舌乃心之苗。观小儿吐舌弄舌。木舌重舌。皆以去心经风火为主。则知舌衄。皆是心火亢盛。血为热逼而
渗出也。治法总宜清泄心火。导赤饮。加黄连大力连翘蒲黄牛膝元参治之。舌肿胀。衄血多者。为火太盛。
泻心汤主之。心烦神昏者。安神丸。加童便血余灰治之。夫舌虽心之苗。然口乃胃之门户。舌在口中。胃火
熏之。亦能出血。大便秘者。玉烛散。加银花治之。口渴兼发热者。竹叶石膏汤。加蒲黄藕节治之。舌本乃肝
脉所络。舌下渗血。肝之邪热。四物汤。加桃仁红花炒栀丹皮牛膝赤苓。重则宜用当归芦荟丸。龙胆泻肝
汤。盖舌衄虽同。而此外所见之证。必显有分别。故分心胃肝三经治之。非强为区别也。
外治之法。与齿衄同。
大衄者。九窍出血之名也。此非疫疠。即中大毒。人身止此九窍。而九窍皆乱。危亡之证。法在不治。惟有猝
然惊恐。而九窍出血者。可用朱砂安经丸。加发灰治之。
零腥者。吐出星点。黄白色。细如米粟。大如豆粒。气极腥臭。杂在漩唾之中。而非漩唾。乃吐血之后。血分瘀
热所化。或未吐血之前。血分之热化为星点。先吐星点。后乃吐血。总系血分瘀热变化而成。治宜清热化
血。降气消痰。以其似痰。必假痰气而生故也。在未吐血之前。而见零腥者。总以降气消痰为主。盖此时血
尚未动。但当治其气分。气厘清。而零腥自除。豁痰丸治之。小柴胡汤亦治之。在既吐血之后。而零腥见者。
总以清热化血为主。以其在吐血之后。乃瘀血壅热而出。故宜兼治瘀血。太平丸治之。生地黄散亦治之。
此证古书不载。吾临证往往遇之。因撰其名。而论列之。以补血证之缺。
The tongue is the sprout of the Heart. Observing children protruding or playing with their tongues, as well as conditions such as Mu She (Wooden Tongue) and Chong She (Double Tongue), treatment primarily focuses on clearing Wind-Fire from the Heart Meridian. From this, it can be inferred that She Nu (Bleeding from the Tongue) is caused by Hyperactivity of Heart Fire, where blood is forced out by Heat. The general treatment method should clear and drain Heart Fire. Dao Chi Yin (Guide Out the Red Powder Decoction) can be used, added with Huang Lian (Coptidis Rhizoma), Da Li Zi (Arctii Fructus), Lian Qiao (Forsythiae Fructus), Pu Huang (Typhae Pollen), Niu Xi (Achyranthis Bidentatae Radix), and Yuan Shen (Scrophulariae Radix). If the tongue is swollen and bleeding is profuse, indicating excessive Fire, Xie Xin Tang (Drain the Epigastrium Decoction) is the primary formula. If accompanied by mental restlessness and confusion, An Shen Wan (Calming the Spirit Pill) added with Tong Bian (Child's Urine) and Xue Yu Hui (Carbonized Hair) is used. Although the tongue is the sprout of the Heart, the mouth is the gateway of the Stomach. Since the tongue resides in the mouth, it can also bleed due to the steaming effect of Stomach Fire. If constipation is present, Yu Zhu San (Jade Candle Powder) added with Yin Hua (Flos Lonicerae Japonicae) is used; if thirst accompanies fever, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) added with Pu Huang and Ou Jie (Lotus Node) is used. The root of the tongue is connected by the Liver Meridian; oozing blood from under the tongue indicates Evil Heat of the Liver. Si Wu Tang (Four Substances Decoction) added with Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Chao Zhi Zi (Stir-fried Gardenia Fruit), Dan Pi (Moutan Cortex), Niu Xi, and Chi Ling (Poria with Red Core) can be used. In severe cases, Dang Gui Lu Hui Wan (Angelica and Aloe Pill) or Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) are appropriate. Generally, although She Nu presents similarly, the accompanying syndromes must show distinct differences; thus, treatment is differentiated according to the Heart, Stomach, and Liver meridians, not merely for the sake of distinction.
External treatment methods are the same as those for Chi Nu (Bleeding from the Teeth).
Da Nu (Great Hemorrhage) refers to bleeding from all nine orifices. This is either due to epidemic pestilence or poisoning by strong toxins. The human body has only these nine orifices; if all nine are disordered with bleeding, it is a critical condition indicating impending death, which is considered untreatable by standard protocols. Only in cases where sudden fright causes bleeding from the nine orifices may Zhu Sha An Jing Wan (Cinnabar Calming the Vessels Pill) added with Fa Hui (Carbonized Hair) be used.
Ling Xing refers to spitting out speck-like particles, yellowish-white, fine as millet grains but as large as bean seeds, with an extremely fishy odor, mixed in saliva rather than being pure saliva. This arises from Blood-Stasis and Heat in the Blood level after hematemesis, or prior to hematemesis, where Heat in the Blood level transforms into specks, causing them to be spat out first, followed by hematemesis. In summary, this is formed by changes in Blood-Stasis and Heat. Treatment should clear Heat and transform Blood-Stasis, descend Qi, and resolve Phlegm. Because it resembles Phlegm, it necessarily relies on Phlegm-Qi to generate. Before hematemesis occurs, when Ling Xing is seen, treatment primarily focuses on descending Qi and resolving Phlegm. At this stage, Blood has not yet moved; one should treat the Qi level. Once Qi is cleared, Ling Xing will naturally disappear. Huo Tan Wan (Expelling Phlegm Pill) is used, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) is also applicable. After hematemesis has occurred, if Ling Xing appears, treatment primarily focuses on clearing Heat and transforming Blood-Stasis. Since this occurs post-hematemesis, it results from Blood-Stasis obstructing and generating Heat; thus, treating Blood-Stasis concurrently is necessary. Tai Ping Wan (Peaceful World Pill) is used, and Sheng Di Huang San (Rehmannia Powder) is also applicable. This syndrome is not recorded in ancient texts, but I frequently encounter it in clinical practice. Therefore, I have named it and discussed it to supplement the deficiencies in literature regarding Blood Syndromes.