第七章．　治吐衄方

Chapter 7. herbal formula for blood-vomit and bleeding-nose.

1．寒降汤

1. Hanjiang Tang (Han means Cold here in Chinese; jiang: falling down)

 治吐血、衄血，脉洪滑而长，或上入鱼际，此因热而胃气不降也，以寒凉重坠之药，降其胃气则血止矣。
This formula is used for the treatment of blood-spitting and nose-bleeding. The pulse is big, slippery and long, or the pulse can be felt as long as to the thenar muscle. This condition is caused by the Hot in the stomach, which cannot fall down. Here use Cold, Cool and heavy herbs to suppress the stomach Qi down, so to stop the bleeding.

生赭石（六钱，轧细） 清半夏（三钱） 蒌仁（四钱，炒捣） 生杭芍（四钱） 竹茹（三钱） 牛蒡子（三钱，炒捣） 粉甘草（钱半）
Daizheshi 18 gram (grind to powder), Banxia 9 gram, Gualuren 12 gram (fried and grind), Baishao 12 gram, Zhuru 9 gram, Niubangzi 9 gram (fried and grind), Gancao 4.5 gram.

《金匮》治心气不足吐衄，有泻心汤，大黄与黄连、黄芩并用，后世未窥仲景制方之意，恒多误解。不知所谓心气不足者，非不足也，若果不足，何又泻之？盖此证因阳明胃腑之热，上逆冲心，以致心中怔忡不安，若有不足之象。仲景从浅处立说，冀人易晓，遂以心气不足名之。故其立方，独本《内经》吐血、衄血，责重阳明不降之旨，用大黄直入阳明之腑，以降其逆上之热，又用黄芩以清肺金之热，使其清肃之气下行，以助阳明之降力，黄连以清心火之热，使其元阳潜伏，以保少阴之真液，是泻之实所以补之也。且黄连之性肥肠止泻，与大黄并用，又能逗留大黄之力，使之不至滑泻，故吐衄非因寒凉者，服之莫不立愈。且愈后而瘀血全消，更无他患，真良方也。即使心气果系不足，而吐衄不止将有立危之势，先用泻心汤以止其吐衄，而后从容调补，徐复其正，所谓急则治标，亦医家之良图也。乃世人竟畏大黄力猛，不敢轻用，即或用之，病家亦多骇疑。是以愚不得已，拟此寒降汤，重用赭石，以代大黄降逆之力，屡次用之，亦可随手奏效也。

《Jin Kui》introduced the use of herbal formula Xiexin Tang (Xie here means depletion in Chinese) to solve the blood-spitting and nose-bleeding due to Heart Qi insufficiency, in which the Dahuang and Huangliang and Huangqin are used together. Later doctor did not really understand the meaning the Master Zhang Zhongjing in the set up of this formula, so had many misunderstanding. They do not know that, when talked about the “insufficiency” of the Heart Qi, it is not really the “insufficiency”. If it was indeed insufficiency, how it can be depleted further more? The condition solved here by the Xiexin Tang is: the Yangming Stomach Hot moves reverse up to push the Heart, and to cause palpitation, appearing similar to the weakness of the Heart Qi. The Master introduced the herbal formula by using a simple example, by calling this condition as Heart Qi insufficiency, so to make people easy to understand. In the book 《Nei Jing》, it has clearly contributed the blood-spitting and bleeding-nose as the not-falling of the Stomach Qi. In the Xiexin Tang, the herb Dahuang penetrates into the Yangming stage, to suppress the reversed Stomach Fire. The Huangqin works to clear Lung Fire, so to promote its falling property, ans so to help the falling of the Yangming meridian. Herb Huanglian cools the Heart Fire, to make the Yuan Yang hidden, and to save the Shaoyin True Liquid. All work to nourish the insufficiency by clearing the extra condition (Fire). The Huanglian has capacity to restrain the Large Intestine, so to stop diarrhea. It can prevent the diarrhea side effect by over-function of the Dahuang. By this way, if the bleeding is not caused by Cold and weakness, this formula always works fantastic. Again, after stop of the bleeding, the previous dead blood, or stagnated blood is also cleared off. This formula is really good one. Even if the bleeding is really due to the Heart Qi insufficiency and if the condition put the life into risk, this formula should also be used as soon as possible. After stop of the bleeding, consider the treatment of the disease source. This is the principle in the clinic treatment for most urgent conditions.  However, ordinary doctors fear the strong function f the Dahuang, so they are very hesitated to use it, or if use, only use very little of it. Once use it, the family would also be scared and doubted. For this, I have to set up the Hangjiang Tang here, by using large amount of Daizheshi to replace the Dahuang. In my several experience, it worked also well.

或问：后世本草谓血证忌用半夏，以其辛而燥也。子所拟寒降汤，治吐衄之因热者，何以方中仍用半夏，独不虑其辛燥伤血乎？答曰：血证须有甄别，若虚劳咳嗽，痰中带血，半夏诚为所忌。若大口吐血，或衄血不止，虽虚劳证，亦可暂用半夏以收一时之功，血止以后，再徐图他治。盖吐血之证，多由于胃气挟冲气上逆，衄血之证，多由于胃气冲气上逆，并迫肺气亦上逆。《内经》厥论篇曰：阳明厥逆、喘咳身热、善惊衄、呕血。煌煌圣言，万古不易。是治吐衄者，原当以降阳明之厥逆为主，而降阳明胃气之逆者，莫半夏若也。

It might be asked: Later edited pharmacognosy stated not to use the herb Banxia in bleeding conditions, for its spicy and dryness property. In your Hangjie Tang to treat the the bleeding that comes from Hot, why do you use Banxia? You don’t worry its damage to the blood, for its spicy and drying property? Answer: there are different bleeding conditions. If the bleeding occurs in Xulao (exhausting condition) cough, blood in the phlegm, the Banxia should not be used. If the person vomits a lot of blood, or has continuous bleeding from nose, even if it is the Xuhao condition, the Banxia can still be used to stop the bleeding first. After stop of the bleeding, stop the Banxia and use other proper herbal therapy. In most cases, the blood vomit is due to the reverse up of the Stomach Qi that coerces the Chong Qi. The bleeding nose is due to the reverse of the Stomach Qi and the Chong Qi, both pressing the Lung Qi up too. In the Chapter for Jueyin, in the book 《Nei Jing》, it is stated: in the Yangming Jueni condition, the person has cough, asthma, hot body, tends to have scaring bleeding from nose and during vomit. The great statement by ancient generations has been correct for generations. Therefore, to treat the bleeding vomit and bleeding nose, it should be to suppress the Yangming reversed Qi. To turn over the reversed Stomach Qi, it is the Banxai that has to be used.

一童子，年十四，陡然吐血，一昼夜不止，势甚危急，求为诊视。其脉洪长，右部尤重按有力。知其胃气因热不降，血随逆气上升也。为拟此汤，一剂而愈，又服一剂，脉亦和平。
A kid, 14 years of old, vomited blood suddenly for whole day and night. The condition was really dangerous to life. I was asked to have a look. His pulse was big and long. The right side was especially strong upon hard touch. I considered his condition was due to the Stomach Qi not fall due to Hot, so that the blood rushes up reversely. He was given this Hangjie Tang. One dose stopped his bleeding. The second dose completely normalized the pulse too.

