以姜汁。童便。俾浊液仍归浊道而出。血何能上逆耶。时医遇此症。专主育阴清火。填涩阴腻。使内瘀一无去
路。宜其愈治愈剧也。前方极力廓清后。或伤脏气。故后方用续断补肝。远志补心。山药补脾。麦冬补肺。犹
虑余瘀不尽。复以赤芍、益母通涤之。以川贝清化之。与前方攻补兼施。立收奇效。此方百试百验。医家及病
家。宜广传之。其次鼓峰固元汤加五味。（潞党参、炙黄 、酒炒白芍各三钱、归身二钱、炙黑甘草一钱、
黑炮姜五分拌捣五味子三分、陈南枣两枚。）亦治阳虚阴走之失血。其因多属内伤情志。饥饱失时。脾胃先
病。必见恶心神倦。自汗肢厥等症。故用参、 为君。固其元气。气固则血循经络。不止血而血自止。但阴走
血必虚。臣以归、芍、甘草。补血养胃。僧慎柔云。凡欲止吐血。必须炒黑干姜、五味子二物。故佐以干姜炮
黑。血见黑即止。五味酸收。能收逆气也。虽然。真阴失守而走。势必格阳于上。血随而溢。以致大吐大衄。
恶心干呕。手足厥冷。六脉微细。元阳脱在顷刻者。速宜景岳镇阴煎。（别直参三钱、附子二钱、紫 桂八
分、拌捣大熟地六钱、黑炮姜七分、淮牛膝、泽泻各钱半、炙甘草一钱。）益气固脱。滋阴纳阳。以救气随血
脱之危症。失血狂吐之候。临证时每有所见。不可不知此急救之法也。
【荣斋按】“夹血伤寒”，俞氏指出“一名伤寒夹瘀”。秀山先生更明白地说∶“先有瘀血在内，因感
时病，引动痼疾，谓之夹血。与太阳病当汗不汗，邪陷暴结而为蓄血者，仍同实异。”在此，我们可以知道
本症与蓄血不同，与伤寒兼失血亦各异。不过、举一反三，同中求异，了解其有关方面的证治，我们是应该
争取的。关于伤寒兼“失血”，廉臣先生已作了详细的介绍，分“衄血”“咳血”“呕吐血”“齿血”“便血”
“溺血”六种，论证清楚，治法都是他一生经验的结晶。只“蓄血”症未曾提及，特作如下补充。考《伤寒论》
说∶“凡太阳病不解，其邪由经入腑，热结膀胱，则血凝蓄，血瘀则心气结，其人故如狂；血下者愈，邪从
血下而解也。其外不解者，当先解其外，宜桂枝汤。外已解，但小腹急结者，是蓄血也；桃仁承气汤下之。”
又说∶“太阳病六七日，表症仍在，脉微而沉者，病邪向里也。反不结胸者，热结下焦也。其人发狂，小腹
硬满，小便自利
者，以太阳随经瘀血蓄于里也。抵当汤下之，则愈。”从这两条经文中可以看出“蓄血”的证状，
是∶“如狂”，“小便自利”，“小腹急结”，甚则“发狂”，“小腹硬满”；许学士又补出“蓄血在上
则喜忘，蓄血在下则为狂。”至于治法，在经文里可以看出有两个阶段；桃仁承气汤是治瘀血初结的阶段，
抵当汤是治瘀血已结的阶段。从前后两条经文里观察证状，也显著地分出轻重；前条说“小腹急结”，
后条说“小腹硬满”，“硬满”原较“急结”为重。前条说“如狂”，后条说“发狂”，“发狂”原较
“如狂”为重。前条有“血下者愈”，后条须下其血乃愈，较血能自下者为重。前条不言脉，我意当在浮而
数之例，后条则“脉微而沉”，原较前为重。前条用植物性药，后条用动物性药，动物性药的功能原较
值物性药为烈。这都是彰明较着的事实。《伤寒第一书》则加以分析说∶“蓄血一症，虽病在血分，亦须
分别阴阳治之。如血瘀上焦为阳，血蓄下焦为阴；太阳失表，热瘀于里，血蓄下焦为阳，太阳误下，阳气
下陷，血蓄下焦为阴。上焦蓄血，因不得汗不能发 而蓄血也，其脉人迎必紧，紧者，数而有力之象也。
外证面红舌燥，发躁欲狂，或头摇目瞪，大便下血水，两手除食指之外，其余各指皆抽掣是也；宜犀角、
桃仁、生地、赤芍、归尾、丹皮、丹参、郁金之类，清之行之。下焦阳证蓄血，即仲景所称热结膀胱之证，
桃仁大黄之属下之是也。若下焦阴证蓄血，乃因误下阳气下陷，阴血受伤，血因寒而凝也。其见证面白唇
青，眉皱目瞪，寒战口噤，舌苔白滑，大便下血水，两手除食指之外，其余各指皆抽掣是也、宜温补之。
如人参、附子、白术、当归、肉桂、桃仁、升麻、炙草之类，温补以升阳气。”这又是掌握原因，分析现证
的医疗方法，是值得采取的。
用姜汁和童便（儿童尿液），使浊液仍然通过浊道排出。这样血怎么能向上逆乱呢？当时的医生遇到这种病症，专门主张滋阴降火，使用滋腻填涩的药物，使得体内的瘀血完全没有出路。难怪病情越治越重。在前方极力清除瘀滞之后，可能会损伤脏腑之气，所以后方使用续断来补肝，远志来补心，山药来补脾，麦冬来补肺。还担心残留的瘀血不能排尽，又加入赤芍、益母草以通利涤荡瘀血，加入川贝母以清热化痰。这与前方攻补兼施的方法相比，能迅速收到奇效。这个方子百试百验，医生和病人都应该广泛传播它。其次，鼓峰固元汤加五味子。（潞党参、炙黄芪、酒炒白芍各三钱，当归身二钱，炙黑甘草一钱，黑炮姜五分拌捣，五味子三分，陈南枣两枚。）也治疗因阳虚导致阴血外走的失血证。其病因多属于内伤情志，或饥饱失常，导致脾胃先生病，必然出现恶心、神疲乏力、自汗、四肢厥冷等症状。所以用人参、黄芪作为君药，以固护元气。气固则血循行于经络，不专门止血而血自然停止。但是阴血外走必然导致血虚，所以用当归、白芍、甘草作为臣药，以补血养胃。僧人慎柔说：“凡是要止吐血，必须用炒黑的干姜和五味子两味药。”所以佐以炮黑的干姜，血见黑色即止；五味子酸收，能收敛逆乱之气。虽然如此，如果是真阴失守而外走，势必导致阳气格拒于上，血随之溢出，以致大吐、鼻衄，伴有恶心干呕，手足厥冷，六脉微细，元阳在顷刻间就要脱失的情况。此时应速用景岳镇阴煎。（别直参三钱，附子二钱，紫桂八分，拌捣大熟地六钱，黑炮姜七分，淮牛膝、泽泻各一钱半，炙甘草一钱。）以益气固脱，滋阴纳阳，从而救治气随血脱的危重症候。失血狂吐的症状，临证时经常见到，不可不知道这种急救方法。
【荣斋按】“夹血伤寒”，俞氏指出“一名伤寒夹瘀”。秀山先生更明白地说：“先有瘀血在内，因感受时病，引动痼疾，称为夹血。与太阳病应当发汗而不发汗，邪气陷入暴结而为蓄血者，虽然表现相同但本质不同。”在这里，我们可以知道本症与蓄血不同，与伤寒兼失血也有差异。不过，举一反三，同中求异，了解其有关方面的证治，是我们应该争取做到的。关于伤寒兼“失血”，廉臣先生已作了详细的介绍，分为“衄血”“咳血”“呕吐血”“齿血”“便血”“溺血”六种，论证清楚，治法都是他一生经验的结晶。只是“蓄血”症未曾提及，特作如下补充。考证《伤寒论》说：“凡是太阳病不解，其邪气由经入腑，热结膀胱，则血凝蓄，血瘀则心气结，其人故如狂；血下者愈，邪从血下而解也。其外不解者，当先解其外，宜桂枝汤。外已解，但小腹急结者，是蓄血也；桃仁承气汤下之。”又说：“太阳病六七日，表症仍在，脉微而沉者，病邪向里也。反不结胸者，热结下焦也。其人发狂，小腹硬满，小便自利者，以太阳随经瘀血蓄于里也。抵当汤下之，则愈。”