《内经》厥论篇谓“阳明厥逆衄呕血”，此阳明指胃腑而言
也。盖胃腑以熟腐水谷，传送饮食为职，其中气化，原以息息下
行为顺。乃有时不下行而上逆，胃中之血亦恒随之上逆。其上逆之极，可将胃壁之膜排挤破裂，而成呕血
之证；或循阳明之经络上行，而成衄血之证。是以《内经》谓阳明厥逆衄呕血也。由此知∶无论其证之或虚
或实，或凉或热，治之者，皆当以降胃之品为主。而降胃之最有力者，莫赭石若也，故愚治吐衄之证，方中
皆重用赭石，再细审其胃气不降之所以然，而各以相当之药品辅之。兹爰将所用之方，详列于下。
【平胃寒降汤】治吐衄证脉象洪滑重按甚实者，此因热而胃气不降也。
生赭石（一两轧细） 栝蒌仁（一两炒捣） 生杭芍（八钱） 嫩竹茹（三钱细末） 牛蒡子
（三钱捣碎） 甘草（钱半）
此拙拟寒降汤，而略有加减也。服后血仍不止者，可加生地黄一两，三七细末三钱（分两次用头煎二煎之汤送服）。
吐衄之证，忌重用凉药及药炭强止其血。因吐衄之时，血不归经，遽止以凉药及药炭，则经络瘀塞，血
止之后，转成血痹虚劳之证。是以方中加生地黄一两，即加三七之善止血兼善化瘀血者以辅之也。
【健胃温降汤】治吐衄证脉象虚濡迟弱，饮食停滞胃口，不能下行，此因凉而胃气不降也。
生赭石（八钱轧细） 生怀山药（六钱） 白术（四钱炒） 干姜（三钱）
清半夏（三钱温水淘净矾味） 生杭芍（二钱） 浓朴（钱半）
此方原名温降汤，兹则于其分量略有加减也。方中犹用芍药者，防肝中所寄之相火不受干姜之温热也。
吐衄之证因凉者极少，愚临证四十余年，仅遇两童子，一因
凉致胃气不降吐血，一因凉致胃气不降衄血，皆用温降汤治愈，
其详案皆载原方之后，可参观。
【泻肝降胃汤】治吐衄证左脉弦长有力，或肋下胀满作疼，
或频作呃逆，此肝胆之气火上冲胃腑，致胃气不降而吐衄也。
生赭石（八钱捣细） 生杭芍（一两） 生石决明（六钱捣细） 栝蒌仁（四钱炒捣）
甘草（四钱） 龙胆草（二钱） 净青黛（二钱）
此方因病之原因在胆火肝气上冲，故重用芍药、石决明及龙
胆、青黛诸药，以凉之、镇之。至甘草多用至四钱者，取其能缓肝之急，兼以防诸寒凉之药伤脾胃也。
【镇冲降胃汤】治吐衄证右脉弦长有力，时觉有气起在下
焦，上冲胃腑，饮食停滞不下，或频作呃逆，此冲气上冲，以致胃不降而吐衄也。
生赭石（一两轧细） 生怀山药（一两） 生龙骨（八钱捣细） 生牡蛎（八钱捣细）
生杭芍（三钱） 甘草（二钱） 广三七（细末二钱分两次用头煎二煎之汤送服）
方中龙骨、牡蛎，不但取其能敛冲，且又能镇肝，因冲气上冲之由，恒与肝气有关系也。
【滋阴清降汤】治吐衄证失血过多，阴分亏损，不能潜阳而作热，不能纳气而作喘，甚或冲气因虚
上干，为呃逆、眩晕、咳嗽，心血因不能内荣，为怔忡、惊悸、不寐，脉象浮数重按无力者。
生赭石（八钱轧细） 生怀山药（一两） 生地黄（八钱） 生龙骨（六钱捣细）
生牡蛎（六钱捣细） 生杭芍（四钱） 甘草（二钱） 广三七（细末二钱分两次用头煎二煎之汤送服）
此方即清降汤，加龙骨、牡蛎、地黄、三七也。原方所主之
病，原与此方无异，而加此数味治此病尤有把握。此因临证既多，屡次用之皆验，故于原方有所增加也。
【保元清降汤】治吐衄证血脱气亦随脱，言语若不接续，动则作喘，脉象浮弦，重按无力者。
生赭石（一两轧细） 野台参（五钱） 生地黄（一两） 生怀山药（八钱） 净萸肉（八钱） 生
龙骨（六钱捣细） 生杭芍（四钱） 广三七（细末三钱分两次用头煎二煎之汤送服）
此方曾载吐衄门，而兹则略有加减也。
【保元寒降汤】治吐衄证血脱气亦随脱，喘促咳逆，心中烦热，其脉上盛下虚者。
生赭石（一两轧细） 野台参（五钱） 生地黄（一两） 知母（八钱） 净萸肉（八钱） 生龙骨（六
钱捣细） 生牡蛎（六钱捣细） 生杭芍（四钱） 广三七（细末三钱捣分两次用头煎二煎药汤送服）
此方亦载于吐衄门中，而兹则略有更改也。至于医方所载此二方之原方，非不可用，宜彼宜此之间，细
为斟酌可也。
上所列诸方，用之与病因相当，大抵皆能奏效。然病机之呈露多端，病因即随之各异，临证既久，所治
愈吐衄之验案，间有不用上列诸方者，如拙拟秘红丹及补络补管汤等方后各案，可互相参观。
吐衄证最忌黄 、升、柴、桔梗诸药，恐其能助气上升血亦
随之上升也。若确知病系宗气下陷，可以放胆用之，然必佐以龙骨、牡蛎，以固血之本源，始无血随气升之虞也。
然吐衄证之因宗气下陷者极少，愚临证四十余年，仅遇赵姓一人，再四斟酌，投以升陷汤加龙骨、牡蛎
治愈，然此方实不可轻试也。近津沽有张姓，年过三旬，患吐血证，医者方中有柴胡二钱，服后遂大吐不止。
仓猝迎愚诊视，其脉弦长有力，心中发热，知系胃气因热不降也。所携药囊中，有生赭石细末约两余，
俾急用水送服强半。候约十二分钟，觉心中和平，又送服其余，其吐顿止。继用平胃寒降汤调之，全愈。是知
同一吐血证也，有时用柴胡而愈，有时用柴胡几至误人性命，审证时岂可不细心哉。
至于妇女倒经之证，每至行经之期，其血不下行而上逆作吐衄者，宜治以四物汤去川芎，加怀牛膝、
生赭石细末，先期连服数剂可愈。然其证亦间有因气陷者，临证时又宜细察。曾治一室女吐血，及一少妇
衄血，皆系倒行经证，其脉皆微弱无力，气短不足以息，少腹时有气下坠，皆治以他止血之药不效，后再三斟
酌，皆投以升陷汤，先期连服，数日全愈。总之，吐衄之证，大抵皆因热而气逆，其因凉气逆者极少，即兼
