叶 血止咳不已，脉沉带数，其根犹未去也。盖气犹风也，血犹水也，咳则气逆不顺，血亦逆而不顺矣。经
络不和，血不宁静，必降其气而后血不复升，亦必充其阴而后火乃退耳。
大生地 紫菀 丹皮 川贝 赤苓 元精石 甜杏仁 沙参 赤芍 枇杷叶
渊按∶此喻妙极，从《内经》天暑地热悟会得来。
尤 血止干咳，阴虚也。急以生津救肺。
沙参 丹皮 麦冬 茯神 五味子 桑白皮 蛤壳 川贝 鲜藕 甜杏仁
侯 脉数血涌，胃气大虚。胸中痞塞，大便带溏，是痞为虚痞，数为虚数。咳血三月，今忽冲溢，唇白
面青，断非实火。大凡实火吐血，宜清宜降；虚火吐血，宜补宜和。古人谓见痰休治
痰，见血休治血，血久不止，宜胃药收功。今援引此例。
人参（一钱） 白扁豆（一两） 川贝（三钱） 茯苓（三钱） 藕汁（一杯，冲） 好墨汁（三匙，冲）
又 脉数退，血少止，而反恶寒汗出。盖血脱则气无所根据，气属阳，主外，卫虚则不固也。最怕喘呃暴
脱。犹幸胸痞已宽，稍能容纳。仿血脱益气例。经曰阳生阴长，是之谓耳。
人参 炒扁豆 五味子 炙甘草 炮姜炭 怀山药 藕汁
又 血脱益气，前贤成法。今血虽大止，而神气益惫，唇白面青，怕其虚脱。欲牢根底，更进一层。
人参 炮姜 陈皮 大熟地（砂仁拌炒） 麦冬 冬术 炒扁豆 五味子 附子（秋石汤制）
灶心黄土煎汤代水
又 肝肾之气从下泛上，青黑之色见于面部。阴阳离散，交子丑时防脱。勉拟镇摄，希冀万一。
人参 大熟地 紫石英 五味子 麦冬 肉桂 茯苓 青铅 坎
又 血止三日，痰吐如污泥且臭，是胃气大伤，肺气败坏而成肺痿。痿者，萎也。如草木萎而不振，终
属劳损沉 。《外台》引用炙甘草汤，取其益气生津，以救肺之枯萎。后人用其方，恒
去姜、桂之辛热，此症面青不渴，正宜温以扶阳。但大便溏薄，
除去麻仁可耳。
人参 炙甘草 麦冬 阿胶 大生地 炮姜 五味子 肉桂 紫石英
又 病势仍然，从前方加减。
前方去炮姜，加制洋参。
又 连进炙甘草汤，病情大有起色。但咳呛则汗出，肺气耗散矣。散者收之，不宜再兼辛热，当参收敛之品。
人参 大熟地（沉香末拌炒） 炙甘草 阿胶 五味子 黄 粟壳 大枣
渊按∶如此险证，一丝不乱。景岳所谓非常之病，非非常之医不能治。
某 久咳失血，精气互伤。连进滋补，颇获小效。但血去过多，骤难充复。从来血症肺肾两虚者，宜冬不
宜夏。盖酷暑炎蒸，有水涸金销之虑。今交仲夏，宜日饵生津益气，大滋金水之虚，
兼扶胃土，则金有所恃。且精气注成于水谷，久病以胃气为要也。
制洋参 大熟地 麦冬 黄 怀山药 大生地 五味子 茯苓 陈皮 炙甘草 白扁豆 党参
又 血止，胃稍醒，仍守前法。
前方加粟壳蜜炙。另用白芨一味为丸，每朝服三钱。
朱 中气素虚，兼患痰饮，冬必咳嗽。近劳碌感寒，忽气升吐血，微寒发热，汗则心嘈。其血必三日一
来，寒热亦三日一作。盖热邪内炽，逼血上行，病在三阴之枢，恐其下厥上竭，冲溢喘脱。
麻黄 西洋参 白芍 麦冬 五味子 归身 炙甘草 黄 川贝 荆芥炭 茅根 藕汁
渊按∶汗出心嘈，营阴虚矣。麻黄总属不宜。
邢 先天不足之体，曾发虚痰，溃而将敛。交春阳气升发，渐觉喉痒，咳嗽，二三日来，忽然吐血。
今又大吐血，色鲜红。诊脉细促，心嘈若饥。一团虚火，炎炎莫御。用药虽已清降，亦
当预顾真阴。否则恐血脱阴伤而晕。
生地 沙参 丹皮炭 茜草炭 小蓟炭 阿胶 麦冬 五味子 朱茯神 京墨汁（三匙） 童便（一杯，冲）
又 照前方加川贝、茅根。
又 节届春分，阳气勃勃升动。血证际此，稍平复盛。良以身中之肝阳，应天时之阳气上升无制，故又
忽然大吐。急当休养其阴，兼以清降。所恐火愈降而阴愈伤耳。
羚羊角 元参 鲜生地 丹皮 大生地 茯神 麦冬 阿胶 茜草炭 石决明 侧柏叶汁 茅根 藕汁
渊按∶降火滋阴，亦不得不然之势。
张 阴虚内热，咳嗽痰红，脉数无神，渐延劳损。
沙参 白芍 川贝 丹皮 白扁豆 麦冬 甜杏仁 茯神 丹参 茜草炭 百合（一两，煎汤代水）
吴 血色紫而有块，此属肝火乘胃，瘀凝上泛也。仿缪仲醇法。
阿胶（蒲黄炒） 丹皮 白芍 苏子 鲜石斛 降香 大黄（醋炒成炭） 藕汁 黑山栀 白扁豆 枇杷叶
程 咳嗽而至于失血音哑，津液枯槁，劳损成矣。脉形细弱，精气内亏。《内经》于针药所莫治
者，调以甘药。《金匮》遵之而立黄 建中汤，急建其中气，俾饮食增，津气旺，阳生阴
长，而复其真阴之虚，盖舍此别无良法也。今仿其意而损益之。
黄 （秋石三分，化水拌，炙焦） 茯神 白芍 麦冬 川贝 生甘草 炙甘草 玉竹 沙参 橘饼
顾 酒客湿热熏蒸，肺受火刑而失清肃之令。咳嗽音哑，吐血痰红，喉痹干燥，是皆肺火见证，尚非全属
阴虚。虽然火亢不息，久必伤阴，究宜戒酒为上。治以清肃高源，兼养胃阴为法。
沙参 甜杏仁 丹皮 元参 山栀 川贝 茜草炭 鸡距子 藕汁 茅根
某 始由寒饮咳嗽，继而化火动血。一二年来血证屡止屡发，而咳嗽不已，脉弦形瘦，饮邪未去，阴血
已亏。安静则咳甚，劳动则气升。盖静则属阴，饮邪由阴生也；动则属阳，气升
由火动也。阴虚痰饮，四字显然。拟金水六君同都气丸法，补肾之阴以纳气，化胃之痰以蠲饮。饮去则咳自减，
气纳则火不升。
大生地（海浮石拌炒） 半夏（青盐制） 麦冬（元米炒） 五味子（炒） 紫石英（
） 丹皮（炒成炭） 牛膝（盐水炒） 怀山药（炒） 蛤壳（打） 诃子 茯苓 青铅 枇杷叶（蜜炙）
渊按∶咳血一证，非尽由阴虚。若痰饮久咳，乃胃络受伤，胃气不降，血从气逆而来。治痰饮，降胃气，
血自止矣。徒事滋阴，恐气愈逆而血愈多也。
范 脉虚数，两尺愈虚。心肝脾胃俱受其病，惟肾独虚。心肝火亢，肺胃受戕，痰由湿生，血随气逆，
咳嗽黄痰带血，掌中觉热。法宜养肾之阴，以清心肝之火，而肃肺胃之气。
大生地（海浮石拌） 丹皮炭 沙参 川贝 白扁豆 甜杏仁 茜
草炭 生苡仁 阿胶（米粉炒） 茯苓 藕节 枇杷叶
顾 头痛呕血，皆在上午，阳经之火无疑。法以清降。
犀角 羚羊角 麦冬 石决明 生石膏 知母 丹皮（炒焦） 竹叶 钩钩
又 清泄阳明之火，头痛已减，仍用前法。
羚羊角 元参 生石膏 麦冬 泽泻 知母 石决明 淡芩 生甘草
许 形寒饮冷则伤肺，两寒相感，中外皆伤，故气逆而咳嗽也。咳而欲呕曰胃咳。加以用力劳动，阳络
受伤。痰中带血，久而不已，易入损门。
旋复花 代赭石 杏仁 丹皮 郁金 半夏曲 款冬花 橘红 紫菀 茯苓 枇杷叶
某 咳嗽吐血，晡热便溏，腹中有块攻痛。肺肾阴伤，脾阳复弱，肝木横于中矣。饮食少纳，仓廪空虚，
心如悬罄，何恃不恐？
党参 白芍（吴萸三分，拌炒） 怀山药 枣仁 新会皮 川贝 款冬花 丹皮（炒焦） 茯神 沙苑子 生谷芽
某 饥饱劳伤，其病在胃，胃为多气多血之乡，胃伤则血从吐出。拟和胃、降气、化瘀法。
