衄血之候鼻干燥，身热不渴苦头疼，失表分汗麻桂治，内热犀角泻心清。
[注]
衄血者，鼻中出血也，
其候鼻中干燥，身热不渴，苦头痛，是热伤阳络也，
有因伤寒失汗衄血者，乃热郁于荣，其身无汗，宜以麻黄汤汗之，
身有汗者，宜以桂枝汤解之，
设无表病，因内热而衄血者，宜以犀角地黄汤清之，
热盛者，四物三黄泻心汤泻之，
外俱用发灰散，或黑栀子末吹鼻，其衄自止
(麻黄汤) 麻黄 杏仁炒去皮尖 桂枝 甘草生 引用生姜水煎服。
(方歌)
伤寒失表荣郁热，身体无汗血妄行，须用麻黄汤调治，桂麻杏草引生姜。
(桂枝汤) 方见自汗。
(犀角地黄汤) 牡丹皮 白芍药 犀角 生地黄 水煎服。便硬者加川大黄。
(方歌)犀角地黄汤，治衄效非常，丹皮芍犀地，便秘加大黄。
(四物三黄泻心汤)
川芎 当归酒洗 生地黄 赤芍药 黄芩 黄连 川大黄酒洗 水煎服。
(方歌)
物四三黄泻心汤，热盛吐衄功最良，芎归生地赤芍药，黄芩黄连川大黄。
(发灰散) 取壮实人头发，阴阳瓦煆成灰，放在地上，去火性，研细末，
吹入鼻中，血衄自止
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失血门
吐血下咳因热逆，若兼咳嗽努劳伤，内热犀角地黄治，努伤承气四物尝，
劳伤有热鸡苏散，无热须用救肺良。
[注]
小儿吐血不咳嗽者，多因内热，致血妄行上逆也，宜以犀角地黄汤主之，
若因努劳吐血者，兼咳嗽，
先用桃仁承气汤以破逐之，次用加味四物汤和之，
又有劳伤吐血者，亦兼咳嗽，
痰中带血有热者，鸡苏散主之，无热者救肺散主之。
(犀角地黄汤) 方见本门衄血。
(桃仁承气汤) 桃仁去皮尖研 大黄 芒硝 甘草 桂枝
加当归 芍药 苏木 红花，水煎服。
(方歌)
努伤吐血先破逐，桃仁承气汤妙绝，桃仁黄硝草桂枝，加人归芍苏红捷。
(加味四物汤) 当归 芍药 川芎 生地黄 茅根 蒲黄 牡丹皮
栀子炒黑 甘草生 引用藕节酒水煎服。
(方歌)
劳伤吐血须活血，四物为主真妙诀，再加茅根与蒲黄，丹皮栀草引藕节。
(鸡苏散) 鸡苏薄荷叶 川贝母去心 麦门冬去心 桔梗 阿胶蛤粉炒
生地黄 甘草生 黄耆炙 白茅根 蒲黄炒 水煎服。
(方歌)
劳伤有热嗽痰血，鸡苏贝母麦门冬，桔梗阿胶生地草，黄耆茅根蒲黄同。
(加味救肺散) 麦冬去心 人参 黄耆炙 郁金 五味子 当归酒洗
白芍药酒炒 川贝母去心研 甘草炙 马兜铃 水煎服。
(方歌)
劳伤无热嗽痰血，加味救肺麦冬参，黄耆郁金主味子，归芍贝母草兜铃。
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失血门
Symptoms of nosebleed (Nuxue) include dryness in the nose, fever without thirst, and severe headache. If caused by failure to induce sweating for exterior syndrome, treat with Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) to induce sweating; if caused by internal heat, clear it with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction).
[Note]
Nosebleed refers to bleeding from the nasal cavity.
Its manifestations are dryness in the nose, fever without thirst, and severe headache, which indicate that heat has injured the Yang collaterals.
Some patients suffer nosebleed due to failure to sweat after contracting cold damage (Shanghan), where heat is constrained in the Ying (Nutrient) level. Since there is no sweating, Mahuang Tang should be used to induce sweating.
If sweating is already present, Guizhi Tang should be used to resolve the exterior.
Assuming there is no exterior syndrome but nosebleed is caused by internal heat, Xijiao Dihuang Tang should be used to clear the heat.
If the heat is excessive, Siwu Sanhuang Xiexin Tang (Four Substances and Three Yellows Xiexin Decoction) should be used to purge fire.
Externally, Fahui San (Hair Ash Powder) can be applied, or black Zhizi (Gardeniae Fructus) powder can be insufflated into the nose, and the bleeding will stop spontaneously.
(Mahuang Tang) Ingredients: Ephedrae Herba (Mahuang), Armeniacae Semen Amarum (Xingren) stir-fried and peeled, Cinnamomi Ramulus (Guizhi), Glycyrrhizae Radix et Rhizoma (Gancao) raw. Use fresh ginger and water for decoction.
(Verse)
Failure to treat exterior cold leads to heat constraint in the Nutrient level, body has no sweat, blood runs wild; must use Mahuang Tang for treatment, containing Cinnamon Twig, Ephedra, Apricot Seed, Licorice, guided by Ginger.
(Guizhi Tang) See the section on spontaneous sweating.
