（共十三条，以下凡诸见血者，皆当于此类求其义）
一、吐血之病当知轻重。凡偶有所伤，而根本未摇者，轻而易治。但随其所伤而宜清则
清，宜养则养，随药可愈，无足虑也。惟积劳积损，以致元气大虚，真阴不守者，乃为危证
。此惟不慎其初，所以致病于前，倘病已及身而犹不知慎，则未有能善其终者。凡患此者，
非加意慎重，而徒恃药力以求免者，难矣。
一、吐血咯血，凡因劳损而气虚脉静，或微弦无力，既非火证，又非气逆，而血有妄行
者，此真阴内损，络脉受伤而然，惟用甘醇补阴培养脉络，使营气渐固，而血自安矣。宜一
阴煎、左归饮、六味地黄汤、小营煎之类，酌宜用之。若虚在气分者，宜五福饮或大补元煎
为最佳。此等证候，最忌寒凉，亦忌行散，皆非虚损所宜也。
一、吐血咯血，凡兼口渴咽痛，躁烦喜冷，脉滑便实，小水赤热等证，此水不济火，阴
虚阳胜而然。治当滋阴壮水，微佐清凉，宜二阴煎、四阴煎，或加减一阴煎、生地黄饮子、
天门冬丸之类，察其脏气随宜用之。若热不甚者，唯一阴煎、左归饮，或六味地黄汤之类为
宜。凡此证候，大忌辛温。如芎、归、 、术、杜仲、破故纸、香附、砂仁、姜、桂之属，
皆所当避。
一、吐血全由火盛而逼血上行者，宜察火之微甚。火微者，宜《局方》犀角地黄汤或清
化饮主之。火暴盛而根本无伤者，宜抽薪饮、徙薪饮，或黄连解毒汤、三黄丸之类主之。若
胃火热甚而烦热作渴，头痛，脉滑，气壅，而吐血不止者，宜白虎汤或抽薪饮。若胃火炽盛
而兼阴虚水亏者，宜玉女煎。若阳明实热之甚，而兼便结，腹胀，气壅不降者，宜《拔萃》
犀角地黄汤，或凉膈散，或桃仁承气汤之类主之。然此证不多见，必审知的确，乃可用之，
毋孟浪也。凡属火证，皆宜童便。
一、饮酒过多而吐血者，宜徙薪饮、清化饮，或葛花解酲汤加黄连、丹皮主之。
一、怒气伤肝，动肝火则火载血上，动肝气则气逆血奔，所以皆能呕血。凡肝火盛者，
必有烦热脉证。宜芍药、生地黄、丹皮、栀子、泽泻、芩、连之属，降其火而血自清。若肝
气逆者，必有胸胁痛满等证。宜芍药、生地黄、青、陈、枳壳、贝母、泽泻之属，行其气而
血自清。若火因气逆者，惟化肝煎为宜。其有病虽因怒，而或逆气已散者，不得再加行散以
伤真气。或肝火已平，勿得过用苦寒再损元阳。且凡肝气为邪，每多侮土，故常致脾胃受伤
及营血失守等证。若察其无胀无火，脉虚神困而血妄行者，此其病伤在脾，治当专理中气。
宜五阴煎、五福饮之类主之。或兼火不生土，则理中汤、理阴煎之属，皆不可少。勿谓始因
怒气而专意伐肝也。
一、忧思过度，损伤心脾以致吐血咯血者，其病多非火证。或常见气短气怯，形色憔悴
，或胸怀郁然，食饮无味，或腹虽觉饥而不欲食，或神魂惊困而卧不安，是皆中气亏损不能
收摄所致，速宜救本，不得治标。惟五福饮、五阴煎之类为宜。其或气陷而稍滞者，宜归脾
汤。若阳分不足者，宜理中汤或理阴煎之类主之。若素多劳倦思虑，或善呕吐，或善泄泻，
而忽致吐血下血者，此脾虚不能摄血，非火证也，宜六味回阳饮大加白术主之，切不可用清
寒等药。
暑毒伤人，多令人吐衄失血，盖暑气通心，火毒刑肺也。然暑既伤心，热又伤气，其人
必脉虚气怯，体倦息微，若但知为热而过用寒凉，则气必愈伤，害斯甚矣。此惟生脉散、人
参汤之属为宜。若气虚之甚者，当以人参、黄 并加用之。若火甚而热渴烦闷者，宜人参白
虎汤，或竹叶石膏汤。若气不甚虚者，宜《局方》犀角地黄汤，或枇杷叶散。
一、格阳失血之证，多因色欲劳伤过度，以致真阳失守于阴分，则无根虚火浮泛于上，
多见上热下寒，或头红面赤，或喘促躁烦，而大吐大衄，失血不止，但其六脉细微，四肢厥
逆，或小水清利，大便不实者，此格阳虚火证也。速宜引火归原，用镇阴煎，或八味地黄汤
之类，则火自降而血自安矣。若用寒凉，阳绝则死。
一、所吐之血，色黑而黯，必停积失位之血，非由火逼而动也。或面白息微，脉见缓弱
，身体清凉者，此必脾肾气虚，不能摄血而然，皆非火证。若用凉血之剂，必致殆矣。《三
因方》云∶理中汤能止伤胃吐血，以其温中，大能分理阴阳，安和胃气，故当用也。若察其
虚在阴分，则又惟理阴煎为最宜。
一、暴吐暴衄，失血如涌，多致血脱气亦脱，危在顷刻者，此其内伤败剧而然。当此之
际，速宜以气为主。盖有形之血不能即生，无形之气所当急固，但使气不尽脱，则命犹可保
，血渐可生。宜急用人参一二两为细末，加飞罗面一钱许，或温水，或井花冷水，随其所好
，调如稀糊，徐徐服之，或浓煎独参汤徐服亦可。此正血脱益气，阳生阴长之大法也。
