唾血者，由伤损肺。肺者为五脏上盖，易为伤损。若为热气所加，则唾血。唾上如红缕者，此伤肺也。胁
下痛，唾鲜血者，此伤肝。关上脉微芤，则唾血。脉沉弱者生，牢实者死。（《病源论》）（按∶此证疑是痰血。
《虚劳凝唾候》曰∶肾液为唾。上焦热，热冲咽喉，故唾生凝结也。盖唾血之唾亦是凝唾，凝唾即痰也。又《
脉诀》牢实作实大。）
唾血一证，不嗽者易治，兼嗽者为难愈，谓肺伤故也。（《济生续方》）
吐血止，而后嗽中血出如线，引胁下时痛，日渐羸瘦，此
由悲忧伤肺。肺主气而血随气，伤则血无所主，故始则暴去，后随病而上下。脉缓小可治，细数加急者不治。
（《鸡峰》）
热壅于肺能嗽血，久嗽损肺亦能嗽血。壅于肺者易治，不过凉之而已，损于肺者难治，已久成劳也。（《要
诀》）
嗽血乃肺热，咳出唾中红丝乃是肺痿。（《原病集》）
咳血者，因咳嗽而见血，或干咳，或痰中见红丝血点一两口，气急喘促，此虽肺体自燥，亦为火逆咳伤血膜
而血随痰出也。其脉微弱平缓易治，弦数急实、气促声嘶咽痛者不治。（《医通》）
咳血多是火郁肺中，治宜清肺降火，开郁消痰，咳止而血亦止也。不可纯用血药，使气滞痰塞而郁不开，咳
既不止，血安止哉。设下午身热而脉细数，此真阴不足，当清上补下。（《赤水》）
先吐血后见痰嗽，多是阴虚火动，痰不下降，四物汤为主，加痰药火药。先痰嗽后见红，多是痰积热，降痰
火为急。痰嗽涎带血出，此是胃口清血，热蒸而出，重者栀子，轻者蓝实。挟痰若用血药，则泥而不行，只治火
则止，吐血火病也。（《丹溪》）
瘀血作吐《活人书》云∶伤寒太阳证衄血者病欲愈，热结膀胱而血自下者亦欲愈。以此观之，他病伏
热之人，上焦瘀血而作吐者，亦其病之有瘳也。虽然，血既吐而自止则可矣。（《直指》）
此来上虞熙汤馆于魏氏，一日乘盛暑肩舆入邑，途中吐血数口，亟还则吐甚，胸拒痛，体热头眩，病且殆。
或以为劳心焦思所致，与茯苓补心汤。生至，诊其脉洪而滑，曰∶是大醉饱，胃血壅遏，为暑迫上行。先与犀角
地黄汤，继以桃仁承气汤，去瘀血宿积，后治暑即安。（《医史撄宁生
传》）
李士材治张鸣之吐血两年，面色痿黄，潮热咳嗽，膈有微痛，脉数而沉且搏，其痛不可按而甚于夜分。是坚
血蓄积，非大下之不可。又以久病未敢峻攻，用郁金、降真、归、地、山甲、蓬术、人参，下血如漆者数次而痛
减。月余复痛，此病重而药轻也，乃以大黄、干漆、蓬术、郁金、山甲、肉桂、归尾、桃仁、虻虫为丸，每日服
参、 之剂，午后服丸药钱许，十日血积大下，数次而安。（《医通》）
内伤瘀积在胃，不时吐血者，其人面色槁而滞，脉多弦涩。当先与百劳丸去瘀，后用异功、六君调补。
（同上）
（百劳丸见《骨蒸》门。）
假热证 有一等真阴失守，命门火衰，火不归元，水盛而逼其浮游之火于上，上焦咳嗽气喘，恶热面红，
呕吐痰涎出血，此系假阳之证，须用八味地黄丸，引火归原。何以辨其为假而识之？余辨之舌耳。凡有实热者，
舌胎必燥而焦，甚则黑（假热亦有黑舌，但不兼焦燥耳）。假热者，舌虽有白胎而必滑，口虽渴而不能饮水，
饮水不过一二口，甚者少顷亦吐出，面虽赤色必娇嫩，身作躁而欲坐卧于泥水中，此为辨也。（《医贯》）
冷证 按患人果身受寒气，口受冷物，邪入血分，血得冷而不归经络而仍妄行者，其血必黯黑，其面色
必白而夭，其脉必微迟，其身必清凉，不用姜桂而用凉血之剂殆矣。临病之工，宜详审焉。（《准绳》）
暑毒证 暑毒失血者，脉大气喘，多汗烦渴，盖心主血而暑气喜归心也。此病多于酒客及阴虚之人有之。
（《金匮翼》）（按∶伏暑发衄或吐血，用五苓散，见《三因》。）
怒极证（宜参清凉诸方）仆尝治一人吐血，诊其脉，
肝部弦，气口濡，吐因怒极而得之。遂用苏合香丸和鸡苏丸，服即效。（《妇人良方》）（龙脑鸡苏丸，见《和
剂》。）
吐血有因怒而得者，经曰怒则气逆，甚则呕血。宜平肝降火，炒栀子、青皮、芩、连、柴胡。（《六要》）
有怒气伤肝而成吐衄者，其人必唇青面青脉弦，须用柴胡栀子清肝散。（《医贯》）
伤力证 有负重为物所压，或持重远行，忽心口痛，口鼻出血，俗名伤力，乃内膜及肺胃悉伤损挣破也。
大凡吐血，须审病因，不可遽投凉药，如用力打扑喊叫，内伤脉络，口鼻出血，是肺胃上脘有损破，必以白芨或
飞罗面，米饮调，先填注损处，次用大补气血兼消瘀。若误治，必不救。（《六要》）
吐血后诸证 凡吐血之后，体中但自 然（《病源论》KT KT 然）心中不闷者，辄自愈。假令烦躁，心
中闷乱纷纷，呕吐颠倒不安。医工又与黄土汤、阿胶散，益加闷乱，卒至不济。如此闷者，当急吐之。（《千金》）
（按∶吐方用瓜蒂、杜蘅、人参。）
吐血之后，脏腑虚竭，荣卫不理，阴阳隔绝，阳虚于上，故身体虚热，胸中痞则口燥。（《病源论》）
吐血人多发渴，名为血渴，四物汤、十全大补汤（《医通》或生脉散加黄 、煨葛根、枇杷叶），量胃气虚
实用之。（《要诀》）
吐血不死咳嗽必死 今之医者，谓吐血为虚劳之病，此大谬也。夫吐血有数种，大概咳者成劳，不咳者
不成劳。间有吐时偶咳者，当其吐血之时，野狼狈颇甚，吐止即痊，皆不成劳。何也？其吐血一止，则周身无病，
饮食如故而精神生矣。即使亡血之后，或阴虚内热，或筋骨疼痛，皆可服药而痊。若咳嗽，则
血止而病仍在，日嗽夜嗽，痰壅气升，多则三年，少则一年而死矣。盖咳嗽不止，则肾中之元气震荡不宁。肺为
肾之母，母病则子亦病故也。又肺为五脏之华盖。经云∶谷气入胃，以传于肺，五脏六腑皆以受气，其清者为营，
