大意
血者。水谷之精气也。（玉机）饮食入胃。取汁变化。生于脾。总统于心。藏于肝。宣布于肺。施泄于肾。（内经）
和调五脏。洒陈六腑。其入于脉也。源源而来。灌溉一身。（玉机）目得血而能视。耳得血而能听。手得血而能摄。掌
得血而能握。足得血而能步。脏得之而能液。腑得之而能气。（内经）是以出入升降之道。濡润宣通者。皆血
之使然也。生化旺则诸经由此而长养。衰耗竭则百脉由此而空虚。（玉机）
内因
天地之道。阳常有余。阴常不足。故人身精血难成而易亏。（丹溪）女子二七而经行。七七而经断。男子二八
而精通。八八而精竭。（内经）可见阴气之成。止供三十年之运用。已先亏矣。况人之情欲无涯。（丹溪）喜怒不
节。起居不时。饮食自倍。荣血乱行。内停则为蓄血。外溢则为渗血。（汇补）
外候
妄行于上则吐衄。衰涸于内则虚劳。流渗于下则便血。热蓄膀胱则溺血。渗入肠间为痔血。阴虚阳搏为
崩中。湿蒸热瘀为血痢。热极腐化为脓血。火极似水。色紫黑。热胜于阴。为疮疡。湿滞于血。为瘾疹。热极沸
腾。为发斑。蓄在上。令人喜忘。蓄在下。令人如狂。堕恐跌仆。则瘀恶凝结。内滞痰污。则 瘕积块。（玉机）
血分经来
从肺而溢于鼻者为衄。从胃而逆于口者为吐。从肾而夹于唾者为咯。从嗽而来于肺者为咳。又痰涎血
出于脾。牙宣出于肾。舌衄出于心。（绳墨）肌衄出于心肺。 血出于膀胱。（汇补）
血分轻重
大概血病于内。瘀则易治。干则难医。血走于外。下流为顺。上溢为逆。凡血症身无潮热者轻。有潮热者重。
如九窍出血。而兼身热不能卧者死。惟妇人产后瘀血妄行。九窍出血。有用逐瘀之药而生者。不可遽断
其必死。若无故卒然暴厥。九窍出血者。死。久病之人。忽然上下见血。亦死。所谓阳络伤则血外溢。阴络伤
则血内溢也。（汇补）
血症脉法
脉者。血之府也。注于脉。少则涩。盛则滑。充则实。衰则虚。虚甚则微细。此其常也。若失血而脉反洪大中空
者。即为芤脉。盖阴血既亏。阳无所根据。浮散于外。故见此象。所以产后失血后。恒得芤大之脉。设不明辨。误
用寒凉则谬。（叔承）故崔氏曰。诸症失血。皆见芤脉。随其上下。以验所出。又尺脉滑而疾者。亦为血虚。肝脉
弦而紧。症兼胁痛者。有瘀血。大凡失血脉滑小沉弱者生。实大急数者死。（脉经）
总治
血症有四。曰虚。曰瘀。曰热。曰寒。治血之法有五。曰补。曰下。曰破。曰凉。曰温是也。血虚者。其症朝凉暮
热。手足心热。皮肤干涩甲错。唇白。女子月事。前后不调。脉细无力。法宜补之。血瘀者。其症在上则烦躁。漱水不
咽。在下则如狂谵语。发黄。舌黑。小腹满。小便自长。大便黑而少。法宜下之。在女子则经停腹痛。产后小腹
胀痛。手不可按。法宜破之。血热者。其症吐衄咳咯溺血。午后发热。女子月事先期而来。脉弦而数。法宜凉
之。血寒者。其症麻木疲软。皮肤不泽。手足清冷。心腹怕寒。腹有块痛。得热则止。在女子则月事后期而痛。
脉细而缓。法宜温之。又有吐衄便血。久而不止。因血不能附气失于归经者。当温脾肾二经。脾虚不统摄
者。用姜、附以温中焦。肾虚不归经者。用桂、附以温命门。皆温之之法也。（六要）
调气
气血者。同出而异名也。故血随气行。气行则行。气止则止。气温则滑。气寒则凝。凡凉血必先清气。气凉则
血自归经。（入门）活血必先顺气。气降而血自下行。温血必先温气。气暖而血自运动。养血必先养气。气旺
而血自滋生。（汇补）
血虚补气
阳生则阴长。血脱则益气。（仲景）凡上下血溢。大出不止者。宜甘补之品。急补元气。（三锡）盖血病每以胃药
收功。胃气一复。其血自止。（入门）昧者不知调理脾胃之法。概用滋阴。致食少泻多。皆地黄纯阴泥膈之故
也。（三锡）
血气所本
脾为后天之本。三阴之首也。脾气健则元气旺而阴自固。肾为先天之本。三阴之蒂也。肾水足则龙火潜
而阴亦宁。故血症有脾虚者。当补脾以统其血。有肾虚者。当壮水以制其阳。有肾中阳虚者。当益火以引
其归。能于三法而寻绎之。其调摄血门一道。思过半矣。（汇补）
血家禁戒
亡血家不可发汗。汗之则筋脉失养。变为筋惕肉 。甚者必发 。（仲景）宜养荣以救之。（汇补）
血症用药
常法。以四物汤为主。血瘀。加桃仁、红花、苏木、丹皮。血滞。加玄胡索、香附、蒲黄、牛膝。血溢。加藕节、
柏叶、小蓟汁、童便、茅花、京墨汁。血崩。加续断、荆芥穗、阿胶、艾叶。便血。加地榆、槐角、阿胶。血痛在肢节。
加乳香、没药。在心腹。加蒲黄、五灵脂。血虚。加枸杞、苁蓉。血燥。加乳酪、蜂蜜。血热。加天冬、生地。血寒。
加干姜、肉桂。活血。加韭汁、牛膝。养血。加丹参、秦艽。其间审择采用以为佐使。存乎其人。至于君主之方。当遵
虚实大法。实热者。犀角地黄汤。虚热者。四生丸、生地黄散。虚寒者。建中汤、理中汤。细而分之。血症肝虚者。逍
遥散。肺虚者。麦冬饮子。肾虚者。地黄汤。心虚者。归脾汤。脾虚者。异功散。若再进而五脏兼病者。又当推而互之。
肾虚而肺家有火者。地黄汤。加麦冬、山栀、贝母、沙参。肾虚而肺气衰耗者。地黄汤加麦冬、五味。肺脉虚甚者。再
加人参。肾虚而下焦寒冷者。地黄汤加肉桂、五味。脾虚而元气下陷者。补中益气汤。脾虚而荣卫两弱者。人参养
荣汤。脾肾两虚。上焦有热者。清宁膏。脾肾两虚。下焦阴寒者。八味丸。脾肾两虚。中下二焦俱寒者。理中汤
加肉桂、补骨脂。夫血症而用炮姜、肉桂、附子、理中、建中、八味者。因外有假热。内有真寒。孤阳浮露。血不能
藏。故用温剂以吸血归元。乃变病变法也。（汇补）
血症选方
四物汤 统治血症。（方见中风）
丹溪方 治一切火载血而上升之症。
四物汤加山栀、童便、姜汁。或用韭汁、童便。相和服之。
犀角地黄汤（活人） 治上焦实热血溢之症。
犀角 白芍药（各一钱） 生地黄（四钱） 丹皮（一钱半）
水煎服。一方。有黄芩、黄连、大黄。无芍药、丹皮。
