理，又太阳寒水，少阴肾水，俱易以感寒，一有所感，皮毛先入，肺主皮毛，水冷金
寒，肺经先受，血亦水也，故经中之水与血，一得寒气皆凝滞而不行，咳嗽带痰而
出，问其人必恶寒，切其脉必紧，视其血中间必有，或紫，或黑数点，此皆寒淫之验
也。医者，不为详审，便以为阴虚火动，而概用滋阴降火，病日深而死日迫矣。赵氏尝
用麻黄桂枝汤一服，得微汗而愈，盖汗与血一物也。夺血者无汗，夺汗者无血，赘方于
后，以为因寒致血者之治法。
治吐血，外感寒邪，内伤蕴热。东垣治一贫士病脾胃虚，与补药愈后，继居旷室，
卧热炕，咳血，吐血，东垣谓此久虚弱，冬居旷室，衣服单薄，是重虚其阳，表有大寒
壅遏里热，火邪不得舒伸，故血出于口。当补表之阳，泻里之虚热，因思仲景治阳寒脉
浮紧，当与麻黄汤发汗而不与之，遂成衄血，却与麻黄汤立愈，与此甚同，因作此
汤，一服而愈。
人参（益上焦元气不足，而固其中也） 麦冬（保护肺气） 桂枝（辛甘发散寒气）
当归（和养气血） 麻黄（去根，发散外寒） 炙甘草（和药性补脾） 黄 （助表达卫）
五味子（保敛肺气） 白芍药（和肝以抑麻黄、桂枝之性） 水三盏，先煮麻黄一味，令沸去沫，入
余药，同煎至一盏，去渣，热服，只一服而愈，不再作。
此足太阳手足太阴药也。《纲目》曰∶观此一方，足以为万世模范矣。盖取仲景麻
黄汤与补剂各半服之，但凡虚人当服仲景方者，当以此为则也。
独有伤暑吐衄者，可用河间法，暂抑阳光。究竟暑能伤心，心气既虚，暑气故乘而
入之，心主血，故吐衄。心既虚而不能主血，亦不宜过用寒凉以泻心，须以清暑益气
汤中，加丹皮、生地，兼暑伤气，其人必无气以动，以参麦助气，使气能摄血斯无弊也。
凡治血症，前后调理，须按三经用药，以心主血，脾统血，肝藏血，而归脾汤一
方，三经之主剂也。远志、枣仁补肝以生心
火；茯神、龙眼，补心以生脾土；参 术草，补脾以固肺气；木香者，香先入脾。总
欲使血归于脾，故以归脾汤名。有郁怒伤脾，思虑伤脾者，尤宜。火旺者，加山栀、
丹皮；火衰者，加丹皮、肉桂。又有八味丸以培先天之根。治无余法矣。
仲景伤寒症中有云∶误发少阴汗，动其经血者，下竭上厥，为难治。盖下竭者，阴
血竭于下也。上厥者，阴气逆于上也。夫血与气，两相维附，气不得血则散而无统，血
不得气则凝而不流，故阴火动而阴气不得不上奔，阴气上奔，而阴血不得不从之上溢，
阴血上溢则下竭矣。血既上溢，其随血之气散于胸中，不能复返本位，则上厥矣。阴气
上逆，不过至颈而止，何能越高颠清阳之位？是以喉间窒塞，心忡耳鸣，胸膈不舒
也。然岂但窒塞不舒已哉！阴气久居于上，势必龙雷之火应之于下，血不尽竭不止也。
气不尽厥亦不止也。所以仲景为难治者此耳。然于法外而求至当之治法，则以健脾中
阳气为第一义，盖龙雷之火，必阴云四合，然后遂其腾升之势，若天日清朗则退藏不动
矣。故用凉药清火者，皆以水制火之常法，施之于阴火，未有不助其疟者也。健脾之阳
亦有三善焉，一者，脾中之阳气旺，如天清日朗而龙雷潜伏也。一者，脾中之阳气旺，
而饮食运化精微，复能生其下竭之血也。况地气必先蒸上为湿，然后上升为云。若土无
蒸而不湿，则地气于中隔绝矣。天气不常清乎，且万物以土为根，元气以土为宅，可不
理欤！
仲景云∶阴旺能生阴血，盖言人之真阳盛旺，自能化生阴血耳。今人不悟其理，但
见阴血不足，便用人参、黄 补之，初用一二服之间，火得温补，略见一效，以为中
病，久泥于方，不无反助火邪，盖令咳嗽气促，肌肉消烁，往往以致危亡，良可悯哉！
但血本不病，因气虚而血无所倚，故血亦消亡者，只补其气，则血自复，即所谓阳旺能
生阴血，无阳则阴无以生也。
立斋先生遇星士张东谷谈命，时出中庭，吐血一二口，云久有此症，遇劳即发。
先生曰，此劳伤肺气，其血必散，视之果在，与补中益气汤加麦冬、五味、山药、熟
地、茯神、远志服之而愈。翼早请见云∶服四物黄连山栀之类，血益多而倦益甚，得公
一七吐血顿止，精神如故，何也？先生曰∶脾统血，肺主气，此劳伤脾肺，致血妄行，
故用前药健脾肺之气，而嘘血归原耳。
肺为华盖，至清之脏，有火则咳，有痰则嗽。肺主气，气逆为咳，肾主水，水泛为
痰，肾脉上入肺，循喉咙，其支者从肺络心，属胸中，故病则俱病也。涎唾中有少血
散漫者，此肾从相火炎上之血也。若血如红缕，从痰中咳出者，引肺络受热伤之血也。
若咳出白血浅红色，似肉似肺者，必死。凡唾中带血，咯出有血，或血丝，属肾经。鼻
衄出血，咳嗽有血，属肺经。呕吐成盆成碗者，属胃经。自两胁逆上吐出者，属肝经。
溺血属小肠膀胱经。下血属大肠经。牙宣出血属胃肾虚火，舌血谓之舌衄，汗孔。出血
谓之肌衄，心与肝也。又惊而动血者属心，怒而动血者属肝，忧而动血者属肺，思而动
血者属脾，劳而动血者属肾。
童子之症，须看先天父母之气，而母气尤为重。凡惊风痘疹，肾虚发热，俱以母气
为主，如母有火者，其子必有火；母脾虚者，子必多脾病；母火衰者，子必从幼。有
肾虚症，如齿迟、语迟、行迟，囟门大开，肾疳等症，皆先天不足，从幼调补，亦有可
复之天。
肺不特衄血，亦能咳血唾血，胃不特呕血，肝亦呕血，盖肺主气，肝藏血，肝血不
藏，乱气自两胁中逆而出之。然总之是肾水随相火炎上之血也。肾主水，水化液为痰，
为唾、为血，肾脉上入肺，循喉咙，挟舌本，其支者，从肺络心，注胸中，故病则俱
病也。但衄血出于经，衄行清道，吐血出于
胃，吐行浊道，喉与咽二管不同也。盖经者，循经之血，走而不守，随气而行，火气
急迫，故随经直犯清道，上脑而出于鼻为衄。其不出于鼻者，则为咳咯，从肺窍而出
于咽也。胃者，守营之血，守而不走，存于胃中者也。若胃气虚，不能摄血，或为火
逼，故令人呕吐，从喉而出于口也。吐血之热在腑，衄血之热在经，杂病衄血为里热，
伤寒衄血为表热，今人一见吐衄，便以犀角地黄为必用之药，以犀为水兽，可以分水，
可以通天，鼻衄之血，从任督而至颠顶入鼻中，惟犀角能下入肾水，引地黄滋阴之品由
肾脉而上，故变对症。凡阴虚火动，吐血与咳咯者，可以借用成功。若阳虚劳力及脾胃
虚者，俱不宜也。
凡有实热者，舌苔必燥而焦，甚则黑，脉来必重按有力也。（然有釜下无火，津液不行，干
舌燥症而焦黑者，不可不知。）假热者，舌虽有白苔而必滑，口虽渴而不能饮水，饮而不欲咽，
面虽赤而色必娇嫩，身作躁而欲坐卧于泥水中，脉来重按空虚，此为辨也。
有饮酒过多，伤胃而吐血，从吐后出者，以葛花解醒汤，加丹皮倍黄连佐之，上
下分消，酒病愈，血亦愈矣。有过啖炙爆辛热等物，上焦壅热，胸腹满痛，血出紫黑成
块者，可用桃仁承气汤从大便导之，此釜底抽薪之法，此皆内之外因，不从本源而得，
故可寒凉克削，所谓应犯而犯，似乎无犯之。有曰血从下出者顺，上出者逆，一应血
溢血泄诸蓄妄行之证，苟非脾虚泄泻，嬴瘦不禁者，皆当以大黄醋，入和生地汁及桃仁
泥、丹皮、丹参、阿胶、黑荆芥、玄明粉、赤芍、当归之属，折其锐气，从大便导之，
使血下行，以转逆为顺，然后区别治之。或问失血复下虚，何以当？殊不知血既妄行迷
失故道，不去蓄利瘀，转逆为顺，则以妄为常，何以御之？且如妇人之于血也，经水足
而为胞胎，则蓄者自蓄，生者自生，及至产育而为恶露，则去者自去，生者自生，何蓄
之有？不知此而从事于苓、连、枝、柏，辅四物而行之，未有不伤气血而败脾胃者。血
既下行之后，多用薏苡仁及百合、麦门冬、鲜地骨皮，嗽渴加枇杷叶、五味子、桑白
皮，有痰加贝母，皆气薄味淡，西方兑金之本药。如可用独补者，以地黄麦冬金水二脏
之药相佐用之，虽然书曰失血家须用下剂破血，盖宜施之于蓄妄之初也。又曰∶亡血家
不可下，盖切戒之于亡失之后也。
阴虚之症，大抵上热下寒者多，始而以寒凉进之，上焦非不爽快，稍久则食减。又
以为食滞不化，加神曲、山楂，再久而热愈盛，痰嗽愈多烦燥愈甚，又以药力欠到，寒
凉倍迸，而渴泄腹胀之症作矣。乃以枳壳、腹皮宽中快气之品，不毙何待？是故咳嗽吐
血，未必成瘵也。服四物知柏不己，则瘵成矣。胸满膨胀，未必成胀也。服楂曲不已，
则胀成矣。面浮跗肿，未必成水也，服渗利之药不已，则水成矣。气滞膈塞，未必成噎
也，服宽快之药不已，则噎成矣。戒之哉！
夫涩可去脱，然气脱专以气药，血脱兼以血药，亦兼气药者，盖气乃血之帅也。若
阳脱者，见鬼，阴脱者，目盲，此神脱也。当补阳助阴，又非涩剂所能收也。
丹溪云∶吐血成碗吐出者，甚有出而盈盆者，多是阳盛阴虚，故血不得下行，因火
势炎上而涌出，脉必大而芤，大者，发热，芤者，血滞与失血也。多属阳明以其多血多
气也。
吐血有三种，有内衄、有肺疽、有伤胃。内衄者，出血如鼻衄，不从鼻孔出，是
近在心肺间，津液出，还流入胃中，或如豆羹汁，或如切 ，（音勘，凝血也）。血凝停
胃中，因即满闷，便吐，或出数斗至一石者是也。得之于劳倦饮食过常也。肺疽者，因
酒后热毒满闷，吐之时血从吐后出，或一合半合，半升一升是也。伤胃者，因饮食大饱
之后，胃中冷，不能消化，便烦闷，强呕吐，使所食之物与气共上冲蹙，因伤裂胃，
令吐血色鲜正赤，小腹绞痛。若自汗出，其脉紧而数者，为难治也。前人言，诸失血
