秦子曰∶胃中呕出名吐血；肺中嗽出名咳血。吐血阳明胃家症；咳血太阴肺家症。丹溪
以呕血嗽血，皆从口中吐出，总名之曰吐血，故呕咳不分，肺胃罔别。余今分别咽中胃管呕
出名吐血；喉中肺管嗽出名咳血，则经络分明，治法不混。
【外感吐血之症】发热烦躁，面赤目赤，口干唇红，夜不得卧，从口吐出，纯血无痰
，此外感吐血之症也。
【外感吐血之因】内有积热，诸经火盛，外有风寒，束其肌表，血络热甚，不得外越
，妄行上冲，从口呕出，故外感吐血，责之邪热妄行。
【外感吐血之脉】脉必洪大；或见浮紧，表邪未解；或见沉数，里热炽盛；失血太多
，若见芤涩。洪大和缓易治，沉细弦急难医。
【外感吐血之治】若身痛发热，表邪未解，此太阳邪热攻冲，脉浮大而数者，羌活冲
加减治之，佐以清胃之药。若表邪已散，身仍发热，目痛不眠，此阳明经邪热；脉长而数者
，干葛石膏汤，佐以凉血之药；或用犀角地黄丸；耳聋寒热，兼用小柴胡汤；脉芤而涩者，
归芍地黄汤；血紫胸痛，红花桃仁汤。外感门衄血，乃是表邪，今吐血门，乃是热邪在里，
羌活冲和汤 治太阳失汗，表邪未解者。
羌活 黄芩 生地 荆芥 川芎 葛根 甘草
葛根石膏汤 治阳明热盛，吐血不止者。
葛根 石膏 山栀 黄芩 荆芥 丹皮 生地
热甚者加川连；大便结，加大黄。
犀角地黄汤
生地 犀角 丹皮 山栀 白芍药 荆芥
小柴胡汤 治吐血兼少阳经见证。
柴胡 黄芩 广皮 甘草
归芍地黄汤
当归 白芍药 生地 丹皮 茯苓 山药 山茱萸 泽泻
红花桃仁汤
红花 桃仁 丹皮 楂肉 赤芍药 泽兰 归尾 红曲
大便结，加酒煮大黄。
Qin Zi stated: Vomiting blood from the stomach is termed hematemesis (hemoptysis/tu xue); coughing up blood from the lungs is termed hemoptysis (ke xue). Hematemesis belongs to the syndrome of the Yangming Stomach channel; hemoptysis belongs to the syndrome of the Taiyin Lung channel. Danxi considered that both vomiting blood and coughing up blood are expelled from the mouth, thus collectively naming them hematemesis, thereby confusing vomiting with coughing and failing to distinguish between the Lungs and the Stomach. I now differentiate them as follows: blood vomited from the pharynx and esophagus (wei guan) is hematemesis; blood coughed up from the larynx and trachea (fei guan) is hemoptysis. In this way, the meridians are clearly distinguished, and treatment methods will not be confused.
[Symptoms of Exogenous Hematemesis] Fever, irritability, redness of the face and eyes, dry mouth with red lips, inability to sleep at night, and expulsion of pure blood without phlegm from the mouth constitute the symptoms of exogenous hematemesis.
[Etiology of Exogenous Hematemesis] Internal accumulation of heat and excessive fire in various channels, combined with external wind-cold binding the muscle surface, causes extreme heat in the blood collaterals. The blood cannot diffuse outward and rushes upward recklessly, vomiting from the mouth. Therefore, exogenous hematemesis is attributed to reckless movement due to pathogenic heat.
[Pulse Signs of Exogenous Hematemesis] The pulse must be surging (Hong) and large; or floating-tight (Fu Jin), indicating unresolved exterior pathogens; or deep-rapid (Chen Shu), indicating blazing interior heat; if excessive blood loss occurs, a knotted (Kou) or choppy (Se) pulse may appear. A surging and harmonious pulse is easy to treat, whereas a deep, fine, wiry, and rapid pulse is difficult to cure.
[Treatment of Exogenous Hematemesis] If there is body pain and fever with unresolved exterior pathogens, this is an attack by Yangming pathogenic heat; if the pulse is floating, large, and rapid, use Qianghuo Chonghe Tang (Notopterygium Decoction for Harmonization) with modifications, assisted by herbs that clear the Stomach heat. If the exterior pathogens have dispersed but fever persists, accompanied by eye pain and insomnia, this is pathogenic heat in the Yangming channel; if the pulse is long and rapid, use Gegen Shigao Tang (Pueraria and Gypsum Decoction) assisted by blood-cooling herbs; alternatively, use Xijiao Dihuang Wan (Rhinoceros Horn and Rehmannia Pill); if there is deafness and alternating chills and fever, combine with Xiaochaihu Tang (Minor Bupleurum Decoction); if the pulse is knotted and choppy, use Guishao Dihuang Tang (Angelica and White Peony and Rehmannia Decoction); if the blood is dark purple with chest pain, use Honghua Taoren Tang (Safflower and Peach Kernel Decoction). Epistaxis (nosebleed) in the Exogenous chapter is caused by exterior pathogens; however, hematemesis in this chapter is caused by heat pathogens in the interior. Qianghuo Chonghe Tang treats cases where the Taiyin channel has not sweated out the pathogens, leaving the exterior unresolved.
Ingredients for Qianghuo Chonghe Tang: Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Shengdi (Rehmanniae Radix), Jingjie (Schizonepetae Herba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Gegen (Puerariae Lobatae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Gegen Shigao Tang treats cases of blazing Yangming heat with incessant hematemesis.
Ingredients: Gegen (Puerariae Lobatae Radix), Shigao (Gypsi Fibrosus), Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Jingjie (Schizonepetae Herba), Danpi (Moutan Cortex), Shengdi (Rehmanniae Radix).
For severe heat, add Chuanlian (Coptidis Rhizoma); for constipation, add Dahuang (Rhei Radix et Rhizoma).
Xijiao Dihuang Tang
Ingredients: Shengdi (Rehmanniae Radix), Xijiao (Rhinocerotis Cornu - *Note: Substitute with water buffalo horn in modern practice*), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus), Baishaoyao (Paeoniae Radix Alba), Jingjie (Schizonepetae Herba).
Xiaochaihu Tang treats hematemesis accompanied by Shaoyang channel manifestations.
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Guishao Dihuang Tang
Ingredients: Danggui (Angelicae Sinensis Radix), Baishaoyao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), Zexie (Alismatis Rhizoma).
Honghua Taoren Tang
Ingredients: Honghua (Carthami Flos), Taoren (Persicae Semen), Danpi (Moutan Cortex), Zharon (Crataegi Fructus), Chishaoyao (Paeoniae Radix Rubra), Zelan (Leonuri Herba), Guiwei (Angelicae Sinensis Radix), Hongqu (Rhizophora Mucor).
For constipation, add Dahuang (Rhei Radix et Rhizoma) stewed with wine.