涩为血少，滑为血充。失血脉应微细，而反见浮大无力，即为虚芤。盖阴既亏，
阳无所根据，浮散于外，故见此象。凡失血证，脉虚小沉弱，安静身凉者生；实大急
数，躁动身热，喘咳气逆，不得卧者死。瘀血胁痛，肝脉弦紧，此为常，勿以必
死论。
吐血治法。凡血逆上行，宜降气，降气火自降。若徒以寒凉降火，往往伤脾作
泻。脾寒不能行血，血愈不归经，宜行血，血行归经自止。（归经非已离经之血，复能返于经
也，但未离经者得不脱，即为归耳。）若徒事止血，必有瘀蓄之患。宜补肝，不宜伐肝。肝火
动，由肝血之虚，滋阴则火自降。用寒凉伐肝，火被郁，则怒发而愈烈矣。凡吐血
属火者，饮童便立止。或捣侧柏叶汁，以童便二分，酒一分，和而温饮之，大能止
血。或白汤化阿胶二钱，发灰二钱，入童便、生藕汁、生地黄汁、刺蓟汁各一杯，
仍浓磨好墨汁，顿温服。或急用加味四生饮，生荷叶、生艾叶、生柏叶、生地黄各
等分，入降香，童便煎服。元气虚弱，即将童便浸前药，水丸，独参汤送下。或苏
子降气汤，加人参、阿胶各一钱，下养正丹。（并见气。气降则血自下矣。）凡上膈壅滞吐血，
脉有力，精神不倦，觉胸中满痛，或血是紫黑块者，用生地黄、赤芍、当归、丹皮、
荆芥、阿胶、滑石、大黄醋制、元明粉、桃仁泥之属，从大便夺之，此釜底抽薪法
也。（盖血从下出为顺，上出为逆，用大黄等引血下行，转逆为顺也。观仲景谓蓄血证，下血则愈。又谓∶无病忽
恶利血，为病进；若血上行后，忽恶利血，为邪欲愈，可见矣。）血下行后，用苡仁、百合、麦冬、地
骨皮，（鲜者更佳。）嗽渴加枇杷叶、五味子、桑白皮，有痰加贝母。（皆气薄味淡，肺经之本药也。）
因其衰而减之，于虚劳证尤宜。吐血在暑天，病患口渴、面垢、头晕、干呕，煎茅
花、灯心、麦门冬汤，仍入藕节汁、侧柏汁、茅根汁、生姜汁少许，生蜜亦少许，
调五苓散。（见伤湿。）血止，用生地黄、当归、牡丹皮、赤芍药、百草霜末煎服一二帖，
却用黄 六一汤调理。暑气通心，火毒刑肺，虽致吐衄，然大热伤气，其人必
脉虚气怯体倦息微，此惟生脉散、（见中暑。）人参汤之属为宜，不得滥用寒凉。若气不
甚虚者，宜《局方》犀角地黄汤，或枇杷叶散。（见中暑。）凡肝火盛者，必有烦热脉证，
宜芍药、生地、丹皮、栀子、泽泻、芩、连之属，降其火而血自消。若肝气逆者，
必有胸胁痛满等证，芍药、生地、青皮、枳壳、贝母、泽泻之属，行其气而血自清。
怒气伤肝者，唇青面青脉弦，当用柴胡清肝散，或鸡苏丸，煎四物汤吞下，并
用十四友丸，（见惊。）灯心、麦门冬汤吞下，盖其中有理肝之药。其有病虽因怒，察其
无胀无火，是逆气已散，肝火已平，无得再散再清。若脉虚神困，病伤及脾，治当
专理中气，宜景岳五阴煎，五福饮之类主之。勿谓始因怒气，而专意伐肝也。凡忧
思损伤心脾，以致吐血，证见气短形悴，或胸怀郁然，食饮无味，或饥不欲食，或
魂魄惊困而卧不安，是皆中气亏损，不能摄血所致，速宜救本，不宜治标，宜归脾
汤。饮酒伤胃吐血，宜葛花解酲汤（见伤饮食），加黄连、丹皮，或汤中加金钩子、干葛、
茅花。过啖炙爆辛热，上焦壅满痛，血出紫黑成块，桃仁承气汤导之。酒色过度，
饥饱吐血，效方∶枇杷叶、款冬花、北紫菀、杏仁、鹿茸、桑白皮、木通、大黄为
末，蜜丸噙化。又有饱食，胃冷不化，强吐之，使所食物与气冲裂胃口，吐鲜血，
宜理中汤（见中寒），加川芎、扁豆，或川芎、干葛。劳心吐血，用莲子心五十粒，糯米
五十粒，研末温酒调服，及天门冬汤。劳力太过，吐血不止，苏子降气汤（见气）
加人参、阿胶，用猪肝煮熟，蘸白芨末食之。打扑损伤吐血，先以藕节汁、侧柏汁、茅
根汁、韭汁、童便磨墨汁，化阿胶止之。却以芎、归、白芍、百合、荆芥穗、阿胶、
丹皮、紫金藤、大黄、滑石、红花煎汤，调番降香末、白芨末与服。或先用苏合香
丸，（见诸中）。却以黑神散，和小乌沉汤，童便调服。凡努力及跌打等伤吐血，宜芎归
