此脾脉气虚之候，非大剂参、 不可。病家曰∶前医戒之甚严，而君用之甚多，何相悬也？李曰∶此医能任决
效否？曰∶不能也。李曰∶请易参五斤，毋掣其肘，期于三月，可以报绩。彼信而从，遂用六君间补中益气，
及七味丸疗之，日轻一日，果如所约。
林上舍多郁，且有暴怒，吐血甚多，倦怠异常，李以六君子，纳参一两，干姜一钱，木香八分，四日而血
止。后因怒气，血复大作，李先与平肝，继当大补，然后得脉。所谓早见非时之脉，当其时不能再见矣。果如期而殁。
董元宰少外家，吐血蒸嗽，先用清火，继用补中，俱不效。李脉之，两尺沉实，曰∶少腹按之必痛。询之果
然。此怒后蓄血，经年不行，乃为蒸热，热甚而吐血，阴伤之甚也。乃与四物汤加郁金、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，又下黑血块，及如桃胶蚬肉者三四升，腹痛乃止。
虚倦异常，与独参汤饮之，三日而血减六七。服十全大补汤，百余日而痊。
唐主政劳心太过，因食河鲜，吐血有痰，喉间如梗，日晡烦热。喜其六脉不数，惟左寸涩而细，右关大而
软，思虑伤心脾也。以归脾汤大料，加丹参、麦冬、生地，二十剂，症减六七。兼服六味丸三月，遂不复发。
冯氏女发热咳嗽已半年，十月间，吐鲜血甚多，一日之内，不过食粥一盏，大肉消陷，大便溏泄，沉困卧
床，脉来七至。李曰∶法在不救，人所共知，若能惟余是听，不为旁挠，可救十中之一。每帖用人参五钱，桂、
附各一钱， 、术三钱，归、芍二钱，陈皮一钱，一日三帖，进七八帖，及壮水丸三斤而后起。又三月，饮食如常。
卢不远云∶《千金方》用药动辄数斤，习见吾侪不过两许，令人不敢动手。看立斋案，又进一步。庚子孙
孝廉吐血十日，夜危坐，不敢交睫，否则血奔射出，以六味丸料加安魂药，煎服而愈。此火象也，以润下剂平
之，病热炽烈，岂杯水可救？倘有识见，放胆用药，多多益善矣。（《芷园臆草》。）
卢不远腊月十七日，围炉露坐大半夜，次日爪甲尽折。先自十月间暴怒，顿足叫呼，气喘食顷，兹复火为
寒郁，渐觉神思昏瞀。至二十七夜，因房后患腹痛恶寒泄泻，平旦且止，至暮复作，明日又止。至开正五日，
意为肾泻，服四神丸一大剂，泻痛竟止。早间肛右有核，其痛渐近尾闾，暮痛不可反侧，次暮以水化熊胆涂
之，立觉凉气直上肺左，痛渐缓，（火毒悉内窜矣。）中夜吐痰，痰内见血一二点，辰时痔出白脓，竟可起坐。
十一日早，方话顷，血从咳至，作意引定，煎六味丸料服，夜半睡觉，血即上涌如潮，喘声如锯。进童便及六味煎
药，气稍定。才闻姜汤气，血即随涌，平旦始缓，夜再发如前，寐则背心蒸热，醒即血来，咽喉如截断，一涌
盈掬，心躁急乱，欲多语言，声一响而血游至。至十三早，议下莫敢应。至晚，势急似无生理，乃用泻心配血
药下之，不应。时方寒 ，用水调大黄末服，转欲去衣被，啜芩、连苦寒如甘旨。至五更，强进清米饮，药力
忽转，解黑粪瘀秽不可近，凡三次，血来少平。十五寅时立春，以建莲浓煎，呷之甚美，少间，足心汗出，次
及手心背心，一日安和。暮又吐鲜血数口，以赤小豆，连翘，合泻心方法服之，觉上身气即开，脐以下不动而
闷，汗出似前者三日，血亦渐减。二十外，大便如青泥，次下如铁弹者二三枚，血方净尽。溯病之由，以火郁
误认肾虚服四神丸，致祸几死。良医自病犹尔，矧其他耶？（此正谚云∶卢医不自医。）
冯楚瞻治杨某吐血之后，大渴不止，两寸甚洪，关尺甚弱，此阴血暴亡，脏腑失养，津液槁燥，阴火上炎，
名为血竭也。以熟地三两，麦冬五钱，五味子一钱，附子二钱，浓煎二碗，代茶饮之，日三剂，渴止而寸脉和
平。若作胃火，妄用石膏、栀子、芩、连，反激阴火上炎，益增躁烦喘乏患矣。喻嘉言曰∶津液结则病，津液
竭则死。故救病而不知救津液者，真庸工也。
吴孚先治何氏女，患吐血咳嗽，食减便难，六脉兼数，左部尤甚。医用四物汤加黄芩、知母。吴曰∶归、
芎辛窜，吐血不宜，芩、母苦寒伤脾，咳嗽在所禁用。乃与米仁、玉竹、白芍、枸杞、麦冬、沙参、川续断、
建莲、百合，二十剂稍缓，五十剂渐瘳。
林西仲春间吐血，医用苦寒过剂，口胃不开，大便不实。脉之，左关沉弦，右关弦数，得之劳神伤脾，而
后郁怒也。宜归脾汤合逍遥散，加莲实为丸，补脾开郁乃愈。
王监司外家，吐血既久，犹进苦寒，脉芤带数，不思饮食，大便微溏，此凉剂太过，阴阳两损也。人参、莲
肉、山药、麦冬、五味、白芍，兼左归丸而愈。
黑虎丹，治一切吐血衄血诸失血之症。便血血淡，以黄柏易黄芩，亦名清炎散。荆、黄、黄芩各等分，炒
极黑为末，每服三钱，丹参汤调下。丹参色赤气轻，能于气分中生血去瘀，贤于四物远矣。此方活人甚多。血
