天津冯××，年三十二岁，得吐血证久不愈。
病因 因劳心劳力过度，遂得此证。
证候 吐血已逾二年，治愈，屡次反复。病将发时，觉胃中气化不通，满闷发热，大便滞塞，
旋即吐血，兼咳嗽多吐痰涎。其脉左部弦长，右部长而兼硬，一息五至。
诊断 此证当系肝火挟冲胃之气上冲，血亦随之上逆，又兼失血久而阴分亏也。为其肝火炽盛，
是以左脉弦长；为其肝火挟冲胃之气上冲，是以右脉长而兼硬；为其失血久而真阴亏损，是以其
脉既弦硬（弦硬即有阴亏之象）而又兼数也。此宜治以泻肝降胃之剂，而以大滋真阴之药佐之。
处方 生赭石（一两轧细） 玄参（八钱） 大生地（八钱） 生怀山药（六钱）
栝蒌仁（六钱炒捣） 生杭芍（四钱） 龙胆草（三钱） 川贝母（三钱）
甘草（钱半） 广三七（二钱细末）
药共十味，先将前九味煎汤一大盅，送服三七细末一半，至煎渣重服时，再送服其余一半。
效果 每日煎服一剂，初服后血即不吐，服至三剂咳嗽亦愈，大便顺利。再诊其脉，左右皆
有和柔之象，问其心中闷热全无。遂去蒌仁、龙胆草，生山药改用一两，俾多服数剂，吐
血之病可从此永远除根矣。
天津张姓，年过三旬，偶患吐血证。
病因 其人性嗜酒，每日必饮，且不知节。初则饮酒过量即觉胸
间烦热，后则不饮酒时亦觉烦热，遂至吐血。
证候 其初吐血之时，原不甚剧，始则痰血相杂，因咳吐出。即或纯吐鲜血，亦不过一日数口，
继复因延医服药，方中有柴胡三钱，服药半点钟后，遂大吐不止，仓猝迎愚往视。及至，则所吐之血
已盈痰盂，又复连连呕吐，若不立为止住，实有危在目前之惧。幸所携药囊中有生赭石细末一包，俾先
用温水送下五钱，其吐少缓须臾，又再送下五钱遂止住不吐。诊其脉弦而芤，数逾五至，其左寸
摇摇有动意，问其心中觉怔忡乎？答曰∶怔忡殊甚，几若不能支持。
诊断 此证初伤于酒，继伤于药，脏腑之血几于倾囊而出。犹幸速为立止，宜急服汤药以养
其血，降其胃气保其心气，育其真阴，连服数剂，庶其血不至再吐。
处方 生怀山药（一两） 生赭石（六钱轧细） 玄参（六钱） 生地黄（六钱）
生龙骨（六钱捣碎） 生牡蛎（六钱捣碎） 生杭芍（五钱） 酸枣仁（四钱炒捣）
柏子仁（四钱） 甘草（钱半） 广三七（三钱细末）
此方将前十味煎汤，三七分两次用，头煎及二煎之汤送服。
效果 每日服药一剂，连服三日血已不吐，心中不复怔忡。再诊
其脉芤动皆无，至数仍略数，遂将生地黄易作熟地黄，俾再服数剂以善其后。
Mr. Feng from Tianjin, aged thirty-two, suffered from hematemesis (vomiting blood) for a long time without recovery.
Etiology The disease was caused by excessive mental and physical labor.
Symptoms Hematemesis had persisted for over two years; although cured previously, it recurred repeatedly. Before an episode, he felt stagnation of Qi transformation in the stomach, accompanied by distension, fullness, feverish sensation, and constipation. Subsequently, hematemesis occurred, accompanied by coughing and copious expectoration of phlegm-saliva. His pulse was wiry and long on the left side, and long with hardness on the right side, beating five times per respiratory cycle (one breath).
Diagnosis This condition is likely due to Liver Fire carrying the ascending Qi of the Chong Mai (Penetrating Vessel) and Stomach upward, causing Blood to rebel upwards as well, compounded by Yin deficiency resulting from prolonged blood loss. Because Liver Fire is blazing, the left pulse is wiry and long; because Liver Fire carries the ascending Qi of the Chong and Stomach, the right pulse is long and hard; because true Yin is depleted after prolonged blood loss, the pulse is both wiry and hard (wiry and hard indicates Yin deficiency) and rapid. Treatment should employ formulas that purge Liver Fire and direct Stomach Qi downward, assisted by herbs that greatly nourish True Yin.
