【脉】 脉涩濡弱为亡血；细弦而涩，按之虚，为脱血也。脉浮弱，按之而绝者
，为下血；
烦咳者，必吐血。脉沉弦，面无血色，无寒热者，必衄。沉为在里，营卫内结，胸满必吐血
。脉滑小弱者生，浮大牢数者死；又血温身热，脉躁者死，热为血气散故也。藏血，脉俱弦
者死，滑大者生。
【因】 外有肺痈、肺痿，亦能咳嗽脓血。劳亦能吐血。
【证治】 麻黄汤 治伤寒证大壅塞内热，火气不伸成衄。脉浮紧为寒。
桂枝汤 治证同前，脉浮缓为风。
五苓散 治伏暑，热流入经络。
黄芩芍药汤 治伤寒、风二证，脉微。
衄血方 治出于肺经。如不止，用寒水纸于胸、脑、大椎三处贴之。
犀角 升麻 山栀 黄芩 白芍 生地 丹参 紫参 阿胶 荆芥穗
研服亦良。萝卜头段捣饮，又汁滴之亦良。大椎、哑门灸之亦止。
咯唾血方 出于肾。亦有瘀血内积，肺气壅遏，不能下降。肺壅，非吐不可。
天冬 麦冬 知母 贝母 桔梗 熟地 远志 黄柏
有寒加干姜、肉桂。
呕痰涎血方 出于脾。
黄 黄连 白芍 当归 甘草 沉香 葛根
呕吐血方 出于胃。
犀角地黄汤 治实，及病余瘀血。
犀角（一两） 生地（八两） 白芍（三两） 丹皮（二两）
小建中汤加黄连 治虚及伤胃吐血。
三黄补血汤 治六脉大，按之虚，面赤善惊，上热，乃手少阴心之脉也。此气盛
而亡血，泻火补气，以坠气浮。
丹皮（一钱） 川芎（二钱） 熟地（二钱） 生地（三钱） 柴胡 当归（各一钱半） 升麻
黄（各一钱） 白芍（五钱）
人参饮子 治脾胃虚弱，衄血、吐血。又治吐血久不愈，于气冲三棱针出血，立
愈。
甘草（一钱） 麦冬（二钱） 当归（三钱） 黄 （一钱） 五味子（五个） 白芍（一钱）
救肺饮 治咳、吐血。
升麻 柴胡 白术 白芍（各一钱） 归尾 熟地 黄 人参（各二钱） 苏木 陈皮
甘草（各五分）
作一服。
清心莲子饮 治咳血兼痰。
凉血地黄汤 治肠 下血，水谷与血，另作一派。
知母（炒） 黄柏（炒，各一两） 槐子（炒） 青皮熟地 当归
如余证，同痢门法治之。
胃气汤 治风毒客肠胃，动则血下。
芍 术 参 归 桂 芎 苓（各等分）
尿血方 治心肾因房劳、忧思气结。
发灰，能消瘀血，通闭，醋汤下三钱。棕榈烧灰，米饮下亦可。
三汁丹 治小便出血。
水杨树脑 老鸦饭草 赤脚马兰
各自然汁，以水服之。
益阴散 治阳浮阴翳，咯血、衄血。
黄柏 黄连 黄芩（以蜜水浸，炙干） 白芍 人参 白术 干姜（各三钱） 甘草（炙，
六钱） 雨前茶（一两二钱） 香油釜炒红，米饮下三四钱，立安。
三黄丸 治衄血不止，大便结燥者，下之。
大黄（半两） 芒硝 地黄（二钱） 黄连 黄芩 山栀（各一钱）
老蜜炼丸。
咳血丹 治因身热，痰盛血虚。
青黛 栝蒌仁（二味治痰） 诃子 海石（涩） 杏仁（治嗽甚） 四物汤（治虚） 姜汁 童
便山栀
蜜调噙化。
呕血丹 治因火载血上，错经。
四物汤 山栀（炒） 郁金 童便 姜汁 韭汁 山茶花
痰加竹沥。喉中痛是气虚，加参、 、术、柏。
衄血丹（凉血）犀角地黄汤入郁金。
溺血丹 治热。
生地（四两） 苏木根 淡竹叶 山栀（炒） 滑石 甘草 蒲黄 藕节 当归
血虚，加四物、牛膝膏、通草。
下血丹 四物汤。热，加连（酒煮温）、山栀（炒）、秦艽、升麻、胶珠、白芷；虚
，加干姜（炮）、五倍子；寒，加辛升温散，一行一止。
神效方 治吐血，痰血，酒色过度者。
枇杷叶（去毛） 款冬 紫菀茸 杏仁（去皮尖） 鹿茸（炙如法） 桑白皮 木通（各一两）
大黄（半两）
炼蜜丸，临卧含化口中。
圣饼子 治咯血。
青黛（一钱） 杏仁（四十粒，去皮尖）
上杏仁，以黄蜡煎黄色，研细，入黛作捏饼子。每日柿一个，中破开入药合定，湿纸煨
，饮下。
罗面丹 治内损吐血。
飞罗面（略炒） 京墨（磨下，二钱）
越桃散 治下血及血痢。
山栀 槐花 大枣 干姜（各等分）
烧存性，研，米饮下三钱。
伏龙肝散 治便血。因内外有感，凝住在胃，随气下通，亦妄行之类。
伏龙肝（八两） 白术 阿胶 黄芩 干地黄 甘草（各三两）
煎服。
赤豆归散 治先血后便，谓之近血。
赤小豆（五两，浸令芽出，晒干） 当归（一两）
为末浆水下。
五灵脂散 治下血。
五灵脂（炒为末）
芎归汤下。
有血脱尽，色白而夭、不泽，脉濡。此大寒证，乃始同而末异。治宜辛温益血，甘热温
经，干姜类是也。
有阴结者便血。夫邪在五脏，则阴脉不和，阴不和则血留之，血无所禀，渗入肠间，其
脉虚涩，非肠风脏毒也。治宜生地黄汁、小蓟汁各一升、砂糖、地榆、阿胶、侧柏叶。
[Pulse]
A choppy (Se), soggy (Ru), and weak pulse indicates blood loss; a fine (Xi), wiry (Xian), and choppy pulse, which feels deficient upon deep pressure, indicates severe blood depletion. A floating (Fu) and weak pulse, where the pulse disappears upon deep pressure, indicates lower body bleeding; accompanied by irritability and coughing, it inevitably leads to hematemesis. A deep (Chen) and wiry pulse, with a pale complexion and absence of chills or fever, inevitably indicates epistaxis. A deep pulse indicates the pathology is in the interior, with Ying and Wei Qi constrained internally; chest fullness inevitably leads to hematemesis. A slippery (Hua), small, and weak pulse indicates survival, whereas a floating, large, firm (Lao), and rapid (Shu) pulse indicates death. Furthermore, if the blood feels warm, the body is hot, and the pulse is restless (Zao), it indicates death, as heat causes the dispersion of Qi and Blood. If the Zang organs fail to store blood and all pulses are wiry, it indicates death; if the pulses are slippery and large, it indicates survival.
[Etiology]
Exterior conditions such as Lung Abscess (Fei Yong) and Lung Withering (Fei Wei) can also cause coughing up of pus and blood. Laborious strain can also lead to hematemesis.
[Syndrome Differentiation and Treatment]
Mahuang Tang (Ephedra Decoction): Treats Taiyang disease syndromes characterized by severe internal obstruction and heat, where Fire Qi cannot extend, resulting in epistaxis. A floating and tight pulse indicates Cold.
Guizhi Tang (Cinnamon Twig Decoction): Treats the same syndrome as above, but with a floating and slow pulse indicating Wind.
Wuling San (Five-Ingredient Powder with Poria): Treats latent summerheat, where heat flows into the meridians.
Huangqin Shaoyao Tang (Scutellaria and Peony Decoction): Treats both Taiyang Cold and Wind syndromes, with a faint pulse.
Nuxue Fang (Epistaxis Formula): Treats epistaxis originating from the Lung Meridian. If bleeding does not stop, apply cold-water paper to the chest, head, and Dazhui (GV14).
Herbs: Xijiao (Rhinoceros Horn), Shengma (Cimicifugae Rhizoma), Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix), Danshen (Salviae Miltiorrhizae Radix), Zican (Bupleuri Radix), Ejiao (Colla Corii Asini), Jingjie Sui (Schizonepetae Spica). Grind and take; this is also effective. Crush the root section of radish and drink the juice, or drip the juice into the nostrils; this is also effective. Moxibustion on Dazhui (GV14) and Yamen (GV15) can also stop bleeding.
Ketuoxue Fang (Formula for Coughing up Blood): Originates from the Kidney. It may also be caused by internal accumulation of blood stasis, causing Lung Qi obstruction and failure to descend. When Lung Qi is obstructed, vomiting is necessary to expel it.
Herbs: Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), Beimu (Fritillariae Cirrhosae Bulbus), Jiegeng (Platycodonis Radix), Shudi (Rehmanniae Radix Preparata), Yuanzhi (Polygalae Radix), Huangbai (Phellodendri Cortex). If there is Cold, add Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex).
Outou Tanxian Xue Fang (Formula for Vomiting Phlegm and Blood): Originates from the Spleen.
