【歌】血是人身水谷精，生于脾胃统于心。动言视听皆资用，脉络形容足壮神。阳火煎熬偏易耗，阴精有
质故难成。虚劳咳咯真阴损，吐衄多因火载升。男子便红缘湿火，女人血热病崩淋。脉芤而涩知无血，色夺神
枯是损阴。血热血寒虚与实，临时诊候细详情。若缘蓄血生潮热，药剂斟量及早行。血因脱损焦姜补，燕地归
芎信有灵。
【论】夫血者，水谷之精也。和调于五脏，洒陈于六腑，乃能入于脉也。源源而来，生化于脾，总统于心，
藏于肝，宣布于肺，灌溉一身。故目得之而能视，耳得之而能听，掌得之而能摄，足得之而能履，脏得之而能
液，腑得之而能气。所以，视、听、言、动、脏、腑、脉络，靡不由于血之运用也，故曰∶血者，神气也。持
之则存，失之则亡，血盛则形盛，血弱则神衰，神静则阴生，形役则阳亢。注之于脉，少则涩，充则实，故阳
生阴长，取汁变化而为血。《内经》所谓∶脉者，血之府也。生化旺，则诸经恃此而长养，衰耗竭，则百脉由
此而空虚，可不谨养哉？盖血属阴，难成而易亏。由乎人之节欲者少，不能谨养，以致阳火滋甚，日
渐煎熬，真阴内损，而吐衄，血妄行于上，便溺，血渗泄于下，而精神内损，百病由此而生焉。
【脉】诸证见血，皆见芤涩。随其上下，以验所出。大凡失血，脉贵沉细。设见洪大，后必难治。
四物汤
补血之要药。
当归（二钱，分三，治血中主药也，通肝经，全能活血，各归其经也）
熟地黄（一钱，血中血药也，通肾经，能生真阴之虚也）
川芎（一钱半，血中气药也，通肝经，能行血滞于气也）
白芍药（一钱半，阴分药也，通脾经，能治血虚腹痛也）
上锉，一剂，水煎服。
经脉不行，加红花、苏木。妊妇动胎，加艾叶、香附、苏梗。血痢，加阿胶、艾叶。口干烦渴，加麦冬、
乌梅、干葛。便秘，加桃仁、大黄。大渴烦躁，加人参、麦冬、知母、石膏。五心烦热，加黄芩、柴胡、地骨
皮、百合，虚烦不睡，加淡竹叶、石膏、人参。怔忡恍惚，加远志、枣仁。
咳血
咳血者，火乘金位，肺络受伤，故血从嗽而出也。丹溪云∶先痰嗽而后见红者，多是痰积生热，以降痰火
为急，宜煎桔梗、枳壳、黄芩、橘红，送下天门冬丸。先见红而后痰嗽者，多是阴虚火动，痰不下降，宜以四
物汤加痰药、火药。
天门冬丸
治咯血、吐血，润肺止嗽。
天门冬（一两） 阿胶（炮，五钱） 甘草（五钱） 贝母（去心，五钱） 白茯苓（五钱） 杏仁（五钱）
上为细末，蜜丸，如弹子大，噙化。
咯血
咯血者，痰中咯出血疙瘩也。
按∶薛立斋云∶此证多因心气虚耗，不能主血，血不归经，停留于内，故得咯而出。其证面色萎黄，五心
烦热是也。若郁热甚者，生地黄散。咯血及痰中血丝者，四物汤加竹沥、姜汁、牛膝、童便、青黛。虚嗽咯
血者，太平丸。劳瘵咯血者，详本条内。
生地黄散
治痰火郁结，衄血、咯血、吐血，阴虚阳亢。
枸杞子（五分） 软柴胡（五分） 黄连（炒，五分） 地骨皮（五分） 天门冬（五分） 白芍药（五
分） 甘草（炒，五分） 黄芩（炒，五分） 黄 （五分） 生地黄（五分） 熟地黄（五分）
太平丸（方见虚劳门。）
吐血
吐血者，呕出全血是也。
达按∶经云∶心主血，而不能藏，夜则复归于肝。肝藏血，而不能主，昼则听令于心。心为君，肝为相，
君火一动，相火从之，相火一动，六经之火从之。火动，则血随以动，火升，则血随以升。善调摄者，寡欲节
劳，常使君火不动，相火隐伏。火伏，则血随以伏矣，何病之有？惟不知命者，不自量其血气之强弱，本元之
虚实，奔走道路而不惮其劳，纵情女色而强努其力，以有限之精神，而供无穷之作用。六经受伤，血液流迸，
聚于两胁胸臆之间，乘火而升。其伤重者，从夹脊而上，如潮涌至，势不可遏，法当从其出，不可强为之御也。
盖所出之血，皆败血也，纵能止之，亦不归经，久当复出，故不可御。必服以消血之药，佐以润下之剂，使其
败血下行，乃服止血之剂，以杜其根，服补血之剂，以还其
元，庶可以收全功也。
花蕊石散（方见劳瘵条。）
四生丸
治吐血、衄血，阳乘于阴者。
生荷叶 生艾叶 生柏叶 生地黄（各等分）
上研，为丸，如鸡子大，每服一丸，水煎服。
麦门冬饮子
治气虚吐血，或血虚不能摄血者。
麦冬（去心，一钱） 黄 （蜜炙，一钱） 当归身（五分） 人参（五分） 生地黄（五分） 五味子
（十粒，杵）
上锉，一剂，水煎服。
血不止加阿胶、炒蒲黄、白茅花。兼痰加贝母、桔梗。
丹溪方
治呕血，衄血，一切火载血升，上行之证。
四物加山栀、童便、姜汁，或用韭汁，童便相和饮之。
衄血
衄血，鼻中出血也。夫气血调和，则循环经络。若劳伤元气，阴虚火动，气逆于肺，则血随鼻而衄也，犀
角地黄汤主之。经云∶诸见血，身热，脉大者难治，是火邪胜也。身凉，脉静者易治，是正气复也。
犀角地黄汤
治热郁不解，泛行经络，或流肠胃，随气涌泄，以致衄血，吐血，或为便血，或为蓄血等证。
犀角（上） 生地黄（中） 芍药（中） 丹皮（下）
上锉，水煎温服。
若活血，加桃仁、红花。若止血，加黄连、山栀。止衄，加黄芩、茅花。破瘀血，加桃仁、大黄，用此
者，恐桃仁承
气太峻故也。如吐、衄血甚，不止者，用茅根、侧柏、藕三味捣汁，磨京墨入本方调服即止。鼻衄不止者，外
用劫法∶用水纸搭在鼻冲，随用山栀炒黑，牡蛎、龙骨火 ，京墨、百草霜共为细末，加血余烧灰各等分，用
茅花水湿蘸药，入鼻中即止。如无茅花，将纸捻水湿蘸前药末入鼻中，甚妙。
便血
便血者，大便血也。多因饮食起居，或六淫七情致伤，令元气亏损，阳络外伤而然也。若膏粱积热者，
加味清胃散。大肠风热者，四物加侧柏、荆芥、秦艽、枳壳、丹皮、柴胡。阴结者，平胃地榆汤。
加味清胃散
即本方加犀角、连翘、甘草。（方见火证。）
加减四物汤
治肠风下血。
侧柏（炒，五分） 荆芥（五分） 槐花（炒，五分） 甘草（炙，五分） 枳壳（麸炒，一钱） 生地黄
（一钱） 当归（一钱） 川芎（一钱）
上锉，一剂，姜一片，水煎服。
若热炽甚 加山栀、黄芩、黄连。血不止，加升麻、秦艽、阿胶、地榆。
平胃地榆汤
治阴统便血，即《内经》所谓∶结阴者，便血一升，再结二升，三结三升是也。
人参（八分） 白术（八分） 茯苓（七分） 甘草（七分） 陈皮（七分） 苍术（七分） 浓朴（七
