虚损潮热，升阳散火汤，后用大补；或日日发潮，一寒一热，宜用益气汤，重加黄 、
甘草，甘温除大热也。或脉细数，或脉空大，其病将危，五服不验，治亦难矣。
看病有脾胃证规，则原起于脾胃，或寒或热，只从脾胃上调理，诸证自退。
病多潮热不退，初时可用补中益气汤，后则不可，惟宜熟地丸，补纳肾气而潮热自退。
久病潮热，气血两虚，用益气汤，甘草生熟重用之，发散药一味不可加，调理宜八珍汤
、十全大补汤，或为丸亦可。
凡潮热自汗，血气往来未定，六味汤加人参、黑姜，可服十帖。
验案
一人夏时，夜则身热，寅卯时即退，大便或溏，或如常，用参苓白术散。嘈杂加川连少
许；不嘈杂去连，加白芍。盖此证脾胃中有湿热，夜则身热者，卫气昼行于阳，夜行于阴，三阴
之脉布腹中，阳气与湿热相合，故身热。便溏者，湿也，发于夏者，湿热之令助本病也。白
术散和中利湿，加芍补脾阴。
一小儿久热不退，一日三次发热，热后微汗，汗后发热，昼夜不息，气短促，诸药不效
。此久病脾阴虚也。用保元、茯苓二帖而愈。
血证属火无二议，五脏六腑皆出血之路，所以吐者火也，至后则虚矣！用药一概寒凉，
则胃气渐损，生发之气渐衰，血以气为主，血无气养，血不归络，累发之而累寒之，自然成阴虚
火动之证。脾、肺二络有损，咳嗽、喘促、泄泻，理必然也。血热火动，滋阴可愈；血热火
越，滋阴求愈则不能矣。不见天之大雨，是滋阴也，反击动其火，草木皆焚，滋阴补阴，何
以别之！四物汤治血之有余，不治血之不足。若论不足，男女之血皆不足也。血虚则无气，
血虚发热，气虚生寒，血后寒热往来，是气血两虚，宜用东垣甘温除大热之法。阴从阳生，
所以人参、黄 能补其生化之原也。若见自汗咳嗽，乃肺虚也。血脱益气，古圣之言，虽有
杂证，亦末治之。盖血药治血之有余，不治血之不足；寒剂治火之有余，不治火之不足。吐
血概用滋阴清火，则胃失生发之气，脾肺先绝，血从何生？必至于死矣！
失血证，皆见芤脉，随其上下以察所出。凡失血者，脉贵沉细，若脉浮大则难治，豁大
无力尚可延；短数、细数、紧数、豁大有力皆为不祥。
治血初起，以苦甘寒药散火凉血为君，辛凉开郁利气为臣，升清药俾复其位为佐使，久
则以酸涩止塞其源，用甘温药收补于后，如此未有不愈者。（王胥山曰∶治血之要略备矣。）
凡咳嗽吐血有汗，用茯苓补心汤，或潮热咳嗽，八珍汤加陈皮、贝母、五味子，以泻胸
中之痰。老痰是热，宜贝母、花粉；清痰是虚，宜人参、白术。
吐血之证，或七情所伤，或咳嗽日久，或因伤寒表里不清，渐传而至，心气耗散，不能
藏血
胸膈饱闷，咽嗌不利，虚火上炎，服三四帖则止，发则再服，盖火郁宜发之也。渴甚加麦冬
凡病先防胃伤，宜六味丸、八珍汤加减。寒药不可，热亦不宜。血怕气滞，滞则生发之气反郁而成火。
血来鲜红属热，淡色属虚。血色青淡，参汤磨服犀角、羚羊角，阳气上升，其血必能下
降，倘气不升上，血必不复下。可见气有生血之妙，血无益气之功也。
去左胁下积血，乌药二分，枳壳三分，磨服；脉不短数，尚可迁延。吐血血不归经，用
炮姜温暖中气，使血归经。炮姜入脾、肺二经，脾统血，肺主气，气行血行也。
吐血，先血病而后吐泻者，无忘其吐泻，四君子加归、芍之类；先吐泻而后血病者，无
忘其血病，四君子加山栀、川连之类。吐血宜行血、凉血、和血、补血，茯苓补心汤、六味汤，
或四物汤加炮姜，八珍汤加陈皮、贝母、麦冬、五味子。血病必从血治，此为正法。
吐血久而不愈者，肾虚不纳气故也；杂病久而不愈者，脾虚不能统血故也。故血病宜求
之肾。杂病宜求之脾。
吐血因阳胜阴虚，故血不得下行，乘炎上之势而出。大法补阴抑火，使复其位。山栀只
清胃脘之血，桃仁承气治气壅火塞而吐紫血者，然非治血之正法也。
先吐血后见痰嗽，皆是阴虚火动，气不得下降也；先痰嗽后见红者，是痰积热壅，火炎
吐血也。以炮姜末、童便调服，或天一丸，盖壮水之主，以制阳光也。
天一丸
黄柏 知母（俱童便炒） 生地 丹皮 杞子 五味子 牛膝 茯苓 蜜丸。
血证药味各有专司。川芎血中气药，性味辛散，通肝经而行血滞于气也；地黄血中血药
，通肾经，性味甘寒，能滋真阴；当归分三治，性味辛温，全用活血，血各归经；白芍阴分药也
，通脾经，性味酸寒，能凉血，治血虚腹痛也；人参补血虚，阳旺则生阴血也。辅佐之属，
若桃仁、红花、苏木、血竭、丹皮，血滞所宜；蒲黄、阿胶、地榆、百草霜、棕灰，血崩所
宜；乳香、没药、五灵脂，血痛所宜；苁蓉、琐阳、牛膝、杞子、益母草、夏枯草、龟板，
血虚所宜；乳酪血液之物，血燥所宜；炮姜、肉桂，血寒所宜；生地、苦参，血热所宜。此
验案
石埭陈友，年三十五岁，性嗜酒色，忽患吐血，一日三五次，不思饮食，每日只吃粥一
碗，滚酒能饮数杯，次日清晨再吃粥，前粥尽行吐出，吐后反腹胀，时时作酸割痛，昼夜不眠，
吃滚酒数杯略好，来日亦如此，近七月矣，医人俱言不可治，并无论及积血者。予诊之，六