一人，年十八，偶得吐血证，初不甚剧。因医者误治，遂大吐不止。诊其脉如水上浮麻，莫辨至数，此虚弱之极候也。若不用药立止其血，危可翘足而待。遂投以此汤，去竹茹，加生山药一两，赭石改用八钱，一剂血止。再诊其脉，左右皆无，重按亦不见。愚不禁骇然。询之心中亦颇安稳，惟觉酸懒无力。忽忆吕沧洲曾治一发斑证，亦六脉皆无，沧洲谓：脉者血之波澜，今因发斑伤血，血伤不能复作波澜，是以不见，斑消则脉出矣。遂用白虎加人参汤，化其斑毒，脉果出（详案在青盂汤下）。今此证大吐亡血，较之发斑伤血尤甚，脉之重按不见，或亦血分虚极，不能作波澜欤？其吐之时，脉如水上浮麻者，或因气逆火盛，强迫其脉外现欤？不然闻其诊毕还里（相距十里），途中复连连呕吐，岂因路间失血过多欤？踌躇久之，乃放胆投以大剂六味地黄汤，减茯苓、泽泻三分之二，又加人参、赭石各数钱，一剂脉出。又服平补之药二十余剂，始复初。 

A man, 18 years of old, had vomited blood occasionally, which was not severe in the beginning. Later, due to a wrong treatment, he had big blood vomit. His pulse was as floating grass over the water. It was so frequent that it is hard to count the pulse rate. This belongs to very weak condition. His life was threatened without a proper treatment. He was so given this Hanjie Tang, with removal of Shanyao, but with additional of Shanyao 30 gram, and with modification of Daizheshe to 24 gram. One dose stopped bleeding. His pulse could not be touched at all on both sides, however. I was terribly scared. When asked, he said he felt kind of calm in heart, only sour, lazy and weak. I suddenly remembered a case of skin bleeding that was treated by Mr. Lu Canzhou: the person also had no any pulse. Mr. Canzhou said: the pulse is the wave of blood. Now the blood is damaged by skin bleeding, so there is no waving of the pulse and it is hard to touch it. After disappear of the skin bleeding, the pulse recurred. I (Mr. Canzhou) then used Baihu jia Renshen Tang to solve the skin bleeding, and the pulse returned back again. (This case was introduced under chapter for Qingyu Tang). Now, in the case here, the damage of the big vomit to the blood is much stronger than the skin bleeding, would the no-pulse be due to heavy damage of the blood by the bleeding, so the blood cannot pump as waving? When he vomited, his pulse was as floating-grass over water, is it due to the pushing of the pulse by the reversed Qi and Fire? I heard that, after visit to me and return back home on the way, he vomited several times again. Is it due to more loss of blood? I have considered for a long time, the decided to use large amount of Liuwei Dihuang Wan, with reduction of Fuling and Zexie two third, addition of Renshen and Daizheshi several grams each. One doses made his pulse appeared. With additional twenty doses, his condition recovered completely.

按：因寒因热，皆可使胃气不降。然因热胃气不降者，人犹多知之，因寒胃气不降者，则知者甚鲜。黄氏论胃气不降，专主因寒一面，盖有所感触而言也。曾有一少妇，上焦烦热，不能饮食，频频咳吐，皆系稀涎，脉象弦细无力。知系脾胃湿寒，不能运化饮食下行，致成留饮为恙也。询其得病之初，言偶因咳嗽懒食，延本处名医投以栝蒌、贝母、麦冬之类，旋愈旋即反复，服药月余竟至如此。遂为开苓桂术甘汤，加干姜、半夏（细观理饮汤后跋语自知），且细为剖析用药之意。及愚旋里，其药竟不敢服，复请前医治之，月余而亡。夫世之所谓名医者，其用药大抵如此，何不读黄氏之论，而反躬自省也哉！

Comments: either Cold or Hot can cause stagnation of Stomach Qi. The condition is well known if it is due to Hot. But it is not commonly known when it is due to Cold. Mr. Huang exclusively discussed the Cold-caused reverse of Stomach Qi, for he had had experience. There was one lady. She had Upper Jiao annoying hot, not able to eat, had frequent vomiting of water-like saliva. Her pulse was string, thin and weak. It was considered to be the Spleen-Stomach Damp-Cold. It blocked the digestion function of the Spleen-Stomach, so as to cause Yin (Damp) condition (water-accumulation condition). When asked, he told that, in the beginning of the disease, he had cough and lazy to eat. A local famous doctor gave him Gualu, Beimu and Maidong. The condition was improved very soon, but very soon again, it recurred. The condition lasted so far for month. I prescribed him Linguizhugan Tang, plus Ganjiang and Banxia (see Liyin Tang) and told him the meaning of the herbs. After I left, he dared not to take it and he turned back to the previous doctor. After month, he died. It is just so so, of a so called famous doctor. Why not read the Mr. Huang’s book and criticizes self!

门人高××实验一方：赭石、滑石等分研细，热时新汲井泉水送服，冷时开水送服，一两或至二两，治吐衄之因热者甚效。高××又在保阳，治一吐血证甚剧者，诸药皆不效，诊其脉浮而洪，至数微数，重按不实。初投以拙拟保元寒降汤，稍见效，旋又反复。高××遂放胆投以赭石二两、台参六钱、生杭芍一两，一剂而愈。
My student, Mr. Gao, had tried one formula: use equal amount of Daizheshi and Huashi. Grind it to thin powder. Drink it with newly get spring or well water when the weather is hot; or drink it with hot water when it is cold weather. Dink it 30 gram to 60 gram, it worked very well in the treatment of blood vomit or bleeding nose due to extreme Hot. He also treated a case in Gaoyang city. The patient had heavy blood vomit. No herbs worked for him. His pulse was floating and strong. It was either very frequent or slight frequent, but not strong when pressed heavier. He was given Baoyun Hanjiang Tang first. The condition was slightly improved, but recurred again. Mr. Gao so give Daizheshi 60 gram, Taishen 18 gram, and Baishao 30 gram. One dose solved his problem.

附录：
Appendix 

直隶青县张××来函：
Mr. Zhang, from Qing city, Zhili province:

天津曹××，年二十五岁，自春日患吐血证，时发时愈，不以介意。至仲冬，忽吐血较前剧，咳嗽音哑，面带贫血，胸中烦热，食少倦怠，屡治罔效，来寓求诊。左脉细弱，右脉则弦而有力，知其病久生热，其胃气因热上逆，血即随之上升也。为开寒降汤方，为其咳嗽音哑，加川贝三钱，连服二剂，病大轻减。又服二剂，不但吐血已止，而咳嗽音哑诸病皆愈。

Mr. Cao, in Tianjin city, 25 years of old, had blood vomit from spring, which occurred and recurred, so that he did not pay much attention. Upon winter, the blood vomit became severe. He coughed with hoarse voice and anemia face, had annoying hot in the chest, ate little and felt tired. He visited doctors but no effect, so he came to me. His left pulse was thin and weak and right one was string and strong. I considered that his condition was due to long time of disease, which created Hot. The Hot Qi moves reversely up, so bring the blood up too. I prescribed him the Hanjiang Tang. For his cough and hoarse voice, Chuan Beimu 9 gram was added. For two doses, the condition was much improved. Additional two doses later, his blood vomit stopped, as well as cough, harsh voice and other symptoms.

安徽当阳吴××来函：
Letter from Mr. Wu, Dangyang city, Anhui province.

孟夏二十三日，赤日晴天，铄人脏腑。有陶××者，因业商，斯日出外买粮，午后忽于路中患吐血，迨抵家尚呕不止。凌晨来院求治。诊其脉象洪滑，重按甚实，知其为热所迫而胃气不降也。因夫子尝推《金匮》泻心汤为治吐衄良方，遂俾用其方煎汤，送服黑山栀细末二钱。服后病稍愈而血仍不止，诊其脉仍然有力，遂为开寒降汤，加广三七细末三钱，俾将寒降汤煎一大盅，分两次将三七细末送服。果一剂而愈。

One day during a summer, the weather was very hot. There was a man called Mr. Tao, who was a business man and went out to buy grains every day. In an afternoon, he vomited blood on his way. The vomit did not stop upon home. He came to me in the early morning. His pulse was big and slippery, which is still strong when pressed heavier. His condition was considered to be: the Hot presses the Stomach Qi and the Stomach Qi could not fall or move down. Since it is recommended to use the Xiexin Tang in the book 《Jing Kui》to treat the blood vomit and bleeding nose, I prescribed this formula, with swallow of Black Zhizi powder 6 gram with the herbal tea. After drink, the blood was not stopped, and his pulse was still very strong. I then used this Hangjiang Tang, with addition of Sanqi powder 9 gram. One dose solved his problem.