沙参 生苡仁 丹皮（炒焦） 茜草炭 杏仁 郁金 炙甘草 桃仁泥 白扁豆 茯苓 藕节
某 咳嗽成劳最难治，《十药神书》传葛氏。生津顺气化痰浊，补血安神分次第。病经一载元气亏，节届
春分恐危殆。安谷则昌古所言，姑拟一方补脾胃。
玉竹 怀山药 生苡仁 白扁豆 川贝 茯苓 甜杏仁 款冬花 生谷芽 沙参
朱 操劳思虑，阴津元气内亏，脾失运而生痰，肺失降而为咳。痰中带红，时生内热。劳损之根，勿得轻视。
大熟地 川贝 生苡仁 怀山药 丹皮（炒焦） 甜杏仁 麦冬 茯神 半夏 枇杷叶
吕 脉数左寸独锐，心经有火，吐血不止，法宜清养。
犀角 鲜生地 淡芩 阿胶（蒲黄炒） 丹皮（炒焦） 山栀 杏仁 茜草炭 茅根 藕节
庞 去秋咳嗽，些微带血，已经调治而痊。交春吐血甚多，咳嗽至今不止，更兼寒热，朝轻晡甚，饮食少
纳，头汗不休。真阴大亏，虚阳上亢，肺金受烁，脾胃伤戕，津液日益耗，元气日益损。脉沉细涩，口腻而干。
虚极成劳，难为力矣。姑拟生脉六君子汤，保肺清金，调元益气。扶过夏令再议。
生洋参 沙参 麦冬 五味子 白扁豆 制半夏 茯神 陈
皮炙甘草 枇杷露（一小杯，冲服） 野蔷薇露（各一小杯，冲服）
生脉散保肺清金。六君子去术嫌其燥，加扁豆培养脾阴，土
旺自能生金也。不用养阴退热之药，一恐滋则腻肠，一恐
凉则妨胃耳。从来久病总以胃气为本，经云有胃则生，此其道也。
雷 久咳带血，今又音哑咽痛，此怒动肝火，肺失清肃，所谓金破不鸣。宜培土生金，稍佐降火。
沙参 甜杏仁 白扁豆 元参 茯苓 桔梗 生苡仁 蝉衣 川贝 玉竹 白蜜 猪板油（同蜜烊化，冲服）
薛 吐血鼻血，牙血发斑，斑中出血，阳明之火极炽。而腹满濡软，少阴之气不运。病已三月，血有间断，
有瘀血在腹中故也。食少，身热，脉数，其阴已虚。拟养阴化瘀，清胃和中。
大生地 五灵脂（醋炒） 归身炭 犀角 白芍 炮姜炭 茜草炭 茯苓 丹皮炭 焦山栀 荆芥炭 延
胡索（醋炒） 陈皮（盐水炒） 鲜藕
又 血上下溢，责之中虚，而邪复扰之。血去既多，余热上炽，鼻血时流，便血时下，中州之扰犹未已也。
安中州，清热邪，理中汤加味治之。
西洋参（元米制） 白术炭 牛膝炭 黄芩 炙甘草 茜草炭 丹皮炭 炮姜炭 赤苓 百草霜 伏龙肝
渊按∶脾阴虚而伏热扰血分，黑归脾，黑地黄最合。
某 吐血时发时止，阳络受伤，或夹瘀凝而然，不足虑也。血止之后，喉痒干咳，却不相宜。夫干咳则气热
而火动，火动则难免其血之不来。倘加内热，易入损途。刻下胃纳甚少，先议养胃阴一法。
川石斛 丹皮 郁金 茯苓 炙甘草 生苡仁 麦冬 沙参
川贝 白扁豆 鲜藕
薛 痰饮久咳，咳伤肺络，失血。脉不数，舌苔白。不必过清。但顺气化痰，气顺则血自归经，痰化则
咳嗽可止。
苏子 杏仁 川贝 茜草炭 郁金 桑白皮 丹皮 蛤壳 冬瓜子 藕节 枇杷叶
渊按∶非但不可过清，直不宜清耳。仲景云∶痰饮须以温药和之。可谓要言不繁。
华 咳嗽内伤经络，吐血甚多。脉不数，身不热，口不渴，切勿见血投凉。法当益胃，拟理中加味。
党参（元米炒） 白扁豆（炒焦） 炙甘草 炮姜 白芍 归身炭 血余炭 丹皮炭 杏仁 藕节 陈粳米
李 伤酒吐血，血出于胃。虽属无妨，其阴久亏。拟和胃降火法。
鲜石斛 川贝 丹皮 白扁豆 茯苓 山栀 白芍 沙参 炙甘草 元参 茅根 鲜藕
钱 内则阴虚有火，外则寒邪深袭。失血咳嗽，又兼三疟，病已数月。疟来心口酸痛，胸腹空豁难过。
经云∶阳维为病苦寒热，阴维为病苦心痛。此阴阳营卫之偏虚也。拟黄 建中法，和中
脏之阴阳而调营卫。复合生脉保肺之阴，复脉保肾之阴。通盘合局，头头是道矣。
归身炭 炙甘草 大生地（砂仁炒） 五味子 鳖甲 黄 青蒿 沙参 白芍（桂技三分，拌炒） 阿
胶麦冬 煨生姜 红枣
渊按∶三疟寒热，并非阳维为病。心口 痛难过，乃胃有寒痰，肝有蕴热，肺胃失顺降之常，再袭寒邪
而咳血矣。腻补之方，恐不相合。
殷 肝胃不和，脘痛呕酸，兼以酒湿熏蒸于胃，胃为多气多
血之乡，故吐出瘀血甚多。血止之后，仍脘中作胀，呕吐酸水。法宜调和肝胃，切戒寒凉。
制半夏 陈皮 郁金 乌药 桃仁泥 炮姜炭 延胡 茯苓 香附 鸡距子 苏梗
孙 热在中脘部分，时吐红痰带臭，不甚咳嗽。病在于胃，留热伏于中宫。法当清泄。
犀角 冬瓜子 射干 当归 桃仁 苡仁 元明粉 川贝 连翘 大黄（酒浸炒） 金银花
又 不咳嗽，但吐红痰如脓，自觉灼热在胃脘之中，将及二月。此非肺痈，乃瘀伤湿热留胃中故也。当以清化。
川贝 冬瓜子 当归 苡仁 沙参 连翘 川石斛 金银花 赤豆 芦根
郁 历春夏秋，血症屡发。诊脉虚弱，形容清瘦，年方十七，精未充而早泄，阴失守而火升。异日难名之
疾，恐应褚氏之言。治宜滋水降火，须自保养为要。
大生地 生洋参 丹皮炭 茯神 白扁豆（炒焦） 怀山药 茜草炭 阿胶（蒲黄炒） 麦冬 茅根 莲肉 鲜藕
仁渊曰∶少年咳血，多起于遗精，遗精多由于妄想。夫男子二八精道通，情欲念起。起而不遂，则相火时
动。动而不已，致精关不得闭固，则梦交精滑。阴精下虚，相火上炎，迫其血府，
叶姓患者：咳嗽不止，咳血未能停止，脉象沉而带数，说明病根仍未去除。气就像风，血就像水，咳嗽导致气机逆乱不顺，血液也随之逆乱而不顺。经络不和，血液不能安宁，必须降下上逆之气，然后血液才不再上升；也必须滋养阴液，然后虚火才能消退。
大生地、紫菀、丹皮、川贝、赤苓、元精石、甜杏仁、沙参、赤芍、枇杷叶。
渊按语：这个比喻非常精妙，是从《内经》中“天暑地热”的道理领悟而来的。
尤姓患者：血止后仍有干咳，这是阴虚的表现。急需生津以救肺。
沙参、丹皮、麦冬、茯神、五味子、桑白皮、蛤壳、川贝、鲜藕、甜杏仁。
侯姓患者：脉数且血涌，胃气大虚。胸中痞塞，大便溏薄，这是因虚导致的痞塞，脉数是因虚导致的数脉。咳血三个月，现在突然冲溢而出，嘴唇苍白，面色发青，断然不是实火。一般来说，实火吐血，宜用清热降逆的方法；虚火吐血，宜用补益调和的方法。古人说，见到痰不要只治痰，见到血不要只治血，如果出血长久不止，应当用调理胃气的药物来收功。现在援引这个例子。
人参（一钱）、白扁豆（一两）、川贝（三钱）、茯苓（三钱）、藕汁（一杯，冲服）、好墨汁（三匙，冲服）。
又诊：脉数退去，出血减少，反而出现恶寒汗出。这是因为失血导致气无所依附，气属阳，主司体表，卫气虚弱则不能固摄。最怕的是气喘呃逆导致暴脱。幸好胸中痞塞已经缓解，稍微能够进食。仿照“血脱益气”的法则。经书说“阳生阴长”，说的就是这个道理。
人参、炒扁豆、五味子、炙甘草、炮姜炭、怀山药、藕汁。
又诊：血脱益气，是前贤的成法。现在血虽然大部分止住，但神气更加疲惫，嘴唇苍白，面色发青，担心发生虚脱。想要稳固根本，再进一层治疗。
人参、炮姜、陈皮、大熟地（用砂仁拌炒）、麦冬、冬术、炒扁豆、五味子、附子（用秋石汤炮制）。
