初诊：久患失眠之疾，每日午睡及夜间，必服用安眠药方能勉强入睡，然睡而不熟，多梦易醒，甚或彻夜难眠。入睡前又必咯出多量黄白浓痰，而后胸膈舒畅，始能入睡。日常有乏力、气短、自汗、头昏、心烦、口苦或口淡、手足心热、尿频等症。适度假来昆，邀余会诊。诊脉细弦，舌红，苔白腻。此系脾虚湿邪不化，痰热内蕴，心胆受扰。《内经》云：“阳气不得入于阴故目不瞑”。法当祛痰除湿，滤胆清热，养心安神。宜日午进温胆涤痰之剂，夜服养心安神之方，标本并治，俾阴阳交合，自能安卧入寐。处方：
一方： 法半夏9克 茯苓15克 细枳实3克(炒冲) 广化
红6克生甘草3克竹茹6克川贝母6克(冲)光杏仁9竟
瓜萎壳1个(碎)
二方：枣仁15克 茯神15克 川芎6克 炒知母4．5克 柏
子仁9克 炙远志6克 法半夏9克 广桔络9克 浮小
麦16克 小红枣11～／-净杷叶3片夜交藤1 5克生甘草3克
以上二方日、夜服用一周后，患者咯出大量痰浊，渐感神清气爽，胸膈舒畅，睡前已不吐痰。减少或停用安眠药亦能入睡，梦境减少，自汗、头昏诸症渐失。脉象调和，舌红，苔薄自。此痰热、湿邪涤后，心胆安宁。续以第二方加减调治，诸症痊愈。处方：
枣仁15克(冲)茯神15克川芎6克炒知母6克夜交藤15克
广桔络9克荷叶顶3个炙远志6克浮小麦15克炙甘
草3克小枣11枚
[按]日午进温胆涤痰之加味温胆汤，涤痰化浊，以升清阳，夜服安神宁心之加味酸枣仁汤，以（氵必/皿）真阴。气机调畅，阴阳交合，即能安寐。
关 格
郭××，女，三十五岁，干部。
1971年7月于某医院会诊：患者自述患胃疾十余年，每年发作二、三次，无出血史。此次发病半月，先是胸膈胃脘部作胀闷，不思饮食，继则出现呃逆、吞酸、暖气、吞咽不灵，觉食道部如有物梗阻作痛。大便十余日未行，小便短少，睡卧不宁，面色萎黄，日愈消瘦。某医院检查诊断：怀疑食道中有异物。
脉象两关弦细、寸口微浮，舌苔薄腻。前代医家谓；“二便不出谓之关，饮食不下谓之格。”患者二症俱见，是属“关格”之症。治则宽中理气，降逆、疏利，兼以滋润通导。处方：
公丁香4．5克(冲) 柿蒂4．5克 法半夏9克 广陈皮6克
波蔻6克 藿香梗4．5克 佩兰叶4．5克 炒枳壳6克 茯
苓15克 代赭石9克 伏龙肝30克(烧红淬水煨药)
每服调兑生蜂蜜二匙、牛奶一匙为引。
二诊：服上方三剂后，觉胸膈渐舒，闷胀、呃逆、吞酸、暖气均显著轻减。大便一次、量少、如羊粪，小便次数稍增，量仍少。能进少许稀粥，喉中梗痛略减，吞咽仍难，精神倦怠，四肢乏力，脉舌如前。治则仍守原意。处方：
公丁香4。5克柿蒂4．5克 法半夏9克 广陈皮6克老苏
梗9克藿香梗6克广台乌9克 代赭石9克炒枳壳9克
小红枣11枚
每服用生蜂蜜二匙、牛奶一匙为引。
三诊：上方连服三剂后，患者胸膈舒畅，吞咽顺利，喉中梗痛消失，能进面条、馒头等食物。大便畅行，小便量增。睡卧安宁，余症皆除。脉细弱和缓，舌红苔润。病渐愈，续用舒肝调胃，理气宽胸健脾。处方：
太子参9克 法半夏9克 广陈皮6克 广木香3克 西砂
仁6克 炒杭芍9克 茯苓15克 生姜2片 甘草3克 小
枣n枚 秫米15克
上方服二剂，病愈出院。嘱往后服用香砂六君丸巩固。
[按]经云：“阴阳不相应，病名曰关格。”病因和机理，究属寒热不清，湿痰不化，肝胃逆气，结于咽膈，人迎部；由是出纳、升降失司，运化、传导失职，气血失养，津液难滋。
本例治以芳香通利，宽中降逆，兼佐滋润，因势利导，取效顺迅。
寒霍乱
苏××，女，五十二岁，昆明市郊区。1941年夏。
初诊：因于田间劳动至午，暑热醋什，渴饮沟水数捧，旋觉腹中雷鸣绞痛，吐泻交作。余时因抗日期间，疏散在乡，患者家属延往救治。症见神识昏蒙，面青唇绀，四肢厥逆，冷汗不止，诊脉濡微沉细，舌淡白。余谓此寒霍乱也，卒中阴寒，脾阳大伤，脱变之势甚危!急拟下方挽救：
党参15克 附片30克(开水先煨透) 炒苍术12克茯苓15克
合香4．5克 西砂仁9克(冲) 公丁香3克(冲) 上肉桂
6克(冲)(泡水兑服) 煅龙骨12克 炙吴萸4．5克 灶心土
1块(烧红淬水煎药)
二诊：上方急煎后，频频灌服，昼夜尽剂。翌日，神识渐苏。厥回、汗收、吐泻轻减。面仍苍白，尚呃逆，腹鸣。
咏象渐起，舌转淡红。此阳回中虚，胃滞气逆。拟方续以温运：
党参15克 附片30克(开水先煨透) 炒苍术9克 茯苓15克
西砂仁6克法半夏9克 上肉桂6克(泡水兑服) 丁公
香3克(冲) 干姜9克 秫米IS)Z 陈米15克 小枣10枚
三诊：上方服后，胃气渐复，思饮食，并能起坐，脉弱缓，舌粉润。脱危之象已解，现正虚体弱。当温调兼补，数剂而安。处方：
党参15克 白术12克 干姜9克 西砂仁9克 上肉桂6克
(冲) (泡水兑服) 附片30克(开水先煨透) 甘草3克 大
枣3枚 炒玉米、老米各12克
按语见下案“热霍乱”。
热霍乱
张××，男，三十四岁，昆明市郊区。1941年夏。
初诊：天暑劳累，坐卧湿地，咨啖冷物。后即心烦，头晕，吐泻暴作，昼夜数十次。而口唇干燥，烦热，溺短，自汗不止，胸中挥霍撩乱。症见思者面赤烦乱，脉象浮滑且数，舌红、苔黄。急索冷饮，呕泻仍频。此热霍乱也，是伤于暑湿，而心胆火灼，故清浊相干，气机逆乱。与前案病同症异。治宜清暑利湿，芳香化浊。处方：
香薷6克 藿香6克 生扁豆12克(冲) 茯苓12克益元
散12克 波蔻9克(冲) 炒谷、麦芽各9克 秫米30克淡
竹叶9克烧鸡金2个
二诊：服上方后，面赤、烦渴、汗出均减。发热较退，呕泻止半。纳呆食少，胸闷腹鸣，小便稍清。脉象滑数，舌苔黄腻。此暑热较解，气化调顺。续拟芳香清化：
藿香6克 粉葛9克 醋法半夏9克益元散12克茯神15克
猪苓片9克 波蔻9克(冲) 佩兰叶9克 秫米30克 烧
鸡金2个车前仁6克净竹茹9克
三诊：汗、渴，烦、热、呕、泻等症均减。脉滑，舌腻微黄。症得药力已效，再以清化。处方：
藿香6克 醋法半夏9克 茯苓15克 猪苓片9克 波蔻
6克(冲) 炒扁豆15克(冲) 广陈皮6克 车前子6E
秫米15克 竹茹6克 烧鸡金2个 炒枳壳6克
四诊：上方服二剂 诸症渐熄，思饮食，神疲乏力。脉滑缓，舌微黄。吐泻既多，中气未复。为拟健运调理、滋养之剂而痊。处方：
白术12克茯苓15克猪苓片9克 泽泻6克 炒扁豆15克
苏条参15克 寸冬9克 波蔻6克(冲) 广陈皮6克 甘
草3克 炒玉米、老米各12克
[按]霍乱一症，对我国人民之危害，自古而然。历代医家，纷述治验。迄至新中国成立，医疗卫生条件改善，斯疾极少流行。
本书二例发生于1941年，当时昆明地方霍乱大流行，死者甚众。
上述两例皆属霍乱，但病同症异，一寒一热。前者为寒霍乱因脾阳大伤，元气欲脱，所以采用回阳救厥；后者为热霍乱，因肝胆火灼，气化逆乱，所以采用芳香化浊等法。两例并皆获效。
肠痈便血
石××，男，六十三岁，住昆明市。1962年8月。
初诊：自诉素嗜烟酒辛辣厚腻，大便下血廿余年，时作时止。近来因饮酒过多，便血大作，每日七、八次，或于便前流血，或无便而尽为鲜血，少腹部隐隐作痛。头晕心慌，面色萎黄微浮，自汗，食纳日减。夜卧不安，多梦，精神倦怠，病发月余，已用各种止血剂均无效应。
