甚哉。阴阳之理微而阴阳之治难也。阴阳之病则变乱。闪烁而莫可捉摸者也。今以失血
言之
。血主阴气主阳。阳之性动。阴之体静。阳之气热。阴之性寒。而阴阳则相维为既济之。水
火也。故气行则血亦行气止则血亦止。气盛则血亦盛。气衰则血亦衰。气热则血燥。气寒则
血凝。气盛而逆。则血因从上见。血虚而陷。则气亦随下脱。其为治也。逆于上者降之。陷
于下者升之。初病阴阳错乱者平之。寒热不调者和之。嗣究其原。应寒则寒。应热则热。应
补则补。应泻则泻。法难定执。治随人施耳。夫血既外溢则阳动之太过也。治专主寒则阴制
之。有余也。益气固云救血未免动而复动。了无归息之日。泻阴虽曰抑阳乃至静而益静殊。
绝
生发之机均非有得乎。治血之。 而亦未识其所以为静之。体矣。虽然、血固种种不一。总
当
循元气脉气形气病气而精辨之也。独怪河涧作俑。谬称诸血无寒。致今庸流混治杀人。遗
不小。殊可悲恨。岂知寒剂治血。惟上古形病俱实者宜之。犀角地黄汤。乃专治胃经积热实
证。只可暂用。中病便止而非疗血之纲剂也。四物汤虽为血药。用芎归则通血之壅滞也。白
芍则收血之耗散也。生地则制火动之阳光也。而非益阴之品。且芍性酸寒。尚伐生气。亦惟
血凝滞及耗散者用之相应。设使阳焰正炽。而辛窜之 归。不益助其上炎之火性乎。失血
甫
定尚留停瘀。最忌固敛。若生地芩连。虽赋性沉寒。固可扑未灭之余焰。独不思脾虚而血不
统血脱而脾愈虚敢用此。而轻泻药脾阳乎。脾本虚而复虚则阴不受摄。而血愈脱矣。察唯诸气
俱实。得有犀角四物本症始可用耳。又有阳焰。未熄而遽投补气之剂是反以动乎。阴尤非
福也。亦须察果元气顿虚色脉两亏。而补中归脾四君十全之属。是所必需。甚至虚寒与气俱
脱。参附八味。忍缓投乎。此则一偏于凉泻。一偏于温补乃为通变之机权。而非正治之活法
也。惟必明乎。为静之体与夫失静之。由庶可语乎。治静之之方矣。血主乎。阴以静为体阴
中蕴。阳静处寓动盖此。静非沉寂之静。乃生化之静。今立一方不专以寒者。恐愈痼真阴也
。又不骤以温者。恐益助邪阳也。议以不濡不燥中和恬静之品。非惟天一可复。且令水火两
平。得葆其静之体。而益完其静之。神者也。治本常法。药非奇草。推求仲景之肾气。允为
疗血之佳珍。设曰熟地膏润。不宜遽补。岂知血脱阴亏内伤。非补何以填阴。丹皮甘香生新
消瘀之良药也。且制燎原。然真阴既耗。元阳少附脾失。资生土气馁矣。必用山药茯苓。平
扶胃气。而非归术温补之比也。泽泻引虚热以下行。石枣固藏血之本经。加炙草则平五火。
益黑栀以敛二络。术无逾此试亦屡效。倘逢肺胃郁热。方增麦芩而减山萸。若疗肝肾实焰。
不
辞连柏而佐芍药。即君主凡火之动。苦寒必需。倘命宫真阳将谢。温热恐后。久饵平剂不愈
。必加益气之参术。错投降火增剧。莫缓升阳之蒡 。第病情变幻。而成方难守。当熟察元
气之虚实。色脉之吉凶。与夫病气之重轻。阳中阴易扶阴中阴难疗阴属经易。治阳属藏亦危
及至用药温凉补泻。新久顺逆。随宜辄应。庶了然无疑于胸中。方可逃枉治之重愆。此特鄙
人蠡见。宜详立斋全案。
太微妙了。阴阳的道理深奥，而调和阴阳的治疗也很困难。阴阳失调就会发生病变，这种变化闪烁不定，难以捉摸。现在以失血病为例来说明：血属于阴，气属于阳。阳的特性是运动，阴的形体是静止；阳的气性是热，阴的本性是寒。阴阳相互维系，就像水火既济的关系。所以气行则血也行，气止则血也止；气盛则血也盛，气衰则血也衰；气热则血燥，气寒则血凝。如果气盛而上逆，血液就会随气上溢而出；如果血虚而下陷，气也会随之脱陷于下。治疗时，对于气逆于上的要降逆，对于气陷于下的要升提；初病时阴阳错乱的要使其平复，寒热不调的要使其调和。随后探究病因本源，该用寒法的就用寒法，该用热法的就用热法，该补的就补，该泻的就泻。治疗方法不能死板固执，而是根据患者的具体情况灵活施治。
既然血液已经外溢，说明阳气动得太过了。如果治疗专门主用寒凉药来抑制它，虽然能制约阳气，但这是有余之治。益气固表固然可以救血，但未免使气动而复动，没有安宁休息的时候。泻阴虽然说是为了抑制阳，但到了极度静止的状态，反而断绝了生机发用的功能。这些都不是真正掌握了治疗血的要领，也没有认识到“静”的本质是什么。
尽管如此，失血的情况确实多种多样，总应当遵循元气、脉象、形气、病气的不同进行精细辨别。唯独令人奇怪的是，朱丹溪（河间）开了头，错误地声称各种出血证都没有寒证，导致如今庸医混治杀人，遗留祸患不小，实在可悲可恨。哪里知道寒凉药物治疗出血，只有上古时期形体和病气都实盛的才适宜使用。犀角地黄汤，是专门治疗胃经积热实证的方法，只可暂时使用，中病即止，并不是治疗出血的根本方剂。四物汤虽然是补血药，但其中川芎、当归的作用是疏通血的壅滞；白芍的作用是收敛血的耗散；生地黄的作用是制约火动的阳光（虚火），而不是益阴的佳品。况且白芍性味酸寒，尚且会伐伤生气，也只适用于血有凝滞及耗散的情况。假如阳焰正炽盛，辛窜的当归岂不是更助长其上炎的火性吗？失血刚刚停止，体内尚留有停瘀，最忌讳固涩收敛。像生地黄、黄芩、黄连，虽然赋性沉寒，确实可以扑灭未灭之余焰，但不想想脾虚而不能统摄血液，血脱则脾更虚，怎么敢轻易使用这些寒凉泻药损伤脾阳呢？脾本已虚，再受寒凉变虚，则阴血无法被摄纳，出血会更加严重。只有当诸气都实盛，且有犀角地黄汤和四物汤的本症时，才可以服用。又有那种阳焰未熄就急于投用补气药剂的，这反而是扰动阴血，尤其不是福气。也必须观察是否确实是元气突然虚弱，面色和脉象两亏，此时补中益气汤、归脾汤、四君子汤、十全大补汤之类的才是必需的。甚至遇到虚寒与气俱脱的情况，人参、附子、八味丸等温补药物，也要谨慎缓投。这些情况是一偏于凉泻，一偏于温补，乃是通变的权宜之计，而不是正治的活法。只有必须明白“静”的体性和失静的缘由，才可以谈论治疗血的静定方剂。
血主属阴，以静为体，阴中蕴藏阳，静处寓动。这个“静”并非沉寂不动的静，而是生化运行的静。现在拟定一方，不专门用寒凉药，是担心进一步伤害真阴；也不骤然用温药，是担心助长邪阳。建议采用不濡润也不干燥、中和恬静的药物。这不仅能使天一之水（肾阴）恢复，而且令水火两平，得以保持其静的体性，并完善其静的神机。这是治本常法，药物并非奇草异卉。推求张仲景的肾气丸，确为治疗出血的佳珍。如果说熟地黄膏润，不宜立即进补，哪里知道血脱阴亏的内伤病，不通过补益如何填补阴精？牡丹皮甘香，是生新消瘀的良药，且能制止燎原之火。然而真阴既然耗损，元阳无所依附，脾失资生之源，土气气馁了。必须用山药、茯苓平和地扶持胃气，而不是当归、白术温补可比。泽泻引导虚热下行，山茱萸固藏血之本经。加入炙甘草则平抑五火，增加黑栀子以收敛二络。方法没有超过这个的，尝试过也屡见疗效。倘若遇到肺胃郁热，方中增加麦冬、黄芩而减少山茱萸。若治疗肝肾实焰，不辞黄连、黄柏而佐以芍药。即使是君主凡火之动，苦寒药也是必需的。倘若命门真阳将谢，温热药恐后，久服平剂不愈，必须加入益气的人参、白术。交错使用投降火的药会加剧病情，不如暂缓升阳的牛蒡子。只是病情变幻莫测，成方难以死守，应当仔细察验元气的虚实，面色脉象的吉凶，以及病气的轻重。阳分中的阴证容易扶正，阴分中的阴证难疗；阴证在经易治，阳证在脏亦危。至于用药的温凉补泻，病程的新久顺逆，都要随宜应对，这样心中才能了然无疑，方可避免误治的重大过失。这只是我个人的浅见，详细情况宜参考薛立斋的全案。
