东垣治一贫者。脾胃虚弱。气促。精神短少。衄血吐血。以麦门冬二分。人参、归身各
三分。黄 、白芍、甘草各一钱。五味五枚。作一服。水煎。稍热服愈。继而至冬。天寒居
密室。卧大热炕。而吐血数次。再求治。此久虚弱。外有寒形。而有火热在内。上气不足。
阳气外虚。当补表之阳气。泻里之虚热。夫冬寒衣薄。是重虚其阳。表有大寒。壅遏里热。
火邪不得舒伸。故血出于口。忆仲景伤寒论云。太阳伤寒。当以麻黄汤发汗而不与之。遂成
衄。却与麻黄汤立愈。此法相同。遂用之。以麻黄桂枝汤。人参益上焦元气而实其表。麦门
冬保肺气。各三分。桂枝以补表虚。当归身和血养血。各五分。麻黄去根节。去外寒。甘草
补脾胃之虚。黄 实表益卫。白芍药各一钱。五味三枚。安其肺气。卧时热服。一服而愈。
震按此案认病制方。其义最精。药之分两甚轻者。因受病在卫在肺。皆系亲上部位。经
云。补上治上制以缓。缓则气味薄也。然系久虚之体。热为寒束。故用法若此。体不虚而热
为寒束者。又当以麻杏甘膏汤。加血药以治之。
丹溪治一壮年。患嗽而咯血。发热肌瘦。医用补药数年而病甚。脉涩。此因好色而多怒
精神耗少。又补塞药多。荣卫不行。瘀血内积。肺气壅遏。不能下降。治肺壅。非吐不可
精血耗。非补不可。唯倒仓法二者兼备。但使吐多于泻耳。兼灸肺俞二穴。在三椎骨下横
过各一寸半。灸五次而愈。
震按肺俞灸法。今人颇用之。然效甚 。倒仓法无敢用者。德清邑宰查公。讳克萨。吐
血成痨。曾用之。亦无效。丹溪此案。以补药数年。瘀血内积。尚非死证。故以二法奏功。
滑伯仁治一人。盛暑出门。途中吐血数口。亟还则吐甚。胸拒痛。体热头眩。病且殆。
或以为劳心焦思所致。与茯苓补心汤。仁至。诊其脉洪而滑。曰。是大醉饱。胃血壅遏。为
暑迫血上行。先与犀角地黄汤。继以桃仁承气汤去瘀血宿积。后治暑即安。
震按此条为孙东宿二案之祖。可以并看。
陈斗严治薛上舍。高沙人。素无恙。骤吐血半缶。陈诊之曰。脉弦急。此薄厥也。病得
之大怒。气逆。阴阳奔并。饮六郁汤而愈。
震按上条逐瘀清暑。此条开郁。皆治暴病吐血法。类案原本载吴茭山治吐血不止。即以
吐出之血炒黑与服。亦是第一回暴起吐血法。
薛立斋治一童子。年十四。发热吐血。薛谓宜补中益气以滋化源。不信。用寒凉降火。
愈甚。始谓薛曰。童子未室。何肾虚之有。参 补气。奚为用之。薛曰。丹溪云。肾主闭藏
肝主疏泄。二藏俱有相火。而其系上属于心。心为君火。为物所感则易动。心动则相火翕
然而随。虽不交会。其精暗耗矣。又精血篇云。男子精未满而御女以通其精。则五脏有不满
之处。异日有难状之疾。遂用补中益气及地黄丸而瘥。
汪石山治一人。形实而黑。病咳。痰少声嘶。间或咯血。诊之。右脉大无伦。时复促而
中止。左比右略小而软。亦时中止。曰。此脾肺肾三经之病也。盖秋阳燥烈。热则伤肺。加
之以劳倦伤脾。脾为肺母。母病而子失其所养。女色伤肾。肾为肺子。子伤必盗母气以自奉
而肺愈虚矣。法当从清暑益气汤例而增减之。以人参二钱或三钱。白术、白芍、麦门冬、
茯苓各一钱。生地、当归身各八分。黄柏、知母、陈皮、神曲各七分。甘草五分。煎服。月
余而安。
震按上条童年发热吐血。此条咳嗽声嘶咯血。皆用参、术合补阴药而愈。观二公之议论
可悟失血之源头。今人一味滋阴清火。宜乎不效。
一人形瘦而苍。年逾二十。忽病咳嗽咯血。兼吐黑痰。医用参、术之剂。病愈甚。汪诊
之。两手寸关浮软。两尺独洪而滑。此肾虚火旺而然也。遂以四物汤加黄柏、知母、白术、
陈皮、麦冬之类。治之月余。尺脉稍平。肾热亦减。根据前方再加人参一钱。兼服枳术丸加人
参、山栀以助其脾。六味地黄丸加黄柏以滋其肾。半年而愈。
震按四物加知、柏合两尺之洪滑。白术、麦冬合寸关之浮软。妙极。至于前用参、术而
病甚。后以尺脉稍平仍加人参。苟非石山之高明。岂敢复蹈前辙。其收功于枳术丸加人参、
山栀。及地黄丸加黄柏。尤见工巧。
一人年逾四十。面色苍白。平素内外过劳。或为食伤。则咯硬痰而带血丝。因服寒凉清
肺药消痰药至五六十帖。声渐不清而至于哑。夜卧不寐。醒来口苦舌干而常白胎。或时喉中
觉痛。或胸膈痛。或嗳气夜食难消。或手靠物久则麻。常畏寒。不怕热。前有 疝。后有内
痔。遇劳则发。初诊左脉沉弱而缓。右脉浮软无力。续后三五日一诊。心肺二脉浮虚。按不
应指。或时脾脉轻按阁指。重按不足。又时或快或缓。或浮或沉。或大或小。变动无常。夫
脉不常。血气虚也。譬之虚伪之人。朝更夕改。全无定准。以脉参证。其虚无疑。虚属气虚
为重也。盖劳则气耗而肺伤。肺伤则声哑。又劳则伤脾。脾伤则食易积。前疝后痔。遇劳而
发者。皆因劳耗其气。气虚下陷。不能升降故也。且脾喜温恶寒。而肺亦恶寒。故曰。形寒
饮冷则伤肺。以已伤之脾肺。复伤于药之寒凉。则声安得不哑。舌安得不胎。胎者。仲景谓
胃中有寒。丹田有热也。夜不寐者。由子盗母气。心虚而神不安也。痰中血丝者。由脾伤不
能裹血也。胸痛嗳气者。气虚不能健运。故郁于中而嗳气。或滞于上则胸痛也。遂用参、
各四钱。麦冬、归身、贝母各一钱。远志、酸枣仁、牡丹皮、茯神各八分。石菖蒲、甘草各
五分。其他山楂、麦芽、杜仲。随病出入。煎服年余而复。益以宁志丸药。前病渐愈矣。且
此病属于燥热。故白术尚不敢用。况他燥剂乎。
