（咳血 嗽血 咯血 唾血 呕血附）
吐血，阳亢阴虚症也。症有三因，外因系火风暑燥之邪，内因系肝肾心脾之损，不内外因系坠跌努力烟酒
之伤。外因者，火灼风温之呛血，暑瘵燥咳之伤血。邪在肺卫心营，理肺卫，宜甘凉肃降。如沙参、麦冬、贝
母、花粉、玉竹、石斛。治心营，宜轻清滋养。如生地、元参、丹参、连翘、竹叶、茯神。以此二法为宗，
随症加减。火灼则加入苦寒；如山栀、黄芩、知母、地骨皮。风温则参以甘凉；如蔗汁、芦根、羚羊角、
桑叶。暑瘵入营，则兼清润；如杏仁、银花、鲜生地、犀角。燥咳在气，则佐纯甘；如天冬、梨、枣、阿胶。
别有内热外寒吐血者，宜麻黄参芍汤主之。此治客感吐血大略也。内因者，怒动肝火，宜苦辛降气，如苏子、
郁金、降香、丹皮、山栀、栝蒌、橘白。郁损肝阳，宜六郁汤。郁损肝阴，宜甘酸熄风，如阿胶、鸡蛋黄、
金橘、白芍、生地。思伤心脾，宜甘温益营。如保元汤、归脾汤。房劳伤肾，其阴虚失纳者，宜壮水镇阳。
青铅六味饮加五味、牛膝、童便。阳虚不摄者，宜导火归窟。肉桂七味丸加童便。夺精亡血者，急固真元，
大填精血。如人参、海参、熟地、河车胶、杞子、五味、紫石英。此治内损吐血大略也。不内外因者，坠
跌血瘀上泛，先须导下，复元活血汤，代抵当汤。或用韭白汁散之。再用通补。元戎四物汤，或当归、郁金、
牛膝、白芍、三七。若努力伤血，调补，忌用凝涩，宜和营通络理虚。当归建中汤、旋复花汤，或六味饮加
牛膝、杜仲。若烟酒伤肺，烟辛泄肺，酒热戕胃，皆能助火动血。呛血，改定紫菀茸汤去术加芍。饮多伤胃
失血，六君子汤加香、砂、葛花。此治不内外因大略也。以上参用《指南》邵序。凡血来如潮涌，喘息未定，
饮还元水立定。吐血乍止，用燕窝、冰糖各四饯，煎服七日。可不复发。血出汪洋，不即凝者，烦劳动胃火也。
犀角地黄汤加桃仁、藕汁、童便。血出散漫不聚者，烦劳伤肺气也。补中益气汤去柴胡，加麦、味、茯苓、
山药。胁痛吐血者，肝气逆也。化肝煎。神劳吐血者，心气损也。天冬汤。龙焰升，则吐衄骤加，宜潜火。
海参、淡菜、龟甲心、茯神、
熟地、五味子熬膏，秋石汤下。元海空，则行动喘促，速固根蒂。人参、核桃、坎 、杞子、牛膝、五味、
沙苑子、茯苓、人乳粉。胃纳少，则中宫乏镇，须扶胃阳，切勿清嗽。人参建中汤、归 异功散。胃络虚，
则厥阳易犯，急调胃阴，可免升逆。生脉散加白扁豆、沙参、玉竹、石斛、茯神，或《金匮》麦门冬汤去半
夏加杏仁。仁斋所谓血症经久，多以胃药收功也。若夫肺痿吐血，人参固本膏。劳怯吐血，四阴煎。血虚发
热，当归补血汤。血虚发痉，十全大补汤。脾肺气虚，养营汤。络脉不和，当归须、鸡血藤膏、牛膝、降香、
郁金、韭白汁。血色鲜紫，吐后神疲懒言，以补气药摄之；独参汤。血色晦淡，息微脉缓，为血寒不得归经，
以辛甘温摄之。大剂理中汤。尺脉虚弦，大剂生料六味丸，加肉桂。其劳动火，口津干，能食，脉洪数，元
霜紫雪膏。数吐血两口，不渴不发热，数月又发，胸中刺痛，小乌沉汤送黑神散。吐后胸满痛，脉洪大有力，
用当归、丹皮、酒大黄、元明粉、桃仁、延胡，从大便导之。不可骤用止涩，不可专行腻补，不可轻用苦
寒，不可妄用攻伐，审症切脉以调之，勿拘成法可耳。
缪仲淳曰∶吐血有三诀∶宜行血不宜止血。血不循经络者，气逆上壅也。行血令循经络，不止自止，止
之则血凝，血凝必发热，胸胁痛，病日痼矣。宜补肝不宜伐肝。经云∶五脏者，藏精气而不泻者也，肝主藏血，吐
血者肝失其职也。养肝则肝平，而血有所归；伐肝则肝虚不能藏血，愈不止矣。宜降气不宜降火。气有余便是
火，气降则火降，火降则气不升，血随气行，无溢出上窍之患。且降火必寒凉之剂，反伤胃气；胃气伤，则脾
不能统血，血愈不能归经矣。
