伤寒下血，若太阳病外已解，但少腹急结者，桃仁承气汤也。（方论见蓄血。）
若阳明胃实谵语者，宜刺期门穴。（论见谵语。）
太阳病，以火熏汗不得汗，其人必躁而清血。（论见躁。）淋家不可发汗，发汗则便血。太阳病下之，其
脉浮滑者，必下血。（论见大法。）
少阴病，但欲寐，一身手足尽热者，必便血也。伤寒热少厥微，不欲食，烦躁数日，小便利，色白，若欲
食者愈，若呕而胸胁烦满者，必便血也。
咽痛吐血，若面赤斑斑如锦纹者，为阳毒，宜升麻鳖甲汤。（方论见阳毒。）
若下后利不止，手足厥逆，下部脉不至者，麻黄升麻汤。（方论见下利。）
脉浮热甚，反灸之，必咽燥唾血。（论见大法。）服桂枝汤吐者，必吐脓血。（论见吐。）
身黄如狂，屎黑喜忘者，为蓄血。太阳病，表证在而发热恶寒，脉反沉结，而身黄发狂，少腹硬
满者，若小便不利，为无血也，小便自利，血证谛也，宜以抵当汤主之。
（论见发热）。
抵当汤
水蛭（十个，熬去子，杵） 虻虫（十枚，去翅足熬） 大黄（一两，汤浸，去皮） 桃仁（七枚，
去皮，捶碎）
上 咀，作一服，水一盏，煎七分，去渣温服。
伤寒有热，少腹满，应小便不利，今反利者，为有血也，当下之，不用余药，宜抵当丸。
水蛭（五枚，炙） 虻虫（五枚，去翅足，炒） 桃仁（六枚） 大黄（三钱）
上为末，炼蜜和作一丸，以水一盏，煎至七分，顿服， 时当下血。不下再服。
太阳病不解，热结膀胱，其人似狂，若血自下者，病愈。其外未解者，尚未可攻，当先解外。外解，
但小腹急结者，宜攻之，桃仁承气汤。（王海藏方有姜七片，桂、硝各三钱。）
桃仁（十二枚，去皮尖，双仁者不用） 大黄（一两） 甘草（炙） 桂枝 芒硝（各半两）
上 咀，每服一两，水二盏，煎至一盏，去渣，入硝化开，食后服。
阳明症，胃家实，喜忘，大便黑色，虽硬反易者，有蓄血，宜抵当汤。（论见胃实。）
〔海〕初便褐色者重，再便深褐色者愈重，三便黑色者为尤重。色变者，以其火燥也，如羊血在日色中，
须臾变褐色，久则渐变而为黑色，即此意也，当详察之。
〔许〕血在上则喜忘，在下则发狂。
病患无表里症，发热七八日，虽脉浮数者，可下之。假令已下，脉不解，胃热则消谷善饥，至六七
日不大便者，有瘀血，宜抵当汤。若脉数不解，血下不止，必协热而便脓血也。
〔成〕当不大便六七日之际，无喜忘如狂之症，又无少腹硬满之候，何以知其有蓄血？盖以其脉浮数故也。
浮则热客于气，数则热客于血，下后浮数俱去，则病已，若下后数去而浮仍在，则荣血中热去而卫气中
热在，为邪气独留心下，善饥，邪热不杀谷，潮热反渴也。若下后浮去而数不解，则卫气中热去而荣血中热
在，血热合并，迫血下行，胃虚协热，消谷善饥。血至下焦，若下不止，则血得以泄，必脓血也。若不
大便六七日，则血不得出泄，必蓄在下焦为瘀血，故须以抵当汤下之。
病者胸满痞痿，舌青口燥，但漱水不欲下咽，无寒热，脉微大来迟，腹不满，其人言我满，为有瘀血。
（海云∶漱水不咽，胸满，心下手不可近者，桃仁承气汤主之。）
病者如热状，烦满，口干燥而渴，其脉反无热，此为阴伏，是瘀血也，当下之。
伤寒导致下血，如果太阳病表证已解，仅表现为少腹急迫结聚的，使用桃仁承气汤。（方剂论述见蓄血篇。）
如果是阳明胃实热并伴有谵语的，适宜针刺期门穴。（论述见谵语篇。）
太阳病，用火熏法发汗却未能出汗，病人必定烦躁并出现便血。（论述见烦躁篇。）患有淋证的病人不可发汗，若发汗则会导致便血。太阳病误用下法，脉象浮滑的，必定出现下血。（论述见大法篇。）
少阴病，表现为只想睡觉，全身及手足均发热的，必定出现便血。伤寒热势轻微而四肢厥冷也轻微，不想进食，烦躁数日，小便通畅且颜色清白，如果想进食则是病情向愈；如果出现呕吐且胸胁部烦闷胀满的，必定出现便血。
咽喉疼痛并吐血，如果面部红赤如锦纹般斑斑点点的，属于阳毒，适宜使用升麻鳖甲汤。（方剂论述见阳毒篇。）
