龙骨入肝敛魂，牡蛎入肾固精，皆收敛精魂之品入桂枝汤中，则为固蛰封藏之本药也。若失
精悸衄腹痛，本方加胶饴为小建中；里急为营卫枯槁，更加黄 为黄 建中，此皆后天不足
以调和营卫为主治。后人专用滋阴降火，未至
于剧用此，尚可挽回。若先天肾虚者八味肾气∶虚烦不眠酸枣仁汤；干血者 虫丸。惟薯
蓣丸专治表邪不解、误用凉药伤犯肺胃、自上而下之虚劳。”秦元宫曰∶“仲景用建中复脉以
扶胃而创建中气，以胃为气血生化之原。其人稍见膈虚内热，神气不旺，以建中未雨绸缪，
桂枝和卫，白芍和营，调剂阴阳，而以饴糖、甘草、大枣补胃土，以生姜、生发多服，胃气旺而
上升于肺，肺行降下之令而主水，所谓地气上为云也，天气下为雨，山泽通气之道也。故一
则曰脉大为劳；又曰浮则无血，大则无气；又曰脉极虚芤迟，从未闻数脉也，亦未闻兼咳嗽
也，失此不治而阴火上升，脉之迟者变而为数，火上弄金而咳嗽起，岂可仍用桂枝。”按∶
此条论仲景所治，非今日脉数咳噘阴火上升之虚劳也。后贤论治，或以谓补气者，当补肺
之母脾；补血者当补肝之母肾。又曰土旺而金自生，勿拘拘乎保肺；水盛而大自熄，勿汲汲
乎寒凉。东垣谓∶“人参补肺，气旺则四脏之气皆旺，精自生而形自盛。”白飞霞谓∶“多服人
参，回元气于无何有之乡。肺虚喘嗽者，并宜服之。”王好古谓∶“肺，热还伤肺。王节斋谓∶
“虚劳服参 者必死。”按∶古书如聚讼，愚以谓无脉证而论治，犹无题而论文。宋元清名家
论理极是，施之实事皆属似是而非，惟沈朗仲曰∶“阴虚多火之人，即感客邪，蒸热咳嗽，切
忌羌防柴葛表散，亦不可用桔杏苏橘清肺止嗽，有积者忌消导，当静以养阴。”亦属调停之
见（以上论古）。大抵此症起于斫丧者，肝肾过劳，多亡血失精，强中阴竭而死；起于郁结者，
内火烁津，多致血结，干咳，嗜食，发 而死；起于药误者，脾肺受疾居多，多致饮食减少，
喘漱泄泻而死。此其大概也，治之之法∶阴火刑金而咳，脉数，为内风生，生则气行急疾，一
呼一吸或六七至，气急巽风用事，逼血妄行，或吐衄，或血去，而阴益虚，不独肺燥，胆汁亦
枯。胆枯木将自焚，且肺既嗽，又能激动火势化液为痰，逮肺枯而痿生，水之源绝，潮热不
休，安得不死。仲景曰∶“脉数者风发也，以饮
食消息止之。”至精至妙。实虚劳生死之关，趁其人胃气尚强以饮食补之，所谓形不足者补
之以味。补气血，以肥鸭牛肉之属；补阴如海参、鳗、鳖；补土如童雌黄鸡、鲫鱼、 鱼；清火
则燕窝、蛤蜊；补肺猪肺、百合；健脾大枣、莲子。多其火候，恣意食之；不可过饱，恐脾难运
化，食后徐步，服滋生丸一丸；俾心闲气静内火不生，久久食入，于阴气长于阳，胃气充足
上升于肺，肺能生水，脉数乃退，所忌发风动气生冷之品。此胃尚强时，饮食调补一法也
（以上食养）。其或迁延日久，服药差误大耗真气，中虚胃弱，食少不运，前法难施，议者多本
壮水制火，知柏苦寒，地黄湿滞，即苓术亦苦燥。夫水从金出为天一之水，方能有济。金之
所以能生水者，全赖脾胃之气上升而水可生。脾湿胃益弱，而肺金愈无土生。若用敛降，无
论难降即或，火降而气既下陷，酷日无云，雨安从来，过时复升，其火愈甚，皆不明水出高
源、水泽通气之义也。盖脉数不除，风行不息，必无愈机。诊虚劳脉者，尽一昼夜间必有一刻
其数少减，此正阴阳自为胜复之时，乘此投药迎机而导，否则寅初气注肺时服回风汤入米
露一杯。数服后，兼服丙辛汤。及三合水汤脉少减者，即是生机。盖此风与中风之风异，
彼则阴霾昼晦发屋拔木狂暴之风，此则夏日亢阳东南熏熟之风。逆其势自西而东，则西方
凉风至，而雨可望矣。故阳不上升者用柴胡左升以趋右，今当升右之阳以趋左，此又一法也
（以上回风）。若夫虚火上升，面赤心烦，咳嗽口干，其脉寸盛尺弱，来盛去衰者，病又加进，
先用导火汤引火下入小肠，静坐数刻，火从下降，降至丹田，乘火在下时服赤帜汤填实中
焦，不使火得再上，是韩信拔赵帜立汉帜法也，此又一法也（以上赤帜法）。若血初见时，
慎不可用酸敛止涩及生地之泥滞，恐血凝而瘀，须用黑金散降火去瘀最妙。若劳力内伤呕
血者，活蟹一大只捣烂，温陈酒调服，此皆阴火上升而生内风之虚劳也（以上血症）。如痰
中带血如丝缕者，是因咳伤肺也；用清肺汤血
从咯出者，从肝肾来，火犹未入于肺，急服镇火汤统治诸血；发热者，有三阴阳虚劳，常服
者有升阴养血汤、止嗽汤。常服金生丸，可引肺气下入于肾（以上总治）。此外有发热昼夜
不休，肌肤涩绝无汗者，必有外邪未清，或误为补药所痼，用内托汤热服发汗（以上夹邪）。
又有骨蒸劳病，肌肤不甚热，按之骨间甚热，其人善食而瘦，皮肤枯涩，无汗，大便结实，其
脉沉紧数有力，与诸虚劳不同，皆起于风寒外邪，日久蕴蓄而成，当用苦寒大补阴之类，大
忌燥热之品。盖其热在骨髓，亦不宜用升散之使其热炎灼于外。又诸虚皆系胆汁枯，则肝木
之火无水制，而风火大发。骨蒸一症，胆汁尤枯，用退蒸汤（以上骨蒸）。又如每日先寒后热
如疟，汗出而热始退者，桂枝柴胡各半汤加胆汁二匙。此外有因血瘀而发者，妇人尤多，古
人虫丸之外有麦煎散，今方黑金丸。若夫传尸瘵症，其症心中烦热欲露体，覆之即闷，惊
悸、怔忡、面无颜色、忘前失后，乃心蒸之状，用传尸劳方。若骨蒸五心烦热者，清骨散。
问∶烂喉丹痧见于仲景书否，此症宋元名家议论绝少，能言其发病之故乎？或曰由乎司
天，然燥令湿令俱能发病，主气客气不一，其说能详说其所以然乎？顺症何如，逆症何如，
初起之治法当何如，中后之治法当何如，当清之见证当何若，当下之见症何若，能详言欤？
此症近来颇多。
家大人已立论在前，尤当扩充其意而详说之。
《金匮》云∶“阳毒之为病，面赤斑斑如锦纹，咽喉痛吐脓血，五日可治，七日不可治。升
麻鳖甲汤主之。”此条经文与今之烂喉丹痧绝似，而治法则不可从，无论蜀椒、雄黄温燥不
可服。亦思此症发于春夏，地气本升，不当再用升麻，因于温热，血中伏火不必更用当归，
人所共知也。古书绝少今时盛行者，宋元名家多北人，而此病盛于江南也，从来论司天者其
说不一，吾以为客气不足凭，当实求之主气。与营运之令气客气如先天之八卦，有定位而
无用。主气令气则参互错综，随时而见。如今年春令地气本温而多西北风，阴雨数旬，此太
阴湿土令气加临少阳相火。主气病必见湿遏郁伏，烂喉丹痧所由发也。发之何如？因疫
之气从口鼻而入于肺胃也。何以烂喉？湿热郁蒸也。如何为痧？与疹为类，是血络中病，
与之出于胃者不同，当主芳香透络，辛凉解肌，甘寒清血，其后逆传心胞，仍不外乎叶老
温热之旨。然一症宜分三种，风邪化热者治宜清透，湿邪化热者治宜清渗，痰火凝结者治宜
清降。顺症初起，脉紧弦数，恶寒，头胀，肤红，肌热，喉中碎腐而痛，疹现隐隐。三四日后温
邪化火，热盛痧透。五六日后，热甚，神昏，喉烂。此火盛逆传，内逼心胞见症也。七日后，
热退，偏体焦紫，痧如麸壳脱皮而愈，此顺症也。若逆症，一二日脉见细劲，身虽红痧不外
透，神识已昏，语言错乱，气逆喘急，此由邪毒内闭肺胃，内闭则外厥而脱矣。治之之法∶顺
症一二日宜疏表，牛蒡解肌汤或银翘散，加消食之品，吹以珠黄散。三四日化火，前方加犀
角、羚角、花粉、石斛。五六日，见内逼心胞，症在营分，犀角地黄汤。有汗神清者，邪在气分，
玉女煎加胆星、石菖、西黄药珠，甚则紫雪。中后之治法大都如此。其或便结燥实、舌干而黄
黑者，凉膈散，即下法也。协热便泄、舌苔白腻者，葛根芩连。至于逆症，火毒内闭于肺胃，用
鲜地四两捣汁，加金汁、梨汁、蔗浆更葛根、芩、连。至于逆症，火毒内闭于肺胃，用鲜地四
两捣汁，加金汁、梨汁、蔗浆，更用鲜芦根煎汤，磨犀角汁，冲和紫雪丹，或珠黄散，要不外
乎清开泄热为主。若夫不治之症，鼻塞流涕者，肺已伤，不治；合眼朦胧者，肝欲坏，不治；
色白如粉皮者，气色败，尤属不治。盖元气虚者，不能托毒外出，毒且深伏，虽有清补化邪
一法，究属难图，尚不如阴虚者可重用养阴泄热也。治详于温热症下焦篇中。家大人老年
议论甚恶夫清之太早者，以感风感湿未曾化火而先清，必有结毒发颐之变。善乎！祖鸿范
之言曰∶“初起发热憎寒者，以透散为主，火郁
发之也。恶寒已止，内蕴之邪火方张，以凉解为宜，若仍执辛散，火得风而益炽，肿热必增，
当于先后次第之间随机权变，各中其款要，斯为尽善。”
问∶妇人之病胎产为要，妊子之脉能分辨欤？男女之分可预测欤？试胎之法果孰胜欤？
恶阻之因治之之法能详言欤？胎漏小产其因其治能详说欤？妊妇有头痛、心痛、胃脘痛、少
腹痛、股痛、环跳痛、目赤、咽痛、甚至于跌仆损伤，能各举其证因治法大略欤？胎死腹中验
法下法，亦附详焉。
经曰∶“手少阴脉动甚为妊子，阴搏阳别为妊子，身病无邪脉为妊子，尺脉不绝为妊
子。”夫尺者是少阴肾脉也。肾脉滑利亦见带症，惟与手少阴心动脉相应乃为妊子，无疑是
即所谓阴搏阳别也。且血留气聚胞宫内实，能无尺阴滑数乎？其与虚劳数脉分别处∶胎脉数
中有胃气，劳脉则兼弦涩无胃气也。然亦有中年羸妇细小而不数者，其微弱中必有隐隐滑
动之象可凭也。辨男女之脉最难执，左大为男、右大为女之说，不有脏气偏胜者乎？闻之
先业师曰∶妇人背阴而面阳，其左男子之右也，右则男子之左也。所以丹溪谓是诊脉者左
右手。此不可凭者也，惟两寸浮滑为阳脉，主男胎；两尺沉滑为阴脉，主女胎。庶几近之然。
易不辨之男胎三月动而脐凸硬腹如釜、女胎五月动脐软腹如箕之为直捷也。瘀阻与胎混，
不得已而用试法∶陈酒调佛手散（归七分芎一钱），待两时许，脐腹微动为胎，不动者为经
滞。法颇稳当，恶阻者恶心，阻其饮食也。其故有二∶一由胃虚，宿有痰饮而兼气滞；一由
冲任上壅，气不下行，盖经血既闭，水渍于脏，脏气不宣通，故心烦愦闷、气逆而呕吐。及三
月后胎渐大，子能食血，自无上逆之患。然而间有不恶阻者，何也？中宫气健，胃无宿痰，清
浊自能升降，不令秽气上壅，自无恶阻矣。治法∶虚者加味参橘饮（温胆加参、木、归、藿、
砂），实者小和中饮（陈、朴、苓、查、扁、草），吐酸不止者二香（藿草、香附）为末（服二钱）。大
约胃寒者加丁香、豆蔻、砂仁，脾虚有火加黄芩、山栀、竹茹。要不外丹溪两言∶“肥人多痰，
瘦人多火。”其法则二陈加减，须知此病不必疑半夏、茯苓二味为碍胎。胎漏小产由于气血
虚弱者多，气虚则提摄不固、血弱则灌溉不周。而系胞者肾，腰为肾腑，腰痛则堕，不可不
防。外此，则血太热而妄行。大凡暴下水者，胎必堕。若徐下者，可用补气安神治之。此症
之脉宜弦牢滑利，忌沉细而微。其治视禀质所偏，阴虚内热者而用艾、附、白术、砂仁，温剂
