肝主怒，怒则伤肝。脾主思，思则伤脾。病缘情志不适，初患上焦痞闷嗳噫，此肝气横
逆，
阻其胃降而然。医者不察，浪投槟榔枳朴，损伤胃气，转致胸脘胀痛，泛泛欲呕，食面尚安
，稍饮米汤，脘中即觉不爽，纠缠三载，似隔非隔，百计图之，总不见效。经云∶肝在地为
木，其谷麦不能食谷而能食麦者，肝强胃弱之故也。盖胃弱故谷不安，肝强故麦可受耳。安
胃制肝法当不谬，但证属情志内伤，未可全凭药力。张鸡峰以为神思间病，当内观静养，惟
逃禅二字甚妙。夫禅而名之曰逃，其心境为何如哉?
安波按∶安胃制肝法，想如半夏、广皮、炒香荷叶蒂、茯苓、杵头糠等以安胃，如乌
梅、
白芍、绿萼梅、木蝴蝶、枣儿、槟榔之类以制肝。需以清香洁络，松灵不钝，使横逆之气下
行，而胃阳疏动矣。
脉大不敛，阳虚，体质兼多烦劳，旧病喘汗，服温补煎丸相安。月前偶感咳嗽，续见鼻
衄痰
红，日来吐多不止，口苦食减，头昏气促。若论寻常吐血，不过肝肺之火，药股清降，火平
，其血自止。尊体精气本虚，一阳初复，形神交劳，水火不交，气随血脱，病关根本，再投
清降损真，则阴阳离决矣。先哲有见血休治血之语，可味也。议从黑归脾汤，培养心脾，佐
以生脉保金，摄纳肾气。服药三剂，血止脉敛。经云∶人四十而阴气自半。平素质亏多病，
今复大失其血，生生不继，脏真耗伤，灌溉栽培，尤非易事，夫血虽生于心，藏于肝，实则
统于脾。古人治血证，每以胃药收功，良有以也。再按痰之本水也，原于肾，痰之动湿也，
由于脾。《内经》以痰多为白血，此果痰也，果精血也，岂精血之外，别有称痰者耶。故昔
贤又有见痰休治痰之论，参五阴煎，水土金先天一气化源也。
安波按∶方义精妙入神，吐血以归脾法治，大不易事。学人须审究的确，否则祸不旋
踵矣。
肝主司怒，愤怒则会损伤肝脏。脾主司思虑，过度思虑则会损伤脾脏。此病源于情志不畅，起初表现为上焦痞塞闷胀、嗳气呃逆，这是由于肝气横逆，阻碍了胃气的下降所致。医生未能仔细诊察，盲目投用槟榔、枳实、厚朴等破气之药，反而损伤了胃气，导致胸脘部胀痛加剧，恶心欲呕，虽然吃面食尚且安稳，但稍喝一点米汤，胃脘中便感到不适。病情纠缠三年，症状似噎膈（吞咽困难）又非噎膈，虽用尽各种办法治疗，始终不见疗效。《黄帝内经》云：“肝在五行中属木，其对应的谷物为麦。”不能进食五谷却能食用麦类食物，是因为肝气强盛而胃气虚弱的缘故。大概因为胃气虚弱，所以五谷难以消化；肝气强盛，所以麦类尚可耐受。采用安胃制肝的方法应当不会出错，但此证属于情志内伤，不能完全依赖药物力量。张鸡峰认为这是神思之间的疾病，应当通过内观静养来调理，其中“逃禅”二字极为精妙。既然将修行称为“逃”，其心境又是如何呢？
安波按语：所谓的安胃制肝法，我想大概是使用半夏、广陈皮、炒香的荷叶蒂、茯苓、杵头糠等药物来安定胃气，使用乌梅、白芍、绿萼梅、木蝴蝶、枣儿、槟榔等药物来制约肝气。需要用清香洁净经络的药物，使气机松灵而不滞钝，让横逆之气下行，从而使胃阳得以疏达运动。
脉象宏大而不能收敛，提示阳气虚弱，体质兼有多烦劳的特点，旧有的气喘、出汗病症，服用温补的煎剂和丸剂尚能维持平衡。月前偶然感受外邪出现咳嗽，随后出现鼻出血、痰中带血，近日吐血不止，伴有口苦、食欲减退、头晕、气短。若论寻常的吐血，不过是肝肺之火亢盛，用药清降，火平则血自止。但患者体质精气本已亏虚，一阳初复，形体与精神双重劳累，水火不交济，气随血脱，病根在于根本元气受损，如果再投用清降类药物损伤真气，就会导致阴阳离决（生命终结）。先哲有“见血休治血”的说法，值得细细品味。建议采用黑归脾汤，培养心脾，佐以生脉散保肺金，摄纳肾气。服药三剂后，血止脉敛。《黄帝内经》云：“人到了四十岁，阴气自然减半。”平时体质亏损多病，如今又大失血液，生生不息之源接续不上，脏腑真气耗伤，想要灌溉栽培恢复健康，尤其不是容易的事。虽然血由心生，藏于肝，实则统摄于脾。古人治疗血证，往往以调理脾胃的药收功，确实是有道理的。再按：痰的根本是水，源于肾；痰的动因是湿，由于脾。《内经》称痰多为白血，这究竟是痰呢，还是精血呢？难道在精血之外，还有被称为痰的东西吗？所以先贤又有“见痰休治痰”的论述。参考五阴煎，水、土、金代表先天一气化的源头。
The Liver governs anger; anger injures the Liver. The Spleen governs thought; excessive thought injures the Spleen. This illness originates from emotional distress. Initially, it presented with fullness and oppression in the Upper Jiao (Upper Burner), belching, and hiccuping. This was caused by Liver Qi rebelling horizontally, obstructing the descending function of Stomach Qi. The physician failed to examine carefully and blindly administered Qi-breaking herbs such as Areca Seed (Binglang), Immature Bitter Orange (Zhishi), and Magnolia Bark (Houpo), which damaged Stomach Qi. Consequently, distending pain in the chest and epigastrium worsened, accompanied by nausea and a desire to vomit. Although wheat-based foods were tolerated, drinking even a little rice soup caused discomfort in the epigastrium. The condition persisted for three years, resembling dysphagia (difficulty swallowing) but not being true dysphagia. Despite trying every possible method, there was no effect. The *Yellow Emperor's Inner Classic* states: "In the Five Elements, the Liver corresponds to Wood, and its associated grain is Wheat." The inability to eat grains but ability to eat wheat is due to strong Liver Qi and weak Stomach Qi. Essentially, because Stomach Qi is weak, grains are difficult to digest; because Liver Qi is strong, wheat can be tolerated. The method of calming the Stomach and restraining the Liver should not be wrong. However, since this syndrome belongs to internal injury from emotions, it cannot rely solely on medicinal power. Zhang Jifeng considered this a disorder of the spirit and mind, suggesting introspection and quiet cultivation. The phrase "fleeing to Zen" (Tao Chan) is particularly exquisite. If cultivation is termed "fleeing," what must the state of mind be like?
