一切诸失血症。脉沉小身凉者生。脉大身热者死。吐后。脉微者。可治。吐衄后。复大
热。脉反躁。急者死。
夫人身之血。名曰荣。荣者。谓荣润于身之物也。血生精。故血充则力强体健。颜色青
为血虚。色赤为血热。白色气血两虚。血属阴。阴乃阳之守也。阴有质者。则阳气得以倚附
焉。阴精一虚。则诸火炎炎。众液沸腾妄行矣。夫人之五内。心生血。脾统血。肝藏血
水也。中和则循经调畅。寒则凝滞。热则涌射。惟小儿不知冷热。衣被过浓。亦致客热。则
鼻中衄也。郁热结于阳明之经。故伤寒鼻流血。名曰红汗。邪随而解矣。治法不同。其男妇
阴血。皆系于心脾。君相二火协动。以致妄行而成血症。其先天真阴不足者。欲虽不淫。亦
作斫丧精竭而论。相火暴炽冲上。血涌诸络管而来。鲜者宜凉补之剂止之。瘀者不可用京墨
及十灰散、三七等劫药阻塞。惟清凉引血归元。补益滋阴降火。乃为良策也。
一论吐血。皆因虚火妄动。血得热而妄行。此方主之。
凉血地黄汤
犀角（乳汁磨临服入药内或锉末煎四分） 生地黄（酒洗一钱） 牡丹皮（二钱） 赤芍（七
分）
黄连（酒炒一钱） 黄芩（酒炒一钱） 黄柏（酒炒五分） 知母（一钱） 玄参（一钱） 天门冬（
去心一钱） 扁柏叶（三钱许） 茅根（二钱）
上锉。水煎。入后十汁同服。
一吐血成块者。加大黄一钱。桃仁十个。去皮尖。研如泥。衄血。加栀子、沙参、玄参
溺
血。加木瓜、牛膝、条芩、荆穗、地榆。倍知、柏。便血。加黄连、槐花、地榆、荆穗、乌
梅。善酒者。加葛根、天花粉。
十汁饮
藕节 甜梨 茅根 韭菜 萝卜 家园生地黄 沙蜜 竹沥 童便 京墨（磨藕汁）
上十汁。合作一处。不见火。入前汤药半钟。频频服之。不可间断。服至血止。再服后
滋阴清火汤同服。
一治吐血不止神方
家园生地黄（半斤洗净捣烂扭汁） 生大黄末（一方寸七钱许）
上煎地黄汁三沸。下大黄末调匀。空心服。温饮一小盏。一日三服。血即止。
一治吐血咳嗽。上喘心慌。脉洪火盛。死在须臾。家园生地黄（北人呼为婆娑奶遍地有
之）取来洗净。捣汁半钟。白童便半钟。二味合一处。重汤煮一沸。温服立效。
一论吐血。觉胸中气塞上。吐紫血者。此上焦积热也。宜桃仁承气汤。（方见伤寒）
一治诸失血。韭菜连根洗净。石臼内捣烂。入童便。用布扭去渣。重汤煮荡令热。浊者
居下不用。止用清者。或单服。或入药服俱好。或调百草霜二钱服之。血止效。
一论吐血衄血。宜用
滋阴清火汤
当归（二钱） 川芎（五分） 赤芍（七分） 生地黄（一钱五分） 黄柏（乳汁炒一钱） 生知
母（
一钱） 麦门冬（去心一钱） 牡丹皮（一钱） 玄参（一钱） 犀角（一钱） 山栀仁（炒黑一钱）
阿胶（炒五分） 甘草（三分）
上锉一剂。水煎。入十汁饮同服。如不思饮食。加白术去芦一钱。
一治吐血不止。属实热者。胡云阁传。
将军丸
锦纹大黄酒拌。九蒸九晒。为末。水丸如梧桐子大。每服四五十丸。白滚汤送下。下血
条芩汤送下。
一论先吐血而后见痰者。是阴虚也。宜
清火滋阴汤
天门冬（去心） 麦门冬（去心） 生地黄 牡丹皮 赤芍 栀子 黄连 山药 山茱萸（
去核） 泽泻 赤茯苓（去皮） 甘草
上锉一剂。水煎。入童便同服。
一论先吐痰而后见血者。是积热也。宜
清肺汤
白茯苓（去皮） 陈皮 当归 生地黄 芍药 天门冬（去心） 麦门冬（去心） 黄芩 山
栀紫菀 阿胶（炒） 甘草（减半） 乌梅（一个） 桑白皮（各等分）
上锉一剂。枣一枚。水煎服。喘急。加苏子。去天门冬。
一治吐血。一服立止。
归尾 赤芍 生地黄 百合 贝母 栀子（炒） 麦门冬（去心各一钱） 蒲黄（炒黑） 牡
丹皮（各七分） 川芎 阿胶（炒） 熟地黄 桃仁（去皮尖各五分）
上锉一剂。生姜一片。水煎服。
一论痰中见血。
当归（一钱） 白芍（一钱） 白术（一钱五分） 青皮（五分） 桃仁（去皮尖一钱） 牡丹
皮（一
钱五分） 黄芩（八分） 桔梗（五分） 贝母（一钱） 栀子（炒黑八分） 甘草（三分）
潮热。加柴胡、赤茯苓。
上锉一剂。生姜三片。水煎。温服。
一论每言语过多。即吐血一二口。久有此病。遇劳即作。此劳伤肺气。其血必散。视之
果然
宜服补中益气汤。（方见内伤）根据本方加麦门冬、五味子、山药、地黄、茯神、远志立效。
一论吐血。每遇劳则作。咳嗽有痰。吐血。脾胃肾三脉皆洪数。宜补中益气汤。根据本方加贝
母、茯苓、石枣、山药、麦门、五味。一男子鳏居数年。素勤苦。劳则吐血发热烦躁。服犀
角地黄汤。气高而喘。前病益盛。更遗精白浊。形体倦怠。饮食少思。脉洪大。举按有力。
服十全大补汤。加麦门冬、五味、山药、山茱而愈。
一儒者素勤劳苦。吐血发痉。不知人事。余以为脾胃虚损。用十全大补汤。及加减八味
丸。而痉愈。用归脾汤而血止。
一童子年十四。发热吐血。余谓宜补中益气汤。兼滋化源。伊芳信用寒凉降火。愈甚。始
谓余
曰。童子未室。何肾虚之有。参、 补气。奚为用之。余述丹溪云。肾主闭藏。肝主疏泄。
二脏俱有相火。而其系上属于心。心为君火。为物所感。则易于动。心动则相火翕然而随。
虽不交会。其精亦暗耗矣。又精血篇云。男子精末满而御女以通其精。则五脏有不满之处。
异日有难状之疾。遂用补中益气汤。及六味地黄丸。加麦门冬、五味。治之而愈。后因劳怒
忽吐紫血块。先用花蕊石散。又用独参汤渐愈。后劳则咳嗽吐血一二口。脾胃肾三脉皆
洪数。用补中益气汤、六味地黄丸全愈。
