〔薛〕 疮疡出血，因五脏之气亏损，虚火动而错经妄行也，当求其经，审其因而治
之。若肝热而血妄行者，四物炒栀、丹皮、苓术。肝虚而不能藏血者，六味地黄丸。心虚
而不能主血者，四物炒连、丹皮、苓术。脾虚热而不能统血者，四君炒栀、丹皮。若脾
经郁结，用归脾汤加五味子。脾肺气虚，用补中益气加五味子。气血俱虚，用十全大补。
阴火动，用六味丸加五味子。大凡失血过多，见烦热发渴等证，勿论其脉，急用独参汤以
补气。经云∶血生于气。苟非参 、归术甘温等剂，以生心肝之血，决不能愈。若发热
脉大者，不治。凡患血症，皆当以犀角地黄汤为主。翰林屠渐山，年四十，患湿毒疮疾，
误用轻粉之剂，亏损元气，久不能愈。一日将晡之际，诊之，肝脉忽洪数而有力，余曰∶
何肝脉之如此？侵晨，疮出黯血三四碗，体倦自汗，虽甚可畏，所喜血黯而脉静。余曰∶
此轻粉之热，血受其毒而妄行，轻粉之毒亦得以泄，邪气去而真气虚也，当急用独参汤
注之。余重其为人，体恤甚笃，但惑于他言，不果。致邪气连绵不已，惜哉！一人背疮出
血，烦躁作渴，脉洪大，按之如无，此血脱发躁，用当归补血汤二剂，少愈。又以八珍
加黄 、山栀，数剂全愈。一妇人，溃后吐鲜血三碗许，余用独参汤而血止，用四君熟
地、芎归而疮愈。此血脱补气，阳生阴长之理也。若用凉血降火，沉阴之剂，脾土生气
复伤，不惟血不归源而死无疑矣。一老妇，手大指患疔，为人针破，出鲜血，手背俱肿，半
体皆痛，神思昏愦五日矣。用活命饮，始知痛在手，疮势虽恶，不宜大攻，再用大补剂
又各一剂，外用隔蒜灸。喜此手背赤肿而出毒水，又各一剂，赤肿渐溃，又用托里药而
瘥。南仪部，贺朝卿，升山西少参，别时余见其唇鼻青黑，且时搔背，问其故，曰∶有
一小疮耳！余与视之，果疽也，此脾胃败坏，为不治之证。余素与善，悲其途次不便殡敛，
遂托其僚友张东沙辈强留之，勉与大补，但出紫血，虚极也。或谓毒炽不能为脓，乃服
攻毒药一盅，以致呕逆、脉脱，果卒于南都。金宪张碧崖，腰患疽，醉而入房，脉洪数，两
尺更大。余辞不治，将发舟，其子强留。顷间吐臭血五六碗，余意此肾经虚火而血妄行，
血必从齿缝出，将合肉桂等补肾制火之药，各用罐别煎熟听用，血止拭齿视之，果然。遂
合一盅冷服之，热渴顿止，少顷，温服一盅，脉细欲说，气息奄奄，得药则脉少复，良久
仍脱，其子疑内有脓，欲刺之。余曰∶必无，乃以鹅翎管 内，果如余言。次日脉脱脚寒
至膝，腹内如冰，急用六君加姜附，腹始温，脓始溃，疮口将完。彼因侍者皆爱外家，又患
小便不通，此阴已痿而思色以降其精，精内败不出而然耳，用加减八味丸料，加参 、白
术一剂，小便虽愈，疮口不敛而殁。
东垣圣愈汤 治诸恶疮血出不止，以寒水石细末，掺之立止。或疮时间作黑色，不
可溃也，药力去尽却红和。如血出多而心烦不安，不得眠睡，此亡血也，此汤主之。
熟地黄 生地黄（各三钱） 当归身（一钱半） 川芎(二钱） 黄 (五分） 人参(三分)
上 咀。都作一服，水一盏半，煎至一盏。去滓，稍热，服无时。(按此方，参 与归地
轻重悬殊，必有讹也。）
济主犀角地黄汤 治胃火血热妄行，吐衄或大便下血者。
犀角（镑末） 生地黄 赤芍药 牡丹皮（各一钱半） 升麻 黄芩（炒，各一钱）
上水煎熟，入犀角末服。
若因怒而致，加山栀、柴胡。若脾气虚而不能摄，用归脾汤。若肝脾火动而妄行，用
加味逍遥散。若脾气虚而不能统，用补中益气汤，加炮黑干姜。若血虚有火而妄行，用
四物加炮姜。若肾经虚火而血妄行，用六味丸料。不应，急加肉桂以引虚火归源。
独参汤 治一切失血，或脓水出多，血气俱虚，恶寒发热，作渴烦躁。盖血生于气，
故血脱补气，阳生阴长之理也。用人参二两，枣十枚，姜十片，水煎徐徐服。
托里消毒散加减法 脓多带赤，血虚也，去金银花、连翘、白芷三味，加归地、参术。
如不应，暂用八珍汤，加牡丹皮。忿怒晡热而出血，肝火血虚也，去三味，加牡丹皮、炒
黑山栀，熟地。如不应，暂用八珍汤送六味丸。面青胁胀而出血，肝气虚而不能藏血也，
去三味加山茱、山药、五味子。如不应，兼六味丸。食少体倦而出血，脾气虚而不能摄
血也，去三味加参术、归地。兼郁怒少寐，更加远志、酸枣仁、茯神、龙眼肉。如不应，暂
用归脾汤。
【薛己】疮疡出血，是由于五脏之气亏损，虚火妄动导致血液错经妄行所致，应当追溯其所属经络，审察病因进行治疗。如果是肝热导致血妄行的，用四物汤加炒栀子、牡丹皮、茯苓、白术。肝虚不能藏血的，用六味地黄丸。心虚不能主血的，用四物汤加炒黄连、牡丹皮、茯苓、白术。脾虚有热不能统摄血液的，用四君子汤加炒栀子、牡丹皮。如果是脾经郁结，用归脾汤加五味子。脾肺气虚的，用补中益气汤加五味子。气血俱虚的，用十全大补汤。阴火妄动的，用六味地黄丸加五味子。大凡失血过多，出现烦热发渴等症状时，不论脉象如何，急用独参汤来补气。经文说：血生于气。如果不是用人参、当归、白术等甘温的药物，来生养心肝之血，决不能痊愈。如果发热且脉大的，属于不治之症。凡是患血症的，都应当以犀角地黄汤为主方。翰林屠渐山，四十岁时，患湿毒疮疾，误用轻粉制剂，损伤元气，久治不愈。一天傍晚时分，诊察发现他的肝脉忽然洪数而有力，我说：“为什么肝脉如此？”次日清晨，疮口流出暗红色血液三四碗，身体疲倦自汗，虽然非常可怕，但庆幸血色暗红而脉象平静。我说：“这是轻粉的火热之毒，血液受其毒性而妄行，轻粉的毒素也得以宣泄，邪气去除而真气虚弱，应当急用独参汤注入补充。”我重视他的人格，体恤很深，但他被他人言论迷惑，最终没有照做。致使邪气连绵不断，可惜啊！有一人背部长疮出血，烦躁口渴，脉象洪大，重按却感觉空虚，这是血脱导致的烦躁，用当归补血汤两剂，稍见好转。又用八珍汤加黄芪、栀子，几剂后完全痊愈。一位妇人，溃烂后吐出鲜血约三碗，我用独参汤使血止住，再用四君子汤加熟地黄、川芎、当归使疮口愈合。这是血脱补气的道理，即阳生阴长的原理。如果使用凉血降火的沉寒药物，会再次损伤脾土生气，不仅血不归源，而且必死无疑。一位老妇人，手大拇指患疔疮，被人针破，流出鲜血，手背全部肿胀，半身疼痛，神志昏沉五天了。用活命饮，开始知道疼痛在手上，疮势虽然严重，不宜猛烈攻伐，再用大补药剂各一剂，外用隔蒜灸。幸好手背赤肿排出毒水，又各服一剂，赤肿逐渐溃破，再用托里药而痊愈。南仪部贺朝卿，升任山西少参，告别时我看见他唇鼻青黑，并且时常搔背，问其原因，他说：“有一个小疮罢了！”我给他看，果然是疽，这是脾胃败坏，属于不治之症。我平素与他交好，悲叹他在旅途中不便殡葬，于是托付他的僚友张东沙等人强行挽留他，勉强给予大补药物，只流出紫血，说明极度虚弱。有人说毒气炽盛不能化脓，于是服用攻毒药一盅，以致呕吐逆乱、脉象消失，果然在南都去世。金宪张碧崖，腰部患疽，酒后行房事，脉象洪数，两尺脉更大。我推辞说不治，准备开船离开，他的儿子强行挽留。一会儿吐出臭血五六碗，我心想这是肾经虚火导致血妄行，血液必定从齿缝流出，准备合配肉桂等补肾制火的药物，分别用罐煎熟备用，血止后擦拭牙齿查看，果然如此。于是合为一盅冷服，热渴顿时停止，过了一会儿温服一盅，脉象细弱欲绝，气息奄奄，得到药后脉象稍微恢复，良久仍然脱失，他的儿子怀疑里面有脓，想要刺破。我说：“一定没有”，乃将鹅翎管插入，果然如我所言。第二天脉象脱失，脚冷至膝盖，腹内如冰，急用六君子汤加干姜、附子，腹部才温暖，脓才开始溃出，疮口即将愈合。他因为侍者都喜爱外家（岳母家），又患小便不通，这是阴精已痿废而思色欲以泄精，精液在内败坏排不出所致，用加减八味丸料，加人参、白术一剂，小便虽然好了，但疮口不收敛而死亡。
