世之读朱丹溪书者。见其多用凉药。于是废黜热药。贻误不少。而丹溪不任咎也。盖丹溪之书。实未常废
热药。世之读陈修园书者。见其多用热药。于是废黜凉药。为害尤多。而修园不任咎也。盖修园之书。实未
尝废凉药。两贤立论。不过救一时之偏。明一己之见。世之不善读者。得其所详。忽其所略。岂知两贤所略。
亦曰人所已详。吾固不必详焉耳。初何尝废黜不言哉。即如予作此书。亦多用凉药。少用热药。然非弃热
药而不用。特以血症宜凉者多。非谓血症全不用热药也。予于每条当用热药者。未尝不反复言之。慎毋
误读是书。而有偏重凉药之弊。总在分别阴阳。审症处方。斯无差忒。又予是书为血症说法。与杂症不同。
泥此书以治杂症固谬。若执杂症以攻此书。尤谬。读吾书者。未知流弊若何。吾且为此论。先下一针砭。
平人之血。畅行脉络。充达肌肤。流通无滞。是谓循经。谓循其经常之道也。一旦不循其常。溢出于肠胃之
间。随气上逆。于是吐出。盖人身之气游于血中。而出于血外。故上则出为呼吸。下则出为二便。外则出于
皮毛而为汗。其气冲和则气为血之帅。血随之而营运。血为气之守。气得之而静谧。气结则血凝。气虚则
血脱。气迫则血走。气不止而血欲止。不可得矣。方其未吐之先。血失其经常之道。或由背脊走入膈间。由
膈溢入胃中。病重者其血之来。辟辟弹指。漉漉有声。病之轻者。则无声响。故凡吐血。胸背必痛。是血由背
脊而来。气迫之行。不得其和。故见背痛之证也。又或由两胁肋。走油膜。入小肠。重则潮鸣有声。逆入于胃。
以致吐出。故凡失血。复多腰胁疼痛之证。此二者。来路不同。治法亦异。由背上来者。以治肺为主。由胁下
来者。以治肝为主。盖肺为华盖。位在背与胸膈。血之来路。既由其界分溢出。自当治肺为是。肝为统血之
脏。位在胁下。血从其地而来。则又以治肝为是。然肝肺虽系血之来路。而其吐出。实则胃主之也。凡人吐
痰吐食。皆胃之咎。血虽非胃所主。然同是吐证。安得不责之于胃。况血之归宿。在于血海。冲为血海。其脉
丽于阳明。未有冲气不逆上。而血逆上者也。仲景治血以治冲为要。冲脉丽于阳明。治阳明即治冲也。阳
明之气。下行为顺。今乃逆吐。失其下行之令。急调其胃。使气顺吐止。则血不致奔脱矣。此时血之原委。不
暇究治。惟以止血为第一要法。血止之后。其离经而未吐出者。是为瘀血。既与好血不相合。反与好血不
相能。或壅而成热。或变而为痨。或结瘕。或刺痛。日久变证。未可预料。必亟为消除。以免后来诸患。故以消
瘀为第二法。止吐消瘀之后。又恐血再潮动。则须用药安之。故以宁血为第三法。邪之所辏。其正必虚。去
血既多。阴无有不虚者矣。阴者阳之守。阴虚则阳无所附。久且阳随而亡。故又以补虚为收功之法。四者
乃通治血证之大纲。而纲领之中。又有条目。今并详于下方云。
一止血。其法独取阳明。阳明之气。下行为顺。所以逆上者。以其气实故也。吐血虽属虚证。然系血虚非气
虚。且初吐时。邪气最盛。正虽虚而邪则实。试思人身之血。本自潜藏。今乃大反其常。有翻天覆地之象。非
实邪与之战斗。血何从而吐出哉。故不去其邪。愈伤其正。虚者益虚。实者愈实矣。况血入胃中。则胃家实。
虽不似伤寒证。以胃有燥屎。为胃家实。然其血积在胃。亦实象也。故必亟夺其实。釜底抽薪。然后能降气
止逆。仲景泻心汤主之。血多者。加童便茅根。喘满者。加杏仁浓朴。血虚者。加生地当归。气随血脱不归根
者。加人参当归五味附片。有寒热者。加柴胡生姜。或加干姜艾叶。以反佐之。随证加减。而总不失其泻心
之本意。则深得圣师之旨。而功效亦大。盖气之原在肾。水虚则气热。火之原在心。血虚则火盛。火热相搏
则气实。气实则逼血妄行。此时补肾水以平气。迂阔之谈也。补心血以配火。不及之治也。故惟有泻火一
法。除暴安良。去其邪以存其正。方名泻心。实则泻胃。胃气下泄。则心火有所消导。而胃中之热气。亦不上
壅。斯气顺而血不逆矣。且大黄一味。能推陈致新。以损阳和阴。非徒下胃中之气也。即外而经脉肌肤躯
壳。凡属气逆于血分之中。致血有不和处。大黄之性。亦无不达。盖其药气最盛。故能克而制之。使气之逆
者。不敢不顺。既速下降之势。又无遗留之邪。今人多不敢用。惜哉。然亦有病之轻者。割鸡焉用牛刀。葛可
久十灰散。亦可得效。义取红见黑即止之意。其妙全在大黄降气即以降血。吐血之证。属实证者十居六
七。以上二方。投之立效。然亦有属虚属寒者。在吐血家。十中一二。为之医者不可不知也。虚证去血太多。
其证喘促昏愦。神气不续。六脉细微虚浮散数。此如刀伤出血。血尽而气亦尽。危脱之证也。独参汤救护
其气。使气不脱。则血不奔矣。寒证者。阳不摄阴。阴血因而走溢。其证必见手足清冷。便溏遗溺。脉细微迟
涩。面色惨白。唇口淡和。或内寒外热。必实见有虚寒假热之真情。甘草干姜汤主之。以阳和运阴血。虚热
退而阴血自守矣。然血系阴汁。刚燥之剂。乃其所忌。然亦有阳不摄阴者。亦当用姜附也。上寒下热。芩连
姜附同用亦有焉。以上数法。用之得宜。无不立愈。其有被庸医治坏。而血不止者。延日已久。证多杂见。但
用以上诸方。未能尽止血之法。审系瘀血不行。而血不止者。血府逐瘀汤主之。火重者。加黄芩黄连。痰多
