一胁肋胀痛，若大便通和，喘咳吐痰者，肝火侮肺也，用小柴胡汤加青皮、山栀清之。
若胸腹胀痛，大便不通，喘咳吐血者，瘀血停滞也，用当归导滞散通之。《内经》云∶肝藏
血，脾统血。盖肝属木，生火侮土，肝火既炽，肝血必伤，脾气必虚。宜先清肝养血，则瘀
血不致凝滞，肌肉不致遍溃；次壮脾健胃，则瘀血易溃，新肉易生；若行克伐，则虚者益虚
，滞者益滞，祸不旋踵矣。
一肚腹作痛，或大便不通，按之痛甚，此瘀血在内也，用加味承气汤下之。既下而痛不
止，按之仍痛，瘀血未尽也，用加味四物汤补而行之。若腹痛按之不痛，血气伤也，用四物
汤加参、 、白术，补而和之。若下而胸胁反痛，肝血伤也，用四君、芎、归补之。既下而
发热，阴血伤也，用四物、参、术补之。既下而恶寒，阳气伤也，用十全大补汤补之。既下
而恶寒发热，气血俱伤也，用八珍汤补之。既下而欲呕，胃气伤也，用六君、当归补之。既
下而泄泻，脾肾伤也，用六君、肉果、破故纸补之。若下后，手足俱冷，昏愦出汗，阳气虚
寒也，急用参附汤。吐泻手足俱冷，指甲青者，脾肾虚寒之甚也，急用大剂参附汤。口噤手
撒，遗尿痰盛，唇青体冷者，虚极之坏症也，急投大剂参附汤，多有得生者。
一肌肉间作痛，营卫之气滞也，用复元通气散。筋骨作痛，肝肾之气伤也，用六味地黄
丸。内伤下血作痛，脾胃之气虚也，用补中益气汤。外伤出血作痛，脾肺之气虚也，用八珍
汤。大凡下血不止，脾胃之气脱也，吐泻不食，脾胃之气败也，苟预为调补脾胃，则无此患
矣。
一作痛，若痛至四五日不减，或至一二日方痛，欲作脓也，用托里散。若以指按下复起
，脓已成也，刺去其脓，痛自止。若头痛时作时止，气血虚也，痛而兼眩属痰也，当生肝血
补脾气。
一青肿不溃，用补中益气汤以补气。肿黯不消，用加味逍遥散以散血。若 肿胀痛，瘀
血作脓也，以八珍汤加白芷托之。若脓溃而反痛，气血虚也，以十全大补汤补之。若骨HT 接
而复脱，肝肾虚也，用地黄丸。肿不消，青不退，气血虚也，内用八珍汤，外用葱熨法，则
瘀血自散，肿痛自消。若行血破血，则脾胃愈虚，运气愈滞。若敷贴凉药，则瘀血益凝，内
腐益深，致难收拾。
一发热，若出血过多；或脓溃之后脉洪大而虚，重按全无，此阴虚发热也，用当归补血
汤。脉沉微，按之软弱，此阴盛发躁也，用四君、姜、附。若发热烦躁，肉 筋惕，亡
血也，用圣愈汤。如汗不止，血脱也，用独参汤。其血脱脉实，汗后脉躁者难治，细小者易
治。《外台秘要》云∶阴盛发躁，欲坐井中，用附子四逆汤加葱白。王太仆先生云∶凡热来
复去，昼见夜伏，夜见昼伏，不时而动者，名曰无火，此无根之虚火也。
一作呕，若因痛甚，或因克伐而伤胃者，用四君、当归、半夏、生姜。或因忿怒而肝伤
者，用小柴胡汤加山栀、茯苓。若因痰火盛，用二陈、姜炒黄连、山栀。若因胃气虚，用补
中益气汤、生姜、半夏。若出血过多，或因溃后，用六君子汤加当归。
一喘咳，若出血过多，面黑胸胀；或胸膈痛而发喘者，乃气虚血乘于肺也，急用二味参
苏饮。若咳血衄血者，乃气逆血蕴于肺也，急用十味参苏饮加山栀、芩、连、苏木。
一作渴，若因出血过多，用四物参术汤；不应，用人参、黄 以补气，当归、熟地以养
血。若因溃后，用八珍汤。若因胃热伤津液，用竹叶黄 汤。胃虚津液不足，用补中益气汤
。胃火炽盛，用竹叶石膏汤。若烦热作渴，小便淋涩，乃肾经虚热，非地黄丸不能救。
一出血，若患处或诸窍出者，肝火炽盛，血热错经而妄行也，用加味逍遥散，清热养血
。若中气虚弱，血无所附而妄行，用加味四君子汤，补益中气。或元气内脱，不能摄血，用
独参汤加炮姜以回阳；如不应，急加附子。或血蕴于内而呕血，用四物加柴胡、黄芩。凡伤
损劳碌怒气，肚腹胀闷，误服大黄等药伤经络，则为吐血、衄血、便血、尿血；伤阴络，则
为血积、血块、肌肉青黯。此脏腑亏损，经隧失职，急补脾肺，亦有生者，但患者不悟此理
，不用此法，惜哉！
一手足损伤，若元气虚弱，或不戒房劳，或妄行攻伐，致死肉上延；或腐而不痛，黑而
不脱者，当大补元气，庶可保生。若手足节HT 断去者，无妨，骨断筋连，不急剪去。若侵及
好肉则不治。若预为调补脾气，则无此患。大凡脓瘀肉 者，即针之而投托里散。或口噤遗
尿而似破伤风者，急用十全大补汤加附子，多有生者。
一腐肉不溃，或恶寒而不溃，用补中益气汤。发热而不溃，用八珍汤。若因克伐而不溃
者，用六君子汤加当归。其外皮黑坚硬不溃者，内火蒸炙也，内服八珍汤，外涂当归膏。其
死肉不能溃，或新肉不能生而致死者，皆失于不预补脾胃也。
一新肉不生，若患处夭白，脾气虚也，用六君、芎、归。患处绯红，阴血虚也，用四物
、参、术。若恶寒发热，气血虚也，用十全大补汤。脓稀白而不生者，脾肺气虚也，用补中
益气汤。脓稀赤而不生者，心脾血虚也，用东垣圣愈汤。寒热而不生者，肝火动也，用加味
逍遥散。晡热而不生，肝血虚也，用八珍、牡丹皮。食少体倦而不生，脾胃气虚也，用六君
子汤。脓秽而不生者，元气内
