寸口脉动而弱，动即为惊，弱则为悸。
【注】寸口通指三部也。脉动而弱，主惊悸病也。动即为惊，以惊为外触而动也；弱
即为悸，以悸为内生而怯也。
【集注】徐彬曰∶惊为外邪袭心，故其寸口脉动。动者，脉来乱动也。悸乃神不自主，
故其寸口脉弱。弱者，脉沉无力也。邪之所袭，因心之虚，故惊悸并见。
李 曰∶此寸口脉兼三部而言。盖惊自外至者也，惊则气乱，故脉动而不宁；悸自
内惕者也，悸因中虚，故脉弱而无力。
师曰∶夫脉浮，目睛晕黄，衄未止，晕黄去，目睛慧了，知衄今止。
【注】浮脉主阳主表，若目睛清洁，主阳表病也；目睛晕黄，主血脉病也。盖以诸脉
络于目，而血热则赤，血瘀则黄。今目睛黄晕，知其衄未止也；若黄晕去，目睛慧了，知
其衄已止，故曰∶衄今止也。
又曰∶从春至夏衄者，太阳；从秋至冬衄者，阳明。
【注】衄血，阳络伤也。下血，阴络伤也。
太阳主外，春夏主外，故从春至夏衄血，属太阳也。阳明主内，秋冬主内，故从秋至冬
衄血，属阳明也。
【集注】李 曰∶衄血出于鼻。手太阳经上 抵鼻，目下为 ；足太阳经，从巅入络
脑，鼻与脑通；手阳明经挟鼻孔；足阳明经起鼻交额中。四经皆循鼻分，故皆能致衄。太
阳行身之表，经云∶太阳为开。是春生夏长，阳气在外有开之义，故春夏衄者太阳。阳明
行身之里，经云∶阳明为阖。是秋敛冬藏，阳气在内，有藏之义，故秋冬衄者阳明。
尤怡曰∶少阳之脉不入鼻额，故不主衄。
衄家不可汗，汗出必额上陷脉紧急，直视，不能 ，不得眠。
【注】衄，该吐血而言也，衄血吐血之家，阴已亡矣，若发其汗，汗出液竭，诸脉失养，
则额角上陷中之脉为热所灼，紧且急也。目直视，目瞪不转睛也。不能 ，目睫不合也。
亦为热灼其脉，引缩使然也。不得眠，阳气不能行于阴也。凡此之病，皆阳盛阴微之危
证，故衄家慎不可汗也。
【集注】赵良曰∶足太阳经主表，上巅入额，贯目睛，衄则在上络脉之血己脱，若更
发汗，是重竭津液，津液竭则脉枯，故额上陷中脉紧而急，牵引其目，视不能合也。无
血阴虚，故不得眠。
病患面无血色，无寒热，脉沉弦者，衄；脉浮弱，手按之绝者，下血；烦咳者，必吐
血。
【按】脉沉，当是“脉浮”；脉浮，当是“脉沉”，文义始属。必传写之讹。
【注】赤色，血色也，面无血色，谓面白之人，纯白而天赤；面黄之人，纯黄而不红
也。人有恐怖则面色脱白，其状惊骇；人有愧心，乍白乍红，其状惶怯。今无故而面天
血色，则可知非惊愧致气乱血散也；且无寒热病，又可知非虚损不生血少血也。既非血
散，又非血少，当询之病患，必有失血之故。诊之于脉，必有吐衄、下血之因。衄吐属阳，
故脉见浮弦，按之必芤，营血空也；下血属阴，脉见沉弱，按之欲绝，营气微也。且脉
色如斯，而证兼烦咳，是病在心肺，故必吐血也。
夫吐血，咳逆，上气，其脉数，而有热，不得卧者，死。
【注】吐血咳逆，肺大伤也；上气，肺无降也；脉数有热，火烁肺金也；不得卧者，阳
不入阴，故曰死也。
【集注】赵良曰∶脉数有热，阳独胜也；不能卧，阴已绝也。阴既绝，阳岂独生耶？故
死。若得卧者，阴未绝，未可言死。
程林曰∶吐血、咳逆。上气，则肺脏伤矣。脉数则虚热不去，火来刑金矣。阴血消
亡，故不得卧，死可必矣。
夫酒客咳者，必致吐血，此因极饮过度所致也。
【注】酒性大热，溃脉伤经，极饮过度，必致咳嗽吐血也。
【集注】徐彬曰∶此言吐血，不必由于气不摄血，亦不必由于阴火炽盛。其有酒客而
致咳，则肺伤已极，又为咳所击动，必致吐血，故曰∶极饮过度所致。则治之者，当以
清酒热为主也。
亡血不可发其表，汗出则寒栗而振。
【注】凡失血之后，血气未复为亡血也，皆不可发汗。失血之初，固属阳热，亡血之
后，热随血去，热虽消而气逐血虚，阳亦微矣。若发其汗，则阳气衰微，力不能支，故
身寒噤栗而振振耸动也。发阴虚之汗，汗出则亡阴，即发吐衄之汗也，故见不得 ，不
得眠，亡阴之病也。发阳虚之汗，汗出则亡阳，即发亡血之汗也，故见寒栗而振，亡阳
之病也。
【集注】李 曰∶夺血者无汗，以汗与血俱属心液，血亡液竭，无复余液作
汗也。今又发表，则阴虚且更亡阳，表间卫气虚极，故寒栗而振。
吐血不止者，柏叶汤主之。
【注】吐血之病，热伤阳络，当清其热；劳伤阳络，当理其损。今以柏叶汤温散之品，
而治吐血不止者，则必是热伏阴分，用此宣发，使热行阳分，血不为热所迫，则自止矣。
柏叶汤方
柏叶 干姜（各三两） 艾（三把）
上三味，以水五升，取马通汁一升合煮，取一升，分温再服。
【集解】程林曰∶《神农经》云∶柏叶主吐血，干姜止唾血，艾叶止吐血。马通者，白
马尿也。凡尿必达洞肠乃出，故曰通，亦微温止吐血。四味皆辛温行阳之品，使血归经，
遵行隧道，而血自止，故吐血不止，以柏叶汤主之也。
心气不足，吐血、衄血，泻心汤主之。
【按】心气“不足”二字，当是“有余”二字，若是不足，如何用此方治之，必是传
