张三锡曰∶营血之行，各有常道。为火所迫，则错乱沸腾，而诸失血之证作矣。有如火急汤沸，
势不可遏。丹溪之论曰∶口鼻出血，皆是阳盛阴虚，有升无降，血随气上，越出上窍。法当补阴抑阳，气降
则血归经矣。是论血症三昧语。盖阳明之脉络鼻，是经火盛，迫血妄行，从鼻出者曰衄，从口涌出者曰吐。
初起脉洪大，宜犀角地黄汤。犀角性升散，能散一切有余之火，乃阳明经药，故曰如无犀角，以升麻代之。
今人不知，泥于犀角解乎心热一句，不分虚实，与四物同用。若是实火，固为得宜，阴虚者宁免飞扬之祸？
吐血，心口胀懑，口中血腥气，用韭汁、童便、姜汁、郁金同饮，其血自清。势盛脉芤大吐，用十灰
散遏之，次用花蕊石散消之，后用清血药郁金、丹皮、赤芍之类，加降火。有因怒而得者，宜平肝降火，炒
栀子、青皮、芩、连、柴胡。一切上焦血症，用五生饮，大获奇验。用生韭、藕（荷叶亦可）京墨、侧柏、
生地，各取汁一杯，对童便。其生地、侧柏研烂，以童便和方得汁。凡一应上溢之症，若脾胃气壮，不
泻能食者，皆当以大黄醋制，和生地汁，及桃仁泥、牡丹皮之属，引入血分，使血下行，转逆为顺也，
最妙法。不知此而徒事凉药，脾胃反伤。今人治此，无一生者，此也。诸失血后，倦怠昏愦，面失血，
懒于言动，浓煎人参汤，所谓血脱补气也，最妙。
先恶心，血杂痰出，呕多至升许者，为呕血。有怒而得者，有过饮得者，郁悒人久之，气血凝滞，
中焦运化失常，亦作呕痰带血出，宜分治之。若肝脉旺，两手弦数，宜平肝降火，连、栀、青皮、香附、
柴胡、甘草、归、芍，或用赤茯泻心汤，是实者泻其子也。若右寸脉洪滑或数，解酒毒，降火和中，二陈加
芩、连、栀、丹皮。若沉结或洪数，宜舒郁，越鞠丸去苍术，加丹皮、赤芍、归尾主之，加韭汁亦妙。
脾统血，肺主气，劳神多言，脾肺致伤，血妄行，忌凉剂，必用补中益气汤加减。遇劳即发，心肺受伤，
其血必散，补中益气加麦冬、五味、山药、熟地、茯神、远志佳。
咳血，热壅于肺者易治，损于肺者难治。瘦人有此，脉细数，多成劳，宜二母、二冬、紫菀、花粉、生地、
丹皮、竹沥、童便、姜汁，选用一方。服药血不止，是肺上有窍也。用白芨末、猪肺煮熟，蘸食，日三四次，
妙不可言。昔人为白芨下咽至血窍，则窍为填而血止。详见《本草纲目》。一法，取末于粥中吃，妙。劳伤
肺经，咳嗽有血，鸡苏散最妙。功在阿胶、炒蒲黄。劳嗽，服阿胶不止，无药用矣。咳血非静养绝欲，不可与
治。诸病皆然，此尤当慎者。
咳血胸中痛，腥臭异常，肺脉数而虚，是肺痿。诸失血过多，体倦少食，及血不止，扶正气为急，人
参、黄 、五味子、芍药、麦冬、甘草、归身，加郁金亦可。
唾血，平时津唾中有血，一属肾虚有热，一属上焦实火。
有余则泻，加减凉膈加牡丹皮、藕节之类；不足则补，滋肾坎离，酒炒黄柏、肉桂一分许，泻肾火，
或加二冬、二母。
咯血，不嗽而咳出血也，咯同于痰。气郁于喉咙之下，滞不得出，咯而乃出。求其所属，咯、唾同出于
肾也。咯血为病最重，以肺手太阴之经。气多血少，又肺为清肃之脏，为火所烁，迫血上行，以为咯血，
逆之甚矣。上气见血，下闻病音，谓喘而见血，且咳嗽也，为难治。初起用童便、青黛，以泻手足少阳三焦
胆经之相火，而姜汁为佐，用地黄、牛膝辈以补阴，安其血。如喉中咯出小血块或血点，亦分虚实，瘦人最
忌。大法四物入童便，姜汁、青黛，或牛膝膏、地黄膏，尤妙。上焦一切血症，稍止即服六味丸，最不可缓。
有血症者，终身不可脱。
滑伯仁曰∶失血家须用下剂破血，盖施之于妄蓄之初。亡血虚家不可下，盖戒于亡失之后。
朱丹溪曰∶凡血症既久，古人多以胃药收功。
喻嘉言曰∶血证有新久微甚，本无不由于火，然火有阴阳不同，治法因之迥远。今有暴病呕血数盂，
经曰暴病非阳，则其为火也，即非阳火甚明。阳火者。五行之火，天地间经常可久之物，何暴之有？惟夫龙
雷之火，潜伏阴中，方其未动，不知其为火也。及其一发，暴不可御，以故载阴血而上溢。盖龙雷之性，
