补心如麦冬养荣汤。（潞党参、麦冬、归身、生地、生白芍各三钱、白知母二钱、北五味念粒、青盐陈皮八
分、清炙草六分、大红枣三枚。）十味补心汤。（辰茯神八钱、潞党参、生熟地各三钱、麦冬、炒枣仁、归身
各二钱、制香附钱半、远志八分、龙眼肉五朵。）琼玉膏。（鲜生地一斤取汁、净白蜜一斤、西洋参八两、云
苓十二两先将地汁白蜜入瓷瓶内、后将参、苓为末、和匀放水中、煮三昼夜、悬井中一夜、取起白汤化服一
两。）八仙玉液。（鲜生地汁、藕汁各二杯、梨汁、蔗汁、人乳各一杯、先将鸡子白两枚、鲜茅根一百枝、龙
眼肉七朵，煎取浓汁二杯、和入前四汁人乳、重汤炖温服。）天王补心丹之类。（熟地五钱、归身、生地、天
冬、麦冬、元参、炒枣仁、柏子仁、木茯神、党参、丹参各三钱、远志、五味、桔梗各一钱、净蜜为丸、每服
三钱。）补脾如加味归脾汤。（潞党参、炙黄 、生晒术、茯神、归身各三钱、枣仁、远志各二钱、阿胶、焦
山栀、丹皮各一钱、清炙草、广木香各五分、龙眼肉五枚。）养真汤。（党参、黄 、白术、麦冬各钱半、云
苓，山药、莲子、白芍各三钱、五味子、炙甘草各五分。）参燕异功煎。（吉林参、光燕条各一钱、生于术、
云苓各钱半、广橘白六分，清炙草四分。）补阴益气煎之类。补肝如地骨皮饮。（地骨皮、生地、白芍各三
钱、丹皮、归身各钱半、川芎六分。）唐氏补肝寄生汤。（生地、归身、萸肉、淮山药、炒枣仁、桑寄生各三
钱、木瓜一钱、白术五分、川芎六分、北五味二十粒。）三甲复脉汤。（即复脉汤去麻仁、姜、桂、加化龙骨三
钱、左牡蛎、生龟甲心各四钱。）清燥养营汤。四物绛覆汤之类。补肾如张氏左归饮。（熟地六钱、茯苓、山
药、甘杞子、山萸肉各三钱、盐水炒甘草六分。）六味地黄汤。（即左归饮去杞、草、加丹皮、泽泻各一钱、
若济君火、加元参、杞子、益肺气、加人参、麦冬、五味子、火甚者、加川柏、知母。）丹溪大补阴丸。（熟
地八两、川柏、知母各三两、炙龟版四两、猪脊髓四条、蜜丸、每服三四钱、淡盐汤送下。）龟柏地黄汤。坎
气潜龙汤。滋任益阴煎之类。此四法者。乃通治血证之大纲也。总之外感风寒。变为咳血。此证最多。失治误
治。往往酿成肺痨。若春夏秋感温热暑邪失血者。必兼身热心烦不卧等证。乃邪热扰营迫血所致。宜清营分之
邪热为主。犀地清络饮去桃仁。以藕汁、广郁金汁易姜蒲二汁。轻则羚角清营汤（羚角片一钱、鲜生地六钱、
焦山栀、银花、青连翘、血见愁各三钱、生蒲黄钱半、童便一杯冲。）若失血后热退身凉。神清气静者。邪热
已去也。审无别疾他故。只以生藕汁。或童便。日服一二杯。以济其阴可也。不必穷治。或服玉露饮。（大白
萝卜一个、切下蒂、挖空、入白糖填满、仍盖定、以线扎紧、取鲜稻上露三碗、煮极烂、以纱笼罩、露一宿、
炖温、空腹服、善治邪热伤肺胃营分而吐血者、并治烟酒过度、致咳血失血久不愈、均验。）尤多收效。他若
肥甘过度。肺胃湿热蕴隆。蒸痰动血。及烟酒不节。戕伤清气。咳呕频并。痰血时出。或便血溲血者。宜清肃
中上气机。菀贝茅根汤主之。（紫菀五钱、川贝四钱、鲜茅根一两、生桑皮、生苡仁、赤苓各三钱、青子芩、
竹沥半夏各钱半。）并戒荤酒。自能渐愈。若旧有闪挫等伤。其胸膈胁肋间。必向有一定痛痹之处。凡感邪热
内攻。冲动宿瘀。瘀血从上或从下出者。乃宿疾乘势欲除之机。慎勿止涩。如去之不快。身有结痛者。孙络之
瘀行而不尽也。犹需行血和络之药。如生蒲黄、生荷叶、蜜炙延胡、生藕汁之类。加入散邪清热方中。以除其
宿瘀。宿瘀一净。吐血已罢。心中不闷者。必止。若烦躁闷乱刺胀者。尚有瘀血在内也。以生萝卜汁一大碗。
顿饮。探吐之令净。或以开水调七厘散五分。日二服。以化之令散。否则牵延不愈。令瘀血不去。新血不守。
时时溢出。百治无功。不成痨瘵。则变内外诸痈矣。若因远行负重。劳伤失血。气逆于上。胸胁闷痛。甚则呼
吸亦痛。咳嗽带红。此等劳力伤气。宜用结者散之之法。初用降气和络饮。（栝蒌皮、甜杏仁、紫菀、川贝各
三钱、枇杷叶去毛筋净一两、苏丹参、生淮牛膝各三钱、参三七汁、广郁金汁各四匙、生藕汁两瓢、和匀同
冲）轻降辛润以疏化之。继用藕汁木耳煎。（生藕汁一杯、和入童便一杯、酒半杯、木耳洗去砂、瓦上焙脆、
研入三钱、白者更佳、但用一钱、日三服、数日愈。）和血宁络以除根。惟外感温热。内夹愤怒。怒则气逆。
血从上溢而大吐者。必见胸胁热痛。口燥心烦。二便赤热。手足躁扰等症。宜用龙胆泻肝汤去柴、归、车、
泽。加醋炒川连、广郁金、川楝子、代赭石等。以清肝火而止血。血失仍多。而精神声色。起居如常。唇舌红
赤者。尚属热逼血溢。宜三黄犀角汤。（生川军、青子芩、粉丹皮各二钱、加醋炒黑、鲜生地一两、生赤白芍
各三钱、黑犀角、盐水炒川连各八分、淡竹茹五钱。）大剂以泄降之。外用清盐卤一盆。令病患坐浸两足。若
血出虽少。已见头晕耳鸣。腰痛脚酸等症者。肾阴虚而肝阳不藏也。宜多服阿胶鸡子黄汤及龟版地黄汤等。育
阴潜阳以善后。
四夹齿血。血从牙龈流出也。故一名牙宣。甚有盈碗成盆。如线索牵拽而出。症见身热口渴。龈肿溺赤便闭
者。胃有实火也。治以咸苦泄降。犀连承气汤加藕节、童便。轻则大便通利者。不必凉泻。但用清解。犀地清
络饮。去桃仁、姜、蒲二汁。加藕汁、童便。如脉细数。舌光绛。口烂龈糜者。胃中虚火也。宜清热兼滋阴。
新加玉女煎去石英、磁石。加骨碎补、黑蒲黄。外用冷醋水漱口。十灰散掺。内外并治。奏功更速。
五夹便血。金匮但分远血近血。先粪后血曰远血。属小肠寒湿。先血后粪曰近血。属大肠湿热。寒湿用黄土
汤。（焦冬术、熟地炭各三钱、条芩炭、陈阿胶各二钱、淡附片、清炙草各六分、先用灶心黄土一两、冷水搅
化、澄清取水煎药。）湿热用赤豆当归散。（赤豆芽五钱、全当归三钱、研细、每服三钱、清浆水调下。）岂知
便血一证。外感六淫。皆能致病。非黄土汤当归散二方所可统治。必先治肠以去其标。后治各脏以清其源。若
纯下清血。其疾如箭。肛门不肿痛。而肠中鸣响者。此为肠风下血。治以清火疏风为主。清肝达郁汤去归菊。
送下保元槐角丸。（槐角、当归、生地、黄芩、黄柏、侧柏叶各三钱、枳壳、地榆、荆芥、防风各二钱、黄
连、川芎、生姜各一钱、乌梅三枚、用鲜荷叶汁白蜜炼丸、每服二三钱。）继用加味白头翁汤去贯仲、茉莉。
加阿胶、炙甘草。清肝坚肠。凉血滋阴以善后。若粪前下血。散而紫黯。或血色淡红。胃弱便溏。素无痔漏
证者。此为小肠寒湿下血。治以温补敛肠为主。加减黄土汤。（土炒白术、花龙骨、地榆炭各三钱、陈阿胶二
钱、黑炮姜、炙甘草、春砂仁各八分、先用伏龙肝一两、水化搅烊、澄清煎药、胡在兹先生验方。）继用加味
石脂禹粮汤。（赤石脂、禹余粮各三钱、土炒川 子、生于术、川芎炭各二钱、醋炒蕲艾一钱。）填窍补络以
善后。若下血色如烟尘。沉晦瘀浊。便溏不畅。胃气不健。肢体倦怠者。此由膏粱积热。酒酪聚湿。而为脏毒
下血。宜以苦辛淡泄。芩连二陈汤去姜沥二汁。加炒槐米二钱。大黑木耳三钱。茅根藕节各一两。重则清肠
解毒汤。（焦山栀三钱、银花炭、青子芩、连翘、赤芍各二钱、川连、川柏、生川军、焦枳壳、煨防风各一
钱。）继用木耳豆腐煎。（大黑木耳五钱、生豆腐四两、食盐一钱。）送下加味脏连丸。（川连五两、苦参三
两、生川军二两、圆皂角仁、白芷各一两五钱、光桃仁一两各为细末、取猪大肠洗净、纳入肠中、酒水各
半、煮烂捣研、和入百草霜一两、红曲三两、共捣为丸、每服三钱、朝晚空肚服、胡在兹先生验方。）清涤
肠浊以除根。若粪后下血。鲜红光泽。或色深紫。或有凝块紫亮者。此为肠热下血。宜以凉血泄热。地柏清肠
汤。（鲜生地六钱、生侧柏叶四钱、银花、茜草、赤芍、夏枯草、血见愁各二钱、紫葳花二钱、先用鲜茅根、
生藕各二两、煎汤代水、胡在兹先生验方。）继用脏连六味丸。（熟地五钱、萸肉、山药、赤苓、丹皮、泽泻、
川连各三钱、白矾一钱、嵌柿饼焙焦二枚、入猪大肠内、同糯米煮熟、去米、共捣为丸、每服二三钱、朝晚空
肚服。）如肛门肿坠。滴血淋漓。或血线如溅。里急后重。因大便随下清血不止。甚则 赤肿痛。此为内痔下
血。名曰血痔。治先荡涤瘀热。清肠解毒汤去防风。加槐米、桃仁、生地、炒 皮。痛极而下血多者。加乳
香、没药、发灰。红肿痛而不克收进者。外用点痔法。（大水田螺一个、挑去靥、入冰麝少许、过一宿、即化
水、点上痔即收进、如无水田螺、用大蜗牛一个去壳、生白果一枚、同捣烂、代之亦效。）俟肿痛血止。即用
