血溢血泄，其目颇繁，然有不须强设区别者。今约为九类，而冒以通说，盖其方剂，亦多可互用者云。
病因概略 夫血犹水也，水由地中行，百川皆理，则无壅决之虞。血之周流于人身荣经府俞，外不为
四气所伤，内不为七情所郁，自然顺适。万一微爽节宣，必至壅闭，故血不得循经流注，荣养百脉，或泣或散，
或下而亡反，或逆而上溢，乃有吐衄便利汗痰诸证生焉。十种走失，无重于斯，随证别之，乃可施治。（《三
因》）
血之为患，其妄行则吐衄，其衰涸则虚劳，蓄之在上其人忘，蓄之在下其人狂，逢寒则筋不荣而挛急，挟热
则毒内瘀而发黄，在小便者为淋痛，在大便者为肠风，其于妇人月事进退，漏下崩中，病犹不一，凡此者，血使
之然也。（《直指》）
人具此阴阳，即有此血气。气阳也，血阻也。男以阳为主，则阳胜乎阴；女以阴为主，则阴胜乎阳。气血之
为病，男女则同耳。人皆知百病生于气，又孰知血为百病之胎乎。血犹水也，水行乎地中，百川理而无壅遏之患。
人之血脉，一或凝滞于经络肠胃之间，百病由此而根矣。乍寒乍热，发黄发斑， 妄惊狂，烦闷呕恶，痴痰自汗，
哄热虚劳，尿淋漏崩，吐衄咳唾，以至眩晕厥冷，昏愦迷忘，块痛瘀疼，起止遗溺，凡此数证，非血而何。经所
谓先去其血，然后调之，良有以也。（同上）
其为病也，有虚有滞，有热有寒。夫血虚则阳盛，阳盛
则火动，火动则载血上行，越出诸窍而为吐血、呕血、衄鼽血等证。血热者，阳气陷入血中，血因而热，随气下
流，而为溺血、便血、崩血、肠风下血等证。血寒则凝于脏腑之间，而为 瘕之病。血滞则蓄于皮肤之间，而为壅
脓之毒。（《原理》）（按∶《医意商》亦有虚瘀寒热说，宜参证治梗概条。）
血本阴精，不宜动也，而动则为病；血主营气，不宜损也，而损则为病。盖动者多由于火，火盛则逼血妄行；
损者多由乎气，气伤则血无以存。故有以七情而伤火者，有以七情而伤气者；有以劳倦色欲而动火者，有以劳倦色
欲而伤阴者。或外邪不解而热郁于经，或纵饮不节而火动于胃，或中气虚寒，则不能收摄而注陷于下，或阴盛格阳，
则火不归原而泛溢于上，是皆动血之因也。故妄行于上则见于七窍，流注于下则出乎二阴，或壅瘀于经络则发为痈
疽脓血，或郁结于腑脏则留为血块血症，或乘风热则为斑为疹，或滞阴寒则为痛为痹，此皆血病之证也。（《景
岳》）
血得热则溢 《内经》谓胆移热于脑，则辛 鼻渊，传为衄 瞑目。夫血得热则涌溢，得寒则凝泣，
胆受胃热，循脉而上移于脑，盖阳络溢则血妄行，在鼻为衄，在汗空为 ，二者不同，此热厥血溢之过也。（《圣
济》）（按∶先君子曰∶ ，王氏注污血，见《说文》。《圣济》以污为汗，太疏。）
诸气皆属于阳，诸血皆属于阴。阴盛则阳亏，阳盛则阴亏。经所谓阳胜则阴病，阴胜则阳病。诸血衄血由阳气
侵阴，阴气被伤，血失常道，或从口出，或从鼻出。若暴出而色鲜，心烦躁闷，时欲引出，至一二斗，此阳邪暴入
于阴分，血得热则流散，盖人之经血，譬如天地之经水，天暑地
热，则经水沸溢而涌起，故有衄血肺疽，其证大同而小异。（《鸡峰》）
夫血之妄行也，未有不因热之所发。盖血得热则淖溢，血气俱热，血随气上，乃吐衄也。（《济生》）
夫血得寒则闭涩，得热则宣流。荣气虚竭，风冷交侵，固易为虚劳月闭之证。其若出血等类，大抵多因蓄
热致之，荣道一开解，血亦为之不禁矣，（《直指》）
血随气行，气寒而行迟则血涩滞，气热而行快则血沸腾。盖血属阴，非阳不运，故遇寒而凝；气属火，非少
则壮，故遇热而灼。（《医碥》）
上溢下脱之理 或问∶人身阳气为阴血之引导，阴血为阳气之根据归。何为清浊相干，乱于中外，而致血不
归经，则有上溢下脱之患？其血或从吐出，或从呕出，或从咯出，或从鼻出，或从眼耳齿舌出，或从津唾而出，
或从肌肤而出，或从二便而出，复有蓄积不行者，为患各有不同。愿一一显示至理，条分脏腑经络之源，以启学
人蒙昧。石顽答曰∶经言血之与气，异名同类，虽有阴阳清浊之分，总由水谷精微所化。其始也混然一区，未厘清
浊，得脾气之鼓运，如雾上蒸于肺而为气，气不耗，归精于肾而为精；精不泄，归精于肝而化清血；血不泻，归
精于心，得离火之化而为真血，以养脾脏，以司运动，以奉生身，莫贵乎此。虽经有上注于肺乃化为血之说，而
实不离五行之气化，转注如环也。如上所云，不过统论营卫血气之大端，乃节文耳。夫营卫者精气也，血者神气也。
气主煦之，血主濡之。虽气禀阳和，血禀阴质，而阴中有阳，阳中有阴，不能截然两分。其至清至纯者，得君主
之令，以和调五脏，藏而不失，乃养脏之血也。其清中之浊者，秉输运之权，以洒陈六腑，实而不满，则灌注之血也。
其清中之清者，会营周之度，流行百脉，满而不泄，此营经之血也。其源则一，析而为三，各有司属。若各守
其乡，则阴平阳秘，安有上溢下脱之患乎。盖缘人之禀赋不无偏胜，劳役不无偏伤，其血则从偏衰偏胜之处而渗漏
焉。夫人禀赋既偏，则水谷多从偏胜之气化，而胜者愈胜，弱者愈弱，阳胜则阴衰，阴衰则火旺，火旺则血随之
而上溢；阴胜则阳微，阳微则火衰，火衰则火失其统而下脱。其上溢之血，非一于火盛也；下脱之血，非一于阳
衰也。但以色之鲜紫浓浓，则为火盛；色之晦淡无光，即为阳衰。究其所脱之源，或缘脏气之逆，或缘腑气之乖，
皆能致病。从上溢者，势必假道肺胃，从下脱者，势必由于二肠，及从膀胱下达耳。（《医通》）（此下辨五脏胃
肠血色之异，录在后。）
脉候（色诊、死证） 尺脉滑而疾，为血虚。涩则少血。脉得诸涩濡弱为亡血。脉有阴阳，趺阳少阴脉
皆微，其人不吐，下必亡血。（《脉经》）
其脉洪数者为逆，微小者为顺。（《鸡峰》）
诸证失血，皆见芤脉，随其上下，以验所出。大凡失血，脉贵沉细，设见浮大，后必难治。（《崔氏脉诀》）
（按∶失血脉芤，本于仲景。脉贵沉细云云，本于《十七难》。）
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。（《东垣试效方》）
失血脉宜沉细和缓，不宜浮大实大。（《回春》）
大凡失血，脉皆洪大无力，即芤脉也。阴血既亏，阳无所根据，浮散于外，故见此象，所以产后多此脉也。
误认为实火，大违。（《六要》）
大凡病后咳嗽吐血，脉大而乱，属上焦阳络伤；下血溺
血，为阴络伤，俱危。（《准绳》）
大都失血之脉，宜沉细濡弱，或浮沉和缓，或洪大不数，或浮沉滑缓，或虚微，或暴吐暴脱而六脉俱伏，
此脉与病合，则为易治。或见浮芤浮革，或浮沉皆涩，或结或短，此脉属虚而病属重，则为难治，治得其宜，亦
