世人患吐衄者多，而洁古则曰∶见血无寒。东垣亦云∶诸见血皆责于热。丹溪亦曰∶血无火不升。三
家之论出，而世之治吐衄者，皆以滋阴降火为法矣。岂知《内经》论血溢、血泄，六淫皆有，故《纲目》序失血症，独
载运气六淫之邪。王海藏云∶六气能使人失血，不独一火。此语大发千古聋聩。夫六气使人失血，此为外感之邪言也。
然外邪之来，未有不由于内伤者。如忧愁思虑则伤心，饮食劳倦则伤脾，持重远行则伤肝，形寒饮冷则伤肺，入房过度
则伤肾。五脏有伤，而后外邪乘虚袭入。故凡治失血，必先审其为风、为寒、为暑、为湿、为燥、为火，先清外感，
次理内伤，则邪易伏而易疗。若不先治标，而即救本，凡一切失血专主一火，日事芩、连、知、柏、山
栀、生地、丹皮为治，未见其能愈人也。血得热则行，得寒则凝。寒凉之剂日进，而血之屡止屡发者，往往而
剧。此吐血之病之死，不死于病而死于医也。悲哉！
眩者，头晕也，眼有黑花，如立舟车之上，而旋转者是也。刘河间专主于火，谓肝木自病。经云∶诸
风掉眩，皆属于肝。肝风动而火上炎也。故丹溪尝言无火不生痰，痰随火上，故曰无痰不作眩。夫眩，病
也。痰，非病也。痰非人身素有之物。痰者，身之津液也。气滞、血凝，则津液化而为痰，是痰因病而生
者也。若云无痰不作眩，似以痰为眩病之本矣。岂知眩晕之来也，有气虚而眩，有血虚而眩，有肾虚而眩。气虚者，阳
气衰乏，则清阳不上升。经云∶上气不足，头为之苦倾是也。血虚者，吐衄、崩漏、产后血脱，则虚火上炎，眼生黑花。
经云∶肝虚则目 无所见是也。肾虚者，房欲过度，则肾气不归元而逆奔于上。经云∶ 蒙招尤目瞑，上实下虚，过
在足少阴、巨阳。又云∶髓海不足，目为之眩是也。风火之眩晕属外感，三虚之眩晕本内伤。其云痰而作眩
者，必内外合邪而后痰聚而为害，非竟主乎痰而可以为眩也。若一纯攻痰，而不大补气血、壮水滋阴，以
救其本，病未有不毙者也。
世人患吐血、鼻衄（鼻出血）的很多，而李东垣（洁古）却说：见到出血就没有寒证。朱丹溪也说：凡是出血都归咎于热邪。这三家的言论一出，世间治疗吐血、鼻衄的人，都把滋阴降火作为治疗方法了。哪里知道《黄帝内经》论述血溢、血泄，六淫（风、寒、暑、湿、燥、火六种外感病邪）都能导致，所以《本草纲目》在叙述失血症时，唯独记载了运气学说中的六淫之邪。王海藏说：六气都能使人失血，不仅仅只有火邪。这句话极大地唤醒了千古以来的蒙昧。六气使人失血，这是针对外感邪气而言的。然而外邪的到来，没有不是由于内伤引起的。比如忧愁思虑会伤心，饮食劳倦会伤脾，负重远行会伤肝，形体受寒或饮用冷物会伤肺，房事过度会伤肾。五脏有了损伤，然后外邪才会乘虚侵袭进来。所以凡是治疗失血，必须先审察是风、寒、暑、湿、燥、火哪种邪气所致，先清除外感，再调理内伤，这样邪气容易平息且容易治愈。如果不先治标，就直接救本，凡是一切失血都专门主张是火邪，每天使用黄芩、黄连、知母、黄柏、山栀、生地、丹皮来治疗，没见能治好人的。血遇热则运行，遇寒则凝结。寒凉的药物每天服用，而血却屡次止住又发作，往往病情加剧。这吐血病的死亡，不是死于疾病本身，而是死于医生的误治啊！可悲啊！
眩，就是头晕，眼前出现黑花，像坐在船车之上，感到旋转的症状。刘河间专门主张火邪，认为肝木自病。经书说：各种风症引起的动摇眩晕，都归属于肝。肝风发动而火气上炎。所以丹溪曾经说没有火就不会生痰，痰随着火气上行，所以说没有痰就不会发生眩晕。眩，是一种病；痰，不是一种病。痰不是人体原本就有的东西。痰，是人体的津液。气机阻滞、血液凝滞，津液就会化而为痰，这是因生病而产生的痰。如果说没有痰就不会发生眩晕，似乎把痰当作眩晕病的根本了。哪里知道眩晕的发生，有因气虚而眩晕的，有因血虚而眩晕的，有因肾虚而眩晕的。气虚的人，阳气衰少，清阳之气不能上升。经书说：上部之气不足，头部就会痛苦地倾斜下垂。血虚的人，吐血、鼻衄、崩漏（非经期大量阴道出血）、产后失血过多，导致虚火上炎，眼睛生出黑花。经书说：肝虚则眼睛看不清东西。肾虚的人，房事过度，导致肾气不能归元而逆乱奔涌于上。经书说：头昏眼花视物不清，上实下虚，病位在足少阴肾经和足太阳膀胱经。又说：髓海不足，眼睛就会眩晕。风火引起的眩晕属于外感，三种虚损引起的眩晕根本在于内伤。那些说是痰引起眩晕的，一定是内外邪气结合后痰聚积才为害，并不是单纯以痰为主就能导致眩晕的。如果一味地攻伐痰邪，而不大补气血、壮水滋阴来挽救根本，病人没有不死亡的。
There are many people suffering from hematemesis (vomiting blood) and epistaxis (nosebleed), yet Jiegu (Li Gao) stated: "In cases of bleeding, there is no cold." Dongyuan also said: "All instances of bleeding should be attributed to heat." Danxi further remarked: "Blood does not ascend without fire." With the emergence of these three schools' theories, practitioners treating hematemesis and epistaxis universally adopted the method of nourishing yin and descending fire. Little did they know that the *Huangdi Neijing* (Yellow Emperor's Inner Canon) discusses blood overflow and leakage as being caused by all six exogenous pathogens (wind, cold, summer-heat, dampness, dryness, and fire). Therefore, in the preface to the chapter on hemorrhage in *Bencao Gangmu* (Compendium of Materia Medica), only the pathogenic factors of Six Qi from the theory of Five Movements and Six Qi were recorded. Wang Haizang stated: "The Six Qi can cause hemorrhage, not just fire alone." This statement greatly awakened the deafness and blindness of millennia. The assertion that Six Qi causes hemorrhage refers to exogenous pathogenic factors. However, the arrival of exogenous evils invariably stems from internal injury. For instance, sorrow and worry damage the Heart; improper diet and overwork damage the Spleen; carrying heavy loads or traveling long distances damages the Liver; exposure to cold or consuming cold drinks damages the Lung; and excessive sexual activity damages the Kidney. Once the Zang organs are injured, exogenous pathogens then invade due to deficiency. Thus, when treating hemorrhage, one must first ascertain whether it is caused by wind, cold, summer-heat, dampness, dryness, or fire. One must first clear the exogenous infection, and then address the internal injury, so that the pathogen can be subdued and the disease easily cured. If one fails to treat the branch (symptoms) first and immediately attempts to treat the root, assuming all hemorrhage is solely due to fire, and daily employing herbs such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Shanzhi (Gardeniae Fructus), Shengdi (Rehmanniae Radix), and Danpi (Moutan Cortex) for treatment, one will rarely see patients cured. Blood flows when heated and coagulates when cooled. As cold-natured remedies are administered daily, the bleeding stops and recurs repeatedly, often becoming more severe. The death of those with hematemesis is not due to the disease itself, but due to medical error. How tragic!
Xuan (vertigo/dizziness) refers to dizziness, visual obscurations described as black flowers before the eyes, and a sensation of rotation as if standing on a moving boat or cart. Liu Hejian exclusively emphasized fire, attributing it to self-disease of the Liver Wood. The Classics state: "All wind disorders involving tremors and vertigo belong to the Liver." When Liver wind stirs, fire flares upward. Hence, Danxi once said, "Without fire, phlegm is not generated"; phlegm follows the fire upward, hence the saying, "Without phlegm, there is no vertigo." Xuan is a disease; phlegm is not a disease. Phlegm is not something inherently present in the human body. Phlegm is transformed from the body's Jin-Ye (body fluids). When Qi stagnates and Blood coagulates, Jin-Ye transforms into phlegm; thus, phlegm is generated by disease. To say "without phlegm, there is no vertigo" implies that phlegm is the root cause of vertigo. However, one must realize that vertigo arises from Qi deficiency, Blood deficiency, or Kidney deficiency. In cases of Qi deficiency, Yang Qi is depleted, preventing Clear Yang from ascending. The Classics state: "When Qi above is insufficient, the head suffers from heaviness and tilting." In cases of Blood deficiency, due to hematemesis, epistaxis, metrorrhagia (profuse uterine bleeding), or postpartum blood loss, deficient fire flares upward, causing black spots in vision. The Classics state: "When the Liver is deficient, vision becomes obscured." In cases of Kidney deficiency, due to excessive sexual desire, Kidney Qi fails to return to its origin and rebels upward. The Classics state: "Dizziness and blurred vision indicate excess above and deficiency below, with pathology in the Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder) meridians." It also states: "When the Sea of Marrow is insufficient, the eyes suffer from vertigo." Vertigo caused by wind and fire belongs to exogenous infections, while vertigo caused by the three types of deficiency originates from internal injury. Those who attribute vertigo to phlegm believe that only when exogenous and endogenous pathogens combine does phlegm accumulate to cause harm; it is not merely phlegm alone that causes vertigo. If one solely attacks phlegm without significantly tonifying Qi and Blood, strengthening Water, and nourishing Yin to save the root, the patient will inevitably die.