脉
诸证失血，皆见芤脉，随其上下，以验所出。大凡失血，脉宜沉细，设见浮大，后必难治。
证
夫失血之证，非止一端。有吐血，有咳血，有唾血，有咯血，有衄血，有溺血。虽有名色之异，大概俱
是热证，但有新旧虚实之不同耳，或妄言寒者，误也。丹溪曰∶血从上窍出，皆是阳盛阴
虚，有升无降，血随气上，越出上窍。法当补阴抑阳气，气降则血归经。
吐血者，吐出全血是也。因血溢妄行，流入胃脘，令人吐血。有因饮食过饱，负重伤胃而吐血者；有
因思虑伤心，及积热而吐血者；有伤心肺而吐血者；有因思伤脾而吐血者；有因肺生痈疽而吐
血者；有从高坠下，伤损五内而吐血者；有伤寒不解，邪热在经，随气上涌而吐血者。
吐血者，或因四气伤于外，七情动于内；或饮食房劳，坠闪伤损，致荣血流聚膈间，满
则吐嗌，世谓妄行；或吐瘀血，此名内伤。
治
有先吐血后见痰嗽者，是阴虚火动，痰不下降，四物汤为主，加清痰降火药。有先见痰嗽，后吐血者，
是积热，降痰火为急。
有暴吐紫血成块者，是热伤血结于中，吐出为好，用四物汤加清热药调之。吐血亦有因怒而得者。经曰∶
怒则气逆，甚则呕血。怒则暴甚故也。吐血不止，用干姜炮，为末，童便调服，此从治之法也。
一、咳血者，嗽出痰内有血者是也，因热壅于肺而成。久嗽损
肺，亦能嗽血，壅于肺者易治，不过凉之而已；损于肺者难治，以
其不足也。热嗽有血者，宜金沸草加阿胶；劳嗽有血者，补肺汤加阿胶、白芨；嗽血损肺，宜薏苡仁炒为末，
蘸熟猪肺食之；如热嗽咽痛，痰带血丝，或痰中多血而色鲜者，并宜服金沸草散。如服
凉剂不愈，此非热症，宜杏子汤主之。
一、唾血者，鲜血随唾而出者是也。此出于肾，亦有瘀血内损，
肺气壅遏，不得下降，用天麦冬、知母、桔梗、黄柏、熟地黄、远志，或加干姜。
一、咯血者，不嗽而咯出血疙瘩者是也。用姜汁、童便、青黛
入血药中用之，或入四物汤、地黄膏、牛膝膏之类。
一、衄血者，鼻中出血也。此出于肺，以犀角、升麻、栀子、黄芩、芍药、生地黄、紫参、丹
参之类治之。
一、溺血者，小便中出血也，乃膀胱所致。用炒黑山栀水煎服
之，或用小蓟、琥珀。小蓟治下焦结热血淋。溺血，因血虚者，四物加牛膝膏。
一、下血者，大便出血也。乃脏腑蕴积湿热之毒而成。或因气郁酒色过度，及多食炙爆热
毒之物，或风邪所冒，或七情六淫所伤，使气血逆乱，荣卫失度，皆能令人下血。
予尝治诸虚吐衄咯血，药中每人童便一合，其效甚速。凡单服，重汤顿服，无不效应。盖溲溺降火
滋阴，又能消瘀血，止吐衄诸血。先贤有言∶凡诸失血，服寒凉十无一生，服溲溺百无一死。斯言信矣。每用
童便一钟，少入姜汁二三点，搅匀徐徐服之，日进二三次。如天寒，却以重汤顿温服。服此，但以进饮食相远为佳。
方
全生饮（云林制）〔批〕（按此方治诸失血之总司也） 止吐血、衄血、嗽血、咯血、唾血。
藕汁（磨墨一寸） 梨汁 茅根汁 韭汁 生地黄汁（各一两） 刺刺菜
汁萝卜汁 白蜜 竹沥 生姜汁 童便（各半盏）
上合一处，频频冷服。此方乃治诸失血之总司。
犀角地黄汤 治上焦有热，口舌生疮，发热，或血热妄行，或下血，及不嗽，血自来者，并宜服之。
乌犀角（镑，一钱半） 生地黄（二钱） 赤芍药（一钱） 牡丹皮（一钱） 加黄芩（一钱） 黄连（一钱）
上锉一剂，水二钟，煎一钟，温服。肝经血，加条芩。心经血，加黄连、麦门冬。脾经唾血，加白芍药、
百合。肺经衄血，加天门冬、山栀、百部。肾经血，加玄参、黄柏、知母。三焦涌血，加连翘、地骨皮。胆
经血，加柴胡、淡竹叶。胃经吐血，加大黄、干葛。心胞血，倍牡丹皮，加茅根。大肠便血，加炒山栀、炒槐