浊者为卫。是则脏腑皆取精于肺，肺病则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭矣，故咳嗽为真劳不
治之疾也。然亦有咳嗽而不死者，其嗽亦有时稍缓，其饮食起居不甚变，又其人善于调摄，延至三年之后，起居如
旧，间或一发，静养即愈，此乃百中难得一者也。更有不咳之人，血证屡发，肝竭肺伤，亦变咳嗽，久而亦死，
此则不善调摄以轻变重也。执此以决血证之死生，百不一失矣。（《源流论》）
不治证 喷血，脉实大而涩，绝食吐泻者。咳血，脉数大，小便不利，气喘乏力者。（《识病捷法》）
治例 血随气行，气逆而上奔，则血不循于经络而涌吐矣。人知吐血出于上焦有热固也，然能用柴胡、
黄芩、蒲黄、茅花等辈，而不能用枳壳、北梗、青皮、生姜、乌梅佐之，又不能用通利丸子，以开其中脘，导其
大便，则气如何而下降，血如何而下行。吾恐逆奔而上，有不可得而止之者。若夫根据前治法，血止而后，又当
以人参、川芎、当归、茯苓、橘皮、半夏、甘草为之调理，虚则加木香，热则加柴胡，壅则加桑皮、荆芥，尤在
权衡。（《直指》）
夫男子妇人咯血、衄血、嗽血、咳脓血，可服三黄丸、黄连解毒汤、凉膈散，加桔梗、当归，大料煎剂，时
时呷之。《内经》曰，治心肺之病最近，药剂不厌频而少，时时呷之者是也。（《治病百法》）
治之须究其因，伤胃者调胃安血，劳心者补益其心志，热则清之，气郁则顺之，伤脾则安之。（《大成》）
衄行清道，吐行浊道，流入胃脘，令人吐血。妄行于上，或吐或咯或嗽，用琥珀效者固多有之，宜择末药中
入此一味，或煎药去滓可调服。吐甚头晕，发为寒热者，降气汤和四物汤各半帖，加阿胶一钱。若单单发热者，
茯苓补心汤。有因劳力太过，吐血不止，苏子降气汤加人参半钱煎。有时或吐血两口，随即无事，数日又发，经
年累月不愈者，宜黑神散和小乌沉汤常服。（《要诀》）
初起脉洪大，用犀角地黄汤，调郁金、黑栀子灰或荆芥穗灰。吐后有血，是酒毒。如胸间作痛，是呕破胃脘，
童便调白芨末。脉数急，心不痛，只作火治。大吐不止，诸药不效，用干姜炒黑为末，童便调服，此从治之法也。
（《六要》）（按∶黑姜、童便本出丹溪。）
若血脱至甚，气亦随之，因至厥逆昏愦者，速当益气以固生机，宜六味回阳饮或四味回阳饮主之，若再用寒
凉即死。（《景岳》）
凡吐血脉微身凉恶风者，须于地黄、芍药中，加肉桂一钱，虚冷人多有此证。（《金匮翼》）
治吐血三要 宜降气不宜降火，气有余即是火，气降则火降，火降则气不上升，血随气行，无溢出上窍之
患矣。降火必用寒凉之剂，反伤胃气，胃气伤则脾不能统血，血愈不能归经矣。今之疗吐血者大患有二∶一则专
用寒凉之味，如芩、连、山栀、青黛、柿饼灰、四物汤、黄柏、知母之类，往往伤脾作泄，以致不救。一则专用人
参，肺热还伤肺，咳逆愈甚。亦有用参而愈者，此是气虚喘嗽，气属阳，不由阴虚火炽所致，然亦百不一二也。宜
以白芍药、炙甘草制肝，枇杷叶、麦门冬、薄荷、橘红、贝母清肺，薏苡仁、怀山药养脾，韭菜、番降香、真苏子
下气，青蒿、鳖甲、银柴胡、牡
丹皮，地骨皮补阴清热，酸枣仁、白茯神养心，山茱萸、枸杞子、牛膝补肾，此累试辄验之方。然阴无骤补之法，
非多服药不效。病家欲速其功，医者张皇无主，百药杂试，以致殒命，覆辙相寻而不悟，悲夫！（《广笔记》曰∶
郁金治吐血圣药，患无真者尔。）宜行血不宜止血，血不循经络者，气逆上壅也。夫血得热则行，得寒则凝，故
降气行血，则血循经络，不求其止而自止矣。止之则血凝，血凝必发热恶食，及胸胁痛，病日沉痼矣。宜补肝不
宜伐肝，经曰∶五脏者，藏精气而不泻者也。肝为将军之官，主藏血。吐血者，肝失其职也。养肝则肝气平而血
有所归，伐之则肝不能藏血，血愈不止矣。（《本草经疏》）
凉温有宜 仆观初虞世治吐血，不喜用竹茹、生地黄、藕汁，然亦不可滞泥此说。如阳乘于阴，血得热
则流散，经水沸溢，宜阴凉药以解之，大黄、犀角、生地黄、生艾、藕汁岂能无效。如阴乘于阳，所谓天寒地冻，
水凝成冰，宜服温药以暖之，干姜、肉桂岂能无功，学人更宜思之。（《妇人良方》）
血从上出，皆是阳盛阴虚，有升无降，血随气上，越出上窍，法当补阴抑阳，气降则血归经。（《丹溪》）
此论平人无故忽然病此者是也。然有打伤跌扑，从高坠下，内损经络而吐衄者，有食填太阴，或胃寒呕吐，蹙破胃
脘而吐血者；有劳役过度，色欲无节，肺肾大亏，不能摄血而血妄行者，不可不辨。误用凉药，必致杀人。（《六
要》）
凡酒色过度，损伤肺肾真阴，咳嗽吐痰，衄血吐血咳血咯血等证，误服参、 等甘温之药，则病日增，服之
过多则死不可治。盖甘温助气，气属阳，阳旺则阴愈消。前项病证，乃阴血虚而阳火旺，宜服苦甘寒之药以生血降
火。世
人不识，往往服参、 以为补，予见服此而死者多矣。（《明医杂着》）噫！此亦一隅之说，非天下之通论。诸失
血证，固为火盛妄行，而不宜于甘温，理故然也。其有虚火体气弱甚者，宁有不用参、 者乎。葛可久治大吐
血后，用独参汤一味服之，所以治其虚也。大抵用药补泻，宜审人之虚实，则无施而不当也，何甘温之必不可用
哉。（《医统》）
泻下方法 血盛大者，先消瘀血，次止血凉血。盖血来多，必有瘀于胸膈者，不先消化，则止之凉之不
应也。（《杂着》）
脉洪实有力，精神不倦，或觉胸中满痛，或血是紫血块者，用生地、赤芍、当归、牡丹皮、荆芥、阿胶、滑
石、大黄、玄明粉、桃仁泥之属，从大便导之，此釜底抽薪法也。今人不知，徒事芩、连、栀、柏辅四物，使气血
两伤，脾胃俱败，百不一生，悲哉！（《六要》）（宜与通说相参）