饮，引血归经，有瘀则加大黄、桃仁、红花，或郁金、黄酒以行之。凡吐衄失血如
涌，多致血脱气亦脱，危在顷刻者，此际有形之血不能即生，无形之气所当急固，
急用人参一二两为细末，加飞罗面一钱许，或温水，或井花冷水，随其所好，调如
稀糊，徐徐服之。或浓煎独参汤徐服亦可。此正血脱益气，阳生阴长之理也。凡郁
证吐血，（六淫七情，皆能郁气成热，郁于经则衄，郁于腑则吐。）脉多枯涩，证恶风寒，误以为虚，
温补之，殆矣。观其面色多滞，喜作呕哕，口苦酸，即当散郁，加味逍遥散（见郁）主之，
后用六味（见虚损）滋阴。杨仁斋曰∶血遇热则流，故止血多用凉药。然有虚寒致血错行
者，当温中，使血归经，理中汤（见中寒）加木香，或甘草干姜汤，甚效。《医贯》云∶血
得寒而凝，不归经络而妄行者，其血必黑黯，面色必夭白，脉必微迟，身必清凉。
古人谓∶凡失血证，多以胃药收功。肾寒火虚，逼阳上升，载血而出，脉沉足冷，
舌必无胎，即有亦白薄而滑，虽渴不能饮冷，强饮亦不能多，少顷即吐出，面虽赤，
色必娇嫩，八味汤（见虚损）冷服。（此为内伤之证。又有外感寒邪，直中肾经，逼火上冲，致吐血者，须服白
通汤即愈。内伤渐致，外感暴来，分别在此。）此为雷龙之火，不可直折。若觉肾热，脉洪足温，
又为水干火炎，去桂附，纯用六味。（见虚损。）
热嗽血治法，宜金沸草散（见咳嗽）加阿胶一钱，痰盛加栝蒌仁、贝母。痨嗽有血，
宜补肺汤加阿胶、杏仁、桑白皮各一钱，吞养正丹（见气），或三炒丹，间进百花膏，或
七伤散、大阿胶丸。阴虚火动嗽血，滋阴保肺汤。痰带血丝出，童便、竹沥止之。
感冒小恙，不知解表，过服寒凉，肺经之血凝滞，咳嗽带痰而出，证恶寒而脉紧，
或寒束热于肺，久嗽出血，麻黄、桂枝、甘草、当归、杏仁、枳梗，（后证宜加清
凉之品。）得微汗愈。（血证最忌汗，惟此当汗耳。）
咯唾血治法。痨瘵咯血，七珍散加阿胶、当归各半钱，恶甜人更加百药煎半
钱，仍调钟乳粉为佳。一味钟乳粉，用糯米饮调，吐血、嗽血亦治。因饱屈身，伤
肺吐嗽血者，白芨枇杷丸，或白芨莲须散。治咯血，黄药子、汉防己各一两，为末，
每服一钱，水一盏，小麦二十粒同煎，食后温服。白芨一两，藕节半两，为末，每
一钱，汤调下。新绵灰半钱，酒调下，苡仁为末，煮熟猪胰切片，蘸药，食后腹微空时服。
鼻衄治法，乱发烧存性，细研，水服方寸匕，并吹鼻中。萱草根汁每一盏，入
生姜汁半盏，相和细呷。竹蛀屑，水调服。线扎中指中节，左鼻出扎左指，右出扎
右，两出两扎之。有头风自衄，头风才发则衄不止，宜芎附饮，间进一字散。下虚
上盛而衄，不宜过用寒剂，宜四物汤，加参、 、麦冬、五味，磨沉香下养正丹
（见气）、八味地黄丸。（见虚损。）伤湿而衄，肾着汤（见伤湿）加川芎，名除湿汤。伏暑而衄，茅
花汤调五苓散（见伤湿）。饮酒过多而衄，茅花汤加干葛，鸡距子，或理中汤（见中寒）去干
姜，加干葛、茅花。 而衄不止，苏合香丸（见诸中）一丸。或以小乌沉汤一钱，白汤调
下。或煎浓紫苏汤，独调小乌沉汤。或添入黑神散一钱，盐汤调下亦得。仍蓦然以
水其面，使惊，则血止。非特 衄，凡五窍出血皆治。衄后头晕，四物汤、
十全大补汤。（见虚损。）
溲血治法，先与生料五苓散（见伤湿）和四物汤。若服药不效，其人素病于色者，此
属虚证。宜五苓散和胶艾汤，吞鹿茸丸或八味地黄丸（见虚损），或鹿角胶丸。或辰砂妙
香散（见心痛）和五苓散，吞二项丸子。若小便自清，后有数点血者，五苓散加赤芍药一
钱。亦有如砂石而色红，却无石淋之痛，亦属虚证，宜五苓散和胶艾汤，或五苓散
和辰砂妙香散，吞鹿茸丸、八味丸、鹿角胶丸。灰发二钱，茅根、车前草煎汤调下。
夏枯草烧灰存性为末，米饮或凉水调下。
便血治法。发热烦躁，不欲近衣，大渴脉洪，以无目痛鼻干，知非白虎证，此
阴虚发躁，当以黄 一两，当归二钱煎服。风冷入客肠胃，下瘀血如豆汁，八珍汤
