倪孝廉者，年逾四旬，素以灯窗思虑之劳，伤及脾气，时有呕吐之证，过劳即发，余常
以理阴煎、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，其多可畏。急以延余，而余适他往，复延一时名者，云
∶此因劳而火起心脾，兼以暑令正旺，而二火相济，所以致此。乃与犀角、地黄、童便、知
母之属，药及两剂，其吐愈甚，脉益紧数，困惫垂危。彼医云∶此其脉证俱逆，原无生理，
不可为也。其子皇惧，复至恳余，因往视之，则情势俱剧，第以素契不可辞，乃用人参、熟
地、干姜、甘草四味大剂与之。初服毫不为动。次服觉呕恶稍止而脉中微有生意，及复加附
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。遂大加温补，调理旬日而复健如故。余初用此药
，适一同道者在，见之惊骇，莫测其谓，及其既愈，乃始心服，曰∶向始不有公在，必为童
便、犀角、黄连、知母之所毙，而人仍归誉于前医，曰∶彼原说脉证俱逆，本不可治。终是
识高见到，人莫及也。嗟嗟！夫童便最能动呕，犀角、知、连最能败脾，时当二火，而证非
二火，此人此证，以劳倦伤脾而脾胃阳虚，气有不摄，所以动血，再用寒凉，脾必败而死矣
。倘以此杀人，而反以此得誉，天下不明之事类多如此，亦何从而辨白哉！此后有史姓等数
人，皆同此证，予悉用六味回阳饮活之。此实至理，而人以为异，故并纪焉。
倪孝廉，年龄超过四十岁，平时因为长期在灯下苦读、思虑过度，损伤了脾气，时常出现呕吐的症状，劳累就会发作。我常用理阴煎、温胃饮这类方剂，他随服随愈。
有一天正值暑气将尽之时，因为连续多日应酬交际，导致心脾劳损，于是上部发生吐血，下部发生便血（泄血），血色或紫或红，血量极大如手掌片状，令人畏惧。急忙请我去诊治，但我恰好外出，又延请了一位当时的名医。那位医生说：“这是因为劳累导致心脾之火亢盛，加上正值暑令，外暑内火相济，所以导致此病。”于是给予犀角、地黄、童便、知母等寒凉药物，服用两剂后，呕吐更加严重，脉象更加紧数，病人困倦疲惫，濒临死亡。那位医生说：“这脉证都是逆象，原本没有生机，无法救治了。”他的儿子非常恐惧，再次恳求我去诊治。于是我前往诊视，见病情危重，但因为与患者素有交情，不可推辞，于是用人参、熟地、干姜、甘草四味药大剂量给他服用。初次服药后毫无反应。第二次服药后，觉得恶心呕吐稍止，且脉象中微微有了生气。随后又加入附子、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，黄昏时分服用，竟然能熟睡。直到半夜四鼓时分，再次进药，呕吐和出血都停止了。于是加大温补力度，调理十天后，身体恢复得像以前一样健康。
我刚开始使用这些药物时，有一位同行医生在场，见到后感到惊骇，不明白其中的道理。等到病人痊愈后，他才心服口服，说：“起初若不是有您在，病人必定会被童便、犀角、黄连、知母这些寒凉药物害死，而人们还会归功于之前的医生，说：‘他本来就说脉证俱逆，本不可治。’终究还是您的见识高明，无人能比啊！”唉！童便最容易引发呕吐，犀角、知母、黄连最能败坏脾胃。当时正值二火（暑火与劳火）旺盛之时，但病症并非二火所致，这个人和这个病症，是因为劳倦损伤脾胃而导致脾胃阳虚，气不能统摄血液，所以动血。如果再使用寒凉药物，脾胃必然败坏而死。如果因此杀死了人，反而因此得到赞誉，天下不明的事例大多如此，又从哪里去辩白呢？此后有史姓等几个人，都是同样的病症，我都用六味回阳饮救活了他们。这确实是至理名言，但人们却认为奇异，所以一并记录下来。
Mr. Ni, a Xiao Lian (a title for successful candidates in the imperial examinations), was over forty years old. He had long suffered from damage to the Spleen Qi due to the fatigue of studying by lamplight and excessive mental exertion. He frequently experienced vomiting, which would occur upon overexertion. I often treated him with formulas such as Li Yin Jian (Nourish Yin Decoction) and Wen Wei Yin (Warm the Stomach Decoction), and he recovered immediately after taking them.
One day, at the end of the summer heat season, due to continuous social engagements, he fatigued his Heart and Spleen. Consequently, he began to vomit blood (hematemesis) and pass blood from the lower orifice (hematochezia). The clots were large, resembling hand-sized slices, varying in color from purple to red, and the volume was alarming. He urgently summoned me, but I happened to be away. He then invited a renowned physician of the time. The physician stated: "This is caused by fire arising from the Heart and Spleen due to fatigue, compounded by the peak of the summer heat season, where internal and external fires reinforce each other." He prescribed cold-natured herbs such as Rhinoceros Horn (Xi Jiao), Rehmannia Root (Di Huang), Child's Urine (Tong Bian), and Anemarrhena Rhizome (Zhi Mu). After two doses, the vomiting worsened significantly, the pulse became tighter and more rapid, and the patient grew exhausted and critical. The physician remarked: "The pulse and symptoms are both adverse; there is no hope for survival, and it cannot be treated." The patient's son, terrified, begged me again. I went to examine him. Seeing the severity of the condition, but unable to refuse due to our prior friendship, I administered a large dose of Ginseng Root (Ren Shen), Prepared Rehmannia Root (Shu Di Huang), Dried Ginger (Gan Jiang), and Licorice Root (Gan Cao).
After the first dose, there was no effect. After the second dose, the nausea and vomiting subsided slightly, and a faint sign of life appeared in the pulse. Subsequently, I added Aconite Root (Fu Zi) and Charred Ginger (Pao Jiang), each 2 qian, Ginseng Root and Prepared Rehmannia Root, each 1 liang, Atractylodes Macrocephala Rhizome (Bai Zhu) 4 qian, Honey-fried Licorice Root (Zhi Gan Cao) 1 qian, and Poria (Fu Ling) 2 qian. This was administered at dusk, and the patient fell into a deep sleep. By the fourth watch of the night (midnight), another dose was given, after which both vomiting and bleeding stopped. I then intensified the warming and tonifying treatment. After ten days of regulation, his health returned to normal.
When I first used this prescription, a colleague was present and was shocked, unable to comprehend my reasoning. Only after the patient recovered did he become convinced, saying: "If you had not been here initially, the patient would certainly have died from the child's urine, rhino horn, Coptis Rhizome (Huang Lian), and Anemarrhena Rhizome. People would still praise the previous doctor, saying, 'He originally stated that the pulse and symptoms were adverse and incurable.' Your insight is truly superior and unmatched!" Alas! Child's urine most easily induces vomiting; Rhino Horn, Anemarrhena, and Coptis most easily damage the Spleen. Although the season was characterized by "two fires" (summer heat and labor-induced fire), the syndrome was not caused by these fires. In this person and this case, the bleeding was caused by fatigue damaging the Spleen, leading to Spleen and Stomach Yang Deficiency, where Qi failed to control the blood. Using cold-natured herbs would have destroyed the Spleen and caused death. If killing someone in this manner brings praise, how can one clarify such unjust situations prevalent in the world? Later, several patients with surnames like Shi presented with identical syndromes, all of whom I successfully treated using Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang). This is indeed the ultimate truth, though people considered it strange. Therefore, I record it here.