甲、概况
小儿寡七情之火，故内伤吐血，较成人为少，然偶或患之，则较成人为重，必须加意治疗，以免变端。
凡血之夹痰而出者，是为肺血，可从咳嗽一类参看之（见第六章）。若巨口吐出者则为胃血。新病吐血者，
先宜行瘀，再进和络，久病吐血者则宜止涩之。然胃中是否夹痰，是否夹湿，是否积有死血，均须详别。
至于有因胃寒而吐者更居少数，暴涌而呕出者，属于大热。辨之明察，庶可无误。
乙、治法
小儿因咳伤气管而咯血者，进润肺化痰之品，即可渐愈。若咳嗽历久，痰中带血，则宜照内伤咳嗽之
例为之治。具有巨口吐
出，属于胃血，宜柏枝饮；暴涌呕出者，宜急用童便乘热饮以止之，否则出血过多，必有暴脱之危也。通
常吐血一证，行瘀之剂为桃仁、三七、红花之属，吐血初起色紫者宜加而用之；破血之剂为莪术、三棱、大
黄之属，瘀血久而积块者宜之；和络之剂为丹皮、白芍、丹参之属，血络有热者宜之；止血之剂为白芨、棕
榈炭、代赭石之属，伤重血多者宜之；夹痰者栝蒌、杏仁、贝母之属可用；夹湿者白术、茯苓、泽泻之属
可用；血热者宜降，犀角、地黄、茜草之属可用；血寒者宜温，肉桂、干姜、沉香之属可用。至于吐血和平
之剂，最无弊害者，有茅根、莲须、藕节等品，不寒不热，不塞不通，用之于小儿为尤适也。
附方
（一）柏枝饮 治小儿衄血、吐血。
柏枝 藕节（等分）
研为末，三岁小儿每服五分，藕汁入蜜沸汤调下。本方加代赭石、白芍，功用尤大。
（二）干姜甘草汤 治心肺寒而呕血，或感受寒凉，多食生冷，吐血色黯黑，面白脉微者。
干姜 甘草
甲、概况
小儿由于七情（喜、怒、忧、思、悲、恐、惊）之火较少，因此因内伤导致的吐血症状比成人少见，但偶尔患病时，病情往往比成人更重，必须加以重视治疗，以免出现变证。
凡是血液夹杂痰液而出的，称为肺血（肺部出血），可以参考咳嗽类病症进行辨析（见第六章）。如果是大口吐出的，则属于胃血（胃部出血）。新近发病的吐血，起初宜采用行瘀（促进血液循环以消除瘀滞）的方法，随后再进和络（调和经络气血）之法；久病吐血者则宜采用止涩（收敛止血）的方法。然而，胃中是否夹杂痰湿、是否有湿气、是否积存有死血（陈旧性瘀血），都必须详细辨别。至于因胃寒而引发吐血的病例更是少数，若是暴涌而出并伴有呕吐的，属于大热证。只有辨证明察秋毫，才能避免误诊。
乙、治法
小儿因咳嗽损伤气管而导致咯血（咳出血液）的，服用润肺化痰的药物，即可逐渐痊愈。如果咳嗽日久，痰中带血，则应按照内伤咳嗽的例程进行治疗。对于大口吐出且属于胃血的情况，宜用柏枝饮；若是暴涌呕出的，宜急用童便（健康儿童的尿液，中医认为其有滋阴降火止血之效）趁热饮用以止血，否则出血过多，必有阳气暴脱的危险。通常治疗吐血一证，行瘀的药剂多为桃仁、三七、红花等药物；破血（强力破除瘀血）的药剂多为莪术、三棱、大黄等药物，适用于瘀血日久并形成积块的情况；和络的药剂多为丹皮、白芍、丹参等药物，适用于血络有热的情况；止血的药剂多为白芨、棕榈炭、代赭石等药物，适用于伤势重、出血多的情况；若夹杂痰邪，可用栝蒌、杏仁、贝母等药物；若夹杂湿邪，可用白术、茯苓、泽泻等药物；若属血热，宜用清热降火之法，可用犀角、地黄、茜草等药物；若属血寒，宜用温阳散寒之法，可用肉桂、干姜、沉香等药物。至于治疗吐血平和无弊的药物，最无害的是茅根、莲须、藕节等，这些药物不寒不热，既不壅塞也不通泄，用于小儿尤为适宜。
附方
（一）柏枝饮 治疗小儿鼻衄（鼻出血）、吐血。
柏枝、藕节（用量相等）
研成粉末，三岁小儿每次服用五分，用藕汁加入蜂蜜，用沸水冲调后服用。本方加入代赭石、白芍，功效更大。
（二）干姜甘草汤 治疗心肺虚寒而呕血，或感受寒凉，多食生冷食物，导致吐血色黯黑，面色苍白，脉象微弱的情况。
干姜、甘草
A. General Overview
Children are less prone to fire caused by the Seven Emotions (joy, anger, worry, thought, sadness, fear, and fright); therefore, hematemesis due to internal injury is less common in children than in adults. However, when it does occur, the condition is often more severe than in adults. It requires careful treatment to prevent complications.