2．温降汤

2. Wenjiang Tang (Wen means warm in Chinese. Jiang means reducing, falling down)

治吐衄脉虚濡而迟，饮食停滞胃口，不能消化，此因凉而胃气不降也，以温补开通之药，降其胃气，则血止矣。
This formula is for the condition, in which the patient has blood vomit, or bleeding nose. His pulse is xue, weak, ru, and late. The food ate stops in the upper abdomen, hard to digest. This condition is due to Cold, that makes the Stomach Qi not falling down. This herbal formula is to warm, supply and to open the stagnated Stomach Qi, so to stop the bleeding.

白术（三钱） 清半夏（三钱） 生山药（六钱） 干姜（三钱） 生赭石（六钱，轧细） 生杭芍（二钱） 川浓朴（钱半） 生姜（二钱）
Baizhu 9 gram, Banxia 9 gram, Shanyao 18 gram, Ganjiang 9 gram, Daizheshi 18 gram, Baishao 6 gram, Houpu 4.5 gram, and fresh ginger 6 gram.

或问：此汤以温降为名，用药宜热不宜凉矣。乃既用干姜之热，复用芍药之凉，且用干姜而更用生姜者何也？答曰：脾胃与肝胆，左右对待之脏腑也。肝胆属木，中藏相火，其性恒与热药不宜。用芍药者，所以防干姜之热力入肝也。且肝为藏血之脏，得芍药之凉润者以养之，则宁谧收敛，而血不妄行。更与生姜同用，且能和营卫，调经络，引血循经，此所以用干姜又用生姜也。《内经》厥论篇谓阳明厥逆衄呕血，所谓阳明者，指胃腑而言也，所谓厥逆者，指胃腑之气上行而言也。

It might be asked: this formula is named Wenjiang Tang. The herbs used should so be warmed not cold herbs. Since the Ganjiang is used, why use Shaoyao for its cooling property, and why also use fresh ginger? Answer: the Spleen-Stomach and the Liver-Gall Bladder, are the opposite organ couples. The Liver-Gall Bladder belongs to Wood, which holds Xiang Fire inside. Its nature dislikes Hot herbs. To use the Shaoyao is to prevent the Hot power of the Ganjiang into the Liver. Again, the Liver is the storage place of blood. The Shaoyao could nourish the Liver by cooling it down and humidify it. By this way, the Liver is calm and restrained, the blood would not hurry everywhere without order. When used with Ganjiang, it can harmony the Yin and Wei, adjust and direct the meridians, and to direct the blood within the blood vessels. This is the reason for the combination of the Ganjiang (dried ginger) and the fresh ginger. In the Jueyin chapter of the book 《Nei Jing》, it said that when there is Jueni in the Yangming, there would be blood vomit and/or nose bleeding. The so called Yangming, means the Stomach. The so said Jueni, means the rushing reversely up of the Stomach Qi.

盖胃以消化饮食，传送下行为职，是以胃气以息息下行为顺，设或上行则为厥逆；胃气厥逆，可至衄血、呕血，因血随胃气上行也。然胃气厥逆因热者固多，因寒者亦间有之。岁在壬寅，邑之北境，有学生刘××者，年十三岁，一日之间衄血四次。诊其脉甚和平，询其心中不觉凉热。因思吐衄之证热者居多，且以童子少阳之体，时又当夏令，遂略用清凉止血之品。衄益甚，脉象亦现微弱，知其胃气因寒不降，转迫血上逆而为衄也。投以拙拟温降汤，一剂即愈。隔数日又有他校学生，年十四岁，吐血数日不愈，其吐之时，多由于咳嗽。诊其脉，甚迟濡，右关尤甚。疑其脾胃虚寒，不能运化饮食，询之果然。盖吐血之证多由于胃气不降，饮食不能运化，胃气即不能下降。咳嗽之证，多由于痰饮入肺。饮食迟于运化，又必多生痰饮，因痰饮而生咳嗽，因咳嗽而气之不降者更转而上逆，此吐血之所由来也。亦投以温降汤，一剂血止，接服数剂，饮食运化，咳嗽亦愈。

The Stomach functions to digest food, and to conduct the digested food down. Therefore it is normal that the Stomach Qi should go down. If it goes up, it is a wrong condition. The reversed Stomach Qi can cause blood vomit and/or nose bleeding, since the blood would also hurry up with the reversed Qi. However, though in most cases, the reverse of Stomach Qi is due to Hot, it can also be seen caused by Cold. A young student, 13 years of old, had nose bleeding four times. His pulse was calm. When asked, he said no special hot or cold feeling in his chest. I considered that, the nose bleeding is mostly due to Hot, and the children body is Shaoyang, and it was summer at that time, I used cooling and blood-stopping herbs to him. His bleeding was worse and his pulse was weaker. I so understood that his condition was due to Cold, which turned the blood up to cause the nose bleeding.  I gave him the Wenjinag Tang. One dose solved his problem. After several days, there was student in another school, 14 years of old, had blood vomiting for several days. His vomit was mostly due to cough. His pulse was late and ru, especially on the right Guan position. I suggested he might have Spleen-Stomach weak and Cold, which may also damage his digestion function. Upon asked, he confirmed. The blood vomiting is mostly due to the Stomach Qi not-falling down. If the Stomach Qi does not go down, the food cannot be digested. The cough is mostly due to the accumulation of Phlegm-Damp in the lung. The poor digested food would cause more phlegm to accumulate to store in the lung to cause cough. If the cough makes the Qi not go down, and moves reversely up, there would also be the bleeding. He was given this Wenjiang Tang. One doses stopped the bleeding. After additional several doses, the cough stopped and digestion became normal too.

近在沈阳论及此事，李××谓，从前有老医徐××者，曾用理中汤治愈历久不愈之吐血证，是吐血诚有因寒者之明征也。然徐××但用理中汤以暖胃补胃，而不知用赭石、半夏佐之以降胃气，是处方犹未尽善也。特是药局制药，多不如法，虽清半夏中亦有矾，以治吐衄及呕吐，必须将矾味用微温之水淘净。淘时，必于方中原定之分量外，多加数钱，以补其淘去矾味所减之分量及药力。
Recently we have talked about this case when we were in Shenyang city. Mr. Li said, previously there was a doctor named Dr. Xu, who treated a long term blood vomiting case by use of formula Lizhong Tang. It is the clear proven that the bleeding can be caused by weak and cold in stomach. However, Dr. Li knew to use Lizhong Tang to warm and nourish the Stomach, but not knew to use Daizheshi and Banxian to suppress the reversed Stomach Qi. So his formula is not perfect. Especially if the herbal formula is prepared by herb shop, the way to prepare the formula is usually not correct. The Banxia usually contains vitrial. To treat the bleeding vomit or bleeding nose, it should be washed off. After wash, the depleted weight of total herbs should be refilled with more Banxia.

又：薛立斋原有血因寒而吐者，治用理中汤加当归之说。特其因寒致吐血之理，未尝帮助，是以后世间有驳其说者。由斯知着医书者宜将病之原因仔细发透，俾读其书者易于会悟，不至生疑为善。
In addition, Mr. Xue Lizhai has a experience to treat the bleeding due to Cold, by use of Lizhong Tang plus Danggui. Since he did not clear the mechanism by which the Cold could cause bleeding, so there are argues about his formula. This suggests that, authors of medical books need to clarify the mechanism by which the formula or herbs work, to help the readers to understand. Otherwise, there might be suspect.

