例四王XX，女，41岁。因口腔出血伴皮肤起红点4天而就医。查血小板12000／立方毫米，西医诊断为原发性血小板减少性紫癜，即转来我处治疗。衄血如注，满嘴鲜血，周身红点及紫癜密布，气怯面黄，唇甲苍白，头昏而晕，心悸不宁，口干而不欲饮，齿痛而无红肿，脉沉细无力，舌质淡，苔薄白。辨证：气阴两虚，虚火上炎。治法：补气摄血，滋阴养血，益肾潜阳，引火归原。方药：绵黄芪15克太子参9克西当归9克杭白芍9克清阿胶6克(烊化冲入)活磁石15克墨旱莲15克枸杞子9克骨碎补15克川石斛15克血余炭9克(包)小红枣5个(切开)炮姜炭1．5克制附片3克肉桂粉0。9克(吞服)本方从喻嘉言，黄坤载血证方脱化而来。若残火不敛，徒补气摄血，滋阴养血，益肾潜阳则难以奏效，方用姜、附、桂是敛残火，亦反佐变通之法。服药后血即渐止，半月后衄血全止，身上红点以紫癜隐没，精神好转，血小板升至6万／立方毫米，乃出院休养。半月后来院复查，血小板已升至10万／立方毫米，而停止服药。’(邹云翔经验，黄新吾整理：反佐疗法在临床上的应用，《新医药杂志》6：11，1978)
例五赵X，男。经云：“脾者仓廪之本，荣之居也。”脾为统血之脏，今肝木贼之，湿伤太久，而致脾所统之血，错乱妄行，湿气留滞，清浊相混，三焦气化不相调，四旁不应，上下充斥，是以内脏之外阅诸宫窍，皆见出血，大便黑，小溲赤，鼻衄，牙龈溢血尤盛，此“脾气散精，上归于肺”之脾肺相关者也。肉渐脱，肤色天白，四末及爪甲更少荣色，舌绛，边缘猩红，苔白腻，唇白不焦而无华，纳少，口干不欲饮，日晡微热而潮汗，脉弦滑数，两关大。据述发病迄今已半年有余。西医检查谓“败血症’屡治不效，近来日益增剧。症颇险恶，姑拟清滋潜阳，扶健脾土，渗湿化燥，宣疏行气、助胃止血之标本兼顾法。鳖血青蒿12克血余炭9克血琥珀(先煎)6克生牡蛎(先煎)15克赤小豆(布包煎)30克焦谷稻芽各12克旋复花(布包煎)9克珍珠母(研先煎)30克蒲黄炭9克鲜藕30克鲜茅根30克鲜石斛(先煎)30克焦栀子9克生赭石9克川柏9克银花炭12克生滑石块15克川牛膝9克川郁金9克灵磁石(生研先煎)9克乌犀角尖0．9克(另煎兑入)犀黄丸6克(冲服)黄土汤煎药，早晚各一次温服共诊16次，服药40余剂，所患痊愈。黄土汤煎药法：以净黄土(取新鲜者)120克及清水1000毫升左右，放入锅中，沸煎一小时，然后放入白矾少许使之沉淀，俟冷用纱布滤出澄清，再取黄土汤入砂锅内代水煎药。(孔嗣伯介绍：孔伯华先生学术经验简介，《中医杂志》7：5，1962)[评按1衄血是指鼻、齿龈，耳、舌以及皮肤不因外伤而出血的病证。由于出血的部位不同，因而又有鼻衄、齿衄、舌衄、肌衄之称。衄血一般多为少量缓慢渗血，但也有大量急性出血，造成失血、亡血，甚而引起脱证。衄血虽可分辨，但临床或可与他处衄血并见。
例一以齿衄、鼻衄为主证。鼻为肺窍，齿龈属胃络，肺胃热盛，迫血妄行，或肝肾阴虚，虚火上炎，损伤脉络，都可以引起衄血。本案证属肝热上冲，瘀血内滞。治以清肝凉血，化瘀消滞。郭氏认为：本病在进展期多属肝热血滞的实热证，拟以寒凉直折，务需大便通畅，实热外泄方可取效。
例二证属毒热郁营，热迫血溢。首用清热解毒凉血止血，使外邪清解，血热内撤，犹如釜底抽薪，继以滋阴清营，待血热已清，营阴渐复，后加健脾益气之剂，使之中气充足，气足能以摄血，疗效方可巩固。
例三证情繁杂，五脏俱病，但以寒湿困脾最为突出。董氏治以苦温燥湿，醒脾开胃之法，处方有治后天以固本元，调脾胃以安五脏之意，与一般治法迥然有别，药虽无奇而有奇效。
例四衄血如注，满口鲜血、周身红点紫癜。证属气阴两伤，虚火上炎。治以反佐变通之法，于大队滋阴养血，补气摄血药中，反佐姜、桂、附收敛残火，引火归原，颇有独到之处。
例五西医诊为“败血症’临床可谓“七窍出血”，屡治不效，症颇险恶。孔氏施治心思细密，治法虽较复杂而运意灵巧，颇具章法。药虽繁而配伍谨严，标本兼顾，遂获良效。
(十一)咳血
例一李XX，男，74岁：初诊日期：1974年12月17日。患者咳血经久不愈已四月余。经胸透排除肺癌和肺结核，原有轻度肺气肿。目前咳不甚剧，前晚曾咯出鲜血十余口，痰如白沫，有时左胁隐痛，口干，动则气急，饮食二便均正常。舌苔薄，脉弦。辨证：肝火犯肺，肺络受伤。治法：清肺平肝，化瘀和络。方药：泻白散合黛蛤散加味。桑白皮12克地骨皮12克北沙参9克杏仁9克桃仁4．5克丹皮9克赤芍9克制川军4．5克黄芩9克炙苏子12克黛蛤散12克(包煎)12月24日(二诊)，咯血已止，胁痛亦减，咯痰不爽，纳食如常，舌苔薄，脉弦。仍与清肺平肝，滋阴宁络之法。原方去桃仁，加瓜蒌皮9克、麦冬9克，再进6剂。12月31日(三诊)；十余日来来见咯血，但左胁偶有牵痛，咳已少，鼻燥，二便正常。苔薄腻，脉弦。再拟清养气阴，润肺化痰以善其后。北沙参9克桑白皮9克地骨皮9克黄芩9克杏仁9克冬瓜子12克丝瓜络6克赤芍9克炙远志4．5克(《黄文东医案》)
例二田XX，男，27岁，初诊日期：1976年6月10日。咳嗽，吐白粘痰。十天前突然咳血，满口皆血。随后痰中带血点、血丝。有时痰血相混。口干，咽干，时有胸痛。舌质红，少苔，脉沉，至数正常。’辨证：肺气失宣，咳伤肺络。治法：宣肺化痰，理气止血。方药：桔梗6克贝母10克紫菀10克橘红6克炙杷叶6克瓜蒌10克麦冬10克百部10克甘草5克茜草6克阿胶10克藕节10克仙鹤草12克地骨皮12克桑叶12克竹叶6克6月14日(二诊)：上方服4剂，咳嗽，痰中已无血，晚间咽干，胸痛减轻，头晕愈。下午手烧，腰困，脉沉弱，仍遵上法。方药：桔梗6克贝母10克杏仁10克紫菀10克橘红6克炙杷叶6克瓜蒌仁12克麦冬10克百部10克苏子6克茜草6克地骨皮10克甘草5克沉香6克丹皮6克桑叶10克6月18日(三诊)；服上方4剂，再未咳血，胸痛好转。只有劳动时觉轻微疼痛。咳痰白粘，咽干，盗汗，小便频数，手烧，腰困。脉仍沉弱。治宜滋补肺肾，化痰止嗽，辅以敛汗。上方改橘红为10克，瓜萎仁10克，地骨皮12克，加辽沙参10克，五味子5克，菟丝子15克，杜仲12克，煅龙骨10克，煅牡蛎10克，浮小麦18克，枸杞子10克，去苏子、杏仁、紫菀、炙杷叶，茜草，沉香，桑叶，水煎服。6月28日(四诊)；上方加减服6剂，胸痛轻微，咳嗽痰少而粘，盗汗止，小便次数减少，但尿时仍痛，手心还烧，腰困。脉沉弱。上方加知母10克，桑叶10克，地骨皮改为21克，继服6剂，诸证渐安。(《张子琳医疗经验选辑》)[评按]咳血系指由肺经气道咳嗽而出，痰血相兼，或痰中带血，或纯血鲜红间夹气泡的病证。多因外感风热燥气或内伤情志，直接或间接伤及肺络所致。