则阴愈消，如草木之无雨露，枯萎立见矣。阳虚内寒者，而用芩、芍，凉血则脾胃虚寒，气血
亦弱，如果实秋冬少结矣。三月前宜养脾胃，四月后宜壮腰肾，此大法也。以泰山磐石山散
为主方（八珍去苓，加参、断、芩、 ）。血热者加黄柏、阿胶，气寒者加艾叶、炮姜。然而胎漏
一症，辨之宜慎。有妊妇血盛月信常来而不堕者，治之反堕；亦有孕妇脉见滑数、月事略少，
至三四月止者。今人以为七月生，其实足月也。又有壮盛之妇前三月按月去血点滴者，苟
无腰酸胎动，不须服药。此又当合形体论也。再世人一月堕胎者最多，其人好洁，日必举足
洗下体而滑也。胎前诸痛、气虚血虚、血热三种宜常目在之。而外感内伤，仍各宜分剖。如
头痛血虚多火者，四物加减；感风者，加味芎归（芩、木、茶）；心腹痛或素有痰饮更触外感
者，正气散；按之痛者积滞，保元；不痛者脾胃伤，六君；满痛及心，芩、术、芍三味；不时腹痛
者血虚，熟地、当归二味煎汤服之；重坠者气虚也，补中益气；胁痛者不宜破气，童便和酒
服之；少腹冷痛，小建中加炮姜；腰痛，环跳痛者，宜补；目赤、口舌咽痛者，凉膈亦可服；若
跌仆伤者，胶、艾、芎、归加地。此其大略也。至如面青舌红母死子活，面红舌青母活子死，为
验死胎之诀，一定无疑。下之之法∶丹溪用佛手散重剂（归一两芎七钱），要不若平胃加芒
硝为稳。
问∶胎前症，最多子悬症，多心腹胀满，以紫苏饮为主方，其故何欤？抑另有法欤？又有
龙骨入肝经以收敛神魂，牡蛎入肾经以固摄精关，这两味都是收敛精气的药物，加入桂枝汤中，便成为巩固封藏根本的药物。如果出现遗精、心悸、鼻衄、腹痛等症状，原方加入饴糖即为小建中汤；如果感到腹部拘急疼痛，这是因为营卫气血枯槁，再加入黄芪即为黄芪建中汤，这些方剂都是以调理后天脾胃不足、调和营卫为主要治疗原则。后人专门使用滋阴降火的方法，在病情尚未严重时使用此法，还可以挽回局面。如果是先天肾虚的患者，可用八味肾气丸；虚烦不眠的可用酸枣仁汤；干血内结的可用大黄䗪虫丸。只有薯蓣丸专门治疗表邪未解、误用凉药损伤肺胃、由上而下的虚劳病。”秦元宫说：“张仲景使用建中汤和复脉汤来扶助胃气以建立中气，因为胃是气血化生的源头。病人稍微出现膈部虚弱、内热、神气不振的情况，用建中汤防患于未然，桂枝调和卫气，白芍调和营气，调剂阴阳，并用饴糖、甘草、大枣补益胃土，生姜发散，多服后胃气旺盛并上升于肺，肺行使下降的职能并主管水液，这就是所谓的地气上升化为云，天气下降化为雨，山水之间气息相通的道理。所以说：脉大是劳损的表现；又说：脉浮说明无血，脉大说明无气；又说：脉极虚、芤、迟，从未听说过数脉，也从未听说兼有咳嗽的。如果错过这个时机不治疗，导致阴火上升，原本迟缓的脉象变为数脉，火克金（肺）而出现咳嗽，此时难道还能继续使用桂枝吗？”按语：这一条论述的是张仲景所治疗的病症，并不是今天这种脉数、咳嗽、阴火上升的虚劳病。后世医家论治，有的认为补气应当补脾（脾为肺之母），补血应当补肾（肾为肝之母）。又有人说：土旺则金自生，不要拘泥于保肺；水盛则火自熄，不要急切地使用寒凉药物。李东垣说：“人参补肺，气旺则四脏之气皆旺，精气自然生成，形体自然强盛。”白飞霞说：“多服人参，能在虚无之中恢复元气。肺虚喘嗽的人，都适宜服用。”王好古说：“肺热会进一步伤害肺。”王节斋说：“虚劳病人服用参茸类药物必死无疑。”按语：古代医书如同聚讼纷纭，我认为没有脉证依据而论治，就像没有题目而写文章一样。宋元清时期的名家在理论探讨上非常精辟，但应用到实际病例中却大多似是而非，只有沈朗仲说：“阴虚多火的人，即使感受外邪，出现蒸热咳嗽，切忌使用羌活、防风、柴胡、葛根等发表散邪的药物，也不可使用桔梗、杏仁、苏叶、橘皮等清肺止咳的药物，有积滞的忌用消导药，应当静养以滋养阴液。”这也是一种折中的见解（以上讨论古人观点）。大抵这类疾病，起于过度房事或劳累耗损的，多是肝肾过劳，导致亡血失精，因强中（阳强不倒）阴竭而死；起于情志郁结的，内火灼烧津液，多导致血结，干咳，嗜食，最终发痨而死；起于用药失误的，多是脾肺受损，多导致饮食减少，喘咳泄泻而死。这是大概情况。治疗方法：阴火刑金（克制肺金）而咳嗽，脉数，这是内生风邪，风生则气行急疾，一呼一吸间脉搏跳动六七次，气急如巽风当令，逼迫血液妄行，或者吐血、鼻衄，或者出血过多，导致阴更加虚弱，不仅肺燥，胆汁也枯竭。胆汁枯竭，木火将自焚，况且肺已经咳嗽，又能激动火势，将津液化为痰，等到肺干枯而产生痿证，水源断绝，潮热不休，怎么能不死呢？张仲景说：“脉数是由于风邪发作，通过饮食调养来制止它。”真是至精至妙。这确实是虚劳生死的关键所在，趁着病人胃气还强健时，用饮食来补益，这就是所谓“形不足者，补之以味”。补气血，用肥鸭、牛肉之类；补阴用海参、鳗鱼、鳖；补土（健脾）用童母鸡、鲫鱼、黄颡鱼；清火用燕窝、蛤蜊；补肺用猪肺、百合；健脾用大枣、莲子。烹饪时要火候充足，尽情食用；但不要过饱，恐怕脾胃难以运化，饭后慢慢散步，服用滋生丸一丸；使心境闲适、气息平静，内火不生，久而久之，阴气增长于阳气之上，胃气充足上升于肺，肺能生水，脉数自然消退。禁忌食用发风动气及生冷食物。这是在胃气尚强时的饮食调补方法（以上为食养）。如果病情迁延日久，服药差错严重耗伤真气，导致中焦虚弱、胃气衰弱，饮食减少且无法运化，前面的方法难以施行。议者多主张壮水制火，但知母、黄柏苦寒，地黄滋腻湿滞，即使是茯苓、白术也偏于苦燥。水从金出称为天一之水，这样才能有所济助。金之所以能生水，全赖脾胃之气上升而水可生。如果脾湿胃弱，那么肺金就更没有土的生助了。如果使用收敛降逆的方法，无论是否难降，即使火降了，气既然下陷，就像烈日当空没有云彩，雨水从哪里来呢？过时火气再次上升，火势更加猛烈，这都是不明白水出高源、水泽通气道理的缘故。大概脉数不除，风邪流行不息，必定没有痊愈的机会。诊断虚劳病人的脉象，一整天中必然有一刻钟脉数稍微减轻，这正是阴阳自我胜复的时候，乘这个机会投药引导，否则在寅初（凌晨3-5点）肺气注旺时服用回风汤，送服米露一杯。服用几剂后，兼服丙辛汤、三合水汤。脉象稍微减轻的，就是生机。大概这种风与中风的风不同，那种是阴霾遮蔽白天、刮倒房屋拔起树木的狂暴之风，这种则是夏日亢阳东南吹来的熏热风。违背其势头，使其从西向东转变，那么西方的凉风就会到来，雨水也就有望了。所以阳气不能上升的用柴胡左升汤以趋向右边，现在应当提升右边的阳气以趋向左边，这是另一种方法（以上为回风法）。如果是虚火上升，面红心烦，咳嗽口干，脉象寸部盛尺部弱，来势盛去势衰的，病情又加重了，先用导火汤引火下行进入小肠，静坐片刻，火从下降，降至丹田，趁火在下时服用赤帜汤填实中焦，不让火再上行，这是韩信拔赵军旗帜立汉军旗帜的方法，这也是另一种方法（以上为赤帜法）。如果刚开始见血，千万不要使用酸敛止涩及生地的黏滞药物，恐怕血液凝结成瘀，必须使用黑金散降火祛瘀最好。如果是劳力内伤导致的呕血，取活蟹一只捣烂，用温陈酒调服，这些都是阴火上升而生内风的虚劳病（以上为血症）。如果痰中带血丝，是因为咳嗽伤了肺；用清肺汤；血从咯出的，是从肝肾来的，火还没有进入肺，急服镇火汤统管各种出血；发热的，有三阴阳虚劳，常服升阴养血汤、止嗽汤。常服金生丸，可以引导肺气下行进入肾（以上为总治法）。此外有发热昼夜不停，肌肤干燥绝无汗出的，一定是有外邪未清，或者是误用补药导致邪气固结，用内托汤热服发汗（以上为夹邪）。又有骨蒸劳病，肌肤不是很热，按压骨头间很热，病人食欲好但消瘦，皮肤枯涩，无汗，大便干结，脉象沉紧数有力，与各种虚劳不同，都起于风寒外邪，日久蕴蓄而成，应当使用苦寒大补阴之类的药物，大忌燥热之品。大概热在骨髓，也不宜使用升散药物使其热气炎灼于体表。另外各种虚证都伴有胆汁枯竭，那么肝木之火没有水制约，风火大发。骨蒸一症，胆汁尤其枯竭，用退蒸汤（以上为骨蒸）。又如每天先冷后热像疟疾，出汗后热才退的，用桂枝柴胡各半汤加胆汁两匙。此外有因血瘀而发的，妇人尤其多，古人在大黄䗪虫丸之外还有麦煎散，现在的方子是黑金丸。如果是传尸瘵症，症状是心中烦热想裸露身体，盖上被子就闷，惊悸、怔忡、面色无华、忘前失后，这是心蒸的症状，用传尸劳方。如果是骨蒸五心烦热的，用清骨散。问：烂喉丹痧见于张仲景的书吗？这个症状宋元名家议论极少，能说出发病的缘故吗？有人说由于司天运气，然而燥令和湿令都能发病，主气和客气不一致，这个说法能详细说明其中的原因吗？顺症如何，逆症如何，初起的治法应当如何，中后期的治法应当如何，应当清解的见证应当怎样，应当攻下的见证怎样，能详细说说吗？这个症状近来很多。家父以前已经立论，更应当扩充其意并详细说明。《金匮要略》说：“阳毒这个病，面部红赤斑斑像锦纹，咽喉痛吐脓血，五天可治，七天不可治。用升麻鳖甲汤主治。”这条经文与现在的烂喉丹痧极其相似，但治法不可照搬，不用说蜀椒、雄黄温燥不可服用。我也想到这个症状发于春夏，地气本应上升，不应当再用升麻升提，因为是由于温热，血中伏火，不必再用当归，这是人所共知的。古书中很少记载今时盛行的病，宋元名家多是北方人，而这个病盛行于江南。从来论述司天运气的说法不一，我认为客气不足以凭信，应当切实求之于主气。与营运的令气、客气如同先天八卦，有固定位置而没有作用。主气令气则参互错综，随时显现。比如今年春季地气本温而多西北风，阴雨数十天，这是太阴湿土令气加临少阳相火。主气病必然见到湿遏郁伏，这就是烂喉丹痧发作的原因。发作是怎样的？因为疫疠之气从口鼻进入肺胃。为什么会烂喉？湿热郁蒸。什么是痧？与疹同类，是血络中的病，与从胃发出的不同，应当主要用芳香透络、辛凉解肌、甘寒清血的方法，其后逆传心包，仍然不外乎叶天士温热学的宗旨。然而一种病应当分三种，风邪化热的治宜清透，湿邪化热的治宜清渗，痰火凝结的治宜清降。顺症初起，脉紧弦数，恶寒，头胀，肤红，肌热，喉咙碎腐而痛，疹子隐隐出现。三四天后温邪化火，热盛痧透。五六天后，热甚，神昏，喉咙腐烂。这是火盛逆传，内逼心包的见证。七日后，热退，全身焦紫，痧像麸壳脱皮而愈，这是顺症。如果是逆症，一二日脉见细劲，身体虽红但痧不外透，神识已昏，语言错乱，气逆喘急，这是由于邪毒内闭肺胃，内闭则外厥而脱。治疗方法：顺症一二日宜疏表，用牛蒡解肌汤或银翘散，加消食之品，吹珠黄散。三四日化火，前方加犀角、羚角、花粉、石斛。五六日，见内逼心包，症在营分，用犀角地黄汤。