[总诀]血随气布要循经，气上因而血沸腾。降逆消瘀为妙诀，莫施补剂致痨蒸。
骤然吐血，兼见头痛寒热者，外感伤经脉也。宜麻黄芍药汤。
藕节（二钱） 枯芩（一钱） 生地（二钱） 川芎（五分） 白芍（三钱） 当归（三钱） 麻黄（八
分） 丹皮（二钱） 香附（三钱） 麦冬（三钱） 杏仁（三钱） 蒲黄（一钱） 枳壳（一钱） 甘草（一
钱）
歌曰∶失血头痛外感伤，藕芩地芍与麻黄。
归芎香附丹蒲杏，枳草和冬煮与尝。
吐血口渴，脉洪数而溺赤者，火热伤阴分也。宜加味四生丸。
生地（三钱） 艾叶（一钱） 柏叶（三钱） 荷叶（三钱） 丹皮（三钱） 枯芩（三钱）
酒军（七分） 知母（三钱） 花粉（三钱） 牛膝（一钱） 茅根（三钱） 马通（即白马屎一
两泡取水）
歌曰∶脉洪失血渴难当，知地丹芩与大黄。
牛膝马通花粉入，茅荷艾柏叶同尝。
吐血口和，脉弦微而溺清者，阳虚而阴脱也。宜变化理中汤。
党参（二钱） 黄 （二钱） 黑姜（八分） 甘草（一钱） 白芍（二钱） 白术（二钱）
五味（五分） 当归（三钱） 木香（一钱） 侧柏（二钱） 醋艾（一钱） 马通（即白马屎一两
泡取水）
歌曰∶脉微血脱溺还清，姜草参 芍共烹。
术味马通归柏艾，木香加入病能轻。
吐后口渴，血带黑而腹痛者，瘀血积腹里也。宜加味四物汤。
生地（三钱） 当归（三钱） 川芎（一钱） 桃仁（研，三钱） 白芍（三钱） 大黄（一钱） 丹皮（
三钱） 香附（三钱） 枳壳（一钱） 降香（一钱）
歌曰∶血方吐过口旋干，腹痛瘀停归地餐。
芎枳降香香附子，大黄加芍佐桃丹。
吐血之前，必先大发恶心者，血潮而凌心也。宜郁金丹皮汤。
郁金（二钱） 生地（三钱） 麦冬（三钱） 牛膝（二钱） 五味（七分） 丹皮（二钱） 炒栀（
二钱） 当归（二钱） 白芍（二钱） 玉竹（二钱） 枣仁（二钱） 知母（一钱） 木香（二钱）
朱砂（研冲服八分）
歌曰∶吐血之前发恶心，木香知味芍归寻。
朱砂牛地冬和枣，玉竹丹栀与郁金。
（伯未按，鲜蚕豆叶、捣汁和陈皮酒炖温服。）
先行咳嗽，然后得吐血证者，肺燥伤阴脉也。宜清燥和血汤。
生地（三钱） 麦冬（三钱） 百合（二钱） 五味（五分） 当归（三钱） 贝母（二钱） 杏仁（
三钱） 续断（二钱） 藕节（二钱） 荆芥（一钱） 竹茹（二钱） 蒲黄（一钱） 红花（五分）
降香（一钱）
歌曰∶先行咳嗽血方来，地合归冬杏贝裁。
续降芥茹同五味，红花藕节与蒲灰。
（伯未按∶枇杷叶膏可时冲服。）
先行吐血，然后得咳嗽证者，阴阳不相符也。宜调阴和阳汤。
当归（二钱） 白芍（二钱） 生地（二钱） 阿胶（一钱） 五味（七分） 百合（二钱） 贝母（
二钱） 杏仁（二钱） 沉香（五分） 牛膝（一钱） 白薇（二钱） 蒲黄（一钱） 牡蛎（二钱）
降香（一钱）
歌曰∶先行吐血咳相随，药用阿胶地芍归。
味合降沉和贝杏，蒲黄牡蛎膝兼薇。
吐血之后，肌肉鱼鳞甲错者，腹中有干血也。宜大黄 虫丸。
大黄（一钱） 桃仁（一钱） 甘草（一钱） 虻虫（炒，一钱） 蛴螬（一钱） 阿胶（一钱） 当归（
一钱） 炒荆芥（一钱） 水蛭（炒，二条） 虫（炒，一钱）
歌曰∶血干肌肉似鱼鳞，蛭 螬虻效若神。
黄与胶归分佐使，再加芥草与桃仁。
大便下血，其下在粪之前者，肠风疮痔类也。宜赤豆加味散。
当归（三钱） 地榆（三钱） 银花（一钱） 防己（一钱） 麦冬（三钱） 牛蒡子（三钱） 丹
皮（三钱） 白芍（二钱） 槐角（三钱） 棕灰（一钱） 杏仁（三钱） 黄柏（二钱） 甘草（一钱）
赤豆（芽，三钱）
歌曰∶痔疮下血用归榆，赤豆银防冬芍俱。
牛蒡棕槐丹杏共，寸冬黄柏草梢须。
大便下血，其下在粪之后者，肝脾不统血也。宜仲景黄土汤。
白术（三钱） 附子（二钱） 炙草（二钱） 生地（三钱） 黄芩（二钱） 阿胶（二钱） 灶
心土（三钱）
歌曰∶肝脾失驭血违经，便后长流势不停。
术附地芩胶共草，汤煎黄土服之灵。
通身汗血，甚则沾衣尽赤者，火甚而血溢也。宜加味六黄汤。
当归（三钱） 黄连（二钱） 黄芩（三钱） 黄柏（二钱） 蝉蜕（一钱） 酒军（一钱） 生
地（三钱） 黄 （二钱） 熟地（三钱） 白芍（三钱） 竹茹（二钱） 杏仁（三钱） 甘草（一
钱） 地骨皮（二钱）
歌曰∶通身汗出血沾衣，两地芩连芍与归。
地骨竹茹蝉杏草，生军 柏汗当稀。
鼻中流血，以及齿缝出血者，胃中之燥热也。宜清凉甘露饮。
生地（三钱） 熟地（三钱） 麦冬（三钱） 天冬（三钱） 黄芩（三钱） 枳壳（一钱） 石
斛（三钱） 茵陈（三钱） 藕节（三钱） 蒲黄（一钱） 牛膝（二钱） 甘草（一钱） 枇杷叶（
去毛蜜炙，二钱）
歌曰∶鼻中流血要清凉，芩枳茵陈两地黄。
藕斛枇杷牛膝共，二冬和草煮成汤。
