经曰∶清者为荣，浊者为卫，荣行脉中，卫行脉外。盖荣者，水谷之精气也，和调于五脏，
洒陈于六腑，故能入于脉。夫荣者，阴血也，所主在心，统化在脾，藏内在肝，宣布在肺，
输泄在肾，灌溉一身，滋养百脉，诸经由此而生毓焉。然血之所统者气也，故曰∶气主 之
；血主濡之。是以气行则血行，气止则血止，阳生阴长，夫唱妇随之道也。若气一伤，则变
症百出，故妄行则吐衄，衰涸则虚劳，降下则便红，热陷则溺赤，渗于肠胃则为肠风，阳虚
阴搏则为崩漏，此皆气有殄戾之乖，而血乃生渗溢之患也。然养阴者可不先知养阳之道乎？
小儿患之，多因禀赋积热，或食膏粱浓味，或乳母七情郁火所致。治法∶若气虚血弱，当以
人参补之，阳旺则阴生血也。若四物汤者，独能主血分受伤，为气不虚也。若左寸关脉数而
无力，血虚也，四物汤加参、术。浮而无力，气虚也，补中益气汤。尺脉数而无力，肾虚也
，六味地黄丸。右寸关脉数而有力者，肺胃热也，犀角地黄汤；后用四物汤加参、苓、白术。尺脉数
而无力，阴虚也，用六味地黄丸。若面黄目涩，眵多手麻者，脾肺虚也，用黄 芍药汤。
治验
一小儿年十余岁，鼻衄，肝脉弦数，肝藏血，此肝火血热而妄行，用小柴胡加山栀、龙胆草
，四剂而血止；又用四物、芩、连、芦荟、山栀、甘草，作丸服；又以地黄丸滋肾水，生肝
血而愈。
一小儿久鼻衄，右腮鼻准微赤，此脾胃传热于肺而不能统也，先用六君、桔梗、当归、山栀
而血止，次用人参黄 散，以调补脾肺而愈。
一小儿壮热吐血，或兼衄血，右腮鼻准赤色，乃肺胃积热，用济生犀角地黄四剂而血并止。
后因母饮酒复作，用清胃散，母子服之而愈。
一小儿吐血不止，鼻准赤色，审其乳母有郁热，用加味归脾汤、加味逍遥散，母子并服各数
剂血少止，又用八珍汤加柴胡、牡丹皮而愈。
一小儿因母屡恚怒，发热吐血，或时衄，用加味小柴胡汤之类，治其母并愈。后其母因劳役
兼怒气，致儿患惊搐，或用抱龙丸，又加吐血，予以加味逍遥散，母子并愈。厥后乳母仍劳
役发热，此儿即惊搐，或吐血、或衄血，母用补中益气汤，子用犀角地黄汤顿愈。
一小儿十岁，因伤浓味吐血，用济生犀角地黄汤，解食毒，清胃热；又用四君、牡丹皮、升
麻，调补脾胃而愈。惟肢体倦怠，两手作麻，用黄 芍药汤数剂而安。
一小儿吐血，因乳母火郁发热，两胁作痛，后吐血，以加味归脾汤加吴茱萸、制黄连治母，
儿不时饮数匙，月余并愈。后母因怒吐血寒热，儿亦吐血，先用加味小柴胡汤二剂，后用加
味逍遥散治其母悉愈。
一女子年十四岁，因惊寒热发搐，服镇惊之药，更吐血，寻衣撮空，身如炙，烦躁不眠，饮
食不入，脉洪大而无伦次，按之豁然而空，用加减八味丸料二剂，诸症悉退。脉息按之如丝
，无气以动，用人参一两煎服，不应，仍用人参一两、附子五分，二剂元气顿复。
一女子十三岁，因怒吐血，切牙发搐，用加味逍遥散加钩藤钩而愈。次年出嫁，怀抱郁结，
胸满食少，吐血面赤，此因肝火动而血热，气虚而不能摄血也，用六味丸及归脾汤加山栀、
贝母而愈。
一小儿十四岁，发热吐血，属足三阴虚，余谓宜补中益气以滋化源。不信，仍用寒凉降火，
前症愈甚。或谓曰∶小儿未有室，何肾虚之有，参、 补气，奚为用之？余述丹溪先生云∶
肾主闭藏，肝主疏泄，二脏俱有相火，而其系上属于心。心为君火，为物所感，则相火翕然
而起，虽不交会，而其精亦暗耗矣。又褚氏云∶男子精未满而御女，以通其精，则五脏有不
满之处，异日有难状之疾。正此谓也。遂用补中益气汤及六味地黄丸而痊。
黄 芍药汤 治衄多岁，面黄眼涩，多眵手麻。
黄 （三两） 甘草（炙） 升麻 葛根 芍药（炒黄。各一两） 羌活（半两）
上每三钱，水煎服。
愚按∶此手足太阴阳明药也。然血虚久，则阳亦虚矣，故血不足则麻木，阴虚火动，变症百
出，实非风也。此出升阳滋阴例。
人参黄 散 治虚劳客热，消瘦倦怠，口燥咽干，日晡潮热，五心烦热，盗汗胸满，食少作
渴，咳唾时有脓血。
天门冬（去心，三两） 半夏 知母（炒黄） 桑白皮 赤芍药（炒） 黄 （炒） 紫菀 甘草（炙。各半两）
白茯苓 柴胡 秦艽 生地黄 熟地黄 地骨皮（各二两） 人参 桔梗（各一两） 鳖甲（醋炙，
上锉散，每服三五钱，水煎服，大人亦得。一方有生姜。
四物汤（方见急惊）
加味小柴胡汤（方见痉症）
小柴胡汤（方见肝脏）
清胃散
加味归脾汤
加味逍遥散
四君子汤
六君子汤（五方见内钓）
济生犀角地黄汤（方见便血）
补中益气汤（方见虚羸）
八珍汤（即四君、四物二汤合用也）
六味地黄丸（方见肾脏）
The *Yellow Emperor's Inner Canon* states: The clear and light portion becomes Ying Qi (Nutritive Qi), the turbid and heavy portion becomes Wei Qi (Defensive Qi). Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. Generally, Ying Qi is the essence of water and grain, harmonized in the five Zang organs and distributed to the six Fu organs, thus it can enter the vessels. Ying Qi is Yin Blood; it is governed by the Heart, transformed and controlled by the Spleen, stored in the Liver, disseminated by the Lung, and transported and excreted by the Kidney. It irrigates the whole body and nourishes all vessels, allowing all meridians to grow and