大意
心主血而不能藏。夜则复归于肝。肝藏血而不能主。昼则听命于心。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。（指掌）
内因
或四气伤于外。七情动于中。及饮食房欲。坠闪劳损。（三锡）六经受伤。血液流并。聚于胸臆两胁之间。乘火
而升。（指掌）从胃脘而越出。（入门）其伤重者。夹背而上。如潮涌至。势不可遏。（指掌）
外候
积热肺胃者。必胸满脉实。大怒气逆者。必面青脉弦。阳虚而血外走。必虚冷恶寒。阴虚而火上亢。必喘咳
哄热。劳心不能主血。必烦心躁闷。劳力不能摄血。必自汗倦怠。郁结伤脾。忧恚少食。劳伤肺气。久咳无痰。
气虚不统者。其血散漫。积瘀停蓄者。其血成块。热郁在上者。血必紫。虚炎下起者。血必鲜。感寒泣血。血白
黑点。肺生痈疽。血必兼脓。先痰带血者。痰火积热。先血兼痰者。阴虚火猖。饮食饱闷而吐血。必食伤胃脘
而不运。饮酒过醉而吐血。必酒伤清道而妄行。（汇补）
血分浮沉
吐血水内。浮者。肺血也。沉者。肝血也。半浮半沉者。心血也。色赤如太阳之红者。肾血也。各随见症而参之。
（摘玄）
血分顺逆
凡血上越为呕吐者。皆逆。其治难。后变下行为恶利者。为顺。其治易。（东垣）
血分阴阳
血症身热多渴。脉大者。是火邪胜也。其治难。身凉不渴。脉静者。是正气复也。其治易。
危症
若心肺脉破。血如涌泉。口鼻俱流。气促汗冷者危。
脉法
脉得诸濡弱为亡血。芤为失血。涩为少血。牢为蓄血。大抵沉弱滑小者生。实大弦牢者死。关尺之脉弦细
如循刀刃者死。
治血大法
凡血越上窍。皆阳盛阴虚。有升无降。俱宜补阴抑阳。气降而血自归经。（纂要）
虚中实法
若大醉大饱大怒大劳之后。忽然吐血者。宜降气。不宜降火。宜行血。不宜止血。宜补肝。不宜伐肝。（经疏）
虚中虚法
如素有虚损病根。而时常见血者。宜甘寒凉血。辛平行气。酸敛止塞其源。甘温收补其后。（入门）
服童便法
凡血症服寒凉药。则百不一生。饮溲溺则百不一死。（褚澄）盖溲溺降火滋阴。又能消瘀血而止吐衄也。
见黑止法
血热则行冷则凝。见黑则止。理之必然。（神书）故止血之药。必用炒黑。乃水能制火也。（汇补）
瘀血宜消
血不可单行单止。盖血来未多。必有瘀于胸膈。当先消瘀。而佐以润下之品。使败血下行。乃服止血药以
固其根。用补血药以还其元。（指掌）
血虚宜补
若吐久不止。当用温补以健理脾胃。使脾和则能裹血也。若暴吐不止。当用参、术。以急固元阳。血脱益气。
阳生阴长之理也。（医贯）
势急从治
凡吐血太甚。势难遏止。此火性急速。如泛用凉药。反增搏击。宜辛味从治。用炒黑干姜末童便调服之。（六要）
血家治禁
劳伤误用寒凉。则胸满膈痛。血愈郁矣。阴火误用燥热。则血愈枯竭。痨瘵成矣。坠堕闪锉。气逆气郁。误行
补涩。则瘀蓄于胃。心下胀满。食入即吐。名曰血逆。瘀蓄于脾。大腹膨胀。渐成鼓满。名曰血蛊。（汇补）
用药
主以四物汤去川芎。消瘀。加丹皮、茶花、韭汁、童便。清热。加玄参、黄芩、麦冬。降气。加苏子、枇杷叶。行
血。加牛膝、丹参。止涩。加蒲黄、牛膝、藕节。通导。加大黄、桃仁。此常法也。若暴吐不止。气随血脱者。则四物
等汤所不及。当以独参汤追其元阳。若真阴失守。血随火沸。则参、附等药。尤不相宜。当以地黄汤加五味子滋其化
源。如肾中阳虚。下寒上热。宜八味丸以引火归源。此阴阳虚实之机。最宜审察。如久吐不止。加白芨末服
之。古人亦有用猪羊肺蘸食之者。
吐衄咳咯血辨
吐血出于胃。吐行浊道。衄血出于经。衄行清道。喉与咽二者不同也。盖经者走。经之血走而不守。随气而
行。火性急速。故随经直犯清道而出于鼻。其不出于鼻者。则挟火凌金渗入肺窍。而出于咽为咳咯也。胃
者守营之血。守而不走。存于胃中。胃气有伤。不能摄血。故令人呕吐。从喉而出于口也。（汇补）
【附衄血】
肺开窍于鼻。能为衄血。然肺经多气少血。惟冲任二脉。为血之海。附于阳明。阳明之经。上交鼻额。又为多
血少气之乡。所以火起冲任。血流阳明。此衄血又属胃经也。大抵劳伤元气。阴虚火动。逆于肺而衄者。宜
凉血散气。逆于胃而衄者。宜清胃生脉。如六脉弦细而涩。面色枯白不泽者。此脱血大虚而挟寒。宜甘温
补血。如六脉洪大而虚。面赤心动善惊者。此心火上炎而血溢。宜甘寒凉血。有下虚上盛而衄者。当辛温
以补命门。有上焦积热而衄者。当寒凉以泻心肺。衄后眩晕者。十全大补汤。流而不止者。用百草霜。或人
中末。或胎发灰。或莱菔汁。或山栀末。或葱汁吹滴鼻内。再以韭根、葱白。捣如枣核大。塞鼻中。或用茅根烧
烟酒醋吸气。或用湿纸搭顶门。或用大蒜捣贴足心。皆法之验而可试者。（汇补）
【附呕血】
经云。怒则气逆。甚则呕血。宜抑怒以全阴。否则五志之火动极。不治。四物汤去川芎。加丹皮、韭汁、童便、青
皮、香附、郁金、山茶花治之。若六脉弦急。血菀于上。名曰薄厥。六郁汤治之。又有胸中气塞。便吐紫黑血块
者。此为痰血。宜消瘀解毒。不可止涩。变生别病。壮实者。用釜底抽薪法。（汇补）
【附咳血】
咳血者。火乘金位。肺络受伤。（指掌）热壅于肺则咳血。久嗽损肺。亦能咳血。壅于肺者易治。不过清之而已。
损于肺者难治。久成痨瘵。宜甘桔汤。加阿胶、黄芩、贝母、麦冬、茯苓、丹皮、生地、款冬、沙参主之。或天门冬丸。
（汇补）
【附咯血】
