东垣曰伤寒家衄血者仲景言不可发汗盖为脉微也若浮紧者麻黄汤浮缓者桂枝汤脉已微者
二药
俱不可用宜黄芩芍药汤主之杂病见血多责其热如衄血出于肺以犀角升麻栀子黄芩芍药生地黄
紫参丹参阿胶之类主之咯唾血者出于肾以天门冬麦门冬贝母知母桔梗百部黄柏远志熟地黄之
类主之痰涎血者出于脾葛根黄 黄连芍药当归甘草沉香之类主之呕吐血出于胃也实者犀角地
黄汤主之虚者小建中汤加黄连主之血证上行或唾或呕或吐皆逆也若变而下行为恶痢者顺也血
上行为逆其治难下行为顺其治易故仲景云蓄血证下血者当自愈也与此意同若无病之人忽然下
痢其病进也今病血证上行而复下行恶痢者其邪欲去是知吉也经曰诸见血身热脉大者难治是火
邪胜也身凉脉静者易治是正气复也故脉诀云鼻衄吐血沉细宜忽然浮大即倾危此之谓也
妇室经血诸证详见妇人门
败毒散治风热流入大肠经下血不止若因酒毒加黄连
方见咳门
按此出少阳例表里药也
本事方槐花散治肠风脏毒下血
槐花(炒) 柏叶(杵) 荆芥穗 枳壳(等分)
上为末每服二钱空心米饮送下
拔萃方结阴丹治肠风下血脏毒下血
枳壳(炒) 威灵仙 黄 陈皮 椿根 何首乌 荆芥穗(等分)
上为末酒糊丸桐子大每五七十丸米饮下入醋少许
按此二方手太阴阳明药也
济生加减四物汤治肠风下血不止
侧柏叶 生地黄 当归 川芎(各一两) 枳壳 荆芥穗 槐花(炒) 甘草(各半两炙)
上咀每四钱入乌梅姜同煎
按此手足厥阴太阴药也大抵此药主补血凉血而以风为虚象者盖非风客于肠间也
东垣黄 芍药汤治衄多岁面黄眼涩多眵手麻
黄 (三两) 甘草(炙二两) 升麻 葛根 芍药(各一两) 羌活(半两)
上 咀每三钱水煎温服
按此手足太阴阳明药也然血虚久则阳分亦虚矣故血不足则麻木阴虚火动变证百出亦实非
风也此出升阳滋阴例
李东垣说：伤寒病患者出现鼻衄（鼻出血）的情况，张仲景指出不可使用发汗法，这是因为脉象微弱。如果脉象浮紧，可用麻黄汤；如果脉象浮缓，可用桂枝汤；但如果脉象已经微弱，这两种药都不可使用，适宜用黄芩芍药汤来主治。
杂病中见到出血症状，大多归咎于热邪。例如鼻衄出于肺经，应用犀角、升麻、栀子、黄芩、芍药、生地黄、紫参、丹参、阿胶等药物来主治。咯血或唾血出于肾经，应用天门冬、麦门冬、贝母、知母、桔梗、百部、黄柏、远志、熟地黄等药物来主治。痰中带血出于脾经，应用葛根、黄连、芍药、当归、甘草、沉香等药物来主治。呕吐出血出于胃经，实证用犀角地黄汤主治，虚证用小建中汤加黄连主治。
血证表现为血液上行，无论是咯吐还是呕出，都属于逆证。如果转变为下行排出恶臭痢疾样便，则属于顺证。血液上行为逆，治疗困难；血液下行为顺，治疗容易。所以张仲景说：蓄血证若通过大便排出血，应当自愈，这与上述意思相同。如果没有患病的人突然发生下痢，说明病情进展加重。现在患有血证且血液上行，却又转为下行排出恶臭痢疾样便，这是邪气欲去的表现，可知是吉兆。
《内经》说：凡是见血的患者，如果身体发热、脉象大，属于难治，这是因为火邪亢盛所致。如果身体凉爽、脉象平静，属于易治，这是因为正气恢复所致。所以《脉诀》说：鼻衄或吐血时，脉象沉细为宜，如果忽然变得浮大，就会危及生命，说的就是这种情况。
妇女室女经血的各种病症，详见妇人门。
败毒散治疗风热侵入大肠经导致的下血不止。如果是因酒毒引起，加黄连。（方剂详情见咳嗽门）按语：此方出自少阳病例，属于表里双解之药。
《本事方》中的槐花散治疗肠风和脏毒引起的下血。
药材：槐花（炒）、侧柏叶（捣碎）、荆芥穗、枳壳（各等分）。
制法与用法：以上研为细末，每次服用二钱，空腹时用米汤送服。
《拔萃方》中的结阴丹治疗肠风下血和脏毒下血。
药材：枳壳（炒）、威灵仙、黄芩、陈皮、椿根皮、何首乌、荆芥穗（各等分）。
制法与用法：以上研为细末，用酒糊制成梧桐子大小的丸药，每次服用五七十丸，用米汤送服，可加入少许醋。
按语：这两个方剂主要作用于手太阴肺经和手阳明大肠经。
《济生方》中的加减四物汤治疗肠风下血不止。
药材：侧柏叶、生地黄、当归、川芎（各一两），枳壳、荆芥穗、槐花（炒）、甘草（各半两，炙）。
制法与用法：将药材切碎，每次取四钱，加入乌梅和生姜同煎。
按语：此方主要作用于足厥阴肝经、足太阴脾经。大体而言，此药主补血凉血，而将“风”视为虚象，并非因为风邪客居在肠间。
李东垣的黄耆芍药汤治疗多年鼻衄，伴有面色萎黄、眼睛干涩多眵、手部麻木等症状。
药材：黄耆（三两）、甘草（炙二两）、升麻、葛根、芍药（各一两）、羌活（半两）。
制法与用法：将药材切碎，每次取三钱，水煎后温服。
按语：此方主要作用于手足太阴肺脾经和手足阳明胃大肠经。然而，血虚日久会导致阳气部分也虚弱。所以血不足则导致麻木，阴虚火动则变证百出，这也确实不是风邪所致。此方出自升阳滋阴的法则。
Li Dongyuan stated: In cases of nasal epistaxis (nosebleed) in patients with Shanghan (Cold Damage), Zhang Zhongjing advised against using diaphoresis (sweating method) because the pulse is thready. If the pulse is floating and tight, Mahuang Tang (Ephedra Decoction) may be used; if the pulse is floating and slow, Guizhi Tang (Cinnamon Twig Decoction) may be used. However, if the pulse has already become thready, neither of these two formulas should be used. Instead, Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) is appropriate for treatment.