止后，单服丹参半载，永不复发。每月参一斤，合陈细茶半斤，用以代茶服，不可间断。
张路玉治汤刑部，年八十二，痰中见血，服诸宁咳止血药不应。脉得气口芤大，两尺微紧，面色微黄，屡
咳痰不得出，咳甚方有黄色粘痰，此精气神三者并亏，兼伤于热，耗其津液而咳动肺胃之血也。因其平时多火，
不受温补，遂以六味丸合生脉散，加葳蕤煎膏服之，取金水相生，源流俱泽，不必用痰血药，而痰血自除也。
钱曙昭久咳吐血，四五日不止，不时哄热面赤，或时成盆成碗，或时吐粉红色痰，夜热自汗，一夕吐出一
团，与鱼肠无异，杂于血红中，薄暮骤涌不已，神昏欲脱，灌童便亦不止。因思瘀结之物既去，正宜峻补，遂
进独参汤稍定。缘脉数疾无力，略加肉桂、炮姜、童便少许，因势利导，以敛虚阳之逆，一夜尽参二两。明晨
势稍定，血亦不来，糜粥渐进，脉色渐和，改用六味丸作汤，调补真阴，半月而愈。
张飞畴治苏氏子，新婚后暴吐血数升，命煎人参五钱，入童便与服。明日，医谓人参补截瘀血，难以轻用，
议进生地、山栀、牛膝等味。张曰∶六脉虚微而数，无瘀可知，血脱益气，先正成法。若谓人参补瘀，独不思
血得寒则凝，反无后患耶？今神魂莫主，转侧昏晕，非峻用人参，何以固其元气之脱乎？遂进参一两，二服顿
安。次与四君、保元、六味间服，后以乌骨鸡丸，调理而痊。
杨乘六治汪文远病血症，午后发热，倦怠嗜卧，四肢酸软，五心烦热。或用凉血清火之药两月余，益剧。
更医曰∶弱症已成，不可为矣。诊之，察其面黄而瘦，舌黄而滑，右寸关大而缓，左寸关细而紧，两尺俱洪而
旺。据症合色与脉，乃脾肺气虚下陷，不能摄血归经也。其胸中必恶心漾漾，其血色必鲜血而淡。询之曰∶然。
遂以补中益气，倍参、 、术、草，加白芍、五味、炮姜与之，曰∶第服此，血自止，身自凉，诸症自退矣。
服至四剂，果如所言。继用养荣加附子作丸，早晚两次，每服五钱，两月而愈。
孙炳章患吐血，咳嗽发热，饮食不思，怔忡不寐，健忘惊悸，肌肉渐减，肚脐右侧有块作痛。或用消瘀理
血，滋阴清肺等剂，俱不应，病甚剧，其家疑药误。脉之，左寸芤大，右关结滞，两尺洪盛，面色白中泛红，
舌色淡黄，不燥不滑。症乃思郁伤脾，不能统血归经，至阴虚发热，血燥作痛。其块必不阔而长，不横而
竖，形若镰刀，非瘀亦非痞，乃痹气而居胃旁者也。血盈则润而软，血少则躁而痛，凡郁甚与思虑重者，类多
患此，《内经》所谓二阳之病发心脾，男子则隐曲不利，女子则月事不来，正此病也。其传为风消，为息贲者不
治。今肌肉虽减，气犹未急，亟救三阴，症尚可痊，乃用归脾汤去木香，加白芍、五味，送都气丸，两月而愈。
柴屿青治甘州太守高棠溪，在沈阳工部时，忽吐血，医教用凉药止血之药。及诊其两脉安靖，曰∶君教读
心劳，偶动相火，血随而升者，服止血药则遗恶不浅。力劝其勿药，次日口吐淡血，三日即止，然后调理数剂，
永不后发。
丁酉春，韦法海少女，患痰嗽四十余日，不能卧，卧即两胁发胀，惟背拥枕蓐趺坐而已，且吐血成碗，
医与消痰，止血药不效。诊之，两脉洪滑，曰∶此肺胀也，弗止血，当活血。遂用四物汤加桃仁、青皮、诃子、
竹沥。因沈阳无竹，改用栝蒌。服下即血止安睡，调理数月而痊。
户部正郎李紫垣，咳嗽身热，吐血不止，屡治增剧。检其方，均止血补血重剂。脉之，两手尚和缓，惟右
尺关洪大，乃脾胃风热，为药所瘀，以致发热卧床，遂用清理脾胃之剂，数日后，身凉热减，调养一月而安。
大凡诸见血症，脉贵沉细，设见洪大，后必难治。前症洪大，乃因补药壅瘀而然，原非本脉，故得收功。总之，
血症初起，别无外邪者，先应消血，佐以润下之剂，使败血下行，后用止血药，以杜其根，服补血药以复其元，
庶无后患。倘因内伤暴血不止，或劳力过度，其血妄行，出如泉涌，口鼻皆流，须臾不救则死，是又不拘前例，
急用人参一二两为细末，入飞罗面一钱，新汲水调如稀糊，不拘时啜，或服独参汤亦可。盖有形之血，不能速
生，无形之气，所当亟固。若真阴失守，虚阳泛上，亦大吐血，须用八味、六味汤，固其真阴，则又不可早用
人参也。尝见患此症者甚多，若不辨别六经脉症，任意混治，贻害不浅，故不惮琐琐言之。
吕东庄治从子园丁，吐血求诊，视其血鲜红，中间有紫小血块。脉之涩濡，色白，问胸中作恶否？曰∶然。
时颇作痛，直上至背，曰∶知之矣。用桃仁泥三钱，红花三钱，合理中汤，加桂一钱，戒之曰∶频服之，必有
黑血大至，待黑尽而鲜者来，乃再来告。丁如言，吐痰积数升，胸痛即平。复来求诊，则脉圆实矣，与以理肾
养荣之剂，复用填补命门丸子一料，全愈。
