经云。太阳厥逆僵仆。呕血善衄。阳明厥逆。喘咳身热。善惊衄呕吐。血气者。喜温而恶寒。
寒则泣不能流。温则消而去之。失血气于气。异名同类。营卫者。精气也。血者。神气也。故夺
血者无汗。（夺血者不可复发其汗。夺汗者不可复取其血。）脾移热于肝。则为惊衄。脉至而搏。
血衄身热者死。脉来悬钩浮为常脉。（言脉来虚浮。按之傍指屈曲而出。形容芤脉之象也。）大怒
则形气绝。而血菀于上。（菀积也。）悲哀太甚则胞络绝。胞绝则阳气内动。发则心下崩。数溲血
也。胞移热于膀胱。则癃溺血。
金匮云。师曰。尺脉浮。目睛晕黄。衄未止。晕黄去。目睛慧了。知衄今止。
尺以候肾。肾虚则相火扰其阴血。从膀胱而升。故脉浮也。肾之精。上营瞳子。膀胱之脉下
额中。二经中有不归经之血。故晕黄。黄退则血亦散。所以知衄止也。明理论云。伤寒衄血。责
邪在表。杂病衄血。责邪在里。此曰尺浮。不言寸浮。知为肾虚血逆。非外邪也。
病患面无色。无寒热。脉沉弦者衄。浮弱手按之绝者下血。烦渴者必吐血。（一作病患面无血色。）
面者血之华。血统则华鲜。若有寒热。为伤其血而致。今无寒热。则是因血脱而然矣。夫脉
浮以候阳。沉以候阴。若
但见沉弦。轻取绝无者。是无阳也。无阳知血之上脱。若止见浮弱。重按绝无者。是无阴也。无
阴知血之下脱。而烦渴呕血者。以火气扰乱则神烦。火动于膈则咳逆。咳则涌血而上越也。然则
沉之无浮。浮之无沉。何便见为脱血乎。以其面无血色而脉弦弱也。
男子脉虚沉弦。无寒热。短气里急。小便不利。面色白。时目瞑兼衄。小腹满。此为劳使之然。
脉虚沉弦者。以按之则少神。且无寒热。明非外感之邪也。其短气里急。少腹满。小便不利。
而面色白。皆内伤于气之候。故虽时目瞑而衄。洵为劳役所致而然也。
男子面色薄者。主渴及亡血。卒喘悸。脉虚者。里虚也。
心主血。心虚则脉虚。上句以面色薄。而主心血不荣于外。下句以喘悸脉浮。而主心气不充
于里。皆由心神耗散。血亡津伤所致也。
夫吐血咳逆上气。其脉数而有热。不得卧者死。
此金水二脏不足故也。水不足。则火独光。而金伤矣。夫阴血之安养内外者。皆肾水主之也。
肾水虚。则不能安静。而血被火逼。遂溢出。血出则五脏内外之阳皆失其配。失配之阳。无根之
狂阳也。有升无降。炎烁肺金而为咳逆上气。肺肾之阴。有绝无复耳。脉数身热。阳独胜也。不
能卧。阴已绝也。阴绝则阳不能独生。故曰死。
夫酒客咳者。必致吐血。此因极饮过度所致也。
酒性大热伤胃。胃气不守。乱于胸中。中焦之血。不布于经络。因热射肺而为咳逆。随气溢
出也。此即千金所谓由
伤胃吐血也。
吐血不止者。柏叶汤主之。
夫水者。遇寒则坚冰潜于地中。遇风则汹涌起于平陆。人之吐血。皆风火使然。柏叶禀西方
金气。可制肝木之逆。则血有所藏。艾叶之温。可使火反归阴而宿藏于下。用马通以降血逆。尤
属相宜。家秘多阿胶三钱。时珍纲目有阿胶无艾。总取辛温之力以和苦寒之性。不独治吐血不止。
而下血者亦可用之。
病患胸满。唇痿舌青口燥。但欲漱水不欲咽。无寒热。脉微大来迟。腹不满。其人言我满。
为有瘀血。
凡内外诸邪。有血相搏。积而不行者。即为瘀血。血积则津液不布。是以唇痿舌青口燥。但
欲漱水以润其燥。血为阴邪。且内无热。故不欲咽也。脉大为热。迟为寒。今无寒热之病而微大
者。乃气并于上。故胸满也。迟者。血积膈下也。积在阴经之隧道。不似气积于阳之肓膜。然阳
道显。阴道隐。气在肓膜者。则壅胀显于外。血积隧道。惟闭塞而已。故腹不满。因闭塞自觉其
满。所以知瘀血使然也。
病者如热状。烦满。口干燥而渴。其脉反无热。此为阴伏。是瘀血也。当下之。
血阴也。配于阳。气得之以和。神得之以安。咽得之以润。经脉得之以行。身形之中。不可
斯须离也。今因血积。神无以养则烦。气无以和则满。口无以润则燥。胃无以泽则渴。是皆阳失
所配。营卫不布。津液不化。而为是证也。非阳之自强而生热比。故曰如热状。脉反无热。阴邪
不能鼓激其脉。故为阴伏。
下血先便后血。此远血也。黄土汤主之。亦止吐血衄血。
经言大肠小肠皆属于胃。又云。阴络伤则血内溢。今因胃中寒邪。并伤阴络。致清阳失守。
迫血下溢二阳。遂成本寒标热之患。因取白术附子汤之温胃助阳祛散阴络之寒。其间但去姜、枣
之辛散。而加阿胶、地黄以固护阴血。其妙尤在黄芩佐地黄分解血室之标热。灶土领附子直温中
土之本寒。使无格拒之虞。然必血色瘀晦不鲜者为宜。若紫赤浓浓光泽者。用之必殆。斯皆审证
不明之误。岂立方之故欤。千金用续断止血汤。方用续断、当归、桂心、蒲黄、阿胶、甘草、干
姜、生地黄八味。附此以备按证取用。
下血先血后便。此近血也。赤小豆当归散主之。
此方在狐惑例中。治脉数无热微烦。默默但欲卧。汗出。初得之三四日。目赤如鸠眼。七八
日目四 黑。全是湿热伤血。菀化为脓之候。此先血后便。乃小肠热毒流于大肠。为火克金之象。
故亦主此方。以赤小豆之清热利水为君。且浸令芽出以发越蕴积之毒。使丙丁之火。疾趋水道而
降。佐以当归司统握之权。使血有所归。而不致于散漫也。千金用伏龙肝汤。即治先便后血之黄
土汤中除去术、附。加干姜、牛膝、地榆、发灰。与金匮主治则有寒热之殊。不可不辨。可见治
血。但使归经。不必论其远近也。
心气不足。吐血衄血。泻心汤主之。
心气不足。言阴津不足。非心火之不足也。故以大黄导蕴结之火。芩、连泻心下之热。而血自安矣。
赵养葵曰。凡肾经吐血者。俱是下寒上热。阴盛于下。逼阳于上之假证。世人不识。而为所
误者多矣。吾独窥其微。而以假寒治之。盖真阴失守。命门火衰。火不归源。阴邪逼其浮游之火
于上。上焦咳嗽气喘。恶热面红。呕吐痰涎出血。
此系假阳之证。须用八味丸引火归源。水探冷服。下嗌之后。冷性既除。热性始发。因而呕哕皆
除。即仲景人尿猪胆汁加于白通汤中以通格拒之意也。倘一服寒凉。顷刻立化。慎之哉。
人有偏阴偏阳者。此气禀也。太阳之人。虽冬月身不须绵。口常饮水。色欲无度。大便数日
一行。芩、连、知、柏、硝、黄。恬不知怪。太阴之人。虽暑月不离复衣。食饮稍凉。便觉腹痛
泄泻。参、术、姜、桂。时不绝口。一有欲事。呻吟不已。此两等人。各禀阴阳之一偏者也。与
之谈医。各执其性之一偏。面目为全体。今之为医者。不鉴其偏之弊。而制为不寒不热之方。举