灶心黄土煎汤代水。
又诊：肝肾之气从下部泛溢到上部，青黑色的色泽出现在面部。阴阳即将离散，在子时和丑时之间要防止脱证。勉强拟定镇摄之法，希望有万一的疗效。
人参、大熟地、紫石英、五味子、麦冬、肉桂、茯苓、青铅、坎炁。
又诊：止血三天后，吐出的痰像污泥一样且发臭，这是胃气大伤，肺气败坏而形成的肺痿。痿，就是枯萎的意思。就像草木枯萎而不能振奋，最终属于劳损沉疴。《外台秘要》引用炙甘草汤，取其益气生津，以挽救肺脏的枯萎。后人使用这个方子，常常去掉姜、桂的辛热之性，此症见面青色且不口渴，正适宜用温药扶助阳气。只是大便溏薄，除去麻仁即可。
人参、炙甘草、麦冬、阿胶、大生地、炮姜、五味子、肉桂、紫石英。
又诊：病情依然如故，从前方的基础上加减。
前方去掉炮姜，加入制洋参。
又诊：连续服用炙甘草汤，病情大有起色。但是咳嗽呛逆时就会出汗，这是肺气耗散的表现。对于耗散的症状应当收敛，不宜再兼用辛热药物，应当参考收敛的药物。
人参、大熟地（用沉香末拌炒）、炙甘草、阿胶、五味子、黄芪、粟壳、大枣。
渊按语：如此危险的病症，处理得一丝不乱。正如景岳所说，非常之病，只有非常之医才能治愈。
某患者：久咳失血，精气互相损伤。连续服用滋补药物，颇获小效。但是血液流失过多，骤然难以补充恢复。历来血症中肺肾两虚的患者，适宜在冬季治疗，不适宜在夏季治疗。因为酷暑炎热，有水干金销（肺阴枯竭）的忧虑。现在正值仲夏，适宜每日服用生津益气的药物，大滋金水（肺肾）之虚，兼扶胃土，这样肺金有所依靠。而且精气注成于水谷，久病以胃气为关键。
制洋参、大熟地、麦冬、黄芪、怀山药、大生地、五味子、茯苓、陈皮、炙甘草、白扁豆、党参。
又诊：血止住了，胃气稍醒，仍守前法。
前方加蜜炙粟壳。另外单用白芨一味药制成丸剂，每天早上服用三钱。
朱姓患者：中气素来虚弱，兼患痰饮，冬天必定咳嗽。最近因劳碌感受寒邪，忽然气机上逆吐血，微寒发热，出汗后心中嘈杂不安。他的血必定三天来一次，寒热也三天发作一次。这是因为热邪在内炽盛，逼迫血液上行，病在三阴之枢机，恐怕出现下厥上竭（下部虚寒，上部血竭），冲逆溢出，气喘脱证。
麻黄、西洋参、白芍、麦冬、五味子、归身、炙甘草、黄芪、川贝、荆芥炭、茅根、藕汁。
邢姓患者：先天不足的体质，曾经发作虚痰，溃破后将要收敛。进入春季，阳气升发，渐渐觉得喉痒，咳嗽，两三日来，忽然吐血。现在又大吐血，血色鲜红。诊脉细促，心中嘈杂似饥饿感。一团虚火，炎炎猛烈无法抵御。用药虽然已经清降，也应当预先顾护真阴。否则恐怕血脱阴伤而导致晕厥。
生地、沙参、丹皮炭、茜草炭、小蓟炭、阿胶、麦冬、五味子、朱茯神、京墨汁（三匙）、童便（一杯，冲服）。
又诊：节气到了春分，阳气勃勃升动。血证在这个时候，稍微平复后又旺盛起来。大概是因为身体中的肝阳，顺应天时之阳气上升而无制约，所以又忽然大吐血。急当休养其阴，兼以清降。所担心的是火愈降而阴愈伤。
羚羊角、元参、鲜生地、丹皮、大生地、茯神、麦冬、阿胶、茜草炭、石决明、侧柏叶汁、茅根、藕汁。
张姓患者：阴虚内热，咳嗽痰中带红，脉数无神，逐渐延绵成劳损。
沙参、白芍、川贝、丹皮、白扁豆、麦冬、甜杏仁、茯神、丹参、茜草炭、百合（一两，煎汤代水）。
吴姓患者：血色紫而有块，这属于肝火乘胃，瘀血凝结上泛。仿照缪仲醇的方法。
阿胶（蒲黄炒）、丹皮、白芍、苏子、鲜石斛、降香、大黄（醋炒成炭）、藕汁、黑山栀、白扁豆、枇杷叶。
程姓患者：咳嗽以至于失血音哑，津液枯槁，劳损已成。脉形细弱，精气内亏。《内经》对于针药所不能治的情况，主张用甘药调治。《金匮要略》遵循这一原则建立了黄芪建中汤，急建其中气，使饮食增加，津气旺盛，阳生阴长，从而恢复真阴之虚，除了这个方法别无良法。现在仿照其意而损益之。
黄芪（秋石三分，化水拌，炙焦）、茯神、白芍、麦冬、川贝、生甘草、炙甘草、玉竹、沙参、橘饼。
顾姓患者：酒客湿热熏蒸，肺受火刑而失去清肃之令。咳嗽音哑，吐血痰红，喉痹干燥，这些都是肺火的见证，尚非全属阴虚。虽然火亢不息，久必伤阴，终究以戒酒为上策。治疗以清肃高源（肺），兼养胃阴为法。
沙参、甜杏仁、丹皮、元参、山栀、川贝、茜草炭、鸡距子、藕汁、茅根。
某患者：开始由寒饮咳嗽，继而化火动血。一二年来血证屡次止住又屡次发作，而咳嗽不已，脉弦形体消瘦，饮邪未去，阴血已亏。安静时咳嗽加重，劳动时气机上逆。安静属阴，饮邪由阴生；劳动属阳，气升由火动。阴虚痰饮，这四个字很明显。拟用金水六君汤同都气丸法，补肾之阴以纳气，化胃之痰以蠲除饮邪。饮去则咳自减，气纳则火不升。
大生地（海浮石拌炒）、半夏（青盐制）、麦冬（元米炒）、五味子（炒）、紫石英、丹皮（炒成炭）、牛膝（盐水炒）、怀山药（炒）、蛤壳（打碎）、诃子、茯苓、青铅、枇杷叶（蜜炙）。
渊按语：咳血一证，并不尽由阴虚引起。如果是痰饮久咳，乃是胃络受伤，胃气不降，血液随气逆而来。治疗痰饮，降胃气，血自然能止。单纯从事滋阴，恐怕气更逆而血更多。
范姓患者：脉虚数，两尺部更虚。心肝脾胃俱受其病，惟独肾最虚。心肝火亢，肺胃受戕害，痰由湿生，血随气逆，咳嗽黄痰带血，手掌中觉热。治法宜养肾之阴，以清心肝之火，而肃降肺胃之气。
大生地（海浮石拌）、丹皮炭、沙参、川贝、白扁豆、甜杏仁、茜草炭、生苡仁、阿胶（米粉炒）、茯苓、藕节、枇杷叶。
顾姓患者：头痛呕血，都在上午发生，这是阳经之火无疑。治法以清降为主。
犀角、羚羊角、麦冬、石决明、生石膏、知母、丹皮（炒焦）、竹叶、钩钩。
又诊：清泄阳明之火，头痛已减轻，仍用前法。
羚羊角、元参、生石膏、麦冬、泽泻、知母、石决明、淡芩、生甘草。
许姓患者：形寒饮冷则伤肺，两寒相感，内外皆伤，所以气逆而咳嗽。咳嗽想呕吐叫胃咳。加上用力劳动，阳络受伤。痰中带血，久而不已，容易进入损门（虚损范畴）。
旋复花、代赭石、杏仁、丹皮、郁金、半夏曲、款冬花、橘红、紫菀、茯苓、枇杷叶。
某患者：咳嗽吐血，午后发热，大便溏薄，腹中有块攻痛。肺肾阴伤，脾阳复弱，肝木横逆于中焦。饮食少纳，仓廪空虚，心如悬罄，有什么可依赖而不恐惧呢？
党参、白芍（吴萸三分，拌炒）、怀山药、枣仁、新会皮、川贝、款冬花、丹皮（炒焦）、茯神、沙苑子、生谷芽。
某患者：饥饱劳伤，病在胃，胃是多气多血的场所，胃伤则血从吐出。拟用和胃、降气、化瘀法。
沙参、生苡仁、丹皮（炒焦）、茜草炭、杏仁、郁金、炙甘草、桃仁泥、白扁豆、茯苓、藕节。
某患者：咳嗽成劳最难治，《十药神书》传葛氏。生津顺气化痰浊，补血安神分次第。病经一年元气亏，节届春分恐危殆。安谷则昌古所言，姑拟一方补脾胃。
玉竹、怀山药、生苡仁、白扁豆、川贝、茯苓、甜杏仁、款冬花、生谷芽、沙参。
朱姓患者：操劳思虑，阴津元气内亏，脾失运化而生痰，肺失肃降而为咳。痰中带红，时生内热。劳损之根，不可轻视。
