（一名伤寒夹瘀）
【因】内伤血郁。外感风寒。或脱衣斗殴。触冒冷风。又或跌扑打伤。一时不觉。过数日作寒热。状似伤寒。
【证】头痛身热。恶寒烦渴。胸胁串疼。腹有痛处不移。或少腹痛甚。手不可按。乍寒乍热。夜有谵语。
甚至昏厥不省。少顷复苏。苏后或变如狂。剧则疼极发狂。舌色紫暗。扪之滑润。或深紫而赤。甚或青紫。
【脉】左紧而涩。右多沉弦。总宜弦强。最忌细涩。仲景所谓弦为阳逆。涩则营气不足也。
【治】活血解表为先。轻则香苏葱豉汤去香附。加枳、芎、归须。重则桂枝桃仁汤加味。（川桂枝八分、光桃
仁七粒、赤白芍各一钱、炒细生地钱半、清炙草五分、黑炮姜三分、大红枣二枚。）次下瘀血。轻则五仁橘皮汤合
代抵当丸。重则桃仁承气汤。俟瘀降便黑。痛势轻减者。可用四物绛覆汤。滋血活络以善后。或用新加酒沥汤。滋
阴调气以芟根。若少腹痛剧。寒热如疟。夜则谵语如见鬼者。热结血室也。加减小柴胡汤以去邪通络。甚则昏厥
不省。一苏转痉。便闭腹胀。剧则如狂者。热瘀上冲心胞也。柴胡羚角汤以破结逐瘀。病势轻减后。
调营活络饮加减。（归尾、赤芍、生地、生淮、牛膝各二钱、光桃仁、酒炒生锦纹、川芎、干地龙各一钱、
杜红花、炒川甲各五分。）消余瘀以除根。若筋脉时痛时止。或愈或发者。宿瘀结在孙络也。四物绛覆汤调乳
香定痛散。（明乳香、净没药、生淮牛膝各五钱、川芎、白芷、赤芍、丹皮、生地各七钱半、炙甘草二钱、为末。）
以补血活络。络通瘀去。则筋络之内伤自愈矣。若跌扑内伤。瘀血上壅。气喘胸闷。大便秘结者。急用当归
导气散。（酒洗生川军一两、当归三钱、麝香三分、为末、每服三钱、醇酒一钟、童便两杯、调下、日二夜一。）
降瘀下行。以平肺气。总之夹血一证。最难辨而易忽。大要有痛处定而不移者。多是夹血。痛处散而不定者。
多是夹气。治必先辨其所因。详察其部分。消息其微甚。随证用药。分经制方。始能奏效。临时不可不观形察色。
审问明辨也。
【秀按】伤寒夹气证固多。夹血证亦不鲜。或素因内伤跌扑。或素因郁怒伤肝。及妇人停经血 。皆先有瘀
积在内。因感时病。引动痼疾。谓之夹血。与太阳病当汗不汗。邪陷暴结而为蓄血者。似同实异。其证必有痛
处定而不移。或胸脘痛。或胸胁痛。或大腹痛。或少腹痛。或腰胁痛。或肢臂痛。初起虽有风寒表邪。不得用
麻黄青龙等剂。每见发汗太过。误触瘀血。证变或呕或泄。或发呃逆。即感温暑热病。亦不得纯用苦寒凉血。
血得寒则凝。凝则瘀结不散。或发如狂。或变咳喘。甚至瘀血上冲。昏迷不醒。酿成血厥。大便或闭或黑。黑
兼紫红而散者可治。黑如败 。凝结成块者难治。黑如污泥。粘腻不断。臭秽异常者不治。以其正气已脱。血
液已败。与浊腐同下故也。俞君谓先审病原。继察部分。消息瘀血之微甚。对证发药。正治感症夹血之准绳也。
【廉勘】伤寒夹血。初治香苏葱豉汤加减。方尚轻稳。寒重桂枝桃仁汤加味。亦可暂用。若温热伏邪夹瘀。
初起一二日。病之表症悉具。而脉或芤或涩。颇类阳症阴脉。但须细询其胸腹胁肋四肢。有痛不可按而拒手
者。即为瘀血。确知其非阳症见阴脉。则是表症见里脉矣。治法必兼消瘀。如红花、桃仁、归尾、赤芍、元
