薛立斋治星士张东谷，谈命时出中庭吐血一二口。云∶久有此证，遇劳即发。余意此劳
伤肺气，其血必败，视之果然，与补中益气加麦冬、五味、山药、熟地、茯神、远志，服之
而愈。翌早请见云∶服四物、黄连、山栀之属而倦更甚，得公一匕，吐血顿止，精神如故，
何也？曰∶脾统血，肺主气，此劳伤脾肺，致血妄行，故用前药健脾肺之气而嘘血归原耳。
《褚氏遗书》曰∶喉有窍，咳血杀人；肠有窍，便血杀人。便血犹可治，咳血不可医。
饮溲溺者百不一死，服寒凉者百不一生。血虽阴类，运之者其和阳乎。
愚谓褚氏和阳之说，真玄理之法言，必不可不知也。若溲溺之用，则但于邪热上炎者，
借以降火，是诚善矣。其若伤在脾胃，或阳虚阴胜等证，则大非所宜，勿谓百不一死，可概
用也。
杨仁斋曰∶血遇热则宣流，故止血多用凉药。然亦有气虚挟寒，阴阳不相为守，营气虚
散，血亦错行，所谓阳虚阴必走耳。外必有寒冷之状，法当温中。使血自归于经络，可用理
中汤加南木香，或甘草干姜汤，其效甚着。又有饮食伤胃，胃虚不能传化，其气上逆，亦能
吐衄，宜木香理中汤、甘草干姜汤通用。
徐东皋论王节斋曰∶凡酒色过度，损伤肺肾真阴，咳嗽吐痰，吐、衄、咳、咯血等证，
误服参 等甘温之药，则病日增，世人不识，往往服之，致不救者多矣，噫！此一隅之说，
非天下之通论，甫论节斋议论多长，而独短于此。何则？凡诸失血证，因火盛妄行而不宜于
甘温者，理固然也。其有虚火体气弱甚者，宁有不用参、 者乎？葛可久治大吐血后用独参
汤一味服之，所以治其虚也。经曰∶虚者补之。是以 仙集之，以为《十药神书》。
今之治劳怯吐血，立有起死回生之效，然则彼以独参汤者，何其神欤？又如丹溪治一人，年
五十，劳嗽吐血，用人参、黄 、白术、茯苓、百合、阿胶、白芍药、桑白皮、杏仁、贝母
、栝蒌、海石、五味、天冬而愈。又如《局方》人参汤，专治胃弱吐血衄血之证。然则彼皆
非欤？大抵用药补泻，宜审人之虚实，则无施不当也，何甘温之必不可用哉！
薛立斋治疗一位以算命为业的张东谷，在谈论命运时走出庭院吐了一两口血。他说：这个病症已经持续很久了，一劳累就会发作。我推测这是劳损伤了肺气，血液必然败坏，观察后确实如此，于是给予补中益气汤加入麦冬、五味子、山药、熟地黄、茯神、远志，服用后痊愈。第二天早上请见时说：服用四物汤、黄连、山栀这类药物后疲倦更加严重，得到您的一剂药，吐血立刻停止，精神恢复如常，这是为什么呢？我说：脾统摄血液，肺主气，这是劳损伤及脾肺，导致血液妄行，所以用前面的药物健脾益肺之气，使血液回归本源。
《褚氏遗书》说：喉咙有窍道，咳血会致死；肠道有窍道，便血会致死。便血还可以治疗，咳血不可医治。饮用尿液的人一百个里不到一个死亡，服用寒凉药物的人一百个里没有一个能活下来。血液虽然属于阴类，但推动它的难道是温和的阳气吗？
我认为褚氏关于“和阳”的说法，真是深奥的道理和精辟的言论，一定不能不知道。至于使用尿液的方法，只是对于邪热上炎的情况，借以降火，这确实是好的。但如果病证是脾胃受损，或者阳虚阴盛等，就非常不适宜，不要说一百个人里不到一个死，就可以一概使用了。
杨仁斋说：血液遇到热就会扩散流动，所以止血多用凉药。然而也有气虚挟带寒邪，阴阳不能相互守持，营气虚弱散乱，血液也会错乱运行，这就是所谓的阳虚则阴血必走。外在一定伴有寒冷的症状，治法应当温中。使血液自然归于经络，可以使用理中汤加入南木香，或者甘草干姜汤，效果非常显著。又有因饮食损伤胃腑，胃虚不能传化运化，气机上逆，也能引起吐血衄血，适宜通用木香理中汤、甘草干姜汤。
徐东皋评论王节斋说：凡是酒色过度，损伤肺肾真阴，出现咳嗽吐痰，吐血、衄血、咳血、咯血等证候，误服人参等甘温的药物，那么病情日益加重，世人不认识这一点，往往服用，导致无法救治的人很多，唉！这只是片面的说法，不是天下的普遍理论，刚才评论节斋的议论大多长于某方面，唯独在这方面短浅。为什么呢？凡是各种失血证候，因为火盛妄行而不适宜于甘温药物的，道理固然如此。那些有虚火且体质极度虚弱的，难道有不使用人参、黄芪的吗？葛可久治疗大吐血后用独参汤一味药服用，是用来治疗其虚损的。经书说：虚证就要补益。因此被仙集收录，编成《十药神书》。现在治疗劳怯吐血，立下起死回生的功效，然而他们使用独参汤，为什么这么神奇呢？又如丹溪治疗一个人，五十岁，劳嗽吐血，用人参、黄芪、白术、茯苓、百合、阿胶、白芍药、桑白皮、杏仁、贝母、栝蒌、海浮石、五味子、天冬而痊愈。又如《局方》中的人参汤，专门治疗胃弱导致的吐血衄血证候。然而他们都是错的吗？大致用药补泻，应该审察人的虚实，那么就没有不恰当的，为什么甘温药物必不可使用呢！
Xue Lizhai treated a fortune-teller named Zhang Donggu, who vomited one or two mouthfuls of blood after stepping out into the courtyard while discussing fate. He said: "I have had this condition for a long time, and it recurs whenever I exert myself." I surmised that this was damage to Lung Qi due to overexertion, and the blood must be corrupted; upon examination, this proved true. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Shanyao (Dioscoreae Rhizoma), Shudi (Rehmanniae Radix Praeparata), Fushen (Poria cum Radice et Mycelium), and Yuanzhi (Polygalae Radix). After taking it, he recovered. The next morning, when he came to see me, he said: "After taking medicines such as Siwu Tang (Four Substances Decoction), Huanglian (Coptidis Rhizoma), and Shanzhi (Gardeniae Fructus), my fatigue became even worse. With just one dose from you, the hematemesis stopped immediately, and my spirit returned to normal. Why is this?" I replied: "The Spleen controls the blood, and the Lung governs Qi. This was damage to the Spleen and Lung due to overexertion, causing the blood to move recklessly. Therefore, I used the aforementioned herbs to strengthen the Spleen and Lung Qi, guiding the blood back to its source."
