人有感暑伤气，忽然吐血盈碗者，有劳力受伤，逢节吐血者，有伤怒伤肝，冲口而出，
一时
昏晕欲绝者，有脾不统血，血不归经，溢入胃而吐出者，有感冒风寒，咳呛破络，由肺咯出
者，皆为可治之症。惟有房劳过度，思虑伤神，吐心肾之血者，十无一治其余诸血，皆当审
其症因而施治法，或清或温，或补或泻，或攻或散，或和或通，不胶成见，惟病是视，以调
其营卫，和其三焦，使气归血附，此引血归经之法也。
炳按∶此说蓝本好，尚无语病。惟瘀留不肯复出，必溜入肺脏，而咳嗽变痨，先生未
知也。所以吐血之后，一有咳嗽，医治甚难也。
今之治血证者，不问何因，皆称火盛血淫，骤用寒凉之品以直折之，非不暂止，而血未
归经，
往往变为劳瘵不起之症。不知血归经，则血行而不吐；血不归经，虽强遏住之，积久亦必吐
也。犹治水然，不顺水之性，而宣之使通，乃逆水之性，而防之使止，其有不横决而四溢者
哉？是故寒凉之药，用之得当，其效甚速；用不得当，为害亦深，血证其一端也。
治喉证者，不敢用温药，与血症同。不知喉证之因乎风热者十之七，因乎郁火者十之三
。果
系郁火喉痛，自宜用寒凉之品以折之，挟风者，即当兼散其风。自有白喉忌表之说行，并祛
风之药亦不敢用，因豆豉之为害，而误会牛蒡之不可服，于是乎一见喉痛，不问其为风为寒
，一味以犀、羚、珠、黄、马勃、射干、板蓝、大青等极寒极凉之品为方，遂成一篇刻板文
字矣。以喉科名者，莫不皆然。并有妄指为白喉以骇人者，岂知白喉之症，因于煤毒，北方
专用煤烧，故有此症。南方不常见也。今有忽然喉中作响，响如打鼾，舌色白而不肿，顷刻
即死者，人皆不知其为何症，诸书皆称肺绝。近人名为肺闭。其实肾经中寒，阴证喉痹，误
服寒凉以致死耳。如服桂姜汤立愈。桂姜汤专治顷刻而起，前无毫恙者，此虚寒阴火之症
，
非实火也。治法用肉桂、炮姜、炙草各五分，同研细末，共归碗内，取滚汤冲入，仍将碗顿
于滚水，掉药口许，漫以咽下，立愈。或以生川附切片，涂白蜜，（名三因蜜附子）。火炙透
黑收贮，临用取如细粟一粒，口含咽津，亦立刻痊愈。又方∶无论冬夏，用四逆汤、（附子
、干姜、炙草。）姜附理中等汤。（白术、人参、炙草、加姜附。）自愈。切忌表散、清降、
寒
下等剂。如非寒证，误用姜、桂、附，则不可救，是以辨证为尤要。姜桂汤、蜜附片治法，
见《外科全生集》；四逆汤等治法，见《良方集要》。因此症最易误治，故特表而出之。
炳按∶喉证风热为多，夹痰夹湿夹温，厉有霉毒，种种不一也。寻常有表邪咳嗽，身热
脉弦
数，头痛，均疏散中参清咽解毒，亦非一味凉剂者，故前人无不以肺胃感风热证，以先散后
清立法。《白喉论》初见浏阳张绍修着立五方。其表也，葛根、桑叶、连翘、牛蒡、制蚕、
蝉衣。其清也，黄芩、生地、银花、胆草、马勃、青果、土茯苓、石膏，只用三钱，后子午
香室忌表抉微，连桑叶、薄荷亦忌，所立养阴八柱汤，大生地、白芍、麦冬、元参等寒凉滋
腻，抑遏风热，祸害病患，所云服三因蜜附子者，名少阴肾伤寒，急者一周时，不及救也。
《外科全生集》、《良方集要》，皆简单引用之书，法脉甚小。
王严士论述：
有人感受暑邪损伤正气，突然吐血满碗的；有人因劳累过度受伤，每逢节气便吐血的；有人因愤怒伤肝，血随气逆从口冲出，一时昏晕几乎死亡的；有人因脾虚不能统摄血液，血液不循常道运行，溢出进入胃中而呕吐出来的；有人因感冒风寒，咳嗽剧烈导致脉络破裂，由肺部咯出的。这些都属于可以治疗的病症。只有因房事过度、思虑过多损伤心神，导致心肾之血外溢的，十人中难救一人。其余各种出血证，都应当审察其病因和症状来施治，或清热，或温补，或补益，或泻下，或攻逐，或消散，或调和，或通利，不拘泥于固定成见，只根据病情进行诊治，以调和营卫之气，疏通三焦，使气能固摄血液，引导血液回归经脉，这就是引血归经的方法。
炳按（批注）：这种说法蓝本很好，没有语病。但是瘀血停留体内不肯排出，必然流入肺脏，从而引发咳嗽并转变为虚劳病，先生对此并不知晓。所以吐血之后，一旦出现咳嗽，医治就非常困难了。
当今治疗血证的人，不问是什么原因，都称之为火盛血淫，立即使用寒凉药物来直接遏制火势，虽然暂时止血，但血液未能回归经脉，往往转变为难以治愈的虚劳重症。不知道血液回归经脉，则血液正常运行而不外溢；血液不回归经脉，即使强行遏制住它，积久以后也必然会再次出血。这就像治水一样，不顺从水的本性使其通畅，反而违背水的本性去防止它流动以图止住，哪有不发生决堤泛滥四处横流的呢？因此，寒凉药物如果使用得当，疗效很快；如果使用不当，危害也很深，血证只是其中一方面罢了。
