麻黄人参芍药汤(东垣) 治吐血外感寒邪,内虚蕴热。
桂枝(五分,补表虚) 麻黄(去外寒) 黄 (实表益卫) 炙甘草(补脾) 白芍(安太阴)
人参(益元气而实表) 麦冬(补肺气,各三分) 五味子(五粒安肺气) 当归(五分,和血养血)
水煎,热服。按此方以解表为止血,是东垣之巧思幸中,非有定识也。观其每味自注药
性,俱悖圣经,便知其陋。
甘草干姜汤(《金匮》)
炙甘草(四钱) 干姜(二钱,炮)
水二杯,煎八分服。
柏叶汤(《金匮》) 治吐血不止。
柏叶(生用,三钱,无生者用干者二钱) 干姜(一钱) 艾叶(生用,二钱,如无生者,用干者一钱)
水四杯,取马通二杯,煎一杯服。如无马通,以童便二杯,煎八分服。
黄土汤(《金匮》) 治先便后血为远血。亦治衄血、吐血、血不止。
灶心黄土(八钱,原方四钱) 生地 黄芩 甘草 阿胶 白术 附子(炮,各一钱五分)
水三杯,煎八分服。
赤小豆散(《金匮》) 治先血后便为近血。
赤小豆(浸令出芽晒干,一两) 当归(四钱)
共研末。每服三钱,浆水下。即洗米水,三日后有酸味是也。按凡止血标药可随宜作引
,血余灰可用一二两同煎,诸血皆验。栀子、茜草、干侧柏治上血,槐花、生地黄、乌梅、
续断治血崩。凡下血及血痢,口渴,后重,脉洪有力者为火盛。可用苦参子去壳,仁勿破,
外以龙眼肉包之,空腹以仓米汤送下九粒,一日二三服,渐加至十四粒,二日效。
麻黄人参芍药汤(李东垣方)用于治疗吐血,病因是外感寒邪,体内虚弱且蕴藏热邪。
桂枝(五分,用于补益表虚)、麻黄(去除外寒)、黄芪(固实肌表、增益卫气)、炙甘草(补益脾胃)、白芍(安抚太阴经)、人参(补益元气并固实肌表)、麦冬(补益肺气,以上各三分)、五味子(五粒,以安肺气)、当归(五分,调和血液并养血)。
用水煎煮,趁热服用。按语:此方以解表作为止血的手段,这是李东垣的巧妙构思,侥幸奏效,并非拥有确定的医学见识。观察其每味药都自行注释药性,全都违背了经典医籍的原则,由此可知其学识浅陋。
甘草干姜汤(出自《金匮要略》)
炙甘草(四钱)、干姜(二钱,炮制过)。
用水两杯,煎至八分,服用。
柏叶汤(出自《金匮要略》)用于治疗吐血不止。
侧柏叶(生用,三钱;若无生品则用干品二钱)、干姜(一钱)、艾叶(生用,二钱;若无生品则用干品一钱)。
用水四杯,加入马通汁(马粪浸出的汁液)两杯,煎至一杯,服用。如果没有马通汁,可以用童便(健康儿童的小便)两杯,煎至八分,服用。
黄土汤(出自《金匮要略》)用于治疗先排便后出血的症状,称为“远血”。也治疗鼻衄、吐血及出血不止。
灶心黄土(八钱,原方为四钱)、生地黄、黄芩、甘草、阿胶、白术、附子(炮制过,以上各一钱五分)。
用水三杯,煎至八分,服用。
赤小豆散(出自《金匮要略》)用于治疗先出血后排便的症状,称为“近血”。
赤小豆(浸泡至发芽后晒干,一两)、当归(四钱)。
共同研磨成粉末。每次服用三钱,用浆水送服。所谓浆水,就是洗米水,放置三天后产生酸味的那种。按语:凡是止血的治标药物都可以酌情作为引经药使用,血余炭(头发煅烧后的灰)可用一两到二两同煎,对各种出血都有效。栀子、茜草、干侧柏可以治疗上部出血,槐花、生地黄、乌梅、续断可以治疗血崩。凡是下部出血及痢疾带血,伴有口渴、里急后重、脉象洪大有力的,属于火邪亢盛。可以使用苦参子,去掉外壳,保持仁完整不破,外面用龙眼肉包裹,空腹时用仓米汤送服九粒,每天服用二三次,逐渐增加至十四粒,两天后见效。
Mahuang Renshen Shaoyao Decoction (by Li Dongyuan) is used to treat hematemesis caused by external cold pathogen invasion and internal deficiency with accumulated heat.
