顾枚先年二十余岁。身躯肥大。平素嗜酒。迩来鳏居郁郁。壬午孟夏。患失血证。每晚去血一二盏。至
季夏时。去血无算。面色不见憔悴。肌肉不见消瘦。诊其脉亦不见洪盛。昼夜亦不见寒热。但苦上气喘促。夜
多咳嗽。喉间窒塞。胸前紧逼。背后刺胀。腹中闷痛。躁急多怒。医以人参阿胶治失血成法。用之月
余。逾增其势。更医多方。以图用膏子之润上。而气时降也。用牛膝黄柏之导下。而血时息也。及服酒研三
七少许。则血止而 亦不作。但未久。血复至。咳复增。又以为龙雷之火所致。思用八味丸中之些微桂附。
以引火归原。总繇未识病情也。请因是证而益广病机焉。人身血为阴。男子不足于阴。故以血为宝。
是以失血之证。阴虚多致发热。面色多致枯黑。肌肉多致消瘦。
今病者不然。岂其有余于血哉。以病为饮醇伤胃。胃为水谷之海。多气多血。二十余年水谷充养之精华。以
渐内亏。而外不觉也。胃之脉从头走足。本下行也。以呕血之故。逆而上行。则呼吸之音。必至喘急矣。胃
之气传入大小肠膀胱等处。亦本下行也。以屡呕之故。上逆而不下达。则肠腹之间。必致痛闷矣。
胃气上奔。呕逆横决。则胸中之气必乱。至于紧逼痛楚。则乱之甚矣。胸中之位舍有限。已乱之气。无处可
容。势必攻入于背。以背为胸之府也。至于肩 骨空。钻如刃刺。则入之深矣。故一胃耳。分为三脘。上脘
气多。下脘血多。中脘气血俱多。今胃中既乱。气血混矣。不但胃也。胃之上为膈。其心烦多怒者。正内
经所谓血并于膈之上。气并于膈之下致然。气血倒矣。所以内经又言血并于阳。气并于阴。乃为热中。又
言瘅成为消中。瘅即热也。消中者善食多饥。而肌肉暗减也。病者之嗜饮。为热积胃中。其不病消中。而
病呕血者何耶。内经又以胃脉本宜洪盛。反得沉细者。为胃气已逆。若见人迎脉盛。则热聚于胃。而内生
痈。今胃脉已见沉细。其不成胃痈。而成呕血者又何耶。不知病者呕血之源。与此二者同出异名耳。热积于
中即为消。血积于中即为痈。而随积随呕。则为此证。揆其致此之繇。必以醉饱入房而得之。盖人身气动则
血动。而 精时之气。有乾坤鼓铸之象。其血大动。精者血之所化也。灌输原不止胃之一经。独此一
经所动之血。为醉饱之余所阻。不能与他经之血。缉续于不息之途。是以开此脱血一窦。今者竟成熟路矣。
欲治此病。不如此其分经辨证。何从措手乎。岂惟经也。络亦宜辨。胃之大络。贯膈络肺。不辨其络。亦孰知
膈间紧迸。肺间气胀痰胶。为胃病之所传哉。当此长夏土旺。不惟母病。而子失养。抑且母邪尽传于
子。至三秋燥金司令。咳嗽喘满之患必增。不急治之。则无及矣。今岁少阴司天。少阴之上。热气主之。运
气热也。夏月适当暑热。时令热也。而与胃中积热。合煽其虐。不治其热。血必不
止。然不难于血之止也。第患其止而聚也。聚于中为蛊为痈。犹缓也。聚于上为喘为厥。
则骤也。惟遵内经热淫血溢。治以咸寒之旨为主治。咸能走血。寒可胜热。庶于消渴痈疽两患。可无妨
碍。然必先除经病。务俾经脉下走。经气下行。后乃可除络中之病。譬沟渠通而行潦始消也。未易言也。
病者呕血经久。无法可止。父兄敦请仆往救治。告以必须议病不议药。方能用。予乃定是案。用玄明粉
化水煮黄柏。秋石化水煮知母。以清解蕴热而消瘀化疽。加甘草以调其苦。独取咸寒气味。进四剂而血
止。可谓神矣。医者果然破药性太寒。渠家果不终其用。延至八月。病者胸胁高肿数围。肺内生痈。寒热
大作。喘咳不休。食饮不入。俯几不敢动移。以致瘠肉磨穿。危在呼吸。百计强与医治。断不应命。父兄因
生仇恨。再求为其所难。以曲尽人情。只得极力治之。变证蜂出。通计免于五死而得五生。病者不戒。兼啖
生冷。肺复生痈。一夕呕痰。如猪胆状者。百十余枚。一脏两伤。竟至不起。仆焦劳百日。心力俱殚。第无
如末流难挽何哉。
胡卣臣先生曰。向传顾病治愈。竞称神仙。其后未免以成败论矣。倘
用咸寒时。遇有识者赞之。何至渴而穿井。斗而铸兵耶。然此案自堪传也。
顾枚先，二十多岁。身体肥胖。平时喜欢喝酒。近来丧妻后心情抑郁。壬午年孟夏（农历四月），患上失血证。每晚吐血一两只碗的量。到了季夏（农历六月）时，吐血无限量。面色看不出憔悴，肌肉看不出消瘦。诊察他的脉象也不见洪大旺盛。昼夜也不见寒热交替。只是苦于上气喘促，夜里多咳嗽，喉间堵塞感，胸前紧逼感，背后刺痛胀满，腹中闷痛，烦躁易怒。医生按照治疗失血的成法用人参、阿胶，使用了一个多月，病情反而加重。换了好几位医生，多方设法，想用膏滋的滋润来使气下降；用牛膝、黄柏来引导下行，使血停止。等到服用酒制三七少许，则血止而喘也暂时不作。但未过多久，血又复发，咳又增加。又认为是龙雷之火所致，想用八味丸中少量的桂枝、附子，以引火归原。这总归是因为没有认清病情。请借此证进一步阐述病机。
人体的血属于阴，男子阴气不足，所以以血为宝。因此失血的病症，阴虚多导致发热，面色多呈现枯黑，肌肉多消瘦。
现在的病人却不是这样。难道他血有余吗？这是因为饮酒损伤了胃。胃是水谷之海，多气多血。二十多年来水谷充养的精华，逐渐内亏，但外表看不出来。胃的经脉从头走向足，本性是下行的。因为呕血的原因，气逆而上行，那么呼吸的声音，必然导致喘急。胃的气传入大小肠、膀胱等处，也是本性下行的。因为屡次呕吐的缘故，气上逆而不能下达，那么肠腹之间，必然导致疼痛闷胀。