补阴益气煎去熟地。加阿胶、生地、黑木耳。升气滋阴以善后。
六夹溺血。如证见淋漓割痛。小便点滴不畅者。此为染毒赤淋。治宜去毒通淋。导赤八珍散加味。（鲜生地、
滑石包煎各六钱、瞿麦、扁蓄、海金砂包煎、焦山栀各三钱、淡竹叶二钱、木通、生锦纹各一钱、生甘梢八
分、先用土茯苓、鲜车前草、去皮鲜茅根各一两、煎汤代水。）若无淋毒。但心经遗热于膀胱。膀胱热结则尿
血。症见虚烦不寐。或昏睡不省。或舌咽作痛。或怔忡懊 。治宜凉血泄热。导赤清心汤去茯、麦。加焦栀、
瞿麦、琥珀。如由肝经遗热者。必兼少腹满。胁肋刺痛。口苦耳聋。寒热往来。溺多赤淋。甚则筋痿茎疼。治
宜凉肝泻火。龙胆泻肝汤加丹皮、郁金。轻则清肝达郁汤去荷、菊。加龙胆草、生牛膝梢、鲜车前草。若治心
肝不效。当清其肺。肺为肾水之上源。肺清则水清。水宁则血宁。清燥救肺汤加蒲黄、茅根、藕节可也。总而
言之。止血之法。先要虚实寒热认得清。始能补泻温凉用得当。补如阿胶、熟地、线鱼胶等。壮水补虚之药
也。人参、沙参、燕窝。益气补虚之药也。泻如大黄、芩、连、胆草。苦寒泻火之药也。鲜地、梨、蔗、藕、
四汁。甘寒泻火之药也。干姜炭、肉桂炭、鹿角炭、枸杞炭。温寒止血之药也。葛氏十灰散。清热止血之药
也。他如苏子、郁金、降香、青皮、韭汁、则为降气伐肝药。石决明、左牡蛎、海蛤壳、代赭石。则为降血镇
肝药。皆治血随气上之法也。血瘀则大黄灰、干漆灰、山楂灰、红曲灰。血滑则棕皮灰、莲房灰、榴皮灰、没
石子。三七、郁金、丹皮。行血中之气也。大蓟、小蓟、茜根。消血中之滞也。侧柏、紫葳、剪草、竹茹。
凉血中之热也。犀角、玳瑁、珠粉、琥珀、清血中之神也。茅根、牛膝、童便。引血使之下行也。藕节汁、荷
叶汁、陈蔗汁、止血而兼行瘀也。血药多端。岂仅止涩之剂哉。
【幼廉注】缪氏治吐血三诀。首条云宜行血不宜止血。深恐止则血凝。血凝则发热恶食而病日锢。每致血瘀
成痨。然行血之药。首推大黄。家君创制立止吐血膏一方。既能引血下行。又能止血逐瘀。凡治血来汹涌。屡
投辄验。较葛氏十灰散。奏功尤捷。但宜下于妄行之初。不宜下于脱血之后。其次立止咳血膏。（剪草一斤、
地锦二斤、野百合、黑木耳、白芨、没石子各一两、鲜藕节二两、鲜枇杷叶去毛筋净、鲜刮淡竹茹、鲜茭白根
各八两、先煎去渣、滤净、入净白蜜一斤、奎冰糖八两、煎浓成膏。）治寻常咳血妄行。每服一小匙。日二夜
一。空心服。十日即愈。如久病损肺咳血。五更服此。上下午服琼玉膏。一月亦愈。历收成绩。盖因血溢上
窍。阳盛阴虚。有升无降者。十居八九。故家君立此降气泻火。补络填窍二方。随证酌治以取效。惟杨仁斋谓
失血一证。有阳虚阴必走者。百中常见三四。故舒驰远于虚损失血。极斥滋阴之谬。陈修园亦主此说。皆属此
等因证。治以陕西丁雁峰先生秘传血证二方。最多神效。治血第一方。（广郁金、炒黑紫苏、真川朴、酒炒生
锦纹各八分、枳壳、桔梗、当归各七分、紫 桂五分、水二钟、煎成、加童便半盏、姜汁一小匙、和匀同
冲、只服一二剂。）治血第二方。（麦冬二钱、川贝、川断各一钱、赤芍七分、远志六分、山药四分、益母
草三分、水二钟、煎八分、服十剂、不论老少男女、新旧吐血之症、照服立愈除根、如服数剂、吐血已止、亦
须服完十剂之数、也勿加减药味、改动分量至嘱至嘱、此症忌服寒凉、以致血凝气滞、倘先误服凉药者、服此
方、渐次咳嗽痰涎、阴寒尽化、服完后、或空咳不止、可服健脾丸。）蓉城名医张少泉先生发明曰。前方妙在
枳、桔、朴、苏。提降疏通。使邪无所留滞。再以当归、郁金。从血中开导。后以肉桂佐大黄。温通下行。引
补心法如同麦冬养荣汤。（由潞党参、麦冬、当归身、生地黄、生白芍各三钱，知母二钱，北五味子二十粒，青盐、陈皮八分，清炙甘草六分，大红枣三枚组成。）十味补心汤。（由辰茯神八钱，潞党参、生熟地黄各三钱，麦冬、炒酸枣仁、当归身各二钱，制香附一钱半，远志八分，龙眼肉五枚组成。）琼玉膏。（取鲜生地黄一斤榨汁，净白蜜一斤，西洋参八两，云茯苓十二两。先将地黄汁和白蜜放入瓷瓶中，然后将人参和茯苓研成粉末，混合均匀后放入水中，煮三天三夜，再悬挂在井中一夜，取出后用白开水化服一两。）八仙玉液。（取鲜生地黄汁、藕汁各两杯，梨汁、甘蔗汁、人乳各一杯。先将两个鸡蛋的蛋清、鲜茅根一百枝、龙眼肉七枚煎取浓汁两杯，与前四汁及人乳混合，隔水炖温服用。）天王补心丹之类。（由熟地黄五钱，当归身、生地黄、天冬、麦冬、玄参、炒酸枣仁、柏子仁、木茯神、党参、丹参各三钱，远志、五味子、桔梗各一钱，用净蜂蜜制成丸药，每次服用三钱。）
补脾法如同加味归脾汤。（由潞党参、炙黄芪、生晒白术、茯神、当归身各三钱，酸枣仁、远志各二钱，阿胶、焦山栀、丹皮各一钱，清炙甘草、广木香各五分，龙眼肉五枚组成。）养真汤。（由党参、黄芪、白术、麦冬各一钱半，云茯苓、山药、莲子、白芍各三钱，五味子、炙甘草各五分组成。）参燕异功煎。（由吉林参、光燕条各一钱，生白术、云茯苓各一钱半，广橘白六分，清炙甘草四分组成。）补阴益气煎之类。
补肝法如同地骨皮饮。（由地骨皮、生地黄、白芍各三钱，丹皮、当归身各一钱半，川芎六分组成。）唐氏补肝寄生汤。（由生地黄、当归身、山茱萸、淮山药、炒酸枣仁、桑寄生各三钱，木瓜一钱，白术五分，川芎六分，北五味子二十粒组成。）三甲复脉汤。（即复脉汤去掉火麻仁、生姜、桂枝，加入煅龙骨三钱、左牡蛎、生龟甲心各四钱。）清燥养营汤。四物绛覆汤之类。
补肾法如同张氏左归饮。（由熟地黄六钱，茯苓、山药、甘枸杞子、山茱萸肉各三钱，盐水炒甘草六分组成。）六味地黄汤。（即左归饮去掉枸杞子、甘草，加入丹皮、泽泻各一钱；若兼治君相之火，加玄参、枸杞子以益肺气，加人参、麦冬、五味子；火势猛烈者，加黄柏、知母。）丹溪大补阴丸。（由熟地黄八两，黄柏、知母各三两，炙龟版四两，猪脊髓四条，用蜂蜜制成丸药，每次服用三四钱，淡盐汤送下。）龟柏地黄汤。坎气潜龙汤。滋任益阴煎之类。这四种方法，是通治血证的大纲。
总的来说，外感风寒，变为咳血，这种证候最多。如果失治或误治，往往酿成肺痨（肺结核）。如果在春夏秋季节感受温热暑邪导致失血，必定兼见身热心烦不能卧等证候，这是邪热扰乱营分、逼迫血液妄行所致。治疗应以清除营分邪热为主，可用犀地清络饮去掉桃仁，用藕汁、广郁金汁代替姜汁和蒲黄汁。轻症可用羚角清营汤（羚羊角片一钱，鲜生地黄六钱，焦山栀、金银花、青连翘、血见愁各三钱，生蒲黄一钱半，童便一杯冲服）。如果失血后热退身凉，神清气静，说明邪热已去。仔细审查没有其他疾病或缘故，只需服用生藕汁或童便，每天服用一二杯，以资助其阴液即可，不必过度治疗。或者服用玉露饮（大白萝卜一个，切下蒂部，挖空，填入白糖填满，盖好，用线扎紧，取鲜稻叶上的露水三碗，煮至极烂，用纱布过滤，露天放置一夜，炖温后空腹服用，善于治疗邪热损伤肺胃营分而导致的吐血，并治疗因烟酒过度导致的咳血失血久不愈，均有疗效），尤其多能收到效果。
其他如肥甘厚味过度，导致肺胃湿热蕴结隆盛，蒸腾痰浊而动血，以及烟酒不节制，戕伤清气，咳嗽呕吐频繁发作，痰中带血时出，或者便血、尿血者，宜清肃中上二焦的气机，主方用菀贝茅根汤（紫菀五钱，川贝母四钱，鲜茅根一两，生桑白皮、生薏苡仁、赤茯苓各三钱，黄芩、竹沥半夏各一钱半）。并戒除荤腥酒类，自然能逐渐痊愈。
如果旧有闪挫等外伤，胸膈胁肋间必然有固定疼痛的部位。凡是感受邪热内攻，冲动宿瘀，瘀血从上或从下排出者，这是宿疾乘势欲除的机理，切勿使用收敛止涩之法。如果排出不快，身体有结痛感，说明孙络中的瘀血运行未尽，仍需使用行血和络的药物，如生蒲黄、生荷叶、蜜炙延胡索、生藕汁之类，加入散邪清热方中，以去除宿瘀。宿瘀一旦清理干净，吐血停止，心中不觉闷胀，必然会痊愈。如果烦躁闷乱、刺痛胀满，说明体内还有瘀血，可饮用一大碗生萝卜汁，探吐使其排净；或者用开水调服七厘散五分，每天两次服用，以化解消散它。否则拖延不愈，导致瘀血不去，新血不得守舍，时时溢出，各种治疗都无效，要么不成劳瘵，就会变成内外各种痈肿。
如果因为远行负重，劳力伤气，气逆于上，胸胁闷痛，甚至呼吸也痛，咳嗽带红，这类劳力伤气的情况，宜用“结者散之”的方法。初用降气和络饮（瓜蒌皮、甜杏仁、紫菀、川贝母各三钱，枇杷叶去毛筋净一两，苏丹参、生怀牛膝各三钱，参三七汁、广郁金汁各四匙，生藕汁两瓢，混合均匀同冲）轻轻降气辛润以疏化解之。继用藕汁木耳煎（生藕汁一杯，和入童便一杯，酒半杯，木耳洗净去砂，瓦上焙脆，研入三钱，白色的更好，但只用一钱，每天三次服用，数日痊愈），以和血宁络来除根。