四生丸 治火症上焦吐衄。
生荷叶 生柏叶 生艾叶 生地黄（各等分）
捣为丸。鸡子大。每服一丸。水煎服。
生地黄饮子 治虚热血症。
生地 熟地 黄芩 地骨皮 天门冬 白芍药 甘草 银柴胡 麦门冬 黄 （各等分）
水煎。
理中汤 治血症久不止。属中焦脾胃虚寒不能统血者。（方见中寒）
建中汤（仲景） 治脾虚肝旺。中气衰馁而失血。症属虚寒者。
肉桂 甘草（炙各一钱半） 芍药（三钱） 大枣（二枚） 胶饴（半合） 生姜（一钱半）
水煎服。 加当归、白术人参。以治血家虚寒症。
逍遥散 治肝虚内热血症。（方见火症）
麦冬饮子 治肺虚内热血症。
麦冬 黄 当归 生地 人参 五味子 阿胶 挟痰。加贝母。
水煎服。
地黄汤 治肾家阴虚血症。
归脾汤 治劳心过度血症。（二方俱见中风）
异功散 治脾虚血症。食少泻多者。
人参 白术 茯苓（各一钱半） 甘草 陈皮（各七分） 姜（三片） 枣（二枚）
即六君子汤减去半夏。以血家忌用半夏也。
生脉散 能养脾保肺。随所见症。或与地黄汤同用。或与异功散合用。（方见暑症）
补中益气汤 治失血久而元气下陷者。
人参养荣汤 治血症心肝脾三经荣卫两虚者。（二方俱见中风）
清宁膏 治血家脾肺肾三经俱虚。不可寒凉又不可温燥者。
葳蕤 橘红 百合 贝母 甘草 桔梗 龙眼 薏苡仁 麦门冬 石斛 生地 白术
河水煎膏。空心。滚汤化下五匙。此方亦可作煎剂服。如病患胸膈不宽。食少作胀者。减去生地。如咳
痰不清。嗽甚见血者。减去白术。
八味丸 治血病上热下寒。两足清冷。尺脉微细者。（方见中风）
【大意】
血，是水谷精微化生的精气。（出自《玉机真脏论》）饮食进入胃中，经过消化提取汁液并变化，由脾脏生成，受心脏统摄，贮藏于肝脏，宣发输布于肺脏，排泄施用于肾脏。（出自《内经》）
血液调和五脏，洒陈散布于六腑。当它进入脉管时，源源不断地流注，灌溉滋养全身。（出自《玉机真脏论》）眼睛得到血的濡养就能视物，耳朵得到血的濡养就能听声，手部得到血的濡养就能抓取，手掌得到血的濡养就能握持，足部得到血的濡养就能行走，脏腑得到血的濡养就能产生津液和元气。（出自《内经》）因此，人体出入升降的通道，以及濡润宣通的功能，都是依靠血的作用实现的。气血生化旺盛，各条经脉就由此得到长养；气血衰耗枯竭，百脉就由此变得空虚。（出自《玉机真脏论》）
【内因】
天地运行的规律是阳气常有余而阴气常不足。所以人体的精血难以形成却容易亏损。（出自朱丹溪）女子十四岁月经来潮，四十九岁经血断绝；男子十六岁精气通畅，六十四岁精气枯竭。（出自《内经》）由此可见，阴气的生成，仅够三十年运用，就已经先期亏损了。何况人的情欲没有边际。（出自朱丹溪）喜怒情绪不加节制，起居作息不按时令，饮食过量一倍，导致营血运行紊乱。在内停滞就成为蓄血，在外溢出就成为渗血。（出自《证治汇补》）
【外候】
血妄行于上部则出现吐血、鼻衄；内部衰竭枯竭则成为虚劳；流渗于下部则出现便血；热邪蓄积在膀胱则出现尿血；渗入肠间成为痔血；阴虚而阳热搏结则成为崩中漏下；湿热蒸腾瘀滞成为血痢；热极腐败化脓成为脓血；火极似水，血色紫黑；热胜于阴，成为疮疡；湿邪滞留于血分，成为瘾疹（风团）；热极沸腾，成为发斑；瘀血蓄积在上部，使人喜欢忘事；蓄积在下部，使人神志如狂。堕胎、惊恐、跌打损伤，则导致瘀血恶露凝结；内部停滞痰浊污秽，则形成瘕积块。（出自《玉机真脏论》）
【血分来源】
从肺脏溢出而从鼻腔流出的是衄血；从胃逆乱而从口中吐出的是吐血；从肾脏夹杂在唾液中吐出的是咯血；从咳嗽而来源于肺脏的是咳血。又有痰涎中的血出于脾脏，牙龈出血出于肾脏，舌上出血出于心脏。（出自《医宗绳墨》）皮肤出血（肌衄）出于心肺，尿道出血出于膀胱。（出自《证治汇补》）
【血病轻重】
大致而言，血病在体内，瘀血容易治疗，干涸难治。血走于体外，向下流淌为顺证，向上溢出为逆证。凡是血症患者身体没有潮热的病情轻，有潮热的病情重。如果九窍出血，并且兼有身热不能卧倒的，预后不良（死）。只有妇女产后因瘀血妄行导致九窍出血的，有用逐瘀药物而存活的，不可立即断定必死无疑。如果是无故突然暴厥，九窍出血的，预后不良（死）。久病之人，忽然上下同时见血，也预后不良（死）。这就是所谓阳络受伤则血外溢，阴络受伤则血内溢的道理。（出自《证治汇补》）
【血症脉法】
脉，是血的府库。血注入脉中，血量少则脉涩，血量盛则脉滑，血量充盛则脉实，血量衰少则脉虚，虚甚则脉微细，这是正常的脉象。如果失血而脉象反而洪大中空，这就是芤脉。因为阴血已经亏损，阳气无所依附，浮散于外，所以出现这种脉象。因此产后失血后，常常得到芤大之脉。如果不仔细辨别，误用寒凉药物就会出错。（出自崔氏《脉诀》）所以崔氏说：各种病症失血，都会见到芤脉，根据脉象出现的部位，可以验证出血的来源。另外，尺脉滑而疾快的，也是血虚的表现；肝脉弦而紧，症状兼有胁痛的，是有瘀血。大凡失血之后，脉象滑小沉弱的能生，实大急数的会死。（出自《脉经》）
【总治原则】
血症有四种类型：虚、瘀、热、寒。治疗血的方法有五种：补、下、破、凉、温。血虚的症状：早晨凉晚上热，手足心发热，皮肤干燥粗糙如鳞甲，嘴唇苍白，女子月经前后不调，脉细无力。治法适宜用补法。血瘀的症状：在上部则烦躁，漱水但不咽下；在下部则神志如狂、胡言乱语，发黄，舌苔黑，小腹胀满，小便自利，大便黑而量少。治法适宜用下法。在女子则表现为月经停闭腹痛，产后小腹胀痛，手不可按压。治法适宜用破血法。血热的症状：吐血、鼻衄、咳血、咯血、尿血，午后发热，女子月经提前来潮，脉弦而数。治法适宜用凉血法。血寒的症状：麻木疲软，皮肤无光泽，手足清冷，心腹部怕冷，腹部有块状疼痛，得热则缓解。在女子则表现为月经后期且疼痛，脉细而缓。治法适宜用温法。又有吐血、鼻衄、便血，久而不止，因为血不能依附于气而失去回归经络的能力，应当温补脾肾二经。脾虚不能统摄血液的，用干姜、附子以温中焦；肾虚不能引血归经的，用肉桂、附子以温命门。这都是温法的应用。（出自《景岳全书·六要》）
