主衄血方。
生地黄 黄芩(各一两) 柏叶(一把) 阿胶(炙) 甘草(炙,各二两)
上五味, 咀。以水七升,煮取三升,去滓,纳胶煎取二升五合,分三服。
又方∶
生地黄(三斤,切) 阿胶(二两,炙) 蒲黄(六合)
上三味,以水五升,煮取三升,分三服。
治鼻口沥血三升,气欲绝方。
龙骨细筛一枣核许,微以气吹入鼻中即断,更出者再吹之,取瘥止。
又方∶细切葱白,捣绞取汁,沥鼻中一枣许,即断,慎酒、肉、五辛、热面、生冷等。
主衄血不止方∶
阿胶(炙) 龙骨 当归 细辛 桂心(各一两) 蒲黄(五合) 乱发(三两,烧灰)
上七味,捣筛为散。先食饮服方寸匕,日三服,三剂瘥,亦可蜜丸酒服。
主鼻衄、五脏热结,或吐血、衄血方。
伏龙肝(鸡子大,一枚) 生地黄(一斤,切) 生竹茹(一升) 芍药 当归 黄芩 芎
上九味, 咀。以水一斗三升煮竹茹,减三升,纳药,煮取三升,分三服。(《千金》
无桂心)
主失血虚劳,胸腹烦满疼痛,血来脏虚不受谷气,呕逆,不用食,补中治血方。
干地黄(三两) 浓朴(炙) 干漆(熬) 枳实(炙) 干姜 防风 大黄 细辛 白
术(各
一两) 前胡(一两半) 人参 茯苓(各五分) 虻虫(去翅足,熬) 虫(熬,各十
五枚)
当归 黄芩 麦门冬(去心) 甘草(炙,各二两)
上一十八味,捣罗为末,炼蜜和丸,如梧子。先食,酒服五丸,日三。
论曰∶凡下血者,先见血后见便,此为远血,宜服黄土汤;先见便,后见血,此为近血
,宜服赤小豆当归散。人病虽一,得病之始不同,血气强弱堪否次第,是以用药制方,随其
浅深,取其能堪,为方不一,各取所宜也。
黄土汤方
灶中黄土(半升) 甘草(炙) 干地黄 白术 附子(炮,去皮) 阿胶 黄芩(各
三两)
上七味, 咀。以水八升,煮取二升,分温三服,亦主吐血。
赤小豆当归散方
赤小豆(三升浸令芽出,曝干) 当归(三两)
上二味,捣筛为散。浆服一方寸匕,日三。
主治鼻出血的方剂。
生地黄、黄芩(各一两)、柏叶(一把)、阿胶(炙过)、甘草(炙过,各二两)。
以上五味药,切碎。用七升水,煎煮至三升,滤去药渣,加入阿胶再煎至二升五合,分三次服用。
另一个方子:
生地黄(三斤,切片)、阿胶(二两,炙过)、蒲黄(六合)。
以上三味药,用五升水,煎煮至三升,分三次服用。
治疗鼻口出血达三升,气息将绝的方剂。
龙骨细筛取如枣核大小的一点点,轻轻吹入鼻孔中即可止血,若再次出血则再吹一次,直到痊愈为止。
另一个方子:将葱白细细切碎,捣烂绞取汁液,滴入鼻孔中如枣核大小,即可止血。服药期间需忌酒、肉、五辛(指大蒜、茱萸、芸苔、胡荽、兴渠五种有辛辣气味的蔬菜)、热面、生冷等食物。
主治鼻出血不止的方剂:
阿胶(炙过)、龙骨、当归、细辛、桂心(各一两)、蒲黄(五合)、乱发(三两,烧成灰)。
以上七味药,捣碎过筛制成散剂。饭前用温水送服一方寸匕,每日三次,服用三副即可痊愈。也可以做成蜜丸,用酒送服。
主治鼻衄、五脏热结,或者吐血、鼻血的方剂。
伏龙肝(如鸡蛋大,一枚)、生地黄(一斤,切片)、生竹茹(一升)、芍药、当归、黄芩、川芎。
以上九味药,切碎。用一斗三升水煮竹茹,煮至减少三升后,加入其他药物,煎煮至三升,分三次服用。(《千金要方》原方中没有桂心)
主治失血导致的虚劳,胸腹烦闷胀满疼痛,血液流失导致脏腑虚弱无法受纳谷气,呕吐逆气,不能进食,具有补益中焦、治疗出血作用的方剂。
干地黄(三两)、厚朴(炙过)、干漆(熬制)、枳实(炙过)、干姜、防风、大黄、细辛、白术(各一两)、前胡(一两半)、人参、茯苓(各五分)、虻虫(去掉翅膀和足,熬制)、䗪虫(熬制,各十五枚)、当归、黄芩、麦门冬(去心)、甘草(炙过,各二两)。
以上十八味药,捣碎过筛制成粉末,用炼蜜调和制成丸药,大小如梧桐子。饭前用酒送服五丸,每日三次。
论述说:凡是便血的患者,先见血后见大便,这称为远血,适宜服用黄土汤;先见大便后见血,这称为近血,适宜服用赤小豆当归散。人虽然都患病,但发病之初的情况不同,气血强弱及耐受程度各异,因此用药制方,要根据病情的深浅,选择患者能够承受的剂量,所以方剂各不相同,各自取其适宜之处。
黄土汤方
灶心黄土(半升)、甘草(炙过)、干地黄、白术、附子(炮制,去皮)、阿胶、黄芩(各三两)。
以上七味药,切碎。用八升水,煎煮至二升,分三次温服,此方也主治吐血。
