论三首，方三十首
论曰∶凡吐血有三种，有内衄，有肺疽，有伤胃。内衄者，出血如鼻衄，但不从鼻孔出
，是近心肺间津液出，还流入胃中，或如豆汁，或如 血凝停胃中，满闷便吐，或去数升乃
至一斗，得之于劳倦饮食过常所为也；肺疽者，或饮酒之后闷吐，血从吐出，或一合半升；
伤胃者，因饮食大饱之后，胃中冷则不能消化，便烦闷强呕，吐之物与气共上冲蹙伤裂胃口
，血色鲜赤，腹中绞痛，自汗出，其脉紧而数者，为难治也，吐之后体中但奄奄然心中不闷
者，辄自愈，假令烦躁，心中闷乱，纷纷欲吐，颠倒不安，医者又与黄土汤、阿胶散，益使
闷乱，卒至不救，如此闷者，当急吐之。
吐方
瓜蒂（半两） 杜蘅 人参（各一分）
上三味，捣筛为散。服一钱匕，水浆无在，得下而已，羸者小减之，吐去青黄或血二三
升，无苦。
主忧恚呕血，烦满少气，胸中痛方。
生地黄（二斤） 大枣（五十枚，擘） 阿胶（炙） 甘草（炙，各三两）
上四味， 咀。以水六升，煮取四升，分为四服，日三夜一。
主虚劳内伤，寒热频连，吐血方。
糖（三斤） 芍药 半夏（洗） 生姜（各三两，切）大枣（五十枚，擘） 生地黄（一
斤）
上六味， 咀。以水二斗，煮取七升，分七服，日三夜一。（《千金》有甘草、桂心，
无地黄）
治噫止唾血方
石膏（四两，碎） 生姜（切） 麻黄（去节） 五味子（各二两） 小麦（一升） 浓
朴（炙）
半夏（洗） 杏仁（去皮尖、双仁，各三两）
上八味， 咀。以水一斗煮麻黄，去上沫，纳诸药，煮取二升五合，分再服。
又方
伏龙肝（如鸡子大，两枚） 干姜 当归 桂心 芍药 白芷 阿胶（预渍之） 甘草
（炙
，各二两） 细辛（半两） 芎 （一两） 生地黄（八两） 吴茱萸（二升）
上一十二味， 咀。以清酒七升，水三升，合煮取三升半，去滓，纳胶煎取三升，分三
服，亦治衄血。（《千金》名黄土汤，主吐血）
Three discourses, thirty prescriptions.
Discourse: Generally speaking, hematemesis (vomiting blood) presents in three types: internal nasal bleeding (Nei Nu), lung abscess (Fei Ju), and stomach injury (Shang Wei). Internal nasal bleeding refers to bleeding similar to epistaxis (nosebleed), but not flowing from the nostrils; rather, it originates from fluids between the heart and lungs leaking out, returning and flowing into the stomach. It may resemble bean curd dregs or coagulated blood stagnating in the stomach, causing fullness and oppression leading to vomiting. The volume of blood loss can reach several sheng or even one dou, caused by overexertion, fatigue, and irregular diet. Lung abscess refers to cases where, after drinking alcohol, the patient feels chest oppression and vomits, expelling blood, with a volume of approximately one he or half a sheng. Stomach injury occurs when, after overeating, the coldness in the stomach prevents digestion, causing irritability and forced retching. The expelled material and qi rush upward together, compressing and tearing the gastric opening. The blood is bright red, accompanied by colicky abdominal pain and spontaneous sweating. If the pulse is tight and rapid, it is difficult to treat. However, if after vomiting the body remains weak but without mental oppression, it will likely heal spontaneously. Conversely, if there is restlessness, mental confusion, frequent urge to vomit, and extreme agitation, and the physician prescribes Huangtu Tang (Yellow Earth Decoction) or Ejiao San (Donkey-Hide Gelatin Powder), it will only exacerbate the confusion and oppression, potentially leading to sudden death. In such cases of induced oppression, urgent emesis (inducing vomiting) should be employed.
Prescription for Emesis
Genggen (Cucurbitae Trichosanthis Fructus, half liang) Tudeng (Aristolochiae debilis Radix) Renshen (Panacis Ginseng Radix et Rhizoma, each one fen)
Crush and sieve the above three ingredients to make a powder. Administer one qianbi dose. It can be taken regardless of whether there is water or liquid in the stomach; stop once vomiting occurs. For frail patients, reduce the dose slightly. Vomiting out two or three sheng of yellow-green fluid or blood is not harmful.
Prescription for Hematemesis Caused by Sorrow and Anger, Accompanied by Irritability, Fullness, Shortness of Breath, and Chest Pain
Shengdihuang (Rehmanniae Radix, two jin) Dazao (Jujubae Fructus, fifty pieces, split) Ejiao (Asini Corii Colla, processed) Gancao (Glycyrrhizae Radix et Rhizoma, processed, each three liang)
Cut the above four ingredients into small pieces. Add six sheng of water and decoct to obtain four sheng of liquid. Divide into four doses: take three times during the day and once at night.
Prescription for Hematemesis Due to Deficiency Consumption and Internal Injury, with Frequent Alternating Chills and Fever
Yitang (Maltose) Shaoyao (Paeoniae Radix) Banxia (Pinelliae Rhizoma, washed) Shengjiang (Zingiberis Rhizoma Recens, each three liang, sliced) Dazao (Jujubae Fructus, fifty pieces, split) Shengdihuang (Rehmanniae Radix, one jin)
Cut the above six ingredients into small pieces. Add two dou of water and decoct to obtain seven sheng of liquid. Divide into seven doses: take three times during the day and once at night. (Note: *Qianjin Yaofang* contains Gancao and Guixin, but lacks Shengdihuang.)
Prescription for Belching and Cessation of Spitting Blood
Shigao (Gypsum Fibrosum, four liang, crushed) Shengjiang (Zingiberis Rhizoma Recens, sliced) Mahuang (Ephedrae Herba, nodes removed) Wuweizi (Schisandrae Fructus, each two liang) Xiaomai (Tritici Fructus, one sheng) Houpo (Magnoliae Officinalis Cortex, processed) Banxia (Pinelliae Rhizoma, washed) Xingren (Armeniacae Semen Amarum, peeled, tips and twin kernels removed, each three liang)
Cut the above eight ingredients into small pieces. Add one dou of water, boil Mahuang first, remove the foam on the surface, then add the remaining herbs. Decoct to obtain two sheng and five he of liquid. Divide into two doses.
Another Prescription
Fulonggan (Daucoptis Caulis Carbonized, size of a chicken egg, two pieces) Ganjiang (Zingiberis Rhizoma) Danggui (Angelicae Sinensis Radix) Guixin (Cinnamomi Ramulus) Shaoyao (Paeoniae Radix) Baizhi (Angelicae Dahuricae Radix) Ejiao (Asini Corii Colla, pre-soaked) Gancao (Glycyrrhizae Radix et Rhizoma, processed, each two liang) Xixin (Asari Radix et Rhizoma, half liang) Xiongqiong (Ligusticum Chuanxiong Rhizoma, one liang) Shengdihuang (Rehmanniae Radix, eight liang) Wuzhuyu (Evodiae Fructus, two sheng)
Cut the above twelve ingredients into small pieces. Add seven sheng of clear wine and three sheng of water. Decoct together to obtain three sheng and half. Strain the residue, add the gelatin, and simmer until three sheng remain. Divide into three doses. This prescription also treats epistaxis. (In *Qianjin Yaofang*, this is named Huangtu Tang and primarily treats hematemesis.)