小儿鼻中出血，为衄血。其候鼻中干燥，身热不渴，苦头痛，是热伤阳络也。有因伤寒失汗衄血者，乃热郁
于荣，其身无汗，古法主麻黄汤以汗之（如麻黄、杏仁、桂枝、生甘草，引用生姜）。
身有汗者，古法主桂枝汤以解之（如桂枝、白芍、炙甘草，引用姜、枣）。
设无表病，因内热而衄血者，古法主犀角地黄汤以清之（如犀角、生地、丹皮、白芍等味）。便秘者加大黄。
〔真按〕血为水谷之精，调和于五脏，洒陈于六腑，乃能入于脉，主化于脾，总统于心，藏受于肝，宣
布于肺，施泄于肾，濡润宣通，皆此血也。鼻衄乃脾热传肺，血行清道，故血从鼻出，未尝闻小儿因伤寒失汗而衄
血者。方用大麦冬钱半，黑栀仁五分，片黄芩八分，细生地一钱，生甘草三分，引用灯芯十茎，鲜竹叶七片，热
甚加犀角尖磨汁二分，冲服。
小儿吐血不咳嗽者，多因内热，致血妄行上逆也。古法主犀角地黄汤（方见本门衄血）。
若因努劳吐血者，兼咳嗽，古法主先用桃仁承气汤，以破逐之（如桃仁、大黄、芒硝、甘草、桂枝，加当
归、白芍、苏木、红花四味）。
继用加味四物汤和之（如当归、白芍、川芎、生地、茅根、
蒲黄、牡丹皮、黑栀子、生甘草，引用藕节），酒水煎服。
又有劳伤吐血者，亦兼咳嗽，痰中带血，有热者，古法主鸡苏散（如鸡苏、薄荷叶、川贝母、麦门冬、桔梗、
阿胶、生地黄、生甘草、炙黄 、白茅根、炙蒲黄等味）。无热者，古法主救肺汤（如麦冬、人参、炙黄 、郁
金、五味子、酒洗当归、酒炒白芍、川贝母、炙甘草、马兜铃等味）。
〔真按〕凡吐血者，荣卫之气逆也。盖心者血之主，肺者气之主，气主煦之，血主濡之，荣养百骸，溉灌
筋脉，升降有常，自然顺适，或外干六淫，内伤饮食，气留不行，血壅不濡，所以热极涌泄，不无妄动之患。且
气有余便是火，火乘于血，得热妄行，故上奔而为吐血也。小儿吐血，因食伤者最多，盖阳明多气多血，若郁热
内逼，必致荣血妄行。所以小儿吐血，属胃者十之七八、甚至尚在襁褓而吐血者，多由重闱暖阁，火气熏蒸，或
过啖辛辣，流于乳房，儿吮之后，积温成热，热极上崩而吐血者有之。即衄血便血溺血，亦皆由乎此。若因久嗽
吐血，是又肺虚所致。肺调百脉之气，肝统诸经之血，脾胃有伤，荣卫虚损，故血失常道而妄行。倘此儿气虚神
倦，唇无红色，切勿误用寒凉，方以西洋参八分，生于术一钱，白云苓二钱，生甘草五分，加灯芯七茎，竹叶十
片，以救其脾，脾实则血自止。
若因胃中积热而吐，则宜先清胃火，使血归经，方用净知母一钱，怀生地二钱，粉丹皮钱半，雅川连五分，
白归身三分，大麦冬一钱，润玄参一钱，炙甘草五分。襁褓小儿，但用细生地一钱，连心麦冬八分，生甘草五分，
引用灯芯十茎，竹叶七片。
小儿咳嗽见血，此因心肾水火不升降，火炎无制，肺胃枯燥，不可作童子痨治。方用大生地一钱，杭白芍一
钱，肥知母一钱，白莲肉一钱，玄参一钱，寸麦冬钱半，真雅连八分，天花粉五分，炙甘草五分。
小儿鼻中出血，称为衄血。其症状表现为鼻腔干燥、身体发热但不口渴、痛苦地头痛，这是热邪损伤阳络所致。有的因为伤寒失于发汗而导致衄血，这是热邪郁结在营分，其人身无汗，古法主张用麻黄汤（如麻黄、杏仁、桂枝、生甘草，引用生姜）来发汗解表。如果身上有汗的，古法主张用桂枝汤（如桂枝、白芍、炙甘草，引用姜、枣）来解肌发表。假如没有表证，是因为内热而衄血的，古法主张用犀角地黄汤（如犀角、生地、丹皮、白芍等药味）来清热凉血。伴有便秘的，加大黄。
〔陈守真按〕血是水谷精微所化，在五脏调和，散布于六腑，才能进入脉管，由脾主化生，由心统摄，由肝贮藏，由肺宣发，由肾施泄，濡润宣通，都是依靠这血。鼻衄是脾热传于肺，血液运行于清道，所以血从鼻出，我未曾听说过小儿因伤寒失汗而衄血的。我的方子用大麦冬一钱半，黑栀子仁五分，片黄芩八分，细生地一钱，生甘草三分，引用灯芯十茎，鲜竹叶七片，热势严重的加犀角尖磨汁二分，冲服。
小儿吐血且不咳嗽的，多因内热，导致血液妄行上逆。古法主张用犀角地黄汤（方剂见本门衄血条下）。如果是因用力努挣导致吐血的，兼有咳嗽，古法主张先用桃仁承气汤（如桃仁、大黄、芒硝、甘草、桂枝，加当归、白芍、苏木、红花四味药），以破血逐瘀。接着用加味四物汤（如当归、白芍、川芎、生地、茅根、蒲黄、牡丹皮、黑栀子、生甘草，引用藕节）来调和气血，酒水煎服。又有因劳伤导致吐血的，也兼有咳嗽，痰中带血，有热的，古法主张用鸡苏散（如鸡苏、薄荷叶、川贝母、麦门冬、桔梗、阿胶、生地黄、生甘草、炙黄芪、白茅根、炙蒲黄等药味）。没有热的，古法主张用救肺汤（如麦冬、人参、炙黄芪、郁金、五味子、酒洗当归、酒炒白芍、川贝母、炙甘草、马兜铃等药味）。
〔陈守真按〕凡是吐血，都是营卫之气逆乱所致。大概心是血的主宰，肺是气的主宰，气主温煦，血主濡养，营养百骸，灌溉筋脉，升降有常度，自然顺适；或者外感六淫邪气，内伤饮食，气机停留不行，血液壅滞不濡，所以热极涌泄，难免有妄动之患。而且气有余便是火，火乘袭于血，得热则妄行，所以上奔而为吐血。小儿吐血，因食积损伤的最多，因为阳明经多气多血，若郁热内逼，必然导致营血妄行。所以小儿吐血，属胃的占十分之七八，甚至尚在襁褓之中就吐血的，多由居室温暖，火气熏蒸，或过食辛辣之物，流注于乳房，婴儿吮吸后，积温成热，热极上崩而吐血的情况也有。即使是衄血、便血、溺血，也都是由此引起。如果是因久咳导致吐血，这是又由肺虚所致。肺调节百脉之气，肝统辖诸经之血，脾胃受伤，营卫虚损，所以血失常道而妄行。倘若这孩子气虚神倦，嘴唇没有红色，切勿误用寒凉药物，方子用西洋参八分，生于术一钱，白云苓二钱，生甘草五分，加灯芯七茎，竹叶十片，以救其脾，脾实则血自止。
