守，卫气虚散，营亦妄行，法以大剂参附之类以补元气，气旺自能摄血矣。一曰补益，凡失血人阴分亏损，法于
四物汤中取一二味以为主药，或人参养荣汤、十全大补汤以培养之，则自阳生阴长矣。一曰阻遏，血色红赤，逢黑
即止，水克火之义，久而不止，法以百草霜、京墨、十灰散之类以控抑之，或花蕊石以消化之，庶不令上溢矣。
一曰升阳，缘阳气不升，血乃下漏，法以升、柴、荆、防之类升之，则血自安于故道矣。总之，血循气行，气升
则升，气降则降。火气上升，逼于火则血因之上溢；湿气下行，滞于湿则血因之而下渗。故治上溢无如降气，若
瘀则破之，寒则温之，而阻遏之方则兼用之。治下渗无如升阳，若虚则补
之，热则清之，而阻遏之方则多用之。总以甘温收补，调理脾胃，以建末功，此大法也。（《易简方论》）
治血三法（治血诸药）论治血三法，药各不同。血虚宜补之，虚则发热内热，法宜甘寒、甘平、酸寒、
酸温以益荣血，其药为熟地黄、白芍药、牛膝、炙甘草、酸枣仁、龙眼肉、鹿角胶、肉苁蓉、甘枸杞子、甘菊花、
人乳之属。血热宜清之凉之，热则为痈肿疮疖，为鼻衄，为齿衄，为牙龈肿，为舌上出血，为舌肿，为血崩，为
赤淋，为月事先期，为热入血室，为赤游丹，为眼暴赤痛，法宜酸寒、苦寒、咸寒、辛凉以除实热，其药为童便、
牡丹皮、赤芍药、生地黄、黄芩、犀角、地榆、大小蓟、茜草、黄连、山栀、大黄、青黛、天门冬、玄参、荆芥
之属。血瘀宜通之，瘀必发热发黄，作痛作肿，及作结块癖积，法宜辛温、辛热、辛平、辛寒、甘温以入血通经，
佐以咸寒乃可软坚，其药为当归、红花、桃仁、苏木、桂、五灵脂、蒲黄、姜黄、郁金、京三棱、延胡索、花蕊
石、没药、 虫、干漆、自然铜、韭汁、童便、牡蛎、芒硝之属。盖血为荣，阴也，有形可见，有色可察，有证
可审者也。证既不同，药亦各异，治之之法，要在合宜，倘失其宜，为厉不浅，差剧之门，可不谨乎。（《本草
经疏》）
夫川芎，血中气药也，通肝经，性味辛散，能行血滞于气也。地黄，血中血药也，通肾经，性味甘寒，能生
真阴之虚也。当归分二治，血中主药也，通肝经，性味辛温，全用能活血，各归其经也。芍药，阴分药也，通脾
经，性味酸寒，能和血，治虚腹痛也。若求阴药之属，必于此而取则焉。若气虚血弱，又当从长沙血虚以人参补
之，阳旺则生阴血也。若四物者，独能主血分受伤，为气不虚也。辅佐之属，若桃仁、红花、苏木、血竭、牡丹
皮者，血滞所宜。蒲
黄、阿胶、地榆、百草霜、棕榈灰者，血崩所宜。乳香、没药、五灵脂、凌霄花者，血闭所宜。苁蓉、琐阳、
牛膝、枸杞子、益母草、夏枯草、败龟板者，血虚所宜。乳酪血液之物，血燥所宜。干姜、桂者，血寒所宜。
生地黄、苦参，血热所宜。特取其正治大略耳，以能触类而长，可谓应无穷之变矣。（《微义》）
治气为上 今之治衄 者，专于治衄，不知血之行留，气为之本，犹海水潮汐，阴阳之气使然也。明夫
经络逆顺，则血与气俱流通而无妄行之患矣。（《圣济》）（按∶《圣济》以 为汗血，此说盖兼诸失血而言，
故列于斯。）
男子妇人吐衄便利，及诸证失血，用此药（香附子一两。炒去皮毛为末，每两入甘草一钱，沸汤点服，名顺元
汤）佐以米饮，丸百草霜末，每服百余丸，或以其它烧灰药皆能作效。不可遽以燥涩之剂止之，必致壅遏腐败，
却出它证。大抵血不能行，气使之然。若气得其平，则血循故道，必无妄行之患矣。香附子善能导气，用之每得
其宜。（《易简》）
予思失血，外邪积热妄行者，多用凉剂。其间随情妄用，喜怒忧郁，劳佚内伤，误投前剂，岂不郁而愈郁，
以致积血于胸，满而膈痛之患哉。是知人身之血，赖气升降矣，气升则升，气降则降，气逆则逆，气和则和，
气浊则乱，如此，失血岂不皆由气浊遇热妄行之所致欤。故治水者必以堤防，治血者莫先清气。气清则血和，
气浊则血乱，斯言信矣。（《辨疑》）（按∶《直指》有血荣气卫论，详辨气血调治之要，吴氏盖用其意。）
治者，当以气而平之，致令气归于经而血不妄行者可也。又以血而和之，致使气归于血而气不妄动者可也。
治血之法。全在兹乎。（《绳墨》）
凉温有宜（火证禁止涩） 血遇热而行，故止血多用凉药。然亦有中寒气虚，阴阳不相守，血乃妄行者，
经所谓阳虚阴必凑之者是也。却当用辛温药如干姜、官桂之类，中温则血自归经也。吐、泻、衄皆有此证。
（《简易》）（按妇人良方。亦有此说。见吐血中。宜参。）
出血诸证，每每以胃药收功。盖心主血、肝藏血，胃者又所以生其血而能使真气归元，故其血自止。（《直
指》）
诸血之证，医者便认为热而以苦寒攻之，至死不悟。殊不知苦泻土，土脾胃也，脾胃一身之本。今火既为病
而泻其土，火固未尝除而土先已病矣。土病则胃虚，胃虚则营气不能滋荣百脉，元气不循天度，气随阴化而无
声，肌寒至此，则难治矣。按∶《褚氏遗书》云∶诸血服寒凉者，百无一生；饮溲溺者，十无一死。《杨仁斋直
指方》云∶吐血须煎干姜、甘草作汤与服，或四物理中汤亦可，如此无不愈者。若服此生地、犀角、藕节之类，则
难救矣。如遇相火用事之时，血多妄行，切禁止涩，宜清表攻里，其血自止。若先用止涩之剂，去生便远。凡男
子妇人血证，散者或色鲜红者属热，或成块者或色瘀者属寒，不可拘于血得热而淖溢之说。古云∶水寒成冰，血寒
成块。《玄珠经》十剂条内有云∶气温则血滑，气寒则血凝。虽然亦有中寒气虚云云（按∶全取《简易》），当切
脉以明之，慎不可例用凉药，夭折人命。（《续医说》）
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。（《医通》）
凡治血者当察虚实，是固然矣。然实中有虚，有不宜寒凉者。热中有寒，有速宜温补者。血热妄行，初起治
法，可用清凉；而日久则热随血去，又有不可概用清凉者。此中变化，总惟因心而施，则审其证，凭其脉，以斟
酌于临时。（《医学指要》）（按∶此说本于景岳。）