必阴云四合，然后遂其升腾之势。若天青日朗，则退藏不动矣。故凡用凉血清火之药者，皆以水制火之常法，
施之于阴火，未有不转助其虐者。大法惟宜温补，而温补之微细曲折，要在讲明有素。经曰少阴之脉营舌本，
又曰咯血者属肾，明乎阴火发于阴中。
其血咯之成块而出，不比咳嗽劳症，痰中带血为阳火也。此义惟张长沙伤寒症中垂戒一款，云误发少
阴汗，动其经血
者，下竭上厥，为难治。后人于下竭上厥之理，总之弗省。不知下竭者，阴血竭于下也；上厥者，阴气逆于
上也。故阴火动，而阴气不得不上奔；阴气上奔，而阴血不得不从上溢；阴血上溢，则下竭矣。血既上溢，
其随血之气，散于胸中，不能复返本位，则上厥矣。阴气上逆不过至颈而止，不能越高巅清阳之位，是以喉
间窒塞，心忡耳鸣，胸膈不舒也。然阴气久居于上，势必龙雷之火应之于下。血不尽，竭不止也；气不尽，厥
不止也。仲景断为难治，其以是乎？
吾将辟其扃，则以健脾中之阳气为第一义。健脾之阳有三善；一者，脾中之阳气旺，如青天日朗，而龙雷
潜伏也；一者，脾中之阳气旺，而胸中窒塞之阴气，如太空不留纤翳也；一者，脾中之阳气旺，而饮食运化精
微，复生其下竭之血也。况乎地气必先蒸土为湿，然后上升为云。若土燥而不湿，地气于中隔绝矣，天气不常
清乎。
今方书皆治阳火之法，至龙雷之火，徒有其名，而无其治。反妄引久嗽成痨，痰中带血之阳症，不敢用健
脾增嗽为例。不思咯血之嗽，不过气逆上厥，气下则不嗽矣。
古方治龙雷之火用桂附，然施于暴血之症，可暂不可常。盖已亏之血，恐不能制其悍；而未动之血，恐不
可滋之扰。况此症以劳房忧恐，伤精伤肾。又肝惟疏泄，是以少阴之气当藏不藏，而少阴之血无端溢出，与仲
景所谓误发少阴，汗动其血者，无少异矣。
究而论治龙雷之火，全以收藏为主，以秋冬则龙雷潜伏也。故治法惟以崇土为先，土浓则阴浊不升，而血
患自息矣。
缪仲淳曰∶吐血有三要。宜降气，不宜降火。气有余即是火，气降则火降，血随气行，无溢出上窍之患
矣。降火必用寒凉之剂，反伤胃气，胃气伤则脾不能统血，血愈不能归
经矣。今之疗吐血者，大患有二∶一则专用寒凉，往往伤脾作泄，以致不救；一则专用人参，肺热伤肺，
咳逆愈甚。亦有用参而愈者，此是气虚喘嗽，不由阴火致。然宜以白芍、炙草制肝，枇杷叶、麦冬、薄荷、
橘红、贝母清肺，苡仁、山药养脾，番降香、苏子下气，青 、鳖甲、银柴胡、丹皮、地骨皮补阴清热，
酸枣仁、茯神养心，山萸、枸杞子、牛膝补肾，此累试辄验之方。然阴无骤补之法，非多服不效。
宜行血，不宜止血。血不循经络者，气逆上壅也。血得热则行，得寒则凝，故降气行血，则血循经络
矣。若血凝必发热、及胸胁痛、病曰沉痼耳。
宜补肝，不宜伐肝。经曰∶五脏者，藏精气而不泻者也。肝主藏血，吐者肝失其职也。养肝则肝气平，
而血有所归；伐之则肝不能藏血，血愈不止矣。
薛立斋曰∶血症多属形病俱虚，治者当求其属而主之。若郁热伤肺而衄者，用黄 益气汤；肺气虚热，
不能摄血而衄者，用四君加芎、归、五味；郁结伤脾而咳吐血者，用归脾汤；胃经有热而咳吐血者，用犀角
地黄汤；胃气弱而咳吐血者，用四君子加川芎、当归、升麻；肾经虚热，阴火内动而咯吐血者，用六味丸、
补中益气汤；怒动肝火而见血者，用逍遥散。虽曰血得热而错经妄行，亦有卫气虚不能统摄营血而为妄行者，
不可不察，临症审诸。
又曰∶劳嗽见血，亦有劳伤元气，内火妄动而伤肺者；亦有劳伤肾水，阴火上炎而伤肺者；有因过服天冬
、生地寒药，损伤脾胃，不能生肺气而不愈者；有因误用黄柏、知母之类，
损伤阳气，不能生阴精而不愈者。凡此脾肺亏损，而肾水不足，以致虚火上炎，真脏为患也，须用补中益气汤
补脾土而生肺金，用六味丸滋肾水而生阴精，否则不救。
戴元礼曰∶牙宣有二证∶有风壅牙宣，有肾虚牙宣。风壅者，消风散擦，仍服。肾虚者，以肾主骨，
