时复者。谓血家春夏得病。至次年春夏复发。秋冬得病。至次年秋冬。其病复发。值其时而仍病。故曰时复。
夫人身五脏六腑。与天之气运。呼吸相通。原是一体。故天之阴阳。能构人之疾病。其实非天病患也。乃人
身气血先有偏盛。故感天气之偏盛。而病遂作焉。
血家病得于春者。乃肝经血虚火旺。春木之气。内通于肝。肝经感木气。而风动火发。故值春时。旧病复作。
其已发吐血者。宜地骨皮饮。加蒲黄黄芩龙胆草杏仁柴胡荆芥。醋炒大黄治之。尚未发作者。须服五味
逍遥散。加牡蛎阿胶龙骨香附子五味子。或用左归饮。加阿胶龟板牡蛎五味子。以滋养之。使肝肾阴足。
则火伏而不动矣。凡冬日春时。得血病者。均宜用此法。以养肝肾。使阳气封谧而不泄。斯病不发矣。又凡
肝经火动者。必先有热蒸口苦。魂梦不宁诸证。柴胡清骨散亦治之。
失血之病。得于夏者。乃心经火旺。次逢夏月复发。宜泻心汤。加丹皮蒲黄生地黄木通甘草梢降香牛膝。
其未发时。若见烦热。即宜预服生地黄散。以遏止之。或天王补心丹以养之。又按夏月暑盛。病多发于阳
明。以阳明主燥热。暑热相合。故多属阳明。病在阳明者。口渴身热。烦躁便闭。恶闻人声。脉势洪大。以此为
辨。其吐出之血。亦必甚多。宜犀角地黄汤。加葛根金银花知母蒲黄大黄枳壳。若尚未动血。初觉发热口
渴者。玉女煎。加蝉蜕秦皮茵陈枳壳。或先服甘露饮。以养胃阴。免动燥气。
秋乃金令。肺气主之。凡失血家。至秋时皮毛收敛。未能秘密。往往外合风气。内壅热邪。发咳动血。尤为容
易。病家医家。皆须善为调理。庶可补天再造也。若是秋时得病。是病本得于肺。次逢秋月。本脏不润。复发
痿燥。而咳血者。清燥救肺汤。加生地蒲黄治之。人参清肺汤。加紫菀当归蒲黄亦可。葛可久太平丸。既滋
肺阴。兼清风痰。尤治肺良方。若肺气郁而不布。卫阳不外达。津液不下降。皮毛洒淅。寒热作咳者。宜小柴
胡。加荆芥防风桔梗杏仁蒲黄苏木栝蒌根麦冬桑皮陈皮枇杷叶治之。风寒客于肺中。久咳不止者。宜
千金麦门冬汤。其麻黄捣茸炙过。以搜陈寒。或重用太平丸。重加薄荷。亦和散之法。
冬令属水。肾气主之。此时阴气坚凝。则阳气潜藏。龙雷不作。若阴气不足。则阳气不潜。况此时阳气皆入
于内。人身阴虚者。既多内热。加以阳气入内。两热相合。致失冬令寒热之象。此与冬行夏令无异。是以火
迫血动。而复发也。治法。宜滋肾阴。泄内热。使其阴凝阳秘。复成为大冬之令。斯病愈矣。已动血者。玉女煎。
加蒲黄丹皮苏木。继服大补阴丸。六味丸。以收功。乘其未发。先用麦味地黄汤滋之。火之不藏。如三冬不
雪。腊月鸣雷。潜纳阳气。皆可加龙骨牡蛎。吾于冲脉言之甚详。须参看。
凡物有根者。逢时必发。失血何根。瘀血即其根也。故凡复发者。其中多伏瘀血。以及遇节气。遇阴雨。而即
蒸热发动者。均是瘀血为病。宜血府逐瘀汤。加干漆桃奴治之。或用仲景大黄 虫丸。少少与之。此理须
知。方不为血证所瞒。
所谓“时复”，是指有出血病史的患者，在春季或夏季患病，到了第二年的春、夏季节病情复发；若在秋季或冬季患病，则到次年的秋、冬季节复发。正值相应的时节而疾病再次发作，因此称为“时复”。
人的五脏六腑与自然界的气候运行，通过呼吸相互贯通，原本就是一个整体。因此，自然界的阴阳变化能够引发人体的疾病。这其实并非天灾致病，而是人体内的气血先有偏盛偏衰，从而感应了自然界气候的偏盛，导致疾病发生。
失血患者如果在春季发病，是由于肝经血虚而火旺。春季属木，其气内通于肝。肝经感受了春季的木气，导致风动火发，因此在春季时令，旧病就会复发。对于已经发作出现吐血症状的，宜用地骨皮饮，加入蒲黄、黄芩、龙胆草、杏仁、柴胡、荆芥，以及用醋炒的大黄来治疗。对于尚未发作的，必须服用五味逍遥散，加入牡蛎、阿胶、龙骨、香附子、五味子；或者使用左归饮，加入阿胶、龟板、牡蛎、五味子，以滋养肝肾，使肝肾阴液充足，则虚火潜伏而不妄动。凡是冬季或春季得血证的，都适宜采用这种方法，以滋养肝肾，使阳气封藏静谧而不外泄，这样疾病就不会复发。另外，凡是肝经火动的，必定先有热蒸口苦、神魂梦境不安等症状，柴胡清骨散也可以治疗这些症状。