凡失血之证，以甘寒之剂和之自止。止血不难，惟生血为难。若泥用苦寒，先伤脾胃之气，多致生机日损，
传为虚怯，可不慎欤。（《证治百问》）
初宜用下 失血家须用下剂破血，盖施之于蓄妄之初；亡血家不可下，盖戒之于亡失之后。（《准绳》）
（按∶血溢血泄必失下之，本出撄宁先生《危言》，亦见《准绳》所引，既拈于《伤寒》中，仍不赘。）
一应上溢之证，苟非脾虚泄泻、羸瘦不禁者，皆当以大黄醋制，和生地黄汁，及桃仁泥、牡丹皮之属，引入
血分，使血下行，转逆为顺，此妙法也。不知此而日从事于芩、连、栀、柏之属，辅四物而行之，使气血俱伤，
脾胃两败。今医治血证，百岂有一生者耶。（同上）（互见《吐血》中，宜参。）
按去者自去，生者自生（按∶此撄宁生语），人易知也；瘀者未去，则新者不守，人未易知也。细心体验自
见。（《金匮翼》）
论犀角地黄汤（方出《伤寒》中，兹不复。）热伤一切失血之病，皆宜犀角地黄汤。若胸膈满痛，是为
瘀血，加桃
仁、大黄。若吐血热盛，加黄芩、黄连。因怒致吐血及呕血者，加柴胡、炒栀。唾血，加玄参、黄柏、知母。
咯血，加天冬、麦冬。嗽血，加知母、贝母。（《金鉴》）
犀角地黄，乃是衄血之的方。若阴虚火动吐血与咳咯者，可以备用成功，若阳虚劳力及脾胃虚者，俱不宜。
（《医贯》）
药误变证 抑论血疾阴火，误用阳燥热药，则血枯瘦怯，痨瘵成矣。劳伤误用寒药，则胸满膈痛，血
愈郁矣。坠堕闪锉，误行补涩，则瘀蓄于胃，心下胀满，食入即吐，名曰血逆。血疾难调，最宜斟酌。（《入
门》）
守，卫气虚弱散乱，营血也会妄行，治法应用大剂量的参附类药物来补益元气，元气旺盛自然能统摄血液。一曰补益，凡是失血之人阴分亏损，治法在四物汤中选取一二味作为主药，或者用人参养荣汤、十全大补汤来培补滋养，那么自然就能阳生阴长了。一曰阻遏，血色红赤，遇到黑色即止，这是水克火的道理，如果久治不止，治法用百草霜、京墨、十灰散之类来控制抑制，或者用花蕊石来化解消散，这样才不会让血液上溢。一曰升阳，因为阳气不升，血液才会下漏，治法用升麻、柴胡、荆芥、防风之类来提升阳气，那么血液自然安守于正常的脉络了。总之，血液随着气运行，气升则血升，气降则血降。火气上升，逼迫血液，血液因此上溢；湿气下行，阻滞血液，血液因此下渗。所以治疗上溢没有比降气更好的方法，如果有瘀血就破除它，有寒邪就温煦它，而阻遏止血的方法则兼用。治疗下渗没有比升阳更好的方法，如果有虚证就补益它，有热证就清解它，而阻遏止血的方法则多用。总以甘温收敛补益为主，调理脾胃，以取得最终疗效，这是大法。（《易简方论》）
治血三法（治疗出血的各种药物）论述治疗出血的三种方法，药物各不相同。血虚应当补益，虚则发热内热，治法宜用甘寒、甘平、酸寒、酸温的药物来补益营血，其药物为熟地黄、白芍药、牛膝、炙甘草、酸枣仁、龙眼肉、鹿角胶、肉苁蓉、甘枸杞子、甘菊花、人乳之类。血热应当清解凉润，热则导致痈肿疮疖，导致鼻衄，导致齿衄，导致牙龈肿，导致舌上出血，导致舌肿，导致血崩，导致赤淋，导致月经先期，导致热入血室，导致赤游丹，导致眼暴赤痛，治法宜用酸寒、苦寒、咸寒、辛凉的药物来清除实热，其药物为童便、牡丹皮、赤芍药、生地黄、黄芩、犀角、地榆、大小蓟、茜草、黄连、山栀、大黄、青黛、天门冬、玄参、荆芥之类。血瘀应当通利，瘀滞必然发热发黄，疼痛肿胀，以及形成结块癖积，治法宜用辛温、辛热、辛平、辛寒、甘温的药物进入血分疏通经络，佐以咸寒药物才可以软坚散结，其药物为当归、红花、桃仁、苏木、桂枝、五灵脂、蒲黄、姜黄、郁金、京三棱、延胡索、花蕊石、没药、虻虫、干漆、自然铜、韭汁、童便、牡蛎、芒硝之类。大概血属于营，属阴，是有形可见、有色可察、有证候可审察的。证候既然不同，药物也各异，治疗的方法，关键在于适宜，倘若失去适宜，造成的危害不小，这是病情恶化加重的关口，能不谨慎吗？（《本草经疏》）
川芎，是血中的气药，通肝经，性味辛散，能行气以消除血中的气滞。地黄，是血中的血药，通肾经，性味甘寒，能滋养生真阴之虚损。当归分为两种用法，是血中的主药，通肝经，性味辛温，全用能活血，使血各归其经。芍药，是阴分药，通脾经，性味酸寒，能和血，治疗虚腹痛。如果寻求阴药的范畴，必定从这里取法。如果是气虚血弱，又应当遵循长沙（张仲景）血虚用人参补益的原则，阳气旺盛则能生阴血。如果是四物汤，只能主治血分受伤，而气不虚的情况。辅助佐使之类，如桃仁、红花、苏木、血竭、牡丹皮，是血滞所适宜的。蒲黄、阿胶、地榆、百草霜、棕榈灰，是血崩所适宜的。乳香、没药、五灵脂、凌霄花，是血闭所适宜的。苁蓉、琐阳、牛膝、枸杞子、益母草、夏枯草、败龟板，是血虚所适宜的。乳酪等血液之物，是血燥所适宜的。干姜、桂枝，是血寒所适宜的。生地黄、苦参，是血热所适宜的。这只是取其正治的大略罢了，能够触类旁通，可以说是能适应无穷的变化了。（《微义》）
治气为上 现在治疗鼻衄的人，专门治疗鼻衄，不知道血的运行留止，气是根本，就像海水的潮汐，是阴阳之气的作用。明白经络的逆顺，那么血与气都能流通而没有妄行的祸患了。（《圣济》）（按：《圣济总录》将“汗血”列为此处，此说大概兼指各种失血而言，所以列在这里。）
男子妇人吐血、鼻衄、大小便出血，以及各种证候失血，使用此药（香附子一两，炒去皮毛研末，每两加入甘草一钱，沸水冲服，名为顺元汤），佐以米饮，丸百草霜末，每次服用百余丸，或者其他烧成灰的药物都能见效。不可急于用燥涩的药物止血，必然导致壅遏腐败，却生出其他病证。大概血不能运行，是气使其如此。如果气得其平和，那么血循常道，必然没有妄行的祸患了。香附子善于疏导气机，使用得当每每有效。（《易简》）
