吐血，阳盛阴虚，故血不得下行。因火炎上之势而上出，脉必大而芤，大者发
热，芤者血滞
之
动，痰不下降，四物汤为主，加痰药、火药；先痰嗽后见红，多是痰积热，降痰火为急；痰
嗽涎带血出，此是胃口清血热蒸而出，重者栀子，轻者蓝实；或暴吐紫血一碗者无事，吐
出为好。此热伤血死于中，用四物汤、解毒汤之类。吐血挟痰，积吐一二碗者，亦只补阴降
火，四物加火剂之类。挟痰若用血药，则泥而不行，只治火则止。吐血，火病也。大吐红不
止，以干姜炮末，童便调从治。喉腕痰血，用荆芥散。舌上无故出血，如线不止，以槐花炒
末干掺之。若吐血，一方∶童便一分，酒半分，擂柏叶温饮，非酒不行。呕吐，血出于胃也
。实者，犀角地黄汤主之；虚者，小建中汤加黄连主之。
入方
二黄补血汤 治初见血，及见血多，宜服。
熟地黄（一钱） 生地黄（五分） 当归（七分半） 柴胡（五分） 升麻 白芍（二钱） 牡丹皮（五分） 川
芎（七分半） 黄 （五分）
上以水煎服。血不止，可加桃仁半钱，酒大黄酌量虚实用之，内却去柴胡、升麻。
又方 治见血后，脾胃弱，精神少，血不止者。
人参（一钱） 黄 （三钱） 五味（十三个） 芍药 甘草（五分） 当归（五分） 麦门冬（五分）
上 咀。水煎服。加郁金研入亦可。
又方
人参（一钱） 白术（一钱） 茯苓（一钱） 半夏曲（五分） 陈皮（一钱） 甘草 青皮（三分） 川
芎（五分）
上 咀。水煎服。如胃不和，加藿香；如渴者，加葛
芩半钱，去白陈皮半钱；若小便赤色，加炒黄柏半钱；若大便结燥，加当归七分；心烦，加
黄连（酒拌晒干）半钱；若小便滑，加 牡蛎；如见血多，去半夏，恐燥，加生地黄一钱，牡
丹半钱，桃仁三分；若胃中不足，饮食少进，加炒山栀子仁八分；若血溢入浊道，留聚膈间，满
吐血，宜苏子降气汤加人参、阿胶各半钱；上膈壅热吐血者，以四汤仁加荆芥、阿胶各半
。更不止，于本方中加大黄、滑石各半钱；胃伤吐血，宜理中汤加川芎、干葛各半钱。此
饮酒伤胃也。吐血不止，用生茜根为末二钱，水煎，放冷，食后服良。白芨末调治治吐血。
以上诸方，虽非丹溪所出，以其药同，故录于前。
〔附录〕凡血证上行，或唾或呕或吐，皆逆也；若变而下行为恶痢者，顺也。上行为逆，
其治难；下行为顺，其治易。故仲景云∶蓄血证，下血者，当自愈也。与此意同。若无病患
忽然下痢，其病进也。今病血证上行，而复下行恶痢者，其邪欲去，是知吉也。诸见血，身热
脉
忽然浮大即倾危。
附方
四生丸 治吐血，阳乘于阴，血热妄行，服之良。
生荷叶 生艾叶 生柏叶 生地黄（等分）
上烂研如鸡子大。服一丸，水三盏，煎一盏，去滓服。
大阿胶丸 治肺虚客热，咳嗽咽干，多唾涎沫，或有鲜血。劳伤肺胃，吐血呕血，并可
麦门冬（去心） 茯神 柏子仁 百部根 杜仲（炒） 丹参 贝母（炒） 防风（各半两） 山
药五味 熟地黄 阿胶（炒，各一两） 远志 人参（各二钱半） 茯苓（一两）
上为末，炼蜜丸如弹子大。每服一丸，水煎六分，和渣
犀角地黄丸 治伤寒，汗下不解，郁于经络，随气涌泄，为衄血。或清道闭塞，流入胃
腹，吐出清血，如鼻衄。吐血不尽，余血停留，致面色痿黄，大便黑者，更宜服之。
犀角（镑） 生地黄 白芍 牡丹（等分）
上 咀。每服五钱，水煎温服，实者可服。
桃仁承气汤
芒硝（三钱） 甘草（二钱半）大黄（一两） 桂（三钱） 桃仁（半两，去皮尖）
上 咀。每两入姜同煎。
斛毒汤 见中暑。
荆芥散
荆芥穗（半两） 炙草（一两） 桔梗（二两）
上 咀。姜煎，食后服。
小建中汤
桂枝 甘草（炙，三钱） 大枣 白芍（六钱） 生姜（二钱） 阿胶（炒，一合）
上 咀。水煎。
苏子降气汤 见气类。
理中汤 见中寒。
吐血，是由于阳气偏盛、阴液亏虚，导致血液不能正常下行。因火势炎上之势，血液随之上逆而出，脉象必然呈现大而芤（中空如葱管）的特征。脉大者伴有发热，脉芤者提示血行停滞且动乱不安。治疗以四物汤为主方，加入化痰药和清热泻火药；若先出现痰嗽随后见红，多属痰积化热，当务之急是降泄痰火；若痰嗽时涎液中带血，这是胃中清血受热蒸腾而溢出，重症用栀子，轻症用蓝实；或者突然吐出紫黑色血液一碗的，无需过度惊慌，吐出后反而有益。此乃热邪损伤血脉，瘀血留滞于中焦，可用四物汤、解毒汤之类治疗。吐血兼夹痰浊，累计吐出一二碗的，也只宜滋阴降火，使用四物汤加清热泻火剂之类。若兼夹痰浊却使用补血活血药，则药性黏腻阻碍气机运行，只有针对火热病机治疗才能止血。吐血，本质上是火邪为患的大病。大量吐血不止，可用干姜炮制研末，用童子尿调服，此为从治之法。喉间有痰带血，用荆芥散治疗。舌上无故出血，如线状不止，用槐花炒研成末直接外敷。若是吐血，有一个方子：一份童子尿，半份酒，研磨侧柏叶温服，必须借助酒力才能发挥药效。呕吐出的血，来源于胃。实证，用犀角地黄汤主治；虚证，用小建中汤加黄连主治。