从这两条经文中可以看出“蓄血”的症状，是：“如狂”，“小便自利”，“小腹急结”，甚则“发狂”，“小腹硬满”；许学士又补充说“蓄血在上则喜忘，蓄血在下则为狂。”至于治法，在经文里可以看出有两个阶段；桃仁承气汤是治瘀血初结的阶段，抵当汤是治瘀血已结的阶段。从前后两条经文里观察症状，也显著地分出轻重；前条说“小腹急结”，后条说“小腹硬满”，“硬满”原来较“急结”为重。前条说“如狂”，后条说“发狂”，“发狂”原来较“如狂”为重。前条有“血下者愈”，后条须下其血乃愈，较血能自下者为重。前条不言脉，我意应当在浮而数的例子，后条则“脉微而沉”，原来较前为重。前条用植物性药，后条用动物性药，动物性药的功能原来较植物性药为烈。这都是彰明较著的事实。《伤寒第一书》则加以分析说：“蓄血一症，虽病在血分，亦须分别阴阳治之。如血瘀上焦为阳，血蓄下焦为阴；太阳失表，热瘀于里，血蓄下焦为阳，太阳误下，阳气下陷，血蓄下焦为阴。上焦蓄血，因不得汗不能发汗而蓄血也，其脉人迎必紧，紧者，数而有力之象也。外证面红舌燥，发躁欲狂，或头摇目瞪，大便下血水，两手除食指之外，其余各指皆抽掣是也；宜犀角、桃仁、生地、赤芍、归尾、丹皮、丹参、郁金之类，清之行之。下焦阳证蓄血，即仲景所称热结膀胱之证，桃仁大黄之属下之是也。若下焦阴证蓄血，乃因误下阳气下陷，阴血受伤，血因寒而凝也。其见证面白唇青，眉皱目瞪，寒战口噤，舌苔白滑，大便下血水，两手除食指之外，其余各指皆抽掣是也、宜温补之。如人参、附子、白术、当归、肉桂、桃仁、升麻、炙草之类，温补以升阳气。”这又是掌握原因，分析现证的医疗方法，是值得采取的。
Use ginger juice and tongbian (child's urine) to allow turbid fluids to still be discharged through the turbid pathways. How then can blood reverse upwards? Contemporary physicians, upon encountering this syndrome, exclusively focus on nourishing yin and clearing fire, using cloying and astringent yin-nourishing herbs, thereby leaving no outlet for internal blood stasis. It is no wonder that the condition worsens with each treatment. After the previous formula has vigorously cleared the pathogen, it may damage the qi of the zang-fu organs. Therefore, the subsequent formula uses Xuduan (Dipsacus Root) to tonify the Liver, Yuanzhi (Polygala Root) to tonify the Heart, Shanyao (Chinese Yam Rhizome) to tonify the Spleen, and Maidong (Ophiopogon Tuber) to tonify the Lung. Still fearing that residual stasis remains, Chishao (Red Peony Root), Yimucao (Motherwort Herb), are added to promote circulation and cleanse stasis, while Chuanbeimu (Fritillaria Bulb) is added to clear heat and transform phlegm. Compared to the previous formula which combined purging and tonifying, this one yields miraculous effects rapidly. This formula has proven effective in every trial; both physicians and patients should widely disseminate it. Secondly, Gufeng Guyuan Tang (Drum Peak Decoction to Consolidate Original Qi) with Wuweizi (Schisandra Fruit). (Lupardenshen (Codonopsis Root), Zhi Huangqi (Honey-fried Astragalus Root), Jiu Chao Baishao (Wine-processed White Peony Root) each 3 qian, Guishen (Angelica Sinensis Root Body) 2 qian, Zhi Hei Gancao (Honey-fried Black Licorice Root) 1 qian, Hei Pa Jiang (Black Roasted Ginger) 5 fen mixed and pounded with Wuweizi (Schisandra Fruit) 3 fen, Chen Nanzao (Aged Southern Jujube) 2 pieces.) also treats hemorrhage caused by yang deficiency leading to yin/blood escaping. The etiology mostly belongs to internal emotional injury or irregular diet, causing initial disease of the Spleen and Stomach. Symptoms must include nausea, mental fatigue, spontaneous sweating, and cold limbs. Therefore, Renshen (Ginseng Root) and Huangqi (Astragalus