多有痊者。如见浮数洪数，或细数不鼓，或浮大而散，或促代无力，或如滑而无胃气，或弦牢，或实大，或细
小劲疾，此病与脉反，则为不治，纵有卢扁，亦为之束手矣。故经云∶阳道实，阴道虚。越人曰∶细为虚，牢为
实。失血者脉宜沉细，反浮大而牢者死，虚病见实脉也。夫血濡脉络，体主阴静，血未失，则脉络濡软而和缓。
及火炅迫血外溢，真阴耗竭，则成阴绝阳亢，火充空舍而见实脉，致孤阳用事，岂能独生哉。又须以色为诊，凡
失血之后，或面色带黄青白有神，或目瞑合喜睡，或肢体温和，饮食如常，或不喜高声，声微不厉，此为顺，无
别刑克证候，为易治。若其面色青黯无光，或两颧暴赤，唇口如朱，或乍起乍眠，烦躁不寐，或身体大炅，或四
肢厥逆，或气喘息粗，或扬声厉语，或谵狂神昏，或循衣摸床，肉 筋惕，或自汗如雨，头汗独见，或周身厥冷，
颅囟独炅，或眼眶暴陷。或口渴思水，或肢体肿满，或脐腹绞痛不休，或胃气已败，呕吐拒食，此皆凶候，不治
也。（《轩岐救正论》）
证治梗概 血病之故有四∶曰虚，曰瘀，曰寒，曰热。治血之法有五∶曰补，曰下，曰破，曰凉，曰温。
血虚者，其证朝凉暮热，手足心热，皮肤干涩甲错，唇白，女子月事前后不齐，脉微细无力，法宜补之。血热者，
其证衄血吐血，便血尿血，午后发热，女子月事先期，脉微细而数，法宜凉之。血寒者，血不能配气而失营运之
度，其证麻木疲
软，皮肤不泽，腹有块痛，女子月事后期，脉微细而缓，法宜温之。瘀血在上焦者，其证上焦热，烦躁，嗽水
不咽，法宜凉而破之。瘀血在下焦者，其证如狂，谵语燥渴，身目发黄，舌黑，少腹满痛，小便自利，大便秘，
法宜下之。血瘀而兼寒者，其证无头疼，不恶寒，身热发渴，言语无伦，如见鬼状，小便利，大便黑，法宜温
而行之。（《医意商》）
大抵瘀尚易治，干则难医。（《医碥》）
瘀去则新生，故易治。血海干枯，则阴难骤长，故难治。（《医级》）
咳血溲血 至于血充目则视明，充耳则听聪，充四肢则举动强，充肌肤则身色白，渍则黑，去则黄，
外热则赤，内热则上蒸喉。或下蒸大肠为小窍，喉有窍则咳血杀人，肠有窍则便血杀人，便血犹可止，咳血不易医。
喉不停物，毫发必咳，血渗入喉，愈渗愈咳，愈咳愈渗，饮溲溺则百不一死。服寒凉则百不一生。血虽阴类，运
之者其和阳乎。（《褚氏遗书》）
上下逆顺 血证上行，或唾或呕或吐，皆逆也；若变而下行为恶痢者，顺也。血上行为逆，其治难；下行
为顺，其治易。故仲景云∶蓄血证下血者，当自愈也。与此意同。若无病之人，忽然下痢，其病进也。今病血
证上行而复下行恶痢者，其邪欲去，是知吉也。（《东垣》）
大抵从下为顺易冶，溢上为逆难治。冶宜补阴运阳，清热调气，气顺血自归经。（《如宣》）
验色 盖出于肺者，或缘龙雷亢逆，或缘咳逆上奔，血必从之上溢，多带痰沫及粉红色者。其出于心包，
亦必上溢，色必正赤，如朱漆光泽。若吐出便凝，摸之不粘指者，为守脏之血，见之必死。出于脾者，或从胃脘
上溢，或从小肠下脱，亦必鲜紫
浓浓，但不若心包血之光泽也。出于肝者，或从上呕，或从下脱，血必青紫稠浓，或带血缕，或有结块。出于肾
者，或从咳逆，或从咯吐，或稀痰中杂出如珠，血虽无几，色虽不鲜，其患最剧，间有从精窍而出者，若气化受
伤，则从膀胱溺孔而出，总皆关乎脏气也。其出于胃者，多兼水液痰涎，吐则成盘成盏，汪洋满地，以其多气多
血，虽药力易到，不若脏血之笃，然为五脏之本，亦不可忽。（《医通》）（按∶此说稍过精微、或有难必者，
录以俟后考。又吐血中有说，互相发，宜参。又色鲜为热，瘀为寒，诸家既有其言，互见后诸条。）
发热 诸失血而发热甚者难治，十仅可一二全者。（《要诀》）
阳盛身热多渴，阴盛身凉不渴。然血阴也，身凉者易愈。（《入门》）
无潮热者轻，有潮热者重。（《医碥》）
无热不喘者可痊（血去阴虚，热收于内，外无热现，此其常也。不喘者，血虽病而气未浮也，故可治），
有热不卧者危败（失血身热，阳无所附，而浮散于形层之外也。不得卧者，气根已离也，故当危败）。（《医级》）
失血后大热大渴发热，证似白虎，惟脉虚大不长实为异尔，误用凉剂必死，当归补血汤主之，方用黄 一两，
当归二钱。（《准绳》）
凡失血之后，必大发热，名曰血虚发热。古方立当归补血汤，川黄 一两，当归六钱。名曰补血而以黄 为君，
阳旺能生阴血也。如丹溪于产后发热，用参、 、归、芎，黑姜以佐之。或问曰∶干姜辛热，何以用之？曰∶姜
味辛，能引血药入气分而生新血（炮黑则入血，炮熟则温中），当神
而明之。（《医贯》）
眩晕 血虚眩晕卒倒，不可艾灸惊哭叫动，动则乘虚而死矣。须以当归、川芎、白芍、熟地黄、黄 、
人参、白术、茯苓、陈皮、荆芥穗、甘草各七分，枣二枚，乌梅一个，同煎服。（《金匮翼》）
失血后头晕发热者往往有之，此是虚火上炎外扰之故，不可误认外感而用风药。（《医通》）
治分八法 治分八法∶一曰降气，缘上盛下虚，气升不降，血随气上，越出上窍，法以苏子、沉香之
类顺其气，气降而血自归经矣。一曰破瘀，缘上膈壅热积瘀，紫黑成块，胸中满痛，法以熟大黄、桃仁、丹皮、
枳实之类导之使下，转逆为顺矣。一曰温中，缘衣冷食寒，渗入血分，血得寒则凝，不归经络而妄行，血出黯
黑，色夭身凉，法以炮姜、肉桂之类温中和气，气温和则血自归经矣。一曰温散，倘衣冷感寒，色黯窍热，身痛
头痛，法以姜、桂、芎、苏之类温中散寒，寒去血自归经矣。一曰补气，缘人真气素亏，精神疲惫，阴阳不相为
血溢和血泄，其表现颇为繁多，然而其中有不需强行加以区分的。现将其概括为九类，并冠以通说，因为这些方剂大多可以互相通用。
病因概略 血液就像水一样，水在地面下流动，如果百川都理顺了，就没有壅塞决堤的担忧。血液在人体荣经、腑俞中周流不息，外不受四气（风、寒、暑、湿）伤害，内不被七情（喜、怒、忧、思、悲、恐、惊）郁结，自然顺畅适宜。万一稍微失调，必然导致壅闭，所以血液不能遵循经脉流注，荣养百脉，或凝涩或散乱，或向下流失而反常，或逆向上涌溢出，于是就有吐血、鼻衄、大小便出血、汗血、痰中带血等各种证候产生。十种走失（指血液异常流失），没有比这更严重的了，根据证候分别对待，才能施治。（《三因极一病证方论》）
血液为患，其妄行则表现为吐血、鼻衄；其衰涸则导致虚劳；瘀血蓄积在上部使人健忘；蓄积在下部使人发狂；遇寒则筋脉失养而拘挛紧急；挟热则毒邪内瘀而发黄；在小便方面表现为淋痛；在大便方面表现为肠风；对于妇女月经的进退、漏下、崩中等病，情况还不止这些，大凡这些情况，都是血液造成的。（《济生方》/《直指方》）