【入方】
二黄补血汤：治疗初见出血，以及出血量多时，适宜服用。
熟地黄（一钱）、生地黄（五分）、当归（七分半）、柴胡（五分）、升麻、白芍（二钱）、牡丹皮（五分）、川芎（七分半）、黄芩（五分）。
以上药材用水煎服。若血不止，可加桃仁半钱，大黄酌量虚实情况使用，此时需去掉柴胡、升麻。
又一方：治疗出血后，脾胃虚弱，精神萎靡，出血不止者。
人参（一钱）、黄芪（三钱）、五味子（十三个）、芍药、甘草（五分）、当归（五分）、麦门冬（五分）。
以上药材切碎。用水煎服。也可加入郁金研碎同服。
又一方：
人参（一钱）、白术（一钱）、茯苓（一钱）、半夏曲（五分）、陈皮（一钱）、甘草、青皮（三分）、川芎（五分）。
以上药材切碎。用水煎服。如果胃气不和，加藿香；如果口渴，加葛根、黄芩各半钱，去掉白陈皮半钱；如果小便颜色赤红，加炒黄柏半钱；如果大便干结燥硬，加当归七分；心烦意乱，加黄连（酒拌晒干）半钱；如果小便滑利不禁，加煅牡蛎；如果出血量大，去掉半夏，恐其燥烈，加生地黄一钱，牡丹皮半钱，桃仁三分；如果胃中不足，饮食减少，加炒山栀子仁八分；如果血液溢入浊道（消化道），积聚在膈间，满闷欲吐，宜用苏子降气汤加人参、阿胶各半钱；上焦壅热导致吐血者，用四物汤加荆芥、阿胶各半钱。如果仍不止血，在本方中加入大黄、滑石各半钱；胃受伤导致的吐血，宜用理中汤加川芎、干葛各半钱。这是由于饮酒损伤胃腑所致。吐血不止，可用生茜草根研成末二钱，用水煎煮，放冷后，饭后服用效果良好。白及粉也可用于调治吐血。
以上各方，虽然并非丹溪先生所创，但因药物组成相同，故记录在前面。
〔附录〕凡是血证向上逆行，或唾血、或呕血、或吐血，都属于逆证；如果转变为向下排泄成为恶痢，属于顺证。向上逆行是逆证，治疗困难；向下排泄是顺证，治疗容易。所以张仲景说：蓄血证，如果能下血，应当自愈。这与上述意思相同。如果没有患病却忽然下痢，说明病情进展恶化。现在患有血证上行，却又转为下行恶痢，说明邪气欲去，这是吉兆。凡见出血症状，如果身体发热，脉象忽然浮大，即预示危重。
附方
四生丸：治疗吐血，阳乘于阴，血热妄行，服用效果良好。
生荷叶、生艾叶、生柏叶、生地黄（等分）。
以上捣烂研细，做成如鸡蛋大小的丸剂。每次服用一丸，用水三盏，煎至一盏，去渣服用。
大阿胶丸：治疗肺虚客热，咳嗽咽干，多唾涎沫，或有鲜血。劳伤肺胃，吐血呕血，均可服用。
麦门冬（去心）、茯神、柏子仁、百部根、杜仲（炒）、丹参、贝母（炒）、防风（各半两）、山药、五味子、熟地黄、阿胶（炒，各一两）、远志、人参（各二钱半）、茯苓（一两）。
以上研成粉末，炼蜜制成如弹子大小的丸剂。每次服用一丸，用水煎至六分，连渣一起服用。
犀角地黄丸：治疗伤寒，汗下法不解，邪气郁于经络，随气机上涌泄出，导致衄血。或者清道闭塞，邪气流入胃腹，吐出清血，如同鼻衄。吐血不尽，余血停留体内，导致面色萎黄，大便发黑者，更适宜服用。
犀角（镑片）、生地黄、白芍、牡丹皮（等分）。
以上切碎。每次服用五钱，用水煎煮温服，实证者可服用。
桃仁承气汤
芒硝（三钱）、甘草（二钱半）、大黄（一两）、桂枝（三钱）、桃仁（半两，去皮尖）。
以上切碎。每两药材加入生姜同煎。
荆芥散
荆芥穗（半两）、炙甘草（一两）、桔梗（二两）。
以上切碎。加生姜煎煮，饭后服用。
小建中汤
桂枝、炙甘草（三钱）、大枣、白芍（六钱）、生姜（二钱）、炒阿胶（一合）。
以上切碎。用水煎煮。
苏子降气汤：见气类章节。
Hematemesis (vomiting blood) is caused by excess Yang and deficiency of Yin, preventing blood from descending normally. Due to the upward-flaring tendency of Fire, blood follows this path and erupts upwards; the pulse must be large and Kou (cork-like, indicating hollow vessels). A large pulse indicates fever, while a Kou pulse suggests stagnation and chaotic movement of blood. The treatment should primarily use Siwu Tang (Four Substances Decoction), adding