（见虚损）去生地、甘草，加桂，名胃风汤。暑毒入肠胃下血者，一味黄连煎汤饮。酒积
下血不止，粪后见，神曲一两半，白酒药二丸，为末，水调作饼，慢火炙黄为细末，
每服二钱，白汤调下。肠风腹痛肛肿，败毒散（见伤湿）加槐角、荆芥，或槐花汤、
枳壳散。脏毒腹略疼，肛肿凸，大便难通，先以拔毒疏利之剂，追出恶血脓水，
然后内托，并凉血祛风，虚兼参、术，助养胃气。下血久，面色痿黄，渐成虚惫，
宜用黄 四君子汤（见气），下断红丸。气虚脱血，补中益气汤（见气）。中蛊脏腑败坏，下血
如鸡肝如烂肉，其证唾水沉，心腹绞痛，马蔺根末，水服方寸匕，蛊随吐出。 毛
烧末，水服方寸匕，亦吐。苦瓠一枚，水二升煮取一升服，亦吐。
蓄血治法。仲景抵当丸难用，用韩氏生地黄汤。虚人难下者，以四物汤加穿山
甲煎服妙。亦有用花蕊石散，以童子小便煎服，或酒调下。
补虚∶熟地 归身 枸杞 萸肉 枣仁 苁蓉
润燥∶蜜 当归 阿胶 柏子仁 乳酪
凉血∶二冬 生地 芩 连 栀子 知母 黄柏 元参 花粉 丹皮 白芍 犀角 胆草 槐花
温血∶附子 肉桂 黑姜
止血∶棕灰 发灰 童便 茅花 乌梅 白芨 柏叶 藕节 地榆 蒲黄（炒黑） 百
草霜 椿白皮
行滞∶瞿麦 川芎 香附 乳香 没药 韭汁 生牛膝 滑石 蒲黄（生用） 玄胡索 益母草 五灵脂
破结∶大黄 芒硝 桃仁 红花 三棱 莪术 姜黄 归尾 花蕊石 苏木（多用）
举陷∶荆芥穗 升麻 川芎 柴胡 荷叶
有三药必用，二药必禁。服寒凉百不一生，则知母、黄柏宜禁。服童便百不一
死，则童便宜服。血虽阴类，运之者阳，荷叶仰盂象震，最能运血，则荷叶宜用。
降气莫善于降香，则降香宜用也。（旧说如此，勿泥。）
Rapid pulse indicates a deficiency of blood, while slippery pulse indicates abundant blood. After hemorrhage, the pulse should be faint and fine; if it instead appears floating, large, and forceless, it is known as Xu-Kou (Deficient and Hollow) pulse. This occurs because Yin fluids are depleted, leaving Yang Qi without a foundation, causing it to float and scatter outward, thus presenting this image. In all cases of hemorrhage, if the pulse is deficient, small, deep, and weak, and the patient is quiet with a normal body temperature, survival is likely; if the pulse is excess, large, rapid, and frequent, and the patient is restless, feverish, panting, coughing, experiencing rebellious Qi, and unable to lie flat, death is likely. For hypochondriac pain caused by blood stasis, a Liver pulse that is wiry and tight is normal and should not be judged as inevitably fatal.