只有外感温热，内夹愤怒，怒则气逆，血从上溢而大吐者，必定见胸胁热痛、口燥心烦、二便赤热、手足躁扰等症状。宜用龙胆泻肝汤去掉柴胡、当归、车前子、泽泻，加醋炒黄连、广郁金、川楝子、代赭石等，以清肝火而止血。如果失血仍然很多，但精神声色、起居如常，唇舌红赤者，尚属热逼血溢，宜用三黄犀角汤（生大黄、黄芩、粉丹皮各二钱，加醋炒黑，鲜生地黄一两，生赤白芍各三钱，黑犀角、盐水炒黄连各八分，淡竹茹五钱），大剂量以泄降之。外用一盆清盐卤，让病人坐浸双脚。
如果出血虽少，但已见头晕耳鸣、腰痛脚酸等症状，这是肾阴虚而肝阳不藏，宜多服阿胶鸡子黄汤及龟版地黄汤等，育阴潜阳以善后。
第四种夹证是齿血，血从牙龈流出，所以一名牙宣。严重的甚至盈碗成盆，像线索牵拽而出。症状见身热口渴、龈肿溺赤便闭者，是胃有实火。治疗以咸苦泄降为主，用犀连承气汤加藕节、童便。轻症且大便通利者，不必用凉泻，只需用清解法，用犀地清络饮去掉桃仁、姜汁、蒲黄汁，加藕汁、童便。如果脉细数、舌光绛、口烂龈糜者，是胃中虚火。宜清热兼滋阴，用新加玉女煎去掉石英、磁石，加骨碎补、黑蒲黄。外用冷醋水漱口，掺十灰散，内外并治，奏效更快。
第五种夹证是便血。《金匮要略》只分远血和近血。先排便后出血叫远血，属小肠寒湿；先出血后排便叫近血，属大肠湿热。寒湿用黄土汤（焦白术、熟地炭各三钱，条芩炭、陈阿胶各二钱，淡附片、清炙甘草各六分，先用灶心黄土一两，冷水搅化，澄清取水煎药）。湿热用赤豆当归散（赤豆芽五钱，全当归三钱，研细，每次服用三钱，清浆水调下）。哪里知道便血这一证候，外感六淫都能致病，不是黄土汤和当归散两方所能统管。必须先治肠以去除其标，后治各脏以清其源。如果纯下清血，病势急如箭，肛门不肿痛，而肠中鸣响者，此为肠风下血。治疗以清火疏风为主，用清肝达郁汤去掉当归、菊花，送下保元槐角丸（槐角、当归、生地、黄芩、黄柏、侧柏叶各三钱，枳壳、地榆、荆芥、防风各二钱，黄连、川芎、生姜各一钱，乌梅三枚，用鲜荷叶汁白蜜炼丸，每次服用二三钱）。继用加味白头翁汤去掉贯众、茉莉，加阿胶、炙甘草，清肝坚肠，凉血滋阴以善后。
如果粪前下血，血色散而紫黯，或色淡红，胃弱便溏，素无痔漏证者，此为小肠寒湿下血。治疗以温补敛肠为主，用加减黄土汤（土炒白术、花龙骨、地榆炭各三钱，陈阿胶二钱，黑炮姜、炙甘草、春砂仁各八分，先用伏龙肝一两，水化搅烊，澄清煎药，胡在兹先生验方）。继用加味石脂禹粮汤（赤石脂、禹余粮各三钱，土炒川椒子、生白术、川芎炭各二钱，醋炒蕲艾一钱），填窍补络以善后。
如果下血色如烟尘，沉晦瘀浊，便溏不畅，胃气不健，肢体倦怠者，此由膏粱积热，酒酪聚湿，而为脏毒下血。宜以苦辛淡泄，用芩连二陈汤去掉姜汁、竹沥汁，加炒槐米二钱，大黑木耳三钱，茅根藕节各一两。重症用清肠解毒汤（焦山栀三钱，银花炭、黄芩、连翘、赤芍各二钱，黄连、黄柏、生大黄、焦枳壳、煨防风各一钱）。继用木耳豆腐煎（大黑木耳五钱，生豆腐四两，食盐一钱），送下加味脏连丸（黄连五两，苦参三两，生大黄二两，圆皂角仁、白芷各一两五钱，光桃仁一两，各为细末，取猪大肠洗净，纳入肠中，酒水各半，煮烂捣研，和入百草霜一两，红曲三两，共捣为丸，每次服用三钱，早晚空腹服用，胡在兹先生验方），清涤肠浊以除根。
如果粪后下血，鲜红光泽，或色深紫，或有凝块紫亮者，此为肠热下血。宜以凉血泄热，用地柏清肠汤（鲜生地黄六钱，生侧柏叶四钱，银花、茜草、赤芍、夏枯草、血见愁各二钱，紫葳花二钱，先用鲜茅根、生藕各二两，煎汤代水，胡在兹先生验方）。继用脏连六味丸（熟地黄五钱，山茱萸、山药、赤茯苓、丹皮、泽泻、黄连各三钱，白矾一钱，嵌柿饼焙焦二枚，入猪大肠内，同糯米煮熟，去米，共捣为丸，每次服用二三钱，早晚空腹服用）。
如果肛门肿坠，滴血淋漓，或血线如溅，里急后重，因大便随下清血不止，甚则红肿痛，此为内痔下血，名曰血痔。治疗先荡涤瘀热，用清肠解毒汤去掉防风，加槐米、桃仁、生地、炒枳壳皮。痛极而下血多者，加乳香、没药、发灰。红肿痛而不能收进者，外用点痔法（大水田螺一个，挑去壳，入冰片、麝香少许，过夜，即化成水，点上痔核即收进，如无大水田螺，用大蜗牛一个去壳，生白果一枚，同捣烂，代之亦效）。待肿痛血止，即用补阴益气煎去掉熟地黄，加阿胶、生地、黑木耳，升气滋阴以善后。
第六种夹证是溺血。如果症状见淋漓割痛，小便点滴不畅者，此为染毒赤淋。治疗宜去毒通淋，用导赤八珍散加味（鲜生地黄、滑石包煎各六钱，瞿麦、扁蓄、海金砂包煎、焦山栀各三钱，淡竹叶二钱，木通、生大黄各一钱，生甘草梢八分，先用土茯苓、鲜车前草、去皮鲜茅根各一两，煎汤代水）。如果没有淋毒，只是心经遗热于膀胱，膀胱热结则尿血。症状见虚烦不寐，或昏睡不省人事，或舌咽作痛，或怔忡懊恼。治疗宜凉血泄热，用导赤清心汤去掉茯苓、麦冬，加焦栀子、瞿麦、琥珀。如果由肝经遗热者，必兼少腹满、胁肋刺痛、口苦耳聋、寒热往来、溺多赤淋，甚至筋痿茎疼。治疗宜凉肝泻火，用龙胆泻肝汤加丹皮、郁金。轻症用清肝达郁汤去掉荷叶、菊花，加龙胆草、生牛膝梢、鲜车前草。如果治心肝不效，当清其肺。肺为肾水之上源，肺清则水清，水宁则血宁，用清燥救肺汤加蒲黄、茅根、藕节即可。
总而言之，止血之法，首先要虚实寒热认得清楚，始能补泻温凉用得当。补法如阿胶、熟地黄、线鱼胶等，是壮水补虚的药。人参、沙参、燕窝，是益气补虚的药。泻法如大黄、黄芩、黄连、龙胆草，是苦寒泻火的药。鲜地黄、梨、蔗、藕，四汁是甘寒泻火的药。干姜炭、肉桂炭、鹿角炭、枸杞炭，是温寒止血的药。葛氏十灰散，是清热止血的药。其他如苏子、郁金、降香、青皮、韭汁，则是降气伐肝药。石决明、左牡蛎、海蛤壳、代赭石，则是降血镇肝药，都是治血随气上逆的方法。血瘀则用大黄灰、干漆灰、山楂灰、红曲灰。血滑则用棕皮灰、莲房灰、榴皮灰、没石子。三七、郁金、丹皮，是行血中之气。大蓟、小蓟、茜根，是消血中之滞。侧柏、紫葳、剪草、竹茹，是凉血中之热。犀角、玳瑁、珠粉、琥珀，是清血中之神。茅根、牛膝、童便，是引血使之下行。藕节汁、荷叶汁、陈蔗汁，是止血而兼行瘀。血药种类繁多，岂仅是止涩之剂哉。
【幼廉注】缪氏治疗吐血的三诀，首条说宜行血不宜止血，深恐止住则血凝，血凝则发热恶食而病日益固结，每致血瘀成劳。然而行血的药，首推大黄。家父创制立止吐血膏一方，既能引血下行，又能止血逐瘀。凡治疗血来汹涌，屡投辄验，较葛氏十灰散，奏效尤其快捷。但适宜在下法用于妄行之初，不适宜在下法用于脱血之后。其次立止咳血膏（剪草一斤，地锦二斤，野百合、黑木耳、白芨、没石子各一两，鲜藕节二两，鲜枇杷叶去毛筋净，鲜刮淡竹茹，鲜茭白根各八两，先煎去渣，滤净，入净白蜜一斤，奎冰糖八两，煎浓成膏）。治疗寻常咳血妄行，每次服用一小匙，日二次夜一次，空心服，十日即愈。如久病损肺咳血，五更服此，上下午服琼玉膏，一月亦愈，历来收到成绩。大概因为血溢上窍，阳盛阴虚，有升无降的情况，十居八九。故家父立此降气泻火、补络填窍二方，随证酌治以取效。惟杨仁斋谓失血一证，有阳虚阴必走者，百中常见三四。故舒驰远在虚损失血方面，极斥滋阴之谬。陈修园也主张此说，皆属此类因证。治疗以陕西丁雁峰先生秘传血证二方，最多神效。
治血第一方（广郁金、炒黑紫苏、真川朴、酒炒生大黄各八分，枳壳、桔梗、当归各七分，紫油桂五分，水二钟，煎成，加童便半盏，姜汁一小匙，和匀同冲，只服一二剂）。治血第二方（麦冬二钱，川贝、川断各一钱，赤芍七分，远志六分，山药四分，益母草三分，水二钟，煎八分，服十剂，不论老少男女，新旧吐血之症，照服立愈除根，如服数剂，吐血已止，也必须服完十剂的数目，也不要加减药味，改动分量，至嘱至嘱，此症忌服寒凉，以致血凝气滞，倘先误服凉药者，服此方，渐次咳嗽痰涎，阴寒尽化，服完后，或空咳不止，可服健脾丸）。蓉城名医张少泉先生发明曰：前方妙在枳壳、桔梗、厚朴、紫苏，提降疏通，使邪无所留滞。再以当归、郁金，从血中开导。后以肉桂佐大黄，温通下行，引
