此言黄瘅有土受木克之证。以柴胡汤治其呕痛。亦非谓柴胡汤治诸黄也。止言柴胡
汤。未分大小。意者随见证而临时择用也。
柴胡汤方（见呕吐）
男子黄。小便自利。（知非湿热交郁之黄。而为土虚其色外现之黄。）当与虚劳小
建中汤。
此为虚黄证而出其方也。黄证不外于郁。虚得补则气畅而郁开。郁开则黄去矣。单
言男子者。谓在妇人则血分有热。正未可知。又当另有消息也。
尤在泾云、黄瘅之病。湿热所郁也。故在表者汗而发之。在里者攻而去之。此大法
也。乃亦有不湿而燥者。则变清利为润导。如猪膏发煎之治也。不热而寒。不实而虚者。
则变攻为补。变寒为温。如小建中之
法也。其有兼证错出者。则先治兼证。而后治本证。如小半夏及小柴胡之治也。仲景论
黄瘅一证。而于正变虚实之法。详尽如此其心可谓尽矣。
附方
瓜蒂散 治诸黄。（方见 病） 按删繁方云。服讫吐出黄汁。亦治脉浮欲吐者之法
也。
千金麻黄醇酒汤 治黄瘅。
麻黄（三两）
上一味。以美酒五升。煮取二升半。顿服尽。冬月用酒。春月用水煮之。
寸口脉动而弱。（为惊悸之主脉也。惊自外至。气乱则脉动。）动即为惊。（悸自
内惕。气怯则脉弱。）弱则为浮。（外有所触。内不自主。则脉动而弱。有惊与悸而并
见者。有惊与悸而各见者。）
此言惊属外一边。悸属内一边。惊悸并见。为内已虚而外复干之也。
师曰。（衄为清道之血。从督脉由风府贯顶下鼻中。其所以上越而妄出者。由肝肾
之郁热逼也。若其人）尺脉浮。（则知肾有游火矣。）目睛晕黄。（则知肝有蓄热矣。
肝肾之火上冲。则）衄未止。（若）晕黄云。目睛慧了。（肝肾之热俱除。故）知衄今
止。
此言血随火而升也。
又曰、（衄既为阳经清道之血。总非阴经所主。彼手足少阳之脉。不能入鼻 。所以
不主衄也。主之者惟手足太阳手足阳明四经。太阳行身之表。为开。春生夏长。阳气
在表。有开之义之也。故）从春至夏衄者（属）太阳。
（阳明行身之里。为阖。秋收冬藏。阳气在里。有阖之义。故）从秋至冬衄者（属）
阳明。
此以四时合四经。而提衄血之大纲也。四时宜活看。
尤在泾云、血从阴经并冲任而出者。则为吐。从阳经并督脉而出者。则为衄。故衄
病皆在阳经。但春夏阳气浮。则属太阳。秋冬阳气伏。则属阳明。为异耳。所以然者。
就阴阳言。则阳主外。阴主内。就三阳言。则太阳为开。阳明为阖。少阳之脉。不入鼻
。故不主衄也。
或问衄皆在阳。是已。然所谓尺脉浮。目睛晕黄者。非阴中事乎。曰、前所谓尺脉
浮。目睛晕黄者。言火自阴中出。非言衄自阴中来也。此所谓太阳阳明者。言衄所从出
之路也。谁谓病之在阳者。不即为阴之所迫而然耶。
衄家。（为阴血已亡。）不可（再）汗。（以重竭其阴。若）汗出必额上陷。（中
之）脉（为热所烁而）紧急。（目得血而能视。血亡则目）直视不能 （阳归于阴则卧。
阳亢则）不得眠。
此言衄家当以发汗为戒也。知所戒。则知所治矣。况泻心汤黄土汤皆衄证之的方乎。
高士宗云、欲辨衄之重轻。须察衄之冷热。衄出觉热者。乃阳明络脉之血。轻也。
治宜凉血滋阴。衄出觉冷者。乃阳明经脉之血。重也。治宜温经助阳。要言不烦。特附
录于此。
男（元犀）按、泻心汤。即凉血之剂。黄土汤。即温经之剂。但后人多用滋阴。究
不若养阴引阳之为得矣。
病患面无色。（便知其血气衰而不华于面也。身）无寒热。（
便知其外无病而内自亏也。然内经云。察色按脉。当别阴阳。今按其脉。沉为肾。弦为
肝。其）脉沉弦（并见）者（是龙雷之火迅发。血随上溢
而为）衄。（若察其面无色。按其）脉浮弱。（浮为阴虚。弱为阳弱。浮弱之极）手按之（
即）绝者。（阳不下交于阴。则阴失阳而脱陷。所以）下血。（若察其面无色。按其脉
浮弱。而竟见）烦咳者。（曷故。盖日月出矣。爝火无光。此为胸中之阳不宣。而阴火
乘之。乘于心则烦。乘于肺则咳。咳则气逆于上。而血随之。可以）必（其）吐血。
合参此条面无色三字是主。盖人身中阴阳相杂。而阴实统于阳。血者阴也。故阳能
统阴。则血无妄出。今面无色。知其阳和不足。阳和不足。则阴火乘之。假令脉平。则
如平人无事。尚可支持而度日也。今观其面。既已无色。察其证。又无表邪之寒热。而
诊其脉。何以忽见此沉弦之象。当知沉为肾。弦为肝。沉弦并见。为肝肾之气不靖。龙
雷之火肆逆于上。逼血奔于清道。则为衄矣。若面无色。其脉不为沉而为浮。不为弦而
为弱。浮为阴虚。弱为阳弱。极其虚弱之象。以手按之即绝。此为阴阳两虚。而阳为阴
主。若虚在下焦之阴。无元阳以维之。而血下漏矣。面无色。脉浮弱。按之绝者。忽见
烦咳证。烦属心。咳属肺。心肺病。而胸中之阳。不能以御阴火。血随虚火涌于浊道。
则从口出矣。以上三条。皆起于真阳不足。血无所统。故治血之良法。大概苦寒不如甘
温。补肾必兼补脾。所以黄土汤原治先便后血之证。其方下小注云。亦主吐衄。此即金
针之度也。余每用此方。以干姜易附子。以赤石脂一斤代黄土。取效更捷。甚者加干侧
柏四两。鲜竹茹六斤。
夫（人卒然）吐血。（血后不咳。其证顺而易愈。若）咳逆上气。（则阴虚而阳无
附丽矣。若）其脉数而（身）有热。（夜间）不得卧者。（是既耗之阴。而从独胜之阳。
有不尽不已之势。主）死。
此言血后真阴亏而难复也。若用滋润之剂。恐阴云四合。龙雷之火愈升。若用辛温
之方。又恐孤阳独
胜。而燎原之势莫当。师所以定其死而不出方也。余于死证中觅一生路。用二加龙骨汤
加阿胶。愈者颇多。
（吐血。有不尽由于气虚不摄者。亦有不尽由于阴虚火盛者。）夫（不有）酒客（热
积于胃。而上熏于肺者乎。熏于肺。则肺为热伤。未有不）咳者。（咳则击动络脉。）
