凡症之可畏者。莫甚于失血。使不急有以止之。则危亡随焉。然止之而不
得止。或屡止而屡发者何故。良由世之治者。执火载血上。错经妄行之说。
不求阴阳原委。漫以寒凉投之。设在火症。偶尔获效。危亡者接踵矣。褚齐
贤有服寒凉百不一生之叹。岂过甚哉。窃念人之一身。内而脏腑。外而皮
肤。而血潜行于中。岂容有发越也哉。惟伤于肺。则血缕带于痰中。伤于脾。
则血散漫于痰涎。伤于肝。则血凝结而紫黑。伤于肾。则血随咳唾而出。伤
于心与肾。则血暴吐而成盂。其间脏腑。虽有气血多少之别。断未有真阴
足而妄动者。亦未有元气充而不摄者。每见失血之人。非有大损于脏腑。
则血不易以至。一至焉。则症不易以复。从可识矣。端赖求其原而疗之。或
补其阳。以固脾肺之气。如面色黄白。而脉虚大空软者是也。或补其阴。以
固肾肝之气。如面赤口干。而脉虚细弦数者是也。然补阳无论矣。而补阴
之中。又有火衰者。其症面青白而脉迟弱。或服寒凉而脉反鼓指者。皆当
以导火归元。如八味丸以消阴翳是也。不见立斋治张东谷。遇劳则吐血
一二口。用补中益气汤。加门冬五味山药熟地茯神远志。非补脾肺乎。丹
溪每用炮姜止血。缪仲仁用四君六君加木香。谓古人治血多以胃药收
功。非补中焦乎。养葵谓心主血。脾裹血。肝藏血。归脾汤。三脏之药毕具。用
之鲜不神效。非补心脾乎。余治一友。汪子轶干。应乡试过劳。及归。吐血。屡
发屡止。遍服补阴药。逾年不效。余见之面色白。脉虚数无力。体中未尝畏
热。余曰此不特脾肺虚而命门之火亦衰。遂用归脾汤加炮姜五味倍人
参。而血势少衰。偶加门冬。则又如故。继以八味丸无间服之。血遂止。若八
味少弛。则血又复。以后连获二子。应试如初。非补命门乎。乃知有形之血。
固于无形之气。无形之气。资于命门之火。所谓精足则气旺。气旺则神生。
神者血之华也。不信然哉。及观古人治脱血。必用大剂独参汤以挽之。岂
血未至于脱。而反不可用人参乎。此亦余之所不解矣。故余治失血症。上
必顾其脾肺。下必滋其肾元。切禁苦寒以伐之。庶几无愧于前哲。而不遗
人夭枉也。
按上治五脏法也。胃多气多血。暴吐成碗成盂。当火炽方盛时。必用四
生丸。生地凉血。荷叶柏叶破血。假艾叶辛温济之。则血不复滞而归经
矣。胸中气塞。血成紫块者。此必血菀于上。宜桃仁枳壳陈皮香附之属。
破而降之。则气平而血止矣。小便尿血。心移热于小肠。清心莲子加柏
叶牛膝小蓟主之。大便下血。元气下陷。补中益气加槐花槐角地榆主
之。审其虚实而施治可也。至鼻衄。血冲清道。四生丸为最妙。虚则生脉
散加黄 芍药以摄之。牙宣出血。六味丸加骨碎补。虚寒者。八味丸加
骨碎补。生脉散亦效。此又岂法之所拘哉。
生地丹皮汤 治脉数内热咳嗽痰血者。
怀生地 牡丹皮 川贝母（去心研） 麦门冬（去心）
广陈皮（各一钱） 炙甘草（三分） 沙参（一钱） （如不止加阿胶一钱蛤粉炒成珠）
加焙扁柏叶一钱。水煎服。如吐血。去门冬加荷叶艾叶。或加藕节童便。
当归止血汤 治脉弦胁痛气逆者。
当归（一钱） 香附（一钱便制） 生地（一钱） 白芍药（一钱酒炒） 牡丹皮（一钱）
苏子（一钱） 炙甘草（三分） 广陈皮（一钱）
加焙扁柏叶一钱。水煎服。
白芨汤 治内伤吐血。
白芨 茜草 生地 丹皮 牛膝 广皮 归尾（各一钱）
加荷叶蒂五个。水煎服。
补方见论内
凡是病症中令人畏惧的，没有比失血更严重的了。如果不立即采取措施止血，生命危险就会随之而来。然而，有时止血无效，或者屡次止血却屡次复发，这是什么原因呢？这主要是因为当时的医生们拘泥于“火载血上”、“错经妄行”的说法，不探究阴阳的根本原委，随意投用寒凉药物。如果是实火证，偶尔可能见效，但对于虚损导致的危重病人来说，后果往往是接踵而至的死亡。褚齐贤曾感叹服用寒凉药的人百无一人生还，这难道不是过分夸张吗？
