〔万〕气为阳，血为阴，阳主动，阴主静，人身之血，不可妄动也。经曰∶阳络伤则血外溢，血外溢则衄血，
阴络伤则血内溢，血内溢则后血。今疮疹之火熏灼于里，迫血妄行，血亦随火而动，阳络伤则血从上焦出，
或衄血，或呕血。阴络伤则血从下焦出，或溺血，或便血。阴阳俱伤则血上下出也。诸失血惟从鼻出者，或有
可治之理，其余皆死证也。亦有痘疮灌烂，不能收较，出血不止者，此阳疮出血，
亦不可治。〔张〕所云血之妄行，从口、从大小便、从阳疮，或痘毒而出者，悉
皆不治，盖指出之多而不止者言之耳，若初出之时，苟详推其因而善为清理，岂俱无生者耶。若痘疮赤痛，烦热
作渴，或便血、或衄血，先用犀角地黄汤（失血）。次用加减大紫草散（痘灰白）去黄 加木通主之。吴氏治诸失血，
始终用犀角地黄汤加山栀、芩、连、白芍药，有初出时衄血不止，用下药而得效者。〔薛〕一小儿痘后，非衄血，
即便血，痘痕赤白靡定，手指冷热无常。余谓此元气虚，而无根之火，倏往忽来也。朝用补中益气汤，夕用五味异
功散，各二十余剂而愈。后因劳心复发，仍用前二药为主，佐以十全大补汤而愈。
犀角地黄汤 治痘疹并麻疹与衄血便血者可服。
牡丹皮 犀角 赤芍药 生地黄
热盛者，加酒炒黄连。若有瘀血停胸，加醋制大黄。若口鼻出血，加大蓟茅
根。若小便去血，去大黄、加小蓟，水煎服。
二宝散 治痘紫色，发热鼻衄，小便如血，口渴乱语。
犀角 玳瑁
二味磨汁，顿服，即愈。
【衄血吐血】〔薛〕《痘疹方》云∶若痘发之际，正宜微见，与发汗同体，然血与汗虽殊，其源则一，盖痘疹
乃秽血所发，邪结肺胃，毒瓦斯自然上越也。若见此证，不可妄投以药，恐治失其宜，瘀蓄者不出，而已出者复伤，
反生变证也。若作渴饮冷，手足并热，此毒瓦斯炽盛，而血上溢也，宜用《圣济》犀角地黄汤。若肺经热毒
而鼻衄，用地黄清肺饮。胃经热毒而吐血，亦用《圣济》犀角地黄汤。若肠胃热毒而便血，亦用之。作渴饮汤，手
足不热者，脾肺气虚不能摄血而妄行也，宜用五味异功散。若出血作渴烦躁，面赤色者，血脱也，宜用当归补血汤。
一小儿衄血，上寸脉数。此肺金有火也。用泻白散而血止，但四肢倦怠，用益气汤而愈。一小儿痘
疮赤色，吐血发热。此胃经热毒也。先用《圣济》犀角地黄汤，诸证渐愈，又用五味异功散而痊。〔万〕疮疹发热失血，
皆非佳候，但从鼻出者，此火刑于肺，鼻为肺之窍，宜泻火凉血清肺，以玄参地黄汤调郁金末、加茅根汁、磨京墨
汁饮之，衄止者佳，一向不止者，不治。
玄参 地黄汤
玄参 生地黄 牡丹皮 栀子仁（各一钱半） 甘草 升麻（各半钱） 白芍药（一钱）
上锉细。加炒蒲黄半钱，水一盏，煎七分，去滓，温服。
斩关散 痘紫发热，鼻红不止。
生地黄 牡丹皮 黄芩（各五分） 升麻（三分） 藕节 茅根（各一钱） 绿豆（四十九粒）
上，水煎服。
【便血】凡痘子大便出血者，看其血来何如，又看是何时，如疮子正壮，大便数日未行，血从粪出者，此
肛门伤血出也。如疮已收，大便脓血者，此倒靥之血也。非此二类，但溺血便血者，乃脏腑败坏，阴血妄行，必
死之候。〔薛〕闻人氏云∶痘疹大便下血或黑粪，若睡而不醒，是为恶候，乃内热盛也，用犀角地黄汤、抱龙
丸、小柴胡汤加生地黄主之。窃谓前证若寒热作渴，小柴胡加生地黄。发热体倦，用五味异功散加当归。口干作
渴，用人参白术散。大凡作渴引饮发热者属实热，作渴饮汤手足不热者属虚热，手足逆冷者属虚寒，治者审之。
一小儿痘疮下血，且不起发。先君谓气血不足。用紫草快 汤加参、 、归、术，血顿止，疮顿起，用八
珍汤而愈。一小儿痘疮下血，小便赤色，疮色如赭，发热饮冷，二便不利。先君谓心小肠实热。用八正散，后用