胃气上奔，呕逆横决，那么胸中的气必然紊乱。至于紧逼痛楚，则是紊乱得很严重了。胸中的位置有限，已经紊乱的气，无处可容，势必攻入于背部，因为背是胸的府库。至于肩胛骨空处，钻痛如刃刺，则是侵入得深了。所以一个胃，分为三脘：上脘气多，下脘血多，中脘气血俱多。现在胃中既已紊乱，气血混杂了。不仅限于胃。胃之上为膈，其心烦多怒，正是《内经》所说的“血并于膈之上，气并于膈之下”导致的。气血倒置了。所以《内经》又说“血并于阳，气并于阴”，这就成为热中症。又说“瘅成为消中”。瘅就是热。消中症是善食多饥，而肌肉暗中减少。病人的嗜饮，是因为热积在胃中。他不患消中症，而患呕血症，为什么呢？《内经》又说胃脉本宜洪盛，反得沉细者，是胃气已逆。若见人迎脉盛，则是热聚于胃，而生内痈。现在胃脉已见沉细，不成胃痈，而成呕血，又是为什么呢？不知道病人呕血的源头，与上述两种情况同出异名罢了。热积于中即为消症，血积于中即为痈症。而随积随呕，就形成了这个证候。推究导致此病的缘由，必定是因为醉饱后行房事而得的。大概人身气动则血动，而精气时的气，有乾坤鼓铸之象。其血大动，精是由血所化。灌输之处不止胃这一条经脉。唯独这一经所动的血，被醉饱之余所阻，不能与他经之血，在不息的途径中接续。因此开了这个脱血的窦道。如今竟然成了熟路了。想要治疗这个病，不如此分经辨证，从哪里下手呢？
岂止经脉，络脉也应当辨别。胃的大络，贯穿膈部联络肺脏。不辨别其络脉，谁知道膈间紧迸，肺间气胀痰胶，是胃病所传变而来的呢？当此长夏土旺之时，不仅母病，而且子失养，况且母邪尽传于子。到了三秋燥金司令之时，咳嗽喘满的祸患必然增加。不紧急治疗，就来不及了。今年少阴司天，少阴之上，热气主之。运气是热。夏月正当暑热，时令是热。而与胃中积热，合起来煽动其虐。不治疗其热，血必然不止。然而不难于让血停止。只担心血止后聚集。聚集于中为蛊为痈，还算缓慢。聚集于上为喘为厥，则是突然发作。只有遵循《内经》“热淫血溢，治以咸寒”的宗旨为主治。咸能走血，寒可胜热。这样对于消渴、痈疽两患，可以无妨碍。然而必须先除经脉的病，务必使经脉下走，经气下行，然后才可以除去络中的病。就像沟渠通了，而行潦（雨水）才开始消退一样。不容易说清楚啊。
病人呕血经久，无法停止。父兄恳切邀请我去救治。我告诉他们必须议病不议药，才能用药。于是我定下这个方案，用玄明粉化水煮黄柏，秋石化水煮知母，以清解蕴热而消瘀化疽。加甘草以调和其苦味。独取咸寒气味，进服四剂而血止。可谓神效了。医生果然认为药性太寒，他们家果然没有坚持用完。拖延到八月，病人胸胁高肿数围，肺内生痈，寒热大作，喘咳不休，饮食不入，俯伏几案不敢动移，以致瘦肉磨穿，危在旦夕。百计强行医治，断然不应命。父兄因此产生仇恨，再次请求他为难之事，以曲尽人情。只得极力治疗。变证蜂拥而出，通计免于五死而得五生。病人不戒忌，兼吃生冷，肺复生痈。一晚吐痰，像猪胆状的一百多枚。一脏两伤，竟至不起。我焦劳百日，心力俱殚。只是无奈末流难挽何哉。
胡卣臣先生说：“先前传说顾某的病治愈了，竞相称颂为神仙。其后未免以成败论英雄了。如果在用咸寒药时，遇到有见识的人称赞它，何至于渴而穿井，斗而铸兵呢？然而此案自然值得流传。”
Gu Meixian, in his early twenties. His body was obese. He had a habit of indulging in alcohol. Recently, after becoming widowed, he lived in depression. In the first month of summer (Mengxia) of the Renwu year, he suffered from a hemorrhagic disorder. Every night, he vomited blood equivalent to one or two bowls. By the third month of summer (Jixia), the amount of blood loss became immeasurable. His complexion did not appear haggard, nor did his muscles show emaciation. Palpation of his pulse revealed no surging and fullness. There were no alternating chills and fever throughout day and night. He only suffered from panting and shortness of breath, frequent coughing at night, a sensation of obstruction in the throat, tightness