脉虚数，此证吐后宜宽反胀，吃滚酒略可，此积血之证也。盖酒是邪阳，色亦邪阳，邪阳胜
则正阳衰，又兼怒气伤肝，肝不纳血，思虑伤脾，脾不统血，中气受伤，血不归络，积血中
焦无疑。宜吐宜利，但脾胃大虚，不使阳气升发，阴寒何由而消？先用六君汤，白术、苍术
制之，加丁香温胃，草蔻治中脘痛，三十余帖，再用良姜一两，百年陈壁土四两同煮，待土
化切片，陈皮去白，草蔻、人参、白术、茯苓、甘草、胡椒、丁香各五钱，细辛四钱，共末
，空心清盐酒送下二钱，此药功在扶阳，积血阴寒凝结，得阳旺而阴自化。服药后血从下行
者吉，如血从上吐，约六、七碗，胸中闷乱，手足逆冷，不醒人事。急煎人参五钱，炮姜八
分，服之遂静。定后胸中闷乱，脐下火起而昏。用茯苓补心汤一帖而安，又用六味加人参、
一人咳嗽吐血，用人参、花粉为末，蜜水调服而愈。
一女白带、吐血，子午潮热，口干脉弦，此肝木大旺，脾之真元被木所夺也。清肺则木
平，补脾则中气固，六味加人参、炮姜而愈。
一人痰中见血，脉大有力，肺部更甚，此证肺失下降之令也。肺不降者，中宫为浊气郁
结，
Deficiency-induced tidal fever is treated with Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction), followed by a major tonifying formula. If tidal fever occurs daily with alternating chills and heat, Yiqi Tang (Qi-Supplementing Decoction) is indicated, with increased doses of Huangqi (Astragali Radix) and Gancao (Glycyrrhizae Radix et Rhizoma), employing sweet-warm herbs to eliminate great heat. If the pulse is fine and rapid, or empty and large, the condition is critical; if ineffective after five doses, treatment becomes difficult.
When diagnosing, one must follow the rules of Spleen-Stomach syndromes. Since the origin lies in the Spleen and Stomach, whether cold or heat, regulating from the Spleen and Stomach will cause other symptoms to recede naturally.
For persistent tidal fever, Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) may be used initially, but not later. Instead, Shudi Wan (Rehmannia Pill) is suitable to tonify and grasp Kidney Qi, allowing tidal fever to subside naturally.
In chronic cases of tidal fever with deficiency of both Qi and Blood, Yiqi Tang is used with heavy doses of raw and cooked Gancao (Glycyrrhizae Radix et Rhizoma). No dispersing herbs should be added. Regulation is best achieved with Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten Significant Tonification Decoction), or prepared as pills.
For tidal fever with spontaneous sweating and unsettled Qi and Blood, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Renshen (Ginseng Radix) and Heijiang (Scorched Ginger) can be taken for ten doses.
