包左 仲秋，上失血下便血，治愈之后，季冬又发，吐血盈盆，便血如注，发热形寒，头痛骨楚，咳嗽胁肋牵
疼，艰于转侧，舌苔罩白，脉象浮滑芤数，良由阴分大伤，肝火内炽，蓄瘀留恋，复感新邪，蕴袭肺胃，引动木
火上炎，损伤血络，血不归经，邪不外达。书云∶夺血者不可汗，然不汗则邪无出路，病已入险，用药最难着
手。暂拟轻剂解表，以透其邪，清营祛瘀，引血归经，冀其应手为幸。
炒黑荆芥（一钱五分） 桑叶（二钱） 丹皮（二钱） 清豆卷（四钱） 薄荷叶（八分） 茜草根（二钱）
炙柏炭（一钱五分） 川象贝（各二钱） 马勃（八分） 鲜竹茹（三钱） 白茅根（去心，二扎） 白茅花（包，
一钱） 参三七（另研末冲，三分） 藕汁（冲服，二两）
二诊 服药后，烦躁得汗，表热头痛均已减轻，温邪虽有外解之势，而吐血不止，咳呛胁肋牵痛，寐不安，
便血依然，舌苔转黄，脉弦芤而数。此阴分素亏，君相
之火内炽，逼冲任之血妄行，假肺胃为出路。肺受火刑，肺炎叶举，清肃之令，不得下行，颇虑血涌暴脱之
险！亟拟养阴凉荣，清肺降气，冀水来制火，火降气平，气为血帅，气平则血自易下行。然乎否乎？质诸高明。
西洋参（一钱五分） 粉丹皮（二钱） 炙白苏子（二钱） 玄参（二钱） 桑叶（二钱） 茜草根（二钱）
羚羊片（煎冲，四分） 川贝母（三钱） 侧柏叶（二钱） 甜杏（三钱） 犀角尖（煎冲，四分） 鲜竹茹（三钱）
茅芦根（去心节，各一两）
三诊 投养阴凉营清肺降气之剂，吐血大减，咳呛依然，里热口干，内痔便血，舌边红苔黄，脉芤数不静。
此坎水早亏，离火上亢，肺金受制，清肃之令不得下行，肺与大肠为表里，肺移热于大肠，逼血下注，内痔便血，
所由来也，虽逾险岭，未涉坦途。既见效机，仍守原意扩充。
西洋参（一钱五分） 羚羊片（煎冲，四分） 生石决（八分） 冬桑叶（二钱） 丹皮（二钱） 茜草根（二钱）
侧柏炭（一钱五分） 槐花炭（三钱） 川贝（三钱） 甜杏（三钱） 鲜竹茹（三钱） 冬瓜子（三钱） 枇杷叶
露（后入，四两） 蚕豆花露（后入，四两） 活芦根（去节，一尺）
四诊 吐血渐止，便血亦减，而咳呛内热，胁肋牵痛，动则气逆，舌质红苔黄，脉芤数不静，血去阴伤，木
扣金鸣，肺炎络损，清肃无权。再以凉肝清肺，养阴生津，冀阴平阳秘，水升火降，始能出险入夷。
西洋参（一钱五分） 川石斛（三钱） 桑叶（二钱） 丹皮（二钱） 生石决（八钱） 茜草根（二钱）
侧柏炭（一钱五分） 川贝（二钱） 甜杏（三钱） 槐花炭（三钱） 鲜竹茹（三钱） 冬瓜子（三钱）
活芦根（去节，一尺） 枇杷叶露（后入，四两）
五诊 吐血便血均止，里热亦减，惟咳呛依然，痰多而稠，动则气逆，脉数较缓，舌质红苔黄，阴液难复，
木火易升，肺受其冲，不能输布津液，而反化为稠痰也。今拟补肺阿胶汤合清燥救肺汤意，滋养化源，而清木火。
蛤粉炒阿胶（二钱） 川贝（二钱） 甜光杏（三钱） 生石决（八钱） 川石斛（三钱） 粉丹皮（一钱五分）
桑叶（二钱） 茜草根（二钱） 生甘草（五分） 大麦冬（二钱） 鲜竹茹（三钱） 冬瓜子（三钱）
活芦根（去节，一尺） 北秫米（包，三钱） 枇杷叶露（后入，四两）
六诊 投补肺阿胶清燥救肺以来，咳呛已见轻减，肺获滋润之力也。脉濡软而数，胁肋痛亦止，木火有下
降之势。再守原法，加入培土生金之品，取虚则补母之
意。
蛤粉炒阿胶（二钱） 川贝（二钱） 甜光杏（三钱） 左牡蛎（四钱） 大麦冬（二钱） 茜草根（二钱）
桑叶（二钱） 抱茯神（三钱） 淮山药（三钱） 鲜竹茹（三钱） 冬瓜子（三钱） 北秫米（包，三钱）
干芦根（去节，一两） 枇杷叶露（后入，四两）
另琼玉膏（三两），每日用三钱，分早晚二次开水冲服。
戚左 吐血四天，盈盏成盆，色不鲜红，脉象芤数无力，舌苔淡白。阅前服之方，均是凉血清营，未能应
效，今脉舌参看，阴分本亏，阳气亦虚，不能导血归经，而反上溢妄行也，势非轻浅。姑仿金匮侧柏叶汤加味。
蛤粉炒阿胶（三钱） 侧柏叶（三钱） 炮姜炭（六分） 丹参（二钱） 茜草根（二钱） 怀牛膝（二钱）
茯神（三钱） 川贝（二钱） 竹茹（二钱） 藕节炭（三枚） 清童便（冲服，一酒杯）
二诊 前方服二剂，吐血已止，原方加茺蔚子（三钱）。
崔右 经云∶中焦受气取汁，变化而赤是为血。血属阴，主静，赖阳气以营运，内则洒陈五脏，外则循行经
络。今阳虚气滞，不能导血归经，血因停蓄，蓄久则络损血溢，上为吐血，盈盏成盆，下为便血，色黑如墨。舌
淡白，脉芤无力。所谓阳络损伤，则血上溢，阴络损伤，则血下溢是也。上下交损，宜治其中，理中汤加味。
炒潞党参（一钱五分） 生白术（一钱五分） 云苓（三钱） 清炙草（四分） 炮姜炭（八分） 陈广皮（一钱）
全当归（二钱） 丹参（二钱） 怀牛膝（二钱） 藕节炭（二枚）
二诊 投两剂，上下之血均止，惟胃呆纳少，加砂仁（八分）、焦谷芽（四钱）。
支左 吐血七昼夜，狂溢不止，有数斗许，神志恍惚，气短，四肢逆冷过于肘膝，舌质红苔灰黄，脉象微
