《准绳》、《六要》并曰∶夫人饮食起居一失其宜，皆能使血瘀滞不行，故百病由污血者多，而医书分门
类证，有七气而无蓄血，予故增着之。此说为是，然古人间有为蓄血立类者，但不多见耳。
脉候 弦而紧，胁痛脏伤，有瘀血（一作有寒血）。脉来细而滑，按之能虚，因急持直者，僵仆，从
高堕下，病在内。（《脉经》）
从高顿仆，内有血，腹胀满，其脉坚疆者生，小弱者死。（同上）
据脉验之，挟血者脉来乍涩乍数，闪烁明灭，或沉细而隐伏也。若夫血与热交攻，则左手寸关按之洪盛。盖
心主血，肝藏血，固如是尔。（《直指》）（宜参伤寒）
瘀血内蓄，却宜牢大，沉小涩微，反成其害。（《续焰》）
瘀血胁痛，肝脉弦紧，此为常，勿以必死论。（《医碥》）
源候 夫肝藏血而心主之，动则血运于诸经，静则血归于肝脏。肝受血则能视，足受血则能步，掌受血
则能握，指受血则能摄。故血凝于肤者为痹，凝于脉者为泣，凝于足者为厥。凡神志昏昏，惊狂冒闷，烦渴呕吐，
语短内疼，鼻衄唾红，眼红面赤，骨热肤哄，肠垢尿多，胸满顽痰， 语多汗，甚至四肢厥冷，懵不知人，不
问男子妇人，皆血证耳。（《直指》）
蓄血俗名内伤，或积劳，或多怒，或饱后行房，或负重努力，或登高坠下，或奔逐过急，皆致蓄血。其证
多发热，其热类外感，而不头疼，不作渴，天明少间，至午复剧，有汗汗多，剂颈而还，自汗无气以息，目光短，
不思饮食，不得眠，二便自利，小便或赤，大便或泄。（《本草经疏》）
三焦辨异（膈间证试法）经曰∶血上逆则忘，血下蓄则狂。上焦瘀血，小便必难；下焦瘀血，小便必自
利。血之所在，当以此推。（《直指》）
何以知其蓄在下焦？曰∶脐下结急，外热内痛，尺脉洪而数也。（同上）
衄血，蓄血上焦。心下手不可近，蓄血中焦。其脐腹小肿大痛，蓄血下焦。蓄血上焦，或呕或衄或吐，此胸
中手不可近也。（《元戎》）
衄血蓄血上焦 年高噎膈，饮食屈曲下行，胃口有蓄血也。妇人郁结，久亦有之，心下手不可近，蓄在
中焦。好嗜炙 辛辣热酒，积久血瘀胃脘，嘈杂有痛。脐腹肿大痛，血蓄下焦，小便自利。三焦蓄血，脉俱见，
左手中脉多弦涩。（《六要》）
前后心胀，喉中有血腥气，气口脉涩，此膈间有蓄血也。试法，呷热姜汤，有呃者瘀血也。犀角地黄汤加
童便、桃仁、大黄攻散之，或平胃合越鞠（方见《诸气》）加韭汁，童便消伐之。（《医通》）
伤寒瘀血（详见《伤寒》中）伤寒内有瘀血候∶夫人先瘀结在内，因伤寒病，若热搏于久瘀，则发热
如狂。（《病源论》）
病余瘀血 病者或因发汗不彻，及吐衄不尽，瘀蓄在内，使人面黄唇白，大便黑，脚弱气喘，甚则狂
闷，皆瘀血所致。（《三因》）
坠堕瘀血 凡有所坠堕，恶血留内，若有所大怒，气上而不能下，积于左胁下则伤肝，肝伤者其人脱
肉，又卧口欲得张，时时手足青，目瞑瞳人痛，此为肝脏伤所致也。（《脉经》）
病者有所坠堕，恶血留内，或因大怒，肝血并湿停蓄不散，两胁疼痛，脚善 ，骨节时肿，气上不止，皆由
瘀血在内。（《三因》）
人有恶寒发热，状似伤寒，其脉芤涩，其证胁下与小腹疼痛，手不可近，大便黑小便利者，此瘀血证谛也。
盖胁与小腹乃属肝部，肝为血海，故有瘀血蓄积于此，须审其日前曾有跌坠挫闪拳踢之情。若服寒凉药，恐血得
寒则凝。倘瘀血上冲，昏迷不省，良久复苏，此皆血证之候也，宜行气活血之药可也。（《岭南卫生方·附录》）
跌扑损伤，或被人打踢，或物相撞，或取闪肭，或奔走努力，或受困屈，或发恼怒，一时不觉，过至半日
或一、二、三日而发者有之，十数日或半月、一月而发者有之，一般寒热交作，其心胸胁下小腹满痛，按之手不
可近者，此有瘀血
也。或一时伤重，就发寒热，瘀血上冲，则昏迷不醒，如死之状，良久复苏。轻则复元活血汤，重则桃仁承气汤
主之，量其元气，下其瘀血则愈。在上者宜饮韭汁，切不可饮冷水，血见寒则凝，但一丝血入心即死。（《订补
指掌》）
登高坠下，重物撞打，箭簇刃伤，胸腹积血不散，以童便同酒，煎大黄，随轻重下之，或香壳散加童便。腰
胁滞痛，复元通气散（方见《寒疝》）去牵牛，加枳壳、柴胡、牡丹皮。恶血留于腹胁，痛不可忍，复元活血汤。
挟血如见祟状，当归活血汤。（《医通》）（当归活血汤用归、芍。生地、桂、桃仁、茯苓、枳壳、柴胡、甘草、
干姜、红花十一味。）