分） 干姜（炮，六分） 益智（炮，六分） 附子（炮，六分） 升麻（六分） 葛根（七分） 地榆（八分）
神曲（六分） 白芍药（八分） 当归（八分）
上锉，一剂，姜三片，枣二枚，水煎服。
溺血
溺血者，小便血也。盖心主血，通行经络，循环脏腑。若得寒则凝涩，得热则妄行，失其常道，则溢
渗于脬，小便出血也。不痛，小蓟饮。不止，蒲黄散。实者，当归承气汤，后以四物汤，加小蓟、山栀、滑石、
琥珀。虚者，胶艾汤。
小蓟饮
小蓟（一钱） 山栀（一钱） 当归（一钱） 生地黄（一钱半） 滑石（一钱） 甘草（八分） 蒲黄
（一钱） 藕节（一钱半） 淡竹叶（八分） 通草（六分）
上锉，一剂，水煎，温服。
当归承气汤
即小承气汤加当归。（小承气方见伤食。）
胶艾汤
即四物汤加阿胶、艾叶、炙甘草各一钱。
瘀血
达按∶跌扑损伤，或被人打踢，或物相撞，或取闪肭，或奔走努力，或受困屈，或发恼怒，一时不觉，
过至半日或一、二、三日而发者有之，十数日或半月、一月而发者有之。一般寒热交作，其心胸、肋下、小腹
满痛，按之手不可近者，此有瘀血也。或一时伤重，就发寒热，瘀血上冲，则昏迷不醒，如死之状，良久复苏。
轻则复元活血汤，重则桃仁承气汤主之，量其元气，下其瘀血则愈。在上者，宜饮韭汁，切不可饮冷水，血见
寒则凝，但一丝血入心即死。若医家不识，见其寒热胀满，罔察其痛处，若有痛肿，手难近，按其脉芤涩，或
数，以明之。盖肝为血海，凡有瘀血，必蓄积于心胸、胁下，或小腹之分，乃肝部也。心主血，肝藏血，脾为之
流，但小便如常者，蓄血证也。内伤瘀血证，必自汗。
复元活血汤
治瘀血留于胸胁腹肚，疼痛不可忍。
柴胡（上） 花粉 当归（中） 红花 甘草（下） 大黄（上，酒浸） 穿山甲（炮） 桃仁（中，
酒浸，研如泥）
上，用水一盏，酒半盏，煎一盏，加桃仁泥，再煎至八分，温服，以利为度。
桃仁承气汤
治蓄血胀满，大实大痛，手不可近者。
桃仁 大黄 芒硝（上） 甘草（下） 桂枝（中） 加∶丹皮（上） 枳壳（中）
上锉，一剂，水二盏，煎至一盖，入大黄一、二沸，再下芒硝，一沸，热服，取下黑物。
外有热加柴胡。在上，加桔梗（中）、苏木。在下，加牛膝（中）。两胁并小腹硬满痛者，加青皮（中）、
川芎（中）、归尾（上）、芍药（中）。痛甚，加玄胡索、红花。血未下，加童便、姜汁少许。血证若头面、
身黄者，姜渣绢裹擦之，其黄自退矣。
【歌诀】血液是人体水谷精微化生的物质，产生于脾胃，由心所统摄。视、听、言、动等功能都依赖血液的滋养，血脉充盈则精神饱满。阳火过盛容易煎熬耗伤阴血，而阴精有形质，生成困难。虚劳咳嗽是真阴受损的表现，吐血、衄血多因火气上冲所致。男子大便下红多因湿热之火，女子崩漏淋证多因血热。脉象芤而涩提示无血，面色枯槁、精神萎靡是阴精亏损之象。血热或血寒，有虚有实，需临证仔细诊察详情。若因瘀血阻滞引起潮热，应及时斟酌药剂进行治疗。血液因脱失亏损，可用炮姜温补；当归、川芎在补血方面确有灵效。
【论述】所谓血，是水谷精微转化而成的。它调和于五脏，布散于六腑，然后进入脉管中。血液源源不断地生成，源于脾的生化，由心所统领，藏于肝，宣发于肺，灌溉全身。因此，眼睛得到血的滋养就能视物，耳朵得到血的滋养就能听觉灵敏，手掌得到血的滋养就能握持，足部得到血的滋养就能行走，脏腑得到血的滋养就能分泌津液、运行气机。所以，视、听、言、动以及脏腑、脉络的功能，无不依赖于血的运用，所以说：血就是神气的载体。保持血液充足则生命存在，失去血液则生命消亡；血盛则形体壮盛，血弱则精神衰败；神志安静则阴气生长，形体过度劳累则阳气亢盛。血液注入脉中，量少则脉道涩滞，充盈则脉道充实，所以阳生阴长，取汁变化而成血。《内经》所说：脉是血液汇聚的府库。血液生化旺盛，各条经脉依靠它来生长养育；血液衰耗枯竭，百脉由此而空虚，怎能不谨慎调养呢？大概血属于阴，难成而易亏。由于人们节制欲望的人少，不能谨慎调养，导致阳火滋长，日渐煎熬，真阴在内受损，于是出现吐血、衄血，血液妄行于上；小便出血，血液渗泄于下；精神在内受损，各种疾病由此而生。
【脉诊】各种见血的病证，脉象多见芤脉和涩脉。根据脉象变化的部位，可以验证出血的来源。大凡失血病人，脉象以沉细为贵。如果见到洪大脉，预后往往不良，难以治疗。
四物汤
补血的要药。
当归（二钱，分为三服，是治血的主药，通入肝经，能全面活血，使血各归其经）
熟地黄（一钱，是血中的血药，通入肾经，能生补真阴之虚）
川芎（一钱半，是血中的气药，通入肝经，能行气以推动血滞）
白芍药（一钱半，是阴分药，通入脾经，能治疗血虚引起的腹痛）
以上锉碎，一剂，用水煎服。
经脉不通畅，加红花、苏木。孕妇胎动不安，加艾叶、香附、苏梗。血痢，加阿胶、艾叶。口干烦渴，加麦冬、乌梅、干葛。便秘，加桃仁、大黄。极度口渴烦躁，加人参、麦冬、知母、石膏。五心烦热，加黄芩、柴胡、地骨皮、百合；虚烦失眠，加淡竹叶、石膏、人参。心悸恍惚，加远志、枣仁。
咳血
咳血，是火邪侵犯肺金之位，损伤肺络，所以血液随咳嗽而出。丹溪说：先有痰嗽而后见红的，多是痰积生热，应以降痰火为急务，宜煎桔梗、枳壳、黄芩、橘红，送服天门冬丸。先见红而后有痰嗽的，多是阴虚火动，痰不下降，宜用四物汤加入化痰药、清火药。
天门冬丸
治疗咯血、吐血，润肺止咳。
天门冬（一两） 阿胶（炮制，五钱） 甘草（五钱） 贝母（去心，五钱） 白茯苓（五钱） 杏仁（五钱）
以上研为细末，蜂蜜炼丸，如弹子大小，含化服用。
咯血
咯血，是指痰中咯出血块。
按：薛立斋说：此证多因心气虚耗，不能主司血液，血不归经，停留体内，所以咯出。症状见面色萎黄，五心烦热。如果郁热严重，用生地黄散。咯血及痰中带血丝的，用四物汤加竹沥、姜汁、牛膝、童便、青黛。虚劳咳嗽咯血的，用太平丸。劳瘵（肺结核类疾病）咯血的，详见本条内。
生地黄散
治疗痰火郁结，衄血、咯血、吐血，阴虚阳亢。
枸杞子（五分） 软柴胡（五分） 黄连（炒，五分） 地骨皮（五分） 天门冬（五分） 白芍药（五分） 甘草（炒，五分） 黄芩（炒，五分） 黄芪（五分） 生地黄（五分） 熟地黄（五分）
