〔海〕血症古人用药，虽有轻重之殊，而无上下之别。今分作上中下三等，以衄血、呕血、唾血、吐血为
上部，血结胸中为中部，蓄血下焦为下部。夫既有三部之分，故药亦当随其轻重也。
汗多为衄血，脉浮，灸之。咽燥为唾血，当汗不汗，热入于里者，为呕血、吐血。此在上也，犀角地黄汤
主之，凉膈散加生地黄亦可。然衄、唾、呕、吐俱在上，亦当以轻重分之。大凡血证皆不饮水，惟气证则饮之，
宜详之。此证乃足太阴所主，脾所不裹，越而上行，所以有吐血、呕血之候也。实者犀角地黄汤，虚者黄芩芍
药汤。凡病呕吐者，以脾所主，故咸用芍药主之，是知太阴药也。
血结胸中头痛身痛，漱水不咽者，衄。无热胸满，漱水不欲咽者，喜忘昏迷，其人如狂，心下手不可近
者，血在中也，桃仁承气汤主之。
蓄血下焦其人发狂，小腹满硬，小便自利，大便反黑，及脐下疼者，抵当汤丸主之。如狂者在中，发狂
者在下。
抵当汤丸，药味同剂，如何是二法？盖喜忘发狂，身黄屎黑者，疾之甚也；但小腹满硬，小便利者，轻也，
故有汤丸之别。桃仁、大黄等分，水蛭、虻虫多者作汤，三之二者作丸，丸之名取其数少而缓也，故汤用煎服
一升，丸止服七合也。
〔《活》〕病患无表症，不发寒热，唇燥，但欲漱水不欲入咽，其脉微而沉，小腹硬满，小便反利，大便必
黑，身黄发狂，此血证谛也。大抵伤寒当汗不汗，里热蓄化为血，其人喜忘而如狂，血上逆则喜忘，血下蓄则
如狂，轻者犀角地黄汤、桃仁承气汤，甚者抵当汤丸，须取尽黑物为效。（按太阳病蓄血者，表症仍在也，
今云无表证者，但说得阳明蓄血，为未备。）
〔海〕喜忘发狂，身黄屎黑者，疾之甚也；但小腹满小便利者，轻也。
生地黄丸 病患七八日后，两手脉沉细微，肤冷，脐下满，或狂或躁，大便实而色黑，小便自利者，
此蓄血证也。若老幼气虚弱者，宜此方主之。
生地黄（自然汁一升，如无生地黄，只用生干地黄二两） 干漆（半两，炒烟尽） 生藕（自然汁半升，
如无藕，用刺蓟汁一升半） 蓝叶（一握，切细，干者用末半升） 虻虫（二十个，去翅足，麸内炒黄）
水蛭（十个，炒） 大黄（一两，锉如豆大） 桃仁（研碎，半两）
上一处，入水三升，同慢火熬及二升，放冷，分二服。先投一服，至半日许，血未下，再投之。此地黄
汤，比抵当汤丸其势甚轻。如无地黄与藕汁升数，添水同煎。抵当丸恐用之太过，不止损血，故以此汤主
之。
【海藏珠微】古代治疗血症的药物，虽然有用量轻重的区别，但没有根据病位上下进行区分。现在将其分为上、中、下三等：将衄血（鼻出血等上部出血）、呕血、唾血、吐血归为上部；血液结聚于胸中归为中部；蓄血在下焦归为下部。既然有了上中下三部的区分，那么用药也应当根据病情的轻重来调整。
出汗过多导致衄血，脉象浮，可以用灸法治疗。咽喉干燥导致唾血，本应发汗却未发汗，热邪内传入里，导致呕血、吐血。这些属于上部病变，用犀角地黄汤主治，凉膈散加生地黄也可以。然而衄血、唾血、呕血、吐血都发生在上部，也应当根据轻重程度进一步区分。大凡血证患者通常不饮水，只有气分证患者才会想喝水，这一点需要仔细辨别。此证由足太阴脾经所主，脾气不能统摄血液，血液溢出而上行，所以出现吐血、呕血的症状。实证用犀角地黄汤，虚证用黄芩芍药汤。凡是呕吐的病人，因为与脾有关，所以都用芍药为主药，可知这是太阴经的药。
血液结聚在胸中，出现头痛、身痛，漱口但不愿咽下的，是衄血。没有发热但胸部胀满，漱口不想咽下，伴有健忘、昏迷，病人像发狂一样，心下部位拒按的，是血在中部，用桃仁承气汤主治。
蓄血在下焦，病人发狂，小腹胀满坚硬，小便自利，大便反而发黑，以及脐下疼痛的，用抵当汤或抵当丸主治。像发狂（如狂）的病证病位在中部，真正发狂的病证病位在下部。
抵当汤和抵当丸药物组成相同，为什么有两种剂型？大概是因为健忘、发狂、身黄、大便黑的，病情严重；只是小腹胀满坚硬、小便通利的，病情较轻，所以有汤剂和丸剂的区别。桃仁、大黄各半，水蛭、虻虫用量多的做成汤剂，用量少三分之二（即较少）的做成丸剂，丸剂名称取其量少而作用缓和之意，所以汤剂服用一升，丸剂只服用七合。
【活人书】病人没有表证，不发寒热，嘴唇干燥，只想漱口但不愿咽下，脉象微而沉，小腹硬满，小便反而通利，大便必然发黑，身黄发狂，这是确凿的血证。大抵伤寒病当发汗而未发汗，里热蓄积化为瘀血，病人健忘且像发狂，血向上逆则健忘，血向下蓄积则像发狂，轻的用犀角地黄汤、桃仁承气汤，重的用抵当汤丸，必须排出黑色的瘀血才算见效。（按：太阳病蓄血证，表证仍然存在；这里说无表证，仅说明了阳明蓄血的情况，论述尚不完整。）
【海藏珠微】健忘、发狂、身黄、大便黑的，病情严重；只是小腹胀满、小便通利的，病情较轻。
生地黄丸 病人患病七八日后，两手脉象沉细微，皮肤冷，脐下胀满，或狂躁不安，大便干结颜色黑，小便自利的，这是蓄血证。如果是老人、儿童或气血虚弱的人，适宜用此方主治。
生地黄（取自然汁一升，如果没有生地黄，只用生干地黄二两） 干漆（半两，炒至烟尽） 生藕（取自然汁半升，如果没有藕，用刺蓟汁一升半） 蓝叶（一把，切碎，干品用粉末半升） 虻虫（二十个，去掉翅足，用麦麸炒黄） 水蛭（十个，炒） 大黄（一两，锉成豆粒大小） 桃仁（研碎，半两）
