青。非中寒中恶。猝厥而至危亡顷刻之青。特舌心不红而青白。非重症也。盖舌之本色。边白而中青。外阳内
阴者。离之象也。胃以后天精捍之气充之。则红润而有色。以胃之别络、系舌本而通酾泉之窍。故也。今络瘀
而血液不上滋。故舌青而且口燥者。亦此理也。津液干于上。故欲漱水。胃络血瘀。不但不供津液于上。亦且
不行水饮于下。中湿拒水。故不欲咽也。以上错叙诸症。如此。当看下文。层层逼入微妙。真所谓独见若神也。
一层、以外症无寒热。知非少阳。二层、以脉大。知在胃腑。三层、以脉大无力而微迟。知非阳明结热。而但属瘀
血。四层、以腹本不满。而自觉为满。知结者不在胃中。而瘀在胃络。故直断之曰。为有瘀血也。盖谓胸满唇痿
等六症。大似少阳风火之邪上逆。然少阳逆热。必见寒热。而此则无寒热之表症。脉又非少阳之弦。而但微
大而迟。大脉搏浓宽裕。其象为土而属胃。胃中热实之气上冲。或见种种等候。然必脉至有力而不微。数而
不迟。是为合诊。今见微迟。则大非实热可知。夫大为胃脉。又大则为芤。合断之。明系胃中伤血之应。且微为
气体不充。迟为发机沉滞。俱壅塞之诊。故知胃有瘀血。但血瘀胃中。法当 胀而腹满。今腹不满。而病患自
以为满。则知满在胃络。而为血瘀之所致也。
十三条 病者如热状。烦满。口干燥而渴。其脉反无热。此为阴伏。是瘀血也。当下之。
烦满、口干而渴。本非热因。以血瘀而生阴不滋之应。故曰如热状。且曰脉无热也。阴伏者。一切生气。俱畏鬼
气。如灯火恶烟。树根恶炭之类。血瘀而营阴恶之。不复上滋。而有伏藏之象。故曰阴伏。此条。虽比上条多烦
渴二症。言不必如前症之全。即此已为阴伏。盒饭用攻下之法。以通其瘀矣。不出方者。岂以伤寒论中。已有
桃核承气。并抵当汤丸。以治结血之例耶。前条之血瘀在胃络。胃络瘀。故上不行津。而唇痿、舌青、口燥、漱
水等干症。见于上。下不行水。而中湿拒水。故不欲咽水之症见于中。此条之血瘀在大肠络。故并中焦之胃。
亦在津液短少之内。其烦而干燥且渴者。此也。当下之三字。是总承二条。非单言此症也。
十四条 吐血不止者。柏叶汤主之。
柏叶汤方 柏叶（三两） 干姜（三两炮） 艾叶（三把）
上三味。以水五升。取马通汁一升。合煮取一升。分温再服。
此承七条脉浮弱。按之绝。烦咳者必吐血句。夫吐血。因下焦虚寒之气。上冲而致咳。咳多上顿。而气亦升浮。
因之血随气逆而上涌。故用柏叶汤温下焦之寒气。而逆自平。血自止矣。其意以干姜辛热。辛能平逆。热能
散寒。加之炮黑。则守而不走。更能入血分。而温其按之欲绝之脉。且肺肾为子母。温肾即所以温肺。而尤能
止其烦咳也。艾叶性温。气味俱重。味重入血。味重而气亦重。则入血而尤能行血中之气。与姜为佐。既济其
温暖之功。复援其入血之用也。又恐温药与寒气不相入。故用苦寒而不畏霜雪之柏叶以为反佐。则深入
下焦虚寒之地。而使姜艾得行其回阳之力。亦犹白通之用人尿胆汁之义也。加马通汁者、马为午兽。得丙
火之正。故其为畜。尝病热而不病寒。以其脏腑多阳气故也。且吐血不止。其血由胃与大肠之络脉。渗入肠
胃而上出者。故用其下走肠胃之汁。以平上逆耳。仲景但欲生千古之吐血者。而不自惜其呕出心肝矣。痛哉。
十五条 下血。先便后血。此远血也。黄土汤主之。
黄土汤方 白术 附子 干地黄 阿胶 黄芩 甘草（各三两） 灶中黄土（半斤）
上七味。以水八升。煮取三升。分温三服。
此承七条脉浮弱。按之绝者下血句。夫浮为上焦有余之邪火。凭凌胃中之血液。故中取以弱应。灌注大肠
之虚脱而下。故按之以绝应。先便后血。便在大肠而血在胃。是血从胃而下注大肠者。胃比大肠较远。故曰
远血。主黄土汤者。以浮为上焦之实热。故用黄芩。撤胸膈之火。以缓其吹嘘之势。弱为中取而见。则知脾胃