者。加云苓瓜霜。咳逆。加杏仁五味寸冬。盗汗身热。加青蒿冬桑叶黄柏牡蛎。喘者。加杏仁苏子。身痛。胸腹
满。大便闭。为瘀结。加大黄。如欲求详。参看痰瘀痨热等门。乃尽其治。又有审病之因。而分别以止其血者。
治法尤不厌详。因于酒及煎炒浓味之物者。其证脉数滑。口干燥。胸中烦热。大小便不利。宜用白虎汤。加
茵陈炒栀大黄藕节治之。因于外感者。先见头痛恶寒发热。脉浮而紧者。为寒犯血分。外束闭而内逆壅。
是以吐血。麻黄人参芍药汤治之。若脉浮而数者。为伤风。风为阳邪。宜小柴胡汤。加荆芥防风当归白芍
丹皮蒲黄知母石膏杏仁治之。若因瘟疫。外证颇似伤寒。而内有伏热攻发。口舌苔白。恶热羞明。小便短
赤。大便浊垢。心中躁烦。脉见滑数。宜升降散。加桃仁丹皮花粉生地蒌仁石膏杏仁甘草治之。犀角地黄
汤亦治之。若因于暑。则发热心烦。暑者。湿热二气合化之名也。以清热利湿为主。升降清化汤。加防己木
通蒌仁治之。病轻者去大黄。因于怒气逆上。血沸而吐者。宜丹栀逍遥散。加青皮牡蛎蒲黄胆草治之。气
火太甚者。则用当归芦荟丸。以平其横决。因于劳倦困苦饥饱不匀。以及忧思抑郁。心神怔忡。食少气短。
吐血虚烦者。宜用归脾汤主之。中土虚寒者加煨姜。虚热者加柴胡山栀。因于跌打损伤。以及用力努挣。
而得失血之证者。法宜补气以续其绝。消瘀以治其伤。四物汤。加黄 人参续断桃仁红花陈酒童便治
之。因于色欲过度。阴虚火旺。其证夜则发热。盗汗梦交。耳鸣不寐。六脉细数芤革。宜地黄汤。加蒲黄藕节
阿胶五味治之。止血之法。此其大略。如欲变化而尽善。非参透全书。不能丝丝入彀。总而论之。血之为物。
热则行。冷则凝。见黑则止。遇寒亦止。故有用热药止血者。以行血为止血。姜艾等是也。有用凉水止血者。
或用急流水。或用井华水。取冷则凝之义。芩连诸药。亦即冷止之义。有用百草霜京墨十灰散等。以止血
者。取见黑则止之义。黑为水之色。红为火之色。水治火故止也。此第取水火之色。犹能相克而奏功。则能
知水火之性。以消息用药。何血证难治之有。又有用咸以止血者。童便马通扬尘水之类。此内经咸走血
之义。童便尤能自还神化。服制火邪以滋肾水。大有功用。故世医云。服童便者。百无不生。不服童便者。百
无不死。本人小便。清晨每服一碗。名回龙汤。各种随笔。赞回龙汤之妙者。甚伙。病家皆所当服也。顾止血
之法虽多。而总莫先于降气。故沉香、降香、苏子、杏仁、旋复、枳壳、半夏、尖贝、浓朴、香附之类。皆须随宜取用。
而大黄一味。既是气药。即是血药。止血而不留瘀。尤为妙药。识得诸法。其于止血之用。思过半矣。夫所谓
止血者。非徒止其溢入胃中之血。使不吐出而已也。盖大吐之时。经脉之血。辐辏而至。其溢入胃中者。听
其吐可也。下可也。即停留胃中。亦与糟粕无异。固无大害也。独动于经脉之中。而尚未溢出者。若令溢出。
则不可复返矣。惟急止之。使犹可复还经脉。仍循故道。复返而为冲和之血。所谓止血者。即谓此未曾溢
出。仍可复还之血。止之使不溢出。则存得一分血。便保得一分命。非徒止已入胃中之死血已耳。今医动
言止血。先要化瘀。不知血初吐时。尚未停蓄。何处有瘀。若先逐瘀。必将经脉中已动之血。尽被消逐。则血
愈枯而病愈甚。安能免于虚损乎。惟第用止血。庶血复其道。不至奔脱尔。故以止血为第一法。
二消瘀。血既止后。其经脉中已动之血。有不能复还故道者。上则着于背脊胸膈之间。下则着于胁肋少
腹之际。着而不和。必见疼痛之证。或流注四肢。则为肿痛。或滞于肌腠。则生寒热。凡有所瘀。莫不壅塞气
道。沮滞生机。久则变为骨蒸干血痨瘵。不可不急去之也。且经隧之中。既有瘀血踞住。则新血不能安行
无恙。终必妄走而吐溢矣。故以去瘀为治血要法。用花蕊石散。令瘀血化水而下。且不动五脏真气。为去
瘀妙药。如无花蕊石。用三七郁金桃仁牛膝醋炒大黄。亦有迅扫之功。顾旧血不去。则新血断然不生。而
新血不生。则旧血亦不能自去也。譬诸君子之道不长。则小人之道亦不消。须知瘀血之去。乃新血日生。
瘀血无处可留。迫之不得不去。故或化而走小便。或传而入大肠。花蕊石。化血从小便去。醋黄散。下血从
大便去。但能去瘀血。而不能生新血。不知克敌者存乎将。祛邪者赖乎正。不补血而去瘀。瘀又安能尽去
哉。治法宜用圣愈汤以补血。加桃仁丹皮红花枳壳香附云苓甘草。补泻兼行。瘀既去而正不伤。治瘀之
法。大旨如是。然亦有宜用温药者。内经曰。血者喜阴而恶寒。寒则涩而不流。温则消而去之。且有热伏阴
分。凉药不效。而宜用从治之法。以引阳出阴者。方用仲景柏叶汤。为寒凝血滞之正治。亦瘀血伏于阴分
之从治法也。然三药纯温。设遇火烈之证。非其所宜。或略加柔药调之。则合四物汤用。又有合泻心汤用
者。则直以此反佐之也。以上通论治瘀之法。而瘀血着留在身。上下内外。又各有部分不同。分别部居。直
探巢穴。治法尤百不失一。审系血瘀上焦。则见胸背肩膊疼痛麻木逆满等证。宜用血府逐瘀汤。或人参
泻肺汤。加三七郁金荆芥。使上焦之瘀。一并廓清。血瘀中焦。则腹中胀满。腰胁着痛。带脉绕脐一周。下连
