下气属心虚。经云∶夏脉者心也，心脉不及，下为气泄者是也。
〔河〕肠胃郁结，谷气内发，而不能宣通于肠胃之外，故善噫而或下气也。
〔《诊》〕癫痫痨瘵，若气下泄不止者必死。此真气竭绝，肠胃腠理闭塞，谷气不能宣通于
肠胃之外，故从肠胃中泄出也。
〔垣〕衄血出于肺，以犀角、升麻、栀子、黄芩、芍药、生地、紫参、丹参、阿胶之类主之。
咯唾血者出于肾，以天门、麦门、贝母、知母、桔梗、百部、黄柏、远志、熟地黄之类主之。
如有寒者，干姜、肉桂之类主之。痰涎血者出于脾，葛根、黄 、黄连、芍药、甘草、当归、沉香
之类主之。呕血出于胃，实者犀角地黄汤主之，虚者小建中汤加黄连主之。
荣之生病也，寒热少气，血上下行。方见寒热。
〔《素》〕帝曰∶有病胸胁支满者，妨于食，病至则先闻腥臊臭，出清液，先唾血，四肢清，
目眩，时时前后血，病名为何？何以得之？岐伯曰∶病名血枯。此得之年少时有所大脱血，若醉
入房中，气竭肝伤，故月事衰少不来也。帝曰∶治之奈何？复以何术？岐伯曰∶以四乌 骨，
一芦茹，二物并合之，丸以雀卵，大如小豆，以五丸为后饭，饮以鲍鱼汁，利肠中及伤肝也。
（腹中论）
〔洁〕诸见血无寒，衄血、吐血、溺血，皆属于热。但血家症，宜服生地黄散主之。
生地 熟地 枸杞子 地骨皮 甘草 天门冬 黄 芍药 黄芩
上锉，每一两，水盏半，煎一盏，去滓，温服。脉微、身凉、恶风，每一两加桂半钱。
吐血者多有此证。
〔海〕龙脑鸡苏丸治上焦热，除烦解劳；去肺热，咳衄；血热，惊悸；脾胃热，口甘吐血；
肝胆热，泣退场门苦；肾热，神志不定；上而酒毒，膈热消渴；下而血滞，五淋血崩等疾。
薄荷（一斤） 麦冬（去心，二两） 甘草（一两半） 生地（六两） 黄 新蒲黄（炒）
阿胶（炒，二两） 黄连（一两） 人参（二两。以上俱末） 木通（二两） 银柴胡（二两，锉，
同木通沸汤浸一日夜绞汁）
上为细末，好蜜二斤，先煎一二沸，然后下生地黄末，不住手搅，时加木通、柴胡汁浸熬
成膏，勿令火紧焦了。然后加前药末和丸，如豌豆大。每服二十丸，白汤下。虚劳虚烦，栀子
汤下。肺热，黄芩汤下。心热，悸动恍惚，人参汤下。唾、咳、吐、衄四血，去心麦门冬汤下。
肝热，防风汤下。肾热，黄柏汤下。以上并食后临卧服。治五淋及妇人漏下，车前子汤下。痰
嗽者，生姜汤下。茎中痛者，蒲黄、滑石水一钟调下。气逆者，橘皮汤下。室女虚劳，寒热潮作，
柴胡人参汤下。
〔梅〕治吐血下血，并妇人漏下。鸡苏茎叶，煎取汁饮之。
〔海〕胸中聚集之残火，腹里积久之太阴，上下隔绝，脉络部分，阴阳不通。用苦热以定于中，
使辛热以行于外，升以甘温，降以辛润，化严肃为春温，变凛冽为和气，汗而愈也，然余毒土苴
犹有存者，周身阳和，尚未泰然，胸中微躁而思凉饮，因食冷物，服凉剂，阳气复消，余阴再作，
脉退而小，弦细而迟，激而为衄血、唾血者有之，心肺受邪也；下而为便血、溺血者有之，肾肝
受邪也。三焦出血，色紫不鲜，此重沓寒湿，化毒凝泣水谷道路，浸渍而成。若见血证，不详本源，
便用凉折，变乃生矣。（阳证溢出鲜血，阴证下如豚肝。）
上而血者，黄 桂枝汤、白芍当归汤。中而血者，当归建中汤、增损胃风汤。下而血者，芎
归术附汤、桂附六合汤。若三血证在行阳二十五度见，黄 四君子汤主之。若三血证在行阴二十
五度见，当归四逆加吴茱萸主之。
〔《玄》〕血证。吐血、衄血、便血，其人阴虚阳走，其脉沉而散，其外证虚寒无热候，宜乌金
丸散止之。法宜上用散，下用丸，次以木香理中汤加大七气汤，入川芎煎，调苏合香丸温之。
运气 上下出血有四∶
一、曰热助心火甚而血涌沸也。经云∶岁火太过，炎暑流行，肺金受邪，民病血溢血泄。
又云∶少阳之复，火气内发，血溢血泄。王注谓∶血上七窍为血溢，泄利便血为血泄者是也。
二曰寒攻心火虚而血逃亡也。经云∶太阳司天，寒淫所胜，血变于中，民病呕血血泄，鼽衄善
悲。又云∶
太阳在泉，寒淫所胜，民病血见是也。
三曰湿胜血亡。经云∶太阴在泉，湿淫所胜，民病血见是也。
四曰寒热凌犯血亡经云∶少阴司天之政，水火寒热持于气交。热病生于上，冷病生于下，
寒热凌犯而争于中，民病血溢血泄是也。
〔丹〕血余散治血淋，兼治内崩吐血，舌上出血，小便出血。用乱发，皂角水净洗，晒干烧灰
为末，每二钱，以茅草根、车前草煎汤调下。《本草》谓发灰消瘀血，通关格，利水道，破 瘕血衄。
有人生血瘤，大如栗。常被衣擦破，则血出不止，用此血余灰敷之愈。
一人刀伤血流不止，用胎发灰敷之亦愈。
〔海〕孙真人九窍出血方。荆叶捣取汁，酒和服之。
〔丹〕九窍出血，以刺蓟一握绞汁，以酒半盏和服之。如无生者，捣干者为末，冷水调三钱。
舌上无故出血如线，用槐花炒研末，用手掺之。