一人年五十。形色苍白。性急。语不合。则叫号气喘呕吐。一日左乳下忽一点痛。后有过劳
恼怒。腹中觉有秽气。冲上即嗽。极吐。亦或干咳无痰。甚则呕血。时发时疟。或以疟治。
或从痰治。皆不效。汪诊之。脉皆浮细。略弦而快。曰。此土虚木旺也。性急多怒。肝火时
动。故左乳下痛者。肝气郁也。秽气冲者。肝火凌脾而逆上也。呕血者。肝被火扰不能藏其
血也。咳嗽者。金失所养。又受火克而然也。呕吐者。脾虚不能运化。食郁为痰也。寒热者
水火交战也。兹宜泄肝木之实。补脾土之虚。清肺金之燥。庶几可安。以青皮、山栀各七
分。白芍、黄 、麦冬各一钱。归身、阿胶各七分。甘草、五味各五分。白术一钱五分。人
参三钱。煎服月余。诸证悉平。
震按上条声哑喉痛。口苦舌胎。而用参、 各四钱。此条左乳下痛。秽气冲上即嗽。而
用人参三钱。 、术次之。非石山岂能辨此。且上条脉软无力。变动不常。尚可认为气虚。
此条脉浮细弦数。不以滋肾清肝。治更难及。
村庄一妇。年五十余。久嗽咯脓血。日轻夜重。汪诊之。脉皆细濡而滑。曰。此肺痿也
平日所服人参清肺饮、知母茯苓汤等剂。皆犯人参、半夏。一助肺中伏火。一燥肺之津液
故病益加。乃以天麦门冬、阿胶、贝母为君。知母、生地、紫菀、山栀为臣。桑白皮、马
兜铃为佐。款冬花、归身、甜葶苈、桔梗、甘草为使。五剂而安。
震按石山治血证。多用参、术。而此条及下条前半段治法。如出两人。可见其原非执守
一法。但下条用滋阴凉药。竟得脉缓不数。殆有天幸焉。近来此种病极多。此种药效者殊少
一人形色苍白。年三十余。咳嗽咯血声哑。夜热自汗。汪诊之。脉濡细而近快。曰。此
得之色欲也。遂以四物加麦冬、紫菀、阿胶、黄柏、知母。三十余帖。诸证悉减。又觉胸腹
痞满。恶心畏食。或时粪溏。诊之脉皆缓弱。无复快矣。曰。今阴虚之病已退。再用甘温养
其脾胃。则病根去矣。遂以四君子汤加神曲、陈皮、麦冬。服十余帖而安。
江篁南治其弟患嗽血。初一二剂用知、贝、二冬、归、芍清肺之剂。夜加胁疼。继用人
参一钱五分。胁疼减。后知参至二钱。左脉近大而快。右略敛。少带弦而快。每嗽则有血。
大便溏。一日三更衣。以人参三钱。白术、紫菀各一钱五分。茯苓、白芍各一钱。甘草九分
牡丹皮八分。加茅根、小溲。脉弦快稍减。加黄 二钱。百部六分。是日嗽止。血渐少。
既而血亦止。然便溏。乃倍参、 、术、山药、陈皮、甘草、苡仁、白芍等药。兼与健脾丸
而愈。
震按此案纯仿石山治法。
孙东宿治臧六老。上吐血。下泻血。胸膈背心皆胀。原从怒触。又犬肉所伤。故发热而
渴。医者用滋阴降火药。胸背愈胀。血来更多。孙诊之两关俱洪滑有力。曰。此肝脾二经有
余证也。作阴虚治。左矣。阴虚者脉数无力。今之脉既不同。午后潮热。夜半而退。与今之
昼夜常热者。亦不同也。经云。怒伤肝。甚则呕血并下泄。胸背胀痛。瘀血使然。脾为犬肉
所伤。故不能统血。误用地黄、知、柏等剂。是以脾益伤。而上焦瘀血愈滞也。即与山楂、
香附、枳实。调气消导为君。丹参、丹皮、桃仁、滑石、茅根。化瘀血为臣。黄连、芦根。
解犬肉之热为佐。四帖胸背宽。吐血止。惟腹中不舒。仍以前药同保和丸与之。大下臭黑粪
而全安。
族侄明之。作文过劳。痰火上逆。大吐痰沫。因而呕血。一涌数碗。昏晕汗出。奄奄而
卧。略不敢动。稍动即呕吐而血随出。色鲜红。饮食汤水皆不敢入。入即吐而眩晕。血即随
之。医者皆曰。血如涌泉。体热脉大。眩晕而药食难入。似无佳兆。孙诊之曰。无妨。凡看
证要圆活。勿拘泥。经云。心主血。肝藏血。又云。怒则气上。又云。脉虚身热。得之伤暑
今左脉弦大。右脉虚大。是不独作文劳心动火。且亦被怒伤肝。抑又为暑所逼。以致木火
上升。眩晕作吐。经云。诸风掉眩。皆属于肝。诸呕吐逆。皆属于火。又诸动属火。内为木
火上冲。外为暑气所迫。故吐而汗多。血随吐出也。先以白丸子三钱解其暑气。清其痰饮。
抑其冲逆。则吐可止。吐止气平。血自归经。服后果嗒然而睡。醒则吐止食进。眩晕寻已。
继用滑石、香薷各三钱。黄连、扁豆各一钱五分。竹茹一钱。甘草五分。四帖全安。
震按上条胸背皆胀。服阴药胀更甚。合以两关脉之洪滑有力。尚易辨其非阴虚。况恼怒
食犬。亦可问而知之。此条因作文过劳。呕血数碗。昏晕汗出。稍动即吐。而血随至。势殊
危矣。况右脉虚大。不认为虚而认为暑。竟合左脉之弦大。大剂清暑清汗。真妙手也。
李士材曰。尚宝卿须日华。林下多郁。且有暴怒。吐血甚多。倦怠异常。余以六君子纳
参一两。干姜一钱。木香八分。四日而血止。后因怒。血复大作。余曰。先与平肝。继当大
补。然夏得秋脉。所谓早见非时之脉。当其时不能再见矣。果如期而殁。
震按吐血甚多。其因由于郁且怒。则肝脾受伤久矣。重用人参。佐辛热以从治。可谓
技
进乎道者也。若解郁平肝。血岂能止。然血止后因怒复大作。更何法可治。其死无疑矣。
大宗伯董元宰有少外家。吐血蒸嗽。先用清火。继用补中。俱不见效。士材诊之。曰。两尺沉
实。少腹按之必痛。询之果然。此怒后蓄血。经年弗去。乃为蒸热。热甚而吐血。阴伤之甚
也。以四物汤加郁金、桃仁、穿山甲、大黄少许。下黑血升余。少腹痛仍在。更以前药加大
黄三钱煎服。又下血黑块如桃胶蚬肉者三四升。腹痛乃止。虚倦异常。与独参汤饮之。三日
而热减六七。服十全大补汤百余日而康。