血室。女子以系胎。男子以束体。乃血之管领也。凡血证。未有带脉不病者。今瘀血滞于其分。则宜去之以
安带脉。带脉在中焦脾之部分。即从脾治之。观仲景肾着汤。可知治脾即是治带。带有瘀血。宜用甲己化
土汤。加桃仁当归姜黄主之。腰痛甚者。加鹿角尖。胁腹痛甚者。加蒲黄灵脂。血瘀下焦。腰以下痛。小腹季
胁等处胀满。是血瘀肝之部分。或积胞中血海为痛。宜归芎失笑散主之。大便闭结者。均加大黄。仲景逐
瘀大剂。则有抵当汤。桃仁承气汤数方。皆苦寒大破下。为治瘀能事。亦有当用温药下之者。生化汤及牛
膝散主之。本女科治产后恶露。及胞衣不下之方。余谓男女虽异。其血则同。同是下焦瘀血。故借用其方。
往往有验。且下焦原系阴分。上焦之瘀多属阳热。每以温药为忌。下焦之瘀多属阴凝。故产妇喜温而忌
寒。以其血在下焦也。知此。则知以温药。治下焦瘀血。尤为合宜。然亦须审系寒凝乃用温药。若血室热。则
仍是桃仁承气之证。又有瘀血流注。四肢疼痛肿胀者。宜化去瘀血。消利肿胀。小调经汤。加知母云苓桑
皮牛膝治之。又有瘀血客于肌腠。阻滞荣卫。发寒发热。似疟非疟。骨蒸盗汗。咳逆交作。用小柴胡汤。加当
归桃仁丹皮白芍主之。寒甚者。再加艾穗细辛。热甚者。再加花粉粉葛青蒿知母。咳有痰火。加瓜霜杏仁
寸冬五味云苓知母。水饮上冲。加葶苈子。益小柴胡。原是从中上疏达肝气之药。使肝气不郁。则畅行肌
腠。而荣卫调和。今加去瘀之品。则偏于去瘀。凡瘀血阻滞荣卫者。用之立验。总而论之。血瘀于脏腑之间
者。久则变为干血。化为痨虫。血瘀于躯壳之间者。或病偏枯。或化 脓。血瘀于肌腠之间者。则变骨蒸。毛
发焦折。肢体瘦削。一切不治之证。总由不善去瘀之故。凡治血者。必先以去瘀为要。另详瘀血门。
世人阅读朱丹溪的著作，见其多用寒凉药物，于是废弃温热药物，导致误人不少，而朱丹溪并不承担这个责任。因为朱丹溪的书中，其实从未废弃温热药物。世人阅读陈修园的著作，见其多用温热药物，于是废弃寒凉药物，造成的危害尤其多，而陈修园也不承担这个责任。因为陈修园的书中，其实从未废弃寒凉药物。这两位贤者建立理论，不过是纠正一时的偏颇，阐明一己之见解。后世不善于读书的人，只看到他们详细论述的部分，忽略了他们简略提及的部分，哪里知道两位贤者所简略的，也是人们已经详细论述过的内容，我本来就不必再详细论述罢了。起初何曾废弃不言说呢？就像我写这本书，也多用寒凉药物，少用温热药物，但这并非抛弃温热药物不用，只是针对血症适宜用寒凉的居多，并非说血症完全不用温热药物。我在每一条应当使用温热药物的情况下，未曾不反复说明。千万不要误读这本书，而产生偏重寒凉药物的弊端。关键在于分辨阴阳，审察症状后开具处方，这样就不会有差错。另外，我的这本书是针对血症立论的，与杂病不同。拘泥于这本书来治疗杂病固然错误，如果执着于治疗杂病的方法来攻击这本书，更是大错。读我书的人，不知道流弊会怎样，我先发表这篇论述，作为预先的针砭警示。
正常人的血液，在脉络中畅行无阻，充盈达于肌肤，流通没有停滞，这叫做“循经”，即遵循其正常的规律。一旦不遵循常态，溢出到肠胃之间，随着气机上逆，于是被吐出。大概人身之气游走在血中，并显现于血外，所以在上面则表现为呼吸，在下面则表现为大小便，在外面则通过皮毛化为汗液。当气机冲和时，气成为血的统帅，血跟随气运行；血是气的守卫，气得到血的依附而宁静。气机郁结则血液凝滞，气虚则血液脱失，气机迫急则血液妄行。气机不止而想使血液停止，是不可能的。在吐血发生之前，血液失去了正常的运行道路，有的从背脊进入膈间，由膈部溢入胃中。病情重的，血液涌来的声音，像弹指一样辟辟作响，像漏水一样漉漉有声；病情轻的，就没有声响。所以凡是吐血，胸背部必定疼痛，这是血液从背脊而来，气机逼迫血液运行，不得调和，所以出现背痛的症状。又有的从两胁肋，经过油膜（腹膜），进入小肠，重的有潮鸣声，逆流入胃，以致吐出。所以凡是失血，又多伴有腰胁疼痛的症状。这两种情况，来源不同，治疗方法也不同。从背脊上来的，以治肺为主；从胁下上来的，以治肝为主。因为肺为华盖，位置在背部与胸膈，血液的来源既然从其界分溢出，自然应当治肺才对。肝是统摄血液的脏器，位置在胁下，血液从那里而来，那么又以治肝才对。然而肝肺虽然可以说是血液的来源路径，但血液吐出，实际上是由胃主导的。凡人吐痰、吐食，都是胃的过错。血液虽然不是胃所主，但同样是吐证，怎么能不归责于胃呢？况且血液的归宿在于血海，冲脉为血海，其经脉附丽于阳明胃经，没有冲气不逆上而血液逆上的情况。张仲景治疗出血以调理冲脉为关键，冲脉附丽于阳明，治疗阳明就是治疗冲脉。阳明之气，下行是顺应的，现在反而逆上呕吐，失去了下行的命令，急需调理胃气，使气顺吐止，那么血液就不会奔脱了。此时血液的原始原因，来不及探究治疗，只以止血为第一要法。血止之后，那些离经而未吐出的，称为瘀血。它既与好血不相融合，反而与好血不相容，或者壅塞而成热，或者变而为劳损，或者结成瘕块，或者刺痛，日久产生的变证，不可预料，必须紧急消除，以免后来产生各种祸患。所以以消瘀为第二法。在止血、消瘀之后，又担心血液再次潮动，就必须用药安定它。所以以宁血为第三法。邪气聚集的地方，正气必然虚弱。失血既多，阴气没有不虚的。阴是阳的守卫，阴虚则阳无所依附，久而久之阳气也会随之亡失。所以又以补虚作为收功的方法。这四条乃是通治血证的大纲，而在纲领之中，又有具体的条目，现在一并详细列在下面。