解毒防风汤（痘证治大法）及饮芹菜汁、而痊。一小儿痘将愈而便血，面白恶寒，大便欲去而不去。余谓此元气
虚而下陷也。用益气汤。不信，服凉血之剂，致吐泻腹痛而殁。一小儿痘将愈，患便血，面白恶寒，手足并冷，脉
沉细如无。余谓阳气虚寒，欲用人参、姜、桂。不从，翌日而死，手足青黑，惜哉。一小儿出痘三四日，大便下
血，日有数滴，至八日不能
起。御医钱春林谓其脾气虚寒。用木香散二剂，加丁香十一粒、人参五钱，次日痘起有脓，由是血止，二十余日而愈。
【溺血】〔袁〕痘两三日而小便溺血者，名为沁砂红，盖因枭毒辏于心，心失其主，而血随毒激，故奔散而
妄驰，心通小肠，注于膀胱而溺血也，或如黑豆汁，或如苏木水，痛者易治，不痛者难治。
主方
木通 生地黄 黄 赤芍药 犀角 地榆 升麻 紫草 车前叶（多用） 灯草
水煎服。痛，加甘草稍、滑石、山栀。
余治此痘，要在于清心解毒，使阴血总归于荣，升麻黄 ，贵宜详察而投，不可执方以害人也。若便如黑
豆汁者，毒已冲心而荣元已离，十亡八九，致有小便涩，留结血条如绵线寸长，欲尿则号哭，痛不可忍者，
急用炒山栀末、青龙须草汁调服，再以木通汤饮之，可也。
【 裂出血】〔薛〕闻人氏云∶痘疮大便不通，小便如血，或结痈毒，身痘破裂，乃内火炽盛，失于解利，急
用犀角地黄汤、小柴胡汤加生地黄、四顺饮之类治之。窃谓前证若心脾热盛，用犀角地黄汤。心肝热盛，用小柴胡
汤加生地黄。若大便不通，先用四顺饮，次用犀角汤。苦色赤 痛，二便不通，急用活命饮加硝黄。若色
赤痛，恶寒发热，用活命饮加麻黄。若因乳母怒火，用加味逍遥散、加味归脾汤。
【万全论述】气属阳，血属阴，阳主动，阴主静，人体内的血液不可妄动。《内经》说：阳络（分布于体表上部的络脉）受伤则血液外溢，血液外溢则出现鼻衄；阴络（分布于体内下部的络脉）受伤则血液内溢，血液内溢则出现便血。如今疮疹之火在体内熏灼，逼迫血液妄行，血液也随着火势而动荡，阳络受伤则血液从上焦排出，或表现为鼻衄，或表现为呕血。阴络受伤则血液从下焦排出，或表现为尿血，或表现为便血。如果阴阳之络都受伤，则血液上下同时排出。各种失血中只有从鼻子出血的，或许还有可治的道理，其余的都是死证。也有痘疮溃烂，不能结痂收敛，出血不止的，这是阳证疮疡出血，也不可治愈。
【张景岳论述】所说的血液妄行，从口、大小便、阳证疮疡或痘毒而出的，都属于不治之症，这指的是出血多且不止的情况而言。如果在初起之时，仔细推究病因并妥善清理治疗，难道就没有能存活的人吗？如果痘疮红赤疼痛，烦热作渴，或便血、或鼻衄，先用犀角地黄汤（用于失血）。接着用加减大紫草散（用于痘色灰白）去掉黄连加入木通来主治。吴氏治疗各种失血，始终使用犀角地黄汤加上山栀、黄芩、黄连、白芍药，有初起时鼻衄不止，使用泻下药而见效的案例。
【薛己论述】一个小孩出痘后，不是鼻衄，就是便血，痘痕颜色红白不定，手指冷热无常。我认为这是元气虚弱，无根之火忽来忽去所致。早晨服用补中益气汤，晚上服用五味异功散，各服二十多剂后痊愈。后来因为劳心导致复发，仍然以前两种药为主，辅以十全大补汤而痊愈。
犀角地黄汤 治疗痘疹及麻疹伴有鼻衄、便血者可服用。
牡丹皮 犀角 赤芍药 生地黄
热盛者，加酒炒黄连。若有瘀血停滞胸中，加醋制大黄。若口鼻出血，加大蓟、白茅根。若小便出血，去掉大黄，加小蓟，水煎服。
二宝散 治疗痘色紫暗，发热鼻衄，小便如血，口渴胡言乱语。
犀角 玳瑁
将这两味药磨成汁，一次性服下，即可痊愈。
【衄血吐血】
