（即齿衄）
牙宣有二证。有风壅牙宣。有肾虚牙宣。风壅牙宣。消风散擦之。仍服。肾虚牙宣。以
肾主
丸。间黑锡丹。仍用姜盐炒香附。黑色为末。揩擦。其妙不可言也。
吐血者。血溢入浊道。留聚膈间。满则吐血。名曰内衄。宜苏子降气汤加人参阿胶各半
钱。
下养正丹。湿溢血伤。能令吐血。肾着汤。加川芎名除湿汤。此乃湿毒郁于经络。血溢妄行
从鼻则衄衄行清道。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。
一吐血咯血。炒绿豆粉。和小乌沉汤。白汤点服。吐血不止者。菜头捣汁呷之。咯血者
每日空心进一二呷。入侧柏一两。沙参一两。焙研末。入飞面二钱。调如稀糊啜服。
上膈壅热吐血、四物汤、加荆芥、阿胶、各半钱。更不止。于本方中。加大黄滑石各半
钱。或降气汤。吞木香槟榔丸。从大便导之。（此实热则可。虚劳则不可）
吐甚头晕发为寒热者。降气汤。加四物汤各半帖。加阿胶一钱。若单单发热者。茯苓补
心汤。
胃伤吐血。宜理中汤。加川芎干葛。俱各半钱。或只根据理中本方。加川芎扁豆尤好。不
必干
葛。若渴甚。用葛打损恶血。渗入胃中。以致吐血。宜先进苏合香丸。仍以黑神散。和小乌
沉汤。童便调治。夏月伏暑吐血。茅花汤调五苓散。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
吐血。人多发渴。名为血渴。四物汤。十全大补汤。量胃气虚实用之。吐血后、血止而变生诸
证者。见衄血证。
舌衄（舌部出血）：将槐花研成粉末，外掺于患处。或者用麦门冬煎汤，调和妙香散服用。
肌衄（血液从毛孔渗出）：名为肌衄。使用男胎发烧成灰，外敷患处。
（即齿衄，牙龈出血）
牙宣（牙龈萎缩出血）有两种证型：有风壅牙宣，有肾虚牙宣。风壅牙宣，用消风散擦拭，并内服药物。肾虚牙宣，使用补肾主丸，间服黑锡丹。同时用姜盐炒香的附子（原文“香附”结合语境及“黑色为末”、“揩擦”及传统治法，此处疑为附子或特定炮制药材，但依原文提取实体为香附，然“黑色为末”常指附子或熟地等，此处严格按原文“香附”提取，但在翻译中保留原意），研成黑色粉末，用于揩擦牙龈，效果奇妙不可言喻。
吐血：血液溢出进入浊道（消化道），积聚在膈间，满溢后吐出，名为内衄。适宜使用苏子降气汤，加入人参、阿胶各半钱。随后服用养正丹。湿气泛滥损伤血络，能导致吐血。肾着汤加入川芎，名为除湿汤。这是湿毒郁结于经络，导致血液妄行溢出。如果从鼻出则为衄，衄血走清道；吐血走浊道。血液流入胃脘，令人呕吐。血液妄行于上部，或吐血，或咯血，或咳嗽。使用琥珀有效的情况确实很多，宜选择粉末状药物中加入这一味药，或者煎煮药物去渣后，可调服。
对于吐血、咯血，可用炒绿豆粉，配合小乌沉汤，用白开水送服。吐血不止者，用萝卜捣汁少量频饮。咯血者，每日空腹进服一二口。加入侧柏叶一两、沙参一两，焙干研成粉末，加入飞面二钱，调成稀糊状饮用。
上焦壅热导致的吐血，用四物汤，加入荆芥、阿胶各半钱。如果仍不止血，在原方中加入大黄、滑石各半钱。或者用降气汤，吞服木香槟榔丸，从大便引导排出。（此法适用于实热证，虚劳证则不可用）。
吐血严重导致头晕，进而出现寒热症状者，用降气汤，加入四物汤各半帖，加入阿胶一钱。如果只是单纯发热者，用茯苓补心汤。
胃伤导致的吐血，适宜用理中汤，加入川芎、干葛（葛根），各半钱。或者只根据理中汤原方，加入川芎、扁豆更好，不必用干葛。如果是因渴甚，用葛根打碎以祛除恶血，渗入胃中，以致吐血。适宜先进服苏合香丸，仍以黑神散，配合小乌沉汤，用童便调治。夏季伏暑导致的吐血，用茅花汤调服五苓散。有因劳力太过，吐血不止者，用苏子降气汤加人参半钱煎服。
有时吐两口血，随即无事，数日后又发作，经年累月不愈者，适宜常服黑神散，配合小乌沉汤。
吐血的人多会感到口渴，名为血渴。可用四物汤、十全大补汤，根据胃气的虚实来选用。吐血后，血止而变生其他证候者，参见衄血证篇。
Tongue bleeding (She Nu): Powder the Sophora flower (Huaihua) and apply it topically to the affected area. Alternatively, decoct Ophiopogon tuber (Maimendong) in water, and mix with Miao Xiang San for oral administration.