花。小肠溺血，加炒栀子、木通、牛膝、茅根。积热，加大黄、芒硝。吐血不止，加大黄、桃仁。
止血立应散（王双湖方） 治吐衄不止如神。
大黄（酒浸，五钱） 青黛（一钱） 槐花（炒，一钱） 血余（五钱， 存性）
上为末，每服三钱，用栀子、丹皮各二钱，煎汤调，食后服。有热，汤内加地骨皮三钱。
清热解毒汤〔批〕（按此方凉血止血之剂） 治吐血衄血。
升麻（二两） 干葛（五钱） 赤芍药（五钱） 生地黄（一两） 牡丹皮（五钱） 黄
连（五钱） 黄柏（八钱） 黄芩（五钱） 桔梗（五钱） 栀子（五钱） 甘草（五钱） 连翘（五钱）
上锉，每剂一两，水二钟，煎一钟，温服。
清热滋阴汤〔批〕（按此方止瘀血生新血之剂） 治吐血、衄血、便血、溺血。
当归（酒洗，三分） 川芎（酒洗，七分） 生地（酒洗，二钱） 黄柏（酒炒，三分）
知母（酒炒，五分） 陈皮（酒洗，三分） 白术（炒，五分） 麦门冬（一钱五分） 牡丹
皮（一钱） 赤芍药（七分） 玄参（一钱） 山栀（炒黑，一钱半） 甘草（五分）
上锉一剂，水煎温服。身热，加地骨皮一钱，柴胡五分，子芩一钱。吐、衄血，加炒干姜七分，柏叶、
茜根、大小蓟各一
钱。大便血，加炒槐花、地榆、百草霜各一钱。溺血，加炒黑山栀子、车前子、小蓟、黄连各
八分。四病血俱用阿胶珠五分，姜汁、韭汁、童便同服。
止鼻衄方（刘尚书传）
百草霜 发灰（二物等分） 清烟墨（一锭） 童便 韭汁 无灰老酒（各一钱）
上下三味合一处，用墨浓磨，调上二物服。
陈槐汤（刘尚书传） 治吐血衄血不止。
当归（头、尾，二钱） 川芎（二钱） 赤芍药（二钱） 黄芩（二钱） 槐花（二钱）
陈皮（二钱） 侧柏叶（蜜炒，二钱） 乌药（二钱） 山栀子（七个） 藕节（三分） 细茶（三钱）
上用水二钟，煎一钟，不拘时热服。
通关止血丸（秘方） 治鼻衄。
枯白矾（一钱） 沉香（三分） 半夏（四个） 糯米（十四粒） 麝香（一分）
上为末，面糊为丸如豌豆大。每用二丸塞左右两耳，即服陈槐汤。
治鼻衄良方。
用大蚯蚓数十条捣烂，井花水和稀，患轻澄清饮，重则并渣、汁调服，立愈。
扎指法 治鼻衄不止。
用线紧扎中指中节，如左鼻孔出血，扎右手指；右鼻孔出血，扎左手指；两孔俱出，左右俱扎之。
鼻衄不止，用水纸搭在鼻冲上，随用秘方。
栀子（炒黑） 百草霜 龙骨（火 ） 京墨 血余（ 存性）
上为末，用茅花水蘸湿，蘸药入鼻孔。如无茅花，将纸捻水湿，蘸药入鼻中，真良法也。
Pulse
In various syndromes involving blood loss, a Kou pulse (Kou Mai, floating, large, and empty in the center, resembling a green onion stalk) is observed. By examining the location of the pulse, one can verify the source of the bleeding. Generally, for blood loss, the pulse should be deep and fine. If a floating and large pulse appears instead, the condition is critical and difficult to treat subsequently.
