痛。或胸膈痛。或嗳气。夜食难化。或手靠物。久则麻木。常畏寒。不怕热。前有 疝。后有内
痔。遇劳即发。初诊。左脉沉弱而缓。右脉浮软无力。续后三五日一诊。或时心肺二部浮虚。按
不应指。或时脾脉轻按格指。重按不足。又时或数或缓。或浮或沉。或大或小。变动无常。夫脉
无常。血气虚而随火用事也。譬之虚伪之人。朝更夕改。全无定准。以脉参证。其虚无疑。盖劳
则气耗而伤肺。肺伤则声哑。又劳则伤脾。脾伤则食易积。前疝后痔。遇劳则发者。皆因劳耗其
气。气虚下陷。不能升降故也。且脾喜温恶寒。而肺亦恶寒。故曰。形寒饮冷则伤肺。以既伤之
脾肺。复伤于药之寒凉。则声安得不哑。舌安得不苔。苔者。仲景谓之胃中有寒。丹田有热也。
夜不寐者。由子盗母气。心虚而神不安也。痰中血丝者。由脾伤不能固血也。
胸痛嗳气者。气虚不能健运。食郁于中而嗳气。或滞于上则胸痛。遂以参、 各四钱。麦冬、当
归、贝母各一钱。远志、枣仁、丹皮、茯神各八分。菖蒲、甘草各五分。有食则加山楂、麦芽。
随病出入。服年余而渐愈。此病属于燥热。故白术尚不敢用。况他燥剂乎。
又诊一人。年二十余。形瘦色脆。病咳血。医用滋阴降火清燥之药。延及三年不减。又一医
用参苏饮去人参。服之病益剧。延汪诊之。脉虽五至而细。其证皆逆不可治也。或曰。五至平和
之脉。何不可治。汪曰。五脏已衰。六腑已竭。九候虽调。犹死也。视其形证。皆属死候。经曰。
肉脱热甚死。嗽而下泄上喘者死。嗽而左不得眠肝胀。右不得眠肺胀。俱为死证。今皆犯之。虽
能饮食。不为肌肤。去死近矣。越五日果死。凡患虚劳。犯前数证。又或嗽而声哑。喉痛不能药
食。或嗽而肛门发 者。皆在不救。医者不可不知。
喻嘉言治一人。素有失血病。晨起陡暴一口。倾血一盆。喉间气壅。神思飘荡。壮热如蒸。
颈筋粗劲。诊其脉尺中甚乱。曰。此昨晚大犯房劳也。因出验血色。如太阳之红。再至寝所谓曰。
少阴之脉系舌本。少阴者肾也。今肾家之血。汹涌而出。舌本已硬。无法可以救急。不得已用丸
药一服。镇安元气。若得气转丹田。尚可缓图。因浓煎人参汤下黑锡丹三十粒。喉间 有声。
渐入少腹。顷之舌柔能言。但声不出。急用润下之剂以继前药。遂与阿胶一两溶化。分三次热服。
半日服尽。身热渐退。颈筋渐消。进粥。与补肾药。多加秋石。服之遂愈。
石顽治刑部汤元洲。年八十二。而痰中见血。服诸宁嗽止血药不应。脉得气口芤大。两尺微
紧。面色槁白。屡咳痰不得出。咳甚方有黄色结痰。此精气神三者并亏。兼伤于热。耗其津液。
而咳动肺胃之血也。因其平时多火。不受
温补。遂以六味丸合生脉散加葳蕤。煎膏服之。取金水相生。源流俱泽。而咳血自除。不必用痰
血药也。
又治钱曙昭。久咳吐血。四五日不止。不时哄热面赤。或时成盆成碗。或时吐粉红色痰。至
夜则发热自汗。一夕吐出一团。与鱼肠无异。杂于鲜血之中。薄暮骤涌不已。神气昏昏欲脱。灌
童子小便亦不止。同道相商无策。因思瘀结之物既去。正宜峻补之时。遂猛进独参汤。稍定。缘
脉数疾无力。略加肉桂、炮姜、童便少许。因势利导。以敛虚阳之逆。一夜中尽参二两。明晨其
势稍定。血亦不来。而糜粥渐进。脉息渐和。改用六味丸作汤。调补真阴。半月而安。同时有胡
又曾。亦患虚劳吐血。一夕吐出如守宫状者一条。头足宛然。色如樱桃。不崇朝而毙。
陆晦庵曰。昔余患吐血。暴涌如潮。七八日不已。吾吴诸名家。莫能救止。有云间沈四雅寓
吴中。延请调治。慨然担当。求其定方。用人参三两。附子一两。肉桂一钱。举家惶惑。未敢轻
用。越二日。其血益甚。更请诊视。求其改用稍缓之方。彼云。病势较前更剧。前方正欲改定。
始克有济。更加人参至五两。附子至二两。亲戚见之愈惊。彼曰。喘呕脱血。数日不止。且头面
哄热。下体厥冷。正阳欲脱亡之兆。命在呼吸。若今日不进。来日不可为矣。子侄辈恳其稍裁参、
附。彼坚持不允。力谕放胆煎服。仆当坐候成功。亲友见予势急。且见其肯坐候进药。料可无虞。
遂根据方求服。彼欣出熟附二十余块授咀。面称二两。同人参五两。煎成入童便、地黄汁一大碗。
调肉桂末冷服。服后少顷。下体至足微汗。便得熟睡。睡觉血止喘定。周身柔和。渐可转侧。因
馈十二金。求其收功。不受。加至二十金始受。愈后。盛见垣先生见其一剂而效。心甚疑骇。询
其居常无病时。恒服人参两许无间。今虽五两峻补。止煎数沸。其味未尽。犹可当之。至于血证。
用附子二两。从古未闻。因密贻其制药者。云惯用附子汁收入甘草。其附已经煎过十余次。虽
用二两。不抵未煎者二三钱。始知方士之术如此。