All hemorrhagic syndromes: If the pulse is deep and fine (Chen Xiao) and the body is cool, there is hope for survival. If the pulse is large (Da) and the body is hot, it indicates a fatal prognosis. After vomiting blood, if the pulse is faint (Wei), it is treatable. After hematemesis or epistaxis, if high fever returns and the pulse becomes rapid and restless (Zao), it is a death sign.
The blood in the human body is called Ying Blood (Ying Xue), meaning the substance that nourishes and moistens the body. Blood generates essence; therefore, abundant blood results in strong physical power and health. A bluish complexion indicates blood deficiency (Xue Xu); a red complexion indicates blood heat (Xue Re); a white complexion indicates both Qi and blood deficiency (Qi Xue Liang Xu). Blood belongs to Yin, and Yin guards Yang. Since Yin has substance, Yang Qi can rely upon it. Once Yin Essence is deficient, various fires blaze fiercely, causing bodily fluids to boil and flow recklessly. Among the five internal organs, the Heart generates blood, the Spleen controls blood, and the Liver stores blood. When harmonious, blood flows smoothly through the meridians; when cold, it stagnates; when hot, it surges and sprays. Only children do not know how to regulate warmth and coldness; excessive clothing leads to external heat retention, causing epistaxis. Stagnant heat accumulates in the Yangming Meridian, so in Cold Damage (Shang Han), nasal bleeding is called "Red Sweat" (Hong Han), and the pathogen resolves with the blood. The treatment method differs. The Yin blood of men and women is associated with the Heart and Spleen. Ministerial Fire (Xiang Huo) and Sovereign Fire (Jun Huo) act together, causing blood to flow recklessly and resulting in hemorrhage. Those with congenital True Yin deficiency may exhaust their essence even without sexual indulgence. Sudden blazing of Ministerial Fire rushing upward causes blood to surge from various collaterals. For fresh bright blood, cooling and tonifying agents should be used to stop bleeding. For dark clotted blood, harsh astringents like Jing Mo (Beijing Ink), Shi Hui San (Ten Ash Powder), or San Qi are contraindicated for blocking. Instead, cooling methods to guide blood back to its origin, combined with tonifying Yin and descending fire, are the best strategy.
