某(三月) 酒客多湿,湿热内扰,酒性 悍,致伤胃络,络血上溢下注遂致吐血便血,脉右芤大,治宜清解。
犀角盘 茜根炭 丹皮 玫瑰花 鲜地 淡芩 怀牛膝 藕汁 黑栀 东白芍 丝瓜络 车前草。
费(东街,年三十一岁,三月) 肝火冲激胃络,络血不时上溢,脉弦数,治宜清络。
小蓟炭 鲜地 怀牛膝 麋衔草 藕节 蒲黄炭 东白芍 丝瓜络 仙鹤草 茜根
炭丹皮 玫瑰花 白茅根
甘心服童便终身无恙;
常服藕粉大佳;
心肺火甚加连翘,黑栀,犀角;
阳明胃火加淡芩,制军;
肝火甚加青黛,石决明;
肾火甚加女贞,旱莲草;
血虚加阿胶,生地。
高(新市西河头,年三十一岁,巧月二十四) 少阴不足为病之本,阳明有余为病之
标,血不足气有余,有余便是火。齿是肾之余,牙龈又属阳明经脉所注,火犯阳经,血热妄
行,血自齿缝中流出,甚且牙衄不止,去血过多而营阴受伤,内热神疲,四肢酸倦,脉左小
弦数,右寸关弦数而芤,舌胎光红甚且起有火沟,治宜壮水之主,以制阳光法。
米炒西洋参 东白芍 怀牛膝 鲜佛手 黄衣 米炒大麦冬 左牡蛎 连翘壳 玫瑰
花大生地 粉丹皮 银花露 鲜谷芽 带心竹叶
臧左(环域,三月) 努力伤络,络血上溢盈碗,离经之血未净,咯痰见红,兼有咳嗽,五
内烦热,良由操劳动肝,肝火激动胃络所致,脉弦数,治宜清解。
照东街费姓血溢之方加苏子川贝。
【三月】某患者长期饮酒,体内多湿,湿热内扰,酒性猛烈,导致胃络受损,络脉中的血液向上溢出、向下灌注,从而引起吐血和便血。脉象右侧芤大(浮大中空,如按葱管),治疗宜采用清热解法。
处方:犀角盘(注:原文如此,通常指水牛角或犀角)、茜草根炭、牡丹皮、玫瑰花、鲜地黄、黄芩、怀牛膝、藕汁、黑栀子、东白芍、丝瓜络、车前草。
【东街,31岁,三月】费姓患者肝火冲激胃络,络脉中的血液不时向上溢出,脉象弦数(细直而长,跳动快),治疗宜采用清络法。
处方:小蓟炭、鲜地黄、怀牛膝、麋衔草、藕节、蒲黄炭、东白芍、丝瓜络、仙鹤草、茜草根炭、牡丹皮、玫瑰花、白茅根。
医嘱:甘心服用童便(童子尿)可终身无病;常服藕粉效果极佳;若心肺火盛,加连翘、黑栀子、犀角;若阳明胃火盛,加黄芩、制大黄;若肝火盛,加青黛、石决明;若肾火盛,加女贞子、旱莲草;若血虚,加阿胶、生地黄。
【新市西河头,31岁,七月二十四日】高姓患者以少阴不足为发病之本,阳明有余为发病之标,血不足而气有余,气有余便是火。牙齿是肾之余气所主,牙龈又属于阳明经脉所过之处,火热侵犯阳经,血热妄行,血液从齿缝中流出,甚至牙衄不止,失血过多导致营阴受伤,出现内热、神疲、四肢酸倦等症状。脉象左侧小弦数,右侧寸关部弦数且芤,舌苔光红,甚至有火沟(裂纹),治疗宜采用壮水之主,以制阳光的方法(即滋阴降火)。
处方:米炒西洋参、东白芍、怀牛膝、鲜佛手、黄衣(注:可能指黄芪衣或特定炮制品,此处保留原名)、米炒大麦冬、左牡蛎、连翘壳、玫瑰花、大生地、粉丹皮、银花露、鲜谷芽、带心竹叶。
【环域,三月】臧姓患者因用力过度损伤络脉,络脉出血盈碗,离经之血未净,咯痰带血,兼有咳嗽,五脏烦热。这主要是由于操劳伤肝,肝火激动胃络所致,脉象弦数,治疗宜采用清热解法。
处方:参照东街费姓患者血溢的方剂,加入紫苏子、川贝母。
[March] A certain patient is a habitual drinker with much dampness in the body. Damp-heat disturbs internally, and the fierce nature of alcohol damages the stomach collaterals (Wei Luo). Blood from the collaterals overflows upward and pours downward, resulting in hematemesis (vomiting blood) and hematochezia (blood in stool). The pulse on the right side is Kou and Da (floating, large, and empty like a scallion stalk). The treatment should focus on clearing heat and resolving the pathogen.