有汗神清的，邪在气分，用玉女煎加胆星、石菖蒲、西黄药珠，严重的用紫雪丹。中后期的治法大都如此。如果有便秘燥实、舌干而黄黑的，用凉膈散，这就是下法。协热便泄、舌苔白腻的，用葛根芩连汤。至于逆症，火毒内闭于肺胃，用鲜生地四两捣汁，加金汁、梨汁、蔗浆，再加葛根、芩、连。至于逆症，火毒内闭于肺胃，用鲜生地四两捣汁，加金汁、梨汁、蔗浆，再用鲜芦根煎汤，磨犀角汁，冲服紫雪丹，或珠黄散，总之不外乎清开泄热为主。如果不治之症，鼻塞流涕的，肺已伤，不治；眼睛闭合朦胧的，肝欲坏，不治；面色白如粉皮的，气色败，尤其属不治。大概元气虚的人，不能托毒外出，毒邪深伏，虽然有清补化邪一法，终究难以图谋，还不如阴虚者可重用养阴泄热。治法详见于温热症下焦篇中。家父老年议论很厌恶过早使用清热药，因为感风感湿尚未化火而先清热，必然会有结毒发颐的变证。祖鸿范的话说得好：“初起发热憎寒的，以透散为主，这是火郁发之。恶寒已止，内蕴的邪火正盛，以凉解为宜，如果仍坚持辛散，火得风而更炽，肿热必增，应当在先后次第之间随机权变，各中其关键，这才是尽善尽美。”问：妇人的病胎产最重要，妊娠的脉能分辨吗？男女之分可以预测吗？试胎之法究竟哪个更好？恶阻的原因和治法能详细说说吗？胎漏小产的病因和治疗能详细说说吗？孕妇有头痛、心痛、胃脘痛、少腹痛、股痛、环跳痛、目赤、咽痛，甚至于跌仆损伤，能分别列举其证因治法的大概吗？胎死腹中的验法和下法，也请附带详细说明。经上说：“手少阴脉动甚为妊娠，阴搏阳别为妊娠，身病无邪脉为妊娠，尺脉不绝为妊娠。”尺脉是少阴肾脉。肾脉滑利也可见于带下病，只有与手少阴心动脉相应才是妊娠，这无疑是所谓的阴搏阳别。而且血留气聚胞宫，宫内充实，能不尺阴滑数吗？它与虚劳数脉的区别在于：胎脉数中有胃气，劳脉则兼弦涩无胃气。但也有中年瘦弱妇女脉细小而不数的，其微弱中必有隐隐滑动的迹象可以凭借。辨别男女的脉最难执着，左大为男、右大为女的说法，难道没有脏气偏胜的情况吗？听我先师说：妇人背阴而面阳，她的左手对应男子的右手，右手对应男子的左手。所以朱丹溪说是诊脉者的左右手，这是不可凭信的，只有两寸浮滑为阳脉，主男胎；两尺沉滑为阴脉，主女胎，这才接近正确。不过不如不辨男女，看男胎三月动而脐凸硬腹如釜、女胎五月动脐软腹如箕来得直接。瘀血阻滞与胎混淆，不得已而用试胎法：用陈酒调服佛手散（当归七分，川芎一钱），等待两个时辰左右，脐腹微动为胎，不动者为经血阻滞。这个方法颇稳当。恶阻就是恶心，阻碍饮食。其原因有二：一是由于胃虚，素有痰饮而兼气滞；一是冲任之气上壅，气不下行，因为经血既闭，水渍于脏，脏气不宣通，所以心烦愦闷、气逆而呕吐。到了三个月后胎渐大，胎儿能食血，自然没有上逆的患害。然而间或有不恶阻的，为什么呢？中宫气健，胃无宿痰，清浊自能升降，不让秽气上壅，自然没有恶阻了。治法：虚者用加味参橘饮（温胆汤加人参、木香、当归、藿香、砂仁），实者用小和中饮（陈皮、厚朴、茯苓、山楂、扁豆、甘草），吐酸不止的用二香散（藿香、草果、香附）研末（服二钱）。大概胃寒者加丁香、豆蔻、砂仁，脾虚有火者加黄芩、山栀、竹茹。总不出朱丹溪两句话：“肥人多痰，瘦人多火。”其法则以二陈汤加减，须知此病不必怀疑半夏、茯苓二味碍胎。胎漏小产多由于气血虚弱，气虚则提摄不固，血弱则灌溉不周。而系胞的是肾，腰为肾之腑，腰痛则堕胎，不可不防。除此之外，则是血太热而妄行。大凡暴下水的，胎必堕。如果徐下的，可用补气安神法治之。此症的脉宜弦牢滑利，忌沉细而微。其治疗视禀质所偏，阴虚内热者用艾叶、附子、白术、砂仁，如果用温剂则阴愈消，如草木无雨露，枯萎立见。阳虚内寒者，用黄芩、白芍，凉血则脾胃虚寒，气血亦弱，如果实秋冬少结。三月前宜养脾胃，四月后宜壮腰肾，这是大法。以泰山磐石散为主方（八珍汤去茯苓，加人参、续断、黄芩、阿胶）。血热者加黄柏、阿胶，气寒者加艾叶、炮姜。然而胎漏一症，辨证宜慎。有妊妇血盛月信常来而不堕的，治疗反而致堕；也有孕妇脉见滑数、月事略少，至三四月停止的。今人以为七月生，其实足月也。又有壮盛之妇前三月按月去血点滴的，如果没有腰酸胎动，不需要服药。这又应当结合形体来论。再者世人一月堕胎者最多，其人爱干净，每日必举足洗下体而滑。胎前诸痛，气虚、血虚、血热三种宜常记在心。而外感内伤，仍各自宜分辨。如头痛血虚多火的，四物汤加减；感风的，加味芎归汤（黄芩、木香、茶）；心腹痛或素有痰饮更触外感的，正气散；按之痛的为积滞，保元汤；不痛的为脾胃伤，六君子汤；满痛及心的，用黄芩、白术、白芍三味；不时腹痛的为血虚，熟地、当归二味煎汤服之；重坠的为气虚，补中益气汤；胁痛的不宜破气，童便和酒服之；少腹冷痛，小建中汤加炮姜；腰痛、环跳痛的，宜补；目赤、口舌咽痛的，凉膈散亦可服；若跌仆伤的，胶艾汤加川芎、当归、地黄。这是大概情况。至于面青舌红母死子活，面红舌青母活子死，是验死胎的诀要，一定无误。下死胎之法：丹溪用佛手散重剂（当归一两，川芎七钱），总不如平胃散加芒硝为稳妥。问：胎前症，最多子悬症，多心腹胀满，以紫苏饮为主方，这是什么缘故呢？抑或另有法呢？又有
Longgu (Fossilized Bone) enters the Liver meridian to astringe the Hun (ethereal soul), and Muli (Oyster Shell) enters the Kidney meridian to consolidate Jing (essence). Both are astringent substances that consolidate essence and spirit. When added to Guizhi Tang (Cinnamon Twig Decoction), they become medicines for consolidating the root of storage and sealing. If there is seminal emission, palpitations, epistaxis, or abdominal pain, adding Yitang (Maltose) to the original formula creates Xiaojianzhong Tang (Minor Construct the Middle Decoction). If there is urgency and tension in the abdomen, it indicates withered Ying (nutritive) and Wei (defensive) qi; adding Huangqi (Astragali Radix) creates Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction). All these formulas focus on treating deficiency of the Post-Heaven (Spleen/Stomach) to harmonize Ying and Wei Qi. Later generations specialized in nourishing Yin and descending Fire. If used before the condition becomes severe, recovery is still possible. For patients with congenital Kidney deficiency, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is used; for restlessness and insomnia due to deficiency heat, Suanzaoren Tang (Ziziphus Seed Decoction) is used; for dry blood accumulation, Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is used. Only Shuyu Wan (Dioscorea Pill) specifically treats consumptive disease caused by unresolved exterior pathogens and damage to the Lung and Stomach from misused cooling medicines, progressing from above downwards. Qin Yuangong stated: "Zhang Zhongjing used Jianzhong and Fumai decoctions to support Stomach Qi and establish Middle Qi, because the Stomach is the source of Qi and Blood generation. If a patient shows slight Diaphragm deficiency, internal heat, and weak Shen (spirit), Jianzhong Tang is used preemptively. Guizhi (Cinnamomi Ramulus) harmonizes Wei Qi, Baishao (Paeoniae Radix Alba) harmonizes Ying Qi, adjusting Yin and Yang. Yitang, Gancao (Glycyrrhizae Radix et Rhizoma), and Dazao (Zizyphi Fructus) tonify Stomach Earth. Shengjiang (Zingiberis Rhizoma Recens) disperses. With frequent use, Stomach Qi becomes strong and rises to the