【薛己论述】《痘疹方》说：在痘疹发出之际，正宜微微透出，这与发汗的原理相同，虽然血与汗不同，但它们的源头一致，因为痘疹是秽浊之血所发，邪气结聚于肺胃，毒气自然向上越出。如果出现这种症状，不可胡乱投药，恐怕治疗不当，导致未出的瘀滞无法排出，已出的又受损伤，反而产生变证。如果口渴想喝冷水，手足都热，这是毒气炽盛，血液上溢，适宜使用《圣济总录》中的犀角地黄汤。如果是肺经热毒导致的鼻衄，用地黄清肺饮。胃经热毒导致的吐血，也使用《圣济总录》中的犀角地黄汤。如果是肠胃热毒导致的便血，也使用此方。如果口渴想喝热水，手足不热，这是脾肺气虚不能统摄血液而妄行，适宜使用五味异功散。如果出血伴口渴烦躁，面色红润，这是血脱，适宜使用当归补血汤。
有一个小孩鼻衄，寸脉数。这是肺金有火。使用泻白散使血止，但四肢倦怠，使用益气汤而痊愈。
有一个小孩痘疮颜色红赤，吐血发热。这是胃经热毒。先用《圣济总录》中的犀角地黄汤，诸证逐渐痊愈，又用五味异功散而康复。
【万全论述】疮疹发热导致失血，都不是好征兆，但从鼻子出血的，这是火刑克肺，鼻为肺之窍，适宜泻火凉血清肺，用玄参地黄汤调服郁金末、加入茅根汁、磨京墨汁饮用，鼻衄停止为佳，一直不止的，不可治愈。
玄参地黄汤
玄参 生地黄 牡丹皮 栀子仁（各一钱半） 甘草 升麻（各半钱） 白芍药（一钱）
以上药材切碎细末。加入炒蒲黄半钱，水一盏，煎至七分，去渣，温服。
斩关散 治疗痘色紫暗发热，鼻红出血不止。
生地黄 牡丹皮 黄芩（各五分） 升麻（三分） 藕节 茅根（各一钱） 绿豆（四十九粒）
以上药材，水煎服。
【便血】凡是痘子大便出血的，要看血的情况，又要看是什么时候。如果痘疮正旺盛，大便数日未行，血从粪便中排出，这是肛门受伤出血。如果痘疮已经收靥，大便脓血，这是倒靥（痘疮内陷）的血。如果不是这两类，只要是尿血便血，都是脏腑败坏，阴血妄行，必死的征候。
【薛己论述】闻人氏说：痘疹大便下血或黑粪，如果睡而不醒，这是恶候，是内热盛，用犀角地黄汤、抱龙丸、小柴胡汤加生地黄主治。我私下认为前述症状如果寒热交替作渴，用小柴胡汤加生地黄。发热体倦，用五味异功散加当归。口干作渴，用人参白术散。大凡口渴引饮发热者属实热，口渴想喝热水手足不热者属虚热，手足逆冷者属虚寒，医者需审慎辨别。
有一个小孩痘疮下血，且不起发。先父认为是气血不足。用紫草快斑汤加人参、茯苓、当归、白术，血顿时止住，痘疮顿时起发，用八珍汤而痊愈。
有一个小孩痘疮下血，小便赤色，痘色像赭石色，发热饮冷，二便不利。先父认为是心与小肠实热。用八正散，后用解毒防风汤（痘证治大法）及饮用芹菜汁，而痊愈。
有一个小孩痘将愈而便血，面白恶寒，大便欲解而不得。我认为是元气虚而下陷。用益气汤。家属不信，服用凉血药剂，导致吐泻腹痛而死。
有一个小孩痘将愈，患便血，面白恶寒，手足皆冷，脉沉细如无。我认为是阳气虚寒，想用参、姜、桂。家属不从，次日死亡，手足青黑，可惜啊。
有一个小孩出痘三四天，大便下血，每天有几滴，到第八天不能起发。御医钱春林认为是脾气虚寒。用木香散两剂，加丁香十一粒、人参五钱，次日痘起有脓，由此血止，二十多天而痊愈。
【溺血】
【袁氏论述】痘疹两三天而小便溺血的，名为沁砂红，这是因为枭毒汇聚于心，心失去主宰，血液随毒气激荡，所以奔散妄行，心通小肠，注入膀胱而溺血，或者像黑豆汁，或者像苏木水，痛的容易治，不痛难治。
主方
木通 生地黄 黄芪 赤芍药 犀角 地榆 升麻 紫草 车前叶（多用） 灯心草
水煎服。痛，加甘草梢、滑石、山栀。
我治疗这种痘疹，关键在于清心解毒，使阴血总归于营分，升麻和黄芪，贵在详细察辨后投药，不可拘泥于方剂害人。如果小便像黑豆汁，说明毒已冲心而营元已离，十死八九，致使小便涩滞，留结血条如棉线寸长，想尿则号哭，痛不可忍，急用炒山栀末、青龙须草汁调服，再用木通汤饮用，可以。