细，似有若无。此乃阴不敛阳，阳不抱阴，气难摄血，血不归经，虚脱之变，即在目前。先哲治血，有血脱益气
之例，有形之血，势将暴脱，无形之气，所当急固。益气纳气，大剂频进，冀挽回于万一。
吉林人参（另煎冲服，三钱） 蛤粉炒阿胶（三钱） 炙白苏子（二钱） 左牡蛎（五钱） 花龙骨（五钱） 川
贝母（三钱） 白归身（二钱） 怀牛膝（二钱） 养心丹（分三次吞服，三十粒）
水、童便各半煎服。
二诊 连服益气纳气，气平血止肢温，脉渐起，汗亦收，阴平阳秘，大有生机。仍守原法，毋庸更张。
原方去养心丹，加抱茯神（三钱）、淮山药（三钱）。
三诊 原方加旱莲草二钱。
原按∶此吐血中之最剧者，家祖连诊十余次，守方
不更，至半月后停药，每日吞服人参粉（一钱五分），琼玉膏（三钱），开水冲服，服至一月后，诸恙已愈，精神渐
复，亦可谓幸矣。孙济万志。
翁左 吐血已延数月之久，时发时止，形神萎顿，面无华泽，所吐之血，色淡红不鲜，脉象虚细，良由烦劳
太过，心脾并亏，络损血溢，气不摄纳。拟归脾汤加减，徒恃养阴凉营，无益也。
潞党参（三钱） 炙黄 （三钱） 淮山药（三钱） 茯神（三钱） 炙远志（一钱） 酸枣仁（二钱）
白归身（二钱） 大白芍（二钱） 清炙草（五分） 橘络（一钱） 红枣（五枚） 藕节（三枚）
周左 始由胁肋作痛，烦躁少寐，继则吐血不止，内热口干，舌质红苔黄，脉弦芤而数，良由郁怒伤肝，操
烦劳心，气郁化火，火炽气焰，扰动阳络，则血上溢也。亟拟清气凉肝，祛瘀生新。
生白芍（三钱） 茜草根（二钱） 川贝母（三钱） 粉丹皮（二钱） 侧柏炭（一钱五分） 黛蛤散（包，四钱）
黑山栀（二钱） 山茶花（一钱五分） 羚羊角（煎冲，四分） 竹茹（三钱） 鲜藕汁（冲服，二两） 白茅根（
去心，二扎）
二诊 服清气凉肝，祛瘀生新之剂，吐血渐减，而未能尽止，烦躁不寐，胁痛依然，脉弦数而芤，按之不
静。气火入络，络热则痛，水不制火，心肾不交，还虑血
涌！今拟壮水清肝，泄热和络。
大麦冬（三钱） 生白芍（二钱） 生甘草（五分） 粉丹皮（二钱） 川贝（二钱） 茜草根（二钱）
侧柏叶（一钱五分） 黛蛤散（包，四钱） 生石决（八钱） 茯神（三钱） 制军炭（一钱五分） 真新绛（八分）
鲜竹茹（三钱） 白茅花（包，一钱） 白茅根（去心，二扎）
三诊 胁痛减，夜寐稍安，吐血不止，而反狂涌，幸脉转小数，神疲萎顿，缘已出络之血尽去，阴分大伤，虚
火炎炎，大有吸尽西江之势，颇为可虑。今仿血脱益气之例治之。
西洋参（三钱） 大麦冬（三钱） 左牡蛎（四钱） 阿胶珠（三钱） 石斛（三钱） 茜草根（二钱）
侧柏炭（一钱五分） 生白芍（二钱） 丹皮（二钱） 怀牛膝（二钱） 抱茯神（三钱） 鲜竹茹（三钱）
鲜藕汁（冲服，二两）
四诊 吐血已止，原方去藕汁，加琼玉膏（三钱）冲服。
楮左 伤寒两感证已半月，叠投温经达邪，诸恙向安，昨忽吐血，鼻衄、牙龈舌衄俱见，昼夜不止，盈盏成
盆，幸脉象濡中不洪，神识尚清，盖由气分大伤，邪热入营，逼血妄行，虽曰衄解，然尚在危险中也。今拟大剂
育阴清营，以制炎上之火，未识能得挽回否？
西洋参（三钱） 京玄参（三钱） 大麦冬（三钱） 大生地（一两）
生白芍（三钱） 犀角片（煎冲，四分） 粉丹皮（二钱） 侧柏叶（二钱） 鲜藕（切片入煎，四两）
鲜竹茹（三钱）
二诊 服育阴清营之剂，诸衄已见轻减，原方去犀角，加川石斛（三钱）。
三诊 加清阿胶（三钱）。
凌左 水不涵木，肝火升腾，阳络损伤，则血上溢，血去阴伤，阴不抱阳，阳不摄阴。宜益气养阴，清肺凉肝。
西洋参（一钱五分） 生白芍（二钱） 粉丹皮（二钱） 栝蒌皮（三钱） 细生地（三钱） 生石决（八钱）
怀牛膝（二钱） 生牡蛎（四钱） 大麦冬（一钱五分） 茜草根（二钱） 川贝母（三钱） 藕节炭（二枚）
童便（冲服，一酒杯）
赵左 春令木旺，肝胆之火升腾，风燥之邪外袭，肺金受制，阴络损伤，咳呛吐血，胁肋牵痛，燥化火，火
刑金，肺炎叶举，脉数苔黄，虑其血涌狂吐，亟拟凉肝清燥，润肺去瘀。
冬桑叶（二钱） 粉丹皮（二钱） 生石决（八钱） 马勃（八分） 茜草根（二钱） 侧柏叶（一钱五分）
川象贝（各二钱） 甜光杏（三钱） 竹茹（三钱） 白茅花（包，一钱） 冬瓜子（三钱） 活芦根（去节，一尺）
蚕豆花露 枇杷叶露（冲服，
各四两）
喻左 负重努力，血络损伤，血由上溢，吐血盈碗。胁肋牵痛，艰于转侧，脉象芤数，去瘀生新主治。
全当归（二钱） 紫丹参（二钱） 怀牛膝（二钱） 茜草根（二钱） 川贝（二钱） 刘寄奴（一钱五分）
仙鹤草（三钱） 真新绛（八分） 川郁金（一钱五分） 竹茹（三钱） 白茅花（包，一钱） 茺蔚子（三钱）
参三七（另研细末冲，三分） 藕汁（冲服，二两）
匡左 水亏不能涵木，木火升腾，阳络损伤，则血上溢，咯血内热，舌质红，脉芤数，还虑血涌。宜壮水柔
肝，祛瘀生新。
天麦冬（各二钱） 左牡蛎（四钱） 粉丹皮（二钱） 生石决（八钱） 白芍（二钱） 茜草根（二钱）
