禀水谷之精华，出于中焦，以调和五脏，洒陈六腑者，血也。生化于脾，宣布于肺，统于心，藏于肝，
化精于肾，灌输百脉，其清而纯者，为守脏之血，清中之浊者，为腑络之血，清中之清者，为营经之血，皆
有气以护之，膜以隔之，络以通之，原不至上溢而下脱也。一有偏伤，或怒劳迫而上升，或阴阳虚而失守，
则为吐，为衄，为呕，为咯，为咳血唾血，经所谓阳络伤则血外溢也。或阴虚阳搏，或阳衰阴脱，或湿热下
陷，则为崩中，为漏下，为溺血，为便血，为肠风血痢，经所谓阴络伤则内溢也。更有瘀血在里，漱血不欲咽，
小腹满，身黄便黑，在上则喜忘，在下则如狂。《伤寒论》所谓三焦蓄血证也。夫血行清道出于鼻，行浊道
出于口，吐血出于胃，衄血咳血出于肺，呕血出于肝，咯血出于心，痰涎之血出于脾，唾血出于肾。鼻血
为衄，口鼻俱出为脑衄，耳血为 ，目血为眼衄，齿血为牙衄，舌血为舌衄，九窍俱出为大衄，胸前一孔出血
为心漏，脐间出为胃血，肤血为红汗，为肌衄。上出如泉涌为血溢；冲任不摄为崩漏；由精窍出，溺孔出为血
淋；由膀胱出，不痛为溺血∶色稠红为结阴便血；清
而色鲜，四射如溅，为肠风；浊而色暗，为脏毒；脓血杂痢为肠癖；射血如线为痔血。凡血色鲜浓者属火，
紫黑者火极；晦淡无光者，阳衰不能摄阴。粉红者肺血；赤如朱漆光者心包血；鲜稠浓紫者脾肝血；痰唾杂红
点红丝者肾血；血虽少，治最难。吐多成碗成盆者胃血。胃多气多血。欲知何脏之血，吐在水碗中。浮者肺血，
沉者肝血，半沉半浮者心血。各随所见以羊肺、羊肝、羊心煮熟蘸白芨末日食之。吐血服药而血不止，乃肺上
有窍也。用白芨末，以猪肺煮熟蘸食之，日服三四次，使窍为芨末填满，其血自止。方名独胜散。下注之血，
血淋多因房劳肾虚；溺血多因气化移热。便后血为远血，由肠胃来；便前血为近血，由肛门出。溅射者风淫；
点滴者湿着。血下行为顺，其治易；上行为逆，其治难。得寒则凝涩，得温则行，见黑则止；常随气行，
气和则血循经，气逆则血越络。上溢之血，火乘之，实气逆之也，故治血宜调气，不宜降火，猛进苦寒，以寒
能凝涩，且易伤脾，若脾伤，则愈不能统摄诸血以归经矣。入手须辨阴阳，阳症吐衄，血色鲜红；阴症血色紫
暗如猪肝。阳症脉洪滑，口渴面红，喘烦溺赤，火载血升，宜清降凉剂；阴症脉虚数，口干颊赤，烦躁足冷，
乃真阳失守，无根之火上炎，宜引火归元，切忌寒凉降火。治火前后调理，须按三经用药。宜归脾汤，盖
心主血，肝藏血，脾统血，此方乃三经主剂也。远志、枣仁，补肝以生心火；茯神、龙眼，补心以生脾土；
参、 、术，草，补脾以固肺金；木香，香先入脾，总欲使血归于脾，故名归脾汤。有郁怒伤肝，思虑伤脾
者，尤宜。如火旺，加黑栀、丹皮。火衰加桂心。再以八味地黄丸，培先天根本，治得其要矣。
凡血症见咳嗽喘满，及膈左右胀痛者，病在肺也，宜清降，不宜升浮。如膻中一丝牵痛，或懊恼嘈杂者，
病在心包也，宜营养，不宜耗散。如腹膨不饥，食不知味，吐涎沫者，病在脾也，宜温中，不宜酸寒。如胁肋
牵痛，躁扰不安，往来寒热者，病在肝也，宜甘缓，宜疏利，不宜秘滞。如气短似喘，咽痛音哑，骨蒸盗汗者，病
在肾也，宜滋阴壮水，不宜香燥。如呕吐烦渴，大热不得卧者，病在胃也，补泻当察兼症，勿谓阳明尽可攻
也。至
用药有君臣，或专用兼用，当知其类。如治血虚，甘温为主，宜人乳、鹿胶、阿胶、熟地、杞子、炙草、龙眼、
红枣。甘酸为佐。山药、茯苓、枣仁、山萸、五味、牛膝、白芍。又如天真丸、海参胶，乌骨鸡丸、河车膏、
燕窝饮，皆血肉有情补法。血虚热，当凉润。生地，麦冬、莲子、茯神、小麦、沙参、玉竹、藕汁、茅根、
童便。血虚寒，宜辛热。桂心、炮姜、杜仲、沉香，必火不归元者用之。气逆血升，宜苦降。山栀、丹皮、
赤芍、栝蒌、枳壳、杏仁、苏子、郁金。血热妄行，宜咸寒苦寒。犀角、元参、三七、鲜生地、黄连、黄芩、
知母、青黛。血虚而滞，宜辛甘以和之。桂枝、当归、橘皮、丹参、泽兰、益母、侧柏叶。血滞而痛，宜辛
温以行之。韭汁、当归须、延胡、郁金、便香附、五灵脂、降香末。血陷下，宜辛苦香以举之。白芷、川芎、
升麻。血滑脱，宜酸涩收之。花蕊石、续断、白芨、莲房、地榆、百草霜、乌梅、蒲黄灰、棕灰、发灰。气
虚血脱，宜温补以摄之。人参、黄 、白术、炙草。血枯经闭，宜咸温以通之。乌 鱼骨、 茹、牛膝、肉
苁蓉。血瘀而结，宜苦泻之，酸泄之。大黄、桃仁、三棱、苏木、红曲、红花、茜根、山楂、琥珀。血积
而坚，宜咸寒以软之。元明粉、牡蛎、青盐、旋复花、秋石、鲮鲤甲。血燥，宜甘润以滑之。乳酪、蜂蜜、
黄明胶、核桃肉、柏子仁、鸡蛋黄、麻仁、芝麻。其风淫袭血，散之。防风、炒荆芥、秦艽、紫苏叶。温邪
呛血，清之。甘蔗、甜梨、石斛、银花露、天冬、象贝母。暑 嗽血，凉之。杏仁、扁豆、沙参、竹叶、
麦冬、薄荷、百合。火热迫血，泻之。石膏、花粉、连翘、犀角、龙胆草、栀心、地骨皮、生地、丹皮、童便。
