诸阳受病蕴邪热。在表当汗汗不发。（巢源方云。吐血者。皆由诸阳受邪热。初在表。应发汗。而汗不发。致使热毒
入深。结于五脏。内有瘀积。故吐血也。）热毒入深结在中。瘀血既停须吐血。轻者犀角地黄汤。重者抵当方能绝。（小
品犀角地黄汤。主伤寒及温病。应发汗而不发之。内瘀蓄血。及鼻衄吐血者。此汤主之。抵当汤治瘀血在内。）大下寸口
脉沉迟。吐血升麻安可缺。（阳毒升麻汤。证云。阳毒二药。吐下之后。便成阳毒。或吐血下痢。其脉浮大数。面赤斑如
锦纹。唾脓血者。此汤主之。）
太阳阳盛必须衄。衄已解时何福祉。（巢氏云。脉浮紧发热。其身无汗自衄者愈。盖太阳病。有因衄血而便自解者。）
浮紧无汗系麻黄。脉浮自汗桂枝属。二者服之不中病。脉尚如前宜再服。（仲景云。伤寒脉浮紧。不发汗。因致衄者。麻
黄汤主之。故自汗脉浮者。宜桂枝也。麻黄桂枝正分表里。服之不中病尚宜再服。此活人书之意也。予谓此候不可不审
察。细详仲景之书。又云。阳明病。口燥。但欲饮水不咽入者。此必衄。衄家不可攻其表。汗出额上陷。直视不能眠。
不得 。又云。亡血家。不可攻其表。汗出。则寒栗而振。）衄后脉微血已虚。慎勿服之令病笃。且看犀角地黄汤。不止
茅花须预速。（若脉微血虚。则麻黄桂枝皆不可用也。短剧犀角地黄汤。活人书云。茅花汤皆可用。）阴证本来无此候。
少阴强发红来触。下厥上竭不可医。血流口鼻或耳目。（仲景云。少阴病。但欲无汗。而强发之。则衄血。不知从何道出。
或从口鼻耳目中出。是为下厥上竭。为难治。）
诸阳经受病，蕴藏邪热。病在表应当发汗，但汗不得出。（《诸病源候论》说：吐血，都是由于诸阳经受邪热所致。初起在表，应当发汗，但汗不得出，致使热毒深入，结聚于五脏，体内有瘀血积滞，所以发生吐血。）热毒深入结聚在中焦，瘀血既已停留，就必须吐血。轻症用犀角地黄汤，重症用抵当汤才能断绝病根。（《小品方》中的犀角地黄汤，主治伤寒及温病，应当发汗而未发汗，导致体内瘀蓄血，以及鼻衄、吐血者，此汤主治。抵当汤治疗瘀血在内。）若误用大下法，寸口脉沉迟，吐血时升麻汤怎能缺少？（《阳毒升麻汤》证条说：阳毒由两种药物引起，吐下之后，便成为阳毒。或吐血下痢，脉象浮大数，面色红赤如锦纹，唾脓血者，此汤主治。）
太阳经阳气盛必须通过衄血来解表。衄血后病解了，有什么福佑呢？（巢元方说：脉浮紧发热，身体无汗而自衄的会痊愈。大概太阳病，有因衄血而自行解除的。）脉浮紧无汗属于麻黄汤证，脉浮自汗属于桂枝汤证。这两者服用后如果不中病，脉象还像从前一样，应该再服用。（张仲景说：伤寒脉浮紧，不发汗，因而致衄的，用麻黄汤主治。所以自汗脉浮的，适宜用桂枝汤。麻黄汤和桂枝汤正分主表实和表虚，服用后不中病尚且适宜再服，这是《活人书》的意思。我认为这个证候不可不审察，详细研读仲景的书，又说：阳明病，口干燥，只想喝水但不咽下的，这必定衄血。衄血家不可攻其表，如果汗出，额头凹陷，直视不能眠，不得……又说：亡血家，不可攻其表，如果汗出，则寒战而振颤。）衄血后脉微，血已虚，千万不要服用（麻黄、桂枝等发汗药）使病情加重。且看犀角地黄汤，如果不止血，茅花汤须预先快速使用。（如果脉微血虚，那么麻黄、桂枝都不可用。《短剧方》中的犀角地黄汤，《活人书》说茅花汤都可以用。）阴证本来没有这种证候，少阴病强行发红来触犯。下厥上竭不可医治，血流出口鼻或耳目。（张仲景说：少阴病，只想无汗，而强行发汗，则衄血。不知道从哪个通道流出，或从口鼻耳目中流出，这叫下厥上竭，为难治。）
All Yang channels are affected by disease, harboring pathogenic heat. When the pathogen is in the exterior, sweating should be induced, but if sweat does not emerge... (The *Zhu Bing Yuan Hou Lun* states: Hematemesis is caused by all Yang channels receiving pathogenic heat. Initially in the exterior, sweating should be induced, but if it fails to emerge, the heat-toxin penetrates deeply, knotting within the five Zang organs. With internal blood stasis accumulating, hematemesis occurs.) If the heat-toxin penetrates deeply and knots in the middle, once the blood stasis has settled, hematemesis must follow. For mild cases, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used; for severe cases, Didang Tang (Ephedra and Persimmon Seed Decoction) is required to eradicate the condition. (*Xiaopin Fang*'s Xijiao Dihuang Tang treats Shanghan and warm diseases where sweating should have been induced but was not, leading to internal blood stasis, as well as epistaxis and hematemesis. Didang Tang treats internal blood stasis.) If a drastic purgative is misused, causing the Cun (inch) pulse to become deep and slow, Shengma Tang (Cimicifuga Decoction) cannot be omitted when treating hematemesis. (The syndrome description for Yangdu Shengma Tang states: Yang Du results from two medications; after vomiting or purging, Yang Du forms. Symptoms may include hematemesis with dysentery, a floating-large-rapid pulse, red face with patterns like brocade, and spitting of pus and blood; this decoction treats such cases.)
