答曰：此元阴不足以致肺燥，复感客燥而移燥于大肠也。诸书俱称赤白为湿热病，以白属湿，以赤属热，照方施治，应效者少。余细维此理，人身以坎、离立极，运用机关全在心、肺，心属火，化血而居肺下；肺属金，化气而居心上。肺位最尊，气机运转，外充皮肤肌肉，内充筋骨脏腑，有天包乎地之义。肺气一行，心血随之，下而复上，上而复下，循环不已，二气调和，百节无伤；肺气、血气偶乖，诸症蜂起，岂独痢疾为然。查痢疾多生于秋，乃燥金主气之时，复感外来之燥邪，客于肺金，闭塞清道，转输失职，津液不行于大肠，大肠亦生燥热，故曰肺移燥于大肠也。肺气壅则大肠之气壅，而血亦与之俱壅，故痢症作。白者重在气之滞，赤者重在血之涩，赤、白相兼，心、肺俱受燥也。治痢者当在心、肺二处求之，切勿惑于夏伤于暑，秋必成痢。推是说也，以为夏日炎天，暑湿大行，交秋之际，暑湿未尽，胶固大肠，欲出不出而成痢。余谓人之肠胃糟粕，有一、二日换一次者，有三、五日换一次者，岂尽湿热之胶固大肠耶？以白为湿，湿甚宜泻；以赤为热，热甚宜闭。今则不泻不闭，而欲出不出，其为肺气之滞，心血之涩也明甚，何得即以湿、热蕴酿加之？此说亦近理，但湿、热合病亦多，何不成痢？独于秋月乃痢，明明燥邪客于肺。要知白者，气也、火也，亦大肠之精也；赤者，血也、水也，亦大肠之液也。赤色虽似火象，其实周身血液，俱从火化得来，故曰血为阴，又曰血虽阴类，运从阳，指肺气行而血随之也。余谓治痢当着重肺燥为主，虽赤、白有浅深之分，其源总归于燥之一字，但治其燥，则二脏之气即舒，不治痢而痢自止，不治赤白而赤白自消，握要之法也。
舒驰远以痢为四纲，其说亦可从，但未将受病根处明明指出，概谓白属湿成，赤属血因，纷纷聚讼，愈出愈奇，总非确论，惟有调气、行血一语，略可遵从。法宜清燥、救肺为主，方用杏、冬二皮白蜜甘桔汤主之。至于似痢非痢，亦不可不辨。痢之为病，腹痛拘急，逼胀异常，欲出不出，出亦无多，日数十次。似痢非痢者，腹虽痛而不甚，便虽逼胀而所出尚多，日三、五次，甚七、八次，一痛即泻，四时皆有，多得于大病久病之后。乃由中气大衰，大肠失职，肠、胃稍有存积，气虚不能载之，故似痢而实非痢也。法宜大健中土，中土气足，自能载之，而不失节也。方用附子理中汤，加吴茱萸、安桂最妙。治痢诸书，皆云调气、行血，余亦立一方，亦可酌用，名大黄木香汤。
杏冬二皮甘桔白蜜汤
杏仁五钱天冬四钱麦冬四钱地骨皮三钱桑皮五钱桔梗四钱甘草三钱白蜂蜜半杯
用药意解
按杏冬二皮汤一方，乃清燥、润肺之方也。因燥邪客肺，肺气壅塞，津液不行于大肠，以致气机滞涩，故取杏仁之苦以降之利之，又佐二冬、二皮、甘、桔、白蜜以开之、润之，俾燥邪去而肺气清，肃令行而气机畅，何痢之有哉？
按大黄木香汤一方，乃调气、行血之方也。大黄同当归、甘草，能泻血分之燥热而化阴，木香、苏叶、白蜜，能调气分之滞而化阳，气、血两化，阴、阳不偏，自然痢疾不作矣。
问曰：病人每日早饭后心烦，两手、足心痛痒异常，至午初即愈者，何故？
答曰：此元阴不足，心阳气有余也。夫人身上下四旁，莫非二气充塞，二气皆不可偏，偏于阳则阴虚，偏于阴则阳弱。今病人两手心痒，两足心痒，阴虚、阳虚皆有此候，不得概谓血虚。此病而断为阴虚者，见其病之在上半日也。人身就是这一团真气，出阴入阳，出阳入阴，一日之内，上半日属三阳，阳有馀，阴即不足，故易曰："君子道长，小人道消"；下半日属三阴，阴有余，阳即不足，故易曰："小人道长，君子道消"。君子、小人，即阴、阳之谓也。其实推其至极，还是这一团真气，由盛而衰，由衰而盛也，故圣人云："老子其犹龙乎！＂反之吾身，不亦有犹龙之老子乎！此病法宜补阴以配阳，方用黄连鸡子阿胶汤，或补血汤，解见上。查阴虚发痒，外形手、足心肉必干枯，起粗白皮。阳虚发痒者，手、足心肉柔润不枯，无白皮干粗色，但痒极而欲重按重压，以此定之，再参看各部气色（更）〔便〕了。阳虚宜收纳回阳为主，方用潜阳丹、四逆汤、封髓丹之类，解见阳虚门。
答曰：此血虚而不能荣于上也。夫头晕一症，有上实下虚者，有上虚下实者，有清阳不升者，有浊阴上干者，有挟虚风者，有挟虚火者，有脏腑偏盛而致者，种种不一，括其旨归，总不出阴、阳两字。
凡治此病，察其人面白无神，饮食减少，二便自利，困倦欲卧，喜热畏冷，或气短而心悸不宁，或饱闷而腹痛泄泻，或遗尿不禁而自汗频添，脉浮无力而空，诸如此类，都属阳虚，清气不充所作，法宜辛甘扶阳之品，按定上、中、下病情消息以斟酌之便了。察其人精神不衰，舌黄、喜冷，饮食易消，二便短少，或心烦热而咳吐黄痰，或饱食而即刻昏晕，或晕数刻而依旧如常，脉实有力而长，诸如此类，都属阴虚火旺，上干所作，法宜苦甘化阴之品，按定上、中、下病情消息以酌量之便了。此病既由吐血而后眩晕，明明阴血暴虚，不能上荣于巅，血虚亦能风生，故作眩，法宜养血为主。方用补血汤主之，加味随机而施。如外感六淫之气，只作痛不作眩，学者须知。
问曰：女病血崩后，忽顶巅痛甚者，何故？
答曰：此血虚甚而阳无所附，暴浮于上也。夫气、血两字，彼此互为其根，不可稍有缺陷，阳气暴虚，阴血即无所主，阴血暴虚，阳气即无所托。今病人血骤下奔，海底枯涸，龙无水养，飞腾于上，故顶巅痛甚。此际若不细察受病之因，而见痛治痛，则既竭于上之阳，倾刻即灭也。法宜峻补其水，海中有水，龙即能返于渊，此真阴、真阳互根之妙用也。方用补血汤主之，解见上。或补水汤可。
补水汤
用药意解
按补水汤一方，乃苦甘化阴之方也。夫洋参色白味苦，苦能补心，心者、生血之源也；黄柏味苦，苦能坚肾，肾者，注水之区也；又得白蜜之甘，能润肺而生金，金者、水之母也。况苦与甘合，足以化阴，阴得化生，而源不竭，龙虽属阳而性喜水，既有其水，则龙潜于渊，太空廓朗，而上、下咸安矣，何顶痛之有哉？
以上数十条，专论阴虚，指出元阴不足一句，反复推明。要知元阴即血也、水也，真火寓于其中，则为太极，则为气、血相依，又为水、火互根，又为心藏神。凡血虚之症，所现纯是一派枯槁、憔悴、燥熯，干粗之火形，何也？血中寓火，火旺自然阴亏，阴虚自然火旺，以此推求，便得阴虚之主脑也。三阴与三阳，病形各殊，三阳不足之症，所现纯是阴色，为其阳不足，而阴有余也；三阴不足之症，所现全是阳色，为其阴不足，而阳有余也，此辨认阴虚、阳虚之切法也。