东垣圣愈汤治疗各种恶疮出血不止，用寒水石细末掺敷，立即止血。或者疮口间或呈现黑色，不可溃破，药力耗尽后却转为红润调和。如果出血多而心烦不安，无法睡眠，这是亡血，此汤主治。
熟地黄、生地黄（各三钱） 当归身（一钱半） 川芎（二钱） 黄芪（五分） 人参（三分）
以上药材切碎。共作一服，用水一盏半，煎至一盏。去渣滓，稍热，随时服用。（按：此方中人参、黄芪与当归、地黄的用量轻重悬殊，必有错误。）
济生犀角地黄汤治疗胃火血热妄行，吐血、衄血或大便下血者。
犀角（镑成末） 生地黄 赤芍药 牡丹皮（各一钱半） 升麻 黄芩（炒，各一钱）
以上用水煎熟，加入犀角末服用。
如果是因愤怒导致，加栀子、柴胡。如果是脾气虚不能摄血，用归脾汤。如果是肝脾火动而妄行，用加味逍遥散。如果是脾气虚不能统血，用补中益气汤，加炮黑干姜。如果是血虚有火而妄行，用四物汤加炮姜。如果是肾经虚火而血妄行，用六味地黄丸料。如果不效，急加肉桂以引虚火归源。
独参汤治疗一切失血，或脓水流出过多，气血俱虚，恶寒发热，口渴烦躁。盖因血生于气，所以血脱补气，符合阳生阴长的原理。用人参二两，枣十枚，姜十片，水煎徐徐服用。
托里消毒散加减法：脓多带赤，是血虚，去掉金银花、连翘、白芷三味，加当归、地黄、人参、白术。如果不效，暂用八珍汤，加牡丹皮。愤怒、傍晚发热而出血，是肝火血虚，去掉三味，加牡丹皮、炒黑栀子、熟地黄。如果不效，暂用八珍汤送服六味丸。面色青、胁肋胀满而出血，是肝气虚不能藏血，去掉三味加山茱萸、山药、五味子。如果不效，兼服六味丸。食少体倦而出血，是脾气虚不能摄血，去掉三味加人参、白术、当归、地黄。兼有郁怒少寐，再加远志、酸枣仁、茯神、龙眼肉。如果不效，暂用归脾汤。
[Xue Ji] Bleeding from sores and ulcers is caused by the deficiency of Qi in the five Zang organs, where deficient fire moves recklessly, causing blood to flow out of its normal channels. One should trace the affected meridians, examine the etiology, and treat accordingly. If bleeding results from Liver heat, use Siwu Tang (Four Substances Decoction) with stir-fried Gardenia Fructus (Zhizi), Moutan Cortex (Mudanpi), Poria (Fuling), and Atractylodes Rhizome (Baizhu). If Liver deficiency fails to store blood, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If Heart deficiency fails to govern blood, use Siwu Tang with stir-fried Coptis Rhizome (Huanglian), Mudanpi, Fuling, and Baizhu. If Spleen deficiency with heat fails to control blood, use Sijunzi Tang (Four Gentlemen Decoction) with stir-fried Zhizi and Mudanpi. If there is constraint in the Spleen meridian, use Guipi Tang (Restore the Spleen Decoction) with Schisandra Fructus (Wuweizi). If there is Qi deficiency of the Spleen and Lungs, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Wuweizi. If both Qi and Blood are deficient, use Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction). If Yin fire moves recklessly, use Liuwei Dihuang Wan with Wuweizi. Generally, when excessive blood loss presents with symptoms such as irritability, heat, and thirst, regardless of the pulse, one should urgently use Duchang Tang (Single Ginseng Decoction) to tonify Qi. The Classics state: "Blood is generated by Qi." Unless one uses sweet-warm agents such as Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizome (Baizhu) to generate