如果是因胃中积热而吐，则宜先清胃火，使血归经，方子用净知母一钱，怀生地二钱，粉丹皮一钱半，雅川连五分，白归身三分，大麦冬一钱，润玄参一钱，炙甘草五分。襁褓中的小儿，只用细生地一钱，连心麦冬八分，生甘草五分，引用灯芯十茎，竹叶七片。
小儿咳嗽见血，这是因为心肾水火不升降，火炎无制，肺胃枯燥，不可当作童子痨（肺结核）治疗。方子用大生地一钱，杭白芍一钱，肥知母一钱，白莲肉一钱，玄参一钱，寸麦冬一钱半，真雅连八分，天花粉五分，炙甘草五分。
Epistaxis in children is referred to as Nu Xue (Nasal Bleeding). Its manifestations include dryness of the nasal cavity, fever without thirst, and distressing headache, which indicates heat damaging the Yang Collaterals. In cases where epistaxis results from neglected sweating due to Cold Damage (Shang Han), heat is constrained within the Ying (Nutritive) Level; the patient has no sweat. Ancient methods prescribe Mahuang Tang (Ephedra Decoction) to induce sweating (comprising Ephedrae Herba, Armeniacae Semen Amarum, Cinnamomi Ramulus, Raw Glycyrrhizae Radix et Rhizoma, with Fresh Zingiberis Rhizoma as a guide). If the patient sweats, ancient methods prescribe Guizhi Tang (Cinnamon Twig Decoction) to resolve the exterior (comprising Cinnamomi Ramulus, Paeoniae Radix Alba, Honey-fried Glycyrrhizae Radix et Rhizoma, with Ginger and Jujube as guides). In the absence of exterior syndromes, if epistaxis is caused by internal heat, ancient methods prescribe Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to clear heat (comprising Rhinocerotis Cornu, Rehmanniae Radix, Moutan Cortex, Paeoniae Radix Alba, etc.). If constipation is present, add Rheum Radix et Rhizoma.
[Chen Shouzhen's Note] Blood is refined from food and water, harmonized in the Five Zang Organs, and distributed to the Six Fu Organs, thereby entering the vessels. It is transformed by the Spleen, commanded by the Heart, stored by the Liver, disseminated by the Lungs, and excreted by the Kidneys. Its moistening and unblocking functions rely on this blood. Epistaxis occurs when Spleen heat transmits to the Lungs, causing blood to flow through the clear orifices, thus exiting from the nose. I have never heard of children suffering epistaxis due to neglected sweating from Cold Damage. My prescription uses half a qian of Damaidong (Ophiopogonis Tuber), five fen of Heizhiren (Gardeniae