〔垣〕治一贫士，病脾胃虚，与补剂药愈后，继而居旷室，卧热炕，咳而吐血数次。予谓此久虚弱，外有寒形，
而有火热在内，上气不足，阳气外虚，当补表之阳气，泻里之虚热。盖冬居旷室，衣服单薄，是重虚其阳。
表有大寒，壅遏里热，火邪不得舒伸，故血出于口。因思仲景治伤寒脉浮紧，当以麻黄汤发汗，而不与之，
遂成衄血，却与麻黄汤立愈，与此甚同，因与麻黄人参芍药汤。
麻黄（一钱，去外寒） 桂枝（半钱，补表虚） 白芍药（一钱） 黄 （一钱，实表益卫）
甘草（炙，一钱，补脾） 五味（五粒，安肺气） 门冬（三分，保肺气） 人参（三分，益三焦元气不足
而实其表） 当归（五分，和血养血）
上 咀，作一服，水三盏，煎麻黄一味，令沸去沫，至二盏，入余药同煎，至一盏，去渣热服，临卧一服愈。
观此一方，足以为万世模范也。盖取仲景麻黄汤与补剂各半服之，但凡虚人合用仲景方者，皆当以此为则也。）
〔《活》〕伤寒吐血，诸阳受邪，初热在表应发汗，热毒入经，结于五脏，内有瘀积，故吐血也。瘀血甚
者，抵当汤也；轻者，桃仁承气汤。兼服犀角地黄汤、三黄丸。
短气，骨节痛，不得屈伸，汗出小便不利，恶风身肿者，为风湿，宜甘草附子汤。（方论见体痛。）
短气腹满胁痛，其人若脉弦浮大，外不解，无汗，嗜卧身黄，小便难，有潮热者，小柴胡汤也。（论见胃实。
方见往来寒热。）
若表未解，手足 然汗出，或有潮热者，宜大承气汤。（方论见潮热条。）若表解心下痞硬，干呕短
气者，宜十枣汤。（方论见上。）
短气烦躁，若发汗不彻，续微汗出，不恶寒，表证不罢，面赤者，为并病，更发汗则愈。（论见面赤。）
若下后，心中懊 ，心下硬痛者，用大陷胸汤。（论见结胸。）
趺阳脉微而紧，紧则为寒，微则为虚。微紧相搏，则为短气。坐而伏者，短气也。（论见大法。）
【李东垣】治疗一位贫寒读书人，患有脾胃虚弱之证，服用补益药物痊愈后，接着居住在空旷寒冷的房间，睡在热炕上，咳嗽并多次吐血。我认为这是久病体虚，外有寒邪侵袭的表象，而内有火热郁结，上焦气不足，卫阳在外虚弱，应当补益体表的阳气，清泻体内的虚热。因为冬天居住在空旷房间，衣服单薄，这进一步损伤了阳气。体表受大寒侵袭，壅滞遏阻了体内的热气，导致火邪无法舒展发散，所以血液从口中溢出。由此想到张仲景治疗伤寒脉象浮紧，本应用麻黄汤发汗解表，若不予使用，遂导致鼻衄（鼻出血），此时再给予麻黄汤即可立即痊愈，此情况与此非常相似，因此给予麻黄人参芍药汤。
麻黄（一钱，去除外寒） 桂枝（半钱，补益表虚） 白芍药（一钱） 黄芪（一钱，充实体表、增益卫气）
甘草（炙用，一钱，补益脾土） 五味子（五粒，安定肺气） 麦冬（三分，保护肺气） 人参（三分，补益三焦元气不足以充实体表） 当归（五分，调和血液、滋养血液）
以上药材切碎，作为一剂服用，用水三盏，先单独煎煮麻黄，煮沸后撇去浮沫，煎至二盏，加入其余药物共同煎煮，煎至一盏，滤去药渣，趁热服用，睡前服一次即愈。观察这一方剂，足以成为万世的典范。这是因为取用了张仲景的麻黄汤与补益药剂各半合用，凡是体质虚弱之人适宜使用张仲景方剂的，都应当以此为准则。
【《活》】伤寒导致的吐血，是诸阳经受邪所致，初起热邪在表应当发汗，若热毒深入经脉，结聚于五脏，体内有瘀血积滞，故而吐血。瘀血严重的，用抵当汤；轻症的，用桃仁承气汤。兼服犀角地黄汤、三黄丸。
短气，骨节疼痛，不能屈伸，出汗且小便不利，怕风身体浮肿的，属于风湿证，宜用甘草附子汤。（方论见“体痛”条。）
短气伴腹部胀满、胁肋疼痛，患者若脉象弦、浮、大，表证未解，无汗，嗜睡，身黄，小便困难，有潮热的，用小柴胡汤。（论述见“胃实”条。方剂见“往来寒热”条。）
如果表证未解，手足濈然汗出，或有潮热的，宜用大承气汤。（方论见“潮热”条。）如果表证已解，但心下痞塞坚硬，干呕、短气的，宜用十枣汤。（方论见上文。）
短气烦躁，如果是发汗不彻底，随后微汗出，不怕冷，表证未罢，面色发红的，属于并病，再次发汗则痊愈。（论述见“面赤”条。）
[Li Dongyuan] Treated a poor scholar who suffered from Spleen and Stomach deficiency. After his condition improved with tonifying prescriptions, he subsequently lived in a spacious, cold room and slept on a heated kang (heated brick bed). He coughed and hemoptysis occurred several times. I reasoned that this was a case of chronic weakness, with an exterior pattern of cold and interior accumulation of heat. There was insufficiency of Qi in the upper Jiao and deficiency of Yang Qi at the exterior. It was necessary to tonify the Yang Qi at the exterior and drain the deficient heat within. Since he resided in a spacious room during winter with thin clothing, his Yang Qi was further depleted. Severe cold at the exterior obstructed and contained the interior heat, preventing the Fire pathogen from dispersing smoothly, thus causing blood to emerge from the mouth. This reminded me of Zhang Zhongjing’s treatment of Taiyang disease with floating and tight pulse, where Mahuang Tang should be used to induce sweating. If not administered initially, it may lead to epistaxis; administering Mahuang Tang at that stage can cure it immediately. This situation is very similar. Therefore, I prescribed Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and White Peony Decoction).