我思考人的身体，内部有脏腑，外部有皮肤，血液在体内潜行运行，怎么容许它发散越出呢？只有当肺受到损伤时，血丝会混杂在痰中；脾受到损伤时，血液会散漫在痰涎里；肝受到损伤时，血液凝结呈紫黑色；肾受到损伤时，血液会随着咳嗽吐唾而出；心和肾同时受损时，血液会暴涌吐出，甚至满盂。其间脏腑虽然有气血多少的区别，但绝没有真阴充足而让血妄动的情况，也没有元气充沛而不摄血的情况。
我经常见到失血的人，如果不是脏腑有大损伤，血是不容易流失的。一旦流失，病情就不容易恢复，这是可以识别的。关键在于探求病因根源进行治疗。或者补阳，以巩固脾肺之气，比如面色黄白、脉象虚大空软的就是这种情况；或者补阴，以巩固肾肝之气，比如面赤口干、脉象虚细弦数的就是这种情况。
然而，补阳的道理大家都知道了，而在补阴之中，又有火衰的情况。其症状是面色青白、脉象迟弱，或者服用寒凉药后脉象反而鼓指有力（假热之象）。这些都应当采用“导火归元”的方法，比如使用八味丸来消除阴翳（阴寒之邪）。没看到李梴（立斋）治疗张东谷的例子吗？他遇劳累就吐血一两口，李梴用补中益气汤，加上麦冬、五味子、山药、熟地、茯神、远志，这不是在补脾肺吗？朱丹溪常用炮姜止血，缪希雍（仲仁）用四君子汤或六君子汤加木香，说古人治血多以调理胃气收功，这不是在补中焦吗？养葵认为心主血，脾裹血，肝藏血，归脾汤三脏的药物都具备，使用它很少不神效的，这不是在补心脾吗？
我治疗一位朋友汪轶干，他在参加乡试时过度劳累，回家后吐血，屡次发作屡次止血，遍服补阴药，过了一年都不见效。我看他面色苍白，脉象虚数无力，身体并不怕热。我说：这不仅脾肺虚弱，命门之火也衰微了。于是我用归脾汤加炮姜、五味子，加倍人参，出血势头稍微减弱。偶然加了麦冬，病情又回到老样子。接着不间断地服用八味丸，血才停止。如果八味丸稍一停药，血又会复发。后来他接连生了两个儿子，应试如常。这不是在补命门吗？由此可知，有形的血，依赖于无形的气；无形的气，滋养于命门之火。所谓精足则气旺，气旺则神生，神是血的精华，难道不是这样吗？
等到看古人治疗脱血症，必定用大剂量的独参汤来挽救，难道血还没有到脱失的程度，反而不可以用人参吗？这也是我不理解的地方。所以我治疗失血症，上面必须顾护脾肺，下面必须滋补肾元，切忌苦寒药物来攻伐，这样才能无愧于前代哲人，也不致让人夭折枉死。
按语：以上是治疗五脏的方法。胃是多气多血的脏腑，突然吐血成碗成盂，当火势炽盛正旺时，必须用四生丸。生地凉血，荷叶和柏叶破血，借艾叶的辛温来调和，那么血就不会停滞而归入经脉了。胸中气塞，血结成紫块的，这一定是血郁积在上部，适宜用桃仁、枳壳、陈皮、香附这类药物，攻破瘀血并降逆，那么气平而血止了。小便尿血，是心移热于小肠，用清心莲子饮加柏叶、牛膝、小蓟主治。大便下血，是元气下陷，用补中益气汤加槐花、槐角、地榆主治。审察其虚实然后施治就可以了。至于鼻衄，血冲清道，四生丸最为巧妙。虚证则用生脉散加黄芪、芍药来收敛。牙龈出血，用六味丸加骨碎补。虚寒者，用八味丸加骨碎补，生脉散也有效。这哪里又是被固定法则所拘束的呢？
生地丹皮汤：治疗脉数、内热、咳嗽、痰中带血者。
怀生地、牡丹皮、川贝母（去心研碎）、麦门冬（去心）、广陈皮（各一钱）、炙甘草（三分）、沙参（一钱）。（如果不止血，加阿胶一钱，蛤粉炒成珠状）。加焙干的侧柏叶一钱，水煎服。如果是吐血，去掉麦冬，加荷叶、艾叶，或者加藕节、童便。
当归止血汤：治疗脉弦、胁痛、气逆者。
当归（一钱）、香附（一钱，酒制）、生地（一钱）、白芍药（一钱，酒炒）、牡丹皮（一钱）、苏子（一钱）、炙甘草（三分）、广陈皮（一钱）。加焙干的侧柏叶一钱，水煎服。
白芨汤：治疗内伤吐血。
