东垣云∶衄血出于肺，以犀角、升麻、栀子、黄芩、芍药、生地、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。如有寒者，干姜、肉桂之类主之。痰涎血者出于脾，
葛根、黄 、黄连、芍药、甘草、当归、沉香之类主之。呕血出于胃，实者犀角地
黄汤主之。虚者小建中汤加黄连主之。
海藏云∶胸中聚集之残火，腹里积久之太阴，上下隔绝，脉络部分，阴阳不通，
用苦热以定于中，使辛热以行于外，升以甘温，降以辛润，化严肃为春温，变凛冽为
和气，汗而愈也。然余毒土苴犹有存者，周身阳和尚未泰然，胸中微躁而思凉饮，
因食冷物服凉剂，阳气复消，余阴再作，脉退而小，弦细而迟，激而为衄血，唾血
者有之，心肺受邪也。下而为便血、溺血者有之，肾肝受邪也。三焦出血，色紫不
鲜，此重沓寒湿化毒，凝泣水谷道路，浸渍而成。若见血证，不详本源，便用凉折，
变乃生矣。阳证溢出鲜血。阴证下如豚肝。
上而血者，黄 桂枝汤，白芍当归汤。中而血者，当归建中汤，增损胃风汤。
下而血者，芎归术附汤，桂附六合汤。若三血证在行阳二十五度见，黄 四君子汤
主之。若三血证在行阴二十五度见，当归四逆加吴茱萸主之。
吐血、衄血、便血，其人阴虚阳走，其脉沉而散，其外证虚寒无热候，宜乌金
丸、散止之，法宜上用散，下用丸，次以木香理中汤和大七气汤，入川芎煎，调苏
合香丸温之。《仁斋直指》云∶血遇热则宣流，故止血多用凉药。然亦有气虚挟寒，
阴阳不相为守，荣气虚散，血亦错行，所谓阳虚阴必走是耳。外证必有虚冷之状，
法当温中，使血自归于经络，可用理中汤加南木香，或《局方》七气汤加川芎，或
甘草干姜汤，其效甚着。又有饮食伤胃，或胃虚不能传化，其气逆上，亦令吐衄，
木香理中汤，甘草干姜汤。出血诸证，每以胃药收功，木香理中汤，或参苓白术散
二分，枳壳散一分，夹和，米汤乘热调下，或真方四君子汤，夹和小乌沉汤，米汤
调下，以上并用姜枣略煎亦得，上药不惟养胃，盖以调气辈与之并行。若夫桔梗枳
壳汤，夹和二陈汤，姜枣同煎，入苏合香丸少许佐之，又调气之上药也。
经云∶岁火太过，炎暑流行，肺金受邪，民病血溢血泄。又云∶少阳之复，火
气内发，血溢血泄。是火气能使人失血者也。而又云∶太阳司天，寒淫所胜，血变
于中，民病呕血血泄，鼽衄善悲。又云∶太阳在泉，寒淫所胜，民病血见。是寒气
能使人失血也。又云∶太阴在泉，湿淫所胜，民病血见。是湿气能使人失血也。又
云∶少阴司天之政，水火寒热持于气交，热病生于上，冷病生于下，寒热凌犯而争
于中，民病血溢血泄。是寒热凌犯能使人失血也。太阴司天之政，初之气，风湿相
薄，民病血溢。是风湿相薄血溢也。又云∶岁金太过，燥气流行，病反侧咳逆，甚
而血溢。是燥气亦能使血溢也。然则六气皆能使人失血，何独火乎。
《撄宁生卮言》云∶古人言诸见血非寒证，皆以血为热迫，遂至妄行，然皆复有
所挟也。或挟风，或挟湿，或挟气，又有因药石而发者，其本皆热。上中下治，各
有所宜。在上则栀子、黄芩、黄连、芍药、犀角、蒲黄，而济以生地黄、牡丹皮之
类。胃血，古人有胃风汤，正是以阳明火邪为风所扇，而血为之动，中间有桂，取
其能伐木也。若苍术、地榆、白芍药之类，而济以火剂。大肠血，以手阳明火邪，
为风为湿也。治以火剂、风剂，风能胜湿也。如黄连、黄芩、芍药、柏皮、荆芥、
防风、羌活之类，兼用鸡冠花，则又述类之义也。惊而动血者，属心。怒而动血者，
属肝。忧而动血者，属肺。思而动血者，属脾。劳而动血者，属肾。血溢、血泄、
诸蓄妄证，其始也，予率以桃仁、大黄行血破瘀之剂折其锐气，而后区别治之。虽
往往获中，然犹不得其所以然也。后来四明遇故人苏伊芳举，间论诸家之术，伊芳举曰
吾乡有善医者，每治失血蓄妄，必先以快药下之。或问失血复下，虚何以当？则曰
血既妄行，迷失故道，不去蓄利瘀，则以妄为常，曷以御之，且去者自去，生者自
生，何虚之有。予闻之愕然曰名言也。昔者之疑，今释然矣。
妇人之于血也，经水蓄而为胞胎，则蓄者自蓄，生者自生，及其产育为恶露，
则去者自去，生者自生，其 而为乳，则无复下，满而为月矣。失血为血家妄逆，
产妇为妇人常事，其去其生则一也。失血家须用下剂破血，盖施之于蓄妄之初，亡
血虚家不可下，盖戒之于亡失之后。
【九窍出血】南天竺饮主之。或用血余灰，自发为佳，无即父子一气者，次则男胎发，又次
则乱发，皂角水净洗，晒干烧灰为末，每二钱以茅草根、车前草煎汤调下。荆叶捣
取汁，酒和服。刺蓟一握绞汁，酒半盏和服。如无生者，捣干者为末，冷水调三钱。
【血从毛孔出】名曰肌衄，用人中白不拘多少，刮在新瓦上，用火逼干，研令极细，每服二钱，
入麝香少许，温酒调下。外以男胎发烧灰KT 之。未效，以郁金末水调，鹅翎扫之即
止。《九灵山房集》云∶湖心寺僧履师，偶搔 中疥，忽自出血，汨汨如涌泉，竟日
不止，疡医治疗弗效。邀吕元膺往视时，已困极无气可语，及持其脉，惟尺脉如蛛
丝，他部皆无，即告之曰，夫脉血气之先也，今血妄溢，故荣气暴衰，然两尺尚可
按，惟当益荣以泻其阴火，乃作四神汤加荆芥穗、防风，不间晨夜并进，明日脉渐
出，更服十全大补汤一剂遂痊。