不惟吐衄之证有因寒者，即便血之证亦有因寒者，特其证皆不多见耳。邻村高某，年四十余，小便下血久不愈，其脉微细而迟，身体虚弱，恶寒，饮食减少。知其脾胃虚寒，中气下陷，黄坤载所谓“血之亡于便溺者，太阴不升也。”为疏方：干姜、于术各四钱，生山药、熟地黄各六钱，乌附子、炙甘草各三钱。煎服一剂，血即见少。连服十余剂，全愈。此方中不用肉桂者，恐其动血分也。

Not only the bleeding vomit or bleeding nose can be caused by Cold, so bleeding bowel stool or bleeding urine, though it is not common. Mr. Gao in another village, about 40 years of old, had bleeding urine for a long time. His pulse was mild, weak, thin and late. His body was weak; he felt chilly, eat very little. His condition was considered to be due to Spleen-Stomach weak and Cold, so the Middle Qi sink. Thi is as Dr. Huang Kunzai said: “the reason for the loss of blood due to bleeding urine is the inability of Taiyin.” He was then given herbs: Ganjiang 12 gram, Baizhu 12 gram, Shanyao 18 gram, Shoudi 18 gram, Fuzi 9 gram and Zhi Gancao 9 gram. After one dose, the blood disappeared in urine. Continuous intake of about ten doses, the condition was completely cured. The reason for not use herb Rougui, is the fear that it may disturb blood.  

3．清降汤

3. Qingjinag Tang (Qing means cleansing here in Chinese; jiang: suppress)

 治因吐衄不止，致阴分亏损，不能潜阳而作热，不能纳气而作喘。甚或冲气因虚上干，为呃逆、为眩晕。心血因虚甚不能内荣，为怔忡、为惊悸不寐。或咳逆、或自汗诸虚证蜂起之候。
This formula is used to treat continuous bleeding from vomit or nose, that causes Yin deficiency, which again cannot restrain the Yang, and the Yang becomes Hot. The Hot again causes inability of body in inhalation and causes asthma. In severe case, the reversed Qi could rush up to cause hiccup or dizziness. Due to Heart blood weakness, which cannot nourish the body, the person feels palpitation, scaring and hard to fall sleep, or has cough, hiccup, or sweat, and other more.

生山药（一两） 清半夏（三钱） 净萸肉（五钱） 生赭石（六钱，轧细） 牛蒡子（二钱，炒捣）生杭芍（四钱） 甘草（钱半）

Shangyao 30 gram, Banxia 9 gram, Shanyurou 15 gram, Daizheshi 18 gram, Niubangzi 6 gram (fried and grind), Baishao 12 gram, and Gancao 4.5 gram.

4．保元寒降汤

4. Baoyuan Hanjiang Tang (Baoyuan means protest here in Chinese; Han: cold; Jiang: falling, suppressing)

治吐血过多，气分虚甚，喘促咳逆，血脱而气亦将脱。其脉上盛下虚，上焦兼烦热者。
This formula is for over bleeding, so that the Qi part of the body is very weak; the person has asthma, short of breath, and cough. The blood is to escape, so the Qi.  

生山药（一两） 野台参（五钱） 生赭石（八钱，轧细） 知母（六钱） 大生地（六钱） 生杭芍（四钱）牛蒡子（四钱，炒捣） 三七（二钱，细轧药汁送服）
Shanyao 30 gram, wild Taishen 15 gram, Daizheshi 24 gram, Zhimu 18 gram, Shengdi 18 gram, Shaoyao 12 gram, Niubangzi 12 gram (fried and grind), and Sanqi 6 gram (grind, drink with help of the herbal tea).

一叟，年六十四，素有劳疾，因劳嗽太甚，呕血数碗。其脉摇摇无根，或一动一止，或两三动一止。此气血虚极，将脱之候也。诊脉时见其所嗽吐者，痰血相杂。询其从前呕吐之时心中发热。为制此汤，一剂而血止，又服数剂脉亦调勺。
A old man, 64 years of old, had Laoji (exhausting condition) for a long time. For cough too much, he had nausea and vomited blood several bowls. His pulse was shacking without root, or one moved, on stopped, or for every two or three pulses, there was one stop. This is a very weak condition for Qi and Blood, both of which were to escape. Upon diagnosis, it is seen that the phlegm and blood are mixed. Upon asked, he said he had hot feeling in the chest before. He was given this Baoyuan Hanjiang Tang. After one dose, his bleeding stopped. Several more doses solved his pulse too.

附录：
Appendix:

直隶青县张××来函：
Letter from Mr. Zhang, Qing city in Zhili province:

河间裘××，年二十八岁。患咳嗽吐血，且咯吐甚多，气分太虚，喘息迫促，上焦烦热，其脉大而无力，右部尤甚，盖血脱而气亦将脱也。急用保元寒降汤，加青竹茹、麦门冬各三钱。一剂血止。至第二剂，将台参五钱易为西洋参一钱，服之而愈。方病相投，效如影响，洵不误也。

Mr. Qiu in Hejiang city, 28 years of old, had cough and bleeding during cough. The amount of blood was too much, so the Qi part of the body was very weak. He had asthma and short of breath. He had hot feeling in the Upper Jiao. His pulse was big but not strong, especially on the right side. It indicates that the Blood is to escape and the Qi too. It was hurry to give him Baoyuan Hanjiang Tang, with addition of fresh Zhuru 9 gram and Meimendong 9 gram. After one dose, the bleeding stopped. On the second dose, the Taishen was replaced by American Ginseng 3 gram. The formula solved his condition. When the herbs match the sick condition, it works very fast.

5．保元清降汤

5. Baoyuan Qingjiang Tang

治吐衄证，其人下元虚损，中气衰惫，冲气胃气因虚上逆，其脉弦而硬急，转似有力者。
This formula is for blood vomiting or nose bleeding. The person has weakness in the Lower Jiao and the Middle Qi is weak and withered, so that the Chong Qi hushes up. The pulse was string, hard and urgent, felt as strong.

野台参（五钱） 生赭石（八钱，轧细） 生芡实（六钱） 生山药（六钱） 生杭芍（六钱） 牛蒡子（二钱，炒捣） 甘草（钱半）
Wild Taishen 15 gram, Daizheshi 24 gram (grind in powder), Qianshi 18 gram, Shanyao 18 gram, Baishao 18 gram, Niubangzi 6 gram (fry and grind), Gancao 4.5 gram.

附录：
Appendix:

友人毛××曾治一少年吐血证。其人向经医者治愈，旋又反复。毛××诊其脉弦而有力，知其为冲胃之气上逆也。遂于治吐血方中，重用半夏、赭石以降逆，白芍、牡蛎（不 ）以敛冲泻热，又加人参以补其中气，使中气健旺以斡旋诸药成功。有从前为治愈之医者在座，颇疑半夏不可用，毛××力主服之。一剂血止，再剂脉亦和平，医者讶为异事。毛××晓知曰：“此证乃下元虚损，冲气因虚上逆，并迫胃气亦上逆，脉似有力而非真有力，李士材四字脉诀所谓：直上直下，冲脉昭昭者，即此谓也。若误认此脉为实热，而恣用苦寒之药凉其血分，血分因凉而凝，亦可止而不吐，而异日瘀血为恙，竟成劳瘵者多矣。今方中用赭石、半夏以镇冲气，使之安其故宅，而即用白芍、牡蛎以敛而固之，使之永不上逆。夫血为气之配，气为血之主，气安而血自安矣，此所以不治吐血，而吐血自止也。况又有人参之大力者，以参赞诸药，使诸药之降者、敛者，皆得有所凭借以成功乎。”

