（《东垣》）
治吐血外感寒邪，内虚蕴热（东垣尝治一贫士，病脾胃虚，与补药，愈后继居旷室，卧
热炕，咳而吐血。东垣谓此久虚弱，冬居旷室，衣服单薄，是重虚其阳，表有大寒，壅遏里
热，火邪不得舒伸，故血出于口，当补表之阳，泻里之虚热。因思仲景治伤寒脉浮紧，当以
麻黄汤
桂枝（五分。补表虚） 麻黄（去外寒） 黄 （实表益卫） 甘草（炙。补脾） 白
芍（安太阴。各一钱） 人参（益元气而实表） 麦冬（保肺气。各三分） 五味子（五粒。
安肺气） 当
此足太阳、手足大阴药也。《纲目》曰∶观此一方，足以为万世模范矣。盖取仲景麻黄
汤与补剂各半服之，但凡虚人当服仲景方者，当以此为则也。
（《济生》）
治伤寒胃火热盛，吐血衄血，嗽血便血，蓄血如狂，漱水不欲咽，及阳毒发斑（口血曰
吐，鼻血曰衄，吐行浊道，衄行清道，喉与咽二管不同也。经者循经之血，走而不守，随气
而行，火气急迫，故随经直犯清道，上脑而出于鼻为衄；其从肺窍而出于咽者，则为咳血、
咯血；
吐血
也。
寒便
血发
阳明
疹者
迟，
色
下
生地黄（两半） 白芍（一两） 丹皮 犀角（三钱半。角尖尤良。鹿取茸，犀取尖，
其精
因怒致血者，加
节庵加当归、红花、桔梗、陈皮、甘草、藕汁，名加味犀角地黄汤∶治同（当归引血归经，
藕汁凉血散瘀，桔
此足阳明、太阴药也。血属阴本静，因诸经火逼，遂不安其位而妄行。犀角大寒，解胃
热而清心火；芍药酸寒，和阴血而泻肝火（肝者心之母）；丹皮苦寒，泻血中之伏火；生地
大寒，凉血而滋水；以共平诸经之僭逆也（海藏曰∶血分三部，药有重轻。犀角地黄汤治上
血，如吐衄之类；桃仁承气治中血，如血蓄中焦，下痢脓血之类；抵当汤丸治下血，如蓄血
如狂之类。又曰∶此证足太阴所主，脾不裹血，越而上行，实者犀角地黄汤，虚者黄芩芍药
汤。凡病呕吐血者，咸用芍药主之，故知太阴药也。《医贯》曰∶犀角地黄汤乃衄血之方，
盖犀，水兽也，可以分水，可以通天，鼻衄之血，从任督而至巅顶，入鼻中，惟犀角能下入
肾水，引地黄滋阴之品由肾脉而上，故为对证，若阴虚火动，吐血与咳咯，可借用成功；若
阳虚劳嗽，及脾胃虚者，皆不宜。伤寒汗出不彻，能逼动经血，误发其汗，亦动经血，二者
不同。陶尚文治一人，伤寒四五日，吐血不止，医以犀角地黄汤、茅花汤治之，反剧。陶切
其脉，浮数而紧，遂用麻黄汤汗出而愈；此取脉不取证也，可谓得仲景心法矣。使脉不浮紧
而数，其可用乎。经曰∶伤寒脉浮紧，不发汗，因致衄者，麻黄汤主之。又曰∶太阳病脉浮
紧，发热，身无汗，自衄者愈。风寒在经，郁而发热，不得汗解，衄则热随血散，俗名红汗，
故愈。若全未发汗致衄者，仍须用麻黄发之。成无己曰∶伤寒衄者，为邪气不得发散，壅盛
于经，逼迫于血也。桂枝、麻黄汤治衄者，非治衄也，即是发散经中邪气耳。血郁于上而吐
血者，谓之薄厥；留于下而瘀者，谓之蓄血；此由太阳随经瘀热在里，血为热所搏，结于下
焦，少腹当鞭，小便自利。朱肱《活人书》言瘀血入里，吐衄血者，犀角地黄汤乃阳明圣药，
如无犀角，代以升麻，二药性味相远，何以为代。盖以升麻能引诸药同入阳明也。朱二允曰∶
升麻性升，犀角性降，用犀角止血，乃借其下降之气，清心肝之火，使血下行归经耳；倘误
用升麻，血随气升，不愈涌出不止乎。故古方亦未可尽泥也）。
（出自《东垣》）
治疗因外感寒邪、内里虚热蕴结导致的吐血。李东垣曾治疗一位贫寒读书人，其脾胃虚弱，服用补药后病情好转，但随后居住在空旷寒冷的房屋中，睡在热炕上，导致咳嗽并吐血。李东垣认为此人久病体虚，冬天住在空旷房间，衣服单薄，这是使阳气更加虚弱，体表有大寒，壅遏了体内的热气，火邪无法舒展伸发，所以血液从口中溢出。应当补益体表的阳气，清泻里部的虚热。因此想到张仲景治疗伤寒脉象浮紧时，应当使用麻黄汤。
方剂组成：桂枝（五分，用于补益表虚）、麻黄（用于去除外寒）、黄芪（用于充实体表、增益卫气）、甘草（炙用，用于补脾）、白芍（用于安定太阴经，各一钱）、人参（用于益元气而充实体表）、麦冬（用于保肺气，各三分）、五味子（五粒，用于安肺气）。
这是足太阳膀胱经和手足太阴肺脾经的药物组合。《本草纲目》说：看这一张方子，足以成为万世的模范。大概是取张仲景的麻黄汤与补益药剂各半服用，凡是身体虚弱的人应当服用张仲景方剂的，都应当以此为准则。
（出自《济生》）
治疗伤寒导致胃中火热炽盛，出现吐血、鼻衄、咳血、便血，蓄血如狂乱之状，想漱口但不愿吞咽水，以及阳毒引起的发斑。
（注：从口吐出称为吐，从鼻流出称为衄。呕吐走浊道，鼻衄走清道，喉与咽是两个不同的管道。经脉循行的血液，流动而不守位，随气而行，火气急迫，所以顺着经脉直犯清道，上达脑部而从鼻出为衄；从肺窍而出从咽出的，则为咳血、咯血；从胃而出的则为吐血。）
方剂组成：生地黄（一两半）、白芍（一两）、牡丹皮、犀角（三钱半，角尖尤其好。鹿取茸，犀取尖，取其精华）。因愤怒导致出血者，加……节庵加入当归、红花、桔梗、陈皮、甘草、藕汁，名为加味犀角地黄汤：治疗相同（当归引血归经，藕汁凉血散瘀，桔梗……）。