辛丑夏，薛在嘉兴屠内翰第，遇星士张谷，谷谈命时，出中庭吐血一二口，云∶久有此症，遇劳即作。余
意此劳伤脾气，其血必散。视之果然。于补中益气加麦冬、五味、山药、熟地、茯神、远志，服之而愈。翌早
请见，云∶每服四物、黄连、山栀之类，血益多而倦益甚，得公一匕，血顿止，神思如故，何也？曰∶脾统血，
肺主气，此劳伤脾肺，致血妄行，故用前药健脾肺之气，而虚血归原耳。（此案《医贯》采为论。）
立斋治一男子，鳏居数年，素苦，劳则吐血，发热烦躁，服犀角地黄汤，气高而喘，前病益甚，更白浊遗
精，形体倦怠，饮食少思，脉洪大，举按有力。服十全大补加麦冬、五味、山茱萸、山药而愈。
儒者杨启元，素勤苦，吐血发痉，不知人事，此脾胃虚损，用十全大补汤，及加减八味丸而痉愈。再用归
脾汤而血止。
一男子咳嗽吐血，热渴痰盛，盗汗遗精，用地黄丸料加麦冬、五味治之而愈。后因劳怒，忽吐紫血块，先
用花蕊石散，又用独参汤，渐愈。后劳则咳嗽，吐血一二块，脾肺肾三部皆洪数，用补中益气、六味地黄全愈。
一妇人素勤苦，冬初咳嗽吐痰发热，久而吐血盗汗，经水两月或三月一至，遍身作痛。或用清热化痰等剂，
口噤筋挛。乃用加减八味丸，及补中益气加门冬、五味、山药，治之年余而痊。
李东垣治郑仲本，年二十三岁，因心痛，服丹、附等药，得上气，两胁急迫，胸膈不快，常时嗽咯出血，
病形渐瘦，大便燥而难，脉弦数，夜间略热，食稍减。因于灯笼草，和节麻黄细末，以白术、桔梗、木通、甘
草汤下，十余服，病减半。又于通圣散去石膏为丸，以桃仁汤下之。
朱丹溪治一妇人，年五十六岁，夏吐红痰，有一二声咳。人参、陈皮、茯苓各一钱，白术钱半，防风、桔
梗各五分，干姜三分，甘草一分，煎二之一，入藕汁二大蛤再煎，带热下三黄丸。
吴丞相冲卿忽吐血，孙兆用水澄蚌粉研细，入辰砂少许，米饮调下二钱，日三服遂安。兆秘此方，吴以术
得之，韩子功方用朱砂一钱，真蚌粉五分。（《医说续编》。）
张子和治岳八郎，常日嗜酒，偶大饮醉，吐血，近一年身黄如橘，昏愦发作，数日不醒，浆粥不下，强直
如厥，两手脉皆沉细。张曰∶脉沉细者，病在里也，中有积聚。用舟车丸百余粒，浚川散五六钱，大下十余行，
状如葵叶汁，中燥粪，气秽异常，忽开两目，伸腕，问左右曰∶我缘何至此？左右曰∶你吐血后，数日不醒，
张治之乃醒。自是，五六日必泻，凡四五次，其血方止。但时咳一二声，潮热未退，以凉膈散加桔梗、当归各
称二两，水一大盂，加老竹叶，入蜜少许同煎，去滓，时时呷之，闻与人参白虎汤，不一月复故。
李氏范初病嗽血，以调胃承气汤一两，加当归使服之不动。再以舟车丸五六十粒，过三四行，又呕血一碗。
（ 按∶若庸工则必疑。）不再宿，又与舟车丸百余粒，通经散三四钱大下之，过十余行，已愈过半。仍以黄连
This is a manifestation of Spleen Qi deficiency. Only large doses of Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) can treat it. The patient's family said, "Previous doctors warned us strictly against this, yet you use so much. Why is there such a discrepancy?" Li Zhongzi said, "Can that doctor take responsibility for the efficacy?" They replied, "No." Li said, "Please procure five jin of Renshen, do not hinder my treatment, and I promise results within three months." They believed and followed, using Liu Jun Zi Tang (Six Gentlemen Decoction) alternating with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), along with Qi Wei Wan (Seven-Ingredient Pill), to treat the condition. The illness improved day by day, exactly as promised.