历代以来，著作者数十余家，皆含糊不清，并未将阴、阳底蕴明明指出，一味在后天五行生克上论，铺张满纸，究竟人身立极，一元妙义，二气消长机关，全未说透，宗旨不明，源头不澈，故知斯道之精者寡矣。可惜仲景一生心法，无一人道破，定六经之旨归，罕能了了。甚至有著瘟疫，著痢症，自诩专家，欲与仲景并驾，不知立法之祖，定六经早已判乾坤之界限，明六气业已括万病之攸归。六气即是六经之体，外感六气，便是六经之客。三百九十七法，法法神奇；一百一十三方，方方绝妙。全是活活泼泼天机，绝无一毫碍法。知其妙者，以四逆汤、白通汤、理中、建中诸方，治一切阳虚症候，决不有差；以黄连鸡子阿胶、导赤散、补血、独参诸方，治一切阴虚症候，定不能误。虽然阴虚所备诸方，尤贵圆通，有当柔润以扶阴者，独参、黄连、当归补血之类是也；有当清凉以扶阴者，导赤、人参白虎之类是也；有当苦寒以扶阴者，大、小承气、三黄石膏之类是也。此皆救阴、补阴之要诀也。补阳亦然，有当轻清以扶阳者，大、小建中之类是也；有当温养以扶阳者，甘草干姜汤、理中汤之类是也；有当辛温、辛热以扶阳者，四逆、白通之类是也。此皆治阳虚之要诀也。他如外感六气，按节令，掣提纲，随邪变化，细详六经贯解。须知仲景伤寒之六经，并非专为伤寒说法，而六步之法已经说明。即以太阴一经而论，太阴主湿而恶湿，主湿是本经之气，恶湿即外之客气，湿土旺于长夏，故六月末①土旺而湿令大行，人之本气弱者，感外来之湿邪，每多腹痛、吐、泻。仲景故立理中汤一法，后贤改用香砂、四君、六君，以调脾土一切诸症，皆是套理中汤一方出来也，又何常不可用哉？千百年来，名贤迭出，立方亦多，而仲景之法，遂晦而不明，不得不宣扬① "末"：原书为"未"之也。
医理真传卷四
杂问
答曰：吐血一症，其要有三：有阳虚者，有阴虚者，有因外邪阻滞者，不可不知，亦不可不辨也。夫人身不外气、血两字，气为阳，天也、夫也；血为阴，地也、妻也。男正位乎外，女正位乎内，阴、阳自然之定理，气、血相依而行，气法乎上，血法乎下，流通无滞，均平不偏，何吐血之有乎？至于吐血，乃气机之逆也。阳虚之逆血者，缘由阳气衰弱，不能统血，阴气太旺，势必上僭，渐干清道，以致外越，如今之懦弱丈夫，不能约束其妻也。阴虚之逆血者，由于阳气独旺，阳气过旺，势必上冲，冲之过节，血亦因而外越，如今人之丈夫酷烈，而妻不敢安其室也。外邪阻滞之逆血者，或因风、寒之邪，阻其升、降之气机，而循行经络之血液，失其常度，或留胸膈，或停胃口，一触即发，血故外越。如沟渠之水，流行自如，忽从中闸定，上流欲下之水，势必逆行上涌，亦气机自然之理也。又曰：吐血三要，已得闻矣，敢问三要之症，如何辨认？如何施治？曰：凡阳虚吐血之人，言语无神，脉息无神，面色无神，气衰力竭，困倦喜卧，不思饮食，咳多清痰，又须审察上、中、下三部，何处病情独见，便可按法治之也。法宜辛甘化阳之品，调其中土，扶其元阳，如甘草干姜汤、理中、建中之类。阴虚吐血之人，言语有神，面色有神，脉息有神，吐虽多不觉其病，咳多胶粘之痰，又贵察其上、中、下三部，何处病形独现，便可识其脏腑之偏，而用药自有据也。法宜苦甘化阴之品，如泻心汤、导赤散、鸡子汤（即《伤寒论》黄连阿胶汤）之类。风寒阻滞而吐者，必现发热、头疼、身痛，脉浮或紧，看定提纲，按法治之。法宜升散清凉为主，如桂枝汤、麻黄汤、葛根汤之类。桂、麻、建中、理中、甘草诸方，见阳虚门；泻心、导赤、鸡子诸方，见阴虚门。
古方分两太重，取其直达太阳膀胱之经输，而祛邪早出也。若用以治吐血，务要果真有太阳病，项背几几，无汗恶风，与阳明合病，下利方可，不然未可轻试也。今改用分两，从俗之意，亦当察病轻重，再为酌量。
用药意解
按葛根汤一方，乃肌、表两解之方，亦太阳、阳明合解之方也。
夫风寒之邪，一从肌腠而入，则为桂枝汤症，一从肤表而入，则为麻黄汤症，今以桂枝汤加麻黄、葛根，是从肌腠以达肤表，俾邪直出。
太阳与阳明接壤，太阳之邪已在经输，逼近阳明，此刻阳明不病亦病也。去太阳之邪，即所以救阳明也。师取葛根，乃三路进剿之法，葛根为阳明之主药，用之以截阳明之路，而邪不敢入，又能鼓胃气上腾，足以助桂、麻发散祛邪之力，是以攻无不胜，战无不克也。吐血门中，罕用此方，此方原不治此病，设有因风、寒闭塞，以致吐血，兼见项背几几，自汗恶寒者，此方亦未始不可用也。
问曰：大便下血如注，其有要乎？
答曰：下血之症，论因则多，论要则二。二者何？即阴、阳两字也。阴、阳即气、血，夫血固以下行为顺，是顺行其经络之谓，非妄行之谓也。阳虚之人，下血如注，是下焦之阳不足，而不能统摄也；阴虚之人，下血如注，是下焦之阴不足，阴虚则火旺，火旺遂逼血外溢也。阳虚阴虚，察脉察色，与上辨吐血法同。阳虚之下血，宜培中下之阳，方用四逆汤、理中汤，见阳虚门。阴虚之下血，宜培中下之阴，方用泻心汤、六味、补血汤（即六味地黄汤、当归补血汤），见阴虚门。
或又曰：粪前血、粪后血，何谓也？曰：粪前血者，循行大肠之血失度也；粪后血者，脾胃之阴失度也。亦不必细分，总在这粪之鞕、溏，以判肠胃之虚、实，又要察其人平日起居，外形之有神无神，而虚、实自判也。先血而粪鞕者，胃火旺而致也，人参白虎、麻仁丸可用；先血而粪溏者，脾不摄血也，理中、建中可用；粪鞕而血后来者，心火旺也，导赤散可用；粪溏而血后来者，心血之虚也，补血汤、参枣汤可医。仲景以先便后血为远血，主以黄土汤；先血后便为近血，主以赤小豆当归散。
问：患赤白痢疾，每天发作几十次，腹部疼痛且拘挛紧急，这是什么原因？
答：这是元阴不足导致肺燥，又感受外界的燥邪，将燥气转移到大肠的缘故。各种医书都称赤白痢为湿热病，认为白色属湿，红色属热，按照这个方子治疗，见效的很少。我仔细思考这个道理，人身以坎（肾水）、离（心火）确立根本，运用的机关全在心、肺，心属火，化生血液并位于肺之下；肺属金，化生气并位于心之上。肺的位置最尊贵，气机的运转，外充皮肤肌肉，内充筋骨脏腑，有天包乎地（天覆盖地）的意义。肺气一旦运行，心血随之流动，下而复上，上而复下，循环不已，二气调和，全身关节骨骼就没有损伤；如果肺气、血气偶尔失调，各种病症就会蜂拥而起，难道只有痢疾是这样吗？查痢疾多生于秋季，那是燥金主气的时节，又感受外来的燥邪，客居于肺金，闭塞清肃之道，转输功能失职，津液不能下行于大肠，大肠也产生燥热，所以说肺将燥气移于大肠。肺气壅滞则大肠之气也壅滞，血液也随之壅滞，所以痢疾发作。白色重在气的阻滞，红色重在血的涩滞，赤白相兼，是心和肺都受到燥邪的影响。治疗痢疾应当从心、肺两处着手，千万不要被“夏伤于暑，秋必成痢”的说法所迷惑。推究这种说法，认为是夏日炎天，暑湿盛行，到了秋天，暑湿未尽，胶固在大肠，想拉拉不出而成痢。我认为人的肠胃糟粕，有一两天换一次的，有三五天换一次的，难道都是湿热胶固大肠吗？把白色当作湿，湿重应该泻下；把红色当作热，热重应该收敛。现在既不能泻下也不能收敛，而是想拉拉不出，这显然是肺气滞涩、心血涩滞造成的，怎么能立刻归咎于湿热蕴酿呢？这种说法也接近事理，但湿热合病也很多，为什么不成痢疾？偏偏在秋天才得痢疾，明明是燥邪客居肺金。要知道白色的，是气、是火，也是大肠的精；红色的，是血、是水，也是大肠的液。红色虽然像火的象，其实全身的血液，都是从火化得来的，所以说血为阴，又说血虽属阴类，但运化依靠阳，指的是肺气运行而血随之流动。我认为治疗痢疾应当着重肺燥为主，虽然赤、白有深浅之分，其根源总归于“燥”这一个字，只要治疗燥邪，那么心肺二脏的气机就舒展了，不专门治痢疾而痢疾自然停止，不专门治赤白而赤白自然消除，这是抓住要领的方法。