脉象细数而芤，舌质红，苔淡黄腻。 《金匮要略》谓：“下血．先血后便，此近血也，赤小豆当归散主之”。此皆由于素嗜烟酒辛辣等物，肠腑湿热积滞甚重之故。治宜首重清化湿热，活血止血。处方：
赤小饭豆18克(冲) 土炒全川当归15克炒赤白芍药各9克
浙贝母9克(冲) 吴白芷9克干地黄15克金银花炭9克
藕节炒炭9克 粉丹皮6克炒地榆炭9克炒黄芩炭6克
二诊：上方眼三剂后，便血渐少，头晕心慌自汗均减。
但每日仍有五、六次先血后便，少腹部时感疼痛。夜卧较宁，食纳稍增，面色尚萎黄。舌上黄苔退薄，诊脉芤象己减，而仍沉数。此因湿热未净，血不归经，再以止血育阴，清化湿热治之。拟方：
东阿胶15克(烊化分次调服) 炒云连3克 冲饭豆15克 当
归15克 炒赤白芍各9克槐花6克炒地榆9克炒枯芩6克
茯神12克 金银花炭15克 干地黄15克
三诊：上方连服五剂后，大便日二、三行，仅偶有少量鲜血，少腹疼痛渐渐消失。面黄瘦，已不浮。食纳日增，夜可安卧。脉沉弦，舌淡苔薄。症属失血过多，阴虚气弱，肝脾失调，宜滋阴固气养血，赓续调治。处方：
东阿胶15克(烊化分次调服) 干地黄12克 当归15克 炒白
芍12克 茯神15克 苏条参9克 赤小豆12克(冲) 炒槐
花6克炒枯芩4．5克生甘草3克炒苡仁12克广木香1．5克
嘱戒烟酒辛辣。
[按]金匮要略指出：“先便后血为远血”似属于胃及十二直肠溃疡出血一类病症。“先血后便为近血”是直肠肛门痈疡破溃出血。此例患者，因湿热郁结而发生“近血”，治疗即遵金匮：用赤小豆散灵活化裁，止血活血，清化湿热。
后又养阴，健脾调肝，滋益气血。李时珍：“赤小豆除寒热痈肿，排脓散血，解酒毒，治肿消胀，下利肠澼……。”确具一定疗效。另外值得提出的是，患者能够遵照医嘱，力戒烟酒及辛辣厚味，杜绝致病原因，故能获彻底治愈。
胃痛吐血
钟××，男，四十三岁，干部。
1965年6月10日深夜，某医院邀余会诊。患者胃病廿余年，近因劳力过猛，即觉胸胃疼痛如针刺，大口吐血，血色暗红，并有黑色块状。自服“云南白药”半小瓶后，即入医院急救。诊断为上消化道出血，经多方止血无效，拟行手术，而患者要求中医会诊。症见音低息弱，面色皓白，自汗，脉沉细而濇，舌质淡，苔薄白。诊属失血过多，气阴大亏，脾阳不足。若再耽延，恐气随血脱，即难救治。当先止血固摄，拟方：
云南参三七粉9克(分次调兑) 侧柏叶炭9克 陈棕炭9克
炒艾炭9克 炮姜炭9克藕节炭6克 阿胶珠15克
每服点入童便一小酒杯为引。
二诊：上方缓缓服后，至翌日中午，大吐血已基本止住，只少量血块夹痰沫吐出，色紫黑。患者精神萎顿，少气懒言，饮食不思，面色苍白。脉象关部仍沉细而涪，两寸浮芤，尺部沉微，舌仍薄白。证属气血两亏，肝脾失调，心神不足。治宜益气荣血，养肝湿脾，兼佐化痰。拟方如下：
吉林红参9克(另煨兑服) 土炒白术12克 茯神18克 东阿
胶18克(烊化分次调兑) 炮姜炭6克 当归12克 炒杭芍9克
侧柏叶炭6克参三七粉4．5克(分次调兑) 生甘草3克(点
童便为引)
三诊：上方连服二剂，吐血停止，能进少量流质，自汗已收，能安卧，胸胃刺痛轻减。自觉头昏神倦无力。脉转缓和，较前有力，舌质淡红，苔渐润。续用原方加减：
吉林红参9克(五剂后改苏条参15克) 炒白术12克 茯神15克
砂仁6克(冲) 当归15克炒杭芍9克广陈皮6克炙甘
草3克莲子12克(去心) 龙眼肉9克炮姜4．5克大枣3枚
上方连服十余剂，诸症消失，饮食增加，病愈出院。
[按]本例患者，素有胃病，又因挣伤，发生大吐血不止，脾胃大伤，有气随血脱之危!急当止血固摄。而止血之法，血宜活，不宜结，故方中以三七为主。宜调顺气机，少点童便为引。血渐止，增加益气荣血，养肝温脾之品。继叉养心安神，补益气血，强健脾胃，以善其后。
胃痛便血
陈××，男，六十岁，工人。1970年5月。
初诊：患者胃痛三十年，十年来症状加重。常感胸膈胃脘疼痛胀闷，呃逆吞酸，大便二、三日一行，时呈黑褐色、或便后鲜血。渐至形体极度消瘦，颜面苍白，食纳稀少，自汗，畏寒肢冷，精神萎顿。曾经钡餐检查；证实为胃及十二指肠溃疡。大便潜盘试验(+)至(++++)不等。因多次治疗无效，特来住院治疗。脉象沉细而紧，舌淡，苔薄白，中心黄腻。此病久阳虚脾弱，寒湿内滞，气血失和，胃络受损。法当温运。处方：
党参15克 土炒白术12克 茯苓12克 法半夏0克 西砂
仁9克 上肉桂6克(兑服) 荜澄茄6克公丁香4．5克(冲)
甘草3克 侧柏叶炭9克 烧鸡金6克 炮姜炭9克
二诊；上方服三剂后，胀闷疼痛略减，而现口燥唇干，头昏心慌，气短自汗，夜卧不安，便秘，色褐尤深。诊脉沉细紧而数，舌苔黄燥少津。此中焦寒湿稍化，而上方偏燥，有阴虚热浮之象，改拟下方：
红人参9克(兑服) 当归15克 炒杭芍9克 土炒白术9克
茯神15克海螵蛸12克(煅) 浙贝母9克(冲) 西砂仁9克
初诊：患者长期患有失眠症，每天午睡和夜间必须服用安眠药才能勉强入睡，但睡眠浅、多梦且易醒，甚至整夜无法入睡。入睡前必须咳出大量黄白色浓痰，之后胸膈部感到舒畅，才能入睡。日常伴有乏力、气短、自汗、头晕、心烦、口苦或口淡、手足心热、尿频等症状。适逢度假来到昆明，邀请我会诊。诊脉细弦，舌红，苔白腻。这是脾虚导致湿邪不能运化，痰热内蕴，扰乱心胆。《内经》说：“阳气不能进入阴分，所以眼睛闭不上（失眠）。”治法应当祛痰除湿，清泄胆热，养心安神。适宜在中午服用温胆汤加减以涤除痰浊，晚上服用养心安神的方剂，标本兼治，使阴阳交合，自然能安稳入睡。处方：
一方：法半夏9克 茯苓15克 炒枳实3克（冲服） 广陈皮6克 生甘草3克 竹茹6克 川贝母6克（冲服） 光杏仁9克 瓜蒌壳1个（捣碎）
二方：酸枣仁15克 茯神15克 川芎6克 炒知母4.5克 柏子仁9克 炙远志6克 法半夏9克 广桔络9克 浮小麦16克 小红枣11枚 净枇杷叶3片 夜交藤15克 生甘草3克
以上两方日夜服用一周后，患者咳出大量痰浊，逐渐感觉神清气爽，胸膈舒畅，睡前不再吐痰。减少或停用安眠药也能入睡，梦境减少，自汗、头晕等症状逐渐消失。脉象调和，舌红，苔薄白。此时痰热、湿邪已清除，心胆安宁。继续用第二方加减调治，诸症痊愈。处方：
酸枣仁15克（冲服） 茯神15克 川芎6克 炒知母6克 夜交藤15克 广桔络9克 荷叶顶3个 炙远志6克 浮小麦15克 炙甘草3克 小枣11枚
[按语]中午服用加味温胆汤，涤痰化浊，以升发清阳；晚上服用加味酸枣仁汤，安神宁心，以滋养真阴。气机调畅，阴阳交合，就能安然入睡。
关格
郭××，女，三十五岁，干部。
1971年7月在某医院会诊：患者自述患胃病十余年，每年发作二三次，无出血史。此次发病半月，先是胸膈胃脘部胀闷，不思饮食，继则出现呃逆、吞酸、嗳气、吞咽不灵，感觉食道部如有物梗阻作痛。大便十余日未行，小便短少，睡卧不宁，面色萎黄，日益消瘦。某医院检查诊断：怀疑食道中有异物。
脉象两关弦细、寸口微浮，舌苔薄腻。前代医家说：“二便不出谓之关，饮食不下谓之格。”患者两种症状都具备，属于“关格”之症。治则宽中理气，降逆、疏利，兼以滋润通导。处方：
公丁香4.5克（冲服） 柿蒂4.5克 法半夏9克 广陈皮6克 白豆蔻6克 藿香梗4.5克 佩兰叶4.5克 炒枳壳6克 茯苓15克 代赭石9克 伏龙肝30克（烧红后淬水煎药）
每服药时调入生蜂蜜两匙、牛奶一匙作为药引。