冲气肝气冲逆，亦皆挟热，若至因气下陷致吐衄者，不过千中之一二耳。
天津赵××，年近三旬，病吐血，经医治愈，而饮食之间若稍食硬物，或所食过饱，病即反复。诊其
六脉和平，重按似有不足，知其脾胃消化弱，其胃中出血之处，所生肌肉犹未撤消，是以被食物撑挤，因
伤其处而复出血也。斯当健其脾胃，补其伤处，吐血之病庶可除根。为疏方用生山药、赤石脂各八钱， 龙
骨、 牡蛎、净萸肉各五钱，白术、生明没药各三钱，天花粉、甘草各二钱。按此方加减，服之旬余，病遂
除根。此方中重用石脂者，因治吐衄病凡其大便不实者，可用之以代赭石降胃。盖赭石能降胃而兼能通大便，
赤石脂亦能降胃而转能固大便，且其性善保护肠胃之膜，而有生肌之效，使胃膜因出血而伤者可速愈也。
或问∶方书治吐衄之方甚多，今详论吐衄治法，皆系自拟，岂治吐衄成方皆无可取乎？答曰∶非也。
《金匮》治吐衄有泻心汤，其方以大黄为主，直入阳明，以降胃气，佐以黄芩，以清肺
金之热，俾其清肃之气下行，以助阳明之降力，黄连以清心火之
热，俾其亢阳默化潜伏，以保少阴之真液，是泻之适所以补之也。凡因热气逆吐衄者，至极危险之时用之，
皆可立止。血止以后，然后细审其病因，徐为调补未晚也。然因方中重用大黄，吐衄者皆不敢轻服，则良方
竟见埋没矣。不知大黄与黄连并用，但能降胃，不能通肠，虽吐衄至身形极虚，服后断无泄泻下脱之
弊。乃素遇吐衄证，曾开此方两次，病家皆不敢服，遂不得已另拟平胃寒降汤代之，此所以委曲以行其救
人之术也。
《金匮》有柏叶汤方，为治因寒气逆以致吐血者之良方也。故其方中用干姜、艾叶以暖胃，用马通
汁以降胃，然又虑姜、艾之辛热，宜于脾胃，不宜于肝胆，恐服药之后，肝胆所寄之相火妄动，故又用柏叶
之善于镇肝且善于凉肝者以辅之。此所谓有节制之师，先自立于不败之地，而后能克敌致胜也。至后世薛立斋
谓，因寒吐血者，宜治以理中汤加当归，但知暖胃，不知降胃，并不知镇肝凉肝，其方远逊于柏叶汤矣。
然此时有喜服西药，恒讥中药为不洁，若杂以马通汁，将益嫌其不洁矣，是以愚另拟健胃温降汤以代之也。
近时医者治吐衄，喜用济生犀角地黄汤。然其方原治伤寒胃火热盛以致吐血、衄血之方，无外感而吐
衄者用之，未免失于寒凉，其血若因寒凉而骤止，转成血痹虚劳之病。至愚治寒温吐衄者，亦偶用其方，
然必以其方煎汤送服三七细末二钱，始不至血瘀为恙。若其脉左右皆洪实者，又宜加羚羊角二钱，以泻肝胆之
热，则血始能止。
至葛可久之十灰散，经陈修园为之疏解，治吐衄者亦多用之。夫以药炭止血，原为吐衄者所甚忌，
犹幸其杂有大黄炭（方下注灰存性即是炭），其降胃开瘀之力犹存，为差强人意耳。其方遇吐
衄之轻者，或亦能奏效，而愚于其方，实未尝一用也。至于治吐衄便方，有用其吐衄之血 作炭服者，
有用发 （即剃下之短发） 作炭
服者，此二种炭皆有化瘀生新之力，而善止血，胜于诸药之炭但能止血而不能化瘀血以生新血者远矣。
方书有谓血脱者，当先益其气，宜治以独参汤。然血脱须有分别，若其血自二便下脱，其脉且微弱无
力者，独参汤原可用。若血因吐衄而脱者，纵脉象微弱，亦不宜用。夫人身之阴阳原相维系，即人身之气血
相维系也。吐衄血者因阴血亏损，维系无力，原有孤阳浮越之虞，而复用独参汤以助其浮越，不但其气易上奔
（喻嘉言谓气虚欲脱者但服人参转令气高不返），血亦将随之上奔而复吐衄矣。是拙拟治吐
衄方中，凡用参者，必重用赭石辅之，使其力下达也。
寻常服食之物，亦有善止血者，鲜藕汁、鲜莱菔汁是也。曾见有吐衄不止者，用鲜藕自然汁一大盅温饮
之（勿令熟），或鲜莱菔自然汁一大盅温饮之，或二汁并饮之，皆可奏效。
有堂兄××，年五旬，得吐血证，延医治不效，脉象滑动，按之不实。时愚年少，不敢轻于疏方，遂
用鲜藕、鲜白茅根各四两，切碎，煎汤两大碗，徐徐当茶饮之，数日全愈。自言未饮此汤时，心若虚悬无着，
既饮之后，若以手按心还其本位，何其神妙如是哉！隔数日，又有邻村刘姓少年患吐血证，其脉象有力，心
中发热，遂用前方，又加鲜小蓟根四两，如前煮汤饮之，亦愈。因名前方为二鲜饮，后方为三鲜饮。
至于咳血之证，上所录医案中间或连带论及，实非专为咳血发也。因咳血原出于肺，其详细治法皆载
于治肺病方中，兹不赘。
《内经》的《厥论篇》中提到“阳明经气逆乱会导致鼻出血、呕吐血液”，这里的“阳明”指的是胃腑。因为胃腑的功能是熟腐水谷，传送饮食，其中的气化运动原本以不断向下运行作为顺常。然而有时不向下运行反而向上逆乱，胃中的血液也常常随之向上逆乱。其向上逆乱的极端情况，可以将胃壁的膜排挤破裂，从而形成呕吐血的证候；或者沿着阳明的经络上行，形成鼻出血的证候。因此《内经》说阳明经气逆乱会导致鼻出血和呕吐血。由此可知：无论这个证候是虚还是实，是寒还是热，治疗时都应当以降胃的药物为主。而在降胃药物中，最有力量的是代赭石，所以我治疗吐血、鼻出血的证候，在方剂中都重用代赭石，再仔细审察胃气不下降的原因，并分别用相应的药物辅助。现将所使用的方剂详细列举如下。
【平胃寒降汤】治疗吐血、鼻出血证候，脉象洪大滑利，重按非常坚实的，这是因热邪导致胃气不下降。
生代赭石（一两轧细） 瓜蒌仁（一两炒捣） 生白芍（八钱） 嫩竹茹（三钱研成细末） 牛蒡子（三钱捣碎） 甘草（一钱半）
这是我拟定的寒降汤，只是略有加减。服用后如果血仍然不止，可以加生地黄一两，三七细末三钱（分两次用头煎和二煎的药汤送服）。