【调气】
气和血，同源而异名。所以血随气而行，气行则血行，气止则血止，气温则血行滑利，气寒则血凝滞。凡是凉血必须先清气，气凉则血自然回归经络。（出自《医学入门》）活血必须先顺气，气降则血自然下行。温血必须先温气，气暖则血自然运动。养血必须先养气，气旺则血自然滋生。（出自《证治汇补》）
【血虚补气】
阳生则阴长，血脱则益气。（出自张仲景）凡是上下出血，大量不止的，适宜用甘温补益的药物，紧急补益元气。（出自《三锡方》）大概血病往往通过调理脾胃而痊愈，胃气一旦恢复，血自然停止。（出自《医学入门》）愚昧的人不知道调理脾胃的方法，一概使用滋阴药，导致食少腹泻多，这都是地黄纯阴滋腻碍胃的缘故。（出自《三锡方》）
【血气所本】
脾是后天之本，三阴经之首。脾气健运则元气旺盛而阴血自固。肾是先天之本，三阴经的根基。肾水充足则龙雷之火潜伏而阴血亦安宁。所以血症中有脾虚的，应当补脾以统摄血液；有肾虚的，应当壮水以制约阳亢；有肾中阳虚的，应当益火以引导血归原经。能在这三种方法中推究寻绎，那么调理血证的门道，也就掌握大半了。（出自《证治汇补》）
【血家禁戒】
亡血之家不可发汗。发汗则筋脉失去濡养，变为筋惕肉瞤（肌肉跳动），严重的必然发生痉病。（出自张仲景）适宜用养荣血的方法来救治。（出自《证治汇补》）
【血症用药】
常规治法，以四物汤为主。血瘀，加桃仁、红花、苏木、丹皮。血滞，加玄胡索、香附、蒲黄、牛膝。血溢，加藕节、侧柏叶、小蓟汁、童便、茅花、京墨汁。血崩，加续断、荆芥穗、阿胶、艾叶。便血，加地榆、槐角、阿胶。血痛在肢节，加乳香、没药。在心腹，加蒲黄、五灵脂。血虚，加枸杞、肉苁蓉。血燥，加乳酪、蜂蜜。血热，加天冬、生地黄。血寒，加干姜、肉桂。活血，加韭汁、牛膝。养血，加丹参、秦艽。其间审慎选择采用作为佐使药，取决于医生本人。至于君药的主方，应当遵循虚实的大法。实热者，用犀角地黄汤；虚热者，用四生丸、生地黄散；虚寒者，用建中汤、理中汤。细致细分，血症肝虚者，用逍遥散；肺虚者，用麦冬饮子；肾虚者，用地黄汤；心虚者，用归脾汤；脾虚者，用异功散。如果再进而五脏兼病，又应当推演互参。肾虚而肺家有火的，用地黄汤，加麦冬、山栀、贝母、沙参。肾虚而肺气衰耗的，用地黄汤加麦冬、五味子。肺脉虚甚的，再加人参。肾虚而下焦寒冷的，用地黄汤加肉桂、五味子。脾虚而元气下陷的，用补中益气汤。脾虚而营卫两弱的，用人参养荣汤。脾肾两虚，上焦有热的，用清宁膏。脾肾两虚，下焦阴寒的，用八味丸。脾肾两虚，中下二焦俱寒的，用理中汤加肉桂、补骨脂。对于血症使用炮姜、肉桂、附子、理中汤、建中汤、八味丸的，是因为外有假热，内有真寒，孤阳浮露，血不能藏，所以用温剂来吸引血归元，这是变病变法。（出自《证治汇补》）
【血症选方】
四物汤 统治各类血症。（方剂见中风章节）
丹溪方 治疗一切火载血而上升的病症。
四物汤加山栀、童便、姜汁。或者用韭汁、童便，混合服用。
犀角地黄汤（出自《千金翼方》/活人书） 治疗上焦实热血溢的病症。
犀角 白芍药（各一钱） 生地黄（四钱） 丹皮（一钱半）
水煎服。另一版本，有黄芩、黄连、大黄，无芍药、丹皮。
四生丸 治疗火症引起的上焦吐衄。
生荷叶 生柏叶 生艾叶 生地黄（各等分）
捣碎制成丸药，鸡蛋大小。每次服用一丸，水煎服。
生地黄饮子 治疗虚热血症。
生地 熟地 黄芩 地骨皮 天门冬 白芍药 甘草 银柴胡 麦门冬 黄芪（各等分）
水煎服。
理中汤 治疗血症久治不愈，属于中焦脾胃虚寒不能统血的。（方剂见中寒章节）
建中汤（张仲景方） 治疗脾虚肝旺，中气衰馁而失血，症状属虚寒的。
肉桂 甘草（炙各一钱半） 芍药（三钱） 大枣（二枚） 胶饴（半合） 生姜（一钱半）
水煎服。加当归、白术、人参，用来治疗血家虚寒症。
逍遥散 治疗肝虚内热血症。（方剂见火症章节）
麦冬饮子 治疗肺虚内热血症。
麦冬 黄芪 当归 生地 人参 五味子 阿胶 挟痰者，加贝母。
水煎服。
地黄汤 治疗肾家阴虚血症。
归脾汤 治疗劳心过度导致的血症。（以上二方均见中风章节）
异功散 治疗脾虚血症，食少腹泻多的。
人参 白术 茯苓（各一钱半） 甘草 陈皮（各七分） 姜（三片） 枣（二枚）
即六君子汤减去半夏，因为血家忌用半夏。
生脉散 能养脾保肺。根据所见症状，或与地黄汤同用，或与异功散合用。（方剂见暑症章节）
补中益气汤 治疗失血久而元气下陷的。
人参养荣汤 治疗血症中心肝脾三经营卫两虚的。（以上二方均见中风章节）
清宁膏 治疗血家脾肺肾三经俱虚，不可用寒凉也不可温燥的。
葳蕤 橘红 百合 贝母 甘草 桔梗 龙眼 薏苡仁 麦门冬 石斛 生地 白术
河水煎煮成膏。空腹时，用滚开水化开五匙服用。此方也可作煎剂服用。如果病患胸膈不宽畅，食少腹胀的，减去生地。如果咳痰不清，咳嗽严重见血的，减去白术。
八味丸 治疗血病上热下寒，两脚清冷，尺脉微细的。（方剂见中风章节）
[General Principle]
Blood is the essence and qi transformed from water and grain. (From *Yu Ji*) When food and drink enter the stomach, their juices are extracted and transformed, generated by the Spleen, commanded by the Heart, stored in the Liver, distributed by the Lung, and excreted/utilized by the Kidney. (From *Nei Jing*)