我思考失血，外邪积热妄行的，多用凉剂。其中随情欲妄用，喜怒忧郁，劳逸内伤，误投前剂，岂不是郁结更甚，以致积血于胸，满而膈痛的祸患呢。由此可知人身之血，依赖气的升降，气升则升，气降则降，气逆则逆，气和则和，气浊则乱，如此，失血难道不是都由气浊遇热妄行所致吗。所以治水的人一定用堤防，治血的人莫先于清气。气清则血和，气浊则血乱，这话确实可信。（《辨疑》）（按：《直指方》有血荣气卫论，详细辨析气血调治的要领，吴氏大概是运用了其意。）
治疗者，应当以气来平复它，致使气归于经脉而血不妄行就可以了。又以血来调和它，致使气归于血而气不妄动就可以了。治疗血的方法，全在于此。（《绳墨》）
凉温有宜（火证禁止涩） 血遇热而行，所以止血多用凉药。然而也有中寒气虚，阴阳不相守，血乃妄行的，经书所说的阳虚阴必凑之的就是这种情况。却应当用辛温药如干姜、官桂之类，中焦温则血自然归经。吐、泻、衄都有这种证候。（《简易》）（按：《妇人大全良方》也有此说，见吐血中，宜参考。）
出血诸证，每每以胃药收功。大概心主血、肝藏血，胃又是产生血并使真气归元的所在，所以血自然停止。（《直指》）
各种血证，医者便认为是热而以苦寒攻伐，至死不悟。却不知道苦泻土，土对应脾胃，脾胃是一身之本。现在火既为病而泻其土，火固然未除而土先已病了。土病则胃虚，胃虚则营气不能滋荣百脉，元气不循天道，气随阴化而无声音，肌寒至此，就难治了。按：《褚氏遗书》说：各种血证服用寒凉的，百无一活；饮用溲溺的，十无一生。《杨仁斋直指方》说：吐血须煎干姜、甘草作汤服用，或者四物理中汤也可以，如此无不痊愈的。如果服用生地黄、犀角、藕节之类，就难救了。如遇相火用事之时，血多妄行，切禁止涩，宜清表攻里，其血自止。若先用止涩之剂，离死亡就近了。凡男子妇人血证，散者或色鲜红者属热，或成块者或色瘀者属寒，不可拘泥于血得热而淖溢的说法。古语说：水寒成冰，血寒成块。《玄珠经》十剂条内有云：气温则血滑，气寒则血凝。虽然也有中寒气虚云云（按：全取《简易》），当切脉以明辨，慎不可例用凉药，夭折人命。（《续医说》）
证候有虚中挟实，治法有补中寓泻、从少从多的活法，贵在临病处裁。大概血气喜温而恶寒，寒则泣而不能流，温则消而去之，这是轩辕岐伯的密旨。但世上号称名医的人，一见血证，每每以寒凉济阴为务，起初并非不应手而取效于一时，屡发屡折，而既病之虚阳愈衰，必然导致呕逆喘乏，夺食泄泻。还以为是药力未逮，猛进苦寒，在阴不济阳而上溢的，尚且像戈戟一样伤害身体，何况阳不统阴而亡脱的，更是如同砒鸩。大概因阳药性暴，稍有不顺，下咽立见其害，不如阴柔之性，至死不知其误，而免旁人讥谤也。噫！医的弊病，仅为知己道，难为世俗言也。（《医通》）
凡是治血应当察虚实，这固然正确。然而实中有虚，有不宜寒凉的。热中有寒，有速宜温补的。血热妄行，初起治法，可用清凉；而日久则热随血去，又有不可概用清凉的。其中的变化，总惟因心而施，则审其证，凭其脉，以斟酌于临时。（《医学指要》）（按：此说本于景岳。）
凡是失血的证候，以甘寒之剂和之自然停止。止血不难，惟生血为难。如果拘泥用苦寒，先伤脾胃之气，多致生机日损，传为虚怯，可不谨慎吗？（《证治百问》）
初宜用下 失血家须用下剂破血，大概施之于蓄妄之初；亡血家不可下，大概戒之于亡失之后。（《准绳》）（按：血溢血泄必失下之，本出撄宁先生《危言》，亦见《准绳》所引，既拈于《伤寒》中，仍不赘述。）
一应上溢之证，苟非脾虚泄泻、羸瘦不禁者，皆当以大黄醋制，和生地黄汁，及桃仁泥、牡丹皮之类，引入血分，使血下行，转逆为顺，这是妙法。不知道此法而日从事于黄芩、黄连、山栀、黄柏之类，辅佐四物汤而行之，使气血俱伤，脾胃两败。今医治血证，百岂有一生者耶。（同上）（互见《吐血》中，宜参考。）
按去者自去，生者自生（按：这是撄宁先生的话），人容易知道；瘀者未去，则新者不守，人不容易知道。细心体验自然看见。（《金匮翼》）
论犀角地黄汤（方出《伤寒论》中，兹不复述。）热伤一切失血之病，皆宜犀角地黄汤。若胸膈满痛，是为瘀血，加桃仁、大黄。若吐血热盛，加黄芩、黄连。因怒致吐血及呕血者，加柴胡、炒栀子。唾血，加玄参、黄柏、知母。咯血，加天冬、麦冬。嗽血，加知母、贝母。（《金鉴》）
犀角地黄，乃是衄血的特效方。若阴虚火动吐血与咳咯者，可以备用成功，若阳虚劳力及脾胃虚者，都不适宜。（《医贯》）
药误变证 抑论血疾阴火，误用阳燥热药，则血枯瘦怯，痨瘵成矣。劳伤误用寒药，则胸满膈痛，血愈郁矣。坠堕闪锉，误行补涩，则瘀蓄于胃，心下胀满，食入即吐，名曰血逆。血疾难调，最宜斟酌。（《入门》）
Shou (Guarding), when Wei Qi (Defensive Qi) is deficient and scattered, Ying Blood (Nutritive Blood) will also flow recklessly. The treatment method involves using large doses of Shen Fu (Ginseng and Aconite) type formulas to tonify Yuan Qi (Original Qi). When Yuan Qi is robust, it naturally controls the blood. One method is Tonification: for those who have lost blood and suffer from Yin deficiency, select one or two herbs from Si Wu Tang (Four Substances Decoction) as the main drugs, or use Ren Shen Yang Rong Tang (Ginseng Nourishing the Spirit