外治法芒硝、五味、牛膝、荆芥、银花各三钱，煎水含漱。又法牙皂五分，梅片一分，麝香五厘，点入牙缝，其痛立止。虫痛寒痛加川椒四五分。痰火痛加芒硝一钱，共研末。
《评琴书屋医略》卷二终 评琴书屋医略 卷三
淋有五淋之分，浊有精浊便浊之别，总属肾病。肾有二窍，一出溺一出精。淋出溺窍，而属肝胆；浊出精窍，而属心肾，不得混治。
赤茯苓四钱 当归梢一钱 山栀仁一钱川萆薢四钱 甘草梢一钱 石菖蒲三分
石淋下如沙石，用银硝、朱砂、滑石等分，研匀(朴硝一味，宜隔纸炒，炒至纸变黄色为度)，每服三钱(或加发灰、石首鱼头内石灰)，即将此汤送下，甚则日服二三次(另用海金沙、木通，煎汤送)。膏淋下如膏脂，加乌药、益智仁(冲监些少)。气淋气滞不通，脐下闷痛，加荆芥、制香附、麦芽。劳淋从劳力而得，加人参、黄耆、白术，少佐升麻、柴胡(归，改用全归草改用炙草)。
血淋瘀血停蓄茎中作痛，加牛膝、郁金、桃仁，或冲韭白汁小杯同服。
至若点滴，俱无症名，癃闭，加北杏三四钱，麻黄一钱，同煎(夏月麻黄用四五分)。若癃闭而不渴，此法不宜，须另用通关丸主治(即滋肾丸)。
附案二(石淋)
黄阁乡张某，年七十余，患石淋，小便点滴而出，痛甚，少腹胀，气微喘，能食。医用清利法罔效，求余治。左尺弦大直上左关。余用大补阴丸合滋肾丸治，龟版一两，地黄五钱，知母、黄柏各三钱，肉桂六分。张畏桂性热减其半，服后小便稍通，腹胀略减，而痛不除。再求治，余谓必须佐桂六分乃效。信服之。小便大利，出石数粒如橘核大，遂愈。
明经乡周韶石叔令昆年将三十，石淋阻塞溺窍，点滴不通，以至腹胀如鼓，痛楚不堪，卧床不起。危急之际，延余治。脉呆钝不甚应指(气不升降转旋失职故也)。余用京柿炭一个(连霜蒂煅)，朱砂三钱(二味方得白杨溶马虞阶孝廉，谓：凡小便不通，皆合用粥水送下。余用治血淋屡效。今又仿之以治石淋)芒硝三钱，同研末。用杜牛膝五钱(时药店无，以鲜土牛膝一两代)，怀牛膝、川滑石、黄柏、桃仁、大韭白各三钱，甘草梢、石菖蒲各七分，煎汤送下。服后出石一条，长约一寸大，如粗箸，小便遂频出，床地俱湿，腹胀顿消而愈。
治浊症方
建莲米四钱，连心 麦冬一钱，连心 石菖蒲五分，盐水炒 云茯苓三钱 益智八分， 远志肉八分，青黛拌水，煮干 川萆薢三钱 乌药八分，甘草梢八分，盐水炒
湿盛加苍术、白术、黄柏(去麦冬、远志、莲米)。便浊加猪苓、泽泻或海金沙、滑石(亦去麦冬、远志、莲米)。精浊加免丝子、桑螵蛸、生龙骨，或关沙苑、山药、五味(去草梢、萆薜、乌药、益智)。赤浊加生地、当归、天冬(去萆薢、乌药、益智)。白浊加人参、黄耆、白术，或苍术、猪苓(去萆薢、麦冬、乌药，或再去远志、莲米)。凡茎中痛，必须加盐水炒黄柏为引。
遗 精
此症当辨有梦无梦与湿热之因，有梦治心，无梦治肾，湿热治小肠、膀胱。阴虚者填精，阳虚者补气，阳强者泻火。故前贤治法，有宁心益肾，填精固元，与清利湿热之别。兹先拟一宁心益肾固摄之剂，以便因各见症加减治之。
桑螵蛸二钱 云茯神三钱 大麦冬二钱，连心 建莲米五钱，连心 熟枣仁一钱半 远志肉五分，制
加龟版打碎五钱，生龙骨打碎三钱，二味先煎，或加菖蒲、云连各三四分，为佐使(如有梦加多些黄连，无梦但加五味、人参)。
阴虚加熟地、天冬、阿胶、当归等(去枣仁、远志、茯神)。阳虚加人参、黄耆、杞子、杜仲、白术等(去龟版、麦冬、龙骨、桑螵蛸)。阳强加生地、知母、黄柏(去枣仁、远志、茯神)。遗泄频频，宜佐以固摄之品，如兔丝子、五味子、覆盆子、金樱子、莲须之类，选入一二味为佐使。至若精遗，因湿热者，宜另用猪苓汤法治之(其芡实、山药、沙苑、莲米，凡遗泄症皆可常食)。
便 血
此症有风淫肠胃，有湿热伤脾。始则脏腑受伤，久则阴络亦损，治原不一(肯堂《医镜》芊录《尊生》引述颇详，当参考之)，兹即大肠受热者订一方，俟因症加减。
大生地六钱 黄柏炭七分 槐花一钱半赤小豆四钱 地榆炭七分 银花一钱半
热甚再加黄芩、莲叶，或桑叶、丹皮如服二三贴，血仍见，必须用黑芝麻(洗净打破)、生首乌各四钱，加入同煎(去木贼、梅)。因湿加防风、白术(去生地)。因风加荆芥、当归、防风(去银、槐花)。若血下色淡者，另用四物汤加龟版、生首乌、制首乌，煎服。便合。倘便血流连止而复发，用生首乌末，米糊丸，每服三四钱，甚效(用京柿黑豆煎汤送下更佳)。《金匮》分别粪前下血为近血，用赤小豆散；粪后下血为远血，用黄土汤，果于脉症有相合，则于古法自堪师。余尝治戴姻兄便血，或粪前或粪后无定，用生首乌、制首乌、大生地各四钱，白术、防风、木瓜、白芍各一钱，当归、陈皮各七分一帖血减，三帖全愈，凡便血京柿、黑豆、绿豆、赤小豆、黑芝麻、莲米可常服(或糖作羹，或选入同猪精肉柴鱼，或猪大肠煎汤，俱佳)。
小 便 血
即尿血，溺窍病也。其源由于肾虚，非若血淋。由于湿热，其分辨处以痛不痛为断。痛属血淋，不痛属尿血，余订是方，施治颇效，因录存之。且此方不但治尿血，方中乌梅炭、当归、兔丝子皆倍用，生地改用熟地，其当归、莲米二味同，用黑米醋煮透，炒干，妇女崩漏，久不愈，亦会迭效。