大熟地、川贝、生苡仁、怀山药、丹皮（炒焦）、甜杏仁、麦冬、茯神、半夏、枇杷叶。
吕姓患者：脉数左寸独锐，心经有火，吐血不止，治法宜清养。
犀角、鲜生地、淡芩、阿胶（蒲黄炒）、丹皮（炒焦）、山栀、杏仁、茜草炭、茅根、藕节。
庞姓患者：去年秋天咳嗽，少许带血，已经调治痊愈。进入春季吐血甚多，咳嗽至今不止，更兼寒热，早晨轻傍晚重，饮食少纳，头汗不休。真阴大亏，虚阳上亢，肺金受烁，脾胃伤戕，津液日益消耗，元气日益受损。脉沉细涩，口腻而干。虚极成劳，难以为力了。姑且拟定生脉散合六君子汤，保肺清金，调元益气。扶过夏令再议。
生洋参、沙参、麦冬、五味子、白扁豆、制半夏、茯神、陈皮、炙甘草、枇杷露（一小杯，冲服）、野蔷薇露（各一小杯，冲服）。
生脉散保肺清金。六君子汤去掉白术嫌其燥，加扁豆培养脾阴，土旺自能生金。不用养阴退热之药，一是怕滋腻碍肠，二是怕凉性妨碍胃气。从来久病总以胃气为本，经云有胃则生，这就是这个道理。
雷姓患者：久咳带血，现在又音哑咽痛，这是怒动肝火，肺失清肃，所谓金破不鸣。宜培土生金，稍佐降火。
沙参、甜杏仁、白扁豆、元参、茯苓、桔梗、生苡仁、蝉衣、川贝、玉竹、白蜜、猪板油（同蜜烊化，冲服）。
薛姓患者：吐血鼻血，牙血发斑，斑中出血，这是阳明之火极炽。而腹满濡软，少阴之气不运。病已三月，血有间断，是有瘀血在腹中缘故。食少，身热，脉数，其阴已虚。拟用养阴化瘀，清胃和中。
大生地、五灵脂（醋炒）、归身炭、犀角、白芍、炮姜炭、茜草炭、茯苓、丹皮炭、焦山栀、荆芥炭、延胡索（醋炒）、陈皮（盐水炒）、鲜藕。
又诊：血上下溢，责之中虚，而邪复扰之。血去既多，余热上炽，鼻血时流，便血时下，中州之扰犹未已也。安中州，清热邪，理中汤加味治之。
西洋参（元米制）、白术炭、牛膝炭、黄芩、炙甘草、茜草炭、丹皮炭、炮姜炭、赤苓、百草霜、伏龙肝。
某患者：吐血时发时止，阳络受伤，或者夹瘀凝所致，不足为虑。血止之后，喉痒干咳，却不相宜。夫干咳则气热而火动，火动则难免其血之不来。倘加内热，易入损途。刻下胃纳甚少，先议养胃阴一法。
川石斛、丹皮、郁金、茯苓、炙甘草、生苡仁、麦冬、沙参、川贝、白扁豆、鲜藕。
薛姓患者：痰饮久咳，咳伤肺络，失血。脉不数，舌苔白。不必过清。但顺气化痰，气顺则血自归经，痰化则咳嗽可止。
苏子、杏仁、川贝、茜草炭、郁金、桑白皮、丹皮、蛤壳、冬瓜子、藕节、枇杷叶。
渊按语：不仅不可过清，简直不宜清。仲景说：痰饮须以温药和之。可谓要言不繁。
华姓患者：咳嗽内伤经络，吐血甚多。脉不数，身不热，口不渴，切勿见血投凉。治法当益胃，拟理中汤加味。
党参（元米炒）、白扁豆（炒焦）、炙甘草、炮姜、白芍、归身炭、血余炭、丹皮炭、杏仁、藕节、陈粳米。
李姓患者：伤酒吐血，血出于胃。虽属无妨，其阴久亏。拟用和胃降火法。
鲜石斛、川贝、丹皮、白扁豆、茯苓、山栀、白芍、沙参、炙甘草、元参、茅根、鲜藕。
钱姓患者：内则阴虚有火，外则寒邪深袭。失血咳嗽，又兼三疟，病已数月。疟来心口酸痛，胸腹空豁难过。
经云：阳维为病苦寒热，阴维为病苦心痛。这是阴阳营卫之偏虚。拟用黄芪建中法，和中脏之阴阳而调营卫。复合生脉散保肺之阴，复脉汤保肾之阴。通盘合局，头头是道矣。
归身炭、炙甘草、大生地（砂仁炒）、五味子、鳖甲、黄芪、青蒿、沙参、白芍（桂枝三分，拌炒）、阿胶、麦冬、煨生姜、红枣。
渊按语：三疟寒热，并非阳维为病。心口疼痛难过，乃胃有寒痰，肝有蕴热，肺胃失顺降之常，再袭寒邪而咳血矣。腻补之方，恐不相合。
殷姓患者：肝胃不和，脘痛呕酸，兼以酒湿熏蒸于胃，胃为多气多血之乡，故吐出瘀血甚多。血止之后，仍脘中作胀，呕吐酸水。治法宜调和肝胃，切戒寒凉。
制半夏、陈皮、郁金、乌药、桃仁泥、炮姜炭、延胡、茯苓、香附、鸡距子、苏梗。
孙姓患者：热在中脘部分，时吐红痰带臭，不甚咳嗽。病在于胃，留热伏于中宫。治法当清泄。
犀角、冬瓜子、射干、当归、桃仁、苡仁、元明粉、川贝、连翘、大黄（酒浸炒）、金银花。
又诊：不咳嗽，但吐红痰如脓，自觉灼热在胃脘之中，将及二月。此非肺痈，乃瘀伤湿热留胃中故也。当以清化。
川贝、冬瓜子、当归、苡仁、沙参、连翘、川石斛、金银花、赤豆、芦根。
郁姓患者：历春夏秋，血症屡发。诊脉虚弱，形容清瘦，年方十七，精未充而早泄，阴失守而火升。异日难名之疾，恐应褚氏之言。治宜滋水降火，须自保养为要。
大生地、生洋参、丹皮炭、茯神、白扁豆（炒焦）、怀山药、茜草炭、阿胶（蒲黄炒）、麦冬、茅根、莲肉、鲜藕。
仁渊曰：少年咳血，多起于遗精，遗精多由于妄想。夫男子二八精道通，情欲念起。起而不遂，则相火时动。动而不已，致精关不得闭固，则梦交精滑。阴精下虚，相火上炎，迫其血府，
Patient Ye: Coughing persists, and hemoptysis has not ceased. The pulse is deep with a rapid quality, indicating that the root cause remains. Qi is like wind, and blood is like water; coughing causes qi to rebel and become unsmooth, and blood also rebels and becomes unsmooth. When meridians and collaterals are disharmonious, blood cannot remain tranquil. It is necessary to descend the rebellious qi so that blood will no longer ascend, and it is also necessary to replenish yin so that fire will recede.
Sheng Di Huang (Rehmanniae Radix), Zi Wan (Asteris Radix), Mu Dan Pi (Moutan Cortex), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Chi Fu Ling (Poria cum Rubro), Yuan Jing Shi (Natrii Sulfas), Tian Xing Ren (Armeniacae Semen Amarum), Sha Shen (Glehniae Radix), Chi Shao (Paeoniae Radix Rubra), Pi Pa Ye (Loquats Folium).