凡九窍出血皆可用∶墙头苔藓可以塞。车前草汁可以滴。火烧莲房用水调。锅
底黑煤可以吃。石榴花片可以塞。生莱菔汁可以滴。火烧龙骨可以吹。水煎茅花可
以吃。《玉机微义》曰∶经云，荣者、水谷之精也，和调五脏，洒陈于六腑，乃能入
于脉也。源源而来，生化于脾，总统于心，脏受于肝，宣布于肺，施泄于肾，灌溉
一身。目得之而能视，耳得之而能听，手得之而能摄，掌得之而能握，足得之而能
步，脏得之而能液，腑得之而能气，是以出入升降濡润宣通者，由此使然也。注
之于脉，少则涩，充则实。常以饮食日滋，故能阳生阴长，取汁变化而赤为血也。
生化旺则诸经恃此而长养，衰耗竭则百脉由此而空虚，可不谨养哉。故曰血者神气
也，得之则存，失之则亡。是知血盛则形盛，血弱则形衰，神静则阴生，形役则阳
亢。阳盛则阴必衰，又何言阳旺而生阴血也，盖谓血气之常，阴从乎阳，随气营运
于内，苟无阴以羁束，则气何以树立，故其致病也易，调治也难，以其比阳常亏而
又损之，则阳易亢阴易乏之论，可以见矣。诸经有云∶阳道实，阴道虚，阴道常乏。
阳常有余，阴常不足。妇人之生也，年至十四经行，四十九而经断，可见阴血之难
成易亏如此。阴气一伤，所变立至，妄行于上则吐衄，衰涸于外则虚劳，妄反于下
则便红，积热膀胱则癃闭溺血，渗透肠间则为肠风，阴虚阳搏则为崩中，湿蒸热瘀
则为滞下，热极腐化则为脓血。火极似水，血色紫黑。热胜于阴，发为疮疡，湿滞
于血则为痛痒，瘾疹皮肤则为冷痹。蓄之在上则人喜忘，蓄之在下则人喜狂。堕恐
跌仆则瘀恶内凝。若分部位，身半以上同天之阳，身半以下同地之阴。此特举其所
显之证者。治血必血属之药，欲求血药，其四物之谓乎。河间谓随证辅佐，谓之六
合汤者，详言之矣。予故陈其气味，专司之要，不可不察。夫川芎血中气药也，通
肝经，性味辛散，能行血滞于气也。地黄血中血药也，通肾经，性味甘寒，能生真
阴之虚也。当归分三治，血中主药也，通肝经，性味辛温，全用能活血，各归其经
也。芍药阴分药也，通脾经，性味酸寒，能和血，治虚腹痛也。若求阴药之属，必
于此而取则焉。《脾胃论》有云∶若善治者，随证损益，摘其一二味之所宜为主治可也。
此特论血病而求血药之属者也。若气虚血弱，又当如长沙血虚以人参补之，阳旺则
生阴血也。若四物者，独能主血分受伤，为气不虚也。辅佐之属，若桃仁、红花、
苏木、血竭、牡丹皮者，血滞所宜。蒲黄、阿胶、地榆、百草霜、棕榈灰者，血崩
所宜。乳香、没药、五灵脂、凌霄花者，血痛所宜。苁蓉、琐阳、牛膝、枸杞子、
益母草、夏枯草、败龟板者，血虚所宜。乳酪血液之物，血燥所宜。干姜、肉桂，
血寒所宜。生地黄、苦参，血热所宜。特取其正治大略耳。人能触类而长，可以应无
穷之变矣。
【诊】脱血而脉实者难治。病若吐血复鼽衄，脉当沉细，反浮大而牢者死。吐
血衄血，脉滑、弱小者生，实大者死。汗出若衄，其脉滑小者生，大躁者死。呕血
胸满引痛，脉小而疾者逆也。脉至而搏，血衄身热者死。吐血，咳逆上气，其脉数
而有热，不得卧者死。诸见血，身热脉大者难治，难治者，邪胜也。身凉脉静者易
治，易治者，正气复也。衄血者，若但头汗出，身无汗，及汗出不至足者死。血溢
上行，或唾、或呕、或吐，皆凶也。若变而下行为恶利者顺也。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。若无病之人，忽然下
利者，其病进也。今病血证上行而复下行恶利者，其邪欲去，是知吉也。
李东垣说：鼻出血（衄血）源于肺，治疗以犀角、升麻、栀子、黄芩、芍药、生地黄、紫参、丹参、阿胶等药物为主。咳唾带血者源于肾，治疗以天门冬、麦门冬、贝母、知母、桔梗、百部、黄柏、远志、熟地黄等药物为主。如果伴有寒象，则以干姜、肉桂等药物为主。痰中带血者源于脾，治疗以葛根、黄芩、黄连、芍药、甘草、当归、沉香等药物为主。呕血源于胃，实证用犀角地黄汤治疗；虚证用小建中汤加黄连治疗。
张元素（号海藏）说：胸中聚集的余火与腹中积久的太阴寒气上下隔绝，脉络阻滞，阴阳不通。此时应用苦热药以安定中焦，用辛热药以通达外周，用甘温药升提，用辛润药降逆，将肃杀之气化为春日的温和，变凛冽为和气，通过发汗而痊愈。然而，残留的病邪如同糟粕依然存在，周身阳气尚未完全调和，患者心中微躁且想喝冷饮，若因食用冷物或服用凉药，导致阳气再次消减，残余阴寒再次发作，脉象退去变得细小、弦细而迟，激荡而引发鼻出血或咳唾血，这是心肺受邪所致。向下发展为便血、尿血者，是肾肝受邪所致。三焦出血，血色紫暗不鲜亮，这是重沓的寒湿化毒，凝滞了水谷运行的道路，浸渍而成。如果见到出血证，不详察本源，就使用寒凉药强行折损，病情就会发生变化。阳证溢出鲜血；阴证下血如猪肝色。
上部出血，用黄芩桂枝汤、白芍当归汤；中部出血，用当归建中汤、增损胃风汤；下部出血，用川芎归术附汤、桂附六合汤。如果三种出血证在行阳二十五度时出现，用黄芩四君子汤治疗；如果在行阴二十五度时出现，用当归四逆加吴茱萸汤治疗。