[General Principle] Blood follows Qi in its distribution and must circulate according to the meridians; when Qi rebels upward, blood boils and flows recklessly. The exquisite principle is to direct rebellious Qi downward and eliminate stasis; do not apply tonifying agents lest they cause consumptive fever.
If hematemesis occurs suddenly accompanied by headache, aversion to cold, and fever, it is due to external pathogens injuring the meridians. Mahuang Shaoyao Tang (Ephedra and White Peony Decoction) is suitable.
Herbs: Nelumbinis Plumulae Caulis (Ou Jie, 2 qian), Scutellariae Radix (Ku Qin, 1 qian), Rehmanniae Radix (Sheng Di, 2 qian), Chuanxiong Rhizoma (Chuan Xiong, 5 fen), Paeoniae Radix Alba (Bai Shao, 3 qian), Angelicae Sinensis Radix (Dang Gui, 3 qian), Ephedrae Herba (Ma Huang, 8 fen), Moutan Cortex (Dan Pi, 2 qian), Cyperi Rhizoma (Xiang Fu, 3 qian), Ophiopogonis Radix (Mai Dong, 3 qian), Armeniacae Semen (Xing Ren, 3 qian), Polygoni Multiflori Caulis (Pu Huang, 1 qian), Aurantii Fructus Immaturus (Zhi Ke, 1 qian), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian).
Song says: Hematemesis with headache indicates external pathogen injury; use Ou Jie, Ku Qin, Sheng Di, Bai Shao, and Ma Huang.
Add Dang Gui, Chuan Xiong, Xiang Fu, Dan Pi, Pu Huang, Xing Ren, Zhi Ke, Gan Cao, and Mai Dong, decoct and take.
If hematemesis is accompanied by thirst, a surging and rapid pulse, and dark red urine, it is due to fire-heat injuring the Yin aspect. Jiawei Sisheng Wan (Modified Four Living Pills) is suitable.
Herbs: Rehmanniae Radix (Sheng Di, 3 qian), Artemisiae Argyi Folium (Ai Ye, 1 qian), Platycladi Cacumen (Bai Ye, 3 qian), Nelumbinis Folium (He Ye, 3 qian), Moutan Cortex (Dan Pi, 3 qian), Scutellariae Radix (Ku Qin, 3 qian), Rheum Palmatum prepared with wine (Jiu Jun, 7 fen), Anemarrhenae Rhizoma (Zhi Mu, 3 qian), Trichosanthis Radix (Hua Fen, 3 qian), Achyranthis Bidentatae Radix (Niu Xi, 1 qian), Imperatae Rhizoma (Mao Gen, 3 qian), Equi Feces (Ma Tong, 1 liang soaked for juice).
