某 天下无倒行之水，因风而方倒行，人身无逆行之血，因火而即逆上。湿热有余，肝阳偏亢，肺胃之
络。为阳气所触，遂致络损不固，吐血频来，时易汗出，阳气发泄太过，不言可喻。脉象弦，两关微滑，亦属
火气有余之象。清养肺胃益水之上源，方可不涉呆滞而助湿生痰，特王道无近功耳。
金石斛 茜草炭 女贞子 茯苓神 黑豆衣 北沙参 牡蛎（盐水炒） 炒白薇 川贝
某 吐血时止时来，胸脘作痛，时易火升。此由努力任重，伤损肺胃之络。缪仲醇谓宜降气不宜降火，
宜行血不宜止血，旨哉言乎。
磨郁金 侧柏炭 丹皮炭 磨三七 茜草炭 栝蒌炭 黑山栀 代赭石 生赤芍 醋炒当归炭 鲜藕煎汤代水。
此症经陈莲舫治过，用止血药，故案有隐射语。（正蒙附志）
曹（左） 内伤营络，吐血盈碗者再。涌溢之际，血难骤出，以致瘀血散入肺中，肺之降令不行。咳嗽气逆，
将入损途。
旋复花（二钱包） 延胡索（一钱五分酒炒） 赤芍（一钱五分炒） 红花（四分酒炒） 锦纹大黄（一钱五
分酒炙成炭） 桃仁泥（二钱） 川郁金（一钱五分） 桂枝尖（二分） 土鳖虫（三枚去头足炙）
又 咳嗽稍减，气升略定。大便解出带黑，瘀从下行之征。然猛药不能频进，再降肺化痰。
旋复花（三钱包） 桃仁泥（二钱） 炒苏子（三钱炒研） 紫丹参（二钱） 冬瓜子（三钱） 局猩绛（五分）
川郁金（一钱五分切） 白茯苓（四钱） 红花（四分酒炒） 枇杷叶（去毛炙四片）
汪（右） 幼时曾有血症，血膜已有破绽。去秋燥气加临，咳嗽不已，金气暗伤，不能制木，当一阳来复之
际，厥阳从而上逆，失血满碗而来。数月之中或涌或夹带，竟无全止之时，胸中隐隐掣痛。脉象细弦，右
部兼滑。良以厥阳逆冲，肺胃之络，为之激损，一时络难扃固，所以夹杂而不能净尽也。若不急急图治，
深恐络之损处日甚，而致暴涌，不可不慎。
钉头赭石（四钱 ） 郁金（五分磨冲） 川贝母（二钱） 百草霜（二分包） 茜草炭（一钱） 丹皮炭（二钱）
金石斛（四钱） 桑叶（一钱三分） 栝蒌霜（四钱） 降真香（一钱劈） 竹茹（一钱五分盐水炒） 苏子（
三钱炒研）
鲜藕节（一两煎汤代水）
俞（左） 吐血四日不止，昨晚胸闷恶心，有似痧秽之象，非痧也，木旺而清肃不行，肺肝气逆故也。人身
之津液，流布者即为清津，凝滞者即为痰湿，痰湿内阻，升降之机，不循常度，气火上逆，载血逆行，是失
血之因于胃中寒湿，原属至理。特寒湿而致阻塞升降，甚至失血盈碗，则是非寻常之湿矣。可疑者，初
无痞满等象，而此时转觉气阻脘痞，呃忒频频，连宵不寐。脉象细数不调，而右关独见弦滑。良由肝升
太过，胃府之气，为之耸涌，不能通降，所以血之出于胃者，愈出愈多，浊之聚于胃者，愈聚愈满。自觉胸
中有物窒塞，大便不行，九窍不和，皆属胃病。经云、六腑以通为补。前方专主通降者为此。拟方如左，以
急降其胃气，总期呃止血止，方可续商。
代赭石（四钱） 杏仁泥（三钱） 茯苓（五钱） 枳实（一钱） 上湘军（一钱） 竹茹（一钱五分盐水炒）
栝蒌炭（六钱） 莱菔子（四钱） 西血珀（三分） 侧柏炭（七分） 白蒺藜（去刺炒三钱）
又 吐血之症，或出于肺，或出于肝，各经不同。人身喉属肺，主气之出，咽属胃，主气之入，所以各经之
血，其出于口也，莫不假道于胃，而溢于喉。今吐血九日不止，左脉并不浮露，病非肝肾而来。虽倾吐之
时，足冷面赤，未始无龙相上越之象。然倾吐之时，气血紊乱，虽有见象，难为定凭。多饮多溲，其肺气能
通调水道，下输膀胱，其病不由于肺可知。间有一二呛咳，亦由肝火上烁，木叩之而金偶鸣耳。下不由
于肝肾，上不由于心肺，推诸两胁不舒。中脘自喜挫磨等象，则是病之由于肝胃，已可显见。良由平素
郁结，郁则伤肝，木为火母，阳明胃府居肝之上，为多气多血之乡，肝郁而气火上浮，则阳明独当其冲，
胃络损破，血即外溢。胃府以通为用，九日以来，所进实胃滞胃之品多，降胃通胃之物少，胃不降而独
欲其气之与血皆从下行，不能也。于此而曰血无止法，医无确见，遂曰天也命也。岂理也哉。曰、前论未
及于心，而不关心肺。何所见而与心无涉哉。夫心为君主，凡血出于心，断无成口之多，虽有不寐，则胃
不和耳。世无伯乐，何必言马，子诚真伯乐也，言者谆谆，未识听者何如。
代赭石（四钱） 炒竹茹（一钱五分） 郁金（六分磨冲） 茯苓（六钱） 杏仁泥（三钱） 丹皮炭
（一钱五分） 枳实（七分） 苏子（盐水炒三钱） 山栀（三钱） 侧柏炭（四分） 降香（一钱五分劈）
百草霜（三分） 湘军（七分酒炒） 三七（三分磨冲）
从来吐血三大法，宜行血不宜止血，宜降气不宜降火，宜养肝不宜伐肝，特此附识。