吐血、鼻出血、便血，患者阴虚而阳气走散，脉象沉而散，外在症状表现为虚寒而无热象，宜用乌金丸、散剂止血，治法宜上部用散剂，下部用丸剂，随后用木香理中汤和大七气汤，加入川芎煎煮，调服苏合香丸以温之。《仁斋直指方》说：血液遇热则宣散流动，所以止血多用凉药。但也有气虚挟寒，阴阳不能相互守持，营气虚弱散乱，血液也错乱运行，这就是所谓的“阳虚阴必走”。外在症状必有虚冷的表现，治法应当温中，使血液自然回归经络，可用理中汤加南木香，或《局方》七气汤加川芎，或甘草干姜汤，疗效显著。又有饮食损伤胃气，或胃虚不能运化，气机上逆，也会导致吐血、鼻出血，用木香理中汤、甘草干姜汤。各种出血证，往往以调理胃气的药物收功，可用木香理中汤，或参苓白术散二分、枳壳散一分混合，用米汤趁热调服；或用真方四君子汤，混合小乌沉汤，米汤调服。以上方剂均用生姜、大枣略煎也可以。上述药物不仅养胃，更是因为调理气机的药物与之并行。至于桔梗枳壳汤，混合二陈汤，加生姜、大枣同煎，加入少许苏合香丸辅助，又是调理气机的上等方剂。
《内经》说：岁火太过，炎暑流行，肺金受邪，百姓患病血溢、血泄。又说：少阳复气，火气内发，血溢、血泄。这说明火气能使人失血。又说：太阳司天，寒邪盛行，血在中改变，百姓患病呕血、血泄、鼻塞流涕、鼻出血、易悲伤。又说：太阳在泉，寒邪盛行，百姓患病见血。这说明寒气能使人失血。又说：太阴在泉，湿邪盛行，百姓患病见血。这说明湿气能使人失血。又说：少阴司天之政，水火寒热在气交之中维持平衡，热病生于上，冷病生于下，寒热相互侵犯争斗于中，百姓患病血溢、血泄。这说明寒热相互侵犯能使人失血。太阴司天之政，初之气，风湿相搏，百姓患病血溢。这说明风湿相搏会导致血溢。又说：岁金太过，燥气流行，病人反而侧卧咳嗽气逆，严重时血溢。这说明燥气也能使人血溢。既然这样，六气都能使人失血，为何唯独说是火呢？
《撄宁生卮言》说：古人说各种出血证不是寒证，都认为血是被热逼迫，以至于妄行，但都夹杂有其他因素。有的挟风，有的挟湿，有的挟气，又有因服药不当而引发的，其根本都是热。上、中、下三焦的治疗，各有适宜的方法。在上焦则用栀子、黄芩、黄连、芍药、犀角、蒲黄，辅以生地黄、牡丹皮之类。胃出血，古人有胃风汤，正是针对阳明火邪被风所煽动，而血随之动荡，方中有桂枝，取其能伐肝木之意。若用苍术、地榆、白芍药之类，辅以火剂。大肠出血，是由于手阳明火邪，受风和湿的影响。治疗用火剂、风剂，风能胜湿。如黄连、黄芩、芍药、黄柏、荆芥、防风、羌活之类，兼用鸡冠花，这又符合取类比象的意义。惊恐而动血者，属心；愤怒而动血者，属肝；忧愁而动血者，属肺；思虑而动血者，属脾；劳累而动血者，属肾。对于血溢、血泄、各种蓄积妄行的证候，起初我通常用桃仁、大黄等行血破瘀的药剂来挫其锐气，然后再区别治疗。虽然往往有效，但仍不知其所以然。后来在四明遇到故人苏伊芳举，间或讨论各家医术，伊芳举说：“我们乡里有位善医者，每次治疗失血蓄妄，必定先用峻下药攻下。”有人问：“失血之后再用下法，虚弱怎么承受得住？”回答说：“血既已妄行，迷失了原来的轨道，不去除蓄积、利导瘀血，就会把妄行当作常态，用什么来抵御它呢？况且去除的是病理产物，新生的是正气，有什么虚的呢？”我听后愕然，说：“这是名言啊！”昔日的疑惑，如今释然了。
妇女的经血蓄积成为胞胎，则蓄积的自蓄积，新生的自新生；等到分娩产生恶露，则排出的自排出，新生的自新生；转化为乳汁，则不再有下行，满盈则为月经。失血是血家妄逆，产妇是妇人的常事，其排出与新生的道理是一样的。失血家须用下剂破血，这是因为施用于蓄积妄行之初；亡血虚家不可用下法，这是告诫在亡失之后的情况。
【九窍出血】主用南天竺饮。或者使用血余灰，以头发自然脱落者为佳，没有则用父子一气者（指同一父亲所生兄弟的头发），其次用男胎发，再次用乱发，用皂角水洗净，晒干烧成灰末，每服二钱，用茅草根、车前草煎汤调服。荆叶捣取汁，加酒和服。刺蓟一握绞汁，加半盏酒和服。如果没有新鲜的，捣干品为末，冷水调服三钱。
【血从毛孔出】名为肌衄，用人中白不拘多少，刮在新瓦上，用火烤干，研成极细末，每服二钱，加入少许麝香，温酒调服。外用男胎发烧成的灰吹敷患处。未见效，用郁金末水调，用鹅翎扫涂患处即止。《九灵山房集》记载：湖心寺僧人履师，偶然搔抓疥疮，忽然自行出血，汨汨如涌泉，整天不止，外科医生治疗无效。邀请吕元膺前往诊治，当时患者困倦至极，无气力说话，切其脉，只有尺脉如蛛丝般细微，其他部位皆无脉，随即告诉他说：“脉是气血的先兆，现在血妄溢，所以营气暴衰，但两尺脉尚可按到，只当益营气以泻其阴火。”于是制作四神汤加荆芥穗、防风，不分早晚连续进服，第二天脉象逐渐显现，再服十全大补汤一剂遂痊愈。