Treatment methods for hematemesis (vomiting blood). Whenever blood rebels and flows upward, one should employ methods to descend Qi; when Qi descends, Fire naturally descends. If one merely uses cold-cooling herbs to subdue Fire, it often damages Spleen Yang, leading to diarrhea. When Spleen Cold fails to move blood, blood becomes even less able to return to its vessels; therefore, one should promote blood circulation, and once blood moves freely and returns to its vessels, bleeding will stop naturally. ("Returning to vessels" does not mean that blood which has already left the vessels can return to them, but rather that blood which has not yet left the vessels is prevented from escaping, which is called returning.) If one only focuses on stopping bleeding, there will inevitably be the hazard of blood stasis accumulation. Treatment should tonify the Liver, not attack it. Liver Fire flaring up is due to Liver Blood deficiency; nourishing Yin will naturally subdue the Fire. Using cold-cooling herbs to attack the Liver will cause Fire to be constrained internally, leading to anger and making the condition more severe. For hematemesis caused by Fire, drinking child's urine (Tongbian) stops it immediately. Alternatively, crush fresh leaves of Platycladi Cacumen (Ce Bai Ye) for juice, mix with two parts child's urine and one part wine, and drink warm; this greatly stops bleeding. Alternatively, dissolve two qian of Ejiao (Donkey-hide Gelatin) in white water, add two qian of hair ash (Fa Hui), one cup each of Tongbian, fresh lotus rhizome juice (Ou Jie Zhi), Rehmanniae Radix Fresh Juice (Sheng Di Huang Zhi), and Cirsii Japonici Herba Juice (Ci Ji Zhi), then grind good ink into thick liquid and take warm in one dose. Or urgently use Modified Si Sheng Yin (Four Raw Decoction), consisting of equal parts of fresh Nelumbinis Folium (Sheng He Ye), fresh Artemisiae Argyi Folium (Sheng Ai Ye), Platycladi Cacumen (Sheng Bai Ye), and Rehmanniae Radix (Sheng Di Huang), adding Xiang Xiang (Aquilariae Lignum Resinatum), decocted with Tongbian. If Yuan Qi is weak, soak the aforementioned herbs in Tongbian, make water pills, and swallow with Du Shen Tang (Single Ginseng Decoction). Or use Su Zi Jiang Qi Tang (Perilla Fruit Descending Qi Decoction), adding one qian each of Renshen (Ginseng) and Ejiao, taken with Yang Zheng Dan (Nourishing Right Pill). (See "Qi" chapter. When Qi descends, blood naturally goes down.) For hematemesis caused by congestion in the upper jiao, where the pulse is forceful, spirit is unweary, chest feels full and painful, or vomited blood consists of purple-black clots, use herbs such as Sheng Di Huang (Rehmanniae Radix), Chi Shao (Paeoniae Radix Rubra), Dang Gui (Angelicae Sinensis Radix), Mu Dan Pi (Moutan Cortex), Jing Jie (Schizonepetae Spica), Ejiao, Hua Shi (Talcum), Da Huang (Rhei Radix et Rhizoma) prepared with vinegar, Yuan Ming Fen (Mirabilite), and Tao Ren (Persicae Semen) paste, to purge via the large intestine. This is the method of "removing firewood from under the cauldron." (Because blood exiting downward is favorable, while exiting upward is unfavorable; using Da Huang etc. guides blood downward, turning unfavorable to favorable. As Zhang Zhongjing stated regarding Blood Accumulation syndrome, purging blood leads to cure. Also: sudden aversion to bloody stools without illness indicates disease progression; if after blood exits upward, sudden aversion to bloody stools indicates pathogen resolution, this is evident.) After blood moves downward, use Yi Yi Ren (Coicis Semen), Bai He (Lilii Bulbus), Mai Dong (Ophiopogonis Radix), and Di Gu Pi (Lycii Cortex), (fresh is better); for cough and thirst add Pi Pa Ye (Eriobotryae Folium), Wu Wei Zi (Schisandrae Fructus), Sang Bai Pi (Mori Cortex); for phlegm add Bei Mu (Fritillariae Bulbus). (These are all herbs with thin Qi and bland flavor, belonging to the Lung meridian.) Reduce dosage according to the decline of healthy Qi, especially suitable for consumptive diseases. In summer, for hematemesis with patient thirst, dirty complexion, dizziness, and dry retching, decoct Mao Hua (Saussurea Involucrata Inflorescence), Deng Xin Cao (Junci Medulla), and Mai Men Dong (Ophiopogonis Radix), adding small amounts of Ou Jie Zhi (Lotus Rhizome Node Juice), Ce Bai Zhi (Platycladi Cacumen Juice), Mao Gen Zhi (Imperatae Rhizoma Juice), Sheng Jiang Zhi (Zingiberis Recens Juice), and raw honey, mixed with Wu Ling San (Five-Ingredient Powder with Poria). (See "Dampness Injury" chapter.) After bleeding stops, decoct and take one or two doses of Sheng Di Huang, Dang Gui, Mu Dan Pi, Chi Shao Yao, and Bai Cao Shuang (Soot from burning grasses), then regulate with Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction). Summer heat connects to the Heart, Fire toxin punishes the Lung; although this causes hematemesis and epistaxis, great heat damages Qi, so