Herbs: Huangqi (Astragali Radix), Huanglian (Coptidis Rhizoma), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chenxiang (Aquilariae Lignum), Gegen (Puerariae Lobatae Radix).
Outouxue Fang (Formula for Vomiting Blood): Originates from the Stomach.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction): Treats Excess patterns and residual blood stasis after illness.
Dosages: Xijiao (1 liang), Shengdi (8 liang), Baishao (3 liang), Danpi (2 liang).
Xiaojianzhong Tang (Minor Construct the Middle Decoction) plus Huanglian: Treats Deficiency patterns and hematemesis due to Stomach injury.
Sanhuang Buxue Tang (Three-Yellow Blood-Nourishing Decoction): Treats cases where all six pulses are large but feel empty upon pressure, with a red face, susceptibility to fright, and upper body heat. This corresponds to the pulse of the Hand-Shaoyin Heart Meridian. This is Qi excess leading to blood loss; the treatment is to drain Fire and tonify Qi to sink floating Qi.
Dosages: Danpi (1 qian), Chuanxiong (2 qian), Shudi (2 qian), Shengdi (3 qian), Chaihu (1.5 qian), Danggui (1.5 qian), Shengma (1 qian), Huangqi (1 qian), Baishao (5 qian).
Renshen Yinzi (Ginseng Infusion): Treats hematemesis and epistaxis due to Spleen and Stomach deficiency. It also treats chronic hematemesis that has not healed; pricking the Qichong (ST30) acupoint with a three-edged needle to release blood will cure it immediately.
Dosages: Gancao (1 qian), Maidong (2 qian), Danggui (3 qian), Huangqi (1 qian), Wuweizi (5 berries), Baishao (1 qian).
Jiu Fei Yin (Lung-Saving Infusion): Treats coughing and hematemesis.
Dosages: Shengma (1 qian), Chaihu (1 qian), Baizhu (1 qian), Baishao (1 qian), Guiwei (2 qian), Shudi (2 qian), Huangqi (2 qian), Renshen (2 qian), Sumu (0.5 qian), Chenpi (0.5 qian), Gancao (0.5 qian).
Take as one dose.
Qingxin Lianzi Yin (Clear Heart Lotus Seed Infusion): Treats hemoptysis accompanied by phlegm.
Liangxue Dihuang Tang (Cool Blood and Rehmannia Decoction): Treats lower body bleeding from the intestines, where food/water and blood are separated into distinct streams.
Dosages: Zhimu (stir-fried, 1 liang), Huangbai (stir-fried, 1 liang), Huaizi (stir-fried), Qingpi, Shudi, Danggui.
For other symptoms, treat according to the methods in the Dysentery chapter.
Weiqi Tang (Stomach Qi Decoction): Treats wind-toxin lodging in the intestines and stomach, causing bleeding when moved.
Dosages: Shaoyao, Baizhu, Renshen, Danggui, Guizhi, Chuanxiong, Fuling (equal parts).
Niaoxue Fang (Hematuria Formula): Treats Heart and Kidney disorders due to sexual exhaustion, worry, and Qi stagnation.
Fa Hui (Hair Ash): Dissolves blood stasis and unblocks obstruction; take 3 qian with vinegar decoction. Zonglv (Livistona chinensis leaf ash) burned to ash, taken with rice water, is also effective.
Sanzhi Dan (Three-Juice Pill): Treats hematuria.
Herbs: Shuiyangshu Nao (Water Poplar Bud), Laoya Fan Cao (Old Crow Rice Grass), Chijiao Malan (Red-footed Horseweed).
Extract natural juices from each and take with water.
Yiyin San (Yin-Nourishing Powder): Treats floating Yang and obscured Yin, causing hemoptysis and epistaxis.
Dosages: Huangbai, Huanglian, Huangqin (soaked in honey water, stir-fried dry), Baishao, Renshen, Baizhu, Ganjiang (each 3 qian), Gancao (roasted, 6 qian), Yuqiancha (pre-Rain tea, 1.2 liang). Stir-fry sesame oil in a cauldron until red, take 3-4 qian with rice water for immediate relief.
Sanhuang Wan (Three-Yellow Pill): Treats persistent epistaxis with dry, constipated stool; use purgative method.
Dosages: Dahuang (0.5 liang), Mangxiao, Dihuang (2 qian), Huanglian, Huangqin, Shanzhi (each 1 qian).
Make pills with aged honey.
Kexue Dan (Hemoptysis Pill): Treats hemoptysis due to body heat, abundant phlegm, and blood deficiency.
Herbs: Qingdai (Indigo Naturalis), Gualou Ren (Trichosanthis Semen) [these two treat phlegm], Hezi (Terminalia Chebula Retius), Haishi (Fossilia Osseum), Xingren (Armeniacae Semen Amarum) [treats severe cough], Siwu Tang (Four Substances Decoction) [treats deficiency], Jiangzhi (Ginger Juice), Tongbian (Child's Urine), Shanzhi.