舒驰远把痢疾分为四纲，他的说法也可以听从，但没有明确指出受病的根本所在，一概说白色属湿形成，红色属血引起，纷纷争论，越说越奇怪，总不是确切的结论，只有“调气、行血”这一句话，略微可以遵从。治法宜以清燥、救肺为主，方剂用杏、冬二皮白蜜甘桔汤主治。至于似痢非痢的情况，也不可不予以辨别。痢疾这种病，腹痛拘急，憋胀异常，想拉拉不出，拉出来也不多，一天几十次。似痢非痢的人，腹部虽然痛但不严重，大便虽然憋胀但排出的还比较多，一天三、五次，甚至七、八次，一痛就泻，四季都有，大多得于大病久病之后。这是由于中气大衰，大肠失职，肠、胃稍有积存，气虚不能运载它，所以似痢而实非痢。治法宜大补中土，中土气足，自然能运载它，而不失节制。方剂用附子理中汤，加吴茱萸、安桂（肉桂）最好。治疗痢疾的各种书籍，都说要调气、行血，我也立一方，也可酌情使用，名叫大黄木香汤。
杏冬二皮甘桔白蜜汤
杏仁五钱 天冬四钱 麦冬四钱 地骨皮三钱 桑皮五钱 桔梗四钱 甘草三钱 白蜂蜜半杯
大黄六钱 木香六钱 当归五钱 苏叶三钱 甘草三钱 白蜂蜜半杯
用药意解
按杏冬二皮汤一方，是清燥、润肺的方子。因为燥邪客居肺中，肺气壅塞，津液不能下行于大肠，导致气机滞涩，所以取杏仁的苦味来降气利气，又佐以二冬（天冬、麦冬）、二皮（地骨皮、桑皮）、甘草、桔梗、白蜂蜜来开宣肺气、滋润肠道，使燥邪去除而肺气清肃，肃降令行而气机通畅，哪里还有痢疾呢？
按大黄木香汤一方，是调气、行血的方子。大黄同当归、甘草，能泻血分的燥热而化阴；木香、苏叶、白蜂蜜，能调气分的滞涩而化阳，气、血两化，阴、阳不偏，自然痢疾就不发作了。
问：病人每天早饭后心烦，两手、两脚心瘙痒异常，到中午初时就痊愈了，这是什么原因？
答：这是元阴不足，心阳气有余的缘故。人身上下的四周，没有不是由阴阳二气充塞的，二气都不可偏颇，偏于阳则阴虚，偏于阴则阳弱。现在病人两手心痒，两脚心痒，阴虚、阳虚都有这种症状，不能一概说是血虚。这个病断定为阴虚，是因为看到病发在上半天。人身就是这一团真气，出阴入阳，出阳入阴，一天之内，上半日属三阳，阳有余，阴即不足，所以《易经》说：“君子道长，小人道消”；下半日属三阴，阴有余，阳即不足，所以《易经》说：“小人道长，君子道消”。君子、小人，就是指阴、阳而言。其实推究到极致，还是这一团真气，由盛而衰，由衰而盛，所以圣人说：“老子他就像龙一样啊！”反过来看我们自己，不也有像龙一样的老子吗！这个病治法宜补阴以配阳，方剂用黄连鸡子阿胶汤，或补血汤，解释见上文。查阴虚发痒，外形上手、脚心的肉一定干枯，起粗白皮。阳虚发痒的人，手、脚心的肉柔润不枯，没有白皮干粗色，只是痒极了想要重按重压，以此来确定，再参看各部位的气色（便）了就清楚了。阳虚宜以收纳回阳为主，方剂用潜阳丹、四逆汤、封髓丹之类，解释见阳虚门。
答：这是血虚而不能荣养头部所致。头晕这一症状，有上实下虚的，有上虚下实的，有清阳不升的，有浊阴上犯的，有挟虚风的，有挟虚火的，有脏腑偏盛而致的，种种不一，概括其主旨，总离不开阴、阳两个字。
凡是治疗这个病，观察其人面白无神，饮食减少，大小便正常，困倦想睡觉，喜欢热怕冷，或者气短而心悸不安，或者饱闷而腹痛泄泻，或者遗尿不禁而自汗频繁增加，脉浮无力而空，诸如此类，都属于阳虚，是清气不充盛所作，治法宜用辛甘扶阳的药物，根据上、中、下病情斟酌处理即可。观察其人精神不衰，舌苔黄、喜冷饮，饮食易消化，大小便短少，或者心烦热而咳吐黄痰，或者饱食后即刻昏晕，或者晕几刻钟后依旧如常，脉实有力而长，诸如此类，都属于阴虚火旺，向上冲犯所作，治法宜用苦甘化阴的药物，根据上、中、下病情斟酌处理即可。这个病既然由吐血而后出现眩晕，明明是阴血突然虚损，不能上行荣养头顶，血虚也能生风，所以作眩，治法宜以养血为主。方剂用补血汤主治，加味随机而施。如果是外感六淫之气，只作痛不作眩，学者须知这一点。
问：女子患血崩后，忽然头顶剧烈疼痛，这是什么原因？
答：这是血虚甚而阳气无所依附，暴浮于上的缘故。气、血这两个字，彼此互为根本，不可稍有缺陷，阳气暴虚，阴血就无所主宰，阴血暴虚，阳气就无所依托。现在病人血骤下奔，海底（肾/下焦）枯涸，龙无水养，飞腾于上，所以头顶剧痛。这个时候如果不仔细察看出病的缘由，而是见痛治痛，那么已经竭于上的阳，顷刻间就会熄灭。治法宜峻补其水，海中有水，龙就能返回深渊，这是真阴、真阳互根的妙用。方剂用补血汤主治，解释见上文。或者用补水汤也可以。
补水汤
用药意解
按补水汤一方，是苦甘化阴的方子。洋参色白味苦，苦能补心，心是生血之源；黄柏味苦，苦能坚肾，肾是注水的区域；又得到白蜜的甘味，能润肺而生金，金是水的母亲。况且苦与甘合，足以化阴，阴得化生，而源头不枯竭，龙虽然属阳但性喜水，既有其水，则龙潜于深渊，太空廓朗，而上、下都安宁了，哪里还有头顶痛呢？
以上数十条，专门论述阴虚，指出“元阴不足”一句，反复推明。要知道元阴就是血、就是水，真火寓于其中，就是太极，就是气、血相依，又是水、火互根，又是心藏神。凡血虚之症，所呈现的全是一派枯槁、憔悴、燥熯（干燥），干粗的火形，为什么呢？血中寓火，火旺自然阴亏，阴虚自然火旺，以此推求，便得到阴虚的主脑了。三阴与三阳，病形各不相同，三阳不足之症，所呈现的全是阴色，为其阳不足，而阴有余；三阴不足之症，所呈现的全是阳色，为其阴不足，而阳有余，这是辨认阴虚、阳虚的关键方法。
历代以来，著作者几十家，都含糊不清，并没有将阴、阳底蕴明明指出，一味在后天五行生克上论，铺张满纸，究竟人身立极，一元妙义，二气消长机关，全未说透，宗旨不明，源头不澈，所以知道这门学问精深的人很少了。可惜仲景一生的心法，无一人道破，定六经的宗旨归宿，很少有人能弄清楚。甚至有写瘟疫的，写痢疾的，自诩专家，想与仲景并驾齐驱，不知道立法之祖，定六经早已判定了乾坤的界限，明六气业已概括了万病的归宿。六气即是六经的体，外感六气，便是六经的客。三百九十七法，法法神奇；一百一十三方，方方绝妙。全是活活泼泼的天机，绝无一毫碍法。知其妙的，用四逆汤、白通汤、理中、建中诸方，治一切阳虚症候，决不会有差误；用黄连鸡子阿胶、导赤散、补血、独参诸方，治一切阴虚症候，定不会误。虽然阴虚所备诸方，尤其贵在圆通，有当柔润以扶阴的，如独参、黄连、当归补血之类；有当清凉以扶阴的，如导赤、人参白虎之类；有当苦寒以扶阴的，如大、小承气、三黄石膏之类。这都是救阴、补阴的要诀。补阳亦然，有当轻清以扶阳的，如大、小建中之类；有当温养以扶阳的，如甘草干姜汤、理中汤之类；有当辛温、辛热以扶阳的，如四逆、白通之类。这都是治阳虚的要诀。其他如外感六气，按节令，掣提纲，随邪变化，细详六经贯解。须知仲景伤寒的六经，并非专为伤寒说法，而六步之法已经说明。即以太阴一经而论，太阴主湿而恶湿，主湿是本经之气，恶湿即外之客气，湿土旺于长夏，所以六月末土旺而湿令大行，人的本气弱的，感外来之湿邪，每多腹痛、吐、泻。仲景故立理中汤一法，后贤改用香砂、四君、六君，以调脾土一切诸症，都是套理中汤一方出来的，又何尝不可用呢？千百年来，名贤迭出，立方也多，而仲景之法，遂晦而不明，不得不宣扬。
