《千金翼》治舌上黑，有数孔出血如涌泉，此心脏病也方。
戎盐 黄芩 黄柏 大黄（各五两） 人参 桂心（各二两） 甘草（一两，炙）
上七味，末之，炼蜜丸，如梧子。每服十丸，日三服。仍烧铁烙之。
〔曾〕小儿九道出血，何为而然？盖人之所有者，血与气也，心者，血之主，肺
者，气之主，气主 之，血主濡之，荣养百骸，灌溉丝脉，升降上下，荣卫谐和，
自然顺适，一或不调，疾由生矣，或外为六淫所侵，内因七情所沮，气乃留而不行，
血乃壅而不濡，内外抑郁，不能流注以荣于身，必有妄动之患。叔和以芤脉为失血
之义，在七表属阳故也，阳明主乎多气多血，未有不因热而得，盖气血俱热，热郁
内逼，失其常度，是以妄行。有在襁褓患此证者，固非七情所伤，皆因乳母执着，
不自宽释，及啖辛辣之物，流于乳络，儿饮之后，停滞不散，郁蒸于内，亦能动血。
或居重帏暖阁，火气熏逼，不令常见风日，积温成热，热种则涌泄，或吐或衄，或
大小腑亦多血来者。有气虚而邪热乘之，则血不得循流故道，渗于诸经，亦生走失
之证，其面 白，脉沉微，血淡紫，口气缓，是也。又况婴孩脆弱，易虚易实，因
热内攻，血随气行，或壅而上逆，或下而忘返，遂有吐血、衄血、泻血、溺血之
证，然而血不苟动，因气使之，风不自生，因热而起，由是而论，可以类推。治法，
先明虚实，审得病源，随经施治，药饵无瘥，则不失其机要。实则小柴胡汤加生地
黄、丝茅根，或苦参亦好，并用水煎服。或 咀五苓散合五和汤，亦加丝茅根、苦
参、水煎，及投消毒饮。次用《局方》鸡苏丸、三黄丸、间服。虚则理中汤，及人
参芎归汤皆可服。间有医者见其血盛，以为热极，过投凉剂，遂使血寒不能归源而
妄流，其色紫黯而凝滞，或成小片，当服姜附之剂以温之，自然流畅，毋致妄行为佳。
小柴胡汤（潮热） 五苓散（惊） 五和汤（里热） 消毒饮（喉痹） 《局方》
鸡苏丸（大吐血） 三黄丸（里热） 理中汤（吐泻）
人参芎归汤 治九道血妄行。
人参（去芦） 川芎 当归（酒洗。各半两） 荆芥（二钱半）
上每服二钱，水一盏，煎七分，温服，无时。
黄芩丸 治小儿衄血、吐血、下血。
上，以黄芩为末，炼蜜、丸如鸡头大。三岁一丸，浓盐汤下。柏叶、石榴花，
为末吹鼻，治衄血吐血。一方，定州瓷器末，治呕血，破血止血。
茅花汤 治鼻衄不止，吐血下血。
用茅花一大把，水三盏，煎浓汁一盏，分二服，即瘥。无花，根梗代之。兼治
血痢黑痢。
《千金翼方》记载治疗舌面发黑，且有多个孔窍出血如涌泉般的情况，这是针对心脏病变的方剂。
戎盐、黄芩、黄柏、大黄（各五两）、人参、桂心（各二两）、甘草（一两，经蜜炙）。
以上七味药，研成细末，用炼过的蜂蜜制成丸药，大小如梧桐子。每次服用十丸，每日三次。同时烧红铁器进行烙烫止血。
〔曾氏〕小儿九窍出血，为什么会这样？大概来说，人拥有的主要是血和气。心是血的主宰，肺是气的主宰。气主要推动运行，血主要滋润濡养，营养全身骨骼脉络，灌溉细微血管，升降于上下周身，营卫之气协调和谐，自然顺畅适宜。一旦不调和，疾病就会产生。或者外受六淫（风、寒、暑、湿、燥、火六种外感病邪）侵袭，内因七情（喜、怒、忧、思、悲、恐、惊七种情志变化）阻碍，导致气滞留而不能运行，血壅塞而不能濡养。内外郁结，不能流注以滋养身体，必然产生妄动出血的祸患。王叔和认为芤脉（浮大中空，如按葱管）代表失血的意义，因为它在七表脉中属于阳脉。阳明经主多气多血，没有不是因为热邪而导致的，大概是气血俱热，热邪郁结在内逼迫，失去了正常的度，所以血液妄行。