世宗之。以为王道。岂知人之受病。以偏得之。感于寒则偏于寒。感于热则偏于热。以不寒不热
之剂投之。何以补其偏而救其弊哉。故以寒治热。以热治寒。此方士之绳墨也。然苦寒频进而积
热弥炽。辛热比年而沉寒益滋者何耶。此不知阴阳之属也。凡治血证前后调理。须按心脾肝三经
用药。心主血。脾裹血。肝藏血。归脾汤一方。三经之药也。远志、枣仁补肝以生心火。茯神补
心以生脾土。参、 、甘草补脾以固肺气。木香者。香先入脾。总欲使血归于脾。故曰归脾。凡
有郁怒伤肝。思虑伤脾者尤宜。火旺者。加山栀、丹皮。火衰者。加肉桂、丹皮。又有八味丸以
培先天之根。治无余法矣。血溢血泻。诸蓄妄证。其始也。宜以行血破瘀之剂折其脱气。而后区
别治之。或问失血复下。虚何以当。答曰。血既妄行。迷失故道。不去蓄利瘀。则以妄为常。曷
以御之。且去者自去。生者自生。何虚之有。失血家须用下剂破血。盖施之于蓄妄之初。亡血虚
家不可下。盖戒之于亡失之后也。
或问人身阳气。为阴血之引导。阴血为阳气之根据归。何为清浊相干。乱于中外。而致血不归
经。则有上溢下脱之患。其血或从吐出。或从呕出。或从咯出。或从鼻出。或从眼耳齿舌出。或
从津唾而出。或从肌肤而出。或从二便而出。复
有蓄积不行者。为患各有不同。愿一一显示至理。条分脏腑经络之源。以启学人蒙昧。石顽答曰。
经言血之与气。异名同类。虽有阴阳清浊之分。总由水谷精微所化。其始也混然一区。未厘清浊。
得脾气之鼓运。如雾上蒸于肺而为气。气不耗。归精于肾而为精。精不泄。归精于肝而化清血。
血不泻。归精于心。得离火之化。而为真血。以养脾脏。以司运动。以奉生身。莫贵乎此。虽经
有上注于肺。乃化为血之说。而实不离五行之气化。转注如环也。如上所云。不过统论营卫血气
之大端。乃节文耳。夫营卫者精气也。血者神气也。气主煦之。血主濡之。虽气禀阳和。血禀阴
质。而阴中有阳。阳中有阴。不能截然两分。其至清至纯者。得君主之令。以和调五脏。藏而不
失。乃养脏之血也。其清中之浊者。秉输运之权。以洒陈六腑。实而不满。则灌注之血也。其清
中之清者。会营周之度。流行百脉。满而不泄。此营经之血也。其源则一。析而为三。各有司属。
若各守其乡。则阴平阳秘。安有上溢下脱之患乎。盖缘人之禀赋。不无偏胜。劳役不无偏伤。其
血则从偏衰偏伤之处而渗漏焉。夫人禀赋既偏。则水谷多从偏胜之气化。而胜者愈胜。弱者愈弱。
阳胜则阴衰。阴衰则火旺。火旺则血随之而上溢。阴胜则阳微。阳微则火衰。火衰则火失其统而
下脱。其上溢之血。非一于火盛也。下脱之血。非一于阳衰也。但以色之鲜紫浓浓则为火盛。色
之晦淡无光即为阳衰。究其所脱之源。或缘脏气之逆。或缘腑气之乖。皆能致病。后上溢者。势
必假道肺胃。从下脱者。势必由于二肠及从膀胱下达耳。盖出于肺者。或缘龙雷亢逆。或缘咳逆
上奔。血必从之上溢。多带痰沫及粉红色者。其出于心包。亦必上溢。色必正赤如朱漆光泽。若
吐出便凝摸之不粘指者。为守藏之血。见之必死。出于脾者。或从胃腕上溢。或从小肠下脱。亦
必鲜紫浓浓。但不若心包血之光泽也。出于肝者。或从上呕。或从下脱。血必青紫稠浓。或带血
缕。或有结块。出于肾者。或从
咳逆。或从咯吐。或稀痰中杂出如珠。血虽无几。色虽不鲜。其患最剧。间有从精窍而出者。若
气化受伤。则从膀胱溺孔而出。总皆关乎脏气也。其出于胃者。多兼水液痰涎。吐则成盘成盏。
汪洋满地。以其多气多血。虽药力易到。不若藏血之笃。然为五脏之本。亦不可忽。其衄血种种。
各有所从。不独出于鼻者为衄也。鼻衄皆火乘肺金。亦有阴盛迫其虚阳而脱者。虽经有脏腑诸衄
不同。然不离手太阴之经。所以治有从阴从阳。顺治逆治之辨别。证有久衄暴衄。宜补宜泻之悬
殊。其齿衄。有阳明少阴及风热之辨。但从板齿出者为牙宣。属阳明。齿动摇者为骨病。属少阴。
龈肿上壅者。少阳风热也。耳衄则有肝肾二经之殊。但以常有不多不肿不疼者。为少阴之虚。暴
出疼肿者。则厥阴经火也。眼衄亦属厥阴。但以卒视无所见者为实火。常流血泪者。素患之风热
也。其有诸窍一齐涌出。多缘颠扑骤伤。或药毒所致。若因肝肾疲极。五脏内崩。多不可活。舌
衄皆手厥阴心包之火旺。但以舌尖破碎者为虚火。脉大满口者。挟龙雷之势而上侮君主也。涎中
见血为唾衄。足太阴经气不约也。汗孔有血为肌衄。足阳明经气不固也。如上诸衄。皆缘营气之
逆满。卫气之疏豁。不能固护而行清道。总无关乎脏气也。其下行之血。见于魄门者。则以便前
便后分远近。近则大肠。远则小肠也。以溅洒点滴分风湿。溅则风淫。滴则湿着也。以鲜紫清晦
分阴阳。鲜则阳盛。晦则阳衰也。与肠 之血。痔漏之血。妇人经癸胎产之血无异。虽由二肠。
颇关经络。是以随经下趋。各有不同。至于崩淋下脱。倒经上溢。虽下上之歧路攸分。然皆冲脉
为病。而崩淋皆脾气下陷。倒经则肝血上逆。以脾为身之津梁。冲为肝之血海。是皆关乎脏气。
更有肝脾受伤。血虽不下。而气色痿黄。大便稠黑。乃蓄血之征验。为患种种。难以悉陈。如内
伤发黄。鼓胀喘满。腹大青筋。及产后败血流于经络。皆蓄血致病。但证有虚中挟实。治有补中
寓泻。从少从多之活
法。贵乎临病处裁。大抵血气喜温而恶寒。寒则泣不能流。温则消而去之。此轩岐密旨。但世之
名于医者。一见血证。每以寒凉济阴为务。其始非不应手。而取效于一时。屡发屡折。而既病之
虚阳愈衰。必致呕逆喘乏。夺食泄泻。尚以为药力未逮。猛进苦寒。在阴不济阳而上溢者尚为戈
戟。况阳不统阴而亡脱者。尤为砒鸩。盖因阳药性暴。稍有不顺。下咽立见其害。不若阴柔之性。
至死不知其误。而免旁人讥谤也。噫。医之弊。仅为知己道。难为世俗言也。
《黄帝内经》说：太阳经气厥逆，会导致身体僵硬跌倒，呕吐血液，容易鼻出血。阳明经气厥逆，会出现气喘咳嗽、身体发热，容易惊恐、鼻出血和呕吐。血和气，喜欢温暖而厌恶寒冷。寒冷时，血液凝涩不能流通；温暖时，血液消散流动恢复正常。失血和气，名称不同但本质同类。营气和卫气，是精气所化；血，是神气所化。所以，对于已经严重失血的人，不可再用发汗法治疗。（所谓夺血者不可复发其汗，夺汗者不可复取其血。）脾脏将热邪转移给肝脏，就会导致惊恐和鼻出血。脉象来势搏击有力，伴有鼻出血和身体发热的，预后不良，主死。脉象悬钩浮（指脉来虚浮，按之旁指屈曲而出，形容芤脉的象），属于常脉。（此处解释脉象特征）大怒会使形体之气断绝，导致血液郁积在头部上方。（“菀”意为积聚）悲哀过度会使胞络闭塞，胞络闭塞则阳气在内扰动，发作时心下崩漏，频繁小便出血。胞络的热邪转移给膀胱，就会导致小便不通或尿血。