必致吐血。此（与上言吐血分途。以其）因极饮过度所致也。
此言酒客吐血。专主湿热而言。凡湿热盛者。皆可作酒客观也。师未出方。余用泻
心汤及猪苓汤。或五苓散去桂加知母石膏竹茹多效。
寸口脉（轻按）弦而（重按）大。弦则为（阳气微而递）减。大则为（外盛而中）
芤。减则（阳不自振。）为（诸）寒。芤则（阴不守中。）为（中）虚。虚寒相搏。此
名为革。（革脉不易明。以弦减芤虚二脉形容之。则不易明者。明矣。见此
脉者。）妇人则（不能安胎而）半产（不能调经而）漏下。男子则亡血。
此因上二节一言阴虚。一言阳盛。恐人误走滋阴泻火一路。故于此节急提出虚寒失血
之证。以见阳虚阴必走也。可见古人立言精密。
（上言衄家不可汗。虑其亡阴。然而不止亡其阴也。凡）亡血（者。既亡其阴。）不
可发其表。（更伤其阳。若服表药。令其）汗出。（阳不外固。）即寒栗（阴不内守。
）而（动）振。
此遥承上节衄后复汗为竭其阴。此则并亡其阳也。
（试言瘀血之证）病患（血瘀。则气为之不利而）胸满（血瘀不荣于唇。则）唇痿。
（血瘀而色应于舌。则）舌青（血瘀而气不化液。则）口燥。但欲漱水。（而）不欲咽。
（上虽燥而中无热也。病非外感。则身）无寒热。脉微大来迟。（以血积经隧。则脉涩不
利也。）腹（本）不满。（而）其人（竟自）言我满。（外无形而内有滞。知其血积在
阴。而非气壅在阳也。此）为有瘀血。
病者如有热状。烦满。口干燥而渴。（既现如此之热状。应见数大之热脉。乃）其脉反无
热。此（非阳之外扰。）为阴（之内）伏。（阴者何。）是（即）瘀血也。（瘀属有形。）当下
之。
此二节。辨瘀血之见证也。
徐忠可云、仲景论妇人有瘀血。以其证唇口干燥。故知之。则此所谓唇痿口燥。
即口干燥。足证瘀血无疑矣。然前一证言漱水不欲咽。后一证又言渴。可知瘀血证。不
甚。则但漱水。甚则亦有渴者。盖痰久而热郁也。
（试为惊者出其方。）火邪者。（所包者广。不止以火逼劫亡阳惊狂一证。然举其
方治。可以启其悟机。但认得火邪为主。即以）桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。
此为惊证出其方也。以火邪二字为主。而其方不过举以示其概也。
徐忠可云、惊悸似属神明边病。然仲景以此冠于吐衄下血及瘀血之上。可知此方重
在治其瘀结。以复其阳。而无取乎镇坠。故治惊全以宣阳散结宁心去逆为主。至于悸。
则又专责之痰。而以半夏麻黄发其阳。化其痰为主。谓结邪不去。则惊无由安。而正阳
不发。则悸邪不去也。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两去皮） 甘草（二两炙） 龙骨（四两） 牡蛎（五两） 生姜（三两）
大枣（十二枚） 蜀漆（三两洗去腥）
上为末。以水一斗二升。先煮蜀漆减二升。纳诸药。煮取三升。去滓。温服一升。
（为悸者出其方。）心下悸者。半夏麻黄丸主之。
此为悸证出其方也。但悸病有心包血虚火旺者。有肾水虚而不交于心者。有肾邪凌
心者。有心脏自虚者。有痰饮所致者。此则别无虚证。惟饮气之为病欤。
半夏麻黄丸方
半夏 麻黄（各等分）
上二味末之。炼蜜和丸小豆大。饮服三丸。日三服。
（为吐血不止者出其方。凡吐血者。热伤阳络。当清其热。劳伤阳络。当理其损。
今）吐血（服诸寒凉止血之药而）不止者。（是热伏阴分。必用温散之品。宣发其热。
则阴分之血。不为热所逼而自止。以）柏叶汤主之。
此为吐血不止者出其方也。吐血无止法。强止之。则停瘀而变证百出。惟导其归经。
是第一法。详于时方妙用三字经实在易三书。不赘。又徐氏谓此方有用柏叶一把。干
姜三片。阿胶一挺合煮。入马通汁一升服。无马通以童便代之。存参。
柏叶汤方
柏叶 干姜（各三两） 艾（三把）
上三味。水五升。取马通汁一升合煮。取一升。分温再服。千金加阿胶三两亦佳。
（为先便后血者出其方。凡）下血。先便后血。此远血也。（以）黄土汤主之。
尤在泾云、下血先便后血者。以脾虚气寒。失其统御之权。以致胞中血海之血。不
从冲脉而上行。外达
渗漏于下而失守也。脾去肛门远。故曰远血。
高士宗云、大便下血。或在粪前。或在粪后。但粪从肠内出。血从肠外出。肠外出
者。从肛门之宗眼出也。此胞中血海之血。不从冲脉而上行外达。反渗漏于下。用力大
便。血随便出矣。
徐忠可云、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。知未便时气分不动。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。故以附子温肾之阳。又恐过燥。阿胶地黄
壮阴为佐。白术健脾土之气。土得水气则生物。故以黄芩甘草清热。而以经火之黄土与
脾为类者。引之入脾。使脾得暖气。如冬时地中之阳气。而为发生之本。真神方也。脾
肾为先后天之本。调则营卫相得。血无妄出。故又主吐衄。愚谓吐血自利者尤宜之。（
愚每用此方。以赤石脂一斤。代黄土如神。或以干姜代附子。或加鲜竹茹侧柏叶各四两。
）
黄土汤方（亦主吐衄）
甘草 干地黄 白术 附子（各三两炮） 阿胶（三两） 黄芩（三两） 灶中黄
土（半斤）
上七味。以水八升。煮取三升。分温三服。
（为先血后便者出其方。凡）下血。先血后便。此近血也。（以）赤豆当归散主之。
（方见狐惑中）
尤在泾云、下血先血后便者。由大肠伤于湿热。热气太盛。以致胞中血海之血。不
能从冲脉而上行。渗