the person must have a deficient pulse, timid Qi, fatigue, and faint respiration. Only Sheng Mai San (Generate Pulse Powder) (See "Heat Stroke" chapter) and Renshen Tang (Ginseng Decoction) are appropriate; do not abuse cold-cooling herbs. If Qi deficiency is not severe, Ju Fang Xi Jiao Di Huang Tang (Rhino Horn Rehmannia Decoction from Formulary of the Imperial Medical Bureau) or Pi Pa Ye San (Loquat Leaf Powder) (See "Heat Stroke" chapter) are suitable. For excessive Liver Fire, there must be vexation, heat, and corresponding pulses/symptoms; use Shao Yao (Paeoniae Radix), Sheng Di, Mu Dan Pi, Zhi Zi (Gardeniae Fructus), Ze Xie (Alismatis Rhizoma), Huang Qin (Scutellariae Radix), and Huang Lian (Coptidis Rhizoma) to lower Fire so blood dissipates naturally. For rebellious Liver Qi, there must be chest and hypochondriac pain/fullness; use Shao Yao, Sheng Di, Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Qiao (Aurantii Fructus), Bei Mu, Ze Xie to move Qi so blood clears naturally. For Liver injury due to anger, with blue lips, blue face, and wiry pulse, use Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder) or Ji Su Wan (Chicken Mint Pill), swallowed with Si Wu Tang (Four Substances Decoction), along with Shi Si You Wan (Fourteen Friends Pill) (See "Fright" chapter), swallowed with Deng Xin Cao and Mai Men Dong Tang. These contain herbs that regulate the Liver. If illness is due to anger but observation shows no distension or Fire, indicating rebellious Qi has dispersed and Liver Fire has calmed, do not disperse or clear again. If pulse is deficient and spirit is exhausted, illness has damaged the Spleen; treatment should focus solely on regulating Middle Qi, using Jing Yue Wu Yin Jian (Wu Yin Decoction) or Wu Fu Yin (Five Blessings Decoction) as main treatments. Do not assume that because it started with anger, one should exclusively attack the Liver. For hematemesis caused by worry and thought damaging Heart and Spleen, showing shortness of breath, emaciation, mental depression, loss of appetite, hunger without desire to eat, or frightened spirit with restless sleep, these are all due to Middle Qi deficiency failing to control blood. Quickly save the root, do not treat the branch; use Gui Pi Tang (Restore the Spleen Decoction). For hematemesis due to alcohol damaging the Stomach, use Ge Hua Jie Cheng Tang (Kud Flower Relieving Intoxication Decoction) (See "Food Injury" chapter), adding Huang Lian and Mu Dan Pi, or add Jin Gou Zi (Berberidis Fructus), Ge Gen (Puerariae Radix), and Mao Hua to the decoction. For excessive consumption of roasted/spicy/hot foods causing upper jiao congestion/pain and purple-black blood clots, use Tao Ren Cheng Qi Tang (Peach Kernel Draining Qi Decoction) to guide out. For hematemesis due to excess alcohol/sex and irregular eating, an effective formula is: Pi Pa Ye, Kuan Dong Hua (Farfarae Flos), Bei Zi Wan (Asteris Radix), Xing Ren (Armeniacae Semen Amarum), Lu Rong (Cervi Cornu Pantotrichum), Sang Bai Pi, Mu Tong (Akebiae Caulis), Da Huang, ground to powder, made into honey pills to be held in mouth. Another case: after full meal, stomach cold fails to digest, forced vomiting tears the stomach opening, causing bright red blood vomiting; use Li Zhong Tang (Regulate the Middle Decoction) (See "Cold Damage") adding Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Bian Dou (Phaseoli Semen), or Chuan Xiong and Ge Gen. For hematemesis due to mental overwork, use 50 Lotus Plumule (Lian Zi Xin) and 50 Glutinous Rice grains, ground to powder, taken with warm wine, and Tian Men Dong Tang (Asparagi Radix Decoction). For hematemesis due to physical overexertion, use Su Zi Jiang Qi Tang (See "Qi" chapter) adding Renshen and Ejiao, cooked liver dipped in Bai Ji (Bletillae Rhizoma) powder to eat. For hematemesis due to trauma/blows, first stop bleeding with Ou Jie Zhi, Ce Bai Zhi, Mao Gen Zhi, Jiu Zhi (Allii Tuberosi Juice), Tongbian, and ground ink dissolved with Ejiao. Then decoct Chuan Xiong, Dang Gui, Bai Shao, Bai He, Jing Jie Sui (Schizonepetae Spica), Ejiao, Mu Dan Pi, Zi Jin Teng (Uncariae Ramulus cum Uncis), Da Huang, Hua Shi, Hong Hua (Carthami Flos), decoct soup, mix with Fan Jiang Xiang (Aquilariae Lignum Resinatum) powder and Bai Ji powder to take. Or first use Su He Xiang Wan (Styrax Pill) (See "Various Collapses"), then use Hei Shen San (Black Divine Powder) combined with Xiao Wu Chen Tang (Minor Black Settling Qi Decoction), taken with Tongbian. For hematemesis due to straining or falls/blows, use Xiong Gui Yin (Chuanxiong and Angelica Drink) to guide blood back to vessels; if stasis exists, add Da Huang, Tao Ren, Hong Hua, or Yu Jin (Curcumae Radix) and Huang Jiu (Yellow Wine) to move blood. For massive hematemesis/epistaxis causing blood depletion and Qi collapse, critical in moments, at this time formed blood cannot be generated quickly, but