咯血属肾。或成疙瘩。或如红丝。在痰中唾中。咳咯而出。（东垣）多因心气虚耗。不能主血。血不归经。停留于
内。得咯而出。其症面色痿黄。五心烦热。（立斋）此是肺肾有伤。治宜滋阴降火。生地黄散主之。（入门）
【附唾血】
唾中带血。属在肾经。亦有瘀血内积。肺气壅遏。不能下降者。脉坚强者死。软滑者生。清唾汤主之。（汇补）
【附痰涎血】
痰中带血。多属脾经。须分痰血先后施治。先见血而后嗽痰者。此相火上炎。煎熬成痰。降火为主。若用消
痰。则血溢而不止。其先痰嗽而后见血者。是积热生痰。载血上行。清痰为要。若用血药。则痰滞而不行。（汇补）
【附齿衄】
有血从齿缝牙龈中出者。名曰齿衄。属阳明少阴二经症。从阳明者。龈肉腐烂。痛甚口臭。齿不动摇。由好
饮及膏粱积热所致。从少阴者。齿浮动脱落。口不臭。由好色火旺水亏所致。其属阳明者。服清胃散。热甚
者。承气汤。外敷石膏散。属少阴者。六味丸。加黄柏、骨碎补。阳虚者。八味丸。外敷雄鼠骨散。或青盐炒香附
擦之。外治用烧盐、釜墨二物研匀。临卧擦牙漱口亦佳。（汇补）
【附肌衄】
有皮毛节次出血。少间不出。即皮胀如鼓。口鼻眼目俱皆胀合。名曰脉溢。以姜汁和水。各一二盏饮之。（类案）
【附 血】
有膝腕后委中穴。搔之血出不止。谓之 血。此肾与膀胱虚热也。
吐血选方
四物汤 统治血症。
归脾汤 收功调补者用之。
六味丸 阴虚火动者用之。
八味丸 阳虚水泛者用之。（以上四方俱见中风）
理中汤 阳虚阴走者用之。（方见中寒）
独参汤 血脱益气者用之。
人参分量随定。须拣上等者。清水浓煎顿服。
犀角地黄汤 上病疗下之方。
当归 丹皮 犀角（各一钱） 生地（四钱）
一方用大黄、黄芩、黄连。
门冬饮子 治气虚不能摄血。
麦冬 五味子 人参 当归 黄 生地
水煎。
生地黄散 清上滋下之方。
生地 熟地 枸杞 地骨皮 天冬 白芍 甘草 黄芩 黄
天门冬丸
天冬 阿胶 甘草 贝母 茯苓 杏仁
炼蜜丸。
四生丸
生荷叶 生艾叶 生柏叶 生地
等分。捣烂。每服一钱。水煎。
清胃散 治阳明胃火。
黄连 生地 当归（各三分） 升麻（一钱） 丹皮（五分）
水煎。冷服。
三黄补血汤 阳生阴长之方。
熟地（二钱） 生地（三钱） 黄 丹皮 川芎 升麻（各一钱） 当归 柴胡（各一钱五分） 白芍（五钱）
清唾汤 治唾中带血。随唾而出。
知母 贝母 桔梗 黄柏 熟地 玄参 远志 天冬 麦冬（各等分） 炮姜（减半）
水煎。
又方 用芦根汁、藕节汁、梨汁和童便饮之。
【大意】
心脏主宰血液，但不能贮藏血液。夜间，血液回归肝脏。肝脏贮藏血液，但不能主宰血液。白天，肝脏听从心脏的指挥。心脏为君主之官，肝脏为宰相之官。君火一旦发动，相火便随之而动。相火一旦发动，六经的火邪便随之而起。火热内动，血液便随之妄行；火势上炎，血液便随之上逆。（出自《指掌》）
【内因】
或者是四时外感邪气损伤体表，或者是七情内伤扰动脏腑，以及饮食不节、房事过度、跌仆闪挫和劳力损伤。（出自《三锡》）导致六经受伤，血液流溢汇聚，积聚在胸膈和两胁之间，乘火势而上逆。（出自《指掌》）从胃脘部涌出。（出自《入门》）伤势严重者，血液夹带背部向上涌出，如潮水般汹涌而至，势头猛烈无法遏制。（出自《指掌》）
【外候】
肺胃积热者，必然胸部胀满，脉象实大。大怒气逆者，必然面色发青，脉象弦紧。阳虚导致血液外泄者，必然伴有虚寒、畏冷。阴虚导致虚火上亢者，必然出现气喘咳嗽、烘热感。劳心过度不能统摄血液者，必然心烦躁闷。劳力过度不能固摄血液者，必然自汗、倦怠乏力。郁结伤脾，忧思恼怒导致食欲不振。劳伤肺气，久咳无痰。气虚不能统摄血液者，血液散漫不成形；瘀血停滞蓄积者，血液结成块状。热郁在上焦者，血色必紫暗；虚火起于下焦者，血色必鲜红。感受寒邪使血液凝泣者，血色黑中有斑点。肺生痈疽者，血液中必兼有脓液。先有痰后带血者，多为痰火积热；先有血后带痰者，多为阴虚火旺。饮食过饱胸闷而吐血者，必然是食物损伤胃脘导致运化失常。饮酒过量醉酒而吐血者，必然是酒毒损伤清道导致血液妄行。（出自《汇补》）
【血分浮沉】
将吐出的血放入水中，漂浮在水面上的，是肺血；沉在水底的，是肝血；半浮半沉的，是心血；颜色赤红如太阳般的，是肾血。各随其出现的症状进行参合判断。（出自《摘玄》）
【血分顺逆】
凡是血液上越表现为呕吐的，都属于逆证，治疗困难。后来转变为下行表现为腹泻恶臭的，属于顺证，治疗容易。（出自李东垣）
【血分阴阳】
血症患者身体发热且多口渴，脉象大的，这是火邪盛的表现，治疗困难。身体凉爽且不口渴，脉象平静的，这是正气恢复的表现，治疗容易。
【危症】
如果心肺脉象破裂，血液像涌泉一样喷出，口鼻同时流血，呼吸急促、冷汗淋漓的，病情危重。
【脉法】
脉象呈现诸濡弱，是失血的表现；芤脉是失血的表现；涩脉是血少的表现；牢脉是瘀血蓄积的表现。大致而言，脉象沉弱滑小的预后良好（生）；脉象实大弦牢的预后不良（死）。关脉和尺脉的脉象弦细如同触摸刀刃一样的，预后不良（死）。
【治血大法】
凡是血液从上窍溢出，都是阳盛阴虚，只有升发没有降敛，都应当滋补阴液以抑制阳气，气机下降则血液自然归经。（出自《纂要》）
【虚中实法】