伤也，用补中益气汤。如夏月，用调中益气汤。作泻用清暑益气汤。秋令作泻，用清燥汤。
一重伤昏愦者，急灌以独参汤。虽内瘀血切不可下，急用花蕊石散，内化之，恐因泻而
亡阴也。若元气虚甚者，尤不可下，亦用以前散化之。凡瘀血在内，大小便不通，用大黄、
朴硝。血凝而不下者，急用木香、肉桂末二三钱，以熟酒调灌服，血下乃生。如怯弱之人，
用硝、黄，须加肉桂、木香同煎，假其热，以行其寒也。
一大便秘结，若大肠血虚火炽者，用四物汤送润肠丸，或以猪胆汁导之。若肾虚火燥者
，用六味地黄丸。肠胃气虚，用补中益气汤。
一伤损症用黑羊皮者，盖羊性热，能补气也。若杖疮伤甚，内肉已坏，欲其溃者贴之，
成脓固速；苟内非补剂壮其根本，毒瓦斯不无内侵。外非砭刺，泄其瘀秽，良肉不无伤坏者；
受刑轻，外皮破伤者，但宜当归膏敷贴，更服四物、芩、连、柴胡、山栀、白术、茯苓。又
疔痂不结，伤肉不溃，死血自散，肿痛自消，若概行罨贴，则酝酿瘀毒矣。
一跳跃捶胸闪挫，举重劳役恚怒，而胸腹痛闷，喜手摸者，肝火伤脾也，用四君、柴胡
、山栀。畏手摸者，肝经血滞也，用四物、柴胡、山栀、桃仁、红花。若胸胁作痛，饮食少
思，肝脾气伤也，用四君、芎、归。若胸腹不利，食少无寐，脾气郁结也，用加味归脾汤。
若痰气不利，脾肺气滞也，用二陈、白术、芎、归、栀子、青皮。若切牙发搐，肝旺脾虚也
，用小柴胡汤、川芎、山栀、天麻、钩藤钩。或用风药，则肝血益伤，肝火益甚。或饮糖酒
，则肾水益虚，肝火愈炽。若用大黄等药，内伤阴络，反致下血。少壮者必为痼疾，老弱者
多致不起。（以上若胸胁作痛，发热晡热，肝经血伤也，用加味逍遥散。）
一破伤风，河间云∶风症善行数变，入脏甚速，死生在反掌之间，宜急分表里虚实而治
之。邪在表者，则筋脉拘急，时或寒热，筋惕搐搦，脉浮弦，用羌活防风汤散之。在半表半
里者，则头微汗，身无汗，用羌活汤和之。传入里者，舌强口噤，项背反张，筋惕搐搦，痰
涎壅盛，胸腹满闷，便溺闭赤，时或汗出，脉洪数而弦，以大芎黄汤导之。既下而汗仍出，
表虚也，以白术防风汤补之，不时灌以粥饮为善。前云乃气虚未损之法也，若脓血太泄，阳
随阴散，气血俱虚，而类前症者，悉宜大补脾胃，切忌祛风之药。
一发痉，仲景云∶诸痉项强，皆属于温。又云∶太阳病，发汗太多，致痉风病。下之则
痉复发，汗则拘急。疮家发汗则痉，是汗下重亡津液所致。有汗而不恶寒曰柔痉，以风能散
气也，宜白术汤加桂心、黄 。无汗而恶寒曰刚痉，以寒能涩血也，宜葛根汤。皆气血内伤
，筋无所营，而变非风也。杖疮及劳伤气血而变者，当补气血；未应，用独参汤；手足冷加
桂、附，缓则不救。
胁肋部胀痛，若大便通畅调和，伴有气喘咳嗽、吐痰的，是肝火犯肺所致，用小柴胡汤加青皮、山栀来清泻。
若胸腹胀痛，大便不通，伴有气喘咳嗽、吐血的，是瘀血停滞所致，用当归导滞散来通利。《内经》说：肝藏血，脾统血。大概因为肝属木，生火后反侮脾土，肝火既已炽盛，肝血必然受损，脾气必然虚弱。应当先清肝养血，这样瘀血就不会凝滞，肌肉也不会全面溃烂；接着壮脾健胃，这样瘀血容易消散，新肉容易生长；如果采用攻伐之法，那么虚弱的会更虚，停滞的会更滞，灾祸立刻就会降临。
腹部疼痛，或者大便不通，按压时疼痛加剧的，这是内有瘀血，用加味承气汤来攻下。攻下之后疼痛仍不止，按压依然疼痛的，说明瘀血未尽，用加味四物汤补益并推动血行。如果腹痛但按压不痛，是气血损伤，用四物汤加人参、（此处原文缺字，通常指白芍或类似药，依上下文补中益气之意，暂译为参、术等补气药）、白术，进行补益调和。如果攻下后胸胁反而疼痛，是肝血受伤，用四君子汤加川芎、当归来补益。攻下后发热，是阴血受伤，用四物汤加人参、白术来补益。攻下后恶寒，是阳气受伤，用十全大补汤来补益。攻下后既恶寒又发热，是气血俱伤，用八珍汤来补益。攻下后想呕吐，是胃气受伤，用六君子汤加当归来补益。攻下后泄泻，是脾肾受伤，用六君子汤加肉豆蔻、补骨脂来补益。如果攻下后，手足都冷，神志昏沉迷糊且出汗，是阳气虚寒，急用参附汤。吐泻且手足冰冷，指甲发青的，是脾肾虚寒到了极点，急用大剂量参附汤。牙关紧闭、手撒尿遗、痰多、嘴唇青紫身体冰冷的，是极度虚损的坏证，急投大剂量参附汤，大多能存活。
肌肉间疼痛，是营卫之气滞涩，用复元通气散。筋骨疼痛，是肝肾之气受伤，用六味地黄丸。内伤导致下血疼痛，是脾胃之气虚弱，用补中益气汤。外伤导致出血疼痛，是脾肺之气虚弱，用八珍汤。大凡下血不止，是脾胃之气外脱；吐泻不能进食，是脾胃之气败绝。如果预先调补脾胃，就没有这种祸患了。
发生疼痛，如果疼痛持续四五日不减，或者过了一两天才开始痛，是想化脓的表现，用托里散。如果用手指按压后凹陷随即弹起，说明脓已形成，刺破排脓，疼痛自然停止。如果头痛时作时止，是气血虚弱；疼痛兼有眩晕属于痰湿，应当生肝血、补脾气。