此用药类例也。
凡口鼻出血，皆阳盛阴衰，有升无降，血随气上，越出上窍，法当补阴抑阳，气降血自归经矣。然有阳
气本虚，复为寒凉所伤，致脉沉而不浮，尺小于寸，右弱于左，色夭而血黯，宜生脉散加肉桂、熟附、炙草。
继以理中汤、八味丸，间服。若果受寒气，食冷物，血得寒则凝，不归经络，色必黑黯，脉必沉迟，身必清
凉，若此者，不用姜桂，而用凉血之剂，殆矣。
The essence derived from the refined grains and water, generated in the Middle Jiao (Middle Burner), used to harmonize the Five Zang Organs and distribute to the Six Fu Organs, is Blood. It is transformed by the Spleen, announced by the Lung, controlled by the Heart, stored by the Liver, and its essence is transformed by the Kidney, pouring into all vessels. Among these, the clear and pure part serves as the blood guarding the Zang organs; the clear yet turbid part serves as the blood in the Fu collaterals; the clearest part serves as the Ying (Nutritive) vessel blood. All are protected by Qi, separated by membranes, and connected by collaterals, originally preventing them from overflowing upwards or escaping downwards. If injured unevenly, or forced upward by anger and overexertion, or losing control due to Yin-Yang deficiency, it results in hematemesis (vomiting blood), epistaxis (nosebleed), vomiting of blood, hemoptysis (coughing up blood), or spitting of blood. As stated in the classics: "Injury to the Yang collaterals leads to external bleeding." If there is Yin deficiency with Yang hyperactivity, or Yang decline with Yin loss, or damp-heat sinking downward, it results in metrorrhagia and metrostaxis (uterine bleeding), persistent spotting, hematuria (blood in urine), hematochezia (blood in stool), or intestinal wind dysentery. As stated in the classics: "Injury to the Yin collaterals leads to internal bleeding." Furthermore, if stasis-blood remains inside, manifesting as a desire to rinse the mouth but not swallow, lower abdominal fullness, yellowing of the body, and black stools; if located above, it causes forgetfulness; if below, it causes mania-like restlessness. This is what the *Shanghan Lun* refers to as the Stasis-Blood Syndrome of the Three Jiao.