一、凡血逆上焦，紫黑成块，或痛或闷，结聚不散者。惟宜行散，或吐出方好。大都治
血之法，多忌辛散，恐其能动血也。惟此留滞之血，则不妨用之。如四物汤加香附、肉桂、
苏木、红花之属，无不可也。或服韭汁，亦善行瘀血。若火郁不散，致血有留滞者。惟于四
物汤加炒山栀，大能清胃脘之血。
一、吐血不能止者，惟饮童便最效。或捣侧柏叶。以童便二分，酒一分，和而温饮之，
大能止血。
（共十三条，以下凡是出现各种出血症状的，都应当在此类中寻求其道理）
一、治疗吐血之病，必须知晓病情的轻重。凡是偶然受到损伤，而根本元气并未动摇的，病情轻且容易治疗。只需根据所伤之处，适宜清热的就清热，适宜调养的就调养，随药力即可痊愈，无需担忧。只有因长期劳累和过度损耗，导致元气极度虚弱，真阴不能固守的，才是危重证候。这是因为起初不慎，所以在前面致病；如果病已经发生身体上还不知道谨慎，那么就没有能够善终的。凡是患此病的人，如果不加意慎重，而仅仅依赖药力以求免除灾祸，是很难做到的。
二、吐血和咯血，凡是因劳损导致气虚脉象平静，或微弦无力，既不是火证，也不是气逆，而血液妄行的，这是真阴在内受损，络脉受伤所致。唯有使用甘醇的药物补阴以培养脉络，使营气逐渐巩固，血液自然安宁。适宜选用一阴煎、左归饮、六味地黄汤、小营煎之类的方剂，酌情使用。如果虚损在气分，适宜五福饮或大补元煎为最佳。这类证候，最忌讳寒凉药物，也忌讳行气散瘀药物，这些都不适合虚损病症。
三、吐血和咯血，凡是兼有口渴咽痛、烦躁喜冷、脉滑大便实、小便赤热等症状的，这是水不济火，阴虚阳胜所致。治疗应当滋阴壮水，稍微佐以清凉药物，适宜二阴煎、四阴煎，或加减一阴煎、生地黄饮子、天门冬丸之类的方剂，观察脏腑之气酌情使用。如果热势不严重的，仅用一阴煎、左归饮，或六味地黄汤之类的为宜。凡是这类证候，非常忌讳辛温药物。如川芎、当归、白术、杜仲、破故纸、香附、砂仁、生姜、肉桂之类，都是应当避免的。
四、吐血完全由火盛逼迫血液上行引起的，应当观察火的程度轻重。火轻微的，适宜《局方》犀角地黄汤或清化饮主治。火暴烈旺盛而根本元气没有受伤的，适宜抽薪饮、徙薪饮，或黄连解毒汤、三黄丸之类主治。如果是胃火热甚而烦热作渴、头痛、脉滑、气壅，并且吐血不止的，适宜白虎汤或抽薪饮。如果胃火炽盛而兼有阴虚水亏的，适宜玉女煎。如果是阳明实热非常严重，并且兼有大便干结、腹胀、气壅不降的，适宜《拔萃》犀角地黄汤，或凉膈散，或桃仁承气汤之类主治。然而这类证候不多见，必须审察确知属实，才能使用，不要鲁莽。凡是属于火证，都适宜饮用童便。
五、饮酒过多而导致吐血的，适宜徙薪饮、清化饮，或葛花解酲汤加黄连、丹皮主治。
六、怒气伤肝，动肝火则火载血上行，动肝气则气逆血奔，所以都能引起呕血。凡是肝火盛的，必定有烦热脉证。适宜芍药、生地黄、丹皮、栀子、泽泻、黄芩、黄连之类，降其火而血自然清。如果肝气逆的，必定有胸胁痛满等症状。适宜芍药、生地黄、青皮、陈皮、枳壳、贝母、泽泻之类，行其气而血自然清。如果火因气逆引起的，惟独化肝煎为宜。如果有病虽然因怒而起，但逆气已经消散的，不得再加用行气散瘀药物以伤害真气。或者肝火已经平息，不要过用苦寒药物再损伤元阳。而且凡肝气被邪气侵犯，往往多会侮犯脾土，所以常导致脾胃受伤及营血失守等证候。如果观察其无胀无火，脉虚神疲而血液妄行的，这是病伤在脾，治疗应当专门调理中气。适宜五阴煎、五福饮之类主治。或者兼有火不生土的情况，则理中汤、理阴煎之类，都不可少。不要说开始是因为怒气就专门去伐肝。
七、忧思过度，损伤心脾以致吐血咯血的，这种病大多不是火证。或者常见气短气怯、形色憔悴，或者胸怀郁结、饮食无味，或者腹虽觉饥但不欲食，或者神魂惊困而卧不安，这些都是中气亏损不能收摄所致，速宜救本，不得治标。惟独五福饮、五阴煎之类为宜。其中如果气陷而稍滞的，适宜归脾汤。如果阳分不足的，适宜理中汤或理阴煎之类主治。如果素来多劳倦思虑，或者善于呕吐，或者善于泄泻，而忽然导致吐血下血的，这是脾虚不能摄血，不是火证，适宜六味回阳饮大加白术主治，切不可使用清寒等药。
暑毒伤人，多令人吐衄失血，因为暑气通心，火毒刑克肺脏。然而暑既伤心，热又伤气，其人必定脉虚气怯、体倦息微，如果只知道是热而过用寒凉，那么气必定更加受伤，害处就非常大了。这惟独生脉散、人参汤之类为宜。如果气虚严重的，当以人参、黄芪并加使用。如果火甚而热渴烦闷的，适宜人参白虎汤，或竹叶石膏汤。如果气不甚虚的，适宜《局方》犀角地黄汤，或枇杷叶散。