难易 蓄血下黑如漆，最为危殆。但下后神气稍宁，脉无变异，即为可疗。如下后神气昏愦，脉见虚脱，
加以厥冷呃逆，多不可救。（《医通》）
治例 《活人总括》所载小柴胡汤、犀角地黄汤、桃仁承气汤皆其要药，血结者汤剂中入醋为佐，特于
此而申言之。（《直指》）
忌破气，复忌补气。下、苦寒、辛燥，宜行血、辛温，佐以咸寒。瘀血行后，宜补血、益脾、和肝。（《本
草经疏》）
身有寒热发黄，脉弦细而伏，服补泻诸药不应，《千金》用大黄、芒硝、归尾、桃仁、人参、桂心为散，酒
服二方寸匕，借参、桂之力以攻之。膏粱肥盛，多为痰湿热血蓄胃口，或兼胁满，或少腹结痛，朝用浚血丸（按∶
此用参、术、苓、甘、半夏曲、浮石、牡丹、当归、桃仁、山甲、桂）兼培胃气，夕用变通抵当丸（按∶此去水蛭，
加虫者）专散蓄血，方得峻药缓攻之妙。虚人虽有瘀血，其脉亦芤，必
有一部带弦，宜兼补以去其血，桃核承气加人参五钱，分三服，缓攻之，可救十之二三。又中气虚人，胃脘有死
血，每食姜汤必呃，宜人参、云术各二两为末，桃仁一两同干漆炒，去漆，细研蜜丸弹子大，早晚细嚼一丸，
醇酒下。（《医通》）
痰血相挟 先因伤血，血逆则气滞，气滞则生痰，痰与血相聚，名曰瘀血挟痰。所患之处，按之则痛而
不移。其证则痰裹其血，或自汗到颈而还，或吐血，或衄血，或大便黑而小便清长，治宜导痰消血。若素有郁痰
所积，后因伤血，故血随蓄滞与痰相聚，名曰痰挟瘀血。所患之处，则痛而少移。其证则血裹其痰，或为胀闷，
或为寒热，治宜破血消痰，先破其血而后消痰，或消痰破血二者兼而治之也。医或误与补药及寒凉之剂，致使病邪
郁久而成窠囊者，不治。其窠囊之验，如腋下偏热烙手，所患之处，则痛而不能转侧，或肺幕间偏热偏肿，而喘
嗽痰臭，其痰似水，验之则沉而不浮是矣。故丹溪云∶痰挟瘀血，遂成窠囊者不治。正此谓也。（《粹言》）（按∶
此说过凿，姑存之。）
破瘀方法 凡血妄行瘀蓄，必用桃仁、大黄行血破瘀之剂。盖瘀败之血，势无复返于经之理，不去则留
蓄为患，故不问人之虚实强弱，必去无疑，虚弱者加入补药可也。（《医碥》）
鸡鸣散，治从高坠下，及木石所压，凡是伤损，血瘀凝积，气绝欲死，并久积瘀血，烦躁疼痛，叫呼不得，并
以此药，利去瘀血即愈。此药推陈致新，治折伤神效。
大黄（一两酒蒸） 杏仁（三七粒去皮尖，《纲目》引作桃仁）
上研细，酒一碗，煎至六分，碗裂去滓，鸡鸣时服，次日取下瘀血即愈。若便觉气绝，不能言，取药不及，
急擘口
开，以热小便灌之。（《三因》）
当归导滞散，治打扑损伤，落马堕车瘀血，大便不通，洪肿暗青，疼痛昏闷，蓄血内壅欲死。
川大黄（一两） 当归（三钱） 麝香（少许另研）
上为末，入麝香研匀，每服三钱。热酒一盏调下。食前。（《宝鉴》）
复元活血汤，治从高坠下，恶血留于胁下，疼痛不可忍。
大黄（一两酒浸） 柴胡（五钱） 栝蒌根 穿山甲（炮） 当归（各三钱） 红花 甘草（各二钱）
桃仁（汤泡去皮尖研如泥五十个）
上除桃仁为 咀，每服一两重，水二盏半，酒半盏，同煎至七分，下桃仁泥，再煎一两沸，去渣温服食前，
以利为度。（同上）（按∶《准绳》代抵当丸，用大黄、芒硝、桃仁、当归、生地、穿山甲、桂，盖从此方而
变化者。《医通》曰∶治虚人蓄血，宜此缓攻。）
犀角地黄汤，治主脉浮，客脉芤，浮芤相合，血积胸中，热甚血在上焦，此药主之。
犀角（镑） 大黄（各一钱） 黄芩 黄连（各二钱） 生地黄（四钱）
上作一服，用水二钟，煎至一钟，食后服。（《选要》）（按∶此本云岐子方，今加犀角。又《医统》引
《拔萃》亦有犀角。）
和血诸方 加减四物汤，治血气不足，肢体乏力，或瘀血腹痛，或下血过多。
当归 川芎 白芍药 干姜（炒各半两） 南木香 甘草（炒各二钱半）
上锉散，每服三钱，食前煎服。若腹不痛，则无瘀血。更加人参，又能益血。（《直指》）
柴胡疏肝散，治怒火伤肝，胁痛，血菀于上。
柴胡 橘皮（醋炒各二钱） 川芎（童便浸切） 芍药 枳壳（炒各钱半） 甘草（炙五分） 香附（醋炒钱半）
山栀（姜汁炒黑一钱） 煨姜（一片）
水煎，食前温服。吐血，加童子小便半盏。（《医通》）
香壳散，治蓄血暴起，胸胁小腹作痛。