侧柏炭（一钱五分） 川贝母（二钱） 紫丹参（二钱） 牛膝（二钱） 鲜竹茹（二钱） 白茅花（包，一钱）
白茅根（去心，两扎） 鲜藕（切片入煎，二两）
莫左 肾阴不足，肝火有余，吐血屡发，脉微寡神，血不华色，舌苔淡白，血去阴伤。阴不抱阳，则阳益亢；
阴不胜阳，故阴愈亏。脉症相参，损症已着。姑仿王太仆壮水之主，以制阳光，以冀万一之幸。
大生地（三钱） 淮山药（二钱） 生石决（五钱） 熟女贞（三钱） 粉丹皮（一钱五分） 生白芍（三钱）
旱莲草（三钱） 茜草根
（一钱四分） 抱茯神（三钱） 清炙草（五分） 潼蒺藜（三钱） 鲜竹茹（一钱五分） 鲜藕（二两）
祈左 肾阴早亏，龙雷之火，肆逆于上，逼血妄行，以致涌吐六七日，盈盏盈盆，汗多气喘，脉细如丝，有欲
脱之象，阴不抱阳，阳不摄阴，气血有涣散之虞，阴阳有脱离之险，病势至此，危在顷刻！宗经旨血脱益气之法，
峻补其气，以生其血，未识能得挽回否。
吉林人参（二钱） 黑锡丹（五分）
二诊 涌吐大减，气喘略平，脉细无力，是血去阴伤，龙雷之火上升，肺气不能下降。古人云∶天下无逆
流之水，人身无倒行之血，水之逆流者因乎风，血之倒流者因乎气，气逆则血溢矣。症情尚在险关，还虑意外
之变。再宜益气益阴，顺气降逆，以望转机。
吉林参（一钱五分） 当归身（三钱） 陈广皮（八分）
黄左 吐血后，咳嗽吐涎沫，形瘦色萎，阴损及阳，土不生金。脾为生痰之源，肺为贮痰之器，脾虚不能为
胃行其津液，水谷之湿，生痰聚饮，渍之于肺，肺失清肃之权，涎出于脾，脾无摄涎之能，谷气既不化精微，何以
能生长肌肉，形瘦色萎，职是故也。经云∶一损损于皮毛，皮聚而毛落。三损损于肌肉，肌肉消瘦。病情参
合，肺劳之势渐着。书云∶损之自上而下者，过于胃则不可治，自下而上者，过于脾则不可治。盖深知人身之
[Patient Bao, Left] In mid-autumn, the patient experienced upper hematemesis and lower hematochezia. After recovery, the condition relapsed in late winter (Jidong), with hematemesis filling basins and hematochezia flowing like a stream. Symptoms included fever, aversion to cold, headache, generalized bone ache, cough with pulling pain in the hypochondrium, difficulty turning the body, a white greasy tongue coating, and a floating, slippery, hollow (Kou), and rapid pulse. This is primarily due to severe injury of the Yin aspect, blazing Liver Fire internally, lingering blood stasis, combined with a new external pathogenic factor invading the Lung and Stomach. This triggered the upward flaming of Wood Fire, damaging the blood collaterals, causing blood to deviate from its vessels, and preventing the pathogen from being expelled via the exterior. As the classics state: "One who has lost blood should not be treated with sweating methods." However, without sweating, there is no outlet for the pathogen, and the disease has entered a perilous stage, making treatment difficult. A light formula is tentatively prescribed to release the exterior and vent the pathogen, clear the Ying level, dispel stasis, and guide blood back to its vessels, hoping for an immediate response.