如果经过泻下治疗后腹泻不止，手足逆冷，下部脉搏摸不到的，使用麻黄升麻汤。（方剂论述见下利篇。）
脉象浮而热势严重，反而使用灸法，必定导致咽喉干燥并唾血。（论述见大法篇。）服用桂枝汤后发生呕吐的，必定吐出脓血。（论述见呕吐篇。）
身体发黄、神志如狂、大便色黑且健忘的，属于蓄血证。太阳病，表证仍在且发热恶寒，脉象反而沉结，身体发黄、发狂，少腹部硬满的，如果小便不利，说明没有瘀血；如果小便自利，则是确凿的瘀血证，适宜用抵当汤主治。（论述见发热篇。）
抵当汤
水蛭（十个，炒去子，捣碎） 虻虫（十只，去掉翅足，炒） 大黄（一两，热水浸泡，去皮） 桃仁（七枚，去皮，捣碎）
以上药材切碎，作为一服量，用水一盏，煎至七分，去渣后温服。
伤寒有热，少腹胀满，本应小便不利，现在反而小便通利的，是有瘀血，应当攻下，不用其他药物，适宜用抵当丸。
水蛭（五只，炙） 虻虫（五只，去掉翅足，炒） 桃仁（六枚） 大黄（三钱）
以上研为末，用炼蜜和成一颗药丸，用水一盏，煎至七分，一次性服下，此时应当排出瘀血。如果未排出，再服用。
太阳病不解，热邪结于膀胱，病人神志似狂，如果瘀血自行排出，病就好了。如果表证仍未解除，尚不可攻逐瘀血，应当先解表。表证解除后，仅少腹急结的，适宜攻逐瘀血，用桃仁承气汤。（王海藏方中加生姜七片，桂枝、芒硝各三钱。）
桃仁（十二枚，去皮尖，双仁者不用） 大黄（一两） 甘草（炙） 桂枝 芒硝（各半两）
以上药材切碎，每次服用一两，用水二盏，煎至一盏，去渣，加入芒硝溶化，饭后服用。
阳明症，胃家实热，健忘，大便黑色，虽然干硬反而容易排出的，是有蓄血，适宜用抵当汤。（论述见胃实证篇。）
〔海〕初次排便呈褐色的为重，再次排便呈深褐色的更重，三次排便呈黑色的尤为严重。颜色变化，是因为火燥所致，如同羊血在阳光下，片刻变为褐色，久则逐渐变为黑色，就是这个意思，应当详细察辨。
〔许〕血在上焦则健忘，在下焦则发狂。
病患没有表里症状，发热七八天，即使脉象浮数，也可以攻下。假如已经攻下，脉象仍不解，胃中有热则消谷善饥，到了六七天不大便的，有瘀血，适宜用抵当汤。如果脉数不解，出血不止，必定协热而便脓血。
〔成无己〕在不大便六七天之际，如果没有健忘如狂的症状，又没有少腹硬满的表现，怎么知道有蓄血呢？大概是因为脉象浮数。浮表示热邪客于卫气，数表示热邪客于营血。攻下后浮数和脉象都消失，则病愈；如果攻下后数脉消失而浮脉仍在，则营血中的热邪已去而卫气中的热邪仍在，邪气独留心下，导致善饥，邪热不能腐熟水谷，出现潮热反渴。如果攻下后浮脉消失而数脉不解，则卫气中的热邪已去而营血中的热邪仍在，血热合并，迫血下行，胃虚协热，导致消谷善饥。血液流至下焦，如果下血不止，则血液得以泄出，必定是脓血。如果不大便六七天，则血液不得出泄，必定蓄积在下焦成为瘀血，所以需要用抵当汤攻下。
病人胸满痞塞，舌质青紫，口干燥，只是含水漱口而不欲咽下，无寒热表现，脉象微大来迟，腹部不胀满，但病人自称胀满的，是有瘀血。
（海云：漱水不咽，胸满，心下部位按之痛不可近者，用桃仁承气汤主治。）
病人像有热状，烦闷，口干燥而渴，但脉象反而不显热象，这是阴分伏热，是瘀血，应当攻下。
Blood discharge in cold damage: If the exterior syndrome of Taiyang disease has been resolved, but there is only urgency and binding in the lower abdomen, Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) should be used. (Discussion on formulas can be found under "Accumulated Blood".)