Root) are used as sovereign drugs to consolidate original qi. When qi is consolidated, blood circulates within the meridians; without specifically stopping bleeding, the bleeding stops naturally. However, since blood escaping implies blood deficiency, Guizhi (Cinnamon Twig) and Baishao (White Peony Root), Gancao (Licorice Root) are used as minister drugs to tonify blood and nourish the stomach. Monk Shenrou stated: "Whenever one wishes to stop hematemesis, one must use charred dried ginger and Schisandra fruit." Thus, Paogan (Roasted Ginger) is added as an assistant; blood stops when it sees black. Wuweizi (Schisandra Fruit) is sour and astringent, capable of restraining rebellious qi. Nevertheless, if true yin loses its hold and escapes, it will inevitably cause yang to be repelled upwards, with blood following to overflow, resulting in severe vomiting and epistaxis, accompanied by nausea and dry retching, cold hands and feet, faint and thin pulses throughout the six positions, and yuan yang about to collapse in an instant. In such cases, one should immediately use Jingyue Zhenyin Jian (Jingyue's Formula to Anchor Yin). (Biezhi Renshen (Korean Ginseng Root) 3 qian, Fuzi (Prepared Aconite Root) 2 qian, Zigui (Cinnamon Bark) 8 fen, mixed and pounded with Dushudi (Prepared Rehmannia Root) 6 qian, Hei Pa Jiang (Black Roasted Ginger) 7 fen, Huainiuqi (Asparagus Tuber), Zexie (Alisma Rhizome) each 1.5 qian, Zhi Gancao (Honey-fried Licorice Root) 1 qian.) to tonify qi and secure collapse, nourish yin and draw down yang, thereby rescuing from the critical condition of qi collapsing following blood loss. The symptom of manic vomiting due to blood loss is frequently seen in clinical practice; one must not be unaware of this emergency rescue method.
[Rongzhai's Note]: "Shanghan with Blood Stasis" (Jiaxue Shanghan), Yu pointed out it is "also known as Shanghan with Blood Stasis" (Shanghan Jiayu). Mr. Xiushan stated more clearly: "There was pre-existing blood stasis inside; due to contracting a seasonal pathogen, the chronic illness is triggered, called Jiaxue (Clasping Blood). This differs from Taiyang disease where sweating is indicated but withheld, causing pathogenic factors to sink and violently knot, resulting in Xueyu (Blood Accumulation); although the presentation is similar, the nature is different." Here, we understand that this syndrome is distinct from Xueyu (Blood Accumulation) and also differs from Shanghan complicated by blood loss. However, inferring other cases from one example, seeking differences amidst similarities, and understanding the relevant syndrome differentiation and treatment are efforts we should strive for. Regarding Shanghan complicated by "blood loss," Mr. Lianchen has provided a detailed