如果在大量饮酒、饱食、大怒或极度劳累之后，突然吐血，应当降气，不宜单纯降火；应当活血，不宜单纯止血；应当补肝，不宜伐肝。（出自《经疏》）
【虚中虚法】
如果有素体虚损的病根，而时常出现出血症状的，应当用甘寒药物凉血，辛平药物行气，酸味药物收敛以堵塞出血之源，甘温药物收补以巩固其后。（出自《入门》）
【服童便法】
凡是血症服用寒凉药物，往往百无一活；饮用尿液（童便）则百无一死。（出自褚澄）大概因为尿液能降火滋阴，又能消除瘀血并止住吐血和鼻衄。
【见黑止法】
血热则运行，血冷则凝固。见到黑色就能止血，这是必然的道理。（出自《神书》）所以止血的药物，必须炒成黑色，这是因为水能制火的道理。（出自《汇补》）
【瘀血宜消】
血液不可单独使用行血或止血的单一方法。因为血液涌来未多时，必有瘀血停滞在胸膈。应当先消除瘀血，并辅以润下的药物，使败血下行，然后再服用止血药以巩固根本，使用补血药以恢复元气。（出自《指掌》）
【血虚宜补】
如果吐血日久不止，应当使用温补药物来健脾理胃，使脾胃调和则能裹摄血液。如果暴发性吐血不止，应当用人参、白术，以紧急固护元阳。这是“血脱益气”、“阳生阴长”的道理。（出自《医贯》）
【势急从治】
凡是吐血非常严重，势头难以遏制的，这是因为火性急速。如果泛用凉药，反而会增加搏击之势。应当采用“从治”法（反佐法），使用炒黑的干姜末，用童便调服。（出自《六要》）
【血家治禁】
劳伤误用寒凉药物，会导致胸部胀满、膈间疼痛，血液更加郁滞。阴火误用燥热药物，会导致血液更加枯竭，形成痨瘵。跌仆闪挫导致气逆气郁，误用补涩药物，则瘀血蓄积在胃，心下胀满，吃入即吐，名叫“血逆”。瘀血蓄积在脾，大腹膨胀，逐渐形成鼓胀，名叫“血蛊”。（出自《汇补》）
【用药】
主方用四物汤去掉川芎，以消除瘀血；加入牡丹皮、茶花、韭菜汁、童便，以清热；加入玄参、黄芩、麦冬，以降气；加入苏子、枇杷叶，以行血；加入牛膝、丹参，以止涩；加入蒲黄、牛膝、藕节，以通导；加入大黄、桃仁。这是常规治法。如果暴发性吐血不止，气随血脱，那么四物汤等方剂就不够了，应当用独参汤追复元阳。如果是真阴失守，血液随火沸腾，那么人参、附子等药物尤其不适宜，应当用地黄汤加入五味子来滋生化之源。如果是肾中阳虚，下寒上热，应当用八味丸以引火归源。这些关于阴阳虚实的关键机理，最需谨慎审察。如果久吐不止，可以加入白及末服用。古人也有用猪肺或羊肺蘸着吃的。
【吐衄咳咯血辨】
吐血出于胃，走的是浊道；衄血出于经络，走的是清道。喉与咽二者是不同的。所谓经络，是运行的通道，经络中的血液运行而不固守，随着气而行。火性急速，所以顺着经络直犯清道而从鼻而出。如果不从鼻出，则挟带火邪侵犯肺金，渗入肺窍，而从咽部出来成为咳咯。胃中的血液是营血，守而不走，存留于胃中。胃气受损，不能摄血，所以令人呕吐，从喉咙而出到口中。（出自《汇补》）
【附衄血】
肺开窍于鼻，能引起衄血。然而肺经多气少血，只有冲脉和任脉，被称为血海，附着于阳明经。阳明的经脉，上交于鼻额部位，又是多血少气的地方。所以火起于冲任，血液流入阳明，这种衄血又属于胃经。大致而言，劳伤元气，阴虚火动，逆乱于肺而衄血的，应当凉血散气；逆乱于胃而衄血的，应当清胃生脉。如果六脉弦细而涩，面色枯白无光泽的，这是脱血大虚而挟寒，应当用甘温药物补血。如果六脉洪大而虚，面赤心慌易惊的，这是心火上炎而血溢，应当用甘寒药物凉血。有下虚上盛而衄血的，应当用辛温药物补命门。有上焦积热而衄血的，应当用寒凉药物泻心肺。衄血后眩晕的，用十全大补汤。血流不止的，用百草霜，或者人中白末，或者胎发灰，或者莱菔汁，或者山栀末，或者葱汁吹滴入鼻内。再用韭根、葱白，捣成枣核大小，塞入鼻中。或者用茅根烧烟，吸入醋气。或者用湿纸贴在头顶百会穴。或者用大蒜捣烂贴敷足心。这些都是有效且可尝试的方法。（出自《汇补》）
【附呕血】
经文说：愤怒则气逆，严重时呕血。应当抑制怒气以保全阴液，否则五志之火动极，将无法治愈。用四物汤去掉川芎，加入牡丹皮、韭菜汁、童便、青皮、香附、郁金、山茶花治疗。如果六脉弦急，血液郁积于上部，名叫薄厥，用六郁汤治疗。又有胸中气塞，吐出紫黑血块的，这是痰血，应当消除瘀血解毒，不可止涩，以免变生其他疾病。体质壮实的，用釜底抽薪法。（出自《汇补》）
【附咳血】
咳血，是火邪乘袭肺金之位，肺络受伤。（出自《指掌》）热邪壅塞于肺则咳血，久嗽损伤肺脏，也能咳血。壅塞于肺的容易治疗，不过清肺而已。损伤于肺的难治，久则成为痨瘵。宜用甘桔汤，加入阿胶、黄芩、贝母、麦冬、茯苓、牡丹皮、生地、款冬花、沙参主治。或者用天门冬丸。（出自《汇补》）
【附咯血】
咯血属于肾经。或者结成疙瘩，或者像红丝，在痰液中唾液中，咳咯而出。（出自李东垣）多因心气虚耗，不能主宰血液，血液不归经，停留于体内，得咯而出。其症状是面色萎黄，五心烦热。（出自薛立斋）这是肺肾有伤，治疗应当滋阴降火，用生地黄散主治。（出自《入门》）
【附唾血】
唾液中带有血液，病位在肾经。也有瘀血内积，肺气壅遏，不能下降的情况。脉象坚强有力的预后不良（死），脉象软滑的预后良好（生）。用清唾汤主治。（出自《汇补》）
【附痰涎血】
