又芍药柏皮丸。治先血而后便。为之脏毒。
白芍药 黄柏 当归（以上各等分）
上为细末。滴水为丸。如桐子大。每服五七十丸。煎甘草汤送下。（
案湿毒脏毒。即远血近血也。故附载以备考。）
心气不足。吐血衄血泻心汤主之。（千金心脏门。不足。作不定。）
〔尤〕心气不足者。心中之阴气不足也。阴不足则阳独盛。血为热迫。而妄行不止矣。大黄黄连黄芩。
泻其心之热。而血自宁。寇氏云。若心气独不足。则当不吐衄也。此乃邪热因不足。而客之。故令吐衄。以
苦泄其热。以苦补其心。盖一举而两得之。（案出本草衍义。）此说亦通。济众方。用大黄生地
汁。治衄血。其下热凉血。亦泻心汤类耳。（案金鉴。改不足二字。作有余二字。非。）
泻心汤方（〔原注〕亦治霍乱。○案程沈尤金鉴。删去四字。是。）
大黄（二两） 黄连 黄芩（各一两）
上三味。以水三升。煮取一升。顿服之。
〔程〕心主血。心气不足。而邪热乘之。则迫血妄行。故
有吐衄之患。夫炎上作苦。故内经曰。苦先入心。三黄之苦。以泄心之邪热。
千金。巴郡太守奏三黄丸。治男子五劳七伤。消渴不生肌肉。妇人带下。手足寒热者方。
春三月黄芩（四两） 大黄（三两） 黄连（四两）
夏三月黄芩（六两） 大黄（一两） 黄连（七两）
秋三月黄芩（六两） 大黄（二两） 黄连（三两）
冬三月黄芩（三两） 大黄（五两） 黄连（二两）
上三味。随时加减。和捣以蜜为丸。如大豆。饮服五丸。日三。不知。稍加至七丸。取下而已。
又三黄散。治黄胆身体面目尽黄。（外台。集验。大黄散同。）
本方三味。各四两。治下筛。先食服方寸匕。日三。
和剂局方。三黄丸。治丈夫妇人。三焦积热。上焦有热。攻冲眼目。赤肿头项肿痛。口舌生疮。中焦
有热。心膈烦躁。不美饮食。下焦有热。小便赤涩。大便秘结。五脏俱热。即生 疖疮痍。及治五般痔疾。粪
门肿痛。或下鲜血。小儿积热。
本方三味。各十两。上为细末。炼蜜为丸。如梧桐子大。
每服三十丸。用熟水吞下。如脏腑壅实。加服丸数。
本事方。三黄散。治衄血无时。
本方三味。细末。每服二钱。新汲水调下。蜜水亦得。
直指方。川芎三黄散。治实热衄血。
于本方。加川芎。各等分。为末。每服二钱。食后井水调服。
拔萃方。犀角地黄汤。治热甚血积胸中。
于本方。加犀角地黄。
神效名方。黄连散。治黄胆。大小便秘涩壅热。
于本方。用黄连三两。加甘草一两。
上为细末。每服二钱。食后。温水调下。一日三服。
另外有芍药柏皮丸。治疗先出血而后大便的情况。这被称为脏毒。
白芍药 黄柏 当归（以上各取等量）
将上述药物研成细末。滴入水制成丸剂。大小如梧桐子。每次服用五七十丸。用煎好的甘草汤送服。（
按语：湿毒和脏毒，就是远血和近血。所以附载于此以作参考。）
心气不足。出现吐血、鼻衄的症状，用泻心汤主治。（《千金方·心脏门》中，“不足”作“不定”解。）
〔尤在泾〕所谓心气不足，是指心中阴气不足。阴气不足则阳气独盛。血液被热邪逼迫，从而妄行不止。大黄、黄连、黄芩，能够清泻心的热邪，而血液自然安宁。寇氏说：如果仅仅是心气单独不足，那么应当不会出现吐血、衄血的症状。这是因为邪热趁着正气不足而客居体内，所以才导致吐血、衄血。用苦味药来泄热，用苦味药来补心，可谓一举两得。（按语：此说出自《本草衍义》。这种说法也是通的。《济众方》使用大黄、生地汁，治疗鼻衄，其作用是下热凉血，也属于泻心汤的类别。（按语：《医宗金鉴》将“不足”二字改为“有余”，是不对的。）
泻心汤方（〔原注〕也治疗霍乱。○按语：程林、沈明宗、尤在泾、吴谦《医宗金鉴》删去了这四个字，是正确的。）
大黄（二两） 黄连 黄芩（各一两）
将这三味药，用水三升，煮取一升。一次性服下。
〔程林〕心主血脉。心气不足，而邪热乘虚而入，就会逼迫血液妄行。所以有吐血、衄血的祸患。火性炎上且味苦，所以《内经》说：苦味先入心。三黄的苦味，用来泄除心的邪热。
《千金方》记载巴郡太守奏呈的三黄丸方，治疗男子五劳七伤、消渴症不长肌肉、妇人带下病、手足寒热等症状。
春季三个月：黄芩（四两） 大黄（三两） 黄连（四两）
夏季三个月：黄芩（六两） 大黄（一两） 黄连（七两）
秋季三个月：黄芩（六两） 大黄（二两） 黄连（三两）
冬季三个月：黄芩（三两） 大黄（五两） 黄连（二两）
将这三味药，根据季节加减用量，混合捣碎，用蜂蜜制成丸剂，大小如大豆。空腹时饮服五丸，每日三次。若无效，逐渐增加至七丸，以大便通畅为度。
另外还有三黄散，治疗黄疸，身体面目全部发黄。（《外台秘要》、《集验方》中的大黄散与此相同。）
本方三味药，各四两。研磨过筛。饭前服用一方寸匕，每日三次。
《和剂局方》的三黄丸，治疗男女三焦积热。上焦有热，攻冲眼目，导致眼睛红肿、头项肿痛、口舌生疮；中焦有热，导致心胸膈部烦躁、饮食无味；下焦有热，导致小便赤涩、大便秘结。五脏都有热，就会生疖子、疮疡痍疹。以及治疗五种痔疮疾病，肛门肿痛，或者便下鲜血。小儿积热。
本方三味药，各十两。研成细末，炼蜜为丸，大小如梧桐子。
每次服用三十丸，用熟开水吞服。如果脏腑壅实，可以增加服药丸数。
《本事方》的三黄散，治疗随时发生的鼻衄。
在本方基础上，加川芎，各取等量。研成细末。每次服用二钱，用新打的井水调服。用蜜水也可以。
《直指方》的川芎三黄散，治疗实热引起的鼻衄。