之阴阳两空。故以灶中黄土为君。白术、甘草为臣。而益其中焦之气。以地黄、阿胶为佐。而并益其中焦之血。
然后殿之以附子者。盖又以辛热而托其按欲绝之脉。并以提其下脱之血也。
十六条 下血。先血后便。此近血也。赤小豆当归散主之。（方见狐惑篇）
先血后便。血在广肠之末。故曰近血。赤豆蔓生。且色红脐黑。蔓生具经络之象。色红则入血分。脐黑则又走
下焦者也。浸令芽出者。取芽性之生阳上锐也。仲景之意。以脉之按欲绝者。为下焦气脱血陷之诊。则中取
之而弱。轻取之而浮者。但当于下焦之虚处责之可矣。故用赤豆走下焦血分之性。令其芽出而上锐。领补
血之当归。直走广肠。而复提血气以上行也。要之、上条之血。渗自中焦。故于浮弱按欲绝之脉。三部俱责。以
浮、为上焦实邪。按欲绝、为下焦虚寒。以实邪奔迫虚寒。直将中焦血液随势逼下。故三焦俱治。此律家不分
首从之议也。此条之血。单责在按欲绝一边。以血在魄门相近。其症最低。与按之欲绝之里脉逼对。则知但
因下焦之虚脱。而招上中之下陷耳。上焦之血下陷。故轻取之脉以浮见。中焦之气下陷。故中取之脉以弱
见。只用补其下而复提之。不特血反故道而病愈。且血宁则气聚。而欲绝之脉自起。并中上二焦之气血得
还。而浮弱之脉亦可渐变矣。此春秋讨罪。而独严主令之义也。又上条之血。从足阳明之胃络。渗入胃中而
下。故黄土汤之方意。瞩目在胃中者居多。此条之血。从手阳明之大肠络。渗入肠中而下。故赤豆当归散。只
注意在大肠而已。诸解梦梦。俱道不着。
十七条 心气不足。吐血衄血。泻心汤主之。
泻心汤方 大黄（二两） 黄连（一两） 黄芩（一两）
上三味。以水三升。煮取一升。顿服之。
此承本篇第四条尺脉浮二节。并七条之面无血色、脉沉弦二句。而言治衄之法。吐血二字。特因同源异出
者而连及之耳。泻心非吐血之正例也。与柏叶汤症细辨自见。误用则立死矣。心气不足。兼下焦有余之实
邪而言。详首二条惊悸下。以下焦之有余。而凌犯上焦之不足。病神志则为惊悸。病气血则为吐衄。神志杳
冥。天之道也。故主清虚之气药。补上以泄下。桂枝救逆汤、半夏麻黄丸之辛甘而温者。是也。血气形质。地之
化也。故主重浊之味药。平地以成天。本方大黄、连、芩之苦寒。是也。门人问曰。柏叶汤症。则主温剂。泻心汤
症。则又主寒剂。几不知仲景之所谓心气者何在。毕竟是寒是热。且柏叶泻心两症之所以异。并泻心一症之何以
或吐或衄也。余曰。悉哉问也。夫心气者。托于心之血。而又为神之奥宅。外与心肺夹空之宗气相因。譬之于水。
心气如井泉。心下之气如江河。虽不相通。然而井泉尝视江河以为消长者也。其性温温。其道存存。如太和生气
之在春。故遇寒、则畏结而不伸。遇热、则恶焦而欲奔。尝立于不寒不热之间。而独尊者也。若夫沉取脉绝。虚
寒在下。上冲于肺。肺恶寒湿。形缩喘咳。气血上并。涌出内络。是为寒因。寒者热之。理所宜也。至于寸口动
弱。沉弦在尺。动弱、上虚。沉弦、下实。虚者、招侮。实、则上击。以实乘虚。地 天德。阳位扁浅。气血逼
侧。出从上窍。其理可得。掘地疏河。神禹妙策。地平天成。圣人之则。是为塞因。塞者通之。乌可已哉。脏腑内主。
经络外裹。内外相通。各有玄窍。经络实。而胸分之气虚者。实热之邪。从肠胃之大络而扛抬其气血于直上。
则由喉嗓而见于吐。宗气充。而经分之气虚者。实热之邪。从脏腑之别络而外逼其气血于经隧。则由巅顶
而见于衄矣。吐衄虽殊。而其为实热上冲则一。故皆主泻心。以泻其亢害耳。
