论曰∶诸阳统气，诸阴主血。阴盛则阳亏而阳病，阳盛则阴亏而阴病。阳气侵阴，血失
常道，故或吐或衄，或从口，或从鼻。若暴出而色鲜，心烦燥闷，时欲引饮，出自三斗，阳
入于阴也。血得热则流散，譬如天地之经水，天暑地热，则经水沸溢而垄起，故有内衄肺疽
其证大同而小异。其脉洪数者为逆，微小者为顺。宜栀子柏皮汤，煎金汤。大热者宜地黄
若吐血时，先闻腥臊臭，出清液，胸胁支满，妨于食，目眩，时时前后血，此由素经大
夺血，或醉入房中，气竭伤肝，女子则月事衰少不来，病名血枯，栀子柏皮汤主之。
栀子柏皮汤
黄柏 栀子（各一两） 甘草（半两）
上为散。每服五钱，水二盏，煎至一盏，去滓温服。
煎金汤
金花并茎叶阴干，不拘多少。
上浓煮汁，顿服立定。
地黄煎
生地黄汁（半斤） 大黄（末，一两）
上将地黄汁熬耗一半，内大黄末同熬，候可丸，如梧桐子大。熟水下五粒，未效，加至
十粒。
若吐血，服汤后转加闷乱烦躁，纷纷欲呕，颠倒不安，由胸上有留血，其脉沉伏，急须
吐之，人参散主之。
人参散
人参芦
上为末。水调下一、二钱。
若血随呕出，胸中痞闷，呕毕则目睛痛而气急，由怒气伤肝胆，血随呕出，竹皮汤主之
竹皮汤
青竹皮 甘草（炙） 芎 黄芩 当归（洗，各六分） 芍药 白术 人参 桂心（各
一
两）
上为散。每服五钱，水二盏，煎至一盏，去滓温服。
若先吐血，血止后嗽，嗽中血出如线，痛引胁下，日渐羸瘦，由悲忧伤肺。肺主诸气，
血常随之，气伤则血无以运，故横流而暴出，后随病而上下也。其脉缓小者可治，细数加急
者不可治，黄 汤主之。
黄 汤
黄 （蜜炙，一两） 白术（炒，二两） 人参 甘草（炙，各一两） 白芍（一两） 陈
皮（
半两） 藿香（半两）
上为散。每服四钱，水一盏半，煎至七分，去滓温服。
若衄血吐血，发作无时，肌肉减少，由气虚弱，或从高堕下，劳伤所致，其脉虚弱，当
补阴平阳，阿胶散主之。
阿胶散
阿胶（蛤粉拌炒，一两半） 杏仁（炮，去皮尖，七钱） 马兜铃（焙） 牛蒡子（炒，
各一
两） 甘草（炙） 糯米（一两）
上为细末。熟水调下一二钱。
若吐血腹中绞痛，汗自出，胸中闷，由饮食伤胃，胃气不转，气上冲胸，所食之物与气
迫蹙，因胃裂，白术汤主之。
白术汤（方缺）
It is stated: The Yang meridians govern Qi, and the Yin meridians govern Blood. When Yin is in excess, Yang becomes deficient, leading to Yang pathology; when Yang is in excess, Yin becomes deficient, leading to Yin pathology. When Yang Qi invades the Yin aspect, Blood loses its normal pathway, resulting in either hematemesis (vomiting blood) or epistaxis (nosebleed), some coming from the mouth and others from the nose. If bleeding occurs suddenly and profusely with bright red blood, accompanied by mental restlessness, dryness, and oppression, along with a frequent desire to drink, even if the volume is massive (e.g., "three dou"), it indicates that Yang has entered the Yin. Blood flows and scatters when exposed to heat, similar to rivers on earth; when the weather is hot and the earth is warm, river water boils over and rises, thus causing internal epistaxis and lung abscesses. These syndromes are largely similar with minor differences. A洪数 (Hong-Shu, surging and rapid) pulse indicates an adverse prognosis, while a微小 (Wei-Xiao, minute and faint) pulse indicates a favorable one. Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) or Jian Jin Tang (Boiled Gold Decoction) is suitable. For cases of intense heat, Di Huang Jian (Rehmannia Paste) is appropriate.
If, prior to hematemesis, one smells a fishy or fetid odor, vomits clear fluid, experiences distension and fullness in the chest and hypochondrium, difficulty eating, dizziness, and frequent bleeding from both bowels and urine, this is due to previous severe blood loss or sexual activity after drunkenness, which exhausts Qi and injures the Liver. In women, menstruation becomes scanty or ceases entirely; this disease is named Xue Ku (Blood Withering), and Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) should be used.
Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction)
Phellodendri Cortex (Huang Bo) and Gardeniae Fructus (Zhi Zi) (each 1 liang), Glycyrrhizae Radix et Rhizoma (Gan Cao) (0.5 liang).
Grind the above into a powder. Take 5 qian per dose, add 2 zhan of water, decoct until 1 zhan remains, remove the dregs, and take warm.
