皆因邪热中三焦。当汗医家失审量。热毒入深成吐血。桃仁承气地黄汤。
吐血者。诸阳受热。其邪在表。当汗不汗。致使热毒入腑。积瘀于内。迫血妄行而吐也。宜以桃仁承气汤主之。亦
有服桂枝汤而吐血者。宜犀角地黄汤主之。大抵吐血衄血。有阳乘阴者。有阴乘阳者。阳乘阴者。血热妄行是也。阴乘
阳者。血不归经是也。
太阳衄血病将瘳。犀角黄芩芍药搜。漱水阳明犀角进。当归四逆少阴授。
衄血者。经络
及服桂枝汤后而衄者。此皆阳气盛长病欲解也。宜犀角地黄汤。及黄芩芍药汤。茜根汤。茅
花汤。加减主之。有因少阴发汗而动衄者。此症难治。亦可用当归四逆汤主之。大抵吐血衄
血。脉滑小者生。脉实大者死。脉微者易治。若热甚。脉反数急者死也。衄而头汗出。或身
上有汗。不至足者。皆难治也。凡衄血亡血家不可发汗。发汗则阴阳俱虚。针经曰。夺汗者
无血。夺血者无汗。此之谓也。
当归四逆桂枝芍。细辛甘草木通合。直加大枣治阴厥。脉细阳虚由血弱。
伤寒脉伏是何缘。阳极如阴大汗全。更有夹阴沉伏见。须投姜附灸关元。
伤寒一手脉沉曰单伏。两手脉沉曰双伏。不可以阳症见阴为诊。乃火邪内郁。不得发越
极似阴。故脉伏。必有大汗而解。正如久旱将雨。六合阴晦。雨后庶物皆苏之义。又有夹阴
伤寒。先有伏阴在内。外复感寒。阴盛阳衰。四肢厥冷。六脉沉伏。须投姜附及灸关元。脉
乃复出也。若太溪冲阳。皆无脉者必死。
都是因为邪热侵入三焦。医生在应当使用发汗法时未能审慎权衡。热毒深入体内导致吐血。此时应使用桃仁承气汤合地黄汤。
所谓吐血，是诸阳经受热邪侵袭，病邪尚在体表，本应发汗却未发汗，致使热毒内传入腑，瘀血积滞于内，逼迫血液妄行而吐出。适宜用桃仁承气汤为主治疗。也有服用桂枝汤后出现吐血的，适宜用犀角地黄汤为主治疗。大抵而言，吐血和衄血（鼻出血），有的是阳邪乘袭阴分，有的是阴邪乘袭阳分。阳乘阴，是指血热妄行；阴乘阳，是指血液不能归经。
太阳经衄血，病情即将痊愈。可用犀角、黄芩、芍药来搜剔余邪。阳明经衄血，漱水不欲咽，需用犀角等药进治。少阴经衄血，当授以当归四逆汤。
所谓衄血，包括经络受邪以及服用桂枝汤后出现的衄血，这都是因为阳气盛长，疾病将要解除的表现。适宜用犀角地黄汤，以及黄芩芍药汤、茜根汤、茅花汤加减治疗。有因少阴病误用发汗法而导致衄血的，此症难以治疗，也可用当归四逆汤为主治疗。大抵而言，吐血或衄血，脉象滑小者预后良好，脉象实大者预后不良（主死）。脉微者容易治疗。如果热势极盛，脉象反而数急的，预后不良（主死）。衄血且头部出汗，或者身上有汗但不到足部，都属于难治之症。凡是患有衄血或失血的人，不可使用发汗法，若强行发汗，则会导致阴阳俱虚。《针经》说：夺汗者无血，夺血者无汗，说的就是这个道理。
当归四逆汤由桂枝、芍药、细辛、甘草、木通组成，并加大枣，用于治疗阴厥。脉象细微，是因为阳气虚弱源于血弱。
伤寒脉伏是什么原因？这是阳极似阴，大汗之后脉象沉伏。还有夹阴伤寒呈现沉伏脉象。必须投用姜附类药物并灸关元穴。
伤寒中一手脉沉称为单伏，两手脉沉称为双伏。不能因为阳证见到阴脉就诊断为阴证，这是因为火邪内郁，不得发散，极像阴证，所以脉伏。必定要通过大汗才能解病，正如久旱将雨，天地昏暗，雨后万物复苏的道理一样。又有夹阴伤寒，先有伏阴在内，外部又感受寒邪，阴盛阳衰，四肢厥冷，六脉沉伏。必须投用姜附类药物及灸关元穴，脉象才会复出。如果太溪穴和冲阳穴都摸不到脉象，必定死亡。
This is all due to pathogenic heat invading the Sanjiao (Triple Burner). Physicians failed to carefully assess when sweating therapy was indicated. When heat-toxins penetrate deeply, it results in hematemesis (vomiting blood). Tao Ren Cheng Qi Tang combined with Di Huang Tang should be used.