Black-fried Schizonepetae Spica (1.5 qian) Mulberry Leaf (2 qian) Moutan Cortex (2 qian) Clear Soybean Sprout (4 qian) Mint Leaf (0.8 fen) Rubiae Radix (2 qian) Fried Phellodendri Cortex Charcoal (1.5 qian) Sichuan Fritillaria Bulb & Trichosanthes Fruit (2 qian each) Magnolia Flower Bud (0.8 fen) Fresh Bamboo Shavings (3 qian) Imperatae Rhizoma (decentred, 2 bundles) Imperatae Flower (wrapped, 1 qian) Notoginseng Radix et Rhizoma (separately ground powder, taken with decoction, 0.3 fen) Lotus Juice (taken with decoction, 2 liang)
Second visit: After taking the medicine, irritability subsided with sweating, and the exterior heat and headache were significantly relieved. Although the warm pathogen shows signs of external resolution, hematemesis continues, accompanied by coughing, wheezing, pulling pain in the hypochondrium, restlessness during sleep, and persistent hematochezia. The tongue coating has turned yellow, and the pulse is wiry, hollow, and rapid. This indicates a constitutional deficiency of the Yin aspect, with the Sovereign and Ministerial Fires blazing internally, forcing the blood of the Chong and Ren vessels to act recklessly, seeking an exit through the Lung and Stomach. The Lung suffers from Fire oppression, leading to lung tissue distension; the descending function of clarity and purity cannot go downward. There is great concern regarding the danger of sudden blood gushing and collapse! It is urgent to prescribe nourishing Yin and cooling the Blood, clearing the Lung and directing Qi downward, hoping that Kidney Water will control Heart Fire. Once Fire descends and Qi levels, since Qi is the commander of Blood, the Blood will easily flow downward. Is this correct? I submit this to experts for judgment.
American Ginseng (1.5 qian) Powdered Moutan Cortex (2 qian) Fried Perilla Seed (2 qian) Scrophulariae Radix (2 qian) Mulberry Leaf (2 qian) Rubiae Radix (2 qian) Antelope Horn Slice (decocted, taken with liquid, 0.4 fen) Sichuan Fritillaria Bulb (3 qian) Platycladi Cacumen (2 qian) Sweet Apricot Kernel (3 qian) Rhinoceros Horn Tip (decocted, taken with liquid, 0.4 fen) Fresh Bamboo Shavings (3 qian) Imperatae Rhizoma and Arundo Rhizoma (decentred and jointless, 1 liang each)
Third visit: After administering the formula to nourish Yin, cool the Ying level, clear the Lung, and direct Qi downward, hematemesis decreased significantly, but coughing and wheezing persist. Internal heat and dry mouth are present, along with internal hemorrhoids and hematochezia. The tongue edges are red with a yellow coating, and the pulse is hollow, rapid, and restless. This signifies early depletion of Kidney Water (Kan Water), with Heart Fire (Li Fire) hyperactive. Lung Metal is constrained, and its descending function fails. Since the Lung and Large Intestine are interior-exterior partners, Lung heat transfers to the Large Intestine, forcing blood downward, causing internal hemorrhoids and hematochezia. Although the dangerous pass has been crossed, the road ahead is not yet smooth. Since efficacy is observed, the original principle is maintained and expanded.
American Ginseng (1.5 qian) Antelope Horn Slice (decocted, taken with liquid, 0.4 fen) Raw Abalone Shell (0.8 fen) Winter Mulberry Leaf (2 qian) Moutan Cortex (2 qian) Rubiae Radix (2 qian) Platycladi Cacumen Charcoal (1.5 qian) Sophorae Flos Charcoal (3 qian) Sichuan Fritillaria (2 qian) Sweet Apricot Kernel (3 qian) Fresh Bamboo Shavings (3 qian) Benincasa Semen (3 qian) Loquat Leaf Dew (added later, 4 liang) Vicia Faba Flower Dew (added later, 4 liang) Living Arundo Rhizoma (jointless, 1 chi)
Fourth visit: Hematemesis gradually stopped, and hematochezia also decreased. However, coughing, wheezing, internal heat, and pulling pain in the hypochondrium persist, with Qi rebellion upon movement. The tongue substance is red with a yellow coating, and the pulse is hollow, rapid, and restless. Blood loss has injured Yin; Liver Wood strikes Lung Metal, causing Lung collateral damage and loss of regulatory power. The approach remains cooling the Liver, clearing the Lung, nourishing Yin, and generating fluids, hoping for balance between Yin and Yang, ascending Water and descending Fire, thereby moving from danger to safety.