此先生自注于方后者也。先生于吐血一门，特有心得，故案语尤有独到之处，可法可传。（文涵志）
胡（左） 痰带血点，痰稠如胶，心中有难过莫名之状。此本水亏于下，痰热扰上，切勿以其势微而忽之也。
海浮石（三钱） 决明（四钱） 川石斛（四钱） 丹皮炭（一钱五分） 藕节（二枚） 黑山栀（二钱）
钩钩（三钱后入） 竹茹（一钱水炒） 栝蒌霜（三钱） 蛤黛散（四钱） 磁石（三钱）
又 痰血已止，痰稠稍稀。的是肝火上撼心肺。再为清化。
海浮石（三钱） 煨决明（四钱） 川石斛（四钱） 丹皮炭（一钱五分） 栝蒌霜（三钱） 磁石
（二钱） 川贝母（二钱） 海蛤粉（四钱） 茯神（辰砂拌三钱） 麦冬（一钱五分辰砂拌）
又 血止而心阴未复，再平肝养阴。
朱茯神 楝麦冬（辰砂拌） 当归炭 柏子仁 磁石（ ） 金铃子
醋炒枣仁 丹参炭 龙骨 代赭石 香附（盐水炒）
某 湿热熏蒸，面色油晦小溲浑赤，咯血鲜红再淡以渗之，苦以泄之。
碧玉散 冬瓜子 生薏仁 郁金 盐水炒竹茹 泽泻
丹皮炭 杏仁泥 赤白苓 川黄柏 枇杷叶
某 心中似有气冲，则咯吐全红。今血虽止住，而气冲未定。脉来弦大。肝火撼胃，胃气逆，血因之而上
矣。
代赭石 丹皮炭 竹茹 牛膝炭 藕节 枳实
云苓 黑山栀 栝蒌炭 磨郁金
祝（左） 血仍不止，头胀少寐，吸气短促。脉象左弦。无非阳气上逆，载血妄行。还恐涌溢。
羚羊片 磨郁金 炒赤芍 代赭石 丹皮炭 墨汁旱莲草
磨三七 牛膝炭 百草霜 细生地 鲜藕（二两煎汤代水）
又 血虽渐少，而腹满不舒。良由肝脏之气不和，肝火不能藏蛰。前法参以调气，气降即火降也。
磨郁金 乳汁磨沉香 炒赤芍 太阴元精石 炒黑丹皮 黑山栀
白蒺藜 墨汁旱莲草 茜草炭 藕节
顾（左） 风温袭肺，由咳而致见红，至今时来时止。脉象浮芤。恐其复涌。
丹皮（二钱） 栝蒌霜（三钱） 川贝（三钱） 石斛（四钱） 青黛（五分包） 山栀（三钱）
生扁豆衣（四钱） 郁金（五分磨冲） 连翘（三钱） 竹茹（一钱五分盐水炒） 藕节（二枚）
左 本是风湿留络，遍体酸楚。二旬以来，由咳而致痰红。风伤阳络，与水亏金损者有间也。
蜜炙桑叶 象贝母 丹皮炭 光杏仁 连翘壳 广郁金
荆芥穗 川贝母 炒蒌皮 紫菀肉 藕节
顾（左） 咽痛过食甘寒，风热内郁，激损肺络，由呛咳而致带红，痰稠而浓，颧红火升，血来每在清晨。脉
象数大。宜泄膈热。
甘草（三分） 防风（七分） 薄荷（五分） 海蛤粉（三钱） 天花粉（一钱） 柿霜（一钱）
桔梗（八分） 磨犀尖（二分） 贝母（一钱五分）
顾（左） 咳经数月，渐至吐血盈盆，至今仍然夹带。脉象细弦，舌红少苔。阴虚木火上凌，营络损破，而气
火仍然不平。还恐暴涌。
大生地（五钱） 大天冬（三钱） 侧柏炭（三钱） 茜草炭（一钱五分） 藕汁（一杯） 竹茹（一钱五分水炒）
生白芍（二钱） 丹皮炭（一钱五分） 蒲黄炭（八分） 阿胶珠（三钱）
又 滋肾水以制木火，血已止住，而呛咳仍然不减。金水并调，一定之理。
大生地（四钱） 川贝母（二钱） 蛤黛散（四钱包） 阿胶珠（二钱） 大天冬（三钱） 生白芍（一钱五分）
茜草炭（二钱） 怀牛膝（盐水炒三钱） 枇杷叶（去毛炙三钱） 都气丸（四钱开水先服）
王（右） 吐血大势虽定，痰中仍然带红，气冲呛咳。脉细弦而数。阴虚木火凌金，冲气从而上逆。拟育阴
以制冲阳上逆之盛。
阿胶珠（二钱） 生甘草（三分） 怀牛膝（盐水炒三钱） 茜草炭（一钱五分） 川石斛（三钱） 生白
芍（一钱五分） 川贝母（三钱） 蛤黛散（三钱） 生山药（三钱） 藕节（三枚）
二诊 痰红已止，咳亦略减。脉细弦数稍缓。冲阳稍平，肺肾阴伤不复。再金水双调。
炙生地（四钱） 川贝母（二钱） 生白芍（一钱五分） 茜草炭（一钱五分） 白茯苓（四钱） 北沙参（
四钱） 蛤黛散（四钱） 生山药（三钱） 冬瓜子（三钱） 藕节炭（三枚） 都气丸（三钱先服）
陈（左） 屡次失血，渐致呛咳咽痒，气从上升，而痰中时仍带红，痰稠而浓。脉细弦数。是肾水不足，木火
上凌损肺，遂令络血外溢，血去阴伤，气不收摄，出纳因而失常。恐入损门。
冬瓜子（四钱） 生薏仁（四钱） 炙桑皮（二钱） 车前子（三钱） 青芦尖（一两） 光杏仁（三钱）
川贝母（二钱） 怀牛膝（盐水炒三钱） 茜草炭（一钱五分） 都气丸（五钱二次服）
二诊 血已止住，略能右卧然仍咽痒呛咳，气从上升。脉细弦数，气口独大。血去既多，肾阴安得不伤，
然上焦定然未肃。再清其上。
冬瓜子（四钱打） 生薏仁（三钱） 丝瓜络（一钱五分） 炒蒌仁（三钱） 鲜荷叶（三钱） 鲜桑叶络（三钱）
象贝母（二钱） 光杏仁（三钱打） 炒栀皮（三钱） 鲜枇杷叶（一两去毛） 活水芦根（一两去节）