Regarding Hematemesis: It is all caused by deficient fire moving recklessly, and blood flowing recklessly due to heat. This formula treats it.
Liang Xue Di Huang Tang (Cool Blood Rehmannia Decoction)
Xi Jiao (Rhinoceros Horn - use milk to grind and add before taking, or crush into powder and decoct 4 fen) Sheng Di Huang (Raw Rehmanniae Radix, washed with wine 1 qian) Mu Dan Pi (Moutan Cortex, 2 qian) Chi Shao (Red Peony Root, 7 fen)
Huang Lian (Coptidis Rhizoma, fried with wine 1 qian) Huang Qin (Scutellariae Radix, fried with wine 1 qian) Huang Bai (Phellodendri Cortex, fried with wine 5 fen) Zhi Mu (Anemarrhenae Rhizoma, 1 qian) Xuan Shen (Scrophulariae Radix, 1 qian) Tian Men Dong (Asparagi Radix, remove heart 1 qian) Bian Bai Ye (Platycladi Cacumen, approx. 3 qian) Mao Gen (Imperatae Rhizoma, 2 qian)
Crush the above herbs, decoct in water, and take with the following ten juices.
If blood vomited forms clots, add Da Huang (Rhei Radix et Rhizoma) 1 qian and Tao Ren (Persicae Semen, remove skin and tip, 10 seeds, grind into paste). For epistaxis, add Zhi Zi (Gardeniae Fructus), Sha Shen (Glehniae Radix), and Xuan Shen. For hematuria, add Mu Gua (Chaenomelis Fructus), Niu Xi (Achyranthis Bidentatae Radix), Tiao Qin (Scutellariae Radix), Jing Sui (Schizonepetae Spica), and Di Yu (Sanguisorbae Radix), doubling the dosage of Zhi Mu and Huang Bai. For melena, add Huang Lian, Huai Hua (Sophorae Flos), Di Yu, Jing Sui, and Wu Mei (Mume Fructus). For those who drink alcohol, add Ge Gen (Puerariae Lobatae Radix) and Tian Hua Fen (Trichosanthis Radix).
Shi Zhi Yin (Ten Juices Drink)
Ou Jie (Nelumbinis Nodeus) Tian Li (Sweet Pear) Mao Gen (Imperatae Rhizoma) Jiu Cai (Chinese Chive) Luo Bo (Radish) Jia Yuan Sheng Di Huang (Garden-grown Raw Rehmanniae Radix) Mi Feng (Honey) Zhu Li (Bamboo Sap) Tong Bian (Child's Urine) Jing Mo (Beijing Ink, ground into Ou Jie juice)
Mix the ten juices together, do not cook over fire, add half a cup of the previous decoction, and take frequently without interruption. Once bleeding stops, continue taking Zi Yin Qing Huo Tang (Nourish Yin Clear Fire Decoction) together.
Divine prescription for intractable hematemesis:
Jia Yuan Sheng Di Huang (Half jin of garden-grown raw Rehmanniae Radix, washed, pounded, and juiced) Sheng Da Huang Mo (Powder of Raw Rhei Radix et Rhizoma, approx. 1 qian)
Boil the Rehmannia juice three times, mix in the Da Huang powder evenly. Take on an empty stomach with a small cup of warm water. Take three times a day; bleeding will stop.
For hematemesis with cough, upper asthma, palpitations, surging pulse indicating excess fire, where death is imminent:
Take Jia Yuan Sheng Di Huang (known as Posuonai in the north, common everywhere), wash clean, pound to extract half a cup of juice. Mix with half a cup of white Tong Bian (child's urine). Combine the two, boil briefly in a double boiler, and take warm for immediate effect.
Regarding hematemesis: If one feels chest oppression and qi rising, vomiting purple blood, this is accumulated heat in the Upper Jiao. Use Tao Ren Cheng Qi Tang (Peach Kernel Cathartic Decoction). (Formula see Shang Han).