八、格阳失血之证，多因色欲劳伤过度，以致真阳失守于阴分，则无根虚火浮泛于上，多见上热下寒，或头红面赤，或喘促躁烦，而大吐大衄，失血不止，但是六脉细微，四肢厥逆，或小便利，大便不成形的，这是格阳虚火证。速宜引火归原，用镇阴煎，或八味地黄汤之类，则火自然下降而血自然安宁。如果使用寒凉药物，阳气绝灭则会死亡。
九、所吐出的血，颜色黑而暗，必定是停积失位之血，不是由火逼迫而动。或者面白息微，脉见缓弱，身体清凉的，这必定是脾肾气虚，不能摄血所致，都不是火证。如果使用凉血药剂，必定导致危险。《三因方》说：理中汤能止伤胃吐血，因为它温中，大能分理阴阳，安和胃气，所以应当使用。如果观察其虚在阴分，则又惟独理阴煎为最适宜。
十、暴吐暴衄，失血如涌，多导致血脱气亦脱，危在顷刻的，这是内伤败坏严重所致。在这个时候，速宜以气为主。因为有形之血不能立即生成，无形之气所应当急固，只要使气不全部脱失，那么生命还可以保全，血渐渐可以生成。适宜急用人参一二两研为细末，加飞罗面一钱左右，或用温水，或井花冷水，随其所好，调成稀糊状，徐徐服用，或者浓煎独参汤徐徐服用也可以。这正是血脱益气的治法，也是阳生阴长的大法。
十一、凡是血逆上焦，紫黑成块，或痛或闷，结聚不散的。惟宜行气散瘀，或者吐出才好。大都治疗血证的方法，多忌讳辛散药物，恐怕它能动血。惟独这种留滞之血，则不妨使用。如四物汤加香附、肉桂、苏木、红花之类，没有不可以的。或者服用韭汁，也能很好地行瘀血。如果火郁不散，导致血液有留滞的。惟独在四物汤中加入炒山栀，大能清胃脘之血。
(There are thirteen articles in total; for all subsequent cases involving various types of bleeding, one should seek the underlying principles within this category.)
1. In treating hematemesis (vomiting blood), one must understand the severity of the condition. If there is an occasional injury but the root vitality remains unshaken, the condition is mild and easy to treat. One should clear heat or nourish as indicated by the specific injury; with appropriate medication, recovery can be achieved without concern. However, if chronic fatigue and excessive damage lead to severe deficiency of Yuan Qi (Original Qi) and failure of True Yin to remain secure, it constitutes a critical syndrome. This occurs because of negligence at the onset; if one fails to exercise caution even after illness has manifested, a favorable outcome is unlikely. For those suffering from this, relying solely on medicinal power without careful attention and prudence makes recovery difficult.