The method of tonifying the heart is exemplified by Maidong Yangrong Tang (Ophiopogon Decoction for Nourishing the Spirit). [Ingredients: Radix Codonopsis Pilosae (Lupangshen), Fructus Ophiopogonis (Maidong), Radix Angelicae Sinensis (Guishen), Rhizoma Anemarrhenae Asphodeloidis (Shengbaishaoyao) each 3 qian, Rhizoma Anemarrhenae Asphodeloidis (Baizhimu) 2 qian, Fructus Schisandrae Chinensis (Beiwuweizi) 20 grains, Salinum (Qingyan), Pericarpium Citri Reticulatae (Chenpi) 8 fen, Radix Glycyrrhizae Preparata (Qingzhigancao) 6 fen, Fructus Jujubae (Dazao) 3 pieces.] Shitwei Buxin Tang (Ten-Ingredient Heart-Tonifying Decoction). [Ingredients: Poria Cocos (Chenfushen) 8 qian, Radix Codonopsis Pilosae (Lupangshen), Rhizoma Dioscoreae Spongiosae (Shengshudi) and Rhizoma Dioscoreae Spongiosae (Renshu) each 3 qian, Fructus Ophiopogonis (Maidong), Semen Ziziphi Spinosae Praefritum (Chaozaoren), Radix Angelicae Sinensis (Guishen) each 2 qian, Rhizoma Cyperi Rotundi Processed (Zhi xiangfu) 1.5 qian, Radix Polygalae (Yuanzhi) 8 fen, Arillus Longan (Longyanrou) 5 arils.] Qiongyu Gao (Jade Dew Paste). [Ingredients: Juice from fresh Rhizoma Dioscoreae Spongiosae (Xianshengdi) 1 jin, Pure White Honey (Jingbaimi) 1 jin, Radix Panacis Quinquefolii (Xiyangshen) 8 liang, Poria Cocos (Yunling) 12 liang. First, place the fresh dioscorea juice and white honey in a porcelain bottle. Then, powder the ginseng and poria, mix evenly, place in water, boil for three days and nights, hang in a well overnight, take out, and dissolve one liang in warm water to take.] Baxian Yuye (Eight Immortals Jade Liquid). [Ingredients: Juice from fresh Rhizoma Dioscoreae Spongiosae (Xianshengdizhi) and juice from Rhizoma Nelumbinis (Ou zhi) each 2 cups, juice from Pyrus bretschneideri (Lizhi), juice from Saccharum officinarum (Zheshi), and human milk (Renru) each 1 cup. First, decoct two egg whites, 100 branches of fresh Herba Imperatae (Xianmaogen), and 7 arils of longan meat (Longyanrou) to obtain 2 cups of concentrated juice. Mix with the previous four juices and human milk, stew in warm water over a double boiler, and take warm.] Lei Gong Bu Xin Dan (Heavenly King's Heart-Tonifying Pill) and similar formulas. [Ingredients: Rhizoma Dioscoreae Spongiosae (Shudi) 5 qian, Radix Angelicae Sinensis (Guishen), Rhizoma Dioscoreae Spongiosae (Shengdi), Radix Ophiopogonis (Tianmai), Fructus Ophiopogonis (Maiwei), Radix Scrophulariae (Yuanshen), Semen Ziziphi Spinosae Praefritum (Chaozaoren), Semen Biocae (Baiziren), Poria Cocos (Mufushen), Radix Codonopsis (Dangshen), Radix Salviae Miltiorrhizae (Danshen) each 3 qian, Radix Polygalae (Yuanzhi), Fructus Schisandrae (Wuweizi), Radix Platycodonis (Jiegeng) each 1 qian. Make pills with pure honey, take 3 qian per dose.]
The method of tonifying the spleen is exemplified by Jiawei Guipi Tang (Modified Return-to-the-Spleen Decoction). [Ingredients: Radix Codonopsis Pilosae (Lupangshen), Radix Astragali Praeparata (Zhihuangqi), Rhizoma Atractylodis Macrocephalae (Shengshuzhu), Poria Cocos (Fushen), Radix Angelicae Sinensis (Guishen) each 3 qian, Semen Ziziphi Spinosae (Zao ren), Radix Polygalae (Yuanzhi) each 2 qian, Corium Asini Collae (Ejiao), Fructus Gardeniae Praecox (Jiaoshanzhi), Cortex Moutan (Danpi) each 1 qian, Radix Glycyrrhizae Preparata (Qingzhigancao), Fructus Amomi (Guangmuxiang) each 5 fen, Arillus Longan (Longyanrou) 5 pieces.] Yangzhen Tang (Nourishing Truth