暑毒失血者，脉大气喘，多汗烦渴，盖心主血，而暑气喜归心也。此病多于酒客，及阴
《千金》治酒客瘟疫，中热毒，干呕吐血方。
蒲黄 犀角 栝蒌根 甘草（各二两） 桑寄生 葛根（各三两）
水七升，煮三升，分三服。
《局方》枇杷叶散 治暑毒攻心，呕吐鲜血。
香薷（二钱） 浓朴 甘草 麦冬 木瓜 茅根（各一钱） 陈皮 枇杷叶
为末，每服二钱，姜水煎服。
蓄热吐血者，热蓄血中，因而妄行，口鼻皆出，热如涌泉，膈上热，胸中满痛，脉洪大
，按之有力，精神不倦，或血是紫黑成块者，须用生地黄、赤芍、茜根、牡丹皮。三制大黄
、滑石、桃仁泥之属，从大便导之。此非釜底抽薪之法，不能夺火热上涌之势也。
海藏云∶畜血喜忘如狂，身热屎黑者，疾已甚也。但小腹满，小便不利者，轻也。
滑伯仁曰∶血溢血泄，诸蓄血证，其始也，予率以桃仁、大黄行血破滞之剂折其锐气，
区别治之，虽往往获效，然犹不得其所以然也。后来四明遇故人苏伊芳举，闲论诸家之术。伊芳
举云∶吾乡有善医者，忘其姓字，每治失血蓄妄，必先以快药下之，或问失血复下，虚何以
当。则曰∶血既妄行，迷失故道，不去血利瘀，则以妄为常，曷以御之。且去者自去，生者
自生，何虚之有。予闻之愕然曰∶昔者之疑，今释然矣。
按∶去者自去，生者自生，人易知也。瘀者未去，则新者不守，人未易知也，细心体验
简要济众
川大黄一两，末，每服一钱，以生地汁一合，水半盏，煎三五沸，服无时。
藕汁茯苓饮
生藕汁 小蓟根汁 生地黄汁 茯苓 蒲黄（炒黑）
后二味等分为末，每服二钱，用三汁调下。
按∶虚人未可下者，宜此法清热，且利瘀也。
按∶《千金》云∶凡吐血后，体中但KT KT ，心中不闷者，辄自愈。假令烦躁，心中闷乱
，纷
中有瘀血不尽故也。然与其涌而上之，不若导而下之之为顺也。吐法昔人且不忌，而况于下
《直指》方
鲜生地黄捣汁煮饮，日数升良。
四生丸 治吐血衄血，热妄行乘于阴也。
生荷叶 生艾叶 侧柏叶 生地黄（各等分）
上捣烂为丸，如鸡子大，每服一丸，用水二盅，煎一盅，去滓服。一方有生薄荷叶，无
十灰散 治呕吐咳嗽血。
大蓟 小蓟 柏叶 荷叶 茅根 茜根 大黄 栀子 棕榈皮 牡丹皮
上各等分，烧存性，出火毒，研为极细末，用生藕汁及生萝卜汁，磨松墨半碗，调服五
Hemorrhage caused by summer-heat toxin is characterized by a large pulse, panting, profuse sweating, irritability, and thirst. This is because the Heart governs blood, and summer-heat pathogenic factors tend to affect the Heart. This condition is more common in individuals who consume alcohol.
The formula from *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) for treating alcoholics suffering from plague, with internal heat-toxin causing dry heaving and hematemesis:
Puhuang (Corylin), Xijiao (Rhinoceros Horn), Gualougen (Trichosanthes Root), Gancao (Licorice Root) (each 2 liang); Sangjisheng (Mulberry Mistletoe Stem), Gegen (Kudzu Root) (each 3 liang).
Boil in 7 sheng of water until reduced to 3 sheng; divide into three doses.
*Ju Fang* (Prescriptions from the Imperial Bureau) Pipa Ye San (Loquat Leaf Powder) treats summer-heat toxin attacking the Heart, causing vomiting of bright red blood:
Xiangru (Mosla Herb) (2 qian), Nongpo (Magnolia Bark), Gancao (Licorice Root), Maidong (Ophiopogon Tuber), Mugua (Chaenomeles Fruit), Maogen (Imperata Rhizome) (each 1 qian), Chenpi (Tangerine Peel), Pipaye (Loquat Leaf).
Grind into powder; take 2 qian per dose, decocted with ginger water.