对于吐血、鼻出血的证候，忌讳重用凉药及药炭强行止血。因为在吐血、鼻出血时，血液不归入经脉，如果立即用凉药及药炭强行止住，就会导致经络瘀塞，血止之后，反而转为血痹虚劳的证候。所以在方中加入生地黄一两，即加入三七这种善于止血兼善于化瘀血的药物来辅助它。
【健胃温降汤】治疗吐血、鼻出血证候，脉象虚弱濡软迟弱，饮食停滞在胃口，不能下行，这是因寒凉导致胃气不下降。
生代赭石（八钱轧细） 生怀山药（六钱） 白术（四钱炒） 干姜（三钱）
清半夏（三钱温水淘洗去矾味） 生白芍（二钱） 厚朴（一钱半）
这个方子原名温降汤，现在只是在分量上略有加减。方中仍使用芍药，是为了防止肝中所寄寓的相火受不了干姜的温热。
吐血、鼻出血的证候因寒凉的极少，我临证四十多年，仅遇到两个童子，一个因寒凉导致胃气不下降而吐血，一个因寒凉导致胃气不下降而鼻出血，都用温降汤治愈，详细的医案都记载在原方之后，可以参考。
【泻肝降胃汤】治疗吐血、鼻出血证候，左脉弦长有力，或者胁下胀满疼痛，或者频繁打呃逆，这是肝胆之气火上冲胃腑，导致胃气不下降而吐血、鼻出血。
生代赭石（八钱捣细） 生白芍（一两） 生石决明（六钱捣细） 瓜蒌仁（四钱炒捣）
甘草（四钱） 龙胆草（二钱） 净青黛（二钱）
这个方子是因为病因在于胆火肝气上冲，所以重用芍药、石决明以及龙胆、青黛等药物，来清凉它们、镇潜它们。至于甘草多用至四钱，是取它能缓解肝之急迫，同时防止各种寒凉药物伤害脾胃。
【镇冲降胃汤】治疗吐血、鼻出血证候，右脉弦长有力，时常觉得有气从下焦升起，上冲胃腑，饮食停滞不下，或者频繁打呃逆，这是冲脉之气上冲，导致胃不下降而吐血、鼻出血。
生代赭石（一两轧细） 生怀山药（一两） 生龙骨（八钱捣细） 生牡蛎（八钱捣细）
生白芍（三钱） 甘草（二钱） 广三七（细末二钱分两次用头煎二煎的药汤送服）
方中的龙骨、牡蛎，不仅取它们能收敛冲脉之气，而且又能镇潜肝气，因为冲气上冲的原因，常常与肝气有关系。
【滋阴清降汤】治疗吐血、鼻出血证候，失血过多，阴分亏损，不能潜藏阳气而发热，不能纳气而气喘，甚至冲脉之气因虚而上扰，导致呃逆、眩晕、咳嗽，心血因不能内荣，导致怔忡、惊悸、失眠，脉象浮数但重按无力。
生代赭石（八钱轧细） 生怀山药（一两） 生地黄（八钱） 生龙骨（六钱捣细）
生牡蛎（六钱捣细） 生白芍（四钱） 甘草（二钱） 广三七（细末二钱分两次用头煎二煎的药汤送服）
这个方子就是清降汤，加上龙骨、牡蛎、地黄、三七。原方所主治的病，本来与此方没有不同，而加上这几味药治疗此病更有把握。这是因为临证多了，屡次使用都有效，所以在原方有所增加。
【保元清降汤】治疗吐血、鼻出血证候，血脱气也随之脱失，言语好像接不上气，一动就气喘，脉象浮弦，重按无力。
生代赭石（一两轧细） 野台参（五钱） 生地黄（一两） 生怀山药（八钱） 净山茱萸肉（八钱） 生龙骨（六钱捣细） 生白芍（四钱） 广三七（细末三钱分两次用头煎二煎的药汤送服）
这个方子曾记载在吐血门中，现在只是略有加减。
【保元寒降汤】治疗吐血、鼻出血证候，血脱气也随之脱失，喘促咳逆，心中烦热，脉象上部盛下部虚。
生代赭石（一两轧细） 野台参（五钱） 生地黄（一两） 知母（八钱） 净山茱萸肉（八钱） 生龙骨（六钱捣细） 生牡蛎（六钱捣细） 生白芍（四钱） 广三七（细末三钱捣碎分两次用头煎二煎的药汤送服）
这个方子也记载在吐血门中，现在只是略有更改。至于医方中记载的这两个方子的原方，并非不可用，在适宜彼方或此方之间，仔细斟酌即可。
上面所列的各种方剂，如果使用与病因相当，大抵都能奏效。然而病机表现多种多样，病因也随之各异，临证久了，所治疗的吐血、鼻出血的有效医案中，偶尔也有不用上述方剂的，如我拟定的秘红丹及补络补管汤等方后的各医案，可以互相参考。
吐血、鼻出血的证候最忌讳黄芩、升麻、柴胡、桔梗等药物，恐怕它们能助长气上升，血液也随之上升。如果确切知道病是由于宗气下陷引起的，可以放心使用这些药，但必须佐以龙骨、牡蛎，以固护血的源头，才没有血随气升的忧虑。
然而吐血、鼻出血的证候因宗气下陷的极少，我临证四十多年，仅遇到赵姓一人，经过再三斟酌，投以升陷汤加龙骨、牡蛎治愈，但这个方子实在不可轻易尝试。最近天津有张姓人，年过三十，患吐血证，医生方中有柴胡二钱，服用后于是大吐不止。仓促迎接我诊视，他的脉弦长有力，心中发热，知道是胃气因热而不下降。他携带的药囊中生代赭石细末约有一两多，让他急忙用水送服大半。等候大约十二分钟，觉得心中平和，又送服剩下的，吐血立刻停止。接着用平胃寒降汤调理，完全痊愈。由此可知同样是吐血证，有时用柴胡而愈，有时用柴胡几乎误人性命，审察证候时怎么能不细心呢？
至于妇女倒经的证候，每逢行经期间，血液不向下行反而向上逆乱导致吐血、鼻出血，适宜用四物汤去掉川芎，加怀牛膝、生代赭石细末，提前连续服用几剂可以痊愈。然而这个证候间或有因气陷引起的，临证时又应该仔细察看。曾经治疗一个未婚女子吐血，和一个少妇鼻出血，都是倒行经证候，他们的脉都微弱无力，气短不足以呼吸，小腹时有气下坠的感觉，都用其他止血药无效，后来再三斟酌，都投以升陷汤，提前连续服用，数日痊愈。总之，吐血、鼻出血的证候，大抵都是因为热而气逆，因寒凉气逆的极少，即使兼有冲气肝气冲逆，也都挟带热邪，如果是因气下陷导致吐血、鼻出血的，不过千中一二罢了。