be nurtured from it. However, Qi controls the blood; therefore, it is said: "Qi primarily moves the blood; Blood primarily moistens the body." Thus, when Qi moves, blood moves; when Qi stops, blood stops. This is the principle of Yang generating Yin and husband leading wife. If Qi is injured, myriad symptoms arise. Therefore, if Qi rebels and flows recklessly, it causes hematemesis (vomiting blood) and epistaxis (nosebleed); if Qi declines and dries up, it causes consumptive disease (Xu Lao); if Qi sinks downward, it causes hematochezia (blood in stool); if Heat sinks inward, it causes dark urine; if it渗es into the intestines and stomach, it becomes Chang Feng (intestinal wind/blood in stool); if Yang deficiency allows Yin to beat violently, it causes Beng Lou (metrorrhagia and metrostaxis). These are all due to Qi being aberrant and disordered, causing blood to leak and overflow. Can those who wish to nourish Yin not first understand the way to nourish Yang?
Children suffering from this condition often do so due to congenital accumulated heat, or consumption of rich and greasy foods, or fire caused by emotional stagnation in the wet nurse. Treatment methods: If Qi is deficient and Blood is weak, Ren Shen (Ginseng Root) should be used to tonify it; when Yang is vigorous, Yin Blood generates. Si Wu Tang (Four Substances Decoction) alone can treat injuries to the Blood aspect when Qi is not deficient. If the pulse at the left Cun and Guan positions is rapid but forceless, it indicates Blood deficiency; use Si Wu Tang added with Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome). If the pulse is floating and forceless, it indicates Qi deficiency; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If the Chi pulse is rapid but forceless, it indicates Kidney deficiency; use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). If the pulse at the right Cun and Guan positions is rapid and forceful, it indicates Lung and Stomach Heat; use Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction); subsequently use Si Wu Tang added with Ren Shen (Ginseng Root), Fu Ling (Poria), and Bai Zhu (Atractylodes Macrocephala Rhizome). If the Chi pulse is rapid but forceless, it indicates Yin deficiency; use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). If the face is yellow, eyes are dry, there is excessive eye discharge, and hands feel numb, it indicates Spleen and Lung deficiency; use Huang Qi Shao Yao Tang (Astragalus and Peony Decoction).