American Ginseng (1.5 qian) Dendrobii Caulis (3 qian) Mulberry Leaf (2 qian) Moutan Cortex (2 qian) Raw Abalone Shell (8 qian) Rubiae Radix (2 qian) Platycladi Cacumen Charcoal (1.5 qian) Sichuan Fritillaria (2 qian) Sweet Apricot Kernel (3 qian) Sophorae Flos Charcoal (3 qian) Fresh Bamboo Shavings (3 qian) Benincasa Semen (3 qian) Living Arundo Rhizoma (jointless, 1 chi) Loquat Leaf Dew (added later, 4 liang)
Fifth visit: Both hematemesis and hematochezia have ceased, and internal heat has subsided. Only coughing and wheezing remain, with profuse, thick sputum, and Qi rebellion upon movement. The pulse is slower than before, the tongue substance is red with a yellow coating. Yin fluids are difficult to restore, and Liver Fire rises easily. The Lung is assaulted by this fire and cannot distribute fluids, instead transforming them into thick phlegm. Now, the intent of Bufeijiao'ao Tang (Lung-Nourishing Donkey-Hide Gelatin Decoction) combined with Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) is adopted to nourish the source of transformation and clear Liver Fire.
Donkey-Hide Gelatin fried with Talcum Powder (2 qian) Sichuan Fritillaria (2 qian) Sweet Light Apricot Kernel (3 qian) Raw Abalone Shell (8 qian) Dendrobii Caulis (3 qian) Powdered Moutan Cortex (1.5 qian) Mulberry Leaf (2 qian) Rubiae Radix (2 qian) Raw Licorice Root (0.5 fen) Ophiopogonis Radix (2 qian) Fresh Bamboo Shavings (3 qian) Benincasa Semen (3 qian) Living Arundo Rhizoma (jointless, 1 chi) Panicum miliaceum Grain (wrapped, 3 qian) Loquat Leaf Dew (added later, 4 liang)
Sixth visit: Since administering Bufeijiao'ao Tang and Qingzao Jiufei Tang, coughing and wheezing have alleviated, indicating the Lung has received moistening power. The pulse is soft and rapid, and hypochondriac pain has ceased, showing Liver Fire is descending. The original method is continued, adding herbs to strengthen Earth to generate Metal, following the principle of "tonifying the mother when deficient."
Donkey-Hide Gelatin fried with Talcum Powder (2 qian) Sichuan Fritillaria (2 qian) Sweet Light Apricot Kernel (3 qian) Left Oyster Shell (4 qian) Ophiopogonis Radix (2 qian) Rubiae Radix (2 qian) Mulberry Leaf (2 qian) Poria Cocos with Hostwood (3 qian) Chinese Yam (3 qian) Fresh Bamboo Shavings (3 qian) Benincasa Semen (3 qian) Panicum miliaceum Grain (wrapped, 3 qian) Dry Arundo Rhizoma (jointless, 1 liang) Loquat Leaf Dew (added later, 4 liang)
Separately, Qiongyu Gao (Jade Dew Paste) (3 liang), 3 qian daily, divided into morning and evening doses, taken with boiled water.
[Patient Qi, Left] Hematemesis for four days, filling cups and basins, blood color not bright red. Pulse is hollow, rapid, and forceless; tongue coating is pale white. Reviewing previous prescriptions, they were all for cooling blood and clearing the Ying level, without effect. Considering pulse and tongue together, the Yin aspect is constitutionally deficient, and Yang Qi is also weak, failing to guide blood back to its vessels, causing it to overflow upwards. The condition is serious. Tentatively imitating Ce Bai Ye Tang (Platycladi Cacumen Decoction) from *Jin Gui Yao Lue* with modifications.
Donkey-Hide Gelatin fried with Talcum Powder (3 qian) Platycladi Cacumen (3 qian) Roasted Ginger Charcoal (0.6 fen) Salviae Miltiorrhizae Radix (2 qian) Rubiae Radix (2 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Poria Cocos (3 qian) Sichuan Fritillaria (2 qian) Bamboo Shavings (2 qian) Lotus Node Charcoal (3 pieces) Clear Child's Urine (taken with decoction, one wine cup)
Second visit: After two doses of the previous formula, hematemesis stopped. Add Vitex Fruit (3 qian) to the original formula.
[Patient Cui, Right] The Classics state: "The Middle Jiao receives Qi, extracts juice, transforms it red, and this is called Blood." Blood belongs to Yin, is static, and relies on Yang Qi for circulation. Internally, it sprinkles the Five Zang organs; externally, it circulates through the meridians. Now, Yang deficiency and Qi stagnation prevent guiding blood back to its vessels. Blood accumulates; over time, collaterals are damaged, and blood overflows. Upward, it manifests as hematemesis, filling cups and basins; downward, as hematochezia, black as ink. The tongue is pale white, and the pulse is hollow and forceless. This is what is meant by: "Damage to Yang collaterals causes blood to overflow upward; damage to Yin collaterals causes blood to overflow downward." When both upper and lower are damaged, treatment should focus on the Middle Jiao. Lizhong Tang (Regulate the Middle Decoction) with modifications is used.