凡是九窍出血都可以用：墙头苔藓可以塞鼻。车前草汁可以滴入。火烧莲房用水调服。锅底黑煤可以吃。石榴花片可以塞鼻。生莱菔汁可以滴入。火烧龙骨可以吹入鼻腔。水煎茅花可以吃。《玉机微义》说：《内经》讲，营气是水谷的精微，调和五脏，布散于六腑，才能进入脉中。源源而来，生化于脾，统摄于心，贮藏于肝，宣布于肺，施泄于肾，灌溉一身。眼睛得到它能视，耳朵得到它能听，手得到它能摄取，手掌得到它能握，脚得到它能行走，脏腑得到它能化液，六腑得到它能化气，所以出入升降、濡润宣通的，都是由此使然。注入脉中，量少则涩，充盈则实。常靠饮食日日滋养，所以能阳生阴长，取汁变化而赤成为血。生化旺盛则诸经依赖此而长养，衰耗竭绝则百脉由此空虚，能不谨慎调养吗？所以说血是神气，得到它则生存，失去它则死亡。因此知道血盛则形体盛，血弱则形体衰，神静则阴生，形体劳役则阳亢。阳盛则阴必衰，又何谈阳旺而生阴血呢？这是指血气的常态，阴随阳而行，随气营运于内，假如没有阴来羁束，气凭什么树立？所以致病容易，调治难，因为它比“阳常亏而阴易乏”的理论，可以看出阳易亢、阴易乏的道理。诸经有云：阳道实，阴道虚，阴道常乏。阳常有余，阴常不足。妇女出生，年到十四月经来潮，四十九岁月经断绝，可见阴血难成易亏如此。阴气一旦受伤，变化立即发生，妄行于上则吐衄，衰涸于外则虚劳，妄反于下则便红，积热膀胱则癃闭溺血，渗透肠间则为肠风，阴虚阳搏则为崩中，湿蒸热瘀则为痢疾，热极腐化则为脓血。火极似水，血色紫黑。热胜于阴，发为疮疡，湿滞于血则为痛痒，瘾疹皮肤则为冷痹。蓄积在上则人喜忘，蓄积在下则人喜狂。堕胎、恐惧、跌仆则瘀恶内凝。若分部位，身半以上同天之阳，身半以下同地之阴。这只是列举其显现的证候。治疗血病必须用属于血的药物，想要寻求血药，大概就是四物汤吧。河间详细论述了随证辅佐，称为六合汤的情况。所以我陈述其气味，专司的要领，不可不考察。川芎是血中的气药，通肝经，性味辛散，能行血滞于气。地黄是血中的血药，通肾经，性味甘寒，能生真阴之虚。当归分三治，是血中的主药，通肝经，性味辛温，全用能活血，各归其经。芍药是阴分药，通脾经，性味酸寒，能和血，治虚腹痛。如果求阴药所属，必从这里取法。《脾胃论》有云：如果善于治疗者，随证损益，摘取一二味适宜的作为主治即可。这仅是论血病而求血药所属。若气虚血弱，又应当像长沙（张仲景）所说，血虚用人参补之，阳旺则生阴血。如果四物汤，只能主治血分受伤，而气不虚的情况。辅佐类药物，如桃仁、红花、苏木、血竭、牡丹皮，适宜于血滞。蒲黄、阿胶、地榆、百草霜、棕榈灰，适宜于血崩。乳香、没药、五灵脂、凌霄花，适宜于血痛。苁蓉、琐阳、牛膝、枸杞子、益母草、夏枯草、败龟板，适宜于血虚。乳酪血液之物，适宜于血燥。干姜、肉桂，适宜于血寒。生地黄、苦参，适宜于血热。这里只是选取正治的大略原则。人能触类旁通，就可以应对无穷的变化了。
【诊法】脱血而脉实者难治。病若吐血又鼻出血，脉应当沉细，反见浮大而牢者死。吐血鼻出血，脉滑、弱小者生，实大者死。出汗或鼻出血，脉滑小者生，大躁者死。呕血伴胸满牵引疼痛，脉小而疾者逆。脉至而搏动，血衄身热者死。吐血，咳逆上气，脉数而有热，不得卧者死。各种出血证，身热脉大者难治，难治是因为邪胜。身凉脉静者易治，易治是因为正气复。鼻出血者，如果只有头部出汗，身体无汗，以及汗出不到足者死。血溢上行，或唾血、或呕血、或吐血，皆凶险。如果变为下行成为恶利（腹泻）者顺。血上行逆，治疗难，下行顺，治疗易。所以仲景说：蓄血证下血者，当自愈。若无病之人，忽然下利，其病进也。今患血证上行而复下行恶利，其邪欲去，可知吉。
Li Dongyuan stated: Epistaxis (nosebleed) originates from the Lung, and treatment is primarily with Rhinoceros Horn (Xijiao), Cimicifugae Rhizoma (Shengma), Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Paeoniae Radix (Shaoyao), Rehmanniae Radix Recens (Shengdi), Polygoni Multiflori Caulis (Zishen), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), and Ecliptae Herba (Ejiao). Hemoptysis (coughing up blood) originates from the Kidney, and treatment is primarily with Asparagi Radix (Tianmendong), Ophiopogonis Radix (Mendong), Fritillariae Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Platycodonis Radix (Jiegeng), Stemona Radix (Baibu), Phellodendri Cortex (Huangbai), Polygalae Radix (Yuanzhi), and Rehmanniae Radix Praeparata (Shudihuang). If accompanied by cold signs, treatment is primarily with Zingiberis Rhizoma (Ganjiang) and Cinnamomi Cortex (Rougui). Blood in phlegm originates from