病源此由诸阳受邪热初在表，应发汗而汗不发，致使热毒入深，结于五脏内有瘀积，故
吐血。（出第八卷中）
仲景伤寒论吐血不止者，柏叶汤主之方。
青柏叶（三两） 干姜（二两切） 艾（三把）
上三味，以水五升煮取一升，去滓，别绞取新出马通汁一升相和，合煎取一升，绵滤之
温分再服，马通是马屎汁也。（一方有阿胶无艾）
又吐血下血黄土汤主之方
釜灶下黄焦土（半升绵裹） 甘草（三两炙） 干地黄（三两） 白术（三两） 附子
（三两
炮破） 阿胶（三两炙） 黄芩（三两）
上七味切，以水八升，煮六味取二升，去滓，纳胶令烊，分三服。忌海藻菘菜芜荑猪肉
桃李雀肉等物。（并出第十六卷中）
古今录验蒲黄汤，疗伤寒温病天行疫毒，及酒客热伤中吐血不止，面黄干呕心烦方。
蒲黄 桑寄生 桔梗（一作栝蒌） 犀角（屑） 甘草（各二两炙） 葛根（三两）
上六味切，以水七升，煮取三升，去滓，分三服，徐徐服之。忌海藻菘菜猪肉。（出第
三卷中）
病源伤寒病衄血者，此由五脏热结所为也，心主血，肝藏血热邪伤于心肝，故衄血也，
衄者，鼻出血也，肺主气而开窍于鼻，血随气行，所以从鼻出，阳明病口燥，但欲漱水不欲
咽者，此必衄，衄家不可攻其表，汗出额上，脉急而紧，直视而不能 ，不得眠，亡血不可
攻其表，汗出则寒栗而振脉浮紧发热，其身无汗，自衄者愈。（出第八卷中）
肘后疗伤寒大病瘥后小劳便鼻衄，牡蛎散及丸方。
左顾牡蛎（十分熬） 石膏（五分）
上二味捣末，酒服方寸匕，日三四，亦可蜜丸如梧子大，酒服十五丸。（集验千金并同
出第二卷中）
短剧芍药地黄汤，疗伤寒及温病，应发汗而不发之，内瘀有蓄血者，及鼻衄吐血不尽，
内余瘀血面黄大便黑者，此主消化瘀血。
芍药（三分） 地黄（半斤） 丹皮（一两） 犀角屑（一两）
上四味切，以水一斗，煮取四升，去滓温服一升，日二三服，有热如狂者，加黄芩二两
，其人脉大来迟，腹不满，自言满者为无热，不用黄芩。
又茅花汤，疗伤寒鼻衄不止主之方。
茅花（一大把）
上以水八升，煮取三升，分三服，即瘥，若无茅花，取茅根代之亦可。
又麦门冬汤，疗伤寒身热衄血呕逆主之方。
麦门冬 石膏 寒水石（各三两） 甘草（二两） 桂心（一两）
上五味切，以水一斗，煮取三升，分三服。
The etiology stems from pathogenic heat invading the Yang meridians. Initially located in the exterior, if sweating therapy is indicated but not administered, the pathogenic heat and toxicity penetrate deeply, stagnating within the Five Viscera and forming blood stasis internally, thus leading to hematemesis (vomiting blood). (From Volume VIII)
Zhang Zhongjing's *Shanghan Lun* states: For Shanghan disease presenting with incessant hematemesis, Baiye Tang (Cypress Leaf Decoction) is the primary formula.
Qingbaiye (Cypress Leaf, 3 liang) Ganjiang (Dried Ginger, 2 liang, sliced) Aiye (Mugwort Leaf, 3 bunches)
These three ingredients are decocted in 5 sheng of water until 1 sheng remains. The dregs are strained out. Fresh Matong juice (juice extracted from horse manure), 1 sheng, is added separately and mixed together, then decocted again until 1 sheng remains. The liquid is filtered through silk cloth and taken warm in two divided doses. Matong refers to the juice of horse manure. (Another version includes Ejiao [Donkey-hide Gelatin] instead of Aiye.)
Furthermore, for hematemesis and lower bleeding (hematochezia/melena), Huangtu Tang (Yellow Earth Decoction) is the primary formula.
