柏叶 干姜各三两 艾三把
右三味，以水五升，取马通汁一升合煮，取一升，分温再服。
【集解】
程林曰：『神农经』云：柏叶主吐血，干姜止唾血，艾叶止吐血。马通者，白马尿也
，凡尿必达洞肠乃出，故曰通，亦微温止吐血。四味皆辛温行阳之品，使血归经，遵
行隧道，而血自止，故吐血不止，以柏叶汤主之也。
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心气不足，吐血、衄血，泻心汤主之。
【按】
心气「不足」二字，当是「有余」二字，若是不足，如何用此方治之，必是传写之□
。
【注】
心气有余，热盛也，热盛而伤阳络，迫血妄行，为吐、为衄。故以大黄、黄连、黄芩
大苦大寒直泻三焦之热，热去而吐衄自止矣。
大黄二两 黄连 黄芩各一两
右三味，以水三升，煮取一升，顿服之。
@@@
病人胸满、唇痿、舌青、口燥，但欲漱水，不欲咽，无寒热，脉微大来迟，腹不满，
其人言我满，为有瘀血。
【注】
表实无汗，胸满而喘者，风寒之胸满也；里实便涩，胸满烦热者，热壅之胸满也；面
目浮肿，胸满喘不得卧者，停饮之胸满也；呼吸不快，胸满太息而稍宽者，气滞之胸
满也。今病人无寒热他病，惟胸满、唇痿、舌青、口燥、漱水不欲咽，乃瘀血之胸满
也。唇、舌、血华之处也，血病不荣，故痿瘁色变也。热在血分，故口燥漱水不欲咽
也。脉微大来迟，阴凝之诊，则当腹满，今腹不满，询之其人，言我满在胸不在腹也
，与上如是之证推之，为有瘀血也。
@@@
病者如热状，烦满，口干燥而渴，其脉反无热，此为阴伏，是瘀血也，当下之。
【注】
此承上文互详证脉，以明其治也。如热状，即所谓心烦胸满，口干燥渴之热证也。其
人当得数大之阳脉，今反见沉伏之阴脉，是为热伏于阴，乃瘀血也。瘀血者当下之，
宜桃核承气、抵当汤、丸之类也。
【集注】
李□曰：血瘀内无实热，故外证但如热状，而其脉不数疾，反无热也。烦满者，血瘀
经气不舒；燥渴者。血瘀津液不布。血属阴，瘀则脉伏于内，故为阴伏。当下之，以
去瘀生新也。
@@@
下血，先便后血，此远血也，黄土汤主之。下血，先血后便，此近血也，赤小豆当归
散主之。
【注】
先便后血，此远血也，谓血在胃也，即古之所谓结阴，今之所谓便血也。先血后便，
此近血也，谓血在肠也，即古之所谓肠澼为痔下血，今之所谓藏毒、肠风下血也。一
用黄土汤以治结阴之血，从温也：一用赤小豆当归散以治藏毒之血，从清也。
【集注】
赵良曰：肠胃阳明经也，以下血言，胃居大肠之上，若聚于胃，必先便后血，去肛门
远，故曰远血。若聚大肠，去肛门近，故曰近血。故治远血黄土汤主之，治近血赤小
豆当归散主之。
Cacumen Platycladi (Baiye) and dried ginger (Ganjiang), each 3 liang; mugwort leaves (Aiye), 3 handfuls.
The above three herbs are decocted with 5 sheng of water, adding 1 sheng of horse manure juice (Matong zhi). The mixture is boiled until 1 sheng remains. It is divided into two doses and taken warm.
[Ji Jie - Collected Explanations]
Cheng Lin states: The "Shennong Classic" records that Cacumen Platycladi (Baiye) treats hematemesis, dried ginger (Ganjiang) stops spitting blood, and mugwort leaves (Aiye) stop hematemesis. Matong refers to the urine of a white horse. Since urine must pass through the intestines to be excreted, it is called "Tong" (unobstructed/passing through); it also has a slightly warm nature to stop hematemesis. These four ingredients are all acrid-warm yang-moving substances, which cause blood to return to the meridians and follow the normal channels, thereby stopping bleeding spontaneously. Therefore, for persistent hematemesis, Cacumen Platcladi Decoction (Baiye Tang) is used as the primary treatment.
@@@
When Heart Qi is insufficient [Note: Text suggests this should be "excess"], accompanied by hematemesis or epistaxis, Heart-Draining Decoction (Xixin Tang) is indicated.
[An Yu - Commentary]
The phrase "Heart Qi insufficient" should likely be "Heart Qi excess". If it were truly insufficient, how could this formula be used? This is certainly an error or omission in transcription.