2. Regarding hematemesis and hemoptysis (coughing up blood), if caused by exhaustion leading to Qi deficiency with a calm pulse, or a slightly wiry and weak pulse, and neither constituting a Fire syndrome nor Qi rebellion, but rather spontaneous bleeding, this results from internal damage to True Yin and injury to the collaterals. One should use sweet and mellow herbs to tonify Yin and nourish the collaterals, allowing Ying Qi (Nutritive Qi) to gradually consolidate, thereby stabilizing the blood. Suitable formulas include Yi Yin Jian (One Yin Decoction), Zuo Gui Yin (Left Restoring Drink), Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill), or Xiao Ying Jian (Small Nourishing Decoction), selected according to circumstances. If the deficiency lies in the Qi aspect, Wu Fu Yin (Five Blessings Drink) or Da Bu Yuan Jian (Great Tonifying Original Decoction) are optimal. Such syndromes strictly contraindicate cold-cooling herbs and moving-scattering herbs, as these are unsuitable for deficiency-damage conditions.
3. In cases of hematemesis and hemoptysis accompanied by thirst, sore throat, restlessness, preference for cold, slippery pulse, solid stool, and dark hot urine, this indicates Water failing to control Fire, resulting from Yin deficiency and Yang hyperactivity. Treatment should focus on nourishing Yin and strengthening Water, with slight assistance from cooling herbs. Suitable formulas include Er Yin Jian (Two Yins Decoction), Si Yin Jian (Four Yins Decoction), modified Yi Yin Jian, Sheng Di Huang Yin Zi (Rehmannia Root Drink), or Tian Men Dong Wan (Asparagus Fern Pill), chosen based on the affected organ's Qi. If the heat is not severe, Yi Yin Jian, Zuo Gui Yin, or Liu Wei Di Huang Tang are appropriate. These syndromes strictly contraindicate acrid-warm herbs such as Chuan Xiong (Ligusticum Rhizome), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala), Du Zhong (Eucommia Bark), Po Gu Zhi (Cistanche Fruit), Xiang Fu (Cyperus Rhizome), Sha Ren (Amomum Fruit), Sheng Jiang (Fresh Ginger), and Rou Gui (Cinnamon Bark).