吐血
吐血，是指呕出全血。
达按：经文说：心主血，但不能藏血，夜间血液复归于肝。肝藏血，但不能主血，白天听从心的号令。心为君火，肝为相火，君火一动，相火随之；相火一动，六经之火随之。火动，则血随之而动；火升，则血随之而升。善于调养的人，寡欲节劳，常使君火不动，相火隐伏。火伏，则血随之而静，有什么病呢？只有那些不知天命的人，不自量力于气血强弱和本元虚实，奔走道路不畏劳累，纵情女色强行用力，以有限的精神供给无穷的作用。六经受伤，血液流迸，聚集在两胁胸臆之间，乘火势而上冲。伤势重的，从夹脊向上，如潮涌至，势不可挡，治法应当顺从其外出之势，不可强行遏制。因为排出的血都是败血，即使止住，也不归经，久后必再复出，所以不可强行遏制。必须服用消散瘀血的药，佐以润下的药剂，使败血下行，然后服用止血的药剂以杜绝病根，服用补血的药剂以恢复元气，才可以收全功。
四生丸
治疗吐血、衄血，阳乘于阴者。
生荷叶 生艾叶 生柏叶 生地黄（各等分）
以上研磨，制成丸药，如鸡蛋大小，每次服一丸，用水煎服。
麦门冬饮子
治疗气虚吐血，或血虚不能摄血者。
麦冬（去心，一钱） 黄芪（蜜炙，一钱） 当归身（五分） 人参（五分） 生地黄（五分） 五味子（十粒，捣碎）
以上锉碎，一剂，用水煎服。
血不止加阿胶、炒蒲黄、白茅花。兼有痰加贝母、桔梗。
丹溪方
治疗呕血，衄血，一切火载血升，上行证的方剂。
四物汤加山栀、童便、姜汁，或用韭汁与童便混合饮用。
衄血
衄血，即鼻中出血。气血调和，则循环经络。如果劳伤元气，阴虚火动，气逆于肺，则血随鼻而出，犀角地黄汤主治。经文说：凡是见血，身体发热，脉大的难治，这是火邪胜的表现。身体凉爽，脉静的易治，这是正气恢复的表现。
犀角地黄汤
治疗热郁不解，泛行经络，或流肠胃，随气涌泄，以致衄血、吐血，或为便血，或为蓄血等证。
犀角（上） 生地黄（中） 芍药（中） 丹皮（下）
以上锉碎，用水煎，温服。
若要活血，加桃仁、红花。若要止血，加黄连、山栀。止衄血，加黄芩、茅花。破瘀血，加桃仁、大黄，使用此方，是恐怕桃仁承气汤药力太峻猛的缘故。如果吐、衄血严重，不止者，用茅根、侧柏、藕三味捣汁，磨京墨调入本方调服即可止住。鼻衄不止者，外用劫法：用水纸搭在鼻孔处，随即用炒黑的山栀、牡蛎、龙骨煅烧后的粉末、京墨、百草霜共研为细末，加血余炭烧灰各等分，用茅花水湿润蘸药，塞入鼻中即止。如果没有茅花，将纸捻用水湿润蘸前药末塞入鼻中，效果很好。
便血
便血，是大便出血。多因饮食起居失调，或六淫七情致病，导致元气亏损，阳络外伤所致。如果是膏粱厚味积热者，用加味清胃散。大肠风热者，用四物汤加侧柏、荆芥、秦艽、枳壳、丹皮、柴胡。阴结者，用平胃地榆汤。
加味清胃散
即本方加犀角、连翘、甘草。（方剂见火证。）
加减四物汤
治疗肠风下血。
侧柏（炒，五分） 荆芥（五分） 槐花（炒，五分） 甘草（炙，五分） 枳壳（麸炒，一钱） 生地黄（一钱） 当归（一钱） 川芎（一钱）
以上锉碎，一剂，姜一片，用水煎服。
如果热势炽盛，加山栀、黄芩、黄连。血不止，加升麻、秦艽、阿胶、地榆。
平胃地榆汤
治疗阴结便血，即《内经》所说的：结阴者，便血一升，再结二升，三结三升。
人参（八分） 白术（八分） 茯苓（七分） 甘草（七分） 陈皮（七分） 苍术（七分） 浓朴（七分） 干姜（炮，六分） 益智（炮，六分） 附子（炮，六分） 升麻（六分） 葛根（七分） 地榆（八分） 神曲（六分） 白芍药（八分） 当归（八分）
以上锉碎，一剂，姜三片，枣二枚，用水煎服。
溺血
溺血，是小便出血。心主血，通行经络，循环脏腑。如果遇到寒则凝涩，遇到热则妄行，失去常道，则溢渗于膀胱，小便出血。不痛的，用小蓟饮。不止的，用蒲黄散。实证，用当归承气汤，后用四物汤加小蓟、山栀、滑石、琥珀。虚证，用胶艾汤。
小蓟饮
小蓟（一钱） 山栀（一钱） 当归（一钱） 生地黄（一钱半） 滑石（一钱） 甘草（八分） 蒲黄（一钱） 藕节（一钱半） 淡竹叶（八分） 通草（六分）
以上锉碎，一剂，用水煎，温服。
瘀血
达按：跌扑损伤，或被他人打踢，或物体相撞，或闪挫扭伤，或奔走努力，或受困屈，或发恼怒，当时不觉，过半天或一、二、三日发作的有之，十数日或半月、一月发作的有之。一般表现为寒热交作，心胸、肋下、小腹满痛，按压时手不可靠近的，这是有瘀血。如果一时伤重，立即发作寒热，瘀血上冲，则昏迷不醒，如死状，良久复苏。轻症用复元活血汤，重症用桃仁承气汤主治，根据其元气情况，攻下瘀血则愈。瘀血在上焦者，宜饮韭汁，切不可饮冷水，血遇寒则凝结，只要一丝血入心即死。如果医生不认识，见其寒热胀满，不仔细观察痛处，如果有痛肿，手难靠近，按其脉芤涩或数，以此明辨。大概肝为血海，凡有瘀血，必蓄积于心胸、胁下，或小腹之分，乃肝部所在。心主血，肝藏血，脾为之流转，但小便如常者，是蓄血证。内伤瘀血证，必有自汗。
复元活血汤
治疗瘀血留于胸胁腹肚，疼痛不可忍。
柴胡（上） 花粉 当归（中） 红花 甘草（下） 大黄（上，酒浸） 穿山甲（炮） 桃仁（中，酒浸，研如泥）
以上，用水一盏，酒半盏，煎至一盏，加桃仁泥，再煎至八分，温服，以利下为度。
桃仁承气汤
治疗蓄血胀满，大实大痛，手不可近者。
桃仁 大黄 芒硝（上） 甘草（下） 桂枝（中） 加：丹皮（上） 枳壳（中）
以上锉碎，一剂，水二盏，煎至一盖，入大黄煮一、二沸，再下芒硝，煮一沸，热服，取下黑物。
外有热加柴胡。瘀血在上，加桔梗（中）、苏木。在下，加牛膝（中）。两胁并小腹硬满痛者，加青皮（中）、川芎（中）、归尾（上）、芍药（中）。痛甚，加玄胡索、红花。血未下，加童便、姜汁少许。血证若头面、身黄者，用姜渣绢裹擦之，其黄自退矣。