香附（姜汁炒三钱） 枳壳（炒二钱） 青皮（炒） 陈皮 乌药 赤芍药 蓬术（醋炒各一钱） 归尾（
三钱） 红花（五分） 甘草（炙二分生三分）
为散，每服四、五钱，水煎去滓，加童便半盏，空心温服，更以桃核黑糖酒助之。不应，加延胡索、穿山甲。
（同上）
《准绳》和《六要》都说：人的饮食起居一旦不合宜，都能导致血液瘀滞不行，所以百病中由污血（指败坏、瘀积之血）引起的很多，而医书分门别类辨证时，有七气病却没有蓄血病，所以我特意增加论述这一部分。这种说法是正确的，然而古人中间有为蓄血设立专门类别的，只是不常见罢了。
脉候 脉象弦而紧，胁痛且脏腑受损，是有瘀血（另一种版本作有寒血）。脉来细而滑，按之感觉空虚，因突然急持身体挺直者，会发生僵仆跌倒，这是从高处坠落所致，病邪在内。（出自《脉经》）
从高处突然跌倒，体内有瘀血，腹部胀满，脉象坚实强劲的为可生，脉象细小虚弱的为死证。（同上）
根据脉象验证，挟带瘀血的，脉来乍涩乍数，忽隐忽现，或者沉细而隐伏。如果是血与热相互交攻，则左手寸关部按之洪大盛实。因为心主血，肝藏血，本来就是这样。（出自《直指》）（应当参考伤寒论中的相关论述）
瘀血内蓄，脉象却宜见牢大，若见沉小涩微，反而成为危害。（出自《续焰》）
瘀血导致的胁痛，肝脉弦紧，这是常理，不要认为是必死之症。（出自《医碥》）
病因病机 肝藏血而心主宰之，活动时血液运行于各条经脉，静止时血液回归肝脏。肝得到血的濡养就能视物，脚得到血的濡养就能行走，手掌得到血的濡养就能握持，手指得到血的濡养就能摄取。所以血液凝滞于皮肤的就叫痹证，凝滞于血脉的就叫泣（通“涩”，指血流不畅），凝滞于足部的就叫厥。凡是神志昏沉，惊狂冒闷，烦渴呕吐，言语短促内部疼痛，鼻出血或唾中带血，眼睛红面部赤红，骨头热皮肤烘热，肠垢尿多，胸满顽痰，多言出汗，甚至四肢厥冷，懵懂不知人，无论男女，都是血证。（出自《直指》）
蓄血俗称内伤，或因积劳，或多怒，或饱食后行房事，或负重用力，或登高坠落，或奔跑追逐过急，都会导致蓄血。其症状多发热，这种热类似外感，但不头疼，不口渴，天亮时稍缓解，到中午又加重，出汗但汗止于颈部，自汗且气息微弱，目光短少，不思饮食，不能安眠，大小便自利，小便有时发红，大便有时泄泻。（出自《本草经疏》）
三焦辨异（膈间证试探法）经文说：血上逆则健忘，血下蓄则发狂。上焦瘀血，小便必定困难；下焦瘀血，小便必定自利。血所在的位置，应当据此推断。（出自《直指》）
怎么知道蓄血在下焦？回答说：脐下结急，外热内痛，尺脉洪大而数。（同上）
衄血，是蓄血在上焦。心下部位手不可触碰，是蓄血在中焦。其脐腹肿大疼痛，是蓄血在下焦。蓄血在上焦，或呕吐或衄血或吐血，这是胸中手不可触碰的地方。（出自《元戎》）
衄血蓄血在上焦 年高患噎膈，饮食曲折下行，是胃口有蓄血。妇人郁结，日久也会有，心下部位手不可触碰，蓄血在中焦。喜好嗜吃烤炙辛辣热酒，积久导致血瘀胃脘，嘈杂且有痛感。脐腹肿大痛，是血蓄下焦，小便自利。三焦蓄血，脉象都可见，左手中脉多弦涩。（出自《六要》）
前后心胀，喉中有血腥气，气口脉涩，这是膈间有蓄血。试探法：喝热姜汤，如果有呃逆的是瘀血。用犀角地黄汤加童便、桃仁、大黄攻散它，或者平胃散合越鞠丸（方剂见《诸气》篇）加韭汁、童便消伐它。（出自《医通》）
伤寒瘀血（详见《伤寒》篇中）伤寒内有瘀血的候证：人原本体内就有瘀结，因患伤寒病，如果热邪搏结于久瘀，则发热如狂。（出自《病源论》）
病余瘀血 病人或因发汗不彻底，以及吐衄不尽，瘀血蓄积在内，使人面黄唇白，大便黑，脚弱气喘，甚则狂闷，都是瘀血所致。（出自《三因》）
坠堕瘀血 凡有所坠落，恶血留于体内，如果伴有大怒，气上逆而不能下行，积聚在左胁下则伤肝，肝伤者其人肌肉消瘦，又睡觉时口想张开，时时手足青紫，眼睛闭瞳孔痛，这是肝脏受伤所致。（出自《脉经》）
病人有所坠落，恶血留于体内，或因大怒，肝血并湿停蓄不散，两胁疼痛，脚善（此处原文似缺字，结合语境推测可能为“痿”或“挛”等，依原文保留），骨节时常肿胀，气上不止，都是由瘀血在内引起。（出自《三因》）