〔《肘》〕舌上忽出血如簪孔者，香薷汁服一升，日三服。
〔无〕用发灰二钱，米醋二合调服，或敷舌上血出孔处。
文蛤散治热壅舌上出血如泉。
五倍子（洗） 白胶香 牡蛎粉（各等分）
上为末，每用少许，掺患处，或烧热铁烙孔上。
〔丹〕治阴虚牙出鲜血，气郁以四物加牛膝、香附、生甘草、侧柏。
〔罗〕牙疼肿痒动摇，牙龈溃烂，宣露出血，口气等疾。
当归 本 地骨皮 防风 白芷 槐花 川芎 甘草（炙） 升麻 细辛（各等分）
上为细末，每用少许擦牙。痛甚者取三钱，水一盏半，黑豆半合，生姜三斤，煎至一盏，
去渣热漱，冷吐之。
〔孙〕治满口齿有血。枸杞根为末，煎汤，漱后吃。又治膈上吐血妙。
〔《衍》〕齿缝中多出血，当以盐汤漱，又能益齿，走血之验也。
〔丹〕齿痛龈出血。夜以盐浓敷龈上，有涎沥尽乃卧。涎出时叩齿勿住，十夜瘥。忌鱼肉
热物。
〔《肘》〕齿间出血不止，苦竹茹以醋浸一宿含之。
〔《千》〕浓煎竹叶汤，入盐少许，含之止，浓煎茶含漱，亦妙。
治牙血。用附米、白芷、大黄三物烧灰，以青盐和擦之。
〔《本》〕治一切牙疼风热，龈常出鲜血以至崩落，口臭不可近人者，宜服之。
大黄（米泔浸令软） 生地黄（大者薄切）
上二味旋切。各用一片，二片合定，贴所患牙上，一夜即愈。未全可，则再如前法用，忌
说话，恐引风毒津液渍痛处。
〔世〕无故牙动，牙宣血出。香附米用姜汁浸一宿，晒干为末，漱口揩齿，令白且坚而不动，
无血矣。又方，以杨梅树皮浓煎汤漱口勿咽，神妙。
〔《千》〕治齿龈间津液出血不止，以矾石一两，烧，水三升，煮取一升，先拭齿，乃含之。
〔《衍》〕有人病齿缝中血出，以纸捻蘸蟾酥少许，于血出处按之，立止。
〔《灵苑》〕治虚气攻牙，齿痛血出，牙龈痒痛。骨碎补二两，细锉，炒令黑色，杵末，根据
常盥漱后，揩齿龈下，良久吐之。临卧后咽之无妨。
〔无〕治耳中出血。以龙骨末吹入，即止。
病者汗出污衣，名曰汗血，皆由大喜伤心，喜则气散，血随气行。妇人产蓐有此证。治以 草
汁。
草（不拘多少，俗名葛勒蔓也。蔓生，叶似蓖麻而小薄，有细刺，花黄白，子如麻子。）
上捣汁二升，醋二合和，空腹饮一盏，或煮浓饮。亦治淋沥尿血。
上九窍血，舌血、牙血、汗血不愈，又当于衄血、吐血条相参用之。
〔洁〕衄血、吐血、下血、妇人下血不止∶隐白（五分灸）
〔东〕又法∶隐白 大陵 神门（各五分） 太溪（七分）
〔《心》〕妇人经脉妄行，钻心胁疼，妄行于上则衄血，中则吐血，下则下血∶哑门（一分，治衄血）
巨阙（一分，治吐血） 气海（五分，治崩血） 中极（三分补） 三阴交（五分）
〔海〕血证与黄证，俱头汗出。
〔垣〕血溢上行，或唾、或呕、或吐，皆凶也。若变而行下，为恶利者，顺也。血上行为逆，
其治难。下行为顺，其治易。故仲景云∶蓄血症，下血者，当自愈。意同。若无病之人，忽然
下利者，其病进也。今病血症，上行而复下行恶利者，其邪欲去，是知吉也。
脉沉为在里，荣卫内结，胸满必吐血。
〔仲〕尺脉浮，目睛晕黄，衄未止，晕黄去，目睛慧了，知衄今止。病患面无血色，无寒热，
脉沉弦者，衄也。浮弱，手按之绝者，下血。烦咳者，必吐血。心脉微涩，为血溢。（全文见诊，下同。）
肺脉滑甚，为唾血。肺脉微滑，为上下出血。
〔仲〕脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此名曰革，妇人
则半产漏下，男子则亡血失精。
〔《素》〕脱血而脉实者，难治。（玉机真藏论）
衄而不止，脉大而逆也。（全文见诊生死。）
〔《难》〕病若吐血，复鼽衄，脉当沉细，反浮大而牢者死。吐血衄血，脉滑弱小者生，实大者
死。汗出若衄，其脉滑小者生，大躁者死。
呕血胸满引背，脉小而疾者逆也。（全文见诊生死。）
〔《素》〕脉至而搏，血衄身热者死。（大奇论）
〔仲〕吐血咳逆上气，其脉数而有热，不得卧者，死。
〔垣〕诸见血身热，脉大者，难治。难治者，邪胜也。身凉脉静者，易治，易治者，正气复也。
衄血者，若但头汗出，身无汗，及汗出不至足者死。
〔《素》〕咸走血，血病无多食咸。（宣明五气篇）
下气（指气向下泄出）属于心虚。经文说：夏季的脉象对应心脏，如果心脉虚弱无力，就会出现气向下泄出的症状，说的就是这种情况。
〔李东垣〕肠胃郁结，谷气在体内发散，但不能宣通于肠胃之外，所以容易嗳气或出现下气。
〔《脉经》〕癫痫、劳瘵等病，如果气向下泄出不止，必定死亡。这是因为真气枯竭断绝，肠胃腠理闭塞，谷气不能宣通于肠胃之外，所以从肠胃中泄出。
〔张元素〕鼻出血出于肺，用犀角、升麻、栀子、黄芩、芍药、生地黄、紫参、丹参、阿胶等药物为主进行治疗。
