族子 劳力伤阴，口干鼻衄，颊赤神疲，是冬阳不潜，当春脉洪晡热，系引动温邪。先治温，后治劳。
黑山栀、生地、白芍、丹皮、麦冬、沙参、蔗汁。三服脉洪已退，鼻衄亦止，而右尺不静，龙焰未熄，宜滋
阴潜阳。六味丸料去泽泻，加龟板、淡菜、五味、白芍。煎服十剂效。
肖 去秋阴疟，病延今夏，三日两发，热重寒轻，鼻衄左孔，膝胫热蒸，乃肾阴下亏，胆火上冒。仍用
柴、防升动，致汗多渴眩，鼽衄不已，皆误药贻咎。生地、丹皮、山栀、知母（酒炒）、牛膝（酒蒸）、白芍、
乌梅、桑叶，三四服病已。嗣此多服六味丸以滋下元。
吕氏 暑热烦劳，下崩上衄，屡次晕绝，肢冷胸温，苏醒后胁满心忡，惊汗不寐，脉虚芤。此心肝血失
所统，而气随血脱也。急须固气以摄血，乃阴从阳长之理。用洋参（五钱）、茯神（三钱）、枣仁、龙骨（各二钱）、
黑甘草（钱半）、龙眼（五枚）、小麦（二合）、五味（八分）。三剂神安熟寐，逾日血仍至，复晕而苏。
用理中汤加荆芥（醋炒黑），数服得止。
王 春初鼻衄，口干恶热，由努力伤络，血凝气聚，脐左板硬如掌，脘痞不容侧卧，脉左大右小。
肝乘络伤，应地气上腾，直犯清道。先进缓肝降逆，俟衄止，再商理瘀。黑山栀、郁金、蒌仁、白芍、阿胶（水化）、
当归（醋炒）、麦冬、丹皮、炙草。一啜甚适，三服衄止，脉左敛。原方去芍、胶、归、草，加牡蛎、降香、
牛膝、归须、桃仁。二服便下瘀黑，脘腹俱宽，盖血以下行为顺，上行为逆。故降逆佐甘缓，理瘀佐软坚。
宗 面苍赤，体质阴虚，病后微热，牙龈血衄成块，随咽下，不痛不肿。治用滋肾以潜龙火，熟地（水煮）、
黄柏（酒炒）、茯苓。丹皮、牛膝（蒸）煎汤，冲真藕粉。二服。外用青盐、青黛、石膏。研细敷齿龈，不
日而衄止。
王 当春大衄，由情志拂逆，胆火上迫，致血直犯清道，昏
眩不时。速用清降，以遏少阳升逆之威。羚羊角、黑山栀、丹皮、阿胶、生地、鲜桑叶，二服衄止。脉来小
涩模糊，胸际隐痛，晡时足肿，由 作伤阳，元气不振，惧其遇劳辄发。法宜和补脾阳，潞参、白术、炙草、
茯神、白芍、当归（醋炒）、郁金（汁）。数服愈。
族子（林氏家族中的侄子）：因劳累过度损伤阴液，出现口干、鼻出血，脸颊发红、精神疲乏的症状。这是冬季阳气不能潜藏，到了春季脉象洪大且傍晚发热，属于引动了温邪。治疗原则是先治温邪，后治劳损。
处方：黑山栀、生地、白芍、丹皮、麦冬、沙参、蔗汁。服用三剂后，洪大的脉象已退，鼻出血也停止了，但右尺脉仍不平静，肾中虚火未熄，适宜采用滋阴潜阳的方法。
处方：六味丸的药材组成，去掉泽泻，加入龟板、淡菜、五味子、白芍。煎服十剂后见效。
肖某：去年秋天患阴疟疾，病情延续到今年夏天，每三天发作两次，发热重而恶寒轻，左侧鼻孔出血，膝盖和小腿感觉热气蒸腾。这是由于肾阴在下部亏虚，胆火上冲所致。此前误用柴胡、防风等升提发散药物，导致汗出过多、口渴眩晕，鼻出血不止，这都是误药造成的过错。
处方：生地、丹皮、山栀、知母（酒炒）、牛膝（酒蒸）、白芍、乌梅、桑叶。服用三四剂后病愈。此后长期服用六味丸以滋补下元。
吕氏家属：因暑热和烦劳过度，出现下部崩漏（大量阴道出血）和上部鼻衄，多次发生晕厥，四肢冰冷但胸部温暖。苏醒后感到胁肋胀满、心悸、惊恐出汗、无法入睡，脉象虚大中空。这是心肝血液失去统摄，气随血脱的表现。急需固护元气以摄血，这是“阴从阳长”的道理。
处方：洋参（五钱）、茯神（三钱）、枣仁、龙骨（各二钱）、黑甘草（钱半）、龙眼肉（五枚）、小麦（二合）、五味子（八分）。服用三剂后神志安定并能熟睡，次日出血再次发生并晕厥，苏醒后。
处方：理中汤加入荆芥（醋炒至黑色），服用数剂后止血。
王某：春初出现鼻出血，口干、怕热，这是由于用力过猛损伤络脉，导致血液凝滞、气机郁聚。左脐旁坚硬如手掌大小，胃脘部痞塞不适，无法侧卧，脉象左边大右边小。
病机为肝气乘犯络脉受损，顺应地气上腾之势，直接侵犯清窍。先采用缓和肝气、降逆的方法，待鼻血停止后，再商议处理瘀血。
处方：黑山栀、郁金、瓜蒌仁、白芍、阿胶（水化开）、当归（醋炒）、麦冬、丹皮、炙甘草。喝一剂后感觉非常舒适，服用三剂后鼻血停止，左脉收敛。
原方去掉白芍、阿胶、当归、甘草，加入牡蛎、降香、牛膝、归须、桃仁。服用两剂后排下黑色瘀血，胃脘和腹部都变得宽松舒畅。这是因为血液以下行为顺，以上行为逆。所以降逆配合甘缓药物，理瘀配合软坚散结药物。
宗某：面色苍白中带赤色，体质阴虚，病后微热，牙龈出血结成血块，随即咽下，不痛不肿。
治疗方法：滋补肾阴以潜降龙雷之火。
处方：熟地黄（水煮）、黄柏（酒炒）、茯苓、丹皮、牛膝（蒸）煎汤，冲服真藕粉。服用两剂。
外用：青盐、青黛、石膏。研成细末敷于牙龈，不久后鼻血停止。
王某：在春季发生严重鼻出血，这是由于情志不畅，胆火上迫，导致血液直接侵犯清窍，不时出现昏眩。
紧急使用清热降逆的方法，以遏制少阳经升发逆乱之势。
处方：羚羊角、黑山栀、丹皮、阿胶、生地、鲜桑叶。服用两剂后鼻血停止。脉象来势小涩模糊，胸际隐痛，傍晚时分足部肿胀，这是由于房事过度损伤阳气，元气不振，担心遇到劳累就会复发。
