulas	Bu Zhong Yi Qi Tang modified Gui Pi Tang Gui Pi Tang + Jiao Ai Tang Bu Wei Fang Yi Qi He Wei Jiao Nang Yi Qi Jian Pi Shou Pi Jian For persistent bleeding: Gu Chong Tangmodified Chinese Patent Medicines: Bu Zhong Yi Qi Wan Sheng Tan Qi Yun Nan Bai Yao With Cold or Spleen Yang Deficiency: Li Zhong Wan
Points	DU-20, REN-6, REN-12, SP-1, SP-4, SP-6, ST-25, ST-36, UB-20, UB-25 SP-1, SP-3, ST-36, UB-20 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Subcortex, Adrenal, Shenmen

SPLEEN YANG DEFICIENCY

Clinical Manifestations	Chronic loose stools or diarrhea which may contain undigested food The stools may be urgent Early morning diarrhea Dark, purplish or pale Blood preceding, following or Black, tarry or Blood-streaked loose stools (the bleeding may also be occult) Dull, persistent abdominal or epigastric cold-pain which improves with warmth and pressure Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Intolerance to Cold Shortness of breath Cold abdomen Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Weakness Exhaustion Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale, wet and swollen with toothmarks C: Thin and white P: Deep and weak or Deep, weak and slow
Treatment Principle	Warm the Center Dispel Cold Nourish the Blood Stop bleeding
Herb Formulas	With relatively severe bleeding: Huang Tu Tang modified With relatively mild bleeding: Fu Zi Li Zhong Wan modified With Dampness in the Lower Jiao and Dryness in the Upper Jiao: Lian Li Tang When the bleeding has stopped: Bu Zhong Yi Qi Tang Si Jun Zi Tang Chinese Patent Medicines: For Spleen Yang Deficiency with severe Cold: Fu Zi Li Zhong Wan For Spleen Yang Deficiency: Li Zhong Wan For bleeding: Yun Nan Bai Yao Sheng Tian Qi Pian
Points	Moxa or moxa needle DU-20, REN-6, REN-12, SP-1, SP-6, ST-25, ST-36, UB-20, UB-25, needle SP-4 With Kidney Yang Deficiency: + moxa or moxa needle REN-4, UB-23 Moxa box REN-8 Moxa LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Adrenal, Subcortex, Shenmen

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Mild constant epigastric pain; relieved by warmth and pressure Anorexia Abdominal pain and fullness after meals Nausea Vomiting Loose, unformed stools Excessive salivation Cold limbs Lassitude Weakness Sallow or pale, dull complexion Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale C: White and greasy P: Deep, thready and forceless
Treatment Principle	Strengthen the Spleen Warm Yang Warm the Center Dispel Cold
Herb Formulas	Wei Feng Tang
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-6, ST-36, UB-20, UB-21

STOMACH FIRE

Clinical Manifestations	Dark, purple Blood in the stools or Black, tarry, sticky stools Epigastric or abdominal distention Burning Heat and pain in the epigastrium Epigastric or abdominal distention Dry mouth Irritating thirst: drinks copious fluids and prefers cold drinks Excessive appetite: hungry again quickly after eating (as if food vanishes) Swelling, pain, ulceration and bleeding of gums Foul breath Bitter taste in the mouth Acid reflux Heartburn Belching Toothache Irritability Restlessness Maybe vomiting right after eating Vomiting acid or undigested food Constipation Maybe scanty, red urine T: Red C: Thick, yellow and dry P: Slippery, big, Excess and rapid or Wiry and rapid or Slippery and rapid
Treatment Principle	Clear and Purge Stomach Fire
Herb Formulas	San Huang Xie Xin Tang + Shi Hui San modified With Damp-Heat: Huang Lian Jie Du Tang With Yin Deficiency: Huang Lian E Jiao Tang modified With severe bleeding precipitating collapse of Yang: Shen Fu Tang With Yin Deficiency due to Stomach Fire Injuring the Kidney Yin: Yu Nu Jian Chinese Patent Medicines: With Damp-Heat: Huang Lian Jie Du Wan With constipation: Niu Huang Qing Huo Wan With Toxic Damp-Heat: Bei Jing Niu Huang Jie Du Pian With bleeding: + Yun Nan Bai Yao + Sheng Tian Qi Pian
Points	LI-4, LI-11, PC-6, PC-8, ST-6, ST-34, ST-36, ST-43, ST-44, ST-45, UB-21 LI-4, LI-11, PC-8, REN-12, SP-10, ST-37, ST-44, ST-45 With epigastric pain: + ST-34 With Yin Deficiency: + UB-21, UB-23 With hematemesis: + PC-4 With Phlegm-Heat: + ST-40 With Shao Yang - Yang Ming: + GB-39, SJ-5, ST-25 LIV-3, REN-12, ST-21, ST-44 GB-29, UB-17, UB-18, UB-20 Ahshi points along the Stomach channel between ST-36 and ST-39, LI-4, PC-7, PC-8, REN-12, ST-21, ST-34, ST-36, ST-44 With Yin Deficiency: + UB-21 , UB-23 With vomiting or spitting Blood: + PC-4 With fever: + LI-11 Ear: Stomach, Duodenum, Large Intestine, Liver, Subcortex, Shenmen