咯血、唾血出于肾，用天门冬、麦门冬、贝母、知母、桔梗、百部、黄柏、远志、熟地黄等药物为主进行治疗。
如果有寒证，用干姜、肉桂等药物为主治疗。痰中带血出于脾，用葛根、黄芪、黄连、芍药、甘草、当归、沉香等药物为主治疗。呕血出于胃，实证用犀角地黄汤为主治疗，虚证用小建中汤加黄连为主治疗。
营气生病时，会出现寒热、少气，血液上下妄行。方剂见“寒热”条。
〔《黄帝内经·素问》〕黄帝问：有胸胁支撑胀满的人，进食受阻，发病时先闻到腥臊臭味，流出清稀液体，先唾血，四肢发冷，头晕目眩，时常大小便出血，这是什么病？怎么得的？岐伯说：这病名叫血枯。这是年轻时曾有大失血，或者醉酒后行房事，导致气竭肝伤，所以月经衰少甚至不来。黄帝问：怎么治疗？用什么方法？岐伯说：用四份乌贼骨，一份芦茹，两物混合，用雀卵做丸，如小豆大，每次五丸，饭后服用，用鲍鱼汁送服，以通利肠道及补益肝脏。（出自《腹中论》）
〔王好古〕各种见血证没有寒证，鼻出血、吐血、尿血，都属于热证。只要是血证患者，适宜服用生地黄散为主治疗。
生地黄、熟地黄、枸杞子、地骨皮、甘草、天门冬、黄芪、芍药、黄芩。
以上药材切碎，每取一两，加水一盏半，煎至一盏，去渣，温服。如果脉微细、身凉、恶风，每两药加桂枝半钱。
吐血者多有此证。
〔朱震亨〕龙脑鸡苏丸治疗上焦热，除烦解劳；清除肺热，治疗咳嗽鼻衄；血热惊悸；脾胃热导致的口甘吐血；肝胆热导致的流泪退场门苦；肾热导致的神志不定；上部酒毒、膈热消渴；下部血滞、五淋血崩等疾病。
薄荷（一斤）、麦冬（去心，二两）、甘草（一两半）、生地黄（六两）、黄芪、新蒲黄（炒）、阿胶（炒，二两）、黄连（一两）、人参（二两。以上均为粉末）、木通（二两）、银柴胡（二两，切碎，同木通用沸水浸泡一天一夜后绞取汁液）。
以上研为细末，用好蜜二斤，先煎一二沸，然后加入生地黄粉末，不停搅拌，不时加入木通、柴胡汁浸熬成膏，不要让火太急烧焦了。然后加入前面的药末和丸，如豌豆大。每次服用二十丸，白开水送下。虚劳虚烦，用栀子汤送下。肺热，用黄芩汤送下。心热，心悸恍惚，用人参汤送下。唾血、咳血、吐血、鼻血四种出血，用心去麦门冬汤送下。肝热，用防风汤送下。肾热，用黄柏汤送下。以上均在饭后临睡前服用。治疗五淋及妇人漏下，用车前子汤送下。痰嗽者，用生姜汤送下。茎中痛者，用蒲黄、滑石一钟水调下。气逆者，用橘皮汤送下。室女虚劳，寒热发作，用柴胡人参汤送下。
〔梅〕治疗吐血、下血，以及妇人漏下。用鸡苏茎叶，煎取汁液饮用。
〔朱震亨〕胸中聚集的残火，腹里积久的太阴之气，上下隔绝，脉络不通，阴阳不相交通。用苦热药以安定中焦，使辛热药运行于外，用甘温药升提，用辛润药降逆，将严肃变为春温，变凛冽为和气，通过发汗而痊愈。然而余毒土苴犹存，周身阳气调和尚未完全恢复，胸中微躁想喝凉饮，因吃冷物、服凉剂，阳气再次消退，余阴再次发作，脉象退小而弦细迟，激惹而为鼻出血、唾血的，有心肺受邪的情况；向下发展为便血、尿血的，有肝肾受邪的情况。三焦出血，血色紫暗不鲜亮，这是重沓寒湿，化毒凝泣水谷道路，浸渍而成。如果见到血证，不详查本源，就用凉药折损，变故就会产生。（阳证溢出鲜血，阴证下血如豚肝。）
上部出血，用黄芪桂枝汤、白芍当归汤。中部出血，用当归建中汤、增损胃风汤。下部出血，用芎归术附汤、桂附六合汤。如果三种血证在行阳二十五度时出现，用黄芪四君子汤为主治疗。如果三种血证在行阴二十五度时出现，用当归四逆加吴茱萸汤为主治疗。
〔罗天益〕血证。吐血、鼻出血、便血，其人阴虚阳走，脉象沉而散，外证虚寒无热象，适宜用乌金丸散止住。治法宜上用散，下用丸，次以木香理中汤加大七气汤，入川芎煎煮，调苏合香丸温服。
运气学说中，上下出血有四种情况：
一、曰热助心火甚而血涌沸也。经文说：岁火太过，炎暑流行，肺金受邪，百姓病血溢血泄。又说：少阳之复，火气内发，血溢血泄。王冰注解说：血从上七窍出为血溢，泄利便血为血泄，说的就是这种情况。
二曰寒攻心火虚而血逃亡也。经文说：太阳司天，寒淫所胜，血变于中，百姓病呕血血泄，鼽衄善悲。又说：
太阳在泉，寒淫所胜，百姓病血见是也。
三曰湿胜血亡。经文说：太阴在泉，湿淫所胜，百姓病血见是也。
四曰寒热凌犯血亡。经文说：少阴司天之政，水火寒热持于气交。热病生于上，冷病生于下，寒热凌犯而争于中，百姓病血溢血泄是也。
〔朱震亨〕血余散治疗血淋，兼治内崩吐血，舌上出血，小便出血。用乱发，皂角水洗净，晒干烧灰为末，每次二钱，用茅草根、车前草煎汤调下。《本草》说发灰能消瘀血，通关格，利水道，破癥瘕血衄。有人生血瘤，大如栗子。常被衣服擦破，则血出不止，用此血余灰敷之痊愈。
一人刀伤血流不止，用胎发灰敷之亦愈。