龟腹版一两，先煎 兔丝子四钱 大生地五钱 鹿角霜三钱，先煎 白当归一钱半 建莲米五钱，连心用，打破煎
加乌梅炭二个(米醋泡洗)为引。
如阴虚火炎加知母、黄柏各一二钱(此配入大补阴丸法)。用猪腰子汤、京柿黑豆汤、旱莲草汤(方书有独重用旱莲治此症者)，代水煎药俱佳。此等间药少用则无功，多用则碍方药煎，故酌用煎汤代水一法(前芦根通草汤即此意)。
王肯堂《医镜》主心经受热，遗热小肠，用五淋汤加石莲、麦冬，而君以黄连治之。余思此方可治血淋，似难治尿血，姑录以，俟考。因《直指》云小肠有气则小便胀，小肠有血则小便涩，小肠有热则小便痛，可知无痛则无热。尿血无痛，故疑王论沈芊绿亦主肾虚，以太极丸主治。
衄 血
肺火上蒸则血从鼻出，名曰鼻衄。大肠与胃热上逼，则血从齿出，名曰齿衄。均宜清降方可统治。但齿衄血症最轻者，可服药，可不服药。
干白茅根四钱，鲜者倍用 大生地三钱 元参三钱 正土桑白四钱，鲜者倍用 大麦冬三钱连心 牛膝一钱半
服二三剂。血不止加童便一小杯冲服，令引热下行，必应热盛钗斛、天冬、丹皮、黑栀、白茅花可任加。
倘鼻衄不甚者亦等齿衄，均无足虑。若其甚者，与吐血无异，盖漏血过多而不止，则非关血热，实由气虚不能统摄，急当补气以摄血，补气以生血。宜用当归补血汤法，黄耆一两，当归三钱，加姜枣煎(不涉医者逐杯试之)。此法虽气息奄奄，亦可回生。至于伤寒鼻衄，名曰红汗。瘟疫鼻衄，名曰外溃，皆喜其得衄而自解，不必再商治(凡一切血症突来太多者，必须于补气法治之)。
吐 血
有内因外因，究竟因于内而七情饥饱劳力所伤者尤多，攻补温寒，须凭脉证，兹先就阴弱阳亢者，拟一方，后参末议。
大生地八钱 干茅根四钱 旧黑栀一钱大天冬三钱， 茜草根一钱 细甘草五钱
服一二剂，倘仍频吐不止，再加生莲叶三四钱，生艾叶二三钱，炮姜五六分，童便一二杯，冲服。或用田三七末。六七分，调入。如脉数热甚，加犀角、黄柏、丹皮。倘症轻者，旱莲、女贞、黑豆皮、浮小麦、麦仁、麦冬、桑寄、知母，可任加。如无外感，鳖甲、龟版、元参、牛膝、秋石皆可酌用。若咳胸胁引痛者，加冬瓜仁、生薏米、苏子、降香以降络，桃仁、红花、以活络。吐血先见胸痛，血黑成块者，此为瘀血，加桃仁、丹皮、香附醋炒，大黄治之(皆去甘草)。然此特初患治法，高鼓峰云：血症久，古人多以胃药收功。如乌药、沉香、炮姜、大枣，此虚家神剂也。倪漱山亦云：七情内伤，脾胃先病(故多见恶心)，固元汤、归脾汤、补中益气汤等法必不可少。而吾见患此症者，医不轻用，补病家尤畏。夫补以至愈后，或数月而复发，或一年而复发，卒至缠绵而莫救者，多矣。亦由其元气已亏，营血未能安常，而循行经络也。余于见信者，虽属热症，以清凉奏功，继主育阴和阳，亦必佐以固本培元之法，如生脉六味、生脉四君与左归饮加参归等，更用归脾丸原方，或遵鼓峰法加减蜜小丸常服。守此法调养，以至于康健胜常，血水不发者，指不胜屈。肯堂于火症血稍止即用龟版、首乌、地榆加入四物汤治之，鼓峰用六君加当归治之，或加黄耆，谓参耆以回其气，气回血自循行经络，或用重料六味左归等饮于水中养木，亦必加人参，谓使气自阴生也。又芊绿引《仁斋直指》云：凡气虚挟寒，阴阳不能相守，血亦妄行，宜理中汤加木香、当归(姜炮黑)，血得暖自循行经络。沈修园亦谓，凡吐血服寒凉及滋润药益甚，而望其形色有寒冷象者，是阳虚阴走，亦主理中汤加木香、乌药，或木香、当归。要之，所因不一，亦难尽述，欲通变达权，温清各当，当于本门所载博览之。
凤浦冯君，薏庭人，瘦而长咳嗽，继以吐血，医与温胃痰药，血益甚。延予治，脉得左坚右弱。予曰：贵恙乃肝肾阴虚而生，内热薰蒸脉络，致血不得宁静。前贤谓瘦人之病虑虚其阴，今服燥药，即犯虚虚之戒，阴愈亏，阳愈炽矣，故血益甚。愚见主先治肝方，用复脉汤去桂、姜(参用丽参)加白芍二钱，生牡蛎块五钱；次日诊，仍用前方加田三七末四分，冲服，另用淡莱黑豆、冬虫草煎猪精肉汤作饭菜；再诊，脉缓血止，惟咳痰难出，转用醒胃汁以涤痰饮一法，麦门冬汤加钗斛二钱(与丽参同先煎)，五六贴，诸恙俱安；继用归脾去木香加陈皮、白芍、五味、麦冬、杞子为小丸，常服。痰咳渐除，身体日健。
凤浦胡君易堂，夏患痰咳失血，医用胶地等作肝肾阴虚生内热治，不效，且痰增胃减。延余诊，脉得右坚左弱。余曰：前人主左坚填肝肾，右坚理肺胃，今右坚治胃为要，炎夏阳气方升泄，胃阴虚而无镇压之权势，必震动胃络，络伤则络中之血因随阳气上升，倘云三阴热蒸，脉必征于左部，据理论治药宜选淡薄味，以调养胃阴，曾服腻药太多，须佐以宣畅脘气方可消痰安谷，生扁豆(用粒不打)五钱，丽参一钱，麦冬、茯神各三钱，石斛、谷芽各二钱，陈皮、甘草各四分，服三贴，再诊，血止脉缓，惟时或心悸，或汗微泄，主兼理心营肺卫，黄耆、沙参各三钱，丽参、麦冬各二钱，五味、炙草各三分，麦仁、枣肉各四钱，多服调养。仍用归脾丸加杞子、五味，蜜小丸，常服。精神自此日旺，体健胜于平时。吾因思胡冯二君皆先服清而后受补，故血不复发，实赖参耆以回其气，气回血得守其常度而循行经络也。夫患血而畏补者，多是以终难了局，因存此二案醒之。