introduction, dividing it into six types: "Epistaxis" (Nuxue), "Hemoptysis" (Kexue), "Hematemesis" (Ou Xuexue), "Dental Bleeding" (Chixue), "Hematochezia" (Bianxue), and "Hematuria" (Niaoxue), with clear arguments and treatments that are the crystallization of his lifelong experience. Only the "Xueyu" (Blood Accumulation) syndrome was not mentioned, so the following supplement is made. Examining the *Shanghan Lun* (Treatise on Cold Damage): "Whenever Taiyang disease does not resolve, and the pathogen enters the fu organs from the channels, heat knots in the Bladder, blood coagulates and accumulates; blood stasis causes heart qi to knot, thus the person becomes like mad; if blood is passed downwards, recovery ensues, and the pathogen resolves through the downward passage of blood. If exterior symptoms remain unresolved, one should first resolve the exterior, preferably using Guizhi Tang (Cinnamon Twig Decoction). Once the exterior is resolved, but there is only urgency and binding in the lower abdomen, this is Xueyu (Blood Accumulation); treat with Tao Ren Cheng Qi Tang (Peach Kernel Cathartic Decoction) to purge." It also states: "In Taiyang disease for six or seven days, if exterior symptoms persist, and the pulse is faint and deep, the pathogenic factor is moving inward. If there is no chest binding, heat knots in the lower jiao. If the person is manic, has hardness and fullness in the lower abdomen, and urination is normal, this is because the Taiyang pathogen followed the channels to accumulate blood stasis internally. Treat with Didang Tang (Definite Decoction) to purge, and recovery will follow." From these two passages, the symptoms of "Xueyu" (Blood Accumulation) can be seen as: "like madness," "normal urination," "urgency and binding in the lower abdomen," and even "mania," "hardness and fullness in the lower abdomen." Xu Xueshi further supplemented: "If blood accumulates in the upper jiao, there is forgetfulness; if in the lower jiao, there is mania." As for treatment methods, two stages can be identified in the text: Tao Ren Cheng Qi Tang (Peach Kernel Cathartic Decoction) treats the stage of initial blood stasis knotting, while Didang Tang (Definite Decoction) treats the stage of established blood stasis. Observing the symptoms from the preceding and succeeding passages reveals a significant distinction in severity; the former mentions "urgency and binding in the lower abdomen," while the latter mentions "hardness and fullness in the lower abdomen"; "hardness and fullness" is originally heavier than "urgency and binding." The former says "like madness," the latter says "mania"; "mania" is originally heavier than "like madness." The former states "recovery follows if blood is passed downwards," while