世之读朱丹溪书者。见其多用凉药。于是废黜热药。贻误不少。而丹溪不任咎也。盖丹溪之书。实未常废
热药。世之读陈修园书者。见其多用热药。于是废黜凉药。为害尤多。而修园不任咎也。盖修园之书。实未
尝废凉药。两贤立论。不过救一时之偏。明一己之见。世之不善读者。得其所详。忽其所略。岂知两贤所略。
亦曰人所已详。吾固不必详焉耳。初何尝废黜不言哉。即如予作此书。亦多用凉药。少用热药。然非弃热
药而不用。特以血症宜凉者多。非谓血症全不用热药也。予于每条当用热药者。未尝不反复言之。慎毋
误读是书。而有偏重凉药之弊。总在分别阴阳。审症处方。斯无差忒。又予是书为血症说法。与杂症不同。
泥此书以治杂症固谬。若执杂症以攻此书。尤谬。读吾书者。未知流弊若何。吾且为此论。先下一针砭。
平人之血。畅行脉络。充达肌肤。流通无滞。是谓循经。谓循其经常之道也。一旦不循其常。溢出于肠胃之
间。随气上逆。于是吐出。盖人身之气游于血中。而出于血外。故上则出为呼吸。下则出为二便。外则出于
皮毛而为汗。其气冲和则气为血之帅。血随之而营运。血为气之守。气得之而静谧。气结则血凝。气虚则
血脱。气迫则血走。气不止而血欲止。不可得矣。方其未吐之先。血失其经常之道。或由背脊走入膈间。由
膈溢入胃中。病重者其血之来。辟辟弹指。漉漉有声。病之轻者。则无声响。故凡吐血。胸背必痛。是血由背
脊而来。气迫之行。不得其和。故见背痛之证也。又或由两胁肋。走油膜。入小肠。重则潮鸣有声。逆入于胃。
以致吐出。故凡失血。复多腰胁疼痛之证。此二者。来路不同。治法亦异。由背上来者。以治肺为主。由胁下
来者。以治肝为主。盖肺为华盖。位在背与胸膈。血之来路。既由其界分溢出。自当治肺为是。肝为统血之
脏。位在胁下。血从其地而来。则又以治肝为是。然肝肺虽系血之来路。而其吐出。实则胃主之也。凡人吐
痰吐食。皆胃之咎。血虽非胃所主。然同是吐证。安得不责之于胃。况血之归宿。在于血海。冲为血海。其脉
丽于阳明。未有冲气不逆上。而血逆上者也。仲景治血以治冲为要。冲脉丽于阳明。治阳明即治冲也。阳
明之气。下行为顺。今乃逆吐。失其下行之令。急调其胃。使气顺吐止。则血不致奔脱矣。此时血之原委。不
暇究治。惟以止血为第一要法。血止之后。其离经而未吐出者。是为瘀血。既与好血不相合。反与好血不
相能。或壅而成热。或变而为痨。或结瘕。或刺痛。日久变证。未可预料。必亟为消除。以免后来诸患。故以消
瘀为第二法。止吐消瘀之后。又恐血再潮动。则须用药安之。故以宁血为第三法。邪之所辏。其正必虚。去
血既多。阴无有不虚者矣。阴者阳之守。阴虚则阳无所附。久且阳随而亡。故又以补虚为收功之法。四者
乃通治血证之大纲。而纲领之中。又有条目。今并详于下方云。
一止血。其法独取阳明。阳明之气。下行为顺。所以逆上者。以其气实故也。吐血虽属虚证。然系血虚非气
虚。且初吐时。邪气最盛。正虽虚而邪则实。试思人身之血。本自潜藏。今乃大反其常。有翻天覆地之象。非
实邪与之战斗。血何从而吐出哉。故不去其邪。愈伤其正。虚者益虚。实者愈实矣。况血入胃中。则胃家实。
虽不似伤寒证。以胃有燥屎。为胃家实。然其血积在胃。亦实象也。故必亟夺其实。釜底抽薪。然后能降气
止逆。仲景泻心汤主之。血多者。加童便茅根。喘满者。加杏仁浓朴。血虚者。加生地当归。气随血脱不归根
者。加人参当归五味附片。有寒热者。加柴胡生姜。或加干姜艾叶。以反佐之。随证加减。而总不失其泻心
之本意。则深得圣师之旨。而功效亦大。盖气之原在肾。水虚则气热。火之原在心。血虚则火盛。火热相搏
则气实。气实则逼血妄行。此时补肾水以平气。迂阔之谈也。补心血以配火。不及之治也。故惟有泻火一
法。除暴安良。去其邪以存其正。方名泻心。实则泻胃。胃气下泄。则心火有所消导。而胃中之热气。亦不上
壅。斯气顺而血不逆矣。且大黄一味。能推陈致新。以损阳和阴。非徒下胃中之气也。即外而经脉肌肤躯
壳。凡属气逆于血分之中。致血有不和处。大黄之性。亦无不达。盖其药气最盛。故能克而制之。使气之逆
者。不敢不顺。既速下降之势。又无遗留之邪。今人多不敢用。惜哉。然亦有病之轻者。割鸡焉用牛刀。葛可