Note by Yuan: This metaphor is extremely brilliant, derived from understanding the principle of "hot heaven and hot earth" in the *Neijing* (*Huangdi Neijing*).
Patient You: After hemostasis, dry cough persists, which indicates yin deficiency. Urgently need to generate fluids to save the lungs.
Sha Shen (Glehniae Radix), Mu Dan Pi (Moutan Cortex), Mai Dong (Ophiopogonis Tuber), Fu Shen (Poria with Hostwood), Wu Wei Zi (Schisandrae Fructus), Sang Bai Pi (Mori Cortex), Ge Qiao (Trionycis Carapax et Plastrum), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Xian Ou (Nelumbinis Rhizoma Recens), Tian Xing Ren (Armeniacae Semen Amarum).
Patient Hou: Pulse is rapid with surging blood, and stomach qi is greatly deficient. Chest oppression and fullness, along with loose stools, indicate false stagnation due to deficiency, and a rapid pulse due to deficiency. Hemoptysis for three months, now suddenly surging forth; pale lips and greenish complexion indicate this is certainly not excess fire. Generally, for hemoptysis due to excess fire, clearing and descending are appropriate; for hemoptysis due to deficient fire, tonifying and harmonizing are appropriate. Ancients said, when seeing phlegm, do not merely treat phlegm; when seeing blood, do not merely treat blood. If bleeding persists for a long time, one should use stomach-regulating herbs to conclude treatment. We follow this example here.
Ren Shen (Codonopsis Ginseng) (1 qian), Bai Bian Dou (Dolichos Lablab Seed) (1 liang), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (3 qian), Fu Ling (Poria) (3 qian), Ou Zhi (Lotus Root Juice) (1 cup, mixed in), Hao Mo Zhi (Good Ink Juice) (3 spoons, mixed in).
Second visit: The rapid pulse has subsided, bleeding has decreased, but there is aversion to cold and sweating. This is because blood loss leaves qi without a foundation. Qi belongs to yang and governs the exterior; when defensive qi is deficient, it fails to secure the exterior. The greatest fear is sudden collapse due to panting and hiccups. Fortunately, chest oppression has eased, and food intake has slightly improved. Following the precedent of "tonifying qi for blood loss." The Classics state, "When yang grows, yin grows," which refers to this.
Ren Shen (Codonopsis Ginseng), Chao Bian Dou (Stir-fried Dolichos Lablab Seed), Wu Wei Zi (Schisandrae Fructus), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Pao Jiang Tan (Charred Ginger), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Ou Zhi (Lotus Root Juice).
Third visit: Tonifying qi for blood loss is an established method of former sages. Although bleeding has largely stopped, spirit and qi are more exhausted, with pale lips and greenish complexion, fearing virtual collapse. To secure the foundation, we advance one step further.
Ren Shen (Codonopsis Ginseng), Pao Jiang (Charred Ginger), Chen Pi (Citri Reticulatae Pericarpium), Da Shu Di (Prepared Rehmanniae Radix) (stir-fried with Sha Ren), Mai Dong (Ophiopogonis Tuber), Dong Zhu (Atractylodis Macrocephalae Rhizoma), Chao Bian Dou (Stir-fried Dolichos Lablab Seed), Wu Wei Zi (Schisandrae Fructus), Fu Zi (Aconiti Lateralis Radix Praeparata) (processed with Qiu Shi Tang).
Zao Xin Tu Huang (Caulis Longanae Arillus Decocted as Water Substitute).
Fourth visit: Qi and blood of the liver and kidney float upward from below, with cyanotic and black discoloration appearing on the face. Yin and yang are separating; prevention of collapse is needed during the Zi and Chou hours. Tentatively prescribing calming and securing methods, hoping for a slight chance of success.
Ren Shen (Codonopsis Ginseng), Da Shu Di (Prepared Rehmanniae Radix), Zi Shi Ying (Fluorite), Wu Wei Zi (Schisandrae Fructus), Mai Dong (Ophiopogonis Tuber), Rou Gui (Cinnamomi Cortex), Fu Ling (Poria), Qing Qian (Lead), Kan Qi (Kidney Channel).
Fifth visit: Three days after hemostasis, expectoration resembles mud and is foul-smelling, indicating severe damage to stomach qi and deterioration of lung qi, resulting in Fei Wei (Lung Flaccidity). Wei means withering, like grass and trees that have withered and lost vigor, ultimately belonging to chronic consumption diseases. The *Waitai Mi Yao* cites Zhi Gan Cao Tang (Honey-fried Licorice Decoction), taking advantage of its ability to tonify qi and generate fluids to rescue the withering lungs. Later generations often remove the acrid-warm properties of Ginger and Cinnamon when using this formula. This patient presents with a greenish complexion and no thirst, making warm herbs to support yang most appropriate. However, since stools are loose, Hemp Seed (Ma Ren) should be removed.
Ren Shen (Codonopsis Ginseng), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Mai Dong (Ophiopogonis Tuber), E Jiao (Donkey-hide Gelatin), Da Sheng Di (Raw Rehmanniae Radix), Pao Jiang (Charred Ginger), Wu Wei Zi (Schisandrae Fructus), Rou Gui (Cinnamomi Cortex), Zi Shi Ying (Fluorite).
Sixth visit: Disease condition remains unchanged; modify the previous prescription.
Remove Pao Jiang from the previous prescription, add Zhi Yang Shen (Processed American Ginseng).
Seventh visit: Continuous administration of Zhi Gan Cao Tang has shown significant improvement. However, sweating occurs during coughing fits, indicating dispersion of lung qi. For dispersion, one should gather/astringe; acrid-warm herbs should no longer be combined. Herbs with astringent properties should be referenced.
Ren Shen (Codonopsis Ginseng), Da Shu Di (Prepared Rehmanniae Radix) (stir-fried with Chen Xiang powder), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), E Jiao (Donkey-hide Gelatin), Wu Wei Zi (Schisandrae Fructus), Huang Qi (Astragali Radix), Su Ke (Poppy Capsule), Da Zao (Jujubae Fructus).
Note by Yuan: Such a critical condition is handled meticulously. As Jingyue said, extraordinary diseases require extraordinary physicians.
Certain Patient: Chronic cough with blood loss, mutual injury of essence and qi. Continuous supplementation has yielded slight effects. However, excessive blood loss makes rapid recovery difficult. Historically, for hemoptysis involving both lung and kidney deficiency, winter treatment is preferred over summer. Because intense summer heat raises concerns of water drying up and metal melting (lung yin exhaustion). Now entering mid-summer, daily administration of herbs to generate fluids and tonify qi is suitable, greatly nourishing the deficiency of Metal and Water (lungs and kidneys), while supporting Earth (spleen/stomach), so that Metal has reliance. Moreover, essence and qi are formed from grain and water; in chronic illness, stomach qi is crucial.
Zhi Yang Shen (Processed American Ginseng), Da Shu Di (Prepared Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Huang Qi (Astragali Radix), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Da Sheng Di (Raw Rehmanniae Radix), Wu Wei Zi (Schisandrae Fructus), Fu Ling (Poria), Chen Pi (Citri Reticulatae Pericarpium), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Bai Bian Dou (Dolichos Lablab Seed), Dang Shen (Codonopsis Radix).
Eighth visit: Bleeding has stopped, stomach function has slightly recovered; adhere to the previous method.
Add Honey-fried Su Ke (Poppy Capsule) to the previous prescription. Additionally, prepare a pill using only Bai Ji (Bletillae Rhizoma), taken orally at 3 qian every morning.
Patient Zhu: Middle qi has always been deficient, complicated by phlegm-fluid retention, causing cough in winter. Recently, due to overwork and cold invasion, qi suddenly rose causing hemoptysis, with mild chills and fever, and palpitations/heart discomfort after sweating. His bleeding occurs every three days, and chills/fever also occur every three days. This is because pathogenic heat is blazing internally, forcing blood upward. The disease is at the pivot of the Three Yin meridians, fearing lower jiaue and upper exhaustion (cold at the bottom, blood depletion at the top), surging overflow, panting, and collapse.
Ma Huang (Ephedrae Herba), Xi Yang Shen (American Ginseng), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus), Gui Shen (Angelicae Sinensis Radix), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Huang Qi (Astragali Radix), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Jing Jie Tan (Schizonepetae Herba Carbonized), Mao Gen (Imperatae Rhizoma), Ou Zhi (Lotus Root Juice).
Note by Yuan: Sweating and heart discomfort indicate deficiency of Ying (nutritive) yin. Ma Huang (Ephedrae Herba) is generally unsuitable.
Patient Xing: Congenital insufficiency, previously suffered from deficiency-phlegm, which ulcerated and was healing. Entering spring, yang qi rises, gradually feeling throat itching and coughing. In the last two or three days, sudden hemoptysis occurred. Now massive hemoptysis again, with bright red blood. Pulse is fine and rapid, heart discomfort resembling hunger. A cluster of deficient fire burns fiercely and cannot be controlled. Although medication has cleared and descended, true yin must be protected in advance. Otherwise, fear collapse of blood and injury to yin leading to fainting.
