桂枝加桂汤 茯苓桂枝甘草大枣汤
王晋三曰∶肾气奔豚，治宜泄之制之。茯苓、桂枝通阳渗泄，保心气以御水凌。甘草、
大枣补土以制水泛，甘澜水缓中而不留，入肾而不着，不助水邪，则奔豚脐悸之势缓。是汤
即茯苓甘草汤。恶生姜性升而去之。其义深切矣。
小半夏加茯苓汤（方见《金匮》）
真武汤（方见《伤寒》）
都气丸
即六味丸加五味子一两。（见《实在易》。）
归脾加栀子丹皮汤（方见《时方》。）
即归脾汤加山栀、丹皮（各一钱）。
朱丹溪云∶血随火而升降。凡治血症，以治火为先，然实火、虚火，灯烛之火，龙雷之火
，不可不辨。
何谓实火？外受风寒，郁而不解，酝酿成热，以致大吐大衄，脉浮而洪，或带紧，宜用
苏子降气汤，加荆芥、茜草根、降真香、玉竹之类以解散之。如风寒郁而不解，以成内热，
或阳脏之人，素有内火，及酒客蕴热、大吐大衄、脉洪而实、或沉而有力，宜犀角地黄汤、
黄连解毒汤以凉泻之。四生丸虽是止血通套药，然止血之中，兼有去瘀生新之妙，所以可用
。今人于此症，不敢用大苦大寒之品，而只以止血套药，如黑栀子、白芨末、百草霜、三才
汤加藕节之类。似若小心，其实姑息容奸，酿成大祸。（止血而不去瘀，则瘀血停滞，而为发
热咳嗽皮肉甲错，成干血劳症。仲景所以有 虫、水蛭、虻虫、大黄之治法。）盖此症火势
燎原，车薪之火，非一杯之水所可救。芩、连、栀、柏及大黄之类，补偏救弊，正在此时。俟火势
一平，即以平补温补之药维之，所谓有胆由于有识也。凡此之类，俱宜釜下抽薪，而釜中之
水，无沸腾之患矣。
四生丸
苏子降气汤
何谓虚火？劳役饥饱过度。东垣谓之内伤，以补中益气汤主之。思虑伤脾，倦怠少食，
肌肉瘦削，怔忡不寐，薛立斋以归脾汤主之。东垣云∶火与元气不两立。元气进一分，则火退
一分，所谓参、 、甘草为泻火之良药是也。此症吐血咳血，必积渐而来，以至盈盆盈斗，脉必
洪大，而重按指下全空，必以前汤及当归补血汤，峻补其虚，虚回而血始止。况血脱益气，古训
昭然。脱血盈盆盈斗，若用柔润之药，凝滞经络，鲜克有济。必以气分大补之品，始可引
其归经，此余屡试屡验之法也。又有脉细小而手足寒冷，腹痛便滑，此虚寒之症，《仁斋
直指》所谓阳虚阴必走是也，以理中汤加木香、当归主之。若泥于诸血属火之说，而用凉
血止血套药，止而复来，必致不起，可不慎哉。
补中益气汤
归脾汤
次男元犀按∶白芍易木香，是高鼓峰法，以建中汤得来，妙不可言。或加五味五分，麦冬
二钱，血不止，加栀子、茜草各一钱。
当归补血汤
以上三方，宜因症加减。如血不止，外以白芨三钱、藕节三钱。研末，以药汁送下三钱
即止。盖凡药必由胃而传化诸经，而此散能直入肺窍而止血也。或另用童便送下四钱亦妙。
何谓灯烛之火？人身阴阳，曰水曰火，水火之宅，俱在两肾之中。如先天不足，肾水素
虚，又兼色欲过度，以竭其精，水衰则火亢，必为咳嗽、吐血、咳血等症。其脉浮虚而数、或涩
而芤。外症干咳骨蒸，口舌生疮，小便赤短。如灯烛之火，油尽而自焚。治之之法，忌用辛
热，固不待言。即苦寒之品，亦须切戒。盖以肾居至阴之地，若用寒凉，则孤阴不生。而过
苦之味，久而化火，俱非阴虚症所宜也。须用甘润至静之品，补阴配阳。赵养葵云∶灯烛之
火，杂一滴水则灭。（指苦寒之物。）惟以六味丸养之以膏油。余每于水虚火亢之重症，用大补
阴丸，多收奇效。
大补阴丸（方各见《时方》）
此方滋阴降火，能治六味丸所不能治之症。勿以知柏之苦寒而疑之也，余向亦不能无疑
，后读《名医方论》，极有发挥，遂信用之。
何谓龙雷之火？肾中相火不安其位，以致烦热不宁，舌燥口渴，为吐血、咳血、衄血等
症。其脉两寸洪大，过于两关。两关洪大，过于两尺，浮按洪大，重按濡弱如无。宜用景岳
镇阴煎、冯氏全真一气汤、七味丸、八味丸主之。盖龙雷之火，得雨而愈炽，惟桂附辛热之
药，可以引之归原，所谓同气相求是也。
镇阴煎（《景岳》）
治阴虚于下，格阳于上，则真阳失守，血随而溢，以致大吐大衄，六脉细脱，手足厥冷
，危在顷刻。
熟地（一二两） 牛膝 泽泻（各二钱） 附子 肉桂 炙草（各一钱）
水煎，温服。如热甚喉痹，以水浸冷服。此方使孤阳有归，则血自安。