Song says: Surging pulse, hematemesis, and unbearable thirst; use Zhi Mu, Sheng Di, Dan Pi, Ku Qin, and Da Huang.
Add Niu Xi, Ma Tong juice, Hua Fen, Mao Gen, He Ye, Ai Ye, and Bai Ye, decoct and take together.
If hematemesis occurs but the mouth feels neutral without thirst, the pulse is wiry, fine, and faint, and urination is clear, it is due to Yang deficiency and Yin-blood depletion. Bianhua Lizhong Tang (Modified Regulation of the Middle Decoction) is suitable.
Herbs: Codonopsis Radix (Dang Shen, 2 qian), Astragali Radix (Huang Qi, 2 qian), Zingiberis Rhizoma Preparatum (Hei Jiang, 8 fen), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian), Paeoniae Radix Alba (Bai Shao, 2 qian), Atractylodis Macrocephalae Rhizoma (Bai Zhu, 2 qian), Schisandrae Fructus (Wu Wei, 5 fen), Angelicae Sinensis Radix (Dang Gui, 3 qian), Aucklandiae Radix (Mu Xiang, 1 qian), Platycladi Cacumen (Ce Bai, 2 qian), Artemisiae Argyi Folium prepared with vinegar (Cu Ai, 1 qian), Equi Feces (Ma Tong, 1 liang soaked for juice).
Song says: Faint pulse, blood depletion, and clear urination; decoct Hei Jiang, Gan Cao, Dang Shen, Huang Qi, and Bai Shao together.
Add Bai Zhu, Wu Wei, Ma Tong juice, Dang Gui, Ce Bai, Ai Ye, and Mu Xiang to alleviate the condition.
If thirst occurs after hematemesis, the blood is black, and abdominal pain is present, it is due to blood stasis accumulating in the abdomen. Jiawei Siwu Tang (Modified Four Substances Decoction) is suitable.
Herbs: Rehmanniae Radix (Sheng Di, 3 qian), Angelicae Sinensis Radix (Dang Gui, 3 qian), Chuanxiong Rhizoma (Chuan Xiong, 1 qian), Persicae Semen (Tao Ren, ground, 3 qian), Paeoniae Radix Alba (Bai Shao, 3 qian), Rheum Palmatum (Da Huang, 1 qian), Moutan Cortex (Dan Pi, 3 qian), Cyperi Rhizoma (Xiang Fu, 3 qian), Aurantii Fructus Immaturus (Zhi Ke, 1 qian), Dalbergiae Odoriferae Lignum (Xiang, 1 qian).
Song says: Thirst arises shortly after bleeding stops; abdominal pain indicates stasis, treat with Dang Gui and Sheng Di.
Use Chuan Xiong, Zhi Ke, Xiang, Xiang Fu, Da Huang, Bai Shao, Tao Ren, and Dan Pi.
If severe nausea precedes hematemesis, it is due to blood flooding and harassing the Heart. Yujin Danpi Tang (Curcuma and Moutan Decoction) is suitable.
Herbs: Curcumae Radix (Yu Jin, 2 qian), Rehmanniae Radix (Sheng Di, 3 qian), Ophiopogonis Radix (Mai Dong, 3 qian), Achyranthis Bidentatae Radix (Niu Xi, 2 qian), Schisandrae Fructus (Wu Wei, 7 fen), Moutan Cortex (Dan Pi, 2 qian), Gardeniae Fructus stir-fried (Chao Zhi, 2 qian), Angelicae Sinensis Radix (Dang Gui, 2 qian), Paeoniae Radix Alba (Bai Shao, 2 qian), Polygonati Odorati Rhizoma (Yu Zhu, 2 qian), Ziziphi Spinosae Semen (Zao Ren, 2 qian), Anemarrhenae Rhizoma (Zhi Mu, 1 qian), Aucklandiae Radix (Mu Xiang, 2 qian), Cinnabaris (Zhu Sha, ground, taken with medicine, 8 fen).
Song says: Nausea before hematemesis; seek Mu Xiang, Zhi Mu, Wu Wei, Bai Shao, and Dang Gui.
Combine Zhu Sha, Niu Xi, Sheng Di, Mai Dong, Zao Ren, Yu Zhu, Dan Pi, Zhi, and Yu Jin.
