龙骨入肝敛魂，牡蛎入肾固精，皆收敛精魂之品入桂枝汤中，则为固蛰封藏之本药也。若失
精悸衄腹痛，本方加胶饴为小建中；里急为营卫枯槁，更加黄 为黄 建中，此皆后天不足
以调和营卫为主治。后人专用滋阴降火，未至
于剧用此，尚可挽回。若先天肾虚者八味肾气∶虚烦不眠酸枣仁汤；干血者 虫丸。惟薯
蓣丸专治表邪不解、误用凉药伤犯肺胃、自上而下之虚劳。”秦元宫曰∶“仲景用建中复脉以
扶胃而创建中气，以胃为气血生化之原。其人稍见膈虚内热，神气不旺，以建中未雨绸缪，
桂枝和卫，白芍和营，调剂阴阳，而以饴糖、甘草、大枣补胃土，以生姜、生发多服，胃气旺而
上升于肺，肺行降下之令而主水，所谓地气上为云也，天气下为雨，山泽通气之道也。故一
则曰脉大为劳；又曰浮则无血，大则无气；又曰脉极虚芤迟，从未闻数脉也，亦未闻兼咳嗽
也，失此不治而阴火上升，脉之迟者变而为数，火上弄金而咳嗽起，岂可仍用桂枝。”按∶
此条论仲景所治，非今日脉数咳噘阴火上升之虚劳也。后贤论治，或以谓补气者，当补肺
之母脾；补血者当补肝之母肾。又曰土旺而金自生，勿拘拘乎保肺；水盛而大自熄，勿汲汲
乎寒凉。东垣谓∶“人参补肺，气旺则四脏之气皆旺，精自生而形自盛。”白飞霞谓∶“多服人
参，回元气于无何有之乡。肺虚喘嗽者，并宜服之。”王好古谓∶“肺，热还伤肺。王节斋谓∶
“虚劳服参 者必死。”按∶古书如聚讼，愚以谓无脉证而论治，犹无题而论文。宋元清名家
论理极是，施之实事皆属似是而非，惟沈朗仲曰∶“阴虚多火之人，即感客邪，蒸热咳嗽，切
忌羌防柴葛表散，亦不可用桔杏苏橘清肺止嗽，有积者忌消导，当静以养阴。”亦属调停之
见（以上论古）。大抵此症起于斫丧者，肝肾过劳，多亡血失精，强中阴竭而死；起于郁结者，
内火烁津，多致血结，干咳，嗜食，发 而死；起于药误者，脾肺受疾居多，多致饮食减少，
喘漱泄泻而死。此其大概也，治之之法∶阴火刑金而咳，脉数，为内风生，生则气行急疾，一
呼一吸或六七至，气急巽风用事，逼血妄行，或吐衄，或血去，而阴益虚，不独肺燥，胆汁亦
枯。胆枯木将自焚，且肺既嗽，又能激动火势化液为痰，逮肺枯而痿生，水之源绝，潮热不
休，安得不死。仲景曰∶“脉数者风发也，以饮
食消息止之。”至精至妙。实虚劳生死之关，趁其人胃气尚强以饮食补之，所谓形不足者补
之以味。补气血，以肥鸭牛肉之属；补阴如海参、鳗、鳖；补土如童雌黄鸡、鲫鱼、 鱼；清火
则燕窝、蛤蜊；补肺猪肺、百合；健脾大枣、莲子。多其火候，恣意食之；不可过饱，恐脾难运
化，食后徐步，服滋生丸一丸；俾心闲气静内火不生，久久食入，于阴气长于阳，胃气充足
上升于肺，肺能生水，脉数乃退，所忌发风动气生冷之品。此胃尚强时，饮食调补一法也
（以上食养）。其或迁延日久，服药差误大耗真气，中虚胃弱，食少不运，前法难施，议者多本
壮水制火，知柏苦寒，地黄湿滞，即苓术亦苦燥。夫水从金出为天一之水，方能有济。金之
所以能生水者，全赖脾胃之气上升而水可生。脾湿胃益弱，而肺金愈无土生。若用敛降，无
论难降即或，火降而气既下陷，酷日无云，雨安从来，过时复升，其火愈甚，皆不明水出高
源、水泽通气之义也。盖脉数不除，风行不息，必无愈机。诊虚劳脉者，尽一昼夜间必有一刻
其数少减，此正阴阳自为胜复之时，乘此投药迎机而导，否则寅初气注肺时服回风汤入米
露一杯。数服后，兼服丙辛汤。及三合水汤脉少减者，即是生机。盖此风与中风之风异，
彼则阴霾昼晦发屋拔木狂暴之风，此则夏日亢阳东南熏熟之风。逆其势自西而东，则西方
凉风至，而雨可望矣。故阳不上升者用柴胡左升以趋右，今当升右之阳以趋左，此又一法也
（以上回风）。若夫虚火上升，面赤心烦，咳嗽口干，其脉寸盛尺弱，来盛去衰者，病又加进，
先用导火汤引火下入小肠，静坐数刻，火从下降，降至丹田，乘火在下时服赤帜汤填实中
焦，不使火得再上，是韩信拔赵帜立汉帜法也，此又一法也（以上赤帜法）。若血初见时，
慎不可用酸敛止涩及生地之泥滞，恐血凝而瘀，须用黑金散降火去瘀最妙。若劳力内伤呕
血者，活蟹一大只捣烂，温陈酒调服，此皆阴火上升而生内风之虚劳也（以上血症）。如痰
中带血如丝缕者，是因咳伤肺也；用清肺汤血
从咯出者，从肝肾来，火犹未入于肺，急服镇火汤统治诸血；发热者，有三阴阳虚劳，常服
者有升阴养血汤、止嗽汤。常服金生丸，可引肺气下入于肾（以上总治）。此外有发热昼夜
不休，肌肤涩绝无汗者，必有外邪未清，或误为补药所痼，用内托汤热服发汗（以上夹邪）。
又有骨蒸劳病，肌肤不甚热，按之骨间甚热，其人善食而瘦，皮肤枯涩，无汗，大便结实，其
脉沉紧数有力，与诸虚劳不同，皆起于风寒外邪，日久蕴蓄而成，当用苦寒大补阴之类，大
忌燥热之品。盖其热在骨髓，亦不宜用升散之使其热炎灼于外。又诸虚皆系胆汁枯，则肝木
之火无水制，而风火大发。骨蒸一症，胆汁尤枯，用退蒸汤（以上骨蒸）。又如每日先寒后热
如疟，汗出而热始退者，桂枝柴胡各半汤加胆汁二匙。此外有因血瘀而发者，妇人尤多，古
人虫丸之外有麦煎散，今方黑金丸。若夫传尸瘵症，其症心中烦热欲露体，覆之即闷，惊
悸、怔忡、面无颜色、忘前失后，乃心蒸之状，用传尸劳方。若骨蒸五心烦热者，清骨散。
问∶烂喉丹痧见于仲景书否，此症宋元名家议论绝少，能言其发病之故乎？或曰由乎司
天，然燥令湿令俱能发病，主气客气不一，其说能详说其所以然乎？顺症何如，逆症何如，
初起之治法当何如，中后之治法当何如，当清之见证当何若，当下之见症何若，能详言欤？
此症近来颇多。
家大人已立论在前，尤当扩充其意而详说之。
《金匮》云∶“阳毒之为病，面赤斑斑如锦纹，咽喉痛吐脓血，五日可治，七日不可治。升
麻鳖甲汤主之。”此条经文与今之烂喉丹痧绝似，而治法则不可从，无论蜀椒、雄黄温燥不
可服。亦思此症发于春夏，地气本升，不当再用升麻，因于温热，血中伏火不必更用当归，
人所共知也。古书绝少今时盛行者，宋元名家多北人，而此病盛于江南也，从来论司天者其
说不一，吾以为客气不足凭，当实求之主气。与营运之令气客气如先天之八卦，有定位而
无用。主气令气则参互错综，随时而见。如今年春令地气本温而多西北风，阴雨数旬，此太
阴湿土令气加临少阳相火。主气病必见湿遏郁伏，烂喉丹痧所由发也。发之何如？因疫
之气从口鼻而入于肺胃也。何以烂喉？湿热郁蒸也。如何为痧？与疹为类，是血络中病，
与之出于胃者不同，当主芳香透络，辛凉解肌，甘寒清血，其后逆传心胞，仍不外乎叶老
温热之旨。然一症宜分三种，风邪化热者治宜清透，湿邪化热者治宜清渗，痰火凝结者治宜
清降。顺症初起，脉紧弦数，恶寒，头胀，肤红，肌热，喉中碎腐而痛，疹现隐隐。三四日后温
邪化火，热盛痧透。五六日后，热甚，神昏，喉烂。此火盛逆传，内逼心胞见症也。七日后，
热退，偏体焦紫，痧如麸壳脱皮而愈，此顺症也。若逆症，一二日脉见细劲，身虽红痧不外
透，神识已昏，语言错乱，气逆喘急，此由邪毒内闭肺胃，内闭则外厥而脱矣。治之之法∶顺
症一二日宜疏表，牛蒡解肌汤或银翘散，加消食之品，吹以珠黄散。三四日化火，前方加犀
角、羚角、花粉、石斛。五六日，见内逼心胞，症在营分，犀角地黄汤。有汗神清者，邪在气分，
玉女煎加胆星、石菖、西黄药珠，甚则紫雪。中后之治法大都如此。其或便结燥实、舌干而黄
黑者，凉膈散，即下法也。协热便泄、舌苔白腻者，葛根芩连。至于逆症，火毒内闭于肺胃，用
鲜地四两捣汁，加金汁、梨汁、蔗浆更葛根、芩、连。至于逆症，火毒内闭于肺胃，用鲜地四
两捣汁，加金汁、梨汁、蔗浆，更用鲜芦根煎汤，磨犀角汁，冲和紫雪丹，或珠黄散，要不外
乎清开泄热为主。若夫不治之症，鼻塞流涕者，肺已伤，不治；合眼朦胧者，肝欲坏，不治；
色白如粉皮者，气色败，尤属不治。盖元气虚者，不能托毒外出，毒且深伏，虽有清补化邪
一法，究属难图，尚不如阴虚者可重用养阴泄热也。治详于温热症下焦篇中。家大人老年
议论甚恶夫清之太早者，以感风感湿未曾化火而先清，必有结毒发颐之变。善乎！祖鸿范
之言曰∶“初起发热憎寒者，以透散为主，火郁
发之也。恶寒已止，内蕴之邪火方张，以凉解为宜，若仍执辛散，火得风而益炽，肿热必增，
当于先后次第之间随机权变，各中其款要，斯为尽善。”
问∶妇人之病胎产为要，妊子之脉能分辨欤？男女之分可预测欤？试胎之法果孰胜欤？
恶阻之因治之之法能详言欤？胎漏小产其因其治能详说欤？妊妇有头痛、心痛、胃脘痛、少
腹痛、股痛、环跳痛、目赤、咽痛、甚至于跌仆损伤，能各举其证因治法大略欤？胎死腹中验
法下法，亦附详焉。
经曰∶“手少阴脉动甚为妊子，阴搏阳别为妊子，身病无邪脉为妊子，尺脉不绝为妊
子。”夫尺者是少阴肾脉也。肾脉滑利亦见带症，惟与手少阴心动脉相应乃为妊子，无疑是