牙者骨之余，虚而上炎，故宣。服凉剂而愈甚者，此属肾，下虚上盛，宜盐汤下安肾丸，间黑锡丹，仍用姜、
盐炒香附黑色，为末揩擦，妙。
鼻衄，鼻通于脑，血上溢于脑，所以从鼻而出。有头风自衄，头风才发，则衄不止，宜芎附饮，间进一
字散。有因虚而衄，此为下虚上盛，不宜过用凉剂；宜养正丹，佐以四物汤、芎归汤，磨沉香饮。伤湿而衄
，肾着汤加川芎，名除湿汤。伤胃致衄者，名酒食衄。喜、怒、忧、思诸气，皆能
动血，以此致衄者，名五脏衄，上膈极热而衄者，金沸草散去麻黄、半夏，加茅花，如荆芥散，或用黄芩芍药
汤加茅花一撮。虚极者，茯苓补心汤。饮酒过多，及食热物而衄，先用茅花汤。衄愈甚，则用理中汤去干姜，
加干葛，蓦然以水喷其面，使战惊则止。衄愈后，血因旧路，一月或三四衄；又有洗面而衄，日以为常，此
即水不通，借路之意，并宜止衄散，茅花煎汤调下。或四物汤加石菖蒲、阿胶、蒲黄各半钱，调熟石膏一匙
许，兼进养正丹。
赵羽皇曰∶营者，水谷之精气也；卫者，水谷之悍气也。又云∶肺朝百脉之气，脾统诸经之血，可知血
藏于肝而属于脾胃，明矣。但人身之失血，种种不同。故有郁热伤胃而吐血者，怒动肝火而见血者，肾虚火泛
而咯血者，治法如清胃散、地黄汤、六味丸之属，用之得宜，无不获效。
独见血之出于脾胃者，每略不讲，一遇此等症，而莫可如何。盖人身之脾为营卫之主，气血之根，今人
思虑不遂，郁伤火动，脾不摄血而从上窍出者，用归脾汤补以敛之；力役过度，中气劳伤，脾不统血而从下
窍出者，用补中汤升以举
之。一滋脾胃之阴，而从阴以引阳；一补脾胃之阳，而从阳以引阴。
先哲有言，曰血脱益气，须以参 救之。又云∶下血诸症，日久多以胃药收功。无非为阳生阴长，
以滋化生之源耳。世人往往不识此症，多用地黄、童便，以清火养阴。岂知脾胃既虚，多不利地黄之泥滞；
中气既弱，断不宜童便之沉寒。予见蹈此病者多，特为拈出。
柯韵伯曰∶失血之症，关系最重。先辈立论甚详，治法甚备。如血脱益气，见之东垣矣；滋阴清火，见
之丹溪矣；安神补血，见之陆迎矣；引血归源，见之吴球矣；攻补迭用，见之伯仁矣；逐淤生新，见之宇泰
矣；辛温从治，见之巢氏矣。先止后补，见之葛氏矣；胃药收功，见之石山矣；宜滋化源，见之立斋矣。无
说不通，无治不善。乃创法者用之而痊，遵法者因循而败，岂古今人有不相及欤？抑亦未知其要耳。
请言治血之要，其取效在调气而补血，其收功在安神而固精。夫人身中惟气血用事，血随气行，谁不能言？
独于失血病，不言调气之理。血脱须补，谁不知之？反于失血症，不知补血之法，惟以降火为确论，寒凉为
定方，至于气绝血凝，犹不悔悟，不深可悯耶？夫气亢于上焦之阳分，则阳络伤，血随气上溢于口鼻，当桃仁
承气以下之；气并于下焦之阴分，则阴络伤，血随气而下陷于二便，用补中益气以举之。气有余必挟火，当
用苦寒以凉其气；气不足便挟寒，宜用甘温以益其气。此调气之大要也。血自心来者，补心丹主之；脾来者，
归脾汤主之；肺来者，生脉散主之∶肾来者，肾气丸主之，此补血之大要。
然气血者后天，精神者先天，故精神不散，气血和调，形体不敝，精神内守。故治血者，必用安神固精，
使病者积精
全神，以善其后，何有夭枉之憾哉？
Zhang Sanxi stated: The circulation of Ying (Nutritive) Blood follows specific normal pathways. When forced by Fire, it becomes chaotic and boiling, giving rise to various hemorrhagic syndromes. This situation is like urgent fire and boiling water; the momentum is fierce and unstoppable.