治疗喉证的人，不敢使用温热药物，这与治疗血证的情况相同。他们不了解喉证的成因吗？其中十分之七是因为风热，十分之三是因为郁火。如果是确属郁火引起的喉痛，自然适宜用寒凉药物来遏制火势，如果兼夹风邪，就应当同时疏散风邪。自从“白喉忌表”的说法流行以来，连祛风的药物也不敢使用了，因为豆豉的危害，而误解牛蒡也不可服用，于是只要一见喉痛，不问是风邪还是寒邪，一味地使用犀角、羚羊角、珍珠、黄连、马勃、射干、板蓝根、大青叶等极寒极凉的药物治疗，形成了一种刻板固定的模式。凡是自称喉科专家的，无不如此。更有甚者，胡乱指认为白喉来恐吓病人，哪里知道白喉这个病症，是由于煤毒引起的，北方专门烧煤，所以有此症，南方不常见。现在有忽然喉咙作响，声音像打鼾，舌色白而不肿胀，顷刻间就死亡的，人们都不知道这是什么病，各种医书都称为肺绝。近代人称为肺闭。其实是肾经中寒，阴证喉痹，误服寒凉药物导致死亡罢了。如果服用桂姜汤立刻痊愈。桂姜汤专门治疗突然发作、之前毫无不适症状的病证，这是虚寒阴火之症，不是实火。治疗方法是用肉桂、炮姜、炙甘草各五分，一起研成细末，放入碗中，取滚开水冲入，仍将碗放在滚水中，摇晃药液片刻，慢慢咽下，立刻痊愈。或者用生川附子切片，涂抹白蜜（名叫三因蜜附子），用火烤透变黑后收存，临用时取如细粟米大小的一粒，含在口中吞咽津液，也能立刻痊愈。又一个方子：无论冬夏，使用四逆汤（附子、干姜、炙甘草）、姜附理中汤（白术、人参、炙甘草，加生姜、附子），即可自愈。切忌使用解表发散、清热降火、寒下等剂型。如果不是寒证，误用姜、桂、附子，那就不可救治，所以辨证尤为重要。姜桂汤、蜜附片的治疗方法，见于《外科全生集》；四逆汤等治疗方法，见于《良方集要》。因为这个病症最容易误治，所以特别提出出来加以说明。
炳按（批注）：喉证多为风热引起，夹杂痰湿、温毒、霉毒等，情况种种不一。寻常有表邪咳嗽、身热、脉弦数、头痛的，均在疏散外邪中参合清咽解毒之法，并非单纯使用凉剂，所以前人无不以肺胃感受风热证为准则，采用先疏散后清热的立法原则。《白喉论》最初由浏阳张绍修著立五个方子。其表散法用葛根、桑叶、连翘、牛蒡子、制僵蚕、蝉蜕。其清热法用黄芩、生地、银花、胆草、马勃、青果、土茯苓、石膏，只用三钱。后来子午香室忌讳解表法并探究细微之处，连桑叶、薄荷也忌讳，所立的养阴八柱汤，以大生地、白芍、麦冬、元参等寒凉滋腻药物为主，压抑遏制风热，祸害病患。所谓服用三因蜜附子的，名为少阴肾伤寒，急症者一周时间内，来不及救治。《外科全生集》、《良方集要》，都是简单引用的书籍，法门流派很小。
Wang Yanshi's Discussion:
There are cases where individuals, affected by summerheat and injured in their qi, suddenly vomit blood filling a bowl; there are cases where laborers, injured by overexertion, vomit blood at the change of solar terms; there are cases where anger injures the Liver, causing blood to rush out from the mouth, leading to temporary fainting and near-death states; there are cases where the Spleen fails to control blood, causing blood to deviate from its vessels, overflow into the Stomach, and be vomited out; there are cases where wind-cold invasion causes violent coughing that ruptures collaterals, resulting in blood being spat out from the Lungs. All these are treatable conditions. Only those caused by excessive sexual activity and excessive mental worry injuring the Shen (Spirit), leading to the hemorrhage of Heart and Kidney blood, are rarely curable (one in ten