〔咳血〕因咳见血，系火乘肺金，干咳络伤，而血渗出也。治同嗽血。
〔嗽血〕因嗽时气急喘促，痰杂血丝血点，亦火伤血膜，而血随痰出也。诸家以咳嗽血出于肺，景岳
谓咳嗽咯唾诸血，皆源于肾，以肾脉贯膈，入肺循喉，肺肾相联，因肾水亏，则火烁金，肺燥络损，液涸成痰，
病之标在肺，其本固由肾也。治主壮水清金，宜六味丸加麦冬、五味。兼润肺止嗽，宜阿胶、贝母、百合、
紫菀。血止后，胃虚食少，气息不续，劫劳散去半夏，加紫菀茸及琼玉膏等。其先嗽痰，后见红者，为积痰生
热，宜降痰火；以栝蒌、贝母、山栀、橘红。水煎，下天门冬丸。先见红，后嗽痰者，为阴虚火动，宜滋化
源。六味阿胶饮。阴虚久嗽，痰中血星如珠，生料六味丸加茜根、乌 骨，和童便。久嗽痰带血丝如缕，六味
丸加蛤粉、阿胶、童便，临卧服。嗽血潮热，八珍汤加贝母、五味。嗽血成劳，肌削神疲，五心烦热，咽干颊
赤，盗汗减食，人参饮子，或四君子汤加黄 、鳖甲、麦冬、五味。天士先生曰∶凡咳血之脉，右坚者治在气
分，系震动胃络所致，宜薄味调养胃阴；如生扁豆、茯苓、北沙参、薏苡仁、石斛等。左坚者乃肝肾阴伤所致，
宜地黄、阿胶、杞子、五味等。脉弦胁痛者，宜苏子、桃仁、降香、郁金等。成盆盈碗者，葛可久花蕊石散，
仲景大黄黄连泻心汤。一症而缕析条分，从此再加分别，则临症有据矣。石顽老人曰∶咳血之脉，微弱平缓易
治；弦数急实，气促声嘶咽痛者，不治。
〔咯血〕不嗽而喉中咯出小血块或血点是也。症最重，由房劳伤肾，火载血升，咯血成块，不比咳嗽痰中
带出也。亦有兼痰咯出者，系肾虚痰泛，初起用白芍、丹皮、茯苓、枣仁、山药、山栀、麦冬、童便，以清手
足少阳厥阴诸经游火。若膈热颊红，咽喉不清，清咽太平丸。后必滋补肾阴，以安其血。六味饮加牛膝、麦冬、
五味。景岳以为心不主血，宜养心汤。嘉言以为阴气上奔，宜四君汤，黄 、山药亦可加入。脾中阳气旺，
而龙雷之火潜伏也。
〔唾血〕鲜血随唾而出，或涎中有血缠如丝、散如点者，多源于肾。右尺虚者，都气丸加桂心。右尺大者，
清唾汤。其有兼心胃者，由脾虚不能摄也。兼心则加味归脾汤，兼胃则七珍散。食少痰清者，异功散加枇杷叶、
扁豆灰。劳嗽唾血者，黄 散。肺痿吐血者，人参平肺散。
〔呕血〕血从脘胁呕出，系木火乘胃所致。良由暴怒火逆，胸满胁痛，伤肝动血。柴胡疏肝散。或负重努
力，伤胃动血。是斋白术散。或饮酒火热上升呕血。葛黄散。或房劳竭力，伤肾呕
血。症必面红足冷，烦躁口渴，生脉散合加减八味丸。或虚劳火升，呕血不止。花蕊石散。
(Coughing Blood, Coughing with Blood, Spitting Blood, Saliva Blood, Vomiting Blood [Appendix])
Hematemesis (vomiting blood) is a syndrome of hyperactive Yang and deficient Yin. There are three causes: external causes involve pathogenic factors such as Fire, Wind, Summerheat, and Dryness; internal causes involve damage to the Liver, Kidney, Heart, and Spleen; and neither-internal-nor-external causes involve trauma from falls or bruises, excessive exertion, and injuries from tobacco and alcohol.