痰中带血，多属于脾经。必须区分痰和血的先后顺序施治。先见血而后咳嗽吐痰的，这是相火上炎，煎熬津液成痰，以降火为主。如果用消痰药，则血液溢出而不止。其先痰嗽而后见血的，是积热生痰，载血上行，以清痰为要。如果用治血药，则痰滞而不行。（出自《汇补》）
【附齿衄】
有血液从齿缝牙龈中出来的，名叫齿衄。属于阳明、少阴二经病症。属于阳明的，牙龈腐烂，疼痛剧烈口臭，牙齿不松动，由喜好饮酒及膏粱厚味积热所致。属于少阴的，牙齿浮动脱落，口不臭，由喜好色欲火旺水亏所致。属于阳明的，服用清胃散，热甚的用承气汤，外用石膏散敷贴。属于少阴的，用六味丸，加入黄柏、骨碎补。阳虚的用八味丸，外用雄鼠骨散，或者用青盐炒香附擦牙。外治法用烧盐、釜墨两种药物研匀，临睡前擦牙漱口也很好。（出自《汇补》）
【附肌衄】
有皮毛依次出血，稍后不出，随即皮肤肿胀如鼓，口鼻眼目全部胀合，名叫脉溢。用姜汁和水，各一二盏饮用。（出自《类案》）
【附 血】
有在膝腕后方委中穴处，搔抓后血液不止，谓之 血。这是肾与膀胱虚热所致。
【吐血选方】
四物汤：统治各种血症。
归脾汤：用于收功调补者。
六味丸：用于阴虚火动者。
八味丸：用于阳虚水泛者。（以上四方均见于中风章节）
理中汤：用于阳虚阴走者。（方剂见中寒章节）
独参汤：用于血脱益气者。
人参分量根据情况确定，须挑选上等者，清水浓煎顿服。
犀角地黄汤：上病疗下的方剂。
当归、丹皮、犀角（各一钱）、生地（四钱）。
一方用大黄、黄芩、黄连。
门冬饮子：治疗气虚不能摄血。
麦冬、五味子、人参、当归、黄芪、生地。
水煎服。
生地黄散：清上滋下的方剂。
生地、熟地、枸杞、地骨皮、天冬、白芍、甘草、黄芩、黄芪。
天门冬丸
天冬、阿胶、甘草、贝母、茯苓、杏仁。
炼蜜为丸。
四生丸
生荷叶、生艾叶、生柏叶、生地。
等分，捣烂。每服一钱，水煎服。
清胃散：治疗阳明胃火。
黄连、生地、当归（各三分）、升麻（一钱）、丹皮（五分）。
水煎，冷服。
三黄补血汤：阳生阴长的方剂。
熟地（二钱）、生地（三钱）、黄芪、丹皮、川芎、升麻（各一钱）、当归、柴胡（各一钱五分）、白芍（五钱）。
清唾汤：治疗唾中带血，随唾而出。
知母、贝母、桔梗、黄柏、熟地、玄参、远志、天冬、麦冬（各等分）、炮姜（减半）。
水煎服。
又方：用芦根汁、藕节汁、梨汁和童便饮用。
[General Principles]
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, the Liver obeys the commands of the Heart. The Heart is the Sovereign (Jun), and the Liver is the Minister (Xiang). When the Sovereign Fire moves, the Minister Fire follows. When the Minister Fire moves, the fire of the Six Channels follows. When fire moves internally, blood follows in its movement; when fire rises, blood follows in its ascent. (From *Zhi Zhang*)
[Internal Causes]
It may be caused by external injuries from the Four Qi (seasonal pathogens) or internal disturbances from the Seven Emotions, as well as improper diet, excessive sexual activity, falls, sprains, and overexertion. (From *San Xi*) These injure the Six Channels, causing blood to flow and gather between the chest/diaphragm and the hypochondrium, rising with the fire. (From *Zhi Zhang*) It erupts from the stomach epigastrium. (From *Ru Men*) In severe cases, it rises along the back, surging like a tide, unstoppable. (From *Zhi Zhang*)
[External Manifestations]