[Verse] Blood is the essence refined from water and grain in the human body, generated by the Spleen and Stomach, and controlled by the Heart. Vision, hearing, speech, and movement all rely on it for nourishment; when vessels are full, spirit is robust. Yang fire simmering easily consumes blood, while Yin essence has substance and is thus hard to form. Deficiency consumption with coughing indicates damage to true Yin; hematemesis (vomiting blood) and epistaxis (nosebleed) often occur due to fire carrying blood upward. Red stool in men stems from damp-heat fire, while women's metrorrhagia (uterine bleeding) and strangury stem from blood heat. A knotted (Kou) and choppy (Se) pulse indicates blood deficiency; a drained complexion and withered spirit denote Yin damage. Whether blood is hot or cold, deficient or excess, one must carefully examine the details at the time of diagnosis. If tidal fever arises from blood stasis, medication should be weighed and administered promptly. For blood loss and depletion, fried ginger provides warming tonification; Danggui (Angelicae Sinensis Radix) and Chuanxiong (Chuanxiong Rhizoma) are indeed effective in nourishing blood.
[Discussion] Blood is the essence derived from water and grain. It harmonizes within the five Zang organs, spreads throughout the six Fu organs, and then enters the vessels. It comes continuously, being transformed and produced by the Spleen, commanded by the Heart, stored in the Liver, distributed by the Lung, and irrigating the whole body. Thus, the eyes see because of blood, the ears hear because of blood, the palms grasp because of blood, the feet walk because of blood, the Zang organs secrete fluids because of blood, and the Fu organs generate Qi because of blood. Therefore, vision, hearing, speech, movement, Zang, Fu, and vessels all depend on the operation of blood. Hence it is said: "Blood is the carrier of Spirit." Retaining it ensures life; losing it leads to death. Abundant blood means robust form; weak blood means depleted spirit. Calm spirit generates Yin; overexertion of form causes Yang hyperactivity. When injected into vessels, scarcity causes sluggishness, while fullness causes solidity. Thus, Yang generates and Yin grows; juice is taken and transformed into blood. As stated in the *Neijing*: "Vessels are the mansion of blood." When blood transformation is vigorous, all meridians rely on it for growth and nourishment; when exhausted, all pulses become empty due to this. How can one not be cautious in nourishing it? Generally, blood belongs to Yin, is hard to form but easy to lose. Because few people restrain their desires and cannot nurture themselves carefully, Yang fire proliferates, simmering day by day, damaging true Yin internally. Consequently, hematemesis and epistaxis occur as blood rebels upward; hematuria and melena occur as blood leaks downward; spirit is damaged internally, and various diseases arise from this.