Decoction). [Ingredients: Radix Codonopsis (Dangshen), Radix Astragali (Huangqi), Rhizoma Atractylodis Macrocephalae (Baizhu), Fructus Ophiopogonis (Maidong) each 1.5 qian, Poria Cocos (Yunling), Rhizoma Dioscoreae (Shanyao), Semen Nelumbinis (Lianzi), Radix Paeoniae Alba (Baishao) each 3 qian, Fructus Schisandrae (Wuweizi), Radix Glycyrrhizae Preparata (Zhi gancao) each 5 fen.] Shenyan Yigong Jian (Ginseng and Swallow Nest Yi Gong Decoction). [Ingredients: Radix Ginseng (Jilinsen), Swallow Nest strips (Guangyantiao) each 1 qian, Rhizoma Atractylodis Macrocephalae (Shengyuzhu), Poria Cocos (Yunling) each 1.5 qian, Exocarpium Citri Reticulatae Viride (Guangju bai) 6 fen, Radix Glycyrrhizae Preparata (Qingzhigancao) 4 fen.] Buyin Yiqi Jian (Tonify Yin and Replenish Qi Decoction) and similar formulas.
The method of tonifying the liver is exemplified by Digupi Yin (Cortex Lycii Decoction). [Ingredients: Cortex Lycii (Digupi), Rhizoma Dioscoreae Spongiosae (Shengdi), Radix Paeoniae Alba (Baishao) each 3 qian, Cortex Moutan (Danpi), Radix Angelicae Sinensis (Guishen) each 1.5 qian, Radix Ligustici Chuanxiong (Chuanxiong) 6 fen.] Tang Shi Bugan Jisheng Tang (Mr. Tang’s Liver-Tonifying Parasitic Decoction). [Ingredients: Rhizoma Dioscoreae Spongiosae (Shengdi), Radix Angelicae Sinensis (Guishen), Fructus Corni (Yurou), Rhizoma Dioscoreae (Huai shanyao), Semen Ziziphi Spinosae Praefritum (Chaozaoren), Ramulus Taxilli (Sangjisheng) each 3 qian, Fructus Chaenomelis (Mugua) 1 qian, Rhizoma Atractylodis Macrocephalae (Baizhu) 5 fen, Radix Ligustici Chuanxiong (Chuanxiong) 6 fen, Fructus Schisandrae (Bei wuweizi) 20 grains.] Sanjia Fumai Tang (Three-Shells Pulse-Recovering Decoction). [This is Fumai Tang minus Sesamum Indicum (Maren), Zingiberis Recens (Jiang), Cinnamomi Ramulus (Gui), plus Ossis Draconis Calcitratum (Hualonggu) 3 qian, Concha Ostreae Sinensis (Zuo muli), Testudo Plastrum et Carapax (Sheng guijia xin) each 4 qian.] Qingzao Yangying Tang (Clear Dryness and Nourish Ying Decoction). Siwu Jiangfu Tang and similar formulas.
The method of tonifying the kidney is exemplified by Zhang Shi Zuogui Yin (Mr. Zhang’s Left-Restoring Decoction). [Ingredients: Rhizoma Dioscoreae Spongiosae (Shudi) 6 qian, Poria Cocos (Fuling), Rhizoma Dioscoreae (Shanyao), Fructus Lycii (Ganqizi), Fructus Corni (Shanyurou) each 3 qian, Radix Glycyrrhizae Preparata (Yanshui chao gancao) 6 fen.] Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill). [This is Zuogui Yin minus Gouqi and Gancao, plus Cortex Moutan (Danpi) and Alisma Orientale (Zexie) each 1 qian. If treating Minister Fire, add Radix Scrophulariae (Yuanshen) and Fructus Lycii (Gouqi) to benefit Lung Qi, add Radix Ginseng (Renshen), Fructus Ophiopogonis (Maidong), and Fructus Schisandrae (Wuweizi); if fire is severe, add Cortex Phellodendri (Chuanbai) and Rhizoma Anemarrhenae (Zhimu).] Danxi Dabu Yin Wan (Danxi’s Great Tonifying Yin Pill). [Ingredients: Rhizoma Dioscoreae Spongiosae (Shudi) 8 liang, Cortex Phellodendri (Chuanbai), Rhizoma Anemarrhenae (Zhimu) each 3 liang, Testudo Plastrum et Carapax (Zhiguiban) 4 liang, Medulla Porci (Zhui jingsui) 4 strips. Make pills with honey, take 3-4 qian per dose, wash down with light salt water.] Gu Bai Dihuang Tang (Turtle-Bark Rehmannia Decoction). Kanqi Qianlong Tang. Ziren Yiyin Jian and similar formulas. These four methods are the general principles for treating blood disorders.
