（即齿衄）
牙宣有二证。有风壅牙宣。有肾虚牙宣。风壅牙宣。消风散擦之。仍服。肾虚牙宣。以
肾主
丸。间黑锡丹。仍用姜盐炒香附。黑色为末。揩擦。其妙不可言也。
吐血者。血溢入浊道。留聚膈间。满则吐血。名曰内衄。宜苏子降气汤加人参阿胶各半
钱。
下养正丹。湿溢血伤。能令吐血。肾着汤。加川芎名除湿汤。此乃湿毒郁于经络。血溢妄行
从鼻则衄衄行清道。吐行浊道。流入胃脘。令人吐。血妄行于上。或吐。或咯。或嗽。用
琥珀效者。固多有之。宜择末药中。入此一味。或煎药去滓。可调服。
一吐血咯血。炒绿豆粉。和小乌沉汤。白汤点服。吐血不止者。菜头捣汁呷之。咯血者
每日空心进一二呷。入侧柏一两。沙参一两。焙研末。入飞面二钱。调如稀糊啜服。
上膈壅热吐血、四物汤、加荆芥、阿胶、各半钱。更不止。于本方中。加大黄滑石各半
钱。或降气汤。吞木香槟榔丸。从大便导之。（此实热则可。虚劳则不可）
吐甚头晕发为寒热者。降气汤。加四物汤各半帖。加阿胶一钱。若单单发热者。茯苓补
心汤。
胃伤吐血。宜理中汤。加川芎干葛。俱各半钱。或只根据理中本方。加川芎扁豆尤好。不
必干
葛。若渴甚。用葛打损恶血。渗入胃中。以致吐血。宜先进苏合香丸。仍以黑神散。和小乌
沉汤。童便调治。夏月伏暑吐血。茅花汤调五苓散。有因劳力太过。吐血不止。苏子降气汤
加人参半钱煎。
有时或吐血两口。随即无事。数日又发。经年累月不愈者。宜黑神散。和小乌沉汤常服
吐血。人多发渴。名为血渴。四物汤。十全大补汤。量胃气虚实用之。吐血后、血止而变生诸
证者。见衄血证。
Tongue bleeding (She Nu): Powder the Sophora flower (Huaihua) and apply it topically to the affected area. Alternatively, decoct Ophiopogon tuber (Maimendong) in water, and mix with Miao Xiang San for oral administration.
Capillary bleeding (Ji Nu), where blood exudes from hair follicles: This is named Ji Nu. Burn male fetal hair to ash and apply it topically.
(Gingival bleeding, Chi Nu)
Gum recession with bleeding (Ya Xuan) presents in two patterns: Wind-accumulation Ya Xuan and Kidney-deficiency Ya Xuan. For Wind-accumulation Ya Xuan, apply Xiao Feng San topically and administer internally. For Kidney-deficiency Ya Xuan, use Shen Zhu Wan, and intermittently administer Hei Xi Dan. Additionally, stir-fry Cyperus rhizome (Xiangfu) with ginger and salt until fragrant, grind into a black powder, and use it to rub the gums; the efficacy is extraordinary.
Hematemesis (Tu Xue): Blood overflows into the turbid pathway (digestive tract), accumulates between the diaphragm, and when full, is vomited out. This is named Nei Nu. It is appropriate to use Su Zi Jiang Qi Tang, adding Ginseng root (Renshen) and Donkey-hide gelatin (Ejiao), half a qian each. Subsequently, administer Yang Zheng Dan. Excessive dampness damaging the blood collaterals can cause hematemesis. Shen Zhuo Tang added with Ligusticum chuanxiong (Chuanxiong) is named Chu Shi Tang. This results from damp-toxin stagnating in the collaterals, causing blood to overflow and act recklessly. If blood exits from the nose, it is called Bi Yi (epistaxis), which travels through the clear pathway; hematemesis travels through the turbid pathway. Blood flowing into the stomach causes vomiting. Reckless movement of blood upwards may result in hematemesis, hemoptysis, or coughing. The use of Amber (Hupo) is indeed effective in many cases. It is advisable to add this ingredient to powdered medicines, or after decocting and straining the medicine, it can be taken orally.
For hematemesis and hemoptysis, stir-fried mung bean powder mixed with Xiao Wu Chen Tang can be taken with plain boiled water. For persistent hematemesis, drink juice extracted from fresh radish (Cai Tou) in small sips. For hemoptysis, take one or two sips daily on an empty stomach. Add one liang of Platycladi seed (Ce Bai Ye) and one liang of Codonopsis root (Shashen), dry them, grind into powder, add two qian of refined wheat flour, mix into a thin paste, and drink.
For hematemesis caused by heat congestion in the upper jiao, use Si Wu Tang, adding Schizonepeta (Jingjie) and Ejiao, half a qian each. If bleeding does not stop, add Rhubarb (Dahuang) and Talc (Huashi), half a qian each, to the original formula. Alternatively, use Jiang Qi Tang and swallow Mu Xiang Bing Lang Wan to guide the expulsion through the large intestine. (This method is suitable for excess-heat patterns, but contraindicated for deficiency-fatigue patterns).
For severe hematemesis leading to dizziness and subsequent alternating chills and fever, use Jiang Qi Tang combined with Si Wu Tang, half a prescription each, plus one qian of Ejiao. If there is only simple fever, use Fu Ling Bu Xin Tang.
For hematemesis due to stomach injury, Li Zhong Tang added with Chuanxiong and Pueraria root (Gegen), half a qian each, is appropriate. Or simply use the base Li Zhong Tang formula, adding Chuanxiong and Dolichos bean (Bian Dou), which is even better; Gegen is not necessary. If excessive thirst occurs, crush Gegen to remove bad blood that has seeped into the stomach causing hematemesis. First administer Su He Xiang Wan, then treat with Hei Shen San combined with Xiao Wu Chen Tang, regulated with child's urine (Tong Bian). For hematemesis caused by summer-heat retention in summer, use Mao Hua Tang to regulate Wu Ling San. For hematemesis persisting due to excessive physical labor, decoct Su Zi Jiang Qi Tang with half a qian of Renshen.
For occasional episodes of vomiting two mouthfuls of blood, followed by relief, recurring every few days without healing for years, regularly administer Hei Shen San combined with Xiao Wu Chen Tang.
Patients with hematemesis often experience thirst, known as Blood Thirst (Xue Ke). Use Si Wu Tang or Shi Quan Da Bu Tang, selecting based on the deficiency or excess of stomach qi. For post-hematemesis conditions where other syndromes arise after bleeding stops, refer to the section on Epistaxis syndromes.