Syndromes
The syndromes of blood loss are not limited to a single manifestation. There is hematemesis (vomiting blood), hemoptysis (coughing up blood), spitting blood, expectorating blood, epistaxis (nosebleed), and hematuria (blood in urine). Although there are differences in names and colors, they are generally heat syndromes, differing only in whether they are new or old, deficiency or excess. It is erroneous to claim they are cold syndromes. Zhu Danxi stated: Blood flowing from the upper orifices is due to excess Yang and deficiency Yin, with rising but no descending, causing blood to ascend with Qi and escape through the upper orifices. The treatment method should tonify Yin to suppress Yang; when Qi descends, blood returns to its vessels.
Hematemesis refers to vomiting whole blood. This occurs because blood overflows and acts recklessly, flowing into the stomach cavity, causing the person to vomit blood. Causes include eating too much, carrying heavy loads damaging the stomach; excessive worry damaging the heart and accumulating heat; damaging the heart and lungs; excessive worry damaging the spleen; lung abscesses; falling from heights damaging the five Zang organs; unresolved exogenous febrile diseases where pathogenic heat remains in the meridians and surges upward with Qi.
Hematemesis may also result from external injuries by the four climatic factors or internal disturbances by the seven emotions; or from improper diet, sexual exhaustion, or traumatic injury from falls and sprains, causing Ying (nutritive) blood to gather in the diaphragm. When full, it regurgitates through the throat, known as reckless blood movement; or expelling stasis blood, termed internal injury.
Treatment
If hematemesis is followed by phlegm and cough, it indicates Yin deficiency with fire hyperactivity and failure of phlegm to descend. Use Siwu Tang (Four Substances Decoction) as the main formula, adding herbs that clear phlegm and reduce fire. If phlegm and cough precede hematemesis, it indicates accumulated heat, requiring urgent reduction of phlegm and fire.
Sudden expulsion of purple, clotted blood indicates heat injuring the blood and causing coagulation in the middle Jiao. Expelling it is favorable. Treat with Siwu Tang (Four Substances Decoction) plus heat-clearing herbs. Hematemesis can also be caused by anger. The Classics state: Anger causes Qi to reverse, and severely, it leads to vomiting blood. This is because anger causes violent Qi reversal. For continuous hematemesis, use calcined Rhizoma Zingiberis (Dried Ginger) powdered and taken with child's urine. This is a counter-treatment method.
1. Hemoptysis is coughing up blood mixed with phlegm, caused by heat obstructing the Lungs. Chronic cough damages the Lungs, also causing hemoptysis. Heat obstruction in the Lungs is easy to treat, merely requiring cooling herbs; Lung damage is difficult to treat due to insufficiency. For heat cough with blood, use Jinfeicao San (Boiling Downweed Powder) plus Cornu Bubali (Water Buffalo Horn) and Corium Corneum Asini (Donkey-hide Gelatin). For劳 cough (consumptive cough) with blood, use Bufei Tang (Tonify Lung Decoction) plus Corium Corneum Asini (Donkey-hide Gelatin) and Radix Bletillae (White Bletilla). For coughing blood damaging the Lungs, stir-fry Coicis Semen (Coix Seed) until done, powder it, and eat it dipped in cooked pig lung. For heat cough with sore throat, blood-streaked sputum, or abundant bright red blood in sputum, Jinfeicao San (Boiling Downweed Powder) is suitable. If cooling agents fail, it is not a heat syndrome; use Xingzi Tang (Apricot Kernel Decoction).
2. Spitting blood is fresh blood coming out with saliva. This originates from the Kidneys. It can also result from internal stasis injury, where Lung Qi is obstructed and cannot descend. Use Tianshen (Radix Glehniae), Maishen (Radix Ophiopogonis), Radix Anemarrhenae (Zhimu), Radix Platycodonis (Jiegeng), Cortex Phellodendri (Huangbai), Radix Rehmanniae Preparata (Shudihuang), and Radix Polygalae (Yuanzhi), possibly adding Rhizoma Zingiberis (Ginger).