Lung. The Lung exercises its descending function and governs Water. This is what is meant by 'Earth Qi rising becomes Clouds, Heaven Qi descending becomes Rain,' the pathway of communication between mountains and marshes. Therefore, it is said: 'A large pulse indicates Lao (consumption);' also, 'Floating indicates lack of Blood, Large indicates lack of Qi;' also, 'Extremely deficient, Kou (corkscrew), and slow pulses.' One has never heard of a rapid pulse, nor one accompanied by cough. If this opportunity is missed and not treated, Yin Fire rises, and a previously slow pulse becomes rapid. Fire insulting Metal (Lung) causes cough. At this point, can one still use Guizhi?" Commentary: This clause discusses conditions treated by Zhang Zhongjing, not the modern consumptive disease characterized by rapid pulse, cough, and rising Yin Fire. Later scholars discussed treatment, stating that for tonifying Qi, one should tonify the Mother of the Lung (Spleen); for tonifying Blood, one should tonify the Mother of the Liver (Kidney). It is also said: "When Earth is prosperous, Metal generates itself; do not rigidly adhere to protecting the Lung; when Water is abundant, Fire extinguishes itself; do not eagerly use cold/harsh medicines." Li Dongyuan said: "Renshen (Ginseng Radix) tonifies the Lung; when Qi is prosperous, Qi of the Four Zang organs becomes prosperous, Jing naturally generates, and the form becomes robust." Bai Feixia said: "Frequent use of Renshen restores Yuan Qi (Original Qi) from the realm of nothingness. Those with Lung deficiency causing wheezing and coughing should all take it." Wang Haogu said: "Lung heat further injures the Lung." Wang Jiezhai said: "Consumptive patients taking Ren [shen] will surely die." Commentary: Ancient medical books are like a heated debate. I believe that discussing treatment without pulse and symptom evidence is like writing an essay without a topic. The theories of masters from the Song, Yuan, and Qing dynasties were extremely precise, but applying them to actual cases often resulted in plausible-sounding but incorrect approaches. Only Shen Langzhong said: "For individuals with Yin deficiency and excessive fire, even if they contract external pathogens and present with steaming fever and cough, one must strictly avoid dispersing the exterior with Qianghuo (Notopterygii Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). One must also avoid clearing the Lung and stopping cough with Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Ziye (Perillae Folium), and Juhong (Citri Reticulatae Pericarpium Rubrum). If there is accumulation, avoid digestive aids. One should remain calm and nourish Yin." This is also a mediating view (Above: Discussion of ancient views). Generally, this disease arises from depletion: overwork of the Liver and Kidneys leads to loss of Blood and Essence, resulting in death from Yang hyperactivity and Yin exhaustion. Arising from emotional stagnation: internal fire scorches fluids, leading to Blood stasis, dry cough, increased appetite, and eventual death from consumption. Arising from medication errors: mostly Spleen and Lung diseases, leading to reduced diet, wheezing, coughing, and diarrhea. This is the general situation. Treatment methods: If Yin Fire insults Metal causing cough with a rapid pulse, this is internal Wind generating. Wind generation makes Qi movement urgent; six or seven beats per breath indicate Wind acting dominantly, forcing Blood to move recklessly, causing hematemesis or epistaxis, or excessive bleeding, further depleting Yin. Not only is the Lung dry, but Gallbladder bile is also withered. Withered bile means Wood fire will self-combust. Moreover, since the Lung is coughing, it agitates Fire, transforming fluids into Phlegm. When the Lung withers, flaccidity syndrome arises, the source of Water is cut off, tidal fever persists, and death is inevitable. Zhang Zhongjing said: "A rapid pulse indicates Wind attack; stop it by adjusting diet." This is extremely profound. It is indeed the critical juncture of life and death in consumptive disease. While the patient's Stomach Qi is still strong, tonify with food, as stated: "For those with insufficient form, tonify with flavor." To tonify Qi and Blood, use fatty duck or