If there is excess heat in the Yangming stomach accompanied by delirious speech, puncturing Qimen (LR14) acupoint is appropriate. (Discussion can be found under "Delirium".)
In Taiyang disease, if fire steaming is used for sweating but no sweat occurs, the patient will inevitably become restless and experience hematochezia. (Discussion can be found under "Restlessness".) Patients with Lin syndrome (dysuria) must not undergo sweating therapy; if sweating is induced, it will lead to hematochezia. In Taiyang disease, if purgation is mistakenly applied and the pulse is floating and slippery, blood discharge will inevitably occur. (Discussion can be found under "General Principles".)
In Shaoyin disease, if the patient desires sleep, and the whole body and hands and feet are hot, hematochezia will inevitably occur. In cold damage, if heat is slight and extremity cold is mild, appetite is lost, restlessness persists for several days, urination is free and urine color is clear/white, desire for food indicates recovery; however, if vomiting occurs with irritability and fullness in the chest and hypochondrium, hematochezia will inevitably occur.
Throat pain with hematemesis: If the face is red with mottled patterns like brocade, this is Yang Du (Yang Toxin), and Sheng Ma Bie Jia Tang (Cimicifuga and Turtle Shell Decoction) is appropriate. (Discussion on formulas can be found under "Yang Toxin".)
If diarrhea persists after purgation, with cold reversal of the hands and feet and absent pulses at the lower position, Ma Huang Sheng Ma Tang (Ephedra and Cimicifuga Decoction) should be used. (Discussion on formulas can be found under "Diarrhea".)
If the pulse is floating and heat is severe, moxibustion is contraindicated; applying it will inevitably cause dry throat and spitting of blood. (Discussion can be found under "General Principles".) If vomiting occurs after taking Gui Zhi Tang (Cinnamon Twig Decoction), pus and blood will inevitably be vomited. (Discussion can be found under "Vomiting".)
Jaundice resembling madness, black stool, and forgetfulness indicate Accumulated Blood (Xu Xue). In Taiyang disease, if exterior symptoms persist with fever and aversion to cold, yet the pulse is sinking and knotted, accompanied by jaundice, madness, and hardness/fullness in the lower abdomen: if urination is difficult, there is no blood stasis; if urination is spontaneous, the diagnosis of blood stasis is confirmed, and Di Dang Tang (Resist the Pill Decoction) is appropriate. (Discussion can be found under "Fever").
Di Dang Tang (Resist the Pill Decoction)
Shui Zhi (Leech, ten pieces, roasted, seeds removed, pounded) Meng Chong (Dragonfly larva, ten pieces, wings and legs removed, roasted) Da Huang (Rhubarb Root and Rhizome, one liang, soaked in boiling water, skin removed) Tao Ren (Peach Seed, seven kernels, skin removed, crushed)
Chop the above ingredients into one dose, add one cup of water, decoct to seven-tenths, remove dregs, and take warm.
In cold damage with heat and lower abdominal fullness, urination should normally be difficult; if it is now free, it indicates blood stasis. It should be purged without other medicines; Di Dang Wan (Resist the Pill) is appropriate.