3. Expectorating blood is coughing up blood clots without coughing. Use Ginger Juice, Child's Urine, and Indigo Naturalis (Qingdai) added to blood-invigorating medicines, or add to Siwu Tang (Four Substances Decoction), Dihuang Gao (Rehmannia Paste), or Niuxi Gao (Achyranthes Paste).
4. Epistaxis is nosebleed. This originates from the Lungs. Treat with Cornu Bubali (Water Buffalo Horn), Rhizoma Cimicifugae (Shengma), Fructus Gardeniae (Zhizi), Radix Scutellariae (Huangqin), Radix Paeoniae Rubra (Chishao), Radix Rehmanniae Recens (Shengdi), Radix Polygoni Cuspidati (Zicangshu/Zican), and Radix Salviae Miltiorrhizae (Danshen).
5. Hematuria is blood in the urine, caused by the Bladder. Use Stir-fried Black Gardenia Fruit (Zhizi) decocted in water, or use Herba Leonuri (Xiaoji) and Succinum (Hupo). Xiaojia treats lower Jiao stagnant heat and bloody strangury. For hematuria due to blood deficiency, use Siwu Tang (Four Substances Decoction) plus Niuxi Gao (Achyranthes Paste).
6. Lower bleeding is blood in the stool. It results from damp-heat toxins accumulating in the Zang-Fu. Causes include Qi stagnation, excessive alcohol and sex, consuming too many roasted/fried hot-toxic foods, exposure to wind pathogens, or injuries from the seven emotions and six climatic factors, leading to chaotic Qi and Blood and imbalanced Ying and Wei.
I have treated various deficiency syndromes with hematemesis, epistaxis, and hemoptysis by adding one he of Child's Urine to the herbal decoction, achieving rapid effects. Taken alone, heated in a double boiler and consumed at once, it is invariably effective. Urine reduces fire, tonifies Yin, eliminates stasis, and stops various bleedings. Ancients said: For all blood loss, ten out of ten die using cold/cooling herbs, but none out of a hundred die using urine. This is true. Use one cup of Child's Urine, add two or three drops of Ginger Juice, mix well, and drink slowly, two to three times daily. In cold weather, warm it in a double boiler. Best taken away from meals.
Formulas
Quansheng Yin (Made by Yunlin) [Commentary: This is the master formula for treating all blood loss.] Stops hematemesis, epistaxis, hemoptysis, expectorating blood, and spitting blood.
Lotus Root Juice (ground like ink, one cun long) Pear Juice Sedge Rhizome Juice Leek Juice Fresh Rehmannia Juice (each 1 liang) Thistle Vegetable Juice Radish Juice White Honey Bamboo Sap Ginger Juice Child's Urine (each half zhan)
Mix all together, take frequently while cold. This is the master formula for all blood loss.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) Treats heat in the Upper Jiao, mouth and tongue sores, fever, reckless bleeding due to blood heat, lower bleeding, and spontaneous bleeding without cough.
Black Rhinoceros Horn (sliced, 1.5 qian) Fresh Rehmannia Root (2 qian) Red Peony Root (1 qian) Moutan Bark (1 qian) Add Scutellaria Root (1 qian) Coptis Rhizome (1 qian)
Cut into one dose, add two zhong of water, decoct to one zhong, take warm. For Liver channel blood, add Tiao Huangqin. For Heart channel blood, add Huanglian and Maidong. For Spleen channel spitting blood, add Baishao and Baihe. For Lung channel epistaxis, add Tiandong, Zhizi, and Baibu. For Kidney channel blood, add Xuanshen, Huangbai, and Zhimu. For Triple Burner surging blood, add Lianqiao and Digupi. For Gallbladder channel blood, add Chaihu and Danyezhu. For Stomach channel hematemesis, add Dahuang and Ge. For Pericardium channel blood, double Mudanpi and add Maogen. For Large Intestine melena, add stir-fried Zhizi and Huaihua. For Small Intestine hematuria, add stir-fried Zhizi, Mutong, Niuxi, and Maogen. For accumulated heat, add Dahuang and Mangxiao. For continuous hematemesis, add Dahuang and Taoren.
Zhixue Liying San (Wang Shuanghu's Formula) Treats continuous hematemesis and epistaxis with miraculous effect.