Regarding external causes, coughing up blood due to Fire scorching and Wind-warming, and injury to blood due to Summerheat consumption and Dryness coughing. When pathogens are in the Lung Wei (Lung Defensive level) and Ying (Nutritive) levels, treating the Lung Wei requires sweet-cool descending methods, using herbs like *Adenophorae Radix* (Shashen), *Ophiopogonis Radix* (Maidong), *Fritillariae Bulbus* (Beimu), *Trichosanthis Radix* (Huafen), *Polygonati Odorati Rhizoma* (Yuzhu), and *Dendrobii Caulis* (Shihu). Treating the Ying level requires light-clear nourishing methods, using herbs like *Rehmanniae Radix* (Shengdi), *Scrophulariae Radix* (Yuanshen), *Salviae Miltiorrhizae Radix et Rhizoma* (Danshen), *Lonicerae Japonicae Flos* (Lianqiao), *Pericarpium Nelumbinis* (Zhuye), and *Poria* (Fushen). These two methods serve as the foundation, modified according to symptoms. If scorched by Fire, add bitter-cold herbs like *Gardeniae Fructus* (Shanzhi), *Scutellariae Radix* (Huangqin), *Anemarrhenae Rhizoma* (Zhimu), and *Lycii Cortex* (Digupi). If affected by Wind-warmth, combine with sweet-cool herbs like Sugarcane Juice, Reed Rhizome (*Imperatae Rhizoma*, Lugeng), *Saiga Tataricae Cornu* (Lingyangjiao), and *Mori Folium* (Sangye). If Summerheat enters the Ying level, combine with clearing and moistening methods, using *Pruni Semen* (Xingren), *Lonicerae Japonicae Flos* (Jinyinhua), fresh *Rehmanniae Radix* (Xianshengdi), and *Rhinocerotis Cornu* (Xijiao). If Dryness cough affects the Qi level, assist with purely sweet substances like *Asparagi Radix* (Tiangong), Pear, Jujube (*Ziziphi Jujubae Fructus*), and *Colla Corii Asini* (Ejiao). For hematemesis caused by internal heat and external cold, *Mahuang Shen Shaohao Tang* (Cinnamon Twig, Ginseng, and White Peony Decoction) is indicated. This outlines the general treatment for hematemesis due to exogenous pathogens.
Regarding internal causes, anger stirring Liver Fire requires bitter-pungent Qi-descending methods, using *Pericarpium Fructus Viticis* (Suzi), *Curcumae Aromaticae Rhizoma* (Yujin), *Aquilariae Lignum Resinatum* (Xiang), *Moutan Cortex* (Danpi), *Gardeniae Fructus* (Shanzhi), *Trichosanthis Fructus* (Gualou), and Tangerine Peel (*Citri Reticulatae Pericarpium*, Ju Bai). Stagnation damaging Liver Yang requires *Liuyu Tang* (Six Stagnations Decoction). Stagnation damaging Liver Yin requires sweet-sour wind-extinguishing methods, using *Colla Corii Asini* (Ejiao), Egg Yolk, Kumquat, *Radix Paeoniae Alba* (Baishao), and *Rehmanniae Radix* (Shengdi). Overthinking damaging the Heart and Spleen requires sweet-warm Ying-nourishing methods, using *Baoyuan Tang* (Preserve Origin Decoction) and *Guipi Tang* (Restore the Spleen Decoction). Sexual exhaustion damaging the Kidney, where Yin deficiency fails to grasp Qi, requires strengthening Water to calm Yang, using *Qingqian Liuwei Yin* (Green Lead Six Substances Decoction) added with *Schisandrae Fructus* (Wuweizi), *Achyranthis Bidentatae Radix* (Niuxi), and Child's Urine (Tongbian). Yang deficiency failing to control blood requires guiding Fire back to its source, using *Rougui Liuwei Wan* (Cinnamon Bark Six Substances Pill) added with Child's Urine. For those who have lost essence and blood, urgently consolidate the True Yuan and greatly replenish essence and blood, using *Ginseng Radix* (Renshen), Sea Cucumber, *Rehmanniae Radix Praeparata* (Shudi), *Placenta Hominis* (Hechejiao), *Lycii Fructus* (Gouqi), *Schisandrae Fructus* (Wuweizi), and *Flint* (Zishi). This outlines the general treatment for hematemesis due to internal damage.