[Pulse Diagnosis] In all conditions involving bleeding, the pulse typically presents as Kou (Knotted/Hollow) and Se (Choppy). By examining the upper and lower aspects, one can verify the source of bleeding. Generally, in patients who have lost blood, a deep and fine pulse is auspicious. If a洪大 (Surging and Large) pulse appears, treatment will be difficult later.
Siwu Tang (Four Substances Decoction)
A crucial herb formula for nourishing blood.
Danggui (Radix Angelicae Sinensis, 2 qian, divided into three doses): The main herb for treating blood, entering the Liver Meridian, capable of invigorating blood comprehensively, allowing each vessel to return to its proper path.
Shudihuang (Prepared Radix Rehmanniae, 1 qian): The "blood within blood" herb, entering the Kidney Meridian, capable of generating deficiency in true Yin.
Chuanxiong (Rhizoma Chuanxiong, 1.5 qian): The "Qi within blood" herb, entering the Liver Meridian, capable of moving Qi to resolve blood stagnation.
Baishao (Radix Paeoniae Alba, 1.5 qian): A Yin-substance herb, entering the Spleen Meridian, capable of treating abdominal pain due to blood deficiency.
Crush the above ingredients. One dose, decoct in water and take orally.
If meridians do not flow, add Honghua (Flos Carthami) and Sumu (Lignum Santali Rubrum). If pregnancy shows signs of fetal disturbance, add Aiye (Folium Artemisiae Argyi), Xiangfu (Rhizoma Cyperi), and Sugeng (Caulis Perillae). For bloody dysentery, add Ejiao (Colla Corii Asini) and Aiye. For dry mouth and vexatious thirst, add Maidong (Tuber Ophiopogonis), Wumei (Fructus Mume), and Gange (Radix Bupleuri alternative/Kudzu Root). For constipation, add Taoren (Semen Persicae) and Dahuang (Radix et Rhizoma Rhei). For extreme thirst and restlessness, add Renshen (Radix Ginseng), Maidong, Zhimu (Rhizoma Anemarrhenae), and Shigao (Gypsum Fibrosum). For five-palm heat, add Huangqin (Radix Scutellariae), Chaihu (Radix Bupleuri), Digupi (Cortex Lycii), and Baihe (Bulbus Lilii); for deficiency vexation and insomnia, add Danzhuyeq (Herba Lophatheri), Shigao, and Renshen. For palpitations and confusion, add Yuanzhi (Radix Polygalae) and Zaoren (Semen Ziziphi Jujubae).