青肿但未溃烂，用补中益气汤来补气。肿胀颜色暗紫不消退，用加味逍遥散来散血。如果肿胀疼痛，是瘀血化脓，用八珍汤加白芷来托毒外出。如果脓液溃破后反而疼痛，是气血虚弱，用十全大补汤来补益。如果骨头接合后又脱位，是肝肾虚弱，用地黄丸。肿胀不消，青色不退，是气血虚弱，内服八珍汤，外用葱熨法，这样瘀血自然消散，肿痛自然消除。如果采用活血破血之法，则脾胃更虚，气血运行更滞涩。如果敷贴凉性药物，则瘀血更加凝结，内部腐烂更深，导致难以收拾。
发热，如果是出血过多；或者脓溃之后脉象洪大但按之空虚，重按完全无力的，这是阴虚发热，用当归补血汤。脉象沉微，按之软弱无力的，这是阴盛格阳导致的烦躁，用四君子汤加干姜、附子。如果发热烦躁，肌肉跳动、筋脉抽搐，是失血所致，用圣愈汤。如果汗出不止，是血脱，用独参汤。其血脱而脉实，汗后脉象躁动的难治，脉象细小的易治。《外台秘要》说：阴盛格阳导致烦躁，想要坐在井中，用附子四逆汤加葱白。王太仆先生说：凡是热势来时又退去，白天出现夜晚潜伏，夜晚出现白天潜伏，不时发作的，名叫“无火”，这是无根的虚火。
发生呕吐，如果是因为疼痛剧烈，或者因攻伐药物伤了胃气，用四君子汤、当归、半夏、生姜。如果是因为愤怒伤了肝，用小柴胡汤加山栀、茯苓。如果是因为痰火旺盛，用二陈汤加姜炒黄连、山栀。如果是因为胃气虚弱，用补中益气汤、生姜、半夏。如果是因为出血过多，或者溃破之后，用六君子汤加当归。
气喘咳嗽，如果是出血过多，面色黑、胸部胀满；或者胸膈疼痛而发喘的，是气虚血乘于肺，急用二味参苏饮。如果咳血、鼻衄，是气逆血蕴于肺，急用十味参苏饮加山栀、黄芩、黄连、苏木。
发生口渴，如果是因出血过多，用四物参术汤；无效，用人参、黄芪以补气，当归、熟地以养血。如果是溃破之后，用八珍汤。如果是因胃热伤津液，用竹叶黄芪汤。胃虚津液不足，用补中益气汤。胃火炽盛，用竹叶石膏汤。如果烦热口渴，小便淋沥涩痛，是肾经虚热，非地黄丸不能救治。
发生出血，如果是患处或各个孔窍出血，是肝火炽盛，血热错经妄行，用加味逍遥散，清热养血。如果是中气虚弱，血无所依附而妄行，用加味四君子汤，补益中气。或者是元气内脱，不能摄血，用独参汤加炮姜来回阳；如果无效，急加附子。或者是血蕴结在内而呕血，用四物汤加柴胡、黄芩。凡是损伤、劳碌、怒气，肚腹胀闷，误服大黄等药损伤经络，就会导致吐血、鼻衄、便血、尿血；损伤阴络，就会导致血积、血块、肌肉青黯。这是脏腑亏损，经络失职，急补脾肺，也有存活的，只是患者不明白这个道理，不使用这种方法，可惜啊！
手足损伤，如果元气虚弱，或者不戒房事，或者妄行攻伐，导致死肉向上蔓延；或者腐肉不痛、黑色且不脱落的，应当大补元气，才可以保全生命。如果手足关节断裂脱落，不要紧，骨头断了但筋连着，不急剪断。如果侵犯到好肉则无法治疗。如果预先调补脾气，就没有这种祸患。大凡脓瘀肉腐的，就针刺并投用托里散。如果出现牙关紧闭、遗尿且像破伤风症状的，急用十全大补汤加附子，大多能存活。
腐肉不溃烂，或者恶寒而不溃烂，用补中益气汤。发热而不溃烂，用八珍汤。如果因攻伐药物导致不溃烂，用六君子汤加当归。外皮黑硬不溃烂的，是内火蒸灼，内服八珍汤，外涂当归膏。死肉不能溃烂，或者新肉不能生长而导致死亡的，都是因为没有预先补益脾胃。
新肉不生，如果患处苍白，是脾气虚弱，用六君子汤加川芎、当归。患处绯红，是阴血虚弱，用四物汤加人参、白术。如果恶寒发热，是气血虚弱，用十全大补汤。脓液稀白而不长肉，是脾肺气虚，用补中益气汤。脓液稀赤而不长肉，是心脾血虚，用东垣圣愈汤。寒热往来而不长肉，是肝火动，用加味逍遥散。午后发热而不长肉，是肝血虚，用八珍汤加牡丹皮。食少体倦而不长肉，是脾胃气虚，用六君子汤。脓液秽浊而不长肉，是元气内伤，用补中益气汤。如果是夏季，用调中益气汤。腹泻用清暑益气汤。秋季腹泻，用清燥汤。
重伤昏迷的，急灌独参汤。虽然内有瘀血切不可攻下，急用花蕊石散，在体内化解它，恐怕因泻下而亡阴。如果元气虚损严重的，尤其不可攻下，也用前面的散剂化解它。凡是瘀血在内，大小便不通，用大黄、朴硝。血凝而不下的，急用木香、肉桂末二三钱，用熟酒调匀灌服，血下行才能生存。如体质怯弱的人，用芒硝、大黄，必须加肉桂、木香同煎，借其热性，以行使其寒性。
大便秘结，如果是大肠血虚火炽，用四物汤送服润肠丸，或者用猪胆汁导便。如果是肾虚火燥，用六味地黄丸。肠胃气虚，用补中益气汤。
伤损病症使用黑羊皮的，大概因为羊性热，能补气。如果杖疮伤得很重，内部肌肉已坏，想让它溃烂的就贴它，成脓确实快；但如果内部不用补剂强壮根本，毒气无不向内侵袭。外部不用砭石刺破，泄出瘀秽，良肉无不受伤损坏的；受刑轻，仅外皮破损的，只宜用当归膏敷贴，再服用四物汤、黄芩、黄连、柴胡、山栀、白术、茯苓。另外疔疮痂不结，伤肉不溃，死血自散，肿痛自消，如果一概进行罨贴，则会酝酿瘀毒。