又案(苦寒过服元气受伤)
羊城宋君勉之知医，素喜清凉，涉稍温补不敢服。久患咳血，所服药饵，无非清降，以致年余反覆不已。近服犀角地黄汤，纳谷渐减，因邀余相参。诊右脉空大无神。余曰；《金匮》云：男子脉大为劳，谓阳气虚未能收敛也。即据君述症咳频则汗泄，显是气失统摄，络血上泛之征，倘依然见血投凉，见嗽治肺，胃口从兹败坏矣。愚见主急固脏真，正合仲景师元气伤当进甘药例。能守此法，胃土自安，肺金自宁，吐血痰咳亦自止。方拟黄耆四钱，人参、麦冬、白芍各一钱，五味、炙草各七分、杞子、南枣肉各二钱，勉之。见信，连服四贴，血止胃渐进，此后从余言，自用归脾汤加减调养而获愈。
续附丁卯新案
[External Treatment] Mangxiao (Natrii Sulfas), Wuweizi (Schisandrae Chinensis Fructus), Niuxi (Achyranthis Bidentatae Radix), Jingjie (Schizonepetae Herba), and Yinhua (Lonicerae Japonicae Flos) each three qian, decocted in water for gargling. Another method: Yazao (Gleditsiae Sinensis Spina), Meipian (Borneolum Syntheticum), and Shexiang (Moscus) in amounts of five fen, one fen, and five li respectively, applied into the interdental space; pain stops immediately. For pain caused by worms or cold, add Chuanjiao (Zanthoxyli Pericarpium) four to five fen; for pain caused by phlegm-fire, add Mangxiao one qian, all ground into powder together.
End of Volume 2 of Pingqin Shuwu Yilue. Start of Volume 3 of Pingqin Shuwu Yilue.
Lin Syndrome (Bai Zhuo [Turbid Urine] and Long Bi [Dysuria] are examined together).
Lin syndrome is divided into five types. Bai Zhuo has distinctions between Jing Zhuo [turbidity from essence] and Bian Zhuo [turbidity from stool], but all belong to Kidney disease. The Kidney has two orifices: one discharges urine, the other discharges essence. Lin discharges through the urinary orifice and belongs to Liver and Gallbladder disorders; Zhuo discharges through the essence orifice and belongs to Heart and Kidney disorders; they must not be treated indiscriminately.
Formula for Treating Lin Syndrome (can govern all five types of Lin; suitable to add guiding herbs based on syndrome differentiation).
Chi Fuling (Poria with Red Hostwood) four qian, Danggui Shao (Radix Angelicae Sinensis Cauda) one qian, Shanzhiren (Gardeniae Semen) one qian, Chuan Bixie (Dioscoreae Hypoglaucae Rhizoma) four qian, Gancao Shao (Glycyrrhizae Radix et Rhizoma Cauda) one qian, Shichangpu (Acori Tatarinowii Rhizoma) three fen.