Hemoptysis (Coughing Blood)
Hemoptysis occurs when fire attacks the Metal position (Lung), damaging the lung collaterals, causing blood to exit with coughing. Danxi said: If phlegm-cough precedes redness, it is mostly phlegm accumulation generating heat; reducing phlegm-fire is urgent. Decoct Jiegeng (Radix Platycodi), Zhike (Fructus Aurantii), Huangqin, and Juhong (Pericarpium Citri Reticulatae), and swallow with Tianmendong Wan. If redness precedes phlegm-cough, it is mostly Yin deficiency with fire hyperactivity and descending phlegm failure; use Siwu Tang plus phlegm-resolving and fire-clearing herbs.
Tianmendong Wan (Asparagus Tuber Pill)
Treats hemoptysis and hematemesis, moistens the Lung and stops coughing.
Tianmendong (Tuber Ophiopogonis, 1 liang) Ejiao (Colla Corii Asini, processed, 5 qian) Gancao (Radix Glycyrrhizae, 5 qian) Beimu (Bulbus Fritillariae Cirrhosae, heart removed, 5 qian) Baifuling (Poria, 5 qian) Xingren (Semen Armeniacae Amarum, 5 qian)
Grind into fine powder, make pills with honey the size of a bullet, and dissolve in the mouth.
Spitting Blood (Geketsu)
Spitting blood refers to spitting out blood clots mixed with phlegm.
Commentary: Xue Lizhai said: This condition often results from Heart Qi deficiency and exhaustion, failing to govern blood, causing blood to leave its channels and accumulate internally, thus being spat out. Symptoms include sallow complexion and heat in the five palms. If depression-heat is severe, use Shengdihuang San. For spitting blood and blood threads in phlegm, use Siwu Tang plus Zhuli (Nodus Bambusae in Taenia), Jiangzhi (Zingiberis Juice), Niuxi (Radix Achyranthis Bidentatae), Tongbian (Infans Urine), and Qingdai (Indigo Naturalis). For deficiency cough with spitting blood, use Taiping Wan. For Laozai (consumption/TB) with spitting blood, see the relevant section.
Shengdihuang San (Rehmannia Powder)
Treats phlegm-fire stagnation, epistaxis, spitting blood, hematemesis, Yin deficiency with Yang hyperactivity.
Gouqizi (Fructus Lycii, 5 fen) Ruan Chaihu (Radix Bupleuri, 5 fen) Huanglian (Radix Coptidis, fried, 5 fen) Digupi (Cortex Lycii, 5 fen) Tianmendong (Tuber Ophiopogonis, 5 fen) Baishao (Radix Paeoniae Alba, 5 fen) Gancao (Radix Glycyrrhizae, fried, 5 fen) Huangqin (Radix Scutellariae, fried, 5 fen) Huangqi (Radix Astragali, 5 fen) Shengdihuang (Radix Rehmanniae Recens, 5 fen) Shudihuang (Radix Rehmanniae Praeparata, 5 fen)
Taiping Wan (See Deficiency Consumption Section)
Hematemesis (Vomiting Blood)
Hematemesis refers to vomiting whole blood.
Da commented: The classics state: The Heart governs blood but does not store it; at night, blood returns to the Liver. The Liver stores blood but does not govern it; during the day, it obeys the Heart's command. The Heart is the Sovereign Fire, the Liver is the Ministerial Fire. When Sovereign Fire moves, Ministerial Fire follows; when Ministerial Fire moves, the fires of the Six Meridians follow. When fire moves, blood moves with it; when fire rises, blood rises with it. Those skilled in regulation practice restraint of desire and labor, keeping Sovereign Fire still and Ministerial Fire hidden. When fire is hidden, blood remains quiet, and what disease would there be? Only those ignorant of fate, unaware of the strength of their Qi and Blood and the deficiency or excess of their root, run roads without fearing fatigue, indulge in lust and force their strength, using limited spirit to supply infinite demands. The Six Meridians are injured, blood spurts, gathering between the hypochondrium and chest, rising with fire. In severe cases, it rises along the paravertebral muscles like a tide, unstoppable. The method should follow its exit; do not forcibly obstruct it. The blood expelled is all spoiled blood; even if stopped, it does not return to the channels and will re-emerge later, so it cannot be forcibly obstructed. One must administer blood-dispersing herbs, assisted by lubricating purgatives, to move the spoiled blood downward, then administer hemostatic agents to cut off the root, and blood-nourishing agents to restore the original Qi, thereby achieving complete success.
Huaruishi San (See Consumption Section)
Sisheng Wan (Four Raw Herbs Pill)
Treats hematemesis and epistaxis where Yang invades Yin.
Sheng Heye (Fresh Lotus Leaf) Sheng Aiy e (Fresh Mugwort Leaf) Sheng Baiye (Fresh Biota Top) Sheng Dihuang (Fresh Rehmannia Root) (Equal parts)
Grind and make pills the size of a chicken egg. Take one pill per dose, decoct in water and take orally.
Mendong Yinzi (Ophiopogon Drink)
Treats Qi-deficient hematemesis or blood deficiency failing to control blood.
