东垣治一贫者。脾胃虚弱。气促。精神短少。衄血吐血。以麦门冬二分。人参、归身各
三分。黄 、白芍、甘草各一钱。五味五枚。作一服。水煎。稍热服愈。继而至冬。天寒居
密室。卧大热炕。而吐血数次。再求治。此久虚弱。外有寒形。而有火热在内。上气不足。
阳气外虚。当补表之阳气。泻里之虚热。夫冬寒衣薄。是重虚其阳。表有大寒。壅遏里热。
火邪不得舒伸。故血出于口。忆仲景伤寒论云。太阳伤寒。当以麻黄汤发汗而不与之。遂成
衄。却与麻黄汤立愈。此法相同。遂用之。以麻黄桂枝汤。人参益上焦元气而实其表。麦门
冬保肺气。各三分。桂枝以补表虚。当归身和血养血。各五分。麻黄去根节。去外寒。甘草
补脾胃之虚。黄 实表益卫。白芍药各一钱。五味三枚。安其肺气。卧时热服。一服而愈。
震按此案认病制方。其义最精。药之分两甚轻者。因受病在卫在肺。皆系亲上部位。经
云。补上治上制以缓。缓则气味薄也。然系久虚之体。热为寒束。故用法若此。体不虚而热
为寒束者。又当以麻杏甘膏汤。加血药以治之。
丹溪治一壮年。患嗽而咯血。发热肌瘦。医用补药数年而病甚。脉涩。此因好色而多怒
精神耗少。又补塞药多。荣卫不行。瘀血内积。肺气壅遏。不能下降。治肺壅。非吐不可
精血耗。非补不可。唯倒仓法二者兼备。但使吐多于泻耳。兼灸肺俞二穴。在三椎骨下横
过各一寸半。灸五次而愈。
震按肺俞灸法。今人颇用之。然效甚 。倒仓法无敢用者。德清邑宰查公。讳克萨。吐
血成痨。曾用之。亦无效。丹溪此案。以补药数年。瘀血内积。尚非死证。故以二法奏功。
滑伯仁治一人。盛暑出门。途中吐血数口。亟还则吐甚。胸拒痛。体热头眩。病且殆。
或以为劳心焦思所致。与茯苓补心汤。仁至。诊其脉洪而滑。曰。是大醉饱。胃血壅遏。为
暑迫血上行。先与犀角地黄汤。继以桃仁承气汤去瘀血宿积。后治暑即安。
震按此条为孙东宿二案之祖。可以并看。
陈斗严治薛上舍。高沙人。素无恙。骤吐血半缶。陈诊之曰。脉弦急。此薄厥也。病得
之大怒。气逆。阴阳奔并。饮六郁汤而愈。
震按上条逐瘀清暑。此条开郁。皆治暴病吐血法。类案原本载吴茭山治吐血不止。即以
吐出之血炒黑与服。亦是第一回暴起吐血法。
薛立斋治一童子。年十四。发热吐血。薛谓宜补中益气以滋化源。不信。用寒凉降火。
愈甚。始谓薛曰。童子未室。何肾虚之有。参 补气。奚为用之。薛曰。丹溪云。肾主闭藏
肝主疏泄。二藏俱有相火。而其系上属于心。心为君火。为物所感则易动。心动则相火翕
然而随。虽不交会。其精暗耗矣。又精血篇云。男子精未满而御女以通其精。则五脏有不满
之处。异日有难状之疾。遂用补中益气及地黄丸而瘥。
汪石山治一人。形实而黑。病咳。痰少声嘶。间或咯血。诊之。右脉大无伦。时复促而
中止。左比右略小而软。亦时中止。曰。此脾肺肾三经之病也。盖秋阳燥烈。热则伤肺。加
之以劳倦伤脾。脾为肺母。母病而子失其所养。女色伤肾。肾为肺子。子伤必盗母气以自奉
而肺愈虚矣。法当从清暑益气汤例而增减之。以人参二钱或三钱。白术、白芍、麦门冬、
茯苓各一钱。生地、当归身各八分。黄柏、知母、陈皮、神曲各七分。甘草五分。煎服。月
余而安。
震按上条童年发热吐血。此条咳嗽声嘶咯血。皆用参、术合补阴药而愈。观二公之议论
可悟失血之源头。今人一味滋阴清火。宜乎不效。
一人形瘦而苍。年逾二十。忽病咳嗽咯血。兼吐黑痰。医用参、术之剂。病愈甚。汪诊
之。两手寸关浮软。两尺独洪而滑。此肾虚火旺而然也。遂以四物汤加黄柏、知母、白术、
陈皮、麦冬之类。治之月余。尺脉稍平。肾热亦减。根据前方再加人参一钱。兼服枳术丸加人
参、山栀以助其脾。六味地黄丸加黄柏以滋其肾。半年而愈。
震按四物加知、柏合两尺之洪滑。白术、麦冬合寸关之浮软。妙极。至于前用参、术而
病甚。后以尺脉稍平仍加人参。苟非石山之高明。岂敢复蹈前辙。其收功于枳术丸加人参、
山栀。及地黄丸加黄柏。尤见工巧。
一人年逾四十。面色苍白。平素内外过劳。或为食伤。则咯硬痰而带血丝。因服寒凉清
肺药消痰药至五六十帖。声渐不清而至于哑。夜卧不寐。醒来口苦舌干而常白胎。或时喉中
觉痛。或胸膈痛。或嗳气夜食难消。或手靠物久则麻。常畏寒。不怕热。前有 疝。后有内
痔。遇劳则发。初诊左脉沉弱而缓。右脉浮软无力。续后三五日一诊。心肺二脉浮虚。按不
应指。或时脾脉轻按阁指。重按不足。又时或快或缓。或浮或沉。或大或小。变动无常。夫
脉不常。血气虚也。譬之虚伪之人。朝更夕改。全无定准。以脉参证。其虚无疑。虚属气虚
为重也。盖劳则气耗而肺伤。肺伤则声哑。又劳则伤脾。脾伤则食易积。前疝后痔。遇劳而
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。以已伤之脾肺。复伤于药之寒凉。则声安得不哑。舌安得不胎。胎者。仲景谓
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
能裹血也。胸痛嗳气者。气虚不能健运。故郁于中而嗳气。或滞于上则胸痛也。遂用参、
各四钱。麦冬、归身、贝母各一钱。远志、酸枣仁、牡丹皮、茯神各八分。石菖蒲、甘草各
五分。其他山楂、麦芽、杜仲。随病出入。煎服年余而复。益以宁志丸药。前病渐愈矣。且
此病属于燥热。故白术尚不敢用。况他燥剂乎。
一人年五十。形色苍白。性急。语不合。则叫号气喘呕吐。一日左乳下忽一点痛。后有过劳
恼怒。腹中觉有秽气。冲上即嗽。极吐。亦或干咳无痰。甚则呕血。时发时疟。或以疟治。
或从痰治。皆不效。汪诊之。脉皆浮细。略弦而快。曰。此土虚木旺也。性急多怒。肝火时
动。故左乳下痛者。肝气郁也。秽气冲者。肝火凌脾而逆上也。呕血者。肝被火扰不能藏其
血也。咳嗽者。金失所养。又受火克而然也。呕吐者。脾虚不能运化。食郁为痰也。寒热者
水火交战也。兹宜泄肝木之实。补脾土之虚。清肺金之燥。庶几可安。以青皮、山栀各七
分。白芍、黄 、麦冬各一钱。归身、阿胶各七分。甘草、五味各五分。白术一钱五分。人
参三钱。煎服月余。诸证悉平。
震按上条声哑喉痛。口苦舌胎。而用参、 各四钱。此条左乳下痛。秽气冲上即嗽。而