失血类疾病如果在夏季发病，是由于心经火旺，次年遇到夏季月份而复发。宜用泻心汤，加入丹皮、蒲黄、生地黄、木通、甘草梢、降香、牛膝。在未发作的时候，如果见到烦热的症状，就应当预先服用生地黄散，以遏制病情；或者服用天王补心丹来滋养心神。另外，夏季暑气旺盛，疾病多发生在阳明经，因为阳明经主燥热，暑热相合，所以多属于阳明病。病在阳明经的，表现为口渴、身热、烦躁、大便闭塞、厌恶听到人声，脉象洪大，以此作为辨证依据。此时吐出的血量必然很多，宜用犀角地黄汤，加入葛根、金银花、知母、蒲黄、大黄、枳壳。如果尚未动血，刚开始感觉发热口渴的，可用玉女煎，加入蝉蜕、秦皮、茵陈、枳壳；或者先服用甘露饮，以滋养胃阴，避免燥气扰动。
秋季是金气当令，由肺气所主。凡是失血患者，到了秋季皮毛收敛，未能固密，往往外感风气，内蕴热邪，引发咳嗽并导致出血，这种情况尤为容易发生。病人和医生都必须善于调理，才有可能使身体恢复健康。如果是秋季得的病，说明病本在于肺，次年遇到秋月，本脏津液不足不润，复发为痿弱干燥，导致咳血的，宜用清燥救肺汤，加入生地黄、蒲黄治疗；人参清肺汤，加入紫菀、当归、蒲黄也可以使用；葛可久的太平丸，既能滋养肺阴，又能清风痰，更是治疗肺病的良方。如果肺气郁结不能布散，卫阳不能向外通达，津液不能向下输布，出现皮肤战栗、寒热交替并伴有咳嗽的，宜用小柴胡汤，加入荆芥、防风、桔梗、杏仁、蒲黄、苏木、栝蒌根、麦冬、桑白皮、陈皮、枇杷叶治疗。风寒客居于肺中，导致久咳不止的，宜用千金麦门冬汤。其中的麻黄需捣碎成茸并炙过，以搜剔陈寒；或者重用太平丸，加重薄荷用量，这也是和解发散的方法。
冬季属水，由肾气所主。此时阴气坚凝，阳气潜藏，龙雷之火不作。如果阴气不足，阳气就不能潜藏。况且此时阳气都进入体内，人体阴虚者本就多有内热，加上阳气入内，两热相合，导致失去了冬季应有的寒象。这与冬天施行夏令无异，因此火热逼迫血液妄行，导致疾病复发。治疗方法，宜滋补肾阴，清泄内热，使其阴凝阳秘，重新恢复冬季闭藏的时令特征，这样疾病就能痊愈。已经动血的，用玉女煎，加入蒲黄、丹皮、苏木；继服大补阴丸、六味丸，以巩固疗效。趁着未发作时，先用麦味地黄汤滋养。对于火不潜藏的情况，就像冬天不下雪、腊月打雷一样，潜纳阳气的方法，都可以加入龙骨、牡蛎。我在冲脉的理论中论述得很详细，需要参考查阅。
凡是物体有根的，遇到时节必定发作。失血病的“根”是什么？瘀血就是它的根。所以凡是复发的失血病，其中大多潜伏着瘀血，以及遇到节气变化、阴雨天气就立即产生蒸热并发动疾病的，都是瘀血致病。宜用血府逐瘀汤，加入干漆、桃奴治疗；或者使用张仲景的大黄䗪虫丸，少量给予。这个道理必须知晓，才不会为血证所蒙蔽。
"Shi Fu" (Time-Recurrence) refers to the condition where patients with a history of bleeding disorders fall ill in spring or summer, and the disease recurs in the following spring or summer; if they fall ill in autumn or winter, it recurs in the following autumn or winter. The disease re-emerges precisely when the corresponding season arrives, hence the term "Shi Fu."