Lin Shangshe suffered from much depression and sudden rage, resulting in severe hematemesis and extreme fatigue. Li used Liu Jun Zi Tang (Six Gentlemen Decoction) with one liang of Renshen (Ginseng Radix et Rhizoma), one qian of Gan Jiang (Zingiberis Rhizoma), and eight fen of Mu Xiang (Aucklandiae Radix). Hemostasis was achieved in four days. Later, due to anger, bleeding recurred heavily. Li first administered Liver-calming herbs, then proceeded with major tonification, after which the pulse could be felt. As the saying goes, if an abnormal pulse appears prematurely, it cannot be seen again at the critical moment. He indeed passed away as predicted.
Dong Yuanzai, while visiting his maternal grandfather's home in his youth, suffered from hematemesis accompanied by steaming fever and cough. Initial treatments with Fire-clearing herbs and Middle-tonifying herbs were ineffective. Li palpated the pulse, finding both Chi (Cunchi) pulses deep and solid, and said, "Pressing the lower abdomen must cause pain." Inquiry confirmed this. This was blood stasis retained after anger, unexcreted for years, transforming into steaming heat. Severe heat caused hematemesis, severely injuring Yin fluids. He prescribed Si Wu Tang (Four Substances Decoction) plus Yu Jin (Curcumae Radix), Tao Ren (Persicae Semen), Chuan Shan Jia (Manis Squama), and a small amount of Da Huang (Rhei Radix et Rhizoma). This expelled over a sheng of black blood. Since lower abdominal pain persisted, he added three qian of Da Huang (Rhei Radix et Rhizoma) to the previous formula. This expelled black blood clots and substances resembling peach gum or clam meat, totaling three to four sheng. Abdominal pain ceased. Due to extreme weakness, Du Shen Tang (Single Ginseng Decoction) was given. Bleeding decreased by six or seven tenths in three days. After taking Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), he recovered after more than a hundred days.
Tang Zhuzheng exerted his mind excessively. After eating freshwater delicacies, he vomited blood with phlegm, feeling a lump in the throat, and experienced evening irritability and fever. Fortunately, the six pulses were not rapid; only the Left Cun (Cunkou) was choppy and thin, and the Right Guan (Guankou) was large and soft. This indicated Heart and Spleen injury from overthinking. He was treated with a large dose of Gui Pi Tang (Restore the Spleen Decoction) plus Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Mai Dong (Ophiopogonis Radix), and Sheng Di Huang (Rehmanniae Radix). After twenty doses, symptoms reduced by six or seven tenths. Taking Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) for three months prevented recurrence.
Miss Feng had fever and cough for half a year. In October, she vomited large amounts of bright red blood. She ate less than one bowl of porridge a day, her muscles wasted, stool was loose, she was heavy and confined to bed, and her pulse beat seven times per breath (extremely rapid). Li said, "Medically, this is incurable, as everyone knows. If you listen only to me and are not distracted by others, one in ten might survive. Each prescription will contain five qian of Renshen (Ginseng Radix et Rhizoma), one qian each of Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Praeparata), three qian each of Fu Ling (Poria) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), two qian each of Dang Gui (Angelicae Sinensis Radix) and Bai Shao (Paeoniae Radix Alba), and one qian of Chen Pi (Citri Reticulatae Pericarpium). Three prescriptions daily, taken for seven or eight doses, followed by three jin of Zhuang Shui Wan (Strengthen Water Pill), and she would recover." After another three months, her diet returned to normal.
Lu Bu Yuan commented: "In *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold), dosages often reach several jin. We commonly see only one or two qian, making people afraid to prescribe. Looking at Lizhai's cases, it is even more advanced. Sun Xiaolian suffered hematemesis for ten days, sitting upright at night, afraid to close his eyes, otherwise blood would gush out. He was cured by decocting Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) ingredients with Soul-Calming herbs. This is a Fire pattern, calmed by moistening and purgative agents. With such fierce heat, how can a cup of water save? If one has insight, one should dare to use drugs boldly; more is better."