Case Record 1
A patient experienced night fever during summer, subsiding at Yin-Mao hours (3:00–7:00 AM). Bowel movements were either loose or normal. Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) was prescribed. If epigastric discomfort was present, a small amount of Chuanlian (Coptidis Rhizoma) was added; if absent, Chuanlian was removed and Baishao (Paeoniae Radix Alba) was added. This syndrome involves damp-heat in the Spleen and Stomach. Night fever occurs because Wei Qi (Defensive Qi) travels through the Yang meridians during the day and Yin meridians at night. The Three Yin meridians distribute in the abdomen; when Yang Qi combines with damp-heat, body heat results. Loose stools indicate dampness. The occurrence in summer is due to the external damp-heat climate exacerbating the internal condition. Baizhu San harmonizes the middle and promotes dampness drainage, while Shaoyao nourishes Spleen Yin.
Case Record 2
A child suffered from persistent fever, occurring three times daily. After slight sweating, fever returned, continuing day and night without cessation. Shortness of breath was present, and various medications failed. This was chronic Spleen Yin deficiency. Baoyuan Tang (Protect the Origin Decoction) and Fuling (Poria) were administered for two doses, resulting in recovery.
Blood disorders are attributed to Fire without exception. The Zang-Fu organs serve as pathways for bleeding; thus, hematemesis is caused by Fire. Later stages involve deficiency. Using only cold-cooling herbs gradually damages Stomach Qi and weakens the generating Qi. Blood relies on Qi for nourishment; without Qi, blood fails to return to its vessels. Repeated episodes combined with repeated use of cold herbs naturally lead to Yin deficiency with Fire hyperactivity. Damage to the Spleen and Lung collaterals inevitably causes cough, panting, and diarrhea. If Blood Heat and Fire Hyperactivity exist, Yin-nourishing methods can cure them. However, if Blood Heat and Fire Surge excessively, Yin-nourishing alone cannot achieve cure. Consider heavy rain: it represents Yin-nourishing, yet it may stir up Fire, burning all vegetation. How does one distinguish Yin-nourishing? Siwu Tang (Four-Substance Decoction) treats excess Blood, not deficiency. In reality, both men and women suffer from Blood deficiency. Blood deficiency leads to Qi deficiency; Blood deficiency generates heat, while Qi deficiency generates cold. Post-hemorrhagic alternating chills and heat indicate dual deficiency of Qi and Blood, requiring Li Dongyuan’s method of using sweet-warm herbs to eliminate great heat. Yin arises from Yang; thus, Renshen (Ginseng Radix) and Huangqi (Astragali Radix) supplement the source of generation. Spontaneous sweating and cough indicate Lung deficiency. "When blood is lost, tonify Qi" is an ancient principle. Even with mixed syndromes, treating the secondary aspect is necessary. Generally, blood-tonifying herbs treat blood excess, not deficiency; cold agents treat fire excess, not deficiency. Using only Yin-nourishing and fire-clearing herbs for hematemesis deprives the Stomach of generating Qi, leading to premature failure of the Spleen and Lungs, from which blood cannot be generated, resulting in death.
Hemorrhagic syndromes typically present with a Kou (Hollow) pulse. Observe the upper and lower aspects to locate the bleeding site. For hemorrhage, a deep and fine pulse is auspicious; a floating and large pulse is difficult to treat. A large but forceless pulse allows for prolongation. Short-rapid, fine-rapid, tight-rapid, or large-forceful pulses are inauspicious.
Initial treatment of blood disorders uses bitter-sweet-cold herbs to disperse fire and cool blood as the sovereign herb, pungent-cool herbs to open depression and regulate Qi as the minister herb, and ascending-clearing herbs as assistant-guiding herbs to restore position. Long-term treatment uses sour-astringent herbs to stop bleeding, followed by sweet-warm herbs for consolidation. Such approaches invariably succeed. (Wang Xushan stated: The essentials of treating blood disorders are well covered here.)
For cough with hematemesis and sweating, Fuling Buxin Tang (Poria-Nourishing Heart Decoction) is used. For tidal fever with cough, Bazhen Tang (Eight-Treasure Decoction) plus Chenpi (Citri Reticulatae Pericarpium), Beimu (Fritillariae Bulbus), and Wuweizi (Schisandrae Fructus) is used to drain phlegm from the chest. Old phlegm is heat-related, suited for Beimu (Fritillariae Bulbus) and Huafen (Trichosanthis Radix); clear phlegm is deficiency-related, suited for Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma).