Shi Lin [Stone Lin] involves passing sand-like stones in urine. Use Yin Xiao (Natrii Sulfas), Zhusha (Cinnabaris), and Huashi (Talcum) in equal parts, ground evenly. (If using Puxiao alone, it should be stir-fried between papers until the paper turns yellow). Take three qian per dose (or add Fa Hui [burnt hair] or Shihouyu Tou Nei Shihui [lime from stonefish head]), immediately delivered with this decoction. In severe cases, take two to three times daily (separately decoct Haijinsha [Lygodii Spora] and Mutong [Akebiae Caulis] to deliver the powder). Gao Lin [Paste Lin] involves passing substance like paste in urine; add Wuyao (Linderae Radix) and Yizhiren (Bletillae Rhizoma / Alpiniae Oxyphyllae Fructus - *Note: Context implies Alpiniae Oxyphyllae Fructus usually, but text says Bletillae/Alpiniae ambiguity, standard is Alpiniae*) a small amount, taken by沖 (dissolving in liquid). Qi Lin [Qi Lin] involves obstruction of Qi stagnation, with stifling pain below the umbilicus; add Jingjie (Schizonepetae Herba), Zhi Xiangfu (Cyperi Rhizoma Preparatum), and Maiya (Hordei Fructus Germinatus). Lao Lin [Labor Lin] results from overexertion; add Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), with a small amount of Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix). (Use Quan Danggui [whole root of Angelicae Sinensis Radix] instead of just the tip, and Zhi Gancao [prepared Licorice] instead of raw).
Xue Lin [Blood Lin] involves stasis of blood accumulating in the urethra causing pain; add Niuxi (Achyranthis Bidentatae Radix), Yujin (Curcumae Radix), and Taoren (Persicae Semen), or mix with a small cup of Jiubai Zhi (juice of garlic chive white part) and take together.
Regarding Long Bi [Dysuria/Oliguria] with no specific symptom name and only drops of urine, add Beixing (Armeniacae Semen Amarum) three to four qian and Mahuang (Ephedrae Herba) one qian, decocted together. (In summer, use Mahuang four to five fen). If Long Bi occurs without thirst, this method is unsuitable; instead, use Tongguan Wan (Passing Through Obstruction Pill) as the main treatment (which is Zishen Wan [Kidney-Nourishing Pill]).
Attached Case 2 (Stone Lin)
Mr. Zhang from Huangge Township, over seventy years old, suffered from Stone Lin. Urine passed only in drops, with severe pain, abdominal distension, slight shortness of breath, but able to eat. Doctors used clearing and draining methods without effect. He sought my treatment. The pulse at Left Chi was wiry and large, extending straight up to Left Guan. I used Dabu Yin Wan (Great Tonify Yin Pill) combined with Zishen Wan. Gui Ban (Testudinis Carapax et Plastrum) one liang, Dihuang (Rehmanniae Radix) five qian, Zimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) each three qian, Rougui (Cinnamomi Cortex) six fen. Mr. Zhang feared the heat nature of Rougui and reduced the dose by half. After taking it, urination improved slightly, abdominal distension decreased slightly, but pain remained. He sought treatment again. I said that Rougui six fen must be added as an assistant for efficacy. He believed me and took it. Urination became profuse, and several stones were passed, sized like orange seeds. He then recovered.
Mr. Zhou Shaoshi’s younger brother from Mingjing Township, nearly thirty years old, had Stone Lin blocking the urinary orifice, unable to pass urine even in drops, leading to abdominal distension like a drum, unbearable pain, and inability to get out of bed. In this critical situation, he invited me to treat him. The pulse was dull and sluggish, not responding well to pressure (due to dysfunction of Qi ascending and descending and rotating). I used one Jing Shi Tan (Charred Chinese Persimmon Fruit, including the calyx calcined), Zhusha (Cinnabaris) three qian (I learned these two ingredients from Bail Yangrong and Ma Yujiexiao Lian, who said: for any case of urinary obstruction, porridge water should be used to deliver the medicine. I have used this successfully many times for Blood Lin. Now I imitate it to treat Stone Lin), Mangxiao (Natrii Sulfas) three qian, all ground into powder. Use Duniu Xi (Chrysanthemi Indici Radix) five qian (fresh Tu Niu Xi [Achyranthis Bidentatae Radix] one liang was used as substitute since the pharmacy lacked it), Huainiu Xi (Achyranthis Bidentatae Radix), Chuan Huashi (Talcum), Huangbai (Phellodendri Cortex), Taoren (Persicae Semen), and Da Jiubai (white part of Allium tuberosum) each three qian, Gancao Shao (Licorice Cauda) and Shichangpu (Acori Tatarinowii Rhizoma) each seven fen. Decoct and use the liquid to deliver the powder. After taking it, a stone strip about one cun long, thick as a chopstick, was passed. Urination became frequent, wetting the bed and floor, abdominal distension disappeared instantly, and he recovered.
Formula for Treating Zhuo Syndrome
Jian Lianmi (Nelumbinis Semen) four qian, with heart; Maidong (Ophiopogonis Radix) one qian, with heart; Shichangpu (Acori Tatarinowii Rhizoma) five fen, stir-fried with salt water; Yun Fuling (Poria) three qian; Yizhi (Alpiniae Oxyphyllae Fructus) eight fen; Yuanzhi Rou (Polygalae Radix Flesh) eight fen, boiled dry after mixing with Qingdai (Indigo Naturalis) and water; Chuan Bixie (Dioscoreae Hypoglaucae Rhizoma) three qian; Wuyao (Linderae Radix) eight fen; Gancao Shao (Licorice Cauda) eight fen, stir-fried with salt water.
If dampness is excessive, add Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), Huangbai (Phellodendri Cortex); remove Maidong, Yuanzhi, and Lianmi. For Bian Zhuo (stool turbidity), add Zhuling (Polyporus), Zexie (Alismatis Rhizoma), or Haijinsha (Lygodii Spora) and Huashi (Talcum); also remove Maidong, Yuanzhi, and Lianmi. For Jing Zhuo (essence turbidity), add Tusizi (Cuscutae Semen), Sangpiaoxiao (Mantis Oötheca), and Sheng Longgu (Fossilia Ossis Maxillaris); or Guanshayuan (Astroci Semen), Shanyao (Dioscoreae Rhizoma), and Wuwei Zi (Schisandrae Fructus); remove Gancao Shao, Bixie, Wuyao, and Yizhi. For Chi Zhuo (red turbidity), add Shengdi (Rehmanniae Radix Recens), Danggui (Angelicae Sinensis Radix), and Tiandong (Asparagi Radix); remove Bixie, Wuyao, and Yizhi. For Bai Zhuo (white turbidity), add Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), or Cangzhu (Atractylodis Rhizoma) and Zhuling (Polyporus); remove Bixie, Maidong, and Wuyao, or further remove Yuanzhi and Lianmi. For any pain in the penis, Salt-stir-fried Huangbai (Phellodendri Cortex) must be added as a guiding herb.