漏于下而奔注也。大肠与肛门近。故曰近血。
（为吐血衄血妄行不止者出其方。病患）心（中之阴）气不足。（则阳独盛。逼其
胞中血海之血。出于浊道。则为）吐血（逼其胞中血海之血。出于清道。则为）衄血。
（须以苦寒下瘀之药降其火。火降则血无沸腾之患矣。宜）泻心汤主之。
此为吐衄之神方也。妙在以连芩之苦寒。泄心之邪热。即所以补心之不足。尤妙在
大黄之通。止其血。而不使其稍停余瘀。致血愈后酿成咳嗽虚劳之根。且釜下抽薪。而
釜中之水自无沸腾之患。此中秘旨。非李时珍李士材薛立斋孙一奎张景岳张石顽冯楚瞻
辈。所能窥及。济生用大黄生地汁治衄血。是从此方套出。
泻心汤方
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。
按、金匮所论血证。虽极精微。而血之原委。尚未明示。致后人无从窥测。余阅高
士宗张隐 书。视各家大有根据。但行文滞晦繁冗。读者靡靡欲卧。今节录而修饰之。
This passage discusses the syndrome of jaundice caused by the liver wood overcoming the spleen earth. Chaihu Tang is used to treat its vomiting and pain; this does not mean that Chaihu Tang treats all types of jaundice, but merely mentions Chaihu Tang without distinguishing between large or small formulations, implying that the choice is made temporarily based on specific manifestations.
Chaihu Tang Formula (see Vomiting)
When a man presents with yellow complexion but urination is normal and free (indicating it is not jaundice due to damp-heat entanglement, but rather yellow complexion due to spleen deficiency with the true color manifesting externally), one should administer Xiao Jianzhong Tang (Minor Construct the Middle Decoction) for deficiency consumptive disease.
This formula is presented for deficiency-type yellow complexion. The pathogenesis of jaundice essentially involves qi stagnation. Tonification in deficiency cases promotes smooth qi flow; once qi flows smoothly, stagnation resolves, and jaundice disappears. The specific mention of "man" implies that in women, the presence of heat in the blood aspect is uncertain and requires further consideration.
You Zaijing stated: Jaundice is caused by damp-heat entrapment. Therefore, those in the exterior are treated with sweating methods, and those in the interior with purgative methods; this is the general principle. However, there are cases that are dry rather than damp, where clearing-draining methods are changed to moistening-guiding methods, such as the treatment with Zhigao Fa Jian (Pig Fat and Hair Decoction). There are cases that are cold rather than hot, or deficient rather than excess, where purgatives are changed to tonics, and cold-natured drugs to warm ones, such as the method of Xiao Jianzhong Tang. If concurrent syndromes appear mixed, treat the concurrent syndromes first, then the principal syndrome, such as with Xiaobanxia Tang (Minor Pinellia Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction). Zhang Zhongjing's discussion on jaundice details the standard treatments, variations, and approaches for deficiency and excess so thoroughly that his dedication can be said to be complete.