Fructus), eight fen of Pian Huangqin (Scutellariae Radix), one qian of Xi Shengdi (Rehmanniae Radix Preparata), three fen of Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), guided by ten stalks of Dengxin (Junci Medulla) and seven slices of Xian Zhuye (Fresh Phyllostachys Folium). If heat is severe, add two fen of Xijiao Jian (Rhinoceros Horn Tip), ground into juice, and taken mixed.
When children vomit blood without coughing, it is mostly due to internal heat causing blood to move recklessly and reverse upward. Ancient methods prescribe Xijiao Dihuang Tang (see Epistaxis section for formula details). If vomiting blood results from straining, accompanied by coughing, ancient methods first prescribe Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to break up and purge stasis (comprising Persicae Semen, Rheum Radix et Rhizoma, Natrii Sulfas, Glycyrrhizae Radix et Rhizoma, Cinnamomi Ramulus, plus Angelicae Sinensis Radix, Paeoniae Radix Alba, Buteae Lignum, and Carthami Flos). Subsequently, Jiawei Siwu Tang (Modified Four Substance Decoction) is used to harmonize (comprising Angelicae Sinensis Radix, Paeoniae Radix Alba, Chuanxiong Rhizome, Rehmanniae Radix, Imperatae Rhizoma, Cyperi Rhizoma, Moutan Cortex, Gardeniae Fructus, Raw Glycyrrhizae Radix et Rhizoma, guided by Nelumbinis Plumula). The decoction is prepared with wine and water. For vomiting blood due to labor injury, also accompanied by coughing and blood in sputum, if there is heat, ancient methods prescribe Jisu San (Elsholtzia Powder) (comprising Elsholtziae Herba, Menthae Haplocalycis Folium, Fritillariae Thunbergii Bulbus, Ophiopogonis Tuber, Platycodonis Radix, Asini Corii Colla, Raw Rehmanniae Radix, Raw Glycyrrhizae Radix et Rhizoma, Honey-fried Astragali Radix, Imperatae Rhizoma, Honey-fried Cyperi Rhizoma, etc.). If there is no heat, ancient methods prescribe Jiufei Tang (Lung-Saving Decoction) (comprising Ophiopogonis Tuber, Ginseng Radix, Honey-fried Astragali Radix, Curcumae Radix, Schisandrae Fructus, Wine-washed Angelicae Sinensis Radix, Wine-fried Paeoniae Radix Alba, Fritillariae Thunbergii Bulbus, Honey-fried Glycyrrhizae Radix et Rhizoma, Aristolochiae Fructus, etc.).