青色的舌象，并非因中寒或中恶导致猝然昏厥、顷刻间危及生命的青色。而是舌心不红而呈现青白色，这不属于重症。因为舌头的本色，边缘白而中间青，这是外阳内阴的离卦之象。胃以后天精悍之气充养舌头，所以舌色红润而有光泽。这是因为胃的别络连接舌根并通达酾泉之窍的缘故。如今络脉瘀阻，血液不能上行滋润，所以舌头青且口燥，也是这个道理。津液在上部干枯，所以想要含水漱口；胃络血瘀，不仅不能向上供应津液，也不能向下运行水饮，中焦湿气阻滞拒纳水饮，所以不想吞咽。以上错杂叙述了各种症状，应当这样理解。要看下文，层层深入微妙之处，真可谓独具慧眼如神。第一层，以外症无寒热，知道不是少阳病；第二层，以脉大，知道病在胃腑；第三层，以脉大无力而微迟，知道不是阳明结热，而只是属于瘀血；第四层，以腹部本来不胀满，但患者自觉胀满，知道结滞不在胃中，而在胃络。所以直接断定说：是有瘀血。大概胸满、唇萎等六个症状，很像少阳风火之邪上逆。然而少阳逆热，必定见寒热，而这里没有寒热的表症，脉也不是少阳的弦脉，只是微大而迟。大脉搏动浓宽裕，其象为土而属胃。胃中热实之气上冲，或许会出现种种候象。然而必定脉至有力而不微弱，数而不迟，这才是符合诊断。现在见到微迟，则明显不是实热可知。大为胃脉，又大则为芤脉，综合判断，明确是胃中伤血的反应。而且微表示气体不充盈，迟表示发机沉滞，都是壅塞的诊断。所以知道胃中有瘀血。如果血瘀在胃中，法当腹胀而腹满。现在腹部不胀满，而病患自以为胀满，就知道胀满在胃络，是由血瘀所导致的。
第十三条 病人好像有热象，心烦胀满，口干燥而渴，其脉反而没有热象，这是阴分伏热，是瘀血。应当用攻下法治疗。
烦满、口干而渴，本不是热邪引起的，是因为血瘀而生阴不滋的反应，所以说像热象。并且说脉无热。阴伏，是指一切生气都畏惧鬼气（阴邪），就像灯火厌恶烟雾，树根厌恶炭火之类。血瘀而营阴厌恶它，不再向上滋润，而有伏藏的现象，所以说阴伏。这一条，虽然比上一条多了烦渴两个症状，言不必像前症那样齐全，仅凭这些已经算是阴伏。应当用攻下之法，来疏通瘀血。不出方子，难道是因为《伤寒论》中已有桃核承气汤和抵当汤丸，作为治疗结血的先例吗？前一条的血瘀在胃络，胃络瘀，所以上面不行津液，而唇萎、舌青、口燥、漱口水等干症出现在上面；下面不行水，而中湿拒水，所以不想喝水的症状出现在中间。这一条的血瘀在大肠络，所以连同中焦的胃，也在津液短少的范围内。其烦而干燥且渴，就是这个原因。“当下之”三个字，是总承上下两条而言，并不是单指这个症状。
第十四条 吐血不止的，用柏叶汤主治。
柏叶汤方：柏叶（三两）、干姜（三两，炮制）、艾叶（三把）。
以上三味药，用水五升，取马通汁一升，混合煮取一升，分两次温服。
这是承接第七条“脉浮弱，按之绝，烦咳者必吐血”一句。夫吐血，是因为下焦虚寒之气上冲导致咳嗽，咳嗽多向上顿挫，气也升浮，因此血随气逆而上涌。所以用柏叶汤温散下焦的寒气，而逆气自平，血自止。其意在于干姜辛热，辛能平逆，热能散寒，加之炮黑，则守而不走，更能入血分，而温煦那按之欲绝的脉。且肺肾为母子关系，温肾即所以温肺，而尤其能止其烦咳。艾叶性温，气味俱重，味重入血，味重而气亦重，则入血而尤其能行血中之气，与姜为佐，既济其温暖之功，又援其入血之用。又担心温药与寒气不相入，所以用苦寒而不畏霜雪的柏叶作为反佐，则能深入下焦虚寒之地，而使姜艾得以发挥回阳之力，这也如同白通汤用人尿胆汁的意义一样。加马通汁的原因，马为午兽，得丙火之正，所以作为牲畜，常患热病而不患寒病，因为其脏腑多阳气。且吐血不止，其血由胃与大肠的络脉，渗入肠胃而上出，所以用其下走肠胃的汁液，来平抑上逆之气。仲景只想救活千古以来的吐血患者，而不吝惜呕出心肝般的苦心。痛哉。
第十五条 下血，先大便后出血，这是远血。用黄土汤主治。
黄土汤方：白术、附子、干地黄、阿胶、黄芩、甘草（各三两）、灶中黄土（半斤）。
以上七味药，用水八升，煮取三升，分三次温服。