Blood traveling through the clear pathways exits via the nose; blood traveling through the turbid pathways exits via the mouth. Hematemesis originates from the Stomach; epistaxis and hemoptysis originate from the Lung; vomiting of blood originates from the Liver; hemoptysis (specifically from the heart region) originates from the Heart; blood in saliva originates from the Spleen; spitting of blood originates from the Kidney. Bleeding from the nose is called Epistaxis; bleeding from both mouth and nose is called Brain Epistaxis; bleeding from the ears is Ear Epistaxis; bleeding from the eyes is Eye Epistaxis; bleeding from the teeth is Tooth Epistaxis; bleeding from the tongue is Tongue Epistaxis; bleeding from all nine orifices is called Great Epistaxis; bleeding from a single pore on the chest is called Heart Leakage; bleeding from the umbilicus is Stomach Blood; bleeding from the skin is Red Sweat or Cutaneous Epistaxis. Upward gushing like a spring is called Blood Overflow; failure of the Chong and Ren vessels to contain leads to Metrorrhagia and Metrostaxis; bleeding from the essence orifice or urethra is Bloody Strangury; bleeding from the bladder without pain is Hematuria; thick red blood is Coiled Yin Hematochezia; clear bright blood spraying like splashes is Intestinal Wind; turbid dark blood is Visceral Toxin; dysentery with pus and blood is Intestinal Dysentery; shooting blood like a thread is Hemorrhoidal Blood.
Generally, fresh and rich-colored blood belongs to Fire; purple-black indicates extreme Fire; dull, pale, and lusterless indicates Yang decline failing to control Yin. Pinkish blood is Lung blood; bright red like lacquer is Pericardium blood; fresh, thick, and purplish is Spleen-Liver blood; sputum mixed with red spots and threads is Kidney blood, which although small in quantity is hardest to treat. Vomiting large amounts filling bowls or basins is Stomach blood, as the Stomach is abundant in Qi and Blood. To identify the source organ, spit the blood into a bowl of water: floating indicates Lung blood; sinking indicates Liver blood; half-floating/half-sinking indicates Heart blood. Based on observation, cook sheep lung, liver, and heart, dip in *Baiji* powder (Rhizoma Bletillae), and eat daily. If hematemesis persists despite medication, it indicates a hole in the Lung. Use *Baiji* powder, cook pig lung, dip and eat, 3-4 times daily, until the hole is filled and bleeding stops. This formula is named *Dusheng San*.
Lower flowing blood: Bloody Strangury often stems from Kidney deficiency due to sexual excess; Hematuria often stems from heat transferred due to Qi transformation dysfunction. Blood after defecation is Distal Blood, coming from the intestines/stomach; blood before defecation is Proximal Blood, coming from the anus. Spraying indicates Wind pathogen; dripping indicates Dampness pathogen. Downward flow is favorable and easier to treat; upward flow is adverse and harder to treat. Blood congeals when cold, moves when warm, and stops when black. Blood follows Qi; when Qi is harmonious, blood follows meridians; when Qi rebels, blood escapes collaterals. Upward overflow is caused by Fire attacking and excessive Qi rebellion. Therefore, treating blood disorders should regulate Qi rather than merely descend Fire. Vigorously using bitter-cold herbs can congeal blood and damage the Spleen; if the Spleen is damaged, it cannot control blood to return to the meridians. One must distinguish Yin and Yang at the outset: Yang syndrome hematemesis/epistaxis has fresh red blood; Yin syndrome has purple-dark blood like pork liver. Yang syndrome presents with surging/slipping pulse, thirst, red face, panting, irritability, and red urine, indicating Fire carrying blood upward; use cooling/descending formulas. Yin syndrome presents with deficient-rapid pulse, dry mouth, red cheeks, irritability, and cold feet, indicating True Yang loss and rootless Fire flaring upward; use methods to guide Fire back to its source, strictly avoiding cold/cooling fire-descending herbs.
