二钱） 阿胶珠（三钱） 金石斛（四钱） 生白芍（二钱） 生牡蛎（八钱） 天花粉（二钱） 浮小麦（五钱）
三诊 滋肾养肝，胃气渐舒，渐能安谷，舌燥渐润。药既应手，无庸更章。即请商进。
金石斛 天麦冬 天花粉 生白芍 炒木瓜 生牡蛎 川贝母 生甘草 粉丹皮
每日晨服六味地黄丸，用阿胶珠三钱，金石斛三钱，大麦冬二钱，煎汤送下。
四诊 胃气渐振，饮食馨增。经谓中焦受气，取汁变化而赤是为血，气者何，谷气是也，谷气既旺，血去
虽多，不虞其不复，舌心干毛，再滋肾水，水足津自升矣。留候叔涛先生商进。
大生地 生山药 粉丹皮 茯神 金石斛 天麦冬 清阿胶 生白芍 花粉 川贝母
五诊 清津渐回，舌质润泽，寐醒燥渴亦定。然平素痰多，此届病后，咯吐之痰绝无仅有。今日形体恶
寒，沉沉欲寐。脉濡微滑。良以谷气渐增，水谷之气，生痰酿浊，弥漫胸中，以致阳气不能流布，神机不能
转运。前法参以化痰。留候商进。
大生地（五钱炒松） 阿胶珠（三钱） 竹茹（一钱水炒） 生白芍（一钱五分） 川贝母（二钱） 栝蒌皮（
三钱炒） 白茯苓（三钱） 海蛤粉（二钱） 天冬（三钱） 陈关蛰（七钱）
六诊 痰稍爽利，神情略振，然胸次气郁不舒，前番呕血之始，亦由此而起。脉形右大，舌干少津。良以
气分久郁，上焦不行，则下脘不通。拟开展上焦气化，参以甘凉救津。即请叔涛先生商进。
炒香豉 炒蒌皮 光杏仁 川贝母 枇杷叶 黑山栀 川郁金 金石斛 大天冬 梨汁
某 溢血之后，未及三日，即起咳嗽，晨汗不寐内热，渐至痰多盈碗，痰味带咸。脉细弱而数，左关微弦，
尺中小涩。此血去太多，火来克金，肾本空虚，失于摄纳。恐延入损途。
熟地炭 青蛤散 五味子 川贝 丹皮 泽泻 紫菀肉 生山药 茯苓神 牛膝炭 款冬花
又 前法未见松减。然咳嗽之所由，当是肺络杂有凝瘀。
生熟牛膝 单桃仁 延胡索 上湘军（酒炒黑） 土鳖虫（去头足）
某 血未复来，痛亦稍安，火之上升者，亦得稍平，脉两关略柔，不可不为起色。无如气口之脉，大于关
部，咳嗽较血涌之时反觉增甚。昨日本已虑及。所以然者，都缘血溢之时，血多喉小，卒不得出，以致瘀
血散入肺络之中，肺气逆而不降。恐由此而入损途。
茜草炭 川贝 光杏仁 当归须 磨三七 川郁金 延胡 代赭石 单桃仁 上湘军
改方加土鳖虫五枚去头足，赤芍二钱，桂枝一分煎汁拌炒。
案语新奇，阅历之精深，心思之警辟，不可多得。（文涵志）
扬（左） 努力损伤肺络，络血外溢，不时见红，左胁作痛，咽燥舌干。宜清养肺胃，以和脉络。
川石斛（四钱） 全当归（二钱醋炒成炭） 鲜竹茹（盐水炒二钱） 降香片（三分） 丹参炭（二钱）
大麦冬（三钱） 冬瓜子（三钱） 杜苏子（盐水炒三钱） 丹皮炭（二钱）
许（左） 每至着卧，辄反不寐，坎水离火，不能相济，略见一斑。春升之际，阳气上升，鼓激损络，遂至咯血。
火灼金伤，渐至咳嗽，至金水不能相生。血既时止时来，咳嗽更无底止，中气日薄，旋运力乏，时涌痰涎。
脉细涩而沉，左关带弦。内伤重症，若得息心静养，或能带病支持。
南沙参（三钱） 光杏仁（三钱） 青蛤散（四钱） 牛膝炭（三钱） 川贝母（二钱炙） 紫菀肉（二钱炙）
云茯苓（四钱） 冬虫夏草（三钱） 生鸡子白（一枚调服） 白蜜（一钱五分冲） 藕节（三枚） 八仙长寿丸
（三钱先送下）
陈（左） 血生于心，藏于肝统于脾。善奕构思，思中有虑，既思且虑，脾土必伤，以致统摄无权，血液外溢，
咯吐带红，以其为血之液也，所以血不鲜赤，心中有难以明言之状。此由少阴心经而来，未可以其势
微也而忽之。拟补益心脾，导血归脾。
炙绵 奎党参 朱茯神 远志肉 野于术 炒枣仁 当归尾 广木香