Heart and Liver blood, recovery is impossible. If there is fever and a large pulse, it is incurable. For all hemorrhagic conditions, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used as the primary formula. Tu Jianshan, a Hanlin academician, aged forty, suffered from damp-toxin sores. He mistakenly used preparations containing Calomelas (Qingfen), damaging his Yuan Qi, and the condition persisted for a long time without healing. One evening, upon examination, his Liver pulse was suddenly surging, rapid, and forceful. I asked, "Why is the Liver pulse like this?" The next morning, three or four bowls of dark blood flowed from the sore. He felt fatigued and sweated spontaneously. Although this was frightening, fortunately, the blood was dark and the pulse was calm. I said, "This is the heat toxin of Qingfen; the blood flows recklessly due to its toxicity, allowing the toxin to be expelled. The pathogenic factor is gone, but the True Qi is deficient. One must urgently inject Duchang Tang to replenish him." I valued his character and felt deep compassion, but he was confused by others' advice and did not comply. Consequently, the pathogenic factors lingered endlessly. What a pity! Another patient had a back sore that bled, accompanied by irritability, thirst, a surging pulse that was empty upon deep pressure. This was irritability due to blood depletion. Two doses of Danggui Buxue Tang (Angelica Tonifies the Blood Decoction) brought slight improvement. Subsequently, Bazhen Tang (Eight Treasures Decoction) with Astragali Radix (Huangqi) and Zhizi cured him completely. A woman, after ulceration, vomited approximately three bowls of bright red blood. I stopped the bleeding with Duchang Tang and healed the sore using Sijunzi Tang with Prepared Rehmanniae Radix (Shudihuang), Ligusticum Chuanxiong Rhizome (Xiongui). This illustrates the principle of tonifying Qi for blood depletion, i.e., Yang generates Yin. If cooling-blood and descending-fire cold agents were used, they would further injure the generating Qi of the Spleen Earth. Not only would the blood fail to return to its source, but death would be inevitable. An elderly woman developed a Ding carbuncle on her thumb. After being pricked by someone, bright red blood flowed, and her hand dorsum swelled entirely, causing pain throughout half her body. She had been delirious for five days. I prescribed Huoming Yin (Decoction for Saving Lives). Initially, the pain was localized to the hand. Although the sore was severe, aggressive treatment was inappropriate. I administered one dose of a major tonifying agent, followed by external garlic-separated moxibustion. Fortunately, the swelling on the hand dorsum discharged toxic