跳跃、捶胸闪挫，举重、劳役、愤怒，导致胸腹痛闷，喜欢用手抚摸的，是肝火伤脾，用四君子汤、柴胡、山栀。害怕用手抚摸的，是肝经血滞，用四物汤、柴胡、山栀、桃仁、红花。如果胸胁作痛，饮食减少思虑，是肝脾气伤，用四君子汤加川芎、当归。如果胸腹不利，食少失眠，是脾气郁结，用加味归脾汤。如果痰气不利，是脾肺气滞，用二陈汤、白术、川芎、当归、栀子、青皮。如果咬牙抽搐，是肝旺脾虚，用小柴胡汤、川芎、山栀、天麻、钩藤。如果使用风药，则肝血更伤，肝火更甚。如果饮用糖酒，则肾水更虚，肝火更炽。如果使用大黄等药，内伤阴络，反而导致下血。年轻力壮者必成痼疾，年老体弱者多致死。（以上若胸胁作痛，发热午后热，是肝经血伤，用加味逍遥散。）
破伤风，河间说：风症善行数变，入脏非常快，生死只在转念之间，应当急分表里虚实而治。邪气在表的，则筋脉拘急，时而寒热，筋惕抽搐，脉浮弦，用羌活防风汤发散。在半表半里的，则头微汗，身无汗，用羌活汤和解。传入里的，舌强口噤，项背反张，筋惕抽搐，痰涎壅盛，胸腹满闷，大小便闭赤，时而出汗，脉洪数而弦，用大芎黄汤导下。攻下后汗仍出，是表虚，用白术防风汤补益，不时灌服米粥饮料为好。前面说的是气虚未损的方法，如果脓血太泄，阳随阴散，气血俱虚，而出现类似前症的，都应当大补脾胃，切忌祛风药。
发痉，仲景说：诸痉项强，皆属于温。又说：太阳病，发汗太多，致痉风病。攻下则痉复发，发汗则拘急。疮家发汗则痉，是汗下过度亡失津液所致。有汗而不恶寒叫柔痉，因为风能散气，宜白术汤加桂心、黄芪。无汗而恶寒叫刚痉，因为寒能涩血，宜葛根汤。都是气血内伤，筋脉无所营养，而变为非风症。杖疮及劳伤气血而变的，应当补气血；无效，用独参汤；手足冷加桂枝、附子，迟缓则无法救治。
Costochondral distension and pain, if the stool is unobstructed and harmonious, accompanied by panting, coughing, and expectoration, indicates Liver Fire insulting the Lung. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Qing Pi (Green Tangerine Peel) and Shan Zhi (Gardenia Fruit) to clear it.
If there is chest and abdominal distension and pain, unobstructed stool, accompanied by panting, coughing, and hemoptysis, it indicates stagnation of Blood stasis. Use Dang Gui Dao Zhi San (Angelica Dahurica Stagnation-Resolving Powder) to unblock it. The *Nei Jing* (Inner Canon) states: "The Liver stores Blood, and the Spleen controls Blood." Generally, the Liver belongs to Wood, generates Fire which insults Earth (Spleen/Stomach). Once Liver Fire is blazing, Liver Blood must be damaged, and Spleen Qi must be deficient. One should first clear the Liver and nourish Blood, so that Blood stasis will not coagulate and muscles will not ulcerate extensively; subsequently, strengthen the Spleen and fortify the Stomach, so that Blood stasis will easily dissipate and new flesh will easily grow. If one employs attacking and reducing methods, the deficient will become more deficient, and the stagnant will become more stagnant, bringing disaster immediately.