写之讹。
【注】心气有余，热盛也，热盛而伤阳络，迫血妄行，为吐、为衄。故以大黄、黄连、黄
芩大苦大寒直泻三焦之热，热去而吐衄自止矣。
泻心汤方
大黄（二两） 黄连 黄芩（各一两）
上三味，以水三升，煮取一升，顿服之。
病患胸满唇痿，舌青口燥，但欲漱水不欲咽，无寒热，脉微大来迟，腹不满，其人言我满，为有瘀血。
【注】表实无汗，胸满而喘者，风寒之胸满也；里实便涩，胸满烦热者，热壅之胸满
也；面目浮肿，胸满喘不得卧者，停饮之胸满也；呼吸不快，胸满太息而稍宽者，气滞
之胸满也。今病患无寒热他病，惟胸满、唇痿、舌青、口燥，漱水不欲咽，乃瘀血之胸
满也。唇、舌，血华之处也，血病不荣，故痿瘁色变也。热在血分，故口燥漱水不欲咽
也。脉微大来迟，阴凝之诊，则当腹满，今腹不满，询之其人，言我满在胸在腹也，与
上如是之证推之，为有瘀血也。
病者如热状，烦满，口干燥而渴，其脉反无热，此为阴伏，是瘀血也。当下之。
【注】此承上文互详证脉，以明其治也。如热状，即所谓心烦胸满，口干燥渴之热证
也。其人当得数大之阳脉，今反见沉伏之阴脉，是为热伏于阴，乃瘀血也。血瘀者当下
之，宜桃核承气、抵当汤丸之类也。
【集注】李 曰∶血瘀内无实热，故外证但如热状，而其脉不数疾，反元热也。烦满
者，血瘀经气不舒；燥渴者，血瘀津液不布。血属阴，瘀则脉伏于内，故为阴伏。当下之，
以去瘀生新也。
下血，先便后血，此远血也，黄土汤主之。下血，先血后便，此近血也，赤小豆当
归散主之。
【注】先便后血，此远血也，谓血在胃也，即古之所谓结阴，今之所谓便血也。先血后
便，此近血也，谓血在肠也，即古之所谓肠 为痔下血，今之所谓脏毒、肠风下血也。一
用黄土汤以治结阴之血，从温也；一用赤小豆当归散以治脏毒之血，从清也。
【集注】赵良曰∶肠胃阳明经也，以下血言，胃居大肠之上，若聚于胃，必先便后血，
去肛门远，故曰远血，若聚大肠，去肛门近，故曰近血。故治远血黄土汤主之，治近血赤
小豆当归散主之。
黄土汤方
甘草 干地黄 白术 附子（炮） 阿胶 黄芩（各三两） 灶中黄土（半斤）
上七味，以水八升，煮取三升，分温二服。
赤小豆当归散方（见狐惑）
寸口脉弦而大，弦则为减，大则为芤；减则为寒，芤则为虚。寒虚相击，此名曰革。妇
人则半产漏下，男子则亡血。
【注】详见《伤寒·辨脉篇》内，不复释。
火邪者，桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。
【按】此方是治火逆惊狂者，与首条之脉动惊病不合，必是错简。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两） 甘草（炙，二两） 生姜（三两） 牡蛎（熬，五两） 龙骨（四两） 大
枣（十二枚） 蜀漆（洗去腥，三两）
上为末，以水一斗二升，先煮蜀漆，减一升，内诸药，煮三升，温服一升。
心下悸者，半夏麻黄丸主之。
【按】此方是治寒水心卞悸者，与首条之脉弱悸病不合，必是错简。
半夏麻黄丸方
半夏 麻黄（等分）
上二味，末之，炼蜜和丸，小豆大，饮服三丸，日三服。
【注】寸口泛指寸、关、尺三部脉。脉象动而弱，主病为惊悸。所谓“动即为惊”，是因为惊是受外界触动而致；所谓“弱即为悸”，是因为悸是内生怯懦所致。
【集注】徐彬说：惊是外邪侵袭心脏，所以寸口脉表现为动。动的含义，是脉搏来去杂乱跳动。悸则是神志不能自主，所以寸口脉表现为弱。弱的含义，是脉搏沉取无力。邪气之所以能侵袭，是因为心脏虚弱，所以惊和悸往往并见。
李 说：这里的寸口脉是兼指三部而言。大概惊是从外部来的，惊则导致气机紊乱，所以脉象动而不宁；悸是从内部产生的恐惧，悸因为中焦虚弱，所以脉象弱而无力。
老师说：如果脉象浮，且眼珠周围有黄晕，说明鼻衄（鼻出血）尚未停止；如果黄晕消退，眼睛变得清明，就知道鼻衄现在已经停止了。
【注】浮脉主阳、主表，如果眼睛清澈明亮，主阳表病；如果眼珠有黄晕，主血脉病。因为各种脉络都联系于目，血热则眼球发红，血瘀则发黄。现在眼珠有黄晕，知道鼻衄未止；如果黄晕消退，眼睛清明，知道鼻衄已止，所以说：“鼻衄现在停止了”。
又说：从春季到夏季发生的鼻衄，属于太阳经病变；从秋季到冬季发生的鼻衄，属于阳明经病变。
太阳经主表，春夏季节阳气主外，所以从春到夏的鼻衄，属于太阳经。阳明经主里，秋冬季节阳气主内，所以从秋到冬的鼻衄，属于阳明经。
【集注】李 说：鼻衄出于鼻腔。手太阳经上行至鼻下；足太阳经从头顶入络脑部，鼻与脑相通；手阳明经挟持鼻孔两侧；足阳明经起于鼻旁交于额中。这四条经脉都循行经过鼻子，所以都能导致鼻衄。太阳经行于身体表面，《内经》说：“太阳为开”。这是春生夏长，阳气在外，有开启之义，所以春夏季鼻衄属太阳。阳明经行于身体内部，《内经》说：“阳明为阖”。这是秋敛冬藏，阳气在内，有闭藏之义，所以秋冬季鼻衄属阳明。