此案血液之论，体会入微，突出前贤，虽使西人见之，亦当折服。（文涵志）
唐（右） 小产之后，肝肾损伤不复，腰足软弱少力，白带绵下，甚则咯血凝浓，外紫内红。肝络暗损。治病
必求其本。
阿胶珠 生白芍 浓杜仲 旱莲草 生山药 牡蛎 炒牛膝 丹皮炭 女贞子 潼沙苑（盐水炒）
又 养肝益肾，脉症相安，带下腰足酸弱，咯血凝浓，有时气冲作呛。肝肾阴虚，奇脉不固。仍守肝肾并
调，兼固奇脉。
阿胶珠（三钱） 白芍（三钱酒炒） 浓杜仲（三钱） 金毛脊（四钱） 生山药（三钱） 生地炭（四钱）
牡蛎（四钱） 潼沙苑（盐水炒三钱） 女贞子（四钱酒蒸） 鸡头子（三钱）
陆（右） 吐血时止时来，今则凝浓，色带紫殷。此由肝络而来者，肝病先厥后逆，肝主乎左所以左卧则
咽痒气冲。非静养不能回复。
大生地（五钱） 生白芍（三钱） 丹皮炭（二钱） 海蛤粉（三钱） 阿胶珠（三钱） 生甘草（五分）
旱莲草（二钱） 川贝母（二钱） 女贞子（三钱） 天麦冬（各二钱）
朱（左） 吐血频来，不时嗳噫，大便数日方行。未吐之先，觉胸腹作痛，既吐之后，其痛转定。脉濡而弦。踊
跻损伤肝胃之络。拟降胃而除陈补新。
赭石（五钱） 鲜竹茹（三钱水炒） 磨三七（三分） 干橘叶（一钱五分） 丹皮炭（二钱） 栝蒌炭（五钱）
炒白芍（三钱） 当归炭（二钱） 枳实（七分） 牛膝炭（三钱） 藕节（三枚）
严（左） 性情躁急，肝经之气火上凌，吐血屡屡，气升呛咳。脉象细弦。气为血帅，降血尤当降气也。
炒竹茹 蒌皮炭 贝母 郁金 降香 丹皮炭 炒苏子 代赭石 杏仁 赤芍 黑山栀 枇杷叶
二诊 熄肝降气，呛咳较平，脉亦略缓。此无根之木，上凌肺金。前法参以育阴。
阿胶珠 大天冬 赭石 炒苏子 生赤芍 金石斛
淡秋石 川贝母 丹皮炭 黑山栀 茜草炭
三诊 血渐止住，气冲亦减。效方出入，再望应手。
生地 龟板 牡蛎 白芍 牛膝炭 茜草炭 代赭石 淡秋石 川贝母 白蒺藜 炒苏子
四诊 血虽止住，血络未扃。气火上凌不平，气每上冲，甚则胸中霍霍有声。非声也，火也。非火也，阳也。
阳一日不平，则干系一日难释，不可不知。
代赭石 白芍 牡蛎 光杏仁 炒蒌皮 旋复花 生地 川贝 黑山栀 枇杷叶
（处方前药）阿胶珠三钱，金石斛四钱，生白芍二钱，生牡蛎八钱，天花粉二钱，浮小麦五钱。
第三次诊疗：通过滋补肾阴、滋养肝血，胃气逐渐舒缓，患者渐渐能够进食谷物，舌面干燥的情况逐渐滋润。药物既然见效，无需更改方章。请（家属/助手）商议后继续进服。
处方：金石斛、天冬与麦冬、天花粉、生白芍、炒木瓜、生牡蛎、川贝母、生甘草。
每日早晨服用六味地黄丸，用阿胶珠三钱、金石斛三钱、大麦冬二钱煎汤送服。
第四次诊疗：胃气逐渐振奋，饮食香味增加。《内经》说中焦接受水谷之气，汲取汁液变化而成红色血液，这气是什么？就是谷气。谷气既已旺盛，虽然失血虽多，也不必担心血液不能恢复。目前舌中心干燥有苔，需再次滋补肾水，肾水充足，津液自然上升。留待叔涛先生商议后进服。
处方：大生地、生山药、粉丹皮、茯神、金石斛、天冬与麦冬、清阿胶、生白芍、花粉、川贝母。
第五次诊疗：清润的津液逐渐回归，舌质变得润泽，睡醒后的燥渴症状也安定下来。然而患者平素痰多，此次病后，咯吐之痰却绝无仅有。今日身体感到恶寒，昏昏欲睡。脉象濡缓且微滑。这是因为谷气逐渐增加，水谷之气滋生痰浊，弥漫于胸中，导致阳气不能流通布散，神机不能转运。前方法中参入化痰之法。留待商议后进服。
处方：大生地（五钱，炒松）、阿胶珠三钱、竹茹一钱（水炒）、生白芍一钱五分、川贝母二钱、栝蒌皮三钱（炒）、白茯苓三钱、海蛤粉二钱、天冬三钱、陈关蛰七钱。
