又尝治一男子，因饱低头负重吐血，诸药无效，亦投四生丸及青饼子即安，更不发。仆
观初虞世治吐血，不喜用竹茹、生地黄、藕汁。然亦不可狎泥此说。如阳乘于阴，血得热则
流散，经水沸溢，宜服凉药以解之。大黄、犀角、生地黄、生艾、藕汁岂能无效？如阴乘于
阳，所谓天寒地冻，水凝成冰，宜服温药以暖之。干姜、肉桂岂能无功？学人更宜思之。
四生丸 疗吐血。凡吐血、衄血，阳乘于阴，血热妄行，宜服此药。
生荷叶 生艾叶 生柏叶 生地黄
上等分烂研，丸如鸡子大，每服一丸。水三盏，煎至一盏，去滓温服，无时候。
陈日华云∶先公绍兴初游福清灵石寺，主僧留饮食。将竟，侍者赴堂，斋罢来侍立，见
桌子不稳，急罄折极之，举首即呕血，盖食饱拗破肺也。明年再至寺，因问去年呕血者无恙
否？其主僧答云∶得四生丸服之遂愈。自得此方，屡救人有效。
疗热甚呕血者。以犀角地黄汤、《局方》小三黄丸，以白茅根煎浓汤吞之妙。
治内有瘀血，鼻衄吐血，面黄，大便黑。
芍药（三分） 生地黄（半斤） 牡丹皮（去心，一两） 犀角屑（一两，如无，升麻
川者代）
上 咀，每服五钱，水煎服。有热如狂者，加黄芩二两。
治咯血。
青黛 杏仁（各一两，华佗方以牡蛎粉炒杏仁，去皮尖，牡蛎不用）
上一处同研成膏，熔黄蜡和作三十饼子。每服一饼子，用干柿半个夹定，以湿纸裹煨令
香，同嚼，粥饮下，无时候。
若阴乘于阳，心肺经寒而呕血者，宜服干姜甘草汤。
我曾经治疗过一个男子，因为饱食后低头负重而吐血，各种药物都无效，后来服用四生丸和青饼子便痊愈了，不再复发。
我观察初虞世治疗吐血时，不喜欢使用竹茹、生地黄、藕汁。然而也不可固执地拘泥于这种说法。如果是阳邪侵犯阴分，血液受热则流动散乱，如同经水沸腾溢出，适宜服用凉性药物来解除热邪。大黄、犀角、生地黄、生艾叶、藕汁难道会没有疗效吗？如果是阴邪侵犯阳分，所谓天寒地冻，水凝结成冰，适宜服用温性药物来温暖身体。干姜、肉桂难道会没有功效吗？学习中医的人更应当深思这个问题。
四生丸：治疗吐血。凡是吐血、鼻出血，属于阳邪乘袭阴分，血热妄行，适宜服用此药。
以上药材等分，捣烂研细，制成如鸡蛋大小的丸剂，每次服用一丸。用水三盏，煎煮至一盏，去渣后温服，不拘时候。
陈日华说：他的先父在绍兴初年游览福清灵石寺，住持僧人留下他饮食。快要结束时，侍者去食堂，斋饭结束后回来侍立，见桌子不稳，急忙弯腰极力支撑，抬头时随即呕吐鲜血，这是因为吃饱饭后强行扭折损伤了肺脏。第二年再次来到寺庙，于是询问去年呕血的人是否安好？住持僧人回答说：服用四生丸后便痊愈了。自从得到这个方子，多次救人都有疗效。
治疗热势严重导致呕血的，用犀角地黄汤、《局方》小三黄丸，用白茅根煎浓汤送服，效果奇妙。
芍药（三分）、生地黄（半斤）、牡丹皮（去心，一两）、犀角屑（一两，如果没有，可用升麻代替）。
以上药材切碎，每次服用五钱，用水煎服。如果有发热如狂的症状，加黄芩二两。
治疗咯血。
青黛、杏仁（各一两，华佗的方子是用牡蛎粉炒杏仁，去皮尖，不用牡蛎）。
将以上药材一起研磨成膏，熔化黄蜡调和做成三十个饼子。每次服用一个饼子，用半个干柿子夹住，用湿纸包裹煨烤至香，一同咀嚼，用米粥饮送下，不拘时候。
I once treated a man who suffered from hematemesis (vomiting blood) after eating to fullness and bending forward while carrying a heavy load. Various medicines were ineffective, but he recovered and did not relapse after taking Sisheng Wan (Four Raw Decoction Pills) and Qingbingzi (Green Cake).