这是承接第七条“脉浮弱，按之绝者下血”句。夫浮脉为上焦有余之邪火，凌犯胃中的血液，所以中取以弱应；灌注大肠之虚脱而下，所以按之以绝应。先便后血，便在大肠而血在胃，是血从胃而下注大肠。胃比大肠较远，所以叫远血。主用黄土汤，是因为浮脉为上焦之实热，所以用黄芩，撤去胸膈之火，以缓和其吹嘘之势。弱脉是中取而见，则知脾胃之阴阳两空，所以以灶中黄土为君药，白术、甘草为臣药，以益其中焦之气；以地黄、阿胶为佐药，以并益其中焦之血。然后殿之以附子，盖又以辛热而托起那按之欲绝的脉，并以提起下脱之血。
第十六条 下血，先出血后大便，这是近血。用赤小豆当归散主治。（方剂见狐惑篇）
先血后便，血在广肠之末，所以叫近血。赤豆蔓生，且色红脐黑。蔓生具有经络之象，色红则入血分，脐黑则又走下焦。浸令发芽，取芽性之生阳上锐。仲景之意，认为脉之按欲绝者，为下焦气脱血陷的诊断，则中取之而弱，轻取之而浮者，只应当于下焦的虚处责求病因即可。所以用赤豆走下焦血分之性，令其芽出而上锐，领补血之当归，直走广肠，而复提血气以上行。总之，上一条的血，渗自中焦，所以在浮弱按欲绝之脉，三部俱责，以浮为上焦实邪，按欲绝为下焦虚寒，以实邪奔迫虚寒，直将中焦血液随势逼下，故三焦俱治。这是律家不分首从的议论。这一条的血，单责在按欲绝一边，以血在魄门相近，其症最低，与按之欲绝之里脉逼对，则知但因下焦之虚脱，而招致上中之下陷耳。上焦之血下陷，故轻取之脉以浮见；中焦之气下陷，故中取之脉以弱见。只用补其下而复提之，不特血反归故道而病愈，且血宁则气聚，而欲绝之脉自起，并中上二焦之气血得还，而浮弱之脉亦可渐变矣。这是春秋讨罪，而独严主令之义。又上一条的血，从足阳明之胃络，渗入胃中而下，所以黄土汤的方意，瞩目在胃中者居多。这一条的血，从手阳明之大肠络，渗入肠中而下，所以赤豆当归散，只注意在大肠而已。诸解梦梦，俱道不着。
第十七条 心气不足，吐血衄血，用泻心汤主治。
泻心汤方：大黄（二两）、黄连（一两）、黄芩（一两）。
以上三味药，用水三升，煮取一升，顿服。
这是承接本篇第四条尺脉浮二节，并第七条之面无血色、脉沉弦二句，而言治衄之法。吐血二字，特因同源异出者而连及之耳。泻心汤并非吐血的正规治法。与柏叶汤症仔细辨别自然可见，误用则立即致死。心气不足，兼下焦有余之实邪而言。详看首二条惊悸之下，以下焦之有余，而凌犯上焦之不足，病神志则为惊悸，病气血则为吐衄。神志杳冥，是天之道。所以主清虚之气药，补上以泄下，桂枝救逆汤、半夏麻黄丸之辛甘而温者，就是这类。血气形质，是地之化。所以主重浊之味药，平地以成天，本方大黄、连、芩之苦寒，就是这类。门人问曰：柏叶汤症，则主温剂；泻心汤症，则又主寒剂，几乎不知仲景所说的“心气”究竟在哪里。毕竟是寒是热？且柏叶汤与泻心汤两症之所以不同，以及泻心汤一症为何有时吐血有时衄血？我说：问得好啊。夫心气者，依托于心之血，而又为神之奥宅，外与心肺夹空之宗气相因。譬之于水，心气如井泉，心下之气如江河，虽不相通，然而井泉常视江河以为消长。其性温温，其道存存，如太和生气之在春。所以遇寒，则畏结而不伸；遇热，则恶焦而欲奔。尝立于不寒不热之间，而独尊者也。若夫沉取脉绝，虚寒在下，上冲于肺，肺恶寒湿，形缩喘咳，气血上并，涌出内络，是为寒因。寒者热之，理所宜也。至于寸口动弱，沉弦在尺，动弱为上虚，沉弦为下实。虚者招侮，实则上击。以实乘虚，天地德。阳位扁浅，气血逼侧，出从上窍，其理可得。掘地疏河，神禹妙策，地平天成，圣人之则。是为塞因塞用。塞者通之，乌可已哉。脏腑内主，经络外裹，内外相通，各有玄窍。经络实，而胸分之气虚者，实热之邪，从肠胃之大络而扛抬其气血于直上，则由喉嗓而见于吐。宗气充，而经分之气虚者，实热之邪，从脏腑之别络而外逼其气血于经隧，则由巅顶而见于衄矣。吐衄虽殊，而其为实热上冲则一。故皆主泻心，以泻其亢害耳。
The bluish color of the tongue is not the cyanosis resulting from sudden collapse due to cold pathogen or evil qi, which leads to critical danger within moments. Rather, it is a bluish-white color in the center of the tongue without redness, indicating that it is not a severe condition. The natural color of the tongue, white at the edges and blue/green in the center, represents the image of the Li trigram (Fire), symbolizing outer Yang and inner Yin. The Stomach nourishes the tongue with its postnatal refined and vigorous Qi, resulting in a ruddy and lustrous appearance. This is because the collateral vessels of the Stomach connect to the root of the tongue and open into the apertures of Shiquan. Now, if the collaterals are obstructed by blood stasis, blood cannot ascend to moisten the tongue, leading to a bluish tongue and dry mouth; this follows the same principle. When body fluids are dried up in the upper jiao, the patient desires to rinse their mouth with water. However, due to blood stasis in the Stomach collaterals, not only can fluids not be supplied upwards, but water metabolism downwards is also impaired. Dampness in the middle jiao rejects water intake, so the patient does not wish to swallow. The above passage describes various symptoms in a non-linear manner. One should read the following text carefully, where the analysis penetrates layer by layer into subtleties, truly demonstrating unique insight akin to divine perception.
