蓄血一症。治之非难。而辨之为难。辨之非难。而辨之之早为难也。当其发
作时。与外感无异。医者从而治之。竟不得愈。何故。盖血病而气不病也。其
人或劳倦。或跌扑。或闪挫。或郁怒。皆足以阻其血。而停蓄成瘀。蓄之久必
发而寒热乃作。节庵谓表邪当汗不汗。热毒内积所致。则未必然也。又曰。
凡见眼闭。目红。神昏。语短。眩冒。健忘。烦躁。漱水。惊狂。谵语。鼻衄。吐红。背冷。
足寒。四肢厥逆。胸腹急满。大便黑。小便数。皆瘀血症。虽有多般。不必悉具。
但见一二。便作血症主张。此言最为得之。非节庵心体熟识。乌能辨此。治
之维何。实者桃仁承气汤加肉桂。虚者六味地黄汤加肉桂。盖瘀血。死血
也。寒则凝。热则行。自然之理。又或用破血理气之药而效者。又或用犀角
地黄汤治上焦。抵当丸治下焦。总之下尽黑物则愈尔。
按蓄血症。面色削瘦。白而无神。四肢无力。遍身发热。用他药不效者。必
是此症。以小柴胡汤加丹皮生地泽兰钩藤治之。甚则加桃仁红花。如
血去多而中气寒者。以理中汤加归芍调之。
治验
一徽商年十八。从远归。当晚忽晕倒。遍体俱冷。医一作火治。一作痰治。俱
不效。余诊之。脉虚而芤。动则眩晕。不能起坐。忽吐出紫血。予曰。此瘀血
症也。下出为顺。用人参二钱。肉桂一钱。泽兰二钱。丹皮当归广皮各一
钱。一剂而血下行。三剂而身渐暖。数剂乃痊。
一男子发热。面白无神。脉得微涩欲绝。大便黑。时头眩。余曰此瘀血症而
脉如此。何敢攻之。连进地黄汤四剂觉安甚。又加桂四剂。所去瘀血不
计。但口干舌燥。加五味子四剂。又下瘀血。腹中安舒。而脉与舌犹故。痰
中见血。以门冬贝母生地丹皮等渐愈。盖此症兼内伤元气。赖温补而
效。肺经未免受克。故以保肺收攻。
和血导瘀汤
泽兰（一钱五分） 牡丹皮（一钱） 当归尾（一钱） 陈皮（一钱） 钩藤钩（一钱）
怀生地（一钱） 桃仁（七粒研） 紫浓朴（七分姜制） 炙甘草（三分） 红花（五分）
加生姜一片。水煎。甚者加苏木。虚者去桃仁红花。
干姜汤 治去血而呕逆肢冷。
炮姜（一钱） 茯苓（一钱） 炙甘草（三分） 当归（一钱） 泽兰（一钱）
广陈皮（一钱） 半夏（一钱） 钩藤（一钱五分）
大枣二枚。水煎。
犀角地黄汤
犀角（一钱） 生地黄（四钱） 牡丹皮（一钱） 芍药（一钱）
水煎。
抵当汤
水蛭 虻虫 桃仁（各十枚） 大黄（八钱）
水煎。
蓄血这一病症，治疗起来并不难，难的是辨证。辨证本身并不困难，难的是尽早进行辨证。当疾病发作时，其表现与外感病没有区别。医生如果按照外感病来治疗，竟然无法痊愈。这是什么原因呢？这是因为只有血分有病，而气分没有病。这些人或因劳累疲倦，或因跌打损伤，或因闪挫扭伤，或因郁怒情绪，这些都足以阻碍血液运行，从而停滞积聚形成瘀血。瘀血停留时间久了必然发作，出现寒热症状。节庵认为这是表邪应当发汗却没有发汗，导致热毒内积所致，但这未必正确。他又说，凡是见到眼睛闭合、眼红、神志昏迷、言语短促、眩晕昏冒、健忘、烦躁、想漱口但不欲咽下、惊狂、胡言乱语、鼻出血、吐血、背部发冷、脚部发冷、四肢厥逆、胸腹部急迫胀满、大便黑色、小便频数，这些都是瘀血症的表现。虽然症状多种多样，不必全部具备。只要见到其中一两个症状，就可以按血症来处理。这番话最为恰当。如果不是节庵内心体察熟悉，怎么能辨别出这些呢？如何治疗呢？实证用桃仁承气汤加肉桂；虚证用六味地黄汤加肉桂。因为瘀血属于死血，寒冷则凝结，温热则运行，这是自然的道理。又或用破血理气的药物也能见效的，或者用犀角地黄汤治疗上焦，抵当丸治疗下焦。总之，直到排出黑色的瘀血才算痊愈。
按：蓄血症患者，面色消瘦枯槁，苍白而无神气，四肢无力，全身发热，使用其他药物无效者，必定是此症。用小柴胡汤加丹皮、生地、泽兰、钩藤来治疗。病情严重的再加桃仁、红花。如果失血过多且中气虚寒者，用理中汤加当归、白芍调理。
治验案例：
一位徽州商人，十八岁，从远方归来，当晚突然晕倒，全身冰冷。有的医生用火法治疗，有的医生按痰证治疗，都无效。我诊察他的脉象，脉虚大而中空（芤脉），一动就眩晕，不能起身坐立。忽然吐出紫黑色的血。我说：“这是瘀血症。”瘀血下行排出为顺。用人参二钱，肉桂一钱，泽兰二钱，丹皮、当归、广陈皮各一钱。服用一剂后瘀血下行，三剂后身体逐渐回暖，服用数剂后痊愈。
一名男子发热，面色苍白无神，脉象微涩几乎摸不到，大便黑色，时常头晕。我说：“这是瘀血症，但脉象如此虚弱，怎么敢用攻伐之法？”连续服用四剂地黄汤后感觉非常安适。又加了肉桂再服四剂，排出的瘀血不计其数。但是口干舌燥，又加了五味子四剂，再次排出瘀血，腹中安舒，但脉象和舌象依然如故。痰中带血，用麦冬、贝母、生地、丹皮等药逐渐治愈。因为这个病症兼有内伤元气，依靠温补才见效。肺经恐怕也受到了克制，所以采用保肺的方法来收束攻伐之效。
和血导瘀汤
泽兰（一钱五分） 牡丹皮（一钱） 当归尾（一钱） 陈皮（一钱） 钩藤钩（一钱）
怀生地（一钱） 桃仁（七粒研碎） 紫浓朴（七分姜制） 炙甘草（三分） 红花（五分）
加生姜一片，水煎服。病情严重的加苏木。虚证去掉桃仁、红花。
干姜汤 治疗因去血过多导致的呕吐逆气和四肢冰冷。
炮姜（一钱） 茯苓（一钱） 炙甘草（三分） 当归（一钱） 泽兰（一钱）
广陈皮（一钱） 半夏（一钱） 钩藤（一钱五分）
大枣两枚，水煎服。
Blood Stasis Syndrome is not difficult to treat, but difficult to differentiate. Differentiation itself is not difficult, but early differentiation is difficult. When the condition manifests, it is indistinguishable from exterior syndromes (Wai Gan Bing). If physicians treat it as an exterior syndrome, it often fails to resolve. Why? This is because the disease lies in the Blood level while the Qi level remains