治疗方法：宜调和补益脾阳。
处方：潞党参、白术、炙甘草、茯神、白芍、当归（醋炒）、郁金（取汁）。服用数剂后痊愈。
Clan nephew: Due to excessive labor injuring Yin fluids, symptoms include dry mouth, epistaxis (nosebleed), flushed cheeks, and mental fatigue. This indicates that Yang Qi failed to submerge during winter; in spring, the pulse became surging with afternoon fever, indicating the triggering of warm pathogens. The treatment principle is to address the warm pathogen first, then the consumptive disorder.
Prescription: Gardenia jasminoides fruit (Hei Shanzhi), Rehmannia glutinosa root (Shengdi), Paeonia lactiflora root (Baishao), Moutan cortex (Danpi), Ophiopogon japonicus tuber (Maidong), Glehnia littoralis root (Shashen), Sugarcane juice. After three doses, the surging pulse subsided, and epistaxis stopped. However, the right Chi position remained unstable, indicating unextinguished ministerial fire. Nourishing Yin and submerging Yang is appropriate.
Prescription: Liuwei Wan formula minus Alisma rhizome (Zexie), added Tortoise plastron (Guiban), Mussel (Dancui), Schisandra chinensis fruit (Wuweizi), and Paeonia lactiflora root (Baishao). Decocted and taken for ten doses with effect.
Xiao: Last autumn, suffered from Yin malaria, extending into this summer. Attacks occurred every three days, twice per cycle, with severe heat and mild chills, left nostril epistaxis, and steaming heat in knees and shins. This resulted from deficiency of Kidney Yin below and flaming up of Gallbladder Fire above. Previous use of Bupleurum root (Chaihu) and Saposhnikovia root (Fangfeng) for ascending and dispersing caused excessive sweating, thirst, vertigo, and persistent epistaxis, all due to medication errors.
Prescription: Rehmannia glutinosa root (Shengdi), Moutan cortex (Danpi), Gardenia jasminoides fruit (Shanzhi), Anemarrhena asphodeloides rhizome (Zhimu, wine-fried), Achyranthes bidentata root (Niuxi, wine-steamed), Paeonia lactiflora root (Baishao), Mume fruit (Wumei), Mulberry leaf (Sangye). Disease resolved after three to four doses. Subsequently, long-term intake of Liuwei Wan to nourish the lower Yuan.