Those with accumulated heat in the Lung and Stomach will necessarily have chest fullness and a large, excess pulse. Those with great anger and rebellious qi will necessarily have a greenish face and a string-taut pulse. Those with Yang deficiency leading to blood escaping externally will necessarily have deficiency-cold and aversion to cold. Those with Yin deficiency leading to hyperactive deficient fire will necessarily have panting, coughing, and hot flashes. Those who overwork the mind and cannot govern blood will necessarily have vexation and restlessness. Those who overwork the body and cannot secure blood will necessarily have spontaneous sweating and fatigue. Depression injuring the Spleen leads to worry, resentment, and poor appetite. Overworking the Lung Qi leads to chronic cough without phlegm. When Qi deficiency fails to control blood, the blood is scattered; when stasis accumulates, the blood forms clots. Heat stagnating in the upper jiao results in purple blood; deficient fire arising from the lower jiao results in bright red blood. Cold contracting causes blood to congeal, appearing black with spots. Lung abscesses result in blood mixed with pus. Blood preceded by phlegm indicates phlegm-fire accumulation; blood followed by phlegm indicates hyperactive Yin-deficient fire. Vomiting blood after overeating and bloating indicates food injury to the stomach impairing transformation. Vomiting blood after drunkenness indicates alcohol damaging the clear pathways causing reckless blood flow. (From *Hui Bu*)
[Float and Sink of Blood]
If vomited blood is placed in water, that which floats is Lung blood; that which sinks is Liver blood; that which is half-floating and half-sinking is Heart blood; that which is red like the sun is Kidney blood. Each should be correlated with the presenting symptoms. (From *Zhai Xuan*)
[Smooth and Adverse Course of Blood]
Generally, blood ascending and vomiting is an adverse condition, difficult to treat. If it later transforms into downward flow with foul diarrhea, it is a smooth condition, easy to treat. (From Li Dongyuan)
[Yin and Yang of Blood Disorders]
In blood disorders, if the body is hot and thirsty with a large pulse, this indicates victorious pathogenic fire, making treatment difficult. If the body is cool, not thirsty, and the pulse is calm, this indicates recovery of healthy Qi, making treatment easy.