第六次诊疗：痰液稍显爽利，神情略微振作，然而胸中气机郁结不舒，前番呕血之初，也是由此而起。脉形右侧较大，舌干少津。这是因为气分久郁，上焦气机不行，则下脘不通。拟开展上焦气化功能，参入甘凉以救津液。即请叔涛先生商议后进服。
处方：炒香豉、炒蒌皮、光杏仁、川贝母、枇杷叶、黑山栀、川郁金、金石斛、大天冬、梨汁。
某患者：溢血之后，不到三天，即出现咳嗽，晨起汗出、失眠、内热，渐至痰多盈碗，痰味带咸。脉细弱而数，左关脉微弦，尺中脉小涩。这是失血太多，火来克伐肺金，肾本空虚，失去摄纳功能。恐怕会延入虚损之途。
处方：熟地炭、青蛤散、五味子、川贝、丹皮、泽泻、紫菀肉、生山药、茯苓神、牛膝炭、款冬花。
又诊：前方法未见松动减轻。然而咳嗽的原因，应当是肺络中杂有凝滞之瘀血。
处方：生熟牛膝、单桃仁、延胡索、上湘军（酒炒黑）、土鳖虫（去头足）。
某患者：血液未再复来，疼痛也稍安，上升的火势也得以稍平，两关脉略见柔和，不可不为病情好转而感到欣慰。无奈气口脉大于关部，咳嗽较血涌之时反而觉得加重。昨日我已考虑到这一点。之所以如此，都因为血溢之时，血量多而喉窍小，突然无法排出，以致瘀血散入肺络之中，肺气逆乱而不能下降。恐怕由此进入虚损之途。
处方：茜草炭、川贝、光杏仁、当归须、磨三七、川郁金、延胡、代赭石、单桃仁、上湘军。
改方加入土鳖虫五枚（去头足），赤芍二钱，桂枝一分煎汁拌炒。
案语新奇，阅历精深，心思警辟，不可多得。（文涵志评）
扬（左）：因努力过度损伤肺络，络外溢血，不时见红，左胁作痛，咽燥舌干。宜清养肺胃，以调和脉络。
处方：川石斛四钱、全当归二钱（醋炒成炭）、鲜竹茹二钱（盐水炒）、降香片三分、丹参炭二钱、大麦冬三钱、冬瓜子三钱、杜苏子三钱（盐水炒）、丹皮炭二钱。
许（左）：每到躺卧时，反而不能入睡，坎水离火，不能相互济助，略见一斑。春升之际，阳气上升，鼓激损伤脉络，遂至咯血。火灼伤肺金，渐至咳嗽，致使金水不能相生。血既时止时来，咳嗽更无休止，中气日渐薄弱，随即体力乏尽，时常涌出痰涎。脉细涩而沉，左关带弦。属内伤重症，若能息心静养，或许能带病支持。
处方：南沙参三钱、光杏仁三钱、青蛤散四钱、牛膝炭三钱、川贝母二钱（炙）、紫菀肉二钱（炙）、云茯苓四钱、冬虫夏草三钱、生鸡子白一枚（调服）、白蜜一钱五分（冲）、藕节三枚、八仙长寿丸三钱（先送下）。
陈（左）：血生于心，藏于肝，统于脾。善于下棋构思，思虑中有忧虑，既思且虑，脾土必受损伤，以致统摄无权，血液外溢，咯吐带红，因为这是血的液体表现，所以血色不鲜赤，心中有难以明言之状。此由少阴心经而来，不可因其势微小而忽视。拟补益心脾，引导血液归脾。
处方：炙绵芪、奎党参、朱茯神、远志肉、野于术、炒枣仁、当归尾、广木香。
此案对血液理论的论述，体会入微，突出前贤，即使让西医见到，也会折服。（文涵志评）
唐（右）：小产之后，肝肾损伤未能恢复，腰足软弱无力，白带绵绵而下，甚则咯血凝固浓稠，外紫内红。此为肝络暗损。治病必求其本。
处方：阿胶珠、生白芍、浓杜仲、旱莲草、生山药、牡蛎、炒牛膝、丹皮炭、女贞子、潼沙苑（盐水炒）。
又诊：养肝益肾，脉症相安，但带下及腰足酸弱，咯血凝固浓稠，有时气冲引发呛咳。此为肝肾阴虚，奇经脉不固。仍守肝肾并调，兼固奇脉。
处方：阿胶珠三钱、白芍三钱（酒炒）、浓杜仲三钱、金毛脊四钱、生山药三钱、生地炭四钱、牡蛎四钱、潼沙苑三钱（盐水炒）、女贞子四钱（酒蒸）、鸡头子三钱。
陆（右）：吐血时止时来，如今则凝固浓稠，色带紫殷。此由肝络而来，肝病先厥逆后气逆，肝主左，所以左卧则咽痒气冲。非静养不能回复。
处方：大生地五钱、生白芍三钱、丹皮炭二钱、海蛤粉三钱、阿胶珠三钱、生甘草五分、旱莲草二钱、川贝母二钱、女贞子三钱、天冬与麦冬各二钱。