天津赵××，年龄近三十岁，患吐血病，经医生治愈，但在饮食方面如果稍微吃硬物，或者吃得过饱，病就会反复。诊察他的六脉和平，重按似乎有不足，知道他的脾胃消化力弱，他胃中出血的地方，新生的肌肉还没有消退，所以被食物撑挤，因而损伤那个地方再次出血。这时应当健运他的脾胃，修补损伤的地方，吐血的病才可以除根。为他开方用生山药、赤石脂各八钱，龙骨、牡蛎、净山茱萸肉各五钱，白术、生明没药各三钱，天花粉、甘草各二钱。按照这个方子加减，服用十几天，病就除根了。这个方中重用石脂，是因为治疗吐血、鼻出血病凡是大便不成形的，可以用它代替代赭石降胃。因为代赭石能降胃而兼能通大便，赤石脂也能降胃而反而能固涩大便，而且它的性质善于保护肠胃的膜，并有生肌的效果，使因出血而受伤的胃膜可以快速愈合。
有人问：医方书中治疗吐血、鼻出血的方子很多，现在详细论述吐血、鼻出血的治疗方法，都是自己拟定的，难道治疗吐血、鼻出血的成方都没有可取之处吗？回答说：不是这样的。《金匮要略》治疗吐血、鼻出血有泻心汤，这个方子以大黄为主药，直入阳明经，以降胃气，佐以黄芩，来清肺金的热，使清肃之气下行，以助阳明经的降力，黄连来清心火的熱，使亢盛的阳气默默转化潜伏，以保全少阴经的真液，这是泻法实际上就是补法。凡是因热气逆乱导致吐血、鼻出血的，到了极其危险的时候使用它，都可以立即停止。血止以后，然后仔细审察病因，慢慢调补也不晚。然而因为方中重用大黄，吐血、鼻出血的人都不敢轻易服用，那么良方竟然被埋没了。不知道大黄与黄连并用，只能降胃，不能通肠，虽然吐血、鼻出血导致身体极其虚弱，服用后绝对没有泄泻下脱的弊端。我曾经遇到吐血、鼻出血证候，曾开过这个方子两次，病家都不敢服用，于是不得已另拟平胃寒降汤替代，这就是我委曲婉转地施行救人的医术。
《金匮要略》有柏叶汤方，是治疗因寒气逆乱导致吐血的良方。所以方中使用干姜、艾叶来暖胃，用马通汁来降胃，但又担心姜、艾的辛热，适宜于脾胃，不适宜于肝胆，恐怕服药之后，肝胆所寄寓的相火妄动，所以又用柏叶这种善于镇肝且善于凉肝的药物来辅助它。这就是所谓的有节制的军队，先让自己立于不败之地，然后才能克敌致胜。至于后世薛立斋说，因寒吐血者，适宜用理中汤加当归治疗，只知道暖胃，不知道降胃，也不知道镇肝凉肝，他的方子远远不如柏叶汤。
然而此时有人喜欢服用西药，经常讥笑中药不干净，如果混杂马通汁，将更加嫌弃它不干净，所以我另外拟定健胃温降汤来替代它。
近时的医生治疗吐血、鼻出血，喜欢用济生犀角地黄汤。然而这个方子原本是治疗伤寒胃火热盛导致吐血、鼻出血的方子，没有外感而吐血、鼻出血的人使用它，未免失于寒凉，如果血液因寒凉而骤然停止，反而转为血痹虚劳的病。至于我治疗寒温病导致的吐血、鼻出血，也偶尔使用这个方子，但一定要用这个方子煎汤送服三七细末二钱，才不至于血瘀成为祸害。如果他的脉左右都洪实，又应该加羚羊角二钱，来泻肝胆的热，这样血才能停止。
至于葛可久的十灰散，经过陈修园为之疏解，治疗吐血、鼻出血的人也多用它。用药物烧成的炭来止血，本来是吐血、鼻出血的人非常忌讳的，幸好其中混杂有大黄炭（方下注灰存性就是炭），它降胃开瘀的力量还存在，算是勉强让人满意。这个方子遇到吐血、鼻出血较轻的，或许也能奏效，但我对于这个方子，实在从未使用过。至于治疗吐血、鼻出血的简便方，有用他们吐血、鼻出血的血烧成炭服用的，有用头发（即剃下的短发）烧成炭服用的，这两种炭都有化瘀生新的力量，而且善于止血，比那些诸药之炭只擅长止血而不能化瘀血以生新血的要好得多。
医方书中有说血脱的人，应当先益其气，适宜用独参汤治疗。然而血脱需要分别情况，如果血液从大小便下脱，脉象且微弱无力的，独参汤原来可以使用。如果血液因吐血、鼻出血而脱失的，纵然脉象微弱，也不宜使用。人身上的阴阳原本相互维系，也就是人身上的气血相互维系。吐血、鼻出血的人因为阴血亏损，维系无力，原有孤阳浮越的忧虑，而复用独参汤来助长其浮越，不但气容易上奔（喻嘉言说气虚欲脱的人只服人参反而会让气高不返），血也将随之上奔而再次吐血、鼻出血了。所以我拟定的治疗吐血、鼻出血的方子中，凡是用人参的，一定重用代赭石来辅助它，使药力下达。
寻常的食物中，也有善于止血的，鲜藕汁、鲜莱菔汁就是。曾经见过有吐血、鼻出血不止的人，用鲜藕自然汁一大盅温饮（不要煮熟），或者鲜莱菔自然汁一大盅温饮，或者两汁一起饮用，都可以奏效。
有个堂兄××，年龄五十岁，得吐血证，请医生治疗无效，脉象滑动，按之不实。当时我年轻，不敢轻易开方，就用鲜藕、鲜白茅根各四两，切碎，煎汤两大碗，慢慢当茶饮，几天就痊愈了。他自己说没喝这个汤之前，心里好像悬空无着落，喝了之后，好像用手按住心脏回到原位，多么神奇啊！过了几天，又有邻村刘姓少年患吐血证，他的脉象有力，心中发热，就用前面的方子，又加鲜小蓟根四两，像前面那样煮汤饮用，也痊愈了。因此把前面的方子命名为二鲜饮，后面的方子命名为三鲜饮。
至于咳血的证候，上面记录的医案中偶尔连带论及，其实并不是专为咳血发表的。因为咳血原本出于肺，其详细的治疗方法都记载在治疗肺病的方子中，这里不再赘述。