First layer: The absence of chills and fever in external symptoms indicates it is not Shaoyang disease.
Second layer: A large pulse indicates the pathology is in the Stomach organ.
Third layer: A large pulse that is forceless, slightly slow, and delayed indicates it is not Yangming internal heat accumulation, but rather blood stasis.
Fourth layer: Although the abdomen is not actually distended, the patient feels fullness, indicating that the stagnation is not in the Stomach proper but in the Stomach collaterals. Therefore, it is directly diagnosed as "presence of blood stasis."
The six symptoms mentioned—chest fullness, withered lips, etc.—resemble the upward reversal of Shaoyang wind-fire pathogens. However, Shaoyang reversed heat must present with chills and fever, whereas here there are no such exterior symptoms. The pulse is not the wiry pulse of Shaoyang, but merely slightly large and slow. A large pulse, thick and broad, corresponds to the Earth element and belongs to the Stomach. If Qi of heat and excess in the Stomach rushes upward, various signs may appear. Yet, the pulse must be forceful, not weak, rapid, not slow, for a consistent diagnosis. Since a slow and delayed pulse is observed, it is clearly not excess heat. A large pulse is characteristic of the Stomach; combined with a hollow (Kou) quality, it confirms injury to blood in the Stomach. Furthermore, a weak pulse indicates insufficient Qi, and a slow pulse indicates sluggish movement, both pointing to obstruction. Thus, blood stasis in the Stomach is identified. If blood were stasis within the Stomach organ itself, abdominal distension and fullness would be expected. Since the abdomen is not distended but the patient feels fullness, the fullness resides in the Stomach collaterals caused by blood stasis.
Article 13: The patient presents with symptoms resembling heat, irritability, chest fullness, dry mouth, and thirst, yet the pulse shows no signs of heat. This is termed "Yin Fu" (hidden Yin pathogen), indicating blood stasis. It should be treated with purgation.
Irritability, fullness, dry mouth, and thirst are not originally caused by heat pathogens but are responses to Yin failing to nourish due to blood stasis; hence, it is described as "resembling heat," and the pulse lacks heat signs. "Yin Fu" refers to the phenomenon where vital Qi fears Yin pathogens (ghost Qi), similar to how lamps fear smoke or tree roots fear charcoal. Blood stasis repels Ying-Yin, preventing it from ascending and moistening, creating a state of hidden storage; thus, it is called Yin Fu. Although this article adds irritability and thirst to the previous symptoms, implying that not all prior symptoms need be present, these suffice to diagnose Yin Fu. Purgative methods should be employed to unblock the stasis. No formula is provided, likely because *Taohe Chengqi Tang* (Peach Kernel Decoction to Order the Qi) and *Didang Tang/Wan* (Mustard Seed Pill) in the *Shanghan Lun* already serve as precedents for treating fixed blood. In the previous article, blood stasis was in the Stomach collaterals; thus, fluids failed to ascend (causing withered lips, bluish tongue, dry mouth, rinsing without swallowing) and water failed to descend (causing damp rejection). Here, blood stasis is in the Large Intestine collaterals, affecting the Middle Jiao Stomach's fluid production, causing irritability, dryness, and thirst. The phrase "should be purged" applies generally to both articles, not just this specific symptom cluster.