fluid. After another dose, the swelling gradually ulcerated. Finally, using interior-supporting medicines, she recovered. He Chaoqing, a Southern Ministry of Rites official, promoted to Vice Minister of Shanxi. Upon parting, I noticed his lips and nose were cyanotic and black, and he frequently scratched his back. When asked, he replied, "It is just a small sore!" Upon inspection, it was indeed a Ju abscess. This indicated failure of the Spleen and Stomach, an incurable condition. Knowing we were friends, I pitied his inconvenience in arranging burial during travel, so I asked his colleagues, such as Zhang Dongsha, to detain him forcibly and administered strong tonics. Only purple blood was discharged, indicating extreme deficiency. Some suggested the toxin was too intense to form pus, so he took a cup of attacking/toxic medicine, leading to vomiting, reversal, and pulse disappearance. He indeed died in Nanjing. Zhang Biya, a censor, developed a Ju abscess on his waist. After drinking, he engaged in sexual intercourse. His pulse was surging and rapid, with the two Chi pulses even larger. I declined treatment and prepared to depart by boat, but his son insisted I stay. Soon after, he vomited five or six bowls of foul-smelling blood. I suspected this was reckless bleeding due to deficient fire in the Kidney meridian, likely emerging from the gums. I prepared decoctions separately in jars, including Cinnamon Bark (Rougui) and other herbs to tonify the Kidney and suppress fire. After the bleeding stopped, I wiped his teeth and checked; it was indeed so. I mixed them into one cup for cold administration. The heat and thirst ceased immediately. After a while, I administered another cup warm. His pulse became fine and nearly imperceptible, his breath faint. With the medicine, the pulse slightly recovered, but soon disappeared again. His son suspected pus inside and wanted to lance it. I said, "There certainly is none," and inserted a goose feather tube, confirming my diagnosis. The next day, his pulse vanished, and cold extended up to his knees. His abdomen felt like ice. I urgently prescribed Liujunzi Tang (Six Gentlemen Decoction) with dried Ginger (Shengjiang) and Prepared Aconite Root (Fuzi). Only then did his abdomen warm up, pus begin to drain, and the sore start to heal. However, because his attendants favored his maternal relatives, and he suffered from urinary retention—indicating his Yin essence was exhausted yet he sought sexual gratification to ejaculate, causing internal essence to fail and remain undischarged—I prescribed modified Liuwei Dihuang Wan ingredients with added Renshen and Baizhu. Although his urination improved, the sore failed to close, and he died.
