向患血证，发将匝月，医用血脱益气之法，未为不是。惟嫌脉数不静，肌肉咽干，呛咳
莫能
正偃，咳甚则血来，咳止血亦止。血去阴阳，阴不恋阳，水不制火，刻值金燥秉权，肺被火
刑，金水不相施化。《医贯》云∶不投甘寒以降火，骤用参 以补阳，此非医误，不知先后
着也。自述胸脘乍觉烦冤，即咳频血溢，按冲为血海，其经起于气街，挟脐上行至胸中，冲
脉动则诸脉皆动，岂非下焦阴火上逆，血随火升之故耶。火在丹田以下曰少火，出丹田以上
曰壮火，少火生气，壮火食气。欲止其血，须止其嗽。欲止其嗽，须熄其火。然非寻常清火
止嗽之药所能奏功，务使下焦阴火敛藏，火不上逆，金不受刑，嗽止血自止矣。
安波按∶拟一阴煎，加青铅山萸，收纳冲脉之逆。
前议安胃制肝，呕吐稍止，脘仍痞痛，大便未圊，手抖目窜，齿 唇干，舌黄肌热，肝
风痉
厥，状已显著。据述病因情怀郁勃，夹食而起。郁则伤肝，食则伤胃。木郁宜达，腑病宜通
。昨宗仲圣厥应下例，便解结粪数枚，中宫痞形稍软，饮入不呕，惟肝风未熄，痉厥仍发，
肌热口渴，面赤齿干，胸脘嘈杂，病由肝木抑郁，腑气阻闭，变化火风，下焦腑气虽通，上
脘火犹未降。姑议平肝熄风，舒郁清热。诸厥属肝，肝为风木之脏，相火内寄，体阴用阳。
肝气上逆，胃当其冲，食不得入，是有火也。古称寒热之气，相结于心下而成痞，相阻于心
下而成格。又云∶厥阴为病，气上冲心，心中热疼，饥不能食。仿半夏泻心减去守中之品。
肝郁逆胃，阻胃之降，中焦痞塞，不食不便，连日肝风势平，脘热亦减，惟胸痞未宽，不思
饮食，前用润下，微解结粪，昨晚两番欲便，未得解出，似有宿滞未净，胃宜通，肝宜凉，
乃病治之法则。郁抑夹食，激动肝风，神昏肢掣，烦热胸痞，不饥不便，曾投承气泻心获效
，加怒病复，连日延医，证犹未减。自言脘中热闷，口渴唇干，头筋抽痛，有时气冲，厥晕
即发，大便欲出不解。病久反复，诚难想法。然扬汤止沸，不若仍用釜底抽薪，阳明腑气一
通，厥阴风木自平。但成败利钝，虽武侯之明，亦难逆睹也。便通复闭，脘痞依然，按之尚
痛，食不阻塞不行。然下法用经两次，燥粪已圊，所有热滞，亦应推荡，何至牢锢若此，迁
延两旬，言微形倦，似未可以再攻。奈痞结不开，补之不纳，仍宗土郁夺之，实有羸状之义
。
安波按∶凡病之变幻不一，在病家之贤愚耳。如今时之人，病有一变，群医华集，或
论寒
，或道热，贻误者焉可胜算。如先生之相信终不更医，亦时也，运也，命也。为之废书一叹
。大约为医一途，命中必要为天医星者，何彼多遇而此不遇耶。
先前患有血证，发作将近一个月，医生使用“血脱益气”的方法治疗，这并非错误。只是嫌弃患者脉象数动而不平静，肌肉消瘦、咽喉干燥，呛咳严重到无法平躺仰卧，咳嗽剧烈时就会吐血，咳停止则出血也停止。血液流失导致阴阳失衡，阴液不能维系阳气，水（肾阴）不能制约火（心火/虚火），此时正值秋季金气燥烈当令，肺脏被火热刑克，金（肺）与水（肾）之间的气化功能不相协调。《医贯》中说：如果不投用甘寒药物来降火，而是骤然用人参等药来补阳，这不是医生的失误，而是不懂得治疗的先后次序罢了。患者自述胸脘部忽然感到烦闷冤屈感，随即频繁咳嗽并溢出鲜血，按冲脉为血海，其经脉起于气街，挟脐上行至胸中，冲脉跳动则全身诸脉皆动，这难道不是下焦的阴火上逆，血液随着火势上升的缘故吗？火在丹田以下称为少火，出丹田以上称为壮火，少火能生气，壮火会耗气。想要止住出血，必须止住咳嗽；想要止住咳嗽，必须熄灭虚火。然而这不是寻常清热止咳的药物所能奏效的，务必使下焦的阴火敛藏，火不上逆，肺金不受刑克，咳嗽停止，出血自然也就停止了。
安波按语：拟定一阴煎，加入青铅、山萸肉，以收纳冲脉上逆之气。
之前的议定方案是安胃制肝，呕吐稍微停止，但胃脘部仍然痞塞疼痛，大便未解，手部颤抖、眼球上窜，牙齿和嘴唇干燥，舌苔黄、肌肤发热，肝风引起的痉厥症状已经非常明显。据叙述病因是情怀郁结勃发，夹杂食积而起。郁结则伤肝，食积则伤胃。肝木郁结应当疏达，腑病应当通利。昨天遵循张仲景《伤寒论》中厥阴病应当攻下的原则，解出了几枚干结的粪便，中焦脾胃的痞塞形态稍微变软，喝水不再呕吐，只是肝风尚未平息，痉厥仍然发作，肌肤发热、口渴、面色红赤、牙齿干燥、胸脘嘈杂不适，病症源于肝木抑郁，腑气阻闭，变化为火和风，虽然下焦腑气已通，但上脘的火势仍未下降。暂时议定平肝熄风，舒解郁结、清泄热邪。各种厥证都属于肝脏，肝为风木之脏，内寄相火，体属阴而用属阳。肝气上逆，胃受其冲击，食物无法进入，这是有火邪所致。古人称寒热之气，相交结于心下而成痞证，相互阻隔于心下而成格拒证。又说：厥阴病发病时，气向上冲撞心脏，心中热痛，饥饿却不想进食。仿照半夏泻心汤，减去守中滋腻的药物。肝气郁结上逆犯胃，阻碍胃气下降，中焦痞塞，不吃不排，连日来肝风之势稍平，胃脘热感也减轻，只是胸中痞闷仍未宽舒，不思饮食，之前用润下药，微微解除了干结粪便，昨晚两次想排便，未能解出，似乎有宿滞未净。胃宜通降，肝宜清凉，这是治病的原则。郁抑夹带食积，激动肝风，神志昏迷、肢体抽搐，烦热胸痞，不饥不便，曾投用承气汤、泻心汤获得疗效，因发怒病情复发，连日来延请医生诊治，证候仍未减轻。自述胃脘中热闷，口渴唇干，头部筋脉抽痛，有时感觉气向上冲，厥晕随即发作，大便想解却解不出。病程长久反复，确实难以想办法。然而扬汤止沸，不如釜底抽薪，阳明腑气一旦通畅，厥阴风木自然平息。但是成败利害，即使是诸葛亮那样明智的人，也难以预先洞察。大便通畅后又闭塞，胃脘痞塞依旧，按压尚且疼痛，食物无法通过下行。然而攻下法已经用了两次，燥粪已排出，所有的热滞，也应该被推荡清除，为何如此牢固禁锢呢？拖延了二十天，言语微弱、形体疲倦，似乎不能再行攻下。无奈痞结不开，进补又无法纳受，仍遵循“土郁夺之”的原则，实有针对虚弱表象而采取攻伐之义。