the Spleen, and treatment is primarily with Puerariae Radix (Gegen), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Paeoniae Radix (Shaoyao), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Danggui), and Aquilariae Lignum Resinatum (Chenxiang). Hematemesis (vomiting blood) originates from the Stomach; excess patterns are treated with Xijiao Dihuang Tang (Rhino-horn and Rehmannia Decoction), while deficiency patterns are treated with Xiaojianzhong Tang (Minor Construct the Middle Decoction) added with Huanglian.
Zhang Yuansu (styled Haicang) stated: Residual fire accumulated in the chest and long-standing Taiyin cold accumulated in the abdomen are separated above and below, causing blockage in the collaterals and obstruction of Yin and Yang. In such cases, bitter-hot herbs should be used to stabilize the middle, and pungent-hot herbs to circulate externally. Sweet-warm herbs should be used to ascend, and pungent-moist herbs to descend, transforming austere energy into spring-like warmth, and changing biting cold into harmonious qi, leading to recovery through sweating. However, residual pathogenic factors remain like dregs, and the body's Yang harmony is not yet fully restored. The patient may feel slight restlessness in the chest and desire cool drinks. If they consume cold food or take cooling formulas, Yang energy is further diminished, and residual Yin cold reactivates. The pulse becomes faint, fine, wiry, and slow. Agitated, this leads to epistaxis or hemoptysis, indicating that the Heart and Lung are affected by pathogens. Progressing downward to melena (blood in stool) or hematuria (blood in urine) indicates that the Kidney and Liver are affected. Bleeding from the Triple Burner presents with dark, dull blood color, caused by heavy damp-cold transforming into toxicity, stagnating the pathways of water and grain, and resulting from infiltration. When encountering bleeding disorders, if the root cause is not investigated and cooling astringents are used blindly, complications will arise. Yang patterns present with bright red blood; Yin patterns present with dark, liver-colored blood.