久十灰散。亦可得效。义取红见黑即止之意。其妙全在大黄降气即以降血。吐血之证。属实证者十居六
七。以上二方。投之立效。然亦有属虚属寒者。在吐血家。十中一二。为之医者不可不知也。虚证去血太多。
其证喘促昏愦。神气不续。六脉细微虚浮散数。此如刀伤出血。血尽而气亦尽。危脱之证也。独参汤救护
其气。使气不脱。则血不奔矣。寒证者。阳不摄阴。阴血因而走溢。其证必见手足清冷。便溏遗溺。脉细微迟
涩。面色惨白。唇口淡和。或内寒外热。必实见有虚寒假热之真情。甘草干姜汤主之。以阳和运阴血。虚热
退而阴血自守矣。然血系阴汁。刚燥之剂。乃其所忌。然亦有阳不摄阴者。亦当用姜附也。上寒下热。芩连
姜附同用亦有焉。以上数法。用之得宜。无不立愈。其有被庸医治坏。而血不止者。延日已久。证多杂见。但
用以上诸方。未能尽止血之法。审系瘀血不行。而血不止者。血府逐瘀汤主之。火重者。加黄芩黄连。痰多
者。加云苓瓜霜。咳逆。加杏仁五味寸冬。盗汗身热。加青蒿冬桑叶黄柏牡蛎。喘者。加杏仁苏子。身痛。胸腹
满。大便闭。为瘀结。加大黄。如欲求详。参看痰瘀痨热等门。乃尽其治。又有审病之因。而分别以止其血者。
治法尤不厌详。因于酒及煎炒浓味之物者。其证脉数滑。口干燥。胸中烦热。大小便不利。宜用白虎汤。加
茵陈炒栀大黄藕节治之。因于外感者。先见头痛恶寒发热。脉浮而紧者。为寒犯血分。外束闭而内逆壅。
是以吐血。麻黄人参芍药汤治之。若脉浮而数者。为伤风。风为阳邪。宜小柴胡汤。加荆芥防风当归白芍
丹皮蒲黄知母石膏杏仁治之。若因瘟疫。外证颇似伤寒。而内有伏热攻发。口舌苔白。恶热羞明。小便短
赤。大便浊垢。心中躁烦。脉见滑数。宜升降散。加桃仁丹皮花粉生地蒌仁石膏杏仁甘草治之。犀角地黄
汤亦治之。若因于暑。则发热心烦。暑者。湿热二气合化之名也。以清热利湿为主。升降清化汤。加防己木
通蒌仁治之。病轻者去大黄。因于怒气逆上。血沸而吐者。宜丹栀逍遥散。加青皮牡蛎蒲黄胆草治之。气
火太甚者。则用当归芦荟丸。以平其横决。因于劳倦困苦饥饱不匀。以及忧思抑郁。心神怔忡。食少气短。
吐血虚烦者。宜用归脾汤主之。中土虚寒者加煨姜。虚热者加柴胡山栀。因于跌打损伤。以及用力努挣。
而得失血之证者。法宜补气以续其绝。消瘀以治其伤。四物汤。加黄 人参续断桃仁红花陈酒童便治
之。因于色欲过度。阴虚火旺。其证夜则发热。盗汗梦交。耳鸣不寐。六脉细数芤革。宜地黄汤。加蒲黄藕节
阿胶五味治之。止血之法。此其大略。如欲变化而尽善。非参透全书。不能丝丝入彀。总而论之。血之为物。
热则行。冷则凝。见黑则止。遇寒亦止。故有用热药止血者。以行血为止血。姜艾等是也。有用凉水止血者。
或用急流水。或用井华水。取冷则凝之义。芩连诸药。亦即冷止之义。有用百草霜京墨十灰散等。以止血
者。取见黑则止之义。黑为水之色。红为火之色。水治火故止也。此第取水火之色。犹能相克而奏功。则能
知水火之性。以消息用药。何血证难治之有。又有用咸以止血者。童便马通扬尘水之类。此内经咸走血
之义。童便尤能自还神化。服制火邪以滋肾水。大有功用。故世医云。服童便者。百无不生。不服童便者。百
无不死。本人小便。清晨每服一碗。名回龙汤。各种随笔。赞回龙汤之妙者。甚伙。病家皆所当服也。顾止血
之法虽多。而总莫先于降气。故沉香、降香、苏子、杏仁、旋复、枳壳、半夏、尖贝、浓朴、香附之类。皆须随宜取用。
而大黄一味。既是气药。即是血药。止血而不留瘀。尤为妙药。识得诸法。其于止血之用。思过半矣。夫所谓
止血者。非徒止其溢入胃中之血。使不吐出而已也。盖大吐之时。经脉之血。辐辏而至。其溢入胃中者。听
其吐可也。下可也。即停留胃中。亦与糟粕无异。固无大害也。独动于经脉之中。而尚未溢出者。若令溢出。
则不可复返矣。惟急止之。使犹可复还经脉。仍循故道。复返而为冲和之血。所谓止血者。即谓此未曾溢
出。仍可复还之血。止之使不溢出。则存得一分血。便保得一分命。非徒止已入胃中之死血已耳。今医动
言止血。先要化瘀。不知血初吐时。尚未停蓄。何处有瘀。若先逐瘀。必将经脉中已动之血。尽被消逐。则血