unaffected. These patients may have suffered from fatigue or overwork, falls and trauma, sprains and strains, or depression and anger, all of which can obstruct blood flow, causing stagnation and accumulation into Blood Stasis (Yu Xue). After accumulating for a long time, it inevitably manifests with alternating chills and fever. Jie'an attributed this to heat toxins accumulating internally due to failure to sweat out exterior pathogens, but this is not necessarily correct. He further stated that whenever one observes closed eyes, red eyes, coma, shortness of speech, dizziness and vertigo, amnesia, irritability, desire to rinse the mouth without swallowing, panic and mania, delirious speech, epistaxis, hematemesis, coldness of the back, coldness of the feet, cold limbs, acute distension and fullness of the chest and abdomen, black stools, and frequent urination, these are all signs of Blood Stasis Syndrome. Although there are many variations, not all need to be present. If even one or two symptoms are observed, one should proceed on the assumption that it is a Blood Stasis case. This statement is most accurate. Without Jie'an's deep internal experience and familiarity, how could he distinguish these? How should it be treated? For excess patterns, Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) with added Rou Gui (Cinnamon Twig); for deficiency patterns, Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill) with added Rou Gui. This is because Blood Stasis constitutes "dead blood"; cold causes coagulation, while heat promotes circulation, which is the natural principle. Alternatively, using herbs that break stasis and regulate Qi can also be effective. One may use Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) to treat the Upper Jiao, or Dang Dang Wan (Dangdang Pill) to treat the Lower Jiao. In summary, recovery occurs only when black material is completely expelled.
Note: Patients with Blood Stasis Syndrome present with emaciated and haggard facial features, pale complexion lacking spirit, weakness in the four limbs, and generalized fever. If other medications fail, it must be this syndrome. Treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Dan Pi (Moutan Cortex), Sheng Di Huang (Rehmanniae Radix), Ze Lan (Lycopus Herba), and Gou Teng (Uncariae Ramulus cum Uncis). For severe cases, add Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos). If excessive blood loss has led to Cold in the Middle Qi, regulate with Li Zhong Tang (Regulate the Middle Decoction) added with Dang Gui (Angelicae Sinensis Radix) and Bai Shao (Paeoniae Radix Alba).