《金匮要略》说：老师讲，尺部脉浮，眼睛周围发黄晕，说明鼻出血尚未停止；如果黄晕消退，眼睛明亮清晰，就知道鼻出血现在已经停止。
尺脉用来候肾。肾虚则相火扰动阴血，随膀胱经上升，所以脉象浮。肾的精气上注于瞳孔，膀胱经脉下行至额中。这两条经络中有不循常规经脉运行的血液，所以出现眼晕黄。黄色退去则血液散归正常，因此知道鼻血已止。《明理论》说：伤寒引起的鼻出血，责在于表邪；杂病引起的鼻出血，责在于里邪。这里提到尺脉浮，而不提寸脉浮，可知这是肾虚导致的血气上逆，并非外邪所致。
病人面色苍白无血色，没有恶寒发热的症状，脉象沉弦的，会发生鼻出血；脉象浮弱，重按感觉消失的，会发生便血。心烦口渴的，一定会吐血。（另一种说法是：病人面无血色。）面部是血的荣华表现，血脉调和则面色鲜艳。如果有恶寒发热，是因为伤血所致。现在没有恶寒发热，则是因血脱造成的。脉浮用来候阳，脉沉用来候阴。如果只见到沉弦脉，轻取完全摸不到的，这是无阳的表现。无阳可知是血向上脱失。如果只见到浮弱脉，重按完全摸不到的，这是无阴的表现。无阴可知是血向下脱失。至于心烦口渴吐血的，是因为火热之气扰乱心神所以心烦，火动于膈膜所以咳逆，咳嗽导致涌血而上越。那么，为什么沉脉不见浮象，浮脉不见沉象，就能轻易判断为脱血呢？因为病人面色无血色且脉象弦弱。
男子脉象虚沉弦，没有恶寒发热，短气，腹部拘急不适，小便不利，面色苍白，时常眼前发黑并伴有鼻出血，小腹胀满，这是由于劳损引起的。脉象虚沉弦，是因为按之少神气，且无恶寒发热，明确不是外感邪气。那些短气、腹部拘急、小腹胀满、小便不利以及面色苍白，都是内伤于气的征候。所以虽然有时眼前发黑并鼻出血，确实是劳役过度所致。
男子面色淡薄的，主要症状是口渴和亡血。突然气喘心悸，脉象虚弱的，是里虚的表现。
心主血，心虚则脉虚。前句以面色淡薄，主治心血不能荣养于外；后句以气喘、心悸、脉浮，主治心气不能充盛于内。这都是由于心神耗散，血亡津伤所导致的。
凡是吐血、咳逆上气，脉数且有发热，不能安卧的，预后不良，主死。
这是因为肺金和肾水两脏不足的缘故。肾水不足，则心火独亢，从而损伤肺金。能够安养内外阴血的，都由肾水主宰。肾水虚弱，就不能宁静，血液被火逼迫，于是溢出。血液流出，则五脏内外的阳气都失去了依附。失去依附的阳气，是无根的狂阳，只有升没有降，炎灼肺金而导致咳逆上气。肺肾之阴，有绝而无复。脉数身热，是阳气独胜。不能安卧，是阴气已绝。阴绝则阳不能独自生存，所以说主死。
凡是嗜酒之人咳嗽，必然导致吐血。这是因为饮酒过度所致。
酒性大热损伤胃气，胃气不守，乱于胸中，中焦的血液不能布散到经络，因热邪射入肺部导致咳逆，随着气机溢出。这就是《千金方》所说的因伤胃而吐血。
吐血不止的，用柏叶汤主治。
水遇到寒冷则在地下结成坚冰，遇到风则在平地上汹涌而起。人的吐血，都是风火引起的。侧柏叶禀受西方金气，可以制约肝木的逆气，使血液有所藏纳。艾叶的温性，可使火气反归于阴而在下方宿藏。使用马通汁来降逆血，尤为适宜。家传秘方多加入三钱阿胶。李时珍《本草纲目》记载阿胶但没有艾叶，总体是取辛温之力来调和苦寒之性。不仅治疗吐血不止，下血也可以用。
病人胸部胀满，嘴唇枯萎，舌色青紫，口干燥，只想含水漱口而不想咽下，没有恶寒发热，脉象微大来迟，腹部并不胀满，但病人自己说胀满，这是有瘀血。
凡是内外各种邪气，与血液相互搏结，积聚而不流动的，就称为瘀血。血液积聚则津液不能布散，所以嘴唇枯萎、舌色青紫、口干燥。只想含水漱口以滋润口腔干燥。血属于阴邪，且内部没有热邪，所以不想咽下。脉大为热，脉迟为寒。现在没有寒热病症而脉微大的，是气并聚于上部，所以胸部胀满。脉迟，是血液积聚在膈下。积聚在阴经的隧道中，不像气积聚在阳经的肓膜。阳道显赫，阴道隐晦。气在肓膜，壅胀表现在外部；血积在隧道，只是闭塞而已。所以腹部外表不胀满，但因为闭塞自觉胀满。因此知道是瘀血所致。
病人像有热象，心烦胀满，口干燥而渴，但脉象反而没有热象，这是阴邪潜伏，是瘀血。应当用攻下法治疗。
血属阴，配属于阳。气得到血的配合则调和，神得到血的滋养则安宁，咽喉得到血的滋润则润泽，经脉得到血的濡养则运行。人体之中，片刻也不能离开血。现在因为血积，神无以滋养则烦，气无以调和则满，口无以滋润则燥，胃无以润泽则渴。这些都是阳气失去配合，营卫不布散，津液不化生，从而产生这些证候。这不是阳气自强而生热相比的，所以说像热象。脉象反而没有热象，是因为阴邪不能鼓动激发脉象，所以称为阴伏。
下血先大便后出血的，这是远血。用黄土汤主治。也可以治疗吐血和鼻出血。
经文说大肠和小肠都属于胃。又说阴络受伤则血内溢。现在因为胃中寒邪，同时损伤阴络，导致清阳失守，逼迫血液向下溢出二阳（指大肠小肠），遂成下寒标热的病患。因此取白术附子汤的温胃助阳，祛除阴络之寒。其中只是去掉姜、枣的辛散，而加入阿胶、地黄来固护阴血。其妙处尤其在于黄芩佐助地黄分解血室的标热，灶心土领引附子直接温补中土的本寒，使得没有格拒的担忧。但是必须血色瘀暗不鲜红的才适宜。如果是紫红浓厚光泽的，使用此方必定危险。这都是辨证不明导致的错误，难道是立方的故意吗？《千金方》用续断止血汤，方用续断、当归、桂心、蒲黄、阿胶、甘草、干姜、生地黄八味药。附录在此以备按照证候选用。
下血先出血后大便的，这是近血。用赤小豆当归散主治。
这个方子在狐惑病条文中，治疗脉数无热微烦，默默只想睡觉，出汗。初得病三四天，眼睛红得像斑鸠的眼睛，七八天后眼睛四周发黑。全是湿热伤血，郁积化为脓的征候。这先血后便，是小肠热毒流注到大肠，是火克金的象。所以也主治此方。以赤小豆清热利水为君药，并且浸泡令其发芽以发散蕴积的毒邪，使丙丁之火迅速趋向水道而降。佐以当归统摄血液，使血有所归，而不致散漫。《千金方》用伏龙肝汤，就是治先便后血的黄土汤中除去白术、附子，加入干姜、牛膝、地榆、发灰。与《金匮要略》的主治则有寒热之别，不可不辨别。可见治疗血证，只要能使血归经，不必论其远近。