震按两尺沉实。决其少腹有瘀。因瘀而蒸热。因蒸热而吐血。盖从脉象认得病根。故
大下而病根去。去后峻补。不用养阴。更妙。
景岳治倪孝廉。素以攻苦。思虑伤脾。时有呕吐之证。过劳即发。用理阴煎、温胃饮之属。
随饮即愈。一日于暑末时。因连日交际。致劳心脾。遂上为吐血。下为泄血。俱大如手片。
或紫或红。甚多可畏。医云。此因劳而火起心脾。兼之暑令。二火相济。所以致此。与犀角
地黄、童便、知母之属。药及两剂。其吐愈甚。脉益紧数。困惫垂危。迨景岳往视。情势
俱
剧。乃以人参、熟地、干姜、甘草四味。大剂与之。初服毫不为动。次服觉呕恶少止。而脉
中微有生意。乃复加附子、炮姜各二钱。人参、熟地各一两。白术四钱。炙甘草一钱。茯苓
二钱。黄昏与服。竟得大睡。直至四鼓。复进之。而呕止血亦止。又服此方数日。而健如故
盖此人以劳倦伤脾。脾胃阳虚。气有不摄。所以动血。时当二火。而证非二火。再用寒凉
脾必败而死矣。
震按此与生生子族侄之病病因同。现证及时令又同。而一用寒凉。一用温补。水火之
别
皆得收功。自非神手不能。但孙脉左弦大右虚大。与紧脉不同。孙案未曾以药尝试。张案
用寒凉而病益甚。亦有不同也。临证者在乎细心体察也。
喻嘉言治一人。素有失血病。晨起陡暴一口。倾血一盆。喉间气壅。神思飘荡。壮热如蒸。
Li Dongyuan treated a poor patient. The patient had weak spleen and stomach, shortness of breath (Qi deficiency), lack of spirit and energy, and presented with epistaxis (nosebleed) and hematemesis (vomiting blood). The prescription used Ophiopogonis Radix (Maidong) 2 fen, Ginseng Radix (Renshen) and Angelicae Sinensis Radix (Danggui Shen) each 3 fen, Astragali Radix (Huangqi), Paeoniae Radix Alba (Baishao), and Glycyrrhizae Radix et Rhizoma (Gancao) each 1 qian, and Schisandrae Fructus (Wuweizi) 5 pieces. This was taken as one dose, decocted in water, and taken slightly warm, resulting in recovery. In winter, due to cold weather, the patient lived in a sealed room and slept on a very hot kang, suffering several episodes of hematemesis again, and sought treatment once more. This was because of long-standing deficiency, with external cold signs but internal heat. There was insufficiency of Qi in the upper Jiao and deficiency of Yang Qi on the exterior. It was necessary to tonify the exterior Yang Qi and purge the interior deficient heat. Winter cold and thin clothing further depleted the Yang; severe exterior cold obstructed the interior heat, preventing the fire pathogen from dispersing, thus causing blood to issue from the mouth. Recalling Zhang Zhongjing's *Treatise on Cold Damage*: for Taiyang Cold Damage, Ma Huang Tang should be used to induce sweating; if not given, it leads to epistaxis, yet giving Ma Huang Tang cures it immediately. This method is the same. Thus, Ma Huang Gui Zhi Tang was used. Ginseng was used to tonify Yuan Qi of the Upper Jiao and strengthen the exterior, Ophiopogonis