Sheng Di (Raw Rehmanniae Radix), Sha Shen (Glehniae Radix), Dan Pi Tan (Moutan Cortex Carbonized), Qian Cao Tan (Rubiae Radix Carbonized), Xiao Ji Tan (Cirsii Japonici Herba Carbonized), E Jiao (Donkey-hide Gelatin), Mai Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus), Zhu Fu Shen (Poria with Hostwood dyed with Cinnabar), Jing Mo Zhi (Beijing Ink Juice) (3 spoons), Tong Bian (Child's Urine) (1 cup, mixed in).
Ninth visit: Add Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) and Mao Gen (Imperatae Rhizoma) to the previous prescription.
Tenth visit: The solar term arrives at Spring Equinox, yang qi rises vigorously. In blood disorders at this time, symptoms may temporarily subside then flare up again. Likely because the liver yang within the body responds to the rising yang of nature without restraint, causing sudden massive hemoptysis. Urgently need to nourish yin and clear/descend. The concern is that as fire descends, yin is further injured.
Ling Yang Jiao (Saiga Antelope Horn), Yuan Shen (Scrophulariae Radix), Xian Sheng Di (Raw Rehmanniae Radix Recens), Dan Pi (Moutan Cortex), Da Sheng Di (Raw Rehmanniae Radix), Fu Shen (Poria with Hostwood), Mai Dong (Ophiopogonis Tuber), E Jiao (Donkey-hide Gelatin), Qian Cao Tan (Rubiae Radix Carbonized), Shi Jue Ming (Haliotidis Concha), Ce Bai Ye Zhi (Biota Top Leaf Juice), Mao Gen (Imperatae Rhizoma), Ou Zhi (Lotus Root Juice).
Note by Yuan: Descending fire and nourishing yin is an inevitable trend.
Patient Zhang: Yin deficiency with internal heat, cough with blood-streaked sputum, pulse rapid and lacking spirit, gradually progressing to consumption.
Sha Shen (Glehniae Radix), Bai Shao (Paeoniae Radix Alba), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Dan Pi (Moutan Cortex), Bai Bian Dou (Dolichos Lablab Seed), Mai Dong (Ophiopogonis Tuber), Tian Xing Ren (Armeniacae Semen Amarum), Fu Shen (Poria with Hostwood), Dan Shen (Salviae Miltiorrhizae Radix), Qian Cao Tan (Rubiae Radix Carbonized), Bai He (Lilii Bulbus) (1 liang, decocted as water substitute).
Patient Wu: Blood color is purple with clots, belonging to liver fire invading the stomach, with stasis condensing and floating upward. Following the method of Miao Zhongchun.
E Jiao (Donkey-hide Gelatin) (stir-fried with Pu Huang), Dan Pi (Moutan Cortex), Bai Shao (Paeoniae Radix Alba), Su Zi (Perillae Fructus), Xian Shi Hu (Dendrobii Caulis Recens), Jiang Xiang (Daemonorops Spatha), Da Huang (Rhei Radix et Rhizoma) (stir-fried with vinegar into charcoal), Ou Zhi (Lotus Root Juice), Hei Shan Zhi (Gardeniae Fructus Charred), Bai Bian Dou (Dolichos Lablab Seed), Pi Pa Ye (Loquats Folium).
Patient Cheng: Cough progressing to blood loss and hoarseness, fluids withered, consumption established. Pulse form is fine and weak, internal deficit of essence and qi. The *Neijing* states that for conditions beyond the reach of acupuncture and herbs, sweet medicines should be used to regulate. The *Jingui Yaolue* follows this to establish Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle), urgently establishing middle qi so that diet increases, fluids and qi prosper, yang generates yin, and true yin deficiency is restored. There is no other good method besides this. We imitate its intent and modify it.
Huang Qi (Astragali Radix) (processed with 3 fen of Qiu Shi dissolved in water, stir-fried until scorched), Fu Shen (Poria with Hostwood), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Yu Zhu (Polygonati Odorati Rhizoma), Sha Shen (Glehniae Radix), Ju Bing (Citri Reticulatae Pericarpium Preserved).
Patient Gu: Alcohol consumers suffer from damp-heat steaming; the lungs suffer fire punishment and lose their clear-descending command. Cough, hoarseness, hemoptysis with red sputum, throat obstruction and dryness—all are signs of lung fire, not entirely yin deficiency. Although unrestrained fire will eventually injure yin, abstaining from alcohol is paramount. Treatment focuses on clearing and descending the high source (lungs) and nourishing stomach yin.
Sha Shen (Glehniae Radix), Tian Xing Ren (Armeniacae Semen Amarum), Dan Pi (Moutan Cortex), Yuan Shen (Scrophulariae Radix), Shan Zhi (Gardeniae Fructus), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Qian Cao Tan (Rubiae Radix Carbonized), Ji Ju Zi (Caraganae Corolla), Ou Zhi (Lotus Root Juice), Mao Gen (Imperatae Rhizoma).
Certain Patient: Initially cold-fluid retention cough, later transforming into fire moving blood. Over one to two years, blood disorders repeatedly stop and recur, cough persists, pulse wiry, body emaciated. Fluid retention remains, yin-blood is depleted. Quietness aggravates cough (quietness belongs to yin, fluid retention arises from yin); movement causes qi to rise (movement belongs to yang, qi rising arises from fire). Yin deficiency with phlegm-fluid retention is evident. Prescribing Jin Shui Liu Jun Tang combined with Du Qi Wan method: tonify kidney yin to grasp qi, transform stomach phlegm to eliminate fluid retention. When fluid retention clears, cough decreases; when qi grasps, fire does not rise.
Da Sheng Di (Raw Rehmanniae Radix) (stir-fried with Hai Fu Shi), Ban Xia (Pinelliae Rhizoma) (processed with Qing Yan), Mai Dong (Ophiopogonis Tuber) (stir-fried with Yuan Mi), Wu Wei Zi (Schisandrae Fructus) (stir-fried), Zi Shi Ying (Fluorite), Dan Pi (Moutan Cortex) (stir-fried into charcoal), Niu Xi (Achyranthis Bidentatae Radix) (stir-fried with salt water), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) (stir-fried), Ge Qiao (Trionycis Carapax et Plastrum) (crushed), He Zi (Terminalia Chebulae Fructus), Fu Ling (Poria), Qing Qian (Lead), Pi Pa Ye (Loquats Folium) (honey-fried).
Note by Yuan: Hemoptysis is not entirely caused by yin deficiency. If chronic cough due to phlegm-fluid retention damages stomach collaterals, and stomach qi fails to descend, blood comes following rebellious qi. Treating phlegm-fluid retention and descending stomach qi will naturally stop bleeding. Merely engaging in yin-nourishing may cause qi to rebel further and bleeding to increase.
Patient Fan: Pulse is deficient and rapid, especially deficient in both Chi positions. Heart, liver, spleen, and stomach are all affected, but the kidney alone is deficient. Heart and liver fire are hyperactive, damaging lungs and stomach. Phlegm arises from dampness, blood follows rebellious qi. Cough with yellow sputum streaked with blood, heat felt in palms. Method: Nourish kidney yin to clear heart and liver fire, and descend lung and stomach qi.
Da Sheng Di (Raw Rehmanniae Radix) (mixed with Hai Fu Shi), Dan Pi Tan (Moutan Cortex Carbonized), Sha Shen (Glehniae Radix), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Bai Bian Dou (Dolichos Lablab Seed), Tian Xing Ren (Armeniacae Semen Amarum), Qian Cao Tan (Rubiae Radix Carbonized), Sheng Yi Yi Ren (Coix Seed Recens), E Jiao (Donkey-hide Gelatin) (stir-fried with rice flour), Fu Ling (Poria), Ou Jie (Lotus Root Node), Pi Pa Ye (Loquats Folium).
Patient Gu: Headache and vomiting blood occur in the morning, undoubtedly fire in yang meridians. Method: Clear and descend.
Xi Jiao (Rhinocerotis Cornu - note: usually substituted with Buffalo Horn in modern practice), Ling Yang Jiao (Saiga Antelope Horn), Mai Dong (Ophiopogonis Tuber), Shi Jue Ming (Haliotidis Concha), Sheng Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Dan Pi (Moutan Cortex) (stir-fried until scorched), Zhu Ye (Bambusae Folium), Gou Gou (Uncariae Ramulus cum Uncis).
Second visit: Clearing and draining fire of the Yangming meridian, headache has reduced; continue previous method.