For regulating Fire, medication should target the Heart, Liver, and Spleen meridians. *Guipi Tang* (Restore the Spleen Decoction) is suitable because the Heart governs Blood, the Liver stores Blood, and the Spleen controls Blood; this formula targets these three meridians. *Yuanzhi* (Radix Polygalae) and *Zaoren* (Semen Ziziphi Spinosae) tonify the Liver to generate Heart Fire; *Fushen* (Poria with Hostwood) and *Longyan* (Arillus Longanae) tonify the Heart to generate Spleen Earth; *Renshen* (Radix Ginseng), *Baizhu* (Rhizoma Atractylodis Macrocephalae), and *Gancao* (Radix Glycyrrhizae) tonify the Spleen to secure Lung Metal; *Muxiang* (Radix Aucklandiae) enters the Spleen first, aiming to return blood to the Spleen, hence the name *Guipi Tang*. It is especially suitable for cases where anger injures the Liver and worry injures the Spleen. If Fire is strong, add *Heizhi* (Fructus Gardeniae Preparatus) and *Danpi* (Cortex Moutan); if Fire is weak, add *Guixin* (Cinnamomi Cortex). Follow with *Bawei Dihuang Wan* (Eight-Ingredient Pill with Rehmannia) to nourish the congenital foundation, grasping the essence of treatment.
In blood disorders, cough, panting, fullness, and distending pain in the left/right diaphragm indicate Lung disease; use descending/clearing methods, avoid ascending/floating herbs. Pain pulling at *Shanzhong* (CV17) or mental restlessness indicates Pericardium disease; use nourishing methods, avoid dispersing/depleting herbs. Abdominal distension, lack of appetite, loss of taste, and spitting saliva indicate Spleen disease; use warming-middle methods, avoid sour-cold herbs. Pulling pain in hypochondrium, irritability, alternating chills and fever indicate Liver disease; use sweet-soothing and dispersing-promoting methods, avoid constipating/stagnating herbs. Shortness of breath resembling panting, sore throat, hoarseness, bone-steaming night sweats indicate Kidney disease; use Yin-nourishing and Water-strengthening methods, avoid aromatic-drying herbs. Vomiting, irritability, thirst, high fever preventing lying down indicate Stomach disease; evaluate supplementation vs. purging based on accompanying symptoms; do not assume Yangming disease is always treatable by purging.