Radix to protect Lung Qi, each 3 fen; Cinnamon Twig (Guizhi) to tonify exterior deficiency, Angelicae Sinensis Radix to harmonize and nourish blood, each 5 fen; Ephedrae Herba (Mahuang), roots and joints removed, to dispel exterior cold; Glycyrrhizae Radix et Rhizoma to tonify Spleen and Stomach deficiency; Astragali Radix to secure the exterior and benefit Wei Qi; Paeoniae Radix Alba each 1 qian; Schisandrae Fructus 3 pieces to calm Lung Qi. Taken hot while lying down, one dose resulted in recovery.
Yu Zhen commented: This case demonstrates exquisite precision in disease differentiation and formula formulation. The light dosage of herbs is because the pathology resides in the Wei (Defensive) level and Lung meridian, which are upper body locations. As the classics state: "Tonifying and treating the upper requires slow-acting formulas; slow action implies thin flavor and aroma." However, since this is a constitution of long-term deficiency with heat constrained by cold, this approach was appropriate. For cases where the constitution is not deficient but heat is constrained by cold, Ma Xing Gan Shi Tang combined with blood-invigorating herbs should be used.
Zhu Danxi treated a young adult male suffering from cough with hemoptysis, fever, and emaciation. He had been treated with tonic medicines for years by other physicians, worsening his condition. His pulse was choppy (Se). This was due to excessive sexual activity and anger, leading to depletion of spirit and essence, compounded by excessive use of cloying tonics that obstructed the flow of Ying (Nutritive) and Wei (Defensive) Qi, causing blood stasis to accumulate internally. Lung Qi was obstructed and could not descend. Treating Lung obstruction required emesis; replenishing consumed essence and blood required tonification. Only the "Inversion of the Granary" method (inducing vomiting to clear stagnation) achieved both. The key was to ensure vomiting exceeded purging. Acupoint Fei Shu (BL13) was moxibusted bilaterally, located 1.5 cun lateral to the lower border of the spinous process of the 3rd thoracic vertebra, five sessions per point, resulting in recovery.