Zhu Danxi discussed: Bleeding from the mouth and nose is always due to Excess Yang and Deficiency Yin, where Qi ascends without descending. Blood follows Qi upward and overflows from the upper orifices. The treatment principle should be to tonify Yin and suppress Yang; once Qi descends, Blood returns to its vessels. This is a profound statement on treating blood disorders. Since the Maiyang (Stomach) meridian connects to the nose, if Fire in this meridian is excessive, forcing Blood to move recklessly, bleeding from the nose is called "Nu" (Nosebleed), while gushing from the mouth is called "Tu" (Vomiting Blood). At the onset, with a洪大 (Surging-Large) pulse, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is suitable. Xijiao (Rhinoceros Horn) has an ascending and dispersing nature, capable of dispersing all excess Fire; it is a herb for the Maiyang meridian. Hence, it is said that if Xijiao is unavailable, Shengma (Cimicifugae Rhizoma) can substitute it. Modern practitioners do not understand this, rigidly adhering to the notion that Xijiao clears Heart Heat, using it indiscriminately with Siwu Tang (Four Substances Decoction) regardless of Excess or Deficiency. If it is Excess Fire, this is appropriate; but for those with Yin Deficiency, how can they avoid the disaster of worsening symptoms?
For vomiting blood accompanied by chest fullness and a bloody taste in the mouth, drinking a mixture of Jiuzhi (Chinese Chive Juice), Tongbian (Child's Urine), Jiangzhi (Ginger Juice), and Yujin (Curcuma Longa Rhizome) will naturally clear the blood. If the condition is severe with a 芤大 (Hollow-Large) pulse and massive hematemesis, first use Shihui San (Ten Ashes Powder) to arrest it, then use Huaruishi San (Flower Nodule Stone Powder) to resolve stasis, and finally use blood-clearing herbs such as Yujin, Danpi (Moutan Cortex), and Chishao (Red Peony Root) combined with fire-descending agents. For cases caused by anger, soothing the Liver and descending Fire with Chao Zhizi (Fried Gardenia), Qingpi (Tangerine Peel), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Chaihu (Bupleurum Root) is indicated. For all upper Jiao (Upper Burner) blood disorders, Wusheng Yin (Five Raw Decoction) yields miraculous results. Take raw Jiuzhi, Ou (Lotus Rhizome, or He Ye/Lotus Leaf), Jingmo (Beijing Ink), Cebaiye (Platycladi Cacumen), and Shengdi (Rehmannia Root) to extract one cup of juice each, mixed with Tongbian. The Shengdi and Cebaiye must be mashed and mixed with Tongbian to obtain the juice. For all types of upward-overflowing symptoms, if the Spleen and Stomach Qi are strong, without diarrhea and able to eat, one should use Dahuang (Rhubarb Root) processed with vinegar, mixed with Shengdi juice, along with Taoren (Peach Seed) paste and Mudanpi, to guide the blood into the blood level, causing it to descend and turning rebellion into obedience. This is the most excellent method. Ignoring this and merely using cold medicines will damage the Spleen and Stomach instead. Modern practitioners fail to cure this because of this reason. After various hemorrhages, if there is fatigue and confusion, pale complexion, and reluctance to speak or move, thickly decocted Renshen (Ginseng Root) soup should be taken. This is the principle of "Tonifying Qi in case of Blood Loss," which is very effective.
If nausea precedes, with blood mixed in sputum and vomiting up to several liters, it is called "Ou Xue" (Hematemesis). It can result from anger, excessive drinking, or long-term depression causing Qi and Blood stagnation and impaired middle Jiao transformation, leading to vomiting blood mixed with phlegm. These should be treated separately. If the Liver pulse is旺 (Prosperous), with wiry and rapid pulses at both wrists, soothe the Liver and descend Fire using Lian (Coptis), Zhi (Gardenia), Qingpi, Xiangfu (Cyperus Rhizome), Chaihu, Gancao (Licorice Root), Danggui (Angelica Sinensis), and Baishao (White Peony Root), or use Chifu Xiexin Tang (Red Poria and Pinellia Decoction to Drain the Heart), which is the method of "draining the son when the pathogen is excess." If the right Cun (Inch) pulse is surging, slippery, or rapid, resolve alcohol toxicity, descend Fire, and harmonize the middle using Erchen Tang (Two Aged Decoction) plus Huangqin, Huanglian, Zhizi, and Danpi. If the pulse is deep, knotted, or surging-rapid, soothe depression using Yueju Wan (Solve Depression Pill) minus Cangzhu (Atractylodes Rhizome), plus Danpi, Chishao, and Dangguiwei (Angelica Sinensis Tail); adding Jiuzhi is also excellent.