以上药材一起放入水中三升，用慢火熬煮至二升，放凉后分两次服用。先服一次，过了半天左右，如果瘀血未下，再服第二次。此地黄汤比抵当汤丸药势要轻缓得多。如果没有规定地黄的量和藕汁的量，可以加水同煎。因为担心抵当丸药力太过猛烈，不仅会损伤正气，所以用此汤剂来主治。
[Haizang Zhuwei] In ancient times, the medication for blood disorders differed in dosage but did not distinguish between upper and lower locations. Now it is divided into three levels: upper, middle, and lower. Epistaxis (nosebleed), hematemesis (vomiting blood), spitting blood, and vomiting blood are classified as the upper level; blood stagnating in the chest is the middle level; blood accumulating in the lower jiao (lower abdomen) is the lower level. Since there is a division into three parts, the medication should also be adjusted according to the severity of the condition.
Excessive sweating leading to epistaxis with a floating pulse can be treated with moxibustion. Dryness of the throat leading to spitting blood, where sweating was indicated but not performed, allowing heat to enter the interior, results in hematemesis and vomiting blood. These belong to the upper level and are primarily treated with Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction); Liangge San (Cool the Diaphragm Powder) added with Sheng Dihuang (Fresh Rehmannia Root) is also effective. However, since epistaxis, spitting blood, hematemesis, and vomiting blood all occur in the upper part, they should further be distinguished by severity. Generally, patients with blood disorders do not desire water, whereas those with qi disorders do; this point requires careful differentiation. This condition is governed by the Foot-Taiyin Spleen Meridian. When the Spleen fails to contain the blood, it overflows and moves upward, resulting in symptoms of vomiting blood and hematemesis. For excess patterns, Xijiao Dihuang Tang is used; for deficiency patterns, Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) is used. For all cases of vomiting, because they are related to the Spleen, Shaoyao (Peony Root) is commonly used as the principal herb, indicating these are medicines for the Taiyin channel.