经常鼻衄的人不可使用发汗法，如果误用发汗法导致出汗，必然出现额头两侧动脉凹陷、脉紧急、两眼直视、眼睑无法闭合、无法入睡的症状。
【注】“衄”这里包括吐血而言。经常鼻衄或吐血的人，阴液已经耗亡，如果再发汗，汗出则津液枯竭，各条脉络失去滋养，那么额角凹陷处的脉络被热邪灼伤，就会紧张急迫。两眼直视，是指眼睛瞪大不转动。眼睑无法闭合，也是由于热邪灼伤脉络，牵引收缩所致。无法入睡，是因为阳气不能入于阴分。凡是这些病症，都是阳盛阴微的危险证候，所以经常鼻衄的人千万不可发汗。
【集注】赵良说：足太阳经主表，上达头顶入额，贯穿目睛。鼻衄说明上部络脉之血已经脱失，如果再发汗，就是再次竭尽津液，津液枯竭则脉络枯槁，所以额头凹陷处的脉紧而急，牵引眼部，导致视物时眼睑不能闭合。无血阴虚，所以无法入睡。
病人面色苍白无血色，没有恶寒发热症状，脉象沉弦的，是鼻衄；脉象浮弱，重按感觉中断的，是便血；伴有烦躁咳嗽的，必定会吐血。
【按】原文中的“脉沉”应当是“脉浮”；“脉浮”应当是“脉沉”，这样文义才通顺。这一定是传抄过程中的错误。
【注】赤色是血色的表现。面无血色，指的是面色纯白而无红润，或者面色纯黄而无红色。人如果有恐惧，面色会脱白，神情惊骇；人如果有羞愧之心，面色乍白乍红，神情惶怯。现在无缘无故地面色苍白无血色，可知不是因惊恐羞愧导致气乱血散；而且没有寒热病，又可知不是因虚损导致生血不足。既然不是血散，也不是血少，应当询问病人，必定有失血的缘故。诊察其脉，必定有吐血、鼻衄或便血的原因。吐衄属于阳证，所以脉见浮弦，按之必有空豁感（芤脉），这是营血空虚的表现；便血属于阴证，脉见沉弱，按之欲绝，这是营气微弱的表现。况且脉象和面色如此，且症状兼有烦躁咳嗽，这是病在心肺，所以必定会吐血。
凡是吐血，伴有咳嗽气逆、气机上冲，脉数且有发热、无法安卧的，预后不良，主死。
【注】吐血伴咳嗽气逆，说明肺脏严重受损；气机上冲，说明肺气不能肃降；脉数且有热，说明火邪灼伤肺金；无法安卧，说明阳气不能入于阴分，所以说主死。
【集注】赵良说：脉数有热，说明阳气独盛；不能安卧，说明阴气已绝。阴气既然已绝，阳气岂能单独生存？所以说主死。如果能安卧，说明阴气未绝，还不能说是死证。
程林说：吐血、咳嗽气逆、气机上冲，说明肺脏受伤。脉数说明虚热不去，火来刑克肺金。阴血消亡，所以无法安卧，死亡是可以预料的。
凡是嗜酒之人发生咳嗽，必定会导致吐血，这是因为极度饮酒过度所导致的。
【注】酒性大热，会损伤脉络和经络，极度饮酒过度，必定导致咳嗽和吐血。
【集注】徐彬说：这里说的吐血，不一定由于气不摄血，也不一定由于阴火炽盛。如果是嗜酒之人导致咳嗽，说明肺脏已经极度受伤，又受到咳嗽的冲击震动，必定导致吐血，所以说这是极度饮酒过度所致。因此治疗者，应当以清解酒热为主。
亡血之人不可使用发表发汗法，如果发汗导致出汗，会出现畏寒战栗、身体振颤的症状。
【注】凡是失血之后，气血尚未恢复称为亡血，都不可发汗。失血之初，固然属于阳热，但亡血之后，热随血而去，虽然热势消退，但气随血虚，阳气也变得微弱了。如果再发汗，则阳气更加衰微，力量不能支撑，所以身体寒冷、战栗颤抖。发阴虚之汗，汗出则亡阴，也就是发吐衄之汗，所以会出现眼睑无法闭合、无法入睡等亡阴的病证。发阳虚之汗，汗出则亡阳，也就是发亡血之汗，所以会出现畏寒战栗等亡阳的病证。
【集注】李 说：夺血者无汗，因为汗与血都属于心液，血亡则液竭，没有剩余的液体可以化作汗了。现在又用发表药，则阴虚且更亡阳，体表的卫气极度虚弱，所以出现畏寒战栗、身体振颤。
【注】吐血的病，如果是热伤阳络，应当清热；如果是劳损伤阳络，应当调理损伤。现在用柏叶汤这种温散的药物来治疗吐血不止，那么必然是热伏于阴分，用此方宣发，使热行于阳分，血不被热邪逼迫，自然就停止了。
柏叶汤方
侧柏叶、干姜（各三两）、艾叶（三把）
以上三味药，用水五升，加入马通汁一升混合煎煮，取药液一升，分两次温服。
【集解】程林说：《神农本草经》记载：侧柏叶主治吐血，干姜止唾血，艾叶止吐血。马通，即白马尿。凡是尿液必须通达肠道后才排出，所以叫“通”，也有微温止吐血的作用。这四味药都是辛温行阳的药物，能使血液回归经脉，遵循正常的通道运行，血液自然停止，所以吐血不止，用柏叶汤主治。
【按】“心气不足”这四个字，应当是“心气有余”四个字，如果是不足，怎么能用这个方子治疗呢？一定是传抄的错误。
【注】心气有余，即热盛，热盛损伤阳络，逼迫血液妄行，导致吐血、鼻衄。所以用大黄、黄连、黄芩这三味大苦大寒的药物，直接泻除三焦的热邪，热去则吐衄自止。
泻心汤方
大黄（二两）、黄连、黄芩（各一两）