【肛裂出血】
【薛己论述】闻人氏说：痘疮大便不通，小便如血，或结痈毒，身体痘疮破裂，是内火炽盛，失于疏解利导，急用犀角地黄汤、小柴胡汤加生地黄、四顺饮之类治疗。我私下认为前述症状如果心脾热盛，用犀角地黄汤。心肝热盛，用小柴胡汤加生地黄。如果大便不通，先用四顺饮，次用犀角汤。如果苦色赤痛，二便不通，急用活命饮加硝黄。如果色赤痛，恶寒发热，用活命饮加麻黄。如果因乳母怒火引起，用加味逍遥散、加味归脾汤。
[Wan] Qi belongs to Yang, Blood belongs to Yin; Yang governs movement, and Yin governs stillness. The blood in the human body must not move recklessly. The Classics state: When the Yang collaterals (collateral vessels distributed on the exterior and upper parts of the body) are injured, blood overflows externally, resulting in epistaxis (nosebleed); when the Yin collaterals (collateral vessels distributed internally and in the lower parts) are injured, blood overflows internally, resulting in hematochezia (blood in stool). Currently, the fire from the pox-rash scorches within, forcing blood to move recklessly, and blood moves along with the fire. If Yang collaterals are injured, blood exits from the Upper Jiao, manifesting as either epistaxis or hematemesis (vomiting blood). If Yin collaterals are injured, blood exits from the Lower Jiao, manifesting as either hematuria (blood in urine) or hematochezia. If both Yin and Yang collaterals are injured, blood exits from both above and below. Among all types of hemorrhage, only those bleeding from the nose may have a chance of being treated; the rest are death syndromes. There are also cases where pockmarks ulcerate and cannot scab or contract, with continuous bleeding; this is hemorrhage from Yang sores, which is also incurable.