Regarding neither-internal-nor-external causes, blood stasis from falls rising upwards requires first guiding it downwards, using *Fuyuan Huoxue Tang* (Restore Vitality and Invigorate Blood Decoction) or *Dai Dandang Tang*. Alternatively, use Leek White Juice to dissipate it, followed by unblocking tonification, such as *Yuanrong Siwu Tang* or *Angelicae Sinensis Radix* (Danggui), *Curcumae Aromaticae Rhizoma* (Yujin), *Achyranthis Bidentatae Radix* (Niuxi), *Radix Paeoniae Alba* (Baishao), and *Notoginseng Radix et Rhizoma* (Sanqi). If injured by excessive exertion, regulate and tonify, avoiding astringents, and harmonize Ying, unblock collaterals, and treat deficiency, using *Danggui Jianzhong Tang* or *Inulae Flos Tang* (Xuanfuhua Tang), or *Liuwei Yin* added with *Achyranthis Bidentatae Radix* (Niuxi) and *Eucommiae Cortex* (Duzhong). If damaged by tobacco and alcohol, tobacco's pungency disperses Lung Qi, and alcohol's heat damages the Stomach, both aiding Fire and moving Blood. For coughing blood, modify *Ziwan Rong Tang* by removing *Atractylodis Rhizoma* (Bai Zhu) and adding *Radix Paeoniae Alba* (Baishao). For stomach injury from excessive drinking causing blood loss, use *Liujunzi Tang* added with *Liquidambaris Resina* (Xiang) and *Amomi Fructus* (Sharen), and *Puerariae Radix* (Ge Hua). This outlines the general treatment for hematemesis due to neither-internal-nor-external causes. The above references the Preface by Shao in *Zhinan*.
If blood gushes like a tide and breathing is unsettled, drinking *Huiyuan Shui* can stabilize it immediately. After hematemesis stops, decoct Bird's Nest and Rock Sugar (4 qian each) and take for seven days to prevent recurrence. If blood flows profusely and does not clot, it indicates Stomach Fire from fatigue and agitation; use *Xijiao Dihuang Tang* (Rhino Horn and Rehmannia Decoction) added with *Persicae Semen* (Taoren), Lotus Root Juice, and Child's Urine. If blood flows scatteredly, it indicates Lung Qi damage from fatigue and agitation; use *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) without *Bupleuri Radix* (Chaihu), added with *Ophiopogonis Radix* (Maidong), *Schisandrae Fructus* (Wuweizi), *Poria* (Fuling), and *Dioscoreae Rhizoma* (Shanyao). Hematemesis with hypochondriac pain indicates rebellious Liver Qi; use *Huaganning Jian* (Regulate the Liver Decoction). Hematemesis from mental labor indicates Heart Qi damage; use *Tiandong Tang* (Asparagus Decoction). If Dragon Fire rises, sudden increase in vomiting blood and epistaxis occurs; subdue Fire using Sea Cucumber, Mussel, *Testudinis Carapax et Plastrum* (Guijiaxin), *Poria* (Fushen), *Rehmanniae Radix Praeparata* (Shudi), and *Schisandrae Fructus* (Wuweizi) boiled into an paste, taken with *Qiushi Tang* (Ash Decoction). If the Source Sea is empty, leading to panting upon movement, quickly consolidate the root using *Ginseng Radix* (Renshen), Walnut Kernel, *Uterus Mus* (Kanqi), *Lycii Fructus* (Gouqi), *Achyranthis Bidentatae Radix* (Niuxi), *Schisandrae Fructus* (Wuweizi), *Astragali Complanati Semen* (Shayuanzi), *Poria* (Fuling), and Human Milk Powder. Poor appetite indicates lack of stabilization in the Middle Palace; support Stomach Yang, do not clear coughs; use *Renshen Jianzhong Tang* or *Yigong San* (Extraordinary Power Powder). Deficiency in Stomach collaterals allows Rebellious Yang to invade easily; urgently regulate Stomach Yin to prevent rebellion, using *Shengmai San* (Generate the Pulse