治吐血者，兢推可久。而葛先生首以二方为止血要着，明明劫剂，毫无顾忌。予由绎之
，始
，发热面红，无不相因而致，故留得一分自家之血，即减得一分上升之火，易为收拾。何今
日之医，动以引血归经为谈，不可概用止血之味，甚至有血溢于外，吐出亦美，壅反为害。
遂令病者信之，迁延时日，阴虚阳旺，煎熬不止，至于不救，果谁之咎？倘谓引经，可必不
妨少俟几日，后用补阴，元神可复。吾恐有形之血，岂能使之速生？而无偶之阳，何法使之
速降？予所以一再思惟，而悟先生急于止血之大旨也。
潘按∶《金匮》治虚痨症，以补虚、祛风、逐瘀为三大纲，此不易之准绳。
陈修园按∶虚痨症，《金匮》以桂枝加龙骨牡蛎汤，从肾虚以立法；建中汤，从脾以立
法；
立法，是以补虚为一大纲也。以薯蓣丸治风气百疾，虚羸诸不足，是以祛风为一大纲也。以
大黄 虫丸，治干血成痨，是以逐瘀为一大纲也。三纲鼎足，为此症不易之准绳。今葛仙翁
以花蕊石散，继于十灰散之后，虽云止血，实欲使瘀血化为黄水而不见血也。然自余思之，
吐血既止，而离经之血，蓄而不行，不可不用此散化之。若血来势如涌泉，相续不绝，竟用
此散，令其尽化为水，是令一身之血，俱归乌有，尚有生理乎？读书不可死于句下，此其一
也。且三大纲因虚而成痨，医书恒有治法，而因风而致者，言之颇罕，而因瘀血而致者，除
仲景《金匮》大黄 虫丸，仲景短剧百痨丸外，未有发明其旨。且《金匮》以薯蓣丸与大黄
虫丸并举，意以风气不去，则足以贼正气而生长不荣，干血不去，则足以留新血而渗灌不
周，怯症种种所由来也。余治吐血诸药不止者，用《金匮》泻心汤，百试百效，其效在生大
黄之多，以行瘀也。附录仲景百痨丸方，当归炒乳香没药各一钱，人参分数阙，虻虫十四个
去翅足，水蛭十四个，炒桃仁十四粒，去皮尖，大黄四钱，蜜丸如梧桐子大，都作一服可百
丸，五更用百劳水下，取恶物为度，服白粥十日。百劳水者，杓扬百遍，即甘澜水也。（
虫，一名地鳖。）
潘按∶薯蓣丸治虚痨诸不足，风气百疾。 虫丸治五痨诸伤，内有干血。肌肤甲错，风
气不
虫丸专治瘀血成痨之症。
治疗吐血病症，人们往往推崇能够长期服用的药物。然而葛先生首先将两个方剂作为止血的关键措施，这明明是峻猛的攻伐之剂，却毫无顾忌地使用。我由此推究其意，发现发热、面红等症状，无不因此（指瘀血或火热）而引发，所以每保留一分自身的血液，就能减少一分上冲的火势，病情就容易收拾。为什么现在的医生，动不动就谈论“引血归经”，认为不能一概使用止血药，甚至有观点认为血溢出体外，吐出来也是好的，如果让血留在体内反而为害。于是让病人相信这种说法，拖延时日，导致阴虚阳亢，煎熬不止，最终到了无法救治的地步，这究竟是谁的过错？如果说要引血归经，不妨稍微等待几天，之后再使用补阴药，元神或许可以恢复。但我担心有形的血液，怎么能迅速生成？而无偶配的阳气，又有什么方法能使其迅速下降？所以我反复思考，才领悟到葛先生急于止血的深意。
潘按语：《金匮要略》治疗虚劳病证，以补虚、祛风、逐瘀为三大纲领，这是不可改变的标准准则。
陈修园按语：虚劳病证，《金匮要略》用桂枝加龙骨牡蛎汤，从肾虚的角度确立治法；小建中汤，从脾虚的角度确立治法；这是以补虚作为一大纲。用薯蓣丸治疗风气百疾、身体虚弱消瘦等各种不足，这是以祛风作为一大纲。用大黄䗪虫丸，治疗干血形成的劳损，这是以逐瘀作为一大纲。三大纲领鼎足而立，是此症不可改变的标准准则。现在葛仙翁在花蕊石散之后，继以十灰散，虽然说是止血，实际上是想要使瘀血化为黄水而不显现出血来。然而从我个人的思考来看，吐血既然停止，但离经之血蓄积而不运行，不可以不用这个方剂来化解它。如果血流势如涌泉，连续不断，竟然只用这个方剂，让它全部化为水，这是让全身的血液都归于乌有，还有生机吗？读书不能死在句子的字面意思下，这是一点。而且这三大纲领是因为虚而成劳，医书中常有治法，但因风邪导致的，提及很少，因瘀血导致的，除了仲景《金匮要略》的大黄䗪虫丸、仲景的短剧百劳丸外，没有其他人阐明其旨意。而且《金匮要略》将薯蓣丸与大黄䗪虫丸并列，意思是风气不去除，就足以伤害正气而生长不荣；干血不去除，就足以阻碍新血生成而渗透灌溉不周，怯症种种症状由此而来。我治疗各种吐血药物无效时，使用《金匮要略》的泻心汤，百试百灵，其效果在于重用生大黄，以行瘀血。附录仲景百劳丸方：当归炒、乳香、没药各一钱，人参分数阙（此处原文可能有误或省略），虻虫十四个去翅足，水蛭十四个，炒桃仁十四粒去皮尖，大黄四钱，蜜丸如梧桐子大小，总共做成一次服用的一百丸，五更天用百劳水送服，以排出恶物为度，服药后喝白粥十天。百劳水，就是勺子扬水一百遍，也就是甘澜水。（䗪虫，一名地鳖。）
潘按语：薯蓣丸治疗虚劳诸不足，风气百疾。䗪虫丸治疗五劳诸伤，内有干血。肌肤甲错，风气不...（注：原文此处似有缺漏或排版错误，依文意理解为䗪虫丸专治瘀血成劳之症）。
For the treatment of hematemesis (vomiting blood), people often advocate for drugs that can be taken over a long period. However, Mr. Ge first presented two formulas as key measures for stopping bleeding. These are clearly drastic purgative agents, yet they were used without any hesitation. By deducing from this, I realized that symptoms such as fever and facial redness are invariably caused by this condition. Therefore, preserving one part of one's own blood reduces one part of the rising fire, making the condition easier to manage. Why do physicians today constantly talk about "guiding blood back to its vessels," claiming that hemostatic agents cannot be used indiscriminately? Some even argue that if blood溢s outside the body and is vomited out, it is beneficial, whereas retaining it inside causes harm. Consequently, patients believe this, delaying treatment until yin deficiency and yang hyperactivity cause continuous simmering, leading to an incurable state. Whose fault is this? If one argues for guiding blood back to its vessels, one might wait a few days before using yin-nourishing herbs, hoping the primordial spirit can recover. However, I fear how can有形 (substantial) blood be generated quickly? And what method can rapidly descend unpaired yang? Thus, after repeated contemplation, I understood Mr. Ge's main intent in urgently stopping bleeding.