以上三味药，用水三升，煮取药液一升，一次性顿服。
病人胸部胀满，口唇枯萎，舌质青紫，口干想漱口但不想咽下，没有恶寒发热，脉象微大来势迟缓，腹部并不胀满，但病人自己说觉得胀满，这是有瘀血的表现。
【注】表实无汗，胸满气喘的，是风寒引起的胸满；里实便秘，胸满烦热的，是热壅引起的胸满；面目浮肿，胸满喘促不能平卧的，是水饮停聚引起的胸满；呼吸不畅，胸满喜欢叹气后稍觉宽舒的，是气滞引起的胸满。现在病人没有寒热等其他疾病，只有胸满、口唇枯萎、舌质青紫、口干想漱口但不想咽下，这是瘀血引起的胸满。嘴唇和舌头是血液荣华之处，血病不能荣养，所以出现枯萎变色。热在血分，所以口干想漱口但不想咽下。脉象微大来势迟缓，是阴凝的脉象，通常应当腹满，现在腹部不胀满，询问病人，他说觉得胀满是在胸部或腹部，结合上述症状推断，是有瘀血。
病人好像有热证的样子，心烦胀满，口干燥而渴，但脉象反而没有热象，这是热伏于阴分，属于瘀血。应当用攻下法治疗。
【注】这是承接上文详细辨析证候和脉象，以明确治疗方法。如热状，就是指前面所说的心烦胸满、口干燥渴的热证。这种人应当得到数大的阳脉，现在反而见到沉伏的阴脉，这是热伏于阴分，属于瘀血。血瘀者应当用攻下法，适宜用桃核承气汤、抵当汤丸之类的方剂。
【集注】李 说：血瘀内部没有实热，所以外在症状只是像热证，但脉象不数疾，反而没有热象。烦满是血瘀导致经气不舒畅；燥渴是血瘀导致津液不能布散。血属阴，瘀滞则脉伏于内，所以称为阴伏。应当用攻下法，以去除瘀血、产生新血。
便血，先排便后出血的，这是远血，用黄土汤主治。便血，先出血后排便的，这是近血，用赤小豆当归散主治。
【注】先便后血，这是远血，说明血在胃部，也就是古时候所说的结阴，现在的所谓便血。先血后便，这是近血，说明血在肠道，也就是古时候所说的肠澼、痔疮下血，现在的所谓脏毒、肠风下血。一种用黄土汤治疗结阴之血，性质偏温；一种用赤小豆当归散治疗脏毒之血，性质偏清。
【集注】赵良说：肠胃属于阳明经。以下血来说，胃位于大肠之上，如果血积聚在胃，必定是先便后血，距离肛门远，所以叫远血；如果积聚在大肠，距离肛门近，所以叫近血。所以治疗远血用黄土汤主治，治疗近血用赤小豆当归散主治。
黄土汤方
甘草、干地黄、白术、附子（炮制）、阿胶、黄芩（各三两）、灶心黄土（半斤）
以上七味药，用水八升，煮取药液三升，分两次温服。
寸口脉弦而大，弦脉表示阳气衰减，大脉表示中空如芤；衰减则为寒，中空则为虚。寒与虚相互搏击，这种脉象叫做革脉。妇女出现革脉则会半产（流产）或漏下（崩漏），男子出现革脉则会亡血。
【注】详见《伤寒论·辨脉篇》内，不再解释。
因火邪致病者，用桂枝去芍药加蜀漆牡蛎龙骨救逆汤主治。
【按】这个方子是治疗火逆导致惊狂的，与第一条提到的脉动惊病不合，一定是简册错乱。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤方
桂枝（三两）、甘草（炙，二两）、生姜（三两）、牡蛎（熬，五两）、龙骨（四两）、大枣（十二枚）、蜀漆（洗去腥味，三两）
以上药物研为末，用水一斗二升，先煮蜀漆，减少一升水，再加入其他药物，煮取三升，温服一升。
The pulse at the cunkou (radial artery) is both moving and weak. A "moving" pulse indicates fright, while a "weak" pulse indicates palpitations.
[Annotation] Cunkou refers generally to the three positions: Cun, Guan, and Chi. A pulse that is moving and weak indicates the disease of fright and palpitations. "Moving indicates fright" because fright arises from external stimulation causing agitation; "weak indicates palpitations" because palpitations arise from internal deficiency causing timidity.