人有恶寒发热，状似伤寒，其脉芤涩，其证胁下与小腹疼痛，手不可触碰，大便黑小便利的，这是瘀血证的确凿证据。因为胁与小腹属于肝部，肝为血海，所以有瘀血蓄积于此，必须审查其日前曾有跌坠挫闪拳踢的情况。如果服用寒凉药，恐怕血得寒则凝结。倘若瘀血上冲，昏迷不省人事，良久复苏，这都是血证的候象，适宜用行气活血的药物。（出自《岭南卫生方·附录》）
跌扑损伤，或被人打踢，或物体相撞，或取闪肭（扭伤），或奔走用力，或受困屈，或发恼怒，一时不觉察，过至半天或一、二、三天才发作的有之，十几天或半月、一月才发作的有之，一般寒热交作，心胸胁下小腹满痛，按压时手不可触碰的，这是有瘀血。或一时伤重，立即发作寒热，瘀血上冲，则昏迷不醒，如死状，良久复苏。轻则用复元活血汤，重则用桃仁承气汤主治，衡量其元气，攻下瘀血则痊愈。瘀血在上者适宜饮用韭汁，切不可饮冷水，血见寒则凝结，但只要一丝血入心即死。（出自《订补指掌》）
登高坠落，重物撞打，箭簇刃伤，胸腹积血不散，用童便同酒，煎煮大黄，根据轻重程度攻下，或者香壳散加童便。腰胁滞痛，用复元通气散（方剂见《寒疝》篇）去掉牵牛子，加枳壳、柴胡、牡丹皮。恶血留于腹胁，痛不可忍，用复元活血汤。挟血如见鬼祟状，用当归活血汤。（出自《医通》）（当归活血汤用归、芍、生地、桂、桃仁、茯苓、枳壳、柴胡、甘草、干姜、红花十一味。）
难易 蓄血下黑如漆，最为危殆。但如果下后神气稍宁，脉无变异，即为可疗。如下后神气昏愦，脉见虚脱，加以厥冷呃逆，大多不可救。（出自《医通》）
治例 《活人总括》所载的小柴胡汤、犀角地黄汤、桃仁承气汤都是重要药物，血结者在汤剂中加入醋作为佐使，特别在此重申说明。（出自《直指》）
忌破气，又忌补气。下法、苦寒、辛燥，宜行血、辛温，佐以咸寒。瘀血行后，宜补血、益脾、和肝。（出自《本草经疏》）
身有寒热发黄，脉弦细而伏，服用补泻诸药不应，《千金》方用大黄、芒硝、归尾、桃仁、人参、桂心研为散，酒服二方寸匕，借参、桂之力以攻之。膏粱肥盛之人，多为痰湿热血蓄积胃口，或兼胁满，或少腹结痛，早晨用浚血丸（按：此方用人参、白术、茯苓、甘草、半夏曲、浮石、牡丹皮、当归、桃仁、穿山甲、桂枝）兼培胃气，晚上用变通抵当丸（按：此方去掉水蛭，加水蛭者注误，应为加水蛭或虫类药，依原文“加虫者”理解）专散蓄血，方得峻药缓攻之妙。虚人虽有瘀血，其脉亦芤，必有一部带弦，宜兼补以去其血，桃核承气汤加人参五钱，分三服，缓攻之，可救十之二三。又中气虚人，胃脘有死血，每食姜汤必呃逆，宜人参、云术各二两为末，桃仁一两同干漆炒，去漆，细研蜜丸弹子大，早晚细嚼一丸，醇酒送下。（出自《医通》）
痰血相挟 先因伤血，血逆则气滞，气滞则生痰，痰与血相聚，名叫瘀血挟痰。所患之处，按之则痛而不移动。其症状则是痰裹其血，或自汗到颈而还，或吐血，或衄血，或大便黑而小便清长，治疗宜导痰消血。如果素有郁痰所积，后因伤血，故血随蓄滞与痰相聚，名叫痰挟瘀血。所患之处，则痛而少移。其症状则是血裹其痰，或为胀闷，或为寒热，治疗宜破血消痰，先破其血而后消痰，或者消痰破血二者兼而治之也。医生如果误给予补药及寒凉之剂，致使病邪郁久而成窠囊的，不治。其窠囊的验证，如腋下偏热烙手，所患之处，则痛而不能转侧，或肺幕间偏热偏肿，而喘嗽痰臭，其痰似水，验之则沉而不浮是矣。所以丹溪说：痰挟瘀血，遂成窠囊者不治。正是这个意思。（出自《粹言》）（按：此说过于凿实，姑且保存。）
破瘀方法 凡是血妄行瘀蓄，必用桃仁、大黄行血破瘀的药剂。因为瘀败之血，势无重新返回经脉的道理，不去则留蓄为患，所以不问人的虚实强弱，必去无疑，虚弱者加入补药即可。（出自《医碥》）
鸡鸣散，治疗从高处坠落，及木石所压，凡是伤损，血瘀凝积，气绝欲死，并久积瘀血，烦躁疼痛，叫呼不得，都用此药，利去瘀血即愈。此药推陈致新，治疗折伤神效。
上面研细，酒一碗，煎至六分，碗裂去滓，鸡鸣时服，次日取下瘀血即愈。如果便觉气绝，不能言，取药不及，急掰开口，以热小便灌之。（出自《三因》）
当归导滞散，治疗打扑损伤，落马堕车瘀血，大便不通，洪肿暗青，疼痛昏闷，蓄血内壅欲死。
上面为末，入麝香研匀，每服三钱。热酒一盏调下。食前。（出自《宝鉴》）
大黄（一两酒浸） 柴胡（五钱） 栝蒌根 穿山甲（炮） 当归（各三钱） 红花 甘草（各二钱） 桃仁（汤泡去皮尖研如泥五十个）