一、止血。这种方法专门取法于阳明经。阳明之气，下行是顺应的。之所以逆上，是因为气实的原因。吐血虽然属于虚证，但是属于血虚而非气虚。而且在初吐的时候，邪气最盛，正气虽虚而邪气则实。试想人身之血，本自潜藏，现在却大大违背常理，有翻天覆地之象，如果不是实邪与之战斗，血怎么会吐出呢？所以不去除邪气，就会更加伤害正气，虚者更虚，实者更实。况且血液进入胃中，则胃家实，虽然不像伤寒证那样，以胃中有燥屎为胃家实，但是血液积聚在胃中，也是实证的表现。所以必须紧急攻夺其实邪，如同釜底抽薪，然后才能降气止逆。张仲景的泻心汤主治。血量多的，加童便、白茅根；喘满的，加杏仁、厚朴；血虚的，加生地、当归；气随血脱不能归根的，加人参、当归、五味子、附片；有寒热的，加柴胡、生姜，或者加干姜、艾叶，作为反佐。随证加减，而总不失去泻心汤的本意，就深得圣师的旨意，而且功效很大。大概气的根源在肾，水虚则气热；火的根源在心，血虚则火盛。火热相搏则气实，气实则逼迫血液妄行。这时候补肾水以平气，是迂腐空谈；补心血以配火，是不及的治疗。所以只有泻火一法，铲除暴戾，安抚良善，去除邪气以保存正气。方名泻心，实际上是泻胃火。胃气下泄，则心火有所消导，而胃中的热气，也不会向上壅塞。这样气顺而血不逆。而且大黄一味药，能推陈致新，损伤阳热以调和阴气，不仅仅是下胃中之气。即使外面经脉肌肤躯壳，凡是属于气逆于血分之中，导致血液不和的地方，大黄的药性，没有不达到的。大概它的药气最盛，所以能克制它，使逆乱的气不敢不顺从。既迅速下降之势，又没有遗留的邪气。现在的人多不敢用，可惜啊。然而也有病情轻的，杀鸡焉用牛刀，葛可久的十灰散，也可以取得效果。义理取自红见黑即止的意思。其妙处全在大黄降气即以降血。吐血的病症，属实证的占十分之六七。以上两个方剂，投用后立即见效。然而也有属于虚证、寒证的，在吐血患者中，十分中有一二。做医生的不可以不知道。虚证失血太多，症状表现为喘促昏愦，神气不接续，六脉细微虚浮散数。这如同刀伤出血，血尽而气亦尽，是危重脱绝的证候。独参汤救护其气，使气不脱，那么血就不会奔脱了。寒证者，阳不摄阴，阴血因而走溢。症状必定见到手足清冷，大便溏薄，遗尿，脉细微迟涩，面色惨白，唇口淡和。或者有内寒外热，必须确实见到有虚寒假热的真情。甘草干姜汤主治。以阳气温运阴血，虚热退而阴血自然守住了。然而血属于阴汁，刚燥的药物，是它所忌讳的。然而也有阳不摄阴的情况，也应当用姜、附。上寒下热，黄芩、黄连、干姜、附子同用的也有。以上几种方法，用得恰当，没有不立即痊愈的。那些被庸医治坏，而血不止的，拖延日子已久，症状多混杂出现，只用以上诸方，不能完全达到止血的效果。审察如果是瘀血不行而血不止的，用血府逐瘀汤主治。火重的，加黄芩、黄连；痰多的，加云苓、瓜霜；咳逆的，加杏仁、五味子、麦冬；盗汗身热的，加青蒿、冬桑叶、黄柏、牡蛎；喘的，加杏仁、苏子；身痛，胸腹胀满，大便闭结，为瘀结，加大黄。如果想要详细，参看痰、瘀、痨、热等门，才算尽其治疗。又有审察病因，而分别以止其血的，治疗方法尤其不厌详尽。因于饮酒及煎炒浓味食物的，症状脉数滑，口干燥，胸中烦热，大小便不利，宜用白虎汤，加茵陈、炒栀子、大黄、藕节治疗。因于外感的，先见头痛恶寒发热，脉浮而紧的，为寒犯血分，外束闭而内逆壅，所以吐血，用麻黄人参芍药汤治疗。如果脉浮而数的，为伤风，风为阳邪，宜用小柴胡汤，加荆芥、防风、当归、白芍、丹皮、蒲黄、知母、石膏、杏仁治疗。如果因于瘟疫，外证颇似伤寒，而内有伏热攻发，口舌苔白，恶热羞明，小便短赤，大便浊垢，心中躁烦，脉见滑数，宜用升降散，加桃仁、丹皮、花粉、生地、蒌仁、石膏、杏仁、甘草治疗。犀角地黄汤也可以治疗。如果因于暑，则发热心烦。暑，是湿热二气合化的名称。以清热利湿为主，用升降清化汤，加防己、木通、蒌仁治疗。病轻的去大黄。因于怒气逆上，血沸而吐的，宜用丹栀逍遥散，加青皮、牡蛎、蒲黄、胆草治疗。气火太甚的，则用当归芦荟丸，以平其横决。因于劳倦困苦、饥饱不匀，以及忧思抑郁，心神怔忡，食少气短，吐血虚烦的，宜用归脾汤主治。中土虚寒的加煨姜，虚热的加柴胡、山栀。因于跌打损伤，以及用力努挣，而得失血证的，法宜补气以续其绝，消瘀以治其伤，用四物汤，加黄芪、人参、续断、桃仁、红花、陈酒、童便治疗。因于色欲过度，阴虚火旺，症状夜间发热，盗汗梦交，耳鸣不寐，六脉细数芤革，宜用地黄汤，加蒲黄、藕节、阿胶、五味子治疗。止血的方法，这只是大致概况。如果想要变化而尽善，非参透全书，不能丝丝入扣。总而言之，血这种东西，热则行，冷则凝，见黑则止，遇寒也止。所以有用温热药止血的，以行血为止血，如姜、艾等。