Hematemesis may result from emotional injury, chronic cough, or progression from Taiyang disease with unclear exterior-interior dynamics, depleting Heart Qi and impairing its ability to store blood.
Chest fullness, throat obstruction, and defying upward flaming of deficient fire can be stopped with three to four doses. Recurrence requires re-administration, as stagnant fire should be dispersed. Severe thirst warrants adding Maidong (Ophiopogonis Radix).
Prevent stomach injury in all diseases; adjust Liuwei Wan (Six-Ingredient Pill) or Bazhen Tang (Eight-Treasure Decoction). Cold herbs are contraindicated; hot herbs are also unsuitable. Blood fears Qi stagnation; stagnation causes generating Qi to郁结 (become stagnant) and transform into fire.
Bright red blood indicates heat; pale color indicates deficiency. Greenish-pale blood is treated with Renshen decoction mixed with Xijiao (Rhinocerotis Cornu) and Lingyangjiao (Saigae Tataricae Cornu). If Yang Qi ascends, blood will descend; if Qi does not ascend, blood will not return downward. Thus, Qi has the wondrous function of generating blood, while blood lacks the merit of benefiting Qi.
To remove accumulated blood under the left hypochondrium, use Wuyao (Linderae Radix) 2 fen and Zhike (Aurantii Fructus) 3 fen, ground and taken. If the pulse is not short-rapid, the condition can be delayed. For hematemesis where blood does not follow its channels, Paojiang (Scorched Ginger) warms the Middle Qi to guide blood back to its channels. Paojiang enters the Spleen and Lung meridians; the Spleen governs blood, and the Lung governs Qi; where Qi moves, blood moves.
For hematemesis: if blood disease precedes vomiting/diarrhea, do not forget the gastrointestinal symptoms; use Sizijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba). If vomiting/diarrhea precedes blood disease, do not forget the blood disorder; use Sizijunzi Tang plus Zhizi (Gardeniae Fructus) and Chuanlian (Coptidis Rhizoma). Hematemesis requires moving, cooling, harmonizing, and tonifying blood. Options include Fuling Buxin Tang (Poria-Nourishing Heart Decoction), Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), Siwu Tang (Four-Substance Decoction) plus Paojiang (Scorched Ginger), or Bazhen Tang (Eight-Treasure Decoction) plus Chenpi (Citri Reticulatae Pericarpium), Beimu (Fritillariae Bulbus), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). Treating blood disorders via blood methods is the orthodox approach.
Chronic hematemesis unhealed is due to Kidney deficiency failing to grasp Qi; chronic miscellaneous diseases unhealed are due to Spleen deficiency failing to control blood. Therefore, blood disorders seek resolution in the Kidney; miscellaneous disorders seek resolution in the Spleen.
Hematemesis due to Yang excess and Yin deficiency causes blood to fail to descend, rising with the flame-like trend. The general method is to nourish Yin and suppress Fire to restore position. Zhizi (Gardeniae Fructus) only clears blood in the stomach region; Taoren Chengqi Tang (Peach Kernel and Rheum Decoction) treats purple blood from Qi stagnation and Fire blockage, but this is not the orthodox method for treating blood disorders.
Hematemesis followed by phlegm-cough indicates Yin deficiency with Fire hyperactivity and failing descent of Qi. Phlegm-cough followed by blood indicates phlegm accumulation, heat congestion, and Fire flaming causing hematemesis. Treat with Paojiang (Scorched Ginger) powder mixed with Tongbian (Child's Urine) or Tianyi Wan (Heaven One Pill), which strengthens the Water master to control Solar Fire.
Tianyi Wan (Heaven One Pill): Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma) [both stir-fried with child's urine], Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Gouqi (Lycii Fructus), Wuweizi (Schisandrae Fructus), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), honey-made pills.