and pressure in the chest, stabbing distension in the back, dull pain in the abdomen, irritability, and anger. Physicians treated the hemorrhage according to established methods using Renshen (Ginseng Radix) and Ejiao (Donkey-hide Gelatin). After more than a month of use, the condition worsened. Several other physicians attempted various remedies: some used moistening pastes to descend Qi; others used Niuxi (Achyranthes Root) and Huangbai (Phellodendron Bark) to guide downward and stop bleeding. A small amount of Sanqi (Notoginseng Radix) processed with wine was administered, which temporarily stopped the bleeding and relieved the panting. However, shortly thereafter, bleeding recurred and coughing intensified. It was then attributed to "Dragon Fire" (hyperactive fire from deficiency), and it was intended to use small amounts of Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) from Bawei Wan (Eight-Ingredient Pill with Rehmannia) to lead fire back to its source. This was ultimately due to a failure to recognize the true nature of the disease. Let us elaborate on the pathogenesis based on this case.
Blood belongs to Yin. Men are naturally deficient in Yin, so they regard blood as precious. Therefore, in cases of hemorrhage, Yin deficiency often leads to fever, a withered and dark complexion, and muscle emaciation.
The present patient is different. Does he have an excess of blood? No. The cause lies in strong alcohol damaging the Stomach. The Stomach is the sea of water and grain, rich in Qi and Blood. The essence nourished by food and drink over twenty years has gradually been depleted internally, though this is not apparent externally. The Stomach meridian runs from the head to the feet, naturally descending. Due to vomiting blood, the Qi rebels and ascends, causing respiratory sounds to become rapid and panting. The Qi transmitted from the Stomach to the Large Intestine, Small Intestine, and Bladder also naturally descends. Due to repeated vomiting, the Qi rebels upward and fails to descend, causing pain and stifling distension in the intestines and abdomen.