Attached Formulas
Gua Di San (Melon Stamen Powder) treats various types of jaundice. (Formula see Miscellaneous Diseases). According to *Shanfan Fang*, after administration, yellow fluid is vomited up; this is also a method for treating pulse floating with a desire to vomit.
Qianjin Mahuang Chunjiu Tang (Mahuang in Mellow Wine Decoction from Qianjin) treats jaundice.
Ephedrae Herba (Mahuang, 麻黄) (3 liang)
Take the above single ingredient, boil in five sheng of fine wine until two and a half sheng remain. Take all at once. In winter, use wine; in spring, boil with water.
The pulse at the cunkou position is agitated and weak. (This is the main pulse for fright palpitations. Fright comes from outside, causing chaotic qi and an agitated pulse.) Agitation indicates fright. (Palpitations arise from within, with timid qi resulting in a weak pulse.) Weakness indicates deficiency. (External stimulation causes internal lack of control, resulting in an agitated and weak pulse. Sometimes fright and palpitations appear together; sometimes they appear separately.)
This text explains that fright belongs to the external factor side, while palpitations belong to the internal factor side. When both appear together, it indicates internal deficiency compounded by external interference.
The Master said: (Nosebleed involves blood from the clear pathways, traveling via the Du vessel through Fengfu to the top of the head and down into the nose. Its upward escape is due to stifling heat in the Liver and Kidney forcing it out. If the person has) a floating pulse at the chi position (one knows there is wandering fire in the Kidney). Yellowish halos around the eyes (indicate accumulated heat in the Liver). When Liver-Kidney fire rushes upward, (then) nosebleed will not stop. (If) the yellow halos disappear and the eyes become clear (the heat in Liver and Kidney is cleared, therefore) one knows the nosebleed has now stopped.
