撄宁生《卮言》云∶古人言诸见血非寒证，皆以血为热迫，遂至妄行，然皆复有所挟也
。或
挟风，或挟湿，或挟气。又有因药石而发者，其本皆热，上中下治各有所宜，在上则栀子、
黄芩、黄连、芍药、犀角、蒲黄，而济以牡丹皮、生地黄之类。古人云∶有冒风寒，正以阳
明火邪为风所
扇，而血为之动，中间有桂，取其能伐木也。若苍术、地榆、白芍药之类，而济以火剂，大
肠血以手
阳明火邪为风为湿也，治以火剂风剂，风能胜湿也，如黄连、黄芩、芍药、柏皮、荆芥、防
风、羌活之
类，兼用鸡冠花，则又述类之义也。血溢血泄诸蓄妄症，其始也，余率以桃仁、大黄行血破
瘀之剂
，以折其锐气。(凡初期骤然吐血，亟宜快药下之，折其锐气。若日久正气已虚，法当调摄
。
仲景云∶亡血虚家，不可下是也。）而后区别治之。虽往往获中，然犹不得其所以然也。后来
四
明，遇故人苏伊芳举曰∶吾乡有善医者，忘其姓字，每治失血蓄妄，必先以快药下之，或问失
血复下
，虚何以当，则曰∶血既妄行，迷失故道，不去蓄积，则以妄为常，曷以洁之。且去者自去
，生者自生，何虚之有?余闻之愕然曰∶名言也。昔之疑，今而后释之矣。
又云∶妇人之于血
也，经水蓄则为胞胎，蓄者自蓄，生者自生，及其产育为恶露，则去者自去，生者自生。其
蕴而为乳，则无腹下漏而为月矣，失血为血家妄逆，产乳妇人常事，其去其生，则一同也。
失
血家须用下剂破血，盖施之于蓄妄之初，亡血虚家不可下，盖戒之于亡失之后。又云∶惊而
动血者，属心。怒而动血者，属肝。忧而动血者，属肺。思而动血者，属脾。劳而动血者，
属肾。又云
∶吐血，则足阳明随经上行，渗溢胃脘而为之也。小便血，足太阳随经入膀胱也。又云∶大
便前后
下血，便前由手阳明随经下行，渗入大肠，传于广肠而下者也。
便后由足阳明随经入胃，(阴络伤
血内溢)。淫溢而下者也。古人所谓近血远血是也。又云∶咯血为病最重，(咯血乃虚劳之渐
，
其症最危。)且难治者，以肺手太阴之经，气多血少。又肺者金象，为清肃之藏，今为火所
制，迫
而上行，以为咯血，逆之甚矣。上气见血，下病闻音，谓喘而咯血且痰咳嗽也。又云∶从高
坠下，惊仆击搏，流滞恶血，皆从中风论，终归于厥阴。此海藏之说。盖厥阴多血，其化风
木，是以然也。有形当从血诊，无形当从常治，夏仲庸因蹈海惊悸，心为不宁，是为无形
，从
风家治之而愈。又云∶唾血责在下焦阳火煎迫击为之也。(唾血属肾虚火炎。)肾主唾，为足
少阴
，少血多气，故其症亦为难治。又有所谓肠风藏毒者，肠风则足阳明积热，久而为风，风有
所以动之也。脏毒则足太阴积热，久而生湿，从而下流也。风则阳受之，湿则阴受之。曹
氏
《必用方》云∶吐血须用干姜、甘草作汤与服，或四物理中汤亦可。如此无不愈者，若服生
地黄、竹茹、藕汁，去生便远。
撄宁生《卮言》中说：古人认为各种出血症状并非寒证，都是由于血受热邪逼迫，导致血液妄行，但其中往往夹杂其他病邪。有的夹风邪，有的夹湿邪，有的夹气滞。又有因服用药物或金石丹药而引发的，其根本原因都属于热证。上、中、下三焦的治疗各有适宜的方法：在上焦（心肺），宜用栀子、黄芩、黄连、芍药、犀角、蒲黄，并辅以牡丹皮、生地黄等药物。古人说：如果有冒受风寒的情况，正是因为阳气旺盛焚烧邪热，被风邪煽动，导致血液妄动，中间加入桂枝，是取其能平抑肝木（伐木）的作用。若夹湿邪，则用苍术、地榆、白芍药等，并辅以火剂（温阳化湿之剂）。大肠出血是因为手阳明大肠经的火邪受到风邪和湿邪的影响，治疗用火剂和风剂，因为风能胜湿，如黄连、黄芩、芍药、黄柏、荆芥、防风、羌活等药物，兼用鸡冠花，这又体现了“述类”（取象比类）的意义。对于血溢、血泄等各种蓄积妄行的病症，起初我通常使用桃仁、大黄等行血破瘀的方剂，以挫败其锐气。（凡是初期骤然吐血，必须急用峻猛药物攻下，以折其锐气。如果病程日久，正气已经虚弱，法则应当调摄。张仲景说：亡血及虚家，不可使用下法。）之后再进行区别治疗。虽然往往能取得疗效，但仍然没有掌握其所以然的原因。后来到了四明，遇到老朋友苏伊芳举说：我们乡里有位善于治病的医生，忘了他的姓名，每次治疗失血蓄妄症，必定先用峻猛药物攻下。有人问：既然已经失血，再用下法，身体怎么承受得住呢？他说：血液既然妄行，迷失了原本的通道，如果不去除蓄积的恶血，就会把这种妄行当作常态，怎么能洁净血液呢？而且，去掉的自然是旧的，新生的自然是新的，有什么虚损可言呢？我听了感到惊讶，说：这是名言啊。以前的疑惑，从今以后就解开了。
他又说：妇女与血的关系，月经蓄积在体内就成为胞胎，蓄积的自会蓄积，新生的自会新生；等到分娩时成为恶露，则是去掉的自会去掉，新生的自会新生。蕴结而成乳汁，就不会有腹部以下漏下月经的情况了。失血是血家常见的妄逆现象，产妇和哺乳期的妇人常事，其去旧生新的道理是一样的。失血患者需要使用下剂破血，这是因为施用于蓄妄初起之时；而亡血虚家不可使用下法，这是告诫在亡失血液之后的情况。
他又说：因惊恐而动血的，属于心；因愤怒而动血的，属于肝；因忧愁而动血的，属于肺；因思虑而动血的，属于脾；因劳累而动血的，属于肾。
他又说：吐血，是由于足阳明胃经随经上行，渗入胃脘所致。小便出血，是由于足太阳膀胱经随经入膀胱所致。他又说：大便前后下血，便前出血是由手阳明大肠经随经下行，渗入大肠，传于广肠而下出的。便后出血是由足阳明胃经随经入胃，（阴络受伤，血液内溢），淫溢而下出的。这就是古人所说的近血和远血。