飞畴治苏天若乃郎宾旭。新婚后。于五月中暴吐血数升。昏夜邀视。汤药不及。命煎人参五
钱。入童便与服。明晨诸医咸集。以为人参补截瘀血。难以轻用。议进生地、山栀、牛膝等味。
予曰。六脉虚微而数。无瘀可知。血脱益气。先圣成法。若谓人参补瘀。独不思血得寒则凝。反
无后患耶。今神魂莫主。转侧昏晕。非峻用人参。何以固其元气之脱乎。遂进参一两。二服顿安。
次与四君、保元、六味等间服。后以乌骨鸡丸调理而痊。
（吐血）疼痛。或者胸膈部疼痛。或者嗳气。夜间食物难以消化。或者喜欢用手支撑身体，时间久了肢体麻木。常常怕冷，不怕热。以前有疝气，后有内痔，劳累就会发作。初诊时，左脉沉弱而缓，右脉浮软无力。随后每隔三五日诊察一次。有时心肺两部脉象浮虚，重按没有感觉。有时脾脉轻按时感觉格拒手指，重按时又觉得不足。有时脉数有时脉缓，有时脉浮有时脉沉，有时脉大有时脉小，变化无常。脉象无常，是因为血气虚弱而随火邪妄动。就像虚伪的人一样，早晚改变，完全没有定准。以脉象参合证候，其虚损无疑。因为劳累则耗气而伤肺，肺受伤则声音嘶哑。又因为劳累则伤脾，脾受伤则食物容易积滞。前面的疝气和后面的痔疮，一遇劳累就发作，都是因为劳累耗伤了气，气虚下陷，不能正常升降的缘故。况且脾喜欢温暖而厌恶寒冷，肺也厌恶寒冷，所以说形体受寒、饮食生冷就会伤肺。对于已经受伤的脾肺，如果再受到寒凉药物的伤害，声音怎么能不嘶哑？舌苔怎么能不出现？舌苔，张仲景称之为胃中有寒，丹田有热。夜里睡不着觉，是因为子盗母气，心气虚弱而神志不安。痰中带血丝，是因为脾受伤不能固摄血液。
胸痛嗳气，是因为气虚不能健运，食物郁结在中焦导致嗳气；如果停滞在上焦就会导致胸痛。于是用党参、白术各四钱，麦冬、当归、贝母各一钱，远志、枣仁、丹皮、茯神各八分，石菖蒲、甘草各五分。如果有食积则加山楂、麦芽。根据病情加减。服药一年多后逐渐痊愈。这个病属于燥热，所以白术尚且不敢使用，何况其他燥性药物呢？
又诊治一个人，二十多岁，形体消瘦，面色脆弱，患咳血病。医生用滋阴降火清燥的药物，拖延了三年病情没有减轻。另一位医生用人参汤去人参服用，病情更加严重。请汪机诊治。脉象虽然五至但细弱，证候都是逆证，不可治疗。有人说，五至是平和的脉象，为什么不可治？汪机说，五脏已经衰败，六腑已经枯竭，九候虽然调和，也是死证。看他的形证，都属于死候。经书说：肌肉脱失且发热严重的会死，咳嗽并伴有下泄和上喘的会死，咳嗽且左侧卧不得安睡导致肝胀，右侧卧不得安睡导致肺胀，都属死证。现在这些都犯了，虽然还能饮食，但不能长养肌肤，离死不远了。过了五天果然死了。凡是患虚劳病，犯了前面几种证候，或者咳嗽且声音嘶哑，喉咙痛不能吃药进食，或者咳嗽且肛门出血的，都在不可救治之列。医者不可不知道。
喻嘉言治疗一个人，平素有失血病。早晨起床突然猛烈吐出一口，倾泻出一盆血，喉间气机壅塞，神思飘荡，壮热如蒸笼，颈筋粗硬强劲。诊其脉尺中非常紊乱，说：“这是昨晚大犯房事劳损所致。”于是查看血色，像太阳之红。再次到卧室询问说：“少阴经脉系于舌本，少阴就是肾。现在肾家的血汹涌而出，舌根已经僵硬，无法急救。不得已用丸药一服，镇安元气。如果能让气转回丹田，还可以慢慢图谋救治。”于是浓煎人参汤送服黑锡丹三十粒。喉间发出声响，药渐入少腹。一会儿舌头变软能说话，只是发不出声音。急忙用润下的药剂接续前药。于是给阿胶一两溶化，分三次热服。半天服完，身热逐渐退去，颈筋逐渐消退，开始喝粥，给予补肾药，多加秋石，服用后痊愈。
石顽治疗刑部官员汤元洲，八十二岁，痰中带血，服用各种宁嗽止血药无效。脉得气口芤大，两尺微紧，面色枯白，多次咳嗽痰出不来，咳得很厉害才有黄色结块痰。这是精气神三者并亏，兼受热邪，耗伤津液，从而咳动肺胃之血。因为他平时多火，不耐受温补。于是用六味地黄丸合生脉散加葳蕤，煎膏服用。取金水相生之意，源流俱泽，咳血自然消除，不必用化痰止血药。
又治疗钱曙昭，久咳吐血，四五天不止，不时烘热面赤，有时成盆成碗地吐，有时吐出粉红色痰，到了夜里就发热自汗。一晚吐出一团东西，与鱼肠无异，混杂在鲜血之中。傍晚突然涌出不停，神气昏昏欲脱。灌童子小便也不能止住。同道商量无计可施。我想瘀结之物既然已去，正宜峻补的时候。于是猛进独参汤，稍定。因为脉数疾无力，略加肉桂、炮姜、少许童便。因势利导，以收敛虚阳之逆。一夜中吃完人参二两，第二天早晨病情稍定，血也不来了，糜粥逐渐进服，脉息逐渐平和。改用六味地黄丸作汤剂，调补真阴，半个月而安定。同时有胡又曾，也患虚劳吐血。一晚吐出一条像守宫（壁虎）状的东西，头足宛然，色如樱桃，不到半天就死了。