心气不足，吐血衄血，用泻心汤主治。
心气不足，是指阴津不足，不是心火不足。所以用大黄引导蕴结的火邪，黄芩、黄连泻心下的热，血自然安定。
赵养葵说：凡是肾经引起的吐血，都是下寒上热，阴盛于下，逼迫阳气于上的假证。世人不认识，而被误治的很多了。我独自窥探其中的微妙，而以假寒的方法治疗。盖真阴失守，命门火衰，火不归源，阴邪逼迫其浮游之火于上，导致上焦咳嗽气喘，怕热面红，呕吐痰涎出血。
这是假阳的证候。必须用八味丸引火归源，用水送服冷药。下咽之后，冷性既除，热性始发，因而呕哕都消除。这就是张仲景在人尿猪胆汁加入白通汤中以通格拒的意思。如果一服用寒凉药，顷刻间就会死亡。务必谨慎啊。
人有偏阴偏阳体质的，这是气禀决定的。太阳体质的人，即使在冬天身体也不需穿棉衣，口中常想饮水，性欲无度，大便几天一次，使用黄芩、黄连、知母、黄柏、芒硝、大黄等寒凉药，安然不觉奇怪。太阴体质的人，即使在夏天也不离厚衣服，饮食稍凉，就觉得腹痛泄泻，人参、白术、干姜、肉桂，口中不断。一旦有房事，就呻吟不停。这两等人，各禀受了阴阳的一偏。与他们谈论医学，各执其性格的一偏，以局部代表整体。现在的医生，不借鉴这种偏颇的弊端，而制定不寒不热的方剂，举世尊崇，认为是王道。哪里知道人患病，是以偏得之，感受寒则偏于寒，感受热则偏于热。用不寒不热的药剂投治，怎么能补其偏而救其弊呢？所以用寒治热，用热治寒，这是医家的准则。然而苦寒药频频进服而积热更炽，辛热药连年服用而沉寒更甚，为什么呢？这是不知道阴阳归属的缘故。凡是治疗血证前后调理，必须按照心、脾、肝三经用药。心主血，脾裹血，肝藏血。归脾汤一方，是三经的药物。远志、酸枣仁补肝以生心火，茯神补心以生脾土，人参、茯苓、甘草补脾以固肺气。木香，香气先入脾，总想让血归于脾，所以叫归脾。凡是有郁怒伤肝、思虑伤脾的尤其适宜。火旺的，加山栀、丹皮；火衰的，加肉桂、丹皮。又有八味丸以培补先天之根，治疗血证就没有遗漏的方法了。血溢血泻，各种蓄妄证，起初，宜用行血破瘀的药剂折损其脱失之气，然后区别治疗。有人问：失血后又用下法，虚证怎么承受？回答说：血既然妄行，迷失了故道，不去除蓄积利导瘀血，就会把妄行当作常态，用什么来抵御它？况且去的自去，生的自生，有什么虚的呢？失血家须用下剂破血，是施用于蓄妄之初；亡血虚家不可用下法，是戒之于亡失之后。
有人问：人身阳气，是阴血的引导；阴血，是阳气的根据和归宿。为什么清浊相干，乱于中外，导致血不归经，就有上溢下脱的祸患？其血有的从吐出，有的从呕出，有的从咯出，有的从鼻出，有的从眼耳齿舌出，有的从津唾而出，有的从肌肤而出，有的从二便而出。还有蓄积不行的，为患各有不同。希望一一显示至理，条分脏腑经络之源，以启发学人的蒙昧。石顽回答说：经文说血与气，异名同类。虽然有阴阳清浊之分，总由水谷精微所化。起初混然一体，未分清浊。得脾气之鼓运，如雾上蒸于肺而为气。气不耗散，归精于肾而为精。精不泄漏，归精于肝而化为清血。血不泻，归精于心，得离火之化，而为真血，以养脾脏，以司运动，以奉养身形，没有比这更宝贵的了。虽然经文有上注于肺乃化为血的说法，而实际不离五行之气化，转注如环。如上所说，不过是统论营卫血气的大端，是节文罢了。营卫是精气，血是神气。气主煦之，血主濡之。虽然气禀阳和，血禀阴质，而阴中有阳，阳中有阴，不能截然两分。其至清至纯的，得君主之令，以和调五脏，藏而不失，是养脏之血。其清中之浊的，秉输运之权，以洒陈六腑，实而不满，是灌注之血。其清中之清的，会营周之度，流行百脉，满而不泄，是营经之血。其源则一，析而为三，各有司属。如果各守其乡，则阴平阳秘，哪里有上溢下脱的祸患呢？大概因为人的禀赋，无不偏胜，劳役无不偏伤。其血就从偏衰偏伤之处渗漏出来。人禀赋既偏，则水谷多从偏胜之气化，而胜者愈胜，弱者愈弱。阳胜则阴衰，阴衰则火旺，火旺则血随之而上溢。阴胜则阳微，阳微则火衰，火衰则火失其统而下脱。其上溢的血，不一定全因火盛；下脱的血，不一定全因阳衰。但以血色鲜紫浓厚则为火盛，血色晦淡无光即为阳衰。究其所脱之源，或因脏气之逆，或因腑气之乖，都能致病。后上溢的，势必假道肺胃；从下脱的，势必由于二肠及从膀胱下达。出于肺的，或因龙雷亢逆，或因咳逆上奔，血必从上溢，多带痰沫及粉红色。出于心包的，也必上溢，色必正赤如朱漆光泽。如果吐出便凝固，摸之不粘手指的，是守藏之血，见之必死。出于脾的，或从胃腕上溢，或从小肠下脱，也必鲜紫浓厚，但不若心包血之光泽。出于肝的，或从上呕，或从下脱，血必青紫稠浓，或带血缕，或有结块。出于肾的，或从咳逆，或从咯吐，或稀痰中杂出如珠，血虽无几，色虽不鲜，其患最剧。间有从精窍而出的，若气化受伤，则从膀胱溺孔而出。总之都关乎脏气。出于胃的，多兼水液痰涎，吐则成盘成盏，汪洋满地。以其多气多血，虽药力易到，不若藏血之笃实。然为五脏之本，也不可忽视。其衄血种种，各有所从，不独出于鼻者为衄。鼻衄都是火乘肺金，也有阴盛逼迫其虚阳而脱的。虽然经文有脏腑诸衄不同，然不离手太阴之经。所以治有从阴从阳，顺治逆治的辨别。证有久衄暴衄，宜补宜泻的悬殊。齿衄，有阳明、少阴及风热的辨别。但从板齿出的为牙宣，属阳明；齿动摇的为骨病，属少阴；龈肿上壅的，为少阳风热。耳衄则有肝肾二经的不同。但以常有不多、不肿、不疼的，为少阴之虚；暴出、疼肿的，则厥阴经火。眼衄亦属厥阴，但以卒视无所见的为实火，常流血泪的，为素患之风热。其有诸窍一齐涌出的，多缘颠扑骤伤，或药毒所致。若因肝肾疲极，五脏内崩，多不可活。舌衄皆手厥阴心包之火旺，但以舌尖破碎的为虚火，脉大满口的，挟龙雷之势而上侮君主。涎中见血为唾衄，足太阴经气不约也。汗孔有血为肌衄，足阳明经气不固也。如上诸衄，皆缘营气之逆满，卫气之疏豁，不能固护而行清道，总无关乎脏气。其下行之血，见于魄门的，则以便前便后分远近。近则大肠，远则小肠。以溅洒点滴分风湿。溅则风淫，滴则湿着。以鲜紫清晦分阴阳。鲜则阳盛，晦则阳衰。与肠澼之血、痔漏之血、妇人经癸胎产之血无异。