Mix with honey and dissolve in the mouth.
Ouxue Dan (Hematemesis Pill): Treats blood carried upward by Fire, flowing into incorrect channels.
Herbs: Siwu Tang, Shanzhi (stir-fried), Yujin (Curcumae Radix), Tongbian, Jiangzhi, Jiuji Zhi (Chinese Chive Juice), Shanchahua (Camellia Flower).
Add Zhuli (Bamboo Sap) if there is phlegm. Throat pain indicates Qi deficiency; add Renshen, Baizhu, Huangbai.
Nuxue Dan (Cooling Blood): Xijiao Dihuang Tang plus Yujin.
Niaoxue Dan (Hematuria Pill): Treats Heat patterns.
Dosages: Shengdi (4 liang), Sumugen (Sumu Root), Danzhuye (Lophatheri Herba), Shanzhi (stir-fried), Huashi (Talcum), Gancao, Puhuang (Typhae Pollen), Oujie (Nelumbinis Rhizomatis Node), Danggui.
If blood deficient, add Siwu Tang, Niuxi Gao (Achyranthes Bidentata Extract), Tongcao.
Xiaxue Dan (Lower Bleeding Pill): Siwu Tang. For Heat, add Lianqiao (wine-boiled and warmed), Shanzhi (stir-fried), Qinjiao, Shengma, Jiaozhu (Gelatinized Gelatin), Baizhi. For Deficiency, add Ganjiang (processed), Wubeizi. For Cold, add acrid-warm dispersing herbs; move and stop simultaneously.
Shenxiao Fang (Divine Efficacy Formula): Treats hematemesis and bloody phlegm due to excessive alcohol and sexual activity.
Dosages: Pipaye (Loquat Leaf, de-hairy), Kuandong (Farfarae Flos), Ziwan (Adenophorae Radix), Xingren (de-skinned and de-pitted), Lurong (Deer Antler, roasted properly), Sangbaipi (Morus Alba Bark), Mutong (Akebiae Caulis) (each 1 liang), Dahuang (0.5 liang).
Make pills with refined honey; dissolve in the mouth before bed.
Shengbingzi (Holy Cake): Treats hemoptysis.
Dosages: Qingdai (1 qian), Xingren (40 kernels, de-skinned and de-pitted).
Fry the almonds in yellow beeswax until yellow, grind finely, mix with Qingdai, and form into cakes. Take one persimmon daily, split open, insert the medicine cake, wrap in wet paper, and bake/roast. Swallow with water.
Luomian Dan (Flour Pill): Treats internal injury and hematemesis.
Dosages: Feiluomian (Fine Wheat Flour, lightly stir-fried), Jingmo (Beijing Ink, ground, 2 qian).
Yuetao San (Prunus Powder): Treats lower bleeding and bloody dysentery.
Dosages: Shanzhi, Huaihua (Sophorae Flos), Dazao (Jujubae Fructus), Ganjiang (each equal part).
Burn until carbonized but retaining properties, grind, and take 3 qian with rice water.
Fulonggan San (Dragon’s House Earth Powder): Treats melena. Caused by external and internal pathogenic factors condensing in the Stomach, following Qi downward, representing abnormal flow.
Dosages: Fulonggan (8 liang), Baizhu, Ejiao, Huangqin, Gan Dihuang, Gancao (each 3 liang).
Decoct and take.
Chidou Gui San (Red Bean and Angelica Powder): Treats blood appearing before stool, known as "Near Bleeding" (Jin Xue).
Dosages: Chixiaodou (5 liang, soaked until sprouted, dried), Danggui (1 liang).
Grind to powder, take with bean dregs water.
Wulingzhi San (Trogopterus Dung Powder): Treats lower bleeding.
Dosages: Wulingzhi (stir-fried and ground).
Take with Xionggui Tang.
If blood is completely depleted, the complexion is white and lifeless/lusterless, and the pulse is soggy. This is a Great Cold pattern, initially similar but ending differently. Treatment should use acrid-warm herbs to benefit blood and sweet-hot herbs to warm the meridians; Ganjiang-type herbs are suitable.
In cases of Yin Constriction, there is melena. When pathogens are in the Five Zang organs, the Yin pulses become discordant; if Yin is discordant, blood stagnates. Without proper nourishment, blood seeps into the intestines. The pulse is deficient and choppy; this is not Intestinal Wind or Zang Toxin. Treatment should use Shengdihuang Juice, Xiaoji Juice (each 1 sheng), Sugar, Diyü, Ejiao, and Ce Bai Ye.