(Note: The author did not adopt this method; fresh Vicia faba leaves can be crushed for juice, stewed warm with Chen Pi wine.)
If coughing precedes hematemesis, it is due to Lung dryness injuring the Yin vessels. Qingzao Hexue Tang (Clear Dryness and Harmonize Blood Decoction) is suitable.
Herbs: Rehmanniae Radix (Sheng Di, 3 qian), Ophiopogonis Radix (Mai Dong, 3 qian), Lilii Bulbus (Bai He, 2 qian), Schisandrae Fructus (Wu Wei, 5 fen), Angelicae Sinensis Radix (Dang Gui, 3 qian), Fritillariae Cirrhosae Bulbus (Bei Mu, 2 qian), Armeniacae Semen (Xing Ren, 3 qian), Dipsaci Radix (Xu Duan, 2 qian), Nelumbinis Plumulae Caulis (Ou Jie, 2 qian), Schizonepetae Spica (Jing Jie, 1 qian), Bambusae Caulis Preparatus (Zhu Ru, 2 qian), Polygoni Multiflori Caulis (Pu Huang, 1 qian), Carthami Flos (Hong Hua, 5 fen), Dalbergiae Odoriferae Lignum (Xiang, 1 qian).
Song says: Cough precedes blood arrival; prepare with Di, He, Gui, Dong, Xing, and Bei.
Combine Xu Duan, Jing Jie, Zhu Ru, Wu Wei, Hong Hua, Ou Jie, and Pu Huang.
(Note: Loquat leaf paste can be taken intermittently.)
If hematemesis precedes coughing, it is due to Yin and Yang failing to harmonize. Tiaoyin Heyang Tang (Harmonize Yin and Yang Decoction) is suitable.
Herbs: Angelicae Sinensis Radix (Dang Gui, 2 qian), Paeoniae Radix Alba (Bai Shao, 2 qian), Rehmanniae Radix (Sheng Di, 2 qian), Asini Corii Colla (E Jiao, 1 qian), Schisandrae Fructus (Wu Wei, 7 fen), Lilii Bulbus (Bai He, 2 qian), Fritillariae Cirrhosae Bulbus (Bei Mu, 2 qian), Armeniacae Semen (Xing Ren, 2 qian), Aquilariae Lignum Resinatum (Chen Xiang, 5 fen), Achyranthis Bidentatae Radix (Niu Xi, 1 qian), Cynanchi Atrati Radix (Bai Wei, 2 qian), Polygoni Multiflori Caulis (Pu Huang, 1 qian), Ostreae Concha (Mu Li, 2 qian), Dalbergiae Odoriferae Lignum (Xiang, 1 qian).
Song says: Hematemesis first, then cough follows; use E Jiao, Sheng Di, Bai Shao, and Dang Gui.
Combine Wu Wei, Xiang, Chen Xiang, Bei Mu, Xing Ren, Pu Huang, Mu Li, Niu Xi, and Bai Wei.
If after hematemesis the muscles are dry and scaly like fish scales, it is due to dried blood accumulating in the abdomen. Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is suitable.
Herbs: Rheum Palmatum (Da Huang, 1 qian), Persicae Semen (Tao Ren, 1 qian), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian), Blatta Orientalis (Meng Chong, stir-fried, 1 qian), Otiorhynchi Larva (Qi Lao, 1 qian), Asini Corii Colla (E Jiao, 1 qian), Angelicae Sinensis Radix (Dang Gui, 1 qian), Stir-fried Schizonepetae Spica (Chao Jing Jie, 1 qian), Hirudo (Shui Zhi, stir-fried, 2 pieces), Eupolyphaga Seu Steleophaga (Zhe Chong, stir-fried, 1 qian).
Song says: Dried blood makes muscles resemble fish scales; Shui Zhi, Zhe Chong, and Meng Chong are effective as if divine.
Da Huang, E Jiao, and Dang Gui act as assistants; add Jing Jie, Gan Cao, and Tao Ren.
Hematochezia where blood appears before stool belongs to Chang Feng or hemorrhoids. Chidou Jiawei San (Red Bean Modified Powder) is suitable.