beef; to tonify Yin, use sea cucumber, eel, or soft-shell turtle; to tonify Earth (Spleen), use young hen, crucian carp, or yellow catfish; to clear Fire, use bird's nest or clam; to tonify the Lung, use pig lung or Lily Bulb; to strengthen the Spleen, use red dates or lotus seeds. Cook thoroughly and eat freely, but do not overeat to avoid burdening Spleen transformation. Walk slowly after meals, take one pill of Zisheng Wan. Keep the mind idle and Qi calm so internal Fire does not generate. Over time, Yin grows stronger than Yang, Stomach Qi suffices and rises to the Lung, the Lung generates Water, and the rapid pulse recedes. Avoid foods that stir Wind or Qi and raw/cold items. This is the method of dietary tonification when Stomach Qi is still strong (Above: Dietary Nourishment). If the disease lingers for a long time, erroneous medication severely depletes True Qi, leading to Middle deficiency, weak Stomach Qi, reduced diet, and inability to transform. Previous methods are difficult to apply. Proponents advocate strengthening Water to control Fire, but Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) are bitter-cold, Dihuang (Rehmanniae Radix) is cloying and dampening, and even Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) are bitter-drying. Water originates from Metal, called Tianyi Water, which can provide assistance. Metal generates Water relying entirely on Spleen and Stomach Qi rising. If Spleen is damp and Stomach is weak, Lung Metal lacks Earth support. Using astringent/descending methods, regardless of difficulty, if Fire descends, Qi sinks. Like a scorching sun without clouds, where does rain come from? When the time passes, Fire rises again, becoming more intense. This stems from not understanding the meaning of Water originating from high sources and water bodies communicating. Generally, if the rapid pulse remains, Wind flows endlessly, and there is no hope of cure. Diagnosing consumptive pulse: within a full day and night, there must be a moment when the rapidity decreases slightly. This is the time of Yin-Yang self-victory and restoration. Seize this opportunity to administer medicine and guide the process. Otherwise, at Yin Chu (3-5 AM) when Qi enters the Lung, administer Huifeng Tang (Return Wind Decoction) with a cup of Rice Dew. After several doses, concurrently administer Bingxin Tang and Sanhe Shui Tang. If the pulse decreases slightly, it is a sign of vitality. This Wind differs from the Wind of Stroke. That is a dark, stormy wind that blinds the day, uproots houses, and breaks trees; this is the hot, humid Southeast wind of summer excess Yang. Reversing its trend from West to East brings Western cool winds and promises rain. Therefore, for Yang failing to rise, use Chaihu Zuosheng Tang to ascend towards the Right. Now, we must ascend Yang from the Right towards the Left. This is another method (Above: Return Wind Method). If Rising Deficient Fire presents with red face, vexation, cough, dry mouth, and a pulse that is盛大 (excessive) at Cun (inch) and weak at Chi (cubit), coming strongly and departing weakly, the condition has worsened. First use Daohuo Tang (Guide Fire Down Decoction) to lead Fire down into the Small Intestine. Sit quietly for a while until Fire descends to the Dantian. While Fire is below, administer Chizhi Tang (Red Banner Decoction) to fill the Middle Jiao, preventing Fire from rising again. This is the method of Han Xin replacing Zhao banners with Han banners. This is another method (Above: Red Banner Method). If Blood appears initially, strictly avoid sour/astringent hemostatics and Shengdi (Rehmanniae Radix) due to their cloying nature, lest Blood congeal into Stasis. Use Heijin San (Black Gold Powder) to descend Fire and remove Stasis, which is best. For hematemesis due to labor-induced internal injury, crush one live crab and mix with warm aged wine for administration. These are all consumptive diseases arising from Rising Yin Fire generating Internal Wind (Above: Blood Syndromes). If sputum contains thread-like blood, it is due to cough injuring the Lung; use Qingfei Tang (Clear Lung Decoction). If Blood is expectorated, it comes from Liver/Kidney, and Fire has not yet entered the Lung; urgently administer Zhenhuo Tang (Suppress Fire