When Stomach Qi rushes upward, rebelling violently, the Qi in the Chest becomes chaotic. The tightness and painful distress indicate severe chaos. Since the space in the Chest is limited, the chaotic Qi has nowhere to reside and inevitably attacks the Back, for the Back is the mansion of the Chest. The drilling pain like a blade stab in the shoulder blade area indicates deep invasion. Thus, the Stomach is divided into three parts: the Upper Jiao (Shangwan) has abundant Qi, the Lower Jiao (Xiawan) has abundant Blood, and the Middle Jiao (Zhongwan) has both. Now that the Stomach is chaotic, Qi and Blood are mixed. This extends beyond the Stomach. Above the Stomach is the Diaphragm. The mental restlessness and anger correspond to the *Neijing* statement: "Blood congregates above the Diaphragm, and Qi congregates below the Diaphragm," resulting in inverted Qi and Blood. The *Neijing* further states: "When Blood congregates in Yang and Qi in Yin, it becomes 'Heat Zhong'." It also says: "Disease caused by heat becomes 'Xiao Zhong'." Heat is 'Dan'. Xiao Zhong is characterized by excessive hunger and appetite but hidden muscle loss. The patient's drinking habit stems from heat accumulating in the Stomach. Why does he suffer from vomiting blood instead of Xiao Zhong? The *Neijing* states that if the Stomach pulse, which should be surging and full, appears deep and fine, it indicates rebellious Stomach Qi. If the Yingchu pulse is surging, heat gathers in the Stomach leading to internal abscesses. Given the current deep and fine pulse, why an abscess and not vomiting blood? The source of this patient's vomiting blood shares the same origin but presents differently. Heat accumulating internally manifests as Xiao (wasting-thirst); Blood accumulating internally manifests as Abscess. With accumulation followed immediately by vomiting, this specific syndrome arises. Investigating the cause, it must stem from sexual activity after heavy drinking and eating. Generally, when Qi moves, Blood moves. The Qi associated with Essence possesses the imagery of heaven and earth forging. When Blood moves excessively, since Essence is transformed from Blood, the infusion is not limited to the Stomach meridian alone. However, the Blood moved in this meridian is obstructed by the remnants of heavy drinking and eating, preventing it from continuing along the unceasing pathways with Blood from other meridians. Thus, a breach for massive blood loss opened. Now it has become a habitual route. To treat this, one must differentiate by meridian and syndrome; otherwise, where does one begin?
It is not only the meridians but also the collaterals that require differentiation. The great collateral of the Stomach pierces the Diaphragm and connects to the Lung. Without distinguishing the collaterals, who would know that the tight bursting in the Diaphragm and Qi distension with sticky phlegm in the Lung are transmissions from Stomach disease? During late summer, when Earth is prosperous, not only does the mother organ suffer, but the child organ loses nourishment, and moreover, the pathogen of the mother fully transmits to the child. By the third autumn, when Dry Metal governs, the afflictions of coughing, panting, and fullness will surely increase. If not treated urgently, it will be too late. This year, Shaoyin governs the Heaven, with Heat Qi presiding above Shaoyin. The movement of Qi is Heat. Summer coincides with hot weather, so the seasonal climate is Heat. Combined with the accumulated heat in the Stomach, they fan the tyranny together. Unless the heat is treated, the bleeding will not stop. However, stopping the bleeding is not difficult; the concern is its aggregation. Aggregation in the middle results in Gu (parasitic disease) or abscess, which is relatively slow. Aggregation in the upper region results in panting and syncope, which is sudden. One must primarily follow the *Neijing* principle: "For excessive heat causing blood overflow, treat with salty and cold substances." Salty substances enter the Blood, and cold substances overcome heat. This way, complications of wasting-thirst and carbuncles can be avoided. First, however, the meridian disease must be removed, ensuring the meridians descend and meridian Qi flows downward, before addressing the collateral disease. This is like clearing ditches so that floodwaters can subside. This is not easy to explain.
The patient had been vomiting blood for a long time with no method to stop it. His father and brothers earnestly invited me to treat him. I told them that one must discuss the disease before discussing the prescription. Only then could medication be used. I formulated this case plan: dissolve Xuanmingfen (Natrii Sulfas) in water to decoct Huangbai (Phellodendri Cortex), and dissolve Qiushi (Calx Gypsumis) in water to decoct Zhimu (Anemarrhenae Rhizoma), to clear concealed heat, resolve stasis, and transform abscesses. Add Gancao (Glycyrrhizae Radix et Rhizoma) to moderate the bitter taste. Exclusively utilizing salty and cold flavors, four doses were administered, and the bleeding stopped. This was miraculous. The physician indeed considered the medicinal properties too cold, and the family failed to complete the course. By August, the patient's chest and hypochondrium swelled several inches around, an abscess formed in the Lung, chills and high fever erupted severely, panting and coughing ceased not, food and drink were refused, lying prone on the desk without movement, causing flesh to wear through, critical and breathing heavily. Hundreds of desperate measures were taken to treat him, but he refused compliance. His father and brothers harbored resentment and again sought his help for the impossible, to satisfy human relations. I had to strive hard to treat him. Complications emerged like bees. Counting all outcomes, five deaths were avoided and five lives saved. The patient did not abstain, consuming raw and cold foods, causing another lung abscess. One night, he expectorated sputum resembling pig bile, over a hundred pieces. One organ injured twice, he eventually died. I labored anxiously for a hundred days, exhausting my mind and strength. Yet, what can be done when the end cannot be reversed?
Mr. Hu Youchen said: "Previously, it was reported that Gu's illness was cured, and people competed to call him a deity. Later, however, judgment was inevitably based on success or failure. If, when using salty and cold medicines, there had been knowledgeable individuals to endorse them, how could it have come to digging a well when thirsty and casting weapons when fighting? Nevertheless, this case is worthy of transmission."