42.伤寒吐血多因逆, 下厥上竭少阴经, 三阳热盛宜清解, 血瘀胸满
痛当攻, 暴吐腐臭内溃死, 过多血脱面无红, 犀角桃仁宜拣用, 救脱
圣愈及养荣.
【注】伤寒吐血, 皆因失汗, 失下, 火逆, 以致邪热炽盛, 沸腾经血
故也. 若血从口鼻耳目而出, 小便难, 此为强发少阴汗, 名曰下厥上
竭,为难治也. 三阳热盛吐血, 宜升麻葛根合犀角地黄汤, 热甚加芩
连清解可也. 若血瘀则胸满或痛, 当以桃仁承气合犀角地黄汤攻之.
若暴吐腐臭之血, 名曰内溃, 内溃者死. 若吐血过多, 面唇无红色,
名曰血脱. 救脱, 轻者以圣愈汤, 重者以人参养荣汤.
43.热在膀胱小便血, 八正导赤利之佳, 热瘀里急下脓血, 黄连白头
与桃花.
【注】阳经之热, 下注膀胱, 伤其营分, 热少血多, 瘀成血蓄. 热多
血少, 热迫血行, 血不得蓄, 而走下窍, 故尿血也, 以八正散, 导赤
散利而清之. 阴经之热, 转迫阳明, 伤其营分, 瘀则血蓄, 喜忘如狂
.不蓄则便血, 热腐则便脓. 便脓热郁, 里急下重, 所必然也. 轻者
宜黄连阿胶汤, 重者白头翁汤清之, 滑脱者, 桃花汤涩之可也.
42. 伤寒吐血多因误治逆乱，（若）下焦厥冷而上部阴血枯竭，则属少阴经病证；三阳经热邪炽盛者适宜清热解表；若伴有血瘀、胸膈满闷疼痛，则应当攻逐瘀血。突然呕吐出腐臭的血，提示内脏溃败，预后不良（致死）；若吐血过多导致血脱，面色苍白无红润之色，此时宜选用犀角和桃仁；救治血脱之证，轻症用圣愈汤，重症用人参养荣汤。
【注】伤寒引起的吐血，都是因为未能及时发汗或攻下，或者因火疗等逆治法，导致邪热炽盛，沸腾扰动经脉中的血液所致。如果血液从口、鼻、耳、目流出，且小便困难，这是因为强行对少阴经患者发汗所致，称为“下厥上竭”，属于难治之证。三阳经热盛导致的吐血，适宜使用升麻葛根汤合犀角地黄汤，若热势极重，可加黄芩、黄连以清热解郁。若有瘀血阻滞，则出现胸膈满闷或疼痛，应当用桃仁承气汤合犀角地黄汤进行攻逐。如果突然呕吐出腐臭的血液，称为“内溃”，发生内溃者多死亡。如果吐血过多，面唇失去红色，称为“血脱”。救治血脱，轻症用圣愈汤，重症用人参养荣汤。
43. 热邪在膀胱导致小便带血，用八正散或导赤散利尿清热效果佳；热邪与瘀血互结于里，出现腹痛急迫并排出脓血，可用黄连阿胶汤、白头翁汤或桃花汤治疗。
【注】阳经的热邪，向下注入膀胱，损伤营分。若热少血多，瘀滞而成蓄血证；若热多血少，热邪逼迫血液运行，血液无法蓄积，而向下窍溢出，故出现尿血，此时应用八正散、导赤散进行利尿和清热。阴经的热邪，转而逼迫阳明经，损伤营分。若形成瘀滞则成蓄血证，表现为健忘甚至如狂状；若不形成蓄血则便血，若热邪腐败血肉则排出脓液。便脓血伴热邪郁结，必然出现里急后重（腹痛窘迫，时时欲泻，肛门重坠）。轻症适宜用黄连阿胶汤，重症用白头翁汤清热，若伴有滑脱不禁者，可用桃花汤固涩。
42. Hematemesis in cold damage (Shanghan) often results from therapeutic contraindications; if there is cold reversal in the lower jiao and exhaustion of yin blood in the upper jiao, it involves the Shaoyin channel. For excessive heat in the three yang channels, clearing and resolving is appropriate. If blood stasis causes chest fullness and pain, purgation to remove stasis is indicated. Sudden vomiting of foul-smelling blood indicates internal ulceration and carries a fatal prognosis. Excessive bleeding leading to blood depletion presents with a pale complexion lacking ruddy color. In such cases, Rhinoceros Horn (Xijiao) and Peach Kernel (Taoren) may be selected. To rescue from depletion, Shengyu Decoction is used for mild cases, and Renshen Yangrong Decoction (Ginseng and Nutritive Qi Nourishing Decoction) for severe cases.
[Note] Hematemesis caused by cold damage arises from failure to induce sweating or purge, or from therapeutic reversals (such as moxibustion errors), leading to rampant pathogenic heat that boils and disturbs the blood in the meridians. If blood flows from the mouth, nose, ears, and eyes, accompanied by difficult urination, this is due to forcibly inducing sweat in patients with Shaoyin disease, termed "lower reversal and upper exhaustion," which is difficult to treat. For hematemesis due to excessive heat in the three yang channels, Shengma Gegen Tang (Bupleurum and Kudzu Root Decoction) combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is suitable. If heat is extreme, add Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) to clear and resolve. If blood stasis is present, causing chest fullness or pain, Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) combined with Xijiao Dihuang Tang should be used to purge. Sudden vomiting of foul-smelling blood is termed "internal ulceration," which is fatal. Excessive bleeding resulting in loss of red color on the face and lips is termed "blood depletion." For rescuing from depletion, Shengyu Tang is used for mild cases, and Renshen Yangrong Tang for severe cases.
43. Heat in the Bladder causing hematuria is best treated with Bazheng San or Daochi San to promote diuresis and clear heat. Heat and stasis binding in the interior, presenting with tenesmus and passage of pus and blood, are treated with Huanglian Ejiao Tang, Baitouweng Tang, or Taohua Tang.
[Note] Heat from the yang channels descending into the Bladder damages the Ying level. If heat is slight and blood abundant, stasis forms leading to blood accumulation. If heat is abundant and blood slight, heat forces blood to move; unable to accumulate, it escapes through the lower orifices, causing hematuria. This is treated with Bazheng San and Daochi San to promote diuresis and clear heat. Heat from the yin channels shifting to force the Yangming channel damages the Ying level. If stasis forms, it leads to blood accumulation, manifesting as forgetfulness or mania-like states. If no accumulation occurs, hematochezia results; if heat rots flesh, pus is passed. Passage of pus and blood with heat stagnation inevitably leads to tenesmus. Mild cases are treated with Huanglian Ejiao Tang; severe cases with Baitouweng Tang to clear heat. If there is slipping and incontinence, Taohua Tang is used to astringe.