吐血不咳因热逆，若兼咳嗽努劳伤，内热犀角地黄治，努伤承气四物尝，
劳伤有热鸡苏散,无热须用救肺良。
【注】小儿吐血不咳嗽者，多因内热，致血妄行上逆也，宜以犀角地黄汤主之。若因
努劳吐血者，则兼咳嗽，先用桃仁承气汤以破逐之，次用加味四物汤和之。又有劳伤吐
血者，亦兼咳嗽。痰中带血有热者，鸡苏散主之；无热者，救肺散主之。
犀角地黄汤（方见本门衄血）
桃仁承气汤
桃仁（去皮尖研） 大黄 芒硝 甘草 桂枝 加当归、芍药、苏木、红花。
水煎服。
【方歌】努伤吐血先破逐，桃仁承气汤绝妙，桃仁黄硝草桂枝，加入归芍苏红捷。
加味四物汤
当归 芍药 川芎 生地黄 茅根 蒲黄 牡丹皮 甘草（生） 栀子（炒黑）
引用藕节，酒水煎服。
【方歌】努伤吐血须活血，四物为主真妙诀，再加茅根与蒲黄，丹皮栀草引藕节。
鸡苏散
鸡苏 薄荷叶 川贝母（去心） 麦门冬（去心） 桔梗 阿胶（蛤粉炒） 生地黄 甘草（生） 黄
（炙） 白茅根 蒲黄（炒）
水煎服。
【方歌】劳伤有热嗽痰血，鸡苏贝母麦门冬，桔梗阿胶生地黄，黄 茅根蒲黄同。
加味救肺散
麦冬（去心） 人参 黄 （炙） 郁金 五味子 当归（酒洗） 白芍药（酒炒） 川贝母（去
心研） 甘草（炙） 马兜铃
水煎服。
【方歌】劳伤无热嗽痰血，加味救肺麦门冬，参 郁金五味子，归芍贝母草兜铃。
吐血但不伴有咳嗽，是由于热邪上逆所致；如果同时伴有咳嗽，则多因用力努挣或劳累过度而受伤。对于内热引起的吐血，使用犀角地黄汤治疗；对于因用力努挣导致的损伤，使用承气汤类方剂配合四物汤调理。如果是劳累过度且伴有发热的吐血，使用鸡苏散；如果不伴有发热，则必须使用救肺散。
【注】小儿出现吐血但不咳嗽的情况，大多是因为体内有热，导致血液妄行并向上逆行，应当以犀角地黄汤为主进行治疗。如果是因用力努挣导致的吐血，通常会兼有咳嗽症状，应先用桃仁承气汤来破除瘀血、逐除病邪，然后再用加味四物汤进行调和。还有因劳累过度导致的吐血，也常兼有咳嗽。痰中带血且有热象的，用鸡苏散主治；没有热象的，用救肺散主治。
桃仁承气汤
桃仁（去皮尖后研碎） 大黄 芒硝 甘草 桂枝 加入当归、芍药、苏木、红花。
用水煎煮后服用。
【方歌】用力努挣导致的吐血应先破除瘀血，桃仁承气汤效果绝妙，方中含桃仁、大黄、芒硝、甘草、桂枝，再加入当归、芍药、苏木、红花见效快。
加味四物汤
当归 芍药 川芎 生地黄 白茅根 蒲黄 牡丹皮 甘草（生用） 栀子（炒黑）
引用藕节，用酒和水共同煎煮后服用。
【方歌】用力努挣导致的吐血需要活血，以四物汤为主真是妙诀，再加上白茅根和蒲黄，以及牡丹皮、栀子、甘草，并用藕节作为引经药。
鸡苏散
鸡苏 薄荷叶 川贝母（去心） 麦门冬（去心） 桔梗 阿胶（用蛤粉炒制） 生地黄 甘草（生用） 黄芩（炙） 白茅根 蒲黄（炒）
用水煎煮后服用。
【方歌】劳累过度伴有发热、咳嗽咳血的，用鸡苏散，含贝母、麦门冬，桔梗、阿胶、生地黄，黄芩、白茅根、蒲黄同用。
加味救肺散
麦冬（去心） 人参 黄芩（炙） 郁金 五味子 当归（酒洗） 白芍药（酒炒） 川贝母（去心研碎） 甘草（炙） 马兜铃
用水煎煮后服用。
Hematemesis without coughing is caused by the counterflow of heat; if accompanied by coughing, it is due to injury from straining or overexertion. For hematemesis caused by internal heat, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used for treatment; for injuries caused by straining, Chengqi Tang (Gut-Purging Decoction) combined with Siwu Tang (Four Substances Decoction) is used for regulation. For hematemesis due to overexertion accompanied by fever, Jisu San (Chicken Mint Powder) is used; if there is no fever, Jiufei San (Lung-Saving Powder) must be used.
