（附血瘥）
男子谓之小肠气。妇人谓之脾血疼。多因血虚后感冷。致血气凝滞小肠。 痛牵引腰胁
宿
有病根。不关月事通闭。宜和气饮。或玄胡索汤失笑散。间进艾附丸。或以盐一捻。置铁匙
上。火烧研碎。酒调下异攻散。大便通则愈。若审知血海虚冷而疼。宜小温经汤。若只瘥不
痛。常如肚饥。此乃血虚胃中枯燥生热。宜益血药滋之。可用四物汤。久不治则成消中。
血瘥者。心头瘥痛。四物汤去地黄。加香附子如数。
有病后血虚者。有本体血虚者。其人往来寒热。或五心发热。言语无力。面色痿黄。头
目昏
晕。变生诸疾、芎归汤加羊肉少许。或十全大补汤、四物汤、养荣汤服之。血虚而气旺宜抑
气汤。即香附末。
血虚而腹疼者。四物汤。
妇人血虚。怒气用心者。如颠状。又如心风。或笑歌。或妄语。月事来及产中。多有此
证。四物汤半帖。去浓朴加人参麦门冬桂芎归各半钱。名增减四七汤。
崩中血热而成者。有气虚而成者。血大至曰崩中。或清或浊。或纯下瘀血。或腐势不可
止
证状非一所感亦异。甚则头目昏晕。四肢厥冷。并宜胶艾汤。咽震灵丹。佐以三灰散。或
以童子小便煎理中汤。或以沉香降气汤加入百草霜。米饮调下。血崩甚而腹痛。人多疑恶血
未尽。
又见血色瘀黑。愈信恶血之说。不敢止截。大凡血之为患。欲出未出之际。停在腹内。即成
瘀色。难尽以瘀为恶。又焉知瘀之不为虚冷乎。若必待见瘀血之后截之。恐并与人无之矣。
此腹痛更有说。积而腹痛。血通而痛止。崩而腹痛。血住则止。止宜芎归汤加干姜熟附一
钱。止其血而痛自定。仍以刺花绣拭黑片。烧灰研末。米饮调下。一方以毛蟹壳烧存性。米
饮下。亦有以早黄麻根烧灰为末。米饮下。
（附血瘥）
男子称为小肠气。妇人称为脾血疼。多因血虚后感受寒邪，导致气血凝滞于小肠。疼痛牵引腰胁，且有宿疾病根，与月经的通闭无关。适宜服用和气饮，或玄胡索汤、失笑散。间歇性服用艾附丸。或者取一捻盐，放在铁匙上，用火烧烤后研碎，用酒调服异攻散。大便通畅后即可痊愈。如果确知是血海虚冷引起的疼痛，适宜用小温经汤。如果只是感觉不适但不疼痛，常像肚子饿一样，这是血虚导致胃中枯燥生热，适宜用补血药滋养。可用四物汤。久治不愈则可能发展为消中症。
血瘥的症状是心口处有刺痛感。使用四物汤去掉地黄，加入等量的香附子。
有病后导致血虚的，有先天体质血虚的。这类人出现忽冷忽热的症状，或者五心（两手心、两足心及心口）发热，说话无力，面色萎黄，头晕目眩。由此引发各种疾病，可用芎归汤加少许羊肉。或者服用十全大补汤、四物汤、养荣汤。血虚而气盛者适宜服用抑气汤，即香附末。
血虚且腹部疼痛者，服用四物汤。
妇人血虚，又因愤怒和用心过度，出现类似癫狂的状态，又像心风病。有时唱歌欢笑，有时胡言乱语。在月经来潮及分娩过程中，多有此证。使用半帖四物汤，去掉厚朴，加入人参、麦门冬、桂枝、川芎、当归各半钱，名为增减四七汤。
崩中症由血热而成者，有由气虚而成者。血量极大涌出称为崩中。血液颜色或清或浊，或纯下瘀血，或腐烂之势无法停止。症状表现不一，感受病因也各异。严重时出现头晕目眩，四肢厥冷。均适宜服用胶艾汤、咽震灵丹，辅以三灰散。或者用童子小便煎煮理中汤，或者在沉香降气汤中加入百草霜，用米汤调服。血崩严重且伴有腹痛时，人们往往怀疑恶血未尽。又见血色瘀黑，更加确信是恶血的说法，不敢使用止血药物。大凡出血为患，在欲出未出之际，停在腹内，就会变成瘀色。不能一概认为瘀血就是恶血，又怎知瘀血不是由于虚冷造成的呢？如果一定要等到看到瘀血之后再止血，恐怕连正常的血都止没了。这里关于腹痛另有说法：积血导致的腹痛，血通后疼痛停止；崩漏导致的腹痛，血止住后疼痛自然停止。适宜使用芎归汤加干姜、熟附子一钱。止住血后疼痛自然安定。另外可以用刺花绣擦拭过的黑片，烧成灰研末，用米汤调服。另一方用毛蟹壳烧至存性，用米汤送服。也有用早黄麻根烧成灰研末，用米汤送服的。
(Attached: Blood Stabbing Pain)
In men, it is called "Xiaochang Qi" (Qi stagnation of the Small Intestine). In women, it is called "Pixue Tong" (Spleen-blood stabbing pain). It is mostly caused by cold pathogen invading after blood deficiency, leading to coagulation and stagnation of Qi and blood in the Small Intestine. The pain radiates to the waist and hypochondrium, with an underlying chronic condition, unrelated to the patency or obstruction of menstruation. Heqi Yin (Harmonizing Qi Decoction), Xuanhusuo Tang (Corydalis Rhizome Decoction), or Shixiao San (Instantly Effective Powder) are suitable. Ai Fu Wan (Mugwort and Asarum Pill) may be taken intermittently. Alternatively, take a pinch of salt, place it on an iron spoon, roast over fire until crushed, and administer Yigong San (Yi Gong Powder) mixed with wine. Recovery occurs when bowel movements become unobstructed. If it is confirmed that the pain is due to deficiency-cold of the Blood Sea (Uterus), Xiaowen Jing Tang (Minor Warming Meridian Decoction) is suitable. If there is only discomfort without pain, often resembling hunger, this indicates dryness and heat generated in the Stomach due to blood deficiency. Blood-nourishing herbs should be used for nourishment; Siwu Tang (Four Substances Decoction) can be used. If untreated for a long time, it may develop into "Xiaozhong" (Middle Consumptive Disease).