八味丸（方见《时方》）
去附子名七味丸。
全真一气汤（冯氏）
滋阴降火之神方。
熟地（一两） 冬白术（人乳拌，蒸晒，二三钱） 麦冬（三钱） 附子（一钱） 牛膝（二钱） 五味（八分） 人
参（二、三钱或七八钱，用开水别炖调入）
水煎服。
咳血、唾血、吐血，方书分别肺胃等症，何庸陋之甚也。凡吐血、衄血、下血，一切血
症，俱不必琐分。惟认其大纲，则操纵自如。
下血之方甚多。火盛者，以苦参子九粒，或十四粒，去壳取仁、勿破，以龙眼肉包好，开
水送下甚效。又于血症诸方中，择其应用者，再加槐花、地榆各三钱、黄芩一钱为使。
下血症属火固多，而虚寒亦复不少。宜以景岳寿脾煎，或圣术煎加黑姜服之。又常服黑地黄丸甚妙。
仲景以先便后血为远血，用黄土汤。先血后便为近血，用赤小豆当归散，神验。
黄土汤
治下血，并治吐血衄血如神。
赤小豆散（方各见《金匮》）
治下血，先血后便为近血。
又妇人血崩方，不外惜红煎加减。如未效，即宜大温大补，黄 、白术可用二、三两，
附子可用至三五钱，方效。（惜红煎见妇人门。）
又男妇尿血，（不痛为尿血，痛为血淋。）以六味汤加血余灰一两，煎好，入生藕汁服。亦有
气虚者，当归补血汤为主。挟热者，加竹叶、栀子主之。挟寒者，加附子主之。
Regardless of whether the pulse is floating, deep, slow, rapid, deficient, excess, large, or small, the most contraindicated are the hurried (Cu), knotted (Jie), and intermittent (Dai) pulses.
Guizhi Jia Gui Tang (Cinnamon Twig Decoction Plus Cinnamon Twig) Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction)
Wang Jin San stated: For Ben Tun (Rushing Pig) caused by Kidney Qi rebelling upwards, treatment should employ draining and restraining methods. Fuling (Poria) and Guizhi (Cinnamon Twig) unblock Yang and promote diuresis to drain dampness, protecting Heart Qi to resist the flooding of Water pathogen. Gancao (Licorice) and Dazao (Jujube) tonify Spleen Earth to restrain Water overflow. Ganlan Shui (Gently Rolling Water) is mild in the middle and does not stagnate; entering the Kidney meridian without adhering, it does not assist the Water pathogen, thereby alleviating the sensation of palpitations at the umbilicus during Ben Tun attacks. This decoction is essentially Fuling Gancao Tang (Poria and Licorice Decoction). The pungent and ascending nature of Shengjiang (Fresh Ginger) is avoided, so it is removed. The principle is profound.