It harmonizes the Five Zang organs and spreads to the Six Fu organs. When it enters the vessels, it flows continuously, irrigating and nourishing the whole body. (From *Yu Ji*) The eyes see when they receive blood; the ears hear when they receive blood; the hands grasp when they receive blood; the palms grip when they receive blood; the feet walk when they receive blood. The Zang organs produce fluids when they receive it; the Fu organs generate Qi when they receive it. (From *Nei Jing*) Therefore, the pathways of ascending, descending, entering, and exiting, as well as the moistening and unblocking functions, are all caused by blood. When the generation and transformation are vigorous, all meridians are nourished thereby; when they decline, deplete, or exhaust, all vessels become empty thereby. (From *Yu Ji*)
[Internal Causes]
The way of Heaven and Earth is that Yang is often in excess, while Yin is often deficient. Thus, human essence and blood are difficult to form but easy to lose. (From Zhu Danxi) Women begin menstruation at age fourteen (two times seven) and cease at age forty-nine (seven times seven). Men's essence becomes clear at age sixteen (two times eight), and their essence exhausts at age sixty-four (eight times eight). (From *Nei Jing*) This shows that the formation of Yin energy suffices for only thirty years of use, having already been deficient beforehand. Moreover, human desires and passions are boundless. (From Zhu Danxi) Unregulated anger and joy, irregular daily routines, and diet exceeding normal amounts cause Ying Blood to circulate chaotically. Internally stagnant, it becomes accumulated blood (Xu Xue); externally overflowing, it becomes seeping blood (Shen Xue). (From *Zheng Zhi Hui Bu*)
[External Manifestations]
If blood rebels upwards, it causes hematemesis or epistaxis. If it depletes internally, it becomes consumptive disease (Xu Lao). If it seeps downwards, it causes hematochezia. Heat accumulating in the Bladder causes hematuria. Seeping into the intestines causes hemorrhoidal bleeding. Yin deficiency with Yang pounding causes metrorrhagia (Beng Zhong). Dampness steaming with heat stasis causes bloody dysentery. Extreme heat causing putrefaction leads to pus