Decoction) to govern all Bleeding. For fever, there is Three-Yang Yin Deficiency Consumptive Disease; commonly take Shengyin Yangxue Tang (Ascend Yin Nourish Blood Decoction) and Zhisou Tang (Stop Cough Decoction). Commonly take Jinsheng Wan (Metal Generates Pill) to guide Lung Qi down into the Kidney (Above: General Treatment). Additionally, for fever unceasing day and night with dry, hairless skin, there must be uncleared exterior pathogens or stubbornness from misused tonics. Use Neituo Tang (Internal Support Decoction) taken hot to induce sweating (Above: Exterior Pathogen Complication). There is also Bone-steaming Consumptive Disease: skin is not very hot, but bones feel hot upon pressure; the patient eats well but is thin; skin is dry and rough, anhidrotic, stool is hard; pulse is deep, tight, rapid, and forceful. This differs from other consumptive diseases, arising from Cold-Wind exterior pathogens accumulating over time. Use bitter-cold, major Yin-tonifying formulas. Strictly avoid drying-hot products. Since the heat is in the marrow, ascending/dispersing agents should not be used to let heat flare externally. Also, various deficiencies involve withered Gallbladder bile, so Liver Wood Fire lacks Water restraint, causing Wind-Fire to erupt massively. In bone-steaming, Gallbladder bile is especially withered; use Tuizheng Tang (Reduce Steaming Decoction) (Above: Bone Steaming). For daily chills followed by fever resembling malaria, resolving only after sweating, use Guizhi Chaihu Geban Tang (Half-Half Guizhi and Chaihu Decoction) plus two spoonfuls of Gallbladder bile. Additionally, cases arising from Blood Stasis are common in women. Besides ancient Dachong Wan (Ground Beetle Pill), there was Maijian San (Wheat Decoction Powder); now there is Heijin Wan (Black Gold Pill). For Chuanshi Zhai Syndrome (Infectious Consumption), symptoms include mental heat wanting to expose the body, stifling sensation when covered, palpitations, fright, pale complexion, and memory loss. This is Heart Steaming; use Chuanshi Lao Fang (Infectious Consumption Formula). For bone-steaming with five-palm heat, use Qinggu San (Clear Bone Powder). Question: Is Lanhou Dansha (Rotting Throat Red Rash) mentioned in Zhang Zhongjing's books? Few Song/Yuan masters discussed this, can you explain its etiology? Some say it relates to Si Tian (Chief Qi of the Year). However, both Dry and Humid commands can cause disease, and Zhu Qi (Main Qi) and Ke Qi (Guest Qi) differ. Can you detail the reasoning? How are favorable and unfavorable syndromes distinguished? What are the initial and mid/late treatments? What are the signs for clearing vs. purging? Please elaborate. This disease is common recently. My father has previously established arguments; please expand and detail them. *Jingui Yaolue* states: "Yang Du (Yang Toxin) disease presents with a red, mottled face like brocade, sore throat, and vomiting pus/blood. Treatable in 5 days, untreatable in 7. Use Shengma Biejia Tang (Angelica Root and Turtle Shell Decoction)." This scripture resembles modern Lanhou Dansha, but the treatment cannot be followed. Shujiao (Sichuan Pepper) and Xionghuang (Realgar) are warming/drying and contraindicated. Considering this disease occurs in Spring/Summer, Earth Qi naturally rises; using Shengma (Angelicae Dahuricae Radix) to ascend is inappropriate. Due to Warmth-Heat, latent Fire in Blood does not require Danggui (Angelicae Sinensis Radix), which is common knowledge. Ancient texts rarely mention diseases prevalent today; Song/Yuan masters were mostly Northern, while this disease prevails in Jiangnan. Discussions on Si Tian vary. I believe Ke Qi is unreliable; one must seek truth in Zhu Qi. Like Qian Tian Bagua, Ke Qi has fixed positions but no function. Zhu Qi and Ling Qi interweave and appear according to time. For example, this Spring, Earth Qi is warm with NW winds and prolonged rain. Taiyin Damp Earth Ling Qi overlays Shaoyang Ministerial Fire. The main Qi pathology manifests as Dampness suppressing and stagnating, causing Lanhou Dansha. How does it manifest? Epidemic Qi enters Lung/Stomach via nose/mouth. Why rotting throat? Damp-Heat stagnation. What is Dansha? Similar to rash, it is a disease of blood collaterals, differing from eruptions