（按胸满。是瘀血中一证。不宜于篇题中有此二字。从删为是。）
按惊悸心疾。血心之所主。此其所以合为一篇欤。
寸口脉动而弱。
〔赵〕心者。君主之官。神明出焉。不役形不劳心。则精气全。而神明安其宅。苟有所伤。则气虚而脉动。动则心
悸神惕。精虚则脉弱。弱则怔忡恐悸。盖惊自外物触入而动。属阳。阳变则脉动。悸自内恐而生。属阴。阴耗则脉弱。
是病宜和平之剂。补其精气。镇其神灵。尤当处之以静也。〔朱〕因物所感则为惊。神虚怵惕则为悸。分言之。似有动
静虚实之别。而惊则未有不悸。悸则未有不易惊者。其原流自属一致。仲景独取寸口。以动而弱三字。绘出惊悸之脉象。
而仍分疏之。曰。何以知其为惊。以其脉之厥厥动摇也。何以知其为悸。以脉动之中。而自软弱也。则脉之动而弱。必
兼见。则症之惊与悸。亦相因而生。此自然之理也。
师曰。尺脉浮。目睛晕黄。衄未止。
〔鉴〕浮脉主阳主表。若目睛清洁。主阳表病也。目睛晕黄。主血脉病也。盖以诸脉络于目。而血热则赤。血瘀则
黄。今目睛黄晕。知其衄未止也。若晕黄去。目睛慧了。知其衄已止。
按尺脉以候血分。金鉴似是。晕黄去。目睛慧了。其脉静者。可推而知也。周礼注。郑司农云。 。谓日光气也。
（即晕字。）释名曰。晕。卷也。气在外卷结之也。日月皆然。
病患面无血色。无寒热。
按面无血色。无寒热。是该衄下血吐血而言。徐氏曰。烦咳条不言脉。浮弱二字贯之也。又金鉴曰。脉沉。当是脉
浮。脉浮。当是脉沉。文义始属。必传写之讹。金鉴说不妥。盖脉浮。是血逆之候。沉弦。是血虚之征。
夫吐血咳逆上气。
按圣惠方香港脚门曰。上气脉数。不得卧者死。盖病属虚。及实中挟虚者。见此脉证。必为不治。夫酒客咳者。必致
吐血。（医心方。引医门方。也字。作难疗二字。）病患胸满。唇痿舌青。
〔赵〕是证瘀血。何邪致之耶。内经。有堕恐恶血留内。腹中满胀。不得前后。又谓大怒则血菀于上。是知内外诸
邪。凡有所抟积而不行者。即为瘀血也。积在阴经之隧道。不似气积于阳之肓膜。然阳道显。阴道隐。气在肓膜者。壅
胀显于外。血积隧道。惟闭塞而已。故腹不满。因闭塞自觉其满。所以知瘀血使然也。
按脉经所谓。当汗出不汗出为瘀血。亦出外台短剧芍药地黄汤主疗。及巢源伤寒诸候中且芍药地黄汤方后云。其人
喜忘如狂者。加地黄三两。黄芩三两。其人脉大来迟。腹不满。自言满者。为无热。但根据方服。不用黄芩也。（右据宋
本录。千金。加地黄。作加大黄。为是。末句。作但根据方不须有所增加。无不用黄芩也字。）据此。此条证。即芍药地
黄汤所主也。
又按唇痿之痿。本是萎字。即失色之谓。金鉴以痿瘁释。误。
病者。如热状烦满。
按而渴。疑不渴讹。盖血热诸条。有但欲漱水证。不敢言有渴。验之病者。亦必不欲咽。且而不互错。往往见之。
（宜考辑义水气篇。）徐氏曰。瘀血症。不甚则但嗽水。甚则亦有渴者。盖瘀久而热郁也。殆是望文生义者已。
心下悸者。半夏麻黄丸主之。（本草。图经。引张仲景伤寒论同。）
按赵氏论悸有三种。文繁不录。
吐血不止者。（赵。止作足。）
〔赵〕夫水者。遇寒则沉潜于下。遇风则波涛于上。人身之血。与水无异也。得寒而和。则居经脉。内养五脏。得
寒之凛冽者。则凝而不流。积而不散。得热之和者。则营运经脉。外充九窍。得热之甚者。风自火狂。则波涛汹起。由
是观之。吐血者风火也。
柏叶汤方（本草。图经云。张仲景方。疗吐血不止者。柏叶汤主之。青柏叶一把。干姜三片。阿胶二铤。炙。
三味。以水二升煮一升。去滓。别绞马通汁一升。相和合煎取一升。绵滤一服尽之。）
按本草黑字。柏叶。艾叶。并味苦微温无毒。白字。干姜。止血。（程氏所举神农经。及马通性用。并黑字文。）
陶氏本草序例曰。云一把者。重二两为正（按医心方。稍有异同。宜参。又引范汪方云。胶一铤。如三指大。长三
寸者。一枚。是也。）
朱氏曰。千金方。有阿胶三两。亦佳。但近日无真阿胶。徒增粘腻耳。
下血先便后血。此远血也。
按徐氏曰。下血较吐血。势顺而不逆。此病不在气也。当从腹中求责。故以先便后血。知未便时血分不动。直至便
后努责。然后下血。是内寒不能温脾。脾元不足。不能统血。脾居中土。自下焦而言之。则为远矣。此说似是。仍存之。
下血先血后便。此近血也。
〔赵〕此出大肠。故先血后便。以湿热之毒。蕴结不入于经。渗于肠中而下。赤小豆。能行水湿。解热毒。梅师方。
皆用此一味治下血。况有当归破宿养新。以名义观之。血当有所归。则不妄行矣。
妇人良方曰。粪后下血者。其来远。粪前有血者。其来近。远近者。言病在上下也。
张氏医通曰。千金用伏龙肝汤。即治先便后血之黄土汤中。除去术附。加干姜。牛膝。地榆。发灰。与金匮主治。
则有寒热之殊。不可不辨。可见治血但使归经。不必论其远近也。外科正宗内痔治验曰。大抵此症所致之由不同。
当究其因治之。如元气有余。形黑气盛。先粪而后紫血者。更兼脉实有力。此属有余。法当凉血止血。药应自效。至若
形体瘦弱。面色痿黄。先鲜血而后粪者。更兼脉虚无力。此属不足。岂可反用凉药止之。致伤脾胃。此症若不温中健脾。
升举中气。其血不得归原。故药难效。远其根本也。（按此说。似与经旨相左。然亦足以互发。仍拈出之。）
鸡峰普济方。赤小豆散。治大便秘。（即本方）
心气不足。吐血衄血。
按赵氏曰。心气不足者。非心火之不足。乃真阳之不足也。此说属 。尤氏暗驳正之。实本于医通。赵又曰。若济
众方。用大黄治衄血。更有生地汁。则是治热凉血。亦泻心汤类耳。此尤所本。
[Note: Chest fullness is one manifestation of blood stasis. It is inappropriate for these two characters to appear in the chapter title; deletion is advisable.]
[Note]: Palpitations and fright palpitations belong to heart diseases. Blood is governed by the Heart, which is why they are combined in this chapter.