STOMACH COLD

Clinical Manifestations	General signs and symptoms: Epigastrium Cold with pain Mild cases: Constant pain Severe cases: Sudden bouts of sharp pain Pain is aggravated by Cold and relieved by warmth and hot drinks Cold hands and feet Cold Penetrates the Stomach and Intestines: Pain is sudden and sharp Pain is relieved by warmth Nausea Diarrhea Loose stools T: Pink C: White P: Deep and tight Retention of Fluid in the Stomach due to Cold: Pain is dull Pain is relieved by warmth Succussion sound in the epigastrium on palpation Vomiting of clear, watery fluid T: Pink C: White and sticky P: Thready or Thready and slow Stomach Deficiency with Stagnation of Cold: Pain is dull Pain is relieved by warmth and pressure Vomiting clear, watery fluid T: Pale C: Thin and white P: Deep and slow or Deep and thready
Treatment Principle	Warm the Stomach Warm Cold
Herb Formulas	In children: Ding Yu Li Zhong Tang
Points	Moxa or moxa needle PC-6, REN-6, REN-12, SP-4, ST-21, ST-36, UB-20, UB-21

BLOOD STAGNATION IN THE STOMACH

Clinical Manifestations	Bleeding of dark, purple Blood from the bowel or Sticky, tarry stools or Mixed dark and fresh Blood Epigastric or abdominal pain The pain may be intermittent or detected on palpation The pain is fixed, stabbing and /or severe Pan is worse with pressure The pain may also be found in the left and right lower abdomen Dark complexion Fixed, palpable masses Bleeding with clots Purple lips Purple nails Dry skin Blue, dark or purplish discoloration of skin in small or large areas, Varicose and spider veins Cold hands and feet Tendency to hemorrhage dark blood or clots T: Purple, possible purple or red spots Red purple if there is Heat Blue purple if there is Cold C: White P: Choppy or Wiry and choppy
Treatment Principle	Activate the Blood Break up Stagnation Move Qi Stop bleeding
Herb Formulas	Shi Xiao San + Dan Shen Yin modified With masses: Ge Xia Zhu Yu Tang With Cold in the lower abdomen: Shao Fu Zhu Yu Tang For severe Blood Stagnation in the Intestines with Heat: Tao He Cheng Qi Tang Chinese Patent Medicines: With Qi and Blood stagnation: Xue Fu Zhu Yu Wan For bleeding: + Yun Nan Bai Yao + Sheng Tian Qi Pian
Points	SP-6, SP-10, ST-36, UB-17, UB-40 Ahshi Points, SP-6, SP-8, SP-10, ST-25, SP-10, ST-36, UB-25 Ear: Stomach, Duodenum, Large Intestine, Small Intestine, Liver, Adrenal, Subcortex, Shenmen

STOMACH YIN DEFICIENCY WITH HEAT

Clinical Manifestations	Black, sticky, tarry or dark, dry stools No appetite or Famished but with no desire to eat or Indeterminate gnawing hunger Persistent, dull, nagging epigastric pain Heartburn Morning nausea Abdominal distention after meals Irritability with low grade fever Maybe dry retching or Hiccups Thirst Dry skin, hair and mucous membranes Tendency toward constipation or Pellet-like stools Facial flushing Malar flush Nightsweats Five-sole-Heat With Kidney Yin Deficiency: Dizziness Tinnitus Low back and knee weakness and pain T: Red or Slightly red with a peeled center or Red and dry C: Little and dry or Peeled in the center or Shiny P: Thready and rapid
Treatment Principle	Nourish Yin Clear Heat Nourish the Stomach Cool the Blood Stop bleeding
Herb Formulas	Yu Nu Jian modified Chinese Patent Medicines: With Stomach Qi and Yin Deficiency: Gu Ben Wan With marked Deficient Heat: Zhi Bai Ba Wei Wan With Stomach Qi and Yin Deficiency: Sheng Mai San Wan With Kidney Yin Deficiency: Liu Wei Di Huang Wan With bleeding: + Yun Nan Bai Yao + Sheng Tian Qi Pian
Points	KI-3, REN-12, SP-6, ST-36, UB-21 With hemafecia: KI-3, KI-6, REN-4, REN-12, SP-6, ST-25, ST-36, UB-20, UB-21, UB-23, UB-25 Ear: Stomach, Kidney, Large Intestine, Distal Segment Rectum, Shenmen, Sympathetic With hematemesis: KI-3, KI-6, REN-4, REN-12, SP-6, ST-36, UB-20, UB-21, UB-23 Ear: Stomach, Duodenum, Adrenal, Esophagus, Shenmen, Subcortex