and blood. Extreme fire resembles water, presenting with purple-black color. Heat prevailing over Yin causes sores and ulcers. Dampness stagnating in the blood layer causes urticaria (Yin Zhen). Extreme heat boiling causes macules (Fa Ban). Accumulation in the upper part causes forgetfulness. Accumulation in the lower part causes mania-like behavior. Abortion, fright, or falls lead to the coagulation of blood stasis and foul lochia. Internal stagnation of phlegm and filth leads to abdominal masses (Jia Jia). (From *Yu Ji*)
[Origins of Bleeding]
Overflowing from the Lung and coming out of the nose is epistaxis (Nu). Reversing from the Stomach and coming out of the mouth is vomiting blood (Tu). Mixed with saliva and coming from the Kidney is spitting blood (Ko). Coming from coughing and originating in the Lung is coughing blood (Ke). Again, blood in sputum originates from the Spleen; gingival bleeding originates from the Kidney; lingual bleeding originates from the Heart. (From *Sheng Mo*) Cutaneous bleeding (Ji Nu) originates from the Heart and Lung; urethral bleeding originates from the Bladder. (From *Zheng Zhi Hui Bu*)
[Severity of Blood Diseases]
Generally, blood diseases within the body: stasis is easy to treat, dryness is difficult to cure. Blood flowing outward: downward flow is favorable (Shun), upward overflow is unfavorable (Ni). In general, blood diseases without tidal fever are mild; those with tidal fever are severe. If there is bleeding from the nine orifices accompanied by fever and inability to lie down, the prognosis is fatal. Only in postpartum women, where wild bleeding of retained blood causes bleeding from the nine orifices, can life be saved using blood-dispelling medicines; one should not hastily declare certain death. If there is sudden syncope without cause, accompanied by bleeding from the nine orifices, the prognosis is fatal. If a person with a chronic illness suddenly presents with bleeding above and below, the prognosis is also fatal. This is what is meant by: injury to Yang collaterals causes external bleeding; injury to Yin collaterals causes internal bleeding. (From *Zheng Zhi Hui Bu*)
[Pulse Diagnosis for Blood Diseases]