在本方基础上，加川芎，各取等量。研成细末。每次服用二钱，饭后用井水调服。
《拔萃方》的犀角地黄汤，治疗热邪极盛，血液积聚在胸中。
在本方基础上，加犀角、地黄。
《神效名方》的黄连散，治疗黄疸，大小便秘涩壅热。
在本方基础上，只用黄连三两，加甘草一两。
研成细末。每次服用二钱，饭后用温水调服。一日三次。
There is also Shaoyao Bopi Wan (Peony and Phellodendron Pill), which treats bleeding occurring before defecation. This is referred to as Zangdu (Visceral Toxin).
Baishao Yao (Radix Paeoniae Alba), Huangbai (Cortex Phellodendri), Danggui (Radix Angelicae Sinensis) [all in equal parts].
Grind the above ingredients into a fine powder. Add water drop by drop to form pills, sized like Sophora japonica seeds. Take 50-70 pills per dose, delivered with decoction of Gancao Tang (Licorice Decoction).
(Note: Shidu (Dampness Toxin) and Zangdu are synonymous with Yuanxue (Remote Blood) and Jinxue (Near Blood). Thus, it is appended here for reference.)
When Heart Qi deficiency presents with hematemesis or epistaxis, Xiexin Tang (Drain the Heart Decoction) is the primary treatment. (In *Qianjin Fang*, Chapter on Heart Diseases, "deficiency" is interpreted as "fluctuating" or "uncertain".)
[You Zaijing] What is meant by Heart Qi deficiency is insufficient Yin Qi within the Heart. When Yin is insufficient, Yang becomes excessively dominant alone. The blood is forced by heat to flow recklessly without stopping. Dahuang (Rhubarb Radix), Huanglian (Coptidis Rhizome), and Huangqin (Scutellariae Radix) drain the heat of the Heart, and the blood naturally calms down. Kou Shi stated: If there were merely a solitary deficiency of Heart Qi, one would not expect hematemesis or epistaxis. This occurs because pathogenic heat takes advantage of the deficiency to lodge itself, thereby causing vomiting of blood and nosebleeds. Using bitter substances to drain the heat and using bitter substances to tonify the Heart achieves two goals with one action. (Note: This theory originates from *Bencao Yan Yi*. This explanation is also plausible. *Jizhong Fang* uses Dahuang and Dihuang juice to treat epistaxis; its function of draining heat and cooling blood also falls under the category of Xiexin Tang. (Note: *Yizong Jinjian* changed the characters "bu zu" (insufficient) to "you yu" (excessive), which is incorrect.)