即所谓阴搏阳别也。且血留气聚胞宫内实，能无尺阴滑数乎？其与虚劳数脉分别处∶胎脉数
中有胃气，劳脉则兼弦涩无胃气也。然亦有中年羸妇细小而不数者，其微弱中必有隐隐滑
动之象可凭也。辨男女之脉最难执，左大为男、右大为女之说，不有脏气偏胜者乎？闻之
先业师曰∶妇人背阴而面阳，其左男子之右也，右则男子之左也。所以丹溪谓是诊脉者左
右手。此不可凭者也，惟两寸浮滑为阳脉，主男胎；两尺沉滑为阴脉，主女胎。庶几近之然。
易不辨之男胎三月动而脐凸硬腹如釜、女胎五月动脐软腹如箕之为直捷也。瘀阻与胎混，
不得已而用试法∶陈酒调佛手散（归七分芎一钱），待两时许，脐腹微动为胎，不动者为经
滞。法颇稳当，恶阻者恶心，阻其饮食也。其故有二∶一由胃虚，宿有痰饮而兼气滞；一由
冲任上壅，气不下行，盖经血既闭，水渍于脏，脏气不宣通，故心烦愦闷、气逆而呕吐。及三
月后胎渐大，子能食血，自无上逆之患。然而间有不恶阻者，何也？中宫气健，胃无宿痰，清
浊自能升降，不令秽气上壅，自无恶阻矣。治法∶虚者加味参橘饮（温胆加参、木、归、藿、
砂），实者小和中饮（陈、朴、苓、查、扁、草），吐酸不止者二香（藿草、香附）为末（服二钱）。大
约胃寒者加丁香、豆蔻、砂仁，脾虚有火加黄芩、山栀、竹茹。要不外丹溪两言∶“肥人多痰，
瘦人多火。”其法则二陈加减，须知此病不必疑半夏、茯苓二味为碍胎。胎漏小产由于气血
虚弱者多，气虚则提摄不固、血弱则灌溉不周。而系胞者肾，腰为肾腑，腰痛则堕，不可不
防。外此，则血太热而妄行。大凡暴下水者，胎必堕。若徐下者，可用补气安神治之。此症
之脉宜弦牢滑利，忌沉细而微。其治视禀质所偏，阴虚内热者而用艾、附、白术、砂仁，温剂
则阴愈消，如草木之无雨露，枯萎立见矣。阳虚内寒者，而用芩、芍，凉血则脾胃虚寒，气血
亦弱，如果实秋冬少结矣。三月前宜养脾胃，四月后宜壮腰肾，此大法也。以泰山磐石山散
为主方（八珍去苓，加参、断、芩、 ）。血热者加黄柏、阿胶，气寒者加艾叶、炮姜。然而胎漏
一症，辨之宜慎。有妊妇血盛月信常来而不堕者，治之反堕；亦有孕妇脉见滑数、月事略少，
至三四月止者。今人以为七月生，其实足月也。又有壮盛之妇前三月按月去血点滴者，苟
无腰酸胎动，不须服药。此又当合形体论也。再世人一月堕胎者最多，其人好洁，日必举足
洗下体而滑也。胎前诸痛、气虚血虚、血热三种宜常目在之。而外感内伤，仍各宜分剖。如
头痛血虚多火者，四物加减；感风者，加味芎归（芩、木、茶）；心腹痛或素有痰饮更触外感
者，正气散；按之痛者积滞，保元；不痛者脾胃伤，六君；满痛及心，芩、术、芍三味；不时腹痛
者血虚，熟地、当归二味煎汤服之；重坠者气虚也，补中益气；胁痛者不宜破气，童便和酒
服之；少腹冷痛，小建中加炮姜；腰痛，环跳痛者，宜补；目赤、口舌咽痛者，凉膈亦可服；若
跌仆伤者，胶、艾、芎、归加地。此其大略也。至如面青舌红母死子活，面红舌青母活子死，为
验死胎之诀，一定无疑。下之之法∶丹溪用佛手散重剂（归一两芎七钱），要不若平胃加芒
硝为稳。
问∶胎前症，最多子悬症，多心腹胀满，以紫苏饮为主方，其故何欤？抑另有法欤？又有
Longgu (Fossilized Bone) enters the Liver meridian to astringe the Hun (ethereal soul), and Muli (Oyster Shell) enters the Kidney meridian to consolidate Jing (essence). Both are astringent substances that consolidate essence and spirit. When added to Guizhi Tang (Cinnamon Twig Decoction), they become medicines for consolidating the root of storage and sealing. If there is seminal emission, palpitations, epistaxis, or abdominal pain, adding Yitang (Maltose) to the original formula creates Xiaojianzhong Tang (Minor Construct the Middle Decoction). If there is urgency and tension in the abdomen, it indicates withered Ying (nutritive) and Wei (defensive) qi; adding Huangqi (Astragali Radix) creates Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction). All these formulas focus on treating deficiency of the Post-Heaven (Spleen/Stomach) to harmonize Ying and Wei Qi. Later generations specialized in nourishing Yin and descending Fire. If used before the condition becomes severe, recovery is still possible. For patients with congenital Kidney deficiency, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is used; for restlessness and insomnia due to deficiency heat, Suanzaoren Tang (Ziziphus Seed Decoction) is used; for dry blood accumulation, Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is used. Only Shuyu Wan (Dioscorea Pill) specifically treats consumptive disease caused by unresolved exterior pathogens and damage to the Lung and Stomach from misused cooling medicines, progressing from above downwards. Qin Yuangong stated: "Zhang Zhongjing used Jianzhong and Fumai decoctions to support Stomach Qi and establish Middle Qi, because the Stomach is the source of Qi and Blood generation. If a patient shows slight Diaphragm deficiency, internal heat, and weak Shen (spirit), Jianzhong Tang is used preemptively. Guizhi (Cinnamomi Ramulus) harmonizes Wei Qi, Baishao (Paeoniae Radix Alba) harmonizes Ying Qi, adjusting Yin and Yang. Yitang, Gancao (Glycyrrhizae Radix et Rhizoma), and Dazao (Zizyphi Fructus) tonify Stomach Earth. Shengjiang (Zingiberis Rhizoma Recens) disperses. With frequent use, Stomach Qi becomes strong and rises to the Lung. The Lung exercises its descending function and governs