阳明衄血热在里，太阳衄血热瘀经，太阳头痛目瞑兆，阳明漱水不咽征。衄后身凉
知作解，不解升麻犀角清。未衄表实麻黄汗，里热犀角芩连同。
【注】阳明衄血热在里也。太阳衄血热瘀经也。太阳失汗则有头痛目瞑之兆，阳明失
下则有漱水不欲咽之征。衄血之后，身凉脉静，知作解也，若仍不解，知衄未尽，热留
于营也。无汗表热，宜升麻葛根合犀角地黄汤清解之；欲作衄未衄者，表实宜麻黄汤汗
之，里热宜犀角地黄汤加芩、连清之。若表
实里热者，则又当合二方两解之。
伤寒吐血多因逆，下厥上竭少阴经，三阳热盛宜清解，血瘀胸满痛当攻，暴吐腐臭
内溃死，过多血脱面无红，犀角桃仁宜拣用，救脱圣愈及养荣。
【注】伤寒吐血，皆因失汗、失下、火逆，以致邪热炽盛，沸腾经血故也。若血从口鼻
耳目而出，小便难，此为强发少阴汗，名曰下厥上竭，为难治也。三阳热盛吐血，宜升
麻葛根合犀角地黄汤，热甚加芩连清解可也。若血瘀则胸满或痛，当以桃仁承气合犀角地
黄汤攻之。若暴吐腐臭之血，名曰内溃，内溃者死。若吐血过多，面唇无红色，名曰血
脱。救脱，轻者以圣愈汤，重者以人参养荣汤。
热在膀胱小便血，八正导赤利之佳，热瘀里急下脓血，黄连白头与桃花。
【注】阳经之热，下注膀胱，伤其营分，热少血多，瘀成血蓄。热多血少，热迫血行，
血不得蓄，而走下窍，故尿血也，以八正散、导赤散利而清之。阴经之热，转迫阳明，伤
其营分，瘀则血蓄，喜忘如狂。不蓄则便血，热腐则便脓。便脓热郁，里急下重，所必然
也。轻者宜黄连阿胶肠，重者白头翁汤清之，滑脱者，桃花汤涩之可也。
Epistaxis in the Yangming channel indicates heat accumulating in the interior; epistaxis in the Taiyang channel indicates heat stagnating in the meridians. Headache and photophobia (aversion to light/closing eyes) in Taiyang disease are precursors of epistaxis; the symptom of wanting to rinse the mouth with water but not swallowing it in Yangming disease is a sign of impending epistaxis. After epistaxis, if the body becomes cool, it indicates that the pathogenic factor is resolving; if symptoms persist, Shengma Xijiao Qingre (Clearing Heat with Cimicifuga and Rhinoceros Horn) should be used. If epistaxis has not yet occurred and there is exterior excess with anhidrosis, Mahuang Tang (Ephedra Decoction) should be used to induce sweating; if it is an interior heat syndrome, Xijiao, Huangqin, Huanglian, and Lianqiao should be used together to clear interior heat.
Hematemesis in Shanghan (Cold Damage) is mostly due to mismanagement. Jue cold in the lower jiao with exhaustion of yin blood in the upper part involves the Shaoyin channel. For hematemesis caused by excessive heat in the three yang channels, clearing heat and resolving the exterior is appropriate; if chest fullness and pain are caused by blood stasis, purgative methods to remove stasis should be employed. Sudden vomiting of foul-smelling blood indicates internal organ rupture, which is a fatal condition. If excessive bleeding leads to blood depletion with a pale complexion lacking luster, Xijiao (Rhinoceros Horn) and Taoren (Peach Kernel) may be selected, or Shengyu Tang (Shengyu Decoction) and Renshen Yangrong Tang (Ginseng Nourishing Nutritive Qi Decoction) can be used to treat blood depletion.
Heat accumulating in the Bladder causing hematuria is best treated with Bazheng San (Eight-Ingredient Powder for Rectification) and Daochi San (Guide Out Redness Powder) to promote urination and clear heat. Heat stagnating in the interior causing tenesmus and passage of pus and blood can be treated with Huanglian (Coptis Rhizome), Baitouweng (Pulsatilla Root), and Taohua Tang (Peach Flower Decoction).