Yu Zhen commented: Moxibustion at Fei Shu is commonly used today, but efficacy is often low. Few dare to use the "Inversion of the Granary" method. Mr. Cha Kesha, magistrate of Deqing, suffered from hemoptysis progressing to consumption and tried this method without effect. In Zhu Danxi's case, despite years of tonic use causing internal stasis, it was not a terminal stage, allowing these methods to succeed.
Hua Bolin treated a person who went out during peak summer heat and vomited a few mouthfuls of blood en route. Upon returning home, vomiting worsened significantly, accompanied by chest pain with tenderness/rejection, fever, and dizziness, placing the patient in critical condition. Some attributed it to mental strain and anxiety, prescribing Fu Ling Bu Xin Tang. Hua Bolin arrived, palpated the pulse as surging (Hong) and slippery (Hua), and stated: "This is due to overeating and drinking alcohol, causing gastric blood to become obstructed, forced upward by summer heat." First, Xi Jiao Di Huang Tang was administered, followed by Tao Ren Cheng Qi Tang to remove old blood stasis. Subsequent treatment for summer heat led to recovery.
Yu Zhen commented: This case is the ancestor of two cases by Sun Dongsu and should be viewed together.
Chen Douyan treated Xue Shangshe, a native of Gaosha, who was previously healthy but suddenly vomited half a jar of blood. Chen diagnosed a wiry (Xian) and rapid pulse, identifying it as Bo Jue (a sudden collapse due to extreme anger). The illness arose from severe anger causing Qi rebellion and chaotic interaction of Yin and Yang. Liu Yu Tang was prescribed, resulting in recovery.
Yu Zhen commented: The previous case addressed stasis and cleared summer heat; this case opens depression. Both are methods for treating acute hemoptysis. The original collection records Wu Jiaoshan treating persistent hemoptysis by frying the vomited blood black and administering it, another first-line method for sudden onset hemoptysis.
Xue Lizhai treated a fourteen-year-old boy with fever and hemoptysis. Xue advised tonifying Middle Jiao Qi to nourish the source of transformation. The family disagreed, using cold-cooling and fire-descending herbs, which worsened the condition. They questioned Xue: "The boy is unmarried, how can Kidney deficiency exist? Why use Ginseng to tonify Qi?" Xue replied: "Zhu Danxi said the Kidney governs storage, and the Liver governs dispersion. Both contain Minister Fire connected to the Heart. The Heart is Sovereign Fire, easily moved by external stimuli. When the Heart moves, Minister Fire follows. Even without intercourse, essence is secretly consumed. Also, the 'Essence and Blood Chapter' states: If a man engages in intercourse before his essence is full, the Five Zang organs will have deficiencies, leading to difficult-to-describe diseases later." Xue then prescribed Bu Zhong Yi Qi Wan and Di Huang Wan, resulting in recovery.
Wang Shishan treated a man with a solid physique and dark complexion, suffering from cough, scant sputum, hoarseness, and occasional hemoptysis. The right pulse was excessively large, sometimes rapid with interruptions; the left pulse was slightly smaller and softer than the right, also with intermittent interruptions. Wang stated: "This is a disease of the Spleen, Lung, and Kidney meridians. Autumn sun is dry and fierce; heat injures the Lung. Fatigue injures the Spleen. Spleen is the Mother of Lung; when the Mother is ill, the Child loses nourishment. Sexual excess injures the Kidney. Kidney is the Child of Lung; when the Child is injured, it drains the Mother's Qi, making the Lung even weaker." The treatment should follow the example of Qing Shu Yi Qi Tang with modifications: Ginseng 2 or 3 qian, Atractylodis Macrocephalae Rhizoma (Baizhu), Paeoniae Radix Alba, Ophiopogonis Radix, and Poria (Fuling) each 1 qian, Rehmanniae Radix (Shengdi) and Angelicae Sinensis Radix each 8 fen, Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Citri Reticulatae Pericarpium (Chenpi), and Massae Medicatae Fermentatae (Shenqu) each 7 fen, Glycyrrhizae Radix et Rhizoma 5 fen. Decocted and taken, peace returned after over a month.
Yu Zhen commented: Both the childhood fever/hemoptysis case and this cough/hoarseness/hemoptysis case were cured using Ginseng and Atractylodis combined with Yin-nourishing herbs. Observing these discussions reveals the root of bleeding disorders. Today's tendency to solely use Yin-nourishing and fire-clearing methods explains their frequent ineffectiveness.
Another case: A man, thin and pale, over twenty years old, suddenly developed cough with hemoptysis and expectoration of black sputum. Treatment with Ginseng and Atractylodis worsened the condition. Wang Shishan found the Cun and Guan positions on both hands floating and soft, while Chi positions alone were surging and slippery. This indicated Kidney deficiency with hyperactive fire. Si Wu Tang was modified with Huangbai, Zhimu, Baizhu, Chenpi, and Ophiopogonis Radix. After a month, the Chi pulse flattened somewhat, and Kidney heat decreased. Ginseng was added to the previous formula. Additionally, Zhi Zhu Wan with Ginseng and Gardeniae Fructus (Shanzhi) was taken to support the Spleen, and Liu Wei Di Huang Wan with Huangbai to nourish the Kidney. Recovery occurred after six months.