Spermatorrhea
This syndrome requires distinguishing between having dreams or not, and the cause of damp-heat. Treat the Heart if there are dreams; treat the Kidney if there are no dreams; treat Small Intestine and Bladder for damp-heat. For Yin deficiency, tonify essence; for Yang deficiency, tonify Qi; for strong Yang, drain fire. Thus, ancient experts’ treatments differ between calming the Heart and benefiting the Kidney, filling essence and securing origin, versus clearing and draining damp-heat. Here, I first draft a formula to calm the Heart, benefit the Kidney, and secure retention, to be modified according to various symptoms.
Sangpiaoxiao (Mantis Oötheca) two qian; Yun Fushen (Poria with Pine Root) three qian; Da Maidong (Ophiopogonis Radix) two qian, with heart; Jian Lianmi (Nelumbinis Semen) five qian, with heart; Shu Zaoren (Ziziphi Jujubae Semen Preparatum) one and a half qian; Yuanzhi Rou (Polygalae Radix Flesh) five fen, prepared.
Add Gui Ban (Testudinis Carapax et Plastrum) crushed, five qian; Sheng Longgu (Fossilia Ossis Maxillaris) crushed, three qian. These two should be decocted first. Or add Shichangpu (Acori Tatarinowii Rhizoma) and Yunlian (Coptidis Rhizoma) three to four fen each, as assistants and guides. (If there are dreams, add more Huanglian; if no dreams, add only Wuwei Zi and Renshen).
For Yin deficiency, add Shudi (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), Ejiao (Colla Corii Asini), and Danggui (Angelicae Sinensis Radix); remove Zaoren, Yuanzhi, and Fushen. For Yang deficiency, add Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Qizi (Lycii Fructus), Duzhong (Eucommiae Cortex), and Baizhu (Atractylodis Macrocephalae Rhizoma); remove Gui Ban, Maidong, Longgu, and Sangpiaoxiao. For strong Yang, add Shengdi (Rehmanniae Radix Recens), Zimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex); remove Zaoren, Yuanzhi, and Fushen. For frequent leakage, add astringent herbs such as Tusizi (Cuscutae Semen), Wuweizi (Schisandrae Fructus), Fupenzi (Rubiae Fructus), Jinyingzi (Chrysanthemi Fructus), and Lianxu (Nelumbinis Stamen); select one or two as assistants and guides. For spermatorrhea caused by damp-heat, use Zhuling Tang (Polyporus Decoction) separately. (Qianshi [Euryales Semen], Shanyao [Dioscoreae Rhizoma], Shayuan [Astroci Semen], and Lianmi [Nelumbinis Semen] can be commonly eaten for all spermatorrhea syndromes).
Hematochezia (Blood in Stool)
This syndrome involves wind invading the intestines and stomach, or damp-heat damaging the spleen. Initially, the zang-fu organs are damaged; later, the yin collaterals are also injured. Treatments vary (Kentang’s *Yi Jing* and Qianlü’s *Zunsheng* cite extensively; refer to them). Here, I formulate a prescription for heat in the Large Intestine, to be modified according to symptoms.
Da Shengdi (Rehmanniae Radix Recens) six qian; Huangbai Tan (Phellodendri Cortex Carbonisatum) seven fen; Huaihua (Sophorae Flos) one and a half qian; Chixiaodou (Phaseoli Semen Rubrum) four qian; Diyu Tan (Sanguisorbae Radix Carbonisatum) seven fen; Yinhua (Lonicerae Japonicae Flos) one and a half qian.
Add Muzei (Equiseti Herba) one qian and Wumei (Mume Fructus) two pieces, decocted together (Wumei may be carbonized).
If heat is severe, add Huangqin (Scutellariae Radix) and Lianye (Nelumbinis Folium), or Sangye (Mori Folium) and Danpi (Moutan Cortex). If bleeding persists after two or three doses, use Hei Zhima (Sesami Fructus Niger) (washed and crushed) and Sheng Shouwu (Polygoni Multiflori Radix Recens) each four qian, added to the decoction (remove Muzei and Wumei). If due to dampness, add Fangfeng (Saposhnikoviae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma); remove Shengdi. If due to wind, add Jingjie (Schizonepetae Herba), Danggui (Angelicae Sinensis Radix), and Fangfeng (Saposhnikoviae Radix); remove Yinhua and Huaihua. If the blood color is pale, use Siwu Tang (Four Substances Decoction) plus Gui Ban (Testudinis Carapax et Plastrum), Sheng Shouwu (Polygoni Multiflori Radix Recens), and Zhi Shouwu (Polygoni Multiflori Radix Preparata), decocted and taken. Bowel movement becomes smooth. If hematochezia recurs after stopping, use Sheng Shouwu powder made into pills with rice paste, taking three to four qian per dose; very effective (delivering with decoction of Beijing Persimmon and Black Bean is better). *Jinkui Yaolue* distinguishes blood before stool as Jin Xue [proximate blood], treated with Chixiaodou San; blood after stool as Yuan Xue [remote blood], treated with Huangtu Tang. If pulse and symptoms match, ancient methods are worthy of emulation. I once treated my brother-in-law Dai with hematochezia, sometimes before, sometimes after stool. I used Sheng Shouwu, Zhi Shouwu, and Da Shengdi each four qian, Baizhu, Fangfeng, Mugua, and Baishao each one qian, Danggui and Chenpi each seven fen. One dose reduced bleeding; three doses cured completely. For hematochezia, Beijing Persimmon, Black Bean, Mung Bean, Chixiaodou, Hei Zhima, and Lianmi can be commonly consumed (made into soup with sugar, or cooked with pork lean meat, dried fish, or pig large intestine broth; all are good).
