武林清和坊顾升泰扇店秋芳。患吐血十余年矣。病起于伤酒过度。血热妄行。而杂药乱投。肌瘦痰盛。恶寒心悸。
神识如痴。自疑虚寒。妄将性热之药。散列四十余味。亦无君臣佐使。犹恐欠热。乃用生姜捣汁煎服。畏寒益甚。虽
在重帏。尤嫌微风。心虚胆怯。常怕屋坍压死。人众杂处。又厌喧烦。丁亥秋。延余诊之。痰喘气逆。脉虚大而数。一
息七八至。盖从前所服大辛大热之药。助火内炽火。盛克金。肺藏已伤。所谓热极反现寒象也。症已危极。勉拟甘寒
育阴法。用鲜芦根、甜水梨、荸荠、鲜生地、麦冬各绞汁半钟。冲入人乳一钟。每日徐徐缓饮。此盖处方于无可处之
地也。服之颇安。其后失于调理。至春而卒。
钱塘张调梅先生。年四十余。下血有年。丁亥九月。在吴山太岁庙斗坛召诊。神气委顿。诊其脉弦细芤迟正仲景
所云革脉也。男子则亡血失精。妇人为半产漏下。余曰。察脉审症。当主腹痛亡血。曰然。余曰。此症乃木强土弱。盖
肝主藏血。脾主统血。今肝木之疏泄太过。则血不内藏而下泄矣。伊芳云下血数年。一日数行。气若注下。后重难忍。
超时便又溏泄。腰尻酸疼。少腹胀急。行动气逆。坐卧必竖足方快。形如伛偻。余曰。此奇脉为病也。小腹两傍名曰
少腹。乃冲脉之所循行。督脉行于背膂。其一道络于腰尻。挟脊贯臀。入 中。而带脉又横束于腰间。夫冲脉为病。
逆气里急。督脉为病。腰溶溶若坐水中。又督脉虚则脊不能挺。尻以代踵。脊以代头。诸病形状如绘。凡奇经之脉。
皆丽于肝肾。方用归、芍、川断、山药、枸杞、鹿角胶、熟地、龟版、牡蛎、寄生、小茴、木香、防风。煎送济生乌梅
丸三钱。数剂血止。后重亦减。乃去木香、防风、乌梅丸、加血肉之品。以峻固奇经。或为汤。或为膏。多方图治。诸
恙渐安。惟肾气从小腹上冲。如贲豚状。后灸中脘。关元、石门。调理两月而愈。凡奇脉亏损。必多用血肉有情。乃克
有效。内经云。精不足者。补之以味是也。至于灸法。则尤宜三致意焉。
武林清和坊顾升泰扇店的伙计秋芳，患吐血病已有十多年了。病因起于饮酒过度导致损伤。血分有热而妄行出血，又胡乱服用各种药物，导致身体消瘦、痰多，伴有恶寒、心悸。
神志恍惚如痴，自己怀疑是虚寒证，妄自服用性质大热的药物，罗列了四十多种药味，也没有君臣佐使的配伍原则，还恐怕药力不够热，于是用生姜捣汁煎服，结果畏寒症状更加严重，即使裹着多层厚被，仍然嫌弃微风。心虚胆怯，常害怕房屋倒塌压死自己；人群混杂处，又厌恶喧闹烦杂。丁亥年秋天，请我诊治。此时出现痰喘、气逆，脉象虚大而数，一息跳动七八次。这是因为从前所服用的大辛大热之药，助长内火炽盛，火盛克金，肺脏已经受伤，这就是所谓的热极反而显现出寒象。病情已极其危重，勉强拟定甘寒育阴的治疗方法，使用鲜芦根、甜水梨、荸荠、鲜生地、麦冬各取半钟汁液，冲入人乳一钟，每日慢慢缓饮。这大概是处于无药可救之地时的处方。服药后颇为安稳，但后来失于调理，到了春天就去世了。
钱塘张调梅先生，年龄四十多岁，下血（便血/尿血等下部出血）已有多年。丁亥年九月，在吴山太岁庙斗坛召我去诊病。患者神气委顿，诊其脉象弦细芤迟，正是张仲景所说的革脉。男子出现此脉则亡血失精，女子则为半产漏下。我说：察脉审症，应当主治腹痛亡血。他回答说：是的。我说：此症乃是肝木强盛而脾土虚弱。因为肝主藏血，脾主统血，现在肝木疏泄太过，则血液不能内藏而下泄。他说下血数年，一天数次，感觉气向下注，肛门重坠难以忍受，超过平时排便时间又有溏泄，腰尻酸痛，少腹胀急，行动时气逆，坐卧必须伸直脚才舒服，身形佝偻像驼背一样。我说：这是奇经八脉为病。小腹两旁名为少腹，是冲脉循行的部位；督脉行于背部脊柱，其中一条支脉联络腰尻，夹脊贯穿臀部，进入会阴；而带脉又横束于腰间。冲脉为病，会出现气逆里急；督脉为病，腰部溶溶然像坐在冷水中；另外督脉虚损则脊柱不能挺直，甚至出现“尻以代踵，脊以代头”（臀部代替脚跟站立，脊柱弯曲头部前倾）的症状。各种病症形状如同描绘一般准确。凡是奇经之脉，都隶属于肝肾。方剂使用当归、白芍、川断、山药、枸杞、鹿角胶、熟地、龟版、牡蛎、桑寄生、小茴香、木香、防风。煎汤送服济生乌梅丸三钱。数剂后血止，后重感也减轻。于是去掉木香、防风、乌梅丸，加入血肉有情之品，以峻补固摄奇经。或作汤剂，或作膏剂，多方治疗，诸恙逐渐安定。只有肾气从小腹上冲，像奔豚状。后来灸中脘、关元、石门穴，调理两个月而痊愈。凡是奇经亏损，必须多用血肉有情之品，才能见效。《内经》说：精不足者，补之以味。至于灸法，尤其应该慎重对待。
Gu Qiufang, an employee of Shengtai Fan Shop in Qinghe Fang, Wulin, had suffered from hematemesis (vomiting blood) for over ten years. The illness originated from excessive alcohol consumption causing damage. Heat in the blood led to reckless bleeding, and indiscriminate use of various medicines resulted in emaciation, profuse phlegm, aversion to cold, and palpitations.