二诊：服用上方三剂后，感觉胸膈渐舒，闷胀、呃逆、吞酸、嗳气均显著减轻。大便一次、量少、如羊粪状，小便次数稍增，量仍少。能进少许稀粥，喉中梗痛略减，吞咽仍难，精神倦怠，四肢乏力，脉舌如前。治则仍守原意。处方：
公丁香4.5克 柿蒂4.5克 法半夏9克 广陈皮6克 老苏梗9克 藿香梗6克 广台乌9克 代赭石9克 炒枳壳9克 小红枣11枚
每服药时用生蜂蜜两匙、牛奶一匙作为药引。
三诊：上方连服三剂后，患者胸膈舒畅，吞咽顺利，喉中梗痛消失，能进食面条、馒头等食物。大便畅行，小便量增。睡卧安宁，余症皆除。脉细弱和缓，舌红苔润。病渐愈，续用舒肝调胃，理气宽胸健脾之法。处方：
太子参9克 法半夏9克 广陈皮6克 广木香3克 西砂仁6克 炒杭芍9克 茯苓15克 生姜2片 甘草3克 小枣11枚 秫米15克
上方服二剂，病愈出院。嘱往后服用香砂六君丸巩固疗效。
[按语]经云：“阴阳不相应，病名曰关格。”病因和机理，究属寒热不清，湿痰不化，肝胃逆气，结于咽膈人迎部；由此导致出纳、升降失司，运化、传导失职，气血失养，津液难滋。
本例治以芳香通利，宽中降逆，兼佐滋润，因势利导，取效迅速。
寒霍乱
苏××，女，五十二岁，昆明市郊区。1941年夏。
初诊：因在田间劳动至中午，暑热交迫，口渴饮沟水数捧，随即觉得腹中雷鸣绞痛，吐泻交作。我当时因抗日战争期间疏散在乡下，患者家属延请我去救治。症见神识昏蒙，面青唇绀，四肢厥逆，冷汗不止，诊脉濡微沉细，舌淡白。我认为这是寒霍乱，卒中阴寒，脾阳大伤，脱变之势甚危！急拟下方挽救：
党参15克 附片30克（开水先煨透） 炒苍术12克 茯苓15克 合香4.5克 西砂仁9克（冲服） 公丁香3克（冲服） 上肉桂6克（冲服）（泡水兑服） 煅龙骨12克 炙吴萸4.5克 灶心土1块（烧红淬水煎药）
二诊：上方急煎后，频频灌服，昼夜尽剂。翌日，神识渐苏。厥回、汗收、吐泻轻减。面仍苍白，尚呃逆，腹鸣。脉象渐起，舌转淡红。此为阳回中虚，胃滞气逆。拟方续以温运：
党参15克 附片30克（开水先煨透） 炒苍术9克 茯苓15克 西砂仁6克 法半夏9克 上肉桂6克（泡水兑服） 丁公香3克（冲服） 干姜9克 秫米15克 陈米15克 小枣10枚
三诊：上方服后，胃气渐复，思饮食，并能起坐，脉弱缓，舌粉润。脱危之象已解，现正虚体弱。当温调兼补，数剂而安。处方：
党参15克 白术12克 干姜9克 西砂仁9克 上肉桂6克（冲服）（泡水兑服） 附片30克（开水先煨透） 甘草3克 大枣3枚 炒玉米、老米各12克
按语见下案“热霍乱”。
热霍乱
张××，男，三十四岁，昆明市郊区。1941年夏。
初诊：天暑劳累，坐卧湿地，恣食冷物。后即心烦，头晕，吐泻暴作，昼夜数十次。而且口唇干燥，烦热，溺短，自汗不止，胸中挥霍撩乱。症见患者面赤烦乱，脉象浮滑且数，舌红、苔黄。急索冷饮，呕泻仍频。此热霍乱也，是伤于暑湿，而心胆火灼，故清浊相干，气机逆乱。与前案病同症异。治宜清暑利湿，芳香化浊。处方：
香薷6克 藿香6克 生扁豆12克（冲服） 茯苓12克 益元散12克 白豆蔻9克（冲服） 炒谷、麦芽各9克 秫米30克 淡竹叶9克 烧鸡金2个
二诊：服用上方后，面赤、烦渴、汗出均减。发热较退，呕泻止半。纳呆食少，胸闷腹鸣，小便稍清。脉象滑数，舌苔黄腻。此暑热较解，气化调顺。续拟芳香清化：
藿香6克 粉葛9克 醋法半夏9克 益元散12克 茯神15克 猪苓片9克 白豆蔻9克（冲服） 佩兰叶9克 秫米30克 烧鸡金2个 车前仁6克 净竹茹9克
三诊：汗、渴，烦、热、呕、泻等症均减。脉滑，舌腻微黄。症得药力已效，再以清化。处方：
藿香6克 醋法半夏9克 茯苓15克 猪苓片9克 白豆蔻6克（冲服） 炒扁豆15克（冲服） 广陈皮6克 车前子6克 秫米15克 竹茹6克 烧鸡金2个 炒枳壳6克
四诊：上方服二剂，诸症渐熄，思饮食，神疲乏力。脉滑缓，舌微黄。吐泻既多，中气未复。为拟健运调理、滋养之剂而痊。处方：
白术12克 茯苓15克 猪苓片9克 泽泻6克 炒扁豆15克 苏条参15克 寸冬9克 白豆蔻6克（冲服） 广陈皮6克 甘草3克 炒玉米、老米各12克
[按语]霍乱一症，对我国人民之危害，自古而然。历代医家，纷述治验。迄至新中国成立，医疗卫生条件改善，斯疾极少流行。
本书二例发生于1941年，当时昆明地方霍乱大流行，死者甚众。
上述两例皆属霍乱，但病同症异，一寒一热。前者为寒霍乱因脾阳大伤，元气欲脱，所以采用回阳救厥；后者为热霍乱，因肝胆火灼，气化逆乱，所以采用芳香化浊等法。两例并皆获效。
肠痈便血
石××，男，六十三岁，住昆明市。1962年8月。
初诊：自诉素嗜烟酒辛辣厚腻，大便下血廿余年，时作时止。近来因饮酒过多，便血大作，每日七、八次，或于便前流血，或无便而尽为鲜血，少腹部隐隐作痛。头晕心慌，面色萎黄微浮，自汗，食纳日减。夜卧不安，多梦，精神倦怠，病发月余，已用各种止血剂均无效应。
脉象细数而芤，舌质红，苔淡黄腻。《金匮要略》谓：“下血．先血后便，此近血也，赤小豆当归散主之”。此皆由于素嗜烟酒辛辣等物，肠腑湿热积滞甚重之故。治宜首重清化湿热，活血止血。处方：
赤小豆18克（冲服） 土炒全川当归15克 炒赤白芍药各9克 浙贝母9克（冲服） 吴白芷9克 干地黄15克 金银花炭9克 藕节炒炭9克 粉丹皮6克 炒地榆炭9克 炒黄芩炭6克
二诊：上方服三剂后，便血渐少，头晕心慌自汗均减。
但每日仍有五、六次先血后便，少腹部时感疼痛。夜卧较宁，食纳稍增，面色尚萎黄。舌上黄苔退薄，诊脉芤象己减，而仍沉数。此因湿热未净，血不归经，再以止血育阴，清化湿热治之。拟方：
东阿胶15克（烊化分次调服） 炒云连3克 冲饭豆15克 当归15克 炒赤白芍各9克 槐花6克 炒地榆9克 炒枯芩6克 茯神12克 金银花炭15克 干地黄15克
三诊：上方连服五剂后，大便日二、三行，仅偶有少量鲜血，少腹疼痛渐渐消失。面黄瘦，已不浮。食纳日增，夜可安卧。脉沉弦，舌淡苔薄。症属失血过多，阴虚气弱，肝脾失调，宜滋阴固气养血，赓续调治。处方：
东阿胶15克（烊化分次调服） 干地黄12克 当归15克 炒白芍12克 茯神15克 苏条参9克 赤小豆12克（冲服） 炒槐花6克 炒枯芩4.5克 生甘草3克 炒苡仁12克 广木香1.5克
嘱戒烟酒辛辣。
[按语]金匮要略指出：“先便后血为远血”似属于胃及十二指肠溃疡出血一类病症。“先血后便为近血”是直肠肛门痈疡破溃出血。此例患者，因湿热郁结而发生“近血”，治疗即遵金匮：用赤小豆散灵活化裁，止血活血，清化湿热。
后又养阴，健脾调肝，滋益气血。李时珍：“赤小豆除寒热痈肿，排脓散血，解酒毒，治肿消胀，下利肠澼……。”确具一定疗效。另外值得提出的是，患者能够遵照医嘱，力戒烟酒及辛辣厚味，杜绝致病原因，故能获彻底治愈。
胃痛吐血
钟××，男，四十三岁，干部。
1965年6月10日深夜，某医院邀余会诊。患者胃病廿余年，近因劳力过猛，即觉胸胃疼痛如针刺，大口吐血，血色暗红，并有黑色块状。自服“云南白药”半小瓶后，即入医院急救。诊断为上消化道出血，经多方止血无效，拟行手术，而患者要求中医会诊。症见音低息弱，面色皓白，自汗，脉沉细而涩，舌质淡，苔薄白。诊属失血过多，气阴大亏，脾阳不足。若再耽延，恐气随血脱，即难救治。当先止血固摄，拟方：