症，身热则死，寒则生，亦大概言之，岂无热生而寒死乎？则必兼脉症而后可也。
治血必求血属之药，四物是也。川芎血中气药，通肝经，性味辛散，能行血滞于气
也。地黄血中血药，通肾经，其性味寒，能补真阴之虚也。当归血中之主药，通肝经，
性辛温，分用有三治，全用能活血，各归其经也。芍药为阴分之药，通脾经，味酸寒，
能凉血，治血虚腹痛也。然特论治血病而求血药之属者也。若气虚血弱，又当从仲景血
虚，以人参补之，阳旺则生阴血也。若四物汤者，独能主血分受伤，为气不虚也。其辅
佐之属。若桃仁、红花、苏木、血竭、丹皮者，血滞所宜；蒲黄、阿胶、地榆、百草
霜、棕桐灰者，血崩所宜；乳香、没药、五灵脂、凌霄花者，血痛所宜；苁蓉、锁阳、
牛膝、枸杞子、益母草、败龟板者，血虚所宜；乳酪、血液之物，血燥所宜；干姜者，
血寒所宜；生地、苦参，血热所宜。特取其证治之大概，以明血药之属，岂可以四君、
四物，便足以尽气血之用。
嗽出痰内有血者，名咳血，其因有二，热壅于肺者易治，不过疏之而已，久嗽损于
肺者，难治，此已成劳也。痰中带血丝者，此阴虚火动，劳伤肺脏也。盖血虽生于心，
统于脾，藏于肝，然实宣布于肺，静则归经，热则妄行，火伤肺络，血随咳出，或带
痰中为咳血，吐出多者，为吐血。若喉中常有血腥，一咯血即出，或鲜、或紫、或细屑
者，谓之咯血。若鲜红随唾而出者，谓之唾血，二者皆出于肾，亦有瘀血内积，肺气壅
逼。若能下降者，更有口中津唾，皆是紫黑血水，如猪血之色晦而不鲜，形瘦体热盗汗
者，为有怫郁所致也。然唾血责在下焦，盖阳火煎迫而为之也。肾主唾，足少阴少血多
气，故其症为难治。然咯血亦以为病最重，而且难治者，亦以其肺手太阴之经，气多血
少。又肺者，金象，为清肃下降之脏，金为火所制迫而上行，乃为咯血，逆之甚矣。
《经》曰∶上气见血，下闻病音，谓喘而咯血，且咳嗽也。是以吐血衄血下血虽去多。
然从肝胃大肠而来、三经气血俱多，故身凉脉微无害，咳血咯血，是从心肺肾而来，三
经皆气多血少，气多则火易生，血少则火易识，故渐见脉洪而数，身热咳嗽，失血虽
少，多致不起。
一方治服药而血不止，是肺上有窍也。用白芨末、猪肺，煮熟蘸食，日三四次，窍
为芨末填满，血自止也。欲知何脏之血，吐在水碗之内，浮者肺血，沉者肝血，半浮半
沉者心血，各随所见，以羊肺肝心熟蘸芨末食之。然须静养绝欲，方可施治。凡咳血、
咯血，最是恶症，其初甚微，渐至不救，以其从心肺来之病也。
有负重为物所压，或持重远行，忽心口痛，口鼻出血，俗名伤力吐血，乃肺胃内膜
伤损挣破也。若用凉药愈遏愈出，卒至胃损咳嗽而死，急以人参细末，飞罗面，童便调
服最佳，或白芨末，童便调下亦可，但不可服凉药耳。
诸症失血皆见芤脉，随其上下以验所出，大凡失血脉贵沉细，设见浮大，后必难
理，又太阳寒水，少阴肾水，俱易以感寒，一有所感，皮毛先入，肺主皮毛，水冷金
寒，肺经先受，血亦水也，故经中之水与血，一得寒气皆凝滞而不行，咳嗽带痰而
出，问其人必恶寒，切其脉必紧，视其血中间必有，或紫，或黑数点，此皆寒淫之验
也。医者，不为详审，便以为阴虚火动，而概用滋阴降火，病日深而死日迫矣。赵氏尝
用麻黄桂枝汤一服，得微汗而愈，盖汗与血一物也。夺血者无汗，夺汗者无血，赘方于
后，以为因寒致血者之治法。
道理在于，足太阳膀胱经属寒水，足少阴肾经属肾水，都容易感受寒邪。一旦受到寒邪侵袭，首先从皮毛进入，因为肺主皮毛，所以寒水导致金（肺）寒冷，肺经最先受邪。血也属于水类，所以经络中的水和血，一旦遇到寒气就会凝滞不通，表现为咳嗽并带有痰液排出。询问病人一定会有怕冷的症状，诊察脉搏一定是紧脉，观察吐出的血中一定会有几点紫色或黑色的血块，这都是寒邪肆虐的验证。医生如果不详细审察，就认为是阴虚火旺，一概使用滋阴降火的药物，病情就会日益加深，死亡也就迫在眉睫了。赵氏曾经用麻黄桂枝汤（Ma Huang Gui Zhi Tang, Ephedra and Cinnamon Twig Decoction），服用一次，微微出汗就好了，大概是因为汗和血同源。大量失血的人不会有汗，大量出汗的人不会失血，在后面附上这个方子，作为治疗因寒导致出血的方法。
治吐血，外感寒邪，内伤蕴热。东垣治一贫士病脾胃虚，与补药愈后，继居旷室，
卧热炕，咳血，吐血，东垣谓此久虚弱，冬居旷室，衣服单薄，是重虚其阳，表有大寒
壅遏里热，火邪不得舒伸，故血出于口。当补表之阳，泻里之虚热，因思仲景治阳寒脉
浮紧，当与麻黄汤发汗而不与之，遂成衄血，却与麻黄汤立愈，与此甚同，因作此
汤，一服而愈。
治疗吐血，如果是外感寒邪，内有郁热。李东垣曾治疗一个贫穷的书生，他患有脾胃虚弱，服用补药痊愈后，接着住在空旷寒冷的屋子里，睡在热炕上，出现咳血、吐血的症状。李东垣认为这是因为长期虚弱，冬天住在空旷屋子，衣服单薄，这是再次损伤了阳气，体表有大寒闭塞，导致里面的热气被遏制，火邪不能舒展伸展，所以血液从口中溢出。应当补益体表的阳气，清泻体内的虚热。于是想到张仲景治疗伤寒脉象浮紧，本应用麻黄汤发汗却没有给用，结果导致了鼻衄（nosebleed），后来用了麻黄汤立刻痊愈，这与现在的病情非常相似，因此制作了这张方子，服用一次就好了。
人参（Ren Shen, Ginseng Root）（补益上焦元气不足，巩固中气） 麦冬（Mai Dong, Ophiopogon Tuber）（保护肺气） 桂枝（Gui Zhi, Cinnamon Twig）（辛甘发散寒气）
当归（Dang Gui, Angelica Sinensis Root）（调和滋养气血） 麻黄（Ma Huang, Ephedra Herb）（去根，发散外寒） 炙甘草（Zhi Gan Cao, Prepared Licorice Root）（调和药性补脾） 黄芪（Huang Qi, Astragalus Root）（助卫气固表）
五味子（Wu Wei Zi, Schisandra Fruit）（收敛保敛肺气） 白芍药（Bai Shao Yao, White Peony Root）（调和肝脏以抑制麻黄、桂枝的燥烈之性） 用水三碗，先煮麻黄一味，煮沸后去掉浮沫，加入其余药物，同煎至一碗，去渣，热服，只服用一次就好了，不再需要第二次。
此足太阳手足太阴药也。《纲目》曰∶观此一方，足以为万世模范矣。盖取仲景麻
黄汤与补剂各半服之，但凡虚人当服仲景方者，当以此为则也。
这是足太阳膀胱经和手太阴肺经、足太阴脾经的药物。《本草纲目》说：看这一张方子，足以成为万世的典范。大概是取了张仲景的麻黄汤和补益剂的各一半合用，凡是身体虚弱的人应当服用张仲景方子的，都应当以此作为准则。
独有伤暑吐衄者，可用河间法，暂抑阳光。究竟暑能伤心，心气既虚，暑气故乘而
入之，心主血，故吐衄。心既虚而不能主血，亦不宜过用寒凉以泻心，须以清暑益气
汤中，加丹皮、生地，兼暑伤气，其人必无气以动，以参麦助气，使气能摄血斯无弊也。
只有中暑导致的吐血、鼻衄，可以用刘河间的治法，暂时抑制亢盛的阳热。毕竟暑邪能伤害心脏，心气既然虚弱，暑气就会趁机侵入，心主血脉，所以会导致吐血、鼻衄。心既然虚弱而不能统摄血液，也不宜过度使用寒凉药物来泻心火，必须在清暑益气汤（Qing Shu Yi Qi Tang, Clear Summerheat and Boost Qi Decoction）中加入牡丹皮（Mu Dan Pi, Moutan Cortex）、生地黄（Sheng Di Huang, Rehmannia Root），兼顾暑邪伤气，病人一定没有力气活动，用人参、麦冬补气，使气能够统摄血液，这样就没有弊端了。
凡治血症，前后调理，须按三经用药，以心主血，脾统血，肝藏血，而归脾汤一
方，三经之主剂也。远志、枣仁补肝以生心
火；茯神、龙眼，补心以生脾土；参 术草，补脾以固肺气；木香者，香先入脾。总
欲使血归于脾，故以归脾汤名。有郁怒伤脾，思虑伤脾者，尤宜。火旺者，加山栀、
丹皮；火衰者，加丹皮、肉桂。又有八味丸以培先天之根。治无余法矣。
凡是治疗血证，前后的调理，必须按照这三条经脉来用药，因为心主血，脾统血，肝藏血，而归脾汤（Gui Pi Tang, Restore the Spleen Decoction）一张方子，是这三经的主方。远志（Yuan Zhi, Polygala Root）、酸枣仁（Suan Zao Ren, Ziziphus Seed）补肝以滋生心火；茯神（Fu Shen, Poria with Hostwood）、龙眼肉（Long Yan Rou, Longan Aril）补心以滋生脾土；人参、白术、甘草（Shen Zhu Cao, Ginseng, Atractylodes, and Licorice）补脾以固护肺气；木香（Mu Xiang, Aucklandia Root），香气先入脾。总体目的是使血液回归脾脏，所以叫归脾汤。对于因抑郁愤怒伤脾，或思虑过度伤脾的人，尤其适宜。火旺的，加山栀子（Shan Zhi Zi, Gardenia Fruit）、牡丹皮；火衰的，加牡丹皮、肉桂（Rou Gui, Cinnamon Bark）。还有八味丸（Ba Wei Wan, Eight-Ingredient Pill）用来培补先天的根本。治疗方法没有遗漏的了。