Abdominal pain, or unobstructed stool, with severe pain upon palpation, indicates internal Blood stasis. Use Jia Wei Cheng Qi Tang (Modified Doubling Qi Decoction) to purge it. After purging, if pain persists and remains painful upon palpation, it indicates incomplete elimination of Blood stasis. Use Jia Wei Si Wu Tang (Modified Four Substances Decoction) to tonify and promote circulation. If abdominal pain is not painful upon palpation, it indicates damage to Qi and Blood. Use Si Wu Tang (Four Substances Decoction) with Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), and others to tonify and harmonize. If after purging, the chest and hypochondrium become painful instead, it indicates damage to Liver Blood. Use Si Jun Zi Tang (Four Gentlemen Decoction) with Xiong Duan (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis Radix) to tonify. If fever occurs after purging, it indicates damage to Yin Blood. Use Si Wu Tang with Ren Shen and Bai Zhu to tonify. If aversion to cold occurs after purging, it indicates damage to Yang Qi. Use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) to tonify. If both aversion to cold and fever occur after purging, it indicates damage to both Qi and Blood. Use Ba Zhen Tang (Eight Treasures Decoction) to tonify. If nausea arises after purging, it indicates damage to Stomach Qi. Use Liu Jun Zi Tang (Six Gentlemen Decoction) with Dang Gui to tonify. If diarrhea occurs after purging, it indicates damage to Spleen and Kidney. Use Liu Jun Zi Tang with Rou Dou Kou (Nutmeg) and Po Gu Zhi (Psoralea Fruit) to tonify. If after purging, both hands and feet are cold, accompanied by stupor and sweating, it indicates deficiency-cold of Yang Qi. Urgently use Shen Fu Tang (Ginseng and Aconite Decoction). If vomiting and diarrhea occur with cold hands and feet and cyanotic fingernails, it indicates extreme deficiency-cold of Spleen and Kidney. Urgently use a large dose of Shen Fu Tang. If teeth are clenched, hands are flaccid, urine is incontinent, phlegm is profuse, lips are cyanotic, and the body is cold, it is a critical condition of extreme deficiency. Urgently administer a large dose of Shen Fu Tang; many survive.