4. When hematemesis is entirely caused by excess Fire forcing blood upward, observe the intensity of the Fire. For mild Fire, Ju Fang Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction from the Bureau Formulary) or Qing Hua Yin (Clearing Transformation Drink) should be used. For violent Fire where the root is undamaged, Chou Xin Yin (Removing Fuel Drink), Xi Xin Yin (Moving Away Fuel Drink), or Huang Lian Jie Du Tang (Coptis Detoxification Decoction) and San Huang Wan (Three Yellows Pill) are suitable. If Stomach Fire is excessive, causing irritability, thirst, headache, slippery pulse, Qi stagnation, and persistent hematemesis, Bai Hu Tang (White Tiger Decoction) or Chou Xin Yin is indicated. If Stomach Fire is blazing combined with Yin deficiency and fluid depletion, Yu Nu Jian (Jade Woman Decoction) is appropriate. If Yangming Excess Heat is severe, accompanied by constipation, abdominal distension, and descending Qi obstruction, Ba Cui Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction from Extracts), Liang Ge San (Cooling the Diaphragm Powder), or Tao Ren Cheng Qi Tang (Peach Kernel Draining-Down Decoction) may be used. However, such cases are rare; they must be confirmed accurately before use, avoiding rashness. All Fire syndromes benefit from drinking Child Urine (Tong Bian).
5. Hematemesis caused by excessive alcohol consumption should be treated with Xi Xin Yin, Qing Hua Yin, or Ge Hua Jie Cheng Tang (Kudzu Flower Relieving Intoxication Decoction) added with Huang Lian (Coptis Rhizome) and Dan Pi (Moutan Cortex).
6. Anger injuring the Liver moves Liver Fire, which carries blood upward, or moves Liver Qi, causing Qi rebellion and blood rushing, both leading to vomiting blood. Excessive Liver Fire presents with irritability and heat-related pulse signs. Herbs such as Shao Yao (Peony Root), Sheng Di Huang (Rehmannia Root), Dan Pi, Zhi Zi (Gardenia Fruit), Ze Xie (Alisma Rhizome), Huang Qin (Scutellaria Root), and Huang Lian are used to descend Fire, clearing the blood. Liver Qi rebellion presents with chest and hypochondriac pain and fullness. Herbs such as Shao Yao, Sheng Di Huang, Qing Pi (Green Tangerina Peel), Chen Pi (Aged Tangerina Peel), Zhi Ke (Bitter Orange Fruit), Bei Mu (Fritillaria Bulb), and Ze Xie are used to move Qi, clearing the blood. If Fire arises from Qi rebellion, Hua Gan Jian (Transforming Liver Decoction) is best. If anger has subsided, avoid further scattering herbs that damage true Qi. If Liver Fire is pacified, avoid overusing bitter-cold herbs that damage Yuan Yang. Since Liver Qi pathology often insults the Spleen and Earth, it frequently causes Spleen-Stomach injury and loss of Ying Blood security. If there is no distension or fire, but a deficient pulse and mental fatigue with spontaneous bleeding, the pathology lies in the Spleen; treatment should focus on regulating Middle Qi. Wu Yin Jian (Five Yins Decoction) or Wu Fu Yin are suitable. If Fire fails to generate Earth, Li Zhong Tang (Regulate the Middle Decoction) or Li Yin Jian (Regulate Yin Decoction) are essential. Do not focus solely on suppressing the Liver just because the initial cause was anger.