phlegm-resolving herbs and fire-clearing herbs. If cough with phlegm precedes the appearance of blood, it is mostly due to heat accumulated in phlegm, and the urgent priority is to descend phlegm and clear fire. If saliva mixed with blood is expectorated during coughing, this is caused by heat steaming the clear blood in the stomach causing it to overflow; severe cases use Gardeniae Fructus (Zhi Zi), while mild cases use Indigo Folium (Lan Shi). Or if one suddenly vomits a bowl of purple-black blood, there is no cause for alarm; vomiting it out is beneficial. This is heat damaging the blood vessels with stasis remaining in the middle jiao; Siwu Tang or Jiedu Tang (Detoxification Decoction) can be used. For hematemesis complicated by phlegm, where one or two bowls are vomited over time, only nourishing Yin and descending fire is appropriate, using Siwu Tang plus fire-descending agents. If blood-invigorating drugs are used when phlegm is present, the medication becomes cloying and fails to circulate; only treating the fire will stop the bleeding. Hematemesis is essentially a disease of Fire. For massive, unceasing hematemesis, processed Rhizoma Zingiberis (Gan Jiang) powder can be taken, mixed with child's urine (Tong Bian), which is a "treating contrary method" approach. For blood-tinged sputum in the throat, Jingjie San (Schizonepeta Powder) is used. For spontaneous bleeding from the tongue that continues like a thread, roasted Sophorae Flos (Huai Hua) powder applied dry is effective. For another formula for hematemesis: one part child's urine, half part wine, with leaves of Platycladi Semen (Bai Ye) pounded and taken warm; wine is essential for efficacy. Blood vomited originates from the Stomach. For excess patterns, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated; for deficiency patterns, Xiaojianzhong Tang (Minor Construct the Middle Decoction) added with Coptidis Rhizoma (Huang Lian) is indicated.