有用凉水止血的，或用急流水，或用井华水，取冷则凝的意思。芩、连诸药，也就是冷止的意思。有用百草霜、京墨、十灰散等止血的，取见黑则止的意思。黑为水之色，红为火之色，水治火故能止。这只是取水火之色，尚且能相克而奏效，那么能知晓水火之性，以斟酌用药，有什么血证难治的呢？又有用咸味止血的，如童便、马通、扬尘水之类，这是《内经》咸走血的意思。童便尤其能自还神化，服用制约火邪以滋肾水，大有功用。所以世医说：服童便的，百无不生；不服童便的，百无不死。本人小便，清晨每服一碗，名叫回龙汤。各种随笔，称赞回龙汤奇妙的很多。病人皆应当服用。尽管止血的方法很多，但总没有比降气更重要的。所以沉香、降香、苏子、杏仁、旋复花、枳壳、半夏、川贝母、厚朴、香附之类，都必须随宜选用。而大黄一味，既是气药，即是血药，止血而不留瘀，尤为妙药。懂得这些方法，对于止血的作用，就思过半了。所谓止血，并不是仅仅停止那些溢入胃中的血，使其不吐出而已。大概大吐之时，经脉之血，辐辏而至，其中溢入胃中的，听任其吐出或下出都可以，即使停留在胃中，也与糟粕无异，本来没有大害。唯独动于经脉之中，而尚未溢出的，如果令其溢出，就不能再返回了。只有紧急止住它，使还能返回经脉，仍循旧道，重新变为冲和之血。所谓止血，就是指这些未曾溢出、仍可返回的血，止住它使其不溢出，那么存得一分血，便保得一分命，不仅仅是停止已经入胃的死血罢了。现在的医生动不动就说止血要先化瘀，不知道血初吐时，尚未停蓄，哪里有瘀？如果先逐瘀，必将经脉中已动的血，全部被消除驱逐，那么血愈枯而病愈重，怎么能免于虚损呢？只有只用止血，才能使血恢复其道，不至于奔脱。所以以止血为第一法。
二、消瘀。血止之后，经脉中已动的血，有不能返回旧道的，在上面则附着于背脊胸膈之间，在下面则附着于胁肋少腹之际。附着而不和，必定出现疼痛的症状。或者流注四肢，则为肿痛；或者滞于肌腠，则生寒热。凡是有瘀血，没有不壅塞气道的，阻碍生机，久而久之变为骨蒸干血痨瘵，不可以不紧急去除。而且经隧之中，既有瘀血占据，则新血不能安行无恙，最终必定妄走而吐溢。所以以去瘀为治疗血证的要法。用花蕊石散，令瘀血化水而下，且不伤五脏真气，是去瘀的妙药。如果没有花蕊石，用三七、郁金、桃仁、牛膝、醋炒大黄，也有迅扫之功。顾念旧血不去，则新血断然不生，而新血不生，则旧血也不能自去。譬如君子之道不长，则小人之道也不消。须知瘀血的去除，是新血日生的结果，瘀血无处可留，逼迫它不得不去。所以有的化走后从小便去，有的传入大肠从大便去。花蕊石化血从小便去，醋黄散下血从大便去。但只能去瘀血，而不能生新血。不知道克敌在于将领，祛邪依靠正气。不补血而去瘀，瘀又怎么能完全去除呢？治法宜用圣愈汤以补血，加桃仁、丹皮、红花、枳壳、香附、云苓、甘草。补泻兼行，瘀既去而正气不伤。治瘀的方法，大致如此。然而也有宜用温药的。《内经》说：血者喜阴而恶寒，寒则涩而不流，温则消而去之。而且有热伏于阴分，凉药无效，而宜用从治之法，以引阳出阴的，方用张仲景的柏叶汤，为寒凝血滞的正治，也是瘀血伏于阴分的从治法。然而这三味药纯温，如果遇到火烈之证，不适合。或者略加柔药调之，则合四物汤用。又有合泻心汤用的，则是直接以此作为反佐。以上通论治瘀的方法，而瘀血着留在身体，上下内外，又各有部分不同。分别部位，直探巢穴，治疗方法尤其百不失一。审察如果是血瘀上焦，则见胸背肩膊疼痛麻木逆满等症状，宜用血府逐瘀汤，或人参泻肺汤，加三七、郁金、荆芥，使上焦之瘀，一并廓清。血瘀中焦，则腹中胀满，腰胁着痛。带脉绕脐一周，下连血室，女子用以系胎，男子用以束体，是血的管领。凡是血证，没有带脉不病的。现在瘀血滞于其分，则宜去除以安带脉。带脉在中焦脾的部分，即从脾治疗。看张仲景的肾着汤，可知治脾即是治带。带有瘀血，宜用甲己化土汤，加桃仁、当归、姜黄主治。腰痛甚的，加鹿角尖；胁腹痛甚的，加蒲黄、五灵脂。血瘀下焦，腰以下痛，小腹季胁等处胀满，是血瘀肝的部分，或者积于胞中血海为痛，宜用归芎失笑散主治。大便闭结的，均加大黄。张仲景逐瘀的大剂，则有抵当汤、桃仁承气汤等方，都是苦寒大破下，为治瘀能事。也有当用温药下的，生化汤及牛膝散主治。本是女科治疗产后恶露，及胞衣不下的方子。我认为男女虽异，其血则同，同是下焦瘀血，所以借用其方，往往有效。而且下焦原系阴分，上焦之瘀多属阳热，每以温药为忌；下焦之瘀多属阴凝，所以产妇喜温而忌寒，因为其血在下焦。知道这一点，就知道用温药治下焦瘀血，尤为合宜。然而也必须审察是寒凝才用温药，若血室热，则仍是桃仁承气汤的证候。又有瘀血流注，四肢疼痛肿胀的，宜化去瘀血，消利肿胀，用小调经汤，加知母、云苓、桑皮、牛膝治疗。又有瘀血客于肌腠，阻滞荣卫，发寒发热，似疟非疟，骨蒸盗汗，咳逆交作的，用小柴胡汤，加当归、桃仁、丹皮、白芍主治。寒甚的，再加艾穗、细辛；热甚的，再加花粉、粉葛、青蒿、知母；咳有痰火的，加瓜霜、杏仁、麦冬、五味子、云苓、知母；水饮上冲的，加葶苈子。益小柴胡，原本是从中上疏达肝气的药，使肝气不郁，则畅行肌腠，而荣卫调和。现在加上去瘀之品，则偏于去瘀。凡瘀血阻滞荣卫的，用之立即见效。总而言之，血瘀于脏腑之间的，久了则变为干血，化为痨虫；血瘀于躯壳之间的，或病偏枯，或化脓；血瘀于肌腠之间的，则变骨蒸，毛发焦折，肢体瘦削。一切不治之证，总由不善去瘀的缘故。凡是治疗血证，必须先以去瘀为要，另详瘀血门。