The pulse at the Cun Kou (inch position) is both agitated and weak.
[ZHAO]: The Heart is the monarch official, from which Shen Ming (Spirit/Mind) emerges. If one does not overexert the body or weary the mind, Jing Qi (Essence and Qi) will be abundant, and Shen Ming will reside peacefully in its dwelling. If injured, Qi deficiency leads to an agitated pulse; agitation causes Xin Ji (heart palpitations) and spiritual fear. Essence deficiency leads to a weak pulse; weakness causes Zheng Chong (palpitations with anxiety) and fearful palpitations. Generally, Jing (fright/startle) arises from external stimuli touching the interior, belonging to Yang; Yang transformation leads to an agitated pulse. Ji (palpitations/fear) arises from internal terror, belonging to Yin; Yin consumption leads to a weak pulse. Therefore, this condition is suitable for mild agents that tonify Essence and Qi and anchor the Spirit. One should particularly maintain tranquility. [ZHU]: Being affected by external things constitutes Jing; Shen (Spirit) deficiency causing timidity constitutes Ji. Separately discussed, there seems to be a distinction between movement/stillness and excess/deficiency. However, those who experience Jing invariably experience Ji, and those with Ji are prone to Jing. Their origin and flow are naturally consistent. Zhang Zhongjing exclusively examines the Cun Kou pulse, using the three characters "agitated" and "weak" to depict the pulse image of Jing and Ji, while still distinguishing them: How do we know it is Jing? Because the pulse trembles violently. How do we know it is Ji? Because within the pulse's agitation, there is inherent softness and weakness. Thus, the pulse being both agitated and weak must coexist, and the symptoms of Jing and Ji arise interdependently. This is the natural principle.
The Master said: The Chi (cubit) pulse is floating, the eyes have yellow halos around them, indicating that epistaxis has not stopped.
[JIAN]: A floating pulse indicates Yang and exterior conditions. If the eyes are clear, it indicates a Yang-exterior disease. If the eyes have yellow halos, it indicates blood vessel disease. Since all meridians connect to the eyes, heat in the blood causes redness, and blood stasis causes yellowness. Now, seeing yellow halos on the eyes, we know epistaxis has not stopped. If the yellow halos disappear and the eyes become bright and clear, we know epistaxis has stopped.