Treatment for various hemorrhages: Wash Chinese chives with roots, pound in a stone mortar, add Tong Bian (child's urine), squeeze out residue with cloth, heat gently in a double boiler. Discard the turbid sediment at the bottom, use only the clear liquid. Take alone or mixed with medicine. Alternatively, mix with 2 qian of Bai Cao Shuang (soot from hundred herbs). Effective for stopping bleeding.
For hematemesis and epistaxis, use:
Zi Yin Qing Huo Tang (Nourish Yin Clear Fire Decoction)
Dang Gui (Angelicae Sinensis Radix, 2 qian) Chuan Xiong (Ligustici Chuanxiong Rhizoma, 5 fen) Chi Shao (Red Peony Root, 7 fen) Sheng Di Huang (Raw Rehmanniae Radix, 1.5 qian) Huang Bai (Phellodendri Cortex, fried with milk 1 qian) Sheng Zhi Mu (Raw Anemarrhenae Rhizoma, 1 qian) Mai Men Dong (Ophiopogonis Radix, remove heart 1 qian) Mu Dan Pi (Moutan Cortex, 1 qian) Xuan Shen (Scrophulariae Radix, 1 qian) Xi Jiao (Rhinoceros Horn, 1 qian) Shan Zhi Ren (Gardeniae Fructus, charred black 1 qian) E Jiao (Donkey-hide Gelatin, fried 5 fen) Gan Cao (Licorice Root, 3 fen)
Crush one dose, decoct in water, and take with Shi Zhi Yin (Ten Juices Drink). If appetite is poor, add Bai Zhu (Atractylodis Macrocephalae Rhizoma, remove rhizome) 1 qian.
For intractable hematemesis due to excess heat, transmitted by Hu Yunge:
Jiang Jun Wan (General Pill)
Jin Wen Da Huang (Brocade-patterned Rhei Radix et Rhizoma) steamed nine times and dried nine times after marinating in wine, ground into powder, formed into pills the size of Sophora seeds. Take 40-50 pills each time with plain boiled water. For lower GI bleeding, take with Tiao Qin Tang (Scutellaria Decoction).
Regarding vomiting blood first then seeing phlegm: This is Yin deficiency. Use:
Qing Huo Zi Yin Tang (Clear Fire Nourish Yin Decoction)
Tian Men Dong (Asparagi Radix, remove heart) Mai Men Dong (Ophiopogonis Radix, remove heart) Sheng Di Huang (Raw Rehmanniae Radix) Mu Dan Pi (Moutan Cortex) Chi Shao (Red Peony Root) Zhi Zi (Gardeniae Fructus) Huang Lian (Coptidis Rhizoma) Shan Yao (Dioscoreae Rhizoma) Shan Zhu Yu (Corni Fructus, remove pit) Ze Xie (Alismatis Rhizoma) Chi Fu Ling (Red Poria, remove skin) Gan Cao (Licorice Root)
Crush one dose, decoct in water, and take with Tong Bian (child's urine).
Regarding vomiting phlegm first then seeing blood: This is accumulated heat. Use:
Qing Fei Tang (Clear Lung Decoction)
Bai Fu Ling (White Poria, remove skin) Chen Pi (Citri Reticulatae Pericarpium) Dang Gui (Angelicae Sinensis Radix) Sheng Di Huang (Raw Rehmanniae Radix) Shao Yao (Paeoniae Radix) Tian Men Dong (Asparagi Radix, remove heart) Mai Men Dong (Ophiopogonis Radix, remove heart) Huang Qin (Scutellariae Radix) Zhi Zi (Gardeniae Fructus) Zi Wan (Asteris Radix) E Jiao (Donkey-hide Gelatin, fried) Gan Cao (Licorice Root, halved) Wu Mei (Mume Fructus, one) Sang Bai Pi (Mori Cortex, equal parts)
Crush one dose, add one jujube, decoct in water, and take. For asthma urgency, add Su Zi (Perillae Fructus) and remove Tian Men Dong.