His mental state was confused as if dazed; he suspected himself of having a deficiency-cold syndrome and recklessly ingested highly heating herbs, listing more than forty ingredients without any principle of Jun-Chen-Zuo-Shi (sovereign, minister, assistant, courier). Fearing the medication was not hot enough, he used ginger juice decocted and taken orally, which exacerbated his aversion to cold. Even wrapped in multiple layers of thick quilts, he still disliked the slightest breeze. His heart was deficient and gallbladder timid; he constantly feared being crushed by collapsing houses. In crowded places, he detested noise and disturbance. In the autumn of Dinghai year, he invited me to treat him. At that time, he presented with phlegmic wheezing and rebellious qi, with a pulse that was empty, large, and rapid, beating seven or eight times per breath. This was because the previously consumed highly acrid and hot herbs had intensified internal fire. Excessive fire damaged Metal (Lung), injuring the Lung organ. This is what is meant by extreme heat manifesting as cold symptoms. The condition was extremely critical. I tentatively prescribed a method of sweet-cold nourishing Yin, using fresh Reed Rhizome juice, sweet pear juice, water caltrop juice, fresh Rehmannia Root juice, and Ophiopogon Root juice, each half zhong, mixed with one zhong of human milk, taken slowly daily. This prescription was made in a desperate situation. He felt somewhat relieved after taking it, but due to lack of proper care later, he passed away in spring.
Mr. Zhang Diaomei from Qiantang, aged over forty, had suffered from lower body bleeding for many years. In September of Dinghai year, he summoned me for consultation at the Douchan Temple on Wushan Mountain. His spirit was exhausted. His pulse was wiry, thin, hollow, and slow, which is exactly the Ge Pulse (Leather Pulse) described by Zhang Zhongjing. For men, this indicates loss of blood and essence; for women, spontaneous abortion or persistent uterine bleeding. I said: Based on pulse and symptom analysis, the primary treatment should address abdominal pain and blood loss. He agreed. I said: This condition stems from Liver Wood being overly strong while Spleen Earth is weak. Since the Liver stores blood and the Spleen controls blood, excessive dispersal by Liver Wood causes blood to fail to be stored internally and leak downwards. He stated that he had been bleeding for years, several times a day, with a sensation of qi rushing downwards, unbearable tenesmus, loose stools exceeding normal bowel movement frequency, soreness and pain in the lower back and sacrum, distension and urgency in the lower abdomen, rebellious qi upon movement, and relief only when sitting or lying with legs extended, resembling a hunchback. I said: This is a disease of the Extraordinary Vessels. The area on both sides of the lower abdomen is called Shaofu, where the Chong Mai (Penetrating Vessel) circulates. The Du Mai (Governing Vessel) runs along the dorsal spine, with a branch connecting to the sacrum, passing through the spine and buttocks, entering the Huiyin point. The Dai Mai (Belt Vessel) encircles the waist. Disease of the Chong Mai presents with rebellious qi and internal tension; disease of the Du Mai presents with a limp sensation in the lower back as if sitting in cold water. Furthermore, Du Mai deficiency leads to an inability to straighten the spine, resulting in postures like "using the buttocks instead of heels" and "using the spine instead of the head." These manifestations are depicted accurately. All extraordinary vessels are affiliated with the Liver and Kidney. The formula used included Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Chuan Duan (Dipsacus Root), Shan Yao (Chinese Yam), Gou Qi Zi (Goji Berry), Lu Jiao Jiao (Deer Antler Glue), Shu Di Huang (Prepared Rehmannia Root), Gui Ban (Turtle Shell), Mu Li (Oyster Shell), Sang Ji Sheng (Taxillus), Xiao Hui Xiang (Fennel), Mu Xiang (Aucklandia Root), and Fang Feng (Saposhnikovia Root). Decoction was taken with San qian (three mace) of Jisheng Wumei Wan (Jisheng Mume Pill). After a few doses, bleeding stopped, and tenesmus decreased. Then, Mu Xiang, Fang Feng, and Wumei Wan were removed, and blood-nourishing substances were added to strongly consolidate the extraordinary vessels. Treatments alternated between decoctions and pastes. Various methods were employed, and symptoms gradually stabilized. However, Kidney Qi rushed up from the lower abdomen, resembling Ben Tun (Rushing Pig) syndrome. Later, moxibustion was applied to Zhongwan (CV12), Guanyuan (CV4), and Shimen (CV5). After two months of regulation, he recovered. Whenever there is deficiency of the extraordinary vessels, blood-nourishing substances must be used extensively to achieve efficacy. As stated in the Neijing: "When essence is insufficient, tonify with flavor." Regarding moxibustion, particular attention should be paid.