愈枯而病愈甚。安能免于虚损乎。惟第用止血。庶血复其道。不至奔脱尔。故以止血为第一法。
二消瘀。血既止后。其经脉中已动之血。有不能复还故道者。上则着于背脊胸膈之间。下则着于胁肋少
腹之际。着而不和。必见疼痛之证。或流注四肢。则为肿痛。或滞于肌腠。则生寒热。凡有所瘀。莫不壅塞气
道。沮滞生机。久则变为骨蒸干血痨瘵。不可不急去之也。且经隧之中。既有瘀血踞住。则新血不能安行
无恙。终必妄走而吐溢矣。故以去瘀为治血要法。用花蕊石散。令瘀血化水而下。且不动五脏真气。为去
瘀妙药。如无花蕊石。用三七郁金桃仁牛膝醋炒大黄。亦有迅扫之功。顾旧血不去。则新血断然不生。而
新血不生。则旧血亦不能自去也。譬诸君子之道不长。则小人之道亦不消。须知瘀血之去。乃新血日生。
瘀血无处可留。迫之不得不去。故或化而走小便。或传而入大肠。花蕊石。化血从小便去。醋黄散。下血从
大便去。但能去瘀血。而不能生新血。不知克敌者存乎将。祛邪者赖乎正。不补血而去瘀。瘀又安能尽去
哉。治法宜用圣愈汤以补血。加桃仁丹皮红花枳壳香附云苓甘草。补泻兼行。瘀既去而正不伤。治瘀之
法。大旨如是。然亦有宜用温药者。内经曰。血者喜阴而恶寒。寒则涩而不流。温则消而去之。且有热伏阴
分。凉药不效。而宜用从治之法。以引阳出阴者。方用仲景柏叶汤。为寒凝血滞之正治。亦瘀血伏于阴分
之从治法也。然三药纯温。设遇火烈之证。非其所宜。或略加柔药调之。则合四物汤用。又有合泻心汤用
者。则直以此反佐之也。以上通论治瘀之法。而瘀血着留在身。上下内外。又各有部分不同。分别部居。直
探巢穴。治法尤百不失一。审系血瘀上焦。则见胸背肩膊疼痛麻木逆满等证。宜用血府逐瘀汤。或人参
泻肺汤。加三七郁金荆芥。使上焦之瘀。一并廓清。血瘀中焦。则腹中胀满。腰胁着痛。带脉绕脐一周。下连
血室。女子以系胎。男子以束体。乃血之管领也。凡血证。未有带脉不病者。今瘀血滞于其分。则宜去之以
安带脉。带脉在中焦脾之部分。即从脾治之。观仲景肾着汤。可知治脾即是治带。带有瘀血。宜用甲己化
土汤。加桃仁当归姜黄主之。腰痛甚者。加鹿角尖。胁腹痛甚者。加蒲黄灵脂。血瘀下焦。腰以下痛。小腹季
胁等处胀满。是血瘀肝之部分。或积胞中血海为痛。宜归芎失笑散主之。大便闭结者。均加大黄。仲景逐
瘀大剂。则有抵当汤。桃仁承气汤数方。皆苦寒大破下。为治瘀能事。亦有当用温药下之者。生化汤及牛
膝散主之。本女科治产后恶露。及胞衣不下之方。余谓男女虽异。其血则同。同是下焦瘀血。故借用其方。
往往有验。且下焦原系阴分。上焦之瘀多属阳热。每以温药为忌。下焦之瘀多属阴凝。故产妇喜温而忌
寒。以其血在下焦也。知此。则知以温药。治下焦瘀血。尤为合宜。然亦须审系寒凝乃用温药。若血室热。则
仍是桃仁承气之证。又有瘀血流注。四肢疼痛肿胀者。宜化去瘀血。消利肿胀。小调经汤。加知母云苓桑
皮牛膝治之。又有瘀血客于肌腠。阻滞荣卫。发寒发热。似疟非疟。骨蒸盗汗。咳逆交作。用小柴胡汤。加当
归桃仁丹皮白芍主之。寒甚者。再加艾穗细辛。热甚者。再加花粉粉葛青蒿知母。咳有痰火。加瓜霜杏仁
寸冬五味云苓知母。水饮上冲。加葶苈子。益小柴胡。原是从中上疏达肝气之药。使肝气不郁。则畅行肌
腠。而荣卫调和。今加去瘀之品。则偏于去瘀。凡瘀血阻滞荣卫者。用之立验。总而论之。血瘀于脏腑之间
者。久则变为干血。化为痨虫。血瘀于躯壳之间者。或病偏枯。或化 脓。血瘀于肌腠之间者。则变骨蒸。毛
发焦折。肢体瘦削。一切不治之证。总由不善去瘀之故。凡治血者。必先以去瘀为要。另详瘀血门。