吐血（《六要》此下曰∶势不可遏），觉胸中气塞，上吐紫血者，桃仁承气汤下之。（《丹溪》）
治虚劳吐血方。
生地黄汁（半升） 川大黄（末一方寸匕）
上二味，温地黄汁一沸，纳大黄搅之，空腹顿服，日三瘥。（《千金》）（按∶此方既出《伤寒》中，然实是
原方，仍更拈之。）治暴热毒，心肺烦而呕血方，大黄二两为末，以地黄汁拌匀，湿即焙干。上为末，每服二钱，
地黄汁调下，以利为度，甘草汤亦得。（《中藏经》）
三黄丸，治三 吐血诸黄证。
黄连（三两） 黄芩（二两） 大黄（一两）
上为末，炼蜜为丸，如桐子大，食后温水下十五丸，量虚实加减服。（《中藏经》）（按∶《本事》为散用，见
《衄血》中。）
治小儿吐血，心躁烦闷，茜根散方。
茜根（半两） 犀角屑 川升麻 川大黄（锉微炒） 黄芩 甘草（各一分）
唾血，是由于肺脏受到损伤所致。肺位于五脏之上，如同盖子一般，容易受到损伤。如果受到热邪的侵袭，就会导致唾血。唾出的血像红色的丝线一样，这是肺脏受伤的表现。胁肋下疼痛，唾出鲜血，这是肝脏受伤的表现。关部脉象微而芤（浮大中空，如按葱管），就会出现唾血。脉象沉弱的是可治之症，脉象牢实（坚搏有力）的是死症。（出自《诸病源候论》）（按语：此证怀疑是痰中带血。《虚劳凝唾候》说：肾液化为唾。上焦有热，热气冲逆咽喉，所以唾液中产生凝结物。大概唾血中的“唾”也是凝唾，凝唾就是痰。另外《脉诀》中将“牢实”解释为“实大”。）
唾血这一病症，不伴有咳嗽的容易治疗，伴有咳嗽的就难以痊愈，这是因为肺脏受伤的缘故。（出自《济生续方》）
吐血停止后，随后在咳嗽中吐出如丝线的血，牵引胁肋部疼痛，身体日渐消瘦，这是由于悲忧伤及肺脏。肺主气，血随气运行，肺伤则血失去主宰，所以开始是大量出血，后来随着病情发展，血液上下妄行。脉象缓小的是可治之症，脉象细数且急促的是不治之症。（出自《鸡峰普济方》）
热邪壅滞于肺能导致咳血，久咳损伤肺脏也能导致咳血。热邪壅滞于肺的容易治疗，不过用凉药清热即可；损伤肺脏的难治，因为已经形成虚劳了。（出自《医学要诀》）
咳血属于肺热，咳嗽时唾液中带有红丝，这属于肺痿。（出自《原病集》）
咳血，是因为咳嗽而见血，或者干咳，或者痰中带有一两口红丝血点，气急喘促。这虽然是肺体自身干燥，也是因为火邪逆上咳嗽损伤了血膜，导致血随痰而出。脉象微弱平缓的是可治之症，脉象弦数急实、气促声嘶咽痛的是不治之症。（出自《医学入门》）
咳血多是火郁结在肺中，治疗应当清肺降火，开郁消痰，咳嗽停止而血也就停止了。不可单纯使用止血药，以免气机阻滞、痰湿堵塞而郁结不开，咳嗽既然不止，血怎么能止呢？如果下午身体发热而脉象细数，这是真阴不足，应当清上焦之火并补下焦之阴。（出自《赤水玄珠》）
先吐血后出现痰嗽，多是阴虚火动，痰液不能下降，以四物汤为主方，加入化痰药和清火药。先痰嗽后见红，多是痰积化热，急需降痰火。痰嗽带血出，这是胃中清血被热蒸腾而出，重的用栀子，轻的用蓝实。如果挟痰而用补血药，就会黏腻阻碍气机，只治火就能止血，吐血属于火病。（出自《丹溪心法》）
瘀血导致的呕吐，《活人书》说：伤寒太阳证出现鼻衄（鼻出血）是病欲愈的表现，热结膀胱而血液自行下行也是病欲愈的表现。由此看来，其他疾病中有伏热的人，上焦有瘀血而呕吐的，也是病情好转的迹象。虽然如此，血吐出来之后自然停止就可以了。（出自《直指方》）
此人来到上虞熙汤馆，在魏家做客。一天在盛夏时节乘轿进城，途中吐血几口，急忙回家则吐血更甚，胸部拒按疼痛，身体发热头晕，病情危急。有人认为是劳心焦思所致，给予茯苓补心汤。医生李士材到达后，诊察其脉象洪大而滑，说：这是大醉饱食，胃中血液壅遏，被暑热逼迫而上行。先用犀角地黄汤，继以桃仁承气汤，去除瘀血宿积，然后治疗暑热就安好了。（出自《医史·撄宁生传》）
李士材治疗张鸣之吐血两年，面色萎黄，潮热咳嗽，膈间有轻微疼痛，脉象数而沉且搏指，疼痛不可按压且在夜间加重。这是坚硬的瘀血蓄积，非用峻下之法不可。但又因久病不敢峻攻，于是用郁金、降真香、当归、地黄、穿山甲、蓬术、人参，排出如漆般的黑血数次后疼痛减轻。月余后疼痛复发，这是病重药轻，于是用大黄、干漆、蓬术、郁金、穿山甲、肉桂、归尾、桃仁、虻虫制成丸药，每天服用参、芪等补气剂，午后服用丸药一钱左右，十日瘀血大量排出，数次后病情安定。（出自《医学入门》）
内伤瘀积在胃，不时吐血的人，面色枯槁而晦滞，脉象多弦涩。应当先用百劳丸去除瘀血，后用异功散、六君子汤调理补益。（同上）
（百劳丸见《骨蒸》门。）
假热证：有一类真阴失守，命门火衰，火不归元，水盛而逼迫浮游之火上行，导致上焦咳嗽气喘，恶热面红，呕吐痰涎出血，这属于假阳之证，必须用八味地黄丸，引火归原。如何辨别它是假热并识别它呢？我通过舌苔来辨别。凡是有实热的，舌苔必定干燥焦裂，甚至发黑（假热也有黑舌，但不兼有焦燥）。假热的，舌苔虽有白色但必定滑润，口中虽渴但不能饮水，饮水不过一二口，严重的过一会儿也吐出来，面色虽红但必定娇嫩，身体躁动却想坐卧在泥水中，这就是辨别的方法。（出自《医贯》）
冷证：如果患者确实感受寒气，食用冷物，邪气进入血分，血得冷则不能回归经络而妄行，其血色必黯黑，面色必白而无光泽，脉象必微迟，身体必清凉。此时不用姜、桂等温热药而用凉血剂，那就危险了。临证医生，应当详细审察。（出自《世医得效方》）