陆晦庵说：“过去我患吐血，暴涌如潮，七八天不停。我们吴地的各位名医，都不能救止。有位云间的沈四雅住在吴中，邀请他调治，他慨然担当。求他定方，用人参三两，附子一两，肉桂一钱。全家惶恐疑惑，不敢轻易使用。过了两天，出血更严重，再请他诊视，求他改用稍缓和的方子。他说：‘病势比以前更剧烈，前方正要改定，才能见效。’再加人参至五两，附子至二两。亲戚见了更加惊恐。他说：‘喘呕脱血，几天不停，而且头面烘热，下肢厥冷，这是真阳即将脱亡的征兆，命在呼吸之间。如果今天不进药，明天就来不及了。’子侄辈恳求他稍微削减人参、附子的用量，他坚持不允，极力劝告放胆煎服。我当坐着等候成功。亲友见我形势危急，且见他肯坐候进药，料想可以无忧。于是依方求服。他高兴地拿出熟附子二十多块切碎，当面称二两，与人参五两一起煎成，加入童便、地黄汁一大碗，调入肉桂末冷服。服后不久，下肢至足部微微出汗，随即熟睡。醒来后血止喘定，周身柔和，渐渐可以转动侧身。因此赠送十二金，求他收功，他不接受。加到二十金才接受。痊愈后，盛见垣先生见他一剂而效，心里非常怀疑惊骇，询问他平时没病时常服人参一两左右不间断。现在虽然用五两峻补，只煎几沸，味道未尽，还可以抵挡。至于血证，用附子二两，从古未闻。于是秘密送给制药者，说是惯用附子汁收入甘草中。他的附子已经煎过十几次，虽然用二两，抵不上未煎者的二三钱。才知道方士的技术如此。”
飞畴治疗苏天若的儿子宾旭。新婚后，在五月中突然吐血数升。深夜邀请诊视，汤药来不及准备，命令煎人参五钱，加入童便服用。第二天早晨各位医生都聚集在一起，认为人参补益会截留瘀血，难以轻用。议论进生地、山栀、牛膝等药。我说：“六脉虚微而数，可知无瘀。血脱益气，是先圣的成法。如果说人参补瘀，难道不想想血得寒则凝，反而会有后患吗？现在神魂无主，转侧昏晕，不用峻用人参，凭什么固护元气之脱呢？”于是进服人参一两，两服后顿时安宁。接着用四君子汤、保元汤、六味地黄丸等交替服用。后来用乌骨鸡丸调理而痊愈。
(Pain) Pain. Or pain in the chest and diaphragm. Or belching. Food is difficult to digest at night. Or leaning on objects with hands, leading to numbness after a long time. Often afraid of cold, not afraid of heat. Previously had hernia (Shan), posteriorly has internal hemorrhoids (Nei Zhi), which flare up upon exertion. Initial diagnosis: Left pulse is deep, weak, and slow; Right pulse is floating, soft, and powerless. Subsequent diagnoses every three to five days. Sometimes the Heart and Lung areas show floating and deficient pulses, which do not respond to pressure. Sometimes the Spleen pulse feels resistant to light pressure but insufficient upon heavy pressure. Sometimes rapid or slow, floating or deep, large or small, changing unpredictably. The pulse is unpredictable because Qi and Blood are deficient and follow the Fire pathogenic factor. It is like a hypocritical person who changes morning and evening without any consistency. Comparing the pulse with the syndrome, the deficiency