[Note]: The Chi pulse is used to inspect the Blood level. JIAN's view is approximately correct. When the yellow halos disappear and the eyes become clear, if the pulse becomes calm, this can be inferred. In the commentary on *Zhou Li*, Zheng Sinong stated: "Yun" refers to the aura of sunlight. (This is the character "Yun".) *Shi Ming* states: Yun means rolling up; it is formed when Qi rolls and knots on the outside. This applies to both the sun and moon.
The patient's face lacks color, without aversion to cold or fever.
[Note]: Lack of facial color without aversion to cold or fever refers to epistaxis, lower bleeding, or hematemesis. XU stated: In the "Vomiting Cough" section, no pulse is mentioned, but the characters "floating and weak" run through it. Additionally, *Jin Jian* states: The original text's "deep pulse" should be "floating pulse," and "floating pulse" should be "deep pulse" for the meaning to make sense; this must be a copying error. *Jin Jian*'s explanation is inappropriate. A floating pulse is a sign of rebellious blood, whereas a deep and wiry pulse is a sign of blood deficiency.
Regarding hematemesis and coughing with qi rebelling upward:
[Note]: *Sheng Hui Fang* in the Gout section states: For upper qi rebellion with a rapid pulse and inability to lie flat, death ensues. Generally, if the disease is deficient, or excess mixed with deficiency presents with these pulse and symptom patterns, it is incurable. Patients who consume alcohol and cough will inevitably suffer hematemesis. (*Yi Xin Fang* cites *Yi Men Fang*, changing "ye" to "nan liao" [difficult to treat].) The patient experiences chest fullness, withered lips, and a bluish tongue.
[ZHAO]: This is a blood stasis syndrome. What pathogen caused it? *Nei Jing* mentions that falling or fear causes evil blood to remain internally, leading to abdominal fullness and inability to pass stool or urine. It also states that great anger causes blood to stagnate in the upper body. From this, we know that various internal and external pathogens that accumulate and fail to circulate result in blood stasis. Stasis accumulates in the tunnels of the Yin meridians, unlike Qi accumulation in the Huang Mo (membranes) of the Yang. However, the Yang path is manifest, while the Yin path is hidden. Qi accumulating in the Huang Mo manifests as external distension; blood stasis in the tunnels merely causes obstruction. Thus, although the abdomen is not actually distended, the patient feels full due to obstruction. Hence, we know this is caused by blood stasis.
[Note]: *Mai Jing* states, "Failure to sweat when sweating is indicated constitutes blood stasis." This also appears in the treatment scope of Shaoyao Dihuang Tang in *Waitai Mi Yao*. Furthermore, in *Bing Yuan Fang Lue* under Cold Damage syndromes, after the formula for Shaoyao Dihuang Tang, it states: If the patient exhibits forgetfulness and mania-like behavior, add 3 liang of Dihuang and 3 liang of Huangqin. If the patient's pulse is large but slow, and the abdomen is not distended yet the patient claims it is, this indicates absence of heat; simply follow the base formula without Huangqin. (Recorded according to the Song edition; *Qianjin Fang* changes "add Dahuang" to "add Dihuang," which is correct. The final sentence reads "simply follow the base formula without additions," omitting "without Huangqin.") Based on this, this syndrome is treated by Shaoyao Dihuang Tang.
Furthermore, "Wei" in "Chun Wei" originally refers to "Wu," meaning loss of color. *Jin Jian*'s interpretation of "Wei Cui" is erroneous.
The patient appears to have heat sensations, irritability, and abdominal fullness.
[Note]: The presence of thirst is suspected to be a corruption of "no thirst." In various blood-heat sections, there are cases of desiring only to rinse the mouth with water, where thirst is not claimed. Verifying the condition, the patient definitely does not wish to swallow. Moreover, "no thirst" and "thirst" are often confused in texts. (See *Shui Qi Pian* for verification.) XU stated: In blood stasis syndromes, mild cases involve only rinsing the mouth with water, while severe cases may involve thirst due to long-standing stasis transforming into heat and郁结 (stagnation). This is likely mere literal interpretation.
For palpitations below the heart, Banxia Mahuang Wan is indicated. (*Ben Cao* and *Tu Jing* cite Zhang Zhongjing's *Shanghan Lun* similarly.)
[Note]: Zhao discussed three types of palpitations; the text is too lengthy to record here.
For unceasing hematemesis: (Zhao's version reads "zu" [foot] instead of "zhi" [stop].)