The five zang organs and six fu organs of the human body communicate with the climatic movements of heaven through respiration, originally forming one entity. Therefore, the yin and yang of heaven can induce diseases in humans. In reality, this is not caused by heavenly pathogenic factors, but rather because the qi and blood within the human body are already imbalanced (excess or deficiency). Consequently, they resonate with the excessive climatic conditions of nature, leading to the onset of disease.
When a patient with bleeding tendencies falls ill in spring, it is due to blood deficiency and hyperactive fire in the Liver Meridian (Liver Channel). Spring corresponds to Wood, and its qi internally connects to the Liver. When the Liver Meridian is affected by the Wood qi, wind stirs and fire erupts; thus, at the arrival of spring, the old illness recurs. For those who have already manifested hematemesis (vomiting blood), Digupi Yin (Bark of Ground Cherry Decoction) should be used, added with Puhuang (Pollen Typhae), Huangqin (Scutellaria Root), Longdancao (Gentiana Root), Xingren (Apricot Seed), Chaihu (Bupleurum Root), Jingjie (Schizonepeta Spike), and Dahuang (Rhubarb Root) stir-fried with vinegar. For those whose symptoms have not yet manifested, Wuwei Xiaoyao San (Five-Ingredient Free and Easy Wanderer Powder) should be taken, added with Muli (Oyster Shell), Ejiao (Donkey-Hide Gelatin), Longgu (Fossilized Bone), Xiangfuzi (Cyperus Rhizome), and Wubeizi (Chinese Gallnut). Alternatively, Zuogui Yin (Left Restoring Decoction) can be used, added with Ejiao, Guiban (Turtle Shell), Muli, and Wubeizi, to nourish the Liver and Kidney. This ensures sufficient Yin of the Liver and Kidney, causing the fire to subside and remain dormant. This method is suitable for all blood disorders occurring in winter or spring, to nourish the Liver and Kidney, allowing Yang Qi to seal and remain tranquil without leaking, thereby preventing recurrence. Furthermore, whenever Liver Meridian fire stirs, there must first be symptoms such as steaming heat with bitter taste in the mouth and restless dreams. Chaihu Qinggu San (Bupleurum Bone-Clearing Powder) is also indicated for these symptoms.
For bleeding disorders occurring in summer, it is due to hyperactive fire in the Heart Meridian, recurring upon the arrival of the summer months. Xiexin Tang (Drain the Heart Decoction) should be used, added with Danpi (Moutan Bark), Puhuang, Shengdihuang (Rehmannia Root), Mutong (Akebia Stem), Gancaoshao (Licorice Root Tip), Jiangxiang (Sappan Wood), and Niuxi (Achyranthes Root). During periods when symptoms have not yet manifested, if irritability and heat are observed, Shengdihuang San (Rehmannia Powder) should be administered preemptively to suppress them; or Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill) can be used for nourishment. Additionally, during summer, summerheat is abundant, and diseases often occur in the Yangming channel, as Yangming governs dryness and heat. The combination of summerheat and heat makes it mostly belong to Yangming pathology. Symptoms of Yangming involvement include thirst, fever, restlessness, constipation, aversion to hearing voices, and a surging pulse. These serve as diagnostic criteria. The amount of blood vomited will necessarily be large; Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used, added with Gegen (Kudzu Root), Jinyinhua (Honeysuckle Flower), Zhimu (Anemarrhena Rhizome), Puhuang, Dahuang, and Zhike (Bitter Orange Fruit). If bleeding has not yet occurred and only initial fever and thirst are felt, Yuni Jian (Jade Woman Decoction) can be used, added with Chantui (Cicada Slough), Qinpi (Ash Bark), Yinchchen (Artemisia Capillaris), and Zhike. Or, Ganlu Yin (Sweet Dew Decoction) can be taken first to nourish Stomach Yin, avoiding the disturbance of dryness qi.