胡、山楂之类。量加一二味。重则加炒川甲、酒炒活 虫等。则表邪易解。而芤涩之脉亦易起。若误认芤涩为
阴。而投温剂。轻则变剧。重则危矣。至于里症发现。可用俞氏桃仁承气汤。加干漆炒川连。泻火攻血。其瘀
血或从呕出。或从泄出。若不呕泄而出。多变呃逆。甚发血厥。但用活血消瘀。如二仁绛覆汤。（光桃仁七
粒、柏子仁二钱、归须、真新绛各钱半、旋复花三钱包煎、青葱管五寸冲。）调下七厘散。（真血蝎一两、粉
口儿茶二钱四分、明乳香、净没药、杜红花各钱半、飞辰砂一钱二分、冰片、麝香各一分二厘、研细匀、每服
四五分。）则呃逆血厥自除。若宿瘀与邪热并结者。必胸腹胁肋结痛。甚则神思如狂。更宜清热逐瘀兼行。使
之一齐顿解。如《千金》犀角地黄汤加味。（犀角片八分、鲜生地六钱、赤芍、丹皮、丹参各钱半、广郁金、花粉
各三钱、光桃仁七粒、生藕汁二瓢冲。）重则再调下失笑散二三钱。以奏速效。最重用局方聚宝丹。（广木香、
上沉香、春砂仁、明乳香、净没药、炒延胡各三钱、血竭钱半、麝香八分、共研细末、糯米浆糊丸、弹子大、
辰砂为衣。）以童便、陈酒、藕汁各四瓢。活 虫浆一小匙。重汤炖温。磨冲丹药。尤多捷效。虽然。消瘀当
分部位。消一身经络之瘀。如王氏身痛逐瘀汤。（羌活、秦艽、川芎、杜红花、制香附各一钱、全当归三钱、
淮牛膝、酒炒地龙各二钱、光桃仁、净没药各钱半、炙甘草八分、陈酒童便各半煎药。）消上焦肺络之瘀。
如仁伯清宣瘀热汤。（活水芦笋、鲜茅根、鲜枇杷叶各一两、新绛钱半、旋复花二钱、青葱管三寸、广郁金汁
四匙同冲。）消上焦血府之瘀。如王氏血府逐瘀汤。（全当归、鲜生地、广郁金各三钱、生枳壳、光桃仁、赤
芍各钱半、川芎、苦桔梗各八分、藏红花四分、陈酒童便煎药。）消中焦膈下之瘀。如王氏膈下逐瘀汤。（当
归、桃仁各三钱、五灵脂、酒炒延胡、赤芍、丹皮各二钱、制香附、炒枳壳各钱半、乌药、川芎各一钱、炙甘
草六分、藏红花五分、陈酒童便煎药。）消下焦少腹之瘀。如王氏少腹逐瘀汤。（归尾、生蒲黄各三钱、酒炒
五灵脂、没药、赤芍各二钱、蜜炙延胡钱半、川芎一钱、官桂四分、黑炮姜二分、酒炒小茴香七粒、陈酒童便
煎药。）消一身窍隧之瘀。如王氏通窍活血汤。（光桃仁三钱、赤芍、川芎各一钱、藏红花五分、青葱管五
寸、红枣二枚、生姜汁二滴、麝香五厘同冲。）此皆按经分部活血消瘀之要剂也。惟曾被斗殴。或失足跌扑。
察所伤止及皮面。跌扑处非关隐要。跌堕后亦绝无他故。眠食照常。隔数日。或二三日。而见寒热体疼。吐衄
便溺诸血。及烦躁恶心喘急。而不因伤起。即痛而不在伤处者。审系他病。切勿妄施逐瘀等药。反致失血。至
若夹失血证。较夹瘀血为尤多。
一夹衄血。血从鼻中来也。伤寒衄血有三。一因太阳失表。热瘀于经而衄者。证必兼头疼目瞑。治宜清解。桑
杏蒌贝汤去甘桔。加鲜竹茹、鲜茅根、鲜生地清降之。不可再汗。二因阳明失下。热瘀于里而衄者。证必兼漱
水不欲咽。治宜清下。养荣承气汤去归朴。加茅根、丹皮、生川牛膝等。釜底抽薪。三因外寒束内热。药宜辛
凉开透。误用辛温而动经血。亦多致衄。治宜清血。犀地清络饮去桃仁、姜沥。加元参、地锦、蜜炙剪草之
属。清营宁络。如衄后身凉脉静。邪从衄解。名曰红汗。不必止其血而血自止。惟衄后病势反剧。衄多不止