Generally speaking, external contraction of wind-cold transforming into hemoptysis is very common. Neglect or mis-treatment often leads to Feilao (Pulmonary Tuberculosis). If bleeding occurs in spring, summer, or autumn due to contracting warm-heat or summer-heat pathogens, it must be accompanied by symptoms such as fever, restlessness, and inability to lie down. This is caused by pathogenic heat disturbing the Ying level and forcing blood to flow recklessly. Treatment should focus on clearing pathogenic heat from the Ying level. Use Xidi Qingluo Yin (Rhino-Corn and Rehmannia Clearing Collateral Decoction) minus Persicae Semen (Taoren), replacing Ginger Juice (Jiang zhi) and Catotylis Juice (Pu zhi) with Lotus Root Juice (Ou zhi) and Curcuma Aromatica Juice (Guang yujin zhi). For mild cases, use Lingjiao Qingying Tang (Antelope Horn Clearing Ying Decoction) [Ingredients: Antelope Horn slice (Lingjiao pian) 1 qian, Fresh Rhizoma Dioscoreae Spongiosae (Xianshengdi) 6 qian, Fructus Gardeniae Praecox (Jiaoshanzhi), Flos Lonicerae (Yinhua), Flos Forsythiae (Qinglianqiao), Plantago asiatica (Xuejianchou) each 3 qian, Raw Polygoni Cuspidati Rhizoma et Radix (Shengpuhuang) 1.5 qian, Urine of a healthy child (Tongbian) 1 cup mixed in]. If after bleeding the fever subsides and the body becomes cool, and the spirit is clear and quiet, the pathogenic heat has gone. Carefully examine that there are no other diseases or causes; simply take fresh lotus root juice or urine of a healthy child, one to two cups daily, to nourish Yin. There is no need for exhaustive treatment. Alternatively, take Yulu Yin (Jade Dew Drink) [Ingredients: One large white radish, cut off the top, hollow it out, fill with white sugar, cover tightly, tie with thread, take three bowls of dew from fresh rice leaves, boil until very soft, filter through gauze, leave exposed overnight, stew warm, take on an empty stomach]. It effectively treats vomiting blood due to pathogenic heat damaging the Ying level of the Lung and Stomach, and also treats chronic hemoptysis and bleeding due to excessive smoking and alcohol, showing consistent efficacy.
Other cases involve excessive consumption of rich and sweet foods, leading to damp-heat accumulation in the Lung and Stomach, steaming phlegm and moving blood; or unregulated smoking and alcohol damaging clear Qi, resulting in frequent coughing and vomiting, intermittent blood in sputum, hematochezia, or hematuria. The Qi mechanism of the Middle and Upper Jiao should be cleared and purified. The main formula is Wanbei Maogen Tang (Aster and Fritillaria and Imperata Decoction) [Ingredients: Radix Asteris Tatarici (Zuan) 5 qian, Bulbus Fritillariae Thunbergii (Chuanbei) 4 qian, fresh Herba Imperatae (Xianmaogen) 1 liang, Cortex Mori Radicis (Sheng sangpi), Semen Coicis (Shengyiren), Polyporus (Chiling) each 3 qian, Radix Scutellariae (Qingzihen), Pinellia Ternata Processed with Ginger Juice (Zhuli banxia) each 1.5 qian]. Abstain from meat and alcohol, and gradual recovery will occur.
If there is a history of sprains or trauma, there will inevitably be fixed pain in the chest, diaphragm, hypochondrium, or ribs. When pathogenic heat attacks internally, stirring up old blood stasis, if blood stasis is expelled from above or below, this is the body's mechanism to eliminate the old disease. Do not use astringents to stop bleeding. If expulsion is incomplete and body ache persists, it indicates that collateral blood stasis has not been fully resolved; blood-invigorating and collateral-nourishing herbs are still needed, such as Raw Polygoni Cuspidati Rhizoma et Radix (Sheng puhuang), Fresh Lotus Leaf (Sheng hey e), Honey-fried Corydalis Yanhusuo (Mi zhi yan hu), and Fresh Lotus Root Juice (Sheng ou zhi). Add these to formulas that scatter pathogens and clear heat to remove old stasis. Once old stasis is clean, bleeding stops, and the chest feels free of oppression, the condition will resolve. If there is irritability, restlessness, stabbing pain, or distension, blood stasis remains inside. Drink a large bowl of raw radish juice to induce vomiting and clear it out, or take 5 fen of Qili San (Seven-Centigram Powder) mixed with boiled water, twice daily, to transform and disperse it. Otherwise, the condition will drag on, blood stasis will not go, new blood will not stay, and bleeding will persist despite all treatments, potentially leading to Laozai (Consumption) or various internal and external abscesses.
If bleeding results from long-distance travel or heavy lifting, damaging Qi and causing Qi rebellion upwards, leading to chest and hypochondriac fullness and pain, even painful breathing, and coughing with blood, this is labor-induced Qi injury. Use the method of "scattering what is knotted." Initially use Jiangqi Hueluo Yin (Descend Qi and Harmonize Collaterals Decoction) [Ingredients: Pericarpium Trichosanthis (Gualou pi), Sweet Almond (Tian xingren), Radix Asteris Tatarici (Ziwan), Bulbus Fritillariae Thunbergii (Chuanbei) each 3 qian, Folium Eriobotryae (Pipaye) de-haired and cleaned 1 liang, Radix Notoginseng (Shudan shen), Radix Achyranthis Bidentatae (Sheng huai niuxi) each 3 qian, Radix Notoginseng Juice (Shen sanqi zhi), Curcuma Aromatica Juice (Guang yujin zhi) each 4 spoons, Fresh Lotus Root Juice (Sheng ou zhi) 2 ladles, mix evenly and take together]. Gently descend and moisten with acrid flavors to diffuse and transform. Subsequently use Ou zhi Mu'er Jian (Lotus Root and Wood Ear Decoction) [Ingredients: Fresh Lotus Root Juice (Sheng ou zhi) 1 cup, mixed with Urine of a healthy child (Tongbian) 1 cup, Wine (Jiu) half a cup, Wood Ear Mushroom (Mu'er) washed clean of sand, baked crisp on tile, powdered to 3 qian (white ones are better, but use only 1 qian), take three times daily, cured in a few days]. This harmonizes blood and calms collaterals to eradicate the root.
Only when external warm-heat is combined with internal anger, where anger causes Qi rebellion and blood overflows from above causing massive vomiting, will there be symptoms of hot pain in the chest and hypochondrium, dry mouth, irritability, red and hot urination and defecation, and restless limbs. Use Longdan Xiegan Tang (Gardenia and Gentian Decoction to Drain the Liver) minus Chaihu, Danggui, Cheqianzi, and Zexie. Add Vinegar-fried Coptidis Rhizoma (Cu chao chuanlian), Curcuma Aromatica (Guang yujin), Fructus Toosendan (Chuanlianzi), and Haematitum (Daizheshi) etc., to clear Liver fire and stop bleeding. If bleeding continues heavily but spirit, voice, and daily activities remain normal, with red lips and tongue, it is still heat forcing blood outflow. Use Sanhuang Xijiao Tang (Three-Yellow Rhino-Horn Decoction) [Ingredients: Raw Rheum Palmatum (Sheng chuanjun), Radix Scutellariae (Qingzihen), Cortex Moutan (Fen danpi) each 2 qian, vinegar-fried blackened; Fresh Rhizoma Dioscoreae Spongiosae (Xianshengdi) 1 liang, Raw Red and White Paeonia Roots (Sheng chi baishao) each 3 qian, Black Rhino Horn (Hei xijiao), Salt-water fried Coptidis Rhizoma (Yanshui chao chuanlian) each 8 fen, Bamboo Shavings (Danzhuru) 5 qian]. Use a large dose to drain and descend. Externally, have the patient sit with feet immersed in a basin of clear salt brine.
If bleeding is slight but accompanied by dizziness, tinnitus, lower back soreness, and leg weakness, it indicates Kidney Yin deficiency and unconstrained Liver Yang. Take more Ejiao Jizihuang Tang (Donkey-hide Gelatin and Egg Yolk Decoction) and Guiban Dihuang Tang (Turtle Shell and Rehmannia Decoction) to nourish Yin and subdue Yang for follow-up care.