用人参三钱。 、术次之。非石山岂能辨此。且上条脉软无力。变动不常。尚可认为气虚。
此条脉浮细弦数。不以滋肾清肝。治更难及。
村庄一妇。年五十余。久嗽咯脓血。日轻夜重。汪诊之。脉皆细濡而滑。曰。此肺痿也
平日所服人参清肺饮、知母茯苓汤等剂。皆犯人参、半夏。一助肺中伏火。一燥肺之津液
故病益加。乃以天麦门冬、阿胶、贝母为君。知母、生地、紫菀、山栀为臣。桑白皮、马
兜铃为佐。款冬花、归身、甜葶苈、桔梗、甘草为使。五剂而安。
震按石山治血证。多用参、术。而此条及下条前半段治法。如出两人。可见其原非执守
一法。但下条用滋阴凉药。竟得脉缓不数。殆有天幸焉。近来此种病极多。此种药效者殊少
一人形色苍白。年三十余。咳嗽咯血声哑。夜热自汗。汪诊之。脉濡细而近快。曰。此
得之色欲也。遂以四物加麦冬、紫菀、阿胶、黄柏、知母。三十余帖。诸证悉减。又觉胸腹
痞满。恶心畏食。或时粪溏。诊之脉皆缓弱。无复快矣。曰。今阴虚之病已退。再用甘温养
其脾胃。则病根去矣。遂以四君子汤加神曲、陈皮、麦冬。服十余帖而安。
江篁南治其弟患嗽血。初一二剂用知、贝、二冬、归、芍清肺之剂。夜加胁疼。继用人
参一钱五分。胁疼减。后知参至二钱。左脉近大而快。右略敛。少带弦而快。每嗽则有血。
大便溏。一日三更衣。以人参三钱。白术、紫菀各一钱五分。茯苓、白芍各一钱。甘草九分
牡丹皮八分。加茅根、小溲。脉弦快稍减。加黄 二钱。百部六分。是日嗽止。血渐少。
既而血亦止。然便溏。乃倍参、 、术、山药、陈皮、甘草、苡仁、白芍等药。兼与健脾丸
而愈。
震按此案纯仿石山治法。
孙东宿治臧六老。上吐血。下泻血。胸膈背心皆胀。原从怒触。又犬肉所伤。故发热而
渴。医者用滋阴降火药。胸背愈胀。血来更多。孙诊之两关俱洪滑有力。曰。此肝脾二经有
余证也。作阴虚治。左矣。阴虚者脉数无力。今之脉既不同。午后潮热。夜半而退。与今之
昼夜常热者。亦不同也。经云。怒伤肝。甚则呕血并下泄。胸背胀痛。瘀血使然。脾为犬肉
所伤。故不能统血。误用地黄、知、柏等剂。是以脾益伤。而上焦瘀血愈滞也。即与山楂、
香附、枳实。调气消导为君。丹参、丹皮、桃仁、滑石、茅根。化瘀血为臣。黄连、芦根。
解犬肉之热为佐。四帖胸背宽。吐血止。惟腹中不舒。仍以前药同保和丸与之。大下臭黑粪
而全安。
族侄明之。作文过劳。痰火上逆。大吐痰沫。因而呕血。一涌数碗。昏晕汗出。奄奄而
卧。略不敢动。稍动即呕吐而血随出。色鲜红。饮食汤水皆不敢入。入即吐而眩晕。血即随
之。医者皆曰。血如涌泉。体热脉大。眩晕而药食难入。似无佳兆。孙诊之曰。无妨。凡看
证要圆活。勿拘泥。经云。心主血。肝藏血。又云。怒则气上。又云。脉虚身热。得之伤暑
今左脉弦大。右脉虚大。是不独作文劳心动火。且亦被怒伤肝。抑又为暑所逼。以致木火
上升。眩晕作吐。经云。诸风掉眩。皆属于肝。诸呕吐逆。皆属于火。又诸动属火。内为木
火上冲。外为暑气所迫。故吐而汗多。血随吐出也。先以白丸子三钱解其暑气。清其痰饮。
抑其冲逆。则吐可止。吐止气平。血自归经。服后果嗒然而睡。醒则吐止食进。眩晕寻已。
继用滑石、香薷各三钱。黄连、扁豆各一钱五分。竹茹一钱。甘草五分。四帖全安。
震按上条胸背皆胀。服阴药胀更甚。合以两关脉之洪滑有力。尚易辨其非阴虚。况恼怒
食犬。亦可问而知之。此条因作文过劳。呕血数碗。昏晕汗出。稍动即吐。而血随至。势殊
危矣。况右脉虚大。不认为虚而认为暑。竟合左脉之弦大。大剂清暑清汗。真妙手也。
李士材曰。尚宝卿须日华。林下多郁。且有暴怒。吐血甚多。倦怠异常。余以六君子纳
参一两。干姜一钱。木香八分。四日而血止。后因怒。血复大作。余曰。先与平肝。继当大
补。然夏得秋脉。所谓早见非时之脉。当其时不能再见矣。果如期而殁。
震按吐血甚多。其因由于郁且怒。则肝脾受伤久矣。重用人参。佐辛热以从治。可谓
技
进乎道者也。若解郁平肝。血岂能止。然血止后因怒复大作。更何法可治。其死无疑矣。
大宗伯董元宰有少外家。吐血蒸嗽。先用清火。继用补中。俱不见效。士材诊之。曰。两尺沉
实。少腹按之必痛。询之果然。此怒后蓄血。经年弗去。乃为蒸热。热甚而吐血。阴伤之甚
也。以四物汤加郁金、桃仁、穿山甲、大黄少许。下黑血升余。少腹痛仍在。更以前药加大
黄三钱煎服。又下血黑块如桃胶蚬肉者三四升。腹痛乃止。虚倦异常。与独参汤饮之。三日
而热减六七。服十全大补汤百余日而康。
震按两尺沉实。决其少腹有瘀。因瘀而蒸热。因蒸热而吐血。盖从脉象认得病根。故
大下而病根去。去后峻补。不用养阴。更妙。
景岳治倪孝廉。素以攻苦。思虑伤脾。时有呕吐之证。过劳即发。用理阴煎、温胃饮之属。
随饮即愈。一日于暑末时。因连日交际。致劳心脾。遂上为吐血。下为泄血。俱大如手片。
或紫或红。甚多可畏。医云。此因劳而火起心脾。兼之暑令。二火相济。所以致此。与犀角
地黄、童便、知母之属。药及两剂。其吐愈甚。脉益紧数。困惫垂危。迨景岳往视。情势
俱
剧。乃以人参、熟地、干姜、甘草四味。大剂与之。初服毫不为动。次服觉呕恶少止。而脉
中微有生意。乃复加附子、炮姜各二钱。人参、熟地各一两。白术四钱。炙甘草一钱。茯苓
二钱。黄昏与服。竟得大睡。直至四鼓。复进之。而呕止血亦止。又服此方数日。而健如故
盖此人以劳倦伤脾。脾胃阳虚。气有不摄。所以动血。时当二火。而证非二火。再用寒凉
脾必败而死矣。
震按此与生生子族侄之病病因同。现证及时令又同。而一用寒凉。一用温补。水火之
别
皆得收功。自非神手不能。但孙脉左弦大右虚大。与紧脉不同。孙案未曾以药尝试。张案
用寒凉而病益甚。亦有不同也。临证者在乎细心体察也。
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。