formless Qi must be urgently secured. Urgently use 1-2 liang of Renshen ground to fine powder, add about one qian of refined wheat flour, or warm water, or well water, mix to thin paste according to preference, and take slowly. Or strong decoction of Du Shen Tang taken slowly is also acceptable. This follows the principle of benefiting Qi in blood depletion, and Yang generating Yin. For hematemesis due to constraint syndromes, (Six Evils and Seven Emotions can all constrain Qi to generate Heat; constrained in meridians causes epistaxis, constrained in fu organs causes vomiting.) pulse is often withered and rough, symptoms include aversion to wind/cold; misjudging as deficiency and using warming/tonifying herbs is dangerous. Observe dull complexion, tendency to retch, bitter/sour taste; disperse constraint using Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) (See "Constraint" chapter), followed by Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) (See "Consumption") to nourish Yin. Yang Renzhai said: Blood flows when heated, so stopping bleeding often uses cooling herbs. However, for blood disorder due to deficiency-cold, one should warm the middle to return blood to vessels; Li Zhong Tang (See "Cold Damage") adding Mu Xiang (Aucklandiae Radix), or Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) are very effective. "Yi Guan" states: Blood coagulates when cold; if it wanders不归经络 (does not return to meridians), the blood is dark/black, face is pale/withered, pulse is faint/slow, body is cool. Ancients said: All hemorrhage cases are often concluded with Stomach-regulating medicines. Kidney cold and deficient Fire forcing Yang upward, carrying blood out, presents with deep pulse, cold feet, tongue coating absent or white/thin/slippery; though thirsty, cannot drink cold, or drinks little and vomits; face may be red but color is delicate/tender; use Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) (See "Consumption") taken cold. (This is internal injury. External cold evil directly entering Kidney meridian, forcing fire upward causing hematemesis, requires Bai Tong Tang for cure. Internal injury develops gradually, external attack comes suddenly; distinction lies here.) This is Thunder-Dragon Fire, cannot be directly suppressed. If feeling Kidney heat, pulse is surging, feet warm, it is Water dry/Fire blazing; remove Gui (Cinnamomi Cortex) and Fu Zi (Aconiti Lateralis Radix Praeparata), use pure Liu Wei Di Huang Wan (See "Consumption").
Treatment methods for hot cough with blood: Use Jin Fei Cao San (Boiling Grass Powder) (See "Cough" chapter) adding one qian Ejiao; for heavy phlegm add Gua Lou Ren (Trichosanthis Semen) and Bei Mu. For consumption cough with blood, use Bu Fei Tang (Tonify Lung Decoction) adding one qian each of Ejiao, Xing Ren, Sang Bai Pi, swallowing Yang Zheng Dan (See "Qi") or San Chao Dan (Three-Fried Pill), alternatively offering Bai Hua Gao (Hundred Flowers Paste) or Qi Shang San (Seven Injuries Powder), Da Ejiao Wan (Large Donkey-hide Gelatin Pill). For Yin deficiency with Fire moving causing cough-blood, use Zi Yin Bao Fei Tang (Nourish Yin Protect Lung Decoction). For phlegm with blood streaks, stop with Tongbian and Zhu Li (Bambusa Sap). For minor colds, if surface release is unknown and cold-cooling herbs are overdosed, Lung meridian blood stagnates, coughing with phlegm, symptoms of aversion to cold and tight pulse, or cold binding heat in Lung, chronic cough bleeding; use Ma Huang (Ephedrae Herba), Gui Zhi (Cinnamomi Ramulus), Gan Cao (Glycyrrhizae Radix), Dang Gui, Xing Ren, Zhi Geng (Platycodonis Radix / Bupleuri Radix - context implies Zhi Ke/Geng Mi usually, here likely Zhi Ke or similar), (for later stages add cooling products), achieve slight sweating to cure. (Blood syndromes most fear sweating, only this case warrants sweating.)
Treatment methods for spitting blood. For tuberculosis spitting blood, use Qi Zhen San (Seven Treasures Powder) adding half qian each of Ejiao and Dang Gui; for those who dislike sweet taste, add half qian Bai Yao Jian (Myrobalan Pill), best mixed with Zhong Ru Fen (Milky Stone Powder). Single Zhong Ru Fen mixed with glutinous rice drink treats hematemesis and cough-blood. For lung injury from bending after full meal causing cough-blood, use Bai Ji Pi Pa Wan (Bletilla Loquat Pill) or Bai Ji Lian Xu San (Bletilla Lotus Stamen Powder). For treating spitting blood, Huang Yao Zi (Dioscoreae Hypoglaucae Rhizoma) and Han Fang Ji (Stephaniae Tetrandrae Radix) one liang each, ground to powder, take one qian per dose, decoct with one cup water and twenty wheat grains, take warm after meals. One liang Bai Ji, half liang Ou Jie, ground to powder, take one qian mixed with water. Half qian Xin Mian Hui (New Cotton Ash), taken with wine; Yi Ren powder, cooked pig pancreas sliced, dip medicine, take when abdomen slightly empty after meal.