The *Jue Lun* (Treatise on Jue) chapter of the *Nei Jing* (Inner Canon) states that "Yangming Jue Ni (rebellious Qi in the Yangming channel) leads to epistaxis and hematemesis." Here, "Yangming" refers to the Stomach organ. The function of the Stomach is to ripen and rot food and drink, and transmit dietary intake; its Qi transformation naturally follows a downward movement as the normal course. However, sometimes it fails to move downward and instead rebels upward, causing blood within the Stomach to frequently rebel upward along with it. When this upward rebellion reaches an extreme, it can squeeze and rupture the mucous membrane of the gastric wall, resulting in the syndrome of hematemesis; or it may travel upward along the Yangming channels and collaterals, resulting in the syndrome of epistaxis. Therefore, the *Nei Jing* states that Yangming Jue Ni leads to epistaxis and hematemesis. From this, we know: regardless of whether the syndrome is deficiency or excess, cold or heat, treatment should primarily focus on using herbs that descend Stomach Qi. Among these, none are more powerful than Dai Zhe Shi (Hematitum). Thus, in my treatment of hematemesis and epistaxis, I heavily utilize Dai Zhe Shi in prescriptions, carefully examining the reasons for the failure of Stomach Qi to descend, and assisting with appropriate herbs accordingly. The prescriptions used are detailed below.
[Ping Wei Han Jiang Tang] Treats hematemesis and epistaxis syndromes where the pulse is surging, slippery, and very solid upon heavy pressure, indicating that Heat causes Stomach Qi to fail to descend.
Sheng Zhe Shi (Crassum Haematitum, one liang, finely crushed) Gua Lou Ren (Semen Trichosanthis, one liang, stir-fried and crushed) Sheng Bai Shao (Radix Paeoniae Alba, eight qian) Nen Zhu Ru (Caulis Bambusae in Taeniam, three qian, ground into fine powder) Niu Bang Zi (Fructus Arctii, three qian, crushed) Gan Cao (Radix Glycyrrhizae, one qian and half)
This is my proposed Han Jiang Tang, with slight modifications. If bleeding continues after ingestion, add Sheng Di Huang (Radix Rehmanniae Recens, one liang) and San Qi (Radix Notoginseng, three qian, fine powder), taken in two doses, washed down with decoctions from the first and second brews.