On the 17th of the twelfth lunar month, Lu Bu Yuan sat exposed by a fire for a long night. The next day, his fingernails broke off completely. Previously, in October, he had a sudden rage, stamping feet and shouting, suffering shortness of breath for a moment. Now, Fire was constrained by Cold, leading to mental confusion. On the night of the 27th, after intercourse, he suffered abdominal pain, aversion to cold, and diarrhea, which stopped at dawn but returned at dusk, stopping again the next day. On the 5th of the first lunar month, suspecting Kidney diarrhea, he took a large dose of Si Shen Wan (Four Spirits Pill), which stopped the diarrhea and pain. That morning, a nodule appeared on the right side of the anus, pain moving toward the tailbone. At night, pain prevented turning over. The next evening, bear bile dissolved in water was applied externally. Immediately, cool air rose to the left lung, and pain eased (Fire toxin had penetrated inward). At midnight, he expectorated phlegm with a few drops of blood. At Chen hour, hemorrhoids discharged white pus, allowing him to sit up. On the 11th, after speaking briefly, blood came from coughing. He tried to calm himself and decocted Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Waking at midnight, blood surged like a tide, wheezing like a saw. Drinking child's urine and the Liu Wei Di Huang Wan decoction stabilized his Qi slightly. Upon smelling ginger soup, blood surged again. It eased at dawn, relapsed at night. Sleeping brought steaming heat to the back; waking brought blood, feeling as if the throat were cut, filling a handful with each surge. Heart anxiety and restlessness increased, wanting to speak more, but sound triggered blood flow. By the morning of the 13th, no one dared to suggest purgation. By evening, the condition seemed hopeless. A Heart-draining and Blood-stopping purgative was used without effect. During the cold, he took Da Huang (Rhei Radix et Rhizoma) powder mixed with water, but wanted to remove clothes and drank bitter Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) as if they were sweet. At Wugeng, forced to drink clear rice water, the drug force shifted. He passed foul black feces three times, and bleeding subsided slightly. At Yin hour on the 15th (Start of Spring), he drank strong Jian Lian (Nelumbinis Semen) decoction, which tasted good. Soon, sweat appeared on the soles of his feet, then palms and back. He was peaceful all day. Evening brought a few mouthfuls of fresh blood. Chi Xiao Dou (Vigna angularis) and Lian Qiao (Forsythiae Fructus) combined with a Heart-draining method were taken. Upper body Qi opened, lower abdomen felt stagnant, sweating occurred similar to the previous three days, and bleeding gradually decreased. After the 20th, stool resembled green mud, followed by iron-ball-like stools, and bleeding cleared. Tracing the cause, Fire constraint was mistaken for Kidney deficiency, and Si Shen Wan (Four Spirits Pill) was taken, causing near-death. Even a good doctor struggles with their own illness, let alone others. (As the proverb says: "The physician Lu cannot cure himself.")
Feng Chuzhan treated Yang Mou after hematemesis. Extreme thirst persisted, Cun pulses were very surging, Guan and Chi pulses were very weak. This was sudden loss of Yin blood, organ malnourishment, dried fluids, and flaming-up of deficient Fire, named "Blood Exhaustion." He used San liang of Shu Di Huang (Rehmanniae Radix Preparata), five qian of Mai Dong (Ophiopogonis Radix), one qian of Wu Wei Zi (Schisandrae Chinensis Fructus), and two qian of Fu Zi (Aconiti Lateralis Radix Praeparata), decocted strongly in two bowls, taken as tea, three doses daily. Thirst stopped, and Cun pulses normalized. If treated as Stomach Fire with Shi Gao (Gypsum Fibrosum), Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), and Huang Lian (Coptidis Rhizoma), it would aggravate deficient Fire, increasing irritability, panting, and fatigue. Yu Jiayan said: "Fluid accumulation causes disease; fluid exhaustion causes death. Therefore, those who treat disease without preserving fluids are truly mediocre physicians."
Wu Fuxian treated Miss He, who had hematemesis, cough, poor appetite, and difficult defecation. Six pulses were rapid, especially on the Left. The doctor used Si Wu Tang (Four Substances Decoction) plus Huang Qin (Scutellariae Radix) and Zhi Mu (Anemarrhenae Rhizoma). Wu said: "Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) are acrid and dispersing, unsuitable for hematemesis; Huang Qin (Scutellariae Radix) and Zhi Mu (Anemarrhenae Rhizoma) are bitter-cold and damage the Spleen, contraindicated for cough." He prescribed Yi Yi Ren (Coicis Semen), Yu Zhu (Polygonati Odorati Rhizoma), Bai Shao (Paeoniae Radix Alba), Gou Qi Zi (Lycii Fructus), Mai Dong (Ophiopogonis Radix), Sha Shen (Glehniae Radix or Adenophorae Radix), Chuan Xu Duan (Dipsaci Radix), Jian Lian (Nelumbinis Semen), and Bai He (Lilii Bulbus). After twenty doses, slight relief; after fifty doses, gradual recovery.
Lin Xizhong suffered hematemesis in spring. Doctors used excessive bitter-cold herbs, closing the mouth and stomach, causing loose stools. Pulse: Left Guan was deep and wiry, Right Guan was wiry and rapid. Caused by mental exhaustion damaging the Spleen, followed by depression and anger. Gui Pi Tang (Restore the Spleen Decoction) combined with Xiao Yao San (Free Wanderer Powder), with Lotus Seeds made into pills, tonified the Spleen and relieved depression, curing the case.
The relative of Supervisor Wang had prolonged hematemesis but continued taking bitter-cold herbs. Pulse was floating and empty with rapidness, no desire for food, slightly loose stool. Excessive cooling damaged both Yin and Yang. Renshen (Ginseng Radix et Rhizoma), Lotus Seeds, Shan Yao (Dioscoreae Rhizoma), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), and Bai Shao (Paeoniae Radix Alba), combined with Zuo Gui Wan (Left Restoring Pill), cured him.