云南参三七粉9克（分次调兑） 侧柏叶炭9克 陈棕炭9克 炒艾炭9克 炮姜炭9克 藕节炭6克 阿胶珠15克
每服点入童便一小酒杯作为药引。
二诊：上方缓缓服后，至翌日中午，大吐血已基本止住，只少量血块夹痰沫吐出，色紫黑。患者精神萎顿，少气懒言，饮食不思，面色苍白。脉象关部仍沉细而涩，两寸浮芤，尺部沉微，舌仍薄白。证属气血两亏，肝脾失调，心神不足。治宜益气荣血，养肝温脾，兼佐化痰。拟方如下：
吉林红参9克（另煨兑服） 土炒白术12克 茯神18克 东阿胶18克（烊化分次调兑） 炮姜炭6克 当归12克 炒杭芍9克 侧柏叶炭6克 参三七粉4.5克（分次调兑） 生甘草3克（点童便为引）
三诊：上方连服二剂，吐血停止，能进少量流质，自汗已收，能安卧，胸胃刺痛轻减。自觉头昏神倦无力。脉转缓和，较前有力，舌质淡红，苔渐润。续用原方加减：
吉林红参9克（五剂后改苏条参15克） 炒白术12克 茯神15克 砂仁6克（冲服） 当归15克 炒杭芍9克 广陈皮6克 炙甘草3克 莲子12克（去心） 龙眼肉9克 炮姜4.5克 大枣3枚
上方连服十余剂，诸症消失，饮食增加，病愈出院。
[按语]本例患者，素有胃病，又因挣伤，发生大吐血不止，脾胃大伤，有气随血脱之危！急当止血固摄。而止血之法，血宜活，不宜结，故方中以三七为主。宜调顺气机，少点童便为引。血渐止，增加益气荣血，养肝温脾之品。继又养心安神，补益气血，强健脾胃，以善其后。
胃痛便血
陈××，男，六十岁，工人。1970年5月。
初诊：患者胃痛三十年，十年来症状加重。常感胸膈胃脘疼痛胀闷，呃逆吞酸，大便二、三日一行，时呈黑褐色、或便后鲜血。渐至形体极度消瘦，颜面苍白，食纳稀少，自汗，畏寒肢冷，精神萎顿。曾经钡餐检查；证实为胃及十二指肠溃疡。大便潜血试验(+)至(++++)不等。因多次治疗无效，特来住院治疗。脉象沉细而紧，舌淡，苔薄白，中心黄腻。此病久阳虚脾弱，寒湿内滞，气血失和，胃络受损。法当温运。处方：
党参15克 土炒白术12克 茯苓12克 法半夏9克 西砂仁9克 上肉桂6克（兑服） 荜澄茄6克 公丁香4.5克（冲服） 甘草3克 侧柏叶炭9克 烧鸡金6克 炮姜炭9克
二诊：上方服三剂后，胀闷疼痛略减，而现口燥唇干，头昏心慌，气短自汗，夜卧不安，便秘，色褐尤深。诊脉沉细紧而数，舌苔黄燥少津。此中焦寒湿稍化，而上方偏燥，有阴虚热浮之象，改拟下方：
红人参9克（兑服） 当归15克 炒杭芍9克 土炒白术9克 茯神15克 海螵蛸12克（煅） 浙贝母9克（冲服） 西砂仁9克
First Visit: The patient has suffered from insomnia for a long time, requiring sleeping pills every day during afternoon naps and at night to barely fall asleep. However, the sleep is shallow, with many dreams and easy awakening, or even staying awake all night. Before falling asleep, the patient must cough up a large amount of yellow-white thick phlegm; only after the chest and diaphragm feel comfortable can they fall asleep. Daily symptoms include fatigue, shortness of breath, spontaneous sweating, dizziness, irritability, bitter or bland taste in the mouth, heat sensation in the palms and soles, and frequent urination. While on vacation in Kunming, the patient invited me for consultation. The pulse was fine and wiry (Xian Mai), the tongue was red, and the coating was white and greasy. This indicates Spleen deficiency leading to failure of dampness transformation, with phlegm-heat accumulating internally and disturbing the Heart and Gallbladder. As stated in the *Neijing* (Classic of Internal Medicine): "When Yang qi cannot enter Yin, the eyes remain open (insomnia)." The treatment principle should be to dispel phlegm and remove dampness, clear Gallbladder heat, and nourish the Heart to calm the Spirit. It is appropriate to administer a Wendan Tang (Warm the Gallbladder Decoction) variant at noon to wash away phlegm turbidity, and a Heart-nourishing and Spirit-calming formula at night, treating both root and branch, so that Yin and Yang intersect, allowing for peaceful sleep. Prescription:
Formula 1: Fa Banxia (Prepared Pinellia Rhizome) 9g, Fuling (Poria) 15g, Chao Zhishi (Stir-fried Immature Bitter Orange) 3g (taken with water), Guang Chenpi (Aged Tangerine Peel) 6g, Sheng Gancao (Raw Licorice Root) 3g, Zhuru (Bamboo Shavings) 6g, Chuan Beimu (Fritillaria Cirrhosa Bulb) 6g (taken with water), Guang Xingren (Apricot Seed) 9g, Gualou Qiao (Trichosanthes Fruit Shell) 1 piece (crushed).
