陈彦质患肠风下血。近三十年。体肥身健。零星去血。旋亦生长。不为害也。旧冬忽然下血数斗。盖谋
虑忧郁。过伤肝脾。肝主血。脾统血。血无主统。故出之暴耳。彼时即宜大补急固。延至春月。则木旺土衰。
脾气益加下溜矣。肝木之风。与肠风交煽。血尽而下尘水。水尽而去肠垢。垢尽而吸取胃中所纳之食。
下行。总不停留变化。直出如箭。以致肛门脱出三五寸。无气可收。每以热汤浴之。睁叫托入。顷之去
后。其肛复脱。一昼夜下痢二十余行。苦不可言。面色浮肿。夭然不泽。唇焦口干。鼻孔黑煤。种种不治。
所共睹矣。仆诊其脉。察其证。因为借箸筹之。得五可治焉。若果阴血脱尽。则目盲无所视。今双眸尚
炯。是所脱者下焦之阴。而上焦之阴犹存也。一也。若果阳气脱尽。当魄汗淋漓。目前无非鬼像。今汗出不过
偶有。而见鬼亦止二次。是所脱者脾中之阳。而他脏之阳犹存也。二也。胃中尚能容谷些少。未显呕吐哕逆之
证。则相连脏腑。未至交绝。三也。夜间虽艰于睡。然交睫时亦多。更不见有发热之候。四也。脉已
虚软无力。而激之间亦鼓指。是禀受原丰。不易摧朽。五也。但脾脏大伤。兼以失治旷日。其气去绝不远耳。
经云。阳气者如天之与日。失其所。则折寿而不彰。今阳气陷入阴中。大股热气。从肛门泄出。如火之烙。不
但失所已也。所以犹存一线生意者。以他脏中未易动摇。如辅车唇齿。相为倚藉。供其绝乏耳。夫他
脏何可恃也。生死大关。全于脾中之阳气。复与不复定之。阳气微复。则食饮微化。便泄微止。肛门微收。
阳气全复。则食饮全化。便泄全止。肛门全收矣。然阴阳两竭之余。偏驳之药。既不可用。所藉者必参术
之无陂。复气之中。即寓生血。始克有济。但人参力未易办。况才入胃中。即从肠出。不得不广服以继之。
此则存乎自裁耳。于是以人参汤调赤石脂末。服之稍安。次以人参白术赤石脂禹余粮为丸服之。全愈。其
后李萍槎先生之病。视此尚轻数倍。乃见石脂余粮之药。骇而不用。奈之何哉。
胡卣臣先生曰。似此死里求生。谁不乐从。其他拂情处。不无太直。然明道之与行术。则径庭矣。
陈彦质患有肠风下血之症，病程已近三十年。他身体肥胖健壮，虽然零星出血，但血液很快又能生成，并未造成严重危害。去年冬天突然大量便血，达数斗之多。这是由于谋虑忧郁过度，损伤了肝脾。肝主藏血，脾主统血，血液失去主宰和统摄，所以出血如此猛烈。当时本应立即大补元气、急固脱证，却拖延到春季，此时木气旺盛而土气衰弱，脾气更加下陷。肝木之风与肠风相互煽动，导致先下尽血液，继而排出尘水；尘水下尽后，又排出肠道污垢；污垢排尽后，胃中摄入的食物无法停留变化，直接下行，如箭般直出。以致肛门脱出三五寸长，因无气可收而回纳困难，每次只能用热汤清洗并用手托入，不久排便后肛门再次脱出。一昼夜腹泻二十多次，痛苦不堪。面色浮肿，枯槁无光泽，嘴唇焦裂口干，鼻孔周围呈黑煤色，种种迹象显示病情危重不治，众人皆目睹此状。
我诊察其脉象，观察其症状，于是借箸筹划分析，发现仍有五处可治的征象。如果阴血完全脱失，则双目失明无法视物，如今双眼依然明亮有神，说明所脱失的是下焦之阴，而上焦之阴尚存，这是第一点。如果阳气完全脱失，应当出现魄汗淋漓（冷汗不止），眼前全是鬼怪幻象，如今出汗只是偶尔发生，见鬼也只出现过两次，说明所脱失的是脾中之阳，而其他脏腑的阳气尚存，这是第二点。胃中尚能容纳少量食物，未显现呕吐呃逆的症状，说明相连的脏腑功能尚未完全断绝，这是第三点。夜间虽然难以入睡，但闭眼休息的时间较多，且未见发热症状，这是第四点。脉象虽虚软无力，但在重按激发之下仍能鼓指有力，说明先天禀赋原本丰厚，根基不易被摧毁，这是第五点。
但是，脾脏受到极大损伤，加上误治旷日持久，正气离去不远矣。《内经》说：“阳气就像天与太阳一样，若失去其正常位置，就会折损寿命而不显赫。”如今阳气陷入阴中，一股热气从肛门泄出，如火灼烧，这不仅是失去正常位置而已。之所以还存有一线生机，是因为其他脏腑尚未轻易动摇，如同辅车唇齿相依，互相倚仗以供给急需。然而其他脏腑怎能长久依赖呢？生死的重大关头，全在于脾中阳气能否恢复，取决于阳气是否回复。阳气微微恢复，则饮食微微消化，泄泻微微停止，肛门微微收回；阳气完全恢复，则饮食完全消化，泄泻完全停止，肛门完全收回。
然而，在阴阳两竭之后，偏颇的药物既不可用，所依赖的必须是人参、白术等纯正无偏之药，在补气之中即蕴含生血之功，才能见效。只是人参力量难以迅速奏效，况且刚进入胃中，随即从肠道排出，不得不广泛服用以接续其力。这就取决于患者自身的裁度了。于是用人参汤调服赤石脂粉末，服药后稍感安宁。随后用人参、白术、赤石脂、禹余粮制成丸药服用，最终痊愈。后来李萍槎先生的病情，比这还要轻数倍，但他见到赤石脂、禹余粮这类药物，惊恐而不敢使用，真是无可奈何啊。
胡卣臣先生说：“像这样死里求生，谁不乐意听从？其中令人拂逆心情的地方，确实有些太直率。然而，阐明道理与施行医术，则是截然不同的路径了。”
Mr. Chen Yanzhi suffered from intestinal wind with hematochezia (blood in stool) for nearly thirty years. He was obese and robust; although he bled intermittently, the blood regenerated quickly and caused no significant harm. Last winter, however, he suddenly experienced massive hemorrhage, losing several dou of blood. This was due to excessive worry and depression, which severely injured the Liver and Spleen. The Liver stores blood, and the Spleen controls blood; when blood loses its master and controller, it erupts violently. At that time, immediate vigorous tonification and urgent consolidation were indicated, but treatment was delayed until spring. In spring, Wood qi becomes prosperous while Earth qi declines, causing the Spleen Qi to sink further. The Wind of Liver Wood and Intestinal Wind fanned each other, leading to the exhaustion of blood followed by the discharge of dust-like water; after the dust-water was exhausted, intestinal filth was discharged; once the filth was gone, food ingested by the Stomach failed to stay or transform, descending directly like an arrow. Consequently, the anus prolapsed three to five cun, unable to retract due to lack of Qi. It had to be washed with hot water and manually pushed back each time, only to prolapse again after defecation. He suffered more than twenty episodes of diarrhea per day, unbearable in pain. His face was swollen, his complexion withered and lusterless, lips cracked and dry, and coal-black discoloration around the nostrils. These signs indicated a critical and incurable condition, witnessed by all.