Decoction) or Shi Quan Da Bu Tang (Great Tonifying Ten Powers Decoction) to cultivate and nourish, so that Yang generates Yin. Another method is Obstruction/Control: if the blood color is bright red, it stops upon contact with black, following the principle of Water overcoming Fire. If bleeding persists for a long time, use Bai Cao Shuang (Soot from Hundred Herbs), Jing Mo (Beijing Ink), or Shi Hui San (Ten Charred Powders) to control and suppress, or use Hua Rui Shi (Oolithus) to dissolve and digest, preventing the blood from overflowing upwards. Another method is Ascending Yang: because Yang Qi fails to ascend, blood leaks downwards. Use Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Jing Jie (Schizonepetae Herba), and Fang Feng (Saposhnikoviae Radix) to lift, so the blood returns to its normal pathways. In summary, blood follows Qi; when Qi ascends, blood ascends; when Qi descends, blood descends. When Fire Qi rises, forcing blood, it overflows upwards; when Dampness descends, stagnating blood, it seeps downwards. Therefore, for upward overflow, nothing is better than descending Qi; if there is stasis, break it; if there is cold, warm it; and obstruction methods are used concurrently. For downward seepage, nothing is better than ascending Yang; if there is deficiency, tonify it; if there is heat, clear it; and obstruction methods are used frequently. Ultimately, use sweet-warm astringent tonics to regulate the Spleen and Stomach to achieve the final result; this is the general principle. (*Yi Jian Fang Lun*)
Three Methods of Treating Blood (Medicines for Various Bleeding Conditions): Discussing the three methods of treating bleeding, the medicines differ. For Blood Deficiency, tonification is appropriate. Deficiency causes internal heat; the method should use Sweet-Cold, Sweet-Ping (Neutral), Sour-Cold, or Sour-Warm herbs to benefit Ying Blood. These include Shu Di Huang (Prepared Rehmanniae Radix), Bai Shao Yao (White Peony Root), Niu Xi (Achyranthis Bidentatae Radix), Zhi Gan Cao (Honey-fried Licorice Root), Suan Zao Ren (Ziziphi Spinosae Semen), Long Yan Rou (Longan Aril), Lu Jiao Jiao (Deer Antler Glue), Rou Cong Rong (Cistanche Deserticola), Gou Qi Zi (Lycium Barbarum Fruit), Ju Hua (Chrysanthemi Flos), and Ren Ru (Human Milk). For Blood Heat, clearing and cooling are appropriate. Heat causes abscesses, sores, boils, epistaxis, dental bleeding, gum