白芨、茜草、生地、丹皮、牛膝、广皮、归尾（各一钱）。加荷叶蒂五个，水煎服。
补益方剂见前面的论述中。
Any disease that is to be feared is none more than hemorrhage. If it is not stopped urgently, danger and death will follow immediately. However, why does hemostasis fail, or recur repeatedly after being stopped? This is largely because physicians of the time adhered to theories such as "fire carrying blood upward" and "erratic flow of blood vessels," without seeking the root causes in Yin and Yang, and indiscriminately administered cold and cool herbs. In cases of excess fire, occasional success might be achieved, but for critical patients with deficiency, deaths would follow one after another. Chu Qixian sighed that among those taking cold and cool herbs, fewer than one in a hundred survived; was this an exaggeration? I ponder that within the human body, there are internal Zang-Fu organs and external skin and muscles, while blood flows quietly within. How can it be allowed to disperse and escape? Only when the Lung is injured does blood appear mixed with phlegm; when the Spleen is injured, blood scatters into saliva and phlegm; when the Liver is injured, blood coagulates into dark purple; when the Kidney is injured, blood comes out with coughing and spitting; when both the Heart and Kidney are injured, blood gushes out violently, filling basins. Although there are differences in the quantity of Qi and Blood among these organs, there is absolutely no case where true Yin is sufficient yet blood moves recklessly, nor is there a case where Yuan Qi is abundant yet fails to contain blood.