者。重伤其阴也。大为危候。急用龟柏地黄汤加麦冬、五味。育阴潜阳以滋补之。衄止则生。更有衄势太甚。
阳随阴走。四肢厥冷者。虚阳随阴火上越也。加味《金匮》肾气汤增牛膝。引火下行以镇纳之。阳秘则生。二夹
咳血。血从咳嗽而出也。风寒咳血有四。一原素有血证。风寒犯肺而咳。震伤血络而上溢者。证必兼头痛
身热。形寒怕风。喉痒胸痛。治宜清疏营卫。吴氏泄卫安营汤加减。（苏叶、梗、炒黑荆芥、苏薄荷各一钱、
光杏仁、紫菀、生白芍各钱半、蜜炙橘红、片芩各八分、清炙草五分、生藕汁二瓢冲。）庶几营卫之邪解。自
然咳止身凉。血不治自止矣。或用疏风止嗽汤。（方载兼风勘语中）加藕汁、童便。亦多奏效。二因内有
伏火。外感风寒。热被寒束。火逼络伤而致咳血者。外证同前。更兼口渴舌干。亦宜清解营卫。银翘麻黄汤
去麻黄、桔梗。加桑叶、丹皮、藕汁、童便。次用和血清络。五汁一枝煎去姜。加梨汁、童便。参甘咸
以安宁之。三原素饮烧酒。及吸水旱烟过多。一经风燥犯肺。干咳失血者。治宜祛风润燥。清燥救肺汤。桑
杏蒌贝汤二方增减。止血加地锦、藕节。清火加枯芩、寸冬。降痰加竹沥、梨汁。降气加白前、蜜炙苏子。
补血加生地、鲜藕。继用胡氏保肺悉尼膏。（悉尼六十枚、压取汁二十杯、生地、白茅根、生藕、合取汁十
杯。白萝卜、麦冬、荸荠合取汁五杯、再入白蜜一斤、饴糖八两、竹沥一杯、柿霜一两、熬成膏、每饭后及
临卧、取汁一杯、冲开水服之、并治肺痿失血、肺痈大势已退、余热未除、多服自愈、须痛戒烟酒、方除
根、胡在兹先生方。）终用参燕麦冬汤。（北沙参、麦冬各三钱、光燕条一钱、奎冰糖四钱、）清补肺脏以
善后。四因外感既久。陈寒入肺。久咳喘满。因而失血者。乃咳嗽气逆。牵动诸经之火以烁肺。肺气亦能
牵动胸背脉络之血。随咳而出。是病虽生于寒。而实因寒动火。火中伏寒。寒中包火。治宜清火之中。佐以
搜剔陈寒。用《千金》麦门冬汤。（麦冬三钱、桑皮三钱、生地、紫菀、竹茹各三钱、竹沥半夏钱半、苦桔
梗八分、蜜炙麻黄、北五味各五分、炙甘草四分、或用细辛二三分代麻黄、再加黑炮姜五分拌捣五味、尤去
肺寒要药。）虽然。寒伏肺中。久亦都从火化。即上焦血滞痰凝。亦属因火所致。盒饭专清其火。佐以消痰
宁络。人参泻肺汤加减。（西洋参、片黄芩、青连翘各钱半、生桑皮、焦山栀、甜杏仁各三钱、生枳壳一钱、
苦桔梗、苏薄荷各六分、酒炒生军八分、淡竹茹四钱。）送下葛氏保和丸。（知母、川贝、天门冬、款冬花、
天花粉、生苡仁、马兜铃、生地、紫菀、苏百合、蜜炙百部、生姜、阿胶、当归身各三钱、紫苏二钱、五味
子、薄荷、甘草各一钱各研细末、饴糖二两为丸、每服二钱、早晚空心服。）如咳犹不止。痰中兼有血丝
血珠者。防变肺痿肺痨。宜早服吴氏宁嗽丸。（南
沙参、桑叶、薄荷、川贝、前胡、茯苓、甜杏仁、竹沥半夏各二两、苏子、橘红各一两、生苡仁三两、炙草五
钱各研细末、用川斛一两。生谷芽二两煎汤法丸、每服二三钱。）夜服五汁猪肺丸。（雄猪肺一具去筋膜，
藕汁、蔗汁、梨汁、茅根汁、百合汁各一碗、代水、将猪肺入白砂罐内煮烂滤去渣、再将肺之浓汁、煎成如