swelling, tongue bleeding, tongue swelling, metrorrhagia, bloody dysentery, early menstruation, heat entering the Blood Chamber, erysipelas, and sudden red painful eyes. The method should use Sour-Cold, Bitter-Cold, Salty-Cold, or Pungent-Cool herbs to remove excess heat. These include Tong Bian (Child's Urine), Mu Dan Pi (Moutan Cortex), Chi Shao Yao (Red Peony Root), Sheng Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix), Xi Jiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), Di Yu (Sanguisorbae Radix), Da Xiao Ji (Cirsii Herba), Qian Cao (Rubiae Cordifoliae Radix), Huang Lian (Coptidis Rhizoma), Shan Zhi Zi (Gardeniae Fructus), Da Huang (Rhei Radix et Rhizoma), Qing Dai (Indigo Naturalis), Tian Dong (Asparagi Radix), Xuan Shen (Scrophulariae Radix), and Jing Jie (Schizonepetae Herba). For Blood Stasis, unblocking is appropriate. Stasis causes fever, jaundice, pain, swelling, nodules, and masses. The method should use Pungent-Warm, Pungent-Hot, Pungent-Ping, Pungent-Cold, or Sweet-Warm herbs to enter the Blood level and unblock meridians, assisted by Salty-Cold herbs to soften hardness. These include Dang Gui (Angelicae Sinensis Radix), Hong Hua (Carthami Flos), Tao Ren (Persicae Semen), Su Mu (Pterocarpi Santalinus Lignatum), Gui Zhi (Cinnamomi Ramulus), Wu Ling Zhi (Trogopterori Faeces), Pu Huang (Typhae Pollen), Jiang Huang (Curcumae Longae Rhizoma), Yu Jin (Curcumae Radix), San Leng (Sparganii Rhizoma), Yan Hu Suo (Corydalis Rhizoma), Hua Rui Shi (Oolithus), Mo Yao (Myrrha), Meng Chong (Blatta Orientalis - *Oriental Cockroach*), Gan Qi (Drynariae Rhizoma - *Note: Text likely refers to Gan Qi 干漆 processed lacquer*, here interpreted as such or potentially a typo for another herb, but kept as literal), Zi Ran Tong (Pyritum), Jiu Zhi (Leek Juice), Tong Bian (Child's Urine), Mu Li (Ostreae Concha), and Mang Xiao (Natrii Sulfas). Blood belongs to Ying, is Yin, has form, color, and symptoms. Since symptoms differ, medicines vary; the key to treatment is appropriateness. Inappropriateness leads to severe harm; one must be cautious. (*Ben Cao Jing Shu*)