Treatment methods for epistaxis. Burn chaotic hair until charred, grind fine, take with water using Fang Cun Bi measure, and blow into nose. One cup Xuan Cao Gen (Daylily Root) juice mixed with half cup Sheng Jiang Zhi, sip slowly. Bamboo worm debris, taken with water. Tie middle finger joint; left nose bleed tie left finger, right tie right, both tie both. Head wind spontaneous epistaxis: when head wind starts, epistaxis does not stop; use Xiong Fu Yin (Chuanxiong and Aconite Drink), alternatively advance Yi Zi San (One Character Powder). Lower deficiency Upper excess epistaxis: do not overuse cold agents; use Si Wu Tang adding Renshen, [Missing Character], Mai Dong, Wu Wei Zi, grind Chen Xiang (Aquilariae Lignum) to swallow Yang Zheng Dan (See "Qi"), Ba Wei Di Huang Wan (See "Consumption"). Dampness injury epistaxis: Shen Zhuo Tang (Kidney Fixation Decoction) (See "Dampness Injury") adding Chuan Xiong, named Chu Shi Tang (Remove Dampness Decoction). Hidden summer heat epistaxis: Mao Hua Tang regulates Wu Ling San (See "Dampness Injury"). Excessive alcohol epistaxis: Mao Hua Tang adding Ge Gen, Ji Ju Zi (Berberidis Fructus), or Li Zhong Tang (See "Cold Damage") removing Gan Jiang, adding Ge Gen and Mao Hua. [Missing Character] epistaxis not stopping: Su He Xiang Wan (See "Various Collapses") one pill. Or Xiao Wu Chen Tang one qian, taken with white water. Or decoct strong Zi Su Tang, separately mix Xiao Wu Chen Tang. Or add one qian Hei Shen San, taken with salt water. Still, suddenly splash water on face to startle, then bleeding stops. Not only [Missing Character] epistaxis, but all five orifices bleeding are treated. Post-epistaxis dizziness: Si Wu Tang, Shi Quan Da Bu Tang (See "Consumption").
Treatment methods for hematuria. First give Sheng Liao Wu Ling San (Unprocessed Five-Ingredient Powder) (See "Dampness Injury") combined with Si Wu Tang. If ineffective, and patient has history of sexual excess, this is deficiency syndrome. Use Wu Ling San combined with Jiao Ai Tang, swallow Lu Rong Wan (Deer Antler Pill) or Ba Wei Di Huang Wan (See "Consumption"), or Lu Jiao Jiao Wan (Deer Antler Gelatin Pill). Or Chen Sha Miao Xiang San (Cinnabar Wondrous Incense Powder) (See "Heart Pain") combined with Wu Ling San, swallow above two pills. If urine is clear but few drops of blood follow, Wu Ling San adds one qian Chi Shao Yao. Also red like gravel but without stone strangury pain, belongs to deficiency; use Wu Ling San combined with Jiao Ai Tang, or Wu Ling San combined with Chen Sha Miao Xiang San, swallow Lu Rong Wan, Ba Wei Wan, Lu Jiao Jiao Wan. Two qian Fa Hui (Hair Ash), decoct Mao Gen (Imperatae Rhizoma) and Che Qian Cao (Plantaginis Herba) to mix. Xia Ku Cao (Prunellae Spica) burned to ash, powder, taken with rice drink or cool water.