Xiao Banxia Jia Fuling Tang (Minor Pinellia plus Poria Decoction) (Formula seen in *Jin Gui Yao Lue*)
Zhen Wu Tang (True Warrior Decoction) (Formula seen in *Shang Han Lun*)
Duqi Wan (Duqi Pill)
This is Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus one liang of Wuweizi (Schisandra Berry). (Seen in *Yi Zong Bi Du*.)
Guipi Jia Zhizi Danpi Tang (Spleen-Restoring Decoction Plus Gardenia and Moutan Bark) (Formula seen in *Shi Fang Ge Kuo*)
This is Guipi Tang (Spleen-Restoring Decoction) plus Shanzhi (Gardenia Fruit) and Danpi (Moutan Cortex), each one qian.
Zhu Danxi said: Blood rises and falls following Fire. In treating blood disorders, addressing Fire is paramount. However, Excess Fire, Deficiency Fire, Candle Fire, and Dragon-Lei Fire must be distinguished.
What is Excess Fire? External contraction of Wind-Cold, constrained and unresolved, brews into Heat, leading to severe vomiting or epistaxis. The pulse is floating and surging, or tight. Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) should be used, added with Jingjie (Schizonepeta), Qiancaogen (Rubia Rootstalk), Jiangzhenxiang (Aquilaria Wood), Yuzhu (Polygonatum Rhizome), etc., to disperse the pathogen. If Wind-Cold remains constrained, forming internal Heat, or in individuals with a Yang constitution who inherently possess internal Fire, or wine drinkers with accumulated heat, presenting with severe vomiting/epistaxis, a surging and excess pulse, or deep and forceful pulse, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or Huanglian Jiedu Tang (Coptis Detoxification Decoction) should be used to cool and purge. Sisheng Wan (Four Generations Pill), although a common hemostatic formula, possesses the subtlety of removing stasis while generating new blood within the act of stopping bleeding, thus it can be used. Modern practitioners, fearing great bitter-cold herbs for such conditions, resort only to standard hemostatic powders like Heizhizi (Charred Gardenia), Baiji (Bletilla Rhizome powder), Baicaoshuang (Herb Ash), Santang Tang (Three Talents Decoction) plus Ou Jie (Lotus Node), seemingly cautious but actually indulging evil, brewing disaster. (Stopping bleeding without removing stasis leads to stasis accumulation, causing fever, cough, rough skin resembling scales, resulting in Dry Blood Lao syndrome. Zhang Zhongjing therefore employed treatments using Ee Chong (Ground Beetle), Shuizhi (Leech), Meng Chong (Dragonfly Larva), and Dahuang (Rhubarb Root).) This condition's fire spreads like a prairie fire; like fuel on a cart, it cannot be extinguished with a cup of water. Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), Huangbai (Phellodendron Bark), and Dahuang (Rhubarb Root) are needed now to correct deviations and remedy defects. Once the fire subsides, mild tonifying or warming-tonifying herbs should be used to maintain balance. This is what is meant by "courage stems from insight." All such cases require drawing fire from under the cauldron (treating the root), so the water in the pot will not boil over.
Sisheng Wan (Four Generations Pill)
Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction)
What is Deficiency Fire? Caused by overexertion and irregular diet. Li Dongyuan termed this Internal Injury, treated primarily with Buzhong Yiqi Tang (Middle-Warmer-Boosting and Qi-Supplementing Decoction). Overthinking damages the Spleen, manifesting as fatigue, poor appetite, emaciation, palpitations, and insomnia. Xue Lizhai treated this with Guipi Tang (Spleen-Restoring Decoction). Li Dongyuan said: Fire and Primordial Qi cannot coexist. As Primordial Qi advances by one point, Fire retreats by one point. Thus, Renshen (Ginseng Root), Huangqi (Astragalus Root), and Gancao (Licorice Root) are excellent herbs for purging fire. Hematemesis and hemoptysis in this condition arise gradually, filling basins and buckets. The pulse is necessarily surging and large, but empty upon heavy pressure. One must use the aforementioned formulas and Danggui Buxue Tang (Angelica Tonifying Blood Decoction) to vigorously tonify deficiency. Only when deficiency is restored will bleeding stop. Moreover, the ancient maxim "tonify Qi when Blood is lost" is clear. When losing blood filling basins and buckets, using soft and moistening herbs will stagnate the collaterals, rarely achieving success. One must use strong Qi-tonifying herbs to guide blood back to its vessels; this is my method tested repeatedly. Another presentation involves a fine pulse, cold hands and feet, abdominal pain, and loose stools. This is a Deficient-Cold pattern, as described in *Ren Zhai Zhi Zhi Fang*: "When Yang is deficient, Yin must wander." It is treated with Lizhong Tang (Regulate the Middle Decoction) added with Muxiang (Aucklandia Root) and Danggui (Angelica Sinensis Root). If one sticks to the theory that all bleeding belongs to Fire and uses cooling-blood/hemostatic formulas, bleeding will recur, inevitably leading to death. Can one not be cautious?