is undeniable. Exertion consumes Qi and injures the Lung; Lung injury leads to hoarseness. Exertion also injures the Spleen; Spleen injury leads to food accumulation. The anterior hernia and posterior hemorrhoids that flare up upon exertion are all due to Qi consumption from exertion, Qi deficiency sinking downward, and failure of ascending and descending functions. Moreover, the Spleen likes warmth and dislikes cold, and the Lung also dislikes cold. Thus it is said: "Cold affecting the body and cold drinks injure the Lung." For the already injured Spleen and Lung, if further injured by cold-natured medicines, how can the voice not be hoarse? How can the tongue coating not appear? Tongue coating, Zhang Zhongjing called it Cold in the Stomach and Heat in the Dantian. Insomnia at night is due to the Son stealing Qi from the Mother, Heart Qi deficiency, and restless Shen. Blood streaks in phlegm are due to Spleen injury failing to secure Blood.
Chest pain and belching are due to Qi deficiency failing to promote transportation, causing food stagnation in the Middle Jiao leading to belching; or stagnation in the Upper Jiao leading to chest pain. Therefore, use Dangshen (Codonopsis Root) and Baizhu (Atractylodes Macrocephala Rhizome) 4 qian each, Maidong (Ophiopogon Tuber), Danggui (Angelica Sinensis Radix), and Zhebei Mu (Fritillaria Thunbergii Bulb) 1 qian each, Yuanzhi (Polygala Root), Zaoren (Ziziphus Seed), Danpi (Moutan Cortex), and Fushen (Poria with Hostwood) 8 fen each, Shichangpu (Acorus Tatarinowii Rhizome) and Gancao (Licorice Root) 5 fen each. If there is food stagnation, add Shanzha (Hawthorn Fruit) and Maiya (Hordeum Germinatum). Adjust according to the disease. Taken for over a year, gradually recovered. This disease belongs to Dryness-Heat, so Baizhu is not even dared to be used, let alone other drying agents.