The pulse is the mansion of blood. When blood enters the vessels, scarcity makes the pulse choppy (Se), abundance makes it slippery (Hua), fullness makes it solid (Shi), and decline makes it deficient (Xu). Extreme deficiency makes it fine and minute (Wei Xi); this is the normal state. However, if after blood loss the pulse is instead flooding and hollow, this is the Coupling Pulse (Kou Mai). Since Yin blood is depleted, Yang has no foundation and floats outward, thus presenting this image. Therefore, after postpartum blood loss, a large and hollow pulse is often obtained. If not clearly distinguished, mistakenly using cold-cooling herbs would be an error. (From Cui Shi) Thus, Master Cui said: All conditions of blood loss present with a Kou Mai. By examining its position (upper or lower), one can verify the source of bleeding. Furthermore, a Slippery and rapid Chi pulse also indicates blood deficiency. A Wiry and Tight Liver pulse, accompanied by hypochondriac pain, indicates blood stasis. Generally, after blood loss, a Slippery, small, deep, and weak pulse indicates survival; a Solid, large, urgent, and rapid pulse indicates death. (From *Mai Jing*)
[General Treatment Principles]
There are four types of blood diseases: Deficiency, Stasis, Heat, and Cold. There are five methods for treating blood: Tonify, Purge, Break, Cool, and Warm.
For Blood Deficiency: Symptoms include morning coolness and evening heat, heat in the palms and soles, dry and scaly skin, pale lips, and irregular menstruation in women. The pulse is fine and powerless. The method should be to Tonify.
For Blood Stasis: Symptoms in the upper part include irritability and rinsing the mouth without swallowing. Symptoms in the lower part include mania, delirium, yellowing of the skin, black tongue, abdominal fullness, free urination, and dark, scanty stools. In women, it presents as amenorrhea with abdominal pain, or postpartum abdominal distension and pain intolerant to pressure. The method should be to Purge or Break stasis.
For Blood Heat: Symptoms include hematemesis, epistaxis, coughing/spitting blood, hematuria, afternoon fever, and early menstruation in women. The pulse is Wiry and Rapid. The method should be to Cool.
For Blood Cold: Symptoms include numbness and weakness, lusterless skin, cold hands and feet, fear of cold in the heart and abdomen, and abdominal mass pain relieved by warmth. In women, it presents as delayed menstruation with pain. The pulse is Fine and Slow. The method should be to Warm.