Formula 2: Zaoren (Sour Jujube Seed) 15g, Fushen (Poria with Hostwood) 15g, Chuanxiong (Szechwan Lovage Rhizome) 6g, Chao Zhimu (Stir-fried Anemarrhena Rhizome) 4.5g, Baiziren (Biota Seed) 9g, Zhi Yuanzhi (Prepared Polygala Root) 6g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Guang Jieluo (Citrus Reticulata Stem) 9g, Xiaomai (Floating Wheat) 16g, Hong Zao (Red Date) 11 pieces, Jing Pipaye (Clean Loquat Leaf) 3 pieces, Yejiaoteng (Polygonum Multiflorum Vine) 15g, Sheng Gancao (Raw Licorice Root) 3g.
After taking these two formulas day and night for one week, the patient coughed up a large amount of phlegm turbidity, gradually feeling refreshed and comfortable in the chest and diaphragm, without needing to spit phlegm before sleep. Sleeping pills were reduced or stopped, yet sleep was achieved, dreams decreased, and symptoms like spontaneous sweating and dizziness gradually disappeared. The pulse became harmonious, the tongue remained red, and the coating became thin and white. With the phlegm-heat and dampness cleared, the Heart and Gallbladder are tranquil. Continue adjusting Formula 2 for treatment, resulting in the cure of all symptoms. Prescription:
Zaoren (Sour Jujube Seed) 15g (taken with water), Fushen (Poria with Hostwood) 15g, Chuanxiong (Szechwan Lovage Rhizome) 6g, Chao Zhimu (Stir-fried Anemarrhena Rhizome) 6g, Yejiaoteng (Polygonum Multiflorum Vine) 15g, Guang Jieluo (Citrus Reticulata Stem) 9g, Hetie Ding (Lotus Leaf Tip) 3 pieces, Zhi Yuanzhi (Prepared Polygala Root) 6g, Xiaomai (Floating Wheat) 15g, Zhi Gancao (Honey-fried Licorice Root) 3g, Xiao Zao (Small Date) 11 pieces.
[Commentary]: Administering modified Wendan Tang at noon clears phlegm and transforms turbidity, thereby raising Clear Yang. Administering modified Suanzaoren Tang at night calms the Spirit and nourishes the Heart, thereby nourishing True Yin. When Qi mechanism is smooth and Yin and Yang intersect, peaceful sleep is achieved.
Guan Ge (Obstruction and Rejection Syndrome)
Guo XX, Female, 35 years old, Cadre.
Consultation at a certain hospital in July 1971: The patient reported suffering from stomach disease for over ten years, occurring two or three times a year, with no history of bleeding. This episode began half a month ago, initially presenting with distension and fullness in the chest, diaphragm, and epigastrium, loss of appetite, followed by hiccups, acid regurgitation, belching, and difficulty swallowing, with a sensation of obstruction and pain in the esophagus. No bowel movement for over ten days, scanty urine, restless sleep, sallow complexion, and progressive emaciation. A certain hospital's examination and diagnosis suspected a foreign body in the esophagus.
The pulse was fine and wiry at both Guan positions and slightly floating at Cun position; the tongue coating was thin and greasy. Ancient physicians stated: "Inability to pass stool and urine is called Guan; inability to take food and drink is called Ge." The patient exhibits both symptoms, belonging to the "Guan Ge" syndrome. The treatment principle is to broaden the middle and regulate Qi, descend rebellious Qi, promote free flow, and moisten and unblock. Prescription:
Gong Dingxiang (Clove) 4.5g (taken with water), Shidi (Persimmon Calyx) 4.5g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Guang Chenpi (Aged Tangerine Peel) 6g, Bo Kou (Cardamom) 6g, Huoxiang Geng (Agastache Stem) 4.5g, Peilan Ye (Eupatorium Leaf) 4.5g, Chao Zhiqiao (Stir-fried Aurantium Fruit) 6g, Fuling (Poria) 15g, Daizheshi (Magnetite) 9g, Fulonggan (Kitchen Hearth Soil) 30g (heated red until smoking, quenched with water for decoction).
Each dose is taken with two spoons of raw honey and one spoon of milk as a guide.
Second Visit: After taking three doses of the above prescription, the patient felt gradual relief in the chest and diaphragm, with significant reduction in distension, hiccups, acid regurgitation, and belching. One bowel movement occurred, small in quantity, resembling sheep dung; urinary frequency increased slightly, but volume remained low. Able to consume a small amount of thin porridge, throat obstruction and pain slightly reduced, but swallowing remains difficult. Mental fatigue and limb weakness persist; pulse and tongue remain unchanged. The treatment principle adheres to the original intent. Prescription:
Gong Dingxiang (Clove) 4.5g, Shidi (Persimmon Calyx) 4.5g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Guang Chenpi (Aged Tangerine Peel) 6g, Lao Sugeng (Old Perilla Stem) 9g, Huoxiang Geng (Agastache Stem) 6g, Guang Taiwu (Cyathula Root) 9g, Daizheshi (Magnetite) 9g, Chao Zhiqiao (Stir-fried Aurantium Fruit) 9g, Hong Zao (Red Date) 11 pieces.
Each dose is taken with two spoons of raw honey and one spoon of milk as a guide.