[Chen Shouzhen's Note] All cases of hematemesis involve the reversal of Ying and Wei Qi. The Heart is the master of blood, and the Lungs are the master of Qi. Qi provides warmth, and blood provides nourishment, sustaining the body and irrigating sinews and vessels. With normal ascent and descent, harmony is maintained. However, external invasion by the Six Excesses or internal dietary injury can cause Qi stagnation and blood obstruction, leading to extreme heat surging and reckless movement. Since excess Qi transforms into Fire, and Fire attacks blood, causing it to move recklessly upon heating, it rushes upward resulting in hematemesis. In children, hematemesis is most often caused by food retention, as the Yangming Meridian is abundant in Qi and Blood; constrained internal heat inevitably causes reckless movement of Ying blood. Thus, 70-80% of pediatric hematemesis cases belong to the Stomach. Even infants in swaddling clothes may vomit blood due to warm living environments steaming with fire, or excessive consumption of spicy foods that pass into breast milk; after the infant suckles, accumulated warmth generates heat, which surges upward causing hematemesis. This also applies to epistaxis, hematochezia, and hematuria. If hematemesis results from chronic coughing, it is caused by Lung deficiency. The Lungs regulate the Qi of all vessels, and the Liver commands the blood of all meridians. Injury to the Spleen and Stomach leads to deficiency of Ying and Wei, causing blood to leave its normal pathway and move recklessly. If the child shows Qi deficiency, mental fatigue, and pale lips, cold-natured herbs must not be mistakenly used. A prescription of Xiyangshen (American Ginseng) 8 fen, Sheng Baizhu (Atractylodes Macrocephala) 1 qian, Baiyunling (Poria) 2 qian, Sheng Gancao (Raw Licorice) 5 fen, plus seven stalks of Dengxin and ten slices of Zhuye, is used to rescue the Spleen; when the Spleen becomes solid, bleeding stops naturally.
If vomiting is due to accumulated heat in the Stomach, one should first clear Stomach fire to return blood to its vessels. The prescription includes Jing Zhimu (Anemarrhenae Rhizoma) 1 qian, Huai Shengdi (Prepared Rehmannia) 2 qian, Fen Danpi (Moutan Cortex) 1.5 qian, Ya Chuanlian (Coptidis Rhizoma) 5 fen, Bai Guishen (Angelicae Sinensis Radix) 3 fen, Da Maidong (Ophiopogonis Tuber) 1 qian, Run Xuanshen (Scrophulariae Radix) 1 qian, and Zhi Gancao (Honey-fried Licorice) 5 fen. For infants in swaddling clothes, use only Xi Shengdi (Fine Prepared Rehmannia) 1 qian, Lianxin Maidong (Ophiopogonis Tuber with heart) 8 fen, and Sheng Gancao (Raw Licorice) 5 fen, guided by ten stalks of Dengxin and seven slices of Zhuye.
When children cough up blood, it is because the Water and Fire of the Heart and Kidneys do not ascend and descend properly, Fire flares without control, and the Lungs and Stomach become dry. This should not be treated as Tongzi Lao (Pediatric Tuberculosis). The prescription uses Da Shengdi (Large Prepared Rehmannia) 1 qian, Hang Baishao (Hangzhou White Peony Root) 1 qian, Fei Zhimu (Plump Anemarrhenae Rhizoma) 1 qian, Bailianrou (White Lotus Seed) 1 qian, Xuanshen (Scrophulariae Radix) 1 qian, Cun Maidong (Small Ophiopogonis Tuber) 1.5 qian, Zhen Ya Lian (Authentic Coptis) 8 fen, Tianhuafen (Trichosanthis Radix) 5 fen, and Zhi Gancao (Honey-fried Licorice) 5 fen.