This explains that blood rises following fire.
It is also said: (Since nosebleed involves blood from the Yang meridians' clear pathways, it is generally not governed by Yin meridians. The Shaoyin meridians of the hand and foot do not enter the nose, so they do not govern nosebleed. Those that do govern it are the Taiyang and Yangming meridians of the hand and foot. Taiyang runs along the body surface, acting as the opening; in Spring and Summer, Yang Qi is in the exterior, having the meaning of opening. Thus,) nosebleeds occurring from Spring to Summer (belong to) Taiyang.
(Yangming runs inside the body, acting as the closing; in Autumn and Winter, Yang Qi is in the interior, having the meaning of closing. Thus,) nosebleeds occurring from Autumn to Winter (belong to) Yangming.
This uses the four seasons to correspond to the four meridians, outlining the general principle of nosebleed. The division of seasons should be viewed flexibly.
You Zaijing said: Blood exiting via Yin meridians and the Chong and Ren vessels is called hematemesis; blood exiting via Yang meridians and the Du vessel is called epistaxis. Therefore, epistaxis occurs in Yang meridians. However, in Spring and Summer when Yang Qi floats, it belongs to Taiyang; in Autumn and Winter when Yang Qi sinks, it belongs to Yangming; this is merely a difference. Why? Regarding Yin and Yang, Yang governs the exterior and Yin the interior; regarding the Three Yang, Taiyang is the opening and Yangming is the closing. Since Shaoyang does not enter the nose, it does not govern epistaxis.
One might ask: Epistaxis is in Yang, understood. But what about the floating chi pulse and yellow eye halos? Are these not matters of Yin? I reply: The previously mentioned floating chi pulse and yellow eye halos refer to fire arising from within Yin, not that epistaxis originates from Yin. What is meant here by Taiyang and Yangming is the pathway of exit for the epistaxis. Who says that a disease in Yang is not forced by Yin?
Patients prone to nosebleed. (Because Yin blood is already depleted.) Must not (be subjected to) sweating. (To avoid further exhausting Yin. If) sweating occurs, the forehead will collapse. (The) pulse (scorched by heat) becomes tight and urgent. (The eyes rely on blood to see; with blood loss, the eyes) stare straight ahead and cannot close (Yang returning to Yin allows sleep; Yang hyperactivity prevents) sleeping.
This explains that patients prone to nosebleed must beware of sweating. Knowing what to avoid leads to knowing how to treat. Moreover, Xiexin Tang and Huangtu Tang are precise formulas for nosebleed.
Gao Shizong said: To distinguish the severity of nosebleed, observe if it is hot or cold. Nosebleed felt as hot is blood from the Yangming collaterals; it is mild. Treatment should cool blood and nourish Yin. Nosebleed felt as cold is blood from the Yangming channels; it is severe. Treatment should warm the channels and assist Yang. Concise and valuable, appended here.
Yuanxi notes: Xiexin Tang is a blood-cooling agent; Huangtu Tang is a channel-warming agent. Later practitioners mostly use Yin-nourishing methods, which are ultimately less effective than nourishing Yin to guide Yang.
A patient with a face lacking color. (One knows Qi and Blood are deficient and fail to flourish on the face. The body) lacks chills or fever. (One knows there is no external pathogen, only internal depletion. However, *Neijing* states: inspect color and palpate pulse to distinguish Yin and Yang. Now palpating the pulse, sinking indicates Kidney, wiry indicates Liver. When) the pulse is sinking and wiry (simultaneously) (this is Dragon-Lei Fire erupting rapidly, with blood surging upward causing) epistaxis. (If observing a face lacking color, and palpating a) floating and weak pulse. (Floating indicates Yin deficiency, weak indicates Yang weakness. Extreme floating and weak) upon pressure (cease). (Yang fails to descend to interact with Yin, so Yin loses Yang's support and collapses, thus) lower bleeding occurs. (If observing a face lacking color, pulse floating and weak, yet suddenly seeing) irritability and coughing. (Why? As the sun rises, small fires lose their light. This is because Yang in the chest is not unblocked, allowing Yin-fire to invade. Invading the Heart causes irritability; invading the Lung causes coughing. Coughing reverses Qi upward, dragging blood with it, so one can) certainly expect) hematemesis.