上面除桃仁为咀，每服一两重，水二盏半，酒半盏，同煎至七分，下桃仁泥，再煎一两沸，去渣温服食前，以利为度。（同上）（按：《准绳》代抵当丸，用大黄、芒硝、桃仁、当归、生地、穿山甲、桂，大概是从此方变化而来。《医通》说：治疗虚人蓄血，宜此缓攻。）
犀角地黄汤，治疗主脉浮，客脉芤，浮芤相合，血积胸中，热甚血在上焦，此药主治。
犀角（镑） 大黄（各一钱） 黄芩 黄连（各二钱） 生地黄（四钱）
上面作一服，用水二钟，煎至一钟，食后服。（出自《选要》）（按：此本云岐子方，今加犀角。又《医统》引《拔萃》亦有犀角。）
和血诸方 加减四物汤，治疗血气不足，肢体乏力，或瘀血腹痛，或下血过多。
当归 川芎 白芍药 干姜（炒各半两） 南木香 甘草（炒各二钱半）
上面锉散，每服三钱，食前煎服。如果腹不痛，则无瘀血。更加人参，又能益血。（出自《直指》）
柴胡 橘皮（醋炒各二钱） 川芎（童便浸切） 芍药 枳壳（炒各钱半） 甘草（炙五分） 香附（醋炒钱半） 山栀（姜汁炒黑一钱） 煨姜（一片）
水煎，食前温服。吐血，加童子小便半盏。（出自《医通》）
香附（姜汁炒三钱） 枳壳（炒二钱） 青皮（炒） 陈皮 乌药 赤芍药 蓬术（醋炒各一钱） 归尾（三钱） 红花（五分） 甘草（炙二分生三分）
*Zhuansheng* and *Liuyao* both state: If a person's diet and daily routine are not in accordance with propriety, it can all cause blood stasis and obstruction. Therefore, many of the hundred diseases arise from foul blood (referring to degenerated or stagnant blood). However, medical texts categorize syndromes by departments; while there is "Seven Qi" disease, there is no category for "Accumulated Blood." Hence, I have added this discussion. This view is correct, although ancient practitioners did occasionally establish specific categories for Accumulated Blood, but such instances were rare.
**Pulse Diagnosis**
A pulse that is wiry and tight, accompanied by hypochondriac pain and visceral injury, indicates blood stasis (another version reads "cold blood"). A pulse that is fine and slippery, feeling empty upon pressure, where the patient suddenly holds their body straight, leading to stiffness and falling, results from a fall from a height, indicating internal pathology. (*Mai Jing*)
Sudden falling from a height, with internal blood accumulation, abdominal distension and fullness: if the pulse is firm and strong, life is possible; if the pulse is small and weak, death ensues. (Ibid.)