Water. This is what is meant by 'Earth Qi rising becomes Clouds, Heaven Qi descending becomes Rain,' the pathway of communication between mountains and marshes. Therefore, it is said: 'A large pulse indicates Lao (consumption);' also, 'Floating indicates lack of Blood, Large indicates lack of Qi;' also, 'Extremely deficient, Kou (corkscrew), and slow pulses.' One has never heard of a rapid pulse, nor one accompanied by cough. If this opportunity is missed and not treated, Yin Fire rises, and a previously slow pulse becomes rapid. Fire insulting Metal (Lung) causes cough. At this point, can one still use Guizhi?" Commentary: This clause discusses conditions treated by Zhang Zhongjing, not the modern consumptive disease characterized by rapid pulse, cough, and rising Yin Fire. Later scholars discussed treatment, stating that for tonifying Qi, one should tonify the Mother of the Lung (Spleen); for tonifying Blood, one should tonify the Mother of the Liver (Kidney). It is also said: "When Earth is prosperous, Metal generates itself; do not rigidly adhere to protecting the Lung; when Water is abundant, Fire extinguishes itself; do not eagerly use cold/harsh medicines." Li Dongyuan said: "Renshen (Ginseng Radix) tonifies the Lung; when Qi is prosperous, Qi of the Four Zang organs becomes prosperous, Jing naturally generates, and the form becomes robust." Bai Feixia said: "Frequent use of Renshen restores Yuan Qi (Original Qi) from the realm of nothingness. Those with Lung deficiency causing wheezing and coughing should all take it." Wang Haogu said: "Lung heat further injures the Lung." Wang Jiezhai said: "Consumptive patients taking Ren [shen] will surely die." Commentary: Ancient medical books are like a heated debate. I believe that discussing treatment without pulse and symptom evidence is like writing an essay without a topic. The theories of masters from the Song, Yuan, and Qing dynasties were extremely precise, but applying them to actual cases often resulted in plausible-sounding but incorrect approaches. Only Shen Langzhong said: "For individuals with Yin deficiency and excessive fire, even if they contract external pathogens and present with steaming fever and cough, one must strictly avoid dispersing the exterior with Qianghuo (Notopterygii Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). One must also avoid clearing the Lung and stopping cough with Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Ziye (Perillae Folium), and Juhong (Citri Reticulatae Pericarpium Rubrum). If there is accumulation, avoid digestive aids. One should remain calm and nourish Yin." This is also a mediating view (Above: Discussion of ancient views). Generally, this disease arises from depletion: overwork of the Liver and Kidneys leads to loss of Blood and Essence, resulting in death from Yang hyperactivity and Yin exhaustion. Arising from emotional stagnation: internal fire scorches fluids, leading to Blood stasis, dry cough, increased appetite, and eventual death from consumption. Arising from medication errors: mostly Spleen and Lung diseases, leading to reduced diet, wheezing, coughing, and diarrhea. This is the general situation. Treatment methods: If Yin Fire insults Metal causing cough with a rapid pulse, this is internal Wind generating. Wind generation makes Qi movement urgent; six or seven beats per breath indicate Wind acting dominantly, forcing Blood to move recklessly, causing hematemesis or epistaxis, or excessive bleeding, further depleting Yin. Not only is the Lung dry, but Gallbladder