安波按语：凡是病情变幻不一，在于病患家属的贤明与愚笨罢了。像现在的人，病情一变，众多医生聚集，有的论述寒证，有的论述热证，贻误病情的情况哪能算得尽。像先生这样始终信任一位医生而不更换，也是时机、运势和命运啊。为此放下书本叹息。大概从事医学这一行，命中注定要有天医星照耀的人，为什么他们多遇到良医而此人却遇不到呢？
Previously suffering from a blood disorder, the episode had lasted nearly a month. The physician's use of the method "tonifying Qi for blood loss" (Bu Yi Fa) was not incorrect. However, it is concerning that the pulse is rapid and restless, muscles are emaciated, and the throat is dry. The patient suffers from violent coughing to the extent that they cannot lie flat; when the cough is severe, blood is expectorated, and bleeding stops when the cough subsides. The loss of blood disrupts Yin and Yang; Yin fails to anchor Yang, and Water (Kidney Yin) fails to control Fire. At this time, the dryness of Metal (Lung/Autumn) holds sway, and the Lung is scorched by Fire, causing the transformation between Metal and Water to fail. As stated in *Yi Guan*: "If one does not administer Sweet-Cold herbs to descend Fire, but instead abruptly uses Ginseng to tonify Yang, this is not a medical error, but a failure to understand the sequence of treatment." The patient describes a sudden sensation of vexation and oppression in the chest and epigastrium, followed by frequent coughing and hemoptysis. The Chong Mai (Penetrating Vessel) is the Sea of Blood; its channel originates at Qichuan (ST30), ascends alongside the umbilicus to the chest. When the Chong Mai pulses, all other vessels move. Is this not due to Yin-Fire rising from the Lower Jiao, with blood ascending along with the fire? Fire below the Dantian is called Shao Huo (Mild Fire), which generates Qi; Fire above the Dantian is called Zhuang Huo (Blazing Fire), which consumes Qi. To stop the bleeding, one must stop the cough. To stop the cough, one must extinguish the fire. However, ordinary clearing-heat and cough-stopping herbs will not suffice. It is essential to cause the Yin-Fire of the Lower Jiao to subside and hide, preventing it from counterflowing, so that Metal is not scorched; once the cough stops, the bleeding will naturally cease.