Herbs for blood disorders have specific functions. Chuanxiong (Ligustici Chuanxiong Rhizoma) is the Qi herb within Blood herbs; pungent and dispersing, it enters the Liver channel to move Qi stagnation affecting Blood. Dihuang (Rehmanniae Radix Preparata) is the Blood herb within Blood herbs; sweet and cold, it enters the Kidney channel to nourish True Yin. Danggui (Angelicae Sinensis Radix) has three treatments; pungent and warm, fully used to invigorate blood and guide it to its channels. Baishao (Paeoniae Radix Alba) is a Yin-substance herb; sour and cold, it enters the Spleen channel to cool blood and treat abdominal pain from Blood deficiency. Renshen (Ginseng Radix) tonifies Blood deficiency; strong Yang generates Yin-Blood. Assistants and guides include: Taoren (Persicae Semen), Honghua (Carthami Flos), Sumu (Sappan Lignum), Xuexie (Draconis Sanguis), Danpi (Moutan Cortex) for blood stasis; Puhuang (Typhae Pollen), Ejiao (Colla Corii Asini), Diyü (Sanguisorbae Radix), Baicaoshuang (Carbonized Herba), Zonghui (Carbonized Palm Fiber) for metrorrhagia; Rushen (Boswelliae Resina), Moyao (Myrrhae Resina), Wulingzhi (Trogopterori Faeces) for blood pain; Rongrong (Cynomorii Herba), Suoyang (Cynomorchii Herba), Niuxi (Achyranthis Bidentatae Radix), Gouqi (Lycii Fructus), Yimucacao (Leonuri Herba), Xiakucao (Prunellae Spica), Guiban (Testudinis Carapax et Plastrum) for blood deficiency; dairy products for blood dryness; Paojiang (Scorched Ginger), Rougui (Cinnamomi Cortex) for blood cold; Shengdi (Rehmanniae Radix), Kushen (Sophorae Flavescentis Radix) for blood heat.
Case Record 3
Chen You from Shidai, aged 35, addicted to alcohol and sex, suddenly developed hematemesis, occurring 3-5 times daily. He had no appetite, eating only one bowl of porridge daily, but could drink several cups of boiling wine. The next morning, he ate porridge again, but vomited the previous meal entirely, followed by abdominal distension, sour cutting pain, insomnia day and night. Drinking boiling wine provided slight relief, repeating daily for nearly seven months. Physicians deemed it incurable, ignoring accumulated blood. My diagnosis revealed six pulses were deficient and rapid. Vomiting should relieve distension, yet it worsened; boiling wine provided slight relief, indicating accumulated blood. Alcohol and sexual indulgence are evil Yang; excessive evil Yang weakens righteous Yang. Anger injured the Liver, preventing it from storing blood; overthinking injured the Spleen, preventing it from controlling blood. Middle Qi was damaged, blood failed to return to vessels, confirming mid-jiao blood accumulation. Although emetics or purgatives might be considered, the Spleen and Stomach are severely deficient. Without raising Yang Qi, how can Yin-Cold dissipate? Initially, Liu Jun Tang (Six-Gentlemen Decoction) was used, with Baizhu (Atractylodis Macrocephalae Rhizoma) and Cangzhu (Atractylodis Rhizoma) to restrain, plus Dingxiang (Caryophylli Flos) to warm the Stomach and Cao Dou (Cardamomi Fructus) to treat epigastric pain, for over thirty doses. Then, Liangjiang (Alpiniae Officinarum Rhizoma) 1 liang and century-old wall earth 4 liang were boiled together until the earth dissolved. Slices of Chenpi (Citri Reticulatae Pericarpium) [white pith removed], Cao Dou (Cardamomi Fructus), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Hujiao (Piperis Longi Fructus), Dingxiang (Caryophylli Flos) each 5 qian, and Xixin (Asari Radix et Rhizoma) 4 qian were ground into powder. Two qian were taken on an empty stomach with clear salted wine. This medicine supports Yang; accumulated cold-blood coagulation resolves when Yang flourishes. If blood descends after taking the medicine, it is auspicious. If blood vomits upwards (6-7 bowls), causing chest oppression, cold extremities, and unconsciousness, urgently decoct Renshen (Ginseng Radix) 5 qian and Paojiang (Scorched Ginger) 8 fen. Administration calms the patient. Post-stabilization, chest oppression and heat rising from below the navel causing dizziness were treated with one dose of Fuling Buxin Tang (Poria-Nourishing Heart Decoction) for relief, followed by Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Renshen (Ginseng Radix)... [text cuts off].
Case Record 4
A patient with cough and hematemesis was cured by powdering Renshen (Ginseng Radix) and Huafen (Trichosanthis Radix), mixed with honey water.
Case Record 5
A female patient with leukorrhea and hematemesis experienced tidal fever at Zi-Wu hours (11 PM-1 AM and 11 AM-1 PM), dry mouth, and wiry pulse. This indicated Liver Wood hyperactivity stealing Spleen Yuan Qi. Clearing the Lung levels the Wood; tonifying the Spleen secures Middle Qi. Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Renshen (Ginseng Radix) and Paojiang (Scorched Ginger) resulted in recovery.
Case Record 6
A patient with blood in sputum presented with a large, forceful pulse, worse in the Lung region. This syndrome indicates loss of Lung descending function. Lung failure to descend is due to turbid Qi stagnation in the Middle Palace,