仲景伤寒症中有云∶误发少阴汗，动其经血者，下竭上厥，为难治。盖下竭者，阴
血竭于下也。上厥者，阴气逆于上也。夫血与气，两相维附，气不得血则散而无统，血
不得气则凝而不流，故阴火动而阴气不得不上奔，阴气上奔，而阴血不得不从之上溢，
阴血上溢则下竭矣。血既上溢，其随血之气散于胸中，不能复返本位，则上厥矣。阴气
上逆，不过至颈而止，何能越高颠清阳之位？是以喉间窒塞，心忡耳鸣，胸膈不舒
也。然岂但窒塞不舒已哉！阴气久居于上，势必龙雷之火应之于下，血不尽竭不止也。
气不尽厥亦不止也。所以仲景为难治者此耳。然于法外而求至当之治法，则以健脾中
阳气为第一义，盖龙雷之火，必阴云四合，然后遂其腾升之势，若天日清朗则退藏不动
矣。故用凉药清火者，皆以水制火之常法，施之于阴火，未有不助其疟者也。健脾之阳
亦有三善焉，一者，脾中之阳气旺，如天清日朗而龙雷潜伏也。一者，脾中之阳气旺，
而饮食运化精微，复能生其下竭之血也。况地气必先蒸上为湿，然后上升为云。若土无
蒸而不湿，则地气于中隔绝矣。天气不常清乎，且万物以土为根，元气以土为宅，可不
理欤！
张仲景在伤寒症中说：错误地发少阴汗，扰动经络之血的，会导致下元枯竭、上部厥逆，难以治疗。所谓下竭，是指阴血在下部枯竭。所谓上厥，是指阴气逆乱于上部。血和气，互相维系依附，气如果没有血就会涣散而没有统摄，血如果没有气就会凝滞而不流动，所以阴火妄动而阴气不得不向上奔涌，阴气向上奔涌，阴血不得不随之从上溢出，阴血从上溢出，下部就枯竭了。血既然从上溢出，跟随血的气散漫在胸中，不能返回原位，这就是上厥。阴气上逆，最多到颈部停止，怎么能超过头顶清阳的位置呢？所以喉咙间感到堵塞，心悸耳鸣，胸膈不舒服。然而难道只是堵塞不舒服吗！阴气长久停留在上部，势必引起下部的龙雷之火（long-lei fire, latent fire due to yin deficiency）响应，血不枯竭不止，气不厥逆不止。所以张仲景认为这是难治的原因。然而在常规治法之外寻求最恰当的治疗方法，就把健脾中的阳气作为第一要义，大概龙雷之火，一定要阴云四合，才能发挥它腾升的势头，如果天空晴朗，它就会退藏不动。所以用凉药清火的，都是用冷水制火的常规方法，应用在阴火上，没有不加重病情的。健脾的阳气也有三个好处：第一，脾中的阳气旺盛，就像天空晴朗，龙雷之火潜伏一样。第二，脾中的阳气旺盛，饮食运化精微，又能生成下部枯竭的血。况且地气必须先蒸发上去变成湿气，然后上升变成云。如果土地没有蒸发就不湿润，那么地气就在中间隔绝了。天气不是经常晴朗吗？而且万物以土为根，元气以土为宅，能不治理吗！
仲景云∶阴旺能生阴血，盖言人之真阳盛旺，自能化生阴血耳。今人不悟其理，但
见阴血不足，便用人参、黄 补之，初用一二服之间，火得温补，略见一效，以为中
病，久泥于方，不无反助火邪，盖令咳嗽气促，肌肉消烁，往往以致危亡，良可悯哉！
但血本不病，因气虚而血无所倚，故血亦消亡者，只补其气，则血自复，即所谓阳旺能
生阴血，无阳则阴无以生也。
张仲景说：阴旺能生阴血，意思是说人的真阳旺盛，自然能化生阴血。现在的人不明白这个道理，只见阴血不足，就用参、黄芪补益，刚开始服用一两副，火得到温补，略微见效，以为对症，长久拘泥于这个方子，反而帮助了火邪，导致咳嗽气短，肌肉消瘦，往往导致危险死亡，实在令人怜悯！但是血本身没有病，因为气虚而血没有依托，所以血也消亡，只要补其气，血自然恢复，这就是所谓的阳旺能生阴血，没有阳则阴无法生成。
立斋先生遇星士张东谷谈命，时出中庭，吐血一二口，云久有此症，遇劳即发。
先生曰，此劳伤肺气，其血必散，视之果在，与补中益气汤加麦冬、五味、山药、熟
地、茯神、远志服之而愈。翼早请见云∶服四物黄连山栀之类，血益多而倦益甚，得公
一七吐血顿止，精神如故，何也？先生曰∶脾统血，肺主气，此劳伤脾肺，致血妄行，
故用前药健脾肺之气，而嘘血归原耳。
薛立斋先生遇到星算家张东谷谈论命运，当时走出庭院，吐了一两口血，说长久有这个症状，遇到劳累就发作。先生说，这是劳累伤了肺气，他的血必然散乱，查看果然如此，给予补中益气汤（Bu Zhong Yi Qi Tang, Tonify the Middle and Augment Qi Decoction）加上麦冬、五味子、山药、熟地黄、茯神、远志，服用后痊愈。第二天早上张东谷请求见面说：服用四物汤、黄连、山栀之类的药，血更多了，疲倦更严重，得到您的方子，七天吐血立刻停止，精神如故，为什么呢？先生说：脾统血，肺主气，这是劳累伤了脾肺，导致血液妄行，所以用前面的药健脾肺之气，而使血回归本源。
肺为华盖，至清之脏，有火则咳，有痰则嗽。肺主气，气逆为咳，肾主水，水泛为
痰，肾脉上入肺，循喉咙，其支者从肺络心，属胸中，故病则俱病也。涎唾中有少血
散漫者，此肾从相火炎上之血也。若血如红缕，从痰中咳出者，引肺络受热伤之血也。
若咳出白血浅红色，似肉似肺者，必死。凡唾中带血，咯出有血，或血丝，属肾经。鼻
衄出血，咳嗽有血，属肺经。呕吐成盆成碗者，属胃经。自两胁逆上吐出者，属肝经。
溺血属小肠膀胱经。下血属大肠经。牙宣出血属胃肾虚火，舌血谓之舌衄，汗孔。出血
谓之肌衄，心与肝也。又惊而动血者属心，怒而动血者属肝，忧而动血者属肺，思而动
血者属脾，劳而动血者属肾。
肺是华盖，是最清净的脏器，有火就会咳，有痰就会嗽。肺主气，气逆就会咳，肾主水，水泛滥就会成痰，肾脉向上进入肺，沿着喉咙，它的分支从肺联络心，属于胸中，所以生病时都会一起生病。涎唾中有少量血液散漫的，这是肾中相火炎上导致的血。如果血像红线，从痰中咳出来的，是肺络受热损伤的血。如果咳出白色的血，浅红色，像肉像肺的，必定死亡。凡是唾液中带血，咯出有血，或有血丝，属于肾经。鼻衄出血，咳嗽有血，属于肺经。呕吐成盆成碗的，属于胃经。从两胁逆上吐出的，属于肝经。尿血属于小肠膀胱经。便血属于大肠经。牙龈出血属于胃肾虚火，舌出血叫做舌衄，汗孔出血叫做肌衄，属于心和肝。另外，惊恐而动血的属于心，愤怒而动血的属于肝，忧愁而动血的属于肺，思虑而动血的属于脾，劳累而动血的属于肾。
童子之症，须看先天父母之气，而母气尤为重。凡惊风痘疹，肾虚发热，俱以母气
为主，如母有火者，其子必有火；母脾虚者，子必多脾病；母火衰者，子必从幼。有
肾虚症，如齿迟、语迟、行迟，囟门大开，肾疳等症，皆先天不足，从幼调补，亦有可
复之天。
儿童的症状，必须看先天父母之气，而母气尤为重要。凡是惊风、痘疹，肾虚发热，都以母气为主，如果母亲有火，孩子一定有火；母亲脾虚的，孩子一定多有脾病；母亲火衰的，孩子从小就会有肾虚症状，如牙齿发育迟缓、说话迟缓、行走迟缓，囟门大开，肾疳等症状，都是先天不足，从小调理补益，也有可以恢复天年的可能。
肺不特衄血，亦能咳血唾血，胃不特呕血，肝亦呕血，盖肺主气，肝藏血，肝血不
藏，乱气自两胁中逆而出之。然总之是肾水随相火炎上之血也。肾主水，水化液为痰，
为唾、为血，肾脉上入肺，循喉咙，挟舌本，其支者，从肺络心，注胸中，故病则俱
病也。但衄血出于经，衄行清道，吐血出于
胃，吐行浊道，喉与咽二管不同也。盖经者，循经之血，走而不守，随气而行，火气
急迫，故随经直犯清道，上脑而出于鼻为衄。其不出于鼻者，则为咳咯，从肺窍而出
于咽也。胃者，守营之血，守而不走，存于胃中者也。若胃气虚，不能摄血，或为火
逼，故令人呕吐，从喉而出于口也。吐血之热在腑，衄血之热在经，杂病衄血为里热，
伤寒衄血为表热，今人一见吐衄，便以犀角地黄为必用之药，以犀为水兽，可以分水，
可以通天，鼻衄之血，从任督而至颠顶入鼻中，惟犀角能下入肾水，引地黄滋阴之品由
肾脉而上，故变对症。凡阴虚火动，吐血与咳咯者，可以借用成功。若阳虚劳力及脾胃
虚者，俱不宜也。
肺不仅会鼻衄，也能咳血、唾血，胃不仅会呕血，肝也会呕血，大概肺主气，肝藏血，肝血不藏，乱气从两胁中逆乱而出。然而总之是肾水随着相火炎上导致的血。肾主水，水化为津液成为痰，成为唾，成为血，肾脉向上进入肺，沿着喉咙，夹着舌根，它的分支，从肺联络心，注入胸中，所以生病时都会一起生病。但是鼻衄血出于经络，衄血走清道，吐血出于胃，吐血走浊道，喉和咽两个管道是不同的。大概经络中的血，循经运行，走而不守，随着气而行，火气急迫，所以随着经络直接侵犯清道，上达脑部而从鼻子出来就是衄血。那些不从鼻子出来的，就是咳咯，从肺窍而出到咽喉。胃中的血，是守营的血，守而不走，存在于胃中。如果胃气虚，不能统摄血液，或被火逼迫，所以让人呕吐，从喉咙而出到口中。吐血的火热在腑，衄血的火热在经，杂病的衄血是里热，伤寒的衄血是表热，现在的人一见到吐血衄血，就以犀角地黄汤（Xi Jiao Di Huang Tang, Rhinoceros Horn and Rehmannia Decoction）为必用的药，因为犀牛是水兽，可以分水，可以通天，鼻衄的血，从任督脉到达头顶进入鼻子中，只有犀角能下入肾水，引导地黄滋阴的药物由肾脉而上，所以变得对症。凡是阴虚火旺，吐血和咳咯的，可以借用成功。如果是阳虚劳累以及脾胃虚弱的，都不适宜。
