〔海〕血症古人用药，虽有轻重之殊，而无上下之别。今分作上中下三等，以衄血、呕血、唾血、吐血为
上部，血结胸中为中部，蓄血下焦为下部。夫既有三部之分，故药亦当随其轻重也。
汗多为衄血，脉浮，灸之。咽燥为唾血，当汗不汗，热入于里者，为呕血、吐血。此在上也，犀角地黄汤
主之，凉膈散加生地黄亦可。然衄、唾、呕、吐俱在上，亦当以轻重分之。大凡血证皆不饮水，惟气证则饮之，
宜详之。此证乃足太阴所主，脾所不裹，越而上行，所以有吐血、呕血之候也。实者犀角地黄汤，虚者黄芩芍
药汤。凡病呕吐者，以脾所主，故咸用芍药主之，是知太阴药也。
血结胸中头痛身痛，漱水不咽者，衄。无热胸满，漱水不欲咽者，喜忘昏迷，其人如狂，心下手不可近
者，血在中也，桃仁承气汤主之。
蓄血下焦其人发狂，小腹满硬，小便自利，大便反黑，及脐下疼者，抵当汤丸主之。如狂者在中，发狂
者在下。
抵当汤丸，药味同剂，如何是二法？盖喜忘发狂，身黄屎黑者，疾之甚也；但小腹满硬，小便利者，轻也，
故有汤丸之别。桃仁、大黄等分，水蛭、虻虫多者作汤，三之二者作丸，丸之名取其数少而缓也，故汤用煎服
一升，丸止服七合也。
〔《活》〕病患无表症，不发寒热，唇燥，但欲漱水不欲入咽，其脉微而沉，小腹硬满，小便反利，大便必
黑，身黄发狂，此血证谛也。大抵伤寒当汗不汗，里热蓄化为血，其人喜忘而如狂，血上逆则喜忘，血下蓄则
如狂，轻者犀角地黄汤、桃仁承气汤，甚者抵当汤丸，须取尽黑物为效。（按太阳病蓄血者，表症仍在也，
今云无表证者，但说得阳明蓄血，为未备。）
〔海〕喜忘发狂，身黄屎黑者，疾之甚也；但小腹满小便利者，轻也。
生地黄丸 病患七八日后，两手脉沉细微，肤冷，脐下满，或狂或躁，大便实而色黑，小便自利者，
此蓄血证也。若老幼气虚弱者，宜此方主之。
生地黄（自然汁一升，如无生地黄，只用生干地黄二两） 干漆（半两，炒烟尽） 生藕（自然汁半升，
如无藕，用刺蓟汁一升半） 蓝叶（一握，切细，干者用末半升） 虻虫（二十个，去翅足，麸内炒黄）
水蛭（十个，炒） 大黄（一两，锉如豆大） 桃仁（研碎，半两）
上一处，入水三升，同慢火熬及二升，放冷，分二服。先投一服，至半日许，血未下，再投之。此地黄
汤，比抵当汤丸其势甚轻。如无地黄与藕汁升数，添水同煎。抵当丸恐用之太过，不止损血，故以此汤主
之。
[Haizang Zhuwei] In ancient times, the medication for blood disorders differed in dosage but did not distinguish between upper and lower locations. Now it is divided into three levels: upper, middle, and lower. Epistaxis (nosebleed), hematemesis (vomiting blood), spitting blood, and vomiting blood are classified as the upper level; blood stagnating in the chest is the middle level; blood accumulating in the lower jiao (lower abdomen) is the lower level. Since there is a division into three parts, the medication should also be adjusted according to the severity of the condition.
Excessive sweating leading to epistaxis with a floating pulse can be treated with moxibustion. Dryness of the throat leading to spitting blood, where sweating was indicated but not performed, allowing heat to enter the interior, results in hematemesis and vomiting blood. These belong to the upper level and are primarily treated with Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction); Liangge San (Cool the Diaphragm Powder) added with Sheng Dihuang (Fresh Rehmannia Root) is also effective. However, since epistaxis, spitting blood, hematemesis, and vomiting blood all occur in the upper part, they should further be distinguished by severity. Generally, patients with blood disorders do not desire water, whereas those with qi disorders do; this point requires careful differentiation. This condition is governed by the Foot-Taiyin Spleen Meridian. When the Spleen fails to contain the blood, it overflows and moves upward, resulting in symptoms of vomiting blood and hematemesis. For excess patterns, Xijiao Dihuang Tang is used; for deficiency patterns, Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) is used. For all cases of vomiting, because they are related to the Spleen, Shaoyao (Peony Root) is commonly used as the principal herb, indicating these are medicines for the Taiyin channel.