Treatment methods for hematochezia. Fever, restlessness, aversion to clothes, great thirst, surging pulse; without eye pain/nose dryness, know it is not Bai Hu Tang syndrome; this is Yin deficiency with agitation, use one liang Huang Qi (Astragali Radix), two qian Dang Gui decocted and taken. Wind-cold invading intestines/stomach, passing dark blood like bean curd dregs; use Ba Zhen Tang (See "Consumption") removing Sheng Di and Gan Cao, adding Gui (Cinnamon), named Wei Feng Tang (Stomach Wind Decoction). Summer toxicity invading intestines/stomach causing bloody stool: single Huang Lian decocted and drunk. Alcohol accumulation causing persistent bloody stool, visible after defecation: one and half liang Shen Qu (Massa Medicata Fermentata), two pills Bai Jiu Yao (White Wine Yeast), ground to powder, mixed with water into cakes, slow-fire roasted yellow, ground to powder, take two qian with white water. Intestinal wind abdominal pain anal swelling: Bai Du San (See "Dampness Injury") adding Huai Jiao (Sophorae Tonkinensis Fructus), Jing Jie, or Huai Hua Tang (Sophora Flower Decoction), Zhi Qiao San (Aurantium Powder). Visceral toxin slight abdominal pain, anal swelling/protrusion, difficult defecation: first use detoxifying and purgative agents to expel bad blood/pus/water, then interior support, plus cooling blood and dispelling wind; deficiency add Renshen, Bai Zhu, assist Stomach Qi. Chronic bloody stool, sallow complexion, gradual exhaustion: use Huang Qi Si Jun Zi Tang (See "Qi"), swallow Duan Hong Wan (Stop Red Pill). Qi deficiency blood collapse: Bu Zhong Yi Qi Tang (See "Qi"). Poisonous insect/internal organ damage, bloody stool like chicken liver/rotten meat, symptoms: saliva sinks, heart/abdomen colic; Ma Lin Gen (Iris Tectori Radix) powder, take one Fang Cun Bi with water, poison expelled with vomit. [Missing Character] hair burned to powder, take one Fang Cun Bi with water, also expels. One Ku Hu (Bitter Bottle), two sheng water boiled to one sheng, taken, also expels.
Treatment methods for Blood Accumulation. Zhongjing's Di Dang Wan is difficult to use; use Han Shi Sheng Di Huang Tang (Han's Rehmannia Decoction). For deficient persons difficult to purge, Si Wu Tang adding Chuan Shan Jia (Manis Squama) decocted is excellent. Some use Hua Rui Shi San (Flower Coral Stone Powder), decocted with Tongbian or taken with wine.
Tonify Deficiency: Shu Di Huang (Prepared Rehmanniae Radix), Dang Gui Shen (Ginseng-like part of Angelica), Gou Qi (Lycii Fructus), Yu Rou (Corni Fructus), Zao Ren (Ziziphi Spinosae Semen), Cong Rong (Cynomorphi Herba).
Moisten Dryness: Honey, Dang Gui, Ejiao, Bai Zi Ren (Platycladi Semen), Milk/Cheese.
Cool Blood: Er Dong (Tian Dong/Mai Dong), Sheng Di, Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Zhi Zi, Zhi Mu, Huang Bo (Phellodendri Cortex), Yuan Shen (Scrophulariae Radix), Hua Fen (Trichosanthis Radix), Dan Pi, Bai Shao, Xi Jiao (Rhinocerotis Cornu), Dan Cao (Gentianae Radix), Huai Hua.
Warm Blood: Fu Zi (Prepared Aconiti Lateralis Radix), Rou Gui (Cinnamomi Cortex), Hei Jiang (Charred Ginger).
Stop Bleeding: Zong Hui (Livistona Fibre Ash), Fa Hui, Tongbian, Mao Hua, Wu Mei (Mume Fructus), Bai Ji, Bai Ye (Platycladi Cacumen), Ou Jie (Lotus Rhizome Node), Di Yu (Sanguisorbae Radix), Pu Huang (Typhae Pollen) (stir-fried black), Bai Cao Shuang, Chun Bai Pi (Toosendan Cortex).
Move Stagnation: Qu Mai (Polygoni Avicularis Herba), Chuan Xiong, Xiang Fu (Cyperi Rhizoma), Ru Xiang (Boswelliae Resina), Mo Yao (Myrrhae Resina), Jiu Zhi, Sheng Niu Xi (Achyranthis Bidentatae Radix), Hua Shi, Pu Huang (raw), Yan Hu Suo (Corydalis Rhizoma), Yi Mu Cao (Leonuri Herba), Wu Ling Zhi (Trogopterori Faeces).
Break Knots: Da Huang, Mang Xiao (Mirabilite), Tao Ren, Hong Hua, San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Jiang Huang (Curcumae Longae Rhizoma), Gui Wei (Angelicae Sinensis Radix Tail), Hua Rui Shi, Su Mu (Sappan Lignum) (use heavily).
Lift Collapse: Jing Jie Sui, Sheng Ma (Cimicifugae Rhizoma), Chuan Xiong, Chai Hu (Bupleuri Radix), He Ye (Nelumbinis Folium).
There are three herbs essential to use, two essential to forbid. Taking cold-cooling herbs results in one survivor in a hundred; thus Zhi Mu and Huang Bo should be forbidden. Taking Tongbian results in one death in a hundred; thus Tongbian should be used. Blood is Yin category, but moved by Yang; He Ye (Lotus Leaf) faces up like Zhen trigram, best at moving blood, thus He Ye should be used. Descending Qi nothing is better than Jiang Xiang (Aquilariae Lignum Resinatum), thus Jiang Xiang should be used. (Old theory says so, do not stick rigidly.)