from the Stomach. Primary treatment: Aromatic collateral-unblocking, Pungent-Cool muscle-releasing, Sweet-Cool Blood-clearing. If it reverses-transmits to Pericardium, it follows Ye Tianshi's Warm Disease principles. However, divide into three types: Wind transforming Heat requires Clearing/Unblocking; Damp transforming Heat requires Clearing/Diffusing; Phlegm-Fire condensation requires Clearing/Descending. Favorable Initial Stage: Tight/String/Rapid pulse, aversion to cold, head distension, red skin, hot muscles, rotten/painful throat, hidden rash. After 3-4 days, Warm Evil transforms to Fire, Heat surges, Rash penetrates. After 5-6 days, severe Heat, coma, rotten throat. This is Fire surging, reverse transmission, pressing inward to Pericardium. After 7 days, Heat subsides, body turns dark purple, Rash sheds like bran, healing. This is favorable. Unfavorable Stage: Days 1-2, fine/tense pulse, body red but Rash does not penetrate, coma, confusion, rebellious Qi/wheezing. This is Evil-Toxin closing internally in Lung/Stomach; internal closure leads to external collapse. Treatment: Favorable Days 1-2: Disperse exterior, Niubang Jienu Tang (Arctium Muscle-Unblocking Decoction) or Yinqiao San (Honeysuckle and Forsythia Powder), add digestives, blow Zhuhuang San (Pearl and Realgar Powder). Days 3-4 Fire transformation: Add Xijiao (Rhinocerotis Cornu - substitute with Buffalo Horn), Lingjiao (Bovis Cornu), Huafen (Trichosanthis Radix), Shihu (Dendrobii Caulis). Days 5-6 Pericardium compression: Ying Level, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Sweating/clear mind: Qi Level, Yunu Jian (Jade Woman Decoction) plus Danxing (Arisaematis Cum Bile), Shichangpu (Acori Tatarinowii Rhizoma), Xihuang (Moschus), severe cases use Zixue San (Purple Snow Powder). Mid/Late treatment similar. Constipation/dry/yellow-black tongue: Liangge San (Cool Diaphragm Powder) = Purging. Diarrhea with Heat/white greasy tongue: Gegen Qinlian Tang (Kudzu and Scutellaria/Coptis Decoction). For Unfavorable cases, Fire-Toxin closed in Lung/Stomach: Fresh Dihuang 4 liang crushed juice, add Jinzhi (Gold Juice), Lizhi (Pear Juice), Zhejiang (Sugarcane Juice), plus Gegen, Qin, Lian. Further: Fresh Lugen (Reed Rhizome) decoction, ground Xijiao juice, mixed with Zixue San or Zhuhuang San. Principle: Clear/Open/Drain Heat. Untreatable cases: Nasal congestion/runny nose (Lung injured); eyes blurry/closed (Liver failing); white powder-like complexion (Qi color failed). These are untreatable. Deficient Yuan Qi cannot expel toxin; toxin hides deep. Although Clear/Tonify/Transform exists, it is difficult. Better to use heavy Yin-nourishing/Heat-draining for Yin deficiency. Detailed treatment in Warm Disease Lower Jiao Chapter. My father dislikes early clearing, fearing unresolved Wind/Damp turning into toxic swelling (Parotitis). Ancestor Hongfan said well: "Initial fever/chills: prioritize dispersing/unblocking (Fire depression release). Once chills stop, internal Fire flares: prioritize cooling/resolving. Persisting with pungent dispersion feeds Fire, increasing swelling/heat. Adapt timing and strategy precisely." Question: Women's diseases prioritize pregnancy/birth. Can pregnancy pulse be distinguished? Can gender be predicted? Which test-fetus method is superior? Explain Ezu (Morning Sickness) etiology/treatment. Explain Tailou (Fetal Leakage) and Xiaochan (Miscarriage) etiology/treatment. Can you list causes/treatments for headache, heart pain, stomach pain, lower abdominal pain, thigh pain, Huantiao pain, red eyes, sore throat, and trauma in pregnant women? Detail fetal death verification and expulsion methods. Classic says: "Hand-Shaoyin pulse moving strongly indicates pregnancy; Yin pulsing distinct from Yang indicates pregnancy; body sick but pulse free of evil indicates pregnancy; Chi pulse uninterrupted indicates pregnancy." Chi is Shaoyin Kidney pulse. Kidney pulse slippery also appears in leukorrhea. Only corresponding with Hand-Shaoyin Heart pulse confirms pregnancy, known as Yin pulsing distinct from Yang. Blood/Qi gather in Uterus, filling it, causing Chi Yin slippery/rapid. Distinction from Consumptive Rapid Pulse: Pregnancy pulse has Stomach Qi; Consumptive pulse is wiry/slipping without Stomach Qi. Middle-aged