朱（左）：吐血频来，不时嗳气噫气，大便数日才行。未吐之前，觉胸腹作痛，既吐之后，其痛转定。脉濡而弦。踊跻（跳跃奔跑等剧烈运动）损伤肝胃之络。拟降胃气而除陈补新。
处方：赭石五钱、鲜竹茹三钱（水炒）、磨三七三分、干橘叶一钱五分、丹皮炭二钱、栝蒌炭五钱、炒白芍三钱、当归炭二钱、枳实七分、牛膝炭三钱、藕节三枚。
严（左）：性情躁急，肝经之气火上凌，吐血屡屡，气升呛咳。脉象细弦。气为血帅，降血尤当降气也。
处方：炒竹茹、蒌皮炭、贝母、郁金、降香、丹皮炭、炒苏子、代赭石、杏仁、赤芍、黑山栀、枇杷叶。
二诊：熄肝降气，呛咳较平，脉亦略缓。此为无根之木，上凌肺金。前方法中参入育阴之法。
处方：阿胶珠、大天冬、赭石、炒苏子、生赤芍、金石斛、淡秋石、川贝母、丹皮炭、黑山栀、茜草炭。
三诊：血渐止住，气冲亦减。效方出入，再望应手。
处方：生地、龟板、牡蛎、白芍、牛膝炭、茜草炭、代赭石、淡秋石、川贝母、白蒺藜、炒苏子。
四诊：血虽止住，血络未闭。气火上凌不平，气每上冲，甚则胸中霍霍有声。这不是声音，是火。不是火，是阳。阳气一日不平，则干系一日难释，不可不知。
处方：代赭石、白芍、牡蛎、光杏仁、炒蒌皮、旋复花、生地、川贝、黑山栀、枇杷叶。
(Previous prescription) Ejiao Zhu (Processed Donkey-hide Gelatin), 3 qian; Jinshihu (Dendrobium officinale), 4 qian; Sheng Baishao (Raw Radix Paeoniae Alba), 2 qian; Sheng Muli (Raw Concha Ostreae), 8 qian; Tianhuafen (Radix Trichosanthis), 2 qian; Fu Xiaomai (Floating Wheat), 5 qian.
Third visit: By nourishing Kidney Yin and Liver Blood, the Stomach Qi gradually relaxed, the patient gradually became able to consume grain food, and the dryness of the tongue surface gradually moistened. Since the medication is effective, there is no need to change the prescription structure. Please discuss and proceed with administration.
Prescription: Jinshihu (Dendrobium officinale), Tiandong (Radix Ophiopogonis Japonici) and Maidong (Radix Ophiopogonis Japonici), Tianhuafen (Radix Trichosanthis), Sheng Baishao (Raw Radix Paeoniae Alba), Chao Mugua (Stir-fried Fructus Chaenomelis), Sheng Muli (Raw Concha Ostreae), Chuan Beimu (Fritillaria Cirrhosa Bulb), Sheng Gancao (Raw Radix Glycyrrhizae Uralensis).