Stewed Codonopsis Root (Lu Shen) (1.5 qian) Raw Atractylodes Macrocephala Rhizome (1.5 qian) Poria Cocos (Yun Ling) (3 qian) Prepared Licorice Root (Qing Zhi Cao) (0.4 fen) Roasted Ginger Charcoal (0.8 fen) Aged Tangerine Peel (Chen Pi) (1 qian) Whole Angelica Sinensis Radix (2 qian) Salviae Miltiorrhizae Radix (2 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Lotus Node Charcoal (2 pieces)
Second visit: After two doses, bleeding from above and below stopped. Due to poor appetite and stomach stagnation, add Amomum Fruit (0.8 fen) and Scorched Barley Sprout (4 qian).
[Patient Zhi, Left] Hematemesis for seven days and nights, continuous violent overflow, amounting to several dou. Mental confusion, shortness of breath, cold limbs extending beyond elbows and knees. Tongue substance red with grey-yellow coating, pulse minute and fine, almost imperceptible. This is Yin failing to contain Yang, Yang failing to embrace Yin, Qi unable to control blood, blood deviating from vessels. Signs of collapse are imminent. Ancients treated blood disorders with the example of "Tonifying Qi in cases of Blood Collapse." Formidable blood loss threatens sudden collapse; formless Qi must be urgently secured. Tonify Qi and grasp Qi, administer large doses frequently, hoping for salvation.
Jilin Ginseng (separately decocted, taken with liquid, 3 qian) Donkey-Hide Gelatin fried with Talcum Powder (3 qian) Fried Perilla Seed (2 qian) Left Oyster Shell (5 qian) Dragon Bone (Hua Long Gu) (5 qian) Sichuan Fritillaria Bulb (3 qian) Angelica Sinensis Radix (Bai Gui Shen) (2 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Yangxin Dan (Heart-Nourishing Pill, swallowed in three doses, 30 pills)
Decoct with half water and half child's urine.
Second visit: Continuous administration of Qi-tonifying and Qi-grasping herbs resulted in leveled Qi, stopped bleeding, warmed limbs, rising pulse, and cessation of sweating. Yin and Yang are balanced, showing great vitality. Continue the original method without change.
Remove Yangxin Dan from the original formula, add Poria Cocos with Hostwood (3 qian) and Chinese Yam (3 qian).
Third visit: Add Ecliptae Herba (2 qian) to the original formula.
Original Note: This is the most severe case of hematemesis. My grandfather diagnosed and treated it over ten times, maintaining the same prescription until stopping medication after half a month. Daily intake of Ginseng Powder (1.5 qian) and Qiongyu Gao (3 qian) taken with boiled water led to complete recovery of symptoms and gradual restoration of spirit after one month. What a fortune. Recorded by Sun Jiwan.
[Patient Weng, Left] Hematemesis has persisted for months, intermittent. Physical and mental exhaustion, lackluster complexion. Vomited blood is pale red and not bright. Pulse is deficient and fine. This is due to excessive mental labor, damaging both Heart and Spleen, damaging collaterals and causing blood overflow, with Qi failing to hold. A modified Guipi Tang (Restore the Spleen Decoction) is prescribed. Relying solely on nourishing Yin and cooling the Ying level is useless.
Codonopsis Root (Lu Shen) (3 qian) Prepared Astragalus Root (Zhi Huang Qi) (3 qian) Chinese Yam (3 qian) Poria Cocos (3 qian) Prepared Polygala Root (Zhi Yuan Zhi) (1 qian) Sour Jujube Seed (Suan Zao Ren) (2 qian) Angelica Sinensis Radix (Bai Gui Shen) (2 qian) White Peony Root (Da Bai Shao) (2 qian) Prepared Licorice Root (Qing Zhi Cao) (0.5 fen) Tangerine Network (Ju Luo) (1 qian) Red Dates (5 pieces) Lotus Node (3 pieces)
[Patient Zhou, Left] Initially hypochondriac pain, irritability, and insomnia, followed by continuous hematemesis, internal heat, dry mouth, red tongue substance with yellow coating, and wiry, hollow, rapid pulse. This is due to depression and anger injuring the Liver, and mental worry injuring the Heart. Qi stagnation transforms into Fire; blazing Fire disturbs Yang collaterals, causing blood to overflow upward. Urgently prescribe clearing Qi, cooling the Liver, dispelling stasis, and generating new blood.
Raw White Peony Root (3 qian) Rubiae Radix (2 qian) Sichuan Fritillaria Bulb (3 qian) Powdered Moutan Cortex (2 qian) Platycladi Cacumen Charcoal (1.5 qian) Dai Ge San (Indigo Naturalis and Clam Shell Powder, wrapped) (4 qian) Black Gardenia Fruit (Hei Shan Zhi) (2 qian) Camellia Japonica Flower (Shan Cha Hua) (1.5 qian) Antelope Horn (decocted, taken with liquid, 0.4 fen) Bamboo Shavings (3 qian) Fresh Lotus Juice (taken with decoction, 2 liang) Imperatae Rhizoma (decentred, 2 bundles)
Second visit: After administering clearing Qi, cooling Liver, dispelling stasis, and generating new blood herbs, hematemesis decreased but did not stop completely. Irritability, insomnia, and hypochondriac pain persist. Pulse is wiry, rapid, and hollow, restless upon pressure. Qi and Fire enter the collaterals; collateral heat causes pain. Water fails to control Fire, Heart and Kidney do not interact. Concern remains about blood gushing! Now prescribe strengthening Water, cooling the Liver, draining heat, and harmonizing collaterals.