(Xijiao Dihuang Tang) Ingredients: Moutan Cortex (Danpi), Paeoniae Radix Alba (Baishao), Rhinoceros Cornu (Xijiao), Rehmanniae Radix (Dihuang). Decoct in water. If stool is hard, add Rhei Radix et Rhizoma (Dahuang).
(Verse) Xijiao Dihuang Tang, extremely effective for nosebleed, contains Moutan, Peony, Rhinoceros Horn, Rehmannia; add Rheum for constipation.
(Siwu Sanhuang Xiexin Tang)
Ingredients: Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui) washed with wine, Rehmanniae Radix (Dihuang), Paeoniae Radix Rubra (Chishaoyao), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Rhei Radix et Rhizoma (Dahuang) washed with wine. Decoct in water.
(Verse)
Siwu Sanhuang Xiexin Tang is best for heat-induced hematemesis and epistaxis, containing Ligusticum, Angelica, Rehmannia, Red Peony, Scutellaria, Coptis, and Rheum.
(Fahui San) Take hair from a healthy adult, calcine it in an unglazed pot until it turns to ash, place it on the ground to remove its "fire" nature, grind into fine powder,
insufflate into the nose, and nosebleed will stop spontaneously.
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Blood Loss Section
Hematemesis and coughing up blood (Ke Xue) are often due to rebellious heat. If accompanied by coughing and caused by straining or labor injury, treat internal heat with Xijiao Dihuang Tang, and treat straining/labor injury with Chengqi Tang combined with Siwu Tang.
For labor injury with heat, use Jisu San; for labor injury without heat, use Jiufei San.
[Note]
Children who vomit blood without coughing usually do so due to internal heat causing blood to run wild and rebel upwards; treat primarily with Xijiao Dihuang Tang.
If vomiting blood is caused by straining or labor injury, accompanied by coughing,
first use Taoren Chengqi Tang to break stasis and purge, then use Jiawei Siwu Tang to harmonize.
There are also cases of vomiting blood due to labor injury, accompanied by coughing;
for blood in sputum with heat, use Jisu San; for no heat, use Jiufei San.
(Xijiao Dihuang Tang) See the "Nosebleed" section of this chapter.
(Taoren Chengqi Tang) Ingredients: Persicae Semen (Taoren) peeled and pounded, Rhei Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnamomi Ramulus (Guizhi).
Add Angelicae Sinensis Radix (Danggui), Paeoniae Radix (Shaoyao), Calami Radix (Sumu), Carthami Flos (Honghua). Decoct in water.
(Verse)
For straining-induced hematemesis, first purge stasis; Taoren Chengqi Tang is excellent, containing Persicae Seed, Rheum, Mirabilite, Licorice, Cinnamon Twig, plus Angelica, Peony, Sumu, and Honghua for swift results.
(Jiawei Siwu Tang) Ingredients: Angelicae Sinensis Radix (Danggui), Paeoniae Radix (Shaoyao), Chuanxiong Rhizoma (Chuanxiong), Rehmanniae Radix (Dihuang), Imperatae Rhizoma (Maogen), Cyperi Rhizoma (Puhuang), Moutan Cortex (Danpi), Gardeniae Fructus (Zhizi) stir-fried black, Glycyrrhizae Radix et Rhizoma (Gancao) raw. Use Cyperus rhizome (Oujie), wine, and water for decoction.
(Verse)
Labor injury hematemesis requires invigorating blood; Siwu Tang is the key formula, adding Imperata, Cyperus, Moutan, Gardenia, Licorice, guided by Cyperus rhizome.
(Jisu San) Ingredients: Menthae Haplocalycis Herba (Jisu/Bohe), Fritillariae Thunbergii Bulbus (Chuanbeimu), Ophiopogonis Tuber (Maimendong), Platycodonis Radix (Jiegeng), Asini Corii Colla (Ejiao) stir-fried with donkey-hide gelatin powder, Rehmanniae Radix (Dihuang), Glycyrrhizae Radix et Rhizoma (Gancao) raw, Astragali Radix (Huangqi) roasted, Imperatae Rhizoma (Maogen), Cyperi Rhizoma (Puhuang) stir-fried. Decoct in water.
(Verse)
Labor injury with heat, coughing blood in sputum uses Jisu San with Fritillaria and Ophiopogon, Platycodon, Ejiao, Rehmannia, Licorice, combined with Astragalus, Imperata, and Cyperus.
(Jiawei Jiufei San) Ingredients: Ophiopogonis Tuber (Maidong) dehearted, Ginseng Radix (Renshen), Astragali Radix (Huangqi) roasted, Curcumae Radix (Yujin), Schisandrae Fructus (Wuweizi), Angelicae Sinensis Radix (Danggui) washed with wine, Paeoniae Radix Alba (Baishao) stir-fried with wine, Fritillariae Thunbergii Bulbus (Chuanbeimu) dehearted and ground, Glycyrrhizae Radix et Rhizoma (Gancao) roasted, Aristolochiae Fructus (Madouling). Decoct in water.
(Verse)
Labor injury without heat, coughing blood in sputum uses Jiawei Jiufei San with Ophiopogon and Ginseng, Astragalus, Curcuma, principal Schisandra, plus Angelica, Peony, Fritillaria, Licorice, and Aristolochia.
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Blood Loss Section