Upon examining his pulse and symptoms, I planned my strategy and identified five indications that the case was still treatable. If Yin Blood were completely depleted, the eyes would go blind; yet his eyes remain bright, indicating that while Lower Jiao Yin is lost, Upper Jiao Yin remains. This is the first point. If Yang Qi were completely depleted, there would be profuse cold sweating (Po Han) and visual hallucinations of ghosts; yet sweating occurs only occasionally, and hallucinations appeared only twice, indicating that while Spleen Yang is lost, Yang Qi of other organs remains. This is the second point. The Stomach can still hold a small amount of food, without vomiting or hiccups, suggesting that connected organs have not yet completely severed their connection. This is the third point. Although sleep is difficult at night, he closes his eyes frequently, and there is no fever. This is the fourth point. The pulse is weak and soft, but responds firmly upon stimulation, indicating strong congenital endowment that is not easily destroyed. This is the fifth point.
However, the Spleen organ is severely damaged, and due to prolonged mismanagement, vital Qi is nearing extinction. The Classic states: "Yang Qi is like Heaven and the Sun; if it loses its proper position, life is shortened and brilliance is obscured." Now, Yang Qi has sunk into Yin, and a large surge of heat escapes from the anus, burning like fire. This is not merely a loss of position. The reason a thread of vitality remains is that other organs are not easily shaken, relying on each other like cheekbones and teeth to supply necessities. Yet, how can one rely on other organs? The critical juncture of life and death depends entirely on whether the Yang Qi of the Spleen recovers. If Yang Qi slightly recovers, food and drink digest slightly, diarrhea stops slightly, and the anus retracts slightly. If Yang Qi fully recovers, digestion, cessation of diarrhea, and retraction of the anus will be complete.
Nevertheless, after the depletion of both Yin and Yang, biased medicines cannot be used. One must rely on pure and unadulterated Ginseng and Atractylodes Macrocephala Rhizome (Baizhu), where Qi tonification inherently generates Blood. Only then can success be achieved. However, the power of Ren Shen (Ginseng Root) is hard to mobilize quickly, and since it enters the Stomach only to exit through the Intestines immediately, it must be taken in large quantities continuously. This depends on the patient's own discretion. Thus, I administered Red Halloysite (Chishizhi) powder mixed with Ren Shen Decoction, after which he felt somewhat relieved. Subsequently, pills made of Ren Shen, Baizhu, Chishizhi, and Yuyuliang (Yuzhuyu Liangshi) were given, resulting in full recovery. Later, Mr. Li Pingcha's illness was several times milder than this case, yet he was terrified by the use of Chishizhi and Yuyuliang and refused them. What could be done?
Mr. Hu Youchen said: "In such a case of seeking life from death, who would not willingly comply? Other aspects may seem too blunt, causing discomfort. However, elucidating principles and practicing medicine are two different paths."