[Critical Conditions]
If the pulses of the Heart and Lung are ruptured, blood spurts like a fountain, flowing from both mouth and nose, accompanied by shortness of breath and cold sweat, the condition is critical.
[Pulse Diagnosis]
A damp and weak pulse indicates loss of blood; a knotted (Kou) pulse indicates hemorrhage; a choppy (Se) pulse indicates insufficient blood; a firm (Lao) pulse indicates stored blood. Generally, sinking, weak, slippery, and small pulses indicate survival; excess, large, string-taut, and firm pulses indicate death. A string-taut and thin pulse at the Guan and Chi positions, feeling like touching a blade, indicates death.
[General Principles for Treating Blood]
Whenever blood escapes from the upper orifices, it is due to excess Yang and deficiency Yin, with only ascending and no descending. Treatment should always tonify Yin to suppress Yang; when Qi descends, blood naturally returns to its vessels. (From *Zuan Yao*)
[Treating Deficiency with Excess Methods]
If sudden hematemesis occurs after heavy drinking, overeating, great anger, or extreme labor, one should descend Qi rather than merely clear fire; move blood rather than merely stop bleeding; tonify the Liver rather than attack the Liver. (From *Jing Shu*)
[Treating Deficiency with Deficiency Methods]
If there is a root of chronic deficiency and frequent bleeding, use sweet-cold herbs to cool blood, pungent-neutral herbs to move Qi, sour herbs to astringe and block the source, and sweet-warm herbs to tonify and consolidate the aftermath. (From *Ru Men*)
[Method of Drinking Child's Urine]
For blood disorders, taking cold-natured drugs often leads to death (one in a hundred survives); drinking urine (child's urine) rarely leads to death (one in a hundred dies). This is because urine descends fire, nourishes Yin, eliminates blood stasis, and stops vomiting and epistaxis. (From Chu Cheng)
[Method of Blackening to Stop Bleeding]
Blood flows when hot and coagulates when cold. Seeing black stops bleeding; this is inevitable logic. (From *Shen Shu*) Therefore, hemostatic herbs must be charred black, based on the principle that Water controls Fire. (From *Hui Bu*)
[Stasis Should Be Dissolved]
Blood cannot be treated solely by moving or stopping methods. Since blood has not yet flowed excessively, there must be stasis in the chest and diaphragm. One should first dissolve stasis, assisting with moistening and purgative agents to send down the failed blood, then take hemostatics to secure the root, and blood-tonics to restore original vitality. (From *Zhi Zhang*)
[Blood Deficiency Should Be Tonified]
If vomiting persists for a long time, use warm tonics to strengthen and regulate the Spleen and Stomach so that harmonious Spleen can contain blood. If violent vomiting persists, use Ginseng and Atractylodes to urgently secure Yuan Yang. This follows the principle of "tonifying Qi in blood loss" and "Yang generates Yin." (From *Yi Guan*)
[Emergency Treatment Following the Pathogen]
When hematemesis is extremely severe and hard to stop, this is due to the rapid nature of fire. Using cold drugs indiscriminately may increase conflict. One should use the "following treatment" method (counter-directional therapy), using charred dried ginger powder mixed with child's urine. (From *Liu Yao*)
[Contraindications for Blood Patients]
Using cold-natured drugs for劳伤 (labor injury) causes chest fullness and diaphragmatic pain, worsening blood stagnation. Using dry-hot drugs for Yin fire causes blood depletion, leading to consumption disease. For falls/sprains causing Qi rebellion/stagnation, using astringents causes blood stasis in the Stomach, leading to subcardiac fullness and immediate vomiting upon eating, named "Blood Rebellion." Stasis in the Spleen causes abdominal distension progressing to drum-like tides, named "Blood Ascites." (From *Hui Bu*)
[Medication]
The main formula is Si Wu Tang removing Chuanxiong to dissolve stasis; add Moutan, tea flowers, leek juice, and child's urine to clear heat; add Scrophularia, Scutellaria, and Ophiopogon to descend Qi; add Perilla seed and Loquat leaf to move blood; add Achyranthes and Salvia to astringe; add Polygonum, Achyranthes, and lotus node to conduct; add Rhubarb and Peach Kernel. This is the standard method. If violent vomiting persists and Qi escapes with blood, Si Wu Tang is insufficient; use Du Shen Tang to recover Yuan Yang. If True Yin is lost and blood boils with fire, Ginseng and Aconite are unsuitable; use Di Huang Tang with Schisandra to nourish the source of transformation. If Kidney Yang is deficient with lower cold and upper heat, use Ba Wei Wan to guide fire back to its source. These mechanisms of Yin/Yang and Excess/Deficiency require careful examination. For chronic vomiting, add Bletilla powder. Ancients also used pig or sheep lungs dipped in medicine.