emaciated women may have small/non-rapid pulses, but hidden slipperiness is present. Distinguishing Gender Pulse is hardest. "Left large=Male, Right large=Female" theory ignores organ Qi bias. My master said: Women are Yin-back/Yang-face; Left corresponds to Male Right, Right to Male Left. Thus Danxi said it refers to doctor's hands, which is unreliable. Two Cun floating/slippery = Yang pulse = Male fetus; Two Chi deep/slippery = Yin pulse = Female fetus. This is closer. But direct observation: Male fetus moves at 3 months, umbilicus protrudes/hard belly like pot; Female fetus moves at 5 months, umbilicus soft/belly like basket. If Blood Stasis confuses fetus, use Test Method: Chenjiu (Aged Wine) + Foshou San (Buddha's Hand Powder: Danggui 7 qian, Chuanxiong 1 qian). Wait 2 hours. Umbilical/abdominal movement = Fetus; No movement = Menstrual obstruction. Stable method. Ezu (Morning Sickness): Nausea blocking diet. Causes: 1. Stomach deficiency, phlegm-fluid retention, Qi stagnation. 2. Chong/Ren Qi rising, not descending. Menstrual blood closed, water floods organs, organ Qi blocked, causing vexation/stuffiness/rebellious Qi/vomiting. After 3 months, fetus grows, consumes blood, no upward rebellion. Rare non-Ezu cases: Central Qi strong, no old phlegm, clear/turbid ascend/descend normally, no turbid Qi rising. Treatment: Deficiency: Jiawei Shenju Yin (Wendan Tang + Renshen, Muxiang, Danggui, Huoxiang, Sharen). Excess: Xiaohe Zhong Yin (Chenpi, Houpo, Fuling, Shanzha, Bian Dou, Gancao). Sour vomiting: Erxiang San (Huoxiang, Caoguo, Xiangfu) powder. Cold Stomach: Dingxiang, Doukou, Sharen. Spleen Deficiency/Fire: Huangqin, Shanzhi, Zhuru. Follow Danxi: "Fat people much Phlegm, Thin people much Fire." Base on Erchen Tang variations. Do not fear Banxia/Fuling harming fetus. Tailou/Xiaochan mostly due to Qi/Blood deficiency. Qi deficiency fails to hold; Blood deficiency fails to nourish. Kidney holds fetus; Waist is Kidney mansion. Waist pain risks miscarriage. Other cause: Blood too hot flowing recklessly. Sudden water flow = miscarriage. Slow flow = Tonify Qi/Calming Spirit. Pulse: String-taut/Slippery/Smooth is good; Deep/Thin/Micro is bad. Treatment based on constitution. Yin Deficiency/Internal Heat: Aiye, Fuzi, Baizhu, Sharen. Warming agents consume Yin further (like plants without rain). Yang Deficiency/Internal Cold: Huangqin, Baishao. Cooling agents weaken Spleen/Stomach Qi/Blood (like fruit lacking autumn/winter結). Before 3 months: Nourish Spleen/Stomach. After 4 months: Strengthen Waist/Kidney. Main formula: Taishan Panshi San (Bazhen Tang minus Fuling, add Renshen, Xuanduan, Huangqin, Ejiao). Blood Heat: Huangbo, Ejiao. Qi Cold: Aiye, Paojiang. Caution: Tailou differentiation. Some women with abundant Blood menstruate without miscarriage; treating causes miscarriage. Some have slippery/rapid pulse, light periods stopping at 3-4 months. People think 7-month birth, actually full term. Robust women spotting blood first 3 months without waist pain/fetal movement need no medicine. Combine with physique. Many monthly miscarriages due to hygiene habits (washing genitals). Remember Qi Deficiency, Blood Deficiency, Blood Heat for prenatal pains. Differentiate Exterior/Interior. Headache Blood Deficiency/Fire: Siwu Tang mod. Wind: Jiawei Xiong Gui Tang (Huangqin, Muxiang, Tea). Heart/Abdominal Pain + Phlegm/Wind: Zhengqi San. Press pain = Accumulation: Baoyuan Tang. No pain = Spleen/Stomach injury: Liu Jun Zi Tang. Full pain to Heart: Huangqin, Baizhu, Baishao. Intermittent pain = Blood Deficiency: Shudi, Danggui decoction. Heavy feeling = Qi Deficiency: Buzhong Yiqi Tang. Hypochondriac pain: Avoid Qi-breaking; Tongbian + Wine. Cold Lower Abdominal Pain: Xiaojianzhong Tang + Paojiang. Waist/Huantiao pain: Tonify. Red Eyes/Sore Throat: Liangge San acceptable. Trauma: Jiao Ai Tang + Chuanxiong, Danggui, Dihuang. General overview. Face Green/Tongue Red = Mother dies/Child lives; Face Red/Tongue Blue = Mother lives/Child dies. Definitive dead fetus signs. Expulsion: Danxi uses heavy Foshou San (Danggui 1 liang, Chuanxiong 7 qian). Pingwei San + Mangxiao is safer. Question: Prenatal disease most common is Zixuan (Fetal Suspension), chest/abdominal fullness, mainly Zisu Yin. Why? Or other methods? And...