Bleeding from the upper part is treated with Huangqin Guizhi Tang (Scutellaria and Cinnamon Twig Decoction) and Baishao Danggui Tang (White Peony and Angelica Decoction). Bleeding from the middle part is treated with Danggui Jianzhong Tang (Angelica Decoct to Build the Middle) and Zengsun Weifeng Tang (Modified Wind-Protecting Decoction). Bleeding from the lower part is treated with Xiongguizhu Fu Tang (Ligusticum, Angelica, Atractylodes, and Aconite Decoction) and GuiFu Liuhe Tang (Cinnamon and Aconite Six-Harmony Decoction). If these three types of bleeding occur during the 25 degrees of Yang circulation, Huangqin Sijunzi Tang (Scutellaria and Four Gentlemen Decoction) is used. If they occur during the 25 degrees of Yin circulation, Danggui Sini Jia Wuzhuyu Tang (Angelica Cold-Reversal Decoction plus Evodia) is used.
In cases of hematemesis, epistaxis, and melena, the patient has Yin deficiency with Yang wandering. The pulse is deep and scattered, and external symptoms show deficiency-cold without heat signs. Wujin Wan (Black Gold Pill) and powders should be used to stop bleeding. The method involves using powders for the upper part and pills for the lower part, followed by Muxiang Lizhong Tang (Costus Regulating Middle Decoction) and Daqi Qi Tang (Great Seven-Qi Decoction), decocted with Chuanxiong, and taken with Suhexiang Wan (Styrax Pill) to warm. *Ren Zhai Zhizhi Fang* states: "Blood flows freely when heated, so cooling herbs are mostly used to stop bleeding." However, there are cases of Qi deficiency with cold, where Yin and Yang cannot guard each other, Ying (Nutrient) Qi is deficient and scattered, and blood moves erratically, which is what is meant by "Yang deficiency leads to Yin wandering." External symptoms must show deficiency-cold signs. The treatment should warm the middle to return blood to the vessels naturally. Lizhong Tang added with Nanmuxiang (Southern Costus), or *Ju Fang* Qi Qi Tang added with Chuanxiong, or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) can be used, showing significant efficacy. Additionally, dietary injury to the Stomach, or Stomach deficiency failing to transport and transform, causes Qi to rebel upward, leading to vomiting and nosebleeds. Muxiang Lizhong Tang and Gancao Ganjiang Tang are indicated. Various bleeding disorders often conclude with Stomach-regulating herbs. One may use Muxiang Lizhong Tang, or mix Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) two parts with Zhike San (Immature Bitter Orange Powder) one part, taken with hot rice gruel. Alternatively, Zhenfang Sijunzi Tang (True Formula Four Gentlemen Decoction) mixed with Xiao Wuchen Tang (Small Black Stagnation Decoction) taken with rice gruel works. All these can be slightly decocted with Shengjiang (Fresh Ginger) and Dazao (Jujube). These drugs not only nourish the Stomach but also work in parallel with Qi-regulating agents. Jiegeng Zhike Tang (Platycodon and Immature Bitter Orange Decoction) mixed with Erchen Tang (Two-Aged Decoction), decocted with ginger and jujube, with a little Suhexiang Wan added, is another superior formula for regulating Qi.
The *Classic* states: "When Fire is excessive in the year, summer heat prevails, Lung Metal is attacked, and the people suffer from blood overflow and discharge." It also says: "When Shaoyang rebounds, Fire Qi erupts internally, causing blood overflow and discharge." This shows that Fire Qi can cause hemorrhage. It also says: "When Taiyin governs, Cold dominates excessively, blood changes within, and the people suffer from hematemesis, blood discharge, rhinitis, epistaxis, and sadness." And: "When Taiyin is in the subterranean position, Cold dominates excessively, and the people suffer from blood manifestations." This shows that Cold Qi can cause hemorrhage. It also says: "When Taiyin is in the subterranean position, Dampness dominates excessively, and the people suffer from blood manifestations." This shows that Dampness can cause hemorrhage. It also says: "In the administration of Shaoyin governing Heaven, Water-Fire, Cold-Heat contend at the Qi intersection. Heat diseases arise above, cold diseases below. Cold and Heat invade and contend in the middle, and the people suffer from blood overflow and discharge." This shows that Cold-Heat invasion can cause hemorrhage. In the administration of Taiyin governing Heaven, in the first Qi period, Wind-Dampness clash, and the people suffer from blood overflow. This shows that Wind-Dampness clash causes blood overflow. It also says: "When Metal is excessive in the year, Dryness prevails, patients cough and reverse Qi, and severely suffer from blood overflow." This shows that Dryness can also cause blood overflow. Thus, all Six Qi can cause hemorrhage; why single out Fire?