Hematemesis occurs when the Yang meridians are affected by heat. The pathogen remains in the exterior; if sweating is not induced as required, heat-toxins enter the Fu organs, causing stasis to accumulate internally and forcing blood to flow recklessly, resulting in vomiting. Tao Ren Cheng Qi Decoction (Peach Kernel Cathartic Decoction) is appropriate as the primary treatment. In some cases, hematemesis occurs after taking Gui Zhi Tang (Cinnamon Twig Decoction); in such instances, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is appropriate. Generally speaking, hematemesis and epistaxis (nosebleed) can result from Yang pathogens attacking Yin, or Yin pathogens attacking Yang. "Yang attacking Yin" refers to reckless bleeding due to blood-heat. "Yin attacking Yang" refers to blood failing to return to its vessels.
In Taiyang (Greater Yang) disease, epistaxis indicates the illness is about to resolve. Xi Jiao (Rhinoceros Horn), Huang Qin (Scutellaria Root), and Shao Yao (Peony Root) can be used to clear residual pathogens. For Yangming (Bright Yang) epistaxis characterized by rinsing the mouth without swallowing, Xi Jiao should be advanced. Shaoyin (Lesser Yin) epistaxis should be treated with Dang Gui Si Ni Tang (Angelica Sinensis Decoction for Frigid Extremities).
Epistaxis includes conditions affecting the meridians and those occurring after taking Gui Zhi Tang. These situations indicate that Yang Qi is flourishing and the disease is resolving. Appropriate treatments include Xi Jiao Di Huang Tang, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction), Qian Gen Tang (Rubia Root Decoction), and Mao Hua Tang (Cat-tail Flower Decoction), modified as needed. Epistaxis caused by improper sweating in Shaoyin disease is difficult to treat but may be managed with Dang Gui Si Ni Tang. Generally, a slippery and small pulse in hematemesis or epistaxis indicates survival, while a solid and large pulse indicates death. A faint pulse is easy to treat. If heat is severe but the pulse becomes rapid and urgent, it indicates death. Epistaxis accompanied by sweating only on the head, or sweating on the body that does not reach the feet, are all difficult to treat. Patients with epistaxis or blood loss must not undergo sweating therapy; doing so leads to deficiency of both Yin and Yang. The *Ling Shu* (Spiritual Pivot) states: "Those who lose sweat have no blood; those who lose blood have no sweat." This principle applies here.
Dang Gui Si Ni Tang consists of Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Xi Xin (Asarum), Gan Cao (Licorice Root), Tong Cao (Tetrapanax Pith), and Da Zao (Jujube Fruit), and is used to treat cold extremities. A fine pulse indicates Yang deficiency stemming from blood weakness.
Why is the pulse hidden (Fu) in Shanghan? This represents extreme Yang resembling Yin, often following profuse sweating. It may also appear in Cold-Yin complicated Shanghan. Ginger and Aconite preparations along with moxibustion at Guan Yuan (CV4) are required.
A hidden pulse in one hand is called Dan Fu (Single Hidden Pulse); in both hands, it is called Shuang Fu (Double Hidden Pulse). One cannot diagnose this as a Yin syndrome merely because Yin-type pulses appear in a Yang syndrome. This occurs because Fire pathogens are constrained internally and cannot vent out, closely mimicking Yin syndrome, hence the hidden pulse. Resolution typically comes through profuse sweating, similar to the sky darkening before rain after a long drought, followed by the revival of all things. In Cold-Yin complicated Shanghan, latent Yin exists internally, and external cold invasion causes Yin excess and Yang deficiency, leading to cold extremities and hidden pulses in all six positions. Ginger and Aconite preparations and moxibustion at Guan Yuan are necessary for the pulse to reappear. If pulses are absent at both Tai Xi (KI3) and Chong Yang (ST42), death is certain.