Blood stagnating in the chest presents with headache and body pain, rinsing the mouth without swallowing (shui shu bu yan), which indicates epistaxis. Absence of fever but with chest fullness, rinsing the mouth without desiring to swallow, accompanied by forgetfulness, coma, and a manic-like state where the area below the heart is tender to touch, indicates blood stagnation in the middle. This is treated with Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction).
Blood accumulating in the lower jiao presents with mania, fullness and hardness of the lower abdomen, free urination, black stools, and pain below the umbilicus. This is treated with Didang Tang or Didang Wan (Vermifuge Decoction or Pill). "Manic-like" (ru kuang) conditions are located in the middle, while true "mania" (fa kuang) conditions are located in the lower part.
Didang Tang and Didang Wan contain the same ingredients but differ in formulation. The rationale is that when forgetfulness, mania, yellow skin, and black stools are present, the disease is severe; whereas if there is only lower abdominal fullness and hardness with free urination, the disease is mild. Hence, the distinction between decoction and pill. With equal amounts of Tao Ren (Peach Kernel) and Da Huang (Rhubarb), higher doses of Shui Zhi (Leech) and Meng Chong (Dragonfly Larva) are made into a decoction, while two-thirds of that amount are made into a pill. The pill form is named for its smaller dose and slower action. Therefore, the decoction is taken as one sheng, while the pill is limited to seven he.
[Huo Ren Shu] If the patient has no exterior syndrome, no chills or fever, dry lips, a desire to rinse the mouth but not swallow, a faint and deep pulse, hard and full lower abdomen, free urination, inevitable black stools, yellow skin, and mania, this is a definitive blood disorder. Generally, in Shanghan (Cold Damage) disease, if sweating is indicated but not performed, interior heat accumulates and transforms into blood stasis. The patient becomes forgetful and manic-like. Blood reversing upward causes forgetfulness; blood accumulating downward causes manic-like behavior. Mild cases are treated with Xijiao Dihuang Tang or Tao Ren Cheng Qi Tang; severe cases are treated with Didang Tang or Didang Wan. Efficacy is confirmed only after black material is expelled. (Note: In Yangming Shanghan blood accumulation, the exterior syndrome persists. Here, stating "no exterior syndrome" refers specifically to Yangming blood accumulation, making the discussion incomplete.)
[Haizang Zhuwei] Forgetfulness, mania, yellow skin, and black stools indicate severe disease; lower abdominal fullness with free urination indicates mild disease.
Sheng Dihuang Wan (Rehmannia Pill)
For patients who have been ill for seven or eight days, presenting with faint, fine, and deep pulses in both hands, cold skin, fullness below the umbilicus, mania or restlessness, solid black stools, and free urination, this is a blood accumulation syndrome. For elderly, young children, or those with deficient qi and blood, this formula is appropriate.
Ingredients:
Sheng Dihuang (Fresh Rehmannia Root Juice, 1 sheng; if unavailable, use dried Fresh Rehmannia Root, 2 liang)
Gan Xi (Processed Dry Resin, 0.5 liang, stir-fried until smoke ceases)
Sheng Ou (Fresh Lotus Rhizome Juice, 0.5 sheng; if unavailable, use Ci Ji Juice [Spiny Thistle Juice], 1.5 sheng)
Lan Ye (Isatis Leaf, 1 handful, chopped; if dried, use powder, 0.5 sheng)
Meng Chong (Dragonfly Larva, 20 individuals, wings and feet removed, stir-fried with bran until yellow)
Shui Zhi (Leech, 10 individuals, stir-fried)
Da Huang (Rhubarb, 1 liang, cut into bean-sized pieces)
Tao Ren (Peach Kernel, crushed, 0.5 liang)
Preparation:
Place all ingredients together with 3 sheng of water. Simmer slowly until reduced to 2 sheng. Allow to cool. Divide into two doses. Administer the first dose. After about half a day, if blood has not been expelled, administer the second dose. This Dihuang Tang is much milder than Didang Tang/Wan. If the specified quantities of Dihuang and Ou juice are unavailable, add water for decoction. Didang Wan is feared to be too harsh, potentially damaging healthy blood/qi; therefore, this decoction is used instead.