凡有实热者，舌苔必燥而焦，甚则黑，脉来必重按有力也。（然有釜下无火，津液不行，干
舌燥症而焦黑者，不可不知。）假热者，舌虽有白苔而必滑，口虽渴而不能饮水，饮而不欲咽，
面虽赤而色必娇嫩，身作躁而欲坐卧于泥水中，脉来重按空虚，此为辨也。
凡是实热的，舌苔一定干燥焦黄，甚至黑色，脉象一定重按有力。（然而有一种情况是锅底下没有火，津液不行，导致舌头干燥焦黑的，不可以不知道。）假热的，舌头虽然有白苔但是一定滑润，口虽然渴但不能喝水，喝了但不想咽下，脸虽然红但颜色一定娇嫩，身体烦躁想要坐在或躺在泥水中，脉象重按空虚，这是辨别的关键。
有饮酒过多，伤胃而吐血，从吐后出者，以葛花解醒汤，加丹皮倍黄连佐之，上
下分消，酒病愈，血亦愈矣。有过啖炙爆辛热等物，上焦壅热，胸腹满痛，血出紫黑成
块者，可用桃仁承气汤从大便导之，此釜底抽薪之法，此皆内之外因，不从本源而得，
故可寒凉克削，所谓应犯而犯，似乎无犯之。有曰血从下出者顺，上出者逆，一应血
溢血泄诸蓄妄行之证，苟非脾虚泄泻，嬴瘦不禁者，皆当以大黄醋，入和生地汁及桃仁
泥、丹皮、丹参、阿胶、黑荆芥、玄明粉、赤芍、当归之属，折其锐气，从大便导之，
使血下行，以转逆为顺，然后区别治之。或问失血复下虚，何以当？殊不知血既妄行迷
失故道，不去蓄利瘀，转逆为顺，则以妄为常，何以御之？且如妇人之于血也，经水足
而为胞胎，则蓄者自蓄，生者自生，及至产育而为恶露，则去者自去，生者自生，何蓄
之有？不知此而从事于苓、连、枝、柏，辅四物而行之，未有不伤气血而败脾胃者。血
既下行之后，多用薏苡仁及百合、麦门冬、鲜地骨皮，嗽渴加枇杷叶、五味子、桑白
皮，有痰加贝母，皆气薄味淡，西方兑金之本药。如可用独补者，以地黄麦冬金水二脏
之药相佐用之，虽然书曰失血家须用下剂破血，盖宜施之于蓄妄之初也。又曰∶亡血家
不可下，盖切戒之于亡失之后也。
有饮酒过多，伤胃而吐血，从呕吐后出来的，用葛花解醒汤（Ge Hua Jie Xing Tang, Kudzu Flower Decoction for Sobering Up），加上牡丹皮，加倍黄连辅助，上下分消，酒病好了，血也好了。有过食烤炸辛辣热物，上焦壅热，胸腹满痛，血出紫黑成块的，可以用桃仁承气汤（Tao Ren Cheng Qi Tang, Peach Kernel Decoction to Order the Qi）从大便导下，这是釜底抽薪的方法，这些都是内因和外因结合，不是从本源得到的，所以可以用寒凉药物克制削减，所谓应该攻伐而攻伐，似乎没有犯禁忌。有人说血从下面出来是顺，从上面出来是逆，一切血溢血泄各种蓄积妄行的证候，如果不是脾虚泄泻，羸弱消瘦不能禁受的，都应该用大黄醋煎，加入和生地汁以及桃仁泥、牡丹皮、丹参、阿胶、黑荆芥、玄明粉、赤芍、当归之类的药，折损其锐气，从大便导下，使血下行，以扭转逆乱为顺，然后再区别治疗。有人问失血后又用下法攻下，怎么合适？殊不知血已经妄行迷失了原来的道路，不去除蓄积通利瘀血，扭转逆乱为顺，就会把妄行当作常态，怎么抵御呢？况且比如妇女对于血来说，经水充足而形成胞胎，那么蓄积的自然蓄积，生成的自然生成，等到生产成为恶露，那么去除的自然去除，生成的自然生成，有什么蓄积呢？不知道这些而从事于茯苓、黄连、桂枝、黄柏，辅助四物汤而行，没有不伤气血而败坏脾胃的。血既下行之后，多用薏苡仁以及百合、麦门冬、新鲜的地骨皮，咳嗽口渴加枇杷叶、五味子、桑白皮，有痰加贝母，都是气薄味淡，西方兑金的本源药物。如果可以用单独补益的，用地黄、麦冬金水两脏的药物相互辅助使用，虽然书上说失血家须用下剂破血，大概适宜施加在蓄积妄行的初期。又说：亡血家不可下，大概严厉告诫在亡失之后。
阴虚之症，大抵上热下寒者多，始而以寒凉进之，上焦非不爽快，稍久则食减。又
以为食滞不化，加神曲、山楂，再久而热愈盛，痰嗽愈多烦燥愈甚，又以药力欠到，寒
凉倍迸，而渴泄腹胀之症作矣。乃以枳壳、腹皮宽中快气之品，不毙何待？是故咳嗽吐
血，未必成瘵也。服四物知柏不己，则瘵成矣。胸满膨胀，未必成胀也。服楂曲不已，
则胀成矣。面浮跗肿，未必成水也，服渗利之药不已，则水成矣。气滞膈塞，未必成噎
也，服宽快之药不已，则噎成矣。戒之哉！
阴虚的症状，大抵上热下寒的多，开始用寒凉药进去，上焦虽然不是不爽快，稍久则食欲减少。又以为是食滞不化，加神曲、山楂，再久则热更盛，痰嗽更多烦躁更甚，又以为药力不够，寒凉加倍迸发，而口渴腹泻腹胀的症状出现了。竟然用枳壳、腹皮宽中快气的药物，不死等什么？所以咳嗽吐血，未必发展成痨瘵（consumption, tuberculosis-like disease）。服用四物汤、知母、黄柏不停，则痨瘵形成了。胸满膨胀，未必发展成鼓胀。服用山楂、神曲不停，则鼓胀形成了。面部浮肿脚肿，未必发展成水肿，服用渗利药物不停，则水肿形成了。气滞膈塞，未必发展成噎膈，服用宽快药物不停，则噎膈形成了。警戒啊！
夫涩可去脱，然气脱专以气药，血脱兼以血药，亦兼气药者，盖气乃血之帅也。若
阳脱者，见鬼，阴脱者，目盲，此神脱也。当补阳助阴，又非涩剂所能收也。
涩法可以去脱证，然而气脱专门用气药，血脱兼用血药，也兼用气药，大概气是血的统帅。如果是阳脱，看见鬼，阴脱，眼睛瞎，这是神脱。应当补阳助阴，又不是涩剂所能收敛的。
丹溪云∶吐血成碗吐出者，甚有出而盈盆者，多是阳盛阴虚，故血不得下行，因火
势炎上而涌出，脉必大而芤，大者，发热，芤者，血滞与失血也。多属阳明以其多血多
气也。
朱丹溪说：吐血成碗吐出来的，甚至有出来盈盆的，多是阳盛阴虚，所以血不能下行，因为火势炎上而涌出，脉象一定大而芤，大的，发热，芤的，血滞与失血。多属于阳明经，因为它多血多气。
吐血有三种，有内衄、有肺疽、有伤胃。内衄者，出血如鼻衄，不从鼻孔出，是
近在心肺间，津液出，还流入胃中，或如豆羹汁，或如切 ，（音勘，凝血也）。血凝停
胃中，因即满闷，便吐，或出数斗至一石者是也。得之于劳倦饮食过常也。肺疽者，因
酒后热毒满闷，吐之时血从吐后出，或一合半合，半升一升是也。伤胃者，因饮食大饱
之后，胃中冷，不能消化，便烦闷，强呕吐，使所食之物与气共上冲蹙，因伤裂胃，
令吐血色鲜正赤，小腹绞痛。若自汗出，其脉紧而数者，为难治也。前人言，诸失血
症，身热则死，寒则生，亦大概言之，岂无热生而寒死乎？则必兼脉症而后可也。
吐血有三种，有内衄、有肺疽、有伤胃。内衄，出血像鼻衄，不从鼻孔出，是在心肺附近，津液流出，还流入胃中，或者像豆羹汁，或者像切开的凝血。血凝停在胃中，因此就满闷，就吐，或者出几斗到一石的，就是这样。得之于劳累倦怠饮食过量。肺疽，因为酒后热毒满闷，吐的时候血从呕吐后出来，或者一合半合，半升一升。伤胃，因为饮食大饱之后，胃中冷，不能消化，就烦闷，强行呕吐，使吃的东西与气共同上冲挤压，因而伤裂胃，导致吐出的血颜色鲜红，小腹绞痛。如果有自汗出，脉紧而数的，是难治的。前人说，各种失血症，身热则死，身寒则生，也是大概说的，难道没有热生而寒死的吗？那就必须兼看脉症才可以。
治血必求血属之药，四物是也。川芎血中气药，通肝经，性味辛散，能行血滞于气
也。地黄血中血药，通肾经，其性味寒，能补真阴之虚也。当归血中之主药，通肝经，
性辛温，分用有三治，全用能活血，各归其经也。芍药为阴分之药，通脾经，味酸寒，
能凉血，治血虚腹痛也。然特论治血病而求血药之属者也。若气虚血弱，又当从仲景血
虚，以人参补之，阳旺则生阴血也。若四物汤者，独能主血分受伤，为气不虚也。其辅
佐之属。若桃仁、红花、苏木、血竭、丹皮者，血滞所宜；蒲黄、阿胶、地榆、百草
霜、棕桐灰者，血崩所宜；乳香、没药、五灵脂、凌霄花者，血痛所宜；苁蓉、锁阳、
牛膝、枸杞子、益母草、败龟板者，血虚所宜；乳酪、血液之物，血燥所宜；干姜者，
血寒所宜；生地、苦参，血热所宜。特取其证治之大概，以明血药之属，岂可以四君、
四物，便足以尽气血之用。
治疗血病必须寻找血分所属的药物，四物汤就是。川芎是血中的气药，通肝经，性味辛散，能行血滞于气。地黄是血中的血药，通肾经，其性味寒，能补真阴之虚。当归是血中的主药，通肝经，性辛温，分用有三种治法，全用能活血，各归其经。芍药是阴分的药，通脾经，味酸寒，能凉血，治血虚腹痛。然而特别论述治疗血病而寻求血药所属的。如果气虚血弱，又应当从张仲景血虚，用人参补益，阳旺则生阴血。如果四物汤，只能主治血分受伤，因为气不虚。其辅助佐使的。比如桃仁、红花、苏木、血竭、牡丹皮，是血滞适宜的；蒲黄、阿胶、地榆、百草霜、棕榈灰，是血崩适宜的；乳香、没药、五灵脂、凌霄花，是血痛适宜的；肉苁蓉、锁阳、牛膝、枸杞子、益母草、败龟板，是血虚适宜的；乳酪、血液之物，是血燥适宜的；干姜，是血寒适宜的；生地、苦参，是血热适宜的。特别选取证治的大概，来阐明血药的所属，难道可以用四君子、四物汤，就足以穷尽气血的作用。