For hematemesis and epistaxis, it is contraindicated to heavily use cold-natured herbs or herbal charcoals to forcibly stop bleeding. During hematemesis and epistaxis, blood does not return to the vessels. If immediately stopped by cold herbs and charcoal, it leads to collateral stasis, and after bleeding stops, it may transform into Xue Bi (Blood Bi) and Xu Lao (Deficiency Consumption) syndromes. Therefore, adding Sheng Di Huang in the prescription is assisted by San Qi, which is good at stopping bleeding and resolving stasis.
[Jian Wei Wen Jiang Tang] Treats hematemesis and epistaxis syndromes where the pulse is deficient, soggy, slow, and weak, with food stagnation at the stomach opening unable to descend, indicating that Cold causes Stomach Qi to fail to descend.
Sheng Zhe Shi (Crassum Haematitum, eight qian, finely crushed) Sheng Huai Shan Yao (Rhizoma Dioscoreae Hypoglaucae, six qian) Bai Zhu (Rhizoma Atractylodis Macrocephalae, four qian, stir-fried) Gan Jiang (Rhizoma Zingiberis Officinalis Preparatum, three qian)
Qing Ban Xia (Rhizoma Pinelliae Preparatum, three qian, rinsed with warm water to remove alum taste) Sheng Bai Shao (Radix Paeoniae Alba, two qian) Hou Po (Cortex Magnoliae Officinalis, one qian and half)
This prescription was originally named Wen Jiang Tang, with only slight modifications in dosage here. Shaoyao (Radix Paeoniae) is still used to prevent the Ministerial Fire residing in the Liver from being affected by the warmth of Gan Jiang.
Syndromes of hematemesis and epistaxis caused by Cold are extremely rare. In over forty years of clinical practice, I have encountered only two young boys: one had hematemesis due to Cold causing Stomach Qi to fail to descend, and the other had epistaxis for the same reason. Both were cured using Wen Jiang Tang. Detailed cases are recorded after the original prescription for reference.
[Xie Gan Jiang Wei Tang] Treats hematemesis and epistaxis syndromes where the left pulse is wiry, long, and forceful, or there is distension and pain in the hypochondrium, or frequent hiccups. This indicates that Qi and Fire of the Liver and Gallbladder rush upward to the Stomach, causing Stomach Qi to fail to descend, leading to hematemesis and epistaxis.
Sheng Zhe Shi (Crassum Haematitum, eight qian, crushed) Sheng Bai Shao (Radix Paeoniae Alba, one liang) Sheng Shi Jue Ming (Concha Argo, six qian, crushed) Gua Lou Ren (Semen Trichosanthis, four qian, stir-fried and crushed)
Gan Cao (Radix Glycyrrhizae, four qian) Long Dan Cao (Radix Gentianae, two qian) Qing Dai (Aza, two qian)
This prescription targets the cause, which is the upward rush of Gallbladder Fire and Liver Qi. Therefore, it heavily utilizes Shaoyao, Shi Jue Ming, Long Dan, and Qing Dai to cool and anchor them. Gan Cao is used in a large dose of four qian to relieve Liver urgency and protect the Spleen and Stomach from various cold-natured herbs.
[Zhen Chong Jiang Wei Tang] Treats hematemesis and epistaxis syndromes where the right pulse is wiry, long, and forceful, with a sensation of Qi rising from the Lower Jiao and rushing upward to the Stomach, food stagnation failing to descend, or frequent hiccups. This indicates that Chong Mai (Penetrating Vessel) Qi rushes upward, causing Stomach Qi to fail to descend, leading to hematemesis and epistaxis.
Sheng Zhe Shi (Crassum Haematitum, one liang, finely crushed) Sheng Huai Shan Yao (Rhizoma Dioscoreae Hypoglaucae, one liang) Sheng Long Gu (Os Draconis et Ossis Mamillae, eight qian, crushed) Sheng Mu Li (Concha Ostreae, eight qian, crushed)
Sheng Bai Shao (Radix Paeoniae Alba, three qian) Gan Cao (Radix Glycyrrhizae, two qian) Guang San Qi (Radix Notoginseng, two qian, fine powder, taken in two doses, washed down with decoctions from the first and second brews)
Long Gu and Mu Li in the prescription not only anchor Chong Qi but also calm Liver Qi, because the cause of Chong Qi rushing upward is often related to Liver Qi.
[Zi Yin Qing Jiang Tang] Treats hematemesis and epistaxis syndromes resulting from excessive blood loss and Yin deficiency, leading to an inability to subdue Yang (causing fever) and an inability to grasp Qi (causing asthma). It may even involve Chong Qi disturbing upwards due to deficiency, causing hiccups, dizziness, and cough; Heart Blood failing to nourish internally, causing palpitations, fright, and insomnia; with a floating, rapid pulse that is powerless upon heavy pressure.
Sheng Zhe Shi (Crassum Haematitum, eight qian, finely crushed) Sheng Huai Shan Yao (Rhizoma Dioscoreae Hypoglaucae, one liang) Sheng Di Huang (Radix Rehmanniae Recens, eight qian) Sheng Long Gu (Os Draconis et Ossis Mamillae, six qian, crushed)
Sheng Mu Li (Concha Ostreae, six qian, crushed) Sheng Bai Shao (Radix Paeoniae Alba, four qian) Gan Cao (Radix Glycyrrhizae, two qian) Guang San Qi (Radix Notoginseng, two qian, fine powder, taken in two doses, washed down with decoctions from the first and second brews)
This prescription is Qing Jiang Tang plus Long Gu, Mu Li, Di Huang, and San Qi. The disease treated by the original prescription is essentially the same as this one, but adding these ingredients makes treatment more effective. Having gained extensive clinical experience and verified its efficacy repeatedly, I added these to the original prescription.
[Bao Yuan Qing Jiang Tang] Treats hematemesis and epistaxis syndromes where blood loss leads to Qi collapse, speech seems disconnected, exertion causes asthma, and the pulse is floating and wiry, powerless upon heavy pressure.