三诊 偏右能卧，气升大退。然呛咳不爽，痰不易出。肺气不克清肃。再清其上。
栝蒌皮（三钱） 光杏仁（三钱） 炒苏子（三钱） 象贝母（二钱） 冬瓜子（四钱） 鲜桑叶络（三钱）
生薏仁（四钱） 盐水炒橘红（一钱） 白茯苓（三钱） 青芦尖（八钱） 枇杷叶露（一两）
四诊 偏右虽能着卧，呛咳气升，减而不止，痰出不爽，日晡发热。肺热阴伤。再润肺清金。
栝蒌仁（三钱） 炙桑叶（一钱五分） 生甘草（五分） 冬瓜子（四钱） 川贝母（二钱） 甜杏仁（三钱）
生薏仁（三钱） 北沙参（三钱） 山栀皮（三钱） 青芦尖（八钱） 肺露（一两冲）
五诊 清金润肺，暮夜呛咳已定，而每晨咳甚，痰不爽出，色带青绿，脉数内热。血去过多，阴伤难复，阳
升凌犯肺金。拟育阴以平阳气之逆。
阿胶珠（二钱） 生甘草（五分） 蛤黛散（三钱） 悉尼膏（五钱） 炙生地（四钱） 川贝母（三钱）
甜杏仁（三钱）
六诊 呛咳时轻时重，气火之升降也。频渴欲饮，咳甚则呕。肺胃阴伤难复，气火凌上不平。从肺胃清
养。
大天冬（三钱） 生甘草（五分） 炒蒌皮（三钱） 冬瓜子（三钱） 川石斛（三钱） 北沙参（四钱）
川贝母（二钱） 黑山栀皮（三钱） 蛤黛散（四钱） 琼玉膏（五钱冲）
王（左） 水亏木旺，虚火上凌，咳嗽不已，吐血时止时来。冲阳逆上，咳甚则呕，以冲脉在下，而布散于胸
中也。症入损门，何易言治。
大生地（四钱） 阿胶珠（三钱） 淡秋石（一钱五分） 牛膝炭（三钱） 丹皮炭（二钱） 大麦冬（三钱）
生白芍（三钱） 青蛤散（三钱） 生山药（三钱） 冬虫夏草（二钱） 金石斛（三钱）
二诊 血未复来，咳嗽降序，呕吐亦止，而腰府作酸。肺肾皆亏，显然可见。药既应手。姑守前意，再望转机。
大生地 生甘草 阿胶珠 青蛤散 生山药 大麦冬 生白芍 牛膝炭 川贝母 都气丸
三诊 咳嗽大退，腰酸稍减，脉亦渐和。然肺肾皆虚，何能遽复，调理之计，非旦夕间事也。诸宜自卫。
清阿胶（溶化冲三钱） 大麦冬（三钱） 青蛤散（三钱） 怀牛膝（三钱） 生白芍（一钱五分） 大
生地（五钱） 川贝母（二钱） 浓杜仲（三钱） 茜根炭（一钱） 冬虫夏草（一钱五分） 都气丸（四钱二次服）
四诊 滋肾养肝保肺，咳嗽十退四五，血亦未来，惟根蒂不除。虚损之症，本无遽复之理，仍从金水两调主治。
大生地（四钱） 生山药（二钱） 海蛤粉（三钱） 茯苓（三钱） 怀牛膝（三钱） 阿胶珠（三钱）
川贝母（二钱） 生白芍（一钱五分） 杜仲（三钱） 枇杷叶（去毛炙三钱） 琼玉膏（五钱二次冲）
[Case 1]
Patient: There is no water that flows backward in nature; it only flows backward due to wind. Similarly, there is no blood that flows counter-current in the human body; it only flows upward due to fire. Excess damp-heat and hyperactive Liver Yang disturb the collaterals of the Lung and Stomach, causing damage and instability of the collaterals, leading to frequent hematemesis and easy sweating. This indicates excessive dispersion of Yang Qi, which goes without saying. The pulse is wiry, with slight slippery qualities at both Guan positions, indicating excess Fire Qi. Treatment should focus on clearing and nourishing the Lung and Stomach, benefiting the upper source of Water (Kidney Yin), to avoid stagnation that aids dampness and phlegm. This is the "Kingly Way" of medicine, which takes time to show results.