例一系因肝火犯肺伤及肺络而咳血。肝火偏旺，阴虚火扰，灼伤肺络，故见咳血。肝脉布于两胁，脉络瘀滞，症现胁肋引痛。治以平肝清肺，化痰和络。方用黛蛤散，泻白散加化瘀药，证治较为合拍。方中黛蛤散清肝化痰，泻白散泻肺清热，桃仁、赤芍等活血化瘀，大黄化瘀清热、推陈致新，肝火得平，肺气肃降，瘀热下行。此案见血而不用止血药，咳血能自止者，乃审证、求因、治本三者相结合之妙。
例二为痰血相兼，或痰中带有血丝、血点。盖肺为娇脏，喜润恶燥，风热燥邪伤肺，则咳痰胶粘不爽，震伤肺中络脉而致咳血。治以祛除外邪，止嗽止血、润肺化痰之法。标本兼顾，构思周密，疗效颇佳。
(十二)吐血
例一鲍姓，女。旰脾不和，湿热交蒸，更兼平素善怒，饮食不节，久而邪气聚当胃脘，遂致胃痛发作之时，痛如刀割，脘中燔热，吞酸，满闷，懊
（忖-寸+农）作吐，有时吐物中伴有血出，大便秘结而黑，舌苔垢腻，经XX医院检查，诊为“十二指肠溃疡”合并“胃出血”，病。脉弦紧而滑，两关位独盛，亟宜镇肝和胃，行气止痛，搜肃湿热以内消之。石决明(生研先煎)24克青竹茹12克台乌药9克盐橘核12克龙胆草(酒炒)9克旋复花(布包煎)12克生赭石12克藕节?枚煨粉葛根1。5克水制甘草1．5克藿香梗9克陈皮6克焦栀子9克土炒焦白芍4．5克槟榔炭(醋炒)4．5克炒枳壳6克醋军炭4．5克川郁金(生白矾水浸)9克苏合香丸1粒(冲服)犀黄丸6克(冲服)共诊9次，服药21剂，然后改配丸药，服两料后疾病痊愈。(孔嗣伯介绍；孔伯华先生学术经验简介，《中医杂志》7：5，1962)
例二肖XX，男，40岁。经常胃脘当心而痛，胸膈痞胀，头昏目眩，耳鸣心悸，自汗失眠，少气不足以息，背恶寒，面色皓白。诊视脉虚弦无力，舌质淡红，数次大量吐血，大便溏黑，困倦异常。此因胃络大伤，脾失统血之职，上溢未尽，流于肠间。法当益气摄血，仿景岳大补元煎意。炙黄芪10克西党参10克淮山药10克炒枣仁10克熟地黄10克北五味3克当归身10克北枸杞10克云茯神7克山萸肉?克炙远志3克广陈皮3克炙甘草5克复诊；连服10剂，血止汗收，夜能安寐，胃纳增进，大便转黄，更益心脾。按上方去地黄、五味，加蒸于术7克，龙眼肉10克。服至10余剂，胃痛全止，面色华润，精神振复。(《李聪甫医案》)[评按]吐血多由胃中出血，从口腔吐出于外。若血呕出，则名呕血。吐血与呕血临证往往不易严格区分。本证多因胃中积热，或肝郁化火伤于阳络所致。由于失血量多也可见亡血气脱、气血两虚等证。
例一证属肝脾不和、湿热交蒸，胃中燔热而致吐血，大便秘结而黑。治以镇肝和胃，搜肃湿热。孔氏认为；“肝阳过强则胃气被遏……殊不知破虽在胃；而其源在肝也，倘徒治胃而不治肝，为舍本逐末，安望其痊。’
例二数次大量失血以致血脱，治以益气摄血，更益心脾以善其后。大凡血证后期，肝脾血亏，心营失养而无虚火上炎者，均可施以益气固脱之法。(十三)便血
例一张X，男，50岁。大便下血，时发时止，历四、五年。近期发作甚剧，血色鲜而量多，日五、六次肛门堕脱，头晕眼黑，气短心跳，食不甘味，面色苍白，身疲，神倦，脉微无力，经过二月余。此症为直肠肛门出血，或因内痔发展所致。乃身体素亏，气血运行不周，胃肠郁热，大便时常燥结，粪毒无由排泄，迫血下行，瘀潴肠内，灌注既满，一泻而下，暂时出血，血止不久，复瘀又倾，如此循环不已，一若瘘管形成，是以数年间时发时止所由来也。若不标本兼顾，仍虑不觉再发，急以止血清热，补中益气之晶为治。别植参6克煎浓汁分二次兑服炙黄芪18克漂白术9克杭白芍9克(柴胡4。5克同炒)黑升麻3克黑芥穗6克炒地榆9克炒槐米9克广皮炭6克当归身9克黑山栀6克炒枳壳6克陈阿胶9克(另溶分二次兑服)炙甘草4．5克二诊：服3剂，血止，大便已复正常，日一次，头晕心跳，气短目黑，面色苍白如雪。亟需调补，继续常服，以防复发。吉林参9克另煎浓汁分二次兑服野于术9克云茯苓神各9克山萸肉(炒)9克龙眼肉15克当归身9克大熟地9克淮山药15克炙绵芪24克远志(炒)9克广木香3克鹿角胶9克(另溶分二次兑服)五味子(打)9克炙甘草3克(施稚墨等整理：施今墨医案，《中医杂志》5：328，1958)
Background Information
Book: Compilation of Verified Cases by Famous Doctors in Modern Times; Chapter: Main Text (6/53); Category: Medical Discussion
Case 4 Wang XX, Female, 41 years old. She sought medical attention due to oral bleeding accompanied by red spots on the skin for 4 days. Platelet count was 12,000/mm³. The Western medicine diagnosis was Primary Thrombocytopenic Purpura (a disease characterized by low platelet count and purpura), and she was transferred to my clinic for treatment. Epistaxis (nosebleed) flowed like a stream, with a mouth full of fresh blood; red spots and purpura were densely distributed all over the body. She had shortness of breath, sallow complexion, pale lips and nails, dizziness, palpitations, dry mouth but no desire to drink, toothache without swelling or redness, a deep, fine, and weak pulse, a pale tongue body, and a thin white coating. Syndrome differentiation: Qi and Yin deficiency with deficient fire flaming upward. Treatment method: Tonify Qi to control bleeding, nourish