他又说：咯血病情最重，且难治，因为手太阴肺经，气多血少。而且肺属金象，是清肃之脏，现在被火邪克制，逼迫血液上行，导致咯血，这是非常严重的逆证。上气见血，下病闻音，指的是气喘、咯血且伴有痰咳嗽的症状。
他又说：从高坠落、惊仆击搏，导致流滞恶血，都按照中风论治，最终归于厥阴经。这是海藏（张元素）的说法。大概因为厥阴经多血，其气化属于风木，所以是这样。有形质的病变应当从血分诊断，无形质的病变应当按常规治疗。夏仲庸因为蹈海受惊心悸，心神不宁，这是无形质的病，从风家治疗而痊愈。
他又说：唾血责之于下焦阳火煎迫所致。（唾血属于肾虚火炎。）肾主唾，为足少阴肾经，少血多气，所以该病症也难治。
又有称为肠风、脏毒的，肠风是足阳明胃经积热，久而生风，风邪有所煽动所致。脏毒是足太阴脾经积热，久而生湿，湿热从而下流。风邪则阳经受之，湿邪则阴经受之。曹氏《必用方》说：吐血必须用干姜、甘草煮汤服用，或者四理（理中汤类）也可。这样没有不愈的，如果服用生地黄、竹茹、藕汁，离治愈就远了。
Yanning Sheng, in *Zhi Yan*, stated: The ancients said that various bleeding syndromes are not cold syndromes; rather, they are caused by heat forcing the blood to act recklessly. However, these cases often involve accompanying pathogenic factors. Some are accompanied by wind (Wind), some by dampness (Dampness), and some by qi stagnation. Others may be triggered by drugs or mineral pills, with heat as the root cause. Treatment for the upper, middle, and lower jiao (Triple Burner) varies appropriately. For the upper jiao, Gardenia (Gardeniae Fructus), Scutellaria (Scutellariae Radix), Coptis (Coptidis Rhizoma), Peony (Paeoniae Radix), Rhinoceros Horn (Rhinocerotis Cornu - *note: modern substitute usually used*), and Cattail Pollen (Typhonii Rhizoma) are used, supplemented by Moutan Bark (Moutan Cortex) and Rehmannia Root (Rehmanniae Radix). The ancients said: If one is exposed to wind and cold, it is because yang fire burns the evil, fanned by wind, causing blood to move recklessly. In such cases, Cinnamon Twig (Cinnamomi Ramulus) is added to "subdue wood" (calm liver wind). If dampness is involved, Atractylodes (Atractylodis Rhizoma), Sanguisorba (Sanguisorbae Radix), and White Peony (Paeoniae Radix Alba) are used, supplemented by "fire agents" (warming agents). Bleeding from the large intestine is due to fire-evil of the Hand-Yangming Large Intestine channel being affected by wind and dampness. It is treated with fire agents and wind agents, as wind can overcome dampness, using herbs like Coptis, Scutellaria, Peony, Phellodendron (Phellodendri Cortex), Schizonepeta (Schizonepetae Spica), Saposhnikovia (Saposhnikoviae Radix), and Notopterygium (Notopterygii Rhizoma et Radix), along with Crown Flower (Celosiae Cristatae Flos), which reflects the principle of "describing categories" (analogy).