Yu Zhen commented: Si Wu Tang plus Zhimu and Huangbai addresses the surging/slippery Chi pulse; Baizhu and Ophiopogonis Radix address the floating/soft Cun/Guan pulse. This is ingenious. Previously, Ginseng and Baizhu worsened the condition; later, adding Ginseng after the Chi pulse stabilized showed great courage and skill. Success relied on Zhi Zhu Wan with Ginseng/Shanzhi and Di Huang Wan with Huangbai.
Another case: A man over forty, pale-faced, subject to internal and external overwork, or dietary injury, expectorated hard sputum with blood streaks. He took fifty to sixty doses of cold-cooling Lung-clearing and phlegm-resolving herbs, leading to progressive hoarseness and aphonia, insomnia, bitter taste, dry tongue with white coating upon waking, occasional throat or chest pain, belching, difficulty digesting night food, numbness in hands after prolonged leaning, aversion to cold but not fear of heat. He had a history of hernia and internal hemorrhoids, triggered by fatigue. Initial pulse: Left deep, weak, and slow; Right floating, soft, and powerless. Follow-up pulses varied: Heart/Lung floating and empty; Spleen pulse elusive on light pressure, insufficient on heavy pressure; varying speed, depth, and size. Irregular pulses indicate Qi and Blood deficiency. Like an insincere person changing constantly. Pulse analysis confirms deficiency, primarily Qi deficiency. Fatigue consumes Qi and injures Lung (causing aphonia); fatigues Spleen (causing food stagnation). Hernia and hemorrhoids triggered by fatigue result from Qi sinking due to exhaustion. Spleen likes warmth and dislikes cold; Lung also dislikes cold ("Cold form and cold drinks injure Lung"). Further injuring already damaged Spleen and Lung with cold herbs caused aphonia and white coating. White coating indicates Cold in Stomach and Heat in Dantian (per Zhang Zhongjing). Insomnia results from "Child draining Mother," Heart deficiency, and restless Spirit. Blood in sputum is due to Spleen failing to contain blood. Chest pain and belching are due to Qi deficiency failing to move normally, leading to stagnation in Middle or Upper Jiao. Prescription: Ginseng and Astragali Radix each 4 qian, Ophiopogonis Radix, Angelicae Sinensis Radix, and Fritillariae Bulbus (Beimu) each 1 qian, Polygalae Radix (Yuanzhi), Ziziphus Seed (Suanzaoren), Moutan Cortex (Mudanpi), and Poria with Wood (Fushen) each 8 fen, Acorus Tatarinowii Rhizome (Shichangpu) and Glycyrrhizae Radix et Rhizoma each 5 fen. Hawthorn Fruit (Shanzha), Malty (Maiya), and Eucommiae Cortex (Duzhong) added as needed. Taken for over a year, he recovered. Ning Zhi Wan was added. Since the disease involves dryness-heat, even Baizhu was avoided, let alone other drying agents.
Another case: A fifty-year-old man, pale, irritable, shouting and panting/vomiting when displeased. Suddenly felt a spot of pain below the left breast. Later, after overwork and anger, felt foul Qi rushing up causing cough and violent vomiting, or dry cough without sputum, even hematemesis. Intermittent fever/chills resembling malaria. Treatments for malaria or phlegm failed. Wang Shishan found all pulses floating, fine, slightly wiry, and rapid. Diagnosis: Earth deficiency with Wood hyperactivity. Irritability and anger cause Liver Fire to flare, causing left breast pain (Liver Qi stagnation). Foul Qi rushing up is Liver Fire invading Spleen/Stomach. Hematemesis is Liver failing to store blood due to Fire disturbance. Cough is Metal lacking nourishment and being controlled by Fire. Vomiting is Spleen deficiency failing to transform, causing food stagnation into phlegm. Chills/fever are Water-Fire conflict. Treatment: Purge Liver excess, tonify Spleen deficiency, clear Lung dryness. Formula: Tangerine Peel (Qingpi) and Gardeniae Fructus each 7 fen, Paeoniae Radix Alba, Astragali Radix, and Ophiopogonis Radix each 1 qian, Angelicae Sinensis Radix and Donkey-hide Gelatin (Ejiao) each 7 fen, Glycyrrhizae Radix et Rhizoma and Schisandrae Fructus each 5 fen, Atractylodis Macrocephalae Rhizoma 1.5 qian, Ginseng Radix 3 qian. Taken for a month, symptoms resolved.