*Yingning Sheng Zhi Yan* states: "Ancients said various bleeding disorders are not cold patterns, believing blood is forced by heat to act recklessly, but all involve accompanying factors. Some accompany Wind, some Dampness, some Qi, and some are triggered by medication, with Heat as the root. Treatment for Upper, Middle, and Lower Jiao varies. For the Upper Jiao, use Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Paeoniae Radix (Shaoyao), Rhinoceros Horn (Xijiao), and Polygoni Multiflori Caulis (Puhuang), assisted by Rehmanniae Radix Recens (Shengdihuang) and Moutan Cortex (Mudanpi). For Stomach blood, ancients used Weifeng Tang, precisely addressing Yangming Fire Pathogen fanned by Wind, causing blood to move. The presence of Cinnamon Twig (Guizhi) aims to suppress Wood (Liver). For large intestine blood, it is due to Hand-Yangming Fire Pathogen affected by Wind and Dampness. Treat with Fire Agents and Wind Agents, as Wind overcomes Dampness. Use Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Paeoniae Radix (Shaoyao), Phellodendri Cortex (Baipi), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), and Notopterygii Rhizoma et Radix (Qianghuo), combined with Celosiae Cristatae Flos (Jiguanhua), following the principle of analogical association. Blood moved by fright belongs to the Heart; anger belongs to the Liver; worry belongs to the Lung; thought belongs to the Spleen; labor belongs to the Kidney. For initial blood overflow, discharge, and reckless accumulation, I usually used Peach Kernel and Rheum Decoctions to break stasis and curb aggression, then treated differently. Although often effective, I did not understand the rationale. Later, in Siming, I met old friend Su Yifangju, who discussed various medical techniques. He said: 'My hometown has a skilled physician who, when treating hemorrhage and reckless accumulation, always uses drastic purgatives first.' Someone asked: 'After hemorrhage, how can the deficiency withstand purging?' He replied: 'Since blood acts recklessly and loses its proper path, if we do not remove accumulation and promote stasis, reckless movement becomes normal. How can we control it? What leaves is pathology; what remains is vitality. Where is the deficiency?' I was startled and said: 'These are profound words!' My past doubts are now resolved.
Women's menstrual blood accumulates to form the fetus; what accumulates stays, what generates grows. After childbirth, lochia is expelled; what leaves leaves, what generates grows. When transformed into milk, it no longer descends, filling until menstruation returns. Hemorrhage is reckless rebellion of blood in blood-pattern individuals; childbirth is normal for women. Their leaving and generating are the same. Hemorrhage patients need purgatives to break blood, applied at the beginning of accumulation/rebellion. Patients with massive blood loss and deficiency should not be purged, as a warning after loss.
[Nine Orifices Bleeding] Nantiantian Yin (Southern Indian Sky Drink) is primary. Alternatively, use Xuanyu Hui (Hair Ash). Naturally shed hair is best; if unavailable, use hair from brothers of the same father; next, male fetal hair; finally, tangled hair. Wash clean with Gleditsiae Sinensis Fructus (Zaojiao) water, dry, burn to ash. Take 2 qian, mixed with decoction of Imperatae Rhizoma (Maocaogen) and Plantaginis Herba (Cheqiancao). Crush fresh Artemisia argyi leaves (Jingye), extract juice, mix with wine. Take one handful of Cirsium japonicum (Ciji), squeeze juice, mix with half cup of wine. If fresh is unavailable, use dried powder, mix with cold water, take 3 qian.
[Bleeding from Skin Pores] Named Jinu (Muscle Epistaxis). Use Renzhongbai (Calculus Humanis) in any amount, scrape onto new tile, bake dry with fire, grind extremely fine. Take 2 qian per dose, add a little Moschus (Shexiang), mix with warm wine. Externally, apply ash of male fetal hair. If ineffective, use Curcumae Radix (Yujin) powder mixed with water, sweep on with goose feather to stop. *Ji Lingshan Fang Ji* records: Monk Lüshi of Huxin Temple scratched a scabies sore, suddenly bleeding profusely like a spring, continuing all day. Surgeons failed. Lü Yuanying was invited. The patient was exhausted, unable to speak. Pulse: only Chi pulse felt like spider thread, others absent. Lü said: 'Pulse is the precursor of Qi and Blood. Now blood rebels, Ying Qi has suddenly declined. But Chi pulses are palpable. Tonify Ying Qi to drain Yin Fire.' Prescribed Sishen Tang (Four Spirit Decoction) added with Jingjie Sui (Schizonepeta Head) and Fangfeng. Administered continuously day and night. Next day, pulse gradually appeared. Then administered Shiquan Dabu Tang (Complete Great Tonifying Decoction) once, and he recovered.