李东垣治疗一位贫苦患者。患者脾胃虚弱，气短促，精神萎靡不足，出现鼻出血和吐血症状。处方用麦门冬二分，人参、当归身各三分，黄芪、白芍、甘草各一钱，五味子五枚。作为一剂药，用水煎煮，稍热时服用即愈。到了冬天，天气寒冷，患者居住在密闭房间，睡在很热的炕上，又吐血几次，再次求治。这是因为久病体虚，外表有寒象，而体内有火热。上焦元气不足，体表阳气虚弱，应当补益体表的阳气，清泻体内的虚热。冬季寒冷衣服单薄，是使阳气更加虚弱，体表有大寒，壅遏了体内的热气，火邪不能舒展伸张，所以血液从口中溢出。想起张仲景《伤寒论》中说：太阳伤寒证，应当用麻黄汤发汗而不给用，于是造成衄血（鼻出血），却给予麻黄汤立刻痊愈。这个治法相同。于是使用麻黄桂枝汤，用人参补益上焦元气以充实体表，麦门冬保护肺气，各三分；桂枝补益表虚，当归身调和血液滋养血液，各五分；麻黄去掉根节以去除外寒，甘草补益脾胃之虚，黄芪固表益卫，白芍药各一钱，五味子三枚，安定肺气。睡觉时热服，一剂药就痊愈了。
俞震按语：此案辨认病情制定方剂，其中的义理最为精妙。药物分量很轻，是因为受病部位在卫分和肺经，都属于人体上部位置。医经说：补益上部、治疗上部，制方要缓和，缓和则药气味轻薄。然而这是久病体虚的体质，热被寒邪束缚，所以用法如此。如果体质不虚而热被寒束的情况，又应当用麻杏甘膏汤，加入活血养血药来治疗。
朱丹溪治疗一位壮年人，患咳嗽并咯血，发热身体消瘦。医生用补药治疗几年反而病情加重。脉象涩滞。这是因为好色且多怒，精神耗损减少，加上补塞药太多，导致营卫运行不畅，瘀血在体内积聚，肺气壅遏，不能下降。治疗肺部的壅滞，非吐不可；精血耗损，非补不可。只有倒仓法二者兼备。只要让呕吐多于腹泻即可。兼灸肺俞穴两个穴位，位于第三椎骨下横向各一寸半处，灸五次而痊愈。
俞震按语：肺俞穴灸法，现在人颇常用，但疗效甚微。没有人敢用倒仓法。德清县令查公，名克萨，吐血成痨病，曾用过此法，也没有效果。朱丹溪的这个案例，因为用了几年补药，导致瘀血内积，尚不是死证，所以用这两种方法奏效。
滑伯仁治疗一个人，盛暑时节出门，途中吐血几口，急忙回家则吐得更厉害，胸部疼痛拒按，身体发热头晕，病情危急。有人认为是劳心焦思所致，给予茯苓补心汤。滑伯仁到达后，诊察其脉象洪大而滑，说：这是大醉饱食后，胃中血液壅遏，被暑气逼迫血液上行。先给予犀角地黄汤，继以桃仁承气汤去除瘀血宿积，后来治疗暑气即安。
陈斗严治疗薛上舍，高沙人，平时没有病，突然吐血半罐。陈斗严诊察后说：脉象弦急，这是薄厥病。病得之于大怒，气机逆乱，阴阳之气奔涌相并。饮用六郁汤而痊愈。
俞震按语：上一条是逐瘀清暑，这一条是开郁，都是治疗突发吐血的方法。类案原本记载吴茭山治疗吐血不止，直接将吐出的血炒黑给患者服用，这也是治疗突发吐血的第一种方法。
薛立斋治疗一个童子，十四岁，发热吐血。薛立斋认为应当补中益气以滋生化源。患者不信，用寒凉降火药，病情更重。才开始对薛立斋说：童子未娶妻室，怎么会有肾虚？人参补气，为什么要用？薛立斋说：朱丹溪说，肾主闭藏，肝主疏泄，两脏都有相火，而其系上属于心。心为君火，被外物所感就容易动，心动则相火随之翕然而起。即使不性交，精气也在暗中耗损。又《精血篇》说：男子精气未满而御女以通其精，则五脏有不满足的地方，日后会有难以形容的疾病。于是用补中益气丸及地黄丸而痊愈。
汪石山治疗一个人，形体结实而肤色黑，患咳嗽，痰少声音嘶哑，偶尔咯血。诊察发现右脉大无比，时常急促而有间歇，左脉比右脉略小且软，也时常有间歇。说：这是脾、肺、肾三经的病。大概秋季阳光燥烈，热则伤肺，再加上劳倦伤脾，脾为肺之母，母病则子失其所养；房事伤肾，肾为肺之子，子伤必盗取母气来供养自己，从而使肺更虚。治法应当参照清暑益气汤的例子进行增减。用人参二钱或三钱，白术、白芍、麦门冬、茯苓各一钱，生地、当归身各八分，黄柏、知母、陈皮、神曲各七分，甘草五分。煎服，一个多月后安宁。
俞震按语：上一条童年发热吐血，这一条咳嗽声嘶咯血，都用参、术配合补阴药而痊愈。观察两位医生的议论可以领悟失血的源头。现在的人一味滋阴清火，应该是不见效的。
另一个人形体瘦弱而面色苍老，年过二十，忽然患病咳嗽咯血，兼吐黑痰。医生用参、术的药剂，病情更重。汪石山诊察发现两手寸关脉浮软，两尺脉独洪而滑。这是肾虚火旺所致。于是用四物汤加黄柏、知母、白术、陈皮、麦冬之类治疗，一个月后，尺脉稍平，肾热也减轻。根据前方再加人参一钱，兼服枳术丸加人参、山栀以助其脾，六味地黄丸加黄柏以滋其肾，半年而痊愈。
俞震按语：四物汤加知母、黄柏合两尺脉的洪滑，白术、麦冬合寸关脉的浮软，非常巧妙。至于之前用参、术而病情加重，后来尺脉稍平仍加人参，如果不是汪石山的高明，岂敢再蹈前辙。他收功在于枳术丸加人参、山栀，以及地黄丸加黄柏，尤其见出工巧。
另一个人年过四十，面色苍白，平时内外过度劳累，或者因饮食损伤，则咯硬痰带血丝。因为服用寒凉清肺药、消痰药多达五六十帖，声音逐渐不清以至于哑，夜间卧睡不寐，醒来口苦舌干而常有白苔。有时喉中觉痛，有时胸膈痛，有时嗳气夜间食物难消化，有时手靠物体久了则麻木，常畏寒，不怕热。以前有疝气，现在有内痔，遇劳累则发作。初诊左脉沉弱而缓，右脉浮软无力。随后三五日一诊，心肺二脉浮虚，按之不应指。有时脾脉轻按搁指，重按不足。有时或快或缓，或浮或沉，或大或小，变动无常。脉象不固定，是血气虚的表现。譬如虚伪之人，朝更夕改，全无定准。以脉象参合证候，其虚无疑。虚属于气虚为重。大概劳累则气耗而肺伤，肺伤则声哑；又劳累则伤脾，脾伤则食物易积滞。以前的疝气和现在的痔疮，遇劳而发，都是因为劳累耗气，气虚下陷，不能升降的缘故。而且脾喜温恶寒，肺也恶寒，所以说：形寒饮冷则伤肺。以已经受伤的脾肺，再受到药物的寒凉伤害，那么声音怎么能不哑，舌苔怎么能不白。白苔，张仲景说是胃中有寒，丹田有热。夜间不寐，是由于子盗母气，心虚而神不安。痰中带血丝，是由于脾伤不能裹血。胸痛嗳气，是由于气虚不能健运，所以郁于中而嗳气，或者滞于上则胸痛。于是用人参、黄芪各四钱，麦冬、当归身、贝母各一钱，远志、酸枣仁、牡丹皮、茯神各八分，石菖蒲、甘草各五分。其他如山楂、麦芽、杜仲，随病情出入加减。煎服一年多而康复。加上宁志丸药，前面的病渐渐痊愈。而且此病属于燥热，所以白术尚且不敢用，何况其他燥剂呢。
另一个人年五十，形色苍白，性情急躁，言语不合意，则叫号气喘呕吐。一天左乳下忽然一点痛，后来有过劳恼怒，腹中觉得有秽气冲上即咳嗽，剧烈呕吐，或者干咳无痰，甚至呕血，时而发作像疟疾。有人按疟疾治，有人从痰治，都不见效。汪石山诊察，脉皆浮细，略弦而快。说：这是土虚木旺。性情急躁多怒，肝火时常发动，所以左乳下痛，是肝气郁结。秽气冲上，是肝火凌犯脾土而逆上也。呕血，是肝被火扰不能藏血。咳嗽，是金失所养，又受火克所致。呕吐，是脾虚不能运化，食物郁滞为痰。寒热，是水火交战。此时应当泄肝木之实，补脾土之虚，清肺金之燥，差不多可以安宁。用青皮、山栀各七分，白芍、黄芪、麦冬各一钱，当归身、阿胶各七分，甘草、五味子各五分，白术一钱五分，人参三钱。煎服一个月，各种症状全部平息。
俞震按语：上一条声音哑喉痛，口苦舌苔，而用人参、黄芪各四钱；这一条左乳下痛，秽气冲上即咳，而用人参三钱，黄芪、白术次之。如果不是汪石山谁能辨别这一点。而且上一条脉软无力，变动不常，还可以认为是气虚；这一条脉浮细弦数，如果不以滋肾清肝治疗，更难达到效果。
村庄里一位妇女，年五十多岁，久咳咯脓血，白天轻晚上重。汪石山诊察，脉皆细濡而滑。说：这是肺痿病。平时所服的人参清肺饮、知母茯苓汤等药剂，都犯了人参、半夏的错误，一人助长肺中伏火，一人燥伤肺之津液，所以病情更加加重。于是以天冬、麦门冬、阿胶、贝母为君药，知母、生地、紫菀、山栀为臣药，桑白皮、马兜铃为佐药，款冬花、当归身、甜葶苈、桔梗、甘草为使药。五剂而安宁。
俞震按语：汪石山治疗血证，多用参、术，而这一条及下一条前半段治法，如同出自两人之手，可见他原本就不是固执守着一法。只是下一条用滋阴凉药，竟然得到脉缓不数的结果，大概是天幸吧。近来这种病极多，这种药效者极少。
另一个人形色苍白，年三十多岁，咳嗽咯血声音哑，夜间发热自汗。汪石山诊察，脉濡细而近快。说：这是得之色欲所致。于是用四物汤加麦冬、紫菀、阿胶、黄柏、知母，三十多帖，各种症状全部减轻。又觉得胸腹痞满，恶心畏食，有时大便溏稀。诊察脉皆缓弱，不再快了。说：现在阴虚的病已退，再用甘温药调养脾胃，则病根去除了。于是用四君子汤加神曲、陈皮、麦冬，服用十多帖而安宁。
江篁南治疗他的弟弟患嗽血。初一二剂用知母、贝母、二冬、当归、白芍清肺的药剂，夜间胁疼加重。继用人参一钱五分，胁疼减轻。后来知道人参用到二钱，左脉近大而快，右脉略收敛，稍带弦而快。每次咳嗽则有血，大便溏稀，一天三次排便。用人参三钱，白术、紫菀各一钱五分，茯苓、白芍各一钱，甘草九分，牡丹皮八分，加茅根、小便（童便）。脉弦快稍减。加黄芪二钱，百部六分。当天咳嗽停止，血渐少。不久血也止住了。然而大便溏，于是加倍人参、黄芪、白术、山药、陈皮、甘草、薏苡仁、白芍等药，兼与健脾丸而痊愈。
孙东宿治疗臧六老，上吐血，下泻血，胸膈背心皆胀。原从愤怒触动，又被狗肉所伤，所以发热而渴。医生用滋阴降火药，胸背更胀，血来得更多。孙东宿诊察两关脉俱洪滑有力。说：这是肝脾二经有余证。当作阴虚治，错了。阴虚者脉数无力，现在的脉既不同。午后潮热，半夜退去，与现在昼夜常热也不同。医经说：怒伤肝，甚则呕血并下泄。胸背胀痛，是瘀血使然。脾被狗肉所伤，所以不能统血。误用地黄、知母、黄柏等药剂，是以脾更伤，而上焦瘀血更滞。立即给予山楂、香附、枳实，调气消导为君药，丹参、丹皮、桃仁、滑石、茅根，化瘀血为臣药，黄连、芦根，解狗肉之热为佐药。四帖胸背宽舒，吐血停止。只有腹中不舒服，仍以前药同保和丸与之，大下臭黑粪而全安。
族侄明之，作文过劳，痰火上逆，大吐痰沫，因而呕血，一涌数碗，昏晕汗出，奄奄一息而卧，稍微不敢动，稍动即呕吐而血随出，血色鲜红，饮食汤水皆不敢入，入即吐而眩晕，血即随之。医者都说：血如涌泉，体热脉大，眩晕而药食难入，似乎没有好兆头。孙东宿诊察说：不要紧。凡看病要圆活，不要拘泥。医经说：心主血，肝藏血。又说：怒则气上。又说：脉虚身热，得之伤暑。现在左脉弦大，右脉虚大，是不独作文劳心动火，而且也被怒伤肝，抑又为暑所逼，以致木火上升，眩晕作吐。医经说：诸风掉眩，皆属于肝。诸呕吐逆，皆属于火。又诸动属火，内为木火上冲，外为暑气所迫，所以吐而汗多，血随吐出。先用白丸子三钱解其暑气，清其痰饮，抑其冲逆，则吐可止。吐止气平，血自归经。服药后果然酣然而睡，醒则吐止食进，眩晕随即消除。继用滑石、香薷各三钱，黄连、扁豆各一钱五分，竹茹一钱，甘草五分。四帖全安。
俞震按语：上一条胸背皆胀，服阴药胀更甚，合以两关脉之洪滑有力，尚易辨其非阴虚。何况恼怒食犬，也可问而知之。这一条因作文过劳，呕血数碗，昏晕汗出，稍动即吐，而血随至，势殊危矣。况右脉虚大，不认为虚而认为暑，竟合左脉之弦大，大剂清暑清热，真是妙手啊。
李士材说：尚宝卿须日华，林下多郁，且有暴怒，吐血甚多，倦怠异常。我用六君子汤纳人参一两，干姜一钱，木香八分，四日而血止。后因怒，血复大作。我说：先与平肝，继当大补。然而夏天得了秋天的脉，所谓早见非时之脉，当其时不能再见了。果然如期而死。
俞震按语：吐血甚多，其因由于郁且怒，则肝脾受伤久矣。重用人参，佐辛热以从治，可谓技进乎道者也。若解郁平肝，血岂能止。然而血止后因怒复大作，更何法可治。其死无疑矣。
大宗伯董元宰有个少外家，吐血蒸嗽。先用清火，继用补中，俱不见效。李士材诊察说：两尺沉实，少腹按之必痛，询问果然。这是怒后蓄血，经年不去，乃为蒸热，热甚而吐血，阴伤之甚也。用四物汤加郁金、桃仁、穿山甲、大黄少许，下黑血升余，少腹痛仍在。更以前药加大黄三钱煎服，又下血黑块如桃胶蚬肉者三四升，腹痛乃止。虚倦异常，与独参汤饮之，三日而热减六七。服十全大补汤百余日而康。
俞震按语：两尺沉实，决其少腹有瘀，因瘀而蒸热，因蒸热而吐血。盖从脉象认得病根，故大下而病根去。去后峻补，不用养阴，更妙。