Chuan Xiong (Ligustici Chuanxiong Rhizoma) is the Qi medicine within Blood, enters the Liver Meridian, has a Pungent and dispersing nature, and moves Qi stagnation in Blood. Di Huang (Rehmanniae Radix) is the Blood medicine within Blood, enters the Kidney Meridian, has a Sweet and Cold nature, and generates True Yin deficiency. Dang Gui (Angelicae Sinensis Radix) has two treatments and is the main medicine for Blood, entering the Liver Meridian, with a Pungent and Warm nature; used whole, it invigorates Blood and directs it to its respective meridians. Shao Yao (Paeoniae Radix) is a Yin-level medicine, enters the Spleen Meridian, has a Sour and Cold nature, harmonizes Blood, and treats deficiency-type abdominal pain. If seeking Yin medicines, one must take these as models. For Qi deficiency and Blood weakness, follow Zhang Zhongjing's principle of using Ren Shen (Ginseng Radix) to tonify Blood deficiency; robust Yang generates Yin Blood. Si Wu Tang (Four Substances Decoction) alone treats Blood level injury when Qi is not deficient. Auxiliary herbs like Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Su Mu (Pterocarpi Santalinus Lignatum), Xue Jie (Dragon's Blood), and Mu Dan Pi (Moutan Cortex) are suitable for Blood stasis. Pu Huang (Typhae Pollen), E Jiao (Colla Corii Asini), Di Yu (Sanguisorbae Radix), Bai Cao Shuang (Soot from Hundred Herbs), and Zong Lv Hui (Palmae Fructus Cinchona Ash) are suitable for metrorrhagia. Ru Xiang (Olibanum), Mo Yao (Myrrha), Wu Ling Zhi (Trogopterori Faeces), and Ling Xiao Hua (Campsis Grandiflorae Flos) are suitable for Blood closure. Rou Cong Rong (Cistanche Deserticola), Suo Yang (Cynomorii Herba), Niu Xi (Achyranthis Bidentatae Radix), Gou Qi Zi (Lycium Barbarum Fruit), Yi Mu Cao (Leonuri Herba), Xia Ku Cao (Prunellae Spica), and Bai Gui Ban (Testudo Carapax et Plastrum) are suitable for Blood deficiency. Dairy products are suitable for Blood dryness. Gan Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamoli Ramulus) are suitable for Blood cold. Sheng Di Huang (Rehmanniae Radix) and Ku Shen (Sophorae Flavescentis Radix) are suitable for Blood heat. This covers the general principles of direct treatment, allowing for adaptation to infinite changes. (*Wei Yi*)
Treating Qi is Paramount: Current practitioners treat epistaxis solely for epistaxis, unaware that the movement and retention of Blood depend on Qi, just as tides depend on Yin and Yang Qi. Understanding the reversal and順 (smooth flow) of meridians ensures smooth circulation of Qi and Blood without reckless flow. (*Sheng Ji Zong Lu*) [Note: *Sheng Ji* lists "sweat blood" here; this view likely encompasses various bleeding conditions.]