An Bo notes: Prescribe Yi Yin Decoction (One-Yin Decoction), adding Qing Qian (Lead) and Shan Yu Rou (Cornus Fruit), to gather and restrain the counterflow of the Chong Mai.
The previous strategy of calming the Stomach and restraining the Liver resulted in slight cessation of vomiting, yet the epigastrium remains distended and painful, and defecation has not occurred. There is hand tremors and eye deviation, dry teeth and lips, yellow tongue coating, and hot skin. The symptoms of Liver Wind causing spasms and syncope are already prominent. According to the history, the etiology involves emotional depression and stagnation combined with food retention. Depression injures the Liver; food retention injures the Stomach. Liver Wood stagnation should be dispersed; Fu organ diseases should be unblocked. Yesterday, following Zhang Zhongjing's principle that Jueyin syndromes require purgation, several hard fecal pellets were passed. The central distension softened slightly, and drinking no longer induced vomiting. However, Liver Wind has not yet subsided, and spasms/syncope persist. There is hot skin, thirst, red face, dry teeth, and gastric discomfort. The disease stems from Liver Wood depression and obstruction of Fu Qi, transforming into Fire and Wind. Although Lower Jiao Fu Qi has been unblocked, Upper Epigastric Fire has not yet descended. For now, the plan is to calm the Liver, extinguish Wind, relieve stagnation, and clear Heat. All types of Jue (reversal/cold extremities) belong to the Liver. The Liver is the Zang organ of Wind-Wood, harboring Ministerial Fire within, with a Yin substance and Yang function. When Liver Qi counterflows upward, it impacts the Stomach, preventing food intake; this indicates the presence of Fire. Ancient texts state that Cold and Hot Qi knotting in the Heart-Xia forms Pi (fullness/stagnation); blocking in the Heart-Xia forms Ge (regurgitation/blockage). It is also said: In Jueyin disease, Qi rushes up to the Heart, causing heat and pain in the heart, hunger without desire to eat. Borrowing from Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction), removing substances that retain/middle-tonify. Liver stagnation counterflowing to the Stomach obstructs Stomach descent, causing Middle Jiao blockage, anorexia, and constipation. Over recent days, Liver Wind has calmed somewhat, and epigastric heat has decreased, but chest fullness remains unrelieved, and there is no appetite. Previously used moistening purgatives slightly resolved hard stool. Last night, there were two urges to defecate, but none occurred, suggesting residual retained pathogenic factors. The Stomach should be unblocked, and the Liver cooled; this is the principle of treatment. Depression combined with food retention agitates Liver Wind, causing unconsciousness, limb convulsions, vexatious heat, chest fullness, anorexia, and constipation. Previously, Cheng Qi Tang (Order the Qi Decoction) and Xie Xin Tang (Heart-Draining Decoction) were effective, but relapse occurred after anger. Despite daily medical visits, the syndrome persists. The patient reports epigastric heat and oppression, thirst, dry lips, throbbing headache with tendon tension, occasional Qi rushing upward triggering syncope, and difficulty defecating. The prolonged and recurrent nature makes it difficult to find a solution. However, stirring soup to stop boiling is inferior to removing firewood from under the pot. Once Yangming Fu Qi is unblocked, Jueyin Wind-Wood will naturally level out. Yet, success or failure, even the wisdom of Zhuge Liang could not predict. Defecation became unblocked then closed again; epigastric fullness remains, tender on pressure, food cannot pass down. Purgative methods have been used twice; dry stool is cleared, and heat-retention should have been expelled. Why is it so firmly entrenched? Delayed for twenty days, speech is faint, form is fatigued; it seems attack/purgation cannot be repeated. Helplessly, the fullness/clumping does not open, tonification is not accepted. Still adhering to "Earth stagnation requires seizing/draining," there is meaning in treating the appearance of deficiency with draining methods.
An Bo notes: The variability of diseases depends on whether the patient's family is wise or foolish. Like people today, when a disease changes, many doctors gather; some discuss Cold, others discuss Heat. How can the number of those misled be calculated? That Mr. [the patient] trusted one doctor until the end without changing, is due to timing, fortune, and destiny. I sigh and put down my book. Generally, in the path of medicine, those destined to meet Heavenly Doctors (Tian Yi Xing) are fortunate; why do they encounter them often while this person does not?