赤小豆当归散方
赤小豆(三升,浸泡令其发芽,晒干)、当归(三两)。
以上两味药,捣碎过筛制成散剂。用米浆送服一方寸匕,每日三次。
Formulas for Epistaxis.
**Formula for Epistaxis**
*Shengdihuang* (Radix Rehmanniae Preparata), *Huangqin* (Scutellariae Radix) [1 liang each], *Baiye* (Cacumen Platycladi) [one handful], *Ejiao* (Colla Corii Asini, prepared by frying) [2 liang], *Gancao* (Radix Glycyrrhizae Preparatae) [2 liang].
Crush the above five herbs. Decoct in 7 sheng of water to obtain 3 sheng. Strain the dregs, add *Ejiao*, and decoct again to obtain 2.5 sheng. Divide into three doses.
**Another Formula**
*Shengdihuang* (Radix Rehmanniae Preparata) [3 jin, sliced], *Ejiao* (Colla Corii Asini, prepared by frying) [2 liang], *Puhuang* (Pollen Typhae) [6 he].
Decoct the above three herbs in 5 sheng of water to obtain 3 sheng. Divide into three doses.
**Formula for Nasal and Oral Hemorrhage with Impending Collapse**
For nasal and oral hemorrhage amounting to 3 sheng, with breath nearly failing:
Sift fine powder of *Longgu* (Os Draconis or Os Mastodi). Take an amount the size of a jujube pit, gently blow it into the nostril to stop bleeding. If bleeding recurs, blow again. Continue until healed.
**Another Formula**
Finely chop white parts of scallion (*Congbai*), crush and squeeze to extract juice. Drip an amount the size of a jujube pit into the nostril to stop bleeding. Avoid alcohol, meat, "five pungent spices" (garlic, allium nectar, turnip greens, coriander, asafetida), hot noodles, and raw/cold foods.
**Formula for Incessant Epistaxis**
*Ejiao* (Colla Corii Asini, prepared by frying), *Longgu* (Os Draconis or Os Mastodi), *Danggui* (Angelicae Sinensis Radix), *Xixin* (Asari Radix et Rhizoma), *Guixin* (Cortex Cinnamomi) [1 liang each], *Puhuang* (Pollen Typhae) [5 he], *Luanfa* (Hair, burned to ash) [3 liang].