Prescription: Dendrobii Caulis (Shihu), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Ligustrum Lucidum Fructus (Nvzhenzi), Poria Cum Radix Pini (Fuling Shen), Phaseoli Semen Nigrum Tegumentum (Heidouyi), Glehniae Radix (Beishashen), Ostreae Concha (Muli, stir-fried with salt water), Anemarrhenae Rhizoma Stir-fried (Baiwei), Fritillariae Bulbus (Chuanbei).
[Case 2]
Patient: Hematemesis comes and goes intermittently, accompanied by chest and epigastric pain and frequent sensations of heat rising. This is caused by strenuous effort and heavy lifting, damaging the collaterals of the Lung and Stomach. Miao Zhongchun stated, "In treating hematemesis, one should descend Qi rather than extinguish Fire, and promote blood circulation rather than stop bleeding." This is a profound insight.
Prescription: Curcumae Aromatae Rhizoma (Yujin), Platycladi Cacumen Carbonized (Cebai Tan), Moutan Cortex Carbonized (Danpi Tan), Notoginseng Radix et Rhizoma Ground (Sanqi), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Trichosanthis Fructus Carbonized (Gualou Tan), Gardeniae Fructus Carbonized (Hezhizhi), Haematitum (Daizheshi), Paeoniae Radix Rubra Raw (Chishao), Angelicae Sinensis Radix Vinegar-fried (Danggui Tan), decocted with fresh Lotus Root (Oujie) as water.
This case was previously treated by Chen Lianfang using hemostatic herbs, hence the implicit reference in this record. (Zhengmeng Appendix)
[Case 3]
Patient Cao (Left): Internal injury to Ying-level collaterals resulted in two episodes of hematemesis filling a bowl. During the surge, blood could not be expelled quickly, leading to blood stasis dispersing into the Lung, impairing the descending function of Lung Qi. Symptoms include cough and rebellious Qi, with a tendency towards "Sun disease" (consumptive disease).
Prescription: Inulae Flos (Xuanfuhua, wrapped), Corydalis Rhizoma (Yanhusuo, wine-fried), Paeoniae Radix Rubra (Chishao, fried), Carthami Flos (Honghua, wine-fried), Rheum Palmatum Radix et Rhizoma (Dahuang, wine-charred), Pruni Semen (Taoren), Curcumae Zedoariae Rhizoma (Yujin), Cinnamomi Ramulus Apicalis (Guizhi Jian), Eupolyphaga Seu Steleophaga (Tubiechong, roasted, heads and feet removed).
Follow-up: Cough has slightly decreased, rebellious Qi has stabilized. Black stools indicate expulsion of blood stasis from below. However, potent drugs cannot be administered frequently. Re-treat by descending Lung Qi and resolving phlegm.
Prescription: Inulae Flos (wrapped), Pruni Semen, Perillae Fructus Stir-fried (Suzi), Salviae Miltiorrhizae Radix (Danshen), Benincasae Semen (Dongguazi), Vermilion Powder (Juxingjiang), Curcumae Zedoariae Rhizoma, Poria (Fuling), Carthami Flos (wine-fried), Loquat Leaf (Pipaye, de-hairy and roasted).
[Case 4]
Patient Wang (Right): History of blood disorders since childhood, with pre-existing lesions in the blood membranes. Last autumn, dryness pathogen invaded, causing persistent cough, secretly injuring Metal Qi (Lung), failing to control Wood (Liver). At the time of the return of Yang (Winter Solstice), Jue-Yang rebelled upward, causing massive hematemesis. For months, bleeding occurred intermittently or continuously, with no complete cessation, accompanied by dull pulling pain in the chest. Pulse is fine and wiry, slippery on the right. This is due to Jue-Yang rebelling and violently damaging the collaterals of the Lung and Stomach, making them unable to close tightly, resulting in mixed and incomplete bleeding. If not treated urgently, fear that collateral damage will worsen, leading to sudden severe hemorrhage. Caution is advised.
Prescription: Haematitum (Daizheshi), Curcumae Aromatae Rhizoma (Yujin, ground and taken with liquid), Fritillariae Bulbus (Chuanbei), Fuligo Silicea (Baicaoshuang), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Moutan Cortex Carbonized (Danpi Tan), Dendrobii Caulis (Shihu), Mori Folium (Sangye), Trichosanthis Fructus Powder (Gualoushuang), Dalbergiae Lignum (Zhenxiang), Bambusae Stem Sap (Zhuru, salt-water fried), Perillae Fructus (Suzi, stir-fried and ground), decocted with fresh Lotus Root Node (Oujie).