〔朱震亨〕九窍出血，用刺蓟一握绞汁，以酒半盏和服之。如无生者，捣干者为末，冷水调三钱。
舌上无故出血如线，用槐花炒研末，用手掺之。
〔《肘后备急方》〕舌上忽出血如簪孔者，香薷汁服一升，日三服。
〔朱震亨〕用发灰二钱，米醋二合调服，或敷舌上血出孔处。
文蛤散治疗热壅舌上出血如泉。
五倍子（洗）、白胶香、牡蛎粉（各等分）。
以上为末，每用少许，掺患处，或烧热铁烙孔上。
〔朱震亨〕治疗阴虚牙出鲜血，气郁用四物汤加牛膝、香附、生甘草、侧柏。
〔罗谦甫〕牙疼肿痒动摇，牙龈溃烂，宣露出血，口气等疾。
当归、藁本、地骨皮、防风、白芷、槐花、川芎、甘草（炙）、升麻、细辛（各等分）。
以上为细末，每用少许擦牙。痛甚者取三钱，水一盏半，黑豆半合，生姜三斤，煎至一盏，去渣热漱，冷吐之。
〔孙思邈〕治疗满口齿有血。枸杞根为末，煎汤，漱后吃。又治疗膈上吐血妙。
〔《衍义》〕齿缝中多出血，当以盐汤漱，又能益齿，走血之验也。
〔朱震亨〕齿痛龈出血。夜以盐浓敷龈上，有涎沥尽乃卧。涎出时叩齿勿住，十夜瘥。忌鱼肉热物。
〔《千金要方》〕浓煎竹叶汤，入盐少许，含之止，浓煎茶含漱，亦妙。
治疗牙血。用附米、白芷、大黄三物烧灰，以青盐和擦之。
〔《本草纲目》〕治疗一切牙疼风热，龈常出鲜血以至崩落，口臭不可近人者，宜服之。
大黄（米泔浸令软）、生地黄（大者薄切）。
以上两味现切。各用一片，二片合定，贴所患牙上，一夜即愈。未全可，则再如前法用，忌说话，恐引风毒津液渍痛处。
〔世传〕无故牙动，牙宣血出。香附米用姜汁浸一宿，晒干为末，漱口揩齿，令白且坚而不动，无血矣。又方，以杨梅树皮浓煎汤漱口勿咽，神妙。
〔《千金要方》〕治疗齿龈间津液出血不止，以矾石一两，烧，水三升，煮取一升，先拭齿，乃含之。
〔《衍义》〕有人病齿缝中血出，以纸捻蘸蟾酥少许，于血出处按之，立止。
〔《灵苑方》〕治疗虚气攻牙，齿痛血出，牙龈痒痛。骨碎补二两，细锉，炒令黑色，杵末，根据常盥漱后，揩齿龈下，良久吐之。临卧后咽之无妨。
〔朱震亨〕治疗耳中出血。以龙骨末吹入，即止。
病者汗出污衣，名曰汗血，皆由大喜伤心，喜则气散，血随气行。妇人产蓐有此证。治疗以莶草汁。
莶草（不拘多少，俗名葛勒蔓也。蔓生，叶似蓖麻而小薄，有细刺，花黄白，子如麻子。）
以上捣汁二升，醋二合和，空腹饮一盏，或煮浓饮。亦治疗淋沥尿血。
上述九窍血，舌血、牙血、汗血不愈，又应当于衄血、吐血条相参用之。
〔王好古〕鼻出血、吐血、下血、妇人下血不止：隐白穴（灸五分）
〔《济生拔萃》〕妇人经脉妄行，钻心胁疼，妄行于上则鼻出血，中则吐血，下则下血：哑门（针一分，治鼻出血）、巨阙（针一分，治吐血）、气海（灸五分，治崩血）、中极（补三分）、三阴交（灸五分）
〔张元素〕血溢上行，或唾、或呕、或吐，都是凶兆。如果变为下行，为恶利者，是顺证。血上行为逆，其治疗难。下行为顺，其治疗易。所以仲景说：蓄血症，下血者，应当自愈。意思相同。如果没有病的人，忽然下利者，其病进也。现在患血证，上行而复下行恶利者，其邪欲去，是知道吉也。
脉沉为在里，荣卫内结，胸满必吐血。
〔张仲景〕尺脉浮，目睛晕黄，衄未止，晕黄去，目睛慧了，知衄今止。病患面无血色，无寒热，脉沉弦者，衄也。浮弱，手按之绝者，下血。烦咳者，必吐血。心脉微涩，为血溢。（全文见诊，下同。）
肺脉滑甚，为唾血。肺脉微滑，为上下出血。
〔张仲景〕脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此名曰革，妇人则半产漏下，男子则亡血失精。
〔《黄帝内经·素问》〕脱血而脉实者，难治。（玉机真藏论）
衄而不止，脉大而逆也。（全文见诊生死。）
〔《难经》〕病若吐血，复鼽衄，脉当沉细，反浮大而牢者死。吐血衄血，脉滑弱小者生，实大者死。汗出若衄，其脉滑小者生，大躁者死。
呕血胸满引背，脉小而疾者逆也。（全文见诊生死。）
〔张元素〕诸见血身热，脉大者，难治。难治者，邪胜也。身凉脉静者，易治，易治者，正气复也。
衄血者，若但头汗出，身无汗，及汗出不至足者死。
Lower Qi (referring to the downward leakage of Qi) belongs to Heart Deficiency. The Classic states: "The summer pulse corresponds to the Heart; if the Heart pulse is insufficient, it manifests as Qi leaking downwards," which refers to this condition.
