感症如上法治之愈矣。顾有讳疾忌医之病家。及操刃杀人之庸技。日久迁延。变如 起。猝
难措手。用集方治如下。
有一种严冬感寒。脉浮而紧。外寒束内热。阳气不得发泄。致咳嗽吐血衄血者。（春有不吐
衄者。）此麻黄症也。而其人素虚。不禁此汤峻险。又非他药可愈。宜麻黄人参芍药汤。
麻黄人参芍药汤
麦冬（君） 五味（使） 白芍（佐） 当归（臣） 甘草（佐） 麻黄（醋制臣） 桂枝
（佐）
黄 （君） 人参（佐）
上水煎麻黄令沸去沫。人余药同煎。热服。
（此方乃东垣精思慧想而成。妙不可言。余曾借治此症。应如桴鼓。然最妙之处。在分两极少。
专宣上焦耳。恐初学人不知此义。故论及之。且将本方定其分数。以备加减焉。）
伤寒热甚。不得汗衄血者。（夺汗者无血。夺血者无汗。若得汗则无衄症矣。）乃热入血分
。欲从衄解也。四物汤去川芎加升麻丹皮黄芩之类清之。（升麻一味。加得尤妙。从犀角地黄汤
如无犀角以升麻代之之义生来。盖阳明之脉络鼻。是经火盛迫血妄行。从鼻出者曰衄。方书言从
肺来。非也。若非升麻。则何以达阳明而清其火哉。）亦有衄后病反重者。更伤其阴也。大为危
候。其衄势必大甚。都气饮或六味饮。加生地黄生白芍。若血来太多。致耗中气。当大补其阳。
当归补血汤加人参甘草。虑虚火上浮。加麦冬五味。（此等加减。真精细。）若审胃气未伤。的
系热邪有升无降者。滋肾丸应手即止。有得生者。
当归补血汤
黄 （蜜炙八分） 当归（二分） （分读去声。即二钱五分也。）
滋肾丸
黄柏（君） 知母（君） 肉桂（使）
上知柏二味俱用酒洗焙干。共为末。炼蜜丸。
外感病证按照上述方法治疗即可痊愈。然而，有些患者讳疾忌医，加上庸医医术低劣如同杀人，导致病情日久拖延，变化莫测，突然发作时难以应对。现收集方剂治疗如下。
有一种在严冬感受寒邪的情况，脉象浮而紧，外有寒邪束缚，内有郁热，阳气不得发泄，导致咳嗽、吐血或鼻衄（鼻出血）。（春季有的不出现吐血和鼻衄。）这是麻黄汤证。但是患者平时体质虚弱，不能耐受这种汤剂的峻烈危险，又非其他药物能治愈，适宜用麻黄人参芍药汤。
麻黄人参芍药汤
麦冬（君药） 五味子（使药） 白芍（佐药） 当归（臣药） 甘草（佐药） 麻黄（醋制，臣药） 桂枝（佐药）
黄芩（君药） 人参（佐药）
以上药材用水煎煮，先煎麻黄至沸腾，去掉浮沫，再加入其余药物共同煎煮，热服。
（此方是李东垣精心思考智慧构想而成，妙不可言。我曾借用此方治疗此类病症，效果如击鼓应槌般迅速准确。然而最精妙之处，在于药量极少，专门宣通上焦罢了。恐怕初学者不懂此义，所以论述这一点，并且将本方的剂量确定下来，以备加减使用。）
伤寒热势严重，无法出汗且出现鼻衄的。（夺汗者无血，夺血者无汗，如果已经出汗就不会有衄血症状了。）这是热邪进入血分，想要通过衄血来解除。用四物汤去掉川芎，加入升麻、丹皮、黄芩之类来清热。（升麻一味药，加得尤其精妙，这源于犀角地黄汤中若无犀角以升麻替代的道理。因为阳明经的脉络连接鼻子，这是经火旺盛逼迫血液妄行，从鼻子出来的叫做衄。方书说来自肺，是不对的。如果不是升麻，怎么能通达阳明经并清除其火热呢？）也有衄血后病情反而加重的，这是因为进一步损伤了阴液。这是非常危险的征候。此时衄血势头必然很大，可用都气饮或六味地黄丸，加入生地黄、生白芍。如果失血过多，导致中气耗损，应当大补阳气，用当归补血汤加入人参、甘草。考虑到虚火上浮，加入麦冬、五味子。（这些加减变化，真是精细入微。）如果审察胃气未受损伤，确系热邪只升不降的，滋肾丸一用即止住衄血，有获得生机的。
Exogenous diseases, when treated according to the above methods, will be cured. However, there are patients who conceal their illness and avoid medical treatment, as well as mediocre physicians whose skills are akin to murder. As time passes and the condition lingers, changes arise unpredictably, making it difficult to handle sudden emergencies. The following formulas are collected for treatment.