bile is also withered. Withered bile means Wood fire will self-combust. Moreover, since the Lung is coughing, it agitates Fire, transforming fluids into Phlegm. When the Lung withers, flaccidity syndrome arises, the source of Water is cut off, tidal fever persists, and death is inevitable. Zhang Zhongjing said: "A rapid pulse indicates Wind attack; stop it by adjusting diet." This is extremely profound. It is indeed the critical juncture of life and death in consumptive disease. While the patient's Stomach Qi is still strong, tonify with food, as stated: "For those with insufficient form, tonify with flavor." To tonify Qi and Blood, use fatty duck or beef; to tonify Yin, use sea cucumber, eel, or soft-shell turtle; to tonify Earth (Spleen), use young hen, crucian carp, or yellow catfish; to clear Fire, use bird's nest or clam; to tonify the Lung, use pig lung or Lily Bulb; to strengthen the Spleen, use red dates or lotus seeds. Cook thoroughly and eat freely, but do not overeat to avoid burdening Spleen transformation. Walk slowly after meals, take one pill of Zisheng Wan. Keep the mind idle and Qi calm so internal Fire does not generate. Over time, Yin grows stronger than Yang, Stomach Qi suffices and rises to the Lung, the Lung generates Water, and the rapid pulse recedes. Avoid foods that stir Wind or Qi and raw/cold items. This is the method of dietary tonification when Stomach Qi is still strong (Above: Dietary Nourishment). If the disease lingers for a long time, erroneous medication severely depletes True Qi, leading to Middle deficiency, weak Stomach Qi, reduced diet, and inability to transform. Previous methods are difficult to apply. Proponents advocate strengthening Water to control Fire, but Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) are bitter-cold, Dihuang (Rehmanniae Radix) is cloying and dampening, and even Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) are bitter-drying. Water originates from Metal, called Tianyi Water, which can provide assistance. Metal generates Water relying entirely on Spleen and Stomach Qi rising. If Spleen is damp and Stomach is weak, Lung Metal lacks Earth support. Using astringent/descending methods, regardless of difficulty, if Fire descends, Qi sinks. Like a scorching sun without clouds, where does rain come from? When the time passes, Fire rises again, becoming more intense. This stems from not understanding the meaning of Water originating from high sources and water bodies communicating. Generally, if the rapid pulse remains, Wind flows endlessly, and there is no hope of cure. Diagnosing consumptive pulse: within a full day and night, there must be a moment when the rapidity decreases slightly. This is the time of Yin-Yang self-victory and restoration. Seize this opportunity to administer medicine and guide the process. Otherwise, at Yin Chu (3-5 AM) when Qi enters the Lung, administer Huifeng Tang (Return Wind Decoction) with a cup of Rice Dew. After several doses, concurrently administer Bingxin Tang and Sanhe Shui Tang. If the pulse decreases slightly, it is a sign of vitality. This Wind differs from the Wind of Stroke. That is a dark, stormy wind that blinds the day, uproots houses, and breaks trees; this is the hot, humid Southeast wind of summer excess Yang. Reversing its trend from West to East brings Western cool winds and promises rain. Therefore, for Yang failing to rise, use Chaihu Zuosheng Tang to ascend towards the Right. Now, we must ascend Yang from the Right towards the Left. This is another method (Above: Return Wind Method). If Rising Deficient Fire presents with red face, vexation, cough, dry mouth, and a pulse that is盛大 (excessive) at Cun (inch) and weak at Chi (cubit), coming strongly and departing weakly, the condition has worsened. First use Daohuo Tang (Guide Fire Down Decoction) to lead Fire down into the Small Intestine. Sit quietly for a while until Fire descends to the Dantian. While Fire is below, administer Chizhi Tang (Red Banner Decoction) to fill the Middle Jiao, preventing Fire from rising again. This is the method of Han Xin replacing Zhao banners with Han banners. This is another method (Above: Red Banner Method). If Blood appears initially, strictly avoid sour/astringent hemostatics and Shengdi (Rehmanniae Radix) due to their cloying nature, lest Blood congeal into Stasis. Use Heijin San (Black Gold Powder) to descend Fire and remove Stasis, which is best. For hematemesis due to labor-induced internal injury, crush one live crab and mix with warm aged wine for administration. These are all consumptive diseases arising from Rising Yin Fire generating Internal Wind (Above: Blood Syndromes). If sputum contains thread-like blood, it is due to cough injuring the Lung; use Qingfei Tang (Clear Lung Decoction). If Blood is expectorated, it comes from Liver/Kidney, and Fire has not yet entered the Lung; urgently administer Zhenhuo Tang (Suppress Fire Decoction) to govern all Bleeding. For fever, there is Three-Yang Yin Deficiency Consumptive Disease; commonly take Shengyin Yangxue Tang (Ascend Yin Nourish Blood Decoction) and Zhisou Tang (Stop Cough Decoction). Commonly take Jinsheng Wan (Metal Generates Pill) to guide Lung Qi down into the Kidney (Above: General Treatment). Additionally, for fever unceasing day and night with dry, hairless skin, there must be uncleared exterior pathogens or stubbornness from misused tonics. Use Neituo Tang (Internal Support Decoction) taken hot to induce sweating (Above: Exterior Pathogen Complication). There is also Bone-steaming Consumptive Disease: skin is not very hot, but bones feel hot upon pressure; the patient eats well but is thin; skin is dry and rough, anhidrotic, stool is hard; pulse is deep, tight, rapid, and forceful. This differs from other consumptive diseases, arising from Cold-Wind exterior pathogens accumulating over time. Use bitter-cold, major Yin-tonifying formulas. Strictly avoid drying-hot products. Since the heat is in the marrow, ascending/dispersing agents should not be used to let heat flare externally. Also, various deficiencies involve withered Gallbladder bile, so Liver Wood Fire lacks Water restraint, causing Wind-Fire to erupt massively. In bone-steaming, Gallbladder bile is especially withered; use Tuizheng Tang (Reduce Steaming Decoction) (Above: Bone Steaming). For daily chills followed by fever resembling malaria, resolving only after sweating, use Guizhi Chaihu Geban Tang (Half-Half Guizhi and Chaihu Decoction) plus two spoonfuls of Gallbladder bile. Additionally, cases arising from Blood Stasis are common in women. Besides ancient Dachong Wan (Ground Beetle Pill), there was Maijian San (Wheat Decoction Powder); now there is Heijin Wan (Black Gold Pill). For Chuanshi Zhai Syndrome (Infectious Consumption), symptoms include mental heat wanting to expose the body, stifling sensation when covered, palpitations, fright, pale complexion, and memory loss. This is Heart Steaming; use Chuanshi Lao Fang (Infectious Consumption Formula). For bone-steaming with five-palm heat, use Qinggu San (Clear Bone Powder). Question: Is Lanhou Dansha (Rotting Throat Red Rash) mentioned in Zhang Zhongjing's books? Few Song/Yuan masters discussed this, can you explain its etiology? Some say it relates to Si Tian (Chief Qi of the Year). However, both Dry and Humid commands can cause disease, and Zhu Qi (Main Qi) and Ke Qi (Guest Qi) differ. Can you detail the reasoning? How are favorable and unfavorable syndromes distinguished? What are the initial and mid/late treatments? What are the signs for clearing vs. purging? Please elaborate. This disease is common recently. My father has previously established arguments; please expand and detail them. *Jingui Yaolue* states: "Yang Du (Yang Toxin) disease presents with a red, mottled face like brocade, sore throat, and vomiting pus/blood. Treatable in 5 days, untreatable in 7. Use Shengma Biejia Tang (Angelica Root and Turtle Shell Decoction)." This scripture resembles modern Lanhou Dansha, but the treatment cannot be followed. Shujiao (Sichuan Pepper) and Xionghuang (Realgar) are warming/drying and contraindicated. Considering this disease occurs in Spring/Summer, Earth Qi naturally rises; using Shengma (Angelicae Dahuricae Radix) to ascend is inappropriate. Due to Warmth-Heat, latent Fire in Blood does not require Danggui (Angelicae Sinensis Radix), which is common knowledge. Ancient texts rarely mention diseases prevalent today; Song/Yuan masters were mostly Northern, while this disease prevails in Jiangnan. Discussions on Si Tian vary. I believe Ke Qi is unreliable; one must seek truth in Zhu Qi. Like Qian Tian Bagua, Ke Qi has fixed positions but no function. Zhu Qi and Ling Qi interweave and appear according to time. For example, this Spring, Earth Qi is warm with NW winds and prolonged rain. Taiyin Damp Earth Ling Qi overlays Shaoyang Ministerial Fire. The main Qi pathology manifests as Dampness suppressing and stagnating, causing Lanhou Dansha. How does it manifest? Epidemic Qi enters Lung/Stomach via nose/mouth. Why rotting throat? Damp-Heat stagnation. What is Dansha? Similar to rash, it is a disease of blood collaterals, differing from eruptions from the Stomach. Primary treatment: Aromatic collateral-unblocking, Pungent-Cool muscle-releasing, Sweet-Cool Blood-clearing. If it reverses-transmits to Pericardium, it follows Ye Tianshi's Warm Disease principles. However, divide into three types: Wind transforming Heat requires Clearing/Unblocking; Damp transforming Heat requires Clearing/Diffusing; Phlegm-Fire condensation requires Clearing/Descending. Favorable Initial Stage: Tight/String/Rapid pulse, aversion to cold, head distension, red skin, hot muscles, rotten/painful throat, hidden rash. After 3-4 days, Warm Evil transforms to Fire, Heat surges, Rash penetrates. After 5-6 days, severe Heat, coma, rotten throat. This is Fire surging, reverse transmission, pressing inward to Pericardium. After 7 days, Heat subsides, body turns dark purple, Rash sheds like bran, healing. This is favorable. Unfavorable Stage: Days 1-2, fine/tense pulse, body red but Rash does not penetrate, coma, confusion, rebellious Qi/wheezing. This is Evil-Toxin closing internally in Lung/Stomach; internal closure leads to external collapse. Treatment: Favorable Days 1-2: Disperse exterior, Niubang Jienu Tang (Arctium Muscle-Unblocking Decoction) or Yinqiao San (Honeysuckle and Forsythia Powder), add digestives, blow Zhuhuang San (Pearl and Realgar Powder). Days 3-4 Fire transformation: Add Xijiao (Rhinocerotis Cornu - substitute with Buffalo Horn), Lingjiao (Bovis Cornu), Huafen (Trichosanthis