张景岳治疗倪孝廉，素以攻苦，思虑伤脾，时有呕吐之证，过劳即发。用理阴煎、温胃饮之类的药，随饮即愈。一日于暑末时，因连日交际，致劳心脾，遂上为吐血，下为泄血，俱大如手片，或紫或红，甚多可畏。医生说：这是因劳而火起心脾，兼之暑令，二火相济，所以致此。给予犀角地黄、童便、知母之类的药，药及两剂，其吐愈甚，脉益紧数，困惫垂危。等到张景岳前往视诊，情势俱剧，乃以人参、熟地、干姜、甘草四味，大剂与之。初服毫不为动，次服觉呕恶少止，而脉中微有生意，乃复加附子、炮姜各二钱，人参、熟地各一两，白术四钱，炙甘草一钱，茯苓二钱。黄昏与服，竟得大睡，直至四鼓，复进之，而呕止血亦止。又服此方数日，而健如故。盖此人以劳倦伤脾，脾胃阳虚，气有不摄，所以动血。时当二火，而证非二火，再用寒凉，脾必败而死矣。
俞震按语：此与生生子族侄之病病因同，现证及时令又同，而一用寒凉，一用温补，水火之别皆得收功。自非神手不能。但孙东宿脉左弦大右虚大，与紧脉不同。孙案未曾以药尝试，张案用寒凉而病益甚，亦有不同也。临证者在乎细心体察也。
Li Dongyuan treated a poor patient. The patient had weak spleen and stomach, shortness of breath (Qi deficiency), lack of spirit and energy, and presented with epistaxis (nosebleed) and hematemesis (vomiting blood). The prescription used Ophiopogonis Radix (Maidong) 2 fen, Ginseng Radix (Renshen) and Angelicae Sinensis Radix (Danggui Shen) each 3 fen, Astragali Radix (Huangqi), Paeoniae Radix Alba (Baishao), and Glycyrrhizae Radix et Rhizoma (Gancao) each 1 qian, and Schisandrae Fructus (Wuweizi) 5 pieces. This was taken as one dose, decocted in water, and taken slightly warm, resulting in recovery. In winter, due to cold weather, the patient lived in a sealed room and slept on a very hot kang, suffering several episodes of hematemesis again, and sought treatment once more. This was because of long-standing deficiency, with external cold signs but internal heat. There was insufficiency of Qi in the upper Jiao and deficiency of Yang Qi on the exterior. It was necessary to tonify the exterior Yang Qi and purge the interior deficient heat. Winter cold and thin clothing further depleted the Yang; severe exterior cold obstructed the interior heat, preventing the fire pathogen from dispersing, thus causing blood to issue from the mouth. Recalling Zhang Zhongjing's *Treatise on Cold Damage*: for Taiyang Cold Damage, Ma Huang Tang should be used to induce sweating; if not given, it leads to epistaxis, yet giving Ma Huang Tang cures it immediately. This method is the same. Thus, Ma Huang Gui Zhi Tang was used. Ginseng was used to tonify Yuan Qi of the Upper Jiao and strengthen the exterior, Ophiopogonis Radix to protect Lung Qi, each 3 fen; Cinnamon Twig (Guizhi) to tonify exterior deficiency, Angelicae Sinensis Radix to harmonize and nourish blood, each 5 fen; Ephedrae Herba (Mahuang), roots and joints removed, to dispel exterior cold; Glycyrrhizae Radix et Rhizoma to tonify Spleen and Stomach deficiency; Astragali Radix to secure the exterior and benefit Wei Qi; Paeoniae Radix Alba each 1 qian; Schisandrae Fructus 3 pieces to calm Lung Qi. Taken hot while lying down, one dose resulted in recovery.