嗽出痰内有血者，名咳血，其因有二，热壅于肺者易治，不过疏之而已，久嗽损于
肺者，难治，此已成劳也。痰中带血丝者，此阴虚火动，劳伤肺脏也。盖血虽生于心，
统于脾，藏于肝，然实宣布于肺，静则归经，热则妄行，火伤肺络，血随咳出，或带
痰中为咳血，吐出多者，为吐血。若喉中常有血腥，一咯血即出，或鲜、或紫、或细屑
者，谓之咯血。若鲜红随唾而出者，谓之唾血，二者皆出于肾，亦有瘀血内积，肺气壅
逼。若能下降者，更有口中津唾，皆是紫黑血水，如猪血之色晦而不鲜，形瘦体热盗汗
者，为有怫郁所致也。然唾血责在下焦，盖阳火煎迫而为之也。肾主唾，足少阴少血多
气，故其症为难治。然咯血亦以为病最重，而且难治者，亦以其肺手太阴之经，气多血
少。又肺者，金象，为清肃下降之脏，金为火所制迫而上行，乃为咯血，逆之甚矣。
咳嗽出痰内有血的，名叫咳血，其原因有两个，热壅于肺的容易治，不过疏通而已，久咳损伤肺的，难治，这已经成为劳损了。痰中带血丝的，这是阴虚火动，劳伤肺脏。大概血虽然生于心，统于脾，藏于肝，然而实际上宣布于肺，静止则归经，热则妄行，火伤肺络，血随咳出，或者带痰中为咳血，吐出的多的，为吐血。如果喉中常有血腥，一咯血就出来，或者鲜红、或者紫、或者细屑的，叫做咯血。如果鲜红随唾而出的，叫做唾血，这两个都出于肾，也有瘀血内积，肺气壅逼。如果能下降的，更有口中津唾，都是紫黑血水，像猪血的颜色晦暗不鲜亮，形体消瘦身体发热盗汗的，是有郁结所致。然而唾血责任在下焦，大概阳火煎熬逼迫而造成的。肾主唾，足少阴肾经少血多气，所以这个症状难治。然而咯血也认为是病最重，而且难治的，也是因为肺手太阴经，气多血少。另外肺是金的象征，是清肃下降的脏器，金被火制约逼迫而上行，就成为咯血，逆乱得很厉害。
《经》曰∶上气见血，下闻病音，谓喘而咯血，且咳嗽也。是以吐血衄血下血虽去多。
然从肝胃大肠而来、三经气血俱多，故身凉脉微无害，咳血咯血，是从心肺肾而来，三
经皆气多血少，气多则火易生，血少则火易识，故渐见脉洪而数，身热咳嗽，失血虽
少，多致不起。
《内经》说：上气见血，下闻病音，指气喘而咯血，并且咳嗽。所以吐血、衄血、下血虽然去得多。然而从肝、胃、大肠而来，这三经气血都多，所以身凉脉微无害，咳血、咯血，是从心、肺、肾而来，这三经都是气多血少，气多则火易生，血少则火易识别，所以渐渐见到脉洪大而数，身热咳嗽，失血虽然少，多导致不能起床（死亡）。
一方治服药而血不止，是肺上有窍也。用白芨末、猪肺，煮熟蘸食，日三四次，窍
为芨末填满，血自止也。欲知何脏之血，吐在水碗之内，浮者肺血，沉者肝血，半浮半
沉者心血，各随所见，以羊肺肝心熟蘸芨末食之。然须静养绝欲，方可施治。凡咳血、
咯血，最是恶症，其初甚微，渐至不救，以其从心肺来之病也。
一个方子治疗服药而血不止，是肺上有孔洞。用白及末、猪肺，煮熟蘸着吃，一天三四次，孔洞被白及末填满，血自然停止。想知道是哪个脏器的血，吐在水碗里，浮的是肺血，沉的是肝血，半浮半沉的是心血，各自根据看到的，用羊肺、肝、心煮熟蘸白及末吃。然而必须静养断绝欲望，才可以施治。凡是咳血、咯血，是最严重的症状，起初很轻微，渐渐到无法救治，因为这是从心肺来的病。
有负重为物所压，或持重远行，忽心口痛，口鼻出血，俗名伤力吐血，乃肺胃内膜
伤损挣破也。若用凉药愈遏愈出，卒至胃损咳嗽而死，急以人参细末，飞罗面，童便调
服最佳，或白芨末，童便调下亦可，但不可服凉药耳。
有负重被物体压迫，或者持重物远行，忽然心口痛，口鼻出血，俗名叫伤力吐血，是肺胃内膜损伤挣破。如果用凉药越遏制越多，最终导致胃损咳嗽而死，急忙用人参细末，飞罗面，童便调服最好，或者白及末，童便调下也可以，但不可服凉药。
诸症失血皆见芤脉，随其上下以验所出，大凡失血脉贵沉细，设见浮大，后必难
The principle lies in the fact that the Foot-Taiyang Bladder Meridian belongs to Cold Water, and the Foot-Shaoyin Kidney Meridian belongs to Kidney Water; both are prone to contracting Cold pathogens. Once contracted, the pathogen enters through the skin and hair first. Since the Lung governs the skin and hair, Cold Water leads to Cold Metal (Lung), causing the Lung Meridian to be affected first. Blood also belongs to the Water element; therefore, once the water and blood within the meridians encounter Cold Qi, they become stagnant and cease to flow. This manifests as coughing with phlegm expulsion. Inquiry will reveal aversion to cold, and palpation will reveal a tight pulse. Observation of the expelled blood will show purple or black spots, all of which are signs of Cold pathogenic invasion. If physicians fail to examine carefully and instead assume it is Yin deficiency with Fire hyperactivity, generally using herbs to nourish Yin and descend Fire, the condition will deepen daily, hastening death. Zhao used Ma Huang Gui Zhi Tang (Ma Huang Gui Zhi Tang, Ephedra and Cinnamon Twig Decoction) once, resulting in slight sweating and recovery. This is because sweat and blood share the same origin. Those who lose blood do not sweat, and those who lose sweat do not lose blood. The following formula is appended as a treatment method for bleeding caused by Cold.
Treating hematemesis (hematemesis, vomiting blood) caused by external Cold contraction and internal heat accumulation. Li Dongyuan treated a poor scholar who suffered from Spleen-Stomach deficiency. After recovering with tonifying herbs, he moved into a spacious, cold room and slept on a heated kang. He then developed hemoptysis (hemoptysis, coughing up blood) and hematemesis. Li Dongyuan stated that this was due to long-term weakness; living in a spacious room in winter with thin clothing further depleted his Yang. External severe Cold obstructed internal heat, preventing the Fire pathogen from dispersing, thus forcing blood out of the mouth. The treatment should tonify exterior Yang and drain interior deficient heat. Recalling Zhang Zhongjing’s treatment of Taiyang Cold damage with a floating-tight pulse, where failure to use Ma Huang Tang for sweating led to epistaxis (epistaxis, nosebleed), which was then cured immediately by Ma Huang Tang, Li found this case very similar. Thus, he formulated this decoction, which cured the patient after one dose.
