总括 九道何为血妄行，只因抑郁热邪生；随经施治明虚实，气顺如常血自行。
脉法 吐血脉滑小弱者生，实大者死。
《内经》曰∶清者为荣，浊者为卫。荣行脉中，卫行脉外。盖荣者水谷之精气也，和调于五脏，洒陈于六腑，故能
入于脉。夫荣者阴血也，所注在心，统化在脾，藏纳在肝，宣布在肺，输泻在肾。灌溉一身，滋养百脉。诸经由此而生
毓焉。然血之所统者气也。气主 之，血主濡之，是以气行则血行，气止则血止，阳生阴长，夫倡妇随之道也。若气一
伤则变症百出，故妄行则吐衄，衰涸则虚劳，降下则便红，热陷则溺赤，渗于肠胃则为肠风。阴虚阳搏则为崩漏，此皆
气有殄戾之乖，而血有渗溢之患也，养阴者可不先知养阳之道乎。
巢氏曰∶吐血者是热气盛而血虚，热乘于血，血性得热则流散妄行，气逆则血随气上，故令吐血也。或食饱之后，
脾胃内冷不能消化，忽吐所伤之物，气血相冲，因伤肺胃亦令吐血。若久嗽气逆，面目浮肿而吐血，是肺虚损也，服柏
枝饮、犀角地黄汤。
衄血者是五脏热结所为也，血随气行，通流脏腑，冷热调和，不失常道，无有壅塞，亦不流溢，血得寒而凝结，得
热而流散，热乘于血，血随气发溢，出于鼻窍也。又有因伤寒瘟疫，诸阳受病不得发越，热毒停聚五脏，故从鼻出也，
龙胆丸、柏皮汤、胶黄散治之。
大便下血者，是大肠热结，损伤所为也。脏气既伤，风邪自入，或蓄热，或积冷，或湿热藏于脾胃，或疳食伤于脏
腑，因兹疳热冷湿互作，致动血气停流于内，凝聚无归，渗入肠中，故大便下血也。或有腹胀，冷气在内攻，亦令大便
下血。又因风冷乘虚，客入脾胃，或瘀血在于肠间，湿毒下如豆汁。又疳伤于脏，亦能便血。若上焦心肺积热，流注于
大肠，亦令大便下血也。
亡血者，脾热必渴，久则血虚，其人必肌体萎黄，头发不黑，宜五倍丸服之。
溺血者，盖心主血，与小肠相合，血之流行，周遍经络，循环脏腑，若热聚膀胱，血渗入胞，故小便出血也，火府
丹服之。如实热用清心莲子饮，虚热用六味地黄丸。
（批∶血溢、血泄、诸蓄妄症，其治也，当以大黄、桃仁行血破瘀之剂，折其锐气而后区别治之。善医者每治失血
蓄妄，必先以快药治之。或问失血复下，虚何以当？曰∶血既妄行，迷失故道，不去蓄利，以妄为常，曷以御之，且去
者自去，生者自生。）
补遗∶
《内经》曰∶阳明厥逆，喘嗽身热，善惊、衄血、吐血。又曰∶脾遗热于肝，则为惊衄。胞移热于膀胱，则为癃而
溺血。小儿吐血者，荣卫气逆也，荣卫相济，不失常道，有所胜则致妄行血水也，决东则东、决西则西。气之使血，其
势然也。
〔附方〕
柏枝饮（治吐血衄血） 干柏枝 干藕节 为末入蜜，沸汤调下。一方加白芍、犀角汁同服。
犀角地黄汤 犀角 赤芍 丹皮 生地
龙胆丸（止血） 黄连 胆草
枯皮汤 柏皮 山栀 甘草
胶黄散（治口鼻耳出血） 阿胶（一两） 蒲黄（五钱）加生地汁服。
五倍丸 以五倍末之，蜜丸，绿豆大，一岁用十丸，米汤空心下。
火府丹 见热症内。
清心莲子饮 黄芩 门冬 骨皮 甘草 车前子 石莲 茯苓 黄 柴胡 如虚加人参。
总括：九道中为何会出现血液妄行？只因为情志抑郁导致热邪产生；根据病邪所在的经络进行治疗，辨明虚实，气机顺畅后血液自然恢复正常运行。
脉法：吐血患者若脉象滑、小、弱则预后良好（生），若脉象实、大则预后不良（死）。
《黄帝内经》说：清轻的部分成为营气，浑浊的部分成为卫气。营气在脉管内运行，卫气在脉管外运行。所谓营气，是水谷精微中的精气部分，它调和于五脏，散布于六腑，因此能够进入脉管。营气属于阴血，其灌注中心在心，统摄化源于脾，贮藏于肝，宣发肃降由肺负责，输注排泄归于肾。它灌溉全身，滋养百脉，各条经脉都由此生长孕育。然而，血液的统摄依靠的是气。气主要推动血液运行，血主要濡养身体，所以气行则血行，气止则血止，这是阳生阴长、如夫唱妇随的道理。如果气受到损伤，就会变症百出，因此气乱则血液妄行出现吐血、鼻衄，气衰枯竭则形成虚劳，血下行则便血，热邪下陷则小便赤红，渗入肠胃则为肠风。阴虚而阳脉搏击则导致崩漏，这些都是因为气机乖戾失常，而血液有渗漏溢出的祸患，想要滋养阴血的人，难道不先要知道养护阳气的方法吗？