Hematuria (Blood in Urine)
Also called Niao Xue, this is a disease of the urinary orifice. Its source is Kidney deficiency, unlike Blood Lin which is due to damp-heat. The distinction lies in pain: pain indicates Blood Lin; no pain indicates Hematuria. I formulated this prescription, which is quite effective, so I record it. Moreover, this prescription treats not only Hematuria; in it, Wumei Tan (Mume Fructus Carbonisatum), Danggui (Angelicae Sinensis Radix), and Tusizi (Cuscutae Semen) are doubled. Shengdi is changed to Shudi (Rehmanniae Radix Preparata). Danggui and Lianmi are boiled thoroughly in black rice vinegar and stir-fried dry. For women with Bing Lou [metrorrhagia and leukorrhea] that does not heal for a long time, it also yields repeated success.
Gui Fu Ban (Carapax Testudinis et Plastrum from the belly) one liang, decocted first; Tusizi (Cuscutae Semen) four qian; Da Shengdi (Rehmanniae Radix Recens) five qian; Lu Jiao Shuang (Cornu Cervi Pantotrichum Preparatum) three qian, decocted first; Bai Danggui (Angelicae Sinensis Radix) one and a half qian; Jian Lianmi (Nelumbinis Semen) five qian, with heart, crushed and decocted.
Add Wumei Tan (Mume Fructus Carbonisatum) two pieces (soaked and washed in rice vinegar) as a guiding herb.
If Yin deficiency with flaming fire, add Zimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) one to two qian each (this follows the method of combining with Dabu Yin Wan). Use Pig Kidney Soup, Beijing Persimmon and Black Bean Soup, or Hanliancao (Ecliptae Herba) Soup to replace water for decocting; all are good. These herbs are ineffective in small doses and obstruct the formula in large doses, so the method of decocting soup to replace water is used appropriately (the previous Lugentongcao Tang shares this intent).
Wengtengtang’s *Yi Jing* states that heat in the Heart Meridian transmits to the Small Intestine; use Wulin Tang (Five Lin Decoction) plus Shilian (Nelumbinis Plumula) and Maidong (Ophiopogonis Radix), with Huanglian (Coptidis Rhizoma) as the sovereign drug. I think this formula can treat Blood Lin but seems difficult for Hematuria; I record it tentatively for verification. Because *Zhizhi* states: Small Intestine qi causes urinary distension; Small Intestine blood causes urinary difficulty; Small Intestine heat causes urinary pain. Thus, no pain means no heat. Since Hematuria has no pain, I doubt Wang’s theory. Shen Qianlü also attributes it to Kidney deficiency and uses Taiji Wan as the main treatment.
Epistaxis (Nosebleed)
When Lung fire steams upward, blood flows from the nose, named Bi Nu (Nasal Epistaxis). When Large Intestine and Stomach heat force upward, blood flows from the teeth, named Chi Nu (Gingival Bleeding). Both are suitably governed by clearing and descending methods. However, the mildest cases of Gingival Bleeding may be treated with or without medicine.
Gan Bai Mao Gen (Imperatae Rhizoma Dry) four qian; fresh double the dose; Da Shengdi (Rehmanniae Radix Recens) three qian; Yuan Shen (Scrophulariae Radix) three qian; Zheng Tu Sang Bai Pi (Mori Cortex Radix) four qian; fresh double the dose; Da Maidong (Ophiopogonis Radix) three qian, with heart; Niuxi (Achyranthis Bidentatae Radix) one and a half qian.
Add Xian Zhu Ru (Bambusae Caulis in Tenon) and Qing Yuan Cha (Green Tea) each two qian, decocted together. (The formula is mild; decoct abundantly and drink as tea).
Take two to three doses. If bleeding does not stop, add a small cup of Tong Bian (Child’s Urine) to dissolve and take, directing heat downward. It will surely work. For severe heat, Shihu (Dendrobii Caulis), Tiandong (Asparagi Radix), Danpi (Moutan Cortex), Hei Zhi (Gardeniae Fructus Carbonisatum), and Bai Mao Hua (Imperatae Flos) can be added as needed.
If nasal epistaxis is not severe, it is similar to gingival bleeding and needs no worry. If severe, it is no different from hematemesis. Generally, if leakage is excessive and unceasing, it is not due to blood heat, but actually due to Qi deficiency failing to control. Urgently tonify Qi to grasp blood, and tonify Qi to generate blood. Use Danggui Buxue Tang (Danggui Tonify Qi Decoction) method: Huangqi (Astragali Radix) one liang, Danggui (Angelicae Sinensis Radix) three qian, decocted with Ginger and Jujube. (Do not involve doctors testing cup by cup). Although breathing is faint, this method can restore life. Nasal epistaxis in Cold Damage is called Hong Han (Red Sweat). Nasal epistaxis in Epidemic Disease is called Wai Kui (External Ulceration). Both are welcomed as self-resolution; no further treatment discussion is needed. (For all sudden heavy bleeding, Qi-tonifying methods must be used).
Hematemesis (Vomiting Blood)
There are internal and external causes. Ultimately, internal causes due to Seven Emotions, hunger/fullness, and labor are more common. Attack, tonify, warm, and cool must depend on pulse and symptoms. Here, I first draft a formula for Yin weakness and Yang hyperactivity, followed by final remarks.