Taiyang excess Yang necessitates epistaxis for resolution. Once resolved by epistaxis, what benefit remains? (Chao Shi states: A floating-tight pulse with fever and no spontaneous sweating leads to self-resolving epistaxis. Generally, Taiyang syndromes may resolve spontaneously through epistaxis.) Floating-tight pulse with no sweating indicates Mahuang Tang (Ephedra Decoction); floating pulse with spontaneous sweating indicates Guizhi Tang (Cinnamon Twig Decoction). If these fail to cure the disease and the pulse remains unchanged, they may be administered again. (Zhang Zhongjing states: In Shanghan with a floating-tight pulse, if sweating is not induced and epistaxis ensues, Mahuang Tang is indicated. Thus, for spontaneous sweating with a floating pulse, Guizhi Tang is appropriate. Mahuang Tang and Guizhi Tang distinguish between exterior excess and deficiency. If ineffective, re-administration is permissible, per the *Huo Ren Shu*. However, one must examine carefully. Further reading of Zhang's texts notes: In Yangming disease, dry mouth with desire to drink but inability to swallow indicates impending epistaxis. Patients prone to epistaxis should not undergo exterior-releasing treatments. Sweating may cause forehead depression, fixed gaze, insomnia, and... Also, patients with blood loss should not undergo exterior-releasing treatments; sweating may cause chills and tremors.) After epistaxis, if the pulse is faint and blood is deficient, do not administer [exterior-releasing herbs] lest the illness worsen. Consider Xijiao Dihuang Tang; if bleeding persists, Maohua Tang (Sedge Flower Decoction) should be prepared promptly. (If the pulse is faint and blood is deficient, neither Mahuang nor Guizhi should be used. *Duanju Fang* recommends Xijiao Dihuang Tang; *Huo Ren Shu* states Maohua Tang is also applicable.) Yin syndromes originally lack this manifestation. Shaoyin syndrome forcibly manifesting redness triggers danger. Lower Jue and Upper Exhaustion are incurable; blood flows from the mouth, nose, ears, or eyes. (Zhang Zhongjing states: In Shaoyin disease, desiring no sweating, but forcing sweating induces epistaxis. The exit route is unknown; it may flow from the mouth, nose, ears, or eyes. This is termed Lower Jue and Upper Exhaustion, making it difficult to treat.)