医理真传卷四
杂问
答：吐血一症，其要点有三：有阳虚的，有阴虚的，有因外邪阻滞的，不可不知，也不可不予以辨别。人身体不外乎气、血两个字，气为阳，是天、是夫；血为阴，是地、是妻。男正位乎外，女正位乎内，阴、阳是自然的定理，气、血相依而行，气法乎上，血法乎下，流通无滞，均平不偏，哪里有吐血呢？至于吐血，是气机逆乱所致。阳虚之逆血，缘由阳气衰弱，不能统摄血液，阴气太旺，势必上僭，渐渐干扰清道，以致外越，如今之懦弱丈夫，不能约束其妻。阴虚之逆血，由于阳气独旺，阳气过旺，势必上冲，冲之过节，血也因而外越，如今人之丈夫酷烈，而妻不敢安其室。外邪阻滞之逆血，或因风、寒之邪，阻其升、降之气机，而循行经络的血液，失去常度，或留胸膈，或停胃口，一触即发，血故外越。如沟渠之水，流行自如，忽从中闸定，上流欲下之水，势必逆行上涌，也是气机自然的道理。又说：吐血三要，已经听说了，敢问三要的症状，如何辨认？如何施治？曰：凡阳虚吐血之人，言语无神，脉息无神，面色无神，气衰力竭，困倦喜卧，不思饮食，咳多清痰，又须审察上、中、下三部，何处病情独见，便可按法治之。治法宜用辛甘化阳的药物，调其中土，扶其元阳，如甘草干姜汤、理中、建中之类。阴虚吐血之人，言语有神，面色有神，脉息有神，吐虽多不觉其病，咳多胶粘之痰，又贵察其上、中、下三部，何处病形独现，便可识其脏腑之偏，而用药自有依据。治法宜用苦甘化阴的药物，如泻心汤、导赤散、鸡子汤（即《伤寒论》黄连阿胶汤）之类。风寒阻滞而吐者，必现发热、头疼、身痛，脉浮或紧，看定提纲，按法治之。治法宜升散清凉为主，如桂枝汤、麻黄汤、葛根汤之类。桂、麻、建中、理中、甘草诸方，见阳虚门；泻心、导赤、鸡子诸方，见阴虚门。
葛根四钱 麻黄三钱 甘草二钱 芍药一钱 桂枝二钱 生姜三钱 大枣三枚
古方分两太重，取其直达太阳膀胱之经输，而祛邪早出也。若用以治吐血，务要果真有太阳病，项背强几几，无汗恶风，与阳明合病，下利方可，不然不可轻试。今改用分两，从俗之意，也应当察病轻重，再为酌量。
用药意解
按葛根汤一方，是肌、表两解的方子，也是太阳、阳明合解的方子。
风寒之邪，一从肌腠而入，则为桂枝汤症，一从肤表而入，则为麻黄汤症，今以桂枝汤加麻黄、葛根，是从肌腠以达肤表，使邪气直出。
太阳与阳明接壤，太阳之邪已在经输，逼近阳明，此刻阳明不病也会病。去太阳之邪，就是救阳明。师取葛根，乃三路进剿之法，葛根为阳明之主药，用之以截阳明之路，而邪不敢入，又能鼓胃气上腾，足以助桂、麻发散祛邪之力，是以攻无不胜，战无不克。吐血门中，罕用此方，此方原不治此病，设有因风、寒闭塞，以致吐血，兼见项背强几几，自汗恶寒者，此方也未始不可用。
问：大便下血如注，有什么要点吗？
答：下血之症，论因则多，论要则二。二者是什么？即阴、阳两个字。阴、阳即气、血，血固然是以下行为顺，是顺行其经络的意思，不是妄行的意思。阳虚之人，下血如注，是下焦之阳不足，而不能统摄；阴虚之人，下血如注，是下焦之阴不足，阴虚则火旺，火旺遂逼血外溢。阳虚阴虚，察脉察色，与上面辨吐血的方法相同。阳虚之下血，宜培中下之阳，方剂用四逆汤、理中汤，见阳虚门。阴虚之下血，宜培中下之阴，方剂用泻心汤、六味、补血汤（即六味地黄汤、当归补血汤），见阴虚门。
有人又说：粪前血、粪后血，是什么意思？曰：粪前血者，是循行大肠的血失度；粪后血者，是脾胃之阴失度。也不必细分，总在这粪便的硬、溏，以判断肠胃的虚、实，又要察其人平日起居，外形之神有无，而虚、实自然判断。先血而粪硬者，是胃火旺而致，人参白虎、麻仁丸可用；先血而粪溏者，是脾不摄血，理中、建中可用；粪硬而血后来者，是心火旺，导赤散可用；粪溏而血后来者，是心血之虚，补血汤、参枣汤可医。仲景以先便后血为远血，主以黄土汤；先血后便为近血，主以赤小豆当归散。
Q: A patient suffers from dysentery with red and white discharge, occurring dozens of times a day, accompanied by abdominal pain and cramping urgency. What is the cause?
A: This is caused by a deficiency of Primordial Yin (Yuan Yin) leading to Lung dryness, compounded by an invasion of external Dryness pathogen, which transfers the dryness to the Large Intestine. Most medical texts attribute red and white dysentery to Damp-Heat, considering white as Dampness and red as Heat. Treating according to this formula yields few effective results. I have carefully pondered this principle: the human body is established on Kan (Kidney Water) and Li (Heart Fire). The mechanism of operation lies entirely in the Heart and Lungs. The Heart belongs to Fire, transforms Blood, and resides below the Lung; the Lung belongs to Metal, transforms Qi, and resides above the Heart. The Lung holds the most honorable position. The movement of Qi mechanisms fills the skin and muscles externally, and the sinews, bones, and viscera internally, embodying the concept of Heaven covering