巢元方说：吐血是因为热气盛而血虚，热邪侵袭血液，血液性质受热则流散妄行，气机上逆则血液随气上冲，所以导致吐血。或者在吃饱饭后，脾胃内部寒冷不能消化食物，突然吐出所伤之物，气血相互冲撞，因而损伤肺胃也导致吐血。如果久咳导致气机上逆，面目浮肿且吐血，这是肺虚损的表现，服用柏枝饮、犀角地黄汤。
衄血（鼻出血）是五脏热结所致，血液随气运行，流通脏腑，冷热调和，不失常道，没有壅塞，也不流溢，血液遇寒则凝结，遇热则流散，热邪侵袭血液，血液随气发散溢出，从鼻窍流出。又有因伤寒瘟疫，诸阳经受病不得发散，热毒停聚在五脏，所以从鼻子流出，用龙胆丸、柏皮汤、胶黄散治疗。
大便下血，是大肠热结，损伤所致。脏气既已受伤，风邪自行侵入，或者是蓄积热邪，或者是积存冷邪，或者是湿热藏在脾胃，或者是疳积饮食损伤了脏腑，因此疳热与冷湿互相作用，致使动血之气停滞流淌在内，凝聚无处归依，渗入肠中，所以大便下血。或者有腹胀，冷气在体内攻冲，也导致大便下血。又因风冷乘虚客入脾胃，或者瘀血在肠间，湿毒下泄如豆汁。还有疳积损伤脏腑，也能导致便血。如果上焦心肺积热，流注到大肠，也导致大便下血。
亡血（失血过多），脾热必然口渴，久了则血虚，其人必定肌肤萎黄，头发不黑，适宜服用五倍丸。
溺血（尿血），盖因心主血，与小肠相合，血液流行，周遍经络，循环脏腑，如果热邪聚集在膀胱，血液渗入膀胱胞宫，所以小便出血，服用火府丹。如果是实热证用清心莲子饮，虚热证用六味地黄丸。
（批注：对于血溢、血泄、各种蓄积妄行之症，治疗时应当先用大黄、桃仁等行血破瘀的药剂，挫败其锐气之后，再区别对待进行治疗。善于治病的医生每次治疗失血蓄积妄行之症，必定先用峻烈药物（快药）治疗。有人问：失血后又用泻下药，虚弱之体怎能承受？回答说：血液既然妄行，迷失了原来的道路，如果不去除蓄积利导，以妄行为常态，用什么来抵御呢？况且去者自去，生者自生。）
补遗：
《黄帝内经》说：阳明经气厥逆，气喘咳嗽身热，容易惊恐、衄血、吐血。又说：脾将热邪遗留给肝，则导致惊悸和衄血。胞室的热邪移交给膀胱，则导致小便不通和尿血。小儿吐血，是营卫气机逆乱所致，营卫相互济助，不失常道，如果有偏胜就会导致血液和水液妄行，决口向东则流向东方，决口向西则流向西方。气驱使血，其势态就是这样的。
〔附方〕
柏枝饮（治疗吐血、衄血） 干柏枝、干藕节，研为末，加入蜂蜜，用沸水调服。另一配方加白芍、犀角汁同服。
犀角地黄汤 犀角、赤芍、丹皮、生地
龙胆丸（止血） 黄连、胆草
枯皮汤（原文作“枯皮汤”，疑为“柏皮汤”之误或异名，此处依原文翻译） 柏皮、山栀、甘草
胶黄散（治疗口、鼻、耳出血） 阿胶（一两）、蒲黄（五钱），加生地汁服用。
五倍丸 将五倍子研末，蜜丸，绿豆大小，一岁的患儿用十丸，空腹米汤送下。
火府丹 见热症章节内。
清心莲子饮 黄芩、门冬、骨皮、甘草、车前子、石莲、茯苓、黄（疑为黄芪或黄柏，原文缺字，暂译音）、柴胡。如属虚证加人参。
General Principles: Why does blood run recklessly among the nine pathways? It is solely due to emotional depression generating heat pathogens; treating according to the affected meridians and clarifying deficiency and excess, once qi flows smoothly, blood will naturally return to normal circulation.