*Chu Shi Yi Shu* (Remnant Books of Master Chu) states: "The throat has orifices; hemoptysis kills. The intestines have orifices; hematochezia kills. Hematochezia can still be treated, but hemoptysis cannot be cured. Among those who drink urine, fewer than one in a hundred dies; among those who take cold-cooling herbs, not one in a hundred survives. Although blood belongs to Yin, what moves it is surely harmonious Yang."
I believe Master Chu’s theory of "harmonizing Yang" is indeed profound truth and exquisite words, which must not be ignored. As for the use of urine, it is indeed beneficial for descending fire by borrowing its properties in cases where pathogenic heat flares upward. However, if the injury lies in the Spleen and Stomach, or in conditions such as Yang deficiency with Yin excess, it is highly inappropriate. One should not assume that because fewer than one in a hundred die [from drinking urine], it can be applied universally.
Yang Renzhai stated: "Blood flows freely when heated; therefore, hemostasis often employs cooling herbs. Yet there are cases of Qi deficiency accompanied by cold, where Yin and Yang fail to guard each other, Ying Qi is deficient and scattered, and blood also moves erratically—this is what is meant by 'when Yang is deficient, Yin blood must flee.' Externally, there must be signs of cold. The treatment method should be to warm the interior. This allows the blood to naturally return to the meridians. Li Zhong Tang (Regulate the Middle Decoction) with added Nanmuxiang (Aucklandiae Radix), or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), can be used, with remarkable efficacy. Additionally, if dietary injury damages the Stomach, and Stomach deficiency fails to transport and transform, leading to rebellious Qi, hematemesis and epistaxis may also occur. Muxiang Lizhong Tang or Gancao Ganjiang Tang are generally suitable."
Xu Donggao commented on Wang Jiezhai: "Whenever excessive alcohol and sexual activity damage the True Yin of the Lung and Kidney, resulting in coughing with phlegm, hematemesis, epistaxis, hemoptysis, and spitting blood, mistakenly administering sweet-warm herbs like Renshen (Ginseng Radix) causes the disease to worsen daily. People of the world do not recognize this and often administer them, leading to many untreatable cases. Alas! This is a partial view, not a universal principle of the world. Just as I previously noted that Jiezhai’s discussions were mostly strong but weak in this specific aspect. Why? For all hemorrhagic conditions caused by excessive fire moving recklessly, avoiding sweet-warm herbs is indeed correct. But for those with deficient fire and severely weak constitution, how could one avoid using Renshen (Ginseng Radix) and Huangqi (Astragali Radix)? Ge Kejiu treated severe hematemesis by administering Dushen Tang (Single Ginseng Decoction) consisting of only one herb, thereby treating the deficiency. The Classics state: 'Deficiency requires tonification.' Thus, it was collected by Immortals and compiled into *Shi Yao Shen Shu* (Divine Book of Ten Herbs). Today, treating consumption-related hematemesis with this method yields miraculous effects of bringing the dead back to life. Then why was their use of Dushen Tang so divine? Furthermore, Danxi treated a fifty-year-old man with consumption cough and hematemesis using Renshen (Ginseng Radix), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Baihe (Lilii Bulbus), Ejiao (Asini Corii Colla), Baishao (Paeoniae Radix Alba), Sangbaipi (Morus Cortex), Xingren (Armeniacae Semen Amarum), Beimu (Fritillariae Cirrhosae Bulbus), Gualou (Trichosanthis Fructus), Haishi (Aragonitum), Wuweizi (Schisandrae Fructus), and Tiandong (Asparagi Radix), resulting in recovery. Also, the Renshen Tang (Ginseng Decoction) in *Ju Fang* specifically treats hematemesis and epistaxis due to Stomach weakness. Are they all wrong? Generally, whether using tonification or purging in medication, one must examine the patient's deficiency or excess; then no application will be inappropriate. Why must sweet-warm herbs never be used!"