晋翁乃媳，秋间咳嗽，不以为意。交冬渐甚，午后寒热。医云外感，服药不效，遂致形
倦肌
瘦，食少便溏。予视其行动气促，诊脉弦劲无胃，询其经期，三月未至，私谓晋翁曰∶此殆
证也，危期速矣。翁惊曰∶是病不过咳嗽寒热，何以至此?予曰∶经云二阳之病发心脾，有
不得隐曲，女子不月，传为风消息贲者，死不治。矧脉弦劲无胃，乃真脏也。经又云∶形瘦
脉大，胸中多气者死。脉证如此，何以得生。辞不举方，逾旬而殁。
潘氏室女，年十五岁，初患腹痛，驯至咳嗽寒热，形瘦食少，诊脉细数，询经事愆期三
月。
予曰∶瘵证也。辞不治。未百日而殁。历见妇人咳嗽寒热，脉数经闭者，多不可治，若室女
更无一生。任用补虚清热，解郁调经诸法，总无灵效。求诸古训，鲜有良法。惟《金匮》载
有大黄 虫丸，及百劳丸二方，喻氏阐发其义，窃思此证当其初起，血痹不行，痨瘵将成未
成之际，即以此药投之，祛旧生新，或能图功，亦未可料。倘迁延时日，元气已衰，则无及
矣。识此质诸明哲。
灿翁年近七旬，向患腹痛，一夕忽吐下紫瘀血块数碗，头晕自汗，目阖神疲，诊脉芤虚
，谓
其子曰∶此血脱证也。书云∶久痛多蓄瘀。盖腹痛数年，瘀蓄已久，一旦倾囊而出，夫气为
血之帅，高年气虚，切虑晕脱。古人治血脱，每用独参汤以益其气，但目下参价甚昂，恐难
措办，乃订大剂黑归脾汤，资其化源，固其统摄，未几获痊，次年病复。虽不若前之剧，亦
觉困倦莫支，仍守前法治愈。其子忧甚，恐其再发，商图善后之策。予思血蓄之故，必有窠
囊，如水之盈科而进，按胃为生血之源，脾为统血之脏，苟脾健胃强，则气血周流，何蓄之
有?经以六经为川，肠胃为海，譬诸洪水泛滥，究缘江河失疏，为订二方，早用归脾丸，晚
用参苓白术散，每方俱加丹参干漆二味，冀其去瘀生新。服药经年，其病遂绝。
方晋偕老先生的儿媳，秋季出现咳嗽症状，家人并未在意。到了冬季病情逐渐加重，午后出现寒热交替的症状。医生诊断为外感病，服药后无效，导致身体疲倦、肌肉消瘦、食欲减退、大便稀溏。我观察她行动时气息急促，诊脉弦劲且无胃气（指脉象缺乏柔和之象，提示脏腑精气衰竭），询问她的月经情况，发现三个月未来潮。我私下对方晋翁说：这大概是痨证（一种以慢性消耗为主要特征的疾病，类似肺结核），危重时刻即将到来。方晋翁惊讶地说：这病不过是咳嗽和寒热，怎么会到这种地步？我说：《内经》记载：“二阳之病发心脾，有不得隐曲，女子不月”，若传变为风消或息贲（均为中医病名，指因久咳导致的严重虚损病症），则死亡且无法治疗。况且脉象弦劲无胃气，这是真脏脉（预示病情极重，预后不良的脉象）。《内经》又记载：“形瘦脉大，胸中多气者死”。脉象与症状如此，怎么能存活呢？我不开具处方，过了十天病人去世。
潘家的未婚女子，十五岁，起初患腹痛，逐渐发展为咳嗽、寒热、身体消瘦、食欲减退，诊脉细数，询问月经情况，发现延期三个月。我说：这是瘵证（即痨病，特指传染性较强的肺痨）。拒绝治疗。不到一百天病人去世。我曾见过许多妇女出现咳嗽、寒热、脉数且经闭的情况，大多不可治愈，如果是未婚女子，更是无一能生。无论使用补虚、清热、解郁、调经等各种方法，都没有灵验的效果。查阅古代医训，也很少有好办法。只有《金匮要略》记载有大黄䗪虫丸及百劳丸两个方子，喻嘉言阐发了其中的义理。我私下思考，此病在初起阶段，血痹不通，痨瘵将成未成之际，如果立即投用这些药物，祛除瘀血、生成新血，或许能取得功效，但也难以预料。如果拖延时日，元气已经衰败，那就来不及救治了。记录此事以请教高明之士。
方灿侣老先生年近七十，一向患有腹痛。一天晚上突然吐出和下出紫黑色的瘀血块好几碗，出现头晕、自汗、眼睛闭合、精神疲惫的症状。诊脉芤虚（浮大中空，如按葱管，主失血），我对他的儿子说：这是血脱证（大量失血导致的气随血脱危象）。医书说：久痛多蓄瘀。大概是因为腹痛数年，瘀血积聚已久，一旦大量排出，气为血之帅，老年人本身气虚，非常担心发生晕厥脱证。古人治疗血脱证，常用独参汤来益气固脱，但目前人参价格昂贵，恐怕难以筹措，于是制定大剂量的黑归脾汤，资助气血化生的源头，巩固统摄血液的功能，不久便痊愈了。第二年病情复发。虽然不如之前剧烈，但也感到困倦难支，仍然按照前法治疗而痊愈。他的儿子非常担忧，害怕再次发作，商量寻求善后调理的策略。我思考血瘀积聚的原因，必定有固定的巢穴（病灶），就像水注满洼地再向前流一样。根据中医理论，胃是生血之源，脾是统血之脏，如果脾胃强健，则气血周流全身，哪里还会有瘀血积聚呢？《内经》以六经为河流，肠胃为大海，比喻如同洪水泛滥，终究是因为江河失去了疏导功能。因此为他制定两个方子：早上服用归脾丸，晚上服用参苓白术散，每方都加入丹参和干漆两味药，希望达到祛瘀生新的效果。服药经过一年，此病彻底断绝。
The daughter-in-law of Mr. Fang Jinxiang suffered from cough in autumn, which was ignored. As winter approached, the condition worsened, presenting with alternating chills and fever in the afternoon. Physicians diagnosed it as an external contraction (wai gan), but medication proved ineffective, leading to physical fatigue, emaciation, poor appetite, and loose stools. Upon examination, her breathing was rapid upon movement, and her pulse was wiry and forceful without a "stomach qi" (a sign of depleted organ essence). Inquiry revealed amenorrhea for three months. I privately told Mr. Fang: This is likely a Lao syndrome (a chronic consumptive disease similar to tuberculosis); the critical period is imminent. Mr. Fang exclaimed in shock: The illness is merely cough and fever; how could it reach this state? I replied: The Classic states, "Diseases of the Two Yangs originate in the Heart and Spleen; when there are hidden grievances, women suffer from amenorrhea." If transmitted into Feng Xiao or Xi Fen (terms for severe consumptive conditions resulting from prolonged coughing), death is inevitable and untreatable. Moreover, a wiry and forceless pulse indicates a True Zang pulse (a terminal pulse indicating extreme severity). The Classic further states, "Emaciation with a large pulse and excessive Qi in the chest indicates death." Given such pulse and symptoms, survival is impossible. I declined to prescribe medicine, and the patient died ten days later.