Fourth complication: Dental Bleeding. Blood flows from the gums, also known as Yaxuan. Severe cases may fill bowls or basins, flowing out like threads. Symptoms include fever, thirst, swollen gums, red urine, and constipation, indicating excess fire in the Stomach. Treat with salty and bitter descending methods. Use Xilian Chengqi Tang (Rhino-Horn and Coptitis Da Huang Decoction) plus Lotus Root Node (Oujie) and Urine of a healthy child (Tongbian). For mild cases with unobstructed bowel movements, cooling purgatives are not needed; use clearing resolution methods instead. Use Xidi Qingluo Yin minus Taoren, Jiang zhi, and Pu zhi, adding Ou zhi and Tongbian. If the pulse is fine and rapid, tongue is glossy and crimson, with mouth ulcers and gum erosion, it is deficient fire in the Stomach. Clear heat and nourish Yin simultaneously. Use Xinjia Yvnu Jian (Newly Added Woman's Decoction) minus Shiy ing and Ci shi, adding Radix Drynariae (Gusuibu) and Black Polygoni Cuspidati Rhizoma et Radix (Hei puhuang). Externally rinse with cold vinegar water and apply Shihui San (Ten Ashes Powder). Internal and external treatment works faster.
Fifth complication: Hematochezia. The Jingui Yaolue distinguishes between distant and proximal bleeding. Defecation before bleeding is distant bleeding, belonging to Cold-Dampness of the Small Intestine. Bleeding before defecation is proximal bleeding, belonging to Damp-Heat of the Large Intestine. For cold-dampness, use Huangtu Tang (Yellow Earth Decoction) [Ingredients: Scorched Atractylodis Macrocephalae Rhizoma (Jiaozhu), Charred Rhizoma Dioscoreae Spongiosae (Shuditan) each 3 qian, Charred Radix Scutellariae (Tiaohuotan), Charred Donkey-hide Gelatin (Chen ejiao) each 2 qian, Light Aconite Slice (Dan fupian), Radix Glycyrrhizae Preparata (Qingzhigancao) each 6 fen. First, take 1 liang of Kitchen Hearth Earth (Zaoxin huangtu), dissolve in cold water, clarify, and use the water to decoct the herbs]. For damp-heat, use Chidou Danggui San (Red Bean and Angelica Powder) [Ingredients: Sprouted Vigna Angularis (Chidou ya) 5 qian, Whole Radix Angelicae Sinensis (Quan danggui) 3 qian, finely powdered, take 3 qian per dose mixed with clear grain water]. However, hematochezia can be caused by all six exogenous pathogens, not just managed by Huangtu Tang and Danggui San. First treat the intestines to address the branch, then treat the organs to clear the source. If pure bright red blood flows rapidly like an arrow, without anal swelling/pain but with intestinal borborygmus, this is Changfeng Xiaxue (Intestinal Wind Bleeding). Treat primarily by clearing fire and dispersing wind. Use Qinggan Dayu Tang minus Danggui and Juhua, taken with Baoyuan Huaijiao Wan (Baoyuan Huaijiao Pill) [Ingredients: Fructus Sophorae (Huaijiao), Radix Angelicae Sinensis (Danggui), Rhizoma Dioscoreae Spongiosae (Shengdi), Radix Scutellariae (Huangqin), Cortex Phellodendri (Huangbai), Folium Platycladi (Cebaiye) each 3 qian, Fructus Aurantii (Zhiqiao), Radix Sanguisorbae (Diyu), Herba Schizonepetae (Jingjie), Radix Saposhnikoviae (Fangfeng) each 2 qian, Rhizoma Coptidis (Hlian), Radix Ligustici Chuanxiong (Chuanxiong), Rhizoma Zingiberis Recens (Shengjiang) each 1 qian, Fructus Pruni Mume (Wumei) 3 pieces. Make pills with fresh lotus leaf juice and white honey, take 2-3 qian per dose]. Subsequently use Jiawei Baitouweng Tang minus Guanzhong and Moli, adding Ejiao and Zhigancao, to clear Liver fire, strengthen intestines, cool blood, and nourish Yin for follow-up.
If blood appears before stool, scattered and dark purple, or pale red, with weak stomach and loose stools, and no history of hemorrhoids/fistulas, this is Small Intestine Cold-Dampness bleeding. Treat primarily by warming, tonifying, and astringing the intestines. Use Jiajian Huangtu Tang [Ingredients: Earth-fried Atractylodis Macrocephalae Rhizoma (Tu chao baizhu), Flower Dragon Bone (Hualonggu), Charred Radix Sanguisorbae (Diyutan) each 3 qian, Old Donkey-hide Gelatin (Chen ejiao) 2 qian, Charred Prepared Ginger (Hei paojing), Radix Glycyrrhizae Preparata (Zhigancao), Fructus Amomi Rotundus (Chunsharen) each 8 fen. First, take 1 liang of Fulonggan (Kitchen Hearth Earth), dissolve in water, stir until melted, clarify, and use to decoct herbs. Verified prescription by Mr. Hu Zaizi]. Subsequently use Jiawei Shizhi Yuliang Tang (Modified Red Stone and Yu Liang Decoction) [Ingredients: Lapis Kaolinis (Chishizhi), Lapis Limonitae (Yuyuliang) each 3 qian, Earth-fried Sichuan Pepper Seeds (Tu chao chuanjiazi), Raw Atractylodis Macrocephalae Rhizoma (Shengyuzhu), Charred Radix Ligustici Chuanxiong (Chuanxiong tan) each 2 qian, Vinegar-fried Ai Ye (Qiai) 1 qian], to fill pores and repair collaterals for follow-up.
If the blood color is like smoke and dust, dull and turbid, with loose stools, poor stomach function, and limb fatigue, this is Zangdu Xiaxue (Visceral Poison Bleeding) caused by accumulated heat from rich food and dampness from wine/dairy. Treat with bitter, acrid, and bland draining methods. Use Qinlian Erchen Tang minus Jiang zhi and Zhuli zhi, adding Fried Sophora Seed (Chuai mi) 2 qian, Large Black Wood Ear (Da hei mu'er) 3 qian, Maogen and Oujie each 1 liang. For severe cases, use Qingchang Jiedu Tang [Ingredients: Scorched Fructus Gardeniae Praecox (Jiaoshanzhi) 3 qian, Charred Flos Lonicerae (Yinhua tan), Radix Scutellariae (Qingzihen), Fructus Forsythiae (Lianqiao), Radix Paeoniae Rubra (Chishao) each 2 qian, Rhizoma Coptidis (Chuanlian), Cortex Phellodendri (Chuanbai), Raw Rheum Palmatum (Sheng chuanjun), Scorched Fructus Aurantii (Jiaozhiqiao), Calcined Saposhnikoviae Root (Wei fangfeng) each 1 qian]. Subsequently use Mu'er Doufu Jian (Wood Ear and Tofu Decoction) [Ingredients: Large Black Wood Ear (Da hei mu'er) 5 qian, Raw Tofu (Sheng doufu) 4 liang, Table Salt (Yan) 1 qian], taken with Jiawei Zanglian Wan (Modified Visceral Connection Pill) [Ingredients: Rhizoma Coptidis (Chuanlian) 5 liang, Radix Sophorae Flavescentis (Kushen) 3 liang, Raw Rheum Palmatum (Sheng chuanjun) 2 liang, Round Soapberry Kernel (Yuan zaorén), Radix Angelicae Dahuricae (Baizhi) each 1.5 liang, Peach Kernel (Guang taoren) 1 liang. All finely powdered. Clean pig large intestine, stuff with powder, cook in half wine/half water until soft, pound and grind, mix with 1 liang Caobao shuang (soot from burning grass) and 3 liang Hongqu (Red Yeast Rice), make pills, take 3 qian morning and evening on empty stomach. Verified prescription by Mr. Hu Zaizi], to cleanse intestinal turbidity and eradicate the root.