[Zhang] What is said about blood moving recklessly—exiting from the mouth, large or small intestines, Yang sores, or due to pox toxins—are all considered incurable, referring specifically to cases where bleeding is profuse and does not stop. However, if at the initial onset, one carefully deduces the cause and manages it properly, how could there be no survivors? If pockmarks are red and painful, accompanied by vexation, heat, thirst, hematochezia, or epistaxis, first use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for hemorrhage. Then use Jiajian Dazicao San (Modified Great Arneia Powder) for grayish-white pocks, removing Huanglian (Coptis Rhizome) and adding Mutong (Akebia Caulis). Wu treats various hemorrhages by consistently using Xijiao Dihuang Tang plus Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Lianzi (Nelumbinis Semen - *Note: Context implies Lianzi or similar clearing herb, but text says Lianzi/Lianzi usually refers to Lotus Seed, however in context of clearing heat often implies Huanglian or similar, sticking to literal translation of characters provided*), Baishaoyao (Paeoniae Radix Alba). There are cases where epistaxis at the beginning did not stop but responded to purgatives.
[Xue] A child after having pocks presented with either epistaxis or hematochezia. The pock scars were irregularly red and white, and the fingers alternated between cold and hot. I stated this was due to deficiency of Yuan Qi (Original Qi) and rootless fire coming and going suddenly. In the morning, administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); in the evening, administer Wuyi Yigong San (Five-Ingredient Powder for Extraordinary Merit). After taking more than twenty doses of each, the child recovered. Later, due to mental exertion, the condition recurred. Still using the previous two formulas as the main treatment, supplemented with Shiquan Dabu Tang (Ten Complete Tonifying Decoction), the child recovered.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction): Indicated for pocks-rashes and measles accompanied by epistaxis or hematochezia.
Mudanpi (Moutan Cortex), Xijiao (Rhinoceros Cornu), Chishaoyao (Red Paeonia Root), Shengdihuang (Raw Rehmannia Root).
For excessive heat, add Jiu Chao Huanglian (Wine-fried Coptis Rhizome). If there is stagnant blood in the chest, add Cu Zhi Dahuang (Vinegar-processed Rheum Rhizome). For oral or nasal bleeding, add Daji (Great Thistle Root) and Maogen (Imperata Rhizome). For hematuria, remove Dahuang and add Xiaojì (Herba Hieracii Japonici). Decoct in water and take warm.
Erbao San (Two-Treasure Powder): Indicated for purple pocks, fever, epistaxis, hematuria, thirst, and delirious speech.
Xijiao (Rhinoceros Cornu), Dai Mao (Trionyx Carapax).
Grind these two ingredients into juice and take in one dose; recovery will follow immediately.
[Epistaxis and Hematemesis]
[Xue] The "Pox-Rash Formula" states: At the time of pock eruption, it is appropriate for them to appear slightly, similar in principle to sweating. Although blood and sweat differ, their source is one. Pocks-rashes arise from turbid blood; pathogens knot in the Lung and Stomach, and toxic vapors naturally ascend. If this syndrome appears, do not blindly administer medicine, lest improper treatment prevent expelled stagnation from exiting and damage what has already exited, causing complications. If there is thirst for cold drinks and heat in hands and feet, this indicates blazing toxic vapors and overflowing blood; use Xijiao Dihuang Tang from the "Shengji Zonglu". If epistaxis is due to Lung Meridian heat-toxin, use Dihuang Qingfei Yin (Rehmannia Lung-Clearing Drink). If hematemesis is due to Stomach Meridian heat-toxin, also use Xijiao Dihuang Tang from the "Shengji Zonglu". If hematochezia is due to Intestine/Stomach heat-toxin, also use this formula. If thirst is for hot drinks and hands/feet are not hot, this is Spleen and Lung Qi deficiency failing to control blood, causing reckless movement; use Wuyi Yigong San. If bleeding is accompanied by thirst, vexation, and ruddy complexion, this is Blood depletion; use Danggui Buxue Tang (Angelica Tonify Blood Decoction).