Another case: A patient, over twenty years old, thin and frail complexion, suffering from hemoptysis. Doctors used Yin-nourishing, Fire-descending, and Dryness-clearing medicines, delaying for three years without improvement. Another doctor used Renshen Su Yin (Ginseng and Perilla Decoction) minus Renshen, and the condition worsened. Wang Ji diagnosed. Pulse was five beats per breath but fine. All syndromes were adverse and untreatable. Someone asked: "Five beats is a balanced pulse, why untreatable?" Wang said: "The Five Zang organs are exhausted, the Six Fu organs are depleted. Even if the Nine Pulses are harmonious, it is death." Looking at his form and syndrome, all belong to death omens. The Classics say: "Muscle depletion with severe heat leads to death. Cough with diarrhea and upper panting leads to death. Cough with inability to sleep on the left causing Liver distension, or inability to sleep on the right causing Lung distension, are all death syndromes." Now he violates all of them. Although he can eat, it does not nourish flesh and skin; he is close to death. Five days later, he indeed died. Anyone suffering from Consumption (Xu Lao) who violates the aforementioned syndromes, or coughs with hoarseness, throat pain preventing medicine/food intake, or coughs with anal bleeding, are all beyond rescue. Physicians must know this.
Yu Jiayan treated a person who habitually suffered from blood loss. One morning, suddenly vomiting violently, pouring out a basin of blood. Qi congested in the throat, spirit wandering, high fever as if steaming, neck tendons thick and stiff. Diagnosing the pulse, the Chi position was very chaotic. He said: "This is due to excessive sexual exertion last night." He examined the blood color, red like the sun. Returning to the bedroom, he said: "The Shaoyin meridian connects to the root of the tongue. Shaoyin is the Kidney. Now the Kidney's blood is gushing out, the tongue root is already stiff. No method can save this emergency. Reluctantly, I will use one dose of pill medicine to stabilize Yuan Qi. If Qi can return to the Dantian, we can plan slowly." So, decocted Renshen (Ginseng Root) soup strongly to swallow thirty pills of Heixi Dan (Black Tin Pill). Sound emerged from the throat, medicine gradually entered the lower abdomen. Soon the tongue became soft and able to speak, but no voice. Urgently used a moistening purgative agent to follow the previous medicine. Then gave Ejiao (Donkey-hide Gelatin) 1 liang dissolved, taken hot in three doses. Finished in half a day. Body heat gradually receded, neck tendons subsided. Started eating congee, given Kidney-tonifying medicine, adding Qushi (Mineral Salt), and recovered.
Shi Wan treated Tang Yuanzhou, a Ministry of Justice official, aged 82, with blood in phlegm. Various calming cough and stopping blood medicines were ineffective. Pulse at the Qi Kou position was hollow and large, both Chi positions slightly tight. Complexion withered and white. Repeated coughing could not expel phlegm; only when coughing severely did yellow clumped phlegm appear. This is simultaneous deficiency of Essence, Qi, and Spirit, combined with Heat injury consuming Jin Ye (Body Fluids), thus moving Lung and Stomach blood during coughing. Because he usually has much Fire and cannot tolerate warm tonification, Shi Wan used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) combined with Shengmai San (Generate the Pulse Powder) plus Weirui (Polygonatum Odoratum Rhizome), decocted into a paste. Taking advantage of Metal generating Water, nourishing source and flow, the hemoptysis naturally cleared. There was no need to use phlegm-blood medicines.