Medication involves Sovereign, Minister, Assistant, and Envoy roles. For Blood Deficiency, use Sweet-Warm as Sovereign: Human milk, Deer Antler Glue, Donkey-Hide Gelatin, Prepared Rehmannia, Goji Berry, Honey-fried Licorice, Longan Aril, Red Date. Use Sweet-Sour as Assistant: Chinese Yam, Poria, Sour Jujube Seed, Cornus Fruit, Schisandra, Achyranthes, White Peony Root. Also, *Tianzhen Wan*, Sea Cucumber Glue, Black-bone Chicken Pill, Placenta Paste, Bird's Nest Drink are "flesh-and-blood有情" (sentient/nourishing) tonics. For Blood Deficiency with Heat, use Cooling-Moistening: Raw Rehmannia, Ophiopogon, Lotus Seed, Poria, Wheat, Glehnia, Polygonatum Odoratum, Lotus Rhizome Juice, Imperata Rhizome Juice, Child's Urine. For Blood Deficiency with Cold, use Acrid-Warm: Cinnamon Heart, Roasted Ginger, Eucommia, Agarwood (only for Fire not returning to source). For Qi Rebellion causing Blood Ascension, use Bitter-Descent: Gardenia, Moutan Bark, Red Peony Root, Trichosanthes Fruit, Aurantium, Apricot Seed, Perilla Fruit, Curcuma Aromatica. For Wild Running Blood due to Heat, use Salty-Cold/Bitter-Cold: Rhinoceros Horn (substitute with Buffalo Horn), Scrophularia, Notoginseng, Fresh Rehmannia, Coptis, Scutellaria, Anemarrhena, Indigo Naturalis. For Blood Deficiency with Stasis, use Acrid-Sweet to Harmonize: Cinnamon Twig, Angelica Sinensis, Tangerine Peel, Salvia, Lygodium Spore, Motherwort, Biota Leaf. For Blood Stasis with Pain, use Acrid-Warm to Move: Leek Juice, Angelica Sinensis Tail, Corydalis, Curcuma Aromatica, Cyperus, Trogopterus Dung, Costus Root Powder. For Sunken Blood, use Acrid-Bitter-Aromatic to Lift: Angelica Dahurica, Ligusticum, Cimicifuga. For Slippery/Escaping Blood, use Sour-Astringent to Consolidate: Flower Ochre Stone, Dipsacus, Bletilla, Lotus Calyx, Sanguisorba, Charred Grass Ash, Plum, Charred Polygonum Multiflorum, Charred Palm Fiber, Charred Hair. For Qi Deficiency with Blood Loss, use Warm-Tonifying to Control: Ginseng, Astragalus, Atractylodes, Honey-fried Licorice. For Blood Dryness with Amenorrhea, use Salty-Warm to Unblock: Cuttlebone, Rubia, Achyranthes, Cistanche. For Blood Stasis with Knots, use Bitter-Purgative/Acid-Draining: Rhubarb, Peach Kernel, Burreed Tuber, Bixa Orellana Seed, Safflower, Rubia Root, Hawthorn, Amber. For Blood Accumulation with Hardness, use Salty-Cold to Soften: Mirabilite, Oyster Shell, Green Salt, Inula Flower, Autumn Stone, Pangolin Scale. For Blood Dryness, use Sweet-Moistening to Lubricate: Milk/Cheese, Honey, Yellow Ming Gelatin, Walnut Meat, Biota Seed, Egg Yolk, Hemp Seed, Sesame. For Wind Pathogen invading Blood, disperse with: Saposhnikovia, Processed Schizonepeta, Gentian, Perilla Leaf. For Warm Pathogen causing Coughing Blood, clear with: Sugarcane, Sweet Pear, Dendrobium, Honeysuckle Dew, Asparagus Tuber, Fritillaria Thunbergii. For Summerheat causing Coughing Blood, cool with: Apricot Seed, Coix Seed, Glehnia, Bamboo Leaf, Ophiopogon, Mint, Lily Bulb. For Fire/Heat forcing Blood, purge with: Gypsum, Trichosanthes Root, Forsythia, Rhinoceros Horn (Buffalo Horn), Gentian Root, Gardenia Heart, Ground Tree Bark, Raw Rehmannia, Moutan Bark, Child's Urine. These are the categories of medication.
Oral/Nasal bleeding usually indicates Excess Yang and Deficient Yin, rising without descending, with blood following Qi upward exiting upper orifices. The method should be Tonifying Yin and Suppressing Yang; as Qi descends, blood returns to meridians. However, if Yang Qi was originally deficient and injured by cold/cooling herbs, resulting in deep/non-floating pulse, Chi pulse smaller than Cun pulse, Right pulse weaker than Left pulse, dull complexion, and dark blood, use *Shengmai San* (Generate the Pulse Powder) plus Cinnamon Heart, Prepared Aconite, and Honey-fried Licorice. Follow with *Lizhong Tang* (Regulate the Middle Decoction) and *Bawei Wan* (Eight-Ingredient Pill), taken alternately. If indeed affected by cold air or cold food, blood congeals due to cold, fails to enter meridians, appearing black/dark with deep-slow pulse and cool body; in such cases, using cooling blood agents instead of Ginger/Cinnamon would be erroneous.