In observing Chu Yushi's treatment of hematemesis, he disliked using Zhu Ru (Bamboo Shavings), Sheng Di Huang (Rehmanniae Radix Recens), and Ou Zhi (Lotus Root Juice). However, one should not rigidly adhere to this view. If Yang pathogen invades the Yin aspect, blood becomes heated and scatters, similar to water boiling over; in such cases, it is appropriate to administer cooling herbs to resolve the heat. Would Da Huang (Rhei Radix et Rhizoma), Xi Jiao (Rhino Horn), Sheng Di Huang, Sheng Ai Ye (Mugwort Leaf), and Ou Zhi be ineffective? Conversely, if Yin pathogen invades the Yang aspect, akin to freezing weather where water turns to ice, it is appropriate to administer warming herbs to warm the body. Would Gan Jiang (Zingiberis Rhizoma) and Rou Gui (Cinnamon Bark) be without efficacy? Students of medicine should ponder this deeply.
Sisheng Wan (Four Raw Decoction Pills): Treats hematemesis. For any case of hematemesis or epistaxis (nosebleed) caused by Yang pathogen invading Yin, leading to reckless bleeding due to blood heat, this formula is suitable.
Sheng He Ye (Fresh Lotus Leaf), Sheng Ai Ye (Fresh Mugwort Leaf), Sheng Bai Ye (Fresh Biota Top), Sheng Di Huang (Rehmanniae Radix Recens).
Take equal parts of the above, pound until soft and grind finely, form into pills the size of a chicken egg. Take one pill per dose. Decoct with three cups of water until reduced to one cup, remove dregs, and take warm at any time.
Chen Rihua stated: His father traveled to Lingshi Temple in Fuqing during the early Shaoxing era. The abbot hosted him for a meal. As the meal was concluding, an attendant went to the hall; upon returning after the vegetarian meal, he stood in attendance. Seeing that the table was unstable, he bent his waist severely to support it. Upon raising his head, he immediately vomited blood, as the full stomach combined with the twisting motion ruptured the lung tissue. The following year, when visiting the temple again, he asked if the person who had vomited blood the previous year was well. The abbot replied that he had recovered after taking Sisheng Wan. Since obtaining this formula, it has been used successfully to save many lives.
For severe heat causing hematemesis, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Xiao Sanhuang Wan (Minor Three Yellows Pills) from the *Jufang* (Official Formulary), taken with thick decoction of Bai Mao Gen (Imperatae Rhizoma). This method is excellent.
To treat internal blood stasis presenting with epistaxis, hematemesis, sallow complexion, and black stools:
Shao Yao (Paeoniae Radix Alba) (3 fen), Sheng Di Huang (Rehmanniae Radix Recens) (8 liang), Mu Dan Pi (Moutan Cortex) (remove heart, 1 liang), Xi Jiao Xie (Rhino Horn shavings) (1 liang; if unavailable, use Sheng Ma or Chuan Xiong as substitutes).
Cut the herbs into small pieces. Take 5 qian per dose, decoct with water and take orally. If there is fever accompanied by delirious behavior, add Huang Qin (Scutellariae Radix) 2 liang.
To treat hemoptysis (coughing up blood):
Qing Dai (Indigo Naturalis), Xing Ren (Prunus Semen) (each 1 liang. Hua Tuo's formula uses apricot kernels fried with Ouli Fen (Ostreae Concha powder), removing skin and tips; Ostreae Concha is not used).
Grind these together into a paste. Melt Huang La (Beeswax) and mix to form thirty cakes. Take one cake per dose. Sandwich it between half a dried persimmon, wrap in wet paper, and roast until fragrant. Chew together and swallow with congee drink, at any time.
If Yin pathogen invades Yang, causing cold in the Heart and Lung meridians leading to hematemesis, Gan Jiang Gan Cao Tang (Ginger and Licorice Decoction) is appropriate.