Radix), Shihu (Dendrobii Caulis). Days 5-6 Pericardium compression: Ying Level, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Sweating/clear mind: Qi Level, Yunu Jian (Jade Woman Decoction) plus Danxing (Arisaematis Cum Bile), Shichangpu (Acori Tatarinowii Rhizoma), Xihuang (Moschus), severe cases use Zixue San (Purple Snow Powder). Mid/Late treatment similar. Constipation/dry/yellow-black tongue: Liangge San (Cool Diaphragm Powder) = Purging. Diarrhea with Heat/white greasy tongue: Gegen Qinlian Tang (Kudzu and Scutellaria/Coptis Decoction). For Unfavorable cases, Fire-Toxin closed in Lung/Stomach: Fresh Dihuang 4 liang crushed juice, add Jinzhi (Gold Juice), Lizhi (Pear Juice), Zhejiang (Sugarcane Juice), plus Gegen, Qin, Lian. Further: Fresh Lugen (Reed Rhizome) decoction, ground Xijiao juice, mixed with Zixue San or Zhuhuang San. Principle: Clear/Open/Drain Heat. Untreatable cases: Nasal congestion/runny nose (Lung injured); eyes blurry/closed (Liver failing); white powder-like complexion (Qi color failed). These are untreatable. Deficient Yuan Qi cannot expel toxin; toxin hides deep. Although Clear/Tonify/Transform exists, it is difficult. Better to use heavy Yin-nourishing/Heat-draining for Yin deficiency. Detailed treatment in Warm Disease Lower Jiao Chapter. My father dislikes early clearing, fearing unresolved Wind/Damp turning into toxic swelling (Parotitis). Ancestor Hongfan said well: "Initial fever/chills: prioritize dispersing/unblocking (Fire depression release). Once chills stop, internal Fire flares: prioritize cooling/resolving. Persisting with pungent dispersion feeds Fire, increasing swelling/heat. Adapt timing and strategy precisely." Question: Women's diseases prioritize pregnancy/birth. Can pregnancy pulse be distinguished? Can gender be predicted? Which test-fetus method is superior? Explain Ezu (Morning Sickness) etiology/treatment. Explain Tailou (Fetal Leakage) and Xiaochan (Miscarriage) etiology/treatment. Can you list causes/treatments for headache, heart pain, stomach pain, lower abdominal pain, thigh pain, Huantiao pain, red eyes, sore throat, and trauma in pregnant women? Detail fetal death verification and expulsion methods. Classic says: "Hand-Shaoyin pulse moving strongly indicates pregnancy; Yin pulsing distinct from Yang indicates pregnancy; body sick but pulse free of evil indicates pregnancy; Chi pulse uninterrupted indicates pregnancy." Chi is Shaoyin Kidney pulse. Kidney pulse slippery also appears in leukorrhea. Only corresponding with Hand-Shaoyin Heart pulse confirms pregnancy, known as Yin pulsing distinct from Yang. Blood/Qi gather in Uterus, filling it, causing Chi Yin slippery/rapid. Distinction from Consumptive Rapid Pulse: Pregnancy pulse has Stomach Qi; Consumptive pulse is wiry/slipping without Stomach Qi. Middle-aged emaciated women may have small/non-rapid pulses, but hidden slipperiness is present. Distinguishing Gender Pulse is hardest. "Left large=Male, Right large=Female" theory ignores organ Qi bias. My master said: Women are Yin-back/Yang-face; Left corresponds to Male Right, Right to Male Left. Thus Danxi said it refers to doctor's hands, which is unreliable. Two Cun floating/slippery = Yang pulse = Male fetus; Two Chi deep/slippery = Yin pulse = Female fetus. This is closer. But direct observation: Male fetus moves at 3 months, umbilicus protrudes/hard belly like pot; Female fetus moves at 5 months, umbilicus soft/belly like basket. If Blood Stasis confuses fetus, use Test Method: Chenjiu (Aged Wine) + Foshou San (Buddha's Hand Powder: Danggui 7 qian, Chuanxiong 1 qian). Wait 2 hours. Umbilical/abdominal movement = Fetus; No movement = Menstrual obstruction. Stable method. Ezu (Morning Sickness): Nausea blocking diet. Causes: 1. Stomach deficiency, phlegm-fluid retention, Qi stagnation. 