Maidong (Tuber Ophiopogonis, heart removed, 1 qian) Huangqi (Radix Astragali, honey-fried, 1 qian) Dangguishen (Radix Angelicae Sinensis, central part, 5 fen) Renshen (Radix Ginseng, 5 fen) Shengdihuang (Radix Rehmanniae Recens, 5 fen) Wuweizi (Fructus Schisandrae, 10 grains, crushed)
Crush the above. One dose, decoct in water and take orally.
If bleeding does not stop, add Ejiao, Chao Puhuang (Fried Spora Typhae), and Baimaohua (Floretum Euphrasiae). If accompanied by phlegm, add Beimu and Jiegeng.
Danxi Formula
Treats hematemesis, epistaxis, and all conditions where fire carries blood upward.
Siwu Tang plus Zhizi (Fructus Gardeniae), Tongbian (Infans Urine), and Jiangzhi (Zingiberis Juice), or mix Jiuzhi (Allii Tuberosi Juice) with Tongbian and drink.
Epistaxis (Nosebleed)
Epistaxis is bleeding from the nose. When Qi and Blood are harmonious, they circulate through the meridians. If vital Qi is injured by overwork, Yin deficiency causes fire hyperactivity, Qi rebels in the Lung, and blood exits via the nose. Xijiao Dihuang Tang is the primary treatment. The classics say: In all bleeding conditions, if the body is hot and the pulse large, it is difficult to treat, indicating fire pathogen dominance. If the body is cool and the pulse calm, it is easy to treat, indicating recovery of righteous Qi.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction)
Treats unresolved heat stagnation spreading through meridians or flowing into intestines/stomach, surging with Qi and leaking, causing epistaxis, hematemesis, hematochezia, or blood accumulation.
Xijiao (Cornu Rhinocerotis, Upper grade) Shengdihuang (Radix Rehmanniae Recens, Middle grade) Shaoyao (Radix Paeoniae, Middle grade) Danpi (Cortex Moutan, Lower grade)
Crush the above, decoct in water, and take warm.
To invigorate blood, add Taoren and Honghua. To stop bleeding, add Huanglian and Zhizi. To stop epistaxis, add Huangqin and Maohua. To break blood stasis, add Taoren and Dahuang; this prescription is used fearing that Taoren Chengqi Tang is too harsh. If vomiting or nosebleeding is severe and unceasing, use Gen (Rhizoma Imperatae), Cebei (Folium Platycladi), and Ou (Rhizoma Nelumbinis) crushed for juice, mixed with Jingmo (Chinese Ink) and the base formula to stop bleeding. For unceasing epistaxis, use external expulsion method: Place wet paper on the nasal passage. Immediately use fried black Zhizi, calcined Muli (Concha Ostreae), Longgu (Os Draconis), Jingmo, and Baicaoshuang (Carbo Vegetabilis) ground into fine powder, mixed with equal parts of Xuyurao Hui (Ash of Human Hair). Dip into Maohua water, wet the medicine, and insert into the nose to stop bleeding. If Maohua is unavailable, dip a wet paper twist into the powder and insert into the nose; this is excellent.
Melena (Bloody Stool)
Melena is blood in the stool. It often results from irregular diet and lifestyle, or Six Excesses and Seven Emotions injuring the body, causing vital Qi deficiency and external injury to Yang collaterals. For heat accumulation from rich food, use Jiawei Qingwei San. For Large Intestine wind-heat, use Siwu Tang plus Cebei, Jingjie (Herba Schizonepetae), Qinjiao (Radix Gentianae Macrophyllae), Zhike, Danpi, and Chaihu. For Yin constipation, use Pingwei Diyutang.
Jiawei Qingwei San (Modified Stomach-Clearing Powder)
This formula plus Xijiao, Lianqiao (Forsythiae Fructus), and Gancao. (See Fire Conditions.)
Jiajian Siwu Tang (Modified Four Substances Decoction)
Treats intestinal wind with bloody stool.
Cebei (Folium Platycladi, fried, 5 fen) Jingjie (Herba Schizonepetae, 5 fen) Huaihua (Flos Sophorae, fried, 5 fen) Gancao (Radix Glycyrrhizae, honey-fried, 5 fen) Zhike (Fructus Aurantii, bran-fried, 1 qian) Shengdihuang (Radix Rehmanniae Recens, 1 qian) Danggui (Radix Angelicae Sinensis, 1 qian) Chuanxiong (Rhizoma Chuanxiong, 1 qian)
Crush the above. One dose, with one slice of ginger, decoct in water and take orally.
If heat is intense, add Zhizi, Huangqin, and Huanglian. If bleeding does not stop, add Shengma (Rhizoma Cimicifugae), Qinjiao, Ejiao, and Diyutu (Radix Sanguisorbae).
Pingwei Diyutang (Pingwei and Sanguisorba Decoction)
Treats Yin-constipation melena, i.e., as stated in the *Neijing*: "Yin knotting causes melena: one sheng first, two sheng second, three sheng third."
Renshen (Radix Ginseng, 8 fen) Baizhu (Rhizoma Atractylodis Macrocephalae, 8 fen) Fuling (Poria, 7 fen) Gancao (Radix Glycyrrhizae, 7 fen) Chenpi (Pericarpium Citri Reticulatae, 7 fen) Cangzhu (Rhizoma Atractylodis Lanceae, 7 fen) Houpo (Cortex Magnoliae Officinalis, 7 fen) Ganjiang (Rhizoma Zingiberis Recens, processed, 6 fen) Yizhi (Fructus Alpiniae Oxyphyllae, processed, 6 fen) Fuzi (Radix Aconiti Lateralis Preparata, processed, 6 fen) Shengma (Rhizoma Cimicifugae, 6 fen) Gegen (Radix Puerariae, 7 fen) Diyutang (Radix Sanguisorbae, 8 fen) Shenqu (Massa Medicata Fermentata, 6 fen) Baishao (Radix Paeoniae Alba, 8 fen) Danggui (Radix Angelicae Sinensis, 8 fen)
Crush the above. One dose, with three slices of ginger and two jujubes, decoct in water and take orally.