Hei Hu Dan (Black Tiger Pill) treats all types of hematemesis, epistaxis, and other bleeding disorders. For pale blood in stool, replace Huang Qin (Scutellariae Radix) with Huang Bo (Phellodendri Cortex), also called Qing Yan San (Clear Heat Powder). Jing Jie (Schizonepetae Spica), Da Huang (Rhei Radix et Rhizoma), and Huang Qin (Scutellariae Radix) in equal parts, stir-fried until extremely black, ground to powder. Take three qian per dose, guided by Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) decoction. Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) is red and light in nature, generating blood and removing stasis in the Qi level, far superior to Si Wu Tang (Four Substances Decoction). This formula saves many lives. After bleeding stops, taking only Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) for half a year prevents recurrence. One jin of Renshen (Ginseng Radix et Rhizoma) combined with half a jin of aged fine tea, taken as tea monthly, without interruption.
Zhang Luyu treated Tang Xingbu, aged 82, with blood in sputum. Various cough-stopping and hemostatic drugs failed. Pulse at Qi Kou was floating and empty and large, both Chi pulses slightly tight, complexion slightly yellow. Repeated coughing failed to expel phlegm; only when coughing severely did yellow sticky phlegm appear. This was simultaneous deficiency of Essence, Qi, and Spirit, combined with Heat injury consuming fluids, causing cough to move Lung and Stomach blood. Since he usually had excess Fire and could not tolerate warm tonics, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) combined with Sheng Mai San (Generate the Pulse Powder) plus Rui Yu (Polygonati Odorati Rhizoma) decocted into paste was used. This promotes Metal generating Water, nourishing source and stream. Phlegm and blood drugs were unnecessary; phlegm and blood removed themselves.
Qian Shuzhao had chronic cough and hematemesis for four or five days continuously. Occasional flushing and fever, vomiting bowlfuls of blood or pink phlegm, night sweats, and steaming fever. One night, he expectorated a mass resembling fish intestines mixed with blood. At dusk, sudden gushing continued, consciousness faded, and child's urine failed to stop it. Thinking that since stasis was gone, vigorous tonification was needed, Du Shen Tang (Single Ginseng Decoction) was given, stabilizing him slightly. Since the pulse was rapid, weak, and powerless, a little Rou Gui (Cinnamomi Cortex), Pao Jiang (Zingiberis Rhizoma Preparatum), and child's urine were added to guide the path and restrain rebellious deficient Yang. Two liang of Renshen (Ginseng Radix et Rhizoma) were consumed in one night. Next morning, condition stabilized, bleeding stopped, congee intake increased, pulse and color normalized. Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) decocted as soup was used to tonify True Yin, curing him in half a month.
Zhang Feichou treated Su Shi's son, who suddenly vomited several sheng of blood after marriage. He ordered five qian of Renshen (Ginseng Radix et Rhizoma) decocted with child's urine. The next day, another doctor argued that Renshen (Ginseng Radix et Rhizoma) tonifies and traps stasis, advising against its use, suggesting Sheng Di Huang (Rehmanniae Radix), Shan Zhi Zi (Gardeniae Fructus), and Niu Xi (Achyranthis Bidentatae Radix) instead. Zhang said: "Six pulses are empty, minute, and rapid; no stasis is evident. 'Blood loss requires Qi tonification' is the established method. If Renshen (Ginseng Radix et Rhizoma) traps stasis, does it not coagulate blood when cold, causing later trouble? Now spirit and soul are lost, fainting upon movement. Without large-dose Renshen (Ginseng Radix et Rhizoma), how to secure collapsing Yuan Qi?" One liang of Renshen (Ginseng Radix et Rhizoma) was given; two doses brought instant peace. Then Si Jun Zi Tang (Four Gentlemen Decoction), Bao Yuan Tang (Preserve the Origin Decoction), and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) were alternated. Finally, Wu Gu Ji Wan (Black-Bone Chicken Pill) regulated him to recovery.
Yang Chengliu treated Wang Wenyuan's blood disorder. Afternoon fever, fatigue, drowsiness, sore limbs, and five-palm heat. Cooling blood and clearing Fire herbs taken for over two months worsened it. Another doctor said, "Weakness is established, incurable." Palpating, face was yellow and thin, tongue yellow and slippery, Right Cun and Guan large and slow, Left Cun and Guan thin and tight, both Chi surging and vigorous. Symptoms, color, and pulse indicated Spleen and Lung Qi deficiency sinking, failing to control blood in vessels. Chest nausea and pale bright blood were confirmed. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen (Ginseng Radix et Rhizoma), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Gan Cao (Glycyrrhizae Radix et Rhizoma), plus Bai Shao (Paeoniae Radix Alba), Wu Wei Zi (Schisandrae Chinensis Fructus), and Pao Jiang (Zingiberis Rhizoma Preparatum) was given. "Take this, blood will stop, body will cool, symptoms will retreat." Four doses worked as predicted. Yang Rong Tang (Nourish the Nutritive Decoction) with Fu Zi (Aconiti Lateralis Radix Praeparata) made into pills, taken twice daily, five qian each, cured him in two months.
