阳虚失血者，脾胃气虚，不能固护阴气也。《仁斋直指》云∶血遇热则宣流，故止血多用凉
剂。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。其血色必黯黑而不鲜，法当温中，使血自归经络。可用理中汤加楠木香，或甘
草干姜汤，其效甚着。曹氏云∶吐血须煎干姜甘草汤与服，或四物理中汤亦可。若服生地黄、竹茹、藕汁，去生便远。
《三因》云∶理中汤能止伤胃吐血，以其最理中脘，分利阴阳，安定血脉也。
按∶经云∶荣气出于中焦，是以脾胃为统血之司，而甘温气味，有固血之用也。世医畏其能
动血，虽遇当用而不敢用者多矣。厥疾不瘳，谁之过欤。或有仿《千金》例于伏龙肝、甘草
、干姜、白术之中，加阿胶之润，黄芩之苦，以折炎上之势，而复既脱之阴，亦《内经》甚者从之之意也。
理中汤
人参 白术 甘草 干姜（炮，各三两）
水八升，煮取三升，去滓，温服一升，日三服。
甘草干姜汤
甘草（炙，四两） 干姜（炮，二两）
水三升，煮取一升五合，去滓，分温再服。
黑神散（《和剂》）
黑豆（炒，半升，去皮） 干熟地（酒浸） 当归（去芦，酒制） 肉桂（去粗皮） 干姜
（炮） 甘草（炙） 芍药 蒲黄（各四两）
上为细末，每服二钱，酒半盏，童子小便半盏，不拘时煎服。
凡吐血脉微、身凉恶风者，须于地黄、芍药中加肉桂一钱，虚冷人多有此证。
阳虚导致的失血，是由于脾胃之气虚弱，无法固护阴气。《仁斋直指》说：血液遇到热就会扩散流淌，所以止血多使用凉性药剂。然而也有因气虚夹杂寒邪，导致阴阳不能相互守持的情况。营气（运行于脉中的精气）虚弱散乱，血液也会运行失常，这就是所说的“阳虚则阴必走泄”。外在症状必然有虚寒的表现。其血色必定是黯黑而不鲜红，治疗法则应当温中焦，使血液自然回归经络。可以使用理中汤加木香，或者甘草干姜汤，疗效非常显著。曹氏说：吐血必须煎服干姜甘草汤，或者四物汤合用理中汤也可以。如果服用生地黄、竹茹、藕汁，离康复就越来越远了。
《三因极一病证方论》说：理中汤能止住因损伤胃气引起的吐血，因为它最能调理中脘，分清泌浊阴阳，安定血脉。
按语：经典医籍说：营气产生于中焦，因此脾胃是统摄血液的枢纽，而甘温性质的药物气味，具有固摄血液的作用。世间的医生害怕它能动血，虽然遇到应当使用的情况却不敢使用的人很多了。疾病不愈，这是谁的过错呢？有的人模仿《千金方》的体例，在伏龙肝、甘草、干姜、白术中加入阿胶的滋润，黄芩的苦寒，以折抑火热上炎的趋势，并恢复已经脱失的阴液，这也符合《内经》“甚者从之”的治疗意旨。
理中汤
人参 白术 甘草 干姜（炮制，各三两）
用水八升，煮取三升，去掉药渣，温服一升，每日三次。
甘草干姜汤
甘草（炙，四两） 干姜（炮制，二两）
用水三升，煮取一升五合，去掉药渣，分两次温服。
黑神散（出自《太平惠民和剂局方》）
黑豆（炒，半升，去皮） 干熟地黄（酒浸） 当归（去芦头，酒制） 肉桂（去粗皮） 干姜（炮制） 甘草（炙） 芍药 蒲黄（各四两）
以上药材研为细末，每次服用二钱，用酒半盏、童子小便半盏，不拘时间煎服。
Hemorrhage due to Yang deficiency arises from the deficiency of Qi in the Spleen and Stomach, which fails to secure the Yin Qi. *Ren Zhi Zhi Zhi* states: "Blood flows diffusely when encountering heat; therefore, hemostatic formulas mostly employ cooling agents." However, there are cases where Qi deficiency is accompanied by Cold, causing Yin and Yang to fail to guard each other. When Ying Qi (nutritive Qi circulating within the vessels) is deficient and scattered, blood also moves erratically. This is what is meant by "Yang deficiency leads to the escape of Yin." Externally, there must be signs of deficiency and cold. The color of the blood will necessarily be dark black rather than bright red. The treatment principle should be to warm the Middle Jiao so that blood naturally returns to the collaterals. Lizhong Tang (Regulate the Middle Decoction) with Nanmu Xiang (Aucklandiae Radix) or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) can be used, with remarkable efficacy. Cao Shi stated: "For hematemesis, one must decoct and administer Gancao Ganjiang Tang, or a combination of Siwu Tang (Four Substances Decoction) and Lizhong Tang is also acceptable." If Sheng Dihuang (Rehmanniae Radix Recens), Zhuru (Bambusae Caulis in Taeniam), and Ou Zhi (Nelumbinis Rhizomatis Succus) are administered, recovery will be further delayed.
*Sanyin Fang* states: "Lizhong Tang can stop hematemesis caused by stomach injury because it best regulates the Zhongwan region, separates and distributes Yin and Yang, and stabilizes the blood vessels."
Commentary: The Classics state: "Ying Qi originates from the Middle Jiao." Therefore, the Spleen and Stomach are the managers of blood control, and herbs with sweet and warm properties have the function of securing blood. Many physicians in later generations fear that these herbs might move blood; thus, although they encounter indications for their use, they dare not administer them. Whose fault is it if the chronic disease remains uncured? Some imitate the example in *Qianjin Fang* by adding E-Jiao (Donkey-hide Gelatin) for its moistening property and Huangqin (Scutellariae Radix) for its bitter property to the mixture of Fulonggan (Dragon's House Earth), Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), and Baizhu (Atractylodis Macrocephalae Rhizoma). This aims to curb the upward flare of fire and restore the already lost Yin, which also aligns with the principle of "treating severe conditions by following the pathogenic factor" found in the *Neijing*.
Lizhong Tang (Regulate the Middle Decoction)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma) [processed, 3 liang each]
Add 8 sheng of water, boil to obtain 3 sheng, remove the dregs, take 1 sheng warm, three times daily.
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma) [roasted, 4 liang], Ganjiang (Zingiberis Rhizoma) [processed, 2 liang]
Add 3 sheng of water, boil to obtain 1.5 sheng, remove the dregs, divide into two doses and take warm.
Heishen San (Black Divine Powder) [from *Tai Ping Hui Min He Ji Ju Fang*]
Heidou (Sojae Semen Nigrum) [stir-fried, half sheng, skin removed], Gan Shudi (Rehmanniae Radix Preparata) [soaked in wine], Danggui (Angelicae Sinensis Radix) [remove rhizome, processed with wine], Rougui (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma) [processed], Gancao (Glycyrrhizae Radix et Rhizoma) [roasted], Shaoyao (Paeoniae Radix), Puhuang (Typhae Pollen) [each 4 liang]
Grind all above into fine powder. For each dose, take 2 qian, decoct with half zhan of wine and half zhan of urine from an unblemished boy, at any time.
For patients with hematemesis presenting with a faint pulse, cool body, and aversion to wind, add 1 qian of Rougui (Cinnamomi Cortex) to Sheng Dihuang (Rehmanniae Radix Recens) and Shaoyao (Paeoniae Radix). Patients with deficiency-cold constitution often present with this syndrome.