survives). For other types of bleeding disorders, one must examine the etiology and symptoms to apply treatment methods, whether clearing heat, warming, tonifying, purging, attacking, dispersing, harmonizing, or unblocking, without adhering rigidly to preconceived notions, but treating according to the disease itself, to regulate Ying and Wei (Nutritive and Defensive Qi), harmonize the Sanjiao (Triple Burner), so that Qi can anchor Blood and guide Blood back to its vessels. This is the method of guiding blood back to its normal course.
Bing's Commentary: This theory has a good foundation and contains no logical flaws. However, it overlooks that if blood stasis remains and does not re-emerge, it will inevitably flow into the Lung organ, causing coughing that transforms into consumption (Lao disease). The author was unaware of this. Therefore, after hematemesis, if coughing appears, medical treatment becomes very difficult.
Contemporary practitioners treating blood disorders, regardless of the cause, all attribute it to "excessive fire and rampant blood," immediately using cold and cool herbs to suppress the fire directly. Although this may temporarily stop the bleeding, the blood does not return to its vessels, often transforming into incurable consumption syndromes. They do not understand that when blood returns to its vessels, it circulates normally without vomiting; when blood does not return to its vessels, even if forcibly suppressed, it will inevitably vomit again after accumulation. It is like managing water: if one does not follow the nature of water to allow it to flow freely, but instead goes against its nature to prevent flow in an attempt to stop it, how can one avoid catastrophic bursting and widespread flooding? Thus, cold and cool medicines, when used appropriately, have rapid effects; when used inappropriately, they cause deep harm. Blood disorders are just one aspect of this.