Verifying via pulse: In cases with blood stasis, the pulse may be intermittently choppy and rapid, flickering between visibility and invisibility, or deep, fine, and hidden. If blood and heat attack each other, the cun and guan positions on the left hand will feel surging and excessive. This is because the Heart governs blood and the Liver stores blood. (*Zhizhi*) (Refer to discussions in Shanghan Lun.)
When blood stasis accumulates internally, the pulse should ideally be firm and large. If it appears deep, small, choppy, or faint, it becomes detrimental. (*Xuyan*)
Hypochondriac pain caused by blood stasis, with a wiry and tight liver pulse, is common; do not assume it is invariably fatal. (*Yibian*)
**Etiology and Pathogenesis**
The Liver stores blood, which is governed by the Heart. When active, blood circulates through the meridians; when at rest, it returns to the Liver. The Liver nourishes the eyes allowing vision; the feet receive blood to enable walking; the palms receive blood to enable grasping; the fingers receive blood to enable holding. Thus, blood coagulating in the skin causes Bi syndrome (obstruction); coagulating in the vessels causes Qi (stagnation/sluggish flow); coagulating in the feet causes Jue (cold extremities/altered consciousness). General symptoms include mental confusion, fright, mania, oppression, thirst, vomiting, shortness of speech, internal pain, epistaxis, hemoptysis, red eyes and face, bone heat, hot skin, intestinal mucus, polyuria, chest fullness with stubborn phlegm, excessive talking with sweating, even cold extremities, and unconsciousness. Regardless of gender, these are all blood syndromes. (*Zhizhi*)
Accumulated Blood is commonly known as internal injury. It may result from chronic fatigue, excessive anger, sexual activity after a full meal, bearing heavy loads with effort, falling from heights, or frantic running/chasing. Symptoms often include fever resembling external contraction but without headache or thirst. The fever may ease slightly at dawn but worsen around noon. Sweating occurs but stops at the neck. There is spontaneous sweating with weak breathing, short gaze, anorexia, insomnia, and normal urination and defecation, though urine may be red and stool loose. (*Bencao Jingshu*)
**Differentiation by Sanjiao (Triple Burner) - Test for Diaphragmatic Syndrome**
The Classics state: Blood reversing upward causes forgetfulness; blood accumulating downward causes mania. With upper jiao blood stasis, urination must be difficult; with lower jiao blood stasis, urination must be normal. One can deduce the location of the blood based on this. (*Zhizhi*)
How to know if accumulation is in the lower jiao? The umbilical region feels knotted and tense, there is external heat and internal pain, and the chi pulse is surging and rapid. (Ibid.)
Epistaxis indicates accumulated blood in the upper jiao. Tenderness under the heart (epigastrium) where touch is unbearable indicates middle jiao accumulation. Abdominal swelling and pain indicate lower jiao accumulation. Upper jiao accumulation may present with vomiting, epistaxis, or hematemesis, characterized by tenderness in the chest. (*Yuanrong*)
**Upper Jiao Epistaxis and Accumulated Blood**
In elderly patients with dysphagia (food sticking), where food descends tortuously, there is accumulated blood in the stomach opening. In women with emotional constraint, long-standing cases also occur. Tenderness under the heart indicates middle jiao accumulation. Those fond of roasted, spicy, and hot alcoholic beverages may develop gastric wall blood stasis over time, causing burning discomfort and pain. Abdominal swelling and pain with normal urination indicate lower jiao accumulation. In sanjiao accumulation, pulses manifest accordingly, with the middle position on the left often being wiry and choppy. (*Liuyao*)
Distension in the anterior and posterior chest, a metallic/bloody smell in the throat, and a choppy qi-kou pulse indicate accumulated blood in the diaphragm. Test method: Drink hot ginger soup; if hiccups occur, it is blood stasis. Treat with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus child's urine, Tao Ren (Peach Kernel), and Dahuang (Rhubarb) to attack and disperse. Alternatively, use Pingwei San combined with Yueju Wan plus leek juice and child's urine to dissipate it. (*Yitong*)
**Shanghan (Cold Damage) Blood Stasis**
(See detailed discussion in *Shanghan* chapters.)
