诸病失血，脉必见芤。缓小可喜，数大可忧。
卫行脉外，荣行脉中。凡失血之病，脉中必空，故见芤象。若缓小不足，与病
相宜，是可喜也。脉数而大，邪盛正衰，且为火象，必烁真阴，诚为大可忧者。
瘀血内蓄，却宜牢大。沉小涩微，反成其害。
血蓄于内，瘀凝不行。瘀凝则脉大，不行则脉牢，亦因病呈象也。逐之使去，
巢穴一空，而致新不难矣。（宜桃仁承气汤或丹皮、红花之类。）设脉沉小涩微，是病有余而脉
反不足，病有物而脉若无物。虽云瘀血，亦不过着于经络。如仲景所云∶荣卫气伤，
内有干血之类。似非瘀蓄于一处者，故脉见如斯。补之有碍，逐之不能，是反成其害也。（宜大黄 虫丸。）
仲景桃核承气汤（见第二十）
仲景大黄 虫丸 结在内者，手足脉必相失，宜此方。然必兼大补剂琼玉膏之类服之。
大黄（十分。古以二钱半为一分。当是二两半，蒸） 黄芩（二两） 甘草（三两） 桃仁（一升）
杏仁（去皮尖一升） 地黄（十两） 芍药（四两） 干漆（一两） 虻虫（一升） 水蛭（百枚）
蛴螬（一升） 虫（半升）
上十二味，末之。炼蜜为丸，小豆大。酒饮服五丸。日三服。
遗精白浊，微涩而弱。火盛阴虚，芤濡洪数。
肾主藏精，欲后方为施泄。今或念动即出，或无欲自遗，此皆肾虚不能藏摄故
耳。（宜知柏八味丸、河间秘真丸、猪肚丸之类。）白浊者，小便色白而浊，亦为肾虚胞冷不能厘清
所致。（宜清心莲子饮、萆 厘清饮之类。）形属精液，证属脱亡，脉安得不微涩而弱也？设见
芤濡洪数之脉，芤濡固为阴虚，而洪数实因火盛。火盛则精遗，火盛则便浊，似与
肾之虚、胞之寒而不能藏、不能别者，大径庭矣。临诊可忽乎故？（宜六味丸、导赤散、六一散之类。）
各种疾病导致失血，脉象必定呈现芤脉（中空如葱管）。脉象缓小而弱是令人欣喜的吉兆，脉象数大而有力则是令人担忧的凶兆。
卫气运行于脉管之外，营气运行于脉管之中。凡是失血的疾病，脉管中必然空虚，所以出现芤脉的征象。如果脉象缓小且不足，这与病情相适应，这是可喜的现象。如果脉象数而大，说明邪气盛而正气衰，且这属于火象，必然会灼伤真阴，这确实是极其令人担忧的情况。
体内有瘀血蓄积，脉象应当表现为牢大（沉实坚长）。如果脉象沉小、涩或微，反而会造成危害。
血液蓄积在体内，瘀滞凝结而不流通。瘀滞凝结则脉象变大，不流通则脉象变牢，这也是因病势而呈现出的脉象。使用攻逐的方法使瘀血去除，巢穴一空，那么生成新血就不难了。（适宜使用桃仁承气汤或丹皮、红花等药物。）假如脉象沉小、涩或微，这是病邪有余而脉象反而不足，病中有实物而脉象却像没有实物一样。虽然说是瘀血，但也只是附着在经络上。就像张仲景所说的：营卫之气受伤，体内有干血之类。这似乎不是瘀血蓄积在一处，所以脉象呈现这种状态。此时若用补法会有阻碍，用攻逐法又无法奏效，这反而会造成危害。（适宜使用大黄䗪虫丸。）
张仲景的桃核承气汤（见第二十节）
张仲景的大黄䗪虫丸：瘀结在体内的，手足脉象必不相称（指寸口与趺阳脉不一致），适宜使用此方。但是必须配合琼玉膏等大补剂一起服用。
大黄（十分。古时以二钱半为一分。应当是二两半，经过蒸制） 黄芩（二两） 甘草（三两） 桃仁（一升） 杏仁（去皮尖，一升） 地黄（十两） 芍药（四两） 干漆（一两） 虻虫（一升） 水蛭（一百枚） 蛴螬（一升） 䗪虫（半升）
以上十二味药，研成细末。用炼蜜制成丸子，大小如梧桐子。用酒送服五丸。每天服用三次。
遗精和白浊，脉象多呈微涩而弱。如果是火盛阴虚，脉象则呈芤、濡、洪、数。
肾主藏精，要在情欲发动之后才进行施泄。现在有的人念头一动就射精，或者没有欲望也自行遗精，这都是因为肾虚不能固摄的缘故。（适宜使用知柏八味丸、河间秘真丸、猪肚丸等方剂。）白浊，是指小便颜色白且浑浊，也是因为肾虚膀胱寒冷不能分清泌浊所致。（适宜使用清心莲子饮、萆薢分清饮等方剂。）其形态属于精液，其证候属于脱亡，脉象怎么能不呈现微涩而弱的状态呢？假如出现芤、濡、洪、数的脉象，芤和濡固然代表阴虚，但洪和数实际上是因为火盛。火盛则导致精液遗泄，火盛则导致小便浑浊，这似乎与肾虚、膀胱寒而不能藏精、不能分别清浊的情况截然相反。临诊时能忽视这一点吗？（适宜使用六味丸、导赤散、六一散等方剂。）
In various diseases involving blood loss, the pulse must present as a Kou (Hollow) pulse. A slow and small pulse is auspicious, whereas a rapid and large pulse is ominous.