the latter requires purging the blood for recovery, which is heavier than blood passing downwards spontaneously. The former does not mention the pulse; I assume it would fall under floating and rapid examples, whereas the latter has a "faint and deep pulse," originally heavier than the former. The former uses plant-based medicines, while the latter uses animal-based medicines; the efficacy of animal-based medicines is originally more potent than that of plant-based medicines. These are obvious facts. *Shanghan Diyi Shu* (The First Book on Shanghan) analyzes this saying: "The syndrome of Xueyu (Blood Accumulation), although involving the blood level, must also be treated differently according to yin and yang. For instance, blood stasis in the upper jiao is yang; blood accumulation in the lower jiao is yin; if Taiyang fails to release the exterior, heat stasis occurs internally, and blood accumulates in the lower jiao, this is yang; if Taiyang is incorrectly purged, yang qi sinks, and blood accumulates in the lower jiao, this is yin. Upper jiao blood accumulation, due to inability to sweat, leads to blood accumulation; the Renying pulse must be tight, tightness being a sign of rapid and forceful qualities. Exterior signs include red face, dry tongue, irritability and desire for mania, or head shaking and staring eyes, bloody stool water, and spasms in all fingers except the index finger on both hands; suitable herbs include Xijiao (Rhinoceros Horn - now prohibited/replace with alternatives in modern context, e.g., Niuxi or Shui Niu Jiao), Taoren (Peach Kernel), Shengdi (Rehmannia Root), Chishao (Red Peony Root), Guiwei (Cinnamon Twig tip/Angelica Tail), Danpi (Moutan Cortex), Danshen (Salvia Root), Yujin (Curcuma Rhizome), etc., to clear and move. Lower jiao yang syndrome blood accumulation, i.e., the heat knotting in the Bladder syndrome referred to by Zhongjing, is treated by purging with Tao Ren (Peach Kernel) and Dahuang (Rhubarb Root). If lower jiao yin syndrome blood accumulation, it is due to incorrect purging causing yang qi to sink, injuring yin blood, and blood congealing due to cold. Signs include pale face, blue lips, furrowed brows, staring eyes, chills, locked jaw, white slippery tongue coating, bloody stool water, and spasms in all fingers except the index finger on both hands; warm tonification is suitable. Such as Renshen (Ginseng Root), Fuzi (Prepared Aconite Root), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root), Rougui (Cinnamon Bark), Taoren (Peach Kernel), Shengma (Cimicifuga Rhizome), Zhi Cao (Honey-fried Licorice Root), etc., to warm and tonify to raise yang qi." This is another medical method of grasping the cause and analyzing current manifestations, which is worth adopting.