Yu Zhen commented: This case demonstrates exquisite precision in disease differentiation and formula formulation. The light dosage of herbs is because the pathology resides in the Wei (Defensive) level and Lung meridian, which are upper body locations. As the classics state: "Tonifying and treating the upper requires slow-acting formulas; slow action implies thin flavor and aroma." However, since this is a constitution of long-term deficiency with heat constrained by cold, this approach was appropriate. For cases where the constitution is not deficient but heat is constrained by cold, Ma Xing Gan Shi Tang combined with blood-invigorating herbs should be used.
Zhu Danxi treated a young adult male suffering from cough with hemoptysis, fever, and emaciation. He had been treated with tonic medicines for years by other physicians, worsening his condition. His pulse was choppy (Se). This was due to excessive sexual activity and anger, leading to depletion of spirit and essence, compounded by excessive use of cloying tonics that obstructed the flow of Ying (Nutritive) and Wei (Defensive) Qi, causing blood stasis to accumulate internally. Lung Qi was obstructed and could not descend. Treating Lung obstruction required emesis; replenishing consumed essence and blood required tonification. Only the "Inversion of the Granary" method (inducing vomiting to clear stagnation) achieved both. The key was to ensure vomiting exceeded purging. Acupoint Fei Shu (BL13) was moxibusted bilaterally, located 1.5 cun lateral to the lower border of the spinous process of the 3rd thoracic vertebra, five sessions per point, resulting in recovery.
Yu Zhen commented: Moxibustion at Fei Shu is commonly used today, but efficacy is often low. Few dare to use the "Inversion of the Granary" method. Mr. Cha Kesha, magistrate of Deqing, suffered from hemoptysis progressing to consumption and tried this method without effect. In Zhu Danxi's case, despite years of tonic use causing internal stasis, it was not a terminal stage, allowing these methods to succeed.
Hua Bolin treated a person who went out during peak summer heat and vomited a few mouthfuls of blood en route. Upon returning home, vomiting worsened significantly, accompanied by chest pain with tenderness/rejection, fever, and dizziness, placing the patient in critical condition. Some attributed it to mental strain and anxiety, prescribing Fu Ling Bu Xin Tang. Hua Bolin arrived, palpated the pulse as surging (Hong) and slippery (Hua), and stated: "This is due to overeating and drinking alcohol, causing gastric blood to become obstructed, forced upward by summer heat." First, Xi Jiao Di Huang Tang was administered, followed by Tao Ren Cheng Qi Tang to remove old blood stasis. Subsequent treatment for summer heat led to recovery.
Yu Zhen commented: This case is the ancestor of two cases by Sun Dongsu and should be viewed together.
Chen Douyan treated Xue Shangshe, a native of Gaosha, who was previously healthy but suddenly vomited half a jar of blood. Chen diagnosed a wiry (Xian) and rapid pulse, identifying it as Bo Jue (a sudden collapse due to extreme anger). The illness arose from severe anger causing Qi rebellion and chaotic interaction of Yin and Yang. Liu Yu Tang was prescribed, resulting in recovery.
Yu Zhen commented: The previous case addressed stasis and cleared summer heat; this case opens depression. Both are methods for treating acute hemoptysis. The original collection records Wu Jiaoshan treating persistent hemoptysis by frying the vomited blood black and administering it, another first-line method for sudden onset hemoptysis.
Xue Lizhai treated a fourteen-year-old boy with fever and hemoptysis. Xue advised tonifying Middle Jiao Qi to nourish the source of transformation. The family disagreed, using cold-cooling and fire-descending herbs, which worsened the condition. They questioned Xue: "The boy is unmarried, how can Kidney deficiency exist? Why use Ginseng to tonify Qi?" Xue replied: "Zhu Danxi said the Kidney governs storage, and the Liver governs dispersion. Both contain Minister Fire connected to the Heart. The Heart is Sovereign Fire, easily moved by external stimuli. When the Heart moves, Minister Fire follows. Even without intercourse, essence is secretly consumed. Also, the 'Essence and Blood Chapter' states: If a man engages in intercourse before his essence is full, the Five Zang organs will have deficiencies, leading to difficult-to-describe diseases later." Xue then prescribed Bu Zhong Yi Qi Wan and Di Huang Wan, resulting in recovery.
Wang Shishan treated a man with a solid physique and dark complexion, suffering from cough, scant sputum, hoarseness, and occasional hemoptysis. The right pulse was excessively large, sometimes rapid with interruptions; the left pulse was slightly smaller and softer than the right, also with intermittent interruptions. Wang stated: "This is a disease of the Spleen, Lung, and Kidney meridians. Autumn sun is dry and fierce; heat injures the Lung. Fatigue injures the Spleen. Spleen is the Mother of Lung; when the Mother is ill, the Child loses nourishment. Sexual excess injures the Kidney. Kidney is the Child of Lung; when the Child is injured, it drains the Mother's Qi, making the Lung even weaker." The treatment should follow the example of Qing Shu Yi Qi Tang with modifications: Ginseng 2 or 3 qian, Atractylodis Macrocephalae Rhizoma (Baizhu), Paeoniae Radix Alba, Ophiopogonis Radix, and Poria (Fuling) each 1 qian, Rehmanniae Radix (Shengdi) and Angelicae Sinensis Radix each 8 fen, Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Citri Reticulatae Pericarpium (Chenpi), and Massae Medicatae Fermentatae (Shenqu) each 7 fen, Glycyrrhizae Radix et Rhizoma 5 fen. Decocted and taken, peace returned after over a month.
Yu Zhen commented: Both the childhood fever/hemoptysis case and this cough/hoarseness/hemoptysis case were cured using Ginseng and Atractylodis combined with Yin-nourishing herbs. Observing these discussions reveals the root of bleeding disorders. Today's tendency to solely use Yin-nourishing and fire-clearing methods explains their frequent ineffectiveness.
Another case: A man, thin and pale, over twenty years old, suddenly developed cough with hemoptysis and expectoration of black sputum. Treatment with Ginseng and Atractylodis worsened the condition. Wang Shishan found the Cun and Guan positions on both hands floating and soft, while Chi positions alone were surging and slippery. This indicated Kidney deficiency with hyperactive fire. Si Wu Tang was modified with Huangbai, Zhimu, Baizhu, Chenpi, and Ophiopogonis Radix. After a month, the Chi pulse flattened somewhat, and Kidney heat decreased. Ginseng was added to the previous formula. Additionally, Zhi Zhu Wan with Ginseng and Gardeniae Fructus (Shanzhi) was taken to support the Spleen, and Liu Wei Di Huang Wan with Huangbai to nourish the Kidney. Recovery occurred after six months.
Yu Zhen commented: Si Wu Tang plus Zhimu and Huangbai addresses the surging/slippery Chi pulse; Baizhu and Ophiopogonis Radix address the floating/soft Cun/Guan pulse. This is ingenious. Previously, Ginseng and Baizhu worsened the condition; later, adding Ginseng after the Chi pulse stabilized showed great courage and skill. Success relied on Zhi Zhu Wan with Ginseng/Shanzhi and Di Huang Wan with Huangbai.