Sun Bingzhang had hematemesis, cough, fever, anorexia, palpitations, insomnia, forgetfulness, fright, muscle wasting, and painful mass on the right of the umbilicus. Blood-invigorating, Yin-nourishing, and Lung-cooling herbs failed. Condition severe, family suspected wrong medicine. Pulse: Left Cun floating and empty, Right Guan knotted, both Chi surging. Complexion white with red flush, tongue pale yellow, neither dry nor slippery. Syndrome: Overthinking and depression damaged Spleen, failing to control blood; Yin deficiency generated heat, blood dryness caused pain. Mass was narrow and long, vertical like a sickle, not stasis or fullness, but obstructed Qi beside the Stomach. Full blood makes it soft; less blood makes it painful. Those with severe depression and heavy thinking often suffer this. *Nei Jing* says: "Diseases of Er Yang (Stomach and Large Intestine) originate in Heart and Spleen. Men have hidden difficulties; women miss menses." This is that disease. Transformation into Wind Consumption or Breath Distension is incurable. Though muscles wasted, Qi not urgent, urgently saving Three Yin allows recovery. Gui Pi Tang (Restore the Spleen Decoction) minus Mu Xiang (Aucklandiae Radix), plus Bai Shao (Paeoniae Radix Alba) and Wu Wei Zi (Schisandrae Chinensis Fructus), delivered with Du Qi Wan (All-Qi Pill), cured him in two months.
Chai Yuqing treated Gao Tangxi, Prefect of Ganzhou, who suddenly vomited blood while working in Shenyang Ministry of Works. Doctors advised cooling hemostatics. Palpating calm pulses, Chai said: "You teach reading, exhausting Heart, stirring Ministerial Fire, blood rises with it. Hemostatics will leave deep harm." Persuaded to stop medication. Next day, pale blood vomited, stopped in three days. Several regulating doses prevented recurrence.
Spring of Ding You year, Wei Fahai's young daughter had phlegm-cough for 40+ days, unable to lie down, ribs distended when lying, only able to sit propped up. Vomited bowlfuls of blood. Phlegm-resolving and hemostatic herbs failed. Pulses surging and slippery. "This is Lung Distension. Do not stop blood; invigorate blood." Si Wu Tang (Four Substances Decoction) plus Tao Ren (Persicae Semen), Qing Pi (Citri Reticulatae Pericarpium Viride), He Zi (Terminalia Chebulae Fructus), and Zhu Li (Bambusae Succus) was used. No bamboo in Shenyang, so Gua Lou (Trichosanthis Fructus) substituted. Blood stopped, slept peacefully, recovered after months of regulation.
Li Ziyuan, Director of Revenue Ministry, had cough, fever, continuous hematemesis, worsening with treatment. Prescriptions were heavy hemostatic and blood-tonifying. Pulses relatively mild, except Right Chi and Guan surging and large. Stomach-Spleen Wind-Heat, blocked by drugs, causing fever and bedridden state. Stomach-Spleen clearing agents used. Fever reduced in days, recovered after month of care.
Generally, in blood disorders, pulses should be deep and thin. If surging and large, prognosis is poor. Previous surging/large pulses were due to clogging by tonics, not original pulse, hence success. Generally, early blood disorder without external pathogens should first resolve blood, aided by moistening purgatives to move bad blood downward, then hemostatics to prevent root, then blood tonics to restore origin. If internal injury causes violent unceasing bleeding, or overexertion causes wild bleeding gushing like a spring from mouth/nose, immediate rescue is needed or death ensues. This differs from previous rules. Urgently use one to two liang of Renshen (Ginseng Radix et Rhizoma) powdered, mixed with one qian of refined flour, new well-water to paste consistency, sip anytime, or Du Shen Tang (Single Ginseng Decoction). Formless blood cannot generate quickly; formless Qi must be secured urgently. If True Yin fails and deficient Yang floats upward, causing massive hematemesis, Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) or Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) must solidify True Yin; Renshen (Ginseng Radix et Rhizoma) should not be used early here. Having seen many such cases, failing to distinguish Six Channel patterns leads to harm, so I elaborate.
Lv Dongzhuang treated nephew Gardener for hematemesis. Blood bright red with small purple clots. Pulse choppy and soggy, complexion white. Asked about chest nausea/pain radiating to back. Confirmed. Used Tao Ren Ni (Peach Kernel Paste) three qian, Hong Hua (Carthami Flos) three qian, combined with Li Zhong Tang (Regulate the Middle Decoction), plus Gui Zhi (Cinnamomi Ramulus) one qian. Warned: "Frequent intake will bring large amounts of black blood. Wait until black stops and fresh comes, then report." Patient followed, expectorated bucketfuls of phlegm/stasis, chest pain ceased. Returned, pulse round and solid. Given Kidney-regulating and Nutritive-nourishing herbs, plus Ming Men Wan (Gate of Life Pill), fully recovered.
Summer of Xin Chou year, Xue met astrologer Zhang Gu at Scholar Tu's residence. While discussing fate, Zhang vomited one or two mouthfuls of blood in the courtyard, saying he had this condition long ago, triggered by labor. Xue thought Labor damages Spleen Qi, blood scatters. Confirmed. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Shan Yao (Dioscoreae Rhizoma), Shu Di Huang (Rehmanniae Radix Preparata), Fu Shen (Poria cum Radix), and Yuan Zhi (Polygalae Radix) cured him. Next morning, Zhang asked why Si Wu Tang (Four Substances Decoction), Huang Lian (Coptidis Rhizoma), Shan Zhi Zi (Gardeniae Fructus) increased bleeding and fatigue, while Xue's dose stopped it instantly. Xue said: "Spleen controls blood, Lung governs Qi. Labor damages Spleen-Lung, causing wild blood. Former herbs tonified Spleen-Lung Qi, returning deficient blood to origin." (This case adopted in *Yi Guan*).