There is a type of cold damage contracted in severe winter, characterized by a floating and tight pulse. External cold binds the exterior while internal heat accumulates, preventing the venting of Yang Qi, leading to cough, hematemesis (vomiting blood), or epistaxis (nosebleed). (In spring, some cases do not present with hematemesis or epistaxis.) This is a Mahuang Syndrome. However, if the patient has a constitutionally deficient state and cannot tolerate the harsh and dangerous nature of this decoction, and no other herbs can cure it, Mahuang Renshen Shaoyao Tang (Mahuang, Ginseng, and White Peony Decoction) is appropriate.
**Mahuang Renshen Shaoyao Tang (Mahuang, Ginseng, and White Peony Decoction)**
* Maidong (Ophiopogonis Radix) [Monarch]
* Wuweizi (Schisandrae Fructus) [Envoy]
* Baishao (Paeoniae Radix Alba) [Assistant]
* Danggui (Angelicae Sinensis Radix) [Deputy]
* Gancao (Glycyrrhizae Radix et Rhizoma) [Assistant]
* Mahuang (Ephedrae Herba, vinegar-processed) [Deputy]
* Guizhi (Cinnamomi Ramulus) [Assistant]
* Huangqin (Scutellariae Radix) [Monarch]
* Renshen (Ginseng Radix) [Assistant]
Boil Mahuang in water until boiling, skim off the foam, then add the remaining herbs and decoct together. Take hot.
(This formula was created through Li Dongyuan's profound thinking and wisdom; its efficacy is indescribable. I once borrowed this formula to treat such conditions, and the response was as immediate as striking a drum. The most exquisite aspect lies in the extremely small dosages, specifically targeting the宣通 (venting/unblocking) of the Upper Jiao. Fearing that beginners may not understand this principle, I discuss it here and fix the dosages of this formula for reference in modifications.)
In Shanghan (Cold Damage) with severe heat, where sweating is impossible and epistaxis occurs: (Those deprived of sweat have no blood; those deprived of blood have no sweat. If sweat is obtained, epistaxis would not occur.) This indicates heat entering the Blood level, seeking release through epistaxis. Use Siwu Tang (Four Substances Decoction) removing Chuanxiong, adding Shengma (Cimicifugae Rhizoma), Mudanpi (Moutan Cortex), Huangqin (Scutellariae Radix), etc., to clear heat. (Adding Shengma is particularly brilliant, derived from the principle in Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) where Shengma replaces Xijiao (Rhinoceros Horn) when unavailable. The meridians of the Yangming Stomach connect to the nose; this is due to excessive fire in the meridian forcing blood to move recklessly, exiting via the nose, termed epistaxis. Formulas books claim it comes from the Lung, which is incorrect. Without Shengma, how could one reach the Yangming meridian to clear its fire?) There are also cases where the condition worsens after epistaxis, further injuring Yin. This is a critical prognosis. The epistaxis must be severe. Use Duqi Yin (All-Qi Drink) or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), adding Shengdihuang (Rehmanniae Radix Recens) and Sheng Baishao (Raw White Peony Root). If excessive blood loss depletes Middle Qi, one should greatly tonify Yang using Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) added with Renshen (Ginseng) and Gancao (Licorice). Considering floating deficiency fire, add Maidong (Ophiopogon) and Wuweizi (Schisandra). (These modifications are truly meticulous.) If the Stomach Qi is assessed as undamaged, and it is confirmed that the pathogenic heat rises without descending, Zishen Wan (Kidney-Nourishing Pill) will stop the bleeding immediately, offering hope for recovery.
**Danggui Buxue Tang (Danggui Tonifies the Blood Decoction)**
* Huangqi (Astragali Radix, honey-fried): 8 fen
* Danggui (Angelicae Sinensis Radix): 2 fen
*(Note: "fen" pronounced with departing tone, meaning 2 qian 5 fen)*
**Zishen Wan (Kidney-Nourishing Pill)**
* Huangbai (Phellodendri Cortex) [Monarch]
* Zhimu (Anemarrhenae Rhizoma) [Monarch]
* Rougui (Cinnamomi Cortex) [Envoy]
Wash Zhimu and Huangbai with wine, bake until dry, grind into powder, and form pills with refined honey.