The Spleen controls Blood, and the Lung governs Qi. Mental exertion and excessive speech damage the Spleen and Lung, causing reckless blood movement. Cold formulas should be avoided; instead, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) modified is necessary. For episodes triggered by labor, indicating Heart and Lung injury with scattered blood, add Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Shanyao (Dioscorea Rhizome), Shudi (Prepared Rehmannia Root), Fushen (Poria with Hostwood), and Yuanzhi (Polygala Root) to Buzhong Yiqi Tang.
For hemoptysis, if caused by Heat obstructing the Lung, it is easy to treat; if due to Lung damage, it is difficult. In thin individuals with this condition and a fine-rapid pulse, it often develops into consumption. Select one formula from Ermu San (Two Mothers Powder), Erdong (Asparagus and Ophiopogon Tubers), Ziwan (Aster Root), Huafen (Trichosanthes Root), Shengdi, Danpi, Zhuli (Bamboo Sap), Tongbian, and Jiangzhi. If bleeding continues after medication, it indicates a lesion in the Lung. Use Baiji (Bletilla Rhizome) powder cooked with pig lung, eaten dipped, three to four times daily, which is extremely effective. Ancients believed Baiji reaches the blood lesion upon swallowing, filling the hole and stopping bleeding. See *Bencao Gangmu* (Compendium of Materia Medica). Another method is eating Baiji powder mixed in porridge, which is also excellent. For Lung meridian injury from overwork, coughing with blood, Jisu San (Chicken Mint Powder) is best, owing to the efficacy of Ejiao (Donkey-hide Gelatin) and Chao Puhuang (Fried Lygodium Spore). For chronic cough with blood, if Ejiao fails, no other medicine works. Hemoptysis cannot be cured without rest and sexual abstinence. All diseases are similar, but this requires particular caution.
Hemoptysis with chest pain and abnormal fishy odor, with a rapid and deficient Lung pulse, indicates Fei Wei (Lung萎/Atrophy). For excessive loss of blood, body weakness, poor appetite, and uncontrolled bleeding, supporting Righteous Qi is urgent. Use Renshen, Huangqi (Astragalus Root), Wuweizi, Shaoyao (Peony Root), Maidong, Gancao, and Dangguishen (Angelica Sinensis Head); adding Yujin is also acceptable.
Saliva containing blood belongs either to Kidney Deficiency with Heat or Upper Jiao Excess Fire. For Excess, drain using Jiajian Liangge San (Modified Cool the Chest Decoction) plus Mudanpi and Oujie (Lotus Node). For Deficiency, tonify by nourishing Kidney Yin and Yang (Kan and Li), using wine-fried Huangbai (Phellodendron Bark) and Rougui (Cinnamon Bark) in small amounts to drain Kidney Fire, or add Erdong and Ermu.
Kou Xue (Spitting Blood) is coughing up blood without the sound of coughing, resembling phlegm. Qi is stagnant below the throat, unable to exit, and comes out only after spitting. Tracing its origin, Kou and Tuo (Saliva) both stem from the Kidney. Kou Xue is the most severe disease because the Hand Taiyin Lung meridian has much Qi and little Blood, and the Lung is a pure and肃 (Clear) organ. When scorched by Fire, Blood is forced upward, creating Kou Xue, which is a severe reversal. Upper Qi disturbance with blood, lower sounds of disease—meaning wheezing with blood and coughing—is difficult to treat. Initially, use Tongbian and Qingdai (Indigo Naturalis) to drain the Ministerial Fire of the Hand and Foot Shaoyang (Sanjiao and Gallbladder) meridians, assisted by Jiangzhi, and use Dihuang (Rehmannia Root) and Niuxi (Achyranthes Root) to tonify Yin and stabilize Blood. If small blood clots or spots are spat from the throat, distinguish Excess and Deficiency; it is most contraindicated in thin people. The general method uses Siwu Tang added with Tongbian, Jiangzhi, and Qingdai, or Niuxi Gao (Achyranthes Paste) and Dihuang Gao, which is especially excellent. For all upper Jiao blood disorders, take Liuwei Wan (Six-Ingredient Pill with Rehmannia) as soon as bleeding stops slightly; delay is inadvisable. Patients with blood disorders must maintain this regimen lifelong.
Slippery Bo Ren (Hua Tuo's disciple) stated: Patients with hemorrhage require purgatives to break stasis, applied initially when reckless accumulation begins. Patients who have lost blood and are deficient must not be purged, warning against this after blood loss.