Xiexin Tang Formula ([Original Note]: Also treats Huoluan (Cholera-like syndrome). ○ Note: Cheng Lin, Shen Mingzong, You Zaijing, and Wu Qian's *Yizong Jinjian* deleted these four characters, which is correct.)
Dahuang (2 liang), Huanglian, Huangqin (each 1 liang).
Take these three herbs, add 3 sheng of water, boil to obtain 1 sheng. Take all at once.
[Cheng Lin] The Heart governs blood. When Heart Qi is deficient and pathogenic heat exploits this weakness, it forces blood to move recklessly, leading to the danger of hematemesis and epistaxis. Fire flares upward and has a bitter taste; thus, the *Neijing* states that bitter flavors enter the Heart first. The bitterness of the Three Yellows drains the pathogenic heat of the Heart.
*Qianjin Fang* records the Sanhuang Wan (Three Yellows Pill) presented by the Administrator of Ba Commandery, treating men suffering from Five Exhaustions and Seven Injuries, Xiao Ke (Wasting and Thirsting syndrome) with lack of muscle growth, women with leukorrhea, and symptoms of alternating cold and heat in hands and feet.
Spring months: Huangqin (4 liang), Dahuang (3 liang), Huanglian (4 liang).
Summer months: Huangqin (6 liang), Dahuang (1 liang), Huanglian (7 liang).
Autumn months: Huangqin (6 liang), Dahuang (2 liang), Huanglian (3 liang).
Winter months: Huangqin (3 liang), Dahuang (5 liang), Huanglian (2 liang).
Process the three herbs according to seasonal adjustments, mix and pound them, bind with honey to form pills the size of soybeans. Take 5 pills with water upon an empty stomach, three times daily. If ineffective, gradually increase to 7 pills, until bowel movements are unblocked.
Additionally, there is Sanhuang San (Three Yellows Powder), which treats Huangdan (Jaundice) where the body, face, and eyes are entirely yellow. (*Waitai Miyao* and *Jiyi Fang*'s Dahuang San are identical.)
For this formula, take each of the three herbs at 4 liang. Grind and sieve. Take one Fang Cun Bi (square-inch measure) before meals, three times daily.
The *Heji Jufang* (Bureau of Formulations) Sanhuang Wan treats accumulated heat in the Triple Burner for both men and women. Heat in the Upper Burner attacks the eyes, causing redness, swelling, head and neck pain, and sores in the mouth and tongue. Heat in the Middle Burner causes irritability in the heart and diaphragm, and poor appetite. Heat in the Lower Burner causes dark, scanty, painful urination and constipation. Heat in all five Zang organs leads to boils, ulcers, and skin lesions. It also treats five types of hemorrhoids, with swelling and pain at the anus, or passage of fresh blood. It treats pediatric accumulated heat.
For this formula, take each of the three herbs at 10 liang. Grind into a fine powder, bind with refined honey to form pills the size of Sophora japonica seeds.
Take 30 pills per dose, swallowed with warm boiled water. If there is stagnation and fullness in the Zang-Fu organs, increase the number of pills taken.
*Benshi Fang* (Formulas from Verified Facts) Sanhuang San treats spontaneous epistaxis.
To the base formula, add Chuanxiong (Ligusticum Rhizome) in equal parts. Grind into powder. Take 2 qian per dose, mixed with newly drawn well water. Honey water is also acceptable.
*Zhizhi Fang* (Direct Guide Formulas) Chuanxiong Sanhuang San treats epistaxis due to excess heat.
To the base formula, add Chuanxiong in equal parts. Grind into powder. Take 2 qian per dose, mixed with well water after meals.
*Bacui Fang* (Extracted Excellence Formulas) Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) treats extreme heat with blood accumulation in the chest.
To the base formula, add Xijiao (Cornu Rhinocerotis - *Note: Use substitutes in modern practice*) and Dihuang (Rehmanniae Radix).
*Shenxiao Mingfang* (Divine Efficacy Famous Formulas) Huanglian San treats jaundice with constipation and urinary difficulty due to stagnant heat.
For this formula, use only Huanglian (3 liang) and add Gancao (Licorice Root, 1 liang).
Grind into a fine powder. Take 2 qian per dose, mixed with warm water after meals. Take three times daily.