Those who read the works of Zhu Danxi see that he mostly used cold medicines, and thus discarded hot medicines, causing many errors, yet Zhu Danxi does not bear the blame. This is because Zhu Danxi's books never actually discarded hot medicines. Those who read the works of Chen Xiuyuan see that he mostly used hot medicines, and thus discarded cold medicines, causing even more harm, yet Chen Xiuyuan does not bear the blame. This is because Chen Xiuyuan's books never actually discarded cold medicines. The theories established by these two sages were merely to correct the biases of their times and clarify their own perspectives. Readers in later generations who are not good at studying books only see what they detailed and ignore what they omitted. How could they know that what the two sages omitted was also what people had already detailed? I naturally did not need to detail it either. Did they ever discard or fail to mention them initially? Just as when I wrote this book, I also used mostly cold medicines and few hot medicines. However, this does not mean abandoning hot medicines for use; it is simply that for blood disorders (Xue Zheng), cold medicines are suitable more often, not that hot medicines are completely unused for blood disorders. For every case where a hot medicine should be used, I have repeatedly explained it. Do not misread this book and fall into the bias of overemphasizing cold medicines. The key lies in distinguishing Yin and Yang, examining symptoms before prescribing, so as to avoid errors. Furthermore, this book discusses blood disorders, which differ from miscellaneous diseases (Za Zheng). Rigidly applying this book to treat miscellaneous diseases is indeed wrong; conversely, using methods for miscellaneous diseases to attack this book is even more erroneous. Readers of my book may not know what the detrimental effects might be, so I present this discussion as a preemptive warning.
