陈彦质患肠风下血。近三十年。体肥身健。零星去血。旋亦生长。不为害也。旧冬忽然下血数斗。盖谋
虑忧郁。过伤肝脾。肝主血。脾统血。血无主统。故出之暴耳。彼时即宜大补急固。延至春月。则木旺土衰。
脾气益加下溜矣。肝木之风。与肠风交煽。血尽而下尘水。水尽而去肠垢。垢尽而吸取胃中所纳之食。
下行。总不停留变化。直出如箭。以致肛门脱出三五寸。无气可收。每以热汤浴之。睁叫托入。顷之去
后。其肛复脱。一昼夜下痢二十余行。苦不可言。面色浮肿。夭然不泽。唇焦口干。鼻孔黑煤。种种不治。
所共睹矣。仆诊其脉。察其证。因为借箸筹之。得五可治焉。若果阴血脱尽。则目盲无所视。今双眸尚
炯。是所脱者下焦之阴。而上焦之阴犹存也。一也。若果阳气脱尽。当魄汗淋漓。目前无非鬼像。今汗出不过
偶有。而见鬼亦止二次。是所脱者脾中之阳。而他脏之阳犹存也。二也。胃中尚能容谷些少。未显呕吐哕逆之
证。则相连脏腑。未至交绝。三也。夜间虽艰于睡。然交睫时亦多。更不见有发热之候。四也。脉已
虚软无力。而激之间亦鼓指。是禀受原丰。不易摧朽。五也。但脾脏大伤。兼以失治旷日。其气去绝不远耳。
经云。阳气者如天之与日。失其所。则折寿而不彰。今阳气陷入阴中。大股热气。从肛门泄出。如火之烙。不
但失所已也。所以犹存一线生意者。以他脏中未易动摇。如辅车唇齿。相为倚藉。供其绝乏耳。夫他
脏何可恃也。生死大关。全于脾中之阳气。复与不复定之。阳气微复。则食饮微化。便泄微止。肛门微收。
阳气全复。则食饮全化。便泄全止。肛门全收矣。然阴阳两竭之余。偏驳之药。既不可用。所藉者必参术
之无陂。复气之中。即寓生血。始克有济。但人参力未易办。况才入胃中。即从肠出。不得不广服以继之。
此则存乎自裁耳。于是以人参汤调赤石脂末。服之稍安。次以人参白术赤石脂禹余粮为丸服之。全愈。其
后李萍槎先生之病。视此尚轻数倍。乃见石脂余粮之药。骇而不用。奈之何哉。
胡卣臣先生曰。似此死里求生。谁不乐从。其他拂情处。不无太直。然明道之与行术。则径庭矣。
Mr. Chen Yanzhi suffered from intestinal wind with hematochezia (blood in stool) for nearly thirty years. He was obese and robust; although he bled intermittently, the blood regenerated quickly and caused no significant harm. Last winter, however, he suddenly experienced massive hemorrhage, losing several dou of blood. This was due to excessive worry and depression, which severely injured the Liver and Spleen. The Liver stores blood, and the Spleen controls blood; when blood loses its master and controller, it erupts violently. At that time, immediate vigorous tonification and urgent consolidation were indicated, but treatment was delayed until spring. In spring, Wood qi becomes prosperous while Earth qi declines, causing the Spleen Qi to sink further. The Wind of Liver Wood and Intestinal Wind fanned each other, leading to the exhaustion of blood followed by the discharge of dust-like water; after the dust-water was exhausted, intestinal filth was discharged; once the filth was gone, food ingested by the Stomach failed to stay or transform, descending directly like an arrow. Consequently, the anus prolapsed three to five cun, unable to retract due to lack of Qi. It had to be washed with hot water and manually pushed back each time, only to prolapse again after defecation. He suffered more than twenty episodes of diarrhea per day, unbearable in pain. His face was swollen, his complexion withered and lusterless, lips cracked and dry, and coal-black discoloration around the nostrils. These signs indicated a critical and incurable condition, witnessed by all.
Upon examining his pulse and symptoms, I planned my strategy and identified five indications that the case was still treatable. If Yin Blood were completely depleted, the eyes would go blind; yet his eyes remain bright, indicating that while Lower Jiao Yin is lost, Upper Jiao Yin remains. This is the first point. If Yang Qi were completely depleted, there would be profuse cold sweating (Po Han) and visual hallucinations of ghosts; yet sweating occurs only occasionally, and hallucinations appeared only twice, indicating that while Spleen Yang is lost, Yang Qi of other organs remains. This is the second point. The Stomach can still hold a small amount of food, without vomiting or hiccups, suggesting that connected organs have not yet completely severed their connection. This is the third point. Although sleep is difficult at night, he closes his eyes frequently, and there is no fever. This is the fourth point. The pulse is weak and soft, but responds firmly upon stimulation, indicating strong congenital endowment that is not easily destroyed. This is the fifth point.
However, the Spleen organ is severely damaged, and due to prolonged mismanagement, vital Qi is nearing extinction. The Classic states: "Yang Qi is like Heaven and the Sun; if it loses its proper position, life is shortened and brilliance is obscured." Now, Yang Qi has sunk into Yin, and a large surge of heat escapes from the anus, burning like fire. This is not merely a loss of position. The reason a thread of vitality remains is that other organs are not easily shaken, relying on each other like cheekbones and teeth to supply necessities. Yet, how can one rely on other organs? The critical juncture of life and death depends entirely on whether the Yang Qi of the Spleen recovers. If Yang Qi slightly recovers, food and drink digest slightly, diarrhea stops slightly, and the anus retracts slightly. If Yang Qi fully recovers, digestion, cessation of diarrhea, and retraction of the anus will be complete.
Nevertheless, after the depletion of both Yin and Yang, biased medicines cannot be used. One must rely on pure and unadulterated Ginseng and Atractylodes Macrocephala Rhizome (Baizhu), where Qi tonification inherently generates Blood. Only then can success be achieved. However, the power of Ren Shen (Ginseng Root) is hard to mobilize quickly, and since it enters the Stomach only to exit through the Intestines immediately, it must be taken in large quantities continuously. This depends on the patient's own discretion. Thus, I administered Red Halloysite (Chishizhi) powder mixed with Ren Shen Decoction, after which he felt somewhat relieved. Subsequently, pills made of Ren Shen, Baizhu, Chishizhi, and Yuyuliang (Yuzhuyu Liangshi) were given, resulting in full recovery. Later, Mr. Li Pingcha's illness was several times milder than this case, yet he was terrified by the use of Chishizhi and Yuyuliang and refused them. What could be done?
Mr. Hu Youchen said: "In such a case of seeking life from death, who would not willingly comply? Other aspects may seem too blunt, causing discomfort. However, elucidating principles and practicing medicine are two different paths."