Herbs: Angelicae Sinensis Radix (Dang Gui, 3 qian), Sanguisorbae Radix (Di Yu, 3 qian), Lonicerae Japonicae Flos (Yin Hua, 1 qian), Stephaniae Tetrandrae Radix (Fang Ji, 1 qian), Ophiopogonis Radix (Mai Dong, 3 qian), Arctii Fructus (Niu Bang Zi, 3 qian), Moutan Cortex (Dan Pi, 3 qian), Paeoniae Radix Alba (Bai Shao, 2 qian), Sophorae Flos (Huai Jiao, 3 qian), Palmae Fructus Carbonis (Zong Hui, 1 qian), Armeniacae Semen (Xing Ren, 3 qian), Phellodendri Cortex (Huang Bo, 2 qian), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian), Phaseoli Vulgaris Germin (Chi Dou Ya, 3 qian).
Song says: For hemorrhoidal bleeding, use Dang Gui and Di Yu; Chi Dou, Yin Hua, Fang Ji, Mai Dong, and Bai Shao are all included.
Niu Bang Zi, Zong Hui, Huai Jiao, Dan Pi, and Xing Ren are combined; Mai Dong, Huang Bo, and Gan Cao tip are essential.
Hematochezia where blood appears after stool is due to Liver and Spleen failing to control blood. Zhongjing Huangtu Tang (Yellow Earth Decoction by Zhang Zhongjing) is suitable.
Herbs: Atractylodis Macrocephalae Rhizoma (Bai Zhu, 3 qian), Aconiti Lateralis Radix Preparata (Fu Zi, 2 qian), Glycyrrhizae Radix et Rhizoma Praeparata (Zhi Cao, 2 qian), Rehmanniae Radix (Sheng Di, 3 qian), Scutellariae Radix (Huang Qin, 2 qian), Asini Corii Colla (E Jiao, 2 qian), Caudex Longanae (Zao Xin Tu, 3 qian).
Song says: Liver and Spleen fail to govern, blood deviates from vessels, flowing continuously after stool.
Bai Zhu, Fu Zi, Sheng Di, Huang Qin, E Jiao, and Gan Cao are decocted with Huang Tu for effective administration.
Whole-body sweating of blood, even staining clothes entirely red, is due to excessive fire causing blood extravasation. Jiawei Liu Huang Tang (Modified Six Yellow Decoction) is suitable.
Herbs: Angelicae Sinensis Radix (Dang Gui, 3 qian), Coptidis Rhizoma (Huang Lian, 2 qian), Scutellariae Radix (Huang Qin, 3 qian), Phellodendri Cortex (Huang Bo, 2 qian), Bombyx Batryticatus (Chan Tui, 1 qian), Rheum Palmatum prepared with wine (Jiu Jun, 1 qian), Rehmanniae Radix (Sheng Di, 3 qian), Astragali Radix (Huang Qi, 2 qian), Rehmanniae Radix Preparata (Shu Di, 3 qian), Paeoniae Radix Alba (Bai Shao, 3 qian), Bambusae Caulis Preparatus (Zhu Ru, 2 qian), Armeniacae Semen (Xing Ren, 3 qian), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian), Lycii Cortex (Di Gu Pi, 2 qian).
Song says: Whole-body bloody sweat stains clothes; combine Di, Huang Qin, Huang Lian, Bai Shao, and Dang Gui.
Di Gu Pi, Zhu Ru, Chan Tui, Xing Ren, Gan Cao, Sheng Jun, and Huang Bo make bloody sweat sparse.
Epistaxis and gingival bleeding are due to dryness-heat in the Stomach. Qingliang Ganlu Yin (Cooling Sweet Dew Drink) is suitable.
Herbs: Rehmanniae Radix (Sheng Di, 3 qian), Rehmanniae Radix Preparata (Shu Di, 3 qian), Ophiopogonis Radix (Mai Dong, 3 qian), Asparagi Radix (Tian Dong, 3 qian), Scutellariae Radix (Huang Qin, 3 qian), Aurantii Fructus Immaturus (Zhi Ke, 1 qian), Dendrobii Caulis (Shi Hu, 3 qian), Artemisiae Scopariae Herba (Yin Chen, 3 qian), Nelumbinis Plumulae Caulis (Ou Jie, 3 qian), Polygoni Multiflori Caulis (Pu Huang, 1 qian), Achyranthis Bidentatae Radix (Niu Xi, 2 qian), Glycyrrhizae Radix et Rhizoma (Gan Cao, 1 qian), Eriobotryae Folium (Pi Pa Ye, honey-fried, 2 qian).
Song says: Epistaxis requires cooling; use Huang Qin, Zhi Ke, Yin Chen, and two types of Di.
Combine Ou Jie, Shi Hu, Pi Pa Ye, Niu Xi, Tian Dong, Mai Dong, and Gan Cao to decoct into a drink.