An Bo comments: The method of calming the Stomach and restraining the Liver likely involves using Pinellia Tuber (Banxia), Tangerine Peel (Guangpi), stir-fried Lotus Leaf Peduncle (Chao Xiang He Ye Di), Poria (Fuling), and Rice Germ Husk (Chutou Kang) to calm the Stomach, while using Mume Fruit (Wumei), White Peony Root (Baishao), Green Calyx Plum Blossom (Lvemei), Butterfly Orchid Flower (Muhudie), Jujube (Zaor), and Areca Seed (Binglang) to restrain the Liver. It requires aromatic and cleansing herbs to clear the collaterals, ensuring the Qi mechanism is loose and agile without dullness, allowing the rebellious Qi to descend, thereby enabling the Yang of the Stomach to move freely.
The pulse is large and fails to gather, indicating Yang deficiency. The constitution is also prone to excessive mental and physical labor. The old ailments of wheezing and sweating were managed peacefully with decoctions and pills of warming and tonifying nature. A month ago, an accidental contraction of external pathogens caused coughing, followed by epistaxis (nosebleed) and blood-streaked sputum. Recently, vomiting blood has continued incessantly, accompanied by bitter taste in the mouth, reduced appetite, dizziness, and shortness of breath. Regarding ordinary hematemesis (vomiting blood), it is usually due to Fire in the Liver and Lungs. Medicines that clear and descend would extinguish the Fire, and the bleeding would stop naturally. However, the patient's essence and Qi are originally deficient. With the initial recovery of one Yang, both form and spirit are exhausted, and Water and Fire fail to interact. Qi follows Blood out of the body, and the disease concerns the root essence. Administering more clearing and descending medicines would damage Zhen Qi (True Qi), leading to the separation of Yin and Yang (death). The ancient sages said, "When seeing blood, do not treat the blood directly," a statement worthy of deep reflection. It is proposed to use Black Guipi Tang (Black Spleen-Nourishing Decoction) to nourish the Heart and Spleen, assisted by Shengmai San (Generate the Pulse Powder) to protect Metal (Lung) and grasp Kidney Qi. After taking three doses, the bleeding stopped, and the pulse gathered. The *Inner Classic* states: "At forty, Yin Qi naturally halves." Normally deficient in constitution and often ill, now having lost a large amount of blood, the source of life generation cannot continue. Visceral True Qi is consumed. Irrigation and cultivation (restoration) are especially difficult. Although Blood is generated by the Heart and stored in the Liver, it is actually controlled by the Spleen. Ancients treating blood disorders often achieved success with stomach-regulating medicines, which is indeed reasonable. Furthermore, the root of Phlegm is Water, originating from the Kidney; the movement of Phlegm is Dampness, arising from the Spleen. The *Neijing* refers to excessive Phlegm as white blood. Is this truly Phlegm, or is it Essence and Blood? Can there be something called Phlegm apart from Essence and Blood? Thus, the ancients also argued, "When seeing Phlegm, do not treat the Phlegm directly." Referencing Wuyin Jian (Five Yin Decoction), Water, Earth, and Metal represent the source of Qi transformation of the Pre-Heaven (Innate) One Qi.
An Bo comments: The rationale of the prescription is exquisitely profound. Treating hematemesis with the Guipi method is a very difficult task. Practitioners must investigate and determine the diagnosis accurately; otherwise, disaster will follow swiftly.