有在婴儿期患此证的，固然不是由七情所伤，都是因为乳母情绪执着，不能自我宽解，以及食用辛辣食物，热气流入乳络，婴儿饮用后，停滞不散，郁积蒸腾于体内，也能引动出血。或者居住在厚重的帷帐和温暖的阁室里，火气熏蒸逼迫，不让常见风吹日晒，积温而成热，热邪种子则导致涌泄，有的呕吐，有的鼻衄，有的大小便也多有出血。有气虚而邪热乘虚而入的，则血不能循着正常通道流动，渗入各条经脉，也会产生失血的证候，表现为面色苍白，脉象沉微，血色淡紫，口气缓弱，就是这种情况。更何况婴孩体质脆弱，容易虚也容易实，因热邪内攻，血随气行，或者壅滞而上逆，或者下行而忘返，于是出现吐血、鼻衄、便血、尿血的证候。然而血不轻易妄动，是因为气使之然；风不自生，是因为热而起。由此而论，可以类推。治疗方法，先明确虚实，审察病因，根据经络施治，如果药物无效，就不会错过关键时机。实证用小柴胡汤加生地黄、白茅根，或者苦参也好，一并用水煎服。或者将五苓散与五和汤合用，也加入白茅根、苦参，水煎，并投予消毒饮。其次使用《太平惠民和剂局方》中的鸡苏丸、三黄丸，交替服用。虚证则服用理中汤，以及人参芎归汤都可以服用。间或有医生见其出血量大，认为是热极，过量投用凉性药剂，致使血寒不能归源而妄流，血色紫暗而凝滞，或结成小片，应当服用姜附类药剂以温之，自然流畅，不要导致妄行为佳。
小柴胡汤（主治潮热） 五苓散（主治惊悸） 五和汤（主治里热） 消毒饮（主治喉痹） 《局方》鸡苏丸（主治大吐血） 三黄丸（主治里热） 理中汤（主治吐泻）
人参芎归汤 治疗九窍血液妄行。
人参（去芦头）、川芎、当归（酒洗，各半两）、荆芥（二钱半）。
以上每服二钱，用水一盏，煎至七分，温服，不拘时候。
黄芩丸 治疗小儿鼻衄、吐血、下血。
以上，以黄芩为细末，用炼蜜制成如鸡头大小的丸药。三岁儿童服一丸，用浓盐水送下。柏叶、石榴花，研成细末吹入鼻腔，治疗鼻衄吐血。另一方案，定州瓷器末，治疗呕血，破血止血。
茅花汤 治疗鼻衄不止，吐血下血。
用茅花一大把，水三盏，煎取浓汁一盏，分两次服用，即可痊愈。如果没有花，用根梗代替。兼治血痢和黑痢。
The *Qianjin Yi* records a prescription for treating a black tongue with multiple pores bleeding like a gushing spring; this is a formula for heart disease.
Rongyan (Halite), Huangqin (Scutellariae Radix), Huangbai (Phellodendri Cortex), Dahuang (Rhei Radix et Rhizoma) (each 5 liang), Renshen (Ginseng Radix), Guixin (Cinnamomi Ramulus) (each 2 liang), Gancao (Licorice Radix et Rhizoma) (1 liang, honey-fried).
The above seven ingredients are powdered, mixed with refined honey to form pills the size of a Chinese quince seed. Take ten pills per dose, three times daily. Additionally, apply cauterization with a heated iron tool.