Take Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) every morning, delivered with a decoction made of Ejiao Zhu (Processed Donkey-hide Gelatin) 3 qian, Jinshihu (Dendrobium officinale) 3 qian, and Da Maidong (Large Radix Ophiopogonis Japonici) 2 qian.
Fourth visit: Stomach Qi gradually revitalized, dietary intake increased in aroma and quantity. The *Neijing* states that the Middle Jiao receives Qi from food and drink, extracts juices, transforms them into red blood. What is this Qi? It is Grain Qi. Once Grain Qi is robust, even if significant blood loss occurs, one need not worry about the inability to regenerate blood. Currently, the center of the tongue is dry with coating; it is necessary to again nourish Kidney Water. When Kidney Water is sufficient, body fluids will naturally ascend. To be discussed by Mr. Shutao before administration.
Prescription: Da Shengdi (Large Raw Radix Rehmanniae Preparata), Sheng Shanyao (Raw Rhizoma Dioscoreae Oppositae), Fen Danpi (Powdered Cortex Moutan), Fushen (Poria with Hostwood), Jinshihu (Dendrobium officinale), Tiandong (Radix Ophiopogonis Japonici) and Maidong (Radix Ophiopogonis Japonici), Qing Ejiao (Clear Donkey-hide Gelatin), Sheng Baishao (Raw Radix Paeoniae Alba), Huafen (Radix Trichosanthis), Chuan Beimu (Fritillaria Cirrhosa Bulb).
Fifth visit: Clear and moistening body fluids gradually returned, the tongue substance became moist, and the dryness/thirst upon waking settled. However, the patient usually has much phlegm, yet after this illness, there is hardly any expectorated phlegm. Today, the physical form feels aversion to cold, heavy and drowsy. The pulse is Ru (Soggy) and slightly Hua (Slippery). This is because Grain Qi has gradually increased; the Qi of food and water generates Phlegm and turbidity, filling the chest, preventing the free flow and distribution of Yang Qi, and hindering the movement of Shen (Spirit) mechanisms. The previous method should incorporate methods to resolve Phlegm. To be discussed before administration.
Prescription: Da Shengdi (Large Raw Radix Rehmanniae Preparata, 5 qian, stir-fried until loose), Ejiao Zhu (Processed Donkey-hide Gelatin, 3 qian), Zhuru (Bamboo Shavings, 1 qian, stir-fried with water), Sheng Baishao (Raw Radix Paeoniae Alba, 1.5 qian), Chuan Beimu (Fritillaria Cirrhosa Bulb, 2 qian), Gualou Pi (Pericarpium Trichosanthis, 3 qian, stir-fried), Bai Fuling (White Poria, 3 qian), Haigefen (Powdered Concha Meretricis), Tiandong (Radix Ophiopogonis Japonici, 3 qian), Chenguanzhe (Chenpi/Aged Tangerine Peel, 7 qian).
Sixth visit: Phlegm is slightly easier to expectorate, mental spirit slightly revived, yet Qi stagnation in the chest remains uncomfortable. The initial hematemesis also originated from this. The pulse shape is larger on the right side, the tongue is dry with little fluid. This is due to long-term Qi stagnation; when Upper Jiao Qi mechanism does not function, the Lower Wan (Stomach) cannot unblock. Plan to expand Upper Jiao Qi transformation, incorporating Sweet-Cool methods to rescue fluids. To be discussed by Mr. Shutao before administration.
Prescription: Chao Xiangchi (Stir-fried Black Soybean Paste), Chao Loupi (Stir-fried Pericarpium Trichosanthis), Guang Xingren (Light Apricot Seed), Chuan Beimu (Fritillaria Cirrhosa Bulb), Pipa Ye (Loquat Leaf), Hei Shanzhi (Black Gardenia Fruit), Chuan Yujin (Curcuma Wenyujin Rhizome), Jinshihu (Dendrobium officinale), Da Tiandong (Large Radix Ophiopogonis Japonici), Lizhi (Pear Juice).
Patient [Name Redacted]: After hemorrhage, within three days, coughing started, morning sweating, insomnia, internal heat, gradually progressing to bowl-fulls of phlegm, phlegm tastes salty. Pulse is Xi (Fine) Ruo (Weak) Er Shu (Rapid), Left Guan is Wei Xian (Slightly Wiry), Chi is Xiao Se (Small and Choppy). This is excessive blood loss, Fire attacking Metal (Lungs), Kidney root is empty, failing to grasp and retain. Fear it will progress to Xu Sun (Deficiency Consumption).