Shui Zhi (Leech, five pieces, dried over fire) Meng Chong (Dragonfly larva, five pieces, wings and legs removed, stir-fried) Tao Ren (Peach Seed, six kernels) Da Huang (Rhubarb Root and Rhizome, three qian)
Grind the above into powder, mix with refined honey to form one pill. Add one cup of water, decoct to seven-tenths, and take in one dose. Blood stasis should be discharged at this time. If not discharged, administer again.
If Taiyang disease is unresolved and heat binds in the Bladder, the patient appears manic. If blood discharges spontaneously, the disease resolves. If the exterior is not yet resolved, attacking the interior is premature; resolve the exterior first. Once the exterior is resolved, if only urgency and binding in the lower abdomen remain, attack with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi). (Wang Haizang's formula adds seven slices of fresh ginger, Gui Zhi [Cinnamon Twig] and Mang Xiao [Mirabilite], each three qian.)
Tao Ren (Peach Seed, twelve kernels, skin and tips removed, double-kernel ones excluded) Da Huang (Rhubarb Root and Rhizome, one liang) Gan Cao (Licorice Root, roasted) Gui Zhi (Cinnamon Twig) Mang Xiao (Mirabilite, half liang each)
Chop the above ingredients. For each dose, use two cups of water, decoct to one cup, remove dregs, dissolve Mang Xiao, and take after meals.
In Yangming syndrome, with excess in the Stomach organ, forgetfulness, black stool that is hard yet easy to pass, this indicates Accumulated Blood (Xu Xue), and Di Dang Tang (Resist the Pill Decoction) is appropriate. (Discussion can be found under "Stomach Excess".)
[Ha] The first passage being brown is severe; the second being dark brown is more severe; the third being black is most severe. The color change is due to fire and dryness, similar to sheep blood turning brown in sunlight, then gradually blackening over time. This principle should be carefully observed.
[Xu] Blood in the upper jiao causes forgetfulness; blood in the lower jiao causes madness.
When a patient has neither exterior nor interior symptoms but has had fever for seven or eight days, even if the pulse is floating and rapid, purgation may be used. If purgation has already been performed and the pulse remains unresolved, gastric heat leads to efficient digestion and frequent hunger. If there is no bowel movement for six or seven days, blood stasis exists, and Di Dang Tang (Resist the Pill Decoction) is appropriate. If the rapid pulse persists and bleeding continues, it will inevitably result in pus and blood mixed with heat.
[Cheng Wujing] During the period of no bowel movement for six or seven days, without symptoms of forgetfulness or mania, and without lower abdominal hardness/fullness, how do we know there is accumulated blood? It is because of the floating and rapid pulse. Floating indicates heat lodged in Wei Qi (Defensive Qi); rapid indicates heat lodged in Ying Qi (Nutritive Qi). After purgation, if both floating and rapid pulses disappear, the disease is cured. If the rapid pulse disappears but the floating pulse remains, heat in Ying Qi is gone but heat in Wei Qi remains; pathogenic qi lingers in the epigastrium, causing frequent hunger, inability to digest food properly due to pathogenic heat, tidal fever, and paradoxical thirst. If the floating pulse disappears but the rapid pulse persists, heat in Wei Qi is gone but heat in Ying Qi remains. Blood heat combines, forcing blood downward. With deficient Stomach heat, efficient digestion and frequent hunger occur. When blood reaches the Lower Jiao, if downward bleeding does not stop, blood is expelled, resulting in pus and blood. If there is no bowel movement for six or seven days, blood cannot be expelled, accumulating in the Lower Jiao as blood stasis; thus, Di Dang Tang (Resist the Pill Decoction) is required to purge it.
When a patient presents with chest fullness and痞 (plugged sensation), blue tongue, dry mouth, desiring to rinse water in the mouth but not swallow, without chills or fever, with a pulse that is slightly large and slow in return, and claims abdominal fullness despite no visible distension, this indicates blood stasis.
[Hai Yun]: Rinsing water without swallowing, chest fullness, and tenderness/pain in the epigastrium unapproachable to touch are treated with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi).
When a patient appears to have heat, irritability, dry mouth, and thirst, yet the pulse shows no signs of heat, this is Yin Fu (hidden Yin heat), indicating blood stasis, which should be purged.