Autumn is governed by Metal, with Lung Qi taking charge. For patients with bleeding disorders, upon reaching autumn, the skin and hair pores contract but fail to seal completely. They often combine external Wind pathogens with internal Heat stagnation, triggering cough and inducing bleeding, which occurs particularly easily. Both patients and physicians must manage care skillfully to restore health. If the illness originated in autumn, the root lies in the Lung. Upon encountering autumn months, the organ lacks moisture, recurring as flaccidity and dryness, leading to hemoptysis (coughing up blood). Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) should be used, added with Shengdihuang and Puhuang. Renshen Qingfei Tang (Ginseng Lung-Clearing Decoction) added with Ziwan (Aster Root), Danggui (Angelica Sinensis), and Puhuang is also acceptable. Ge Kejiu's Taiping Wan (Taiping Pill) nourishes Lung Yin while clearing Wind-Phlegm, making it an excellent formula for lung diseases. If Lung Qi is stagnant and fails to distribute, Wei Yang (Defensive Yang) fails to reach the exterior, and Body Fluids fail to descend, presenting with chills, alternating fever, and cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used, added with Jingjie, Fangfeng (Saposhnikovia Root), Jiegeng (Platycodon Root), Xingren, Puhuang, Sumu (Sappan Wood), Gualougen (Trichosanthes Root), Maidong (Ophiopogon Tuber), Sangbaipi (Mulberry Bark), Chenpi (Tangerine Peel), and Pipaye (Loquat Leaf). If Cold-Wind invades the Lungs causing persistent chronic cough, Qianjin Maodong Tang (Thousand Gold Magnolia Root Decoction) is indicated. The Mahuang (Ephedra) should be pounded into pulp and roasted to search out lingering cold. Alternatively, heavy use of Taiping Wan with increased Bohe (Mint) serves as a harmonizing and dispersing method.
Winter belongs to Water, governed by Kidney Qi. At this time, Yin Qi is solid and condensed, causing Yang Qi to hide, and Dragon-Lei Fire does not arise. If Yin Qi is insufficient, Yang Qi cannot hide. Moreover, since Yang Qi enters the interior during this period, individuals with Yin deficiency already possess internal heat; combined with the entering Yang Qi, the two heats merge, destroying the characteristic coldness of winter. This is no different from Summer acting in Winter. Thus, Fire forces Blood to move recklessly, causing recurrence. The treatment principle is to nourish Kidney Yin and drain internal heat, restoring the state of Yin condensation and Yang secrecy, returning to the proper Winter command, so the disease may heal. For those who have already bled, Yuni Jian is used, added with Puhuang, Danpi, and Sumu, followed by Dabu Yin Wan (Great Tonify Yin Pill) and Liuwei Wan (Six-Ingredient Pill) to conclude treatment. While prevention is possible, Maiwei Dihuang Tang (Lily and Eucommia Rehmannia Decoction) should be used first to nourish. For Fire failing to store, akin to lack of snow in winter or thunder in the twelfth lunar month, methods to anchor and absorb Yang Qi can include adding Longgu and Muli. I have discussed this extensively regarding the Chong Mai (Penetrating Vessel); please refer to that section.
All things with roots will manifest according to the season. What is the root of bleeding disorders? Blood Stasis (Yu Xue) is its root. Therefore, in cases of recurrence, latent Blood Stasis is often present. Similarly, episodes triggered by solar terms or rainy weather, accompanied by steaming heat and activation, are all caused by Blood Stasis. Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction) added with Ganqi (Dry Lacquer) and Taonu (Dried Peach) should be used. Or, Zhang Zhongjing's Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) can be given in small doses. One must understand this principle to avoid being deceived by bleeding syndromes.