Pain in the muscles indicates stagnation of Ying and Wei Qi. Use Fu Yuan Tong Qi San (Revive Origin Unblocking Qi Powder). Pain in sinews and bones indicates damage to Liver and Kidney Qi. Use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). Internal injury causing lower bleeding and pain indicates deficiency of Spleen and Stomach Qi. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). External trauma causing bleeding and pain indicates deficiency of Spleen and Lung Qi. Use Ba Zhen Tang (Eight Treasures Decoction). Generally, continuous lower bleeding indicates escape of Spleen and Stomach Qi. Vomiting, diarrhea, and inability to eat indicate collapse of Spleen and Stomach Qi. If Spleen and Stomach were regulated and tonified in advance, this affliction would not have occurred.
Pain lasting four to five days without reduction, or pain starting only after one or two days, indicates impending suppuration. Use Tuo Li San (Support Interior Powder). If depression upon finger pressure rebounds immediately, pus has formed. Puncture to drain the pus, and pain will cease spontaneously. Headache that comes and goes indicates deficiency of Qi and Blood. Pain accompanied by dizziness indicates Phlegm. One should generate Liver Blood and tonify Spleen Qi.
Cyan swelling without suppuration is treated with Bu Zhong Yi Qi Tang to tonify Qi. Dark purple swelling that does not resolve is treated with Jia Wei Xiao Yao San (Modified Free Wanderer Powder) to dissipate Blood. If swelling is painful, indicating Blood stasis turning into pus, use Ba Zhen Tang with Bai Zhi (Angelica Dahurica Root) to support and expel. If pain recurs after pus rupture, it indicates deficiency of Qi and Blood. Use Shi Quan Da Bu Tang to tonify. If bone joints reconnect but dislocate again, it indicates deficiency of Liver and Kidney. Use Di Huang Wan (Rehmannia Pill). Swelling that does not subside and cyanosis that does not fade indicate deficiency of Qi and Blood. Internally use Ba Zhen Tang; externally apply Cong Yun Fa (Scallion Moxibustion Method). Thus, Blood stasis will naturally dissipate, and swelling and pain will naturally subside. If one uses blood-invigorating and blood-breaking methods, Spleen and Stomach will become more deficient, and Qi mechanism will become more stagnant. If cooling herbs are applied topically, Blood stasis will coagulate further, internal corruption will deepen, making the situation difficult to manage.
Fever due to excessive bleeding, or after pus rupture, with a pulse that is flooding but empty, and completely absent upon deep pressure, indicates Yin deficiency fever. Use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction). A pulse that is deep and minute, soft and weak upon pressure, indicates excess Yin causing restlessness. Use Si Jun Zi Tang with Sheng Jiang (Fresh Ginger) and Fu Zi (Prepared Aconite Lateral Root). Fever with restlessness, muscle twitching, and sinew tremors indicates loss of Blood. Use Sheng Yu Tang (Holy Recovery Decoction). Continuous sweating indicates Blood exhaustion. Use Du Shen Tang (Single Ginseng Decoction). If Blood exhaustion presents with a full pulse, and the pulse becomes rapid after sweating, it is difficult to treat; if the pulse is fine and small, it is easy to treat. The *Waitai Miyao* (Secrets of the Outer Hall) states: Excess Yin causing restlessness, desiring to sit in a well, is treated with Fu Zi Si Ni Tang (Aconite Reversing the Cold Decoction) plus Cong Bai (Scallion White). Master Wang Tai Pu stated: Any heat that comes and goes, appears during the day and hides at night, or appears at night and hides during the day, moving irregularly, is named "No Fire." This is rootless deficient fire.
Vomiting due to severe pain, or stomach damage from attacking drugs, is treated with Si Jun Zi Tang, Dang Gui, Ban Xia (Pinellia Tuber), and Sheng Jiang. Vomiting due to anger damaging the Liver is treated with Xiao Chai Hu Tang plus Shan Zhi and Fu Ling (Poria). Vomiting due to profuse Phlegm-Fire is treated with Er Chen Tang (Two-Chinese Herb Decoction) plus Jiang Chao Huang Lian (Gastrodia Rhizome fried in ginger) and Shan Zhi. Vomiting due to Stomach Qi deficiency is treated with Bu Zhong Yi Qi Tang, Sheng Jiang, and Ban Xia. Vomiting due to excessive bleeding or post-ulceration is treated with Liu Jun Zi Tang plus Dang Gui.
Panting and coughing due to excessive bleeding, with a dark face and chest distension; or panting with chest and diaphragm pain, indicates Qi deficiency allowing Blood to invade the Lung. Urgently use Er Wei Shen Su Yin (Two-Ingredient Ginseng and Perilla Drink). Hemoptysis and epistaxis due to rebellious Qi and accumulated Blood in the Lung require urgent use of Shi Wei Shen Su Yin (Ten-Ingredient Ginseng and Perilla Drink) plus Shan Zhi, Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Su Mu (Sappan Wood).