Referencing the three characters "face lacking color" in this clause is key. Generally, Yin and Yang mix in the body, but Yin is governed by Yang. Blood is Yin; thus Yang governs Yin, preventing reckless bleeding. A face lacking color indicates insufficient Yang. Insufficient Yang allows Yin-fire to invade. If the pulse were peaceful, it would be like a healthy person, manageable. But seeing a colorless face, no chills/fever of exterior pathogens, yet finding a sinking-wiry pulse: sinking is Kidney, wiry is Liver. Sinking and wiry together indicate unsettled Qi in Liver and Kidney, with Dragon-Lei Fire raging upward, forcing blood into clear pathways, causing epistaxis. If the face is colorless, pulse is not sinking but floating, not wiry but weak—floating is Yin deficiency, weak is Yang weakness—this is extreme deficiency. Pressure makes it cease; this is dual deficiency of Yin and Yang, with Yang governing Yin. If lower Jiao Yin is deficient without Yuan Yang to sustain it, blood leaks downward. Colorless face, floating-weak pulse, ceasing on pressure, sudden irritability/cough: irritability relates to Heart, cough to Lung. Heart-Lung pathology means Chest Yang cannot resist Yin-fire; blood surges turbidly via turbid pathways, exiting the mouth. The above three clauses all stem from insufficiency of True Yang, leaving blood without governance. Therefore, good methods for treating bleeding generally favor sweet-warm over bitter-cold. Tonifying Kidney must include tonifying Spleen. Thus, Huangtu Tang originally treats bleeding after stool (distal bleeding). The note under the formula says: "Also treats hematemesis and epistaxis." This is the secret needle technique. I often use this formula, replacing Fuzi with Ganjiang, and substituting Hongshizhi (1 jin) for Huangtu, achieving faster results. Severe cases add Gan Ce Bai (4 liang) and Xian Zhu Ru (6 jin).
Sudden (hematemesis. If there is no cough after bleeding, the syndrome is favorable and easy to heal. If there is) coughing and rebellious Qi. (Then Yin is deficient and Yang has no attachment. If) the pulse is rapid and (body) has heat. (Nighttime) inability to lie down. (This is exhausted Yin suffering from dominant Yang, with a trend of endless consumption, indicating) death.
This explains that post-hematemesis True Yin deficiency is hard to recover. Using moistening agents may cause Yin clouds to gather, raising Dragon-Lei Fire further; using acrid-warm formulas may allow solitary Yang to dominate, creating an uncontrollable prairie fire. The Master deemed it fatal and provided no formula. I seek life in fatal cases, using Erjia Longgu Tang plus Ejiao, with many cures.
(Hematemesis is not always due to Qi deficiency failing to contain, nor always due to Yin deficiency with flourishing fire.) Do not (there be) wine drinkers (with heat accumulating in the Stomach and steaming upward to the Lung? Steaming the Lung damages it with heat, inevitably causing) coughing. (Coughing shakes the collaterals.) Leading inevitably to hematemesis. This (differs from the previous discussion on hematemesis, as it is) caused by excessive drinking.
This discusses hematemesis in wine drinkers, focusing on damp-heat. Any case of abundant damp-heat can be viewed similarly. The Master gave no formula; I use Xiexin Tang, Zhuling Tang, or Wuling Tang minus Guizhi plus Zhimu, Shigao, and Zhu Ru, with much efficacy.
The pulse at cunkou is (lightly pressed) wiry and (heavily pressed) large. Wiry indicates (Yang Qi is slight and decreasing). Large indicates (externally full but internally) Kou. Decreasing means (Yang cannot sustain itself), indicating (various) cold. Kou means (Yin cannot guard the center), indicating (central) deficiency. Deficiency and cold contend, named Ge pulse. (Ge pulse is hard to understand; describing it via decreasing wiry and deficient kou pulses clarifies it. Seeing this pulse:) In women, it causes miscarriage (and failure to regulate menstruation leading to) dripping bleeding. In men, it causes blood loss.
This follows previous sections discussing Yin deficiency and Yang excess, warning against mistakenly entering Yin-nourishing and fire-clearing paths, urgently presenting deficiency-cold bleeding to show that Yang deficiency leads to Yin leakage. This shows the precision of ancient texts.
(Above, it was said nosebleed patients must not sweat, fearing Yin loss. However, it is not just Yin loss.) Blood loss (patients, having lost Yin,) must not have their exterior released. (Further injuring Yang. If taking exterior-releasing drugs causing) sweating. (Yang fails to secure the exterior.) Immediately chills (Yin fails to guard the interior.) and tremors.