In a healthy person, blood flows smoothly through the meridians (Mai Luo), nourishes the skin and muscles, and circulates without stagnation. This is called "following the channels" (Xun Jing), meaning following the normal pathway. Once it deviates from the norm, it overflows between the intestines and stomach, reverses upward with Qi, and is vomited out. Generally, Qi in the human body moves within the blood and manifests outside it. Thus, above it manifests as respiration, below as urination and defecation, and externally through the skin and hair as sweat. When Qi is harmonious, it acts as the commander of blood, guiding its circulation; blood acts as the guardian of Qi, keeping it tranquil. If Qi becomes stagnant, blood coagulates; if Qi is deficient, blood escapes; if Qi is forced, blood rushes. It is impossible to stop blood while Qi continues to move violently. Before vomiting occurs, blood loses its normal path. In severe cases, blood comes from the spine into the diaphragm and overflows into the stomach. The sound of blood rushing may be sharp like snapping fingers or gurgling like leaking water. In mild cases, there is no sound. Therefore, in all cases of hematemesis (Tu Xue), there must be pain in the chest and back, indicating the blood came from the spine, forced by Qi movement lacking harmony, hence the back pain. Alternatively, blood may come from the hypochondrium, pass through the omentum, enter the small intestine, and reverse into the stomach, causing vomiting. Thus, blood loss is often accompanied by waist and hypochondriac pain. These two origins require different treatments: bleeding from the back focuses on treating the Lung, while bleeding from the hypochondrium focuses on treating the Liver. The Lung, as the canopy, is located in the back and chest/diaphragm area; since the blood source overflows from this boundary, treating the Lung is appropriate. The Liver, the organ governing blood storage, is located in the hypochondrium; since blood comes from there, treating the Liver is appropriate. However, although the Liver and Lung are sources of blood flow, the act of vomiting is actually governed by the Stomach. Vomiting phlegm or food is the fault of the Stomach. Although blood is not primarily governed by the Stomach, since it is also a vomiting syndrome, responsibility must be assigned to the Stomach. Moreover, the destination of blood is the Sea of Blood (Chong Mai), whose meridian attaches to the Yangming Stomach channel. There is no instance of rebellious Chong Qi without rebellious blood. Zhang Zhongjing emphasized regulating the Chong Mai to treat bleeding. Since the Chong Mai attaches to Yangming, treating Yangming treats Chong. Yangming Qi should descend; rebellion causes vomiting. Urgently regulating Stomach Qi to restore downward flow stops vomiting and prevents blood from rushing away. At this stage, investigating the root cause is secondary; stopping bleeding is the primary method. After bleeding stops, blood that has left the vessels but was not vomited is called stasis (Yu Xue). It conflicts with healthy blood, potentially causing heat, consumption (Lao), masses, or stabbing pain. Unpredicted complications may arise over time, so eliminating stasis urgently is necessary to prevent future issues. Thus, eliminating stasis is the second method. After stopping bleeding and eliminating stasis, one must worry about blood stirring again, so calming the blood is the third method. Where pathogens gather, deficiency exists. Massive blood loss inevitably leads to Yin deficiency. Yin guards Yang; without Yin, Yang has no attachment and may eventually perish. Thus, tonifying deficiency is the final method for recovery. These four constitute the general principles for treating blood disorders, with specific details listed below.
1. Stop Bleeding. This method specifically targets the Yangming channel. Yangming Qi should descend; rebellion occurs due to excess. Hematemesis is technically a deficiency syndrome (blood deficiency rather than Qi deficiency), but during initial vomiting, pathogens are strong while Zheng Qi is weak. Blood normally remains hidden; violent reversal implies a battle with excess pathogens. Removing pathogens protects Zheng Qi; otherwise, deficiency worsens and excess persists. Blood accumulating in the Stomach creates a "Stomach Excess" condition, similar to dry stool in Cold Damage but distinct. One must urgently drain this excess, like removing firewood from under the pot, to descend Qi and stop rebellion. Zhang Zhongjing's Xie Xin Tang (Drain the Epigastrium Decoction) is indicated. For heavy bleeding, add Tongbian (Child's Urine) and Baomao Gen (White Imperata Rhizome); for wheezing/fullness, add Xing Ren (Apricot Seed) and Hou Po (Magnolia Bark); for blood deficiency, add Sheng Di Huang (Rehmannia Root) and Dang Gui (Angelica Sinensis); for Qi collapse following