Yin and blood, benefit Kidney to anchor Yang, and guide fire back to its source. Prescription: Astragali Radix (Huangqi) 15g, Codonopsis Radix (Taizishen) 9g, Angelicae Sinensis Radix (Danggui) 9g, Paeoniae Radix Alba (Baishao) 9g, Ecliptae Herba (Hanliancao) 15g, prepared Donkey-hide Gelatin (Ejiao) 6g (melted and taken with decoction), Magnetitum (Cishi) 15g, Lithospermi Fructus (Gusuibu) 15g, Dendrobii Caulis (Shihu) 15g, Hominis Crinis Carbonisatus (Xuyutann) 9g (wrapped), Red Jujube (Xiaohongzao) 5 pieces (cut open), Zingiberis Rhizoma Preparatum (Paojiangtan) 1.5g, Prepared Aconiti Lateralis Radix (Fupian) 3g, Cinnamomi Cortex Pulvis (Rouguifen) 0.9g (swallowed). This prescription is derived from the hemostatic formulas of Yu Jiayan and Huang Kunzai. If residual fire cannot be contained, merely using methods to tonify Qi to control bleeding, nourish Yin and blood, and benefit Kidney to anchor Yang will be ineffective. The use of Ginger, Aconite, and Cinnamon in the formula is to contain residual fire, which is also a method of counter-assistance and flexibility. After taking the medicine, bleeding gradually stopped. Half a month later, epistaxis completely ceased, and the red spots and purpura on the body faded. Her spirit improved, and her platelet count rose to 60,000/mm³, so she was discharged for rest. Half a month later, upon follow-up examination at the clinic, her platelet count had risen to 100,000/mm³, and she stopped taking medication. (Experience of Zou Yunxiang, organized by Huang Xinwu: "Application of Counter-Assistance Therapy in Clinical Practice," *New Medicine Magazine* 6:11, 1978)
Case 5 Zhao X, Male. The *Classic of Internal Medicine* states: "The Spleen is the root of granaries and the residence of Ying (Nutritive) Qi." The Spleen is the organ that controls blood. Now, Liver Wood attacks it, and long-term dampness injury causes the blood controlled by the Spleen to move chaotically. Dampness stagnates, mixing clear and turbid substances, and the Qi transformation of the San Jiao (Triple Burner) is not harmonized, failing to nourish the four extremities. Consequently, bleeding occurs through all orifices outside the internal organs: black stool, red urine, epistaxis, and especially severe gum bleeding. This reflects the relationship between Spleen and Lung described as "Spleen disperses essence, sending it up to return to the Lung." Muscles are wasting away, skin color is deathly white, and the four extremities and nails lack luster. The tongue is crimson with scarlet edges, coated with a thick white greasy coating. Lips are white, not scorched, but lacking luster. Appetite is poor, mouth is dry but there is no desire to drink, slight fever and tidal