伤胃吐血者，酒食过饱，胃间不安，或强吐之，气脉贲乱，损伤心胃，血随呕出也。
《简易》黑神散 治伤酒食，醉饱过度，胃络内伤，及低头掬损吐血，致多口鼻
百草霜（不拘多少，村居者佳）
上研细，每服二钱，糯米汤下。喜凉水者，新汲水调服。
鼻衄有表寒、里热之异。表寒者，伤寒不解，而闭热于经也，详伤寒门。里热者，阳明
，而血为热迫也，宜犀角地黄汤主之。或阳明之热，不得下通，而反上壅者，宜《拔萃》犀
角地黄汤，通其下而上自愈。
诸衄血家不可与白虎汤，虚者亦不可与。卒得之，腹痛而利者，但可温之。
罗谦甫云∶经历晋才卿，膏粱而饮，至春病衄，易医数四，皆用苦寒之剂，俱欲胜其热
，然终不愈。而饮食起居，浸不如初，肌寒而时躁，言语无声，口气臭秽，恶冷风，而其衄
之余滴，则未绝也。彼惟知见血为热，而以苦寒攻之，抑不知苦泻土，土，脾胃也，脾胃人
之所以为本者。今火为病，而泻其土，火固未尝除，而土已病矣。土病则胃虚，胃虚则荣气
不能滋荣百脉，元气不循天度，气随阴化，而无声肌寒也。粗工嘻嘻，以为可治，热病未已
项彦章治一妇患衄三年许，医以血得热则淖溢，与泻心凉血之剂，益困，衄出数滴，辄昏去
，六脉微弱，而寸为甚。曰∶肝藏血而心主之，今寸口脉微，知心虚也，心虚则不能主血，
故逆而妄行，法当补心，兼养脾气。脾者，心之子，实则心不虚也。与琥珀诸补心药遂安。
按∶心虚补脾，即《千金》脾旺则气感于心之意。然补脾药未议及，窃谓当兼补脾阴，
不当专补脾气也。
犀角地黄汤 易老云∶治鼻衄，此药为最胜。
犀角 芍药 丹皮（各一钱半） 生地（四钱） 甘草（五分）
水一盅半，煎八分服。《拔萃》加大黄、黄连、黄芩。
茅花汤
白茅花 水煎浓汁两碗，分二服，如无花，以根代之。
人参莲心散
人参（一钱） 莲子心（一分）
共为末，以水空心下二钱，以瘥为度。
一方∶莲子心五十个，糯米五十粒，为末酒调服，治劳心吐血。
发灰散 发灰（一钱） 人中白（炙研，五分） 麝香（研，一分）
用少许吹鼻中，立愈。
《元珠》鸡苏散
鸡苏叶 黄 生地 阿胶 白茅根（各一两） 麦门冬（去心） 桔梗 蒲黄
（炒） 贝母（去心） 炙甘草（五钱）
每服四钱，姜三片，水煎服。
麦门冬饮子 治脾肺虚弱，气促，精神短少，衄血吐血。
人参 麦门冬 当归（各五分） 五味子（五个） 黄 甘草 芍药（各一钱） 紫菀（一钱五分）
上 咀，分作二服，水二盏，煎至一盏，去滓温服，食后。一方有生地，无甘草、芍药
伤胃吐血，是由于饮酒和进食过饱，导致胃部不适；或者强行催吐，致使气机紊乱，损伤心与胃，血液随呕吐而出。
《简易方》中的黑神散，用于治疗因饮酒和饮食过度导致的胃络内伤，以及因低头或弯腰用力造成的吐血，这种出血往往从口鼻大量涌出。
药材：百草霜（用量不限，乡村出产的质量较好）。
将上述药材研成细末，每次服用二钱，用糯米汤送服。喜欢喝凉水的人，可用新汲取的冷水调服。
鼻衄（鼻出血）有表寒和里热两种不同的情况。属于表寒的，是伤寒病未解，热邪闭阻在经络中，详见“伤寒”章节。属于里热的，是阳明经有热，血液被热邪逼迫妄行，适宜用犀角地黄汤主治。或者是阳明的热邪不能向下通泄，反而向上壅滞，适宜使用《拔萃方》中的犀角地黄汤，通过通泄下焦的热邪，上部的症状自然痊愈。
所有患有各种鼻衄血证的患者，不可使用白虎汤，即使是虚证患者也不可使用。如果突然发病，出现腹痛并伴有腹泻，只可采用温补的方法治疗。
罗谦甫说：晋才卿这个人，长期食用肥甘厚味并饮酒，到了春天患上了鼻衄病，更换了多位医生，都使用苦寒的药物，都想以此清除热邪，但最终都没有治愈。他的饮食起居逐渐不如从前，身体发冷但时常烦躁，说话没有声音，口气臭秽，厌恶冷风，但他鼻衄后滴出的余血仍未断绝。那些医生只知道见血就是热证，而用苦寒药攻伐，却不知道苦味会泻脾胃之气，脾胃是人体的根本。现在虽然有火邪为病，却泻伤了脾胃，火邪固然没有清除，脾胃却已经生病了。脾胃生病则胃气虚弱，胃气虚弱则营气不能滋养全身血脉，元气不能遵循正常的生理规律运行，气随着阴寒之气转化，从而出现无声、肌寒的症状。粗劣的医生嘻嘻哈哈，认为可以治愈，但实际上热病并未停止。项彦章治疗一位妇女，患鼻衄三年左右，医生认为血得热则沸腾溢出，给予泻心凉血的药物，使病情更加困顿，鼻衄仅出几滴，人就昏厥过去，六脉微弱，其中寸脉尤为明显。项彦章说：肝藏血而心主之，现在寸口脉微，说明心气虚弱。心气虚弱则不能统摄血液，所以血液逆乱妄行，治法应当补益心气，兼养脾气。脾是心的子脏，如果脾气充实，心就不会虚弱。于是给予琥珀等补心药物，病人随即安定。
按语：心虚而补脾，即《千金方》中“脾气旺盛则能感应于心”的意思。然而原文中补脾的药物并未详细列出，我个人认为应当兼补脾阴，而不应当专门补益脾气。
犀角地黄汤：易老（张元素）说：治疗鼻衄，此药最为有效。
药材：犀角、芍药、丹皮（各一钱半），生地（四钱），甘草（五分）。
用水一盅半，煎至八分，服用。《拔萃方》版本加大黄、黄连、黄芩。