虽由二肠，颇关经络，是以随经下趋，各有不同。至于崩淋下脱，倒经上溢，虽下上之歧路攸分，然皆冲脉为病。而崩淋皆脾气下陷，倒经则肝血上逆。以脾为身之津梁，冲为肝之血海，是皆关乎脏气。更有肝脾受伤，血虽不下，而气色痿黄，大便稠黑，乃蓄血之征验。为患种种，难以悉陈。如内伤发黄，鼓胀喘满，腹大青筋，及产后败血流于经络，皆蓄血致病。但证有虚中挟实，治有补中寓泻，从少从多的活法，贵乎临病处裁。大抵血气喜温而恶寒，寒则泣不能流，温则消而去之。这是轩岐（黄帝、岐伯）的密旨。但世上名医，一见血证，每以寒凉济阴为务。其始非不应手，而取效于一时。屡发屡折，而既病之虚阳愈衰，必致呕逆喘乏，夺食泄泻。尚以为药力未逮，猛进苦寒。在阴不济阳而上溢者尚为戈戟，况阳不统阴而亡脱者，尤为砒鸩。盖因阳药性暴，稍有不顺，下咽立见其害。不若阴柔之性，至死不知其误，而免旁人讥谤也。噫。医之弊，仅为知己道，难为世俗言也。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Qi of the Taiyang (Greater Yang) channel reverses, it leads to stiffness and falling, vomiting of blood, and a tendency towards epistaxis (nosebleed). When the Qi of the Yangming (Yang Brightness) channel reverses, it results in panting, coughing, body heat, a tendency towards fright, epistaxis, and vomiting. Blood and Qi favor warmth and dislike cold. In cold, blood becomes stagnant and cannot flow; in warmth, it dissipates and flows normally. Loss of blood and loss of Qi are different names but share the same essence. Ying (Nutritive) Qi and Wei (Defensive) Qi are transformed from Essence-Qi; Blood is transformed from Spirit-Qi. Therefore, for those who have suffered severe blood loss, sweating should not be induced again. (Those whose blood has been depleted should not have their sweat further depleted; those whose sweat has been depleted should not have their blood further depleted.) If Heat from the Spleen transfers to the Liver, it causes fright and epistaxis. A pulse that beats forcefully, accompanied by epistaxis and body heat, indicates a fatal prognosis. A pulse described as "suspended hook floating" (referring to a hollow pulse, *Kou Mai*, which feels empty on pressure with sides firm like a bent finger) is considered a normal variation in this context. Great anger causes the form and Qi to sever, leading to blood stagnating in the upper body ("Yu" means accumulation). Excessive grief causes the Pericardium Collateral to close off; when closed, Yang Qi moves internally, causing collapse from below the heart and frequent hematuria (blood in urine). If Heat from the Pericardium Collateral transfers to the Bladder, it leads to strangury (difficulty/painful urination) or hematuria.
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: The Master said, if the Chi (Cun Cun position at the wrist, corresponding to the lower jiao/kidneys) pulse is floating, and there is yellowish discoloration around the eyes, the epistaxis has not stopped. If the yellowish discoloration disappears and the eyes become clear, one knows the epistaxis has now stopped.