blood loss, add Ren Shen (Ginseng), Dang Gui, Wu Wei Zi (Schisandra), and Fu Pian (Prepared Aconite); for alternating chills and fever, add Chai Hu (Bupleurum) and Sheng Jiang (Fresh Ginger), or Gan Jiang (Dried Ginger) and Ai Ye (Mugwort Leaf) as counter-agents. Adjust according to symptoms while maintaining the core intent of Xie Xin Tang. The origin of Qi is in the Kidney; Water deficiency causes Qi heat. The origin of Fire is in the Heart; Blood deficiency causes Fire excess. Heat and Fire combine to create Qi excess, forcing blood to run wild. Tonifying Kidney Water to calm Qi is impractical; tonifying Heart Blood to balance Fire is insufficient. Only draining Fire removes violence and preserves righteousness. Although named "Draining the Heart," it actually drains Stomach Fire. Descending Stomach Qi guides Heart Fire downward, preventing Stomach heat from rising, thus harmonizing Qi and stopping blood rebellion. Da Huang (Rhubarb) promotes renewal, damages Yang to harmonize Yin, and descends Qi, not just in the Stomach but throughout meridians and skin where Qi rebels in the Blood level. Its potent nature subdues rebellion. Modern physicians fear using it, which is regrettable. For mild cases, Ge Kejiu's Shi Hui San (Ten Ash Powder) suffices, based on the principle that red turns black and stops. Its efficacy lies in Da Huang descending Qi to descend Blood. Six or seven out of ten hematemesis cases are excess type; these formulas work immediately. One or two cases are deficiency/cold. Severe deficiency presents with panting, confusion, faint pulse—like fatal hemorrhage. Du Shen Tang (Single Ginseng Decoction) saves Qi; if Qi doesn't collapse, Blood won't rush. Cold syndrome involves Yang failing to control Yin, leading to overflow, cold limbs, loose stools, pale face, and slow/thin pulse. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) warms Yang to manage Yin blood. However, blood is Yin fluid; harsh drying agents are contraindicated unless Yang failure requires Ginger/Aconite. Upper cold/lower heat may use Qin Lian Jiang Fu combination. Proper application yields quick results. For cases ruined by incompetent doctors with prolonged bleeding, examine for stasis. Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) is indicated. Add Huang Qin, Huang Lian for heat; Fu Ling, Gua Lou for phlegm; Xing Ren, Wu Wei Zi, Mai Dong for cough; Qing Hao, Sang Ye, Huang Bai, Mu Li for night sweats/fever; Xing Ren, Su Zi for wheezing; Da Huang for constipation/stasis. Investigate etiology for specific treatments: Alcohol/spicy food causes heat/slipping pulse; use Bai Hu Tang (White Tiger Decoction) with Yin Chen, Zhi Zi, Da Huang, Ou Jie. External cold causing headache/chills/tight pulse indicates Cold invading Blood level; use Ma Huang Ren Shen Shao Yao Tang. Wind-heat (floating/rapid pulse) uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Jing Jie, Fang Feng, Dang Gui, Bai Shao, Dan Pi, Pu Huang, Zhi Mu, Shi Gao, Xing Ren. Plague with latent heat uses Sheng Jiang San (Ascending-Descending Powder) with Tao Ren, Dan Pi, Fen Hua, Sheng Di, Gua Lou Ren, Shi Gao, Xing Ren, Gan Cao; Xi Jiao Di Huang Tang is also applicable. Summerheat (fever/restlessness) uses Sheng Jiang Qing Hua Tang with Fang Ji, Mu Tong, Gua Lou Ren (remove Da Huang for mild cases). Anger causing Qi/Fire rebellion uses Dan Zhi Xiao Yao San with Qing Pi, Mu Li, Pu Huang, Long Dan Cao; extreme cases use Dang Gui Lu Hui Wan. Fatigue/starvation/worry causing Heart/Spleen deficiency uses Gui Pi Tang; add Wei Jiang for Spleen cold, Chai Hu, Shan Zhi for deficiency heat. Trauma/straining uses Si Wu Tang with Huang Qi, Ren Shen, Xu Duan, Tao Ren, Hong Hua, aged wine, Tongbian. Sexual excess causing Yin deficiency/Fire hyperactivity uses Di Huang Tang with Pu Huang, Ou Jie, E Jiao, Wu Wei Zi. In summary, blood flows with heat, coagulates with cold, stops with black, and stops with cold. Hot medicines like Jiang/Ai stop bleeding by moving blood. Cold water or well water stops bleeding by coagulation. Qin/Lian herbs follow the cold principle. Bai Cao Shuang, Jing Mo, Shi Hui San stop bleeding via the "black stops red" principle (Water controls Fire). Salty substances like Tongbian follow the Nei Jing principle that salty enters Blood. Tongbian regulates Fire and nourishes Kidney Water. Taking morning urine (Hui Long Tang) is highly recommended. Regardless of methods, descending Qi is paramount. Chen Xiang, Jiang Xiang, Su Zi, Xing Ren, Xuan Fu Hua, Zhi Ke, Ban Xia, Bei Mu, Hou Po, Xiang Fu are useful. Da Huang is both a Qi and Blood herb, stopping bleeding without leaving stasis. Understanding these methods covers most of hemostasis. True hemostasis prevents blood in meridians from overflowing, preserving life, not just stopping vomited blood. Premature stasis removal during active bleeding depletes healthy blood. Thus, stopping bleeding is first.