Blood stagnating in the chest presents with headache and body pain, rinsing the mouth without swallowing (shui shu bu yan), which indicates epistaxis. Absence of fever but with chest fullness, rinsing the mouth without desiring to swallow, accompanied by forgetfulness, coma, and a manic-like state where the area below the heart is tender to touch, indicates blood stagnation in the middle. This is treated with Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction).
Blood accumulating in the lower jiao presents with mania, fullness and hardness of the lower abdomen, free urination, black stools, and pain below the umbilicus. This is treated with Didang Tang or Didang Wan (Vermifuge Decoction or Pill). "Manic-like" (ru kuang) conditions are located in the middle, while true "mania" (fa kuang) conditions are located in the lower part.
Didang Tang and Didang Wan contain the same ingredients but differ in formulation. The rationale is that when forgetfulness, mania, yellow skin, and black stools are present, the disease is severe; whereas if there is only lower abdominal fullness and hardness with free urination, the disease is mild. Hence, the distinction between decoction and pill. With equal amounts of Tao Ren (Peach Kernel) and Da Huang (Rhubarb), higher doses of Shui Zhi (Leech) and Meng Chong (Dragonfly Larva) are made into a decoction, while two-thirds of that amount are made into a pill. The pill form is named for its smaller dose and slower action. Therefore, the decoction is taken as one sheng, while the pill is limited to seven he.
[Huo Ren Shu] If the patient has no exterior syndrome, no chills or fever, dry lips, a desire to rinse the mouth but not swallow, a faint and deep pulse, hard and full lower abdomen, free urination, inevitable black stools, yellow skin, and mania, this is a definitive blood disorder. Generally, in Shanghan (Cold Damage) disease, if sweating is indicated but not performed, interior heat accumulates and transforms into blood stasis. The patient becomes forgetful and manic-like. Blood reversing upward causes forgetfulness; blood accumulating downward causes manic-like behavior. Mild cases are treated with Xijiao Dihuang Tang or Tao Ren Cheng Qi Tang; severe cases are treated with Didang Tang or Didang Wan. Efficacy is confirmed only after black material is expelled. (Note: In Yangming Shanghan blood accumulation, the exterior syndrome persists. Here, stating "no exterior syndrome" refers specifically to Yangming blood accumulation, making the discussion incomplete.)
[Haizang Zhuwei] Forgetfulness, mania, yellow skin, and black stools indicate severe disease; lower abdominal fullness with free urination indicates mild disease.
Sheng Dihuang Wan (Rehmannia Pill)
For patients who have been ill for seven or eight days, presenting with faint, fine, and deep pulses in both hands, cold skin, fullness below the umbilicus, mania or restlessness, solid black stools, and free urination, this is a blood accumulation syndrome. For elderly, young children, or those with deficient qi and blood, this formula is appropriate.
Ingredients:
Sheng Dihuang (Fresh Rehmannia Root Juice, 1 sheng; if unavailable, use dried Fresh Rehmannia Root, 2 liang)
Gan Xi (Processed Dry Resin, 0.5 liang, stir-fried until smoke ceases)
Sheng Ou (Fresh Lotus Rhizome Juice, 0.5 sheng; if unavailable, use Ci Ji Juice [Spiny Thistle Juice], 1.5 sheng)
Lan Ye (Isatis Leaf, 1 handful, chopped; if dried, use powder, 0.5 sheng)
Meng Chong (Dragonfly Larva, 20 individuals, wings and feet removed, stir-fried with bran until yellow)
Shui Zhi (Leech, 10 individuals, stir-fried)
Da Huang (Rhubarb, 1 liang, cut into bean-sized pieces)
Tao Ren (Peach Kernel, crushed, 0.5 liang)
Preparation:
Place all ingredients together with 3 sheng of water. Simmer slowly until reduced to 2 sheng. Allow to cool. Divide into two doses. Administer the first dose. After about half a day, if blood has not been expelled, administer the second dose. This Dihuang Tang is much milder than Didang Tang/Wan. If the specified quantities of Dihuang and Ou juice are unavailable, add water for decoction. Didang Wan is feared to be too harsh, potentially damaging healthy blood/qi; therefore, this decoction is used instead.