[Zhu - Annotation]
Heart Qi excess indicates heat hyperactivity. Heat hyperactivity damages the Yang collaterals, forcing blood to move recklessly, resulting in hematemesis and epistaxis. Therefore, Rhizoma et Radix Rhei (Dahuang), Rhizoma Coptidis (Huanglian), and Radix Scutellariae (Huangqin)—all bitter-cold herbs—are used to directly drain the heat of the Triple Burner. Once the heat is eliminated, hematemesis and epistaxis cease naturally.
Rhizoma et Radix Rhei (Dahuang), 2 liang; Rhizoma Coptidis (Huanglian) and Radix Scutellariae (Huangqin), each 1 liang.
The above three herbs are decocted with 3 sheng of water until 1 sheng remains. Take in one dose.
@@@
The patient presents with chest fullness, withered lips, cyanotic tongue, and dry mouth. They desire to rinse their mouth with water but do not wish to swallow. There is no aversion to cold or fever. The pulse is slightly large and slow in onset. The abdomen is not distended, yet the patient complains of fullness. This indicates the presence of Blood Stasis.
[Zhu - Annotation]
Exterior excess with no sweating, chest fullness, and wheezing constitutes chest fullness due to Wind-Cold. Interior excess with constipation, chest fullness, and irritability constitutes chest fullness due to Heat obstruction. Facial and ocular edema, chest fullness, wheezing, and inability to lie flat constitute chest fullness due to Fluid Retention. Uncomfortable breathing, chest fullness relieved slightly by sighing constitutes chest fullness due to Qi Stagnation. Currently, the patient lacks exterior symptoms like aversion to cold or fever, presenting only with chest fullness, withered lips, cyanotic tongue, dry mouth, and the desire to rinse without swallowing. This is chest fullness due to Blood Stasis. The lips and tongue are where the essence of Blood manifests. When Blood disease fails to nourish, withering, deterioration, and color changes occur. Heat in the Blood level causes dry mouth and the desire to rinse without swallowing. A pulse that is slightly large and slow indicates Yin coagulation; typically, abdominal distension would be expected. However, the abdomen is not distended. Upon inquiry, the patient states the fullness is in the chest, not the abdomen. Inferring from these symptoms, there is Blood Stasis.
@@@
The patient exhibits symptoms resembling heat, such as irritability and fullness, along with dry mouth and thirst. However, the pulse does not reflect heat. This indicates Heat concealed within Yin, which is Blood Stasis. It should be treated with purgation.
[Zhu - Annotation]
This follows up on the previous text to detail the signs and pulses to clarify the treatment. "Resembling heat" refers to the heat syndrome described earlier: heart vexation, chest fullness, dry mouth, and thirst. Such a patient should present with rapid and large Yang pulses. Instead, a deep and concealed Yin pulse is observed. This signifies Heat concealed within Yin, indicating Blood Stasis. Blood Stasis requires purgation. Suitable formulas include Peach Kernel Decoction to Overcome the Accumulation (Taohé Chengqi Tang), Dangdang Decoction (Didang Tang), or Didang Pills.
[Ji Zhu - Collected Annotations]
Li [Name obscured] states: Internal Blood Stasis without excess heat results in external symptoms merely resembling heat, while the pulse is not rapid and the body feels cool. Irritability and fullness arise because Blood Stasis obstructs the smooth flow of Jing Qi. Dryness and thirst occur because Blood Stasis prevents the distribution of Body Fluids. Blood belongs to Yin; when stagnant, the pulse is concealed internally, hence termed "Yin Concealment." Purgation is required to eliminate stasis and generate new blood.
@@@
For lower GI bleeding, if stool precedes blood, it is called "Remote Bleeding" (Yuan Xue), treated primarily with Yellow Earth Decoction (Huangtu Tang). If blood precedes stool, it is called "Near Bleeding" (Jin Xue), treated primarily with Adzuki Bean and Angelica Decoction (Chixiaodou Danggui San).
[Zhu - Annotation]
Stool preceding blood is Remote Bleeding, implying the blood originates from the Stomach. This corresponds to the ancient term "Jie Yin" and the modern term "hematochezia/melena." Blood preceding stool is Near Bleeding, implying the blood originates from the Intestines. This corresponds to the ancient term "Chang Pi" (intestinal discharge/hemorrhoids) and the modern terms "Zang Du" (internal toxin) or "Chang Feng" (intestinal wind) bleeding. One uses Huangtu Tang to treat Jie Yin bleeding, employing a warming approach. The other uses Chixiaodou Danggui San to treat Zang Du bleeding, employing a clearing approach.
[Ji Zhu - Collected Annotations]
Zhao Liang states: The Large Intestine and Stomach belong to the Yangming Meridians. Regarding lower bleeding, since the Stomach is located above the Large Intestine, if blood accumulates in the Stomach, stool will necessarily precede blood. Because it is far from the anus, it is called Remote Bleeding. If blood accumulates in the Large Intestine, it is close to the anus, so it is called Near Bleeding. Therefore, Huangtu Tang is used for Remote Bleeding, and Chixiaodou Danggui San is used for Near Bleeding.