Ren Shen (Ginseng Root) (Tonifies insufficient Yuan Qi in the Upper Jiao and consolidates the Middle); Mai Dong (Ophiopogon Tuber) (Protects Lung Qi); Gui Zhi (Cinnamon Twig) (Pungent and sweet to disperse Cold); Dang Gui (Angelica Sinensis Root) (Harmonizes and nourishes Qi and Blood); Ma Huang (Ephedra Herb) (Roots removed to disperse external Cold); Zhi Gan Cao (Prepared Licorice Root) (Harmonizes herb properties and tonifies Spleen); Huang Qi (Astragalus Root) (Assists Wei Qi to secure the exterior); Wu Wei Zi (Schisandra Fruit) (Preserves and astringes Lung Qi); Bai Shao Yao (White Peony Root) (Harmonizes Liver to restrain the acrid-warm nature of Ma Huang and Gui Zhi). Use three bowls of water. First, boil Ma Huang alone until boiling, skim off the foam, then add the remaining herbs. Simmer together until one bowl remains, strain, and take hot. One dose is sufficient for recovery; no second dose is needed.
This prescription acts on the Foot-Taiyang and Hand-Foot-Taiyin meridians. *Bencao Gangmu* states: "Observing this single formula is sufficient to serve as a model for ten thousand generations." It essentially combines half of Zhang Zhongjing’s Ma Huang Tang with half of a tonifying formula. For any deficient person requiring Zhang Zhongjing’s formulas, this should be the standard.
Only in cases of hematemesis and epistaxis caused by Summerheat, Liu Hejian’s method can be used to temporarily suppress excessive Yang. Ultimately, Summerheat damages the Heart. Since Heart Qi is deficient, Summerheat Qi takes advantage to enter. The Heart governs Blood, leading to hematemesis and epistaxis. Since the Heart is deficient and cannot govern Blood, it is inappropriate to excessively use Cold-Cooling herbs to drain Heart Fire. Instead, one must add Mu Dan Pi (Moutan Cortex) and Sheng Di Huang (Rehmannia Root) to Qing Shu Yi Qi Tang (Qing Shu Yi Qi Tang, Clear Summerheat and Boost Qi Decoction). Considering Summerheat also damages Qi, the patient will lack energy to move. Using Ren Shen and Mai Dong to boost Qi allows Qi to control Blood, avoiding complications.
In treating blood disorders, regulation before and after must follow the three meridians: the Heart governs Blood, the Spleen controls Blood, and the Liver stores Blood. Gui Pi Tang (Gui Pi Tang, Restore the Spleen Decoction) is the primary formula for these three meridians. Yuan Zhi (Polygala Root) and Suan Zao Ren (Ziziphus Seed) tonify the Liver to generate Heart Fire; Fu Shen (Poria with Hostwood) and Long Yan Rou (Longan Aril) tonify the Heart to generate Spleen Earth; Shen, Zhu, and Cao (Ginseng, Atractylodes, and Licorice) tonify the Spleen to secure Lung Qi; Mu Xiang (Aucklandia Root), being aromatic, enters the Spleen first. The overall goal is to return Blood to the Spleen, hence the name Gui Pi Tang. It is especially suitable for cases where depression/anger injures the Spleen or overthinking injures the Spleen. For excess Fire, add Shan Zhi Zi (Gardenia Fruit) and Mu Dan Pi; for deficient Fire, add Mu Dan Pi and Rou Gui (Cinnamon Bark). Ba Wei Wan (Eight-Ingredient Pill) is also used to cultivate the root of congenital constitution. There are no remaining methods of treatment.