Earth. Once Lung Qi moves, Heart Blood follows, circulating down then up, up then down, endlessly. When these two Qi harmonize, all joints and bones remain uninjured. If Lung Qi and Blood Qi occasionally deviate, various symptoms arise like swarms of insects; is it only dysentery that is so? Dysentery often arises in autumn, when Dryness Metal governs the Qi. When combined with external Dryness pathogens lodging in Lung Metal, blocking the clear pathways and impairing transport functions, Body Fluids fail to reach the Large Intestine, causing Dryness-Heat within the Large Intestine. Thus, it is said that Lung transfers dryness to the Large Intestine. When Lung Qi is obstructed, Large Intestine Qi is also obstructed, and Blood becomes obstructed along with it, hence dysentery occurs. White discharge emphasizes Qi stagnation; red discharge emphasizes Blood stasis. When red and white are mixed, both Heart and Lung suffer from dryness. To treat dysentery, one should seek the root in the Heart and Lung, and must not be confused by the saying "Summer injury by Summer-heat leads to dysentery in Autumn." Pushing this theory, it is believed that in summer's heat, Summer-heat and Dampness prevail; at the turn of autumn, if Summer-heat and Dampness remain unresolved, they glue the Large Intestine, causing desire to defecate without success, resulting in dysentery. I argue that intestinal waste is replaced once every one or two days, or three to five days. Are they all glued by Damp-Heat? Considering white as Dampness, severe Dampness should be purged; considering red as Heat, severe Heat should be astringed. Now, neither purging nor astringing works; the desire to defecate without success clearly indicates Lung Qi stagnation and Heart Blood stasis. How can we immediately blame Damp-Heat accumulation? This view is close to reason, yet Damp-Heat combined diseases are common; why do they not always become dysentery? Why specifically in autumn? It is clearly Dryness pathogens lodging in the Lung. One must know: white represents Qi, Fire, and also the essence of the Large Intestine; red represents Blood, Water, and also the fluid of the Large Intestine. Although red resembles Fire imagery, all blood in the body is derived from Fire transformation. Hence, Blood is Yin, yet it is said that although Blood is a Yin category, its movement relies on Yang, referring to Lung Qi moving and Blood following. I believe treating dysentery should focus primarily on Lung dryness. Although red and white have degrees of depth, their source always returns to the character "Dryness." By treating dryness, the Qi of the two Zang organs relaxes; dysentery stops spontaneously without direct treatment, and red/white discharge resolves without specific targeting. This is the method of grasping the key point.