Lu family member: Due to summer-heat and烦劳 (mental/physical exertion), presented with下部崩漏 (uterine bleeding/beng lou) and upper epistaxis, repeated syncope, cold limbs but warm chest. Upon recovery, felt flank fullness, palpitations,惊汗 (startle sweating), and insomnia. Pulse was deficient and knotted (Kou). This indicates Heart and Liver blood lost its governing function, with Qi escaping following blood loss. Urgent consolidation of Qi to secure blood is required, following the principle of "Yin grows from Yang."
Prescription: American ginseng (Yangshen, 5 qian), Poria cocos (Fushen, 3 qian), Ziziphus jujuba seed (Zaoren), Dragon bone (Longgu, 2 qian each), Black licorice root (Hei Gancao, 1.5 qian), Longan aril (Longyan, 5 pieces), Wheat (Xiaomai, 2 he), Schisandra chinensis fruit (Wuweizi, 8 fen). After three doses, spirit calmed and deep sleep achieved. Next day, bleeding recurred, causing syncope and recovery.
Prescription: Lizhong Tang plus Schizonepeta spike (Jingjie, vinegar-charred). Stopped after several doses.
Wang: Early spring epistaxis, dry mouth, aversion to heat. Caused by strenuous effort damaging collaterals, leading to blood stasis and Qi aggregation. Hardness like a palm felt on the left side of the umbilicus, epigastric fullness preventing lateral lying, pulse large on the left and small on the right.
Pathogenesis: Liver Qi invading damaged collaterals, following Earth Qi ascending directly attacking clear orifices. First, soothe the Liver and descend rebellious Qi; once epistaxis stops, address blood stasis.
Prescription: Gardenia jasminoides fruit (Hei Shanzhi), Curcuma aromatica rhizome (Yujin), Trichosanthes kirilowii fruit (Louren), Paeonia lactiflora root (Baishao), Donkey-hide gelatin (Ejiao, dissolved in water), Angelica sinensis root (Danggui, vinegar-fried), Ophiopogon japonicus tuber (Maidong), Moutan cortex (Danpi), Honey-fried licorice root (Zhicao). One dose felt very comfortable; three doses stopped epistaxis, left pulse converged.
Original prescription minus Baishao, Ejiao, Danggui, Zhicao; added Oyster shell (Muli), Costus root (Xiangjiang/Aucklandiae Radix - note: Jiangxiang usually refers to Dalbergia odorifera), Achyranthes bidentata root (Niuxi), Angelica sinensis root tip (Guixu), Peach kernel (Taoren). Two doses passed black blood stasis, epigastrium and abdomen relaxed. Blood descending is smooth; ascending is rebellious. Thus, descending rebellious Qi assisted by sweet-soothing herbs, resolving stasis assisted by softening hardness.
Zong: Complexion pale with redness, Yin-deficient constitution. Post-illness slight fever, gingival bleeding forming clumps, swallowed immediately, painless and non-swollen.
Treatment: Nourish Kidney to submerge Dragon Fire.
Prescription: Prepared Rehmannia root (Shudi, water-boiled), Phellodendron amurense bark (Huangbai, wine-fried), Poria cocos (Fuling), Moutan cortex (Danpi), Achyranthes bidentata root (Niuxi, steamed) decocted to rinse/mix with real lotus root starch. Two doses.
External: Green salt (Qingyan), Indigo naturalis (Qingdai), Gypsum fibrosum (Shigao). Ground fine and applied to gums. Epistaxis stopped shortly.
Wang: Severe epistaxis in spring due to emotional frustration, Gallbladder Fire forcing upward, blood directly attacking clear orifices, frequent dizziness and vertigo.
Urgently use clearing and descending methods to curb the rebellious rising of Shaoyang.
Prescription: Antelope horn (Lingyangjiao), Gardenia jasminoides fruit (Hei Shanzhi), Moutan cortex (Danpi), Donkey-hide gelatin (Ejiao), Rehmannia glutinosa root (Shengdi), Fresh mulberry leaf (Xian Sangye). Epistaxis stopped after two doses. Pulse small, choppy, and blurred; hidden pain in chest; edema in feet at dusk. Caused by sexual excess injuring Yang, Yuan Qi not vigorous. Fear of recurrence upon labor.
Treatment: Harmonize and tonify Spleen Yang.
Prescription: Codonopsis pilosula root (Lushen), Atractylodes macrocephala rhizome (Baizhu), Honey-fried licorice root (Zhicao), Poria cocos (Fushen), Paeonia lactiflora root (Baishao), Angelica sinensis root (Danggui, vinegar-fried), Curcuma aromatica rhizome juice (Yujin juice). Cured after several doses.