Prescription Raw Oolithum (Hematitum) [Sheng Zhe Shi] (1 liang, finely crushed) Scrophulariae Radix [Xuan Shen] (8 qian) Raw Rehmanniae Radix [Da Sheng Di] (8 qian) Raw Dioscoreae Hypoglaucae Rhizoma [Sheng Huai Shan Yao] (6 qian) Trichosanthis Semen [Gua Lou Ren] (6 qian, stir-fried and crushed) Raw Paeoniae Radix Alba [Sheng Hang Shao] (4 qan) Gentianae Radix [Long Dan Cao] (3 qian) Fritillariae Thunbergii Bulbus [Chuan Bei Mu] (3 qian) Glycyrrhizae Radix et Rhizoma [Gan Cao] (1.5 qian) Panacis Japonici Radix [Guang San Qi] (2 qian, fine powder)
There are ten ingredients in total. First, decoct the first nine ingredients in one large cup of water. Take half of the fine San Qi powder with this decoction. When decocting the dregs for the second dose, take the remaining half of the San Qi powder.
Effect Taking one dose daily, bleeding stopped immediately after the first dose. After three doses, the cough also ceased, and bowel movements became smooth. Upon re-examination, both left and right pulses showed a harmonious and soft quality. The patient reported no more stifling heat in the chest. Therefore, Gua Lou Ren and Long Dan Cao were removed, and the dosage of Sheng Huai Shan Yao was increased to 1 liang, allowing for continued administration to permanently eradicate the hematemesis.
A surnamed Zhang from Tianjin, over thirty years old, occasionally suffered from hematemesis.
Etiology He had a strong preference for alcohol, drinking daily without moderation. Initially, excessive drinking caused a feeling of irritability and heat in the chest. Later, even when not drinking, he felt this irritability and heat, which eventually led to hematemesis.
Symptoms Initially, the hematemesis was not severe; at first, blood was mixed with phlegm and expelled through coughing. Even when pure bright red blood was vomited, it was only a few mouthfuls per day. Later, after consulting a doctor and taking medicine containing Chai Hu (Bupleuri Radix) 3 qian, half an hour after ingestion, he began to vomit blood profusely and uncontrollably. I was summoned urgently. Upon arrival, the vomited blood had filled the spittoon, and vomiting continued incessantly. Without immediate cessation, there was a fear of imminent danger. Fortunately, my medical kit contained a packet of raw Zhe Shi (Oolithum) fine powder. He was instructed to take 5 qian with warm water first. The vomiting slowed slightly after a moment, and another 5 qian was taken, after which the bleeding stopped completely. His pulse was wiry and Kou (cork-like/empty), beating more than five times per breath. The Cun position on the left side felt unstable and trembling. I asked if he felt palpitations (Zhen Tong); he replied that the palpitations were severe, almost unbearable.
Diagnosis This condition was initially injured by alcohol and subsequently aggravated by medication, nearly depleting the blood of the Zang-Fu organs. Fortunately, the bleeding was stopped quickly. Urgent decoction should be administered to nourish the blood, direct Stomach Qi downward, protect Heart Qi, and nurture True Yin. Continuous administration for several doses will prevent further bleeding.
Prescription Raw Dioscoreae Hypoglaucae Rhizoma [Sheng Huai Shan Yao] (1 liang) Raw Oolithum (Hematitum) [Sheng Zhe Shi] (6 qian, finely crushed) Scrophulariae Radix [Xuan Shen] (6 qian) Raw Rehmanniae Radix [Sheng Di Huang] (6 qian) Raw Longgu (Os Draconis) [Sheng Long Gu] (6 qian, crushed) Raw Muli (Concha Ostreae) [Sheng Mu Li] (6 qian, crushed) Raw Paeoniae Radix Alba [Sheng Hang Shao] (5 qian) Ziziphi Spinosae Semen [Suan Zao Ren] (4 qian, stir-fried and crushed) Biota Seed [Bai Zi Ren] (4 qian) Glycyrrhizae Radix et Rhizoma [Gan Cao] (1.5 qian) Panacis Japonici Radix [Guang San Qi] (3 qian, fine powder)
Decoct the first ten ingredients in water. Divide the San Qi powder into two doses, administering each with the decoction from the first and second boil respectively.
Effect Taking one dose daily for three consecutive days, bleeding stopped, and palpitations ceased. Upon re-examination, the Kou and trembling qualities of the pulse disappeared, though the rate remained slightly rapid. Therefore, Sheng Di Huang (Raw Rehmanniae Radix) was replaced with Shu Di Huang (Prepared Rehmanniae Radix) to continue treatment for consolidation and recovery.