In miscellaneous diseases, bleeding symptoms are generally attributed to heat. For instance, nasal epistaxis originating from the Lung meridian should be treated with substances such as Xijiao (Rhinoceros Horn, now substituted with Water Buffalo Horn), Shengma (Cimicifugae Rhizoma), Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix), Shengdihuang (Rehmanniae Radix), Zican (Boraginis Herba), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), and Ejiao (Asini Corii Colla). Hemoptysis or spitting of blood originating from the Kidney meridian should be treated with Tianmendong (Asparagi Radix), Mendong (Ophiopogonis Radix), Beimu (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), Jiegeng (Platycodonis Radix), Baibu (Stemonae Radix), Huangbai (Phellodendri Cortex), Yuanzhi (Polygalae Radix), and Shudihuang (Rehmanniae Radix Preparata). Blood mixed with phlegm originating from the Spleen meridian should be treated with Gegen (Puerariae Lobatae Radix), Huanglian (Coptidis Rhizoma), Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), and Chenxiang (Aquilariae Lignum Resinatum). Vomiting blood originating from the Stomach meridian: for excess patterns, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated; for deficiency patterns, Xiaojianzhong Tang (Minor Construct the Middle Decoction) with added Huanglian is indicated.
Blood disorders manifesting with upward flow, whether through spitting or vomiting, constitute a "rebellious" (ni) pattern. If the condition transforms into downward flow presenting as foul dysentery-like stool, it constitutes a "smooth" (shun) pattern. Upward flow of blood is rebellious and difficult to treat; downward flow is smooth and easier to treat. Therefore, Zhang Zhongjing stated: In cases of Blood Accumulation (Xueyu), if blood is passed via the bowels, the condition will likely resolve spontaneously, which aligns with this principle. If a person without prior illness suddenly develops diarrhea, it indicates disease progression. Now, if a patient with an upward-flowing blood disorder subsequently develops downward flow with foul dysentery-like stool, it indicates that the pathogenic factor is departing; thus, this is auspicious.