Shu Chi-yuan categorized dysentery into four main aspects. His theory is acceptable but fails to clearly identify the root of the disease. He generally states white is formed by Dampness and red is caused by Blood issues, leading to endless debates and increasingly bizarre theories, none of which are definitive conclusions. Only the phrase "regulate Qi and move Blood" is slightly compliant. The method should prioritize clearing dryness and saving the Lung. The prescription used is Xing, Dong Er Pi Bai Mi Gan Jie Tang (Apricot and Winter Skin Honey Licorice Platycodon Decoction). However, conditions resembling dysentery but not being dysentery must also be distinguished. True dysentery involves abdominal pain and cramping urgency, extreme bloating pressure, desire to defecate without success, small volume per episode, occurring dozens of times daily. In cases resembling dysentery, abdominal pain is mild, though there is bloating pressure, the volume discharged is relatively large, occurring three to five times, or even seven to eight times a day. Diarrhea occurs immediately upon pain, happening in all seasons, mostly after severe or chronic illnesses. This is due to severe decline of Middle Qi, failure of the Large Intestine's function, slight retention in intestines/stomach, and Qi deficiency failing to transport it, thus resembling dysentery but not being so. The method should strongly tonify the Middle Earth (Spleen/Stomach). When Middle Earth Qi is sufficient, it can naturally transport without losing rhythm. The prescription is Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), adding Wu Zhu Yu (Evodia Fruit) and An Gui (Cinnamon Twig/Cortex Cinnamomi) is best. Various books on treating dysentery claim regulating Qi and moving Blood. I also established a prescription for optional use, named Da Huang Mu Xiang Tang (Rhubarb and Costus Root Decoction).
Xing Dong Er Pi Gan Jie Bai Mi Tang
Almond (Xing Ren) 5 qian, Asparagus Tuber (Tian Dong) 4 qian, Ophiopogon Tuber (Mai Dong) 4 qian, Ground Bark (Di Gu Pi) 3 qian, Mulberry Bark (Sang Pi) 5 qian, Platycodon Root (Jie Geng) 4 qian, Licorice Root (Gan Cao) 3 qian, White Honey half cup.
Da Huang Mu Xiang Tang
Rhubarb Root (Da Huang) 6 qian, Costus Root (Mu Xiang) 6 qian, Angelica Sinensis Root (Dang Gui) 5 qian, Perilla Leaf (Su Ye) 3 qian, Licorice Root (Gan Cao) 3 qian, White Honey half cup.
Explanation of Medicinal Intent
Regarding Xing Dong Er Pi Tang, this is a formula for clearing dryness and moistening the Lung. Because Dryness pathogens lodge in the Lung, Lung Qi is obstructed, and Body Fluids fail to descend to the Large Intestine, causing Qi mechanism stagnation and roughness. Therefore, Bitter Almond (Xing Ren) is taken for its bitter taste to descend and benefit Qi. It is assisted by Tian Dong, Mai Dong, Di Gu Pi, Sang Pi, Gan Cao, Jie Geng, and White Honey to open and moisten. This allows Dryness pathogens to depart and Lung Qi to clear, ensuring descending functions proceed and Qi mechanisms flow smoothly. How could dysentery exist?
Regarding Da Huang Mu Xiang Tang, this is a formula for regulating Qi and moving Blood. Rhubarb (Da Huang) combined with Dang Gui and Gan Cao can purge Dryness-Heat from the Blood level and transform Yin. Mu Xiang, Su Ye, and White Honey can regulate Qi stagnation and transform Yang. With both Qi and Blood transformed, Yin and Yang are balanced, and dysentery naturally does not occur.
Q: A patient experiences mental restlessness (Fan Xin) every morning after breakfast, with abnormal itching in the palms of hands and soles of feet, resolving by early noon. What is the cause?
A: This is due to insufficient Primordial Yin and excess Heart Yang Qi. The four directions of the human body are filled with these two Qi (Yin and Yang). Neither can be biased; bias toward Yang causes Yin deficiency, bias toward Yin causes Yang weakness. Now, the patient has itchy palms and soles. Both Yin and Yang deficiency present this symptom; one cannot generalize it as Blood deficiency. This case is diagnosed as Yin deficiency because the illness occurs in the first half of the day. The human body possesses a single mass of True Qi, exiting Yin entering Yang, exiting Yang entering Yin. Within a day, the first half belongs to the Three Yang stages. If Yang is excessive, Yin is insufficient. Thus, the I Ching says: "The way of the gentleman grows, the way of the petty man declines." The second half belongs to the Three Yin stages. If Yin is excessive, Yang is insufficient. Thus, the I Ching says: "The way of the petty man grows, the way of the gentleman declines." Gentleman and Petty Man refer to Yin and Yang. Ultimately, pushing to the extreme, it is still this single mass of True Qi, declining from prosperity to decay, and decaying back to prosperity. Hence the Sage said: "Laozi is like the dragon!" Looking back at ourselves, do we not also have a Laozi like the dragon! The treatment for this condition should tonify Yin to match Yang. The prescription is Huang Lian Ji Zi E Huang Tang (Coptis Egg Yolk Donkey-Hide Gelatin Decoction) or Bu Xue Tang (Blood Tonifying Decoction), explained above. Checking Yin deficiency itching, the skin on palms and soles appears dry and withered, with coarse white scales. For Yang deficiency itching, the skin on palms and soles is soft and moist, not dry, lacking coarse white scales, but intense itching desires heavy pressing. This distinguishes them. Further observe the complexion of various parts for clarity. Yang deficiency should be treated primarily with gathering and returning Yang. Prescriptions include Qian Yang Dan (Subduing Yang Powder), Si Ni Tang (Four Reversal Decoction), Feng Sui Dan (Sealing Marrow Powder), etc., explained in the Yang Deficiency section.
Q: After hematemesis (vomiting blood), the patient suffers from continuous dizziness. What is the cause?
A: This is Blood deficiency failing to nourish the upper body. Dizziness can be caused by Upper Excess/Lower Deficiency, Upper Deficiency/Lower Excess, failure of Clear Yang to ascend, intrusion of Turbid Yin, accompanying Deficient Wind, accompanying Deficient Fire, or organ imbalance. These vary greatly, but summarizing the essence, it never goes beyond Yin and Yang.