Blood stabbing pain is characterized by stabbing pain in the heart region. Use Siwu Tang (Four Substances Decoction) removing Rehmanniae Radix (Dihuang), adding Cyperi Rhizoma (Xiangfu) in equal amount.
For those with blood deficiency following illness, or with constitutional blood deficiency: symptoms include alternating chills and fever, heat in the five centers (palms, soles, and chest), weak voice, sallow complexion, dizziness, and vertigo. Various diseases may arise from this. Xionggui Tang (Peony and Angelica Decoction) with a small amount of mutton is suitable. Or take Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction), Siwu Tang (Four Substances Decoction), or Yangrong Tang (Nourishing Vitality Decoction). For blood deficiency with flourishing Qi, Yi Qi Tang (Suppressing Qi Decoction), which is Cyperi Rhizoma powder (Xiangfu Mo), is suitable.
For blood deficiency with abdominal pain, Siwu Tang (Four Substances Decoction) is used.
For women with blood deficiency, exacerbated by anger and mental strain: symptoms resemble mania or "Xinfeng" (Wind affecting the Heart). They may laugh, sing, or speak deliriously. This syndrome often occurs during menstruation and childbirth. Use half a dose of Siwu Tang (Four Substances Decoction), remove Magnoliae Officinalis Cortex (Houpo), add Ginseng Radix (Renshen), Ophiopogonis Tuber (Maimendong), Cinnamomi Ramulus (Guizhi), Ligusticum Chuanxiong Rhizoma (Chuanxiong), and Angelicae Sinensis Radix (Danggui), each 0.5 qian. This is named Zengjian Siqi Tang (Modified Four Seven Decoction).
Bengzhong (Metrorrhagia) caused by blood-heat, or by Qi deficiency: massive bleeding is called Bengzhong. The blood may be clear or turbid, purely clotted blood, or putrid and unstoppable. Symptoms vary, and etiological factors differ. Severe cases present with dizziness, vertigo, and cold limbs. Jiao'ai Tang (Donkey-Hide Gelatin and Mugwort Decoction), Yan Zhen Ling Dan (Zhenling Pill for Throat Tremors), assisted by Sanhui San (Three Ashes Powder) are suitable. Alternatively, decoct Lizhong Tang (Regulate the Middle Decoction) with urine from an uncircumcised boy, or add Cinnamomi Cortex (Baicaoshuang/Rhizoma Imperatae Carbonized) to Chenxiang Jiangqi Tang (Aucklandia Descending Qi Decoction), administered with rice water. When metrorrhagia is severe with abdominal pain, people often suspect that evil blood (clots) remains. Seeing dark, clotted blood reinforces the belief in evil blood, making them afraid to use hemostatic agents. Generally, regarding hemorrhage, when blood is about to exit but has not yet, if it stays inside the abdomen, it becomes clotted. One cannot assume all clots are evil blood; how do we know clots are not due to deficiency-cold? If one waits to see clots before stopping the bleeding, one might stop all blood, leaving none. There is another explanation for abdominal pain: for pain caused by accumulated blood, pain stops when blood flows; for pain caused by metrorrhagia, pain stops when bleeding ceases. Xionggui Tang (Peony and Angelica Decoction) with dried ginger (Ganjiang) and prepared aconite root (Shufu) 1 qian is suitable to stop bleeding, after which pain naturally settles. Alternatively, scrape black pieces from Spina Gleditsiae (Cihuaxiu), burn to ash, powder, and mix with rice water. Another formula uses shell of hairy crab (Moxieqiao) calcined to preserve nature, taken with rice water. Some use root of hemp (Huangma Gen) burned to ash, taken with rice water.