暑毒证：暑毒导致的失血，脉象大，气喘，多汗烦渴，因为心主血而暑气喜欢归于心。这种病多见于嗜酒的人和阴虚之人。（出自《金匮翼》）（按语：伏暑发作引起的鼻衄或吐血，可用五苓散，见《三因极一病证方论》。）
怒极证（宜参考清凉诸方）：我曾治疗一人吐血，诊其脉，肝部脉弦，气口脉濡，吐血是因为大怒至极所致。于是用苏合香丸配合鸡苏丸，服用后立即见效。（出自《妇人大全良方》）（龙脑鸡苏丸，见《太平惠民和剂局方》。）
吐血有因愤怒而得的，经书说：怒则气逆，甚则呕血。应当平肝降火，用炒栀子、青皮、黄芩、黄连、柴胡。（出自《景岳全书·六要》）
有因怒气伤肝而成为吐血的，其人必定唇青面青脉弦，须用柴胡栀子清肝散。（出自《医贯》）
伤力证：有负重被物压住，或持重物远行，忽然心口痛，口鼻出血，俗名叫伤力，这是内膜及肺胃全部因用力挣破所致。大凡吐血，必须审察病因，不可立即投用凉药。如用力打扑喊叫，内伤脉络，口鼻出血，是肺胃上脘有破损，必须用白芨或飞罗面，米饮调服，先填注损伤处，其次用大补气血兼消瘀的药物。如果误治，必然无法挽救。（出自《景岳全书·六要》）
吐血后诸证：凡是吐血之后，身体中只要心中不闷乱的，往往自愈。假如烦躁，心中闷乱纷纷，呕吐颠倒不安。医生又给予黄土汤、阿胶散，更加闷乱，最终致死。如此闷乱的，应当紧急催吐。（出自《千金方》）（按语：吐方用瓜蒂、杜蘅、人参。）
吐血之后，脏腑虚竭，营卫失调，阴阳隔绝，阳虚于上，所以身体虚热，胸中痞塞则口燥。（出自《诸病源候论》）
吐血的人多发生口渴，名为血渴，可用四物汤、十全大补汤（《医学入门》或用生脉散加黄芪、煨葛根、枇杷叶），根据胃气虚实来使用。（出自《医学要诀》）
吐血不死，咳嗽必死：现在的医生，认为吐血是虚劳之病，这是大错特错的。吐血有好几种，大概咳嗽的会发展成劳损，不咳嗽的不会发展成劳损。偶尔在吐血时咳嗽的，当吐血之时，病人非常狼狈，吐止后即痊愈，都不成劳损。为什么呢？吐血一止，则周身无病，饮食如常，精神恢复。即使亡血之后，或有阴虚内热，或筋骨疼痛，都可服药痊愈。如果咳嗽，则血止而病仍在，日夜咳嗽，痰壅气升，多的三年，少的一年就会死亡。盖因咳嗽不止，则肾中元气震荡不宁。肺为肾之母，母病则子亦病。又肺为五脏之华盖。经书说：谷气入胃，传于肺，五脏六腑皆受气，清者为营，浊者为卫。这样脏腑都取精于肺，肺病则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭尽，所以咳嗽是真劳损不治之疾。然而也有咳嗽而不死的，其咳嗽有时稍缓，饮食起居变化不大，加上善于调养，延至三年之后，起居如旧，偶尔发作，静养即愈，这是百中难得一例。更有不咳嗽的人，血证屡发，肝竭肺伤，也变成咳嗽，久而也会死亡，这是不善调养使轻病变重。执此来判断血证生死，百无一失。（出自《景岳全书·源流论》）
不治证：喷血，脉实大而涩，绝食且吐泻的。咳血，脉数大，小便不利，气喘乏力的。（出自《识病捷法》）
治例：血随气行，气逆而上奔，则血不循经络而涌吐。人们知道吐血出于上焦有热固然正确，然而能用柴胡、黄芩、蒲黄、茅花等药，却不能用枳壳、桔梗、青皮、生姜、乌梅来辅助，也不能用通利丸子来开通中脘，引导大便，那么气如何下降，血如何下行？我担心逆气上奔，有不可止住的。如果依据前面的治法，血止之后，又当用人参、川芎、当归、茯苓、橘皮、半夏、甘草来调理，虚则加木香，热则加柴胡，壅滞则加桑白皮、荆芥，尤其在于权衡。（出自《直指方》）
男子妇人咯血、衄血、嗽血、咳脓血，可服用三黄丸、黄连解毒汤、凉膈散，加桔梗、当归，大剂量煎剂，时时呷服。《内经》说，治心肺之病最近，药剂不厌频繁而量少，时时呷服就是这个意思。（出自《治病百法》）
治疗必须探究病因，伤胃的调胃安血，劳心的补益心志，热的清热，气郁的顺气，伤脾的安脾。（出自《针灸大成》）
衄血走清道，吐血走浊道，流入胃脘，令人吐血。妄行于上，或吐或咯或嗽，用琥珀有效的很多，宜选择末药中加入这一味，或煎药去渣后调服。吐甚头晕，发为寒热的，降气汤和四物汤各半帖，加阿胶一钱。若单单发热的，用茯苓补心汤。有因劳力太过，吐血不止的，苏子降气汤加人参半钱煎服。有时或吐血两口，随即无事，数日又发，经年累月不愈的，宜黑神散和小乌沉汤常服。（出自《医学要诀》）
初起脉洪大的，用犀角地黄汤，调郁金、黑栀子灰或荆芥穗灰。吐后有血，是酒毒。如胸间作痛，是呕破胃脘，童便调白芨末。脉数急，心不痛，只作火治。大吐不止，诸药不效，用干姜炒黑为末，童便调服，这是从治之法。（出自《景岳全书·六要》）（按语：黑姜、童便本出自丹溪。）
若血脱严重，气也随之衰竭，导致厥逆昏愦的，速当益气以固生机，宜六味回阳饮或四味回阳饮主治，若再用寒凉药就会死亡。（出自《景岳全书》）
凡是吐血脉微身凉恶风的，须在地黄、芍药中，加肉桂一钱，虚冷人多有此证。（出自《金匮翼》）
治吐血三要：宜降气不宜降火，气有余即是火，气降则火降，火降则气不上升，血随气行，无溢出上窍之患。降火必用寒凉之剂，反伤胃气，胃气伤则脾不能统血，血愈不能归经。现在治疗吐血的大患有二：一则专用寒凉之味，如黄芩、黄连、山栀、青黛、柿饼灰、四物汤、黄柏、知母之类，往往伤脾作泄，以致不救。一则专用人参，肺热还伤肺，咳逆愈甚。也有用参而愈的，这是气虚喘嗽，气属阳，不由阴虚火炽所致，但也百不一二。宜以白芍药、炙甘草制肝，枇杷叶、麦门冬、薄荷、橘红、贝母清肺，薏苡仁、怀山药养脾，韭菜、番降香、真苏子下气，青蒿、鳖甲、银柴胡、牡丹皮、地骨皮补阴清热，酸枣仁、白茯神养心，山茱萸、枸杞子、牛膝补肾，这是屡次试验验证的方子。然而阴无骤补之法，非多服药不效。病家欲速其功，医者张皇无主，百药杂试，以致殒命，覆辙相寻而不悟，可悲啊！（《广笔记》说：郁金治吐血圣药，患无真者尔。）宜行血不宜止血，血不循经络者，气逆上壅也。夫血得热则行，得寒则凝，故降气行血，则血循经络，不求其止而自止。止之则血凝，血凝必发热恶食，及胸胁痛，病日沉痼矣。宜补肝不宜伐肝，经说：五脏者，藏精气而不泻者也。肝为将军之官，主藏血。吐血者，肝失其职也。养肝则肝气平而血有所归，伐之则肝不能藏血，血愈不止矣。（出自《本草经疏》）