膏、量加白莲粉、米仁粉、粳米粉、川贝末、人乳、共捣为丸、每服二三钱。）清金保肺、止嗽宁血以除根。
三夹呕血吐血。同是血退场门中。呕则血出有声。吐则血出无声。吐则其气尚顺。呕则其气更逆。呕血病在于
肝。吐血病在于肺。故呕血重而吐血轻。风寒病呕血吐血者。每因失治所致。有因太阳感寒。恶寒无汗。头痛
发热。寒邪外束。法当发汗。若失于表。阳气不得外泄。则逆走阳络。络血妄行。则致呕血吐血。治当清疏营
卫。表散风寒为先。泄卫安营汤。或疏风止嗽汤。二方酌加藕汁、童便。不拘口鼻失血。但起于头痛。怕冷发
热。无汗者。无论热之久暂。而怕冷等证仍在者。当解其表。表解。则血自止。如表邪虽解。血尚不止者。则
以止血为第一法。庶血复其道。不致奔脱。轻则四生地黄汤。（鲜生地五钱、生侧柏叶、焦山栀、元参心各三
钱、广郁金二钱、黑丹皮、丹参各钱半、广三七八分、生艾叶二分、生荷叶汁、陈京墨汁、童便各一瓢冲。）最
稳而效。重则犀地清络饮去桃仁、姜、蒲二汁。冲下立止吐血膏。（鲜生地一斤、生锦纹三两、桑叶、丹皮、
血见愁、杜牛膝各二两、土三七、苏子、降香各一两、用冰糖四两收膏、每服八钱至一两。）血止之后。其离
经而未吐出者、则为瘀血。必亟为消除。以免后患。故以消瘀为第二法。上焦之瘀。多属阳热。五汁一枝煎加
陈酒、童便。最为轻稳。重则俞氏桃仁承气汤加减。下焦之瘀。多属阴凝。少腹逐瘀汤加减。若血室热瘀。则
仍是桃仁承气之证。其他广郁金、参三七、生川牛膝、醋炒生军等。皆有迅扫之功。而为去瘀要药。均可随证
酌加。如止吐消瘀之后。仍恐血再潮动。则须用药安之。故以宁络为第三法。连茹绛覆汤加茅根、藕汁。惟肝
旺气冲者。轻则桑丹泻白汤去橘、枣。加白芍、白薇、鲜茅根等。重则新加玉女煎。尤为镇肝纳冲之要剂。其
火如不归根。即为龙雷之火。用滋任益阴煎加龙骨、牡蛎。以育阴潜阳。此尤治冲逆更进一层之法。然络血虽
宁。而去血既多。阴液必虚。阴虚则阳无所附。故终以补虚为善后收功之法。补肺如辛字润肺膏。（羊肺一
具、去筋膜白沫净、柿霜、真乳酥各五钱、甜杏仁四钱、天花粉三钱、白蜜四钱、为末搅匀、入肺中、炖熟食）
三参冬燕汤。（太子参、西洋参各一钱、北沙参四钱、麦冬二钱、光燕条一钱、青蔗浆一盏、建兰叶三片。）
参麦阿胶汤。（北沙参四钱、麦冬三钱、阿胶钱半、 皮一钱、北五味二十粒、糯米三十粒。）清燥救肺汤之类。
(Also known as Cold Damage with Blood Stasis)
[Etiology] Internal injury due to blood qi stagnation, combined with external contraction of wind-cold. Or exposure to cold wind after removing clothes, or combat injuries and falls, which are not immediately perceived. After a few days, alternating chills and fever occur, resembling Cold Damage.