Zhu Danxi stated: For long-standing blood disorders, ancients often concluded treatment with stomach-tonifying medicines.
Yu Jiayan stated: Blood disorders vary in newness, chronicity, mildness, and severity, all originating from Fire. However, Fire differs in Yin and Yang, leading to vastly different treatments. Consider sudden vomiting of several cups of blood; the Classics state sudden illness is not Yang. Thus, if it is Fire, it is clearly not Yang Fire. Yang Fire refers to the Fire of the Five Elements, a constant and enduring phenomenon in heaven and earth; how could it be sudden? Only Dragon-Lei (Thunder) Fire, latent in Yin, is unknown as Fire before activation. Once activated, it is violent and uncontrollable, carrying Yin Blood upward. Dragon-Lei nature requires cloudy skies to ascend; in clear weather, it remains hidden. Therefore, using cold-blood-purging medicines, a standard method of controlling Fire with Water, applied to Yin Fire, invariably exacerbates it. The general rule is to use warm tonification, but the subtleties of warm tonification must be thoroughly understood. The Classics state the Shaoyin meridian connects to the tongue base, and Kou Xue belongs to the Kidney, clarifying that Yin Fire arises from within Yin.
Blood spat in clumps differs from Phlegm-Blood in coughing consumption, which is Yang Fire. This concept is warned in Zhang Changsha's (Zhang Zhongjing) *Shanghan Lun* (Treatise on Cold Damage): Mis-sweating Shaoyin disturbs meridian blood, causing Lower Exhaustion and Upper Reversal, which is difficult to treat. Later generations did not understand Lower Exhaustion and Upper Reversal. Lower Exhaustion means Yin Blood exhausted below; Upper Reversal means Yin Qi rebellious above. Thus, when Yin Fire moves, Yin Qi must rush upward; as Yin Qi rushes up, Yin Blood must overflow from above; as Yin Blood overflows, the lower part exhausts. Once blood overflows, the Qi accompanying it scatters in the chest and cannot return to its origin, causing Upper Reversal. Yin Qi rebellion stops at the neck, not reaching the high clear Yang positions, causing throat obstruction, palpitations, tinnitus, and chest discomfort. However, prolonged Yin Qi residence above triggers Dragon-Lei Fire below. As long as Blood is not exhausted, exhaustion continues; as long as Qi is not dispersed, reversal continues. Zhongjing deemed it difficult to treat, likely for these reasons.
I will reveal the key: Tonifying Spleen Yang is the primary principle. There are three benefits to strengthening Spleen Yang: First, robust Spleen Yang is like clear sky and sun, causing Dragon-Lei Fire to subside. Second, robust Spleen Yang clears Yin Qi obstruction in the chest like a spotless void. Third, robust Spleen Yang transforms food essence, regenerating exhausted blood below. Just as Earth Qi must evaporate soil moisture to form clouds, dry soil interrupts Earth Qi, preventing clear Heaven Qi.
Modern formularies only treat Yang Fire, lacking methods for Dragon-Lei Fire. They wrongly cite chronic cough consumption with blood-phlegm (Yang syndrome) to avoid spleen-tonifying methods that might increase cough. They fail to realize that cough in Kou Xue is merely Qi reversal; descending Qi stops the cough.
Ancient formulas used Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) for Dragon-Lei Fire, but these are temporary for acute bleeding, not for long-term use. Depleted blood may not control their harshness; unmoved blood may be disturbed by tonification. Moreover, this syndrome results from overwork, sex, worry, and fear damaging Essence and Kidney. Since the Liver governs dispersion and excretion, Shaoyin Qi fails to store, and Shaoyin Blood overflows unintentionally, similar to Zhongjing's description of mis-sweating Shaoyin disturbing blood.
Investigating the treatment of Dragon-Lei Fire, preservation and storage are paramount, mirroring the latent Fire of autumn and winter. Thus, the method prioritizes thickening Earth; thick Earth prevents Yin turbidity from rising, and blood disorders cease.