Another case: A man over forty, pale-faced, subject to internal and external overwork, or dietary injury, expectorated hard sputum with blood streaks. He took fifty to sixty doses of cold-cooling Lung-clearing and phlegm-resolving herbs, leading to progressive hoarseness and aphonia, insomnia, bitter taste, dry tongue with white coating upon waking, occasional throat or chest pain, belching, difficulty digesting night food, numbness in hands after prolonged leaning, aversion to cold but not fear of heat. He had a history of hernia and internal hemorrhoids, triggered by fatigue. Initial pulse: Left deep, weak, and slow; Right floating, soft, and powerless. Follow-up pulses varied: Heart/Lung floating and empty; Spleen pulse elusive on light pressure, insufficient on heavy pressure; varying speed, depth, and size. Irregular pulses indicate Qi and Blood deficiency. Like an insincere person changing constantly. Pulse analysis confirms deficiency, primarily Qi deficiency. Fatigue consumes Qi and injures Lung (causing aphonia); fatigues Spleen (causing food stagnation). Hernia and hemorrhoids triggered by fatigue result from Qi sinking due to exhaustion. Spleen likes warmth and dislikes cold; Lung also dislikes cold ("Cold form and cold drinks injure Lung"). Further injuring already damaged Spleen and Lung with cold herbs caused aphonia and white coating. White coating indicates Cold in Stomach and Heat in Dantian (per Zhang Zhongjing). Insomnia results from "Child draining Mother," Heart deficiency, and restless Spirit. Blood in sputum is due to Spleen failing to contain blood. Chest pain and belching are due to Qi deficiency failing to move normally, leading to stagnation in Middle or Upper Jiao. Prescription: Ginseng and Astragali Radix each 4 qian, Ophiopogonis Radix, Angelicae Sinensis Radix, and Fritillariae Bulbus (Beimu) each 1 qian, Polygalae Radix (Yuanzhi), Ziziphus Seed (Suanzaoren), Moutan Cortex (Mudanpi), and Poria with Wood (Fushen) each 8 fen, Acorus Tatarinowii Rhizome (Shichangpu) and Glycyrrhizae Radix et Rhizoma each 5 fen. Hawthorn Fruit (Shanzha), Malty (Maiya), and Eucommiae Cortex (Duzhong) added as needed. Taken for over a year, he recovered. Ning Zhi Wan was added. Since the disease involves dryness-heat, even Baizhu was avoided, let alone other drying agents.
Another case: A fifty-year-old man, pale, irritable, shouting and panting/vomiting when displeased. Suddenly felt a spot of pain below the left breast. Later, after overwork and anger, felt foul Qi rushing up causing cough and violent vomiting, or dry cough without sputum, even hematemesis. Intermittent fever/chills resembling malaria. Treatments for malaria or phlegm failed. Wang Shishan found all pulses floating, fine, slightly wiry, and rapid. Diagnosis: Earth deficiency with Wood hyperactivity. Irritability and anger cause Liver Fire to flare, causing left breast pain (Liver Qi stagnation). Foul Qi rushing up is Liver Fire invading Spleen/Stomach. Hematemesis is Liver failing to store blood due to Fire disturbance. Cough is Metal lacking nourishment and being controlled by Fire. Vomiting is Spleen deficiency failing to transform, causing food stagnation into phlegm. Chills/fever are Water-Fire conflict. Treatment: Purge Liver excess, tonify Spleen deficiency, clear Lung dryness. Formula: Tangerine Peel (Qingpi) and Gardeniae Fructus each 7 fen, Paeoniae Radix Alba, Astragali Radix, and Ophiopogonis Radix each 1 qian, Angelicae Sinensis Radix and Donkey-hide Gelatin (Ejiao) each 7 fen, Glycyrrhizae Radix et Rhizoma and Schisandrae Fructus each 5 fen, Atractylodis Macrocephalae Rhizoma 1.5 qian, Ginseng Radix 3 qian. Taken for a month, symptoms resolved.
Yu Zhen commented: Previous case used heavy Ginseng/Astragali for aphonia/throat pain/bitter taste. This case used Ginseng for left breast pain/foul Qi rising. Only Wang Shishan could distinguish these. Previous case had soft/variable pulses indicating Qi deficiency. This case had floating/fine/wiry/rapid pulses; treating with Kidney-nourishing and Liver-clearing methods was crucial.
A village woman, over fifty, chronic cough with purulent bloody sputum, worse at night. Wang Shishan found pulses fine, soggy, and slippery. Diagnosis: Fei Wei (Lung Atrophy). Previous treatments (Ren Shen Qing Fei Yin, Zhimu Fuling Tang) contained Ginseng and Pinelliae Rhizoma (Banxia), which aggravated latent Lung fire and dried Lung fluids. Formula: Tian Dong, Mai Dong, Ejiao, and Beimu as Sovereign; Zhimu, Shengdi, Asteris Radix (Ziwan), and Gardeniae Fructus as Ministers; Sang Bai Pi and Aristolochiae Fructus (Madouling) as Assistants; Kuandonghua, Danggui Shen, Tingli Zi, Platycodonis Radix (Jiegeng), and Gancao as Envoys. Five doses brought relief.
Yu Zhen commented: Wang Shishan usually uses Ginseng/Atractylodis for bleeding, but this case and the next differ, showing flexibility. The next case used Yin-nourishing/cold herbs successfully, perhaps by luck. Such diseases are common now, but effective treatments are rare.
Another case: Pale, thirty-something, cough with hemoptysis, aphonia, night fever, spontaneous sweating. Wang Shishan found pulse fine, soggy, and slightly rapid. Diagnosis: Due to sexual excess. Formula: Si Wu Tang plus Maidong, Ziwan, Ejiao, Huangbai, and Zhimu. Over thirty doses reduced symptoms. Then bloating, nausea, anorexia, and loose stools appeared. Pulse became slow and weak, no longer rapid. Wang stated: Yin deficiency has receded; now use sweet-warm herbs to nourish Spleen/Stomach to remove the root. Formula: Si Jun Zi Tang plus Shenqu, Chenpi, and Maidong. Ten doses brought recovery.
Jiang Huangnan treated his brother with cough-hemoptysis. Initial doses of Zhimu, Beimu, Er Dong, Danggui, and Baishao (Lung-clearing) worsened flank pain at night. Adding 1.5 qian Ginseng reduced pain. Increasing Ginseng to 2 qian made left pulse larger/rapid and right pulse slightly wiry/rapid. Cough produced blood; stools were loose (three times daily). Formula: Ginseng 3 qian, Baizhu and Ziwan 1.5 qian, Fuling and Baishao 1 qian, Gancao 9 fen, Mudanpi 8 fen, plus Mao Gen and Tong Bian (child's urine). Pulse wiry/rapid decreased slightly. Added Huangqi 2 qian and Bupleuri Radix (Baibu) 6 fen. Cough stopped, bleeding decreased, then ceased. Loose stools persisted, so Ginseng, Huangqi, Baizhu, Dioscoreae Rhizoma (Shanyao), Chenpi, Gancao, Coicis Semen (Yiren), and Baishao were doubled. Combined with Jian Pi Wan for recovery.