人具备阴阳，也就有了气血。气属阳，血属阴。男子以阳为主，所以阳胜于阴；女子以阴为主，所以阴胜于阳。气血致病，男女是相同的。人们都知道百病生于气，又谁知道血是百病的根源呢？血就像水一样，水在地中运行，百川理顺就没有壅遏的祸患。人的血脉，一旦在经络肠胃之间凝滞，百病就由此产生了。忽冷忽热，发黄发斑，无故惊恐发狂，烦闷呕恶，痴痰自汗，烘热虚劳，尿淋漏崩，吐血鼻衄咳唾，以至于眩晕厥冷，昏愦遗忘，肿块疼痛瘀疼，起坐遗溺，凡是这些证候，不是血病还能是什么？经文所说的先去其血，然后调理，确实是有道理的。（同上）
血液致病，有虚有滞，有热有寒。血虚则阳气偏盛，阳气偏盛则火动，火动则载血上行，越出诸窍而成为吐血、呕血、鼻衄等证。血热者，阳气陷入血中，血因而变热，随气下行，成为溺血、便血、崩血、肠风下血等证。血寒则凝结在脏腑之间，形成瘕积之病。血滞则蓄积在皮肤之间，形成壅脓的毒疮。（《医宗必读》/《原理》）（按：《医意商》也有虚、瘀、寒、热的说法，宜参证治梗概条。）
血本是阴精，不宜妄动，动了就会生病；血主营气和神气，不宜受损，损了就会生病。大概妄动的多由于火，火盛则逼迫血液妄行；受损的多由于气，气伤则血液无法存留。所以有的因七情而伤火，有的因七情而伤气；有的因劳倦色欲而动火，有的因劳倦色欲而伤阴。或者外邪不解而热郁于经络，或者纵酒不节而火动于胃，或者中气虚寒，则不能收摄而注陷于下，或者阴盛格阳，则火不归原而泛溢于上，这些都是动血的原因。所以妄行于上则见于七窍，流注于下则出于二阴，或者壅瘀于经络则发为痈疽脓血，或者郁结于腑脏则留为血块血症，或者乘风热则为斑为疹，或者滞阴寒则为痛为痹，这都是血病的证候。（《景岳全书》）
血得热则溢出 《内经》说胆移热于脑，则辛螫鼻渊，传为衄血瞑目。血液得热则涌溢，得寒则凝涩。胆受胃热，循脉而上移于脑，大概阳络溢则血液妄行，在鼻为衄，在汗孔为汗血，二者不同，这是热厥血溢的过错。（《圣济总录》）（按：先父说：汗血，王氏注为污血，见《说文解字》。《圣济总录》将汗解释为污，太疏漏了。）
诸气皆属于阳，诸血皆属于阴。阴盛则阳亏，阳盛则阴亏。经文所谓阳胜则阴病，阴胜则阳病。各种血证、衄血由阳气侵扰阴分，阴气被伤，血液失常道，或从口出，或从鼻出。若突然大量出血且血色鲜红，心烦急躁闷乱，时常想引出血液，多达一二斗，这是阳邪暴入于阴分，血得热则流散，大概人的经血，如同天地的河流，天气暑热，则河水沸腾涌起，所以有衄血肺疽，证候大同小异。（《鸡峰普济方》）
血液妄行，没有不是因为热引起的。大概血得热则淖溢（稀薄溢出），血气俱热，血随气上，就是吐血鼻衄。（《济生方》）
血液得寒则闭塞涩滞，得热则宣通流畅。营气虚竭，风冷交侵，固容易成为虚劳月闭的证候。至于出血这类，大抵多因蓄热所致，营道一旦开通，血也就随之不禁了。（《济生方》/《直指方》）
血随气行，气寒而行迟则血涩滞，气热而行快则血沸腾。大概血属阴，非阳不运，所以遇寒而凝；气属火，非少则壮，所以遇热而灼。（《医碥》）
上溢下脱的道理 有人问：人身阳气是阴血的引导，阴血是阳气的归依。为什么清浊相干，乱于内外，导致血不归经，而有上溢下脱的祸患？其血或从吐出，或从呕出，或从咯出，或从鼻出，或从眼耳齿舌出，或从津唾而出，或从肌肤而出，或从二便而出，又有蓄积不行的，为患各有不同。希望一一显示至理，条分脏腑经络之源，以启发学人的蒙昧。石顽回答说：经文说血与气，异名同类，虽然有阴阳清浊之分，总由水谷精微所化。起初混然一体，未分清浊，得脾气的鼓运，如雾上蒸于肺而为气，气不耗，归精于肾而为精；精不泄，归精于肝而化为清血；血不泻，归精于心，得离火的化育而为真血，以养脾脏，以司运动，以奉养全身，没有比这更宝贵的了。虽然经文有上注于肺乃化为血的说法，但实际不离五行之气化，转注如环无端。如上所说，不过是统论营卫血气的大端，是提纲挈领罢了。营卫是精气，血是神气。气主温煦，血主濡润。虽然气禀阳和，血禀阴质，但阴中有阳，阳中有阴，不能截然两分。其至清至纯的，得君主的命令，以和调五脏，藏而不失，是养脏之血。其清中之浊的，秉输运之权，以洒陈六腑，实而不满，是灌注之血。其清中之清的，会合营周的度数，流行百脉，满而不泄，是营经之血。其源则一，析而为三，各有司属。如果各守其乡，则阴平阳秘，哪里有上溢下脱的祸患呢？大概因为人的禀赋无不偏胜，劳役无不偏伤，其血就从偏衰偏胜之处渗漏出来。人禀赋既偏，则水谷多从偏胜的气化，而胜者愈胜，弱者愈弱，阳胜则阴衰，阴衰则火旺，火旺则血随之而上溢；阴胜则阳微，阳微则火衰，火衰则火失其统而下脱。其上溢的血，不一定全是火盛；下脱的血，不一定全是阳衰。但以血色鲜紫浓浓，就是火盛；血色晦淡无光，就是阳衰。究其所脱之源，或因脏气之逆，或因腑气之乖，都能致病。从上溢的，势必假道肺胃；从下脱的，势必由于二肠，及从膀胱下达耳。（《医学入门》/《医通》）（此下辨五脏胃肠血色之异，录在后。）
脉候（色诊、死证） 尺脉滑而疾，为血虚。涩则少血。脉见诸涩濡弱为亡血。脉有阴阳，趺阳、少阴脉皆微，其人若不呕吐，下部必亡血。（《脉经》）
其脉洪数者为逆，微小者为顺。（《鸡峰普济方》）
各种证候失血，皆见芤脉，随其上下，以验证出血部位。大凡失血，脉贵沉细，若见浮大，后必难治。（《崔氏脉诀》）（按：失血脉芤，本于张仲景。脉贵沉细云云，本于《难经·十七难》。）
经文说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。（《东垣试效方》）
失血脉宜沉细和缓，不宜浮大实大。（《回春》）
大凡失血，脉皆洪大无力，即芤脉。阴血既亏，阳无所依，浮散于外，故见此象，所以产后多见此脉。误认为实火，大违背医理。（《六要》）
大凡病后咳嗽吐血，脉大而乱，属上焦阳络伤；下血溺血，为阴络伤，均属危重。（《医学准绳六要》）