Miu Zhongchun stated: Three essentials for vomiting blood. Prioritize descending Qi, not descending Fire. Excess Qi is Fire; descending Qi descends Fire, and Blood follows Qi, avoiding upper orifice overflow. Descending Fire requires cold medicines, which damage Stomach Qi; damaged Stomach Qi impairs Spleen control, preventing Blood from returning to vessels. Modern treatments have two major flaws: First, exclusive use of cold medicines damages Spleen, causing diarrhea and death. Second, exclusive use of Renshen causes Lung Heat injury, worsening cough. Some recover with Renshen, but this is Qi-deficiency wheezing, not Yin Fire. Suitable formulas include Baishao (White Peony) and Zhi Gancao (Honey-fried Licorice) to constrain Liver, Pipaye (Loquat Leaf), Maidong, Bohe (Mint), Juhong (Tangerine Peel), Beimu (Fritillaria Bulb) to clear Lung, Yiren (Coix Seed), Shanyao to nourish Spleen, Fanjiangxiang (Sappan Wood), Suzi (Perilla Fruit) to descend Qi, Qingpi, Biejia (Turtle Shell), Yin Chaihu (Stellaria Root), Danpi, Digupi (Lycium Bark) to tonify Yin and clear Heat, Suanzaoren (Zizyphus Seed), Fushen to nourish Heart, Shanzhuyu (Cornus Fruit), Gouqizi (Goji Berry), Niuxi to tonify Kidney. This tested formula requires long-term use as Yin cannot be rapidly tonified.
Prioritize moving Blood, not stopping it. Blood not following vessels is due to Qi rebellion and congestion. Blood flows with heat and coagulates with cold; thus, descending Qi and moving Blood allows vessels to function. Coagulation causes fever and chest/hypochondriac pain, becoming chronic.
Prioritize tonifying Liver, not attacking it. The Classics state: The Five Zang organs store Essence and Qi without leaking. The Liver stores Blood; vomiting indicates Liver dysfunction. Nourishing Liver calms Qi and guides Blood; attacking Liver prevents storage, worsening bleeding.
Xue Lizhai stated: Blood disorders often involve both Form and Qi deficiency; treat by addressing the root. For Nasal Bleeding due to Depressed Heat injuring Lung, use Huangqi Yiqi Tang (Astragalus Qi-Augmenting Decoction). For Lung Qi Deficiency Heat failing to control Blood, use Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong (Ligusticum Rhizome), Danggui, and Wuweizi. For Depressed Injury to Spleen causing coughing/vomiting blood, use Guipi Tang (Restore the Spleen Decoction). For Stomach Meridian Heat causing coughing/vomiting blood, use Xijiao Dihuang Tang. For weak Stomach Qi causing coughing/vomiting blood, use Sijunzi Tang plus Chuanxiong, Danggui, and Shengma (Cimicifuga Rhizome). For Kidney Meridian Deficiency Heat with internal Yin Fire causing spitting/vomiting blood, use Liuwei Wan (Six-Ingredient Pill) and Buzhong Yiqi Tang. For Liver Fire agitation causing bleeding, use Xiaoyao San (Free and Easy Wanderer Powder). Although Heat causes erratic blood flow, Wei Qi deficiency failing to control Ying Blood also causes bleeding; this must be examined clinically.
He also stated: Consumption cough with blood may result from Qi/Yuan depletion with internal Fire injuring Lung; or Kidney Water depletion with Yin Fire flaming up injuring Lung; or excessive use of cold Tian Dong (Asparagus Root) and Shengdi damaging Spleen/Stomach, failing to generate Lung Qi; or misuse of Huangbai and Zhimu (Anemarrhena Rhizome) damaging Yang, failing to generate Yin Essence. All these involve Spleen/Lung deficiency and Kidney Water insufficiency, causing False Fire to flare and True Zang to suffer. Use Buzhong Yiqi Tang to tonify Spleen Earth and generate Lung Metal, and Liuwei Wan to nourish Kidney Water and generate Yin Essence; otherwise, rescue is impossible.
Dai Yanli stated: Ya Xuan (Gum Recession/Dental Suppuration) has two patterns: Wind Obstruction and Kidney Deficiency. For Wind Obstruction, apply Xiaofeng San (Wind-Dispersing Powder) externally and internally. For Kidney Deficiency, since Kidney governs bones and teeth are bone remnants, deficiency causes Flaming Up. Worsening with cold medicines indicates Kidney pattern, Lower Deficiency and Upper Excess. Use Anshen Wan (Calming Kidney Pill) with salt water, alternating with Heixi Dan (Black Tin Pill). Also, use Xiangfu (Cyperus Rhizome) fried with Ginger and Salt until black, powdered for external application.