This echoes the previous section on post-nosebleed sweating exhausting Yin; here, both Yin and Yang are lost.
(Describing blood stasis syndromes) Patients (with blood stasis, Qi is obstructed causing) chest fullness. (Blood stasis fails to nourish lips, causing) lip atrophy. (Blood stasis reflects on tongue, causing) blue tongue. (Blood stasis prevents Qi from transforming fluids, causing) dry mouth. Only desiring to rinse mouth with water. (And) not swallowing. (Though dry above, there is no heat in the middle. Not an exterior contraction, so body) lacks chills or fever. Pulse slightly large and slow. (Blood accumulation in meridians causes pulse to be choppy and sluggish.) Abdomen (originally) not full. (Yet) the person (claims) I am full. (Externally no shape, internally stagnation; know blood accumulates in Yin, not Qi congestion in Yang. This) indicates blood stasis.
Patient appears to have heat symptoms, irritability, fullness, dry mouth and thirst. (Given such heat signs, one should see rapid-large heat pulses, yet) the pulse surprisingly lacks heat. This (is not external Yang disturbance.) is internal Yin (entrapment.) What is Yin? It is (namely) blood stasis. (Stasis is tangible.) Must purge it.
These two sections differentiate blood stasis manifestations.
Xu Zhongke said: Zhongjing discussed blood stasis in women based on dry lips and mouth. Thus, the mentioned lip atrophy and dry mouth equate to dry mouth, proving blood stasis beyond doubt. However, the first symptom mentions rinsing without swallowing, the second mentions thirst.可知 blood stasis, if mild, only rinses; if severe, there is also thirst. Likely due to phlegm generating heat over time.
(Trying to provide a formula for fright.) Fire pathogen cases. (Cover a wide range, not just fright mania from fire coercing Yang loss. However, listing its treatment opens understanding. Recognizing fire pathogen as primary, use) Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang (Guizhi Decoction minus Shaoyao plus Shuqi, Muli, and Longgu to Rescue from Deviation) as the main treatment.
This provides a formula for fright. Taking "fire pathogen" as the core, the formula illustrates the general approach.
Xu Zhongke said: Fright and palpitations seem related to Spirit. However, Zhongjing places this before hematemesis, lower bleeding, and blood stasis, showing this formula focuses on resolving stasis to restore Yang, avoiding heavy sedation. Treating fright relies on diffusing Yang, dissipating knots, calming heart, and reversing rebellion. For palpitations, focus is on phlegm, using Banxia and Mahuang to raise Yang and transform phlegm. If knot pathogens are not removed, fright cannot settle; if upright Yang does not emerge, palpitation pathogens persist.
Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang Formula
Guizhi (3 liang, peeled) Gancao (2 liang, honey-fried) Longgu (4 liang) Muli (5 liang) Shengjiang (3 liang) Dazao (12 pieces) Shuqi (3 liang, washed to remove fishy smell)
Grind to powder. Boil in 12 sheng water, first boil Shuqi reducing by 2 sheng, add other herbs, boil to 3 sheng, strain, take 1 sheng warm.
(Providing a formula for palpitations.) Palpitations below the heart are treated with Banxia Mahuang Wan (Banxia and Ephedra Pill).
This provides a formula for palpitations. Palpitations can stem from Pericardium Blood deficiency with fire, Kidney Water deficiency failing to communicate with Heart, Kidney evil harassing Heart, Heart self-deficiency, or Phlegm-fluid. Here, aside from deficiency, it is solely Phlegm-fluid pathology.
Banxia Mahuang Wan Formula
Banxia Mahuang (equal parts)
Grind these two ingredients, mix with refined honey into pills the size of adzuki beans. Take 3 pills with water, three times daily.
(Providing a formula for persistent hematemesis. Generally, hematemesis involves heat damaging Yang collaterals, requiring heat clearance; labor damaging Yang collaterals requires repairing damage. Now,) hematemesis (that persists despite taking various cold-hemostatic drugs.) indicates heat lurking in Yin aspects. Must use warm-diffusing agents to vent heat, so Yin blood is not forced by heat and stops naturally. Use Baiye Tang (Cypress Leaf Decoction) as the main treatment.
This provides a formula for persistent hematemesis. Hematemesis has no direct stopping method; forcing it causes stasis and myriad complications. Guiding blood back to its vessel is the primary method. See detailed discussions in contemporary formulas. Xu's note suggests adding Cypress leaf, Ganjiang, Ejiao, boiled with Matong juice (or child's urine substitute).