sweating occur in the afternoon. The pulse is wiry, slippery, and rapid, with prominent pulses at both Guan positions. It is reported that the illness has persisted for more than half a year. Western medical examination diagnosed "Septicemia," which failed to respond to repeated treatments, and the condition has worsened recently. The symptoms are perilous. Tentatively prescribing methods to clear and nourish Yin, anchor Yang, support and strengthen Spleen Earth, leach out dampness and transform dryness, diffuse and regulate Qi, and assist Stomach to stop bleeding, addressing both root and branch. Artemisiae Annuae Blood-processed Herb (Bixue Qinghao) 12g, Hominis Crinis Carbonisatus (Xuyutann) 9g, Succinum (Xuhupo) 6g (decocted first), Ostreae Concha (Muli) 15g (decocted first), Adzuki Bean (Chixiaodou) 30g (wrapped in cloth), Scorized Rice Sprout (Jiaogudoya) 12g each, Inulae Flos (Xuanfuhua) 9g (wrapped in cloth), Margarita (Zhenzhumu) 30g (ground and decocted first), Polygoni Multiflori Caulis Carbonisatus (Puhuangtan) 9g, Fresh Lotus Rhizome (Xian'ou) 30g, Fresh Imperatae Rhizoma (Xianmaogen) 30g, Fresh Dendrobii Caulis (Xianshihu) 30g (decocted first), Scorized Gardeniae Fructus (Jiaozhizi) 9g, Psittacae Os (Shengzheishi) 9g, Phellodendri Cortex (Chuanbai) 9g, Lonicerae Japonicae Flos Carbonisatus (Yinhuaotan) 12g, Gypsum Fibrosum (Shenghuashi) 15g, Achyranthis Bidentatae Radix (Chuan niuxi) 9g, Curcumae Radix (Chuan yujin) 9g, Magnetitum (Lingcishi) 9g (raw ground and decocted first), Rhinocerotis Cornu (Wuxijiaojian) 0.9g (separately decocted and mixed in), Xihuang Wan 6g (mixed in). Decoct herbs using Huangtu Tang (Yellow Earth Decoction), take warm twice daily. Total 16 consultations, took more than 40 doses, and the disease was cured. Method for preparing Huangtu Tang decoction: Take 120g of clean fresh yellow earth and about 1000ml of clear water, boil in a pot for one hour, then add a little Alum (Baijian) to precipitate impurities. Wait for it to cool, filter the clear liquid through gauze, and then use this Huangtu Tang to decoct other herbs in a clay pot. (Introduced by Kong Sibo: "Brief Introduction to Mr. Kong Bohua's Academic Experience," *Chinese Journal of Traditional Chinese Medicine* 7:5, 1962) [Commentary] Nüxue (Nasal and other hemorrhages) refers to bleeding from the nose, gums, ears, tongue, and skin without external trauma. Depending on the site, it is called Epistaxis, Gingival Bleeding, Lingual Bleeding, or Cutaneous Bleeding. Generally, it involves slow, small-volume oozing, but can also involve massive acute bleeding leading to blood loss, exhaustion, or collapse. Although distinguishable, clinically it may occur simultaneously with bleeding from other sites.