My friend, Mr. Mao, treated a young boy with blood vomiting. He was cured by other doctors before, but it recurred. When he came to Mr. Mao, his pulse was string and strong. It was considered as Stomach Qi reverse condition. To the herbal formula, used Banxia and Daizheshi to suppress the reverse Qi, Baishao and Muli to restrain the Chong Qi and cleansing the Hot, used Renshen to nourish Middle Qi, to supply sufficient Qi to help other herbs work. The doctor who previously cured the child was at the clinic too. He suspected the use of Banxia in the formula. Mr. Mao however insisted to use it. After one dose, the bleeding stoppted. After the second, the pulse became calm too. The doctor felt very supprised. Mr. Mao explained to him: “This is a Lower Jiao deficiency condition. The Chong Qi rushes up due to the weakness, which also presses Stomach Qi to rush up together, so that the pulse felt strong but it was not a true strong. Mr. Li called such pulse as: strainght from one end to another end of the pulse. It is also called Chong Mai Zhao Zhao. If this pulse was regarded as true Fire, so to use bitter and cold herbs to cool his blood, the blood would be clotted due to the cold. By this way, the bleeding can also be stopped. However, the clotted blood would stay in the body to cause Laoji condition (exhausting condition). In this formual, Daizheshi and Banxia work to suppress the revesed Qi. The Baishao and Muli keep the returned Qi calm in the Lower Jiao, not reversed up again. In Chinese medicine, the blood is the base that the Qi works on, and the Qi is the director of the blood. When the Qi is in calm, the blood of course is calm. This is the way to treat the blood disorder by not treating it directly. The function of the Renshen in the formula is to help other herbs, making these herbs having sufficient energy to function.

6．秘红丹

6. Mihong Dan

治肝郁多怒，胃郁气逆，致吐血、衄血及吐衄之证屡服他药不效者，无论因凉因热，服之皆有捷效。
When the Liver Qi is stagnated, not stretched smoothly or easily and I the person tends to be angry, the Stomach Qi would reverse up to cause blood vomit or nose bleeding. If such condition is hard to solve with other herbal therapy, no matter if it is caused by Hot or Cold, use the formula here. It works fast.

川大黄（一钱细末） 油肉桂（一钱细末） 生赭石（六钱细末）
上药三味，将大黄、肉桂末和匀，用赭石末煎汤送下。
Chuan Dahuang 3 gram (in powder form), You Rougui 3 gram, and Daizheshi 18 gram (powder form). Mix the Dahuang and Rougui powder well. Drink it with the Daizheshi tea (cooked as regular herbal tea).

一妇人，年近三旬，咳嗽痰中带血，剧时更大口吐血，常觉心中发热。其脉一分钟九十至，按之不实。投以滋阴宁嗽降火之药数剂无效。因思此证，若用药专止其嗽，嗽愈其吐血亦当愈。遂用川贝九钱，煎取清汤四茶盅，调入生山药细末一两，煮作稀粥。俾于一日连进二剂，其嗽顿止（此方可为治虚嗽良方），吐血证亦遂愈。

A lady, about 30 years of old, had cough with blood in phlegm. In severe time, the blood is heavy and she also felt hot in the chest. Her pulse was up to 90 times per min, and it felt not solid. She was given herbs several doses, which work to nourish Yin; stop cough and to clearing Fire, but not use. Upon considering that, if use herbs to stop the cough, and if the cough stops, the bleeding should also stop. So, the herbs used were: Chuan Baimu 27 gram, in the tea of which, added Shanyao powder 30 gram and continued to cook the mixture as soup. This soup was eaten for two doses a day. The cough stopped (this formula is good one to stop cough).  The bleeding also stopped.

数日后，觉血气上潮，肺复作痒而嗽，因此又复吐血。自言夜间睡时，常作生气恼怒之梦，怒极或梦中哭泣，醒后必然吐血。据所云云，其肝气必然郁遏，遂改用舒肝（连翘薄荷不可多用）泻肝（龙胆楝子）之品，而以养肝（柏子仁生阿胶）镇肝（生龙骨生牡蛎）之药辅之，数剂病稍轻减。而犹间作恼怒之梦，梦后仍复吐血。欲辞不治，病家又信服难却。再四踌躇，恍悟平肝之药，以桂为最要，肝属木，木得桂则枯也（以桂作钉钉树，其树立枯），而单用之则失于热。降胃止血之药，以大黄为最要（观《金匮》治吐衄有泻心汤重用大黄可知），胃气不上逆，血即不逆行也，而单用之又失于寒。若二药并用，则寒热相济，性归和平，降胃平肝，兼顾无遗。况俗传方，原有用此二药为散，治吐血者，用于此证当有捷效。而再以重坠之药辅之，则力专下行，其效当更捷也。遂用大黄、肉桂细末各一钱和匀，更用生赭石细末煎汤送下，吐血顿愈，恼怒之梦，亦从此不作。后又遇吐血者数人，投以此方，皆随手奏效。至其人身体壮实而暴得吐血者，又少变通其方：大黄、肉桂细末各用钱半，将生赭石细末六钱与之和匀，分三次服，白开水送下，约点半钟服一次。

Several days later, she felt blood and Qi rushed up. The lung felt itch and she started cough blood again. She said that, at night when she had sleep, she had angry dreams, she could feel angry or cry in the dream. Upon waked up, she would have blood vomiting. According to her statement, her Liver Qi was in a stagnated status. So I used herbs to release the Liver (herb Lianqiao and Bohe should not be used in large amount) and to cleansing the Liver (such as Longgancao and Chuanlianzi). These herbs were helped by herbs to nourish the Liver (Boziren and Ajiao) and herbs to suppress the Liver (Longgu and Muli). After several doses, the condition was improved only to a small level. She still had angry dream and had blood vomit after awake. I decided to give up, but the family insisted to continue. After consideration again and again, I suddenly realized that, to calm the Liver, the best herb is Guizhi. The Liver belongs to Wood. When a wood meets Guizhi, the wood would be withered (see, if insert a nail that is made from the Guizhi, into a tree, the tree will withered to die). However, if use the Guizhi alone, its side effect is Hot. Also, the best herb to suppress the Stomach and stop bleeding is the Dahuang (see the book 《Jing Kui》, in the formula for bleeding, Dahuang was used in a large amount). If the Stomach Qi does not rush up reversely, the blood would not leak either. However, the use of the Dahuang alone has side effect of too Cold. If use them together, they should work well to stop the bleeding but prevent the side effect each other. Not to speak of the fact that, in folk prescription they are used together to treat blood vomiting. So, to use them here, they should work well. Together with additional heavy herbs to suppress the Stomach Qi, the formula should work much well. So, I asked to take Dahuang powder and Guizhi powder, each for 3 gram. Mix them well and drink the mixture with the cooked Daizheshi tea. The bleeding stopped right away, and the angry dream also stopped. Later, there were several other cases with blood vomiting, all are solved with this formula. If the person’s body is strong, this formula can be modified little: use Dahuang power 4.5 gram, Rougui powder 4.5 gram, and Daizheshi powder 18 gram. Drink the powder mixture, one third each time, three times a day. Repeat the drinking every one and half hours.

7．二鲜饮

7. Erxian Yin (Er means number two here in Chinese: Xian: fresh; Yin: drinks)

 治虚劳证，痰中带血。

This formula is used when the person has Xulao condition (exhausting condition) and there is blood in phlegm.

鲜茅根（四两，切碎） 鲜藕（四两，切片）

Fresh Maogeng 120 gram (chop), fresh Ou (lorus root) 120 gram (chop into pieces).

煮汁常常饮之，旬日中自愈。若大便滑者，茅根宜减半。再用生山药细末两许，调入药汁中，煮作茶汤服之。
Cook the herbs as soup and drink it from time to time. After weeks, the condition should be improved. If the stool is too loose, reduce the amount of Maogen to half and use Shangyao powder 30 gram to mix into the soup.