Sheng Zhe Shi (Crassum Haematitum, one liang, finely crushed) Ye Tai Shen (Radix Ginseng, five qian) Sheng Di Huang (Radix Rehmanniae Recens, one liang) Sheng Huai Shan Yao (Rhizoma Dioscoreae Hypoglaucae, eight qian) Jing Yu Rou (Fructus Corni, eight qian) Sheng Long Gu (Os Draconis et Ossis Mamillae, six qian, crushed) Sheng Bai Shao (Radix Paeoniae Alba, four qian) Guang San Qi (Radix Notoginseng, three qian, fine powder, taken in two doses, washed down with decoctions from the first and second brews)
This prescription was previously recorded in the Hematemesis section, with slight modifications here.
[Bao Yuan Han Jiang Tang] Treats hematemesis and epistaxis syndromes where blood loss leads to Qi collapse, with panting, coughing, reverse flow, mental restlessness and heat, and a pulse that is strong above and deficient below.
Sheng Zhe Shi (Crassum Haematitum, one liang, finely crushed) Ye Tai Shen (Radix Ginseng, five qian) Sheng Di Huang (Radix Rehmanniae Recens, one liang) Zhi Mu (Rhizoma Anemarrhenae, eight qian) Jing Yu Rou (Fructus Corni, eight qian) Sheng Long Gu (Os Draconis et Ossis Mamillae, six qian, crushed) Sheng Mu Li (Concha Ostreae, six qian, crushed) Sheng Bai Shao (Radix Paeoniae Alba, four qian) Guang San Qi (Radix Notoginseng, three qian, fine powder, taken in two doses, washed down with decoctions from the first and second brews)
This prescription is also recorded in the Hematemesis section, with slight modifications here. The original prescriptions recorded in medical texts are not unusable; one should carefully deliberate between them.
The prescriptions listed above generally achieve results when matched to the etiology. However, pathogenesis manifests in diverse ways, and etiologies vary accordingly. After long-term clinical practice, among the successful cases of hematemesis and epistaxis I have treated, some did not use the aforementioned prescriptions. For example, refer to the cases following my proposed Mi Hong Dan and Bu Luo Bu Guan Tang for cross-reference.
Hematemesis and epistaxis syndromes strictly contraindicate Huang Qin (Scutellariae Radix), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), and Jie Geng (Platycodonis Radix), as they may assist Qi in ascending, causing blood to follow. If it is certain that the disease is due to Zong Qi (Pectoral Qi) sinking, these herbs can be used boldly, but must be assisted by Long Gu and Mu Li to secure the root of blood, avoiding the risk of blood ascending with Qi.
However, hematemesis and epistaxis caused by Zong Qi sinking are extremely rare. In over forty years of practice, I encountered only one patient surnamed Zhao, who was cured after careful deliberation using Sheng Xian Tang (Ascending the Sink Decoction) plus Long Gu and Mu Li. Yet, this prescription should never be tried lightly. Recently, a Mr. Zhang in Tianjin, over thirty years old, suffered from hematemesis. His doctor's prescription contained Chai Erqian (two qian of Bupleuri Radix); after taking it, he vomited blood excessively. I was summoned urgently. His pulse was wiry, long, and forceful, and his heart felt hot. I determined that Stomach Qi failed to descend due to Heat. He carried about one liang of fine powder of Sheng Zhe Shi in his medicine pouch. I instructed him to take nearly half of it immediately with water. After about twelve minutes, feeling his heart settle, he took the remainder, and vomiting stopped instantly. He was then regulated with Ping Wei Han Jiang Tang and fully recovered. This shows that for the same hematemesis syndrome, Chai Hu may cure it sometimes, but nearly kill the patient other times. How crucial it is to examine the syndrome carefully!
As for women with Dao Jing (retrograde menstruation), where during menstruation blood fails to descend and rebels upward causing hematemesis or epistaxis, Si Wu Tang (Four Substances Decoction) minus Chuan Xiong (Rhizoma Chuanxiong) plus Huai Niu Xi (Radix Achyranthis Bidentatae) and fine powder of Sheng Zhe Shi should be used, taken continuously for several doses beforehand to cure. However, occasionally this syndrome is caused by Qi sinking, requiring careful observation. I once treated an unmarried girl with hematemesis and a young married woman with epistaxis, both due to retrograde menstruation. Their pulses were weak and powerless, they had shortness of breath, and a sensation of Qi sinking in the lower abdomen. Other hemostatic herbs were ineffective. After careful deliberation, both were treated with Sheng Xian Tang, taken continuously beforehand, and fully recovered within days. In summary, hematemesis and epistaxis are mostly due to Heat causing Qi rebellion. Cases due to Cold are rare. Even when accompanied by Chong or Liver Qi rebellion, Heat is usually involved. Cases due to Qi sinking account for only one or two in a thousand.
Mr. Zhao XX from Tianjin, nearly thirty years old, suffered from hematemesis. Although cured by doctors, the condition recurred if he ate hard food or overate. His six pulses were peaceful but seemed insufficient upon heavy pressure. I deduced weak spleen-stomach digestion and that the mucosal tissue at the bleeding site in his stomach had not yet healed, so food pressure re-injured it, causing bleeding again. Treatment should strengthen the spleen and stomach and repair the injury to eradicate the disease. I prescribed Sheng Shan Yao (Rhizoma Dioscoreae Hypoglaucae) and Chi Shi Zhi (Lapis Kaolinicus) each eight qian, Long Gu, Mu Li, and Jing Yu Rou each five qian, Bai Zhu and Sheng Ming Mo Yao (Resina Myrrhae, raw) each three qian, Tian Hua Fen (Radix Trichosanthis) and Gan Cao each two qian. With adjustments, he took it for over ten days and was cured permanently. Heavy use of Shi Zhi in this formula is because for hematemesis/epistaxis patients with loose stools, it can replace Zhe Shi to descend Stomach Qi. While Zhe Shi descends Stomach Qi and promotes bowel movement, Chi Shi Zhi descends Stomach Qi while consolidating the bowels. Its nature protects the gastrointestinal mucosa and promotes tissue regeneration, allowing injured gastric mucosa to heal quickly.