For symptoms of blood overflow, leakage, and other reckless conditions due to accumulation, I initially tended to use formulas containing Peach Kernel (Persicae Semen) and Rhubarb (Rhei Radix et Rhizoma) to promote blood circulation and break up stasis, thereby curbing their aggressive nature. (In cases of sudden hematemesis in the early stage, strong purgatives should be urgently administered to curb the aggressive nature. If the disease has persisted for a long time and righteous qi is already deficient, the method should be regulation. Zhang Zhongjing said: Those who have lost blood or are constitutionally deficient should not be purged.) Later, differentiation and treatment were applied. Although results were often achieved, the underlying principles remained unclear. Later, in Siming, I met an old friend, Su Yifangju, who said: There is a skilled doctor in our hometown whose name I have forgotten. Whenever he treats blood loss and reckless bleeding, he first uses strong purgatives. When asked how the body can withstand purging after blood loss, he replied: Since the blood is acting recklessly and has lost its proper course, if the accumulated stasis is not removed, this reckless behavior will become the norm, and how can the blood be cleansed? Moreover, what is removed goes away, and what is generated arises anew; where is the deficiency? Hearing this, I was startled and said: This is a profound statement. My past doubts are now resolved.
He further said: Regarding women and blood, when menstrual blood accumulates, it becomes the fetus; the accumulated remains accumulated, and the new arises anew. During childbirth, it becomes lochia; what is expelled goes away, and what is generated arises anew. When it transforms into milk, there is no leakage from below as menstruation. Blood loss is a common reckless reversal in blood disorders; for postpartum and nursing women, the processes of expelling and generating are the same. Patients with blood loss need purgatives to break blood stasis, applied at the initial stage of accumulation and recklessness. Conversely, those who have lost blood and are deficient should not be purged, which is a warning for the period after blood loss.
He also said: Blood movement caused by fright belongs to the Heart. Blood movement caused by anger belongs to the Liver. Blood movement caused by worry belongs to the Lung. Blood movement caused by overthinking belongs to the Spleen. Blood movement caused by fatigue belongs to the Kidney.
He also said: Hematemesis occurs when the Foot-Yangming Stomach channel ascends along its pathway,渗溢 (seeping and overflowing) into the stomach cavity. Hematuria occurs when the Foot-Taiyang Bladder channel enters the bladder along its pathway. He also said: Bleeding before and after defecation: bleeding before defecation is due to the Hand-Yangming Large Intestine channel descending along its pathway, seeping into the large intestine and passing through the rectum to exit. Bleeding after defecation is due to the Foot-Yangming Stomach channel entering the stomach (injury to yin collaterals causing internal blood overflow), overflowing and exiting downward. This is what the ancients called "proximal blood" and "distal blood."
He also said: Hemoptysis is the most severe illness and difficult to treat because the Hand-Taiyin Lung channel has abundant qi but little blood. Furthermore, the Lung represents metal and is a clear and descending organ. Now constrained by fire, it forces blood upward, causing hemoptysis, which is a severe deviation. Upper qi disturbance with blood appearance, and lower pathology heard as sound, refers to wheezing, hemoptysis, and coughing with phlegm.
He also said: Falling from heights, startling falls, and blows leading to stagnant evil blood are all discussed under Wind Stroke (Zhong Feng) and ultimately return to the Jueyin (Liver/Pericardium). This is the theory of Haicang (Zhang Yuansu). Generally, Jueyin has much blood and transforms into wind-wood, hence this classification. Organic lesions should be diagnosed from the blood aspect, while non-organic lesions should be treated according to routine methods. Xia Zhongyong suffered palpitations and heart unrest after falling into the sea due to fright; this was a non-organic lesion, treated as a wind case, and he recovered.
He also said: Saliva mixed with blood (sputumting blood) is blamed on the frying and pressing force of yang fire in the lower jiao. (Saliva blood belongs to kidney deficiency with flaming fire.) The Kidney governs saliva and corresponds to the Foot-Shaoyin Kidney channel, which has little blood and abundant qi, making the syndrome difficult to treat.
There are also conditions called "Intestinal Wind" (Chang Feng) and "Visceral Toxin" (Zang Du). Intestinal Wind is caused by accumulated heat in the Foot-Yangming Stomach channel, which turns into wind over time, stirring the blood. Visceral Toxin is caused by accumulated heat in the Foot-Taiyin Spleen channel, which generates dampness over time, flowing downward. Wind affects yang channels, and dampness affects yin channels. Cao's *Bi Yong Fang* states: For hematemesis, dried Ginger (Zingiberis Rhizoma) and Licorice (Glycyrrhizae Radix) decoction should be taken, or Sizhu Li Zhong Tang is also acceptable. Such treatments invariably lead to recovery. If Rehmannia Root, Bamboo Shavings (Bambusae Caulis in Taenia), or Lotus Root Juice are taken, recovery will be far off.