[Collected Annotations] Xu Bin stated: Fright is caused by external pathogens invading the heart, hence the cunkou pulse manifests as moving. "Moving" means the pulse comes and goes in a chaotic, agitated manner. Palpitations are characterized by the spirit losing its autonomy, hence the cunkou pulse manifests as weak. "Weak" means the pulse is deep and forceless. The reason pathogens can invade is due to heart deficiency, so fright and palpitations often appear together.
Li stated: Here, cunkou pulse refers to all three positions. Generally, fright comes from outside; fright causes qi chaos, hence the pulse moves and is restless. Palpitations stem from internal fear; palpitations are due to middle jiao deficiency, hence the pulse is weak and forceless.
The Master said: If the pulse is floating, and there is yellow discoloration around the eyeballs, nasal bleeding has not yet stopped. If the yellow discoloration disappears and the eyes become clear, it is known that the nasal bleeding has now stopped.
[Annotation] A floating pulse indicates Yang and exterior conditions. If the eyes are clear, it indicates an exterior Yang disease; if there is yellow discoloration around the eyes, it indicates blood vessel disease. Since all collaterals connect to the eyes, heat in the blood causes redness, and blood stasis causes yellowing. Now, with yellow discoloration around the eyes, we know nasal bleeding has not stopped; if the yellow discoloration disappears and the eyes become clear, we know nasal bleeding has stopped. Thus it is said: "Nasal bleeding has now stopped."
It is also said: Nasal bleeding occurring from spring to summer belongs to the Taiyang channel; nasal bleeding occurring from autumn to winter belongs to the Yangming channel.
[Annotation] Nasal bleeding is injury to the Yang collaterals; lower body bleeding is injury to the Yin collaterals.
Taiyang governs the exterior, and spring/summer govern the exterior; thus, nasal bleeding from spring to summer belongs to Taiyang. Yangming governs the interior, and autumn/winter govern the interior; thus, nasal bleeding from autumn to winter belongs to Yangming.