Practitioners treating throat disorders dare not use warm medicines, similar to the approach for blood disorders. Do they not understand the etiology of throat disorders? Ten percent are due to wind-heat, and three percent are due to constrained fire. If the sore throat is indeed due to constrained fire, it is appropriate to use cold and cool herbs to suppress the fire; if accompanied by wind, wind should be dispersed simultaneously. Since the saying "white membrane throat contraindicates exterior-releasing methods" became popular, even wind-dispersing herbs are avoided. Due to the perceived harm of fermented soybean (Douchi), people misunderstood that bougainvillea seed (Niubangzi) should also not be taken. Consequently, upon seeing any sore throat, regardless of whether it is wind or cold, they indiscriminately prescribe extremely cold and cool herbs such as rhinoceros horn (Xijiao), antelope horn (Lingyangjiao), pearl (Zhenzhu), Coptis chinensis (Huanglian), Fly agaric mushroom (Mabo), Belamcanda root (Shegan), Isatis root (Banlangen), and Indigo naturalis (Daqingye), creating a rigid, stereotypical pattern. Those claiming expertise in throat diseases are all alike. Some even falsely diagnose white membrane throat to frighten patients. Who knows that white membrane throat is caused by coal toxicity? In the North, where coal is exclusively burned, this disease occurs; it is rare in the South. There are now cases where the throat makes sudden noises, sounding like snoring, with a white tongue that is not swollen, leading to death within moments. People do not know what disease this is; various medical texts call it "Lung Exhaustion." Recent authors call it "Lung Closure." In reality, it is cold in the Kidney meridian, a Yin syndrome throat obstruction, caused by the mistaken use of cold and cool medicines leading to death. If Guizhi Jiangtang (Cinnamon Twig and Ginger Decoction) were administered, immediate recovery would occur. Guizhi Jiangtang specifically treats sudden onset cases with no prior symptoms, which are deficiency-cold Yin-fire syndromes, not excess fire. The treatment method uses 5 fen each of Cinnamon Bark (Rougui), Prepared Ginger (Paojiang), and Honey-fried Licorice Root (Zhigancao), ground into fine powder together, placed in a bowl, poured with boiling water, kept in boiling water, shaken slightly, and swallowed slowly for immediate cure. Alternatively, take fresh Aconite root (Chuanfuzi) slices, coat with white honey (named Sanyin Mifuzi), roast thoroughly until black, store for use. When needed, take a grain-sized piece, hold in the mouth, swallow saliva, and recover instantly. Another prescription: regardless of season, use Sini Tang (Aconite, Dried Ginger, Honey-fried Licorice) or Jiangfu Lizhong Tang (Atractylodes macrocephala, Ginseng, Honey-fried Licorice, added with Ginger and Aconite), and self-healing will occur. Strictly avoid exterior-releasing, heat-clearing descending, and cold-purgative formulas. If it is not a cold syndrome, the mistaken use of Ginger, Cinnamon, and Aconite is incurable; thus, differentiation of symptoms is particularly important. The treatments for Jianggui Tang and Honey-coated Aconite slices are found in *Waike Quansheng Ji* (Complete Collection of External Medicine); the treatments for Sini Tang etc. are found in *Liangfang Jiyao* (Collection of Excellent Prescriptions). Because this syndrome is easily misdiagnosed, it is specially highlighted here.
Bing's Commentary: Throat disorders are mostly caused by wind-heat, complicated by phlegm-dampness, warm pathogens, mold toxins, etc., varying greatly. Common cases with exterior pathogen cough, fever, wiry-rapid pulse, and headache are treated by dispersing exterior pathogens while incorporating throat-clearing and detoxification methods, not merely using cold herbs. Therefore, predecessors always established principles for Lung-Stomach wind-heat syndromes by first dispersing then clearing. *Baihong Lun* (Treatise on White Membrane Throat) initially proposed five prescriptions by Zhang Xiuxiu of Liuyang. The exterior-dispersing formula uses Pueraria root (Gegen), Mulberry leaf (Sangye), Forsythia fruit (Lianqiao), Bougainvillea seed (Niubangzi), Processed Silkworm (Zhi Can), and Cicada slough (Chanyi). The heat-clearing formula uses Scutellaria root (Huangqin), Rehmannia root (Shengdi), Honeysuckle flower (Yinhua), Gentian root (Dancao), Fly agaric mushroom (Mabo), Olive (Qingguo), Smilax glabra rhizome (Tufuling), and Gypsum (Shigao), used only in 3-qian doses. Later, Ziwu Xiangshi, fearing exterior-releasing methods and exploring subtleties, forbade even Mulberry leaf and Mint, establishing Yangyin Bazhu Tang (Nourishing Yin Eight Pillars Decoction) with large doses of Rehmannia root, White Peony root, Ophiopogon tuber, and Scrophularia root, which are cold, cool, cloying, and stifling, suppressing wind-heat and harming patients. Regarding the mention of taking Sanyin Mifuzi, it is named Shaoyin Kidney Cold Damage; in acute cases, within one week, rescue is impossible. *Waike Quansheng Ji* and *Liangfang Jiyao* are simply cited books with narrow therapeutic lineages.