Hematuria (Bloody Urine)
Hematuria is blood in the urine. The Heart governs blood, circulating through meridians and viscera. If cold, it coagulates and becomes sluggish; if heat, it rebels and flows wildly. Losing its normal path, it overflows into the bladder, causing bloody urine. If painless, use Xiaoji Yin. If unceasing, use Puhuang San. For excess patterns, use Danggui Chengqi Tang, followed by Siwu Tang plus Xiaoji (Herba Leonuri), Zhizi, Huashi (Talcum), and Hupo (Succinum). For deficiency patterns, use Jiao'ai Tang.
Xiaoji Yin (Leonurus Drink)
Xiaoji (Herba Leonuri, 1 qian) Zhizi (Fructus Gardeniae, 1 qian) Danggui (Radix Angelicae Sinensis, 1 qian) Shengdihuang (Radix Rehmanniae Recens, 1.5 qian) Huashi (Talcum, 1 qian) Gancao (Radix Glycyrrhizae, 8 fen) Puhuang (Spora Typhae, 1 qian) Oujie (Node of Rhizoma Nelumbonis, 1.5 qian) Danzhuye (Herba Lophatheri, 8 fen) Tongcao (Medulla Tetrapanacis, 6 fen)
Crush the above. One dose, decoct in water, take warm.
Danggui Chengqi Tang (Angelica and Major Order the Qi Decoction)
This is Xiao Chengqi Tang plus Danggui. (Xiao Chengqi Tang seen in Food Injury.)
Jiao'ai Tang (Ejiao and Mugwort Decoction)
This is Siwu Tang plus Ejiao, Aiye, and Zhi Gancao, each 1 qian.
Blood Stasis
Da commented: Falls, injuries, kicks, collisions, sprains, strenuous running/straining, confinement, or anger may not show immediate symptoms. They may manifest after half a day, one to three days, ten days, half a month, or a month. Generally, alternating chills and fever occur, with fullness and pain in the chest, hypochondrium, and lower abdomen, which cannot be touched. This indicates blood stasis. If severely injured initially, chills and fever appear immediately; if blood stasis rushes upward, coma ensues, resembling death, with gradual recovery. Mild cases use Fuyuan Huoxue Tang; severe cases use Tao Ren Chengqi Tang. Assess vital Qi and purge blood stasis to cure. For stasis in the upper jiao, drink Jiuzhi (Allii Tuberosi Juice); absolutely do not drink cold water, as blood congeals with cold. Even a trace of blood entering the Heart causes death. If physicians fail to recognize this, seeing chills, fever, distension, and fullness without observing the painful area, or if swelling prevents touching, and the pulse is Kou, Se, or rapid, clarify this. The Liver is the Sea of Blood; any blood stasis accumulates in the chest, hypochondrium, or lower abdomen, the Liver's domain. The Heart governs blood, the Liver stores blood, the Spleen distributes it. If urination is normal, it is a blood accumulation syndrome. Internal injury blood stasis always presents with spontaneous sweating.
Fuyuan Huoxue Tang (Restore Original Blood Invigorating Decoction)
Treats blood stasis remaining in the chest, hypochondrium, abdomen, and belly, with unbearable pain.
Chaihu (Radix Bupleuri, Upper grade) Huafen (Radix Panacis Quinquefolii) Danggui (Radix Angelicae Sinensis, Middle grade) Honghua (Flos Carthami) Gancao (Radix Glycyrrhizae, Lower grade) Dahuang (Radix et Rhizoma Rhei, Upper grade, wine-soaked) Chuanshanjia (Squama Manitis, processed) Taoren (Semen Persicae, Middle grade, wine-soaked, pounded to paste)
Use one cup of water and half a cup of wine, decoct to one cup. Add Taoren paste, decoct again to 0.8 cup. Take warm. Stop when bowel movement occurs.
Tao Ren Chengqi Tang (Peach Kernel and Major Order the Qi Decoction)
Treats blood accumulation with distension and fullness, severe excess and pain, untouchable.
Taoren (Semen Persicae) Dahuang (Radix et Rhizoma Rhei) Mangxiao (Natrii Sulfas, Upper grade) Gancao (Radix Glycyrrhizae, Lower grade) Guizhi (Ramulus Cinnamomi, Middle grade) Add: Danpi (Cortex Moutan, Upper grade) Zhike (Fructus Aurantii, Middle grade)
Crush the above. One dose, two cups of water, decoct until covered. Add Dahuang, boil one or two times. Add Mangxiao, boil once. Take hot. Expel black matter.
If exterior heat exists, add Chaihu. If in the upper jiao, add Jiegeng and Sumu. If in the lower jiao, add Niuxi. If both hypochondria and lower abdomen are hard, full, and painful, add Qingpi (Pericarpium Citri Reticulatae Viride), Chuanxiong, Guiwei (Cauda Radix Angelicae Sinensis), and Shaoyao. If pain is severe, add Yuanshusuo (Rhizoma Corydalis) and Honghua. If blood has not yet passed, add a little Tongbian and Jiangzhi. If blood conditions present with yellowing of the face and body, wipe with ginger residue wrapped in silk; the yellow will fade naturally.