It is indeed subtle that the principles of Yin and Yang are profound, yet the treatment to harmonize them is difficult. When Yin and Yang are diseased, they become chaotic and fluctuating, making them elusive and hard to grasp. Taking hemorrhage as an example: Blood belongs to Yin, and Qi (Vital Energy) belongs to Yang. The nature of Yang is movement, while the substance of Yin is stillness; the quality of Yang Qi is heat, whereas the nature of Yin is cold. Yin and Yang sustain each other, akin to the relationship between Water and Fire in a state of mutual interaction (Ji Ji). Therefore, when Qi moves, Blood also moves; when Qi stops, Blood also stops. When Qi is abundant, Blood is abundant; when Qi is deficient, Blood is deficient. When Qi is hot, Blood becomes dry; when Qi is cold, Blood coagulates. If Qi is excessive and rebellious upward, Blood will manifest by flowing upwards. If Blood is deficient and sinking, Qi will also follow it into downward collapse. In treatment, for those rebellious upward, one must descend them; for those sinking downward, one must elevate them. For initial diseases where Yin and Yang are disordered, one must pacify them; for disharmonious Cold and Heat, one must harmonize them. Subsequently, investigating the root cause, if Cold is indicated, use Cold methods; if Heat is indicated, use Heat methods; if tonification is indicated, tonify; if purgation is indicated, purge. Treatment methods cannot be rigidly fixed but must be applied flexibly according to the individual.
Since blood has extravasated externally, it indicates that Yang movement has been excessive. If treatment focuses solely on using Cold herbs to suppress it, although Yin controls Yang, this addresses excess. Tonifying Qi to secure it may save blood, but it risks causing Qi to move again and again, leaving no time for rest. Purging Yin to suppress Yang leads to extreme stillness, which unfortunately cuts off the mechanism of vital generation. None of these truly grasp the essence of treating blood or understand the substance of "stillness." Nevertheless, although hemorrhage presents in various forms, one must always carefully distinguish based on Yuan Qi (Primal Qi), pulse characteristics, form-Qi, and disease-Qi. It is particularly strange that Liu Wansu (Hejian) initiated the error of claiming that all hemorrhages lack Cold patterns, leading modern mediocre physicians to treat indiscriminately and kill patients, leaving significant harm, which is truly tragic and regrettable. One should know that Cold-natured drugs for treating hemorrhage are only suitable for cases from ancient times where both the physical constitution and the disease pathogen were excess/real. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is specifically for treating excess syndromes of accumulated heat in the Stomach Meridian. It can only be used temporarily and stopped once the disease is addressed; it is not a general formula for treating hemorrhage. Si Wu Tang (Four Substance Decoction), although composed of blood-invigorating herbs, uses Xiong Gui (Chuanxiong and Danggui) to unblock blood stasis; Bai Shao (White Peony Root) to astringe blood dispersion; and Sheng Di Huang (Raw Rehmannia Root) to control the blazing fire of Yin deficiency. However, these are not primarily Yin-tonifying agents. Moreover, Bai Shao is sour and cold, which may damage the generating Qi, so it is only appropriate for cases with blood stagnation or dispersion. If Yang fire is blazing intensely, wouldn't the pungent and dispersing nature of Dang Gui further assist its flaming upward tendency? Once hemorrhage has just stabilized, residual blood stasis remains, making astringency highly contraindicated. Although Sheng Di Huang, Huang Qin (Scutellaria Root), and Huang Lian (Coptis Rhizome) possess heavy cold natures capable of extinguishing lingering heat, one must consider: if Spleen deficiency fails to control blood, and blood loss further weakens the Spleen, how can one dare lightly use such cold purgatives to damage Spleen Yang? If the already deficient Spleen becomes more deficient due to cold, Yin blood cannot be retained, and hemorrhage will worsen. Only when all Qi aspects are excess and the specific indications for Xi Jiao Di Huang Tang and Si Wu Tang are present can they be used. Furthermore, administering Qi-tonifying formulas prematurely while Yang fire has not subsided disturbs Yin, which is detrimental. One must observe if there is indeed sudden Yuan Qi deficiency with compromised complexion and pulse; in such cases, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Gui Pi Tang (Restore the Spleen Decoction), Si Jun Zi Tang (Four Gentlemen Decoction), and Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) are necessary. Even in cases of deficiency-cold with simultaneous Qi collapse, Shen Fu Wan (Ginseng and Aconite Pill) or Ba Wei Wan (Eight-Ingredient Pill) must be administered cautiously and slowly. These represent deviations towards cooling/purging or warming/tonifying, serving as flexible adaptations rather than standard active treatments. Only by understanding the substance of "stillness" and the causes of losing stillness can one discuss formulas for stabilizing blood.