[Li Dongyuan] When the intestines and stomach are stagnant and knotted, Grain Qi (Gu Qi) emanates internally but cannot be distributed beyond the intestines and stomach, thus leading to frequent belching or lower Qi.
[Zhen Jing] In conditions such as epilepsy and consumptive disease, if Qi leaks downwards ceaselessly, death is inevitable. This occurs because the True Qi (Zhen Qi) is exhausted and severed, the pores and interstices of the intestines and stomach are blocked, and Grain Qi cannot circulate outside the intestines and stomach, causing it to leak out from within.
[Zhang Yuansu] Epistaxis originates from the Lung; treatment is primarily with Rhinoceros Horn (Xijiao), Cimicifugae Rhizoma (Shengma), Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Paeoniae Radix (Shaoyao), Rehmanniae Radix Recens (Shengdihuang), Polygoni Multiflori Caulis (Zican), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), and Eclipticae Herba (Ejiao).
Blood in sputum or saliva originates from the Kidney; treatment is primarily with Asparagi Radix (Tianmendong), Ophiopogonis Radix (Maimendong), Fritillariae Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Platycodonis Radix (Jiegeng), Stemona Radix (Baibu), Phellodendri Cortex (Huangbai), Polygalae Radix (Yuanzhi), and Rehmanniae Radix Preparata (Shudihuang).
If there is Cold, treatment is primarily with Zingiberis Rhizoma (Ganjiang) and Cinnamomi Ramulus (Rougui).
Blood mixed with phlegm and saliva originates from the Spleen; treatment is primarily with Puerariae Radix (Gegen), Astragali Radix (Huangqi), Coptidis Rhizoma (Huanglian), Paeoniae Radix (Shaoyao), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Danggui), and Aquilariae Lignum Resinatum (Chenxiang).
Vomiting blood originates from the Stomach; for Excess patterns, Xijiao Dihuang Tang (Rhino-horn and Rehmannia Decoction) is used primarily; for Deficiency patterns, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) added with Huanglian is used primarily.
When Ying Qi (Nutritive Qi) becomes diseased, symptoms include alternating chills and fever, shortness of breath, and blood moving up and down irregularly. See the section on "Alternating Chills and Fever" for the formula.
[Huangdi Neijing Suwen] The Yellow Emperor asked: There is a person with fullness and distension in the chest and hypochondrium, obstructed eating; upon onset, they first smell a fishy and foul odor, discharge clear fluid, expectorate blood, have cold limbs, dizziness, and frequent bleeding from both bowels and bladder. What is this disease? How is it contracted? Qibo replied: This disease is named Blood Depletion (Xueku). It arises from significant blood loss in youth, or sexual intercourse while intoxicated, leading to Qi exhaustion and Liver injury, resulting in scanty or absent menstruation. The Yellow Emperor asked: How should it be treated? What method should be used? Qibo replied: Use four parts of Sepiae Endoconcha (Wumeigujing) and one part of Rubia Cordifolia Root (Luru). Combine these two substances, form pills using quail eggs, sized like small beans. Take five pills after meals, washed down with Mytilus edulis juice (Baoyu zhi), to benefit the intestines and nourish the Liver. (From "Abdominal Discussions")
[Wang Haogu] All bleeding disorders without Cold belong to Heat. Epistaxis, hematemesis, and hematuria all belong to Heat. For patients with blood disorders, Shengdi Huang San (Rehmannia Powder) is suitable as the primary treatment.
Rehmanniae Radix Recens, Rehmanniae Radix Preparata, Lycii Fructus, Lycii Cortex (Digupi), Glycyrrhizae Radix et Rhizoma, Asparagi Radix, Astragali Radix, Paeoniae Radix, Scutellariae Radix.
Cut the above herbs finely. For every 1 liang, add 1.5 cups of water, decoct to 1 cup, remove dregs, and take warm. If the pulse is faint, body is cool, and there is aversion to wind, add 0.5 qian of Cinnamomi Ramulus per liang of herbs.
Patients with hematemesis often present this syndrome.
