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In the late spring of the Jia-Shen year, the wife of my cousin's nephew from Wu-men had a constitution with inherent heat in the Spleen and Stomach. After contracting wind-pathogens, she experienced dry eyes and a dry nose. She self-administered ginger soup, resulting in hemoptysis (coughing up blood) of several mouthfuls for three consecutive mornings.
She then indulged in drinking lotus root soup, which exacerbated her irritability and distension. The so-called exogenous pathogens enter from the exterior and must be expelled from the exterior. Ginger soup has a singular action and is ineffective; lotus root soup is cooling and astringent, thereby closing off the pathogen. A formula for releasing the exterior was used, adding Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), and Tianhuafen (Trichosanthis Radix). One dose resulted in a cure.

In the summer of the Gui-Wei year, my brother-in-law Chen Kehui, in the prime of life with vigorous qi and blood, drank excessively throughout the night and consumed roasted and fried foods. Several days later, he suffered from gastric discomfort and vomited approximately one bowl of blood. His pulse was surging, slow, and spirited, with no other accompanying symptoms. He was prescribed Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), supplemented with Tianhuafen (Trichosanthis Radix) and Chuanlian (Coptidis Rhizoma). After three doses, while still allowing him to drink lotus root soup freely, he made a full recovery. Previously, this decoction, being cold and cooling to drain fire, was intended for treating excess heat and accumulated heat in the Spleen and Stomach, yielding results as swiftly as striking a drum. Contemporary physicians, unaware of this, assumed its efficacy could be universally applied to treat deficiency-consumption with hemorrhage, thereby damaging the stomach and draining yang, leading patients to death without realization. Do they not know that people vary in age (old vs. young), constitutions differ (deficiency vs. excess), and syndromes present as either cold or heat? Treatment must be tailored appropriately to be effective. How can one indiscriminately apply the same treatment?

In the summer of the Jia-Shen year, the eldest daughter of Lin Dingwan, a fellow student, married my nephew-in-law Chen Changyuan. She was only twenty years old. Her primordial qi was deficient and cold; her complexion was cyanotic and pale; her limbs were frequently cold; she vomited phlegm, felt bloated, and had clear, profuse urination. She suffered from rectal bleeding (hematochezia) that persisted for months without healing. Her pulse was deep and hidden, seemingly absent, becoming palpable only upon heavy pressure to the bone. I stated: The pulse and symptoms correspond. This is hemorrhage due to visceral qi deficiency and cold. I prescribed Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), removing Chuanxiong (Ligustici Chuanxiong Rhizoma) and Baishao (Paeoniae Radix Alba), adding Shufu (Aconiti Lateralis Radix Preparata) and Paojiang (Zingiberis Rhizoma Preparatum), with a small amount of Shengma (Cimicifugae Rhizoma). After only four doses, the rectal bleeding stopped abruptly, her mental clarity improved, and her stomach strength increased, showing appetite. If this syndrome were mistakenly considered heat and treated with cold agents, survival would be unlikely.

In mid-summer of the Wu-Yin year, while visiting Yin Zhou Shou in Dongjiao, I stayed with his contemporary, Zhu Mingshe, a Xiao-liang degree holder. Observing his cyanotic-yellow complexion and frequent trips to the toilet, I inquired about his condition. Zhu replied: Initially, after contracting cold and drinking excessive ginger soup, he suffered from internal heat causing rectal bleeding. It was treated with cold agents like Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma), resulting in an immediate cure. In autumn, upon traveling north, exhaustion triggered a relapse. He continued taking the previous prescription. Upon the second dose, he rejected the medicine and vomited, so he stopped. He managed by consuming bland, quiet dietary care, recovering after twenty days. Recently, due to alarm and fatigue from bandit warnings on desolate roads, the illness recurred. For three months, fatigue has worsened. Several physicians insisted on using cold agents, but he feared them and did not comply. I palpated his pulse; all six positions were deep, slow, soggy, and weak. This is easily treatable, though it requires considerable travel expenses. Zhu said: Having recovered from a three-year chronic ailment suddenly, why spare trifles? He offered a pearl ring to reward my virtue. I said: You initially contracted hot-warm pathogens and received bitter-cold agents matching the syndrome, hence the immediate cure. However, although the heat cleared, the blood vessels of the large intestine had not yet closed. Thus, every instance of labor triggers recurrence. Labor injures the Spleen; when the Spleen is injured, it cannot control blood, causing it to sink and exit through existing vessels. This is indeed due to labor, not heat. Recall Yang Renzhai's saying: When disease persists and heat declines, your syndrome cannot be classified as heat. Why persist with the previous agent? Bitter-cold damages the stomach, leading to vomiting. With three recurrences, primordial qi became increasingly deficient. Thus, the more deficient, the more bleeding; the more bleeding, the more deficient, dragging on for years and increasing debility. Treatment requires purely warm, stabilizing, and tonifying agents to secure vitality. Zhu rose hastily from his seat, slapped the table, and exclaimed: Your few words are sufficient to save my life, let alone teach me like a bird in a cage. In these three years, I traveled through Qin, Chu, Qi, and Liang, visiting famous physicians, but none analyzed from the root source like you. I used Shudi (Rehmanniae Radix Preparata) as the sovereign herb, Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) as ministers, Danpi (Moutan Cortex), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata), Wuweizi (Schisandrae Fructus), Zhimu (Anemarrhenae Rhizoma), Fuling (Poria), and Ejiao (Asini Corii Colla) as assistants, citing Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) as guides, prepared as pills. He was also instructed to drink Guipi Tang (Restore the Spleen Decoction) with minor modifications. After twenty days, bleeding halved, stomach qi gradually strengthened, and within a month, his complexion turned ruddy and all symptoms vanished. At parting, he offered gold and silk, which I firmly declined, saying: Meeting briefly, our friendship is heavier than metal and stone. Saving lives is a great deed; do I dare expect reward? Later, I heard that the eldest son of Lin Jinshu, who managed salt administration, also suffered from this syndrome. Despite seeking famous doctors and treating with blood-cooling and fire-clearing medicines, the condition worsened over time. Each jin of pills contained 4-5 liang of Chuanlian (Coptidis Rhizoma), ultimately causing stomach damage and yang depletion, leading to death. Is this not painful? As a family friend, I went to mourn and learned the details. Although medical texts state that lower hemorrhage belongs to yin and is favorable, such mismanagement reverses this principle.