The Chi pulse inspects the Kidney. Kidney deficiency allows Ministerial Fire to disturb Yin Blood, which rises via the Bladder channel, hence the floating pulse. The Essence of the Kidney nourishes the pupils; the Bladder channel descends to the center of the forehead. Blood that does not follow the regular channels in these two meridians causes the yellowish discoloration. When the yellow fades, the blood disperses normally, thus indicating the nosebleed has stopped. *Ming Lilun* (Theory of Clarity) states: Epistaxis caused by Cold Damage (*Shanghan*) is attributed to pathogenic factors in the Exterior; epistaxis from miscellaneous diseases is attributed to pathogenic factors in the Interior. Here, the Chi pulse is floating, without mention of the Cun pulse floating, indicating Kidney deficiency with rebellious Blood Qi, not an external pathogen.
If a patient's face lacks color, without aversion to cold or fever, and the pulse is deep and wiry, epistaxis may occur; if the pulse is floating and weak, disappearing upon heavy pressure, hematochezia (blood in stool) may occur. Those with irritability and thirst will certainly vomit blood. (Another version reads: the patient's face lacks blood color.) The face is the bloom of Blood; when Blood vessels are harmonious, the complexion is fresh. If there is aversion to cold and fever, it is due to injury to the Blood. Now, without aversion to cold and fever, it is due to Blood depletion. Floating pulses inspect Yang; deep pulses inspect Yin. If only deep and wiry pulses are seen, and light pressure finds none, this is absence of Yang. Absence of Yang indicates upward depletion of Blood. If only floating and weak pulses are seen, and heavy pressure finds none, this is absence of Yin. Absence of Yin indicates downward depletion of Blood. Regarding irritability, thirst, and vomiting blood: Fire Qi disturbs the Spirit causing irritability; Fire moving in the Diaphragm causes cough and rebellion; coughing forces Blood to surge upward. Then, why can the absence of floating in deep pulses and absence of deep in floating pulses easily indicate Blood depletion? Because the face lacks blood color and the pulse is wiry and weak.
In men, a pulse that is deficient, deep, and wiry, without aversion to cold or fever, shortness of breath, abdominal urgency, difficulty urinating, pale complexion, occasional blackouts with epistaxis, and lower abdominal fullness, is caused by overwork. A deficient, deep, wiry pulse indicates lack of Shen Qi upon pressure; without aversion to cold or fever, it is clearly not an external pathogen. Shortness of breath, abdominal urgency, lower abdominal fullness, difficulty urinating, and pale complexion are all signs of internal Qi injury. Thus, although there are occasional blackouts and epistaxis, it is indeed caused by laborious exertion.
Men with a pale/thin facial complexion primarily suffer from thirst and blood loss. Sudden panting and palpitations with a deficient pulse indicate interior deficiency.
The Heart governs Blood; Heart deficiency leads to a deficient pulse. The first clause, citing pale complexion, indicates Heart Blood failing to nourish the exterior. The second clause, citing panting, palpitations, and floating pulse, indicates Heart Qi failing to fill the interior. All result from dissipation of Heart Spirit, loss of Blood, and injury to Jin-Ye (Body Fluids).
For those vomiting blood and experiencing cough with rebellious Qi, if the pulse is rapid, there is heat, and they cannot lie down, the prognosis is death.
This is due to insufficiency of both Metal (Lung) and Water (Kidney). Insufficient Water allows Fire to shine alone, injuring Metal. It is Kidney Water that nourishes Yin Blood inside and out. When Kidney Water is deficient, it cannot remain quiet, and Blood is forced out by Fire. Once Blood exits, the Yang of the Five Zang organs loses its pairing. Unpaired Yang is rootless, wild Yang, rising without descending, scorching Lung Metal, causing cough and rebellious Qi. The Yin of Lung and Kidney is exhausted with no return. Rapid pulse and body heat indicate Yang dominance alone. Inability to lie down indicates Yin exhaustion. When Yin is exhausted, Yang cannot survive alone; hence, it is fatal.
For wine drinkers who cough,吐血 (vomiting blood) inevitably follows. This is caused by excessive drinking.
Wine is intensely hot and injures Stomach Qi. Stomach Qi fails to maintain control, chaos arises in the chest, and Blood of the Middle Jiao cannot distribute to the collaterals. Due to Heat shooting into the Lungs, cough and rebellious Qi occur, and Blood overflows with the Qi. This is what *Qianjin Fang* calls vomiting blood due to Stomach injury.
For continuous vomiting of blood, use Bo Ye Tang (Cypress Leaf Decoction).
Water turns to hard ice underground when cold, and surges on land when windy. Human vomiting of blood is caused by Wind and Fire. Cypress leaf (*Bai Ye*) inherits the Qi of Metal in the West, restraining the rebellion of Liver Wood, so Blood has a place to store. Mugwort leaf (*Ai Ye*) is warm, allowing Fire to return to Yin and settle below. Using horse manure juice (*Ma Tong*) to descend rebellious Blood is very suitable. Family secret recipes often add three qian of Donkey-hide Gelatin (*Ejiao*). Li Shizhen's *Bencao Gangmu* records Ejiao but not Ai Ye; generally, the acrid-warm nature is taken to harmonize the bitter-cold nature. It treats not only continuous vomiting of blood but also lower bleeding.
If a patient has chest fullness, withered lips, blue-green tongue, dry mouth, desires only to rinse water in the mouth without swallowing, no aversion to cold or fever, and a pulse that is slightly large and slow, yet the abdomen is not full though the patient claims fullness, this is Blood stasis.
Any internal or external pathogen clashing with Blood, accumulating and not flowing, constitutes Blood stasis. Blood accumulation prevents distribution of Body Fluids, causing withered lips, blue-green tongue, and dry mouth. One desires to rinse water to moisten dryness. Blood is a Yin pathogen, and there is no internal heat, so one does not wish to swallow. Large pulse indicates Heat; slow pulse indicates Cold. Now, without cold/heat disease but with a slightly large pulse, it is Qi merging in the upper part, causing chest fullness. Slow pulse indicates Blood accumulation below the diaphragm. Accumulation in the tunnels of Yin meridians is not like Qi accumulation in the Huangmo (membranous tissue) of Yang meridians. Yang pathways are manifest; Yin pathways are hidden. Qi in Huangmo manifests as distension externally; Blood in tunnels causes only obstruction. Thus, the abdomen appears not full, but the patient feels full due to obstruction. Hence, we know it is caused by Blood stasis.
If a patient presents with symptoms resembling heat, irritability, fullness, dry mouth, and thirst, but the pulse surprisingly shows no heat signs, this is "Yin lurking"; it is Blood stasis. It should be treated with purgation.
Blood is Yin, paired with Yang. Qi harmonizes with Blood; Spirit rests in Blood; Throat is moistened by Blood; Meridians move with Blood. The body cannot be without Blood for a moment. Now, due to Blood stasis, Spirit lacks nourishment causing irritability; Qi lacks harmony causing fullness; Mouth lacks moisture causing dryness; Stomach lacks lubrication causing thirst. These are all cases where Yang loses its pairing, Ying and Wei do not distribute, and Body Fluids fail to transform, creating these symptoms. This is not comparable to Yang strengthening itself to generate heat; hence, it resembles heat. The pulse surprisingly shows no heat because Yin pathogens cannot stimulate the pulse, hence called "Yin lurking."