大都失血之脉，宜沉细濡弱，或浮沉和缓，或洪大不数，或浮沉滑缓，或虚微，或暴吐暴脱而六脉俱伏，此脉与病合，则为易治。或见浮芤浮革，或浮沉皆涩，或结或短，此脉属虚而病属重，则为难治，治得其宜，亦多有痊愈者。如见浮数洪数，或细数不鼓，或浮大而散，或促代无力，或如滑而无胃气，或弦牢，或实大，或细小劲疾，此病与脉反，则为不治，纵有卢扁（卢医扁鹊），也束手无策。所以经文说：阳道实，阴道虚。越人（秦越人/扁鹊）说：细为虚，牢为实。失血者脉宜沉细，反浮大而牢者死，虚病见实脉也。血液濡养脉络，体主阴静，血未失，则脉络濡软而和缓。及火炽迫血外溢，真阴耗竭，则成阴绝阳亢，火充空舍而见实脉，致孤阳用事，岂能独生哉？又须以色为诊，凡失血之后，或面色带黄青白有神，或目瞑合喜睡，或肢体温和，饮食如常，或不喜高声，声微不厉，此为顺，无别刑克证候，为易治。若其面色青黯无光，或两颧暴赤，唇口如朱，或乍起乍眠，烦躁不寐，或身体大热，或四肢厥逆，或气喘息粗，或扬声厉语，或谵狂神昏，或循衣摸床，肉瞤筋惕，或自汗如雨，头汗独见，或周身厥冷，颅囟独热，或眼眶暴陷。或口渴思水，或肢体肿满，或脐腹绞痛不休，或胃气已败，呕吐拒食，此皆凶候，不治也。（《轩岐救正论》）
证治梗概 血病的原因有四：曰虚，曰瘀，曰寒，曰热。治血的方法有五：曰补，曰下，曰破，曰凉，曰温。血虚者，其证朝凉暮热，手足心热，皮肤干涩甲错，唇白，女子月经前后不齐，脉微细无力，法宜补之。血热者，其证衄血吐血，便血尿血，午后发热，女子月经先期，脉微细而数，法宜凉之。血寒者，血不能配气而失营运之度，其证麻木疲软，皮肤不泽，腹有块痛，女子月经后期，脉微细而缓，法宜温之。瘀血在上焦者，其证上焦热，烦躁，嗽水不咽，法宜凉而破之。瘀血在下焦者，其证如狂，谵语燥渴，身目发黄，舌黑，少腹满痛，小便自利，大便秘，法宜下之。血瘀而兼寒者，其证无头疼，不恶寒，身热发渴，言语无伦，如见鬼状，小便利，大便黑，法宜温而行之。（《医意商》）
大抵瘀血尚易治，干血则难医。（《医碥》）
瘀去则新生，故易治。血海干枯，则阴难骤长，故难治。（《医级》）
咳血溲血 至于血充目则视明，充耳则听聪，充四肢则举动强，充肌肤则身色白，渍则黑，去则黄，外热则赤，内热则上蒸喉。或下蒸大肠为小窍，喉有窍则咳血杀人，肠有窍则便血杀人，便血犹可止，咳血不易医。喉不停物，毫发必咳，血渗入喉，愈渗愈咳，愈咳愈渗，饮溲溺则百不一死。服寒凉则百不一生。血虽阴类，运之者其和阳乎。（《褚氏遗书》）
上下逆顺 血证上行，或唾或呕或吐，皆逆也；若变而下行为恶痢者，顺也。血上行为逆，其治难；下行为顺，其治易。所以仲景说：蓄血证下血者，当自愈也。与此意同。若无病之人，忽然下痢，其病进也。今病血证上行而复下行恶痢者，其邪欲去，是知吉也。（《东垣十书》）
大抵从下为顺易治，溢上为逆难治。治宜补阴运阳，清热调气，气顺血自归经。（《如宜》/《如宣》）
验色 大概出于肺的，或因龙雷亢逆，或因咳逆上奔，血必从之上溢，多带痰沫及粉红色者。出于心包的，也必上溢，色必正赤，如朱漆光泽。若吐出便凝，摸之不粘指者，为守脏之血，见之必死。出于脾的，或从胃脘上溢，或从小肠下脱，也必鲜紫浓浓，但不若心包血之光泽也。出于肝的，或从上呕，或从下脱，血必青紫稠浓，或带血缕，或有结块。出于肾的，或从咳逆，或从咯吐，或稀痰中杂出如珠，血虽无几，色虽不鲜，其患最剧，间有从精窍而出者，若气化受伤，则从膀胱溺孔而出，总皆关乎脏气也。出于胃的，多兼水液痰涎，吐则成盘成盏，汪洋满地，以其多气多血，虽药力易到，不若脏血之笃，然为五脏之本，亦不可忽。（《医学入门》/《医通》）（按：此说稍过精微，或有难必者，录以俟后考。又吐血中有说，互相发，宜参。又色鲜为热，瘀为寒，诸家既有其言，互见后诸条。）
发热 各种失血而发热甚重的难治，十仅可一二全者。（《要诀》）
阳盛身热多渴，阴盛身凉不渴。然而血属阴，身凉者易愈。（《医学入门》）
无热不喘者可痊（血去阴虚，热收于内，外无热现，此其常也。不喘者，血虽病而气未浮也，故可治），有热不卧者危败（失血身热，阳无所附，而浮散于形层之外也。不得卧者，气根已离也，故当危败）。（《医级》）
失血后大热大渴发热，证似白虎汤证，惟脉虚大不长实为异尔，误用凉剂必死，当归补血汤主之，方用黄芪一两，当归二钱。（《医学准绳六要》）
凡失血之后，必大发热，名曰血虚发热。古方立当归补血汤，川黄芪一两，当归六钱。名曰补血而以黄芪为君，阳旺能生阴血也。如丹溪于产后发热，用参、芪、归、芎，黑姜以佐之。或问曰：干姜辛热，何以用之？曰：姜味辛，能引血药入气分而生新血（炮黑则入血，炮熟则温中），当神明之。（《医贯》）
眩晕 血虚眩晕卒倒，不可艾灸惊哭叫动，动则乘虚而死矣。须以当归、川芎、白芍、熟地黄、黄芪、人参、白术、茯苓、陈皮、荆芥穗、甘草各七分，枣二枚，乌梅一个，同煎服。（《金匮翼》）
失血后头晕发热者往往有之，此是虚火上炎外扰之故，不可误认外感而用风药。（《医学入门》/《医通》）
治分八法 治分八法：一曰降气，缘上盛下虚，气升不降，血随气上，越出上窍，法以苏子、沉香之类顺其气，气降而血自归经矣。一曰破瘀，缘上膈壅热积瘀，紫黑成块，胸中满痛，法以熟大黄、桃仁、丹皮、枳实之类导之使下，转逆为顺矣。一曰温中，缘衣冷食寒，渗入血分，血得寒则凝，不归经络而妄行，血出暗黑，色夭身凉，法以炮姜、肉桂之类温中和气，气温和则血自归经矣。一曰温散，倘衣冷感寒，色黯窍热，身痛头痛，法以姜、桂、芎、苏之类温中散寒，寒去血自归经矣。一曰补气，缘人真气素亏，精神疲惫，阴阳不相为
Blood effusion and blood discharge are numerous in manifestation, yet there are cases that do not require forced differentiation. They are now summarized into nine categories, headed by a general discussion, as their formulas are often interchangeable.