Pan's Commentary: In treating consumptive disease (Xu Lao), *Jin Gui Yao Lue* establishes three major principles: tonifying deficiency, dispelling wind, and removing blood stasis. These are unchangeable standards.
Chen Xiuyuan's Commentary: For consumptive disease, *Jin Gui Yao Lue* uses Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) to establish treatment based on kidney deficiency; Jianzhong Tang (Middle-Jian Decoction) to establish treatment based on spleen deficiency. This constitutes the principle of tonifying deficiency. Shuyu Wan (Dioscorea Pill) is used to treat various diseases caused by wind qi and general weakness and insufficiency, constituting the principle of dispelling wind. Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is used to treat labor caused by dry blood, constituting the principle of removing blood stasis. These three principles stand firm like the legs of a tripod, serving as the unchangeable standard for this disease. Now, Ge Xianweng follows Shihui San (Ten Ashes Powder) with Huarui Shi San (Flower Stalactite Powder). Although stated as stopping bleeding, its actual purpose is to transform blood stasis into yellow fluid so that no blood is visible. However, from my perspective, once hematemesis stops, the blood that has left its vessels accumulates and does not circulate; it is necessary to use this powder to resolve it. If the bleeding is profuse like a gushing spring and continuous, using only this powder to convert all blood into water would mean losing all blood in the body, leaving no vitality? One must not interpret texts literally; this is one point. Furthermore, while these three principles address labor caused by deficiency, with many treatments recorded in medical books, those caused by wind are rarely mentioned, and those caused by blood stasis are elucidated only by Zhang Zhongjing's *Jin Gui Yao Lue* Dahuang Zhechong Wan and his Duanju Bailao Wan. Moreover, *Jin Gui Yao Lue* pairs Shuyu Wan with Dahuang Zhechong Wan, implying that if wind qi is not removed, it damages righteous qi and hinders nourishment; if dry blood is not removed, it obstructs new blood generation and impedes circulation, giving rise to various symptoms of timidity and weakness. When treating hematemesis where other herbs fail, I use Xie Xin Tang (Drain the Epigastrium Decoction) from *Jin Gui Yao Lue*, which is effective every time. Its efficacy lies in the heavy use of raw Dahuang (Rhei Radix et Rhizoma) to move blood stasis. Appendix: Formula for Zhongjing's Bailao Wan: Danggui (Angelicae Sinensis Radix) stir-fried, Ruxiang (Olibanum), Moyao (Myrrha) each 1 qian; Ren Shen (Ginseng Radix) amount missing; Mengchong (Blatta Orientalis) 14 pieces, wings and feet removed; Shuizhi (Hirudo) 14 pieces; Taoren (Persicae Semen) 14 pieces, stir-fried, skin and tips removed; Dahuang (Rhei Radix et Rhizoma) 4 qian. Honey-pilled to the size of wutong seeds. Total quantity makes one dose of 100 pills. Take at dawn (5-7 AM) with Billaoshui (Bailao Water), aiming to expel foul matter. Eat white porridge for ten days after taking the medicine. Billaoshui is made by scooping and pouring water 100 times, also known as Ganlan Shui (Sweet Ripple Water). (Zhechong, also known as Dibie.)
Pan's Commentary: Shuyu Wan treats various deficiencies of consumptive disease and diseases caused by wind qi. Zhechong Wan treats injuries from the five labors with internal dry blood. It addresses rough, scaly skin and wind qi... [Text implies] Zhechong Wan specifically treats labor caused by blood stasis.