凉温有宜：我看初虞世治疗吐血，不喜欢用竹茹、生地黄、藕汁，但也不可拘泥于此说。如阳乘于阴，血得热则流散，经水沸溢，宜阴凉药以解之，大黄、犀角、生地黄、生艾、藕汁岂能无效。如阴乘于阳，所谓天寒地冻，水凝成冰，宜服温药以暖之，干姜、肉桂岂能无功，学人更应思考。（出自《妇人大全良方》）
血从上出，皆是阳盛阴虚，有升无降，血随气上，越出上窍，法当补阴抑阳，气降则血归经。（出自《丹溪心法》）
此论说的是平人无故忽然病此的情况。然而有被打伤跌扑，从高坠下，内损经络而吐衄的，有食填太阴，或胃寒呕吐，蹙破胃脘而吐血的；有劳役过度，色欲无节，肺肾大亏，不能摄血而血妄行的，不可不辨。误用凉药，必致杀人。（出自《景岳全书·六要》）
凡是酒色过度，损伤肺肾真阴，咳嗽吐痰，衄血吐血咳血咯血等证，误服人参、黄芪等甘温之药，则病日增，服之过多则死不可治。盖甘温助气，气属阳，阳旺则阴愈消。前项病证，乃阴血虚而阳火旺，宜服苦甘寒之药以生血降火。世人不懂，往往服参、芪以为补，我见服此而死的多矣。（出自《明医杂著》）噫！这也是偏颇之说，非天下之通论。诸失血证，固为火盛妄行，而不宜于甘温，理固然是这样。其有虚火体气弱甚者，难道有不用的吗？葛可久治疗大吐血后，用独参汤一味服之，所以治其虚也。大抵用药补泻，宜审人之虚实，则无施而不当也，何甘温之必不可用哉。（出自《医统》）
泻下方法：血盛大者，先消瘀血，次止血凉血。盖血来多，必有瘀于胸膈者，不先消化，则止之凉之不应。（出自《明医杂著》）
脉洪实有力，精神不倦，或觉胸中满痛，或血是紫血块者，用生地、赤芍、当归、牡丹皮、荆芥、阿胶、滑石、大黄、玄明粉、桃仁泥之属，从大便导之，此釜底抽薪法也。今人不知，徒事芩、连、栀、柏辅四物，使气血两伤，脾胃俱败，百不一生，悲哉！（出自《景岳全书·六要》）（宜与通说相参）
吐血（《景岳全书·六要》此下曰：势不可遏），觉胸中气塞，上吐紫血者，桃仁承气汤下之。（出自《丹溪心法》）
治虚劳吐血方。
生地黄汁（半升） 川大黄（末一方寸匕）
上二味，温地黄汁一沸，纳大黄搅之，空腹顿服，日三瘥。（出自《千金方》）（按语：此方既出《伤寒论》中，然实是原方，仍更拈之。）治暴热毒，心肺烦而呕血方，大黄二两为末，以地黄汁拌匀，湿即焙干。上为末，每服二钱，地黄汁调下，以利为度，甘草汤亦得。（出自《中藏经》）
三黄丸，治三焦吐血诸黄证。
黄连（三两） 黄芩（二两） 大黄（一两）
上为末，炼蜜为丸，如桐子大，食后温水下十五丸，量虚实加减服。（出自《中藏经》）（按语：《本事方》为散用，见《衄血》中。）
Saliva blood (hemoptysis with saliva) results from damage to the Lung. The Lung is the upper cover of the five Zang organs and is easily damaged. If affected by heat pathogens, saliva blood occurs. Saliva blood appearing like red threads indicates Lung damage. Pain in the hypochondrium with fresh blood in saliva indicates Liver damage. A superficial and hollow pulse (Kou Mai) at the Guan position suggests saliva blood. A deep and weak pulse indicates a curable condition, while a firm and solid pulse indicates a fatal one. (From *Zhu Bing Yuan Hou Lun*) [Note: This condition is suspected to be phlegm-blood. *Xu Lao Ning Tuo Hou* states: Kidney fluid transforms into saliva. Heat in the Upper Jiao rushes to the throat, causing condensation in the saliva. Thus, "saliva" in saliva blood refers to condensed saliva, which is phlegm. Additionally, *Mai Jue* interprets "firm and solid" as "large and solid".]