Fuzaoxiahuangjiaotu (Yellow scorched earth from under the cooking pot, 0.5 sheng, wrapped in silk) Gancao (Licorice Root, 3 liang, honey-fried) Shengdihuang (Rehmannia Root, 3 liang) Baizhu (Atractylodes Macrocephala Rhizome, 3 liang) Fuzi (Prepared Aconite Lateral Root, 3 liang, processed and broken) Ejiao (Donkey-hide Gelatin, 3 liang, honey-fried) Huangqin (Scutellaria Root, 3 liang)
These seven ingredients are cut into pieces. Decoct the first six in 8 sheng of water until 2 sheng remain. Strain out the dregs, add Ejiao and stir until dissolved. Divide into three doses. Avoid consuming Haizao (Sargassum), Songcai (Chinese Cabbage), Wuyi (Chrysanthemum Indicum Flower), pork, peach, plum, and sparrow meat. (All from Volume XVI)
Gujin Luyan Puhuang Tang (Pollen Typhae Decoction from Ancient and Modern Records of Verified Prescriptions) treats Shanghan, Wenbing (Warm Diseases), Tianxing Yidu (epidemic toxins transmitted by air), as well as hematemesis caused by heat damaging the Middle Jiao in wine drinkers, accompanied by sallow complexion, dry retching, and mental restlessness.
Puhuang (Pollen Typhae) Sangjisheng (Taxillus Chinensis) Jiegeng (Platycodon Root, alternatively Gualou [Trichosanthes Fruit]) Xijiao (Rhinoceros Horn, crushed) Gancao (Licorice Root, each 2 liang, honey-fried) Gegen (Pueraria Root, 3 liang)
These six ingredients are cut into pieces. Decoct in 7 sheng of water until 3 sheng remain. Strain out the dregs and divide into three doses. Take slowly. Avoid Haizao, Songcai, and pork. (From Volume III)
Regarding etiology, Nyuxue (epistaxis/nosebleed) in Shanghan disease is caused by heat accumulation in the Five Viscera. The Heart governs blood, and the Liver stores blood; when pathogenic heat injures the Heart and Liver, nyuxue occurs. "Nyuxue" refers to bleeding from the nose. The Lung governs Qi and opens into the nose; since blood follows Qi in its circulation, it exits through the nasal cavity. In Yangming disease, dryness of the mouth with a desire only to rinse the mouth without swallowing indicates that epistaxis is inevitable. Patients prone to epistaxis should not undergo exterior-releasing therapies; if sweat is induced erroneously, sweating may occur on the forehead, the pulse becomes rapid and tight, the eyes stare fixedly without movement, and insomnia ensues. Patients who have lost blood should not undergo exterior-releasing therapies; if sweat is induced erroneously, chills and tremors will result. If the pulse is floating and tight, fever is present, and there is no sweat on the body, spontaneous epistaxis leads to recovery. (From Volume VIII)
Zhouhou Fang (*Essential Prescriptions Worth a Thousand Gold*) treats epistaxis occurring after minor exertion following the convalescence of severe Shanghan disease, using Musan San and Wan (Oyster Shell Powder and Pill).
Zuogu Muli (Left-facing Oyster Shell, 10 fen, calcined) Shigao (Gypsum Fibrosum, 5 fen)
These two ingredients are pounded into powder. Take one fangcun bi (a square-inch measure) with wine, three to four times daily. Alternatively, form honey pills the size of wuzi (wu-tzu seeds/medlar seeds) and take fifteen pills with wine. (*Jiyan Fang* and *Qianjin Fang* agree. From Volume II)
Duanju Fang Shaoyao Dihuang Tang (Peony and Rehmannia Decoction from Short Drama Formulas) treats Shanghan and Wenbing where sweating was indicated but not performed, leading to internal blood stasis and accumulation. It also treats incomplete resolution of epistaxis or hematemesis, residual internal blood stasis, sallow complexion, and black stool. This formula primarily functions to resolve blood stasis.
Shaoyao (White Peony Root, 3 fen) Dihuang (Rehmannia Root, 0.5 jin) Danpi (Moutan Cortex, 1 liang) Xijiaoxie (Crushed Rhinoceros Horn, 1 liang)
These four ingredients are cut into pieces. Decoct in 1 dou of water until 4 sheng remain. Strain out the dregs and take 1 sheng warm, two to three times daily. If there is fever and manic behavior, add Huangqin (Scutellaria Root, 2 liang). If the patient's pulse is large but slow upon arrival, the abdomen is not distended, yet the patient complains of fullness, this indicates absence of heat; do not use Huangqin.
Additionally, Maohua Tang (Imperata Rhizome Flower Decoction) treats incessant epistaxis due to Shanghan.
Maohua (Flowers of Imperata Cylindrica, one large bunch)
Decoct in 8 sheng of water until 3 sheng remain. Divide into three doses. Recovery will follow. If Maohua is unavailable, Maogen (Rhizoma Imperatae) can be used as a substitute.
Additionally, Maidong Tang (Ophiopogon Decoction) treats Shanghan presenting with body heat, epistaxis, and vomiting/reversal of Qi.
Maidong (Ophiopogon Tuber) Shigao (Gypsum Fibrosum) Hanshuishi (Calcitum, each 3 liang) Gancao (Licorice Root, 2 liang) Guixin (Cinnamon Twig Bark, 1 liang)
These five ingredients are cut into pieces. Decoct in 1 dou of water until 3 sheng remain. Divide into three doses.