Thirst due to excessive bleeding is treated with Si Wu Shen Shu Tang (Four Substances, Ginseng, and Atractylodes Decoction); if ineffective, use Ren Shen and Huang Qi (Astragalus Root) to tonify Qi, and Dang Gui and Shu Di Huang (Prepared Rehmannia Root) to nourish Blood. Thirst after ulceration is treated with Ba Zhen Tang. Thirst due to Stomach Heat damaging Body Fluids is treated with Zhu Ye Huang Qi Tang (Bamboo Leaf and Astragalus Decoction). Thirst due to Stomach deficiency and insufficient Body Fluids is treated with Bu Zhong Yi Qi Tang. Thirst due to blazing Stomach Fire is treated with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). Restlessness, heat, thirst, and dysuria indicate deficiency-heat of the Kidney channel, which can only be rescued by Di Huang Wan (Rehmannia Pill).
Bleeding from lesions or orifices due to blazing Liver Fire and Heat-Blood disrupting channels and flowing recklessly is treated with Jia Wei Xiao Yao San to clear Heat and nourish Blood. Bleeding due to weakness of Middle Qi, where Blood has no attachment and flows recklessly, is treated with Jia Wei Si Jun Zi Tang to tonify Middle Qi. Bleeding due to internal collapse of Yuan Qi, unable to control Blood, is treated with Du Shen Tang plus Pao Jiang (Roasted Ginger) to restore Yang; if ineffective, urgently add Fu Zi. Internal accumulation of Blood causing hematemesis is treated with Si Wu Tang plus Chai Hu (Bupleurum Root) and Huang Qin. Trauma, overwork, and anger causing abdominal distension, combined with mistaken use of Da Huang (Rhubarb Root) damaging collaterals, leads to hematemesis, epistaxis, hematochezia, and hematuria. Damage to Yin collaterals leads to Blood accumulation, Blood clots, and cyanotic muscles. This is organ deficiency and meridian dysfunction. Urgently tonify Spleen and Lung; survival is possible. However, patients who do not understand this principle and do not use this method are lamentable.
Extremity injuries with deficient Yuan Qi, sexual indiscretion, or reckless attacking leading to necrotic tissue spreading upward; or putrefied tissue that is painless, black, and non-detaching, require major tonification of Yuan Qi to preserve life. Dislocated extremity joints are not fatal if bones are broken but tendons remain connected; do not amputate hastily. If healthy flesh is invaded, it is untreatable. Preemptive tonification of Spleen Qi prevents this. For pus and necrotic tissue, puncture and administer Tuo Li San. Jaw stiffness, urinary incontinence, and symptoms resembling Tetanus require urgent use of Shi Quan Da Bu Tang plus Fu Zi; many survive.
Putrefied tissue not suppurating, or aversion to cold preventing suppuration, is treated with Bu Zhong Yi Qi Tang. Fever preventing suppuration is treated with Ba Zhen Tang. Non-suppuration due to attacking drugs is treated with Liu Jun Zi Tang plus Dang Gui. Black, hard external skin preventing suppuration indicates internal steaming fire. Internally use Ba Zhen Tang; externally apply Dang Gui Gao (Angelica Ointment). Death of tissue preventing suppuration or failure of new flesh growth resulting in death stems from failure to preemptively tonify Spleen and Stomach.
Failure of new flesh growth with pale lesions indicates Spleen Qi deficiency. Use Liu Jun Zi Tang with Xiong Duan and Dang Gui. Red lesions indicate Yin Blood deficiency. Use Si Wu Tang with Ren Shen and Bai Zhu. Aversion to cold and fever indicate Qi and Blood deficiency. Use Shi Quan Da Bu Tang. Thin white pus failing to generate flesh indicates Spleen and Lung Qi deficiency. Use Bu Zhong Yi Qi Tang. Thin red pus failing to generate flesh indicates Heart and Spleen Blood deficiency. Use Dong Yuan Sheng Yu Tang (Dongyuan's Holy Recovery Decoction). Alternating chills and fever failing to generate flesh indicates Liver Fire agitation. Use Jia Wei Xiao Yao San. Afternoon fever failing to generate flesh indicates Liver Blood deficiency. Use Ba Zhen Tang plus Mu Dan Pi (Moutan Cortex). Poor appetite and fatigue failing to generate flesh indicate Spleen and Stomach Qi deficiency. Use Liu Jun Zi Tang. Foul pus failing to generate flesh indicates internal injury to Yuan Qi. Use Bu Zhong Yi Qi Tang. In summer, use Tiao Zhong Yi Qi Tang. Diarrhea requires Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction). Autumn diarrhea requires Qing Zao Tang (Clear Dryness Decoction).
Severe trauma with stupor requires urgent administration of Du Shen Tang. Even with internal Blood stasis, do not purge. Urgently use Hua Rui Shi San (Flower and Coral Stone Powder) to transform it internally, fearing Yin loss from purgation. Severe Yuan Qi deficiency also contraindicates purgation; use the aforementioned powder to transform. Internal Blood stasis with constipation is treated with Da Huang and Po Xiao (Mirabilite). Coagulated Blood not descending requires urgent administration of Mu Xiang (Aucklandia Root) and Rou Gui (Cinnamon Bark) powder, 2-3 qian, mixed with warm wine. Survival follows when Blood descends. For frail individuals using Po Xiao and Da Huang, add Rou Gui and Mu Xiang to decoct together, borrowing their heat to activate the cold properties.