Case Records:
A child over ten years old suffered from epistaxis. The Liver pulse was wiry and rapid. Since the Liver stores blood, this was Liver Fire and Blood Heat causing reckless flow. Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Zhi Zi (Gardenia Fruit) and Long Dan Cao (Gentian Root) was prescribed. After four doses, the bleeding stopped. Then, Si Wu Tang (Four Substances Decoction) added with Huang Qin (Scutellaria Root), Lian Zi (Coptis Rhizome), Lu Hui (Aloe Wood), Zhi Zi (Gardenia Fruit), and Gan Cao (Licorice Root) was made into pills for administration. Finally, Di Huang Wan (Rehmannia Pill) was used to nourish Kidney Water and generate Liver Blood, resulting in recovery.
A child suffered from chronic epistaxis. The right cheek and nasal tip were slightly red. This indicated Heat transmitted from the Spleen and Stomach to the Lung, failing to control the blood. Liu Jun Zi Tang (Six Gentlemen Decoction) added with Jie Geng (Platycodon Root), Dang Gui (Angelica Sinensis Radix), and Zhi Zi (Gardenia Fruit) was used first to stop the bleeding. Subsequently, Ren Shen Huang Qi San (Ginseng and Astragalus Powder) was used to regulate and tonify the Spleen and Lung, leading to recovery.
A child suffered from high fever and hematemesis, sometimes accompanied by epistaxis. The right cheek and nasal tip were red, indicating accumulated Heat in the Lung and Stomach. Ji Sheng Xi Jiao Di Huang Tang (Ji Sheng Rhino Horn and Rehmannia Decoction) was administered for four doses, stopping both hematemesis and epistaxis. Later, due to the mother drinking alcohol, the condition recurred. Qing Wei San (Clear the Stomach Powder) was prescribed, taken by both mother and child, resulting in recovery.
A child suffered from continuous hematemesis with a red nasal tip. Examination revealed the wet nurse had stagnant Heat. Jia Wei Gui Pi Tang (Modified Return the Spleen Decoction) and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) were prescribed for both mother and child for several doses, reducing the bleeding. Then, Ba Zhen Tang (Eight Treasures Decoction) added with Chai Hu (Bupleurum Root) and Mu Dan Pi (Moutan Cortex) was used, resulting in recovery.
A child suffered from fever, hematemesis, and occasional epistaxis because the mother frequently became angry. Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) was used to treat the mother, resulting in her recovery. Later, due to labor and anger, the child developed convulsions. Bao Long Wan (Embracing Dragon Pill) was used, but hematemesis ensued. I prescribed Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) for both mother and child, curing them. Afterwards, when the wet nurse still labored and developed fever, the child experienced convulsions, hematemesis, or epistaxis. The mother took Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), and the child took Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction), resulting in immediate recovery.
A ten-year-old child suffered from hematemesis after consuming rich foods. Ji Sheng Xi Jiao Di Huang Tang (Ji Sheng Rhino Horn and Rehmannia Decoction) was used to resolve food toxicity and clear Stomach Heat. Then, Si Jun Zi Tang (Four Gentlemen Decoction) added with Mu Dan Pi (Moutan Cortex) and Sheng Ma (Cimicifuga Rhizome) was used to tonify and regulate the Spleen and Stomach, leading to recovery. Only limb fatigue and hand numbness remained, which were resolved with several doses of Huang Qi Shao Yao Tang (Astragalus and Peony Decoction).
A child suffered from hematemesis because the wet nurse had Fire stagnation and fever, with pain in the two hypochondria. Later, the child vomited blood. The mother was treated with Jia Wei Gui Pi Tang (Modified Return the Spleen Decoction) added with Wu Zhu Yu (Evodia Fruit) and Zhi Huang Lian (Prepared Coptis Rhizome). The child drank a few spoonfuls occasionally. Both recovered after more than a month. Later, the mother vomited blood with chills and fever due to anger, and the child also vomited blood. Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) was used for two doses, followed by Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) for the mother, resulting in complete recovery.
A fourteen-year-old girl suffered from convulsions due to shock, cold, and fever. After taking sedative medicines, she began vomiting blood, exhibiting signs of picking at clothes and empty air, feeling hot as if roasted, irritability, insomnia, and inability to eat. The pulse was vast and chaotic, feeling hollow upon pressure. Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) was administered for two doses, resolving all symptoms. The pulse felt like a thread, lacking Qi movement. Ren Shen (Ginseng Root) one liang was decocted and taken, but without effect. Ren Shen (Ginseng Root) one liang and Fu Zi (Aconite Lateral Root) five fen were then used for two doses, restoring Yuan Qi immediately.