[Zeng] Why does hemorrhage from the nine orifices occur in children? Generally, what humans possess is blood and qi. The Heart is the master of blood, and the Lungs are the master of qi. Qi primarily governs movement, while blood primarily nourishes and moistens, benefiting the bones and meridians, irrigating the collaterals, ascending and descending throughout the body, ensuring harmony between Ying (Nutritive) and Wei (Defensive) qi, thus maintaining natural smoothness. If harmony is disrupted, disease arises. This may be due to external invasion by the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or internal obstruction by the Seven Emotions (Joy, Anger, Worry, Pensive thought, Sorrow, Fear, Fright). Consequently, qi stagnates and fails to move, and blood becomes obstructed and fails to nourish. Internal and external depression prevents flow and nourishment, inevitably leading to reckless bleeding. He Hanyuan stated that the Kou pulse (Hollow pulse) signifies blood loss because it belongs to the Yang aspect among the seven superficial pulses. The Yangming channel governs abundant qi and blood, and conditions there rarely arise without heat. It is likely that both qi and blood are hot, with heat constrained internally forcing its way out, losing its normal regulation, thereby causing reckless bleeding. Infants suffering from this condition are certainly not injured by the Seven Emotions; rather, it is often due to the wet nurse's emotional fixation and inability to relax, or consumption of spicy foods, allowing heat to enter the milk channels. After the infant drinks, the heat stagnates and steams internally, also provoking bleeding. Alternatively, residing in heavy curtains and warm rooms, subjected to the薰逼 (pungent pressure) of fire heat, and deprived of wind and sunlight, accumulated warmth generates heat. Heat seeds lead to gushing discharge, manifesting as vomiting, epistaxis, or bleeding from the bowels and bladder. In cases of qi deficiency where pathogenic heat takes advantage, blood cannot follow its normal course but渗 (seeps) into the various meridians, generating loss-of-blood syndromes, characterized by a pale face, deep and faint pulse, pale purple blood, and slow breath. Furthermore, infants have fragile constitutions, prone to both deficiency and excess. Due to internal attack by heat, blood follows qi; it may stagnate and reverse upward, or descend without returning, resulting in hematemesis, epistaxis, hematochezia, and hematuria. However, blood does not recklessly move unless driven by qi; wind does not generate spontaneously but arises from heat. From this perspective, one can infer other cases. The treatment method requires first distinguishing deficiency and excess, examining the source of the disease, and treating according to the meridians. If herbal medicine fails, the critical opportunity is missed. For excess patterns, use Xiaochaihu Tang (Minor Bupleurum Decoction) with Shengdihuang (Rehmanniae Radix Recens) and Simao Gen (Imperatae Rhizoma), or Kushen (Sophorae Flavescentis Radix) is also good, decocted in water. Alternatively, combine Wuling San (Five-Ingredient Powder with Poria) and Wuhe Tang (Five-Harmony Decoction), adding Simao Gen and Kushen, decocted in water, along with administering Xiaodu Yin (Detoxification Decoction). Subsequently, administer Jisu Wan (Chicken Mint Pill) and Sanhuang Wan (Three-Yellow Pill) from the *Jufang* alternately. For deficiency patterns, Lizhong Tang (Regulate the Middle Decoction) and Ren Shen Xiong Gui Tang (Ginseng, Ligusticum, and Angelica Decoction) are suitable. Occasionally, physicians seeing heavy bleeding assume extreme heat and overprescribe cooling agents, causing the blood to become cold, unable to return to its source, and flowing recklessly. The blood appears dark purple and stagnant, forming small clots. One should administer Jiangfu (Ginger and Aconite) formulas to warm the body, ensuring smooth flow and preventing reckless bleeding.
Xiaochaihu Tang (for tidal fever) Wuling San (for fright) Wuhe Tang (for interior heat) Xiaodu Yin (for throat bi) Jufang Jisu Wan (for massive hematemesis) Sanhuang Wan (for interior heat) Lizhong Tang (for vomiting and diarrhea)
Ren Shen Xiong Gui Tang treats reckless bleeding from the nine orifices.
Renshen (Ginseng Radix, remove rhizome), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix, wine-washed) (each half liang), Jingjie (Schizonepetae Spica) (2.5 qian).
Take two qian per dose, decoct one cup of water until reduced to 0.7 cups, take warm, at any time.
Huangqin Wan (Scutellaria Pill) treats pediatric epistaxis, hematemesis, and lower bleeding.
Powder the Huangqin (Scutellariae Radix), mix with refined honey to form pills the size of a corn kernel. Children aged three take one pill, swallowed with strong salt water. Baiye (Membranaceae Folium) and Shiliuhua (Punica Granatum Flower) powdered and insufflated into the nose treat epistaxis and hematemesis. Another prescription uses Dingzhou porcelain powder to treat hematemesis and stop bleeding by resolving stasis.
Maohua Tang (Thatch Flower Decoction) treats persistent epistaxis, hematemesis, and lower bleeding.
Use a large handful of Maohua (Thatch Flower), three cups of water, decoct to obtain one cup of concentrated juice, divide into two doses, and the condition will heal. If flowers are unavailable, use roots and stems instead. Also treats bloody dysentery and black dysentery.