Lizhai treated a widowed man living alone for years, prone to hematemesis upon exertion, fever, irritability. Taking Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) caused high Qi and panting, worsening previous illness, plus turbid urine and spermatorrhea, fatigue, poor appetite, surging pulse strong on pressure. Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) plus Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Shan Zhu Yu (Corni Fructus), and Shan Yao (Dioscoreae Rhizoma) cured him.
Confucian scholar Yang Qiyuan, diligent and hardworking, had hematemesis with spasms and unconsciousness. Spleen-Stomach deficiency. Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) and Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) cured spasms. Gui Pi Tang (Restore the Spleen Decoction) stopped bleeding.
A man with cough, hematemesis, heat/thirst, profuse phlegm, night sweats, and spermatorrhea was cured by Di Huang Wan (Rehmannia Pill) ingredients plus Mai Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus). Later, labor/anger caused purple blood clots. Hua Rui Shi San (Flower Coral Stone Powder) then Du Shen Tang (Single Ginseng Decoction) gradually cured him. Later, labor-induced cough/hematemesis with surging/rapid pulses in Spleen/Lung/Kidney channels cured by Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia).
A diligent woman had winter cough/phlegm/fever, later hematemesis/night sweats, irregular menstruation, body pain. Cooling/phlegm-resolving herbs caused jaw locking and tendon contraction. Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Men Dong (Asparagi Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Shan Yao (Dioscoreae Rhizoma) cured her in over a year.
Li Dongyuan treated Zheng Zhongben, 23, with heart pain. Taking Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) caused rising Qi, tight hypochondrium, chest discomfort, chronic bloody sputum, emaciation, dry difficult stool, wiry-rapid pulse, slight night heat, reduced appetite. Lantern grass mixed with Ma Huang (Ephedrae Herba) fine powder, taken with Bai Zhu (Atractylodis Macrocephalae Rhizoma), Jie Geng (Platycodonis Radix), Tong Cao (Tetrapanatis Medulla), and Gan Cao (Glycyrrhizae Radix et Rhizoma) decoction. Ten doses halved illness. Tong Sheng San (Universal Salvation Powder) minus Shi Gao (Gypsum Fibrosum) made into pills, taken with Tao Ren (Persicae Semen) decoction.
Zhu Danxi treated a 56-year-old woman, summer red-phlegm cough. Renshen (Ginseng Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria) one qian each, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1.5 qian, Fang Feng (Saposhnikoviae Radix), Jie Geng (Platycodonis Radix) five fen each, Gan Jiang (Zingiberis Rhizoma) three fen, Gan Cao (Glycyrrhizae Radix et Rhizoma) one fen. Decocted to one-third, added Ou Zhi (Nelumbinis Nelumboflos Juice), boiled again, taken hot with San Huang Wan (Three Yellows Pill).
Prime Minister Wu Chongqing suddenly vomited blood. Sun Zhao used water-washed clam powder finely ground, mixed with minor Cinnabar, taken with rice drink, two qian, three times daily, bringing peace. Sun kept this secret; Wu obtained it through technique. Han Zigong's formula uses one qian Cinnabar and five fen true clam powder. (*Yi Shuo Xu Bian*).
Zhang Zihe treated Yue Balang, habitual drunkard. After binge drinking, hematemesis. Near one year, orange-yellow skin, confusion, days unconscious, unable to eat, rigid like syncope, both pulses deep and thin. Zhang said: "Deep/thin pulse indicates interior disease with accumulation." Zhou Che Wan (Boat Cart Pill) over 100 pills, Jun Chuan San (Draining River Powder) 5-6 qian, massive purgation over ten times. Stool like okra juice with dry feces, foul odor. Eyes opened, wrist extended, asked why. Relatives said: "After hematemesis, unconscious for days, Zhang cured you." Thereafter, diarrhea every 5-6 days, 4-5 times, until blood stopped. Occasional cough, tidal fever remained. Liang Ge San (Cooling Terrace Powder) plus Jie Geng (Platycodonis Radix) and Dang Gui (Angelicae Sinensis Radix) two liang each, water, old bamboo leaves, honey, decocted, sipped occasionally. Hearing about Renshen (Ginseng Radix et Rhizoma) and Bai Hu Tang (White Tiger Decoction), recovered in a month.
Li Shi Fan initially had cough-blood. Tiao Wei Cheng Qi Tang (Regulate the Stomach Descend-Yang Decoction) one liang with Dang Gui (Angelicae Sinensis Radix) ineffective. Zhou Che Wan (Boat Cart Pill) 50-60 pills, 3-4 movements, vomited bowl of blood. (Note: Mediocre doctors would doubt.) Next night, Zhou Che Wan (Boat Cart Pill) over 100 pills, Tong Jing San (Unblocking Channels Powder) 3-4 qian, massive purgation over ten times, half cured. Still using Huang Lian (Coptidis Rhizoma)...