The syndrome of saliva blood is easier to treat if not accompanied by coughing, but difficult to cure if coughing is present, due to Lung injury. (From *Ji Sheng Xu Fang*)
After hematemesis stops, if thread-like blood appears in subsequent coughing, accompanied by hypochondriac pain and gradual emaciation, it is caused by sorrow injuring the Lung. The Lung governs Qi, and blood follows Qi. When injured, blood loses its master, initially bleeding profusely, then moving up and down with the disease progression. A slow and small pulse is curable; a fine, rapid, and urgent pulse is incurable. (From *Ji Feng Pu Ji Fang*)
Heat congestion in the Lung can cause coughing blood, and prolonged coughing damaging the Lung can also cause coughing blood. Congestion in the Lung is easy to treat, requiring only cooling herbs; damage to the Lung is difficult to treat as it has already formed consumptive disease (Lao). (From *Yi Xue Yao Jue*)
Coughing blood belongs to Lung heat; coughing out red threads in saliva belongs to Lung Wei (flaccidity). (From *Yuan Bing Ji*)
Hemoptysis involves seeing blood due to coughing, either dry cough or sputum containing one or two mouthfuls of red threads or blood spots, with shortness of breath and panting. Although this stems from dryness of the Lung body, it is also due to fire rebellion injuring the blood membranes during coughing, causing blood to exit with sputum. A weak, faint, and smooth pulse is curable; a wiry, rapid, urgent, and solid pulse with shortness of breath, hoarseness, and sore throat is incurable. (From *Yi Tong*)
Hemoptysis is mostly due to fire stagnation in the Lung. Treatment should clear the Lung, descend fire, resolve stagnation, and eliminate phlegm. Once coughing stops, bleeding stops. One must not solely use blood-stopping herbs, as this causes Qi stagnation and phlegm obstruction, preventing resolution of stagnation. If coughing persists, how can bleeding stop? If there is afternoon fever with a fine and rapid pulse, this indicates deficiency of True Yin, requiring clearing of the Upper Jiao and tonification of the Lower Jiao. (From *Chi Shui Xuan Zhu*)
Hematemesis followed by phlegm-cough often indicates Yin deficiency with fire hyperactivity and descending failure of phlegm. Use Si Wu Tang as the main formula, adding phlegm-resolving and fire-clearing herbs. Phlegm-cough followed by blood often indicates phlegm accumulation transforming into heat; urgently descending phlegm and fire is required. Blood-tinged saliva in phlegm-cough indicates stomach blood steamed out by heat; severe cases use Gardenia, mild cases use Indigo fruit. If phlegm is present, using blood-tonifying herbs causes stagnation; only treating fire stops the bleeding, as hematemesis is a fire disease. (From *Dan Xi Xin Fa*)
Regarding vomiting due to blood stasis, *Huo Ren Shu* states: Nasal epistaxis in Taiyang syndrome of Shang Han indicates impending recovery; spontaneous bleeding from heat binding the Bladder also indicates recovery. By analogy, vomiting due to upper Jiao blood stasis in other diseases with latent heat also indicates improvement. However, once bleeding stops spontaneously, that is sufficient. (From *Zhi Zhi Fang*)
A patient visited the Xi Tang Inn in Shangyu, staying at the Wei residence. One day, traveling by sedan chair in intense summer heat, he vomited several mouthfuls of blood on the way. Upon returning home, vomiting worsened, with chest tenderness, fever, and dizziness, approaching critical condition. Some attributed it to mental strain and prescribed Fu Ling Bu Xin Tang. Physician Li Shicai arrived, palpated a surging and slippery pulse, and stated: This is due to excessive drinking and overeating, causing gastric blood congestion forced upward by summer heat. First administer Xi Jiao Di Huang Tang, followed by Tao Ren Cheng Qi Tang to remove blood stasis and old accumulations, then treat the summer heat for recovery. (From *Yi Shi · Ying Ning Sheng Zhuan*)
Li Shicai treated Zhang Mingzhi for two years of hematemesis, presenting with sallow complexion, tidal fever, cough, slight diaphragmatic pain, and a rapid, deep, and forceful pulse. The pain was unyielding to pressure and worse at night. This indicated hard blood accumulation, requiring drastic purgation. Due to chronic illness, harsh attack was avoided; instead, used Yu Jin, Jiang Jing Xiang, Dang Gui, Di Huang, Shan Jia, Peng Zhu, and Ren Shen. After expelling lacquer-like blood several times, pain decreased. Pain recurred after a month, indicating heavy disease and light medication. Prepared pills with Da Huang, Gan Qi, Peng Zhu, Yu Jin, Shan Jia, Rou Gui, Gui Wei, Tao Ren, and Meng Chong. Daily administration of Ginseng and Astragalus decoction, with pill dosage of one Qian in the afternoon. After ten days, significant blood accumulation was expelled, and stability was achieved after several doses. (From *Yi Tong*)
Internal injury with blood stasis in the Stomach causing intermittent hematemesis presents with withered and dull complexion and wiry-choppy pulses. First use Bai Lao Wan to remove stasis, then Yi Gong San and Liu Jun Zi Tang to regulate and tonify. (Same source)
(Bai Lao Wan is found in the "Bone Steaming" section.)
Fake Heat Syndrome: In cases where True Yin is lost, Ming Men fire declines, fire fails to return to its origin, and water abundance forces floating fire upward, causing upper Jiao cough, panting, aversion to heat, facial redness, and vomiting of phlegm-blood, this is a fake Yang syndrome. Must use Ba Wei Di Huang Wan to guide fire back to its origin. How to distinguish it as fake? I differentiate by the tongue. Real heat always presents with dry, cracked, or black tongue coating (fake heat may have black coating but lacks dryness/cracking). Fake heat presents with white but slippery coating, thirst without desire to drink (or drinking only 1-2 mouthfuls before vomiting), tender red face, restlessness with desire to lie in mud/water. (From *Yi Guan*)
Cold Syndrome: If the patient truly contracted cold pathogens or consumed cold substances, with evil entering the blood level, blood becomes cold and fails to return to meridians, wandering recklessly. Blood color will be dark/black, complexion pale and lifeless, pulse micro-slow, body cool. Using cooling blood herbs instead of Ginger/Cinnamon is dangerous. Clinicians must examine carefully. (From *Shi Yi De Xiao Fang*)
Summer-Toxin Syndrome: Hemorrhage due to summer-toxin presents with large pulse, panting, profuse sweating, irritability, and thirst. Heart governs blood, and summer Qi tends to enter the Heart. This disease is common in alcoholics and Yin-deficient individuals. (From *Jin Kui Yi*) [Note: Latent summer heat causing epistaxis or hematemesis can be treated with Wu Ling San, see *San Yin*.]