Article 14: For persistent hematemesis (vomiting blood), Baiye Tang (Cypress Leaf Decoction) is the primary treatment.
Baiye Tang Formula: Cypress Leaf (San liang), Dried Ginger (San liang, processed), Mugwort Leaf (Three handfuls).
These three ingredients are boiled in five sheng of water, combined with one sheng of horse manure juice, until one sheng remains. Divide into two warm doses.
This follows Article 7 ("floating and weak pulse, absent upon deep pressure, irritability and cough lead to hematemesis"). Hematemesis occurs when deficiency-cold Qi from the Lower Jiao rushes upward, causing cough. Frequent upward coughing lifts Qi, forcing blood to follow the rebellious Qi upward. Baiye Tang warms the Lower Jiao cold, calming the rebellion and stopping bleeding. Dried Ginger is pungent and hot; pungency calms rebellion, heat disperses cold. Processed ginger stays put rather than moving, entering the blood level to warm the pulse that feels nearly absent upon pressure. Since Lung and Kidney are mother-son organs, warming the Kidney warms the Lung, alleviating irritability and cough. Mugwort is warm with heavy aroma and taste; heavy taste enters the blood, and heavy Qi moves Qi within the blood. Combined with Ginger, it enhances warmth and blood-entry properties. To prevent warm herbs from clashing with cold pathogens, bitter-cold Cypress Leaf is used as an opposing assistant (fan zuo), allowing the formula to penetrate deep into the deficiency-cold of the Lower Jiao, enabling Ginger and Mugwort to restore Yang, analogous to using human urine and pig bile in Baitong Tang. Horse manure juice is added because horses (associated with Wu/Fire) possess strong Yang Qi and rarely suffer from cold. Since bleeding originates from Stomach and Large Intestine collaterals seeping into the gut and exiting upward, horse manure juice directs action downward to counteract the upward rebellion. Zhang Zhongjing’s compassion for saving lives is profound.
Article 15: For hematochezia (bleeding from the rectum) where stool precedes blood, this is "distant blood" (Yuan Xue). Huangtu Tang (Yellow Earth Decoction) is the primary treatment.
Huangtu Tang Formula: Atractylodes Macrocephala Rhizome, Prepared Aconite Root, Rehmannia Root (Prepared), Donkey-hide Gelatin, Scutellaria Root, Licorice Root (each San liang), Hearth Soil (Ban jin).
These seven ingredients are boiled in eight sheng of water until three sheng remain. Divide into three warm doses.
This continues from Article 7 regarding lower bleeding with floating/weak/absent pulses. A floating pulse indicates excess fire in the Upper Jiao harassing Stomach blood (reflected as weak in the middle position); sinking/deep absence indicates deficiency/collapse in the Lower Jiao/Large Intestine. Stool preceding blood means blood originates in the Stomach and flows down to the Large Intestine; since the Stomach is farther from the anus, it is called "distant blood." Huangtu Tang uses Scutellaria to clear Upper Jiao fire. The weak middle pulse indicates emptiness of Spleen-Stomach Yin and Yang. Hearth Soil acts as the Sovereign herb to tonify Middle Jiao Qi, supported by Atractylodes and Licorice. Rehmannia and Donkey-hide Gelatin assist by nourishing Middle Jiao blood. Finally, Prepared Aconite anchors the nearly absent pulse and lifts collapsing blood.
Article 16: For hematochezia where blood precedes stool, this is "near blood" (Jin Xue). Chixiaodou Danggui San (Red Bean and Angelica Powder) is the primary treatment. (Formula seen in Huo Huo Chapter).