Yu Zhen commented: This case strictly imitates Wang Shishan's methods.
Sun Dongsu treated Zang Liulao with upper hematemesis and lower hematochezia, distension in chest/diaphragm/back. Originated from anger and dog meat injury, causing fever and thirst. Doctors used Yin-nourishing/fire-descending herbs, worsening distension and bleeding. Sun found Guan pulses surging, slippery, and forceful. Diagnosis: Excess patterns in Liver and Spleen meridians, not Yin deficiency. Yin deficiency presents with rapid/weak pulses; afternoon tidal fever resolves by midnight, unlike constant day/night heat here. Classics: Anger injures Liver, causing vomiting blood and diarrhea. Distension is due to blood stasis. Dog meat injured Spleen, impairing blood containment. Misuse of Dihuang, Zhimu, Huangbai further injured Spleen and stagnated Upper Jiao stasis. Formula: Shan Zha, Xiang Fu, Zhi Shi (Qi-moving/digestion) as Sovereign; Danshen, Mudanpi, Taoren, Huashi, Mao Gen (blood-stasis resolving) as Ministers; Huanglian and Luzhu Gen (clearing dog meat heat) as Assistants. Four doses relieved distension and stopped bleeding. Abdominal discomfort remained; previous formula combined with Bao He Wan induced passage of foul black stool, leading to full recovery.
Nephew Mingzhi, overworked writing, caused Phlegm-Fire rebelling upward, vomiting large amounts of phlegm foam, then hematemesis (several bowls), fainting, sweating, lying still. Any movement caused vomiting and fresh red blood. Could not tolerate food/water. Doctors saw blood gushing, fever, large pulse, fainting, and inability to take medicine as bad omens. Sun Dongsu said: "No worry. Diagnosis must be flexible. Heart governs Blood, Liver stores Blood. Anger causes Qi ascending. Weak pulse with fever indicates Summerheat. Left pulse wiry/large, Right pulse weak/large indicates not just mental overwork moving Fire, but also Anger injuring Liver and Summerheat forcing Wood-Fire upward. Wind/dizziness belongs to Liver; vomiting/regurgitation belongs to Fire. Internal Wood-Fire rising and external Summerheat forcing cause sweating and blood ejection." First, Bai Wan Zi 3 qian to resolve Summerheat, clear Phlegm, and suppress rebellion. Vomiting stopped, Qi calmed, blood returned to vessels. Patient slept deeply, woke with vomiting stopped, appetite returned, dizziness resolved. Follow-up: Huashi, Xiangru each 3 qian, Huanglian, Dou Geng each 1.5 qian, Zhuru 1 qian, Gancao 5 fen. Four doses full recovery.
Yu Zhen commented: Previous case had distension worsened by Yin herbs, surging/slipping Guan pulses clearly indicating non-Yin deficiency. Anger and dog meat were known. This case had massive hematemesis, fainting, and danger. Right pulse weak/large interpreted as Summerheat rather than deficiency, combined with left wiry/large pulse, using large doses to clear Summerheat was masterful.
Li Shicai stated: Xu Rijia, Imperial Treasure Keeper, had emotional stagnation and sudden anger, causing massive hemoptysis and extreme fatigue. Li used Liu Jun Zi Tang with 1 liang Ginseng, 1 qian Ganjiang, and 8 fen Muxiang. Bleeding stopped in four days. Anger caused recurrence. Li said: "First soothe Liver, then heavily tonify." However, Autumn pulse in Summer indicated premature death. He died as predicted.
Yu Zhen commented: Massive hemoptysis from stagnation/anger injures Liver/Spleen long-term. Heavy Ginseng with acrid-hot herbs to treat contrary symptoms shows high skill. Without soothing Liver/stagnation, how could bleeding stop? But recurrence after anger was untreatable; death was inevitable.
Dong Yuanzai's relative had steaming fever, cough, and hemoptysis. Fire-clearing and Middle-Jiao tonification failed. Li Shicai found Chi pulses deep and solid, with lower abdominal pain on pressure. Diagnosis: Blood stasis from anger persisting for a year, causing steaming heat and severe Yin injury. Si Wu Tang plus Yujin, Taoren, Chuan Shan Jia, and small amount of Dahuang passed over a sheng of black blood. Pain persisted. Larger dose of Dahuang passed 3-4 sheng of black clots like peach gum. Pain stopped. Extreme fatigue treated with Du Shen Tang; heat reduced by 60-70% in three days. Full recovery after 100+ days of Shi Quan Da Bu Tang.
Yu Zhen commented: Deep/solid Chi pulses confirmed lower abdominal stasis. Stasis caused heat, heat caused bleeding. Identifying root via pulse allowed purging to remove root, followed by strong tonification without Yin-nourishing, which was brilliant.
Zhang Jingyue treated Ni Xiaolian, who studied hard, injuring Spleen with overthinking, causing recurrent vomiting triggered by fatigue. Li Yin Jian and Wen Wei Yin worked well. Late summer, socializing exhausted Heart/Spleen, causing massive hematemesis and hematochezia (large pieces, red/purple). Doctors attributed it to Labor-induced Fire in Heart/Spleen combined with Summerheat. Xi Jiao Di Huang Tang, Tong Bian, and Zhimu were given for two doses, worsening vomiting, tightening/rapid pulse, and critical condition. Zhang Jingyue arrived, seeing severe symptoms, prescribed large doses of Renshen, Shudi, Ganjiang, and Gancao. First dose had no effect; second reduced nausea, pulse showed slight vitality. Added Fuzi and Paoyanjiao each 2 qian, Renshen and Shudi each 1 liang, Baizhu 4 qian, Zhi Gancao 1 qian, Fuling 2 qian. Given at dusk, patient slept until midnight. Second dose stopped vomiting and bleeding. Continued for days, fully recovered. Reason: Fatigue injured Spleen, Spleen/Stomach Yang deficiency, Qi failing to control blood. Although season had "Two Fires," the pattern was not Two Fires. Cold herbs would have destroyed Spleen and caused death.
Yu Zhen commented: Same etiology and season as Sun Dongsu's nephew case, but one used cold, one used warm, both successful. Requires divine skill. Sun's pulse (Left wiry/large, Right weak/large) differed from Zhang's tight pulse. Sun did not trial herbs; Zhang saw worsening with cold herbs. Careful observation is key in clinical practice.
Yu Jiayan treated a person with chronic bleeding disorder. Sudden massive hemoptysis in morning, filling a basin. Throat congestion, wandering spirit, high fever like steaming.