[Zhu Zhenheng] Longnao Jisu Wan (Borneol and Mentha Pill) treats Upper Jiao Heat, relieves vexation and fatigue; clears Lung Heat, treating cough and epistaxis; treats blood heat with palpitations and fright; treats Stomach-Spleen Heat causing sweet taste in mouth and hematemesis; treats Liver-Gallbladder Heat causing tearing and bitter taste at the anus; treats Kidney Heat causing unsettled spirit and mind; treats upper alcohol toxicity, diaphragmatic heat, and thirst; treats lower blood stasis, five types of strangury, and uterine bleeding.
Menthae Haplocalycis Herba (Bohe, 1 jin), Ophiopogonis Radix (Maidong, quxin, 2 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 1.5 liang), Rehmanniae Radix Recens (Shengdi, 6 liang), Astragali Radix (Huangqi), fresh Polygoni Cuspidati Rhizoma et Radix (Puhuang, stir-fried), Colla Corii Asini (Ejiao, stir-fried, 2 liang), Coptidis Rhizoma (Huanglian, 1 liang), Ginseng Radix et Rhizoma (Renshen, 2 liang. All above powdered), Akebiae Caulis (Mutong, 2 liang), Bupleuri Radix Chaihu (Yin Chaihu, 2 liang, cut, soaked in boiling water with Mutong for one day and night, then pressed for juice).
Grind the above into fine powder. Use 2 jin of good honey, boil briefly, then add the Shengdi powder, stirring constantly. Periodically add Mutong and Chaihu juice, simmer into a paste, avoiding high heat to prevent burning. Then mix with the herb powders and form pills the size of peas. Take 20 pills each time, washed down with plain boiled water. For deficiency consumption with internal vexation, wash down with Zhizi Tang (Gardenia Decoction). For Lung Heat, wash down with Huangqin Tang (Scutellaria Decoction). For Heart Heat with palpitations and confusion, wash down with Renshen Tang (Ginseng Decoction). For the four types of blood (saliva, cough, vomit, nose), wash down with Maimendong Tang (Ophiopogon Decoction, heart removed). For Liver Heat, wash down with Fangfeng Tang (Saposhnikovia Decoction). For Kidney Heat, wash down with Huangbai Tang (Phellodendron Decoction). Take all above after meals and before bed. For five stranguries and uterine dripping, wash down with Cheqianzi Tang (Plantago Seed Decoction). For phlegm-cough, wash down with Shengjiang Tang (Fresh Ginger Decoction). For pain in the urethra, mix Puhuang and Talcum (Huashi) with one cup of water and take. For rebellious Qi, wash down with Jupi Tang (Citrus Peel Decoction). For virgin women with deficiency consumption and alternating chills/fever, wash down with Chaihu Renshen Tang (Bupleurum and Ginseng Decoction).
[Mei] Treats hematemesis, lower bleeding, and uterine dripping in women. Use stems and leaves of Mentha Arvensis (Jisu), decoct and drink the juice.
[Zhu Zhenheng] Residual fire accumulates in the chest; ancient Taiyin (Cold/Damp) stagnates in the abdomen. Upper and lower are separated, meridians are blocked, Yin and Yang do not communicate. Use bitter-hot herbs to stabilize the middle, and acrid-hot herbs to move externally. Ascend with sweet-warm, descend with acrid-moist. Transform severity into spring warmth, change biting cold into harmonious Qi. Cure through sweating. However, residual toxins remain, and whole-body Yang harmony is not yet complete. The chest feels slightly restless, desiring cool drinks. Due to eating cold food or taking cooling formulas, Yang Qi dissipates again, residual Yin reactivates. The pulse retreats, becoming small, wiry, thin, and slow. Provoked, this leads to epistaxis or bloody sputum, indicating pathogen affecting Heart and Lung. Downward, it leads to hematochezia or hematuria, indicating pathogen affecting Kidney and Liver. Bleeding from the Triple Burner presents with dark, dull blood color, caused by heavy damp-cold transforming into toxin, coagulating the pathways of grain and water, leading to infiltration. If bleeding disorders are seen without investigating the root cause, and cooling/astringent methods are used prematurely, complications will arise. (Yang syndromes overflow with bright red blood; Yin syndromes pass blood resembling pig liver.)
For upper bleeding, use Huangqi Guizhi Tang (Astragalus and Cinnamon Twig Decoction) or Baishao Danggui Tang (White Peony and Angelica Decoction). For middle bleeding, use Danggui Jianzhong Tang (Angelica Construct the Middle Decoction) or Zengsun Weifeng Tang (Modified Stomach Wind Decoction). For lower bleeding, use Xiong Gui Shu Fu Tang (Ligusticum, Angelica, Atractylodes, and Aconite Decoction) or Gui Fu Liuhe Tang (Cinnamon and Aconite Six-Harmony Decoction). If the three blood syndromes appear during the 25 degrees of Yang circulation, use Huangqi Sijunzi Tang (Astragalus and Four Gentlemen Decoction). If they appear during the 25 degrees of Yin circulation, use Danggui Sini Tang plus Wuzhuyu (Angelica Decoction for Cold-Reversal plus Evodia).
[Luo Tianyi] Blood syndromes. Hematemesis, epistaxis, hematochezia: the patient has Yin deficiency with Yang wandering, pulse is deep and scattered, external signs show deficiency-cold without heat. Use Wu Jin Wan San (Black Gold Pill Powder) to stop it. Method: Use powder above, pill below, followed by Muxiang Lizhong Tang plus Da Qi Qi Tang, decocted with Chuanxiong, and taken with Suhexiang Wan (Styrax Pill) to warm.