For men and women with hematemesis, epistaxis, hematochezia/hematuria, and other bleeding conditions, use this medicine: Xiang Fu Zi (Cyperi Rhizoma) 1 liang, stir-fried, peeled, powdered. Add 1 qian of Gan Cao (Licorice Root) per liang. Take with boiling water. Named Shun Yuan Tang (Smooth Origin Decoction). Assist with rice drink. Pill Bai Cao Shuang (Soot from Hundred Herbs) powder, taking over 100 pills per dose. Other ash-forming medicines are also effective. Do not hastily use drying/astringent agents to stop bleeding, as this causes stagnation and corruption, leading to other diseases. Generally, blood fails to move due to Qi. If Qi is balanced, blood follows normal paths, avoiding reckless flow. Xiang Fu Zi effectively guides Qi; used appropriately, it is effective. (*Yi Jian*)
I reflect on bleeding caused by external pathogens and accumulated heat, where coolants are often used. However, misuse based on emotions, anger, depression, fatigue, or internal injury by misusing previous formulas leads to deeper stagnation, accumulating blood in the chest, causing fullness and diaphragmatic pain. Thus, blood relies on Qi's ascent and descent. Qi ascends then blood ascends; Qi descends then blood descends; Qi rebels then blood rebels; Qi harmonizes then blood harmonizes; Qi turbid then blood chaotic. Is bleeding not caused by turbid Qi meeting heat? Therefore, just as water management requires dikes, blood management requires clearing Qi first. Clear Qi harmonizes Blood; turbid Qi chaotizes Blood. This is true. (*Bi Yi*) [Note: *Zhi Zhi Fang* has a discussion on Ying Blood and Wei Qi; Wu Shi likely adopted its intent.]
Treatment should pacify via Qi, ensuring Qi returns to meridians and blood does not flow recklessly. It should also harmonize via Blood, ensuring Qi returns to Blood and does not move recklessly. The method of treating blood lies herein. (*Sheng Mo*)
Cooling and Warming Have Their Appropriateness (Astringents Forbidden for Fire Patterns): Blood flows with heat, so astringents often use cool medicines. However, in cases of Cold invasion and Qi deficiency where Yin and Yang do not guard each other, blood flows recklessly (as stated in the Classics: "When Yang is deficient, Yin encroaches"). Here, Pungent-Warm medicines like Gan Jiang (Zingiberis Rhizoma) and Guan Gui (Cinnamomi Cortex) should be used; warming the middle allows blood to return to meridians. This applies to vomiting, diarrhea, and epistaxis. (*Jian Yi*) [Note: *Fu Ren Da Quan Liang Fang* also mentions this under hematemesis.]