[Case 5]
Patient Yu (Left): Hematemesis for four days without stopping. Last night, chest oppression and nausea appeared, resembling Sha illness, but it is not Sha. It is due to Hyperactive Wood (Liver) failing to allow clear descent of Metal (Lung), causing rebellious Qi of Lung and Liver. Body fluids that flow are clear Jin; those that stagnate become Phlegm-Damp. Phlegm-Damp obstruction disrupts the mechanism of ascent and descent, allowing Qi-Fire to rebel upward, carrying blood counter-currently. While it is true that hematemesis can originate from Cold-Damp in the Stomach, such severe obstruction leading to massive hematemesis is not ordinary Dampness. Initially, there were no signs of fullness, but now there is Qi obstruction, epigastric stuffiness, frequent hiccups, and insomnia all night. Pulse is fine, rapid, and irregular, with wiry-slippery quality exclusively at the Right Guan position. This is due to excessive Liver ascending, causing Stomach Qi to surge and fail to descend, leading to more and more blood loss and accumulation of turbidity in the Stomach. Sensation of chest obstruction, constipation, and disharmony of the nine orifices all belong to Stomach disease. The Classic states: "The six fu organs benefit from unobstructed flow." The previous prescription focused on descending and unblocking for this reason. Proposed formula to urgently descend Stomach Qi, aiming to stop hiccups and bleeding before continuing treatment.
Prescription: Haematitum (Daizheshi), Armeniacae Semen Amarum Paste (Xingrenni), Poria (Fuling), Immature Bitter Orange (Zhishi), Rheum Palmatum Radix et Rhizoma (Shangjunjun), Bambusae Stem Sap (Zhuru, salt-water fried), Trichosanthis Fructus Carbonized (Gualou Tan), Raphani Semen (Laifuzi), Succinum (Xixuepo), Platycladi Cacumen Carbonized (Cebai Tan), Tribuli Fructus (Bajili, de-spined and fried).
Follow-up: Hematemesis originates from different meridians (Lung, Liver, etc.). The throat belongs to the Lung (exit of Qi); the pharynx belongs to the Stomach (entry of Qi). Thus, blood from any meridian exiting the mouth passes through the Stomach and overflows from the throat. Now, hematemesis has lasted nine days. Left pulse is not floating, suggesting the disease does not originate from Kidney/Liver. Although cold feet and red face during vomiting suggest Dragon/Fire rebellion, Qi and Blood are chaotic during vomiting, so these signs are unreliable. Polydipsia and polyuria indicate Lung Qi can regulate water passages, confirming the disease is not in the Lung. Occasional choking cough is due to Liver Fire scorching, causing Wood striking Metal. Disease is not in Lower Jiao (Kidney/Liver) nor Upper Jiao (Heart/Lung), but clearly in Liver and Stomach due to rib discomfort and preference for pressing the epigastrium. Chronic depression injures Liver; Liver is the mother of Fire. Yangming Stomach, located above Liver, is a place of abundant Qi and Blood. Liver depression causes Qi-Fire to float up, bearing the brunt of the attack on Yangming. Stomach collaterals rupture, causing external bleeding. Stomach functions by unblocking. Over nine days, too many cloying/stagnating herbs were used, and too few descending/unblocking ones. Stomach fails to descend, so expecting Qi and Blood to go down is impossible. Saying "there is no method to stop blood" shows lack of medical insight, attributing it to fate, which is unreasonable. Regarding the Heart: The Heart is the Monarch. Blood originating from the Heart would not exit in such large quantities. Insomnia here is due to Stomach disharmony. You are a true Bo Le (expert); your words are earnest.
Prescription: Haematitum (Daizheshi), Bambusae Stem Sap Stir-fried (Zhuru), Curcumae Aromatae Rhizoma (Yujin, ground), Poria (Fuling), Armeniacae Semen Amarum Paste (Xingrenni), Moutan Cortex Carbonized (Danpi Tan), Immature Bitter Orange (Zhishi), Perillae Fructus (salt-water fried), Gardeniae Fructus (Zhizi), Platycladi Cacumen Carbonized (Cebai Tan), Dalbergiae Lignum (Jiangxiang), Fuligo Silicea (Baicaoshuang), Rheum Palmatum Radix et Rhizoma (Xiangjun, wine-fried), Notoginseng Radix et Rhizoma (Sanqi, ground).
Three major principles for treating hematemesis: Promote blood circulation rather than stop bleeding; Descend Qi rather than extinguish Fire; Nourish Liver rather than attack Liver. Recorded here.
(This is the author's post-script. He has unique insights into hematemesis, making his case records exemplary.)
[Case 6]
Patient Hu (Left): Sputum with blood spots, thick like glue, with indescribable mental distress. This is due to Kidney Water deficiency below and Phlegm-Heat disturbing above. Do not ignore it because the symptoms seem mild.
Prescription: Pumex (Haifushi), Cassiae Semen (Jueming), Dendrobii Caulis (Shihu), Moutan Cortex Carbonized (Danpi Tan), Lotus Root Node (Oujie), Gardeniae Fructus (Hezhizhi), Uncaria Ramulus cum Uncinis (Gougou, added later), Bambusae Stem Sap (Zhuru, water-fried), Trichosanthis Fructus Powder (Gualoushuang), Heteroconcha et Margarita Powder (Gaidai San), Magnetitum (Cishi).
Follow-up: Phlegm-blood stopped, sputum less thick. Indeed, Liver Fire shakes Heart and Lung. Re-treat with clearing and transforming.