Buzhong Yiqi Tang (Middle-Warmer-Boosting and Qi-Supplementing Decoction)
Guipi Tang (Spleen-Restoring Decoction)
My second son, Yuan Xi, noted: Replacing Muxiang (Aucklandia Root) with Baishao (White Peony Root) is Gao Bufeng's method, derived from Jianzhong Tang (Establish the Middle Decoction), exquisitely subtle. One may add five fen of Wuweizi (Schisandra Berry) and two qian of Maidong (Ophiopogon Tuber). If bleeding persists, add Zhizi (Gardenia Fruit) and Qiancao (Rubia Root), one qian each.
Danggui Buxue Tang (Angelica Tonifying Blood Decoction)
The above three formulas should be modified according to symptoms. If bleeding persists, externally apply one qian of Baiji (Bletilla Rhizome powder) mixed with three qian of Ou Jie (Lotus Node powder), taken with decoction juice to stop bleeding immediately. Generally, herbs must pass through the Stomach to transmit to other meridians, but this powder enters the Lung orifices directly to stop bleeding. Alternatively, taking four qian delivered by Child's Urine is also effective.
What is Candle Fire? Human Yin and Yang are referred to as Water and Fire. The residence of Water and Fire lies within both Kidneys. If congenital insufficiency exists, and Kidney Water is inherently deficient, compounded by excessive sexual activity depleting Essence, Water deficiency leads to Fire hyperactivity. This causes cough, hematemesis, and hemoptysis. The pulse is floating, deficient, and rapid, or choppy and thready. External symptoms include dry cough, bone-steaming tidal fever, mouth and tongue ulcers, and scanty dark urine. Like a candle flame, it burns itself out when the oil is exhausted. Treatment contraindicates acrid-hot herbs, which goes without saying. Even bitter-cold herbs must be strictly avoided. Since the Kidney resides in the deepest Yin, using cold-cooling herbs prevents solitary Yin from generating. Furthermore, overly bitter flavors transform into Fire over time, unsuitable for Yin deficiency. One must use sweet-moistening and tranquilizing herbs to tonify Yin and harmonize Yang. Zhao Yangkui said: A drop of water extinguishes Candle Fire (referring to bitter-cold substances). Only Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) nourishes it like adding oil. In severe cases of Water deficiency and Fire hyperactivity, I often use Dabu Yin Wan (Great Tonify Yin Pill), achieving miraculous effects.
Dabu Yin Wan (Great Tonify Yin Pill) (Formulas seen in *Shi Fang Ge Kuo*)
This formula nourishes Yin and descends Fire, treating conditions beyond the scope of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Do not doubt it due to the bitterness and coldness of Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark). I too was initially skeptical, but after reading *Ming Yi Fang Lun*, I found it highly insightful and began to trust and use it.
What is Dragon-Lei Fire? Ministerial Fire in the Kidney fails to remain in its proper position, causing irritability, restlessness, dry tongue, thirst, hematemesis, hemoptysis, and epistaxis. The pulse at both Cun positions is surging and large, exceeding Guan positions. The Guan positions are surging and large, exceeding Chi positions. Superficial pressure reveals a surging-large pulse, while deep pressure feels soft-weak or absent. Jingyue's Zhenyin Jian (Stabilize Yin Decoction), Feng Shi's Quanzhen Yiqi Tang (Complete True One Qi Decoction), Qiwei Wan (Seven-Ingredient Pill), and Bawei Wan (Eight-Ingredient Pill) should be used. Dragon-Lei Fire intensifies with rain; only acrid-hot herbs like Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) can guide it back to its origin, following the principle of "similar energies attracting each other."