The Classic states: In all cases of bleeding, if the body is hot and the pulse is large, the prognosis is poor due to excessive Fire pathogen. If the body is cool and the pulse is quiet, the prognosis is good due to the recovery of Healthy Qi (Zhengqi). Therefore, the Pulse Canon states: In cases of nasal epistaxis or hematemesis, a deep and fine pulse is favorable; if the pulse suddenly becomes floating and large, it portends danger. This is what is meant.
Various disorders related to menstrual blood in women are detailed in the Section on Women's Diseases.
Baidu San (Decoction for Overcoming Toxicity) treats continuous lower gastrointestinal bleeding caused by Wind-Heat invading the Large Intestine meridian. If caused by alcohol toxicity, add Huanglian. (Formula details see Section on Cough.) Commentary: This formula derives from the Shaoyang pattern examples and acts as a herb addressing both exterior and interior.
Huaihua San (Sophora Flower Powder) from *Ben Shi Fang* treats lower gastrointestinal bleeding due to Changfeng (Intestinal Wind) and Zangdu (Visceral Toxin).
Ingredients: Huaihua (Sophorae Flos, stir-fried), Baimao Gen / Ce Bai Ye (Biota Top Leaf, pounded), Jingjie Sui (Schizonepeta Spike), Zhike (Aurantii Fructus Immaturus) in equal parts.
Preparation and Administration: Grind into powder. Take 2 qian per dose, administered on an empty stomach with rice water.
Jieyin Dan (Binding Yin Pill) from *Ba Cui Fang* treats lower gastrointestinal bleeding due to Changfeng and Zangdu.
Ingredients: Zhike (Aurantii Fructus Immaturus, stir-fried), Weilingxian (Syneilesis Herba), Huangqin (Scutellariae Radix), Chenpi (Citri Reticulatae Pericarpium), Chun Gen Pi (Toosendan Cortex), Heshouwu (Polygoni Multiflori Radix), Jingjie Sui (Schizonepeta Spike) in equal parts.
Preparation and Administration: Grind into powder, bind with wine paste to form pills the size of paulownia seeds. Take 50–70 pills per dose with rice water, adding a small amount of vinegar.
Commentary: These two formulas primarily target the Hand Taiyin Lung meridian and Hand Yangming Large Intestine meridian.
Jiasheng Jiawei Siwu Tang (Modified Four Substances Decoction from *Jisheng Fang*) treats persistent lower gastrointestinal bleeding due to Changfeng.
Ingredients: Ce Bai Ye (Biota Top Leaf), Shengdihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma) each 1 liang; Zhike (Aurantii Fructus Immaturus), Jingjie Sui (Schizonepeta Spike), Huaihua (Sophorae Flos, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) each 0.5 liang.
Preparation and Administration: Coarsely crush. Take 4 qian per dose, decoct with Wumei (Mume Fructus) and fresh ginger.
Commentary: This formula primarily targets the Foot Jueyin Liver meridian and Foot Taiyin Spleen meridian. Generally, this medication tonifies blood and cools blood. The attribution of "Wind" here is viewed as a manifestation of deficiency, not because Wind pathogen resides in the intestines.
Li Dongyuan's Huangqi Shaoyao Tang (Astragalus and Peony Decoction) treats chronic nasal epistaxis accompanied by sallow complexion, dry eyes with excessive discharge, and hand numbness.
Ingredients: Huangqi (Astragali Radix) 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) 2 liang, Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Shaoyao (Paeoniae Radix) each 1 liang, Qianghuo (Notopterygii Rhizoma et Radix) 0.5 liang.
Preparation and Administration: Coarsely crush. Take 3 qian per dose, decoct in water and take warm.
Commentary: This formula primarily targets the Hand and Foot Taiyin Lung/Spleen meridians and Hand and Foot Yangming Stomach/Large Intestine meridians. However, prolonged blood deficiency leads to deficiency in the Yang aspect. Thus, insufficient blood causes numbness, and Yin deficiency with Fire hyperactivity leads to various complications; this is indeed not caused by Wind. This formula derives from the principle of raising Yang and nourishing Yin.