Hemoptysis accompanied by phlegm is referred to as Lung Blood (bleeding from the lungs) and can be analyzed with reference to cough syndromes (see Chapter 6). Hematemesis expelled in large quantities is referred to as Stomach Blood (bleeding from the stomach). For recent-onset hematemesis, promoting blood circulation to remove stasis (Xing Yu) should be employed first, followed by harmonizing the collaterals (He Luo). For chronic hematemesis, astringent methods to stop bleeding (Zhi Se) are appropriate. However, one must carefully distinguish whether the stomach contains phlegm-dampness, dampness, or fixed blood (Si Xue, old blood stasis). Cases of hematemesis caused by Stomach Cold are rare; sudden gushing vomiting indicates a Great Heat syndrome. Only through clear and accurate differentiation can errors be avoided.
B. Treatment Methods
For children suffering from hemoptysis due to cough damaging the trachea, administering herbs that moisten the lungs and resolve phlegm will lead to gradual recovery. If cough persists for a long time with blood in the sputum, treatment should follow the principles for chronic internal injury cough. For cases involving large-volume expulsion classified as Stomach Blood, Baizhi Yin (Cypress Twig Drink) is indicated. For sudden gushing vomiting, Tongbian (Child's Urine) should be administered hot immediately to arrest bleeding; otherwise, excessive blood loss may lead to sudden collapse (Bao Tuo). Generally, for hematemesis, formulas promoting blood circulation include Tao Ren (Peach Kernel), San Qi (Notoginseng Root), and Hong Hua (Safflower); these are suitable for early-stage hematemesis with dark purple blood. Formulas breaking blood stasis include E Zhu (Curcuma Zedoaria), San Leng (Burreed Tuber), and Da Huang (Rhubarb Root and Rhizome); these are suitable for long-standing blood stasis forming masses. Formulas harmonizing collaterals include Dan Pi (Moutan Cortex), Bai Shao (White Peony Root), and Dan Shen (Salvia Miltiorrhiza); these are suitable for heat in the blood collaterals. Formulas stopping bleeding include Bai Ji (Bletilla Rhizome), Zong Lu Tan (Charred Palm Fruit Fiber), and Dai Zhe Shi (Haematite); these are suitable for severe injuries with heavy bleeding. If phlegm is present, Gua Lou (Trichosanthes Fruit), Xing Ren (Apricot Seed), and Bei Mu (Fritillaria Bulb) may be used. If dampness is present, Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), and Ze Xie (Alisma Rhizome) may be used. For blood heat, cooling and descending methods are indicated, using Xi Jiao (Rhinoceros Horn - *note: now substituted with Water Buffalo Horn in modern practice*), Di Huang (Rehmannia Root), and Qian Cao (Madder Root). For blood cold, warming methods are indicated, using Rou Gui (Cinnamon Bark), Gan Jiang (Dried Ginger), and Chen Xiang (Aquilaria Wood). Among the mild and balanced agents for treating hematemesis with minimal adverse effects are Mao Gen (Imperata Rhizome), Lian Xu (Lotus Stamen), and Ou Jie (Lotus Node). These herbs are neither cold nor hot, neither obstructing nor purging, making them particularly suitable for children.
Appendix Formulas
(1) Baizhi Yin (Cypress Twig Drink): Treats pediatric epistaxis (Nu Xue) and hematemesis.
Baizhi (Cypress Twig) and Ou Jie (Lotus Node) in equal parts.
Grind into powder. For a three-year-old child, administer 0.5 fen per dose. Mix with lotus node juice and honey, and take with boiling water. Adding Dai Zhe Shi (Haematite) and Bai Shao (White Peony Root) to this formula enhances its efficacy.
(2) Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction): Treats hematemesis due to Heart and Lung Cold, or hematemesis resulting from exposure to cold and excessive consumption of raw/cold foods, characterized by dark black vomited blood, pale complexion, and a faint pulse.
Gan Jiang (Dried Ginger) and Gan Cao (Licorice Root)