Additionally, for persistent hematemesis, epistaxis, or hematochezia due to blood failing to adhere to Qi and return to the vessels, one should Warm the Spleen and Kidney meridians. For Spleen deficiency failing to control blood, use Ginger and Aconite to Warm the Middle Jiao. For Kidney deficiency failing to guide blood back, use Cinnamon and Aconite to Warm the Gate of Vitality (Ming Men). These are applications of the Warming method. (From *Liu Yao*)
[Regulating Qi]
Qi and Blood share the same origin but have different names. Therefore, Blood follows Qi; when Qi moves, Blood moves; when Qi stops, Blood stops. When Qi is warm, Blood flows smoothly; when Qi is cold, Blood coagulates. To Cool Blood, one must first Clear Qi; when Qi is cool, Blood naturally returns to the vessels. To Invigorate Blood, one must first Smooth Qi; when Qi descends, Blood naturally flows downward. To Warm Blood, one must first Warm Qi; when Qi is warm, Blood naturally moves. To Nourish Blood, one must first Nourish Qi; when Qi is vigorous, Blood naturally generates. (From *Ru Men*)
[Tonifying Qi for Blood Deficiency]
When Yang grows, Yin grows. When Blood is lost, Tonify Qi. (From Zhang Zhongjing) For massive, unstoppable bleeding from above or below, sweet-tonifying substances should be used to urgently tonify Yuan Qi. Generally, blood diseases are often resolved by treating the Stomach. Once Stomach Qi recovers, the bleeding stops naturally. Ignorant practitioners, unaware of methods to regulate the Spleen and Stomach, indiscriminately use Yin-nourishing herbs, leading to poor appetite and frequent diarrhea, all due to the cloying nature of pure Yin Rehmannia. (From *San Xi*)
[Roots of Qi and Blood]
The Spleen is the Root of Post-Heaven existence and the head of the Three Yin meridians. When Spleen Qi is robust, Yuan Qi is vigorous, and Yin is naturally secured. The Kidney is the Root of Pre-Heaven existence and the蒂 (base/pivot) of the Three Yin meridians. When Kidney Water is sufficient, Dragon Fire is submerged, and Yin is tranquil. Therefore, for blood diseases due to Spleen deficiency, one should Tonify the Spleen to control blood. For Kidney deficiency, one should Strengthen Water to restrain Yang. For Kidney Yang deficiency, one should Benefit Fire to guide blood back. By exploring these three methods, one will have mastered more than half of the principles of regulating blood. (From *Zheng Zhi Hui Bu*)
[Contraindications for Blood Patients]
Patients who have lost blood should not undergo sweating therapy. Sweating deprives the sinews and vessels of nourishment, leading to twitching muscles; severely, it may develop into spasms. (From Zhang Zhongjing) One should use Blood-nourishing methods to rescue them. (From *Zheng Zhi Hui Bu*)
[Medication for Blood Diseases]
The standard method uses Si Wu Tang (Four Substances Decoction) as the main formula.
For Blood Stasis: add Tao Ren, Hong Hua, Su Mu, Dan Pi.
For Blood Stagnation: add Yan Hu Suo, Xiang Fu, Pu Huang, Niu Xi.
For Blood Overflow: add Ou Jie, Bai Ye, Xiao Ji Juice, Tong Bian (Child's Urine), Mao Hua, Jing Mo Zhi.
For Metrorrhagia: add Xu Duan, Jing Jie Sui, E Jiao, Ai Ye.
For Hematochezia: add Di Yu, Huai Jiao, E Jiao.
For Blood Pain in limbs/joints: add Ru Xiang, Mo Yao.
For Blood Pain in heart/abdomen: add Pu Huang, Wu Ling Zhi.
For Blood Deficiency: add Gou Qi, Cong Rong.
For Blood Dryness: add Milk/Cheese, Honey.
For Blood Heat: add Tian Dong, Sheng Di Huang.
For Blood Cold: add Gan Jiang, Rou Gui.
To Invigorate Blood: add Chive Juice, Niu Xi.
To Nourish Blood: add Dan Shen, Qin Jiao.
Selection of adjuvant and guiding herbs depends on the practitioner. As for the sovereign formulas, one must follow the great principles of Deficiency and Excess.
For Excess Heat: Xi Jiao Di Huang Tang.
For Deficient Heat: Si Sheng Wan, Sheng Di Huang Yin Zi.
For Deficient Cold: Jian Zhong Tang, Li Zhong Tang.
Specifically:
Liver Deficiency: Xiao Yao San.
Lung Deficiency: Mai Dong Yin Zi.
Kidney Deficiency: Di Huang Tang.
Heart Deficiency: Gui Pi Tang.
Spleen Deficiency: Yi Gong San.
If multiple Zang organs are involved:
Kidney Deficiency with Lung Fire: Di Huang Tang + Mai Dong, Shan Zhi, Bei Mu, Sha Shen.
Kidney Deficiency with Lung Qi Exhaustion: Di Huang Tang + Mai Dong, Wu Wei Zi.
Severe Lung Pulse Deficiency: Add Ren Shen.
Kidney Deficiency with Lower Jiao Cold: Di Huang Tang + Rou Gui, Wu Wei Zi.
Spleen Deficiency with Yuan Qi Sinking: Bu Zhong Yi Qi Tang.
Spleen Deficiency with Ying and Wei Both Weak: Ren Shen Yang Rong Tang.
Spleen and Kidney Deficiency with Upper Jiao Heat: Qing Ning Gao.
Spleen and Kidney Deficiency with Lower Jiao Yin Cold: Ba Wei Wan.
Spleen and Kidney Deficiency with Middle and Lower Jiao Cold: Li Zhong Tang + Rou Gui, Gu Zhi.