Prescription: Pumex, Calcined Cassiae Semen, Dendrobii Caulis, Moutan Cortex Carbonized, Trichosanthis Fructus Powder, Magnetitum, Fritillariae Bulbus, Meretrix Shell Powder (Haige Fen), Poria Cum Radix Pini (Fushen, cinnabar-coated), Ophiopogonis Radix (Maidong, cinnabar-coated).
Third visit: Blood stopped, but Heart Yin not restored. Calm Liver and nourish Yin again.
Prescription: Cinnabar-coated Poria (Zhufushen), Melia Toosendan Fructus (Lianmudong, cinnabar-coated), Angelicae Sinensis Radix Carbonized (Danggui Tan), Biota Seed (Baiziren), Magnetitum, Chrysanthemi Indici Fructus (Jinlingzi), Sour Jujube Seed Vinegar-fried (Suanzaoren), Salviae Miltiorrhizae Radix Carbonized (Danshen Tan), Longgu, Haematitum (Daizheshi), Cyperi Rhizoma (Xiangfu, salt-water fried).
[Case 7]
Patient: Damp-heat steaming, oily/dull complexion, turbid red urine, bright red then fading hemoptysis. Use bitter herbs to drain heat and acrid/sweet herbs to leach out dampness.
Prescription: Biyu San, Benincasae Semen, Coix Seed Raw (Yiren), Curcumae Aromatae Rhizoma, Bambusae Stem Sap Salt-water Fried (Zhuru), Alisma Rhizoma (Zexie), Moutan Cortex Carbonized (Danpi Tan), Armeniacae Semen Amarum Paste (Xingrenni), Paeoniae Radix Rubra et Paeoniae Radix Alba (Chibailing), Phellodendri Cortex (Huangbai), Loquat Leaf (Pipaye).
[Case 8]
Patient: Sensation of Qi rushing in the chest leads to expectoration of pure red blood. Blood has stopped, but Qi rush is unsettled. Pulse is wiry and large. Liver Fire agitates Stomach, Stomach Qi rebels, carrying blood upward.
Prescription: Haematitum (Daizheshi), Moutan Cortex Carbonized (Danpi Tan), Bambusae Stem Sap (Zhuru), Achyranthes Radix Carbonized (Niuxi Tan), Lotus Root Node (Oujie), Immature Bitter Orange (Zhishi), Poria (Yunling), Gardeniae Fructus (Hezhizhi), Trichosanthis Fructus Carbonized (Gualou Tan), Curcumae Aromatae Rhizoma (Yujin, ground).
[Case 9]
Patient Zhu (Left): Bleeding continues, head distension, poor sleep, shortness of breath on inhalation. Left pulse is wiry. Yang Qi rebels, carrying blood recklessly. Fear of sudden hemorrhage.
Prescription: Antelope Horn Slice (Lingyangpian), Curcumae Aromatae Rhizoma (Yujin, ground), Paeoniae Radix Rubra Stir-fried (Chishao), Haematitum (Daizheshi), Moutan Cortex Carbonized (Danpi Tan), Ecliptae Herba Ink-treated (Hanliancao), Notoginseng Radix et Rhizoma (Sanqi, ground), Achyranthes Radix Carbonized (Niuxi Tan), Fuligo Silicea (Baicaoshuang), Rehmanniae Radix Preparata (Xishengdi), Fresh Lotus Root (Oujie, decocted as water).
Follow-up: Bleeding decreased, but abdominal fullness/discomfort. Liver Qi is disharmonious, Liver Fire cannot hide. Add Qi-regulating methods to previous approach; descending Qi descends Fire.
Prescription: Curcumae Aromatae Rhizoma (Yujin, ground), Agarwood Milk (Chenxiang, ground with milk), Paeoniae Radix Rubra Stir-fried (Chishao), Taiyin Yuanjing Stone (Yuanshishi), Moutan Cortex Carbonized Black (Danpi), Gardeniae Fructus (Hezhizhi), Tribuli Fructus (Bajili), Ecliptae Herba Ink-treated (Hanliancao), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Lotus Root Node (Oujie).
[Case 10]
Patient Gu (Left): Wind-Warmth attacks Lung, leading to hemoptysis from cough, intermittent. Pulse is floating and hollow (Kou). Fear of recurrence.
Prescription: Moutan Cortex (Danpi), Trichosanthis Fructus Powder (Gualoushuang), Fritillariae Bulbus (Chuanbei), Dendrobii Caulis (Shihu), Indigo Naturalis (Qingdai), Gardeniae Fructus (Zhizi), Vigna Radiata Tegumentum Raw (Biandouyi), Curcumae Aromatae Rhizoma (Yujin, ground), Forsythiae Fructus (Lianqiao), Bambusae Stem Sap (Zhuru, salt-water fried), Lotus Root Node (Oujie).
[Case 11]
Patient Zuo: Wind-Damp lingering in collaterals, body ache. After 20 days, cough led to blood-streaked sputum. Wind injured Yang collaterals, distinct from Water deficiency and Metal damage.
Prescription: Honey-fried Mori Folium (Sangye), Fritillariae Thunbergii Bulbus (Xiangbeimu), Moutan Cortex Carbonized (Danpi Tan), Armeniacae Semen Amarum (Guangxingren), Forsythiae Fructus Peel (Lianqiao Qiao), Curcumae Aromatae Rhizoma (Guangyujin), Schizonepeta Spike (Jingjie Sui), Fritillariae Bulbus (Chuanbeimu), Trichosanthis Pericarpium Stir-fried (Loupi), Aster Root (Ziwan Rou), Lotus Root Node (Oujie).