Da Shengdi (Rehmanniae Radix Recens) eight qian; Gan Mao Gen (Imperatae Rhizoma Dry) four qian; Jiu Hei Zhi (Old Gardeniae Fructus Carbonisatum) one qian; Da Tian Dong (Asparagi Radix) three qian; Qian Cao Gen (Rubiae Radix) one qian; Xi Gancao (Licorice Radix et Rhizoma) five qian.
Add Sheng Bai Ye (Thuja Occidentalis Folium Fresh) two to three qian and Xian Ou Jie (Nelumbinis Rhizomatis Node Fresh) three pieces, decocted together.
Take one or two doses. If vomiting blood continues frequently, add Sheng Lian Ye (Nelumbinis Folium Fresh) three to four qian, Sheng Ai Ye (Artemisiae Argyi Folium Fresh) two to three qian, Pao Jiang (Zingiberis Rhizoma Preparatum) five to six fen, and Tong Bian (Child’s Urne) one to two cups, dissolved and taken. Or use Tian Sanqi (Notoginseng Radix et Rhizoma) powder six to seven fen, mixed in. If pulse is rapid and heat is severe, add Xijiao (Rhinocerotis Cornu - *substitute with Shuiniu Jiaojiao or similar in modern context, but text says Xijiao*), Huangbai (Phellodendri Cortex), and Danpi (Moutan Cortex). If symptoms are mild, Hanliancao (Ecliptae Herba), Nvzhenzi (Ligustri Lucidi Fructus), Heidoupi (Sojae Semen Nigrum Pericarpium), Fuxiaomai (Tritici Caput), Mailen (Tritici Semen), Maidong (Ophiopogonis Radix), Sangjisheng (Taxilli Caulis et Folium), and Zimu (Anemarrhenae Rhizoma) can be added as needed. If no external contraction, Biejia (Trionycis Carapax), Gui Ban (Testudinis Carapax et Plastrum), Yuan Shen (Scrophulariae Radix), Niuxi (Achyranthis Bidentatae Radix), and Qushi (Urinal Crystallinum) can be used酌情. If coughing with chest and hypochondriac pulling pain, add Dongguaren (Benincasae Semen), Sheng Yimi (Coicis Semen Recens), Suzi (Perillae Fructus), and Jiangxiang (Dalbergiae Odoriferae Lignum) to descend collaterals; Taoren (Persicae Semen) and Honghua (Carthami Flos) to invigorate collaterals. Vomiting blood preceded by chest pain, with dark clotted blood, indicates blood stasis; add Taoren (Persicae Semen), Danpi (Moutan Cortex), Xiangfu (Cyperi Rhizoma Vinegar-fried), and Dahuang (Rhei Radix et Rhizoma) to treat (remove Gancao). However, this is only the initial treatment method. Gao Gufeng said: For chronic blood diseases, ancients often concluded treatment with Stomach herbs. Such as Wuyao (Linderae Radix), Chenxiang (Aquilariae Lignum Resinatum), Pao Jiang (Zingiberis Rhizoma Preparatum), and Dazao (Ziziphi Jujubae Fructus); these are divine agents for deficient families. Ni Shushan also said: Internal injury from Seven Emotions damages the Spleen and Stomach first (thus nausea is common); Guyuan Tang, Guipi Tang, and Buzhong Yiqi Tang methods are indispensable. But in my experience, doctors rarely use tonics for this syndrome, and patients fear tonification. Even after recovery, relapse may occur months or a year later, eventually becoming intractable. This is because Yuan Qi is already deficient, and Ying Blood cannot maintain normal circulation in the collaterals. For those who trust me, even if it is a heat syndrome initially resolved by cooling, I subsequently focus on nourishing Yin and harmonizing Yang, always assisting with methods to solidify the root and cultivate origin, such as Shengmai Liuwei, Shengmai Sijun, Zuogui Yin plus Renshen and Danggui, etc. More use of Guipi Wan original formula, or modifications of Gufeng’s method into honey pills for regular use. Adhering to this method for regulation leads to health surpassing the norm, with no recurrence of blood issues, countless examples. Kentang, when fire syndrome bleeding stops slightly, adds Gui Ban, Shouwu, and Diyu to Siwu Tang. Gufeng uses Liujun plus Danggui, or adds Huangqi, stating that Renshen and Huangqi return Qi; once Qi returns, blood naturally circulates in collaterals. Or use heavy doses of Liuwei and Zuogui drinks to nourish Wood in Water, also adding Renshen, stating that Qi is generated from Yin. Qianlü cites *Renzhai Zhizhi*: For Qi deficiency with cold, where Yin and Yang cannot abide together, blood also acts recklessly; use Lizhong Tang plus Muxiang (Aucklandiae Radix) and Danggui (Angelicae Sinensis Radix) (Ginger-fried black); blood warms and naturally circulates in collaterals. Shen Xiuyuan also said: For vomiting blood, if cold-cooling and moistening medicines worsen it, and the appearance shows cold signs, it is Yang deficiency with Yin escaping; also advocate Lizhong Tang plus Muxiang and Wuyao, or Muxiang and Danggui. In summary, causes vary, hard to list all. To adapt and balance, warming and clearing appropriately, one must read extensively in this section.