茅根善清虚热而不伤脾胃，藕善化瘀血而兼滋新血，合用之为涵养真阴之妙品。且其形皆中空，均能利水，血亦水属，故能引泛滥逆上之血徐徐下行，安其部位也。至于藕以治血证，若取其化瘀血，则红莲者较优。若用以止吐衄，则白莲者胜于红莲者。
The Maogeng is good to cleansing Xue Fire without damage to Spleen-Stomach. The Ou (lutus root) works to clear dead blood and also promote the new blood production. Their combination is marvelous to nourish the True Yin. The lotus root is hollow, can help water disperse. The blood belongs to water, so the lotus root can bring the flooding and spilling blood move down to it original place. When the lotus root is used in the blood condition, the red lotus root is better than the white one in cleansing of stagnated and dead blood; the white lotus root is better in stopping blood vomiting and nose bleeding.

堂兄××，年五旬，得吐血证，延医治疗不效。脉象滑数，摇摇有动象，按之不实。时愚在少年，不敢轻于疏方，因拟此便方，煎汤两大碗，徐徐当茶温饮之，当日即见愈，五六日后病遂脱然。自言未饮此汤时，心若虚悬无着，既饮后，觉药力所至，若以手按心，使复其位，此其所以愈也。

My brother-in-law, 50 years of old, had blood vomiting condition. He had visited various doctors without improvement. His pulse was slippery and frequent, with kind of shacking feeling, which felt not strong. I was young at that time, dared not to prescribe formula to him, so I let him prepare this simple herbal tips. He was asked to drink this herbal tea as regular green tea for two big bowls. On the day, his condition was much improved. After five to six days, the disease was cured. He said, he felt pending of heart, before drinking the herbal tea. After drinking, he could feel the power of the herbs. He pressed the heart with hand, to restore it into the place. This is the reason for the recovery.

8．三鲜饮

8. Sanxian Yin (San means number three here in Chinese; Xian: fresh; Yin: drinks)

 治同前证兼有虚热者。
This formula works for the same condition as above Erxian Yin, but the person with Xu Hot (hot feeling).

即前方加鲜小蓟根二两。
Add fresh Xiaoji root 60 gram into the Erxian Yin formula above.

大、小蓟皆能清血分之热，以止血热之妄行，而小蓟尤胜。凡因血热妄行之证，单用鲜小蓟根数两煎汤，或榨取其自然汁，开水冲服，均有捷效，诚良药也。
Herb Daji and Xiaoji both works to clear hot/fire in the blood. To stop the flooding of the blood, the Xiaoji is the best. For bleeding condition due to Blood Hot/Fire, use single Xiaoji root tens of grams to cook herbal tea, or to grind it into juice to drink (diluted with boiling water). Both way work well. It is really valuable herb. 

小蓟茎中生虫，即结疙瘩如小枣。若取其鲜者十余枚捣烂，开水冲服，治吐衄之因热者甚效。邻村李××曾告愚曰：“余少年曾得吐血证，屡次服药不效，后得用小蓟疙瘩便方，服一次即愈。因呼之谓清凉如意珠，真药中之佳品也。”

If the stem of the Xiaoji has insect, it would produce a knob, a size as small Chinese date. Collect such fresh knob about tens, grind it into mud, drink it with help of boiling water dilution, is very useful in the treatment of blood vomiting and nose bleeding. Mr. Li in another village told me: “I had blood vomiting when I was young. The condition was not improved with many therapies. Later, I tried this folk tip, and one drink solved my problem. So, I call it Qingliang Ruyi pearl (e.g. a pearl that can meet whatever you want). It is really nice herb.”

9．化血丹

9. Huaxue Dan (Hua means to clear, to melt, or to make it disappear; Xue: blood; Dan: big pill)

治咳血，兼治吐衄，理瘀血，及二便下血。
This formula works for various bleeding condition, such as bleeding from cough, vomit, nose, urine or stool.

花蕊石（三钱， 存性） 三七（二钱） 血余炭（一钱， 存性）
共研细，分两次，开水送服。
Huaruishi (Ophicslcite) 9 gram, Sanqi 6 gram, Xueyutan 3 gram. Grind all the ingredients into powder. Separate into two parts. Drink with hot water.

世医多谓三七为强止吐衄之药，不可轻用，非也。盖三七与花蕊石，同为止血之圣药，又同为化血之圣药，且又化瘀血而不伤新血，以治吐衄，愈后必无他患。此愚从屡次经验中得来，故敢确实言之。即单用三七四五钱，或至一两，以治吐血、衄血及大、小便下血皆效。常常服之，并治妇女经闭成 瘕。至血余炭，其化瘀血之力不如花蕊石、三七，而其补血之功则过之。以其原为人身之血所生，而能自还原化，且 之为炭，而又有止血之力也。
Ordinary doctors believed that, the herb Sanqi is a very strong herb to stop bleeding, so it should not be used in mild bleeding. This is not true. The herb Sanqi and Huaruishi, both are king herbs to stop blood. They both can clear dead blood without damage to new born blood. To treat bleeding vomiting or nose bleeding, there is no side effect after healing. This is my own experience from many cases, so I can say so. Even use the Sanqi alone, 12 to 15 gram, or up to 30 gram, it works for bleeding vomiting or nose bleeding, bleeding in urine or in stool. Take it in a regular manner can also solve mass formed in woman’s system (uterus, ovary, or breast). For herb Xueyutan, its capacity in clearing dead blood is not as good as Huaruishi and Sanqi, but it is better in supplying new blood, since it comes from human body (Note; it is processed from hair), can restore its source and has blood stopping function after processed into charcoal.

曾治一童子，年十五，大便下血，数月不愈，所下者若烂炙，杂以油膜，医者诿谓不治。后愚诊视其脉，弦数无力。俾用生山药轧细作粥，调血余炭六七分服之，日二次，旬日全愈。

I treated a child, 15 years of old. He had bleeding in stool for several months without stop. The stool appeared as mud, mixed with oily membrane. Doctors refused to treat. When I saw him, his pulse was string, frequent but weak. The herbal formula I prescribed was: grind Shanyao into power, cook it as soup, mix Xueyutan 1.8 to 2.1 gram into the soup to drink. Drink the soup twice a day. His condition was solved after about ten days.

10．补络补管汤

10. Buluo Buguan Tang (Bu means to supply, and to repair here in Chinese; Luo: conduct; Guan: blood vessels)

治咳血吐血，久不愈者。
It is used to treat long time of bleeding in cough or vomiting.

生龙骨（一两，捣细） 生牡蛎（一两，捣细） 萸肉（一两，去净核） 三七（二钱，研细药汁送服）
服之血犹不止者，可加赭石细末五六钱。
Longgu 30 gram (grind), Muli 30 gram (grind), Shanyurou 30 gram (remove kernel), Sanqi 6 gram (grind, and drink with help of the herbal tea). If the bleeding does not stop after taking this herbs, add Daizheshi powder 15 to 18 gram.

张景岳谓：“咳嗽日久，肺中络破，其人必咳血。”西人谓：胃中血管损伤破裂，其人必吐血。龙骨、牡蛎、萸肉，性皆收涩，又兼具开通之力（三药之性详既济汤来复汤与理郁升陷汤清带汤下），故能补肺络，与胃中血管，以成止血之功，而又不至有遽止之患，致留瘀血为恙也。又佐以三七者，取其化腐生新，使损伤之处易愈，且其性善理血，原为治衄之妙品也。
… The herb Longgu, Muli and Shanyurou, all bear nature of restraining, and opening. They can repair the blood vessels in the lung and stomach, so to stop the bleeding without over block the blood vessels to cause later side effect. They are helped by the Sanqi, for the Sanqi being able to clear the dead blood and produce new blood, to make the broken vessels easy to heal. In addition, the Sanqi is good at solving bleeding problem, being originally marvelous herb for bleeding.