Zhang Zhongjing stated in Shanghan Lun: "Erroneously inducing sweating in Shaoyin disturbs the meridian blood, leading to exhaustion below and reversal above, which is difficult to treat." Exhaustion below refers to Yin Blood depletion in the lower body. Reversal above refers to Yin Qi rebelling upward. Blood and Qi mutually support each other; without Blood, Qi scatters without control; without Qi, Blood coagulates and does not flow. Thus, when Yin Fire moves, Yin Qi must rush upward. As Yin Qi rushes upward, Yin Blood inevitably overflows from above, leading to depletion below. Once Blood overflows, the Qi accompanying it scatters in the chest and cannot return to its origin, causing reversal above. Yin Qi rebellion stops at the neck; it cannot reach the clear Yang position of the vertex. Hence, there is throat obstruction, palpitations, tinnitus, and chest discomfort. But is it merely obstruction and discomfort? When Yin Qi stays above for a long time, it inevitably triggers Long-Lei Fire (latent fire due to Yin deficiency) below. Bleeding will not stop until blood is exhausted, nor will Qi reversal stop until Qi is exhausted. This is why Zhang Zhongjing considers it difficult to treat. However, seeking a definitive treatment beyond standard methods, the primary principle is to strengthen the Yang Qi of the Spleen. Long-Lei Fire requires cloudy skies to rise; if the sky is clear, it retreats and remains still. Therefore, using Cold herbs to clear Fire is a common method of using Water to control Fire, but applied to Yin Fire, it only exacerbates the condition. Strengthening Spleen Yang has three benefits: First, strong Spleen Yang is like a clear sky, keeping Long-Lei Fire latent. Second, strong Spleen Yang aids digestion and transformation of essences, regenerating depleted lower Blood. Moreover, earth qi must evaporate into moisture before rising as clouds. If soil lacks evaporation, earth qi is isolated. Is the sky not often clear? All things take Earth as their root, and Yuan Qi takes Earth as its home. Can we neglect this?
Zhang Zhongjing said: "Strong Yin generates Yin Blood," meaning that when a person’s True Yang is vigorous, it naturally transforms and generates Yin Blood. Modern people do not understand this principle. Seeing only Yin Blood deficiency, they use Ren Shen and Huang Qi to tonify. Initially, after one or two doses, the Fire receives warm tonification and shows slight improvement, leading them to believe it is correct. Prolonged adherence to this formula反而 assists Fire pathogenic factors, causing cough, shortness of breath, and muscle wasting, often leading to critical danger and death, which is truly pitiable! Blood itself is not diseased; it perishes because Qi deficiency leaves it without support. Therefore, tonifying Qi restores Blood naturally. This is what is meant by "Strong Yang generates Yin Blood; without Yang, Yin cannot be generated."
Mr. Xue Lijia met a fortune teller, Zhang Donggu, discussing destiny. Walking out into the courtyard, Zhang vomited one or two mouthfuls of blood, stating he had this symptom for a long time, triggered by exertion. Mr. Xue said, "This is Lung Qi injury from overexertion; his blood must be scattered." Examination confirmed this. He prescribed Bu Zhong Yi Qi Tang (Bu Zhong Yi Qi Tang, Tonify the Middle and Augment Qi Decoction) plus Mai Dong, Wu Wei Zi, Shan Yao, Shu Di Huang, Fu Shen, and Yuan Zhi. The patient recovered. The next morning, Zhang requested an audience, saying, "After taking Si Wu Tang, Huang Lian, and Shan Zhi Zi, my bleeding increased and fatigue worsened. After taking your prescription for seven days, my hematemesis stopped instantly, and my spirit returned to normal. Why?" Mr. Xue replied, "The Spleen controls Blood, and the Lung governs Qi. Exertion injured the Spleen and Lung, causing blood to run recklessly. Therefore, I used the previous herbs to tonify Spleen and Lung Qi, guiding the blood back to its source."
The Lung is the canopy, the purest organ. Fire causes cough, and Phlegm causes su. The Lung governs Qi; Qi rebellion causes cough. The Kidney governs Water; Water flooding creates Phlegm. The Kidney Meridian enters the Lung, follows the throat, and its branch connects from the Lung to the Heart, belonging to the chest. Thus, when diseased, they affect each other. Scattered blood in saliva indicates blood from Kidney相火 (Ministerial Fire) flaming upward. Red threads coughed up with phlegm indicate blood from Lung collaterals damaged by Heat. White blood, pale red, resembling meat or lung tissue, indicates certain death. Saliva with blood, expectoration with blood or blood threads, belongs to the Kidney Meridian. Epistaxis and coughing blood belong to the Lung Meridian. Vomiting blood in basins or bowls belongs to the Stomach Meridian. Vomiting rising from the hypochondrium belongs to the Liver Meridian. Hematuria belongs to the Small Intestine and Bladder Meridians. Lower bleeding belongs to the Large Intestine Meridian. Gum bleeding belongs to Stomach-Kidney Deficient Fire. Tongue bleeding is called She Nu (tongue epistaxis). Sweat pore bleeding is called Ji Nu (muscle epistaxis), belonging to the Heart and Liver. Fright moving blood belongs to the Heart; anger moving blood belongs to the Liver; sorrow moving blood belongs to the Lung; worry moving blood belongs to the Spleen; exertion moving blood belongs to the Kidney.
Pediatric conditions require examining the congenital Qi of parents, with maternal Qi being particularly important. Conditions like wind-stroke, smallpox/rubella, and Kidney deficiency fever are primarily governed by maternal Qi. If the mother has Fire, the child will have Fire; if the mother’s Spleen is deficient, the child will have many Spleen diseases; if the mother’s Fire is weak, the child will suffer from childhood Kidney deficiency symptoms such as delayed tooth eruption, speech, and walking, open fontanelles, and Kidney malnutrition. These are all congenital insufficiencies. Early regulation and tonification can restore natural lifespan.
The Lung not only causes epistaxis but also hemoptysis and sputum-blood. The Stomach not only causes hematemesis but also the Liver can cause hematemesis. The Lung governs Qi, and the Liver stores Blood. When Liver Blood fails to store, chaotic Qi rebels from the hypochondrium. Ultimately, this is all blood from Kidney Water flaming upward with Ministerial Fire. The Kidney governs Water; Water transforms into fluids, becoming Phlegm, saliva, and Blood. The Kidney Meridian enters the Lung, follows the throat, clamps the tongue root, and its branch connects from the Lung to the Heart, pouring into the chest. Thus, when diseased, they affect each other. However, epistaxis comes from meridians, traveling the clear pathway; hematemesis comes from the Stomach, traveling the turbid pathway. The throat and pharynx are different tubes. Meridian blood circulates freely, following Qi. With urgent Fire Qi, it directly invades the clear pathway, reaches the brain, and exits the nose as epistaxis. If it does not exit the nose, it becomes coughing/sputtering blood, exiting the pharynx from the Lung orifice. Stomach blood is defensive blood, staying put and residing in the Stomach. If Stomach Qi is deficient and cannot control Blood, or is forced by Fire, it causes vomiting from the throat to the mouth. The heat in hematemesis is in the Fu organs; the heat in epistaxis is in the meridians. In miscellaneous diseases, epistaxis is interior heat; in Shanghan, epistaxis is exterior heat. Nowadays, upon seeing hematemesis or epistaxis, people immediately use Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) as essential. Since the rhino is a water animal, it can divide water and connect to heaven. Nasal blood travels from the Ren and Du meridians to the vertex and into the nose. Only Rhino Horn can descend into Kidney Water, guiding Rehmannia’s Yin-nourishing properties up via the Kidney Meridian, making it symptomatic. It can be borrowed successfully for Yin deficiency with Fire hyperactivity causing hematemesis and coughing. However, it is unsuitable for Yang deficiency from labor or Spleen-Stomach deficiency.
For excess Heat, the tongue coating must be dry and scorched, even black, and the pulse must be forceful upon heavy pressure. (However, one must know that a dry, scorched-black tongue can also occur when there is no fire under the pot [Kidney Yang deficiency], preventing fluid distribution.) For false Heat, the tongue may have a white coating but will be slippery; the mouth may be thirsty but unable to drink, or drinking without wanting to swallow; the face may be red but the color delicate; the body may be restless, desiring to sit or lie in mud/water; the pulse will be empty upon heavy pressure. This is the differentiation.