Wei Qi (Defensive Qi) circulates outside the vessels, while Ying Qi (Nutritive Qi) circulates within the vessels. In cases of blood loss, the vessels are necessarily empty, thus presenting the image of a Kou (Hollow) pulse. If the pulse is slow and small, indicating insufficiency, it corresponds appropriately with the disease condition, which is a cause for relief. However, if the pulse is rapid and large, it indicates that pathogenic factors are abundant while healthy qi is depleted; furthermore, this represents a Fire pattern, which will inevitably scorch the True Yin. This is indeed a matter of great concern.
When blood stasis accumulates internally, the pulse should be firm and large (Lao Da). Conversely, a deep, small, choppy, or faint pulse would instead prove detrimental.
Blood accumulating internally becomes stagnant and coagulated, ceasing to flow. Stagnation and coagulation lead to a larger pulse, while lack of flow leads to a firm pulse; these are manifestations arising from the disease itself. By employing methods to purge and remove the stasis, once the nest is emptied, generating new blood becomes not difficult. (Tao Ren Cheng Qi Tang [Peach Kernel Decoction to Order the Qi] or herbs such as Mu Dan Pi [Moutan Cortex] and Hong Hua [Carthamus Flos] are suitable.) If the pulse is deep, small, choppy, or faint, this indicates that the pathogen is excessive while the pulse appears deficient; there is physical pathology, yet the pulse seems devoid of substance. Although termed blood stasis, it may merely adhere to the meridians and collaterals. As Zhang Zhongjing stated: "Damage to Ying and Wei Qi, with dry blood inside." This does not seem to be stasis accumulated in one specific location, hence the pulse presents in this manner. Tonification would be obstructed, and purging would be ineffective, thereby causing harm. (Da Huang Zhe Chong Wan [Rhubarb and Beetle Pill] is suitable.)
Zhang Zhongjing's Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi) (see Section 20).
Zhang Zhongjing's Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill): For stasis knotted internally, where the pulses at the hand and foot are inconsistent (discrepant), this formula is suitable. However, it must be taken concurrently with major tonifying agents such as Qiong Yu Gao (Jade Elixir Paste).
Da Huang (Rhei Radix et Rhizoma, 10 fen. Anciently, 2 qian 5 liang equaled 1 fen; this likely refers to 2 liang 5 qian, steamed) Huang Qin (Scutellariae Radix, 2 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang) Tao Ren (Persicae Semen, 1 sheng) Xing Ren (Armeniacae Semen Amarum, peeled and removed of tips, 1 sheng) Di Huang (Rehmanniae Radix, 10 liang) Shao Yao (Paeoniae Radix Alba, 4 liang) Gan Qi (Dry Lacquer, 1 liang) Meng Chong (Blatta Orientalis, 1 sheng) Shui Zhi (Hirudo, 100 pieces) Qi Cao (Oryctolagi Cuniculi Larva, 1 sheng) Zhe Chong (Eupolyphaga Seu Steleophaga, half sheng).
The above twelve ingredients are powdered. Honey is refined to form pills, sized like adzuki beans. Take five pills with wine. Administer three times daily.
Spermatorrhea and white turbidity typically present with a micro-choppy and weak pulse. In cases of excess Fire and Yin deficiency, the pulse may appear Kou (Hollow), Ru (Flaccid), Hong (Surging), or Shu (Rapid).
The Kidney governs the storage of Jing (Essence), which is only discharged after sexual desire arises. Currently, some individuals ejaculate upon mere thought, or experience spontaneous emission without desire; all these result from Kidney deficiency failing to secure and retain. (Zhi Bai Ba Wei Wan [Anemarrhena, Phellodendron and Eight-Ingredient Pill], He Jian Mi Zhen Wan [Secret Essence Pill by Liu Wansu], and Zhu Du Wan [Pig Stomach Pill] are suitable.) White turbidity refers to urine that is white and cloudy, also caused by Kidney deficiency and Cold in the Bladder failing to separate the clear from the turbid. (Qing Xin Lian Zi Yin [Clear Heart Lotus Seed Decoction] and Bi Xie Fen Qing Yin [Dioscorea Hypoglauca Decoction to Separate the Clear] are suitable.) The form belongs to Jing (Essence), and the syndrome belongs to collapse and loss; how can the pulse not be micro-choppy and weak? If a Kou (Hollow), Ru (Flaccid), Hong (Surging), or Shu (Rapid) pulse appears, Kou and Ru certainly indicate Yin deficiency, but Hong and Shu are actually due to excess Fire. Excess Fire causes spermatorrhea, and excess Fire causes urinary turbidity. This seems diametrically opposed to the patterns of Kidney deficiency and Bladder cold, which fail to store and separate. Can one neglect this when diagnosing? (Liu Wei Wan [Six-Ingredient Pill], Dao Chi San [Guide Out Redness Powder], and Liu Yi San [Six-to-One Powder] are suitable.)