[Note] In children, hematemesis without coughing is mostly due to internal heat causing blood to move recklessly and flow upward in counterflow; it should primarily be treated with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If hematemesis is caused by straining, it is usually accompanied by coughing. One should first use Taoren Chengqi Tang (Peach Kernel Gut-Purging Decoction) to break up stasis and expel pathogens, followed by Jiawei Siwu Tang (Modified Four Substances Decoction) to harmonize. There are also cases of hematemesis due to overexertion, which are often accompanied by coughing. For hemoptysis with sputum containing blood and signs of heat, Jisu San (Chicken Mint Powder) is indicated; for those without heat signs, Jiufei San (Lung-Saving Powder) is indicated.
Xijiao Dihuang Tang (Formula see "Epistaxis" section in this chapter)
Taoren Chengqi Tang (Peach Kernel Gut-Purging Decoction)
Taoren (Peach Kernel, peeled and core removed, ground) Dahuang (Rhubarb Root and Rhizome) Mangxiao (Mirabilite) Gancao (Licorice Root) Guizhi (Cinnamon Twig) Added: Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Sumu (Sappan Wood), Honghua (Carthamus Flower).
Decoct in water and take orally.
[Formula Song] For hematemesis due to straining, one must first break up stasis; Taoren Chengqi Tang (Peach Kernel Gut-Purging Decoction) is superb. It contains Peach Kernel, Rhubarb, Mirabilite, Licorice, Cinnamon Twig; adding Angelica, Peony, Sappan Wood, and Carthamus brings quick results.
Jiawei Siwu Tang (Modified Four Substances Decoction)
Danggui (Angelica Sinensis Root) Shaoyao (Peony Root) Chuanxiong (Szechwan Lovage Rhizome) Shengdihuang (Rehmannia Root, Fresh) Baigemgen (Imperata Rhizome) Puhuang (Typha Pollen) Mudanpi (Moutan Bark) Gancao (Licorice Root, raw) Zhizi (Gardenia Fruit, stir-fried until black)
Use Oujie (Lotus Rhizome Node) as a guide, decoct in wine and water, and take orally.
[Formula Song] For hematemesis due to straining, blood-activating methods are necessary; Siwu Tang (Four Substances Decoction) as the main formula is truly a wonderful secret. Add Imperata Rhizome and Typha Pollen, Moutan Bark, Gardenia, Licorice, and use Lotus Rhizome Node as a guide.
Jisu San (Chicken Mint Powder)
Jisu (Elsholtzia Herb) Boheye (Mint Leaf) Chuanbeimu (Fritillaria Bulb, heart removed) Maidong (Ophiopogon Tuber, heart removed) Jiegeng (Platycodon Root) Ejiao (Donkey-Hide Gelatin, stir-fried with donkey-hide powder) Shengdihuang (Rehmannia Root, Fresh) Gancao (Licorice Root, raw) Huangqin (Scutellaria Root, honey-fried) Baigemgen (Imperata Rhizome) Puhuang (Typha Pollen, stir-fried)
Decoct in water and take orally.
[Formula Song] For overexertion with heat, coughing, and bloody sputum, use Jisu San (Chicken Mint Powder): Fritillaria, Ophiopogon, Platycodon, Donkey-Hide Gelatin, Rehmannia, Scutellaria, Imperata Rhizome, and Typha Pollum together.
Jiawei Jiufei San (Modified Lung-Saving Powder)
Maidong (Ophiopogon Tuber, heart removed) Renshen (Ginseng Root) Huangqin (Scutellaria Root, honey-fried) Yujin (Curcuma Tuber) Wuweizi (Schisandra Fruit) Danggui (Angelica Sinensis Root, wine-washed) Baishao (White Peony Root, wine-stir-fried) Chuanbeimu (Fritillaria Bulb, heart removed, ground) Gancao (Licorice Root, honey-fried) Madouling (Aristolochia Root)
Decoct in water and take orally.
[Formula Song] For overexertion without heat, coughing, and bloody sputum, use Jiawei Jiufei San (Modified Lung-Saving Powder): Ophiopogon, Ginseng, Scutellaria, Curcuma, Schisandra, Angelica, Peony, Fritillaria, Licorice, and Aristolochia.