Excessive alcohol consumption injuring the Stomach and causing hematemesis, emerging after vomiting, can be treated with Ge Hua Jie Xing Tang (Kudzu Flower Decoction for Sobering Up), adding Mu Dan Pi and doubling Huang Lian to assist. This disperses heat up and down; the alcohol disease heals, and so does the bleeding. Overeating roasted, fried, spicy, and hot foods causing upper Jiao heat congestion, chest/abdominal fullness/pain, and purple-black clotted blood can be treated with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) to guide it out via the large intestine. This is the method of removing firewood from under the cauldron. These are internal and external causes, not originating from the root, so Cold-Cooling and draining herbs can be used. It is said that blood exiting downward is smooth, while exiting upward is rebellious. For all conditions of blood overflow, leakage, and reckless movement, unless there is Spleen deficiency with diarrhea and emaciation, Da Huang (Rhubarb) vinegar decoction, mixed with Sheng Di Huang juice, Tao Ren paste, Mu Dan Pi, Dan Shen, E Jiao, Hei Jing Jie, Xuan Ming Fen, Chi Shao, and Dang Gui, should be used to break their锐气 (sharp momentum) and guide them downward via the large intestine, turning rebellion into smoothness, followed by differentiated treatment. One might ask: Is it appropriate to use purgatives after blood loss? Not knowing that once blood runs recklessly and loses its proper path, failing to remove stagnation and resolve stasis to turn rebellion into smoothness means accepting recklessness as normal, how can it be controlled? Consider women: sufficient menstrual blood forms the fetus; stored blood stores itself, generated blood generates itself. During childbirth, lochia goes, and new blood generates. Where is the stagnation? Ignoring this and using Fu Ling, Huang Lian, Gui Zhi, Huang Bai, assisting Si Wu Tang, will inevitably damage Qi and Blood and ruin the Spleen-Stomach. After blood descends, use Yi Yi Ren, Bai He, Mai Men Dong, fresh Di Gu Pi. For cough/thirst, add Pi Pa Ye, Wu Wei Zi, Sang Bai Pi. For phlegm, add Bei Mu. These are all mild in Qi and light in Flavor, the fundamental herbs of the West/Metal element. If exclusive tonification is needed, combine Di Huang and Mai Dong, herbs of the Metal-Water organs. Although books say blood-loss patients need purgatives to break blood, this applies only to the initial stage of stagnation/recklessness. It also says: Blood-loss patients must not be purged; this is a strict warning for after significant blood loss.
Yin deficiency conditions are mostly upper Heat and lower Cold. Initially, Cold-Cooling herbs provide relief in the Upper Jiao, but soon appetite decreases. Mistaking this for food stagnation, Shen Qu and Shan Zha are added. Prolonged use increases Heat, phlegm-cough, and irritability. Believing the medicine is insufficient, Cold-Cooling herbs are doubled, leading to thirst, diarrhea, and abdominal distension. Then, Zhi Ke and Fu Pi (Qi-moving herbs) are used. Is death not inevitable? Thus, coughing and hematemesis do not necessarily develop into consumption (tuberculosis). Unceasing use of Si Wu Tang, Zhi Mu, and Huang Bai leads to consumption. Chest fullness/distension does not necessarily develop into drum-distension. Unceasing use of Shan Zha and Shen Qu leads to drum-distension. Facial/ankle edema does not necessarily develop into water-swelling. Unceasing use of diuretics leads to water-swelling. Qi stagnation/chest oppression does not necessarily develop into dysphagia. Unceasing use of Qi-moving herbs leads to dysphagia. Beware!
Astringents can treat collapse, but Qi collapse uses Qi herbs, while Blood collapse uses Blood herbs and also Qi herbs, because Qi is the commander of Blood. Yang collapse involves hallucinations; Yin collapse involves blindness; this is Spirit collapse. Tonifying Yang and assisting Yin is required; astringents cannot contain this.
Danxi said: "Vomiting blood in bowls, even filling basins, is mostly Yang excess and Yin deficiency. Thus, blood cannot descend. Due to Fire flaming upward, it surges out. The pulse must be large and Kou (hollow). Large indicates Fever; Kou indicates Blood stagnation and loss. This mostly belongs to the Yangming Meridian because it is abundant in Qi and Blood."
There are three types of hematemesis: Nei Nu (internal epistaxis), Fei Ju (lung abscess), and Shang Wei (Stomach injury). Nei Nu: Bleeding resembles epistaxis but does not come from the nostrils. It originates near the Heart-Lung, flows into the Stomach, appearing like bean soup or clotted blood. Blood stagnates in the Stomach, causing fullness and vomiting, sometimes several dou to one shi. This results from fatigue and irregular diet. Fei Ju: Caused by heat-toxin congestion after drinking alcohol. Blood emerges after vomiting, ranging from one-half liang to one-sheng. Shang Wei: Occurs after overeating, when the Stomach is cold and cannot digest, causing irritability and forced vomiting. Food and Qi rush upward, tearing the Stomach, causing bright red blood and lower abdominal cramping. If spontaneous sweating occurs with a tight-numerous pulse, it is difficult to treat. Ancients said: In all blood-loss conditions, fever indicates death, cold indicates survival. This is a generalization; are there no cases of survival with fever and death with cold? One must consider pulse and symptoms together.
To treat blood disorders, one must seek herbs belonging to the Blood category, such as Si Wu Tang. Chuan Xiong is the Qi herb in Blood, entering the Liver Meridian; its pungent-dispersing nature moves Blood stagnation caused by Qi. Di Huang is the Blood herb in Blood, entering the Kidney Meridian; its cold nature tonifies True Yin deficiency. Dang Gui is the main Blood herb, entering the Liver Meridian; its pungent-warm nature has three uses depending on application; whole use activates Blood, returning it to its meridian. Shao Yao is a Yin-benefit herb, entering the Spleen Meridian; its sour-cold nature cools Blood and treats Blood-deficiency abdominal pain. This specifically discusses treating blood diseases by seeking Blood-category herbs. If Qi is deficient and Blood is weak, follow Zhang Zhongjing: tonify Blood deficiency with Ren Shen, as Strong Yang generates Yin Blood. Si Wu Tang alone addresses Blood-matrix injury when Qi is not deficient. Its assistants include: Tao Ren, Hong Hua, Su Mu, Xue Jie, Mu Dan Pi for Blood stagnation; Pu Huang, E Jiao, Di Yu, Bai Cao Shuang, Zong Tong Hui for Blood flooding; Ru Xiang, Mo Yao, Wu Ling Zhi, Ling Xiao Hua for Blood pain; Cong Rong, Suo Yang, Niu Xi, Gou Qi Zi, Yi Mu Cao, Bai Gui Ban for Blood deficiency; Dairy/blood products for Blood dryness; Gan Jiang for Blood cold; Sheng Di, Ku Shen for Blood heat. This outlines the general treatment to clarify Blood-category herbs. Can Si Jun Zi and Si Wu Tang exhaust the uses of Qi and Blood?
Coughing blood with phlegm is named Ke Xue (coughing blood). Causes are twofold: Heat congestion in the Lung is easy to treat, merely requiring dispersion. Chronic cough damaging the Lung is difficult to treat, indicating consumptive disease. Blood threads in phlegm indicate Yin deficiency with Fire hyperactivity and Lung injury from overwork. Although Blood is born in the Heart, controlled by the Spleen, and stored in the Liver, it is actually distributed by the Lung. Still, it returns to meridians; with Heat, it runs recklessly. Fire damages Lung collaterals, and blood follows cough. If accompanied by phlegm, it is Ke Xue; if expelled in large amounts, it is Tu Xue (hematemesis). If there is always a metallic taste in the throat, and blood spurts out upon spitting, fresh, purple, or fine particles, it is Luo Xue (spitting blood). If fresh red blood comes out with saliva, it is Tuo Xue (saliva blood). Both originate from the Kidney. There may also be internal blood stasis and Lung Qi congestion. If it can descend, saliva may be dark purple-black blood-water, like pig blood, dull and not fresh. Emaciation, body heat, and night sweats indicate constraint/depression. Tuo Xue is blamed on the Lower Jiao, caused by Yang Fire simmering and pressing. The Kidney governs saliva; the Foot-Shaoyin Meridian has little Blood and much Qi, making this condition difficult to treat. Luo Xue is also considered severe and difficult because the Hand-Taiyin Lung Meridian has much Qi and little Blood. The Lung is Metal, a clear-descending organ. When Metal is constrained by Fire and forced upward, it becomes Luo Xue, a severe rebellion.
The Classic says: "Upper Qi shows blood, lower sounds indicate disease," meaning wheezing with Luo Xue and coughing. Thus, although hematemesis, epistaxis, and lower bleeding may involve large losses, since they come from the Liver, Stomach, and Large Intestine—three meridians abundant in Qi and Blood—cool body and faint pulse are harmless. Ke Xue and Luo Xue come from the Heart, Lung, and Kidney—three meridians abundant in Qi and scarce in Blood. Much Qi generates Fire easily; little Blood makes Fire recognizable. Thus, gradually appearing洪-numerous pulse, fever, and cough mean that even slight blood loss often leads to death.
One formula treats persistent bleeding despite medication, indicating a hole in the Lung. Use Bai Ji powder and pig lungs, cooked and dipped in powder, eaten 3-4 times daily. The hole is filled by Bai Ji powder, and bleeding stops. To identify the organ of blood, spit into a water bowl: floating is Lung blood, sinking is Liver blood, half-floating/half-sinking is Heart blood. Based on observation, eat cooked sheep Lung/Liver/Heart dipped in Bai Ji powder. However, quiet rest and abstinence from desires are required for treatment. Ke Xue and Luo Xue are the worst conditions; initially subtle, they become incurable because they originate from the Heart and Lung.
Carrying heavy loads, being crushed, or walking far with weight, suddenly causing heart/chest pain and mouth/nose bleeding, commonly known as "Injury-force Hematemesis," is due to tearing of the inner mucosa of the Lung and Stomach. Using Cold herbs will suppress more and bleed more, eventually leading to Stomach damage, cough, and death. Immediately use Ren Shen fine powder, Fei Luo Mian (fine flour), and Tong Bian (child's urine) mixed and taken orally. Or Bai Ji powder with Tong Bian. Do not use Cold herbs.
All blood-loss conditions show a Kou pulse. Verify the source based on location. Generally, blood-loss pulses should be deep and fine. If floating and large, prognosis is poor later.