If blood appears after stool, bright red and lustrous, or deep purple, or with shiny purple clots, this is Intestinal Heat Bleeding. Cool blood and drain heat using Dibei Qingchang Tang [Ingredients: Fresh Rhizoma Dioscoreae Spongiosae (Xianshengdi) 6 qian, Raw Folium Platycladi (Sheng cebaiye) 4 qian, Flos Lonicerae (Yinhua), Radix Rubiae Cordifoliae (Qiancao), Radix Paeoniae Rubra (Chishao), Herba Prunellae Spicae (Xiakucao), Plantago asiatica (Xuejianchou) each 2 qian, Flos Catalpae (Ziwei hua) 2 qian. First decoct fresh Herba Imperatae (Xian maogen) and fresh Rhizoma Nelumbinis (Sheng ou) each 2 liang to replace water. Verified prescription by Mr. Hu Zaizi]. Subsequently use Zanglian Liuwei Wan (Visceral Connection Six-Ingredient Pill) [Ingredients: Rhizoma Dioscoreae Spongiosae (Shudi) 5 qian, Fructus Corni (Yurou), Rhizoma Dioscoreae (Shanyao), Polyporus (Chiling), Cortex Moutan (Danpi), Alisma Orientale (Zexie), Rhizoma Coptidis (Chuanlian) each 3 qian, Alum (Bai fan) 1 qian, Roasted Date Cake (Shibing) 2 pieces embedded with alum, cooked in pig intestine with glutinous rice, remove rice, pound into pills, take 2-3 qian morning and evening on empty stomach]. If anus is swollen and prolapsed, dripping blood continuously, or blood spurts like splashes, with tenesmus, and continuous bright red blood with stool, even severe swelling/redness/pain, this is Internal Hemorrhoid Bleeding, named Xuemi. First purge stasis and heat, use Qingchang Jiedu Tang minus Fangfeng, add Huai mi, Taoren, Shengdi, and fried Zhiqiao pi. If pain is extreme with heavy bleeding, add Rush Xiang (Ruxiang), Moyao (Myrrha), and Fa Hui (Hair Ash). If red/swollen/painful and cannot retract, use external Hemorrhoid Pointing Method [Ingredients: One large water snail, remove shell, add small amount of Bingpian (Borneol) and Shexiang (Musk), leave overnight until liquefied, apply to hemorrhoid to retract. If no water snail, use one large garden snail removed from shell, one raw Ginkgo nut, pound together, substitute equally effective)]. Wait until swelling, pain, and bleeding stop, then use Buyin Yiqi Jian minus Shudi, adding Ejiao, Shengdi, and Hei Mu'er, to raise Qi and nourish Yin for follow-up.
Sixth complication: Hematuria. If symptoms include dribbling cutting pain and scanty difficult urination, this is Ran Du Chi Lin (Poison-infected Red Strangury). Treat by removing poison and promoting urination. Use Daochi Bazhen San modified [Ingredients: Fresh Rhizoma Dioscoreae Spongiosae (Xianshengdi), Talcum (Huashi wrapped) each 6 qian, Herba Diantherae (Qumai), Herba Scopariae (Bianxu), Spora Tectariae (Haijinsha wrapped), Scorched Fructus Gardeniae Praecox (Jiaoshanzhi) each 3 qian, Folium Menthae haplocalycis (Dan zhuye) 2 qian, Radix Akebiae (Mutong), Raw Rheum Palmatum (Sheng jinwen) each 1 qian, Radix Glycyrrhizae Preparata (Sheng gan shao) 8 fen. First decoct Smilax Glabra Rhizome (Tu fuling), fresh Herba Portulacae (Xian cheqian cao), peeled fresh Herba Imperatae (Qu pi xian maogen) each 1 liang to replace water]. If no strangury poison, but Heart channel residual heat transfers to Bladder, causing Bladder heat binding and hematuria, symptoms include vexation, insomnia, or coma/unconsciousness, or throat/tongue pain, or palpitations/annoyance. Treat by cooling blood and draining heat. Use Daochi Qingxin Tang minus Fuling and Maidong, add Jiaozhi, Qumai, and Hupo (Amber). If heat originates from Liver channel, accompanied by lower abdominal fullness, stabbing hypochondriac pain, bitter taste, deafness, alternating chills and fever, profuse red strangury, even sinew atrophy and penile pain, treat by cooling Liver and draining fire. Use Longdan Xiegan Tang plus Danpi and Yujin. Mild cases use Qinggan Dayu Tang minus Heye and Juhua, add Longdancao, Sheng Niuxi shao, and Xian Cheqian cao. If treating Heart and Liver is ineffective, clear the Lung. The Lung is the upper source of Kidney Water; clear Lung then Water clears, calm Water then Blood calms. Use Qingzao Jiufei Tang plus Puhuang, Maogen, and Oujie.
In summary, hemostatic methods require clear differentiation of deficiency/excess and cold/heat to correctly apply tonification/draining and warming/cooling. Tonification includes Ejiao, Shudi, Xianyu jiao, etc., which strengthen Water and tonify deficiency. Renshen, Shashen, Yanyin tonify Qi and deficiency. Draining includes Dahuang, Huangqin, Huanglian, Dancao, bitter-cold fire-draining drugs. Fresh Di, Pear, Sugarcane, Lotus Root juices are sweet-cold fire-draining drugs. Ganjiang tan, Rougui tan, Lu jiao tan, Gouqi tan are warming-cold hemostatic drugs. Ge Shi's Shihui San is heat-clearing hemostatic drug. Others like Suzi, Yujin, Jiangxiang, Qingpi, Jiu zhi are Qi-descending and Liver-subduing drugs. Shijueming, Zuo Muli, Haige ke, Daizheshi are Blood-descending and Liver-calming drugs. All treat blood rising with Qi. For blood stasis, use Dahuang hui, Ganqi hui, Shanzha hui, Hongqu hui. For slippery blood, use Zongpi hui, Lianfang hui, Liupi hui, Meishi zi. Sanqi, Yujin, Danpi move Qi within Blood. Daji, Xiaoji, Qian gen eliminate stagnation in Blood. Ce bai, Ziwei, Jiancao, Zhuru cool heat in Blood. Xijiao, Daimao, Zhufen, Hupo clear Spirit in Blood. Maogen, Niuxi, Tongbian guide blood downward. Oujie zhi, Heye zhi, Chen zhe zhi stop bleeding while moving stasis. Blood medicines are numerous, far more than just astringents.
[Youlian's Note]: Mr. Miao's Three Principles for Treating Hematemesis state first: promote blood circulation rather than stop bleeding. Deep fear that stopping leads to coagulation, coagulation leads to fever/anorexia, and disease becomes entrenched, often resulting in blood stasis turning into Consumption. Among blood-circulating drugs, Dahuang is foremost. My father created Lizhi Tuyue Gao (Immediate Stop Hematemesis Paste) [Ingredients: Jiancao 1 jin, Dijin 2 jin, Ye Baihe, Hei Mu'er, Baiji, Meishi zi each 1 liang, Fresh Oujie 2 liang, Fresh Pipaye de-haired/cleaned, Fresh scraped Danzhuru, Fresh Jiaobaigen each 8 liang. Decoct, remove dregs, filter, add Jingbaimi 1 jin, Kuibingtang 8 liang, boil to thick paste]. It treats ordinary reckless hemoptysis. Take one small spoon, twice day/once night, on empty stomach, cured in ten days. For chronic Lung damage hemoptysis, take this at 5 AM, and Qiongyu Gao morning/evening, cured in one month, with consistent results. Since blood overflowing upper orifices is mostly Yang excess/Yin deficiency with ascending without descending (90%), my father established these two formulas: Jiangqi Xiehuo (Descend Qi Drain Fire) and Buluo Tianqiao (Repair Collaterals Fill Pores), treating according to syndrome. However, Yang Renzhai stated that in bleeding disorders, Yang deficiency causing Yin leakage accounts for 3-4 in 100. Thus, Shuchiyuan strongly criticized nourishing Yin for deficiency bleeding. Chen Xiuyuan also supports this view, applicable to such syndromes. Treat with Mr. Ding Yanfeng of Shaanxi's secret Two Prescriptions for Blood Disorders, which are highly effective.
Prescription 1 for Treating Blood [Ingredients: Guang Yujin, Chaohei Zisu, Zhen Chuanpu, Jiuchao Sheng Jinwen each 8 fen, Zhiqiao, Jiegeng, Danggui each 7 fen, Zi Yougui 5 fen. Decoct 2 zhong water, add Tongbian half cup, Jiangzhi one small spoon, mix and take. Only take 1-2 doses]. Prescription 2 for Treating Blood [Ingredients: Maidong 2 qian, Chuanbei, Chuanduan each 1 qian, Chishao 7 fen, Yuanzhi 6 fen, Shanyao 4 fen, Yimucao 3 fen. Decoct 2 zhong water to 8 fen, take 10 doses. Regardless of age/gender or old/new hematemesis, take as directed for immediate cure and eradication. Even if bleeding stops after a few doses, complete the 10 doses. Do not change ingredients or dosages. Crucial! Avoid cold-cooling drugs to prevent blood coagulation/Qi stagnation. If cold drugs were mistakenly taken initially, this prescription will gradually transform cold-phlegm/saliva. After finishing, if dry cough persists, take Jianpi Wan]. Famous doctor Mr. Zhang Shaoquan from Rongcheng elucidated: The former prescription is excellent because Zhi, Jie, Piao, and Su lift, descend, and dredge, leaving no pathogenic residue. Then Danggui and Yujin guide from within the blood. Finally, Rougui assists Dahuang to warm, unblock, and descend, guiding