7. Excessive worry and thought damaging the Heart and Spleen, leading to hematemesis and hemoptysis, are rarely Fire syndromes. Symptoms may include shortness of breath, timidity, emaciation, depression, lack of appetite, hunger without desire to eat, or restless sleep due to frightened spirit. These result from Middle Qi deficiency failing to contain blood. Urgent treatment of the root is required, not the branch. Wu Fu Yin or Wu Yin Jian are suitable. If Qi sinks with slight stagnation, Gui Pi Tang (Restore the Spleen Decoction) is indicated. If Yang deficiency exists, Li Zhong Tang or Li Yin Jian are appropriate. If chronic fatigue and overthinking, frequent vomiting, or diarrhea suddenly lead to hematemesis and lower bleeding, this is Spleen deficiency failing to control blood, not a Fire syndrome. Liu Wei Hui Yang Yin (Six-Ingredient Returning Yang Drink) with a large dose of Bai Zhu is suitable; cold-cooling drugs must be avoided.
Summer-toxin harming people often causes epistaxis (nosebleed) and blood loss, as summer Qi connects to the Heart and Fire-toxin attacks the Lung. Summer damages the Heart, and heat damages Qi, resulting in a deficient pulse, timidity, fatigue, and faint breathing. Overusing cold-cooling herbs thinking it is merely heat will further damage Qi, causing great harm. Sheng Mai San (Generate Pulse Powder) or Ren Shen Tang (Ginseng Decoction) are suitable. For severe Qi deficiency, add Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root). If Fire is severe with heat, thirst, and oppression, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) are indicated. If Qi deficiency is not severe, Ju Fang Xi Jiao Di Huang Tang or Pi Pa Ye San (Loquat Leaf Powder) are suitable.
8. Ge Yang (Gridlock Yang) blood loss syndromes are often due to excessive sexual activity and fatigue, causing True Yang to lose security in the Yin aspect. Rootless deficient Fire floats upward, presenting with upper heat and lower cold, red face, panting, restlessness, massive hematemesis or epistaxis, and continuous blood loss. However, the six pulses are minute, limbs are cold, urination is clear and profuse, and stool is loose. This is a Ge Yang deficient Fire syndrome. Urgently guide Fire back to its source using Zhen Yin Jian (Settling Yin Decoction) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill); the Fire will descend and blood will stabilize. Using cold-cooling herbs will lead to Yang extinction and death.
9. Blood vomited that is black and dark indicates stagnant blood out of position, not moved by Fire. A pale face, faint breathing, slow-weak pulse, and cool body indicate Spleen-Kidney Qi deficiency failing to control blood, not a Fire syndrome. Using blood-cooling agents will lead to danger. The *San Yin Fang* states: Li Zhong Tang can stop Stomach-injury hematemesis because it warms the middle, regulates Yin and Yang, and harmonizes Stomach Qi. If deficiency is in the Yin aspect, Li Yin Jian is most suitable.
10. Sudden massive hematemesis or epistaxis with blood gushing leads to blood loss and concurrent Qi collapse, a critical emergency due to severe internal injury. At this moment, prioritize Qi. Formidable blood cannot regenerate immediately, but formless Qi must be urgently secured. As long as Qi does not completely collapse, life can be preserved, and blood will gradually regenerate. Urgently administer 1-2 liang of Ren Shen powder mixed with 1 qian of refined flour, diluted with warm water or well water to a thin paste, taken slowly. Alternatively, strong Du Shen Tang (Single Ginseng Decoction) taken slowly is effective. This follows the great principle of benefiting Qi in blood collapse and generating Yin through Yang.
11. For blood rebelling to the Upper Jiao, forming purple-black clots, causing pain or oppression, and accumulating without dispersing, moving and scattering methods are suitable, or inducing vomiting is beneficial. Generally, treating blood disorders contraindicates acrid-scattering herbs to avoid disturbing blood. However, for stagnant blood, such methods are permissible. Si Wu Tang (Four Substances Decoction) added with Xiang Fu, Rou Gui, Su Mu (Sappan Wood), and Hong Hua (Carthamus Flower) is effective. Drinking Leek Juice also effectively moves stasis. If constrained Fire causes blood stagnation, adding Chao Shan Zhi (Stir-fried Gardenia Fruit) to Si Wu Tang clears Stomach heat and blood.
12. For intractable hematemesis, drinking Tong Bian (Child Urine) is most effective. Alternatively, crush Ce Bai Ye (Biota Top Branches), mix two parts Tong Bian with one part wine, and drink warm. This greatly stops bleeding.