Crush and sieve the above seven herbs into a powder. Take one *cunbi* (square-inch measure) with warm water before meals, three times daily. Three doses will cure. Alternatively, make honey pills and take with wine.
**Formula for Epistaxis, Heat Stagnation in Five Zang Organs, Hematemesis, or Epistaxis**
*Fulonggan* (Caulis Longanae Ardentis), *Shengdihuang* (Radix Rehmanniae Preparata) [1 jin, sliced], *Shengzhuru* (Bambusae Caulis in Taeniam), *Shaoyao* (Paeoniae Radix), *Danggui* (Angelicae Sinensis Radix), *Huangqin* (Scutellariae Radix), *Xiong* (Ligustici Chuanxiong Rhizoma).
Crush the above nine herbs. Decoct *Shengzhuru* in 13 sheng of water until reduced by 3 sheng. Add other herbs and decoct to obtain 3 sheng. Divide into three doses. (Note: *Guixin* is absent in the original text of *Qianjin Yaofang*).
**Formula for Deficiency Consumption due to Blood Loss, Chest/Abdominal Fullness/Pain, Organ Weakness Unable to Receive Grain Qi, Vomiting/Nausea, Anorexia, Tonifying Middle Jiao and Treating Bleeding**
*Gandihuang* (Radix Rehmanniae Preparata) [3 liang], *Houpo* (Magnoliae Officinalis Cortex, prepared by frying), *Ganqi* (Resina Taxodi), *Zhishi* (Fructus Aurantii Immaturus, prepared by frying), *Ganjiang* (Zingiberis Rhizoma), *Fangfeng* (Saposhnikoviae Radix), *Dahuang* (Rhei Radix et Rhizoma), *Xixin* (Asari Radix et Rhizoma), *Baizhu* (Atractylodis Macrocephalae Rhizoma) [1 liang each], *Qianhu* (Peucedani Radix) [1.5 liang], *Renshen* (Ginseng Radix), *Fuling* (Poria) [0.5 fen each], *Mengchong* (Blatta orientalis, wings and feet removed, prepared by frying), *Chong* (Eupolyphaga or Steleophaga, prepared by frying) [15 each], *Danggui* (Angelicae Sinensis Radix), *Huangqin* (Scutellariae Radix), *Mendong* (Ophiopogonis Tuber, heart removed), *Gancao* (Radix Glycyrrhizae Preparatae) [2 liang each].
Crush and sieve the above eighteen herbs into powder. Mix with refined honey to form pills the size of wu zi (wuju fruit seeds). Take five pills with wine before meals, three times daily.
**Discussion:**
In cases of lower gastrointestinal bleeding, if blood appears before stool, it is termed "remote blood" (Yuan Xue), suitable for treatment with *Huangtu Tang*. If stool appears before blood, it is termed "proximate blood" (Jin Xue), suitable for treatment with *Chixiaodou Danggui San*. Although the disease is the same, the initial onset differs, and the strength of qi and blood varies in tolerance. Therefore, prescription formulation must follow the depth of the pathology and the patient's capacity, resulting in diverse formulas tailored to specific indications.
**Huangtu Tang Formula**
*Zaohuangtu* (Caulis Longanae Ardentis) [0.5 sheng], *Gancao* (Radix Glycyrrhizae Preparatae), *Gandihuang* (Radix Rehmanniae Preparata), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Fuzi* (Aconiti Lateralis Radix Praeparata, roasted, skin removed), *Ejiao* (Colla Corii Asini), *Huangqin* (Scutellariae Radix) [3 liang each].
Crush the above seven herbs. Decoct in 8 sheng of water to obtain 2 sheng. Divide into three warm doses. This formula also treats hematemesis.
**Chixiaodou Danggui San Formula**
*Chixiaodou* (Vigna angularis), soaked until sprouted, then dried [3 sheng], *Danggui* (Angelicae Sinensis Radix) [3 liang].
Crush and sieve the above two herbs into a powder. Take one *cunbi* with rice gruel, three times daily.