Yu Zhen commented: Previous case used heavy Ginseng/Astragali for aphonia/throat pain/bitter taste. This case used Ginseng for left breast pain/foul Qi rising. Only Wang Shishan could distinguish these. Previous case had soft/variable pulses indicating Qi deficiency. This case had floating/fine/wiry/rapid pulses; treating with Kidney-nourishing and Liver-clearing methods was crucial.
A village woman, over fifty, chronic cough with purulent bloody sputum, worse at night. Wang Shishan found pulses fine, soggy, and slippery. Diagnosis: Fei Wei (Lung Atrophy). Previous treatments (Ren Shen Qing Fei Yin, Zhimu Fuling Tang) contained Ginseng and Pinelliae Rhizoma (Banxia), which aggravated latent Lung fire and dried Lung fluids. Formula: Tian Dong, Mai Dong, Ejiao, and Beimu as Sovereign; Zhimu, Shengdi, Asteris Radix (Ziwan), and Gardeniae Fructus as Ministers; Sang Bai Pi and Aristolochiae Fructus (Madouling) as Assistants; Kuandonghua, Danggui Shen, Tingli Zi, Platycodonis Radix (Jiegeng), and Gancao as Envoys. Five doses brought relief.
Yu Zhen commented: Wang Shishan usually uses Ginseng/Atractylodis for bleeding, but this case and the next differ, showing flexibility. The next case used Yin-nourishing/cold herbs successfully, perhaps by luck. Such diseases are common now, but effective treatments are rare.
Another case: Pale, thirty-something, cough with hemoptysis, aphonia, night fever, spontaneous sweating. Wang Shishan found pulse fine, soggy, and slightly rapid. Diagnosis: Due to sexual excess. Formula: Si Wu Tang plus Maidong, Ziwan, Ejiao, Huangbai, and Zhimu. Over thirty doses reduced symptoms. Then bloating, nausea, anorexia, and loose stools appeared. Pulse became slow and weak, no longer rapid. Wang stated: Yin deficiency has receded; now use sweet-warm herbs to nourish Spleen/Stomach to remove the root. Formula: Si Jun Zi Tang plus Shenqu, Chenpi, and Maidong. Ten doses brought recovery.
Jiang Huangnan treated his brother with cough-hemoptysis. Initial doses of Zhimu, Beimu, Er Dong, Danggui, and Baishao (Lung-clearing) worsened flank pain at night. Adding 1.5 qian Ginseng reduced pain. Increasing Ginseng to 2 qian made left pulse larger/rapid and right pulse slightly wiry/rapid. Cough produced blood; stools were loose (three times daily). Formula: Ginseng 3 qian, Baizhu and Ziwan 1.5 qian, Fuling and Baishao 1 qian, Gancao 9 fen, Mudanpi 8 fen, plus Mao Gen and Tong Bian (child's urine). Pulse wiry/rapid decreased slightly. Added Huangqi 2 qian and Bupleuri Radix (Baibu) 6 fen. Cough stopped, bleeding decreased, then ceased. Loose stools persisted, so Ginseng, Huangqi, Baizhu, Dioscoreae Rhizoma (Shanyao), Chenpi, Gancao, Coicis Semen (Yiren), and Baishao were doubled. Combined with Jian Pi Wan for recovery.
Yu Zhen commented: This case strictly imitates Wang Shishan's methods.
Sun Dongsu treated Zang Liulao with upper hematemesis and lower hematochezia, distension in chest/diaphragm/back. Originated from anger and dog meat injury, causing fever and thirst. Doctors used Yin-nourishing/fire-descending herbs, worsening distension and bleeding. Sun found Guan pulses surging, slippery, and forceful. Diagnosis: Excess patterns in Liver and Spleen meridians, not Yin deficiency. Yin deficiency presents with rapid/weak pulses; afternoon tidal fever resolves by midnight, unlike constant day/night heat here. Classics: Anger injures Liver, causing vomiting blood and diarrhea. Distension is due to blood stasis. Dog meat injured Spleen, impairing blood containment. Misuse of Dihuang, Zhimu, Huangbai further injured Spleen and stagnated Upper Jiao stasis. Formula: Shan Zha, Xiang Fu, Zhi Shi (Qi-moving/digestion) as Sovereign; Danshen, Mudanpi, Taoren, Huashi, Mao Gen (blood-stasis resolving) as Ministers; Huanglian and Luzhu Gen (clearing dog meat heat) as Assistants. Four doses relieved distension and stopped bleeding. Abdominal discomfort remained; previous formula combined with Bao He Wan induced passage of foul black stool, leading to full recovery.