Mahuang (1 qian, to expel exterior cold) Guizhi (0.5 qian, to tonify exterior deficiency) Baishao Yao (1 qian) Huangqi (1 qian, to solidify the exterior and benefit Wei Qi)
Zhi Gancao (1 qian, to tonify the Spleen) Wuweizi (5 grains, to calm Lung Qi) Maidong (0.3 qian, to protect Lung Qi) Renshen (0.3 qian, to benefit the Yuan Qi of the Three Jiao and solidify the exterior) Danggui (0.5 qian, to harmonize and nourish Blood)
The above herbs were cut into pieces for one dose. Using three cups of water, first decoct Mahang alone until boiling, then skim off the foam. Continue decocting until two cups remain, then add the remaining herbs and decoct together until one cup remains. Strain the dregs and take warm. One dose taken before bedtime resulted in a cure. Observing this prescription, it is sufficient to serve as a model for all generations. It combines half of Zhang Zhongjing’s Mahuang Tang with half of a tonifying prescription. For any patients with deficiency constitution who are suitable for Zhang Zhongjing’s formulas, this should be the standard principle.
[From "Huo"] Hemoptysis caused by Shanghan (Cold Damage) occurs when the Yang meridians are affected by pathogens. Initially, heat is at the exterior and should be treated by inducing sweating. If heat-toxin enters the meridians and knots in the Five Zang organs, leading to internal blood stasis accumulation, hemoptysis results. For severe blood stasis, Didang Tang (Vassal Decoction) is used; for mild cases, Tao Ren Chengqi Tang (Peach Kernel and Rhubarb Decoction) is used. These may be combined with Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) and Sanhuang Wan (Three Yellow Pill).
Shortness of breath, pain in bone joints, inability to flex or extend, sweating with dysuria, aversion to wind, and body swelling indicate Fengshi (Wind-Dampness). Gancao Fuzi Tang (Licorice and Aconite Decoction) is appropriate. (See "Body Pain" for formula discussion.)
Shortness of breath with abdominal fullness and hypochondriac pain, where the pulse is wiry, floating, and large, with unresolved exterior syndrome, absence of sweating, lethargy, jaundice, difficult urination, and tidal fever, indicates Xiaochaihu Tang (Minor Bupleurum Decoction). (See "Stomach Excess" for discussion. See "Alternating Chills and Fever" for formula.)
If the exterior syndrome is not yet resolved, with continuous sweating from the hands and feet, or tidal fever, Da Chengqi Tang (Major Order the Qi Decoction) is appropriate. (See "Tidal Fever" for formula discussion.) If the exterior syndrome has resolved but there is epigastric stiffness and hardness, dry retching, and shortness of breath, Shizao Tang (Ten Jujube Decoction) is appropriate. (See above for formula discussion.)
Shortness of breath and irritability, resulting from incomplete sweating therapy, followed by slight sweating, no aversion to cold, unresolving exterior syndrome, and red face, indicates Bingbing (Combined Disease). Re-inducing sweating will result in recovery. (See "Red Face" for discussion.)
After purgation, if there is mental restlessness and epigastric hardness and pain, Daxiexiong Tang (Major Chest-Trap Decoction) is used. (See "Chest Trap" for discussion.)
At the foot-Yang position, a pulse that is faint and tight indicates cold (tight) and deficiency (faint). The combination of faint and tight pulses leads to shortness of breath. Sitting while leaning forward is a sign of shortness of breath. (See "General Principles" for discussion.)