Capillary bleeding (Ji Nu), where blood exudes from hair follicles: This is named Ji Nu. Burn male fetal hair to ash and apply it topically.
(Gingival bleeding, Chi Nu)
Gum recession with bleeding (Ya Xuan) presents in two patterns: Wind-accumulation Ya Xuan and Kidney-deficiency Ya Xuan. For Wind-accumulation Ya Xuan, apply Xiao Feng San topically and administer internally. For Kidney-deficiency Ya Xuan, use Shen Zhu Wan, and intermittently administer Hei Xi Dan. Additionally, stir-fry Cyperus rhizome (Xiangfu) with ginger and salt until fragrant, grind into a black powder, and use it to rub the gums; the efficacy is extraordinary.
Hematemesis (Tu Xue): Blood overflows into the turbid pathway (digestive tract), accumulates between the diaphragm, and when full, is vomited out. This is named Nei Nu. It is appropriate to use Su Zi Jiang Qi Tang, adding Ginseng root (Renshen) and Donkey-hide gelatin (Ejiao), half a qian each. Subsequently, administer Yang Zheng Dan. Excessive dampness damaging the blood collaterals can cause hematemesis. Shen Zhuo Tang added with Ligusticum chuanxiong (Chuanxiong) is named Chu Shi Tang. This results from damp-toxin stagnating in the collaterals, causing blood to overflow and act recklessly. If blood exits from the nose, it is called Bi Yi (epistaxis), which travels through the clear pathway; hematemesis travels through the turbid pathway. Blood flowing into the stomach causes vomiting. Reckless movement of blood upwards may result in hematemesis, hemoptysis, or coughing. The use of Amber (Hupo) is indeed effective in many cases. It is advisable to add this ingredient to powdered medicines, or after decocting and straining the medicine, it can be taken orally.
For hematemesis and hemoptysis, stir-fried mung bean powder mixed with Xiao Wu Chen Tang can be taken with plain boiled water. For persistent hematemesis, drink juice extracted from fresh radish (Cai Tou) in small sips. For hemoptysis, take one or two sips daily on an empty stomach. Add one liang of Platycladi seed (Ce Bai Ye) and one liang of Codonopsis root (Shashen), dry them, grind into powder, add two qian of refined wheat flour, mix into a thin paste, and drink.
For hematemesis caused by heat congestion in the upper jiao, use Si Wu Tang, adding Schizonepeta (Jingjie) and Ejiao, half a qian each. If bleeding does not stop, add Rhubarb (Dahuang) and Talc (Huashi), half a qian each, to the original formula. Alternatively, use Jiang Qi Tang and swallow Mu Xiang Bing Lang Wan to guide the expulsion through the large intestine. (This method is suitable for excess-heat patterns, but contraindicated for deficiency-fatigue patterns).
For severe hematemesis leading to dizziness and subsequent alternating chills and fever, use Jiang Qi Tang combined with Si Wu Tang, half a prescription each, plus one qian of Ejiao. If there is only simple fever, use Fu Ling Bu Xin Tang.
For hematemesis due to stomach injury, Li Zhong Tang added with Chuanxiong and Pueraria root (Gegen), half a qian each, is appropriate. Or simply use the base Li Zhong Tang formula, adding Chuanxiong and Dolichos bean (Bian Dou), which is even better; Gegen is not necessary. If excessive thirst occurs, crush Gegen to remove bad blood that has seeped into the stomach causing hematemesis. First administer Su He Xiang Wan, then treat with Hei Shen San combined with Xiao Wu Chen Tang, regulated with child's urine (Tong Bian). For hematemesis caused by summer-heat retention in summer, use Mao Hua Tang to regulate Wu Ling San. For hematemesis persisting due to excessive physical labor, decoct Su Zi Jiang Qi Tang with half a qian of Renshen.
For occasional episodes of vomiting two mouthfuls of blood, followed by relief, recurring every few days without healing for years, regularly administer Hei Shen San combined with Xiao Wu Chen Tang.
Patients with hematemesis often experience thirst, known as Blood Thirst (Xue Ke). Use Si Wu Tang or Shi Quan Da Bu Tang, selecting based on the deficiency or excess of stomach qi. For post-hematemesis conditions where other syndromes arise after bleeding stops, refer to the section on Epistaxis syndromes.