[Collected Annotations] Li stated: Nasal bleeding originates from the nose. The Hand-Taiyang channel ascends to below the nose; the Foot-Taiyang channel enters the brain from the vertex, connecting the nose and brain; the Hand-Yangming channel flanks the nostrils; the Foot-Yangming channel begins at the nose and crosses the forehead. These four channels all traverse the nose, so they can all cause nasal bleeding. Taiyang runs on the surface of the body; the Classics say: "Taiyang is the opening." This corresponds to spring birth and summer growth, where Yang Qi is external, having the meaning of opening. Hence, spring/summer nasal bleeding belongs to Taiyang. Yangming runs inside the body; the Classics say: "Yangming is the closing." This corresponds to autumn gathering and winter storing, where Yang Qi is internal, having the meaning of storage. Hence, autumn/winter nasal bleeding belongs to Yangming.
You Yi stated: The Shaoyang channel does not enter the nose or forehead, so it does not primarily govern nasal bleeding.
Patients prone to frequent nasal bleeding should not undergo sweating therapy. If sweating occurs, it will inevitably lead to depression of the vessels in the temples, tight and urgent pulse, staring gaze, inability to close the eyelids, and insomnia.
[Annotation] "Nu" here includes hematemesis. In patients prone to nasal bleeding or vomiting blood, Yin fluids have already been depleted. If sweating is induced, sweat loss leads to fluid exhaustion, and the vessels lose nourishment. The vessels in the depressed area of the temples will be scorched by heat, becoming tight and urgent. Staring gaze refers to eyes fixed without movement. Inability to close the eyelids is also caused by heat scorching the vessels, leading to contraction. Insomnia occurs because Yang Qi cannot enter Yin. All these conditions are critical signs of excess Yang and deficient Yin; therefore, patients prone to nasal bleeding must absolutely avoid sweating therapy.
[Collected Annotations] Zhao Liang stated: The Foot-Taiyang channel governs the exterior, ascending to the vertex and forehead, passing through the eyes. Nasal bleeding indicates that blood in the upper collaterals has already escaped. Further sweating would further deplete fluids. When fluids are exhausted, vessels wither, causing the vessels in the temple depression to become tight and urgent, pulling on the eyes, making eyelid closure difficult. Blood loss leads to Yin deficiency, causing insomnia.
If a patient's face lacks color (is pale), without chills or fever, and the pulse is deep and wiry, it indicates nasal bleeding; if the pulse is floating and weak, feeling absent upon heavy pressure, it indicates lower body bleeding; if accompanied by irritability and cough, hematemesis will certainly occur.
[Note] The text "pulse deep" should likely be "pulse floating"; "pulse floating" should be "pulse deep," for the logic to hold. This is likely a transcription error.
[Annotation] Red is the color of blood. "Face lacking color" means the face is purely white without redness, or purely yellow without redness. Fear causes the face to turn pale with a startled expression; shame causes the face to alternate between pale and red with a timid expression. Now, with unexplained pallor, it is known that this is not due to qi chaos and blood dispersion from fright or shame. Moreover, without chills or fever, it is known that this is not due to deficiency failing to generate blood. Since it is neither blood dispersion nor blood shortage, one must ask the patient; there must be a cause for blood loss. Examining the pulse, there must be a cause such as vomiting blood, nasal bleeding, or lower body bleeding. Vomiting and nasal bleeding belong to Yang, so the pulse appears floating and wiry, feeling hollow (Kou pulse) upon pressure, indicating empty Ying blood. Lower body bleeding belongs to Yin, so the pulse appears deep and weak, feeling nearly absent upon pressure, indicating faint Ying Qi. Furthermore, with such pulse and facial signs, and symptoms including irritability and cough, the disease is in the Heart and Lungs, so hematemesis will certainly occur.
In cases of hematemesis, with cough, rebellious Qi, upward rushing Qi, rapid pulse, heat sensation, and inability to lie down, the prognosis is fatal.
[Annotation] Hematemesis with cough and rebellious Qi indicates severe lung damage; upward rushing Qi indicates failure of Lung Qi to descend; rapid pulse with heat indicates fire scorching Lung Metal; inability to lie down indicates Yang cannot enter Yin, hence death.
[Collected Annotations] Zhao Liang stated: Rapid pulse with heat indicates excessive Yang alone; inability to lie down indicates absolute Yin depletion. If Yin is depleted, how can Yang survive alone? Hence, death. If the patient can lie down, Yin is not depleted, and death cannot yet be declared.
Cheng Lin stated: Hematemesis, cough, rebellious Qi, and upward rushing Qi indicate lung injury. A rapid pulse indicates lingering deficiency heat, with fire attacking Metal. As Yin blood is consumed, inability to lie down ensues, making death inevitable.
For wine drinkers who develop cough, hematemesis will inevitably result; this is caused by excessive drinking.
[Annotation] Wine nature is greatly hot, damaging vessels and meridians. Excessive drinking inevitably leads to cough and hematemesis.
[Collected Annotations] Xu Bin stated: This hematemesis is not necessarily due to Qi failing to control blood, nor due to blazing Yin fire. If a wine drinker develops cough, the lungs are extremely injured. The impact of coughing will inevitably cause hematemesis, hence it is said to be caused by excessive drinking. Therefore, treatment should focus on clearing wine-heat.
