感症如上法治之愈矣。顾有讳疾忌医之病家。及操刃杀人之庸技。日久迁延。变如 起。猝
难措手。用集方治如下。
有一种严冬感寒。脉浮而紧。外寒束内热。阳气不得发泄。致咳嗽吐血衄血者。（春有不吐
衄者。）此麻黄症也。而其人素虚。不禁此汤峻险。又非他药可愈。宜麻黄人参芍药汤。
麻黄人参芍药汤
麦冬（君） 五味（使） 白芍（佐） 当归（臣） 甘草（佐） 麻黄（醋制臣） 桂枝
（佐）
黄 （君） 人参（佐）
上水煎麻黄令沸去沫。人余药同煎。热服。
（此方乃东垣精思慧想而成。妙不可言。余曾借治此症。应如桴鼓。然最妙之处。在分两极少。
专宣上焦耳。恐初学人不知此义。故论及之。且将本方定其分数。以备加减焉。）
伤寒热甚。不得汗衄血者。（夺汗者无血。夺血者无汗。若得汗则无衄症矣。）乃热入血分
。欲从衄解也。四物汤去川芎加升麻丹皮黄芩之类清之。（升麻一味。加得尤妙。从犀角地黄汤
如无犀角以升麻代之之义生来。盖阳明之脉络鼻。是经火盛迫血妄行。从鼻出者曰衄。方书言从
肺来。非也。若非升麻。则何以达阳明而清其火哉。）亦有衄后病反重者。更伤其阴也。大为危
候。其衄势必大甚。都气饮或六味饮。加生地黄生白芍。若血来太多。致耗中气。当大补其阳。
当归补血汤加人参甘草。虑虚火上浮。加麦冬五味。（此等加减。真精细。）若审胃气未伤。的
系热邪有升无降者。滋肾丸应手即止。有得生者。
当归补血汤
黄 （蜜炙八分） 当归（二分） （分读去声。即二钱五分也。）
滋肾丸
黄柏（君） 知母（君） 肉桂（使）
上知柏二味俱用酒洗焙干。共为末。炼蜜丸。
Exogenous diseases, when treated according to the above methods, will be cured. However, there are patients who conceal their illness and avoid medical treatment, as well as mediocre physicians whose skills are akin to murder. As time passes and the condition lingers, changes arise unpredictably, making it difficult to handle sudden emergencies. The following formulas are collected for treatment.
There is a type of cold damage contracted in severe winter, characterized by a floating and tight pulse. External cold binds the exterior while internal heat accumulates, preventing the venting of Yang Qi, leading to cough, hematemesis (vomiting blood), or epistaxis (nosebleed). (In spring, some cases do not present with hematemesis or epistaxis.) This is a Mahuang Syndrome. However, if the patient has a constitutionally deficient state and cannot tolerate the harsh and dangerous nature of this decoction, and no other herbs can cure it, Mahuang Renshen Shaoyao Tang (Mahuang, Ginseng, and White Peony Decoction) is appropriate.
**Mahuang Renshen Shaoyao Tang (Mahuang, Ginseng, and White Peony Decoction)**
* Maidong (Ophiopogonis Radix) [Monarch]
* Wuweizi (Schisandrae Fructus) [Envoy]
* Baishao (Paeoniae Radix Alba) [Assistant]
* Danggui (Angelicae Sinensis Radix) [Deputy]
* Gancao (Glycyrrhizae Radix et Rhizoma) [Assistant]
* Mahuang (Ephedrae Herba, vinegar-processed) [Deputy]
* Guizhi (Cinnamomi Ramulus) [Assistant]
* Huangqin (Scutellariae Radix) [Monarch]
* Renshen (Ginseng Radix) [Assistant]
Boil Mahuang in water until boiling, skim off the foam, then add the remaining herbs and decoct together. Take hot.
(This formula was created through Li Dongyuan's profound thinking and wisdom; its efficacy is indescribable. I once borrowed this formula to treat such conditions, and the response was as immediate as striking a drum. The most exquisite aspect lies in the extremely small dosages, specifically targeting the宣通 (venting/unblocking) of the Upper Jiao. Fearing that beginners may not understand this principle, I discuss it here and fix the dosages of this formula for reference in modifications.)
In Shanghan (Cold Damage) with severe heat, where sweating is impossible and epistaxis occurs: (Those deprived of sweat have no blood; those deprived of blood have no sweat. If sweat is obtained, epistaxis would not occur.) This indicates heat entering the Blood level, seeking release through epistaxis. Use Siwu Tang (Four Substances Decoction) removing Chuanxiong, adding Shengma (Cimicifugae Rhizoma), Mudanpi (Moutan Cortex), Huangqin (Scutellariae Radix), etc., to clear heat. (Adding Shengma is particularly brilliant, derived from the principle in Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) where Shengma replaces Xijiao (Rhinoceros Horn) when unavailable. The meridians of the Yangming Stomach connect to the nose; this is due to excessive fire in the meridian forcing blood to move recklessly, exiting via the nose, termed epistaxis. Formulas books claim it comes from the Lung, which is incorrect. Without Shengma, how could one reach the Yangming meridian to clear its fire?) There are also cases where the condition worsens after epistaxis, further injuring Yin. This is a critical prognosis. The epistaxis must be severe. Use Duqi Yin (All-Qi Drink) or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), adding Shengdihuang (Rehmanniae Radix Recens) and Sheng Baishao (Raw White Peony Root). If excessive blood loss depletes Middle Qi, one should greatly tonify Yang using Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) added with Renshen (Ginseng) and Gancao (Licorice). Considering floating deficiency fire, add Maidong (Ophiopogon) and Wuweizi (Schisandra). (These modifications are truly meticulous.) If the Stomach Qi is assessed as undamaged, and it is confirmed that the pathogenic heat rises without descending, Zishen Wan (Kidney-Nourishing Pill) will stop the bleeding immediately, offering hope for recovery.
**Danggui Buxue Tang (Danggui Tonifies the Blood Decoction)**
* Huangqi (Astragali Radix, honey-fried): 8 fen
* Danggui (Angelicae Sinensis Radix): 2 fen
*(Note: "fen" pronounced with departing tone, meaning 2 qian 5 fen)*
**Zishen Wan (Kidney-Nourishing Pill)**
* Huangbai (Phellodendri Cortex) [Monarch]
* Zhimu (Anemarrhenae Rhizoma) [Monarch]
* Rougui (Cinnamomi Cortex) [Envoy]
Wash Zhimu and Huangbai with wine, bake until dry, grind into powder, and form pills with refined honey.