A thirteen-year-old girl suffered from hematemesis and teeth grinding with convulsions due to anger. Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) added with Gou Teng Hook (Uncaria Ramulus cum Uncis) cured her. The following year, after marriage, she suffered from chest fullness, poor appetite, hematemesis, and a red face due to emotional stagnation. This was Liver Fire moving and Blood Heat, with Qi deficiency failing to control the blood. Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Gui Pi Tang (Return the Spleen Decoction) added with Zhi Zi (Gardenia Fruit) and Bei Mu (Fritillaria Bulb) resulted in recovery.
A fourteen-year-old child suffered from fever and hematemesis, attributed to deficiency of the three Foot meridians. I stated that Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to nourish the source of transformation. Disbelieving, they continued using cold-natured herbs to descend Fire, worsening the condition. Someone asked: "How can a child have Kidney deficiency without sexual activity? Why use Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) to tonify Qi?" I quoted Master Danxi: "The Kidney governs closure and storage; the Liver governs dispersion and excretion. Both viscera contain Ministerial Fire, connected upward to the Heart. The Heart is Sovereign Fire. When affected by external objects, Ministerial Fire rises abruptly. Even without intercourse, essence is secretly consumed." Also, Chu Shi said: "If a man engages in intercourse before his essence is full, exhausting it, the five Zang organs will have unfulfilled aspects, leading to difficult-to-describe diseases later." This explains the situation. Consequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) were used, resulting in recovery.
Huang Qi Shao Yao Tang (Astragalus and Peony Decoction): Treats epistaxis lasting many years, with yellow face, dry eyes, excessive eye discharge, and hand numbness.
Huang Qi (Astragali Radix) (3 liang), Gan Cao (Licoriae Radix et Rhizoma Preparata) (roasted), Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Shao Yao (Paeoniae Radix Alba Preparata) (roasted yellow) (1 liang each), Qiang Huo (Notopterygii Rhizoma et Radix) (0.5 liang).
Take 3 qian per dose, decoct in water and drink.
My commentary: These are herbs for the Hand and Foot Taiyin, Yangming meridians. However, prolonged Blood deficiency leads to Yang deficiency. Thus, insufficient Blood causes numbness; Yin deficiency with Fire movement causes myriad symptoms. This is truly not Wind pathogen. This case exemplifies raising Yang and nourishing Yin.
Ren Shen Huang Qi San (Ginseng and Astragalus Powder): Treats consumptive disease with guest heat, emaciation, fatigue, dry mouth and throat, tidal fever in the afternoon (Shen hour), five-palm heat, night sweats, chest fullness, poor appetite with thirst, coughing with purulent blood.
Tian Men Dong (Asparagi Radix) (decored, 3 liang), Ban Xia (Pinelliae Tuber), Zhi Mu (Anemarrhenae Rhizoma) (roasted yellow), Sang Bai Pi (Mori Cortex), Chi Shao Yao (Paeoniae Radix Rubra Preparata) (roasted), Huang Qi (Astragali Radix Preparata) (roasted), Zi Wan (Asteris Radix), Gan Cao (Licoriae Radix et Rhizoma Preparata) (roasted) (0.5 liang each).
Bai Fu Ling (Poria) (2 liang), Chai Hu (Bupleuri Radix), Qin Jiao (Gentianae Macrophyllae Radix), Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Preparata), Di Gu Pi (Lycii Cortex) (2 liang each), Ren Shen (Ginseng Radix et Rhizoma), Jie Geng (Platycodi Radix) (1 liang each), Bie Jia (Testudinis Carapax et Plastrum Preparatum) (vinegar-roasted).
Crush into powder. Take 3-5 qian per dose, decoct in water and drink. Adults may also take it. One formula includes Sheng Jiang (Zingiberis Rhizoma Recens).
Si Wu Tang (Four Substances Decoction) (Formula seen in Acute Convulsion)
Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) (Formula seen in Spasm)
Xiao Chai Hu Tang (Minor Bupleurum Decoction) (Formula seen in Liver Disease)
Qing Wei San (Clear the Stomach Powder)
Jia Wei Gui Pi Tang (Modified Return the Spleen Decoction)
Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder)
Si Jun Zi Tang (Four Gentlemen Decoction)
Liu Jun Zi Tang (Six Gentlemen Decoction) (Five formulas seen in Internal Hook)
Ji Sheng Xi Jiao Di Huang Tang (Ji Sheng Rhino Horn and Rehmannia Decoction) (Formula seen in Hematochezia)
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (Formula seen in Emaciation)
Ba Zhen Tang (Eight Treasures Decoction) (Combination of Si Jun Zi Tang and Si Wu Tang)
Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) (Formula seen in Kidney Disease)