In the theory of Climate Factors (Yunqi), upper and lower bleeding has four types:
1. Heat assists Heart Fire excessively, causing blood to surge and boil. The Classic says: "When Year Fire is excessive, hot summers prevail, Lung Metal is attacked, people suffer from blood overflow and leakage." Also: "When Shaoyang returns, Fire Qi erupts internally, causing blood overflow and leakage." Wang Bing's commentary states: Blood flowing from the seven orifices upwards is blood overflow; diarrhea with bloody stool is blood leakage.
2. Cold attacks Heart Fire deficiency, causing blood to flee. The Classic says: "When Taiyang governs the year, Cold prevails, blood changes inside, people suffer from vomiting blood, bloody diarrhea, nasal congestion, epistaxis, and sadness." Also: "When Taiyang governs the interior, Cold prevails, people suffer from blood manifestations."
3. Dampness excess causes blood loss. The Classic says: "When Taiyin governs the interior, Dampness prevails, people suffer from blood manifestations."
4. Cold and Heat invade, causing blood loss. The Classic says: "When Shaoyin governs the year's administration, Water and Fire, Cold and Heat contend at the Qi intersection. Heat diseases arise above, cold diseases arise below, Cold and Heat clash in the middle, people suffer from blood overflow and leakage."
[Zhu Zhenheng] Xuyou San (Hair Ash Powder) treats bloody strangury, also treats internal collapse with hematemesis, bleeding from the tongue, and hematuria. Use disordered hair, wash clean with Gleditsia Sinensis fruit water, dry, burn to ash, and powder. Take 2 qian each time, mixed with decoction of Imperatae Rhizoma (Maogen) and Plantaginis Herba (Cheqiancao). Bencao states that hair ash eliminates blood stasis, opens blockages, benefits the water passages, and breaks masses and epistaxis. One person had a blood tumor the size of a chestnut. It was often rubbed open by clothes, causing continuous bleeding; applying this hair ash cured it. Another person with a knife wound had continuous bleeding; applying fetal hair ash also cured it.
[Zhu Zhenheng] Sun Simiao's Formula for Bleeding from Nine Orifices. Crush fresh Artemisia argyi leaves (Jingye), extract juice, mix with wine and take.
[Zhu Zhenheng] For bleeding from nine orifices, take one handful of Cirsium japonicum (Ciji), press for juice, mix with half a cup of wine and take. If fresh is unavailable, dry it, powder it, and mix 3 qian with cold water.
If blood flows from the tongue like a thread for no reason, stir-fry Sophorae Flavescentis Flos (Huaihua), grind to powder, and apply with hand.
[Jiubehouji Fang] If blood suddenly flows from the tongue like a needle hole, take 1 sheng of Elsholtziae Spica (Xiangru) juice, three times a day.
[Zhu Zhenheng] Mix 2 qian of hair ash with 2 he of rice vinegar and take, or apply to the bleeding hole on the tongue.
Wenge San (Clam Shell Powder) treats heat obstruction causing tongue bleeding like a spring.
Forsythiae Fructus (Wubeizi, washed), Colophonium (Baijiaoxiang), Ostreae Concha (Muli fen) in equal parts.
Powder the above. Apply a small amount to the affected area, or apply with a heated iron cauterizing the hole.
[Zhu Zhenheng] To treat Yin deficiency causing gums to bleed bright red, or Qi stagnation, use Siwu Tang added with Achyranthis Bidentatae Radix (Niuxi), Cyperi Rhizoma (Xiangfu), raw Glycyrrhizae Radix et Rhizoma, and Platycladi Cacumen (Cebai).
[Luo Qianfu] Toothache, swelling, itching, loosening, gum ulceration, exposure and bleeding, bad breath, etc.
Angelicae Sinensis Radix, Ligustici Chuanxiong Rhizoma, Albiziae Cortex (Ben), Lycii Cortex, Saposhnikoviae Radix, Angelicae Dahuricae Radix, Sophorae Flavescentis Flos, Chuanxiong, Glycyrrhizae Radix et Rhizoma (roasted), Cimicifugae Rhizoma, Asari Radix et Rhizoma (equal parts).
Grind to fine powder. Apply a small amount to teeth. For severe pain, take 3 qian, add 1.5 cups of water, half he of soybeans, 3 jin of fresh ginger, decoct to 1 cup, remove dregs, gargle hot, and spit out when cool.
[Sun Simiao] Treats blood in all teeth. Grind Lycii Radicis Cortex (Gouqigen) to powder, decoct in water, gargle then swallow. Also excellent for epigastric hematemesis.
[Yanyi] When many bleeds occur from tooth gaps, rinse with salt water. This also benefits teeth, verifying the movement of blood.
[Zhu Zhenheng] Toothache and gum bleeding. At night, apply thick salt paste to gums. Wait until saliva drains completely before sleeping. While saliva comes out, keep clicking teeth without stopping. Cured in ten nights. Avoid fish, meat, and hot foods.
[Jiubehouji Fang] If bleeding between teeth does not stop, soak Phyllostachys nigra bamboo sheath (Kuzhuru) in vinegar overnight and hold in mouth.
[Qianjin Yaofang] Strongly decoct Bambusae Folium (Zhuye) Tang, add a little salt, hold in mouth to stop. Strongly decoct tea and gargle, also effective.
To treat dental bleeding. Burn Ligusticum striatum (Fumi), Angelicae Dahuricae Radix, and Rheum Palmatum (Dahuang) to ash. Mix with green salt and rub.
[Bencao Gangmu] Treats all toothaches due to wind-heat, gums frequently bleeding until falling out, bad breath making others avoid the person. Take this.
Rhei Radix et Rhizoma (soaked in rice water until soft), Rehmanniae Radix Recens (large, thinly sliced).
Slice the above two ingredients freshly. Take one slice of each, bind them together, and apply to the affected tooth overnight. Cured. If not fully cured, repeat. Avoid speaking, lest wind-toxin and fluids infiltrate the painful area.