Jian Jin Tang (Boiled Gold Decoction)
Jin Hua (Chrysanthemi Flos) and its stems and leaves, dried in the shade, quantity不拘 (unrestricted).
Decoct thickly to extract the juice, take in one dose to stop bleeding immediately.
Di Huang Jian (Rehmannia Paste)
Fresh Rehmanniae Radix Juice (Sheng Di Huang Zhi) (0.5 jin), Rheum Palmatum Radix et Rhizoma (Da Huang) (powdered, 1 liang).
First, boil down the fresh Rehmanniae Radix Juice by half, then add the powdered Rheum Palmatum Radix et Rhizoma and continue boiling until it can be formed into pills. Shape into pills the size of Sophora japonica seeds. Swallow 5 pills with cooked water; if ineffective, increase to 10 pills.
In cases of hematemesis, if after taking the decoction, chest oppression worsens, confusion increases, irritability intensifies, frequent vomiting occurs, and there is extreme restlessness, this is due to retained blood in the chest. The pulse is Chen Fu (deep and hidden); urgent emesis is required to expel the retained blood. Ren Shen San (Ginseng Powder) is indicated.
Ren Shen San (Ginseng Powder)
Radix et Caulis Ginseng Rhizoma (Ren Shen Lu).
Grind into fine powder. Mix with water and take 1-2 qian.
If blood is vomited out, accompanied by chest stuffiness and oppression, followed by eye pain and shortness of breath after vomiting, this is caused by anger injuring the Liver and Gallbladder, with blood following the vomit. Zhu Pi Tang (Bamboo Peel Decoction) is indicated.
Zhu Pi Tang (Bamboo Peel Decoction)
Qing Zhu Pi (Green Bamboo Peel), Gan Cao (Zhi) (Honey-fried Licorice Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Huang Qin (Scutellariae Radix), Dang Gui (Angelicae Sinensis Radix) (washed, each 6 fen), Shao Yao (Paeoniae Radix Alba), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ren Shen (Panax Ginseng Radix et Rhizoma), Gui Xin (Cinnamomi Ramulus Heart) (each 1 liang).
Grind the above into a powder. Take 5 qian per dose, add 2 zhan of water, decoct until 1 zhan remains, remove the dregs, and take warm.
If hematemesis occurs first, followed by coughing after the bleeding stops, with blood streaks like threads in the sputum, pain radiating to the hypochondrium, and gradual emaciation, this is due to sorrow injuring the Lung. The Lung governs all Qi, and Blood usually follows Qi. When Qi is injured, Blood cannot be transported properly, leading to erratic flow and sudden eruption, subsequently moving up and down with the progression of the disease. A Huan Xiao (slow and small) pulse is treatable, but a Xi Shu Jiji (fine, rapid, and urgent) pulse is untreatable. Huang Qi Tang (Astragalus Decoction) is indicated.
Huang Qi Tang (Astragalus Decoction)
Huang Qi (Mi Zhi) (Honey-fried Astragali Radix, 1 liang), Bai Zhu (Chao) (Stir-fried Atractylodis Macrocephalae Rhizoma, 2 liang), Ren Shen (Panax Ginseng Radix et Rhizoma), Gan Cao (Zhi) (Honey-fried Licorice Root, each 1 liang), Bai Shao (Paeoniae Radix Alba, 1 liang), Chen Pi (Citri Reticulatae Pericarpium, 0.5 liang), Huo Xiang (Agastaches Herba, 0.5 liang).
Grind the above into a powder. Take 4 qian per dose, add 1.5 zhan of water, decoct until 0.7 zhan remains, remove the dregs, and take warm.
For epistaxis or hematemesis occurring at irregular intervals, with muscle wasting, due to Qi deficiency or injury from falling from heights, where the pulse is weak, Yin and Yang should be tonified and harmonized. E Jiao San (Donkey-hide Gelatin Powder) is indicated.
E Jiao San (Donkey-hide Gelatin Powder)
E Jiao (Ge Fen Ban Chao) (Donkey-hide Gelatin fried with clamshell powder, 1.5 liang), Xing Ren (Pao, Qu Pi Jian) (Processed Apricot Seed, peeled and de-pitted, 7 qian), Lou Lu (Dutchman's Pipe Fruit), Niu Bang Zi (Chao) (Fried Arctii Fructus, each 1 liang), Gan Cao (Zhi) (Honey-fried Licorice Root), Nu Mi (Glutinous Rice, 1 liang).
Grind into fine powder. Mix with cooked water and take 1-2 qian.
If hematemesis is accompanied by colicky abdominal pain, spontaneous sweating, and chest oppression, this is due to dietary injury to the Stomach, failure of Stomach Qi to rotate, Qi rushing upward to the chest, and the forced compression between ingested food and Qi, leading to gastric rupture. Bai Zhu Tang (Atractylodes Decoction) is indicated. (Formula content missing)