I often see people with hemorrhage; unless there is severe damage to the Zang-Fu organs, blood loss is not easy to occur. Once it occurs, recovery from the condition is difficult, which can be discerned. It relies entirely on finding the root cause to treat it. One may tonify Yang to consolidate the Qi of the Spleen and Lung, such as in cases with a yellowish-white complexion and a deficient, large, empty, and soft pulse. Or one may tonify Yin to consolidate the Qi of the Kidney and Liver, such as in cases with a red face, dry mouth, and a deficient, thin, wiry, and rapid pulse. However, while the principle of tonifying Yang is well understood, within the method of tonifying Yin, there are cases of declining Fire. The symptoms include a bluish-white complexion and a slow, weak pulse, or a pulse that becomes bounding upon palpation after taking cold and cool herbs. All these should be treated by guiding fire back to its source (Dao Huo Gui Yuan), such as using Ba Wei Wan (Eight-Ingredient Pill) to dissipate yin shadows (yin-cold pathogens). Did you not see Li Chan (Lizai) treating Zhang Donggu? He vomited one or two mouthfuls of blood upon exertion. Li Chan used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), adding Mai Men Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Shan Yao (Dioscoreae Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata), Fu Shen (Poria cum Radix), and Yuan Zhi (Polygalae Radix). Is this not tonifying the Spleen and Lung? Zhu Danxi often used Pao Jiang (Prepared Ginger) to stop bleeding. Miao Zhongren used Si Jun Zi Tang (Four Gentlemen Decoction) or Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandiae Radix), stating that ancient physicians often concluded treatment of blood disorders by regulating Stomach Qi. Is this not tonifying the Middle Jiao? Yang Kui stated that the Heart governs Blood, the Spleen envelops Blood, and the Liver stores Blood. Gui Pi Tang (Restore the Spleen Decoction) contains herbs for all three organs; using it rarely fails to produce miraculous effects. Is this not tonifying the Heart and Spleen?
I treated a friend, Wang Yigan, who vomited blood after excessive fatigue during the provincial examinations. The bleeding recurred despite repeated attempts to stop it. He had taken various Yin-tonifying herbs for over a year without effect. I observed his pale complexion, deficient, rapid, and powerless pulse, and noted that he did not feel heat intolerance. I said: "This is not only a deficiency of the Spleen and Lung, but also a decline of the Fire of the Gate of Vitality (Ming Men)." Therefore, I used Gui Pi Tang plus Pao Jiang (Prepared Ginger), Wu Wei Zi (Schisandrae Fructus), and doubled the amount of Ren Shen (Ginseng Radix). The bleeding subsided slightly. Occasionally, when I added Mai Men Dong (Ophiopogonis Radix), the condition reverted. Subsequently, I administered Ba Wei Wan (Eight-Ingredient Pill) continuously until the bleeding stopped. If the use of Ba Wei Wan was relaxed even slightly, the bleeding recurred. Later, he fathered two sons and resumed his examinations normally. Was this not tonifying the Ming Men? Thus, we know that substantial Blood depends on insubstantial Qi, and insubstantial Qi is nourished by the Fire of the Ming Men. As the saying goes: When Essence is sufficient, Qi is vigorous; when Qi is vigorous, Spirit arises. Spirit is the brilliance of Blood. Is this not true?
When observing ancient treatments for severe hemorrhage (Tuo Xue), they invariably used large doses of Du Shen Tang (Single Ginseng Decoction) to rescue the patient. Does this mean that if blood has not yet reached the stage of collapse, Ren Shen (Ginseng Radix) cannot be used? This is also something I do not understand. Therefore, in my treatment of hemorrhage, I must attend to the Spleen and Lung above, and nourish the Kidney Yuan below. I strictly prohibit the use of bitter-cold herbs to attack the body. Only then can I be worthy of the sages of old and prevent premature death.