Prescription: Shudi Tan (Charred Prepared Radix Rehmanniae), Qingge San (Green Clam Powder), Wuweizi (Schisandra Berry), Chuan Bei (Fritillaria Cirrhosa Bulb), Danpi (Cortex Moutan), Zexie (Rhizoma Alismatis), Ziwan Rou (Ziwan Flesh), Sheng Shanyao (Raw Rhizoma Dioscoreae Oppositae), Fuling Shen (Poria with Hostwood), Niuxi Tan (Charred Radix Achyranthis Bidentata), Kuandonghua (Farfol Flower).
Second look: Previous method shows no relaxation or reduction. However, the cause of coughing is likely凝瘀 (coagulated stasis) mixed in the Lung collaterals.
Prescription: Sheng Shu Niuxi (Raw and Processed Radix Achyranthis Bidentata), Dan Taoren (Single Peach Kernel), Yanhusuo (Corydalis Rhizome), Shang Junjun (Rhubarb, wine-fried black), Tubiechong (Ground Beetle, head and feet removed).
Patient [Name Redacted]: Blood has not recurred, pain is slightly eased, rising Fire has somewhat calmed, both Guan pulses are slightly soft, which is a sign of improvement. Unfortunately, the Qi Kou (Radial Artery at Cun position) pulse is larger than the Guan position, and coughing feels worse than during the blood surge. I worried about this yesterday. The reason is that during hemorrhage, the volume of blood was high while the throat/orifice was small, causing sudden inability to expel, leading to scattered blood stasis entering the Lung collaterals, causing Lung Qi to rebel and fail to descend. Fear it will enter the path of deficiency consumption.
Prescription: Qiancao Tan (Charred Rubia Cordifolia Root), Chuan Bei (Fritillaria Cirrhosa Bulb), Guang Xingren (Light Apricot Seed), Danggui Xu (Danggui Tail), Mo Sanqi (Mashed Notoginseng Root), Chuan Yujin (Curcuma Wenyujin Rhizome), Yanhu (Corydalis Rhizome), Daizheshi (Haematitum), Dan Taoren (Single Peach Kernel), Shang Junjun (Rhubarb).
Modified prescription adds Tubiechong (Ground Beetle) 5 pieces (head and feet removed), Chishao (Red Peony Root) 2 qian, Guizhi (Cinnamon Twig) 1 fen decocted to mix-fry.
Case commentary is novel, profound in experience, sharp in thought, rare to find. (Comment by Wen Hanzhi)
Yang (Left): Effortful injury damaged Lung collaterals, collateral blood overflows externally, intermittent hemoptysis, left hypochondriac pain, dry throat and tongue. Suitable to clear and nourish Lung and Stomach, to harmonize collaterals.
Prescription: Chuan Shihu (Dendrobium nobile stem) 4 qian, Quan Danggui (Whole Angelica Sinensis Root) 2 qian (vinegar-fried to char), Xian Zhuru (Fresh Bamboo Shavings) 2 qian (salt-water fried), Jiangxiang Pian (Aquilaria Lignum) 3 fen, Danshen Tan (Salvia Miltiorrhiza Charcoal) 2 qian, Da Maidong (Large Radix Ophiopogonis Japonici) 3 qian, Dongguazi (Winter Melon Seed) 3 qian, Du Su Zi (Perilla Fruit) 3 qian (salt-water fried), Danpi Tan (Cortex Moutan Charcoal) 2 qian.
Xu (Left): Whenever lying down, insomnia ensues; Kan Water and Li Fire fail to mutually assist, showing a glimpse. During Spring ascent, Yang Qi rises, agitating and damaging collaterals, leading to hemoptysis. Fire scorches Metal (Lung), gradually causing cough, so Metal and Water fail to generate each other. Blood stops and comes intermittently, coughing has no end, Middle Qi thins daily, strength fails rapidly, salivary phlegm surges. Pulse is Xi (Fine) Se (Choppy) Chen (Deep), Left Guan is Xian (Wiry). Severe internal injury; if one can rest mindfully, perhaps support life with illness.