2. Chong/Ren Qi rising, not descending. Menstrual blood closed, water floods organs, organ Qi blocked, causing vexation/stuffiness/rebellious Qi/vomiting. After 3 months, fetus grows, consumes blood, no upward rebellion. Rare non-Ezu cases: Central Qi strong, no old phlegm, clear/turbid ascend/descend normally, no turbid Qi rising. Treatment: Deficiency: Jiawei Shenju Yin (Wendan Tang + Renshen, Muxiang, Danggui, Huoxiang, Sharen). Excess: Xiaohe Zhong Yin (Chenpi, Houpo, Fuling, Shanzha, Bian Dou, Gancao). Sour vomiting: Erxiang San (Huoxiang, Caoguo, Xiangfu) powder. Cold Stomach: Dingxiang, Doukou, Sharen. Spleen Deficiency/Fire: Huangqin, Shanzhi, Zhuru. Follow Danxi: "Fat people much Phlegm, Thin people much Fire." Base on Erchen Tang variations. Do not fear Banxia/Fuling harming fetus. Tailou/Xiaochan mostly due to Qi/Blood deficiency. Qi deficiency fails to hold; Blood deficiency fails to nourish. Kidney holds fetus; Waist is Kidney mansion. Waist pain risks miscarriage. Other cause: Blood too hot flowing recklessly. Sudden water flow = miscarriage. Slow flow = Tonify Qi/Calming Spirit. Pulse: String-taut/Slippery/Smooth is good; Deep/Thin/Micro is bad. Treatment based on constitution. Yin Deficiency/Internal Heat: Aiye, Fuzi, Baizhu, Sharen. Warming agents consume Yin further (like plants without rain). Yang Deficiency/Internal Cold: Huangqin, Baishao. Cooling agents weaken Spleen/Stomach Qi/Blood (like fruit lacking autumn/winter結). Before 3 months: Nourish Spleen/Stomach. After 4 months: Strengthen Waist/Kidney. Main formula: Taishan Panshi San (Bazhen Tang minus Fuling, add Renshen, Xuanduan, Huangqin, Ejiao). Blood Heat: Huangbo, Ejiao. Qi Cold: Aiye, Paojiang. Caution: Tailou differentiation. Some women with abundant Blood menstruate without miscarriage; treating causes miscarriage. Some have slippery/rapid pulse, light periods stopping at 3-4 months. People think 7-month birth, actually full term. Robust women spotting blood first 3 months without waist pain/fetal movement need no medicine. Combine with physique. Many monthly miscarriages due to hygiene habits (washing genitals). Remember Qi Deficiency, Blood Deficiency, Blood Heat for prenatal pains. Differentiate Exterior/Interior. Headache Blood Deficiency/Fire: Siwu Tang mod. Wind: Jiawei Xiong Gui Tang (Huangqin, Muxiang, Tea). Heart/Abdominal Pain + Phlegm/Wind: Zhengqi San. Press pain = Accumulation: Baoyuan Tang. No pain = Spleen/Stomach injury: Liu Jun Zi Tang. Full pain to Heart: Huangqin, Baizhu, Baishao. Intermittent pain = Blood Deficiency: Shudi, Danggui decoction. Heavy feeling = Qi Deficiency: Buzhong Yiqi Tang. Hypochondriac pain: Avoid Qi-breaking; Tongbian + Wine. Cold Lower Abdominal Pain: Xiaojianzhong Tang + Paojiang. Waist/Huantiao pain: Tonify. Red Eyes/Sore Throat: Liangge San acceptable. Trauma: Jiao Ai Tang + Chuanxiong, Danggui, Dihuang. General overview. Face Green/Tongue Red = Mother dies/Child lives; Face Red/Tongue Blue = Mother lives/Child dies. Definitive dead fetus signs. Expulsion: Danxi uses heavy Foshou San (Danggui 1 liang, Chuanxiong 7 qian). Pingwei San + Mangxiao is safer. Question: Prenatal disease most common is Zixuan (Fetal Suspension), chest/abdominal fullness, mainly Zisu Yin. Why? Or other methods? And...