[Case 12]
Patient Gu (Left): Sore throat followed by excessive sweet/cold food, Wind-Heat internal stagnation, violently damaging Lung collaterals. Choking cough leads to blood-streaked sputum, thick and dense, malar flush, bleeding mostly in morning. Pulse rapid and large. Clear Diaphragm Heat.
Prescription: Glycyrrhizae Radix et Rhizoma (Gancao), Saposhnikoviae Radix (Fangfeng), Menthae Haplocalycis Herba (Bohe), Meretrix Shell Powder (Haige Fen), Trichosanthis Radix (Tianhuafen), Diospyros Fructus Frost (Shishuang), Platycodonis Radix (Jiegeng), Rhinoceros Horn Tip Ground (Xijiantou - *Note: Substitute with Buffalo Horn in modern practice*), Fritillariae Bulbus (Beimu).
[Case 13]
Patient Gu (Left): Cough for months, progressing to hematemesis filling a basin, still intermittent. Pulse fine and wiry, tongue red with little coating. Yin deficiency with Wood-Fire harassing, Ying collaterals damaged, Qi-Fire uncalmed. Fear of sudden hemorrhage.
Prescription: Rehmanniae Radix Preparata (Dadishengdi), Asparagi Radix (Datiantong), Platycladi Cacumen Carbonized (Cebai Tan), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Lotus Juice (Oujiang), Bambusae Stem Sap (Zhuru, water-fried), Paeoniae Radix Alba Raw (Baishao), Moutan Cortex Carbonized (Danpi Tan), Typhae Pollen Carbonized (Puhuang Tan), Euphorbiae Pekinensis Pearl (Ejiao Zhu).
Follow-up: Nourish Kidney Water to control Wood-Fire. Blood stopped, but choking cough persists. Harmonize Metal and Water.
Prescription: Rehmanniae Radix Preparata, Fritillariae Bulbus, Heteroconcha et Margarita Powder (Gaidai San), Euphorbiae Pekinensis Pearl (Ejiao Zhu), Asparagi Radix, Paeoniae Radix Alba Raw, Rubiae Radix et Rhizoma Carbonized, Achyranthes Bidentatae Radix (Huainiuxi, salt-water fried), Loquat Leaf (Pipaye), Duqi Wan (taken first with water).
[Case 14]
Patient Wang (Right): Major hematemesis settled, but sputum still streaked with blood, Qi rush and choking cough. Pulse fine, wiry, rapid. Yin deficiency, Wood-Fire harassing Metal, Chong Qi rebelling upward. Nourish Yin to restrain Chong-Yang rebellion.
Prescription: Euphorbiae Pekinensis Pearl (Ejiao Zhu), Glycyrrhizae Radix et Rhizoma Raw (Shenggancao), Achyranthes Bidentatae Radix (Huainiuxi, salt-water fried), Rubiae Radix et Rhizoma Carbonized (Qiancao Tan), Dendrobii Caulis (Chuanshihu), Paeoniae Radix Alba Raw (Baishao), Fritillariae Bulbus (Chuanbei), Heteroconcha et Margarita Powder (Gaidai San), Dioscoreae Rhizoma (Shanyao), Lotus Root Node (Oujie).
Second visit: Blood-streaked sputum stopped, cough reduced. Pulse fine, wiry, rapid, slightly slower. Chong-Yang calmed, but Lung/Kidney Yin damaged. Harmonize Metal and Water again.
Prescription: Rehmanniae Radix Preparata Roasted (Zhishengdi), Fritillariae Bulbus, Paeoniae Radix Alba Raw, Rubiae Radix et Rhizoma Carbonized, Poria (Baifuling), Glehniae Radix (Beishashen), Heteroconcha et Margarita Powder, Dioscoreae Rhizoma, Benincasae Semen, Lotus Root Node Carbonized (Oujie Tan), Duqi Wan (taken first).
[Case 15]
Patient Chen (Left): Recurrent blood loss, progressing to choking cough, itchy throat, rising Qi, sputum streaked with blood, thick and dense. Pulse fine, wiry, rapid. Kidney Water insufficient, Wood-Fire harasses Lung, damaging collaterals, causing external bleeding. Blood loss injures Yin, Qi fails to secure, intake/excretion abnormal. Fear of entering Sun disease (consumption).
Prescription: Benincasae Semen, Coix Seed Raw, Mori Cortex Radicis (Sangbai Pi), Plantaginis Semen (Cheqianzi), Phragmitis Rhizoma Apex (Qinglujian), Armeniacae Semen Amarum (Guangxingren), Fritillariae Bulbus, Achyranthes Bidentatae Radix (Huainiuxi, salt-water fried), Rubiae Radix et Rhizoma Carbonized, Duqi Wan (divided dose).
Second visit: Blood stopped, can lie on right side, but still itchy throat/choking cough, rising Qi. Pulse fine, wiry, rapid, Qi Kou (Right Cun) large. Massive blood loss injures Kidney Yin, Upper Jiao not cleared. Clear Upper Jiao.
Prescription: Benincasae Semen (crushed), Coix Seed Raw, Luffae Retinervae Fibroreticulatus (Sigualuo), Trichosanthis Semen Stir-fried (Lou Ren), Fresh Lotus Leaf (Xianheye), Fresh Mori Folium Vein (Xiansangyeluo), Fritillariae Thunbergii Bulbus, Armeniacae Semen Amarum (crushed), Gardeniae Cortex Stir-fried (Zhipi), Fresh Loquat Leaf (Xianpipaye), Phragmitis Rhizoma Live (Huoshu Lugeng).