One child had epistaxis with a rapid Cun pulse. This indicated Fire in Metal of the Lung. Use Xiebai San (Drain White Powder) to stop bleeding, but since limbs were listless, use Yiqi Tang (Qi-Augmenting Decoction) to recover.
One child had red pocks, hematemesis, and fever. This was Stomach Meridian heat-toxin. First use Xijiao Dihuang Tang from the "Shengji Zonglu"; as symptoms gradually improved, then use Wuyi Yigong San for cure.
[Wan] Fever and hemorrhage from pocks-rashes are not favorable signs. However, bleeding from the nose indicates Fire punishing the Lung; the nose is the opening of the Lung. It is suitable to drain fire, cool blood, and clear the Lung. Use Xuanshen Dihuang Tang (Scrophularia and Rehmannia Decoction) mixed with Yujin powder (Curcuma Rhizome), added with Maogen juice (Imperata Rhizome juice) and Jingmo juice (Beijing Ink stick juice) to drink. If epistaxis stops, it is good; if it continues indefinitely, it is incurable.
Xuanshen Dihuang Tang (Scrophularia and Rehmannia Decoction)
Xuanshen (Scrophulariae Radix), Shengdihuang (Raw Rehmannia Root), Mudanpi (Moutan Cortex), Zhiziren (Gardeniae Fructus) (each 1.5 qian), Gancao (Licorice Root), Shengma (Cimicifugae Rhizoma) (each 0.5 qian), Baishaoyao (White Peony Root) (1 qian).
Chop finely. Add Ban Chao Puhuang (Half qian of fried Typha Pollen), one cup of water, decoct to 70%, remove dregs, and take warm.
Zhan Guan San (Pass-the-Gate Powder): Indicated for purple pocks with fever and unceasing nasal bleeding.
Shengdihuang (Raw Rehmannia Root), Mudanpi (Moutan Cortex), Huangqin (Scutellariae Radix) (each 0.5 fen), Shengma (Cimicifugae Rhizoma) (0.3 fen), Ou jie (Lotus Rhizome Node), Maogen (Imperata Rhizome) (each 1 qian), Lüdou (Mung Bean) (49 grains).
Decoct in water and take.
[Hematochezia]
For children with blood in stool during pocks, observe the nature of the blood and the timing. If pocks are vigorous and stool has not passed for several days, with blood coming out with feces, this is injury to the anal region causing bleeding. If pocks have retracted and stool contains pus and blood, this is blood from Dao Ye (internal collapse/retraction of pocks). Apart from these two categories, any hematuria or hematochezia indicates deterioration of Zang-Fu organs and reckless movement of Yin blood, which is a fatal sign.
[Xue] Wenren stated: If pocks result in blood in stool or black stools, and the patient sleeps without waking, this is an ominous sign indicating excessive internal heat. Use Xijiao Dihuang Tang, Baolong Wan (Dragon-Holding Pill), and Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Shengdihuang. I privately believe that for the aforementioned symptoms, if there are alternating chills and fever with thirst, use Xiao Chaihu Tang plus Shengdihuang. If there is fever with fatigue, use Wuyi Yigong San plus Danggui (Angelica Sinensis). If there is dry mouth and thirst, use Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder). Generally, thirst with desire to drink and fever indicates Excess Heat; thirst for hot drinks without heat in hands/feet indicates Deficiency Heat; cold extremities indicate Deficiency Cold. Physicians must examine carefully.
One child had pocks with bleeding and failure to erupt. My father attributed this to insufficiency of Qi and Blood. Use Zicao Kuaiban Tang (Arneia Rapid-Eruption Decoction) plus Renshen (Ginseng), Fuling (Poria), Danggui (Angelica), Baizhu (Atractylodes). Bleeding stopped instantly, pocks erupted instantly, and Shizhen Tang (Eight Treasures Decoction) led to recovery.