For bleeding from the anus where stool precedes blood, this is "distant blood." Use Huang Tu Tang (Yellow Earth Decoction). It can also treat vomiting blood and epistaxis.
The Classics state the Large Intestine and Small Intestine belong to the Stomach. It also says injury to Yin collaterals causes internal overflow of blood. Now, due to Cold pathogen in the Stomach injuring Yin collaterals, Clear Yang is lost, forcing Blood to overflow downward into the Two Yang channels (Large and Small Intestines), resulting in a condition of underlying Cold with superficial Heat. Therefore, we take the warming and Yang-assisting properties of Baizhu Fuzi Tang (Atractylodes and Aconite Decoction) to dispel Cold in Yin collaterals. We remove the acrid-dispersing Ginger and Jujube, adding Ejiao and Rehmannia to secure Yin Blood. Its brilliance lies in Scutellaria assisting Rehmannia to resolve superficial Heat in the Blood Chamber, while Kitchen Earth leads Aconite to directly warm the fundamental Cold of the Central Earth, avoiding rejection. However, it is suitable only if the blood color is dark and dull. If the blood is purple-red, thick, and glossy, using this formula will be dangerous. This is an error due to unclear differentiation, not a flaw in the prescription. *Qianjin Fang* uses Xuduan Zhixue Tang (Dipsacus Hemostatic Decoction), composed of Xuduan, Danggui, Guixin, Puhuang, Ejiao, Gancao, Ganjiang, and Shengdihuang. Listed here for reference based on syndrome.
For bleeding from the anus where blood precedes stool, this is "proximal blood." Use Chixiaodou Danggui San (Red Bean and Angelica Powder).
This formula appears in the Herpes Disease section, treating rapid pulse without heat, slight irritability, silence with desire to sleep, sweating. In the first 3-4 days, eyes are red like a turtledove's; after 7-8 days, the four corners of the eyes turn black. This is entirely damp-Heat injuring Blood, stagnating and transforming into pus. This sequence of blood then stool indicates Small Intestine Heat-Toxin flowing into the Large Intestine, a sign of Fire overcoming Metal. Thus, this formula is also indicated. Red Bean (*Chixiaodou*) clears Heat and promotes urination as the sovereign herb; sprouting it helps vent accumulated toxins, directing Bing-Ding (Fire) Qi down through the water pathways. Angelica (*Danggui*) acts as assistant, governing the authority of holding Blood, ensuring Blood returns to its course without scattering. *Qianjin Fang* uses Fulonggan Tang (Village Dragon Liver Decoction), which is Huang Tu Tang minus Baizhu and Fuzi, plus Ganjiang, Niuxi, Diyü, and Fahui. Compared to *Jingui*, there is a difference in Cold vs. Heat treatment; this must be distinguished. Thus, treating blood disorders, as long as Blood returns to its channels, distance need not be discussed.
For Heart Qi insufficiency causing vomiting blood and epistaxis, use Xiexin Tang (Drain the Epigastrium Decoction).
"Heart Qi insufficiency" refers to insufficiency of Yin-Jin (Yin Fluids), not insufficiency of Heart Fire. Therefore, Dahuang guides accumulated Fire; Huangqin and Huanglian drain Heat in the Heart; Blood naturally settles.
Zhao Yangkui said: Vomiting blood originating from the Kidney meridian is always Lower Cold and Upper Heat, a false syndrome of Yin excess below forcing Yang upward. Many people in the world do not recognize this and are misled. I alone perceive its subtleties and treat it as false cold. True Yin is lost, Mingmen Fire declines, Fire does not return to its source; Yin pathogens force floating Fire upward, causing cough, asthma, aversion to heat, red face, vomiting of phlegm-saliva and blood.
This is a false Yang syndrome. One must use Bawei Wan (Eight-Ingredient Pill) to guide Fire back to its source, taking it cold with water. After swallowing, the cold nature dissipates, and the warm nature activates, eliminating vomiting and hiccups. This aligns with Zhang Zhongjing's addition of human urine and pig bile to Baitong Tang to overcome rejection. If cold medicines are used immediately, death occurs instantly. Be cautious!
People have constitutions biased toward Yin or Yang; this is innate Qi endowment. Taiyang-type individuals, even in winter, do not need cotton clothes, constantly drink water, have unlimited sexual desire, and bowel movements once every few days; they take Huangqin, Huanglian, Zhimu, Huangbai, Xiaoshishi, and Dahuang without surprise. Taiyin-type individuals, even in summer, never leave thick clothes; if food/drink is slightly cool, they feel abdominal pain and diarrhea; Renshen, Baizhu, Ganjiang, Rougui are constantly consumed. Upon sexual activity, they groan incessantly. These two types each embody a bias of Yin or Yang. Discussing medicine with them, they cling to their biased nature, mistaking the part for the whole. Current physicians, failing to learn from this bias, formulate non-hot/non-cold prescriptions, revered by the world as the "Kingly Way." They do not realize that illness is contracted through bias: contracting Cold makes one biased toward Cold; contracting Heat makes one biased toward Heat. Using non-hot/non-cold agents cannot correct bias or save the defect. Thus, using Cold to treat Heat, and Heat to treat Cold, is the standard for physicians. However, why does frequent use of bitter-cold increase accumulated Heat, and year-long use of acrid-warm deepen sinking Cold? This is ignorance of Yin-Yang affiliation. In treating blood disorders, regulation before and after must target the Heart, Spleen, and Liver meridians. Heart governs Blood; Spleen envelopes Blood; Liver stores Blood. Guipi Tang (Restore the Spleen Decoction) contains herbs for all three meridians. Yuanzhi and Suanzaoren tonify Liver to generate Heart Fire; Fushen tonifies Heart to generate Spleen Earth; Renshen, Fuling, Gancao tonify Spleen to secure Lung Qi. Muxiang, whose fragrance enters the Spleen first, aims to return Blood to the Spleen, hence "Guipi." It is especially suitable for Liver injury from frustration and Spleen injury from overthinking. For excess Fire, add Zhizi and Danpi; for deficient Fire, add Rougui and Danpi. Bawei Tonics also cultivate the root of Pre-Heaven, leaving no method unused for blood disorders. For initial blood overflow or hemorrhage, use blood-moving and stasis-breaking agents to curb Qi depletion, then differentiate treatment. Question: If blood loss is followed by purgation, how can deficiency tolerate it? Answer: Since Blood wanders and loses its path, removing accumulation and promoting stasis drainage prevents wandering from becoming normal; how else to control it? What goes goes; what comes comes; where is the deficiency? Blood-loss patients require purgatives to break stasis when applied to the initial stage of accumulation/wandering; blood-depleted deficiency patients must not be purged, as a warning after loss.
Question: Human Yang Qi guides Yin Blood; Yin Blood anchors Yang Qi. Why do Clear and Turbid interfere, disrupting inside and outside, causing Blood to leave its channels, leading to upper overflow and lower leakage? Blood may come from vomiting, spitting, nose, eyes, ears, teeth, tongue, saliva, skin, or bowels/bladder. Some accumulate without flowing, causing varied harms. Please reveal the principles, categorizing Zang-Fu and Meridian sources to enlighten students. Shiwan answered: The Classics state Blood and Qi are different names, same essence. Though divided into Yin/Yang and Clear/Turbid, all derive from Grain-Essence. Initially mixed, undifferentiated. Driven by Spleen Qi, like mist steaming to Lungs to become Qi. If Qi is not consumed, it returns to Kidneys as Essence. If Essence is not leaked, it returns to Liver to transform into Clear Blood. If Blood is not drained, it returns to Heart, transformed by Li Fire (Heart Fire) into True Blood, nourishing Spleen, governing movement, sustaining life—nothing is more precious. Although Classics say Qi ascends to Lungs to become Blood, it essentially follows Five Element transformations, circulating like a ring. The above discusses general Ying/Qi/Blood principles. Ying/Wei are Essence-Qi; Blood is Spirit-Qi. Qi warms; Blood moistens. Though Qi is Yang-Harmonious and Blood is Yin-Substantial, Yin contains Yang, Yang contains Yin; they cannot be strictly separated. The purest, obeying the Monarch's command, harmonizes Five Zang, storing without loss, is Nourishing Blood. The turbid within clear, wielding transport power, sprinkles Six Fu, filling without overflowing, is Infusing Blood. The clear within clear, following Ying circulation, flows through hundred vessels, filling without leaking, is Ying-Meridian Blood. Source is one, split into three, each with jurisdiction. If each guards its territory, Yin and Yang are balanced; how could upper overflow/lower leakage occur? Generally, due to innate bias and labor injury, Blood leaks from weak/injured spots. Innate bias causes Grain-Essence to follow biased transformation; winner wins more, loser loses more. Yang excess leads to Yin decline; Yin decline leads to Fire prosperity; Fire prosperity drives Blood upward overflow. Yin excess leads to Yang weakness; Yang weakness leads to Fire decline; Fire decline loses control, causing Blood downward leakage. Upper overflow is not solely due to Fire excess; lower leakage is not solely due to Yang decline. Fresh-purple-thick blood indicates Fire excess; dark-pale-dull blood indicates Yang decline. Investigating the source: either Zang Qi rebellion or Fu Qi disorder causes disease. Upward overflow passes through Lung/Stomach; downward leakage passes through Intestines/Bladder. From Lung: due to Dragon/Thunder rebellion or cough/rebellion, blood overflows upward, often with phlegm foam or pinkish color. From Pericardium: overflows upward, bright red like lacquer. If vomited blood coagulates and doesn't stick to fingers, it is Stored Blood; seeing this means death. From Spleen: overflows from Stomach or leaks from Small Intestine, fresh-purple-thick, but less glossy than Pericardium blood. From Liver: vomits upward or leaks downward, dark-purple-thick, with threads or clots. From Kidney: coughs/spits, mixed in thin sputum like pearls, little blood, dull color, most severe. Rarely from essence aperture; if Qi transformation injured, from Bladder urethra. All relate to Zang Qi. From Stomach: mixed with fluids/phlegm, forms pools; abundant Qi/Blood, easy for medicine to reach, but less solid than stored blood. Yet, as root of Five Zang,不可忽视. Various epistaxis have sources, not just nose. Nasal epistaxis is Fire attacking Lung Metal; some are Yin excess forcing deficient Yang to leak. Though Classics distinguish Zang/Fu epistaxis, all relate to Hand-Taiyin (Lung) channel. Treatment distinguishes Yin/Yang, smooth/rebellious methods. Syndromes distinguish chronic/sudden epistaxis, tonifying/draining approaches. Dental epistaxis distinguishes Yangming/Shaoyin/Wind-Heat. From gum plate is Gingival Fistula (Yangming); loose teeth is Bone Disease (Shaoymin); swollen gums is Shaoyang Wind-Heat. Ear epistaxis distinguishes Liver/Kidney. Frequent, small amount, no swelling/pain is Shaoymin deficiency; sudden, painful, swollen is Jueyin Fire. Eye epistaxis is Jueyin; sudden blindness is Excess Fire; constant tearing/blood is chronic Wind-Heat. All apertures bleeding simultaneously: due to trauma or drug toxicity. If Liver/Kidney exhausted, Five Zang internal collapse, usually fatal. Tongue epistaxis: Hand-Jueyin Pericardium Fire excess. Tip ulcers is Deficient Fire; full-mouth large pulse carries Dragon/Thunder momentum insulting Monarch. Saliva blood is Spittle Epistaxis (Taiyin Qi uncontrolled). Skin pore blood is Muscle Epistaxis (Yangming Qi insecure). Above epistaxis: due to Ying Qi rebellion/fullness, Wei Qi laxity, failing to guard clear paths, unrelated to Zang Qi. Downward blood from Anus: distant/near based on stool timing. Near is Large Intestine; far is Small Intestine. Splashing vs. dripping distinguishes Wind/Damp. Splashing is Wind invasion; dripping is Damp adherence. Fresh/dark distinguishes Yin/Yang. Fresh is Yang excess; dark is Yang decline. Same as intestinal bleeding, hemorrhoids, female menstruation/postpartum blood. Though from intestines, relates to meridians, descending along channels differently. Metrorrhagia/menorrhagia downward leakage, retrograde menstruation upward overflow: though paths differ, all involve Chong Mai disease. Metrorrhagia is Spleen Qi sinking; retrograde menstruation is Liver Blood rebelling. Spleen is fluid bridge; Chong is Sea of Blood for Liver; all relate to Zang Qi. Liver/Spleen injury: blood not down, but sallow complexion, dark stool, indicates Blood stasis. Varied harms, hard to list. Internal injury jaundice, drum-distension, asthma/fullness, abdominal varices, postpartum敗血 (decayed blood) in meridians: all stasis diseases. Syndromes have deficiency-with-excess; treatments have tonifying-with-draining, flexible application depending on case. Generally, Blood/Qi favors warmth, dislikes cold; cold stagnates, warmth resolves. This is the secret of Xuanyuan (Yellow Emperor) and Qibo. But famous doctors today, seeing blood disorders, focus on cooling/Nourishing Yin. Initially effective, but recurring attacks deplete remaining Yang, causing vomiting, panting, loss of appetite, diarrhea. Still thinking medicine insufficient, they aggressively use bitter-cold. For those overflowing due to Yin failing to support Yang, this is hostile; for those leaking due to Yang failing to control Yin, it is poison. Yang drugs are violent; any mishap causes immediate harm. Yin-nature drugs are gentle; errors go unnoticed until death, avoiding criticism. Alas! Medical flaws are only told to confidants, hard to speak to the vulgar.