Attached Case (Liver Disease Mis-treated as Stomach Disease)
Mr. Feng from Fengpu, from Yiting, was thin with chronic cough, followed by hematemesis. Doctors gave warm Stomach and phlegm-resolving medicines, making bleeding worse. He sought my treatment. Pulse was firm on the Left, weak on the Right. I said: Your illness arises from Liver and Kidney Yin deficiency generating internal heat, steaming collaterals, causing blood to lose tranquility. Ancients say for thin people, worry about Yin deficiency. Taking drying medicines now violates the prohibition of "deficiency inducing deficiency." Yin becomes more deficient, Yang more blazing, hence bleeding worsens. My view advocates treating the Liver first. Use Fumai Tang removing Gui (Cinnamomi Ramulus) and Jiang (Zingiberis Rhizoma Recens) (use Lishen [Codonopsis Radix] instead of Renshen), add Baishao (Paeoniae Radix Alba) two qian, Sheng Muli (Concha Ostreae) five qian blocks. Next day’s consultation: still use the previous formula plus Tian Sanqi (Notoginseng Radix et Rhizoma) powder four fen, dissolved and taken. Separately decoct Danshen (Salviae Miltiorrhizae Radix - *Text says Danlai/Dan Shen? Text says 'Dan Lai' likely referring to a specific ingredient or typo for Danshen/Laminaria? Context suggests dietary therapy. 'Dan Lai' might be Laminaria/Sargassum. Let's stick to text 'Dan Lai'*), Black Bean, and Dongchongxiacao (Cordyceps) in Pork Lean Meat Soup as meals. Third consultation: pulse slowed, bleeding stopped, but cough and phlegm difficult to expectorate. Switch to Xingwei Zhi (Awakening Stomach Juice) to wash away phlegm-fluids. Use Maidong Tang plus Shihu (Dendrobii Caulis) two qian (decocted first with Lishen). Five to six doses, all ailments settled. Subsequently use Guipi Wan removing Muxiang, adding Chenpi, Baishao, Wuweizi, Maidong, and Qizi, made into small pills for regular use. Phlegm and cough gradually removed, body strengthened daily.
Another Case (Stomach Disease Mis-treated as Liver Disease)
Mr. Hu Yitang from Fengpu, in summer suffered from phlegm-cough and blood loss. Doctors used Gelatin and Rehmannia to treat as Liver-Kidney Yin deficiency generating internal heat. Ineffective, phlegm increased, appetite decreased. I diagnosed. Pulse was firm on the Right, weak on the Left. I said: Ancients state firm Left fills Liver/Kidney; firm Right regulates Lung/Stomach. Now firm Right makes treating Stomach essential. In hot summer, Yang Qi ascends and dissipates. Stomach Yin deficiency lacks suppressing power, shaking Stomach collaterals. Collateral injury causes blood within to rise with Yang Qi. If it were Three Yin heat steaming, pulse would manifest on the Left. Based on theory, medicines should be light and bland to nourish Stomach Yin. Too much greasy medicine was taken previously; must assist with promoting Stomach Qi to resolve phlegm and settle grain. Use Sheng Bian Dou (Phaseoli Vulgaris Semen) five qian (whole beans, not crushed), Lishen (Codonopsis Radix) one qian, Maidong (Ophiopogonis Radix) and Fushen (Poria with Pine Root) each three qian, Shihu (Dendrobii Caulis) and Guya (Hordei Fructus Germinatus) each two qian, Chenpi (Citri Reticulatae Pericarpium) and Gancao (Licorice Radix et Rhizoma) each four fen. Take three doses. Re-consultation: bleeding stopped, pulse slowed, but occasional palpitations or slight sweating. Focus on simultaneously regulating Heart Ying and Lung Wei. Huangqi (Astragali Radix) and Shashen (Glehniae Radix) each three qian, Lishen (Codonopsis Radix) and Maidong (Ophiopogonis Radix) each two qian, Wuweizi (Schisandrae Fructus) and Zhi Gancao (Prepared Licorice) each three fen, Mailen (Tritici Semen) and Zaorou (Ziziphi Jujubae Pulpa) each four qian. Take more for regulation. Still use Guipi Wan plus Qizi and Wuweizi, honey small pills, regular use. Spirit improves daily, body healthier than usual. I reflect that both Mr. Hu and Mr. Feng first took clearing medicines then received tonification, so blood did not recur. This truly relies on Renshen and Huangqi to return Qi; once Qi returns, blood maintains normal degree and circulates in collaterals. Those fearing tonification when suffering from blood diseases often end in failure. I preserve these two cases to awaken others.
Another Case (Overuse of Bitter-Cold Damaging Yuan Qi)
Mr. Song Mianzhi from Guangzhou knew medicine, always preferring cooling, daring not to take anything slightly warming/tonifying. Suffered from hemoptysis for a long time. Medications taken were purely clearing/descending, causing recurrence for over a year. Recently took Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), food intake gradually decreased. Invited me to consult. Right pulse was empty, large, and spiritless. I said: *Jinkui* states: Men with large pulse indicate Labor (deficiency), meaning Yang Qi deficiency fails to converge. Based on your symptoms, frequent coughing causes sweating, clearly indicating Qi failing to control, collateral blood flooding upward. If you continue to see blood and use cooling, see cough and treat Lung, the Stomach gate will be ruined from now on. My view advocates urgently consolidating Zhen Zang (True Viscera), aligning with Master Zhongjing’s example that when Yuan Qi is damaged, sweet medicines should be advanced. If you adhere to this method, Earth of Stomach will settle, Metal of Lung will calm, and vomiting blood/phlegm/cough will stop spontaneously. Formula: Huangqi (Astragali Radix) four qian, Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), Baishao (Paeoniae Radix Alba) each one qian, Wuweizi (Schisandrae Fructus) and Zhi Gancao (Prepared Licorice) each seven fen, Qizi (Lycii Fructus) and Nan Zao Rou (South Jujube Pulpa) each two qian. Mr. Mianzhi trusted me, took four doses continuously. Bleeding stopped, Stomach function gradually improved. Thereafter, following my advice, he used modified Guipi Tang for regulation and recovered.
Continued Attached New Cases from Dingmao Year
(Yang Deficiency Ascending and Dissipating Forcing Blood to Act Recklessly)