Extreme Anger Syndrome (Refer to cooling formulas): I once treated a patient with hematemesis. Pulse was wiry at the Liver position and soggy at the Qi Kou position. Hematemesis resulted from extreme anger. Prescribed Su He Xiang Wan combined with Ji Su Wan, effective immediately. (From *Fu Ren Da Quan Liang Fang*) (Long Nao Ji Su Wan is in *He Ji Ju Fang*).
Hematemesis due to anger: Classics state anger causes Qi rebellion, leading to vomiting blood if severe. Should soothe Liver and descend fire using fried Gardenia, Qing Pi, Huang Qin, Huang Lian, and Chai Hu. (From *Jing Yue Quan Shu · Liu Yao*)
Liver injury from anger causing hematemesis/epistaxis presents with blue lips/face and wiry pulse. Use Chai Hu Zhi Zi Qing Gan San. (From *Yi Guan*)
Strain Injury: Carrying heavy loads, being crushed, or walking far with weight causes sudden heart/chest pain and oral/nasal bleeding, commonly called "strain injury." This is rupture of internal membranes, Lung, and Stomach due to exertion. For hematemesis, investigate etiology; do not hastily use cooling herbs. If caused by physical strain, internal meridian injury, and oral/nasal bleeding indicate Stomach/Lung upper Jiao rupture. First fill the wound with Bai Ji or refined flour mixed with rice water, then use major Qi and Blood tonics with blood-moving herbs. Mis-treatment leads to death. (From *Jing Yue Quan Shu · Liu Yao*)
Post-Hematemesis Syndromes: After hematemesis, if the patient feels no chest oppression, self-healing often occurs. If irritable, mentally chaotic, vomiting, and restless, and doctors prescribe Huang Tu Tang or E Jiao San, worsening occurs, potentially fatal. Such oppression requires urgent emesis. (From *Qian Jin Fang*) [Note: Emetic formula uses Gua Di, Du Heng, Ren Shen.]
After hematemesis, Zang-Fu are deficient, Ying-Wei disordered, Yin-Yang separated. Yang deficiency above causes body虛heat and chest fullness with dry mouth. (From *Zhu Bing Yuan Hou Lun*)
Hematemesis patients often feel thirsty, named "Blood Thirst." Use Si Wu Tang or Shi Quan Da Bu Tang (*Yi Tong* suggests Sheng Mai San plus Huang Qi, Wei Ge Gen, Pi Pa Ye), based on Stomach Qi deficiency/excess. (From *Yi Xue Yao Jue*)
Hematemesis without death vs. Coughing leads to death: Modern physicians wrongly consider hematemesis as consumptive disease. Hematemesis has types: those who cough develop Lao (consumption); those who don't, do not. Occasional coughing during hematemesis resolves upon stopping bleeding, not becoming Lao. Why? Once bleeding stops, the body is healthy, appetite returns, spirit recovers. Even post-hemorrhage Yin deficiency heat or bone/joint pain can be cured. However, if coughing persists, disease remains despite stopped bleeding. Day and night coughing, phlegm congestion, and Qi rising lead to death in 1-3 years. Persistent coughing shakes Kidney Yuan Qi. Lung is Mother of Kidney; Mother's illness affects Child. Lung is the Canopy of Five Zang. Grain Qi enters Stomach, transmits to Lung, nourishing all Zang-Fu. Clear part becomes Ying, turbid part becomes Wei. All Zang-Fu rely on Lung for essence. Lung disease prevents essence distribution; Zang-Fu wither in one year, exhaust in three. Thus, coughing is true Lao, an incurable disease. Rarely, some cough without death if symptoms ease, lifestyle stable, and care is good, recovering after three years. Conversely, non-coughing patients with recurrent hemorrhage may develop cough due to Liver exhaustion and Lung injury, dying eventually from poor care. This criterion determines prognosis with high accuracy. (From *Jing Yue Quan Shu · Yuan Liu Lun*)
Incurable Syndromes: Spitting blood with large, solid, choppy pulse, anorexia, vomiting, and diarrhea. Coughing blood with large, rapid pulse, difficulty urinating, panting, and weakness. (From *Shi Bing Jie Fa*)
Treatment Principles: Blood follows Qi; Qi rebellion causes blood to surge out of meridians. While upper Jiao heat causes hematemesis, using only Chai Hu, Huang Qin, Pu Huang, Mao Hua without assisting with Zhi Ke, Jie Geng, Qing Pi, Sheng Jiang, or Wu Mei, nor using Tong Li Wan to open the Middle Jiao and guide bowel movement, makes it impossible for Qi to descend and blood to flow downward. Fear of uncontrollable upward rebellion. After bleeding stops per previous methods, regulate with Ren Shen, Chuan Xiong, Dang Gui, Fu Ling, Ju Pi, Ban Xia, Gan Cao. Add Mu Xiang for deficiency, Chai Hu for heat, Sang Bai Pi, Jing Jie for congestion. Balance is key. (From *Zhi Zhi Fang*)
For men and women with expectoration of blood, epistaxis, coughing blood, or purulent bloody sputum, take San Huang Wan, Huang Lian Jie Du Tang, or Liang Ge San, plus Jie Geng and Dang Gui. Decoct heavily and sip frequently. *Nei Jing* states: Treating close diseases (Heart/Lung) requires frequent, small doses. (From *Zhi Bing Bai Fa*)
Investigate etiology: Stomach injury regulates Stomach and calms blood; Heart labor tonifies Heart Spirit; Heat clears; Qi stagnation moves; Spleen injury stabilizes. (From *Zhen Jiu Da Cheng*)
Epistaxis travels the clear pathway, hematemesis the turbid pathway, flowing into Stomach causing vomiting. Reckless upward movement causes vomiting, expectoration, or coughing. Hu Po (Amber) is effective; add powder to decoction or mix with strained decoction. Severe vomiting with dizziness and chills/fevers: Jiang Qi Tang + Si Wu Tang (half dose each) plus E Jiao. Simple fever: Fu Ling Bu Xin Tang. Overexertion causing persistent hematemesis: Su Zi Jiang Qi Tang plus Ren Shen. Intermittent small amounts recurring over years: Hei Shen San + Xiao Wu Chen Tang regularly. (From *Yi Xue Yao Jue*)
Initial surging pulse: Xi Jiao Di Huang Tang adjusted with Yu Jin, charcoalized Gardenia, or Jing Jie Sui ash. Post-vomit blood indicates wine toxin. Chest pain indicates ruptured Stomach; treat with Bai Ji powder mixed with child's urine. Rapid/urgent pulse without chest pain: treat as fire. Unstoppable massive vomiting unresponsive to drugs: Charred Gan Jiang powder mixed with child's urine (counter-treatment method). (From *Jing Yue Quan Shu · Liu Yao*) [Note: Black Ginger and Child's Urine originate from Dan Xi.]