[ZHAO]: Water sinks beneath when encountering cold and surges above when encountering wind. Human blood is no different from water. When harmonized by cold, it resides in the meridians, nourishing the five Zang internally; when pierced by biting cold, it coagulates and fails to flow, accumulating without dispersing; when warmed by gentle heat, it circulates in the meridians, filling the nine orifices externally; when subjected to intense heat, wind follows fire's madness, causing turbulent waves. Thus, hematemesis is caused by wind and fire.
Cebai Ye Decoction Formula (*Ben Cao* and *Tu Jing* state: Zhang Zhongjing's formula for unceasing hematemesis uses Cebai Ye Decoction. Take one handful of fresh Cebai Ye, three slices of Ganjiang, and two ting of Ejiao, roasted. Boil these three ingredients in two sheng of water to reduce to one sheng. Strain the dregs. Mix in one sheng of Matong juice (horse dung juice). Combine and boil to obtain one sheng. Filter through silk and take in one dose.)
[Note]: *Ben Cao* (black text) records: Cebai Ye and Ai Ye are both bitter, slightly warm, non-toxic. White text records: Ganjiang stops bleeding. (Cheng's cited *Shen Nong Ben Cao Jing* and properties of Matong are in the black text.) Tao Hongjing's *Preface to Materia Medica* states: "One handful" weighs exactly two liang. (Note: *Yi Xin Fang* differs slightly; see reference. Also cites Fan Wang's formula: One piece of Ejiao, shaped like three fingers, three cun long, counts as one unit.)
ZHU stated: *Qianjin Fang* uses three liang of Ejiao, which is also good. However, genuine Ejiao is rare nowadays, adding unnecessary stickiness.
For lower bleeding where stool precedes blood, this is distant blood (Yuan Xue).
[Note]: XU stated: Lower bleeding is smoother and less rebellious than hematemesis; this pathology lies not in Qi but should be sought in the abdomen. Thus, stool preceding blood indicates that before defecation, the blood level was undisturbed, and only after straining during defecation did bleeding occur. This indicates interior cold failing to warm the Spleen, and insufficient Spleen Yuan failing to control blood. The Spleen resides in the Central Earth; viewed from the Lower Jiao, it is distant, hence "distant blood." This explanation is plausible and is retained.
For lower bleeding where blood precedes stool, this is proximal blood (Jin Xue).
[ZHAO]: This bleeding originates from the Large Intestine, hence blood precedes stool. It results from damp-heat toxins accumulating without entering the meridians, seeping into the intestines and exiting. Chi Xiao Dou can move water-dampness and resolve heat toxins. *Mei Shi Fang* uses this single herb to treat lower bleeding. Moreover, Dang Gui breaks old blood and nourishes new blood; based on its name, blood finds its return and ceases erratic flow.
*Fu Ren Liang Fang* states: Bleeding after stool indicates a distant source; bleeding before stool indicates a proximate source. "Distant" and "proximate" refer to the location of the disease in the upper or lower parts.
*Zhang Shi Yi Tong* states: *Qianjin Fang* uses Fulonggan Tang, which is the Huangtu Tang for treating stool-preceding-blood, modified by removing Baizhu and Fuzi, adding Ganjiang, Niuxi, Diyuyu, and Fahui. Compared to *Jin Gui*'s indications, there are differences in cold and heat; this must be distinguished. Thus, treating bleeding requires only guiding blood back to the vessels, regardless of distance. *Waike Zhengzong* case study on internal hemorrhoids states: Generally, the causes of this syndrome vary, so etiology must be investigated. If Yuan Qi is sufficient, the body is robust and dark, with purple blood after stool, and the pulse is solid and forceful, this belongs to Excess; the method should be cooling blood and stopping bleeding, and medication will be effective. Conversely, if the body is emaciated, complexion sallow, with fresh blood before stool, and the pulse is empty and weak, this belongs to Deficiency. How can cooling medicines be used to stop bleeding, thereby damaging the Spleen and Stomach? This syndrome requires warming the middle and strengthening the Spleen, raising Middle Qi; otherwise, blood cannot return to its origin, making medication ineffective, as it deviates from the root. (Note: This view seems contrary to classic principles but offers mutual inspiration; it is extracted for reference.)
*Jifeng Puji Fang* Chixiaodou San treats constipation. (This is the same formula.)
Heart Qi insufficiency, with hematemesis and epistaxis.
[Note]: Zhao stated: Heart Qi insufficiency does not mean Heart Fire is insufficient, but rather True Yang is insufficient. This view belongs to... You privately refuted and corrected this, actually deriving it from *Yi Tong*. Zhao further stated: If *Jizhong Fang* uses Dahuang to treat epistaxis, along with Shengdi juice, it treats heat by cooling blood, similar to Xiexin Tang formulas. This is what You derived from.