Prescription: Nan Shashen (Adenophora Root) 3 qian, Guang Xingren (Light Apricot Seed) 3 qian, Qingge San (Green Clam Powder) 4 qian, Niuxi Tan (Charred Radix Achyranthis Bidentata) 3 qian, Chuan Beimu (Fritillaria Cirrhosa Bulb) 2 qian (roasted), Ziwan Rou (Ziwan Flesh) 2 qian (roasted), Yun Fuling (Cloud Poria) 4 qian, Dongchongxiacao (Cordyceps Sinensis) 3 qian, Sheng Jizi Bai (Raw Egg White) 1 unit (mixed), Bai Mi (White Honey) 1.5 qian (dissolved), Ou Jie (Lotus Node) 3 units, Baxian Changshou Wan (Eight-Immortal Longevity Pill) 3 qian (taken first).
Chen (Left): Blood is born in Heart, stored in Liver, governed by Spleen. Good at chess planning, thinking involves worry; both thinking and worrying damage Spleen Earth, leading to loss of governance, blood overflows externally, hemoptysis with red tinge, as this is the fluid of blood, hence blood is not bright red, heart has indescribable feelings. This originates from Shaoyin Heart Meridian, do not ignore it because the condition seems mild. Plan to tonify Heart and Spleen, guide blood back to Spleen.
Prescription: Zhi Mianqi (Honey-fried Astragalus Membranaceus Root), Kui Dangshen (Codonopsis Pilosula Root), Zhu Fushen (Vermilion Poria with Hostwood), Yuanzhi Rou (Polygala Root Flesh), Ye Yuzhu (Atractylodes Macrocephala Rhizome), Chao Zaoren (Stir-fried Ziziphus Jujuba Seed), Danggui Wei (Angelica Sinensis Tail), Guang Muxiang (Costus Root).
This case's discussion on blood theory is insightful, surpassing predecessors; even Western doctors would be convinced. (Comment by Wen Hanzhi)
Tang (Right): After miscarriage, Liver and Kidney damage did not recover, waist and feet weak and lacking strength, continuous leukorrhea, severe cases have coagulated thick hemoptysis, purple outside, red inside. Hidden damage to Liver collaterals. Treating disease must seek its root.
Prescription: Ejiao Zhu (Processed Donkey-hide Gelatin), Sheng Baishao (Raw Radix Paeoniae Alba), Nong Duzhong (Thick Eucommia Bark), Hanliancao (Eclipta Prostrata Herb), Sheng Shanyao (Raw Rhizoma Dioscoreae Oppositae), Muli (Oyster Shell), Chao Niuxi (Stir-fried Radix Achyranthis Bidentata), Danpi Tan (Cortex Moutan Charcoal), Nvzhenzi (Ligustrum Lucidum Fruit), Tong Shayuan (Tongtu Suberous Seed, salt-water fried).
Second look: Nourishing Liver and benefiting Kidney, pulse and symptoms are peaceful, but leukorrhea and waist/foot soreness persist, hemoptysis is coagulated and thick, sometimes Qi rush causes choking. Liver and Kidney Yin deficiency, extraordinary vessels not secured. Still adhere to simultaneous regulation of Liver and Kidney, additionally securing extraordinary vessels.
Prescription: Ejiao Zhu (Processed Donkey-hide Gelatin) 3 qian, Baishao (Radix Paeoniae Alba) 3 qian (wine-fried), Nong Duzhong (Thick Eucommia Bark) 3 qian, Jinmaoji (Cyathula Root) 4 qian, Sheng Shanyao (Raw Rhizoma Dioscoreae Oppositae) 3 qian, Shengdi Tan (Raw Radix Rehmanniae Preparata Charcoal) 4 qian, Muli (Oyster Shell) 4 qian, Tong Shayuan (Tongtu Suberous Seed) 3 qian (salt-water fried), Nvzhenzi (Ligustrum Lucidum Fruit) 4 qian (wine-steamed), Jitouzi (Euryale Seed) 3 qian.
Lu (Right): Hematemesis stops and comes intermittently, now coagulated and thick, color purple-dark. Originates from Liver collaterals; Liver disease first presents with Jue (Cold extremities/rebellion) then Ni (Rebellion); Liver governs the left, so lying on the left causes throat itching and Qi rush. Cannot recover without quiet rest.
Prescription: Da Shengdi (Large Raw Radix Rehmanniae Preparata) 5 qian, Sheng Baishao (Raw Radix Paeoniae Alba) 3 qian, Danpi Tan (Cortex Moutan Charcoal) 2 qian, Haigefen (Powdered Concha Meretricis) 3 qian, Ejiao Zhu (Processed Donkey-hide Gelatin) 3 qian, Sheng Gancao (Raw Radix Glycyrrhizae Uralensis) 0.5 qian, Hanliancao (Eclipta Prostrata Herb) 2 qian, Chuan Beimu (Fritillaria Cirrhosa Bulb) 2 qian, Nvzhenzi (Ligustrum Lucidum Fruit) 3 qian, Tiandong (Radix Ophiopogonis Japonici) and Maidong (Radix Ophiopogonis Japonici) 2 qian each.
