沧州，吴姓媪，年过七旬，偶得温病兼患吐血。
病因 年岁虽高，家庭事务仍自操劳，因劳心过度，心常发热，
时当季春，有汗受风，遂得温病，且兼吐血。
证候 三四日间表里俱壮热，心中热极之时恒吐血一两口，急饮新汲井泉水其血即止。舌苔
白浓欲黄，大便三日未行。脉象左部弦长，右部洪长，一息五至。
诊断 此证因家务劳心过度，心肝先有蕴热，又兼外感之热传入阳明之府。两热相并，逼
血妄行，所以吐血。然其脉象火热虽盛，而正犹不虚，虽在高年，知犹可治。其治法当以清胃腑
之热为主，而兼清其心肝之热，俾内伤外感之热俱清，血自不吐矣。
处方 生石膏（三两轧细） 生怀地黄（一两五钱） 生怀山药（一两） 生杭芍（一两）
知母（三钱） 甘草（三钱） 乌犀角（一钱五分） 广三七（二钱轧细）
药共八味，将前六味煎汤三盅，犀角另煎汤半盅和匀，分三次温服下。每服药一次，即送服三七末三分之一。
效果 将药三次服完，血止热退，脉亦平和，大便犹未通下，俾
煎渣再服，犀角亦煎渣取汤，和于汤药中服之，大便通下全愈。
帮助 愚平素用白虎汤，凡年过六旬者必加人参，此证年过七旬而不加人参者，以其证兼吐血也。为
不用人参，所以重用生山药一两，取其既能代粳米和胃，又可代人参稍补益其正气也。
【背景信息】
书名：《医学衷中参西录》 作者：张锡纯 朝代：清代 章节：第36节 温病兼见吐血 类别：医理论述
【原文内容】
沧州有一位姓吴的老妇人，年龄超过七十岁，偶然患上温病（外感热病），并伴有吐血症状。
病因 虽然年事已高，但家中事务仍亲自操劳，因用心过度，导致心中常觉发热。时值春季末，出汗后受风邪侵袭，于是得了温病，并且兼有吐血。
证候 发病三四天内，表里都出现高热。当心中极度发热时，常常吐出一两口血，急忙饮用新打的井泉水，出血随即停止。舌苔白厚且即将转黄，大便三天未行。脉象左侧弦而长，右侧洪大而长，一呼一吸之间脉搏跳动五次。
诊断 此证是因为家务劳心过度，导致心、肝先有郁热，又兼外感的热邪传入阳明腑（指胃肠等消化器官）。两种热邪相合，逼迫血液妄行，所以发生吐血。然而其脉象虽然火热旺盛，但正气尚未虚弱，虽然年纪很大，但仍然可以治疗。治疗方法应当以清泻胃腑之热为主，同时兼清心、肝之热，使内伤和外感的邪热全部清除，血液自然不再妄行吐血。
处方 生石膏（三两，碾细） 怀地黄（一两五钱，产地为河南怀庆府的生地黄） 怀山药（一两，产地为河南怀庆府的干山药） 杭芍（一两，即白芍，产地为浙江杭州的白芍） 知母（三钱） 甘草（三钱） 乌犀角（一钱五分） 广三七（二钱，碾细）
药物共八味，将前六味药煎煮成三碗汤，犀角单独煎煮半碗汤，混合均匀，分三次温服。每次服药后，随即送服三分之一的三七粉。
效果 将药分三次服完，出血停止，热退，脉象也趋于平和，但大便仍未通畅。于是让患者煎煮药渣再服用一次，犀角的药渣也煎取汤汁，混入汤药中一起服用，大便通畅后完全痊愈。
按语 我平时使用白虎汤（清热生津的主方）时，凡是年龄超过六十岁的患者必定加入人参（补气固脱的要药）。此例患者年龄超过七十岁却没有加入人参，是因为该证兼有吐血。因为不用人参，所以重用怀山药一两，取其既能代替粳米调和胃气，又可以代替人参稍微补益正气的作用。
[Background Information]
Book: *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing Dynasty
Chapter: 36. Warm Disease Accompanied by Hematemesis
Category: Medical Theory
[Original Text Translation]
In Cangzhou, an elderly woman surnamed Wu, over seventy years old, accidentally contracted a warm disease (Wenbing, an exogenous febrile disease) accompanied by hematemesis (vomiting blood).
Etiology Although advanced in age, she still managed household affairs personally. Due to excessive mental exertion, her heart often felt hot. It was late spring; after sweating, she was exposed to wind pathogens. Thus, she contracted a warm disease and developed hematemesis.
Symptoms Within three to four days, there was high fever both on the exterior and interior. Whenever extreme heat accumulated in the chest/heart region, she would vomit one or two mouthfuls of blood. Immediately drinking newly drawn well water stopped the bleeding. The tongue coating was thick white, turning yellow. There had been no bowel movement for three days. The pulse was wiry and long on the left side, and surging and long on the right side, beating five times per breath cycle.
Diagnosis This condition arose because excessive mental labor from household duties caused latent heat in the Heart and Liver. Additionally, external pathogenic heat transmitted into the Yangming Fu organs (specifically the Stomach and Intestines). The combination of these two types of heat forced blood to move recklessly, resulting in hematemesis. However, although the pulse indicated intense heat, the healthy Qi (Zhengqi) was not yet deficient. Despite her advanced age, the condition was treatable. The treatment principle should focus primarily on clearing heat from the Stomach Fu, while simultaneously clearing heat from the Heart and Liver. Once both internal injury-heat and external pathogenic-heat are cleared, the blood will naturally cease to bleed.
Prescription
Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, finely crushed)
Sheng Huai Dihuang (Raw Rehmanniae Radix Praeparata from Huaiqing, 1.5 liang)
Sheng Huai Shanyao (Raw Dioscoreae Rhizoma from Huaiqing, 1 liang)
Sheng Hang Shao (Raw Paeoniae Radix Alba from Hangzhou, 1 liang)
Zhimu (Anemarrhenae Rhizoma, 3 qian)
Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian)
Wu Xijiao (Rhinocerotis Cornu, 1.5 qian)
Guang Sanqi (Notoginseng Radix et Rhizoma from Guangxi, 2 qian, finely crushed)
The eight herbs were processed as follows: The first six herbs were decocted to yield three bowls of liquid. The Xijiao was separately decocted to yield half a bowl of liquid. These were mixed evenly and taken in three divided doses, warmed. After each dose of the decoction, one-third of the Sanqi powder was administered with it.
Outcome After completing the three doses, the bleeding stopped, the fever subsided, and the pulse became calm and regular. However, the bowels remained unopened. Therefore, the dregs of the previous decoction were boiled again for administration. The dregs of the Xijiao were also decocted to extract liquid and mixed into the herbal soup. After the bowels opened, the patient recovered completely.
Commentary In my usual practice using Baihu Tang (White Tiger Decoction), I invariably add Renshen (Ginseng Radix et Rhizoma) for patients over sixty years old. In this case, despite the patient being over seventy, I did not add Renshen because of the accompanying hematemesis. Since Renshen was omitted, I heavily relied on 1 liang of Huai Shanyao (Dioscoreae Rhizoma), utilizing its ability to substitute for Jingmi (Oryzae Semen Germineatum) to harmonize the Stomach, and its capacity to slightly tonify the Healthy Qi, similar to Renshen.