**Overview of Etiology** Blood is like water; when water flows underground and all rivers are regulated, there is no fear of blockage or bursting. Blood circulates through the Ying (Nutrient) meridians and Fu-Shu (Stream-Spring) points of the body; if it is not injured externally by the Four Qi (Wind, Cold, Summer-heat, Dampness) nor depressed internally by the Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright), it flows naturally and smoothly. If there is even slight disharmony in its regulation, blockage inevitably occurs. Consequently, blood cannot follow the meridians to nourish the hundred vessels; it may become stagnant or scattered, flow downward abnormally, or rush upward and overflow. Thus arise various syndromes such as hematemesis (vomiting blood), epistaxis (nosebleed), bleeding from the bowels and bladder, hematohidrosis (sweating blood), and hemoptysis (coughing up blood). Among the ten types of blood loss, none is more severe than this. Differentiating according to syndromes allows for appropriate treatment. (*San Yin Fang*)
The harm caused by blood manifests as hematemesis and epistaxis when it acts recklessly, and as consumptive disease (Xu Lao) when it is depleted. When blood stasis accumulates in the upper part, the person becomes forgetful; when it accumulates in the lower part, the person becomes manic. Encountering cold causes tendons to lose nourishment and become spasmodic; accompanying heat causes internal toxicity and stasis leading to jaundice. In the urine, it presents as painful dysuria; in the stool, it presents as intestinal wind (blood in stool). In women, regarding the advancement or retardation of menstruation, leukorrhea with bleeding, and metrorrhagia, the diseases are varied. All these are caused by blood. (*Zhi Zhi Fang*)
Humans possess Yin and Yang, and thus have Qi and Blood. Qi is Yang, Blood is Yin. Men are governed by Yang, so Yang prevails over Yin; women are governed by Yin, so Yin prevails over Yang. Diseases of Qi and Blood are the same for both men and women. Everyone knows that a hundred diseases arise from Qi, but who knows that Blood is the womb of a hundred diseases? Blood is like water; when water flows underground and rivers are regulated, there is no fear of obstruction. If human blood vessels stagnate in the meridians, channels, stomach, and intestines, the roots of a hundred diseases arise from here. Alternating chills and fever, jaundice and macules, spontaneous fright and mania, irritability and oppression, vomiting and nausea, sticky phlegm and spontaneous sweating, flushing and consumptive disease, painful dysuria, leukorrhea and metrorrhagia, hematemesis, epistaxis, coughing and spitting, dizziness and syncope, cold extremities, confusion and forgetfulness, masses and pain, difficulty in movement and urinary incontinence—all these syndromes, what else could they be but blood diseases? The classic says, "First remove the blood, then regulate it," which is indeed well-founded. (Ibid.)