In treating this, observe if the person has a pale face lacking spirit, reduced appetite, normal urination and defecation, fatigue desiring sleep, preference for warmth and aversion to cold, shortness of breath with palpitations, fullness/distension with abdominal pain and diarrhea, enuresis/incontinence with frequent spontaneous sweating, floating pulse weak and empty. All such signs belong to Yang deficiency, caused by insufficiency of Clear Qi. The method should use Pungent-Sweet Yang-supporting herbs, adjusting based on Upper, Middle, Lower conditions. Observe if the person has undiminished spirit, yellow tongue coating, preference for cold drinks, easy digestion, scanty urine/stool, mental restlessness with hot cough producing yellow phlegm, immediate dizziness after eating, or dizziness lasting a few moments then returning to normal, solid forceful long pulse. All such signs belong to Yin deficiency with Fire hyperactivity, attacking upward. The method should use Bitter-Sweet Yin-transforming herbs, adjusting based on Upper, Middle, Lower conditions. Since this dizziness follows hematemesis, it is clearly sudden severe deficiency of Yin Blood, unable to ascend and nourish the vertex. Blood deficiency generates wind, causing dizziness. The method should prioritize nourishing Blood. Use Bu Xue Tang (Blood Tonifying Decoction) as the base, modifying randomly as needed. Note: External contraction of Six Heterogeneous Pathogens causes pain but not dizziness; students must know this.
Q: A woman suffers from metrorrhagia (uterine bleeding), suddenly experiencing severe pain at the crown of the head. What is the cause?
A: This is severe Blood deficiency leaving Yang without attachment, causing it to float violently upward. Qi and Blood are mutually rooted; neither can lack. If Yang Qi suddenly deficient, Yin Blood has no master; if Yin Blood suddenly deficient, Yang Qi has no support. Now, the patient's blood rushes down, drying the "Sea Bottom" (Lower Jiao/Kidneys). The Dragon (Yang) lacks water to nourish it and flies upward, causing severe crown pain. At this moment, if one does not carefully examine the cause of illness and merely treats the pain, the Yang already exhausted at the top will extinguish instantly. The method should vigorously tonify Water. If the Sea has water, the Dragon returns to the abyss. This is the wonderful application of True Yin and True Yang mutual rooting. Use Bu Xue Tang (Blood Tonifying Decoction) as the base, explained above. Or Bu Shui Tang (Water Tonifying Decoction) may be used.
Bu Shui Tang
For the poor, replace American Ginseng (Yang Shen) with Glehnia Root (Sha Shen). American Ginseng (Yang Shen) 2 liang, Phellodendron Bark (Huang Bo) 1 liang, White Honey 1 liang.
Explanation of Medicinal Intent
Regarding Bu Shui Tang, this is a Bitter-Sweet Yin-transforming formula. American Ginseng is white and bitter; Bitter tonifies the Heart, the source of Blood generation. Huang Bo is bitter; Bitter strengthens the Kidney, the region of Water injection. Combined with the sweetness of White Honey, it moistens the Lung to generate Metal, which is the mother of Water. Moreover, Bitter and Sweet combined sufficiently transform Yin. When Yin is generated, the source does not deplete. Although the Dragon belongs to Yang, it loves Water. With Water present, the Dragon submerges in the abyss, the sky remains clear, and Upper and Lower are peaceful. How could crown pain exist?
The above dozens of entries specifically discuss Yin deficiency, repeatedly clarifying "Primordial Yin deficiency." Know that Primordial Yin is Blood and Water. True Fire resides within it, becoming Taiji, becoming Qi and Blood interdependence, becoming Water and Fire mutual rooting, becoming Heart storing Spirit. Any Blood deficiency syndrome presents purely with withered, haggard, dry, and scorching characteristics, resembling fire. Why? Blood contains Fire; Fire hyperactivity naturally causes Yin deficiency, and Yin deficiency naturally causes Fire hyperactivity. Deduce from this to grasp the core of Yin deficiency. The disease manifestations of Three Yin and Three Yang differ. Symptoms of Three Yang deficiency present purely with Yin colors, because Yang is insufficient and Yin is excessive. Symptoms of Three Yin deficiency present purely with Yang colors, because Yin is insufficient and Yang is excessive. This is the critical method for distinguishing Yin and Yang deficiency.
Throughout history, dozens of authors have been vague, failing to clearly point out the essence of Yin and Yang, discussing only post-heaven Five Element generation and restriction, filling pages with rhetoric. Yet, the fundamental establishment of the human body, the subtle meaning of One Yuan, and the mechanism of Two Qi growth and decline were never fully explained. The宗旨 (purpose) was unclear, the source unpenetrated, so few mastered the essence of this art. Sadly, Zhongjing's life heart-method was never revealed by anyone; determining the purpose of the Six Channels remained obscure. Some wrote about Plague, some about Dysentery, boasting expertise, wanting to rival Zhongjing. They did not know the ancestor of legislation had already defined the boundaries of Heaven and Earth through the Six Channels, and clarified the Six Qi encompassing the destination of all diseases. Six Qi are the substance of the Six Channels; external contraction of Six Qi makes them guests of the Six Channels. Three hundred ninety-seven methods are miraculous; one hundred thirteen prescriptions are superb. All are lively natural mechanisms, absolutely free from hindrance. Those who know the subtleties use Si Ni Tang, Bai Tong Tang, Lizhong, Jianzhong to treat all Yang deficiency syndromes without error; use Huang Lian Ji Zi E Huang, Dao Chi San, Bu Xue, Du Shen to treat all Yin deficiency syndromes without mistake. Although formulas prepared for Yin deficiency require flexibility, some should use moistening to support Yin, such as Du Shen, Huang Lian, Dang Gui Bu Xue; some should use cooling to support Yin, such as Dao Chi, Ren Shen Bai Hu; some should use bitter-cold to support Yin, such as Da Cheng Qi, Xiao Cheng Qi, San Huang Shi Gao. These are essential secrets for saving and tonifying Yin. Tonifying Yang is similar: some should use light-clear to support Yang, such as Da Jian Zhong, Xiao Jian Zhong; some should use warm-nourishing to support Yang, such as Gan Cao Gan Jiang Tang, Lizhong Tang; some should use pungent-warm/pungent-hot to support Yang, such as Si Ni, Bai Tong. These are essential secrets for treating Yang deficiency. Others regarding external Six Qi follow seasons, extract outlines, change with pathogens, detailing Six Channel integration. Note that Zhongjing's Six Channels of Cold Damage are not solely for Cold Damage; the Six Steps method is already explained. Taking the Taiyin channel alone: Taiyin governs Dampness and dislikes Dampness. Governing Dampness is the channel's own Qi; disliking Dampness is external guest Qi. Damp Earth prospers in late summer; thus at the end of June, Earth prospers and Damp commands prevails. People with weak intrinsic Qi contracting external Dampness often suffer abdominal pain, vomiting, and diarrhea. Zhongjing therefore established Lizhong Tang. Later sages substituted Xiang Sha, Si Jun, Liu Jun to regulate Spleen Earth disorders, all derived from Lizhong Tang. Is it not usable? For thousands of years, famous sages emerged, creating many formulas, yet Zhongjing's methods became obscure and unclear, necessitating promotion.