[Symptoms] Headache, body heat, aversion to cold, vexation, and thirst. Stabbing pain in the chest and hypochondrium. Fixed, unchanging painful areas in the abdomen, or severe lower abdominal pain that cannot be touched. Alternating chills and fever. Delirium at night. Even fainting and loss of consciousness, recovering after a short while. After recovery, one may become manic-like; severe pain leads to mania. The tongue is purple and dark, smooth to the touch, or deep purple with red, or even bluish-purple.
[Pulse] The left pulse is tight and choppy (Se). The right pulse is mostly deep and wiry (Xian). Generally, a wiry and strong pulse is preferred; a fine and choppy pulse is most taboo. As Zhang Zhongjing stated: A wiry pulse indicates rebellious Yang Qi; a choppy pulse indicates insufficient Ying Qi (Nutritive Qi).
[Treatment] Prioritize invigorating blood and releasing the exterior. For mild cases, use Xiang Su Cong Chi Tang (Fragrant Perilla and Scallion Decoction), removing Xiang Fu (Cyperi Rhizoma), and adding Zhi Ke (Aurantii Fructus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dang Gui Xu (Angelicae Sinensis Radix Caulis). For severe cases, use Gui Zhi Tao Ren Tang (Cinnamon Twig and Peach Kernel Decoction) with modifications. (Chuan Gui Zhi 8 fen, Guang Tao Ren 7 grains, Chi Shao and Bai Shao 1 qian each, Chao Xi Sheng Di 1.5 qian, Qing Zhi Gan Cao 5 fen, Hei Pao Jiang 3 fen, Da Hong Zao 2 pieces.) Subsequently, purge the blood stasis. For mild cases, combine Wu Ren Ju Pi Tang (Five Seed Tangerine Peel Decoction) with Dai Di Dang Wan (Substitute Dredging Pill); for severe cases, use Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction). Wait until black blood stool is passed and pain subsides, then use Si Wu Jiang Fu Tang (Four Substance Crimson Cover Decoction) to nourish blood and dredge collaterals for convalescence. Alternatively, use Xin Jia Jiu Li Tang (Newly Modified Wine Mucus Decoction) to nourish Yin and regulate Qi to eradicate the root. If lower abdominal pain is severe, chills and fever resemble malaria, and delirium occurs at night as if seeing ghosts, this is Heat binding in the Blood Chamber. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications to dispel pathogens and dredge collaterals. If severe fainting occurs, followed by spasms upon waking, constipation, abdominal distension, and severe pain leading to mania, this is Heat-Stasis rushing upward to the Pericardium. Use Chai Hu Ling Jiao Tang (Bupleurum and Antelope Horn Decoction) to break stagnation and drive out stasis. After the condition alleviates, use Tiao Ying Huo Luo Yin (Regulate Ying and Invigorate Collaterals Decoction) with modifications. (Gui Wei, Chi Shao, Sheng Di, Sheng Huai, Niu Xi 2 qian each; Guang Tao Ren, Jiu Chao Sheng Jun, Chuan Xiong, Gan Di Long 1 qian each; Du Hong Hua, Chao Chuan Jia 5 fen.) Eliminate residual stasis to remove the root. If meridians hurt intermittently or recur, it is old stasis bound in Sun Collaterals. Use Si Wu Jiang Fu Tang combined with Ru Xiang Ding Tong San (Frankincense Pain-Relieving Powder). (Ming Ru Xiang, Jing Mo Yao, Sheng Huai Niu Xi 5 qian each; Chuan Xiong, Bai Zhi, Chi Shao, Dan Pi, Sheng Di 7.5 qian each; Zhi Gan Cao 2 qian, powdered.) To nourish blood and invigorate collaterals. Once collaterals are open and stasis removed, internal injuries to sinews and collaterals heal naturally. If fall injuries cause internal trauma with stasis rushing upward, resulting in asthma, chest oppression, and constipation, urgently use Dang Gui Dao Qi San (Angelica Guiding Qi Powder). (Jiu Xi Sheng Jun 1 liang, Dang Gui 3 qian, She Xiang 3 fen, powdered. Take 3 qian per dose, mixed with 1 cup of pure wine and 2 cups of child's urine. Twice daily, once at night.) Descend stasis and calm Lung Qi. In summary, the syndrome of Cold Damage with Blood Stasis is hardest to differentiate and easily overlooked. Generally, fixed pain indicates Blood Stasis; scattered, shifting pain indicates Qi Stagnation. Treatment must first identify the etiology, examine the location, assess severity, prescribe according to symptoms, and formulate according to channels to be effective. One must observe appearance and complexion, inquire thoroughly, and differentiate clearly.