Third Visit: After taking three consecutive doses, the patient's chest and diaphragm feel comfortable, swallowing is smooth, throat obstruction and pain have disappeared, and foods like noodles and steamed buns can be eaten. Bowel movements are smooth, urine volume increases. Sleep is peaceful, and other symptoms are eliminated. The pulse is fine, weak, and moderate; the tongue is red with a moist coating. The illness is gradually resolving. Continue with soothing Liver, regulating Stomach, regulating Qi, broadening chest, and strengthening Spleen. Prescription:
Taizishen (Pseudostellaria Root) 9g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Guang Chenpi (Aged Tangerine Peel) 6g, Guang Muxiang (Vladimiria Root) 3g, Xi Sharen (Amomum Fruit) 6g, Chao Hangshao (Stir-fried White Peony Root) 9g, Fuling (Poria) 15g, Shengjiang (Fresh Ginger) 2 slices, Gancao (Licorice Root) 3g, Xiao Zao (Small Date) 11 pieces, Sumi (Glutinous Rice) 15g.
After taking two doses of the above prescription, the patient recovered and was discharged. Advised to continue taking Xiangsha Liujun Wan (Atractylodes Macrocephala and Amomum Six Gentlemen Pills) for consolidation.
[Commentary]: The Classics state: "When Yin and Yang do not correspond, the disease is named Guan Ge." The etiology and pathogenesis involve unclear cold and heat, failure of damp-phlegm transformation, rebellious Qi of Liver and Stomach knotting at the pharynx and diaphragm Renying area; thus, intake and output, ascending and descending functions fail, transportation and conduction lose their duty, Qi and Blood lose nourishment, and Body Fluids are difficult to moisten.
This case was treated with aromatic unblocking and promoting free flow, broadening the middle and descending rebellious Qi, assisted by moistening agents, guiding according to the situation, achieving rapid effect.
Cold Huoluan (Acute Vomiting and Diarrhea)
Su XX, Female, 52 years old, Suburbs of Kunming City. Summer 1941.
First Visit: Due to field labor until noon, suffering from intense summer heat, thirst led to drinking several handfuls of ditch water. Soon, rumbling and colicky pain in the abdomen occurred, with simultaneous vomiting and diarrhea. I was then evacuated to the countryside due to the Anti-Japanese War, and the patient's family invited me for treatment. Symptoms included confused consciousness, cyanotic face and lips, cold limbs, incessant cold sweat. Pulse was soggy, minute, deep, and fine; tongue was pale white. I diagnosed this as Cold Huoluan, struck by severe Yin-Cold, causing major damage to Spleen-Yang, with a critical trend towards collapse! Urgently prescribed the following formula to rescue:
Dangshen (Codonopsis Root) 15g, Fupian (Prepared Aconite Lateral Root) 30g (simmered thoroughly in boiling water first), Chao Cangzhu (Stir-fried Atractylodes Lancea Rhizome) 12g, Fuling (Poria) 15g, Hexiang (Agarwood) 4.5g, Xi Sharen (Amomum Fruit) 9g (taken with water), Gong Dingxiang (Clove) 3g (taken with water), Shang Rougui (Cinnamon Bark) 6g (taken with water, mixed and drunk), Duan Longgu (Calcined Dragon Bone) 12g, Zhi Wuyu (Prepared Evodia Fruit) 4.5g, Zaoxin Tu (Kitchen Hearth Soil) 1 piece (heated red until smoking, quenched with water for decoction).
Second Visit: The above prescription was rapidly decocted and frequently administered, completing the dosage day and night. The next day, consciousness gradually returned. Limbs warmed, sweat stopped, vomiting and diarrhea reduced. Face remained pale, still hiccupping, abdominal rumbling. Pulse gradually strengthened, tongue turned pale red. This indicates return of Yang with Middle Deficiency, Stomach stagnation and rebellious Qi. Prescribed formula to continue warming and transporting:
Dangshen (Codonopsis Root) 15g, Fupian (Prepared Aconite Lateral Root) 30g (simmered thoroughly in boiling water first), Chao Cangzhu (Stir-fried Atractylodes Lancea Rhizome) 9g, Fuling (Poria) 15g, Xi Sharen (Amomum Fruit) 6g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Shang Rougui (Cinnamon Bark) 6g (taken with water, mixed and drunk), Gong Dingxiang (Clove) 3g (taken with water), Ganjiang (Dried Ginger) 9g, Sumi (Glutinous Rice) 15g, Chenmi (Aged Rice) 15g, Xiao Zao (Small Date) 10 pieces.
Third Visit: After taking the above prescription, Stomach Qi gradually recovered, desire for food appeared, able to sit up. Pulse was weak and slow, tongue pink and moist. Signs of collapse resolved, now presenting with Righteous Qi deficiency and physical weakness. Treatment should warm, regulate, and tonify; a few doses will bring peace. Prescription:
Dangshen (Codonopsis Root) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Ganjiang (Dried Ginger) 9g, Xi Sharen (Amomum Fruit) 9g, Shang Rougui (Cinnamon Bark) 6g (taken with water, mixed and drunk), Fupian (Prepared Aconite Lateral Root) 30g (simmered thoroughly in boiling water first), Gancao (Licorice Root) 3g, Dazao (Jujube) 3 pieces, Chao Yumi (Stir-fried Corn) and Laomi (Old Rice) 12g each.
Commentary see next case "Hot Huoluan".
Hot Huoluan (Acute Vomiting and Diarrhea)
Zhang XX, Male, 34 years old, Suburbs of Kunming City. Summer 1941.
First Visit: Exhaustion from summer heat, sitting and lying on wet ground, indulging in cold foods. Soon followed by irritability, dizziness, sudden violent vomiting and diarrhea, dozens of times day and night. Lips and mouth dry, feverish sensation, scanty urine, incessant spontaneous sweating, chaotic sensation in the chest. Patient presented with red face and irritability, pulse floating, slippery, and rapid; tongue red with yellow coating. Urgently sought cold drinks, vomiting and diarrhea still frequent. This is Hot Huoluan, caused by injury from Summer-Heat and Dampness, with Fire scorching Heart and Gallbladder, thus Clear and Turbid interfere with each other, Qi mechanism rebels and becomes chaotic. Same disease as previous case but different symptoms. Treatment should clear Summer-Heat and promote dampness drainage, using aromatic methods to transform turbidity. Prescription:
Xiangru (Mosla Herb) 6g, Huoxiang (Patchouli) 6g, Sheng BianDou (Raw Lablab Bean) 12g (taken with water), Fuling (Poria) 12g, YiYuan San (Benefit Origin Powder) 12g, Bo Kou (Cardamom) 9g (taken with water), Chao Gu Ya and Mai Ya (Stir-fried Barley Sprout and Malt) 9g each, Sumi (Glutinous Rice) 30g, Dan Zhuye (Lophatherum Leaf) 9g, Shao Jijin (Roasted Chicken Gizzard Membrane) 2 pieces.
Second Visit: After taking the above prescription, facial redness, irritability/thirst, and sweating decreased. Fever subsided somewhat, vomiting and diarrhea reduced by half. Poor appetite, chest fullness, abdominal rumbling, urine slightly clearer. Pulse slippery and rapid, tongue coating yellow and greasy. Summer-heat is largely resolved, Qi mechanism is regulated. Continue with aromatic clearing and transforming:
Huoxiang (Patchouli) 6g, Fen Ge (Kudzu Root) 9g, Cu Fa Banxia (Vinegar-treated Prepared Pinellia Rhizome) 9g, YiYuan San (Benefit Origin Powder) 12g, Fushen (Poria with Hostwood) 15g, Zhuling (Polyporus) 9g, Bo Kou (Cardamom) 9g (taken with water), Peilan Ye (Eupatorium Leaf) 9g, Sumi (Glutinous Rice) 30g, Shao Jijin (Roasted Chicken Gizzard Membrane) 2 pieces, Cheqian Ren (Plantago Seed) 6g, Jing Zhuru (Clean Bamboo Shavings) 9g.