Third visit: Can lie on right side, rising Qi greatly reduced. But choking cough unsatisfactory, sputum hard to expectorate. Lung Qi not clear/descending. Clear Upper Jiao.
Prescription: Trichosanthis Pericarpium (Gualou Pi), Armeniacae Semen Amarum, Perillae Fructus Stir-fried (Suzi), Fritillariae Thunbergii Bulbus, Benincasae Semen, Fresh Mori Folium Vein, Coix Seed Raw, Tangerine Peel Salt-water Fried (Juhong), Poria, Phragmitis Rhizoma Apex, Loquat Leaf Dew (Pipaye Lu).
Fourth visit: Can lie on right side, but choking cough/rising Qi persist, sputum unsatisfactory, afternoon fever. Lung Heat Yin damage. Moisten Lung, clear Metal.
Prescription: Trichosanthis Semen (Gualou Ren), Mori Folium Roasted (Sangye), Glycyrrhizae Radix et Rhizoma Raw, Benincasae Semen, Fritillariae Bulbus, Armeniacae Dulcis Semen (Tian Xingren), Coix Seed Raw, Glehniae Radix, Gardeniae Cortex (Shanzhipi), Phragmitis Rhizoma Apex, Pulmonis Dew (Feilu, taken with liquid).
Fifth visit: Clear Metal/Moisten Lung, evening choking cough settled, but morning cough severe, sputum green-yellow, pulse rapid with internal heat. Massive blood loss, Yin hard to restore, Yang rises harassing Lung Metal. Nourish Yin to calm Yang rebellion.
Prescription: Euphorbiae Pekinensis Pearl (Ejiao Zhu), Glycyrrhizae Radix et Rhizoma Raw, Heteroconcha et Margarita Powder, Xinyi Gao (Sydney Paste - *likely a specific proprietary paste or typo for another herb like Shihujie/Sijigu*, assuming standard context implies nourishing paste), Rehmanniae Radix Preparata Roasted, Fritillariae Bulbus, Armeniacae Dulcis Semen.
Sixth visit: Choking cough fluctuates, Qi-Fire ascending/descending. Frequent thirst, vomiting when coughing severely. Lung/Stomach Yin damaged, Qi-Fire harassing upward. Clear/Nourish Lung/Stomach.
Prescription: Asparagi Radix, Glycyrrhizae Radix et Rhizoma Raw, Trichosanthis Pericarpium Stir-fried, Benincasae Semen, Dendrobii Caulis, Glehniae Radix, Fritillariae Bulbus, Gardeniae Cortex Black (Hezhizhipi), Heteroconcha et Margarita Powder, Qiongyu Gao (taken with liquid).
[Case 16]
Patient Wang (Left): Water deficiency, Wood hyperactivity, Deficient Fire harassing, persistent cough, intermittent hematemesis. Chong-Yang rebels, severe cough leads to vomiting. Chong Mai is lower but distributes to chest. Disease enters Sun stage, hard to treat.
Prescription: Rehmanniae Radix Preparata (Dadishengdi), Euphorbiae Pekinensis Pearl (Ejiao Zhu), Halitum (Danqiushi), Achyranthes Radix Carbonized (Niuxi Tan), Moutan Cortex Carbonized (Danpi Tan), Ophiopogonis Radix (Damaidong), Paeoniae Radix Alba Raw (Baishao), Qingge San (Green Frog Powder), Dioscoreae Rhizoma (Shanyao), Cordyceps (Dongchong Xiacao), Dendrobii Caulis (Shihu).
Second visit: Blood did not recur, cough subsided, vomiting stopped, but lower back soreness. Lung/Kidney deficiency evident. Medicine effective. Maintain previous intent, await change.
Prescription: Rehmanniae Radix Preparata, Glycyrrhizae Radix et Rhizoma Raw, Euphorbiae Pekinensis Pearl, Qingge San, Dioscoreae Rhizoma, Ophiopogonis Radix, Paeoniae Radix Alba Raw, Achyranthes Radix Carbonized, Fritillariae Bulbus, Duqi Wan.
Third visit: Cough greatly reduced, back soreness lessened, pulse harmonizing. But Lung/Kidney deficiency, recovery takes time. Self-care advised.
Prescription: Ejiao (dissolved), Ophiopogonis Radix, Qingge San, Achyranthes Bidentatae Radix, Paeoniae Radix Alba Raw, Rehmanniae Radix Preparata, Fritillariae Bulbus, Eucommiae Cortex (Duzhong), Rubia Root Carbonized (Qiangentan), Cordyceps, Duqi Wan (divided dose).
Fourth visit: Nourish Kidney, Liver, protect Lung. Cough reduced by 40-50%, no blood, but root cause remains. Consumption diseases do not recover quickly. Continue harmonizing Metal and Water.
Prescription: Rehmanniae Radix Preparata, Dioscoreae Rhizoma, Meretrix Shell Powder (Haige Fen), Poria, Achyranthes Bidentatae Radix, Euphorbiae Pekinensis Pearl, Fritillariae Bulbus, Paeoniae Radix Alba Raw, Eucommiae Cortex, Loquat Leaf (de-hairy/roasted), Qiongyu Gao (divided dose).