[Xiu's Commentary] Cold Damage with Qi Stasis is common, but Blood Stasis is also frequent. Whether due to prior fall injuries, liver injury from depression/anger, or retained menses in women, there is pre-existing internal stasis. Contracting seasonal pathogens activates this latent disease, termed "Cold Damage with Blood Stasis." This differs from Taiyang Disease where failure to sweat causes pathogen collapse into sudden accumulation (Xu Xue/Blood Accumulation). Symptoms must include fixed, unchanging pain: epigastric, hypochondriac, abdominal, lower abdominal, lumbar, or limb pain. Although wind-cold exterior pathogens exist initially, Ma Huang Qing Long Tang etc. must not be used. Excessive sweating often disturbs stasis, causing vomiting, diarrhea, or hiccups. Even with Warm-Heat diseases, bitter-cold blood-cooling herbs should not be used purely. Blood congeals with cold; congestion prevents stasis dispersion, leading to mania or cough/asthma. Severe stasis rushing upward causes coma, forming Blood Syncope. Stool may be closed or black. Black with purple-red scattered patches is treatable; black like spoiled sauce clotted is difficult; black like mud, sticky, foul-smelling is untreatable due to exhaustion of Zheng Qi and corruption of blood. Mr. Yu's method of examining etiology, location, and stasis severity before prescribing is the standard for treating Cold Damage with Blood Stasis.
[Lian's Review] For initial treatment of Cold Damage with Blood Stasis, Xiang Su Cong Chi Tang with modifications is light and stable. For heavy cold, Gui Zhi Tao Ren Tang with modifications can be temporarily used. If Warm-Heat latent pathogen combines with stasis, in the first 1-2 days, exterior symptoms are present, but the pulse is Kou (Hollow) or Se (Choppy), resembling Yang disease with Yin pulse. However, careful inquiry reveals fixed, unbearable pain in chest/abdomen/limbs, confirming stasis. It is not Yang disease with Yin pulse, but exterior disease showing interior pulse. Treatment must combine stasis resolution: Hong Hua, Tao Ren, Gui Wei, Chi Shao, Yuan Hu, Shan Zha, etc. Add heavier herbs like Chao Chuan Jia or Jiu Chao Huo Zhe Chong (Leech) if severe. This resolves exterior pathogens and restores the pulse. Mistaking Kou/Se for Yin and using warm tonics worsens the condition. When interior symptoms appear, use Yu's Tao Ren Cheng Qi Tang with Gan Qi Chao Huang Lian to purge fire and attack blood. Stasis exits via vomit or stool; otherwise, hiccups or Blood Syncope may occur. Use Huo Xue Xiao Yu methods like Er Ren Jiang Fu Tang (Tao Ren, Bai Zi Ren, Gui Xu, Xin Jiang, Xuan Fu Hua, Qing Cong Guan) adjusted with Qi Li San (Xue Xie, Er Cha, Ru Xiang, Mo Yao, Hong Hua, Chen Sha, Bing Pian, She Xiang) to resolve hiccups/syncope. If old stasis binds with heat, causing chest/abdominal pain and mania, clear heat and drive stasis simultaneously using Qian Jin Xi Jiao Di Huang Tang with modifications. For severe cases, Shi Yao San. The most potent is Ju Fang Ju Bao Dan (Mu Xiang, Chen Xiang, Sha Ren, Ru Xiang, Mo Yao, Yan Hu, Xue Jie, She Xiang) taken with child's urine, aged wine, lotus juice, and leech juice. Stasis resolution depends on location: Whole body collaterals use Wang Shi Shen Tong Zhu Yu Tang; Upper Jiao Lung collaterals use Ren Bo Qing Xuan Yu Re Tang; Upper Jiao Blood Mansion uses Wang Shi Xue Fu Zhu Yu Tang; Middle Jiao Diaphragm uses Wang Shi Ge Xia Zhu Yu Tang; Lower Jiao Lower Abdomen uses Wang Shi Shao Fu Zhu Yu Tang; Orifices/Tunnels use Wang Shi Tong Qiao Huo Xue Tang. These are key formulas for channel-specific stasis resolution. Only if injury is superficial, no hidden damage, normal sleep/appetite, and delayed onset of chills/body ache/hemorrhage unrelated to the injury site should one suspect other diseases and avoid stasis-resolving drugs to prevent hemorrhage. Blood-loss syndromes are more common than stasis syndromes.