A maiden of the Pan family, aged fifteen, initially suffered from abdominal pain, which gradually progressed to cough, chills and fever, emaciation, and poor appetite. Her pulse was fine and rapid, and her menses were delayed by three months. I stated: This is a Zhai syndrome (specifically referring to infectious pulmonary tuberculosis). I refused treatment. She died within one hundred days. I have observed that many women presenting with cough, chills and fever, rapid pulse, and amenorrhea are largely incurable, especially maidens, none of whom survive. Regardless of employing methods to tonify deficiency, clear heat, resolve depression, or regulate menstruation, no efficacy is achieved. Ancient texts offer few effective remedies. Only the *Jin Gui Yao Lue* records two formulas: Da Huang Zhe Chong Wan and Bai Lao Wan. Yu Jiayan elucidated their principles. It is my considered opinion that at the initial stage of this disease, when blood bi (obstruction) is present and Lao Zhai is impending but not yet fully formed, administering these medicines to remove old stasis and generate new blood might yield results, though this is uncertain. However, if time is delayed until Yuan Qi (vital energy) is depleted, it will be too late. I record this for discussion with wise physicians.
Mr. Fang Canlv, nearly seventy years old, had a history of abdominal pain. One night, he suddenly vomited and defecated several bowls of dark purple blood clots, accompanied by dizziness, spontaneous sweating, closed eyes, and mental fatigue. His pulse was Koushu (floating, large, and empty like a scallion stalk, indicating blood loss). I told his son: This is a Xue Tuo syndrome (critical condition of Qi collapse following massive hemorrhage). Medical classics state: "Long-standing pain often involves blood stasis." Presumably, due to years of abdominal pain, stasis had accumulated deeply. Its sudden expulsion poses a risk of syncope and collapse, particularly given his advanced age and underlying Qi deficiency. Ancients treated blood depletion with Du Shen Tang (Single Ginseng Decoction) to tonify Qi, but current ginseng prices are prohibitive. Therefore, I prescribed a large dose of Hei Guipi Tang (Black Spleen-Empowering Decoction) to nourish the source of Qi and Blood generation and consolidate the Spleen's function of containing blood. He recovered shortly thereafter. The disease recurred the following year. Although less severe than before, he felt exhausted and weak. Adhering to the previous method, he recovered again. His son, fearing recurrence, sought advice on post-treatment management. I reasoned that blood stasis must have a fixed locus ("nest"), much like water filling depressions before flowing forward. According to theory, the Stomach is the source of Blood generation, and the Spleen is the organ that controls blood. If the Spleen and Stomach are strong, Qi and Blood circulate freely, preventing stasis. The Classic compares the Six Channels to rivers and the Intestines and Stomach to the sea; flooding occurs because the rivers lack proper drainage. Thus, I prescribed two formulas: Guipi Wan (Spleen-Empowering Pill) taken in the morning and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) taken in the evening. Both formulas were supplemented with Danshen (Salvia Miltiorrhiza Root) and Ganqi (Lithospermum Root) to promote the removal of stasis and generation of new blood. After a year of medication, the disease was completely eradicated.