Ophiopogonis Radix (3 qian) Raw White Peony Root (2 qian) Raw Licorice Root (0.5 fen) Powdered Moutan Cortex (2 qian) Sichuan Fritillaria (2 qian) Rubiae Radix (2 qian) Platycladi Cacumen (1.5 qian) Dai Ge San (wrapped) (4 qian) Raw Abalone Shell (8 qian) Poria Cocos (3 qian) Charcoalized Rhubarb (Zhi Jun Tan) (1.5 qian) Genuine Xin Jiang (New Crimson Silk) (0.8 fen) Fresh Bamboo Shavings (3 qian) Imperatae Flower (wrapped, 1 qian) Imperatae Rhizoma (decentred, 2 bundles)
Third visit: Hypochondriac pain reduced, night sleep slightly improved, but hematemesis continues and even violently surges. Fortunately, the pulse has become small and slightly slow. Mental fatigue and emaciation are evident because blood that has left the collaterals is exhausted, severely injuring the Yin aspect. Deficient Fire blazes fiercely, resembling the attempt to drain the West River. This is concerning. Now imitate the example of "Tonifying Qi in cases of Blood Collapse" for treatment.
American Ginseng (3 qian) Ophiopogonis Radix (3 qian) Left Oyster Shell (4 qian) Gelatin Pearl (E Jiao Zhu) (3 qian) Dendrobii Caulis (3 qian) Rubiae Radix (2 qian) Platycladi Cacumen Charcoal (1.5 qian) Raw White Peony Root (2 qian) Moutan Cortex (2 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Poria Cocos with Hostwood (3 qian) Fresh Bamboo Shavings (3 qian) Fresh Lotus Juice (taken with decoction, 2 liang)
Fourth visit: Hematemesis has stopped. Remove Lotus Juice from the original formula, add Qiongyu Gao (3 qian) taken with decoction.
[Patient Chu, Left] Cold Damage with simultaneous involvement of Taiyang and Shaoyang (Liang Gan Zheng) has lasted half a month. Multiple administrations of warming meridians and expelling pathogens brought relief. Yesterday, sudden hematemesis occurred, along with epistaxis, gingival bleeding, and lingual bleeding, continuing day and night, filling cups and basins. Fortunately, the pulse is soft without being surging, and consciousness is clear. This is due to severe injury of the Qi aspect, pathogenic heat entering the Ying level, forcing blood to act recklessly. Although considered as resolving via nasal bleeding (Nu Jie), the condition remains dangerous. Now prescribe large doses of nourishing Yin and clearing the Ying level to control the flaming upward Fire. Whether this can achieve salvation is unknown.
American Ginseng (3 qian) Xuan Shen (3 qian) Ophiopogonis Radix (3 qian) Large Rehmannia Root (Da Sheng Di) (1 liang) Raw White Peony Root (3 qian) Rhinoceros Horn Slice (decocted, taken with liquid, 0.4 fen) Powdered Moutan Cortex (2 qian) Platycladi Cacumen (2 qian) Fresh Lotus (sliced for decoction, 4 liang) Fresh Bamboo Shavings (3 qian)
Second visit: After administering nourishing Yin and clearing Ying herbs, various bleeding episodes have alleviated. Remove Rhinoceros Horn from the original formula, add Dendrobii Caulis (3 qian).
Third visit: Add Qing E Jiao (Clear Gelatin) (3 qian).
[Patient Ling, Left] Water fails to nourish Wood, Liver Fire ascends. Damage to Yang collaterals causes blood to overflow upward. Blood loss injures Yin; Yin fails to embrace Yang, Yang fails to hold Yin. Tonify Qi and nourish Yin, clear the Lung and cool the Liver.
American Ginseng (1.5 qian) Raw White Peony Root (2 qian) Powdered Moutan Cortex (2 qian) Trichosanthis Pericarpium (3 qian) Fine Rehmannia Root (Xi Sheng Di) (3 qian) Raw Abalone Shell (8 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Raw Oyster Shell (4 qian) Ophiopogonis Radix (1.5 qian) Rubiae Radix (2 qian) Sichuan Fritillaria Bulb (3 qian) Lotus Node Charcoal (2 pieces) Child's Urine (taken with decoction, one wine cup)
[Patient Zhao, Left] In spring, Wood is vigorous, Liver and Gallbladder Fire ascends. Wind-Dryness pathogen attacks externally. Lung Metal is constrained, Yin collaterals damaged. Coughing, wheezing, hematemesis, and pulling pain in the hypochondrium occur. Dryness transforms into Fire, Fire oppresses Metal, Lung tissue distends. Pulse is rapid, tongue coating yellow. Fear of violent blood gushing. Urgently prescribe cooling the Liver, clearing dryness, moistening the Lung, and removing stasis.
Winter Mulberry Leaf (2 qian) Powdered Moutan Cortex (2 qian) Raw Abalone Shell (8 qian) Magnolia Flower Bud (0.8 fen) Rubiae Radix (2 qian) Platycladi Cacumen (1.5 qian) Sichuan Fritillaria Bulb & Trichosanthes Fruit (2 qian each) Sweet Light Apricot Kernel (3 qian) Bamboo Shavings (3 qian) Imperatae Flower (wrapped, 1 qian) Benincasa Semen (3 qian) Living Arundo Rhizoma (jointless, 1 chi) Vicia Faba Flower Dew and Loquat Leaf Dew (taken with decoction, 4 liang each)
[Patient Yu, Left] Bearing heavy loads and exerting effort damages blood collaterals. Blood overflows upward, filling bowls with hematemesis. Pulling pain in the hypochondrium, difficulty turning the body. Pulse is hollow and rapid. Treatment focuses on dispelling stasis and generating new blood.