1. Nasal Hemorrhage (Nu Xue): Three types in Cold Damage. First, Taiyang failure to release exterior causes heat-stasis in channels; treat with Sang Xing Lou Bei Tang minus Gan/Jie, add Zhu Ru, Mao Gen, Sheng Di. Do not sweat. Second, Yangming failure to purge causes interior heat-stasis; treat with Yang Rong Cheng Qi Tang minus Dang/Pu, add Mao Gen, Dan Pi, Niu Xi. Third, exterior cold binding interior heat treated incorrectly with acrid-warm herbs moves channel blood; treat with Xi Di Qing Luo Yin minus Tao/Ruo/Jiang, add Xuan Shen, Di Jin, Jian Cao to clear Ying and calm collaterals. If fever/pulse normalize after bleeding, it is "Red Sweat," self-limiting. If worsening or profuse, it injures Yin severely; use Gui Bai Di Huang Tang plus Mai/Wu Wei to nourish Yin and subdue Yang. If extremities are cold due to Yang following Yin, use modified Jin Gui Shen Qi Tang with Niu Xi to guide fire downward.
2. Cough Hemoptysis (Ke Xue): Four types. First, pre-existing blood disorder aggravated by wind-cold invading Lung; treat with Wu Shi Wei An Ying Tang modified. Second, latent fire inside, wind-cold outside, heat trapped by cold injuring collaterals; treat with Yin Qiao Ma Huang Tang minus Ma/Jie, add Sang Ye, Dan Pi, Ou Zhi, Tong Bian. Follow with Wu Zhi Yi Zhi Jian. Third, chronic alcohol/smoke use causing dryness invading Lung; treat with Qing Zao Jiu Fei Tang or Sang Xing Lou Bei Tang modifications. Fourth, long-standing cold entering Lung, chronic cough causing hemorrhage due to fire moving; treat with Qian Jin Mai Men Dong Tang. If cold transforms to fire, use Ren Shen Xie Fei Tang modified with Ge Shi Bao He Wan. If cough persists with blood streaks, prevent Fei Wei/Lao; use Wu Shi Ning Sou Wan and Wu Zhi Zhu Fei Wan at night.
3. Vomiting/Spitting Blood (Ou Xue/Tu Xue): Vomiting implies sound/reversal (Liver pathology); Spitting implies silence/smoothness (Lung pathology). Liver vomiting is heavier. Etiology often involves failed exterior release allowing Yang Qi to rebel into Yang collaterals. Treat with exterior release first (Wei An Ying Tang or Shu Feng Zhi Sou Tang plus Ou Zhi/Tong Bian). If exterior resolved but bleeding continues, stop bleeding first (Si Sheng Di Huang Tang for mild, Xi Di Qing Luo Tang plus Li Zhi Tu Xue Gao for severe). Remove remaining stasis second (Wu Zhi Yi Zhi Jian for upper Jiao, Shao Fu Zhu Yu Tang for lower Jiao, Tao Ren Cheng Qi Tang for Blood Chamber). Calm collaterals third (Lian Ru Jiang Fu Tang). For Liver hyperactivity, use Sang Dan Xie Bai Tang or Xin Jia Yu Nu Jian. If fire is Dragon/Thunder type, use Zi Ren Yi Yin Jian with Long Gu/Mu Li. Finally, tonify deficiency (Xin Zi Run Fei Gao, San Shen Dong Yan Tang, Shen Mai E Jiao Tang, Qing Zao Jiu Fei Tang).