又芍药柏皮丸。治先血而后便。为之脏毒。
白芍药 黄柏 当归（以上各等分）
上为细末。滴水为丸。如桐子大。每服五七十丸。煎甘草汤送下。（
案湿毒脏毒。即远血近血也。故附载以备考。）
心气不足。吐血衄血泻心汤主之。（千金心脏门。不足。作不定。）
〔尤〕心气不足者。心中之阴气不足也。阴不足则阳独盛。血为热迫。而妄行不止矣。大黄黄连黄芩。
泻其心之热。而血自宁。寇氏云。若心气独不足。则当不吐衄也。此乃邪热因不足。而客之。故令吐衄。以
苦泄其热。以苦补其心。盖一举而两得之。（案出本草衍义。）此说亦通。济众方。用大黄生地
汁。治衄血。其下热凉血。亦泻心汤类耳。（案金鉴。改不足二字。作有余二字。非。）
泻心汤方（〔原注〕亦治霍乱。○案程沈尤金鉴。删去四字。是。）
大黄（二两） 黄连 黄芩（各一两）
上三味。以水三升。煮取一升。顿服之。
〔程〕心主血。心气不足。而邪热乘之。则迫血妄行。故
有吐衄之患。夫炎上作苦。故内经曰。苦先入心。三黄之苦。以泄心之邪热。
千金。巴郡太守奏三黄丸。治男子五劳七伤。消渴不生肌肉。妇人带下。手足寒热者方。
春三月黄芩（四两） 大黄（三两） 黄连（四两）
夏三月黄芩（六两） 大黄（一两） 黄连（七两）
秋三月黄芩（六两） 大黄（二两） 黄连（三两）
冬三月黄芩（三两） 大黄（五两） 黄连（二两）
上三味。随时加减。和捣以蜜为丸。如大豆。饮服五丸。日三。不知。稍加至七丸。取下而已。
又三黄散。治黄胆身体面目尽黄。（外台。集验。大黄散同。）
本方三味。各四两。治下筛。先食服方寸匕。日三。
和剂局方。三黄丸。治丈夫妇人。三焦积热。上焦有热。攻冲眼目。赤肿头项肿痛。口舌生疮。中焦
有热。心膈烦躁。不美饮食。下焦有热。小便赤涩。大便秘结。五脏俱热。即生 疖疮痍。及治五般痔疾。粪
门肿痛。或下鲜血。小儿积热。
本方三味。各十两。上为细末。炼蜜为丸。如梧桐子大。
每服三十丸。用熟水吞下。如脏腑壅实。加服丸数。
本事方。三黄散。治衄血无时。
本方三味。细末。每服二钱。新汲水调下。蜜水亦得。
直指方。川芎三黄散。治实热衄血。
于本方。加川芎。各等分。为末。每服二钱。食后井水调服。
拔萃方。犀角地黄汤。治热甚血积胸中。
于本方。加犀角地黄。
神效名方。黄连散。治黄胆。大小便秘涩壅热。
于本方。用黄连三两。加甘草一两。
上为细末。每服二钱。食后。温水调下。一日三服。
There is also Shaoyao Bopi Wan (Peony and Phellodendron Pill), which treats bleeding occurring before defecation. This is referred to as Zangdu (Visceral Toxin).
Baishao Yao (Radix Paeoniae Alba), Huangbai (Cortex Phellodendri), Danggui (Radix Angelicae Sinensis) [all in equal parts].
Grind the above ingredients into a fine powder. Add water drop by drop to form pills, sized like Sophora japonica seeds. Take 50-70 pills per dose, delivered with decoction of Gancao Tang (Licorice Decoction).
(Note: Shidu (Dampness Toxin) and Zangdu are synonymous with Yuanxue (Remote Blood) and Jinxue (Near Blood). Thus, it is appended here for reference.)
When Heart Qi deficiency presents with hematemesis or epistaxis, Xiexin Tang (Drain the Heart Decoction) is the primary treatment. (In *Qianjin Fang*, Chapter on Heart Diseases, "deficiency" is interpreted as "fluctuating" or "uncertain".)
[You Zaijing] What is meant by Heart Qi deficiency is insufficient Yin Qi within the Heart. When Yin is insufficient, Yang becomes excessively dominant alone. The blood is forced by heat to flow recklessly without stopping. Dahuang (Rhubarb Radix), Huanglian (Coptidis Rhizome), and Huangqin (Scutellariae Radix) drain the heat of the Heart, and the blood naturally calms down. Kou Shi stated: If there were merely a solitary deficiency of Heart Qi, one would not expect hematemesis or epistaxis. This occurs because pathogenic heat takes advantage of the deficiency to lodge itself, thereby causing vomiting of blood and nosebleeds. Using bitter substances to drain the heat and using bitter substances to tonify the Heart achieves two goals with one action. (Note: This theory originates from *Bencao Yan Yi*. This explanation is also plausible. *Jizhong Fang* uses Dahuang and Dihuang juice to treat epistaxis; its function of draining heat and cooling blood also falls under the category of Xiexin Tang. (Note: *Yizong Jinjian* changed the characters "bu zu" (insufficient) to "you yu" (excessive), which is incorrect.)