Those who read the works of Zhu Danxi see that he mostly used cold medicines, and thus discarded hot medicines, causing many errors, yet Zhu Danxi does not bear the blame. This is because Zhu Danxi's books never actually discarded hot medicines. Those who read the works of Chen Xiuyuan see that he mostly used hot medicines, and thus discarded cold medicines, causing even more harm, yet Chen Xiuyuan does not bear the blame. This is because Chen Xiuyuan's books never actually discarded cold medicines. The theories established by these two sages were merely to correct the biases of their times and clarify their own perspectives. Readers in later generations who are not good at studying books only see what they detailed and ignore what they omitted. How could they know that what the two sages omitted was also what people had already detailed? I naturally did not need to detail it either. Did they ever discard or fail to mention them initially? Just as when I wrote this book, I also used mostly cold medicines and few hot medicines. However, this does not mean abandoning hot medicines for use; it is simply that for blood disorders (Xue Zheng), cold medicines are suitable more often, not that hot medicines are completely unused for blood disorders. For every case where a hot medicine should be used, I have repeatedly explained it. Do not misread this book and fall into the bias of overemphasizing cold medicines. The key lies in distinguishing Yin and Yang, examining symptoms before prescribing, so as to avoid errors. Furthermore, this book discusses blood disorders, which differ from miscellaneous diseases (Za Zheng). Rigidly applying this book to treat miscellaneous diseases is indeed wrong; conversely, using methods for miscellaneous diseases to attack this book is even more erroneous. Readers of my book may not know what the detrimental effects might be, so I present this discussion as a preemptive warning.