Its pathology involves deficiency and stagnation, heat and cold. Blood deficiency leads to Yang excess; Yang excess leads to Fire stirring; Fire stirring carries blood upward, escaping through the orifices to cause syndromes such as hematemesis, vomiting blood, and epistaxis. In blood heat, Yang Qi sinks into the Blood, making the Blood hot; following Qi downward, it causes hematuria, hematochezia, metrorrhagia, and intestinal wind bleeding. Blood cold coagulates between the Zang-Fu organs, causing mass diseases (Jia Ji). Blood stagnation accumulates in the skin, causing toxic abscesses with pus. (*Yuan Li*) (Note: *Yi Yi Shang* also discusses deficiency, stasis, cold, and heat; refer to the overview of syndrome differentiation and treatment.)
Blood is originally Yin Essence and should not move; movement causes disease. Blood manages Ying Qi and Shen Qi and should not be damaged; damage causes disease. Generally, movement is due to Fire; excessive Fire forces blood to act recklessly. Damage is due to Qi; Qi injury means Blood has nowhere to reside. Thus, some injure Fire through the Seven Emotions, some injure Qi through the Seven Emotions; some stir Fire through fatigue and sexual indulgence, some injure Yin through fatigue and sexual indulgence. Or external pathogens remain unresolved, with Heat郁 (stagnating) in the meridians; or indulgence in alcohol without restraint stirs Fire in the Stomach; or Middle Qi deficiency and cold fail to secure and hold, causing sinking and collapse downward; or Yin excess repels Yang, causing Fire to lose its root and overflow upward. These are all causes of moving blood. Thus, reckless movement above appears in the seven orifices; flow downward exits through the two yin openings; or congestion and stasis in the meridians develop into carbuncles, ulcers, and pus-blood; or depression and knotting in the Zang-Fu organs remain as blood masses and blood syndromes; or encountering Wind-Heat causes macules and rashes; or stagnating Yin-Cold causes pain and bi-syndrome. These are all syndromes of blood disease. (*Jing Yue Quan Shu*)
**Blood Overflows When It Gets Hot** The *Nei Jing* states that if Gallbladder Heat shifts to the Brain, it causes nasal congestion and sinusitis (Yuan), transmitting to nosebleed and blindness. Blood overflows when it gets hot and coagulates when it gets cold. The Gallbladder receives Stomach Heat, follows the meridians upward to shift to the Brain. Generally, if the Yang collaterals overflow, blood acts recklessly; in the nose, it is epistaxis; in the sweat pores, it is hematohidrosis. The two are different; this is the fault of heat-jue blood overflow. (*Sheng Ji Zong Lu*) (Note: My late father said: Hematohidrosis, Wang Shi annotates as "filthy blood," seen in *Shuo Wen*. *Sheng Ji Zong Lu* interpreting it as sweat is too loose.)
All Qi belongs to Yang, all Blood belongs to Yin. Yin excess leads to Yang deficiency; Yang excess leads to Yin deficiency. The classic says, "Yang excess causes Yin disease, Yin excess causes Yang disease." Various blood syndromes and epistaxis occur because Yang Qi invades Yin, injuring Yin Qi, causing blood to leave its normal path, exiting from the mouth or nose. If it erupts suddenly with bright red color, accompanied by heart vexation and irritability, desiring to draw out blood, reaching one or two dou, this is Yang pathogen violently entering the Yin division. Blood gets hot and scatters. Human menstrual blood is like the rivers of heaven and earth; when the weather is hot and the earth is warm, the rivers boil and surge. Thus, there are epistaxis and lung abscesses, with syndromes largely similar but slightly different. (*Ji Feng Pu Ji Fang*)
Blood acting recklessly never arises without Heat. Generally, blood gets hot and overflows; when both Blood and Qi are hot, blood follows Qi upward, resulting in hematemesis and epistaxis. (*Ji Sheng Fang*)
Blood closes and becomes astringent when cold, and flows freely when hot. When Ying Qi is deficient and exhausted, and Wind-Cold invade mutually, it is easy to become a syndrome of consumptive disease and amenorrhea. As for bleeding syndromes, they are mostly caused by accumulated Heat. Once the Ying pathway opens, blood becomes uncontrollable. (*Zhi Zhi Fang*)
Blood follows Qi; when Qi is cold and moves slowly, blood becomes astringent and stagnant; when Qi is hot and moves fast, blood boils. Blood belongs to Yin and does not move without Yang, so it coagulates when encountering cold; Qi belongs to Fire and strengthens when scarce, so it burns when encountering heat. (*Yi Biao*)
**Principles of Upward Overflow and Downward Collapse** A question was asked: Human Yang Qi guides Yin Blood, and Yin Blood grounds Yang Qi. Why do Clear and Turbid interfere with each other, disturbing inside and outside, causing blood to leave its meridians, leading to the danger of upward overflow and downward collapse? Blood may be vomited, spat, coughed up, come from the nose, eyes, ears, teeth, tongue, saliva, skin, or bowels/bladder, or accumulate without flowing, each causing different harms. Please reveal the profound principles, categorizing the sources of Zang-Fu and meridians to enlighten beginners. Shi Wen answered: The classic says Blood and Qi are different names for the same substance. Although divided into Yin/Yang and Clear/Turbid, they are all transformed from the essence of food and water. Initially mixed as one, without distinction of Clear and Turbid, driven by Spleen Qi, they rise like mist to the Lung to become Qi. If Qi is not consumed, it returns to the Kidney as Essence. If Essence is not leaked, it returns to the Liver to transform into clear Blood. If Blood is not drained, it returns to the Heart, transformed by Li Fire into True Blood, nourishing the Spleen, governing movement, and sustaining life. Nothing is more precious than this. Although the classic says "upper injection to the Lung transforms into Blood," it essentially does not depart from the transformation of Five Elements Qi, circulating like a ring. What was said above merely summarizes the main aspects of Ying, Wei, Blood, and Qi. Ying and Wei are Essence Qi; Blood is Shen Qi. Qi warms, Blood moistens. Although Qi inherits Yang harmony and Blood inherits Yin substance, Yin contains Yang and Yang contains Yin; they cannot be strictly separated. The most pure and clear, obeying the Sovereign's command, harmonizes the five Zang organs, storing without losing, is the blood that nourishes the Zang. The turbid within the clear, wielding transport power, sprinkles the six Fu organs, full but not clogged, is the infused blood. The clear within the clear, meeting the measure of Ying circulation, flows through the hundred vessels, full but not leaking, is the Ying meridian blood. Their source is one, analyzed into three, each having its jurisdiction. If each guards its territory, Yin and Yang will be balanced and secreted; how could there be upward overflow and downward collapse? Generally, because human constitution has biases, and labor/injury has biases, blood leaks from the place of deficiency or excess. Since constitution is biased, food and water mostly follow the biased Qi transformation; the strong becomes stronger, the weak becomes weaker. Yang excess leads to Yin decline; Yin decline leads to Fire prosperity; Fire prosperity causes blood to overflow upward. Yin excess leads to Yang weakness; Yang weakness leads to Fire decline; Fire decline loses its control, causing collapse downward. The overflowing blood is not solely due to Fire excess; the collapsing blood is not solely due to Yang decline. But if the color is bright purple and thick, it is Fire excess; if the color is dull and pale without luster, it is Yang decline. Investigating the source of collapse, it may be due to rebellious Zang Qi or disordered Fu Qi, both causing disease. Upward overflow must pass through the Lung and Stomach; downward collapse must occur through the large and small intestines, and descend via the Bladder. (*Yi Tong*) (Below distinguishes the colors of blood from the five Zang and stomach/intestines, recorded later.)