Pulse Diagnosis: For patients with hematemesis (vomiting blood), if the pulse is slippery, small, or weak, prognosis is good; if the pulse is excessive or large, prognosis is fatal.
The *Neijing* states: The clear part becomes Ying (Nutrient) Qi, and the turbid part becomes Wei (Defensive) Qi. Ying circulates within the vessels, while Wei circulates outside the vessels. Ying refers to the essence of water and grain, which harmonizes with the five Zang organs and distributes to the six Fu organs, thus entering the vessels. Ying belongs to Yin Blood; it is infused in the Heart, governed and transformed by the Spleen, stored in the Liver, disseminated by the Lung, and transported and excreted by the Kidney. It irrigates the whole body and nourishes all vessels, from which all meridians grow and develop. However, what governs blood is Qi. Qi primarily moves blood, and blood primarily moistens the body; therefore, when Qi moves, blood moves, and when Qi stops, blood stops. This follows the principle of Yang generating Yin and growing, like a husband leading and a wife following. If Qi is injured, myriad symptoms arise; thus, Qi disorder causes blood to run recklessly resulting in hematemesis or epistaxis, Qi depletion leads to consumptive disease, blood descending results in hematochezia, heat sinking causes dark urine, and seeping into the intestines and stomach results in intestinal wind. Yin deficiency with Yang pulsation leads to metrorrhagia and metrostaxis. These are all due to Qi deviating from its proper course and blood suffering from leakage and overflow. Those who wish to nourish Yin must first know the way to nourish Yang.
Chao Yuanfang stated: Hematemesis occurs when heat is abundant and blood is deficient. Heat attacks the blood, and since blood tends to scatter and run recklessly when heated, combined with rebellious Qi causing blood to rise with Qi, hematemesis results. Alternatively, after a full meal, if the interior of the Spleen and Stomach is cold and unable to digest food, suddenly vomiting the damaged matter causes Qi and Blood to clash, injuring the Lung and Stomach, also leading to hematemesis. If chronic coughing causes Qi rebellion, accompanied by facial and ocular edema and hematemesis, this indicates Lung deficiency and damage; treat with Baizhi Yin (Cypress Branch Drink) or Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).
Epistaxis (nosebleed) is caused by heat accumulation in the five Zang organs. Blood follows Qi, circulating through the organs; when cold and heat are harmonized and do not deviate from the norm, there is no congestion nor overflow. Blood coagulates when cold and scatters when heated. When heat attacks blood, blood scatters with Qi and overflows from the nasal cavity. Additionally, due to cold damage or plague, where Yang meridians are diseased and cannot vent, heat toxins accumulate in the five Zang organs, causing bleeding from the nose. Treat with Longdan Wan (Gentian Pill), Baipi Tang (Cypress Bark Decoction), or Jiahuang San (Gelatin and Rhubarb Powder).