Constipation due to Large Intestine Blood deficiency and blazing Fire is treated with Si Wu Tang administering Run Chang Wan (Intestine-Moistening Pill), or guided by Pig Gallbladder Juice. Constipation due to Kidney deficiency and dry Fire is treated with Liu Wei Di Huang Wan. Constipation due to gastrointestinal Qi deficiency is treated with Bu Zhong Yi Qi Tang.
For trauma using black sheepskin: Sheep is hot-natured and tonifies Qi. For severe beating wounds with internal tissue damage aiming for suppuration, application accelerates pus formation. However, without internal tonics to strengthen the root, toxins may invade internally. Without scarification to drain turbidity, healthy flesh may be damaged. For minor injuries with superficial skin breaks, apply Dang Gui Gao and administer Si Wu Tang with Huang Qin, Huang Lian, Chai Hu, Shan Zhi, Bai Zhu, and Fu Ling. For carbuncles with non-forming crusts and non-suppurating wounds, dead Blood dissipates and swelling/pain subsides spontaneously. General poulticing causes fermentation of toxic stasis.
Trauma from jumping, chest pounding, sprains, heavy lifting, labor, and anger causing chest/abdominal pain and distension, relieved by touch, indicates Liver Fire injuring Spleen. Use Si Jun Zi Tang, Chai Hu, and Shan Zhi. Pain aggravated by touch indicates Liver channel Blood stagnation. Use Si Wu Tang, Chai Hu, Shan Zhi, Tao Ren (Peach Seed), and Hong Hua (Carthamus Flower). Chest/hypochondriac pain with poor appetite indicates Liver/Spleen Qi damage. Use Si Jun Zi Tang with Xiong Duan and Dang Gui. Chest/abdominal discomfort, poor appetite, and insomnia indicate Spleen Qi constraint. Use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction). Phlegm-Qi obstruction indicates Spleen/Lung Qi stagnation. Use Er Chen Tang, Bai Zhu, Xiong Duan, Dang Gui, Zhi Zi (Gardenia Fruit), and Qing Pi. Teeth grinding and convulsions indicate Liver excess and Spleen deficiency. Use Xiao Chai Hu Tang, Chuan Xiong, Shan Zhi, Tian Ma (Gastrodia Rhizome), and Gou Teng (Uncaria Ramulus cum Uncis). Wind-dispelling herbs injure Liver Blood and aggravate Liver Fire. Sweet wine damages Kidney Water and exacerbates Liver Fire. Da Huang damages Yin collaterals internally, causing lower bleeding. Young and strong individuals develop chronic diseases; old and weak individuals often die. (Note: Chest/hypochondriac pain, fever, afternoon fever indicates Liver channel Blood damage; use Jia Wei Xiao Yao San.)
Tetanus: He Jian stated: Wind disorders move quickly and change frequently, entering organs rapidly. Life and death depend on immediate differentiation of exterior/interior and deficiency/excess. Exterior pathogens cause sinew stiffness, alternating chills/fever, muscle twitching, and floating/wiry pulses. Use Qiang Huo Fang Feng Tang (Notopterygium and Saposhnikovia Decoction) to disperse. Half-exterior/half-interior pathogens cause slight head sweat, no body sweat. Use Qiang Huo Tang to harmonize. Interior transmission causes stiff tongue, jaw lock, opisthotonos, muscle twitching, profuse sputum, chest/abdominal fullness, closed/dark urination, occasional sweating, and flooding/rapid/wiry pulses. Use Da Xiong Huang Tang (Major Ligusticum and Rhubarb Decoction) to guide downward. Post-purgation sweating indicates exterior deficiency. Use Bai Zhu Fang Feng Tang (Atractylodes and Saposhnikovia Decoction) to tonify; frequent porridge drinks are beneficial. The previous method applies to Qi deficiency without damage. If pus/blood loss causes Yang to scatter with Yin, resulting in Qi/Blood deficiency mimicking these symptoms, massively tonify Spleen/Stomach. Avoid wind-dispelling herbs.
Spasm: Zhang Zhongjing stated: All spasms with neck stiffness belong to Warmth. Also: Sun Yang disease, excessive sweating leads to spasm. Purging causes recurrent spasm; sweating causes stiffness. Wound patients sweating leads to spasm, caused by excessive fluid loss from sweating/purging. Sweating without aversion to cold is Soft Spasm, as Wind disperses Qi. Use Bai Zhu Tang plus Gui Xin (Cinnamon Heart) and Huang Qi. No sweat with aversion to cold is Hard Spasm, as Cold obstructs Blood. Use Ge Gen Tang (Kudzu Root Decoction). Both result from internal Qi/Blood injury, sinews lacking nourishment, transforming into non-Wind disorders. Beating wounds and labor-induced Qi/Blood injury requiring tonification. If ineffective, use Du Shen Tang. Add Gui and Fu for cold extremities; delay is fatal.