Third Visit: Sweating, thirst, irritability, fever, vomiting, and diarrhea symptoms all reduced. Pulse slippery, tongue coating greasy and slightly yellow. Symptoms responded well to medication, continue with clearing and transforming. Prescription:
Huoxiang (Patchouli) 6g, Cu Fa Banxia (Vinegar-treated Prepared Pinellia Rhizome) 9g, Fuling (Poria) 15g, Zhuling (Polyporus) 9g, Bo Kou (Cardamom) 6g (taken with water), Chao BianDou (Stir-fried Lablab Bean) 15g (taken with water), Guang Chenpi (Aged Tangerine Peel) 6g, Cheqian Zi (Plantago Seed) 6g, Sumi (Glutinous Rice) 15g, Zhuru (Bamboo Shavings) 6g, Shao Jijin (Roasted Chicken Gizzard Membrane) 2 pieces, Chao Zhiqiao (Stir-fried Aurantium Fruit) 6g.
Fourth Visit: After taking two doses of the above prescription, various symptoms gradually subsided, desire for food appeared, mental fatigue and weakness persisted. Pulse slippery and slow, tongue slightly yellow. Due to excessive vomiting and diarrhea, Middle Qi has not recovered. Prescribed a formula for strengthening transportation, regulating, and nourishing to achieve recovery. Prescription:
Baizhu (Atractylodes Macrocephala Rhizome) 12g, Fuling (Poria) 15g, Zhuling (Polyporus) 9g, Zexie (Alisma Rhizome) 6g, Chao BianDou (Stir-fried Lablab Bean) 15g, Sutiaoshen (Codonopsis Root) 15g, Cundong (Ophiopogon Tuber) 9g, Bo Kou (Cardamom) 6g (taken with water), Guang Chenpi (Aged Tangerine Peel) 6g, Gancao (Licorice Root) 3g, Chao Yumi (Stir-fried Corn) and Laomi (Old Rice) 12g each.
[Commentary]: Huoluan has posed a threat to the Chinese people since ancient times. Physicians through the ages have extensively recorded treatment experiences. Until the founding of New China, with improved medical and health conditions, this disease rarely epidemics.
The two cases in this book occurred in 1941, when there was a major epidemic of Huoluan in Kunming, with many deaths.
Both cases belong to Huoluan, but exhibit same disease with different symptoms, one Cold and one Hot. The former is Cold Huoluan due to major damage to Spleen-Yang and impending depletion of Primordial Qi, so Rescuing Yang and Reviving from Collapse method was used; the latter is Hot Huoluan due to Liver-Gallbladder Fire scorching and chaotic Qi mechanism, so Aromatic Transforming Turbidity method was used. Both cases achieved efficacy.
Chang Yong (Intestinal Abscess) with Hematochezia
Shi XX, Male, 63 years old, Resident of Kunming City. August 1962.
First Visit: Reported long-term preference for tobacco, alcohol, spicy, and rich foods. Hematochezia for over twenty years, intermittent. Recently, due to excessive drinking, hematochezia became severe, seven to eight times daily, either bleeding before defecation or entirely fresh blood without defecation, with dull pain in the lower abdomen. Dizziness, palpitations, sallow and slightly puffy complexion, spontaneous sweating, decreasing appetite. Restless sleep, many dreams, mental fatigue. Illness lasted over a month, various hemostatic agents used with no effect.
Pulse was fine, rapid, and Choppy (Kou); tongue body red, coating light yellow and greasy. *Jin Gui Yao Lue* states: "Blood passing below, blood first then stool, this is Near Blood, treated primarily with Chixiaodou Danggui San." This is due to long-term preference for tobacco, alcohol, and spicy foods, causing severe accumulation of Damp-Heat in the Intestines. Treatment should prioritize clearing and transforming Damp-Heat, invigorating Blood and stopping bleeding. Prescription:
Chixiaodou (Adzuki Bean) 18g (taken with water), Tu Chao Quanchuan Danggui (Earth-stir-fried Whole Sichuan Angelica Sinensis Root) 15g, Chao Chi Bai Shao (Stir-fried Red and White Peony Roots) 9g each, Zhe Beimu (Fritillaria Thunbergii Bulb) 9g (taken with water), Wu Baizhi (Angelica Dahurica) 9g, Gan Dihuang (Rehmannia Root) 15g, Jinyinhua Tan (Charred Honeysuckle Flower) 9g, Ou Jie Chao Tan (Charred Lotus Node) 9g, Fen Danpi (Moutan Cortex) 6g, Chao Diyutan (Charred Sanguisorba Root) 9g, Chao Huangqin Tan (Charred Scutellaria Root) 6g.
Second Visit: After taking three doses of the above prescription, hematochezia gradually decreased, dizziness, palpitations, and spontaneous sweating reduced.
However, five to six episodes of blood-first-then-stool still occur daily, occasional lower abdominal pain. Sleep relatively peaceful, appetite slightly increased, complexion still sallow. Yellow tongue coating thinned, pulse Choppy sign reduced but still deep and rapid. This is due to incomplete clearance of Damp-Heat, Blood not returning to its vessels. Continue with hemostasis, nourishing Yin, clearing and transforming Damp-Heat. Prescribed:
Dong Ejiao (Donkey-hide Gelatin) 15g (melted and taken in divided doses), Chao Yunlian (Stir-fried Coptis Rhizome) 3g, Chong Fan Dou (Rice-soaked Adzuki Bean) 15g, Danggui (Angelica Sinensis Root) 15g, Chao Chi Bai Shao (Stir-fried Red and White Peony Roots) 9g each, Huaihua (Sophora Flower) 6g, Chao Diyetan (Charred Sanguisorba Root) 9g, Chao Ku Qin (Charred Scutellaria Root) 6g, Fushen (Poria with Hostwood) 12g, Jinyinhua Tan (Charred Honeysuckle Flower) 15g, Gan Dihuang (Rehmannia Root) 15g.
Third Visit: After taking five consecutive doses of the above prescription, bowel movements two to three times daily, only occasional small amounts of fresh blood, lower abdominal pain gradually disappeared. Face sallow and thin, no longer puffy. Appetite increasing daily, able to sleep peacefully at night. Pulse deep and wiry, tongue pale with thin coating. Symptoms belong to excessive blood loss, Yin deficiency and Qi weakness, Liver-Spleen disharmony. Should nourish Yin, consolidate Qi, nourish Blood, and continue treatment. Prescription:
Dong Ejiao (Donkey-hide Gelatin) 15g (melted and taken in divided doses), Gan Dihuang (Rehmannia Root) 12g, Danggui (Angelica Sinensis Root) 15g, Chao Baishao (Stir-fried White Peony Root) 12g, Fushen (Poria with Hostwood) 15g, Sutiaoshen (Codonopsis Root) 9g, Chixiaodou (Adzuki Bean) 12g (taken with water), Chao Huaihua (Charred Sophora Flower) 6g, Chao Ku Qin (Charred Scutellaria Root) 4.5g, Sheng Gancao (Raw Licorice Root) 3g, Chao Yiren (Stir-fried Coix Seed) 12g, Guang Muxiang (Vladimiria Root) 1.5g.
Advised to quit tobacco, alcohol, and spicy foods.
[Commentary]: *Jin Gui Yao Lue* points out: "Stool first then blood is Far Blood," similar to gastric and duodenal ulcer bleeding. "Blood first then stool is Near Blood," referring to rectal and anal abscess ulceration bleeding. This patient developed "Near Blood" due to Damp-Heat stagnation. Treatment followed *Jin Gui*: flexibly modified Chixiaodou San to stop bleeding, invigorate Blood, and clear/transform Damp-Heat.
Later, nourished Yin, strengthened Spleen, regulated Liver, and replenished Qi and Blood. Li Shizhen stated: "Chixiaodou eliminates cold-heat abscesses, discharges pus and disperses Blood, resolves alcohol toxicity, treats swelling and distension, and benefits intestinal dysentery..." Indeed possesses certain efficacy. Additionally noteworthy is that the patient strictly followed medical advice, forcefully quitting tobacco, alcohol, and spicy/rich foods, eliminating the cause of disease, thus achieving complete cure.