Prescription: Xijiao Pan (Rhino Horn Plate, often substituted with Water Buffalo Horn), Qian Gen Tan (Charred Radix Rubiae), Dan Pi (Cortex Moutan), Meigui Hua (Flos Rosae Rugosae), Xian Di (Fresh Rhizoma Rehmanniae), Dan Qin (Scutellariae Radix), Huai Niu Xi (Radix Achyranthis Bidentata), Ou Zhi (Juncus Effusus Juice), Hei Zhi (Fructus Gardeniae Preparatus), Dong Bai Shao (Radix Paeoniae Lactiflorae), Si Gua Luo (Retinervus Luffae Fructus), Che Qian Cao (Herba Plantaginis).
[Dong Street, 31 years old, March] Patient Fei suffers from Liver Fire rushing against the stomach collaterals, causing blood from the collaterals to overflow upward intermittently. The pulse is Xuan and Shu (wiry and rapid). The treatment should focus on clearing the collaterals.
Prescription: Xiao Ji Tan (Charred Herba Leonuri), Xian Di (Fresh Rhizoma Rehmanniae), Huai Niu Xi (Radix Achyranthis Bidentata), Mi Xian Cao (Herba Siegesbeckiae), Ou Jie (Nodus Nelumbinis Rhizomatis), Pu Huang Tan (Pollen Typhae Preparatus), Dong Bai Shao (Radix Paeoniae Lactiflorae), Si Gua Luo (Retinervus Luffae Fructus), Xian He Cao (Herba Agrimoniae), Qian Gen Tan (Charred Radix Rubiae), Dan Pi (Cortex Moutan), Meigui Hua (Flos Rosae Rugosae), Bai Mao Gen (Rhizoma Imperatae).
Dietary advice: Willingly consuming Tong Bian (Child's Urine) can ensure lifelong health; regularly consuming Ou Fen (Lotus Root Starch) is highly beneficial. If Heart and Lung Fire are excessive, add Lian Qiao (Fructus Forsythiae), Hei Zhi (Fructus Gardeniae Preparatus), and Xi Jiao (Cornu Rhinocerotis); if Yangming Stomach Fire is excessive, add Dan Qin (Scutellariae Radix) and Zhi Jun (Prepared Rheum Palmatum); if Liver Fire is excessive, add Qing Dai (Indigo Naturalis) and Shi Jue Ming (Concha Haliotidis); if Kidney Fire is excessive, add Nu Zhen Zi (Fructus Ligustri Lucidi) and Han Lian Cao (Herba Ecliptae); if Blood Deficiency exists, add E Jiao (Colla Corii Asini) and Sheng Di (Rhizoma Rehmanniae Recens).
[Xinshi Xihe Tou, 31 years old, July 24] Patient Gao’s illness is rooted in Shaoyin Insufficiency and marked by Yangming Excess. There is insufficient Blood but excess Qi; excess Qi manifests as Fire. Teeth are the surplus of the Kidneys, and the gums belong to the Yangming meridians. Fire invading the Yang meridians causes Heat in the Blood to move recklessly, leading to bleeding from the gum fissures. Severe cases may involve persistent gingival bleeding (Ya Nu). Excessive blood loss injures Ying Yin (Nutritive Yin), resulting in internal heat, mental fatigue, and soreness/weakness of the four limbs. The pulse on the left is small, wiry, and rapid; on the right at Cun and Guan positions, it is wiry, rapid, and Kou. The tongue coating is bare and red, even showing fire cracks (fissures). The treatment should employ the method of strengthening the master of Water to control the sunlight (i.e., nourishing Yin to subdue Fire).
Prescription: Mi Chao Xi Yang Shen (Rice-fried American Ginseng), Dong Bai Shao (Radix Paeoniae Lactiflorae), Huai Niu Xi (Radix Achyranthis Bidentata), Xian Fo Shou (Fresh Fructus Citri Sarcodactylis), Huang Yi (Huang Yi, possibly referring to Astragalus skin or specific preparation), Mi Chao Da Mai Dong (Rice-fried Ophiopogonis Radix), Zuo Mu Li (Left-shucked Concha Ostreae), Lian Qiao Ke (Pericarpium Forsythiae), Meigui Hua (Flos Rosae Rugosae), Da Sheng Di (Large Fresh Rhizoma Rehmanniae), Fen Dan Pi (Powdered Cortex Moutan), Yin Hua Lu (Silver Flower Dew), Xian Gu Ya (Fresh Sprouted Hordeum Vulgare), Dai Xin Zhu Ye (Bamboo Leaf with Heart).
[Huan Yu, March] Patient Zang injured the collaterals through strenuous effort, causing collateral blood to overflow filling a bowl. Blood that has left its vessels remains uncleaned, resulting in bloody sputum and cough accompanied by five-organs irritability. This is largely due to labor injuring the Liver, where Liver Fire agitates the stomach collaterals. The pulse is wiry and rapid. The treatment should focus on clearing heat and resolving the pathogen.
Prescription: Refer to the prescription for blood overflow used for Patient Fei at Dong Street, adding Su Zi (Fructus Perillae) and Chuan Bei (Bulbus Fritillariae Cirrhosae).