**Pulse Diagnosis (Color Diagnosis, Death Syndromes)** Chi pulse slippery and rapid indicates Blood deficiency. Choppy indicates little blood. Pulses showing choppy, soft, and weak indicate blood loss. Pulses have Yin and Yang; if both Duyang and Shaoyin pulses are faint, and the person does not vomit, there must be blood loss below. (*Mai Jing*)
If the pulse is洪数 (Surging-Rapid), it is unfavorable; if微小 (Minute-Small), it is favorable. (*Ji Feng Pu Ji Fang*)
In all syndromes of blood loss, the Kou (Hollow) pulse appears. Depending on its position (upper/lower), verify the exit point. Generally, in blood loss, the pulse should be deep and fine. If floating and large, it will be difficult to treat later. (*Cui Shi Mai Jue*) (Note: Kou pulse in blood loss originates from Zhang Zhongjing. "Pulse should be deep and fine" originates from *Nan Jing · Chapter 17*.)
The classic says: Those presenting with blood, fever, and large pulse are difficult to treat; this is Fire pathogen prevailing. Those with cool body and quiet pulse are easy to treat; this is righteous Qi recovering. (*Dong Yuan Shi Xiao Fang*)
Pulse in blood loss should be deep, fine, harmonious, and slow; not floating, large, or solid-large. (*Hui Chun*)
Generally, in blood loss, the pulse is surging, large, and powerless, i.e., Kou pulse. Since Yin Blood is deficient, Yang has no foundation, floating and scattering outward, hence this image; thus, postpartum patients often show this pulse. Mistaking it for Excess Fire greatly violates [principles]. (*Liu Yao*)
Generally, after illness, coughing and vomiting blood with a large and chaotic pulse indicates injury to the Yang collaterals of the Upper Jiao; lower bleeding and hematuria indicate injury to the Yin collaterals; both are critical. (*Zhun Sheng*)
Mostly, pulses in blood loss should be deep, fine, soft, and weak, or floating/sinking harmonious and slow, or surging/large but not rapid, or floating/sinking slippery and slow, or deficient/faint. Or in sudden vomiting/collapse, all six pulses vanish. This pulse matching the disease is easy to treat. Or if floating/Kou/floating-leather appear, or floating/sinking both choppy, or knotted/short, this pulse indicates deficiency while the disease is heavy; if treated appropriately, many recover. If floating-rapid/surging-rapid appear, or fine-rapid without drumming, or floating-large and scattered, or hurried/intermittent and powerless, or slippery without Stomach Qi, or wiry/tough, or solid-large, or fine-small and forceful/rapid, this disease-pulse reversal indicates untreatable conditions; even with Lu Bian (Lu Qian and Bian Que), hands would be tied. So the classic says: Yang path is solid, Yin path is deficient. Yue Ren (Bian Que) said: Fine indicates deficiency, Tough indicates excess. In blood loss, pulse should be deep and fine; reversing to floating-large and tough is death; deficiency disease showing excess pulse. Blood moistens collaterals, body governs Yin stillness. Before blood loss, collaterals are moist, soft, harmonious, and slow. When intense heat forces blood to overflow externally, True Yin is exhausted, leading to Yin exhaustion and Yang hyperactivity. Fire fills empty houses, showing excess pulse, causing solitary Yang to function alone. How can it survive alone? Also, diagnose by color. After blood loss, if face shows yellow/green/white with spirit, or eyes closed preferring sleep, or limbs warm, diet normal, or dislike loud voice, voice faint not harsh, this is favorable, without other clashing syndromes, easy to treat. If face is green/dark without luster, or malar flush, lips/mouth like vermilion, or alternating sleep/wake, vexation/insomnia, or body very hot, or four limbs cold, or breath short/rough, or shouting/harsh speech, or delirium/mania/coma, or grasping clothes/touching bed, muscle twitching/tendon tremor, or sweating like rain, head sweat only, or whole body cold, skull/fontanelle hot, or eye sockets sunken. Or thirst wanting water, or limbs swollen/full, or umbilical/abdominal colic unceasing, or Stomach Qi failed, vomiting/refusing food—all these are ominous signs, untreatable. (*Xuan Qi Jiu Zheng Lun*)
**Overview of Syndrome Differentiation and Treatment** Causes of blood disease are four: Deficiency, Stasis, Cold, Heat. Methods of treating blood are five: Tonify, Purge, Break, Cool, Warm. Blood deficiency syndromes: morning cool/evening hot, heat in palms/soles, dry/scaly skin, white lips, irregular menstruation in women, faint/small/powerless pulse. Method: Tonify. Blood heat syndromes: epistaxis/hematemesis, hematochezia/hematuria, afternoon fever, early menstruation in women, faint/small/rapid pulse. Method: Cool. Blood cold syndromes: inability to match Qi, losing operational rhythm, numbness/weakness, dull skin, abdominal mass/pain, late menstruation in women, faint/small/slow pulse. Method: Warm. Blood stasis in Upper Jiao: Upper Jiao heat, vexation, rinsing mouth without swallowing. Method: Cool and Break. Blood stasis in Lower Jiao: manic-like, delirious/thirsty, jaundiced body/eyes, black tongue, lower abdominal fullness/pain, free urination, constipation. Method: Purge. Blood stasis with Cold: no headache, no aversion to cold, body heat/thirst, incoherent speech, seeing ghosts, free urination, black stool. Method: Warm and Promote. (*Yi Yi Shang*)
Generally, stasis is easy to treat; dryness is hard to cure. (*Yi Biao*)
Once stasis is removed, new blood generates, so it is easy to treat. If the Sea of Blood is dry, Yin cannot grow suddenly, so it is hard to treat. (*Yi Ji*)