Case 1 Main symptoms are gingival bleeding and epistaxis. The nose is the orifice of the Lung, and the gums belong to the Stomach collaterals. Excessive heat in Lung and Stomach forcing blood to move recklessly, or Liver-Kidney Yin deficiency causing deficient fire to flare up and damage collaterals, can all cause bleeding. This case belongs to Liver heat rushing upward and blood stasis stagnating internally. Treatment: Clear Liver and cool blood, resolve stasis and eliminate stagnation. Dr. Guo believes: In the progressive stage, this disease mostly belongs to excess heat syndrome of Liver heat and blood stasis. Prescribe cold-natured herbs to directly subdue it. It is essential to have smooth bowel movements so that excess heat can be expelled externally for efficacy.
Case 2 Syndrome belongs to toxic heat郁 (stagnating) in Ying level, with heat forcing blood to overflow. First use clearing heat, detoxifying, cooling blood, and stopping bleeding methods to resolve external pathogens and withdraw internal blood heat, like removing firewood from under the cauldron. Then nourish Yin and clear Ying level. Once blood heat is cleared and Ying Yin gradually recovers, add spleen-tonifying and Qi-supplementing agents to ensure sufficient Middle Qi, which can control blood, thereby consolidating curative effects.
Case 3 Symptoms are complex, involving all five Zang organs, but Cold-Dampness encumbering the Spleen is most prominent. Dr. Dong treats with bitter-warm drying-dampness and awakening Spleen-opening stomach methods. The prescription implies treating the acquired foundation to consolidate the primordial root and regulating Spleen-Stomach to calm the five Zang organs, differing significantly from general methods. Though the herbs are not extraordinary, they have extraordinary effects.
Case 4 Epistaxis flows like a stream, mouth full of fresh blood, red spots and purpura all over the body. Syndrome belongs to Qi and Yin injury with deficient fire flaming upward. Treatment uses counter-assistance and flexible methods. Among large doses of Yin-nourishing, blood-supplementing, Qi-tonifying, and blood-controlling herbs, counter-assist with Ginger, Cinnamon, and Aconite to contain residual fire and guide fire back to its source, showing unique insight.
Case 5 Western medicine diagnosed "Septicemia," clinically resembling "bleeding from seven orifices," unresponsive to repeated treatments, with perilous symptoms. Dr. Kong’s treatment thoughts are meticulous. Although the treatment method is complex, the intent is agile and well-structured. Though many herbs are used, the compatibility is rigorous, addressing both root and branch, thus achieving good results.
(XI) Hemoptysis (Coughing Blood)
Case 1 Li XX, Male, 74 years old. Initial visit date: December 17, 1974. The patient has suffered from hemoptysis for over four months. Chest fluoroscopy excluded lung cancer and pulmonary tuberculosis; he had mild emphysema. Currently, cough is not severe, but coughed up more than ten mouthfuls of fresh blood the night before last. Sputum is like white foam, sometimes with dull pain in the left hypochondrium, dry mouth, shortness of breath on exertion, normal diet and excretion. Tongue coating is thin, pulse is wiry. Syndrome differentiation: Liver Fire invading Lung, damaging Lung collaterals. Treatment method: Clear Lung and soothe Liver, resolve stasis and harmonize collaterals. Prescription: Xiebai San combined with Daige San modified. Morus Alba Root Bark (Sangbaipi) 12g, Lycii Cortex (Digupi) 12g, Glehniae Radix (Beishashen) 9g, Apricot Seed (Xingren) 9g, Peach Kernel (Taoren) 4.5g, Moutan Cortex (Danpi) 9g, Red Peony Root (Chishao) 9g, Prepared Rheum Palmatum (Zhichuanjun) 4.5g, Scutellariae Radix (Huangqin) 9g, Fried Perilla Fruit (Zhisu zi) 12g, Daige San 12g (wrapped and decocted). December 24 (Second visit): Hemoptysis has stopped, hypochondriac pain reduced, sputum difficult to expectorate, appetite normal, tongue coating thin, pulse wiry. Continue clearing Lung, soothing Liver, nourishing Yin, and calming collaterals. Remove Peach Kernel from original formula, add Trichosanthis Pericarpium (Gualoupi) 9g, Ophiopogonis Radix (Maidong) 9g, take another 6 doses. December 31 (Third visit): No hemoptysis for over ten days, but occasional pulling pain in left hypochondrium, less cough, dry nose, normal excretion. Coating thin-greasy, pulse wiry. Further prescribe clearing and nourishing Qi and Yin, moistening Lung and resolving phlegm to conclude treatment. Glehniae Radix 9g, Morus Alba Root Bark 9g, Lycii Cortex 9g, Scutellariae Radix 9g, Apricot Seed 9g, Benincasa Semen (Dongguazi) 12g, Luffa Sponge Fiber (Sigualuo) 6g, Red Peony Root 9g, Polygala Root (Zhianyuzhi) 4.5g. (*Medical Cases of Huang Wendong*)
Case 2 Tian XX, Male, 27 years old. Initial visit date: June 10, 1976. Cough, expectorating white sticky sputum. Suddenly coughed blood ten days ago, mouth full of blood. Subsequently, sputum contained blood spots and streaks. Sometimes sputum and blood mixed. Dry mouth, dry throat, occasional chest pain. Tongue body red, scant coating, pulse deep, rate normal. Syndrome differentiation: Lung Qi failure to diffuse, cough injuring Lung collaterals. Treatment method: Diffuse Lung and resolve phlegm, regulate Qi and stop bleeding. Prescription: Platycodon Root (Jiegeng) 6g, Fritillaria Bulb (Beimu) 10g, Aster Root (Ziwan) 10g, Tangerine Peel (Juhong) 6g, Fried Loquat Leaf (Zhipaye) 6g, Trichosanthes Fruit (Gualou) 10g, Ophiopogonis Radix (Maidong) 10g, Stemona Root (Baibu) 10g, Licorice Root (Gancao) 5g, Rubia Root (Qiancao) 6g, Donkey-hide Gelatin (Ejiao) 10g, Lotus Node (Oujie) 10g, Agrimonia Herb (Xianhecao) 12g, Lycii Cortex (Digupi) 12g, Mulberry Leaf (Sangye) 12g, Bamboo Leaf (Zhuye) 6g. June 14 (Second visit): Took 4 doses of above prescription. Cough and blood in sputum stopped. Evening dry throat, chest pain relieved, dizziness resolved. Hands feel hot in afternoon, waist feels tired, pulse deep and weak. Follow previous method. Prescription: Platycodon Root 6g, Fritillaria Bulb 10g, Apricot Seed 10g, Aster Root 10g, Tangerine Peel 6g, Fried Loquat Leaf 6g, Trichosanthes Seed (Gualouren) 12g, Ophiopogonis Radix 10g, Stemona Root 10g, Perilla Fruit 6g, Rubia Root 6g, Lycii Cortex 10g, Licorice Root 5g, Agarwood (Chenxiang) 6g, Moutan Cortex 6g, Mulberry Leaf 10g. June 18 (Third visit): Took 4 doses of above prescription. No further hemoptysis, chest pain improved. Only slight pain during labor. Expectorating white sticky sputum, dry throat, night sweats, frequent urination, hands feel hot, waist tired. Pulse still deep and weak. Treatment should nourish Lung and Kidney, resolve phlegm and stop cough, assisted by sweating-stopping methods. Change Tangerine Peel to 10g, Trichosanthes Seed to 10g, Lycii Cortex to 12g. Add Glehniae Radix 10g, Schisandra Fruit (Wuweizi) 5g, Cuscuta Seed (Tusizi) 15g, Eucommia Bark (Duzhong) 12g, Calcined Dragon Bone (Duanyulong) 10g, Calcined Oyster Shell (Duanyumu) 10g, Floating Wheat (Fuxiaomai) 18g, Goji Berry (Gouqizi) 10g. Remove Perilla Fruit, Apricot Seed, Aster Root, Fried Loquat Leaf, Rubia Root, Agarwood, Mulberry Leaf. Decoct in water. June 28 (Fourth visit): Took 6 doses of modified prescription. Chest pain slight, cough with little sticky sputum, night sweats stopped, urination frequency decreased, but pain during urination remains, palms still hot, waist tired. Pulse deep and weak. Add Anemarrhenae Rhizoma (Zhimu) 10g, Mulberry Leaf 10g, change Lycii Cortex to 21g. Continue taking 6 doses. All symptoms gradually stabilized. (*Selected Medical Experiences of Zhang Zilin*) [Commentary] Hemoptysis refers to coughing up blood from the Lung airways, with sputum and blood mixed, or blood streaks in sputum, or pure bright red blood mixed with bubbles. Mostly caused by external contraction of Wind-Heat-Dryness or internal emotional injury, directly or indirectly damaging Lung collaterals.
Case 1 Caused by Liver Fire invading Lung and damaging Lung collaterals, leading to hemoptysis. Liver Fire is hyperactive, Yin deficiency with fire disturbance, scorching Lung collaterals, hence hemoptysis. Liver Meridian distributes to both hypochondria; collateral stasis causes hypochondriac pulling pain. Treatment: Calm Liver and clear Lung, resolve phlegm and harmonize collaterals. Use Daige San and Xiebai San plus blood-activating herbs. The syndrome-treatment match is quite appropriate. Daige San clears Liver and resolves phlegm; Xiebai San drains Lung and clears heat; Peach Kernel, Red Peony Root, etc., activate blood and resolve stasis; Rhubarb resolves stasis, clears heat, and promotes renewal. Liver Fire is calmed, Lung Qi descends, and stasis-heat moves downward. In this case, seeing blood but not using hemostatic herbs allows hemoptysis to stop spontaneously. This is the subtlety of combining syndrome examination, etiology seeking, and root treatment.
Case 2 Sputum and blood mixed, or blood streaks/spots in sputum. The Lung is a delicate organ, preferring moisture and disliking dryness. Wind-Heat-Dryness pathogen injures Lung, causing sticky and difficult-to-expectorate sputum, shaking Lung collaterals and causing hemoptysis. Treatment: Expel external pathogens, stop cough and bleeding, moisten Lung and resolve phlegm. Addressing both root and branch, thoughtfully conceived, with excellent efficacy.
(XII) Hematemesis (Vomiting Blood)
Case 1 Ms. Bao, Female. Liver-Spleen disharmony, Damp-Heat steaming. Additionally, prone to anger, irregular diet. Over time, pathogenic factors gathered in the epigastrium, causing gastric pain attacks where pain feels like knife-cutting, burning sensation in epigastrium, acid regurgitation, fullness, oppression, and retching/vomiting. Sometimes vomitus contains blood. Constipation with black stool, greasy tongue coating. Checked at XX Hospital, diagnosed with "Duodenal Ulcer" complicated by "Gastric Bleeding." Pulse wiry-tight and slippery, particularly strong at both Guan positions. Urgently need to pacify Liver and harmonize Stomach, move Qi and relieve pain, search out and肃 (cleanse) Damp-Heat to dissipate internally. Aragon Shell (Shijueming) 24g (raw ground, decocted first), Green Bamboo Shavings (Qingzhuru) 12g, Lindera Root (Taiwuyao) 9g, Salted Citrus Aurantium Fruit (Yanjue) 12g, Gentiana Root (Longdancao) 9g (wine-fried), Inula Flower (Xuanfuhua) 12g (wrapped), Psittacae Os (Shengzheishi) 12g, Lotus Node (? pieces), Roasted Kudzu Root (Weigengegen) 1.5g, Water-processed Licorice (Shuigancao) 1.5g, Agastache Stem (Huoxianggeng) 9g, Tangerine Peel (Chenpi) 6g, Scorized Gardeniae (Jiaozhizi) 9g, Earth-fried Scorized White Peony Root (Tuchao jiaobaishao) 4.5g, Areca Nut Charcoal (Binglangtan) 4.5g (vinegar-fried), Fried Aurantium (Chaozhiqiao) 6g, Vinegar-processed Rhubarb Charcoal (Cu jun tan) 4.5g, Curcuma Root (Chuan yujin) 9g (soaked in Alum water), Suhexiang Wan 1 pill (mixed in), Xihuang Wan 6g (mixed in). Total 9 consultations, took 21 doses, then switched to pills. After two courses, the disease was cured. (Introduced by Kong Sibo; *Kong Bohua's Academic Experience*, *TCM Journal* 7:5, 1962)
Case 2 Xiao XX, Male, 40 years old. Frequent pain in the epigastrium centering on the heart region, chest and diaphragm stuffiness, dizziness, tinnitus, palpitations, spontaneous sweating, insomnia, shortness of breath, aversion to cold on the back, bright white complexion. Pulse deficiency-wiry and weak, tongue light red. Several episodes of massive hematemesis, loose black stool, extreme fatigue. This is due to major injury of Stomach collaterals, Spleen losing its function of controlling blood, overflow not yet exhausted, flowing into the intestines. Method: Tonify Qi to control bleeding, imitating Jingyue's Dabu Yuan Jian intention. Prepared Astragalus (Zhi Huangqi) 10g, Codonopsis (Xi Dangshen) 10g, Dioscorea (Huai shanyao) 10g, Fried Jujube Seed (Chao zaoren) 10g, Prepared Rehmannia (Shu Dihuang) 10g, Schisandra (Bei wuweizi) 3g, Angelica Body (Dangguishen) 10g, Goji Berry (Bei gouqi) 10g, Poria Spirit Cloud (Yun fushen) 7g, Cornus Fruit (Shanzhuyu) ?g, Prepared Polygala (Zhi yuanzhi) 3g, Broad-leaved Tangerine Peel (Guang chenpi) 3g, Prepared Licorice (Zhi gancao) 5g. Follow-up: Taken 10 doses continuously. Bleeding stopped, sweating ceased, able to sleep peacefully at night, appetite increased, stool turned yellow, further benefiting Heart and Spleen. According to above formula, remove Rehmannia and Schisandra, add Steamed Atractylodes (Zheng Baizhu) 7g, Longan Flesh (Longyanrou) 10g. Taken for over 10 doses, gastric pain completely stopped, complexion rosy and moist, spirit revived. (*Medical Cases of Li Congfu*) [Commentary] Hematemesis mostly results from bleeding in the Stomach, vomiting out from the mouth. If blood is vomited, it is named Ou Xue. Clinically, Hematemesis and Ou Xue are often not strictly distinguished. This syndrome is mostly caused by accumulated heat in the Stomach or Liver depression transforming into fire injuring Yang collaterals. Due to large blood loss, signs of blood exhaustion, Qi collapse, or Qi-Blood deficiency may also appear.
Case 1 Syndrome belongs to Liver-Spleen disharmony, Damp-Heat steaming, Stomach burning heat causing hematemesis, constipation with black stool. Treatment: Pacify Liver and harmonize Stomach, cleanse Damp-Heat. Dr. Kong believes: "Excessive Liver Yang suppresses Stomach Qi... One must know that although the disease is in the Stomach, its source is in the Liver. If only treating the Stomach without treating the Liver, it is abandoning the root for the branch, how can one hope for recovery?"
Case 2 Massive blood loss several times leading to blood exhaustion. Treatment: Tonify Qi to control bleeding, further benefit Heart and Spleen to conclude treatment. Generally, in the late stage of blood syndromes, if Liver-Spleen blood deficiency and Heart Ying malnourishment exist without deficient fire flaming upward, Qi-tonifying and collapse-solidifying methods can be applied.
(XIII) Hematochezia (Blood in Stool)
Case 1 Zhang X, Male, 50 years old. Blood in stool, intermittent for 4-5 years. Recent attack severe, bright red blood, large volume, 5-6 times a day. Anal prolapse, dizziness, dark vision, shortness of breath, palpitations, food tastes bland, pale complexion, body fatigue, mental weariness, faint pulse. Duration over two months. This symptom is rectal-anal bleeding, possibly caused by progression of internal hemorrhoids. The body is constitutionally deficient, Qi-Blood circulation incomplete, Gastrointestinal郁 (stagnant) heat, stool often dry and hard, fecal toxins unable to be excreted, forcing blood downward, stasis accumulating in intestines. When full, it pours down, causing temporary bleeding. Shortly after bleeding stops, stasis accumulates again and pours, cycling endlessly, resembling fistula formation, hence the intermittent nature over years. If root and branch are not addressed simultaneously, recurrence is feared. Urgently treat with hemostasis, clearing heat, and Bu Zhong Yi Qi (Tonify Middle and Augment Qi) methods. Bie Zhi Shen 6g (decocted concentrated juice, divided into two doses mixed in), Prepared Astragalus (Zhi Huangqi) 18g, Bleached Atractylodes (Bai Baizhu) 9g, White Peony Root (Hang Baishao) 9g (fried with Bupleurum 4.5g), Black Cimicifuga (Hei Shengma) 3g, Black Saposhnikovia (Hei Jiesui) 6g, Fried Sanguisorba (Chao Diyu) 9g, Fried Sophora Flower Bud (Chao Huaimi) 9g, Tangerine Peel Charcoal (Guang Pi Tan) 6g, Angelica Body (Dangguishen) 9g, Black Gardeniae (Hei Shanzhi) 6g, Fried Aurantium (Chao Zhiqiao) 6g, Old Donkey-hide Gelatin (Chen Ejiao) 9g (separately melted, divided into two doses mixed in), Prepared Licorice (Zhi Gancao) 4.5g. Second visit: Took 3 doses, bleeding stopped, stool returned to normal, once a day. Dizziness, palpitations, shortness of breath, dark vision, snow-white complexion. Urgently need regulation and supplementation, continue regular intake to prevent recurrence. Jilin Ginseng 9g (separately decocted concentrated juice, divided into two doses mixed in), Wild Atractylodes (Ye Baizhu) 9g, Poria Spirit Cloud (Yun Fushen) 9g each, Stir-fried Cornus (Chao Shanzhuyu) 9g, Longan Flesh (Longyanrou) 15g, Angelica Body (Dangguishen) 9g, Large Prepared Rehmannia (Da Shudi) 9g, Dioscorea (Huai Shanyao) 15g, Prepared Astragalus (Zhi Mianqi) 24g, Stir-fried Polygala (Chao Yuanzhi) 9g, Aucklandia (Guang Muxiang) 3g, Deer Antler Glue (Lujiaojiao) 9g (separately melted, divided into two doses mixed in), Crushed Schisandra (Da Wuweizi) 9g, Prepared Licorice (Zhi Gancao) 3g. (Organized by Shi Zhimo et al.: *Shi Jinmo's Medical Cases*, *TCM Journal* 5:328, 1958)