One child had pocks with bleeding, red urine, pocks color like ochre, fever, desire for cold drinks, and difficulty in urination and defecation. My father attributed this to Excess Heat in Heart and Small Intestine. Use Bazheng San (Eight-Ingredient Powder for Rectification), followed by Jiedu Fangfeng Tang (Detoxifying and Saposhnikovia Decoction) and drinking Celery Juice for recovery.
One child had pocks nearing resolution but developed hematochezia, pale face, aversion to cold, and inability to pass stool despite urge. I attributed this to deficiency of Yuan Qi sinking downward. Use Yiqi Tang. The family did not believe me, administered cooling-blood agents, leading to vomiting, diarrhea, abdominal pain, and death.
One child had pocks nearing resolution but developed hematochezia, pale face, aversion to cold, cold hands and feet, and deep, fine pulse almost imperceptible. I attributed this to Yang Qi deficiency and cold, intending to use Renshen (Ginseng), Jiang (Ginger), Gui (Cinnamon Bark). The family refused. The next day the child died, with blue-black hands and feet. Alas.
One child had pocks for three to four days with a few drops of blood in stool daily, unable to erupt by the eighth day. Imperial Physician Qian Chunlin attributed this to Spleen Qi deficiency and cold. Use Muxiang San (Costus Powder) for two doses, plus 11 Dingxiang (Caryophylli Flos) and 5 qian Renshen (Ginseng). The next day pocks erupted with pus, bleeding stopped, and recovery occurred after twenty-plus days.
[Hematuria]
[Yuan] Hematuria appearing two to three days after pocks onset is named Qinsha Hong (Soaking Sand Red). This is because fierce toxins gather in the Heart, the Heart loses its mastery, and blood follows the toxin agitation, running wildly. The Heart connects to the Small Intestine, pouring into the Bladder causing hematuria. Urine may look like black bean juice or sappan wood water. If painful, it is easy to treat; if painless, difficult.
Main Formula
Mutong (Akebia Caulis), Shengdihuang (Raw Rehmannia Root), Huangqi (Astragali Radix), Chishaoyao (Red Paeonia Root), Xijiao (Rhinoceros Cornu), Diyu (Sanguisorbae Radix), Shengma (Cimicifugae Rhizoma), Zicao (Arnebiae Radix et Rhizoma), Cheqianye (Plantaginis Leaf) (use heavily), Dengcao (Junci Medulla).
Decoct in water. If painful, add Gancaosao (Licorice Root Tip), Huashi (Talcum), Zhizi (Gardeniae Fructus).
My treatment of this pock type focuses on clearing the Heart and resolving toxins, ensuring Yin blood returns to the Ying (Nutrient) level. Shengma and Huangqi should be used only after careful examination; do not rigidly adhere to a formula to harm people. If urine resembles black bean juice, toxins have rushed to the Heart and Ying origin has departed; eight or nine out of ten die. If there is urinary obstruction with blood clots like cotton threads an inch long, crying upon attempting to urinate, unbearable pain, urgently use Chao Zhizi powder (Fried Gardeniae Fructus) mixed with Qinglongxu Cao juice (Equisetum Hiemale Juice) to take, followed by Mutong Tang (Akebia Caulis Decoction).
[Anal Fissure Bleeding]
[Xue] Wenren stated: Constipation with pocks, urine like blood, abscess formation, or ruptured body pocks indicate blazing internal fire neglected by lack of resolution and drainage. Urgently use Xijiao Dihuang Tang, Xiao Chaihu Tang plus Shengdihuang, or Sishun Yin (Four-Smooth Drink). I privately believe: If Heart and Spleen heat is excessive, use Xijiao Dihuang Tang. If Heart and Liver heat is excessive, use Xiao Chaihu Tang plus Shengdihuang. If constipated, first use Sishun Yin, then Xijiao Tang. If bitter taste, red tongue, pain, and blockage of both bowels and urine, urgently use Liming Yin (Life-Saving Drink) plus Xiaofen (Mirabilite) and Dahuang (Rhubarb). If red tongue, pain, aversion to cold and fever, use Liming Yin plus Mahuang (Ephedra Herba). If caused by nursing mother's anger-fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction).