吐血宜分阳症阴症者尤宜细辨盖吐血犯人浊道不比衄血之犯清道也清道者气道也浊道者
食道
也胃中无血而胃中有血吐血从口中而出者非胃中之血而何此血也因胃中有窍不闭而血乃妄行
然而此血非止胃经一经之血也盖心肝肺脾肾之血俱奔腾于胃腕之外而渗入于胃中胃不能藏所
以上涌而吐也然五脏之血俱不可伤而肾经尤甚一伤肾则经年累月而不可止遏矣盖胃为肾之关
关
门不闭而肾中之血自然上升于胃又理之易知者也然同是五脏之失血又何以辨其为阴为阳此又
有故盖吐血无火不能吐血而无水亦不能吐血也无火吐血人能知无水吐血人难测其故又何也吾
先
言其有火者胃本土也而实有火在胃无土气则吐变为火火存胃中自然挟血而上奔此阳火之焚非
水不能相济然而血乃有形之物一时倾盆而出欲急补其水一时既难收功不得不益其气使气生夫
血气生则气行气行则血止实有妙理存乎其间其症必口渴齿痛喉干目赤身热便可知为阳症之吐
血也治之法须用独参汤一两饮之最妙其次莫若当归补血汤之为更神倘二方之中能调之三七根
末
各三钱再加入荆芥炒黑者为末同前二方饮之立止断不再吐无奈世人不知妙法使吐血者致成痨
瘵未必非吾辈天医过于珍重方法不肯传人之咎也至于阴症何以辨之或一日而数口或经年而咳
嗽或痰中见丝或夜重而日无血迹或声哑而声嘶者是也治之法又不可专用参归黄 之品当改用
纯阴之味世医六味地黄汤加麦冬五味最为相宜但此等之病非一二剂可以速效人见六味汤之迂
缓而无近功也往往弃而不用遂至轻变重而重变亡吾今怜惜酌定神方可以长服而不必如六味丸
之必须服至三年也此方大半补阴少加阳药以生胃气又用归经止漏之品以塞其窍较六味汤
为更神且此药味平妥无有动性盖血症最恶动也
熟地（五钱） 山茱萸（三钱） 麦冬（五钱） 玄参（三钱） 天冬（一钱） 车前子（三钱） 荆芥（
炒黑三分） 人参（三分） 山药（五钱） 薏仁（一两） 百合（五钱） 三七根（末五分）水煎服
吐血应当区分阳证和阴证，尤其需要仔细辨别。因为吐血侵犯的是浊道，不同于衄血侵犯清道。所谓清道，是指气道；所谓浊道，是指食道。胃中如果没有血而胃中有血，从口中吐出来的，难道不是胃中的血吗？这是因为胃中有窍孔不闭合，导致血液妄行。
然而，这吐出的血并不仅仅是胃经一脏的血。因为心、肝、肺、脾、肾五脏之血都奔腾在胃脘之外，并渗入到胃中，胃不能藏纳这些血，所以上涌而吐出。但是五脏之血都不可损伤，其中肾经的损伤尤为严重。一旦损伤肾经，就会经年累月无法遏制。因为胃是肾的关隘，如果关门不闭，肾中之血自然上升于胃，这也是容易理解的道理。
然而同样是五脏失血，又凭什么来辨别它是阴证还是阳证呢？这里又有原因。盖因吐血若无火则不能吐血，而无水也不能吐血。对于有火的吐血，人们尚能知晓；对于无水的吐血，人们难以推测其缘故。为什么呢？我先说那有火的情况：胃属土，但胃中实有火存在。如果没有土气制约，呕吐就会变为火邪。火存于胃中，自然会挟带血液向上奔涌，这是阳火焚烧所致，非用水不能相济调和。然而血是有形之物，一时倾盆而出，想要急补其水，一时之间很难见效，不得不通过益气来生血。气生则气行，气行则血止，这其中实在有奥妙的道理。其症状必定表现为口渴、齿痛、喉干、目赤、身热，由此可知为阳证的吐血。治疗的方法，必须使用独参汤（人参单方），一两剂量服用最为奇妙。其次莫过于当归补血汤（当归、黄芪），更为神奇。如果在上述两方之中，加入三七根末各三钱，再加入炒黑后的荆芥（荆芥炭）研末，同前两种方剂一起服用，立时止血，断不再吐。无奈世人不知此妙法，致使吐血者最终发展成痨瘵（慢性消耗性疾病），这未必不是我们作为医生过于珍重方法而不肯传授给他人的过错。
至于阴证如何辨别呢？或者一天吐几次血，或者经年咳嗽，或者痰中带血丝，或者夜间加重而白天无血迹，或者声音嘶哑等症状，就是阴证的表现。治疗的方法，又不可以专用人参、当归、黄芪这类药物，应当改用纯阴性质的药物。世医常用的六味地黄汤（熟地黄、山茱萸、山药、泽泻、牡丹皮、茯苓）加麦冬、五味子最为适宜。但这种病并非一两剂药就能迅速见效，人们见六味地黄汤作用迂缓而没有近功，往往弃而不用，遂至轻症变重症，重症变危亡。我现在怜惜患者，酌定神方，可以长期服用，不必像六味地黄丸那样必须服用三年。此方大半用于补阴，少加阳药以生发胃气，又用归经止漏的药物以堵塞出血的窍孔，比六味地黄汤更为神奇。而且此药性味平妥，没有动性，因为血症最忌讳气血妄动。
处方：熟地黄（五钱）、山茱萸（三钱）、麦冬（五钱）、玄参（三钱）、天冬（一钱）、车前子（三钱）、荆芥（炒黑三分）、人参（三分）、山药（五钱）、薏苡仁（一两）、百合（五钱）、三七根（研末五分）。水煎服。
Hematemesis (vomiting blood) should be differentiated into Yang syndrome and Yin syndrome, requiring particularly careful distinction. This is because hematemesis affects the turbid pathway, unlike epistaxis (nosebleed) which affects the clear pathway. The clear pathway refers to the airway; the turbid pathway refers to the esophagus. If there is no blood in the stomach but blood appears in the stomach and is vomited from the mouth, is it not blood from the stomach? This occurs because orifices in the stomach are not closed, causing blood to flow recklessly.
However, this vomited blood is not merely from the Stomach meridian alone. Blood from the Heart, Liver, Lungs, Spleen, and Kidneys all surge outside the epigastrium and seep into the stomach. Since the Stomach cannot store this blood, it surges upward and is vomited. Nevertheless, blood from the five Zang organs must not be damaged, with damage to the Kidney meridian being particularly severe. Once the Kidney meridian is injured, it may remain uncontrollable for years. This is because the Stomach serves as a gate for the Kidneys; if the gate is not closed, blood from the Kidneys naturally rises to the Stomach, which is an easily understood principle.
Yet, since both involve loss of blood from the five Zang organs, how can one distinguish between Yin and Yang syndromes? There is a reason for this. Hematemesis cannot occur without Fire, nor can it occur without Water deficiency. While people understand hematemesis caused by excess Fire, they struggle to comprehend that caused by Water deficiency. Why? Let me first explain the case with Fire: The Stomach belongs to Earth, yet it often contains Fire. Without the stabilizing Qi of Earth, vomiting transforms into Fire pathogenic factors. Fire residing in the Stomach naturally carries blood upward in a rush. This burning of Yang Fire requires Water to harmonize it. However, blood is a tangible substance; when it pours out like a basin, replenishing Water quickly yields little immediate effect. Therefore, one must tonify Qi to generate Blood. When Qi is generated, it moves; when Qi moves, bleeding stops. There is profound logic within this process. Symptoms must include thirst, toothache, dry throat, red eyes, and fever, indicating Yang syndrome hematemesis. The treatment method requires using Dushen Tang (Ginseng Decoction), taken at a dosage of 1 liang, which is most effective. Next best is Danggui Buxue Tang (Astragalus and Angelica Decoction), which is even more miraculous. If one adds Sanqi root powder (Notoginseng Root Powder) and Jingjie charred (Charred Schizonepeta Herb) powder, each 3 qian, to either of these two formulas and takes them together, bleeding will stop immediately and recurrence will be prevented. Unfortunately, the world does not know this wonderful method, allowing hematemesis patients to develop into Laozai (consumptive disease). This may well be the fault of physicians who treasure their methods too highly and refuse to teach them.
How then is Yin syndrome identified? It may present as several episodes of bleeding per day, chronic coughing over years, blood threads in sputum, worsening at night with no bleeding during the day, or hoarseness. These are signs of Yin syndrome. The treatment must not rely solely on Ren Shen (Ginseng), Dang Gui (Angelica Sinensis), and Huang Qi (Astragalus); instead, purely Yin-nourishing substances should be used. Among physicians, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) is most suitable. However, such diseases do not respond quickly to just one or two doses. People see the slow action of Liuwei Dihuang Tang lacking immediate results and often abandon it, leading to mild conditions becoming severe and severe ones fatal. Out of compassion, I have devised a divine formula that can be taken long-term without needing to be consumed for three years like the standard pill. This formula mostly nourishes Yin, with a small addition of Yang-tonifying herbs to generate Stomach Qi, and uses herbs that enter the meridians to stop leakage and seal orifices, making it superior to Liuwei Dihuang Tang. Moreover, this medicine is mild and stable without moving properties, which is crucial since blood disorders fear movement above all else.
Prescription: Shudi (Prepared Rehmannia Root, 5 qian), Shanzhuyu (Cornus Fruit, 3 qian), Maidong (Ophiopogon Tuber, 5 qian), Xuanshen (Scrophularia Root, 3 qian), Tiandong (Asparagus Tuber, 1 qian), Cheqianzi (Plantago Seed, 3 qian), Jingjie charred (Charred Schizonepeta Herb, 3 fen), Renshen (Ginseng Root, 3 fen), Shanyao (Dioscorea Rhizome, 5 qian), Yiren (Coix Seed, 1 liang), Baihe (Lily Bulb, 5 qian), Sanqi root powder (Notoginseng Root Powder, 5 fen). Decoct in water and take orally.