天津孙××，年二十八岁，得吐血兼咳嗽证。
病因 因事心中着急起火，遂致吐血咳嗽。
证候 其吐血之始，至今已二年矣。经医治愈，屡次反复，少有操劳，心中发热即复吐血。又
频作咳嗽，嗽时吐痰亦恒带血。肋下恒作刺疼，嗽时其疼益甚，口中发干，身中亦间有
灼热，大便干燥。其脉左部弦硬，右部弦长，皆重按不实，一息搏近五至。
诊断 此证左脉弦硬者，阴分亏损而肝胆有热也，右部弦长者，因冲气上冲并致胃气上逆也。为
其冲冲胃逆，是以胃壁血管破裂以至于吐血咳血也。其脉重按不实者，血亏而气亦亏
也。至于口无津液，身或灼热，大便干燥，无非血少阴亏之现象。拟治以清肝、降胃、滋阴、化瘀之剂。
处方 生赭石（八钱轧细） 生怀地黄（一两） 生怀山药（一两） 生杭芍（六钱）
玄参（五钱） 川楝子（四钱捣碎） 生麦芽（三钱） 川贝母（三钱） 甘草（钱半） 广三七（二钱细末）
药共十味，将前九味煎汤一大盅，送服三七末一半，至煎渣重服时，再送服其余一半。
方解 愚治吐血，凡重用生地黄，必用三七辅之，因生地黄最善凉血，以治血热妄行，犹恐妄行
之血因凉而凝，瘀塞于经络中也。三七善化瘀血，与生地黄并用，血止后自无他虞；且此证
肋下作疼，原有瘀血，则三七尤在所必需也。
复诊 将药连服三剂，吐血全愈，咳嗽吐痰亦不见血，肋疼亦愈强半，灼热已无，惟口中仍
发干，脉仍有弦象。知其真阴犹亏也，拟再治以滋补真阴之剂。
处方 生怀山药（一两） 生怀地黄（六钱） 大甘枸杞（六钱） 生杭芍（四钱）
玄参（四钱） 生赭石（四钱轧细） 生麦芽（二钱） 甘草（二钱） 广三七（二钱细末）
服法如前。
效果 将药连服五剂，病全愈，脉亦复常，遂去三七，以熟地黄易生地黄，俾多服数剂以善其后。
Tianjin resident Sun XX, aged 28, suffered from a syndrome of hematemesis (vomiting blood) accompanied by cough.
Etiology The condition was caused by mental anxiety and internal heat generated due to stressful events, leading to hematemesis and cough.
Clinical Manifestations The episode of hematemesis began two years ago. Although cured by previous physicians, the condition recurred repeatedly; any slight physical exertion or sensation of internal heat in the chest would trigger another episode of hematemesis. Frequent coughing occurred, with sputum often containing blood during coughing fits. There was constant stabbing pain in the hypochondriac region, which intensified during coughing. The mouth felt dry, and there were intermittent sensations of burning heat in the body. Stool was dry. The pulse was wiry and hard on the left side, and wiry and long on the right side; both positions felt empty upon heavy pressure. The pulse rate was nearly five beats per breath (approximately 90-100 beats per minute).
Diagnosis The wiry and hard pulse on the left indicates deficiency of Yin and heat in the Liver and Gallbladder. The wiry and long pulse on the right is due to the upward rushing of Chong Qi (Penetrating Vessel Qi) causing rebellious Stomach Qi. Due to this upward rebellion of Chong Qi and Stomach Qi, the blood vessels in the gastric wall ruptured, resulting in hematemesis and hemoptysis (coughing up blood). The emptiness upon heavy pressure of the pulse indicates deficiency of Blood and Qi. The absence of saliva, intermittent burning heat, and dry stool are all manifestations of insufficient Blood and Yin deficiency. The proposed treatment involves using a formula to clear the Liver, descend the Stomach, nourish Yin, and resolve stasis.