Symptoms of internal blood stasis in Shanghan: If a person already has internal blood結 (knots/stasis) and contracts Shanghan, if heat combats the long-standing stasis, fever and manic behavior occur. (*Bingyuanlun*)
**Residual Blood Stasis After Illness**
Patients may suffer from incomplete sweating, or incomplete vomiting/epistaxis, leaving blood stasis internally. This causes yellow complexion, white lips, black stool, weak legs, asthma/panting, and even mania/oppression, all caused by blood stasis. (*Sanyin*)
**Traumatic Fall Blood Stasis**
After any fall, evil blood remains inside. If accompanied by great anger, qi rises but cannot descend, accumulating in the left hypochondrium, injuring the Liver. Liver injury leads to emaciation, sleeping with mouth open, cyanosis of hands and feet, closed eyes, and pupil pain. This is due to Liver injury. (*Mai Jing*)
Patients suffering falls with retained evil blood, or due to great anger, may have liver blood and dampness stagnating and not dispersing, causing bilateral hypochondriac pain, leg weakness/spasms (text implies deficiency/spasm), joint swelling, and ascending qi. All are due to internal blood stasis. (*Sanyin*)
A person with aversion to cold and fever resembling Shanghan, with a hollow and choppy pulse, pain in the hypochondrium and lower abdomen intolerable to touch, black stool, and free urination, presents a definitive diagnosis of blood stasis. The hypochondrium and lower abdomen belong to the Liver, the Sea of Blood. Thus, blood stasis accumulates here. One must inquire about recent falls, twists, or kicks. Cold-natured medicines should be avoided as cold congeals blood. If blood stasis rushes upward causing coma followed by recovery, these are signs of blood syndromes; treat with qi-moving and blood-invigorating herbs. (*Lingnan Weisheng Fang*)
**Falls and Blows**
Trauma, being kicked/hit, collision, sprains, strenuous exertion, confinement, or anger may not show immediate symptoms. Onset may occur after half a day, one to three days, ten days, half a month, or a month. Generally, alternating chills and fever occur, with fullness and pain in the chest, hypochondrium, and lower abdomen, intolerable to palpation, indicating blood stasis. Severe trauma may cause immediate chills/fever; if blood stasis rushes upward, coma ensues resembling death, with eventual recovery. Mild cases use Fuyuan Huoxue Tang; severe cases use Tao Ren Chengqi Tang. Assess the patient's vital energy and purge the stasis to cure. For stasis above, drink leek juice; never drink cold water, as cold congeals blood. Even a trace of blood entering the Heart is fatal. (*Dingbu Zhizhang*)
Falls from heights, heavy impacts, arrow/blade wounds, or unresolved chest/abdominal blood stasis can be treated by decocting Dahuang (Rhubarb) with child's urine and wine, purging according to severity. Or use Xiangke San with child's urine. For dull pain in waist/hypochondrium, use Fuyuan Tongqi San (remove Qian Niu, add Zhi Ke, Chai Hu, Mudan Pi). For unbearable pain from evil blood in abdomen/hypochondrium, use Fuyuan Huoxue Tang. For stasis presenting like spirit possession, use Danggui Huoxue Tang. (*Yitong*) (Danggui Huoxue Tang contains Dang Gui, Bai Shao, Sheng Di Huang, Rou Gui, Tao Ren, Fu Ling, Zhi Ke, Chai Hu, Gan Cao, Gan Jiang, Hong Hua.)
**Difficulty and Prognosis**
Passing black stool like lacquer indicates severe accumulated blood, most critical. If spirit calms slightly and pulse stabilizes after purging, it is treatable. If spirit remains confused, pulse shows collapse, accompanied by cold extremities and hiccups, it is likely incurable. (*Yitong*)
**Treatment Principles**
*Xiaochaihu Tang*, *Xijiao Dihuang Tang*, and *Tao Ren Chengqi Tang* listed in *Huoren Zongkuo* are essential. For blood knots, add vinegar to decoctions as an assistant. (*Zhizhi*)
Avoid qi-breaking and qi-tonifying herbs. Purging, bitter-cold, and pungent-dry methods are contraindicated; favor blood-moving and pungent-warm methods, assisted by salty-cold. After stasis moves, tonify blood, benefit spleen, and harmonize liver. (*Bencao Jingshu*)
For body chills/fever with jaundice, wiry/fine/depressed pulse, unresponsive to tonifying/purging herbs: *Qianjin* formula uses Dahuang, Mangxiao, Guowei, Tao Ren, Renshen, Guixin powdered, taken with wine. Borrow strength from Ginseng and Cinnamon to attack. Obese individuals with rich diets often have phlegm-damp-heat-blood stasis in the stomach, possibly with hypochondriac fullness or lower abdominal knotting/pain. Morning: Junxue Wan (tonifies stomach qi). Evening: Bentong Didang Wan (disperses accumulated blood). This achieves the subtlety of using harsh drugs gently. For deficient persons with stasis (pulse hollow, one section wiry), combine tonification with blood removal: Taohe Chengqi Tang plus 5 qian Renshen, divided into three doses, gentle purging saves 20-30%. For mid-jiao deficient persons with dead blood in stomach (hiccups after ginger tea): Renshen and Baizhu (2 liang each) powder, mixed with Tao Ren (1 liang) stir-fried with Gansui/Ganqi (remove Ganqi), refined honey pills, chewed slowly morning/evening with pure wine. (*Yitong*)
**Phlegm and Blood Interaction**
Initial blood injury causes blood reversal, leading to qi stagnation, which generates phlegm. Phlegm and blood gather, named "Blood Stasis with Phlegm." Pain at the site is fixed upon pressure. Symptoms: phlegm wraps blood, sweating up to neck, hematemesis, epistaxis, black stool with clear urine. Treat by guiding phlegm out and eliminating blood. If pre-existing constrained phlegm exists, followed by blood injury, blood stagnates with phlegm, named "Phlegm with Blood Stasis." Pain is less fixed. Symptoms: blood wraps phlegm, distension/oppression, chills/fever. Treat by breaking blood then resolving phlegm, or both simultaneously. Mistaken use of tonics or cold-cool herbs may cause pathogens to form "nests" (chronic collections), which are incurable. Signs of nests: heat in armpit, immobile painful site, or lung membrane heat/swelling with foul-smelling watery sputum (sinks in water). Danxi said: "Phlegm with blood stasis forming nests is incurable." (*Cuiyan*) (Note: This theory is considered too rigid, preserved for reference.)