[Differentiation of Hematemesis, Epistaxis, Coughing Blood, and Spitting Blood]
Hematemesis originates from the Stomach, traveling through the turbid pathway. Epistaxis originates from the meridians, traveling through the clear pathway. The throat and pharynx are different. Meridians are pathways where blood flows freely without staying put, moving with Qi. Due to the rapid nature of fire, it attacks the clear pathway directly and exits via the nose. If it does not exit via the nose, it carries fire to invade Metal (Lung), seeping into lung orifices and exiting via the pharynx as coughing/spitting. Stomach blood is Ying (Nutrient) blood, guarding and not flowing freely, stored in the Stomach. Stomach Qi injury impairs its ability to control blood, causing vomiting out through the throat and mouth. (From *Hui Bu*)
[Appendix: Epistaxis]
The Lung opens into the nose and can cause epistaxis. However, the Lung meridian has much Qi and little Blood. Only the Chong and Ren meridians are called the Sea of Blood, attaching to the Yangming meridian. Yangming meridians connect above to the nose and forehead and are regions of much Blood and little Qi. Thus, fire arising in Chong/Ren causes blood to flow in Yangming; this type of epistaxis belongs to the Stomach meridian. Generally, for epistaxis due to Qi injury, Yin deficiency, and fire rebelling into the Lung, use cooling-blood and dispersing-Qi methods. For epistaxis due to rebellion into the Stomach, use clearing-Stomach and generating-Mai methods. If all six pulses are string-taut, thin, and choppy with sallow, dull complexion, this is massive blood loss with deficiency and cold; use sweet-warm blood tonics. If pulses are large, empty, with red face, palpitations, and fright, this is Heart fire flaming upward causing blood overflow; use sweet-cold cooling-blood methods. For lower deficiency and upper excess causing epistaxis, use pungent-warm to tonify Mingmen. For upper Jiao accumulated heat causing epistaxis, use cold-cool to drain Heart/Lung. For vertigo after epistaxis, use Shi Quan Da Bu Tang. For continuous flow, use Bai Cao Shuang, Ren Zhong Bai powder, fetal hair ash, radish juice, gardenia powder, or scallion juice blown into the nose. Stuff mashed leek roots and scallion whites (date-sized) into the nose. Inhale smoke from burning mugwort roots with vinegar. Place wet paper on the Baihui point. Apply mashed garlic to the Yongquan point. These are effective trial methods. (From *Hui Bu*)
[Appendix: Vomiting Blood]
The Classic states: Anger causes Qi rebellion; severely, it causes vomiting blood. Suppress anger to preserve Yin; otherwise, extreme movement of the Five Zhi fires is incurable. Use Si Wu Tang removing Chuanxiong, adding Moutan, leek juice, child's urine, Qingpi, Cyperus, Curcuma, and Camellia flower. If six pulses are string-taut and urgent, with blood stagnating upwards, named Bo Jue, use Liu Yu Tang. For chest Qi obstruction with vomiting of purple-black clots, this is Phlegm-Blood; dissolve stasis and resolve toxicity, do not astringe, to avoid other diseases. For robust constitutions, use the "drawing fire from under the cauldron" method. (From *Hui Bu*)
[Appendix: Coughing Blood]
Coughing blood is fire attacking the Metal position, injuring Lung collaterals. (From *Zhi Zhang*) Heat congesting the Lung causes coughing blood; chronic cough damaging the Lung also causes coughing blood. Congestion in the Lung is easy to treat, merely clearing it. Damage to the Lung is difficult, becoming consumption over time. Use Gan Jie Tang adding Donkey-hide gelatin, Scutellaria, Fritillaria, Ophiopogon, Poria, Moutan, Rehmannia, Adenophora, and Glehnia. Or use Tian Men Dong Wan. (From *Hui Bu*)
[Appendix: Spitting Blood]
Spitting blood belongs to the Kidney meridian. It may form nodules or look like red threads, present in phlegm or saliva, expelled by spitting. (From Li Dongyuan) Often due to Heart Qi deficiency failing to govern blood, blood not returning to vessels, stagnating internally, and being spat out. Symptoms include sallow complexion and five-palm heat. (From Xue Lijiaz) This indicates Lung/Kidney injury; treat by nourishing Yin and descending fire, using Sheng Di Huang San. (From *Ru Men*)