Prescription Raw Hematite (Shi Gao, Ochre) [Hematitum] (8 qian, finely ground) Raw Huai Rehmannia Root (Di Huang, Rehmanniae Radix Recens) [Rehmanniae Radix] (1 liang) Raw Huai Chinese Yam (Shan Yao, Dioscoreae Rhizoma) [Dioscoreae Rhizoma] (1 liang) Raw Hang Peony Root (Bai Shao, Paeoniae Radix Alba) [Paeoniae Radix Alba] (6 qian) Scrophularia Root (Xuan Shen, Scrophulariae Radix) [Scrophulariae Radix] (5 qian) Toosendan Fruit (Chuan Lian Zi, Meliae Fructus) [Meliae Fructus] (4 qian, crushed) Raw Barley Sprout (Mai Ya, Hordei Germinatus Semen) [Hordei Germinatus Semen] (3 qian) Fritillaria Bulb (Chuan Bei Mu, Fritillariae Cirrhosae Bulbus) [Fritillariae Cirrhosae Bulbus] (3 qian) Licorice Root (Gan Cao, Glycyrrhizae Radix et Rhizoma) [Glycyrrhizae Radix et Rhizoma] (1.5 qian) Panax Notoginseng Root (San Qi, Notoginseng Radix et Rhizoma) [Notoginseng Radix et Rhizoma] (2 qian, fine powder)
The prescription consists of ten ingredients. Decoct the first nine ingredients in one large bowl of water. Take the decoction while administering half of the San Qi powder. When taking the second decoction from the dregs, administer the remaining half of the San Qi powder.
Formula Analysis In my treatment of hematemesis, whenever I heavily use Raw Rehmannia Root, I must use Panax Notoginseng Root as an assistant. This is because Raw Rehmannia Root is excellent at cooling Blood to treat reckless bleeding due to Blood Heat. However, I fear that the bleeding Blood might coagulate due to the cooling nature and cause stasis obstructing the collaterals. Panax Notoginseng Root is good at resolving blood stasis. Used together with Raw Rehmannia Root, once bleeding stops, there will be no further worry. Moreover, since this case involves stabbing pain in the hypochondriac region indicating existing blood stasis, Panax Notoginseng Root is particularly necessary.
Follow-up Visit After taking three doses consecutively, hematemesis completely ceased, sputum no longer contained blood during coughing, hypochondriac pain decreased by more than half, and the burning sensation disappeared. However, the mouth remained dry, and the pulse still showed a wiry quality. This indicates that True Yin is still deficient. I propose treating it again with a formula to tonify True Yin.
Prescription Raw Huai Chinese Yam (Shan Yao, Dioscoreae Rhizoma) [Dioscoreae Rhizoma] (1 liang) Raw Huai Rehmannia Root (Di Huang, Rehmanniae Radix Recens) [Rehmanniae Radix] (6 qian) Large Sweet Goji Berry (Gou Qi Zi, Lycii Fructus) [Lycii Fructus] (6 qian) Raw Hang Peony Root (Bai Shao, Paeoniae Radix Alba) [Paeoniae Radix Alba] (4 qian) Scrophularia Root (Xuan Shen, Scrophulariae Radix) [Scrophulariae Radix] (4 qian) Raw Hematite (Shi Gao, Ochre) [Hematitum] (4 qian, finely ground) Raw Barley Sprout (Mai Ya, Hordei Germinatus Semen) [Hordei Germinatus Semen] (2 qian) Licorice Root (Gan Cao, Glycyrrhizae Radix et Rhizoma) [Glycyrrhizae Radix et Rhizoma] (2 qian) Panax Notoginseng Root (San Qi, Notoginseng Radix et Rhizoma) [Notoginseng Radix et Rhizoma] (2 qian, fine powder)
Administration method is the same as before.
Outcome After taking five doses consecutively, the disease was completely cured, and the pulse returned to normal. Therefore, Panax Notoginseng Root was removed, and Prepared Rehmannia Root (Shu Di Huang, Rehmanniae Radix Preparata) [Rehmanniae Radix Preparata] was used to replace Raw Rehmannia Root, allowing for several more doses to consolidate the recovery.