Nasal Bleeding: The nose connects to the brain; blood overflowing to the brain exits via the nose. Headwind spontaneous bleeding occurs when Headwind activates, causing persistent bleeding; use Xiongfu Yin (Ligusticum and Aconite Decoction), alternating with Yizi San (One Character Powder). Deficiency-induced bleeding is Lower Deficiency/Upper Excess; avoid excessive colds. Use Yangzheng Dan (Nourish Upright Pill) assisted by Siwu Tang, Xionggui Tang (Ligusticum and Angelica Decoction), and Chenxiang (Agarwood) drink. Dampness-induced bleeding uses Shen Zhuo Tang (Kidney-Dampness Decoction) plus Chuanxiong, named Chushi Tang (Dampness-Removing Decoction). Stomach injury causes Jiushi Nu (Alcohol-Food Nosebleed). Joy, Anger, Worry, and Thought all move Blood; resulting nasal bleeding is Wuzang Nu (Five Organs Nosebleed). Upper Diaphragm Extreme Heat uses Jinfeicao San (Boiling Grass Powder) minus Mahuang (Ephedra) and Banxia (Pinellia), plus Maohua (Canna Flower), like Jingjie San (Schizonepeta Powder), or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) plus Maohua. Extreme Deficiency uses Fuling Buxin Tang (Poria Tonifying Heart Decoction). Excessive drinking or hot food uses Maohua Tang initially. Worsening bleeding uses Lizhong Tang (Regulate the Middle Decoction) minus Ganjiang (Dried Ginger), plus Gegen (Kudzu Root); suddenly spraying water on the face induces shivering to stop bleeding. Post-bleeding recurrence uses Zhinu San (Stop Nosebleed Powder) with Maohua decoction, or Siwu Tang plus Shichangpu (Acorus Rhizome), Ejiao, and Puhuang (Lygodium Spore) with Shuguashi (Calcined Gypsum) and Yangzheng Dan.
Zhao Yuhuang stated: Ying Qi is the essence of Grain and Water; Wei Qi is the fierce Qi of Grain and Water. The Lung directs Qi to all vessels; the Spleen controls Blood in all meridians. Thus, Blood is stored in the Liver but governed by Spleen and Stomach. Hemorrhage varies: Stomach Heat vomiting blood uses Qingwei San (Clear Stomach Powder); Liver Fire bleeding uses Dihuang Tang (Rehmannia Decoction); Kidney Deficiency Fire spitting blood uses Liuwei Wan. Proper use yields results.
However, bleeding from Spleen/Stomach is often ignored. The Spleen is the master of Ying/Wei and root of Qi/Blood. Mental frustration causes Depressed Heat, Spleen failing to control Blood from upper orifices; use Guipi Tang to tonify and astringe. Overwork damages Middle Qi, Spleen failing to control Blood from lower orifices; use Buzhong Tang to lift. One nourishes Spleen/Stomach Yin to guide Yang from Yin; the other tonifies Spleen/Stomach Yang to guide Yin from Yang.
Ancients said: "Qi tonification for Blood Loss" requires Renshen and Huangqi. "Lower bleeding concludes with Stomach medicines." This aims at Yang generating Yin and nourishing the source of transformation. People mistakenly use Shengdi and Tongbian to clear Heat and nourish Yin. But Spleen/Stomach deficiency cannot handle Shengdi's cloying nature; weak Middle Qi cannot tolerate Tongbian's cold depth. I have seen many fall into this trap, hence highlighting it.
Ke Yunbo stated: Blood loss is critical. Ancients provided detailed theories and methods. Li Dongyuan: Qi tonification for Blood Loss. Zhu Danxi: Yin tonification and Fire clearing. Lu Yangyu: Spirit calming and Blood tonification. Wu Qiu: Guiding Blood to Source. Hua Tuo: Alternating attack and tonification. Yutai: Removing Stasis and Generating New. Chao Yuanfang: Acrid-Warm Counter-Treatment. Ge Shi: Stop then Tonify. Xue Lizhai: Stomach medicines for conclusion and Source nourishment. No theory is invalid, no method is ineffective. Yet innovators succeed, followers fail through routine. Is it generational difference or lack of understanding?
The key to treating blood lies in regulating Qi and tonifying Blood; success lies in calming Spirit and securing Essence. Qi and Blood are paramount; Blood follows Qi. Why ignore Qi regulation in hemorrhage? Everyone knows Blood Loss requires tonification, yet many insist on Fire clearing and cold medicines, ignoring Qi collapse and Blood coagulation. This is pitiable. Qi hyperactive in Upper Jiao Yang channels injures Yang collaterals, causing oral/nasal overflow; treat with Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Decoction) to purge. Qi sinking to Lower Jiao Yin channels injures Yin collaterals, causing rectal/urinary bleeding; treat with Buzhong Yiqi Tang to lift. Excess Qi carries Fire; use bitter-cold to cool Qi. Deficient Qi carries Cold; use sweet-warm to tonify Qi. This is Qi regulation. Blood from Heart: Buyin Dan (Heart-Nourishing Pill). From Spleen: Guipi Tang. From Lung: Shengmai San (Generate Pulse Powder). From Kidney: Shenqi Wan (Kidney Qi Pill). This is Blood tonification.
Qi and Blood are Post-Heaven; Spirit is Pre-Heaven. Unscattered Spirit harmonizes Qi/Blood and preserves Form. Treating blood requires calming Spirit and securing Essence, allowing patients to accumulate Essence and preserve Spirit for recovery, avoiding premature death.