Note: The above describes methods for treating the Five Zang organs. The Stomach is rich in both Qi and Blood. In sudden massive vomiting of blood, when the fire pathogen is blazing and intense, Si Sheng Wan (Four Generations Pill) must be used. Sheng Di Huang (Rehmanniae Radix) cools the Blood; He Ye (Nelumbinis Folium) and Bai Ye (Platycladi Cacumen) break up blood stasis; aided by the acrid-warm nature of Ai Ye (Artemisiae Argyi Folium), the blood will no longer stagnate but return to its vessels. For chest oppression due to Qi blockage and purple blood clots, this indicates blood depression in the upper jiao. Herbs such as Tao Ren (Persicae Semen), Zhi Ke (Aurantii Fructus), Chen Pi (Citri Reticulatae Pericarpium), and Xiang Fu (Cyperii Rhizoma) should be used to break stasis and descend rebellious Qi, thereby calming the Qi and stopping the bleeding. For hematuria, caused by Heart heat transferring to the Small Intestine, Qing Xin Lian Zi Yin (Clear the Heart and Lotus Seed Decoction) plus Bai Ye (Platycladi Cacumen), Niu Xi (Achyranthis Bidentatae Radix), and Xiao Ji (Cirsii Herba) is indicated. For hematochezia, caused by sinking of Yuan Qi, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huai Hua (Sophorae Flos), Huai Jiao (Sophorae Immaturus Fructus), and Di Yu (Sanguisorbae Radix) is indicated. Treatment should be based on an assessment of deficiency and excess. As for epistaxis, where blood rushes through the clear passages, Si Sheng Wan (Four Generations Pill) is most excellent. In deficiency cases, Sheng Mai San (Generate the Pulse Powder) plus Huang Qi (Astragali Radix) and Bai Shao (Paeoniae Radix Alba) should be used to astringe. For gingival bleeding, Liu Wei Wan (Six-Ingredient Pill) plus Gu Sui Bu (Drynariae Rhizoma) is used. In deficiency-cold cases, Ba Wei Wan (Eight-Ingredient Pill) plus Gu Sui Bu (Drynariae Rhizoma) is used; Sheng Mai San (Generate the Pulse Powder) is also effective. How could this be bound by rigid rules?
Sheng Di Dan Pi Tang (Rehmannia and Moutan Decoction): Treats conditions with rapid pulse, internal heat, cough, and blood-streaked sputum.
Huai Sheng Di (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, decentered and ground), Mai Men Dong (Ophiopogonis Radix, decentered), Guang Chen Pi (Citri Reticulatae Pericarpium) (each 1 qian), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (0.3 qian), Sha Shen (Glehniae Radix) (1 qian). (If bleeding does not stop, add E Jiao (Asini Corii Colla) 1 qian, stir-fried with Ge Fen (Calcitris) until pearl-like). Add 1 qian of baked Bian Bai Ye (Platycladi Cacumen). Decoct in water and take orally. For vomiting blood, remove Mai Men Dong (Ophiopogonis Radix) and add He Ye (Nelumbinis Folium) and Ai Ye (Artemisiae Argyi Folium), or add Ou Jie (Nelumbinis Node) and Tong Bian (Human Urine).
Dang Gui Zhi Xue Tang (Angelica Hemostatic Decoction): Treats conditions with wiry pulse, hypochondriac pain, and rebellious Qi.
Dang Gui (Angelicae Sinensis Radix) (1 qian), Xiang Fu (Cyperi Rhizoma) (1 qian, prepared with wine), Sheng Di (Rehmanniae Radix) (1 qian), Bai Shao (Paeoniae Radix Alba) (1 qian, stir-fried with wine), Mu Dan Pi (Moutan Cortex) (1 qian), Su Zi (Perillae Fructus) (1 qian), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (0.3 qian), Guang Chen Pi (Citri Reticulatae Pericarpium) (1 qian). Add 1 qian of baked Bian Bai Ye (Platycladi Cacumen). Decoct in water and take orally.
Bai Ji Tang (Bletilla Decoction): Treats internal injury causing vomiting of blood.
Bai Ji (Bletillae Rhizoma), Qian Cao (Rubiae Radix et Rhizoma), Sheng Di (Rehmanniae Radix), Dan Pi (Moutan Cortex), Niu Xi (Achyranthis Bidentatae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gui Wei (Angelicae Sinensis Radix Tail) (each 1 qian). Add five He Ye Di (Nelumbinis Petiole Nodes). Decoct in water and take orally.
Tonifying formulas are found in the preceding discussion.