茅花汤
药材：白茅花。
用水煎煮成浓汁两碗，分两次服用。如果没有花，可以用根代替。
人参莲心散
药材：人参（一钱），莲子心（一分）。
共研为末，空腹时用水送服二钱，以病愈为度。
另一偏方：莲子心五十个，糯米五十粒，研为末，用酒调服，治疗劳心引起的吐血。
发灰散
药材：发灰（一钱），人中白（炙烤后研细，五分），麝香（研细，一分）。
取少许吹入鼻中，立即痊愈。
《元珠》鸡苏散
药材：鸡苏叶、黄芪、生地、阿胶、白茅根（各一两），麦门冬（去心），桔梗，蒲黄（炒），贝母（去心），炙甘草（五钱）。
每次服用四钱，加生姜三片，水煎服。
麦门冬饮子：治疗脾肺虚弱，气短促，精神不足，鼻衄吐血。
药材：人参、麦门冬、当归（各五分），五味子（五个），黄芪、甘草、芍药（各一钱），紫菀（一钱五分）。
将药材切碎，分为两次服用，用水两盏，煎至一盏，去渣温服，饭后服用。另一版本含有生地，无甘草、芍药。
Hematemesis due to stomach injury results from excessive intake of alcohol and food, causing discomfort in the stomach; or from forced vomiting, which disrupts Qi and blood flow, damaging the Heart and Stomach, leading to blood being vomited out.
Heishen San (Black Divine Powder) from *Jianyi Fang* treats internal injury to the stomach collaterals caused by excessive drinking and eating, as well as hematemesis resulting from bending over or straining, where bleeding often flows profusely from the mouth and nose.
Herbs: Baicaoshuang (Soot from burning straw, amount unspecified, preferably from rural areas).
Grind into a fine powder. Take 2 qian each time, washed down with glutinous rice soup. Those who prefer cold water may take it mixed with fresh drawn water.
Epistaxis presents with two distinct patterns: exterior cold and interior heat. Exterior cold refers to unresolved Cold Damage (Shanghan) where heat is trapped in the meridians; see the "Cold Damage" chapter for details. Interior heat refers to Heat in the Yangming channel forcing blood to move recklessly, for which Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is indicated. Alternatively, if Yangming heat cannot descend and instead obstructs upward, *Bacui Fang*'s Xijiao Dihuang Tang should be used to unblock the lower body, after which the upper symptoms will resolve spontaneously.
Patients suffering from various forms of epistaxis should not use Baihu Tang (White Tiger Decoction), nor should those with deficiency patterns. If the condition occurs suddenly accompanied by abdominal pain and diarrhea, only warming methods should be applied.