这是足阳明胃经和足太阴脾经的药物。血属阴，本性安静，因为各经之火逼迫，于是不能安守其位而妄行。犀角大寒，能解胃热而清心火；白芍酸寒，能和养阴血而泻肝火（肝是心的母亲）；牡丹皮苦寒，能泻血中的伏火；生地黄大寒，能凉血并滋补肾水；共同用来平定各经的僭逆之气。（海藏说：血分三部，药物有轻重之分。犀角地黄汤治疗上部出血，如吐血、鼻衄之类；桃仁承气汤治疗中部出血，如血蓄在中焦，下痢脓血之类；抵当汤丸治疗下部出血，如蓄血如狂之类。又说：此证由足太阴所主，脾不统血，血液越而上行，实证用犀角地黄汤，虚证用黄芩芍药汤。凡是呕吐吐血的患者，都用白芍为主药，所以知道这是太阴经的药。《医贯》说：犀角地黄汤是治疗鼻衄的方子，大概犀是水兽，可以分水，可以通天，鼻衄的血，从任督二脉到达巅顶，进入鼻中，只有犀角能下入肾水，引导地黄滋阴的药物由肾脉而上，所以是对证的，如果是阴虚火动导致的吐血和咳咯，可以借用成功；如果是阳虚劳嗽，以及脾胃虚弱者，都不适宜。伤寒汗出不透彻，能逼动经络之血，误用发汗法，也会动经络之血，这两种情况不同。陶尚文治疗一人，伤寒四五日，吐血不止，医生用犀角地黄汤、茅花汤治疗，反而加重。陶切其脉，浮数而紧，于是用麻黄汤发汗而痊愈；这是取脉象而不取症状，可以说是得到了张仲景的心法。如果脉不浮紧而是数，那还能用吗？经文说：伤寒脉浮紧，不发汗，导致鼻衄的，用麻黄汤主治。又说：太阳病脉浮紧，发热，身上无汗，自衄者自愈。风寒在经络，郁结而发热，不得通过汗解，衄血则热随血散，俗名红汗，所以痊愈。如果完全未发汗导致衄血的，仍然需要用麻黄发散。成无己说：伤寒衄血，是因为邪气不得发散，壅盛于经络，逼迫血液。桂枝汤、麻黄汤治疗衄血，不是治疗衄血本身，就是发散经络中的邪气罢了。血郁结于上而吐血，称为薄厥；留滞于下而成瘀，称为蓄血；这是由于太阳随经瘀热在里，血被热所搏结，结于下焦，少腹应当硬满，小便自利。朱肱《活人书》说瘀血入里，吐血衄血，犀角地黄汤是阳明经的神药，如果没有犀角，代替以升麻，两药性味相差很远，凭什么作为替代。大概因为升麻能引诸药同入阳明。朱二允说：升麻性升，犀角性降，用犀角止血，是借其下降之气，清心肝之火，使血下行归经；如果误用升麻，血随气升，岂不是更加涌出不止吗。所以古方也不可完全拘泥）。
(From *Dongyuan*)
Treats hematemesis (vomiting blood) caused by external cold pathogen invasion and internal deficiency with accumulated heat. Li Dongyuan once treated a poor scholar who suffered from Spleen-Stomach deficiency. After taking tonifying medicines, his condition improved, but he subsequently lived in an empty, cold room and slept on a heated kang, leading to coughing and hematemesis. Li Dongyuan stated that this patient had been weak for a long time; living in an empty room in winter with thin clothing further depleted his Yang Qi. There was severe cold on the exterior, which obstructed interior heat, preventing the Fire Pathogen from dispersing, thus causing blood to issue from the mouth. The treatment should tonify the exterior Yang and drain the interior deficiency-heat. Thus, recalling Zhang Zhongjing's treatment of Taiyang disease with floating and tight pulse using Mahuang Tang (Ephedra Decoction):
Formula Composition: Guizhi Twig (Cinnamon Twig, 5 fen) to tonify exterior deficiency; Ephedra Stem (Mahuang, remove exterior cold); Astragalus Root (Huangqi, solidify the exterior and benefit Wei-Qi); Licorice Root (Gancao, roasted) to tonify the Spleen; White Peony Root (Baishao, 1 qian each) to calm the Taiyin; Ginseng Root (Renshen, 3 fen each) to benefit Yuan-Qi and solidify the exterior; Ophiopogon Tuber (Maidong, 3 fen each) to protect Lung Qi; Schisandra Fruit (Wuweizi, 5 grains) to calm Lung Qi.