All nine orifices bleeding can use: Moss from wall tops to plug. Plantago juice to drip. Burned lotus seedpod mixed with water to swallow. Pot bottom soot to eat. Pomegranate flower slices to plug. Raw Radish juice to drip. Burned Longgu (Fossilized Bone) to blow into nose. Decoction of Maohua (Reed Flower) to drink. *Yuji Wei Yi* states: The Classic says, Ying Qi is the essence of water and grain, harmonizing five Zang organs, spreading to six Fu organs, entering vessels. It comes continuously, generated in Spleen, controlled by Heart, stored in Liver, announced by Lung, excreted by Kidney, irrigating the body. Eyes see with it, ears hear with it, hands grasp with it, palms hold with it, feet walk with it, Zang organs produce fluids with it, Fu organs generate Qi with it. Thus, entry/exit, ascent/descent, moistening/venting are due to this. Injected into vessels, less causes涩 (roughness), full causes实 (fullness). Daily diet nourishes it, allowing Yang to generate Yin, extracting juice, changing red to become blood. When generation is vigorous, meridians rely on it for nourishment; when depleted, all vessels become empty. Must one not be careful in nourishing? Thus, Blood is Divine Qi. Gain it to live, lose it to die. Knowing blood abundance means physical abundance, blood weakness means physical decline. Calm spirit generates Yin; bodily labor causes Yang hyperactivity. Yang excess leads to Yin decline. Why speak of Yang prosperity generating Yin blood? This refers to the normal state of Qi and Blood, where Yin follows Yang, circulating internally with Qi. Without Yin to restrain, how can Qi stand? Thus, disease arises easily, treatment is difficult. Compared to the theory that 'Yang is often deficient and Yin easily lacks,' we see Yang easily hyperacts and Yin easily fails. Classics say: Yang path is solid, Yin path is deficient; Yin path is often deficient. Yang is often in excess, Yin is often insufficient. Women begin menstruating at fourteen, cease at forty-nine, showing Yin blood is hard to form and easy to deplete. Once Yin Qi is injured, changes follow immediately. Reckless upward flow causes hematemesis/epistaxis; depletion outward causes consumptive fever; reckless downward flow causes red stool; heat accumulation in Bladder causes strangury/hematuria; penetration into intestines causes intestinal wind; Yin deficiency with Yang pounding causes metrorrhagia; damp-steaming heat-stasis causes dysentery; extreme heat putrefaction causes pus-blood. Extreme Fire resembles Water, blood color purple-black. Heat surpassing Yin causes sores/ulcers; Dampness stagnating in blood causes pain/itching; wind-rash on skin causes cold bi. Accumulation above causes forgetfulness; accumulation below causes mania. Abortion, fear, falls cause internal coagulation of evil stasis. Dividing by location: upper half corresponds to Heaven's Yang; lower half to Earth's Yin. This lists manifest symptoms. Treating blood requires blood-specific herbs. Seeking blood herbs, perhaps Siwu Tang (Four Substances Decoction)? Hejian detailed assisting according to patterns, called Liuhe Tang (Six-Harmony Decoction). I state their flavors and key functions, which must be examined. Chuanxiong is Qi herb in Blood, enters Liver channel, pungent-dispersing, moves blood stasis in Qi. Dihuang is Blood herb in Blood, enters Kidney channel, sweet-cool, generates true Yin deficiency. Danggui is main Blood herb, enters Liver channel, pungent-warm, whole use activates blood, returning to respective channels. Shaoyao is Yin branch herb, enters Spleen channel, sour-cool, harmonizes blood, treats deficiency abdominal pain. To seek Yin herbs, take model here. *Piwei Lun* says: Good practitioners adjust according to patterns, selecting one or two suitable herbs as main treatment. This discusses blood diseases seeking blood herbs. If Qi deficiency and blood weakness, follow Changsha (Zhang Zhongjing): tonify blood deficiency with Ginseng; Yang prosperity generates Yin blood. Siwu Tang alone treats blood branch injury when Qi is not deficient. Assisting herbs: Taoren, Honghua, Sumu, Xuejie, Mudanpi for blood stasis. Puhuang, Ejiao, Diyu, Baicaoshuang, Zonglühui for metrorrhagia. Ruxiang, Moyao, Wulingzhi, Lingxiaohua for blood pain. Congrong, Suoyang, Niuxi, Gouqizi, Yimucao, Xiakucao, Beiguiban for blood deficiency. Dairy/blood substances for blood dryness. Ganjiang, Rougui for blood cold. Shengdihuang, Kushen for blood heat. These are general correct treatments. Touching categories extends to infinite changes.
[Diagnosis] Depletion of blood with excess pulse is difficult to treat. If hematemesis recurs with epistaxis, pulse should be deep-fine; floating-large-firm pulse indicates death. Hematemesis/epistaxis with slippery-small pulse indicates life; excess-large pulse indicates death. Sweating or epistaxis with slippery-small pulse indicates life; large-restless pulse indicates death. Hematemesis with chest fullness and pulling pain, small-rapid pulse indicates adverse. Pulse beating, blood-epistaxis with body heat indicates death. Hematemesis with cough-reverse Qi, rapid pulse with heat, inability to lie down indicates death. All bleeding with body heat and large pulse is difficult to treat (pathogen wins). Body cool, pulse quiet is easy to treat (righteous Qi recovers). Epistaxis with only head sweat, no body sweat, or sweat not reaching feet indicates death. Blood overflowing upward, or spitting/vomiting blood, is ominous. Changing to downward flow as diarrhea is favorable. Upward flow is adverse, difficult to treat; downward flow is favorable, easy to treat. Thus Zhang Zhongjing said: In blood accumulation syndrome, if blood exits, it self-heals. If a healthy person suddenly has diarrhea, the disease progresses. Now, bleeding disorder moving upward then downward as diarrhea, pathogen wants to leave, known as auspicious.