Dahuang (wine-soaked, 5 qian) Qingdai (1 qian) Stir-fried Huaihua (1 qian) Xuyurong (Hair Charcoal, 5 qian, preserved nature)
Powder these. Take 3 qian per dose, mixed with decoction of Zhizi and Mudanpi (2 qian each), taken after meals. If heat is present, add Digupi (3 qian) to the decoction.
Qingre Jiedu Tang [Commentary: A blood-cooling and hemostatic formula] Treats hematemesis and epistaxis.
Shengma (2 liang) Ge Gen (5 qian) Chishao (5 qian) Shengdi (1 liang) Mudanpi (5 qian) Huanglian (5 qian) Huangbai (8 qian) Huangqin (5 qian) Jiegeng (5 qian) Zhizi (5 qian) Gancao (5 qian) Lianqiao (5 qian)
Cut into doses. One liang per dose, two zhong of water, decoct to one zhong, take warm.
Qingre Ziyin Tang [Commentary: A formula to stop stasis and generate new blood] Treats hematemesis, epistaxis, melena, and hematuria.
Danggui (wine-washed, 3 fen) Chuanxiong (wine-washed, 7 fen) Shengdi (wine-washed, 2 qian) Huangbai (wine-fried, 3 fen) Zhimu (wine-fried, 5 fen) Chenpi (wine-washed, 3 fen) Baizhu (stir-fried, 5 fen) Maidong (1.5 qian) Mudanpi (1 qian) Chishao (7 fen) Xuanshen (1 qian) Zhizi (stir-fried black, 1.5 qian) Gancao (5 fen)
Cut into one dose, decoct in water, take warm. For body heat, add Digupi (1 qian), Chaihu (5 fen), and Ziqin (1 qian). For hematemesis/epistaxis, add stir-fried Ganjiang (7 fen), Baiye, Qigen, and Da/Xiaoji (1 qian each). For melena, add stir-fried Huaihua, Diyü, and Baicaoshuang (1 qian each). For hematuria, add stir-fried black Zhizi, Cheqianzi, Xiaoji, and Huanglian (8 fen each). For all four types of bleeding, use Ejiao Zhu (5 fen), taken with Jiangzhi, Jiuzhi, and Tongbian.
Zhi Bi Nie Fang (Liu Shangshu's Transmission)
Baicaoshuang Hair Ash (equal parts) Clear Smoke Ink (one stick) Child's Urine Leek Juice Unfermented Old Wine (each 1 qian)
Mix the first three ingredients. Grind the ink thickly, mix with the other two, and take.
Chenhuai Tang (Liu Shangshu's Transmission) Treats continuous hematemesis and epistaxis.
Danggui (head and tail, 2 qian) Chuanxiong (2 qian) Chishao (2 qian) Huangqin (2 qian) Huaihua (2 qian) Chenpi (2 qian) Cebyeye (honey-fried, 2 qian) Wuyao (2 qian) Zhizi (7 seeds) Ou jie (3 fen) Xi Cha (3 qian)
Add two zhong of water, decoct to one zhong, take hot anytime.
Tongguan Zhixue Wan (Secret Formula) Treats epistaxis.
Ku Baifan (1 qian) Chenxiang (3 fen) Banxia (4 pieces) Nuomi (14 grains) Shexiang (1 fen)
Powder these, make pills with wheat paste the size of pea seeds. Insert two pills into each ear, then immediately drink Chenhuai Tang.
Good Formula for Epistaxis.
Use dozens of large earthworms, mash them, mix with well water. Drink the clarified liquid for mild cases; take the dregs and juice mixed for severe cases. Immediate cure.
Finger Tying Method Treats continuous epistaxis.
Tie tightly with thread around the middle joint of the middle finger. If left nostril bleeds, tie right hand; if right, tie left. If both, tie both.
For continuous epistaxis, place wet paper on the nasal bridge, then use the secret formula:
Stir-fried Black Zhizi Baicaoshuang Calcined Longgu Jingmo Xuyurong (preserved nature)
Powder these. Dip in Mugwort Flower Water, moisten the powder, and insert into nostrils. If no mugwort flower water, wet a paper twist and insert. Truly a good method.