诸病失血，脉必见芤。缓小可喜，数大可忧。
卫行脉外，荣行脉中。凡失血之病，脉中必空，故见芤象。若缓小不足，与病
相宜，是可喜也。脉数而大，邪盛正衰，且为火象，必烁真阴，诚为大可忧者。
瘀血内蓄，却宜牢大。沉小涩微，反成其害。
血蓄于内，瘀凝不行。瘀凝则脉大，不行则脉牢，亦因病呈象也。逐之使去，
巢穴一空，而致新不难矣。（宜桃仁承气汤或丹皮、红花之类。）设脉沉小涩微，是病有余而脉
反不足，病有物而脉若无物。虽云瘀血，亦不过着于经络。如仲景所云∶荣卫气伤，
内有干血之类。似非瘀蓄于一处者，故脉见如斯。补之有碍，逐之不能，是反成其害也。（宜大黄 虫丸。）
仲景桃核承气汤（见第二十）
仲景大黄 虫丸 结在内者，手足脉必相失，宜此方。然必兼大补剂琼玉膏之类服之。
大黄（十分。古以二钱半为一分。当是二两半，蒸） 黄芩（二两） 甘草（三两） 桃仁（一升）
杏仁（去皮尖一升） 地黄（十两） 芍药（四两） 干漆（一两） 虻虫（一升） 水蛭（百枚）
蛴螬（一升） 虫（半升）
上十二味，末之。炼蜜为丸，小豆大。酒饮服五丸。日三服。
遗精白浊，微涩而弱。火盛阴虚，芤濡洪数。
肾主藏精，欲后方为施泄。今或念动即出，或无欲自遗，此皆肾虚不能藏摄故
耳。（宜知柏八味丸、河间秘真丸、猪肚丸之类。）白浊者，小便色白而浊，亦为肾虚胞冷不能厘清
所致。（宜清心莲子饮、萆 厘清饮之类。）形属精液，证属脱亡，脉安得不微涩而弱也？设见
芤濡洪数之脉，芤濡固为阴虚，而洪数实因火盛。火盛则精遗，火盛则便浊，似与
肾之虚、胞之寒而不能藏、不能别者，大径庭矣。临诊可忽乎故？（宜六味丸、导赤散、六一散之类。）
In various diseases involving blood loss, the pulse must present as a Kou (Hollow) pulse. A slow and small pulse is auspicious, whereas a rapid and large pulse is ominous.
Wei Qi (Defensive Qi) circulates outside the vessels, while Ying Qi (Nutritive Qi) circulates within the vessels. In cases of blood loss, the vessels are necessarily empty, thus presenting the image of a Kou (Hollow) pulse. If the pulse is slow and small, indicating insufficiency, it corresponds appropriately with the disease condition, which is a cause for relief. However, if the pulse is rapid and large, it indicates that pathogenic factors are abundant while healthy qi is depleted; furthermore, this represents a Fire pattern, which will inevitably scorch the True Yin. This is indeed a matter of great concern.
When blood stasis accumulates internally, the pulse should be firm and large (Lao Da). Conversely, a deep, small, choppy, or faint pulse would instead prove detrimental.
Blood accumulating internally becomes stagnant and coagulated, ceasing to flow. Stagnation and coagulation lead to a larger pulse, while lack of flow leads to a firm pulse; these are manifestations arising from the disease itself. By employing methods to purge and remove the stasis, once the nest is emptied, generating new blood becomes not difficult. (Tao Ren Cheng Qi Tang [Peach Kernel Decoction to Order the Qi] or herbs such as Mu Dan Pi [Moutan Cortex] and Hong Hua [Carthamus Flos] are suitable.) If the pulse is deep, small, choppy, or faint, this indicates that the pathogen is excessive while the pulse appears deficient; there is physical pathology, yet the pulse seems devoid of substance. Although termed blood stasis, it may merely adhere to the meridians and collaterals. As Zhang Zhongjing stated: "Damage to Ying and Wei Qi, with dry blood inside." This does not seem to be stasis accumulated in one specific location, hence the pulse presents in this manner. Tonification would be obstructed, and purging would be ineffective, thereby causing harm. (Da Huang Zhe Chong Wan [Rhubarb and Beetle Pill] is suitable.)
Zhang Zhongjing's Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi) (see Section 20).
Zhang Zhongjing's Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill): For stasis knotted internally, where the pulses at the hand and foot are inconsistent (discrepant), this formula is suitable. However, it must be taken concurrently with major tonifying agents such as Qiong Yu Gao (Jade Elixir Paste).
Da Huang (Rhei Radix et Rhizoma, 10 fen. Anciently, 2 qian 5 liang equaled 1 fen; this likely refers to 2 liang 5 qian, steamed) Huang Qin (Scutellariae Radix, 2 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang) Tao Ren (Persicae Semen, 1 sheng) Xing Ren (Armeniacae Semen Amarum, peeled and removed of tips, 1 sheng) Di Huang (Rehmanniae Radix, 10 liang) Shao Yao (Paeoniae Radix Alba, 4 liang) Gan Qi (Dry Lacquer, 1 liang) Meng Chong (Blatta Orientalis, 1 sheng) Shui Zhi (Hirudo, 100 pieces) Qi Cao (Oryctolagi Cuniculi Larva, 1 sheng) Zhe Chong (Eupolyphaga Seu Steleophaga, half sheng).
The above twelve ingredients are powdered. Honey is refined to form pills, sized like adzuki beans. Take five pills with wine. Administer three times daily.
Spermatorrhea and white turbidity typically present with a micro-choppy and weak pulse. In cases of excess Fire and Yin deficiency, the pulse may appear Kou (Hollow), Ru (Flaccid), Hong (Surging), or Shu (Rapid).
The Kidney governs the storage of Jing (Essence), which is only discharged after sexual desire arises. Currently, some individuals ejaculate upon mere thought, or experience spontaneous emission without desire; all these result from Kidney deficiency failing to secure and retain. (Zhi Bai Ba Wei Wan [Anemarrhena, Phellodendron and Eight-Ingredient Pill], He Jian Mi Zhen Wan [Secret Essence Pill by Liu Wansu], and Zhu Du Wan [Pig Stomach Pill] are suitable.) White turbidity refers to urine that is white and cloudy, also caused by Kidney deficiency and Cold in the Bladder failing to separate the clear from the turbid. (Qing Xin Lian Zi Yin [Clear Heart Lotus Seed Decoction] and Bi Xie Fen Qing Yin [Dioscorea Hypoglauca Decoction to Separate the Clear] are suitable.) The form belongs to Jing (Essence), and the syndrome belongs to collapse and loss; how can the pulse not be micro-choppy and weak? If a Kou (Hollow), Ru (Flaccid), Hong (Surging), or Shu (Rapid) pulse appears, Kou and Ru certainly indicate Yin deficiency, but Hong and Shu are actually due to excess Fire. Excess Fire causes spermatorrhea, and excess Fire causes urinary turbidity. This seems diametrically opposed to the patterns of Kidney deficiency and Bladder cold, which fail to store and separate. Can one neglect this when diagnosing? (Liu Wei Wan [Six-Ingredient Pill], Dao Chi San [Guide Out Redness Powder], and Liu Yi San [Six-to-One Powder] are suitable.)