咳血之原由于肺，吐血之原由于胃，人之所共知也。而西人于吐血，论之尤详。其说谓：胃中多回血管，有时溃裂一二处而血出，其故或因胃本体自生炎证，烂坏血管，或因跌打外伤，胃中血管断裂，其血棕黑而臭秽，危险难治，但此类甚少。常见之证，大概血管不曾溃裂，其血亦可自管中溢出，其血多带黑色。因回血管之血色原紫黑，而溢出在胃，胃中酸汁又能令血色变黑也。若血溢自胃中血管，实时吐出，其色亦可鲜红。其病原，或因胃致病，或因身虚弱血质稀薄，皆能溢出。有胃自不病，或因别经传入于胃，如妇女倒经，是子宫之血传入于胃。又如肝脾胀大，血不易通行，回血管满溢，入胃则吐出，入大小肠则便出。便与吐之路不同，其理一也。
(Not translated)

或问：《内经》谓：阳明厥逆，则吐衄。西人谓：胃中血管损伤破裂出血，则吐血。此二说亦相通乎？答曰：阳明厥逆，胃腑气血必有膨胀之弊，此血管之所以易破也。降其逆气，血管之破者自闭。设有不闭，则用龙骨、牡蛎诸收涩之药以补之，防其溃烂，佐以三七、乳香、没药诸生肌之品以养之。此拙拟补络补管汤所以效也。设使阳明未尝厥逆，胃中血管或因他故而破裂，则血在胃中，亦恒随饮食下行自大便出，不必皆吐出也。
It might be asked: it is said in the book《Nei Jing》: If there is Jueni in the Yangming, there would have bleeding from vomit or nose. Western medicine said: the blood vessels in the stomach break to cause bleeding. Are these two statements bear similarity? Answer: In the Yangming Jueni condition, the Qi and blood vessels in the stomach must expand, so the vessels are easy to break. To suppress the reversed Qi, the broken blood vessels would close naturally. If not close to heal, the herb Longgu and Muli, for their restraining herbal nature, can repair it and to prevent it to break. Additional Sanqi, Ruxiang and Moyao can produce production of new muscles, so to repair the broken blood vessels. This is the reason that the formula here works. If the bleeding is not due to the Yangming Jueni, the blood vessels in the stomach breaks due to other reasons, the blood is in the stomach, will follow the food down to stool, not spil up as bleeding vomit.

此方原无三七，有乳香、没药各钱半。偶与友人××谈及，××谓：“余治吐血，亦用兄补络补管汤，以三七代乳香、没药，则其效更捷。”愚闻之遂欣然易之。
In the original formula, there was no Sanqi, but Ruxiang 4.5 gram, and Moyao 4.5 gram. One day, My friend said: “When I treat blood vomiting, I also used this Buluo Buguan Tang, but the Sanqi is used to replace Ruxiang and Moyao. The formula works even faster.” I heard this, so changed the formula.

××又谓：“龙骨、牡蛎能收敛上溢之热，使之下行，而上溢之血，亦随之下行归经。至萸肉为补肝之妙药，凡因伤肝而吐血者，萸肉又在所必需也。且龙骨、牡蛎之功用神妙无穷。即脉之虚弱已甚，日服补药毫无起象，或病虚极不受补者，投以大剂龙骨、牡蛎，莫不立见功效，余亦不知其何以能然也。”愚曰：人身阳之精为魂，阴之精为魄。龙骨能安魂，牡蛎能强魄。魂魄安强，精神自足，虚弱自愈也。是龙骨、牡蛎，固为补魂魄精神之妙药也。
He said again: “Longgu and Muli can restrain the upper spilt Hot to make it flow down; the upper spilt blood is also returning down to its vessels. The Shanyurou is the valuable herb to nourish the Liver. Whenever the bleeding is caused due to Liver damage, Shanyurou is the one that must be used. In addition, the function of Longgu and Muli is surprising. Even if the pulse is very weak, daily herbal therapy showing no any improvement, or the person is too weak to endure nourishing herbal therapy, large amount of Lunggu and Muli still can work. I still don’t know why.” I said: The most valuable part of body Yang is Hong, and the most valuable part of Yin is Po. The Longgu can calm down the Hong, and the Muli can calm down the Po. When the Hong and the Po are calmed down, the spirit of the body is sufficient, the weakness would heal by itself, so that they are the marvelous herbs to nourish the spirit.

邑有吐血久不愈者，有老医于××，重用赤石脂二两，与诸止血药治之，一剂而愈。后其子××向愚述其事，因诘之曰：“重用赤石脂之义何据？”其子曰：“凡吐血多因虚火上升，然人心中之火，亦犹炉中之火，其下愈空虚，而火上升之力愈大，重用赤石脂，以填补下焦，虚火自不上升矣。”愚曰：“兄之论固佳，然犹有剩义。赤石脂重坠之力，近于赭石，故能降冲胃之逆，其粘涩之力，近于龙骨、牡蛎，故能补血管之破。兼此二义，重用石脂之奥妙，始能尽悉。是以愚遇由外伤内，若跌碰致吐血久不愈者，料其胃中血管必有伤损，恒将补络补管汤去萸肉，变汤剂为散剂，分数次服下，则龙骨、牡蛎，不但有粘涩之力，且较煎汤服者，更有重坠之力，而吐血亦即速愈也。”其子闻之欣然曰：“先严用此方时，我年尚幼，未知详问，今闻兄言贶我多矣。”

 There was a village, where lived a patient with blood vomiting. An old doctor treated him, by using large amount of Chishizhi 60 grams, as well as other herbs. One dose solved the problem. His son later described to me this story, since his father asked him: “What’s the reason to use Chishizhi?” The son answered: “Blood vomiting is usually caused by Xu Fire floating. The Fire in the Heart is as the Fire in an oven. If the space beneath the oven is more hollow and loose, the floating Fire is stronger. The large amount of Chishizhe can pill up the Lower Jiao of the body, so to reduce the floating of Fire.” I said: “You explanation heard interesting and reasonable. However, it is not complete. The nature of the Chishizhe is heavy and it is similar to the Daizheshi, so it can suppress the up-rushing Stomach Qi down. Also, it is sticky and restraining, similar to the Longgu and Muli, so it can repair the blood vessels. Combination of the two meanings is the complete answer to your father’s question. For this reason, whenever there is a case of bleeding, no matter it is due to trauma, of inside damage, if the bleeding continues, I would consider there is broken of blood vessels. I would use this Buluo Buguan Tang, with removal of Shanyurou and change the cooked herb form into powder form without cooking, and let the patient drink the powder by several times. By this way, the sticky and down-suppressing property of the Longgu and Muli is more than cooked drinks. The bleeding is fast to solve. The son said: “When my father used this formula, I was still young and I did not know well the reason. Now, after your explanation, I learned a lot.

曾治沧州马氏少妇，咳血三年，百药不效，即有愈时，旋复如故。后愚为诊视，其夜间多汗，遂用净萸肉、生龙骨、生牡蛎各一两，俾煎服，拟先止其汗，果一剂汗止，又服一剂咳血亦愈。盖从前之咳血久不愈者，因其肺中之络，或胃中血管有破裂处，萸肉与龙骨、牡蛎同用以涩之敛之，故咳血亦随之愈也。
Mrs. Ma, in Cangzhou city, had bleeding cough for three years. She tried various therapy without any improvement. If one time there was some improvement, the condition turned back again. When I saw her, she had sweat at night. I so used Shanyurou 30 gram, Longgu 30 gram, and Muli 30 gram, with the aim to stop the sweat first. It was true that the sweat stopped. After second herbal tea, the bleeding cough stopped too. The reason for her continuous bleeding cough is due to the fine blood vessels in the lung, or the blood vessels in the stomach have broken. The Shanyurou, Longgu and Muli, for their restraining property, can restrain the blood vessels to heal the opening, so the bleeding is healed. 