Treatment for hematemesis, stops immediately after one dose:
Gui Wei (Cinnamon Twig? No, Angelicae Sinensis Radix Tail) Chi Shao (Red Peony Root) Sheng Di Huang (Raw Rehmanniae Radix) Bai He (Lilii Bulbus) Bei Mu (Fritillariae Cirrhosae Bulbus) Zhi Zi (Gardeniae Fructus, fried) Mai Men Dong (Ophiopogonis Radix, remove heart, 1 qian each) Pu Huang (Typhae Pollen, charred black) Mu Dan Pi (Moutan Cortex, 7 fen each) Chuan Xiong (Ligustici Chuanxiong Rhizoma) E Jiao (Donkey-hide Gelatin, fried) Shu Di Huang (Prepared Rehmanniae Radix) Tao Ren (Persicae Semen, remove skin and tip, 5 fen each)
Crush one dose, add one slice of Sheng Jiang (Fresh Ginger), decoct in water, and take.
Regarding blood in phlegm:
Dang Gui (Angelicae Sinensis Radix, 1 qian) Bai Shao (White Peony Root, 1 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian) Qing Pi (Citri Reticulatae Pericarpium Viride, 5 fen) Tao Ren (Persicae Semen, remove skin and tip, 1 qian) Mu Dan Pi (Moutan Cortex, 1.5 qian) Huang Qin (Scutellariae Radix, 8 fen) Jie Geng (Platycodonis Radix, 5 fen) Bei Mu (Fritillariae Cirrhosae Bulbus, 1 qian) Zhi Zi (Gardeniae Fructus, charred black 8 fen) Gan Cao (Licorice Root, 3 fen)
For tidal fever, add Chai Hu (Bupleuri Radix) and Chi Fu Ling (Red Poria).
Crush one dose, add three slices of Sheng Jiang (Fresh Ginger), decoct in water, and take warm.
Regarding speaking too much leading to vomiting one or two mouthfuls of blood, chronic condition worsening with fatigue: This is Lung Qi injury due to overwork, causing blood to scatter. Observation confirms this. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). (Formula see Nei Shang/Injury by Internal Causes). Add Mai Men Dong (Ophiopogonis Radix), Wu Zi (Schisandrae Fructus), Shan Yao (Dioscoreae Rhizoma), Di Huang (Rehmanniae Radix), Fu Shen (Poria with Hostwood), and Yuan Zhi (Polygalae Radix) to this formula for effective results.
Regarding hematemesis worsening with fatigue, accompanied by cough with phlegm, surging and rapid pulses in Spleen, Stomach, and Kidney positions: Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Add Bei Mu (Fritillariae Cirrhosae Bulbus), Fu Ling (Poria), Shi Zao (Jujubae Fructus? Likely a typo for Shi Chang Pu or similar, but text says Shi Zao), Shan Yao (Dioscoreae Rhizoma), Mai Men Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Fructus). A man living celibate for years, usually hardworking, developed hematemesis, fever, and irritability upon exertion. He took Xi Jiao Di Huang Tang (Rhinoceros Horn Rehmannia Decoction), which worsened his asthma and prior symptoms, leading to seminal emission and cloudy urine, fatigue, poor appetite, and a surging, forceful pulse. He was cured by Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Mai Men Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Shan Yao (Dioscoreae Rhizoma), and Shan Zhu Yu (Corni Fructus).
A scholar, usually hardworking, suffered hematemesis and spasms, losing consciousness. I diagnosed Spleen and Stomach deficiency. Used Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) and Jia Jian Ba Wei Wan (Modified Eight Flavor Pill) to cure spasms, then Gui Pi Tang (Restore the Spleen Decoction) to stop bleeding.
A fourteen-year-old boy had fever and hematemesis. I advised Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation. His father insisted on using cold-cooling fire-descending drugs, worsening the condition. Later he said, "The boy is unmarried, why kidney deficiency? Why use Ginseng and Astragalus to tonify Qi?" I cited Danxi: "The Kidney governs closure/storage, the Liver governs dispersion. Both contain Ministerial Fire, connected to the Heart. The Heart is Sovereign Fire, easily moved by stimuli. When the Heart moves, Ministerial Fire follows. Even without intercourse, essence is secretly consumed." Also, the Chapter on Essence and Blood states: "If a male engages in intercourse before his essence is full, the five zang organs will have deficiencies, leading to difficult-to-describe diseases later." Thus, I used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) added with Mai Men Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Fructus), curing him. Later, due to fatigue and anger, he suddenly vomited purple blood clots. First used Hua Rui Shi San (Flower Coral Stone Powder), then Du Shen Tang (Single Ginseng Decoction) until gradually recovered. Later, fatigue caused cough and vomiting of one or two mouthfuls of blood, with surging, rapid pulses in Spleen, Stomach, and Kidney positions. Cured completely with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill).