心生血兮肝藏血，随处而行无处缺。目视舌言耳能闻，足能步履手能摄。如何错过致妄
行，劳伤火动因而得。吐因肺胃即热蒸，逐口吐出随火升。呕或醉怒或劳役，胃口之血无端
行。咯血之血出于肾，阴火上炎殊分明。咳衄肺金心火克，咳者为重衄为轻。犀角地黄汤主
理，归骨（地骨）栀芩麦知杞。侧柏藕汁共茅根，童便服之浮火已。咳嗽沙参天麦冬，寒热
龟甲青蒿庸。有痰贝蒌花粉入，有泻药（山药）苡苓甘同。不止（失血不止）蒲黄炒荆芥，
韭汁大黄去紫块。血不藏室体极虚，八珍可用阿胶配。
陈参曰∶《内经》分上下失血为阳络阴络，是腑络取胃，脏络取脾。
治血先理腑胃（甘凉肃降法）
沙参 玉竹 花粉 郁金 茜草 绿豆皮 麦冬 桑叶 川斛 杏仁 竹心
又治心营（轻清滋养法）
生地 丹参 地骨皮 连翘 元参 山栀 生粉草
风淫津涸（甘寒法）
芦根 薄荷 羚角 蔗汁
温淫火壮（苦寒法）
石膏 黄芩 山栀 杏仁
暑遍气分（开解法）
滑石 苏梗 杏仁 橘白 薄荷 苡仁 白蔻
暑逼营分（清芳法）
犀角 生地 青蒿 山栀 银花 丹皮 连翘
以上外因。
嗔怒伤肝阳（血随气逆，用胶 ，气为血帅法）
白苏子 郁金 丹皮 钩藤 丹参 降香 川贝母 杏仁 桑叶 橘红 蒺藜
郁勃伤肝阴（木火内燃阳络，柔肝育阴法）
阿胶 麦冬 白芍药 生地 甘草 鸡子黄
烦劳损心脾（气不摄血，甘温培固法）
用归脾汤。见前。保元汤 人参 黄 肉桂 甘草
纵欲伤肾
青铅六味丸 肉桂 七味丸并加童便。
精竭海空，气泛血涌（危症急固真元，大补血法）
人参 五味子 紫河车 熟地 枸杞子 紫石英
以上内因。
烟辛烁肺（治上法）
用千金苇茎汤 鲜苇茎 苡仁 桃仁 瓜瓣 加茅根
酒热戕胃（治中法）
用甘露饮 生地 熟地 天冬 麦冬 石斛 茵陈 黄芩 枳壳 甘草 枇杷叶 加藕汁
坠堕伤瘀血泛，先导下后通补。
怒力伤（属劳伤之根，阳动则络伤血溢，治与虚损有间，宜滋阴补气为主）
用当归建中汤 即小建中汤加当归 虎潜丸 旋复花汤。
何书田曰∶血之主司系心肝脾，血之生化系阳明胃。胃为血之要道，当先治胃。《仁斋
直指》云∶一切血证经久不愈，每以胃药收功。薄味调养胃阴，如《金匮》麦冬汤及沙参、扁
豆、鲜斛、茯苓。甘温创建中阳，如人参建中汤及四君子加减。沉着浓浓，属肝肾之血，用熟
地、枸杞、归身、牛膝、茯苓、青铅。阴虚阳升，头中微痛，当和阳镇逆，用生地、阿胶、牛膝、
白芍、茯苓、青铅。
思虑太过吸伤肾阴，时时茎举，此失血属骄阳独升，用人中白、龟版、知柏等味。心火吸
肾，随阳升腾，阳翔为血溢，阳坠为阴遗腰痛。足胫冷何一非精夺下元损见症，治以人参、熟
地、河车膏、紫石英、茯苓、五味、枸杞、沙苑，谓莫见血以投凉，勿因嗽以理肺，为要旨耳。
肾传脾胃，元海无纳气之权，急急收纳根蒂，人参、河车膏、坎气、枸杞、熟地、五味、沙蒺
藜、茯苓、胡桃等味，在所必用。
陈参曰∶夏月藏阴，冬日藏阳。阳不潜伏，升则血溢，降则遗精。血宜宁静，不宜疏动，动
则有血溢之虞。投凉剂则清气愈伤。
心脏生成血液，肝脏贮藏血液，血液在全身各处运行，无处不到。眼睛能视物，舌头能言语，耳朵能听闻，脚能行走，手能抓取。如果因过度劳累导致内火妄动，就会引起血液不循常道而妄行出血。吐血是因为肺胃有热，热气蒸腾，血液随着火势向上涌出而一口口吐出；呕吐则可能是因为醉酒、发怒或过度劳累，导致胃口的血液无故上行。咯出的血来源于肾脏，这是阴火上炎所致，情况十分明显。咳嗽带血或鼻衄（鼻出血）是由于肺金受到心火的克制，其中咳嗽咯血病情较重，鼻衄较轻。治疗犀角地黄汤为主方，药物包括当归、地骨皮、栀子、黄芩、麦冬、知母、枸杞子。配合侧柏叶、藕汁和白茅根一起服用，再用童便（童子尿）送服，浮游之火即可平息。若伴有咳嗽，加用沙参、天冬、麦冬；若有寒热症状，加用龟甲、青蒿。若有痰，加入贝母、瓜蒌、天花粉；若有腹泻，加入山药、薏苡仁、茯苓、甘草。若失血不止，加入炒蒲黄和荆芥；若有紫黑色的血块，加入韭菜汁和大黄以祛除瘀血。如果血液不能藏于胞宫且身体极度虚弱，可以使用八珍汤并配伍阿胶。
陈修园说：《黄帝内经》将上下失血分为阳络出血和阴络出血，腑络出血取治于胃，脏络出血取治于脾。
治疗血证先调理腑胃（采用甘凉肃降法）：
沙参、玉竹、花粉、郁金、茜草、绿豆皮、麦冬、桑叶、川石斛、杏仁、竹心。
又法治疗心营受损（采用轻清滋养法）：
生地、丹参、地骨皮、连翘、元参、山栀、生粉草。
风邪淫盛导致津液枯竭（采用甘寒法）：
芦根、薄荷、羚角、蔗汁。
暑邪遍布气分（采用开解法）：
滑石、苏梗、杏仁、橘白、薄荷、苡仁、白蔻。
暑邪逼近营分（采用清芳法）：
犀角、生地、青蒿、山栀、银花、丹皮、连翘。
以上为外因所致。
嗔怒伤及肝阳（血随气逆，使用胶艾汤类，遵循气为血帅的原则）：
白苏子、郁金、丹皮、钩藤、丹参、降香、川贝母、杏仁、桑叶、橘红、蒺藜。