Blood governs Yin and takes stillness as its substance; within Yin lies Yang, and within stillness lies movement. This "stillness" is not inert silence but the stillness of biological transformation. The proposed formula does not specialize in Cold herbs to avoid further damaging True Yin, nor does it abruptly use Warm herbs to avoid aiding Evil Yang. Instead, it recommends neutral, tranquil substances that are neither cloying nor drying. This not only restores Tian Yi (Heavenly One/Kidney Yin) but also balances Water and Fire, preserving the substance of stillness and perfecting the spirit of stillness. This is the fundamental method, using common herbs rather than rare ones. Studying Zhang Zhongjing's Shen Qi Wan (Kidney Qi Pill) proves it to be a valuable remedy for hemorrhage. If one argues that Shu Di Huang (Prepared Rehmannia Root) is too rich and greasy for immediate tonification, one fails to realize that for blood loss and Yin deficiency due to internal injury, tonification is essential to fill the Yin. Mu Dan Pi (Moutan Cortex) is sweet and aromatic, a fine herb for generating new tissue and resolving stasis, and it controls raging fire. However, since True Yin is depleted and Yuan Yang lacks attachment, the Spleen loses its source of nourishment, and Earth Qi becomes feeble. One must use Shan Yao (Dioscorea Rhizome) and Fu Ling (Poria) to peacefully support Stomach Qi, which differs from the warming tonification of Dang Gui and Bai Zhu (Atractylodes Rhizome). Ze Xie (Alisma Rhizome) guides deficient heat downward; Shan Zhu Yu (Cornus Fruit) secures the root meridian of blood storage. Adding Zhi Gan Cao (Honey-fried Licorice Root) pacifies the Five Fires; adding Hei Zhi Zi (Black Gardenia Fruit) converges the two collaterals. No method surpasses this, and trials have shown frequent efficacy. If lung and stomach stagnant heat occur, increase Mai Dong (Ophiopogon Tuber) and Huang Qin while reducing Shan Zhu Yu. If treating liver and kidney excess flames, do not hesitate to use Huang Lian and Huang Bo (Phellodendron Bark) assisted by Shao Yao. Even for movements of ministerial fire, bitter-cold herbs are necessary. If Ming Men (Gate of Life) True Yang is fading, warm-hot herbs may lag behind; if long-term neutral formulas fail, add Qi-tonifying Shen (Ginseng) and Bai Zhu. Incorrectly using descending-fire herbs may worsen the condition; better to delay ascending-Yang Niu Bang Zi (Arctium Fruit). Disease conditions are variable, and fixed formulas are hard to maintain. One must carefully examine the deficiency/excess of Yuan Qi, the auspiciousness/inauspiciousness of complexion and pulse, and the severity of disease Qi. Yin patterns within Yang are easier to support; Yin patterns within Yin are harder to treat. Yin patterns in meridians are easier to cure; Yang patterns in zang organs are also critical. Regarding medication—warming/cooling, tonifying/purging, new/old, smooth/rebellious—one must respond appropriately. Only then can one be clear and doubtless in mind, avoiding the grave fault of misdiagnosis and mistreatment. This is merely my limited insight; for detailed cases, refer to Xue Li Zhai's complete records.