又治本村表弟张×，年三十许，或旬日，或浃辰之间，必吐血数口，浸至每日必吐，亦屡治无效。其脉近和平，微有芤象，亦治以此方，三剂全愈。后又将此方加三七细末三钱，煎药汤送服，以治咳血吐血久不愈者，约皆随手奏效。若遇吐血之甚者，宜再加赭石五六钱，与此汤前三味同煎汤，送服三七细末更效。
Mr. Zhang, lived in another village, about 30 years of old, had bleeding cough every tens fo days, or several hours. Later, it developed into bleeding cough every day. He has tried many times for the treatment but not effect at all. His pulse was near calm, with mild Kong feeling. I used this formula to him. After three doses, his problem disappeared. Later, I added herb Sanqi powder 9 gram to the formula, but let patient drink this powder with the help of the original herbal tea for swallow, to solve long term of bleeding vomiting. All worked. If the bleeding vomiting is too severe, to add Daizheshi 15 to 18 gram to cook with the previous three herbal ingredients, with drink of the Sanqi powder is more effective.

邑张某家贫佣力，身挽鹿车运货远行，因枵腹努力太过，遂致大口吐血。卧病旅邸，恐即不起，意欲还里，又乏资斧。乃勉强徒步徐行，途中又复连吐不止，目眩心慌，几难举步。腹中觉饥，怀有干饼，又难下咽。偶拾得山楂十数枚，遂和干饼食之，觉精神顿爽，其病竟愈。盖酸者能敛，而山楂则酸敛之中，兼有化瘀之力。与拙拟补络补管汤之意相近，故获此意外之效也。
Mr. Zhang was poor. He had to have heavy labor work far away home. For too hard work, he got heavy bleeding vomit. …… He felt dizziness and palpitation and hard to get up or to walk. He felt hungry, and he had cake with him, but felt hard to swallow. On acasion, he picked up more than ten hawthorn. He ate them with his cake. After eat, he felt much better and his disease healed. In this case, the fruit is sour in taste. Sour is with restraining property. For hawthorn, among its restraining property, it has dead-blood-melting property too. Its function is similar to the Buluo Buguan Tang, so he could be healed by such surprising matter. 

附录：
Appendix:

江苏崇明县蔡××来函：
Letter from Mr. Cai, Chongming city, Jingsou province:

回忆毕业中学时，劳心过度，致患吐血，虽家祖世医，终难疗治。遍求名医延医，亦时止时吐。及肄业大学时，吐血更甚，医者多劝辍学静养，方可望痊。乃辍学家居，服药静养，病仍如旧。计无所施，自取数世所藏医书遍阅之，又汗牛充栋，渺茫无涯。况玉石混杂，瑜瑕莫辨，徒增望洋之叹也。幸今秋自周小农处购得《衷中参西录》，阅至吐衄方补络补管汤，知为治仆病的方。抄出以呈家祖父，命将药剂减半煎服，颇见效验。遂放胆照原方，兼取寒降汤之义加赭石六钱，连服三剂全愈。从前半月之间，必然反复，今已月余安然无恙，自觉身体渐强，精神倍加。

I remembered when I got graduated from middle school, I suffered from bleeding vomit, due to too heavy study. Though I was in a doctor family, my condition did not solve. I visited various famous doctors, the bleeding sometimes stopped and later recurred. Upon graduation from university, the bleeding became worse. Doctors advised me stop the study and live at home for healing. So I left the study, drink the herbal tea, but the condition was not solved. For no way to go, I picked up some stored medical books at home. The books are so many, with valuable and not-valuable books mixed together, so I felt disappointed very much. This autumn, I got your published book 《Zhongzhong Canxi Lu》, found the Buluo Buguan Tang. I realized that it is the formula for my disease. I cited it out and gave it to my grandfather. He asked to cook the herbal tea, half amount, for me. It worked.  Therefore I used the original amount of the herbs, with addition of Daizheshi 18 gram, following the meaning of Hanjiang Tang. After three doses, my condition was solved. Previously, my condition could recur within half month. Now, months past and there is problem. I felt stronger in my body and stronger in spirit too.

11．化瘀理膈丹

11. Huayu Lige Dan (Huayu: melting dead blood mass; Lige: clear and adjust the function of diagram; Dan: big pill).

治力小任重，努力太过，以致血瘀膈上，常觉短气。若吐血未愈者，多服补药或凉药，或多用诸药炭，强止其血，亦可有此病，皆宜服此药化之。
This formula works for short of breath, which is due to heavy labor work, which makes blood stagnated above the diagram. For person with bleeding vomiting; with large amount intake of nourishing herbs or cooling herbs, or using more charcoal herbs to stop the bleed, could develop this condition. All conditions as such can be solved by this formula.

三七（二钱，捣细） 鸭蛋子（四十粒，去皮）
Sanqi 6 gram (grind), Yadanzi 40 (removal of peel).

上药二味，开水送服，日两次。凡服鸭蛋子，不可嚼破，若嚼破即味苦不能下咽，强下咽亦多呕出。
Drink these two ingredients, swallowing with help of hot water, twice a day. When take the Yadanzi, it should not be broken. The broken Yadanzi is very bitter to swallow. If forced to swallow, it would be spit out or vomit out.

一童子，年十四，夏日牧牛野间。众牧童嬉戏，强屈其项背，纳头裤中，倒缚其手，置而弗顾，戏名为看瓜。后经人救出，气息已断。俾盘膝坐，捶其腰背，多时方苏。惟觉有物填塞胸膈，压其胸中大气，妨碍呼吸。剧时气息仍断，两目上翻，身躯后挺。此必因在 中闷极之时努挣不出，热血随努挣之气力上溢，而停于膈上也。俾单用三七三钱捣细，开水送服，两次全愈。
A child, 14 years of old, played with his friends in a summer day. Other boys pressed his head bending to the his pants, with his hands bending back and tied. Then he was left there. They joked as the play of watching melon. Later, when he was saved by others, his breath stopped. So, he was lifted in sitting position, had his back massaged and pouched. After a long time, he waked up, but felt filling-up in his chest, which presses his Qi in the chest, so felt short of breath. When the condition is severe, his breath stopped, with two eyes turning up, and body bending backwards. This condition must be due to: when he felt very stroke and had tried to open the tied and pressure, but could not, so the Hot blood rushing up with his heavy trying and stopped above the diagram. For him, he was given Sanqi 9 gram (grinded) to drink with hot water. After two times of drinking, his condition was solved.  

一人，年四十七，素患吐血。医者谓其虚弱，俾服补药，连服十余剂，觉胸中发紧，而血益不止。后有人语以治吐血便方，大黄、肉桂各五分轧细，开水送服，一剂血止。然因从前误服补药，胸中常觉不舒，饮食减少，四肢酸懒无力。愚诊之，脉似沉牢，知其膈上瘀血为患也。俾用鸭蛋子五十粒去皮，糖水送服，日两次，数日而愈。

One man, 47 years of old, had long time of bleeding cough. Doctors said his body was too weak and needed nourishing herbs. After tens of doses, he felt tightness in the chest and the blood continued without stop. Later, he was told a folk-tip for the bleeding: use Dahuang 1.5 gram, and Rougui 1.5 gram, both in powder form, drink with hot water. One dose stopped the bleeding. However, due to mistake of the herbs previously, he felt fullness in the chest, had reduced diet, lazy in the extremes. When I saw him, his pulse was deep and lao (a kind of pulse feeling). I considered his condition as there being stagnated dead blood above the diagram. So, I asked him take herb Yadanzi 50 (with peeling), with help of sugar water, twice a day. After several days, his condition was solved.