HEART BLOOD AND SPLEEN QI DEFICIENCY

Clinical Manifestations	Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the Heart and Spleen
Herb Formulas	Gui Pi Tang modified Chinese Patent Medicines: Gui Pi Wan With Cold or Spleen Yang Deficiency: Li Zhong Wan
Points	HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

LIVER QI STAGNATION INVADES THE STOMACH WITH STAGNANT HEAT OR FIRE

Clinical Manifestations	Epigastric bleeding of dark, purplish or occasionally fresh, red Blood from the rectum Epigastric pain The bleeding and pain may be worse when emotionally upset or may appear premenstrually Belching with acid regurgitation Heartburn Nausea Vomiting Anorexia Epigastric, abdominal or hypochondriac, distention and/or pain Distention and pain in the sides or flanks Suffocating sensation in the chest A bitter taste in the mouth Tendency to sigh Melancholy Depression Irritability Inappropriate anger Temporal and frontal headaches Red, sore eyes Facial flushing A dry mouth Thirst Irregular menses Dysmenorrhea Breast distention and pain before and during menses A tendency toward constipation or Alternating constipation and diarrhea T: Red or Red edges or Red spots on the edges C: Thin and yellow P: Wiry and rapid
Treatment Principle	Soothe the Liver Harmonize the Stomach Clear Heat from the Liver and Stomach cool the Blood Stop bleeding
Herb Formulas	Jia Wei Xiao Yao San modified Without Heat: Chai Hu Shu Gan Tang modified Chinese Patent Medicines: Jia Wei Xiao Yao Wan For Liver Fire: Long Dan Xie Gan Wan Without Heat: Chai Hu Shu Gan Wan For bleeding: + Yun Nan Bai Yao + Sheng Tian Qi Pian
Points	Ahshi points, LI-4, LI-11, LIV-2, LIV-13, SP-10, ST-25, ST-44 Ear: Stomach, Liver, Large Intestine, Subcortex, Shenmen

DAMP-HEAT IN THE LIVER AND GALL BLADDER

Clinical Manifestations	Yang jaundice (sclera and skin bright yellow) Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium Bitter taste in mouth Nausea Vomiting sour and bitter fluids Anorexia Maybe alternating chills and fever Concentrated, dark urine Abdominal distention Hematochezia Women: Yellow vaginal discharge with foul smell Pruritis vulvae Men: Pain, swelling and burning sensations of testicles T: Pink C: Yellow and greasy or sticky P: Wiry and rapid or Slippery and rapid
Treatment Principle	Clear Dampness Purge Heat from Liver and Gall Bladder
Herb Formulas	Long Dan Xie Gan Tang
Points	Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48

KIDNEY AND LIVER YIN DEFICIENCY

Clinical Manifestations	Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome), weakness Tinnitus Deafness Forgetfulness Low back and knees sore and painful Throat dry and painful Five sole Heat Low-grade fever Night sweats Irritability Insomnia Stools difficult to pass Constipation Men: Spermatorrhea Women: Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red C: None P: Thready and rapid
Treatment Principle	Nourish and Reinforce the Liver and Kidneys
Herb Formulas	Er Zhi Wan
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

TOXIC HEAT

Clinical Manifestations	High fever Fidgeting Thirst with desire for drinks Skin eruptions Hot feeling of the skin Irritability Insomnia Mania Unconsciousness Hematemesis Epistaxis Hemafecia T: Deep purplish C: White, greasy and thick, obvious in the middle part or Thin and white, with scanty fluids P: Wiry and rapid or Thready and rapid
Treatment Principle	Clear Heat Relieve toxicity
Herb Formulas	Lu Dou Gan Cao Tang Xi Jiao San
Points

INCONSOLIDATION OF THE CHONG AND REN CHANNELS

Clinical Manifestations	Continuous uterine bleeding (either spotting or gushing) Leukorrhea Pale, thin Blood Palpitations Shortness of breath Hemafecia T: Pale C: Thin and white P: Thready and weak or Gigantic and forceless or Weak and soft or Feeble and hollow
Treatment Principle	Tonify the Spleen Benefit Qi Astringe and consolidate the Chong and Ren channels Stop bleeding
Herb Formulas	Gu Chong Tang
Points