Zhenyin Jian (Stabilize Yin Decoction) (From *Jing Yue Quan Shu*)
Treats Yin deficiency below and Yang repulsion above, causing loss of True Yang control, leading to massive hematemesis or epistaxis. The six pulses are minute and faint, hands and feet are cold, danger is imminent.
Shudihuang (Rehmannia Root, 1-2 liang) Niuxi (Achyranthes Root) Zexie (Alisma Rhizome, 2 qian each) Fuzi (Prepared Aconite Root) Rougui (Cinnamon Bark) Zhigancao (Honey-fried Licorice Root, 1 qian each)
Decoct in water, take warm. If heat is severe causing throat obstruction, take cooled after soaking in water. This formula gives solitary Yang a return path, stabilizing blood.
Bawei Wan (Eight-Ingredient Pill) (Formula seen in *Shi Fang Ge Kuo*)
Removing Fuzi (Prepared Aconite Root) yields Qiwei Wan (Seven-Ingredient Pill).
Quanzhen Yiqi Tang (Complete True One Qi Decoction) (Feng Shi)
A divine formula for nourishing Yin and descending Fire.
Shudihuang (Rehmannia Root, 1 liang) Dong Baizhu (Winter Atractylodes Macrocephala Rhizome, steamed/dried with human milk, 2-3 qian) Maidong (Ophiopogon Tuber, 3 qian) Fuzi (Prepared Aconite Root, 1 qian) Niuxi (Achyranthes Root, 2 qian) Wuweizi (Schisandra Berry, 8 fen) Renshen (Ginseng Root, 2-3 qian or 7-8 qian, separately stewed in boiling water and mixed in)
Decoct in water and take.
Hemoptysis, spitting blood, and hematemesis are separated by formularies into Lung and Stomach syndromes, how vulgar and shallow! For all blood disorders including hematemesis, epistaxis, and lower bleeding, there is no need for trivial differentiation. Grasping the general principle allows free manipulation.
There are many formulas for lower bleeding. For Excess Fire, nine or fourteen Kusanzi (Sophora Seed), shelled, kernel intact, wrapped in Longyanrou (Longan Aril), taken with boiled water, is very effective. Also, select applicable blood formulas and add Huaihua (Sophora Flower), Diyü (Sanguisorba Root), each three qian, and Huangqin (Scutellaria Root), one qian, as guides.
Lower bleeding is mostly Fire-related, but Deficient-Cold is also common. Jingyue's Shoupi Jian (Longevity Spleen Decoction) or Shengzhu Jian (Holy Atractylodes Decoction) added with Heijiang (Charred Ginger) is suitable. Regularly taking Hei Di Huang Wan (Black Rehmannia Pill) is also excellent.
Zhongjing defined bleeding after stool as distant blood, treated with Huangtu Tang (Yellow Earth Decoction). Bleeding before stool as proximate blood, treated with Chixiaodou Danggui San (Red Bean and Angelica Powder), which is miraculous.
Huangtu Tang (Yellow Earth Decoction)
Treats lower bleeding, and hematemesis/epistaxis with divine efficacy.
Chixiaodou San (Red Bean Powder) (Formulas seen in *Jin Gui Yao Lue*)
Treats lower bleeding, specifically proximate blood (bleeding before stool).
For women with metrorrhagia, modifications of Xihong Jian (Cherish Red Decoction) are used. If ineffective, strong warming and tonifying are required. Huangqi (Astragalus Root) and Baizhu (Atractylodes Rhizome) can be used in 2-3 liang doses; Fuzi (Prepared Aconite Root) up to 3-5 qian for efficacy. (Xihong Jian seen in Women's Section.)
For men and women with hematuria (painless is hematuria, painful is bloody strangury), Liuwei Tang (Six-Ingredient Decoction) added with Xuyu Hui (Hair Ash), one liang, decocted and mixed with fresh Ouzhi (Lotus Juice), is effective. For Qi deficiency, Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is primary. For heat, add Zhuye (Bamboo Leaf) and Zhizi (Gardenia Fruit). For cold, add Fuzi (Prepared Aconite Root).