Hematochezia (blood in stool) is caused by heat accumulation in the Large Intestine and damage. Once organ Qi is injured, Wind pathogens enter spontaneously, or there is accumulated heat, accumulated cold, damp-heat hidden in the Spleen and Stomach, or malnutrition-dietary injury to the organs. Consequently, malnutrition-heat and cold-dampness interact, disturbing Qi and Blood, causing stagnation and flow internally, condensing without returning, and seeping into the intestines, resulting in hematochezia. Abdominal distension with internal cold attacking can also cause hematochezia. Furthermore, wind-cold invading the Spleen and Stomach due to deficiency, or blood stasis in the intestines, may result in damp-toxin discharge resembling bean curd dregs. Malnutrition damaging the organs can also cause bloody stools. If heat accumulates in the Upper Jiao (Heart and Lungs) and flows into the Large Intestine, it also causes hematochezia.
Excessive blood loss: Spleen heat inevitably causes thirst; prolonged deficiency leads to blood deficiency, manifesting as sallow complexion and black hair loss. Treat with Wubei Wan (Chinese Gall Pill).
Hematuria (blood in urine): The Heart governs blood and pairs with the Small Intestine. Blood circulates through meridians and organs. If heat gathers in the Bladder, blood seeps into the bladder sac, causing blood in urine. Treat with Huofu Dan (Fire Mansion Pill). For excess heat, use Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink); for deficiency heat, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
(Preface: For conditions of blood overflowing, leaking, and various forms of reckless accumulation, treatment should initially employ agents that move blood and break stasis, such as Dahuang (Rhubarb Root) and Taoren (Peach Kernel), to curb their aggressive nature before differentiating and treating further. Skilled physicians always treat hemorrhagic and reckless accumulation conditions first with strong purgatives. One might ask: After losing blood, how can a deficient body withstand purgation? The answer is: Since blood has run recklessly and lost its original path, if one does not remove the accumulation and promote drainage, allowing recklessness to become the norm, how can one control it? Moreover, what leaves departs, and what generates regenerates.)
Supplementary Notes:
The *Neijing* states: Rebellious Qi in the Yangming Meridian causes wheezing, coughing, body heat, fright, epistaxis, and hematemesis. It also states: If the Spleen transmits heat to the Liver, it causes fright and epistaxis. If heat from the Bao (Uterus/Bladder area) transfers to the Bladder, it causes strangury and hematuria. In children, hematemesis is due to rebellious Ying and Wei Qi. When Ying and Wei assist each other and follow the proper path, any excess leads to reckless flowing of blood and fluids; if the channel is broken eastward, it flows east; if westward, it flows west. Qi drives blood, and this is its natural tendency.
[Attached Formulas]
Baizhi Yin (Treats hematemesis and epistaxis): Ginkgo Branch (Dried Cypress Branch) and Lotus Root Node (Dried), ground into powder, mixed with honey, taken with boiling water. Another prescription adds Baishao (White Peony Root) and Xijiao juice (Rhino Horn Juice).
Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction): Xijiao (Rhino Horn), Chishao (Red Peony Root), Danpi (Moutan Cortex), Shengdi (Rehmannia Root).
Longdan Wan (Stop Bleeding): Huanglian (Coptis Rhizome), Danshen/Danchao (Gentian Root - note: text says Dancao/Gentian).
Kupi Tang (Cypress Bark Decoction): Baipi (Cypress Leaf/Bark), Zhizi (Gardenia Fruit), Gancao (Licorice Root).
Jiahuang San (Treats bleeding from mouth, nose, ears): Ejiao (Donkey-hide Gelatin, 1 liang), Puhuang (Pollen Typhae, 5 qian), taken with Shengdi juice (Rehmannia Root Juice).
Wubei Wan: Chinese Gall (Wubeizi) ground into powder, made into pills with honey, size of mung beans. Infants take 10 pills on an empty stomach with rice soup.
Huofu Dan: See section on Heat Syndromes.
Qingxin Lianzi Yin: Huangqin (Scutellaria Root), Mendong (Ophiopogon Tuber), Guopi (Phellodendron Bark), Gancao (Licorice Root), Cheqianzi (Plantago Seed), Shilian (Lotus Seed), Fuling (Poria), Huang [missing character, likely Huangqi or Huangbai], Chaihu (Bupleurum Root). Add Renshen (Ginseng) for deficiency.