Powder) added with *Dolichos Semen* (Baibian Dou), *Adenophorae Radix* (Shashen), *Polygonati Odorati Rhizoma* (Yuzhu), *Dendrobii Caulis* (Shihu), and *Poria* (Fushen), or *Maimendong Tang* from *Jingui Yaolue* without *Pinelliae Rhizoma* (Banxia), added with *Pruni Semen* (Xingren). Renzhai stated that chronic blood syndromes often conclude with Stomach-regulating medicines. For Lung萎 (Flaccidity) with hematemesis, use *Renshen Guben Gao* (Ginseng Solidifying Base Paste). For consumptive hematemesis, use *Siyin Jian* (Four Yin Decoction). For blood deficiency with fever, use *Danggui Buxue Tang* (Angelica Tonify Blood Decoction). For blood deficiency with spasms, use *Shiquan Dabu Tang* (Ten Complete Great Tonifying Decoction). For Spleen and Lung Qi deficiency, use *Yangying Tang* (Nourish Ying Decoction). For disharmony of collaterals, use *Danggui Xu* (Angelica Tail), *Spatholobi Caulis* (Jixueteng) paste, *Achyranthis Bidentatae Radix* (Niuxi), *Aquilariae Lignum Resinatum* (Xiang), *Curcumae Aromaticae Rhizoma* (Yujin), and Leek White Juice. Bright purple blood with fatigue and reluctance to speak after vomiting indicates need for Qi-tonifying to control blood; use *Dushen Tang* (Single Ginseng Decoction). Dark pale blood with faint breath and slow pulse indicates Cold Blood failing to return to vessels; use pungent-sweet-warm herbs to control blood, large dose of *Lizhong Tang* (Regulate the Middle Decoction). Empty wiry Chi pulse indicates large dose of *Shengliao Liuwei Wan* (Raw Material Six Substances Pill) added with *Cinnamomi Cortex* (Rougui). If labor generates Fire, dry saliva, good appetite, and surging rapid pulse, use *Yuanshuang Zixue Gao*. Two mouthfuls of blood vomited multiple times without thirst or fever, recurring months later with stabbing chest pain, use *Xiao Wuchen Tang* delivering *Heishen San* (Black Divine Powder). Chest fullness and pain after vomiting with surging forceful pulse, use *Angelicae Sinensis Radix* (Danggui), *Moutan Cortex* (Danpi), Wine-processed *Rhei Radix et Rhizoma* (Dahuang), *Mirabilite* (Yuanmingfen), *Persicae Semen* (Taoren), and *Cyperi Rhizoma* (Yanhusu) to guide out via bowels. Do not abruptly use astringents, do not exclusively use cloying tonics, do not lightly use bitter-cold, do not recklessly use purgatives; examine symptoms and palpate pulses to regulate, do not be bound by established formulas.
Miao Zhongchun said: There are three principles for hematemesis: Promote blood circulation rather than stop bleeding. Blood not following meridians is due to Qi rebellion and congestion. Promoting circulation allows blood to follow meridians, stopping naturally; forcing cessation causes blood stasis, leading to fever and hypochondriac pain, making the disease entrenched. Tonify the Liver rather than attack it. The Classics state: The Five Zang organs store essence and Qi and do not drain. The Liver stores blood; in hematemesis, the Liver loses its function. Nourishing the Liver calms it, allowing blood to find its home; attacking the Liver causes deficiency, preventing blood storage, worsening bleeding. Descend Qi rather than descend Fire. Excess Qi becomes Fire; descending Qi descends Fire, Fire descends so Qi does not rise, blood follows Qi without overflowing upper orifices. Moreover, descending Fire requires cold-cool agents which damage Stomach Qi; damaged Stomach Qi impairs Spleen's ability to control blood, causing blood to fail to return to vessels.