Using Pao Jiang, Rou Gui, Fu Zi, Li Zhong Tang, Jian Zhong Tang, or Ba Wei Wan for blood diseases is because there is false heat externally and true cold internally, with solitary Yang floating and blood unable to be contained. Thus, warming agents are used to attract blood back to its origin. This is a change in pathology and treatment method. (From *Zheng Zhi Hui Bu*)
[Selected Formulas for Blood Diseases]
Si Wu Tang (Four Substances Decoction): Treats all blood diseases. (See Stroke chapter)
Dan Xi Formula: Treats all conditions where Fire carries Blood rising upwards.
Si Wu Tang + Shan Zhi, Tong Bian, Jiang Zhi. Or mix Jiu Zhi and Tong Bian and take together.
Xi Jiao Di Huang Tang (from *Huo Ren*): Treats Upper Jiao Excess Heat causing blood overflow.
Rhinoceros Horn (Xi Jiao), White Peony Root (Bai Shao Yao) (1 qian each), Raw Rehmannia Root (Sheng Di Huang) (4 qian), Moutan Bark (Dan Pi) (1.5 qian).
Decoct in water and take. Another version contains Huang Qin, Huang Lian, Da Huang, without Bai Shao Yao and Dan Pi.
Si Sheng Wan (Four Generations Pill): Treats Upper Jiao hematemesis/epistaxis due to Fire syndrome.
Raw Lotus Leaf, Raw Bié Yè (Cacumen Platycladi), Raw Ai Ye (Folium Artemisiae Argyi), Raw Di Huang (Equal parts).
Pound into pills, size of a chicken egg. Take one pill per dose, decoct in water and take.
Sheng Di Huang Yin Zi: Treats Deficient Heat blood diseases.
Sheng Di, Shu Di, Huang Qin, Di Gu Pi, Tian Dong, Bai Shao Yao, Gan Cao, Yin Chai Hu, Mai Dong, Huang Qi (Equal parts).
Decoct in water.
Li Zhong Tang: Treats prolonged blood diseases belonging to Middle Jiao Spleen-Stomach Deficient Cold failing to control blood. (See Cold Syndrome chapter)
Jian Zhong Tang (Zhang Zhongjing): Treats Spleen Deficiency with Liver Excess, Middle Qi collapse causing blood loss, symptoms belonging to Deficient Cold.
Rou Gui, Roasted Gan Cao (1.5 qian each), Shao Yao (3 qian), Da Zao (2 pieces), Yi Tang (0.5 he), Sheng Jiang (1.5 qian).
Decoct in water and take. Add Dang Gui, Bai Zhu, Ren Shen to treat Deficient Cold blood diseases.
Xiao Yao San: Treats Liver Deficiency with Internal Heat blood diseases. (See Fire Syndrome chapter)
Mai Dong Yin Zi: Treats Lung Deficiency with Internal Heat blood diseases.
Mai Dong, Huang Qi, Dang Gui, Sheng Di, Ren Shen, Wu Wei Zi, E Jiao. If complicated by Phlegm, add Bei Mu.
Decoct in water and take.
Di Huang Tang: Treats Kidney Yin Deficiency blood diseases.
Gui Pi Tang: Treats blood diseases due to excessive mental labor. (Both formulas see Stroke chapter)
Yi Gong San: Treats Spleen Deficiency blood diseases with poor appetite and frequent diarrhea.
Ren Shen, Bai Zhu, Fu Ling (1.5 qian each), Gan Cao, Chen Pi (0.7 fen each), Jiang (3 slices), Zao (2 pieces).
This is Liu Jun Zi Tang minus Ban Xia, as Ban Xia is contraindicated for blood patients.
Sheng Mai San: Can nourish Spleen and protect Lung. Depending on symptoms, use with Di Huang Tang or combine with Yi Gong San. (See Summerheat Syndrome chapter)
Bu Zhong Yi Qi Tang: Treats prolonged blood loss with sinking of Yuan Qi.
Ren Shen Yang Rong Tang: Treats blood diseases with Ying and Wei deficiency in Heart, Liver, and Spleen meridians. (Both formulas see Stroke chapter)
Qing Ning Gao: Treats blood patients with simultaneous deficiency of Spleen, Lung, and Kidney meridians, where neither cold-cooling nor warming-drying is suitable.
Yu Zhu, Ju Hong, Bai He, Bei Mu, Gan Cao, Jie Geng, Long Yan, Yi Yi Ren, Mai Dong, Shi Hu, Sheng Di, Bai Zhu.
Decoct in river water into a paste. Take five spoons dissolved in boiling water on an empty stomach. This formula can also be taken as a decoction. If the patient has chest oppression and bloating after eating, remove Sheng Di. If there is unclear expectoration, severe coughing with blood, remove Bai Zhu.
Ba Wei Wan (Eight-Ingredient Pill): Treats blood diseases with Upper Heat and Lower Cold, cold feet, and fine/minimal Chi pulse. (See Stroke chapter)