Dongyuan's Shengyu Tang treats continuous bleeding from various malignant sores. Applying fine powder of Hypotrichous Stone (Han Shui Shi) stops bleeding immediately. If the sore occasionally turns black and cannot ulcerate, and medicinal efficacy fades leaving it red and harmonious, this formula is used. If excessive bleeding causes mental restlessness and insomnia, this indicates blood loss, and this formula is indicated.
Prepared Rehmanniae Radix (Shudihuang) and Raw Rehmanniae Radix (Shengdihuang) (each 3 qian), Angelicae Sinensis Radix (Danggui) body (1.5 qian), Ligusticum Chuanxiong Rhizome (Chuanxiong) (2 qian), Astragali Radix (Huangqi) (0.5 fen), Ginseng Radix (Renshen) (0.3 fen).
Cut the herbs. Combine for one dose. Add 1.5 cups of water, decoct to 1 cup. Strain, drink slightly warm at any time. (Note: In this formula, the dosage disparity between Renshen/Huangqi and Danggui/Shudihuang is significant, suggesting an error.)
Jisheng's Xijiao Dihuang Tang treats reckless bleeding due to Stomach fire and blood heat, manifesting as hematemesis, epistaxis, or hematochezia.
Rhino Horn (powdered), Raw Rehmanniae Radix (Shengdihuang), Red Peony Root (Chi Shaoyao), Moutan Cortex (Mudanpi) (each 1.5 qian), Cimicifugae Rhizoma (Shengma), Scutellariae Radix (Huangqin) (stir-fried, each 1 qian).
Decoct in water, add Rhino Horn powder, and take.
If caused by anger, add Gardenia Fructus (Zhizi) and Bupleuri Radix (Chaihu). If Spleen Qi deficiency fails to control blood, use Guipi Tang. If Liver and Spleen fire move recklessly, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Spleen Qi deficiency fails to govern blood, use Buzhong Yiqi Tang with stir-fried Black Dry Ginger (Pao Ganjiang). If Blood deficiency with fire causes reckless bleeding, use Siwu Tang with stir-fried Ginger (Pao Jiang). If Kidney meridian deficient fire causes reckless bleeding, use Liuwei Dihuang Wan ingredients. If ineffective, urgently add Rougui to guide deficient fire back to its source.
Duchang Tang treats all types of blood loss, or excessive discharge of pus and water, where both Qi and Blood are deficient, presenting with aversion to cold, fever, thirst, and irritability. Since blood is generated by Qi, tonifying Qi for blood depletion follows the principle that Yang generates Yin. Use 2 liang of Renshen, 10 Jujubae Fructus (Zao), and 10 slices of fresh Ginger (Shengjiang). Decoct in water and take slowly.
Modifications of Tuoli Xiaodu San: If pus is abundant and bloody, it indicates Blood deficiency. Remove Jin Yin Hua (Lonicerae Japonicae Flos), Lian Qiao (Forsythiae Fructus), and Bai Zhi (Angelicae Dahuricae Radix); add Danggui, Dihuang, Renshen, and Baizhu. If ineffective, temporarily use Bazhen Tang with Mudanpi. If anger and afternoon fever cause bleeding, it indicates Liver fire and Blood deficiency. Remove the three aforementioned herbs; add Mudanpi, stir-fried black Zhizi, and Shudihuang. If ineffective, temporarily take Bazhen Tang with Liuwei Wan. If face is cyanotic and hypochondriac distension occurs with bleeding, it indicates Liver Qi deficiency failing to store blood. Remove the three herbs; add Cornus Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), and Wuweizi. If ineffective, combine with Liuwei Wan. If poor appetite and fatigue occur with bleeding, it indicates Spleen Qi deficiency failing to control blood. Remove the three herbs; add Renshen, Baizhu, Danggui, and Dihuang. If combined with depression, anger, and insomnia, add Polygalae Radix (Yuanzhi), Ziziphus Seed (Suanzaoren), Poria (Fushen), and Longan Aril (Longyanrou). If ineffective, temporarily use Guipi Tang.