Whole Angelica Sinensis Radix (2 qian) Purple Salviae Miltiorrhizae Radix (2 qian) Achyranthes Bidentatae Radix (Huai Niu Xi) (2 qian) Rubiae Radix (2 qian) Sichuan Fritillaria (2 qian) Liu Ji Nu (1.5 qian) Agrimoniae Herba (3 qian) Genuine Xin Jiang (0.8 fen) Curcuma Aromatica Rhizome (Chen Yu Jin) (1.5 qian) Bamboo Shavings (3 qian) Imperatae Flower (wrapped, 1 qian) Vitex Fruit (3 qian) Notoginseng Radix et Rhizoma (separately ground fine powder, taken with decoction, 0.3 fen) Lotus Juice (taken with decoction, 2 liang)
[Patient Kuang, Left] Water deficiency fails to nourish Wood, Wood-Fire ascends. Damage to Yang collaterals causes blood to overflow upward. Hemoptysis with internal heat, red tongue substance, hollow and rapid pulse. Fear of blood gushing. Strengthen Water to soften the Liver, dispel stasis, and generate new blood.
Tian Dong and Mai Dong (2 qian each) Left Oyster Shell (4 qian) Powdered Moutan Cortex (2 qian) Raw Abalone Shell (8 qian) White Peony Root (2 qian) Rubiae Radix (2 qian) Platycladi Cacumen Charcoal (1.5 qian) Sichuan Fritillaria Bulb (2 qian) Purple Salviae Miltiorrhizae Radix (2 qian) Achyranthes Bidentatae Radix (Niu Xi) (2 qian) Fresh Bamboo Shavings (2 qian) Imperatae Flower (wrapped, 1 qian) Imperatae Rhizoma (decentred, 2 bundles) Fresh Lotus (sliced for decoction, 2 liang)
[Patient Mo, Left] Kidney Yin insufficiency, excess Liver Fire. Recurrent hematemesis. Pulse is minute and lacking spirit, blood fails to luster the complexion, tongue coating pale white. Blood loss injures Yin. Yin fails to embrace Yang, so Yang becomes hyperactive; Yin cannot overcome Yang, so Yin becomes more deficient. Correlating pulse and symptoms, consumption disease is established. Tentatively imitate Wang Bing's principle: "Strengthen the master of Water to control the sunlight," hoping for a miracle.
Large Rehmannia Root (3 qian) Chinese Yam (2 qian) Raw Abalone Shell (5 qian) Prepared Ligustrum Lucidum Fruit (Shu Nu Zhen) (3 qian) Powdered Moutan Cortex (1.5 qian) Raw White Peony Root (3 qian) Ecliptae Herba (3 qian) Rubiae Radix (1.4 qian) Poria Cocos with Hostwood (3 qian) Prepared Licorice Root (0.5 fen) Tuckahoe Tribulus (Tong Ji Li) (3 qian) Fresh Bamboo Shavings (1.5 qian) Fresh Lotus (2 liang)
[Patient Qi, Left] Kidney Yin depleted early, Dragon-Lei Fire rebels upward, forcing blood to act recklessly. Violent vomiting and hematemesis for six to seven days, filling cups and basins. Profuse sweating, panting, pulse thread-like, signs of impending collapse. Yin fails to embrace Yang, Yang fails to hold Yin. Qi and Blood face dispersion; Yin and Yang face separation. The condition is critical, danger imminent! Follow the Classic principle of "Tonifying Qi in cases of Blood Collapse," vigorously tonify Qi to generate Blood. Whether this can achieve salvation is unknown.
Jilin Ginseng (2 qian) Hei Xi Dan (Black Tin Pill) (0.5 fen)
Second visit: Violent vomiting greatly reduced, panting slightly eased. Pulse is thin and forceless. This indicates blood loss injuring Yin, Dragon-Lei Fire ascending, and Lung Qi failing to descend. The ancients said: "There is no backward-flowing water in the world, nor inverted-flowing blood in the human body. Backward water flows due to wind; inverted blood flows due to Qi. Qi rebellion causes blood overflow." The condition remains in a dangerous phase, fearing unexpected changes. Again, tonify Qi and Yin, direct Qi downward, hoping for a turnaround.
Jilin Ginseng (1.5 qian) Angelica Sinensis Radix (Dang Gui Shen) (3 qian) Aged Tangerine Peel (Chen Pi) (0.8 fen)
[Patient Huang] After hematemesis, coughing with salivary frost, emaciation, and lackluster complexion. Yin injury affects Yang, Earth fails to generate Metal. The Spleen is the source of phlegm production; the Lung is the container of phlegm storage. Spleen deficiency fails to transport fluids for the Stomach. Dampness from food and drink generates phlegm and fluid retention, soaking the Lung. The Lung loses its authority of clarity and purity. Saliva originates from the Spleen, which lacks the ability to hold saliva. Grain Qi fails to transform into essence, so how can muscles grow? Emaciation and lackluster complexion result from this. The Classics state: "First degree injury damages skin and hair; skin gathers and hair falls. Third degree injury damages muscles; muscles waste away." Correlating the condition, Lung Consumption (Fei Lao) is gradually establishing. The books say: "Injury proceeding from top to bottom, if it passes the Stomach, it is incurable; from bottom to top, if it passes the Spleen, it is incurable." This deeply understands the human body's...