Severe blood loss leading to Qi collapse, syncope, or coma: Urgently tonify Qi to secure vital energy. Use Liu Wei Hui Yang Yin or Si Wei Hui Yang Yin. Cooling herbs will cause death. (From *Jing Yue Quan Shu*)
Hematemesis with micro-pulse, cool body, and aversion to wind: Add Rou Gui (one Qian) to Di Huang and Shao Yao. Common in deficiency-cold constitutions. (From *Jin Kui Yi*)
Three Essentials for Treating Hematemesis:
1. Descend Qi, not Fire: Excess Qi is Fire. Descending Qi descends Fire, preventing upward Qi rise and bleeding. Cooling herbs damage Stomach Qi, impairing Spleen control over blood, worsening bleeding. Two major errors: (a) Sole use of cooling herbs (Huang Qin, Huang Lian, Zhi Zi, Qing Dai, etc.) damages Spleen, causing diarrhea and death. (b) Sole use of Ren Shen injures Lung heat, worsening cough. Rare exceptions exist for Qi deficiency asthma. Recommended formula: Bai Shao, Zhi Gan Cao (soothe Liver); Pi Pa Ye, Mai Dong, Bo He, Ju Hong, Bei Mu (clear Lung); Yi Yi Ren, Huai Shan Yao (nourish Spleen); Jiu Cai, Fan Jiang Xiang, Zhen Su Zi (descend Qi); Qing Hao, Bie Jia, Yin Chai Hu, Mu Dan Pi, Di Gu Pi (tonify Yin, clear heat); Suan Zao Ren, Bai Fu Shen (nourish Heart); Shan Zhu Yu, Gou Qi Zi, Niu Xi (tonify Kidney). Yin cannot be rapidly tonified; patience is required. Hasty treatment leads to death. (Note: Yu Jin is a holy herb for hematemesis, but authenticity is rare.)
2. Move Blood, do not Stop Blood: Blood leaving meridians is due to Qi rebellion. Blood flows with heat, coagulates with cold. Descending Qi and moving blood allows natural cessation. Stopping blood causes coagulation, fever, anorexia, and chest/hypochondriac pain, leading to chronic illness.
3. Tonify Liver, do not Attack Liver: Zang organs store essence. Liver stores blood. Hematemesis indicates Liver dysfunction. Nourishing Liver calms Qi and restores blood storage; attacking Liver prevents storage, worsening bleeding. (From *Ben Cao Jing Shu*)
Cooling and Warming Appropriateness: Chu Yu Shi disliked Zhu Ru, Sheng Di Huang, Ou Zhi for hematemesis, but one should not be dogmatic. Yang invading Yin (heat causing blood dispersion) requires cooling herbs (Da Huang, Xi Jiao, Sheng Di Huang, Sheng Ai, Ou Zhi). Yin invading Yang (cold causing congealing) requires warming herbs (Gan Jiang, Rou Gui). Students must reflect. (From *Fu Ren Da Quan Liang Fang*)
Blood exiting upwards indicates Yang excess and Yin deficiency, ascending without descending, following Qi rebellion. Method: Tonify Yin, suppress Yang, descend Qi so blood returns to meridians. (From *Dan Xi Xin Fa*)
This theory applies to sudden onset in healthy people. Differentiate from trauma (falls/strikes causing internal meridian injury), food stagnation in Taiyin, cold Stomach vomiting causing rupture, or overexertion/libido depleting Lung/Kidney failing to control blood. Misusing cooling herbs kills. (From *Jing Yue Quan Shu · Liu Yao*)
Excessive alcohol/sex damaging Lung/Kidney True Yin, causing cough, sputum, epistaxis, hematemesis, etc., misusing sweet-warm herbs (Ren Shen, Huang Qi) increases disease and causes death. Sweet-warm aids Qi (Yang), consuming Yin. These conditions are Yin/Blood deficiency with Yang/Fire excess; require bitter-sweet-cold herbs to generate blood and descend fire. Many die from misunderstanding. Note: This is a partial view. While fire-excess hemorrhage contraindicates sweet-warm, severe deficiency-fire with weak constitution may require Ren Shen/Huang Qi. Ge Ke Jiu used Du Shen Tang for massive hematemesis to treat deficiency. Medication must match deficiency/excess. (From *Yi Tong*)
Purgative Methods: For abundant blood, first resolve stasis, then stop/cool blood. Large volume implies chest/diaphragm stasis;若不 resolving first, stopping/cooling fails. (From *Ming Yi Za Zhu*)
Surging/solid pulse, energetic, chest fullness/pain, or purple clots: Use Sheng Di, Chi Shao, Dang Gui, Mu Dan Pi, Jing Jie, E Jiao, Hua Shi, Da Huang, Xuan Ming Fen, Tao Ren Ni to purge via bowels ("pulling firewood from under the pot"). Modern error: Using only Huang Qin, Huang Lian, Zhi Zi, Bai Hu with Si Wu Tang damages Qi/Blood and Spleen/Stomach, leading to death. (From *Jing Yue Quan Shu · Liu Yao*)
Hematemesis (uncontrollable), chest oppression, vomiting purple blood: Tao Ren Cheng Qi Tang to purge. (From *Dan Xi Xin Fa*)
Formula for Consumptive Hematemesis:
Sheng Di Huang Zhi (Half Sheng), Chuan Da Huang (One Fang Cun Bi powder).
Warm Sheng Di Huang Zhi, boil once, add Da Huang, stir. Take on empty stomach at once, three times daily until cured. (From *Qian Jin Fang*) [Note: Formula originates from *Shang Lun*, retaining original.]
Formula for Acute Heat-Toxin, Heart/Lung irritability, and vomiting blood:
Da Huang (Two Liang) powdered, mixed with Di Huang Zhi, dried if wet. Powder form, take 2 Qian with Di Huang Zhi, until purged. Gan Cao Tang is also acceptable. (From *Zhong Zang Jing*)
San Huang Wan for Three-Jiao Hematemesis and Jaundice:
Huang Lian (Three Liang), Huang Qin (Two Liang), Da Huang (One Liang).
Powder, honey pills (walnut size). Take 15 pills with warm water after meals, adjust based on deficiency/excess. (From *Zhong Zang Jing*) [Note: *Benshi Fang* uses powder, see *Nixue*.]
Formula for Children's Hematemesis with Irritability: Qian Gen San.
Qian Gen (Half Liang), Xi Jiao Xie, Chuan Sheng Ma, Chuan Da Huang (crushed, lightly fried), Huang Qin, Gan Cao (each 1 Fen).