2. Eliminate Stasis. After bleeding stops, blood that failed to return to vessels becomes stasis, attaching to the back/chest/diaphragm or hypochondrium/lower abdomen, causing pain. Flowing to limbs causes swelling; stagnating in muscles causes chills/fever. Stasis blocks Qi and vitality, potentially leading to bone-steaming consumption. It must be removed urgently. Stagnant stasis prevents new blood from circulating safely, leading to eventual rupture. Thus, removing stasis is essential. Hua Rui Shi San (Flower Nodule Stone Powder) liquefies stasis for excretion without harming Zhen Qi. Alternatives include San Qi, Yu Jin, Tao Ren, Niu Xi, and Cu Chao Da Huang. Old stasis prevents new blood generation; new blood generation helps eliminate old stasis. Stasis exits via urine (Hua Rui Shi) or feces (Cu Huang San). However, eliminating stasis alone is insufficient; one must tonify blood. Sheng Yu Tang (Sufficient Vitality Decoction) with Tao Ren, Dan Pi, Hong Hua, Zhi Ke, Xiang Fu, Fu Ling, Gan Cang tonifies and purges simultaneously. Warm medicines may be needed as Blood dislikes cold and prefers warmth to dissolve stasis. Bai Ye Tang (Leaf of Catalpa Decoction) treats cold-stagnation. Pure warm herbs may need softening agents or combination with Si Wu Tang or Xie Xin Tang as counter-agents. Stasis location dictates treatment: Upper Jiao (chest/back pain) uses Xue Fu Zhu Yu Tang or Ren Shen Xie Fei Tang with San Qi, Yu Jin, Jing Jie. Middle Jiao (abdominal distension/hypochondriac pain) involves the Dai Mai (Girdle Vessel); treat the Spleen. Jia Ji Hua Tu Tang with Tao Ren, Dang Gui, Jiang Huang is indicated; add Lu Jiao Jian for severe back pain, Pu Huang, Ling Zhi for hypochondriac pain. Lower Jiao (lower abdominal/flank pain) involves the Liver/Blood Sea; Gui Xiong Shi Yao San is indicated; add Da Huang for constipation. Zhang Zhongjing's strong purgatives like Di Dang Tang or Tao Ren Cheng Qi Tang treat severe stasis. Warm purgatives like Sheng Hua Tang or Niu Xi San (originally for postpartum lochia) can be borrowed for lower Jiao stasis in men, as lower Jiao is Yin and prone to cold coagulation. Limb pain/swelling from stasis uses Xiao Tiao Jing Tang with Zhi Mu, Fu Ling, Sang Bai Pi, Niu Xi. Stasis in muscles blocking Ying/Wei causing malaria-like symptoms uses Xiao Chai Hu Tang with Dang Gui, Tao Ren, Dan Pi, Bai Shao; add Ai Sui, Xi Xin for cold; Fen Hua, Ge Gen, Qing Hao, Zhi Mu for heat; Gua Lou, Xing Ren, Mai Dong, Wu Wei Zi, Fu Ling, Zhi Mu for phlegm-fire; Ting Li Zi for fluid retention. Xiao Chai Hu Tang soothes Liver Qi; adding stasis-resolving herbs targets stasis effectively. Stasis in organs leads to dry blood/consumption; in body shell to paralysis/abscess; in muscles to bone-steaming/emaciation. All incurable conditions stem from poor stasis management. Treating blood disorders always prioritizes eliminating stasis. See the Stasis chapter for details.