Blood preceding stool indicates blood originates near the end of the rectum (Guochang), hence "near blood." Red beans grow vines (symbolizing collaterals), are red (entering blood level), and have black hilums (directing to Lower Jiao). Sprouting them utilizes the rising, sharp nature of new Yang. Zhang Zhongjing interprets the "absent upon deep pressure" pulse as Lower Jiao Qi collapse and blood sinking. With floating (superficial) and weak (middle) pulses, the pathology lies in Lower Jiao deficiency. Red bean targets Lower Jiao blood; sprouted red bean combined with Angelica Sinensis (Danggui) directs action to the rectum, lifting Qi and blood upward. Unlike the previous case (Middle Jiao origin, requiring treatment of all three Jiaos due to excess harassing deficiency), this case focuses solely on Lower Jiao deficiency causing sinking. Superficial floating pulse reflects Upper Jiao blood sinking; middle weak pulse reflects Middle Jiao Qi sinking. Tonifying the Lower and lifting restores blood to its normal path, stabilizes Qi, raises the pulse, and resolves the floating/weak signs. This mirrors the strict judgment of primary offenders in Spring and Autumn annals. The previous case involved Foot Yangming Stomach collaterals; this involves Hand Yangming Large Intestine collaterals. Hence, Huangtu Tang focuses on the Stomach, while Chixiaodou Danggui San focuses on the Large Intestine. Other interpretations miss the mark.
Article 17: For insufficiency of Heart Qi manifesting as hematemesis and epistaxis (nosebleed), Xiexin Tang (Drain the Epigastrium Decoction) is the primary treatment.
Xiexin Tang Formula: Rhubarb (Liang liang), Coptis Rhizome (Liang liang), Scutellaria Root (Liang liang).
These three ingredients are boiled in three sheng of water until one sheng remains. Take in one dose.
This follows Article 4 (floating radial pulse) and Article 7 (pale face, deep-wiry pulse) regarding epistaxis treatment. "Hematemesis" is included due to shared origin but different exit. Xiexin Tang is not the standard treatment for all vomiting blood; confusion with Baiye Tang can be fatal. "Heart Qi insufficiency" is discussed alongside Lower Jiao excess pathogens. Excess in Lower Jiao harasses deficiency in Upper Jiao: affecting Spirit causes palpitations/fright; affecting Blood/Qi causes bleeding. Spirit is Heaven-like; thus, clear/light herbs (like Guizhi Jiuni Tang or Banxia Mahuang Wan) tonify Upper by draining Lower. Blood/Qi are Earth-like; thus, heavy/turbid herbs (Rhubarb, Coptis, Scutellaria) level Earth to raise Heaven. A student asks: Baiye Tang uses warm herbs; Xiexin Tang uses cold herbs. Where is "Heart Qi"? Is it cold or hot? Why do some cases vomit blood and others bleed from the nose? Answer: Heart Qi relies on Heart Blood and houses the Spirit, interacting with Zong Qi (Gathering Qi) between Heart and Lungs. Like a well (Heart Qi) vs. river (Qi below chest), they influence each other. Heart Qi is warm and stable, like spring vitality. Cold causes constriction; heat causes fleeing. It stands between extremes. Deep absence/pulse indicates Lower Jiao deficiency-cold rushing to Lungs, causing cough and blood eruption from internal collaterals—this is cold etiology, requiring warm treatment. Conversely, superficial weak pulse at Cun and deep-wiry at Chi indicate Upper deficiency and Lower excess. Excess attacks deficiency, pushing blood out through upper orifices. This is "obstruction treated by unblocking" (Se Yin Sai Yong). Collaterals being excess while Chest Qi is deficient allows heat pathogens to lift blood upward via major collaterals (causing vomiting) or minor collaterals (causing epistaxis). Though exits differ, the mechanism of excess heat rushing upward is the same; thus, Xiexin Tang drains the hyperactive harm.