[Formulas]
Erhuang Buxue Tang (Two Huangs Blood-Nourishing Decoction): Suitable for initial onset of bleeding or heavy bleeding.
Shu Dihuang (Prepared Rehmanniae Radix, 1 qian), Sheng Dihuang (Raw Rehmanniae Radix, 0.5 qian), Danggui (Angelicae Sinensis Radix, 0.75 qian), Chaihu (Bupleuri Radix, 0.5 qian), Shengma (Cimicifugae Rhizoma), Baishao (Paeoniae Radix Alba, 2 qian), Mudanpi (Moutan Cortex, 0.5 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.75 qian), Huangqin (Scutellariae Radix, 0.5 qian).
Decoct these ingredients in water and take orally. If bleeding does not stop, add Tao Ren (Persicae Semen, 0.5 qian); use Dahuang (Rhei Radix et Rhizoma) cautiously according to deficiency or excess conditions, removing Chaihu and Shengma at this stage.
Another Formula: For post-bleeding states with weak Spleen and Stomach, low spirit, and persistent bleeding.
Renshen (Ginseng Radix et Rhizoma, 1 qian), Huangqi (Astragali Membranacei Radix, 3 qian), Wuweizi (Schisandrae Chinensis Fructus, 13 berries), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian), Danggui (Angelicae Sinensis Radix, 0.5 qian), Maimendong (Ophiopogonis Radix, 0.5 qian).
Cut into pieces. Decoct in water and take orally. Curcumae Aromatae Rhizoma (Yujin) can also be added and ground into the mixture.
Another Formula:
Renshen (Ginseng Radix et Rhizoma, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Fuling (Poria, 1 qian), Banxia Qu (Pinelliae Fermentatum, 0.5 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride, 0.3 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.5 qian).
Cut into pieces. Decoct in water and take orally. If Stomach Qi is disharmonious, add Huoxiang (Agastaches Herba); if thirsty, add Gegen (Puerariae Lobatae Radix) and Huangqin (Scutellariae Radix) each 0.5 qian, remove Baichenpi (White Tangerine Peel) 0.5 qian; if urine is red, add fried Huangbai (Phellodendri Cortex) 0.5 qian; if stool is dry and constipated, add Danggui (Angelicae Sinensis Radix) 0.7 qian; if irritable, add Huanglian (Coptidis Rhizoma, wine-processed and dried) 0.5 qian; if urination is slippery/involuntary, add Mu Li (Ostreae Concha); if bleeding is heavy, remove Banxia (Pinelliae Rhizoma) to avoid dryness, add Sheng Dihuang (Raw Rehmanniae Radix) 1 qian, Mudanpi (Moutan Cortex) 0.5 qian, Tao Ren (Persicae Semen) 0.3 qian; if Stomach deficiency leads to poor appetite, add fried Zhizi Ren (Gardeniae Semen, 0.8 qian); if blood overflows into the turbid pathway (digestive tract) and accumulates between the diaphragm, causing fullness and urge to vomit, use Suzi Jiangqi Tang (Perillae Seed Descending Qi Decoction) plus Renshen (Ginseng Radix et Rhizoma) and Ejiao (Asini Corii Colla) each 0.5 qian; for upper jiao heat obstruction causing hematemesis, use Siwu Tang (Four Substances Decoction) plus Jingjie (Schizonepetae Spica) and Ejiao (Asini Corii Colla) each 0.5 qian. If bleeding still does not stop, add Dahuang (Rhei Radix et Rhizoma) and Huashi (Talcum) each 0.5 qian to the base formula; for hematemesis due to Stomach injury, use Lizhong Tang (Regulate the Middle Decoction) plus Chuanxiong (Ligustici Chuanxiong Rhizoma) and Genge (Puerariae Lobatae Radix) each 0.5 qian. This is caused by alcohol damaging the Stomach. For unceasing hematemesis, use 2 qian of raw Qiangeng (Rubiae Cordifoliae Radix) powder, decocted in water, cooled, and taken after meals for good effect. Baiji (Bletillae Rhizoma) powder can also be used to treat hematemesis.
The above formulas were not originally created by Danxi, but because the ingredients are identical, they are recorded here.