Stomach Pain with Hematemesis
Zhong XX, Male, 43 years old, Cadre.
Late night of June 10, 1965, invited by a certain hospital for consultation. Patient suffered from stomach disease for over twenty years. Recently, due to strenuous labor, experienced stabbing pain in chest and stomach, massive hematemesis with dark red blood and black clots. Self-administered half a small bottle of "Yunnan Baiyao" before entering hospital for emergency care. Diagnosed with upper gastrointestinal bleeding. Various hemostatic measures failed, surgery planned, but patient requested TCM consultation. Symptoms included low voice and weak breathing, bright white complexion, spontaneous sweating, pulse deep, fine, and rough (Se); tongue pale, coating thin and white. Diagnosis: Excessive blood loss, major Qi and Yin deficiency, insufficient Spleen-Yang. If delayed further, fear Qi will follow Blood into collapse, making rescue difficult. First priority: Stop bleeding and consolidate/astringe. Prescribed:
Yunnan Sanqi Powder (Notoginseng Root Powder) 9g (mixed in divided doses), Ce Baiye Tan (Charred Biota Twig) 9g, Chen Zong Tan (Charred Palm Fiber) 9g, Chao Ai Tan (Charred Mugwort Leaf) 9g, Pao Jiang Tan (Charred Processed Ginger) 9g, Ou Jie Tan (Charred Lotus Node) 6g, Ejiao Zhu (Gelatin Pellet) 15g.
Each dose guided by a small wine glass of Tongbian (Child Urine).
Second Visit: After slowly taking the above prescription, massive hematemesis basically stopped by noon the next day, only small amounts of blood clots mixed with phlegm foam spat out, purple-black color. Patient mentally depressed, short of breath, reluctant to speak, no desire for food, pale face. Pulse at Guan position still deep, fine, and rough; Cun positions floating and Choppy; Chi position deep and minute; tongue still thin and white. Syndrome belongs to dual deficiency of Qi and Blood, Liver-Spleen disharmony, Heart-Spirit insufficiency. Treatment should tonify Qi and enrich Blood, nourish Liver and warm Spleen, assisted by resolving phlegm. Prescribed:
Jilin Hongshen (Jilin Red Ginseng) 9g (decocted separately and mixed), Tu Chao Baizhu (Earth-stir-fried Atractylodes Macrocephala Rhizome) 12g, Fushen (Poria with Hostwood) 18g, Dong Ejiao (Donkey-hide Gelatin) 18g (melted and taken in divided doses), Pao Jiang Tan (Charred Processed Ginger) 6g, Danggui (Angelica Sinensis Root) 12g, Chao Hangshao (Stir-fried White Peony Root) 9g, Ce Baiye Tan (Charred Biota Twig) 6g, Sanqi Powder (Notoginseng Root Powder) 4.5g (mixed in divided doses), Sheng Gancao (Raw Licorice Root) 3g (guided by Tongbian/Child Urine).
Third Visit: After taking two consecutive doses of the above prescription, hematemesis stopped, able to consume small amounts of liquid diet, spontaneous sweating ceased, able to sleep peacefully, stabbing pain in chest/stomach reduced. Complained of dizziness, mental fatigue, and weakness. Pulse became moderate and slower, stronger than before; tongue body pale red, coating gradually moist. Continue with original formula modifications:
Jilin Hongshen (Jilin Red Ginseng) 9g (change to Sutiaoshen/Codonopsis Root 15g after five doses), Chao Baizhu (Stir-fried Atractylodes Macrocephala Rhizome) 12g, Fushen (Poria with Hostwood) 15g, Sharen (Amomum Fruit) 6g (taken with water), Danggui (Angelica Sinensis Root) 15g, Chao Hangshao (Stir-fried White Peony Root) 9g, Guang Chenpi (Aged Tangerine Peel) 6g, Zhi Gancao (Honey-fried Licorice Root) 3g, Lianzi (Lotus Seed) 12g (heart removed), Longyanrou (Longan Aril) 9g, Pao Jiang (Processed Ginger) 4.5g, Dazao (Jujube) 3 pieces.
After taking more than ten doses of the above prescription, all symptoms disappeared, appetite increased, patient recovered and was discharged.
[Commentary]: This patient had chronic stomach disease, and due to strain injury, suffered continuous massive hematemesis, severely damaging Spleen and Stomach, with danger of Qi following Blood into collapse! Urgently needed to stop bleeding and consolidate. In hemostasis, Blood should be moved, not coagulated; thus, Sanqi (Notoginseng) is the main herb. Should regulate Qi mechanism, using a little Tongbian (Child Urine) as guide. As bleeding gradually stops, increase herbs for tonifying Qi, enriching Blood, nourishing Liver, and warming Spleen. Subsequently, calm Heart and Spirit, tonify Qi and Blood, strengthen Spleen and Stomach to conclude treatment.
Stomach Pain with Melena/Hematochezia
Chen XX, Male, 60 years old, Worker. May 1970.
First Visit: Patient suffered from stomach pain for thirty years, symptoms worsening over the past ten years. Often feels pain, distension, and fullness in chest/diaphragm and epigastrium, hiccups, acid regurgitation. Bowel movements once every two to three days, sometimes black-brown, or fresh blood after defecation. Gradually became extremely emaciated, face pale, sparse appetite, spontaneous sweating, aversion to cold, cold limbs, mental depression. Barium meal examination confirmed gastric and duodenal ulcer. Fecal occult blood test varied from (+) to (++++). Due to ineffective multiple treatments, specially admitted for hospitalization. Pulse deep, fine, and tight; tongue pale, coating thin and white, yellow and greasy in center. This long-standing illness involves Yang deficiency and Spleen weakness, internal stagnation of Cold-Damp, disharmony of Qi and Blood, damage to Stomach collaterals. Treatment principle: Warm and transport. Prescription:
Dangshen (Codonopsis Root) 15g, Tu Chao Baizhu (Earth-stir-fried Atractylodes Macrocephala Rhizome) 12g, Fuling (Poria) 12g, Fa Banxia (Prepared Pinellia Rhizome) 9g, Xi Sharen (Amomum Fruit) 9g, Shang Rougui (Cinnamon Bark) 6g (mixed and drunk), Bi Cheng Qie (Schisandra Fruit) 6g, Gong Dingxiang (Clove) 4.5g (taken with water), Gancao (Licorice Root) 3g, Ce Baiye Tan (Charred Biota Twig) 9g, Shao Jijin (Roasted Chicken Gizzard Membrane) 6g, Pao Jiang Tan (Charred Processed Ginger) 9g.
Second Visit: After taking three doses of the above prescription, distension and pain slightly reduced, but now presents with dry mouth and lips, dizziness, palpitations, shortness of breath, spontaneous sweating, restless sleep, constipation, stool color especially dark brown. Pulse deep, fine, tight, and rapid; tongue coating yellow, dry, and lacking fluids. This indicates slight resolution of Middle Jiao Cold-Damp, but the above prescription is too drying, showing signs of Yin deficiency with floating Heat. Changed to the following prescription:
Hong Renshen (Red Ginseng) 9g (mixed and drunk), Danggui (Angelica Sinensis Root) 15g, Chao Hangshao (Stir-fried White Peony Root) 9g, Tu Chao Baizhu (Earth-stir-fried Atractylodes Macrocephala Rhizome) 9g, Fushen (Poria with Hostwood) 15g, Haipiaoxiao (Cuttlefish Bone) 12g (calcined), Zhe Beimu (Fritillaria Thunbergii Bulb) 9g (taken with water), Xi Sharen (Amomum Fruit) 9g.