Luo Qianfu stated: Jin Caiqing consumed rich foods and alcohol for years. In spring, he developed epistaxis. After seeing several physicians who all prescribed bitter-cold herbs to clear heat without success, his diet and lifestyle deteriorated. He experienced cold muscles but occasional restlessness, loss of voice, foul breath, aversion to cold wind, yet residual dripping from the nose persisted. Physicians merely saw blood and assumed heat, using bitter-cold purgatives, unaware that bitter flavors drain Earth (Spleen/Stomach), which is the root of human life. Although Fire pathology exists, draining Earth harms the Spleen and Stomach before clearing the Fire. When Earth is diseased, Stomach Qi becomes deficient; when Stomach Qi is deficient, Ying Qi (Nutritive Qi) fails to nourish the vessels, and Yuan Qi (Original Qi) fails to follow its natural course, transforming with Yin-Cold, resulting in silence and cold muscles. Quackish physicians laughed, claiming it was curable, while the heat pathology remained.
Xiang Yanzhang treated a woman who had suffered from epistaxis for about three years. Physicians believed that blood overflows when heated and administered Heart-draining and blood-cooling agents, worsening her condition. She would faint after only a few drops of blood flowed. Her six pulses were weak, especially at the Cun (Inch) position. Xiang said: The Liver stores Blood, and the Heart governs it. A weak pulse at the Cun indicates Heart deficiency. Heart deficiency fails to govern Blood, causing it to rebel and flow recklessly. The treatment should tonify the Heart and support the Spleen. Since the Spleen is the Child of the Heart, if the Spleen is solid, the Heart will not be deficient. He prescribed Amber and other Heart-tonifying herbs, and she stabilized.
Note: Tonifying the Spleen for Heart deficiency aligns with the principle in *Qianjin Fang* that "when Spleen Qi is prosperous, it influences the Heart." However, specific Spleen-tonifying herbs were not discussed in the original text. I believe one should simultaneously tonify Spleen Yin rather than focusing solely on Spleen Qi.
Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction): Yi Lao (Zhang Yuansu) stated: For treating epistaxis, this formula is superior.
Herbs: Xijiao (Rhinoceros Horn), Shaoyao (Peony Root), Danpi (Moutan Cortex) (each 1.5 qian), Shengdi (Rehmannia Root) (4 qian), Gancao (Licorice Root) (0.5 qian).
Boil in 1.5 cups of water until reduced to 0.8 cup. (*Bacui Fang* adds Dahuang (Rhubarb Radix), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root)).
Maohua Tang (White Reed Flower Decoction)
Herbs: Baimaohua (White Reed Flower).
Boil in water to make two bowls of concentrated decoction, taken in two doses. If flowers are unavailable, use the roots.
Ren Shen Lian Xin San (Ginseng and Lotus Plumule Powder)
Herbs: Renshen (Ginseng Radix et Rhizoma) (1 qian), Lianzixin (Lotus Plumule) (0.1 fen).
Grind into powder. Take 2 qian with water on an empty stomach until cured.
Another prescription: 50 Lotus Plumules and 50 Glutinous Rice Grains, ground into powder, taken with wine. Treats hematemesis due to mental exhaustion.
Fahui San (Hair Ash Powder)
Herbs: Fahui (Hair Ash) (1 qian), Renzhongbai (Calcinata Urinae Humanis) (roasted and ground, 0.5 qian), Shexiang (Moschus) (ground, 0.1 fen).
Blow a small amount into the nose for immediate cessation.
*Yuanzhu* Jisu San (Elsholtzia Decoction)
Herbs: Jisu Ye (Elsholtzia Leaf), Huangqi (Astragali Radix), Shengdi (Rehmanniae Radix), Ejiao (Donkey-Hide Gelatin), Baimaogen (Imperatae Rhizoma) (each 1 liang), Maidong (Ophiopogonis Tuber) (decored), Jiegeng (Platycodon Radix), Puhuang (Typhae Pollen) (stir-fried), Beimu (Fritillariae Bulbus) (decored), Zhigancao (Prepared Licorice Root) (5 qian).
Take 4 qian per dose with 3 slices of ginger, boiled in water.
Maidong Yinzi (Ophiopogon Drink): Treats Spleen and Lung deficiency, shortness of breath, lack of spirit, epistaxis, and hematemesis.
Herbs: Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Tuber), Danggui (Angelicae Sinensis Radix) (each 0.5 qian), Wuweizi (Schisandrae Fructus) (5 berries), Huangqi (Astragali Radix), Gancao (Licorice Root), Shaoyao (Paeoniae Radix Alba) (each 1 qian), Ziwan (Asteris Radix) (1.5 qian).
Cut into pieces, divide into two doses. Boil in 2 cups of water until reduced to 1 cup. Strain and take warm after meals. Another version includes Shengdi (Rehmanniae Radix) but excludes Gancao and Shaoyao.