**Hemoptysis and Hematuria** When blood fills the eyes, vision is clear; fills ears, hearing is acute; fills limbs, movement is strong; fills skin, complexion is white. Stained, it turns black; lost, it turns yellow. External heat makes it red; internal heat steams upward to the throat. Or steams downward to the large intestine as small orifices. Throat has orifices, so hemoptysis kills; intestine has orifices, so hematochezia kills. Hematochezia can still be stopped; hemoptysis is hard to cure. Throat stops nothing; even a hair causes cough. Blood seeping into throat, the more it seeps, the more it coughs; the more it coughs, the more it seeps. Drinking diuretics saves one in a hundred. Taking cold-cooling herbs kills one in a hundred. Although Blood is Yin category, what moves it is Harmonious Yang. (*Chu Shi Yi Shu*)
**Upward/Downward Unfavorable/Favorable** Blood syndromes moving upward, whether spitting, vomiting, or ejecting, are all unfavorable (Ni); if changing to downward movement as foul diarrhea, it is favorable (Shun). Blood moving upward is unfavorable, hard to treat; moving downward is favorable, easy to treat. So Zhongjing said: "In blood accumulation syndrome, if blood is passed, it should heal itself." This intent is the same. If a healthy person suddenly has diarrhea, the disease progresses. Now, if a blood syndrome patient moves upward then reverts to downward foul diarrhea, the pathogen wants to leave; this is known as auspicious. (*Dong Yuan*)
Generally, downward movement is favorable and easy to treat; upward overflow is unfavorable and hard to treat. Treatment should tonify Yin and move Yang, clear heat and regulate Qi; when Qi is smooth, blood returns to meridians. (*Ru Xuan*)
**Examining Color** Blood originating from Lung, due to Dragon/Lei hyperactivity or cough/rebellion, must overflow upward, often mixed with phlegm foam and pink-red. Originating from Pericardium, also overflows upward, color must be true red, like lacquer luster. If clotting upon vomiting, non-sticky to touch, it is guarding organ blood; seeing this means death. Originating from Spleen, either overflowing from Stomach region or collapsing from Small Intestine, must be bright purple thick, but less lustrous than Pericardium blood. Originating from Liver, either vomiting upward or collapsing downward, blood must be blue-purple thick, possibly with blood threads or clots. Originating from Kidney, either from cough/rebellion or spitting, or mixed in thin phlegm like pearls. Though little blood, color not bright, harm is most severe. Occasionally from essence orifice; if Qi transformation injured, exits from Bladder urethra. All relate to Zang Qi. Originating from Stomach, mostly mixed with fluid/phlegm, vomiting forms plates/cups, spreading everywhere. Because abundant Qi/Blood, medicine power reaches easily, not as severe as Zang blood, but as root of five Zang, cannot be ignored. (*Yi Tong*) (Note: This theory is slightly too subtle, perhaps not absolute; recorded for future study. Also discussed in hematemesis, mutually developing, refer. Also, bright color is heat, stasis is cold; since various schools have stated this, see subsequent articles.)
**Fever** All blood loss with severe fever is difficult to treat; only one or two in ten recover. (*Yao Jue*)
Yang excess body heat with much thirst; Yin excess body cool without thirst. However, Blood is Yin; body cool is easy to heal. (*Ru Men*)
No tidal fever is mild; tidal fever is severe. (*Yi Biao*)
No fever, no panting: curable (Blood loss, Yin deficiency, heat retained inside, no external heat manifestation, this is normal. No panting means although Blood is diseased, Qi has not floated, so treatable). Fever, unable to lie down: critical failure (Blood loss body heat, Yang has no attachment, floating/scattering outside form layers. Unable to lie down means Qi root has detached, so critical). (*Yi Ji*)
After blood loss, great heat, great thirst, fever, syndrome resembles Bai Hu Tang, except pulse is deficient-large not becoming solid. Mistaken use of cooling herbs causes death. Dang Gui Bu Xue Tang is primary formula: Huang Qi one liang, Dang Gui two qian. (*Zhun Sheng*)
After all blood loss, great fever often occurs, named Blood Deficiency Fever. Ancient formula Dang Gui Bu Xue Tang: Chuan Huang Qi one liang, Dang Gui six qian. Named tonifying blood but using Huang Qi as sovereign; Yang prosperity generates Yin blood. Like Dan Xi used for postpartum fever: Shen, Qi, Gui, Xiong, Hei Jiang to assist. Questioned: Dried Ginger is pungent-hot, why use it? Answer: Ginger is pungent, can guide blood herbs into Qi branch to generate new blood (charred enters blood, cooked warms middle). Understand spiritually. (*Yi Guan*)
**Dizziness** Blood deficiency dizziness sudden collapse: cannot moxa, cannot startle/cry/move. Movement leads to death by vacuity. Must use Dang Gui, Chuan Xiong, Bai Shao, Shu Di Huang, Huang Qi, Ren Shen, Bai Zhu, Fu Ling, Chen Pi, Jing Jie Sui, Gan Cao each seven fen, Jujube two pieces, Wu Mei one piece, decoct together. (*Jin Kui Yi*)
Dizziness and fever after blood loss often occur; this is deficiency Fire flaming upward and disturbing externally. Do not mistake for external contraction and use Wind herbs. (*Yi Tong*)
**Treatment Divided into Eight Methods** Treatment divided into eight methods: One is Descending Qi, due to upper excess/lower deficiency, Qi rising not descending, blood following Qi upward, escaping upper orifices. Method: Su Zi, Chen Xiang etc. to smooth Qi; Qi descends, blood returns to meridians. Two is Breaking Stasis, due to upper chest heat/stagnant stasis, purple-black clots, chest fullness/pain. Method: Shu Da Huang, Tao Ren, Dan Pi, Zhi Shi etc. to guide downward, turning unfavorable to favorable. Three is Warming Middle, due to cold clothes/food penetrating Blood branch, blood getting cold coagulating, not returning to meridians acting recklessly, blood dark/black, sallow color, cool body. Method: Pao Jiang, Rou Gui etc. to warm middle and harmonize Qi; Qi harmonious, blood returns to meridians. Four is Warming Dispersing, if cold clothes/contracting cold, dark color/orifice heat, body/head pain. Method: Jiang, Gui, Xiong, Su etc. to warm middle disperse cold; cold gone, blood returns to meridians. Five is Tonifying Qi, due to person's True Qi always deficient, spirit tired, Yin/Yang not interacting...