He also treated Qian Shuzhao, who suffered from chronic cough and hemoptysis for four or five days continuously. Occasional flushing and red face, sometimes vomiting basins or bowls full, sometimes pink phlegm. At night, fever and spontaneous sweating. One night, vomited a mass resembling fish intestines, mixed with fresh blood. Late afternoon, sudden continuous gushing, spirit dim and about to collapse.灌 Tongzi Xiaobian (Child's Urine) did not stop it. Colleagues consulted without strategy. Thinking that since the stagnant material had been expelled, it was time for strong tonification, Shi Wan urgently advanced Dushen Tang (Single Ginseng Decoction). Condition stabilized slightly. Because the pulse was rapid, frantic, and powerless, he added Rougui (Cinnamon Bark), Pa Jiang (Prepared Ginger), and a little Tongzi Xiaobian. Guiding the momentum to converge the rebellious Deficient Yang. Consumed two liang of Renshen in one night. Next morning, condition slightly stabilized, bleeding stopped, congee gradually ingested, pulse and respiration harmonized. Changed to Liuwei Dihuang Wan decocted as soup to tonify True Yin. Settled in half a month. Meanwhile, Hu Youzeng also suffered from Consumption and hemoptysis. One night, vomited a strip resembling a gecko, head and feet distinct, color like cherry. Died within half a day.
Lu Hui'an said: "In the past, I suffered from hemoptysis, gushing violently like a tide, lasting seven or eight days. Famous doctors in Wu could not stop it. Shen Siya from Yunjian, residing in Wu, was invited to treat me. He generously took responsibility. Asking for his prescription: Renshen 3 liang, Fuzi (Aconite Lateralis Radix Preparata) 1 liang, Rougui 1 qian. The whole family was panicked and confused, daring not use it lightly. Two days later, bleeding increased. Re-invited him. Asked to change to a milder formula. He said: 'The disease is more severe than before. The previous formula is exactly what needs adjustment to have effect.' Increased Renshen to 5 liang, Fuzi to 2 liang. Relatives were even more shocked. He said: 'Panting, vomiting, blood loss, continuing for days. Plus facial flushing and cold lower limbs. This is a sign of impending True Yang collapse. Life hangs by a breath. If medicine is not taken today, tomorrow it will be too late.' Nephews begged to reduce Renshen and Fuzi. He insisted firmly, urging bold administration. I sat waiting for success. Relatives saw my critical state and his willingness to wait, assuming safety. So we followed the prescription. He happily provided over twenty pieces of prepared Fuzi, chopped, weighing 2 liang as stated, with 5 liang Renshen. Decocted, added a large bowl of Tongzi Xiaobian and Dihuang juice, mixed with Rougui powder, taken cold. Shortly after taking, slight sweat appeared from lower limbs to feet, then fell into deep sleep. Upon waking, bleeding stopped, panting settled, body relaxed, gradually able to turn. Gave 12 taels of silver to conclude treatment, refused. Increased to 20 taels, then accepted. After recovery, Mr. Sheng Jianyuan saw the efficacy of one dose, deeply suspicious and amazed. Inquired that normally, when healthy, he constantly took about 1 liang of Renshen daily without interruption. Although now using 5 liang for strong tonification, boiled only briefly, the flavor not fully extracted, it could still suffice. As for blood syndromes, using 2 liang of Fuzi was unheard of since ancient times. Secretly sent to the medicine maker, who said he was accustomed to collecting Fuzi juice into Gancao. His Fuzi had been decocted over ten times. Although 2 liang was used, it was equivalent to only 2-3 qian of un-decocted Fuzi. Only then did I realize the techniques of physicians are such."
Feichou treated Xu Binxu, son of Su Tianruo. After new marriage, in mid-May, suddenly vomiting several sheng of blood. Invited at night, decoction not ready. Ordered decoction of Renshen 5 qian, mixed with Tongzi Xiaobian and administered. Next morning, all doctors gathered, believing Renshen tonifies and traps blood stasis, difficult to use lightly. Discussed using Shengdi (Rehmannia Root), Shanzhi (Gardenia Fruit), Niuxi (Achyranthes Root), etc. I said: "Six pulses are deficient, minute, and rapid. No stasis is known. Blood loss requires Qi tonification, a sage's established method. If you say Renshen tonifies stasis, do you not consider that Blood coagulates with Cold, causing future trouble? Now the spirit has no master, turning causes fainting. Without strong Renshen, how to secure the collapsing Yuan Qi?" So administered 1 liang of Renshen. After two doses, instantly peaceful. Then alternated Sizijun Zi Tang (Four Gentlemen Decoction), Baoyuan Tang (Preserve Origin Decoction), and Liuwei Dihuang Wan. Later regulated with Wuguji Wan (Black Bone Chicken Pill) and recovered.