[Coughing Blood] Blood appearing due to coughing results from Fire invading Lung Metal, dry cough damaging collaterals, causing blood seepage. Treatment is same as Coughing with Blood.
[Coughing with Blood] Accompanied by shortness of breath and panting during coughing, sputum mixed with blood threads and spots, also due to Fire damaging blood membranes, blood exiting with sputum. Most schools attribute coughing blood to the Lung. Jingyue states that all blood from coughing, spitting, and saliva originates from the Kidney, as the Kidney meridian passes through the diaphragm, enters the Lung, and follows the throat; Lung and Kidney are connected. Due to Kidney Water deficiency, Fire scorches Metal, Lung Dryness damages collaterals, fluid depletion forms phlegm. The manifestation is in the Lung, but the root lies in the Kidney. Treatment focuses on strengthening Water and clearing Metal, using *Liuwei Wan* (Six Substances Pill) added with *Ophiopogonis Radix* (Maidong) and *Schisandrae Fructus* (Wuweizi). To additionally moisten the Lung and stop coughing, use *Colla Corii Asini* (Ejiao), *Fritillariae Bulbus* (Beimu), *Lilii Bulbus* (Baihe), and *Asteris Radix* (Ziwan). After blood stops, if Stomach deficiency leads to poor appetite and interrupted breath, use *Jie Lao San* (Stop Consumption Powder) without *Pinelliae Rhizoma* (Banxia), added with *Asteris Radix* (Ziwan Rong) and *Qiongyu Gao* (Jade Essence Paste). If sputum precedes blood, it is accumulated phlegm generating Heat; descend Phlegm-Fire using *Trichosanthis Fructus* (Gualou), *Fritillariae Bulbus* (Beimu), *Gardeniae Fructus* (Shanzhi), and *Citri Reticulatae Pericarpium* (Juhong) decocted in water, delivered with *Tianmendong Wan* (Asparagus Pill). If blood appears before sputum, it is Yin deficiency with Fire movement; nourish the Source using *Liuwei Ejiao Yin* (Six Substances and Donkey-hide Gelatin Decoction). Chronic Yin deficiency cough with blood stars like pearls in sputum, use raw material *Liuwei Wan* added with *Rubiae Radix et Rhizoma* (Qiangen) and *Testudinis Carapax et Plastrum* (Wuguji), mixed with Child's Urine. Chronic cough with blood threads like silk in sputum, use *Liuwei Wan* added with *Meretrix Concha* (Gafen), *Colla Corii Asini* (Ejiao), and Child's Urine, taken before sleep. Coughing blood with tidal fever, use *Bazhen Tang* (Eight Treasures Decoction) added with *Fritillariae Bulbus* (Beimu) and *Schisandrae Fructus* (Wuweizi). Coughing blood progressing to consumption, with emaciation, fatigue, five-palm heat, dry throat, red cheeks, night sweats, and reduced appetite, use *Renshen Yinzi* (Ginseng Infusion) or *Sijunzi Tang* (Four Gentlemen Decoction) added with *Astragali Radix* (Huangqi), *Testudinis Carapax et Plastrum* (Biejia), *Ophiopogonis Radix* (Maidong), and *Schisandrae Fructus* (Wuweizi). Mr. Tianshi said: Regarding coughing blood pulses, firmness on the right indicates treatment at the Qi level, caused by shaking Stomach collaterals; nourish Stomach Yin with bland flavors like Raw *Dolichos Semen* (Baibian Dou), *Poria* (Fuling), Northern *Adenophorae Radix* (Beishashen), *Coicis Semen* (Yiyiren), and *Dendrobii Caulis* (Shihu). Firmness on the left indicates Liver-Kidney Yin damage; use *Rehmanniae Radix* (Shengdi), *Colla Corii Asini* (Ejiao), *Lycii Fructus* (Gouqi), and *Schisandrae Fructus* (Wuweizi). Wiry pulse with hypochondriac pain, use *Pericarpium Fructus Viticis* (Suzi), *Persicae Semen* (Taoren), *Aquilariae Lignum Resinatum* (Xiang), and *Curcumae Aromaticae Rhizoma* (Yujin). For amounts filling basins and bowls, use Ge Kejiu's *Huaruishi San* (Flower Porphyry Stone Powder) or Zhang Zhongjing's *Dahuang Huanglian Xiexin Tang* (Rhubarb, Scutellaria, and Coptis Decoction to Drain the Heart). Analyzing one symptom in detail allows for further differentiation, providing evidence for clinical practice. Old Man Shiwan said: Coughing blood pulses that are weak, fine, and smooth are easy to treat; wiry, rapid, urgent, and solid pulses with shortness of breath, hoarseness, and sore throat are untreatable.