Baiye Tang Formula
Baiye Ganjiang (each 3 liang) Ai Ye (3 bundles)
Boil these three in 5 sheng water, add 1 sheng Matong juice, reduce to 1 sheng. Divide into two warm doses. Qianjin adds Ejiao (3 liang), also good.
(Providing a formula for bleeding after stool. Generally,) lower bleeding, stool first then blood, is distal bleeding. (Treat with) Huangtu Tang (Yellow Earth Decoction).
You Zaijing said: Bleeding after stool is due to Spleen deficiency and cold Qi, losing governance power, causing blood from the Sea of Blood in the uterus to fail ascending via Chong vessel, leaking downward. Spleen is far from anus, hence "distal bleeding."
Gao Shizong said: Rectal bleeding may occur before or after stool. Feces come from intestine interior, blood from exterior. Exterior blood exits via anal root. Blood from Sea of Blood fails ascending via Chong, leaking downward, expelled with straining during defecation.
Xu Zhongke said: Lower bleeding is smoother than hematemesis, not involving Qi, so investigate abdomen. Bleeding after stool indicates Qi was stable before defecation, bleeding only after straining, indicating internal cold failing to warm Spleen, Spleen Yuan insufficient to govern blood. Spleen is central Earth; from lower Jiao perspective, it is distant. Use Fuzi to warm Kidney Yang, but fear dryness, so use Ejiao and Dihuang to strengthen Yin. Baizhu strengthens Spleen Earth Qi; Earth generates with Water, so use Huangqin and Gancao to clear heat. Use fired Huangtu (similar to Spleen) to guide into Spleen, warming it like subterranean Yang in winter, the root of generation. Spleen and Kidney are posterior and anterior Heaven roots; harmonized, Ying and Wei match, blood does not leak recklessly, hence also treats hematemesis/epistaxis. I find it especially suitable for hematemesis with diarrhea. (I often use this formula, replacing Huangtu with 1 jin Hongshizhi, or Ganjiang for Fuzi, or adding fresh Zhu Ru and Ce Bai Ye each 4 liang.)
Huangtu Tang Formula (Also treats hematemesis/epistaxis)
Gancao Sheng Dihuang Baizhu Fuzi (each 3 liang, prepared) Ejiao (3 liang) Huangqin (3 liang) Zaotian Huangtu (0.5 jin)
Boil seven ingredients in 8 sheng water to 3 sheng. Divide into three warm doses.
(Providing a formula for bleeding before stool. Generally,) lower bleeding, blood first then stool, is proximal bleeding. (Treat with) Chidou Danggui San (Adzuki Bean and Angelica Powder).
(Formula see Huoxue Disease)
You Zaijing said: Bleeding before stool is due to Large Intestine damaged by damp-heat, excessive heat causing blood from Sea of Blood to fail ascending via Chong, leaking downward and rushing. Large Intestine is near anus, hence "proximal bleeding."
(Providing a formula for reckless persistent hematemesis/epistaxis. Patient's) Heart (Yin) Qi is insufficient. (Then Yang dominates alone, forcing blood from Sea of Blood into turbid pathways, causing) hematemesis (forcing blood into clear pathways, causing) epistaxis. (Must use bitter-cold blood-purging drugs to lower fire; once fire lowers, blood boils over risk ceases. Use) Xiexin Tang (Heart-Purging Decoction) as the main treatment.
This is the divine formula for hematemesis/epistaxis. Its brilliance lies in using bitter-cold Lian and Qin to drain Heart pathogenic heat, thereby supplementing Heart insufficiency. Especially brilliant is Da Huang's unblocking action, stopping blood without leaving residual stasis that could later cause coughing/consumption. Like removing fire from under the pot, boiling ceases. This secret principle was inaccessible to Li Shizhen, Li Shicai, Xue Lizhai, Sun Yikui, Zhang Jingyue, Zhang Shiwang, Feng Chuzhan, etc. Jisheng used Da Huang and Shengdi juice for epistaxis, derived from this formula.
Xiexin Tang Formula
Da Huang (2 liang) Huanglian Huangqin (each 1 liang)
Boil three ingredients in 3 sheng water to 1 sheng. Take all at once.
Note: Although *Jinkui* discusses blood syndromes exquisitely, the origin and course of blood are not explicitly clarified, leaving later generations unable to fathom. Reading Gao Shizong and Zhang Yin'an's works, they have solid foundations compared to others. However, their writing is obscure and verbose, making readers drowsy. I have excerpted and refined it here.