This formula comprises herbs of the Foot-Taiyang Bladder meridian and the Hand-Foot-Taiyin Lung and Spleen meridians. *Bencao Gangmu* states: "Observing this single prescription, it is sufficient to serve as a model for ten thousand generations." It essentially combines half of Zhang Zhongjing's Mahuang Tang with half of a tonifying formula. For any deficient person requiring Zhang Zhongjing's formulas, this should be taken as the standard.
(From *Jisheng*)
Treats Stomach fire blazing due to Shanghan (cold damage), manifesting as hematemesis, epistaxis (nosebleed), hemoptysis (coughing up blood), hematochezia (blood in stool), sanguineous accumulation with manic behavior, the desire to rinse the mouth without swallowing, and macules caused by Yang toxicity.
(Note: Blood vomited from the mouth is called Tu (hematemesis); blood flowing from the nose is called Nu (epistaxis). Vomiting follows the turbid pathway, while epistaxis follows the clear pathway; the throat and pharynx are two different passages. Blood circulating in the meridians flows freely and does not stay in one place, moving with Qi. Due to the urgency of Fire and Qi, it attacks the clear pathways directly along the meridians, reaching the head and exiting through the nose as epistaxis; if it exits from the Lung orifice through the pharynx, it is hemoptysis or spitting blood; if it comes from the Stomach, it is hematemesis.)
Formula Composition: Rehmannia Root (Shengdihuang, 1.5 liang); White Peony Root (Baishao, 1 liang); Moutan Bark (Danpi); Rhinoceros Horn (Xijiao, 3.5 qian, the tip is especially good. Deer antler velvet is taken for deer, rhino horn tip for rhino, to obtain their essence). If bleeding is caused by anger, add... Jie'an added Angelica Sinensis Root (Danggui), Safflower (Honghua), Platycodon Root (Jiegeng), Tangerine Peel (Chenpi), Licorice Root (Gancao), and Lotus Root Juice (Ou Zhi), named Modified Xijiao Dihuang Tang: treats the same conditions (Angelica Sinensis guides blood back to the vessels; Lotus root juice cools blood and dissipates stasis; Platycodon...).