Zhu (Left): Frequent hematemesis, intermittent belching, bowel movements only after several days. Before vomiting, chest and abdomen hurt; after vomiting, pain settles. Pulse is Ru (Soggy) and Xian (Wiry). Jumping/exertion damaged Liver and Stomach collaterals. Plan to descend Stomach Qi, remove old, replenish new.
Prescription: Zheshi (Haematitum) 5 qian, Xian Zhuru (Fresh Bamboo Shavings) 3 qian (water-fried), Mo Sanqi (Mashed Notoginseng Root) 0.3 qian, Gan Jiuye (Dried Tangerine Leaf) 1.5 qian, Danpi Tan (Cortex Moutan Charcoal) 2 qian, Gualou Tan (Charred Pericarpium Trichosanthis) 5 qian, Chao Baishao (Stir-fried Radix Paeoniae Alba) 3 qian, Danggui Tan (Charred Angelica Sinensis Root) 2 qian, Zhishi (Immature Bitter Orange) 0.7 qian, Niuxi Tan (Charred Radix Achyranthis Bidentata) 3 qian, Ou Jie (Lotus Node) 3 units.
Yan (Left): Irritable temperament, Liver Meridian Qi and Fire harass upwards, frequent hematemesis, Qi rise causes choking cough. Pulse is Xi (Fine) Xian (Wiry). Qi is the commander of Blood; descending blood especially requires descending Qi.
Prescription: Chao Zhuru (Stir-fried Bamboo Shavings), Loupi Tan (Charred Pericarpium Trichosanthis), Beimu (Fritillaria Bulb), Yujin (Curcuma Rhizome), Jiangxiang (Aquilaria Wood), Danpi Tan (Cortex Moutan Charcoal), Chao Suzi (Stir-fried Perilla Fruit), Daizheshi (Haematitum), Xingren (Apricot Seed), Chishao (Red Peony Root), Hei Shanzhi (Black Gardenia Fruit), Pipa Ye (Loquat Leaf).
Second visit: Extinguishing Liver and descending Qi, choking cough is flatter, pulse slightly slower. This is rootless wood harassing Lung Metal. Previous method incorporates Yin-nourishing.
Prescription: Ejiao Zhu (Processed Donkey-hide Gelatin), Da Tiandong (Large Radix Ophiopogonis Japonici), Zheshi (Haematitum), Chao Suzi (Stir-fried Perilla Fruit), Sheng Chishao (Raw Red Peony Root), Jinshihu (Dendrobium officinale), Dan Qiushi (Light Autumn Stone), Chuan Beimu (Fritillaria Cirrhosa Bulb), Danpi Tan (Cortex Moutan Charcoal), Hei Shanzhi (Black Gardenia Fruit), Qiancao Tan (Charred Rubia Cordifolia Root).
Third visit: Blood gradually stopped, Qi rush also reduced. Effective formula variations, hoping for further success.
Prescription: Shengdi (Prepared Radix Rehmanniae), Guiban (Carapax et Plastrum Testudinis), Muli (Oyster Shell), Baishao (Radix Paeoniae Alba), Niuxi Tan (Charred Radix Achyranthis Bidentata), Qiancao Tan (Charred Rubia Cordifolia Root), Daizheshi (Haematitum), Dan Qiushi (Light Autumn Stone), Chuan Beimu (Fritillaria Cirrhosa Bulb), Baijili (Seed Tribulus Terrestris), Chao Suzi (Stir-fried Perilla Fruit).
Fourth visit: Although blood stopped, blood collaterals are not closed. Qi and Fire harass upwards unevenly, Qi frequently rushes upward, even causing roaring sounds in the chest. This is not sound, it is Fire. Not Fire, it is Yang. As long as Yang is uneven for one day, the complication remains unresolved for one day; this must be known.
Prescription: Daizheshi (Haematitum), Baishao (Radix Paeoniae Alba), Muli (Oyster Shell), Guang Xingren (Light Apricot Seed), Chao Loupi (Stir-fried Pericarpium Trichosanthis), Xuanfuhua (Inula Flower), Shengdi (Prepared Radix Rehmanniae), Chuan Bei (Fritillaria Cirrhosa Bulb), Hei Shanzhi (Black Gardenia Fruit), Pipa Ye (Loquat Leaf).