[Appendix: Saliva with Blood]
Saliva containing blood belongs to the Kidney meridian. It may also be due to internal blood stasis obstructing Lung Qi, preventing descent. Strong/firm pulses indicate death; soft/smooth pulses indicate life. Use Qing Tuo Tang. (From *Hui Bu*)
[Appendix: Phlegm-Saliva with Blood]
Phlegm containing blood mostly belongs to the Spleen meridian. Treatment depends on whether blood or phlegm appears first. If blood appears before coughing phlegm, this is Minister fire flaming upward, refining fluids into phlegm; focus on descending fire. Using phlegm-resolving drugs will cause blood to overflow uncontrollably. If phlegm-cough appears before blood, this is accumulated heat generating phlegm carrying blood upward; focus on clearing phlegm. Using blood-acting drugs will cause phlegm stagnation. (From *Hui Bu*)
[Appendix: Gum Bleeding]
Bleeding from gum fissures is named Gum Epistaxis (Chi Nu), belonging to Yangming and Shaoyin meridians. Yangming type: gum rot, severe pain, bad breath, teeth not loose, caused by alcohol and rich food heat. Shaoyin type: loose/falling teeth, no bad breath, caused by sexual excess, fire excess, and water deficiency. Yangming type: take Qing Wei San; for severe heat, Cheng Qi Tang; externally apply Gypsum Powder. Shaoyin type: Liu Wei Wan adding Phellodendron and Drynaria. Yang deficiency: Ba Wei Wan; externally apply Male Rat Bone Powder or stir-fried Ligusticum with rock salt. External treatment: mix burnt salt and soot, rub teeth before bed and rinse. (From *Hui Bu*)
[Appendix: Cutaneous Purpura]
Bleeding sequentially from skin pores, stopping briefly, then skin swells like a drum, eyes/nose/mouth close due to swelling, named Mai Yi. Drink ginger juice mixed with water, 1-2 cups. (From *Lei An*)
[Appendix: [Missing Character] Blood]
Scratching the Weizhong acupoint behind the knee/ankle causes continuous bleeding, named [Missing Character] Blood. This is deficiency-heat in Kidney and Bladder.
[Selected Formulas for Hematemesis]
Si Wu Tang: Governs all blood disorders.
Gui Pi Tang: Used for concluding treatment and regulation/tonification.
Liu Wei Wan: Used for Yin deficiency with fire hyperactivity.
Ba Wei Wan: Used for Yang deficiency with water flooding. (All four formulas seen in Stroke chapter)
Li Zhong Tang: Used for Yang deficiency with Yin wandering. (Formula seen in Cold Injury chapter)
Du Shen Tang: Used for tonifying Qi in blood loss.
Ginseng dosage varies; select top grade, decoct strongly in clear water, take in one dose.
Xi Jiao Di Huang Tang: Formula treating upper disease by addressing lower.
Dang Gui, Dan Pi, Xi Jiao (each 1 qian), Sheng Di (4 qian).
Another prescription uses Da Huang, Huang Qin, Huang Lian.
Men Dong Yin Zi: Treats Qi deficiency failing to control blood.
Mai Dong, Wu Wei Zi, Ren Shen, Dang Gui, Huang Qi, Sheng Di.
Decoct in water.
Sheng Di Huang San: Formula clearing upper and nourishing lower.
Sheng Di, Shu Di, Gou Qi, Di Gu Pi, Tian Dong, Bai Shao, Gan Cao, Huang Qin, Huang Qi.
Tian Men Dong Wan
Tian Dong, E Jiao, Gan Cao, Bei Mu, Fu Ling, Xing Ren.
Refined honey pills.
Si Sheng Wan
Sheng He Ye, Sheng Ai Ye, Sheng Bai Ye, Sheng Di.
Equal parts, mash. Take 1 qian per dose, decoct in water.
Qing Wei San: Treats Yangming Stomach fire.
Huang Lian, Sheng Di, Dang Gui (each 3 fen), Sheng Ma (1 qian), Dan Pi (5 fen).
Decoct, take cold.
San Huang Bu Xue Tang: Formula for Yang generating Yin.
Shu Di (2 qian), Sheng Di (3 qian), Huang Qi, Dan Pi, Chuan Xiong, Sheng Ma (each 1 qian), Dang Gui, Chai Hu (each 1.5 qian), Bai Shao (5 qian).
Qing Tuo Tang: Treats blood in saliva coming out with spit.
Zhi Mu, Bei Mu, Jie Geng, Huang Bo, Shu Di, Xuan Shen, Yuan Zhi, Tian Dong, Mai Dong (equal parts), Pao Jiang (half amount).
Decoct in water.
Another prescription: Drink reed rhizome juice, lotus node juice, pear juice mixed with child's urine.