Various bleeding conditions often conclude with Stomach medicines. The Heart governs Blood, the Liver stores Blood, and the Stomach generates Blood and returns True Qi to its origin, thus stopping bleeding. (*Zhi Zhi*)
Physicians often assume all blood diseases are Heat and attack with Bitter-Cold, dying without realizing their error. Bitter herbs drain Earth (Spleen/Stomach), which is the root of the body. Draining Earth while Fire is diseased harms Earth before Fire is removed. Earth disease leads to Stomach deficiency; Stomach deficiency prevents Ying Qi from nourishing vessels; Yuan Qi fails to follow natural laws; Qi transforms with Yin, losing voice; muscle coldness ensues, making it difficult to treat. *Chu Shi Yi Shu* states: "Of those taking cold medicines for bleeding, none survive; of those drinking urine, nine out of ten survive." *Yang Ren Zhai Zhi Zhi Fang* states: "For hematemesis, decoct Gan Jiang (Zingiberis Rhizoma) and Gan Cao (Licorice Root); or Si Ni Tang/Si Ni Jia Zhu Tang. All recover. Using Sheng Di Huang (Rehmanniae Radix), Xi Jiao (Rhinocerotis Cornu), or Ou Jie (Nelumbinis Node) makes rescue difficult." During periods of Ministerial Fire activity, when blood flows recklessly, strictly forbid astringents; clear exterior and purge interior, and blood stops. Using astringents first brings death closer. For men and women, scattered or bright red blood indicates Heat; clots or dark blood indicate Cold. Do not stick to "Heat makes blood fluid" theory. Ancient saying: "Cold water becomes ice; Cold blood forms clots." *Xuan Zhu Jing* Ten Formulas states: "Warm Qi makes blood slippery; Cold Qi makes blood coagulate." Although Cold/Dampness exists, pulse diagnosis is essential. Do not routinely use cool medicines, killing lives. (*Xu Yi Shuo*)
Patterns may involve Deficiency with Excess; treatment involves Tonification with Drainage, varying degrees of application, requiring clinical judgment. Blood and Qi prefer Warmth and dislike Cold; Cold causes stagnation, Warmth resolves it. This is the secret teaching of Xuanyuan and Qibo. However, modern physicians see bleeding and pursue Cooling/Yin-nourishing. Initially effective, recurrence depletes Yang further, causing vomiting, wheezing, anorexia, and diarrhea. They increase Bitter-Cold, harming Yin failing to support Yang (overflow) or Yang failing to control Yin (collapse). Yang medicines are violent; errors are immediate. Yin medicines are gentle; errors go unnoticed, avoiding criticism. Alas! Medical flaws are known only to confidants, not the public. (*Yi Tong*)
Treating blood requires assessing Deficiency and Excess. However, Excess may contain Deficiency (unsuitable for Coolants); Heat may contain Cold (suitable for Warm Tonics). Initial Blood Heat reckless flow may use Cooling; prolonged loss removes Heat, making Cooling unsuitable. Changes depend on the physician's mind, examining patterns and pulses. (*Yi Xue Zhi Yao*) [Note: Based on Jing Yue.]
Bleeding conditions stop with Sweet-Cold harmonizing. Stopping bleeding is easy; generating blood is hard. Adhering to Bitter-Cold damages Spleen/Stomach Qi, reducing vitality, leading to deficiency consumptive diseases. Be cautious. (*Zheng Zhi Bai Wen*)
Initially, Purging is Appropriate: Those with blood accumulation need purgatives to break stasis initially. Those who have lost much blood should not be purged after loss. (*Zhun Sheng*) [Note: Derived from Ying Ning's *Wei Yan*, cited in *Zhun Sheng* and *Shang Han*.]
For upward overflow, unless Spleen deficiency with diarrhea/emaciation exists, use Da Huang (Rhei Radix et Rhizoma) vinegar-processed, mixed with Sheng Di Huang juice, Tao Ren paste, and Mu Dan Pi to enter the Blood level, directing blood downward, reversing rebellion to顺 (smoothness). This is a subtle method. Ignoring this and using Huang Qin, Huang Lian, Zhi Zi, Huang Bai with Si Wu Tang damages Qi and Blood, ruining Spleen/Stomach. How can any survive today? (Same source) [See Hematemesis.]
What goes goes; what grows grows. But if stasis remains, new blood cannot settle. This is hard to understand; careful experience reveals it. (*Jin Kui Yi*)
On Xi Jiao Di Huang Tang (From *Shang Han Lun*): For all heat-injured bleeding, Xi Jiao Di Huang Tang is suitable. For chest/diaphragm fullness/pain (Blood stasis), add Tao Ren and Da Huang. For severe heat hematemesis, add Huang Qin and Huang Lian. For anger-induced hematemesis/vomiting blood, add Chai Hu and fried Zhi Zi. For spitting blood, add Xuan Shen, Huang Bai, and Zhi Mu. For coughing blood, add Tian Dong and Mai Dong. For chronic coughing blood, add Zhi Mu and Bei Mu. (*Jin Jian*)
Xi Jiao Di Huang Tang is the specific formula for epistaxis. Suitable for Yin deficiency with Fire disturbing hematemesis/coughing blood. Unsuitable for Yang deficiency, labor injury, or Spleen/Stomach deficiency. (*Yi Guan*)
Medicine Errors Causing Variations: For blood diseases with Yin Fire, mistakenly using Yang-Dry-Hot medicines causes Blood exhaustion, emaciation, and consumption. For labor injuries, mistakenly using Cold medicines causes chest fullness, diaphragmatic pain, and worsened Blood stagnation. For falls/injuries, mistakenly using Tonifying/Astringent medicines causes Blood stasis in the Stomach, subcardiac fullness, and immediate vomiting upon eating, named Blood Rebellion. Blood diseases are hard to regulate; careful consideration is best. (*Ru Men*)