[Appendix] Any blood disorder moving upward, whether spitting, vomiting, or ejecting blood, is considered a "Rebellious" pattern; if it transforms into downward expulsion as foul diarrhea, it is considered a "Smooth" pattern. Upward rebellion is difficult to treat; downward smoothness is easy to treat. Thus, Zhang Zhongjing stated: In Blood Accumulation syndrome, if blood is passed downwards, it should heal itself naturally. This shares the same meaning. If one suddenly develops diarrhea without prior illness, the condition is progressing worsely. Now, if a patient with an upward blood disorder develops downward foul diarrhea, it indicates the pathogen is leaving, which is auspicious. For any visible bleeding, if the body is hot and the pulse suddenly becomes floating and large, it indicates imminent danger.
Attached Formulas
Sisheng Wan (Four Generations Pill): Treats hematemesis caused by Yang invading Yin, with reckless movement of blood due to heat; effective.
Sheng Heye (Fresh Nelumbinis Leaf), Sheng Aye (Fresh Artemisiae Argyi Folium), Sheng Baiye (Fresh Platycladi Cacumen), Sheng Dihuang (Raw Rehmanniae Radix) in equal parts.
Grind thoroughly and form pills the size of chicken eggs. Take one pill, decocted in three cups of water until one cup remains, strain, and drink.
Da Ejiao Wan (Large Donkey-Hide Gelatin Pill): Treats Lung deficiency with external heat, cough, dry throat, excessive salivation/phlegm, or fresh blood. Effective for labor-induced damage to Lung and Stomach, causing hematemesis or hematemesis.
Maimendong (Ophiopogonis Radix, heart removed), Fushen (Poria with Hostwood), Baiziren (Platycladi Semen), Baibu Gen (Stemonae Radix), Duzhong (Eucommiae Cortex, fried), Danshen (Salviae Miltiorrhizae Radix), Beimu (Fritillariae Cirrhosae Bulbus, fried), Fangfeng (Saposhnikoviae Radix) (each 0.5 liang), Shanyao (Dioscoreae Rhizoma), Wuwei Zi (Schisandrae Chinensis Fructus), Shu Dihuang (Prepared Rehmanniae Radix), Ejiao (Asini Corii Colla, fried) (each 1 liang), Yuanzhi (Polygalae Radix), Renshen (Ginseng Radix et Rhizoma) (each 2.5 qian), Fuling (Poria) (1 liang).
Grind into powder, mix with refined honey, and form pills the size of marbles. Take one pill per dose, decocted in water until 6 fen remains, consume with the dregs.
Xijiao Dihuang Wan (Rhinoceros Horn and Rehmannia Pill): Treats Cold Damage where sweating and purging methods fail, pathogen stagnates in collaterals, surges with Qi and exits as epistaxis. Or if clear pathways are blocked, pathogen flows into Stomach and abdomen, vomiting clear blood similar to epistaxis. For incomplete hematemesis with residual blood staying inside, leading to sallow complexion and black stools, this is especially suitable.
Xijiao (Rhinocerotis Cornu, shaved), Sheng Dihuang (Raw Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Mudanpi (Moutan Cortex) in equal parts.
Cut into pieces. Take 5 qian per dose, decoct in water, take warm. Suitable for excess patterns.
Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction)
Mangxiao (Natrii Sulfas, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2.5 qian), Dahuang (Rhei Radix et Rhizoma, 1 liang), Guizhi (Cinnamomi Ramulus, 3 qian), Tao Ren (Persicae Semen, 0.5 liang, skin and tip removed).
Cut into pieces. Add ginger when decocting every 1 liang of herbs.
Jiedu Tang (Detoxification Decoction): See Heatstroke section.
Jingjie San (Schizonepeta Powder)
Jingjie Sui (Schizonepetae Spica, 0.5 liang), Zhigancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1 liang), Jiegeng (Platycodonis Radix, 2 liang).
Cut into pieces. Decoct with ginger, take after meals.
Xiaojianzhong Tang (Minor Construct the Middle Decoction)
Guizhi (Cinnamomi Ramulus), Zhigancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 qian), Dazao (Ziziphi Jujubae Fructus), Baishao (Paeoniae Radix Alba, 6 qian), Shengjiang (Zingiberis Rhizoma Recens, 2 qian), Chao Ejiao (Fried Asini Corii Colla, 1 he).
Cut into pieces. Decoct in water.
Suzi Jiangqi Tang (Perillae Seed Descending Qi Decoction): See Qi Disorders section.
Lizhong Tang (Regulate the Middle Decoction): See Cold Damage section.