Ling Yang Jiao (Saiga Antelope Horn), Yuan Shen (Scrophulariae Radix), Sheng Shi Gao (Gypsum Fibrosum), Mai Dong (Ophiopogonis Tuber), Ze Xie (Alismatis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Shi Jue Ming (Haliotidis Concha), Dan Qin (Scutellariae Radix light), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma).
Patient Xu: Cold shape and cold drinks injure the lungs; two colds interacting injure both interior and exterior, causing rebellious qi and cough. Cough with desire to vomit is called Stomach Cough. Adding strenuous labor injures yang collaterals. Blood in sputum persisting for a long time easily enters the realm of consumption.
Xuan Fu Hua (Inulae Flos), Dai Zhe Shi (Haematitum), Xing Ren (Armeniacae Semen Amarum), Dan Pi (Moutan Cortex), Yu Jin (Curcumae Radix), Ban Xia Qu (Pinelliae Fermented Rhizoma), Kuan Dong Hua (Farfarae Flos), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Zi Wan (Asteris Radix), Fu Ling (Poria), Pi Pa Ye (Loquats Folium).
Certain Patient: Cough with hemoptysis, afternoon fever, loose stools, abdominal mass with attacking pain. Lung and kidney yin damaged, spleen yang weak again, liver wood horizontal in the middle. Diet intake is low, granaries empty, heart hangs like an empty gourd, what reliance prevents fear?
Dang Shen (Codonopsis Radix), Bai Shao (Paeoniae Radix Alba) (mixed and stir-fried with 3 fen of Wu Zhu Yu), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Zao Ren (Ziziphi Spinosae Semen), Xin Hui Pi (Xinhui Citri Reticulatae Pericarpium), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Kuan Dong Hua (Farfarae Flos), Dan Pi (Moutan Cortex) (stir-fried until scorched), Fu Shen (Poria with Hostwood), Sha Yuan Zi (Astragali Complanati Semen), Sheng Gu Ya (Germinatio Hordei).
Certain Patient: Injury from hunger/fullness and overwork affects the stomach. The stomach is the residence of abundant qi and blood; stomach injury causes blood to be vomited. Method: Harmonize stomach, descend qi, resolve stasis.
Sha Shen (Glehniae Radix), Sheng Yi Yi Ren (Coix Seed Recens), Dan Pi (Moutan Cortex) (stir-fried until scorched), Qian Cao Tan (Rubiae Radix Carbonized), Xing Ren (Armeniacae Semen Amarum), Yu Jin (Curcumae Radix), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Tao Ren Ni (Persicae Semen Paste), Bai Bian Dou (Dolichos Lablab Seed), Fu Ling (Poria), Ou Jie (Lotus Root Node).
Certain Patient: Cough turning into consumption is hardest to treat, transmitted by Ge Shi in *Shi Yao Shen Shu*. Generate fluids, smooth qi, transform turbid phlegm; tonify blood, calm spirit in sequence. Disease lasting a year depletes original qi; approaching Spring Equinox fears danger. "Ability to digest food leads to prosperity," as ancients said; tentatively prescribe a formula to tonify spleen and stomach.
Yu Zhu (Polygonati Odorati Rhizoma), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Sheng Yi Yi Ren (Coix Seed Recens), Bai Bian Dou (Dolichos Lablab Seed), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Fu Ling (Poria), Tian Xing Ren (Armeniacae Semen Amarum), Kuan Dong Hua (Farfarae Flos), Sheng Gu Ya (Germinatio Hordei), Sha Shen (Glehniae Radix).
Patient Zhu: Overwork and worry deplete internal yin fluids and original qi. Spleen loses transport, generating phlegm; lungs lose descending, causing cough. Blood in sputum, occasional internal heat. Root of consumption, do not underestimate.
Da Shu Di (Prepared Rehmanniae Radix), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Sheng Yi Yi Ren (Coix Seed Recens), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Dan Pi (Moutan Cortex) (stir-fried until scorched), Tian Xing Ren (Armeniacae Semen Amarum), Mai Dong (Ophiopogonis Tuber), Fu Shen (Poria with Hostwood), Ban Xia (Pinelliae Rhizoma), Pi Pa Ye (Loquats Folium).
Patient Lv: Pulse rapid, left Cun particularly sharp, fire in heart meridian, continuous hemoptysis. Method: Clear and nourish.
Xi Jiao (Rhinocerotis Cornu), Xian Sheng Di (Raw Rehmanniae Radix Recens), Dan Qin (Scutellariae Radix light), E Jiao (Donkey-hide Gelatin) (stir-fried with Pu Huang), Dan Pi (Moutan Cortex) (stir-fried until scorched), Shan Zhi (Gardeniae Fructus), Xing Ren (Armeniacae Semen Amarum), Qian Cao Tan (Rubiae Radix Carbonized), Mao Gen (Imperatae Rhizoma), Ou Jie (Lotus Root Node).
Patient Pang: Last autumn cough with slight blood, treated and cured. Entering spring, massive hemoptysis, cough persists, accompanied by chills and fever, lighter in morning, worse in evening, poor appetite, incessant head sweating. True yin greatly deficient, deficient yang hyperactive, lung metal scorched, spleen and stomach damaged, fluids consumed day by day, original qi damaged day by day. Pulse deep, fine, and choppy, mouth sticky yet dry. Extreme deficiency leads to consumption, difficult to manage. Tentatively prescribe Sheng Mai San combined with Liu Jun Zi Tang to protect lungs, clear metal, regulate yuan, and tonify qi. Re-evaluate after passing summer.
Sheng Yang Shen (Fresh American Ginseng), Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus), Bai Bian Dou (Dolichos Lablab Seed), Zhi Ban Xia (Prepared Pinelliae Rhizoma), Fu Shen (Poria with Hostwood), Chen Pi (Citri Reticulatae Pericarpium), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Pi Pa Lu (Loquat Syrup) (1 small cup, mixed in), Ye Qiang Wei Lu (Wild Rose Dew) (1 small cup each, mixed in).
Sheng Mai San protects lungs and clears metal. Liu Jun Zi Tang removes Bai Zhu to avoid dryness, adds Bian Dou to cultivate spleen yin; when earth prospers, it naturally generates metal. Avoid yin-nourishing and heat-clearing herbs: first, fear cloying intestines; second, fear cooling damaging stomach. Chronic illness always prioritizes stomach qi; Classics say "With stomach, there is life," this is the way.
Patient Lei: Chronic cough with blood, now hoarse with sore throat, caused by anger stirring liver fire, lungs losing clear-descending, known as "broken metal does not sound." Method: Cultivate earth to generate metal, slightly assist in descending fire.
Sha Shen (Glehniae Radix), Tian Xing Ren (Armeniacae Semen Amarum), Bai Bian Dou (Dolichos Lablab Seed), Yuan Shen (Scrophulariae Radix), Fu Ling (Poria), Jie Geng (Platycodonis Radix), Sheng Yi Yi Ren (Coix Seed Recens), Chan Yi (Bombyx Batryticatus), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Yu Zhu (Polygonati Odorati Rhizoma), Bai Mi (White Honey), Zhu Ban You (Pig Back Fat) (melted with honey, mixed in).
Patient Xue: Hemoptysis, epistaxis, gingival bleeding, macules with bleeding within macules, indicating extreme blazing of Yangming fire. Abdominal fullness with softness, shaoyin qi not transporting. Disease for three months, bleeding intermittent, due to blood stasis in abdomen. Poor appetite, body heat, rapid pulse, yin already deficient. Method: Nourish yin, resolve stasis, clear stomach, harmonize middle.
Da Sheng Di (Raw Rehmanniae Radix), Wu Ling Zhi (Trogopterori Faeces) (stir-fried with vinegar), Gui Shen Tan (Angelicae Sinensis Radix Carbonized), Xi Jiao (Rhinocerotis Cornu), Bai Shao (Paeoniae Radix Alba), Pao Jiang Tan (Charred Ginger), Qian Cao Tan (Rubiae Radix Carbonized), Fu Ling (Poria), Dan Pi Tan (Moutan Cortex Carbonized), Jiao Shan Zhi (Gardeniae Fructus Scorched), Jing Jie Tan (Schizonepetae Herba Carbonized), Yan Hu Suo (Corydalis Rhizoma) (stir-fried with vinegar), Chen Pi (Citri Reticulatae Pericarpium) (stir-fried with salt water), Xian Ou (Lotus Root Recens).
Second visit: Blood overflowing above and below is blamed on middle deficiency, with pathogens disturbing again. After much blood loss, residual heat blazes upward, epistaxis flows intermittently, hematochezia occurs intermittently, disturbance in the central region continues. Stabilize the central region, clear pathogenic heat, treat with Li Zhong Tang modified.