Medical Principles True Transmission Volume 4
Miscellaneous Questions
Q: Regarding hematemesis, is it Yang deficiency or Yin deficiency?
A: Hematemesis has three essentials: Yang deficiency, Yin deficiency, and obstruction by external pathogens. This must be known and distinguished. The human body consists of Qi and Blood. Qi is Yang, Heaven, Husband; Blood is Yin, Earth, Wife. Men occupy the exterior, women the interior; this is the natural law of Yin and Yang. Qi and Blood depend on each other; Qi acts upward, Blood acts downward, flowing without stagnation, balanced without bias. How could hematemesis occur? Hematemesis is reversal of Qi mechanism. Yang deficiency causing blood reversal stems from weak Yang failing to control Blood, allowing Yin to surge excessively, invading clear pathways and escaping outward, like a weak husband failing to control his wife. Yin deficiency causing blood reversal stems from exclusive Yang hyperactivity; excessive Yang surges upward, crossing limits, forcing Blood outward, like a tyrannical husband making his wife unsafe. External pathogen obstruction causing blood reversal: Wind-Cold pathogens block ascending-descending Qi mechanisms, causing circulating Blood to lose normal degree, lingering in chest/diaphragm or stomach, triggering easily upon contact, causing Blood to escape outward. Like canal water flowing freely, suddenly blocked mid-stream, upstream water forced to reverse and surge upward, a natural law of Qi mechanism. Furthermore: I have heard the three essentials of hematemesis. May I ask how to distinguish the symptoms of the three essentials and how to treat them? Answer: For Yang deficiency hematemesis, speech lacks spirit, pulse lacks spirit, complexion lacks spirit, Qi is weak and strength exhausted, fatigued desiring sleep, no appetite, coughing clear phlegm. Examine Upper, Middle, Lower regions to see where symptoms uniquely appear, then treat accordingly. Method: Use Pungent-Sweet Yang-transforming herbs, regulate Middle Earth, support Primordial Yang, such as Gan Cao Gan Jiang Tang, Lizhong, Jianzhong. For Yin deficiency hematemesis, speech has spirit, complexion has spirit, pulse has spirit, despite much vomiting, the patient feels little illness, coughing sticky phlegm. Crucially examine Upper, Middle, Lower regions to see where pathology uniquely manifests, identifying Zang-Fu bias, ensuring medication has basis. Method: Use Bitter-Sweet Yin-transforming herbs, such as Xie Xin Tang, Dao Chi San, Ji Zi Tang (Huang Lian E Jiao Tang from Shanghan Lun). For Wind-Cold obstruction causing vomiting, fever, headache, body ache appear, pulse floating or tight. Determine outline, treat accordingly. Method: Prioritize ascending-dispersing and cooling, such as Gui Zhi Tang, Ma Huang Tang, Ge Gen Tang. Gui, Ma, Jianzhong, Lizhong, Gan Cao formulas are in Yang Deficiency section; Xie Xin, Dao Chi, Ji Zi formulas are in Yin Deficiency section.
Ge Gen Tang
Kudzu Root (Ge Gen) 4 qian, Ephedra Herb (Ma Huang) 3 qian, Licorice Root (Gan Cao) 2 qian, Peony Root (Shao Yao) 1 qian, Cinnamon Twig (Gui Zhi) 2 qian, Fresh Ginger (Sheng Jiang) 3 qian, Jujube (Da Zao) 3 pieces.
Ancient formulas used heavy dosages to ensure direct arrival at the Taiyang Bladder channel acupoints to expel pathogens early. If used for hematemesis, it must be confirmed Taiyang syndrome exists: stiff neck/back, no sweat, aversion to wind, combined with Yangming disease, diarrhea. Otherwise, do not lightly try. Current dosage changes follow custom; one must still assess disease severity for adjustment.
Explanation of Medicinal Intent
Ge Gen Tang is a formula resolving both muscle and surface, and combining Taiyang and Yangming resolution.
Wind-Cold pathogens entering via muscle pores cause Gui Zhi Tang syndrome; entering via skin surface cause Ma Huang Tang syndrome. Here, Gui Zhi Tang adds Ma Huang and Ge Gen, reaching from muscle pores to skin surface, allowing pathogens to exit directly.
Taiyang and Yangming border each other. Taiyang pathogens in channel acupoints approach Yangming; if Yangming is not diseased, it becomes diseased. Removing Taiyang pathogens saves Yangming. The Master uses Ge Gen as a three-pronged attack method. Ge Gen is the chief herb of Yangming; using it blocks Yangming paths so pathogens dare not enter, while stimulating Stomach Qi to rise, assisting Gui Zhi and Ma Huang in dispersing and expelling pathogens. Thus, attacks are victorious, battles won. Rarely used in hematemesis section, as it originally does not treat this disease. If wind-cold closure causes hematemesis accompanied by stiff neck/back, spontaneous sweating, and aversion to cold, this formula may indeed be used.
Q: Bowel bleeding flows like a spout. Is there an essential principle?
A: Causes of lower bleeding are numerous, but essentials are two. What are they? Yin and Yang. Yin and Yang are Qi and Blood. Blood naturally flows downward smoothly; this means smooth flow through meridians, not reckless flow. In Yang deficiency, lower bleeding like a spout is due to Lower Jiao Yang insufficiency failing to control. In Yin deficiency, lower bleeding like a spout is due to Lower Jiao Yin insufficiency; Yin deficiency leads to Fire hyperactivity, forcing Blood to overflow. Distinguishing Yang/Yin deficiency via pulse and color is same as hematemesis differentiation. Yang deficiency lower bleeding: tonify Middle/Lower Yang. Formulas: Si Ni Tang, Lizhong Tang (see Yang Deficiency section). Yin deficiency lower bleeding: tonify Middle/Lower Yin. Formulas: Xie Xin Tang, Liu Wei, Bu Xue Tang (Liu Wei Di Huang Tang, Dang Gui Bu Xue Tang) (see Yin Deficiency section).
Another asks: What is blood before stool vs. blood after stool? Answer: Blood before stool is Blood circulation in Large Intestine losing degree. Blood after stool is Spleen/Stomach Yin losing degree. No need to细分 (subdivide); judge Intestine/Stomach deficiency/excess by stool hardness/looseness. Also observe patient's daily habits and external spirit presence to judge deficiency/excess. Blood before, hard stool: Stomach Fire hyperactivity. Ren Shen Bai Hu, Ma Ren Wan usable. Blood before, loose stool: Spleen failing to control Blood. Lizhong, Jianzhong usable. Hard stool, blood later: Heart Fire hyperactivity. Dao Chi San usable. Loose stool, blood later: Heart Blood deficiency. Bu Xue Tang, Shen Zao Tang usable. Zhongjing considers blood after stool as distant blood, treating with Huang Tu Tang; blood before stool as proximate blood, treating with Chi Xiao Dou Dang Gui San.
Huang Tu Tang