Question: Medical texts contain many prescriptions for hematemesis and epistaxis. Your detailed discussion relies on self-formulated prescriptions. Are existing prescriptions worthless? Answer: No. The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) has Xie Xin Tang (Drain the Epigastrium Decoction) for hematemesis and epistaxis. It uses Da Huang (Radix et Rhizoma Rhei) as the main herb to enter the Yangming channel and descend Stomach Qi. Huang Qin (Scutellariae Radix) clears Lung Heat, aiding descending Qi to assist Yangming descent. Huang Lian (Rhizoma Coptidis) clears Heart Fire, subduing hyperactive Yang to preserve True Fluids of Shaoyin. Thus, draining is actually tonifying. For hematemesis/epistaxis due to rebellious Heat, it can stop bleeding immediately in critical moments. After bleeding stops, carefully examine the etiology and slowly tonify. However, due to heavy Da Huang usage, patients fear taking it, burying this excellent prescription. Unbeknownst to them, Da Huang combined with Huang Lian descends Stomach Qi without purging the intestines; even in severe deficiency, it causes no diarrhea or collapse. I prescribed this twice before, but families refused, forcing me to substitute Ping Wei Han Jiang Tang. This was my tactful way of practicing life-saving medicine.
*Jin Gui* also has Bai Ye Tang (Cupressi Cacumen Decoction), an excellent prescription for hematemesis due to Cold rebellion. It uses Gan Jiang and Ai Ye (Folium Artemisiae Argyi) to warm the Stomach, and Ma Tong Zhi (Cauda Equina Bovis Succus) to descend Stomach Qi. Fearing the acrid-heat of Ginger and Mugwort might disturb Ministerial Fire in the Liver/Gallbladder, it adds Bai Ye (Cupressi Cacumen) to calm and cool the Liver. This is like a disciplined army securing itself before defeating the enemy. Later, Xue Lizhai suggested Li Zhong Tang (Regulate the Middle Decoction) plus Dang Gui (Radix Angelicae Sinensis) for Cold-induced hematemesis. Knowing only to warm the Stomach, but not to descend Stomach Qi or calm/cool the Liver, his prescription is far inferior to Bai Ye Tang.
However, modern patients preferring Western medicines often mock Chinese medicine as unclean. Adding Ma Tong Zhi would exacerbate this perception. Hence, I formulated Jian Wei Wen Jiang Tang as a substitute.
Recent physicians favor Ji Sheng Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction for Benefiting Life) for hematemesis/epistaxis. Originally designed for hematemesis/epistaxis due to Stomach Fire from Typhoid, using it for non-external contraction cases is too cold. If blood stops abruptly due to cold, it may transform into Xue Bi and Xu Lao. Occasionally, I use this for hematemesis/epistaxis from cold-warm diseases, but always wash down with two qian of San Qi fine powder to prevent blood stasis. If the pulse is surging and solid on both sides, add Ling Yang Jiao (Cornu Saigae Tataricae, two qian) to drain Liver/Gallbladder Heat, ensuring bleeding stops.
Ge Kejiu's Shi Hui San (Ten Ash Powder), explained by Chen Xiuyuan, is widely used for hematemesis/epistaxis. Herbal charcoal for stopping bleeding is generally contraindicated. Fortunately, it contains Da Huang Tan (Charred Radix et Rhizoma Rhei), retaining some power to descend Stomach Qi and open stasis, making it acceptable. It may work for mild cases, but I have never used it. Some simple remedies use charred hematemesis/epistaxis blood or charred hair (Tai Fa) for internal use. These charred substances have power to resolve stasis and generate new blood, stopping bleeding effectively, far superior to other charred herbs that only stop bleeding without resolving stasis.
Medical texts state that for Blood Collapse, one should first tonify Qi using Du Shen Tang (Single Ginseng Decoction). However, Blood Collapse requires differentiation. If blood leaks from bowels/bladder with a weak pulse, Du Shen Tang is usable. But for blood loss via hematemesis/epistaxis, even with a weak pulse, it is unsuitable. Yin and Yang, Qi and Blood are mutually sustaining. Hematemesis/epistaxis causes Yin-Blood deficiency and weak sustenance, risking floating Yang. Using Du Shen Tang to boost Qi further aids floating, causing Qi to rush up (as Yu Jiayan warned, Qi deficiency collapse treated with Ginseng may lead to Qi rising irreversibly) and blood to follow, causing recurrent bleeding. Therefore, in my hematemesis/epistaxis prescriptions using Shen (Ginseng), I always heavily pair it with Zhe Shi to direct the force downward.
Common foods also stop bleeding well: fresh Lotus Root Juice and fresh Radish Juice. I have seen persistent hematemesis/epistaxis cured by drinking a large cup of warm fresh Lotus Root juice (uncooked), or warm fresh Radish juice, or both.
My cousin XX, fifty years old, suffered from hematemesis unresponsive to doctors. Pulse was sliding but empty upon pressure. Being young myself, I hesitated to prescribe. Instead, I used four liang each of fresh Lotus Root and fresh Bai Mao Gen (Rhizoma Imperatae), chopped and decocted into two large bowls, drunk slowly as tea. He recovered in days. He said before drinking, his heart felt suspended; after, it felt settled. Days later, a young man surnamed Liu from a neighboring village had hematemesis with a forceful pulse and heart heat. I used the previous formula plus four liang of fresh Xiao Ji Gen (Radix Cirsii Japonici), decocted and drunk, and he also recovered. I named the former formula Er Xian Yin (Two Fresh Drinks) and the latter San Xian Yin (Three Fresh Drinks).
Regarding Ke Xue (hemoptysis), mentioned incidentally in previous cases, this text is not specifically for it. Ke Xue originates from the Lung; detailed treatments are in Lung disease prescriptions, so I will not elaborate here.