Xi Yang Shen (American Ginseng) (processed with Yuan Mi), Bai Zhu Tan (Atractylodis Macrocephalae Rhizoma Carbonized), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized), Huang Qin (Scutellariae Radix), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Qian Cao Tan (Rubiae Radix Carbonized), Dan Pi Tan (Moutan Cortex Carbonized), Pao Jiang Tan (Charred Ginger), Chi Fu Ling (Poria cum Rubro), Bai Cao Shuang (Herba Artemisiae Argyi Carbonized), Fu Long Gan (Caulis Longanae Arillus Decocted Sediment).
Note by Yuan: Spleen yin deficiency with latent heat disturbing blood level, Hei Gui Pi Tang and Hei Di Huang Wan are most suitable.
Certain Patient: Hemoptysis starts and stops intermittently, yang collateral injured, possibly with stasis condensation, not worth worrying about. After bleeding stops, throat itching and dry cough are inappropriate. Dry cough implies qi heat and fire movement; fire movement makes bleeding hard to avoid. If internal heat adds, it easily enters the path of consumption. Currently, stomach intake is very low, first discuss nourishing stomach yin.
Chuan Shi Hu (Dendrobii Caulis), Dan Pi (Moutan Cortex), Yu Jin (Curcumae Radix), Fu Ling (Poria), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Sheng Yi Yi Ren (Coix Seed Recens), Mai Dong (Ophiopogonis Tuber), Sha Shen (Glehniae Radix), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Bai Bian Dou (Dolichos Lablab Seed), Xian Ou (Lotus Root Recens).
Patient Xue: Chronic phlegm-fluid retention cough, cough damages lung collaterals, blood loss. Pulse not rapid, tongue coating white. No need for excessive clearing. Just smooth qi and transform phlegm; when qi is smooth, blood returns to vessels; when phlegm transforms, cough stops.
Su Zi (Perillae Fructus), Xing Ren (Armeniacae Semen Amarum), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Qian Cao Tan (Rubiae Radix Carbonized), Yu Jin (Curcumae Radix), Sang Bai Pi (Mori Cortex), Dan Pi (Moutan Cortex), Ge Qiao (Trionycis Carapax et Plastrum), Dong Gua Zi (Benincasae Semen), Ou Jie (Lotus Root Node), Pi Pa Ye (Loquats Folium).
Note by Yuan: Not only should one not clear excessively, one simply should not clear. Zhongjing said: Phlegm-fluid retention must be harmonized with warm herbs. Truly concise and essential.
Patient Hua: Cough internally damages meridians, massive hemoptysis. Pulse not rapid, body not hot, mouth not thirsty, do not blindly use cooling herbs for blood. Method: Benefit stomach, prescribe Li Zhong Tang modified.
Dang Shen (Codonopsis Radix) (stir-fried with Yuan Mi), Bai Bian Dou (Dolichos Lablab Seed) (stir-fried until scorched), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Pao Jiang (Charred Ginger), Bai Shao (Paeoniae Radix Alba), Gui Shen Tan (Angelicae Sinensis Radix Carbonized), Xue Yu Tan (Calami Capillaris Carbonized), Dan Pi Tan (Moutan Cortex Carbonized), Xing Ren (Armeniacae Semen Amarum), Ou Jie (Lotus Root Node), Chen Jing Mi (Aged Rice).
Patient Li: Alcohol injury causing hemoptysis, blood originates from stomach. Although seemingly harmless, yin has been deficient for a long time. Method: Harmonize stomach, descend fire.
Xian Shi Hu (Dendrobii Caulis Recens), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Dan Pi (Moutan Cortex), Bai Bian Dou (Dolichos Lablab Seed), Fu Ling (Poria), Shan Zhi (Gardeniae Fructus), Bai Shao (Paeoniae Radix Alba), Sha Shen (Glehniae Radix), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Yuan Shen (Scrophulariae Radix), Mao Gen (Imperatae Rhizoma), Xian Ou (Lotus Root Recens).
Patient Qian: Internally yin deficiency with fire, externally deep cold pathogen invasion. Blood loss and cough, plus triple malaria, disease for months. Malaria attacks cause heart/chest pain, hollow feeling in chest/abdomen.
Classics say: Yang Wei disease suffers chills and fever; Yin Wei disease suffers heart pain. This is deficiency of yin-yang, ying, and wei. Prescribe Huang Qi Jian Zhong method to harmonize yin-yang of middle zang and regulate ying-wei. Combine with Sheng Mai to protect lung yin, and Fu Mai to protect kidney yin. Comprehensive strategy, logical and thorough.
Gui Shen Tan (Angelicae Sinensis Radix Carbonized), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Da Sheng Di (Raw Rehmanniae Radix) (stir-fried with Sha Ren), Wu Wei Zi (Schisandrae Fructus), Bie Jia (Testudinis Carapax et Plastrum), Huang Qi (Astragali Radix), Qing Hao (Artemisiae Annuae Herba), Sha Shen (Glehniae Radix), Bai Shao (Paeoniae Radix Alba) (mixed and stir-fried with 3 fen of Gui Zhi), E Jiao (Donkey-hide Gelatin), Mai Dong (Ophiopogonis Tuber), Wei Sheng Jiang (Ginger Recens roasted), Hong Zao (Jujubae Fructus).
Note by Yuan: Triple malaria chills and fever are not Yang Wei disease. Heart/chest pain and difficulty breathing are due to cold-phlegm in stomach, latent heat in liver, loss of descending function in lungs and stomach, plus cold pathogen invasion causing hemoptysis. Cloying tonification formulas may not be suitable.
Patient Yin: Liver-stomach disharmony, epigastric pain and acid regurgitation, compounded by alcohol-dampness steaming the stomach. Stomach is the residence of abundant qi and blood, hence vomiting large amounts of dark blood. After bleeding stops, epigastric distension and acid regurgitation persist. Method: Harmonize liver and stomach, strictly avoid cold/cool herbs.
Zhi Ban Xia (Prepared Pinelliae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Yu Jin (Curcumae Radix), Wu Yao (Linderae Radix), Tao Ren Ni (Persicae Semen Paste), Pao Jiang Tan (Charred Ginger), Yan Hu (Corydalis Rhizoma), Fu Ling (Poria), Xiang Fu (Cyperi Rhizoma), Ji Ju Zi (Caraganae Corolla), Su Geng (Perillae Caulis).
Patient Sun: Heat in the middle jiao, occasionally vomiting red sputum with odor, not much cough. Disease is in the stomach, latent heat in the central palace. Method: Clear and drain.
Xi Jiao (Rhinocerotis Cornu), Dong Gua Zi (Benincasae Semen), She Gan (Belamcandae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Tao Ren (Persicae Semen), Yi Yi Ren (Coix Seed), Yuan Ming Fen (Natrii Sulfatis Crystal), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Lian Qiao (Forsythiae Fructus), Da Huang (Rhei Radix et Rhizoma) (soaked in wine and stir-fried), Jin Yin Hua (Lonicerae Japonicae Flos).
Second visit: No cough, but vomiting red sputum like pus, feeling burning heat in epigastrium, nearly two months. This is not Lung Abscess, but stasis-injury with damp-heat remaining in the stomach. Method: Clear and transform.
Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Dong Gua Zi (Benincasae Semen), Dang Gui (Angelicae Sinensis Radix), Yi Yi Ren (Coix Seed), Sha Shen (Glehniae Radix), Lian Qiao (Forsythiae Fructus), Chuan Shi Hu (Dendrobii Caulis), Jin Yin Hua (Lonicerae Japonicae Flos), Chi Dou (Adzuki Bean), Lu Gen (Phragmitis Rhizoma).
Patient Yu: Throughout spring, summer, and autumn, blood disorders recur frequently. Pulse deficient, appearance thin, age seventeen, essence not filled but leaked early, yin loses control and fire rises. Future untreatable disease, perhaps fulfilling Chu Shi's words. Method: Nourish water to descend fire, self-care is essential.
Da Sheng Di (Raw Rehmanniae Radix), Sheng Yang Shen (Fresh American Ginseng), Dan Pi Tan (Moutan Cortex Carbonized), Fu Shen (Poria with Hostwood), Bai Bian Dou (Dolichos Lablab Seed) (stir-fried until scorched), Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma), Qian Cao Tan (Rubiae Radix Carbonized), E Jiao (Donkey-hide Gelatin) (stir-fried with Pu Huang), Mai Dong (Ophiopogonis Tuber), Mao Gen (Imperatae Rhizoma), Lian Rou (Nelumbinis Semen), Xian Ou (Lotus Root Recens).
Yuan Ren says: Youthful hemoptysis often starts with nocturnal emission; nocturnal emission often stems from delusional thoughts. At sixteen, male essence channels open, desires arise. If aroused but not satisfied, ministerial fire moves frequently. Continuous movement prevents closure of the essence gate, leading to dream intercourse and seminal leakage. Lower yin essence deficient, ministerial fire flares upward, forcing blood vessels...