Guizhi (Cinnamon Twig, 5 fen, to tonify exterior deficiency), Mahuang (Ephedra Herb, to dispel external cold), Huangqi (Astragalus Root, to solidify the exterior and benefit Wei Qi), Zhi Gancao (Prepared Licorice Root, to tonify Spleen), Baishao (White Peony Root, to soothe the Taiyin channel), Renshen (Ginseng Root, to benefit Yuan Qi and solidify the exterior), Maidong (Ophiopogon Tuber, to tonify Lung Qi, each 3 fen), Wuweizi (Schisandra Fruit, 5 grains, to calm Lung Qi), Danggui (Angelica Sinensis Root, 5 fen, to harmonize and nourish Blood).
Decoct in water and take hot. Note: This formula uses the method of releasing the exterior to stop bleeding. This is a clever idea of Li Dongyuan that happened to be effective, but it does not reflect profound medical insight. Observing that he annotated the properties of each herb himself, all of which contradict the classic texts, reveals his limited knowledge.
Gancao Ganjiang Tang (from *Jin Gui Yao Lue*)
Zhi Gancao (Prepared Licorice Root, 4 qian), Ganjiang (Dried Ginger, 2 qian, processed).
Decoct in two cups of water until reduced to eight-tenths, then administer.
Baiye Tang (from *Jin Gui Yao Lue*) is used to treat persistent hematemesis.
Baiye (Calamansi Leaf, raw, 3 qian; if unavailable, use dried Baiye, 2 qian), Ganjiang (Dried Ginger, 1 qian), Aye (Mugwort Leaf, raw, 2 qian; if unavailable, use dried Aye, 1 qian).
Decoct in four cups of water with Matong (Horse Dung Juice, 2 cups) until reduced to one cup, then administer. If Matong is unavailable, use Tongbian (Child's Urine, 2 cups), decoct until reduced to eight-tenths, then administer.
Huangtu Tang (from *Jin Gui Yao Lue*) is used to treat "distant blood" (hematochezia where blood appears after stool). It also treats epistaxis, hematemesis, and uncontrollable bleeding.
Zaoxin Huangtu (Caulined Earth, 8 qian; original formula uses 4 qian), Sheng Dihuang (Rehmannia Root, raw), Huangqin (Scutellaria Root), Gancao (Licorice Root), Ejiao (Donkey-Hide Gelatin), Baizhu (Atractylodes Rhizome), Fuzi (Aconite Lateral Root, processed, each 1.5 qian).
Decoct in three cups of water until reduced to eight-tenths, then administer.
Chixiaodou San (from *Jin Gui Yao Lue*) is used to treat "near blood" (bleeding before stool).
Chixiaodou (Adzuki Bean, soaked until sprouted and sun-dried, 1 liang), Danggui (Angelica Sinensis Root, 4 qian).
Grind together into powder. Take 3 qian per dose, administered with Jiangshui (Sour Rice Water). Jiangshui refers to rice washing water left for three days until it develops a sour taste. Note: Any hemostatic symptomatic treatment can be used as an guiding agent according to circumstances. Xueyu Hui (Hair Charcoal) can be decocted together in amounts of 1-2 liang and is effective for various types of bleeding. Zhizi (Gardenia Fruit), Qiancao (Rubia Root), and Gansibai (Dried Calamansi Leaf) treat upper bleeding; Huaihua (Sophora Flower), Sheng Dihuang (Raw Rehmannia Root), Wumei (Mume Fruit), and Xuduan (Dipsacus Root) treat metrorrhagia. For lower bleeding and bloody dysentery, accompanied by thirst, tenesmus, and a surging and forceful pulse, this indicates excessive fire. One may use Kushenzi (Sophora Seed), remove the shell without breaking the kernel, wrap it in Longyanrou (Longan Aril), and take nine grains on an empty stomach with Cangmi Tang (Rice Decoction), two to three times a day, gradually increasing to fourteen grains. Effect should be seen within two days.