Case Record 1:
A merchant from Huizhou, aged eighteen, returned from a distant journey. That night, he suddenly fainted, and his entire body became cold. Physicians attempted treatment with fire therapy or by treating it as Phlegm, both of which failed. I examined his pulse: it was deficient and large and hollow (Kou Mai). Movement induced dizziness, and he could not rise or sit up. Suddenly, he vomited purple blood. I said, "This is a Blood Stasis Syndrome." Expulsion of the blood downward is favorable. I prescribed Ren Shen (Ginseng Radix) 2 qian, Rou Gui (Cinnamon Twig) 1 qian, Ze Lan (Lycopus Herba) 2 qian, Dan Pi (Moutan Cortex), Dang Gui (Angelicae Sinensis Radix), and Guang Chen Pi (Citri Reticulatae Pericarpium) each 1 qian. After one dose, the blood moved downward; after three doses, his body gradually warmed; after several doses, he recovered.
Case Record 2:
A male patient presented with fever, a pale face lacking spirit, a pulse that was faint and choppy almost imperceptible, black stools, and occasional dizziness. I said, "This is a Blood Stasis Syndrome, yet the pulse is so weak; how dare I use purgative methods?" I administered Di Huang Tang (Rehmannia Decoction) continuously for four doses, after which he felt significantly relieved. I then added Rou Gui (Cinnamon Twig) for another four doses, resulting in the expulsion of an immeasurable amount of stasis. However, he experienced dry mouth and tongue. I added Wu Wei Zi (Schisandrae Fructus) for four doses, leading to further expulsion of stasis. His abdomen felt comfortable, but his pulse and tongue remained unchanged. There was blood in the phlegm. He gradually recovered using Mai Dong (Ophiopogonis Tuber), Bei Mu (Fritillariae Bulbus), Sheng Di Huang (Rehmanniae Radix), and Dan Pi (Moutan Cortex). This case involved damage to the Original Qi from internal injury, responding only to warming and tonification. The Lung Meridian likely suffered suppression, hence the strategy of protecting the Lung to conclude the aggressive treatment.
He Xue Dao Yu Tang (Harmonize Blood and Guide Out Stasis Decoction)
Ze Lan (Lycopus Herba) 1.5 qian, Dan Pi (Moutan Cortex) 1 qian, Dang Gui Wei (Tail of Angelicae Sinensis Radix) 1 qian, Chen Pi (Citri Reticulatae Pericarpium) 1 qian, Gou Teng Gou (Uncariae Ramulus cum Uncis) 1 qian, Huai Sheng Di Huang (Rehmanniae Radix Preparata) 1 qian, Tao Ren (Persicae Semen) 7 grains (pounded), Zhi Niu Pi (Magnoliae Officinalis Cortex processed with ginger) 0.7 fen, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 0.3 fen, Hong Hua (Carthami Flos) 0.5 fen. Add one slice of Sheng Jiang (Zingiberis Rhizoma Recens). Decoct in water. For severe cases, add Su Mu (Sappan Lignum). For deficiency patterns, remove Tao Ren and Hong Hua.
Gan Jiang Tang (Dried Ginger Decoction)
Treats vomiting, retching, and cold limbs due to excessive blood loss.
Pao Jiang (Prepared Zingiberis Rhizoma) 1 qian, Fu Ling (Poria) 1 qian, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 0.3 fen, Dang Gui (Angelicae Sinensis Radix) 1 qian, Ze Lan (Lycopus Herba) 1 qian, Guang Chen Pi (Citri Reticulatae Pericarpium) 1 qian, Ban Xia (Pinelliae Tuber) 1 qian, Gou Teng (Uncariae Ramulus cum Uncis) 1.5 qian. Add two Da Zao (Jujubae Fructus). Decoct in water.
Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction)
Xi Jiao (Rhinoceri Cornu) 1 qian, Sheng Di Huang (Rehmanniae Radix) 4 qian, Dan Pi (Moutan Cortex) 1 qian, Shao Yao (Paeoniae Radix) 1 qian. Decoct in water.
Di Dang Tang (Di Dang Decoction)
Shui Zhi (Hirudo) Bu Chong (Ophryognathia), Tao Ren (Persicae Semen) (10 each), Da Huang (Rhei Radix et Rhizoma) 8 qian. Decoct in water.