**Methods to Break Stasis**
For reckless bleeding and stasis, Tao Ren and Dahuang are essential for moving and breaking blood. Degenerated blood cannot return to vessels; if not removed, it causes harm. Removal is necessary regardless of deficiency or excess; add tonics for the weak. (*Yibian*)
**Jiming San**: For falls, crushing injuries, any trauma with blood stasis, impending death, chronic stasis, irritability, pain, inability to cry out. Promotes renewal, effective for fractures.
Ingredients: Dahuang (1 liang, wine-steamed), Xingren (37 kernels, peeled/split, or Tao Ren per Gangmu).
Grind fine, decoct in 1 bowl wine to 60%, strain when bowl cracks. Take at dawn. Next day, pass stasis and recover. If sudden collapse/unconsciousness, force open mouth and灌 (pour) hot urine. (*Sanyin*)
**Danggui Daoshi San**: For trauma, horse/carriage accidents, constipation, swelling/ecchymosis, pain/coma, internal壅 (blockage) nearing death.
Ingredients: Chuan Dahuang (1 liang), Dang Gui (3 qian), Shexiang (small amount, separately ground).
Powder, mix Shexiang. Take 3 qian with warm wine before meals. (*Baojian*)
**Fuyuan Huoxue Tang**: For falls, evil blood in hypochondrium, unbearable pain.
Ingredients: Dahuang (1 liang, wine-soaked), Chai Hu (5 qian), Gualou Gen, Chuanshanjia (fried), Dang Gui (3 qian each), Honghua, Gan Cao (2 qian each), Tao Ren (50 kernels, soaked/peeled/grinded).
Chop ingredients (except Tao Ren paste). Take 1 liang dose, decoct in 2.5 bowls water + 0.5 bowl wine to 70%. Add Tao Ren paste, boil briefly, strain, take warm before meals. Stop when bowels move. (Ibid.) (Note: *Zhuansheng*'s Dai Dang Wan varies from this. *Yitong* notes it treats deficient persons' stasis gently.)
**Xijiao Dihuang Tang**: For floating main pulse, hollow guest pulse, blood accumulation in chest, intense heat in upper jiao.
Ingredients: Xijiao (shaved), Dahuang (1 qian each), Huang Qin, Huang Lian (2 qian each), Sheng Di Huang (4 qian).
One dose, decoct in 2 zhong water to 1 zhong. Take after meals. (*Xuanyao*) (Note: Originally Yunqizi's formula, now adds Xijiao. *Yitong* cites *Bacui* also having Xijiao.)
**Harmonizing Blood Formulas**
**Jiajian Siwu Tang**: For blood/qi deficiency, limb weakness, stasis abdominal pain, or excessive bleeding.
Ingredients: Dang Gui, Chuan Xiong, Bai Shao Yao, Gan Jiang (fried, 0.5 liang each), Nan Mu Xiang, Gan Cao (fried, 2.5 qian each).
Cut coarse, take 3 qian, decoct before meals. If no abdominal pain, no stasis. Adding Renshen benefits blood. (*Zhizhi*)
**Chaihu Shugan San**: For anger injuring Liver, hypochondriac pain, blood stagnating upward.
Ingredients: Chai Hu, Ju Pi (vinegar-fried, 2 qian each), Chuan Xiong (soaked in child's urine/cut), Shao Yao, Zhi Ke (fried, 1.5 qian each), Gan Cao (roasted, 0.5 qian), Xiang Fu (vinegar-fried, 1.5 qian), Shan Zhi (blackened with ginger juice, 1 qian), Wei Jiang (1 slice).
Decoct in water, take warm before meals. For hematemesis, add 0.5 zhong child's urine. (*Yitong*)
**Xiangke San**: For sudden onset of accumulated blood, chest/hypochondrium/lower abdominal pain.
Ingredients: Xiang Fu (ginger-fried, 3 qian), Zhi Ke (fried, 2 qian), Qing Pi (fried), Chen Pi, Wu Yao, Chi Shao Yao, Peng Ze (vinegar-fried, 1 qian each), Guo Wei (3 qian), Hong Hua (0.5 qian), Gan Cao (roasted 0.2 qian, raw 0.3 qian).
Powder, take 4-5 qian, decoct, strain, add 0.5 zhong child's urine, take warm on empty stomach. Assist with Taohe Black Sugar Wine. If ineffective, add Yan Hu Suo, Chuanshanjia. (Ibid.)