[Worldly Transmission] For spontaneous tooth mobility and gingival bleeding. Soak Cyperi Rhizoma (Xiangfum) in ginger juice overnight, dry, powder. Rinse mouth and rub teeth until white, firm, and immobile, stopping bleeding. Another method: Strongly decoct Myrica rubra bark (Yangmei shupi) for rinsing, do not swallow. Divine and miraculous.
[Qianjin Yaofang] For continuous bleeding of fluid-blood from gums. Calcine 1 liang of Alumen (Fanshi), boil in 3 sheng of water to obtain 1 sheng. Wipe teeth first, then hold in mouth.
[Yanyi] Someone with bleeding from tooth gaps. Dip a paper twist in a little Chan Su (Toad Venom), press on the bleeding spot, stops immediately.
[Lingyuan Fang] Treats deficient Qi attacking teeth, toothache with bleeding, itchy/painful gums. Drynariae Rhizoma (Gusuibu) 2 liang, finely cut, stir-fry until black, pound to powder. After usual washing/rinsing, rub under gums, wait long, then spit. Safe to swallow before bed.
[Zhu Zhenheng] Treats ear bleeding. Blow Longgu (Dragon Bone) powder into ear, stops immediately.
Patient sweats staining clothes, named Hanxue (Sweat Blood). All caused by extreme joy injuring Heart; joy disperses Qi, blood follows Qi. Women postpartum may have this syndrome. Treat with Xi Cao (Siegesbeckiae Herba) juice.
Xi Cao (any amount, commonly known as Geleman. Vining, leaves similar to castor bean but smaller/thinner, with fine thorns, yellow-white flowers, seeds like sesame).
Crush to obtain 2 sheng juice, mix with 2 he of vinegar. Drink 1 cup on empty stomach, or decoct strongly and drink. Also treats dribbling hematuria.
If the above nine-orifice bleeds (tongue, teeth, sweat) do not heal, refer to the sections on epistaxis and hematemesis for combined treatment.
[Wang Haogu] Epistaxis, hematemesis, lower bleeding, continuous uterine bleeding in women: Moxibustion Yinbai (5 fen).
[Li Dong] Another method: Moxibustion Yinbai, Daling, Shenmen (each 5 fen); Taixi (7 fen).
[Jisheng Babui] Women with irregular menstruation, piercing hypochondriac pain. Upward irregular flow causes epistaxis, middle causes hematemesis, lower causes lower bleeding: Needling Yamenh (1 fen, for epistaxis), Juque (1 fen, for hematemesis), Qihai (5 fen moxa, for metrorrhagia), Zhongji (tonify 3 fen), Sanyinjiao (5 fen moxa).
[Zhu Zhenheng] Blood syndromes and Jaundice syndromes both present with head sweating.
[Zhang Yuansu] Blood overflowing upwards, whether expectorated, vomited, or spat, is ominous. If it changes to flow downwards, it is favorable. Upward flow is adverse, difficult to treat. Downward flow is favorable, easy to treat. Thus Zhongjing said: In Blood Accumulation syndrome, if blood exits downwards, it should heal itself. The meaning is the same. If a healthy person suddenly has diarrhea, the disease progresses. Now, a blood syndrome patient who moves upward then downward favorably indicates the pathogen is leaving, which is auspicious.
Deep pulse indicates interior location; Ying and Wei knot internally, chest fullness必然 leads to hematemesis.
[Zhang Zhongjing] Floating pulse at Chi position, halo around eyes, epistaxis not stopped. When halo disappears and eyes become clear, know epistaxis has stopped. Patient with pale face, no chills/fever, deep-wiry pulse, has epistaxis. Floating-weak pulse, disappearing on pressure, indicates lower bleeding. Irritable cough必然 leads to hematemesis. Heart pulse slightly choppy indicates blood overflow. (Full text see Diagnosis, same below.)
Lung pulse slippery-excessive indicates bloody sputum. Lung pulse slightly slippery indicates upper and lower bleeding.
[Zhang Zhongjing] Pulse wiry and large. Wiry indicates decline, large indicates hollow. Decline indicates Cold, hollow indicates Deficiency. Deficiency and Cold combine, named Ge (Leather) pulse. In women, it causes miscarriage and dripping; in men, blood loss and essence loss.
[Huangdi Neijing Suwen] Blood depletion with Excess pulse is difficult to treat. (Yuji Zhenzang Lun)
Epistaxis not stopping, with large and adverse pulse. (Full text see Diagnosis of Life/Death.)
[Nanjing] If patient has hematemesis and recurrent epistaxis, pulse should be deep and fine; if contrary floating-large and firm, death. Hematemesis/epistaxis with slippery-small-weak pulse lives, Excess-large pulse dies. Sweating with epistaxis, slippery-small pulse lives, large-restless pulse dies.
Hematemesis with chest fullness radiating to back, small-rapid pulse is adverse. (Full text see Diagnosis of Life/Death.)
[Huangdi Neijing Suwen] Pulse beating violently, with epistaxis and body heat, dies. (Daqi Lun)
[Zhang Zhongjing] Hematemesis with coughing/rebellious Qi, rapid pulse with heat, inability to lie down, dies.
[Zhang Yuansu] All bleeding with body heat and large pulse is difficult to treat. Difficult means pathogen wins. Cool body and quiet pulse is easy to treat, easy means righteous Qi recovers.
For epistaxis, if only head sweats, body has no sweat, or sweat does not reach feet, dies.
[Huangdi Neijing Suwen] Salty flavor enters Blood. For blood diseases, do not eat much salty. (Xuanming Wuqi Pian)