郁结勃发伤及肝阴（木火内燃损伤阳络，采用柔肝育阴法）：
阿胶、麦冬、白芍药、生地、甘草、鸡子黄。
烦劳损伤心脾（气不摄血，采用甘温培固法）：
使用归脾汤。见前文。保元汤由人参、黄芪、肉桂、甘草组成。
精竭如海空，气泛血涌（危重急症需固护真元，大补气血）：
人参、五味子、紫河车、熟地、枸杞子、紫石英。
以上为内因所致。
烟辛灼伤肺脏（治疗上焦之法）：
使用千金苇茎汤（鲜苇茎、苡仁、桃仁、瓜瓣），加白茅根。
酒热戕害胃腑（治疗中焦之法）：
使用甘露饮（生地、熟地、天冬、麦冬、石斛、茵陈、黄芩、枳壳、甘草、枇杷叶），加藕汁。
怒力损伤（属于劳伤的根源，阳气妄动则络脉受伤血液溢出，治疗与虚损有所不同，宜以滋阴补气为主）：
使用当归建中汤（即小建中汤加当归）、虎潜丸、旋复花汤。
何书田说：血液的主司在于心、肝、脾三脏，血液的生化源于阳明胃。胃是血液运行的要道，应当先治胃。《仁斋直指方》说：一切血证经久不愈，往往通过调理胃药而收效。清淡饮食调养胃阴，如《金匮要略》中的麦冬汤以及沙参、扁豆、鲜石斛、茯苓。甘温之药建立中阳，如人参建中汤以及四君子汤加减。沉着浓厚的血色，属于肝肾之血，使用熟地、枸杞、归身、牛膝、茯苓、青铅。阴虚阳升，头部轻微疼痛，应当调和阳气、镇逆，使用生地、阿胶、牛膝、白芍、茯苓、青铅。
思虑太过吸伤肾阴，时时出现阴茎勃起，这种失血属于骄阳独升，用人中白、龟版、知母、黄柏等药。心火吸引肾水，随阳气升腾，阳气上浮则血液溢出，阳气下坠则遗精腰痛。足胫寒冷，哪一样不是精气亏损、下元受损的表现？治疗应使用人参、熟地、河车膏、紫石英、茯苓、五味子、枸杞、沙苑子。关键在于不要一见出血就投用凉药，不要因为咳嗽就单纯理肺，这是主要宗旨。
肾气传至脾胃，元气之海失去纳气的权力，急需收纳根蒂，人参、河车膏、坎气、枸杞、熟地、五味子、沙蒺藜、茯苓、胡桃等药，是必须使用的。
陈修园说：夏季收藏阴气，冬季收藏阳气。阳气如果不潜伏，上升则导致血液溢出，下降则导致遗精。血液宜宁静，不宜疏动，一旦扰动就有血液溢出的危险。投用凉剂则会进一步损伤清气。
The Heart generates blood, and the Liver stores blood; it circulates everywhere without absence. The eyes see, the tongue speaks, the ears hear, the feet walk, and the hands grasp. How can one miss this and cause reckless movement? It is obtained due to labor injury and fire agitation. Hematemesis (vomiting blood) arises from heat steaming in the Lung and Stomach, with blood following the fire rising and being vomited out mouthful by mouthful. Vomiting may result from drunkenness, anger, or overwork, causing blood from the stomach gate to flow aimlessly upward. Blood expectorated comes from the Kidney, where Yin fire flares upward, which is quite distinct. Coughing with blood or epistaxis (nosebleed) occurs because Metal of the Lung is overcome by Fire of the Heart; coughing indicates a severe condition, while epistaxis is mild. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is the primary treatment, consisting of Danggui (Angelica Sinensis), Digupi (Bark of Ground Tree Bark), Zhizi (Gardenia Fruit), Huangqin (Scutellaria Root), Maidong (Ophiopogon Tuber), Zhimu (Anemarrhena Rhizome), and Gouqi (Goji Berry). Combined with Ce Baiye (Biota Tops), Ou Zhi (Lotus Root Juice), and Maogen (Imperata Rhizome), taken with Tongbian (Child's Urine), the floating fire will subside. For cough, add Shashen (Glehnia Root), Tiantianmai (Asparagus Tuber), and Maidong. For chills and fever, use Guijia (Tortoise Shell) and Qinghao (Artemisia Annua L.). If there is phlegm, add Beimu (Fritillaria Bulb), Gualou (Trichosanthes Fruit), and Huafen (Trichosanthes Root Powder). If there is diarrhea, add Shanyao (Dioscorea Rhizome), Yiren (Coix Seed), Fuling (Poria), and Gancao (Licorice Root). If bleeding does not stop, add Chao Puhuang (Processed Lygodium Spore) and Jingjie (Schizonepeta Spike). To remove purple clots, use Jiu Zhi (Leek Juice) and Dahuang (Rhubarb Root). If blood fails to reside in the uterus and the body is extremely deficient, Bazhen Tang (Eight Treasure Decoction) can be used with Ejiao (Donkey-hide Gelatin).
Chen Xiuyuan said: The *Neijing* divides upper and lower hemorrhage into Yang Collateral bleeding and Yin Collateral bleeding. Fu Collateral bleeding is treated via the Stomach, and Zang Collateral bleeding via the Spleen.
To treat blood disorders, first regulate the Fu organs and Stomach (using the method of Sweet-Cool and Descending):
Shashen, Yuzhu, Huafen, Yujin, Qiancao, Lüdoupi, Maidong, Sangye, Chuanhu, Xingren, Zhuxin.
Another method treats Heart Ying deficiency (using the method of Light-Clear and Nourishing):
Shengdi, Danshen, Digupi, Lianqiao, Yuan Shen, Shanzhi, Sheng Fengcao.
Wind pathogen excess leading to fluid dryness (using the Sweet-Cold method):
Lugen, Bohe, Lingjiao, Zheshi.
Warm pathogen excess leading to strong fire (using the Bitter-Cold method):
Shigao, Huangqin, Shanzhi, Xingren.
Summerheat pervading the Qi level (using the method of Opening and Resolving):
Huashi, Sugeng, Xingren, Ju Bai, Bohe, Yiren, Baiko.
Summerheat pressing on the Ying level (using the method of Clearing and Aromatic):
Xijiao, Shengdi, Qinghao, Shanzhi, Yinhua, Danpi, Lianqiao.
These are external causes.
Anger injuring Liver Yang (blood follows rebellious Qi, using Jiao Ai Tang principles, adhering to "Qi is the commander of Blood"):
Baizu Zi, Yujin, Danpi, Gouteng, Danshen, Jiangxiang, Chuanbeimu, Xingren, Sangye, Juhong, Jili.
Depression and agitation injuring Liver Yin (Wood and Fire burning internally damaging Yang Collaterals, using the method of Softening Liver and Nourishing Yin):
Ejiao, Maidong, Baishao, Shengdi, Gancao, Jizihuang.
Vexation and fatigue damaging Heart and Spleen (Qi failing to control blood, using the method of Sweet-Warm and Fortifying):
Use Guipi Tang. See previous text. Baoyuan Tang consists of Renshen, Huangqi, Rougui, and Gancao.
Excessive sexual desire injuring the Kidney:
Qinglian Liuwei Wan, Rougui, Qiwei Wan, all taken with Tongbian.
Essence exhausted like an empty sea, Qi surging and blood flooding (critical emergency requiring immediate consolidation of True Yuan and massive tonification of Blood):
Renshen, Wuweizi, Zihewei, Shudi, Gouqi, Zhi Shiyin.
These are internal causes.
Smoking pungency scorching the Lung (treating the Upper Jiao):
Use Qianjin Weijing Tang (Fresh Weijing, Yiren, Taoren, Gua Ban), plus Maogen.
Alcohol heat damaging the Stomach (treating the Middle Jiao):
Use Ganlu Yin (Shengdi, Shudi, Tiandong, Maidong, Shihu, Yinchén, Huangqin, Zhike, Gancao, Pipaye), plus Ou Zhi.
Trauma causing stasis blood to flood; first guide down the stasis, then tonify and unblock.
Anger and force causing injury (root of labor injury; Yang moving recklessly damages collaterals causing blood overflow; treatment differs from deficiency, favoring nourishing Yin and supplementing Qi):
Use Danggui Jianzhong Tang (Xiao Jianzhong Tang plus Danggui), Huyang Wan, Xuanfuhua Tang.
He Shutian said: The governance of blood lies in the Heart, Liver, and Spleen; the generation and transformation of blood depend on the Yangming Stomach. The Stomach is the crucial pathway for blood, so it should be treated first. *Ren Zhi Zhi Fang* states: All blood disorders that persist for a long time often achieve success through treating the Stomach. Light flavors nourish Stomach Yin, such as Maidong Tang from *Jinkui Yaolue*, as well as Shashen, Biandou, fresh Shihu, and Fuling. Sweet-warm herbs establish Middle Yang, such as Renshen Jianzhong Tang and modifications of Sijunzi Tang. Dark and thick blood belongs to the Liver and Kidney, using Shudi, Gouqi, Guishen, Niuxi, Fuling, and Qinglian. Yin deficiency with Yang rising causing slight headache requires harmonizing Yang and suppressing rebellion, using Shengdi, Ejiao, Niuxi, Baishao, Fuling, and Qinglian.
Excessive thinking inhaling and damaging Kidney Yin, with frequent erection of the penis, indicates this hemorrhage is due to solitary rising of extreme Yang. Use Renzhongbai, Guiban, Zhimu, and Huangbai. Heart fire inhaling Kidney water rises with Yang; Yang soaring leads to blood overflow, while Yang sinking leads to seminal emission and lower back pain. Cold calves and shins—what are these if not signs of essence depletion and Lower Yuan damage? Treatment uses Renshen, Shudi, Heche Gao, Zhi Shiyin, Fuling, Wuweizi, Gouqi, Shayuanzi. The key principle is: do not administer cooling agents merely upon seeing blood, nor treat the Lung merely due to coughing.
When Kidney transmits to Spleen and Stomach, and the Sea of Yuan loses its power to grasp Qi, urgently consolidate the root. Renshen, Heche Gao, Kanqi, Gouqi, Shudi, Wuweizi, Sha Jili, Fuling, and Hetao are essential.
Chen Xiuyuan said: In summer, Yin is stored; in winter, Yang is stored. If Yang does not hide, rising leads to blood overflow, and sinking leads to seminal emission. Blood should be tranquil, not agitated; agitation risks blood overflow. Administering cooling agents further injures clear Qi.