[Spitting Blood] Spitting small blood clots or spots from the throat without coughing. This is the most severe syndrome, caused by sexual exhaustion damaging the Kidney, Fire carrying Blood upward, forming clots, unlike blood mixed in sputum from coughing. Some cases include phlegm, due to Kidney deficiency with Phlegm flooding. Initially use *Radix Paeoniae Alba* (Baishao), *Moutan Cortex* (Danpi), *Poria* (Fuling), *Ziziphi Spinosa Semen* (Suanzaoren), *Dioscoreae Rhizoma* (Shanyao), *Gardeniae Fructus* (Shanzhi), *Ophiopogonis Radix* (Maidong), and Child's Urine to clear wandering Fire in the Hand and Foot Shaoyang and Jueyin meridians. If Diaphragm Heat with red cheeks and unclear throat, use *Qingyan Taiping Wan* (Clear Throat Supreme Peace Pill). Later must nourish Kidney Yin to settle blood, using *Liuwei Yin* added with *Achyranthis Bidentatae Radix* (Niuxi), *Ophiopogonis Radix* (Maidong), and *Schisandrae Fructus* (Wuweizi). Jingyue believed the Heart does not govern blood, recommending *Yangxin Tang* (Nourish Heart Decoction). Jiayan believed Yin Qi rushing upward, recommending *Sijunzi Tang* (Four Gentlemen Decoction), with *Astragali Radix* (Huangqi) and *Dioscoreae Rhizoma* (Shanyao) also added. Strong Spleen Yang keeps Dragon-Leopard Fire latent.
[Saliva Blood] Fresh blood emerging with saliva, or blood in saliva winding like silk or scattering like spots, mostly originates from the Kidney. Deficient Right Chi pulse, use *Duqi Wan* (All-Qi Pill) added with *Cinnamomi Cortex* (Guixin). Large Right Chi pulse, use *Qingsuo Tang* (Clear Saliva Decoction). Cases involving Heart and Stomach are due to Spleen deficiency failing to control. Involving Heart, use Modified *Guipi Tang*; involving Stomach, use *Qizhen San* (Seven Precious Powder). Poor appetite with clear phlegm, use *Yigong San* (Extraordinary Power Powder) added with *Loquat Leaf* (Pipaye) and Charred *Dolichos Semen* (Biandouhui). Consumptive cough with saliva blood, use *Huangqi San* (Astragalus Powder). Lung flaccidity with hematemesis, use *Renshen Pingfei San* (Ginseng Calming Lung Powder).
[Vomiting Blood] Blood vomited from the epigastrium and hypochondrium, caused by Wood-Fire invading the Stomach. Often due to sudden anger causing Qi rebellion, chest fullness, hypochondriac pain, damaging Liver and moving blood; *Chaihu Shugan San* (Bupleurum Soothing Liver Powder). Or burden-bearing exertion damaging Stomach and moving blood; *Shizhai Baizhu San* (Shizhai Atractylodes Powder). Or alcohol-induced Heat rising causing vomiting blood; *Gehuang San* (Kudzu and Rhubarb Powder). Or sexual exhaustion damaging Kidney causing vomiting blood. Symptoms must include red face, cold feet, irritability, and thirst; *Shengmai San* combined with *Jiajian Bawei Wan* (Modified Eight Substances Pill). Or deficiency consumption with Fire rising causing incessant vomiting blood; *Huaruishi San* (Flower Porphyry Stone Powder).