In a healthy person, blood flows smoothly through the meridians (Mai Luo), nourishes the skin and muscles, and circulates without stagnation. This is called "following the channels" (Xun Jing), meaning following the normal pathway. Once it deviates from the norm, it overflows between the intestines and stomach, reverses upward with Qi, and is vomited out. Generally, Qi in the human body moves within the blood and manifests outside it. Thus, above it manifests as respiration, below as urination and defecation, and externally through the skin and hair as sweat. When Qi is harmonious, it acts as the commander of blood, guiding its circulation; blood acts as the guardian of Qi, keeping it tranquil. If Qi becomes stagnant, blood coagulates; if Qi is deficient, blood escapes; if Qi is forced, blood rushes. It is impossible to stop blood while Qi continues to move violently. Before vomiting occurs, blood loses its normal path. In severe cases, blood comes from the spine into the diaphragm and overflows into the stomach. The sound of blood rushing may be sharp like snapping fingers or gurgling like leaking water. In mild cases, there is no sound. Therefore, in all cases of hematemesis (Tu Xue), there must be pain in the chest and back, indicating the blood came from the spine, forced by Qi movement lacking harmony, hence the back pain. Alternatively, blood may come from the hypochondrium, pass through the omentum, enter the small intestine, and reverse into the stomach, causing vomiting. Thus, blood loss is often accompanied by waist and hypochondriac pain. These two origins require different treatments: bleeding from the back focuses on treating the Lung, while bleeding from the hypochondrium focuses on treating the Liver. The Lung, as the canopy, is located in the back and chest/diaphragm area; since the blood source overflows from this boundary, treating the Lung is appropriate. The Liver, the organ governing blood storage, is located in the hypochondrium; since blood comes from there, treating the Liver is appropriate. However, although the Liver and Lung are sources of blood flow, the act of vomiting is actually governed by the Stomach. Vomiting phlegm or food is the fault of the Stomach. Although blood is not primarily governed by the Stomach, since it is also a vomiting syndrome, responsibility must be assigned to the Stomach. Moreover, the destination of blood is the Sea of Blood (Chong Mai), whose meridian attaches to the Yangming Stomach channel. There is no instance of rebellious Chong Qi without rebellious blood. Zhang Zhongjing emphasized regulating the Chong Mai to treat bleeding. Since the Chong Mai attaches to Yangming, treating Yangming treats Chong. Yangming Qi should descend; rebellion causes vomiting. Urgently regulating Stomach Qi to restore downward flow stops vomiting and prevents blood from rushing away. At this stage, investigating the root cause is secondary; stopping bleeding is the primary method. After bleeding stops, blood that has left the vessels but was not vomited is called stasis (Yu Xue). It conflicts with healthy blood, potentially causing heat, consumption (Lao), masses, or stabbing pain. Unpredicted complications may arise over time, so eliminating stasis urgently is necessary to prevent future issues. Thus, eliminating stasis is the second method. After stopping bleeding and eliminating stasis, one must worry about blood stirring again, so calming the blood is the third method. Where pathogens gather, deficiency exists. Massive blood loss inevitably leads to Yin deficiency. Yin guards Yang; without Yin, Yang has no attachment and may eventually perish. Thus, tonifying deficiency is the final method for recovery. These four constitute the general principles for treating blood disorders, with specific details listed below.
1. Stop Bleeding. This method specifically targets the Yangming channel. Yangming Qi should descend; rebellion occurs due to excess. Hematemesis is technically a deficiency syndrome (blood deficiency rather than Qi deficiency), but during initial vomiting, pathogens are strong while Zheng Qi is weak. Blood normally remains hidden; violent reversal implies a battle with excess pathogens. Removing pathogens protects Zheng Qi; otherwise, deficiency worsens and excess persists. Blood accumulating in the Stomach creates a "Stomach Excess" condition, similar to dry stool in Cold Damage but distinct. One must urgently drain this excess, like removing firewood from under the pot, to descend Qi and stop rebellion. Zhang Zhongjing's Xie Xin Tang (Drain the Epigastrium Decoction) is indicated. For heavy bleeding, add Tongbian (Child's Urine) and Baomao Gen (White Imperata Rhizome); for wheezing/fullness, add Xing Ren (Apricot Seed) and Hou Po (Magnolia Bark); for blood deficiency, add Sheng Di Huang (Rehmannia Root) and Dang Gui (Angelica Sinensis); for Qi collapse following blood loss, add Ren Shen (Ginseng), Dang Gui, Wu Wei Zi (Schisandra), and Fu Pian (Prepared Aconite); for alternating chills and fever, add Chai Hu (Bupleurum) and Sheng Jiang (Fresh Ginger), or Gan Jiang (Dried Ginger) and Ai Ye (Mugwort Leaf) as counter-agents. Adjust according to symptoms while maintaining the core intent of Xie Xin Tang. The origin of Qi is in the Kidney; Water deficiency causes Qi heat. The origin of Fire is in the Heart; Blood deficiency causes Fire excess. Heat and Fire combine to create Qi excess, forcing blood to run wild. Tonifying Kidney Water to calm Qi is impractical; tonifying Heart Blood to balance Fire is insufficient. Only draining Fire removes violence and preserves righteousness. Although named "Draining the Heart," it actually drains Stomach Fire. Descending Stomach Qi guides Heart Fire downward, preventing Stomach heat from rising, thus harmonizing Qi and stopping blood rebellion. Da Huang (Rhubarb) promotes renewal, damages Yang to harmonize Yin, and descends Qi, not just in the Stomach but throughout meridians and skin where Qi rebels in the Blood level. Its potent nature subdues rebellion. Modern physicians fear using it, which is regrettable. For mild cases, Ge Kejiu's Shi Hui San (Ten Ash Powder) suffices, based on the principle that red turns black and stops. Its efficacy lies in Da Huang descending Qi to descend Blood. Six or seven out of ten hematemesis cases are excess type; these formulas work immediately. One or two cases are deficiency/cold. Severe deficiency presents with panting, confusion, faint pulse—like fatal hemorrhage. Du Shen Tang (Single Ginseng Decoction) saves Qi; if Qi doesn't collapse, Blood won't rush. Cold syndrome involves Yang failing to control Yin, leading to overflow, cold limbs, loose stools, pale face, and slow/thin pulse. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) warms Yang to manage Yin blood. However, blood is Yin fluid; harsh drying agents are contraindicated unless Yang failure requires Ginger/Aconite. Upper cold/lower heat may use Qin Lian Jiang Fu combination. Proper application yields quick results. For cases ruined by incompetent doctors with prolonged bleeding, examine for stasis. Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) is indicated. Add Huang Qin, Huang Lian for heat; Fu Ling, Gua Lou for phlegm; Xing Ren, Wu Wei Zi, Mai Dong for cough; Qing Hao, Sang Ye, Huang Bai, Mu Li for night sweats/fever; Xing Ren, Su Zi for wheezing; Da Huang for constipation/stasis. Investigate etiology for specific treatments: Alcohol/spicy food causes heat/slipping pulse; use Bai Hu Tang (White Tiger Decoction) with Yin Chen, Zhi Zi, Da Huang, Ou Jie. External cold causing headache/chills/tight pulse indicates Cold invading Blood level; use Ma Huang Ren Shen Shao Yao Tang. Wind-heat (floating/rapid pulse) uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Jing Jie, Fang Feng, Dang Gui, Bai Shao, Dan Pi, Pu Huang, Zhi Mu, Shi Gao, Xing Ren. Plague with latent heat uses Sheng Jiang San (Ascending-Descending Powder) with Tao Ren, Dan Pi, Fen Hua, Sheng Di, Gua Lou Ren, Shi Gao, Xing Ren, Gan Cao; Xi Jiao Di Huang Tang is also applicable. Summerheat (fever/restlessness) uses Sheng Jiang Qing Hua Tang with Fang Ji, Mu Tong, Gua Lou Ren (remove Da Huang for mild cases). Anger causing Qi/Fire rebellion uses Dan Zhi Xiao Yao San with Qing Pi, Mu Li, Pu Huang, Long Dan Cao; extreme cases use Dang Gui Lu Hui Wan. Fatigue/starvation/worry causing Heart/Spleen deficiency uses Gui Pi Tang; add Wei Jiang for Spleen cold, Chai Hu, Shan Zhi for deficiency heat. Trauma/straining uses Si Wu Tang with Huang Qi, Ren Shen, Xu Duan, Tao Ren, Hong Hua, aged wine, Tongbian. Sexual excess causing Yin deficiency/Fire hyperactivity uses Di Huang Tang with Pu Huang, Ou Jie, E Jiao, Wu Wei Zi. In summary, blood flows with heat, coagulates with cold, stops with black, and stops with cold. Hot medicines like Jiang/Ai stop bleeding by moving blood. Cold water or well water stops bleeding by coagulation. Qin/Lian herbs follow the cold principle. Bai Cao Shuang, Jing Mo, Shi Hui San stop bleeding via the "black stops red" principle (Water controls Fire). Salty substances like Tongbian follow the Nei Jing principle that salty enters Blood. Tongbian regulates Fire and nourishes Kidney Water. Taking morning urine (Hui Long Tang) is highly recommended. Regardless of methods, descending Qi is paramount. Chen Xiang, Jiang Xiang, Su Zi, Xing Ren, Xuan Fu Hua, Zhi Ke, Ban Xia, Bei Mu, Hou Po, Xiang Fu are useful. Da Huang is both a Qi and Blood herb, stopping bleeding without leaving stasis. Understanding these methods covers most of hemostasis. True hemostasis prevents blood in meridians from overflowing, preserving life, not just stopping vomited blood. Premature stasis removal during active bleeding depletes healthy blood. Thus, stopping bleeding is first.
2. Eliminate Stasis. After bleeding stops, blood that failed to return to vessels becomes stasis, attaching to the back/chest/diaphragm or hypochondrium/lower abdomen, causing pain. Flowing to limbs causes swelling; stagnating in muscles causes chills/fever. Stasis blocks Qi and vitality, potentially leading to bone-steaming consumption. It must be removed urgently. Stagnant stasis prevents new blood from circulating safely, leading to eventual rupture. Thus, removing stasis is essential. Hua Rui Shi San (Flower Nodule Stone Powder) liquefies stasis for excretion without harming Zhen Qi. Alternatives include San Qi, Yu Jin, Tao Ren, Niu Xi, and Cu Chao Da Huang. Old stasis prevents new blood generation; new blood generation helps eliminate old stasis. Stasis exits via urine (Hua Rui Shi) or feces (Cu Huang San). However, eliminating stasis alone is insufficient; one must tonify blood. Sheng Yu Tang (Sufficient Vitality Decoction) with Tao Ren, Dan Pi, Hong Hua, Zhi Ke, Xiang Fu, Fu Ling, Gan Cang tonifies and purges simultaneously. Warm medicines may be needed as Blood dislikes cold and prefers warmth to dissolve stasis. Bai Ye Tang (Leaf of Catalpa Decoction) treats cold-stagnation. Pure warm herbs may need softening agents or combination with Si Wu Tang or Xie Xin Tang as counter-agents. Stasis location dictates treatment: Upper Jiao (chest/back pain) uses Xue Fu Zhu Yu Tang or Ren Shen Xie Fei Tang with San Qi, Yu Jin, Jing Jie. Middle Jiao (abdominal distension/hypochondriac pain) involves the Dai Mai (Girdle Vessel); treat the Spleen. Jia Ji Hua Tu Tang with Tao Ren, Dang Gui, Jiang Huang is indicated; add Lu Jiao Jian for severe back pain, Pu Huang, Ling Zhi for hypochondriac pain. Lower Jiao (lower abdominal/flank pain) involves the Liver/Blood Sea; Gui Xiong Shi Yao San is indicated; add Da Huang for constipation. Zhang Zhongjing's strong purgatives like Di Dang Tang or Tao Ren Cheng Qi Tang treat severe stasis. Warm purgatives like Sheng Hua Tang or Niu Xi San (originally for postpartum lochia) can be borrowed for lower Jiao stasis in men, as lower Jiao is Yin and prone to cold coagulation. Limb pain/swelling from stasis uses Xiao Tiao Jing Tang with Zhi Mu, Fu Ling, Sang Bai Pi, Niu Xi. Stasis in muscles blocking Ying/Wei causing malaria-like symptoms uses Xiao Chai Hu Tang with Dang Gui, Tao Ren, Dan Pi, Bai Shao; add Ai Sui, Xi Xin for cold; Fen Hua, Ge Gen, Qing Hao, Zhi Mu for heat; Gua Lou, Xing Ren, Mai Dong, Wu Wei Zi, Fu Ling, Zhi Mu for phlegm-fire; Ting Li Zi for fluid retention. Xiao Chai Hu Tang soothes Liver Qi; adding stasis-resolving herbs targets stasis effectively. Stasis in organs leads to dry blood/consumption; in body shell to paralysis/abscess; in muscles to bone-steaming/emaciation. All incurable conditions stem from poor stasis management. Treating blood disorders always prioritizes eliminating stasis. See the Stasis chapter for details.