This formula consists of herbs of the Foot-Yangming Stomach meridian and the Foot-Taiyin Spleen meridian. Blood belongs to Yin and is inherently quiet; however, forced by Fire from various meridians, it loses its position and acts recklessly. Rhinoceros Horn is extremely cold, resolving Stomach heat and clearing Heart fire; White Peony Root is sour and cold, harmonizing Yin-blood and draining Liver fire (the Liver is the mother of the Heart); Moutan Bark is bitter and cold, draining latent fire in the blood; Rehmannia Root is extremely cold, cooling blood and nourishing Kidney water; together they pacify the rebellious Qi of various meridians. (Haizang said: Blood is divided into three parts, and drugs have varying weights. Xijiao Dihuang Tang treats upper bleeding, such as hematemesis and epistaxis; Taoren Chengqi Tang treats middle bleeding, such as blood accumulation in the Middle Jiao with dysentery containing pus and blood; Didang Tang/Wan treats lower bleeding, such as sanguineous accumulation with manic behavior. He also said: This syndrome is governed by the Foot-Taiyin; when the Spleen fails to contain blood, it rebels and moves upward. For excess patterns, use Xijiao Dihuang Tang; for deficiency patterns, use Huangqin Shaoyao Tang. In all cases of vomiting blood, Baishao is used as the primary herb, hence knowing it is a Taiyin medicine. *Yi Guan* states: Xijiao Dihuang Tang is a formula for epistaxis. Rhinoceros is a water animal, capable of dividing water and connecting to heaven. Epistaxis blood travels from the Ren and Du meridians to the vertex, entering the nose. Only Rhinoceros Horn can descend into Kidney Water, guiding the Yin-nourishing properties of Rehmannia up via the Kidney meridian, making it symptomatic. If Yin-deficiency with Fire hyperactivity causes hematemesis or hemoptysis, it may be borrowed for success; however, for Yang-deficiency with laborious cough, or Spleen-Stomach deficiency, it is unsuitable. In Shanghan, incomplete sweating can force blood in the meridians; erroneous sweating also disturbs meridian blood, but these two situations differ. Tao Shangwen treated a patient with Shanghan for four to five days with incessant hematemesis. Physicians treated him with Xijiao Dihuang Tang and Maohua Tang, worsening the condition. Tao palpated the pulse, finding it floating, rapid, and tight, and used Mahuang Tang to induce sweating, resulting in recovery. This prioritizes pulse over symptoms, truly obtaining Zhang Zhongjing's core method. If the pulse were not floating and tight but merely rapid, could it still be used? The Classic states: In Shanghan, if the pulse is floating and tight, and failure to sweat leads to epistaxis, Mahuang Tang governs. It also states: In Taiyang disease, if the pulse is floating and tight, there is fever, no sweating, and spontaneous epistaxis occurs, the disease resolves. Wind-Cold in the meridians stagnates and generates heat; unable to resolve via sweating, epistaxis allows heat to scatter with blood, commonly known as 'red sweat,' thus resolving. If epistaxis occurs without prior sweating, Mahuang must still be used to disperse. Cheng Wuji stated: Epistaxis in Shanghan occurs because pathogens cannot be dispersed, becoming congested in the meridians and forcing blood. Guizhi Tang and Mahuang Tang treat epistaxis not by treating the bleeding itself, but by dispersing pathogens in the meridians. Blood stagnating upward causing hematemesis is called Bojue; blood remaining downward causing stasis is called Xuxue; this arises from Taiyang following the meridians with stagnant heat in the interior, where blood is constrained by heat and knots in the Lower Jiao, causing hardness in the lower abdomen with free urination. Zhu Gong's *Huoren Shu* states that when blood stasis enters the interior causing hematemesis and epistaxis, Xijiao Dihuang Tang is the sacred medicine of the Yangming. If Rhinoceros Horn is unavailable, substitute with Cimicifuga Rhizome (Shengma); however, their nature and flavor are vastly different, how can they substitute? Presumably because Shengma guides other herbs into the Yangming. Zhu Eryun stated: Shengma ascends, while Xijiao descends. Using Xijiao to stop bleeding borrows its descending Qi to clear Heart and Liver fire, causing blood to descend and return to the vessels; if Shengma is mistakenly used, blood will ascend with Qi, leading to unceasing hemorrhage. Therefore, ancient formulas should not be rigidly adhered to.)