Hematemesis caused by accumulated heat occurs when heat accumulates within the blood, causing it to flow recklessly out through the mouth and nose. The bleeding is forceful like a gushing spring, accompanied by heat above the diaphragm, fullness and pain in the chest, a surging and large pulse that feels strong upon deep pressure, unweary spirit, or purple-black clotted blood. One must use Shengdihuang (Rehmannia Root), Chishao (Red Peony Root), Qiangeng (Rubia Root), Mudanpi (Tree Peony Bark), as well as Sanzhi Dahuang (Polygoni Multiflori Radix processed in three ways), Huashi (Talcum), and Taoren Ni (Persicae Semen paste) to guide the heat out through the bowels. Without this method of "removing firewood from under the cauldron" (clearing heat at its source), one cannot curb the momentum of flaming heat rushing upward.
Haizang stated: In cases of blood accumulation, symptoms include forgetfulness, mania-like behavior, body heat, and black stool, indicating severe disease. If there is only lower abdominal fullness and difficult urination, the condition is mild.
Slip Bo Ren (Hu Bosi) said: Regarding blood overflow, blood leakage, and various blood accumulation syndromes, initially I usually used agents containing Tao Ren (Persicae Semen) and Dahuang (Rhubarb Root) to promote blood circulation and break stagnation to subdue their aggressive nature, treating them differently. Although often effective, I still did not understand the underlying principles. Later, in Siming, I met an old friend, Su Yifangju, and we discussed various medical schools of thought. Yifangju said: There was a skilled physician in my hometown whose name I have forgotten. Whenever he treated hemorrhage and reckless blood flow due to accumulation, he would first administer a drastic purgative. When asked how a patient could withstand purgation after losing blood, given their deficiency, he replied: Since the blood has flowed recklessly and lost its proper course, if we do not remove the blood stasis, reckless flow will become the norm; how can we control it? Moreover, what is expelled leaves room for what is new to generate naturally; where is the deficiency? Hearing this, I was startled and said: My previous doubts are now resolved.
Commentary: That "what is expelled leaves room for what is new to generate" is easily understood by people. However, that if stasis remains, new blood cannot settle is not easily understood. Carefully experience and apply *Jianyao Jizhong*:
Chuan Dahuang (Rhubarb Root) 1 liang, ground into powder. Take 1 qian per dose, decocted with 1 he of Sheng Dihuang Zhi (Fresh Rehmannia Juice) and half a zhan of water, boiled for three to five boils. Take at any time.
Ou Zhi Fuling Yin (Lotus Root Juice and Poria Drink):
Sheng Ou Zhi (Fresh Lotus Root Juice), Xiaoji Gen Zhi (Cirsii Japonici Root Juice), Sheng Dihuang Zhi (Fresh Rehmannia Juice), Fuling (Poria), Puhuang (Typha Pollen, charred).
Grind the latter two ingredients equally into powder; take 2 qian per dose, mixed with the three juices.
Commentary: For patients with deficiency constitution who cannot tolerate purgation, this method is suitable to clear heat and promote the discharge of stasis.
Commentary: *Qianjin Fang* states: After hematemesis, if the body feels merely slightly uncomfortable but the heart/mind is not oppressed, it will likely heal itself. If there is irritability and mental oppression/confusion, it is due to incomplete residual blood stasis within. Therefore, rather than inducing vomiting to expel upwards, guiding downwards is more appropriate. Ancients did not hesitate to use emetics; how much less should purgatives be avoided?
*Zhizhi Fang*:
Fresh Sheng Dihuang (Rehmannia Root) crushed for juice, boiled and drunk; consuming several sheng daily is beneficial.
Sisheng Wan (Four Raw Herbs Pill) treats hematemesis and epistaxis caused by reckless heat invading the Yin:
Sheng Heye (Fresh Nelumbinis Folium), Sheng Aiyè (Fresh Artemisia Argyi Folium), Cebaiye (Platycladi Cacumen), Sheng Dihuang (Fresh Rehmannia Root) (equal parts).
Mash these ingredients thoroughly to form pills the size of chicken eggs. Take one pill per dose, decocted in 2 zhong of water until reduced to 1 zhong; strain and drink. Another variation includes Sheng Bohe Ye (Fresh Menthae Haplocalycis Folium) and excludes...
Shihui San (Ten Ashes Powder) treats hemoptysis and coughing up blood due to vomiting:
Daji (Urtica Longissima), Xiaoji (Cirsii Japonici Herba), Baiye (Platycladi Cacumen), Heye (Nelumbinis Folium), Maogen (Imperatae Rhizoma), Qiangeng (Rubiae Radix et Rhizoma), Dahuang (Rhei Radix et Rhizoma), Zhizi (Gardeniae Fructus), Zonglupi (Livistonae Petiolus), Mudanpi (Moutan Cortex).
Take equal parts of each, burn until carbonized but retaining properties (charred), eliminate fire toxicity, grind into extremely fine powder. Mix with Sheng Ou Zhi (Fresh Lotus Root Juice) and Sheng Luobo Zhi (Fresh Radish Juice), along with half a bowl of ground Pine Ink; take 5 qian per dose...