Patients with blood loss should not undergo exterior-releasing sweating therapy. If sweating occurs, it will lead to chills and tremors.
[Annotation] After blood loss, when Qi and Blood have not recovered, it is called blood loss; sweating must not be induced. Initially, blood loss may involve Yang heat, but after blood loss, heat leaves with the blood. Although heat subsides, Qi becomes deficient following blood loss, and Yang also becomes weak. If sweating is induced, Yang Qi becomes severely deficient and unable to support the body, leading to cold chills and trembling. Inducing sweat in Yin deficiency leads to Yin collapse (similar to inducing sweat in vomiting/nasal bleeding), resulting in symptoms like inability to close eyelids and insomnia, which are signs of Yin collapse. Inducing sweat in Yang deficiency leads to Yang collapse (similar to inducing sweat in blood loss), resulting in chills and trembling, which are signs of Yang collapse.
[Collected Annotations] Li stated: Those who have lost blood do not sweat, because sweat and blood both belong to Heart fluids. When blood is lost and fluids are exhausted, no residual fluid remains to form sweat. Using exterior-releasing drugs now causes both Yin and Yang collapse. Wei Qi on the exterior becomes extremely deficient, leading to chills and trembling.
For continuous hematemesis, Bo Ye Tang (Cinnabar Leaf Decoction) is the primary formula.
[Annotation] For hematemesis caused by heat injuring Yang collaterals, heat should be cleared; for damage due to overwork, the injury should be regulated. Using Bo Ye Tang, a warming and dispersing formula, for continuous hematemesis implies that heat is concealed in the Yin division. This formula promotes dispersal, allowing heat to move to the Yang division, so blood is not forced by heat and stops naturally.
Bo Ye Tang Formula
Ce Bai Ye (Platycladi Cacumen), Gan Jiang (Dried Ginger) [each 3 liang], Ai Ye (Mugwort Leaf) [3 bundles]
These three ingredients are boiled with 5 sheng of water and 1 sheng of Ma Tong Zhi (Horse Manure Juice), reducing to 1 sheng. Divide into two warm doses.
[Collected Annotation] Cheng Lin stated: *Shennong Bencao Jing* records: Ce Bai Ye treats hematemesis; Gan Jiang stops spitting blood; Ai Ye stops vomiting blood. Ma Tong is white horse urine. Urine must pass through the intestines to exit, hence "Tong" (through); it is slightly warm and stops hematemesis. All four ingredients are acrid-warm and promote Yang, guiding blood back to the vessels and normal pathways, stopping bleeding. Hence, for continuous hematemesis, Bo Ye Tang is used.
For "Heart Qi Deficiency" (likely "Excess") manifesting as hematemesis and nasal bleeding, Xie Xin Tang (Drain the Epigastrium Decoction) is the primary formula.
[Note] The phrase "Heart Qi Deficiency" should likely be "Heart Qi Excess." If it were deficiency, this formula would not be applicable. This is likely a transcription error.
[Annotation] Heart Qi Excess means Heat Excess. Excessive heat injures Yang collaterals, forcing blood to move recklessly, causing hematemesis and nasal bleeding. Therefore, Da Huang (Rhubarb Root), Huang Lian (Coptis Rhizome), and Huang Qin (Scutellaria Root) are used—three bitter-cold herbs—to directly drain Heat from the Three Jiao. Once heat is removed, vomiting and nasal bleeding stop spontaneously.
Xie Xin Tang Formula
Da Huang (2 liang), Huang Lian, Huang Qin [each 1 liang]
These three ingredients are boiled with 3 sheng of water, reducing to 1 sheng. Take in one dose.
A patient presents with chest fullness, withered lips, blue tongue, dry mouth desiring to rinse with water but not swallow, absence of chills or fever, a pulse that is slightly large but slow in return, and abdominal distension reported by the patient despite no visible abdominal swelling. This indicates Blood Stasis.
[Annotation] Exterior excess with no sweat and chest fullness with wheezing indicates Wind-Cold chest fullness. Interior excess with constipation, chest fullness, and irritability indicates Heat obstruction chest fullness. Facial edema, chest fullness, wheezing, and inability to lie flat indicate Fluid Retention chest fullness. Uncomfortable breathing, chest fullness relieved by sighing indicates Qi Stagnation chest fullness. Now, the patient has no chills, fever, or other diseases, only chest fullness, withered lips, blue tongue, and dry mouth desiring to rinse but not swallow. This is Chest Fullness due to Blood Stasis. Lips and tongue are where Blood flourishes; Blood disease fails to nourish, causing withering and color change. Heat in the Blood division causes dry mouth desiring to rinse but not swallow. A pulse that is slightly large but slow indicates Yin coagulation, which usually accompanies abdominal fullness. However, the abdomen is not full; asking the patient reveals the sensation of fullness is in the chest or abdomen. Inferring from these symptoms, there is Blood Stasis.