Xiexin Tang Formula ([Original Note]: Also treats Huoluan (Cholera-like syndrome). ○ Note: Cheng Lin, Shen Mingzong, You Zaijing, and Wu Qian's *Yizong Jinjian* deleted these four characters, which is correct.)
Dahuang (2 liang), Huanglian, Huangqin (each 1 liang).
Take these three herbs, add 3 sheng of water, boil to obtain 1 sheng. Take all at once.
[Cheng Lin] The Heart governs blood. When Heart Qi is deficient and pathogenic heat exploits this weakness, it forces blood to move recklessly, leading to the danger of hematemesis and epistaxis. Fire flares upward and has a bitter taste; thus, the *Neijing* states that bitter flavors enter the Heart first. The bitterness of the Three Yellows drains the pathogenic heat of the Heart.
*Qianjin Fang* records the Sanhuang Wan (Three Yellows Pill) presented by the Administrator of Ba Commandery, treating men suffering from Five Exhaustions and Seven Injuries, Xiao Ke (Wasting and Thirsting syndrome) with lack of muscle growth, women with leukorrhea, and symptoms of alternating cold and heat in hands and feet.
Spring months: Huangqin (4 liang), Dahuang (3 liang), Huanglian (4 liang).
Summer months: Huangqin (6 liang), Dahuang (1 liang), Huanglian (7 liang).
Autumn months: Huangqin (6 liang), Dahuang (2 liang), Huanglian (3 liang).
Winter months: Huangqin (3 liang), Dahuang (5 liang), Huanglian (2 liang).
Process the three herbs according to seasonal adjustments, mix and pound them, bind with honey to form pills the size of soybeans. Take 5 pills with water upon an empty stomach, three times daily. If ineffective, gradually increase to 7 pills, until bowel movements are unblocked.
Additionally, there is Sanhuang San (Three Yellows Powder), which treats Huangdan (Jaundice) where the body, face, and eyes are entirely yellow. (*Waitai Miyao* and *Jiyi Fang*'s Dahuang San are identical.)
For this formula, take each of the three herbs at 4 liang. Grind and sieve. Take one Fang Cun Bi (square-inch measure) before meals, three times daily.
The *Heji Jufang* (Bureau of Formulations) Sanhuang Wan treats accumulated heat in the Triple Burner for both men and women. Heat in the Upper Burner attacks the eyes, causing redness, swelling, head and neck pain, and sores in the mouth and tongue. Heat in the Middle Burner causes irritability in the heart and diaphragm, and poor appetite. Heat in the Lower Burner causes dark, scanty, painful urination and constipation. Heat in all five Zang organs leads to boils, ulcers, and skin lesions. It also treats five types of hemorrhoids, with swelling and pain at the anus, or passage of fresh blood. It treats pediatric accumulated heat.
For this formula, take each of the three herbs at 10 liang. Grind into a fine powder, bind with refined honey to form pills the size of Sophora japonica seeds.
Take 30 pills per dose, swallowed with warm boiled water. If there is stagnation and fullness in the Zang-Fu organs, increase the number of pills taken.
*Benshi Fang* (Formulas from Verified Facts) Sanhuang San treats spontaneous epistaxis.
To the base formula, add Chuanxiong (Ligusticum Rhizome) in equal parts. Grind into powder. Take 2 qian per dose, mixed with newly drawn well water. Honey water is also acceptable.
*Zhizhi Fang* (Direct Guide Formulas) Chuanxiong Sanhuang San treats epistaxis due to excess heat.
To the base formula, add Chuanxiong in equal parts. Grind into powder. Take 2 qian per dose, mixed with well water after meals.
*Bacui Fang* (Extracted Excellence Formulas) Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) treats extreme heat with blood accumulation in the chest.
To the base formula, add Xijiao (Cornu Rhinocerotis - *Note: Use substitutes in modern practice*) and Dihuang (Rehmanniae Radix).
*Shenxiao Mingfang* (Divine Efficacy Famous Formulas) Huanglian San treats jaundice with constipation and urinary difficulty due to stagnant heat.
For this formula, use only Huanglian (3 liang) and add Gancao (Licorice Root, 1 liang).
Grind into a fine powder. Take 2 qian per dose, mixed with warm water after meals. Take three times daily.