Nephew Mingzhi, overworked writing, caused Phlegm-Fire rebelling upward, vomiting large amounts of phlegm foam, then hematemesis (several bowls), fainting, sweating, lying still. Any movement caused vomiting and fresh red blood. Could not tolerate food/water. Doctors saw blood gushing, fever, large pulse, fainting, and inability to take medicine as bad omens. Sun Dongsu said: "No worry. Diagnosis must be flexible. Heart governs Blood, Liver stores Blood. Anger causes Qi ascending. Weak pulse with fever indicates Summerheat. Left pulse wiry/large, Right pulse weak/large indicates not just mental overwork moving Fire, but also Anger injuring Liver and Summerheat forcing Wood-Fire upward. Wind/dizziness belongs to Liver; vomiting/regurgitation belongs to Fire. Internal Wood-Fire rising and external Summerheat forcing cause sweating and blood ejection." First, Bai Wan Zi 3 qian to resolve Summerheat, clear Phlegm, and suppress rebellion. Vomiting stopped, Qi calmed, blood returned to vessels. Patient slept deeply, woke with vomiting stopped, appetite returned, dizziness resolved. Follow-up: Huashi, Xiangru each 3 qian, Huanglian, Dou Geng each 1.5 qian, Zhuru 1 qian, Gancao 5 fen. Four doses full recovery.
Yu Zhen commented: Previous case had distension worsened by Yin herbs, surging/slipping Guan pulses clearly indicating non-Yin deficiency. Anger and dog meat were known. This case had massive hematemesis, fainting, and danger. Right pulse weak/large interpreted as Summerheat rather than deficiency, combined with left wiry/large pulse, using large doses to clear Summerheat was masterful.
Li Shicai stated: Xu Rijia, Imperial Treasure Keeper, had emotional stagnation and sudden anger, causing massive hemoptysis and extreme fatigue. Li used Liu Jun Zi Tang with 1 liang Ginseng, 1 qian Ganjiang, and 8 fen Muxiang. Bleeding stopped in four days. Anger caused recurrence. Li said: "First soothe Liver, then heavily tonify." However, Autumn pulse in Summer indicated premature death. He died as predicted.
Yu Zhen commented: Massive hemoptysis from stagnation/anger injures Liver/Spleen long-term. Heavy Ginseng with acrid-hot herbs to treat contrary symptoms shows high skill. Without soothing Liver/stagnation, how could bleeding stop? But recurrence after anger was untreatable; death was inevitable.
Dong Yuanzai's relative had steaming fever, cough, and hemoptysis. Fire-clearing and Middle-Jiao tonification failed. Li Shicai found Chi pulses deep and solid, with lower abdominal pain on pressure. Diagnosis: Blood stasis from anger persisting for a year, causing steaming heat and severe Yin injury. Si Wu Tang plus Yujin, Taoren, Chuan Shan Jia, and small amount of Dahuang passed over a sheng of black blood. Pain persisted. Larger dose of Dahuang passed 3-4 sheng of black clots like peach gum. Pain stopped. Extreme fatigue treated with Du Shen Tang; heat reduced by 60-70% in three days. Full recovery after 100+ days of Shi Quan Da Bu Tang.
Yu Zhen commented: Deep/solid Chi pulses confirmed lower abdominal stasis. Stasis caused heat, heat caused bleeding. Identifying root via pulse allowed purging to remove root, followed by strong tonification without Yin-nourishing, which was brilliant.
Zhang Jingyue treated Ni Xiaolian, who studied hard, injuring Spleen with overthinking, causing recurrent vomiting triggered by fatigue. Li Yin Jian and Wen Wei Yin worked well. Late summer, socializing exhausted Heart/Spleen, causing massive hematemesis and hematochezia (large pieces, red/purple). Doctors attributed it to Labor-induced Fire in Heart/Spleen combined with Summerheat. Xi Jiao Di Huang Tang, Tong Bian, and Zhimu were given for two doses, worsening vomiting, tightening/rapid pulse, and critical condition. Zhang Jingyue arrived, seeing severe symptoms, prescribed large doses of Renshen, Shudi, Ganjiang, and Gancao. First dose had no effect; second reduced nausea, pulse showed slight vitality. Added Fuzi and Paoyanjiao each 2 qian, Renshen and Shudi each 1 liang, Baizhu 4 qian, Zhi Gancao 1 qian, Fuling 2 qian. Given at dusk, patient slept until midnight. Second dose stopped vomiting and bleeding. Continued for days, fully recovered. Reason: Fatigue injured Spleen, Spleen/Stomach Yang deficiency, Qi failing to control blood. Although season had "Two Fires," the pattern was not Two Fires. Cold herbs would have destroyed Spleen and caused death.
Yu Zhen commented: Same etiology and season as Sun Dongsu's nephew case, but one used cold, one used warm, both successful. Requires divine skill. Sun's pulse (Left wiry/large, Right weak/large) differed from Zhang's tight pulse. Sun did not trial herbs; Zhang saw worsening with cold herbs. Careful observation is key in clinical practice.
Yu Jiayan treated a person with chronic bleeding disorder. Sudden massive hemoptysis in morning, filling a basin. Throat congestion, wandering spirit, high fever like steaming.