A patient presents with symptoms resembling heat, irritability, fullness, dry mouth, and thirst, but the pulse shows no heat signs. This is Heat Concealed in Yin, indicating Blood Stasis. It should be treated with purgation.
[Annotation] This elaborates on the previous text regarding symptoms and pulse to clarify treatment. "Resembling heat" refers to the heat symptoms mentioned earlier: irritability, chest fullness, dry mouth, and thirst. Such a patient should have a rapid and large Yang pulse, but instead presents with a deep and hidden Yin pulse. This indicates Heat concealed in Yin, which is Blood Stasis. For Blood Stasis, purgation is indicated, suitable formulas include Tao He Cheng Qi Tang or Di Dang Tang/Wan.
[Collected Annotations] Li stated: Internal Blood Stasis without Excess Heat means external symptoms resemble heat, but the pulse is not rapid, showing no heat signs. Irritability and fullness are due to Blood Stasis obstructing Jing Qi flow; dryness and thirst are due to Blood Stasis preventing Jin-Ye distribution. Blood belongs to Yin; stasis causes the pulse to hide internally, hence "Yin Concealment." Purgation should be used to remove stasis and generate new blood.
For lower body bleeding, if stool precedes blood, this is Remote Bleeding, treated with Huang Tu Tang (Yellow Earth Decoction). If blood precedes stool, this is Close Bleeding, treated by Chi Xiao Dou Dang Gui San (Adzuki Bean and Angelica Decoctio).
[Annotation] Stool preceding blood is Remote Bleeding, indicating blood in the stomach, formerly called Jie Yin, now known as hematochezia. Blood preceding stool is Close Bleeding, indicating blood in the intestines, formerly called Chang Pi or hemorrhoidal bleeding, now known as Zang Du or Chang Feng lower bleeding. One uses Huang Tu Tang to treat Jie Yin blood, which is warming; the other uses Chi Xiao Dou Dang Gui San to treat Zang Du blood, which is clearing.
[Collected Annotations] Zhao Liang stated: The intestines and stomach belong to the Yangming channels. Regarding lower bleeding, the stomach is above the large intestine. If blood accumulates in the stomach, stool will precede blood; being far from the anus, it is called Remote Bleeding. If it accumulates in the large intestine, being close to the anus, it is called Close Bleeding. Thus, Huang Tu Tang treats Remote Bleeding, and Chi Xiao Dou Dang Gui San treats Close Bleeding.
Huang Tu Tang Formula
Gan Cao (Licorice Root), Gan Di Huang (Rehmannia Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Zi (Prepared Aconite Root), E Jiao (Donkey-Hide Gelatin), Huang Qin (Scutellaria Root) [each 3 liang], Zao Zhong Huang Tu (Furnace Hearth Earth) [0.5 jin]
These seven ingredients are boiled with 8 sheng of water, reducing to 3 sheng. Divide into two warm doses.
Chi Xiao Dou Dang Gui San Formula (See Huo Huo Disease Chapter)
The pulse at cunkou is wiry and large. Wiry indicates reduction (deficiency); large indicates Kou (hollow). Reduction indicates Cold; Hollow indicates Deficiency. Cold and Deficiency striking each other is named Ge Pulse (Leather Pulse). In women, this indicates spontaneous abortion or metrorrhagia; in men, it indicates blood loss.
[Annotation] See detailed explanation in *Shang Han Lun · Bian Mai Pian*; no further explanation provided here.
For disease caused by Fire Pathogen, Gui Zhi Qu Shao Yao Jia Shu Xi Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bud, Oyster Shell, and Dragon Bone to Save from Emergency) is the primary formula.
[Note] This formula treats Fire Reversal causing fright and mania, which does not match the first line's pulse-moving fright disease. This is likely a misplaced bamboo slip.
Gui Zhi Qu Shao Yao Jia Shu Xi Mu Li Long Gu Jiu Ni Tang Formula
Gui Zhi (Cinnamon Twig) [3 liang], Zhi Gan Cao (Honey-fried Licorice Root) [2 liang], Sheng Jiang (Fresh Ginger) [3 liang], Mu Li (Oyster Shell, calcined) [5 liang], Long Gu (Dragon Bone) [4 liang], Da Zao (Jujube) [12 pieces], Shu Xi (Chinese Tallow Tree Bud, washed to remove fishy odor) [3 liang]
Grind into powder. Boil with 12 sheng of water. First boil Shu Xi, reduce by 1 sheng, then add other herbs. Boil to 3 sheng. Take 1 sheng warm.
For epigastric palpitations, Ban Xia Ma Huang Wan (Pinellia and Ephedra Pill) is the primary formula.
[Note] This formula treats cold-fluid harassing the heart causing palpitations, which does not match the first line's pulse-weak palpitation disease. This is likely a misplaced bamboo slip.
Ban Xia Ma Huang Wan Formula
Ban Xia (Pinellia Tuber), Ma Huang (Ephedra Stem) [equal parts]
Grind into fine powder, mix with refined honey to make pills, size of adzuki beans. Take 3 pills with water, three times daily.